system_instruction,user_request,context_document,full_prompt,domain,type,high_level_type "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","I'm middle-aged, never smoked, had my ears blown out in the war, get a case of the sads pretty regular, and eat mostly garbage. What are my risk factors for dementia? What does cognitive engagement have to do with it?","high blood pressure People who have consistent high blood pressure (hypertension) in mid-life (ages 45 to 65) are more likely to develop dementia compared to those with normal blood pressure. High blood pressure can increase the risk of developing dementia, particularly vascular dementia, because of its effect on the heart, the arteries, and blood circulation. Smoking The evidence is strong and consistent that smokers are at a higher risk of developing dementia vs. non-smokers or ex-smokers. It’s never too late to quit! Smokers who quit can reduce their risk of developing dementia. diabetes People with type 2 diabetes in mid-life (ages 45 to 65) are at an increased risk of developing dementia, particularly Alzheimer’s disease and vascular dementia. Obesity Obesity in mid-life (ages 45 to 65) increases the risk of developing dementia. Obesity also increases the risk of developing other risk factors such as type 2 diabetes. lack of physical activity Physical inactivity in later life (ages 65 and up) increases the risk of developing dementia. poor diet An unhealthy diet, high in saturated fat, sugar, and salt, can increase the risk of developing many illnesses, including dementia and cardiovascular disease. high alcohol consumption Drinking excessively (more than 12 drinks per week), can increase your risk of developing dementia low cognitive engagement Cognitive engagement is thought to support the development of a “cognitive reserve”. This is the idea that people who actively use their brains throughout their lives may be more protected against brain cell damage caused by dementia. depression People who experience depression in mid- or later life have a higher risk of developing dementia. However, the relationship between depression and dementia is still unclear. Many researchers believe that depression is a risk factor for dementia, whereas others believe it may be an early symptom of the disease, or both. traumatic brain injury People who experience severe or repeated head injuries are at increased risk of developing dementia. Brain injuries may trigger a process that might eventually lead to dementia. This particularly affects athletes in boxing, soccer, hockey, and football, which often have repeated head injuries. Falls are the leading cause of traumatic brain injury. Falling is especially dangerous for older adults. hearing loss Mild levels of hearing loss increase the risk of cognitive decline and dementia. Though it is still unclear how exactly it affects cognitive decline, hearing loss can lead to social isolation, loss of independence, and problems with everyday activities. social isolation Social isolation can increase the risk of hypertension, coronary heart disease, depression, and dementia. Staying socially active may reduce the risk of dementia. Social interaction may also help slow down the progression of the disease. air pollution The relationship between air pollution and dementia is still unclear. However, it’s estimated that those living close to busy roads have a higher risk of dementia because they may be exposed to higher levels of air pollution from vehicle emissions. It’s never too soon, or too late, to make changes that will maintain or improve your brain health. Learn more about managing some of these risk factors.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I'm middle-aged, never smoked, had my ears blown out in the war, get a case of the sads pretty regular, and eat mostly garbage. What are my risk factors for dementia? What does cognitive engagement have to do with it? {passage 0} ========== high blood pressure People who have consistent high blood pressure (hypertension) in mid-life (ages 45 to 65) are more likely to develop dementia compared to those with normal blood pressure. High blood pressure can increase the risk of developing dementia, particularly vascular dementia, because of its effect on the heart, the arteries, and blood circulation. Smoking The evidence is strong and consistent that smokers are at a higher risk of developing dementia vs. non-smokers or ex-smokers. It’s never too late to quit! Smokers who quit can reduce their risk of developing dementia. diabetes People with type 2 diabetes in mid-life (ages 45 to 65) are at an increased risk of developing dementia, particularly Alzheimer’s disease and vascular dementia. Obesity Obesity in mid-life (ages 45 to 65) increases the risk of developing dementia. Obesity also increases the risk of developing other risk factors such as type 2 diabetes. lack of physical activity Physical inactivity in later life (ages 65 and up) increases the risk of developing dementia. poor diet An unhealthy diet, high in saturated fat, sugar, and salt, can increase the risk of developing many illnesses, including dementia and cardiovascular disease. high alcohol consumption Drinking excessively (more than 12 drinks per week), can increase your risk of developing dementia low cognitive engagement Cognitive engagement is thought to support the development of a “cognitive reserve”. This is the idea that people who actively use their brains throughout their lives may be more protected against brain cell damage caused by dementia. depression People who experience depression in mid- or later life have a higher risk of developing dementia. However, the relationship between depression and dementia is still unclear. Many researchers believe that depression is a risk factor for dementia, whereas others believe it may be an early symptom of the disease, or both. traumatic brain injury People who experience severe or repeated head injuries are at increased risk of developing dementia. Brain injuries may trigger a process that might eventually lead to dementia. This particularly affects athletes in boxing, soccer, hockey, and football, which often have repeated head injuries. Falls are the leading cause of traumatic brain injury. Falling is especially dangerous for older adults. hearing loss Mild levels of hearing loss increase the risk of cognitive decline and dementia. Though it is still unclear how exactly it affects cognitive decline, hearing loss can lead to social isolation, loss of independence, and problems with everyday activities. social isolation Social isolation can increase the risk of hypertension, coronary heart disease, depression, and dementia. Staying socially active may reduce the risk of dementia. Social interaction may also help slow down the progression of the disease. air pollution The relationship between air pollution and dementia is still unclear. However, it’s estimated that those living close to busy roads have a higher risk of dementia because they may be exposed to higher levels of air pollution from vehicle emissions. It’s never too soon, or too late, to make changes that will maintain or improve your brain health. Learn more about managing some of these risk factors. https://alzheimer.ca/en/about-dementia/how-can-i-reduce-risk-dementia/risk-factors-dementia?gad_source=1&gclid=CjwKCAjw3P-2BhAEEiwA3yPhwN2aQl6V8InKOUxaehsfGBSWmuIpGEoeJdWNsl5fH_T9LOUlOk7-gxoCHcYQAvD_BwE",Medical,Effect Analysis,Q&A You formulate answers based solely on the material provided by the user without reference to external facts or knowledge.,"Can you list all the knife brands that sell knives suitable for sharpening at a 14-degree angle? List them according to the minimum angle at which their knives can be sharpened, starting with the smallest.","Knife sharpening angles Manufacturer´s recommendations The recommended angle of your knife is often written on the knife’s packaging. If you don’t find it there you can often find it on the manufacturer’s website. Below you’ll find the angle recommendations from some “well-known” knife manufacturers. Please note that despite the fact that the vast majority of knives are dual-bevel, knife manufacturers list their edge angles based on the number of degrees of a single bevel. For example, dual bevel listed as 15 degrees is actually two 15-degree angles, or 30 degrees total. Therefore, all angles in this document is listed as single bevel angles. Cangshan Cangshan knives are sharpened to an Asian-style 16-degree edge. Learn more at their website. Chroma A Chroma knife should be sharpened to 10-20 degrees. Learn more at their website. F. DICK (Friedr. DICK) Dick recommends 15-20 degrees for their DICK Hoof Knives. Learn more at their website. Fischer-Bargoin Fischer-Bargoin recommends an angle of 15-20 degrees. Learn more at their website. Global Global recommends an angle of 10-15 degrees. Learn more at their website. Korin Korin knives recommends a 10-20 degrees angle on their Western style knives. For their traditional Japanese knife see please go to the website. Learn more at their website. MAC MAC knives have factory edges of 15 degrees. Their recommendation is 10-15 degrees. Learn more at their website. Messermeister Messermeister Elité and Park Plaza knives have a 15-degree angle. Learn more at their website. Starting in 2018, the Four Seasons knife collection now features a 15-degree angle. Learn more at their website. Shun and Kai Shun recommends a 16-degree angle of Shun and Kai double-beveled knives. Learn more at their website. Victorinox Victorinox indicates the total cutting angle. Sharpening a Victorinox should be between 30 to 40 degrees, which is 15-20 degrees on each side. Learn more at their website. Wüsthof The sharpening angle for standard blades is 14 degrees, and for Asian-style blades (Santokus, Nakiris, Chai Daos) it’s 10 degrees. Learn more at their website. Zwilling J. A. Henckels and Miyabi The angle between the blade and the steel should be approximately 15 degrees for ZWILLING knives. Santoku knives and all MIYABI and Kramer made by ZWILLING knives need to be 9-12 degrees. Learn more at their website. Set the existing knife angle using Tormek Marker Method If you want to repeat an existing angle but don’t know the angle of your knife, the easiest way is to use the Tormek Marker Method with a black permanent marker. By following three simple steps you can quickly get the correct angle. 1. Color the bevel, mount the knife in the jig and place it onto the Universal Support. 2. Turn the grinding wheel by hand and check where the coloring is removed, 3. Raise or lower the Universal Support until the coloring is removed from the tip to the heel. Now, the angle is just right and it’s time to start sharpening!","You formulate answers based solely on the material provided by the user without reference to external facts or knowledge. Can you list all the knife brands that sell knives suitable for sharpening at a 14-degree angle? List them according to the minimum angle at which their knives can be sharpened, starting with the smallest. Knife sharpening angles Manufacturer´s recommendations The recommended angle of your knife is often written on the knife’s packaging. If you don’t find it there you can often find it on the manufacturer’s website. Below you’ll find the angle recommendations from some “well-known” knife manufacturers. Please note that despite the fact that the vast majority of knives are dual-bevel, knife manufacturers list their edge angles based on the number of degrees of a single bevel. For example, dual bevel listed as 15 degrees is actually two 15-degree angles, or 30 degrees total. Therefore, all angles in this document is listed as single bevel angles. Cangshan Cangshan knives are sharpened to an Asian-style 16-degree edge. Learn more at their website. Chroma A Chroma knife should be sharpened to 10-20 degrees. Learn more at their website. F. DICK (Friedr. DICK) Dick recommends 15-20 degrees for their DICK Hoof Knives. Learn more at their website. Fischer-Bargoin Fischer-Bargoin recommends an angle of 15-20 degrees. Learn more at their website. Global Global recommends an angle of 10-15 degrees. Learn more at their website. Korin Korin knives recommends a 10-20 degrees angle on their Western style knives. For their traditional Japanese knife see please go to the website. Learn more at their website. MAC MAC knives have factory edges of 15 degrees. Their recommendation is 10-15 degrees. Learn more at their website. Messermeister Messermeister Elité and Park Plaza knives have a 15-degree angle. Learn more at their website. Starting in 2018, the Four Seasons knife collection now features a 15-degree angle. Learn more at their website. Shun and Kai Shun recommends a 16-degree angle of Shun and Kai double-beveled knives. Learn more at their website. Victorinox Victorinox indicates the total cutting angle. Sharpening a Victorinox should be between 30 to 40 degrees, which is 15-20 degrees on each side. Learn more at their website. Wüsthof The sharpening angle for standard blades is 14 degrees, and for Asian-style blades (Santokus, Nakiris, Chai Daos) it’s 10 degrees. Learn more at their website. Zwilling J. A. Henckels and Miyabi The angle between the blade and the steel should be approximately 15 degrees for ZWILLING knives. Santoku knives and all MIYABI and Kramer made by ZWILLING knives need to be 9-12 degrees. Learn more at their website. Set the existing knife angle using Tormek Marker Method If you want to repeat an existing angle but don’t know the angle of your knife, the easiest way is to use the Tormek Marker Method with a black permanent marker. By following three simple steps you can quickly get the correct angle. 1. Color the bevel, mount the knife in the jig and place it onto the Universal Support. 2. Turn the grinding wheel by hand and check where the coloring is removed, 3. Raise or lower the Universal Support until the coloring is removed from the tip to the heel. Now, the angle is just right and it’s time to start sharpening!",Retail/Product,Fact Finding,Q&A "Provide your response in a professional and formal tone. Use the information given in the document without referring to external sources or requiring additional context. Avoid using technical jargon or acronyms that are not explained within the document.",What are some tips on saving money?,"Money Management Tips: 55 Ways to Save Money Recreation and Entertainment: 1. Instead of paying for a fitness club membership fee, buy some weights or go to the ARC. 2. Don’t smoke. Cigarettes are expensive and the money adds up quickly. Also you’ll be fined if you smoke near school facilities. 3. Wait until after half-time at sport events and get in for free! 4. When eating out, look for coupons or special deals- many restaurants offer them! Also, order water. Drinks are highly overpriced. 5. At the beginning of the semester, many local businesses give out coupon books. Grab one! 6. There are hundreds of free activities on campus. Join clubs, attend student concerts, or go to church-sponsored events for cheap fun. There is usually food involved, too! 7. Illinites, student activities, happen at the Illini Union every Friday night for free. 8. Experience some more cultures while in college and attend a show at Krannert. Student tickets are $10 or less. It’s FREE sometimes! 9. If you’re throwing a party, have your guests pay a little money or bring things to offset your cost. 10. Don’t purchase a book unless you think you really want to keep it. You can check out books for free at libraries. 11. Rent movies with a group of friends or go to second-run theaters for $1 or $2 a ticket. 12. Bring your student ID when you go out for a movie. Most theaters will give discount for students. Food and Basic Needs: 13. Be a savvy consumer. Before making a major purchase, do some researches on the product quality through Consumer Reports magazine. 14. Sometimes the cheaper product works just as well as the expensive one. 15. Ask for generic medications at the pharmacy. 16. Ladies, ditch the salon and get your hair done at a cosmetology school. 17. Buying in bulk is usually a good option, but try to shop for items by the per unit price. Often times, the biggest options is not the best way to get the most of your money. 18. Scout out garage/yard sales for housewares, furniture, and stuff to decorate your college dorm or apartment. At the beginning of each semester, the YMCA has a dump and run where they sell items collected from various dorms and apartment on campus. 19. Make things for gifts- it’s cheaper and the time you invest shows you care. 20. Take advantage of sales by buying holiday and birthday gifts throughout the year. 21. Get a job at a place where you already spend a lot of money, so you can get employee discounts. 22. Use mail-in rebates or coupons for groceries or health and beauty items. 23. Don’t buy bottled water. Buy a water filtration pitcher. 24. Don’t buy something just because it is one sale. Consider it’s a need for you before buying. 25. If you shop at a favorite store, apply for their discount card if they have one. Modified by Joe Pleshar, Yuanhang Fan, and Maggie Benson, Peer Educators of Spring 2015. University of Illinois Extension Financial Wellness for College Students Program. Source: National Student Loan Program’s Budget Handout #6: “Money Management Options: 75 Ways to Save Money”, 2002. Money Management Tips: 55 Ways to Save Money 26. Make home cooked meals. A home cooked stead dinner is often cheaper than a fast food binge. Eating at home will save you a lot of money! 27. Pack a lunch instead of eating out. Clothing: 28. Buy clothes at the end of the season when they’re on sales. 29. If you don’t wear certain clothes anymore, take them to a consignment shop or sell them online. You can get part of the profit and free up room in your closet. 30. Share dresses and tuxes with friends for special occasions. 31. If you buy more than one of something, like 2 or 3 shirts, always ask for a discount. 32. Invest in durable clothes, shoes, etc. rather than buying many cheap pairs. Budgeting/ Spending Plan: 33. Set goals for your spending and saving. 34. Keep track of your spending to avoid overspent. There are apps for that! 35. Don’t use a credit card if it will lead you to make more purchases! On average, people have credit cards spend 34% more. 36. Before going out to spend, set a limit for yourself and stick to it! 37. Wait at least two hours before making a big purchase to be sure it’s something you really need. Transportation: 38. Obey traffic laws. Speeding tickets will cost more than just the ticket. It will raise your insurance premiums. 39. Keep your tires inflated properly- you’ll get better gas mileage. 40. Get good grades. Insurance companies offer low rates to student with 3.0+ GPA. 41. Carpool with friend! 42. Search for dependable cards that offer good gas mileage. 43. Drive an older car- the insurance payments and taxes will be less. 44. Walk, bike, or ride to school- it’s good for you to saves on gas. 45. Look around for cheapest gas price before filling up. There are apps for that! Savings: 46. Only use ATM’s of your bank. Other bank’s ATM fees add up! 47. Always put part of our paycheck into a savings account. 48. Spare change adds up! Get a piggy bank or change jar and don’t underestimate the value of your spare changes. 49. Volunteer! If you’re busy, you can’t spend month and it’s a resume booster, too! It’s always make you feel good to help and give back to the community. 50. Use plastic grocery bags for trash can liners. Conserving Resources: 51. Turn off the water while brushing your teeth. 52. Unplug electronics when you aren’t using them. Even while turned off, they still use up costly energy. 53. Use items like shampoo, toothpaste, and paper towels sparingly- enough to do the job without waste. 54. Pay your bills online. Save paper and money on stamps. 55. Ask your landlord to seal gaps between door and windows to prevent heat leaks over the winter. Modified by Joe Pleshar, Yuanhang Fan, and Maggie Benson, Peer Educators of Spring 2015. University of Illinois Extension Financial Wellness for College Students Program. Source: National Student Loan Program’s Budget Handout #6: “Money Management Options: 75 Ways to Save Money”, 2002. ","Provide your response in a professional and formal tone. Use the information given in the document without referring to external sources or requiring additional context. Avoid using technical jargon or acronyms that are not explained within the document. What are some tips on saving money? Money Management Tips: 55 Ways to Save Money Recreation and Entertainment: 1. Instead of paying for a fitness club membership fee, buy some weights or go to the ARC. 2. Don’t smoke. Cigarettes are expensive and the money adds up quickly. Also you’ll be fined if you smoke near school facilities. 3. Wait until after half-time at sport events and get in for free! 4. When eating out, look for coupons or special deals- many restaurants offer them! Also, order water. Drinks are highly overpriced. 5. At the beginning of the semester, many local businesses give out coupon books. Grab one! 6. There are hundreds of free activities on campus. Join clubs, attend student concerts, or go to church-sponsored events for cheap fun. There is usually food involved, too! 7. Illinites, student activities, happen at the Illini Union every Friday night for free. 8. Experience some more cultures while in college and attend a show at Krannert. Student tickets are $10 or less. It’s FREE sometimes! 9. If you’re throwing a party, have your guests pay a little money or bring things to offset your cost. 10. Don’t purchase a book unless you think you really want to keep it. You can check out books for free at libraries. 11. Rent movies with a group of friends or go to second-run theaters for $1 or $2 a ticket. 12. Bring your student ID when you go out for a movie. Most theaters will give discount for students. Food and Basic Needs: 13. Be a savvy consumer. Before making a major purchase, do some researches on the product quality through Consumer Reports magazine. 14. Sometimes the cheaper product works just as well as the expensive one. 15. Ask for generic medications at the pharmacy. 16. Ladies, ditch the salon and get your hair done at a cosmetology school. 17. Buying in bulk is usually a good option, but try to shop for items by the per unit price. Often times, the biggest options is not the best way to get the most of your money. 18. Scout out garage/yard sales for housewares, furniture, and stuff to decorate your college dorm or apartment. At the beginning of each semester, the YMCA has a dump and run where they sell items collected from various dorms and apartment on campus. 19. Make things for gifts- it’s cheaper and the time you invest shows you care. 20. Take advantage of sales by buying holiday and birthday gifts throughout the year. 21. Get a job at a place where you already spend a lot of money, so you can get employee discounts. 22. Use mail-in rebates or coupons for groceries or health and beauty items. 23. Don’t buy bottled water. Buy a water filtration pitcher. 24. Don’t buy something just because it is one sale. Consider it’s a need for you before buying. 25. If you shop at a favorite store, apply for their discount card if they have one. Modified by Joe Pleshar, Yuanhang Fan, and Maggie Benson, Peer Educators of Spring 2015. University of Illinois Extension Financial Wellness for College Students Program. Source: National Student Loan Program’s Budget Handout #6: “Money Management Options: 75 Ways to Save Money”, 2002. Money Management Tips: 55 Ways to Save Money 26. Make home cooked meals. A home cooked stead dinner is often cheaper than a fast food binge. Eating at home will save you a lot of money! 27. Pack a lunch instead of eating out. Clothing: 28. Buy clothes at the end of the season when they’re on sales. 29. If you don’t wear certain clothes anymore, take them to a consignment shop or sell them online. You can get part of the profit and free up room in your closet. 30. Share dresses and tuxes with friends for special occasions. 31. If you buy more than one of something, like 2 or 3 shirts, always ask for a discount. 32. Invest in durable clothes, shoes, etc. rather than buying many cheap pairs. Budgeting/ Spending Plan: 33. Set goals for your spending and saving. 34. Keep track of your spending to avoid overspent. There are apps for that! 35. Don’t use a credit card if it will lead you to make more purchases! On average, people have credit cards spend 34% more. 36. Before going out to spend, set a limit for yourself and stick to it! 37. Wait at least two hours before making a big purchase to be sure it’s something you really need. Transportation: 38. Obey traffic laws. Speeding tickets will cost more than just the ticket. It will raise your insurance premiums. 39. Keep your tires inflated properly- you’ll get better gas mileage. 40. Get good grades. Insurance companies offer low rates to student with 3.0+ GPA. 41. Carpool with friend! 42. Search for dependable cards that offer good gas mileage. 43. Drive an older car- the insurance payments and taxes will be less. 44. Walk, bike, or ride to school- it’s good for you to saves on gas. 45. Look around for cheapest gas price before filling up. There are apps for that! Savings: 46. Only use ATM’s of your bank. Other bank’s ATM fees add up! 47. Always put part of our paycheck into a savings account. 48. Spare change adds up! Get a piggy bank or change jar and don’t underestimate the value of your spare changes. 49. Volunteer! If you’re busy, you can’t spend month and it’s a resume booster, too! It’s always make you feel good to help and give back to the community. 50. Use plastic grocery bags for trash can liners. Conserving Resources: 51. Turn off the water while brushing your teeth. 52. Unplug electronics when you aren’t using them. Even while turned off, they still use up costly energy. 53. Use items like shampoo, toothpaste, and paper towels sparingly- enough to do the job without waste. 54. Pay your bills online. Save paper and money on stamps. 55. Ask your landlord to seal gaps between door and windows to prevent heat leaks over the winter. Modified by Joe Pleshar, Yuanhang Fan, and Maggie Benson, Peer Educators of Spring 2015. University of Illinois Extension Financial Wellness for College Students Program. Source: National Student Loan Program’s Budget Handout #6: “Money Management Options: 75 Ways to Save Money”, 2002. ",Financial,Find & Summarize,Text Transformation You must only use the context to answer the question. You must respond in a bullet point list. The list can be divided into sections.,What are all the contexts when it is right for testing for leptospirosis in dogs specifically?,"Description of the disease: Leptospirosis is a transmissible disease of animals and humans caused by infection with any of the pathogenic members of the genus Leptospira. Acute leptospirosis should be suspected in the following cases: sudden onset of agalactia (in adult milking cattle and sheep); icterus and haemoglobinuria, especially in young animals; meningitis; and acute renal failure or jaundice in dogs. Chronic leptospirosis should be considered in the following cases: abortion, stillbirth, birth of weak offspring (may be premature); infertility; chronic renal failure or chronic active hepatitis in dogs; and cases of periodic ophthalmia in horses.","System instruction: You must only use the context to answer the question. You must respond in a bullet point list. The list can be divided into sections. Question: What are all the contexts when it is right for testing for leptospirosis in dogs specifically? Context: Description of the disease: Leptospirosis is a transmissible disease of animals and humans caused by infection with any of the pathogenic members of the genus Leptospira. Acute leptospirosis should be suspected in the following cases: sudden onset of agalactia (in adult milking cattle and sheep); icterus and haemoglobinuria, especially in young animals; meningitis; and acute renal failure or jaundice in dogs. Chronic leptospirosis should be considered in the following cases: abortion, stillbirth, birth of weak offspring (may be premature); infertility; chronic renal failure or chronic active hepatitis in dogs; and cases of periodic ophthalmia in horses.",Medical,Fact Finding,Q&A "Do not use any information other than that contained in the context block to answer the question. Use concise, easy-to-understand language.",can you summarise all the important information relevant to Annex 1 nationals and refugees?,"This Regulation provides for full harmonisation as regards the third countries whose nationals are subject to a requirement to be in possession of a visa for the crossing of Member States' external borders (also referred to herein as ‘the visa requirement’) and those whose nationals are exempt from that requirement. The determination of the third countries whose nationals are subject to, or exempt from, the visa requirement should be made on the basis of a considered, case-by-case assessment of a variety of criteria. That assessment should be made periodically and could lead to legislative proposals to amend Annex I to this Regulation, which lists the third countries whose nationals are required to be in possession of a visa when crossing the external borders of the Member States, and Annex II to this Regulation, which lists the third countries whose nationals are exempt from the requirement to be in possession of a visa when crossing the external borders of the Member States for stays of no more than 90 days in any 180-day period, notwithstanding the possibility of having country-specific amendments to those Annexes in particular circumstances, for instance as a result of a visa liberalisation process or as the ultimate consequence of a temporary suspension of the exemption from the visa requirement (also referred to herein as ‘the visa exemption’). The composition of the lists of third countries in Annexes I and II should be, and should remain, consistent with the criteria set out in this Regulation. References to third countries in respect of which the situation has changed as regards those criteria should be transferred from one Annex to the other. Developments in international law entailing changes in the status or designation of certain States or entities should be reflected in Annexes I and II. As the Agreement on the European Economic Area exempts nationals of Iceland, Liechtenstein and Norway from the visa requirement, those countries should not be included in the list in Annex II. Since the Agreement between the European Community and its Member States, of the one part, and the Swiss Confederation, of the other part, on the free movement of persons provides for free movement without visas for nationals of Switzerland and of the Member States, Switzerland should not be included in the list in Annex II. As regards recognised refugees and stateless persons, without prejudice to obligations under international agreements signed by the Member States and in particular the European Agreement on the Abolition of Visas for Refugees of the Council of Europe, signed at Strasbourg on 20 April 1959, the decision as to the visa requirement or exemption should be based on the third country in which those persons reside and which issued their travel documents. However, given the differences in the national law applicable to recognised refugees and to stateless persons, Member States should be able to decide whether those categories of persons should be exempted, where the third country in which those persons reside and which issued their travel documents is a third country whose nationals are exempt from the visa requirement.","system instruction: [Do not use any information other than that contained in the context block to answer the question. Use concise, easy-to-understand language.] question: [can you summarise all the important information relevant to Annex 1 nationals and refugees?] context block: [This Regulation provides for full harmonisation as regards the third countries whose nationals are subject to a requirement to be in possession of a visa for the crossing of Member States' external borders (also referred to herein as ‘the visa requirement’) and those whose nationals are exempt from that requirement. The determination of the third countries whose nationals are subject to, or exempt from, the visa requirement should be made on the basis of a considered, case-by-case assessment of a variety of criteria. That assessment should be made periodically and could lead to legislative proposals to amend Annex I to this Regulation, which lists the third countries whose nationals are required to be in possession of a visa when crossing the external borders of the Member States, and Annex II to this Regulation, which lists the third countries whose nationals are exempt from the requirement to be in possession of a visa when crossing the external borders of the Member States for stays of no more than 90 days in any 180-day period, notwithstanding the possibility of having country-specific amendments to those Annexes in particular circumstances, for instance as a result of a visa liberalisation process or as the ultimate consequence of a temporary suspension of the exemption from the visa requirement (also referred to herein as ‘the visa exemption’). The composition of the lists of third countries in Annexes I and II should be, and should remain, consistent with the criteria set out in this Regulation. References to third countries in respect of which the situation has changed as regards those criteria should be transferred from one Annex to the other. Developments in international law entailing changes in the status or designation of certain States or entities should be reflected in Annexes I and II. As the Agreement on the European Economic Area exempts nationals of Iceland, Liechtenstein and Norway from the visa requirement, those countries should not be included in the list in Annex II. Since the Agreement between the European Community and its Member States, of the one part, and the Swiss Confederation, of the other part, on the free movement of persons provides for free movement without visas for nationals of Switzerland and of the Member States, Switzerland should not be included in the list in Annex II. As regards recognised refugees and stateless persons, without prejudice to obligations under international agreements signed by the Member States and in particular the European Agreement on the Abolition of Visas for Refugees of the Council of Europe, signed at Strasbourg on 20 April 1959, the decision as to the visa requirement or exemption should be based on the third country in which those persons reside and which issued their travel documents. However, given the differences in the national law applicable to recognised refugees and to stateless persons, Member States should be able to decide whether those categories of persons should be exempted, where the third country in which those persons reside and which issued their travel documents is a third country whose nationals are exempt from the visa requirement.]",Legal,Summarize,Text Transformation This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Limit your response to 100 words. Do not use bullet points. Limit your answer to six sentences.,Summarize the five overarching principles of tax policy.,"2.1 Overarching principles of tax policy In a context where many governments have to cope with less revenue, increasing expenditures and resulting fiscal constraints, raising revenue remains the most important function of taxes, which serve as the primary means for financing public goods such as maintenance of law and order and public infrastructure. Assuming a certain level of revenue that needs to be raised, which depends on the broader economic and fiscal policies of the country concerned, there are a number of broad tax policy considerations that have traditionally guided the development of taxation systems. These include neutrality, efficiency, certainty and simplicity, effectiveness and fairness, as well as flexibility. In the context of work leading up to the Report on the Taxation of Electronic Commerce (see Annex A for further detail), these overarching principles were the basis for the 1998 Ottawa Ministerial Conference, and are since then referred to as the Ottawa Taxation Framework Conditions. At the time, these principles were deemed appropriate for an evaluation of the taxation issues related to e-commerce. Although most of the new business models identified in Chapter 4 did not exist yet at the time, these principles, with modification, continue to be relevant in the digital economy, as discussed in Chapter 8. In addition to these well-recognised principles, equity is an important consideration for the design of tax policy. • Neutrality: Taxation should seek to be neutral and equitable between forms of business activities. A neutral tax will contribute to efficiency by ensuring that optimal allocation of the means of production is achieved. A distortion, and the corresponding deadweight loss, will occur when changes in price trigger different changes in supply and demand than would occur in the absence of tax. In this sense, neutrality also entails that the tax system raises revenue while minimising discrimination in favour of, or against, any particular economic choice. This implies that the same principles of taxation should apply to all forms of business, while addressing specific features that may otherwise undermine an equal and neutral application of those principles. • Efficiency: Compliance costs to business and administration costs for governments should be minimised as far as possible. • Certainty and simplicity: Tax rules should be clear and simple to understand, so that taxpayers know where they stand. A simple tax system makes it easier for individuals and businesses to understand their obligations and entitlements. As a result, businesses are more likely to make optimal decisions and respond to intended policy choices. Complexity also favours aggressive tax planning, which may trigger deadweight losses for the economy. ADDRESSING THE TAX CHALLENGES OF THE DIGITAL ECONOMY © OECD 2014 2. FUNDAMENTAL PRINCIPLES OF TAXATION – 31 • Effectiveness and fairness: Taxation should produce the right amount of tax at the right time, while avoiding both double taxation and unintentional non-taxation. In addition, the potential for evasion and avoidance should be minimised. Prior discussions in the Technical Advisory Groups (TAGs) considered that if there is a class of taxpayers that are technically subject to a tax, but are never required to pay the tax due to inability to enforce it, then the taxpaying public may view the tax as unfair and ineffective. As a result, the practical enforceability of tax rules is an important consideration for policy makers. In addition, because it influences the collectability and the administerability of taxes, enforceability is crucial to ensure efficiency of the tax system. • Flexibility: Taxation systems should be flexible and dynamic enough to ensure they keep pace with technological and commercial developments. It is important that a tax system is dynamic and flexible enough to meet the current revenue needs of governments while adapting to changing needs on an ongoing basis. This means that the structural features of the system should be durable in a changing policy context, yet flexible and dynamic enough to allow governments to respond as required to keep pace with technological and commercial developments, taking into account that future developments will often be difficult to predict. Equity is also an important consideration within a tax policy framework. Equity has two main elements; horizontal equity and vertical equity. Horizontal equity suggests that taxpayers in similar circumstances should bear a similar tax burden. Vertical equity is a normative concept, whose definition can differ from one user to another. According to some, it suggests that taxpayers in better circumstances should bear a larger part of the tax burden as a proportion of their income. In practice, the interpretation of vertical equity depends on the extent to which countries want to diminish income variation and whether it should be applied to income earned in a specific period or to lifetime income. Equity is traditionally delivered through the design of the personal tax and transfer systems. Equity may also refer to inter-nation equity. As a theory, inter-nation equity is concerned with the allocation of national gain and loss in the international context and aims to ensure that each country receives an equitable share of tax revenues from cross-border transactions (OECD, 2001). The tax policy principle of inter-nation equity has been an important consideration in the debate on the division of taxing rights between source and residence countries. At the time of the Ottawa work on the taxation of electronic commerce, this important concern was recognised by stating that “any adaptation of the existing international taxation principles should be ADDRESSING THE TAX CHALLENGES OF THE DIGITAL ECONOMY © OECD 2014 32 – 2. FUNDAMENTAL PRINCIPLES OF TAXATION structured to maintain fiscal sovereignty of countries, […] to achieve a fair sharing of the tax base from electronic commerce between countries…” (OECD, 2001: 228). Tax policy choices often reflect decisions by policy makers on the relative importance of each of these principles and will also reflect wider economic and social policy considerations outside the field of tax.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Limit your response to 100 words. Do not use bullet points. Limit your answer to six sentences. Summarize the five overarching principles of tax policy. 2.1 Overarching principles of tax policy In a context where many governments have to cope with less revenue, increasing expenditures and resulting fiscal constraints, raising revenue remains the most important function of taxes, which serve as the primary means for financing public goods such as maintenance of law and order and public infrastructure. Assuming a certain level of revenue that needs to be raised, which depends on the broader economic and fiscal policies of the country concerned, there are a number of broad tax policy considerations that have traditionally guided the development of taxation systems. These include neutrality, efficiency, certainty and simplicity, effectiveness and fairness, as well as flexibility. In the context of work leading up to the Report on the Taxation of Electronic Commerce (see Annex A for further detail), these overarching principles were the basis for the 1998 Ottawa Ministerial Conference, and are since then referred to as the Ottawa Taxation Framework Conditions. At the time, these principles were deemed appropriate for an evaluation of the taxation issues related to e-commerce. Although most of the new business models identified in Chapter 4 did not exist yet at the time, these principles, with modification, continue to be relevant in the digital economy, as discussed in Chapter 8. In addition to these well-recognised principles, equity is an important consideration for the design of tax policy. • Neutrality: Taxation should seek to be neutral and equitable between forms of business activities. A neutral tax will contribute to efficiency by ensuring that optimal allocation of the means of production is achieved. A distortion, and the corresponding deadweight loss, will occur when changes in price trigger different changes in supply and demand than would occur in the absence of tax. In this sense, neutrality also entails that the tax system raises revenue while minimising discrimination in favour of, or against, any particular economic choice. This implies that the same principles of taxation should apply to all forms of business, while addressing specific features that may otherwise undermine an equal and neutral application of those principles. • Efficiency: Compliance costs to business and administration costs for governments should be minimised as far as possible. • Certainty and simplicity: Tax rules should be clear and simple to understand, so that taxpayers know where they stand. A simple tax system makes it easier for individuals and businesses to understand their obligations and entitlements. As a result, businesses are more likely to make optimal decisions and respond to intended policy choices. Complexity also favours aggressive tax planning, which may trigger deadweight losses for the economy. ADDRESSING THE TAX CHALLENGES OF THE DIGITAL ECONOMY © OECD 2014 2. FUNDAMENTAL PRINCIPLES OF TAXATION – 31 • Effectiveness and fairness: Taxation should produce the right amount of tax at the right time, while avoiding both double taxation and unintentional non-taxation. In addition, the potential for evasion and avoidance should be minimised. Prior discussions in the Technical Advisory Groups (TAGs) considered that if there is a class of taxpayers that are technically subject to a tax, but are never required to pay the tax due to inability to enforce it, then the taxpaying public may view the tax as unfair and ineffective. As a result, the practical enforceability of tax rules is an important consideration for policy makers. In addition, because it influences the collectability and the administerability of taxes, enforceability is crucial to ensure efficiency of the tax system. • Flexibility: Taxation systems should be flexible and dynamic enough to ensure they keep pace with technological and commercial developments. It is important that a tax system is dynamic and flexible enough to meet the current revenue needs of governments while adapting to changing needs on an ongoing basis. This means that the structural features of the system should be durable in a changing policy context, yet flexible and dynamic enough to allow governments to respond as required to keep pace with technological and commercial developments, taking into account that future developments will often be difficult to predict. Equity is also an important consideration within a tax policy framework. Equity has two main elements; horizontal equity and vertical equity. Horizontal equity suggests that taxpayers in similar circumstances should bear a similar tax burden. Vertical equity is a normative concept, whose definition can differ from one user to another. According to some, it suggests that taxpayers in better circumstances should bear a larger part of the tax burden as a proportion of their income. In practice, the interpretation of vertical equity depends on the extent to which countries want to diminish income variation and whether it should be applied to income earned in a specific period or to lifetime income. Equity is traditionally delivered through the design of the personal tax and transfer systems. Equity may also refer to inter-nation equity. As a theory, inter-nation equity is concerned with the allocation of national gain and loss in the international context and aims to ensure that each country receives an equitable share of tax revenues from cross-border transactions (OECD, 2001). The tax policy principle of inter-nation equity has been an important consideration in the debate on the division of taxing rights between source and residence countries. At the time of the Ottawa work on the taxation of electronic commerce, this important concern was recognised by stating that “any adaptation of the existing international taxation principles should be ADDRESSING THE TAX CHALLENGES OF THE DIGITAL ECONOMY © OECD 2014 32 – 2. FUNDAMENTAL PRINCIPLES OF TAXATION structured to maintain fiscal sovereignty of countries, […] to achieve a fair sharing of the tax base from electronic commerce between countries…” (OECD, 2001: 228). Tax policy choices often reflect decisions by policy makers on the relative importance of each of these principles and will also reflect wider economic and social policy considerations outside the field of tax.",Financial,Summarize,Text Transformation Only use the provided text to answer the question. Do not use outside resources. The entire answer should be short.,"According to the provided text, what is the typical maximum range for Infrared (IR)?","**Robotics Sensors and Actuators** Robot Sensors • Sensors are devices that can sense and measure physical properties of the environment, • e.g. temperature, luminance, resistance to touch, weight, size, etc. • The key phenomenon is transduction • Transduction (engineering) is a process that converts one type of energy to another • They deliver low-­‐level information about the environment the robot is working in. – Return an incomplete description of the world • This information is noisy (imprecise). • Cannot be modelled completely: – Reading = f(env) where f is the model of the sensor – Finding the inverse: • ill posed problem (solution not uniquely deEined) • collapsing of dimensionality leads to ambiguity Types of Sensor • General classification: – active versus passive • Active: emit energy in environment – More robust, less efEicient • Passive: passively receive energy from env. – Less intrusive, but depends on env. e.g. light for camera • Example: stereo vision versus range Einder. – contact versus non-­‐contact Sensors • Proprioceptive Sensors (monitor state of robot) – IMU (accels & gyros) – Wheel encoders – Doppler radar … • Exteroceptive Sensors (monitor environment) – Cameras (single, stereo, omni, FLIR …) – Laser scanner – MW radar – Sonar – Tactile… Sensor Characteristics All sensors are characterized by various properties that describe their capabilities – Sensitivity: (change of output) ÷ (change of input) – Linearity: constancy of (output ÷ input) • Exception: logarithmic response cameras == wider dynamic range. – Measurement/Dynamic range: difference between min. and max. Response Time: time required for a change in input to cause a change in the output – Accuracy: difference between measured & actual – Repeatability: difference between repeated measures – Resolution: smallest observable increment – Bandwidth: result of high resolution or cycle time Types of Sensor Specific examples – tactile – close-­‐range proximity – angular position – infrared – Sonar – laser (various types) – radar – compasses, gyroscopes – Force – GPS – vision Tactile Sensors There are many different technologies – e.g. contact closure, magnetic, piezoelectric, etc. • For mobile robots these can be classiEied as – tactile feelers (antennae) often some form of metal wire passing through a wire loop -­‐ can be active (powered to mechanically search for surfaces) § tactile bumpers solid bar / plate acts on some form of contact switch e.g. mirror deElecting light beam, pressure bladder, wire loops, etc. § Pressure-­‐sensitive rubber with scanning array Vibrassae/whiskers of rats – Surface texture information. – Distance of deElection. – Blind people using a cane. Proximity Sensors Tactile sensors allow obstacle detection – proximity sensors needed for true obstacle avoidance • Several technologies can detect the presence of particular Eields without mechanical contact – magnetic reed switches • two thin magnetic strips of opposite polarity not quite touching • an external magnetic Eield closes the strip & makes contact Hall effect sensors • small voltage generated across a conductor carrying current – inductive sensors, capacitive sensors • inductive sensors can detect presence of metallic objects • capacitive sensors can detect metallic or dielectric materials Infrared Sensors Infrared sensors are probably the simplest type of non-­contact sensor – widely used in mobile robotics to avoid obstacles • They work by – emitting infrared light • to differentiate emitted IR from ambient IR (e.g. lights, sun, etc.), the signal is modulated with a low frequency (100 Hz) – detecting any reElections off nearby surfaces • In certain environments, with careful calibration, IR sensors can be used for measuring the distance to the object – requires uniform surface colours and structures Infrared Sensors (Sharp) Measures the return angle of the infrared beam. Infrared Problems If the IR signal is detected, it is safe to assume that an object is present • However, the absence of reElected IR does not mean that no object is present! – “Absence of evidence is not evidence of absence.” C. Sagan – certain dark colours (black) are almost invisible to IR – IR sensors are not absolutely safe for object detection • In realistic situations (different colours & types of objects) there is no accurate distance information – it is best to avoid objects as soon as possible • IR are short range – typical maximum range is 50 to 100 cm Sonar Sensors • The fundamental principle of robot sonar sensors is the same as that used by bats – emit a chirp (e.g. 1.2 milliseconds) • a short powerful pulse of a range of frequencies of sound – its reElection off nearby surfaces is detected • As the speed of sound in air is known (≈ 330 m·s-­‐1) the distance to the object can be computed from the elapsed time between chirp and echo – minimum distance = 165 tchirp (e.g. 21 cm at 1.2 ms) – maximum distance = 165 twait (e.g. 165 m at 1 s) • Usually referred to as ultrasonic sensors Sonar Problems • There are a number of problems and uncertainties associated with readings from sonar sensors – it is difEicult to be sure in which direction an object is because the 3D sonar beam spreads out as it travels – specular re5lections give rise to erroneous readings • the sonar beam hits a smooth surface at a shallow angle and so reElects away from the sensor • only when an object further away reElects the beam back does the sensor obtain a reading -­‐ but distance is incorrect – arrays of sonar sensors can experience crosstalk • one sensor detects the reElected beam of another sensor – the speed of sound varies with air temp. and pressure • a 16° C temp. change can cause a 30cm error at 10m Laser Range Finders • Laser range Einders commonly used to measure the distance, velocity and acceleration of objects – also known as laser radar or lidar • The operating principle is the same as sonar – a short pulse of (laser) light is emitted – the time elapsed between emission and detection is used to determine distance (using the speed of light) • Due to the shorter wavelengths of lasers, the chance of specular reElections is much less – accuracies of millimetres (16 -­‐ 50mm) over 100m – 1D beam is usually swept to give a 2D planar beam • May not detect transparent surfaces (e.g. glass!) or dark objects RADAR • Radar usually uses electromagnetic energy in the 1 -­‐ 12.5 GHz frequency range – this corresponds to wavelengths of 30 cm -­‐ 2 cm • microwave energy – unaffected by fog, rain, dust, haze and smoke • It may use a pulsed time-­‐of-­‐Elight methodology of sonar and lidar, but may also use other methods – continuous-­‐wave phase detection – continuous-­‐wave frequency modulation • Continuous-­‐wave systems make use of Doppler effect to measure relative velocity of the target Angular Position: Rotary Encoder • Potentiometer – Used in the Servo on the boebots • Optical Disks (Relative) – Counting the slots – Direction by having pars of emitters/receivers out of phase: Quadrature decoding – Can spin very fast: 500 kHz • Optical Disks (Absolute) – Grey encoding for absolute: • 0:0000, 1:1000, 2:1100, 3:0100, 4:0110, • 5:1110, 6:1010, 7:0010, 8:0011 • 9:1011, 10:1111, 11:0111, 12:0101, 13:1101, 14:1001, 15:0001 Compass Sensors • Compass sensors measure the horizontal component of the earth’s magnetic Eield – some birds use the vertical component too • The earth’s magnetic Eield is very weak and non-­‐uniform, and changes over time – indoors there are likely to be many other Eield sources • steel girders, reinforced concrete, power lines, motors, etc. – an accurate absolute reference is unlikely, but the Eield is approx. constant, so can be used for local reference Gyroscopes • A gyroscope is a spinning wheel with most of its mass concentrated in the outer periphery – e.g. a bicycle wheel • Due to the law of conservation of momentum – the spinning wheel will stay in its original orientation – a force is required to rotate the gyroscope • A gyro. can thus be used to maintain orientation or to measure the rate and direction of rotation • In fact there are different types of mechanical gyro. – and even optical gyro’s with no moving parts! • these can be used in e.g. space probes to maintain orientation Ring Gyro's • Use standing waves set up – between mirrors (laser ring gyro) – within a Eiber optic cable (Eibre optic ring gyro) • Measure rotation by observing beats in standing wave as the mirrors ""rotate through it"". IMU's • Gyro, accelerometer combination. • Typical designs (e.g. 3DM-­‐GX1™) use tri-­‐axial gyros to track dynamic orientation and tri-­‐axial DC accelerometers along with the tri-­‐axial magnetometers to track static orientation. • The embedded microprocessors contains programmable Eilter algorithms, which blend these static and dynamic responses in real-­‐time. GPS • GPS uses a constellation of between 24 and 32 Medium Earth Orbit satellites. • Satellite broadcast their position + time. • Use travel time of 4 satellites and trilateration. • Suffers from “canyon” effect in cities. WiFi • Using the SSID and database. Odor Sensing Smell is ubiquitous in nature … both as a active and a passive sensor. Why is it so important? Advantages: evanescent, controllable, multi-­‐valued, useful. What is an actuator? • Device for moving or controlling a system. • “Robot Muscles Hydraulic Actuators • Pros: – Powerful – Fast – Stiff • Cons – Messy – Maintenance – External Pump Pneumatic Actuators • Pros: – Powerful – Cheap • Cons – Soft/Compliant – External Compressor Shape Memory Alloy Actuators • Works by warming and cooling Nitinol wires. • Pros: – Light – Powerful • Cons: – Slow (cooling) Electric Actuators • Pros – Better position precision – Well understood – No separate power source – Cheap • Cons – Heavy – Weaker/slower than hydraulics – Cooling issue • Stepper motors • DC motors – Servos • Continuous • Position • Others (not discussed) – Linear actuators – AC motors"," Only use the provided text to answer the question. Do not use outside resources. The entire answer should be short. ---------------- According to the provided text, what is the typical maximum range for Infrared (IR)? ---------------- **Robotics Sensors and Actuators** Robot Sensors • Sensors are devices that can sense and measure physical properties of the environment, • e.g. temperature, luminance, resistance to touch, weight, size, etc. • The key phenomenon is transduction • Transduction (engineering) is a process that converts one type of energy to another • They deliver low-­‐level information about the environment the robot is working in. – Return an incomplete description of the world • This information is noisy (imprecise). • Cannot be modelled completely: – Reading = f(env) where f is the model of the sensor – Finding the inverse: • ill posed problem (solution not uniquely deEined) • collapsing of dimensionality leads to ambiguity Types of Sensor • General classification: – active versus passive • Active: emit energy in environment – More robust, less efEicient • Passive: passively receive energy from env. – Less intrusive, but depends on env. e.g. light for camera • Example: stereo vision versus range Einder. – contact versus non-­‐contact Sensors • Proprioceptive Sensors (monitor state of robot) – IMU (accels & gyros) – Wheel encoders – Doppler radar … • Exteroceptive Sensors (monitor environment) – Cameras (single, stereo, omni, FLIR …) – Laser scanner – MW radar – Sonar – Tactile… Sensor Characteristics All sensors are characterized by various properties that describe their capabilities – Sensitivity: (change of output) ÷ (change of input) – Linearity: constancy of (output ÷ input) • Exception: logarithmic response cameras == wider dynamic range. – Measurement/Dynamic range: difference between min. and max. Response Time: time required for a change in input to cause a change in the output – Accuracy: difference between measured & actual – Repeatability: difference between repeated measures – Resolution: smallest observable increment – Bandwidth: result of high resolution or cycle time Types of Sensor Specific examples – tactile – close-­‐range proximity – angular position – infrared – Sonar – laser (various types) – radar – compasses, gyroscopes – Force – GPS – vision Tactile Sensors There are many different technologies – e.g. contact closure, magnetic, piezoelectric, etc. • For mobile robots these can be classiEied as – tactile feelers (antennae) often some form of metal wire passing through a wire loop -­‐ can be active (powered to mechanically search for surfaces) § tactile bumpers solid bar / plate acts on some form of contact switch e.g. mirror deElecting light beam, pressure bladder, wire loops, etc. § Pressure-­‐sensitive rubber with scanning array Vibrassae/whiskers of rats – Surface texture information. – Distance of deElection. – Blind people using a cane. Proximity Sensors Tactile sensors allow obstacle detection – proximity sensors needed for true obstacle avoidance • Several technologies can detect the presence of particular Eields without mechanical contact – magnetic reed switches • two thin magnetic strips of opposite polarity not quite touching • an external magnetic Eield closes the strip & makes contact Hall effect sensors • small voltage generated across a conductor carrying current – inductive sensors, capacitive sensors • inductive sensors can detect presence of metallic objects • capacitive sensors can detect metallic or dielectric materials Infrared Sensors Infrared sensors are probably the simplest type of non-­contact sensor – widely used in mobile robotics to avoid obstacles • They work by – emitting infrared light • to differentiate emitted IR from ambient IR (e.g. lights, sun, etc.), the signal is modulated with a low frequency (100 Hz) – detecting any reElections off nearby surfaces • In certain environments, with careful calibration, IR sensors can be used for measuring the distance to the object – requires uniform surface colours and structures Infrared Sensors (Sharp) Measures the return angle of the infrared beam. Infrared Problems If the IR signal is detected, it is safe to assume that an object is present • However, the absence of reElected IR does not mean that no object is present! – “Absence of evidence is not evidence of absence.” C. Sagan – certain dark colours (black) are almost invisible to IR – IR sensors are not absolutely safe for object detection • In realistic situations (different colours & types of objects) there is no accurate distance information – it is best to avoid objects as soon as possible • IR are short range – typical maximum range is 50 to 100 cm Sonar Sensors • The fundamental principle of robot sonar sensors is the same as that used by bats – emit a chirp (e.g. 1.2 milliseconds) • a short powerful pulse of a range of frequencies of sound – its reElection off nearby surfaces is detected • As the speed of sound in air is known (≈ 330 m·s-­‐1) the distance to the object can be computed from the elapsed time between chirp and echo – minimum distance = 165 tchirp (e.g. 21 cm at 1.2 ms) – maximum distance = 165 twait (e.g. 165 m at 1 s) • Usually referred to as ultrasonic sensors Sonar Problems • There are a number of problems and uncertainties associated with readings from sonar sensors – it is difEicult to be sure in which direction an object is because the 3D sonar beam spreads out as it travels – specular re5lections give rise to erroneous readings • the sonar beam hits a smooth surface at a shallow angle and so reElects away from the sensor • only when an object further away reElects the beam back does the sensor obtain a reading -­‐ but distance is incorrect – arrays of sonar sensors can experience crosstalk • one sensor detects the reElected beam of another sensor – the speed of sound varies with air temp. and pressure • a 16° C temp. change can cause a 30cm error at 10m Laser Range Finders • Laser range Einders commonly used to measure the distance, velocity and acceleration of objects – also known as laser radar or lidar • The operating principle is the same as sonar – a short pulse of (laser) light is emitted – the time elapsed between emission and detection is used to determine distance (using the speed of light) • Due to the shorter wavelengths of lasers, the chance of specular reElections is much less – accuracies of millimetres (16 -­‐ 50mm) over 100m – 1D beam is usually swept to give a 2D planar beam • May not detect transparent surfaces (e.g. glass!) or dark objects RADAR • Radar usually uses electromagnetic energy in the 1 -­‐ 12.5 GHz frequency range – this corresponds to wavelengths of 30 cm -­‐ 2 cm • microwave energy – unaffected by fog, rain, dust, haze and smoke • It may use a pulsed time-­‐of-­‐Elight methodology of sonar and lidar, but may also use other methods – continuous-­‐wave phase detection – continuous-­‐wave frequency modulation • Continuous-­‐wave systems make use of Doppler effect to measure relative velocity of the target Angular Position: Rotary Encoder • Potentiometer – Used in the Servo on the boebots • Optical Disks (Relative) – Counting the slots – Direction by having pars of emitters/receivers out of phase: Quadrature decoding – Can spin very fast: 500 kHz • Optical Disks (Absolute) – Grey encoding for absolute: • 0:0000, 1:1000, 2:1100, 3:0100, 4:0110, • 5:1110, 6:1010, 7:0010, 8:0011 • 9:1011, 10:1111, 11:0111, 12:0101, 13:1101, 14:1001, 15:0001 Compass Sensors • Compass sensors measure the horizontal component of the earth’s magnetic Eield – some birds use the vertical component too • The earth’s magnetic Eield is very weak and non-­‐uniform, and changes over time – indoors there are likely to be many other Eield sources • steel girders, reinforced concrete, power lines, motors, etc. – an accurate absolute reference is unlikely, but the Eield is approx. constant, so can be used for local reference Gyroscopes • A gyroscope is a spinning wheel with most of its mass concentrated in the outer periphery – e.g. a bicycle wheel • Due to the law of conservation of momentum – the spinning wheel will stay in its original orientation – a force is required to rotate the gyroscope • A gyro. can thus be used to maintain orientation or to measure the rate and direction of rotation • In fact there are different types of mechanical gyro. – and even optical gyro’s with no moving parts! • these can be used in e.g. space probes to maintain orientation Ring Gyro's • Use standing waves set up – between mirrors (laser ring gyro) – within a Eiber optic cable (Eibre optic ring gyro) • Measure rotation by observing beats in standing wave as the mirrors ""rotate through it"". IMU's • Gyro, accelerometer combination. • Typical designs (e.g. 3DM-­‐GX1™) use tri-­‐axial gyros to track dynamic orientation and tri-­‐axial DC accelerometers along with the tri-­‐axial magnetometers to track static orientation. • The embedded microprocessors contains programmable Eilter algorithms, which blend these static and dynamic responses in real-­‐time. GPS • GPS uses a constellation of between 24 and 32 Medium Earth Orbit satellites. • Satellite broadcast their position + time. • Use travel time of 4 satellites and trilateration. • Suffers from “canyon” effect in cities. WiFi • Using the SSID and database. Odor Sensing Smell is ubiquitous in nature … both as a active and a passive sensor. Why is it so important? Advantages: evanescent, controllable, multi-­‐valued, useful. What is an actuator? • Device for moving or controlling a system. • “Robot Muscles Hydraulic Actuators • Pros: – Powerful – Fast – Stiff • Cons – Messy – Maintenance – External Pump Pneumatic Actuators • Pros: – Powerful – Cheap • Cons – Soft/Compliant – External Compressor Shape Memory Alloy Actuators • Works by warming and cooling Nitinol wires. • Pros: – Light – Powerful • Cons: – Slow (cooling) Electric Actuators • Pros – Better position precision – Well understood – No separate power source – Cheap • Cons – Heavy – Weaker/slower than hydraulics – Cooling issue • Stepper motors • DC motors – Servos • Continuous • Position • Others (not discussed) – Linear actuators – AC motors",Internet/Technology,Fact Finding,Q&A "Answer prompts only using the information provided by the context sources associated with the prompt. If the user asks for medical advice, inform the user that you are unable to provide medical advice as an AI model, and direct them to the proper sources to get medical advice from. If the user asks for medical information, provide a medical disclaimer to the user before answering the prompt. ",What should I know about treatments for Scarlet Fever?,"Scarlet Fever This leaflet offers more information about Scarlet Fever. If you have any further questions or concerns, please speak to the staff member in charge of your child’s care. What is Scarlet Fever? Scarlet Fever is a bacterial infection that affects children. It is caused by the streptococcus bacteria which are found in our throats and on our skin. Scarlet Fever is easily treated with antibiotics. If antibiotic treatment is started early, the chance of children developing complications is rare. What are the signs and symptoms? • Sore throat • Flushed cheeks • Red, swollen tongue • Fever • Typical red, rough (sandpaper) rash appears a couple of days after the sore throat. The rash often starts on the chest and stomach before spreading to the rest of the body. Does my child need any tests to confirm the diagnosis? The doctor will usually be able to diagnose scarlet fever by seeing the typical rash and hearing what symptoms your child has. A swab from your child’s throat may be taken. This will be sent to the laboratory to see if the streptococcus bacteria grow. Your doctor may start treatment while waiting for the result of this swab. What treatments are available? Scarlet fever is easily treated with antibiotics. Liquid penicillin is often used to treat children. These must be taken for seven days, even though most people get better after four to five days. Your child will still be infectious for 24 hours after antibiotic treatment has started and they shouldn't attend nursery or school during this period. What happens if I do not get treatment? Without antibiotic treatment, your child will be infectious for one to two weeks after they became unwell. Rare, but serious complications (rheumatic fever, pneumonia and sepsis) are more likely to occur if antibiotics are not taken. Is there anything I can do to help my child? • Encourage them to drink a lot • Give paracetamol for fever if your child is upset • Use calamine lotion to soothe itchy skin. How to prevent spread? • Encourage coughing and sneezing into tissues and wash hands after sneezing and coughing • Keep children off school for 24 hours after starting antibiotics (or two weeks if antibiotics are not used) • Avoid sharing bed linen, towels, clothes, drinks with people with scarlet fever. For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit www.stgeorges.nhs.uk Additional services Patient Advice and Liaison Service (PALS) PALS can offer you on-the-spot advice and information when you have comments or concerns about our services or the care you have received. You can visit the PALS office between 9.30am and 4.30pm, Monday to Friday in the main corridor between Grosvenor and Lanesborough wings (near the lift foyer). Tel: 020 8725 2453 Email: pals@stgeorges.nhs.uk NHS Choices NHS Choices provides online information and guidance on all aspects of health and healthcare, to help you make decisions about your health. Web: www.nhs.uk NHS 111 You can call 111 when you need medical help fast but it’s not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. Tel: 111 AccessAble You can download accessibility guides for all our services by searching ‘St George’s Hospital’ on the AccessAble website (www.accessable.co.uk). The guides are designed to ensure everyone – including those with accessibility needs – can access our hospital and community sites with confidence. ","System Instructions: Answer prompts only using the information provided by the context sources associated with the prompt. If the user asks for medical advice, inform the user that you are unable to provide medical advice as an AI model, and direct them to the proper sources to get medical advice from. If the user asks for medical information, provide a medical disclaimer to the user before answering the prompt. Question: What should I know about treatments for Scarlet Fever? Context Block: Scarlet Fever This leaflet offers more information about Scarlet Fever. If you have any further questions or concerns, please speak to the staff member in charge of your child’s care. What is Scarlet Fever? Scarlet Fever is a bacterial infection that affects children. It is caused by the streptococcus bacteria which are found in our throats and on our skin. Scarlet Fever is easily treated with antibiotics. If antibiotic treatment is started early, the chance of children developing complications is rare. What are the signs and symptoms? • Sore throat • Flushed cheeks • Red, swollen tongue • Fever • Typical red, rough (sandpaper) rash appears a couple of days after the sore throat. The rash often starts on the chest and stomach before spreading to the rest of the body. Does my child need any tests to confirm the diagnosis? The doctor will usually be able to diagnose scarlet fever by seeing the typical rash and hearing what symptoms your child has. A swab from your child’s throat may be taken. This will be sent to the laboratory to see if the streptococcus bacteria grow. Your doctor may start treatment while waiting for the result of this swab. What treatments are available? Scarlet fever is easily treated with antibiotics. Liquid penicillin is often used to treat children. These must be taken for seven days, even though most people get better after four to five days. Your child will still be infectious for 24 hours after antibiotic treatment has started and they shouldn't attend nursery or school during this period. What happens if I do not get treatment? Without antibiotic treatment, your child will be infectious for one to two weeks after they became unwell. Rare, but serious complications (rheumatic fever, pneumonia and sepsis) are more likely to occur if antibiotics are not taken. Is there anything I can do to help my child? • Encourage them to drink a lot • Give paracetamol for fever if your child is upset • Use calamine lotion to soothe itchy skin. How to prevent spread? • Encourage coughing and sneezing into tissues and wash hands after sneezing and coughing • Keep children off school for 24 hours after starting antibiotics (or two weeks if antibiotics are not used) • Avoid sharing bed linen, towels, clothes, drinks with people with scarlet fever. For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit www.stgeorges.nhs.uk Additional services Patient Advice and Liaison Service (PALS) PALS can offer you on-the-spot advice and information when you have comments or concerns about our services or the care you have received. You can visit the PALS office between 9.30am and 4.30pm, Monday to Friday in the main corridor between Grosvenor and Lanesborough wings (near the lift foyer). Tel: 020 8725 2453 Email: pals@stgeorges.nhs.uk NHS Choices NHS Choices provides online information and guidance on all aspects of health and healthcare, to help you make decisions about your health. Web: www.nhs.uk NHS 111 You can call 111 when you need medical help fast but it’s not a 999 emergency. NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobile phones. Tel: 111 AccessAble You can download accessibility guides for all our services by searching ‘St George’s Hospital’ on the AccessAble website (www.accessable.co.uk). The guides are designed to ensure everyone – including those with accessibility needs – can access our hospital and community sites with confidence. ",Medical,Find & Summarize,Text Transformation You are given a reference document. You must only use information found in the reference document to answer the question asked.,What is the best co sleeper for me and my new baby?,"❚ MadeForMums reviews are independent and based on expertise and testing. When you buy through links on our site, we may earn an affiliate commission, but this never influences our product choices. 8 of the best bedside cribs and cosleepers for safe sleeping for your baby We've tried, tested and reviewed the best bedside cribs, for a brilliant way to sleep closely and safely with your baby Gemma Cartwright Published: March 5, 2024 at 3:20 PM Save A bedside crib is one of the most popular choices for newborn sleep, as it allows you to keep your baby close while still following safe sleep We value your privacy We need your consent so that we and our 172 trusted partners can store and access cookies, unique identifiers, personal data, and information on your browsing behaviour on this device. This only applies to Immediate Media. You can change your preferences at any time by clicking on ‘Manage Privacy Settings’ located at the bottom of any page. You don’t have to agree, but some personalised content and advertising may not work if you don’t. We and our partners use your data for the following purposes: Store and/or access information on a device Precise geolocation data, and identification through device scanning Personalised advertising and content, advertising and content measurement, audience research and services development. Google Consent Mode framework To view our list of partners and see how your data may be used, click or tap ‘More Options’ below. You can also review where our partners claim a legitimate interest to use your data and, if you wish, object to them using it. MORE OPTIONS AGREE guidelines. In the first 6 months, when the risk of sudden infant death syndrome (SIDS) is at its highest, the safest place for a baby to sleep is on their back in their own sleep space, be that a cot, crib or moses basket. Advertisement A bedside crib fastens to the frame of your bed on one side, so you're effectively lying next to your baby. The side can usually be dropped down so you can see and reach over to your child. They're sometimes referred to as side-sleepers or co-sleepers, but the key difference is that you're not sharing a sleep surface or bedding. You and your baby can maximise the soothing benefits that proximity brings while minimising the risks associated with bed sharing. Having your baby at arm's reach also makes night feeds much easier. Best bedside cribs and co-sleepers at a glance Jump to our list of the best bedside cribs and cosleepers • Best bedside crib with an easy drop-down side: Chicco Next2Me Magic, £189 • Best bedside crib with a removable bassinet: SnuzPod 4 Bedside Crib, £199.95 • Best bedside crib for smooth rocking: Tutti Bambini CoZee Air Bedside Crib, £225 • Best bedside crib for longevity: Shnuggle Air Bedside Crib, £180 • There are a wide range of options, so at MadeForMums we’ve analysed the bedside crib market closely to bring you the very best choices. We’ve used feedback from our expert journalist reviewers and parent testers, combined with results from in-house MadeForMums testing, which looked at key features such as breathability, mattress firmness, ease of building as well as functionality. For each bedside crib we’ve listed the key technical features to help you compare across brands and models so you can find the best design to suit your needs. If your baby is struggling to sleep through the night, take a look at our best sleep aids and white noise machines, best nightlights and best baby swaddles. More like this Silver Cross Voyager Co-Sleeper Bedside Crib review What is the new safety standard for bedside cribs? All new bedside cribs manufactured since November 2020 have to meet a new safety standard (with the catchy name BS EN 1130:2019) that introduced new and more rigorous safety requirements for bedside cribs. However, you may find some older versions of cribs are still on sale that only match the previous safety standard. Slowly these will disappear from stores and the only ones available will meet the new standard. The most significant new requirement for BS EN 1130:2019 is for a 120mm Best bedside crib for extra storage: Maxi-Cosie Iora Bedside Sleeper, £149 • Best bedside crib for one-handed operation: Joie Roomie GO, £180 • Best value bedside crib: Red Kite Cozysleep Bedside Crib, £84.99 • Best bedside crib with 360° swivel: Halo BassiNest Premiere Swivel Sleeper, £248.29 • high barrier to be present around the sides of the crib, to ensure your baby is not able to roll off their own mattress onto yours. This means that new bedside cribs can no longer have complete drop-down sides – many now have 'half-height' walls instead. This allows your baby to be positioned next to you with the crib lined up to your bed, but their mattress will be sunk a little lower, providing more of a protective barrier. All the cribs featured in our list comply with these new BS EN 1130:2019 safety requirements. What to look for when buying a bedside crib Will it work with your bed? – Certain bed frames can be trickier to use with a bedside crib. For example, if you have a divan bed you will need longer straps, and may not be able to tuck the legs of the crib underneath the bed and may need to look for a model that has foldable legs or works with your bed style. Height of your bed – Most bedside cribs have adjustable heights to give you an almost perfect fit on most bed frames, but if your bed is particularly low or high, do check the measurements. Also check the size of the crib and whether it will fit next to your bed while allowing you to get in and out easily and safely. This is particularly important for those first few days and weeks after giving birth when your body is still recovering. Mattress – The mattress needs to be firm, flat and breathable – this is a key safety feature. Don’t be tempted by a super soft mattress – your baby will sleep deeply and most importantly safely on a firm mattress. Drop-down side – How easy is it to remove the side? Can you do it with one hand? As you may be doing this in the middle of the night, are there lots of noisy zips and clips? Can it safely be left down while you sleep? Do check this as the rules differ depending on the product. How easy is it to assemble – Are there lots of parts to screw together? Will you need 2 people to build it? We’ve tested how easy different bedside cribs are to build in our reviews. How easy is it to keep clean – Does the mattress have a waterproof cover to protect from leaky nappies, baby sick and dribbles? Is the fabric machine washable or will you have to hand wash it? Portability – Is the crib light enough to move around your house? If you want to take it away with you does it crib fold flat and/or come with a storage bag? Extra features – Does it rock (useful for fussy sleepers), tilt (remember to use tilting with care), detach to become a moses basket or turn into an older baby cot or playpen? These extra features may not be necessary, but they could be useful. For more safety information we've also covered breathability, bedding and how to use the tilting function here. What are the benefits of using a bedside crib? Safe sleep charity The Lullaby Trust, advises that the safest place for your baby to sleep is on their own sleep surface, in the same room as you, for at least the first 6 months. Bedside cribs allow you to have your baby sleeping right next to you at night, but in the safety of their own crib. This means you can still be close to your baby without bed-sharing, which carries a risk of suffocation and overheating. Bedside cribs enable you to lean over and easily pick up your baby when feeding at night. This is especially useful if you’ve had a difficult birth or a c-section and find getting out of bed painful. You can also easily comfort your baby if they are fussing and have a good view of them while they are sleeping. How to do the baby mattress firmness test Press your hand on the centre and the sides of the mattress • A firm mattress shouldn’t mould to the shape of your hand and you’ll feel resistance – it will obviously move beneath the pressure but your hand shouldn’t sink in • When you remove your hand, the mattress should snap back and regain its shape • From a practical perspective, bedside cribs are smaller and more compact than most cots, which means they take up less space in your bedroom than a full-sized cot or cotbed. Do I need a bedside crib for my baby? You don’t have to buy a bedside crib. It's completely safe to put a baby in a regular cot from birth. But they’re a great option if you want your baby as close to you as possible at night, and for saving space. The downside is that most of these cribs only last up to 6 months and you’ll then need to move your baby into a full-sized cot or cotbed. A moses basket is a more economical option, but these can last even less time, and do not have the added features of a bedside crib such as a drop-down side, tilt, or multiple heights. How much does a bedside crib cost? It is possible to buy budget bedside cribs for under £100 but the majority we have reviewed are between £150-£300. Certain features, such as a rocking function or one-handed drop down side, tend to push the price up slightly. How did we choose these bedside cribs? Our 10 of the Best lists are compiled by qualified and experienced parenting journalists. They rely on a number of sources, including our independent reviews, testing undertaken during the MadeForMums Awards, and feedback from our home testing panel and Top Testers Club. Each year thousands of products are put through their paces by hundreds of parents across the country on behalf of MadeForMums, to ensure we’re bringing you honest and true reviews and recommendations. When testing bedside cribs, we consider size, ease of build and fitting, mattress quality and breathability, ease and safety of the drop-down side mechanism and other features, comfort for baby, design and quality, and whether it's worth the money. Our list is not an ordered ranking from 1-10, instead it is a carefully Here are our top 10 bedside cribs for 2024 1. Chicco Next2Me Magic, £189 – Best for easy drop-down side Suitable from: Birth to 6 months/9kg | Weight: 13.1kg | Crib size: H66.5- 82.4cm x W73cm x L99.5cm | Mattress size: L83cm x W50.5cm | Tilt: Yes | Rocks: Yes | Height positions: 11 | Washable mattress cover: Hand wash The Chicco Next2Me Magic is the latest update to the original Next2Me side-sleeping crib, which has won fans for its versatility. It can be used from birth as a bedside co-sleeper, as a standalone crib or possibly as a travel cot, but at over 13kg it's not a light carry. It is slightly more expensive than some other models, but standout features include a really easy drop-side that can be operated with one hand, 11 height levels, a lockable rocking function, 4 tilt options to help reduce reflux, and wheels to make it easy to move around your home. selected group of tried-and-tested products, each of which we believe is best for a different situation or requirement. We don’t just tell you what is best, we help you discover what is best for your family. A large sleeping area means more room for a bigger baby, plus a travel bag is included. MFM tester Lucy said, “I found the Chicco Next2Me Magic a breeze to move around and set up, but also substantial and sturdy. The clever onehanded drop-down mechanism on the side panel can be used while holding your baby in your arms, which is brilliant. ""I've even used the Chicco in my kitchen for safe day naps when I need to be more focused on my older child.” Pros: Firm and breathable mattress, retractable legs to fit any bed, quiet side zip, easy to transport Cons: Tricky to initially assemble, mattress cover is hand wash only Read our full MadeForMums Chicco Next2Me Magic bedside crib review Available from: John Lewis and Mamas & Papas John Lewis & Partners £229.00 Buy now Mamas & Papas £229.00 Buy now 2. SnuzPod 4 Bedside Crib, £199.95 – Best for removable bassinet Suitable from: Birth to 6 months/9kg | Weight: 11.5kg | Crib size: H95cm x W49cm x L100cm | Mattress size: L75cm x W40cm | Tilt: Yes | Rocks: Yes | Height positions: 7 | Washable mattress cover: Machine washable The latest iteration of Snuz's much-loved bedside crib, the Snuzpod4 features a new breathable system (called ComfortAir) that aids the flow of air around the crib and your baby. It offers more side vents, breathable mesh liner and mattress, plus a ventilated base. But the key thing that we're delighted to see is that the Snuzpod4 has a firmer mattress than previous versions – as well as good breathability. Plus Snuz claims that the SnuzPod4 fits more bed heights than any rival, as it will now work with beds up to a maximum adult mattress height of 73cm. It's also designed to be compatible with a range of bed types – divan, ottoman and framed bed bases. Made from sustainably sourced beech solid wood, the Snuzpod4 looks good. MFM mum home tester Mehack commented on ""how stylish and contemporary the design is,"" praising how it ""fits perfectly with the room decor"". We love its versatility – the two-part design includes a lift-off bassinet that can be moved around the house so you have a portable safe sleeping space for your baby, whichever room you're in. The bassinet also has a manual rocking function, as does the crib and the bassinet. There's an optional riser that can be added to create a slight incline to help babies with reflux, but for safety reasons, when the cot is tilted this stops the rocking function from working. Pros: Stylish, removable bassinet, great storage Cons: Can be difficult to put together Read our full MadeForMums SnuzPod 4 bedside crib review Available from: Snuz, Samuel Johnston and Amazon Very.co.uk £159.99 Buy now Samuel Johnston £190.18 Buy now Amazon UK £199.95 Buy now John Lewis & Partners £199.95 Buy now 3. Tutti Bambini CoZee Air Bedside Crib, £225 – Best for smooth rocking Suitable from: Birth to 6 months/9kg | Weight: 11kg | Crib size: H92cm x W12cm x L56cm | Mattress size: L80.5cm x W51cm | Tilt: Yes | Rocks: Yes | Height positions: 6 | Washable mattress cover: Sponge, only machine wash if necessary While it is at the more expensive end of the market, what makes the CoZee Air stand out from the competition is its smooth rocking function. It comes with easy-to-remove caster wheels that you can switch with rocking bars, which easily attach to the legs of the crib. As a safety feature, the CoZee can also only be rocked when it is set up as a standalone crib – when used as a bedside crib, it has flip-out feet that prevent it from doing so. “The rocking feature is fantastic and really helped me to settle my baby when she was overtired and fussing,” said MFM tester Tara. MFM testers also rated the crib highly for its portability – it is ideal as a travel cot, as despite its large size, it is compact when folded. A 30-second open-fold mechanism allows for a quick set up and it comes with a travel bag for easy transportation. While the multiple mesh windows are great for breathability and being able to see your little one, there's a curtain attached to one side of the crib that you can roll down to protect your baby from draughts during colder months. This still leaves one mesh side open to allow for plenty of air flow. When it comes to cleaning, the fabric lining can be removed and put in the washing machine, while the foam mattress can be machine washed if necessary. We also like the addition of a storage shelf that is useful for holding essentials such as baby wipes, nappies, clothes and muslins. Pros: Smooth rocking, quick to collapse down, storage shelf Cons: Higher price point Read our full MadeForMums Tutti Bambini CoZee Air Bedside Crib review Available from: Boots, Kiddies Kingdom and Tutti Bambini Kiddies Kingdom £165.00 Buy now For Your Little One £180.00 Buy now Wayfair £186.63 Buy now Dunelm £219.00 Buy now 4. Shnuggle Air Bedside crib, £180 – Best for longevity Suitable from: Birth to 6 months/9kg (up to 2 years with conversion kit) | Weight: 13.4kg | Crib size: H68.5–83cm x W56cm x L94cm | Mattress size: L83cm x W50cm | Tilt: Yes | Rocks: No | Height positions: 7 | Washable mattress cover: Hand wash While most bedside cribs on the market are only suitable for babies up to 6 months old, the Shnuggle Air stands out by offering 3 products in 1. It can be used as a standalone cot or bedside sleeper and then it transforms after 6 months into a full-sized cot when you buy the additional conversion kit (£109.95) and cot mattress (£50), which will last your child up until around 2 years old. This makes it a great long-term investment. MFM judges and testers were particularly impressed with the firmness of its hypo-allergenic airflow mattress. This crib has dual-view mesh sides, giving it maximum breathability; this also means you can easily see your baby when both sides are up. This was also a feature that stood out to MFM reviewer Tara, who used it with her 6-month-old daughter Elodie. She said, “Elodie slept very soundly and she loved being able to see through the mesh sides.” The drop-down sides are easily removed for nighttime access by releasing the safety catch on the top bar and undoing the zips. However, during the awards testing, it was noted that the safety catch makes a loud click. This was echoed by a MFM user reviewer who said: “The side makes a noise when you click it back in and that can wake up baby!” Unlike most of the others on this list, the side of the Shnuggle Air cannot be left down during sleep, it's simply there for access. The Shnuggle Air is relatively heavy at 13.4kg, and doesn't have wheels, so it's not easy to move around your home. “I’d say once the Shnuggle Air is set up, it’s staying put,” Tara added. Pros: Long-lasting, highly breathable, spacious Cons: Not easily portable, side is noisy when released, hand wash only Read our full MadeForMums Shnuggle Air Bedside Crib review Available from: Amazon, John Lewis and Shnuggle John Lewis & Partners £180.00 Buy now Amazon UK £199.95 Buy now Kiddies Kingdom £299.00 Buy now 5. Maxi-Cosi Iora bedside sleeper, £149 – Best for extra storage Suitable from: Birth to 6 months/9kg | Weight: 10.8kg | Crib size: H74.5cm x W55.5cm x L93cm | Mattress size: L80cm x W58.5cm | Tilt: Yes | Rocks: No | Height positions: 5 | Washable mattress cover: Hand wash With its choice of muted colours, sleek design and quality materials, the Maxi-Cosi Iora is sure to fit in with most room schemes. The large storage basket at the bottom of the crib is great for parents who are short on space as it can easily hold numerous blankets, baby sleeping bags, nappies, wipes and spare clothes. The Iora’s easy-to-adjust height (5 positions in total) and slide function (2 positions in total) also means it can fit snugly against most types of bed when used with the straps. “Our iron-frame bed is somewhat lower than average,” said MFM reviewer Georgina. “But the Iora also sat in the correct position with our mattress.” One feature that our reviewer Georgina particularly liked was that when the side is down, there is a 7-inch (18cm) barrier to stop your baby rolling out. She said: “The Iora allowed me to sleep as close to my daughter as possible, but I was also safe in the knowledge that she was in her own sleeping area and I wasn't going to squash her!” This crib is extremely straightforward to assemble (one of the quickest during MFM testing) and MFM reviewer Georgina managed to put it together speedily without using the instructions. She explained: “It was obvious which pieces go together, simple to build and had neat zips to keep everything in place.” A handy bag also means it can easily be used as a travel cot, especially as it folds down flat. Keep in mind that Georgina did find the outer fabric was prone to creasing when unpacked from the travel bag. Pros: Extra storage, easy height and slide adjustments, portable, smart appearance Cons: Mattress cover hand wash only, outer fabric prone to creasing, not as many height options as other cribs, only mesh on one side Read our full MadeForMums Maxi-Cosi Iora review Available from: Samuel Johnston, John Lewis and Amazon Kiddies Kingdom £169.00 Buy now John Lewis & Partners £199.99 Buy now Mamas & Papas £199.99 Buy now Very.co.uk £199.99 Buy now 6. Joie Roomie GO, £180 – Best for one-handed operation Suitable from: Birth to 6 months/9kg | Weight: 9.5kg | Crib size: H74.8- 82.2cm x W68.5cm x L90.3cm | Mattress size: H6cm x W51cm x L84cm | Tilt: Yes | Rocks: No | Height positions: 5 | Washable mattress cover: Machine washable | Awards: Gold – Bedside/Co-Sleeper Crib, MadeForMum Awards 2023 Awarded Gold in Best Bedside/Co-Sleeper Crib, MadeForMums Awards 2023, the Joie Roomie Go packs in a lot of features for its mid-range price. Offering mesh windows on both sides, providing plenty of ventilation as well as making it easy to keep an eye on your baby, the stylish crib is available in a choice of chic grey or classic black. Our MFM home testers were impressed with the Roomie Go’s aesthetic, with one commenting, “It looks great, is made with good quality material and will look stylish in any room.” The one-handed drop-down panels on both sides of the crib mean you can easily switch which side of the bed you attach it to. You should be able to simply click the handle to lift and lower, although one of our home testers commented that the first couple of times they attempted this the mechanism was a little sticky. Its simple, compact fold means you can pack the crib away in less than a minute and take it with you in the travel bag included, for holidays or trips to the grandparents’. The Joie Roomie Go is also on (lockable) wheels so you can move it around the home during the daytime. It has a tummy tilt for reflux/colic, and there are 5 height adjustments to fit most beds. Praised across the board by our MFM home testers for its comfy mattress and ease of assembly, it’s a great all-rounder both when at home and away. Pros: One-handed operation, tilt function for reflux, comfortable for baby, drop-down panels on both sides, travel bag included Cons: No storage, not as many height options as other cribs Available from: John Lewis, Joie and Argos Very.co.uk £179.99 Buy now argos.co.uk £180.00 Buy now John Lewis & Partners £180.00 Buy now Kiddies Kingdom £180.00 Buy now 7. Red Kite Cozysleep Crib, £84.99 – Best for value Suitable from: Birth to 6 months/9kg | Weight: 9kg | Crib size: H74-87cm x W57-61cm x L88cm | Mattress size: W80cm x L50cm | Tilt: Yes | Rocks: No | Height positions: 7 | Washable mattress cover: No, wipeable only | Awards: Silver – Bedside/Co-Sleeper Crib, MadeForMum Awards 2023 Coming in at just under £85 the Red Kite Cozysleep crib offers really fantastic value. However, the great price doesn't mean there's a compromise on features or style. “It’s a well-made product that looks modern and would easily suit all bedrooms,” said MFM home tester Kiran, who appreciated the simple, yet contemporary look. The crib has a drop-down side, 7 adjustable height positions, a tilt function (great for helping with reflux) and a handy storage shelf for things like nappies and wipes. It's on wheels, so it can be moved around the room or away from the bed with ease, and it also folds down to a more compact size for travel. There’s even a handy storage bag included, which our testers felt helps you to get even more use out of the Cozysleep as a travel cot. One feature that really impressed our home testers was the quality of the soft, quilted mattress, with one MFM home tester commenting, “The mattress is brilliant! I have used other makes of co-sleepers/cribs and this mattress is triple the thickness. It feels soft but firm and very comfy.” Pros: Great value, tilt function, good quality mattress, handy storage shelf, travel bag included Cons: Only mesh on one side Available from: Amazon and Kiddies Kingdom Kiddies Kingdom £79.99 Buy now Samuel Johnston £104.40 Buy now 8. Halo BassiNest Premiere Swivel Sleeper, £248.29 – Best for 360° swivel Suitable from: Birth to 5 months/10kg | Weight: 14.8kg | Crib size: H94cm x W61cm x L114cm | Mattress size: L85cm x W55.8cm | Tilt: No | Rocks: Battery-powered vibrations | Height positions: Customisable between 61cm-84cm | Washable mattress cover: Machine-washable sheet included This is American brand Halo's updated version of its popular BassiNest Essentia swivel sleeper. Offering a slightly different way to sleep closely but safely with your baby, the BassiNest Premiere is a standalone crib with a central stand that slides beneath the bed, rather than fastening on to the side of the bed. Parents can then swivel the crib 360° for easy access, with one MFM home tester pointing out this also ""makes it easy to get in and out of bed without disturbing the baby"". There's no drop-down side, instead the mesh side has enough give that you can push it down to reach and get your baby before it automatically returns to the upright position. Compared to cribs with open sides that sit flush with the bed, the BassiNest is more of a hybrid product, sitting somewhere between a moses basket and a bedside crib. While the BassiNest Premiere doesn't have a rock or tilt function, it does have a built-in “soothing centre” that features an amber nightlight, floorlight, 2 vibration levels and 4 soothing sounds, all with auto shutoff. To use this function you will need 3 x AA batteries (not included). Pros: Flexible, useful when recovering from birth, customisable height to fit most beds, built-in soothing centre Cons: Not a true bedside crib, very heavy, need batteries to access the soothing centre functions, expensive Available from: Halo, John Lewis and Boots John Lewis & Partners £249.00 Buy now How do you use a bedside crib safely? The most important piece of advice for safe sleeping is to lie your baby on their back to sleep. Indeed, since the Back To Sleep campaign was launched in the UK 30 years ago, cases of SIDS (Sudden Infant Death Syndrome) have fallen by 80%. When using a bedside crib, you should ensure there is no gap between the adult's and baby's mattress. Your baby’s mattress should be firm and flat, and sit snugly in the crib with no gaps. Also look for a mattress that is breathable. There's a simple test you can do for this: Most cribs come with a mattress as standard, but if you are given the crib by someone else or buy one second-hand you will need to buy a new mattress – even if the existing one appears to be in good condition. Second-hand mattresses may increase the risk of SIDS and are less likely to be supportive after losing their shape over time. Always use the mattress designed to fit your bedside crib – most retailers sell them separately should you need a replacement. When it comes to a safe sleeping position, place your baby in the crib with their feet at the end of the crib – called the feet-to-foot position. This reduces the risk of their face or head slipping down under the covers if you're using a blanket. How to use tilting and rocking features safely Some bedside cribs offer a tilt option, which may help babies with digestive issues, colic or reflux. If you are going to tilt your baby, you must do so with great care and only at a slight angle, to avoid your baby slipping down. We recommend speaking to your GP or health visitor for advice before using the tilt function. Tilting (and rocking) can only be used when the bedside crib is set up as a Our at-home mattress breathability test Pick up the mattress and place it close to your mouth • Breathe in and see how easy it is to breathe out with the mattress near your mouth • If it’s easier this should mean the mattress offers good ventilation • standalone crib – for safety reasons, you should not tilt or rock the crib when the side is down as there is a chance your baby could fall out. What bedding can I use with a bedside crib? The Lullaby Trust advises, “Firmly tucked-in sheets and blankets (not above shoulder height) or a baby sleep bag are safe for a baby to sleep in.” Make sure you buy the correct size sheets that exactly fit your mattress. You may also choose to swaddle a newborn. The Lullaby Trust does not advise for or against swaddling, but it does have some basic swaddling guidance. You must stop using a swaddle as soon as your baby learns to roll. Not all baby sleeping bags and swaddles are created equal, so make sure the brand you buy adheres to safety standards, is the correct tog for the room temperature and season, and is the right size for your baby, so they can't slip down inside. Don’t use any soft or bulky bedding and never use pillows, duvets, baby bumpers or baby positioners. You should also remove any soft toys from the crib before your baby sleeps. Advertisement Read more... Gemma Cartwright Group Digital Editor Gemma has two decades of experience in digital content. She is mum to a preschooler, and aunt to 4 children under 4. She is particularly passionate about sleep (for babies and parents) and loves testing out gadgets, technology and innovation in the parenting world. 14 of the best baby and toddler sleeping bags • 14 of the best car seats from birth • Bednest: NCT says there is a “small but plausible risk” when using the co-sleeper • You may also like How NatPat's wellness patches may help your family NatPat's range of wellness patches and stickers aim to tackle everything from allergies to lack of focus. We take a closer look at the range. Advertisement feature with NatPat Read now Silver Cross Voyager Co-Sleeper Bedside Crib review Chicco Next2Me Air bedside crib review Cribs & moses baskets Cribs & moses baskets Mamas & Papas Lua Bedside Crib review 10 of the best Moses baskets and cribs for your newborn Cribs & moses baskets Cribs & moses baskets About us Contact us Terms & conditions Code of conduct Privacy policy Cookies policy Complaints MadeForMums Top Testers Club Competitions Manage Privacy Settings This website is owned and published by Immediate Media Company Limited. www.immediate.co.uk © Immediate Media Company Ltd. 2024 Radio Times BBC Good Food Gardeners' World Magazine olive History Extra Junior Magazine The Recommended Baby Names Pregnancy Health Pushchairs & prams Car Seats Weaning & Baby Recipes Travel & holidays","You are given a reference document. You must only use information found in the reference document to answer the question asked. What is the best co sleeper for me and my new baby? ❚ MadeForMums reviews are independent and based on expertise and testing. When you buy through links on our site, we may earn an affiliate commission, but this never influences our product choices. 8 of the best bedside cribs and cosleepers for safe sleeping for your baby We've tried, tested and reviewed the best bedside cribs, for a brilliant way to sleep closely and safely with your baby Gemma Cartwright Published: March 5, 2024 at 3:20 PM Save A bedside crib is one of the most popular choices for newborn sleep, as it allows you to keep your baby close while still following safe sleep We value your privacy We need your consent so that we and our 172 trusted partners can store and access cookies, unique identifiers, personal data, and information on your browsing behaviour on this device. This only applies to Immediate Media. You can change your preferences at any time by clicking on ‘Manage Privacy Settings’ located at the bottom of any page. You don’t have to agree, but some personalised content and advertising may not work if you don’t. We and our partners use your data for the following purposes: Store and/or access information on a device Precise geolocation data, and identification through device scanning Personalised advertising and content, advertising and content measurement, audience research and services development. Google Consent Mode framework To view our list of partners and see how your data may be used, click or tap ‘More Options’ below. You can also review where our partners claim a legitimate interest to use your data and, if you wish, object to them using it. MORE OPTIONS AGREE guidelines. In the first 6 months, when the risk of sudden infant death syndrome (SIDS) is at its highest, the safest place for a baby to sleep is on their back in their own sleep space, be that a cot, crib or moses basket. Advertisement A bedside crib fastens to the frame of your bed on one side, so you're effectively lying next to your baby. The side can usually be dropped down so you can see and reach over to your child. They're sometimes referred to as side-sleepers or co-sleepers, but the key difference is that you're not sharing a sleep surface or bedding. You and your baby can maximise the soothing benefits that proximity brings while minimising the risks associated with bed sharing. Having your baby at arm's reach also makes night feeds much easier. Best bedside cribs and co-sleepers at a glance Jump to our list of the best bedside cribs and cosleepers • Best bedside crib with an easy drop-down side: Chicco Next2Me Magic, £189 • Best bedside crib with a removable bassinet: SnuzPod 4 Bedside Crib, £199.95 • Best bedside crib for smooth rocking: Tutti Bambini CoZee Air Bedside Crib, £225 • Best bedside crib for longevity: Shnuggle Air Bedside Crib, £180 • There are a wide range of options, so at MadeForMums we’ve analysed the bedside crib market closely to bring you the very best choices. We’ve used feedback from our expert journalist reviewers and parent testers, combined with results from in-house MadeForMums testing, which looked at key features such as breathability, mattress firmness, ease of building as well as functionality. For each bedside crib we’ve listed the key technical features to help you compare across brands and models so you can find the best design to suit your needs. If your baby is struggling to sleep through the night, take a look at our best sleep aids and white noise machines, best nightlights and best baby swaddles. More like this Silver Cross Voyager Co-Sleeper Bedside Crib review What is the new safety standard for bedside cribs? All new bedside cribs manufactured since November 2020 have to meet a new safety standard (with the catchy name BS EN 1130:2019) that introduced new and more rigorous safety requirements for bedside cribs. However, you may find some older versions of cribs are still on sale that only match the previous safety standard. Slowly these will disappear from stores and the only ones available will meet the new standard. The most significant new requirement for BS EN 1130:2019 is for a 120mm Best bedside crib for extra storage: Maxi-Cosie Iora Bedside Sleeper, £149 • Best bedside crib for one-handed operation: Joie Roomie GO, £180 • Best value bedside crib: Red Kite Cozysleep Bedside Crib, £84.99 • Best bedside crib with 360° swivel: Halo BassiNest Premiere Swivel Sleeper, £248.29 • high barrier to be present around the sides of the crib, to ensure your baby is not able to roll off their own mattress onto yours. This means that new bedside cribs can no longer have complete drop-down sides – many now have 'half-height' walls instead. This allows your baby to be positioned next to you with the crib lined up to your bed, but their mattress will be sunk a little lower, providing more of a protective barrier. All the cribs featured in our list comply with these new BS EN 1130:2019 safety requirements. What to look for when buying a bedside crib Will it work with your bed? – Certain bed frames can be trickier to use with a bedside crib. For example, if you have a divan bed you will need longer straps, and may not be able to tuck the legs of the crib underneath the bed and may need to look for a model that has foldable legs or works with your bed style. Height of your bed – Most bedside cribs have adjustable heights to give you an almost perfect fit on most bed frames, but if your bed is particularly low or high, do check the measurements. Also check the size of the crib and whether it will fit next to your bed while allowing you to get in and out easily and safely. This is particularly important for those first few days and weeks after giving birth when your body is still recovering. Mattress – The mattress needs to be firm, flat and breathable – this is a key safety feature. Don’t be tempted by a super soft mattress – your baby will sleep deeply and most importantly safely on a firm mattress. Drop-down side – How easy is it to remove the side? Can you do it with one hand? As you may be doing this in the middle of the night, are there lots of noisy zips and clips? Can it safely be left down while you sleep? Do check this as the rules differ depending on the product. How easy is it to assemble – Are there lots of parts to screw together? Will you need 2 people to build it? We’ve tested how easy different bedside cribs are to build in our reviews. How easy is it to keep clean – Does the mattress have a waterproof cover to protect from leaky nappies, baby sick and dribbles? Is the fabric machine washable or will you have to hand wash it? Portability – Is the crib light enough to move around your house? If you want to take it away with you does it crib fold flat and/or come with a storage bag? Extra features – Does it rock (useful for fussy sleepers), tilt (remember to use tilting with care), detach to become a moses basket or turn into an older baby cot or playpen? These extra features may not be necessary, but they could be useful. For more safety information we've also covered breathability, bedding and how to use the tilting function here. What are the benefits of using a bedside crib? Safe sleep charity The Lullaby Trust, advises that the safest place for your baby to sleep is on their own sleep surface, in the same room as you, for at least the first 6 months. Bedside cribs allow you to have your baby sleeping right next to you at night, but in the safety of their own crib. This means you can still be close to your baby without bed-sharing, which carries a risk of suffocation and overheating. Bedside cribs enable you to lean over and easily pick up your baby when feeding at night. This is especially useful if you’ve had a difficult birth or a c-section and find getting out of bed painful. You can also easily comfort your baby if they are fussing and have a good view of them while they are sleeping. How to do the baby mattress firmness test Press your hand on the centre and the sides of the mattress • A firm mattress shouldn’t mould to the shape of your hand and you’ll feel resistance – it will obviously move beneath the pressure but your hand shouldn’t sink in • When you remove your hand, the mattress should snap back and regain its shape • From a practical perspective, bedside cribs are smaller and more compact than most cots, which means they take up less space in your bedroom than a full-sized cot or cotbed. Do I need a bedside crib for my baby? You don’t have to buy a bedside crib. It's completely safe to put a baby in a regular cot from birth. But they’re a great option if you want your baby as close to you as possible at night, and for saving space. The downside is that most of these cribs only last up to 6 months and you’ll then need to move your baby into a full-sized cot or cotbed. A moses basket is a more economical option, but these can last even less time, and do not have the added features of a bedside crib such as a drop-down side, tilt, or multiple heights. How much does a bedside crib cost? It is possible to buy budget bedside cribs for under £100 but the majority we have reviewed are between £150-£300. Certain features, such as a rocking function or one-handed drop down side, tend to push the price up slightly. How did we choose these bedside cribs? Our 10 of the Best lists are compiled by qualified and experienced parenting journalists. They rely on a number of sources, including our independent reviews, testing undertaken during the MadeForMums Awards, and feedback from our home testing panel and Top Testers Club. Each year thousands of products are put through their paces by hundreds of parents across the country on behalf of MadeForMums, to ensure we’re bringing you honest and true reviews and recommendations. When testing bedside cribs, we consider size, ease of build and fitting, mattress quality and breathability, ease and safety of the drop-down side mechanism and other features, comfort for baby, design and quality, and whether it's worth the money. Our list is not an ordered ranking from 1-10, instead it is a carefully Here are our top 10 bedside cribs for 2024 1. Chicco Next2Me Magic, £189 – Best for easy drop-down side Suitable from: Birth to 6 months/9kg | Weight: 13.1kg | Crib size: H66.5- 82.4cm x W73cm x L99.5cm | Mattress size: L83cm x W50.5cm | Tilt: Yes | Rocks: Yes | Height positions: 11 | Washable mattress cover: Hand wash The Chicco Next2Me Magic is the latest update to the original Next2Me side-sleeping crib, which has won fans for its versatility. It can be used from birth as a bedside co-sleeper, as a standalone crib or possibly as a travel cot, but at over 13kg it's not a light carry. It is slightly more expensive than some other models, but standout features include a really easy drop-side that can be operated with one hand, 11 height levels, a lockable rocking function, 4 tilt options to help reduce reflux, and wheels to make it easy to move around your home. selected group of tried-and-tested products, each of which we believe is best for a different situation or requirement. We don’t just tell you what is best, we help you discover what is best for your family. A large sleeping area means more room for a bigger baby, plus a travel bag is included. MFM tester Lucy said, “I found the Chicco Next2Me Magic a breeze to move around and set up, but also substantial and sturdy. The clever onehanded drop-down mechanism on the side panel can be used while holding your baby in your arms, which is brilliant. ""I've even used the Chicco in my kitchen for safe day naps when I need to be more focused on my older child.” Pros: Firm and breathable mattress, retractable legs to fit any bed, quiet side zip, easy to transport Cons: Tricky to initially assemble, mattress cover is hand wash only Read our full MadeForMums Chicco Next2Me Magic bedside crib review Available from: John Lewis and Mamas & Papas John Lewis & Partners £229.00 Buy now Mamas & Papas £229.00 Buy now 2. SnuzPod 4 Bedside Crib, £199.95 – Best for removable bassinet Suitable from: Birth to 6 months/9kg | Weight: 11.5kg | Crib size: H95cm x W49cm x L100cm | Mattress size: L75cm x W40cm | Tilt: Yes | Rocks: Yes | Height positions: 7 | Washable mattress cover: Machine washable The latest iteration of Snuz's much-loved bedside crib, the Snuzpod4 features a new breathable system (called ComfortAir) that aids the flow of air around the crib and your baby. It offers more side vents, breathable mesh liner and mattress, plus a ventilated base. But the key thing that we're delighted to see is that the Snuzpod4 has a firmer mattress than previous versions – as well as good breathability. Plus Snuz claims that the SnuzPod4 fits more bed heights than any rival, as it will now work with beds up to a maximum adult mattress height of 73cm. It's also designed to be compatible with a range of bed types – divan, ottoman and framed bed bases. Made from sustainably sourced beech solid wood, the Snuzpod4 looks good. MFM mum home tester Mehack commented on ""how stylish and contemporary the design is,"" praising how it ""fits perfectly with the room decor"". We love its versatility – the two-part design includes a lift-off bassinet that can be moved around the house so you have a portable safe sleeping space for your baby, whichever room you're in. The bassinet also has a manual rocking function, as does the crib and the bassinet. There's an optional riser that can be added to create a slight incline to help babies with reflux, but for safety reasons, when the cot is tilted this stops the rocking function from working. Pros: Stylish, removable bassinet, great storage Cons: Can be difficult to put together Read our full MadeForMums SnuzPod 4 bedside crib review Available from: Snuz, Samuel Johnston and Amazon Very.co.uk £159.99 Buy now Samuel Johnston £190.18 Buy now Amazon UK £199.95 Buy now John Lewis & Partners £199.95 Buy now 3. Tutti Bambini CoZee Air Bedside Crib, £225 – Best for smooth rocking Suitable from: Birth to 6 months/9kg | Weight: 11kg | Crib size: H92cm x W12cm x L56cm | Mattress size: L80.5cm x W51cm | Tilt: Yes | Rocks: Yes | Height positions: 6 | Washable mattress cover: Sponge, only machine wash if necessary While it is at the more expensive end of the market, what makes the CoZee Air stand out from the competition is its smooth rocking function. It comes with easy-to-remove caster wheels that you can switch with rocking bars, which easily attach to the legs of the crib. As a safety feature, the CoZee can also only be rocked when it is set up as a standalone crib – when used as a bedside crib, it has flip-out feet that prevent it from doing so. “The rocking feature is fantastic and really helped me to settle my baby when she was overtired and fussing,” said MFM tester Tara. MFM testers also rated the crib highly for its portability – it is ideal as a travel cot, as despite its large size, it is compact when folded. A 30-second open-fold mechanism allows for a quick set up and it comes with a travel bag for easy transportation. While the multiple mesh windows are great for breathability and being able to see your little one, there's a curtain attached to one side of the crib that you can roll down to protect your baby from draughts during colder months. This still leaves one mesh side open to allow for plenty of air flow. When it comes to cleaning, the fabric lining can be removed and put in the washing machine, while the foam mattress can be machine washed if necessary. We also like the addition of a storage shelf that is useful for holding essentials such as baby wipes, nappies, clothes and muslins. Pros: Smooth rocking, quick to collapse down, storage shelf Cons: Higher price point Read our full MadeForMums Tutti Bambini CoZee Air Bedside Crib review Available from: Boots, Kiddies Kingdom and Tutti Bambini Kiddies Kingdom £165.00 Buy now For Your Little One £180.00 Buy now Wayfair £186.63 Buy now Dunelm £219.00 Buy now 4. Shnuggle Air Bedside crib, £180 – Best for longevity Suitable from: Birth to 6 months/9kg (up to 2 years with conversion kit) | Weight: 13.4kg | Crib size: H68.5–83cm x W56cm x L94cm | Mattress size: L83cm x W50cm | Tilt: Yes | Rocks: No | Height positions: 7 | Washable mattress cover: Hand wash While most bedside cribs on the market are only suitable for babies up to 6 months old, the Shnuggle Air stands out by offering 3 products in 1. It can be used as a standalone cot or bedside sleeper and then it transforms after 6 months into a full-sized cot when you buy the additional conversion kit (£109.95) and cot mattress (£50), which will last your child up until around 2 years old. This makes it a great long-term investment. MFM judges and testers were particularly impressed with the firmness of its hypo-allergenic airflow mattress. This crib has dual-view mesh sides, giving it maximum breathability; this also means you can easily see your baby when both sides are up. This was also a feature that stood out to MFM reviewer Tara, who used it with her 6-month-old daughter Elodie. She said, “Elodie slept very soundly and she loved being able to see through the mesh sides.” The drop-down sides are easily removed for nighttime access by releasing the safety catch on the top bar and undoing the zips. However, during the awards testing, it was noted that the safety catch makes a loud click. This was echoed by a MFM user reviewer who said: “The side makes a noise when you click it back in and that can wake up baby!” Unlike most of the others on this list, the side of the Shnuggle Air cannot be left down during sleep, it's simply there for access. The Shnuggle Air is relatively heavy at 13.4kg, and doesn't have wheels, so it's not easy to move around your home. “I’d say once the Shnuggle Air is set up, it’s staying put,” Tara added. Pros: Long-lasting, highly breathable, spacious Cons: Not easily portable, side is noisy when released, hand wash only Read our full MadeForMums Shnuggle Air Bedside Crib review Available from: Amazon, John Lewis and Shnuggle John Lewis & Partners £180.00 Buy now Amazon UK £199.95 Buy now Kiddies Kingdom £299.00 Buy now 5. Maxi-Cosi Iora bedside sleeper, £149 – Best for extra storage Suitable from: Birth to 6 months/9kg | Weight: 10.8kg | Crib size: H74.5cm x W55.5cm x L93cm | Mattress size: L80cm x W58.5cm | Tilt: Yes | Rocks: No | Height positions: 5 | Washable mattress cover: Hand wash With its choice of muted colours, sleek design and quality materials, the Maxi-Cosi Iora is sure to fit in with most room schemes. The large storage basket at the bottom of the crib is great for parents who are short on space as it can easily hold numerous blankets, baby sleeping bags, nappies, wipes and spare clothes. The Iora’s easy-to-adjust height (5 positions in total) and slide function (2 positions in total) also means it can fit snugly against most types of bed when used with the straps. “Our iron-frame bed is somewhat lower than average,” said MFM reviewer Georgina. “But the Iora also sat in the correct position with our mattress.” One feature that our reviewer Georgina particularly liked was that when the side is down, there is a 7-inch (18cm) barrier to stop your baby rolling out. She said: “The Iora allowed me to sleep as close to my daughter as possible, but I was also safe in the knowledge that she was in her own sleeping area and I wasn't going to squash her!” This crib is extremely straightforward to assemble (one of the quickest during MFM testing) and MFM reviewer Georgina managed to put it together speedily without using the instructions. She explained: “It was obvious which pieces go together, simple to build and had neat zips to keep everything in place.” A handy bag also means it can easily be used as a travel cot, especially as it folds down flat. Keep in mind that Georgina did find the outer fabric was prone to creasing when unpacked from the travel bag. Pros: Extra storage, easy height and slide adjustments, portable, smart appearance Cons: Mattress cover hand wash only, outer fabric prone to creasing, not as many height options as other cribs, only mesh on one side Read our full MadeForMums Maxi-Cosi Iora review Available from: Samuel Johnston, John Lewis and Amazon Kiddies Kingdom £169.00 Buy now John Lewis & Partners £199.99 Buy now Mamas & Papas £199.99 Buy now Very.co.uk £199.99 Buy now 6. Joie Roomie GO, £180 – Best for one-handed operation Suitable from: Birth to 6 months/9kg | Weight: 9.5kg | Crib size: H74.8- 82.2cm x W68.5cm x L90.3cm | Mattress size: H6cm x W51cm x L84cm | Tilt: Yes | Rocks: No | Height positions: 5 | Washable mattress cover: Machine washable | Awards: Gold – Bedside/Co-Sleeper Crib, MadeForMum Awards 2023 Awarded Gold in Best Bedside/Co-Sleeper Crib, MadeForMums Awards 2023, the Joie Roomie Go packs in a lot of features for its mid-range price. Offering mesh windows on both sides, providing plenty of ventilation as well as making it easy to keep an eye on your baby, the stylish crib is available in a choice of chic grey or classic black. Our MFM home testers were impressed with the Roomie Go’s aesthetic, with one commenting, “It looks great, is made with good quality material and will look stylish in any room.” The one-handed drop-down panels on both sides of the crib mean you can easily switch which side of the bed you attach it to. You should be able to simply click the handle to lift and lower, although one of our home testers commented that the first couple of times they attempted this the mechanism was a little sticky. Its simple, compact fold means you can pack the crib away in less than a minute and take it with you in the travel bag included, for holidays or trips to the grandparents’. The Joie Roomie Go is also on (lockable) wheels so you can move it around the home during the daytime. It has a tummy tilt for reflux/colic, and there are 5 height adjustments to fit most beds. Praised across the board by our MFM home testers for its comfy mattress and ease of assembly, it’s a great all-rounder both when at home and away. Pros: One-handed operation, tilt function for reflux, comfortable for baby, drop-down panels on both sides, travel bag included Cons: No storage, not as many height options as other cribs Available from: John Lewis, Joie and Argos Very.co.uk £179.99 Buy now argos.co.uk £180.00 Buy now John Lewis & Partners £180.00 Buy now Kiddies Kingdom £180.00 Buy now 7. Red Kite Cozysleep Crib, £84.99 – Best for value Suitable from: Birth to 6 months/9kg | Weight: 9kg | Crib size: H74-87cm x W57-61cm x L88cm | Mattress size: W80cm x L50cm | Tilt: Yes | Rocks: No | Height positions: 7 | Washable mattress cover: No, wipeable only | Awards: Silver – Bedside/Co-Sleeper Crib, MadeForMum Awards 2023 Coming in at just under £85 the Red Kite Cozysleep crib offers really fantastic value. However, the great price doesn't mean there's a compromise on features or style. “It’s a well-made product that looks modern and would easily suit all bedrooms,” said MFM home tester Kiran, who appreciated the simple, yet contemporary look. The crib has a drop-down side, 7 adjustable height positions, a tilt function (great for helping with reflux) and a handy storage shelf for things like nappies and wipes. It's on wheels, so it can be moved around the room or away from the bed with ease, and it also folds down to a more compact size for travel. There’s even a handy storage bag included, which our testers felt helps you to get even more use out of the Cozysleep as a travel cot. One feature that really impressed our home testers was the quality of the soft, quilted mattress, with one MFM home tester commenting, “The mattress is brilliant! I have used other makes of co-sleepers/cribs and this mattress is triple the thickness. It feels soft but firm and very comfy.” Pros: Great value, tilt function, good quality mattress, handy storage shelf, travel bag included Cons: Only mesh on one side Available from: Amazon and Kiddies Kingdom Kiddies Kingdom £79.99 Buy now Samuel Johnston £104.40 Buy now 8. Halo BassiNest Premiere Swivel Sleeper, £248.29 – Best for 360° swivel Suitable from: Birth to 5 months/10kg | Weight: 14.8kg | Crib size: H94cm x W61cm x L114cm | Mattress size: L85cm x W55.8cm | Tilt: No | Rocks: Battery-powered vibrations | Height positions: Customisable between 61cm-84cm | Washable mattress cover: Machine-washable sheet included This is American brand Halo's updated version of its popular BassiNest Essentia swivel sleeper. Offering a slightly different way to sleep closely but safely with your baby, the BassiNest Premiere is a standalone crib with a central stand that slides beneath the bed, rather than fastening on to the side of the bed. Parents can then swivel the crib 360° for easy access, with one MFM home tester pointing out this also ""makes it easy to get in and out of bed without disturbing the baby"". There's no drop-down side, instead the mesh side has enough give that you can push it down to reach and get your baby before it automatically returns to the upright position. Compared to cribs with open sides that sit flush with the bed, the BassiNest is more of a hybrid product, sitting somewhere between a moses basket and a bedside crib. While the BassiNest Premiere doesn't have a rock or tilt function, it does have a built-in “soothing centre” that features an amber nightlight, floorlight, 2 vibration levels and 4 soothing sounds, all with auto shutoff. To use this function you will need 3 x AA batteries (not included). Pros: Flexible, useful when recovering from birth, customisable height to fit most beds, built-in soothing centre Cons: Not a true bedside crib, very heavy, need batteries to access the soothing centre functions, expensive Available from: Halo, John Lewis and Boots John Lewis & Partners £249.00 Buy now How do you use a bedside crib safely? The most important piece of advice for safe sleeping is to lie your baby on their back to sleep. Indeed, since the Back To Sleep campaign was launched in the UK 30 years ago, cases of SIDS (Sudden Infant Death Syndrome) have fallen by 80%. When using a bedside crib, you should ensure there is no gap between the adult's and baby's mattress. Your baby’s mattress should be firm and flat, and sit snugly in the crib with no gaps. Also look for a mattress that is breathable. There's a simple test you can do for this: Most cribs come with a mattress as standard, but if you are given the crib by someone else or buy one second-hand you will need to buy a new mattress – even if the existing one appears to be in good condition. Second-hand mattresses may increase the risk of SIDS and are less likely to be supportive after losing their shape over time. Always use the mattress designed to fit your bedside crib – most retailers sell them separately should you need a replacement. When it comes to a safe sleeping position, place your baby in the crib with their feet at the end of the crib – called the feet-to-foot position. This reduces the risk of their face or head slipping down under the covers if you're using a blanket. How to use tilting and rocking features safely Some bedside cribs offer a tilt option, which may help babies with digestive issues, colic or reflux. If you are going to tilt your baby, you must do so with great care and only at a slight angle, to avoid your baby slipping down. We recommend speaking to your GP or health visitor for advice before using the tilt function. Tilting (and rocking) can only be used when the bedside crib is set up as a Our at-home mattress breathability test Pick up the mattress and place it close to your mouth • Breathe in and see how easy it is to breathe out with the mattress near your mouth • If it’s easier this should mean the mattress offers good ventilation • standalone crib – for safety reasons, you should not tilt or rock the crib when the side is down as there is a chance your baby could fall out. What bedding can I use with a bedside crib? The Lullaby Trust advises, “Firmly tucked-in sheets and blankets (not above shoulder height) or a baby sleep bag are safe for a baby to sleep in.” Make sure you buy the correct size sheets that exactly fit your mattress. You may also choose to swaddle a newborn. The Lullaby Trust does not advise for or against swaddling, but it does have some basic swaddling guidance. You must stop using a swaddle as soon as your baby learns to roll. Not all baby sleeping bags and swaddles are created equal, so make sure the brand you buy adheres to safety standards, is the correct tog for the room temperature and season, and is the right size for your baby, so they can't slip down inside. Don’t use any soft or bulky bedding and never use pillows, duvets, baby bumpers or baby positioners. You should also remove any soft toys from the crib before your baby sleeps. Advertisement Read more... Gemma Cartwright Group Digital Editor Gemma has two decades of experience in digital content. She is mum to a preschooler, and aunt to 4 children under 4. She is particularly passionate about sleep (for babies and parents) and loves testing out gadgets, technology and innovation in the parenting world. 14 of the best baby and toddler sleeping bags • 14 of the best car seats from birth • Bednest: NCT says there is a “small but plausible risk” when using the co-sleeper • You may also like How NatPat's wellness patches may help your family NatPat's range of wellness patches and stickers aim to tackle everything from allergies to lack of focus. We take a closer look at the range. Advertisement feature with NatPat Read now Silver Cross Voyager Co-Sleeper Bedside Crib review Chicco Next2Me Air bedside crib review Cribs & moses baskets Cribs & moses baskets Mamas & Papas Lua Bedside Crib review 10 of the best Moses baskets and cribs for your newborn Cribs & moses baskets Cribs & moses baskets About us Contact us Terms & conditions Code of conduct Privacy policy Cookies policy Complaints MadeForMums Top Testers Club Competitions Manage Privacy Settings This website is owned and published by Immediate Media Company Limited. www.immediate.co.uk © Immediate Media Company Ltd. 2024 Radio Times BBC Good Food Gardeners' World Magazine olive History Extra Junior Magazine The Recommended Baby Names Pregnancy Health Pushchairs & prams Car Seats Weaning & Baby Recipes Travel & holidays",Retail/Product,Fact Finding,Q&A You can only respond to the prompt using the information in the context block and no other sources. Give your answer in bullet points and follow each one with an explanation.,"In simple terms, what are key components of US strategic goals related to subsea cables?","Transatlantic Tech Bridge: Digital Infrastructure and Subsea Cables, a US Perspective 1. US strategic interests in digital infrastructure and its industrial policy The United States’ overarching strategic goal is an open, secure, interoperable and global internet, one where US digital leaders can compete (and win). This requires trusted digital infrastructure. US investment in digital infrastructure reveals both domestic and international priorities. The 2021 Bipartisan Infrastructure Bill provides 65 billion US dollars for high-speed internet deployment.6 Its focus is on providing connectivity for low-income households through the Affordable Connectivity Program and reaching underserved rural, agricultural and tribal areas.7 The “Internet for All” initiative manages grants for infrastructure and training.8 In the international development space, digital infrastructure is one of three pillars of USAID’s digital strategy and its digital ecosystem framework.9 US firms retain a leading position in the ownership of subsea cables, and along with Japanese and French firms continue to supply the equipment for most projects. Cables were traditionally owned by a consortium of telecom firms, but this model has seen its share diminish with the influx of cables owned by content providers (the hyperscalers). Unlike other digital technologies, the supply chain for the raw materials that make up the cables is not dependent on China.10 Global cooperation takes place through formats like the UN’s International Telecommunications Union and multistakeholder arrangements like the International Cable Protection Committee. The United Nations Convention on the Law of the Sea (UNCLOS) provides an important legal framework for ocean policy and undersea cables, including cable protection zones and a dispute resolution framework. The US, however, has failed to ratify UNCLOS for decades and even in the case of US ratification, credible enforcement would be difficult.11 Geopolitics and rising concerns about China have upended the world of subsea cables. Digital infrastructure, and undersea cables in particular, fit into a wider strategy for the US and are a key element of “outcompeting” China. This is leading to what has been dubbed a “subsea cold war”.12 Concerns are multifaceted and overlapping, including the physical security of infrastructure, espionage, economic competitiveness and support for domestic firms, fears of technology leakage and geopolitical competition. In promoting the view that “the digital backbones of the modern economy must be open, trusted, interoperable, reliable, and secure”,13 US strategy is highly focused on countering China’s “digital silk road”. Digital infrastructure is critical, but also a potential vector for insecurity and subject to disruptions, both accidental and deliberate. But attribution and assessing conflicting motivations among potential adversaries can be difficult. There is still significant uncertainty around cyberthreats and subsea cables, with limited publicly available information or attribution. The majority of cable faults – around a hundred per year – are attributable to accidental errors, such as damage from fishing vessels, or geologic incidents.14 But the risk and fear of state-directed cyber attacks or physical sabotage is rising. Many examples remain hypothetical; and concrete details or attribution are classified or unknown. One of the few known events, a 2022 cyber-attack in Hawaii that the Department of Homeland Security claimed to have foiled, was merely attributed to an “international hacking group”.15 Chinese ships have been accused of damaging cables in the Taiwan straits as part of a pressure campaign on the island.16 The US is particularly concerned about potential for espionage from adversaries like China and Russia. Tapping into and filtering the enormous quantities of information on subsea cables is extremely difficult, especially at great depths, and only a few countries likely have such capabilities. Landing stations where cables come ashore, however, have been identified as potential vulnerabilities, where lax security could allow for monitoring or tapping of the cables. The US can illustrate its concerns about growing control of infrastructure by adversaries by pointing to cases like the Federated States of Micronesia, where China pressured the government to grant it control of cables and telecom infrastructure via a Memorandum of Understanding.17 The point here is that Chinese infrastructure investments through the digital silk road will lead to de-facto control and facilitate espionage. Cost-reduction measures by cable owners have also led to increased deployment of remote network management systems, which introduce new vulnerabilities to hacking or sabotage since they are connected to the internet.18 The US has responded to these concerns with legislation like the Secure and Trusted Communications Networks Act of 2019, which charged the Federal Communications Commission with carrying out the complex rip-and-replace process for Huawei-made infrastructure domestically.19 The US has also expressed concerns about Europe’s reliance on 5G infrastructure from Huawei.20 The National Security Strategy released in October 2022 warns that autocratic governments “leverage access to their markets and control of global digital infrastructure for coercive purposes” and cites China as a source of “untrusted digital infrastructure”.21 The US has also acted to ensure continued market dominance by US and allied firms. Between 2015 and 2019, Chinese investments through the digital silk road led to control by Huawei Marine (which became HMN Tech in 2019) of about 15 per cent of the global market.22 Sanctions were placed on HMN Tech in 2021, citing its “intention to acquire American technology to help modernize China’s People’s Liberation Army”.23 This issue also predates the current Biden Administration. In addition to sanctions placed on Huawei, President Trump’s “Executive Order on Establishing the Committee for the Assessment of Foreign Participation in the United States Telecommunications Services Sector” provided structure to an interagency team known as “Team Telecom” charged with reviewing foreign investment in telecom and broadcast firms.24 Run by the Department of Justice’s National Security Division, it makes licensing recommendations to the Federal Communications Commission with the goal of ensuring that no cable directly connects the US and the Chinese mainland or Hong Kong.25 The US Congress has also been somewhat vocal on the issue. For example, the Undersea Cable Control Act passed the House in March 2023.26 Recent years have therefore seen significant shifts in undersea cable investment, with many new cables rerouted to avoid China and the South China Sea.27 While warnings of an undersea splinternet may be exaggerated, the sector is nevertheless seeing important shifts in investment, particularly for transpacific cables. From 2016 to 2020, 75 per cent of cables included at least one Chinese owner. Projections for 2021–2025 plummet to 0 per cent (see Figure 2). Significant reductions are apparent in other Asia connections as well. The US government has also intervened in cases of Chinese involvement in infrastructure projects and exerted pressure which has led to cancellation of cable initiatives or contracts if awarded to Chinese firms. For example, a 2018 proposed consortium led by Amazon, Meta and China Mobile met with opposition from Washington. US security concerns remained even following China Mobile’s departure, and the project was shelved despite much of the cable having already been laid.28 The 600 million US dollar SeaWeMe-6 cable connecting Singapore to France was awarded to the US’s SubCom over HMN Tech following diplomatic pressure and incentives like training grants to local telecom firms from the US Trade and Development Agency.29 At the same time, this pressure, along with sanctions, has influenced cable-building endeavours that do not include US investors or connect geographically to the US.30 Such events illustrate the strategic competitive and economic interests at stake, as technology becomes a key site of geopolitical competition. In order to counter China, the United States is working to build a network of partnerships on digital infrastructure. The US CABLES programme provides capacity building and technical assistance to members of the Quad alliance in the Indo-Pacific.31 The Partnership for Global Infrastructure and Investment (PGII) through the G7 aims to offer an alternative to China’s Belt and Road Investments,32 and included cables as part of a recent PGII announcement on the sidelines of the G20.33 The US also launched the Trilateral Partnership for Infrastructure Investment with Australia and Japan in 2018.34 The NATO undersea infrastructure coordination cell, launched in 2023, coordinates between military, civilian and industry interests in subsea infrastructure to increase security.35 The State Department’s 2020 Clean Network Initiative, whose scope extends beyond subsea cables, created a set of shared principles and practices for countries and companies with the goal of blocking Chinese market dominance.36","System instruction: You can only respond to the prompt using the information in the context block and no other sources. Give your answer in bullet points and follow each one with an explanation. Question: In simple terms, what are key components of US strategic goals related to subsea cables? Context block: Transatlantic Tech Bridge: Digital Infrastructure and Subsea Cables, a US Perspective 1. US strategic interests in digital infrastructure and its industrial policy The United States’ overarching strategic goal is an open, secure, interoperable and global internet, one where US digital leaders can compete (and win). This requires trusted digital infrastructure. US investment in digital infrastructure reveals both domestic and international priorities. The 2021 Bipartisan Infrastructure Bill provides 65 billion US dollars for high-speed internet deployment.6 Its focus is on providing connectivity for low-income households through the Affordable Connectivity Program and reaching underserved rural, agricultural and tribal areas.7 The “Internet for All” initiative manages grants for infrastructure and training.8 In the international development space, digital infrastructure is one of three pillars of USAID’s digital strategy and its digital ecosystem framework.9 US firms retain a leading position in the ownership of subsea cables, and along with Japanese and French firms continue to supply the equipment for most projects. Cables were traditionally owned by a consortium of telecom firms, but this model has seen its share diminish with the influx of cables owned by content providers (the hyperscalers). Unlike other digital technologies, the supply chain for the raw materials that make up the cables is not dependent on China.10 Global cooperation takes place through formats like the UN’s International Telecommunications Union and multistakeholder arrangements like the International Cable Protection Committee. The United Nations Convention on the Law of the Sea (UNCLOS) provides an important legal framework for ocean policy and undersea cables, including cable protection zones and a dispute resolution framework. The US, however, has failed to ratify UNCLOS for decades and even in the case of US ratification, credible enforcement would be difficult.11 Geopolitics and rising concerns about China have upended the world of subsea cables. Digital infrastructure, and undersea cables in particular, fit into a wider strategy for the US and are a key element of “outcompeting” China. This is leading to what has been dubbed a “subsea cold war”.12 Concerns are multifaceted and overlapping, including the physical security of infrastructure, espionage, economic competitiveness and support for domestic firms, fears of technology leakage and geopolitical competition. In promoting the view that “the digital backbones of the modern economy must be open, trusted, interoperable, reliable, and secure”,13 US strategy is highly focused on countering China’s “digital silk road”. Digital infrastructure is critical, but also a potential vector for insecurity and subject to disruptions, both accidental and deliberate. But attribution and assessing conflicting motivations among potential adversaries can be difficult. There is still significant uncertainty around cyberthreats and subsea cables, with limited publicly available information or attribution. The majority of cable faults – around a hundred per year – are attributable to accidental errors, such as damage from fishing vessels, or geologic incidents.14 But the risk and fear of state-directed cyber attacks or physical sabotage is rising. Many examples remain hypothetical; and concrete details or attribution are classified or unknown. One of the few known events, a 2022 cyber-attack in Hawaii that the Department of Homeland Security claimed to have foiled, was merely attributed to an “international hacking group”.15 Chinese ships have been accused of damaging cables in the Taiwan straits as part of a pressure campaign on the island.16 The US is particularly concerned about potential for espionage from adversaries like China and Russia. Tapping into and filtering the enormous quantities of information on subsea cables is extremely difficult, especially at great depths, and only a few countries likely have such capabilities. Landing stations where cables come ashore, however, have been identified as potential vulnerabilities, where lax security could allow for monitoring or tapping of the cables. The US can illustrate its concerns about growing control of infrastructure by adversaries by pointing to cases like the Federated States of Micronesia, where China pressured the government to grant it control of cables and telecom infrastructure via a Memorandum of Understanding.17 The point here is that Chinese infrastructure investments through the digital silk road will lead to de-facto control and facilitate espionage. Cost-reduction measures by cable owners have also led to increased deployment of remote network management systems, which introduce new vulnerabilities to hacking or sabotage since they are connected to the internet.18 The US has responded to these concerns with legislation like the Secure and Trusted Communications Networks Act of 2019, which charged the Federal Communications Commission with carrying out the complex rip-and-replace process for Huawei-made infrastructure domestically.19 The US has also expressed concerns about Europe’s reliance on 5G infrastructure from Huawei.20 The National Security Strategy released in October 2022 warns that autocratic governments “leverage access to their markets and control of global digital infrastructure for coercive purposes” and cites China as a source of “untrusted digital infrastructure”.21 The US has also acted to ensure continued market dominance by US and allied firms. Between 2015 and 2019, Chinese investments through the digital silk road led to control by Huawei Marine (which became HMN Tech in 2019) of about 15 per cent of the global market.22 Sanctions were placed on HMN Tech in 2021, citing its “intention to acquire American technology to help modernize China’s People’s Liberation Army”.23 This issue also predates the current Biden Administration. In addition to sanctions placed on Huawei, President Trump’s “Executive Order on Establishing the Committee for the Assessment of Foreign Participation in the United States Telecommunications Services Sector” provided structure to an interagency team known as “Team Telecom” charged with reviewing foreign investment in telecom and broadcast firms.24 Run by the Department of Justice’s National Security Division, it makes licensing recommendations to the Federal Communications Commission with the goal of ensuring that no cable directly connects the US and the Chinese mainland or Hong Kong.25 The US Congress has also been somewhat vocal on the issue. For example, the Undersea Cable Control Act passed the House in March 2023.26 Recent years have therefore seen significant shifts in undersea cable investment, with many new cables rerouted to avoid China and the South China Sea.27 While warnings of an undersea splinternet may be exaggerated, the sector is nevertheless seeing important shifts in investment, particularly for transpacific cables. From 2016 to 2020, 75 per cent of cables included at least one Chinese owner. Projections for 2021–2025 plummet to 0 per cent (see Figure 2). Significant reductions are apparent in other Asia connections as well. The US government has also intervened in cases of Chinese involvement in infrastructure projects and exerted pressure which has led to cancellation of cable initiatives or contracts if awarded to Chinese firms. For example, a 2018 proposed consortium led by Amazon, Meta and China Mobile met with opposition from Washington. US security concerns remained even following China Mobile’s departure, and the project was shelved despite much of the cable having already been laid.28 The 600 million US dollar SeaWeMe-6 cable connecting Singapore to France was awarded to the US’s SubCom over HMN Tech following diplomatic pressure and incentives like training grants to local telecom firms from the US Trade and Development Agency.29 At the same time, this pressure, along with sanctions, has influenced cable-building endeavours that do not include US investors or connect geographically to the US.30 Such events illustrate the strategic competitive and economic interests at stake, as technology becomes a key site of geopolitical competition. In order to counter China, the United States is working to build a network of partnerships on digital infrastructure. The US CABLES programme provides capacity building and technical assistance to members of the Quad alliance in the Indo-Pacific.31 The Partnership for Global Infrastructure and Investment (PGII) through the G7 aims to offer an alternative to China’s Belt and Road Investments,32 and included cables as part of a recent PGII announcement on the sidelines of the G20.33 The US also launched the Trilateral Partnership for Infrastructure Investment with Australia and Japan in 2018.34 The NATO undersea infrastructure coordination cell, launched in 2023, coordinates between military, civilian and industry interests in subsea infrastructure to increase security.35 The State Department’s 2020 Clean Network Initiative, whose scope extends beyond subsea cables, created a set of shared principles and practices for countries and companies with the goal of blocking Chinese market dominance.36 ",Internet/Technology,Summarize & Simplify,Text Transformation You may only use information contained within the provided content block.,What benefits do nasal cannula have over non-rebreathe masks?,"Oxygen is a drug with a correct dosage When administered correctly may be life saving. Aim is to achieve adequate tissue oxygenation (without causing a significant decrease in ventilation and consequent hypercapnia or oxygen toxicity) Need to treat • Tissue hypoxia is difficult to recognize as clinical features are nonspecific –include dyspnoea cyanosis, tachypnoea, arrhythmias, altered mental state, coma. • Treatment of tissue hypoxia should correct any arterial hypoxemia (Cardiopulmonary defect/shunt e.g.-asthma, pneumonia, PE), any transport deficit (anaemia, low cardiac output), and underlying causes. • SaO2/PaO2 can be normal when tissue hypoxia is caused by low cardiac output states. Oxygen administration Equipment The method of delivery will depend on the type and severity of respiratory failure, breathing pattern, respiratory rate, risk of CO2 retention, need for humidification and patient compliance. Each oxygen delivery device comprises • An oxygen supply(>4L/min) • Flow rate 07.Oxygen administration 20 Hand book of Basic Medical Procedure Dr.M.Umakanth • Tubing • Interface + humidification 1) Nasal cannula These direct oxygen via 2 short prongs up the nasal passage They: • Can be used for long periods of time. • Prevent rebreathing. • Can be used during eating and talking. 2) Low flow oxygen masks These deliver oxygen concentrations that vary depending on the patient’s minute volume. Some rebreathing of exhaled gases. 3) Fixed performance masks These deliver constant concentration of oxygen independent of the patient’s minute volume. The masks contain ‘venturi’ barrels where relatively low rates of oxygen are forced through a narrow orifice producing a greater flow rate. 4) Partial and non-rebreathe masks This mask have a ‘reservoir’ bag that is filled with pure oxygen and depend on a system of valves which prevent mixing of exhaled gases with the incoming oxygen. Dr.M.Umakanth Hand book of Basic Medical Procedure 21 5) High flow Oxygen Masks or nasal prongs that generate flows of 50-120ml/ min using a high flow regulator to entrain air and oxygen at specific concentrations. It should always be used with humidification. Procedure • Introduce yourself, confirm patient’s identity, explain the condition, Obtain Verbal consent. • Choose an appropriate oxygen delivery device • Choose an initial dose… o Cardiac or respiratory arrest:100%. o Hypoxaemia with PaCO2 <5.3kPa:40-60%. o Hypoxaemia with PaCO2 >5.3kPa:24% initially. • Decide on the acceptable level of SaO2 or PaO2 and titrate oxygen accordingly. • If possible, try to measure a PaO2 in room air prior to giving supplementary oxygen. • Liaise with nursing staff, physiotherapist or outreach for support in setting up equipment. • Apply the oxygen and monitor via oxymetry(SaO2) and/or repeat ABG(PaO2) in 30 minutes. • If hypoxemia continue, then the patient may require respiratory support either invasively or non-invasivelyliaise with your seniors and/or the respiratory doctors. • Stop supplementary oxygen when tissue hypoxia or arterial hypoxaemia has resolved. 22 Hand book of Basic Medical Procedure Dr.M.Umakanth Equipment Required • NG tube • Disposable gloves • Lubricant gel • Cup of water • 50ml Syringe • Drainage bag (If necessary) • Adhesive tape • Paper towel • Plastic apron. Indication • Feeding (Ryle’s tube) • Patients who have an increased risk of aspiration • Decompression of stomach during bowel obstruction • Gastric larvage Contraindication • Severe Facial trauma • Basal skull fracture • Suspected oesophageal perforation • Grossly abnormal nasal anatomy Procedure • Introduce yourself, confirm patient’s identity, explain the procedure, and obtain verbal consent • Wash hands thoroughly, put on gloves and plastic apron. 08.Nasogastric(NG) tube Insertion Dr.M.Umakanth Hand book of Basic Medical Procedure 23 • Sit the patient up, slightly extending the neck. • Examine patient’s nose for deformity. • Use the tube to measure the length from the nares to the stomach, (Xiphisternum-earlobe-tip of nose) and note the distance. • Lubricate the tip(4-8cm) of the tube, avoiding blocking the lumen. • Insert into the nostril and advance directly posteriorly • Whilst advancing, ask the patient to take sip of water and hold it in their mouth. • Request the patient to swallow and, as the patient swallows, advance the tube down oesophagus. • Continue to advance the tube until 10-20cm beyond pre-measured distance to stomach (60-70cm total). • To confirm correct place ment o Aspirate some gastric contents with syringe and check fluid’s acidic pH(with litmus paper) confirmatory o If unsure, obtain a chest X-ray(CXR) with a view of the stomach. o Although commonly done on wards, injecting 5-10ml air into the tube whilst auscultating for babbling with stethoscope placed over stomach. • Remove guidewire if present • Either Place cap into the end of NG tube or attach a drainage bag. • Secure the tube in place by taping to nose. o 24 Hand book of Basic Medical Procedure Dr.M.Umakanth Complication • Discomfort, pain, gagging • Bleeding (at any site, but particularly nose) • Failure to correctly place tube e.g. Placement in trachea or bronchi • Perforation of esophagus and stomach • Electrolyte imbalance if rapid decompression of stomach. • Esophagitis • Nasal or retropharyngeal necrosis","You may only use information contained within the provided content block. Question: What benefits do nasal cannula have over non-rebreathe masks? Oxygen is a drug with a correct dosage When administered correctly may be life saving. Aim is to achieve adequate tissue oxygenation (without causing a significant decrease in ventilation and consequent hypercapnia or oxygen toxicity) Need to treat • Tissue hypoxia is difficult to recognize as clinical features are nonspecific –include dyspnoea cyanosis, tachypnoea, arrhythmias, altered mental state, coma. • Treatment of tissue hypoxia should correct any arterial hypoxemia (Cardiopulmonary defect/shunt e.g.-asthma, pneumonia, PE), any transport deficit (anaemia, low cardiac output), and underlying causes. • SaO2/PaO2 can be normal when tissue hypoxia is caused by low cardiac output states. Oxygen administration Equipment The method of delivery will depend on the type and severity of respiratory failure, breathing pattern, respiratory rate, risk of CO2 retention, need for humidification and patient compliance. Each oxygen delivery device comprises • An oxygen supply(>4L/min) • Flow rate 07.Oxygen administration 20 Hand book of Basic Medical Procedure Dr.M.Umakanth • Tubing • Interface + humidification 1) Nasal cannula These direct oxygen via 2 short prongs up the nasal passage They: • Can be used for long periods of time. • Prevent rebreathing. • Can be used during eating and talking. 2) Low flow oxygen masks These deliver oxygen concentrations that vary depending on the patient’s minute volume. Some rebreathing of exhaled gases. 3) Fixed performance masks These deliver constant concentration of oxygen independent of the patient’s minute volume. The masks contain ‘venturi’ barrels where relatively low rates of oxygen are forced through a narrow orifice producing a greater flow rate. 4) Partial and non-rebreathe masks This mask have a ‘reservoir’ bag that is filled with pure oxygen and depend on a system of valves which prevent mixing of exhaled gases with the incoming oxygen. Dr.M.Umakanth Hand book of Basic Medical Procedure 21 5) High flow Oxygen Masks or nasal prongs that generate flows of 50-120ml/ min using a high flow regulator to entrain air and oxygen at specific concentrations. It should always be used with humidification. Procedure • Introduce yourself, confirm patient’s identity, explain the condition, Obtain Verbal consent. • Choose an appropriate oxygen delivery device • Choose an initial dose… o Cardiac or respiratory arrest:100%. o Hypoxaemia with PaCO2 <5.3kPa:40-60%. o Hypoxaemia with PaCO2 >5.3kPa:24% initially. • Decide on the acceptable level of SaO2 or PaO2 and titrate oxygen accordingly. • If possible, try to measure a PaO2 in room air prior to giving supplementary oxygen. • Liaise with nursing staff, physiotherapist or outreach for support in setting up equipment. • Apply the oxygen and monitor via oxymetry(SaO2) and/or repeat ABG(PaO2) in 30 minutes. • If hypoxemia continue, then the patient may require respiratory support either invasively or non-invasivelyliaise with your seniors and/or the respiratory doctors. • Stop supplementary oxygen when tissue hypoxia or arterial hypoxaemia has resolved. 22 Hand book of Basic Medical Procedure Dr.M.Umakanth Equipment Required • NG tube • Disposable gloves • Lubricant gel • Cup of water • 50ml Syringe • Drainage bag (If necessary) • Adhesive tape • Paper towel • Plastic apron. Indication • Feeding (Ryle’s tube) • Patients who have an increased risk of aspiration • Decompression of stomach during bowel obstruction • Gastric larvage Contraindication • Severe Facial trauma • Basal skull fracture • Suspected oesophageal perforation • Grossly abnormal nasal anatomy Procedure • Introduce yourself, confirm patient’s identity, explain the procedure, and obtain verbal consent • Wash hands thoroughly, put on gloves and plastic apron. 08.Nasogastric(NG) tube Insertion Dr.M.Umakanth Hand book of Basic Medical Procedure 23 • Sit the patient up, slightly extending the neck. • Examine patient’s nose for deformity. • Use the tube to measure the length from the nares to the stomach, (Xiphisternum-earlobe-tip of nose) and note the distance. • Lubricate the tip(4-8cm) of the tube, avoiding blocking the lumen. • Insert into the nostril and advance directly posteriorly • Whilst advancing, ask the patient to take sip of water and hold it in their mouth. • Request the patient to swallow and, as the patient swallows, advance the tube down oesophagus. • Continue to advance the tube until 10-20cm beyond pre-measured distance to stomach (60-70cm total). • To confirm correct place ment o Aspirate some gastric contents with syringe and check fluid’s acidic pH(with litmus paper) confirmatory o If unsure, obtain a chest X-ray(CXR) with a view of the stomach. o Although commonly done on wards, injecting 5-10ml air into the tube whilst auscultating for babbling with stethoscope placed over stomach. • Remove guidewire if present • Either Place cap into the end of NG tube or attach a drainage bag. • Secure the tube in place by taping to nose. o 24 Hand book of Basic Medical Procedure Dr.M.Umakanth Complication • Discomfort, pain, gagging • Bleeding (at any site, but particularly nose) • Failure to correctly place tube e.g. Placement in trachea or bronchi • Perforation of esophagus and stomach • Electrolyte imbalance if rapid decompression of stomach. • Esophagitis • Nasal or retropharyngeal necrosis ",Retail/Product,Fact Finding,Q&A System Instructions: Only use the provided text. Do not use any outside sources. Do not use any prior knowledge.,Question: What is the Ghon's complex?,"Context: Tuberculosis (TB), which is a curable and preventable disease, is the second most common infectious cause of mortality after coronavirus disease 2019 (COVID-19). It affects close to 10 million people per year[1].Despite the diagnosis of TB often being a diagnostic dilemma in kidney disease patients, kidney transplant candidates (KTC) and kidney transplant recipients (KTR) have a 3.62- and 11.35 times higher risk of developing TB, respectively, compared to the general population[2]. They also have a higher rate of mortality due to TB. Treatment of TB also poses unique challenges in these patients due to renal dose modifications, drug interactions, and nephrotoxicity of anti-tubercular agents.EPIDEMIOLOGYIncidence of TB in dialysis patients and transplant candidatesThe incidence of TB in patients with chronic kidney disease (CKD) ranges between 60-19, 270 per 100000 population in various countries (highest incidence in the African region and lowest in the Americas), the pooled incidence being 3718 per 100000[3]. In general, extrapulmonary TB is more common than pulmonary TB in this population[2,3]. Amongst patients with CKD, those on dialysis, who are conventionally considered transplant candidates, are at a higher risk of developing TB as compared to earlier stages of CKD. Patients on hemodialysis have a higher incidence than those on peritoneal dialysis (5611/100000 vs 3533/100000 respectively)[3].Incidence of TB in KTRTB incidence is said to be 7-27 times higher than the general population in solid organ transplant recipients[4]. KTR have a 4.59 times higher risk of developing TB compared to the general population[5]. The incidence of TB in KTR was 2700/100000 population in a pooled systemic analysis[3] from across the world with a range of 340-14680/100000[6,7].NATURAL HISTORY OF TB IN TRANSPLANT CANDIDATES AND RECIPIENTSMycobacterium tuberculosis acquisitionThe primary transmission route of Mycobacterium tuberculosis (M. tuberculosis) is through aerosols, with the lungs being the primary site of host-pathogen interaction. The innate immune system tends to clear the M. tuberculosis bacilli immediately through phagocytosis. However, there is a possibility of the following four distinct outcomes because of complex host-pathogen interplay[8]: (1) Immediate clearance of bacilli; (2) Chronic or latent infection; (3) Rapidly progressive TB; or (4) Reactivation after a prolonged period.Granuloma formationIf the bacilli are not removed immediately, granulomas are formed, where inflammatory cells and cytokines come together and generate a localized response, known as the ""Ghon's complex"". It includes organ parenchymal involvement along with regional adenopathy. Effective cell-mediated immunity usually develops in 4-6 weeks and halts further infection progression[8].Progression and disseminationWhen the host cannot produce a sufficient cell-mediated immune response, the infection spreads and destroys the tissue. Arterial erosion promotes hematogenous spread, which results in disseminated TB that eventually affects multiple organs.Reactivation and immunosuppressed statesIn immunocompromised states, there may be a reactivation of M. tuberculosis CKD, specifically kidney failure, is one such condition where reactivation of previous infection is the most common cause of TB. Earlier, this reactivation was typically limited to a single organ, the most common site being the upper lobe of the lung[8]. However, now extrapulmonary TB is seen to be more common in these patients. Extrapulmonary involvement can affect various other organs and appear with a myriad of clinical symptoms. Almost every organ being involved has been described, including the musculoskeletal system, gastrointestinal tract, liver, skin, orbit, genitourinary tract, lymph nodes, pericardium, larynx, kidneys, and adrenal glands[8,9]. Prasad P et al. TB in kidney transplantationWJT https://www.wjgnet.com 3September 18, 2024 Volume 14 Issue 3Natural history in transplant recipientsBecause of the immunosuppression, the natural history of TB infection is more complex in transplant patients. In developing countries, reactivation from previously acquired infections is more common than re-infection[8,9]. With a median time of onset of 9 months, most active TB cases are recognized during the first year post-transplantation[10-13]. Also, although pulmonary TB is the most common presentation in KTR, they are more likely to develop extrapulmonary TB compared to the general population[12,14,15].MODES OF TRANSMISSIONFor primary prevention, early diagnosis, and prompt treatment, understanding the various modes of transmission of TB is crucial. The various modes of transmission among transplant candidates and recipients are illustrated in Figure 1 and enlisted below[16,17]: (1) Airborne transmission: Aerosol transmission remains the predominant mechanism, particularly in enclosed and congested environments; (2) Reactivation from latent infection: In areas where TB is highly prevalent, reactivation of latent TB is a frequent mechanism of transmission; (3) Nosocomial transmission: The possibility of nosocomial transmission is a worry in healthcare environments. Strict infection control procedures are necessary in transplant units, where immunocompromised patients are concentrated, to stop TB from spreading among recipients; (4) Donor-derived transmission: Rarely, transmission can occur directly from the donor organ. Thorough screening of potential organ donors is essential to avoid unintentionally spreading TB during transplant procedures; and (5) Unusual routes of transmission: Environmental sources have been reported to host viable and infectious TB for long periods. These sources include soil, rivers, wastewater, fomites, dust, and even cadavers. There have been reports of TB transmission through topical wound site contamination, aerosolization during surgery, and intake of water tainted with sanatorium effluent. Also, the incidence of pediatric cases due to intestinal TB is showing an increasing trend, probably due to the ingestion of contaminated milk or sputum[16].Factors influencing transmissionThe probability that an individual with TB will transmit M. tuberculosis to others is determined by many factors, including the number and rate of infectious droplet production and virulence of the disease of the original host who transmits the infection[18]. Environmental factors include duration and extent of contact. Better air circulation and increased ultraviolet (UV) light exposure in the space of contact decrease the chances of transmission. Host factors include the type of induction and maintenance immunosuppression among transplant patients[18].","System Instructions: Only use the provided text. Do not use any outside sources. Do not use any prior knowledge. Question: What is the Ghon's complex? Context: Tuberculosis (TB), which is a curable and preventable disease, is the second most common infectious cause of mortality after coronavirus disease 2019 (COVID-19). It affects close to 10 million people per year[1].Despite the diagnosis of TB often being a diagnostic dilemma in kidney disease patients, kidney transplant candidates (KTC) and kidney transplant recipients (KTR) have a 3.62- and 11.35 times higher risk of developing TB, respectively, compared to the general population[2]. They also have a higher rate of mortality due to TB. Treatment of TB also poses unique challenges in these patients due to renal dose modifications, drug interactions, and nephrotoxicity of anti-tubercular agents.EPIDEMIOLOGYIncidence of TB in dialysis patients and transplant candidatesThe incidence of TB in patients with chronic kidney disease (CKD) ranges between 60-19, 270 per 100000 population in various countries (highest incidence in the African region and lowest in the Americas), the pooled incidence being 3718 per 100000[3]. In general, extrapulmonary TB is more common than pulmonary TB in this population[2,3]. Amongst patients with CKD, those on dialysis, who are conventionally considered transplant candidates, are at a higher risk of developing TB as compared to earlier stages of CKD. Patients on hemodialysis have a higher incidence than those on peritoneal dialysis (5611/100000 vs 3533/100000 respectively)[3].Incidence of TB in KTRTB incidence is said to be 7-27 times higher than the general population in solid organ transplant recipients[4]. KTR have a 4.59 times higher risk of developing TB compared to the general population[5]. The incidence of TB in KTR was 2700/100000 population in a pooled systemic analysis[3] from across the world with a range of 340-14680/100000[6,7].NATURAL HISTORY OF TB IN TRANSPLANT CANDIDATES AND RECIPIENTSMycobacterium tuberculosis acquisitionThe primary transmission route of Mycobacterium tuberculosis (M. tuberculosis) is through aerosols, with the lungs being the primary site of host-pathogen interaction. The innate immune system tends to clear the M. tuberculosis bacilli immediately through phagocytosis. However, there is a possibility of the following four distinct outcomes because of complex host-pathogen interplay[8]: (1) Immediate clearance of bacilli; (2) Chronic or latent infection; (3) Rapidly progressive TB; or (4) Reactivation after a prolonged period.Granuloma formationIf the bacilli are not removed immediately, granulomas are formed, where inflammatory cells and cytokines come together and generate a localized response, known as the ""Ghon's complex"". It includes organ parenchymal involvement along with regional adenopathy. Effective cell-mediated immunity usually develops in 4-6 weeks and halts further infection progression[8].Progression and disseminationWhen the host cannot produce a sufficient cell-mediated immune response, the infection spreads and destroys the tissue. Arterial erosion promotes hematogenous spread, which results in disseminated TB that eventually affects multiple organs.Reactivation and immunosuppressed statesIn immunocompromised states, there may be a reactivation of M. tuberculosis CKD, specifically kidney failure, is one such condition where reactivation of previous infection is the most common cause of TB. Earlier, this reactivation was typically limited to a single organ, the most common site being the upper lobe of the lung[8]. However, now extrapulmonary TB is seen to be more common in these patients. Extrapulmonary involvement can affect various other organs and appear with a myriad of clinical symptoms. Almost every organ being involved has been described, including the musculoskeletal system, gastrointestinal tract, liver, skin, orbit, genitourinary tract, lymph nodes, pericardium, larynx, kidneys, and adrenal glands[8,9]. Prasad P et al. TB in kidney transplantationWJT https://www.wjgnet.com 3September 18, 2024 Volume 14 Issue 3Natural history in transplant recipientsBecause of the immunosuppression, the natural history of TB infection is more complex in transplant patients. In developing countries, reactivation from previously acquired infections is more common than re-infection[8,9]. With a median time of onset of 9 months, most active TB cases are recognized during the first year post-transplantation[10-13]. Also, although pulmonary TB is the most common presentation in KTR, they are more likely to develop extrapulmonary TB compared to the general population[12,14,15].MODES OF TRANSMISSIONFor primary prevention, early diagnosis, and prompt treatment, understanding the various modes of transmission of TB is crucial. The various modes of transmission among transplant candidates and recipients are illustrated in Figure 1 and enlisted below[16,17]: (1) Airborne transmission: Aerosol transmission remains the predominant mechanism, particularly in enclosed and congested environments; (2) Reactivation from latent infection: In areas where TB is highly prevalent, reactivation of latent TB is a frequent mechanism of transmission; (3) Nosocomial transmission: The possibility of nosocomial transmission is a worry in healthcare environments. Strict infection control procedures are necessary in transplant units, where immunocompromised patients are concentrated, to stop TB from spreading among recipients; (4) Donor-derived transmission: Rarely, transmission can occur directly from the donor organ. Thorough screening of potential organ donors is essential to avoid unintentionally spreading TB during transplant procedures; and (5) Unusual routes of transmission: Environmental sources have been reported to host viable and infectious TB for long periods. These sources include soil, rivers, wastewater, fomites, dust, and even cadavers. There have been reports of TB transmission through topical wound site contamination, aerosolization during surgery, and intake of water tainted with sanatorium effluent. Also, the incidence of pediatric cases due to intestinal TB is showing an increasing trend, probably due to the ingestion of contaminated milk or sputum[16].Factors influencing transmissionThe probability that an individual with TB will transmit M. tuberculosis to others is determined by many factors, including the number and rate of infectious droplet production and virulence of the disease of the original host who transmits the infection[18]. Environmental factors include duration and extent of contact. Better air circulation and increased ultraviolet (UV) light exposure in the space of contact decrease the chances of transmission. Host factors include the type of induction and maintenance immunosuppression among transplant patients[18].",Medical,Explanation/Definition,Q&A "Response must use only information contained in the context block to answer the question. Model should not rely on its own knowledge or outside sources of information when responding.",What are the consequences of using your credit card to get cash instead of just making regular purchases?,"First Timer’s Guide: Credit Cards Used the right way, your credit card can be your new financial BFF. HonestMoney.ca Like most things, with great power comes great responsibility. And credit cards are no different. Used the right way, they can be your new financial BFF. But before you tap, swipe, and charge your way into a bold new financial future, it’s important to have a handle on the basics to avoid some of the downsides of living that plastic life. First things first: What is a credit card? In the most basic sense, a credit card is a piece of plastic that allows you to pay for things with borrowed money. It’s an agreement between you and a financial institution where you can opt to pay on credit rather than with actual money. In practice, it’s a little more involved than that. Your credit card comes with a limit—that is the amount of money you have to borrow against. And those charges? You’re going to pay interest on them if you carry a balance. But we’re getting ahead of ourselves. Before you get swiping, make sure you know why. And how, so you can do it responsibly. Why you should have a credit card? There are lots of reasons why having a credit card can make you into a financial super hero: TO BUILD CREDIT Somewhere down the line, you will need a credit history. And a credit card—when used correctly—is one of the easiest way to build credit. When the time comes to take out a car loan or get a mortgage, your financial institution will refer back to your credit history to see how reliable you are with borrowing money. So even if a credit card seems unnecessary, making frequent purchases with it and immediately paying it off will help you build a positive credit history, which will pay off in the future. FLIGHTS, RENTALS, HOTELS, AND ONLINE SHOPPING If you want to get on planes, trains, or automobiles, or to purchase the latest bobble from your favourite online retailer, you’re going to need a credit card. Ditto for booking a room in a hotel, booking concert tickets, and more. HonestMoney.ca REWARDS A lot of cards actually reward you for using them with things like cash back, travel points, or exclusive offers like concert tickets. As long as you’re managing your balance wisely, using your credit card frequently can help you treat yourself later. EMERGENCIES Hopefully it never happens, but every once and while we all get stuck in emergencies where we just don’t have cash on hand. And although you should never put something on your credit card if you don’t have the money to pay for it, your card might help you get out of a tough situation in the very short term – or at least until you can take stock of your situation and sit down with your financial expert to come up with a longer term plan. How to choose a card that’s right for you Now that you’ve decided to get a credit card, you have to ask yourself—which one should I apply for? Types of credit cards No or Low Annual Fee Cards: These cards offer the convenience of having a credit card in your wallet without a high annual fee. Most low or no annual fee cards offer basic rewards but may not accumulate perks as quickly as a fee-based card. Low Interest Rate Cards: Many cards have interest rates upwards of 19.5%, but there are cards available with lower interest rates in exchange for a low annual fee. These cards often don’t accumulate rewards quickly, but if you find yourself carrying a balance on your card month over month, this can be a smart choice. Cash Back Cards: Not all card rewards come in the form of points. For every purchase you make, cash back cards offer a percentage back in cash credited to your statement at a set time. Rewards Cards: For every purchase you make on your card, you’ll accumulate a set number of rewards points. Points can be redeemed for all sorts of different things, ranging from the latest gadgets and gift cards, to concert tickets and experiences. HonestMoney.ca Student Cards: You guessed it! These cards are specifically meant for students who are just starting to build their credit. These often come with low or no fees and offer basic rewards. Travel Rewards Cards: Similar to a rewards card, but focused on travel. Travel rewards cards feature points that can be redeemed for flights, hotels, and car rentals and often include insurance coverage for things like out-of-country medical, lost luggage, or changes to travel plans. US Dollar Cards: These cards allow you to make purchases directly in US dollars. It’s a good idea to be honest with yourself about how you plan to use your card and what’s really important to you. For instance, if you’re keeping your card in case of emergencies only, a low or no annual fee card might make the most sense. If you find yourself traveling often, the protections and perks that come with a travel rewards card might provide you with the best value. Once you have a better sense of your needs and habits, take the time to go online and do a little bit of research. Check out and compare different cards. Look at the features and benefits and what you need to apply. Some cards have a minimum income threshold to qualify or are designed specifically for students, so make sure you know what you’re getting yourself into. HonestMoney.ca Applying for your card Just because you want a credit card, doesn’t mean you can always get a credit card. Like any kind of credit, there is an application process to complete before you can start spending. 1. Go online (financial institution) or in branch. 2. Fill out an application; pay stubs, Social Insurance Number, ID, employment & income verification; other important info. 3. (If approved) activate your card! How to manage your card So, you have your credit card. Now what? While using your card is pretty straight forward, there are a couple of important things to know about managing your card. First, not every purchase on a credit card is created equal. While most of us tend to think of credit card purchases as tapping or swiping your card in a store or inputting your information online, you can also use your credit card to get cash or to make cash-like transactions. This is called a cash advance. Taking a cash advance might sound like a good idea, but this can be a costly way to access cash in the long run. Cash advances often charge a small fee to initiate and almost always charge a higher rate of interest than regular purchases. The other thing to keep in mind is how interest accumulates. With regular purchases, you have a grace period (usually 21 days or more) before interest begins to accumulate on the money you owe. When you take a cash advance, interest starts to accumulate right away and will continue to accrue until the whole amount of the advance is paid off in full. Don’t apply for every offer: Each time you apply for a credit card there will be an inquiry made on your credit history. Lots of inquiries over a short period of time can impact your credit score and lots of open, available cards can hurt your chances to qualify for more credit in the future. HonestMoney.ca You can also expect to get a monthly statement whether you use your card or not. Statements provide a detailed snapshot for a set period of time and outline your purchases, how much you owe, the minimum payment due, and when you need to make a payment. Statements are monthly, but may not run from the first day of the month to the last. When you get your statement, be sure to review it carefully. If something doesn’t make sense on your statement, or if there is something you don’t recognize, don’t be afraid to speak up and ask your card provider for more details. Credit card Dos and Don’ts DO DON’T • Pay off your full balance each month, if possible • Buy things you can easily pay for • Stay at around 50% of your credit limit • Check your balance on a regular basis • Become familiar with your grace periods and when interest kicks in • Make your payments on time • Take advantage of rewards programs • Just make the minimum payment required each month • Pay for things you can’t afford • Regularly run your balance close to your limit • Ignore your balance and transactions • Pay late or forget to make your payments altogether • Don’t make purchases just to gain rewards Be aware of your terms and conditions: If an offer seems too good to be true, it probably is. And the same goes for credit cards. Be cautious when it comes to 0% offers in exchange for making a big purchase and be sure that you understand the terms and conditions before signing up. Zero interest doesn’t last forever and some credit cards can charge very high interest rates once their introductory offers have expired. HonestMoney.ca Interest Every credit card has an interest rate. When you make a purchase with your credit card, your grace period for that transaction starts. This means that you have around 21-25 days (each credit card provider is different) to pay off that transaction before interest charges kick in. If you keep an unpaid balance on your credit card, interest will keep adding up month by month. But if you pay off the full balance on time, you’ll never have to pay interest! And remember, only making the minimum payment required each month still means you get charged interest on the full balance. % *Assumption: Based on an APR of 19.9%. This does not take into account minimum payments. INITIAL BALANCE $1,000* How your credit card accrues interest. Balance owing after 2 years $1,491.36 Balance owing after 3 years $1,821.27 Balance owing after 1 year $1,221.21 HonestMoney.ca Keeping your credit card info safe Credit cards have a lot of great security features, but knowing how to protect your card information is probably the biggest thing you can do to keep yourself from fraud. Here are a few easy tips that can help. Be aware of email phishing or fraudulent phone calls: Scammers will often try to create a sense of panic, trying to persuade you to give out your information. Don’t do it! Never give you credit card info over the phone or in an email: Your credit card provider or financial institution will never call you and ask for your credit card info over the phone/email. Cancel your card immediately if you ever lose it: Fraudulent transactions can be refunded if you report the card missing before they happen. Don’t write down your credit card information to store it: Enough said! Review your transactions regularly and ask lots of questions: Regularly check your transactions and balance and don’t be afraid to ask your card provider questions if you don’t recognize something. HonestMoney.ca Glossary APR This is short for Annual Percentage Rate. APR is the rate charged to the amount borrowed on your credit card, expressed as a percentage. (See Interest Rate definition.) ANNUAL FEE A yearly fee that is charged for having certain credit cards in your wallet. Not all credit cards have annual fees. The fee can range in price and typically includes access to other perks, points, or benefits above and beyond what you get with a standard, nofee card. BALANCE This is how much money you owe on your credit card. CREDIT LIMIT The maximum dollar amount you can spend on your credit card. GRACE PERIOD Typically, when you make a purchase on your credit card, interest doesn’t begin to accumulate immediately. Instead, you get a grace period (usually a minimum of 21 days) to make payments before you are charged interest. If you pay off the full amount owing on your card before the end of your grace period, you will not be charged interest. INTEREST RATE This is the percentage of interest that is charged on any balance owing on your card after the grace period is up. Interest is calculated daily and charged to your card monthly. Interest rates can vary from card to card. MINIMUM PAYMENT This is the smallest dollar amount that you can pay each month to keep your credit card account in good standing. STATEMENT Your credit card statement is a detailed list showing all of your transactions during your billing cycle, along with your balance owing (as of your statement date), your minimum payment, and when your payment is due.","Response must use only information contained in the context block to answer the question. Model should not rely on its own knowledge or outside sources of information when responding. What are the consequences of using your credit card to get cash instead of just making regular purchases? First Timer’s Guide: Credit Cards Used the right way, your credit card can be your new financial BFF. HonestMoney.ca Like most things, with great power comes great responsibility. And credit cards are no different. Used the right way, they can be your new financial BFF. But before you tap, swipe, and charge your way into a bold new financial future, it’s important to have a handle on the basics to avoid some of the downsides of living that plastic life. First things first: What is a credit card? In the most basic sense, a credit card is a piece of plastic that allows you to pay for things with borrowed money. It’s an agreement between you and a financial institution where you can opt to pay on credit rather than with actual money. In practice, it’s a little more involved than that. Your credit card comes with a limit—that is the amount of money you have to borrow against. And those charges? You’re going to pay interest on them if you carry a balance. But we’re getting ahead of ourselves. Before you get swiping, make sure you know why. And how, so you can do it responsibly. Why you should have a credit card? There are lots of reasons why having a credit card can make you into a financial super hero: TO BUILD CREDIT Somewhere down the line, you will need a credit history. And a credit card—when used correctly—is one of the easiest way to build credit. When the time comes to take out a car loan or get a mortgage, your financial institution will refer back to your credit history to see how reliable you are with borrowing money. So even if a credit card seems unnecessary, making frequent purchases with it and immediately paying it off will help you build a positive credit history, which will pay off in the future. FLIGHTS, RENTALS, HOTELS, AND ONLINE SHOPPING If you want to get on planes, trains, or automobiles, or to purchase the latest bobble from your favourite online retailer, you’re going to need a credit card. Ditto for booking a room in a hotel, booking concert tickets, and more. HonestMoney.ca REWARDS A lot of cards actually reward you for using them with things like cash back, travel points, or exclusive offers like concert tickets. As long as you’re managing your balance wisely, using your credit card frequently can help you treat yourself later. EMERGENCIES Hopefully it never happens, but every once and while we all get stuck in emergencies where we just don’t have cash on hand. And although you should never put something on your credit card if you don’t have the money to pay for it, your card might help you get out of a tough situation in the very short term – or at least until you can take stock of your situation and sit down with your financial expert to come up with a longer term plan. How to choose a card that’s right for you Now that you’ve decided to get a credit card, you have to ask yourself—which one should I apply for? Types of credit cards No or Low Annual Fee Cards: These cards offer the convenience of having a credit card in your wallet without a high annual fee. Most low or no annual fee cards offer basic rewards but may not accumulate perks as quickly as a fee-based card. Low Interest Rate Cards: Many cards have interest rates upwards of 19.5%, but there are cards available with lower interest rates in exchange for a low annual fee. These cards often don’t accumulate rewards quickly, but if you find yourself carrying a balance on your card month over month, this can be a smart choice. Cash Back Cards: Not all card rewards come in the form of points. For every purchase you make, cash back cards offer a percentage back in cash credited to your statement at a set time. Rewards Cards: For every purchase you make on your card, you’ll accumulate a set number of rewards points. Points can be redeemed for all sorts of different things, ranging from the latest gadgets and gift cards, to concert tickets and experiences. HonestMoney.ca Student Cards: You guessed it! These cards are specifically meant for students who are just starting to build their credit. These often come with low or no fees and offer basic rewards. Travel Rewards Cards: Similar to a rewards card, but focused on travel. Travel rewards cards feature points that can be redeemed for flights, hotels, and car rentals and often include insurance coverage for things like out-of-country medical, lost luggage, or changes to travel plans. US Dollar Cards: These cards allow you to make purchases directly in US dollars. It’s a good idea to be honest with yourself about how you plan to use your card and what’s really important to you. For instance, if you’re keeping your card in case of emergencies only, a low or no annual fee card might make the most sense. If you find yourself traveling often, the protections and perks that come with a travel rewards card might provide you with the best value. Once you have a better sense of your needs and habits, take the time to go online and do a little bit of research. Check out and compare different cards. Look at the features and benefits and what you need to apply. Some cards have a minimum income threshold to qualify or are designed specifically for students, so make sure you know what you’re getting yourself into. HonestMoney.ca Applying for your card Just because you want a credit card, doesn’t mean you can always get a credit card. Like any kind of credit, there is an application process to complete before you can start spending. 1. Go online (financial institution) or in branch. 2. Fill out an application; pay stubs, Social Insurance Number, ID, employment & income verification; other important info. 3. (If approved) activate your card! How to manage your card So, you have your credit card. Now what? While using your card is pretty straight forward, there are a couple of important things to know about managing your card. First, not every purchase on a credit card is created equal. While most of us tend to think of credit card purchases as tapping or swiping your card in a store or inputting your information online, you can also use your credit card to get cash or to make cash-like transactions. This is called a cash advance. Taking a cash advance might sound like a good idea, but this can be a costly way to access cash in the long run. Cash advances often charge a small fee to initiate and almost always charge a higher rate of interest than regular purchases. The other thing to keep in mind is how interest accumulates. With regular purchases, you have a grace period (usually 21 days or more) before interest begins to accumulate on the money you owe. When you take a cash advance, interest starts to accumulate right away and will continue to accrue until the whole amount of the advance is paid off in full. Don’t apply for every offer: Each time you apply for a credit card there will be an inquiry made on your credit history. Lots of inquiries over a short period of time can impact your credit score and lots of open, available cards can hurt your chances to qualify for more credit in the future. HonestMoney.ca You can also expect to get a monthly statement whether you use your card or not. Statements provide a detailed snapshot for a set period of time and outline your purchases, how much you owe, the minimum payment due, and when you need to make a payment. Statements are monthly, but may not run from the first day of the month to the last. When you get your statement, be sure to review it carefully. If something doesn’t make sense on your statement, or if there is something you don’t recognize, don’t be afraid to speak up and ask your card provider for more details. Credit card Dos and Don’ts DO DON’T • Pay off your full balance each month, if possible • Buy things you can easily pay for • Stay at around 50% of your credit limit • Check your balance on a regular basis • Become familiar with your grace periods and when interest kicks in • Make your payments on time • Take advantage of rewards programs • Just make the minimum payment required each month • Pay for things you can’t afford • Regularly run your balance close to your limit • Ignore your balance and transactions • Pay late or forget to make your payments altogether • Don’t make purchases just to gain rewards Be aware of your terms and conditions: If an offer seems too good to be true, it probably is. And the same goes for credit cards. Be cautious when it comes to 0% offers in exchange for making a big purchase and be sure that you understand the terms and conditions before signing up. Zero interest doesn’t last forever and some credit cards can charge very high interest rates once their introductory offers have expired. HonestMoney.ca Interest Every credit card has an interest rate. When you make a purchase with your credit card, your grace period for that transaction starts. This means that you have around 21-25 days (each credit card provider is different) to pay off that transaction before interest charges kick in. If you keep an unpaid balance on your credit card, interest will keep adding up month by month. But if you pay off the full balance on time, you’ll never have to pay interest! And remember, only making the minimum payment required each month still means you get charged interest on the full balance. % *Assumption: Based on an APR of 19.9%. This does not take into account minimum payments. INITIAL BALANCE $1,000* How your credit card accrues interest. Balance owing after 2 years $1,491.36 Balance owing after 3 years $1,821.27 Balance owing after 1 year $1,221.21 HonestMoney.ca Keeping your credit card info safe Credit cards have a lot of great security features, but knowing how to protect your card information is probably the biggest thing you can do to keep yourself from fraud. Here are a few easy tips that can help. Be aware of email phishing or fraudulent phone calls: Scammers will often try to create a sense of panic, trying to persuade you to give out your information. Don’t do it! Never give you credit card info over the phone or in an email: Your credit card provider or financial institution will never call you and ask for your credit card info over the phone/email. Cancel your card immediately if you ever lose it: Fraudulent transactions can be refunded if you report the card missing before they happen. Don’t write down your credit card information to store it: Enough said! Review your transactions regularly and ask lots of questions: Regularly check your transactions and balance and don’t be afraid to ask your card provider questions if you don’t recognize something. HonestMoney.ca Glossary APR This is short for Annual Percentage Rate. APR is the rate charged to the amount borrowed on your credit card, expressed as a percentage. (See Interest Rate definition.) ANNUAL FEE A yearly fee that is charged for having certain credit cards in your wallet. Not all credit cards have annual fees. The fee can range in price and typically includes access to other perks, points, or benefits above and beyond what you get with a standard, nofee card. BALANCE This is how much money you owe on your credit card. CREDIT LIMIT The maximum dollar amount you can spend on your credit card. GRACE PERIOD Typically, when you make a purchase on your credit card, interest doesn’t begin to accumulate immediately. Instead, you get a grace period (usually a minimum of 21 days) to make payments before you are charged interest. If you pay off the full amount owing on your card before the end of your grace period, you will not be charged interest. INTEREST RATE This is the percentage of interest that is charged on any balance owing on your card after the grace period is up. Interest is calculated daily and charged to your card monthly. Interest rates can vary from card to card. MINIMUM PAYMENT This is the smallest dollar amount that you can pay each month to keep your credit card account in good standing. STATEMENT Your credit card statement is a detailed list showing all of your transactions during your billing cycle, along with your balance owing (as of your statement date), your minimum payment, and when your payment is due.",Financial,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",I just adopted a German Shepard puppy through a local pet rescue. I also own a small business with inventory in an outbuilding on my property. Can I deduct the adoption fee and all of the expenses for this dog if I am using him a few hours a day as a guard dog?,"When you’re trying to score a break at tax time, maxing out your deductions can potentially lower your bill or result in a bigger tax return. Apart from the standard write-offs for things like mortgage interest or business travel, you may be able to claim more unusual expenses, including the cost of taking care of a pet. The IRS has certain rules about when pet expenses are tax-deductible, so if you’ve got some furry friends at home, here are a few scenarios where you might benefit. Consider working with a financial advisor as you work on a budget, whether that includes a pet or not. You Require a Pet for Medical Reasons Service animals can take many different forms, including dogs, cats and even miniature ponies. If you’re required to have a guide, service or therapy animal because you have a diagnosed medical condition, such as blindness, epilepsy or post-traumatic stress disorder, you may be able to deduct the cost of its care as a medical expense on your taxes. In order to meet the IRS standards your pet must be certified and trained as a service animal. The types of costs you can deduct include grooming, food, veterinary care and training. You might also be able to claim vet bills on taxes for pets you foster, provided that the nonprofit organization hasn’t reimbursed you and the organization is registered with the IRS. Find out now: How much do I need to save for retirement? You Use a Guard Dog for Your Business While you can’t technically put a dog on the payroll, you may still be able to deduct the cost of its care as a business expense if it’s used primarily to guard your premises and inventory. The IRS doesn’t allow you to write off the cost of buying the dog itself, but you can use the deduction for things like food, training, boarding and medical care. Keep in mind that it only applies to the dog’s working hours, not expenses incurred during the animal’s down time. You Foster Pets in Your Home Volunteering with a service animal agency or pet rescue organization is a great way to give back, and it can also pay off at tax time. If you foster pets, either in your home or on your property, you may be eligible to claim the deduction for unreimbursed expenses. That covers food, shelter, veterinary bills, grooming costs, litter and bedding materials. These expenses would qualify as charitable donations, which are deductible up to 50 percent of your adjusted gross income. You’re a Professional Breeder SmartAsset: When Are Pet Expenses Tax-Deductible? If breeding and selling dogs, cats or other animals is your primary occupation, there’s good news: not only can you deduct food, medical bills and boarding costs, but you can also write off any other ordinary and necessary expenses that running your business entails. This includes things like advertising, costs relating to the business use of your home, and travel expenses. If you breed animals as a hobby, you only qualify for the deduction if your expenses exceed 2 percent of your adjusted gross income and you itemize. You’re a Law Enforcement Dog Handler Some of the cost that goes along with maintaining a police dog may also qualify for a tax deduction if you’re not reimbursed for these expenses through your job. If the dog lives in your home when not on-duty and you’re responsible for buying its food or purchasing a kennel, you can generally claim them as a job-related expense. The Main Rule for Cutting Your Tax Bill The No. 1 rule when it comes to claiming deductions for pet care is to make sure you’re documenting your expenses carefully. If you include something that you know is deductible but you don’t have documentation to support it, you may run into trouble if you’re audited. You don’t want to end up in the doghouse with Uncle Sam, so hanging on to all of your receipts is a must. Bottom Line SmartAsset: When Are Pet Expenses Tax-Deductible? Contrary to what many people may think, it is very possible to claim deductions for your pet-related expenses. Just be sure to keep careful and complete records of what you spend and why you spent it. Was it for a work-related matter? Or was it for non-compensated activity like fostering pets? Keep in mind that moving expenses are no longer deductible. Tips on Taxes A financial advisor can offer valuable insight and guidance as you explore ways to reduce your taxes, including by deducting pet-related expenses. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now. Income in America is taxed by the federal government, most state governments and many local governments. The federal income tax system is progressive, so the rate of taxation increases as income increases. Use our free income tax calculator to give you a quick estimate of what you’ll owe.","[question] I just adopted a German Shepard puppy through a local pet rescue. I also own a small business with inventory in an outbuilding on my property. Can I deduct the adoption fee and all of the expenses for this dog if I am using him a few hours a day as a guard dog? ===================== [text] When you’re trying to score a break at tax time, maxing out your deductions can potentially lower your bill or result in a bigger tax return. Apart from the standard write-offs for things like mortgage interest or business travel, you may be able to claim more unusual expenses, including the cost of taking care of a pet. The IRS has certain rules about when pet expenses are tax-deductible, so if you’ve got some furry friends at home, here are a few scenarios where you might benefit. Consider working with a financial advisor as you work on a budget, whether that includes a pet or not. You Require a Pet for Medical Reasons Service animals can take many different forms, including dogs, cats and even miniature ponies. If you’re required to have a guide, service or therapy animal because you have a diagnosed medical condition, such as blindness, epilepsy or post-traumatic stress disorder, you may be able to deduct the cost of its care as a medical expense on your taxes. In order to meet the IRS standards your pet must be certified and trained as a service animal. The types of costs you can deduct include grooming, food, veterinary care and training. You might also be able to claim vet bills on taxes for pets you foster, provided that the nonprofit organization hasn’t reimbursed you and the organization is registered with the IRS. Find out now: How much do I need to save for retirement? You Use a Guard Dog for Your Business While you can’t technically put a dog on the payroll, you may still be able to deduct the cost of its care as a business expense if it’s used primarily to guard your premises and inventory. The IRS doesn’t allow you to write off the cost of buying the dog itself, but you can use the deduction for things like food, training, boarding and medical care. Keep in mind that it only applies to the dog’s working hours, not expenses incurred during the animal’s down time. You Foster Pets in Your Home Volunteering with a service animal agency or pet rescue organization is a great way to give back, and it can also pay off at tax time. If you foster pets, either in your home or on your property, you may be eligible to claim the deduction for unreimbursed expenses. That covers food, shelter, veterinary bills, grooming costs, litter and bedding materials. These expenses would qualify as charitable donations, which are deductible up to 50 percent of your adjusted gross income. You’re a Professional Breeder SmartAsset: When Are Pet Expenses Tax-Deductible? If breeding and selling dogs, cats or other animals is your primary occupation, there’s good news: not only can you deduct food, medical bills and boarding costs, but you can also write off any other ordinary and necessary expenses that running your business entails. This includes things like advertising, costs relating to the business use of your home, and travel expenses. If you breed animals as a hobby, you only qualify for the deduction if your expenses exceed 2 percent of your adjusted gross income and you itemize. You’re a Law Enforcement Dog Handler Some of the cost that goes along with maintaining a police dog may also qualify for a tax deduction if you’re not reimbursed for these expenses through your job. If the dog lives in your home when not on-duty and you’re responsible for buying its food or purchasing a kennel, you can generally claim them as a job-related expense. The Main Rule for Cutting Your Tax Bill The No. 1 rule when it comes to claiming deductions for pet care is to make sure you’re documenting your expenses carefully. If you include something that you know is deductible but you don’t have documentation to support it, you may run into trouble if you’re audited. You don’t want to end up in the doghouse with Uncle Sam, so hanging on to all of your receipts is a must. Bottom Line SmartAsset: When Are Pet Expenses Tax-Deductible? Contrary to what many people may think, it is very possible to claim deductions for your pet-related expenses. Just be sure to keep careful and complete records of what you spend and why you spent it. Was it for a work-related matter? Or was it for non-compensated activity like fostering pets? Keep in mind that moving expenses are no longer deductible. Tips on Taxes A financial advisor can offer valuable insight and guidance as you explore ways to reduce your taxes, including by deducting pet-related expenses. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with up to three financial advisors who serve your area, and you can interview your advisor matches at no cost to decide which one is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now. Income in America is taxed by the federal government, most state governments and many local governments. The federal income tax system is progressive, so the rate of taxation increases as income increases. Use our free income tax calculator to give you a quick estimate of what you’ll owe. https://smartasset.com/personal-finance/when-are-pet-expenses-tax-deductible ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Fact Finding,Q&A Create your answer using only information from the context to answer this question:,What advantages does Nintendo have over its competitors?,"Internal environment of Nintendo (1) Analysis of Nintendo's advantages Competitive advantage refers to an enterprise's ability to outperform its competitors, which helps to achieve its main goal -- profit. Nintendo's strengths lie in the following ways [3]. Nintendo has developed a unique profit distribution system based on its nearly 50 years of experience in the game industry. At that time, the manager in charge of Nintendo drew lessons from the ""collapse of Atari"". First, he set up a ""Mario Club"" game quality supervision agency to strictly screen the game software on the Nintendo game console. Later, he set up a ""royalty system"" and formulated a set of rules for game review, platform access, and game revenue sharing, which brought huge profits to Nintendo, At the same time, it objectively promoted the benign development of the Japanese game industry at that time. These systems are also the internal reason why the overall quality of Nintendo Switch games is much better than its competitors. Super big IPs such as Super Mario and Legend of Zelda have always maintained a good reputation and remain popular among players. It is these unique systems that enable Nintendo to maintain a high-profit margin even in the context of economic depression [4]. (2) Analysis of Nintendo's disadvantages First, Nintendo's failed family business management style. The presidents of Nintendo's Japanese and American divisions (NOA) often have differences due to huge differences in management methods, and the consequences of such differences are devastating because they will lead to key employees becoming vulnerable and even leaving to do other work. Therefore, the family business management model seriously leads to the failure of efficient cooperation between Nintendo's various branches, and will also seriously harm Nintendo's external reputation and damage Nintendo's overall interests [5]. Secondly, weak technology research and development capability. With the growing demand for personalized service, companies are required to provide increasingly specialized service strategies and differentiated solutions, for example, more and more game companies begin to focus on creating products with local characteristics based on the language and cultural background of different regions, which is also the basis for a game to be promoted around the world. In addition, the development of modern games also needs the support of technological innovation. For example, more and more VR, AR, and motion capture games are emerging in the market. It would be unthinkable for Nintendo to spend huge resources on a new generation of high-performance consoles to compete with SONY. Conversely, it is in the area of research and development that Nintendo's other rival, Microsoft, has the greatest advantage. 3.3.2 External environment of Nintendo (1) Opportunity for Nintendo In terms of technology and business environment, Nintendo has much more experience than its competitors with the background of years of exploration in the gaming industry. Even though Microsoft recently acquired the game giant Blizzard, it intends to expand its market share in the game industry. However, Microsoft did not intervene in Blizzard's daily operation, which was also due to its limited experience in the game industry. These factors can also reduce Nintendo's competitive pressure [6]. In terms of the political and legal environment, the government's favorable policies also help game companies expand their overseas markets. Also, under the catalysis of the epidemic economy, video games have become one of the most popular cultural and creative activities for young people in the world. Many governments are aware of this trend and have introduced a series of supportive policies, such as setting up special funds for the game industry; Promise the game developer that adding landmark landmarks in the game can get financial support and tax concessions. These policies are good news for multinational game companies like Nintendo to expand their overseas markets. (2) Threat for Nintendo Highlights in Business, Economics and Management FMIBM 2023 Volume 10 (2023) 194 Microsoft's strong economic strength enables them to continue to operate in the gaming industry after experiencing the cost of failure in the game product competition of 4 billion dollars and make up for the shortcomings of their predecessors in new products. At the same time, Microsoft could use money offensive to buy third-party platform certification. Finally, and most importantly, Microsoft's latest games are coming out one year earlier than Nintendo's or SONY's, making it harder for Nintendo to time and win the market. 4. Nintendo’s market strategy suggestion As the gaming industry continues to evolve, scholars generally agree that gaming companies need not only excellent hardware and software technology but also effective marketing strategies. Schilling MA (2003) believes that if companies in the game industry want to maintain their market share, they need to improve their marketing strategies to follow or even guide the market trend [7]. Marchand A and Hennig-Thurau T (2013) think that companies in the game industry need to pay attention to consumers' preferences in the market, understand consumers' needs in the form of questionnaires, etc., to design their products in a targeted way [8]. SC Jain (1989) thinks that companies in the game industry need to pay attention to consumers' preferences in the market, understand consumers' needs in the form of questionnaires, etc., to design their products in a targeted way [9]. Based on the above analysis of Nintendo's internal and external conditions, this report proposes the following improvement suggestions [10]. Nintendo could consider setting up more offline experience stores overseas. Nintendo's classic game characters, such as Mario, Pokemon, Kirby, and Link, are familiar to the public. Taking these characters as ambassadors of offline experience stores, they can attract enough attention without too much publicity expenses and are very attractive to children and adults. Nintendo could consider adding episode-by-episode, level-by-level incrementally unlocked purchases. Because Nintendo's software games are priced in a complementary way to the console's price, they are generally priced higher than other games in the market. This can lead to players who want to play a game but don't buy it because the price is too high. In this case, the buy-out system can be supplemented with the option of gradually unlocking purchases by episode or level, and players can choose to buy them out or buy them separately. That way, players can play more games, and buying incrementally doesn't feel like a buy-out. This is also a great way for Nintendo to increase its sales. Nintendo could increase its ban on cracking consoles and develop new encryption technologies. For now, Nintendo's crackdown on cracked consoles is not strong enough, and only users who use cracked consoles to connect to the Internet have been blocked. In this case, to protect their intellectual property rights, but also promote the sale of their legitimate games, the development of a new set of encryption technology is worth considering.","Create your answer using only information from the context to answer this question: What advantages does Nintendo have over its competitors? Internal environment of Nintendo (1) Analysis of Nintendo's advantages Competitive advantage refers to an enterprise's ability to outperform its competitors, which helps to achieve its main goal -- profit. Nintendo's strengths lie in the following ways [3]. Nintendo has developed a unique profit distribution system based on its nearly 50 years of experience in the game industry. At that time, the manager in charge of Nintendo drew lessons from the ""collapse of Atari"". First, he set up a ""Mario Club"" game quality supervision agency to strictly screen the game software on the Nintendo game console. Later, he set up a ""royalty system"" and formulated a set of rules for game review, platform access, and game revenue sharing, which brought huge profits to Nintendo, At the same time, it objectively promoted the benign development of the Japanese game industry at that time. These systems are also the internal reason why the overall quality of Nintendo Switch games is much better than its competitors. Super big IPs such as Super Mario and Legend of Zelda have always maintained a good reputation and remain popular among players. It is these unique systems that enable Nintendo to maintain a high-profit margin even in the context of economic depression [4]. (2) Analysis of Nintendo's disadvantages First, Nintendo's failed family business management style. The presidents of Nintendo's Japanese and American divisions (NOA) often have differences due to huge differences in management methods, and the consequences of such differences are devastating because they will lead to key employees becoming vulnerable and even leaving to do other work. Therefore, the family business management model seriously leads to the failure of efficient cooperation between Nintendo's various branches, and will also seriously harm Nintendo's external reputation and damage Nintendo's overall interests [5]. Secondly, weak technology research and development capability. With the growing demand for personalized service, companies are required to provide increasingly specialized service strategies and differentiated solutions, for example, more and more game companies begin to focus on creating products with local characteristics based on the language and cultural background of different regions, which is also the basis for a game to be promoted around the world. In addition, the development of modern games also needs the support of technological innovation. For example, more and more VR, AR, and motion capture games are emerging in the market. It would be unthinkable for Nintendo to spend huge resources on a new generation of high-performance consoles to compete with SONY. Conversely, it is in the area of research and development that Nintendo's other rival, Microsoft, has the greatest advantage. 3.3.2 External environment of Nintendo (1) Opportunity for Nintendo In terms of technology and business environment, Nintendo has much more experience than its competitors with the background of years of exploration in the gaming industry. Even though Microsoft recently acquired the game giant Blizzard, it intends to expand its market share in the game industry. However, Microsoft did not intervene in Blizzard's daily operation, which was also due to its limited experience in the game industry. These factors can also reduce Nintendo's competitive pressure [6]. In terms of the political and legal environment, the government's favorable policies also help game companies expand their overseas markets. Also, under the catalysis of the epidemic economy, video games have become one of the most popular cultural and creative activities for young people in the world. Many governments are aware of this trend and have introduced a series of supportive policies, such as setting up special funds for the game industry; Promise the game developer that adding landmark landmarks in the game can get financial support and tax concessions. These policies are good news for multinational game companies like Nintendo to expand their overseas markets. (2) Threat for Nintendo Highlights in Business, Economics and Management FMIBM 2023 Volume 10 (2023) 194 Microsoft's strong economic strength enables them to continue to operate in the gaming industry after experiencing the cost of failure in the game product competition of 4 billion dollars and make up for the shortcomings of their predecessors in new products. At the same time, Microsoft could use money offensive to buy third-party platform certification. Finally, and most importantly, Microsoft's latest games are coming out one year earlier than Nintendo's or SONY's, making it harder for Nintendo to time and win the market. 4. Nintendo’s market strategy suggestion As the gaming industry continues to evolve, scholars generally agree that gaming companies need not only excellent hardware and software technology but also effective marketing strategies. Schilling MA (2003) believes that if companies in the game industry want to maintain their market share, they need to improve their marketing strategies to follow or even guide the market trend [7]. Marchand A and Hennig-Thurau T (2013) think that companies in the game industry need to pay attention to consumers' preferences in the market, understand consumers' needs in the form of questionnaires, etc., to design their products in a targeted way [8]. SC Jain (1989) thinks that companies in the game industry need to pay attention to consumers' preferences in the market, understand consumers' needs in the form of questionnaires, etc., to design their products in a targeted way [9]. Based on the above analysis of Nintendo's internal and external conditions, this report proposes the following improvement suggestions [10]. Nintendo could consider setting up more offline experience stores overseas. Nintendo's classic game characters, such as Mario, Pokemon, Kirby, and Link, are familiar to the public. Taking these characters as ambassadors of offline experience stores, they can attract enough attention without too much publicity expenses and are very attractive to children and adults. Nintendo could consider adding episode-by-episode, level-by-level incrementally unlocked purchases. Because Nintendo's software games are priced in a complementary way to the console's price, they are generally priced higher than other games in the market. This can lead to players who want to play a game but don't buy it because the price is too high. In this case, the buy-out system can be supplemented with the option of gradually unlocking purchases by episode or level, and players can choose to buy them out or buy them separately. That way, players can play more games, and buying incrementally doesn't feel like a buy-out. This is also a great way for Nintendo to increase its sales. Nintendo could increase its ban on cracking consoles and develop new encryption technologies. For now, Nintendo's crackdown on cracked consoles is not strong enough, and only users who use cracked consoles to connect to the Internet have been blocked. In this case, to protect their intellectual property rights, but also promote the sale of their legitimate games, the development of a new set of encryption technology is worth considering.",Retail/Product,Fact Finding,Q&A "Only use information provided in the document to answer, don't use external knowledge.","In the context of the described medical study in the provided text, what task (or tasks) do ""Neoantigens"" have?","**Mismatch repair deficiency doesn’t always boost immunotherapy response** Mismatch repair deficiency occurs when tumor cells have a mutation in one of several genes that normally correct mistakes in the DNA code. Without that DNA spellchecker, the tumor constantly accumulates genetic mutations, leading to a high tumor mutational burden. To investigate why some tumors with deficient mismatch repair don’t respond to immune checkpoint inhibitors, Dr. Westcott and his colleagues genetically engineered mice to spontaneously grow lung or colorectal tumors that were either deficient in mismatch repair or had functioning mismatch repair. Tumors that were deficient in mismatch repair had many more mutations than tumors with functioning mismatch repair, the researchers confirmed. When they treated both sets of mice with an immune checkpoint inhibitor, they found an unexpected result: mismatch repair–deficient tumors didn’t shrink any more than tumors with functioning mismatch repair. In further experiments, the team figured out why. It came down to both the diversity and the type of mutations in the tumors, Dr. Westcott explained. The mismatch repair–deficient tumors had a lot of genetic diversity, meaning each mutation was only in a small fraction of cancer cells. And cancer-killing immune cells couldn't efficiently attack tumors with high genetic diversity, the researchers found. But when they created tumors in which all of the cancer cells had the same mutations, immune checkpoint inhibitors shrank the tumors and kept them at bay for months. The type of mutation also appeared to influence how immune system responds to tumors. Some mutations cause tumor cells to produce abnormal bits of proteins on their surface, called neoantigens. Neoantigens help the immune system spot cancer cells, whereas other types of mutations are less likely to jump-start the immune system. Cancer-killing immune cells launched a massive attack against tumors in which all of the cancer cells had the same neoantigen, called clonal neoantigens. But that attack weakened when only a fraction of the cancer cells had the neoantigen, the researchers found.","{document} ======= **Mismatch repair deficiency doesn’t always boost immunotherapy response** Mismatch repair deficiency occurs when tumor cells have a mutation in one of several genes that normally correct mistakes in the DNA code. Without that DNA spellchecker, the tumor constantly accumulates genetic mutations, leading to a high tumor mutational burden. To investigate why some tumors with deficient mismatch repair don’t respond to immune checkpoint inhibitors, Dr. Westcott and his colleagues genetically engineered mice to spontaneously grow lung or colorectal tumors that were either deficient in mismatch repair or had functioning mismatch repair. Tumors that were deficient in mismatch repair had many more mutations than tumors with functioning mismatch repair, the researchers confirmed. When they treated both sets of mice with an immune checkpoint inhibitor, they found an unexpected result: mismatch repair–deficient tumors didn’t shrink any more than tumors with functioning mismatch repair. In further experiments, the team figured out why. It came down to both the diversity and the type of mutations in the tumors, Dr. Westcott explained. The mismatch repair–deficient tumors had a lot of genetic diversity, meaning each mutation was only in a small fraction of cancer cells. And cancer-killing immune cells couldn't efficiently attack tumors with high genetic diversity, the researchers found. But when they created tumors in which all of the cancer cells had the same mutations, immune checkpoint inhibitors shrank the tumors and kept them at bay for months. The type of mutation also appeared to influence how immune system responds to tumors. Some mutations cause tumor cells to produce abnormal bits of proteins on their surface, called neoantigens. Neoantigens help the immune system spot cancer cells, whereas other types of mutations are less likely to jump-start the immune system. Cancer-killing immune cells launched a massive attack against tumors in which all of the cancer cells had the same neoantigen, called clonal neoantigens. But that attack weakened when only a fraction of the cancer cells had the neoantigen, the researchers found. ================ {question} ======= In the context of the described medical study in the provided text, what task (or tasks) do ""Neoantigens"" have? ================ {task description} ======= Only use information provided in the document to answer, don't use external knowledge.",Medical,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",Explain intermittent fasting. What are the health benefits of intermittent fasting? What method of intermittent fasting is most effective for weight loss? Make the response to be simple and easily understandable,"Intermittent fasting is an eating pattern that may benefit heart health, reduce inflammation, improve cell repair processes, and help burn fat Intermittent fasting is an eating pattern in which you cycle between periods of eating and periods of fasting. There are many types of intermittent fasting, such as the 16:8 and 5:2 methods. Numerous studies suggest that it can have powerful benefits for your body and brain. Here are 10 evidence-based health benefits of intermittent fasting. 1. Changes in the function of hormones, cells, and genes When you don’t eat for a while, several things happen in your body. For example, your body changes hormone levels to make stored body fat more accessible and starts important cellular repair processes. Here are some of the changesTrusted Source that may happen in your body as a result of intermittent fasting: • Insulin level: Your blood level of insulin drops significantly, which promotes fat burning. • Human growth hormone (HGH) level: Your blood level of HGH may increase dramatically. Higher levels of this hormone promote fat burning and muscle gain and have numerous other benefits. • Cellular repair: Your body starts important cellular repair processes such as removing waste material from cells. • Gene expression: Beneficial changes occur in several genes and molecules related to longevity and protection against disease. Many of the benefits of intermittent fasting are related to these changes in hormones, cellular function, and gene expression. HEALTHLINE NEWSLETTER Get our free diabetes-friendly recipes We rounded up a few nutritious and delicious recipes for you to try next time you need inspiration in the kitchen. Join our diabetes newsletter for your free recipes and expert guidance twice a week. you lose weight and visceral fat Many people try intermittent fasting in an effort to lose weight. Generally, intermittent fasting will make you eat fewer meals. Unless you compensate by eating much more during the other meals, you’ll end up taking in fewer calories. Additionally, intermittent fasting enhances hormone function to promote weight loss. Lower insulinTrusted Source levels, higher HGH levels, and increasedTrusted Source levels of norepinephrine all increase the breakdown of body fat and make it easier for your body to use fat for energy. For this reason, short-term fasting actually improves your metabolismTrusted Source, helping you burn even more calories. In a 2022 studyTrusted Source involving 131 people with obesity, researchers found that those who participated in 12 weeks of intermittent fasting lost an average of 9% of their body weight — more than those who engaged in other weight loss methods. But this study focused on the 5:2 intermittent fasting plan, which means the participants ate normally for 5 days and restricted their calories for 2 days each week. The authors of a 2020 reviewTrusted Source of 27 studies noted that participants doing intermittent fasting lost 0.8–13% of their baseline body weight. In a 2020 trialTrusted Source, researchers focused on people who followed the 16:8 method, which involves fasting for 16 hours per day and eating within an 8-hour window. The people who fasted didn’t lose significantly more weight than those who ate three meals per day. But after testing a subset of the participants in person, the researchers found that those who fasted had lost a significant amount of lean mass, including lean muscle. More studies are needed to investigate the effect of fasting on muscle loss. But, all things considered, intermittent fasting has the potential to be an incredibly powerful weight loss tool."," Only use the provided text to answer the question, no outside sources. Explain intermittent fasting. What are the health benefits of intermittent fasting? What method of intermittent fasting is most effective for weight loss? Make the response to be simple and easily understandable Intermittent fasting is an eating pattern that may benefit heart health, reduce inflammation, improve cell repair processes, and help burn fat Intermittent fasting is an eating pattern in which you cycle between periods of eating and periods of fasting. There are many types of intermittent fasting, such as the 16:8 and 5:2 methods. Numerous studies suggest that it can have powerful benefits for your body and brain. Here are 10 evidence-based health benefits of intermittent fasting. 1. Changes in the function of hormones, cells, and genes When you don’t eat for a while, several things happen in your body. For example, your body changes hormone levels to make stored body fat more accessible and starts important cellular repair processes. Here are some of the changesTrusted Source that may happen in your body as a result of intermittent fasting: • Insulin level: Your blood level of insulin drops significantly, which promotes fat burning. • Human growth hormone (HGH) level: Your blood level of HGH may increase dramatically. Higher levels of this hormone promote fat burning and muscle gain and have numerous other benefits. • Cellular repair: Your body starts important cellular repair processes such as removing waste material from cells. • Gene expression: Beneficial changes occur in several genes and molecules related to longevity and protection against disease. Many of the benefits of intermittent fasting are related to these changes in hormones, cellular function, and gene expression. HEALTHLINE NEWSLETTER Get our free diabetes-friendly recipes We rounded up a few nutritious and delicious recipes for you to try next time you need inspiration in the kitchen. Join our diabetes newsletter for your free recipes and expert guidance twice a week. you lose weight and visceral fat Many people try intermittent fasting in an effort to lose weight. Generally, intermittent fasting will make you eat fewer meals. Unless you compensate by eating much more during the other meals, you’ll end up taking in fewer calories. Additionally, intermittent fasting enhances hormone function to promote weight loss. Lower insulinTrusted Source levels, higher HGH levels, and increasedTrusted Source levels of norepinephrine all increase the breakdown of body fat and make it easier for your body to use fat for energy. For this reason, short-term fasting actually improves your metabolismTrusted Source, helping you burn even more calories. In a 2022 studyTrusted Source involving 131 people with obesity, researchers found that those who participated in 12 weeks of intermittent fasting lost an average of 9% of their body weight — more than those who engaged in other weight loss methods. But this study focused on the 5:2 intermittent fasting plan, which means the participants ate normally for 5 days and restricted their calories for 2 days each week. The authors of a 2020 reviewTrusted Source of 27 studies noted that participants doing intermittent fasting lost 0.8–13% of their baseline body weight. In a 2020 trialTrusted Source, researchers focused on people who followed the 16:8 method, which involves fasting for 16 hours per day and eating within an 8-hour window. The people who fasted didn’t lose significantly more weight than those who ate three meals per day. But after testing a subset of the participants in person, the researchers found that those who fasted had lost a significant amount of lean mass, including lean muscle. More studies are needed to investigate the effect of fasting on muscle loss. But, all things considered, intermittent fasting has the potential to be an incredibly powerful weight loss tool. https://www.healthline.com/nutrition/10-health-benefits-of-intermittent-fasting#TOC_TITLE_HDR_3",Medical,Explanation/Definition,Q&A Answer in 10 words or less. Keep things simple and plain--easy to understand. Don't use any information apart from what I'm giving you.,Give me a list of people that died in 1957.,"After the show, Christian Dior began thinking about his design again, in his mind he thought he had the responsibility to bring fashion to women, and he wanted women looks like flowers. Because the subversive designing and perfect looking, the dresses were accepted by most society people through they were expensive in that time. (Marly, 1990) Christian Dior’s wonderful new look made fashion area crazy in that some, some people liked it very much, others against it. Because of the traditional understanding about the clothes, some governments thought this kind of clothes wasteful and awful, they even ordered some factories stop making the clothes. People who liked Dior’s styles very much, started thinking about against governments, they came to meet Christian Dior and discussed how they could do to protect the clothing line. For Christian Dior himself, he believed his new fashion would be popular by women, he did want return to the old fashion again, and so every 6 months he made a new line to continue his clothes until reached 22 lines. A big change was happened in 1957 when the Master’s death stunned the whole fashion market, he was the creator who made Christian Dior be known. However, the company could not stop developing, and it became the domination in that time of fashion marketing. Dior’s new designs always shocked the fashion marketing after that time it made Christian Dior’s company became more and more famous. A lot of Dior’s stores appeared in Paris, Hollywood, New York…it was well known as a luxury label from that time all over the world. For developing and expanding its market, Christian Dior began to add some other products not only clothes, but also fashion and leather goods, watches and jewelries, wines and spirits, perfumes and cosmetics… The aims of this article is considering the developed of Dior industry in last few years from about 2003 to 2009, and trying to find out some strategies for future development for Dior. And also considered how Christian Dior keeps its predominant in fashion industries, especially in the similar luxury brands like Louis Vuitton, Armani, Gucci, and Channel. It is obliviously that if any industry insists on one strategy or old-fashioned fossilized attitudes in the market, it would be gone out from the market quickly. The following article will discuss the strategies by four tools, which considered from the industry life cycle, PESTAL framework, five framework and strategic group to understand the development of Christian Dior. And through the five tools we also could understand the different strategies used in different time or under different economic environment. And at last, conducting a SWOT analysis of Christian Dior also becomes a necessary step. Industry Life Cycle: The products in any industry should have a process which is called industry life cycle in marketing. Normally, it would separate to four steps: introduction; growth; maturity and decline. The competition becomes white-hot in the luxury marketing, it is a almost total mature market. According to the industry life cycle, it should nearly reach or have already reached the decline step. So, how to change the poison and improve competitive in fashion marketing become an emergence for Manage groups of Christian Dior. Strategies of sustainable development are necessary considered by them in this period. PESTEL Framework (Political, Economic, Social, Technological, Environmental and Legal): Political: Since some new members joint into European Union, the tariff decline quite a lot, it is a big effect to Dior’s export and import business. Expanding new business line and opening new stores in different areas is one of Dior’s most important strategies. It brought a lot of benefits and challenges to Dior. Reduced price of some products to improve its competitive to other luxury brands, and expanding its overseas plan, especially plan in Asian market. The following graph is Dior’s financial report in Europe: Financial Highlights (in millions of euros) 2005 2004 Revenue by business groups Christian Dior Couture 663 595 Wine and Sprites 2,644 2,259 Fashion and leather goods 4,812 4,366 Perfumes and Cosmetics 2,285 2,128 Watches and Jewelry 573 493 Selective Retailing 3,648 3,276 Other activities and eliminations (69) (57) Total 14,556 13,060 Percentage earned outsides France 84% 76% Profit from recurring operations 2,791 2,413 (Source from Christian Dior financial report 2006) Through this report, it seems under this politics, Dior’s export sales increased about 8% in one year. Economic conditions: In 2008, world financial crisis started from America, the economic condition impacted every industry quickly. In the first three months of 2009, Christian Dior (2009) stressed Dior Couture declined about “8% at current exchange rates and of 12% at constant exchange rates”. The United States and Japan is impacted seriously by the financial crisis, the Dior’s goods sales decreased obviously in the period. However, the good news is that sales situation remains strong in China and some Middle East countries. Christian Dior invested strategies into these new areas to develop itself. Christian Dior (2009) stated that the manager groups changed their focus on these new economic powerful countries, and kept the balance between its strengths and weaknesses. This strategy brought a lot of advantages, and keeps Dior’s dominance position on the world luxury marketing in 2009. Social Christian Dior has a huge range of customers, because it consist its best design and quality, it created a fashion culture and history for itself. Dior as a label is respected by many people. Technological To improve competition, Christian Dior signed up a contract with John Galliano who is one of most influential designer in fashion areas. It is a big issue for Dior, and also for fashion industries. For example Dior watch designed by John Galliano and Victoire de Castellane in 2005, it impact the trend of Dior’s Fashion style. It is not difficult to image women would like taking a lot of money in a new style handbag, that means they also would expend a high price on a fashion watch if it is a new fashion trend in their minds. Furthermore to open up new avenues of business, Christian Dior began cracking other business areas. The first step is co-operating with other brands which is famous on other business industries. For example, On June 2008, Dior co-operated with Apple, created a dress for Apple’s iphone. It was named “Dior Homme iPhone Holder”, obviously, it was so expensive, compare with old iPhone, Dior Hommer iPhone Holder cost twice price. It is the not the first time Christian Dior enter into another total different industry. Then, Christian Dior collaborate Mode Labs and produced its handset. This handset is called “My Dior”, and it is extremely expensive, with a 2 Mega pixel camera, a tough screen, and multimedia goodies. One My Dior’s retail is start from 5000 dollars. And Dior’s company will come up with its own new mobile later soon. (Troaca, 2008) Environmental and Legal Obviously, Christian Dior is Legal company, it keeps abiding by every laws, including employee’s law; company environment condition; fair competitive law and others. Because obey these laws are the basic situations to run a company. Five Forces Framework: It will follow 5 parts: Competitive Rivalry, Buyer, Suppliers, Substitutes, and Potential Entrants. Competitive Rivalry Some researches show the price is not the most important factor customers would consider, they are more focus on the value of the products. Like Dior, many rich people are honest fans of its products through the price is very high. This is a big difference between normal products and luxury goods. They buy Dior for distinguishing others. According to the psychology of customers, Dior promoted a strategy from 2003, which is called limited edition. Dior Company produces some goods with specific design, and most important point is the company will control the numbers of the goods. It made a big success until now, every time when Dior creates new limited-good, they will be sold much quickly than others. Beside great quality goods, Dior pays a lot of attentions on its services for customers, Dall’Olmo Riley and Lacroix ( 2000) pointed out that all luxury brands not only focus on selling goods but also making a great relationship with their customers after sale. All of these strategies made Dior Compare with its biggest competitors like Gucci, Armani, and Hermes. Christian Dior got more benefits in sales within its talent manager groups.","[System Instruction] Answer in 10 words or less. Keep things simple and plain--easy to understand. Don't use any information apart from what I'm giving you. [Question] Give me a list of people that died in 1957. [Context] After the show, Christian Dior began thinking about his design again, in his mind he thought he had the responsibility to bring fashion to women, and he wanted women looks like flowers. Because the subversive designing and perfect looking, the dresses were accepted by most society people through they were expensive in that time. (Marly, 1990) Christian Dior’s wonderful new look made fashion area crazy in that some, some people liked it very much, others against it. Because of the traditional understanding about the clothes, some governments thought this kind of clothes wasteful and awful, they even ordered some factories stop making the clothes. People who liked Dior’s styles very much, started thinking about against governments, they came to meet Christian Dior and discussed how they could do to protect the clothing line. For Christian Dior himself, he believed his new fashion would be popular by women, he did want return to the old fashion again, and so every 6 months he made a new line to continue his clothes until reached 22 lines. A big change was happened in 1957 when the Master’s death stunned the whole fashion market, he was the creator who made Christian Dior be known. However, the company could not stop developing, and it became the domination in that time of fashion marketing. Dior’s new designs always shocked the fashion marketing after that time it made Christian Dior’s company became more and more famous. A lot of Dior’s stores appeared in Paris, Hollywood, New York…it was well known as a luxury label from that time all over the world. For developing and expanding its market, Christian Dior began to add some other products not only clothes, but also fashion and leather goods, watches and jewelries, wines and spirits, perfumes and cosmetics… The aims of this article is considering the developed of Dior industry in last few years from about 2003 to 2009, and trying to find out some strategies for future development for Dior. And also considered how Christian Dior keeps its predominant in fashion industries, especially in the similar luxury brands like Louis Vuitton, Armani, Gucci, and Channel. It is obliviously that if any industry insists on one strategy or old-fashioned fossilized attitudes in the market, it would be gone out from the market quickly. The following article will discuss the strategies by four tools, which considered from the industry life cycle, PESTAL framework, five framework and strategic group to understand the development of Christian Dior. And through the five tools we also could understand the different strategies used in different time or under different economic environment. And at last, conducting a SWOT analysis of Christian Dior also becomes a necessary step. Industry Life Cycle: The products in any industry should have a process which is called industry life cycle in marketing. Normally, it would separate to four steps: introduction; growth; maturity and decline. The competition becomes white-hot in the luxury marketing, it is a almost total mature market. According to the industry life cycle, it should nearly reach or have already reached the decline step. So, how to change the poison and improve competitive in fashion marketing become an emergence for Manage groups of Christian Dior. Strategies of sustainable development are necessary considered by them in this period. PESTEL Framework (Political, Economic, Social, Technological, Environmental and Legal): Political: Since some new members joint into European Union, the tariff decline quite a lot, it is a big effect to Dior’s export and import business. Expanding new business line and opening new stores in different areas is one of Dior’s most important strategies. It brought a lot of benefits and challenges to Dior. Reduced price of some products to improve its competitive to other luxury brands, and expanding its overseas plan, especially plan in Asian market. The following graph is Dior’s financial report in Europe: Financial Highlights (in millions of euros) 2005 2004 Revenue by business groups Christian Dior Couture 663 595 Wine and Sprites 2,644 2,259 Fashion and leather goods 4,812 4,366 Perfumes and Cosmetics 2,285 2,128 Watches and Jewelry 573 493 Selective Retailing 3,648 3,276 Other activities and eliminations (69) (57) Total 14,556 13,060 Percentage earned outsides France 84% 76% Profit from recurring operations 2,791 2,413 (Source from Christian Dior financial report 2006) Through this report, it seems under this politics, Dior’s export sales increased about 8% in one year. Economic conditions: In 2008, world financial crisis started from America, the economic condition impacted every industry quickly. In the first three months of 2009, Christian Dior (2009) stressed Dior Couture declined about “8% at current exchange rates and of 12% at constant exchange rates”. The United States and Japan is impacted seriously by the financial crisis, the Dior’s goods sales decreased obviously in the period. However, the good news is that sales situation remains strong in China and some Middle East countries. Christian Dior invested strategies into these new areas to develop itself. Christian Dior (2009) stated that the manager groups changed their focus on these new economic powerful countries, and kept the balance between its strengths and weaknesses. This strategy brought a lot of advantages, and keeps Dior’s dominance position on the world luxury marketing in 2009. Social Christian Dior has a huge range of customers, because it consist its best design and quality, it created a fashion culture and history for itself. Dior as a label is respected by many people. Technological To improve competition, Christian Dior signed up a contract with John Galliano who is one of most influential designer in fashion areas. It is a big issue for Dior, and also for fashion industries. For example Dior watch designed by John Galliano and Victoire de Castellane in 2005, it impact the trend of Dior’s Fashion style. It is not difficult to image women would like taking a lot of money in a new style handbag, that means they also would expend a high price on a fashion watch if it is a new fashion trend in their minds. Furthermore to open up new avenues of business, Christian Dior began cracking other business areas. The first step is co-operating with other brands which is famous on other business industries. For example, On June 2008, Dior co-operated with Apple, created a dress for Apple’s iphone. It was named “Dior Homme iPhone Holder”, obviously, it was so expensive, compare with old iPhone, Dior Hommer iPhone Holder cost twice price. It is the not the first time Christian Dior enter into another total different industry. Then, Christian Dior collaborate Mode Labs and produced its handset. This handset is called “My Dior”, and it is extremely expensive, with a 2 Mega pixel camera, a tough screen, and multimedia goodies. One My Dior’s retail is start from 5000 dollars. And Dior’s company will come up with its own new mobile later soon. (Troaca, 2008) Environmental and Legal Obviously, Christian Dior is Legal company, it keeps abiding by every laws, including employee’s law; company environment condition; fair competitive law and others. Because obey these laws are the basic situations to run a company. Five Forces Framework: It will follow 5 parts: Competitive Rivalry, Buyer, Suppliers, Substitutes, and Potential Entrants. Competitive Rivalry Some researches show the price is not the most important factor customers would consider, they are more focus on the value of the products. Like Dior, many rich people are honest fans of its products through the price is very high. This is a big difference between normal products and luxury goods. They buy Dior for distinguishing others. According to the psychology of customers, Dior promoted a strategy from 2003, which is called limited edition. Dior Company produces some goods with specific design, and most important point is the company will control the numbers of the goods. It made a big success until now, every time when Dior creates new limited-good, they will be sold much quickly than others. Beside great quality goods, Dior pays a lot of attentions on its services for customers, Dall’Olmo Riley and Lacroix ( 2000) pointed out that all luxury brands not only focus on selling goods but also making a great relationship with their customers after sale. All of these strategies made Dior Compare with its biggest competitors like Gucci, Armani, and Hermes. Christian Dior got more benefits in sales within its talent manager groups.",Retail/Product,Find & Summarize,Text Transformation "Using only the information contained in the prompt/context block below, (do not use any external resources or prior knowledge), answer the following question.","Compare/contrast two organic fertilizers: seaweed extract and fish emulsion, how are they the same/different from each other?","Plant by-products: Alfalfa Meal or Pellets Alfalfa meal or pellets are often used as animal feed. Primarily they are used to increase organic matter in the soil but do provide nutrients and a high availability of trace minerals. They contain trianconatol, a natural fatty acid growth stimulant. Corn Gluten meal Corn Gluten products have a high percentage of nitrogen. It carries a warning to allow 1 to 4 months of decomposition in the soil prior to seeding. Allelopathic properties will inhibit the germination of seeds. However, there is no danger to established or transplanted plants. This product is also marketed as a pre-emergent weed control for annual grasses in bluegrass lawns. Cottonseed meal In warm soils this fertilizer is readily available with little danger of over-fertilizing. Use for acid-loving plants such as rhododendrons, blueberries and azaleas. Seaweed extract Seaweed is a good source of trace metals, micronutrients, amino acids and vitamins plus growth hormones that stimulate plant cell division. It doesn't smell as much as a fish emulsion but is more expensive. Kelp Meal – a product of the ocean is primarily used as a trace mineral source. It is often combined with fish meal to add N-P-K value Kelp Powder – similar to kelp meal but ground fine enough to put into solution and applied as a foliar spray or injected into an irrigation system. Liquid Kelp – usually cold processed, liquid kelp will have higher levels of growth hormones than extracts. Some may be enzymatically digested, making growth hormones even more available to the plants. Animal by-products: Manures Nutrient concentrations in manures vary widely with the kind of animal they're from. Fresh manure has the highest concentration and can burn tender roots easily. Composted manure is less harsh. Although the concentration of nutrients is lower in manure than in man-made fertilizers, manure improves soil structure and increases its water holding capacity. Blood meal This dried blood from cattle slaughterhouses is a rich source of nitrogen. Do not apply at more than recommended rates because it is concentrated enough to harm plants. Always wear a mask to protect your lungs from dust. Bone Meal Bone meal decomposes slowly and releases phosphorus gradually. Bone meal is good for bulbs that don't sprout for several months after they're planted and for alkaline-loving plants such as clematis, lilac and hydrangea. NOTE: Rarely need phosphorus in the Spokane area. Feather Meal Sourced from poultry slaughter feather meal has high nitrogen (N) levels but is very slow to release the N. Fish emulsion This well-rounded fertilizer consists of partly decomposed ground fish. The smell is strong but will dissipate in a day or two, and can deter pests that don't like the fish smell. It has a high concentration of nitrogen and can burn plants if over-used (especially container plants). Enzymatically digested hydrolyzed liquid fish Enzymatically digested hydrolyzed fish use enzymes to digest the fish wastes instead of using heat and acids (fish emulsion). This retains more of the proteins, enzymes, vitamins and micronutrients than emulsions. Fish meal Fish meal is ground and heat dried fish waste.","Using only the information contained in the prompt/context block below, (do not use any external resources or prior knowledge), answer the following question. Compare/contrast two organic fertilizers: seaweed extract and fish emulsion, how are they the same/different from each other? Plant by-products: Alfalfa Meal or Pellets Alfalfa meal or pellets are often used as animal feed. Primarily they are used to increase organic matter in the soil but do provide nutrients and a high availability of trace minerals. They contain trianconatol, a natural fatty acid growth stimulant. Corn Gluten meal Corn Gluten products have a high percentage of nitrogen. It carries a warning to allow 1 to 4 months of decomposition in the soil prior to seeding. Allelopathic properties will inhibit the germination of seeds. However, there is no danger to established or transplanted plants. This product is also marketed as a pre-emergent weed control for annual grasses in bluegrass lawns. Cottonseed meal In warm soils this fertilizer is readily available with little danger of over-fertilizing. Use for acid-loving plants such as rhododendrons, blueberries and azaleas. Seaweed extract Seaweed is a good source of trace metals, micronutrients, amino acids and vitamins plus growth hormones that stimulate plant cell division. It doesn't smell as much as a fish emulsion but is more expensive. Kelp Meal – a product of the ocean is primarily used as a trace mineral source. It is often combined with fish meal to add N-P-K value Kelp Powder – similar to kelp meal but ground fine enough to put into solution and applied as a foliar spray or injected into an irrigation system. Liquid Kelp – usually cold processed, liquid kelp will have higher levels of growth hormones than extracts. Some may be enzymatically digested, making growth hormones even more available to the plants. Animal by-products: Manures Nutrient concentrations in manures vary widely with the kind of animal they're from. Fresh manure has the highest concentration and can burn tender roots easily. Composted manure is less harsh. Although the concentration of nutrients is lower in manure than in man-made fertilizers, manure improves soil structure and increases its water holding capacity. Blood meal This dried blood from cattle slaughterhouses is a rich source of nitrogen. Do not apply at more than recommended rates because it is concentrated enough to harm plants. Always wear a mask to protect your lungs from dust. Bone Meal Bone meal decomposes slowly and releases phosphorus gradually. Bone meal is good for bulbs that don't sprout for several months after they're planted and for alkaline-loving plants such as clematis, lilac and hydrangea. NOTE: Rarely need phosphorus in the Spokane area. Feather Meal Sourced from poultry slaughter feather meal has high nitrogen (N) levels but is very slow to release the N. Fish emulsion This well-rounded fertilizer consists of partly decomposed ground fish. The smell is strong but will dissipate in a day or two, and can deter pests that don't like the fish smell. It has a high concentration of nitrogen and can burn plants if over-used (especially container plants). Enzymatically digested hydrolyzed liquid fish Enzymatically digested hydrolyzed fish use enzymes to digest the fish wastes instead of using heat and acids (fish emulsion). This retains more of the proteins, enzymes, vitamins and micronutrients than emulsions. Fish meal Fish meal is ground and heat dried fish waste.",Retail/Product,Concept Comparison,Q&A "Respond only with information present in the document. If the information is not present, respond with ""This information is not available"". When possible, use quotations and cite the document directly.",What were the results of the study?,"2010 Personal Financial Planning Attitudes - A Study Scott A. Yetmar Cleveland State University, s.yetmar@csuohio.edu D. Murphy Follow this and additional works at: https://engagedscholarship.csuohio.edu/bus_facpub Part of the Finance and Financial Management Commons How does access to this work benefit you? Let us know! Original Published Citation Yetmar, S., Murphy, D. (2010). Personal Financial Planning Attitudes - A Study. Management Research Review/ Emerald Publications, 33(8), pp. 811 – 817. This Article is brought to you for free and open access by the Monte Ahuja College of Business at EngagedScholarship@CSU. It has been accepted for inclusion in Business Faculty Publications by an authorized administrator of EngagedScholarship@CSU. For more information, please contact library.es@csuohio.edu. Personal financial planning attitudes: a preliminary study of graduate students David S. Murphy School of Business and Economics, Lynchburg College, Lynchburg, Virginia, USA, and Scott Yetmar College of Business Administration, Cleveland State University, Cleveland, Ohio, USA Abstract Purpose - The purpose of this paper is to report on a survey about the personal financial planning attitudes of MBA students in the USA. Design/methodology/approach - The study surveyed 206 MBA students about their attitudes to personal financial planning. Participants were asked about their level of knowledge, whether they had prepared components of a financial plan, where they might seek assistance in such a process and the criteria for selecting a financial planner. In addition, participants were asked to indicate their level of confidence in a financial plan's capacity to help them meet their long-term needs and the likelihood that they would implement such a plan. Findings - The findings indicate that, while most respondents feel both that financial planning is important and that they are interested in developing a financial plan, very few feel that they have the necessary skills and knowledge to prepare their own plan. In addition, the participants indicated a strong preference for professional personal financial planning advice. The study also indicates that less than 13 percent have prepared a comprehensive personal financial plan. When asked to identify the one professional from whom they would seek advice, certified financial planners were the preferred resource. Research limitations/implications - While the results are not generalizable to the wider population, the views of this group are important because one might expect that educated individuals would be both more interested in personal financial planning and more capable of prepaJing their own plans compaJ'ed with average Americans. Practical implications - The study presents some implications for practice and financial literacy education from a US perspective. Originality/value - A perceived need of respondents is to feel that their financial planner will put their needs first. While some professionals believe this to be the hallmark of ""independence,"" the respondents placed less impOltance on planner independence. In order to foster client confidence, planners must act in ways that convey clearly the primacy of their clients' needs. Keywords Graduates, United States of America, Financial services, Personal finance Paper type Research paper Introduction The need for financial security, especially during retirement years, has been met historically in the United States (USA) in three ways: personal savings (including insurance and annuities), social insurance programs like social security and employersponsored pension programs. Employer-sponsored pension programs have been the cornerstone of these financial security tools. Consequently, pension programs have been the target of continual legislative actions. The Employee Retimnent Income and Security Act of 1974 made significant and wide-sweeping changes that affected most aspects of corporate and self-employed pension programs (that is, legal, tax, investment and actuarial) and initiated 4010,) programs. These changes lead to an increase in the popularity of defined-contribution pension plans. Number oj participants Female lVIale Mean age Hig/zest educatiollal/evel Bachelor's degree lVIaster's degree Doctoral degree Mean years of work experience Number employed in accounting or finance lVIean annual income (USD) (%) Jl = 206 104 50.98 102 49.02 29.1 years 17l 85.9 23 11.6 5 2.5 6.5 years Table II. 25 12.25 Summary participant 47,558 demographics Attitudes toward planning Participants were asked specifically whether they thought that preparing a personal financial plan was important; whether they were interested in preparing such a plan; whether they had time to do so; and whether or not they felt that they had the necessary skills and knowledge to prepare a personal financial plan. The results of these four questions are summarized in Table III. It is interesting to note that the percentage of participants who indicated that they had the skills and knowledge necessary to prepare a personal financial plan (33 percent) is slightly lower than the percentage of Americans in the University of Michigan study who had tried to calculate their retirement fund needs (Employee Benefit News, 2005). Of the 68 participants who indicated that they had the necessary skills and lmowledge to prepare a personal financial plan, 47 indicated employment in accotmting or finance positions. Only 69 of the subjects (33.5 percent) indicated that they had prepared a written, comprehensive personal financial plan. A complete financial plan addresses many issues, some of which are not applicable to all individuals. Consequently, the participants were also asked to identify plan components that they had prepared. These results are summarized in Table IV. As evident in Table Iv, the participants in the study have not prepared many of the components of a comprehensive financial plan. About the same percentage of participants who reported that they had the skills and knowledge needed to prepare a financial plan (33 percent) had actually prepared such a plan (33.5 percent). Approximately one in five participants had prepared an educational funding analysis. Affirmative responses (%) Personal financial planning is important 156 75.7 Interested in personal financial planning 138 67 Table m. Have the time to prepare a personal financial plan 83 40 Financial planning Have the skills and knowledge to prepare a personal financial plan 68 33 interest and knowledge Accountants (CPA) were selected by 19.4 percent of the respondents. This percentage was divided between CPAlPFS (15.5 percent) and CPAs (3.9 percent). Other financial planning designations (for example, Charted Life Underwriter [CLUJ, Certified Fund Specialist [CFS] and Charted Financial Consultant [ChFCl) were included in the study but were selected by only a few participants. Weston (2008) indicates that there are about 250,000 individuals in the marketplace who identify themselves as financial planners. Of that number, about 56,000 have earned some kind of professional certification. The CFp® designation appears to be the most popular with about 58,000 certificate holders (CFP Board, 2008). Participants' reported preference for CFPs® is consistent with the predominance of CFp® certificate holders in the marketplace. When asked whether they preferred fee only, fee and compensation or compensation only planners, the majority of participants (127 or 61.7 percent) indicated that they preferred fee·only planners. Only 30 participants (14.6 percent) indicated a preference for working with a fee and commission planner while 49 (23.8 percent) indicated that they would seek the advice of a commission only planner. Participants were also asked to rank six different reasons for selecting a specific planner. The results of their rankings are shown in Table VI. The most important planner characteristic, as suggested by the participants, is that the planner places the client's needs first. This predisposition is consistent with the expressed desire by the majority of the respondents to work with a fee·only planner. The desire that the planner demonstrates high levels of product familiarity means that fee·only planners must be as familiar with the products that they recommend, as are commission-only planners. Fee-only planners often use noload funds for plan implementation, products for which they do not receive a commission. Low transactions costs or the use of commissionfree financial products ranked last in importance among the participants. Participants ranked freedom of choice third in importance. Thus, it may be important for all planners to present clients with a menu of choices for plan implementation. Selecting a number of different funds, for example, with similar risk-return characteristics and time horizons and letting the client make the final selection may help meet this perceived need. Planner independence and confidence ranked considerably lower than did meeting clients needs first and product familiarity. Independence is an attribute often used as a selling point by CPAlPFSs. It appears that this independence may give them little competitive advantage in the marketplace or at least among graduate business students. Finally, participants were asked to indicate their level of confidence in a financial plan's capacity to help them meet their long-term needs (measured on a scale of 1 = not at all confident to 5 = extremely confident) and the likelihood that they would Criteria Mean ranka SD I want to know that the planner will put my needs first Planner's familiarity with products I want to preserve my freedom of choice in product selection I want to feel that the financial planner is confident in hislher recommendations I want to feel that my planner is independent Reduced transaction costs Note: ""1 = Most important to 6 = least important 1.78 1.61 3.08 1.59 3.37 1.30 3.60 1.48 3.99 1.68 4.86 1.44 Table VI. Planner selection criteria the majority of them do not view their CPAs as potential providers of financial planning advice. Very few of the respondents indicated that they would seek the advice of CFS, ChFC or CLU. These are designations normally held by insurance professionals. This also is surprising because the most frequently mentioned professional relationship was with an insurance agent. Indeed, 40.7 percent of the respondents had established such a relationship. It appears that both the insurance and public accounting professions have not had the same success in promoting members of their professions as personal financial planners. A perceived need by the respondents to feel that their financial planner will put the client's needs first is clearly apparent in Table VI. While some professionals may feel that this is the hallmark of ""independence"", the respondents placed much less importance on a planner's independence. Thus, to foster a client's confidence, planners must act in ways that very clearly convey the message to the client that their needs are paramount. References CFP Board of Standards (2008), ""CFP certificant profile"", available at: www.cfp.net/media/ profile.asp#link4 (accessed 14 September 2008). Employee Benefit News (2005), ""Lack of basic financial knowledge impairs retirement"", available at: www.benefitnews.com/retire/detai1.cfrn?id=8116 (accessed 28 November 2005). Federal Reserve Bank of St Louis (2005), National Economic Trends, available at: http:// research.stlouisfed.org/publicaitons/netl20051101/neL20051108.pdf (accessed 28 November 2005). Harris Interactive (2005), ""Nearly half of US workers participate in a 401(k) or 403(b) plan, New Wall Street Journal OnlinelHarris interactive personal finance poll"", available at: www. harrisinteractive.comlnews/allnewsbydate.asp?NewsID=976 (accessed 10 October 2005). US Department of Labor (2005), Preiimillmy Private Pension Plan Bulletin, Abstract of 2000, Form 5500 Annual Reports. Weston, L.P. (2008), 8 Things YOUI' Financial Planner Won't Tell YOIl, available at: http:// artic1es.moneycentra1.msn.comlRetirementandWills/CreateaPlan/8Things YourFinancial PlannerWontTellYou.aspx (accessed 14 September 2008). Further reading Rattiner, J,H. (2005), Getting Started as a Financial Planner, revised ed., Bloomberg Press, New York, NY.","Respond only with information present in the document. If the information is not present, respond with ""This information is not available"". When possible, use quotations and cite the document directly. What were the results of the study? 2010 Personal Financial Planning Attitudes - A Study Scott A. Yetmar Cleveland State University, s.yetmar@csuohio.edu D. Murphy Follow this and additional works at: https://engagedscholarship.csuohio.edu/bus_facpub Part of the Finance and Financial Management Commons How does access to this work benefit you? Let us know! Original Published Citation Yetmar, S., Murphy, D. (2010). Personal Financial Planning Attitudes - A Study. Management Research Review/ Emerald Publications, 33(8), pp. 811 – 817. This Article is brought to you for free and open access by the Monte Ahuja College of Business at EngagedScholarship@CSU. It has been accepted for inclusion in Business Faculty Publications by an authorized administrator of EngagedScholarship@CSU. For more information, please contact library.es@csuohio.edu. Personal financial planning attitudes: a preliminary study of graduate students David S. Murphy School of Business and Economics, Lynchburg College, Lynchburg, Virginia, USA, and Scott Yetmar College of Business Administration, Cleveland State University, Cleveland, Ohio, USA Abstract Purpose - The purpose of this paper is to report on a survey about the personal financial planning attitudes of MBA students in the USA. Design/methodology/approach - The study surveyed 206 MBA students about their attitudes to personal financial planning. Participants were asked about their level of knowledge, whether they had prepared components of a financial plan, where they might seek assistance in such a process and the criteria for selecting a financial planner. In addition, participants were asked to indicate their level of confidence in a financial plan's capacity to help them meet their long-term needs and the likelihood that they would implement such a plan. Findings - The findings indicate that, while most respondents feel both that financial planning is important and that they are interested in developing a financial plan, very few feel that they have the necessary skills and knowledge to prepare their own plan. In addition, the participants indicated a strong preference for professional personal financial planning advice. The study also indicates that less than 13 percent have prepared a comprehensive personal financial plan. When asked to identify the one professional from whom they would seek advice, certified financial planners were the preferred resource. Research limitations/implications - While the results are not generalizable to the wider population, the views of this group are important because one might expect that educated individuals would be both more interested in personal financial planning and more capable of prepaJing their own plans compaJ'ed with average Americans. Practical implications - The study presents some implications for practice and financial literacy education from a US perspective. Originality/value - A perceived need of respondents is to feel that their financial planner will put their needs first. While some professionals believe this to be the hallmark of ""independence,"" the respondents placed less impOltance on planner independence. In order to foster client confidence, planners must act in ways that convey clearly the primacy of their clients' needs. Keywords Graduates, United States of America, Financial services, Personal finance Paper type Research paper Introduction The need for financial security, especially during retirement years, has been met historically in the United States (USA) in three ways: personal savings (including insurance and annuities), social insurance programs like social security and employersponsored pension programs. Employer-sponsored pension programs have been the cornerstone of these financial security tools. Consequently, pension programs have been the target of continual legislative actions. The Employee Retimnent Income and Security Act of 1974 made significant and wide-sweeping changes that affected most aspects of corporate and self-employed pension programs (that is, legal, tax, investment and actuarial) and initiated 4010,) programs. These changes lead to an increase in the popularity of defined-contribution pension plans. Number oj participants Female lVIale Mean age Hig/zest educatiollal/evel Bachelor's degree lVIaster's degree Doctoral degree Mean years of work experience Number employed in accounting or finance lVIean annual income (USD) (%) Jl = 206 104 50.98 102 49.02 29.1 years 17l 85.9 23 11.6 5 2.5 6.5 years Table II. 25 12.25 Summary participant 47,558 demographics Attitudes toward planning Participants were asked specifically whether they thought that preparing a personal financial plan was important; whether they were interested in preparing such a plan; whether they had time to do so; and whether or not they felt that they had the necessary skills and knowledge to prepare a personal financial plan. The results of these four questions are summarized in Table III. It is interesting to note that the percentage of participants who indicated that they had the skills and knowledge necessary to prepare a personal financial plan (33 percent) is slightly lower than the percentage of Americans in the University of Michigan study who had tried to calculate their retirement fund needs (Employee Benefit News, 2005). Of the 68 participants who indicated that they had the necessary skills and lmowledge to prepare a personal financial plan, 47 indicated employment in accotmting or finance positions. Only 69 of the subjects (33.5 percent) indicated that they had prepared a written, comprehensive personal financial plan. A complete financial plan addresses many issues, some of which are not applicable to all individuals. Consequently, the participants were also asked to identify plan components that they had prepared. These results are summarized in Table IV. As evident in Table Iv, the participants in the study have not prepared many of the components of a comprehensive financial plan. About the same percentage of participants who reported that they had the skills and knowledge needed to prepare a financial plan (33 percent) had actually prepared such a plan (33.5 percent). Approximately one in five participants had prepared an educational funding analysis. Affirmative responses (%) Personal financial planning is important 156 75.7 Interested in personal financial planning 138 67 Table m. Have the time to prepare a personal financial plan 83 40 Financial planning Have the skills and knowledge to prepare a personal financial plan 68 33 interest and knowledge Accountants (CPA) were selected by 19.4 percent of the respondents. This percentage was divided between CPAlPFS (15.5 percent) and CPAs (3.9 percent). Other financial planning designations (for example, Charted Life Underwriter [CLUJ, Certified Fund Specialist [CFS] and Charted Financial Consultant [ChFCl) were included in the study but were selected by only a few participants. Weston (2008) indicates that there are about 250,000 individuals in the marketplace who identify themselves as financial planners. Of that number, about 56,000 have earned some kind of professional certification. The CFp® designation appears to be the most popular with about 58,000 certificate holders (CFP Board, 2008). Participants' reported preference for CFPs® is consistent with the predominance of CFp® certificate holders in the marketplace. When asked whether they preferred fee only, fee and compensation or compensation only planners, the majority of participants (127 or 61.7 percent) indicated that they preferred fee·only planners. Only 30 participants (14.6 percent) indicated a preference for working with a fee and commission planner while 49 (23.8 percent) indicated that they would seek the advice of a commission only planner. Participants were also asked to rank six different reasons for selecting a specific planner. The results of their rankings are shown in Table VI. The most important planner characteristic, as suggested by the participants, is that the planner places the client's needs first. This predisposition is consistent with the expressed desire by the majority of the respondents to work with a fee·only planner. The desire that the planner demonstrates high levels of product familiarity means that fee·only planners must be as familiar with the products that they recommend, as are commission-only planners. Fee-only planners often use noload funds for plan implementation, products for which they do not receive a commission. Low transactions costs or the use of commissionfree financial products ranked last in importance among the participants. Participants ranked freedom of choice third in importance. Thus, it may be important for all planners to present clients with a menu of choices for plan implementation. Selecting a number of different funds, for example, with similar risk-return characteristics and time horizons and letting the client make the final selection may help meet this perceived need. Planner independence and confidence ranked considerably lower than did meeting clients needs first and product familiarity. Independence is an attribute often used as a selling point by CPAlPFSs. It appears that this independence may give them little competitive advantage in the marketplace or at least among graduate business students. Finally, participants were asked to indicate their level of confidence in a financial plan's capacity to help them meet their long-term needs (measured on a scale of 1 = not at all confident to 5 = extremely confident) and the likelihood that they would Criteria Mean ranka SD I want to know that the planner will put my needs first Planner's familiarity with products I want to preserve my freedom of choice in product selection I want to feel that the financial planner is confident in hislher recommendations I want to feel that my planner is independent Reduced transaction costs Note: ""1 = Most important to 6 = least important 1.78 1.61 3.08 1.59 3.37 1.30 3.60 1.48 3.99 1.68 4.86 1.44 Table VI. Planner selection criteria the majority of them do not view their CPAs as potential providers of financial planning advice. Very few of the respondents indicated that they would seek the advice of CFS, ChFC or CLU. These are designations normally held by insurance professionals. This also is surprising because the most frequently mentioned professional relationship was with an insurance agent. Indeed, 40.7 percent of the respondents had established such a relationship. It appears that both the insurance and public accounting professions have not had the same success in promoting members of their professions as personal financial planners. A perceived need by the respondents to feel that their financial planner will put the client's needs first is clearly apparent in Table VI. While some professionals may feel that this is the hallmark of ""independence"", the respondents placed much less importance on a planner's independence. Thus, to foster a client's confidence, planners must act in ways that very clearly convey the message to the client that their needs are paramount. References CFP Board of Standards (2008), ""CFP certificant profile"", available at: www.cfp.net/media/ profile.asp#link4 (accessed 14 September 2008). Employee Benefit News (2005), ""Lack of basic financial knowledge impairs retirement"", available at: www.benefitnews.com/retire/detai1.cfrn?id=8116 (accessed 28 November 2005). Federal Reserve Bank of St Louis (2005), National Economic Trends, available at: http:// research.stlouisfed.org/publicaitons/netl20051101/neL20051108.pdf (accessed 28 November 2005). Harris Interactive (2005), ""Nearly half of US workers participate in a 401(k) or 403(b) plan, New Wall Street Journal OnlinelHarris interactive personal finance poll"", available at: www. harrisinteractive.comlnews/allnewsbydate.asp?NewsID=976 (accessed 10 October 2005). US Department of Labor (2005), Preiimillmy Private Pension Plan Bulletin, Abstract of 2000, Form 5500 Annual Reports. Weston, L.P. (2008), 8 Things YOUI' Financial Planner Won't Tell YOIl, available at: http:// artic1es.moneycentra1.msn.comlRetirementandWills/CreateaPlan/8Things YourFinancial PlannerWontTellYou.aspx (accessed 14 September 2008). Further reading Rattiner, J,H. (2005), Getting Started as a Financial Planner, revised ed., Bloomberg Press, New York, NY.",Financial,Find & Summarize,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",What are the main differences between owning an LLC or Sole proprietorship? Which is better for a small business? what are the steps I would have to take to get either one?,"Your business structure affects how much you pay in taxes, your ability to raise money, the paperwork you need to file, and your personal liability. You'll need to choose a business structure before you register your business with the state. Most businesses will also need to get a tax ID number and file for the appropriate licenses and permits. Choose carefully. While you may convert to a different business structure in the future, there may be restrictions based on your location. This could also result in tax consequences and unintended dissolution, among other complications. Consulting with business counselors, attorneys, and accountants can prove helpful. Review common business structures Sole proprietorship A sole proprietorship is easy to form and gives you complete control of your business. You're automatically considered to be a sole proprietorship if you do business activities but don't register as any other kind of business. Sole proprietorships do not produce a separate business entity. This means your business assets and liabilities are not separate from your personal assets and liabilities. You can be held personally liable for the debts and obligations of the business. Sole proprietors are still able to get a trade name. It can also be hard to raise money because you can't sell stock, and banks are hesitant to lend to sole proprietorships. Sole proprietorships can be a good choice for low-risk businesses and owners who want to test their business idea before forming a more formal business. Partnership Partnerships are the simplest structure for two or more people to own a business together. There are two common kinds of partnerships: limited partnerships (LP) and limited liability partnerships (LLP). Limited partnerships have only one general partner with unlimited liability, and all other partners have limited liability. The partners with limited liability also tend to have limited control over the company, which is documented in a partnership agreement. Profits are passed through to personal tax returns, and the general partner — the partner without limited liability — must also pay self-employment taxes. Limited liability partnerships are similar to limited partnerships, but give limited liability to every owner. An LLP protects each partner from debts against the partnership, they won't be responsible for the actions of other partners. Partnerships can be a good choice for businesses with multiple owners, professional groups (like attorneys), and groups who want to test their business idea before forming a more formal business. Limited liability company (LLC) An LLC lets you take advantage of the benefits of both the corporation and partnership business structures. LLCs protect you from personal liability in most instances, your personal assets — like your vehicle, house, and savings accounts — won't be at risk in case your LLC faces bankruptcy or lawsuits. Profits and losses can get passed through to your personal income without facing corporate taxes. However, members of an LLC are considered self-employed and must pay self-employment tax contributions towards Medicare and Social Security. LLCs can have a limited life in many states. When a member joins or leaves an LLC, some states may require the LLC to be dissolved and re-formed with new membership — unless there's already an agreement in place within the LLC for buying, selling, and transferring ownership. LLCs can be a good choice for medium- or higher-risk businesses, owners with significant personal assets they want protected, and owners who want to pay a lower tax rate than they would with a corporation. Corporation C corp A corporation, sometimes called a C corp, is a legal entity that's separate from its owners. Corporations can make a profit, be taxed, and can be held legally liable. Corporations offer the strongest protection to its owners from personal liability, but the cost to form a corporation is higher than other structures. Corporations also require more extensive record-keeping, operational processes, and reporting. Unlike sole proprietors, partnerships, and LLCs, corporations pay income tax on their profits. In some cases, corporate profits are taxed twice — first, when the company makes a profit, and again when dividends are paid to shareholders on their personal tax returns. Corporations have a completely independent life separate from its shareholders. If a shareholder leaves the company or sells his or her shares, the C corp can continue doing business relatively undisturbed. Corporations have an advantage when it comes to raising capital because they can raise funds through the sale of stock, which can also be a benefit in attracting employees. Corporations can be a good choice for medium- or higher-risk businesses, those that need to raise money, and businesses that plan to ""go public"" or eventually be sold. S corp An S corporation, sometimes called an S corp, is a special type of corporation that's designed to avoid the double taxation drawback of regular C corps. S corps allow profits, and some losses, to be passed through directly to owners' personal income without ever being subject to corporate tax rates. Not all states tax S corps equally, but most recognize them the same way the federal government does and tax the shareholders accordingly. Some states tax S corps on profits above a specified limit and other states don't recognize the S corp election at all, simply treating the business as a C corp. S corps must file with the IRS to get S corp status, a different process from registering with their state. There are special limits on S corps. Check the IRS website for eligibility requirements(Link is external). You'll still have to follow the strict filing and operational processes of a C corp. S corps also have an independent life, just like C corps. If a shareholder leaves the company or sells his or her shares, the S corp can continue doing business relatively undisturbed. S corps can be a good choice for a businesses that would otherwise be a C corp, but meet the criteria to file as an S corp Compare business structures Compare the general traits of these business structures, but remember that ownership rules, liability, taxes, and filing requirements for each business structure can vary by state. The following table is intended only as a guideline. Please confer with a business tax specialist to confirm your specific business needs. Business structure Ownership Liability Taxes Sole proprietorship One person Unlimited personal liability Self-employment tax Partnerships Two or more people Unlimited personal liability unless structured as a limited partnership Self-employment tax (except for limited partners) Limited liability company (LLC) One or more people Owners are not personally liable Self-employment tax","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. What are the main differences between owning an LLC or Sole proprietorship? Which is better for a small business? what are the steps I would have to take to get either one? Your business structure affects how much you pay in taxes, your ability to raise money, the paperwork you need to file, and your personal liability. You'll need to choose a business structure before you register your business with the state. Most businesses will also need to get a tax ID number and file for the appropriate licenses and permits. Choose carefully. While you may convert to a different business structure in the future, there may be restrictions based on your location. This could also result in tax consequences and unintended dissolution, among other complications. Consulting with business counselors, attorneys, and accountants can prove helpful. Review common business structures Sole proprietorship A sole proprietorship is easy to form and gives you complete control of your business. You're automatically considered to be a sole proprietorship if you do business activities but don't register as any other kind of business. Sole proprietorships do not produce a separate business entity. This means your business assets and liabilities are not separate from your personal assets and liabilities. You can be held personally liable for the debts and obligations of the business. Sole proprietors are still able to get a trade name. It can also be hard to raise money because you can't sell stock, and banks are hesitant to lend to sole proprietorships. Sole proprietorships can be a good choice for low-risk businesses and owners who want to test their business idea before forming a more formal business. Partnership Partnerships are the simplest structure for two or more people to own a business together. There are two common kinds of partnerships: limited partnerships (LP) and limited liability partnerships (LLP). Limited partnerships have only one general partner with unlimited liability, and all other partners have limited liability. The partners with limited liability also tend to have limited control over the company, which is documented in a partnership agreement. Profits are passed through to personal tax returns, and the general partner — the partner without limited liability — must also pay self-employment taxes. Limited liability partnerships are similar to limited partnerships, but give limited liability to every owner. An LLP protects each partner from debts against the partnership, they won't be responsible for the actions of other partners. Partnerships can be a good choice for businesses with multiple owners, professional groups (like attorneys), and groups who want to test their business idea before forming a more formal business. Limited liability company (LLC) An LLC lets you take advantage of the benefits of both the corporation and partnership business structures. LLCs protect you from personal liability in most instances, your personal assets — like your vehicle, house, and savings accounts — won't be at risk in case your LLC faces bankruptcy or lawsuits. Profits and losses can get passed through to your personal income without facing corporate taxes. However, members of an LLC are considered self-employed and must pay self-employment tax contributions towards Medicare and Social Security. LLCs can have a limited life in many states. When a member joins or leaves an LLC, some states may require the LLC to be dissolved and re-formed with new membership — unless there's already an agreement in place within the LLC for buying, selling, and transferring ownership. LLCs can be a good choice for medium- or higher-risk businesses, owners with significant personal assets they want protected, and owners who want to pay a lower tax rate than they would with a corporation. Corporation C corp A corporation, sometimes called a C corp, is a legal entity that's separate from its owners. Corporations can make a profit, be taxed, and can be held legally liable. Corporations offer the strongest protection to its owners from personal liability, but the cost to form a corporation is higher than other structures. Corporations also require more extensive record-keeping, operational processes, and reporting. Unlike sole proprietors, partnerships, and LLCs, corporations pay income tax on their profits. In some cases, corporate profits are taxed twice — first, when the company makes a profit, and again when dividends are paid to shareholders on their personal tax returns. Corporations have a completely independent life separate from its shareholders. If a shareholder leaves the company or sells his or her shares, the C corp can continue doing business relatively undisturbed. Corporations have an advantage when it comes to raising capital because they can raise funds through the sale of stock, which can also be a benefit in attracting employees. Corporations can be a good choice for medium- or higher-risk businesses, those that need to raise money, and businesses that plan to ""go public"" or eventually be sold. S corp An S corporation, sometimes called an S corp, is a special type of corporation that's designed to avoid the double taxation drawback of regular C corps. S corps allow profits, and some losses, to be passed through directly to owners' personal income without ever being subject to corporate tax rates. Not all states tax S corps equally, but most recognize them the same way the federal government does and tax the shareholders accordingly. Some states tax S corps on profits above a specified limit and other states don't recognize the S corp election at all, simply treating the business as a C corp. S corps must file with the IRS to get S corp status, a different process from registering with their state. There are special limits on S corps. Check the IRS website for eligibility requirements(Link is external). You'll still have to follow the strict filing and operational processes of a C corp. S corps also have an independent life, just like C corps. If a shareholder leaves the company or sells his or her shares, the S corp can continue doing business relatively undisturbed. S corps can be a good choice for a businesses that would otherwise be a C corp, but meet the criteria to file as an S corp Compare business structures Compare the general traits of these business structures, but remember that ownership rules, liability, taxes, and filing requirements for each business structure can vary by state. The following table is intended only as a guideline. Please confer with a business tax specialist to confirm your specific business needs. Business structure Ownership Liability Taxes Sole proprietorship One person Unlimited personal liability Self-employment tax Partnerships Two or more people Unlimited personal liability unless structured as a limited partnership Self-employment tax (except for limited partners) Limited liability company (LLC) One or more people Owners are not personally liable Self-employment tax https://www.sba.gov/business-guide/launch-your-business/choose-business-structure",Legal,Find & Summarize,Text Transformation Use only the provided text to formulate your answer; use no other sources. Answer in a maximum of two short paragraphs.,Why might a ticket be available in the secondary market?,"Each year, millions of Americans purchase tickets for live entertainment events, such as concerts, theatrical performances, and sporting events. In 2023, about 81 million fans in North America and 145 million fans across the world attended events that were produced by Live Nation Entertainment—a firm that promotes events, owns venues, and provides ticketing services through its subsidiary, Ticketmaster.1 IBISWorld, a market research firm, projects revenue for online ticket sales in the United States in 2024 will be $12.7 billion, with $4.2 billion (33.3%) spent on sporting events; $3.9 billion (30.7%) on concerts; and $1.5 billion (11.8%) on dance, opera, and theatrical performances.2 Congress has held hearings, 3 debated bills, and passed legislation4 related to tickets for live events (Appendix). Some Members of the 118th Congress have called attention to event ticketing issues, such as rising ticket prices (potentially due to higher ticketing service fees), and efforts to increase consumer protection (e.g., by requiring full price disclosure for tickets from the beginning of a transaction). 5 Some states have enacted legislation related to event ticketing, including legislation that seeks to address these same concerns. 6 This report provides an overview of event ticketing and actions taken by the federal government related to event ticketing. It also discusses selected legislative proposals from the 118th Congress. Overview of Event Ticketing and Selected Issues Tickets for live events initially are sold in the primary market. In the primary market, firms that provide ticketing services (i.e., ticketers) work directly with venues, promoters, producers, sports teams, and other entities to sell tickets to consumers (see Figure 1). Most tickets in the primary market are sold online,7 although some tickets may be available through other outlets, such as a local box office or call center.8 Events typically have one primary ticketer selling tickets online. For example, the primary ticketer for most Major League Baseball (MLB) teams is Tickets.com 1 Live Nation Entertainment, Inc., Securities and Exchange Commission (SEC) Form 10-K for the year ending December 31, 2023, pp. 30, 36. 2 IBISWorld, Online Event Ticket Sales in the U.S., April 2024, pp. 8-9 (hereinafter IBISWorld, Online Event Ticket Sales in the U.S.). 3 For example, see U.S. Congress, Senate Committee on the Judiciary, That’s the Ticket: Promoting Competition and Protecting Consumers in Live Entertainment, hearing, 118th Cong., 1st sess., January 24, 2023, S.Hrg. 118-31 (Washington, DC: GPO, 2023), https://www.govinfo.gov/content/pkg/CHRG-118shrg52250/pdf/CHRG118shrg52250.pdf (hereinafter Senate Judiciary hearing, That’s the Ticket), and U.S. Congress, House Energy and Commerce Committee, Subcommittee on Oversight and Investigations, In the Dark: Lack of Transparency in the Live Event Ticketing Industry, hearing, 116th Cong., 2nd sess., February 26, 2020, https://docs.house.gov/Committee/ Calendar/ByEvent.aspx?EventId=110588. 4 The 114th Congress passed the Better Online Ticket Sales Act of 2016 (BOTS Act; P.L. 114-274). For more information about the BOTS Act, see “Federal Oversight of Event Ticketing.” 5 Senate Judiciary hearing, That’s the Ticket. 6 For example, some states require the total price of a ticket, including any taxes and fees, to be provided when the price is initially displayed (e.g., Connecticut General Statute §53-289a, Georgia Code Annotated §43-4B-28(a)(3), and New York Arts and Cultural Affairs Law §25.23). 7 For example, in 2022, Live Nation estimated that it sold 56%, 42%, and 2% of its tickets through mobile apps, websites, and ticket outlets, respectively. Live Nation Entertainment, Inc., SEC Form 10-K for the year ending December 31, 2022, p. 11. 8 IBISWorld, Online Event Ticket Sales in the U.S., p. 12; and U.S. Government Accountability Office (GAO), Event Ticket Sales: Market Characteristics and Consumer Protection Issues, April 2018, pp. 4-5, https://www.gao.gov/assets/ 700/691247.pdf (hereinafter GAO, Event Ticket Sales). E Tickets for Live Entertainment Events Congressional Research Service 2 (a subsidiary of MLB Advanced Media),9 and the primary ticketer for most National Football League (NFL) teams is Ticketmaster. 10 A portion of tickets might be sold through presales (e.g., an artist’s fan club or season tickets), bundled together as a package (e.g., group tickets), or held for certain individuals (e.g., sponsors, media, high-profile guests). 11 Some live event tickets might be nontransferable—consumers might be required to show the credit or debit card that was used to make the purchase and a matching photo ID to enter the event.12 Tickets for some live events also are available in the secondary market. In the secondary market, individuals who purchased tickets in the primary market can resell their tickets, typically using ticketers that operate in the secondary market. Individuals selling tickets in the secondary market can include consumers who cannot or no longer wish to attend the event, as well as ticket brokers who purchase tickets in the primary market with the intention of reselling them in the secondary market for a profit. Some event organizers provide tickets directly to ticket brokers. 13 Thus, an event can have multiple individuals using different secondary ticketers.","Use only the provided text to formulate your answer; use no other sources. Answer in a maximum of two short paragraphs. Provided text: Each year, millions of Americans purchase tickets for live entertainment events, such as concerts, theatrical performances, and sporting events. In 2023, about 81 million fans in North America and 145 million fans across the world attended events that were produced by Live Nation Entertainment—a firm that promotes events, owns venues, and provides ticketing services through its subsidiary, Ticketmaster.1 IBISWorld, a market research firm, projects revenue for online ticket sales in the United States in 2024 will be $12.7 billion, with $4.2 billion (33.3%) spent on sporting events; $3.9 billion (30.7%) on concerts; and $1.5 billion (11.8%) on dance, opera, and theatrical performances.2 Congress has held hearings, 3 debated bills, and passed legislation4 related to tickets for live events (Appendix). Some Members of the 118th Congress have called attention to event ticketing issues, such as rising ticket prices (potentially due to higher ticketing service fees), and efforts to increase consumer protection (e.g., by requiring full price disclosure for tickets from the beginning of a transaction). 5 Some states have enacted legislation related to event ticketing, including legislation that seeks to address these same concerns. 6 This report provides an overview of event ticketing and actions taken by the federal government related to event ticketing. It also discusses selected legislative proposals from the 118th Congress. Overview of Event Ticketing and Selected Issues Tickets for live events initially are sold in the primary market. In the primary market, firms that provide ticketing services (i.e., ticketers) work directly with venues, promoters, producers, sports teams, and other entities to sell tickets to consumers (see Figure 1). Most tickets in the primary market are sold online,7 although some tickets may be available through other outlets, such as a local box office or call center.8 Events typically have one primary ticketer selling tickets online. For example, the primary ticketer for most Major League Baseball (MLB) teams is Tickets.com 1 Live Nation Entertainment, Inc., Securities and Exchange Commission (SEC) Form 10-K for the year ending December 31, 2023, pp. 30, 36. 2 IBISWorld, Online Event Ticket Sales in the U.S., April 2024, pp. 8-9 (hereinafter IBISWorld, Online Event Ticket Sales in the U.S.). 3 For example, see U.S. Congress, Senate Committee on the Judiciary, That’s the Ticket: Promoting Competition and Protecting Consumers in Live Entertainment, hearing, 118th Cong., 1st sess., January 24, 2023, S.Hrg. 118-31 (Washington, DC: GPO, 2023), https://www.govinfo.gov/content/pkg/CHRG-118shrg52250/pdf/CHRG118shrg52250.pdf (hereinafter Senate Judiciary hearing, That’s the Ticket), and U.S. Congress, House Energy and Commerce Committee, Subcommittee on Oversight and Investigations, In the Dark: Lack of Transparency in the Live Event Ticketing Industry, hearing, 116th Cong., 2nd sess., February 26, 2020, https://docs.house.gov/Committee/ Calendar/ByEvent.aspx?EventId=110588. 4 The 114th Congress passed the Better Online Ticket Sales Act of 2016 (BOTS Act; P.L. 114-274). For more information about the BOTS Act, see “Federal Oversight of Event Ticketing.” 5 Senate Judiciary hearing, That’s the Ticket. 6 For example, some states require the total price of a ticket, including any taxes and fees, to be provided when the price is initially displayed (e.g., Connecticut General Statute §53-289a, Georgia Code Annotated §43-4B-28(a)(3), and New York Arts and Cultural Affairs Law §25.23). 7 For example, in 2022, Live Nation estimated that it sold 56%, 42%, and 2% of its tickets through mobile apps, websites, and ticket outlets, respectively. Live Nation Entertainment, Inc., SEC Form 10-K for the year ending December 31, 2022, p. 11. 8 IBISWorld, Online Event Ticket Sales in the U.S., p. 12; and U.S. Government Accountability Office (GAO), Event Ticket Sales: Market Characteristics and Consumer Protection Issues, April 2018, pp. 4-5, https://www.gao.gov/assets/ 700/691247.pdf (hereinafter GAO, Event Ticket Sales). E Tickets for Live Entertainment Events Congressional Research Service 2 (a subsidiary of MLB Advanced Media),9 and the primary ticketer for most National Football League (NFL) teams is Ticketmaster. 10 A portion of tickets might be sold through presales (e.g., an artist’s fan club or season tickets), bundled together as a package (e.g., group tickets), or held for certain individuals (e.g., sponsors, media, high-profile guests). 11 Some live event tickets might be nontransferable—consumers might be required to show the credit or debit card that was used to make the purchase and a matching photo ID to enter the event.12 Tickets for some live events also are available in the secondary market. In the secondary market, individuals who purchased tickets in the primary market can resell their tickets, typically using ticketers that operate in the secondary market. Individuals selling tickets in the secondary market can include consumers who cannot or no longer wish to attend the event, as well as ticket brokers who purchase tickets in the primary market with the intention of reselling them in the secondary market for a profit. Some event organizers provide tickets directly to ticket brokers. 13 Thus, an event can have multiple individuals using different secondary ticketers. Why might a ticket be available in the secondary market?",Legal,Fact Finding,Q&A Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here.,What are the Golden Rules of Great Customer Service?,"GOLDEN RULES TO GREAT CUSTOMER SERVICE Presented by Bill Huninghake & Rich York THE GOLDEN RULE DO UNTO OTHERS AS YOU WOULD HAVE THEM DO UNTO YOU. GOLDEN RULES TO GREAT CUSTOMER SERVICE 1. A CUSTOMER IN NEED IS A CUSTOMER INDEED. 2. HIRE PEOPLE WITH GOOD CUSTOMER SKILLS 3. TRAIN YOUR EMPLOYEES ON STORE POLICIES. 4. CROSS TRAIN YOUR EMPLOYEES. 5. TRAIN YOUR EMPLOYEES HOW TO BUILD RAPPORT. 6. KNOW YOUR CUSTOMERS NAMES AND USE THEM. 7. TRAIN YOUR EMPLOYEES HOW TO ASK OPEN ENDED QUESTIONS. 8. INSTILL A SENSE OF URGENCY IN HELPING CUSTOMERS. 9. TRAIN YOUR EMPLOYEES HOW TO HANDLE ANGRY CUSTOMERS. 10. DON’T LET AN UNHAPPY CUSTOMER LEAVE YOUR STORE. WHAT IS YOUR GOLDEN EGG? 1. IMPROVE CUSTOMER RETENTION 2. COMMUNITY INVOLVEMENT 3. INCREASE NEW CUSTOMERS 4. FRIENDLIEST PLACE AROUND 5. BEST PERISHABLES IN TOWN 6. BEST MEAT DEPARTMENT AROUND SUPERCENTER AFFILIATED FOODS STORE WHY DID THE CUSTOMER CROSS THE ROAD? Why Customers Quit Shopping Your Store Die, 1% Move, 3% Other Friendship, 5% Competition, 9% Product Dissatisfaction, 14% Attitude of an Employee 68% FIRST GOLDEN RULE A CUSTOMER IN NEED IS A CUSTOMER INDEED When there is not much difference between your product and the product of your competitor, there needs to be a BIG difference in the quality of service you provide your customer. SECOND GOLDEN RULE HIRE PEOPLE WITH GOOD CUSTOMER SERVICE SKILLS A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A -- 1 T -- 20 T -- 20 I -- 9 T -- 20 U -- 21 D -- 4 E -- 5 Attitude equals 100%. ATTITUDE IS A LITTLE THING THAT MAKES A BIG DIFFERENCE HOW TO HIRE GREAT EMPLOYEES: Seek out the great employees who already work for you. Interview them, find out what makes them tick. Write profiles of great employees. Find out what qualities they have in common. Then look to hire people with the same qualities. THIRD GOLDEN RULE TRAIN YOUR EMPLOYEES ON STORE POLICIES BE THE EXAMPLE FOR YOUR EMPLOYEES TO EMULATE. DON’T ASK YOUR EMPLOYEES TO DO SOMETHING YOU WOULDN’T. EXAMPLE POLICIES • Visit with customers • No whispering • Walk the customer to product • Don’t get in the customer’s way when working in the aisles • 10 ft rule – Greet the customer • 2 is company but 3 is a crowd – more than two in line call for help • 3 sacks = mandatory carry out • Thank the Customer no matter what FOURTH GOLDEN RULE CROSS TRAIN YOUR EMPLOYEES Provide opportunities for employees to learn. The kind of employees you want are the kind who want to learn. Good workers improve their skills in many areas of work and life. They can either do it on their own, and be more inclined to go elsewhere for continued challenge and learning, or they can learn under your auspices, and develop close ties to your organization while they do. • Communicate the task. Describe exactly what you want done, when you want it done, and what end results you expect. • Furnish context for the task. Explain why the task needs to be done, its importance in the overall scheme of things, and possible complications that may arise during its performance • Determine standards. Agree on the standards that you will use to measure the success of a task's completion. These standards should be realistic and attainable. FIFTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO BUILD RAPPORT WITH THE CUSTOMER Teach your employees how to create excellent customer service through human interaction • All customers are greeted politely and courteously. • Create an atmosphere of friendliness throughout each customer interaction. • Professionalism is displayed through word and deeds. • Show empathy and understanding for a customer with a problem • All customers are treated fairly in every interaction with the store • Conduct yourself with tact SIXTH GOLDEN RULE KNOW YOUR CUSTOMERS NAMES AND USE THEM Use the following to build positive relationships with your customers • KIDS NAMES • ACHIEVEMENTS • HONOR ROLL • MARRIAGE • NEW CAR • HAIR STYLE CHANGE **STAY AWAY FROM PERSONAL SENSITIVE SUBJECTS EVERYONE HAS AN INVISIBLE SIGN HANGING FROM HIS OR HER NECK THAT READS “MAKE ME FEEL IMPORTANT,” NEVER FORGET THIS WHEN WORKING WITH PEOPLE. SEVENTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO ASK OPEN ENDED QUESTIONS Open-ended questions are questions that encourage people to talk about whatever is important to them. They help to establish rapport, gather information, and increase understanding. They are the opposite of closed-ended questions that typically require a simple brief response such “yes” or “no.” Examples of open-ended questions: • How can I be of help? • · Would you tell me more about ___? • · Could you help me understand ___? • · What are the good things and the less good things about ___? • · What do you think you will lose if you give up ___? • · What have you tried before? • · What do you want to do next? Affirmations Affirmations are statements and gestures that recognize client strengths and acknowledge behaviors that lead in the direction of positive change, no matter how big or small. Affirmations build confidence in one’s ability to change. To be effective, affirmations must be genuine and congruent. Examples of affirmation statements: · Thank you for … · I really like the way you … · That was a very creative how you … · You showed a lot of self-control in the way you … · It may not seem like much, but I think it was very impressive how you … · You have a real gift for … “TO GIVE REAL SERVICE YOU MUST ADD SOMETHING WHICH CANNOT BE BOUGHT OR MEASURED WITH MONEY, AND THAT IS SINCERITY AND INTEGRITY” -Donald A. Adams EIGHTH GOLDEN RULE INSTILL A SENSE OF URGENCY IN HELPING CUSTOMERS WHAT DO THESE CUSTOMERS HAVE IN COMMON? EDUCATE YOUR EMPLOYEES ON FIVE PRINCIPLES OF A GOOD EMPLOYEE • URGENCY • OWNERSHIP • LEARN-BY-DOING • LIFELONG LEARNING • MOTIVATION Customers don’t expect you to be perfect. They do expect you to fix things when they go wrong NINTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO HANDLE ANGRY CUSTOMERS NEVER ARGUE WITH A CUSTOMER . LISTEN! CLOSE YOUR MOUTH AND LISTEN!! WHEN THAT DOESN’T WORK……. Saying I’m sorry will often times reduce anger. Apologies even if it was not your fault. Defusing Angry Customers using the LARSON approach • Listen let them vent. Empathize, take notes • Agreement find areas of agreement • Repeat/Restate use the customers words for clarification of issue • Seek Resolution Ask what can be done to resolve the problem • Offer a sincere apology We’re sorry this happened and if were responsible we will make it right • Now solve the problem immediately THE FOUR R’S • REPEAT • REVIEW • RESPOND • RESOLVE TENTH GOLDEN RULE DON’T LET AN ANGRY CUSTOMER LEAVE YOUR STORE 10 WAYS TO BUILD CUSTOMER LOYALTY 1. Take ownership of your customer’s problem. Even if you are not the cause of it. 2. Follow up with every customer who was upset or had a difficult problem. 3. Ask yourself with every customer interaction you have, “If this were me, what would I want?” 4. Thank your customers and co-workers every chance you get! 5. Fax articles or other materials to your customers if you think they can benefit from the information. 10 WAYS TO BUILD CUSTOMER LOYALTY (Continued) 6. Remember personal details about your customers such as birthdays, children’s names and accomplishments. 7. SMILE every time you are on the telephone. 8. Look for ways to bend the rules and remove service obstacles. 9. Time is a person’s most precious commodity. Respect your customer’s time and schedule. 10. Provide your customers with respect, friendliness, and knowledge, and oh, yes, the products and services you sell. COMPARING A KNIGHT IN SHINING ARMOR TO A CUSTOMER SERVICE REPRESENTATIVE WE CONTROL OUR OWN DESTINY AND WE WILL GET THE RESULTS WE WANT BY WORKING THE GOLDEN RULES THANK YOU FOR SPENDING TIME WITH ME TODAY THE END INSERT CLIP FROM PICKLE","Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here. What are the Golden Rules of Great Customer Service? GOLDEN RULES TO GREAT CUSTOMER SERVICE Presented by Bill Huninghake & Rich York THE GOLDEN RULE DO UNTO OTHERS AS YOU WOULD HAVE THEM DO UNTO YOU. GOLDEN RULES TO GREAT CUSTOMER SERVICE 1. A CUSTOMER IN NEED IS A CUSTOMER INDEED. 2. HIRE PEOPLE WITH GOOD CUSTOMER SKILLS 3. TRAIN YOUR EMPLOYEES ON STORE POLICIES. 4. CROSS TRAIN YOUR EMPLOYEES. 5. TRAIN YOUR EMPLOYEES HOW TO BUILD RAPPORT. 6. KNOW YOUR CUSTOMERS NAMES AND USE THEM. 7. TRAIN YOUR EMPLOYEES HOW TO ASK OPEN ENDED QUESTIONS. 8. INSTILL A SENSE OF URGENCY IN HELPING CUSTOMERS. 9. TRAIN YOUR EMPLOYEES HOW TO HANDLE ANGRY CUSTOMERS. 10. DON’T LET AN UNHAPPY CUSTOMER LEAVE YOUR STORE. WHAT IS YOUR GOLDEN EGG? 1. IMPROVE CUSTOMER RETENTION 2. COMMUNITY INVOLVEMENT 3. INCREASE NEW CUSTOMERS 4. FRIENDLIEST PLACE AROUND 5. BEST PERISHABLES IN TOWN 6. BEST MEAT DEPARTMENT AROUND SUPERCENTER AFFILIATED FOODS STORE WHY DID THE CUSTOMER CROSS THE ROAD? Why Customers Quit Shopping Your Store Die, 1% Move, 3% Other Friendship, 5% Competition, 9% Product Dissatisfaction, 14% Attitude of an Employee 68% FIRST GOLDEN RULE A CUSTOMER IN NEED IS A CUSTOMER INDEED When there is not much difference between your product and the product of your competitor, there needs to be a BIG difference in the quality of service you provide your customer. SECOND GOLDEN RULE HIRE PEOPLE WITH GOOD CUSTOMER SERVICE SKILLS A B C D E F G H I J K L M N O P Q R S T U V W X Y Z A -- 1 T -- 20 T -- 20 I -- 9 T -- 20 U -- 21 D -- 4 E -- 5 Attitude equals 100%. ATTITUDE IS A LITTLE THING THAT MAKES A BIG DIFFERENCE HOW TO HIRE GREAT EMPLOYEES: Seek out the great employees who already work for you. Interview them, find out what makes them tick. Write profiles of great employees. Find out what qualities they have in common. Then look to hire people with the same qualities. THIRD GOLDEN RULE TRAIN YOUR EMPLOYEES ON STORE POLICIES BE THE EXAMPLE FOR YOUR EMPLOYEES TO EMULATE. DON’T ASK YOUR EMPLOYEES TO DO SOMETHING YOU WOULDN’T. EXAMPLE POLICIES • Visit with customers • No whispering • Walk the customer to product • Don’t get in the customer’s way when working in the aisles • 10 ft rule – Greet the customer • 2 is company but 3 is a crowd – more than two in line call for help • 3 sacks = mandatory carry out • Thank the Customer no matter what FOURTH GOLDEN RULE CROSS TRAIN YOUR EMPLOYEES Provide opportunities for employees to learn. The kind of employees you want are the kind who want to learn. Good workers improve their skills in many areas of work and life. They can either do it on their own, and be more inclined to go elsewhere for continued challenge and learning, or they can learn under your auspices, and develop close ties to your organization while they do. • Communicate the task. Describe exactly what you want done, when you want it done, and what end results you expect. • Furnish context for the task. Explain why the task needs to be done, its importance in the overall scheme of things, and possible complications that may arise during its performance • Determine standards. Agree on the standards that you will use to measure the success of a task's completion. These standards should be realistic and attainable. FIFTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO BUILD RAPPORT WITH THE CUSTOMER Teach your employees how to create excellent customer service through human interaction • All customers are greeted politely and courteously. • Create an atmosphere of friendliness throughout each customer interaction. • Professionalism is displayed through word and deeds. • Show empathy and understanding for a customer with a problem • All customers are treated fairly in every interaction with the store • Conduct yourself with tact SIXTH GOLDEN RULE KNOW YOUR CUSTOMERS NAMES AND USE THEM Use the following to build positive relationships with your customers • KIDS NAMES • ACHIEVEMENTS • HONOR ROLL • MARRIAGE • NEW CAR • HAIR STYLE CHANGE **STAY AWAY FROM PERSONAL SENSITIVE SUBJECTS EVERYONE HAS AN INVISIBLE SIGN HANGING FROM HIS OR HER NECK THAT READS “MAKE ME FEEL IMPORTANT,” NEVER FORGET THIS WHEN WORKING WITH PEOPLE. SEVENTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO ASK OPEN ENDED QUESTIONS Open-ended questions are questions that encourage people to talk about whatever is important to them. They help to establish rapport, gather information, and increase understanding. They are the opposite of closed-ended questions that typically require a simple brief response such “yes” or “no.” Examples of open-ended questions: • How can I be of help? • · Would you tell me more about ___? • · Could you help me understand ___? • · What are the good things and the less good things about ___? • · What do you think you will lose if you give up ___? • · What have you tried before? • · What do you want to do next? Affirmations Affirmations are statements and gestures that recognize client strengths and acknowledge behaviors that lead in the direction of positive change, no matter how big or small. Affirmations build confidence in one’s ability to change. To be effective, affirmations must be genuine and congruent. Examples of affirmation statements: · Thank you for … · I really like the way you … · That was a very creative how you … · You showed a lot of self-control in the way you … · It may not seem like much, but I think it was very impressive how you … · You have a real gift for … “TO GIVE REAL SERVICE YOU MUST ADD SOMETHING WHICH CANNOT BE BOUGHT OR MEASURED WITH MONEY, AND THAT IS SINCERITY AND INTEGRITY” -Donald A. Adams EIGHTH GOLDEN RULE INSTILL A SENSE OF URGENCY IN HELPING CUSTOMERS WHAT DO THESE CUSTOMERS HAVE IN COMMON? EDUCATE YOUR EMPLOYEES ON FIVE PRINCIPLES OF A GOOD EMPLOYEE • URGENCY • OWNERSHIP • LEARN-BY-DOING • LIFELONG LEARNING • MOTIVATION Customers don’t expect you to be perfect. They do expect you to fix things when they go wrong NINTH GOLDEN RULE TRAIN YOUR EMPLOYEES HOW TO HANDLE ANGRY CUSTOMERS NEVER ARGUE WITH A CUSTOMER . LISTEN! CLOSE YOUR MOUTH AND LISTEN!! WHEN THAT DOESN’T WORK……. Saying I’m sorry will often times reduce anger. Apologies even if it was not your fault. Defusing Angry Customers using the LARSON approach • Listen let them vent. Empathize, take notes • Agreement find areas of agreement • Repeat/Restate use the customers words for clarification of issue • Seek Resolution Ask what can be done to resolve the problem • Offer a sincere apology We’re sorry this happened and if were responsible we will make it right • Now solve the problem immediately THE FOUR R’S • REPEAT • REVIEW • RESPOND • RESOLVE TENTH GOLDEN RULE DON’T LET AN ANGRY CUSTOMER LEAVE YOUR STORE 10 WAYS TO BUILD CUSTOMER LOYALTY 1. Take ownership of your customer’s problem. Even if you are not the cause of it. 2. Follow up with every customer who was upset or had a difficult problem. 3. Ask yourself with every customer interaction you have, “If this were me, what would I want?” 4. Thank your customers and co-workers every chance you get! 5. Fax articles or other materials to your customers if you think they can benefit from the information. 10 WAYS TO BUILD CUSTOMER LOYALTY (Continued) 6. Remember personal details about your customers such as birthdays, children’s names and accomplishments. 7. SMILE every time you are on the telephone. 8. Look for ways to bend the rules and remove service obstacles. 9. Time is a person’s most precious commodity. Respect your customer’s time and schedule. 10. Provide your customers with respect, friendliness, and knowledge, and oh, yes, the products and services you sell. COMPARING A KNIGHT IN SHINING ARMOR TO A CUSTOMER SERVICE REPRESENTATIVE WE CONTROL OUR OWN DESTINY AND WE WILL GET THE RESULTS WE WANT BY WORKING THE GOLDEN RULES THANK YOU FOR SPENDING TIME WITH ME TODAY THE END INSERT CLIP FROM PICKLE",Retail/Product,Find & Summarize,Text Transformation Use the source provided only.,Please answer the following based on the legal specifications: what happens if there is a price change or conflict in a promotion?,"Page # 1 OVERVIEW 1. BY PLACING AN ORDER FOR PRODUCTS FROM THIS WEBSITE, YOU AFFIRM THAT YOU ARE OF LEGAL AGE TO ENTER INTO THIS AGREEMENT, AND YOU ACCEPT AND ARE BOUND BY THESE TERMS AND CONDITIONS. YOU MAY NOT ORDER OR OBTAIN PRODUCTS OR SERVICES FROM THIS WEBSITE IF YOU (A) DO NOT AGREE TO THESE TERMS, (B) ARE NOT THE OLDER OF (i) AT LEAST 18 YEARS OF AGE OR (ii) LEGAL AGE TO FORM A BINDING CONTRACT WITH LAZARUS NATURALS, OR (C) ARE PROHIBITED FROM ACCESSING OR USING THIS WEBSITE OR ANY OF THIS WEBSITE’S CONTENTS, GOODS OR SERVICES BY APPLICABLE LAW. These terms and conditions (these “Terms”) apply to the purchase and sale of products and services through the Lazarus Naturals website (the “Website”). These Terms are subject to change by Lazarus Naturals (referred to as “us”, “we”, or “our” as the context may require) without prior written notice at any time, in our sole discretion. Any changes to the Terms will be in effect as of the “Last Updated Date” referenced on the Website. You should review these Terms prior to purchasing any product or services that are available through this Website. Your ordering of products or services, or continued use of this Website after the “Last Updated Date,’ will constitute your acceptance of and agreement to such changes. 2. Order Acceptance and Cancellation. You agree that your order is an offer to buy, under these Terms, all products and services listed in your order. All orders must be accepted by us or we will not be obligated to sell the products or services to you. We may choose not to accept orders at our sole discretion, even after we send you a confirmation email with your order number and details of the items you have ordered. 3. Prices and Payment Terms. (a) All prices, discounts, and promotions posted on this Website are subject to change without notice. The price charged for a product or service will be the price in effect at the time the order is placed and will be set out in your order confirmation email. Price increases will only apply to orders placed after such changes. Posted prices do not include taxes or charges for shipping and handling. All such taxes and charges will be added to your merchandise total, and will be itemized in your shopping cart and in your order confirmation email. We strive to display accurate price information, however we may, on occasion, make inadvertent typographical errors, inaccuracies or omissions related to pricing and availability. We reserve the right to correct any errors, inaccuracies, or omissions at any time and to cancel any orders arising from such occurrences. Page # 2 (b) We may offer from time to time promotions on the Website that may affect pricing and that are governed by terms and conditions separate from these Terms. If there is a conflict between the terms for a promotion and these Terms, the promotion terms will govern. (c) Terms of payment are within our sole discretion and payment must be received by us before our acceptance of an order. We accept all major credit and debit cards for all purchases. You represent and warrant that (i) the credit and debit card information you supply to us is true, correct and complete, (ii) you are duly authorized to use such credit and debit card for the purchase, (iii) charges incurred by you will be honored by your credit and debit card company, and (iv) you will pay charges incurred by you at the posted prices, including shipping and handling charges and all applicable taxes, if any, regardless of the amount quoted on the Website at the time of your order. Our use of personal information provided by you is governed by our Privacy Policy. 4. Shipments; Delivery; Title and Risk of Loss. (a) We will arrange for shipment of the products to you. Please check our Shipping and Return Policy for specific delivery options. You will pay all shipping and handling charges unless otherwise specified in the order confirmation. (b) Title and risk of loss pass to you upon our transfer of the products to the carrier. Shipping and delivery dates are estimates only and cannot be guaranteed. We are not liable for any delays in shipments. 5. Returns and Refunds. Our return policy is that we will accept any return within 30 days of delivery for any reason. Please check our Shipping and Return Policy for more specific information. 6. Limited Warranty. (a) We warrant to you that for a period of 90 days from the date of shipment (""Warranty Period”), the products purchased through the Website will materially conform to our published specifications in effect as of the date of shipment. (b) EXCEPT FOR THE WARRANTIES SET FORTH IN THIS SECTION 6, WE MAKE NO WARRANTY WHATSOEVER WITH RESPECT TO THE PRODUCTS OR SERVICES PURCHASED THROUGH THE WEBSITE, INCLUDING ANY (i) WARRANTY CONCERNING Page # 3 ANY HEALTH OR NUTRITIONAL BENEFIT, EFFECT, OR USE; (ii) WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE;WHETHER EXPRESS OR IMPLIED BY LAW, COURSE OF DEALING, COURSE OF PERFORMANCE, USAGE OF TRADE, OR OTHERWISE. (c) We shall not be liable for a breach of the warranties set forth in this Section 6 unless: (i) you give written notice of the defective products or services, as the case may be, reasonably described, to us within 90 days of the time when the product is delivered; (ii) provide proof of purchase and purchase information; (iii) if applicable, we are given a reasonable opportunity after receiving the notice of breach of the warranty set forth in this Section to examine such products and you (if we so request) return such products to our place of business at your cost for the examination to take place there; and (iv) we reasonably verify your claim that the products or services are our products and are defective. (d) We shall not be liable for a breach of the warranty set forth in this Section if: (i) you make any further use of such products after you give such notice; (ii) the defect arises because you failed to follow our oral or written instructions as to the storage, use or maintenance of the products; or (iii) you alter such products without our prior written consent. (e) With respect to any such products during the Warranty Period, we shall, in our sole discretion, either: (i) replace with substantially similar products that are non-defective or (ii) credit or refund the amounts paid by you for such products provided that, if we so request, you shall, at your expense, return such products to us. (f) THE REMEDIES SET FORTH IN THIS SECTION 6 SHALL BE THE YOUR SOLE AND EXCLUSIVE REMEDY AND OUR ENTIRE LIABILITY FOR ANY BREACH OF THE LIMITED WARRANTIES SET FORTH IN THIS SECTION 6. 7. Limitation of Liability. (a) INNO EVENT SHALL WE BE LIABLE TO YOU OR ANY THIRD PARTY FOR ANY LOSS OF USE, REVENUE OR PROFIT, OR FOR ANY CONSEQUENTIAL, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR PUNITIVE DAMAGES WHETHER ARISING OUT OF BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE) OR OTHERWISE, REGARDLESS OF WHETHER SUCH DAMAGES WERE FORESEEABLE AND WHETHER OR NOT WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, AND NOTWITHSTANDING THE FAILURE OF ANY AGREED OR OTHER REMEDY OF ITS ESSENTIAL PURPOSE. (b) INNO EVENT SHALL OUR AGGREGATE LIABILITY ARISING OUT OF OR RELATED TO THIS AGREEMENT, WHETHER ARISING OUT OF OR RELATED TO BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE) OR OTHERWISE, EXCEED THE Page # 4 AMOUNTS PAID BY YOU FOR THE PRODUCTS AND SERVICES SOLD THROUGH THE WEBSITE. (c) The limitation of liability set forth above shall: (i) only apply to the extent permitted by law and (ii) not apply to (A) liability resulting from our gross negligence or willful misconduct and (B) death or bodily injury resulting from our acts or omissions. 8. Legal Disclaimer. This Website is not intended to provide medical advice, diagnosis or treatment. The information provided on this Website is “as is” and provided for informational purposes only. Lazarus Naturals does not make any representations or warranties, express or implied, with respect to the information on this Website in relation to the health or benefits of CBD. Please consult with your physician or healthcare professional regarding any medical or health-related diagnosis or treatment options. If you think you are suffering from a medical condition, please seek medical attention. If you are thinking of making any changes to your diet, nutrition, or lifestyle, please consult with your healthcare provider. Do not use CBD products if you are pregnant or thinking of becoming pregnant. 9. Force Majeure. We will not be liable or responsible to you, nor be deemed to have defaulted or breached these Terms, for any failure or delay in our performance under these Terms when and to the extent such failure or delay is caused by or results from acts or circumstances beyond our reasonable control, including, without limitation, acts of God, flood, fire, earthquake, explosion, governmental actions, war, invasion or hostilities (whether war is declared or not), terrorist threats or acts, riot or other civil unrest, national emergency, revolution, insurrection, epidemic, lockouts, strikes or other labor disputes (whether or not relating to our workforce), or restraints or delays affecting carriers or inability or delay in obtaining supplies of adequate or suitable materials, materials or telecommunication breakdown or power outage. 10. Governing Law and Jurisdiction. This Website is operated from the US. All matters arising out of or relating to these Terms are governed by and construed in accordance with the internal laws of the State of Oregon, without giving effect to any choice or conflict of law provision or rule (whether of the State of Oregon or any other jurisdiction) that would cause the application of the laws of any jurisdiction other than those of the State of Oregon. 11. Dispute Resolution and Binding Arbitration. Page # 5 (a) YOU AND LAZARUS NATURALS ARE AGREEING TO GIVE UP ANY RIGHTS TO LITIGATE CLAIMS IN A COURT OR BEFORE A JURY. OTHER RIGHTS THAT YOU WOULD HAVE IF YOU WENT TO COURT MAY ALSO BE UNAVAILABLE OR MAY BE LIMITED IN ARBITRATION. (b) ANY CLAIM, DISPUTE OR CONTROVERSY (WHETHER IN CONTRACT, TORT OR OTHERWISE, WHETHER PRE-EXISTING, PRESENT OR FUTURE, AND INCLUDING STATUTORY, CONSUMER PROTECTION, COMMON LAW, INTENTIONAL TORT, INJUNCTIVE AND EQUITABLE CLAIMS) BETWEEN YOU AND US ARISING FROM OR RELATING IN ANY WAY TO YOUR PURCHASE OF PRODUCTS OR SERVICES THROUGH THE WEBSITE, WILL BE RESOLVED EXCLUSIVELY AND FINALLY BY BINDING ARBITRATION. (c) The arbitration will be administered by the American Arbitration Association (""AAA"") in accordance with the Consumer Arbitration Rules (the “AAA Rules”) then in effect, except as modified by this Section (The AAA Rules are available at www.adr.org/arb_med or by calling the AAA at 1-800-778-7879.) The Federal Arbitration Act will govern the interpretation and enforcement of this section. (d) The arbitrator will have exclusive authority to resolve any dispute relating to arbitrability and/or enforceability of this arbitration provision, including any unconscionability challenge or any other challenge that the arbitration provision or the agreement is void, voidable, or otherwise invalid. The arbitrator will be empowered to grant whatever relief would be available in court under law or in equity. Any award of the arbitrator(s) will be final and binding on each of the parties, and may be entered as a judgment in any court of competent jurisdiction. (e) If any provision of this arbitration agreement is found unenforceable, the unenforceable provision will be severed and the remaining arbitration terms will be enforced. 12. Assignment. You will not assign any of your rights or delegate any of your obligations under these Terms without our prior written consent. Any purported assignment or delegation in violation of this Section is null and void. No assignment or delegation relieves you of any of your obligations under these Terms. ","Use the source provided only. Please answer the following based on the legal specifications: what happens if there is a price change or conflict in a promotion? Page # 1 OVERVIEW 1. BY PLACING AN ORDER FOR PRODUCTS FROM THIS WEBSITE, YOU AFFIRM THAT YOU ARE OF LEGAL AGE TO ENTER INTO THIS AGREEMENT, AND YOU ACCEPT AND ARE BOUND BY THESE TERMS AND CONDITIONS. YOU MAY NOT ORDER OR OBTAIN PRODUCTS OR SERVICES FROM THIS WEBSITE IF YOU (A) DO NOT AGREE TO THESE TERMS, (B) ARE NOT THE OLDER OF (i) AT LEAST 18 YEARS OF AGE OR (ii) LEGAL AGE TO FORM A BINDING CONTRACT WITH LAZARUS NATURALS, OR (C) ARE PROHIBITED FROM ACCESSING OR USING THIS WEBSITE OR ANY OF THIS WEBSITE’S CONTENTS, GOODS OR SERVICES BY APPLICABLE LAW. These terms and conditions (these “Terms”) apply to the purchase and sale of products and services through the Lazarus Naturals website (the “Website”). These Terms are subject to change by Lazarus Naturals (referred to as “us”, “we”, or “our” as the context may require) without prior written notice at any time, in our sole discretion. Any changes to the Terms will be in effect as of the “Last Updated Date” referenced on the Website. You should review these Terms prior to purchasing any product or services that are available through this Website. Your ordering of products or services, or continued use of this Website after the “Last Updated Date,’ will constitute your acceptance of and agreement to such changes. 2. Order Acceptance and Cancellation. You agree that your order is an offer to buy, under these Terms, all products and services listed in your order. All orders must be accepted by us or we will not be obligated to sell the products or services to you. We may choose not to accept orders at our sole discretion, even after we send you a confirmation email with your order number and details of the items you have ordered. 3. Prices and Payment Terms. (a) All prices, discounts, and promotions posted on this Website are subject to change without notice. The price charged for a product or service will be the price in effect at the time the order is placed and will be set out in your order confirmation email. Price increases will only apply to orders placed after such changes. Posted prices do not include taxes or charges for shipping and handling. All such taxes and charges will be added to your merchandise total, and will be itemized in your shopping cart and in your order confirmation email. We strive to display accurate price information, however we may, on occasion, make inadvertent typographical errors, inaccuracies or omissions related to pricing and availability. We reserve the right to correct any errors, inaccuracies, or omissions at any time and to cancel any orders arising from such occurrences. Page # 2 (b) We may offer from time to time promotions on the Website that may affect pricing and that are governed by terms and conditions separate from these Terms. If there is a conflict between the terms for a promotion and these Terms, the promotion terms will govern. (c) Terms of payment are within our sole discretion and payment must be received by us before our acceptance of an order. We accept all major credit and debit cards for all purchases. You represent and warrant that (i) the credit and debit card information you supply to us is true, correct and complete, (ii) you are duly authorized to use such credit and debit card for the purchase, (iii) charges incurred by you will be honored by your credit and debit card company, and (iv) you will pay charges incurred by you at the posted prices, including shipping and handling charges and all applicable taxes, if any, regardless of the amount quoted on the Website at the time of your order. Our use of personal information provided by you is governed by our Privacy Policy. 4. Shipments; Delivery; Title and Risk of Loss. (a) We will arrange for shipment of the products to you. Please check our Shipping and Return Policy for specific delivery options. You will pay all shipping and handling charges unless otherwise specified in the order confirmation. (b) Title and risk of loss pass to you upon our transfer of the products to the carrier. Shipping and delivery dates are estimates only and cannot be guaranteed. We are not liable for any delays in shipments. 5. Returns and Refunds. Our return policy is that we will accept any return within 30 days of delivery for any reason. Please check our Shipping and Return Policy for more specific information. 6. Limited Warranty. (a) We warrant to you that for a period of 90 days from the date of shipment (""Warranty Period”), the products purchased through the Website will materially conform to our published specifications in effect as of the date of shipment. (b) EXCEPT FOR THE WARRANTIES SET FORTH IN THIS SECTION 6, WE MAKE NO WARRANTY WHATSOEVER WITH RESPECT TO THE PRODUCTS OR SERVICES PURCHASED THROUGH THE WEBSITE, INCLUDING ANY (i) WARRANTY CONCERNING Page # 3 ANY HEALTH OR NUTRITIONAL BENEFIT, EFFECT, OR USE; (ii) WARRANTY OF FITNESS FOR A PARTICULAR PURPOSE;WHETHER EXPRESS OR IMPLIED BY LAW, COURSE OF DEALING, COURSE OF PERFORMANCE, USAGE OF TRADE, OR OTHERWISE. (c) We shall not be liable for a breach of the warranties set forth in this Section 6 unless: (i) you give written notice of the defective products or services, as the case may be, reasonably described, to us within 90 days of the time when the product is delivered; (ii) provide proof of purchase and purchase information; (iii) if applicable, we are given a reasonable opportunity after receiving the notice of breach of the warranty set forth in this Section to examine such products and you (if we so request) return such products to our place of business at your cost for the examination to take place there; and (iv) we reasonably verify your claim that the products or services are our products and are defective. (d) We shall not be liable for a breach of the warranty set forth in this Section if: (i) you make any further use of such products after you give such notice; (ii) the defect arises because you failed to follow our oral or written instructions as to the storage, use or maintenance of the products; or (iii) you alter such products without our prior written consent. (e) With respect to any such products during the Warranty Period, we shall, in our sole discretion, either: (i) replace with substantially similar products that are non-defective or (ii) credit or refund the amounts paid by you for such products provided that, if we so request, you shall, at your expense, return such products to us. (f) THE REMEDIES SET FORTH IN THIS SECTION 6 SHALL BE THE YOUR SOLE AND EXCLUSIVE REMEDY AND OUR ENTIRE LIABILITY FOR ANY BREACH OF THE LIMITED WARRANTIES SET FORTH IN THIS SECTION 6. 7. Limitation of Liability. (a) INNO EVENT SHALL WE BE LIABLE TO YOU OR ANY THIRD PARTY FOR ANY LOSS OF USE, REVENUE OR PROFIT, OR FOR ANY CONSEQUENTIAL, INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, OR PUNITIVE DAMAGES WHETHER ARISING OUT OF BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE) OR OTHERWISE, REGARDLESS OF WHETHER SUCH DAMAGES WERE FORESEEABLE AND WHETHER OR NOT WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES, AND NOTWITHSTANDING THE FAILURE OF ANY AGREED OR OTHER REMEDY OF ITS ESSENTIAL PURPOSE. (b) INNO EVENT SHALL OUR AGGREGATE LIABILITY ARISING OUT OF OR RELATED TO THIS AGREEMENT, WHETHER ARISING OUT OF OR RELATED TO BREACH OF CONTRACT, TORT (INCLUDING NEGLIGENCE) OR OTHERWISE, EXCEED THE Page # 4 AMOUNTS PAID BY YOU FOR THE PRODUCTS AND SERVICES SOLD THROUGH THE WEBSITE. (c) The limitation of liability set forth above shall: (i) only apply to the extent permitted by law and (ii) not apply to (A) liability resulting from our gross negligence or willful misconduct and (B) death or bodily injury resulting from our acts or omissions. 8. Legal Disclaimer. This Website is not intended to provide medical advice, diagnosis or treatment. The information provided on this Website is “as is” and provided for informational purposes only. Lazarus Naturals does not make any representations or warranties, express or implied, with respect to the information on this Website in relation to the health or benefits of CBD. Please consult with your physician or healthcare professional regarding any medical or health-related diagnosis or treatment options. If you think you are suffering from a medical condition, please seek medical attention. If you are thinking of making any changes to your diet, nutrition, or lifestyle, please consult with your healthcare provider. Do not use CBD products if you are pregnant or thinking of becoming pregnant. 9. Force Majeure. We will not be liable or responsible to you, nor be deemed to have defaulted or breached these Terms, for any failure or delay in our performance under these Terms when and to the extent such failure or delay is caused by or results from acts or circumstances beyond our reasonable control, including, without limitation, acts of God, flood, fire, earthquake, explosion, governmental actions, war, invasion or hostilities (whether war is declared or not), terrorist threats or acts, riot or other civil unrest, national emergency, revolution, insurrection, epidemic, lockouts, strikes or other labor disputes (whether or not relating to our workforce), or restraints or delays affecting carriers or inability or delay in obtaining supplies of adequate or suitable materials, materials or telecommunication breakdown or power outage. 10. Governing Law and Jurisdiction. This Website is operated from the US. All matters arising out of or relating to these Terms are governed by and construed in accordance with the internal laws of the State of Oregon, without giving effect to any choice or conflict of law provision or rule (whether of the State of Oregon or any other jurisdiction) that would cause the application of the laws of any jurisdiction other than those of the State of Oregon. 11. Dispute Resolution and Binding Arbitration. Page # 5 (a) YOU AND LAZARUS NATURALS ARE AGREEING TO GIVE UP ANY RIGHTS TO LITIGATE CLAIMS IN A COURT OR BEFORE A JURY. OTHER RIGHTS THAT YOU WOULD HAVE IF YOU WENT TO COURT MAY ALSO BE UNAVAILABLE OR MAY BE LIMITED IN ARBITRATION. (b) ANY CLAIM, DISPUTE OR CONTROVERSY (WHETHER IN CONTRACT, TORT OR OTHERWISE, WHETHER PRE-EXISTING, PRESENT OR FUTURE, AND INCLUDING STATUTORY, CONSUMER PROTECTION, COMMON LAW, INTENTIONAL TORT, INJUNCTIVE AND EQUITABLE CLAIMS) BETWEEN YOU AND US ARISING FROM OR RELATING IN ANY WAY TO YOUR PURCHASE OF PRODUCTS OR SERVICES THROUGH THE WEBSITE, WILL BE RESOLVED EXCLUSIVELY AND FINALLY BY BINDING ARBITRATION. (c) The arbitration will be administered by the American Arbitration Association (""AAA"") in accordance with the Consumer Arbitration Rules (the “AAA Rules”) then in effect, except as modified by this Section (The AAA Rules are available at www.adr.org/arb_med or by calling the AAA at 1-800-778-7879.) The Federal Arbitration Act will govern the interpretation and enforcement of this section. (d) The arbitrator will have exclusive authority to resolve any dispute relating to arbitrability and/or enforceability of this arbitration provision, including any unconscionability challenge or any other challenge that the arbitration provision or the agreement is void, voidable, or otherwise invalid. The arbitrator will be empowered to grant whatever relief would be available in court under law or in equity. Any award of the arbitrator(s) will be final and binding on each of the parties, and may be entered as a judgment in any court of competent jurisdiction. (e) If any provision of this arbitration agreement is found unenforceable, the unenforceable provision will be severed and the remaining arbitration terms will be enforced. 12. Assignment. You will not assign any of your rights or delegate any of your obligations under these Terms without our prior written consent. Any purported assignment or delegation in violation of this Section is null and void. No assignment or delegation relieves you of any of your obligations under these Terms. ",Legal,Find & Summarize,Text Transformation You may only use the text included in this prompt for your answer. You are not allowed to use any external resources or prior knowledge.,How would a digital asset that had been deemed a security be reevaluated?,"C. Reasonable Expectation of Profits Derived from Efforts of Others Usually, the main issue in analyzing a digital asset under the Howey test is whether a purchaser has a reasonable expectation of profits (or other financial returns) derived from the efforts of others. A purchaser may expect to realize a return through participating in distributions or through other methods of realizing appreciation on the asset, such as selling at a gain in a secondary market. When a promoter, sponsor, or other third party (or affiliated group of third parties) (each, an “Active Participant” or “AP”) provides essential managerial efforts that affect the success of the enterprise, and investors reasonably expect to derive profit from those efforts, then this prong of the test is met. Relevant to this inquiry is the “economic reality”12 of the transaction and “what character the instrument is given in commerce by the terms of the offer, the plan of distribution, and the economic inducements held out to the prospect.”13 The inquiry, therefore, is an objective one, focused on the transaction itself and the manner in which the digital asset is offered and sold. The following characteristics are especially relevant in an analysis of whether the third prong of the Howey test is satisfied. 1. Reliance on the Efforts of Others The inquiry into whether a purchaser is relying on the efforts of others focuses on two key issues: Does the purchaser reasonably expect to rely on the efforts of an AP? Are those efforts “the undeniably significant ones, those essential managerial efforts which affect the failure or success of the enterprise,”14 as opposed to efforts that are more ministerial in nature? Although no one of the following characteristics is necessarily determinative, the stronger their presence, the more likely it is that a purchaser of a digital asset is relying on the “efforts of others”: An AP is responsible for the development, improvement (or enhancement), operation, or promotion of the network,15 particularly if purchasers of the digital asset expect an AP to be performing or overseeing tasks that are necessary for the network or digital asset to achieve or retain its intended purpose or functionality.16 o Where the network or the digital asset is still in development and the network or digital asset is not fully functional at the time of the offer or sale, purchasers would reasonably expect an AP to further develop the functionality of the network or digital asset (directly or indirectly). This particularly would be the case where an AP promises further developmental efforts in order for the digital asset to attain or grow in value. There are essential tasks or responsibilities performed and expected to be performed by an AP, rather than an unaffiliated, dispersed community of network users (commonly known as a “decentralized” network). An AP creates or supports a market for,17 or the price of, the digital asset. This can include, for example, an AP that: (1) controls the creation and issuance of the digital asset; or (2) takes other actions to support a market price of the digital asset, such as by limiting supply or ensuring scarcity, through, for example, buybacks, “burning,” or other activities. An AP has a lead or central role in the direction of the ongoing development of the network or the digital asset. In particular, an AP plays a lead or central role in deciding governance issues, code updates, or how third parties participate in the validation of transactions that occur with respect to the digital asset. An AP has a continuing managerial role in making decisions about or exercising judgment concerning the network or the characteristics or rights the digital asset represents including, for example: o Determining whether and how to compensate persons providing services to the network or to the entity or entities charged with oversight of the network. o Determining whether and where the digital asset will trade. For example, purchasers may reasonably rely on an AP for liquidity, such as where the AP has arranged, or promised to arrange for, the trading of the digital asset on a secondary market or platform. o Determining who will receive additional digital assets and under what conditions. o Making or contributing to managerial level business decisions, such as how to deploy funds raised from sales of the digital asset. o Playing a leading role in the validation or confirmation of transactions on the network, or in some other way having responsibility for the ongoing security of the network. o Making other managerial judgements or decisions that will directly or indirectly impact the success of the network or the value of the digital asset generally. Purchasers would reasonably expect the AP to undertake efforts to promote its own interests and enhance the value of the network or digital asset, such as where: o The AP has the ability to realize capital appreciation from the value of the digital asset. This can be demonstrated, for example, if the AP retains a stake or interest in the digital asset. In these instances, purchasers would reasonably expect the AP to undertake efforts to promote its own interests and enhance the value of the network or digital asset. o The AP distributes the digital asset as compensation to management or the AP’s compensation is tied to the price of the digital asset in the secondary market. To the extent these facts are present, the compensated individuals can be expected to take steps to build the value of the digital asset. o The AP owns or controls ownership of intellectual property rights of the network or digital asset, directly or indirectly. o The AP monetizes the value of the digital asset, especially where the digital asset has limited functionality. In evaluating whether a digital asset previously sold as a security should be reevaluated at the time of later offers or sales, there would be additional considerations as they relate to the “efforts of others,” including but not limited to: Whether or not the efforts of an AP, including any successor AP, continue to be important to the value of an investment in the digital asset. Whether the network on which the digital asset is to function operates in such a manner that purchasers would no longer reasonably expect an AP to carry out essential managerial or entrepreneurial efforts. Whether the efforts of an AP are no longer affecting the enterprise’s success. ","You may only use the text included in this prompt for your answer. You are not allowed to use any external resources or prior knowledge. How would a digital asset that had been deemed a security be reevaluated? C. Reasonable Expectation of Profits Derived from Efforts of Others Usually, the main issue in analyzing a digital asset under the Howey test is whether a purchaser has a reasonable expectation of profits (or other financial returns) derived from the efforts of others. A purchaser may expect to realize a return through participating in distributions or through other methods of realizing appreciation on the asset, such as selling at a gain in a secondary market. When a promoter, sponsor, or other third party (or affiliated group of third parties) (each, an “Active Participant” or “AP”) provides essential managerial efforts that affect the success of the enterprise, and investors reasonably expect to derive profit from those efforts, then this prong of the test is met. Relevant to this inquiry is the “economic reality”12 of the transaction and “what character the instrument is given in commerce by the terms of the offer, the plan of distribution, and the economic inducements held out to the prospect.”13 The inquiry, therefore, is an objective one, focused on the transaction itself and the manner in which the digital asset is offered and sold. The following characteristics are especially relevant in an analysis of whether the third prong of the Howey test is satisfied. 1. Reliance on the Efforts of Others The inquiry into whether a purchaser is relying on the efforts of others focuses on two key issues: Does the purchaser reasonably expect to rely on the efforts of an AP? Are those efforts “the undeniably significant ones, those essential managerial efforts which affect the failure or success of the enterprise,”14 as opposed to efforts that are more ministerial in nature? Although no one of the following characteristics is necessarily determinative, the stronger their presence, the more likely it is that a purchaser of a digital asset is relying on the “efforts of others”: An AP is responsible for the development, improvement (or enhancement), operation, or promotion of the network,15 particularly if purchasers of the digital asset expect an AP to be performing or overseeing tasks that are necessary for the network or digital asset to achieve or retain its intended purpose or functionality.16 o Where the network or the digital asset is still in development and the network or digital asset is not fully functional at the time of the offer or sale, purchasers would reasonably expect an AP to further develop the functionality of the network or digital asset (directly or indirectly). This particularly would be the case where an AP promises further developmental efforts in order for the digital asset to attain or grow in value. There are essential tasks or responsibilities performed and expected to be performed by an AP, rather than an unaffiliated, dispersed community of network users (commonly known as a “decentralized” network). An AP creates or supports a market for,17 or the price of, the digital asset. This can include, for example, an AP that: (1) controls the creation and issuance of the digital asset; or (2) takes other actions to support a market price of the digital asset, such as by limiting supply or ensuring scarcity, through, for example, buybacks, “burning,” or other activities. An AP has a lead or central role in the direction of the ongoing development of the network or the digital asset. In particular, an AP plays a lead or central role in deciding governance issues, code updates, or how third parties participate in the validation of transactions that occur with respect to the digital asset. An AP has a continuing managerial role in making decisions about or exercising judgment concerning the network or the characteristics or rights the digital asset represents including, for example: o Determining whether and how to compensate persons providing services to the network or to the entity or entities charged with oversight of the network. o Determining whether and where the digital asset will trade. For example, purchasers may reasonably rely on an AP for liquidity, such as where the AP has arranged, or promised to arrange for, the trading of the digital asset on a secondary market or platform. o Determining who will receive additional digital assets and under what conditions. o Making or contributing to managerial level business decisions, such as how to deploy funds raised from sales of the digital asset. o Playing a leading role in the validation or confirmation of transactions on the network, or in some other way having responsibility for the ongoing security of the network. o Making other managerial judgements or decisions that will directly or indirectly impact the success of the network or the value of the digital asset generally. Purchasers would reasonably expect the AP to undertake efforts to promote its own interests and enhance the value of the network or digital asset, such as where: o The AP has the ability to realize capital appreciation from the value of the digital asset. This can be demonstrated, for example, if the AP retains a stake or interest in the digital asset. In these instances, purchasers would reasonably expect the AP to undertake efforts to promote its own interests and enhance the value of the network or digital asset. o The AP distributes the digital asset as compensation to management or the AP’s compensation is tied to the price of the digital asset in the secondary market. To the extent these facts are present, the compensated individuals can be expected to take steps to build the value of the digital asset. o The AP owns or controls ownership of intellectual property rights of the network or digital asset, directly or indirectly. o The AP monetizes the value of the digital asset, especially where the digital asset has limited functionality. In evaluating whether a digital asset previously sold as a security should be reevaluated at the time of later offers or sales, there would be additional considerations as they relate to the “efforts of others,” including but not limited to: Whether or not the efforts of an AP, including any successor AP, continue to be important to the value of an investment in the digital asset. Whether the network on which the digital asset is to function operates in such a manner that purchasers would no longer reasonably expect an AP to carry out essential managerial or entrepreneurial efforts. Whether the efforts of an AP are no longer affecting the enterprise’s success. ",Legal,Find & Summarize,Text Transformation Present your answer without any extraneous information.,What is optimal foraging theory when compared to automotive theft?,"See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/257885522 Prey selection among Los Angeles car thieves Article in Crime Science · December 2013 DOI: 10.1186/2193-7680-2-3 CITATIONS 14 READS 183 1 author: P. Jeffrey Brantingham University of California, Los Angeles 159 PUBLICATIONS 8,448 CITATIONS SEE PROFILE All content following this page was uploaded by P. Jeffrey Brantingham on 17 April 2020. The user has requested enhancement of the downloaded file. R E S EAR CH Open Access Prey selection among Los Angeles car thieves P Jeffrey Brantingham Abstract More than 63,000 cars were reported stolen in Los Angeles in 2003–04. However, the distribution of thefts across car types is very uneven. Some cars types such as the Honda Civic were stolen at much higher frequencies than the majority of car types. Charnov’s classic prey selection model suggests that such uneven targeting should be related to variations in the environmental abundance, expected payoffs, and handling costs associated with different car types. Street-based surveys in Los Angeles suggest that differences in abundance explain the majority of thefts. Cars stolen despite being rare may reflect offender preference based on differential payoffs, probably in some non-monetary currency such as prestige or excitement. Differential handling costs play a more ambiguous role in target selection, but may underlie thieves’ decisions to ignore some cars common in the environment. The unspecialized nature of car theft in Los Angeles suggests that the behavioral and cognitive capacities needed to be a successful car thief are generic. The evolved capacity to solve foraging problems in boundedly-rational ways, mixed with small amounts of trial-and-error and/or social learning, are sufficient to produce experts from inexperienced thieves. Keywords: Crime; Environmental criminology; Behavioral ecology; Optimal foraging; Bounded-rationality; Social learning Background The rational choice theory of crime holds that offenders engage in crime because they stand to receive significant short-term benefits with little attendant risk and small associated costs (Cornish and Clarke 1986, 1987). Presented with a suitable target or victim, unguarded by an effective security measure, the reasoning offender generally capitalizes on that opportunity (Felson and Clarke 1998; Freeman 1996). Beyond implying a common-sense relationship between benefits and costs, however, rational choice theory does not immediately identify what makes any given victim or target suitable. A conceptual framework introduced by Clarke (1999) suggests that property targets are suitable when they are concealable, removable, available, valuable, enjoyable and disposable, capturing several of the dimensions of costs and benefits that are important in offender decision making. While useful, the so-called CRAVED approach also leaves much unspecified about the relative importance of relationships among the different dimensions of target suitability. Here I turn to theory arising outside of criminology to provide a formal framework in which understand the relationships between target characteristics and offender target selection. Specifically, I use Charnov’s (1976) prey selection model to evaluate offender choice to steal different car types. The prey selection model postulates that a forager will ignore a particular prey type upon encounter if the expected return from a future prey encounter is greater. Preference in Charnov’s model is defined in terms of the relative abundance of different prey types and their respective handling costs and payoffs upon consumption. Intuitively, prey that are easy to handle or have high payoffs may be preferred but rarely taken, if they are rarely encountered. Prey that are hard to handle or have low payoffs may still be taken, if more profitable prey are rarely encountered. Here the predictions of Charnov’s prey selection model are rejected based on findings that unique car types are stolen almost exclusively in response to their environmental availability. Only occasionally are cars targeted because they have higher perceived payoffs. Overall, Los Angeles car thieves operate primarily as unspecialized foragers. Correspondence: branting@ucla.edu Department of Anthropology, University of California, Los Angeles, 341 Haines Hall, UCLA, Box 951553, Los Angeles, CA 90095-1553, USA © 2013 Brantingham; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Brantingham Crime Science 2013, 2:3 http://www.crimesciencejournal.com/content/2/1/3 Optimal foraging theory and crime Foraging theory is the branch of ecology that seeks to understand how animal behavior facilitates the encounter, acquisition and processing of resources necessary to survival (Stephens and Krebs 1986). The foraging challenges facing an animal are substantial. Essential resources are rarely located in the same location as the animal needing them, necessitating behaviors that either carry the animal to the resources, or position the animal to intercept resources that move. Many resource types possess defenses that aim to thwart acquisition, even after a forager has encountered them. Animals therefore need behavioral strategies designed discriminate among resource types and defeat their defenses once they have decided to acquire them. Finally, even after a resource as been encountered and acquired, it may contain a mixture of useable and unusable constituents. Behaviors may play a key role in sorting and separating these constituents. Only after jumping these foraging hurdles may an animal benefit from the resource. Recognize, however, that the behaviors deployed to facilitate encounter, acquisition and processing of a resources are not cost free. Optimal foraging theory therefore posits that evolution and/or learning has shaped animal behavior to maximize the average or long-term return rate from essential resources, net the costs of encounter, acquisition and processing. Here I cast car theft as a foraging problem and test the proposition that the specific car types stolen represent behaviors consistent with optimal foraging theory. Three conditions must be met to consider car theft as an optimal foraging problem (see also Bernasco 2009; Felson 2006; Johnson et al. 2009). First, car theft should satisfy a need that is perceived by the offender to be essential. Car thieves report a range of motivations for stealing cars including financial motives such as theftfor-export or an immediate need for cash, mundane or routine motives such as transportation, and recreational motives such as a search for excitement, prestige or status (Copes 2003; Dhami 2008; Kellett and Gross 2006; Lantsman 2013; Light et al. 1993). With the exception of theft-for-transport, car theft is not remarkable in motivation compared with other crimes (Wright et al. 2006; Wright and Decker 1994). However, car theft may be a comparably low risk alternative to satisfy these needs (Copes and Tewksbury 2011). Between 2003 and 2006, ~12.9% of reported car thefts in the US were cleared by arrests, while robberies over the same period were cleared at a rate twice as high ~25.8% (Federal Bureau of Investigation 2003–2006). The vast majority of car thefts therefore entail no negative consequences, at least over the short term (Freeman 1999). The benefits may therefore be substantial. Payoffs to car theft might be calculated in a cash currency, if cars and/or their parts are being fenced (Clarke 1999; Tremblay et al. 2001). Payoffs might also be calculated in non-cash commodities such as barter value in drugs (Stevenson and Forsythe 1998) or prestige and excitement—an essential resource for joy riding teenagers (Copes 2003; Jacobs et al. 2003; Kellett and Gross 2006). Second, car thieves must also have behavioral alternatives to deploy during foraging and these alternatives must result in different payoff outcomes. Ethnographic evidence indicates that car theft involves choices between alternative search strategies, tools and techniques for gaining entry and ‘hot wiring’ targeted vehicles, and strategies for escape and disposal of stolen vehicles (Copes and Cherbonneau 2006; Copes and Tewksbury 2011; Farrell et al. 2011; Langworthy and Lebeau 1992; Lantsman 2013; Light et al. 1993; Lu 2003). Whether these different behavioral alternatives lead to real differences in payoffs is an open question. The observation that different car types are stolen to satisfy different needs may imply differential payoffs (Clarke 1999). However, the extent to which alternative behavioral strategies drive these payoffs, as required by optimal foraging theory, is unknown. Finally, there must be a mechanism by which car thieves select among the alternative behaviors, yielding near-optimal strategies for locating, stealing and disposing of cars. Simple trial-and-error and/or social learning in the context of co-offending appear to play this role (Akers 2008; Reiss and Farrington 1991). Juvenile car thieves often start as passengers, observing the actions of their more experienced friends (Light et al. 1993). Such learning mechanisms seem capable quickly producing effective cognitive scripts that car thieves can adhere to during commission of a crime (Tremblay et al. 2001). The prey selection model The foraging problem confronted by car thieves is similar in many ways to prey selection, a classical problem in behavioral ecology studied by Charnov (1976) and others (see Krebs et al. 1977; Stephens and Krebs 1986). Given sequential encounters with prey types, each having different expected returns and handling costs, which types should be pursued and captured? Let ei, hi and λi be the expected payoff, handling cost and local density of a prey of type i. Prey types i = 1, 2, … N are ranked in descending order of the ratio of payoff to handling cost ei/hi. The prey classification algorithm says that prey types i = 1, 2, … j should be pursued and captured upon encounter, but prey type j + 1 should be ignored if its payoff to handling cost ratio is below the mean for all higher ranked prey: Brantingham Crime Science 2013, 2:3 Page 2 of 11 http://www.crimesciencejournal.com/content/2/1/3 X j i¼1 λiei 1 þX j i¼1 λihi > ejþ1 hjþ1 ð1Þ In other words, if the expected return from future prey encounters is higher than would be gained by taking the current target, then it is better to wait. The prey choice model makes two distinctive predictions. First, prey types are either always taken upon encounter, or always ignored. This is the so-called “zero–one” rule in reference to the analytical result that an attack on prey type i will occur with probability qi = 0, or qi = 1, and nothing in between (Stephens and Krebs 1986). Second, whether or not a prey type is taken is dependent only on the encounter rate with higherranked prey, not its own encounter rate. Note that the term λi appears only on the left-hand side in Equation (1). The implication is that only changes in the encounter rate with higher ranked prey items will impact the decision to attack a lower ranked prey item once it has been encountered. Thus, if a higher ranked prey type becomes very scarce, a lower ranked prey type may be added to the diet. However, if a lower ranked prey type suddenly becomes very common, it will not necessarily be added to the diet without a concomitant change in the rate of encounter with higher ranked types. Empirical evidence from both animal (Hughes and Dunkin 1984; Prugh 2005; but see Pyke 1984) and human foragers (Hames and Vickers 1982; Smith 1991) suggests that the prey classification algorithm provides insights into prey selection behavior across a diverse range of taxa and foraging contexts. Car theft may be considered a special case of prey selection if car types vary in expected payoffs, handling costs and/or local abundance and offenders are attentive to these differences. As discussed in the Methods section, the available data on payoffs and handling times do not allow for a fine-grained test of either the zero–one rule, or the hypothesis that changes in the encounter rate with higher-ranked car types impact the inclusion of lower ranked car types in an offender’s ‘diet’. A strict reading of the prey choice model also suggests that car theft may not perfectly conform to all of its assumptions (see for comparison Smith 1991). The prey choice model assumes that: (1) foragers are long-term rate maximizers, meaning that average results of stealing cars over long time periods, rather than short-term gains, are optimized by different foraging strategies; (2) searching for and handling of targeted vehicles are mutually exclusive; (3) encounters with vehicles follow a Poisson process, meaning that two cars cannot be encountered simultaneously and each encounter is statistically independent of all others; (4) the payoff to stealing cars ei, the handling costs hi, and encounter rates λi are environmentally fixed in time and space; and (5) that the foraging car thief has perfect information about ei, hi and λi. Assumptions 1, 2, 3 and 5 may be reasonable for car theft. The notion that criminal behavioral strategies might be shaped by learning to produce long-term average rate maximization (Assumption 1) seems far fetched at first (but see Tremblay and Morselli 2000). Criminal offenders tend to be present-oriented (Gottfredson and Hirschi 1990; Nagin and Paternoster 1994) and therefore appear little concerned with the long-term costs and benefits of crime (Wilson and Abrahamse 1992). However, the question at hand is not whether crime pays relative to non-crime alternatives, but rather whether stealing one car type is more profitable in the long run than stealing an alternative car type. It is conceivable that offenders adopt strategies that maximize the longterm or average payoffs from car theft by making discriminating choices about which cars to steal. It is also reasonable to suppose that simultaneous search for cars to steal and the physical act stealing a car are mutually exclusive activities (Assumption 2). This is made more complicated by co-offending, which is quite common for younger car thieves (Light et al. 1993), if some in an offending party search nearby targets while others are breaking into a given car. It is unknown whether encounters with cars to steal follow a Poisson process (Assumption 3). Ultimately, this is an empirical question for which data need to be collected. Conceptually, however, a motivated car thief walking down a linear street segment encounters cars sequentially and independently. Whether such conditions hold in a parking lot may depend on situational factors such as the layout of and available observation points in the lot. The prey choice model is not obviated under these circumstances (Stephens and Krebs 1986: 38–45), but additional costs associated with discriminating between simultaneously encountered car types must be taken into account. Perhaps the greatest challenge comes from strictly assuming that the key parameters of prey selection remain fixed in time and space (Assumption 4) (Suresh and Tewksbury 2013). At intermediate time scales (months to years), the payoffs to stealing different car types certainly change with turnover in the composition of cars on the street. Early and late model years may differ significantly in both perceived or actual value as well as handling costs, for example, following the introduction of RFID keys for ignition systems (Farrell et al. 2011). Similarly, there may be short-term (hourly-daily) fluctuations in environmental abundance of cars parked in locations where they might be stolen. Nevertheless, it is reasonable to assume that car thieves have relatively Brantingham Crime Science 2013, 2:3 Page 3 of 11 http://www.crimesciencejournal.com/content/2/1/3 accurate knowledge of the encounter rates, payoffs and handling costs associated with different cars, or learn them very quickly when conditions change (Assumption 5) (Akers 2008; Light et al. 1993). Given the above limitations, I test a conservative null hypothesis in place of the two detailed predictions made by the prey selection model: H0. If every car yields the same payoff and all are equally difficult to steal (i. e., ei/hi = ej/hj ∀ i, j), then differences in theft rates arise only from differences in relative abundances of car types λi. In other words, if all cars rank equally in the ratio of payoffs to handling costs, then all cars are part of the ‘diet’ and should be taken immediately upon encounter. Cars encountered more frequently will appear in the diet more often and, in fact, will be stolen at a frequency proportional to λi. One should therefore expect a strong correlation between relative abundances and theft rates if the null hypothesis is true. Failure to reject the null hypothesis implies that car thieves are unspecialized foragers and take only what is presented to them by the environment. Rejection of the null hypothesis, for all or even some car types, may constitute evidence that differential payoffs and/or handling costs enter into car thieves’ situational foraging decisions. Under these circumstances we can evaluate the role that payoffs and/or handling costs may play in driving target choice. Methods Car types are defined as unique make-models or, where necessary, make-model-years. For example, 1992 and 2002 Honda Civics may be different car types, from the point of view of the offender, because they have different perceived payoffs and may also differ in how easy they are to break into and ‘hot wire’ (Farrell et al. 2011). An initial database of car make-model-years was assembled using a popular car shopping and research website, www.edmonds.com. A student assistant was then trained to quickly and accurately identify car types in pilot surveys of a university campus parking structures. Street-based surveys were conducted in three Los Angeles zip codes (90034, 90045 and 90291) during two excursions in October-December 2004 and OctoberDecember 2005. The three survey locations had the highest volume of car thefts in 2003 among zip codes on the Los Angeles West Side. Surveys involved walking between one and three contiguous blocks, first up one side and then down the other. Surveys on the exact same block segments were conducted at two-hour intervals between 6AM and 6PM. The most dramatic change in density of cars parked on the street occurred between 6AM and 8AM. I therefore assume that the mix of car types seen at 6AM represents the overnight diversity. Only vehicles in publically accessible street locations were recorded. The observed relative frequency of each car type i is used as a measure of encounter rate λi. Expected value on the illegal market is used as a proxy for the payoffs ei associated with stealing different car types (Copes 2003; Matsueda et al. 1992). I do not assume that all car thieves seek cash. Rather, illegal market value is a generic currency that is expected to be positively correlated with non-monetary payoffs. For example, a ‘hot car’ is not only more likely to demand more money in an illegal market context, but it is also expected to have a higher payoff in excitement and prestige for the teenage car thief. Illegal market value is calculated as ei = f ∑ ipivi, where pi is the proportion of cars of a given make-model-year stolen, vi is the legal market value of the car at the time of theft as determined from the Kelley Blue Book (DeBacker 2003), and f is the fraction of the legal market value realized on the illegal market. I assume that f = 0.1, but choice of a different constant does not impact the results. I use break-in times as a proxy for overall handling costs hi. The UK-based “What Car?” Security Supertest (Secured by Design 2000, 2003) conducted attack testing of new cars marketed in the UK. The tests evaluated the ability of new vehicles to withstand attacks by trained locksmiths using the non-destructive entry techniques commonly deployed by car thieves. The tests included 123 unique make-models and measured the time, in seconds, needed to gain entry to each vehicle. A car was considered to pass the test if it was not possible to gain entry within two minutes. Break-in time represents only one of the handling costs associated with car theft. I assume, however, that the handling costs at different critical points in the theft process are positively correlated. For example, if a car is easy to enter, it is also more likely to be easy to ‘hot wire’, less likely to have a geo-location device installed and be easier to chop. Evaluation of the relationships between car theft, environmental abundances, payoffs and handling costs is conducted using non-parametric statistics that are robust to ordinal scale data and non-normal distribution characteristics (Conover 1998). Theft frequencies and environmental abundances are compared using Kendall’s τ, a generalized correlation coefficient that measures the similarity of ranked order lists. Kendall’s τ b allows for rank order ties. Illegal market values and break-in times among common and rare cares are non-normally distributed. Medians therefore provide the most robust measure of central tendency and the non-parametric Mann–Whitney U the most appropriate corresponding statistical test. Differences in distribution shape are computed using the non-parametric Kolmogorov-Smirnov D. Brantingham Crime Science 2013, 2:3 Page 4 of 11 http://www.crimesciencejournal.com/content/2/1/3 Results Between 1 Jan 2003 and 31 December 2004, 63,528 vehicles were reported stolen within the City of Los Angeles (Federal Bureau of Investigation 2003–2006). In zip codes 90034, 90045 and 90291, located on the West Side of Los Angeles and representing ~3.5% of the land area of the City, a total of 2,251 cars were stolen during the same period, or ~3.5% of all thefts. These cars are divided into 271 unique make-model types. The Honda Civic and Accord, Toyota Camry and Corolla, and Nissan Sentra together comprise ~25% of the total thefts and 87 car types are represented by single thefts (Figure 1A, Table 1). To test whether the observed bias in thefts towards some car types is driven by environmental abundance, I conducted surveys of main artery and residential streets (see Methods). A total of 1,825 cars were observed and these were classified into 262 unique make-model types. As with reported thefts, the cars available on the streets are dominated by a few types (Figure 1B). Seventy seven types identified in the survey are singletons. The distribution is qualitatively similar to rank species abundance curves in ecology, which show environments numerically dominated by a few species, but most of the richness is accumulated through species with small numbers of individuals Hubbell (2001). Here I focus on the top 25 most commonly stolen cars. These car types account for 53% of the total observed volume of stolen cars (N = 1198) and the bulk of the variation in theft frequency. A comparison of theft and density rank order frequencies shows a significant positive relationship (Kendall’s τ b = 0.491, p < 0.001) (Figure 2). Thirteen of the top 25 most stolen cars are also in the top 25 for abundance (Table 1). In general, the most common cars on the street are also the most stolen. The positive relationship between abundance and theft is particularly strong among the top nine most stolen cars (Kendall’s τ b = 0.611, p = 0.022). Honda Civics are the most abundant cars and the most frequently stolen. For the top nine cars it is difficult to reject the null hypothesis that environmental abundance is driving the targeting of these vehicles for theft. Note, however, that approximately one half (N = 12) of the top 25 most stolen cars are not in the top 25 for abundance. Several of these are significant outliers (Table 1). For example, the Chrysler 300M is ranked 14, with 33 thefts in 2003–04, but was observed only 0 20 40 60 80 100 120 140 160 180 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 244 253 262 271 Number of Thefts Theft Rank Honda Civic Toyota Camry Honda Accord Jeep Grand Cherokee Ferrari 360 N = 2,251 A 0 20 40 60 80 100 120 140 Number of Cars Honda Civic Honda Accord Toyota Corolla Chevy Cavalier Porsche Carerra N = 1,825 B Figure 1 Rank order plots of make-model car types stolen and observed in street-based surveys in three Los Angeles zip codes. (A) Cars stolen in zip codes 90034, 90045 and 90291 between Jan 1, 2003 and December 31, 2004 are numerically dominated by a few car types. (B) The rank order abundance of car types in the same zip codes, observed in street surveys conducted in 2004 and 2005, reveals the structure of car theft opportunities. Brantingham Crime Science 2013, 2:3 Page 5 of 11 http://www.crimesciencejournal.com/content/2/1/3 once in the 1,825 cars identified in street surveys (survey rank = 224). Similarly, the Pontiac Grand AM was ranked 10, with 44 thefts, but was observed only four times in the same surveys (survey rank = 110.5). It may be that thieves targeted these rare cars based on specialized evaluation of the expected payoffs, handling costs, or both, made at the time of encounter. Taking into account car make, model and year, I calculated the expected illegal market value for each car stolen in 2003 as 10% of the Kelley Blue Book value at the time of theft (see Methods) (DeBacker 2003; Stevenson and Forsythe 1998; Tremblay et al. 2001). Illegal market value is used as broad proxy for both monetary and non-monetary payoffs. Figure 3 shows that the distribution of expected illegal market values for the outliers is significantly different from that associated with environmentally common cars (Mann–Whitney U = 8562, Wilcoxon = 73542, Z = −11.327, p < .001). Among the environmentally common cars, the median expected illegal market value is $740 (min = $293, max = $2,916). Among the environmentally rare cars, the median is twice as large at $1,515 (min = $210, max $4,493). These data suggest that the outliers within the sample of stolen cars may be targeted because they offer a higher expected payoff. It is also possible that ease-of-theft is responsible for the observed outliers (Farrell et al. 2011; Light et al. 1993; Wiles and Costello 2000). The UK-based “WhatCar?” Security Supertest (Secured by Design 2000, 2003), evaluated the ability of a range of new vehicles to withstand attacks using non-destructive entry techniques (see Methods). Break-in time is used as a proxy for handling costs at all stages of the theft process. The aggregated results from 2000 and 2003, excluding those cars that passed the test, show a weak, but significant relationship between break-in times and Table 1 The top 25 most stolen car types in 2003–2004 and their environmental densities in Los Angeles zip codes 90034, 90045 and 90291 Make-model Theft N Survey N Recovery N Theft p Survey p Recovery p Theft rank Survey rank HONDA CIVIC 155 128 110 0.069 0.070 0.710 1 1 TOYOTA CAMRY 151 59 118 0.067 0.032 0.781 2 4 HONDA ACCORD 109 94 81 0.048 0.052 0.743 3 2 TOYOTA COROLLA 68 86 47 0.030 0.047 0.691 4 3 NISSAN SENTRA 60 33 45 0.027 0.018 0.750 5 9 ACURA INTEGRA 52 21 28 0.023 0.012 0.538 6 14 FORD MUSTANG 50 20 41 0.022 0.011 0.820 7 16 FORD EXPLORER 49 57 35 0.022 0.031 0.714 8 5 FORD TAURUS 46 28 36 0.020 0.015 0.783 9 11 PONTIAC GRAND AM/PRIX 43 4 38 0.019 0.002 0.884 10 110.5 NISSAN ALTIMA 35 42 27 0.016 0.023 0.771 11 7 CHEVY IMPALA 34 6 26 0.015 0.003 0.765 12.5 79.5 DODGE STRATUS 34 5 30 0.015 0.003 0.882 12.5 93.5 CHRYSLER 300M 33 1 31 0.015 0.001 0.939 14 224 CHEVY BLAZER 32 15 24 0.014 0.008 0.750 15 25 CHRYSLER PT CRUISER 31 8 26 0.014 0.004 0.839 16 58 DODGE CARAVAN 28 8 18 0.012 0.004 0.643 17.5 58 DODGE INTREPID 28 9 23 0.012 0.005 0.821 17.5 49.5 JEEP CHEROKEE 27 34 16 0.012 0.019 0.593 19 8 LINCOLN TOWN CAR 24 4 22 0.011 0.002 0.917 20 110.5 DODGE NEON 23 2 19 0.010 0.001 0.826 21.5 165.5 FORD FOCUS 23 7 20 0.010 0.004 0.870 21.5 68.5 CHRYSLER SEBRING 21 3 15 0.009 0.002 0.714 24 132.5 FORD EXPEDITION 21 12 13 0.009 0.007 0.619 24 32.5 JEEP GRAND CHEROKEE 21 20 14 0.009 0.011 0.667 24 16 Note: Theft and recovery proportions are calculated with respect to all 2,251 cars stolen. Survey proportions are calculated with respect to the 1,825 unique car types identified in street-based surveys. Environmental densities were measured in two survey periods October-December 2004 and October-December 2005. Brantingham Crime Science 2013, 2:3 Page 6 of 11 http://www.crimesciencejournal.com/content/2/1/3 market price in US Dollars (r 2 = .258, p < .001) (Figure 4A). The median break-in time for all vehicle types successfully attacked was 29 seconds and the minimum time was two seconds. Twenty three cars (~19%) have break-in times under 15 seconds. Vehicle make-models are not equivalent between the UK and US markets, despite similar names, and comparable data are not available from US contexts. It is not possible therefore to map break-in times from the Security Supertests directly to car types stolen in the US Number of Thefts 100 80 60 40 20 0 Illegal Market Value in $ 0 1,000 2,000 3,000 4,000 5,000 100 80 60 40 20 0 A B Figure 3 Frequency histograms of the estimated illegal market values show much lower expected payoffs may be attributed to the top nine most stolen cars (A), where density is expected to the major determinant of theft, compared with the outliers (B), where environmental density is not implicated. 0 5 10 15 20 25 0 50 100 150 200 250 Theft Rank Survey Rank Chrysler300M Dodge Neon Chevy Impala Pontriac Grand Prix/Am Dodge Stratus Chrysler Sebring Lincoln Town Car Ford Focus Chrysler PT Cruiser Dodge Caravan Dodge Intrepid Figure 2 A scatter plot of abundance rank order against theft rank order shows a strong positive relationship between car availability and theft risk. Eleven car-types are stolen much more frequently than their environmental abundance would suggest. Line represents a hypothetical 1:1 relationship between rank abundance and rank theft. Brantingham Crime Science 2013, 2:3 Page 7 of 11 http://www.crimesciencejournal.com/content/2/1/3 using the UK data. However, some indication of handling costs may be gained by examining patterns within manufactures. Seven of the cars stolen in disproportion to their environmental density were manufactured by Daimler-Chrysler, three by Ford and two by GM (Table 1). Of the 123 cars tested in the Security Supertests, 44 were vehicles by these manufacturers. Eleven (25%) successfully withstood attacks lasting two minutes, compared with 24 of the remaining 79 car types (44%). The data may suggest that Daimler-Chrysler, GM and Ford vehicles are more broadly susceptible to attack. However, a range of break-in times characterize the vehicles that did not pass the test (Table 2). Low and high-mid market cars sold under the Chrysler brand (e.g., Neon, Grand Voyager) have minimum break-in times of between four and six seconds, while one low-market GM car sold under the Vauxhall brand had a brake-in time of two seconds. Midmarket GM cars, also sold under the Vauxhall brand, had a mean break-in time of 81 seconds. The aggregate results do not indicate that cars made by DaimlerChrysler, Ford or GM are disproportionately easier for car thieves to handle. Indeed, cars marketed by other manufacturers show a significant skew towards shorter break-in times and, by implication, lower handling costs for thieves (Kolmogorov-Smirnov Z = 1.349, p = 0.053) (Figure 4B,C). Discussion and conclusion It is difficult to reject the null hypothesis that environmental abundance is the primary determinant of what cars are targeted for theft. There is a particularly strong relationship between abundance and theft rank for the top-nine most stolen cars. In the CRAVED conceptual framework put forward by Clarke (1999), availability would seem to outweigh other dimensions that might influence theft choice. In the instances where cars are targeted despite being rare, payoff differences may play some role. Car recovery rates provide one measure of the importance of non-monetary, or possibly limited monetary payoffs to car theft (Clarke and Harris 1992). There is little systematic difference in the rate of recovery across car types (Table 1), suggesting that none of the top 25 most stolen cars are disproportionately landing in fully-body chop shops or being stolen for export. The payoffs here seem to be primarily non-monetary. Furthermore, among the outliers that are stolen despite being rare, it appears that the newest model years are targeted. For example, eight of 12 Chrysler 300s and seven of 13 Chrysler Sebrings stolen during 2003 were 2004 model years, which became available only in the last five months of the year. The implication is that these cars, though rare, were targeted precisely because they were perceived to be ‘hot rides’ (Wiles and Costello 2000). That some cars are more valuable or enjoyable can override their low availability, but this occurs infrequently. It is less apparent that lower handling costs biased thieves’ decisions to target environmentally rare cars, although ethnographic work suggests that handling costs are often a significant concern (Clarke 1999; Light et al. 1993; Wiles and Costello 2000). Recent research suggests that the potential for encountering opposition from car owners is a major concern (Copes and Tewksbury 2011), but it is uncertain how the probability of opposition might relate to car type. Direct handling costs may have played a role in driving Los Angeles car thieves to A BC Figure 4 Break-in times for UK make-models measured by the “WhatCar?” Security Supertest in 2000 and 2003. (A) Scatter plot of break-in time versus US market price implies only a weak relationship between payoffs and handling costs. Frequency histograms of the break-in times for (B) GM-, Daimler-Chrysler- and Ford-group cars and (C) all other car types. Brantingham Crime Science 2013, 2:3 Page 8 of 11 http://www.crimesciencejournal.com/content/2/1/3 ignore certain environmentally common cars. Seven make-model types including the Volkswagen Jetta, Toyota RAV4 and Nissan Xterra ranked within the top 25 for abundance, but were rarely or never stolen (Table 3). An average of 57% of the vehicles sold by the corresponding manufactures in the UK passed the Security Supertests. This is compared only 25% of Daimler-Chrysler, GM and Ford cars representative of the environmentally rare group. The implication is that these cars may be ignored because they are more resistant to attack. Detailed attack analyses of cars from the US market could help resolve the exact role of handling costs in the differential targeting of some cars. In spite of the narrow role that differential payoffs and handling costs appear to play the choice of which cars to steal, one must be careful to not fall prey to the ecological fallacy. Ethnographic evidence points to a degree of specialization among car thieves, with distinctions among those engaged in opportunistic theft and those in organized crime, and among younger and older offenders. Such specializations are not directly visible in aggregate car theft data. It is possible that the population of Los Angeles car thieves consists of several different types each with their preferred prey. The observed frequency of stolen car types might therefore represent a mixture of fixed, independent strategies, some rare and Table 3 Environmentally abundant cars of low theft rank in zip codes 90034, 90045 and 90291 and the aggregated 2000 and 2003 “WhatCar?” Security Supertest results for cars from the corresponding manufacturers Make-model Theft N Survey N Theft rank Survey rank N tested Passing p Models failing Mean (s) σ (s) Min (s) Max (s) Volkswagen Jetta 9 56 63 6 6 0.50 Lupo 1.4S, Polo Gti, Golf 1.6SE 32 16.09 19 50 Toyota RAV4 5 19 91 18 8 0.63 Yaris Verso, Corolla, Avensis 46.33 15.50 31 46 Lexus ES 15 229 25 3 0.67 IS 111 Nissan Xterra 2 16 164 21 5 0.80 Micra 1.3 SE 14 Volvo S Class 17 229 19.5 3 0.67 XC90 70 Subaru Outback 2 15 164 25 3 0.00 Impreza, Impreza Turbo, Legacy 22.67 24.79 5 51 Table 2 Break-in times in seconds for Daimler-Chrysler, Ford and GM brands sold in the UK tested in the “WhatCar?” Security Supertest in 2000 and 2003 Manufacturer Make-model Market N Mean (seconds) σ (seconds) Min (seconds) Max (seconds) Daimler-Chysler Chrysler Neon Low 1 4 Daimler-Chysler Mercedes A Class Mid 1 30 Daimler-Chysler Chrysler Grand Voyager High-mid 1 6 Daimler-Chysler Mercedes C, E Class High 2 70 7.07 65 75 Ford Fiesta, Focus Ghia Estate, Ka 3, Mazda 626 Sport Low 4 40.75 15.9 23 60 Ford Focus TDi Ghia, Ka, Streetka, Landrover Freelander, Mazda MPV, Mazda Premacy Mid 6 33.83 17.08 19 65 Ford Focus, Land Rover Discovery, Mazda 6 High-mid 3 43 13.45 28 54 Ford Mondeo, Jaguar XKR, Range Rover 4.0 HSE, Volvo XC90 High 4 69 21.76 40 93 GM Vauxall Agilla, Astra Low 2 12 13.44 2 21 GM Vauxall Corsa, Frontera, Meriva, Zafira Mid 4 81 40.04 21 108 GM Saab 93, Saab 95, Vauxall Astra High-mid 3 45.67 10.69 39 58 GM Cadillac Seville STS, Vauxall Vectra High 2 58 74.95 5 111 Total Daimler-Chrysler, GM, Ford 33 46.88 30.68 2 111 Other Car types 55 32.22 29.36 2 115 Brantingham Crime Science 2013, 2:3 Page 9 of 11 http://www.crimesciencejournal.com/content/2/1/3 some common, not variation in the behavior of offenders in general. The converse is also potentially true. There is a danger of falling prey to an ethnographic fallacy that confounds our ability to infer aggregate characteristics from ethnographically rich data collected at an individual scale. To wit, given interviews with tens of car thieves about their offending preferences, can we reliably infer the population characteristics of the many thousands of individuals likely responsible for the 63,000 cars stolen in Los Angeles in 2003-2004? There is no easy way to resolve the ecological or ethnographic fallacy. I suspect, however, that the unspecialized foragers responding primarily to environmental abundances greatly outnumber the specialists, making the latter practically invisible in aggregate data. The results described here are important for understanding the broader causes of criminal behavior and may suggest novel approaches to crime prevention based on formal ecological models (see also Bernasco 2009; Brantingham et al. 2012; Felson 2006). The unspecialized nature of car theft in Los Angeles implies that the behavioral and cognitive capacities needed to be a successful thief are generic. Indeed, humans are well-equipped to become effective foragers for criminal opportunities given an evolved psychology to solve foraging problems in boundedly-rational ways (Hutchinson et al. 2007), combined with small amounts of individual trial-and-error or social learning (Akers 2008; Boyd and Richerson 1985). Indeed, the co-offending that characterizes the early careers (<20 years old) of most offenders, including car thieves, is ideally suited to the transmission of the simple skills sufficient to produce experts from inexperienced thieves (Reiss and Farrington 1991). That auto theft in Los Angeles is driven primarily by environmental structure provides further evidence that the greatest gains in crime prevention are to be had in altering the structure of criminal opportunity (Brantingham and Brantingham 1981; Farrell et al. 2011; Felson and Clarke 1998). How environmental alterations impact situational foraging behaviors and longer-term population trajectories are well-studied within ecology (Henle et al. 2004; Kerr et al. 2007), suggesting a way forward for formal crime ecology. Competing interests The author declares that he has no competing interests. Acknowledgements This work was supported in part by grants NSF-FRG DMS-0968309, ONR N000141010221, ARO-MURI W911NF-11-1-0332, and AFOSR-MURI FA9550-10-1-0569, and by the UCLA Faculty Senate. I am indebted to the Los Angeles Police Department for providing the data analyzed here. Thank you to David Bell from Secured by Design and Silas Borden for assistance with the street-based surveys. Received: 29 November 2012 Accepted: 29 April 2013 Published: 3 July 2013 References Akers, R (2008). Social learning and social structure: A general theory of crime and deviance. Boston: Northeastern University Press. Bernasco, W. (2009). Foraging strategies of homo criminalis: lessons from behavioral ecology. Crime Patterns and Analysis, 2(1), 5–16. Boyd, R, & Richerson, PJ (1985). Culture and the Evolutionary Process. Chicago: University of Chicago Press. Brantingham, PJ, & Brantingham, PL (1981). Environmental Criminology. Beverly Hills: Sage. Brantingham, PJ, Tita, GE, Short, MB, & Reid, SE. (2012). The ecology of gang territorial boundaries. Criminology, 50(3), 851–885. Charnov, EL. (1976). Optimal foraging - attack strategy of a mantid. American Naturalist, 110(971), 141–151. Clarke, RV. (1999). Hot Products: Understanding, Anticipating and Reducing Demand for Stolen Goods (Police Research Series, Paper 112.). London: Home Office. Clarke, RV, & Harris, PM (1992). Auto Theft and its Prevention. In M Tonry (Ed.), Crime and Justice: A Review of Research (Vol. 16, pp. 1–54). Chicago: University of Chicago Press. Conover, WJ. (1998). Practical Nonparametric Statistics. Hoboken: Wiley. Copes, H. (2003). Streetlife and the rewards of auto theft. Deviant Behavior, 24(4), 309–332. Copes, H, & Cherbonneau, M. (2006). The key to auto theft - Emerging methods of auto theft from the offenders' perspective. British Journal of Criminology, 46(5), 917–934. Copes, H, & Tewksbury, R. (2011). Criminal experience and perceptions of risk: what auto thieves fear when stealing cars. Journal of Crime and Justice, 34(1), 62–79. Cornish, DB, & Clarke, RV (1986). Introduction. In DB Cornish & RV Clarke (Eds.), The Reasoning Criminal: Rational Choice Perspectives on Criminal Offending. New York: Springer-Verlag. Cornish, DB, & Clarke, RV. (1987). Understanding crime displacement: An application of rational choice theory. Criminology, 25(4), 933–947. DeBacker, P (Ed.). (2003). Kelley Blue Book Used Car Guide Consumer Edition 1988–2002. Irvine, CA: Kelly Blue Book. Dhami, MK. (2008). Youth auto theft: a survey of a general population of canadian youth. Canadian Journal of Criminology and Criminal Justice, 50(2), 187–209. Farrell, G, Tseloni, A, & Tilley, N. (2011). The effectiveness of vehicle security devices and their role in the crime drop. Criminology and Criminal Justice, 11(1), 21–35. Federal Bureau of Investigation (2003–2006). Crime in the United States, Uniform Crime Reports. http://www.fbi.gov/ucr/ucr.htm. Felson, M (2006). Crime and Nature. Thousand Oaks: Sage. Felson, M, & Clarke, RV (1998). Opportunity Makes the Thief: Practical Theory for Crime Prevention (Police Research Series Paper 98). London: Home Office Policing and Reducing Crime Unit. Freeman, RB. (1996). Why do so many young american men commit crimes and what might we do about it? The Journal of Economic Perspectives, 10(1), 25–42. Freeman, RB. (1999). The economics of crime. Handbook of Labor Economics, 3, 3529–3571. Gottfredson, MR, & Hirschi, T (1990). A General Theory of Crime. Stanford: Stanford University Press. Hames, RB, & Vickers, WT. (1982). Optimal diet breadth theory as a model to explain variability in Amazonian hunting. American Ethnologist, 9(2), 358–378. Henle, K, Davies, KF, Kleyer, M, Margules, C, & Settele, J. (2004). Predictors of species sensitivity to fragmentation. Biodiversity and Conservation, 13(1), 207–251. Hubbell, SP (2001). The Unified Neutral Theory of Biodiversity and Biogeography. Princeton: Princeton University Press. Hughes, RN, & Dunkin, SD. (1984). Behavioral components of prey selection by Dogwhelks, Nucella-Lapillus (L), feeding on Mussels, Mytilus-Edulis-L, in the Laboratory. Journal of Experimental Marine Biology and Ecology, 77(1–2), 45–68. Hutchinson, JMC, Wilke, A, & Todd, PM. (2007). Patch leaving in humans: can a generalist adapt its rules to dispersal of items across patches? Animal Behavior, 75, 1331–1349. Jacobs, BA, Topalli, V, & Wright, R. (2003). Carjacking, streetlife and offender motivation. British Journal of Criminology, 43(4), 673–688. Johnson, SD, Summers, L, & Pease, K. (2009). Offender as forager? a direct test of the boost account of victimization. Journal of Quantitative Criminology, 25(2), 181–200. Brantingham Crime Science 2013, 2:3 Page 10 of 11 http://www.crimesciencejournal.com/content/2/1/3 Kellett, S, & Gross, H. (2006). Addicted to joyriding? An exploration of young offenders' accounts of their car crime. Psychology Crime & Law, 12(1), 39–59. Kerr, JT, Kharouba, HM, & Currie, DJ. (2007). The macroecological contribution to global change solutions. Science, 316(5831), 1581–1584. Krebs, JR, Erichsen, JT, Webber, MI, & Charnov, EL. (1977). Optimal prey selection in great tit (parus-major). Animal Behaviour, 25(FEB), 30–38. Langworthy, RH, & Lebeau, JL. (1992). The spatial-distribution of sting targets. Journal of Criminal Justice, 20(6), 541–551. Lantsman, L. (2013). “Moveable currency”: the role of seaports in export oriented vehicle theft. Crime, Law and Social Change, 59(2), 157–184. Light, R, Nee, C, & Ingham, H (1993). Car Theft: The Offender's Perspective (Home Office Rresearch Study No. 30). London: Home Office. Lu, YM. (2003). Getting away with the stolen vehicle: an investigation of journeyafter-crime. The Professional Geographer, 55(4), 422–433. Matsueda, RL, Piliavin, I, Gartner, R, & Polakowski, M. (1992). The prestige of criminal and conventional occupations: a subcultural model of criminal activity. American Sociological Review, 57(6), 752–770. Nagin, DS, & Paternoster, R. (1994). Personal capital and social control: the detterence implications of a theory of individual differences in criminal offending. Criminology, 32(4), 581–606. Prugh, LR. (2005). Coyote prey selection and community stability during a decline in food supply. Oikos, 110(2), 253–264. Pyke, GH. (1984). Optimal foraging theory - a critical-review. Annual Review of Ecology and Systematics, 15, 523–575. Reiss, AJ, & Farrington, DP. (1991). Advancing knowledge about co-offending: results from a prospective longitudinal survey of London males. The Journal of Criminal Law and Criminology, 82(2), 360–395. Secured by Design (2000, 2003). The ""WhatCar?"" Security Supertests were conducted in 2000 and 2003. The attack tests are described online at http://www.whatcar.co.uk/news-special-report.aspx?NA=204498. Smith, EA (1991). Inujjuamiut Foraging Strategies: Evolutionary Ecology of an Arctic Hunting Economy. New York: Aldine de Gruyter. Stephens, DW, & Krebs, JR (1986). Foraging Theory. In. Princeton: Princeton University Press. Stevenson, RJ, & Forsythe, LMV (1998). The Stolen Goods Market in New South Wales. Sydney: New South Wales Bureau of Crime Statistics and Research. Suresh, G, & Tewksbury, R. (2999). Locations of motor vehicle theft and recovery. American Journal of Criminal Justice, 1–16. Tremblay, P, & Morselli, C. (2000). Patterns in criminal achievement: Wilson and Abrahamse revisited. Criminology, 38(2), 633–659. Tremblay, P, Talon, B, & Hurley, D. (2001). Body switching and related adaptations in the resale of stolen vehicles. Script elaborations and aggregate crime learning curves. British Journal of Criminology, 41(4), 561–579. Wiles, P, & Costello, A (2000). The 'Road to Nowhere': The Evidence for Travelling Criminals (Report 207). London: Home Office. Wilson, JQ, & Abrahamse, A. (1992). Does crime pay? Justice Quarterly, 9, 359–377. Wright, R, Brookman, F, & Bennett, T. (2006). The foreground dynamics of street robbery in Britain. British Journal of Criminology, 46(1), 1–15. Wright, RT, & Decker, SH (1994). Burglars on the Job: Streetlife and Residential Breakins. Boston: Northeastern University Press. doi:10.1186/2193-7680-2-3 Cite this article as: Brantingham: Prey selection among Los Angeles car thieves. Crime Science 2013 2:3. Submit your manuscript to a journal and benefi t from: 7 Convenient online submission 7 Rigorous peer review 7 Immediate publication on acceptance 7 Open access: articles freely available online 7 High visibility within the fi eld 7 Retaining the copyright to your article Submit your next manuscript at 7 springeropen.com Brantingham Crime Science 2013, 2:3 Page 11 of 11 http://www.crimesciencejournal.com/content/2/1/3 View publication stats","Present your answer without any extraneous information. What is optimal foraging theory when compared to automotive theft? See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/257885522 Prey selection among Los Angeles car thieves Article in Crime Science · December 2013 DOI: 10.1186/2193-7680-2-3 CITATIONS 14 READS 183 1 author: P. Jeffrey Brantingham University of California, Los Angeles 159 PUBLICATIONS 8,448 CITATIONS SEE PROFILE All content following this page was uploaded by P. Jeffrey Brantingham on 17 April 2020. The user has requested enhancement of the downloaded file. R E S EAR CH Open Access Prey selection among Los Angeles car thieves P Jeffrey Brantingham Abstract More than 63,000 cars were reported stolen in Los Angeles in 2003–04. However, the distribution of thefts across car types is very uneven. Some cars types such as the Honda Civic were stolen at much higher frequencies than the majority of car types. Charnov’s classic prey selection model suggests that such uneven targeting should be related to variations in the environmental abundance, expected payoffs, and handling costs associated with different car types. Street-based surveys in Los Angeles suggest that differences in abundance explain the majority of thefts. Cars stolen despite being rare may reflect offender preference based on differential payoffs, probably in some non-monetary currency such as prestige or excitement. Differential handling costs play a more ambiguous role in target selection, but may underlie thieves’ decisions to ignore some cars common in the environment. The unspecialized nature of car theft in Los Angeles suggests that the behavioral and cognitive capacities needed to be a successful car thief are generic. The evolved capacity to solve foraging problems in boundedly-rational ways, mixed with small amounts of trial-and-error and/or social learning, are sufficient to produce experts from inexperienced thieves. Keywords: Crime; Environmental criminology; Behavioral ecology; Optimal foraging; Bounded-rationality; Social learning Background The rational choice theory of crime holds that offenders engage in crime because they stand to receive significant short-term benefits with little attendant risk and small associated costs (Cornish and Clarke 1986, 1987). Presented with a suitable target or victim, unguarded by an effective security measure, the reasoning offender generally capitalizes on that opportunity (Felson and Clarke 1998; Freeman 1996). Beyond implying a common-sense relationship between benefits and costs, however, rational choice theory does not immediately identify what makes any given victim or target suitable. A conceptual framework introduced by Clarke (1999) suggests that property targets are suitable when they are concealable, removable, available, valuable, enjoyable and disposable, capturing several of the dimensions of costs and benefits that are important in offender decision making. While useful, the so-called CRAVED approach also leaves much unspecified about the relative importance of relationships among the different dimensions of target suitability. Here I turn to theory arising outside of criminology to provide a formal framework in which understand the relationships between target characteristics and offender target selection. Specifically, I use Charnov’s (1976) prey selection model to evaluate offender choice to steal different car types. The prey selection model postulates that a forager will ignore a particular prey type upon encounter if the expected return from a future prey encounter is greater. Preference in Charnov’s model is defined in terms of the relative abundance of different prey types and their respective handling costs and payoffs upon consumption. Intuitively, prey that are easy to handle or have high payoffs may be preferred but rarely taken, if they are rarely encountered. Prey that are hard to handle or have low payoffs may still be taken, if more profitable prey are rarely encountered. Here the predictions of Charnov’s prey selection model are rejected based on findings that unique car types are stolen almost exclusively in response to their environmental availability. Only occasionally are cars targeted because they have higher perceived payoffs. Overall, Los Angeles car thieves operate primarily as unspecialized foragers. Correspondence: branting@ucla.edu Department of Anthropology, University of California, Los Angeles, 341 Haines Hall, UCLA, Box 951553, Los Angeles, CA 90095-1553, USA © 2013 Brantingham; licensee Springer. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Brantingham Crime Science 2013, 2:3 http://www.crimesciencejournal.com/content/2/1/3 Optimal foraging theory and crime Foraging theory is the branch of ecology that seeks to understand how animal behavior facilitates the encounter, acquisition and processing of resources necessary to survival (Stephens and Krebs 1986). The foraging challenges facing an animal are substantial. Essential resources are rarely located in the same location as the animal needing them, necessitating behaviors that either carry the animal to the resources, or position the animal to intercept resources that move. Many resource types possess defenses that aim to thwart acquisition, even after a forager has encountered them. Animals therefore need behavioral strategies designed discriminate among resource types and defeat their defenses once they have decided to acquire them. Finally, even after a resource as been encountered and acquired, it may contain a mixture of useable and unusable constituents. Behaviors may play a key role in sorting and separating these constituents. Only after jumping these foraging hurdles may an animal benefit from the resource. Recognize, however, that the behaviors deployed to facilitate encounter, acquisition and processing of a resources are not cost free. Optimal foraging theory therefore posits that evolution and/or learning has shaped animal behavior to maximize the average or long-term return rate from essential resources, net the costs of encounter, acquisition and processing. Here I cast car theft as a foraging problem and test the proposition that the specific car types stolen represent behaviors consistent with optimal foraging theory. Three conditions must be met to consider car theft as an optimal foraging problem (see also Bernasco 2009; Felson 2006; Johnson et al. 2009). First, car theft should satisfy a need that is perceived by the offender to be essential. Car thieves report a range of motivations for stealing cars including financial motives such as theftfor-export or an immediate need for cash, mundane or routine motives such as transportation, and recreational motives such as a search for excitement, prestige or status (Copes 2003; Dhami 2008; Kellett and Gross 2006; Lantsman 2013; Light et al. 1993). With the exception of theft-for-transport, car theft is not remarkable in motivation compared with other crimes (Wright et al. 2006; Wright and Decker 1994). However, car theft may be a comparably low risk alternative to satisfy these needs (Copes and Tewksbury 2011). Between 2003 and 2006, ~12.9% of reported car thefts in the US were cleared by arrests, while robberies over the same period were cleared at a rate twice as high ~25.8% (Federal Bureau of Investigation 2003–2006). The vast majority of car thefts therefore entail no negative consequences, at least over the short term (Freeman 1999). The benefits may therefore be substantial. Payoffs to car theft might be calculated in a cash currency, if cars and/or their parts are being fenced (Clarke 1999; Tremblay et al. 2001). Payoffs might also be calculated in non-cash commodities such as barter value in drugs (Stevenson and Forsythe 1998) or prestige and excitement—an essential resource for joy riding teenagers (Copes 2003; Jacobs et al. 2003; Kellett and Gross 2006). Second, car thieves must also have behavioral alternatives to deploy during foraging and these alternatives must result in different payoff outcomes. Ethnographic evidence indicates that car theft involves choices between alternative search strategies, tools and techniques for gaining entry and ‘hot wiring’ targeted vehicles, and strategies for escape and disposal of stolen vehicles (Copes and Cherbonneau 2006; Copes and Tewksbury 2011; Farrell et al. 2011; Langworthy and Lebeau 1992; Lantsman 2013; Light et al. 1993; Lu 2003). Whether these different behavioral alternatives lead to real differences in payoffs is an open question. The observation that different car types are stolen to satisfy different needs may imply differential payoffs (Clarke 1999). However, the extent to which alternative behavioral strategies drive these payoffs, as required by optimal foraging theory, is unknown. Finally, there must be a mechanism by which car thieves select among the alternative behaviors, yielding near-optimal strategies for locating, stealing and disposing of cars. Simple trial-and-error and/or social learning in the context of co-offending appear to play this role (Akers 2008; Reiss and Farrington 1991). Juvenile car thieves often start as passengers, observing the actions of their more experienced friends (Light et al. 1993). Such learning mechanisms seem capable quickly producing effective cognitive scripts that car thieves can adhere to during commission of a crime (Tremblay et al. 2001). The prey selection model The foraging problem confronted by car thieves is similar in many ways to prey selection, a classical problem in behavioral ecology studied by Charnov (1976) and others (see Krebs et al. 1977; Stephens and Krebs 1986). Given sequential encounters with prey types, each having different expected returns and handling costs, which types should be pursued and captured? Let ei, hi and λi be the expected payoff, handling cost and local density of a prey of type i. Prey types i = 1, 2, … N are ranked in descending order of the ratio of payoff to handling cost ei/hi. The prey classification algorithm says that prey types i = 1, 2, … j should be pursued and captured upon encounter, but prey type j + 1 should be ignored if its payoff to handling cost ratio is below the mean for all higher ranked prey: Brantingham Crime Science 2013, 2:3 Page 2 of 11 http://www.crimesciencejournal.com/content/2/1/3 X j i¼1 λiei 1 þX j i¼1 λihi > ejþ1 hjþ1 ð1Þ In other words, if the expected return from future prey encounters is higher than would be gained by taking the current target, then it is better to wait. The prey choice model makes two distinctive predictions. First, prey types are either always taken upon encounter, or always ignored. This is the so-called “zero–one” rule in reference to the analytical result that an attack on prey type i will occur with probability qi = 0, or qi = 1, and nothing in between (Stephens and Krebs 1986). Second, whether or not a prey type is taken is dependent only on the encounter rate with higherranked prey, not its own encounter rate. Note that the term λi appears only on the left-hand side in Equation (1). The implication is that only changes in the encounter rate with higher ranked prey items will impact the decision to attack a lower ranked prey item once it has been encountered. Thus, if a higher ranked prey type becomes very scarce, a lower ranked prey type may be added to the diet. However, if a lower ranked prey type suddenly becomes very common, it will not necessarily be added to the diet without a concomitant change in the rate of encounter with higher ranked types. Empirical evidence from both animal (Hughes and Dunkin 1984; Prugh 2005; but see Pyke 1984) and human foragers (Hames and Vickers 1982; Smith 1991) suggests that the prey classification algorithm provides insights into prey selection behavior across a diverse range of taxa and foraging contexts. Car theft may be considered a special case of prey selection if car types vary in expected payoffs, handling costs and/or local abundance and offenders are attentive to these differences. As discussed in the Methods section, the available data on payoffs and handling times do not allow for a fine-grained test of either the zero–one rule, or the hypothesis that changes in the encounter rate with higher-ranked car types impact the inclusion of lower ranked car types in an offender’s ‘diet’. A strict reading of the prey choice model also suggests that car theft may not perfectly conform to all of its assumptions (see for comparison Smith 1991). The prey choice model assumes that: (1) foragers are long-term rate maximizers, meaning that average results of stealing cars over long time periods, rather than short-term gains, are optimized by different foraging strategies; (2) searching for and handling of targeted vehicles are mutually exclusive; (3) encounters with vehicles follow a Poisson process, meaning that two cars cannot be encountered simultaneously and each encounter is statistically independent of all others; (4) the payoff to stealing cars ei, the handling costs hi, and encounter rates λi are environmentally fixed in time and space; and (5) that the foraging car thief has perfect information about ei, hi and λi. Assumptions 1, 2, 3 and 5 may be reasonable for car theft. The notion that criminal behavioral strategies might be shaped by learning to produce long-term average rate maximization (Assumption 1) seems far fetched at first (but see Tremblay and Morselli 2000). Criminal offenders tend to be present-oriented (Gottfredson and Hirschi 1990; Nagin and Paternoster 1994) and therefore appear little concerned with the long-term costs and benefits of crime (Wilson and Abrahamse 1992). However, the question at hand is not whether crime pays relative to non-crime alternatives, but rather whether stealing one car type is more profitable in the long run than stealing an alternative car type. It is conceivable that offenders adopt strategies that maximize the longterm or average payoffs from car theft by making discriminating choices about which cars to steal. It is also reasonable to suppose that simultaneous search for cars to steal and the physical act stealing a car are mutually exclusive activities (Assumption 2). This is made more complicated by co-offending, which is quite common for younger car thieves (Light et al. 1993), if some in an offending party search nearby targets while others are breaking into a given car. It is unknown whether encounters with cars to steal follow a Poisson process (Assumption 3). Ultimately, this is an empirical question for which data need to be collected. Conceptually, however, a motivated car thief walking down a linear street segment encounters cars sequentially and independently. Whether such conditions hold in a parking lot may depend on situational factors such as the layout of and available observation points in the lot. The prey choice model is not obviated under these circumstances (Stephens and Krebs 1986: 38–45), but additional costs associated with discriminating between simultaneously encountered car types must be taken into account. Perhaps the greatest challenge comes from strictly assuming that the key parameters of prey selection remain fixed in time and space (Assumption 4) (Suresh and Tewksbury 2013). At intermediate time scales (months to years), the payoffs to stealing different car types certainly change with turnover in the composition of cars on the street. Early and late model years may differ significantly in both perceived or actual value as well as handling costs, for example, following the introduction of RFID keys for ignition systems (Farrell et al. 2011). Similarly, there may be short-term (hourly-daily) fluctuations in environmental abundance of cars parked in locations where they might be stolen. Nevertheless, it is reasonable to assume that car thieves have relatively Brantingham Crime Science 2013, 2:3 Page 3 of 11 http://www.crimesciencejournal.com/content/2/1/3 accurate knowledge of the encounter rates, payoffs and handling costs associated with different cars, or learn them very quickly when conditions change (Assumption 5) (Akers 2008; Light et al. 1993). Given the above limitations, I test a conservative null hypothesis in place of the two detailed predictions made by the prey selection model: H0. If every car yields the same payoff and all are equally difficult to steal (i. e., ei/hi = ej/hj ∀ i, j), then differences in theft rates arise only from differences in relative abundances of car types λi. In other words, if all cars rank equally in the ratio of payoffs to handling costs, then all cars are part of the ‘diet’ and should be taken immediately upon encounter. Cars encountered more frequently will appear in the diet more often and, in fact, will be stolen at a frequency proportional to λi. One should therefore expect a strong correlation between relative abundances and theft rates if the null hypothesis is true. Failure to reject the null hypothesis implies that car thieves are unspecialized foragers and take only what is presented to them by the environment. Rejection of the null hypothesis, for all or even some car types, may constitute evidence that differential payoffs and/or handling costs enter into car thieves’ situational foraging decisions. Under these circumstances we can evaluate the role that payoffs and/or handling costs may play in driving target choice. Methods Car types are defined as unique make-models or, where necessary, make-model-years. For example, 1992 and 2002 Honda Civics may be different car types, from the point of view of the offender, because they have different perceived payoffs and may also differ in how easy they are to break into and ‘hot wire’ (Farrell et al. 2011). An initial database of car make-model-years was assembled using a popular car shopping and research website, www.edmonds.com. A student assistant was then trained to quickly and accurately identify car types in pilot surveys of a university campus parking structures. Street-based surveys were conducted in three Los Angeles zip codes (90034, 90045 and 90291) during two excursions in October-December 2004 and OctoberDecember 2005. The three survey locations had the highest volume of car thefts in 2003 among zip codes on the Los Angeles West Side. Surveys involved walking between one and three contiguous blocks, first up one side and then down the other. Surveys on the exact same block segments were conducted at two-hour intervals between 6AM and 6PM. The most dramatic change in density of cars parked on the street occurred between 6AM and 8AM. I therefore assume that the mix of car types seen at 6AM represents the overnight diversity. Only vehicles in publically accessible street locations were recorded. The observed relative frequency of each car type i is used as a measure of encounter rate λi. Expected value on the illegal market is used as a proxy for the payoffs ei associated with stealing different car types (Copes 2003; Matsueda et al. 1992). I do not assume that all car thieves seek cash. Rather, illegal market value is a generic currency that is expected to be positively correlated with non-monetary payoffs. For example, a ‘hot car’ is not only more likely to demand more money in an illegal market context, but it is also expected to have a higher payoff in excitement and prestige for the teenage car thief. Illegal market value is calculated as ei = f ∑ ipivi, where pi is the proportion of cars of a given make-model-year stolen, vi is the legal market value of the car at the time of theft as determined from the Kelley Blue Book (DeBacker 2003), and f is the fraction of the legal market value realized on the illegal market. I assume that f = 0.1, but choice of a different constant does not impact the results. I use break-in times as a proxy for overall handling costs hi. The UK-based “What Car?” Security Supertest (Secured by Design 2000, 2003) conducted attack testing of new cars marketed in the UK. The tests evaluated the ability of new vehicles to withstand attacks by trained locksmiths using the non-destructive entry techniques commonly deployed by car thieves. The tests included 123 unique make-models and measured the time, in seconds, needed to gain entry to each vehicle. A car was considered to pass the test if it was not possible to gain entry within two minutes. Break-in time represents only one of the handling costs associated with car theft. I assume, however, that the handling costs at different critical points in the theft process are positively correlated. For example, if a car is easy to enter, it is also more likely to be easy to ‘hot wire’, less likely to have a geo-location device installed and be easier to chop. Evaluation of the relationships between car theft, environmental abundances, payoffs and handling costs is conducted using non-parametric statistics that are robust to ordinal scale data and non-normal distribution characteristics (Conover 1998). Theft frequencies and environmental abundances are compared using Kendall’s τ, a generalized correlation coefficient that measures the similarity of ranked order lists. Kendall’s τ b allows for rank order ties. Illegal market values and break-in times among common and rare cares are non-normally distributed. Medians therefore provide the most robust measure of central tendency and the non-parametric Mann–Whitney U the most appropriate corresponding statistical test. Differences in distribution shape are computed using the non-parametric Kolmogorov-Smirnov D. Brantingham Crime Science 2013, 2:3 Page 4 of 11 http://www.crimesciencejournal.com/content/2/1/3 Results Between 1 Jan 2003 and 31 December 2004, 63,528 vehicles were reported stolen within the City of Los Angeles (Federal Bureau of Investigation 2003–2006). In zip codes 90034, 90045 and 90291, located on the West Side of Los Angeles and representing ~3.5% of the land area of the City, a total of 2,251 cars were stolen during the same period, or ~3.5% of all thefts. These cars are divided into 271 unique make-model types. The Honda Civic and Accord, Toyota Camry and Corolla, and Nissan Sentra together comprise ~25% of the total thefts and 87 car types are represented by single thefts (Figure 1A, Table 1). To test whether the observed bias in thefts towards some car types is driven by environmental abundance, I conducted surveys of main artery and residential streets (see Methods). A total of 1,825 cars were observed and these were classified into 262 unique make-model types. As with reported thefts, the cars available on the streets are dominated by a few types (Figure 1B). Seventy seven types identified in the survey are singletons. The distribution is qualitatively similar to rank species abundance curves in ecology, which show environments numerically dominated by a few species, but most of the richness is accumulated through species with small numbers of individuals Hubbell (2001). Here I focus on the top 25 most commonly stolen cars. These car types account for 53% of the total observed volume of stolen cars (N = 1198) and the bulk of the variation in theft frequency. A comparison of theft and density rank order frequencies shows a significant positive relationship (Kendall’s τ b = 0.491, p < 0.001) (Figure 2). Thirteen of the top 25 most stolen cars are also in the top 25 for abundance (Table 1). In general, the most common cars on the street are also the most stolen. The positive relationship between abundance and theft is particularly strong among the top nine most stolen cars (Kendall’s τ b = 0.611, p = 0.022). Honda Civics are the most abundant cars and the most frequently stolen. For the top nine cars it is difficult to reject the null hypothesis that environmental abundance is driving the targeting of these vehicles for theft. Note, however, that approximately one half (N = 12) of the top 25 most stolen cars are not in the top 25 for abundance. Several of these are significant outliers (Table 1). For example, the Chrysler 300M is ranked 14, with 33 thefts in 2003–04, but was observed only 0 20 40 60 80 100 120 140 160 180 1 10 19 28 37 46 55 64 73 82 91 100 109 118 127 136 145 154 163 172 181 190 199 208 217 226 235 244 253 262 271 Number of Thefts Theft Rank Honda Civic Toyota Camry Honda Accord Jeep Grand Cherokee Ferrari 360 N = 2,251 A 0 20 40 60 80 100 120 140 Number of Cars Honda Civic Honda Accord Toyota Corolla Chevy Cavalier Porsche Carerra N = 1,825 B Figure 1 Rank order plots of make-model car types stolen and observed in street-based surveys in three Los Angeles zip codes. (A) Cars stolen in zip codes 90034, 90045 and 90291 between Jan 1, 2003 and December 31, 2004 are numerically dominated by a few car types. (B) The rank order abundance of car types in the same zip codes, observed in street surveys conducted in 2004 and 2005, reveals the structure of car theft opportunities. Brantingham Crime Science 2013, 2:3 Page 5 of 11 http://www.crimesciencejournal.com/content/2/1/3 once in the 1,825 cars identified in street surveys (survey rank = 224). Similarly, the Pontiac Grand AM was ranked 10, with 44 thefts, but was observed only four times in the same surveys (survey rank = 110.5). It may be that thieves targeted these rare cars based on specialized evaluation of the expected payoffs, handling costs, or both, made at the time of encounter. Taking into account car make, model and year, I calculated the expected illegal market value for each car stolen in 2003 as 10% of the Kelley Blue Book value at the time of theft (see Methods) (DeBacker 2003; Stevenson and Forsythe 1998; Tremblay et al. 2001). Illegal market value is used as broad proxy for both monetary and non-monetary payoffs. Figure 3 shows that the distribution of expected illegal market values for the outliers is significantly different from that associated with environmentally common cars (Mann–Whitney U = 8562, Wilcoxon = 73542, Z = −11.327, p < .001). Among the environmentally common cars, the median expected illegal market value is $740 (min = $293, max = $2,916). Among the environmentally rare cars, the median is twice as large at $1,515 (min = $210, max $4,493). These data suggest that the outliers within the sample of stolen cars may be targeted because they offer a higher expected payoff. It is also possible that ease-of-theft is responsible for the observed outliers (Farrell et al. 2011; Light et al. 1993; Wiles and Costello 2000). The UK-based “WhatCar?” Security Supertest (Secured by Design 2000, 2003), evaluated the ability of a range of new vehicles to withstand attacks using non-destructive entry techniques (see Methods). Break-in time is used as a proxy for handling costs at all stages of the theft process. The aggregated results from 2000 and 2003, excluding those cars that passed the test, show a weak, but significant relationship between break-in times and Table 1 The top 25 most stolen car types in 2003–2004 and their environmental densities in Los Angeles zip codes 90034, 90045 and 90291 Make-model Theft N Survey N Recovery N Theft p Survey p Recovery p Theft rank Survey rank HONDA CIVIC 155 128 110 0.069 0.070 0.710 1 1 TOYOTA CAMRY 151 59 118 0.067 0.032 0.781 2 4 HONDA ACCORD 109 94 81 0.048 0.052 0.743 3 2 TOYOTA COROLLA 68 86 47 0.030 0.047 0.691 4 3 NISSAN SENTRA 60 33 45 0.027 0.018 0.750 5 9 ACURA INTEGRA 52 21 28 0.023 0.012 0.538 6 14 FORD MUSTANG 50 20 41 0.022 0.011 0.820 7 16 FORD EXPLORER 49 57 35 0.022 0.031 0.714 8 5 FORD TAURUS 46 28 36 0.020 0.015 0.783 9 11 PONTIAC GRAND AM/PRIX 43 4 38 0.019 0.002 0.884 10 110.5 NISSAN ALTIMA 35 42 27 0.016 0.023 0.771 11 7 CHEVY IMPALA 34 6 26 0.015 0.003 0.765 12.5 79.5 DODGE STRATUS 34 5 30 0.015 0.003 0.882 12.5 93.5 CHRYSLER 300M 33 1 31 0.015 0.001 0.939 14 224 CHEVY BLAZER 32 15 24 0.014 0.008 0.750 15 25 CHRYSLER PT CRUISER 31 8 26 0.014 0.004 0.839 16 58 DODGE CARAVAN 28 8 18 0.012 0.004 0.643 17.5 58 DODGE INTREPID 28 9 23 0.012 0.005 0.821 17.5 49.5 JEEP CHEROKEE 27 34 16 0.012 0.019 0.593 19 8 LINCOLN TOWN CAR 24 4 22 0.011 0.002 0.917 20 110.5 DODGE NEON 23 2 19 0.010 0.001 0.826 21.5 165.5 FORD FOCUS 23 7 20 0.010 0.004 0.870 21.5 68.5 CHRYSLER SEBRING 21 3 15 0.009 0.002 0.714 24 132.5 FORD EXPEDITION 21 12 13 0.009 0.007 0.619 24 32.5 JEEP GRAND CHEROKEE 21 20 14 0.009 0.011 0.667 24 16 Note: Theft and recovery proportions are calculated with respect to all 2,251 cars stolen. Survey proportions are calculated with respect to the 1,825 unique car types identified in street-based surveys. Environmental densities were measured in two survey periods October-December 2004 and October-December 2005. Brantingham Crime Science 2013, 2:3 Page 6 of 11 http://www.crimesciencejournal.com/content/2/1/3 market price in US Dollars (r 2 = .258, p < .001) (Figure 4A). The median break-in time for all vehicle types successfully attacked was 29 seconds and the minimum time was two seconds. Twenty three cars (~19%) have break-in times under 15 seconds. Vehicle make-models are not equivalent between the UK and US markets, despite similar names, and comparable data are not available from US contexts. It is not possible therefore to map break-in times from the Security Supertests directly to car types stolen in the US Number of Thefts 100 80 60 40 20 0 Illegal Market Value in $ 0 1,000 2,000 3,000 4,000 5,000 100 80 60 40 20 0 A B Figure 3 Frequency histograms of the estimated illegal market values show much lower expected payoffs may be attributed to the top nine most stolen cars (A), where density is expected to the major determinant of theft, compared with the outliers (B), where environmental density is not implicated. 0 5 10 15 20 25 0 50 100 150 200 250 Theft Rank Survey Rank Chrysler300M Dodge Neon Chevy Impala Pontriac Grand Prix/Am Dodge Stratus Chrysler Sebring Lincoln Town Car Ford Focus Chrysler PT Cruiser Dodge Caravan Dodge Intrepid Figure 2 A scatter plot of abundance rank order against theft rank order shows a strong positive relationship between car availability and theft risk. Eleven car-types are stolen much more frequently than their environmental abundance would suggest. Line represents a hypothetical 1:1 relationship between rank abundance and rank theft. Brantingham Crime Science 2013, 2:3 Page 7 of 11 http://www.crimesciencejournal.com/content/2/1/3 using the UK data. However, some indication of handling costs may be gained by examining patterns within manufactures. Seven of the cars stolen in disproportion to their environmental density were manufactured by Daimler-Chrysler, three by Ford and two by GM (Table 1). Of the 123 cars tested in the Security Supertests, 44 were vehicles by these manufacturers. Eleven (25%) successfully withstood attacks lasting two minutes, compared with 24 of the remaining 79 car types (44%). The data may suggest that Daimler-Chrysler, GM and Ford vehicles are more broadly susceptible to attack. However, a range of break-in times characterize the vehicles that did not pass the test (Table 2). Low and high-mid market cars sold under the Chrysler brand (e.g., Neon, Grand Voyager) have minimum break-in times of between four and six seconds, while one low-market GM car sold under the Vauxhall brand had a brake-in time of two seconds. Midmarket GM cars, also sold under the Vauxhall brand, had a mean break-in time of 81 seconds. The aggregate results do not indicate that cars made by DaimlerChrysler, Ford or GM are disproportionately easier for car thieves to handle. Indeed, cars marketed by other manufacturers show a significant skew towards shorter break-in times and, by implication, lower handling costs for thieves (Kolmogorov-Smirnov Z = 1.349, p = 0.053) (Figure 4B,C). Discussion and conclusion It is difficult to reject the null hypothesis that environmental abundance is the primary determinant of what cars are targeted for theft. There is a particularly strong relationship between abundance and theft rank for the top-nine most stolen cars. In the CRAVED conceptual framework put forward by Clarke (1999), availability would seem to outweigh other dimensions that might influence theft choice. In the instances where cars are targeted despite being rare, payoff differences may play some role. Car recovery rates provide one measure of the importance of non-monetary, or possibly limited monetary payoffs to car theft (Clarke and Harris 1992). There is little systematic difference in the rate of recovery across car types (Table 1), suggesting that none of the top 25 most stolen cars are disproportionately landing in fully-body chop shops or being stolen for export. The payoffs here seem to be primarily non-monetary. Furthermore, among the outliers that are stolen despite being rare, it appears that the newest model years are targeted. For example, eight of 12 Chrysler 300s and seven of 13 Chrysler Sebrings stolen during 2003 were 2004 model years, which became available only in the last five months of the year. The implication is that these cars, though rare, were targeted precisely because they were perceived to be ‘hot rides’ (Wiles and Costello 2000). That some cars are more valuable or enjoyable can override their low availability, but this occurs infrequently. It is less apparent that lower handling costs biased thieves’ decisions to target environmentally rare cars, although ethnographic work suggests that handling costs are often a significant concern (Clarke 1999; Light et al. 1993; Wiles and Costello 2000). Recent research suggests that the potential for encountering opposition from car owners is a major concern (Copes and Tewksbury 2011), but it is uncertain how the probability of opposition might relate to car type. Direct handling costs may have played a role in driving Los Angeles car thieves to A BC Figure 4 Break-in times for UK make-models measured by the “WhatCar?” Security Supertest in 2000 and 2003. (A) Scatter plot of break-in time versus US market price implies only a weak relationship between payoffs and handling costs. Frequency histograms of the break-in times for (B) GM-, Daimler-Chrysler- and Ford-group cars and (C) all other car types. Brantingham Crime Science 2013, 2:3 Page 8 of 11 http://www.crimesciencejournal.com/content/2/1/3 ignore certain environmentally common cars. Seven make-model types including the Volkswagen Jetta, Toyota RAV4 and Nissan Xterra ranked within the top 25 for abundance, but were rarely or never stolen (Table 3). An average of 57% of the vehicles sold by the corresponding manufactures in the UK passed the Security Supertests. This is compared only 25% of Daimler-Chrysler, GM and Ford cars representative of the environmentally rare group. The implication is that these cars may be ignored because they are more resistant to attack. Detailed attack analyses of cars from the US market could help resolve the exact role of handling costs in the differential targeting of some cars. In spite of the narrow role that differential payoffs and handling costs appear to play the choice of which cars to steal, one must be careful to not fall prey to the ecological fallacy. Ethnographic evidence points to a degree of specialization among car thieves, with distinctions among those engaged in opportunistic theft and those in organized crime, and among younger and older offenders. Such specializations are not directly visible in aggregate car theft data. It is possible that the population of Los Angeles car thieves consists of several different types each with their preferred prey. The observed frequency of stolen car types might therefore represent a mixture of fixed, independent strategies, some rare and Table 3 Environmentally abundant cars of low theft rank in zip codes 90034, 90045 and 90291 and the aggregated 2000 and 2003 “WhatCar?” Security Supertest results for cars from the corresponding manufacturers Make-model Theft N Survey N Theft rank Survey rank N tested Passing p Models failing Mean (s) σ (s) Min (s) Max (s) Volkswagen Jetta 9 56 63 6 6 0.50 Lupo 1.4S, Polo Gti, Golf 1.6SE 32 16.09 19 50 Toyota RAV4 5 19 91 18 8 0.63 Yaris Verso, Corolla, Avensis 46.33 15.50 31 46 Lexus ES 15 229 25 3 0.67 IS 111 Nissan Xterra 2 16 164 21 5 0.80 Micra 1.3 SE 14 Volvo S Class 17 229 19.5 3 0.67 XC90 70 Subaru Outback 2 15 164 25 3 0.00 Impreza, Impreza Turbo, Legacy 22.67 24.79 5 51 Table 2 Break-in times in seconds for Daimler-Chrysler, Ford and GM brands sold in the UK tested in the “WhatCar?” Security Supertest in 2000 and 2003 Manufacturer Make-model Market N Mean (seconds) σ (seconds) Min (seconds) Max (seconds) Daimler-Chysler Chrysler Neon Low 1 4 Daimler-Chysler Mercedes A Class Mid 1 30 Daimler-Chysler Chrysler Grand Voyager High-mid 1 6 Daimler-Chysler Mercedes C, E Class High 2 70 7.07 65 75 Ford Fiesta, Focus Ghia Estate, Ka 3, Mazda 626 Sport Low 4 40.75 15.9 23 60 Ford Focus TDi Ghia, Ka, Streetka, Landrover Freelander, Mazda MPV, Mazda Premacy Mid 6 33.83 17.08 19 65 Ford Focus, Land Rover Discovery, Mazda 6 High-mid 3 43 13.45 28 54 Ford Mondeo, Jaguar XKR, Range Rover 4.0 HSE, Volvo XC90 High 4 69 21.76 40 93 GM Vauxall Agilla, Astra Low 2 12 13.44 2 21 GM Vauxall Corsa, Frontera, Meriva, Zafira Mid 4 81 40.04 21 108 GM Saab 93, Saab 95, Vauxall Astra High-mid 3 45.67 10.69 39 58 GM Cadillac Seville STS, Vauxall Vectra High 2 58 74.95 5 111 Total Daimler-Chrysler, GM, Ford 33 46.88 30.68 2 111 Other Car types 55 32.22 29.36 2 115 Brantingham Crime Science 2013, 2:3 Page 9 of 11 http://www.crimesciencejournal.com/content/2/1/3 some common, not variation in the behavior of offenders in general. The converse is also potentially true. There is a danger of falling prey to an ethnographic fallacy that confounds our ability to infer aggregate characteristics from ethnographically rich data collected at an individual scale. To wit, given interviews with tens of car thieves about their offending preferences, can we reliably infer the population characteristics of the many thousands of individuals likely responsible for the 63,000 cars stolen in Los Angeles in 2003-2004? There is no easy way to resolve the ecological or ethnographic fallacy. I suspect, however, that the unspecialized foragers responding primarily to environmental abundances greatly outnumber the specialists, making the latter practically invisible in aggregate data. The results described here are important for understanding the broader causes of criminal behavior and may suggest novel approaches to crime prevention based on formal ecological models (see also Bernasco 2009; Brantingham et al. 2012; Felson 2006). The unspecialized nature of car theft in Los Angeles implies that the behavioral and cognitive capacities needed to be a successful thief are generic. Indeed, humans are well-equipped to become effective foragers for criminal opportunities given an evolved psychology to solve foraging problems in boundedly-rational ways (Hutchinson et al. 2007), combined with small amounts of individual trial-and-error or social learning (Akers 2008; Boyd and Richerson 1985). Indeed, the co-offending that characterizes the early careers (<20 years old) of most offenders, including car thieves, is ideally suited to the transmission of the simple skills sufficient to produce experts from inexperienced thieves (Reiss and Farrington 1991). That auto theft in Los Angeles is driven primarily by environmental structure provides further evidence that the greatest gains in crime prevention are to be had in altering the structure of criminal opportunity (Brantingham and Brantingham 1981; Farrell et al. 2011; Felson and Clarke 1998). How environmental alterations impact situational foraging behaviors and longer-term population trajectories are well-studied within ecology (Henle et al. 2004; Kerr et al. 2007), suggesting a way forward for formal crime ecology. Competing interests The author declares that he has no competing interests. Acknowledgements This work was supported in part by grants NSF-FRG DMS-0968309, ONR N000141010221, ARO-MURI W911NF-11-1-0332, and AFOSR-MURI FA9550-10-1-0569, and by the UCLA Faculty Senate. I am indebted to the Los Angeles Police Department for providing the data analyzed here. Thank you to David Bell from Secured by Design and Silas Borden for assistance with the street-based surveys. Received: 29 November 2012 Accepted: 29 April 2013 Published: 3 July 2013 References Akers, R (2008). Social learning and social structure: A general theory of crime and deviance. Boston: Northeastern University Press. Bernasco, W. (2009). Foraging strategies of homo criminalis: lessons from behavioral ecology. Crime Patterns and Analysis, 2(1), 5–16. Boyd, R, & Richerson, PJ (1985). Culture and the Evolutionary Process. Chicago: University of Chicago Press. Brantingham, PJ, & Brantingham, PL (1981). Environmental Criminology. Beverly Hills: Sage. Brantingham, PJ, Tita, GE, Short, MB, & Reid, SE. (2012). The ecology of gang territorial boundaries. Criminology, 50(3), 851–885. Charnov, EL. (1976). Optimal foraging - attack strategy of a mantid. American Naturalist, 110(971), 141–151. Clarke, RV. (1999). Hot Products: Understanding, Anticipating and Reducing Demand for Stolen Goods (Police Research Series, Paper 112.). London: Home Office. Clarke, RV, & Harris, PM (1992). Auto Theft and its Prevention. In M Tonry (Ed.), Crime and Justice: A Review of Research (Vol. 16, pp. 1–54). Chicago: University of Chicago Press. Conover, WJ. (1998). Practical Nonparametric Statistics. Hoboken: Wiley. Copes, H. (2003). Streetlife and the rewards of auto theft. Deviant Behavior, 24(4), 309–332. Copes, H, & Cherbonneau, M. (2006). The key to auto theft - Emerging methods of auto theft from the offenders' perspective. British Journal of Criminology, 46(5), 917–934. Copes, H, & Tewksbury, R. (2011). Criminal experience and perceptions of risk: what auto thieves fear when stealing cars. Journal of Crime and Justice, 34(1), 62–79. Cornish, DB, & Clarke, RV (1986). Introduction. In DB Cornish & RV Clarke (Eds.), The Reasoning Criminal: Rational Choice Perspectives on Criminal Offending. New York: Springer-Verlag. Cornish, DB, & Clarke, RV. (1987). Understanding crime displacement: An application of rational choice theory. Criminology, 25(4), 933–947. DeBacker, P (Ed.). (2003). Kelley Blue Book Used Car Guide Consumer Edition 1988–2002. Irvine, CA: Kelly Blue Book. Dhami, MK. (2008). Youth auto theft: a survey of a general population of canadian youth. Canadian Journal of Criminology and Criminal Justice, 50(2), 187–209. Farrell, G, Tseloni, A, & Tilley, N. (2011). The effectiveness of vehicle security devices and their role in the crime drop. Criminology and Criminal Justice, 11(1), 21–35. Federal Bureau of Investigation (2003–2006). Crime in the United States, Uniform Crime Reports. http://www.fbi.gov/ucr/ucr.htm. Felson, M (2006). Crime and Nature. Thousand Oaks: Sage. Felson, M, & Clarke, RV (1998). Opportunity Makes the Thief: Practical Theory for Crime Prevention (Police Research Series Paper 98). London: Home Office Policing and Reducing Crime Unit. Freeman, RB. (1996). Why do so many young american men commit crimes and what might we do about it? The Journal of Economic Perspectives, 10(1), 25–42. Freeman, RB. (1999). The economics of crime. Handbook of Labor Economics, 3, 3529–3571. Gottfredson, MR, & Hirschi, T (1990). A General Theory of Crime. Stanford: Stanford University Press. Hames, RB, & Vickers, WT. (1982). Optimal diet breadth theory as a model to explain variability in Amazonian hunting. American Ethnologist, 9(2), 358–378. Henle, K, Davies, KF, Kleyer, M, Margules, C, & Settele, J. (2004). Predictors of species sensitivity to fragmentation. Biodiversity and Conservation, 13(1), 207–251. Hubbell, SP (2001). The Unified Neutral Theory of Biodiversity and Biogeography. Princeton: Princeton University Press. Hughes, RN, & Dunkin, SD. (1984). Behavioral components of prey selection by Dogwhelks, Nucella-Lapillus (L), feeding on Mussels, Mytilus-Edulis-L, in the Laboratory. Journal of Experimental Marine Biology and Ecology, 77(1–2), 45–68. Hutchinson, JMC, Wilke, A, & Todd, PM. (2007). Patch leaving in humans: can a generalist adapt its rules to dispersal of items across patches? Animal Behavior, 75, 1331–1349. Jacobs, BA, Topalli, V, & Wright, R. (2003). Carjacking, streetlife and offender motivation. British Journal of Criminology, 43(4), 673–688. Johnson, SD, Summers, L, & Pease, K. (2009). Offender as forager? a direct test of the boost account of victimization. Journal of Quantitative Criminology, 25(2), 181–200. Brantingham Crime Science 2013, 2:3 Page 10 of 11 http://www.crimesciencejournal.com/content/2/1/3 Kellett, S, & Gross, H. (2006). Addicted to joyriding? An exploration of young offenders' accounts of their car crime. Psychology Crime & Law, 12(1), 39–59. Kerr, JT, Kharouba, HM, & Currie, DJ. (2007). The macroecological contribution to global change solutions. Science, 316(5831), 1581–1584. Krebs, JR, Erichsen, JT, Webber, MI, & Charnov, EL. (1977). Optimal prey selection in great tit (parus-major). Animal Behaviour, 25(FEB), 30–38. Langworthy, RH, & Lebeau, JL. (1992). The spatial-distribution of sting targets. Journal of Criminal Justice, 20(6), 541–551. Lantsman, L. (2013). “Moveable currency”: the role of seaports in export oriented vehicle theft. Crime, Law and Social Change, 59(2), 157–184. Light, R, Nee, C, & Ingham, H (1993). Car Theft: The Offender's Perspective (Home Office Rresearch Study No. 30). London: Home Office. Lu, YM. (2003). Getting away with the stolen vehicle: an investigation of journeyafter-crime. The Professional Geographer, 55(4), 422–433. Matsueda, RL, Piliavin, I, Gartner, R, & Polakowski, M. (1992). The prestige of criminal and conventional occupations: a subcultural model of criminal activity. American Sociological Review, 57(6), 752–770. Nagin, DS, & Paternoster, R. (1994). Personal capital and social control: the detterence implications of a theory of individual differences in criminal offending. Criminology, 32(4), 581–606. Prugh, LR. (2005). Coyote prey selection and community stability during a decline in food supply. Oikos, 110(2), 253–264. Pyke, GH. (1984). Optimal foraging theory - a critical-review. Annual Review of Ecology and Systematics, 15, 523–575. Reiss, AJ, & Farrington, DP. (1991). Advancing knowledge about co-offending: results from a prospective longitudinal survey of London males. The Journal of Criminal Law and Criminology, 82(2), 360–395. Secured by Design (2000, 2003). The ""WhatCar?"" Security Supertests were conducted in 2000 and 2003. The attack tests are described online at http://www.whatcar.co.uk/news-special-report.aspx?NA=204498. Smith, EA (1991). Inujjuamiut Foraging Strategies: Evolutionary Ecology of an Arctic Hunting Economy. New York: Aldine de Gruyter. Stephens, DW, & Krebs, JR (1986). Foraging Theory. In. Princeton: Princeton University Press. Stevenson, RJ, & Forsythe, LMV (1998). The Stolen Goods Market in New South Wales. Sydney: New South Wales Bureau of Crime Statistics and Research. Suresh, G, & Tewksbury, R. (2999). Locations of motor vehicle theft and recovery. American Journal of Criminal Justice, 1–16. Tremblay, P, & Morselli, C. (2000). Patterns in criminal achievement: Wilson and Abrahamse revisited. Criminology, 38(2), 633–659. Tremblay, P, Talon, B, & Hurley, D. (2001). Body switching and related adaptations in the resale of stolen vehicles. Script elaborations and aggregate crime learning curves. British Journal of Criminology, 41(4), 561–579. Wiles, P, & Costello, A (2000). The 'Road to Nowhere': The Evidence for Travelling Criminals (Report 207). London: Home Office. Wilson, JQ, & Abrahamse, A. (1992). Does crime pay? Justice Quarterly, 9, 359–377. Wright, R, Brookman, F, & Bennett, T. (2006). The foreground dynamics of street robbery in Britain. British Journal of Criminology, 46(1), 1–15. Wright, RT, & Decker, SH (1994). Burglars on the Job: Streetlife and Residential Breakins. Boston: Northeastern University Press. doi:10.1186/2193-7680-2-3 Cite this article as: Brantingham: Prey selection among Los Angeles car thieves. Crime Science 2013 2:3. Submit your manuscript to a journal and benefi t from: 7 Convenient online submission 7 Rigorous peer review 7 Immediate publication on acceptance 7 Open access: articles freely available online 7 High visibility within the fi eld 7 Retaining the copyright to your article Submit your next manuscript at 7 springeropen.com Brantingham Crime Science 2013, 2:3 Page 11 of 11 http://www.crimesciencejournal.com/content/2/1/3 View publication stats",Financial,Concept Comparison,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",Researchers at Foch Hospital in France published this study of pregnancy outcomes in two groups of patients. Please summarize outcomes across the three kinds of complications that the researchers studied.,"Objectives: Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is an independent factor of obstetric, fetal, and neonatal complications. Patients and methods: A monocentric, French study “exposed-unexposed” was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25–35 years old. Results: One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively, p < 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1% p < 0.001), preterm birth (10.4 vs. 6.5% p < 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean, p < 0.001) and fetal death in utero (2.1 vs. 0.5% in the study group, p < 0.001). These results were also significantly different in multivariate analysis. Objectives The main objective of the study is to determine the incidence of obstetric, fetal, and neonatal complication and to assess whether age is an independent factor of these complications. The secondary objectives are to determine whether there is an association between some complications (pre-eclampsia, gestational diabetes, prematurity) and the conception mode associated with the type of pregnancy (singleton or twin). The obstetrical complications studied are gestational hypertension (defined as systolic >140 mmH and/or diastolic >90 mmHg without proteinuria), pre-eclampsia (systolic >140 mmHand/or diastolic >90 mmHg associated with a proteinuria of 24 h >300 mg), gestational diabetes (defined according to the recommendations of the 2015 CNGOF), cesarean section (CS), admission of women to the intensive care unit during their pregnancies, postpartum hemorrhage (loss of more than 500 cc of blood within 24 h after vaginal delivery or CS) and blood transfusion. The fetal complications studied are intrauterine growth retardation (IUGR) (defined as having an estimation of fetal weight <5e p) and fetal death in utero (FDIU). The neonatal complications studied were prematurity (birth before 37 weeks), pH at birth (acidosis with pH <7.10), APGAR score (<7), and pediatric care just after the birth. Discussion Our study shows that advanced maternal age is an independent risk factor for obstetric and neonatal complications (14, 15). In fact, multivariate analysis found significant results for three of the most common pregnancy-related diseases: gestational hypertension, pre-eclampsia, and gestational diabetes. Our large sample significantly confirms the occurrence of pre-eclampsia in women aged 40 and above, unlike some studies with small samples that did not find this result in multivariate analysis (3). Moreover, there is a higher risk of pre-eclampsia when the patient has some other risk factor such as twin pregnancy or medical history (hypertension and/or diabetes and/or VTE/vascular disease/lupus) (16, 17). Even more, these women with advanced maternal age are at higher risk of developing cardiovascular and nephrological diseases in the long term (18). In the case of tobacco, it has not been found as an independent risk factor, which can probably be explained by a significant underestimation of women reporting smoking during pregnancy. The high proportion of cesareans in the study group of women over 40 is due to some contributing factors. On one hand, the percentage of scheduled cesareans is higher because there is a higher prevalence of uni or multi-cicatricial uterus. Cesareans for high maternal age or for maternal request finally represented a small sample (22 women/1,982, 1% in the exposed group vs. 1/1,982 in the unexposed group). There was also a higher rate about the emergency cesareans deliveries in the study group over 40 years old. Several physiological hypotheses have been mentioned in previous studies (2, 3): a higher rate of dystocia presentation and scarred uterus, uterine contractility less effective than for a woman aged 25–35. In our sample, the most common indications for CS were abnormalities of cardio-fetal rhythm and cervical dystocia (19). It is likely that CFR abnormalities are more severely judged by the obstetrician, in the context of older patients, especially if the pregnancy is a result of ART, putting some women at a risk of cesarean that is not always justified (20). In total, this large proportion of CS in women 40 years and older has also been shown in other studies (3, 4, 17, 20–22). However, these results should be taken with caution because some indications for CS are inherent to the protocols practiced in our unit. The association between advanced maternal age and fetal deaths in utero should also be taken into account. Among those 43 FDIUs, we have looked at every medical files of those women and we did not find any events that could explained this high number. Indeed, among the 43 FDIUs in women aged 40 and above, there were no more patients using ART, nor more patients with obstetric pathology. This can be explained by a small number of FDIU. The only common point in our study group was the advanced maternal age. In these circumstances, instead of worrying the patients, it might be more appropriate to give them clear and reassuring information while performing a pre-conception close monitoring and throughout the pregnancy. This would help detect and manage these complications much earlier. In addition, with the advanced technology, several risks are now monitored using non-invasive prenatal screening or even the pre-implantation diagnosis (23–26). The incidence of maternal complications is likely to increase over time due to increased maternal age. It will be difficult to reduce the incidence of these complications, but we can reduce the serious complications of preeclampsia, gestational diabetes (such as eclampsia, and macrosomia) through appropriate management (induce delivery before 41 weeks, close monitoring of the fetus) (27, 28). With regard to neonatal complications, few significant differences were found in our study, as well as in the literature (29, 30). This is partly explained by the fact that several obstetrical factors can interfere without being related to age (the length of the delivery, abnormalities of the RCF, chorioamnionitis (3, 31, 32). Our study has several advantages. On the one hand, our study was done on a large sample, with data processing from medical records with a complete search for missing data. International and European studies with large samples use public health registers, thereby providing a lot of information on the characteristics of the population (5, 10). However, this is often at the expense of information such as the type of delivery, the methods of neonatology care which are sometimes different in hospitals. On the other hand, we took a period of 11 years, to check if there had been a difference in daily practices. We did not notice any difference between the periods 2006–2010 and 2011–2017 except for the increasing number of patients who have access to ART. On the other hand, we matched each patient aged 40 and above to a patient aged between 25 and 35 whose delivery number followed the patient case. Indeed, this allowed us to limit as far as possible all the variability of practices on the delivery route (natural delivery vs. cesarean, neonatal care). We also had the advantage of separating fetuses, newborns, and mothers, which has not been realized in other studies, and which may lead to a classification bias regarding perinatal outcomes. Our study is yet limited by its monocentric character and retrospective aspect. In addition, Foch Hospital has an ART center, so our sample probably contained more patients using these techniques. However, we had the opportunity to have 18.2% of women over 40 using ART. This allowed us to highlight the significant increase in preeclampsia and prematurity in patients over 40 years of age who have used ART. After 44 years, 1 out of 2 women used the ART. This rate is surely underestimated because there is a large number of patients who voluntarily omit to declare their use of ART in particular the use of donated oocytes (33). It is especially remembered that maternal complications occurring decades ago are less morbid today than before (22, 34). Screening and management of maternal and neonatal complications are progressively improving, and a high-risk pregnancy at age 40 in the 1980s should no longer discourage patients and obstetricians in 2020.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Researchers at Foch Hospital in France published this study of pregnancy outcomes in two groups of patients. Please summarize outcomes across the three kinds of complications that the researchers studied. Objectives: Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is an independent factor of obstetric, fetal, and neonatal complications. Patients and methods: A monocentric, French study “exposed-unexposed” was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25–35 years old. Results: One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively, p < 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1% p < 0.001), preterm birth (10.4 vs. 6.5% p < 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean, p < 0.001) and fetal death in utero (2.1 vs. 0.5% in the study group, p < 0.001). These results were also significantly different in multivariate analysis. Objectives The main objective of the study is to determine the incidence of obstetric, fetal, and neonatal complication and to assess whether age is an independent factor of these complications. The secondary objectives are to determine whether there is an association between some complications (pre-eclampsia, gestational diabetes, prematurity) and the conception mode associated with the type of pregnancy (singleton or twin). The obstetrical complications studied are gestational hypertension (defined as systolic >140 mmH and/or diastolic >90 mmHg without proteinuria), pre-eclampsia (systolic >140 mmHand/or diastolic >90 mmHg associated with a proteinuria of 24 h >300 mg), gestational diabetes (defined according to the recommendations of the 2015 CNGOF), cesarean section (CS), admission of women to the intensive care unit during their pregnancies, postpartum hemorrhage (loss of more than 500 cc of blood within 24 h after vaginal delivery or CS) and blood transfusion. The fetal complications studied are intrauterine growth retardation (IUGR) (defined as having an estimation of fetal weight <5e p) and fetal death in utero (FDIU). The neonatal complications studied were prematurity (birth before 37 weeks), pH at birth (acidosis with pH <7.10), APGAR score (<7), and pediatric care just after the birth. Discussion Our study shows that advanced maternal age is an independent risk factor for obstetric and neonatal complications (14, 15). In fact, multivariate analysis found significant results for three of the most common pregnancy-related diseases: gestational hypertension, pre-eclampsia, and gestational diabetes. Our large sample significantly confirms the occurrence of pre-eclampsia in women aged 40 and above, unlike some studies with small samples that did not find this result in multivariate analysis (3). Moreover, there is a higher risk of pre-eclampsia when the patient has some other risk factor such as twin pregnancy or medical history (hypertension and/or diabetes and/or VTE/vascular disease/lupus) (16, 17). Even more, these women with advanced maternal age are at higher risk of developing cardiovascular and nephrological diseases in the long term (18). In the case of tobacco, it has not been found as an independent risk factor, which can probably be explained by a significant underestimation of women reporting smoking during pregnancy. The high proportion of cesareans in the study group of women over 40 is due to some contributing factors. On one hand, the percentage of scheduled cesareans is higher because there is a higher prevalence of uni or multi-cicatricial uterus. Cesareans for high maternal age or for maternal request finally represented a small sample (22 women/1,982, 1% in the exposed group vs. 1/1,982 in the unexposed group). There was also a higher rate about the emergency cesareans deliveries in the study group over 40 years old. Several physiological hypotheses have been mentioned in previous studies (2, 3): a higher rate of dystocia presentation and scarred uterus, uterine contractility less effective than for a woman aged 25–35. In our sample, the most common indications for CS were abnormalities of cardio-fetal rhythm and cervical dystocia (19). It is likely that CFR abnormalities are more severely judged by the obstetrician, in the context of older patients, especially if the pregnancy is a result of ART, putting some women at a risk of cesarean that is not always justified (20). In total, this large proportion of CS in women 40 years and older has also been shown in other studies (3, 4, 17, 20–22). However, these results should be taken with caution because some indications for CS are inherent to the protocols practiced in our unit. The association between advanced maternal age and fetal deaths in utero should also be taken into account. Among those 43 FDIUs, we have looked at every medical files of those women and we did not find any events that could explained this high number. Indeed, among the 43 FDIUs in women aged 40 and above, there were no more patients using ART, nor more patients with obstetric pathology. This can be explained by a small number of FDIU. The only common point in our study group was the advanced maternal age. In these circumstances, instead of worrying the patients, it might be more appropriate to give them clear and reassuring information while performing a pre-conception close monitoring and throughout the pregnancy. This would help detect and manage these complications much earlier. In addition, with the advanced technology, several risks are now monitored using non-invasive prenatal screening or even the pre-implantation diagnosis (23–26). The incidence of maternal complications is likely to increase over time due to increased maternal age. It will be difficult to reduce the incidence of these complications, but we can reduce the serious complications of preeclampsia, gestational diabetes (such as eclampsia, and macrosomia) through appropriate management (induce delivery before 41 weeks, close monitoring of the fetus) (27, 28). With regard to neonatal complications, few significant differences were found in our study, as well as in the literature (29, 30). This is partly explained by the fact that several obstetrical factors can interfere without being related to age (the length of the delivery, abnormalities of the RCF, chorioamnionitis (3, 31, 32). Our study has several advantages. On the one hand, our study was done on a large sample, with data processing from medical records with a complete search for missing data. International and European studies with large samples use public health registers, thereby providing a lot of information on the characteristics of the population (5, 10). However, this is often at the expense of information such as the type of delivery, the methods of neonatology care which are sometimes different in hospitals. On the other hand, we took a period of 11 years, to check if there had been a difference in daily practices. We did not notice any difference between the periods 2006–2010 and 2011–2017 except for the increasing number of patients who have access to ART. On the other hand, we matched each patient aged 40 and above to a patient aged between 25 and 35 whose delivery number followed the patient case. Indeed, this allowed us to limit as far as possible all the variability of practices on the delivery route (natural delivery vs. cesarean, neonatal care). We also had the advantage of separating fetuses, newborns, and mothers, which has not been realized in other studies, and which may lead to a classification bias regarding perinatal outcomes. Our study is yet limited by its monocentric character and retrospective aspect. In addition, Foch Hospital has an ART center, so our sample probably contained more patients using these techniques. However, we had the opportunity to have 18.2% of women over 40 using ART. This allowed us to highlight the significant increase in preeclampsia and prematurity in patients over 40 years of age who have used ART. After 44 years, 1 out of 2 women used the ART. This rate is surely underestimated because there is a large number of patients who voluntarily omit to declare their use of ART in particular the use of donated oocytes (33). It is especially remembered that maternal complications occurring decades ago are less morbid today than before (22, 34). Screening and management of maternal and neonatal complications are progressively improving, and a high-risk pregnancy at age 40 in the 1980s should no longer discourage patients and obstetricians in 2020. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.00208/full",Medical,Find & Summarize,Text Transformation Use only the provided text to formulate your response. Do not rely on any outside knowledge. Provide me a three-paragraph response.,How does the second lien differ from the first lien?,"Overview of Major Consumer Finance Markets The following sections examine specific issues within major consumer debt markets: mortgage lending, student loans, automobile loans, credit cards and payments, payday loans and other credit alternative financial products, and checking accounts and substitutes. The markets discussed are under the jurisdiction of the CFPB, and sometimes other regulators as well. Each section briefly describes the financial product, recent market developments, and selected policy issues that may lead each market away from its efficient price or outcomes. These sections focus on the consumer and household perspective as well as consumer protection policy issues in each market. Mortgage Lending Market A mortgage loan is a loan collateralized by a house and its land.47 Generally, consumers use these loans to purchase a new home or refinance an existing one. These types of mortgages are often called first liens, because if a consumer defaults on the loan, the lender is typically the first in line to be compensated through the proceeds of a home foreclosure. First-lien mortgage loans are usually installment loans, in which the consumer pays off the loan in monthly installments over 15 years or 30 years. Most mortgage loans in the United States have a fixed interest rate and fixed installment amount over the course of the loan, affected by the consumer’s credit score and market conditions.48 Households buying a new home and taking out a mortgage loan to purchase it generally cannot borrow for the full cost of the house’s value. To limit the risk to the lender, borrowers are typically required to make a down payment, the difference between the house’s value and the mortgage loan. If the down payment is less than 20% of the home’s value, the borrower is often required to pay for additional insurance. In addition to first-lien purchase mortgages, a consumer may choose to take out a home equity line of credit (often referred to as HELOC) or a smaller installment mortgage loan, which often is a second lien. A second lien means that the lender is second in line, after the first lien holder, to be compensated if the consumer defaults and the home is foreclosed upon. These loans are underwritten using the value of the home, but can be used for a variety of different purposes either related to the home or not. For example, second mortgages can be used to renovate the home, pay for college, or consolidate credit card debts. Mortgage loans are by far the largest consumer credit market in the United States, and homes are a large part of most households’ wealth. According to the Fed, more than $9 trillion of mortgage debt is currently outstanding,49 and more than $20 trillion in real estate equity is owned by households.50 As of the third quarter of 2020, 67.4% of U.S. households owned their home. 51 Many people view homeownership as an important way to build wealth over time, both through price appreciation and home equity by paying down their mortgage. Nevertheless, because home prices can fluctuate over time, this investment can be risky, especially if the home owner only stays in the home for a short time. Although homeownership has certain benefits, such as tax benefits like the mortgage interest tax deduction,52 it also imposes costs on the household, such as mortgage loan closing costs and home maintenance. As noted above, most experts believe that a housing price bubble was a central cause of the 2008 financial crisis. In response, Dodd-Frank reformed the mortgage market by attempting to strengthen mortgage underwriting standards, to reduce the risk that consumers’ default on their mortgages, even if house prices fluctuated in the future. Dodd-Frank also directed the CFPB to update federal mortgage disclosure forms (called the combined TILA/RESPA form) 53 and improve standards for mortgage servicing (a company who manages mortgage loans after the loan is originated).54 During and after the financial crisis, mortgage lenders tightened underwriting standards, making it harder for consumers to qualify for a loan.55 Although most borrowers with good credit scores continued to qualify for mortgage credit, other borrowers in weaker financial positions found it more difficult to obtain a mortgage.56 As the economy has recovered from the Great Recession, concerns exist about whether new consumer compliance regulation in the mortgage market has struck the right balance between prudent mortgage underwriting and access to credit for potential borrowers to build wealth.57 Certain features of mortgages during the mortgage boom that were considered to be particularly risky, such as teaser interest rates and loans with little or no income verification, are now uncommon in the mortgage market.58 However, research suggests that the regulation of underwriting standards may have caused lenders to prefer certain borrowers, such as those with lower debt-to-income ratios.59 Mortgage shopping is another policy issue in this market. Consumers do not tend to shop among lenders for more advantageous mortgage interest rates, even though large price differences exist in the market. According to the CFPB, nearly half of all borrowers only seriously consider one lender or broker before taking out a mortgage.60 Given the range of interest rates available to a consumer at any given time, the CFPB estimates that a consumer could save thousands of dollars on a mortgage by shopping for the best interest rates.61 More recently, the COVID-19 pandemic has impacted the mortgage market. Many consumers who would likely have experienced difficulty repaying their mortgage loans received loan forbearance. 62 Loan forbearance plans can prevent a consumer from becoming delinquent, giving the consumer time to repay the debts owed rather than potentially experiencing adverse consequences, such as credit score declines or foreclosure.63 As previously mentioned, the CARES Act established consumer rights to be granted forbearance for federally backed mortgages for up to a year. The CARES Act’s consumer protections and financial institutions’ loan forbearance programs arguably helped avoid sharp increases in loan delinquencies by making it possible for many loans to receive forbearance during the spring and summer of 2020.64 However, when these programs expire, some consumers may fall delinquent on their loans, impacting the mortgage market. In addition, during the second and third quarters of 2020, mortgage debt balances increased as interest rates reached historic lows, causing more mortgage refinances and other mortgage finance activity. 65 ","Use only the provided text to formulate your response. Do not rely on any outside knowledge. Provide me a three-paragraph response. How does the second lien differ from the first lien? Overview of Major Consumer Finance Markets The following sections examine specific issues within major consumer debt markets: mortgage lending, student loans, automobile loans, credit cards and payments, payday loans and other credit alternative financial products, and checking accounts and substitutes. The markets discussed are under the jurisdiction of the CFPB, and sometimes other regulators as well. Each section briefly describes the financial product, recent market developments, and selected policy issues that may lead each market away from its efficient price or outcomes. These sections focus on the consumer and household perspective as well as consumer protection policy issues in each market. Mortgage Lending Market A mortgage loan is a loan collateralized by a house and its land.47 Generally, consumers use these loans to purchase a new home or refinance an existing one. These types of mortgages are often called first liens, because if a consumer defaults on the loan, the lender is typically the first in line to be compensated through the proceeds of a home foreclosure. First-lien mortgage loans are usually installment loans, in which the consumer pays off the loan in monthly installments over 15 years or 30 years. Most mortgage loans in the United States have a fixed interest rate and fixed installment amount over the course of the loan, affected by the consumer’s credit score and market conditions.48 Households buying a new home and taking out a mortgage loan to purchase it generally cannot borrow for the full cost of the house’s value. To limit the risk to the lender, borrowers are typically required to make a down payment, the difference between the house’s value and the mortgage loan. If the down payment is less than 20% of the home’s value, the borrower is often required to pay for additional insurance. In addition to first-lien purchase mortgages, a consumer may choose to take out a home equity line of credit (often referred to as HELOC) or a smaller installment mortgage loan, which often is a second lien. A second lien means that the lender is second in line, after the first lien holder, to be compensated if the consumer defaults and the home is foreclosed upon. These loans are underwritten using the value of the home, but can be used for a variety of different purposes either related to the home or not. For example, second mortgages can be used to renovate the home, pay for college, or consolidate credit card debts. Mortgage loans are by far the largest consumer credit market in the United States, and homes are a large part of most households’ wealth. According to the Fed, more than $9 trillion of mortgage debt is currently outstanding,49 and more than $20 trillion in real estate equity is owned by households.50 As of the third quarter of 2020, 67.4% of U.S. households owned their home. 51 Many people view homeownership as an important way to build wealth over time, both through price appreciation and home equity by paying down their mortgage. Nevertheless, because home prices can fluctuate over time, this investment can be risky, especially if the home owner only stays in the home for a short time. Although homeownership has certain benefits, such as tax benefits like the mortgage interest tax deduction,52 it also imposes costs on the household, such as mortgage loan closing costs and home maintenance. As noted above, most experts believe that a housing price bubble was a central cause of the 2008 financial crisis. In response, Dodd-Frank reformed the mortgage market by attempting to strengthen mortgage underwriting standards, to reduce the risk that consumers’ default on their mortgages, even if house prices fluctuated in the future. Dodd-Frank also directed the CFPB to update federal mortgage disclosure forms (called the combined TILA/RESPA form) 53 and improve standards for mortgage servicing (a company who manages mortgage loans after the loan is originated).54 During and after the financial crisis, mortgage lenders tightened underwriting standards, making it harder for consumers to qualify for a loan.55 Although most borrowers with good credit scores continued to qualify for mortgage credit, other borrowers in weaker financial positions found it more difficult to obtain a mortgage.56 As the economy has recovered from the Great Recession, concerns exist about whether new consumer compliance regulation in the mortgage market has struck the right balance between prudent mortgage underwriting and access to credit for potential borrowers to build wealth.57 Certain features of mortgages during the mortgage boom that were considered to be particularly risky, such as teaser interest rates and loans with little or no income verification, are now uncommon in the mortgage market.58 However, research suggests that the regulation of underwriting standards may have caused lenders to prefer certain borrowers, such as those with lower debt-to-income ratios.59 Mortgage shopping is another policy issue in this market. Consumers do not tend to shop among lenders for more advantageous mortgage interest rates, even though large price differences exist in the market. According to the CFPB, nearly half of all borrowers only seriously consider one lender or broker before taking out a mortgage.60 Given the range of interest rates available to a consumer at any given time, the CFPB estimates that a consumer could save thousands of dollars on a mortgage by shopping for the best interest rates.61 More recently, the COVID-19 pandemic has impacted the mortgage market. Many consumers who would likely have experienced difficulty repaying their mortgage loans received loan forbearance. 62 Loan forbearance plans can prevent a consumer from becoming delinquent, giving the consumer time to repay the debts owed rather than potentially experiencing adverse consequences, such as credit score declines or foreclosure.63 As previously mentioned, the CARES Act established consumer rights to be granted forbearance for federally backed mortgages for up to a year. The CARES Act’s consumer protections and financial institutions’ loan forbearance programs arguably helped avoid sharp increases in loan delinquencies by making it possible for many loans to receive forbearance during the spring and summer of 2020.64 However, when these programs expire, some consumers may fall delinquent on their loans, impacting the mortgage market. In addition, during the second and third quarters of 2020, mortgage debt balances increased as interest rates reached historic lows, causing more mortgage refinances and other mortgage finance activity. 65 ",Financial,Fact Finding,Q&A You must only use information contained in the included context block to answer the question. Your answer should be limited to no more than three paragraphs and no more than 200 words.,How did the Interim Final Rule change the Head Start rules that govern child safety?,"47. Before November 30, 2021, Head Start rules (45 C.F.R. § 1302.94(a)) governed volunteer health only to the following limited extent: (a) A program must ensure regular volunteers have been screened for appropriate communicable diseases in accordance with state, tribal or local laws. In the absence of state, tribal or local law, the Health Services Advisory Committee must be consulted regarding the need for such screenings. 48. But now the Interim Final Rule revises paragraph (a) to read as follows: (a) A program must ensure volunteers have been screened for appropriate communicable diseases in accordance with state, tribal or local laws. In the absence of state, tribal, or local law, the Health Services Advisory Committee must be consulted regarding the need for such screenings. (1) All volunteers in classrooms or working directly with children other than their own must be fully vaccinated for COVID-19, other than those volunteers: (i) For whom a vaccine is medically contraindicated; (ii) For whom medical necessity requires a delay in vaccination; or (iii) Who are legally entitled to an accommodation with regard to the COVID19 vaccination requirements based on an applicable Federal law. (2) Those granted an accommodation outlined in paragraph (a)(1) of this section must undergo SARS-CoV-2 testing for current infection at least weekly with those who have negative test results to remain in the classroom or work directly with children. Those with positive test results must be immediately excluded from the facility, so they are away from children and staff until they are determined to no longer be infectious. 86 Fed. Reg. at 68,101. 49. The new paragraphs require volunteers to be vaccinated, and to get tested weekly if granted an accommodation against being vaccinated. No such requirement existed in the prior version. 50. Before November 30, 2021, Head Start rules (45 C.F.R. § 1302.47(b)(5)) governed child safety only to the following limited extent: (5) Safety practices. All staff and consultants follow appropriate practices to keep children safe during all activities, including, at a minimum: (i) Reporting of suspected or known child abuse and neglect, including that staff comply with applicable federal, state, local, and tribal laws; (ii) Safe sleep practices, including ensuring that all sleeping arrangements for children under 18 months of age use firm mattresses or cots, as appropriate, and for children under 12 months, soft bedding materials or toys must not be used; (iii) Appropriate indoor and outdoor supervision of children at all times; (iv) Only releasing children to an authorized adult, and; (v) All standards of conduct described in § 1302.90(c). 9 51. The Interim Final Rule adds paragraph (b)(5)(vi) to read as follows: (vi) Masking, using masks recommended by CDC, for all individuals 2 years of age or older when there are two or more individuals in a vehicle owned, leased, or arranged by the Head Start program; indoors in a setting when Head Start services are provided; and for those not fully vaccinated, outdoors in crowded settings or during activities that involve sustained close contact with other people, except: (A) Children or adults when they are either eating or drinking; (B) Children when they are napping; (C) When a person cannot wear a mask, or cannot safely wear a mask, because of a disability as defined by the Americans with Disabilities Act; or (D) When a child’s health care provider advises an alternative face covering to accommodate the child’s special health care needs. 86 Fed. Reg. at 68,101. 52. The new paragraph requires masking. No such requirement existed in the prior version. 53. Paragraph (vi) applies to all “individuals 2 years of age or older” who are “indoors in a setting when Head Start services are provided” and “outdoors in crowded settings or during activities that involve sustained close contact with other people” According to the Interim Final Rule, “The Office of Head Start notes that being outdoors with children inherently includes sustained close contact for the purposes of caring for and supervising children.” 86 Fed. Reg. at 68,060. Thus, the Mask Mandate appears to also apply to parents who enter a Head Start facility (either when dropping off or picking up their child or at any other time) and to parents are outside with their children (either when dropping them off, picking them up, or at any other time), since being outside with children “inherently includes sustained close contact.” ","System Instructions: You must only use information contained in the included context block to answer the question. Your answer should be limited to no more than three paragraphs and no more than 200 words. Context Block: 47. Before November 30, 2021, Head Start rules (45 C.F.R. § 1302.94(a)) governed volunteer health only to the following limited extent: (a) A program must ensure regular volunteers have been screened for appropriate communicable diseases in accordance with state, tribal or local laws. In the absence of state, tribal or local law, the Health Services Advisory Committee must be consulted regarding the need for such screenings. 48. But now the Interim Final Rule revises paragraph (a) to read as follows: (a) A program must ensure volunteers have been screened for appropriate communicable diseases in accordance with state, tribal or local laws. In the absence of state, tribal, or local law, the Health Services Advisory Committee must be consulted regarding the need for such screenings. (1) All volunteers in classrooms or working directly with children other than their own must be fully vaccinated for COVID-19, other than those volunteers: (i) For whom a vaccine is medically contraindicated; (ii) For whom medical necessity requires a delay in vaccination; or (iii) Who are legally entitled to an accommodation with regard to the COVID19 vaccination requirements based on an applicable Federal law. (2) Those granted an accommodation outlined in paragraph (a)(1) of this section must undergo SARS-CoV-2 testing for current infection at least weekly with those who have negative test results to remain in the classroom or work directly with children. Those with positive test results must be immediately excluded from the facility, so they are away from children and staff until they are determined to no longer be infectious. 86 Fed. Reg. at 68,101. 49. The new paragraphs require volunteers to be vaccinated, and to get tested weekly if granted an accommodation against being vaccinated. No such requirement existed in the prior version. 50. Before November 30, 2021, Head Start rules (45 C.F.R. § 1302.47(b)(5)) governed child safety only to the following limited extent: (5) Safety practices. All staff and consultants follow appropriate practices to keep children safe during all activities, including, at a minimum: (i) Reporting of suspected or known child abuse and neglect, including that staff comply with applicable federal, state, local, and tribal laws; (ii) Safe sleep practices, including ensuring that all sleeping arrangements for children under 18 months of age use firm mattresses or cots, as appropriate, and for children under 12 months, soft bedding materials or toys must not be used; (iii) Appropriate indoor and outdoor supervision of children at all times; (iv) Only releasing children to an authorized adult, and; (v) All standards of conduct described in § 1302.90(c). 9 51. The Interim Final Rule adds paragraph (b)(5)(vi) to read as follows: (vi) Masking, using masks recommended by CDC, for all individuals 2 years of age or older when there are two or more individuals in a vehicle owned, leased, or arranged by the Head Start program; indoors in a setting when Head Start services are provided; and for those not fully vaccinated, outdoors in crowded settings or during activities that involve sustained close contact with other people, except: (A) Children or adults when they are either eating or drinking; (B) Children when they are napping; (C) When a person cannot wear a mask, or cannot safely wear a mask, because of a disability as defined by the Americans with Disabilities Act; or (D) When a child’s health care provider advises an alternative face covering to accommodate the child’s special health care needs. 86 Fed. Reg. at 68,101. 52. The new paragraph requires masking. No such requirement existed in the prior version. 53. Paragraph (vi) applies to all “individuals 2 years of age or older” who are “indoors in a setting when Head Start services are provided” and “outdoors in crowded settings or during activities that involve sustained close contact with other people” According to the Interim Final Rule, “The Office of Head Start notes that being outdoors with children inherently includes sustained close contact for the purposes of caring for and supervising children.” 86 Fed. Reg. at 68,060. Thus, the Mask Mandate appears to also apply to parents who enter a Head Start facility (either when dropping off or picking up their child or at any other time) and to parents are outside with their children (either when dropping them off, picking them up, or at any other time), since being outside with children “inherently includes sustained close contact.” Question: How did the Interim Final Rule change the Head Start rules that govern child safety?",Legal,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Can you summarize the following text in bullet form. Each bullet must contain a quote from the passage supporting the summary point but still describe the points. Don't use the word AI and make sure to talk about all of the points made. PLease provide some specific examples and names/descriptions of organizations and can you describe the code of conduct stuff? Talk about specific acts and list out specific guidelines they are implementing. Limit it to 400 words.,"Abraham Lincoln once observed: “In the world’s history, certain inventions and discoveries occurred of peculiar value . . . in facilitating all other inventions and discoveries.” Lincoln was speaking of the written word and, later, the printing press. But today, we are living through another such invention: artificial intelligence. Powerful generative AI systems like GPT-4 are ushering in a new era of this technology. They’re revolutionising the production of knowledge: vastly increasing the capacity of machines to generate original content, perform complex tasks and solve important problems. They are also dramatically lowering the barriers for people to access AI and its benefits. This new era brings serious potential hazards. These include the risk of AI generating false information, reinforcing bias and discrimination, being misused for repressive or destabilising purposes or proliferating the knowledge to make a bioweapon or conduct a cyber attack. But even with these risks — which we’re determined to minimise — AI holds an exhilarating potential to improve people’s lives and help solve some of the world’s biggest challenges, from curing cancer to mitigating the effects of climate change to solving global food insecurity. The future of AI — whether it makes our societies more or less equitable, unlocks breakthroughs or becomes a tool of authoritarians — is up to us. The question is not whether to use it, but how. The United States, as home to many of the leading companies, technologies and minds driving the AI revolution, has the ability and responsibility to lead on its governance. We are committed to doing so in partnership with others around the world to ensure the future reflects our shared values and vision for this technology. We have already taken action to guide AI’s use. We set out a Blueprint for an AI Bill of Rights with principles for how automated systems are designed and used, and developed an AI Risk Management Framework to help improve user protections. Last week, President Joe Biden announced the next step with a set of commitments from leading companies designed to enhance safety, security and trust. These commitments will mitigate risks of AI including misuse, and support new technologies and standards to distinguish between human and AI-generated content. They will encourage companies and individuals to report on systems’ capabilities and limitations, and facilitate information sharing. And they will promote the development of AI systems designed to address society’s greatest challenges. The commitments offer a starting point for action to limit near-term risks while fostering innovation. They will be complemented by key lines of effort with partners around the world. Over the coming weeks, we will continue to work with the G7 through the Japan-led Hiroshima Process to expand and internationalise these commitments. We want AI governance to be guided by democratic values and those who embrace them, and G7-led action could inform an international code of conduct for private actors and governments, as well as common regulatory principles for states. As we co-ordinate globally, we will also align our domestic approaches in forums like the US-EU Trade and Technology Council. We will work intensively with other governments to build a shared understanding of longer-term AI risks and how to limit them. The US looks forward to participating in the UK’s Global Summit on AI Safety and other opportunities for global engagement to build a more secure future. The US is committed to making AI work for, and designing governance with, developing countries, whose voices are crucial to the global discussion. India will play a critical role, including through the Global Partnership on AI. We are also working on inclusivity for AI through discussions with the UN. We will partner with countries around the world, as well as the private sector and civil society, to advance a key goal of the commitments: creating AI systems that make people’s lives better. Today, we’re on track to meet just 12 per cent of the UN’s Sustainable Development Goals. AI could change that trajectory by accelerating efforts to deliver clean water and sanitation, eliminate poverty, advance public health and further other development goals. To shape the future of AI, we must act quickly. We must also act collectively. No country or company can shape the future of AI alone. The US has taken an important step — but only with the combined focus, ingenuity and co-operation of the international community will we be able to fully and safely harness the potential of AI. The writers are US secretary of state and US secretary of commerce","""================ ======= Abraham Lincoln once observed: “In the world’s history, certain inventions and discoveries occurred of peculiar value . . . in facilitating all other inventions and discoveries.” Lincoln was speaking of the written word and, later, the printing press. But today, we are living through another such invention: artificial intelligence. Powerful generative AI systems like GPT-4 are ushering in a new era of this technology. They’re revolutionising the production of knowledge: vastly increasing the capacity of machines to generate original content, perform complex tasks and solve important problems. They are also dramatically lowering the barriers for people to access AI and its benefits. This new era brings serious potential hazards. These include the risk of AI generating false information, reinforcing bias and discrimination, being misused for repressive or destabilising purposes or proliferating the knowledge to make a bioweapon or conduct a cyber attack. But even with these risks — which we’re determined to minimise — AI holds an exhilarating potential to improve people’s lives and help solve some of the world’s biggest challenges, from curing cancer to mitigating the effects of climate change to solving global food insecurity. The future of AI — whether it makes our societies more or less equitable, unlocks breakthroughs or becomes a tool of authoritarians — is up to us. The question is not whether to use it, but how. The United States, as home to many of the leading companies, technologies and minds driving the AI revolution, has the ability and responsibility to lead on its governance. We are committed to doing so in partnership with others around the world to ensure the future reflects our shared values and vision for this technology. We have already taken action to guide AI’s use. We set out a Blueprint for an AI Bill of Rights with principles for how automated systems are designed and used, and developed an AI Risk Management Framework to help improve user protections. Last week, President Joe Biden announced the next step with a set of commitments from leading companies designed to enhance safety, security and trust. These commitments will mitigate risks of AI including misuse, and support new technologies and standards to distinguish between human and AI-generated content. They will encourage companies and individuals to report on systems’ capabilities and limitations, and facilitate information sharing. And they will promote the development of AI systems designed to address society’s greatest challenges. The commitments offer a starting point for action to limit near-term risks while fostering innovation. They will be complemented by key lines of effort with partners around the world. Over the coming weeks, we will continue to work with the G7 through the Japan-led Hiroshima Process to expand and internationalise these commitments. We want AI governance to be guided by democratic values and those who embrace them, and G7-led action could inform an international code of conduct for private actors and governments, as well as common regulatory principles for states. As we co-ordinate globally, we will also align our domestic approaches in forums like the US-EU Trade and Technology Council. We will work intensively with other governments to build a shared understanding of longer-term AI risks and how to limit them. The US looks forward to participating in the UK’s Global Summit on AI Safety and other opportunities for global engagement to build a more secure future. The US is committed to making AI work for, and designing governance with, developing countries, whose voices are crucial to the global discussion. India will play a critical role, including through the Global Partnership on AI. We are also working on inclusivity for AI through discussions with the UN. We will partner with countries around the world, as well as the private sector and civil society, to advance a key goal of the commitments: creating AI systems that make people’s lives better. Today, we’re on track to meet just 12 per cent of the UN’s Sustainable Development Goals. AI could change that trajectory by accelerating efforts to deliver clean water and sanitation, eliminate poverty, advance public health and further other development goals. To shape the future of AI, we must act quickly. We must also act collectively. No country or company can shape the future of AI alone. The US has taken an important step — but only with the combined focus, ingenuity and co-operation of the international community will we be able to fully and safely harness the potential of AI. The writers are US secretary of state and US secretary of commerce https://www.commerce.gov/news/op-eds/2023/07/op-ed-antony-blinken-gina-raimondo-shape-future-ai-we-must-act-quickly ================ ======= Can you summarize the following text in bullet form. Each bullet must contain a quote from the passage supporting the summary point but still describe the points. Don't use the word AI and make sure to talk about all of the points made. PLease provide some specific examples and names/descriptions of organizations and can you describe the code of conduct stuff? Talk about specific acts and list out specific guidelines they are implementing. Limit it to 400 words. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Internet/Technology,Summarize & Format,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Explain the clinical symptoms of rhabdovirus in under 600 words and so a 5th grader can understand. At the end of the explanation, provide a description of the virus in bold print.","Clinical Manifestations Rabies virus causes acute infection of the central nervous system. Five general stages are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death. The incubation period is exceptionally variable, ranging from fewer than 10 days to longer than 2 years, but is usually 1–3 months. Structure Rabies virus is a rod- or bullet-shaped, single-stranded, negative-sense, unsegmented, enveloped RNA virus. The virus genome encodes five proteins. Classification and Antigenic Types Placement within the family is based on the distinctive morphology of the virus particle. Cross- reactive nucleoprotein antigens or comparative genomic sequences determine inclusion in the genus Lyssavirus, which includes rabies virus and at least five other pathogenic rabies-like viruses. Multiplication The viral RNA uncoats in the cytoplasm of infected cells. The genome is transcribed by a virion-associated RNA-dependent RNA polymerase. Viral RNA is then translated into individual viral proteins. Replication occurs with synthesis of positive-stranded RNA templates for the production of progeny negative-stranded RNA. Pathogenesis After inoculation, rabies virus may enter the peripheral nervous system directly and migrates to the brain or may replicate in muscle tissue, remaining sequestered at or near the entry site during incubation, prior to central nervous system invasion and replication. It then spreads centrifugally to numerous other organs. The case:fatality ratio approaches unity, but exact pathogenic mechanisms are not fully understood. Host Defenses Susceptibility to lethal infection is related to the animal species, viral variant, inoculum concentration, location and severity of exposure, and host immune status. Both virus-neutralizing antibodies and cell-mediated immunity are important in host defense. Epidemiology Rabies occurs in nearly all countries. Disease in humans is almost always due to a bite by an infected mammal. Nonbite exposures (e.g., mucosal contact) rarely cause rabies in humans. Diagnosis Early diagnosis is difficult. Rabies should be suspected in human cases of unexplained viral encephalitis with a history of animal bite. Unvaccinated persons are often negative for virus-neutralizing antibodies until late in the course of disease. Virus isolation from saliva, positive immunofluorescent skin biopsies or virus neutralizing antibody (from cerebrospinal fluid, or serum of a non-vaccinated patient), establish a diagnosis. Control Vaccination of susceptible animal species, particularly dogs and cats, will control this zoonotic disease. Introduction The family Rhabdoviridae consists of more than 100 single-stranded, negative-sense, nonsegmented viruses that infect a wide variety of hosts, including vertebrates, invertebrates, and plants. Common to all members of the family is a distinctive rod- or bullet-shaped morphology. Human pathogens of medical importance are found in the genera Lyssavirus and Vesiculovirus.Only rabies virus, medically the most significant member of the genus Lyssavirus, is reviewed in this chapter. Clinical Manifestations Five general stages of rabies are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death (or, very rarely, recovery) (Fig. 61-1). No specific antirabies agents are useful once clinical signs or symptoms develop. The incubation period in rabies, usually 30 to 90 days but ranging from as few as 5 days to longer than 2 years after initial exposure, is more variable than in any other acute infection. Incubation periods may be somewhat shorter in children and in individuals bitten close to the central nervous system (e.g., the head). Clinical symptoms are first noted during the prodromal period, which usually lasts from 2 to 10 days. These symptoms are often nonspecific (general malaise, fever, and fatigue) or suggest involvement of the respiratory system (sore throat, cough, and dyspnea), gastrointestinal system (anorexia, dysphagia, nausea, vomiting, abdominal pain, and diarrhea), or central nervous systems (headache, vertigo, anxiety, apprehension, irritability, and nervousness). More remarkable abnormalities (agitation, photophobia, priapism, increased libido, insomnia, nightmares, and depression) may also occur, suggesting encephalitis, psychiatric disturbances, or brain conditions. Pain or paresthesia at the site of virus inoculation, combined with a history of recent animal bite, should suggest a consideration of rabies. The acute neurologic period begins with objective signs of central nervous system dysfunction. The disease may be classified as furious rabies if hyperactivity (i.e., hydrophobia) predominates and as dumb rabies if paralysis dominates the clinical picture. Fever, paresthesia, nuchal rigidity, muscle fasciculations, focal and generalized convulsions, hyperventilation, and hypersalivation may occur in both forms of the disease. At the end of the acute neurologic phase, periods of rapid, irregular breathing may begin; paralysis and coma soon follow. Respiratory arrest may occur thereafter, unless the patient is receiving ventilatory assistance, which may prolong survival for days, weeks, or longer, with death due to other complications. Although life support measures can prolong the clinical course of rabies, rarely will they affect the outcome of disease. The possibility of recovery, however, must be recognized, and when resources permit, every effort should be made to support the patient. At least seven cases of human “recovery” have been documented. Structure The rabies virus is a negative-sense, non-segmented, single-stranded RNA virus measuring approximately 60 nm × 180 nm. It is composed of an internal protein core or nucleocapsid, containing the nucleic acid, and an outer envelope, a lipid-containing bilayer covered with transmembrane glycoprotein spikes. The virus genome encodes five proteins associated with either the ribonucleoprotein (RNP) complex or the viral envelope (Fig. 61-3). The L (transcriptase), N (nucleoprotein), and NS (transcriptase-associated) proteins comprise the RNP complex, together with the viral RNA. These aggregate in the cytoplasm of virus-infected neurons and compose Negri bodies, the characteristic histopathologic finding of rabies virus infection. The M (matrix) and G (glycoprotein) proteins are associated with the lipid envelope. The G protein forms the protrusions that cover the outer surface of the virion envelope and is the only rabies virus protein known to induce virus-neutralizing antibody. Classification and Antigenic Types The genus Lyssavirus includes rabies virus and the antigenically- and genetically-related rabies- like viruses: Lagos bat, Mokola, and Duvenhage viruses, and two suggested subtypes of European bat lyssaviruses. Cross-protection studies suggest that animals immunized with traditional rabies vaccines may not be fully protected if challenged with other lyssaviruses. Rabies viruses may be categorized as either fixed (adapted by passage in animals or cell culture) or street (wild type). The use of monoclonal antibodies and genetic sequencing to differentiate street rabies viruses has been helpful in identifying viral variants originating in major host reservoirs throughout the world and suggesting the likely sources of human exposure when a history of definitive animal bite was otherwise missing from a patient's case history. Multiplication The replication of rabies virus is believed to be similar to that of other negative-stranded RNA viruses. The virus attaches to the host cell membranes via the G protein, penetrates the cytoplasm by fusion or pinocytosis, and is uncoated to RNP. The core initiates primary transcription of the five complementary monocistronic messenger RNAs by using the virion-associated RNA-dependent RNA polymerase. Each RNA is then translated into an individual viral protein. After viral proteins have been synthesized, replication of the genomic RNA continues with the synthesis of full length, positive-stranded RNA, which acts as a template for the production of progeny negative-stranded RNA.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Explain the clinical symptoms of rhabdovirus in under 600 words and so a 5th grader can understand. At the end of the explanation, provide a description of the virus in bold print. {passage 0} ========== Clinical Manifestations Rabies virus causes acute infection of the central nervous system. Five general stages are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death. The incubation period is exceptionally variable, ranging from fewer than 10 days to longer than 2 years, but is usually 1–3 months. Structure Rabies virus is a rod- or bullet-shaped, single-stranded, negative-sense, unsegmented, enveloped RNA virus. The virus genome encodes five proteins. Classification and Antigenic Types Placement within the family is based on the distinctive morphology of the virus particle. Cross- reactive nucleoprotein antigens or comparative genomic sequences determine inclusion in the genus Lyssavirus, which includes rabies virus and at least five other pathogenic rabies-like viruses. Multiplication The viral RNA uncoats in the cytoplasm of infected cells. The genome is transcribed by a virion-associated RNA-dependent RNA polymerase. Viral RNA is then translated into individual viral proteins. Replication occurs with synthesis of positive-stranded RNA templates for the production of progeny negative-stranded RNA. Pathogenesis After inoculation, rabies virus may enter the peripheral nervous system directly and migrates to the brain or may replicate in muscle tissue, remaining sequestered at or near the entry site during incubation, prior to central nervous system invasion and replication. It then spreads centrifugally to numerous other organs. The case:fatality ratio approaches unity, but exact pathogenic mechanisms are not fully understood. Host Defenses Susceptibility to lethal infection is related to the animal species, viral variant, inoculum concentration, location and severity of exposure, and host immune status. Both virus-neutralizing antibodies and cell-mediated immunity are important in host defense. Epidemiology Rabies occurs in nearly all countries. Disease in humans is almost always due to a bite by an infected mammal. Nonbite exposures (e.g., mucosal contact) rarely cause rabies in humans. Diagnosis Early diagnosis is difficult. Rabies should be suspected in human cases of unexplained viral encephalitis with a history of animal bite. Unvaccinated persons are often negative for virus-neutralizing antibodies until late in the course of disease. Virus isolation from saliva, positive immunofluorescent skin biopsies or virus neutralizing antibody (from cerebrospinal fluid, or serum of a non-vaccinated patient), establish a diagnosis. Control Vaccination of susceptible animal species, particularly dogs and cats, will control this zoonotic disease. Introduction The family Rhabdoviridae consists of more than 100 single-stranded, negative-sense, nonsegmented viruses that infect a wide variety of hosts, including vertebrates, invertebrates, and plants. Common to all members of the family is a distinctive rod- or bullet-shaped morphology. Human pathogens of medical importance are found in the genera Lyssavirus and Vesiculovirus.Only rabies virus, medically the most significant member of the genus Lyssavirus, is reviewed in this chapter. Clinical Manifestations Five general stages of rabies are recognized in humans: incubation, prodrome, acute neurologic period, coma, and death (or, very rarely, recovery) (Fig. 61-1). No specific antirabies agents are useful once clinical signs or symptoms develop. The incubation period in rabies, usually 30 to 90 days but ranging from as few as 5 days to longer than 2 years after initial exposure, is more variable than in any other acute infection. Incubation periods may be somewhat shorter in children and in individuals bitten close to the central nervous system (e.g., the head). Clinical symptoms are first noted during the prodromal period, which usually lasts from 2 to 10 days. These symptoms are often nonspecific (general malaise, fever, and fatigue) or suggest involvement of the respiratory system (sore throat, cough, and dyspnea), gastrointestinal system (anorexia, dysphagia, nausea, vomiting, abdominal pain, and diarrhea), or central nervous systems (headache, vertigo, anxiety, apprehension, irritability, and nervousness). More remarkable abnormalities (agitation, photophobia, priapism, increased libido, insomnia, nightmares, and depression) may also occur, suggesting encephalitis, psychiatric disturbances, or brain conditions. Pain or paresthesia at the site of virus inoculation, combined with a history of recent animal bite, should suggest a consideration of rabies. The acute neurologic period begins with objective signs of central nervous system dysfunction. The disease may be classified as furious rabies if hyperactivity (i.e., hydrophobia) predominates and as dumb rabies if paralysis dominates the clinical picture. Fever, paresthesia, nuchal rigidity, muscle fasciculations, focal and generalized convulsions, hyperventilation, and hypersalivation may occur in both forms of the disease. At the end of the acute neurologic phase, periods of rapid, irregular breathing may begin; paralysis and coma soon follow. Respiratory arrest may occur thereafter, unless the patient is receiving ventilatory assistance, which may prolong survival for days, weeks, or longer, with death due to other complications. Although life support measures can prolong the clinical course of rabies, rarely will they affect the outcome of disease. The possibility of recovery, however, must be recognized, and when resources permit, every effort should be made to support the patient. At least seven cases of human “recovery” have been documented. Structure The rabies virus is a negative-sense, non-segmented, single-stranded RNA virus measuring approximately 60 nm × 180 nm. It is composed of an internal protein core or nucleocapsid, containing the nucleic acid, and an outer envelope, a lipid-containing bilayer covered with transmembrane glycoprotein spikes. The virus genome encodes five proteins associated with either the ribonucleoprotein (RNP) complex or the viral envelope (Fig. 61-3). The L (transcriptase), N (nucleoprotein), and NS (transcriptase-associated) proteins comprise the RNP complex, together with the viral RNA. These aggregate in the cytoplasm of virus-infected neurons and compose Negri bodies, the characteristic histopathologic finding of rabies virus infection. The M (matrix) and G (glycoprotein) proteins are associated with the lipid envelope. The G protein forms the protrusions that cover the outer surface of the virion envelope and is the only rabies virus protein known to induce virus-neutralizing antibody. Classification and Antigenic Types The genus Lyssavirus includes rabies virus and the antigenically- and genetically-related rabies- like viruses: Lagos bat, Mokola, and Duvenhage viruses, and two suggested subtypes of European bat lyssaviruses. Cross-protection studies suggest that animals immunized with traditional rabies vaccines may not be fully protected if challenged with other lyssaviruses. Rabies viruses may be categorized as either fixed (adapted by passage in animals or cell culture) or street (wild type). The use of monoclonal antibodies and genetic sequencing to differentiate street rabies viruses has been helpful in identifying viral variants originating in major host reservoirs throughout the world and suggesting the likely sources of human exposure when a history of definitive animal bite was otherwise missing from a patient's case history. Multiplication The replication of rabies virus is believed to be similar to that of other negative-stranded RNA viruses. The virus attaches to the host cell membranes via the G protein, penetrates the cytoplasm by fusion or pinocytosis, and is uncoated to RNP. The core initiates primary transcription of the five complementary monocistronic messenger RNAs by using the virion-associated RNA-dependent RNA polymerase. Each RNA is then translated into an individual viral protein. After viral proteins have been synthesized, replication of the genomic RNA continues with the synthesis of full length, positive-stranded RNA, which acts as a template for the production of progeny negative-stranded RNA. https://www.ncbi.nlm.nih.gov/books/NBK8618/",Medical,Explanation/Definition,Q&A Only use the provided text to answer.,When should egfr be considered?,"FDA Approved Indication(s) SGLT2 inhibitors are indicated as adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Dapagliflozin-, canagliflozin-, and empagliflozin-containing products are also indicated in adult patients with type 2 diabetes mellitus and established cardiovascular disease (CV) (or multiple cardiovascular risk factors [dapaglifozin only]) to: • Reduce the risk of hospitalization for heart failure (HF) (dapagliflozin) • Reduce the risk of major adverse CV events: CV death, nonfatal myocardial infarction, and nonfatal stroke (canagliflozin) • Reduce the risk of CV death (empagliflozin) Canagliflozin-containing products are additionally indicated to reduce the risk of end-stage kidney disease, doubling of serum creatinine, CV death, and hospitalization for HF in adults with type 2 diabetes mellitus and diabetic nephropathy with albuminuria > 300 mg/day. Farxiga is additionally indicated to: • Reduce the risk of CV death and hospitalization for HF in adults with heart failure with reduced ejection fraction (HFrEF) (New York Heart Association [NYHA] class II-IV) • Reduce the risk of sustained estimated glomerular filtration rate (eGFR) decline, end stage kidney disease cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease (CKD) at risk of progression Jardiance is additionally indicated to: • Reduce the risk of CV death plus hospitalization for HF in adults with HFrEF Limitation(s) of use: • SGLT2 inhibitors should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. SGLT2 inhibitors may increase the risk of diabetic ketoacidosis. • Qternmet XR initiation is intended only for patients currently taking metformin. • Farxiga is not recommended for use to improve glycemic control in adults with type 2 diabetes mellitus with an eGFR less than 45 mL/min/1.73 m2. Farxiga is likely to be ineffective in this setting based upon its mechanism of action. • Farxiga is not recommended for the treatment of chronic kidney disease in patients with polycystic kidney disease or patients requiring or with a recent history of immunosuppressive therapy for the treatment of kidney disease. Farxiga is not expected to be effective in these populations. CLINICAL POLICY Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors Page 2 of 9 • Jardiance is not recommended for use to improve glycemic control in adults with type 2 diabetes mellitus with an eGFR less than 30 mL/min/1.73 m2. Jardiance is likely to be ineffective in this setting based upon its mechanism of action. Policy/Criteria Provider must submit documentation (such as office chart notes, lab results or other clinical information) supporting that member has met all approval criteria. Health plan approved formularies should be reviewed for all coverage determinations. Requirements to use preferred alternative agents apply only when such requirements align with the health plan approved formulary. It is the policy of health plans affiliated with Envolve Pharmacy Solutions™ that SGLT2 inhibitors are medically necessary when the following criteria are met: I. Initial Approval Criteria A. Type 2 Diabetes Mellitus (must meet all): 1. Diagnosis of type 2 diabetes mellitus; 2. Age ≥ 18 years; 3. Member meets one of the following (a or b): a. Failure of ≥ 3 consecutive months of metformin, unless contraindicated or clinically significant adverse effects are experienced; b. For medication-naïve members, requested agent is approvable if intended for concurrent use with metformin due to HbA1c ≥ 8.5% (drawn within the past 3 months); 4. Failure of ≥ 3 consecutive months of Jardiance or Invokana, unless both are contraindicated or clinically significant adverse effects are experienced; 5. Dose does not exceed the FDA-approved maximum recommended dose (see Section V). Approval duration: 12 months B. Heart Failure (must meet all): 1. Diagnosis of HFrEF of NYHA Class II, III, or IV; 2. Request is for Farxiga or Jardiance; 3. Prescribed by or in consultation with a cardiologist; 4. Age ≥ 18 years; 5. Left ventricular ejection fraction (LVEF) is ≤ 40%; 6. Member does not have a diagnosis of type 1 diabetes mellitus; 7. Member is currently receiving standard HF drug therapy at target doses for ≥ 4 weeks, including both of the following (a and b) unless clinically significant adverse effects are experienced or all are contraindicated: a. Angiotensin converting enzyme inhibitor, angiotensin receptor blocker, or Entresto®; b. Beta blocker; 8. Dose does not exceed 10 mg (1 tablet) per day. Approval duration: 12 months C. Chronic Kidney Disease (must meet all): 1. Diagnosis of CKD; 2. Request is for Farxiga; 3. Age ≥ 18 years; 4. Both of the following (a and b): a. eGFR between 25 and 75 mL/min/1.73 m2; b. Urine albumin creatinine ratio (UACR) ≥ 200 mg/g; 5. Member does not have a diagnosis of type 1 diabetes mellitus or polycystic kidney disease; 6. Member has not received immunosuppressive therapy for the treatment of kidney disease in the past 6 months; CLINICAL POLICY Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors Page 3 of 9 7. Member is currently receiving standard CKD drug therapy (angiotensin converting enzyme inhibitor or angiotensin receptor blocker) at maximally tolerated doses for ≥ 4 weeks, unless clinically significant adverse effects are experienced or all are contraindicated; 8. Dose does not exceed 10 mg (1 tablet) per day. Approval duration: 12 months D. Other diagnoses/indications 1. Refer to ERX.PA.01 if diagnosis is NOT specifically listed under section III (Diagnoses/Indications for which coverage is NOT authorized). II. Continued Therapy A. Type 2 Diabetes Mellitus (must meet all): 1. Currently receiving medication via a health plan affiliated with Envolve Pharmacy Solutions or member has previously met initial approval criteria; 2. Member is responding positively to therapy; 3. If request is for a dose increase, new dose does not exceed the FDA-approved maximum recommended dose (see Section V). Approval duration: 12 months B. Heart Failure (must meet all): 1. Currently receiving medication via a health plan affiliated with Envolve Pharmacy Solutions, or documentation supports that member is currently receiving Farxiga for HFrEF and has received this medication for at least 30 days; 2. Request is for Farxiga or Jardiance; 3. Member is responding positively to therapy; 4. If request is for a dose increase, new dose does not exceed 10 mg (1 tablet) per day. Approval duration: 12 months C. Chronic Kidney Disease (must meet all): 1. Currently receiving medication via a health plan affiliated with Envolve Pharmacy Solutions or member has previously met initial approval criteria; 2. Request is for Farxiga; 3. Member is responding positively to therapy; 4. If request is for a dose increase, new dose does not exceed 10 mg (1 tablet) per day. Approval duration: 12 months D. Other diagnoses/indications (must meet 1 or 2): 1. Currently receiving medication via a health plan affiliated with Envolve Pharmacy Solutions and documentation supports positive response to therapy. Approval duration: Duration of request or 12 months (whichever is less); or 2. Refer to ERX.PA.01 if diagnosis is NOT specifically listed under section III (Diagnoses/Indications for which coverage is NOT authorized). III. Diagnoses/Indications for which coverage is NOT authorized: A. Non-FDA approved indications, which are not addressed in this policy, unless there is sufficient documentation of efficacy and safety according to the off-label use policy – ERX.PA.01 or evidence of coverage documents. ","Context Block: [FDA Approved Indication(s) SGLT2 inhibitors are indicated as adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Dapagliflozin-, canagliflozin-, and empagliflozin-containing products are also indicated in adult patients with type 2 diabetes mellitus and established cardiovascular disease (CV) (or multiple cardiovascular risk factors [dapaglifozin only]) to: • Reduce the risk of hospitalization for heart failure (HF) (dapagliflozin) • Reduce the risk of major adverse CV events: CV death, nonfatal myocardial infarction, and nonfatal stroke (canagliflozin) • Reduce the risk of CV death (empagliflozin) Canagliflozin-containing products are additionally indicated to reduce the risk of end-stage kidney disease, doubling of serum creatinine, CV death, and hospitalization for HF in adults with type 2 diabetes mellitus and diabetic nephropathy with albuminuria > 300 mg/day. Farxiga is additionally indicated to: • Reduce the risk of CV death and hospitalization for HF in adults with heart failure with reduced ejection fraction (HFrEF) (New York Heart Association [NYHA] class II-IV) • Reduce the risk of sustained estimated glomerular filtration rate (eGFR) decline, end stage kidney disease cardiovascular death, and hospitalization for heart failure in adults with chronic kidney disease (CKD) at risk of progression Jardiance is additionally indicated to: • Reduce the risk of CV death plus hospitalization for HF in adults with HFrEF Limitation(s) of use: • SGLT2 inhibitors should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis. SGLT2 inhibitors may increase the risk of diabetic ketoacidosis. • Qternmet XR initiation is intended only for patients currently taking metformin. • Farxiga is not recommended for use to improve glycemic control in adults with type 2 diabetes mellitus with an eGFR less than 45 mL/min/1.73 m2. Farxiga is likely to be ineffective in this setting based upon its mechanism of action. • Farxiga is not recommended for the treatment of chronic kidney disease in patients with polycystic kidney disease or patients requiring or with a recent history of immunosuppressive therapy for the treatment of kidney disease. Farxiga is not expected to be effective in these populations. CLINICAL POLICY Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors Page 2 of 9 • Jardiance is not recommended for use to improve glycemic control in adults with type 2 diabetes mellitus with an eGFR less than 30 mL/min/1.73 m2. Jardiance is likely to be ineffective in this setting based upon its mechanism of action. Policy/Criteria Provider must submit documentation (such as office chart notes, lab results or other clinical information) supporting that member has met all approval criteria. Health plan approved formularies should be reviewed for all coverage determinations. Requirements to use preferred alternative agents apply only when such requirements align with the health plan approved formulary. It is the policy of health plans affiliated with Envolve Pharmacy Solutions™ that SGLT2 inhibitors are medically necessary when the following criteria are met: I. Initial Approval Criteria A. Type 2 Diabetes Mellitus (must meet all): 1. Diagnosis of type 2 diabetes mellitus; 2. Age ≥ 18 years; 3. Member meets one of the following (a or b): a. Failure of ≥ 3 consecutive months of metformin, unless contraindicated or clinically significant adverse effects are experienced; b. For medication-naïve members, requested agent is approvable if intended for concurrent use with metformin due to HbA1c ≥ 8.5% (drawn within the past 3 months); 4. Failure of ≥ 3 consecutive months of Jardiance or Invokana, unless both are contraindicated or clinically significant adverse effects are experienced; 5. Dose does not exceed the FDA-approved maximum recommended dose (see Section V). Approval duration: 12 months B. Heart Failure (must meet all): 1. Diagnosis of HFrEF of NYHA Class II, III, or IV; 2. Request is for Farxiga or Jardiance; 3. Prescribed by or in consultation with a cardiologist; 4. Age ≥ 18 years; 5. Left ventricular ejection fraction (LVEF) is ≤ 40%; 6. Member does not have a diagnosis of type 1 diabetes mellitus; 7. Member is currently receiving standard HF drug therapy at target doses for ≥ 4 weeks, including both of the following (a and b) unless clinically significant adverse effects are experienced or all are contraindicated: a. Angiotensin converting enzyme inhibitor, angiotensin receptor blocker, or Entresto®; b. Beta blocker; 8. Dose does not exceed 10 mg (1 tablet) per day. Approval duration: 12 months C. Chronic Kidney Disease (must meet all): 1. Diagnosis of CKD; 2. Request is for Farxiga; 3. Age ≥ 18 years; 4. Both of the following (a and b): a. eGFR between 25 and 75 mL/min/1.73 m2; b. Urine albumin creatinine ratio (UACR) ≥ 200 mg/g; 5. Member does not have a diagnosis of type 1 diabetes mellitus or polycystic kidney disease; 6. Member has not received immunosuppressive therapy for the treatment of kidney disease in the past 6 months; CLINICAL POLICY Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors Page 3 of 9 7. Member is currently receiving standard CKD drug therapy (angiotensin converting enzyme inhibitor or angiotensin receptor blocker) at maximally tolerated doses for ≥ 4 weeks, unless clinically significant adverse effects are experienced or all are contraindicated; 8. Dose does not exceed 10 mg (1 tablet) per day. Approval duration: 12 months D. Other diagnoses/indications 1. Refer to ERX.PA.01 if diagnosis is NOT specifically listed under section III (Diagnoses/Indications for which coverage is NOT authorized). II. Continued Therapy A. Type 2 Diabetes Mellitus (must meet all): 1. Currently receiving medication via a health plan affiliated with Envolve Pharmacy Solutions or member has previously met initial approval criteria; 2. Member is responding positively to therapy; 3. If request is for a dose increase, new dose does not exceed the FDA-approved maximum recommended dose (see Section V). Approval duration: 12 months B. Heart Failure (must meet all): 1. Currently receiving medication via a health plan affiliated with Envolve Pharmacy Solutions, or documentation supports that member is currently receiving Farxiga for HFrEF and has received this medication for at least 30 days; 2. Request is for Farxiga or Jardiance; 3. Member is responding positively to therapy; 4. If request is for a dose increase, new dose does not exceed 10 mg (1 tablet) per day. Approval duration: 12 months C. Chronic Kidney Disease (must meet all): 1. Currently receiving medication via a health plan affiliated with Envolve Pharmacy Solutions or member has previously met initial approval criteria; 2. Request is for Farxiga; 3. Member is responding positively to therapy; 4. If request is for a dose increase, new dose does not exceed 10 mg (1 tablet) per day. Approval duration: 12 months D. Other diagnoses/indications (must meet 1 or 2): 1. Currently receiving medication via a health plan affiliated with Envolve Pharmacy Solutions and documentation supports positive response to therapy. Approval duration: Duration of request or 12 months (whichever is less); or 2. Refer to ERX.PA.01 if diagnosis is NOT specifically listed under section III (Diagnoses/Indications for which coverage is NOT authorized). III. Diagnoses/Indications for which coverage is NOT authorized: A. Non-FDA approved indications, which are not addressed in this policy, unless there is sufficient documentation of efficacy and safety according to the off-label use policy – ERX.PA.01 or evidence of coverage documents.] System Instruction: [Only use the provided text to answer.] Question: [When should egfr be considered?]",Medical,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",Give me the insights on the problems people faced with Windows Vista from a forgotten trove of internal Microsoft emails in 500 words or less.,"A number of notes, emails, and presentations from Microsoft were made public due to a lawsuit filed against the company after the launch of Windows Vista. The Windows Vista era of Microsoft was plagued by bugs, delays, compatibility problems, and a general shrugging of shoulders from computer users. Microsoft reduced the graphics requirements for new Windows XP machines to receive the ""Vista capable"" designation, which signaled their suitability to run what was then the upcoming version of the operating system. Microsoft lowered the graphics requirement to help Intel ""make their quarterly earnings, so they could continue to sell motherboards with 915 graphics embedded"". As a result of lowering the graphics requirements, many of the Windows Vista qualified XP machines were unable to run Vista's signature features, with user's instead getting a stripped down version of the operating system, which caused confusion and challenges. The internal emails offer a vivid glimpse into what was happening inside Microsoft during this time. Highlights of these emails include then-CEO Steve Ballmer providing tech support to then-Microsoft board member Jon Shirley, who was struggling to get his scanners to work with Windows Vista due to a lack of drivers. Steven Sinofsky, the executive who was brought in to lead Windows development after repeated delays with Windows Vista, wrote about his own problems with Vista, as well as some insights he picked up from listening to customers at a Best Buy store. There is also a page of notes from an unidentified executive outlining the challenges of Microsoft's two-tiered approach to the Windows Vista versions. There is also documents pertaining to Dell's Windows Vista launch post mortem, which the PC maker prepared for a meeting with Microsoft's team. One of the slides shows how hard it is to say something good about Windows Vista. There is also a bona-fied Harvard Business School case-study about Windows Vista, which was published in 2009 by then-Harvard professor Ben Edelman. As the writer was dusting off old computers searching for audio from past-interviews, they stumbled upon a long-forgotten archive of Internal Microsoft emails, presentations, and notes, circa 2005-2007, which details the troubled Windows Vista-era. All of these documents were made public as a result of a lawsuit that was filed a few years after the launch of Windows Vista. The reason all these documents are being revisited is because Microsoft's 50th anniversary is next year, which they say is the perfect time to reconsider its history, and to take a new look at where the company is going. Many amazing moments from Microsoft's past will be remembered and celebrated to mark this milestone, however, the failure of Windows Vista will not be one of them. The writer of the article managed to find several pieces of audio from interviews they had with Bill Gates and Steve Ballmer, which they offered to Acquired's Ben Gilbert to help with his research for the Microsoft Volume II series. Ben Gillbert and co-host David Rosenthal are known for getting extensive background material for their show, which explorers the history and strategies of well known businesses and brands.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Give me the insights on the problems people faced with Windows Vista from a forgotten trove of internal Microsoft emails in 500 words or less. {passage 0} ========== A number of notes, emails, and presentations from Microsoft were made public due to a lawsuit filed against the company after the launch of Windows Vista. The Windows Vista era of Microsoft was plagued by bugs, delays, compatibility problems, and a general shrugging of shoulders from computer users. Microsoft reduced the graphics requirements for new Windows XP machines to receive the ""Vista capable"" designation, which signaled their suitability to run what was then the upcoming version of the operating system. Microsoft lowered the graphics requirement to help Intel ""make their quarterly earnings, so they could continue to sell motherboards with 915 graphics embedded"". As a result of lowering the graphics requirements, many of the Windows Vista qualified XP machines were unable to run Vista's signature features, with user's instead getting a stripped down version of the operating system, which caused confusion and challenges. The internal emails offer a vivid glimpse into what was happening inside Microsoft during this time. Highlights of these emails include then-CEO Steve Ballmer providing tech support to then-Microsoft board member Jon Shirley, who was struggling to get his scanners to work with Windows Vista due to a lack of drivers. Steven Sinofsky, the executive who was brought in to lead Windows development after repeated delays with Windows Vista, wrote about his own problems with Vista, as well as some insights he picked up from listening to customers at a Best Buy store. There is also a page of notes from an unidentified executive outlining the challenges of Microsoft's two-tiered approach to the Windows Vista versions. There is also documents pertaining to Dell's Windows Vista launch post mortem, which the PC maker prepared for a meeting with Microsoft's team. One of the slides shows how hard it is to say something good about Windows Vista. There is also a bona-fied Harvard Business School case-study about Windows Vista, which was published in 2009 by then-Harvard professor Ben Edelman. As the writer was dusting off old computers searching for audio from past-interviews, they stumbled upon a long-forgotten archive of Internal Microsoft emails, presentations, and notes, circa 2005-2007, which details the troubled Windows Vista-era. All of these documents were made public as a result of a lawsuit that was filed a few years after the launch of Windows Vista. The reason all these documents are being revisited is because Microsoft's 50th anniversary is next year, which they say is the perfect time to reconsider its history, and to take a new look at where the company is going. Many amazing moments from Microsoft's past will be remembered and celebrated to mark this milestone, however, the failure of Windows Vista will not be one of them. The writer of the article managed to find several pieces of audio from interviews they had with Bill Gates and Steve Ballmer, which they offered to Acquired's Ben Gilbert to help with his research for the Microsoft Volume II series. Ben Gillbert and co-host David Rosenthal are known for getting extensive background material for their show, which explorers the history and strategies of well known businesses and brands. https://www.geekwire.com/2024/business-lessons-from-windows-vista-insights-from-a-forgotten-trove-of-internal-microsoft-emails/",Retail/Product,Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","Can a President be charged with a crime for his or her actions taken while President? If not, are there any exceptions to a get-out-of-jail-free card?","A grand jury indicted former President Donald J. Trump on four counts for conduct that occurred during his Presidency following the November 2020 election. The indictment alleged that after losing that election, Trump conspired to overturn it by spreading knowingly false claims of election fraud to obstruct the collecting, counting, and certifying of the election results. Trump moved to dismiss the indictment based on Presidential immunity, arguing that a President has absolute immunity from criminal prosecution for actions performed within the outer perimeter of his official responsibilities, and that the indictment’s allegations fell within the core of his official duties. The District Court denied Trump’s motion to dismiss, holding that former Presidents do not possess federal criminal immunity for any acts. The D. C. Circuit affirmed. Both the District Court and the D. C. Circuit declined to decide whether the indicted conduct involved official acts. Held: Under our constitutional structure of separated powers, the nature of Presidential power entitles a former President to absolute immunity from criminal prosecution for actions within his conclusive and preclusive constitutional authority. And he is entitled to at least presumptive immunity from prosecution for all his official acts. There is no immunity for unofficial acts. Pp. 5–43. (a) This case is the first criminal prosecution in our Nation’s history of a former President for actions taken during his Presidency. Determining whether and under what circumstances such a prosecution may proceed requires careful assessment of the scope of Presidential power under the Constitution. The nature of that power requires that a former President have some immunity from criminal prosecution for official acts during his tenure in office. At least with respect to the President’s exercise of his core constitutional powers, this immunity must be absolute. As for his remaining official actions, he is entitled to at least presumptive immunity. Pp. 5–15 (1) Article II of the Constitution vests “executive Power” in “a President of the United States of America.” §1, cl. 1. The President has duties of “unrivaled gravity and breadth.” Trump v. Vance, 591 U. S. 786, 800. His authority to act necessarily “stem[s] either from an act of Congress or from the Constitution itself.” Youngstown Sheet & Tube Co. v. Sawyer, 343 U. S. 579, 585. In the latter case, the President’s authority is sometimes “conclusive and preclusive.” Id., at 638 (Jackson, J., concurring). When the President exercises such authority, Congress cannot act on, and courts cannot examine, the President’s actions. It follows that an Act of Congress—either a specific one targeted at the President or a generally applicable one—may not criminalize the President’s actions within his exclusive constitutional power. Neither may the courts adjudicate a criminal prosecution that examines such Presidential actions. The Court thus concludes that the President is absolutely immune from criminal prosecution for conduct within his exclusive sphere of constitutional authority. Pp. 6–9. 2) Not all of the President’s official acts fall within his “conclusive and preclusive” authority. The reasons that justify the President’s absolute immunity from criminal prosecution for acts within the scope of his exclusive constitutional authority do not extend to conduct in areas where his authority is shared with Congress. To determine the President’s immunity in this context, the Court looks primarily to the Framers’ design of the Presidency within the separation of powers, precedent on Presidential immunity in the civil context, and criminal cases where a President resisted prosecutorial demands for documents. P. 9. (i) The Framers designed the Presidency to provide for a “vigorous” and “energetic” Executive. The Federalist No. 70, pp. 471–472 (J. Cooke ed. 1961) (A. Hamilton). They vested the President with “supervisory and policy responsibilities of utmost discretion and sensitivity.” Nixon v. Fitzgerald, 457 U. S. 731, 750. Appreciating the “unique risks” that arise when the President’s energies are diverted by proceedings that might render him “unduly cautious in the discharge of his official duties,” the Court has recognized Presidential immunities and privileges “rooted in the constitutional tradition of the separation of powers and supported by our history.” Id., at 749, 751, 752, n. 32. In Fitzgerald, for instance, the Court concluded that a former President is entitled to absolute immunity from “damages liability for acts within the ‘outer perimeter’ of his official responsibility.” Id., at 756. The Court’s “dominant concern” was to avoid “diversion of the President’s attention during the decision-making process caused by needless worry as to the possibility of damages actions stemming from any particular official decision.” Clinton v. Jones, 520 U. S. 681, 694, n. 19.","""================ ======= A grand jury indicted former President Donald J. Trump on four counts for conduct that occurred during his Presidency following the November 2020 election. The indictment alleged that after losing that election, Trump conspired to overturn it by spreading knowingly false claims of election fraud to obstruct the collecting, counting, and certifying of the election results. Trump moved to dismiss the indictment based on Presidential immunity, arguing that a President has absolute immunity from criminal prosecution for actions performed within the outer perimeter of his official responsibilities, and that the indictment’s allegations fell within the core of his official duties. The District Court denied Trump’s motion to dismiss, holding that former Presidents do not possess federal criminal immunity for any acts. The D. C. Circuit affirmed. Both the District Court and the D. C. Circuit declined to decide whether the indicted conduct involved official acts. Held: Under our constitutional structure of separated powers, the nature of Presidential power entitles a former President to absolute immunity from criminal prosecution for actions within his conclusive and preclusive constitutional authority. And he is entitled to at least presumptive immunity from prosecution for all his official acts. There is no immunity for unofficial acts. Pp. 5–43. (a) This case is the first criminal prosecution in our Nation’s history of a former President for actions taken during his Presidency. Determining whether and under what circumstances such a prosecution may proceed requires careful assessment of the scope of Presidential power under the Constitution. The nature of that power requires that a former President have some immunity from criminal prosecution for official acts during his tenure in office. At least with respect to the President’s exercise of his core constitutional powers, this immunity must be absolute. As for his remaining official actions, he is entitled to at least presumptive immunity. Pp. 5–15 (1) Article II of the Constitution vests “executive Power” in “a President of the United States of America.” §1, cl. 1. The President has duties of “unrivaled gravity and breadth.” Trump v. Vance, 591 U. S. 786, 800. His authority to act necessarily “stem[s] either from an act of Congress or from the Constitution itself.” Youngstown Sheet & Tube Co. v. Sawyer, 343 U. S. 579, 585. In the latter case, the President’s authority is sometimes “conclusive and preclusive.” Id., at 638 (Jackson, J., concurring). When the President exercises such authority, Congress cannot act on, and courts cannot examine, the President’s actions. It follows that an Act of Congress—either a specific one targeted at the President or a generally applicable one—may not criminalize the President’s actions within his exclusive constitutional power. Neither may the courts adjudicate a criminal prosecution that examines such Presidential actions. The Court thus concludes that the President is absolutely immune from criminal prosecution for conduct within his exclusive sphere of constitutional authority. Pp. 6–9. 2) Not all of the President’s official acts fall within his “conclusive and preclusive” authority. The reasons that justify the President’s absolute immunity from criminal prosecution for acts within the scope of his exclusive constitutional authority do not extend to conduct in areas where his authority is shared with Congress. To determine the President’s immunity in this context, the Court looks primarily to the Framers’ design of the Presidency within the separation of powers, precedent on Presidential immunity in the civil context, and criminal cases where a President resisted prosecutorial demands for documents. P. 9. (i) The Framers designed the Presidency to provide for a “vigorous” and “energetic” Executive. The Federalist No. 70, pp. 471–472 (J. Cooke ed. 1961) (A. Hamilton). They vested the President with “supervisory and policy responsibilities of utmost discretion and sensitivity.” Nixon v. Fitzgerald, 457 U. S. 731, 750. Appreciating the “unique risks” that arise when the President’s energies are diverted by proceedings that might render him “unduly cautious in the discharge of his official duties,” the Court has recognized Presidential immunities and privileges “rooted in the constitutional tradition of the separation of powers and supported by our history.” Id., at 749, 751, 752, n. 32. In Fitzgerald, for instance, the Court concluded that a former President is entitled to absolute immunity from “damages liability for acts within the ‘outer perimeter’ of his official responsibility.” Id., at 756. The Court’s “dominant concern” was to avoid “diversion of the President’s attention during the decision-making process caused by needless worry as to the possibility of damages actions stemming from any particular official decision.” Clinton v. Jones, 520 U. S. 681, 694, n. 19. https://www.supremecourt.gov/opinions/23pdf/23-939_e2pg.pdf ================ ======= Can a President be charged with a crime for his or her actions taken while President? If not, are there any exceptions to a get-out-of-jail-free card? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Legal,Effect Analysis,Q&A System Instruction: This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge.,Question: What limitations of the PDA were solved for with the PWFA?,"Several different federal laws protect workers from discrimination based on pregnancy. The oldest of these, the Pregnancy Discrimination Act (PDA), generally protects job applicants and employees from adverse action—for example, firing, demotion, refusal to hire, or forced leave— because of pregnancy or related conditions. The PDA also addresses harassment based on pregnancy and bans retaliation against workers for making complaints about pregnancy discrimination. Pregnancy-related conditions can include fertility treatments, medical complications, delivery, postpartum conditions, and lactation. The PDA was enacted as an amendment to Title VII of the Civil Rights Act of 1964, which protects against sex discrimination (as well as certain other forms of discrimination) in employment. As construed by the Supreme Court, the PDA does not generally require employers to make changes in working conditions to accommodate pregnant workers unless employers provide accommodations to other similarly situated nonpregnant workers. So while employers cannot fire workers for being pregnant, this statute (depending on the facts) may not require them to make workplace changes (e.g., scheduling flexibility, an extra bathroom break) simply because employees’ demands are pregnancy-related. The Pregnant Workers Fairness Act (PWFA), passed in 2022 and effective June 27, 2023, mandates additional protections for pregnant workers. Modeled on the Americans with Disabilities Act (ADA), it requires employers to modify workplace conditions where needed to accommodate pregnancy-related conditions as long as an accommodation is reasonable and does not present an undue hardship to the employer. The PWFA requires a reasonable accommodation, after a case-specific assessment, even if a pregnancy-related condition does not amount to a disability, and even if the accommodation includes reassignment of an essential job function. Relief from an essential job function is only required, however, if it is temporary. In addition, under the PWFA, an employer may not require an employee to take leave if a reasonable accommodation would allow her to keep working. Some pregnant people face pregnancy-related impairments serious enough to satisfy the ADA’s definition of a “disability” and may, along with any PDA or PWFA claims, bring ADA claims for accommodations. Separately, many workers can invoke the Family and Medical Leave Act (FMLA) for unpaid leave for pregnancy-related medical needs. After childbirth, provisions of the Fair Labor Standards Act (FLSA) entitle most nursing mothers to appropriate breaks and accommodations for expressing breast milk. Preceding the passage of the PWFA, many advocates and legislators proposed expanding legal protections for pregnancy. Proposals included new pregnancy accommodation requirements (modeled on disability law), antidiscrimination measures (expanding current statutes), and leave entitlements (in line with many analogous mandates for reemployment rights or leave entitlements to protect workers engaged in endeavors such as military service). The PWFA focused on this first approach: accommodations. In addition, many states have strengthened rights for pregnant workers in recent years, and the PWFA does not preempt those laws when they offer greater protection. ","Several different federal laws protect workers from discrimination based on pregnancy. The oldest of these, the Pregnancy Discrimination Act (PDA), generally protects job applicants and employees from adverse action—for example, firing, demotion, refusal to hire, or forced leave— because of pregnancy or related conditions. The PDA also addresses harassment based on pregnancy and bans retaliation against workers for making complaints about pregnancy discrimination. Pregnancy-related conditions can include fertility treatments, medical complications, delivery, postpartum conditions, and lactation. The PDA was enacted as an amendment to Title VII of the Civil Rights Act of 1964, which protects against sex discrimination (as well as certain other forms of discrimination) in employment. As construed by the Supreme Court, the PDA does not generally require employers to make changes in working conditions to accommodate pregnant workers unless employers provide accommodations to other similarly situated nonpregnant workers. So while employers cannot fire workers for being pregnant, this statute (depending on the facts) may not require them to make workplace changes (e.g., scheduling flexibility, an extra bathroom break) simply because employees’ demands are pregnancy-related. The Pregnant Workers Fairness Act (PWFA), passed in 2022 and effective June 27, 2023, mandates additional protections for pregnant workers. Modeled on the Americans with Disabilities Act (ADA), it requires employers to modify workplace conditions where needed to accommodate pregnancy-related conditions as long as an accommodation is reasonable and does not present an undue hardship to the employer. The PWFA requires a reasonable accommodation, after a case-specific assessment, even if a pregnancy-related condition does not amount to a disability, and even if the accommodation includes reassignment of an essential job function. Relief from an essential job function is only required, however, if it is temporary. In addition, under the PWFA, an employer may not require an employee to take leave if a reasonable accommodation would allow her to keep working. Some pregnant people face pregnancy-related impairments serious enough to satisfy the ADA’s definition of a “disability” and may, along with any PDA or PWFA claims, bring ADA claims for accommodations. Separately, many workers can invoke the Family and Medical Leave Act (FMLA) for unpaid leave for pregnancy-related medical needs. After childbirth, provisions of the Fair Labor Standards Act (FLSA) entitle most nursing mothers to appropriate breaks and accommodations for expressing breast milk. Preceding the passage of the PWFA, many advocates and legislators proposed expanding legal protections for pregnancy. Proposals included new pregnancy accommodation requirements (modeled on disability law), antidiscrimination measures (expanding current statutes), and leave entitlements (in line with many analogous mandates for reemployment rights or leave entitlements to protect workers engaged in endeavors such as military service). The PWFA focused on this first approach: accommodations. In addition, many states have strengthened rights for pregnant workers in recent years, and the PWFA does not preempt those laws when they offer greater protection. System Instruction: This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Question: What limitations of the PDA were solved for with the PWFA?",Legal,Effect Analysis,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",What are the most common pathways to allow me to obtain permanent residency in Spain without any significant time or financial commitments required from me?,"Overview of Spain Permanent Residence Permit There are substantial benefits of living in Spain and having Permanent Residency status. Advantages of getting a Permanent Residency card in Spain include having many of the same rights as Spanish citizens. With Permanent Residency you are entitled to work, study and access healthcare. It does not give you the right to vote in national elections or hold a Spanish passport – these rights are only available to those who hold full Spanish citizenship. However, obtaining Permanent Residency is a major step towards eventually obtaining citizenship of Spain. Qualifying for Permanent Residency in Spain There are conditions that must be met before applying for Permanent Residency in Spain. You should ensure you meet all the criteria before applying otherwise you could risk refusal – which can be costly and impact on future immigration applications. If you are unclear if you do qualify for Permanent Residency then you may want to consider contacting an immigration specialist to seek advice. The following are able to acquire the right of permanent residence once five years of continuous living legally in Spain has been reached: Citizens of a EU state and family members who not EU state nationals Workers or those self-employed who have reached pension age – as long as they have worked in Spain for the previous 12 months. Self-employed workers who opt for early retirement – although they must have been working in Spain for the previous year before applying. Workers or self-employed who worked in Spain but have had to stop working due to permanent incapacity to work. Workers or self-employed workers who have worked and lived in Spain for three years and have then worked in another EU country but have continued to have a place of residence in Spain which they have returned to at least once a week. Non-EU national family members of a Spanish citizen or EU citizen who have been living in Spain for five years as long as the family relationship still exists – or if the relationship has ended due to dealth, annulment or divorce. Documents Required When Applying For Residency in Spain In order to be eligible for the benefits associated with gaining a Permanent Residency in Spain, the candidate must provide documentation attesting to their legal residency during the previous five years. When you have completed the necessary duration of time in Spain, you can apply for a Permanent Residency visa. You must go to the appropriate police station in Spain with the application form and required paperwork, as well as the funds to pay the processing fee. You must submit your application for Permanent Residence at least three months prior to your present visa or permission expiration. You will be asked to provide the following documents: A completed application form. Provide evidence about your current residency statuses, such as student, employment contract, retired individual, or self-employed person. A document that proves that you have resided in Spain for five years – this could be a property deed or a rental agreement. Providing a registration document issued by the city’s police department where the applicant resides. A document that proves your ongoing residency in Spain, such as a rental contract, utility bills, etc. Proof of income, investments, or financial means of support, such as bank statements, tax returns, payroll, etc. Provide a certificate of your health and medical insurance in Spain. In some critical circumstances, you should be asked to submit a criminal record certificate, as well as a divorce or marriage certificate. The consulate general will inform you formally if your application is accepted. Once your application is approved, the police department in Spain will contact you to come and submit your fingerprints and finish the procedure. It may take around one month for your Permanent Resident Card to be issued. Don’t miss out on the chance to call Spain your permanent home. Get in touch with us for help with applying for Permanent Residency today. Contact Us Cost of Applying for Permanent Residency in Spain The cost of applying for Permanent Residency in Spain is relatively low compared to other visa charges. The exact amount required by the Spanish immigration authorities varies depending on a number of factors including the cost of getting documents translated if they are not originally in Spanish. However, you can expect to pay around 80 euros to submit the application. Renewing Permanent Residency in Spain Once your application for Permanent Residency has been approved then you will be issued with a residency card that is valid for five years. You must apply to renew this card before it expires otherwise you could risk your immigration status in Spain. To renew you will need to complete the appropriate form and submit with the following documents: Proof of address in Spain Original residency card Passport You are also required to resubmit your fingerprints and pay the Permanent Residency renewal fee. When you apply to renew your Permanent Resident status you are not required to prove you have lived in the country for the five years preceding the renewal. However, you may have your application to renewl your Permanent Residency card refused it you have spent more than 12 months outside of Spain or another EU member country. What if Your Permanent Residency Application is Rejected? If your application for Permanent Residency in Spain is rejected then you may be able to appeal the decision if you feel that you have met all the requirements and can demonstrate so. You will need to file an appeal with the High Court of Justice in Madrid and you must do this within two months of being notified that your application has been refused. This could be a potentially lengthy process so you should seek advice from Spanish immigration experts to ensure you complete the appeal process correctly and increase your chances of a successful outcome.","[question] What are the most common pathways to allow me to obtain permanent residency in Spain without any significant time or financial commitments required from me? ===================== [text] Overview of Spain Permanent Residence Permit There are substantial benefits of living in Spain and having Permanent Residency status. Advantages of getting a Permanent Residency card in Spain include having many of the same rights as Spanish citizens. With Permanent Residency you are entitled to work, study and access healthcare. It does not give you the right to vote in national elections or hold a Spanish passport – these rights are only available to those who hold full Spanish citizenship. However, obtaining Permanent Residency is a major step towards eventually obtaining citizenship of Spain. Qualifying for Permanent Residency in Spain There are conditions that must be met before applying for Permanent Residency in Spain. You should ensure you meet all the criteria before applying otherwise you could risk refusal – which can be costly and impact on future immigration applications. If you are unclear if you do qualify for Permanent Residency then you may want to consider contacting an immigration specialist to seek advice. The following are able to acquire the right of permanent residence once five years of continuous living legally in Spain has been reached: Citizens of a EU state and family members who not EU state nationals Workers or those self-employed who have reached pension age – as long as they have worked in Spain for the previous 12 months. Self-employed workers who opt for early retirement – although they must have been working in Spain for the previous year before applying. Workers or self-employed who worked in Spain but have had to stop working due to permanent incapacity to work. Workers or self-employed workers who have worked and lived in Spain for three years and have then worked in another EU country but have continued to have a place of residence in Spain which they have returned to at least once a week. Non-EU national family members of a Spanish citizen or EU citizen who have been living in Spain for five years as long as the family relationship still exists – or if the relationship has ended due to dealth, annulment or divorce. Documents Required When Applying For Residency in Spain In order to be eligible for the benefits associated with gaining a Permanent Residency in Spain, the candidate must provide documentation attesting to their legal residency during the previous five years. When you have completed the necessary duration of time in Spain, you can apply for a Permanent Residency visa. You must go to the appropriate police station in Spain with the application form and required paperwork, as well as the funds to pay the processing fee. You must submit your application for Permanent Residence at least three months prior to your present visa or permission expiration. You will be asked to provide the following documents: A completed application form. Provide evidence about your current residency statuses, such as student, employment contract, retired individual, or self-employed person. A document that proves that you have resided in Spain for five years – this could be a property deed or a rental agreement. Providing a registration document issued by the city’s police department where the applicant resides. A document that proves your ongoing residency in Spain, such as a rental contract, utility bills, etc. Proof of income, investments, or financial means of support, such as bank statements, tax returns, payroll, etc. Provide a certificate of your health and medical insurance in Spain. In some critical circumstances, you should be asked to submit a criminal record certificate, as well as a divorce or marriage certificate. The consulate general will inform you formally if your application is accepted. Once your application is approved, the police department in Spain will contact you to come and submit your fingerprints and finish the procedure. It may take around one month for your Permanent Resident Card to be issued. Don’t miss out on the chance to call Spain your permanent home. Get in touch with us for help with applying for Permanent Residency today. Contact Us Cost of Applying for Permanent Residency in Spain The cost of applying for Permanent Residency in Spain is relatively low compared to other visa charges. The exact amount required by the Spanish immigration authorities varies depending on a number of factors including the cost of getting documents translated if they are not originally in Spanish. However, you can expect to pay around 80 euros to submit the application. Renewing Permanent Residency in Spain Once your application for Permanent Residency has been approved then you will be issued with a residency card that is valid for five years. You must apply to renew this card before it expires otherwise you could risk your immigration status in Spain. To renew you will need to complete the appropriate form and submit with the following documents: Proof of address in Spain Original residency card Passport You are also required to resubmit your fingerprints and pay the Permanent Residency renewal fee. When you apply to renew your Permanent Resident status you are not required to prove you have lived in the country for the five years preceding the renewal. However, you may have your application to renewl your Permanent Residency card refused it you have spent more than 12 months outside of Spain or another EU member country. What if Your Permanent Residency Application is Rejected? If your application for Permanent Residency in Spain is rejected then you may be able to appeal the decision if you feel that you have met all the requirements and can demonstrate so. You will need to file an appeal with the High Court of Justice in Madrid and you must do this within two months of being notified that your application has been refused. This could be a potentially lengthy process so you should seek advice from Spanish immigration experts to ensure you complete the appeal process correctly and increase your chances of a successful outcome. https://iasservices.org.uk/es/residency/permanent-residency-in-spain/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","I am writing a report about vaccines in the context of the Covid-19 pandemic. I am a PhD student and my focus is on the molecular aspects of vaccines. Can you give me a list of the different types of vaccines and their characteristics? Keep it brief, I don't want the response to exceed 300 words. I also want to know how Toll-like receptors are related to vaccines.","In late 2019, a novel beta coronavirus emerged in Wuhan, China, and rapidly spread worldwide. The Coronavirus disease 2019 (COVID-19) has a high potential of a pandemic due to its high contagious rate with high mortality globally (Sharma et al. 2020; Su et al. 2020; Wibawa 2021). Therefore, substantial efforts are needed to develop effective vaccines or therapies against the disease (Su et al. 2020). Symptoms of COVID-19 disease vary, including mild flu-like symptoms, pneumonia, acute respiratory distress syndrome (ARDS), and fatal outcome. Patients with cancer, diabetes, cardiovascular diseases, older adults, and even genetically predisposed individuals are at highest risk of COVID-19 severity (Sharma et al. 2020; Su et al. 2020; Wibawa 2021; Vakil et al. 2022). As per the World Health Organization (WHO) recommendations, wearing masks, using antiviral drugs, social distancing, and adherence to vaccination procedures are crucial behaviors to control of COVID-19 pandemic around the world (Sharma et al. 2020). The scientific effort towards development of efficient vaccines against invasive pathogens dates back many years since long (Deb et al. 2020; Zhang et al. 2020; Wibawa 2021). These vaccine platforms have also been designed against pathogenic bacteria (Farhani et al. 2019; Jafari and Mahmoodi 2021). In this regard, developing an efficient, protective, and safe vaccine is considered as a pivotal preventive approach to hinder the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread (Moore and Klasse 2020). Therefore, different pharmaceutical companies and research teams worldwide competed to present a safe and efficient vaccine against the COVID-19 for international community use. These efforts have developed other vaccine platforms to enter preclinical and clinical trials and some of them have been approved (Chen et al. 2021), including traditional vaccines such as live or inactivated, subunit, and nucleic acid-based vaccines as next-generation vaccines (Moore and Klasse 2020). Based on the scientific evidence, live-attenuated vaccines stimulate the innate, cellular, and humoral immune responses by inducing Toll-like Receptors (TLRs) with long-term immunity and may develop hypersensitivity. The main drawback of these vaccines is their costly safety and efficacy assessments. Inactivated viral vaccines poorly provoke cellular immune responses which mitigate their efficacy. In April 2020, an inactivated COVID-19 vaccine was manufactured by Sinovac and Wuhan Institute of Biological Products (Sinopharm) (Moore and Klasse 2020; Su et al. 2020). Subunit vaccines are safe, with some defects including low immunogenicity, booster or adjuvant requirement, and high cost (Koirala et al. 2020; Su et al. 2020). Nucleic acid-based vaccines have been developed based on sequence information. They include DNA or mRNA sequences of antigens that strongly stimulate cellular and humoral immune responses in various doses. Due to their advantages, such as fast production, and the earliest COVID-19 vaccines in clinical trials, a noticeable advantage of DNA-based vaccines is their stability in various storage conditions (Silveira et al. 2020; van Riel and de Wit 2020). RNA-based vaccines received more attention from pharmaceutical companies like Pfizer/Biontech and Moderna. In contrast to DNA vaccines, they stimulate effective humoral immune response as TLR ligand without adjuvant, and its sequence is modified to preclude mRNA degradation (Moore and Klasse 2020; van Riel and de Wit 2020; Soiza et al. 2021)."," Only use the provided text to answer the question, no outside sources. I am writing a report about vaccines in the context of the Covid-19 pandemic. I am a PhD student and my focus is on the molecular aspects of vaccines. Can you give me a list of the different types of vaccines and their characteristics? Keep it brief, I don't want the response to exceed 300 words. I also want to know how Toll-like receptors are related to vaccines. In late 2019, a novel beta coronavirus emerged in Wuhan, China, and rapidly spread worldwide. The Coronavirus disease 2019 (COVID-19) has a high potential of a pandemic due to its high contagious rate with high mortality globally (Sharma et al. 2020; Su et al. 2020; Wibawa 2021). Therefore, substantial efforts are needed to develop effective vaccines or therapies against the disease (Su et al. 2020). Symptoms of COVID-19 disease vary, including mild flu-like symptoms, pneumonia, acute respiratory distress syndrome (ARDS), and fatal outcome. Patients with cancer, diabetes, cardiovascular diseases, older adults, and even genetically predisposed individuals are at highest risk of COVID-19 severity (Sharma et al. 2020; Su et al. 2020; Wibawa 2021; Vakil et al. 2022). As per the World Health Organization (WHO) recommendations, wearing masks, using antiviral drugs, social distancing, and adherence to vaccination procedures are crucial behaviors to control of COVID-19 pandemic around the world (Sharma et al. 2020). The scientific effort towards development of efficient vaccines against invasive pathogens dates back many years since long (Deb et al. 2020; Zhang et al. 2020; Wibawa 2021). These vaccine platforms have also been designed against pathogenic bacteria (Farhani et al. 2019; Jafari and Mahmoodi 2021). In this regard, developing an efficient, protective, and safe vaccine is considered as a pivotal preventive approach to hinder the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread (Moore and Klasse 2020). Therefore, different pharmaceutical companies and research teams worldwide competed to present a safe and efficient vaccine against the COVID-19 for international community use. These efforts have developed other vaccine platforms to enter preclinical and clinical trials and some of them have been approved (Chen et al. 2021), including traditional vaccines such as live or inactivated, subunit, and nucleic acid-based vaccines as next-generation vaccines (Moore and Klasse 2020). Based on the scientific evidence, live-attenuated vaccines stimulate the innate, cellular, and humoral immune responses by inducing Toll-like Receptors (TLRs) with long-term immunity and may develop hypersensitivity. The main drawback of these vaccines is their costly safety and efficacy assessments. Inactivated viral vaccines poorly provoke cellular immune responses which mitigate their efficacy. In April 2020, an inactivated COVID-19 vaccine was manufactured by Sinovac and Wuhan Institute of Biological Products (Sinopharm) (Moore and Klasse 2020; Su et al. 2020). Subunit vaccines are safe, with some defects including low immunogenicity, booster or adjuvant requirement, and high cost (Koirala et al. 2020; Su et al. 2020). Nucleic acid-based vaccines have been developed based on sequence information. They include DNA or mRNA sequences of antigens that strongly stimulate cellular and humoral immune responses in various doses. Due to their advantages, such as fast production, and the earliest COVID-19 vaccines in clinical trials, a noticeable advantage of DNA-based vaccines is their stability in various storage conditions (Silveira et al. 2020; van Riel and de Wit 2020). RNA-based vaccines received more attention from pharmaceutical companies like Pfizer/Biontech and Moderna. In contrast to DNA vaccines, they stimulate effective humoral immune response as TLR ligand without adjuvant, and its sequence is modified to preclude mRNA degradation (Moore and Klasse 2020; van Riel and de Wit 2020; Soiza et al. 2021). https://link.springer.com/article/10.1007/s00203-023-03480-5",Medical,Summarize & Format,Text Transformation Only use the information contained within the provided text to answer the question. Do not use outside sources. Write a full sentence and use a bullet point. Ensure the entire sentence is in italics.,"According only to the article provided, what are the main difference between corporate bonds and preferred stocks?","**Overview of Corporate Bonds** The stock market crash of the late 2000s taught many investors a painful lesson about the importance of diversifying their investments. They remain committed to low- to moderate-risk investment vehicles that provide a compromise between security and return on investment. Corporate bonds are one such vehicle. They can provide predictable interest payments for income-seeking investors at manageable risk levels. They occupy a middle ground between low-interest, low-risk government bonds and stocks, which may offer higher returns but are much riskier overall. But corporate bonds are not perfect. Individual corporate bonds have significant drawbacks you should carefully consider before investing. What Is a Corporate Bond? Both private and public companies sell corporate bonds to raise money for business operations. In exchange, they pay you interest on the amount you purchased. Like other assets that pay interest, companies most often use corporate bonds to fund capital projects. This term encompasses just about any investment a company can make, such as: • Construction of a new warehouse or manufacturing facility • Purchasing or leasing new property • Purchasing or leasing new equipment • Buying inventory They typically come in units that carry a face value of $1,000. Also known as “par value,” it’s the amount the company, known as the bond issuer, must pay the holder on the bond’s maturity date. Some bonds require investors to buy more than one unit, so they may have a minimum purchase amount, such as $3,000 or $5,000. Corporate Bonds Structure A corporate bond makes regular interest payments to its investors. It’s popular among income-seeking investors, from financial institutions looking to offset higher-risk investments to retirement investors trying to earn interest income over a set period. Maturity Period & Call Date Like a U.S. Treasury bond, a corporate bond has a specific maturity date. That’s the day you get the original amount of your investment back. Maturity terms on corporate bonds — the period between their issue date and maturity date — range from as short as one year to as long as 30 years. Corporate bonds with less than one year maturity periods are known as “corporate paper” or “short-term financing.” The most common investors in these bonds are likely to be larger financial entities, including banks, mutual funds, and hedge funds rather than individual investors. Many corporate bonds also have call dates. Call dates are the first date the issuing company can legally buy the bond back from investors if it no longer needs the money. Prospectus Before it issues a new bond to the general public, the company must release a prospectus that outlines the intended use of the money. This requirement applies even to private companies not listed on any stock exchange. The prospectus describes the bond’s term, including its final maturity date and call date. It also outlines the bond’s initial interest rate and describes how and when the bond pays interest quarterly, semiannually, annually, or in a lump sum when the issuer buys the bond back. Finally, the prospectus outlines the bondholder’s right of repayment if the issuing company defaults or declares bankruptcy. It includes the order in which investors receive repayment based on their investor type, which depends on whether the bond is secured or unsecured. Secured vs. Unsecured Corporate Bonds Corporate bonds can be secured or unsecured. Secured bonds are guaranteed by some form of collateral, such as inventory, real property, or monetary assets. When a corporate bond issuer declares bankruptcy, secured bondholders have a legal right to seize the collateral. Unsecured bonds, also known as debentures, are only guaranteed by the company’s promise to repay. Unsecured bondholders have no right to seize property. In the event of bankruptcy, they may be forced to forfeit future interest payments as well as a significant fraction of their principal payments. Some bond types are always unsecured, such as convertible notes (which you can convert into shares of company stock). Others, such as fixed-rate and variable-rate bonds, may be either. You can find the bond’s secured status in the prospectus. Because unsecured bonds are considered riskier for investors, they have higher interest rates than secured bonds. However, convertible bonds tend to come with lower interest rates because you can convert them into equity. Corporate Bonds vs. Preferred Stocks Corporate bonds share some features with preferred stock, such as regular payments to investors. These similarities are enough to create confusion for inexperienced investors. But there are some important differences between the two as well: • Debt vs. Equity. A corporate bond is a debt instrument that provides no ownership stake in its issuer. In contrast, a preferred stock is an equity vehicle that does confer ownership in the underlying company. • Liquidity. You can trade both corporate bonds and preferred stock on secondary markets. But preferred stock often trades on stock exchanges, increasing the potential market size and making it easier for investors to buy and sell them. • Repayment Order. In bankruptcy, preferred stockholders are entitled to repayment before common stockholders but after corporate bondholders. • Exchange for Common Stock. You can exchange convertible corporate bonds for the issuers’ common shares under certain circumstances. Otherwise, it’s difficult or impossible for bondholders to exchange their holdings for stock. In contrast, you can always exchange preferred stocks for common stocks at an agreed-upon ratio. Types of Corporate Bonds Corporate bonds come in several different forms. A given bond can fall into more than one of these categories. Fixed-Rate Bonds This type of bond carries a fixed interest rate for its entire life. The rate is determined by its issuer’s credit rating on the bond’s issue date. Companies with higher credit ratings pay lower interest rates on their bonds, while companies with lower credit ratings pay higher interest rates. Fixed-rate bonds typically make semiannual interest payments. They’re currently the most common type of corporate bond. Variable-Rate Bonds Variable-rate bonds’ interest rates change in response to fluctuations in long-term benchmark rates, with most bonds changing once per year. Their yield is generally determined by the company’s credit rating on the date of each interest payment. Floating-Rate Bonds Floating-rate bonds’ interest rates fluctuate with market benchmarks like Libor or the Federal Reserve’s federal funds rate and the company’s credit rating on the date of each readjustment. Unlike variable-rate bonds’ annual readjustments, changes in floating-rate bond rates usually occur after each quarterly interest payment. Zero-Coupon Bonds Zero-coupon bonds don’t pay interest. Instead, they trade at deep discounts to par value (face value). At maturity, the investor can redeem their zero-coupon bond for par value, realizing a profit over what they originally paid. Callable Bonds Issuers of callable bonds have the right to buy them back after an initial lockup period ends but before maturity. The first date the issuer can buy back the bond is known as the call date. The buyback is always voluntary. For example, a company that issues a callable bond with a final maturity date of Jan. 31, 2030, and a call date of Jan. 31, 2024, can buy it back after the earlier of the two dates, but it doesn’t have to. If a bond is called, its issuer typically pays par value and any unpaid accrued interest. Callable bonds can have fixed, variable, or floating rates. A company may call bonds for various reasons. But most often, it’s because prevailing interest rates have fallen and the issuer’s credit allows it to secure lower rates on new debt issues. Since called bonds are usually replaced with lower-yield bonds, an investor whose bond is called may have to settle for lower yields on future bond purchases that offer comparable levels of risk. They also miss out on future interest payments on the called bond. Both factors reduce their overall yield. Putable Bond Putable bonds, also called put bonds or retractable bonds, are the reverse of callable bonds. After a set date, holders of putable bonds are entitled to ask the issuer for repayment of their principal plus all accumulated interest. It often occurs when a bondholder dies. Heirs of deceased bondholders may have a “survivor’s option” that entitles them to sell inherited bonds back to their issuers. Bondholders may also exercise the put in inflationary environments. As prevailing interest rates rise, bonds with lower interest rates become less attractive, and their market value falls. It makes sense for bondholders to exercise the put sooner rather than later and use the proceeds to invest in bonds paying higher rates. Because they give bondholders the right to early repayment, put bonds are less risky, more attractive investments. They typically have lower interest rates as a result. Convertible You can convert a convertible bond into a set amount of its issuer’s common stock. It allows a company’s creditor to secure an actual equity stake in it. Like callable and putable bonds, convertible bonds come with restrictions on how and when you can convert to stock. They’re also more susceptible to issuers’ stock price fluctuations than other types of bonds. Corporate Bond Ratings Every corporate bond is rated by at least one of the major U.S. rating agencies — Fitch, Standard & Poor’s, or Moody’s. Each agency has its own letter-grade scale, but the most important distinction is between the two broad risk categories: investment grade and noninvestment grade. Noninvestment-grade bonds are popularly known as “junk,” as in “junk bonds.” In more polite circles, they’re known as “high-yield bonds.” On S&P’s scale, which is the most commonly used measurement in the United States, all bonds rated below BBB- are considered noninvestment grade. A bond’s yield is inversely proportional to its issuer’s credit rating. The higher the rating, the lower the yield. Lower-rated bonds come with a higher risk of default. However, they also have high interest rates — far higher than investors could get in a savings account or CD. That’s worth the risk to some people. Corporate bondholders do enjoy greater security than stockholders. Whereas a publicly traded company may suspend dividends on common or preferred stock at any time, any company that issues a corporate bond has a legal obligation to issue regular interest payments. The only ways out of it are to default on its bonds or declare bankruptcy.","{query} ======= According only to the article provided, what are the main difference between corporate bonds and preferred stocks? {task} ======= Only use the information contained within the provided text to answer the question. Do not use outside sources. Write a full sentence and use a bullet point. Ensure the entire sentence is in italics. {text} ======= **Overview of Corporate Bonds** The stock market crash of the late 2000s taught many investors a painful lesson about the importance of diversifying their investments. They remain committed to low- to moderate-risk investment vehicles that provide a compromise between security and return on investment. Corporate bonds are one such vehicle. They can provide predictable interest payments for income-seeking investors at manageable risk levels. They occupy a middle ground between low-interest, low-risk government bonds and stocks, which may offer higher returns but are much riskier overall. But corporate bonds are not perfect. Individual corporate bonds have significant drawbacks you should carefully consider before investing. What Is a Corporate Bond? Both private and public companies sell corporate bonds to raise money for business operations. In exchange, they pay you interest on the amount you purchased. Like other assets that pay interest, companies most often use corporate bonds to fund capital projects. This term encompasses just about any investment a company can make, such as: • Construction of a new warehouse or manufacturing facility • Purchasing or leasing new property • Purchasing or leasing new equipment • Buying inventory They typically come in units that carry a face value of $1,000. Also known as “par value,” it’s the amount the company, known as the bond issuer, must pay the holder on the bond’s maturity date. Some bonds require investors to buy more than one unit, so they may have a minimum purchase amount, such as $3,000 or $5,000. Corporate Bonds Structure A corporate bond makes regular interest payments to its investors. It’s popular among income-seeking investors, from financial institutions looking to offset higher-risk investments to retirement investors trying to earn interest income over a set period. Maturity Period & Call Date Like a U.S. Treasury bond, a corporate bond has a specific maturity date. That’s the day you get the original amount of your investment back. Maturity terms on corporate bonds — the period between their issue date and maturity date — range from as short as one year to as long as 30 years. Corporate bonds with less than one year maturity periods are known as “corporate paper” or “short-term financing.” The most common investors in these bonds are likely to be larger financial entities, including banks, mutual funds, and hedge funds rather than individual investors. Many corporate bonds also have call dates. Call dates are the first date the issuing company can legally buy the bond back from investors if it no longer needs the money. Prospectus Before it issues a new bond to the general public, the company must release a prospectus that outlines the intended use of the money. This requirement applies even to private companies not listed on any stock exchange. The prospectus describes the bond’s term, including its final maturity date and call date. It also outlines the bond’s initial interest rate and describes how and when the bond pays interest quarterly, semiannually, annually, or in a lump sum when the issuer buys the bond back. Finally, the prospectus outlines the bondholder’s right of repayment if the issuing company defaults or declares bankruptcy. It includes the order in which investors receive repayment based on their investor type, which depends on whether the bond is secured or unsecured. Secured vs. Unsecured Corporate Bonds Corporate bonds can be secured or unsecured. Secured bonds are guaranteed by some form of collateral, such as inventory, real property, or monetary assets. When a corporate bond issuer declares bankruptcy, secured bondholders have a legal right to seize the collateral. Unsecured bonds, also known as debentures, are only guaranteed by the company’s promise to repay. Unsecured bondholders have no right to seize property. In the event of bankruptcy, they may be forced to forfeit future interest payments as well as a significant fraction of their principal payments. Some bond types are always unsecured, such as convertible notes (which you can convert into shares of company stock). Others, such as fixed-rate and variable-rate bonds, may be either. You can find the bond’s secured status in the prospectus. Because unsecured bonds are considered riskier for investors, they have higher interest rates than secured bonds. However, convertible bonds tend to come with lower interest rates because you can convert them into equity. Corporate Bonds vs. Preferred Stocks Corporate bonds share some features with preferred stock, such as regular payments to investors. These similarities are enough to create confusion for inexperienced investors. But there are some important differences between the two as well: • Debt vs. Equity. A corporate bond is a debt instrument that provides no ownership stake in its issuer. In contrast, a preferred stock is an equity vehicle that does confer ownership in the underlying company. • Liquidity. You can trade both corporate bonds and preferred stock on secondary markets. But preferred stock often trades on stock exchanges, increasing the potential market size and making it easier for investors to buy and sell them. • Repayment Order. In bankruptcy, preferred stockholders are entitled to repayment before common stockholders but after corporate bondholders. • Exchange for Common Stock. You can exchange convertible corporate bonds for the issuers’ common shares under certain circumstances. Otherwise, it’s difficult or impossible for bondholders to exchange their holdings for stock. In contrast, you can always exchange preferred stocks for common stocks at an agreed-upon ratio. Types of Corporate Bonds Corporate bonds come in several different forms. A given bond can fall into more than one of these categories. Fixed-Rate Bonds This type of bond carries a fixed interest rate for its entire life. The rate is determined by its issuer’s credit rating on the bond’s issue date. Companies with higher credit ratings pay lower interest rates on their bonds, while companies with lower credit ratings pay higher interest rates. Fixed-rate bonds typically make semiannual interest payments. They’re currently the most common type of corporate bond. Variable-Rate Bonds Variable-rate bonds’ interest rates change in response to fluctuations in long-term benchmark rates, with most bonds changing once per year. Their yield is generally determined by the company’s credit rating on the date of each interest payment. Floating-Rate Bonds Floating-rate bonds’ interest rates fluctuate with market benchmarks like Libor or the Federal Reserve’s federal funds rate and the company’s credit rating on the date of each readjustment. Unlike variable-rate bonds’ annual readjustments, changes in floating-rate bond rates usually occur after each quarterly interest payment. Zero-Coupon Bonds Zero-coupon bonds don’t pay interest. Instead, they trade at deep discounts to par value (face value). At maturity, the investor can redeem their zero-coupon bond for par value, realizing a profit over what they originally paid. Callable Bonds Issuers of callable bonds have the right to buy them back after an initial lockup period ends but before maturity. The first date the issuer can buy back the bond is known as the call date. The buyback is always voluntary. For example, a company that issues a callable bond with a final maturity date of Jan. 31, 2030, and a call date of Jan. 31, 2024, can buy it back after the earlier of the two dates, but it doesn’t have to. If a bond is called, its issuer typically pays par value and any unpaid accrued interest. Callable bonds can have fixed, variable, or floating rates. A company may call bonds for various reasons. But most often, it’s because prevailing interest rates have fallen and the issuer’s credit allows it to secure lower rates on new debt issues. Since called bonds are usually replaced with lower-yield bonds, an investor whose bond is called may have to settle for lower yields on future bond purchases that offer comparable levels of risk. They also miss out on future interest payments on the called bond. Both factors reduce their overall yield. Putable Bond Putable bonds, also called put bonds or retractable bonds, are the reverse of callable bonds. After a set date, holders of putable bonds are entitled to ask the issuer for repayment of their principal plus all accumulated interest. It often occurs when a bondholder dies. Heirs of deceased bondholders may have a “survivor’s option” that entitles them to sell inherited bonds back to their issuers. Bondholders may also exercise the put in inflationary environments. As prevailing interest rates rise, bonds with lower interest rates become less attractive, and their market value falls. It makes sense for bondholders to exercise the put sooner rather than later and use the proceeds to invest in bonds paying higher rates. Because they give bondholders the right to early repayment, put bonds are less risky, more attractive investments. They typically have lower interest rates as a result. Convertible You can convert a convertible bond into a set amount of its issuer’s common stock. It allows a company’s creditor to secure an actual equity stake in it. Like callable and putable bonds, convertible bonds come with restrictions on how and when you can convert to stock. They’re also more susceptible to issuers’ stock price fluctuations than other types of bonds. Corporate Bond Ratings Every corporate bond is rated by at least one of the major U.S. rating agencies — Fitch, Standard & Poor’s, or Moody’s. Each agency has its own letter-grade scale, but the most important distinction is between the two broad risk categories: investment grade and noninvestment grade. Noninvestment-grade bonds are popularly known as “junk,” as in “junk bonds.” In more polite circles, they’re known as “high-yield bonds.” On S&P’s scale, which is the most commonly used measurement in the United States, all bonds rated below BBB- are considered noninvestment grade. A bond’s yield is inversely proportional to its issuer’s credit rating. The higher the rating, the lower the yield. Lower-rated bonds come with a higher risk of default. However, they also have high interest rates — far higher than investors could get in a savings account or CD. That’s worth the risk to some people. Corporate bondholders do enjoy greater security than stockholders. Whereas a publicly traded company may suspend dividends on common or preferred stock at any time, any company that issues a corporate bond has a legal obligation to issue regular interest payments. The only ways out of it are to default on its bonds or declare bankruptcy.",Financial,Concept Comparison,Q&A Use the information in the context block only; do not rely on your prior knowledge or any external sources.,Summarize the arguments that support and oppose the claim that the ICWA is unconstitutional.,"Is the Indian Child Welfare Act Constitutional? In Brackeen v. Zinke, a federal district court declared that the Indian Child Welfare Act (ICWA)—a 1978 law meant “to protect the best interests of Indian children and to promote the stability and security of Indian tribes and families”—was unconstitutional in several ways. This decision is currently pending before the U.S. Court of Appeals for the Fifth Circuit (Fifth Circuit), and its practical implications have been paused until the appeal is decided. If upheld, this decision would eliminate many of the special rules that apply to the adoption and foster care placements of Indian children in the three states involved in this case: Texas, Louisiana, and Indiana. Among other things, these rules allow a tribe to assume jurisdiction over, or otherwise to have input into, the placements of children who are eligible for tribal membership. In 1978, Congress recognized that an “alarmingly high percentage of Indian families” were being broken up by often-unwarranted removal of their children by nontribal entities, placing many of these children in non-Indian foster and adoptive homes. Citing its responsibility for protecting and preserving Indian tribes, Congressional Research Service https://crsreports.congress.gov LSB10245 Congressional Research Service 2 Congress passed ICWA to protect Indian children as vital to the tribes’ continued existence. ICWA is designed to do two primary things: (1) set standards for placing Indian children with foster or adoptive families, and (2) help tribes set up child and family programs. Though a number of lawsuits have challenged ICWA over the past 40 years, including on the grounds that the statute impermissibly treated Indian children differently on the basis of race, until Brackeen, none of those challenges had been successful. Instead, courts in prior cases had noted Congress’s “plenary” authority over Indian affairs—derived principally from the Indian Commerce Clause and the Treaty Power—and concluded that applying special rules to Indian children was constitutional because, among other things, the distinction between Indians and non-Indians was not an impermissible race-based classification, but was instead a recognition of the unique political status of Indian tribes. This Sidebar gives a brief overview of ICWA, outlines the Brackeen court’s decision with relevant legal context, and explores the possible impacts, including potential for higher court and congressional action. Relevant ICWA provisions and associated regulations Most relevant to the claims at issue in Brackeen, ICWA sets forth a series of duties that must be fulfilled for Indian child placements. For the purposes of ICWA, an “Indian child” is any unmarried person under eighteen who is either a member of an Indian tribe or is both eligible for membership in an Indian tribe and the biological child of a member of an Indian tribe. Three main aspects of ICWA are relevant to the issues raised in Brackeen. First, under ICWA, any party seeking involuntary termination of parental rights to an Indian child under state law must first demonstrate that active efforts have been made to provide remedial services and rehabilitative programs designed to prevent the breakup of the Indian family. Second, involuntary termination requires evidence beyond a reasonable doubt (including expert witness testimony), that the continued custody of the child by the parent or Indian custodian would likely result in serious emotional or physical damage to the child. Third, when an Indian child is placed with a foster or adoptive family under state law, ICWA lists general preferences for that placement: (1) a member of the child’s extended family; (2) other members of the Indian child’s tribe; or (3) other Indian families. However, if a tribe wants to re-order those preferences for Indian children associated with that tribe, it may pass a resolution doing so, and state agencies and courts generally must follow that amended order of preference. In any event, ICWA provides that these preferences may be circumvented in an individual case upon a showing of “good cause.” The Bureau of Indian Affairs (BIA) has authority to make regulations governing ICWA’s implementation. Though BIA chose not to do so when the statute was first passed, in 2016 it issued a Final Rule aimed at reconciling different states’ interpretations of ICWA—for example, by clarifying the circumstances in which “good cause” exists for circumventing ICWA’s placement preferences. Brackeen v. Zinke: the plaintiffs’ claims and the district court’s decision A group of plaintiffs comprising three states (Indiana, Louisiana, and Texas) and several private parties— primarily non-Indian couples who had adopted or wanted to adopt an Indian child—challenged several facets of ICWA and related regulations (including the 2016 Final Rule, as well as certain funding provisions conditioned on ICWA compliance), seeking to have them declared unconstitutional or otherwise rendered invalid. They filed these challenges in the United States District Court for the Northern District of Texas, where Judge Reed O’Connor did declare much of ICWA unconstitutional, granting nearly all of the plaintiffs’ claims. (This decision is arguably the second-most consequential decision by Judge O’Connor in recent months, as he ruled in December 2018 that the Affordable Care Act was also unconstitutional). The federal defendants, intervening tribes, and a group of amicus curiae Congressional Research Service 3 including numerous federally recognized tribes, several Indian organizations, and a number of states, disputed plaintiffs’ characterization of ICWA and contended the challenged laws and implementing regulations were lawful. The plaintiffs’ claims about ICWA’s validity, and the court’s responses to them, are discussed below. Equal protection: does ICWA use a race-based classification, and if so, can it survive strict scrutiny? The state and the individual plaintiffs together claimed that ICWA ran afoul of the Fifth Amendment’s equal protection guarantees, by impermissibly using a race-based classification. The plaintiffs’ claim relied primarily on the Supreme Court’s decisions in two cases. First, in Adarand Constructors v. Peña, the Supreme Court established that any time the federal government subjects individuals to unequal treatment based on their race, that action is subject to “strict scrutiny”—a test that asks whether the classification (1) serves a compelling government interest and (2) is narrowly tailored to further that interest. Second, in Rice v. Cayetano, in the course of invalidating a Hawaiian law that permitted only persons of native Hawaiian descent to vote in certain elections, the Supreme Court recognized that “[a]ncestry can be a proxy for race” and may be subject to the same constitutional limitations as directly race-based classifications. The plaintiffs in Brackeen argued that ICWA involved a race-based classification because its definition of Indian children was based on the children’s ancestry, rather than strictly on membership in a federally recognized tribe. Plaintiffs alleged that this classification neither served any compelling interest, nor was narrowly tailored. The federal defendants, intervening tribes, and several amici disputed plaintiffs’ characterization of ICWA as a race-based classification. In particular, they emphasized longstanding Supreme Court jurisprudence holding that the federal government’s relationship with federally recognized Indian tribes is based on a political, rather than racial categorization. For example, in Morton v. Mancari, the Court upheld BIA’s employment preference for members of federally recognized tribes because the preference was a political classification—it singled out members of tribal entities who have a unique relationship with the federal government—rather than a racial one. The Supreme Court further opined that because “[l]iterally every piece of legislation dealing with Indian tribes” is “explicitly designed to help only Indians,” deeming such legislation racial discrimination would jeopardize “the solemn commitment of the Government toward the Indians.” Because the federal defendants relied on the argument that ICWA’s distinctions were political rather than racial in nature, they proffered no arguments on whether ICWA would withstand the strict scrutiny that would be applied if it were a race-based classification. However, they asked that the court permit additional briefing in the event strict scrutiny applied—a request that the court denied. The district court, however, agreed with the plaintiffs that the definition of Indian children was race-based rather than political. In doing so, the court concluded that this case was more like Rice than like Mancari, because Mancari involved only tribe members rather than Indians eligible for tribal membership. The court then decided—in the absence of any counterarguments from the government—that the race-based classification was not narrowly tailored, even assuming that it served a compelling interest. Nondelegation: does ICWA impermissibly delegate legislative power to tribes? The state plaintiffs argued that giving the tribes power to reorder ICWA’s placement preferences violated the nondelegation doctrine, which generally prohibits Congress from delegating its core legislative powers, whether to other government entities or to private parties. Courts generally use the “intelligible principle” test to assess whether a congressional delegation of legislative power to governmental entities is permissible. This is a forgiving standard; the Supreme Court has not invalidated a statute on these Congressional Research Service 4 grounds since 1935. However, some have also read the Court’s jurisprudence as prohibiting Congress from delegating its powers to private entities outside the government. Here, the district court relied upon both these understandings of the nondelegation doctrine to conclude that ICWA was invalid. First, the court held that Congress had not delineated a clear legal framework to guide how the delegated authority under ICWA would be implemented. Instead, the district court agreed with plaintiffs that the Indian tribes’ authority to reorder adoption placement preferences under ICWA was an essentially legislative authority that could not be delegated. Moreover, the court decided that even if that power could be delegated in some circumstances, Indian tribes were akin to private entities that could not exercise delegated powers. The district court was not receptive to arguments that Indian tribes are fundamentally distinct from other private parties (such as corporations), and should thus be treated differently in nondelegation analysis. Anti-commandeering: does ICWA infringe on state sovereignty over child custody matters, forcing the state to perform federal regulatory functions? The state plaintiffs claimed ICWA violated the anti-commandeering doctrine, rooted in the Constitution’s allocation of powers between the federal government and the states, which prohibits Congress from forcing state political branches to perform regulatory functions on the federal government’s behalf. The court granted this claim, agreeing that ICWA requires state courts and executive agencies to apply federal standards and directives to policy areas that are normally reserved for non-federal jurisdiction, such as adoptions, foster care policies, and other child custody issues. The district court tersely rejected the federal government’s argument that ICWA is instead an exercise of Congress’s “plenary and exclusive” authority over Indian tribes. Agency rulemaking: did a 2016 regulation violate the APA? The plaintiffs also used the Administrative Procedure Act (APA) to challenge the BIA’s 2016 Final Rule. The challenged rule tried to establish uniformity in ICWA’s application by, among other things, clarifying the “good cause” requirement for circumventing ICWA’s placement preferences for Indian children. The district court took a two-pronged approach to plaintiffs’ claims that BIA’s regulation was impermissible under the APA. First, the court announced that any regulation implementing the newly invalid portions of ICWA (i.e., the parts of ICWA that the court had already declared unconstitutional) should be struck down. The court then held in the alternative that the regulation exceeded the scope of BIA’s statutory regulatory authority—in the court’s view, the regulation “clarified” a provision that was not ambiguous and needed no clarification. Because the district court viewed the underlying provision as unambiguous, it gave no deference to the agency’s determination that the regulation was necessary. Remaining claims: Indian Commerce Clause and due process The court purported to grant plaintiffs’ claim that ICWA itself exceeded Congress’s legislative powers under the Indian Commerce Clause, but did so as an extension of its ruling that ICWA violated the anticommandeering doctrine, as Congress’s exercise of its power over Indian commerce cannot be employed to commandeer the states. Finally, the court denied the individual plaintiffs’ substantive due process claims, premised on ICWA allegedly infringing upon their fundamental rights of custody and family togetherness as foster or wouldbe adoptive parents of Indian children. The district court observed that the Supreme Court has not applied the fundamental rights of custody and of keeping families together to foster families, and the district court declined to extend recognition of such rights to the individual plaintiffs challenging ICWA. Congressional Research Service 5 Additional Context Similar challenges to ICWA have been brought over the years. At least one advocacy group has made challenging ICWA part of its core mission, claiming that Native American children are being harmed because ICWA hinders the ability of (non-Native) persons to adopt them. By contrast, ICWA’s supporters fear that challengers are jeopardizing longstanding principles underlying tribal sovereignty, while “[c]loaking [their] efforts in the language of civil rights.” Until Brackeen, however, direct challenges to ICWA generally had been unsuccessful—with perhaps one limited, but notable, exception. In a 2013 case, Adoptive Couple v. Baby Girl (popularly known as the Baby Veronica case), the U.S. Supreme Court limited the range of circumstances in which ICWA might apply. In a 5-4 decision, the Court ruled that several of ICWA’s provisions were inapplicable if the parent seeking to invoke them never had legal or physical custody of the Indian child. In the Baby Veronica case, that meant that the Indian father—who had never had custody of his daughter—could not invoke his and his tribe’s rights under ICWA to block her adoption. Second, the Court stated that the ICWA’s placement preferences for an Indian child adoption were relevant only if multiple parties actually sought to adopt the Indian child. In the Baby Veronica case, because only one party—a non-Indian couple—was trying to adopt the child, ICWA’s placement preferences could not prevent the adoption from being finalized. The Baby Veronica case was only the second ICWA case heard by the Supreme Court. The first came more than twenty years earlier, in 1989, when the Supreme Court held that, for ICWA purposes, the domicile of an Indian child was the domicile of the parents, regardless of where the child was actually born. The Baby Veronica case thus seemed to signal to some that ICWA was newly ripe for challenges, but the Supreme Court has so far declined to hear other cases challenging ICWA. However, many challenges like Brackeen have been raised in federal or state courts. As one example, the United States Court of Appeals for the Ninth Circuit recently dismissed a challenge to ICWA’s constitutionality, holding that it was mooted by the fact that the would-be adoptive parents had been able to complete their adoptions. In Brackeen v. Zinke, however, Judge O’Connor denied a motion to dismiss on similar grounds. What’s Next? The Brackeen v. Zinke decision has already been appealed to the Fifth Circuit. By stipulation of the parties, briefing in the appeal has been expedited and is scheduled to be completed in February 2019; the case is tentatively calendared for oral argument in March 2019. Although Judge O’Connor declined to stay the effect of his ruling pending appeal, the Fifth Circuit granted just such a stay despite the plaintiffs’ objection, so at least for now, the district court decision will not change the way ICWA is administered in Texas, Louisiana, or Indiana. In the event the Fifth Circuit agrees that ICWA is unconstitutional on one or more grounds, the adversely affected parties would likely seek appeal to the United States Supreme Court. The federal defendants filed their brief in January, arguing that each aspect of the district court’s decision was “unprecedented and in conflict with binding authority.” The brief also renewed challenges to the plaintiffs’ standing and argued that ICWA’s severability clause meant the ruling should have been narrower in any case. With regard to the equal protection claim, the government previewed the argument it would have made in supplemental briefing below: ICWA protects tribe members and their families, which includes the not-yet-enrolled children of tribal members, and is narrowly tailored to protect the best interests of those children. Nonetheless, the government suggested that if the Fifth Circuit agreed that strict scrutiny applied, it should remand to the district court for full briefing on the issue. In addition to ruling on the merits of the constitutional challenge to ICWA, the Fifth Circuit’s decision might also provide an opportunity for an appellate court to elaborate further on many of the Congressional Research Service 6 LSB10245 · VERSION 5 · UPDATED constitutional issues discussed, oftentimes in succinct terms, by the district court in Brackeen. The relationship between the Supreme Court’s jurisprudence on equal protection and tribal issues has prompted extensive legal commentary, and some have questioned what, if any, relevance the Brackeen decision might have for other Indian law statutes. The significance of these issues might make the Brackeen decision, to the extent it is upheld by the Fifth Circuit, particularly ripe for Supreme Court resolution. ","Use the information in the context block only; do not rely on your prior knowledge or any external sources. Is the Indian Child Welfare Act Constitutional? In Brackeen v. Zinke, a federal district court declared that the Indian Child Welfare Act (ICWA)—a 1978 law meant “to protect the best interests of Indian children and to promote the stability and security of Indian tribes and families”—was unconstitutional in several ways. This decision is currently pending before the U.S. Court of Appeals for the Fifth Circuit (Fifth Circuit), and its practical implications have been paused until the appeal is decided. If upheld, this decision would eliminate many of the special rules that apply to the adoption and foster care placements of Indian children in the three states involved in this case: Texas, Louisiana, and Indiana. Among other things, these rules allow a tribe to assume jurisdiction over, or otherwise to have input into, the placements of children who are eligible for tribal membership. In 1978, Congress recognized that an “alarmingly high percentage of Indian families” were being broken up by often-unwarranted removal of their children by nontribal entities, placing many of these children in non-Indian foster and adoptive homes. Citing its responsibility for protecting and preserving Indian tribes, Congressional Research Service https://crsreports.congress.gov LSB10245 Congressional Research Service 2 Congress passed ICWA to protect Indian children as vital to the tribes’ continued existence. ICWA is designed to do two primary things: (1) set standards for placing Indian children with foster or adoptive families, and (2) help tribes set up child and family programs. Though a number of lawsuits have challenged ICWA over the past 40 years, including on the grounds that the statute impermissibly treated Indian children differently on the basis of race, until Brackeen, none of those challenges had been successful. Instead, courts in prior cases had noted Congress’s “plenary” authority over Indian affairs—derived principally from the Indian Commerce Clause and the Treaty Power—and concluded that applying special rules to Indian children was constitutional because, among other things, the distinction between Indians and non-Indians was not an impermissible race-based classification, but was instead a recognition of the unique political status of Indian tribes. This Sidebar gives a brief overview of ICWA, outlines the Brackeen court’s decision with relevant legal context, and explores the possible impacts, including potential for higher court and congressional action. Relevant ICWA provisions and associated regulations Most relevant to the claims at issue in Brackeen, ICWA sets forth a series of duties that must be fulfilled for Indian child placements. For the purposes of ICWA, an “Indian child” is any unmarried person under eighteen who is either a member of an Indian tribe or is both eligible for membership in an Indian tribe and the biological child of a member of an Indian tribe. Three main aspects of ICWA are relevant to the issues raised in Brackeen. First, under ICWA, any party seeking involuntary termination of parental rights to an Indian child under state law must first demonstrate that active efforts have been made to provide remedial services and rehabilitative programs designed to prevent the breakup of the Indian family. Second, involuntary termination requires evidence beyond a reasonable doubt (including expert witness testimony), that the continued custody of the child by the parent or Indian custodian would likely result in serious emotional or physical damage to the child. Third, when an Indian child is placed with a foster or adoptive family under state law, ICWA lists general preferences for that placement: (1) a member of the child’s extended family; (2) other members of the Indian child’s tribe; or (3) other Indian families. However, if a tribe wants to re-order those preferences for Indian children associated with that tribe, it may pass a resolution doing so, and state agencies and courts generally must follow that amended order of preference. In any event, ICWA provides that these preferences may be circumvented in an individual case upon a showing of “good cause.” The Bureau of Indian Affairs (BIA) has authority to make regulations governing ICWA’s implementation. Though BIA chose not to do so when the statute was first passed, in 2016 it issued a Final Rule aimed at reconciling different states’ interpretations of ICWA—for example, by clarifying the circumstances in which “good cause” exists for circumventing ICWA’s placement preferences. Brackeen v. Zinke: the plaintiffs’ claims and the district court’s decision A group of plaintiffs comprising three states (Indiana, Louisiana, and Texas) and several private parties— primarily non-Indian couples who had adopted or wanted to adopt an Indian child—challenged several facets of ICWA and related regulations (including the 2016 Final Rule, as well as certain funding provisions conditioned on ICWA compliance), seeking to have them declared unconstitutional or otherwise rendered invalid. They filed these challenges in the United States District Court for the Northern District of Texas, where Judge Reed O’Connor did declare much of ICWA unconstitutional, granting nearly all of the plaintiffs’ claims. (This decision is arguably the second-most consequential decision by Judge O’Connor in recent months, as he ruled in December 2018 that the Affordable Care Act was also unconstitutional). The federal defendants, intervening tribes, and a group of amicus curiae Congressional Research Service 3 including numerous federally recognized tribes, several Indian organizations, and a number of states, disputed plaintiffs’ characterization of ICWA and contended the challenged laws and implementing regulations were lawful. The plaintiffs’ claims about ICWA’s validity, and the court’s responses to them, are discussed below. Equal protection: does ICWA use a race-based classification, and if so, can it survive strict scrutiny? The state and the individual plaintiffs together claimed that ICWA ran afoul of the Fifth Amendment’s equal protection guarantees, by impermissibly using a race-based classification. The plaintiffs’ claim relied primarily on the Supreme Court’s decisions in two cases. First, in Adarand Constructors v. Peña, the Supreme Court established that any time the federal government subjects individuals to unequal treatment based on their race, that action is subject to “strict scrutiny”—a test that asks whether the classification (1) serves a compelling government interest and (2) is narrowly tailored to further that interest. Second, in Rice v. Cayetano, in the course of invalidating a Hawaiian law that permitted only persons of native Hawaiian descent to vote in certain elections, the Supreme Court recognized that “[a]ncestry can be a proxy for race” and may be subject to the same constitutional limitations as directly race-based classifications. The plaintiffs in Brackeen argued that ICWA involved a race-based classification because its definition of Indian children was based on the children’s ancestry, rather than strictly on membership in a federally recognized tribe. Plaintiffs alleged that this classification neither served any compelling interest, nor was narrowly tailored. The federal defendants, intervening tribes, and several amici disputed plaintiffs’ characterization of ICWA as a race-based classification. In particular, they emphasized longstanding Supreme Court jurisprudence holding that the federal government’s relationship with federally recognized Indian tribes is based on a political, rather than racial categorization. For example, in Morton v. Mancari, the Court upheld BIA’s employment preference for members of federally recognized tribes because the preference was a political classification—it singled out members of tribal entities who have a unique relationship with the federal government—rather than a racial one. The Supreme Court further opined that because “[l]iterally every piece of legislation dealing with Indian tribes” is “explicitly designed to help only Indians,” deeming such legislation racial discrimination would jeopardize “the solemn commitment of the Government toward the Indians.” Because the federal defendants relied on the argument that ICWA’s distinctions were political rather than racial in nature, they proffered no arguments on whether ICWA would withstand the strict scrutiny that would be applied if it were a race-based classification. However, they asked that the court permit additional briefing in the event strict scrutiny applied—a request that the court denied. The district court, however, agreed with the plaintiffs that the definition of Indian children was race-based rather than political. In doing so, the court concluded that this case was more like Rice than like Mancari, because Mancari involved only tribe members rather than Indians eligible for tribal membership. The court then decided—in the absence of any counterarguments from the government—that the race-based classification was not narrowly tailored, even assuming that it served a compelling interest. Nondelegation: does ICWA impermissibly delegate legislative power to tribes? The state plaintiffs argued that giving the tribes power to reorder ICWA’s placement preferences violated the nondelegation doctrine, which generally prohibits Congress from delegating its core legislative powers, whether to other government entities or to private parties. Courts generally use the “intelligible principle” test to assess whether a congressional delegation of legislative power to governmental entities is permissible. This is a forgiving standard; the Supreme Court has not invalidated a statute on these Congressional Research Service 4 grounds since 1935. However, some have also read the Court’s jurisprudence as prohibiting Congress from delegating its powers to private entities outside the government. Here, the district court relied upon both these understandings of the nondelegation doctrine to conclude that ICWA was invalid. First, the court held that Congress had not delineated a clear legal framework to guide how the delegated authority under ICWA would be implemented. Instead, the district court agreed with plaintiffs that the Indian tribes’ authority to reorder adoption placement preferences under ICWA was an essentially legislative authority that could not be delegated. Moreover, the court decided that even if that power could be delegated in some circumstances, Indian tribes were akin to private entities that could not exercise delegated powers. The district court was not receptive to arguments that Indian tribes are fundamentally distinct from other private parties (such as corporations), and should thus be treated differently in nondelegation analysis. Anti-commandeering: does ICWA infringe on state sovereignty over child custody matters, forcing the state to perform federal regulatory functions? The state plaintiffs claimed ICWA violated the anti-commandeering doctrine, rooted in the Constitution’s allocation of powers between the federal government and the states, which prohibits Congress from forcing state political branches to perform regulatory functions on the federal government’s behalf. The court granted this claim, agreeing that ICWA requires state courts and executive agencies to apply federal standards and directives to policy areas that are normally reserved for non-federal jurisdiction, such as adoptions, foster care policies, and other child custody issues. The district court tersely rejected the federal government’s argument that ICWA is instead an exercise of Congress’s “plenary and exclusive” authority over Indian tribes. Agency rulemaking: did a 2016 regulation violate the APA? The plaintiffs also used the Administrative Procedure Act (APA) to challenge the BIA’s 2016 Final Rule. The challenged rule tried to establish uniformity in ICWA’s application by, among other things, clarifying the “good cause” requirement for circumventing ICWA’s placement preferences for Indian children. The district court took a two-pronged approach to plaintiffs’ claims that BIA’s regulation was impermissible under the APA. First, the court announced that any regulation implementing the newly invalid portions of ICWA (i.e., the parts of ICWA that the court had already declared unconstitutional) should be struck down. The court then held in the alternative that the regulation exceeded the scope of BIA’s statutory regulatory authority—in the court’s view, the regulation “clarified” a provision that was not ambiguous and needed no clarification. Because the district court viewed the underlying provision as unambiguous, it gave no deference to the agency’s determination that the regulation was necessary. Remaining claims: Indian Commerce Clause and due process The court purported to grant plaintiffs’ claim that ICWA itself exceeded Congress’s legislative powers under the Indian Commerce Clause, but did so as an extension of its ruling that ICWA violated the anticommandeering doctrine, as Congress’s exercise of its power over Indian commerce cannot be employed to commandeer the states. Finally, the court denied the individual plaintiffs’ substantive due process claims, premised on ICWA allegedly infringing upon their fundamental rights of custody and family togetherness as foster or wouldbe adoptive parents of Indian children. The district court observed that the Supreme Court has not applied the fundamental rights of custody and of keeping families together to foster families, and the district court declined to extend recognition of such rights to the individual plaintiffs challenging ICWA. Congressional Research Service 5 Additional Context Similar challenges to ICWA have been brought over the years. At least one advocacy group has made challenging ICWA part of its core mission, claiming that Native American children are being harmed because ICWA hinders the ability of (non-Native) persons to adopt them. By contrast, ICWA’s supporters fear that challengers are jeopardizing longstanding principles underlying tribal sovereignty, while “[c]loaking [their] efforts in the language of civil rights.” Until Brackeen, however, direct challenges to ICWA generally had been unsuccessful—with perhaps one limited, but notable, exception. In a 2013 case, Adoptive Couple v. Baby Girl (popularly known as the Baby Veronica case), the U.S. Supreme Court limited the range of circumstances in which ICWA might apply. In a 5-4 decision, the Court ruled that several of ICWA’s provisions were inapplicable if the parent seeking to invoke them never had legal or physical custody of the Indian child. In the Baby Veronica case, that meant that the Indian father—who had never had custody of his daughter—could not invoke his and his tribe’s rights under ICWA to block her adoption. Second, the Court stated that the ICWA’s placement preferences for an Indian child adoption were relevant only if multiple parties actually sought to adopt the Indian child. In the Baby Veronica case, because only one party—a non-Indian couple—was trying to adopt the child, ICWA’s placement preferences could not prevent the adoption from being finalized. The Baby Veronica case was only the second ICWA case heard by the Supreme Court. The first came more than twenty years earlier, in 1989, when the Supreme Court held that, for ICWA purposes, the domicile of an Indian child was the domicile of the parents, regardless of where the child was actually born. The Baby Veronica case thus seemed to signal to some that ICWA was newly ripe for challenges, but the Supreme Court has so far declined to hear other cases challenging ICWA. However, many challenges like Brackeen have been raised in federal or state courts. As one example, the United States Court of Appeals for the Ninth Circuit recently dismissed a challenge to ICWA’s constitutionality, holding that it was mooted by the fact that the would-be adoptive parents had been able to complete their adoptions. In Brackeen v. Zinke, however, Judge O’Connor denied a motion to dismiss on similar grounds. What’s Next? The Brackeen v. Zinke decision has already been appealed to the Fifth Circuit. By stipulation of the parties, briefing in the appeal has been expedited and is scheduled to be completed in February 2019; the case is tentatively calendared for oral argument in March 2019. Although Judge O’Connor declined to stay the effect of his ruling pending appeal, the Fifth Circuit granted just such a stay despite the plaintiffs’ objection, so at least for now, the district court decision will not change the way ICWA is administered in Texas, Louisiana, or Indiana. In the event the Fifth Circuit agrees that ICWA is unconstitutional on one or more grounds, the adversely affected parties would likely seek appeal to the United States Supreme Court. The federal defendants filed their brief in January, arguing that each aspect of the district court’s decision was “unprecedented and in conflict with binding authority.” The brief also renewed challenges to the plaintiffs’ standing and argued that ICWA’s severability clause meant the ruling should have been narrower in any case. With regard to the equal protection claim, the government previewed the argument it would have made in supplemental briefing below: ICWA protects tribe members and their families, which includes the not-yet-enrolled children of tribal members, and is narrowly tailored to protect the best interests of those children. Nonetheless, the government suggested that if the Fifth Circuit agreed that strict scrutiny applied, it should remand to the district court for full briefing on the issue. In addition to ruling on the merits of the constitutional challenge to ICWA, the Fifth Circuit’s decision might also provide an opportunity for an appellate court to elaborate further on many of the Congressional Research Service 6 LSB10245 · VERSION 5 · UPDATED constitutional issues discussed, oftentimes in succinct terms, by the district court in Brackeen. The relationship between the Supreme Court’s jurisprudence on equal protection and tribal issues has prompted extensive legal commentary, and some have questioned what, if any, relevance the Brackeen decision might have for other Indian law statutes. The significance of these issues might make the Brackeen decision, to the extent it is upheld by the Fifth Circuit, particularly ripe for Supreme Court resolution. Summarize the arguments that support and oppose the claim that the ICWA is unconstitutional.",Legal,Find & Summarize,Text Transformation "This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Use language appropriate for a 9th grade civics class. Use real life examples to make things comprehensible for someone with minimal legislative knowledge.",Summarize NetChoice’s two challenges. Explain why they challenged the restrictions. Bold the major actors names and also any legislative references that are included in the text.,"NetChoice’s Challenge to Florida’s S.B. 7072 Florida’s S.B. 7072 imposes restrictions on any information service, system, internet search engine, or access software provider that enables access by multiple users to a computer server, is organized as a legal entity, does business in Florida, and satisfies certain specified user- or revenue-based thresholds. Thus, while the litigation about the law emphasized the limitations it imposed on social media platforms, the law applied more broadly. NetChoice challenged restrictions that generally fall into two categories: content moderation restrictions and individualized-explanation requirements. The Supreme Court’s analysis in Moody focused on the content moderation restrictions. Those provisions limit the ability of covered platforms to delete content, make content less visible to other users, or ban users. Under S.B. 7072, platforms may not “deplatform” a political candidate or deprioritize a candidate’s or “journalistic enterprise’s” posts. They must “apply censorship, deplatforming, and shadow banning standards in a consistent manner,” and they cannot change the rules or terms that apply to users more than once every 30 days. Deplatforming occurs when a platform bans a user for at least 14 days. Shadow banning occurs when a platform deletes a user’s content or makes the account’s content less visible to other users. Before S.B. 7072 took effect, NetChoice sued, alleging that the content moderation provisions, on their face, violate the First Amendment. The U.S. Court of Appeals for the Eleventh Circuit affirmed a preliminary injunction barring enforcement of the content moderation provisions while NetChoice’s challenge is litigated. The court held that the provisions likely “trigger[] First Amendment scrutiny because [S.B. 7072] restricts social-media platforms’ exercise of editorial judgment.” It decided that the challenged provisions likely fail constitutional scrutiny because they lack a “substantial or compelling interest that would justify [the provisions’] significant restrictions on platforms’ editorial judgment.” NetChoice’s Challenge to Texas’s H.B. 20 Texas’s H.B. 20 applies to social media platforms with more than 50 million monthly active users in the United States. The law defines social media platforms as public websites or applications that enable users to create accounts and communicate for the primary purpose of posting user-generated information. Internet service providers, email providers, and websites “that consist primarily of news, sports, entertainment, or other” content that is not user generated are excluded from the definition. As with Florida’s law, H.B. 20 limits when covered platforms may delete or restrict access to user-posted content. Subject to enumerated exceptions, covered platforms are prohibited from censoring a user’s content based on viewpoint or the user’s geographic location in Texas. Censor is defined to mean “block[ing], ban[ning], remove[ing], deplatform[ing], demonetiz[ing], de-boost[ing], restrict[ing], deny[ing] equal access or visibility to, or otherwise discriminat[ing] against expression.” Again, NetChoice challenged H.B. 20’s content moderation provisions on their face and asked a court to enjoin their enforcement before the law took effect. The U.S. Court of Appeals for the Fifth Circuit denied the request. Expressly disagreeing with the Eleventh Circuit’s reasoning about Florida’s law, the Fifth Circuit held that Texas’s content moderation provisions do not likely implicate First Amendment rights. According to the Fifth Circuit, NetChoice was seeking to assert a “right to censor what people say” that is not protected by the First Amendment. In the alternative, the court held that, even if the law restricted protected expression, it is a content- and viewpoint-neutral law—so subject to intermediate scrutiny—and Texas’s interest in protecting the free exchange of ideas is sufficiently important to satisfy that standard.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Use language appropriate for a 9th grade civics class. Use real life examples to make things comprehensible for someone with minimal legislative knowledge. Summarize NetChoice’s two challenges. Explain why they challenged the restrictions. Bold the major actors names and also any legislative references that are included in the text. NetChoice’s Challenge to Florida’s S.B. 7072 Florida’s S.B. 7072 imposes restrictions on any information service, system, internet search engine, or access software provider that enables access by multiple users to a computer server, is organized as a legal entity, does business in Florida, and satisfies certain specified user- or revenue-based thresholds. Thus, while the litigation about the law emphasized the limitations it imposed on social media platforms, the law applied more broadly. NetChoice challenged restrictions that generally fall into two categories: content moderation restrictions and individualized-explanation requirements. The Supreme Court’s analysis in Moody focused on the content moderation restrictions. Those provisions limit the ability of covered platforms to delete content, make content less visible to other users, or ban users. Under S.B. 7072, platforms may not “deplatform” a political candidate or deprioritize a candidate’s or “journalistic enterprise’s” posts. They must “apply censorship, deplatforming, and shadow banning standards in a consistent manner,” and they cannot change the rules or terms that apply to users more than once every 30 days. Deplatforming occurs when a platform bans a user for at least 14 days. Shadow banning occurs when a platform deletes a user’s content or makes the account’s content less visible to other users. Before S.B. 7072 took effect, NetChoice sued, alleging that the content moderation provisions, on their face, violate the First Amendment. The U.S. Court of Appeals for the Eleventh Circuit affirmed a preliminary injunction barring enforcement of the content moderation provisions while NetChoice’s challenge is litigated. The court held that the provisions likely “trigger[] First Amendment scrutiny because [S.B. 7072] restricts social-media platforms’ exercise of editorial judgment.” It decided that the challenged provisions likely fail constitutional scrutiny because they lack a “substantial or compelling interest that would justify [the provisions’] significant restrictions on platforms’ editorial judgment.” NetChoice’s Challenge to Texas’s H.B. 20 Texas’s H.B. 20 applies to social media platforms with more than 50 million monthly active users in the United States. The law defines social media platforms as public websites or applications that enable users to create accounts and communicate for the primary purpose of posting user-generated information. Internet service providers, email providers, and websites “that consist primarily of news, sports, entertainment, or other” content that is not user generated are excluded from the definition. As with Florida’s law, H.B. 20 limits when covered platforms may delete or restrict access to user-posted content. Subject to enumerated exceptions, covered platforms are prohibited from censoring a user’s content based on viewpoint or the user’s geographic location in Texas. Censor is defined to mean “block[ing], ban[ning], remove[ing], deplatform[ing], demonetiz[ing], de-boost[ing], restrict[ing], deny[ing] equal access or visibility to, or otherwise discriminat[ing] against expression.” Again, NetChoice challenged H.B. 20’s content moderation provisions on their face and asked a court to enjoin their enforcement before the law took effect. The U.S. Court of Appeals for the Fifth Circuit denied the request. Expressly disagreeing with the Eleventh Circuit’s reasoning about Florida’s law, the Fifth Circuit held that Texas’s content moderation provisions do not likely implicate First Amendment rights. According to the Fifth Circuit, NetChoice was seeking to assert a “right to censor what people say” that is not protected by the First Amendment. In the alternative, the court held that, even if the law restricted protected expression, it is a content- and viewpoint-neutral law—so subject to intermediate scrutiny—and Texas’s interest in protecting the free exchange of ideas is sufficiently important to satisfy that standard.",Internet/Technology,Summarize,Text Transformation "For this task, return an answer which is based solely on the context provided to you. If you find that you can not answer the question using only the context provided, say ""There is not enough information in the text provided to sufficiently answer this question.""",Explain the differences between demand-pull inflation and cost-push inflation with examples.,"Demand-Pull Inflation Inflation that is caused by an increase in aggregate demand (overall spending) absent a proportional increase in aggregate supply (overall production) is known as demand-pull inflation. When aggregate demand increases by more than its trend rate, typically the productive capacity of the economy does not immediately adjust to meet higher demand, particularly if the economy is at or near full employment.16 In response to the increased demand in the economy, producers will attempt to increase the quantity of goods and services they provide. To increase production, producers may attempt to hire more workers by increasing wages. Assuming producers are not willing to eat into profits in order to ramp up production,17 they are likely to increase the prices of their final goods and services to compensate themselves for the increase in wages (which increases production costs), thereby creating inflation.18 Inflation can work to lower demand and increase supply and thus can be the means to bring supply and demand back into equilibrium, particularly in an overheating economy in which demand has risen above what the economy can produce at full employment.19 Any number of factors could contribute to increases in aggregate demand, including the normal ebbs and flows of the business cycle, consumer and investor sentiment, the value of the dollar, and fiscal and monetary policy, among others. Expansionary fiscal policies include an increase in the budget deficit by lowering taxes or increasing government spending or transfers to individuals. Such policies work to increase overall spending in the economy by driving up consumer demand, in the case of lower taxes, or both consumer demand and government purchases in the case of increased spending. This in turn can lead to increased production and decreasing unemployment levels. The downside to achieving these benefits through expansionary fiscal policy is that it can result in demand-pull inflation in the short term, particularly if the economy is at full employment. Expansionary fiscal policy is unlikely to cause sustained inflation, as it typically involves temporary increases in spending. Such one-time increases may produce similar one-time increases in inflation but would be likely to cause persistent increases in inflation only if such policy were persistently applied. Additionally, monetary policy can potentially be used to offset the inflationary effects of such policy. Cost-Push Inflation Inflation that is caused by a decrease in aggregate supply as a result of increases in the cost of production absent a proportional decrease in aggregate demand is known as cost-push inflation. An increase in the cost of raw materials or any of the factors of production—land, labor, capital, entrepreneurship—will result in increased production costs.23 Assuming producers’ productivity is at or near its maximum, producers will not be able to maintain existing profit margins in response. Much the same as the demand-side issue, if producers cannot or will not accept lowered profits, they will raise prices.24 The classic example of cost-push inflation is the result of a commodity price shock, which sharply decreases the supply of a given commodity and increases its price. Certain commodities are inputs in the production process, and as the price of an important input good increases, so does the price of the final goods and services, resulting in inflation. Cost-push inflation, especially when caused by a supply shock, tends to result in only a temporary increase in inflation unless accommodated by monetary policy. Supply disruptions are often alleviated naturally, and for inflation to be persistently high, supply shock after supply shock would need to occur.25 One of the reasons a commodity shock in particular is a widely cited example of something that causes cost-push inflation is that demand for many commodities is considered to be inelastic. The elasticity of demand refers to how consumers’ appetite for a good changes given the price it is offered at.26 A completely inelastic good is one that consumers would purchase at the same rate regardless of the price. For example, demand for oil and its derivative petroleum products—such as gasoline, diesel fuel, and petrochemicals—is generally fairly inelastic, because they are necessary purchases for consumers and businesses, with few substitutes readily available. Another commonly cited example of cost-push inflation is caused by increases in the cost of labor, often referred to as wage-push inflation. An increase in the federal minimum wage, for example, could theoretically cause inflation. When producers need to pay their workers more, they may opt to pass that cost along to the consumer, reduce profits to pay the increased cost, or decrease the amount of workers they employ to keep costs down. The extent to which an increase in wages affects the price level depends largely on how many workers are affected by the wage increase and the size of the increase. In the case of the minimum wage, very few workers or very many workers could be affected, depending on the level of increase. ","For this task, return an answer which is based solely on the context provided to you. If you find that you can not answer the question using only the context provided, say ""There is not enough information in the text provided to sufficiently answer this question."" Context: Demand-Pull Inflation Inflation that is caused by an increase in aggregate demand (overall spending) absent a proportional increase in aggregate supply (overall production) is known as demand-pull inflation. When aggregate demand increases by more than its trend rate, typically the productive capacity of the economy does not immediately adjust to meet higher demand, particularly if the economy is at or near full employment.16 In response to the increased demand in the economy, producers will attempt to increase the quantity of goods and services they provide. To increase production, producers may attempt to hire more workers by increasing wages. Assuming producers are not willing to eat into profits in order to ramp up production,17 they are likely to increase the prices of their final goods and services to compensate themselves for the increase in wages (which increases production costs), thereby creating inflation.18 Inflation can work to lower demand and increase supply and thus can be the means to bring supply and demand back into equilibrium, particularly in an overheating economy in which demand has risen above what the economy can produce at full employment.19 Any number of factors could contribute to increases in aggregate demand, including the normal ebbs and flows of the business cycle, consumer and investor sentiment, the value of the dollar, and fiscal and monetary policy, among others. Expansionary fiscal policies include an increase in the budget deficit by lowering taxes or increasing government spending or transfers to individuals. Such policies work to increase overall spending in the economy by driving up consumer demand, in the case of lower taxes, or both consumer demand and government purchases in the case of increased spending. This in turn can lead to increased production and decreasing unemployment levels. The downside to achieving these benefits through expansionary fiscal policy is that it can result in demand-pull inflation in the short term, particularly if the economy is at full employment. Expansionary fiscal policy is unlikely to cause sustained inflation, as it typically involves temporary increases in spending. Such one-time increases may produce similar one-time increases in inflation but would be likely to cause persistent increases in inflation only if such policy were persistently applied. Additionally, monetary policy can potentially be used to offset the inflationary effects of such policy. Cost-Push Inflation Inflation that is caused by a decrease in aggregate supply as a result of increases in the cost of production absent a proportional decrease in aggregate demand is known as cost-push inflation. An increase in the cost of raw materials or any of the factors of production—land, labor, capital, entrepreneurship—will result in increased production costs.23 Assuming producers’ productivity is at or near its maximum, producers will not be able to maintain existing profit margins in response. Much the same as the demand-side issue, if producers cannot or will not accept lowered profits, they will raise prices.24 The classic example of cost-push inflation is the result of a commodity price shock, which sharply decreases the supply of a given commodity and increases its price. Certain commodities are inputs in the production process, and as the price of an important input good increases, so does the price of the final goods and services, resulting in inflation. Cost-push inflation, especially when caused by a supply shock, tends to result in only a temporary increase in inflation unless accommodated by monetary policy. Supply disruptions are often alleviated naturally, and for inflation to be persistently high, supply shock after supply shock would need to occur.25 One of the reasons a commodity shock in particular is a widely cited example of something that causes cost-push inflation is that demand for many commodities is considered to be inelastic. The elasticity of demand refers to how consumers’ appetite for a good changes given the price it is offered at.26 A completely inelastic good is one that consumers would purchase at the same rate regardless of the price. For example, demand for oil and its derivative petroleum products—such as gasoline, diesel fuel, and petrochemicals—is generally fairly inelastic, because they are necessary purchases for consumers and businesses, with few substitutes readily available. Another commonly cited example of cost-push inflation is caused by increases in the cost of labor, often referred to as wage-push inflation. An increase in the federal minimum wage, for example, could theoretically cause inflation. When producers need to pay their workers more, they may opt to pass that cost along to the consumer, reduce profits to pay the increased cost, or decrease the amount of workers they employ to keep costs down. The extent to which an increase in wages affects the price level depends largely on how many workers are affected by the wage increase and the size of the increase. In the case of the minimum wage, very few workers or very many workers could be affected, depending on the level of increase. Question: Explain the differences between demand-pull inflation and cost-push inflation with examples.",Financial,Concept Comparison,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","What is the technical difference between a VPN and an Extranet, and how do both get utilized safely in an enterprise environment without breaking connections between computers?","2.3 VPNs and Extranets The term 'extranet' is commonly used to refer to a scenario whereby two or more companies have networked access to a limited amount of each other's corporate data. For example a manufacturing company might use an extranet for its suppliers to allow it to query databases for the pricing and availability of components, and then to order and track the status of outstanding orders. Another example is joint software development, for instance, company A allows one development group within company B to access its operating system source code, and company B allows one development group in company A to access its security software. Note that the access policies can get arbitrarily complex. For example company B may internally restrict access to its security software to groups in certain geographic locations to comply with export control laws, for example. A key feature of an extranet is thus the control of who can access what data, and this is essentially a policy decision. Policy decisions are typically enforced today at the interconnection points between different domains, for example between a private network and the Internet, or between a software test lab and the rest of the company network. The enforcement may be done via a firewall, router with access list functionality, application gateway, or any similar device capable of applying policy to transit traffic. Policy controls may be implemented within a corporate network, in addition to between corporate networks. Also the interconnections between networks could be a set of bilateral links, or could be a separate network, perhaps maintained by an industry consortium. This separate network could itself be a VPN or a physical network. Introducing VPNs into a network does not require any change to this model. Policy can be enforced between two VPNs, or between a VPN and the Internet, in exactly the same manner as is done today without VPNs. For example two VPNs could be interconnected, which each administration locally imposing its own policy controls, via a firewall, on all traffic that enters its VPN from the outside, whether from another VPN or from the Internet. This model of a VPN provides for a separation of policy from the underlying mode of packet transport used. For example, a router may direct voice traffic to ATM Virtual Channel Connections (VCCs) for guaranteed QoS, non-local internal company traffic to secure tunnels, and other traffic to a link to the Internet. In the past the secure tunnels may have been frame relay circuits, now they may also be secure IP tunnels or MPLS Label Switched Paths (LSPs) Gleeson, et al. Informational [Page 9] RFC 2764 IP Based Virtual Private Networks February 2000 Other models of a VPN are also possible. For example there is a model whereby a set of application flows is mapped into a VPN. As the policy rules imposed by a network administrator can get quite complex, the number of distinct sets of application flows that are used in the policy rulebase, and hence the number of VPNs, can thus grow quite large, and there can be multiple overlapping VPNs. However there is little to be gained by introducing such new complexity into a network. Instead a VPN should be viewed as a direct analogue to a physical network, as this allows the leveraging of existing protocols and procedures, and the current expertise and skill sets of network administrators and customers."," Only use the provided text to answer the question, no outside sources. What is the technical difference between a VPN and an Extranet, and how do both get utilized safely in an enterprise environment without breaking connections between computers? 2.3 VPNs and Extranets The term 'extranet' is commonly used to refer to a scenario whereby two or more companies have networked access to a limited amount of each other's corporate data. For example a manufacturing company might use an extranet for its suppliers to allow it to query databases for the pricing and availability of components, and then to order and track the status of outstanding orders. Another example is joint software development, for instance, company A allows one development group within company B to access its operating system source code, and company B allows one development group in company A to access its security software. Note that the access policies can get arbitrarily complex. For example company B may internally restrict access to its security software to groups in certain geographic locations to comply with export control laws, for example. A key feature of an extranet is thus the control of who can access what data, and this is essentially a policy decision. Policy decisions are typically enforced today at the interconnection points between different domains, for example between a private network and the Internet, or between a software test lab and the rest of the company network. The enforcement may be done via a firewall, router with access list functionality, application gateway, or any similar device capable of applying policy to transit traffic. Policy controls may be implemented within a corporate network, in addition to between corporate networks. Also the interconnections between networks could be a set of bilateral links, or could be a separate network, perhaps maintained by an industry consortium. This separate network could itself be a VPN or a physical network. Introducing VPNs into a network does not require any change to this model. Policy can be enforced between two VPNs, or between a VPN and the Internet, in exactly the same manner as is done today without VPNs. For example two VPNs could be interconnected, which each administration locally imposing its own policy controls, via a firewall, on all traffic that enters its VPN from the outside, whether from another VPN or from the Internet. This model of a VPN provides for a separation of policy from the underlying mode of packet transport used. For example, a router may direct voice traffic to ATM Virtual Channel Connections (VCCs) for guaranteed QoS, non-local internal company traffic to secure tunnels, and other traffic to a link to the Internet. In the past the secure tunnels may have been frame relay circuits, now they may also be secure IP tunnels or MPLS Label Switched Paths (LSPs) Gleeson, et al. Informational [Page 9] RFC 2764 IP Based Virtual Private Networks February 2000 Other models of a VPN are also possible. For example there is a model whereby a set of application flows is mapped into a VPN. As the policy rules imposed by a network administrator can get quite complex, the number of distinct sets of application flows that are used in the policy rulebase, and hence the number of VPNs, can thus grow quite large, and there can be multiple overlapping VPNs. However there is little to be gained by introducing such new complexity into a network. Instead a VPN should be viewed as a direct analogue to a physical network, as this allows the leveraging of existing protocols and procedures, and the current expertise and skill sets of network administrators and customers. https://rfc-editor.org/rfc/rfc2764",Internet/Technology,Concept Comparison,Q&A Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here.,"What percentage of Canadians have at least one credit card, and how many pay them off monthly?","The Bottom Line Credit cards offer valuable benefits for both consumers and retailers. And the majority of Canadians use their credit card as a method of payment rather than a means of borrowing. Credit card benefits For Consumers A credit card is a convenient and flexible payment tool accepted in more than 200 countries and at millions of locations worldwide. Benefits include: • Access to unsecured credit (no collateral required against amounts charged). • Interest-free payment from time of purchase to the end of the billing period. • Instant payment of purchases, allowing for instant receipt of goods and services. Focus: Credit Cards: Statistics and Facts Focus Sheet • Credit cards provide interest-free credit from the time of purchase to the end of the billing period • More than 70% of Canadians pay their credit card balance in full each month1 , so for them the interest rate is zero • For those who choose to carry a balance: o Credit cards offer access to unsecured credit (no collateral required) o There are many low interest rate cards on the market and over 30 of those cards have an interest rate of under 13% FAST FACTS • Coverage for purchases if the item is damaged, stolen or not delivered within 90 days. • 24/7 access. • Fraud protection with zero liability to the consumer in cases of fraud. • Other rewards and benefits, such as air travel points, car insurance, damage and loss insurance and extended warranty programs. For retailers Retailers are not required to accept credit cards, but do so to provide payments options for their customers. Retailers that do accept credit cards receive many benefits, including: • Reaching a large customer base – Credit cards are the preferred method of payment for many customers, and customers will select retailers that allow them to choose their preferred method of payment. • Fast, guaranteed payment, which can reduce line-ups at checkout. If every credit card transaction took an extra 30 seconds, it would use up an additional 27 million hours of staff time each year. • The ability of accepting credit without worrying about the creditworthiness of customers, insufficient funds or outstanding receivables. • Reduced cash on hand and cash handling time and costs, including counting cash at the end of the day, armoured transport, higher likelihood of theft and pilfering and potential mistakes by cashiers. • Expanded markets; ability to sell to customers throughout Canada and around the world in the currency used by the retailer. • Access to innovative new payments – innovations in payment options introduced by banks and credit card companies, such as contactless cards and online and mobile payments, benefit retailers and make it easier for customer to make purchases. Moreover, a very large majority (94 per cent) of merchants say their business benefits from accepting credit cards.2 • Sixty-nine per cent of merchants say they benefit from letting customers earn rewards on their purchases. 3 Competition and choice When making a purchase, consumers can choose to use cash, cheques, debit cards, credit cards as well as electronic payments services like PayPal and Interac Online. Nearly nine out of ten adult Canadians have at least one credit card4 and this method of payment is the choice for the overwhelming majority of retail e-commerce transactions. When it comes to choosing a credit card, banks offer consumers a wide variety of products. Customers may choose among standard cards without an annual fee, premium cards that offer rewards and features, and low-rate cards if the interest rate is a key consideration influencing the card choice. • Hundreds of institutions in Canada, including banks, credit unions, retailers, caisses populaires, trust companies and finance companies offer credit card products. • 76.2 million Visa and MasterCard cards are in circulation in Canada. 5 • There are many low-rate cards on the market and over 30 of those cards have an interest rate of under 13%. • Eight in 10 (84 per cent) consumers are satisfied with their credit cards and roughly the same proportion (86 per cent) say they offer great value. 6 • Canadians appreciate their rewards points programs and the majority use them to help make a family vacation more attainable with travel points, save money on their grocery bills with cash-back rewards or use their rewards points to donate to a favourite charity. • Research has found that eighty-three per cent of consumers use a credit card that provides them with rewards. 7 • 58 per cent of Canadians who are frequent credit card users listed “receiving discounts/loyalty points/rewards’’ as their main reason for frequently using credit cards for purchases. 8 • Roughly two-thirds of consumers (65 per cent) say credit card purchases are advantageous to merchants and directly help them grow their businesses. 9 Consumers should visit the Financial Consumer Agency of Canada (FCAC) website www.fcac.gc.ca, for an extensive list of cards and features, and use the credit card comparison tool to help select the card that best suits their needs. Strong regulations 10 Consumers with credit cards from banks are protected by Bank Act regulations that require: • Statements to include itemized transactions, the amount you must pay on or before the due date in order to have the benefit of a grace period. • Disclosure of the previous month’s payments and the current month’s purchases, credit advances, as well as interest and non-interest charges. • Disclosure of the interest rate at the time of solicitation or application, and on every monthly statement. • Plain language information for customers. • Rules on advertising. • Limits on consumer liability in the event of fraud. Credit card pricing There are a number of factors that influence card fees and interest rates. • An interest-free period from purchase to payment, depending on the card, as long as the balance is paid in full when owing. • Access to unsecured credit where no collateral is needed, which makes it a higher risk for the credit card issuer. • Significant costs to operating the credit card system including processing a large volume of transactions, technology that is constantly updated to support transactions, preparing and mailing statements, collecting payments and the costs for providing value- added rewards programs. Most Canadians pay cards off every month • A Payments Canada survey found that 71% of Canadians pay their balance off in full every month. 11 • Banks work with clients who are concerned about their debt, helping them get control of their finances or choose more suitable credit products. Banks also support non-profit credit counseling services. The Canadian Bankers Association is the voice of more than 60 domestic and foreign banks that help drive Canada’s economic growth and prosperity. The CBA advocates for public policies that contribute to a sound, thriving banking system to ensure Canadians can succeed in their financial goals. Last updated: March 2023 1 Canadian Payment Methods and Trends Report 2022: 71% of Canadians pay their balance off in full every month. https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf 2 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 3 Ibid 4 Canadian Payment Methods and Trends Report 2019: https://leger360.com/wp- content/uploads/2019/12/canadianpaymentmethod sandtrendsreport_2019.pdf p. 17 5 CBA credit card statistics as of January 2021 6 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 7 ibid 8 Canadian Payment Methods and Trends Report 2022, pg 27: https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf 9 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 10 Note – these protections only extend to federally-regulated financial institutions (not other card issuers) 11 Canadian Payment Methods and Trends Report 2022: 71% of Canadians pay their balance off in full every month. https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf","Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here. What percentage of Canadians have at least one credit card, and how many pay them off monthly? The Bottom Line Credit cards offer valuable benefits for both consumers and retailers. And the majority of Canadians use their credit card as a method of payment rather than a means of borrowing. Credit card benefits For Consumers A credit card is a convenient and flexible payment tool accepted in more than 200 countries and at millions of locations worldwide. Benefits include: • Access to unsecured credit (no collateral required against amounts charged). • Interest-free payment from time of purchase to the end of the billing period. • Instant payment of purchases, allowing for instant receipt of goods and services. Focus: Credit Cards: Statistics and Facts Focus Sheet • Credit cards provide interest-free credit from the time of purchase to the end of the billing period • More than 70% of Canadians pay their credit card balance in full each month1 , so for them the interest rate is zero • For those who choose to carry a balance: o Credit cards offer access to unsecured credit (no collateral required) o There are many low interest rate cards on the market and over 30 of those cards have an interest rate of under 13% FAST FACTS • Coverage for purchases if the item is damaged, stolen or not delivered within 90 days. • 24/7 access. • Fraud protection with zero liability to the consumer in cases of fraud. • Other rewards and benefits, such as air travel points, car insurance, damage and loss insurance and extended warranty programs. For retailers Retailers are not required to accept credit cards, but do so to provide payments options for their customers. Retailers that do accept credit cards receive many benefits, including: • Reaching a large customer base – Credit cards are the preferred method of payment for many customers, and customers will select retailers that allow them to choose their preferred method of payment. • Fast, guaranteed payment, which can reduce line-ups at checkout. If every credit card transaction took an extra 30 seconds, it would use up an additional 27 million hours of staff time each year. • The ability of accepting credit without worrying about the creditworthiness of customers, insufficient funds or outstanding receivables. • Reduced cash on hand and cash handling time and costs, including counting cash at the end of the day, armoured transport, higher likelihood of theft and pilfering and potential mistakes by cashiers. • Expanded markets; ability to sell to customers throughout Canada and around the world in the currency used by the retailer. • Access to innovative new payments – innovations in payment options introduced by banks and credit card companies, such as contactless cards and online and mobile payments, benefit retailers and make it easier for customer to make purchases. Moreover, a very large majority (94 per cent) of merchants say their business benefits from accepting credit cards.2 • Sixty-nine per cent of merchants say they benefit from letting customers earn rewards on their purchases. 3 Competition and choice When making a purchase, consumers can choose to use cash, cheques, debit cards, credit cards as well as electronic payments services like PayPal and Interac Online. Nearly nine out of ten adult Canadians have at least one credit card4 and this method of payment is the choice for the overwhelming majority of retail e-commerce transactions. When it comes to choosing a credit card, banks offer consumers a wide variety of products. Customers may choose among standard cards without an annual fee, premium cards that offer rewards and features, and low-rate cards if the interest rate is a key consideration influencing the card choice. • Hundreds of institutions in Canada, including banks, credit unions, retailers, caisses populaires, trust companies and finance companies offer credit card products. • 76.2 million Visa and MasterCard cards are in circulation in Canada. 5 • There are many low-rate cards on the market and over 30 of those cards have an interest rate of under 13%. • Eight in 10 (84 per cent) consumers are satisfied with their credit cards and roughly the same proportion (86 per cent) say they offer great value. 6 • Canadians appreciate their rewards points programs and the majority use them to help make a family vacation more attainable with travel points, save money on their grocery bills with cash-back rewards or use their rewards points to donate to a favourite charity. • Research has found that eighty-three per cent of consumers use a credit card that provides them with rewards. 7 • 58 per cent of Canadians who are frequent credit card users listed “receiving discounts/loyalty points/rewards’’ as their main reason for frequently using credit cards for purchases. 8 • Roughly two-thirds of consumers (65 per cent) say credit card purchases are advantageous to merchants and directly help them grow their businesses. 9 Consumers should visit the Financial Consumer Agency of Canada (FCAC) website www.fcac.gc.ca, for an extensive list of cards and features, and use the credit card comparison tool to help select the card that best suits their needs. Strong regulations 10 Consumers with credit cards from banks are protected by Bank Act regulations that require: • Statements to include itemized transactions, the amount you must pay on or before the due date in order to have the benefit of a grace period. • Disclosure of the previous month’s payments and the current month’s purchases, credit advances, as well as interest and non-interest charges. • Disclosure of the interest rate at the time of solicitation or application, and on every monthly statement. • Plain language information for customers. • Rules on advertising. • Limits on consumer liability in the event of fraud. Credit card pricing There are a number of factors that influence card fees and interest rates. • An interest-free period from purchase to payment, depending on the card, as long as the balance is paid in full when owing. • Access to unsecured credit where no collateral is needed, which makes it a higher risk for the credit card issuer. • Significant costs to operating the credit card system including processing a large volume of transactions, technology that is constantly updated to support transactions, preparing and mailing statements, collecting payments and the costs for providing value- added rewards programs. Most Canadians pay cards off every month • A Payments Canada survey found that 71% of Canadians pay their balance off in full every month. 11 • Banks work with clients who are concerned about their debt, helping them get control of their finances or choose more suitable credit products. Banks also support non-profit credit counseling services. The Canadian Bankers Association is the voice of more than 60 domestic and foreign banks that help drive Canada’s economic growth and prosperity. The CBA advocates for public policies that contribute to a sound, thriving banking system to ensure Canadians can succeed in their financial goals. Last updated: March 2023 1 Canadian Payment Methods and Trends Report 2022: 71% of Canadians pay their balance off in full every month. https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf 2 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 3 Ibid 4 Canadian Payment Methods and Trends Report 2019: https://leger360.com/wp- content/uploads/2019/12/canadianpaymentmethod sandtrendsreport_2019.pdf p. 17 5 CBA credit card statistics as of January 2021 6 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 7 ibid 8 Canadian Payment Methods and Trends Report 2022, pg 27: https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf 9 Abacus Data survey commissioned by the Canadian Bankers Association, October 2022 10 Note – these protections only extend to federally-regulated financial institutions (not other card issuers) 11 Canadian Payment Methods and Trends Report 2022: 71% of Canadians pay their balance off in full every month. https://payments.ca/sites/default/files/PaymentsCa nada_Canadian_Payment_Methods_and_Trends_ Report_2022_En_0.pdf",Financial,Fact Finding,Q&A "Only utilize the information in the article provided to answer the question, do not refer to any outside information. Answer the question in full sentences.",What are 5 goals of Customer Relationship Management Systems implementation within an enterprise?,"**Customer Relationship Management Systems** What is a CRM system? A CRM system gathers, links, and analyses all collected customer data, including contact information, interactions with company representatives, purchases, service requests, assets, and quotes/proposals. The system then lets users access that data and understand what happened at each touchpoint. Through this understanding, a complete customer profile is developed, and a solid customer relationship is built. Customer data can also be aggregated to populate incentive compensation modelling, sales forecasting, territory segmentation, campaign design, product innovation, and other sales, marketing, and customer service activities. CRM tools and software help you streamline the customer engagement process, close more sales deals, establish strong customer relationships, build customer loyalty, and ultimately increase sales and profits. Learn more about Oracle's comprehensive CRM sales solution Who should use a CRM? CRM tools have almost always been seen as sales tools. However, over time, these solutions have extended their reach and become integral to marketing, ecommerce, and customer service functions. The power of customer relationship management is derived by constantly gathering customer data, analysing that data, and then using those insights to deepen relationships and improve business results. It allows any customer-facing employee to convey, ""We know you, and we value you."" A set of data-driven CRM tools supports you beyond the sales process, which is crucial to business performance. With the in-depth knowledge of your customers, you can: Offer and sell new, add-on products—at the right time in the right way at the right price Help customer service teams resolve issues faster Help development teams create better products and services CRM: What is the goal? CRM software supports strong, productive, loyal customer relationships through informed and superior customer experiences. The goal? To improve customer acquisition and retention by providing experiences that keep your customers coming back. Customer relationship management is both a strategy and a tool that supports those experiences in five key ways. 1 Answer the most basic customer questions Customer relationship management helps you find new customers, sell to them, and develop a loyal customer relationship with them. These systems collect many different types of customer data and organize it so you understand your customers/prospects better and can answer (or even anticipate) their questions. 2 Manage customer data Bad decisions come from a lack of access to and inability to interpret customer data. Being able to store, track, and validate customer data within an automated system will allow sales and marketing teams to optimize customer engagement strategies and build better relationships. 3 Automate the sales process Sales force automation makes selling more efficient, helping you sell more quickly. The best CRM systems use artificial intelligence (AI) and unified customer data to automate the sales process by prompting sellers with recommended next-best actions. 4 Personalize marketing campaigns Customers and potential customers arrive through various channels, including websites, social media, email, online/offline events, etc. Unfortunately, many businesses struggle to connect marketing efforts across all these channels. Marketing teams can improve conversions, strengthen customer relationships, and align messaging across their digital customer channels by leveraging CRM systems. 5 Align sales and marketing With customer relationship management, marketing and sales work better together to drive sales and increase revenue. When sales and marketing are in sync, sales productivity goes up along with marketing ROI. CRM features and benefits Customer relationship management solutions are one of the largest and fastest-growing enterprise application software categories. The CRM market size was valued at $41.93 billion in 2019 and is projected to reach $96.39 billion by 2027, growing at a CAGR of 11.1% from 2020 to 2027. More and more companies are using CRM solutions to acquire more sales leads, improve the sales pipeline, boost productivity, and improve customer satisfaction. However, many have encountered problems ranging from cost overruns and CRM integration challenges to system limitations. These are avoidable problems, and you can help ensure success by focusing on a customer-first strategy. It's critical for businesses to have integrated, customizable, and comprehensive views into their customers’ and potential customers’ solution/product interests, customer service needs, and purchase history. A good CRM system should provide that view. All data is in a single location, viewable through optimized dashboards. Additionally, your marketing team can leverage CRM solutions to orchestrate personalized marketing and lead generation campaigns. These systems can help track all cross-channel interactions—from engagement to purchase. Mature cloud CRM solutions do more. They are fully integrated with back-office solutions to successfully support the entire customer journey. Because it manages prospect and customer engagement points across all channels, your CRM system can inform all your communications and marketing activities, delivering the 360-degree customer view needed for a truly connected omnichannel experience. Many different vendors have many different types of solutions. However, a few capabilities are must-haves. Be easy to use, or people won't use it Fit within your budget and provide an acceptable ROI Integrate well with your other software systems Provide accurate, consistent data for that much-needed, complete customer 360-degree view Types of CRM CRM software solutions, at their core, are used to manage customer relationships and sales interactions. Still, many businesses leverage these systems simply as a sales force automation tool. But these solutions, such as Oracle's, offer many more valuable capabilities that span a wide range of marketing and sales functions, including marketing, customer service, sales, and partner channel management. Today’s CRM software can support the entire customer journey. But what one company may need from a CRM system can be vastly different from what another company might require. To help you select the right CRM for your organization, it’s helpful to know that there are three main types of CRM solutions: collaborative, operational, and analytical. CRM and data Data is the most critical part of any CRM software solution. In fact, customer data is the starting point for all marketing and sales activities. Successful customer engagement and relationship strategies hinge on accurate, complete, and accessible customer profiles. Bad data comes from several places, including: Fraudulently entered data Keystroke errors Duplicate customer information Natural changes (company bankruptcy, job changes) Incomplete and inaccurate data can increase quickly to degrade the value of your CRM tools, resulting in unnecessary expenses. Conversely, when customer data is complete and accurate, businesses stand a better chance of reaching their target customers and prospects. In short, your data is a valuable asset. So it’s important to focus on collecting and optimizing these four CRM data types: Identity data Identity data includes descriptive details to identify customers, leads, and contacts. This data should be used for marketing segmentation. Descriptive data Descriptive data includes lifestyle details relevant to your contacts. It is what completes that all-important 360-degree view of leads and contacts. Quantitative data Quantitative data includes measurable data points that can help you interpret how your leads and contacts have interacted with you. Qualitative data Qualitative data can help you better understand your contacts’ intent, including search behaviours related to buying decisions. CRM vs. marketing automation Both CRM and marketing automation systems are data-driven. They focus on gathering, storing, and using data. For example, marketing automation systems gather leads by communicating with potential and current customers. Specifically, marketing automation looks to gather enough customer data points to show intent and then hands that person off to the sales team as a marketing-qualified lead (MQL). A CRM solution picks up where the marketing automation solution left off and works to convert those marketing-qualified leads into contacts. AI in CRM Discover the next generation of CRM (0:38) The best CRM systems offer robust analytics coupled with AI and machine learning. AI is the future of customer relationship management, going beyond contact management and sales force automation to truly helping you sell. AI in CRM can guide you toward the next-best actions and provide smart talking points—specific to each customer opportunity. AI also delivers timely customer intelligence that helps you optimize customer experience (CX) across marketing, sales, and customer service. CRM vs. CX When customer relationship management first arrived on the scene, businesses would capture data but not know what to do with it. Today, CRM systems are integrated with AI, which helps interpret and predict what that data means. CRM AI capabilities are the foundation to using a 360-degree view of the customer that will start them on their way to becoming your customer. As these AI enhancements continue to evolve, CX will continue to improve—and in turn, customer expectations will continue to increase. Your business needs to fully understand your customers (and how they buy) to not only meet their expectations but to provide them with compelling experiences. This is the future of CX and should serve as your guide to selecting the best CRM solution. How CRM improves customer experience A complete customer view is necessary for business success and growth. Without a CRM system, you'll struggle to develop that much-needed 360-degree view of the customer that you need to: Personalize customer interactions Automate business processes (with appropriate CX integrations) Track all customer interactions","{Context} ========== **Customer Relationship Management Systems** What is a CRM system? A CRM system gathers, links, and analyses all collected customer data, including contact information, interactions with company representatives, purchases, service requests, assets, and quotes/proposals. The system then lets users access that data and understand what happened at each touchpoint. Through this understanding, a complete customer profile is developed, and a solid customer relationship is built. Customer data can also be aggregated to populate incentive compensation modelling, sales forecasting, territory segmentation, campaign design, product innovation, and other sales, marketing, and customer service activities. CRM tools and software help you streamline the customer engagement process, close more sales deals, establish strong customer relationships, build customer loyalty, and ultimately increase sales and profits. Learn more about Oracle's comprehensive CRM sales solution Who should use a CRM? CRM tools have almost always been seen as sales tools. However, over time, these solutions have extended their reach and become integral to marketing, ecommerce, and customer service functions. The power of customer relationship management is derived by constantly gathering customer data, analysing that data, and then using those insights to deepen relationships and improve business results. It allows any customer-facing employee to convey, ""We know you, and we value you."" A set of data-driven CRM tools supports you beyond the sales process, which is crucial to business performance. With the in-depth knowledge of your customers, you can: Offer and sell new, add-on products—at the right time in the right way at the right price Help customer service teams resolve issues faster Help development teams create better products and services CRM: What is the goal? CRM software supports strong, productive, loyal customer relationships through informed and superior customer experiences. The goal? To improve customer acquisition and retention by providing experiences that keep your customers coming back. Customer relationship management is both a strategy and a tool that supports those experiences in five key ways. 1 Answer the most basic customer questions Customer relationship management helps you find new customers, sell to them, and develop a loyal customer relationship with them. These systems collect many different types of customer data and organize it so you understand your customers/prospects better and can answer (or even anticipate) their questions. 2 Manage customer data Bad decisions come from a lack of access to and inability to interpret customer data. Being able to store, track, and validate customer data within an automated system will allow sales and marketing teams to optimize customer engagement strategies and build better relationships. 3 Automate the sales process Sales force automation makes selling more efficient, helping you sell more quickly. The best CRM systems use artificial intelligence (AI) and unified customer data to automate the sales process by prompting sellers with recommended next-best actions. 4 Personalize marketing campaigns Customers and potential customers arrive through various channels, including websites, social media, email, online/offline events, etc. Unfortunately, many businesses struggle to connect marketing efforts across all these channels. Marketing teams can improve conversions, strengthen customer relationships, and align messaging across their digital customer channels by leveraging CRM systems. 5 Align sales and marketing With customer relationship management, marketing and sales work better together to drive sales and increase revenue. When sales and marketing are in sync, sales productivity goes up along with marketing ROI. CRM features and benefits Customer relationship management solutions are one of the largest and fastest-growing enterprise application software categories. The CRM market size was valued at $41.93 billion in 2019 and is projected to reach $96.39 billion by 2027, growing at a CAGR of 11.1% from 2020 to 2027. More and more companies are using CRM solutions to acquire more sales leads, improve the sales pipeline, boost productivity, and improve customer satisfaction. However, many have encountered problems ranging from cost overruns and CRM integration challenges to system limitations. These are avoidable problems, and you can help ensure success by focusing on a customer-first strategy. It's critical for businesses to have integrated, customizable, and comprehensive views into their customers’ and potential customers’ solution/product interests, customer service needs, and purchase history. A good CRM system should provide that view. All data is in a single location, viewable through optimized dashboards. Additionally, your marketing team can leverage CRM solutions to orchestrate personalized marketing and lead generation campaigns. These systems can help track all cross-channel interactions—from engagement to purchase. Mature cloud CRM solutions do more. They are fully integrated with back-office solutions to successfully support the entire customer journey. Because it manages prospect and customer engagement points across all channels, your CRM system can inform all your communications and marketing activities, delivering the 360-degree customer view needed for a truly connected omnichannel experience. Many different vendors have many different types of solutions. However, a few capabilities are must-haves. Be easy to use, or people won't use it Fit within your budget and provide an acceptable ROI Integrate well with your other software systems Provide accurate, consistent data for that much-needed, complete customer 360-degree view Types of CRM CRM software solutions, at their core, are used to manage customer relationships and sales interactions. Still, many businesses leverage these systems simply as a sales force automation tool. But these solutions, such as Oracle's, offer many more valuable capabilities that span a wide range of marketing and sales functions, including marketing, customer service, sales, and partner channel management. Today’s CRM software can support the entire customer journey. But what one company may need from a CRM system can be vastly different from what another company might require. To help you select the right CRM for your organization, it’s helpful to know that there are three main types of CRM solutions: collaborative, operational, and analytical. CRM and data Data is the most critical part of any CRM software solution. In fact, customer data is the starting point for all marketing and sales activities. Successful customer engagement and relationship strategies hinge on accurate, complete, and accessible customer profiles. Bad data comes from several places, including: Fraudulently entered data Keystroke errors Duplicate customer information Natural changes (company bankruptcy, job changes) Incomplete and inaccurate data can increase quickly to degrade the value of your CRM tools, resulting in unnecessary expenses. Conversely, when customer data is complete and accurate, businesses stand a better chance of reaching their target customers and prospects. In short, your data is a valuable asset. So it’s important to focus on collecting and optimizing these four CRM data types: Identity data Identity data includes descriptive details to identify customers, leads, and contacts. This data should be used for marketing segmentation. Descriptive data Descriptive data includes lifestyle details relevant to your contacts. It is what completes that all-important 360-degree view of leads and contacts. Quantitative data Quantitative data includes measurable data points that can help you interpret how your leads and contacts have interacted with you. Qualitative data Qualitative data can help you better understand your contacts’ intent, including search behaviours related to buying decisions. CRM vs. marketing automation Both CRM and marketing automation systems are data-driven. They focus on gathering, storing, and using data. For example, marketing automation systems gather leads by communicating with potential and current customers. Specifically, marketing automation looks to gather enough customer data points to show intent and then hands that person off to the sales team as a marketing-qualified lead (MQL). A CRM solution picks up where the marketing automation solution left off and works to convert those marketing-qualified leads into contacts. AI in CRM Discover the next generation of CRM (0:38) The best CRM systems offer robust analytics coupled with AI and machine learning. AI is the future of customer relationship management, going beyond contact management and sales force automation to truly helping you sell. AI in CRM can guide you toward the next-best actions and provide smart talking points—specific to each customer opportunity. AI also delivers timely customer intelligence that helps you optimize customer experience (CX) across marketing, sales, and customer service. CRM vs. CX When customer relationship management first arrived on the scene, businesses would capture data but not know what to do with it. Today, CRM systems are integrated with AI, which helps interpret and predict what that data means. CRM AI capabilities are the foundation to using a 360-degree view of the customer that will start them on their way to becoming your customer. As these AI enhancements continue to evolve, CX will continue to improve—and in turn, customer expectations will continue to increase. Your business needs to fully understand your customers (and how they buy) to not only meet their expectations but to provide them with compelling experiences. This is the future of CX and should serve as your guide to selecting the best CRM solution. How CRM improves customer experience A complete customer view is necessary for business success and growth. Without a CRM system, you'll struggle to develop that much-needed 360-degree view of the customer that you need to: Personalize customer interactions Automate business processes (with appropriate CX integrations) Track all customer interactions {Query} ========== What are 5 goals of Customer Relationship Management Systems implementation within an enterprise? {Task Instruction} ========== Only utilize the information in the article provided to answer the question, do not refer to any outside information. Answer the question in full sentences.",Internet/Technology,Find & Summarize,Text Transformation "In constructing your response, you are to exclusively rely on the information presented in the provided context source, avoiding all information from other external sources. Additionally, your response is to be presented in a paragraph format - Do not make use of markdown formatting.",What sort of differences exist in the various exceptions to the knock-and-announce rule?,"Law Enforcement Identification When Executing a Warrant Overview As noted above, amid recent calls for legislative changes to police practices, another area that has received attention concerns the authority for law enforcement officers to execute a warrant by entering a home without first seeking consensual entry by announcing themselves and their purpose. As a default, law enforcement officers must comply with the knock and announce rule— an “ancient” common-law doctrine, which generally requires officers to knock and announce their presence before entering a home to execute a search warrant. The Supreme Court has interpreted the Fourth Amendment’s reasonableness requirement as generally mandating compliance with the knock and announce rule. The knock and announce rule is also codified in a federal statute, but the Supreme Court has interpreted that statute as “prohibiting nothing” and “merely [authorizing] officers to damage property [upon entry] in certain instances.” When officers violate the knock and announce rule, they may be subject to civil lawsuits and “internal police discipline.” However, in Hudson v. Michigan the Supreme Court curtailed the remedies available for knock and announce violations by concluding that evidence obtained following such a violation is not subject to the exclusionary rule, which “prevents the government from using most evidence gathered in violation of the United States Constitution.” There are two closely related exceptions to the knock and announce rule, the first of which is for exigent circumstances. Exigent circumstances are those where the “police have a ‘reasonable suspicion’ that knocking and announcing would be dangerous, futile, or destructive to the purposes of the investigation.” Typical examples include instances where police believe that the suspect is armed or likely to destroy evidence. Exigent circumstances must be based on the “particular circumstances” of each case, and may not amount to a “blanket exception to the [knock and announce] requirement” for “entire categor[ies] of criminal activity.” For example, the Supreme Court rejected an assertion that “police officers are never required to knock and announce their presence when executing a search warrant in a felony drug investigation.” Instead, “in each case, it is the duty of a court confronted with the question to determine whether the facts and circumstances of the particular entry justified dispensing with the knock-and-announce requirement.” The second exception is for no-knock warrants, which provide explicit authority for judges to grant so-called “no-knock” entry in the warrant itself, upon a finding of certain factual predicates. The justifications for no-knock warrants are similar to, and sometimes described interchangeably with, the concept of exigent circumstances. No-knock warrants, and exigent circumstances, both typically involve instances where there is a risk that knocking and announcing would endanger officers or result in the destruction of evidence. A key distinction between no-knock warrants and no-knock entry pursuant to the exigent circumstances exception is temporal. With no-knock warrants, officers “have anticipated exigent circumstances before searching, and have asked for pre-search judicial approval to enter without knocking.” In contrast, when officers lack a no-knock warrant and enter without knocking due to exigent circumstances the justification for bypassing knock and announce requirements may arise as late as when the officers are at the door. A number of states have statutes that authorize magistrate judges to grant no-knock warrants in certain circumstances. Although a federal statute previously authorized no-knock warrants for certain drug searches, Congress repealed it. As a result, the legal status of federal no-knock search warrants is unsettled, although federal officers do sometimes employ no-knock warrants or act pursuant to no-knock warrants issued by state courts when serving on joint state-federal task forces. From a Fourth Amendment standpoint, the Supreme Court has indicated some approval of “[t]he practice of allowing magistrates to issue no-knock warrants . . . when sufficient cause to do so can be demonstrated ahead of time,” assuming that the practice does not amount to a blanket exception to knock and announce. However, one unresolved question is whether federal courts have authority to issue no- Congressional Research Service 4 knock warrants in the absence of a statute expressly providing that power, as federal courts “possess only that power authorized by Constitution and statute . . . .” The DOJ has concluded that federal courts are authorized to do so, in large part because the federal rule governing search warrants has been broadly interpreted by courts in other contexts to include specific searches that it does not expressly authorize. In one sense, the legal vitality of federal no-knock warrants may be of limited practical significance; as noted, federal law enforcement officers may still be permitted to enter a home without knocking and announcing if exigent circumstances are present. However, some courts have concluded that no-knock warrants shield officers from responsibility for independently assessing the existence of exigent circumstances at the time of entry. To the extent that is true, no-knock warrants could permit no-knock entry where the exigent circumstances exception would not—for example, in an instance where the factors that justified the no-knock warrant are no longer present at the time of entry. Relatedly, if a valid no-knock warrant provides such a shield against the responsibility of reassessing exigent circumstances at the time of entry, it could limit the availability of civil lawsuits as a remedy where officers disregard knock and announce requirements pursuant to a no-knock warrant, but exigent circumstances no longer exist at the time of entry.","In constructing your response, you are to exclusively rely on the information presented in the provided context source, avoiding all information from other external sources. Additionally, your response is to be presented in a paragraph format - Do not make use of markdown formatting. Law Enforcement Identification When Executing a Warrant Overview As noted above, amid recent calls for legislative changes to police practices, another area that has received attention concerns the authority for law enforcement officers to execute a warrant by entering a home without first seeking consensual entry by announcing themselves and their purpose. As a default, law enforcement officers must comply with the knock and announce rule— an “ancient” common-law doctrine, which generally requires officers to knock and announce their presence before entering a home to execute a search warrant. The Supreme Court has interpreted the Fourth Amendment’s reasonableness requirement as generally mandating compliance with the knock and announce rule. The knock and announce rule is also codified in a federal statute, but the Supreme Court has interpreted that statute as “prohibiting nothing” and “merely [authorizing] officers to damage property [upon entry] in certain instances.” When officers violate the knock and announce rule, they may be subject to civil lawsuits and “internal police discipline.” However, in Hudson v. Michigan the Supreme Court curtailed the remedies available for knock and announce violations by concluding that evidence obtained following such a violation is not subject to the exclusionary rule, which “prevents the government from using most evidence gathered in violation of the United States Constitution.” There are two closely related exceptions to the knock and announce rule, the first of which is for exigent circumstances. Exigent circumstances are those where the “police have a ‘reasonable suspicion’ that knocking and announcing would be dangerous, futile, or destructive to the purposes of the investigation.” Typical examples include instances where police believe that the suspect is armed or likely to destroy evidence. Exigent circumstances must be based on the “particular circumstances” of each case, and may not amount to a “blanket exception to the [knock and announce] requirement” for “entire categor[ies] of criminal activity.” For example, the Supreme Court rejected an assertion that “police officers are never required to knock and announce their presence when executing a search warrant in a felony drug investigation.” Instead, “in each case, it is the duty of a court confronted with the question to determine whether the facts and circumstances of the particular entry justified dispensing with the knock-and-announce requirement.” The second exception is for no-knock warrants, which provide explicit authority for judges to grant so-called “no-knock” entry in the warrant itself, upon a finding of certain factual predicates. The justifications for no-knock warrants are similar to, and sometimes described interchangeably with, the concept of exigent circumstances. No-knock warrants, and exigent circumstances, both typically involve instances where there is a risk that knocking and announcing would endanger officers or result in the destruction of evidence. A key distinction between no-knock warrants and no-knock entry pursuant to the exigent circumstances exception is temporal. With no-knock warrants, officers “have anticipated exigent circumstances before searching, and have asked for pre-search judicial approval to enter without knocking.” In contrast, when officers lack a no-knock warrant and enter without knocking due to exigent circumstances the justification for bypassing knock and announce requirements may arise as late as when the officers are at the door. A number of states have statutes that authorize magistrate judges to grant no-knock warrants in certain circumstances. Although a federal statute previously authorized no-knock warrants for certain drug searches, Congress repealed it. As a result, the legal status of federal no-knock search warrants is unsettled, although federal officers do sometimes employ no-knock warrants or act pursuant to no-knock warrants issued by state courts when serving on joint state-federal task forces. From a Fourth Amendment standpoint, the Supreme Court has indicated some approval of “[t]he practice of allowing magistrates to issue no-knock warrants . . . when sufficient cause to do so can be demonstrated ahead of time,” assuming that the practice does not amount to a blanket exception to knock and announce. However, one unresolved question is whether federal courts have authority to issue no- Congressional Research Service 4 knock warrants in the absence of a statute expressly providing that power, as federal courts “possess only that power authorized by Constitution and statute . . . .” The DOJ has concluded that federal courts are authorized to do so, in large part because the federal rule governing search warrants has been broadly interpreted by courts in other contexts to include specific searches that it does not expressly authorize. In one sense, the legal vitality of federal no-knock warrants may be of limited practical significance; as noted, federal law enforcement officers may still be permitted to enter a home without knocking and announcing if exigent circumstances are present. However, some courts have concluded that no-knock warrants shield officers from responsibility for independently assessing the existence of exigent circumstances at the time of entry. To the extent that is true, no-knock warrants could permit no-knock entry where the exigent circumstances exception would not—for example, in an instance where the factors that justified the no-knock warrant are no longer present at the time of entry. Relatedly, if a valid no-knock warrant provides such a shield against the responsibility of reassessing exigent circumstances at the time of entry, it could limit the availability of civil lawsuits as a remedy where officers disregard knock and announce requirements pursuant to a no-knock warrant, but exigent circumstances no longer exist at the time of entry. Legislation in the 116th Congress At least two bills introduced in the 116th Congress would change the legal landscape regarding unannounced home entry by law enforcement during execution of search warrants. (A third bill, the JUSTICE Act, while not directly altering existing practices, would require reporting on the use of noknock warrants.) In the House, one section of the Justice in Policing Act of 2020 (H.R. 7120) would establish that search warrants issued in federal drug cases must “require that a law enforcement officer execute the search warrant only after providing notice of his or her authority and purpose.” The bill would also require states and localities that receive certain federal funds to “have in effect a law that prohibits the issuance of a no-knock warrant in a drug case.” At least with respect to the requirement for states and localities in H.R. 7120, it appears that unannounced entry would still be permitted in exigent circumstances. The bill only requires states and localities to prohibit the issuance of no-knock warrantsin drug cases to receive the specified federal funding, and as noted above, it is well-established that law enforcement officers may dispense with the knock-andannounce requirement when they have reasonable suspicion of exigent circumstances regardless of whether the warrant authorizes no-knock entry. The more difficult question may be what effect the requirement for federal drug warrants in H.R. 7120 would have. Under the bill’s terms, all warrants authorized in federal drug cases would have to expressly require that they be executed “only after” a law enforcement officer has provided notice of his or her authority and purpose. As such, were the bill to become law, it could possibly create tension between the “exigent circumstances” exception to the knock and announce rule and the required terms of warrants under the new statute. For example, officers might encounter a situation where knocking and announcing would be “dangerous” or “destructive of the purposes of the investigation” and thus excused under Supreme Court doctrine, yet the terms of the warrant would still expressly require knocking and announcing without exception. In this scenario, the bill’s blanket requirement might produce uncertainty as to the officers’ authority. That said, though warrants would require notice under the proposal, and officers who did not comply with that requirement would violate the terms of the warrant, it is not clear that no-knock entry in such a circumstance would lead to consequences like evidence exclusion. In other contexts where warrants have been executed in ways that exceed the warrants’ terms, some courts have declined to suppress evidence in the absence of “extreme” violations or “flagrant disregard for the terms” at issue. A court might also interpret H.R. 7120 as implicitly incorporating the exigent circumstances exception. The Supreme Court has taken this view of the federal statute that codifies the common-law knock-and-announce rule and has observed more generally that when a magistrate declines to authorize no-knock entry in advance, that decision “should Congressional Research Service 5 LSB10499· VERSION 1 · NEW not be interpreted to remove the officers’ authority to exercise independent judgment concerning the wisdom of a no-knock entry at the time the warrant is being executed.” What sort of differences exist in the various exceptions to the knock-and-announce rule?",Legal,Concept Comparison,Q&A "Only use this document as a source, do not use any outside knowledge. ",What impact did Bratz doll have on Mattel?,"**Mattel: Overcoming Marketing and Manufacturing Challenges** It all started in a California garage workshop when Ruth and Elliot Handler and Matt Matson founded Mattel in 1945. The company started out making picture frames, but the founders soon recognized the profitability of the toy industry and switched their emphasis. Mattel became a publicly owned company in 1960, with sales exceeding $100 million by 1965. Over the next 40 years, Mattel went on to become the world’s largest toy company in terms of revenue. Today, Mattel, Inc. is a world leader in the design, manufacture, and marketing of family products. Well-known for toy brands such as Barbie, Fisher-Price, Disney, Hot Wheels, Matchbox, Tyco, Cabbage Patch Kids, and board games such as Scrabble, the company boasts nearly $6 billion in annual revenue. Headquartered in El Segundo, California, with offices in 36 countries, Mattel markets its products in more than 150 nations. In spite of its overall success, Mattel has had its share of losses over its history. During the mid to late 1990s, Mattel lost millions due to declining sales and bad business acquisitions. In January 1997, Jill Barad took over as Mattel’s CEO. Barad’s management style was characterized as strict, and her tenure at the helm proved challenging for many employees. Although Barad had been successful in building the Barbie brand to $2 billion near the end of the twentieth century, growth slowed rapidly after that time. Declining sales at outlets such as Toys ‘‘R’’ Us and the mismanaged acquisition of The Learning Company marked the start of some difficulties for the toy maker, including a dramatic 60 percent drop in stock price under Barad’s three-year stint as CEO. Barad accepted responsibility for these problems and resigned in 2000. The company soon installed Robert Eckert, a 23-year Kraft veteran, as chairman and CEO. During Eckert’s first three years on the job, the company’s stock price increased to over $20 per share, and Mattel was ranked fortieth on Business Week’s list of top-performing companies. Implementing techniques used by consumer-product companies, Eckert adopted a mission to bring stability and predictability to Mattel. He sold unprofitable units, streamlined work processes, and improved relations with retailers. Under Eckert, Mattel was granted the highly sought-after licensing agreement for products related to the Harry Potter series of books and movies. The company continued to flourish and build its reputation, even earning the Corporate Responsibility Award from UNICEF in 2003. By 2008, Mattel had fully realized a turnaround and was recognized as one of Fortune magazine’s ‘‘100 Best Companies to Work For’’ and Forbes magazine’s ‘‘100 Most Trustworthy U.S. Companies.’’ Mattel’s Core Products Barbie Among its many lines of popular toy products, Mattel is famous for owning top girls’ brands. In 1959, Mattel made the move that would establish them at the forefront of the toy industry. After seeing her daughter’s fascination with cutout paper dolls, Ruth suggested that a three-dimensional doll should be produced so that young girls could live out their dreams and fantasies. This doll was named ‘‘Barbie,’’ the nickname of Ruth and Elliot Handler’s daughter. The first Barbie doll sported open-toed shoes, a ponytail, sunglasses, earrings, and a zebra-striped bathing suit. Fashions and accessories were also available for the doll. Although buyers at the annual Toy Fair in New York took no interest in the Barbie doll, little girls of the time certainly did. The intense demand seen at the retail stores was insufficiently met for several years. Mattel just could not produce the Barbie dolls fast enough. Today, Barbie is Mattel’s flagship brand and its number one seller—routinely accounting for approximately half of Mattel’s sales revenue. This makes Barbie the best-selling fashion doll in most global markets. The Barbie line today includes dolls, accessories, Barbie software, and a broad assortment of licensed products such as books, apparel, food, home furnishings, home electronics, and movies. Although Barbie was introduced as a teenage fashion model, she has taken on almost every possible profession. She has also acquired numerous male and female friends and family over the years. Ken, Midge, Skipper, Christie, and others were introduced from the mid-1960s on. The Barbie line has even seen a disabled friend in a wheelchair: Share a Smile Becky. Barbie’s popularity has even broken stereotypes. Retrofitted versions of Barbie dolls, on sale in select San Francisco stores, feature ‘‘Hooker’’ Barbie, ‘‘Trailer Trash’’ Barbie, and ‘‘Drag Queen’’ Barbie. There are also numerous ‘‘alternative’’ Barbies, such as ‘‘Big Dyke’’ Barbie, but Mattel does not want the Barbie name to be used in these sales. Redressed and accessorized Barbies are okay with Mattel as long as no one practices trademark infringement. Barbie’s Popularity Slips Although Barbie remains a blockbuster by any standard, Barbie’s popularity has slipped over the past decade. There are two major reasons for Barbie’s slump. First, the changing lifestyles of today’s young girls are a concern for Mattel. Many young girls prefer to spend time with music, movies, or the Internet than play with traditional toys like dolls. Second, Barbie has suffered at the hands of new and innovative competition, including the Bratz doll line that gained significant market share during the early 2000s. The dolls, which featured contemporary, ethnic designs and skimpy clothes, were a stark contrast to Barbie and an immediate hit with young girls. In an attempt to recover, Mattel introduced the new line of My Scene dolls aimed at ‘‘tweens.’’ These dolls are trendier, look younger, and are considered to be more hip for this age group who is on the cusp of outgrowing playing with dolls. A website (http://www.myscene.com) engages girls in a variety of fun, engaging, and promotional activities. Barbie’s Legal Battle with MGA Entertainment Since 2004, Mattel has been embroiled in a bitter intellectual property battle with former employee Carter Bryant and MGA Entertainment, Inc., over rights to MGA’s popular Bratz dolls. Carter Bryant, an onagain/off-again Mattel employee, designed the Bratz dolls and pitched them to MGA. A few months after the pitch, Bryant left Mattel to work at MGA, which began producing Bratz in 2001. In 2002, Mattel launched an investigation into whether Bryant had designed the Bratz dolls while employed with Mattel. After two years of investigation, Mattel sued Bryant. A year later MGA fired off a suit of its own, claiming that Mattel’s My Scene dolls were an attempt to copy the Bratz line. Mattel answered by expanding its own lawsuit to include MGA and its CEO, Isaac Larian. For decades, Barbie had reigned supreme in the doll market. However, Bratz dolls gave Barbie a run for her money. In 2005, four years after the brand’s debut, Bratz sales were at $2 billion. By 2009, Barbie’s worldwide sales had fallen by 15 percent, although Bratz was not immune to sluggish sales either once consumers began to cut back on spending during the 2008–2009 recession. Much evidence points toward Bryant having conceived of Bratz dolls while at Mattel. Four years after the initial suit was filed, Bryant settled with Mattel under an undisclosed set of terms. However, although some decisions were made, the battle between Mattel and MGA has continued. In July 2008, a jury deemed MGA and its CEO liable for what it termed ‘‘intentional interference’’ regarding Bryant’s contract with Mattel. In August 2008, Mattel received damages of $100 million. Although Mattel first requested damages of $1.8 billion, the company was pleased with the principle behind the victory. MGA is appealing the decision. In December 2008, Mattel appeared to win another victory when a California judge banned MGA from making or selling Bratz dolls. The decision was devastating to the Bratz line, as retailers have avoided the brand in anticipation of Mattel’s takeover. Many industry analysts, however, expect Mattel to work out a deal with MGA in which MGA can continue to sell Bratz dolls as long as Mattel shares in the profits. MGA plans to appeal the court ruling. Whatever the outcome, Mattel has managed to gain some control over Barbie’s toughest competition. American Girl In 1998, Mattel acquired Pleasant Company, maker of the American Girl collection—a well-known line of historical dolls, books, and accessories. Originally, American Girl products were sold exclusively through catalogs. Mattel extended that base by selling American Girl accessories (not the dolls) in major chain stores like Walmart and Target. More recent efforts to increase brand awareness include the opening of American Girl Place shops in New York, Chicago, Los Angeles, Atlanta, Dallas, Boston, and Minneapolis. The New York store features three floors of dolls, accessories, and books in the heart of the 5th Avenue shopping district. The store also offers a cafe where girls can dine with their dolls and a stage production where young actresses bring American Girl stories to life. The American Girl collection is wildly popular with girls in the 7- to 12-year-old demographic. The dolls have a wholesome and educational image—the antithesis to Barbie. This move by Mattel represented a long-term strategy to reduce reliance on traditional products and to take away the stigma surrounding the ‘‘perfect image’’ of Barbie. Each American Girl doll lives during a specific time in American history, and all have stories that describe the hardships they face while maturing into young adults. For example, Felicity’s stories describe life in 1774 just prior to the Revolutionary War. Likewise, Josephina lives in New Mexico in 1824 during the rapid growth of the American West. Other dolls include Kaya (a Native American girl growing up in 1764), Elizabeth (Colonial Virginia), Kirsten (pioneer life in 1854), Addy (1864 during the Civil War), Samantha and Nellie (1904 New York), Kit (1934 during the Great Depression), Molly (1944 during World War II), and Emily (a British girl who comes to America during World War II). The American Girl brand includes several book series, accessories, clothing for dolls and girls, and a magazine that ranks in the top 10 American children’s magazines. Hot Wheels Hot Wheels roared into the toy world in 1968. More than 40 years later, the brand is hotter than ever and includes high-end collectibles, NASCAR (National Association for Stock Car Auto Racing) and Formula One models for adults, high-performance cars, track sets, and play sets for children of all ages. The brand is connected with racing circuits worldwide. More than 15 million boys ages 5 to 15 are avid collectors, each owning an average of 41 cars. ","{Query} ================== What impact did Bratz doll have on Mattel? {Instructions} ================== Only use this document as a source, do not use any outside knowledge. {Text Passage} ================== **Mattel: Overcoming Marketing and Manufacturing Challenges** It all started in a California garage workshop when Ruth and Elliot Handler and Matt Matson founded Mattel in 1945. The company started out making picture frames, but the founders soon recognized the profitability of the toy industry and switched their emphasis. Mattel became a publicly owned company in 1960, with sales exceeding $100 million by 1965. Over the next 40 years, Mattel went on to become the world’s largest toy company in terms of revenue. Today, Mattel, Inc. is a world leader in the design, manufacture, and marketing of family products. Well-known for toy brands such as Barbie, Fisher-Price, Disney, Hot Wheels, Matchbox, Tyco, Cabbage Patch Kids, and board games such as Scrabble, the company boasts nearly $6 billion in annual revenue. Headquartered in El Segundo, California, with offices in 36 countries, Mattel markets its products in more than 150 nations. In spite of its overall success, Mattel has had its share of losses over its history. During the mid to late 1990s, Mattel lost millions due to declining sales and bad business acquisitions. In January 1997, Jill Barad took over as Mattel’s CEO. Barad’s management style was characterized as strict, and her tenure at the helm proved challenging for many employees. Although Barad had been successful in building the Barbie brand to $2 billion near the end of the twentieth century, growth slowed rapidly after that time. Declining sales at outlets such as Toys ‘‘R’’ Us and the mismanaged acquisition of The Learning Company marked the start of some difficulties for the toy maker, including a dramatic 60 percent drop in stock price under Barad’s three-year stint as CEO. Barad accepted responsibility for these problems and resigned in 2000. The company soon installed Robert Eckert, a 23-year Kraft veteran, as chairman and CEO. During Eckert’s first three years on the job, the company’s stock price increased to over $20 per share, and Mattel was ranked fortieth on Business Week’s list of top-performing companies. Implementing techniques used by consumer-product companies, Eckert adopted a mission to bring stability and predictability to Mattel. He sold unprofitable units, streamlined work processes, and improved relations with retailers. Under Eckert, Mattel was granted the highly sought-after licensing agreement for products related to the Harry Potter series of books and movies. The company continued to flourish and build its reputation, even earning the Corporate Responsibility Award from UNICEF in 2003. By 2008, Mattel had fully realized a turnaround and was recognized as one of Fortune magazine’s ‘‘100 Best Companies to Work For’’ and Forbes magazine’s ‘‘100 Most Trustworthy U.S. Companies.’’ Mattel’s Core Products Barbie Among its many lines of popular toy products, Mattel is famous for owning top girls’ brands. In 1959, Mattel made the move that would establish them at the forefront of the toy industry. After seeing her daughter’s fascination with cutout paper dolls, Ruth suggested that a three-dimensional doll should be produced so that young girls could live out their dreams and fantasies. This doll was named ‘‘Barbie,’’ the nickname of Ruth and Elliot Handler’s daughter. The first Barbie doll sported open-toed shoes, a ponytail, sunglasses, earrings, and a zebra-striped bathing suit. Fashions and accessories were also available for the doll. Although buyers at the annual Toy Fair in New York took no interest in the Barbie doll, little girls of the time certainly did. The intense demand seen at the retail stores was insufficiently met for several years. Mattel just could not produce the Barbie dolls fast enough. Today, Barbie is Mattel’s flagship brand and its number one seller—routinely accounting for approximately half of Mattel’s sales revenue. This makes Barbie the best-selling fashion doll in most global markets. The Barbie line today includes dolls, accessories, Barbie software, and a broad assortment of licensed products such as books, apparel, food, home furnishings, home electronics, and movies. Although Barbie was introduced as a teenage fashion model, she has taken on almost every possible profession. She has also acquired numerous male and female friends and family over the years. Ken, Midge, Skipper, Christie, and others were introduced from the mid-1960s on. The Barbie line has even seen a disabled friend in a wheelchair: Share a Smile Becky. Barbie’s popularity has even broken stereotypes. Retrofitted versions of Barbie dolls, on sale in select San Francisco stores, feature ‘‘Hooker’’ Barbie, ‘‘Trailer Trash’’ Barbie, and ‘‘Drag Queen’’ Barbie. There are also numerous ‘‘alternative’’ Barbies, such as ‘‘Big Dyke’’ Barbie, but Mattel does not want the Barbie name to be used in these sales. Redressed and accessorized Barbies are okay with Mattel as long as no one practices trademark infringement. Barbie’s Popularity Slips Although Barbie remains a blockbuster by any standard, Barbie’s popularity has slipped over the past decade. There are two major reasons for Barbie’s slump. First, the changing lifestyles of today’s young girls are a concern for Mattel. Many young girls prefer to spend time with music, movies, or the Internet than play with traditional toys like dolls. Second, Barbie has suffered at the hands of new and innovative competition, including the Bratz doll line that gained significant market share during the early 2000s. The dolls, which featured contemporary, ethnic designs and skimpy clothes, were a stark contrast to Barbie and an immediate hit with young girls. In an attempt to recover, Mattel introduced the new line of My Scene dolls aimed at ‘‘tweens.’’ These dolls are trendier, look younger, and are considered to be more hip for this age group who is on the cusp of outgrowing playing with dolls. A website (http://www.myscene.com) engages girls in a variety of fun, engaging, and promotional activities. Barbie’s Legal Battle with MGA Entertainment Since 2004, Mattel has been embroiled in a bitter intellectual property battle with former employee Carter Bryant and MGA Entertainment, Inc., over rights to MGA’s popular Bratz dolls. Carter Bryant, an onagain/off-again Mattel employee, designed the Bratz dolls and pitched them to MGA. A few months after the pitch, Bryant left Mattel to work at MGA, which began producing Bratz in 2001. In 2002, Mattel launched an investigation into whether Bryant had designed the Bratz dolls while employed with Mattel. After two years of investigation, Mattel sued Bryant. A year later MGA fired off a suit of its own, claiming that Mattel’s My Scene dolls were an attempt to copy the Bratz line. Mattel answered by expanding its own lawsuit to include MGA and its CEO, Isaac Larian. For decades, Barbie had reigned supreme in the doll market. However, Bratz dolls gave Barbie a run for her money. In 2005, four years after the brand’s debut, Bratz sales were at $2 billion. By 2009, Barbie’s worldwide sales had fallen by 15 percent, although Bratz was not immune to sluggish sales either once consumers began to cut back on spending during the 2008–2009 recession. Much evidence points toward Bryant having conceived of Bratz dolls while at Mattel. Four years after the initial suit was filed, Bryant settled with Mattel under an undisclosed set of terms. However, although some decisions were made, the battle between Mattel and MGA has continued. In July 2008, a jury deemed MGA and its CEO liable for what it termed ‘‘intentional interference’’ regarding Bryant’s contract with Mattel. In August 2008, Mattel received damages of $100 million. Although Mattel first requested damages of $1.8 billion, the company was pleased with the principle behind the victory. MGA is appealing the decision. In December 2008, Mattel appeared to win another victory when a California judge banned MGA from making or selling Bratz dolls. The decision was devastating to the Bratz line, as retailers have avoided the brand in anticipation of Mattel’s takeover. Many industry analysts, however, expect Mattel to work out a deal with MGA in which MGA can continue to sell Bratz dolls as long as Mattel shares in the profits. MGA plans to appeal the court ruling. Whatever the outcome, Mattel has managed to gain some control over Barbie’s toughest competition. American Girl In 1998, Mattel acquired Pleasant Company, maker of the American Girl collection—a well-known line of historical dolls, books, and accessories. Originally, American Girl products were sold exclusively through catalogs. Mattel extended that base by selling American Girl accessories (not the dolls) in major chain stores like Walmart and Target. More recent efforts to increase brand awareness include the opening of American Girl Place shops in New York, Chicago, Los Angeles, Atlanta, Dallas, Boston, and Minneapolis. The New York store features three floors of dolls, accessories, and books in the heart of the 5th Avenue shopping district. The store also offers a cafe where girls can dine with their dolls and a stage production where young actresses bring American Girl stories to life. The American Girl collection is wildly popular with girls in the 7- to 12-year-old demographic. The dolls have a wholesome and educational image—the antithesis to Barbie. This move by Mattel represented a long-term strategy to reduce reliance on traditional products and to take away the stigma surrounding the ‘‘perfect image’’ of Barbie. Each American Girl doll lives during a specific time in American history, and all have stories that describe the hardships they face while maturing into young adults. For example, Felicity’s stories describe life in 1774 just prior to the Revolutionary War. Likewise, Josephina lives in New Mexico in 1824 during the rapid growth of the American West. Other dolls include Kaya (a Native American girl growing up in 1764), Elizabeth (Colonial Virginia), Kirsten (pioneer life in 1854), Addy (1864 during the Civil War), Samantha and Nellie (1904 New York), Kit (1934 during the Great Depression), Molly (1944 during World War II), and Emily (a British girl who comes to America during World War II). The American Girl brand includes several book series, accessories, clothing for dolls and girls, and a magazine that ranks in the top 10 American children’s magazines. Hot Wheels Hot Wheels roared into the toy world in 1968. More than 40 years later, the brand is hotter than ever and includes high-end collectibles, NASCAR (National Association for Stock Car Auto Racing) and Formula One models for adults, high-performance cars, track sets, and play sets for children of all ages. The brand is connected with racing circuits worldwide. More than 15 million boys ages 5 to 15 are avid collectors, each owning an average of 41 cars. ",Retail/Product,Effect Analysis,Q&A Draw your answer only from the text below.,"Please describe modifications to insulin that have resulted in improvements in safety, effectiveness, and convenience to patients. Please describe just one modification that pertains to the three areas listed above.","Insulin is a small protein composed of 51 amino acids. Because insulin is derived from a living organism, it is considered a biologic, or biological product (the text box below defines biologics and describes their regulatory framework). Since the discovery of insulin, incremental modifications over time have resulted in improvements in safety, effectiveness, and convenience to patients.5 Insulin was discovered in 1921 by two University of Toronto researchers who sold their U.S. patents to the university for $1 each, so the drug could be produced at a reasonable cost.6 Facing challenges manufacturing sufficient quantities of insulin for the North American market, in 1923, the University of Toronto team partnered with—and licensed manufacturing rights to—several pharmaceutical companies.7 Commercially available insulins today differ from the insulin discovered by the Toronto team. The original insulin was a short-acting product with a duration of action of 6-8 hours, making it less suitable for providing 24-hour coverage. In the late 1930s through the 1950s, researchers altered regular insulin by adding substances (e.g., protamine and zinc) to gain longer action, resulting in what are now called intermediate-acting insulins. One such advance, Neutral Protamine Hagedorn (NPH), was patented in 1946. It allowed for the combination of two types of insulin (long-acting and short-acting insulin) in premixed vials, making a single daily injection possible for some patients.8 At that time, insulin was obtained by extraction from animals. As animal-derived products, insulins were subject to problems inherent to animal-tissue extracts, such as impurities, which could cause immunologic reactions impacting their safety and effectiveness.9 Insulin production has changed over the years, as researchers altered insulin to improve the patient experience. In the late 1970s, advancements in biotechnology allowed for the replacement of animal insulin extracted from cattle and pig pancreases with human insulin produced using recombinant DNA technology. In 1982, Eli Lilly brought the first recombinant human insulins to the U.S. market: Humulin R (regular) and N (NPH). In the late 1980s, advancements in recombinant technology allowed scientists to modify insulin’s structure to improve its physiological effects. This advancement resulted in the development of insulin analogs, which more closely replicate normal insulin patterns in the body. In 1996, Humalog (insulin lispro) became the first rapid-acting insulin analog to be approved, followed by Novolog (insulin aspart) in 2000, and others thereafter.10 This same technology allowed for the development of long-acting insulin analogs. In 2000, Lantus (insulin glargine) became the first long-acting insulin analog, and others followed.11 Some studies have questioned whether the more expensive analogs provide an advantage over regular insulin in controlling glucose levels or preventing diabetes-related complications in patients with type 2 diabetes.12 In addition to modifications to insulin itself, associated delivery devices, such as insulin pens, have provided a more convenient route of administration for patients compared with syringes. Subsequent patenting of these modifications upon approval has shielded insulin products from competition for extended periods. As new insulin products entered the market, insulin manufacturers discontinued many older versions of these products. The regulatory framework created challenges for bringing generic insulins to the market.13 ","Draw your answer only from the text below. Please describe modifications to insulin that have resulted in improvements in safety, effectiveness, and convenience to patients. Please describe just one modification that pertains to the three areas listed above. Insulin is a small protein composed of 51 amino acids. Because insulin is derived from a living organism, it is considered a biologic, or biological product (the text box below defines biologics and describes their regulatory framework). Since the discovery of insulin, incremental modifications over time have resulted in improvements in safety, effectiveness, and convenience to patients.5 Insulin was discovered in 1921 by two University of Toronto researchers who sold their U.S. patents to the university for $1 each, so the drug could be produced at a reasonable cost.6 Facing challenges manufacturing sufficient quantities of insulin for the North American market, in 1923, the University of Toronto team partnered with—and licensed manufacturing rights to—several pharmaceutical companies.7 Commercially available insulins today differ from the insulin discovered by the Toronto team. The original insulin was a short-acting product with a duration of action of 6-8 hours, making it less suitable for providing 24-hour coverage. In the late 1930s through the 1950s, researchers altered regular insulin by adding substances (e.g., protamine and zinc) to gain longer action, resulting in what are now called intermediate-acting insulins. One such advance, Neutral Protamine Hagedorn (NPH), was patented in 1946. It allowed for the combination of two types of insulin (long-acting and short-acting insulin) in premixed vials, making a single daily injection possible for some patients.8 At that time, insulin was obtained by extraction from animals. As animal-derived products, insulins were subject to problems inherent to animal-tissue extracts, such as impurities, which could cause immunologic reactions impacting their safety and effectiveness.9 Insulin production has changed over the years, as researchers altered insulin to improve the patient experience. In the late 1970s, advancements in biotechnology allowed for the replacement of animal insulin extracted from cattle and pig pancreases with human insulin produced using recombinant DNA technology. In 1982, Eli Lilly brought the first recombinant human insulins to the U.S. market: Humulin R (regular) and N (NPH). In the late 1980s, advancements in recombinant technology allowed scientists to modify insulin’s structure to improve its physiological effects. This advancement resulted in the development of insulin analogs, which more closely replicate normal insulin patterns in the body. In 1996, Humalog (insulin lispro) became the first rapid-acting insulin analog to be approved, followed by Novolog (insulin aspart) in 2000, and others thereafter.10 This same technology allowed for the development of long-acting insulin analogs. In 2000, Lantus (insulin glargine) became the first long-acting insulin analog, and others followed.11 Some studies have questioned whether the more expensive analogs provide an advantage over regular insulin in controlling glucose levels or preventing diabetes-related complications in patients with type 2 diabetes.12 In addition to modifications to insulin itself, associated delivery devices, such as insulin pens, have provided a more convenient route of administration for patients compared with syringes. Subsequent patenting of these modifications upon approval has shielded insulin products from competition for extended periods. As new insulin products entered the market, insulin manufacturers discontinued many older versions of these products. The regulatory framework created challenges for bringing generic insulins to the market.13 ",Medical,Fact Finding,Q&A Respond using only information in the context block provided. Do not use any acronyms in your response.,"List every influence of the pandemic in a bullet list, using only three sentences for each point.","One of the main ways in which the economy impacts CRE is via interest rates. Higher interest rates in both the short term and the long term are likely to affect industries that rely on credit, such as CRE.6 Tighter credit conditions can affect the ability of builders to obtain financing for new construction. Higher borrowing costs can in turn reduce CRE growth or increase rents for CRE occupants. If CRE owners ultimately cannot make payments on higher cost loans, this could result in losses for those individuals and institutions that finance CRE. In recent years, interest rates rose significantly, one of several fundamental shifts in the economic environment. Prior to the pandemic, inflation was low and stable despite over a decade of historically low interest rates and accommodative monetary policy.7 This led to low borrowing costs. However, inflation began rising in 2021, reaching highs not seen since the 1980s, and interest rates have also risen significantly. In response to inflation, the Federal Reserve (Fed) raised the federal funds rate (FFR) over five percentage points between March 2022 and July 2023.8 Other interest rates in the economy responded to the Fed’s actions, resulting in a higher interest rate environment and higher borrowing costs. The Fed has yet to begin lowering rates but is expected to begin lowering rates in late 2024. The Fed projects that the appropriate monetary policy path will result in an FFR of 2.8% in the longer run—relatively low in historical terms but higher than most of the period since the 2007-2009 financial crisis and recession.9 CRE is also likely to be affected by other economic conditions, including demand and investment behavior. Despite the Fed’s efforts to reduce demand through interest rate hikes, the economy has remained unexpectedly robust in the face of monetary tightening particularly with respect to metrics that could affect CRE, such as consumer spending and labor market conditions. While monetary tightening has weighed somewhat on investment, including residential investment (which includes multifamily CRE properties), consumer spending has been strong, which could help retail CRE properties. Overall, the labor market closed out 2023 relatively strong with unemployment at 3.7%, and economic growth largely beat expectations in 2023 at 2.5% for the year. 10 While the first quarter of 2024 did show an increase in the unemployment rate, higher than-anticipated inflation, and slower growth, the economy remains in relatively good condition, with growth at a strong 3.0% in the second quarter. A continued strong economic performance could help buoy CRE markets despite higher borrowing costs. Economic Outlook for CRE Since the Fed began raising rates in response to high inflation in March 2022, it has been trying to achieve a soft landing—a return to low inflation while maintaining moderate economic growth and full employment.11 Achieving a soft landing after sustained monetary policy tightening is notoriously difficult. Historically, most periods of sustained tightening have been followed by hard landings, meaning recessions. Nonetheless, the recent period of monetary policy tightening has so far resulted in falling inflation without a significant decline in employment or economic activity. A soft landing would be advantageous to CRE, as it would be to all sectors of the economy. All else equal, low and stable inflation, moderate growth, and a strong labor market would lead to robust and sustainable demand, including consumer spending and business investment. A hard landing would lead to lower demand and likely lower CRE growth. In terms of CRE, the path of interest rates may be of particular policy interest given the role they play in CRE. In the projected scenario of a soft landing, interest rates are likely to decrease beginning this year. As of June 2024, the Fed’s Federal Open Market Committee projected that one rate decrease in the second half of 2024 would be appropriate, with the median projected appropriate policy path resulting in an FFR of 5.1% at the end of 2024, 4.1% at the end of 2025, and 3.1% at the end of 2026.12 In August 2024, Fed Chair Jerome Powell stated that “the time has come for policy to adjust,” indicating likely rate cuts beginning in September 2024.13 However, changes in the FFR are unlikely to affect longer-term interest rates by the same magnitude. For example, an Organisation for Economic Co-operation and Development model for long-term interest rates forecasts that the rate on a 10-year government security will be 3.9% in the third quarter of 2025.14 The yield on a 10-year Treasury as of July 2, 2024, was 4.43%.15 Easing credit conditions could boost construction and CRE growth generally, although there is a high degree of uncertainty about how much interest rates will ultimately fall. While most economists are not predicting an imminent recession, it is possible that one could occur nonetheless. For example, the recent increases in the unemployment rate have some concerned that the economy is weakening.16 In this scenario, the Fed may opt to lower the FFR either more quickly or by a larger magnitude than it may otherwise have done. Such an economic contraction would likely hurt CRE growth, but the monetary response would help it to recover, all else equal. Structural Changes Affecting CRE Properties While certain broad economic conditions may be expected to affect CRE broadly, the impacts can look quite different based on type. For example, COVID-19 was a shock to all CRE segments as well as the broader economy. However, based on the nature of the pandemic, demand for office or retail space took relatively big hits, as restrictions on in-person contact made spending in brick and-mortar stores difficult and resulted in increased telework. 17 While the performance of CRE sectors has largely been mixed, the office sector in particular is continuing to show signs of stress and has the highest potential to cause stress in the banking sector. For example, while vacancy rates are up since pre-pandemic for multifamily and retail, they are elevated to a lesser degree than in the office sector, which shows record-level vacancy rates. In the industrial sector, vacancy rates have fallen since the beginning of the pandemic. Other metrics, such as rents, tell a less consistent story across sectors over this period. Nonetheless, as of the second quarter of 2024, quarterly effective rent growth was positive in all sectors apart from office.18 The Office Sector The pandemic resulted in a structural shift away from in-office work, resulting in high vacancy rates for this segment of CRE that persist today. With the rise in telework, many companies renting space from the office subsector of CRE owners are not renewing their leases. This is evidenced by higher office vacancy rates (see Figure 1), which continue to rise, hitting a record 20.1% in the second quarter of 2024, according to Moody’s Analytics, a credit rating agency. 19 Consequently, the number of office property rental leases has declined, generating lower revenues and potentially imperiling the ability of the property owners to pay back financing costs. According to Moody’s, effective rents have been negative or largely unchanged for the four quarters ending in Q2 2024 (see Figure 1).20 To minimize losses, some CRE owners have been willing to break leases and renegotiate terms with tenants. 21 Further, while norms surrounding remote and hybrid work have shifted in the past few years owing to the COVID-19 pandemic, the extent to which remote work will shift the CRE landscape is uncertain. While rates of office utilization are lower than prior to the pandemic (i.e., February 2020), according to some estimates, they have, on average, trended upward in selected major cities after the initial onset (i.e., March 2020) of the pandemic (see Figure 2). ","System instruction: [Respond using only information in the context block provided. Do not use any acronyms in your response.] User question: [List every influence of the pandemic in a bullet list, using only three sentences for each point.] Context block: [One of the main ways in which the economy impacts CRE is via interest rates. Higher interest rates in both the short term and the long term are likely to affect industries that rely on credit, such as CRE.6 Tighter credit conditions can affect the ability of builders to obtain financing for new construction. Higher borrowing costs can in turn reduce CRE growth or increase rents for CRE occupants. If CRE owners ultimately cannot make payments on higher cost loans, this could result in losses for those individuals and institutions that finance CRE. In recent years, interest rates rose significantly, one of several fundamental shifts in the economic environment. Prior to the pandemic, inflation was low and stable despite over a decade of historically low interest rates and accommodative monetary policy.7 This led to low borrowing costs. However, inflation began rising in 2021, reaching highs not seen since the 1980s, and interest rates have also risen significantly. In response to inflation, the Federal Reserve (Fed) raised the federal funds rate (FFR) over five percentage points between March 2022 and July 2023.8 Other interest rates in the economy responded to the Fed’s actions, resulting in a higher interest rate environment and higher borrowing costs. The Fed has yet to begin lowering rates but is expected to begin lowering rates in late 2024. The Fed projects that the appropriate monetary policy path will result in an FFR of 2.8% in the longer run—relatively low in historical terms but higher than most of the period since the 2007-2009 financial crisis and recession.9 CRE is also likely to be affected by other economic conditions, including demand and investment behavior. Despite the Fed’s efforts to reduce demand through interest rate hikes, the economy has remained unexpectedly robust in the face of monetary tightening particularly with respect to metrics that could affect CRE, such as consumer spending and labor market conditions. While monetary tightening has weighed somewhat on investment, including residential investment (which includes multifamily CRE properties), consumer spending has been strong, which could help retail CRE properties. Overall, the labor market closed out 2023 relatively strong with unemployment at 3.7%, and economic growth largely beat expectations in 2023 at 2.5% for the year. 10 While the first quarter of 2024 did show an increase in the unemployment rate, higher than-anticipated inflation, and slower growth, the economy remains in relatively good condition, with growth at a strong 3.0% in the second quarter. A continued strong economic performance could help buoy CRE markets despite higher borrowing costs. Economic Outlook for CRE Since the Fed began raising rates in response to high inflation in March 2022, it has been trying to achieve a soft landing—a return to low inflation while maintaining moderate economic growth and full employment.11 Achieving a soft landing after sustained monetary policy tightening is notoriously difficult. Historically, most periods of sustained tightening have been followed by hard landings, meaning recessions. Nonetheless, the recent period of monetary policy tightening has so far resulted in falling inflation without a significant decline in employment or economic activity. A soft landing would be advantageous to CRE, as it would be to all sectors of the economy. All else equal, low and stable inflation, moderate growth, and a strong labor market would lead to robust and sustainable demand, including consumer spending and business investment. A hard landing would lead to lower demand and likely lower CRE growth. In terms of CRE, the path of interest rates may be of particular policy interest given the role they play in CRE. In the projected scenario of a soft landing, interest rates are likely to decrease beginning this year. As of June 2024, the Fed’s Federal Open Market Committee projected that one rate decrease in the second half of 2024 would be appropriate, with the median projected appropriate policy path resulting in an FFR of 5.1% at the end of 2024, 4.1% at the end of 2025, and 3.1% at the end of 2026.12 In August 2024, Fed Chair Jerome Powell stated that “the time has come for policy to adjust,” indicating likely rate cuts beginning in September 2024.13 However, changes in the FFR are unlikely to affect longer-term interest rates by the same magnitude. For example, an Organisation for Economic Co-operation and Development model for long-term interest rates forecasts that the rate on a 10-year government security will be 3.9% in the third quarter of 2025.14 The yield on a 10-year Treasury as of July 2, 2024, was 4.43%.15 Easing credit conditions could boost construction and CRE growth generally, although there is a high degree of uncertainty about how much interest rates will ultimately fall. While most economists are not predicting an imminent recession, it is possible that one could occur nonetheless. For example, the recent increases in the unemployment rate have some concerned that the economy is weakening.16 In this scenario, the Fed may opt to lower the FFR either more quickly or by a larger magnitude than it may otherwise have done. Such an economic contraction would likely hurt CRE growth, but the monetary response would help it to recover, all else equal. Structural Changes Affecting CRE Properties While certain broad economic conditions may be expected to affect CRE broadly, the impacts can look quite different based on type. For example, COVID-19 was a shock to all CRE segments as well as the broader economy. However, based on the nature of the pandemic, demand for office or retail space took relatively big hits, as restrictions on in-person contact made spending in brick and-mortar stores difficult and resulted in increased telework. 17 While the performance of CRE sectors has largely been mixed, the office sector in particular is continuing to show signs of stress and has the highest potential to cause stress in the banking sector. For example, while vacancy rates are up since pre-pandemic for multifamily and retail, they are elevated to a lesser degree than in the office sector, which shows record-level vacancy rates. In the industrial sector, vacancy rates have fallen since the beginning of the pandemic. Other metrics, such as rents, tell a less consistent story across sectors over this period. Nonetheless, as of the second quarter of 2024, quarterly effective rent growth was positive in all sectors apart from office.18 The Office Sector The pandemic resulted in a structural shift away from in-office work, resulting in high vacancy rates for this segment of CRE that persist today. With the rise in telework, many companies renting space from the office subsector of CRE owners are not renewing their leases. This is evidenced by higher office vacancy rates (see Figure 1), which continue to rise, hitting a record 20.1% in the second quarter of 2024, according to Moody’s Analytics, a credit rating agency. 19 Consequently, the number of office property rental leases has declined, generating lower revenues and potentially imperiling the ability of the property owners to pay back financing costs. According to Moody’s, effective rents have been negative or largely unchanged for the four quarters ending in Q2 2024 (see Figure 1).20 To minimize losses, some CRE owners have been willing to break leases and renegotiate terms with tenants. 21 Further, while norms surrounding remote and hybrid work have shifted in the past few years owing to the COVID-19 pandemic, the extent to which remote work will shift the CRE landscape is uncertain. While rates of office utilization are lower than prior to the pandemic (i.e., February 2020), according to some estimates, they have, on average, trended upward in selected major cities after the initial onset (i.e., March 2020) of the pandemic (see Figure 2).] ",Financial,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",I bought my kids some new toothpaste and it contains the ingredient xylitol. I want to know more about what that is so I found this article. Please explain what xylitol is and what benefits it has. Use at least 400 words in your response.,"Should I Switch to Xylitol Toothpaste? Dental benefits Xylitol toothpaste Vs. fluoride In children Gum and candy Daily intake Side effects FAQ Takeaway Some research suggests that xylitol toothpaste may benefit your teeth, such as preventing cavities. However, research is mixed. More studies are needed to fully support its dental health benefits. Xylitol is a sugar alcohol. Although it occursTrusted Source naturally in some fruits, it’s considered an artificial sweetener. Some research suggests that xylitol may have several dental benefits. However, the American Academy of Pediatric Dentistry (AAPD) doesn’t support using xylitol toothpaste because there isn’t enough research on its effectiveness for dental health, and the current research is mixed. Keep reading to learn more about the possible dental health benefits and side effects of xylitol toothpaste, as well as how to use it. Xylitol and dental health benefits Xylitol may be an effective defenseTrusted Source against the bacteria Streptococcus mutans (S. mutans). This type of cariogenic, or cavity-causing, bacteria is a key contributor to tooth decay and enamel breakdown. Sugar serves as food for the cariogenic bacteria that live in your mouth. When those bacteria feed on fermentable sugars, they produce lactic acid that damages tooth enamel. This damage can eventually lead to cavities. Xylitol is an unfermentable sugar alcohol that the bacteria can’t process. That means no lactic acid is produced to damage the enamel. Xylitol may also help prevent dental plaque, which may lead to cavities. Benefits of xylitol toothpaste Several studies have found that xylitol toothpaste may be an effective delivery system for xylitol. However, the research is mixed on how much xylitol is needed to experience notable benefits. For instance, a 2023 study found that using 25% xylitol toothpaste twice daily for 24 months significantly reduced levels of S. mutans in the mouth. The researchers concluded that xylitol toothpaste may be an effective home remedy for preventing cavities. A 2024 studyTrusted Source found similar results when using 25% xylitol toothpaste twice daily for 3 months, while a 2022 reviewTrusted Source found that products containing xylitol, such as chewing gum and toothpaste, helped prevent cavities. On the other hand, the AAPD found that taking xylitol less than three times daily had no protective effects, which differs from the positive results above. However, the AAPD did note that consuming 5 to 10 grams (g) of xylitol three times daily may help reduce cavities by up to 80%. ADVERTISEMENT Compare Medicare Advantage Plans See a list of Medicare Advantage plans in your area that may be suited to your unique needs with HelloMedicare™. We offer Medicare Advantage plans in All 50 States Multiple Insurance Carriers Available Compare Plans Medicare Costs Defined Xylitol toothpaste vs. fluoride toothpaste Research comparing xylitol toothpaste and fluoride toothpaste is limited. A small 2018 studyTrusted Source found that fluoride toothpaste was more effective at reducing S. mutans than xylitol toothpaste. Some xylitol proponents suggest that it’s more effective when combined with fluoride in toothpaste. Xylitol helps protect the teeth from damage, and fluoride helps repair any damage that the teeth might sustain. A 2015 reviewTrusted Source of 10 studies compared fluoride toothpaste to fluoride toothpaste with 10% xylitol added. When children used xylitol-fluoride toothpaste for 2.5 to 3 years, their cavities were reduced by an additional 13%. That said, the evidence was deemed to be of low quality. However, a 2014 studyTrusted Source found no significant difference in tooth decay reduction between children using xylitol-fluoride toothpaste and those using fluoride-only toothpaste. More research is needed to compare the effects of fluoride and xylitol toothpaste. Xylitol toothpaste for children Some studies have found that xylitol toothpaste may be an effective strategy for reducing cavities in kids. The AAPD has endorsed xylitol as part of a complete strategy to prevent tooth decay or cavities. However, due to mixed and limited research, the AAPD doesn’t recommend using xylitol toothpaste for children. Xylitol chewing gum and candy According to the AAPD, some research has found that chewing may enhance xylitol’s anti-cariogenic, or anti-tooth decay, effect. This means that chewing gum, lozenges, and candies may be more effective at preventing cavities than toothpaste. A 2014 study also found that erythritol candy was significantly more effective at reducing cavities than xylitol candy. However, more research is needed. How much xylitol you need The research on how much xylitol you need per day is mixed. For instance, a 2014 review suggests that a daily dose of 6 to 10 gTrusted Source could help prevent carries. However, the AAPD notes that three daily doses of 5 to 10 g, for a daily total of 15 to 30 g, are needed to experience dental benefits. Side effects of xylitol Xylitol is digested slowly in the large intestine. This may result in its primary side effects, which may include: flatulence diarrhea more frequent bowel movements It’s also important to note that xylitol is especially toxic to dogs. If your dog eats xylitol toothpaste — or xylitol in any form — take them to the veterinarian immediately. Make sure to bring along the packaging from the xylitol product for the vet’s reference. Frequently asked questions Is xylitol toothpaste good for your teeth? Some research suggests xylitol toothpaste could help reduce plaque buildup and bacteria that may lead to cavities. However, more research is needed. Is there xylitol in Crest toothpaste? Some types of Crest toothpaste may have xylitol, such as Crest 3D white. However, if you want xylitol in your toothpaste, it’s best to read the labels because not all toothpaste contains xylitol. The bottom line Xylitol is a sugar replacement that could help prevent cavities and tooth decay. Some research suggests that xylitol toothpaste may have a significant impact on cavity prevention. However, toothpaste may not be the most effective delivery system for xylitol. If you’re considering switching to a toothpaste with xylitol, speak with a dentist first. They could help you decide whether it’s right for you and provide suggestions to help you prevent cavities. This may include modifying your oral hygiene routine and recommending regular visits to the dentist.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I bought my kids some new toothpaste and it contains the ingredient xylitol. I want to know more about what that is so I found this article. Please explain what xylitol is and what benefits it has. Use at least 400 words in your response. {passage 0} ========== Should I Switch to Xylitol Toothpaste? Dental benefits Xylitol toothpaste Vs. fluoride In children Gum and candy Daily intake Side effects FAQ Takeaway Some research suggests that xylitol toothpaste may benefit your teeth, such as preventing cavities. However, research is mixed. More studies are needed to fully support its dental health benefits. Xylitol is a sugar alcohol. Although it occursTrusted Source naturally in some fruits, it’s considered an artificial sweetener. Some research suggests that xylitol may have several dental benefits. However, the American Academy of Pediatric Dentistry (AAPD) doesn’t support using xylitol toothpaste because there isn’t enough research on its effectiveness for dental health, and the current research is mixed. Keep reading to learn more about the possible dental health benefits and side effects of xylitol toothpaste, as well as how to use it. Xylitol and dental health benefits Xylitol may be an effective defenseTrusted Source against the bacteria Streptococcus mutans (S. mutans). This type of cariogenic, or cavity-causing, bacteria is a key contributor to tooth decay and enamel breakdown. Sugar serves as food for the cariogenic bacteria that live in your mouth. When those bacteria feed on fermentable sugars, they produce lactic acid that damages tooth enamel. This damage can eventually lead to cavities. Xylitol is an unfermentable sugar alcohol that the bacteria can’t process. That means no lactic acid is produced to damage the enamel. Xylitol may also help prevent dental plaque, which may lead to cavities. Benefits of xylitol toothpaste Several studies have found that xylitol toothpaste may be an effective delivery system for xylitol. However, the research is mixed on how much xylitol is needed to experience notable benefits. For instance, a 2023 study found that using 25% xylitol toothpaste twice daily for 24 months significantly reduced levels of S. mutans in the mouth. The researchers concluded that xylitol toothpaste may be an effective home remedy for preventing cavities. A 2024 studyTrusted Source found similar results when using 25% xylitol toothpaste twice daily for 3 months, while a 2022 reviewTrusted Source found that products containing xylitol, such as chewing gum and toothpaste, helped prevent cavities. On the other hand, the AAPD found that taking xylitol less than three times daily had no protective effects, which differs from the positive results above. However, the AAPD did note that consuming 5 to 10 grams (g) of xylitol three times daily may help reduce cavities by up to 80%. ADVERTISEMENT Compare Medicare Advantage Plans See a list of Medicare Advantage plans in your area that may be suited to your unique needs with HelloMedicare™. We offer Medicare Advantage plans in All 50 States Multiple Insurance Carriers Available Compare Plans Medicare Costs Defined Xylitol toothpaste vs. fluoride toothpaste Research comparing xylitol toothpaste and fluoride toothpaste is limited. A small 2018 studyTrusted Source found that fluoride toothpaste was more effective at reducing S. mutans than xylitol toothpaste. Some xylitol proponents suggest that it’s more effective when combined with fluoride in toothpaste. Xylitol helps protect the teeth from damage, and fluoride helps repair any damage that the teeth might sustain. A 2015 reviewTrusted Source of 10 studies compared fluoride toothpaste to fluoride toothpaste with 10% xylitol added. When children used xylitol-fluoride toothpaste for 2.5 to 3 years, their cavities were reduced by an additional 13%. That said, the evidence was deemed to be of low quality. However, a 2014 studyTrusted Source found no significant difference in tooth decay reduction between children using xylitol-fluoride toothpaste and those using fluoride-only toothpaste. More research is needed to compare the effects of fluoride and xylitol toothpaste. Xylitol toothpaste for children Some studies have found that xylitol toothpaste may be an effective strategy for reducing cavities in kids. The AAPD has endorsed xylitol as part of a complete strategy to prevent tooth decay or cavities. However, due to mixed and limited research, the AAPD doesn’t recommend using xylitol toothpaste for children. Xylitol chewing gum and candy According to the AAPD, some research has found that chewing may enhance xylitol’s anti-cariogenic, or anti-tooth decay, effect. This means that chewing gum, lozenges, and candies may be more effective at preventing cavities than toothpaste. A 2014 study also found that erythritol candy was significantly more effective at reducing cavities than xylitol candy. However, more research is needed. How much xylitol you need The research on how much xylitol you need per day is mixed. For instance, a 2014 review suggests that a daily dose of 6 to 10 gTrusted Source could help prevent carries. However, the AAPD notes that three daily doses of 5 to 10 g, for a daily total of 15 to 30 g, are needed to experience dental benefits. Side effects of xylitol Xylitol is digested slowly in the large intestine. This may result in its primary side effects, which may include: flatulence diarrhea more frequent bowel movements It’s also important to note that xylitol is especially toxic to dogs. If your dog eats xylitol toothpaste — or xylitol in any form — take them to the veterinarian immediately. Make sure to bring along the packaging from the xylitol product for the vet’s reference. Frequently asked questions Is xylitol toothpaste good for your teeth? Some research suggests xylitol toothpaste could help reduce plaque buildup and bacteria that may lead to cavities. However, more research is needed. Is there xylitol in Crest toothpaste? Some types of Crest toothpaste may have xylitol, such as Crest 3D white. However, if you want xylitol in your toothpaste, it’s best to read the labels because not all toothpaste contains xylitol. The bottom line Xylitol is a sugar replacement that could help prevent cavities and tooth decay. Some research suggests that xylitol toothpaste may have a significant impact on cavity prevention. However, toothpaste may not be the most effective delivery system for xylitol. If you’re considering switching to a toothpaste with xylitol, speak with a dentist first. They could help you decide whether it’s right for you and provide suggestions to help you prevent cavities. This may include modifying your oral hygiene routine and recommending regular visits to the dentist. https://www.healthline.com/health/xylitol-toothpaste#takeaway",Medical,Effect Analysis,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Compare how technology has affected children's attention space to how reading affects it. What are the technological advances that negatively shifted the way children's attention span works? Also what are some that positively affects attention span? Give me no more than 750 words.,"How Technology Is Changing the Way Children Think and Focus Are your children prepared to think and focus for success in 21st-century life? Posted December 4, 2012 | Reviewed by Lybi Ma Key points Attention is a highly malleable quality and most directly influenced by the environment in which it is used. The internet creates a learning environment in which consistent attention is impossible, imagination is unnecessary, and memory is inhibited. Video games improve visual-spatial capabilities, increase attentional ability, reaction times, and the ability to identify details among clutter. Thinking. The capacity to reflect, reason, and draw conclusions based on our experiences, knowledge, and insights. It’s what makes us human and has enabled us to communicate, create, build, advance, and become civilized. Thinking encompasses so many aspects of who our children are and what they do, from observing, learning, remembering, questioning, and judging to innovating, arguing, deciding, and acting. There is also little doubt that all of the new technologies, led by the internet, are shaping the way we think in ways obvious and subtle, deliberate and unintentional, and advantageous and detrimental The uncertain reality is that, with this new technological frontier in its infancy and developments emerging at a rapid pace, we have neither the benefit of historical hindsight nor the time to ponder or examine the value and cost of these advancements in terms of how it influences our children’s ability to think. There is, however, a growing body of research that technology can be both beneficial and harmful to different ways in which children think. Moreover, this influence isn’t just affecting children on the surface of their thinking. Rather, because their brains are still developing and malleable, frequent exposure by so-called digital natives to technology is actually wiring the brain in ways very different than in previous generations. What is clear is that, as with advances throughout history, the technology that is available determines how our brains develop. For example, as the technology writer Nicholas Carr has observed, the emergence of reading encouraged our brains to be focused and imaginative. In contrast, the rise of the internet is strengthening our ability to scan information rapidly and efficiently. The effects of technology on children are complicated, with both benefits and costs. Whether technology helps or hurts in the development of your children’s thinking depends on what specific technology is used and how and what frequency it is used. At least early in their lives, the power to dictate your children’s relationship with technology and, as a result, its influence on them, from synaptic activity to conscious thought. Over the next several weeks, I’m going to focus on the areas in which the latest thinking and research has shown technology to have the greatest influence on how children think: attention, information overload, decision making, and memory/learning. Importantly, all of these areas are ones in which you can have a counteracting influence on how technology affects your children. Attention You can think of attention as the gateway to thinking. Without it, other aspects of thinking, namely, perception, memory, language, learning, creativity, reasoning, problem-solving, and decision making are greatly diminished or can’t occur at all. The ability of your children to learn to focus effectively and consistently lays the foundation for almost all aspects of their growth and is fundamental to their development into successful and happy people. Attention has been found to be a highly malleable quality and most directly influenced by the environment in which it is used. This selective attention can be found in the animal kingdom in which different species develop attentional skills that help them function and survive. For example, wolves, lions, tigers, and other predators have highly tuned visual attention that enables them to spot and track their prey. In contrast, their prey, including deer and antelope, have well-developed auditory attention that allows them to hear approaching predators. In both cases, animals’ attentional abilities have developed based on the environment in which they live. The same holds true for human development. Whether infant recognition of their parents’ faces or students paying attention in class, children’s immediate environment determines the kind of attention that they develop. In generations past, for example, children directed considerable amounts of their time to reading, an activity that offered few distractions and required intense and sustained attention, imagination, and memory. The advent of television altered that attention by offering children visual stimuli, fragmented attention, and little need for imagination. Then the internet was invented and children were thrust into a vastly different environment in which, because distraction is the norm, consistent attention is impossible, imagination is unnecessary, and memory is inhibited. Technology conditions the brain to pay attention to information very differently than reading. The metaphor that Nicholas Carr uses is the difference between scuba diving and jet skiing. Book reading is like scuba diving in which the diver is submerged in a quiet, visually restricted, slow-paced setting with few distractions and, as a result, is required to focus narrowly and think deeply on the limited information that is available to them. In contrast, using the internet is like jet skiing, in which the jet skier is skimming along the surface of the water at high speed, exposed to a broad vista, surrounded by many distractions, and only able to focus fleetingly on any one thing. In fact, studies have shown that reading uninterrupted text results in faster completion and better understanding, recall, and learning than those who read text filled with hyperlinks and ads. Those who read a text-only version of a presentation, as compared to one that included video, found the presentation to be more engaging, informative, and entertaining, a finding contrary to conventional wisdom, to be sure. Additionally, contrary to conventional educational wisdom, students who were allowed internet access during class didn’t recall the lecture nor did they perform as well on a test of the material as those who weren’t “wired” during class. Finally, reading develops reflection, critical thinking, problem-solving, and vocabulary better than visual media. Exposure to technology isn’t all bad. Research shows that, for example, video games and other screen media improve visual-spatial capabilities, increase attentional ability, reaction times, and the capacity to identify details among clutter. Also, rather than making children stupid, it may just be making them different. For example, the ubiquitous use of internet search engines is causing children to become less adept at remembering things and more skilled at remembering where to find things. Given the ease with which information can be found these days, it only stands to reason that knowing where to look is becoming more important for children than actually knowing something. Not having to retain information in our brain may allow it to engage in more “higher-order” processing such as contemplation, critical thinking, and problem-solving. What does all this mean for raising your children? The bottom line is that too much screen time and not enough other activities, such as reading, playing games, and good old unstructured and imaginative play, will result in your children having their brains wired in ways that may make them less, not more, prepared to thrive in this crazy new world of technology.","[question] Compare how technology has affected children's attention space to how reading affects it. What are the technological advances that negatively shifted the way children's attention span works? Also what are some that positively affects attention span? Give me no more than 750 words. ===================== [text] How Technology Is Changing the Way Children Think and Focus Are your children prepared to think and focus for success in 21st-century life? Posted December 4, 2012 | Reviewed by Lybi Ma Key points Attention is a highly malleable quality and most directly influenced by the environment in which it is used. The internet creates a learning environment in which consistent attention is impossible, imagination is unnecessary, and memory is inhibited. Video games improve visual-spatial capabilities, increase attentional ability, reaction times, and the ability to identify details among clutter. Thinking. The capacity to reflect, reason, and draw conclusions based on our experiences, knowledge, and insights. It’s what makes us human and has enabled us to communicate, create, build, advance, and become civilized. Thinking encompasses so many aspects of who our children are and what they do, from observing, learning, remembering, questioning, and judging to innovating, arguing, deciding, and acting. There is also little doubt that all of the new technologies, led by the internet, are shaping the way we think in ways obvious and subtle, deliberate and unintentional, and advantageous and detrimental The uncertain reality is that, with this new technological frontier in its infancy and developments emerging at a rapid pace, we have neither the benefit of historical hindsight nor the time to ponder or examine the value and cost of these advancements in terms of how it influences our children’s ability to think. There is, however, a growing body of research that technology can be both beneficial and harmful to different ways in which children think. Moreover, this influence isn’t just affecting children on the surface of their thinking. Rather, because their brains are still developing and malleable, frequent exposure by so-called digital natives to technology is actually wiring the brain in ways very different than in previous generations. What is clear is that, as with advances throughout history, the technology that is available determines how our brains develop. For example, as the technology writer Nicholas Carr has observed, the emergence of reading encouraged our brains to be focused and imaginative. In contrast, the rise of the internet is strengthening our ability to scan information rapidly and efficiently. The effects of technology on children are complicated, with both benefits and costs. Whether technology helps or hurts in the development of your children’s thinking depends on what specific technology is used and how and what frequency it is used. At least early in their lives, the power to dictate your children’s relationship with technology and, as a result, its influence on them, from synaptic activity to conscious thought. Over the next several weeks, I’m going to focus on the areas in which the latest thinking and research has shown technology to have the greatest influence on how children think: attention, information overload, decision making, and memory/learning. Importantly, all of these areas are ones in which you can have a counteracting influence on how technology affects your children. Attention You can think of attention as the gateway to thinking. Without it, other aspects of thinking, namely, perception, memory, language, learning, creativity, reasoning, problem-solving, and decision making are greatly diminished or can’t occur at all. The ability of your children to learn to focus effectively and consistently lays the foundation for almost all aspects of their growth and is fundamental to their development into successful and happy people. Attention has been found to be a highly malleable quality and most directly influenced by the environment in which it is used. This selective attention can be found in the animal kingdom in which different species develop attentional skills that help them function and survive. For example, wolves, lions, tigers, and other predators have highly tuned visual attention that enables them to spot and track their prey. In contrast, their prey, including deer and antelope, have well-developed auditory attention that allows them to hear approaching predators. In both cases, animals’ attentional abilities have developed based on the environment in which they live. The same holds true for human development. Whether infant recognition of their parents’ faces or students paying attention in class, children’s immediate environment determines the kind of attention that they develop. In generations past, for example, children directed considerable amounts of their time to reading, an activity that offered few distractions and required intense and sustained attention, imagination, and memory. The advent of television altered that attention by offering children visual stimuli, fragmented attention, and little need for imagination. Then the internet was invented and children were thrust into a vastly different environment in which, because distraction is the norm, consistent attention is impossible, imagination is unnecessary, and memory is inhibited. Technology conditions the brain to pay attention to information very differently than reading. The metaphor that Nicholas Carr uses is the difference between scuba diving and jet skiing. Book reading is like scuba diving in which the diver is submerged in a quiet, visually restricted, slow-paced setting with few distractions and, as a result, is required to focus narrowly and think deeply on the limited information that is available to them. In contrast, using the internet is like jet skiing, in which the jet skier is skimming along the surface of the water at high speed, exposed to a broad vista, surrounded by many distractions, and only able to focus fleetingly on any one thing. In fact, studies have shown that reading uninterrupted text results in faster completion and better understanding, recall, and learning than those who read text filled with hyperlinks and ads. Those who read a text-only version of a presentation, as compared to one that included video, found the presentation to be more engaging, informative, and entertaining, a finding contrary to conventional wisdom, to be sure. Additionally, contrary to conventional educational wisdom, students who were allowed internet access during class didn’t recall the lecture nor did they perform as well on a test of the material as those who weren’t “wired” during class. Finally, reading develops reflection, critical thinking, problem-solving, and vocabulary better than visual media. Exposure to technology isn’t all bad. Research shows that, for example, video games and other screen media improve visual-spatial capabilities, increase attentional ability, reaction times, and the capacity to identify details among clutter. Also, rather than making children stupid, it may just be making them different. For example, the ubiquitous use of internet search engines is causing children to become less adept at remembering things and more skilled at remembering where to find things. Given the ease with which information can be found these days, it only stands to reason that knowing where to look is becoming more important for children than actually knowing something. Not having to retain information in our brain may allow it to engage in more “higher-order” processing such as contemplation, critical thinking, and problem-solving. What does all this mean for raising your children? The bottom line is that too much screen time and not enough other activities, such as reading, playing games, and good old unstructured and imaginative play, will result in your children having their brains wired in ways that may make them less, not more, prepared to thrive in this crazy new world of technology. https://www.psychologytoday.com/us/blog/the-power-of-prime/201212/how-technology-is-changing-the-way-children-think-and-focus?msockid=314010dc793467982e9a043678f6665c ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Concept Comparison,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","What are medications used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD)? In a bulleted format, please also review these medications in further detail such as mechanism of action and risks.","Treatment Before starting treatment, it is important to identify the target outcomes to guide the therapy decision. Drug treatment should be based on a thorough assessment and should always be part of a comprehensive treatment plan that includes psychosocial, behavioural, and educational advice and interventions. Psychotherapy combined with medication may play a role in treating behavioural problems, organisational issues and psychiatric comorbidities [57]. In Italy, an ADHD diagnosis can only be made at a regional referral centre approved by the Italian Ministry of Health. Treatment guidelines put forward by the Ministry of Health and based on European guidelines, specify that pharmacological treatment can only be initiated after failure of cognitive behavioural therapy over a period of 6 months or longer has been demonstrated. Patients must first be enrolled in the ADHD medication registry before treatment with MPH or atomoxetine (ATX) can be prescribed. Behavioural therapy and pharmacological treatment have both been shown to benefit ADHD patients. A longitudinal study of the efficacy of different treatments (an intensively monitored medication program, behavioural therapy, combination of medication and behavioural therapy or treatment as usual by community care) showed after 8-year follow-up that all four of the original treatment groups had a similar outcome: all showed improvement in comparison with pretreatment baseline scores, but none demonstrated superiority [58]. The fronto-subcortical circuits (lateral prefrontal cortex, dorsal anterior cingulate cortex, caudate, and putamen) associated with ADHD are rich in catecholamines, which are involved in the mechanism of action of medications used to treat this disorder. Neuropharmacological studies have provided evidence that ADHD involves dysregulation of both noradrenaline (NE) and DA neurotransmitter systems [59]. MPH treatment causes an increase in DA signalling through multiple actions, including blockade of the DA reuptake transporter, amplification of DA response duration, disinhibition of the dopamine D2 receptor and amplification of DA tone [60]. MPH is also an inhibitor of NE re-uptake. ATX is a selective inhibitor of synaptic re-uptake, and in vivo, it specifically increases extracellular levels of DA in the prefrontal cortex but not in the striatum; probably by modulating cortical synaptic DA uptake via the NE transporter [61]. Dextroamphetamine increases the synaptic activity of DA and NE by increasing the release of the neurotransmitters into the synaptic cleft, decreasing reuptake back into the presynaptic neuron, and inhibiting their catabolism [62]. Strong evidence exists indicating that stimulant medications, such as MPH and dextroamphetamine, and the non-stimulant ATX, are effective in improving ADHD symptoms [63]. Guanfacine is a selective alpha2A adrenergic receptor agonist, which improves working memory by stimulating postsynaptic alpha2A adrenoceptors, strengthening the functional connectivity of prefrontal cortex networks [64]. Guanfacine has also been shown to be effective in reducing ADHD symptoms [65, 66]. Table 1 summarises the most important characteristics of these pharmacological treatments for ADHD. Only ATX and immediate release MPH are currently approved for the treatment of ADHD in Italy. Table 1 Clinical characteristics of ADHD pharmacotherapies Full size table ADHD pharmacological therapies are generally well-tolerated (Table 1). However, concerns surrounding the cardiovascular safety of some of these drugs has prompted a recent examination of the effects of ATX and MPH on blood pressure (BP), heart rate (HR), and ECG parameters. MPH appears to cause minor increases in BP and HR, with no strong data to suggest that itincreases the QT interval. Limited data suggest that ATX may increase BP and HR in the short term; in the long term it appears to only increase BP. The effects of ATX on QT interval remain uncertain. Because the current evidence is based on research that has not been specifically designed to investigate the cardiovascular effects of these drugs, it is difficult to draw firm conclusions [67]. Both MPH and ATX significantly increase activation in key cortical and subcortical regions subserving attention and executive functions. Therefore, alterations in dopaminergic and noradrenergic function are apparently necessary for the clinical efficacy of pharmacological treatment of ADHD [68]. However MPH and ATX have both common and distinct neural effects, consistent with the observation that while many children respond well to both treatments, some respond preferentially to one or the other. Although pharmacotherapy for ADHD appears to prepare and facilitate the brain for learning, experiential programs need to elicit compensatory development in the brain. The clinical amelioration of some children after environmental experiential inputs and early cognitive/behavioural treatment could indicate outcome-associated plastic brain response [69]. One year of treatment with MPH may be beneficial to show enduring normalisation of neural correlates of attention. However, little is known about the long-term effects of stimulants on the functional organisation of the developing brain [70]. Recent findings have shown that chronic MPH use in drug-naive boys with ADHD enhanced neuropsychological functioning on ""recognition memory"" component tasks with modest executive demands [71]. Patients receiving pharmacological treatment for ADHD should always be closely monitored for both common and unusual potentially severe adverse effects.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. What are medications used in the treatment of Attention Deficit Hyperactivity Disorder (ADHD)? In a bulleted format, please also review these medications in further detail such as mechanism of action and risks. Treatment Before starting treatment, it is important to identify the target outcomes to guide the therapy decision. Drug treatment should be based on a thorough assessment and should always be part of a comprehensive treatment plan that includes psychosocial, behavioural, and educational advice and interventions. Psychotherapy combined with medication may play a role in treating behavioural problems, organisational issues and psychiatric comorbidities [57]. In Italy, an ADHD diagnosis can only be made at a regional referral centre approved by the Italian Ministry of Health. Treatment guidelines put forward by the Ministry of Health and based on European guidelines, specify that pharmacological treatment can only be initiated after failure of cognitive behavioural therapy over a period of 6 months or longer has been demonstrated. Patients must first be enrolled in the ADHD medication registry before treatment with MPH or atomoxetine (ATX) can be prescribed. Behavioural therapy and pharmacological treatment have both been shown to benefit ADHD patients. A longitudinal study of the efficacy of different treatments (an intensively monitored medication program, behavioural therapy, combination of medication and behavioural therapy or treatment as usual by community care) showed after 8-year follow-up that all four of the original treatment groups had a similar outcome: all showed improvement in comparison with pretreatment baseline scores, but none demonstrated superiority [58]. The fronto-subcortical circuits (lateral prefrontal cortex, dorsal anterior cingulate cortex, caudate, and putamen) associated with ADHD are rich in catecholamines, which are involved in the mechanism of action of medications used to treat this disorder. Neuropharmacological studies have provided evidence that ADHD involves dysregulation of both noradrenaline (NE) and DA neurotransmitter systems [59]. MPH treatment causes an increase in DA signalling through multiple actions, including blockade of the DA reuptake transporter, amplification of DA response duration, disinhibition of the dopamine D2 receptor and amplification of DA tone [60]. MPH is also an inhibitor of NE re-uptake. ATX is a selective inhibitor of synaptic re-uptake, and in vivo, it specifically increases extracellular levels of DA in the prefrontal cortex but not in the striatum; probably by modulating cortical synaptic DA uptake via the NE transporter [61]. Dextroamphetamine increases the synaptic activity of DA and NE by increasing the release of the neurotransmitters into the synaptic cleft, decreasing reuptake back into the presynaptic neuron, and inhibiting their catabolism [62]. Strong evidence exists indicating that stimulant medications, such as MPH and dextroamphetamine, and the non-stimulant ATX, are effective in improving ADHD symptoms [63]. Guanfacine is a selective alpha2A adrenergic receptor agonist, which improves working memory by stimulating postsynaptic alpha2A adrenoceptors, strengthening the functional connectivity of prefrontal cortex networks [64]. Guanfacine has also been shown to be effective in reducing ADHD symptoms [65, 66]. Table 1 summarises the most important characteristics of these pharmacological treatments for ADHD. Only ATX and immediate release MPH are currently approved for the treatment of ADHD in Italy. Table 1 Clinical characteristics of ADHD pharmacotherapies Full size table ADHD pharmacological therapies are generally well-tolerated (Table 1). However, concerns surrounding the cardiovascular safety of some of these drugs has prompted a recent examination of the effects of ATX and MPH on blood pressure (BP), heart rate (HR), and ECG parameters. MPH appears to cause minor increases in BP and HR, with no strong data to suggest that itincreases the QT interval. Limited data suggest that ATX may increase BP and HR in the short term; in the long term it appears to only increase BP. The effects of ATX on QT interval remain uncertain. Because the current evidence is based on research that has not been specifically designed to investigate the cardiovascular effects of these drugs, it is difficult to draw firm conclusions [67]. Both MPH and ATX significantly increase activation in key cortical and subcortical regions subserving attention and executive functions. Therefore, alterations in dopaminergic and noradrenergic function are apparently necessary for the clinical efficacy of pharmacological treatment of ADHD [68]. However MPH and ATX have both common and distinct neural effects, consistent with the observation that while many children respond well to both treatments, some respond preferentially to one or the other. Although pharmacotherapy for ADHD appears to prepare and facilitate the brain for learning, experiential programs need to elicit compensatory development in the brain. The clinical amelioration of some children after environmental experiential inputs and early cognitive/behavioural treatment could indicate outcome-associated plastic brain response [69]. One year of treatment with MPH may be beneficial to show enduring normalisation of neural correlates of attention. However, little is known about the long-term effects of stimulants on the functional organisation of the developing brain [70]. Recent findings have shown that chronic MPH use in drug-naive boys with ADHD enhanced neuropsychological functioning on ""recognition memory"" component tasks with modest executive demands [71]. Patients receiving pharmacological treatment for ADHD should always be closely monitored for both common and unusual potentially severe adverse effects. https://link.springer.com/article/10.1186/1824-7288-36-79",Medical,Fact Finding,Q&A All information in your response must come from the provided text. Do not use any outside information.,What are the leading arguments around private equity firms trying to increase revenue and reduce costs in healthcare?,"A 2021 report from the Medicare Payment Advisory Commission (MedPAC) found that private equity investments in health care substantially expanded in the preceding 20 years, particularly with respect to acquisitions of health care providers, including hospitals, physician groups, and nursing homes. While the overall significance of these investments to the health care sector is disputed, they have attracted regulatory, legislative, and academic interest, particularly in the midst of ongoing conversations about health care quality and costs. Scrutiny often focuses on the structure and incentives of private equity investment in health care. Private equity funds typically aim to acquire portfolio companies, increase their value, and exit from these investments, generally in a defined time frame. The structure of private equity can involve an array of corporate entities, which may generally shield fund managers and investors from liability. Regulators have expressed concern that these institutional features may give private equity firms an “undue focus on short-term profits and aggressive cost-cutting” that creates unique risks relative to other market participants, with impacts on patient care and competition. For example, MedPAC’s report details ongoing debates regarding the effects of private equity efforts to increase profitability in health care investments by increasing revenue while reducing costs. On the other hand, private equity representatives and other stakeholders argue that such efforts can improve both efficiency and patient care, and that private equity has been scapegoated for broader issues in the health care system. In December 2023, the Biden Administration announced that federal agencies, including the Department of Justice (DOJ), the Department of Health and Human Services (HHS), and the Federal Trade Commission (FTC), would take increased actions to lower health care costs, increase quality, and protect consumers. As part of this effort, the agencies released a Request for Information (RFI) soliciting public comments on the effects of private equity investments on patients and health care workers. The agencies argued that “[a]cademic research and agency experience in enforcement actions” have demonstrated that “patients, health care workers, and others may suffer negative consequences” as a result of these investments in the health care sector. Although there is limited federal law that directly addresses private equity ownership in health care, private equity firms and funds have recently faced claims alongside their portfolio companies in the health care sector under federal laws concerning both fraudulent and anticompetitive behavior. Legal commentators have noted the increased legal risk such trends create for private equity investors, whose involvement in managing portfolio businesses may support alleged knowledge of wrongdoing. This Legal Sidebar explores recent regulatory and enforcement activities involving private equity investments in health care under federal antitrust law and the False Claims Act, including efforts to hold private equity firms and funds directly liable alongside portfolio companies. The term private equity is often used to refer to a variety of investments that typically pool private funds from specific, qualified investors for a set period of time and use them to purchase controlling interests in operating businesses, known as portfolio companies. Private equity funds are generally structured as limited partnerships; the general partners manage the fund’s investments, and limited partners are those that invest in the fund but are not directly involved in its operation. A private equity firm may serve as the general partner for multiple funds, each with their own limited partners and portfolio companies. The qualified investors who invest as limited partners include pension plans, other private funds, foreign institutional investors, insurance companies, and high-net-worth individuals. Investments in portfolio companies could take the form of leveraged buyouts. For more information on the private equity industry generally, including its structure, size, and common terminology, see CRS Report R47053, Private Equity and Capital Markets Policy, by Eva Su. The typical structure of a private equity fund will thus involve several separate entities, all of which are distinct from the portfolio companies controlled by the fund. Portfolio companies may themselves consist of a collection of separate legal entities, including corporations and limited liability companies (LLCs). Under general principles of corporate law, the shareholders of a corporation and the members of an LLC are ordinarily not liable for the entity’s obligations. Instead, they risk only the amount they have invested in the business. These principles do not always shield owners from liability. In some rare circumstances, the corporate entity may be disregarded and liability imposed upon the company’s owners for corporate conduct, a process called piercing the corporate veil. Owners of a company may also be held directly liable for their own conduct, separate from the company’s conduct or liability. ","All information in your response must come from the provided text. Do not use any outside information. A 2021 report from the Medicare Payment Advisory Commission (MedPAC) found that private equity investments in health care substantially expanded in the preceding 20 years, particularly with respect to acquisitions of health care providers, including hospitals, physician groups, and nursing homes. While the overall significance of these investments to the health care sector is disputed, they have attracted regulatory, legislative, and academic interest, particularly in the midst of ongoing conversations about health care quality and costs. Scrutiny often focuses on the structure and incentives of private equity investment in health care. Private equity funds typically aim to acquire portfolio companies, increase their value, and exit from these investments, generally in a defined time frame. The structure of private equity can involve an array of corporate entities, which may generally shield fund managers and investors from liability. Regulators have expressed concern that these institutional features may give private equity firms an “undue focus on short-term profits and aggressive cost-cutting” that creates unique risks relative to other market participants, with impacts on patient care and competition. For example, MedPAC’s report details ongoing debates regarding the effects of private equity efforts to increase profitability in health care investments by increasing revenue while reducing costs. On the other hand, private equity representatives and other stakeholders argue that such efforts can improve both efficiency and patient care, and that private equity has been scapegoated for broader issues in the health care system. In December 2023, the Biden Administration announced that federal agencies, including the Department of Justice (DOJ), the Department of Health and Human Services (HHS), and the Federal Trade Commission (FTC), would take increased actions to lower health care costs, increase quality, and protect consumers. As part of this effort, the agencies released a Request for Information (RFI) soliciting public comments on the effects of private equity investments on patients and health care workers. The agencies argued that “[a]cademic research and agency experience in enforcement actions” have demonstrated that “patients, health care workers, and others may suffer negative consequences” as a result of these investments in the health care sector. Although there is limited federal law that directly addresses private equity ownership in health care, private equity firms and funds have recently faced claims alongside their portfolio companies in the health care sector under federal laws concerning both fraudulent and anticompetitive behavior. Legal commentators have noted the increased legal risk such trends create for private equity investors, whose involvement in managing portfolio businesses may support alleged knowledge of wrongdoing. This Legal Sidebar explores recent regulatory and enforcement activities involving private equity investments in health care under federal antitrust law and the False Claims Act, including efforts to hold private equity firms and funds directly liable alongside portfolio companies. The term private equity is often used to refer to a variety of investments that typically pool private funds from specific, qualified investors for a set period of time and use them to purchase controlling interests in operating businesses, known as portfolio companies. Private equity funds are generally structured as limited partnerships; the general partners manage the fund’s investments, and limited partners are those that invest in the fund but are not directly involved in its operation. A private equity firm may serve as the general partner for multiple funds, each with their own limited partners and portfolio companies. The qualified investors who invest as limited partners include pension plans, other private funds, foreign institutional investors, insurance companies, and high-net-worth individuals. Investments in portfolio companies could take the form of leveraged buyouts. For more information on the private equity industry generally, including its structure, size, and common terminology, see CRS Report R47053, Private Equity and Capital Markets Policy, by Eva Su. The typical structure of a private equity fund will thus involve several separate entities, all of which are distinct from the portfolio companies controlled by the fund. Portfolio companies may themselves consist of a collection of separate legal entities, including corporations and limited liability companies (LLCs). Under general principles of corporate law, the shareholders of a corporation and the members of an LLC are ordinarily not liable for the entity’s obligations. Instead, they risk only the amount they have invested in the business. These principles do not always shield owners from liability. In some rare circumstances, the corporate entity may be disregarded and liability imposed upon the company’s owners for corporate conduct, a process called piercing the corporate veil. Owners of a company may also be held directly liable for their own conduct, separate from the company’s conduct or liability. What are the leading arguments around private equity firms trying to increase revenue and reduce costs in healthcare?",Financial,Concept Comparison,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",My vet told me he thinks my dog has pancreatitis. I'm worried I have done something to cause it. What are the signs and symptoms of this? Are certain breeds prone to this and what are some risk factors? He wants me to bring him in for testing. What will they do to him?,"Key Points Pancreatitis in dogs is potentially life-threatening — know the signs to look for. If you suspect your dog may have pancreatitis, a call to the veterinarian quickly is vital. There are a number of causes and risk factors that can bring on pancreatitis, though it often seems to hit out of the blue. emergency Pancreatitis in dogs is one of those conditions that owners must be informed about before it strikes because the warning signs may not always be obvious at first, the symptoms might be mistaken for something less serious, and yet it’s potentially life-threatening. The medical definition of pancreatitis is simple: “inflammation of the pancreas.” But like all serious conditions, there is more to it than that. Because it is dangerous, a suspected case of pancreatitis needs to be addressed by a veterinarian as quickly as possible and not dealt with by “DIY” treatments. As with all medical issues, even the best online resource is not a replacement for the medical guidance from your vet. Before looking at the details of pancreatitis, let’s take away the “ititis” and explain the small but vital organ itself: The pancreas is responsible for releasing enzymes that aid in digestion. When the organ is working normally, the enzymes become active only when they reach the small intestine. In a dog with pancreatitis, however, the enzymes activate when they’re released, inflaming and causing damage to the pancreas and its surrounding tissue and other organs. According to the Whole Dog Journal, the enzymes can actually begin to digest the pancreas itself, which causes extreme pain to your dog. pancreatitis xray Classic signs of pancreatitis in dogs Hunched back Repeated vomiting (either several times within a few hours or periodically over several days) Pain or distention of the abdomen (dog appears uncomfortable or bloated) Diarrhea Loss of appetite Dehydration Weakness/lethargy Fever If your dog exhibits one of these signs, and only infrequently, monitor her. But if she exhibits multiple signs at once, and repeatedly, a call to the veterinarian quickly is vital. Dehydration and pancreatitis in dogs Dehydration is due to a greater fluid loss than fluid intake. Diarrhea or vomiting can cause dehydration, but those signs together will cause a greater fluid deficit and dehydration because the dog’s fluid input (drinking) cannot keep up with the fluid losses. If the diarrhea becomes bloody, the condition worsens and the dehydration can become an emergency. Other factors such as fever require increase fluid intake and can lead to dehydration along with other metabolic issues such as kidney disease, etc. Blood in a dog’s stool indicates a loos and significant inflammatory response requiring a veterinarian’s attention but it can be cause by a multitude of factors, from ulceration to parasites. Dehydration is a serious condition that can lead to death. It is an emergency and requires immediate veterinary care. Any lethargic dog who is not drinking water or cannot hold water down should be suspect of dehydration and examined by a veterinarian. Dry mucous membranes (such as gums) may be a quick way of assessing dehydration but as always, when in doubt, consult with your veterinarian. Cane Corso laying down in the shade outdoors. ©Evelina - stock.adobe.com Causes of pancreatitis in dogs There are a number of causes and risk factors that can bring on pancreatitis. Though often the attack appears seemingly out of the blue. Among them are: A high-fat diet This is a major cause of pancreatitis, especially for a dog who gets one large helping of fatty food in one sitting A history of dietary indiscretion (a medical term for saying your dog will eat anything) Obesity Hypothyroidism (or other endocrine diseases) Severe blunt trauma Diabetes mellitus Certain medications or other toxins These include cholinesterase inhibitors, calcium, potassium bromide, phenobarbital, l-asparaginase, estrogen, salicylates, azathioprine, thiazide diuretics, and vinca alkaloids. There may, in some cases, be a genetic predisposition. Certain breeds or types of dogs have been associated with higher risks of pancreatitis such as Miniature Schnauzers and some of the smaller toy and terrier breeds. More about those fats: Human food is especially dangerous, though even high-fat dog food may cause pancreatitis. So owner vigilance is particularly required around holidays and other festive occasions—they can bring well-meaning guests who slip your buddy a fatty piece of lamb, or a tray of buttery cookies left within reach of an eager muzzle. In fact, the day after Thanksgiving is known for more than just Black Friday bargains. It’s one of the busiest days of the year pancreatitis-related emergency vet visits. Basically, if your dog is showing any signs of abdominal pain, the worst thing to do is feed him a fatty diet. This is one of many reasons that giving your dog table scraps, as tempting as it may be, is not advisable. How does a vet diagnose pancreatitis in dogs? Your dog’s medical history Blood tests to measure pancreatic enzymes Physical examination including stomach, gums, heart, temperature Radiographs or ultrasound, to rule out other causes Fine needle aspiration of the pancreas As the Merck Veterinary Manual notes, as with any disease, no test should be used in isolation for diagnosis, and all clinical findings should be used in conjunction to arrive at the most appropriate diagnosis. What’s the difference between acute and chronic pancreatitis? Acute Pancreatitis An acute attack of pancreatitis means it comes on suddenly, with no previous appearance of the condition before. It can become life threatening to other organs if the inflammation spreads. Chronic Pancreatitis A chronic condition is one that has developed over time, slowly, and often without symptoms. This condition can result from repeated bouts of acute pancreatitis. Both acute and chronic forms can be either severe or mild, and both result in pain. Treatment and management of pancreatitis in dogs There’s no fancy treatment for acute pancreatitis. First and foremost, your dog’s pain must be managed, and early intervention to prevent further complications is key. The most common treatment and management options are: Intravenous (IV) fluid therapy in severe pancreatitis Vigorous monitoring of a worsening condition Antiemetic medication for vomiting (to prevent dehydration) Resting the pancreas (withholding food and water for 24 hours) Long-term management includes: Vigilant monitoring of fat intake—No table scraps allowed! Use of a prescription diet of gastrointestinal-supportive low-fat, or ultra-low fat, food. Feed smaller, more frequent meals instead of one larger meal Have amylase and lipase levels checked by a veterinarian regularly Can supplements be used to prevent or manage pancreatitis in dogs? It is important to reiterate that pancreatitis is a serious condition, so home remedies shouldn’t be used in place of veterinary intervention. That said, some vets believe digestive enzyme supplements with pancreatin can help some (not all) dogs by reducing the work of the pancreas and inhibiting pancreatic secretion. These come in over-the-counter strength as well as prescription strength. Fish oil may seem counterintuitive at first, because of its high fat content, but it can actually help lower blood lipid levels. Studies suggest a high level of fish oil (about 1,000 mg. per 10 pounds of body weight for dog with high lipid levels; about half that amount for dogs with normal levels) is helpful to dogs with acute pancreatitis. When supplementing with fish oil, also supplement with 5 to 10 IU of vitamin E. There have been human studies suggesting that vitamin E (with selenium), vitamin C, beta-carotene, and methionine may help prevent pancreatitis. Conversely, another human study reveals that probiotics can make acute pancreatitis worse. Always speak with your veterinarian before offering any supplements to your pet.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. My vet told me he thinks my dog has pancreatitis. I'm worried I have done something to cause it. What are the signs and symptoms of this? Are certain breeds prone to this and what are some risk factors? He wants me to bring him in for testing. What will they do to him? Key Points Pancreatitis in dogs is potentially life-threatening — know the signs to look for. If you suspect your dog may have pancreatitis, a call to the veterinarian quickly is vital. There are a number of causes and risk factors that can bring on pancreatitis, though it often seems to hit out of the blue. emergency Pancreatitis in dogs is one of those conditions that owners must be informed about before it strikes because the warning signs may not always be obvious at first, the symptoms might be mistaken for something less serious, and yet it’s potentially life-threatening. The medical definition of pancreatitis is simple: “inflammation of the pancreas.” But like all serious conditions, there is more to it than that. Because it is dangerous, a suspected case of pancreatitis needs to be addressed by a veterinarian as quickly as possible and not dealt with by “DIY” treatments. As with all medical issues, even the best online resource is not a replacement for the medical guidance from your vet. Before looking at the details of pancreatitis, let’s take away the “ititis” and explain the small but vital organ itself: The pancreas is responsible for releasing enzymes that aid in digestion. When the organ is working normally, the enzymes become active only when they reach the small intestine. In a dog with pancreatitis, however, the enzymes activate when they’re released, inflaming and causing damage to the pancreas and its surrounding tissue and other organs. According to the Whole Dog Journal, the enzymes can actually begin to digest the pancreas itself, which causes extreme pain to your dog. pancreatitis xray Classic signs of pancreatitis in dogs Hunched back Repeated vomiting (either several times within a few hours or periodically over several days) Pain or distention of the abdomen (dog appears uncomfortable or bloated) Diarrhea Loss of appetite Dehydration Weakness/lethargy Fever If your dog exhibits one of these signs, and only infrequently, monitor her. But if she exhibits multiple signs at once, and repeatedly, a call to the veterinarian quickly is vital. Dehydration and pancreatitis in dogs Dehydration is due to a greater fluid loss than fluid intake. Diarrhea or vomiting can cause dehydration, but those signs together will cause a greater fluid deficit and dehydration because the dog’s fluid input (drinking) cannot keep up with the fluid losses. If the diarrhea becomes bloody, the condition worsens and the dehydration can become an emergency. Other factors such as fever require increase fluid intake and can lead to dehydration along with other metabolic issues such as kidney disease, etc. Blood in a dog’s stool indicates a loos and significant inflammatory response requiring a veterinarian’s attention but it can be cause by a multitude of factors, from ulceration to parasites. Dehydration is a serious condition that can lead to death. It is an emergency and requires immediate veterinary care. Any lethargic dog who is not drinking water or cannot hold water down should be suspect of dehydration and examined by a veterinarian. Dry mucous membranes (such as gums) may be a quick way of assessing dehydration but as always, when in doubt, consult with your veterinarian. Cane Corso laying down in the shade outdoors. ©Evelina - stock.adobe.com Causes of pancreatitis in dogs There are a number of causes and risk factors that can bring on pancreatitis. Though often the attack appears seemingly out of the blue. Among them are: A high-fat diet This is a major cause of pancreatitis, especially for a dog who gets one large helping of fatty food in one sitting A history of dietary indiscretion (a medical term for saying your dog will eat anything) Obesity Hypothyroidism (or other endocrine diseases) Severe blunt trauma Diabetes mellitus Certain medications or other toxins These include cholinesterase inhibitors, calcium, potassium bromide, phenobarbital, l-asparaginase, estrogen, salicylates, azathioprine, thiazide diuretics, and vinca alkaloids. There may, in some cases, be a genetic predisposition. Certain breeds or types of dogs have been associated with higher risks of pancreatitis such as Miniature Schnauzers and some of the smaller toy and terrier breeds. More about those fats: Human food is especially dangerous, though even high-fat dog food may cause pancreatitis. So owner vigilance is particularly required around holidays and other festive occasions—they can bring well-meaning guests who slip your buddy a fatty piece of lamb, or a tray of buttery cookies left within reach of an eager muzzle. In fact, the day after Thanksgiving is known for more than just Black Friday bargains. It’s one of the busiest days of the year pancreatitis-related emergency vet visits. Basically, if your dog is showing any signs of abdominal pain, the worst thing to do is feed him a fatty diet. This is one of many reasons that giving your dog table scraps, as tempting as it may be, is not advisable. How does a vet diagnose pancreatitis in dogs? Your dog’s medical history Blood tests to measure pancreatic enzymes Physical examination including stomach, gums, heart, temperature Radiographs or ultrasound, to rule out other causes Fine needle aspiration of the pancreas As the Merck Veterinary Manual notes, as with any disease, no test should be used in isolation for diagnosis, and all clinical findings should be used in conjunction to arrive at the most appropriate diagnosis. What’s the difference between acute and chronic pancreatitis? Acute Pancreatitis An acute attack of pancreatitis means it comes on suddenly, with no previous appearance of the condition before. It can become life threatening to other organs if the inflammation spreads. Chronic Pancreatitis A chronic condition is one that has developed over time, slowly, and often without symptoms. This condition can result from repeated bouts of acute pancreatitis. Both acute and chronic forms can be either severe or mild, and both result in pain. Treatment and management of pancreatitis in dogs There’s no fancy treatment for acute pancreatitis. First and foremost, your dog’s pain must be managed, and early intervention to prevent further complications is key. The most common treatment and management options are: Intravenous (IV) fluid therapy in severe pancreatitis Vigorous monitoring of a worsening condition Antiemetic medication for vomiting (to prevent dehydration) Resting the pancreas (withholding food and water for 24 hours) Long-term management includes: Vigilant monitoring of fat intake—No table scraps allowed! Use of a prescription diet of gastrointestinal-supportive low-fat, or ultra-low fat, food. Feed smaller, more frequent meals instead of one larger meal Have amylase and lipase levels checked by a veterinarian regularly Can supplements be used to prevent or manage pancreatitis in dogs? It is important to reiterate that pancreatitis is a serious condition, so home remedies shouldn’t be used in place of veterinary intervention. That said, some vets believe digestive enzyme supplements with pancreatin can help some (not all) dogs by reducing the work of the pancreas and inhibiting pancreatic secretion. These come in over-the-counter strength as well as prescription strength. Fish oil may seem counterintuitive at first, because of its high fat content, but it can actually help lower blood lipid levels. Studies suggest a high level of fish oil (about 1,000 mg. per 10 pounds of body weight for dog with high lipid levels; about half that amount for dogs with normal levels) is helpful to dogs with acute pancreatitis. When supplementing with fish oil, also supplement with 5 to 10 IU of vitamin E. There have been human studies suggesting that vitamin E (with selenium), vitamin C, beta-carotene, and methionine may help prevent pancreatitis. Conversely, another human study reveals that probiotics can make acute pancreatitis worse. Always speak with your veterinarian before offering any supplements to your pet. https://www.akc.org/expert-advice/health/pancreatitis-in-dogs/",Medical,Fact Finding,Q&A "Only information from the provided context can be used to respond to user requests. Information not in the source text should be disregarded. Any surnames used in your responses must be given in all capitals.","I'm interested in learning more about Kahneman, and I think the book they're referring to is Thinking Fast and Thinking Slow. What search terms should I use to identify the work mentioned in this text?","The emergence of foundation models, especially Large Language Models (LLMs), has revolutionized the field of artificial intelligence. These models, exemplified by their extensive training data and capacity for generalization, have dramatically expanded the horizons of computational linguistics, text understanding, and text generation [5, 10, 34–37]. However, a critical challenge faced by LLMs is their limited efficacy in executing complex reasoning tasks, particularly in areas requiring deep, abstract thought such as advanced mathematics [25]. This limitation points towards a need for enhanced methodologies that can augment LLMs’ reasoning faculties. The root of this challenge lies in the architecture of modern LLMs, which is predominantly oriented toward auto-regressive token prediction [5, 35, 36]. While efficient for a broad spectrum of tasks, this approach is not meticulously designed to support the depth and sophistication of human-like analytical thinking. This discrepancy is highlighted by the dual-process theory of cognitive psychology, articulated by Kahneman [21], which differentiates the fast, intuitive responses of System 1 thinking from the slower, more deliberate reasoning of System 2 thinking. LLMs, in their typical operations, mirror System 1 processes and thus encounter difficulties with tasks that require the more deliberate, structured approach characteristic of System 2 thinking. Attempts to bridge this gap have led to the development of innovative methodologies such as Chain-of-Thought (CoT) [44] and Tree-of-Thought (ToT) [28, 49], which guide LLMs in articulating intermediate steps in reasoning tasks. These methods, although valuable, have not fully realized the depth and flexibility of human cognitive processes in an abstract sense. In response to these challenges, we introduce Meta Prompting (MP) and establish a theoretical framework for it, a novel approach that represents a substantial advance in the field of LLM reasoning. Meta Prompting extends beyond existing methods by abstracting and generalizing key principles for enhanced cognitive processing. Unlike its predecessors, Meta Prompting shifts the focus from content-driven reasoning to a more structure-oriented perspective. This method draws inspiration from category theory and type theory, establishing a functorial relationship between tasks and their corresponding prompts. This categorical approach allows for a more systematic and adaptable framework, capable of addressing a wide range of cognitive tasks with depth and nuance akin to human reasoning. Furthermore, a pivotal aspect of meta prompting is its application to Meta Prompting for prompting tasks in an in-context and recursive way utilizing the functorial and compositional properties of Meta Prompting, which we call Recursive Meta Prompting (RMP). This concept, akin to metaprogramming in programming language theory, involves using LLMs to design new prompts autonomously. The functorial nature of Meta Prompting allows for this advanced capability, where LLMs can not only solve problems but also generate the structures to solve them. This self-referential and recursive ability marks a significant leap in LLMs’ autonomy and adaptability. The practical efficacy of the Meta Prompting framework is empirically validated through a series of experiments, ranging from solving the Game of 24 puzzles [49] to addressing complex MATH problems [17], underscoring the Meta Prompting’s versatility and empowering LLMs with advanced reasoning capabilities. In summary, our contributions can be listed as follows: • We propose the structured and syntax-oriented Meta Prompting (MP), and introduce a theoretical framework for meta prompting based on category theory. We further investigate meta prompting for prompting tasks and Recursive Meta Prompting (RMP) in a metaprogramming-like manner. • Our experiments on solving MATH problems with a Qwen-72B base language model [3] equipped with meta prompt without instruction-tuning to solve MATH problems with accuracy at 46.3% which surpasses the supervised fine-tuned counterpart trained with extensive mathematical QA instruction pairs and even the initial version of GPT-4, solving GSM8K problems with 83.5% accuracy with zero-shot meta-prompted Qwen-72B base language model, and solving the Game of 24 tasks with 100% success rate using GPT-4, show the efficacy of meta prompting in problem-solving and in-context alignment.","Only information from the provided context can be used to respond to user requests. Information not in the source text should be disregarded. Any surnames used in your responses must be given in all capitals. The emergence of foundation models, especially Large Language Models (LLMs), has revolutionized the field of artificial intelligence. These models, exemplified by their extensive training data and capacity for generalization, have dramatically expanded the horizons of computational linguistics, text understanding, and text generation [5, 10, 34–37]. However, a critical challenge faced by LLMs is their limited efficacy in executing complex reasoning tasks, particularly in areas requiring deep, abstract thought such as advanced mathematics [25]. This limitation points towards a need for enhanced methodologies that can augment LLMs’ reasoning faculties. The root of this challenge lies in the architecture of modern LLMs, which is predominantly oriented toward auto-regressive token prediction [5, 35, 36]. While efficient for a broad spectrum of tasks, this approach is not meticulously designed to support the depth and sophistication of human-like analytical thinking. This discrepancy is highlighted by the dual-process theory of cognitive psychology, articulated by Kahneman [21], which differentiates the fast, intuitive responses of System 1 thinking from the slower, more deliberate reasoning of System 2 thinking. LLMs, in their typical operations, mirror System 1 processes and thus encounter difficulties with tasks that require the more deliberate, structured approach characteristic of System 2 thinking. Attempts to bridge this gap have led to the development of innovative methodologies such as Chain-of-Thought (CoT) [44] and Tree-of-Thought (ToT) [28, 49], which guide LLMs in articulating intermediate steps in reasoning tasks. These methods, although valuable, have not fully realized the depth and flexibility of human cognitive processes in an abstract sense. In response to these challenges, we introduce Meta Prompting (MP) and establish a theoretical framework for it, a novel approach that represents a substantial advance in the field of LLM reasoning. Meta Prompting extends beyond existing methods by abstracting and generalizing key principles for enhanced cognitive processing. Unlike its predecessors, Meta Prompting shifts the focus from content-driven reasoning to a more structure-oriented perspective. This method draws inspiration from category theory and type theory, establishing a functorial relationship between tasks and their corresponding prompts. This categorical approach allows for a more systematic and adaptable framework, capable of addressing a wide range of cognitive tasks with depth and nuance akin to human reasoning. Furthermore, a pivotal aspect of meta prompting is its application to Meta Prompting for prompting tasks in an in-context and recursive way utilizing the functorial and compositional properties of Meta Prompting, which we call Recursive Meta Prompting (RMP). This concept, akin to metaprogramming in programming language theory, involves using LLMs to design new prompts autonomously. The functorial nature of Meta Prompting allows for this advanced capability, where LLMs can not only solve problems but also generate the structures to solve them. This self-referential and recursive ability marks a significant leap in LLMs’ autonomy and adaptability. The practical efficacy of the Meta Prompting framework is empirically validated through a series of experiments, ranging from solving the Game of 24 puzzles [49] to addressing complex MATH problems [17], underscoring the Meta Prompting’s versatility and empowering LLMs with advanced reasoning capabilities. In summary, our contributions can be listed as follows: • We propose the structured and syntax-oriented Meta Prompting (MP), and introduce a theoretical framework for meta prompting based on category theory. We further investigate meta prompting for prompting tasks and Recursive Meta Prompting (RMP) in a metaprogramming-like manner. • Our experiments on solving MATH problems with a Qwen-72B base language model [3] equipped with meta prompt without instruction-tuning to solve MATH problems with accuracy at 46.3% which surpasses the supervised fine-tuned counterpart trained with extensive mathematical QA instruction pairs and even the initial version of GPT-4, solving GSM8K problems with 83.5% accuracy with zero-shot meta-prompted Qwen-72B base language model, and solving the Game of 24 tasks with 100% success rate using GPT-4, show the efficacy of meta prompting in problem-solving and in-context alignment. I'm interested in learning more about Kahneman, and I think the book they're referring to is Thinking Fast and Thinking Slow. What search terms should I use to identify the work mentioned in this text?",Internet/Technology,Fact Finding,Q&A Draw information from the context only to inform your response.,Discuss the concept of fast fashion and its effect on workers as outlined in the text.,"I. Introduction Fast fashion is an approach to the design, creation, and marketing of clothing with an emphasis on making trends quickly and cheaply available to consumers.2 The term was coined by the New York Times in the early 2000s when describing Zara’s mission to take a garment from the design stage to being sold in stores in just fifteen days.3 The idea behind this phenomenon is to get the newest styles on the market as fast as possible so that consumers can get them at the height of their popularity.4 Increased consumption in wealthy, first-world countries has driven the success of fast fashion and placed a significant strain on garment factories and their workers.5 Because fashion is one of the most labor-dependent industries—as each piece of apparel must be handmade along a lengthy supply chain—brands have looked to outsource labor overseas to minimize costs and maximize profits.6 The goal of outsourcing is to locate low-cost production sources in emerging economies, like Bangladesh, where input costs are low and productivity is high.7 As retail prices have decreased and production prices have increased, there continues to be pressure on manufacturers’ margins.8 Because of this cycle, garment workers are often subjected to poor employment conditions and factories are less able to invest in the improvement of labor conditions or increase workers’ pay.9 For decades, brands have turned a blind eye to these key issues, continuing to profit off cheap, forced labor.10 Zara, H&M, and Topshop were among the first companies to take looks and designs from top fashion houses and reproduce them quickly and cheaply.11 Key characteristics of fast fashion brands include: (1) having thousands of styles, particularly those that touch on the latest trends; (2) extremely short turnaround times between when a trend is seen on the catwalk and when it hits the shelves; (3) offshore manufacturing where labor is cheap; (4) limited quantities of particular garments; and (5) cheap, low-quality materials.12 This note will explore how the fast fashion cycle perpetuates neglect of consumer responsibility, social and ecological harm, capitalization of fast production and cheap prices, and labor exploitation. II. Background A. A Journey Down the Supply Chain As clothes have gotten cheaper, trend cycles have sped up, and shopping has become a hobby, consumers, perhaps unknowingly, have perpetuated a cycle of abusive labor practices in overseas garment factories.13 Because labor costs remain high in the Western Hemisphere, production has largely moved overseas and fashion companies industry-wide are utilizing subcontracting to produce their garments.14 Subcontracting is the process by which a company divides parts of the supply chain across multiple countries and into multiple parts, including design, spinning, yarn production, dyeing, cutting, stitching, and final garment production.15 The general supply chain involves multiple steps: (1) cotton is grown and sold to the global market; (2) spinners use cotton or synthetic fibers to produce yarn or fabric; (3) garment factories cut and sew the fabric and add trim to produce garments; (4) garment factories that lack capacity for some processes subcontract them to other facilities; (5) garments are shipped to the brands that place the order; (6) brands distribute the garments to retail and online stores; and (7) consumers purchase the garments.16 Subcontracting allows for the success of fast fashion because it permits companies to utilize the low cost of overseas labor as subcontracted units are not regulated.17 It is not uncommon that the clothing consumers buy in store has already been in multiple different countries or factories before hitting the shelves.18 Manufacturing supply chains in the fashion industry are known for being rife with abuse, forced labor, and extremely low wages.19 Buyers often participate in a practice called “underground bidding,” where they use the quoted prices of one factory to get another factory to lower their prices.20 The company then selects the factory that commits to the fastest turnaround time and the lowest price, effectively pushing down wages and worsening working conditions.21 This perpetuates a skewed power dynamic where buyers dominate, as factories accept low prices for orders while remaining under pressure to maintain high product quality and productivity levels with very little financial resources.22 As delivery time for orders has decreased ten to twenty percent over the last five years, urgent orders have become more frequent.23 Consequently, workers are forced to work overtime hours, often without overtime pay, in order to meet these quick turnaround times and order changes.24 B. Working Conditions in Overseas Garment Factories Workers in fashion supply chains often endure unimaginable conditions in garment factories, where buildings lack fire alarms, and managers can lock doors and keep workers in until they complete the orders.25 Other dangerous conditions include crumbling buildings, broken alarms, and missing sprinklers and fire barriers.26 In countries like Bangladesh, local laws regulating fire safety, pay, and working conditions are not well-enforced as there are not enough inspectors and there is significant potential for the corruption of officials.27 Specifically, the Bangladesh government has failed to enforce national building codes, especially in buildings owned by wellconnected landlords.28 Thus, garment workers often endure brutal, unsafe working conditions at the mercy of their employer.29 In 2013, an eight-story clothing manufacturing building in Dhaka, Bangladesh collapsed, killing over one thousand garment workers.30 Just five months earlier, at least 112 workers died in a factory fire in Tazreen on the outskirts of Dhaka.31 Following these incidents, many major United States (U.S.) retailers joined safety-monitoring groups that required them to stop selling clothing from factories that violated safety standards.32 But Amazon—one of the world’s largest retailers— did not join this coalition and continues to sell clothing made from factories operating under similar conditions.33 Amazon has stated that it does not inspect the factories that produce the clothing they buy from wholesalers or other third-party sellers.34 In fact, the company will only remove a product from their site if they become aware that the product came from a factory that may not meet their supply chain standards.35 With a marketplace as large as Amazon’s, this is clearly a problem as it keeps unsafe workplaces up and running.36 While consumers may not currently be aware that the clothing they are buying originated in a factory where workers are subject to long hours and serious injuries, it is important that it is made known and steps are taken to end such practices. III. Development and Problems A. Absence of Worker Protections in the Garment Industries Stark contrasts exist between garment workers’ rights in countries like the U.S. and Bangladesh.37 While workers in the U.S. have protection under the Fair Labor Standards Act (FLSA) and through regulatory oversight, Bangladesh lacks a well-functioning labor inspection system or enforcement mechanisms.38 Moreover, because supply chains are organizationally fragmented and geographically dispersed, it becomes difficult for garment workers to unionize and fight for change.39 1. Minimum Wage A living wage is the lowest wage paid to a full-time worker—earned in no more than forty-eight hours per week—needed to cover basics like food, decent housing, healthcare, clothing, transportation, utilities, childcare, education, and other essential needs, in addition to some savings for the future and unexpected events.40 The legal minimum wage for garment workers in Bangladesh is approximately 8000 taka per month, which amounts to $79 USD.41 But instead of paying workers a legal minimum wage, some factories will utilize a piece-rate system in which they pay workers pennies per garment sewn—a practice also used in the U.S.42 Under this system, workers are paid $0.02 to $0.06 per garment, which can translate to, at most, $6 per hour.43 Although the Bangladesh government sets a minimum wage, it is not properly enforced, resulting in many workers making much less.44 In a research study examining the working conditions and lives of garment workers in Bangladesh and Vietnam, one hundred percent of garment workers interviewed in Bangladesh earned below a living wage.45 Of those interviewed, ninety percent said they could not afford enough food for themselves or their families, seventy-two percent could not afford medical treatment when they got sick or injured, seventy-six percent had no running water inside their home, and thirty-three percent had been separated from their children, primarily due to insufficient income.46 Moreover, Fifty-six percent of workers reported that they experienced wage cuts, although technically illegal in Bangladesh, for things such as not meeting targets, absence, late attendance, poor quality, product mistakes, or refusing to do overtime or night duty. In order to make ends meet, parents often remove their children from school to start working in garment factories—some as young as eleven years old.","System Instructions: Draw information from the context only to inform your response. Prompt: Discuss the concept of fast fashion and its effect on workers as outlined in the text. Context: I. Introduction Fast fashion is an approach to the design, creation, and marketing of clothing with an emphasis on making trends quickly and cheaply available to consumers.2 The term was coined by the New York Times in the early 2000s when describing Zara’s mission to take a garment from the design stage to being sold in stores in just fifteen days.3 The idea behind this phenomenon is to get the newest styles on the market as fast as possible so that consumers can get them at the height of their popularity.4 Increased consumption in wealthy, first-world countries has driven the success of fast fashion and placed a significant strain on garment factories and their workers.5 Because fashion is one of the most labor-dependent industries—as each piece of apparel must be handmade along a lengthy supply chain—brands have looked to outsource labor overseas to minimize costs and maximize profits.6 The goal of outsourcing is to locate low-cost production sources in emerging economies, like Bangladesh, where input costs are low and productivity is high.7 As retail prices have decreased and production prices have increased, there continues to be pressure on manufacturers’ margins.8 Because of this cycle, garment workers are often subjected to poor employment conditions and factories are less able to invest in the improvement of labor conditions or increase workers’ pay.9 For decades, brands have turned a blind eye to these key issues, continuing to profit off cheap, forced labor.10 Zara, H&M, and Topshop were among the first companies to take looks and designs from top fashion houses and reproduce them quickly and cheaply.11 Key characteristics of fast fashion brands include: (1) having thousands of styles, particularly those that touch on the latest trends; (2) extremely short turnaround times between when a trend is seen on the catwalk and when it hits the shelves; (3) offshore manufacturing where labor is cheap; (4) limited quantities of particular garments; and (5) cheap, low-quality materials.12 This note will explore how the fast fashion cycle perpetuates neglect of consumer responsibility, social and ecological harm, capitalization of fast production and cheap prices, and labor exploitation. II. Background A. A Journey Down the Supply Chain As clothes have gotten cheaper, trend cycles have sped up, and shopping has become a hobby, consumers, perhaps unknowingly, have perpetuated a cycle of abusive labor practices in overseas garment factories.13 Because labor costs remain high in the Western Hemisphere, production has largely moved overseas and fashion companies industry-wide are utilizing subcontracting to produce their garments.14 Subcontracting is the process by which a company divides parts of the supply chain across multiple countries and into multiple parts, including design, spinning, yarn production, dyeing, cutting, stitching, and final garment production.15 The general supply chain involves multiple steps: (1) cotton is grown and sold to the global market; (2) spinners use cotton or synthetic fibers to produce yarn or fabric; (3) garment factories cut and sew the fabric and add trim to produce garments; (4) garment factories that lack capacity for some processes subcontract them to other facilities; (5) garments are shipped to the brands that place the order; (6) brands distribute the garments to retail and online stores; and (7) consumers purchase the garments.16 Subcontracting allows for the success of fast fashion because it permits companies to utilize the low cost of overseas labor as subcontracted units are not regulated.17 It is not uncommon that the clothing consumers buy in store has already been in multiple different countries or factories before hitting the shelves.18 Manufacturing supply chains in the fashion industry are known for being rife with abuse, forced labor, and extremely low wages.19 Buyers often participate in a practice called “underground bidding,” where they use the quoted prices of one factory to get another factory to lower their prices.20 The company then selects the factory that commits to the fastest turnaround time and the lowest price, effectively pushing down wages and worsening working conditions.21 This perpetuates a skewed power dynamic where buyers dominate, as factories accept low prices for orders while remaining under pressure to maintain high product quality and productivity levels with very little financial resources.22 As delivery time for orders has decreased ten to twenty percent over the last five years, urgent orders have become more frequent.23 Consequently, workers are forced to work overtime hours, often without overtime pay, in order to meet these quick turnaround times and order changes.24 B. Working Conditions in Overseas Garment Factories Workers in fashion supply chains often endure unimaginable conditions in garment factories, where buildings lack fire alarms, and managers can lock doors and keep workers in until they complete the orders.25 Other dangerous conditions include crumbling buildings, broken alarms, and missing sprinklers and fire barriers.26 In countries like Bangladesh, local laws regulating fire safety, pay, and working conditions are not well-enforced as there are not enough inspectors and there is significant potential for the corruption of officials.27 Specifically, the Bangladesh government has failed to enforce national building codes, especially in buildings owned by wellconnected landlords.28 Thus, garment workers often endure brutal, unsafe working conditions at the mercy of their employer.29 In 2013, an eight-story clothing manufacturing building in Dhaka, Bangladesh collapsed, killing over one thousand garment workers.30 Just five months earlier, at least 112 workers died in a factory fire in Tazreen on the outskirts of Dhaka.31 Following these incidents, many major United States (U.S.) retailers joined safety-monitoring groups that required them to stop selling clothing from factories that violated safety standards.32 But Amazon—one of the world’s largest retailers— did not join this coalition and continues to sell clothing made from factories operating under similar conditions.33 Amazon has stated that it does not inspect the factories that produce the clothing they buy from wholesalers or other third-party sellers.34 In fact, the company will only remove a product from their site if they become aware that the product came from a factory that may not meet their supply chain standards.35 With a marketplace as large as Amazon’s, this is clearly a problem as it keeps unsafe workplaces up and running.36 While consumers may not currently be aware that the clothing they are buying originated in a factory where workers are subject to long hours and serious injuries, it is important that it is made known and steps are taken to end such practices. III. Development and Problems A. Absence of Worker Protections in the Garment Industries Stark contrasts exist between garment workers’ rights in countries like the U.S. and Bangladesh.37 While workers in the U.S. have protection under the Fair Labor Standards Act (FLSA) and through regulatory oversight, Bangladesh lacks a well-functioning labor inspection system or enforcement mechanisms.38 Moreover, because supply chains are organizationally fragmented and geographically dispersed, it becomes difficult for garment workers to unionize and fight for change.39 1. Minimum Wage A living wage is the lowest wage paid to a full-time worker—earned in no more than forty-eight hours per week—needed to cover basics like food, decent housing, healthcare, clothing, transportation, utilities, childcare, education, and other essential needs, in addition to some savings for the future and unexpected events.40 The legal minimum wage for garment workers in Bangladesh is approximately 8000 taka per month, which amounts to $79 USD.41 But instead of paying workers a legal minimum wage, some factories will utilize a piece-rate system in which they pay workers pennies per garment sewn—a practice also used in the U.S.42 Under this system, workers are paid $0.02 to $0.06 per garment, which can translate to, at most, $6 per hour.43 Although the Bangladesh government sets a minimum wage, it is not properly enforced, resulting in many workers making much less.44 In a research study examining the working conditions and lives of garment workers in Bangladesh and Vietnam, one hundred percent of garment workers interviewed in Bangladesh earned below a living wage.45 Of those interviewed, ninety percent said they could not afford enough food for themselves or their families, seventy-two percent could not afford medical treatment when they got sick or injured, seventy-six percent had no running water inside their home, and thirty-three percent had been separated from their children, primarily due to insufficient income.46 Moreover, Fifty-six percent of workers reported that they experienced wage cuts, although technically illegal in Bangladesh, for things such as not meeting targets, absence, late attendance, poor quality, product mistakes, or refusing to do overtime or night duty. In order to make ends meet, parents often remove their children from school to start working in garment factories—some as young as eleven years old.",Retail/Product,Effect Analysis,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",My credit card interest rates are the highest they have ever been. It's really making it hard to pay them down when I can only afford the minimum payment and it mostly goes to interest. How have the interest rates changed?,"Higher APR margin has fueled the profitability of revolving balances. Typically, card issuers set an APR margin to generate a profit that is at least commensurate with the risk of lending money to consumers. In the eight years after the Great Recession, the average APR margin stayed around 10 percent, as issuers adapted to reforms in the Credit Card Accountability Responsibility and Disclosure Act of 2009 (CARD Act) that restricted harmful back-end and hidden pricing practices. But issuers began to gradually increase APR margin in 2016. The trend accelerated in 2018, and it continued through the pandemic. Over the past decade, card issuers increased APR margin despite lower charge-off rates and a relatively stable share of cardholders with subprime credit scores. The average APR margin increased 4.3 percentage points from 2013 to 2023 (while the prime rate was nearly 5 percentage points higher). As such, the profitability of revolving balances excluding loan loss provisions (the money that banks set aside for expected charge-offs) has been increasing over this time period. Figure 2: Average APR Margin and Charge-Off Rate (Federal Reserve) Figure 2 is a line graph that shows the quarterly average APR margin and charge off rate from 1995 through 2023. Since 2013, the APR margin has generally increased while the charge off rate decreased. Source: Federal Reserve Excess APR margin costs consumers billions of dollars a year. In 2023, major credit card issuers, with around $590 billion in revolving balances, charged an estimated $25 billion in additional interest fees by raising the average APR margin by 4.3 percentage points over the last ten years. For an average consumer with a $5,300 balance across credit cards, the excess APR margin cost them over $250 in 2023. Since finance charges are typically part of the minimum amount due, this additional interest burden may push consumers into persistent debt, accruing more in interest and fees than they pay towards the principal each year — or even delinquency. The increase in APR margin has occurred across all credit tiers. Even consumers with the highest credit scores are incurring higher costs. The average APR margin for accounts with credit scores at 800 or above grew 1.6 percentage points from 2015 to 2022 without a corresponding increase in late payments. Credit card interest rates are a core driver of profits. Credit card issuers are reliant on revenue from interest charged to borrowers who revolve on their balances to drive overall profits, as reflected in increasing APR margins. The return on assets on general purpose cards, one measure of profitability, was higher in 2022 (at 5.9 percent) than in 2019 (at 4.5 percent), and far greater than the returns banks received on other lines of business. Even when excluding the impact of loan loss provisions, the profitability of credit cards has been increasing. CFPB research has found high levels of concentration in the consumer credit card market and evidence of practices that inhibit consumers’ ability to find alternatives to expensive credit card products. These practices may help explain why credit card issuers have been able to prop up high interest rates to fuel profits. Our recent research has shown that while the top credit card companies dominate the market, smaller issuers many times offer credit cards with significantly lower APRs. The CFPB will continue to take steps to ensure that the consumer credit card market is fair, competitive, and transparent and to help consumers avoid debt spirals that can be difficult to escape.","""================ ======= Higher APR margin has fueled the profitability of revolving balances. Typically, card issuers set an APR margin to generate a profit that is at least commensurate with the risk of lending money to consumers. In the eight years after the Great Recession, the average APR margin stayed around 10 percent, as issuers adapted to reforms in the Credit Card Accountability Responsibility and Disclosure Act of 2009 (CARD Act) that restricted harmful back-end and hidden pricing practices. But issuers began to gradually increase APR margin in 2016. The trend accelerated in 2018, and it continued through the pandemic. Over the past decade, card issuers increased APR margin despite lower charge-off rates and a relatively stable share of cardholders with subprime credit scores. The average APR margin increased 4.3 percentage points from 2013 to 2023 (while the prime rate was nearly 5 percentage points higher). As such, the profitability of revolving balances excluding loan loss provisions (the money that banks set aside for expected charge-offs) has been increasing over this time period. Figure 2: Average APR Margin and Charge-Off Rate (Federal Reserve) Figure 2 is a line graph that shows the quarterly average APR margin and charge off rate from 1995 through 2023. Since 2013, the APR margin has generally increased while the charge off rate decreased. Source: Federal Reserve Excess APR margin costs consumers billions of dollars a year. In 2023, major credit card issuers, with around $590 billion in revolving balances, charged an estimated $25 billion in additional interest fees by raising the average APR margin by 4.3 percentage points over the last ten years. For an average consumer with a $5,300 balance across credit cards, the excess APR margin cost them over $250 in 2023. Since finance charges are typically part of the minimum amount due, this additional interest burden may push consumers into persistent debt, accruing more in interest and fees than they pay towards the principal each year — or even delinquency. The increase in APR margin has occurred across all credit tiers. Even consumers with the highest credit scores are incurring higher costs. The average APR margin for accounts with credit scores at 800 or above grew 1.6 percentage points from 2015 to 2022 without a corresponding increase in late payments. Credit card interest rates are a core driver of profits. Credit card issuers are reliant on revenue from interest charged to borrowers who revolve on their balances to drive overall profits, as reflected in increasing APR margins. The return on assets on general purpose cards, one measure of profitability, was higher in 2022 (at 5.9 percent) than in 2019 (at 4.5 percent), and far greater than the returns banks received on other lines of business. Even when excluding the impact of loan loss provisions, the profitability of credit cards has been increasing. CFPB research has found high levels of concentration in the consumer credit card market and evidence of practices that inhibit consumers’ ability to find alternatives to expensive credit card products. These practices may help explain why credit card issuers have been able to prop up high interest rates to fuel profits. Our recent research has shown that while the top credit card companies dominate the market, smaller issuers many times offer credit cards with significantly lower APRs. The CFPB will continue to take steps to ensure that the consumer credit card market is fair, competitive, and transparent and to help consumers avoid debt spirals that can be difficult to escape. https://www.consumerfinance.gov/about-us/blog/credit-card-interest-rate-margins-at-all-time-high/ ================ ======= My credit card interest rates are the highest they have ever been. It's really making it hard to pay them down when I can only afford the minimum payment and it mostly goes to interest. How have the interest rates changed? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Financial,Summarize & Simplify,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",What is the mechanism of action of the drug Amoxicillin and what are some of the potential side effects involved with its usage? Respond in more than 150 words.,"Amoxicillin is a widely utilized beta-lactam antimicrobial drug approved by the U.S. Food and Drug Administration (FDA) for use in the primary care setting. Amoxicillin is an aminopenicillin created by adding an extra amino group to penicillin to battle antibiotic resistance. This drug is indicated for the treatment of infections caused by susceptible isolates of selected bacteria, specifically those that are beta-lactamase–negative, including ear, nose, and throat infections, Helicobacter pylori eradication, lower respiratory and urinary tract infections, acute bacterial sinusitis, and skin and structure infections. Amoxicillin is effective against a wide range of gram-positive bacteria, offering additional coverage against some gram-negative organisms compared to penicillin. Amoxicillin's spectrum of activity includes coverage against Streptococcus species, with heightened efficacy against Listeria monocytogenes and Enterococcus spp. Furthermore, amoxicillin also demonstrates effectiveness against Haemophilus influenzae, select Escherichia coli strains, Actinomyces spp., Clostridium species, Salmonella spp., Shigella spp., and Corynebacteria spp. This activity delves into the indications, mechanism of action, administration, contraindications, and adverse event profiles associated with amoxicillin. This activity equips clinicians with a comprehensive understanding of amoxicillin to optimally enhance their ability to manage infectious diseases in patients. Amoxicillin is a widely utilized beta-lactam antimicrobial drug approved by the U.S. Food and Drug Administration (FDA) for use in the primary care setting. Amoxicillin is an aminopenicillin created by adding an extra amino group to penicillin to battle antibiotic resistance. The medication is effective against a wide range of gram-positive bacteria, offering additional coverage against some gram-negative organisms compared to penicillin. Amoxicillin's spectrum of activity includes coverage against Streptococcus species, with heightened efficacy against Listeria monocytogenes and Enterococcus spp. Furthermore, amoxicillin also demonstrates effectiveness against Haemophilus influenzae, select Escherichia coli strains, Actinomyces spp., Clostridium species, Salmonella spp., Shigella spp., and Corynebacteria spp. FDA-Approved Indications Amoxicillin is indicated for treating infections caused by susceptible isolates of selected bacteria, specifically beta-lactamase–negative, in the conditions listed below. Ear, nose, and throat infections: Amoxicillin is approved for the treatment of tonsillitis, pharyngitis, and otitis media in adults and pediatric patients aged 12 and older. The microbiological spectrum covers infections caused by beta-lactamase–negative Streptococcus species (alpha- and beta-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcus species, or H influenzae.[1] Helicobacter pylori eradication: H pylori eradication involves triple therapy using clarithromycin, amoxicillin, and lansoprazole to reduce the risk of duodenal ulcer recurrence. In addition, dual treatment with amoxicillin and lansoprazole is FDA-approved for eradicating H pylori infection.[2] Lower respiratory tract infections: Amoxicillin is prescribed for treating lower respiratory tract infections caused by beta-lactamase–negative Streptococcus species (limited to alpha- and beta-hemolytic strains), Pneumococcus or Staphylococcus species, or H influenzae. In cases of community-acquired pneumonia, the Infectious Diseases Society of America (IDSA) recommends a combination therapy comprising amoxicillin and a macrolide antibiotic.[3] Acute bacterial sinusitis: The treatment for acute bacterial sinusitis involves addressing infections caused by beta-lactamase–negative Streptococcus species (limited to alpha- and beta-hemolytic isolates), S pneumoniae, Staphylococcus species, or H influenzae.[4] Skin and skin structure infections: Amoxicillin in the immediate-release formulation is prescribed to treat skin infections caused by beta-lactamase–negative Streptococcus species (restricted to alpha- and beta-hemolytic strains), Staphylococcus species, or E coli.[5] Urinary tract infection: Amoxicillin is indicated for treating genitourinary tract infections caused by beta-lactamase–negative E coli, Proteus mirabilis, or Enterococcus faecalis.[6] The Centers for Disease Control and Prevention (CDC) recommends using amoxicillin as a second-line agent for post-exposure prophylaxis for anthrax.[7] Off-label Uses Amoxicillin is often used for Lyme disease if there are contraindications for doxycycline.[8] Infectious endocarditis prophylaxis is recommended for individuals with high-risk cardiac conditions, such as a prosthetic cardiac valve or congenital heart disease, using amoxicillin.[9] Amoxicillin, combined with metronidazole, is used to treat periodontitis.[10] Amoxicillin is often used for the treatment of actinomycosis.[11] Amoxicillin belongs to the class of beta-lactam antimicrobials. Beta-lactams bind to penicillin-binding proteins, inhibiting transpeptidation — a crucial step in cell wall synthesis involving cross-linking. This action activates autolytic enzymes in the bacterial cell wall, resulting in cell wall lysis and bacterial cell destruction. This mechanism is known as bactericidal killing.[12] Amoxicillin administration can be combined with a beta-lactamase inhibitor, such as clavulanic acid or sulbactam. These inhibitors function by irreversibly binding to the catalytic site of the organism's beta-lactamase enzyme, preventing resistance to the original beta-lactam ring of amoxicillin. Although these inhibitors lack inherent bactericidal activity, their combination with amoxicillin may broaden its spectrum to include organisms producing the beta-lactamase enzyme.[13] Pharmacokinetics Absorption: Amoxicillin exhibits stability in the presence of gastric acid and is rapidly absorbed after oral administration, with average peak blood levels typically reached within 1 to 2 hours. Distribution: Amoxicillin displays significant tissue and fluid diffusion throughout the body, with the exception of the brain and spinal fluid, except in cases where meningeal inflammation is present. Amoxicillin exhibits approximately 20% plasma protein binding. Metabolism: The metabolism of amoxicillin involves oxidation, hydroxylation, and deamination processes. Amoxicillin is a substrate of organic anion transporters (OATs), specifically OATs 1 and 3.[14][15] Elimination: Amoxicillin has an approximate half-life of 61.3 minutes, and about 60% of the administered dose is excreted in the urine within 6 to 8 hours. Co-administration of probenecid can delay amoxicillin excretion, as the majority of the drug is eliminated unchanged in the urine. Common Adverse Drug Reactions Although generally well-tolerated, amoxicillin may lead to common gastrointestinal symptoms, including nausea, vomiting, and diarrhea. Additional adverse drug reactions associated with amoxicillin are listed below. Nephrotoxicity: Amoxicillin may cause crystalluria and interstitial nephritis.[23][24] Hypersensitivity reactions: Amoxicillin has the potential to cause hypersensitivity reactions categorized as type I, II, III, or IV. Differentiating between a type-I and type-IV reaction is crucial due to varying danger levels. A type-I hypersensitivity reaction involves an IgE-mediated response in sensitized patients, inducing widespread histamine release, resulting in an urticarial-like pruritic rash or severe anaphylaxis. In contrast, a type-IV hypersensitivity reaction is not mediated by histamine release and typically presents as a more papular or morbilliform rash, often without itching. Notably, almost all patients receiving amoxicillin inadvertently for infectious mononucleosis may develop a maculopapular rash attributed to a type IV–mediated hypersensitivity reaction. Notably, reactions of this type are not associated with anaphylaxis.[25] Hepatotoxicity: Cases of idiosyncratic liver injury have been reported in individuals receiving amoxicillin. The associated serum enzyme pattern reveals a hepatocellular pattern characterized by significant elevations in aspartate transaminase (AST) and alanine transaminase (ALT), with minimal increases in alkaline phosphatase. Most patients experience rapid recovery upon withdrawal of amoxicillin. The cause of liver injury associated with amoxicillin use is attributed to hypersensitivity. Although rare, cases of acute liver failure and vanishing bile duct syndrome have been reported. Corticosteroids are often used to treat allergic reactions caused by penicillin-related immunoallergic hepatitis, which is a rare cause of clinically apparent liver injury, with a likelihood score of B.[26] Postmarketing Adverse Drug Reactions Gastrointestinal: Gastrointestinal effects may include black hairy tongue, pseudomembranous colitis, and hemorrhagic colitis.[27] Neurological: Neurological effects may encompass reversible hyperactivity, agitation, anxiety, insomnia, confusion, convulsions, and aseptic meningitis.[28] Dermatological: Dermatological effects may manifest as serum sickness-like reactions, erythematous maculopapular rashes, exfoliative dermatitis, toxic epidermal necrolysis, and hypersensitivity vasculitis.[30]","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. What is the mechanism of action of the drug Amoxicillin and what are some of the potential side effects involved with its usage? Respond in more than 150 words. Amoxicillin is a widely utilized beta-lactam antimicrobial drug approved by the U.S. Food and Drug Administration (FDA) for use in the primary care setting. Amoxicillin is an aminopenicillin created by adding an extra amino group to penicillin to battle antibiotic resistance. This drug is indicated for the treatment of infections caused by susceptible isolates of selected bacteria, specifically those that are beta-lactamase–negative, including ear, nose, and throat infections, Helicobacter pylori eradication, lower respiratory and urinary tract infections, acute bacterial sinusitis, and skin and structure infections. Amoxicillin is effective against a wide range of gram-positive bacteria, offering additional coverage against some gram-negative organisms compared to penicillin. Amoxicillin's spectrum of activity includes coverage against Streptococcus species, with heightened efficacy against Listeria monocytogenes and Enterococcus spp. Furthermore, amoxicillin also demonstrates effectiveness against Haemophilus influenzae, select Escherichia coli strains, Actinomyces spp., Clostridium species, Salmonella spp., Shigella spp., and Corynebacteria spp. This activity delves into the indications, mechanism of action, administration, contraindications, and adverse event profiles associated with amoxicillin. This activity equips clinicians with a comprehensive understanding of amoxicillin to optimally enhance their ability to manage infectious diseases in patients. Amoxicillin is a widely utilized beta-lactam antimicrobial drug approved by the U.S. Food and Drug Administration (FDA) for use in the primary care setting. Amoxicillin is an aminopenicillin created by adding an extra amino group to penicillin to battle antibiotic resistance. The medication is effective against a wide range of gram-positive bacteria, offering additional coverage against some gram-negative organisms compared to penicillin. Amoxicillin's spectrum of activity includes coverage against Streptococcus species, with heightened efficacy against Listeria monocytogenes and Enterococcus spp. Furthermore, amoxicillin also demonstrates effectiveness against Haemophilus influenzae, select Escherichia coli strains, Actinomyces spp., Clostridium species, Salmonella spp., Shigella spp., and Corynebacteria spp. FDA-Approved Indications Amoxicillin is indicated for treating infections caused by susceptible isolates of selected bacteria, specifically beta-lactamase–negative, in the conditions listed below. Ear, nose, and throat infections: Amoxicillin is approved for the treatment of tonsillitis, pharyngitis, and otitis media in adults and pediatric patients aged 12 and older. The microbiological spectrum covers infections caused by beta-lactamase–negative Streptococcus species (alpha- and beta-hemolytic isolates only), Streptococcus pneumoniae, Staphylococcus species, or H influenzae.[1] Helicobacter pylori eradication: H pylori eradication involves triple therapy using clarithromycin, amoxicillin, and lansoprazole to reduce the risk of duodenal ulcer recurrence. In addition, dual treatment with amoxicillin and lansoprazole is FDA-approved for eradicating H pylori infection.[2] Lower respiratory tract infections: Amoxicillin is prescribed for treating lower respiratory tract infections caused by beta-lactamase–negative Streptococcus species (limited to alpha- and beta-hemolytic strains), Pneumococcus or Staphylococcus species, or H influenzae. In cases of community-acquired pneumonia, the Infectious Diseases Society of America (IDSA) recommends a combination therapy comprising amoxicillin and a macrolide antibiotic.[3] Acute bacterial sinusitis: The treatment for acute bacterial sinusitis involves addressing infections caused by beta-lactamase–negative Streptococcus species (limited to alpha- and beta-hemolytic isolates), S pneumoniae, Staphylococcus species, or H influenzae.[4] Skin and skin structure infections: Amoxicillin in the immediate-release formulation is prescribed to treat skin infections caused by beta-lactamase–negative Streptococcus species (restricted to alpha- and beta-hemolytic strains), Staphylococcus species, or E coli.[5] Urinary tract infection: Amoxicillin is indicated for treating genitourinary tract infections caused by beta-lactamase–negative E coli, Proteus mirabilis, or Enterococcus faecalis.[6] The Centers for Disease Control and Prevention (CDC) recommends using amoxicillin as a second-line agent for post-exposure prophylaxis for anthrax.[7] Off-label Uses Amoxicillin is often used for Lyme disease if there are contraindications for doxycycline.[8] Infectious endocarditis prophylaxis is recommended for individuals with high-risk cardiac conditions, such as a prosthetic cardiac valve or congenital heart disease, using amoxicillin.[9] Amoxicillin, combined with metronidazole, is used to treat periodontitis.[10] Amoxicillin is often used for the treatment of actinomycosis.[11] Amoxicillin belongs to the class of beta-lactam antimicrobials. Beta-lactams bind to penicillin-binding proteins, inhibiting transpeptidation — a crucial step in cell wall synthesis involving cross-linking. This action activates autolytic enzymes in the bacterial cell wall, resulting in cell wall lysis and bacterial cell destruction. This mechanism is known as bactericidal killing.[12] Amoxicillin administration can be combined with a beta-lactamase inhibitor, such as clavulanic acid or sulbactam. These inhibitors function by irreversibly binding to the catalytic site of the organism's beta-lactamase enzyme, preventing resistance to the original beta-lactam ring of amoxicillin. Although these inhibitors lack inherent bactericidal activity, their combination with amoxicillin may broaden its spectrum to include organisms producing the beta-lactamase enzyme.[13] Pharmacokinetics Absorption: Amoxicillin exhibits stability in the presence of gastric acid and is rapidly absorbed after oral administration, with average peak blood levels typically reached within 1 to 2 hours. Distribution: Amoxicillin displays significant tissue and fluid diffusion throughout the body, with the exception of the brain and spinal fluid, except in cases where meningeal inflammation is present. Amoxicillin exhibits approximately 20% plasma protein binding. Metabolism: The metabolism of amoxicillin involves oxidation, hydroxylation, and deamination processes. Amoxicillin is a substrate of organic anion transporters (OATs), specifically OATs 1 and 3.[14][15] Elimination: Amoxicillin has an approximate half-life of 61.3 minutes, and about 60% of the administered dose is excreted in the urine within 6 to 8 hours. Co-administration of probenecid can delay amoxicillin excretion, as the majority of the drug is eliminated unchanged in the urine. Common Adverse Drug Reactions Although generally well-tolerated, amoxicillin may lead to common gastrointestinal symptoms, including nausea, vomiting, and diarrhea. Additional adverse drug reactions associated with amoxicillin are listed below. Nephrotoxicity: Amoxicillin may cause crystalluria and interstitial nephritis.[23][24] Hypersensitivity reactions: Amoxicillin has the potential to cause hypersensitivity reactions categorized as type I, II, III, or IV. Differentiating between a type-I and type-IV reaction is crucial due to varying danger levels. A type-I hypersensitivity reaction involves an IgE-mediated response in sensitized patients, inducing widespread histamine release, resulting in an urticarial-like pruritic rash or severe anaphylaxis. In contrast, a type-IV hypersensitivity reaction is not mediated by histamine release and typically presents as a more papular or morbilliform rash, often without itching. Notably, almost all patients receiving amoxicillin inadvertently for infectious mononucleosis may develop a maculopapular rash attributed to a type IV–mediated hypersensitivity reaction. Notably, reactions of this type are not associated with anaphylaxis.[25] Hepatotoxicity: Cases of idiosyncratic liver injury have been reported in individuals receiving amoxicillin. The associated serum enzyme pattern reveals a hepatocellular pattern characterized by significant elevations in aspartate transaminase (AST) and alanine transaminase (ALT), with minimal increases in alkaline phosphatase. Most patients experience rapid recovery upon withdrawal of amoxicillin. The cause of liver injury associated with amoxicillin use is attributed to hypersensitivity. Although rare, cases of acute liver failure and vanishing bile duct syndrome have been reported. Corticosteroids are often used to treat allergic reactions caused by penicillin-related immunoallergic hepatitis, which is a rare cause of clinically apparent liver injury, with a likelihood score of B.[26] Postmarketing Adverse Drug Reactions Gastrointestinal: Gastrointestinal effects may include black hairy tongue, pseudomembranous colitis, and hemorrhagic colitis.[27] Neurological: Neurological effects may encompass reversible hyperactivity, agitation, anxiety, insomnia, confusion, convulsions, and aseptic meningitis.[28] Dermatological: Dermatological effects may manifest as serum sickness-like reactions, erythematous maculopapular rashes, exfoliative dermatitis, toxic epidermal necrolysis, and hypersensitivity vasculitis.[30] https://www.ncbi.nlm.nih.gov/books/NBK482250/",Medical,Fact Finding,Q&A You must respond only using the information provided in the prompt context. No outside information or prior knowledge can be utilized in your answer.,When can a person give consent to process their data?,"Lawfulness of processing 1. Processing shall be lawful only if and to the extent that at least one of the following applies: (a) the data subject has given consent to the processing of his or her personal data for one or more specific purposes; (b) processing is necessary for the performance of a contract to which the data subject is party or in order to take steps at the request of the data subject prior to entering into a contract; (c) processing is necessary for compliance with a legal obligation to which the controller is subject; (d) processing is necessary in order to protect the vital interests of the data subject or of another natural person; (e) processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller; (f) processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child. Point (f) of the first subparagraph shall not apply to processing carried out by public authorities in the performance of their tasks. 2. Member States may maintain or introduce more specific provisions to adapt the application of the rules of this Regulation with regard to processing for compliance with points (c) and (e) of paragraph 1 by determining more precisely specific requirements for the processing and other measures to ensure lawful and fair processing including for other specific processing situations as provided for in Chapter IX. 3. The basis for the processing referred to in point (c) and (e) of paragraph 1 shall be laid down by: (a) Union law; or (b) Member State law to which the controller is subject. The purpose of the processing shall be determined in that legal basis or, as regards the processing referred to in point (e) of paragraph 1, shall be necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller. That legal basis may contain specific provisions to adapt the application of rules of this Regulation, inter alia: the general conditions governing the lawfulness of processing by the controller; the types of data which are subject to the processing; the data subjects concerned; the entities to, and the purposes for which, the personal data may be disclosed; the purpose limitation; storage periods; and processing operations and processing procedures, including measures to ensure lawful and fair processing such as those for other specific L 119/36 EN Official Journal of the European Union 4.5.2016 processing situations as provided for in Chapter IX. The Union or the Member State law shall meet an objective of public interest and be proportionate to the legitimate aim pursued. 4. Where the processing for a purpose other than that for which the personal data have been collected is not based on the data subject's consent or on a Union or Member State law which constitutes a necessary and proportionate measure in a democratic society to safeguard the objectives referred to in Article 23(1), the controller shall, in order to ascertain whether processing for another purpose is compatible with the purpose for which the personal data are initially collected, take into account, inter alia: (a) any link between the purposes for which the personal data have been collected and the purposes of the intended further processing; (b) the context in which the personal data have been collected, in particular regarding the relationship between data subjects and the controller; (c) the nature of the personal data, in particular whether special categories of personal data are processed, pursuant to Article 9, or whether personal data related to criminal convictions and offences are processed, pursuant to Article 10; (d) the possible consequences of the intended further processing for data subjects; (e) the existence of appropriate safeguards, which may include encryption or pseudonymisation. Article 7 Conditions for consent 1. Where processing is based on consent, the controller shall be able to demonstrate that the data subject has consented to processing of his or her personal data. 2. If the data subject's consent is given in the context of a written declaration which also concerns other matters, the request for consent shall be presented in a manner which is clearly distinguishable from the other matters, in an intelligible and easily accessible form, using clear and plain language. Any part of such a declaration which constitutes an infringement of this Regulation shall not be binding. 3. The data subject shall have the right to withdraw his or her consent at any time. The withdrawal of consent shall not affect the lawfulness of processing based on consent before its withdrawal. Prior to giving consent, the data subject shall be informed thereof. It shall be as easy to withdraw as to give consent. 4. When assessing whether consent is freely given, utmost account shall be taken of whether, inter alia, the performance of a contract, including the provision of a service, is conditional on consent to the processing of personal data that is not necessary for the performance of that contract. Article 8 Conditions applicable to child's consent in relation to information society services 1. Where point (a) of Article 6(1) applies, in relation to the offer of information society services directly to a child, the processing of the personal data of a child shall be lawful where the child is at least 16 years old. Where the child is below the age of 16 years, such processing shall be lawful only if and to the extent that consent is given or authorised by the holder of parental responsibility over the child. Member States may provide by law for a lower age for those purposes provided that such lower age is not below 13 years. 4.5.2016 EN Official Journal of the European Union L 119/37 2. The controller shall make reasonable efforts to verify in such cases that consent is given or authorised by the holder of parental responsibility over the child, taking into consideration available technology. 3. Paragraph 1 shall not affect the general contract law of Member States such as the rules on the validity, formation or effect of a contract in relation to a child. Article 9 Processing of special categories of personal data 1. Processing of personal data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data, biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a natural person's sex life or sexual orientation shall be prohibited. 2. Paragraph 1 shall not apply if one of the following applies: (a) the data subject has given explicit consent to the processing of those personal data for one or more specified purposes, except where Union or Member State law provide that the prohibition referred to in paragraph 1 may not be lifted by the data subject; (b) processing is necessary for the purposes of carrying out the obligations and exercising specific rights of the controller or of the data subject in the field of employment and social security and social protection law in so far as it is authorised by Union or Member State law or a collective agreement pursuant to Member State law providing for appropriate safeguards for the fundamental rights and the interests of the data subject; (c) processing is necessary to protect the vital interests of the data subject or of another natural person where the data subject is physically or legally incapable of giving consent; (d) processing is carried out in the course of its legitimate activities with appropriate safeguards by a foundation, association or any other not-for-profit body with a political, philosophical, religious or trade union aim and on condition that the processing relates solely to the members or to former members of the body or to persons who have regular contact with it in connection with its purposes and that the personal data are not disclosed outside that body without the consent of the data subjects; (e) processing relates to personal data which are manifestly made public by the data subject; (f) processing is necessary for the establishment, exercise or defence of legal claims or whenever courts are acting in their judicial capacity; ","You must respond only using the information provided in the prompt context. No outside information or prior knowledge can be utilized in your answer. When can a person give consent to process their data? Lawfulness of processing 1. Processing shall be lawful only if and to the extent that at least one of the following applies: (a) the data subject has given consent to the processing of his or her personal data for one or more specific purposes; (b) processing is necessary for the performance of a contract to which the data subject is party or in order to take steps at the request of the data subject prior to entering into a contract; (c) processing is necessary for compliance with a legal obligation to which the controller is subject; (d) processing is necessary in order to protect the vital interests of the data subject or of another natural person; (e) processing is necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller; (f) processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party, except where such interests are overridden by the interests or fundamental rights and freedoms of the data subject which require protection of personal data, in particular where the data subject is a child. Point (f) of the first subparagraph shall not apply to processing carried out by public authorities in the performance of their tasks. 2. Member States may maintain or introduce more specific provisions to adapt the application of the rules of this Regulation with regard to processing for compliance with points (c) and (e) of paragraph 1 by determining more precisely specific requirements for the processing and other measures to ensure lawful and fair processing including for other specific processing situations as provided for in Chapter IX. 3. The basis for the processing referred to in point (c) and (e) of paragraph 1 shall be laid down by: (a) Union law; or (b) Member State law to which the controller is subject. The purpose of the processing shall be determined in that legal basis or, as regards the processing referred to in point (e) of paragraph 1, shall be necessary for the performance of a task carried out in the public interest or in the exercise of official authority vested in the controller. That legal basis may contain specific provisions to adapt the application of rules of this Regulation, inter alia: the general conditions governing the lawfulness of processing by the controller; the types of data which are subject to the processing; the data subjects concerned; the entities to, and the purposes for which, the personal data may be disclosed; the purpose limitation; storage periods; and processing operations and processing procedures, including measures to ensure lawful and fair processing such as those for other specific L 119/36 EN Official Journal of the European Union 4.5.2016 processing situations as provided for in Chapter IX. The Union or the Member State law shall meet an objective of public interest and be proportionate to the legitimate aim pursued. 4. Where the processing for a purpose other than that for which the personal data have been collected is not based on the data subject's consent or on a Union or Member State law which constitutes a necessary and proportionate measure in a democratic society to safeguard the objectives referred to in Article 23(1), the controller shall, in order to ascertain whether processing for another purpose is compatible with the purpose for which the personal data are initially collected, take into account, inter alia: (a) any link between the purposes for which the personal data have been collected and the purposes of the intended further processing; (b) the context in which the personal data have been collected, in particular regarding the relationship between data subjects and the controller; (c) the nature of the personal data, in particular whether special categories of personal data are processed, pursuant to Article 9, or whether personal data related to criminal convictions and offences are processed, pursuant to Article 10; (d) the possible consequences of the intended further processing for data subjects; (e) the existence of appropriate safeguards, which may include encryption or pseudonymisation. Article 7 Conditions for consent 1. Where processing is based on consent, the controller shall be able to demonstrate that the data subject has consented to processing of his or her personal data. 2. If the data subject's consent is given in the context of a written declaration which also concerns other matters, the request for consent shall be presented in a manner which is clearly distinguishable from the other matters, in an intelligible and easily accessible form, using clear and plain language. Any part of such a declaration which constitutes an infringement of this Regulation shall not be binding. 3. The data subject shall have the right to withdraw his or her consent at any time. The withdrawal of consent shall not affect the lawfulness of processing based on consent before its withdrawal. Prior to giving consent, the data subject shall be informed thereof. It shall be as easy to withdraw as to give consent. 4. When assessing whether consent is freely given, utmost account shall be taken of whether, inter alia, the performance of a contract, including the provision of a service, is conditional on consent to the processing of personal data that is not necessary for the performance of that contract. Article 8 Conditions applicable to child's consent in relation to information society services 1. Where point (a) of Article 6(1) applies, in relation to the offer of information society services directly to a child, the processing of the personal data of a child shall be lawful where the child is at least 16 years old. Where the child is below the age of 16 years, such processing shall be lawful only if and to the extent that consent is given or authorised by the holder of parental responsibility over the child. Member States may provide by law for a lower age for those purposes provided that such lower age is not below 13 years. 4.5.2016 EN Official Journal of the European Union L 119/37 2. The controller shall make reasonable efforts to verify in such cases that consent is given or authorised by the holder of parental responsibility over the child, taking into consideration available technology. 3. Paragraph 1 shall not affect the general contract law of Member States such as the rules on the validity, formation or effect of a contract in relation to a child. Article 9 Processing of special categories of personal data 1. Processing of personal data revealing racial or ethnic origin, political opinions, religious or philosophical beliefs, or trade union membership, and the processing of genetic data, biometric data for the purpose of uniquely identifying a natural person, data concerning health or data concerning a natural person's sex life or sexual orientation shall be prohibited. 2. Paragraph 1 shall not apply if one of the following applies: (a) the data subject has given explicit consent to the processing of those personal data for one or more specified purposes, except where Union or Member State law provide that the prohibition referred to in paragraph 1 may not be lifted by the data subject; (b) processing is necessary for the purposes of carrying out the obligations and exercising specific rights of the controller or of the data subject in the field of employment and social security and social protection law in so far as it is authorised by Union or Member State law or a collective agreement pursuant to Member State law providing for appropriate safeguards for the fundamental rights and the interests of the data subject; (c) processing is necessary to protect the vital interests of the data subject or of another natural person where the data subject is physically or legally incapable of giving consent; (d) processing is carried out in the course of its legitimate activities with appropriate safeguards by a foundation, association or any other not-for-profit body with a political, philosophical, religious or trade union aim and on condition that the processing relates solely to the members or to former members of the body or to persons who have regular contact with it in connection with its purposes and that the personal data are not disclosed outside that body without the consent of the data subjects; (e) processing relates to personal data which are manifestly made public by the data subject; (f) processing is necessary for the establishment, exercise or defence of legal claims or whenever courts are acting in their judicial capacity; ",Legal,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",Please summarize all of the major points in this article. Describe and explain the differences between the various protocols. Make sure to define them in relation to each other and the concepts discussed in the article so I can understand them better.,"Point-to-Point Generic Routing Encapsulation over IP Security Generic Routing Encapsulation (GRE) is a widely used encapsulation protocol in computer networking. It allows the transmission of diverse network protocols over an IP network infrastructure. In this blog post, we'll delve into the details of the GRE and its significance in modern networking. GRE acts as a tunneling protocol, encapsulating packets from one network protocol within another. By creating a virtual point-to-point link, it facilitates the transmission of data across different network domains. This enables the interconnection of disparate networks, making GRE a crucial tool for securely building virtual private networks (VPNs) and connecting remote sites. P2P GRE is a tunneling protocol that allows the encapsulation of various network layer protocols within IP packets. It provides a secure and reliable method of transmitting data between two points in a network. By encapsulating packets in IP headers, P2P GRE ensures data integrity and confidentiality. IP Security (IPsec) plays a crucial role in enhancing the security of P2P GRE tunnels. By leveraging cryptographic algorithms, IPsec provides authentication, integrity, and confidentiality of data transmitted over the network. It establishes a secure channel between two endpoints, ensuring that data remains protected from unauthorized access and tampering. Enhanced Network Security: P2P GRE over IP Security offers a robust security solution for organizations by providing secure communication channels across public and private networks. It allows for the establishment of secure connections between geographically dispersed locations, ensuring the confidentiality of sensitive data. Improved Network Performance: P2P GRE over IP Security optimizes network performance by encapsulating and routing packets efficiently. It enables the transmission of data across different network topologies, reducing network congestion and enhancing overall network efficiency. Seamless Integration with Existing Infrastructures: One of the key advantages of P2P GRE over IP Security is its compatibility with existing network infrastructures. It can be seamlessly integrated into existing networks without the need for significant architectural changes, making it a cost-effective solution for organizations. Security Measures: Implementing P2P GRE over IP Security requires careful consideration of security measures. Organizations should ensure that strong encryption algorithms are utilized, proper key management practices are in place, and regular security audits are conducted to maintain the integrity of the network. Scalability and Performance Optimization: To ensure optimal performance, network administrators should carefully plan and configure the P2P GRE tunnels. Factors such as bandwidth allocation, traffic prioritization, and Quality of Service (QoS) settings should be taken into account to guarantee the efficient operation of the network. Generic Tunnelling Understanding P2P GRE & IPSec P2P GRE is a tunneling protocol that allows the encapsulation of different network protocols within an IP network. It provides a secure and efficient mechanism for transmitting data between two network endpoints. By encapsulating packets, P2P GRE ensures that information is protected from external threats and remains intact during transmission. IPsec, on the other hand, is a suite of protocols that provides security services at the IP layer. It offers authentication, confidentiality, and integrity to IP packets, ensuring that data remains secure even when traversing untrusted networks. IPsec can be combined with P2P GRE to create a robust and secure communication channel. The combination of P2P GRE and IPsec brings several benefits to network administrators and organizations. Firstly, it enables secure communication between geographically dispersed networks, allowing for seamless connectivity. Additionally, P2P GRE over IPsec provides strong encryption, ensuring the confidentiality of sensitive data. It also allows for the creation of virtual private networks (VPNs), offering a secure and private network environment. P2P GRE over IPsec finds applications in various scenarios. One common use case is connecting branch offices of an organization securely. By establishing a P2P GRE over IPsec tunnel between different locations, organizations can create a secure network environment for their remote sites. Another use case is securely connecting cloud resources to on-premises infrastructure, enabling secure and seamless integration. The role of GRE: In GRE, packets are wrapped within other packets that use supported protocols, allowing the use of protocols not generally supported by a network. To understand this, consider the difference between a car and a ferry. On land, cars travel on roads, while ferries travel on water. Usually, cars cannot travel on water but can be loaded onto ferries. In this analogy, terrain could be compared to a network that supports specific routing protocols and vehicles to data packets. Similarly, one type of vehicle (the car) is loaded onto a different kind of vehicle (the ferry) to cross terrain it could not otherwise. GRE tunneling: how does it work? GRE tunnels encapsulate packets within other packets. Each router represents the end of the tunnel. GRE packets are exchanged directly between routers. When routers are between forwarding packets, they use headers surrounding them rather than opening the encapsulated packets. Every packet of data sent over a network has the payload and the header. The payload contains the data being sent, while the headers contain information about the source and group of the packet. Each network protocol attaches a header to each packet. Unlike load limits on automobile bridges, data packet sizes are limited by MTU and MSS. An MSS measurement only measures a packet’s payload, not its headers. Including the headers, the MTU measures the total size of a packet. Packets that exceed MTU are fragmented to fit through the network. GRE configuration GRE Operation GRE is a layer three protocol, meaning it works at the IP level of the network. It enables a router to encapsulate packets of a particular protocol and send them to another router, where they are decapsulated and forwarded to their destination. This is useful for tunneling, where data must traverse multiple networks and different types of hardware. GRE encapsulates data in a header containing information about the source, destination, and other routing information. The GRE header is then encapsulated in an IP header containing the source and destination IP addresses. When the packet reaches the destination router, the GRE header is stripped off, and the data is sent to its destination. GRE over IPsec Understanding Multipoint GRE Multipoint GRE, or mGRE, is a tunneling protocol for encapsulating packets and transmitting them over an IP network. It enables virtual point-to-multipoint connections, allowing multiple endpoints to communicate simultaneously. By utilizing a single tunnel interface, mGRE simplifies network configurations and optimizes resource utilization. One of Multipoint GRE’s standout features is its ability to transport multicast and broadcast traffic across multiple sites efficiently. It achieves this through a single tunnel interface, eliminating the need for dedicated point-to-point connections. This scalability and flexibility make mGRE an excellent choice for large-scale deployments and multicast applications. DMVPN, as the name suggests, is a virtual private network technology that dynamically creates VPN connections between multiple sites without needing dedicated point-to-point links. It utilizes a hub-and-spoke architecture, with the hub as the central point for all communication. Using the Next Hop Resolution Protocol (NHRP), DMVPN provides a highly scalable and flexible solution for securely interconnecting sites. Multipoint GRE, or mGRE, is a tunneling protocol my DMVPN uses to create point-to-multipoint connections. It allows multiple spokes to communicate directly with each other, bypassing the hub. By encapsulating packets within GRE headers, mGRE establishes virtual links between spokes, providing a flexible and efficient method of data transmission.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Please summarize all of the major points in this article. Describe and explain the differences between the various protocols. Make sure to define them in relation to each other and the concepts discussed in the article so I can understand them better. {passage 0} ========== Point-to-Point Generic Routing Encapsulation over IP Security Generic Routing Encapsulation (GRE) is a widely used encapsulation protocol in computer networking. It allows the transmission of diverse network protocols over an IP network infrastructure. In this blog post, we'll delve into the details of the GRE and its significance in modern networking. GRE acts as a tunneling protocol, encapsulating packets from one network protocol within another. By creating a virtual point-to-point link, it facilitates the transmission of data across different network domains. This enables the interconnection of disparate networks, making GRE a crucial tool for securely building virtual private networks (VPNs) and connecting remote sites. P2P GRE is a tunneling protocol that allows the encapsulation of various network layer protocols within IP packets. It provides a secure and reliable method of transmitting data between two points in a network. By encapsulating packets in IP headers, P2P GRE ensures data integrity and confidentiality. IP Security (IPsec) plays a crucial role in enhancing the security of P2P GRE tunnels. By leveraging cryptographic algorithms, IPsec provides authentication, integrity, and confidentiality of data transmitted over the network. It establishes a secure channel between two endpoints, ensuring that data remains protected from unauthorized access and tampering. Enhanced Network Security: P2P GRE over IP Security offers a robust security solution for organizations by providing secure communication channels across public and private networks. It allows for the establishment of secure connections between geographically dispersed locations, ensuring the confidentiality of sensitive data. Improved Network Performance: P2P GRE over IP Security optimizes network performance by encapsulating and routing packets efficiently. It enables the transmission of data across different network topologies, reducing network congestion and enhancing overall network efficiency. Seamless Integration with Existing Infrastructures: One of the key advantages of P2P GRE over IP Security is its compatibility with existing network infrastructures. It can be seamlessly integrated into existing networks without the need for significant architectural changes, making it a cost-effective solution for organizations. Security Measures: Implementing P2P GRE over IP Security requires careful consideration of security measures. Organizations should ensure that strong encryption algorithms are utilized, proper key management practices are in place, and regular security audits are conducted to maintain the integrity of the network. Scalability and Performance Optimization: To ensure optimal performance, network administrators should carefully plan and configure the P2P GRE tunnels. Factors such as bandwidth allocation, traffic prioritization, and Quality of Service (QoS) settings should be taken into account to guarantee the efficient operation of the network. Generic Tunnelling Understanding P2P GRE & IPSec P2P GRE is a tunneling protocol that allows the encapsulation of different network protocols within an IP network. It provides a secure and efficient mechanism for transmitting data between two network endpoints. By encapsulating packets, P2P GRE ensures that information is protected from external threats and remains intact during transmission. IPsec, on the other hand, is a suite of protocols that provides security services at the IP layer. It offers authentication, confidentiality, and integrity to IP packets, ensuring that data remains secure even when traversing untrusted networks. IPsec can be combined with P2P GRE to create a robust and secure communication channel. The combination of P2P GRE and IPsec brings several benefits to network administrators and organizations. Firstly, it enables secure communication between geographically dispersed networks, allowing for seamless connectivity. Additionally, P2P GRE over IPsec provides strong encryption, ensuring the confidentiality of sensitive data. It also allows for the creation of virtual private networks (VPNs), offering a secure and private network environment. P2P GRE over IPsec finds applications in various scenarios. One common use case is connecting branch offices of an organization securely. By establishing a P2P GRE over IPsec tunnel between different locations, organizations can create a secure network environment for their remote sites. Another use case is securely connecting cloud resources to on-premises infrastructure, enabling secure and seamless integration. The role of GRE: In GRE, packets are wrapped within other packets that use supported protocols, allowing the use of protocols not generally supported by a network. To understand this, consider the difference between a car and a ferry. On land, cars travel on roads, while ferries travel on water. Usually, cars cannot travel on water but can be loaded onto ferries. In this analogy, terrain could be compared to a network that supports specific routing protocols and vehicles to data packets. Similarly, one type of vehicle (the car) is loaded onto a different kind of vehicle (the ferry) to cross terrain it could not otherwise. GRE tunneling: how does it work? GRE tunnels encapsulate packets within other packets. Each router represents the end of the tunnel. GRE packets are exchanged directly between routers. When routers are between forwarding packets, they use headers surrounding them rather than opening the encapsulated packets. Every packet of data sent over a network has the payload and the header. The payload contains the data being sent, while the headers contain information about the source and group of the packet. Each network protocol attaches a header to each packet. Unlike load limits on automobile bridges, data packet sizes are limited by MTU and MSS. An MSS measurement only measures a packet’s payload, not its headers. Including the headers, the MTU measures the total size of a packet. Packets that exceed MTU are fragmented to fit through the network. GRE configuration GRE Operation GRE is a layer three protocol, meaning it works at the IP level of the network. It enables a router to encapsulate packets of a particular protocol and send them to another router, where they are decapsulated and forwarded to their destination. This is useful for tunneling, where data must traverse multiple networks and different types of hardware. GRE encapsulates data in a header containing information about the source, destination, and other routing information. The GRE header is then encapsulated in an IP header containing the source and destination IP addresses. When the packet reaches the destination router, the GRE header is stripped off, and the data is sent to its destination. GRE over IPsec Understanding Multipoint GRE Multipoint GRE, or mGRE, is a tunneling protocol for encapsulating packets and transmitting them over an IP network. It enables virtual point-to-multipoint connections, allowing multiple endpoints to communicate simultaneously. By utilizing a single tunnel interface, mGRE simplifies network configurations and optimizes resource utilization. One of Multipoint GRE’s standout features is its ability to transport multicast and broadcast traffic across multiple sites efficiently. It achieves this through a single tunnel interface, eliminating the need for dedicated point-to-point connections. This scalability and flexibility make mGRE an excellent choice for large-scale deployments and multicast applications. DMVPN, as the name suggests, is a virtual private network technology that dynamically creates VPN connections between multiple sites without needing dedicated point-to-point links. It utilizes a hub-and-spoke architecture, with the hub as the central point for all communication. Using the Next Hop Resolution Protocol (NHRP), DMVPN provides a highly scalable and flexible solution for securely interconnecting sites. Multipoint GRE, or mGRE, is a tunneling protocol my DMVPN uses to create point-to-multipoint connections. It allows multiple spokes to communicate directly with each other, bypassing the hub. By encapsulating packets within GRE headers, mGRE establishes virtual links between spokes, providing a flexible and efficient method of data transmission. https://network-insight.net/2014/12/15/point-to-point-generic-routing-encapsulation-gre-over-ip-security-ipsec/",Internet/Technology,Explanation/Definition,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Summarize the user's primary intent for the article and give evidence. How does the expiration of this Act affect me if I make less than 400,000 as a couple business owner?","Crapo Statement at Hearing on the 2025 Tax Policy Debate Washington, D.C.--U.S. Senate Finance Committee Ranking Member Mike Crapo (R-Idaho) delivered the following remarks at a hearing entitled, “The 2025 Tax Policy Debate and Tax Avoidance Strategies.” As prepared for delivery: “Thank you, Mr. Chairman. This hearing is a timely hearing on one of the more critical issues that will face our nation next year and frankly, is facing us right now. “We’ll have an opportunity to talk about the reality of the 2017 Tax Cuts and Jobs Act (TCJA), which is the focus of the debate next year, and what it really does. “The reality, contrary to what is often said by my colleagues on the other side of the aisle, is that the TCJA that was put into place when the Republicans and President Trump controlled the congress, had a massive positive effect on everyone in America. “The economy grew to be the strongest economy, I think, in any of our lifetimes, unemployment was at historic lows, wage growth and job growth was increasing month after month, inflation was at 2 percent rates, and we were moving ahead rapidly and strongly. “Americans today, though, are rightly concerned about rising living costs, slow job growth and an unemployment rate that remains above 4 percent. Not to mention the inflation rate that cumulatively, over just the last three and a half years, is well over 20 percent. “Taxpayers already face too much uncertainty as they look to work, save and invest in this economic environment. And given the litany of tax hike proposals on the table from many of my Democratic colleagues, no area is more uncertain as we head into this election than tax. “When it comes to the 2025 tax policy debate, those proposing all these tax increases continue to avoid a fundamental question: will they allow the Tax Cuts and Jobs Act to expire and inflict multi-trillion-dollar tax hikes on the American people? “Vice President Harris has largely avoided policy specifics and adopted rhetoric about taxing the wealthy and corporations, which ignores the reality of what our current tax code means for middle-income taxpayers. “TCJA lowered tax rates across the board, providing trillions of dollars in tax savings, with middle-income taxpayers receiving the largest proportional benefit of the cuts. “It also doubled the standard deduction, and doubled and expanded the child tax credit, which made the tax code simpler and provided targeted tax relief for the middle class. “If these provisions are allowed to expire, individuals making less than $400,000 per year would face a tax increase at the end of 2025 of more than $2 trillion, breaking the Biden-Harris pledge not to impose tax hikes on the middle class. “And that does not even account for inflation. By the end of this year, that pledge would need to be increased to nearly $500,000 to account for the crushing inflation that families have experienced under the Biden-Harris Administration. The pledge also ignores the marriage penalty for couples who together make more than $400,000, but who if filing separately would be well below it. “Despite her promise to help those starting businesses, Vice President Harris has also not addressed the 20 percent deduction for pass-throughs—the chosen business form for 95 percent of American businesses. Small business owners have repeatedly said extending this deduction is their top priority, stressing that it enables them to create new jobs, pay their employees more and reinvest in their businesses. “Unless Congress moves to extend these provisions by the end of next year, taxpayers would face the largest tax increase in U.S. history. “Despite critics’ rhetoric that the TCJA was simply a ‘tax break for billionaires,’ the law provided a tax break for 80 percent of Americans, and actually limited tax breaks for the wealthy by reducing costly deductions. “For example, the TCJA limited the state and local tax deduction (SALT), effectively a subsidy for many high-income residents in high-tax states like California and New York. “In stark contrast, Senate Democrats pledged as recently as last month to end the cap on SALT, which even the left-leaning Tax Policy Center said would ‘overwhelmingly benefit high income households.’ “By endorsing the Biden budget, Vice President Harris is calling for $5 trillion of tax increases on Americans, which would clearly hit Americans across the income spectrum, and hurt job creators and workers across the country: tax hikes on individuals and families; tax hikes on small business owners, including a top pass-through rate of 44.6 percent, which amounts to a tax increase of more than 50 percent; tax hikes on corporations, and we all know that the burden of the corporate tax is paid by workers, consumers and retirees; tax hikes on savings and investment; and another round of super-sized funding for IRS audits. “Again, these far-left proposals are often presented under the guise of ‘taxing the rich’ and ‘paying one’s fair share.’ “But facts matter. “In fact, the TCJA made the tax code even more progressive, with the share of income taxes paid by high income earners actually increasing, while the bottom 50 percent of earners received the largest reduction in average tax rates. “The Biden-Harris Administration has repeatedly—and falsely—claimed that the federal tax rate for high-income earners is only 8 percent, but the Joint Committee on Taxation recently confirmed their average rate is quadruple that amount, at 34 percent. “As this Committee considers tax policy in the year ahead, the American people deserve more than empty platitudes and $5 trillion in tax hike proposals that even a fully Democrat Congress could not pass. “They deserve careful deliberation of policies that will provide economic growth, tax certainty and opportunities for all Americans. “I am committed to helping all hardworking taxpayers get ahead and I will work with anyone, from either party, who is ready to focus on that priority. “We have an excellent panel before us today. “Thank you all for being here. I look forward to hearing your testimony.”","[question] Summarize the user's primary intent for the article and give evidence. How does the expiration of this Act affect me if I make less than 400,000 as a couple business owner? ===================== [text] Crapo Statement at Hearing on the 2025 Tax Policy Debate Washington, D.C.--U.S. Senate Finance Committee Ranking Member Mike Crapo (R-Idaho) delivered the following remarks at a hearing entitled, “The 2025 Tax Policy Debate and Tax Avoidance Strategies.” As prepared for delivery: “Thank you, Mr. Chairman. This hearing is a timely hearing on one of the more critical issues that will face our nation next year and frankly, is facing us right now. “We’ll have an opportunity to talk about the reality of the 2017 Tax Cuts and Jobs Act (TCJA), which is the focus of the debate next year, and what it really does. “The reality, contrary to what is often said by my colleagues on the other side of the aisle, is that the TCJA that was put into place when the Republicans and President Trump controlled the congress, had a massive positive effect on everyone in America. “The economy grew to be the strongest economy, I think, in any of our lifetimes, unemployment was at historic lows, wage growth and job growth was increasing month after month, inflation was at 2 percent rates, and we were moving ahead rapidly and strongly. “Americans today, though, are rightly concerned about rising living costs, slow job growth and an unemployment rate that remains above 4 percent. Not to mention the inflation rate that cumulatively, over just the last three and a half years, is well over 20 percent. “Taxpayers already face too much uncertainty as they look to work, save and invest in this economic environment. And given the litany of tax hike proposals on the table from many of my Democratic colleagues, no area is more uncertain as we head into this election than tax. “When it comes to the 2025 tax policy debate, those proposing all these tax increases continue to avoid a fundamental question: will they allow the Tax Cuts and Jobs Act to expire and inflict multi-trillion-dollar tax hikes on the American people? “Vice President Harris has largely avoided policy specifics and adopted rhetoric about taxing the wealthy and corporations, which ignores the reality of what our current tax code means for middle-income taxpayers. “TCJA lowered tax rates across the board, providing trillions of dollars in tax savings, with middle-income taxpayers receiving the largest proportional benefit of the cuts. “It also doubled the standard deduction, and doubled and expanded the child tax credit, which made the tax code simpler and provided targeted tax relief for the middle class. “If these provisions are allowed to expire, individuals making less than $400,000 per year would face a tax increase at the end of 2025 of more than $2 trillion, breaking the Biden-Harris pledge not to impose tax hikes on the middle class. “And that does not even account for inflation. By the end of this year, that pledge would need to be increased to nearly $500,000 to account for the crushing inflation that families have experienced under the Biden-Harris Administration. The pledge also ignores the marriage penalty for couples who together make more than $400,000, but who if filing separately would be well below it. “Despite her promise to help those starting businesses, Vice President Harris has also not addressed the 20 percent deduction for pass-throughs—the chosen business form for 95 percent of American businesses. Small business owners have repeatedly said extending this deduction is their top priority, stressing that it enables them to create new jobs, pay their employees more and reinvest in their businesses. “Unless Congress moves to extend these provisions by the end of next year, taxpayers would face the largest tax increase in U.S. history. “Despite critics’ rhetoric that the TCJA was simply a ‘tax break for billionaires,’ the law provided a tax break for 80 percent of Americans, and actually limited tax breaks for the wealthy by reducing costly deductions. “For example, the TCJA limited the state and local tax deduction (SALT), effectively a subsidy for many high-income residents in high-tax states like California and New York. “In stark contrast, Senate Democrats pledged as recently as last month to end the cap on SALT, which even the left-leaning Tax Policy Center said would ‘overwhelmingly benefit high income households.’ “By endorsing the Biden budget, Vice President Harris is calling for $5 trillion of tax increases on Americans, which would clearly hit Americans across the income spectrum, and hurt job creators and workers across the country: tax hikes on individuals and families; tax hikes on small business owners, including a top pass-through rate of 44.6 percent, which amounts to a tax increase of more than 50 percent; tax hikes on corporations, and we all know that the burden of the corporate tax is paid by workers, consumers and retirees; tax hikes on savings and investment; and another round of super-sized funding for IRS audits. “Again, these far-left proposals are often presented under the guise of ‘taxing the rich’ and ‘paying one’s fair share.’ “But facts matter. “In fact, the TCJA made the tax code even more progressive, with the share of income taxes paid by high income earners actually increasing, while the bottom 50 percent of earners received the largest reduction in average tax rates. “The Biden-Harris Administration has repeatedly—and falsely—claimed that the federal tax rate for high-income earners is only 8 percent, but the Joint Committee on Taxation recently confirmed their average rate is quadruple that amount, at 34 percent. “As this Committee considers tax policy in the year ahead, the American people deserve more than empty platitudes and $5 trillion in tax hike proposals that even a fully Democrat Congress could not pass. “They deserve careful deliberation of policies that will provide economic growth, tax certainty and opportunities for all Americans. “I am committed to helping all hardworking taxpayers get ahead and I will work with anyone, from either party, who is ready to focus on that priority. “We have an excellent panel before us today. “Thank you all for being here. I look forward to hearing your testimony.” https://www.finance.senate.gov/ranking-members-news/crapo-statement-at-hearing-on-the-2025-tax-policy-debate ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]","I want to sell put credit spreads on Apple to start making passive income but I don't want to own the stock. Based on this article, explain in 500 words if this strategy would truly have defined risk and prevented me from being assigned shares.","In the money or out of the money? The buyer (""owner"") of an option has the right, but not the obligation, to exercise the option on or before expiration. A call option5 gives the owner the right to buy the underlying security; a put option6 gives the owner the right to sell the underlying security. Conversely, when you sell an option, you may be assigned—at any time regardless of the ITM amount—if the option owner chooses to exercise. The option seller has no control over assignment and no certainty as to when it could happen. Once the assignment notice is delivered, it's too late to close the position and the option seller must fulfill the terms of the options contract: A long call exercise results in buying the underlying stock at the strike price. A short call assignment results in selling the underlying stock at the strike price. A long put exercise results in selling the underlying stock at the strike price. A short put assignment results in buying the underlying stock at the strike price. An option will likely be exercised if it's in the option owner's best interest to do so, meaning it's optimal to take or to close a position in the underlying security at the strike price rather than at the current market price. After the market close on expiration day, ITM options may be automatically exercised, whereas OTM options are not and typically expire worthless (often referred to as being ""abandoned""). The table below spells it out. If the underlying stock price is... ...higher than the strike price ...lower than the strike price If the underlying stock price is... A long call is... ...higher than the strike price ...ITM and typically exercised ...lower than the strike price ...OTM and typically abandoned If the underlying stock price is... A short call is... ...higher than the strike price ...ITM and typically assigned ...lower than the strike price ...OTM and typically abandoned If the underlying stock price is... A long put is... ...higher than the strike price ...OTM and typically abandoned ...lower than the strike price ...ITM and typically exercised If the underlying stock price is... A short put is... ...higher than the strike price ...OTM and typically abandoned ...lower than the strike price ...ITM and typically assigned The guidelines in the table assume a position is held all the way through expiration. Of course, you typically don't need to do that. And in many cases, the usual strategy is to close out a position ahead of the expiration date. We'll revisit the close-or-hold decision in the next section and look at ways to do that. But assuming you do carry the options position until the end, there are a few things you need to consider: Know your specs. Each standard equity options contract controls 100 shares of the underlying stock. That's pretty straightforward. Non-standard options may have different deliverables. Non-standard options can represent a different number of shares, shares of more than one company stock, or underlying shares and cash. Other products—such as index options or options on futures—have different contract specs. Stock and options positions will match and close. Suppose you're long 300 shares of XYZ and short one ITM call that's assigned. Because the call is deliverable into 100 shares, you'll be left with 200 shares of XYZ if the option is assigned, plus the cash from selling 100 shares at the strike price. It's automatic, for the most part. If an option is ITM by as little as $0.01 at expiration, it will automatically be exercised for the buyer and assigned to a seller. However, there's something called a do not exercise (DNE) request that a long option holder can submit if they want to abandon an option. In such a case, it's possible that a short ITM position might not be assigned. For more, see the note below on pin risk7? You'd better have enough cash. If an option on XYZ is exercised or assigned and you are ""uncovered"" (you don't have an existing long or short position in the underlying security), a long or short position in the underlying stock will replace the options. A long call or short put will result in a long position in XYZ; a short call or long put will result in a short position in XYZ. For long stock positions, you need to have enough cash to cover the purchase or else you'll be issued a margin8 call, which you must meet by adding funds to your account. But that timeline may be short, and the broker, at its discretion, has the right to liquidate positions in your account to meet a margin call9. If exercise or assignment involves taking a short stock position, you need a margin account and sufficient funds in the account to cover the margin requirement. Short equity positions are risky business. An uncovered short call or long put, if assigned or exercised, will result in a short stock position. If you're short a stock, you have potentially unlimited risk because there's theoretically no limit to the potential price increase of the underlying stock. There's also no guarantee the brokerage firm can continue to maintain that short position for an unlimited time period. So, if you're a newbie, it's generally inadvisable to carry an options position into expiration if there's a chance you might end up with a short stock position. A note on pin risk: It's not common, but occasionally a stock settles right on a strike price at expiration. So, if you were short the 105-strike calls and XYZ settled at exactly $105, there would be no automatic assignment, but depending on the actions taken by the option holder, you may or may not be assigned—and you may not be able to trade out of any unwanted positions until the next business day. But it goes beyond the exact price issue. What if an option is ITM as of the market close, but news comes out after the close (but before the exercise decision deadline) that sends the stock price up or down through the strike price? Remember: The owner of the option could submit a DNE request. The uncertainty and potential exposure when a stock price and the strike price are the same at expiration is called pin risk. The best way to avoid it is to close the position before expiration. The decision tree: How to approach expiration As expiration approaches, you have three choices. Depending on the circumstances—and your objectives and risk tolerance—any of these might be the best decision for you. 1. Let the chips fall where they may. Some positions may not require as much maintenance. An options position that's deeply OTM will likely go away on its own, but occasionally an option that's been left for dead springs back to life. If it's a long option, the unexpected turn of events might feel like a windfall; if it's a short option that could've been closed out for a penny or two, you might be kicking yourself for not doing so. 2. Close it out. If you've met your objectives for a trade, then it might be time to close it out. Otherwise, you might be exposed to risks that aren't commensurate with any added return potential (like the short option that could've been closed out for next to nothing, then suddenly came back into play). Keep in mind, there is no guarantee that there will be an active market for an options contract, so it is possible to end up stuck and unable to close an options position."," Only use the provided text to answer the question, no outside sources. I want to sell put credit spreads on Apple to start making passive income but I don't want to own the stock. Based on this article, explain in 500 words if this strategy would truly have defined risk and prevented me from being assigned shares. In the money or out of the money? The buyer (""owner"") of an option has the right, but not the obligation, to exercise the option on or before expiration. A call option5 gives the owner the right to buy the underlying security; a put option6 gives the owner the right to sell the underlying security. Conversely, when you sell an option, you may be assigned—at any time regardless of the ITM amount—if the option owner chooses to exercise. The option seller has no control over assignment and no certainty as to when it could happen. Once the assignment notice is delivered, it's too late to close the position and the option seller must fulfill the terms of the options contract: A long call exercise results in buying the underlying stock at the strike price. A short call assignment results in selling the underlying stock at the strike price. A long put exercise results in selling the underlying stock at the strike price. A short put assignment results in buying the underlying stock at the strike price. An option will likely be exercised if it's in the option owner's best interest to do so, meaning it's optimal to take or to close a position in the underlying security at the strike price rather than at the current market price. After the market close on expiration day, ITM options may be automatically exercised, whereas OTM options are not and typically expire worthless (often referred to as being ""abandoned""). The table below spells it out. If the underlying stock price is... ...higher than the strike price ...lower than the strike price If the underlying stock price is... A long call is... ...higher than the strike price ...ITM and typically exercised ...lower than the strike price ...OTM and typically abandoned If the underlying stock price is... A short call is... ...higher than the strike price ...ITM and typically assigned ...lower than the strike price ...OTM and typically abandoned If the underlying stock price is... A long put is... ...higher than the strike price ...OTM and typically abandoned ...lower than the strike price ...ITM and typically exercised If the underlying stock price is... A short put is... ...higher than the strike price ...OTM and typically abandoned ...lower than the strike price ...ITM and typically assigned The guidelines in the table assume a position is held all the way through expiration. Of course, you typically don't need to do that. And in many cases, the usual strategy is to close out a position ahead of the expiration date. We'll revisit the close-or-hold decision in the next section and look at ways to do that. But assuming you do carry the options position until the end, there are a few things you need to consider: Know your specs. Each standard equity options contract controls 100 shares of the underlying stock. That's pretty straightforward. Non-standard options may have different deliverables. Non-standard options can represent a different number of shares, shares of more than one company stock, or underlying shares and cash. Other products—such as index options or options on futures—have different contract specs. Stock and options positions will match and close. Suppose you're long 300 shares of XYZ and short one ITM call that's assigned. Because the call is deliverable into 100 shares, you'll be left with 200 shares of XYZ if the option is assigned, plus the cash from selling 100 shares at the strike price. It's automatic, for the most part. If an option is ITM by as little as $0.01 at expiration, it will automatically be exercised for the buyer and assigned to a seller. However, there's something called a do not exercise (DNE) request that a long option holder can submit if they want to abandon an option. In such a case, it's possible that a short ITM position might not be assigned. For more, see the note below on pin risk7? You'd better have enough cash. If an option on XYZ is exercised or assigned and you are ""uncovered"" (you don't have an existing long or short position in the underlying security), a long or short position in the underlying stock will replace the options. A long call or short put will result in a long position in XYZ; a short call or long put will result in a short position in XYZ. For long stock positions, you need to have enough cash to cover the purchase or else you'll be issued a margin8 call, which you must meet by adding funds to your account. But that timeline may be short, and the broker, at its discretion, has the right to liquidate positions in your account to meet a margin call9. If exercise or assignment involves taking a short stock position, you need a margin account and sufficient funds in the account to cover the margin requirement. Short equity positions are risky business. An uncovered short call or long put, if assigned or exercised, will result in a short stock position. If you're short a stock, you have potentially unlimited risk because there's theoretically no limit to the potential price increase of the underlying stock. There's also no guarantee the brokerage firm can continue to maintain that short position for an unlimited time period. So, if you're a newbie, it's generally inadvisable to carry an options position into expiration if there's a chance you might end up with a short stock position. A note on pin risk: It's not common, but occasionally a stock settles right on a strike price at expiration. So, if you were short the 105-strike calls and XYZ settled at exactly $105, there would be no automatic assignment, but depending on the actions taken by the option holder, you may or may not be assigned—and you may not be able to trade out of any unwanted positions until the next business day. But it goes beyond the exact price issue. What if an option is ITM as of the market close, but news comes out after the close (but before the exercise decision deadline) that sends the stock price up or down through the strike price? Remember: The owner of the option could submit a DNE request. The uncertainty and potential exposure when a stock price and the strike price are the same at expiration is called pin risk. The best way to avoid it is to close the position before expiration. The decision tree: How to approach expiration As expiration approaches, you have three choices. Depending on the circumstances—and your objectives and risk tolerance—any of these might be the best decision for you. 1. Let the chips fall where they may. Some positions may not require as much maintenance. An options position that's deeply OTM will likely go away on its own, but occasionally an option that's been left for dead springs back to life. If it's a long option, the unexpected turn of events might feel like a windfall; if it's a short option that could've been closed out for a penny or two, you might be kicking yourself for not doing so. 2. Close it out. If you've met your objectives for a trade, then it might be time to close it out. Otherwise, you might be exposed to risks that aren't commensurate with any added return potential (like the short option that could've been closed out for next to nothing, then suddenly came back into play). Keep in mind, there is no guarantee that there will be an active market for an options contract, so it is possible to end up stuck and unable to close an options position. https://www.schwab.com/learn/story/options-exercise-assignment-and-more-beginners-guide",Financial,Summarize & Format,Text Transformation Only use information in the text here when responding.,treatments for types of arthritis?,"Types of Arthritis • Peripheral Arthritis. Peripheral arthritis usually affects the large joints of the arms and legs, including the elbows, wrists, knees, and ankles. The discomfort may be “migratory,” moving from one joint to another. If left untreated, the pain may last from a few days to several weeks. Peripheral arthritis tends to be more common among people who have ulcerative colitis or Crohn’s disease of the colon. The level of inflammation in the joints generally mirrors the extent of inflammation in the colon. Although no specific test can make an absolute diagnosis, various diagnostic methods—including analysis of joint fluid, blood tests, and X-rays—are used to rule out other causes of joint pain. Fortunately, IBD-related peripheral arthritis usually does not cause any lasting damage and treatment of the underlying IBD typically results in improvement in the joint discomfort. • Axial Arthritis. Also known as spondylitis or spondyloarthropathy, axial arthritis produces pain and stiffness in the lower spine and sacroiliac joints (at the bottom of the back). Interestingly, and especially in young people, these symptoms may come on months or even years before the symptoms of IBD appear. Unlike peripheral arthritis, axial arthritis may cause permanent damage if the bones of the vertebral column fuse together—thereby creating decreased range of motion in the back. In some cases, a restriction in rib motion may make it difficult for people to take deep breaths. Active spondylitis generally subsides by age 40. Therapy for people with axial arthritis often includes the use of biologic therapies. Non-medical therapies are geared toward improving range of motion in the back. Stretching exercises are recommended, as is the application of moist heat to the back. Treatment of the underlying IBD is helpful, but generally less effective than in patients with peripheral arthritis. • Ankylosing Spondylitis. A more severe form of spinal arthritis, ankylosing spondylitis (AS) is a rare complication, affecting between 2% and 3% of people with IBD. It is seen more often in Crohn’s disease than in ulcerative colitis. In addition to causing arthritis of the spine and sacroiliac joints, ankylosing spondylitis can cause inflammation of the eyes, lungs, and heart valves. The cause of AS is not known, but most affected individuals share a common genetic marker. In some cases, the disease occurs in genetically susceptible people after exposure to bowel or urinary tract infections. Occasionally, AS foretells the development of IBD. AS typically strikes people under the age of 30, mainly adolescents and young adult males, appearing first as a dramatic loss of flexibility in the lower spine. Rehabilitation therapy is essential to help maintain joint flexibility. But even with optimal therapy, some people will develop a stiff or “ankylosed” spine. Symptoms of AS may continue to worsen even after surgical removal of the colon. It is important to see a rheumatologist when this disease is suspected, as biologic treatments often help reduce complications and joint damage. Diagnosis It is not always easy to determine if the arthritis is linked to the intestinal condition. In general, the arthritis that complicates IBD is not as severe as rheumatoid arthritis. The joints do not ordinarily undergo destructive changes, and joint involvement is not symmetric (affecting the same joints on both sides of the body). Except for ankylosing spondylitis, arthritis associated with IBD usually improves as intestinal symptoms improve. Treatment In the general population, people with peripheral arthritis may use nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints. However, as a rule, these medications—which include aspirin and ibuprofen—are not a good option for everyone with IBD because they can irritate the intestinal lining and increase the inflammation. (It should be noted, though, that some people with IBD can tolerate NSAIDs and find these medications helpful in relieving symptoms of arthritis. It is important to discuss medication usage with your doctor.) Corticosteroids also may be used to treat the arthritis symptoms as well as IBD. In most cases, doctors manage the symptoms of peripheral arthritis by controlling the inflammation within the colon. Only axial arthritis seems not to improve as the intestinal inflammation resolves. Once inflammation has decreased, possibly after a course of a medication such as prednisone or sulfasalazine (or other 5-aminosalicylates), joint pain generally disappears. Because they take months to work, the immunomodulators azathioprine and/or 6-mercaptopurine are not used specifically to control joint inflammation. However, the immunomodulator methotrexate can be an effective treatment for IBD-associated joint pain. Similarly, the newer biologic agents such as infliximab (Remicade®), adalimumab (Humira®), and certolizumab (Cimzia®) have all been shown to be very effective in reducing joint inflammation and swelling. Infliximab and adalimumab have even shown good results as a primary treatment for ankylosing spondylitis, preventing joint damage and destruction. In addition to medication, doctors may recommend resting the affected joint, occasional use of moist heat, or range of motion exercises, as demonstrated by a physical therapist.","treatments for types of arthritis? Only use information in the text here when responding. Types of Arthritis • Peripheral Arthritis. Peripheral arthritis usually affects the large joints of the arms and legs, including the elbows, wrists, knees, and ankles. The discomfort may be “migratory,” moving from one joint to another. If left untreated, the pain may last from a few days to several weeks. Peripheral arthritis tends to be more common among people who have ulcerative colitis or Crohn’s disease of the colon. The level of inflammation in the joints generally mirrors the extent of inflammation in the colon. Although no specific test can make an absolute diagnosis, various diagnostic methods—including analysis of joint fluid, blood tests, and X-rays—are used to rule out other causes of joint pain. Fortunately, IBD-related peripheral arthritis usually does not cause any lasting damage and treatment of the underlying IBD typically results in improvement in the joint discomfort. • Axial Arthritis. Also known as spondylitis or spondyloarthropathy, axial arthritis produces pain and stiffness in the lower spine and sacroiliac joints (at the bottom of the back). Interestingly, and especially in young people, these symptoms may come on months or even years before the symptoms of IBD appear. Unlike peripheral arthritis, axial arthritis may cause permanent damage if the bones of the vertebral column fuse together—thereby creating decreased range of motion in the back. In some cases, a restriction in rib motion may make it difficult for people to take deep breaths. Active spondylitis generally subsides by age 40. Therapy for people with axial arthritis often includes the use of biologic therapies. Non-medical therapies are geared toward improving range of motion in the back. Stretching exercises are recommended, as is the application of moist heat to the back. Treatment of the underlying IBD is helpful, but generally less effective than in patients with peripheral arthritis. • Ankylosing Spondylitis. A more severe form of spinal arthritis, ankylosing spondylitis (AS) is a rare complication, affecting between 2% and 3% of people with IBD. It is seen more often in Crohn’s disease than in ulcerative colitis. In addition to causing arthritis of the spine and sacroiliac joints, ankylosing spondylitis can cause inflammation of the eyes, lungs, and heart valves. The cause of AS is not known, but most affected individuals share a common genetic marker. In some cases, the disease occurs in genetically susceptible people after exposure to bowel or urinary tract infections. Occasionally, AS foretells the development of IBD. AS typically strikes people under the age of 30, mainly adolescents and young adult males, appearing first as a dramatic loss of flexibility in the lower spine. Rehabilitation therapy is essential to help maintain joint flexibility. But even with optimal therapy, some people will develop a stiff or “ankylosed” spine. Symptoms of AS may continue to worsen even after surgical removal of the colon. It is important to see a rheumatologist when this disease is suspected, as biologic treatments often help reduce complications and joint damage. Diagnosis It is not always easy to determine if the arthritis is linked to the intestinal condition. In general, the arthritis that complicates IBD is not as severe as rheumatoid arthritis. The joints do not ordinarily undergo destructive changes, and joint involvement is not symmetric (affecting the same joints on both sides of the body). Except for ankylosing spondylitis, arthritis associated with IBD usually improves as intestinal symptoms improve. Treatment In the general population, people with peripheral arthritis may use nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce pain and swelling of the joints. However, as a rule, these medications—which include aspirin and ibuprofen—are not a good option for everyone with IBD because they can irritate the intestinal lining and increase the inflammation. (It should be noted, though, that some people with IBD can tolerate NSAIDs and find these medications helpful in relieving symptoms of arthritis. It is important to discuss medication usage with your doctor.) Corticosteroids also may be used to treat the arthritis symptoms as well as IBD. In most cases, doctors manage the symptoms of peripheral arthritis by controlling the inflammation within the colon. Only axial arthritis seems not to improve as the intestinal inflammation resolves. Once inflammation has decreased, possibly after a course of a medication such as prednisone or sulfasalazine (or other 5-aminosalicylates), joint pain generally disappears. Because they take months to work, the immunomodulators azathioprine and/or 6-mercaptopurine are not used specifically to control joint inflammation. However, the immunomodulator methotrexate can be an effective treatment for IBD-associated joint pain. Similarly, the newer biologic agents such as infliximab (Remicade®), adalimumab (Humira®), and certolizumab (Cimzia®) have all been shown to be very effective in reducing joint inflammation and swelling. Infliximab and adalimumab have even shown good results as a primary treatment for ankylosing spondylitis, preventing joint damage and destruction. In addition to medication, doctors may recommend resting the affected joint, occasional use of moist heat, or range of motion exercises, as demonstrated by a physical therapist.",Medical,Fact Finding,Q&A "Answer in a full sentence, no less than 50 words, and cite the part of the text that supports your statement.","According to this article, what are the advantages of a Balloon Loan?","**Balloon Payment: What It Is, How It Works** A balloon payment is the final amount due on a loan that is structured as a series of small monthly payments followed by a single much larger sum at the end of the loan period. The early payments may be all or almost all payments of interest owed on the loan, with the balloon payment being the principal of the loan. This type of loan is known as a balloon loan. The balloon home mortgage loan became common in the years before the 2007-2008 financial crisis. It allowed people eager to buy a home to obtain a mortgage payment that they could afford, at least in the early years. The balloon loan did not disappear with the financial crisis but is now more often used for business loans. A project can be financed with a loan that allows for minimal payments early on, with the balloon payment due only when the project is earning a return on the investment. A balloon payment is a type of loan structured so that the last payment is far larger than prior payments. Balloon payments are an option for home mortgages, auto loans, and business loans. Borrowers have lower initial monthly payments under a balloon loan. The interest rate is usually higher for a balloon loan, and only borrowers with high creditworthiness are considered. The balloon payment may be a weighted payment amount or, under an interest-only payment plan, be the full balance of the principal due. Understanding Balloon Payments As the term ""balloon"" suggests, the final payment on this type of loan is significantly large. In recent years, balloon payments have been more common in commercial lending than in consumer lending. It allows a commercial lender to keep short-term costs lower and take care of the balloon payment with future earnings. The same logic is used by individual homebuyers, but the risks are greater. Homebuyers are keeping their short-term costs low while assuming that their incomes will be far greater when the balloon payment comes due, that they will be able to refinance their mortgage before it is due, or that they can sell the house and pay off the entire mortgage before the balloon payment comes due. That strategy failed in the 2008-2009 financial crisis, when homeowners who financed their purchases with balloon mortgages found it impossible to sell their homes at a price high enough to pay off the amount they had borrowed. Balloon payments are often packaged into two-step mortgages. In this financing structure, a borrower receives an introductory and often lower interest rate at the start of their loan. Then, the loan shifts to a higher interest rate after an initial borrowing period. Balloon Payment Examples A balloon debt structure can be implemented for any type of debt. It's most commonly used in mortgages, auto loans, and business loans. Mortgage The balloon mortgage is rarely used for traditional 15-year or 30-year mortgages since lenders don't want to wait that long to get their money back. For balloon mortgages, lenders prefer a five-year to ten-year term. Interest-only balloon mortgages are available primarily to high-net-worth individuals who can afford large down payments. They are often taken with the intention of refinancing before the balloon payment is due. Balloon Loan vs. ARM A balloon loan is sometimes confused with an adjustable-rate mortgage (ARM). With an ARM, the borrower receives an introductory rate for a set amount of time, usually for one to five years. The interest rate resets at that point and might continue to reset periodically until the loan has been fully repaid. The incentive is a very low-interest rate at the beginning, compared to the fixed-rate mortgage rate. The downside is the potential for a substantially higher rate down the road. Business Loan It is usually easier for a business to secure a balloon loan if the business has a proven financial history and favorable credit record. An established business can be in a better position than an individual wage-earner to raise sufficient money to pay off the balloon payment. For this reason, lenders often consider businesses less risky than individual consumers for business loans. Balloon payments can be strategically used by a business to finance short-term needs. The business may draw on a balloon loan with no intention of holding the debt to the end of the term. Instead, the company can use the money to repay the loan in full before the end of the loan term. Options for Avoiding a Balloon Payment A borrower has a couple of ways to get rid of a looming payment. In addition to extinguishing the debt by paying off the balloon payment, a borrower can: Refinance the loan. A lender may be willing to work with a borrower to repurpose the debt into a different loan vehicle or modify the terms of the original agreement. Sell the underlying asset. If the balloon payment is due to the purchase of an asset, a borrower may be forced to liquidate the holding to avoid defaulting on the loan. Pay principal upfront. Though not required, a borrower may be able to pay a portion of the debt early. Any payment made more than the interest assessment will be applied to the principal balance. Check with your lender to ensure there are no prepayment penalties or fees. Negotiate an extension. Similar to refinancing, an extension changes the terms of the prior loan. However, instead of receiving a new deal, an extension will simply push out the timing of the balloon payment. You'll likely have the same payment terms as before but with different obligation dates. Balloon loans usually require collateral. For home or car loans, the lender may require a lien on the property being purchased. Should you default on your loan and not be able to satisfy the balloon payment, the lender has a legal claim to seize the property. Advantages of Balloon Payments The obvious advantage of balloon payments is the low initial payment requirement. The monthly balloon payment amount during the fixed period is generally less than the payment amount of a fully amortized loan. The timing of the payment size may mesh well with the borrower's income expectations. As the borrower's salary increases due to career progression, the debt obligation will rise as well. A balloon note or loan often has a shorter underwriting process compared to other loans. For this reason, there may be lower administrative or transaction fees in securing the loan. A borrower may also not be required to show as much documentation for this type of loan, as balloon mortgages often do not require a home appraisal as part of loan closing. A balloon payment structure is strategically advantageous for some borrowers. For example, people who flip houses can secure lower upfront monthly payments. The borrower has time to remodel the house and sell it before the balloon payment is due. This allows borrowers to preserve future cash flow for other purposes. Disadvantages of Balloon Payments Balloon payments can be a big problem in a falling housing market. As home prices decline, homeowners may be unable to sell their homes for enough to cover the balloon payment, and they might be unable to sell at any price. For home flippers, this means getting stuck with a high-interest rate loan should sales stall. Borrowers often have no choice but to default on their loans and enter foreclosure, regardless of their household incomes, when faced with a balloon payment they cannot afford. This results in the loss of the borrower's home. Some will be able to take out another loan to cover the upcoming balloon mortgage payment, but this puts a tremendous strain on a family's finances. Balloon mortgages and auto loans may be difficult to refinance depending on the amount of equity that has been paid off. The loans may only pay interest early on. In this case, the owner may have little-to-no equity in the property despite making consistent payments for years. These types of loans can be harder to qualify for. Because principal payments are deferred, lenders often prefer borrowers with a high credit score or high down payment. In addition, to compensate for the flexibility of the principal obligation and increased risk for the lender, lenders usually charge higher interest rates for balloon debt compared to other types of loans. What Is a Balloon Payment? A balloon payment is a lump sum principal balance that is due at the end of a loan term. The borrower pays much smaller monthly payments until the balloon payment is due. These payments may be entirely or almost entirely interest on the loan rather than principal. Borrowers are assuming that they can refinance the mortgage or sell the home at a profit before the balloon payment falls due. If the housing market takes an unexpected downturn and their home loses value, that strategy may fail.","[Instructions] ======= Answer in a full sentence, no less than 50 words, and cite the part of the text that supports your statement. [Query] ======= According to this article, what are the advantages of a Balloon Loan? [Context] ======= **Balloon Payment: What It Is, How It Works** A balloon payment is the final amount due on a loan that is structured as a series of small monthly payments followed by a single much larger sum at the end of the loan period. The early payments may be all or almost all payments of interest owed on the loan, with the balloon payment being the principal of the loan. This type of loan is known as a balloon loan. The balloon home mortgage loan became common in the years before the 2007-2008 financial crisis. It allowed people eager to buy a home to obtain a mortgage payment that they could afford, at least in the early years. The balloon loan did not disappear with the financial crisis but is now more often used for business loans. A project can be financed with a loan that allows for minimal payments early on, with the balloon payment due only when the project is earning a return on the investment. A balloon payment is a type of loan structured so that the last payment is far larger than prior payments. Balloon payments are an option for home mortgages, auto loans, and business loans. Borrowers have lower initial monthly payments under a balloon loan. The interest rate is usually higher for a balloon loan, and only borrowers with high creditworthiness are considered. The balloon payment may be a weighted payment amount or, under an interest-only payment plan, be the full balance of the principal due. Understanding Balloon Payments As the term ""balloon"" suggests, the final payment on this type of loan is significantly large. In recent years, balloon payments have been more common in commercial lending than in consumer lending. It allows a commercial lender to keep short-term costs lower and take care of the balloon payment with future earnings. The same logic is used by individual homebuyers, but the risks are greater. Homebuyers are keeping their short-term costs low while assuming that their incomes will be far greater when the balloon payment comes due, that they will be able to refinance their mortgage before it is due, or that they can sell the house and pay off the entire mortgage before the balloon payment comes due. That strategy failed in the 2008-2009 financial crisis, when homeowners who financed their purchases with balloon mortgages found it impossible to sell their homes at a price high enough to pay off the amount they had borrowed. Balloon payments are often packaged into two-step mortgages. In this financing structure, a borrower receives an introductory and often lower interest rate at the start of their loan. Then, the loan shifts to a higher interest rate after an initial borrowing period. Balloon Payment Examples A balloon debt structure can be implemented for any type of debt. It's most commonly used in mortgages, auto loans, and business loans. Mortgage The balloon mortgage is rarely used for traditional 15-year or 30-year mortgages since lenders don't want to wait that long to get their money back. For balloon mortgages, lenders prefer a five-year to ten-year term. Interest-only balloon mortgages are available primarily to high-net-worth individuals who can afford large down payments. They are often taken with the intention of refinancing before the balloon payment is due. Balloon Loan vs. ARM A balloon loan is sometimes confused with an adjustable-rate mortgage (ARM). With an ARM, the borrower receives an introductory rate for a set amount of time, usually for one to five years. The interest rate resets at that point and might continue to reset periodically until the loan has been fully repaid. The incentive is a very low-interest rate at the beginning, compared to the fixed-rate mortgage rate. The downside is the potential for a substantially higher rate down the road. Business Loan It is usually easier for a business to secure a balloon loan if the business has a proven financial history and favorable credit record. An established business can be in a better position than an individual wage-earner to raise sufficient money to pay off the balloon payment. For this reason, lenders often consider businesses less risky than individual consumers for business loans. Balloon payments can be strategically used by a business to finance short-term needs. The business may draw on a balloon loan with no intention of holding the debt to the end of the term. Instead, the company can use the money to repay the loan in full before the end of the loan term. Options for Avoiding a Balloon Payment A borrower has a couple of ways to get rid of a looming payment. In addition to extinguishing the debt by paying off the balloon payment, a borrower can: Refinance the loan. A lender may be willing to work with a borrower to repurpose the debt into a different loan vehicle or modify the terms of the original agreement. Sell the underlying asset. If the balloon payment is due to the purchase of an asset, a borrower may be forced to liquidate the holding to avoid defaulting on the loan. Pay principal upfront. Though not required, a borrower may be able to pay a portion of the debt early. Any payment made more than the interest assessment will be applied to the principal balance. Check with your lender to ensure there are no prepayment penalties or fees. Negotiate an extension. Similar to refinancing, an extension changes the terms of the prior loan. However, instead of receiving a new deal, an extension will simply push out the timing of the balloon payment. You'll likely have the same payment terms as before but with different obligation dates. Balloon loans usually require collateral. For home or car loans, the lender may require a lien on the property being purchased. Should you default on your loan and not be able to satisfy the balloon payment, the lender has a legal claim to seize the property. Advantages of Balloon Payments The obvious advantage of balloon payments is the low initial payment requirement. The monthly balloon payment amount during the fixed period is generally less than the payment amount of a fully amortized loan. The timing of the payment size may mesh well with the borrower's income expectations. As the borrower's salary increases due to career progression, the debt obligation will rise as well. A balloon note or loan often has a shorter underwriting process compared to other loans. For this reason, there may be lower administrative or transaction fees in securing the loan. A borrower may also not be required to show as much documentation for this type of loan, as balloon mortgages often do not require a home appraisal as part of loan closing. A balloon payment structure is strategically advantageous for some borrowers. For example, people who flip houses can secure lower upfront monthly payments. The borrower has time to remodel the house and sell it before the balloon payment is due. This allows borrowers to preserve future cash flow for other purposes. Disadvantages of Balloon Payments Balloon payments can be a big problem in a falling housing market. As home prices decline, homeowners may be unable to sell their homes for enough to cover the balloon payment, and they might be unable to sell at any price. For home flippers, this means getting stuck with a high-interest rate loan should sales stall. Borrowers often have no choice but to default on their loans and enter foreclosure, regardless of their household incomes, when faced with a balloon payment they cannot afford. This results in the loss of the borrower's home. Some will be able to take out another loan to cover the upcoming balloon mortgage payment, but this puts a tremendous strain on a family's finances. Balloon mortgages and auto loans may be difficult to refinance depending on the amount of equity that has been paid off. The loans may only pay interest early on. In this case, the owner may have little-to-no equity in the property despite making consistent payments for years. These types of loans can be harder to qualify for. Because principal payments are deferred, lenders often prefer borrowers with a high credit score or high down payment. In addition, to compensate for the flexibility of the principal obligation and increased risk for the lender, lenders usually charge higher interest rates for balloon debt compared to other types of loans. What Is a Balloon Payment? A balloon payment is a lump sum principal balance that is due at the end of a loan term. The borrower pays much smaller monthly payments until the balloon payment is due. These payments may be entirely or almost entirely interest on the loan rather than principal. Borrowers are assuming that they can refinance the mortgage or sell the home at a profit before the balloon payment falls due. If the housing market takes an unexpected downturn and their home loses value, that strategy may fail.",Financial,Find & Summarize,Text Transformation You must respond using only information contained in the prompt and provided provided text. Answer with a header followed by bullet points.,What are some exercises for initial strengthening during latarjet recovery?,"P a g e 1 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. PHYSICAL THERAPY PROTOCOL AFTER LATARJET PROCEDURE: The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an open Latarjet procedure. It is no means intended to be a substitute for one’s clinical decision making regarding the progression of a patient’s post-operative course based on their physical exam/findings, individual progress, and/or the presence of postoperative complications. If a clinician requires assistance in the progression of a postoperative patient, they should consult with the referring Surgeon. Depending on the intraoperatively determined bone quality of the bone block, the surgeon defines in the operative report when pendulum exercises, passive range of motion (PROM), active range of motion (AROM) may be started. Accordingly, the postoperative protocol is defined individually for each patient by the surgeon and recorded in the operation report. P a g e 2 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase I – Immediate Post-Surgical Phase (Week 1-4): Goals: • Protect the integrity of the surgical repair • Achieve gradual restoration of passive range of motion (PROM) • Enhance/ensure adequate scapular function Precautions: • No active range of motion (AROM) of Shoulder • Maintain arm in sling, remove only for exercise for elbow, wrist and fingers, only removing for showering. Shower with arm held at side • No lifting of objects • No shoulder motion behind back • No excessive stretching or sudden movements • No supporting of body weight by hands • Keep incision clean and dry • Patient education regarding limited use of upper extremity despite the potential lack of or minimal pain or other symptoms DAY 1 TO 6: • Abduction brace or pillow / sling except when performing distal upper extremity exercises. Begin restoring AROM of elbow/wrist/hand of operative extremity • Sleep in brace or pillow / sling • Scapular clock exercises progressed to scapular isometric exercises • Ball squeezes • Cryotherapy for pain and inflammation -Day 1-2: as much as possible -Day 3-6: post activity, or for pain, or for comfort (IMPORTANT: USE TOWEL TO PROTECT SKIN AND PAUSE CRYOTHERAPY AT LEAST FOR 20 MIN/HOUR TO PREVENT FROSTBITES) P a g e 3 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. DAY 7 TO 28: • Continue use of brace/ pillow / sling • Continue Elbow, wrist, and finger AROM / resisted • Begin shoulder PROM (do not force any painful motion) in first two weeks or as directed by surgeon • Forward flexion and elevation to tolerance • Abduction in the plane of the scapula to tolerance • Internal rotation (IR) to 45 degrees at 30 degrees of abduction • External rotation (ER) in the plane of the scapula from 0-25 degrees or as directed by surgeon; begin at 30- 40 degrees of abduction; respect anterior capsule tissue integrity with ER range of motion; seek guidance from intraoperative measurements of external rotation ROM • Active and manual scapula strengthening exercises: Exercises: shoulder shrug and roll • Pendulum Exercises: (start of pendulum exercises is defined by the surgeon in the OR report. Do not start pendulum exercises if the operation report states that pendulum exercises should be started from the 6th or 8th postoperative week.). pendulum exercises • Start passive ROM (PROM): The PROM exercises should be supervised by the physiotherapist during the first session. In addition, the PROM home exercises should be trained by the physiotherapist. (start of passive ROM is defined by the surgeon in the OR report. Do not start PROM exercises if the operation report states that PROM exercises should be started from the 6th or 8th postoperative week). P a g e 4 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase II – Intermediate Phase (Week 5-8): Goals: • Do not overstress healing tissue • Discontinue brace / sling at end of week 6 • Gradually start active range of motion • Initiate active assisted range of motion (AAROM) under guidance of physical therapy: • Begin light waist level activities Precautions: • No active movement of shoulder till adequate PROM with good mechanics • No lifting with affected upper extremity • No excessive external rotation ROM / stretching. seek guidance from intraoperative measurements of external rotation ROM) • Do not perform activities or strengthening exercises that place an excessive load on the anterior capsule of the shoulder joint (i.e. no pushups, pec fly, etc..) • Do not perform scaption with internal rotation (empty can) during any stage of rehabilitation due to the possibility of impingement • Continued patient education: posture, joint protection, positioning, hygiene, etc. Exercises: 1. flexion in supine position 2. sitting assisted forward reach (elevation) 3. standing wall-assisted forward flexion 4. Cane-Assisted External Rotation at 20 degrees, 45 degrees abduction 5. Doorway Standing External Rotation 6. Scapular plane Abduction to Tolerance 7. Active Range of Motion Forward Flexion in the Scapular Plane 8. Active Range Of Motion External Rotation in Multiple Positions: Side-Lying or Sitting P a g e 5 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase III – strengthening phase (week 9-12): Goal: • Maintain Full AROM and Maintain Full PROM • Gradual restoration of shoulder strength, power, and endurance (Elastic bands) •Gradual return to functional activities Precautions: • No heavy lifting of objects (no heavier than 5 lbs.) • No sudden lifting or pushing activities • No sudden jerking motions • No heavy lifting of objects (no heavier than 5 lbs.) • No sudden lifting or pushing activities • No sudden jerking motions Start of strengthening with elastic bands and light weights is defined by the surgeon in the OR report. Do not start strengthening if the operation report states that strengthening should be started later. In patients with poor bone quality, strengthening is occasionally started later. Exercises: 1. Active Range of Motion External Rotation with Band Strengthening 2. Active Range of Motion Internal Rotation with Band Strengthening 3. Row with Resistance Band 4. Towel/Hand-assisted Internal Rotation Stretch 5. Side lying Internal Rotation Stretch at 70 and 90 Degrees 6. Cross-Body Stretch 7. Water (pool) therapy Standing in water with float under arm, lower body into water to help stretch into flexion 8. Standing in water with float under arm, lower body to side to help with external rotation P a g e 6 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase IV Advanced strengthening phase (week 13- 22): About 12 weeks postoperatively, a CT scan is performed to determine whether the bone block has healed. Depending on the findings, the surgeon will decide whether to move on to phase IV. Goals: • Maintain full non-painful active ROM • Advance conditioning exercises for Enhanced functional use of UE • Improve muscular strength, power, and endurance (light weights) • Gradual return to full functional activities • Continue to perform ROM stretching, if motion is not complete Exercises: • Side-lying External Rotation with Towel • Full Can in the Scapular Plane • Prone Scaption • Diagonal • Dynamic Hug • Internal Rotation at 90 Degrees Abduction • Forward Band Punch • Sitting Supported External Rotation at 90 Degrees • Standing Unsupported External Rotation at 90 Degrees • Biceps Curl Phase V – Return to activity phase (week 23): Goals: • Gradual return to strenuous work activities • Gradual return to recreational activities • Gradual return to sport activities • Continue strengthening and stretching • Continue stretching, if motion is tight • May initiate interval sport program","What are some exercises for initial strengthening during latarjet recovery? You must respond using only information contained in the prompt and provided provided text. Answer with a header followed by bullet points. P a g e 1 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. PHYSICAL THERAPY PROTOCOL AFTER LATARJET PROCEDURE: The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone an open Latarjet procedure. It is no means intended to be a substitute for one’s clinical decision making regarding the progression of a patient’s post-operative course based on their physical exam/findings, individual progress, and/or the presence of postoperative complications. If a clinician requires assistance in the progression of a postoperative patient, they should consult with the referring Surgeon. Depending on the intraoperatively determined bone quality of the bone block, the surgeon defines in the operative report when pendulum exercises, passive range of motion (PROM), active range of motion (AROM) may be started. Accordingly, the postoperative protocol is defined individually for each patient by the surgeon and recorded in the operation report. P a g e 2 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase I – Immediate Post-Surgical Phase (Week 1-4): Goals: • Protect the integrity of the surgical repair • Achieve gradual restoration of passive range of motion (PROM) • Enhance/ensure adequate scapular function Precautions: • No active range of motion (AROM) of Shoulder • Maintain arm in sling, remove only for exercise for elbow, wrist and fingers, only removing for showering. Shower with arm held at side • No lifting of objects • No shoulder motion behind back • No excessive stretching or sudden movements • No supporting of body weight by hands • Keep incision clean and dry • Patient education regarding limited use of upper extremity despite the potential lack of or minimal pain or other symptoms DAY 1 TO 6: • Abduction brace or pillow / sling except when performing distal upper extremity exercises. Begin restoring AROM of elbow/wrist/hand of operative extremity • Sleep in brace or pillow / sling • Scapular clock exercises progressed to scapular isometric exercises • Ball squeezes • Cryotherapy for pain and inflammation -Day 1-2: as much as possible -Day 3-6: post activity, or for pain, or for comfort (IMPORTANT: USE TOWEL TO PROTECT SKIN AND PAUSE CRYOTHERAPY AT LEAST FOR 20 MIN/HOUR TO PREVENT FROSTBITES) P a g e 3 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. DAY 7 TO 28: • Continue use of brace/ pillow / sling • Continue Elbow, wrist, and finger AROM / resisted • Begin shoulder PROM (do not force any painful motion) in first two weeks or as directed by surgeon • Forward flexion and elevation to tolerance • Abduction in the plane of the scapula to tolerance • Internal rotation (IR) to 45 degrees at 30 degrees of abduction • External rotation (ER) in the plane of the scapula from 0-25 degrees or as directed by surgeon; begin at 30- 40 degrees of abduction; respect anterior capsule tissue integrity with ER range of motion; seek guidance from intraoperative measurements of external rotation ROM • Active and manual scapula strengthening exercises: Exercises: shoulder shrug and roll • Pendulum Exercises: (start of pendulum exercises is defined by the surgeon in the OR report. Do not start pendulum exercises if the operation report states that pendulum exercises should be started from the 6th or 8th postoperative week.). pendulum exercises • Start passive ROM (PROM): The PROM exercises should be supervised by the physiotherapist during the first session. In addition, the PROM home exercises should be trained by the physiotherapist. (start of passive ROM is defined by the surgeon in the OR report. Do not start PROM exercises if the operation report states that PROM exercises should be started from the 6th or 8th postoperative week). P a g e 4 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase II – Intermediate Phase (Week 5-8): Goals: • Do not overstress healing tissue • Discontinue brace / sling at end of week 6 • Gradually start active range of motion • Initiate active assisted range of motion (AAROM) under guidance of physical therapy: • Begin light waist level activities Precautions: • No active movement of shoulder till adequate PROM with good mechanics • No lifting with affected upper extremity • No excessive external rotation ROM / stretching. seek guidance from intraoperative measurements of external rotation ROM) • Do not perform activities or strengthening exercises that place an excessive load on the anterior capsule of the shoulder joint (i.e. no pushups, pec fly, etc..) • Do not perform scaption with internal rotation (empty can) during any stage of rehabilitation due to the possibility of impingement • Continued patient education: posture, joint protection, positioning, hygiene, etc. Exercises: 1. flexion in supine position 2. sitting assisted forward reach (elevation) 3. standing wall-assisted forward flexion 4. Cane-Assisted External Rotation at 20 degrees, 45 degrees abduction 5. Doorway Standing External Rotation 6. Scapular plane Abduction to Tolerance 7. Active Range of Motion Forward Flexion in the Scapular Plane 8. Active Range Of Motion External Rotation in Multiple Positions: Side-Lying or Sitting P a g e 5 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase III – strengthening phase (week 9-12): Goal: • Maintain Full AROM and Maintain Full PROM • Gradual restoration of shoulder strength, power, and endurance (Elastic bands) •Gradual return to functional activities Precautions: • No heavy lifting of objects (no heavier than 5 lbs.) • No sudden lifting or pushing activities • No sudden jerking motions • No heavy lifting of objects (no heavier than 5 lbs.) • No sudden lifting or pushing activities • No sudden jerking motions Start of strengthening with elastic bands and light weights is defined by the surgeon in the OR report. Do not start strengthening if the operation report states that strengthening should be started later. In patients with poor bone quality, strengthening is occasionally started later. Exercises: 1. Active Range of Motion External Rotation with Band Strengthening 2. Active Range of Motion Internal Rotation with Band Strengthening 3. Row with Resistance Band 4. Towel/Hand-assisted Internal Rotation Stretch 5. Side lying Internal Rotation Stretch at 70 and 90 Degrees 6. Cross-Body Stretch 7. Water (pool) therapy Standing in water with float under arm, lower body into water to help stretch into flexion 8. Standing in water with float under arm, lower body to side to help with external rotation P a g e 6 | 6 Rehabilitation Protocol after Latarjet: Copyright © 2020 Massachusetts General Hospital, Boston Shoulder Institute, all rights reserved. Phase IV Advanced strengthening phase (week 13- 22): About 12 weeks postoperatively, a CT scan is performed to determine whether the bone block has healed. Depending on the findings, the surgeon will decide whether to move on to phase IV. Goals: • Maintain full non-painful active ROM • Advance conditioning exercises for Enhanced functional use of UE • Improve muscular strength, power, and endurance (light weights) • Gradual return to full functional activities • Continue to perform ROM stretching, if motion is not complete Exercises: • Side-lying External Rotation with Towel • Full Can in the Scapular Plane • Prone Scaption • Diagonal • Dynamic Hug • Internal Rotation at 90 Degrees Abduction • Forward Band Punch • Sitting Supported External Rotation at 90 Degrees • Standing Unsupported External Rotation at 90 Degrees • Biceps Curl Phase V – Return to activity phase (week 23): Goals: • Gradual return to strenuous work activities • Gradual return to recreational activities • Gradual return to sport activities • Continue strengthening and stretching • Continue stretching, if motion is tight • May initiate interval sport program",Medical,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","According to the reference text, how does the criteria for a DUI change when the offending party is a minor? Using only the reference text, what is the criteria for a felony DUI versus a misdemeanor?","First DUI Offense A first offense DUI in California is a misdemeanor typically punished by: ‍Penalties & Fee's: $390.00+‍ License Suspension: 6 - 16 months‍ Jail: Up to 6 Months‍ Alcohol Treatment: 3 Months Confronting a first DUI offense in Los Angeles can be a daunting experience, one that necessitates a nuanced understanding of specific DUI laws. The stakes are notably high; a conviction carries ramifications that can ripple through your personal and professional life. It's crucial to seek the guidance of a seasoned Los Angeles DUI attorney, versed in the intricacies of DUI defense. At The H Law, our legal acumen is geared towards mitigating the penalties that come with a DUI. These penalties often include fines, license suspension, mandatory DUI education programs, and, in some cases, incarceration. Our strategic approach in DUI defense frames a robust representation, crafted to protect your rights and challenge the prosecution's case. In Los Angeles, the law doesn't take DUI lightly, and neither should you. Securing expert legal defense early can significantly alter the outcome of a first Los Angeles DUI offense. Second DUI Offense When convicted of a 2nd DUI in California, the penalties typically imposed by the court are as follows: Penalties & Fee's: $2,000‍ License Suspension: Two years‍ Jail: Minimum of 96 hours‍ Alcohol Treatment: 18-30 months Facing a second DUI charge in Los Angeles can be a profoundly unsettling experience, with the potential for more severe consequences compared to a first offense. The stakes are undeniably higher, as Los Angeles DUI laws prescribe harsher penalties that may include longer jail time, increased fines, mandatory attendance at DUI school, and extended driver's license suspension. Additionally, the imposition of an ignition interlock device (IID) on your vehicle may become a requisite. Here at The H Law, we understand the gravity of a second DUI and the impact it holds over your freedom and future. With our expert DUI attorneys by your side, you can navigate the complex legal landscapes of DUI charges and work tirelessly towards a favorable outcome. Third DUI Offense When convicted of a 3rd Offense DUI in California, the penalties typically imposed by the court are as follows: Penalties & Fee's: $2,500 to $3,000‍ License Suspension: 3-year Revocation‍ Jail: Minimum of 120 days to One year‍ Alcohol Treatment: 30 Months+ Addressing a third DUI offense in Los Angeles carries severe consequences, warranting the astute legal counsel provided by The H Law. With penalties escalating sharply from the first and second offenses, it is paramount to understand the gravity of a third Los Angeles DUI charge. Under California law, a third DUI conviction within a 10-year period can result in significantly increased jail time, stringent probation conditions, and mandatory alcohol programs. Moreover, the financial implications are profound, encompassing steep fines and surcharges, which underscore the necessity of a determined defense strategy. The expertise of The H Law in defending against DUI charges is pivotal; our approach is tailored to navigate the intricacies of DUI laws, ensuring the most favorable outcome possible. Underage DUI Offense When dealing with an underage DUI in Los Angeles, it's crucial to understand the unique aspects of California DUI laws that apply. The state imposes a zero-tolerance policy for drivers under 21, meaning any detectable amount of alcohol can result in a DUI charge. At The H Law, we're well-versed in the nuances of Los Angeles DUI cases, including those impacting lives of younger drivers. With stricter penalties and potential long-term consequences on educational and employment opportunities, an underage DUI can be particularly damaging. It's essential to have a knowledgeable Los Angeles drunk driving attorney who can navigate the complexities of these offenses. Our expertise in California DUI law enables us to provide a robust defense for those facing underage DUI allegations, aiming to minimize the impact on their future. Choose The H Law to ensure your rights are fervently protected in the face of these significant legal challenges. Felony DUI Offense The consequences of a Felony DUI vary greatly. However, a few penalties could be: Penalties & Fee's: $1015-5000, plus restitution License Suspension: up to 5 years‍ Jail: 16 months to 16 years‍ Alcohol Treatment: 18 or 30 months When facing a felony DUI charge in Los Angeles, it's imperative to understand the gravity of the situation. Unlike misdemeanor DUI charges, a felony DUI can carry severe consequences, including significant jail time, hefty fines, and a lasting impact on one's civil liberties and future opportunities. If you've been charged with a felony DUI, swift and strategic legal intervention is crucial. The enhanced penalties are direct outcomes of either prior DUI convictions, inflicting bodily harm, or other aggravating factors. Such charges demand a highly qualified Los Angeles DUI attorney to meticulously analyze the details of your case to protect your rights. With the right defense, even serious DUI charges can be challenged, potentially mitigating the severe repercussions of a felony DUI conviction."," Only use the provided text to answer the question, no outside sources. According to the reference text, how does the criteria for a DUI change when the offending party is a minor? Using only the reference text, what is the criteria for a felony DUI versus a misdemeanor? First DUI Offense A first offense DUI in California is a misdemeanor typically punished by: ‍Penalties & Fee's: $390.00+‍ License Suspension: 6 - 16 months‍ Jail: Up to 6 Months‍ Alcohol Treatment: 3 Months Confronting a first DUI offense in Los Angeles can be a daunting experience, one that necessitates a nuanced understanding of specific DUI laws. The stakes are notably high; a conviction carries ramifications that can ripple through your personal and professional life. It's crucial to seek the guidance of a seasoned Los Angeles DUI attorney, versed in the intricacies of DUI defense. At The H Law, our legal acumen is geared towards mitigating the penalties that come with a DUI. These penalties often include fines, license suspension, mandatory DUI education programs, and, in some cases, incarceration. Our strategic approach in DUI defense frames a robust representation, crafted to protect your rights and challenge the prosecution's case. In Los Angeles, the law doesn't take DUI lightly, and neither should you. Securing expert legal defense early can significantly alter the outcome of a first Los Angeles DUI offense. Second DUI Offense When convicted of a 2nd DUI in California, the penalties typically imposed by the court are as follows: Penalties & Fee's: $2,000‍ License Suspension: Two years‍ Jail: Minimum of 96 hours‍ Alcohol Treatment: 18-30 months Facing a second DUI charge in Los Angeles can be a profoundly unsettling experience, with the potential for more severe consequences compared to a first offense. The stakes are undeniably higher, as Los Angeles DUI laws prescribe harsher penalties that may include longer jail time, increased fines, mandatory attendance at DUI school, and extended driver's license suspension. Additionally, the imposition of an ignition interlock device (IID) on your vehicle may become a requisite. Here at The H Law, we understand the gravity of a second DUI and the impact it holds over your freedom and future. With our expert DUI attorneys by your side, you can navigate the complex legal landscapes of DUI charges and work tirelessly towards a favorable outcome. Third DUI Offense When convicted of a 3rd Offense DUI in California, the penalties typically imposed by the court are as follows: Penalties & Fee's: $2,500 to $3,000‍ License Suspension: 3-year Revocation‍ Jail: Minimum of 120 days to One year‍ Alcohol Treatment: 30 Months+ Addressing a third DUI offense in Los Angeles carries severe consequences, warranting the astute legal counsel provided by The H Law. With penalties escalating sharply from the first and second offenses, it is paramount to understand the gravity of a third Los Angeles DUI charge. Under California law, a third DUI conviction within a 10-year period can result in significantly increased jail time, stringent probation conditions, and mandatory alcohol programs. Moreover, the financial implications are profound, encompassing steep fines and surcharges, which underscore the necessity of a determined defense strategy. The expertise of The H Law in defending against DUI charges is pivotal; our approach is tailored to navigate the intricacies of DUI laws, ensuring the most favorable outcome possible. Underage DUI Offense When dealing with an underage DUI in Los Angeles, it's crucial to understand the unique aspects of California DUI laws that apply. The state imposes a zero-tolerance policy for drivers under 21, meaning any detectable amount of alcohol can result in a DUI charge. At The H Law, we're well-versed in the nuances of Los Angeles DUI cases, including those impacting lives of younger drivers. With stricter penalties and potential long-term consequences on educational and employment opportunities, an underage DUI can be particularly damaging. It's essential to have a knowledgeable Los Angeles drunk driving attorney who can navigate the complexities of these offenses. Our expertise in California DUI law enables us to provide a robust defense for those facing underage DUI allegations, aiming to minimize the impact on their future. Choose The H Law to ensure your rights are fervently protected in the face of these significant legal challenges. Felony DUI Offense The consequences of a Felony DUI vary greatly. However, a few penalties could be: Penalties & Fee's: $1015-5000, plus restitution License Suspension: up to 5 years‍ Jail: 16 months to 16 years‍ Alcohol Treatment: 18 or 30 months When facing a felony DUI charge in Los Angeles, it's imperative to understand the gravity of the situation. Unlike misdemeanor DUI charges, a felony DUI can carry severe consequences, including significant jail time, hefty fines, and a lasting impact on one's civil liberties and future opportunities. If you've been charged with a felony DUI, swift and strategic legal intervention is crucial. The enhanced penalties are direct outcomes of either prior DUI convictions, inflicting bodily harm, or other aggravating factors. Such charges demand a highly qualified Los Angeles DUI attorney to meticulously analyze the details of your case to protect your rights. With the right defense, even serious DUI charges can be challenged, potentially mitigating the severe repercussions of a felony DUI conviction. https://www.thehfirm.com/california/los-angeles-dui-laws-charges-penalty-guides-and-attorneys",Legal,Fact Finding,Q&A Do not use any outside sources. Only use the provided text to answer. Do not use any prior knowledge. Omit all filler.,Does this apply to me if I have ground-mounted solar panels in a field at my house that I use to sell back extra energy to the grid?,"HB 2281 Initials EB Page 1 Natural Resources, Energy & Water ARIZONA HOUSE OF REPRESENTATIVES Fifty-sixth Legislature Second Regular Session HB 2281: solar royalties fund; county residents Sponsor: Representative Biasiucci, LD 30 Committee on Natural Resources, Energy & Water Overview Requires each county Board of Supervisors (BOS) to establish a County Resident Solar Royalties Fund (Fund). History Counties are required to adopt the standards for issuing permits for the use of certain solar energy devices. Various specifications must be met depending on if the solar energy device is used for: 1) construction with solar photovoltaic systems that are intended to connect to a utility system; or 2) solar water heating systems (A.R.S. § 11-323). Provisions 1. Requires the BOS of each county to establish a Fund to be administered by the county treasurer. (Sec. 1) 2. States that the Fund will be funded by each owner or operator of a solar panel in that county whose solar panel: a) is located in the relevant county; and b) is not: i. owned by a public service corporation that is regulated by the Arizona Corporation Commission (ACC) or by a public power entity that has service territory in Arizona; and ii. subject wholly to an exclusive power purchase agreement with either a public service corporation regulated by the ACC or a public power entity that has service territory in Arizona. (Sec. 1) 3. Requires the private owner or operator of a solar panel not owned by a public service corporation to pay the county where the solar panel is located 12.5% of every $1 that is received in revenues from the sale of kilowatt-hours from the solar panel. (Sec. 1) 4. Specifies these monies must be deposited in the Fund. (Sec. 1) 5. Requires the county treasurer to: a) determine the total amount of monies in the Fund and the total number of qualified individuals who live in the county; b) use monies in the Fund for administrative costs that do not exceed 10% of the monies in the Fund; c) pay, by check, each qualified resident of the county an equal distribution of the total amount of monies available in the Fund, after administrative costs are paid. (Sec. 1) ☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note HB 2281 Initials EB Page 2 Natural Resources, Energy & Water 6. States that the requirements of the Fund do not apply to solar panels that: a) produce power for only on-site use by a commercial or industrial user; b) does not export power to the grid; or c) is a rooftop solar power system, regardless of whether the system exports power to the grid. (Sec. 1)","System Instructions: Do not use any outside sources. Only use the provided text to answer. Do not use any prior knowledge. Omit all filler. Question: Does this apply to me if I have ground-mounted solar panels in a field at my house that I use to sell back extra energy to the grid? Context: HB 2281 Initials EB Page 1 Natural Resources, Energy & Water ARIZONA HOUSE OF REPRESENTATIVES Fifty-sixth Legislature Second Regular Session HB 2281: solar royalties fund; county residents Sponsor: Representative Biasiucci, LD 30 Committee on Natural Resources, Energy & Water Overview Requires each county Board of Supervisors (BOS) to establish a County Resident Solar Royalties Fund (Fund). History Counties are required to adopt the standards for issuing permits for the use of certain solar energy devices. Various specifications must be met depending on if the solar energy device is used for: 1) construction with solar photovoltaic systems that are intended to connect to a utility system; or 2) solar water heating systems (A.R.S. § 11-323). Provisions 1. Requires the BOS of each county to establish a Fund to be administered by the county treasurer. (Sec. 1) 2. States that the Fund will be funded by each owner or operator of a solar panel in that county whose solar panel: a) is located in the relevant county; and b) is not: i. owned by a public service corporation that is regulated by the Arizona Corporation Commission (ACC) or by a public power entity that has service territory in Arizona; and ii. subject wholly to an exclusive power purchase agreement with either a public service corporation regulated by the ACC or a public power entity that has service territory in Arizona. (Sec. 1) 3. Requires the private owner or operator of a solar panel not owned by a public service corporation to pay the county where the solar panel is located 12.5% of every $1 that is received in revenues from the sale of kilowatt-hours from the solar panel. (Sec. 1) 4. Specifies these monies must be deposited in the Fund. (Sec. 1) 5. Requires the county treasurer to: a) determine the total amount of monies in the Fund and the total number of qualified individuals who live in the county; b) use monies in the Fund for administrative costs that do not exceed 10% of the monies in the Fund; c) pay, by check, each qualified resident of the county an equal distribution of the total amount of monies available in the Fund, after administrative costs are paid. (Sec. 1) ☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note HB 2281 Initials EB Page 2 Natural Resources, Energy & Water 6. States that the requirements of the Fund do not apply to solar panels that: a) produce power for only on-site use by a commercial or industrial user; b) does not export power to the grid; or c) is a rooftop solar power system, regardless of whether the system exports power to the grid. (Sec. 1)",Legal,Fact Finding,Q&A Refer only to the provided text and do not use any outside information.,What motivated congress to approve two competing bills?,"House-passed H.R. 8070 H.R. 8070, known as the Servicemember Quality of Life Improvement and National Defense Authorization Act for Fiscal Year 2025, would authorize $883.7 billion, as requested, according to the accompanying committee report, H.Rept. 118-529. Together with amounts for certain defense-related programs not within the legislation’s purview or requiring additional authorization, the discretionary budget authority implication of the bill would total $895.2 billion—consistent with the defense discretionary spending cap for FY2025 established in the Fiscal Responsibility Act of 2023 (P.L. 118-5). During an April 30, 2024, hearing on the FY2025 DOD budget request, Representative Mike Rogers, chair of the House Armed Services Committee (HASC), described the department’s request as inadequate to restore deterrence. “But this is the hand dealt to us by the Fiscal Responsibility Act that we all have responsibility for enacting,” he said. “As we move to mark up the FY2025 NDAA, we will play that hand that was dealt to us.” In preparation for House consideration of the legislation, Representative Barbara Lee submitted an amendment that would have reduced the amount authorized by the bill by $100 billion, excluding accounts related to the Defense Health Program, military personnel, and pay and benefits. The amendment was not considered for floor debate. A bipartisan amendment adopted as Section 1005 of the bill would reduce funding for a military department or defense agency by 0.5% upon failure to submit financial statements or achieve an independent audit opinion. While the overall level of funding authorizations in H.R. 8070 would match the President’s request, amounts authorized for certain types of accounts would differ from the request. For example, in terms of DOD titles, the legislation would authorize $3.8 billion (2.1%) more than requested for military personnel (MILPERS) appropriations, largely to support a 19.5% pay raise for certain junior enlisted service members and an expanded housing allowance benefit as part of a package of “quality of life” initiatives. The legislation would authorize $2.8 billion (1.7%) less than requested for procurement Congressional Research Service 3 appropriations, including the Shipbuilding and Conversion, Navy account—with no funding authorized for the Navy to procure the seventh Constellation-class (FFG) frigate, a type of small surface combatant. In a Statement of Administration Policy on H.R. 8070, the Biden Administration “strongly” opposed changing the basic pay schedule before the completion of the Fourteenth Quadrennial Review of Military Compensation (QRMC) and expressed disappointment at the level of shipbuilding funding, among other areas of disagreement. SASC-reported S. 4638 S. 4638 would authorize $908.4 billion, $25.1 billion more than requested for DOD to “accelerate equipment recapitalization, increase military construction, address the highest-priority unfunded requirements of the military services and combatant commanders, decrease the Department’s facility maintenance backlog, and strengthen the defense industrial base.” During debate of the bill in a closed session, the Senate Armed Services Committee (SASC) voted 16-9 on a motion “to include a provision that would increase the topline by $25.0 billion.” Senator Roger Wicker, Ranking Member of SASC, filed the motion following the release of a plan calling for a “generational investment” in the U.S. military—with proposed funding increases of $55 billion in FY2025 and additional amounts to reach 5% of Gross Domestic Product in the future—to prevent conflict, recapitalize U.S. military equipment, and safeguard national security innovation. Senator Jack Reed, chair of SASC, said he voted against reporting the bill to the Senate because it included “a funding increase that cannot be appropriated without breaking lawful spending caps and causing unintended harm to our military. I appreciate the need for greater defense spending to ensure our national security, but I cannot support this approach.” S. 4638 would authorize $25.1 billion more funding than requested for DOD, across each appropriation title, with $10.0 billion more than requested for procurement accounts; $2.9 billion more for research, development, test, and evaluation (RDT&E) accounts; and $3.1 billion more for military construction (MILCON) accounts. ","Refer only to the provided text and do not use any outside information. What motivated congress to approve two competing bills? House-passed H.R. 8070 H.R. 8070, known as the Servicemember Quality of Life Improvement and National Defense Authorization Act for Fiscal Year 2025, would authorize $883.7 billion, as requested, according to the accompanying committee report, H.Rept. 118-529. Together with amounts for certain defense-related programs not within the legislation’s purview or requiring additional authorization, the discretionary budget authority implication of the bill would total $895.2 billion—consistent with the defense discretionary spending cap for FY2025 established in the Fiscal Responsibility Act of 2023 (P.L. 118-5). During an April 30, 2024, hearing on the FY2025 DOD budget request, Representative Mike Rogers, chair of the House Armed Services Committee (HASC), described the department’s request as inadequate to restore deterrence. “But this is the hand dealt to us by the Fiscal Responsibility Act that we all have responsibility for enacting,” he said. “As we move to mark up the FY2025 NDAA, we will play that hand that was dealt to us.” In preparation for House consideration of the legislation, Representative Barbara Lee submitted an amendment that would have reduced the amount authorized by the bill by $100 billion, excluding accounts related to the Defense Health Program, military personnel, and pay and benefits. The amendment was not considered for floor debate. A bipartisan amendment adopted as Section 1005 of the bill would reduce funding for a military department or defense agency by 0.5% upon failure to submit financial statements or achieve an independent audit opinion. While the overall level of funding authorizations in H.R. 8070 would match the President’s request, amounts authorized for certain types of accounts would differ from the request. For example, in terms of DOD titles, the legislation would authorize $3.8 billion (2.1%) more than requested for military personnel (MILPERS) appropriations, largely to support a 19.5% pay raise for certain junior enlisted servicemembers and an expanded housing allowance benefit as part of a package of “quality of life” initiatives. The legislation would authorize $2.8 billion (1.7%) less than requested for procurement Congressional Research Service 3 appropriations, including the Shipbuilding and Conversion, Navy account—with no funding authorized for the Navy to procure the seventh Constellation-class (FFG) frigate, a type of small surface combatant. In a Statement of Administration Policy on H.R. 8070, the Biden Administration “strongly” opposed changing the basic pay schedule before the completion of the Fourteenth Quadrennial Review of Military Compensation (QRMC) and expressed disappointment at the level of shipbuilding funding, among other areas of disagreement. SASC-reported S. 4638 S. 4638 would authorize $908.4 billion, $25.1 billion more than requested for DOD to “accelerate equipment recapitalization, increase military construction, address the highest-priority unfunded requirements of the military services and combatant commanders, decrease the Department’s facility maintenance backlog, and strengthen the defense industrial base.” During debate of the bill in a closed session, the Senate Armed Services Committee (SASC) voted 16-9 on a motion “to include a provision that would increase the topline by $25.0 billion.” Senator Roger Wicker, Ranking Member of SASC, filed the motion following the release of a plan calling for a “generational investment” in the U.S. military—with proposed funding increases of $55 billion in FY2025 and additional amounts to reach 5% of Gross Domestic Product in the future—to prevent conflict, recapitalize U.S. military equipment, and safeguard national security innovation. Senator Jack Reed, chair of SASC, said he voted against reporting the bill to the Senate because it included “a funding increase that cannot be appropriated without breaking lawful spending caps and causing unintended harm to our military. I appreciate the need for greater defense spending to ensure our national security, but I cannot support this approach.” S. 4638 would authorize $25.1 billion more funding than requested for DOD, across each appropriation title, with $10.0 billion more than requested for procurement accounts; $2.9 billion more for research, development, test, and evaluation (RDT&E) accounts; and $3.1 billion more for military construction (MILCON) accounts. ",Financial,Fact Finding,Q&A Only provide commentary from the context included.,Summarize the STRATEGIC Financial PRIORITIES 2004-07 for Alberta.,"207FINANCE BUSINESS PLAN 2004-07 Finance ACCOUNTABILITY STATEMENT The Business Plan for the three years commencing April 1, 2004 was prepared under my direction in accordance with the Government Accountability Act and the government's accounting policies. All of the government's policy decisions as of February 27, 2004 with material economic or fiscal implications of which I am aware have been considered in preparing the Business Plan. The Ministry's priorities outlined in the Business Plan were developed in the context of the government's business and fiscal plans. I am committed to achieving the planned results laid out in this Business Plan. [original signed] Patricia L. Nelson, Minister of Finance March 4, 2004 THE MINISTRY The Ministry of Finance includes the Department of Finance, Alberta Capital Finance Authority, Alberta Pensions Administration Corporation, ATB Financial, Alberta Insurance Council, Credit Union Deposit Guarantee Corporation and their subsidiaries. The Ministry of Finance also includes the activities of a number of companies in wind-up. The Department of Finance has four main areas: Office of Budget and Management; Pensions, Insurance and Financial Institutions; Treasury Management; and Corporate Support. The Finance Business Plan incorporates all the entities reporting to the Minister into an integrated strategic plan that focuses on the key priorities for the Ministry. The following plan does not include the day-to-day activities of the Ministry. BUSINESS PLAN 2004-07 208 FINANCE BUSINESS PLAN 2004-07 VISION A province that is innovative and globally competitive with a fiscally sustainable and accountable government. LINK TO THE GOVERNMENT STRATEGIC BUSINESS PLAN This plan supports the 3-Year Government of Alberta (GOA) Business Plan to have a prosperous economy (Goal 7), which is aligned with the 20-Year Government of Alberta Strategic Business Plan of competing in a global marketplace (Opportunity 3). The Finance plan provides support by keeping taxes competitive and the regulatory system effective. The plan also supports the 3-Year GOA Business Plan of having a financially stable, open and accountable government (Goal 8). This is aligned with the 20-Year Strategic Plan of making Alberta the best place to live, work and visit (Opportunity 4). Support is provided through the ministry's efforts to smooth out fluctuations in resource revenue, eliminate debt on schedule, keep spending affordable, ensure future sustainability of revenue to meet needs, monitor performance and assist with capital planning and financing for infrastructure. Finally, the Ministry Plan supports the 3-Year GOA Business Plan to have an effective, responsive and well-managed local government (Goal 6), which is aligned with the 20-Year Strategic Plan to make Alberta the best place to live, work and visit (Opportunity 4). The ministry provides support through the Alberta Capital Finance Authority. SIGNIFICANT OPPORTUNITIES AND CHALLENGES Maintaining a strong and sustainable financial position poses challenges. Changing world economic conditions, exchange rates and energy prices impact Alberta's economy and fiscal plan. The decline of high royalty rate conventional energy revenues is an issue that is being addressed. Disasters and emergencies, such as BSE and severe weather conditions, are unpredictable events that can have budget consequences. Volatile capital markets can affect pension plans and endowment funds like the Alberta Heritage Savings Trust Fund, especially if markets are weak for extended periods. The Sustainability Fund will help manage risks from energy and other revenues, as well as disasters and emergencies. An aging population and early retirements will also impact pension plans. Recognizing pressures on pension plans will enable stakeholders to work together to review pension plan governance and establish stabilizing strategies. MISSION Develop and implement the government's fiscal framework and financial policies. CORE BUSINESSES Core Business 1: Fiscal Planning and Financial Management Goal 1 - A financially strong, sustainable and accountable government Goal 2 - A fair and competitive provincial tax system Goal 3 - Effective management of financial assets, liabilities and risk Core Business 2: Regulation of Provincial Financial Institutions Goal 4 - Reliable and competitive financial and insurance products and services Core Business 3: Pensions Policy, Regulation and Administration Goal 5 - Pensions that deliver on promises Core Business 4: Financial Services Goal 6 - Quality and competitive financial services accessible to Albertans and local authorities 209FINANCE BUSINESS PLAN 2004-07 The government's new fiscal framework is designed to provide predictability, sustainability and continued discipline to prepare Alberta for the challenges that lie ahead, while maintaining a competitive tax environment. Finance will work with other ministries to maintain a balanced approach in fiscal planning. In addition, Finance will implement the accepted Financial Management Commission (FMC) recommendations, including the risk analysis, three-year capital plans, alternative mechanisms for capital project financing, capitalization and amortization of assets, and continued refinements to the government reporting entity. Public-private partnerships (P3s) have been identified as one option to deliver capital projects, where appropriate. Finance provides financial expertise to other ministries on financing government and government-funded capital projects, ranging from construction to information technology. Finance also determines the appropriate accounting treatment and the impact on the Province's financial position and fiscal plan. Finance will assess the costs and risks of alternate financing vehicles, including P3s, and make recommendations to mitigate provincial financial risk and achieve optimal value for money. The Alberta government faces risks from a variety of sources. The concept of enterprise risk management is to identify the sources of risk to all major components of the Province's revenues and expenses and to use the collective strength of the enterprise to manage those risks with a comprehensive cost-effective strategy. In cooperation with other departments, Finance will develop an enterprise risk management framework and provide recommendations for government consideration. The Government is committed to ensuring Albertans have access to affordable automobile insurance. Finance will work to implement recommendations from the government's review of automobile insurance, including issues respecting automobile injury claims and related premium increases. Finance, in consultation with public sector boards and stakeholders, will review current governance arrangements for public pension plans (in the context of recent proposals for independence) with the objective of making recommendations to improve accountability to plan members and taxpayers. STRATEGIC PRIORITIES 2004-07 Through the Ministry’s review of external and internal challenges, the strategic priorities described below have been identified. These are in addition to the important ongoing core activities of the Ministry. 1. Maintaining Alberta's Fiscal Framework Linkage: Goal 1 2. Public-Private Partnerships (P3s) Linkage: Goals 1 and 3 3. Enterprise-Wide Risk Management Linkage: Goal 3 4. Automobile Insurance Linkage: Goal 4 5. Public Pension Plans Governance Linkage: Goal 5 210 FINANCE BUSINESS PLAN 2004-07 Strategies • Assess the financial costs and risks to the government of proposed P3s and make recommendations to reduce provincial financial risk and optimize value for money. • Continue overseeing cross-government implementation of the accepted Financial Management Commission (FMC) recommendations. Finance will concentrate on supporting further development of the capital plan. In response to the Public Sector Accounting Board's recommendations, Finance will also work with other ministries to determine what entities should be consolidated in the government's reporting entity, with planned implementation for fiscal years beginning with Budget 2006 at the earliest. • Continue to repay accumulated debt in accordance with the legislated plan. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Alberta's credit rating AAA AAA AAA AAA Accumulated debt less cash set aside for debt repayment $4.7 billion $3.0 billion $2.7 billion $2.7 billion Number of accepted FMC recommendations 1 11 of 22 (2003-04) 15 of 22 19 of 22 22 of 22 implemented as scheduled (accumulated) (accumulated) (accumulated) (accumulated) Percentage of Albertans who think they get enough information on the government's financial performance 63% 70% 70% 70% 1 http://www.finance.gov.ab.ca/whatsnew/newsrel/2002/n020926_fmc_response.pdf 1 A financially strong, sustainable and accountable government Maintaining Alberta's strong financial position means keeping the budget balanced and sustainable. Strategic fiscal planning and prudent economic forecasting are required to meet today's priorities and sustain essential programs and services over the longer term. The Alberta Sustainability Fund has been established to cushion ongoing operating spending plans from volatile energy revenues and the costs of emergencies and disasters. The new Fiscal Framework includes a three-year capital plan, with some funding of capital from the capital account and alternative financing arrangements. The government will continue to balance the budget every year in accordance with the fiscal framework and to reduce the province's existing debt as scheduled. The government will also continue to fulfill its legislated commitment to be accountable to Albertans by publishing three-year consolidated fiscal plans, quarterly fiscal updates and annual performance reports, including audited financial statements, as required by the Government Accountability Act. In executing its leadership role for these initiatives, Finance will continue to assess the economic impact associated with issues of concern to Albertans, including the implementation of the Climate Change Strategy. The department will also take an active role in strategic corporate approaches to information technology investment, governance and accountability. GOAL ONE What it means CORE BUSINESSES, GOALS, STRATEGIES AND MEASURES Core Business One: Fiscal Planning and Financial Management 211FINANCE BUSINESS PLAN 2004-07 Strategies • As affordable, complete implementation of the Business Tax Plan to reduce the general corporate income tax rate from 11.5% to 8%. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Provincial tax load for a family of four1 Lowest in Lowest in Lowest in Lowest in Canada Canada Canada Canada Provincial tax load on businesses 1 Third Lowest Lowest in Lowest in Lowest in In Canada Canada Canada Canada 1 Shared measure with Alberta Revenue. 2 A fair and competitive provincial tax system Government policy is a low rate, broad base policy approach to promote efficiency of the tax system. Taxes are necessary to provide the revenue that government needs to fund programs and services. The tax system must be fair and promote self-reliance. Our taxes must also be competitive with those in other provinces and countries with which Alberta competes, in order to attract the investment, jobs and skilled workers necessary to keep our economy performing well. Alberta has a low single rate income tax, the lowest tax on gasoline in the country and no general payroll tax. Alberta is the only province without a capital tax or a general retail sales tax. Finance continues to work with the federal government, other provinces and territories to promote effective tax systems and collection arrangements. GOAL TWO What it means Strategies • Effective investment policies are in place to ensure optimal return. • Develop an enterprise-wide risk management framework for government decisions. • Invest the Sustainability Fund in high quality fixed income assets. 3 Effective management of financial assets, liabilities and risk Finance through the Treasury Management Division has responsibility for the province's ongoing cash management including short-term borrowing and investing, management of banking arrangements and cash forecasting as well as arranging short and long-term financing for the government and provincial corporations. Through prudent management of liabilities and assets, the Ministry endeavors to minimize financing costs and maximize investment returns. The Ministry has assumed a leadership role in developing an enterprise risk management framework so that the Alberta Government can effectively manage the day-to-day financial challenges. GOAL THREE What it means 212 FINANCE BUSINESS PLAN 2004-07 Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Return on: • Sustainability Fund New To be determined • Debt Retirement Account compared to 6 basis points higher the cost of the debt on the day the than market cost on Greater Greater Greater investment is made matching debt • Consolidated Cash Investment Under performed Greater by Greater by Greater by Trust Fund compared to ScotiaMcLeod by 10 basis 10 basis 10 basis 91 day Treasury Bill Index 4 basis points1 points 1 points 1 points 1 All in cost of debt issued compared to an issue Cost Lower by of comparable term in the Canadian public $596,500 on Lower Lower Lower debt market $100 million 2 Government decision on enterprise risk Research phase Government Program Program management program completed approval of Implemented Implemented framework 1 Basis point is 1/100 of a percent. 2 Amount raised via private placements during the year. Strategies • Implement recommendations from the government's review of issues respecting automobile insurance, including compensation for automobile injury claims and premium increases. • Work with industry and consumer stakeholders to review the statutory provisions of the Insurance Act respecting insurance contracts. • Ensure a supervisory framework is in place to govern Alberta Treasury Branches (ATB Financial) and that it is appropriate and comparable to that for private sector financial institutions. 4 Reliable and competitive financial and insurance products and services Financial service providers are responsible for ensuring that Albertans receive the services they have purchased. Finance regulates the credit union, insurance, loan and trust industries in Alberta, in the interests of depositors, insurance policy holders, insurance intermediaries, trust beneficiaries and the companies themselves. Finance is working with the automobile insurance industry to implement recommendations from the government's review of automobile insurance, including issues respecting automobile injury claims and related premium increases. In addition, Finance will monitor issues that face the insurance industry and consumers with respect to general property and liability insurance in Alberta. GOAL FOUR What it means Core Business Two: Regulation of Provincial Financial Institutions 213FINANCE BUSINESS PLAN 2004-07 Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Automobile Insurance Review Review Recommendations – – completed implemented implemented and Bill 33 introduced Revision of Insurance Act respecting contracts n/a Review of Insurance Act – Insurance Act revised ATB Financial supervisory framework implemented n/a Implemented – – Strategies • In consultation with public pension boards and stakeholders, facilitate the improvement of pension governance frameworks. • Review funding requirements for public pension plans. • Review investment rules and returns for private pension plan assets. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Percentage of APA client members and 95% of 95% of 95% of 95% of employers satisfied or very satisfied with clients and clients and clients and clients and products and services employers 1 employers 1 employers 1 employers 1 Improved pension governance frameworks In progress Developed and implemented – – Percentage of private sector plans that meet minimum funding requirements New 98% 98% 98% 1 Average of client and employer satisfaction. 5 Pensions that deliver on promises Pension plan members need to be assured that their benefits are secure. Employers and other plan sponsors need to know that pension regulation is fair and even-handed. Finance assesses private sector pension plan compliance with legislative standards and ensures that action is taken and 'at risk ' plans comply with regulations. Finance will also continue to monitor funding of private sector pension plans. The Department provides advice to the Minister of Finance on the financial soundness and governance of the public pension plans. Alberta Pensions Administration Corporation (APA) provides administrative services. Finance works with the federal government and the other provinces to maintain the sustainability of the Canada Pension Plan and explores alternatives to allow Albertans to secure their retirement income. The Department provides support and information for government initiatives on public pension issues. In addition, Finance works with stakeholders and other jurisdictions across Canada to harmonize and streamline private pension legislation and regulatory processes. GOAL FIVE What it means Core Business Three: Pensions Policy, Regulations and Administration 214 FINANCE BUSINESS PLAN 2004-07 Strategies • ATB Financial continues to operate on sound financial institution and business principles with the objective of earning a fair return. • ACFA will continue to provide local authorities within the province with flexible funding for capital projects at the lowest possible cost, consistent with the viability of ACFA. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Local authorities' cost of borrowing from ACFA relative to borrowing costs of other Canadian municipalities within the viability of the Corporation Lowest1 Lowest Lowest Lowest ATB Financial • Loan loss provisions as a percentage of average total loans (0.39%) 0.30% 0.30% 0.35% • Expenses to operating revenue 66.99% 66.15% 66.30% 66.11% • Return on average assets (before tax) 1.55% 0.97% 1.06% 1.16% 1 Lowest at short and long-term maturities, but slightly higher than the lowest rate in Canada for mid-term (i.e., 5 and 10 years) rates. 6 Quality and competitive financial services accessible to Albertans and local authorities Alberta's dynamic economy and entrepreneurial spirit requires readily accessible and technologically advanced financial services and products. Alberta Treasury Branches (ATB Financial) and the Alberta Capital Finance Authority (ACFA) are public sector components of the financial services sector. ATB Financial is a full-service financial institution, with the largest branch network in the province. It provides services to individuals, small businesses and the agri-industry in 240 communities across Alberta. ACFA provides financing to a variety of local authorities including municipalities, towns, counties, hospitals, schools and post-secondary institutions throughout the province for capital projects. GOAL SIX What it means Core Business Four: Financial Services 215FINANCE BUSINESS PLAN 2004-07 MINISTRY STATEMENT OF OPERATIONS (thousands of dollars) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target REVENUE Internal Government Transfers 280,243 95,679 115,886 84,365 105,995 93,858 Other Taxes 1,702 600 1,700 750 750 750 Transfers from Government of Canada 4,055 4,030 4,055 4,055 4,055 4,055 Investment Income 528,710 504,311 539,500 504,259 468,993 445,267 Premiums, Fees and Licences 19,406 26,582 15,039 20,341 21,800 23,352 Net Income from Commercial Operations 224,899 156,660 165,563 155,837 151,344 164,220 Other Revenue 126,144 28,313 26,830 27,593 26,783 26,618 MINISTRY REVENUE 1,185,159 816,175 868,573 797,200 779,720 758,120 EXPENSE Program Fiscal Planning and Accountability 7,735 9,338 8,727 9,270 9,218 9,018 Treasury Management 72,211 71,887 74,529 77,838 78,918 81,057 Financial Sector Operations 4,477 4,881 6,513 5,650 6,037 6,143 Public Sector Pension Policy and Administration 23,264 27,068 26,163 26,210 25,967 25,827 Financing to Local Authorities 331,263 315,518 322,172 313,595 292,526 274,236 Ministry Support Services 5,272 5,074 5,306 5,165 5,108 5,164 Valuation Adjustments and Other Provisions (345) 300 200 - - - Total Program Expense* 443,877 434,066 443,610 437,728 417,774 401,445 Debt Servicing Costs Department Voted 70,675 61,503 61,503 53,020 45,246 38,046 Department Statutory 397,429 396,000 211,000 302,000 275,800 262,300 Ministry Debt Servicing Costs 468,104 457,503 272,503 355,020 321,046 300,346 MINISTRY EXPENSE 911,981 891,569 716,113 792,748 738,820 701,791 Gain (Loss) on Disposal of Capital Assets - - - - - - NET OPERATING RESULT 273,178 (75,394) 152,460 4,452 40,900 56,329 * Subject to the Fiscal Responsibility Act . Program expense includes the province's cash payments towards the unfunded pension liability (which will be eliminated under a separate legislated plan). Program expense does not include the annual change in the unfunded pension obligations, which is a non-cash expense that does not affect borrowing requirements. The annual increases (decreases) in the Ministry of Finance's unfunded pension obligations are: 81,349 (6,000) (9,000) (13,000) (16,000) (17,000) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target Fiscal Planning and Financial Management 550,923 542,246 359,342 445,247 412,264 393,519 Regulation of Provincial Institutions 4,521 4,928 5,942 5,652 6,046 6,174 Pension Policy, Regulation and Administration 24,834 28,430 27,822 27,792 27,537 27,407 Financial Services 331,703 315,965 323,007 314,057 292,973 274,691 MINISTRY EXPENSE 911,981 891,569 716,113 792,748 738,820 701,791 EXPENSE BY CORE BUSINESS (thousands of dollars) 216 FINANCE BUSINESS PLAN 2004-07 CONSOLIDATED NET OPERATING RESULT (thousands of dollars) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target Ministry Revenue 1,185,159 816,175 868,573 797,200 779,720 758,120 Inter-ministry consolidation adjustments (350,139) (174,274) (185,762) (158,297) (185,887) (177,352) Consolidated Revenue 835,020 641,901 682,811 638,903 593,833 580,768 Ministry Program Expense 443,877 434,066 443,610 437,728 417,774 401,445 Inter-ministry consolidation adjustments (175) (196) (164) (194) (194) (194) Consolidated Program Expense 443,702 433,870 443,446 437,534 417,580 401,251 Ministry Debt Servicing Costs 468,104 457,503 272,503 355,020 321,046 300,346 Inter-ministry consolidation adjustments (87,575) (95,394) (86,708) (89,726) (94,503) (96,716) Consolidated Debt Servicing Costs 380,529 362,109 185,795 265,294 226,543 203,630 Consolidated Expense 824,231 795,979 629,241 702,828 644,123 604,881 Gain (Loss) on Disposal of Capital Assets - - - - - - CONSOLIDATED NET OPERATING RESULT 10,789 (154,078) 53,570 (63,925) (50,290) (24,113)","Only provide commentary from the context included. Summarize the STRATEGIC Financial PRIORITIES 2004-07 for Alberta. 207FINANCE BUSINESS PLAN 2004-07 Finance ACCOUNTABILITY STATEMENT The Business Plan for the three years commencing April 1, 2004 was prepared under my direction in accordance with the Government Accountability Act and the government's accounting policies. All of the government's policy decisions as of February 27, 2004 with material economic or fiscal implications of which I am aware have been considered in preparing the Business Plan. The Ministry's priorities outlined in the Business Plan were developed in the context of the government's business and fiscal plans. I am committed to achieving the planned results laid out in this Business Plan. [original signed] Patricia L. Nelson, Minister of Finance March 4, 2004 THE MINISTRY The Ministry of Finance includes the Department of Finance, Alberta Capital Finance Authority, Alberta Pensions Administration Corporation, ATB Financial, Alberta Insurance Council, Credit Union Deposit Guarantee Corporation and their subsidiaries. The Ministry of Finance also includes the activities of a number of companies in wind-up. The Department of Finance has four main areas: Office of Budget and Management; Pensions, Insurance and Financial Institutions; Treasury Management; and Corporate Support. The Finance Business Plan incorporates all the entities reporting to the Minister into an integrated strategic plan that focuses on the key priorities for the Ministry. The following plan does not include the day-to-day activities of the Ministry. BUSINESS PLAN 2004-07 208 FINANCE BUSINESS PLAN 2004-07 VISION A province that is innovative and globally competitive with a fiscally sustainable and accountable government. LINK TO THE GOVERNMENT STRATEGIC BUSINESS PLAN This plan supports the 3-Year Government of Alberta (GOA) Business Plan to have a prosperous economy (Goal 7), which is aligned with the 20-Year Government of Alberta Strategic Business Plan of competing in a global marketplace (Opportunity 3). The Finance plan provides support by keeping taxes competitive and the regulatory system effective. The plan also supports the 3-Year GOA Business Plan of having a financially stable, open and accountable government (Goal 8). This is aligned with the 20-Year Strategic Plan of making Alberta the best place to live, work and visit (Opportunity 4). Support is provided through the ministry's efforts to smooth out fluctuations in resource revenue, eliminate debt on schedule, keep spending affordable, ensure future sustainability of revenue to meet needs, monitor performance and assist with capital planning and financing for infrastructure. Finally, the Ministry Plan supports the 3-Year GOA Business Plan to have an effective, responsive and well-managed local government (Goal 6), which is aligned with the 20-Year Strategic Plan to make Alberta the best place to live, work and visit (Opportunity 4). The ministry provides support through the Alberta Capital Finance Authority. SIGNIFICANT OPPORTUNITIES AND CHALLENGES Maintaining a strong and sustainable financial position poses challenges. Changing world economic conditions, exchange rates and energy prices impact Alberta's economy and fiscal plan. The decline of high royalty rate conventional energy revenues is an issue that is being addressed. Disasters and emergencies, such as BSE and severe weather conditions, are unpredictable events that can have budget consequences. Volatile capital markets can affect pension plans and endowment funds like the Alberta Heritage Savings Trust Fund, especially if markets are weak for extended periods. The Sustainability Fund will help manage risks from energy and other revenues, as well as disasters and emergencies. An aging population and early retirements will also impact pension plans. Recognizing pressures on pension plans will enable stakeholders to work together to review pension plan governance and establish stabilizing strategies. MISSION Develop and implement the government's fiscal framework and financial policies. CORE BUSINESSES Core Business 1: Fiscal Planning and Financial Management Goal 1 - A financially strong, sustainable and accountable government Goal 2 - A fair and competitive provincial tax system Goal 3 - Effective management of financial assets, liabilities and risk Core Business 2: Regulation of Provincial Financial Institutions Goal 4 - Reliable and competitive financial and insurance products and services Core Business 3: Pensions Policy, Regulation and Administration Goal 5 - Pensions that deliver on promises Core Business 4: Financial Services Goal 6 - Quality and competitive financial services accessible to Albertans and local authorities 209FINANCE BUSINESS PLAN 2004-07 The government's new fiscal framework is designed to provide predictability, sustainability and continued discipline to prepare Alberta for the challenges that lie ahead, while maintaining a competitive tax environment. Finance will work with other ministries to maintain a balanced approach in fiscal planning. In addition, Finance will implement the accepted Financial Management Commission (FMC) recommendations, including the risk analysis, three-year capital plans, alternative mechanisms for capital project financing, capitalization and amortization of assets, and continued refinements to the government reporting entity. Public-private partnerships (P3s) have been identified as one option to deliver capital projects, where appropriate. Finance provides financial expertise to other ministries on financing government and government-funded capital projects, ranging from construction to information technology. Finance also determines the appropriate accounting treatment and the impact on the Province's financial position and fiscal plan. Finance will assess the costs and risks of alternate financing vehicles, including P3s, and make recommendations to mitigate provincial financial risk and achieve optimal value for money. The Alberta government faces risks from a variety of sources. The concept of enterprise risk management is to identify the sources of risk to all major components of the Province's revenues and expenses and to use the collective strength of the enterprise to manage those risks with a comprehensive cost-effective strategy. In cooperation with other departments, Finance will develop an enterprise risk management framework and provide recommendations for government consideration. The Government is committed to ensuring Albertans have access to affordable automobile insurance. Finance will work to implement recommendations from the government's review of automobile insurance, including issues respecting automobile injury claims and related premium increases. Finance, in consultation with public sector boards and stakeholders, will review current governance arrangements for public pension plans (in the context of recent proposals for independence) with the objective of making recommendations to improve accountability to plan members and taxpayers. STRATEGIC PRIORITIES 2004-07 Through the Ministry’s review of external and internal challenges, the strategic priorities described below have been identified. These are in addition to the important ongoing core activities of the Ministry. 1. Maintaining Alberta's Fiscal Framework Linkage: Goal 1 2. Public-Private Partnerships (P3s) Linkage: Goals 1 and 3 3. Enterprise-Wide Risk Management Linkage: Goal 3 4. Automobile Insurance Linkage: Goal 4 5. Public Pension Plans Governance Linkage: Goal 5 210 FINANCE BUSINESS PLAN 2004-07 Strategies • Assess the financial costs and risks to the government of proposed P3s and make recommendations to reduce provincial financial risk and optimize value for money. • Continue overseeing cross-government implementation of the accepted Financial Management Commission (FMC) recommendations. Finance will concentrate on supporting further development of the capital plan. In response to the Public Sector Accounting Board's recommendations, Finance will also work with other ministries to determine what entities should be consolidated in the government's reporting entity, with planned implementation for fiscal years beginning with Budget 2006 at the earliest. • Continue to repay accumulated debt in accordance with the legislated plan. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Alberta's credit rating AAA AAA AAA AAA Accumulated debt less cash set aside for debt repayment $4.7 billion $3.0 billion $2.7 billion $2.7 billion Number of accepted FMC recommendations 1 11 of 22 (2003-04) 15 of 22 19 of 22 22 of 22 implemented as scheduled (accumulated) (accumulated) (accumulated) (accumulated) Percentage of Albertans who think they get enough information on the government's financial performance 63% 70% 70% 70% 1 http://www.finance.gov.ab.ca/whatsnew/newsrel/2002/n020926_fmc_response.pdf 1 A financially strong, sustainable and accountable government Maintaining Alberta's strong financial position means keeping the budget balanced and sustainable. Strategic fiscal planning and prudent economic forecasting are required to meet today's priorities and sustain essential programs and services over the longer term. The Alberta Sustainability Fund has been established to cushion ongoing operating spending plans from volatile energy revenues and the costs of emergencies and disasters. The new Fiscal Framework includes a three-year capital plan, with some funding of capital from the capital account and alternative financing arrangements. The government will continue to balance the budget every year in accordance with the fiscal framework and to reduce the province's existing debt as scheduled. The government will also continue to fulfill its legislated commitment to be accountable to Albertans by publishing three-year consolidated fiscal plans, quarterly fiscal updates and annual performance reports, including audited financial statements, as required by the Government Accountability Act. In executing its leadership role for these initiatives, Finance will continue to assess the economic impact associated with issues of concern to Albertans, including the implementation of the Climate Change Strategy. The department will also take an active role in strategic corporate approaches to information technology investment, governance and accountability. GOAL ONE What it means CORE BUSINESSES, GOALS, STRATEGIES AND MEASURES Core Business One: Fiscal Planning and Financial Management 211FINANCE BUSINESS PLAN 2004-07 Strategies • As affordable, complete implementation of the Business Tax Plan to reduce the general corporate income tax rate from 11.5% to 8%. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Provincial tax load for a family of four1 Lowest in Lowest in Lowest in Lowest in Canada Canada Canada Canada Provincial tax load on businesses 1 Third Lowest Lowest in Lowest in Lowest in In Canada Canada Canada Canada 1 Shared measure with Alberta Revenue. 2 A fair and competitive provincial tax system Government policy is a low rate, broad base policy approach to promote efficiency of the tax system. Taxes are necessary to provide the revenue that government needs to fund programs and services. The tax system must be fair and promote self-reliance. Our taxes must also be competitive with those in other provinces and countries with which Alberta competes, in order to attract the investment, jobs and skilled workers necessary to keep our economy performing well. Alberta has a low single rate income tax, the lowest tax on gasoline in the country and no general payroll tax. Alberta is the only province without a capital tax or a general retail sales tax. Finance continues to work with the federal government, other provinces and territories to promote effective tax systems and collection arrangements. GOAL TWO What it means Strategies • Effective investment policies are in place to ensure optimal return. • Develop an enterprise-wide risk management framework for government decisions. • Invest the Sustainability Fund in high quality fixed income assets. 3 Effective management of financial assets, liabilities and risk Finance through the Treasury Management Division has responsibility for the province's ongoing cash management including short-term borrowing and investing, management of banking arrangements and cash forecasting as well as arranging short and long-term financing for the government and provincial corporations. Through prudent management of liabilities and assets, the Ministry endeavors to minimize financing costs and maximize investment returns. The Ministry has assumed a leadership role in developing an enterprise risk management framework so that the Alberta Government can effectively manage the day-to-day financial challenges. GOAL THREE What it means 212 FINANCE BUSINESS PLAN 2004-07 Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Return on: • Sustainability Fund New To be determined • Debt Retirement Account compared to 6 basis points higher the cost of the debt on the day the than market cost on Greater Greater Greater investment is made matching debt • Consolidated Cash Investment Under performed Greater by Greater by Greater by Trust Fund compared to ScotiaMcLeod by 10 basis 10 basis 10 basis 91 day Treasury Bill Index 4 basis points1 points 1 points 1 points 1 All in cost of debt issued compared to an issue Cost Lower by of comparable term in the Canadian public $596,500 on Lower Lower Lower debt market $100 million 2 Government decision on enterprise risk Research phase Government Program Program management program completed approval of Implemented Implemented framework 1 Basis point is 1/100 of a percent. 2 Amount raised via private placements during the year. Strategies • Implement recommendations from the government's review of issues respecting automobile insurance, including compensation for automobile injury claims and premium increases. • Work with industry and consumer stakeholders to review the statutory provisions of the Insurance Act respecting insurance contracts. • Ensure a supervisory framework is in place to govern Alberta Treasury Branches (ATB Financial) and that it is appropriate and comparable to that for private sector financial institutions. 4 Reliable and competitive financial and insurance products and services Financial service providers are responsible for ensuring that Albertans receive the services they have purchased. Finance regulates the credit union, insurance, loan and trust industries in Alberta, in the interests of depositors, insurance policy holders, insurance intermediaries, trust beneficiaries and the companies themselves. Finance is working with the automobile insurance industry to implement recommendations from the government's review of automobile insurance, including issues respecting automobile injury claims and related premium increases. In addition, Finance will monitor issues that face the insurance industry and consumers with respect to general property and liability insurance in Alberta. GOAL FOUR What it means Core Business Two: Regulation of Provincial Financial Institutions 213FINANCE BUSINESS PLAN 2004-07 Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Automobile Insurance Review Review Recommendations – – completed implemented implemented and Bill 33 introduced Revision of Insurance Act respecting contracts n/a Review of Insurance Act – Insurance Act revised ATB Financial supervisory framework implemented n/a Implemented – – Strategies • In consultation with public pension boards and stakeholders, facilitate the improvement of pension governance frameworks. • Review funding requirements for public pension plans. • Review investment rules and returns for private pension plan assets. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Percentage of APA client members and 95% of 95% of 95% of 95% of employers satisfied or very satisfied with clients and clients and clients and clients and products and services employers 1 employers 1 employers 1 employers 1 Improved pension governance frameworks In progress Developed and implemented – – Percentage of private sector plans that meet minimum funding requirements New 98% 98% 98% 1 Average of client and employer satisfaction. 5 Pensions that deliver on promises Pension plan members need to be assured that their benefits are secure. Employers and other plan sponsors need to know that pension regulation is fair and even-handed. Finance assesses private sector pension plan compliance with legislative standards and ensures that action is taken and 'at risk ' plans comply with regulations. Finance will also continue to monitor funding of private sector pension plans. The Department provides advice to the Minister of Finance on the financial soundness and governance of the public pension plans. Alberta Pensions Administration Corporation (APA) provides administrative services. Finance works with the federal government and the other provinces to maintain the sustainability of the Canada Pension Plan and explores alternatives to allow Albertans to secure their retirement income. The Department provides support and information for government initiatives on public pension issues. In addition, Finance works with stakeholders and other jurisdictions across Canada to harmonize and streamline private pension legislation and regulatory processes. GOAL FIVE What it means Core Business Three: Pensions Policy, Regulations and Administration 214 FINANCE BUSINESS PLAN 2004-07 Strategies • ATB Financial continues to operate on sound financial institution and business principles with the objective of earning a fair return. • ACFA will continue to provide local authorities within the province with flexible funding for capital projects at the lowest possible cost, consistent with the viability of ACFA. Performance Measures Last Actual Target Target Target (2002-03) 2004-05 2005-06 2006-07 Local authorities' cost of borrowing from ACFA relative to borrowing costs of other Canadian municipalities within the viability of the Corporation Lowest1 Lowest Lowest Lowest ATB Financial • Loan loss provisions as a percentage of average total loans (0.39%) 0.30% 0.30% 0.35% • Expenses to operating revenue 66.99% 66.15% 66.30% 66.11% • Return on average assets (before tax) 1.55% 0.97% 1.06% 1.16% 1 Lowest at short and long-term maturities, but slightly higher than the lowest rate in Canada for mid-term (i.e., 5 and 10 years) rates. 6 Quality and competitive financial services accessible to Albertans and local authorities Alberta's dynamic economy and entrepreneurial spirit requires readily accessible and technologically advanced financial services and products. Alberta Treasury Branches (ATB Financial) and the Alberta Capital Finance Authority (ACFA) are public sector components of the financial services sector. ATB Financial is a full-service financial institution, with the largest branch network in the province. It provides services to individuals, small businesses and the agri-industry in 240 communities across Alberta. ACFA provides financing to a variety of local authorities including municipalities, towns, counties, hospitals, schools and post-secondary institutions throughout the province for capital projects. GOAL SIX What it means Core Business Four: Financial Services 215FINANCE BUSINESS PLAN 2004-07 MINISTRY STATEMENT OF OPERATIONS (thousands of dollars) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target REVENUE Internal Government Transfers 280,243 95,679 115,886 84,365 105,995 93,858 Other Taxes 1,702 600 1,700 750 750 750 Transfers from Government of Canada 4,055 4,030 4,055 4,055 4,055 4,055 Investment Income 528,710 504,311 539,500 504,259 468,993 445,267 Premiums, Fees and Licences 19,406 26,582 15,039 20,341 21,800 23,352 Net Income from Commercial Operations 224,899 156,660 165,563 155,837 151,344 164,220 Other Revenue 126,144 28,313 26,830 27,593 26,783 26,618 MINISTRY REVENUE 1,185,159 816,175 868,573 797,200 779,720 758,120 EXPENSE Program Fiscal Planning and Accountability 7,735 9,338 8,727 9,270 9,218 9,018 Treasury Management 72,211 71,887 74,529 77,838 78,918 81,057 Financial Sector Operations 4,477 4,881 6,513 5,650 6,037 6,143 Public Sector Pension Policy and Administration 23,264 27,068 26,163 26,210 25,967 25,827 Financing to Local Authorities 331,263 315,518 322,172 313,595 292,526 274,236 Ministry Support Services 5,272 5,074 5,306 5,165 5,108 5,164 Valuation Adjustments and Other Provisions (345) 300 200 - - - Total Program Expense* 443,877 434,066 443,610 437,728 417,774 401,445 Debt Servicing Costs Department Voted 70,675 61,503 61,503 53,020 45,246 38,046 Department Statutory 397,429 396,000 211,000 302,000 275,800 262,300 Ministry Debt Servicing Costs 468,104 457,503 272,503 355,020 321,046 300,346 MINISTRY EXPENSE 911,981 891,569 716,113 792,748 738,820 701,791 Gain (Loss) on Disposal of Capital Assets - - - - - - NET OPERATING RESULT 273,178 (75,394) 152,460 4,452 40,900 56,329 * Subject to the Fiscal Responsibility Act . Program expense includes the province's cash payments towards the unfunded pension liability (which will be eliminated under a separate legislated plan). Program expense does not include the annual change in the unfunded pension obligations, which is a non-cash expense that does not affect borrowing requirements. The annual increases (decreases) in the Ministry of Finance's unfunded pension obligations are: 81,349 (6,000) (9,000) (13,000) (16,000) (17,000) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target Fiscal Planning and Financial Management 550,923 542,246 359,342 445,247 412,264 393,519 Regulation of Provincial Institutions 4,521 4,928 5,942 5,652 6,046 6,174 Pension Policy, Regulation and Administration 24,834 28,430 27,822 27,792 27,537 27,407 Financial Services 331,703 315,965 323,007 314,057 292,973 274,691 MINISTRY EXPENSE 911,981 891,569 716,113 792,748 738,820 701,791 EXPENSE BY CORE BUSINESS (thousands of dollars) 216 FINANCE BUSINESS PLAN 2004-07 CONSOLIDATED NET OPERATING RESULT (thousands of dollars) Comparable Comparable Comparable 2002-03 2003-04 2003-04 2004-05 2005-06 2006-07 Actual Budget Forecast Estimates Target Target Ministry Revenue 1,185,159 816,175 868,573 797,200 779,720 758,120 Inter-ministry consolidation adjustments (350,139) (174,274) (185,762) (158,297) (185,887) (177,352) Consolidated Revenue 835,020 641,901 682,811 638,903 593,833 580,768 Ministry Program Expense 443,877 434,066 443,610 437,728 417,774 401,445 Inter-ministry consolidation adjustments (175) (196) (164) (194) (194) (194) Consolidated Program Expense 443,702 433,870 443,446 437,534 417,580 401,251 Ministry Debt Servicing Costs 468,104 457,503 272,503 355,020 321,046 300,346 Inter-ministry consolidation adjustments (87,575) (95,394) (86,708) (89,726) (94,503) (96,716) Consolidated Debt Servicing Costs 380,529 362,109 185,795 265,294 226,543 203,630 Consolidated Expense 824,231 795,979 629,241 702,828 644,123 604,881 Gain (Loss) on Disposal of Capital Assets - - - - - - CONSOLIDATED NET OPERATING RESULT 10,789 (154,078) 53,570 (63,925) (50,290) (24,113)",Financial,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]","I keep hearing about cryptocurrencies, and I would like to own some. I'm a customer at a local bank, and I was wondering how cryptocurrencies will change the future of banks. I would like my bank and cryptocurrency to be intertwined, as that gives me a sense of security.","Although the world of cryptocurrency is steadily expanding and gaining popularity, traditional banks are hesitant to adopt the use of these digital assets—believing that their inherent risks outweigh their potential benefits. However, regulatory agencies such as the Office of the Comptroller of the Currency (OCC) are working to change banks’ perception of digital currencies, believing that these assets could positively drive financial institutions to a new era of innovation and efficiency. Recently, the OCC issued several interpretive letters detailing how traditional financial institutions can enter into transactions (or develop services) involving digital currencies. This effort coincides with the OCC’s hope that additional regulatory guidance will help banks become more comfortable with these digital assets. In early January, the OCC announced that national banks and federal savings associations can now use public blockchains and stablecoins to perform payment activities. This opens the door for banks to have the ability to process payments much quicker and without the need of a third-party agency. Essentially, this clarifying letter puts blockchain networks in the same category as SWIFT, ACH, and FedWire, paving the way for these networks to be part of the larger banking ecosystem. Banks may be wary of cryptocurrency, thinking that transactions involving these assets present heightened risk and require lengthy and expensive due diligence. But digital currencies can offer many benefits to financial institutions and their customers, they just need to take the leap. Why Banks are Cautious of Cryptocurrencies According to a study conducted by the Association of Certified Anti-Money Laundering Specialists (ACAMS) and the U.K.’s Royal United Services Institute, nearly 63% of respondents who work in the banking industry perceive cryptocurrency as a risk rather than an opportunity. Decentralized Nature Crypto assets were created as an alternative to traditional banking infrastructure that don’t need an intermediary and aren’t tethered to the capacity of a centralized government, bank, or agency. Instead of relying on centralized intermediaries in these transactions, the trust is placed in the blockchain code and the distributed nature of the blockchain. A cryptocurrency that’s managed by a central bank diminishes the appeal of the asset in the first place, so some banks don’t believe that they’ll be able to enter this space successfully. The decentralized nature of the currency is seen to undermine the authority of central banks, leaving some to believe that they won’t be needed anymore, or they’ll be unable to control the money supply. AML/KYC Concerns Cryptocurrencies allow for peer-to-peer transactions without a regulated intermediary, giving the user the ability to easily transfer funds quickly without having to pay transaction fees. Instead of identifying the transaction by an individual bank account through a financial institution, transactions are simply linked to the transaction ID on the blockchain. This type of pseudonymity worries many banks who are concerned about the lack of anti-money laundering (AML) and know your customer (KYC) regulations surrounding digital currency transactions. Oftentimes, banks are under the impression that cryptocurrency transactions can’t be tracked for AML and KYC considerations, which could lead to illegal activity and scams on the network. Volatility The price of cryptocurrencies (bitcoin specifically) have generally been volatile over their short life. There are many reasons for this including market size, liquidity, and the number of market participants. Banks see this as a risk because historically, the price hasn’t been stable, so they believe the currency might not remain a stable investment vehicle over time. How Banks Can Get Involved in the Cryptocurrency Industry To avoid being left behind, banks need to find a way to embrace this technology and treat it as a friend rather than an enemy. Cryptocurrency adoption could streamline, enhance, and upgrade financial services, and there are plenty of recent industry advancements that can ease banks’ concerns around the risks and instead let them recognize the potential benefits. Custody Services In July, the OCC stated that banks and savings associations could provide crypto custody services for customers, including holding unique cryptographic keys associated with accessing private wallets. This means that the OCC believes that banks could safely and effectively hold either the cryptocurrency itself, or the key to access crypto on a personal digital wallet for its customers. Easy Onboarding & Expert Assistance Banks could help bring new, less experienced individual investors into the space by developing tools that would facilitate the adoption of crypto by their customers. For example, inexperienced cryptocurrency investors may not have the capabilities to set up their own wallet to custody their own cryptocurrency. Rather than leaving their cryptocurrency “off exchange” or at an unregulated third party, they may find it easier and more secure to hold it within a trusted financial institution. Banks could offer interest-bearing crypto accounts, where customers could invest the crypto on the back end or through other financial tools. Banks might relieve some of the stress of investors that aren’t experts in the nuances of crypto by acting as a trusted third party that’s well-respected in the finance industry and can keep investors’ assets protected. AML/KYC Regulations Administered In 2019, the Financial Crimes Enforcement Network’s (FinCEN) determined that any cryptocurrency transactions and custody services conducted through crypto entities that are considered money service businesses must still abide by AML/KYC regulations. This will help avoid malicious transactions, illegal activity, or scams using these platforms. These regulations could help banks and larger financial institutions conduct due diligence on customers involved in crypto transactions, further diminishing their anxieties about the risks that these transactions pose. There’s even a possibility that blockchain technology could automate AML and KYC verifications. Blockchain could potentially allow for a streamlined view of shared data on individuals between banks, loan officers, and other institutions. In other words, there could eventually be one blockchain that stores all customer data. This blockchain data could then be utilized by all financial institutions, allowing for fast reviews of customers to quickly identify any red flags insinuating nefarious or illegal activity. Security Concerns Banks can help mitigate the security concerns of cryptocurrency holders. Hacking of personal wallets and exchanges is a concern for many holders. Well-established banks could help secure digital currencies from theft or hacks, putting clients’ minds at ease. Bringing cryptocurrency under bank supervision could help diminish criminal activity or the appearance to outsiders that cryptocurrency transactions aren’t secure. Payments As indicated in the most recent OCC letter, banks can utilize public blockchains, including stablecoins, to speed up their payment processes. Blockchain technology provides a faster and less expensive alternative to clearing houses when processing transactions. The clearing and settlements could occur at a much faster rate if banks utilized blockchain technology. Smart Contracts When entering into an agreement through a smart contract, there’s a reduced level of trust needed among parties because the success of the transaction relies on computer code instead of an individual’s behavior. Banks could reinforce that trust by becoming a reliable third party that utilizes these smart contracts for mortgages, commercial loans, letters of credit, or other transactions. Guidance and regulation surrounding digital assets is sparse, leaving many financial institutions wary of adoption. Concerns surrounding the security and stability of cryptocurrency also hold banks back from entering this space—but instead of fearing the risks of this technology, banks should be looking ahead to its potential benefits. Financial institutions should also shift from thinking of crypto as a competitor to that of a partner. Banks can actually play a significant role in the crypto industry, adding some much needed assurance and security to the largely unregulated environment. Adopting cryptocurrencies and blockchain technology overall can streamline processes and take banking into the next generation of efficiency and innovation."," Only use the provided text to answer the question, no outside sources. I keep hearing about cryptocurrencies, and I would like to own some. I'm a customer at a local bank, and I was wondering how cryptocurrencies will change the future of banks. I would like my bank and cryptocurrency to be intertwined, as that gives me a sense of security. Although the world of cryptocurrency is steadily expanding and gaining popularity, traditional banks are hesitant to adopt the use of these digital assets—believing that their inherent risks outweigh their potential benefits. However, regulatory agencies such as the Office of the Comptroller of the Currency (OCC) are working to change banks’ perception of digital currencies, believing that these assets could positively drive financial institutions to a new era of innovation and efficiency. Recently, the OCC issued several interpretive letters detailing how traditional financial institutions can enter into transactions (or develop services) involving digital currencies. This effort coincides with the OCC’s hope that additional regulatory guidance will help banks become more comfortable with these digital assets. In early January, the OCC announced that national banks and federal savings associations can now use public blockchains and stablecoins to perform payment activities. This opens the door for banks to have the ability to process payments much quicker and without the need of a third-party agency. Essentially, this clarifying letter puts blockchain networks in the same category as SWIFT, ACH, and FedWire, paving the way for these networks to be part of the larger banking ecosystem. Banks may be wary of cryptocurrency, thinking that transactions involving these assets present heightened risk and require lengthy and expensive due diligence. But digital currencies can offer many benefits to financial institutions and their customers, they just need to take the leap. Why Banks are Cautious of Cryptocurrencies According to a study conducted by the Association of Certified Anti-Money Laundering Specialists (ACAMS) and the U.K.’s Royal United Services Institute, nearly 63% of respondents who work in the banking industry perceive cryptocurrency as a risk rather than an opportunity. Decentralized Nature Crypto assets were created as an alternative to traditional banking infrastructure that don’t need an intermediary and aren’t tethered to the capacity of a centralized government, bank, or agency. Instead of relying on centralized intermediaries in these transactions, the trust is placed in the blockchain code and the distributed nature of the blockchain. A cryptocurrency that’s managed by a central bank diminishes the appeal of the asset in the first place, so some banks don’t believe that they’ll be able to enter this space successfully. The decentralized nature of the currency is seen to undermine the authority of central banks, leaving some to believe that they won’t be needed anymore, or they’ll be unable to control the money supply. AML/KYC Concerns Cryptocurrencies allow for peer-to-peer transactions without a regulated intermediary, giving the user the ability to easily transfer funds quickly without having to pay transaction fees. Instead of identifying the transaction by an individual bank account through a financial institution, transactions are simply linked to the transaction ID on the blockchain. This type of pseudonymity worries many banks who are concerned about the lack of anti-money laundering (AML) and know your customer (KYC) regulations surrounding digital currency transactions. Oftentimes, banks are under the impression that cryptocurrency transactions can’t be tracked for AML and KYC considerations, which could lead to illegal activity and scams on the network. Volatility The price of cryptocurrencies (bitcoin specifically) have generally been volatile over their short life. There are many reasons for this including market size, liquidity, and the number of market participants. Banks see this as a risk because historically, the price hasn’t been stable, so they believe the currency might not remain a stable investment vehicle over time. How Banks Can Get Involved in the Cryptocurrency Industry To avoid being left behind, banks need to find a way to embrace this technology and treat it as a friend rather than an enemy. Cryptocurrency adoption could streamline, enhance, and upgrade financial services, and there are plenty of recent industry advancements that can ease banks’ concerns around the risks and instead let them recognize the potential benefits. Custody Services In July, the OCC stated that banks and savings associations could provide crypto custody services for customers, including holding unique cryptographic keys associated with accessing private wallets. This means that the OCC believes that banks could safely and effectively hold either the cryptocurrency itself, or the key to access crypto on a personal digital wallet for its customers. Easy Onboarding & Expert Assistance Banks could help bring new, less experienced individual investors into the space by developing tools that would facilitate the adoption of crypto by their customers. For example, inexperienced cryptocurrency investors may not have the capabilities to set up their own wallet to custody their own cryptocurrency. Rather than leaving their cryptocurrency “off exchange” or at an unregulated third party, they may find it easier and more secure to hold it within a trusted financial institution. Banks could offer interest-bearing crypto accounts, where customers could invest the crypto on the back end or through other financial tools. Banks might relieve some of the stress of investors that aren’t experts in the nuances of crypto by acting as a trusted third party that’s well-respected in the finance industry and can keep investors’ assets protected. AML/KYC Regulations Administered In 2019, the Financial Crimes Enforcement Network’s (FinCEN) determined that any cryptocurrency transactions and custody services conducted through crypto entities that are considered money service businesses must still abide by AML/KYC regulations. This will help avoid malicious transactions, illegal activity, or scams using these platforms. These regulations could help banks and larger financial institutions conduct due diligence on customers involved in crypto transactions, further diminishing their anxieties about the risks that these transactions pose. There’s even a possibility that blockchain technology could automate AML and KYC verifications. Blockchain could potentially allow for a streamlined view of shared data on individuals between banks, loan officers, and other institutions. In other words, there could eventually be one blockchain that stores all customer data. This blockchain data could then be utilized by all financial institutions, allowing for fast reviews of customers to quickly identify any red flags insinuating nefarious or illegal activity. Security Concerns Banks can help mitigate the security concerns of cryptocurrency holders. Hacking of personal wallets and exchanges is a concern for many holders. Well-established banks could help secure digital currencies from theft or hacks, putting clients’ minds at ease. Bringing cryptocurrency under bank supervision could help diminish criminal activity or the appearance to outsiders that cryptocurrency transactions aren’t secure. Payments As indicated in the most recent OCC letter, banks can utilize public blockchains, including stablecoins, to speed up their payment processes. Blockchain technology provides a faster and less expensive alternative to clearing houses when processing transactions. The clearing and settlements could occur at a much faster rate if banks utilized blockchain technology. Smart Contracts When entering into an agreement through a smart contract, there’s a reduced level of trust needed among parties because the success of the transaction relies on computer code instead of an individual’s behavior. Banks could reinforce that trust by becoming a reliable third party that utilizes these smart contracts for mortgages, commercial loans, letters of credit, or other transactions. Guidance and regulation surrounding digital assets is sparse, leaving many financial institutions wary of adoption. Concerns surrounding the security and stability of cryptocurrency also hold banks back from entering this space—but instead of fearing the risks of this technology, banks should be looking ahead to its potential benefits. Financial institutions should also shift from thinking of crypto as a competitor to that of a partner. Banks can actually play a significant role in the crypto industry, adding some much needed assurance and security to the largely unregulated environment. Adopting cryptocurrencies and blockchain technology overall can streamline processes and take banking into the next generation of efficiency and innovation. https://www.wolfandco.com/resources/insights/how-cryptocurrencies-may-impact-the-banking-industry/",Financial,Explanation/Definition,Q&A "Answer in complete sentences, only use the context document, no outside knowledge.","According to the document, how many copies of Mario Kart 8 Deluxe have been sold?","**What's publicly known about ""Switch 2""** Nintendo, notoriously secretive, has so far said nothing — or almost nothing — on the record about its next game console. As Nintendo Switch approaches its seventh birthday in March 2024, questions about how much longer it will last are natural: Seven years is a typical lifespan for a console generation, Switch sales are falling fast, and the technology powering the console is showing its age. But Nintendo has flatly refused to engage with those questions. Behind the scenes, however, Nintendo is gearing up for the release of its new machine, briefing its partners, and releasing development kits. Information has started to leak, and a picture of what form the console will take has begun to emerge, as well as when we can expect to hear about it and when we can expect to buy one. It’s no surprise that Nintendo is treading carefully. The Switch has been an enormous success — it’s the third-best-selling console of all time, behind only PlayStation 2 and Nintendo’s own DS handheld — which presents both a big opportunity and a big risk. Historically, Nintendo has struggled to follow its most popular formats: Wii and DS were followed by the flop of Wii U and the relative disappointment (in sales terms) of 3DS. Nintendo’s usual insistence on hardware innovation has proven as likely to alienate its audience as to find a new one. Will Nintendo break with its own tradition and follow the Switch with a more powerful take on the same formula, or will it try something different? Nintendo is targeting a March 2025 release for the successor to Switch, according to a Nikkei report (as spotted and translated by VGC) on Feb. 26. Nikkei corroborates earlier reporting by the specialist press that the console’s release had slipped out of its original late 2024 window. Nikkei has a few new details to add. First is that firm March window, as opposed to “early 2025” — indicating that Nintendo, as expected, still hopes to release Switch 2 in its next financial year. Secondly, Nintendo’s reason for the delay is not just ensuring a strong software lineup, but trying to build up enough inventory of the console itself to avoid the shortages and widespread reselling by scalpers that blighted the PlayStation 5’s launch. Thirdly and most ominously, Nikkei says that Switch 2’s release could slip beyond March if the software isn’t ready and if Nintendo hasn’t manufactured enough units. Elsewhere, Nikkei corroborates earlier reports that Switch 2 will be a hybrid portable device like Switch, and that it will feature a larger screen than the current model. Regarding its name, the answer is that we don’t know. It’s worth noting that Nintendo has never before named its consoles in numerical sequence, even when they were direct follow-ups to a previous generation, such as the Super Nintendo Entertainment System, Game Boy Advance, and Nintendo 3DS. Super Nintendo Switch (or Super Switch!) has a certain ring to it, if you ask us. But for now, “Switch 2” is a serviceable shorthand, and what we’ll use in this article. The answer here appears to be yes. Recent reporting by VGC, citing multiple sources after dev kits arrived at partner studios, said that the console “would be able to be used in portable mode, similar to the Nintendo Switch.” This was later corroborated by Nikkei. There’s no word yet on whether the console will feature detachable Joy-Con controllers like the Switch, or whether it will have a handheld-only variant like the Switch Lite. But early signs are that Nintendo is keen to follow closely in the footsteps of the 130-million-plus-selling Switch. It might be a bit bigger, though. A 2024 report from a Japanese analyst suggests the console will have an 8-inch screen, compared to the original Switch’s 6.2 inches and the Switch OLED model’s 7 inches. Nintendo hasn’t officially indicated when the Switch 2 will be released, but we have a few clues. Originally, multiple sources reported that the console was planned to debut in the second half of 2024. However, it now appears that Nintendo is targeting a March 2025 release date. Brazilian games journalist Pedro Henrique Lutti Lippe originally broke the news of the slip to 2025, saying that multiple sources said they were working on games that are set to launch alongside the Switch 2. Both Eurogamer and VGC heard similar claims from their sources. Nikkei then reported Nintendo was targeting March 2025 in an effort to avoid hardware shortages and ensure a strong lineup of games — but noted a slip beyond March was still possible. While this is later than we previously expected, it fits in with an October 2023 interview with Nintendo president Shuntaro Furukawa, who reiterated that the company would remain focused on Switch until the end of Nintendo’s current fiscal year in March 2024, and added that it would continue to support Switch with new titles in the following fiscal year. The shift from “focus” to “support” for the Switch implies that a new console will launch in Nintendo’s next fiscal year — so, between April 2024 and March 2025. This also lines up with what we know about declining Switch sales, the stage Nintendo is at in the development of the console, and the release schedule for Switch games. Nintendo previously ruled out releasing a new console before the end of March 2024, and it now has Switch games scheduled through summer 2024; the latest release on the current schedule is Luigi’s Mansion 2 HD, which has been given a summer 2024 slot. (It’s also worth noting that the recently announced remake of Paper Mario: The Thousand-Year Door doesn’t have a more precise release date than “2024.”) This does mean the Switch 2 will miss the 2024 holiday season, but it’ll give the company more time to stockpile some first-party titles, according to VGC sources. This is the big question, with many users hoping — or outright expecting — to carry forward their game libraries to Nintendo’s next console, as has become the norm with the latest generations of Xbox and PlayStation consoles. The answer remains unknown, and it’s not easy to predict, either. VGC’s report said that the backward compatibility of the machine “remains unclear.” Some third-party publishers were said to be worried about the potential impact on sales of next-gen titles if the machine is backward-compatible. For its part, Nintendo has (in a rare on-the-record comment) said it hopes to bring Switch users over to the new platform with their Nintendo accounts; if the Nintendo account system persists, that would in theory make it easy for users to access previous purchases. But that’s not the same thing as the console being technically capable of it. Nintendo has a decent, if not flawless, record for supporting backward compatibility. Wii played GameCube games, and Wii U played Wii games; Game Boy Advance was backward-compatible with Game Boy, and 3DS with DS. But the Switch, with its new game cartridge format, enforced a clean break with the past, and Nintendo has made a mint from rereleasing Wii U games on the machine, particularly the 55-million-selling Mario Kart 8 Deluxe. On balance, as long as the machine uses the same format for physical releases (see below), Nintendo’s record suggests that it will make the Switch 2 backward-compatible. However, there remain technical hurdles to implementing backward compatibility, and much will depend on the chip architecture Nintendo has chosen for the Switch 2, which is not currently known. Of all the console manufacturers, Nintendo’s ties to the retail industry are perhaps the strongest — stronger even than Sony’s — so Nintendo is extremely unlikely to go digital-only for the Switch 2, even if this would seem to make sense for a portable machine. Indeed, VGC’s report included the detail that the new console will have a cartridge slot for physical releases. This is as close to a dead cert as we can get with the Switch 2 — and it also happens to support the machine having the same or similar form factor as the Switch, as well as increasing the likelihood of backward compatibility. Thanks to Microsoft’s legal battles over its acquisition of Activision Blizzard, and reports of demos given by Nintendo to partners at Gamescom, we are beginning to get a sense of how capable the Switch 2’s hardware will be. Internal emails released as part of the FTC v. Microsoft case revealed that Activision executives met with Nintendo in December 2022 to discuss the console, and came away with the impression that performance would be close to “Gen8 platforms” — in other words, PlayStation 4 and Xbox One. (Activision Blizzard CEO Bobby Kotick later said that he had not seen tech specs for the machine, however.) If anything, the “Gen8” comparison sounds as though it might undersell the Switch 2’s capabilities. According to Eurogamer’s and VGC’s reporting on the behind-closed-doors Gamescom demos, Nintendo showed hardware targeting the specs of the console running The Matrix Awakens’ Unreal Engine 5 tech demo with ray tracing enabled and “visuals comparable to Sony’s and Microsoft’s current-gen consoles.” This doesn’t mean that the Switch 2 will be as powerful as PlayStation 5 and Xbox Series X. Instead, Nintendo is likely using clever techniques to reduce the demand on a less powerful graphics processor. VGC reported that the demo ran using Nvidia’s advanced DLSS upscaling technology, which uses AI to upscale the resolution of the image. Still, the mention of Unreal Engine 5 — which is establishing itself as the industry standard engine, targeting current console hardware — along with DLSS and ray tracing suggests that Nintendo is keen to get closer to PS5 and Xbox Series X in terms of performance, and perhaps make it more feasible for developers to port their home console releases on the Switch 2. Reporting by Reuters and Digital Foundry suggests the console will use a custom Nvidia chip that will be capable of both ray-tracing and DLSS. Also at Gamescom, a special, improved version of The Legend of Zelda: Breath of the Wild was shown, running at higher resolution and frame rate than it does on Switch. The Switch 2 will feature one tech downgrade, however: Reportedly, the console will feature an LCD screen, unlike the OLED screen seen in the current top-of-the-range Switch model, as a cost-cutting measure."," ======= Answer in complete sentences, only use the context document, no outside knowledge. ================ ======= **What's publicly known about ""Switch 2""** Nintendo, notoriously secretive, has so far said nothing — or almost nothing — on the record about its next game console. As Nintendo Switch approaches its seventh birthday in March 2024, questions about how much longer it will last are natural: Seven years is a typical lifespan for a console generation, Switch sales are falling fast, and the technology powering the console is showing its age. But Nintendo has flatly refused to engage with those questions. Behind the scenes, however, Nintendo is gearing up for the release of its new machine, briefing its partners, and releasing development kits. Information has started to leak, and a picture of what form the console will take has begun to emerge, as well as when we can expect to hear about it and when we can expect to buy one. It’s no surprise that Nintendo is treading carefully. The Switch has been an enormous success — it’s the third-best-selling console of all time, behind only PlayStation 2 and Nintendo’s own DS handheld — which presents both a big opportunity and a big risk. Historically, Nintendo has struggled to follow its most popular formats: Wii and DS were followed by the flop of Wii U and the relative disappointment (in sales terms) of 3DS. Nintendo’s usual insistence on hardware innovation has proven as likely to alienate its audience as to find a new one. Will Nintendo break with its own tradition and follow the Switch with a more powerful take on the same formula, or will it try something different? Nintendo is targeting a March 2025 release for the successor to Switch, according to a Nikkei report (as spotted and translated by VGC) on Feb. 26. Nikkei corroborates earlier reporting by the specialist press that the console’s release had slipped out of its original late 2024 window. Nikkei has a few new details to add. First is that firm March window, as opposed to “early 2025” — indicating that Nintendo, as expected, still hopes to release Switch 2 in its next financial year. Secondly, Nintendo’s reason for the delay is not just ensuring a strong software lineup, but trying to build up enough inventory of the console itself to avoid the shortages and widespread reselling by scalpers that blighted the PlayStation 5’s launch. Thirdly and most ominously, Nikkei says that Switch 2’s release could slip beyond March if the software isn’t ready and if Nintendo hasn’t manufactured enough units. Elsewhere, Nikkei corroborates earlier reports that Switch 2 will be a hybrid portable device like Switch, and that it will feature a larger screen than the current model. Regarding its name, the answer is that we don’t know. It’s worth noting that Nintendo has never before named its consoles in numerical sequence, even when they were direct follow-ups to a previous generation, such as the Super Nintendo Entertainment System, Game Boy Advance, and Nintendo 3DS. Super Nintendo Switch (or Super Switch!) has a certain ring to it, if you ask us. But for now, “Switch 2” is a serviceable shorthand, and what we’ll use in this article. The answer here appears to be yes. Recent reporting by VGC, citing multiple sources after dev kits arrived at partner studios, said that the console “would be able to be used in portable mode, similar to the Nintendo Switch.” This was later corroborated by Nikkei. There’s no word yet on whether the console will feature detachable Joy-Con controllers like the Switch, or whether it will have a handheld-only variant like the Switch Lite. But early signs are that Nintendo is keen to follow closely in the footsteps of the 130-million-plus-selling Switch. It might be a bit bigger, though. A 2024 report from a Japanese analyst suggests the console will have an 8-inch screen, compared to the original Switch’s 6.2 inches and the Switch OLED model’s 7 inches. Nintendo hasn’t officially indicated when the Switch 2 will be released, but we have a few clues. Originally, multiple sources reported that the console was planned to debut in the second half of 2024. However, it now appears that Nintendo is targeting a March 2025 release date. Brazilian games journalist Pedro Henrique Lutti Lippe originally broke the news of the slip to 2025, saying that multiple sources said they were working on games that are set to launch alongside the Switch 2. Both Eurogamer and VGC heard similar claims from their sources. Nikkei then reported Nintendo was targeting March 2025 in an effort to avoid hardware shortages and ensure a strong lineup of games — but noted a slip beyond March was still possible. While this is later than we previously expected, it fits in with an October 2023 interview with Nintendo president Shuntaro Furukawa, who reiterated that the company would remain focused on Switch until the end of Nintendo’s current fiscal year in March 2024, and added that it would continue to support Switch with new titles in the following fiscal year. The shift from “focus” to “support” for the Switch implies that a new console will launch in Nintendo’s next fiscal year — so, between April 2024 and March 2025. This also lines up with what we know about declining Switch sales, the stage Nintendo is at in the development of the console, and the release schedule for Switch games. Nintendo previously ruled out releasing a new console before the end of March 2024, and it now has Switch games scheduled through summer 2024; the latest release on the current schedule is Luigi’s Mansion 2 HD, which has been given a summer 2024 slot. (It’s also worth noting that the recently announced remake of Paper Mario: The Thousand-Year Door doesn’t have a more precise release date than “2024.”) This does mean the Switch 2 will miss the 2024 holiday season, but it’ll give the company more time to stockpile some first-party titles, according to VGC sources. This is the big question, with many users hoping — or outright expecting — to carry forward their game libraries to Nintendo’s next console, as has become the norm with the latest generations of Xbox and PlayStation consoles. The answer remains unknown, and it’s not easy to predict, either. VGC’s report said that the backward compatibility of the machine “remains unclear.” Some third-party publishers were said to be worried about the potential impact on sales of next-gen titles if the machine is backward-compatible. For its part, Nintendo has (in a rare on-the-record comment) said it hopes to bring Switch users over to the new platform with their Nintendo accounts; if the Nintendo account system persists, that would in theory make it easy for users to access previous purchases. But that’s not the same thing as the console being technically capable of it. Nintendo has a decent, if not flawless, record for supporting backward compatibility. Wii played GameCube games, and Wii U played Wii games; Game Boy Advance was backward-compatible with Game Boy, and 3DS with DS. But the Switch, with its new game cartridge format, enforced a clean break with the past, and Nintendo has made a mint from rereleasing Wii U games on the machine, particularly the 55-million-selling Mario Kart 8 Deluxe. On balance, as long as the machine uses the same format for physical releases (see below), Nintendo’s record suggests that it will make the Switch 2 backward-compatible. However, there remain technical hurdles to implementing backward compatibility, and much will depend on the chip architecture Nintendo has chosen for the Switch 2, which is not currently known. Of all the console manufacturers, Nintendo’s ties to the retail industry are perhaps the strongest — stronger even than Sony’s — so Nintendo is extremely unlikely to go digital-only for the Switch 2, even if this would seem to make sense for a portable machine. Indeed, VGC’s report included the detail that the new console will have a cartridge slot for physical releases. This is as close to a dead cert as we can get with the Switch 2 — and it also happens to support the machine having the same or similar form factor as the Switch, as well as increasing the likelihood of backward compatibility. Thanks to Microsoft’s legal battles over its acquisition of Activision Blizzard, and reports of demos given by Nintendo to partners at Gamescom, we are beginning to get a sense of how capable the Switch 2’s hardware will be. Internal emails released as part of the FTC v. Microsoft case revealed that Activision executives met with Nintendo in December 2022 to discuss the console, and came away with the impression that performance would be close to “Gen8 platforms” — in other words, PlayStation 4 and Xbox One. (Activision Blizzard CEO Bobby Kotick later said that he had not seen tech specs for the machine, however.) If anything, the “Gen8” comparison sounds as though it might undersell the Switch 2’s capabilities. According to Eurogamer’s and VGC’s reporting on the behind-closed-doors Gamescom demos, Nintendo showed hardware targeting the specs of the console running The Matrix Awakens’ Unreal Engine 5 tech demo with ray tracing enabled and “visuals comparable to Sony’s and Microsoft’s current-gen consoles.” This doesn’t mean that the Switch 2 will be as powerful as PlayStation 5 and Xbox Series X. Instead, Nintendo is likely using clever techniques to reduce the demand on a less powerful graphics processor. VGC reported that the demo ran using Nvidia’s advanced DLSS upscaling technology, which uses AI to upscale the resolution of the image. Still, the mention of Unreal Engine 5 — which is establishing itself as the industry standard engine, targeting current console hardware — along with DLSS and ray tracing suggests that Nintendo is keen to get closer to PS5 and Xbox Series X in terms of performance, and perhaps make it more feasible for developers to port their home console releases on the Switch 2. Reporting by Reuters and Digital Foundry suggests the console will use a custom Nvidia chip that will be capable of both ray-tracing and DLSS. Also at Gamescom, a special, improved version of The Legend of Zelda: Breath of the Wild was shown, running at higher resolution and frame rate than it does on Switch. The Switch 2 will feature one tech downgrade, however: Reportedly, the console will feature an LCD screen, unlike the OLED screen seen in the current top-of-the-range Switch model, as a cost-cutting measure. ================ ======= According to the document, how many copies of Mario Kart 8 Deluxe have been sold?",Internet/Technology,Fact Finding,Q&A All your responses are based exclusively in the user-provided text. You do not use any outside information or prior knowledge in your responses.,Explain the differences between gamma ray and infrared telescopes.,"How Telescopes Are Like Eyes Telescopes and eyes are both tools for collecting and detecting light. In fact, telescopes can be thought of as bigger, more powerful eyes. Eyes have an opening called the pupil where the light enters; a lens to focus the light; and a retina in the back to detect the light. Telescopes also have an opening to let in light; a lens or mirror to focus the light; and a detector to receive and process the light. In the eye, chemical reactions in the retina convert light into electrical signals, w h i c h are processed by the brain. In telescopes, several different kinds of light detectors are used. Some telescopes contain electronic devices that convert light into electrical signals that can be analyzed and stored by a computer. In other telescopes, the light is focused onto photographic film, where the information is recorded as a photograph. In simple backyard telescopes, the light is focused onto the eye of the person looking through the telescope. In this case, the telescope’s light detector is a human eye. When you look through a telescope, all of the light that enters eventually reaches the back of your eye. Hundreds of times more light enters a small telescope than would n o rmally enter your eye because the telescope’s opening (also known as its “apert u r e ” ) is much bigger than your pupil. The telescope’s lens or mirror focuses all of this light so that it fits through your pupil. This is why telescopes let you see objects that do not give off enough light to see by unaided eye alone. Telescopes have several advantages over eyes, including larger light-collecting areas; collecting light for longer periods of time; and the ability to detect wavelengths of light invisible to humans. Larger Light-Collecting Areas When you move from a bright area into darkness, the pupil in your eye can expand from less than 1/1 6 inch to more than o inch in diameter — becoming sixteen times greater in area —in order to take in more light. Telescopes offer a way to expand the light-collecting area even further, in effect increasing the size of your pupil by hundreds or thousands of times. A simple backyard telescope with a 4-inch-diameter lens can capture 250 times more light than an eye with a o -inch-wide pupil, and the Hubble Space Telescope’s 94.5-inch mirror captures 143,000 times as much light as a o -inch pupil. Telescopes that capture radio waves look nothing like optical telescopes, but the surface area of the collector still determines how powerful the telescope is. Radio telescopes collect light in “dishes” that resemble satellite TV antennas. The wider the dish, the more powerful the telescope, because a wider dish can capture more light. The radio telescope at the Arecibo Observatory in Puerto Rico has a dish 1,000 feet wide Collecting Light for Longer Periods of Time The light detectors in telescopes can gather light from a single source over a long period of time. In some cases, light collected over several hours is used to create a single image. This is something the human eye cannot do. The cells in your retina collect light for just a fraction of a second. Then they repeat the process, essentially taking a new picture about twenty times a second. This enables your eye to keep track of moving objects. If your eye did not constantly update its information about where things are, moving objects would become a blur. When collecting light from faint objects such as distant galaxies, however, a twentieth of a second is not enough time for your eye to see anything at all, even if you are looking through a large telescope. Astronomers solve this problem by attaching special detectors to telescopes. This lets them point a telescope at a single object for minutes or even hours and combine all the light the camera receives into a single image. The resulting image reveals much more than a person could see with their eyes, even looking through the same telescope. In the past, telescope detectors used photographic film. Though some still use film, most research telescopes now use electronic cameras that store digital images on a computer. The electronic light detectors used in telescopes are called charged-coupled devices, or CCDs. CCD chips are made of thousands of tiny sensors that convert light into an electrical signal. The amount of electricity that passes through a given spot on the chip reveals how much light struck that point. Computers process the electrical information to make a digital image. The same technology is used in photocopiers, fax machines, video cameras, and bar code readers, all of which convert light signals into electrical signals. The Ability to Detect Wavelengths of Light Invisible to Humans Many telescopes are built to detect wavelengths of light your eyes cannot. Light from space comes in many wavelengths, most of which are invisible to the human eye—including gamma rays, X rays, ultraviolet and infrared light, microwaves, and radio waves. Whether visible or invisible, all light contains information about its source. So astronomers use special telescopes to detect wavelengths of light not visible to humans. The hotter an object is, the shorter the wavelengths of light it gives off. Because stars are so hot, much of the light they emit is in wavelengths too short for your eyes to see. Pictures of the Sun taken in ultraviolet or X-ray light, for instance, show hot, glowing jets of gas arching out of the Sun. These shapes are always there, but they cannot be seen in visible wavelengths. Telescopes sensitive to different wavelengths of light are useful in observing different astronomical phenomena. Gamma Ray Telescopes Gamma rays have the shortest wavelength and contain the most energy of any form of light. They are believed to come from highly energetic processes such as collisions between two black holes, collisions between two neutron stars, or the collapse of hyperstars—giant stars even bigger than the ones that cause supernovas. The design of a gamma-ray telescope is unique in that the telescope itself is one big detector without any lenses or mirrors. The wavelengths of gamma rays are so small that they pass easily through conventional lenses or mirrors. X-ray Telescopes X-ray telescopes are used to observe extremely hot sources, such as the gases around black holes. X-ray telescopes cannot focus X-ray light the same way that ordinary telescopes do, because X-rays go right through most mirrors. Some X ray telescopes have special mirrors shaped like long, narrow tubes. As X rays enter the tube, they graze the mirror just enough to reflect gently toward a detector instead of passing through the mirror. Ultraviolet Telescopes Ultraviolet (UV) light has shorter wavelengths than visible light. These waves come from very hot stars. Ultraviolet telescopes can also be used to observe the hot gases surrounding the Sun. UV telescopes appear very similar in design to visible light telescopes except they are equipped with specially designed detectors sensitive to UV light. Visible Light Telescopes Optical telescopes capture the same kind of light your eyes can see. They reveal how distant objects would look if we were closer to them. Most of the cosmic images we see in magazines and newspapers come from visible light telescopes. Visible light is also a good source of information about average-temperature stars like the Sun. Infrared Telescopes Infrared light has fairly long wavelengths that pass through clouds of dust better than light with shorter wavelengths. Infrared telescopes are used to observe objects surrounded by dust, such as young stars being born inside nebulae. Because all warm objects give off infrared light, infrared telescopes are chilled so that they won’t detect their own glow. The lifespan of an infrared telescope is limited by how long the telescope can be kept cool. Microwave Telescopes Microwaves are used to observe the afterglow of the Big Bang, the ancient explosion that created the Universe. Microwave radiation also reveals the presence of many small molecules, such as carbon monoxide. The design of microwave telescopes is most similar to that of radio telescopes: large metallic “dishes” that collect and focus the longer wavelengths of microwave light. Radio Telescopes Radio waves have long wavelengths, from a meter on up to over a kilometer. Extremely large telescope dishes are required to capture these long wavelengths. Radio telescopes can reveal details of distant galaxies and nebulae. Radio telescopes helped astronomers discover “pulsars,” which are collapsed stars that rotate rapidly, emitting pulses of radio waves like the rotating lights on a police car or a lighthouse. ","Question: Explain the differences between gamma ray and infrared telescopes. System Instructions: All your responses are based exclusively in the user-provided text. You do not use any outside information or prior knowledge in your responses. Text: The Ability to Detect Wavelengths of Light Invisible to Humans Many telescopes are built to detect wavelengths of light your eyes cannot. Light from space comes in many wavelengths, most of which are invisible to the human eye—including gamma rays, X rays, ultraviolet and infrared light, microwaves, and radio waves. Whether visible or invisible, all light contains information about its source. So astronomers use special telescopes to detect wavelengths of light not visible to humans. The hotter an object is, the shorter the wavelengths of light it gives off. Because stars are so hot, much of the light they emit is in wavelengths too short for your eyes to see. Pictures of the Sun taken in ultraviolet or X-ray light, for instance, show hot, glowing jets of gas arching out of the Sun. These shapes are always there, but they cannot be seen in visible wavelengths. Telescopes sensitive to different wavelengths of light are useful in observing different astronomical phenomena. Gamma Ray Telescopes Gamma rays have the shortest wavelength and contain the most energy of any form of light. They are believed to come from highly energetic processes such as collisions between two black holes, collisions between two neutron stars, or the collapse of hyperstars—giant stars even bigger than the ones that cause supernovas. The design of a gamma-ray telescope is unique in that the telescope itself is one big detector without any lenses or mirrors. The wavelengths of gamma rays are so small that they pass easily through conventional lenses or mirrors. X-ray Telescopes X-ray telescopes are used to observe extremely hot sources, such as the gases around black holes. X-ray telescopes cannot focus X-ray light the same way that ordinary telescopes do, because X-rays go right through most mirrors. Some X ray telescopes have special mirrors shaped like long, narrow tubes. As X rays enter the tube, they graze the mirror just enough to reflect gently toward a detector instead of passing through the mirror. Ultraviolet Telescopes Ultraviolet (UV) light has shorter wavelengths than visible light. These waves come from very hot stars. Ultraviolet telescopes can also be used to observe the hot gases surrounding the Sun. UV telescopes appear very similar in design to visible light telescopes except they are equipped with specially designed detectors sensitive to UV light. Visible Light Telescopes Optical telescopes capture the same kind of light your eyes can see. They reveal how distant objects would look if we were closer to them. Most of the cosmic images we see in magazines and newspapers come from visible light telescopes. Visible light is also a good source of information about average-temperature stars like the Sun. Infrared Telescopes Infrared light has fairly long wavelengths that pass through clouds of dust better than light with shorter wavelengths. Infrared telescopes are used to observe objects surrounded by dust, such as young stars being born inside nebulae. Because all warm objects give off infrared light, infrared telescopes are chilled so that they won’t detect their own glow. The lifespan of an infrared telescope is limited by how long the telescope can be kept cool. Microwave Telescopes Microwaves are used to observe the afterglow of the Big Bang, the ancient explosion that created the Universe. Microwave radiation also reveals the presence of many small molecules, such as carbon monoxide. The design of microwave telescopes is most similar to that of radio telescopes: large metallic “dishes” that collect and focus the longer wavelengths of microwave light. Radio Telescopes Radio waves have long wavelengths, from a meter on up to over a kilometer. Extremely large telescope dishes are required to capture these long wavelengths. Radio telescopes can reveal details of distant galaxies and nebulae. Radio telescopes helped astronomers discover “pulsars,” which are collapsed stars that rotate rapidly, emitting pulses of radio waves like the rotating lights on a police car or a lighthouse. ",Internet/Technology,Concept Comparison,Q&A "Model must only respond using information contained in the context block. Model should not rely on its own knowledge or outside sources of information when responding. ",In which situations will the Accidental Death Policy not pay out?,"LIFE INSURANCE AND CRITICAL ILLNESS COVER POLICY SUMMARY. This policy is provided by Legal & General Assurance Society Limited. OVERVIEW. These policies are designed for people who want to help protect against the impact of death or terminal illness or critical illness. The policy could be used to help pay your outstanding mortgage or to help protect your family’s lifestyle and everyday living expenses. This Policy Summary is only a brief guide to the cover and exclusions. You will find full details in the Policy Booklet which will form the basis of our contract with you. WHAT IS COVERED? Life insurance You will be covered if before the end of the policy: • you die. • you are diagnosed as being terminally ill, and in the opinion of your hospital consultant and our medical officer, the illness is expected to lead to death within 12 months. We’ll pay out your amount of cover once. After this happens, the policy will end and you’ll no longer have any cover. Critical illness cover If you choose to add critical illness cover alongside your life insurance as a separate policy, (also referred to as additional or independent critical illness cover) you will be covered if before the end of the policy: • You are diagnosed with or undergo a medical procedure for one of the critical illnesses we cover and you survive for 14 days from diagnosis. We’ll pay out your amount of cover in full once. After this happens, the policy will end and you’ll no longer have any cover. T 2 LIFE INSURANCE AND CRITICAL ILLNESS COVER XWHAT IS NOT COVERED? You are not covered if you don’t give us full and honest answers to the questions we ask you before the policy starts. Please don’t assume that we’ll contact your doctor to find out your full medical details. Life insurance We won’t pay out: • If within the first year of the policy, your death is caused by suicide or, intentional and serious self-injury or an event where, in our reasonable opinion, you took your own life. • If some elements of cover are restricted based on the information you give us. If we do this we’ll tell you what we’ve excluded in your policy booklet under ‘What you are not covered for’. • The amount of cover more than once if a joint life policy is chosen. This may be when the first person dies or has a valid claim. We have a replacement cover option which could allow the other person covered to take out a new single life policy, ensuring they still have some protection in place. • If you are diagnosed with a terminal illness which doesn’t meet our definition. Terminal Illness cover can’t be claimed: • after your death • or if the length of the policy is less than two years. Critical illness cover We won’t pay out: • If you are diagnosed with or undergo a medical procedure for one of the critical illnesses we cover which doesn’t meet our definition. • If death occurs within 14 days of diagnosis of one of the critical illnesses we cover. • If you die. • If some elements of cover are restricted based on the information you give us. If we do this we’ll tell you what we’ve excluded in your policy booklet under ‘What you are not covered for’. • The amount of cover more than once if a joint life policy is chosen. This will be when the first person has a valid claim. We have a replacement cover option which could allow the other person covered to take out a new single life policy, ensuring they still have some protection in place. For all policies • Life cover policies have no cash value and we will not pay out if you reach the end of the policy without making a valid claim. • If you stop paying your premiums your cover will end 60 days after the first missed premium. 3 LIFE INSURANCE AND CRITICAL ILLNESS COVER ABOUT THE POLICY. YOUR PREMIUMS Your premiums will remain the same during the length of the policy unless you make any changes. AGE LIMITS Product Maximum age for buying a policy Minimum length of the policy Maximum length of the policy Your policy must end before age Life Insurance* 77 1 year 50 years 90 Decreasing Life Insurance* 74 5 years 50 years 90 Critical Illness Cover* 67 2 years 50 years 75 The minimum age to take out a policy is 18. The policy must not end before your 29th birthday. *Guaranteed premiums 4 LIFE INSURANCE AND CRITICAL ILLNESS COVER YOUR COVER Level cover If you choose level cover, your amount of cover will stay the same unless you change it. If the policy is to help repay a mortgage, you need to ensure that your amount of cover matches your outstanding mortgage. The policy may not completely pay off your outstanding mortgage, if you change the mortgage you have in any way and you don’t adjust your cover to match your new arrangements. Decreasing cover If you choose decreasing cover it is often used to help protect a repayment mortgage. Therefore the amount of cover reduces roughly in line with the way a repayment mortgage decreases. You need to ensure that your amount of cover matches your outstanding mortgage. The policy may not completely pay off your outstanding mortgage, if: • you change the mortgage you have in any way and you don’t adjust your cover to match your new arrangements. • the interest rate on your mortgage becomes higher than the rate applied to the policy. The rate will be shown in your Personal Quote or the Policy Booklet. 5 LIFE INSURANCE AND CRITICAL ILLNESS COVER BENEFITS FOR LIFE INSURANCE. The following benefit(s) may have eligibility criteria and restrictions that apply. ACCIDENTAL DEATH BENEFIT Included at no extra cost. WHAT IS COVERED? We’ll cover you from when we receive your application, for up to 90 days or until we accept, postpone or decline your application. This means that if you die due to an accident during this time, we’ll pay out the amount you’ve asked to be insured for, up to a maximum of £300,000 for all applications. The benefit will be paid out if the person covered, or one of the persons covered, sustains a bodily injury caused by accidental, violent, external and visible means, which solely and independently of any other cause results in death within 90 days of the accident. WHAT IS NOT COVERED? We won’t pay out if death occurs from: • Suicide, intentional and serious self-injury or an event where, in our reasonable opinion, you took your own life. • Taking part or attempting to take part in a dangerous sport or pastime. • Taking part or attempting to take part in any aerial flight other than as a fare paying passenger on a licensed airline. • Committing, attempting or provoking an assault or criminal offence. • War (whether declared or not), riot or civil commotion. • Taking alcohol or drugs (unless these drugs were prescribed by a registered doctor in the United Kingdom). • Accidents that happened before you applied. We don’t provide this benefit: • If we have been told that the application is to replace an existing policy with us while cover is still provided under the existing policy. • From the date you tell us that you no longer want the application to proceed. Your lump sum will be paid only once either under the Accidental Death Benefit, Free Life Cover or the policy itself. T X 6 LIFE INSURANCE AND CRITICAL ILLNESS COVER FREE LIFE COVER Included at no extra cost if you are moving home. WHAT IS COVERED? We’ll cover you if you die between exchange of contracts and completion of your property purchase up to a maximum of 90 days, provided you are accepted on standard terms and we have everything we need to start your policy. Your Free Life Cover will end as soon as the policy starts. You’ll be covered for the lower of your proposed amount of cover or the amount of your mortgage, up to a maximum of £300,000. If you live in Scotland, you’ll be covered between completion of missives and your date of entry. WHAT IS NOT COVERED? You won’t be accepted for Free Life Cover if you are 55 years old or over. For joint life policies you both need to be under this age for Free Life Cover to apply. We won’t provide cover if you have another policy with any provider covering the same mortgage. Your amount of cover will be paid only once either under Free Life Cover, Accidental Death Benefit or the policy itself. T X 7 LIFE INSURANCE AND CRITICAL ILLNESS COVER CRITICAL ILLNESSES COVERED. If you choose Critical Illness Cover, you will be covered for the illnesses shown below. For a claim to pay out, your illness must meet Legal & General’s definition. It must also be verified by a consultant at a hospital in the UK, who is a specialist in an area of medicine appropriate to the cause of your claim as in some instances cover may be limited. For example: • some types of cancer are not covered • to make a claim for some illnesses, you need to have permanent symptoms. Please check the full definitions found in the Guide to Critical Illness Cover and Policy Booklet to make sure that you understand exactly what is covered. • Aorta graft surgery - requiring surgical replacement. • Aplastic anaemia - with permanent bone marrow failure. • Bacterial meningitis - resulting in permanent symptoms • Benign brain tumour - resulting in either surgical removal or permanent symptoms. • Blindness - permanent and irreversible. • Cancer - excluding less advanced cases. • Cardiac arrest - with insertion of a defibrillator. • Cardiomyopathy - of specified severity. • Coma - with associated permanent symptoms. • Coronary artery by-pass grafts – with surgery to divide the breastbone or thoracotomy. • Creutzfeldt-Jakob disease (CJD) – resulting in permanent symptoms. • Deafness - permanent and irreversible. • Dementia including Alzheimer’s disease - of specified severity. • Encephalitis - resulting in permanent symptoms. • Heart attack - of specified severity. • Heart valve replacement or repair - with surgery. • Kidney failure - requiring permanent dialysis. • Liver failure - of advanced stage. • Loss of hand or foot – permanent physical severance. • Loss of speech - total permanent and irreversible. • Major organ transplant – from another donor. • Motor neurone disease - resulting in permanent symptoms. • Multiple sclerosis - where there have been symptoms. • Multiple system atrophy – resulting in permanent symptoms. 8 LIFE INSURANCE AND CRITICAL ILLNESS COVER • Open heart surgery – with median sternotomy. • Paralysis of limb – total and irreversible. • Parkinson’s disease - resulting in permanent symptoms. • Primary pulmonary hypertension - of specified severity. • Progressive supranuclear palsy – resulting in permanent symptoms. • Removal of an eyeball – due to injury or disease. • Respiratory failure - of advanced stage. • Spinal stroke - resulting in symptoms lasting at least 24 hours. • Stroke - resulting in symptoms lasting at least 24 hours. • Systemic lupus erythematosus - with severe complications. • Third degree burns - covering 20% of the surface area of the body or 20% of the face or head. • Traumatic brain injury – resulting in permanent symptoms. • Total and Permanent Disability – of specified severity. We’ll cover you for the loss of physical or mental ability, due to an illness or injury, to do either your own occupation or at least three of the six Specified Work Tasks (see section headed Specified Work Tasks). The definition that applies to you will be shown in the Policy Booklet and will depend on your occupation, employment status and whether you are paid for your work. Total and Permanent Disability will end when the oldest person covered reaches the policy end date, or 70th birthday, whichever is earlier. SPECIFIED WORK TASKS Walking – The ability to walk more than 200 metres on a level surface. Climbing – The ability to climb up a flight of 12 stairs and down again, using the handrail if needed. Lifting – The ability to pick up an object weighing 2kg at table height and hold for 60 seconds before replacing the object on the table. Bending – The ability to bend or kneel to touch the floor and straighten up again. Getting in and out of a car – The ability to get into a standard saloon car, and out again. Writing – The manual dexterity to write legibly using a pen or pencil, or type using a desktop personal computer keyboard. 9 LIFE INSURANCE AND CRITICAL ILLNESS COVER ADDITIONAL COVER IF CRITICAL ILLNESS COVER IS CHOSEN. • Carcinoma in situ of the breast - treated by surgery. • Low grade prostate cancer - requiring treatment. WHAT IS COVERED? Unless specifically excluded in the Policy Booklet under the heading ‘What you are not covered for’: We’ll pay out 25% of your amount of cover up to a maximum of £25,000. Your amount of cover and premiums will not be affected if we make an additional payment to you and we’ll still pay out the amount you are covered for under the main policy in case of a terminal illness or critical illness or death. We’ll only pay out once for each definition shown above. If joint life cover is chosen both lives insured will be able to claim. WHAT IS NOT COVERED? Please check the full definitions found in the Guide to Critical Illness Cover and Policy Booklet to make sure you understand exactly what is not covered. T X 10 LIFE INSURANCE AND CRITICAL ILLNESS COVER EXTRA BENEFITS INCLUDED IF CRITICAL ILLNESS COVER IS CHOSEN. ACCIDENT HOSPITALISATION BENEFIT WHAT IS COVERED? We’ll pay £5,000 if you are in hospital with physical injuries for a minimum of 28 consecutive days, immediately following an accident. WHAT IS NOT COVERED? This benefit will not be payable if a valid claim has been made for Critical Illness Cover. We’ll only pay one claim for each person covered T X 11 LIFE INSURANCE AND CRITICAL ILLNESS COVER CHILDREN'S CRITICAL ILLNESS COVER WHAT IS COVERED? We’ll cover a relevant child* or any children you have in the future if, before the end of your policy, they’re diagnosed with one of the critical illnesses we cover, including Additional Cover (except for Total and Permanent Disability). They are covered from when they’re 30 days old to their 18th birthday (or 21st birthday if they’re in full time education). We’ll pay out 50% of your original amount of cover up to a maximum of £25,000 for a valid claim. Your amount of cover and premiums will not be affected if we make an additional payment to you. We’ll pay out one claim per relevant child* under the policy. Once two claims in total have been made, children’s cover will end. If the same relevant child* is covered by more than one policy issued by us, we’ll pay out a maximum of £50,000 for that relevant child*. WHAT IS NOT COVERED? Your children will not be covered: • For Total and Permanent Disability. • For Terminal Illness Cover. • For any condition that was present at birth. • Where the symptoms arose before the relevant child* was covered. • If death occurs within 14 days of diagnosis of one of the critical illnesses we cover. T X 12 LIFE INSURANCE AND CRITICAL ILLNESS COVER ADDITIONAL BENEFITS INCLUDED FOR CHILDREN'S CRITICAL ILLNESS COVER Your amount of cover and premiums will not be affected if we make an additional benefit payment to you. For further details, please read your Policy Booklet. Child Accident Hospitalisation Benefit - pays £5,000 if a relevant child* is admitted to hospital with physical injuries for a minimum of 28 consecutive days immediately following an accident. Child Funeral Benefit - contributes £4,000 towards the funeral of a relevant child*. Childcare Benefit - if we have paid a claim for a critical illness under this policy, and you have a natural child, legally adopted child or stepchild under 5 years old, we’ll pay up to £1,000 towards childcare with a registered childminder. Family Accommodation Benefit - pays £100 for every night a relevant child* spends in hospital, in the three months immediately following diagnosis of one of the critical illnesses covered (up to a maximum of £1,000). *Relevant child - a natural child, legally adopted child or stepchild of the person covered, who is at least 30 days old and younger than 18 (21 years old if in full-time education). 13 LIFE INSURANCE AND CRITICAL ILLNESS COVER FURTHER INFORMATION. CAN I INCREASE MY COVER? You can apply to increase your cover at anytime. Usually, changes to your amount of cover will be assessed at the time. However, if the ‘Changing your policy’ section is shown in your Policy Booklet then you can increase your cover, for certain life events, without the need to provide us with further medical information. Please see your Policy Booklet for further information. Eligibility criteria apply. CAN I MAKE CHANGES? You can make changes to the policy. Please talk to us and we’ll consider your request and let you know if what you’re asking for is possible and what your new premium will be. If you make any changes to the policy then a new policy may be set up and different terms and conditions could apply. WHAT HAPPENS IF I MOVE ABROAD? If you move abroad during the length of the policy, please check the Policy Booklet, as your policy may be affected. ARE PAY OUTS TAXED? For life insurance Any pay outs we make should be free from UK Income Tax and Capital Gains Tax. The Government may change this tax position at any time. If the policy is written under a suitable trust, the amount of cover payable on death should not form part of the estate for Inheritance Tax purposes. If the policy is not written in trust, the amount of cover payable will normally go into the estate and Inheritance Tax may apply. For critical illness cover Any pay outs that we make should be free from UK Income Tax and Capital Gains Tax. The Government may change this tax position at any time. If you are diagnosed with or undergo a medical procedure for one of the specified critical illnesses we cover and you survive 10 days from diagnosis then the policy may pay out after you die in which case the amount of cover will be payable to your estate and may be subject to Inheritance Tax. If the policy is absolutely assigned, the amount of cover payable should not form part of the estate for Inheritance Tax purposes. The policy cannot be issued or assigned into a trust. 14 LIFE INSURANCE AND CRITICAL ILLNESS COVER WHAT IF I WANT TO CANCEL OR CLAIM? You can cancel the policy at any time. When you first take out the policy you will have the opportunity to cancel. If you cancel within 30 days, we’ll refund any premiums you’ve paid. If you cancel the policy at a later stage, you will not get any money back if you pay your premiums monthly. If you pay annually you will receive a proportionate refund of your annual premium. To cancel or claim you can write to us at: Claims or Cancellations Department, Legal & General Assurance Society Limited, City Park, The Droveway, Hove, East Sussex BN3 7PY. Or call or email us: • For Life claims: 0800 137 101* life.claims@landg.com • For critical illness claims: 0800 068 0789* health.claims@landg.com • For Cancellations: 0370 010 4080* HOW DO I COMPLAIN? If you have a complaint about our service or would like a copy of our internal complaint handling procedure, please contact us at: Legal & General Assurance Society Limited, Four Central Square, Cardiff CF10 1FS 0370 010 4080* Making a complaint doesn’t affect your legal rights. If you’re not happy with the way we handle your complaint, you can talk to the Financial Ombudsman Service at: Exchange Tower, London E14 9SR 0800 023 4567 0300 123 9123 complaint.info@financial-ombudsman.org.uk www.financial-ombudsman.org.uk * Calls may be recorded and monitored. Call charges may vary. 15 LIFE INSURANCE AND CRITICAL ILLNESS COVER M www.legalandgeneral.com Legal & General Assurance Society Limited Registered in England and Wales No. 00166055 Registered office: One Coleman Street, London EC2R5AA We are authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. 02/2024 QGI16569 THE FINANCIAL SERVICES COMPENSATION SCHEME (FSCS) We are covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if we cannot meet our obligations. Whether or not you are able to claim and how much you may be entitled to will depend on the specific circumstances at the time. For further information about the scheme please contact the FSCS at: www.fscs.org.uk or call them on: 0800 678 1100. Alternative formats If you would like a copy of this in large print, braille, PDF or in an audio format, call us on 0370 010 4080. We may record and monitor calls. Call charges will vary.","Model must only respond using information contained in the context block. Model should not rely on its own knowledge or outside sources of information when responding. In which situations will the Accidental Death Policy not pay out? LIFE INSURANCE AND CRITICAL ILLNESS COVER POLICY SUMMARY. This policy is provided by Legal & General Assurance Society Limited. OVERVIEW. These policies are designed for people who want to help protect against the impact of death or terminal illness or critical illness. The policy could be used to help pay your outstanding mortgage or to help protect your family’s lifestyle and everyday living expenses. This Policy Summary is only a brief guide to the cover and exclusions. You will find full details in the Policy Booklet which will form the basis of our contract with you. WHAT IS COVERED? Life insurance You will be covered if before the end of the policy: • you die. • you are diagnosed as being terminally ill, and in the opinion of your hospital consultant and our medical officer, the illness is expected to lead to death within 12 months. We’ll pay out your amount of cover once. After this happens, the policy will end and you’ll no longer have any cover. Critical illness cover If you choose to add critical illness cover alongside your life insurance as a separate policy, (also referred to as additional or independent critical illness cover) you will be covered if before the end of the policy: • You are diagnosed with or undergo a medical procedure for one of the critical illnesses we cover and you survive for 14 days from diagnosis. We’ll pay out your amount of cover in full once. After this happens, the policy will end and you’ll no longer have any cover. T 2 LIFE INSURANCE AND CRITICAL ILLNESS COVER XWHAT IS NOT COVERED? You are not covered if you don’t give us full and honest answers to the questions we ask you before the policy starts. Please don’t assume that we’ll contact your doctor to find out your full medical details. Life insurance We won’t pay out: • If within the first year of the policy, your death is caused by suicide or, intentional and serious self-injury or an event where, in our reasonable opinion, you took your own life. • If some elements of cover are restricted based on the information you give us. If we do this we’ll tell you what we’ve excluded in your policy booklet under ‘What you are not covered for’. • The amount of cover more than once if a joint life policy is chosen. This may be when the first person dies or has a valid claim. We have a replacement cover option which could allow the other person covered to take out a new single life policy, ensuring they still have some protection in place. • If you are diagnosed with a terminal illness which doesn’t meet our definition. Terminal Illness cover can’t be claimed: • after your death • or if the length of the policy is less than two years. Critical illness cover We won’t pay out: • If you are diagnosed with or undergo a medical procedure for one of the critical illnesses we cover which doesn’t meet our definition. • If death occurs within 14 days of diagnosis of one of the critical illnesses we cover. • If you die. • If some elements of cover are restricted based on the information you give us. If we do this we’ll tell you what we’ve excluded in your policy booklet under ‘What you are not covered for’. • The amount of cover more than once if a joint life policy is chosen. This will be when the first person has a valid claim. We have a replacement cover option which could allow the other person covered to take out a new single life policy, ensuring they still have some protection in place. For all policies • Life cover policies have no cash value and we will not pay out if you reach the end of the policy without making a valid claim. • If you stop paying your premiums your cover will end 60 days after the first missed premium. 3 LIFE INSURANCE AND CRITICAL ILLNESS COVER ABOUT THE POLICY. YOUR PREMIUMS Your premiums will remain the same during the length of the policy unless you make any changes. AGE LIMITS Product Maximum age for buying a policy Minimum length of the policy Maximum length of the policy Your policy must end before age Life Insurance* 77 1 year 50 years 90 Decreasing Life Insurance* 74 5 years 50 years 90 Critical Illness Cover* 67 2 years 50 years 75 The minimum age to take out a policy is 18. The policy must not end before your 29th birthday. *Guaranteed premiums 4 LIFE INSURANCE AND CRITICAL ILLNESS COVER YOUR COVER Level cover If you choose level cover, your amount of cover will stay the same unless you change it. If the policy is to help repay a mortgage, you need to ensure that your amount of cover matches your outstanding mortgage. The policy may not completely pay off your outstanding mortgage, if you change the mortgage you have in any way and you don’t adjust your cover to match your new arrangements. Decreasing cover If you choose decreasing cover it is often used to help protect a repayment mortgage. Therefore the amount of cover reduces roughly in line with the way a repayment mortgage decreases. You need to ensure that your amount of cover matches your outstanding mortgage. The policy may not completely pay off your outstanding mortgage, if: • you change the mortgage you have in any way and you don’t adjust your cover to match your new arrangements. • the interest rate on your mortgage becomes higher than the rate applied to the policy. The rate will be shown in your Personal Quote or the Policy Booklet. 5 LIFE INSURANCE AND CRITICAL ILLNESS COVER BENEFITS FOR LIFE INSURANCE. The following benefit(s) may have eligibility criteria and restrictions that apply. ACCIDENTAL DEATH BENEFIT Included at no extra cost. WHAT IS COVERED? We’ll cover you from when we receive your application, for up to 90 days or until we accept, postpone or decline your application. This means that if you die due to an accident during this time, we’ll pay out the amount you’ve asked to be insured for, up to a maximum of £300,000 for all applications. The benefit will be paid out if the person covered, or one of the persons covered, sustains a bodily injury caused by accidental, violent, external and visible means, which solely and independently of any other cause results in death within 90 days of the accident. WHAT IS NOT COVERED? We won’t pay out if death occurs from: • Suicide, intentional and serious self-injury or an event where, in our reasonable opinion, you took your own life. • Taking part or attempting to take part in a dangerous sport or pastime. • Taking part or attempting to take part in any aerial flight other than as a fare paying passenger on a licensed airline. • Committing, attempting or provoking an assault or criminal offence. • War (whether declared or not), riot or civil commotion. • Taking alcohol or drugs (unless these drugs were prescribed by a registered doctor in the United Kingdom). • Accidents that happened before you applied. We don’t provide this benefit: • If we have been told that the application is to replace an existing policy with us while cover is still provided under the existing policy. • From the date you tell us that you no longer want the application to proceed. Your lump sum will be paid only once either under the Accidental Death Benefit, Free Life Cover or the policy itself. T X 6 LIFE INSURANCE AND CRITICAL ILLNESS COVER FREE LIFE COVER Included at no extra cost if you are moving home. WHAT IS COVERED? We’ll cover you if you die between exchange of contracts and completion of your property purchase up to a maximum of 90 days, provided you are accepted on standard terms and we have everything we need to start your policy. Your Free Life Cover will end as soon as the policy starts. You’ll be covered for the lower of your proposed amount of cover or the amount of your mortgage, up to a maximum of £300,000. If you live in Scotland, you’ll be covered between completion of missives and your date of entry. WHAT IS NOT COVERED? You won’t be accepted for Free Life Cover if you are 55 years old or over. For joint life policies you both need to be under this age for Free Life Cover to apply. We won’t provide cover if you have another policy with any provider covering the same mortgage. Your amount of cover will be paid only once either under Free Life Cover, Accidental Death Benefit or the policy itself. T X 7 LIFE INSURANCE AND CRITICAL ILLNESS COVER CRITICAL ILLNESSES COVERED. If you choose Critical Illness Cover, you will be covered for the illnesses shown below. For a claim to pay out, your illness must meet Legal & General’s definition. It must also be verified by a consultant at a hospital in the UK, who is a specialist in an area of medicine appropriate to the cause of your claim as in some instances cover may be limited. For example: • some types of cancer are not covered • to make a claim for some illnesses, you need to have permanent symptoms. Please check the full definitions found in the Guide to Critical Illness Cover and Policy Booklet to make sure that you understand exactly what is covered. • Aorta graft surgery - requiring surgical replacement. • Aplastic anaemia - with permanent bone marrow failure. • Bacterial meningitis - resulting in permanent symptoms • Benign brain tumour - resulting in either surgical removal or permanent symptoms. • Blindness - permanent and irreversible. • Cancer - excluding less advanced cases. • Cardiac arrest - with insertion of a defibrillator. • Cardiomyopathy - of specified severity. • Coma - with associated permanent symptoms. • Coronary artery by-pass grafts – with surgery to divide the breastbone or thoracotomy. • Creutzfeldt-Jakob disease (CJD) – resulting in permanent symptoms. • Deafness - permanent and irreversible. • Dementia including Alzheimer’s disease - of specified severity. • Encephalitis - resulting in permanent symptoms. • Heart attack - of specified severity. • Heart valve replacement or repair - with surgery. • Kidney failure - requiring permanent dialysis. • Liver failure - of advanced stage. • Loss of hand or foot – permanent physical severance. • Loss of speech - total permanent and irreversible. • Major organ transplant – from another donor. • Motor neurone disease - resulting in permanent symptoms. • Multiple sclerosis - where there have been symptoms. • Multiple system atrophy – resulting in permanent symptoms. 8 LIFE INSURANCE AND CRITICAL ILLNESS COVER • Open heart surgery – with median sternotomy. • Paralysis of limb – total and irreversible. • Parkinson’s disease - resulting in permanent symptoms. • Primary pulmonary hypertension - of specified severity. • Progressive supranuclear palsy – resulting in permanent symptoms. • Removal of an eyeball – due to injury or disease. • Respiratory failure - of advanced stage. • Spinal stroke - resulting in symptoms lasting at least 24 hours. • Stroke - resulting in symptoms lasting at least 24 hours. • Systemic lupus erythematosus - with severe complications. • Third degree burns - covering 20% of the surface area of the body or 20% of the face or head. • Traumatic brain injury – resulting in permanent symptoms. • Total and Permanent Disability – of specified severity. We’ll cover you for the loss of physical or mental ability, due to an illness or injury, to do either your own occupation or at least three of the six Specified Work Tasks (see section headed Specified Work Tasks). The definition that applies to you will be shown in the Policy Booklet and will depend on your occupation, employment status and whether you are paid for your work. Total and Permanent Disability will end when the oldest person covered reaches the policy end date, or 70th birthday, whichever is earlier. SPECIFIED WORK TASKS Walking – The ability to walk more than 200 metres on a level surface. Climbing – The ability to climb up a flight of 12 stairs and down again, using the handrail if needed. Lifting – The ability to pick up an object weighing 2kg at table height and hold for 60 seconds before replacing the object on the table. Bending – The ability to bend or kneel to touch the floor and straighten up again. Getting in and out of a car – The ability to get into a standard saloon car, and out again. Writing – The manual dexterity to write legibly using a pen or pencil, or type using a desktop personal computer keyboard. 9 LIFE INSURANCE AND CRITICAL ILLNESS COVER ADDITIONAL COVER IF CRITICAL ILLNESS COVER IS CHOSEN. • Carcinoma in situ of the breast - treated by surgery. • Low grade prostate cancer - requiring treatment. WHAT IS COVERED? Unless specifically excluded in the Policy Booklet under the heading ‘What you are not covered for’: We’ll pay out 25% of your amount of cover up to a maximum of £25,000. Your amount of cover and premiums will not be affected if we make an additional payment to you and we’ll still pay out the amount you are covered for under the main policy in case of a terminal illness or critical illness or death. We’ll only pay out once for each definition shown above. If joint life cover is chosen both lives insured will be able to claim. WHAT IS NOT COVERED? Please check the full definitions found in the Guide to Critical Illness Cover and Policy Booklet to make sure you understand exactly what is not covered. T X 10 LIFE INSURANCE AND CRITICAL ILLNESS COVER EXTRA BENEFITS INCLUDED IF CRITICAL ILLNESS COVER IS CHOSEN. ACCIDENT HOSPITALISATION BENEFIT WHAT IS COVERED? We’ll pay £5,000 if you are in hospital with physical injuries for a minimum of 28 consecutive days, immediately following an accident. WHAT IS NOT COVERED? This benefit will not be payable if a valid claim has been made for Critical Illness Cover. We’ll only pay one claim for each person covered T X 11 LIFE INSURANCE AND CRITICAL ILLNESS COVER CHILDREN'S CRITICAL ILLNESS COVER WHAT IS COVERED? We’ll cover a relevant child* or any children you have in the future if, before the end of your policy, they’re diagnosed with one of the critical illnesses we cover, including Additional Cover (except for Total and Permanent Disability). They are covered from when they’re 30 days old to their 18th birthday (or 21st birthday if they’re in full time education). We’ll pay out 50% of your original amount of cover up to a maximum of £25,000 for a valid claim. Your amount of cover and premiums will not be affected if we make an additional payment to you. We’ll pay out one claim per relevant child* under the policy. Once two claims in total have been made, children’s cover will end. If the same relevant child* is covered by more than one policy issued by us, we’ll pay out a maximum of £50,000 for that relevant child*. WHAT IS NOT COVERED? Your children will not be covered: • For Total and Permanent Disability. • For Terminal Illness Cover. • For any condition that was present at birth. • Where the symptoms arose before the relevant child* was covered. • If death occurs within 14 days of diagnosis of one of the critical illnesses we cover. T X 12 LIFE INSURANCE AND CRITICAL ILLNESS COVER ADDITIONAL BENEFITS INCLUDED FOR CHILDREN'S CRITICAL ILLNESS COVER Your amount of cover and premiums will not be affected if we make an additional benefit payment to you. For further details, please read your Policy Booklet. Child Accident Hospitalisation Benefit - pays £5,000 if a relevant child* is admitted to hospital with physical injuries for a minimum of 28 consecutive days immediately following an accident. Child Funeral Benefit - contributes £4,000 towards the funeral of a relevant child*. Childcare Benefit - if we have paid a claim for a critical illness under this policy, and you have a natural child, legally adopted child or stepchild under 5 years old, we’ll pay up to £1,000 towards childcare with a registered childminder. Family Accommodation Benefit - pays £100 for every night a relevant child* spends in hospital, in the three months immediately following diagnosis of one of the critical illnesses covered (up to a maximum of £1,000). *Relevant child - a natural child, legally adopted child or stepchild of the person covered, who is at least 30 days old and younger than 18 (21 years old if in full-time education). 13 LIFE INSURANCE AND CRITICAL ILLNESS COVER FURTHER INFORMATION. CAN I INCREASE MY COVER? You can apply to increase your cover at anytime. Usually, changes to your amount of cover will be assessed at the time. However, if the ‘Changing your policy’ section is shown in your Policy Booklet then you can increase your cover, for certain life events, without the need to provide us with further medical information. Please see your Policy Booklet for further information. Eligibility criteria apply. CAN I MAKE CHANGES? You can make changes to the policy. Please talk to us and we’ll consider your request and let you know if what you’re asking for is possible and what your new premium will be. If you make any changes to the policy then a new policy may be set up and different terms and conditions could apply. WHAT HAPPENS IF I MOVE ABROAD? If you move abroad during the length of the policy, please check the Policy Booklet, as your policy may be affected. ARE PAY OUTS TAXED? For life insurance Any pay outs we make should be free from UK Income Tax and Capital Gains Tax. The Government may change this tax position at any time. If the policy is written under a suitable trust, the amount of cover payable on death should not form part of the estate for Inheritance Tax purposes. If the policy is not written in trust, the amount of cover payable will normally go into the estate and Inheritance Tax may apply. For critical illness cover Any pay outs that we make should be free from UK Income Tax and Capital Gains Tax. The Government may change this tax position at any time. If you are diagnosed with or undergo a medical procedure for one of the specified critical illnesses we cover and you survive 10 days from diagnosis then the policy may pay out after you die in which case the amount of cover will be payable to your estate and may be subject to Inheritance Tax. If the policy is absolutely assigned, the amount of cover payable should not form part of the estate for Inheritance Tax purposes. The policy cannot be issued or assigned into a trust. 14 LIFE INSURANCE AND CRITICAL ILLNESS COVER WHAT IF I WANT TO CANCEL OR CLAIM? You can cancel the policy at any time. When you first take out the policy you will have the opportunity to cancel. If you cancel within 30 days, we’ll refund any premiums you’ve paid. If you cancel the policy at a later stage, you will not get any money back if you pay your premiums monthly. If you pay annually you will receive a proportionate refund of your annual premium. To cancel or claim you can write to us at: Claims or Cancellations Department, Legal & General Assurance Society Limited, City Park, The Droveway, Hove, East Sussex BN3 7PY. Or call or email us: • For Life claims: 0800 137 101* life.claims@landg.com • For critical illness claims: 0800 068 0789* health.claims@landg.com • For Cancellations: 0370 010 4080* HOW DO I COMPLAIN? If you have a complaint about our service or would like a copy of our internal complaint handling procedure, please contact us at: Legal & General Assurance Society Limited, Four Central Square, Cardiff CF10 1FS 0370 010 4080* Making a complaint doesn’t affect your legal rights. If you’re not happy with the way we handle your complaint, you can talk to the Financial Ombudsman Service at: Exchange Tower, London E14 9SR 0800 023 4567 0300 123 9123 complaint.info@financial-ombudsman.org.uk www.financial-ombudsman.org.uk * Calls may be recorded and monitored. Call charges may vary. 15 LIFE INSURANCE AND CRITICAL ILLNESS COVER M www.legalandgeneral.com Legal & General Assurance Society Limited Registered in England and Wales No. 00166055 Registered office: One Coleman Street, London EC2R5AA We are authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. 02/2024 QGI16569 THE FINANCIAL SERVICES COMPENSATION SCHEME (FSCS) We are covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if we cannot meet our obligations. Whether or not you are able to claim and how much you may be entitled to will depend on the specific circumstances at the time. For further information about the scheme please contact the FSCS at: www.fscs.org.uk or call them on: 0800 678 1100. Alternative formats If you would like a copy of this in large print, braille, PDF or in an audio format, call us on 0370 010 4080. We may record and monitor calls. Call charges will vary.",Financial,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","I was reading this article about Coca-cola's earnings in Q4 2022, but I need a summary. Did the earnings per share performance have an impact on the data mentioned regarding cash flow? Please explain why or why not, and make it 300-350 words","ATLANTA, Feb. 14, 2023 – The Coca-Cola Company today reported strong fourth quarter and full-year 2022 results. “While 2022 brought many challenges, we are proud of our overall results in a dynamic operating environment,” said James Quincey, Chairman and CEO of The Coca-Cola Company. “As we begin 2023, we continue to invest in our capabilities and strengthen alignment with our bottling partners to maintain flexibility. We are keeping consumers at the center of our innovation and marketing investments, while also leveraging our expertise in revenue growth management and execution. Our growth culture is leading to new approaches, more experimentation, and improved agility to drive growth and value for our stakeholders.” Highlights Quarterly / Full-Year Performance • Revenues: For the quarter, net revenues were strong, growing 7% to $10.1 billion. Organic revenues (non-GAAP) grew 15%. Organic revenue (non-GAAP) performance was strong across operating segments and included 12% growth in price/mix and 2% growth in concentrate sales. The quarter included one additional day, which resulted in a 1-point tailwind to revenue growth. The quarter also benefited from the timing of concentrate shipments. For the full year, net revenues grew 11% to $43.0 billion, and organic revenues (non-GAAP) grew 16%. This performance was driven by 11% growth in price/mix and 5% growth in concentrate sales. • Operating margin: For the quarter, operating margin, which included items impacting comparability, was 20.5% versus 17.7% in the prior year, while comparable operating margin (non-GAAP) was 22.7% versus 22.1% in the 1 prior year. For the full year, operating margin, which included items impacting comparability, was 25.4% versus 26.7% in the prior year, while comparable operating margin (non-GAAP) was 28.7% in both the current year and the prior year. For both the quarter and the full year, operating margin benefited from strong topline growth but was unfavorably impacted by the BODYARMOR acquisition, higher operating costs, an increase in marketing investments versus the prior year, currency headwinds and items impacting comparability. • Earnings per share: For the quarter, EPS declined 16% to $0.47, and comparable EPS (non-GAAP) was even at $0.45. EPS performance included the impact of a 12-point currency headwind, while comparable EPS (non-GAAP) performance included the impact of an 11-point currency headwind. For the full year, EPS declined 3% to $2.19, and comparable EPS (non-GAAP) grew 7% to $2.48. EPS performance included the impact of an 11-point currency headwind, while comparable EPS (non-GAAP) performance included the impact of a 10-point currency headwind. • Market share: For both the quarter and the full year, the company gained value share in total nonalcoholic readyto-drink (“NARTD”) beverages, which included share gains in both at-home and away-from-home channels. • Cash flow: Cash flow from operations was $11.0 billion for the full year, a decline of $1.6 billion versus the prior year, as strong business performance was more than offset by the deliberate buildup of inventory in the face of a volatile commodity environment, cycling working capital benefits from the prior year, and higher tax payments and annual incentive payments in 2022. Free cash flow (non-GAAP) was $9.5 billion, a decline of $1.7 billion versus the prior year. Company Updates • Evolving company leadership to fuel growth: The company continues to focus on having the right leaders and organizational structure to deliver on its growth strategy, while also developing talent for the future. Through recent leadership appointments, the company continued to optimize its organizational design, connecting functions endto-end while identifying key opportunities to drive meaningful growth over the long term. During the quarter, John Murphy began an expanded role as President and Chief Financial Officer, and added oversight of Global Ventures, Bottling Investments, Platform Services, customer and commercial leadership, and online-to-offline digital transformation. The company also named Henrique Braun to the newly created role of President, International Development to oversee seven of the company’s nine operating units. Braun will steward growth of the consumer base across developing and emerging markets as well as developed markets. Braun will partner with Nikos Koumettis, President of the Europe operating unit, and Jennifer Mann, President of the North America operating unit, on global operational strategy in order to scale best practices and help ensure the company captures growth opportunities across all of its markets.","[question] I was reading this article about Coca-cola's earnings in Q4 2022, but I need a summary. Did the earnings per share performance have an impact on the data mentioned regarding cash flow? Please explain why or why not, and make it 300-350 words ===================== [text] ATLANTA, Feb. 14, 2023 – The Coca-Cola Company today reported strong fourth quarter and full-year 2022 results. “While 2022 brought many challenges, we are proud of our overall results in a dynamic operating environment,” said James Quincey, Chairman and CEO of The Coca-Cola Company. “As we begin 2023, we continue to invest in our capabilities and strengthen alignment with our bottling partners to maintain flexibility. We are keeping consumers at the center of our innovation and marketing investments, while also leveraging our expertise in revenue growth management and execution. Our growth culture is leading to new approaches, more experimentation, and improved agility to drive growth and value for our stakeholders.” Highlights Quarterly / Full-Year Performance • Revenues: For the quarter, net revenues were strong, growing 7% to $10.1 billion. Organic revenues (non-GAAP) grew 15%. Organic revenue (non-GAAP) performance was strong across operating segments and included 12% growth in price/mix and 2% growth in concentrate sales. The quarter included one additional day, which resulted in a 1-point tailwind to revenue growth. The quarter also benefited from the timing of concentrate shipments. For the full year, net revenues grew 11% to $43.0 billion, and organic revenues (non-GAAP) grew 16%. This performance was driven by 11% growth in price/mix and 5% growth in concentrate sales. • Operating margin: For the quarter, operating margin, which included items impacting comparability, was 20.5% versus 17.7% in the prior year, while comparable operating margin (non-GAAP) was 22.7% versus 22.1% in the 1 prior year. For the full year, operating margin, which included items impacting comparability, was 25.4% versus 26.7% in the prior year, while comparable operating margin (non-GAAP) was 28.7% in both the current year and the prior year. For both the quarter and the full year, operating margin benefited from strong topline growth but was unfavorably impacted by the BODYARMOR acquisition, higher operating costs, an increase in marketing investments versus the prior year, currency headwinds and items impacting comparability. • Earnings per share: For the quarter, EPS declined 16% to $0.47, and comparable EPS (non-GAAP) was even at $0.45. EPS performance included the impact of a 12-point currency headwind, while comparable EPS (non-GAAP) performance included the impact of an 11-point currency headwind. For the full year, EPS declined 3% to $2.19, and comparable EPS (non-GAAP) grew 7% to $2.48. EPS performance included the impact of an 11-point currency headwind, while comparable EPS (non-GAAP) performance included the impact of a 10-point currency headwind. • Market share: For both the quarter and the full year, the company gained value share in total nonalcoholic readyto-drink (“NARTD”) beverages, which included share gains in both at-home and away-from-home channels. • Cash flow: Cash flow from operations was $11.0 billion for the full year, a decline of $1.6 billion versus the prior year, as strong business performance was more than offset by the deliberate buildup of inventory in the face of a volatile commodity environment, cycling working capital benefits from the prior year, and higher tax payments and annual incentive payments in 2022. Free cash flow (non-GAAP) was $9.5 billion, a decline of $1.7 billion versus the prior year. Company Updates • Evolving company leadership to fuel growth: The company continues to focus on having the right leaders and organizational structure to deliver on its growth strategy, while also developing talent for the future. Through recent leadership appointments, the company continued to optimize its organizational design, connecting functions endto-end while identifying key opportunities to drive meaningful growth over the long term. During the quarter, John Murphy began an expanded role as President and Chief Financial Officer, and added oversight of Global Ventures, Bottling Investments, Platform Services, customer and commercial leadership, and online-to-offline digital transformation. The company also named Henrique Braun to the newly created role of President, International Development to oversee seven of the company’s nine operating units. Braun will steward growth of the consumer base across developing and emerging markets as well as developed markets. Braun will partner with Nikos Koumettis, President of the Europe operating unit, and Jennifer Mann, President of the North America operating unit, on global operational strategy in order to scale best practices and help ensure the company captures growth opportunities across all of its markets. https://d1io3yog0oux5.cloudfront.net/_e75f7be04b2b22ee66e5d86d26087f1e/cocacolacompany/db/734/7960/earnings_release/Coca-Cola+fourth+quarter+and+full+year+2022+full+earnings+release-2.14.23+FINAL.pdf ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Find & Summarize,Text Transformation System Instructions: [Only use the provided context to respond. You cannot use any other sources or prior knowledge. Omit all filler.],"Question: [If GM partners with my insurance company, can they give them information about how much I am driving?]","Context: [INFORMATION COLLECTED AND SOURCES OF INFORMATION As you interact with GM or our products, programs, and services, there may be opportunities for you to provide us with your information. Additionally, we may collect certain information about you or your vehicle as further described below. You may provide us with information about you or your vehicle through a number of sources: GM websites, applications, services, product and related events, surveys, social media platforms, sweepstakes entries and through our customer call centers. We may also collect information that is publicly available. For example, we may collect publicly available information you submit to a blog, a chat room, or a social media platform, and we may use your information for the purposes set out in this Privacy Statement. GM engages with consumers on multiple social media platforms and if you contact us on one of our social media pages, request assistance via social media or otherwise direct us to communicate with you via social media, we may contact you via direct message or use other social media tools to interact with you. In these instances, your interactions with us are governed by this Privacy Statement as well as the privacy policy of the social media platform you use. We also receive information about you through vehicle sales records provided by your dealer and we may obtain, with your consent, data obtained from your vehicle’s Event Data Recorder (“EDR”). For additional information about EDR data, please see your owner’s manual. We also may obtain information about you and your vehicle from GM affiliates, dealers, GM licensees for consumer merchandise, GM partners (for example, credit card bank partners) and other sources such as companies that provide lists of potential vehicle purchasers and current owners, if such companies are permitted to share your information with us pursuant to their privacy statements. We may combine information that we receive from the various sources described in this Privacy Statement, including third-party sources, with information you provide and use or share it for the purposes identified below. The types of information that GM collects about you, your vehicle, or your connected devices (such as your mobile phone, computer, or tablet) may include, but are not limited to: 3  identifiers (such as name, postal address, email address, screen name, account ID, customer number, and telephone number; in limited circumstances, GM may collect a Social Security Number, for example if you win a sweepstakes or receive compensation that must be reported for government tax purposes)  payment information (such as your credit card number, CVV code and expiration date)  information about your vehicle (such as license plate number, vehicle identification number (VIN), geolocation data, make, model, model year, selling dealer, servicing dealer, date of purchase or lease, the lease/financing term, service history, mileage, oil/battery status, fuel history, battery charging and discharging history, electrical system function, gear status, and diagnostic trouble codes)  information about your connected devices and how you interact with our products, services, apps and websites (such as IP address, browser type, unique device identifier, cookie data, and associated identifying and usage information)  demographic or protected classification information (such as gender, date of birth, marital status, household composition, or veteran or military status)  commercial information (such as when you plan to purchase or lease the vehicle in which you're interested)  audio or video information (such as information collected by sensors or cameras in the vehicle, recordings of when you speak with our customer call centers, or photographs and videos such as those that you may submit for contests, sweepstakes, and social sharing)  physiological or biological characteristics, such as medical information collected to provide OnStar emergency services that you have requested  biometric information (such as voiceprints, as described in the Biometric Technology Section below)  information about your home energy usage (such as your charging and discharging of electric vehicles and stationary storage, charging preferences, use of home energy products and services, and rate plans)  relationships you have with GM in addition to the purchase and servicing of your vehicle (such as through a My GM Rewards account, a GM Rewards Card or OnStar, etc.)  relationships you have with third parties in connection with your use of GM products and services (such as GM dealers, energy providers, companies offering or operating in-vehicle applications, and other companies we help you connect with)  information related to My GM Rewards and the My GM Rewards Card Program (“GM Card”), including rewards points, account type, tier status, enrollment, redemption  investor and stockholder services information (such as name, address, phone number, email address, and account information) USE The information GM collects about you, your vehicle, or your connected devices may be used:  to provide products and services, programs, and maintain customer relationshipsw  to improve the quality, safety, and security of our products and services 4  to administer your account(s) and process your payments for products and services  to operate our websites and applications, including online registration processes  to facilitate and support GM dealer and supplier diversity programs and GM grant programs  to autofill data fields on our websites to improve your online experience  to develop new products and services, including connected, autonomous and car-sharing products and services  to provide customer and vehicle support and service (such as recall information)  for warranty administration and validation  to provide information and product updates  to evaluate vehicle performance and safety  for research, evaluation of use, and troubleshooting purposes  to verify eligibility for vehicle purchase or incentive programs  to verify eligibility for GM card and to provide GM card account management services  for marketing and analytics purposes  to support the electronic signature and delivery process between you and your dealer  to customize and improve communication content  to evaluate or conduct a merger, divestiture, acquisition, restructuring, reorganization, dissolution, or other sale or transfer of some or all of our assets  to comply with legal, regulatory or contractual requirements  to protect our rights, or to detect, investigate and prevent fraud or other illegal activity Communications with you in connection with these uses may be via mail, telephone, e-mail, text message, social media, and other electronic messages, through the in-vehicle infotainment or OnStar system or via our websites and applications. Texting with GM is subject to the GM Consolidated Texting Policy (“Texting Policy,” available at gm.com/texting-policy). See “Choices” below to learn how to manage your communication preferences. You may choose to forward information from one of our websites or emails to another person through our Forward to a Friend or similar program. Email addresses submitted to our E-card or other Forward to a Friend programs are not used by us for other marketing purposes unless the recipient interacts with us separately. When we maintain and use information that has been deidentified, we take reasonable steps to ensure that such information is maintained and used only in deidentified form, and will not attempt to reidentify such information unless required or permitted by applicable law. SHARING GM may share the information it collects about you, your vehicle, or your connected devices (including the categories of information listed above) in the following instances and with the following categories of third parties:  within GM, with our GM controlled subsidiaries and affiliates, with GM dealers, with service providers we or our dealers use to deliver products and services to you, and with GM licensees. However, transaction information regarding your GM Card will not be shared with GM dealers 5  with our services providers who work on our behalf and who do not have an independent right to use the information to which they have access or that we disclose to them  with companies we enter into business or marketing arrangements with, such as arrangements supporting services we offer to you and our GM card program  with third parties for research and development purposes (such as university research institutes for improving highway safety)  in connection with the sale, transfer or financing of a significant part of a GM business or its assets, including any such activities associated with a bankruptcy proceeding  when we believe in good faith that disclosure is necessary to protect our rights, protect your safety or the safety of others, detect, investigate and prevent fraud or other illegal activity, or respond to a law enforcement request  as required or permitted by law, such as in conjunction with a subpoena, government inquiry, litigation, dispute resolution or similar legal process]","System Instructions: [Only use the provided context to respond. You cannot use any other sources or prior knowledge. Omit all filler.] Question: [If GM partners with my insurance company, can they give them information about how much I am driving?] Context: [INFORMATION COLLECTED AND SOURCES OF INFORMATION As you interact with GM or our products, programs, and services, there may be opportunities for you to provide us with your information. Additionally, we may collect certain information about you or your vehicle as further described below. You may provide us with information about you or your vehicle through a number of sources: GM websites, applications, services, product and related events, surveys, social media platforms, sweepstakes entries and through our customer call centers. We may also collect information that is publicly available. For example, we may collect publicly available information you submit to a blog, a chat room, or a social media platform, and we may use your information for the purposes set out in this Privacy Statement. GM engages with consumers on multiple social media platforms and if you contact us on one of our social media pages, request assistance via social media or otherwise direct us to communicate with you via social media, we may contact you via direct message or use other social media tools to interact with you. In these instances, your interactions with us are governed by this Privacy Statement as well as the privacy policy of the social media platform you use. We also receive information about you through vehicle sales records provided by your dealer and we may obtain, with your consent, data obtained from your vehicle’s Event Data Recorder (“EDR”). For additional information about EDR data, please see your owner’s manual. We also may obtain information about you and your vehicle from GM affiliates, dealers, GM licensees for consumer merchandise, GM partners (for example, credit card bank partners) and other sources such as companies that provide lists of potential vehicle purchasers and current owners, if such companies are permitted to share your information with us pursuant to their privacy statements. We may combine information that we receive from the various sources described in this Privacy Statement, including third-party sources, with information you provide and use or share it for the purposes identified below. The types of information that GM collects about you, your vehicle, or your connected devices (such as your mobile phone, computer, or tablet) may include, but are not limited to: 3  identifiers (such as name, postal address, email address, screen name, account ID, customer number, and telephone number; in limited circumstances, GM may collect a Social Security Number, for example if you win a sweepstakes or receive compensation that must be reported for government tax purposes)  payment information (such as your credit card number, CVV code and expiration date)  information about your vehicle (such as license plate number, vehicle identification number (VIN), geolocation data, make, model, model year, selling dealer, servicing dealer, date of purchase or lease, the lease/financing term, service history, mileage, oil/battery status, fuel history, battery charging and discharging history, electrical system function, gear status, and diagnostic trouble codes)  information about your connected devices and how you interact with our products, services, apps and websites (such as IP address, browser type, unique device identifier, cookie data, and associated identifying and usage information)  demographic or protected classification information (such as gender, date of birth, marital status, household composition, or veteran or military status)  commercial information (such as when you plan to purchase or lease the vehicle in which you're interested)  audio or video information (such as information collected by sensors or cameras in the vehicle, recordings of when you speak with our customer call centers, or photographs and videos such as those that you may submit for contests, sweepstakes, and social sharing)  physiological or biological characteristics, such as medical information collected to provide OnStar emergency services that you have requested  biometric information (such as voiceprints, as described in the Biometric Technology Section below)  information about your home energy usage (such as your charging and discharging of electric vehicles and stationary storage, charging preferences, use of home energy products and services, and rate plans)  relationships you have with GM in addition to the purchase and servicing of your vehicle (such as through a My GM Rewards account, a GM Rewards Card or OnStar, etc.)  relationships you have with third parties in connection with your use of GM products and services (such as GM dealers, energy providers, companies offering or operating in-vehicle applications, and other companies we help you connect with)  information related to My GM Rewards and the My GM Rewards Card Program (“GM Card”), including rewards points, account type, tier status, enrollment, redemption  investor and stockholder services information (such as name, address, phone number, email address, and account information) USE The information GM collects about you, your vehicle, or your connected devices may be used:  to provide products and services, programs, and maintain customer relationshipsw  to improve the quality, safety, and security of our products and services 4  to administer your account(s) and process your payments for products and services  to operate our websites and applications, including online registration processes  to facilitate and support GM dealer and supplier diversity programs and GM grant programs  to autofill data fields on our websites to improve your online experience  to develop new products and services, including connected, autonomous and car-sharing products and services  to provide customer and vehicle support and service (such as recall information)  for warranty administration and validation  to provide information and product updates  to evaluate vehicle performance and safety  for research, evaluation of use, and troubleshooting purposes  to verify eligibility for vehicle purchase or incentive programs  to verify eligibility for GM card and to provide GM card account management services  for marketing and analytics purposes  to support the electronic signature and delivery process between you and your dealer  to customize and improve communication content  to evaluate or conduct a merger, divestiture, acquisition, restructuring, reorganization, dissolution, or other sale or transfer of some or all of our assets  to comply with legal, regulatory or contractual requirements  to protect our rights, or to detect, investigate and prevent fraud or other illegal activity Communications with you in connection with these uses may be via mail, telephone, e-mail, text message, social media, and other electronic messages, through the in-vehicle infotainment or OnStar system or via our websites and applications. Texting with GM is subject to the GM Consolidated Texting Policy (“Texting Policy,” available at gm.com/texting-policy). See “Choices” below to learn how to manage your communication preferences. You may choose to forward information from one of our websites or emails to another person through our Forward to a Friend or similar program. Email addresses submitted to our E-card or other Forward to a Friend programs are not used by us for other marketing purposes unless the recipient interacts with us separately. When we maintain and use information that has been deidentified, we take reasonable steps to ensure that such information is maintained and used only in deidentified form, and will not attempt to reidentify such information unless required or permitted by applicable law. SHARING GM may share the information it collects about you, your vehicle, or your connected devices (including the categories of information listed above) in the following instances and with the following categories of third parties:  within GM, with our GM controlled subsidiaries and affiliates, with GM dealers, with service providers we or our dealers use to deliver products and services to you, and with GM licensees. However, transaction information regarding your GM Card will not be shared with GM dealers 5  with our services providers who work on our behalf and who do not have an independent right to use the information to which they have access or that we disclose to them  with companies we enter into business or marketing arrangements with, such as arrangements supporting services we offer to you and our GM card program  with third parties for research and development purposes (such as university research institutes for improving highway safety)  in connection with the sale, transfer or financing of a significant part of a GM business or its assets, including any such activities associated with a bankruptcy proceeding  when we believe in good faith that disclosure is necessary to protect our rights, protect your safety or the safety of others, detect, investigate and prevent fraud or other illegal activity, or respond to a law enforcement request  as required or permitted by law, such as in conjunction with a subpoena, government inquiry, litigation, dispute resolution or similar legal process]",Legal,Fact Finding,Q&A "Use only the provided context for your response, without relying on external information.","Only using the provided text, in which types of solid tumors does BRAF mutations occur?","**About BRAF Mutations** TESTING FOR BRAF MUTATIONS IN SOLID TUMORS CAN INFORM CRITICAL TREATMENT DECISIONS BRAF V600 has been identified as a driver mutation across various solid tumors BRAF mutations occur in about 8% of solid tumors, most commonly in melanoma and thyroid cancers Indication TAFINLAR, in combination with MEKINIST, is indicated for the treatment of adult and pediatric patients 1 year of age and older with unresectable or metastatic solid tumors with BRAF V600E mutation who have progressed following prior treatment and have no satisfactory alternative treatment options. This indication is approved under accelerated approval based on overall response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials. Limitation of Use: TAFINLAR, in combination with MEKINIST, is not indicated for the treatment of patients with colorectal cancer because of known intrinsic resistance to BRAF inhibition. TAFINLAR is not indicated for the treatment of patients with wild-type BRAF solid tumors. Important Safety Information New Primary Malignancies Cutaneous Malignancies In the pooled adult safety population of TAFINLAR administered with MEKINIST (“the combination”), the incidence of cutaneous squamous cell carcinoma (cuSCC, including keratoacanthomas) occurred in 2% of patients. Basal cell carcinoma and new primary melanoma occurred in 3% and <1% of patients, respectively. In the pooled pediatric safety population of the combination, new primary melanoma occurred in <1% of patients. Perform dermatologic evaluations prior to initiation of the combination, every 2 months while on therapy, and for up to 6 months following discontinuation. Noncutaneous Malignancies Based on its mechanism of action, TAFINLAR may promote the growth and development of malignancies with activation of monomeric G protein (RAS) through mutation or other mechanisms. In the pooled adult safety population of TAFINLAR monotherapy and the combination, noncutaneous malignancies occurred in 1% of patients. Monitor patients receiving the combination for signs or symptoms of noncutaneous malignancies. Permanently discontinue TAFINLAR for RAS-mutation–positive noncutaneous malignancies. No dose modification is required for MEKINIST in patients who develop noncutaneous malignancies. Tumor Promotion in BRAF Wild-type Tumors. In vitro experiments have demonstrated paradoxical activation of mitogen-activated protein kinase (MAPK) signaling and increased cell proliferation in BRAF wild-type cells that are exposed to BRAF inhibitors. Confirm evidence of BRAF V600E or V600K mutation status prior to initiation of therapy. Hemorrhage. Hemorrhage, including major hemorrhage defined as symptomatic bleeding in a critical area or organ, can occur with the combination. Fatal cases have been reported. In the pooled adult safety population of the combination, hemorrhagic events occurred in 17% of patients; gastrointestinal hemorrhage occurred in 3% of patients; intracranial hemorrhage occurred in 0.6% of patients; fatal hemorrhage occurred in 0.5% of patients. The fatal events were cerebral hemorrhage and brainstem hemorrhage. In the pooled pediatric safety population of the combination, hemorrhagic events occurred in 25% of patients; the most common type of bleeding was epistaxis (16%). Serious events of bleeding occurred in 3.6% of patients and included gastrointestinal hemorrhage (1.2%), cerebral hemorrhage (0.6%), uterine hemorrhage (0.6%), postprocedural hemorrhage (0.6%), and epistaxis (0.6%). Permanently discontinue TAFINLAR for all grade 4 hemorrhagic events and for any grade 3 hemorrhagic events that do not improve. Withhold TAFINLAR for grade 3 hemorrhagic events; if improved, resume at the next lower dose level. Permanently discontinue MEKINIST for all grade 4 hemorrhagic events and for any grade 3 hemorrhagic events that do not improve. Withhold MEKINIST for grade 3 hemorrhagic events; if improved, resume at the next lower dose level. Colitis and Gastrointestinal Perforation. Colitis and gastrointestinal perforation, including fatal outcomes, can occur. In the pooled adult safety population of MEKINIST administered with TAFINLAR, colitis occurred in <1% of patients and gastrointestinal perforation occurred in <1% of patients. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, colitis events occurred in <1% of patients. Monitor patients closely for colitis and gastrointestinal perforations. Venous Thromboembolic Events. In the pooled adult safety population of MEKINIST administered with TAFINLAR, deep vein thrombosis (DVT) and pulmonary embolism (PE) occurred in 2% of patients. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, embolism events occurred in <1% of patients. Advise patients to immediately seek medical care if they develop symptoms of DVT or PE, such as shortness of breath, chest pain, or arm or leg swelling. Permanently discontinue MEKINIST for life-threatening PE. Withhold MEKINIST for uncomplicated DVT and PE for up to 3 weeks; if improved, MEKINIST may be resumed at a lower dose. Cardiomyopathy. Cardiomyopathy, including cardiac failure, can occur. In the pooled adult safety population of the combination, cardiomyopathy, defined as a decrease in left ventricular ejection fraction (LVEF) ≥10% from baseline and below the institutional lower limit of normal (LLN), occurred in 6% of patients. Development of cardiomyopathy resulted in dose interruption or discontinuation of TAFINLAR in 3% and <1% of patients, respectively, and in 3% and <1% of patients receiving MEKINIST, respectively. Cardiomyopathy resolved in 45 of 50 patients who received the combination. In the pooled pediatric safety population of the combination, cardiomyopathy, defined as a decrease in LVEF ≥10% from baseline and below the institutional LLN, occurred in 9% of patients. Assess LVEF by echocardiogram or multigated acquisition (MUGA) scan before initiation of the combination, 1 month after initiation, and then at 2- to 3-month intervals while on treatment. Withhold TAFINLAR for symptomatic cardiomyopathy or asymptomatic left ventricular dysfunction of >20% from baseline that is below institutional LLN. Resume TAFINLAR at the same dose level upon recovery of cardiac function to at least the institutional LLN for LVEF and absolute decrease ≤10% compared to baseline. For an asymptomatic absolute decrease in LVEF of 10% or greater from baseline that is below the LLN, withhold MEKINIST for up to 4 weeks. If improved to normal LVEF value, resume at a lower dose. If no improvement to normal LVEF value within 4 weeks, permanently discontinue MEKINIST. For symptomatic cardiomyopathy or an absolute decrease in LVEF of >20% from baseline that is below LLN, permanently discontinue MEKINIST. Ocular Toxicities Retinal Vein Occlusion (RVO): There were no cases of RVO across clinical trials of the combination. RVO may lead to macular edema, decreased visual function, neovascularization, and glaucoma. Urgently (within 24 hours) perform ophthalmologic evaluation for patient-reported loss of vision or other visual disturbances. Permanently discontinue MEKINIST in patients with documented RVO. Retinal Pigment Epithelial Detachment (RPED): RPED can occur. Retinal detachments may be bilateral and multifocal, occurring in the central macular region of the retina or elsewhere in the retina. In clinical trials, routine monitoring of patients to detect asymptomatic RPED was not conducted; therefore, the true incidence of this finding is unknown. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, RPED events occurred in <1% of patients. Perform ophthalmologic evaluation periodically, and at any time a patient reports visual disturbances. Withhold MEKINIST if RPED is diagnosed. If resolution of the RPED is documented on repeat ophthalmologic evaluation within 3 weeks, resume MEKINIST at the same or a reduced dose. If no improvement after 3 weeks, resume at a reduced dose or permanently discontinue MEKINIST. Uveitis: In the pooled adult safety population of the combination, uveitis occurred in 2% of patients. In the pooled pediatric safety population of the combination, uveitis occurred in 1.2% of patients. Treatment employed in clinical trials included steroid and mydriatic ophthalmic drops. Monitor patients for visual signs and symptoms of uveitis (eg, change in vision, photophobia, and eye pain). If iritis is diagnosed, administer ocular therapy and continue TAFINLAR without dose modification. If severe uveitis (ie, iridocyclitis) or if mild or moderate uveitis does not respond to ocular therapy, withhold TAFINLAR and treat as clinically indicated. Resume TAFINLAR at the same or lower dose if uveitis improves to grade 0 or 1. Permanently discontinue TAFINLAR for persistent grade 2 or greater uveitis of >6 weeks.","{Article} ========== **About BRAF Mutations** TESTING FOR BRAF MUTATIONS IN SOLID TUMORS CAN INFORM CRITICAL TREATMENT DECISIONS BRAF V600 has been identified as a driver mutation across various solid tumors BRAF mutations occur in about 8% of solid tumors, most commonly in melanoma and thyroid cancers Indication TAFINLAR, in combination with MEKINIST, is indicated for the treatment of adult and pediatric patients 1 year of age and older with unresectable or metastatic solid tumors with BRAF V600E mutation who have progressed following prior treatment and have no satisfactory alternative treatment options. This indication is approved under accelerated approval based on overall response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials. Limitation of Use: TAFINLAR, in combination with MEKINIST, is not indicated for the treatment of patients with colorectal cancer because of known intrinsic resistance to BRAF inhibition. TAFINLAR is not indicated for the treatment of patients with wild-type BRAF solid tumors. Important Safety Information New Primary Malignancies Cutaneous Malignancies In the pooled adult safety population of TAFINLAR administered with MEKINIST (“the combination”), the incidence of cutaneous squamous cell carcinoma (cuSCC, including keratoacanthomas) occurred in 2% of patients. Basal cell carcinoma and new primary melanoma occurred in 3% and <1% of patients, respectively. In the pooled pediatric safety population of the combination, new primary melanoma occurred in <1% of patients. Perform dermatologic evaluations prior to initiation of the combination, every 2 months while on therapy, and for up to 6 months following discontinuation. Noncutaneous Malignancies Based on its mechanism of action, TAFINLAR may promote the growth and development of malignancies with activation of monomeric G protein (RAS) through mutation or other mechanisms. In the pooled adult safety population of TAFINLAR monotherapy and the combination, noncutaneous malignancies occurred in 1% of patients. Monitor patients receiving the combination for signs or symptoms of noncutaneous malignancies. Permanently discontinue TAFINLAR for RAS-mutation–positive noncutaneous malignancies. No dose modification is required for MEKINIST in patients who develop noncutaneous malignancies. Tumor Promotion in BRAF Wild-type Tumors. In vitro experiments have demonstrated paradoxical activation of mitogen-activated protein kinase (MAPK) signaling and increased cell proliferation in BRAF wild-type cells that are exposed to BRAF inhibitors. Confirm evidence of BRAF V600E or V600K mutation status prior to initiation of therapy. Hemorrhage. Hemorrhage, including major hemorrhage defined as symptomatic bleeding in a critical area or organ, can occur with the combination. Fatal cases have been reported. In the pooled adult safety population of the combination, hemorrhagic events occurred in 17% of patients; gastrointestinal hemorrhage occurred in 3% of patients; intracranial hemorrhage occurred in 0.6% of patients; fatal hemorrhage occurred in 0.5% of patients. The fatal events were cerebral hemorrhage and brainstem hemorrhage. In the pooled pediatric safety population of the combination, hemorrhagic events occurred in 25% of patients; the most common type of bleeding was epistaxis (16%). Serious events of bleeding occurred in 3.6% of patients and included gastrointestinal hemorrhage (1.2%), cerebral hemorrhage (0.6%), uterine hemorrhage (0.6%), postprocedural hemorrhage (0.6%), and epistaxis (0.6%). Permanently discontinue TAFINLAR for all grade 4 hemorrhagic events and for any grade 3 hemorrhagic events that do not improve. Withhold TAFINLAR for grade 3 hemorrhagic events; if improved, resume at the next lower dose level. Permanently discontinue MEKINIST for all grade 4 hemorrhagic events and for any grade 3 hemorrhagic events that do not improve. Withhold MEKINIST for grade 3 hemorrhagic events; if improved, resume at the next lower dose level. Colitis and Gastrointestinal Perforation. Colitis and gastrointestinal perforation, including fatal outcomes, can occur. In the pooled adult safety population of MEKINIST administered with TAFINLAR, colitis occurred in <1% of patients and gastrointestinal perforation occurred in <1% of patients. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, colitis events occurred in <1% of patients. Monitor patients closely for colitis and gastrointestinal perforations. Venous Thromboembolic Events. In the pooled adult safety population of MEKINIST administered with TAFINLAR, deep vein thrombosis (DVT) and pulmonary embolism (PE) occurred in 2% of patients. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, embolism events occurred in <1% of patients. Advise patients to immediately seek medical care if they develop symptoms of DVT or PE, such as shortness of breath, chest pain, or arm or leg swelling. Permanently discontinue MEKINIST for life-threatening PE. Withhold MEKINIST for uncomplicated DVT and PE for up to 3 weeks; if improved, MEKINIST may be resumed at a lower dose. Cardiomyopathy. Cardiomyopathy, including cardiac failure, can occur. In the pooled adult safety population of the combination, cardiomyopathy, defined as a decrease in left ventricular ejection fraction (LVEF) ≥10% from baseline and below the institutional lower limit of normal (LLN), occurred in 6% of patients. Development of cardiomyopathy resulted in dose interruption or discontinuation of TAFINLAR in 3% and <1% of patients, respectively, and in 3% and <1% of patients receiving MEKINIST, respectively. Cardiomyopathy resolved in 45 of 50 patients who received the combination. In the pooled pediatric safety population of the combination, cardiomyopathy, defined as a decrease in LVEF ≥10% from baseline and below the institutional LLN, occurred in 9% of patients. Assess LVEF by echocardiogram or multigated acquisition (MUGA) scan before initiation of the combination, 1 month after initiation, and then at 2- to 3-month intervals while on treatment. Withhold TAFINLAR for symptomatic cardiomyopathy or asymptomatic left ventricular dysfunction of >20% from baseline that is below institutional LLN. Resume TAFINLAR at the same dose level upon recovery of cardiac function to at least the institutional LLN for LVEF and absolute decrease ≤10% compared to baseline. For an asymptomatic absolute decrease in LVEF of 10% or greater from baseline that is below the LLN, withhold MEKINIST for up to 4 weeks. If improved to normal LVEF value, resume at a lower dose. If no improvement to normal LVEF value within 4 weeks, permanently discontinue MEKINIST. For symptomatic cardiomyopathy or an absolute decrease in LVEF of >20% from baseline that is below LLN, permanently discontinue MEKINIST. Ocular Toxicities Retinal Vein Occlusion (RVO): There were no cases of RVO across clinical trials of the combination. RVO may lead to macular edema, decreased visual function, neovascularization, and glaucoma. Urgently (within 24 hours) perform ophthalmologic evaluation for patient-reported loss of vision or other visual disturbances. Permanently discontinue MEKINIST in patients with documented RVO. Retinal Pigment Epithelial Detachment (RPED): RPED can occur. Retinal detachments may be bilateral and multifocal, occurring in the central macular region of the retina or elsewhere in the retina. In clinical trials, routine monitoring of patients to detect asymptomatic RPED was not conducted; therefore, the true incidence of this finding is unknown. In the pooled pediatric safety population of MEKINIST administered with TAFINLAR, RPED events occurred in <1% of patients. Perform ophthalmologic evaluation periodically, and at any time a patient reports visual disturbances. Withhold MEKINIST if RPED is diagnosed. If resolution of the RPED is documented on repeat ophthalmologic evaluation within 3 weeks, resume MEKINIST at the same or a reduced dose. If no improvement after 3 weeks, resume at a reduced dose or permanently discontinue MEKINIST. Uveitis: In the pooled adult safety population of the combination, uveitis occurred in 2% of patients. In the pooled pediatric safety population of the combination, uveitis occurred in 1.2% of patients. Treatment employed in clinical trials included steroid and mydriatic ophthalmic drops. Monitor patients for visual signs and symptoms of uveitis (eg, change in vision, photophobia, and eye pain). If iritis is diagnosed, administer ocular therapy and continue TAFINLAR without dose modification. If severe uveitis (ie, iridocyclitis) or if mild or moderate uveitis does not respond to ocular therapy, withhold TAFINLAR and treat as clinically indicated. Resume TAFINLAR at the same or lower dose if uveitis improves to grade 0 or 1. Permanently discontinue TAFINLAR for persistent grade 2 or greater uveitis of >6 weeks. ---------- {Instruction} ========== Use only the provided context for your response, without relying on external information. ---------- {Question} ========== Only using the provided text, in which types of solid tumors does BRAF mutations occur?",Medical,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Why wasn't Mady able to get an abortion in texas, and what struggles did she go through to finally get one? Summarize what she had to go through. and include how many clinics she called during this process . put it in bullet points","Chair Sanders, Senator Murray, Ranking Member Cassidy, Members of the Committee: My name is Mady Anderson, and I live in Houston, Texas. Two years ago, during my senior year at the University of Houston, I had just come out of a two-year relationship. After a couple weeks of nausea and not sleeping or eating, I took a pregnancy test. I called my friends to bring me more tests because I was in disbelief. At one point I had five positive tests in front of me. I was pregnant. This was just two weeks after Texas’s abortion ban, known as S.B. 8, went into effect, banning abortion after six weeks. I knew almost immediately that abortion was the right decision for me. I called and got an appointment for the following week at my local Planned Parenthood, five minutes away. I thought I was early enough to be able to get my abortion that week. But at my appointment my pregnancy measured at 11 weeks. I was shocked. I couldn’t get an abortion in Texas. I called 20 different clinics after that first visit. Yes, you heard correct. 20. I called surrounding states and even as far as the Dakotas; no one could see me right away. The earliest I could be seen was two weeks later, at Jackson Women's Health Organization in Mississippi. This was before the Dobbs v. Jackson Women’s Health decision that would take away the federal constitutional right to abortion. Before 20 more states would ban abortion. Before wait times in states without bans grew longer and longer.My dad took off from work, and we drove a total of 720 miles roundtrip, and spent 13 hours on the road. We spent five hours in a hotel trying to sleep, before going to my first appointment — just to turn right around and head back home. And here’s the thing: Because of medically unnecessary restrictions on abortion care in Mississippi, I would have to make the trip all over again. The state, essentially, put patients in a time-out because they don’t trust people to know what is best for our own health and lives. When I got this news, I was angry, sleep-deprived, and starving — and as certain as I ever was that I wanted an abortion. That certainty never faltered. The following week my mom was able to find us affordable tickets, and we flew back to Jackson. We started our day at 7 a.m. for my 1:30 p.m. appointment. After my procedure, I waited in the recovery room for about 20 mins, before hopping in a car to make my flight back home. I want to talk for a moment about money. As a college student who took out multiple student loans, I was counting every penny. ● I had to pay for the appointment in Houston. ● Then gas and hotel for the first trip to Mississippi. ● Then the first appointment in Mississippi. ● Then plane tickets for the second trip to Mississippi. ● Then the abortion itself. ● Then I missed 20 hours of work. ● And 20 hours of my mandatory internship program. ● The total? $2,850. There is no dollar value I can put on the stress of managing all of this. The despair of having to go to such lengths for basic, safe health care that was legal just weeks before I needed it. The gut-wrenching reality of having to disclose this deeply personal thing that should be private to professors, my boss, and anyone else in a position of authority over me for fear of not only losing my job but also failing out of all my classes due to all the classes and assignments I missed. I felt so much anger that politicians in Austin thought they had the right to make this decision for me. I am one of thousands of people who have now gone through this. Every day, every month we go without a federal right to abortion, there will be more of us. More savings accounts drained, more classes and shifts missed, more choices about which bill to skip paying. If I had found out I was pregnant last year or last month, Jackson Women’s Health wouldn’thave been there for me. The people who cared for me that day cannot care for abortion patients in Mississippi. I would have had to go to New Mexico, Kansas, or as far as Illinois. When we talk about abortion, it’s easy to get stuck talking in theoreticals. But I am a real person. The lives of abortion patients are not theoretical. People will continue to get pregnant when we don’t want to be. We will always need abortions. There is simply no place for politicians to decide for us. Thank you for inviting me here today and letting me share my story.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Why wasn't Mady able to get an abortion in texas, and what struggles did she go through to finally get one? Summarize what she had to go through. and include how many clinics she called during this process . put it in bullet points {passage 0} ========== Chair Sanders, Senator Murray, Ranking Member Cassidy, Members of the Committee: My name is Mady Anderson, and I live in Houston, Texas. Two years ago, during my senior year at the University of Houston, I had just come out of a two-year relationship. After a couple weeks of nausea and not sleeping or eating, I took a pregnancy test. I called my friends to bring me more tests because I was in disbelief. At one point I had five positive tests in front of me. I was pregnant. This was just two weeks after Texas’s abortion ban, known as S.B. 8, went into effect, banning abortion after six weeks. I knew almost immediately that abortion was the right decision for me. I called and got an appointment for the following week at my local Planned Parenthood, five minutes away. I thought I was early enough to be able to get my abortion that week. But at my appointment my pregnancy measured at 11 weeks. I was shocked. I couldn’t get an abortion in Texas. I called 20 different clinics after that first visit. Yes, you heard correct. 20. I called surrounding states and even as far as the Dakotas; no one could see me right away. The earliest I could be seen was two weeks later, at Jackson Women's Health Organization in Mississippi. This was before the Dobbs v. Jackson Women’s Health decision that would take away the federal constitutional right to abortion. Before 20 more states would ban abortion. Before wait times in states without bans grew longer and longer.My dad took off from work, and we drove a total of 720 miles roundtrip, and spent 13 hours on the road. We spent five hours in a hotel trying to sleep, before going to my first appointment — just to turn right around and head back home. And here’s the thing: Because of medically unnecessary restrictions on abortion care in Mississippi, I would have to make the trip all over again. The state, essentially, put patients in a time-out because they don’t trust people to know what is best for our own health and lives. When I got this news, I was angry, sleep-deprived, and starving — and as certain as I ever was that I wanted an abortion. That certainty never faltered. The following week my mom was able to find us affordable tickets, and we flew back to Jackson. We started our day at 7 a.m. for my 1:30 p.m. appointment. After my procedure, I waited in the recovery room for about 20 mins, before hopping in a car to make my flight back home. I want to talk for a moment about money. As a college student who took out multiple student loans, I was counting every penny. ● I had to pay for the appointment in Houston. ● Then gas and hotel for the first trip to Mississippi. ● Then the first appointment in Mississippi. ● Then plane tickets for the second trip to Mississippi. ● Then the abortion itself. ● Then I missed 20 hours of work. ● And 20 hours of my mandatory internship program. ● The total? $2,850. There is no dollar value I can put on the stress of managing all of this. The despair of having to go to such lengths for basic, safe health care that was legal just weeks before I needed it. The gut-wrenching reality of having to disclose this deeply personal thing that should be private to professors, my boss, and anyone else in a position of authority over me for fear of not only losing my job but also failing out of all my classes due to all the classes and assignments I missed. I felt so much anger that politicians in Austin thought they had the right to make this decision for me. I am one of thousands of people who have now gone through this. Every day, every month we go without a federal right to abortion, there will be more of us. More savings accounts drained, more classes and shifts missed, more choices about which bill to skip paying. If I had found out I was pregnant last year or last month, Jackson Women’s Health wouldn’thave been there for me. The people who cared for me that day cannot care for abortion patients in Mississippi. I would have had to go to New Mexico, Kansas, or as far as Illinois. When we talk about abortion, it’s easy to get stuck talking in theoreticals. But I am a real person. The lives of abortion patients are not theoretical. People will continue to get pregnant when we don’t want to be. We will always need abortions. There is simply no place for politicians to decide for us. Thank you for inviting me here today and letting me share my story. https://www.help.senate.gov/imo/media/doc/80626e6a-a9e9-50e7-072a-95e7c2a059e3/Anderson%20-%20Testimony.pdf",Medical,Find & Summarize,Text Transformation Answer questions based solely on the text provided. Do not use any prior knowledge or other resources.,"Using bullet points, summarise Florida's restrictions on foreign ownership of land.","Recent State Laws Differ in Their Restrictions State laws differ in their approaches and requirements. For example, some states enacted information- gathering laws that mandate disclosure of, or require studies on, foreign ownership of U.S. land. Other laws directly prohibit certain transactions and may require divestiture of foreign-owned land. Some restrictions apply only to agricultural land; others to land near military installations, critical infrastructure, or economically valuable sites; and others to all real property within the state. State laws also vary as to which groups are subject to land ownership restrictions. Some seek to regulate real property transactions with individuals and entities from a list of named countries. Others aim to govern purchases by all non-U.S. citizens. Another set addresses purchases by individuals and entities from countries identified on lists maintained under federal law, such as the International Traffic in Arms Regulations (Tables 1 and 2 of 22 C.F.R. § 126); the foreign adversaries list generated under Executive Order 13873 and its implementing regulations; sanctions lists maintained by the Office of Foreign Assets Control (OFAC) in the Department of the Treasury; or countries of particular concern designated by the U.S. Secretary of State. SB 264 Creates Two Sets of Restrictions on Land Ownership in Florida Florida’s law, SB 264 (codified at Florida Statutes §§ 692.201–.205), effective July 1, 2023, creates two sets of land ownership restrictions. The first set applies to foreign principals connected with foreign countries of concern (defined as China, Russia, Iran, North Korea, Cuba, the Venezuelan regime of Nicolás Maduro, and Syria). Foreign principals are defined as the foreign governments themselves, certain corporate and political bodies, and individuals domiciled in the countries of concern who are not U.S. citizens or lawful permanent residents. Individuals and entities in these groups cannot acquire or own agricultural land in Florida or real property within 10 miles of a military installation or critical infrastructure facility in the state. SB 264’s second set of restrictions applies only to certain individuals and entities connected with the People’s Republic of China (PRC)—the PRC itself, certain political bodies and individual members of the PRC or the Communist Party of China, companies organized under PRC law or that have their principal place of business there, and individuals domiciled in the PRC who are not U.S. citizens or lawful permanent residents. These PRC-connected individuals and entities cannot purchase any real property in Florida, absent an exception. Both sets of restrictions exempt de minimis investments in some securities or companies registered with the Securities and Exchange Commission. Individuals with nontourist visas or who have been granted asylum may also purchase one parcel up to 2 acres in size that is not within 5 miles of a military installation. Preexisting land owners that acquired their property before SB 264 became effective can continue to own their parcels, but they cannot buy additional land unless permitted by law. SB 264 requires all foreign principals—both existing owners and new purchasers—to register land ownership with state officials if the parcel is within 10 miles of a military installation or critical infrastructure. Some PRC-connected individuals and entities must register regardless of the parcel’s location.","Answer questions based solely on the text provided. Do not use any prior knowledge or other resources. ""Recent State Laws Differ in Their Restrictions State laws differ in their approaches and requirements. For example, some states enacted information- gathering laws that mandate disclosure of, or require studies on, foreign ownership of U.S. land. Other laws directly prohibit certain transactions and may require divestiture of foreign-owned land. Some restrictions apply only to agricultural land; others to land near military installations, critical infrastructure, or economically valuable sites; and others to all real property within the state. State laws also vary as to which groups are subject to land ownership restrictions. Some seek to regulate real property transactions with individuals and entities from a list of named countries. Others aim to govern purchases by all non-U.S. citizens. Another set addresses purchases by individuals and entities from countries identified on lists maintained under federal law, such as the International Traffic in Arms Regulations (Tables 1 and 2 of 22 C.F.R. § 126); the foreign adversaries list generated under Executive Order 13873 and its implementing regulations; sanctions lists maintained by the Office of Foreign Assets Control (OFAC) in the Department of the Treasury; or countries of particular concern designated by the U.S. Secretary of State. SB 264 Creates Two Sets of Restrictions on Land Ownership in Florida Florida’s law, SB 264 (codified at Florida Statutes §§ 692.201–.205), effective July 1, 2023, creates two sets of land ownership restrictions. The first set applies to foreign principals connected with foreign countries of concern (defined as China, Russia, Iran, North Korea, Cuba, the Venezuelan regime of Nicolás Maduro, and Syria). Foreign principals are defined as the foreign governments themselves, certain corporate and political bodies, and individuals domiciled in the countries of concern who are not U.S. citizens or lawful permanent residents. Individuals and entities in these groups cannot acquire or own agricultural land in Florida or real property within 10 miles of a military installation or critical infrastructure facility in the state. SB 264’s second set of restrictions applies only to certain individuals and entities connected with the People’s Republic of China (PRC)—the PRC itself, certain political bodies and individual members of the PRC or the Communist Party of China, companies organized under PRC law or that have their principal place of business there, and individuals domiciled in the PRC who are not U.S. citizens or lawful permanent residents. These PRC-connected individuals and entities cannot purchase any real property in Florida, absent an exception. Both sets of restrictions exempt de minimis investments in some securities or companies registered with the Securities and Exchange Commission. Individuals with nontourist visas or who have been granted asylum may also purchase one parcel up to 2 acres in size that is not within 5 miles of a military installation. Preexisting land owners that acquired their property before SB 264 became effective can continue to own their parcels, but they cannot buy additional land unless permitted by law. SB 264 requires all foreign principals—both existing owners and new purchasers—to register land ownership with state officials if the parcel is within 10 miles of a military installation or critical infrastructure. Some PRC-connected individuals and entities must register regardless of the parcel’s location."" Using bullet points, summarise Florida's restrictions on foreign ownership of land.",Legal,Summarize,Text Transformation You must not use any prior knowledge or external resources to answer this prompt. You must use only the information included in this prompt in your answer. You must use no more than 3 sentences in your answer.,What is the difference between hard information and soft information?,"Challenges and Considerations Promulgating the Final Rule The CFPB took more than a decade before promulgating the final Section 1071 rule. Evaluating the extent of lending gaps—and specifically fair lending risks—in small business credit markets has complications. Dodd-Frank directed the definition of small business, discussed in the section of this report entitled “Summary of the Section 1071 Final Rule.” Nevertheless, the CFPB’s challenge was to design a dataset with the ability to conduct meaningful comparisons across loan products and over time given the various differences in small business types and models. 7 See CFPB, “CFPB Explores Ways to Assess the Availability of Credit for Small Business,” press release, May 10, 2017, https://www.consumerfinance.gov/about-us/newsroom/cfpb-explores-ways-assess-availability-credit-small- business/. 8 For more information, see Federal Financial Institutions Examination Council, Interagency Fair Lending Examination Procedures, August 2009, https://www.ffiec.gov/pdf/fairlend.pdf. 9 See CFPB, “Small Business Lending under the Equal Credit Opportunity Act (Regulation B),” March 30, 2023, https://www.consumerfinance.gov/rules-policy/final-rules/small-business-lending-under-the-equal-credit-opportunity- act-regulation-b/. Congressional Research Service 2 Section 1071: Small Business Lending Data Collection and Reporting Multiple Small Business Definitions No consensus definition of small business exists among the federal government and industry participants. Consequently, establishing a universal dataset to evaluate the performance of small business lending markets is challenging. Definitions of small business include the following: • The SBA defines small business primarily by using a size standards table it compiles and updates periodically. The table lists size thresholds for various industries by either average annual receipts or number of employees.10 The SBA also defines small business differently for different SBA programs. For example, the SBA’s 7(a), Certified Development Company/504, and Small Business Investment Company (SBIC) programs have alternative size standards based on tangible net worth and average net income.11 • Academic research frequently uses a firm that has 500 employees or fewer (but does not monopolize an industry) as a proxy measure for a small business. Various federal agencies—such as the U.S. Census Bureau, the Bureau of Labor Statistics, and the Federal Reserve—have relied upon this definition.12 In addition, some researchers view microbusinesses as a subset of small businesses. A common academic definition of microbusiness is a firm with only one owner, five employees or fewer, and annual sales and assets under $250,000.13 • Definitions of small business also vary in statute. For example, eligibility thresholds for “small business” tax incentives vary under tax law. Certain firms with average annual gross receipts of $25 million or less are able to use cash-based accounting for tax purposes. The tax credit for employee health insurance costs is available to employers with 25 or fewer employees whose average annual compensation is below a certain wage threshold.14 • According to a Federal Deposit Insurance Corporation survey, small and large banks have their own definitions of small business.15 Small banks (defined as banks with $10 billion or less in assets) often view a small business as one in which the owner “wears many hats,” referring to an owner who performs multiple tasks, perhaps because the firm is starting up or still in its early growth stage. Large banks define small business more formally in terms of annual revenues and sales. • Likewise, the definition of small farm varies. For example, the Farm Credit System and parts of the U.S. Department of Agriculture (USDA) each define small farm or ranch as one with gross annual sales of less than $250,000. The USDA Economic Research Service, for statistical purposes, defines small farm as one having less than $350,000 of gross cash farm income. SBA defines small farms as those having less than $5 million in annual sales. The CRA definition of small farm loan is $500,000 or less. The Small Business Regulatory Enforcement Fairness Act of 1996 (P.L. 104-121) also requires the CFPB to address issues that could potentially have significant economic impacts on small entities subject to the Section 1071 rule.16 The CFPB had to consider, for example, key 10 For the current size standards, see SBA, “Table of Size Standards,” https://www.sba.gov/document/support-table- size-standards. For a historical analysis of the size standards, see CRS Report R40860, Small Business Size Standards: A Historical Analysis of Contemporary Issues, by Robert Jay Dilger, R. Corinne Blackford, and Anthony A. Cilluffo. 11 See SBA, “Lender and Development Company Loan Programs,” SOP 50 10 6, October 1, 2020, pp. 118-119. 12 See Karen Gordon Mills and Brayden McCarthy, The State of Small Business Lending: Innovation and Technology and the Implications for Regulation, Harvard Business School Entrepreneurial Management Working Paper no. 17-042, November 29, 2016. 13 See Tammie Hoy, Jessie Romero, and Kimberly Zeuli, Microenterprise and the Small-Dollar Loan Market, Federal Reserve Bank of Richmond, May 2012, https://www.richmondfed.org/-/media/richmondfedorg/publications/research/ economic_brief/2012/pdf/eb_12-05.pdf. 14 See CRS Report RL32254, Small Business Tax Benefits: Current Law, by Gary Guenther. 15 See Federal Deposit Insurance Corporation (FDIC), 2018 FDIC Small Business Lending Survey, revised December 20, 2018, https://www.fdic.gov/bank/historical/sbls/full-survey.pdf. 16 See CFPB, Final Report of the Small Business Review Panel on the CFPB’s Proposals Under Consideration for the Small Business Lending Data Collection Rulemaking, December 14, 2020, https://files.consumerfinance.gov/f/ documents/cfpb_1071-sbrefa-report.pdf. Congressional Research Service 3 Section 1071: Small Business Lending Data Collection and Reporting differences in the lending models of large and small lenders, which affect the type and cost of data that would be collected.17 First, large and small lenders often collect different types of data. Large lenders typically engage in lending to borrowers who possess more conventional financial metrics and documentation (e.g., sales fluctuations, costs of inputs, specific industry factors), which is considered hard information that can be used in automated and statistical underwriting methodologies to price loans.18 By contrast, small lenders typically engage in relationship lending, meaning that they must develop close familiarity with their customers to gather soft information, which contains circumstantial details about factors such as non-standardized business risks, insufficient collateral, or weak or thin (business) credit histories. Because of soft information, the loan underwriting process to determine more customized loan products and loan pricing is generally less algorithmic and more labor intensive.19 Second, the type of information collected, which varies among lenders, would also be expected to influence their reporting costs. For example, because hard information is already quite uniform, large lenders may already have adopted automated technological systems that can handle large volumes of standardized and digitized financial data. In these cases, reporting is likely to be less expensive per applicant. By contrast, soft information is more unique to applicant circumstances, infrequent, and localized such that standardization of the data for electronic collection and reporting purposes is challenging. The reporting cost per applicant is also likely to be more expensive for small lenders that lack the volume of applications to justify the costs to convert soft information to digital and secure formats. Therefore, data likely to be informative about lending gaps in the small business and farm credit markets may be more difficult to standardize and more costly to collect, especially if small lenders predominantly serve these markets. The CFPB also had to consider how Section 1071 implementation requirements might affect the supply of small business loans. For example, some institutions might decide to offer more standardized, less tailored financial products to reduce their reporting costs. Some lenders might require minimum principal loan amounts (e.g., $100,000) to ensure that the loans generate enough revenue to cover the costs to fund and report data, thereby leaving gaps in credit markets for many businesses that are starting up or small. In short, Section 1071 implementation, which is designed to identify any lending gaps, could potentially exacerbate lending gaps in various credit market segments without careful consideration of the potential impact of its requirements.","Challenges and Considerations Promulgating the Final Rule The CFPB took more than a decade before promulgating the final Section 1071 rule. Evaluating the extent of lending gaps—and specifically fair lending risks—in small business credit markets has complications. Dodd-Frank directed the definition of small business, discussed in the section of this report entitled “Summary of the Section 1071 Final Rule.” Nevertheless, the CFPB’s challenge was to design a dataset with the ability to conduct meaningful comparisons across loan products and over time given the various differences in small business types and models. 7 See CFPB, “CFPB Explores Ways to Assess the Availability of Credit for Small Business,” press release, May 10, 2017, https://www.consumerfinance.gov/about-us/newsroom/cfpb-explores-ways-assess-availability-credit-small- business/. 8 For more information, see Federal Financial Institutions Examination Council, Interagency Fair Lending Examination Procedures, August 2009, https://www.ffiec.gov/pdf/fairlend.pdf. 9 See CFPB, “Small Business Lending under the Equal Credit Opportunity Act (Regulation B),” March 30, 2023, https://www.consumerfinance.gov/rules-policy/final-rules/small-business-lending-under-the-equal-credit-opportunity- act-regulation-b/. Congressional Research Service 2 Section 1071: Small Business Lending Data Collection and Reporting Multiple Small Business Definitions No consensus definition of small business exists among the federal government and industry participants. Consequently, establishing a universal dataset to evaluate the performance of small business lending markets is challenging. Definitions of small business include the following: • The SBA defines small business primarily by using a size standards table it compiles and updates periodically. The table lists size thresholds for various industries by either average annual receipts or number of employees.10 The SBA also defines small business differently for different SBA programs. For example, the SBA’s 7(a), Certified Development Company/504, and Small Business Investment Company (SBIC) programs have alternative size standards based on tangible net worth and average net income.11 • Academic research frequently uses a firm that has 500 employees or fewer (but does not monopolize an industry) as a proxy measure for a small business. Various federal agencies—such as the U.S. Census Bureau, the Bureau of Labor Statistics, and the Federal Reserve—have relied upon this definition.12 In addition, some researchers view microbusinesses as a subset of small businesses. A common academic definition of microbusiness is a firm with only one owner, five employees or fewer, and annual sales and assets under $250,000.13 • Definitions of small business also vary in statute. For example, eligibility thresholds for “small business” tax incentives vary under tax law. Certain firms with average annual gross receipts of $25 million or less are able to use cash-based accounting for tax purposes. The tax credit for employee health insurance costs is available to employers with 25 or fewer employees whose average annual compensation is below a certain wage threshold.14 • According to a Federal Deposit Insurance Corporation survey, small and large banks have their own definitions of small business.15 Small banks (defined as banks with $10 billion or less in assets) often view a small business as one in which the owner “wears many hats,” referring to an owner who performs multiple tasks, perhaps because the firm is starting up or still in its early growth stage. Large banks define small business more formally in terms of annual revenues and sales. • Likewise, the definition of small farm varies. For example, the Farm Credit System and parts of the U.S. Department of Agriculture (USDA) each define small farm or ranch as one with gross annual sales of less than $250,000. The USDA Economic Research Service, for statistical purposes, defines small farm as one having less than $350,000 of gross cash farm income. SBA defines small farms as those having less than $5 million in annual sales. The CRA definition of small farm loan is $500,000 or less. The Small Business Regulatory Enforcement Fairness Act of 1996 (P.L. 104-121) also requires the CFPB to address issues that could potentially have significant economic impacts on small entities subject to the Section 1071 rule.16 The CFPB had to consider, for example, key 10 For the current size standards, see SBA, “Table of Size Standards,” https://www.sba.gov/document/support-table- size-standards. For a historical analysis of the size standards, see CRS Report R40860, Small Business Size Standards: A Historical Analysis of Contemporary Issues, by Robert Jay Dilger, R. Corinne Blackford, and Anthony A. Cilluffo. 11 See SBA, “Lender and Development Company Loan Programs,” SOP 50 10 6, October 1, 2020, pp. 118-119. 12 See Karen Gordon Mills and Brayden McCarthy, The State of Small Business Lending: Innovation and Technology and the Implications for Regulation, Harvard Business School Entrepreneurial Management Working Paper no. 17-042, November 29, 2016. 13 See Tammie Hoy, Jessie Romero, and Kimberly Zeuli, Microenterprise and the Small-Dollar Loan Market, Federal Reserve Bank of Richmond, May 2012, https://www.richmondfed.org/-/media/richmondfedorg/publications/research/ economic_brief/2012/pdf/eb_12-05.pdf. 14 See CRS Report RL32254, Small Business Tax Benefits: Current Law, by Gary Guenther. 15 See Federal Deposit Insurance Corporation (FDIC), 2018 FDIC Small Business Lending Survey, revised December 20, 2018, https://www.fdic.gov/bank/historical/sbls/full-survey.pdf. 16 See CFPB, Final Report of the Small Business Review Panel on the CFPB’s Proposals Under Consideration for the Small Business Lending Data Collection Rulemaking, December 14, 2020, https://files.consumerfinance.gov/f/ documents/cfpb_1071-sbrefa-report.pdf. Congressional Research Service 3 Section 1071: Small Business Lending Data Collection and Reporting differences in the lending models of large and small lenders, which affect the type and cost of data that would be collected.17 First, large and small lenders often collect different types of data. Large lenders typically engage in lending to borrowers who possess more conventional financial metrics and documentation (e.g., sales fluctuations, costs of inputs, specific industry factors), which is considered hard information that can be used in automated and statistical underwriting methodologies to price loans.18 By contrast, small lenders typically engage in relationship lending, meaning that they must develop close familiarity with their customers to gather soft information, which contains circumstantial details about factors such as non-standardized business risks, insufficient collateral, or weak or thin (business) credit histories. Because of soft information, the loan underwriting process to determine more customized loan products and loan pricing is generally less algorithmic and more labor intensive.19 Second, the type of information collected, which varies among lenders, would also be expected to influence their reporting costs. For example, because hard information is already quite uniform, large lenders may already have adopted automated technological systems that can handle large volumes of standardized and digitized financial data. In these cases, reporting is likely to be less expensive per applicant. By contrast, soft information is more unique to applicant circumstances, infrequent, and localized such that standardization of the data for electronic collection and reporting purposes is challenging. The reporting cost per applicant is also likely to be more expensive for small lenders that lack the volume of applications to justify the costs to convert soft information to digital and secure formats. Therefore, data likely to be informative about lending gaps in the small business and farm credit markets may be more difficult to standardize and more costly to collect, especially if small lenders predominantly serve these markets. The CFPB also had to consider how Section 1071 implementation requirements might affect the supply of small business loans. For example, some institutions might decide to offer more standardized, less tailored financial products to reduce their reporting costs. Some lenders might require minimum principal loan amounts (e.g., $100,000) to ensure that the loans generate enough revenue to cover the costs to fund and report data, thereby leaving gaps in credit markets for many businesses that are starting up or small. In short, Section 1071 implementation, which is designed to identify any lending gaps, could potentially exacerbate lending gaps in various credit market segments without careful consideration of the potential impact of its requirements. What is the difference between hard information and soft information? You must not use any prior knowledge or external resources to answer this prompt. You must use only the information included in this prompt in your answer. You must use no more than 3 sentences in your answer.",Financial,Concept Comparison,Q&A "You can only respond using data from the information provided in the prompt. Don't use any other data, or external searches.",How could having overly high expectations for the diverse functionality of a product not be good for the user? How could this be more harmful to the product experience?,"The management of the complexity does not try to avoid the conflict existing inside the process of human vs. product interaction by modifying the user behavior. Instead, to reduce the complexity is necessary to alter the suggested tasks for that product, and which are susceptible of being modified by the future user. This modification made by the person is dynamic, such as the evolutionary process of adaptation of the product to his own preferences. But this spectrum of changes must be contemplated inside the original plans of the product conceptualization. Then, the existing level of complexity must be measured by the agent (user) skills. From this point we have two possibilities to define the level of complexity. The first one is aims to identify the level of complexity inside the prescribed activity to be made the agent. And the second possibility is related to the skills or incompetence of the agent. This works with the level of instruction of the human being related to the product that will use. This consideration is important, because it will show in which extend the product will satisfy the users expected necessities. To deal with the components of the system and avoiding its complexity is important to define clearly the kind of model and its final target use. In many situations, the intention of creating ways to demonstrate and clarifying the functions of the product has as a consequence a highly complex product with high cost and underutilization functionality, because the agent (user) is not properly defined or over assisted. While analyzing a group of students, by using a observation and non interventional methodology, was detected the “rookie intention to provide the highest technology to they projects, without considering the total information of users capability or the target of the product under development. Is know, that the intention is the best, but this could generate new problems instead of solve the older. The human evolutionary capability must provide him conditions to assimilate new technologies, but this is not a clearly condition because it depends on his social group and the way it conditions that evolutionary process. So, if this dynamic process is not really understood, the conceptualization of a new product could overestimate the learning capability (increasing the mental load to restrict management levels), generating uncontrollable interface andhigh-level complexity that demands a rework of the tasks defined for that product. An example for this situation, level of product complexity, is the Wi-Fi router. On one side the user operates it and understand it as a easy way of connectivity of its electronic appliances without physic contact (this demands a basic information of its use). On the other side a physic scientist will analyze from another perspective, like radiation, signal intensity or electromagnetic behaviors. So, this is a situation when the complexity achieves highest level, needing to incorporate the interface as its own domain [8].","System Instruction: You can only respond using data from the information provided in the prompt. Don't use any other data, or external searches. Question: How could having overly high expectations for the diverse functionality of a product not be good for the user? How could this be more harmful to the product experience? Context Block: The management of the complexity does not try to avoid the conflict existing inside the process of human vs. product interaction by modifying the user behavior. Instead, to reduce the complexity is necessary to alter the suggested tasks for that product, and which are susceptible of being modified by the future user. This modification made by the person is dynamic, such as the evolutionary process of adaptation of the product to his own preferences. But this spectrum of changes must be contemplated inside the original plans of the product conceptualization. Then, the existing level of complexity must be measured by the agent (user) skills. From this point we have two possibilities to define the level of complexity. The first one is aims to identify the level of complexity inside the prescribed activity to be made the agent. And the second possibility is related to the skills or incompetence of the agent. This works with the level of instruction of the human being related to the product that will use. This consideration is important, because it will show in which extend the product will satisfy the users expected necessities. To deal with the components of the system and avoiding its complexity is important to define clearly the kind of model and its final target use. In many situations, the intention of creating ways to demonstrate and clarifying the functions of the product has as a consequence a highly complex product with high cost and underutilization functionality, because the agent (user) is not properly defined or over assisted. While analyzing a group of students, by using a observation and non interventional methodology, was detected the “rookie intention to provide the highest technology to they projects, without considering the total information of users capability or the target of the product under development. Is know, that the intention is the best, but this could generate new problems instead of solve the older. The human evolutionary capability must provide him conditions to assimilate new technologies, but this is not a clearly condition because it depends on his social group and the way it conditions that evolutionary process. So, if this dynamic process is not really understood, the conceptualization of a new product could overestimate the learning capability (increasing the mental load to restrict management levels), generating uncontrollable interface andhigh-level complexity that demands a rework of the tasks defined for that product. An example for this situation, level of product complexity, is the Wi-Fi router. On one side the user operates it and understand it as a easy way of connectivity of its electronic appliances without physic contact (this demands a basic information of its use). On the other side a physic scientist will analyze from another perspective, like radiation, signal intensity or electromagnetic behaviors. So, this is a situation when the complexity achieves highest level, needing to incorporate the interface as its own domain [8].",Retail/Product,Fact Finding,Q&A You are given a reference document. You must only use information found in the reference document to answer the question asked.,What are Joe Dispenza's core teachings?,"Breaking the Habit of Being Yourself By Dr.Joe Dispenza Big Idea #1: To Change Your Life, Change Your Thoughts This idea is actually in the very first chapter of the book. Dr. Joe Dispenza starts off explaining how our beliefs or thoughts, lead to our feelings which lead to our actions which ultimately leads to our results. This is exactly the same as the concept of ‘TFAR’ in T. Harv Eker’s book ‘The Millionaire Mind”. However, instead of giving simple practical examples, Dr. Joe Dispenza uses the concept of Quantum Physics and other physics concepts to prove this point. Basically, everything in the physical universe is made up of subatomic particles such as electrons. These particles exist as pure potential. They are in their wave state when they’re not being observed. These particles are potential ‘everything’ and ‘nothing’ until they are observed. Hence everything in our physical reality exists as pure potential. What Dispenza means by being ‘observed’ is when we don’t actively look out for it. But when we do see it and ‘observe’ it, we can start to act upon it. What this ultimately implies is that the quantum field or the universe for this matter contains a reality in anything you want. So if you want to become a millionaire, the universe contains a reality in which you are a millionaire. And since our consciousness has effects on energy, we are powerful enough to influence matter. (I know this is a bit too technical but stay with me). Now, the whole point of using this concept of quantum physics is to prove only one point. We can master our skills of observation to intentionally affect our destiny, our life, and our results. In this case, Dispenza uses ‘observation’ to mean we can master what we ‘focus’ on to change our results. To quote Henry Ford: “Whether you think you can, or you think you can’t, you’re right” – Henry Ford For example, I had a friend who was quite miserable at his job. He wanted a pay rise but didn’t think he’d deserve it so he would never ask. A month later, something happened at work and he was blamed for something he didn’t do. He was really mad and thought staying in this job just isn’t worth it for the amount of pay he was getting. So he wanted to quit. But before he quit, he asked for a pay rise first because he had nothing to lose. To his surprise, his boss actually gave him a 10% pay rise. He was delighted and didn’t end up quitting. Now the sudden change in his thoughts to think of himself worthy of getting a pay rise – was the change in his skill to ‘observe’, his ability to change his ‘focus’. He first focused on how h ewasn’t worth an increase in salary to focussing on the fact that the job wasn’t worth him staying. Dispenza says that that the potential of him getting that salary increase was always there. It was there even when he was miserable a month earlier. In fact, even if his job would say no, there still exists a potential situation in the universe where he’d get a 10% pay increase. Maybe this would’ve been through another job. Whatever it is you want, the potential is there. The only missing link is whether we have the ability to ‘observe’, to change our ‘focus’ to look it or not. Big Idea #2: Live Your Desired New Future In the Present Dispenza teaches us that our brain doesn’t know the difference between the internal world (what we imagine in our heads) to what we experience in the external environment. That is, our thoughts can become our experience. This is what Napoleon Hill also said in his book Think & Grow Rich. The reason why we think how we think and do what we do is not that of who we are. Remember, we only act because of our thoughts. This concept is extremely important because as quoted above, we can imagine ourselves being someone totally different. We can imagine a more successful life with more confidence, with more friends and so on. This is a very similar concept of “The New Self Image” by Maxwell Maltz in his book Psycho-Cybernetics. When explaining these kinds of concepts, I like to break it down even more. In layman’s terms, if you’re able to imagine success and everything that it involves in vivid details, even down to the amount of money and house structure. And live that life in the present, meaning living that success right now in the present regardless of your situations, you will manifest it. For example if you want to become a millionaire. Think of how a millionaire would think, act, do, how their house would look like etc. First act in that way. And you will slowly attract the quantum potential of you being a millionaire into your life. It’s like, first you have to be a millionaire kind of person to actually become a millionaire. Now, I know this may sound very weird and bit B.S. but here are some examples that you may relate to. Think of manifesting like dating. For example, imagine your perfect ideal partner in life. You don’t really care about the nitty gritty of how they look but you have to be attracted to them and they have to have the same values and be ambitious in life. Now imagine if they existed, what would they want in their perfect partner? They would want you to also be established. Be caring. Be funny. All that. So even if you’d meet your perfect partner in real life, you’d miss your chance because you’re not the type of person they’re looking for. Chances are even if they’d walk past you on the streets, you won’t even see or notice them because deep down you don’t think you deserve them so you don’t look out for them. Hence think of manifesting like dating. You have to become first, then you will receive. So applying this concept to the previous scenario with my friend wanting to earn 100k, if he just acted, and thought of himself as already being a 100k type of person, asking for that pay rise would be a no brainer to him. Another example is if you want to become a public speaker – the kind that gets invited speak on TED Talks. First treat yourself as that kind of person already and you will slowly see more opportunities to public speak. It’s all about changing our focus to become better ‘observers’ so that we can attract our goal into our life. These questions will help you find your desired new future. Also, when you’re done answering these questions and have a better understanding what your new desired future looks like. Remember not to live in the future but to bring it to the present. Live it in the present and feel the emotions, feel the happiness and feel everything that comes with it. More importantly, act and think like you’re living in the future but in the present. So when choices comes up and when situations arrives, deal with them as if the future you is dealing with them. Big Idea #3: Three Brains: From Thinking To Doing To Being We have three brains. The first brain is the Neocortex, which is responsible for our thoughts. The second brain is the Limbic brain, which is responsible for our emotions. The third brain is the Cerebellum, which is responsible for our habitual thoughts, attitudes, and behaviors. And this is how we learn things. First, we think about the new concept, then we act on the new concept. Once we act on it enough, we can be the new concept. For example, you don’t want to have as much of a temper anymore so instead you want to learn how to be more compassionate. So you immerse yourself in studying compassionate people like Mother Teresa and the Dalai Lama. Everything on how they think, act and what they believed. Now you know exactly how to think like them. The second step after thinking is doing. So a situation comes up where your partner does something you extremely hate. If that was the old you, you would’ve started an argument. But since you just studied how to be compassionate, you start to act compassionately instead. At this stage, Dispenza explains that the act of doing represents us teaching our body what our mind has learned. So the first step was for the mind to learn. This second step is for the body to learn. But acting compassionate in only one situation doesn’t necessarily make you a compassionate person. So what you have to do is act it out repeatedly. Only when you act compassionate repeatedly enough, you’ll move on to ‘being‘ compassionate. At this stage, Dispenza explains you no longer have to think of being compassionate, you just are. Being is when your body acts without needing a signal from the mind. It’s natural, routine, second nature and unconscious. He goes further to say that to master being is when our internal chemical state is greater than anything in our external world. That is no matter how many times someone pushes your buttons or no matter how messy the house looks, nothing in your external environment can make you get mad since you want to be compassionate. And the thing is this might sound foreign to you. As if ‘mastery’ is something very difficult to achieve. But the truth is, we have attained the mastery level. Just not on traits we might like. In fact Dispenza says ‘if you can master suffering, you can just as easily master joy’ – Dr. Joe Dispenza To demonstrate this I have to give you this example from the book which I find demonstrates this so well and at the same time is hilarious. You probably know someone who has mastered suffering, right? So you call her and ask, “How are you?” She answers “So-So.” You go on and say “Listen, I’m going to go out with some friends to a new art gallery and then eat at this restaurant that has really healthy desserts. Afterward, we’re going to listen to some live music. Would you like to come with us?” And after a long pause, your friend answers “No. I don’t feel like it.” But if she said what she actually meant, she’d say, I’ve memorized this emotional state, and nothing in my environment – no person, no experience, no condition, no thing – is going to move me from my internal chemical state of suffering. It feels better to be in pain than to let go and be happy. I am enjoying my addiction for now, and all these things that you want to do might distract me from my emotional dependency. So guess what? We can just as easily master an internal chemical state such as joy or compassion as we can and we do for suffering. This also goes mastering our internal state of thinking we’re not good enough. Which is the most common internal state most of us have. Big Idea #4: The Identity Gap This was one of my favorite ideas from the book. I could resonate with this idea. Dispenza starts off the chapter by telling us what kind of person he used to be before all of this. He had the money, he had the job, he traveled around the world to teach and he had a great family. From the outside, it looked like his life was perfect. But even he didn’t know why even having the perfect life didn’t make him happy. And no it didn’t have anything to do with being grateful for what he had. It was the fact that there was a huge gap in his two identities. Dispenza explains that everyone has two identities: The first is the identity of how you see yourself. The second is the identity of how you appear to others. There’s a gap because we usually don’t want others to see who we truly are inside. So it’s like we put on this front and have two identities. The thing is the second identity was actually created by us to hide our first identity. But now and then the first identity (our true identity) comes out and we try suppressing it further by changing our external world. But what we actually have to do is change our internal world. Dispenza defines happiness as closing this gap. The gap was created because we memorized many emotional layers such as unworthiness, anger, fear, shame, self-doubt, and guilt. Hence our life’s aim is to close this gap. To really show who we truly are inside. This is what will make us ultimately fulfilled. Being self-expressed creates happiness. And we can do this by unlearning and un-memorizing these emotional states. We can do it the long way as explained in Big Idea #3, but the faster way, which is to skip from thinking to just being can be done through meditation. That’s when Dispenza introduces his Step By Step Meditation Guide to do just that. Big Idea #5: Breaking The Habit Of Being Yourself Through Meditation Dispenza explains that one of the main purposes of meditation is to go beyond the conscious mind and enter the subconscious mind, in order to change selfdestructive habits, behaviors, belief, emotional reactions, attitudes, and unconscious states of being. That is, we can skip the doing, to go straight from thinking to being. The power of meditation actually allows us to become more observant within ourselves. It allows us to break our emotional bond with the body, the environment and time. This helps with “Breaking The Habits Of Being Yourself” and helps with creating new thoughts and emotions that are congruent with the new future you. We can actually skip the acting part and just move into being through meditation. Hence Part 3 of the book includes a step-by-step guide to Meditation. It’s a 6- week program where Dr. Joe Dispenza shares tools, resources, how to and the reason behind everything. Unlike other books that only just have concepts and little action plans. Dr. Joe Dispenza has gone out of his way to explain every little step and to designing a meditation specifically aimed to have you break the habit of being yourself. He even includes guided meditations and many other resources on his website to help best perform this meditation. Conclusion: As you can see Breaking The Habit Of Being Yourself reviews concepts that are quite philosophical. I’ve read many similar books like Psycho-Cybernetics, Think & Grow Rich, Secrets Of The Millionaire Mind and The Magic Of Thinking Big just to name a few. They all share one important key concept that actions and results all start from our thoughts. Breaking The Habits Of Being Yourself doesn’t just say statements like ‘Change your thoughts to change your life’, instead it taps into many different concepts of physics, biology, neuroscience and many others to prove that this is not just philosophical but instead a fact. A fact that not many people are taking advantage of. I guess my last words on this is that if you’re willing to be open minded and take the book for what it is instead of nit picking every little thing and actually apply the strategies it shares, I’m certain it will have a positive impact on your life. Go ahead, give it a read and break the habit of being yourself to become the new you. Your Breaking The Habit Of Being Yourself Action Plan Choose your top 3 new traits.For example being compassionate, being bold and caring. Immerse yourself into studying on how to be just that by researching famous figures who embody that trait. Act out those 3 traits.Whenever you get a chance, ask yourself “What would a compassionate person do?” And do this. Do this enough times until you don’t need to consciously remember to be compassionate anymore. Do this for all 3 traits. Unlearn your worst 3 traits. Choose the top 3 traits that you don’t like about yourself. This could also include beliefs about yourself. Beliefs such as I’m not good enough. To unlearn it, take actions no matter how small to prove that you are good enough. And when you do, consciously write them down so you can remember it. Once you build up this bank of examples where you proved to yourself that you are good enough, slowly your old belief will just fall away. Of course, you can also do the meditation to unlearn these traits quicker. However, I’d suggest reading the book first in this case. Quotes: “Can you accept the notion that once you change your internal state, you don’t need the external world to provide you with a reason to feel joy, gratitude, appreciation, or any other elevated emotion?” “A memory without the emotional charge is called wisdom.” “We should never wait for science to give us permission to do the uncommon; if we do, then we are turning science into another religion.” “If you want a new outcome, you will have to break the habit of being yourself, and reinvent a new self.” “Think of it this way: the input remains the same, so the output has to remain the same. How, then, can you ever create anything new?” “The quantum field responds not to what we want; it responds to who we are being.” “By Itself, Conscious Positive Thinking Cannot Overcome Subconscious Negative Feelings” Sources: https://bestbookbits.com/breaking-the-habit-of-being-yourself-dr-joedispenza-book-summary-bestbookbits-com/ https://www.goodreads.com/work/quotes/18108532-breaking-the-habit-ofbeing-yourself-how-to-lose-your-mind-and-create-a","You are given a reference document. You must only use information found in the reference document to answer the question asked. What are Joe Dispenza's core teachings? Breaking the Habit of Being Yourself By Dr.Joe Dispenza Big Idea #1: To Change Your Life, Change Your Thoughts This idea is actually in the very first chapter of the book. Dr. Joe Dispenza starts off explaining how our beliefs or thoughts, lead to our feelings which lead to our actions which ultimately leads to our results. This is exactly the same as the concept of ‘TFAR’ in T. Harv Eker’s book ‘The Millionaire Mind”. However, instead of giving simple practical examples, Dr. Joe Dispenza uses the concept of Quantum Physics and other physics concepts to prove this point. Basically, everything in the physical universe is made up of subatomic particles such as electrons. These particles exist as pure potential. They are in their wave state when they’re not being observed. These particles are potential ‘everything’ and ‘nothing’ until they are observed. Hence everything in our physical reality exists as pure potential. What Dispenza means by being ‘observed’ is when we don’t actively look out for it. But when we do see it and ‘observe’ it, we can start to act upon it. What this ultimately implies is that the quantum field or the universe for this matter contains a reality in anything you want. So if you want to become a millionaire, the universe contains a reality in which you are a millionaire. And since our consciousness has effects on energy, we are powerful enough to influence matter. (I know this is a bit too technical but stay with me). Now, the whole point of using this concept of quantum physics is to prove only one point. We can master our skills of observation to intentionally affect our destiny, our life, and our results. In this case, Dispenza uses ‘observation’ to mean we can master what we ‘focus’ on to change our results. To quote Henry Ford: “Whether you think you can, or you think you can’t, you’re right” – Henry Ford For example, I had a friend who was quite miserable at his job. He wanted a pay rise but didn’t think he’d deserve it so he would never ask. A month later, something happened at work and he was blamed for something he didn’t do. He was really mad and thought staying in this job just isn’t worth it for the amount of pay he was getting. So he wanted to quit. But before he quit, he asked for a pay rise first because he had nothing to lose. To his surprise, his boss actually gave him a 10% pay rise. He was delighted and didn’t end up quitting. Now the sudden change in his thoughts to think of himself worthy of getting a pay rise – was the change in his skill to ‘observe’, his ability to change his ‘focus’. He first focused on how h ewasn’t worth an increase in salary to focussing on the fact that the job wasn’t worth him staying. Dispenza says that that the potential of him getting that salary increase was always there. It was there even when he was miserable a month earlier. In fact, even if his job would say no, there still exists a potential situation in the universe where he’d get a 10% pay increase. Maybe this would’ve been through another job. Whatever it is you want, the potential is there. The only missing link is whether we have the ability to ‘observe’, to change our ‘focus’ to look it or not. Big Idea #2: Live Your Desired New Future In the Present Dispenza teaches us that our brain doesn’t know the difference between the internal world (what we imagine in our heads) to what we experience in the external environment. That is, our thoughts can become our experience. This is what Napoleon Hill also said in his book Think & Grow Rich. The reason why we think how we think and do what we do is not that of who we are. Remember, we only act because of our thoughts. This concept is extremely important because as quoted above, we can imagine ourselves being someone totally different. We can imagine a more successful life with more confidence, with more friends and so on. This is a very similar concept of “The New Self Image” by Maxwell Maltz in his book Psycho-Cybernetics. When explaining these kinds of concepts, I like to break it down even more. In layman’s terms, if you’re able to imagine success and everything that it involves in vivid details, even down to the amount of money and house structure. And live that life in the present, meaning living that success right now in the present regardless of your situations, you will manifest it. For example if you want to become a millionaire. Think of how a millionaire would think, act, do, how their house would look like etc. First act in that way. And you will slowly attract the quantum potential of you being a millionaire into your life. It’s like, first you have to be a millionaire kind of person to actually become a millionaire. Now, I know this may sound very weird and bit B.S. but here are some examples that you may relate to. Think of manifesting like dating. For example, imagine your perfect ideal partner in life. You don’t really care about the nitty gritty of how they look but you have to be attracted to them and they have to have the same values and be ambitious in life. Now imagine if they existed, what would they want in their perfect partner? They would want you to also be established. Be caring. Be funny. All that. So even if you’d meet your perfect partner in real life, you’d miss your chance because you’re not the type of person they’re looking for. Chances are even if they’d walk past you on the streets, you won’t even see or notice them because deep down you don’t think you deserve them so you don’t look out for them. Hence think of manifesting like dating. You have to become first, then you will receive. So applying this concept to the previous scenario with my friend wanting to earn 100k, if he just acted, and thought of himself as already being a 100k type of person, asking for that pay rise would be a no brainer to him. Another example is if you want to become a public speaker – the kind that gets invited speak on TED Talks. First treat yourself as that kind of person already and you will slowly see more opportunities to public speak. It’s all about changing our focus to become better ‘observers’ so that we can attract our goal into our life. These questions will help you find your desired new future. Also, when you’re done answering these questions and have a better understanding what your new desired future looks like. Remember not to live in the future but to bring it to the present. Live it in the present and feel the emotions, feel the happiness and feel everything that comes with it. More importantly, act and think like you’re living in the future but in the present. So when choices comes up and when situations arrives, deal with them as if the future you is dealing with them. Big Idea #3: Three Brains: From Thinking To Doing To Being We have three brains. The first brain is the Neocortex, which is responsible for our thoughts. The second brain is the Limbic brain, which is responsible for our emotions. The third brain is the Cerebellum, which is responsible for our habitual thoughts, attitudes, and behaviors. And this is how we learn things. First, we think about the new concept, then we act on the new concept. Once we act on it enough, we can be the new concept. For example, you don’t want to have as much of a temper anymore so instead you want to learn how to be more compassionate. So you immerse yourself in studying compassionate people like Mother Teresa and the Dalai Lama. Everything on how they think, act and what they believed. Now you know exactly how to think like them. The second step after thinking is doing. So a situation comes up where your partner does something you extremely hate. If that was the old you, you would’ve started an argument. But since you just studied how to be compassionate, you start to act compassionately instead. At this stage, Dispenza explains that the act of doing represents us teaching our body what our mind has learned. So the first step was for the mind to learn. This second step is for the body to learn. But acting compassionate in only one situation doesn’t necessarily make you a compassionate person. So what you have to do is act it out repeatedly. Only when you act compassionate repeatedly enough, you’ll move on to ‘being‘ compassionate. At this stage, Dispenza explains you no longer have to think of being compassionate, you just are. Being is when your body acts without needing a signal from the mind. It’s natural, routine, second nature and unconscious. He goes further to say that to master being is when our internal chemical state is greater than anything in our external world. That is no matter how many times someone pushes your buttons or no matter how messy the house looks, nothing in your external environment can make you get mad since you want to be compassionate. And the thing is this might sound foreign to you. As if ‘mastery’ is something very difficult to achieve. But the truth is, we have attained the mastery level. Just not on traits we might like. In fact Dispenza says ‘if you can master suffering, you can just as easily master joy’ – Dr. Joe Dispenza To demonstrate this I have to give you this example from the book which I find demonstrates this so well and at the same time is hilarious. You probably know someone who has mastered suffering, right? So you call her and ask, “How are you?” She answers “So-So.” You go on and say “Listen, I’m going to go out with some friends to a new art gallery and then eat at this restaurant that has really healthy desserts. Afterward, we’re going to listen to some live music. Would you like to come with us?” And after a long pause, your friend answers “No. I don’t feel like it.” But if she said what she actually meant, she’d say, I’ve memorized this emotional state, and nothing in my environment – no person, no experience, no condition, no thing – is going to move me from my internal chemical state of suffering. It feels better to be in pain than to let go and be happy. I am enjoying my addiction for now, and all these things that you want to do might distract me from my emotional dependency. So guess what? We can just as easily master an internal chemical state such as joy or compassion as we can and we do for suffering. This also goes mastering our internal state of thinking we’re not good enough. Which is the most common internal state most of us have. Big Idea #4: The Identity Gap This was one of my favorite ideas from the book. I could resonate with this idea. Dispenza starts off the chapter by telling us what kind of person he used to be before all of this. He had the money, he had the job, he traveled around the world to teach and he had a great family. From the outside, it looked like his life was perfect. But even he didn’t know why even having the perfect life didn’t make him happy. And no it didn’t have anything to do with being grateful for what he had. It was the fact that there was a huge gap in his two identities. Dispenza explains that everyone has two identities: The first is the identity of how you see yourself. The second is the identity of how you appear to others. There’s a gap because we usually don’t want others to see who we truly are inside. So it’s like we put on this front and have two identities. The thing is the second identity was actually created by us to hide our first identity. But now and then the first identity (our true identity) comes out and we try suppressing it further by changing our external world. But what we actually have to do is change our internal world. Dispenza defines happiness as closing this gap. The gap was created because we memorized many emotional layers such as unworthiness, anger, fear, shame, self-doubt, and guilt. Hence our life’s aim is to close this gap. To really show who we truly are inside. This is what will make us ultimately fulfilled. Being self-expressed creates happiness. And we can do this by unlearning and un-memorizing these emotional states. We can do it the long way as explained in Big Idea #3, but the faster way, which is to skip from thinking to just being can be done through meditation. That’s when Dispenza introduces his Step By Step Meditation Guide to do just that. Big Idea #5: Breaking The Habit Of Being Yourself Through Meditation Dispenza explains that one of the main purposes of meditation is to go beyond the conscious mind and enter the subconscious mind, in order to change selfdestructive habits, behaviors, belief, emotional reactions, attitudes, and unconscious states of being. That is, we can skip the doing, to go straight from thinking to being. The power of meditation actually allows us to become more observant within ourselves. It allows us to break our emotional bond with the body, the environment and time. This helps with “Breaking The Habits Of Being Yourself” and helps with creating new thoughts and emotions that are congruent with the new future you. We can actually skip the acting part and just move into being through meditation. Hence Part 3 of the book includes a step-by-step guide to Meditation. It’s a 6- week program where Dr. Joe Dispenza shares tools, resources, how to and the reason behind everything. Unlike other books that only just have concepts and little action plans. Dr. Joe Dispenza has gone out of his way to explain every little step and to designing a meditation specifically aimed to have you break the habit of being yourself. He even includes guided meditations and many other resources on his website to help best perform this meditation. Conclusion: As you can see Breaking The Habit Of Being Yourself reviews concepts that are quite philosophical. I’ve read many similar books like Psycho-Cybernetics, Think & Grow Rich, Secrets Of The Millionaire Mind and The Magic Of Thinking Big just to name a few. They all share one important key concept that actions and results all start from our thoughts. Breaking The Habits Of Being Yourself doesn’t just say statements like ‘Change your thoughts to change your life’, instead it taps into many different concepts of physics, biology, neuroscience and many others to prove that this is not just philosophical but instead a fact. A fact that not many people are taking advantage of. I guess my last words on this is that if you’re willing to be open minded and take the book for what it is instead of nit picking every little thing and actually apply the strategies it shares, I’m certain it will have a positive impact on your life. Go ahead, give it a read and break the habit of being yourself to become the new you. Your Breaking The Habit Of Being Yourself Action Plan Choose your top 3 new traits.For example being compassionate, being bold and caring. Immerse yourself into studying on how to be just that by researching famous figures who embody that trait. Act out those 3 traits.Whenever you get a chance, ask yourself “What would a compassionate person do?” And do this. Do this enough times until you don’t need to consciously remember to be compassionate anymore. Do this for all 3 traits. Unlearn your worst 3 traits. Choose the top 3 traits that you don’t like about yourself. This could also include beliefs about yourself. Beliefs such as I’m not good enough. To unlearn it, take actions no matter how small to prove that you are good enough. And when you do, consciously write them down so you can remember it. Once you build up this bank of examples where you proved to yourself that you are good enough, slowly your old belief will just fall away. Of course, you can also do the meditation to unlearn these traits quicker. However, I’d suggest reading the book first in this case. Quotes: “Can you accept the notion that once you change your internal state, you don’t need the external world to provide you with a reason to feel joy, gratitude, appreciation, or any other elevated emotion?” “A memory without the emotional charge is called wisdom.” “We should never wait for science to give us permission to do the uncommon; if we do, then we are turning science into another religion.” “If you want a new outcome, you will have to break the habit of being yourself, and reinvent a new self.” “Think of it this way: the input remains the same, so the output has to remain the same. How, then, can you ever create anything new?” “The quantum field responds not to what we want; it responds to who we are being.” “By Itself, Conscious Positive Thinking Cannot Overcome Subconscious Negative Feelings” Sources: https://bestbookbits.com/breaking-the-habit-of-being-yourself-dr-joedispenza-book-summary-bestbookbits-com/ https://www.goodreads.com/work/quotes/18108532-breaking-the-habit-ofbeing-yourself-how-to-lose-your-mind-and-create-a",Unknown,Find & Summarize,Text Transformation "Using only the information in the provided text, answer the question that follows in 200 words or less.",Summarize the reasoning on both sides of this argument about the TikTok ban in Montana.,"Issues Presented to the Ninth Circuit on Appeal Attorneys for Montana unsuccessfully argued to the district court that the law represents a valid exercise of Montana’s police power, that it does not violate any of the claimed constitutional provisions, that federal law does not preempt the ban, and that the ban would have only an indirect, and thus permissible, effect on interstate commerce. Montana then appealed the district court’s order granting the preliminary injunction to the Ninth Circuit. In its opening brief, Montana asserts that SB 419 has a “common sense consumer protection purpose” and that the district court erred in concluding that TikTok and its users would win their constitutional arguments. Montana also argues that the district court erred in its application of the remaining preliminary injunction factors. A selection of Montana’s various arguments, ordered as they appear in the brief, follows: • Police Powers. Montana asserts that protecting consumers is an exercise of police power, under which states have significant discretion. • Data Access. Montana asserts that, based on news reports, the U.S. user data that TikTok collects likely is available to the PRC at will, underscoring that the Montana legislature enacted SB 419 to protect Montana consumers’ data privacy, not to impact the editorial control of the platform. • Burden Shifting. Montana asserts that the district court, in concluding that TikTok and its users would prevail on their constitutional claims, erroneously shifted the evidentiary burden for proving those claims to Montana. The Ninth Circuit’s review of the district court’s order granting the preliminary injunction is limited. Montana asks the court of appeals to hold that the district court abused its discretion by relying on “an erroneous legal standard” or “clearly erroneous factual findings” (internal quotation marks omitted). Montana emphasizes that a preliminary injunction is a “drastic remedy” that should not issue where a plaintiff’s claim is “merely plausible” (internal quotation marks omitted). Virginia, together with 18 other states, filed an amicus brief in support of Montana. TikTok and its users each filed a response brief in late April 2024. They maintain that the district court acted properly and emphasize various arguments, including those that follow (ordered as they appear in the briefs): • First Amendment. TikTok and its users argue that the preliminary injunction is justified because SB 419 violates the First Amendment and the law does not withstand any level of scrutiny that might be applied. • Supremacy Clause (Preemption). TikTok and its users argue that SB 419 impermissibly conflicts with the Defense Production Act and constitutes an improper incursion into foreign affairs. • Commerce Clause. TikTok and its users argue that SB 419 likely violates the Commerce Clause by impeding the flow of interstate commerce. These arguments largely reflect those made before the district court. Between Montana’s filing and the response briefs, Congress passed PAFACAA. The response briefs include mention of this new law to underscore arguments in favor of federal preemption. TikTok has also brought a pre-enforcement challenge of the federal law in the U.S. Court of Appeals for the D.C. Circuit. In the present matter, the Ninth Circuit must weigh the various arguments to determine whether the district court properly considered and applied the legal standards governing whether to grant a preliminary injunction before a final determination on the merits of the claims could be made.","Using only the information in the provided text, answer the question that follows in 200 words or less. Issues Presented to the Ninth Circuit on Appeal Attorneys for Montana unsuccessfully argued to the district court that the law represents a valid exercise of Montana’s police power, that it does not violate any of the claimed constitutional provisions, that federal law does not preempt the ban, and that the ban would have only an indirect, and thus permissible, effect on interstate commerce. Montana then appealed the district court’s order granting the preliminary injunction to the Ninth Circuit. In its opening brief, Montana asserts that SB 419 has a “common sense consumer protection purpose” and that the district court erred in concluding that TikTok and its users would win their constitutional arguments. Montana also argues that the district court erred in its application of the remaining preliminary injunction factors. A selection of Montana’s various arguments, ordered as they appear in the brief, follows: • Police Powers. Montana asserts that protecting consumers is an exercise of police power, under which states have significant discretion. • Data Access. Montana asserts that, based on news reports, the U.S. user data that TikTok collects likely is available to the PRC at will, underscoring that the Montana legislature enacted SB 419 to protect Montana consumers’ data privacy, not to impact the editorial control of the platform. • Burden Shifting. Montana asserts that the district court, in concluding that TikTok and its users would prevail on their constitutional claims, erroneously shifted the evidentiary burden for proving those claims to Montana. The Ninth Circuit’s review of the district court’s order granting the preliminary injunction is limited. Montana asks the court of appeals to hold that the district court abused its discretion by relying on “an erroneous legal standard” or “clearly erroneous factual findings” (internal quotation marks omitted). Montana emphasizes that a preliminary injunction is a “drastic remedy” that should not issue where a plaintiff’s claim is “merely plausible” (internal quotation marks omitted). Virginia, together with 18 other states, filed an amicus brief in support of Montana. TikTok and its users each filed a response brief in late April 2024. They maintain that the district court acted properly and emphasize various arguments, including those that follow (ordered as they appear in the briefs): • First Amendment. TikTok and its users argue that the preliminary injunction is justified because SB 419 violates the First Amendment and the law does not withstand any level of scrutiny that might be applied. • Supremacy Clause (Preemption). TikTok and its users argue that SB 419 impermissibly conflicts with the Defense Production Act and constitutes an improper incursion into foreign affairs. • Commerce Clause. TikTok and its users argue that SB 419 likely violates the Commerce Clause by impeding the flow of interstate commerce. These arguments largely reflect those made before the district court. Between Montana’s filing and the response briefs, Congress passed PAFACAA. The response briefs include mention of this new law to underscore arguments in favor of federal preemption. TikTok has also brought a pre-enforcement challenge of the federal law in the U.S. Court of Appeals for the D.C. Circuit. In the present matter, the Ninth Circuit must weigh the various arguments to determine whether the district court properly considered and applied the legal standards governing whether to grant a preliminary injunction before a final determination on the merits of the claims could be made. Summarize the reasoning on both sides of this argument about the TikTok ban in Montana.",Internet/Technology,Find & Summarize,Text Transformation Draw your answer from the above text only.,What are the different types of web pages?,"WEB PAGES Web pages are what make up the World Wide Web. These documents are written in HTML (Hypertext Markup Language) and are translated by your Web browser. Web pages can either be static or dynamic. Static pages show the same content each time they are viewed. Dynamic pages have content that can change each time they are accessed. These pages are typically written in scripting languages such as PHP, Perl, ASP, or JSP. The scripts in the pages run functions on the server that return things like the date and time, and database information. All the information is returned as HTML code, so when the page gets to your browser, all the browser has to do is translate the HTML. Electronic (digital) document created with HTML and, therefore, accessible with a browser. In addition to text and graphics, web pages may also contain downloadable data files, audio and video files, and hyperlinks to other pages or sites. A website is usually a collection of web pages. A web page is a document that's created in html that shows up on the internet when you type in or go to the web page's address. Web Page A web page is a document commonly written in HyperText Markup Language (HTML) that is accessible through the Internet or other network using a browser. A web page is accessed by entering a URL address and may contain text, graphics, and hyperlinks to other web pages and files. Web pages are created using HTML which stands for HyperText Markup Language. All web pages, whether big or small, have to be developed in HTML to be displayed in web browsers. HTML, contrary to its name, is not a language. Rather, it consists of tags that specify the purpose of what they enclose. For instance, by surrounding a block of text on a web page with the

tag (the paragraph tag) tells the browser that all that text is to be placed as paragraph or using the around a phrase will give emphasis to it. 7 Types of Web Pages Advocacy Web pages established for political candidates, called “e-campaigning,” has become an important part of politics. Surveys show that more than 50 percent of Internet users turn to the Web for information about political topics. Business/marketing Web pages used for shopping on the Internet are increasingly popular. In 1999, 17 million households shopped online. This figure is expected to grow to 49 million by 2004. A survey of back-to-school shoppers 34 years old and younger showed that 17 percent planned to shop online for their children’s school needs. Perhaps more significant, only 6 percent of surveyed shoppers reported being uncomfortable with buying on the Internet. Educational institutions frequently publish informational Web pages. Today, most colleges have web sites that offer course descriptions, information about the student population, and registration costs and deadlines. When shopping for college, surveys show that high school seniors use the Web more than catalogs or guidebooks; about 80 percent of college-bound students start looking at college Web sites as sophomores. News Web pages are the most popular Web sites among Americans with access to the Internet. Although these Web sites often are associated with newspapers, magazines, television stations, or radio stations, some are published only online, without a related print or broadcast media. Portal Web pages often offer the following free services: search engine, news, sports and weather, free personal Web pages, reference tools, shopping malls, e-mail, instant messaging, newsgroups, and chat rooms. The dictionary defines a “portal” as a door or gateway. Portal Web pages are gateways to a host of services. INTERNET CHAT On the Internet, chatting is talking to other people who are using the Internet at the same time you are. Usually, this ""talking"" is the exchange of typed-in messages requiring one site as the repository for the messages (or ""chat site"") and a group of users who take part from anywhere on the Internet. In some cases, a private chat can be arranged between two parties who meet initially in a group chat. Chats can be ongoing or scheduled for a particular time and duration. Most chats are focused on a particular topic of interest and some involve guest experts or famous people who ""talk"" to anyone joining the chat.","What are the different types of web pages? WEB PAGES Web pages are what make up the World Wide Web. These documents are written in HTML (Hypertext Markup Language) and are translated by your Web browser. Web pages can either be static or dynamic. Static pages show the same content each time they are viewed. Dynamic pages have content that can change each time they are accessed. These pages are typically written in scripting languages such as PHP, Perl, ASP, or JSP. The scripts in the pages run functions on the server that return things like the date and time, and database information. All the information is returned as HTML code, so when the page gets to your browser, all the browser has to do is translate the HTML. Electronic (digital) document created with HTML and, therefore, accessible with a browser. In addition to text and graphics, web pages may also contain downloadable data files, audio and video files, and hyperlinks to other pages or sites. A website is usually a collection of web pages. A web page is a document that's created in html that shows up on the internet when you type in or go to the web page's address. Web Page A web page is a document commonly written in HyperText Markup Language (HTML) that is accessible through the Internet or other network using a browser. A web page is accessed by entering a URL address and may contain text, graphics, and hyperlinks to other web pages and files. Web pages are created using HTML which stands for HyperText Markup Language. All web pages, whether big or small, have to be developed in HTML to be displayed in web browsers. HTML, contrary to its name, is not a language. Rather, it consists of tags that specify the purpose of what they enclose. For instance, by surrounding a block of text on a web page with the

tag (the paragraph tag) tells the browser that all that text is to be placed as paragraph or using the around a phrase will give emphasis to it. 7 Types of Web Pages Advocacy Web pages established for political candidates, called “e-campaigning,” has become an important part of politics. Surveys show that more than 50 percent of Internet users turn to the Web for information about political topics. Business/marketing Web pages used for shopping on the Internet are increasingly popular. In 1999, 17 million households shopped online. This figure is expected to grow to 49 million by 2004. A survey of back-to-school shoppers 34 years old and younger showed that 17 percent planned to shop online for their children’s school needs. Perhaps more significant, only 6 percent of surveyed shoppers reported being uncomfortable with buying on the Internet. Educational institutions frequently publish informational Web pages. Today, most colleges have web sites that offer course descriptions, information about the student population, and registration costs and deadlines. When shopping for college, surveys show that high school seniors use the Web more than catalogs or guidebooks; about 80 percent of college-bound students start looking at college Web sites as sophomores. News Web pages are the most popular Web sites among Americans with access to the Internet. Although these Web sites often are associated with newspapers, magazines, television stations, or radio stations, some are published only online, without a related print or broadcast media. Portal Web pages often offer the following free services: search engine, news, sports and weather, free personal Web pages, reference tools, shopping malls, e-mail, instant messaging, newsgroups, and chat rooms. The dictionary defines a “portal” as a door or gateway. Portal Web pages are gateways to a host of services. INTERNET CHAT On the Internet, chatting is talking to other people who are using the Internet at the same time you are. Usually, this ""talking"" is the exchange of typed-in messages requiring one site as the repository for the messages (or ""chat site"") and a group of users who take part from anywhere on the Internet. In some cases, a private chat can be arranged between two parties who meet initially in a group chat. Chats can be ongoing or scheduled for a particular time and duration. Most chats are focused on a particular topic of interest and some involve guest experts or famous people who ""talk"" to anyone joining the chat. Draw your answer from the above text only.",Internet/Technology,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Through the financial troubles and attempt to fix the economy, how much money has Zimbabwe raised through trading bonds explain in 7 to 10 sentences?","In the multicurrency era, domestic public debt reforms include the adoption of the cash budgeting system and introduction of new government securities in secondary market. According to the 2009 budget statement, the Government of National Unity (GNU) effected the cash budgeting system to circumvent further accrual of domestic debt. The cash budgeting system restricted government expenditures to available revenue instead of the cash flow profile associated with approved estimates. The cash budgeting system insulated monetary operations from fiscal operations and the domestic debt market was made inactive. However, in 2014, the government abandoned the cash budgeting system leading to the rejuvenation of excessive fiscal deficits, which aggravated domestic public borrowing and a slowdown in economic growth (IMF, 2015). As a control measure to the rising domestic public indebtedness, the Minister of Finance and Economic Development was instructed by the parliament to set out clearly in the fiscal policy the volume of net treasury securities issuance to be conducted for fiscal policy purposes each year, and how the raised money would be used (ZEPARU, 2013). Also, in a move meant to end quasi-fiscal activities by the reserve bank, the GNU in 2009 appointed the Commercial Bank of Zimbabwe as the state’s bank while modalities were being put in place to restore financial sanity at the apex bank (GoZ, 2009a; 2009b). In 2014, the government for the first time started to trade infrastructure bonds (GoZ, 2014b). The introduction of the 5-year tenor infrastructure bonds at a fixed interest of 9.5 percent, has not only enhanced financial deepening in the economy but also contributed to a paradigm shift in the structure of government debt. Also, the introduction of long term debt instruments by the government was intended at minimising rollover risk and lessen borrowing expenses associated with short term debt (Infrastructure Development Bank of Zimbabwe “IDBZ”, 2016). Until now, the government has raised US$5 million, $15 million and $22 million in 2015, 2016 and 2017, respectively, through the trading of infrastructure bonds on the capital markets (IDBZ, 2015, 2016; GoZ, 2017). At present, the government debt securities are being traded on the Zimbabwe Stock Exchange in the same manner as other stocks. To provide for the management of public debt in Zimbabwe on a statutory basis, mainly foreign public debt, the public debt reforms included public sector financial reforms and the institutionalisation and operationalisation of a Debt Management Office, which is currently housed in the Ministry of Finance and Economic Development. The responsibilities of the Debt Office are among others, to ensure public debt database validation and reconciliation with all creditors and to provide for the raising, management and servicing of loans by the state The Public Management Act Amended (2015) further stipulates that the Debt Office shall (1) formulate and publish a Medium Term Debt Management Strategy, (2) formulate and publish an annual borrowing plan, which includes a borrowing limit, and (3) undertake an annual debt sustainability analyses (MOFED, 2012).In 2011, the GNU instituted several foreign policy shifts, intended at reducing the country’s foreign public debt overhang, by re-engaging with creditors and the global community. The intention of the new re engagement policy reform was to seek comprehensive debt relief initiatives, as well as opening up new lines of offshore financing.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Through the financial troubles and attempt to fix the economy, how much money has Zimbabwe raised through trading bonds explain in 7 to 10 sentences? {passage 0} ========== In the multicurrency era, domestic public debt reforms include the adoption of the cash budgeting system and introduction of new government securities in secondary market. According to the 2009 budget statement, the Government of National Unity (GNU) effected the cash budgeting system to circumvent further accrual of domestic debt. The cash budgeting system restricted government expenditures to available revenue instead of the cash flow profile associated with approved estimates. The cash budgeting system insulated monetary operations from fiscal operations and the domestic debt market was made inactive. However, in 2014, the government abandoned the cash budgeting system leading to the rejuvenation of excessive fiscal deficits, which aggravated domestic public borrowing and a slowdown in economic growth (IMF, 2015). As a control measure to the rising domestic public indebtedness, the Minister of Finance and Economic Development was instructed by the parliament to set out clearly in the fiscal policy the volume of net treasury securities issuance to be conducted for fiscal policy purposes each year, and how the raised money would be used (ZEPARU, 2013). Also, in a move meant to end quasi-fiscal activities by the reserve bank, the GNU in 2009 appointed the Commercial Bank of Zimbabwe as the state’s bank while modalities were being put in place to restore financial sanity at the apex bank (GoZ, 2009a; 2009b). In 2014, the government for the first time started to trade infrastructure bonds (GoZ, 2014b). The introduction of the 5-year tenor infrastructure bonds at a fixed interest of 9.5 percent, has not only enhanced financial deepening in the economy but also contributed to a paradigm shift in the structure of government debt. Also, the introduction of long term debt instruments by the government was intended at minimising rollover risk and lessen borrowing expenses associated with short term debt (Infrastructure Development Bank of Zimbabwe “IDBZ”, 2016). Until now, the government has raised US$5 million, $15 million and $22 million in 2015, 2016 and 2017, respectively, through the trading of infrastructure bonds on the capital markets (IDBZ, 2015, 2016; GoZ, 2017). At present, the government debt securities are being traded on the Zimbabwe Stock Exchange in the same manner as other stocks. To provide for the management of public debt in Zimbabwe on a statutory basis, mainly foreign public debt, the public debt reforms included public sector financial reforms and the institutionalisation and operationalisation of a Debt Management Office, which is currently housed in the Ministry of Finance and Economic Development. The responsibilities of the Debt Office are among others, to ensure public debt database validation and reconciliation with all creditors and to provide for the raising, management and servicing of loans by the state The Public Management Act Amended (2015) further stipulates that the Debt Office shall (1) formulate and publish a Medium Term Debt Management Strategy, (2) formulate and publish an annual borrowing plan, which includes a borrowing limit, and (3) undertake an annual debt sustainability analyses (MOFED, 2012).In 2011, the GNU instituted several foreign policy shifts, intended at reducing the country’s foreign public debt overhang, by re-engaging with creditors and the global community. The intention of the new re engagement policy reform was to seek comprehensive debt relief initiatives, as well as opening up new lines of offshore financing. http://www.ijqr.net/journal/v12-n1/6.pdf",Financial,Fact Finding,Q&A You are given a reference document. You must only use information found in the reference document to answer the question asked.,What is the case for it not being a smart financial decision to participate in Cyber Monday based on the given information?,"Is It A Smart Financial Decision To Participate In Cyber Monday? True Tamplin Contributor Cyber Monday is around the corner, promising big online discounts and deals. With its attractive offers and hidden risks, it’s important to understand how Cyber Monday affects your shopping habits and financial health before deciding whether to take part in this major online event. Benefits Of Cyber Monday Potential Savings And Discounts Retailers compete to attract customers during Cyber Monday, resulting in some of the lowest prices of the year on a wide range of products. These discounts aren’t limited to overstock or outdated items; often, they include the latest electronics, fashion, and more. The key here is the scale and breadth of these discounts, which can apply to both luxury and everyday items, making it a prime opportunity for you to make significant savings on high-ticket items or stock up on essentials. Convenience And Ease Of Shopping In today’s fast-paced world, the ability to shop from anywhere is a significant advantage. This ease of access not only saves time but also reduces the physical and mental stress associated with holiday shopping. Cyber Monday also simplifies comparing prices across different websites, reading reviews, and making informed choices without the pressure of in-store sales tactics. Additionally, the online platform allows for a more personalized shopping experience, with algorithms suggesting products that align with your interests and past shopping behavior. Cyber Monday is known for exclusive deals that are not available at other times of the year. These can include not only price reductions but also bundle deals, where additional products are included at a lower combined cost. These deals can be particularly appealing for acquiring high-demand items like electronics, designer brands, or new releases, which are rarely discounted at other times. Finding Unique Or Hard-To-Find Items Unlike physical stores, which have limited shelf space and tend to stock only the most popular items, online retailers can offer a more diverse range of products. During Cyber Monday, with its expanded focus on sales, even niche retailers and small businesses participate, offering unique or handcrafted items that aren’t available in mainstream stores. This aspect of Cyber Monday can be particularly appealing to those looking for specialty items, collector’s items, or bespoke products. Drawbacks Of Cyber Monday Risk Of Overspending The lure of great deals can sometimes lead to impulsive buying decisions. Consumers often buy items they don’t need, swayed by the perceived value of the discounts. This risk is heightened during Cyber Monday due to the aggressive marketing tactics employed by retailers, leveraging the scarcity and time-limited nature of deals. The psychological impact of seeing a countdown timer or a limited stock alert can override rational decision-making, leading to purchases that might not align with your needs or financial capacity. This can result in financial strain, buyer’s remorse, and unnecessary items, negating the very benefits you sought to gain from the sale. Scams And Fraudulent Websites The high volume of online traffic make Cyber Monday a ripe target for scammers. These fraudulent activities can range from creating entirely fake shopping sites that mimic legitimate ones, to more subtle scams, such as selling counterfeit or substandard products. The risk extends to cybersecurity threats, such as phishing attempts designed to steal personal and financial information. You might end up losing money, compromise your data, or receive inferior products, turning what should have been a savvy shopping experience into a costly mistake. Potential Delays Due to the sheer volume of transactions, the risk of delays in shipping and the possibility of popular items being back-ordered are significant. This can be particularly frustrating when purchasing gifts for the holidays, as items may not arrive in time. The frustration is compounded when customer service lines are overwhelmed, leaving you with little recourse but to wait. If you require immediate product availability, relying on Cyber Monday purchases can be a gamble. Technological Issues Websites crashing or slowing down during high-traffic periods can be a major deterrent, with pages taking too long to load or transactions failing to process. In the worst-case scenario, you might lose out on a deal due to a website crash just as you were about to complete a purchase. This can also raise security concerns, as interrupted transactions might expose your financial details or lead to double-charging. Factors To Consider In Decision-Making Financial Situation And Budget Before diving into Cyber Monday deals, assess your finances. It’s essential to set a budget and stick to it, ensuring that any purchases made are within your means and don’t lead to financial strain. It involves scrutinizing your financial health and setting a budget specifically for Cyber Monday shopping. A well-planned budget should account for not only the cost of the items but also any additional expenses, such as shipping or potential return fees. Shopping Needs And Preferences Are the items you’re interested in likely to be on sale? Does the convenience of online shopping appeal to you? For instance, if you are in the market for high-tech gadgets or specific fashion brands, Cyber Monday might offer the best deals. However, for items that don’t typically see significant discounts, it might not be as beneficial. This assessment also includes considering your shopping habits – whether you enjoy the thrill of finding deals in a time-sensitive environment or prefer a more relaxed, thoughtful shopping experience. Research And Price Comparison Price comparison is crucial, as some deals advertised for Cyber Monday might not be as exclusive or advantageous as they seem. Retailers often inflate original prices to make discounts appear more significant. Additionally, the same product might be available at a lower price at a different time or from a different retailer. Thorough research ensures that the decision to buy is based on the best available information, leading to more satisfactory and value-for-money purchases. Alternative Shopping Occasions Consider other sales events throughout the year, such as Black Friday, post-holiday sales, or even random flash sales. Each of these occasions has its own set of advantages. For example, Black Friday might offer better deals for in-store shopping, while post-holiday sales could be ideal for non-seasonal items. By comparing Cyber Monday with these alternatives, you can determine the best time to purchase the items you need, potentially finding better deals or a shopping experience more suited to your preferences. Final Thoughts Whether or not to participate in Cyber Monday depends on your individual circumstances. If you’re a savvy shopper who knows what you want, can stick to a budget, and are comfortable navigating online platforms, Cyber Monday can be a fruitful shopping experience. If not, there are always other times to shop. Keep an eye out for deals throughout the year, and remember that patience can often lead to better savings without the rush and pressure of a single day event. Happy shopping! Or not. Follow me on Twitter or LinkedIn. Check out my website or some of my other work here. ","You are given a reference document. You must only use information found in the reference document to answer the question asked. What is the case for it not being a smart financial decision to participate in Cyber Monday based on the given information? Is It A Smart Financial Decision To Participate In Cyber Monday? True Tamplin Contributor Cyber Monday is around the corner, promising big online discounts and deals. With its attractive offers and hidden risks, it’s important to understand how Cyber Monday affects your shopping habits and financial health before deciding whether to take part in this major online event. Benefits Of Cyber Monday Potential Savings And Discounts Retailers compete to attract customers during Cyber Monday, resulting in some of the lowest prices of the year on a wide range of products. These discounts aren’t limited to overstock or outdated items; often, they include the latest electronics, fashion, and more. The key here is the scale and breadth of these discounts, which can apply to both luxury and everyday items, making it a prime opportunity for you to make significant savings on high-ticket items or stock up on essentials. Convenience And Ease Of Shopping In today’s fast-paced world, the ability to shop from anywhere is a significant advantage. This ease of access not only saves time but also reduces the physical and mental stress associated with holiday shopping. Cyber Monday also simplifies comparing prices across different websites, reading reviews, and making informed choices without the pressure of in-store sales tactics. Additionally, the online platform allows for a more personalized shopping experience, with algorithms suggesting products that align with your interests and past shopping behavior. Cyber Monday is known for exclusive deals that are not available at other times of the year. These can include not only price reductions but also bundle deals, where additional products are included at a lower combined cost. These deals can be particularly appealing for acquiring high-demand items like electronics, designer brands, or new releases, which are rarely discounted at other times. Finding Unique Or Hard-To-Find Items Unlike physical stores, which have limited shelf space and tend to stock only the most popular items, online retailers can offer a more diverse range of products. During Cyber Monday, with its expanded focus on sales, even niche retailers and small businesses participate, offering unique or handcrafted items that aren’t available in mainstream stores. This aspect of Cyber Monday can be particularly appealing to those looking for specialty items, collector’s items, or bespoke products. Drawbacks Of Cyber Monday Risk Of Overspending The lure of great deals can sometimes lead to impulsive buying decisions. Consumers often buy items they don’t need, swayed by the perceived value of the discounts. This risk is heightened during Cyber Monday due to the aggressive marketing tactics employed by retailers, leveraging the scarcity and time-limited nature of deals. The psychological impact of seeing a countdown timer or a limited stock alert can override rational decision-making, leading to purchases that might not align with your needs or financial capacity. This can result in financial strain, buyer’s remorse, and unnecessary items, negating the very benefits you sought to gain from the sale. Scams And Fraudulent Websites The high volume of online traffic make Cyber Monday a ripe target for scammers. These fraudulent activities can range from creating entirely fake shopping sites that mimic legitimate ones, to more subtle scams, such as selling counterfeit or substandard products. The risk extends to cybersecurity threats, such as phishing attempts designed to steal personal and financial information. You might end up losing money, compromise your data, or receive inferior products, turning what should have been a savvy shopping experience into a costly mistake. Potential Delays Due to the sheer volume of transactions, the risk of delays in shipping and the possibility of popular items being back-ordered are significant. This can be particularly frustrating when purchasing gifts for the holidays, as items may not arrive in time. The frustration is compounded when customer service lines are overwhelmed, leaving you with little recourse but to wait. If you require immediate product availability, relying on Cyber Monday purchases can be a gamble. Technological Issues Websites crashing or slowing down during high-traffic periods can be a major deterrent, with pages taking too long to load or transactions failing to process. In the worst-case scenario, you might lose out on a deal due to a website crash just as you were about to complete a purchase. This can also raise security concerns, as interrupted transactions might expose your financial details or lead to double-charging. Factors To Consider In Decision-Making Financial Situation And Budget Before diving into Cyber Monday deals, assess your finances. It’s essential to set a budget and stick to it, ensuring that any purchases made are within your means and don’t lead to financial strain. It involves scrutinizing your financial health and setting a budget specifically for Cyber Monday shopping. A well-planned budget should account for not only the cost of the items but also any additional expenses, such as shipping or potential return fees. Shopping Needs And Preferences Are the items you’re interested in likely to be on sale? Does the convenience of online shopping appeal to you? For instance, if you are in the market for high-tech gadgets or specific fashion brands, Cyber Monday might offer the best deals. However, for items that don’t typically see significant discounts, it might not be as beneficial. This assessment also includes considering your shopping habits – whether you enjoy the thrill of finding deals in a time-sensitive environment or prefer a more relaxed, thoughtful shopping experience. Research And Price Comparison Price comparison is crucial, as some deals advertised for Cyber Monday might not be as exclusive or advantageous as they seem. Retailers often inflate original prices to make discounts appear more significant. Additionally, the same product might be available at a lower price at a different time or from a different retailer. Thorough research ensures that the decision to buy is based on the best available information, leading to more satisfactory and value-for-money purchases. Alternative Shopping Occasions Consider other sales events throughout the year, such as Black Friday, post-holiday sales, or even random flash sales. Each of these occasions has its own set of advantages. For example, Black Friday might offer better deals for in-store shopping, while post-holiday sales could be ideal for non-seasonal items. By comparing Cyber Monday with these alternatives, you can determine the best time to purchase the items you need, potentially finding better deals or a shopping experience more suited to your preferences. Final Thoughts Whether or not to participate in Cyber Monday depends on your individual circumstances. If you’re a savvy shopper who knows what you want, can stick to a budget, and are comfortable navigating online platforms, Cyber Monday can be a fruitful shopping experience. If not, there are always other times to shop. Keep an eye out for deals throughout the year, and remember that patience can often lead to better savings without the rush and pressure of a single day event. Happy shopping! Or not. Follow me on Twitter or LinkedIn. Check out my website or some of my other work here. ",Financial,Effect Analysis,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","If I have an athletic scholarship and attending a U.S. College with a Visa, can I get an NIL? Use a real life example from someone explaining a legal situation as I do not want to try to comprehend too much jargon.","In June 2021, the long debate over whether college athletes should get paid gained some momentum as the National Collegiate Athletic Association (NCAA) passed its name, image, and likeness (NIL) policy, which enables student-athletes to be compensated for their names, images, and likenesses. This policy, which permitted athletes to pursue commercials, social media endorsements, and merchandise, for starters, served as a game changer for UC San Diego athletes by giving them opportunities to earn income while still maintaining their amateur status. UCSD second-year basketball player and Sixth College Public Health major Francis Nwaokorie is all for it. “I think it’s really good to allow athletes to build their brand up at such a young age and potentially provide for their families in the future,” Nwaokorie said. While Nwaokorie did not consider NIL deals during his freshman year when the NIL policy was new to collegiate athletics, he is starting to look more into NIL deals this year. “Coming in as a freshman last year, I had a lot of offers for NIL deals, but I was really focused on the season and trying to make sure I got playing time and didn’t want to get distracted with that stuff at that time,” Nwaokorie said. “Now, as a sophomore, I’m starting to look more into that stuff now that I am more experienced.” Second-year soccer player Andrew Valverde, a Sixth College Political Science major, transferred from UCLA to UCSD after his freshman season and believes that soccer is one of the sports that lacks the attention that some other high-profile sports like football and basketball receive. Football and basketball receive the most compensation in the NIL market, leaving other sports far behind. However, Valverde has been able to sign multiple NIL deals. “I have had the luck to secure great deals with great sponsors. I was a student-athlete ambassador for a soccer clothing brand called CRKSOLY., and they gave me opportunities to showcase myself and their brand,” Valverde said. “I also have been able to get a sponsorship through a trainer and have access to get free training.” Valverde mentioned the continued struggle most athletes face to find a NIL deal. “I do wish UCSD makes sponsorships more available for all its athletes and maybe more training so athletes know what they are getting into,” Valverde said. “Basketball and soccer may be [some] of the more high profile sports on the NCAA stage but for some sports, the opportunity to maximize their NIL may be tied to their respective schools.” According to Jeff Tourial, UCSD’s Associate Athletic Director, the resources are there for students. “We have created a portal on our website that answers many questions our scholar-athletes may have. In addition, our compliance staff has created a dedicated email address to further provide one-on-one guidance as needed. The Big West partnered with Compass in 2021 to provide a portal assisting SA [student-athletes] in deals,” Tourial stated. Though UCSD’s location in San Diego can mean that there are plenty of opportunities for student-athletes to capitalize on, UCSD’s conference affiliation limits its national exposure to a tier below other schools in the Pac-12 conference such as UCLA, USC, and UC Berkeley — schools that are more known for their athletics and can spend more on athletics, draw in better athletes, and bring more recognition toward their athletes in terms of media exposure. While this does not necessarily mean the NIL opportunities are not there, UCSD student-athletes may have a harder time signing more lucrative NIL deals compared to student-athletes from other schools. “I know a few people on other teams who have made deals with Liquid IV,” UCSD fourth-year water polo player and Eleanor Roosevelt College (ERC) Business Psychology major Kayla Peacock said. “They mostly get merchandise and products, depending on the company.” According to Peacock, there is some frustration regarding the NIL deals’ ambiguous criteria. NIL deals’ criteria states that athletes still have to adhere to school policies and state laws. “My only criticism of NIL is that we were trying to get our team to be sponsored by Crocs and they sent us a discount code and we weren’t allowed to use it. I don’t really understand why. So my complaint is that the rules are unclear for us as scholar-athletes,” Peacock said. NIL opportunities are not available for every student-athlete. For Derek Rong, they are nonexistent. Rong, a first-year ERC Business Economics major, is from Canada and is living in the U.S. on a student visa. Although the visa permits Rong to work on campus, the visa stipulates that he cannot work for a business outside of his college. “I think international students should be able to have the same opportunities,“ stated Rong, who is a fencer. “It’s more about the athlete’s performance and influence. I don’t have any deals, but I would love to explore them.“ This might be the start of a push for more rights for college athletes in California. A bill in the formative stages could see student-athletes earn a share of the revenue tied to graduation. Essentially, athletes could make up a maximum of $25,000 per year and excess money would be placed in a fund that they can access if they graduate within six years. With Division I athletics raking in $15.8 billion in revenue, there is still a lot of money left at the table. “Certainly, I feel like that [increased rights for college athletes] can really help student-athletes who aren’t in the best situation income-wise at home and also help student-athletes pay for more things they need like airfare/transportation back home or even just to have extra money just in case of an emergency,” Nwaokorie said.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== If I have an athletic scholarship and attending a U.S. College with a Visa, can I get an NIL? Use a real life example from someone explaining a legal situation as I do not want to try to comprehend too much jargon. {passage 0} ========== In June 2021, the long debate over whether college athletes should get paid gained some momentum as the National Collegiate Athletic Association (NCAA) passed its name, image, and likeness (NIL) policy, which enables student-athletes to be compensated for their names, images, and likenesses. This policy, which permitted athletes to pursue commercials, social media endorsements, and merchandise, for starters, served as a game changer for UC San Diego athletes by giving them opportunities to earn income while still maintaining their amateur status. UCSD second-year basketball player and Sixth College Public Health major Francis Nwaokorie is all for it. “I think it’s really good to allow athletes to build their brand up at such a young age and potentially provide for their families in the future,” Nwaokorie said. While Nwaokorie did not consider NIL deals during his freshman year when the NIL policy was new to collegiate athletics, he is starting to look more into NIL deals this year. “Coming in as a freshman last year, I had a lot of offers for NIL deals, but I was really focused on the season and trying to make sure I got playing time and didn’t want to get distracted with that stuff at that time,” Nwaokorie said. “Now, as a sophomore, I’m starting to look more into that stuff now that I am more experienced.” Second-year soccer player Andrew Valverde, a Sixth College Political Science major, transferred from UCLA to UCSD after his freshman season and believes that soccer is one of the sports that lacks the attention that some other high-profile sports like football and basketball receive. Football and basketball receive the most compensation in the NIL market, leaving other sports far behind. However, Valverde has been able to sign multiple NIL deals. “I have had the luck to secure great deals with great sponsors. I was a student-athlete ambassador for a soccer clothing brand called CRKSOLY., and they gave me opportunities to showcase myself and their brand,” Valverde said. “I also have been able to get a sponsorship through a trainer and have access to get free training.” Valverde mentioned the continued struggle most athletes face to find a NIL deal. “I do wish UCSD makes sponsorships more available for all its athletes and maybe more training so athletes know what they are getting into,” Valverde said. “Basketball and soccer may be [some] of the more high profile sports on the NCAA stage but for some sports, the opportunity to maximize their NIL may be tied to their respective schools.” According to Jeff Tourial, UCSD’s Associate Athletic Director, the resources are there for students. “We have created a portal on our website that answers many questions our scholar-athletes may have. In addition, our compliance staff has created a dedicated email address to further provide one-on-one guidance as needed. The Big West partnered with Compass in 2021 to provide a portal assisting SA [student-athletes] in deals,” Tourial stated. Though UCSD’s location in San Diego can mean that there are plenty of opportunities for student-athletes to capitalize on, UCSD’s conference affiliation limits its national exposure to a tier below other schools in the Pac-12 conference such as UCLA, USC, and UC Berkeley — schools that are more known for their athletics and can spend more on athletics, draw in better athletes, and bring more recognition toward their athletes in terms of media exposure. While this does not necessarily mean the NIL opportunities are not there, UCSD student-athletes may have a harder time signing more lucrative NIL deals compared to student-athletes from other schools. “I know a few people on other teams who have made deals with Liquid IV,” UCSD fourth-year water polo player and Eleanor Roosevelt College (ERC) Business Psychology major Kayla Peacock said. “They mostly get merchandise and products, depending on the company.” According to Peacock, there is some frustration regarding the NIL deals’ ambiguous criteria. NIL deals’ criteria states that athletes still have to adhere to school policies and state laws. “My only criticism of NIL is that we were trying to get our team to be sponsored by Crocs and they sent us a discount code and we weren’t allowed to use it. I don’t really understand why. So my complaint is that the rules are unclear for us as scholar-athletes,” Peacock said. NIL opportunities are not available for every student-athlete. For Derek Rong, they are nonexistent. Rong, a first-year ERC Business Economics major, is from Canada and is living in the U.S. on a student visa. Although the visa permits Rong to work on campus, the visa stipulates that he cannot work for a business outside of his college. “I think international students should be able to have the same opportunities,“ stated Rong, who is a fencer. “It’s more about the athlete’s performance and influence. I don’t have any deals, but I would love to explore them.“ This might be the start of a push for more rights for college athletes in California. A bill in the formative stages could see student-athletes earn a share of the revenue tied to graduation. Essentially, athletes could make up a maximum of $25,000 per year and excess money would be placed in a fund that they can access if they graduate within six years. With Division I athletics raking in $15.8 billion in revenue, there is still a lot of money left at the table. “Certainly, I feel like that [increased rights for college athletes] can really help student-athletes who aren’t in the best situation income-wise at home and also help student-athletes pay for more things they need like airfare/transportation back home or even just to have extra money just in case of an emergency,” Nwaokorie said. https://triton.news/2023/05/nil-deals-bring-more-frustration-than-they-see-fit/",Legal,Explanation/Definition,Q&A system instructions: Do not use any prior knowledge. Do not use any outside sources. Only use the above text to answer the question. Answer using a numbered list with 3-4 points. Limit each point to one sentence. Put the most important aspect of each point in bold.,question: What actions are suggested to increase understanding of the USDA program?,"context block: Notification Requirements.—The Committee reminds the Department that the Committee uses the definitions for transfer, reprogramming, and program, project, and activity as defined by the Government Accountability Office (GAO). As noted in the fiscal year 2023 Joint Explanatory Statement, a program, project, or activity (PPA) is an element within a budget account. PPAs are identified by reference to include the most specific level of budget items identified in the Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Act, 2023, accompanying Committee reports, explanatory statements, and budget justifications. The Committee notes that the most specific level of budget items in USDA budget justifications is not limited to tables titled ‘‘Project Statement’’. PFAS.—The Committee notes that there are previously provided funds related to polyfluoroalkyl substances (PFAS) which remain available. The Committee remains concerned that there are significant knowledge gaps related to PFAS and its impact on agriculture. Therefore, the Committee awaits a plan from USDA and will continue to monitor PFAS. Resilient Building Materials.—With increases in weather-related and other natural disasters, there is a clear need to increase resilience of the nation’s buildings and infrastructure. Mass timber and other innovative wood products, when appropriately used in the construction of buildings and other infrastructure, have been shown to withstand wind, seismic, and other natural forces with robust results. The Committee acknowledges the need to include these products in any categorization of products considered to be resilient by USDA and other Federal agencies. The Committee, therefore, encourages USDA to support programs that include the use of wood products to improve the nation’s ability to withstand and recover from weather-related and other natural events. Rural Healthcare.—The Committee is encouraged by the opportunities to address nutrition security and rural healthcare across the Department and urges the Department to integrate strategic outcomes from recent summits across Rural Development, Food and Nutrition Services, Agricultural Marketing Service to provide technical assistance and guidance with respect to these outcomes to the Department’s outreach, extension, and county offices, particularly in communities that lack application experience or healthcare facilities. Simplified USDA Applications.—USDA customers are overburdened with complex program applications, contracts, and reporting. The Committee requests a report from USDA describing the barriers to simplifying program applications, contracts, and reporting. The report should also include any plans USDA has to simplify these documents and procedures. Spending Plans.—The bill continues a provision in Title VII that requires USDA to submit spending plans to the Committee within 30 days of enactment. Previous versions of these plans have not included adequate details that would be useful for Committee overVerDate Sep 11 2014 22:55 Jun 28, 2023 Jkt 052642 PO 00000 Frm 00007 Fmt 6659 Sfmt 6602 E:\HR\OC\HR124.XXX HR124 dmwilson on DSKJM0X7X2PROD with REPORTS 8 sight. The Committee requests that USDA spending plans include for each program, project, or activity: (1) a comparison between the budget justification funding levels, the most recent Congressional directives or approved funding levels, and the funding levels proposed by the department or agency; and (2) a clear, concise, and informative description/justification. The Committee reminds USDA of notification requirements, also included in Title VII, for all applicable changes. Status of House and Senate Report Language.—The Department is directed to include in its fiscal year 2025 Congressional Justification, as a single exhibit, a table listing all deliverables, with a column for due dates if applicable. OBPA is directed to provide updates on the status of House and Senate reports upon request from the Committees. Underserved Producers Program.—The Committee is concerned about the Department’s reckless implementation of Section 22007 of the Inflation Reduction Act through nongovernmental entities who undergo no formal application process to aid farmers, ranchers, and foresters who have experienced discrimination in FSA lending programs. The Committee notes that the precursor to this provision, Section 1005 of the American Rescue Plan Act, which provided loan forgiveness for socially disadvantaged farmers and ranchers, was struck down in court on equal protection grounds. The Committee reminds the Department that U.S. courts have held that significant participation by the Federal government in nongovernmental entities’ unconstitutional actions may be a violation of the Fourteenth Amendment. As the Department provides nongovernmental entities with entirely Federal funds, the Committee will closely monitor the Department’s use and involvement in the administration of the Section 22007 funds. USDA Domestic and International Commodity Procurement Review.—The COVID–19 pandemic and resulting supply chain disruptions revealed fragilities in America’s food supply, to the detriment of farmers, producers, and consumers across America. The Committee directs AMS and ERS to review USDA’s application and enrollment procedures, required commodity quality, best and most available commodities for purchase regionally, and outreach practices to small and local farmers for all available domestic and international USDA procurement programs. This will help increase understanding of programs and purchasing to elevate fair participation of America’s small and local farmers. Within 180 days of enactment of this Act, AMS and ERS shall report back on their findings and efforts on improving small and local farmer procurement for relevant USDA programs. USDA Farm Delivery Systems Modernization.—The Committee includes language that requires the Secretary to submit a plan to accelerate the implementation and use of the Farmers.gov application and the Enterprise Data Analytics Platform and Toolset (EDAPT). The Committee is aware that despite continued direction and funding provided by Congress, the Farm Service Agency, the Farm Production and Conservation Business Center, and the Office of the Chief Information Officer continue to maintain numerous legacy mission support systems that should be decommissioned and transitioned to applications that are interoperable, facts-based, data driven, and provide excellent customer service.","context block: Notification Requirements.—The Committee reminds the Department that the Committee uses the definitions for transfer, reprogramming, and program, project, and activity as defined by the Government Accountability Office (GAO). As noted in the fiscal year 2023 Joint Explanatory Statement, a program, project, or activity (PPA) is an element within a budget account. PPAs are identified by reference to include the most specific level of budget items identified in the Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Act, 2023, accompanying Committee reports, explanatory statements, and budget justifications. The Committee notes that the most specific level of budget items in USDA budget justifications is not limited to tables titled ‘‘Project Statement’’. PFAS.—The Committee notes that there are previously provided funds related to polyfluoroalkyl substances (PFAS) which remain available. The Committee remains concerned that there are significant knowledge gaps related to PFAS and its impact on agriculture. Therefore, the Committee awaits a plan from USDA and will continue to monitor PFAS. Resilient Building Materials.—With increases in weather-related and other natural disasters, there is a clear need to increase resilience of the nation’s buildings and infrastructure. Mass timber and other innovative wood products, when appropriately used in the construction of buildings and other infrastructure, have been shown to withstand wind, seismic, and other natural forces with robust results. The Committee acknowledges the need to include these products in any categorization of products considered to be resilient by USDA and other Federal agencies. The Committee, therefore, encourages USDA to support programs that include the use of wood products to improve the nation’s ability to withstand and recover from weather-related and other natural events. Rural Healthcare.—The Committee is encouraged by the opportunities to address nutrition security and rural healthcare across the Department and urges the Department to integrate strategic outcomes from recent summits across Rural Development, Food and Nutrition Services, Agricultural Marketing Service to provide technical assistance and guidance with respect to these outcomes to the Department’s outreach, extension, and county offices, particularly in communities that lack application experience or healthcare facilities. Simplified USDA Applications.—USDA customers are overburdened with complex program applications, contracts, and reporting. The Committee requests a report from USDA describing the barriers to simplifying program applications, contracts, and reporting. The report should also include any plans USDA has to simplify these documents and procedures. Spending Plans.—The bill continues a provision in Title VII that requires USDA to submit spending plans to the Committee within 30 days of enactment. Previous versions of these plans have not included adequate details that would be useful for Committee overVerDate Sep 11 2014 22:55 Jun 28, 2023 Jkt 052642 PO 00000 Frm 00007 Fmt 6659 Sfmt 6602 E:\HR\OC\HR124.XXX HR124 dmwilson on DSKJM0X7X2PROD with REPORTS 8 sight. The Committee requests that USDA spending plans include for each program, project, or activity: (1) a comparison between the budget justification funding levels, the most recent Congressional directives or approved funding levels, and the funding levels proposed by the department or agency; and (2) a clear, concise, and informative description/justification. The Committee reminds USDA of notification requirements, also included in Title VII, for all applicable changes. Status of House and Senate Report Language.—The Department is directed to include in its fiscal year 2025 Congressional Justification, as a single exhibit, a table listing all deliverables, with a column for due dates if applicable. OBPA is directed to provide updates on the status of House and Senate reports upon request from the Committees. Underserved Producers Program.—The Committee is concerned about the Department’s reckless implementation of Section 22007 of the Inflation Reduction Act through nongovernmental entities who undergo no formal application process to aid farmers, ranchers, and foresters who have experienced discrimination in FSA lending programs. The Committee notes that the precursor to this provision, Section 1005 of the American Rescue Plan Act, which provided loan forgiveness for socially disadvantaged farmers and ranchers, was struck down in court on equal protection grounds. The Committee reminds the Department that U.S. courts have held that significant participation by the Federal government in nongovernmental entities’ unconstitutional actions may be a violation of the Fourteenth Amendment. As the Department provides nongovernmental entities with entirely Federal funds, the Committee will closely monitor the Department’s use and involvement in the administration of the Section 22007 funds. USDA Domestic and International Commodity Procurement Review.—The COVID–19 pandemic and resulting supply chain disruptions revealed fragilities in America’s food supply, to the detriment of farmers, producers, and consumers across America. The Committee directs AMS and ERS to review USDA’s application and enrollment procedures, required commodity quality, best and most available commodities for purchase regionally, and outreach practices to small and local farmers for all available domestic and international USDA procurement programs. This will help increase understanding of programs and purchasing to elevate fair participation of America’s small and local farmers. Within 180 days of enactment of this Act, AMS and ERS shall report back on their findings and efforts on improving small and local farmer procurement for relevant USDA programs. USDA Farm Delivery Systems Modernization.—The Committee includes language that requires the Secretary to submit a plan to accelerate the implementation and use of the Farmers.gov application and the Enterprise Data Analytics Platform and Toolset (EDAPT). The Committee is aware that despite continued direction and funding provided by Congress, the Farm Service Agency, the Farm Production and Conservation Business Center, and the Office of the Chief Information Officer continue to maintain numerous legacy mission support systems that should be decommissioned and transitioned to applications that are interoperable, facts-based, data driven, and provide excellent customer service. system instructions: Do not use any prior knowledge. Do not use any outside sources. Only use the above text to answer the question. Answer using a numbered list with 3-4 points. Limit each point to one sentence. Put the most important aspect of each point in bold. question: What actions are suggested to increase understanding of the USDA program?",Legal,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",What do you expect of Bitcoin in the near future? Will it grow or diminish? Make your response thorough and no less than 150 words?,"Bitcoin's recent price movements have caused concern among investors about what might come next. However, by looking at key indicators such as the 200-week moving average, Pi Cycle Top Indicator, and the Golden Ratio Multiplier, we can gain insights into potential support and resistance levels for Bitcoin. Leaning Bearish? If this bearish price action is to continue and price breaks to lower lows the 200-week moving average heatmap (blue line), a historically critical support level, is currently close to $39,000 but fast approaching $40,000 (white line). This round psychological level also aligns with the Bitcoin Investor Tool (green line), which has also converged with the 200-week moving average, could serve as potential downside targets. Figure 1: Converging levels of support at $40,000 if bearish price action continues. Figure 1: Converging levels of support at $40,000 if bearish price action continues. Nearby Targets Above current price there are several important levels closer to the current price that investors need to keep an eye on. The Pi Cycle Top Indicator (upper orange line) suggests a crucial resistance level around $62,000, based on the 111-day moving average. The Golden Ratio Multiplier (lower orange line) indicates that the 350-day moving average, currently around $53,000, has been a solid level of support during this market cycle, especially as this is close to the technical $52,000 support and significant psychological support of $50,000. ADVERTISING Figure 2: Nearby support between $53,000 and $50,000, with immediate resistance between $60,000 and $62,000. Figure 2: Nearby support between $53,000 and $50,000, with immediate resistance between $60,000 and $62,000. More Chop? In the short term, Bitcoin could very well continue ranging between the low $50,000 region and the $60,000 resistance, similar to the range we had formed between $70,000 and $60,000 that led to fairly stagnant price action for a majority of 2024. Despite recent downturns, Bitcoin's long-term outlook is still promising. In the past, Bitcoin has experienced similar periods of fluctuating prices before eventually reaching new highs. However, this process can take some time, potentially weeks or even months, before a sustainable trend reversal occurs following periods of low volatility. Conclusion For long-term investors, it's important to remain calm and not be swayed by day-to-day price changes. Over-trading often leads to poor decisions and losses, and the key is to stick to a strategy, whether it involves accumulating at support levels or taking profits at resistance. Bitcoin's recent price action has not been ideal, but with some simple technical analysis and a clear understanding of support and resistance levels, investors can prepare and react rather than over overreact to natural market fluctuations. While investing in Bitcoin is still considered a wild ride, the asset is quickly maturing. Financial institutions are closing in and creating hybrid vehicles to invest in cryptocurrency. The ecosystem reached a new milestone with the advent of Bitcoin ETFs, making people realize the immensity of Bitcoin’s potential in traditional markets and spurring new demand. It is not enough to leave the knowledge to technical experts or institutions. By understanding the importance of secure Bitcoin storage and the advancements in custody solutions, investors can make better-informed decisions about safeguarding their digital assets.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What do you expect of Bitcoin in the near future? Will it grow or diminish? Make your response thorough and no less than 150 words? {passage 0} ========== Bitcoin's recent price movements have caused concern among investors about what might come next. However, by looking at key indicators such as the 200-week moving average, Pi Cycle Top Indicator, and the Golden Ratio Multiplier, we can gain insights into potential support and resistance levels for Bitcoin. Leaning Bearish? If this bearish price action is to continue and price breaks to lower lows the 200-week moving average heatmap (blue line), a historically critical support level, is currently close to $39,000 but fast approaching $40,000 (white line). This round psychological level also aligns with the Bitcoin Investor Tool (green line), which has also converged with the 200-week moving average, could serve as potential downside targets. Figure 1: Converging levels of support at $40,000 if bearish price action continues. Figure 1: Converging levels of support at $40,000 if bearish price action continues. Nearby Targets Above current price there are several important levels closer to the current price that investors need to keep an eye on. The Pi Cycle Top Indicator (upper orange line) suggests a crucial resistance level around $62,000, based on the 111-day moving average. The Golden Ratio Multiplier (lower orange line) indicates that the 350-day moving average, currently around $53,000, has been a solid level of support during this market cycle, especially as this is close to the technical $52,000 support and significant psychological support of $50,000. ADVERTISING Figure 2: Nearby support between $53,000 and $50,000, with immediate resistance between $60,000 and $62,000. Figure 2: Nearby support between $53,000 and $50,000, with immediate resistance between $60,000 and $62,000. More Chop? In the short term, Bitcoin could very well continue ranging between the low $50,000 region and the $60,000 resistance, similar to the range we had formed between $70,000 and $60,000 that led to fairly stagnant price action for a majority of 2024. Despite recent downturns, Bitcoin's long-term outlook is still promising. In the past, Bitcoin has experienced similar periods of fluctuating prices before eventually reaching new highs. However, this process can take some time, potentially weeks or even months, before a sustainable trend reversal occurs following periods of low volatility. Conclusion For long-term investors, it's important to remain calm and not be swayed by day-to-day price changes. Over-trading often leads to poor decisions and losses, and the key is to stick to a strategy, whether it involves accumulating at support levels or taking profits at resistance. Bitcoin's recent price action has not been ideal, but with some simple technical analysis and a clear understanding of support and resistance levels, investors can prepare and react rather than over overreact to natural market fluctuations. While investing in Bitcoin is still considered a wild ride, the asset is quickly maturing. Financial institutions are closing in and creating hybrid vehicles to invest in cryptocurrency. The ecosystem reached a new milestone with the advent of Bitcoin ETFs, making people realize the immensity of Bitcoin’s potential in traditional markets and spurring new demand. It is not enough to leave the knowledge to technical experts or institutions. By understanding the importance of secure Bitcoin storage and the advancements in custody solutions, investors can make better-informed decisions about safeguarding their digital assets. https://bitcoinmagazine.com/markets/bitcoin-price-action-what-to-expect-next",Financial,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","I have been studying the jurisprudence of Hawaiian courts because I am really interested in their opinions. This case seems to be really relevant, as it was included in some casebooks. Please provide me with the case issue. Furthermore, explain why the portrait is hearsay, what was the portrait's finality, and then tell me why it was still admitted anyway. Do not use more than 250.","State v. Motta 659 P.2d 745 (1983) On April 29, 1980 at about 11:30 p.m., Wendy Iwashita, a cashier on duty at Anna Miller's Coffee House in Pearlridge, was robbed at gunpoint by a man who demanded that she give him all the money she had in her cash register. Iwashita complied and the robber fled with approximately $300.00 in cash. Iwashita gave a description of the robber to the police who arrived at the scene soon thereafter. On May 6, 1980, Iwashita met with Joe Aragon, an artist for the Honolulu Police Department, who drew a composite sketch of the robbery suspect based on Iwashita's description. On June 3, 1980, Iwashita picked appellant's photograph from a photographic array of about twenty-five to thirty pictures. On June 9, 1980, Iwashita positively identified appellant in a preliminary hearing. At trial, Iwashita confirmed her prior identifications and pointed out the appellant as the person who robbed her. Appellant presented an alibi defense at trial. Appellant testified that he was at a nightclub at the time of the robbery. Appellant called several other witnesses to describe his physical appearance on the date of the robbery and to corroborate his alibi. After considering the evidence presented, the jury found appellant guilty of the offense of robbery in the first degree. ... Appellant also contends that the trial court erred in admitting Aragon's composite sketch based on Iwashita's description of the robbery suspect. Appellant argues that the sketch was inadmissible hearsay under Haw.R.Evid. 802 which provides that ""[h]earsay is not admissible except as provided by these rules, or by other rules prescribed by the Hawaii supreme court, or by statute."" Rule 801(3) defines ""hearsay"" as ""a statement, other than one made by the declarant while testifying at the trial or hearing, offered in evidence to prove the truth of the matter asserted."" Other courts have admitted composite sketches into evidence under various rationales. One view, expressed by the Second Circuit Court of Appeals in United States v. Moskowitz, 581 F.2d 14 (2d Cir.), cert. denied, 439 U.S. 871, 99 S. Ct. 204, 58 L. Ed. 2d 184 (1978), is that a police sketch is not even hearsay because it does not qualify as a statement which is defined in Fed.R.Evid. 801(a) as ""(1) an oral or written assertion or (2) nonverbal conduct of a person, if it is intended by him as an assertion."" Under this view, since the sketch did not constitute hearsay, it merely had to satisfy the authentication requirements of Fed.R.Evid. 901. *750 Another approach taken by some state courts is to view the police sketch as hearsay, but admissible under various common-law hearsay exceptions. The Pennsylvania Superior Court in Commonwealth v. Dugan, 252 Pa.Super. 377, 381 A.2d 967 (1977) took this approach and found that a sketch made by a friend of the victim was properly admitted under the ""res gestae"" exception to the hearsay rule since the sketch had been made shortly after the victim had seen the suspect. The Illinois Supreme Court in People v. Rogers, 81 Ill. 2d 571, 44 Ill.Dec. 254, 411 N.E.2d 223 (1980) held that the hearsay rule did not bar admission of a composite sketch used as extra-judicial identification evidence to corroborate a witness' in-court identification. A final alternative, which is available to those courts which have adopted rules similar to the Federal Rules of Evidence, is to allow the admission of composite sketches and other pretrial identifications under the prior identification exception to the general hearsay exclusionary rule under Fed.R. Evid. 801(d)(1)(C). ... After careful review of the various alternatives, we find that the better approach is to recognize a composite sketch as hearsay but nevertheless admissible under the hearsay exception for prior identifications if it complies with Haw.R.Evid. 802.1(3) (which is identical in substance to Fed. R.Evid. 801(d)(1)(C).[4] We recognize along with the majority of courts that a composite sketch is in fact hearsay. It has the same effect as if the victim had made a verbal description of the suspect's physical characteristics. Just because the sketch is in picture form does not change the fact that it is being offered as a statement made out of court to prove what the suspect looked like. See United States v. Moskowitz, 581 F.2d at 22 (Friendly, J., concurring); Commonwealth v. Dugan, 381 A.2d at 971 (Spaeth, J., concurring). Although a composite sketch is hearsay, it may still be admissible as a prior identification under Haw.R.Evid. 802.1(3) if (1) the declarant testifies at trial and is subject to cross-examination concerning the subject matter of his statement and (2) the *751 statement is one of identification of a person made after perceiving him. In the instant action, the admission of the sketch met the requirements of Haw.R.Evid. 802.1(3): the declarant, Wendy Iwashita, testified at trial and was available for cross-examination regarding the subject matter of her description, and the sketch was an identification of the robbery suspect made after Iwashita had seen him. Appellant contends that the composite sketch was admitted solely to corroborate Wendy Iwashita's in-court identification. Appellant consequently argues that since corroborating evidence is only admissible when offered to rebut testimony impeaching the witness and no such impeaching evidence was introduced, the sketch is inadmissible. Appellant misapprehends the nature of the prior identification exception to the hearsay rule. Unlike the common-law extrajudicial identification exception involved in People v. Rogers, supra, the prior identification exception under Fed.R.Evid. 801(d)(1)(C) (and under Haw.R.Evid. 802.1(3)) allows the admission of pretrial identifications, not merely as corroborative evidence, but also as substantive proof of identity. See Haw.R.Evid. 802.1 commentary (""The substantive use of prior identifications is allowed in Fed.R.Evid. 801(d)(1)(C)""); 11 J. Moore, supra § 801.41[5] (""[S]tatutory construction requires that the same substantive effect be given to a prior statement that qualifies under (C) as a prior statement qualifying under (A) or (B) of the same paragraph""). See also Gilbert v. California, 388 U.S. 263, 272, n. 3, 87 S. Ct. 1951, 1956, n. 3, 18 L. Ed. 2d 1178 (1967) (""The recent trend... is to admit the prior identification under the exception that admits as substantive evidence a prior communication by a witness who is available for cross-examination at trial""). Thus, as one commentator notes, Rule 801(d)(1)(C) operates independently of the impeachment process and therefore the statement is admissible as substantive evidence even though it is not a prior inconsistent statement for impeachment purposes as required in Fed.R.Evid. 801(d)(1)(A) nor a prior consistent statement for rehabilitation purposes as required in Rule 801(d)(1)(B). The primary reason for excluding hearsay is the danger that the declarant is not available and her credibility therefore cannot be assessed by the trier of fact. That danger was not present in this case where both Joe Aragon, the police artist who made the sketch, and Wendy Iwashita, the eyewitness who provided the description, testified at trial and were subject to cross-examination by the defense. See also State v. Naeole, 62 Haw., (testimony permitted with regard to photographic lineup where both the officer who conducted the lineup and the person making the identification were present at trial to testify about the prior identification and were subject to cross-examination. Given the fact that the jury was given the opportunity to judge the credibility of both the police artist and the eyewitness at trial, we find no reason to disturb the trial court's discretion in admitting the sketch into evidence.","""================ ======= State v. Motta 659 P.2d 745 (1983) On April 29, 1980 at about 11:30 p.m., Wendy Iwashita, a cashier on duty at Anna Miller's Coffee House in Pearlridge, was robbed at gunpoint by a man who demanded that she give him all the money she had in her cash register. Iwashita complied and the robber fled with approximately $300.00 in cash. Iwashita gave a description of the robber to the police who arrived at the scene soon thereafter. On May 6, 1980, Iwashita met with Joe Aragon, an artist for the Honolulu Police Department, who drew a composite sketch of the robbery suspect based on Iwashita's description. On June 3, 1980, Iwashita picked appellant's photograph from a photographic array of about twenty-five to thirty pictures. On June 9, 1980, Iwashita positively identified appellant in a preliminary hearing. At trial, Iwashita confirmed her prior identifications and pointed out the appellant as the person who robbed her. Appellant presented an alibi defense at trial. Appellant testified that he was at a nightclub at the time of the robbery. Appellant called several other witnesses to describe his physical appearance on the date of the robbery and to corroborate his alibi. After considering the evidence presented, the jury found appellant guilty of the offense of robbery in the first degree. ... Appellant also contends that the trial court erred in admitting Aragon's composite sketch based on Iwashita's description of the robbery suspect. Appellant argues that the sketch was inadmissible hearsay under Haw.R.Evid. 802 which provides that ""[h]earsay is not admissible except as provided by these rules, or by other rules prescribed by the Hawaii supreme court, or by statute."" Rule 801(3) defines ""hearsay"" as ""a statement, other than one made by the declarant while testifying at the trial or hearing, offered in evidence to prove the truth of the matter asserted."" Other courts have admitted composite sketches into evidence under various rationales. One view, expressed by the Second Circuit Court of Appeals in United States v. Moskowitz, 581 F.2d 14 (2d Cir.), cert. denied, 439 U.S. 871, 99 S. Ct. 204, 58 L. Ed. 2d 184 (1978), is that a police sketch is not even hearsay because it does not qualify as a statement which is defined in Fed.R.Evid. 801(a) as ""(1) an oral or written assertion or (2) nonverbal conduct of a person, if it is intended by him as an assertion."" Under this view, since the sketch did not constitute hearsay, it merely had to satisfy the authentication requirements of Fed.R.Evid. 901. *750 Another approach taken by some state courts is to view the police sketch as hearsay, but admissible under various common-law hearsay exceptions. The Pennsylvania Superior Court in Commonwealth v. Dugan, 252 Pa.Super. 377, 381 A.2d 967 (1977) took this approach and found that a sketch made by a friend of the victim was properly admitted under the ""res gestae"" exception to the hearsay rule since the sketch had been made shortly after the victim had seen the suspect. The Illinois Supreme Court in People v. Rogers, 81 Ill. 2d 571, 44 Ill.Dec. 254, 411 N.E.2d 223 (1980) held that the hearsay rule did not bar admission of a composite sketch used as extra-judicial identification evidence to corroborate a witness' in-court identification. A final alternative, which is available to those courts which have adopted rules similar to the Federal Rules of Evidence, is to allow the admission of composite sketches and other pretrial identifications under the prior identification exception to the general hearsay exclusionary rule under Fed.R. Evid. 801(d)(1)(C). ... After careful review of the various alternatives, we find that the better approach is to recognize a composite sketch as hearsay but nevertheless admissible under the hearsay exception for prior identifications if it complies with Haw.R.Evid. 802.1(3) (which is identical in substance to Fed. R.Evid. 801(d)(1)(C).[4] We recognize along with the majority of courts that a composite sketch is in fact hearsay. It has the same effect as if the victim had made a verbal description of the suspect's physical characteristics. Just because the sketch is in picture form does not change the fact that it is being offered as a statement made out of court to prove what the suspect looked like. See United States v. Moskowitz, 581 F.2d at 22 (Friendly, J., concurring); Commonwealth v. Dugan, 381 A.2d at 971 (Spaeth, J., concurring). Although a composite sketch is hearsay, it may still be admissible as a prior identification under Haw.R.Evid. 802.1(3) if (1) the declarant testifies at trial and is subject to cross-examination concerning the subject matter of his statement and (2) the *751 statement is one of identification of a person made after perceiving him. In the instant action, the admission of the sketch met the requirements of Haw.R.Evid. 802.1(3): the declarant, Wendy Iwashita, testified at trial and was available for cross-examination regarding the subject matter of her description, and the sketch was an identification of the robbery suspect made after Iwashita had seen him. Appellant contends that the composite sketch was admitted solely to corroborate Wendy Iwashita's in-court identification. Appellant consequently argues that since corroborating evidence is only admissible when offered to rebut testimony impeaching the witness and no such impeaching evidence was introduced, the sketch is inadmissible. Appellant misapprehends the nature of the prior identification exception to the hearsay rule. Unlike the common-law extrajudicial identification exception involved in People v. Rogers, supra, the prior identification exception under Fed.R.Evid. 801(d)(1)(C) (and under Haw.R.Evid. 802.1(3)) allows the admission of pretrial identifications, not merely as corroborative evidence, but also as substantive proof of identity. See Haw.R.Evid. 802.1 commentary (""The substantive use of prior identifications is allowed in Fed.R.Evid. 801(d)(1)(C)""); 11 J. Moore, supra § 801.41[5] (""[S]tatutory construction requires that the same substantive effect be given to a prior statement that qualifies under (C) as a prior statement qualifying under (A) or (B) of the same paragraph""). See also Gilbert v. California, 388 U.S. 263, 272, n. 3, 87 S. Ct. 1951, 1956, n. 3, 18 L. Ed. 2d 1178 (1967) (""The recent trend... is to admit the prior identification under the exception that admits as substantive evidence a prior communication by a witness who is available for cross-examination at trial""). Thus, as one commentator notes, Rule 801(d)(1)(C) operates independently of the impeachment process and therefore the statement is admissible as substantive evidence even though it is not a prior inconsistent statement for impeachment purposes as required in Fed.R.Evid. 801(d)(1)(A) nor a prior consistent statement for rehabilitation purposes as required in Rule 801(d)(1)(B). The primary reason for excluding hearsay is the danger that the declarant is not available and her credibility therefore cannot be assessed by the trier of fact. That danger was not present in this case where both Joe Aragon, the police artist who made the sketch, and Wendy Iwashita, the eyewitness who provided the description, testified at trial and were subject to cross-examination by the defense. See also State v. Naeole, 62 Haw., (testimony permitted with regard to photographic lineup where both the officer who conducted the lineup and the person making the identification were present at trial to testify about the prior identification and were subject to cross-examination. Given the fact that the jury was given the opportunity to judge the credibility of both the police artist and the eyewitness at trial, we find no reason to disturb the trial court's discretion in admitting the sketch into evidence. https://law.justia.com/cases/hawaii/supreme-court/1983/8466-2.html ================ ======= I have been studying the jurisprudence of Hawaiian courts because I am really interested in their opinions. This case seems to be really relevant, as it was included in some casebooks. Please provide me with the case issue. Furthermore, explain why the portrait is hearsay, what was the portrait's finality, and then tell me why it was still admitted anyway. Do not use more than 250. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Legal,Find & Summarize,Text Transformation You must respond using only the information provided. Do not give any inaccurate answers according to the information provided. Do not respond in any way that is discriminatory or harmful. You are to respond in complete sentences using correct US grammar conventions.,"From this text, how do the five generic images for the technological future differ to the four schools of thought articulated in the Smart Internet Technology CRC’s report, ""Smart Internet""? Include a brief description of each theory in your explanation.","Abstract Australia’s Federal Government announced the National Broadband Network (NBN) in 2009. NBN’s current roll-out is scheduled for completion in 2021, with market forecasts estimating optical fibre overtaking DSL broadband connections in about 2015. This paper provides a timely contribution to more critical and expansive analysis of potential Australian internet futures. First, ‘schools of thought’ and current technological frames (Web 2.0, ‘the cloud’) for the internet and its possible futures are outlined, which provide perspectives on the emergence of the NBN. We then outline five generic images of the future which, as predetermined images, enable quick ‘incasting’ of alternative futures for a technology topic or related object of research: promised future, social/ speculative bubble(s), unfolding disruption/chaos, unintended consequences, and co-existence/‘cooption’. High-level application of the ‘schools’ and generic images to the NBN and Australia’s potential internet futures, suggests policymakers and strategists currently consider too few perspectives. Keywords: national broadband network, internet, incasting, technology foresight, Australia Introduction Analyses of internet futures often outline prevailing trends – such as the shift towards mobile internet and personal/business data capture and analysis – and project major, positive, rapid changes to business, politics and daily life. However, trends constantly evolve and can change dramatically, rendering earlier forecasts obsolete. ‘Virtual worlds’ like Second Life were touted as innovations that would rapidly alter online business and marketing – only interest waned and shifted to educational uses (Salomon, 2010). Conversely, popular social networks like Twitter were initially dismissed – only to rapidly become mainstream, due in part to celebrity uptake (Burns and Eltham, 2009). This article develops an alternative approach to technology foresight, and on prospective thinking about Australia’s internet futures. Analyses are reframe-able expressions of one of many ‘schools of thought’ or mental models on internet futures. We suggest a shift in focus towards alternative futures, and the theoretical and analytical perspectives can inform this analysis. We use a mixed-method approach to consider potential internet futures, identify generic categories of future images, and consider these for ‘incasting’ a focal topic thereby deductively conceptualising alternative futures (Dator, 2002). This article’s core aims are: (1), to present an outline of key ‘schools of thought’ and theoretical perspectives on technological change which informs a new technology futures framework; and, (2), to show how this framework could be used to quickly conceptualise possible futures, in particular, Australia’s potential internet futures. The article also addresses the need to move beyond the dualistic discussion of internet futures as either emancipatory or, alternatively, dystopian. We need to better recognise and consider the diverse mixture of positive and negative outcomes the internet will more plausibly be associated with. As Voros observed, “we can – if we are wise enough – choose the quality of our mental models and guiding images of the future and, therefore, the quality of the decisions we make based upon them” (Voros, 2006). We agree: such ‘guiding images’ are too often taken-for-granted. The paper is structured as follows. We first outline recent perspectives on internet futures. A review of relevant visions and technological change theory is synthesised as a new technological futures framework. Through ‘incasting’ we use this framework to consider the potential for alternative internet futures to emerge in Australia, focusing on the National Broadband Network (NBN) and the 2020 outlook. Current Schools of Thought and Technological Frames Schools of thought The Smart Internet Technology CRC’s report Smart Internet 2010 articulated four schools of thought about possible internet futures (Barr, Burns, & Sharp, 2005). The four ‘schools’ were Rich Media, Adaptive User Environments, Not the Smart Internet and Chaos Rules. Each school encompassed an image of the future, theoretical perspectives, and thought leaders. Each school “ought to be viewed as… shared mindsets” which “suggest possible future outcomes” (Barr, Burns, & Sharp, 2005, p.7). Rich Media was the default future: the “multi-person, multi-device” access envisioned by Microsoft, News Corporation, Nokia and other corporations. This view anticipated debates about Australia’s development of the NBN; rural-based tele-medicine infrastructure; consumer booms in high-definition television, and the Australian Government’s Digital Education Revolution. This ‘school’ is “closely related to … advocates of the pervasive computing approach” (Barr, Burns, & Sharp, 2005, p.41). Adaptive User Environments emphasised end-user experience, adaptability, and design, like Apple’s iPod, iPhone and iPad, and how “social and cultural factors influence the way end users and consumers interact with a wide range of Internet-based technologies and services” (Barr, Burns, & Sharp, 2005, p.24). Not the Smart Internet emphasised “basic services for all” and “open standards”. Chaos Rules was pessimistic and slightly dystopian, questioning the robustness of Internet services (e.g. due to hackers, viruses, and cyber-warfare) and over-reliance on information technology. This school anticipated concerns about digital technologies and social media impacts on brain function, attention spans and society (Watson, 2010). Chaos Rules also foreshadowed Taleb’s (2007) contrarian thinking on low-probability, high-impact ‘Black Swan’ events. Today’s dominant frames: ‘Web 2.0’, ‘Web 3.0’, and ‘the Cloud’ A technological frame structures interactions among relevant social groups via the set of meanings attached to a technology/artifact (Bjiker, 1995). Publisher Tim O’Reilly’s (2005) Web 2.0 is currently the dominant internet frame. After the 2000 dotcom crash, most internet companies struggled to raise finance and survive. Dotcom era visions such as convergence and disintermediation seemed dead. O’Reilly’s Web 2.0 contended the next generation of web tools would be more accessible and end-user friendly, and be associated with collective intelligence, participation, and service delivery. This coincided with Google’s initial public offering and the emergence of social networks like Facebook. The frame also co-opted the UK Blair Government’s promotion of creative industries and the maturation of knowledge management (Leadbeater, 2009; Tapscott & Williams, 2010). Web 2.0 shapes current policy agendas such as ‘Government 2.0’ and ‘e-Health’. Thought leaders now increasingly discuss Web 3.0 which Web 2.0 might evolve into. Web 3.0 might include the mainstreaming of sophisticated, mobile internet connected devices, greater video content, ‘cloud’ computing, ‘the internet of things’ (physical objects are also connected to the internet such as cars, home appliances, buildings), and a broader convergence of digital and physical worlds. Kevin Kelly (2011) defines this frame with six verbs: screening (not reading), interacting (“if it’s not interacting, it doesn’t work”), sharing, flowing, accessing, and generating. An emerging theme is collecting and using personal data. Data is ‘the new oil’: offering a new wave of value creation potential “in a world where nearly everyone and everything are connected in real time”, despite privacy and trust concerns (World Economic Forum, 2011, p.5). The end-user remains central and is part of wider ‘data ecosystems’ which can be ‘mined’ to deliver more personalised services. Information and communication technology (ICT) will be a ubiquitous, intrinsic part of all social behaviours, business practices and government (Greenhill, 2011). The ‘cloud’ – a metaphor for resources accessible on-demand (e.g. software, content) from anywhere via remote internet accessible storage – and associated ‘cloud computing’ models is a front-runner for such as paradigm shift. The ‘cloud’ and ‘internet of things’ relate to emerging agendas for ‘smart’ and ‘embedded’ systems. Through ‘intelligent’ infrastructure and devices, data gathering and management will become infused into service delivery and everyday objects. IBM’s former chief executive officer Samuel Palmisano (2008; 2010) believes computing power will be “delivered in forms so small, abundant and inexpensive” that it is “put into things no one would recognize as computers: cars, appliances, roadways and rail lines, power grids, clothes; across processes and global supply chains; and even in natural systems, such as agriculture and waterways.” Further, ‘systems of systems’ will turn a mass of data into information and insight, to enable smarter healthcare, more efficient energy systems and productivity improvements (Palmisano, 2010; RuedaSabater & Garrity, 2011) However, Web 2.0 and Web 3.0 are uncertain. Google, Facebook, Twitter, and Wikipedia have led to ‘lock-in’ and institutional capture of specific services. Paradoxically, this may limit future innovation. Disruptive challengers may emerge from China and India. Emerging internet communities in developing countries appear to adopt different attitudes and online behaviours which may become more influential (Dutta et al., 2011). A second view considers increasing user concerns about online privacy, identity theft, and changing public attitudes in Western markets. Dutta et al’s (2011, p.9) international user study also found users “want it all: they desire freedom of expression, privacy, trust, and security without viewing these as mutually exclusive.” However, trade-offs between these potentially conflicting priorities may in fact be necessary. We need to think about futures in which people, in effect, ‘trade’ aspects of their privacy in return for other benefits. A final view is that most Web 2.0/ Web3.0 firms are yet to develop sustainable business models beyond start-ups. These perspectives foreshadow alternative futures. Considering Alternative Technological and Internet Potentials In this section we outline five generic images for technological futures, based on a review of different perspectives (such as those described above), technological change theory, and innovation theory. This framework can be used to consider potential internet futures. Promised future (Dominant expectation[s] and vision[s]) The first category is the simplest to describe and identify. ‘Promises’ are made by actors seeking to build support for particular domains – such as those made by thought leaders about ‘Web 3.0’, the ‘internet of things’, and social media. Theoretically, the Sociology of Expectations (SoE) informs this category (Borup et al., 2006; Brown et al., 2000). SoE scholars suggest that expectations of technologies and their impacts/ potential strongly influence the technological development and innovation, such as through ‘self-fulfilling prophecies’ (as seen with Moore’s Law). The more successful a particular ‘expectation’, i.e. the more support it has gained, the more likely key actors are to act in ways that help make it a future reality. Foresight analysts can proactively monitor this process and its outcomes. Shared expectations can play necessary, central roles in creating momentum and stimulating coordination of heterogeneous actors. The Australian Government’s National Broadband Network – discussed in Section 4 – and the European Commission’s new ‘Digital Agenda’ for Europe, illustrate this. Alternatively, they can be problematic if widely accepted expectations (such as the default Rich Media ‘school’ or Web 2.0) remain uncritically accepted. Further, a dominant vision may exclude other possible internet futures from being considered by business and government, just as a dominant ‘official future’ can limit thinking in organisations. Social/Speculative bubble(s) Bubbles refer to a “heightened state of speculative fervour” that emerges in markets which, ultimately, result in investment failures and drastic, sudden market corrections (Shiller, 2005). In technological change, ‘hype cycles’ are similarly quite common (Finn & Raskino, 2008). These are often due to over-promising by promotional actors who are seeking resources (Geels & Smit, 2000). Additionally, greater social focus on a dominant ‘frame’ can emerge as actors become ‘enrolled’ (Bijker, 1995). Some theorists see bubble creation as a natural, necessary part of major technological change. The innovation theory of social bubbles argues collective over-enthusiasm and commitments beyond what would be rationalised by cost benefit analyses, fuelled by hype, is necessary to enable action in the presence of risk and uncertainty (Gisler et al., 2011; Gisler & Sornette, 2009). Perez’s (2002; 2010) technological revolutions theory further contends that a recurring sequence of events occurs during each revolution, each time taking between 40-60 years: an initial ‘installation phase’ (e.g. investments in new supporting infrastructure) first, leading to speculative bubbles and a dramatic turning point, and followed a ‘deployment period’ heralding a new ‘golden age’. Similarly, Kondratieff-like ‘long waves’ are advanced (Freeman & Louca, 2001). Perez argues we are at the ‘turning point’ in the middle of the ICT revolution, during which major bubbles are expected. According to Perez, a ‘new age’ requires a new mode of growth compatible with a new ‘paradigm logic’ (for the revolution), and institutional changes to create the conditions for this growth. Web 2.0 has become the dominant ‘frame’ and recent investment growth illustrates this. Facebook had a more than four-fold increase in valuation as it prepared for an initial public offering (Ozanian, 2011). Microsoft purchased Skype for over 400 times its operating income (Anonymous, 2011). These dramatic changes create hype cycles (Finn & Raskino, 2008). Facebook co-founder Mark Zuckerberg remarked (from a Rich Media worldview): “if you look five years out, every industry is going to be rethought in a social way” (cited in Gelles, 2010). Brands rushing into social media view it “as the panacea to diminishing returns in traditional mass media” (Fournier & Avery, 2011). However, concerns over privacy and how greater marketing and advertising might affect social networks may ‘pop’ such a bubble and herald major shifts. Web 2.0 may be a major speculative bubble like the 1995-2000 dotcom era (Hirschorn, 2007; Raznick, 2011; Vance, 2011; Wooldridge, 2010). As Hirschorn (2007) observed, “in the Web hype-o-sphere, things matter hugely until, very suddenly, they don’t matter at all”. He forecasts social media to be “only another in a long string of putatively disruptive, massively hyped technologies that prove just one more step in the long march.” The propensity of internet discourses to naïve prophetic thinking, self-styled experts and exaggerated promises (Dublin, 1991) partly explains regular shifts from hype to disappointment. Disruption/Chaos Schumpeterian ‘creative destruction’ – the emergence, experimentation and innovation central to technological change and free markets – largely defines this image. ‘Chaos’ can also mean opportunity (as well as the danger normally perceived). Services originally designed to ‘police’ social networks have also led to new innovations in text mining and complex event processing (Sommon & Brown, 2011). ‘Disruption’ can be technological or driven by additional social or political factors. For example, a common pitfall in expectations of future technological developments is believing social practices “to remain constant in spite of the introduction of new technology (Geels & Smit, 2000, p.880). Exponential growth in the miniaturisation of transistors and computer power (Moore’s Law) may no longer hold in coming decade(s) and dramatically change chip fabrication costs (Rupp & Selberherr, 2011). Natural resource limits may disrupt consumer markets: the scarcity of needed rare earth elements in which China controls 95% of global supply (Cohen, 2007). Additional emerging candidates for future disruption are ‘augmented reality’ technologies and ‘nano-electronics’. Early stage augmented reality prototypes and technologies are now being commercialised together with geo-location tools like Geoloqi.com, in which real-world environments are ‘augmented’ by sensory inputs received via technology (via smart phones). An alternative medium-term source of technological disruption is a major new means of chip fabrication and manufacturing. Most prevalent at present is ‘nano-electronics’, a major area of research in Australia and Asia-Pacific. Unintended consequences Unintended social consequences emerge from second-order and third-order effects of technologies along with the appropriation of technologies. Theorists show that technologies are often ‘appropriated’ by diverse end-user groups, typically for uses unforeseen by the technology creators (Burns & Eltham, 2009; Jamison & Hard, 2003). Cyberpunk author William Gibson similarly observed that “the street finds its own use for things.” This category reveals a wide range of internet potentials and perspectives. ‘Cyberrealism’ is an emerging Chaos Rules-like philosophy that challenges the often utopian internet discourses (Morozov, 2011). Further convergence of digital and physical/ social worlds will enable political and other interests to shape the digital world’s development and its use in unexpected ways (Kelly & Cook, 2011; Morozov, 2011). Recent literature suggests unintended consequences may include: information flows being distorted by personalisation features (Pariser, 2011); data security and privacy being compromised by the adoption of open/cloud computing architectures (Bisong & Rahman, 2011; Grobauer et al., 2011); authoritarian governments gaining power from the internet, rather than a power shift to individuals which is more commonly expected (Burns & Eltham, 2009; Morozov, 2011); and the potential for intensified consumerism as more sophisticated ways to advertise and sell become embedded in more online and social technologies. The “open platform paradigm” of Not the Smart Internet can also, paradoxically, compromise content creation and intellectual property (Lanier, 2010). The spectre of increasing cyber-warfare is a topical national security issue and regional flashpoint (Clarke & Nake, 2010). For example, China is blamed for attacks on the ICT systems of Australian mining and resource firms (Wilkinson, 2010). In the Asia-Pacific region, many countries have invested in new national teams and defensive cyber-warfare capabilities. Several different possibilities exist about how cyber-warfare could evolve. Attacks on transnational firms may impact the stability of sovereign financial markets. Countries may develop offensive cyber-warfare capabilities and teams as a form of market intelligence, and as strategies to gain access to intellectual property. Co-existence/Co-option Co-existence/Co-option focusses on the complex ‘co-evolution’ of technology and society. This co-evolution makes unpredicted futures more likely than is commonly recognised despite our best efforts to achieve foresight (Williams, 2006). Through ‘coevolution’ one possibility is the complex co-existence of old and new technologies (Geels & Smit, 2000). This is an important counter-point to common forecasts in which the new replaces or displaces the old. Co-existence/Co-option also recognises 39 that business entrepreneurs and experts often articulate and promote futures they have a vested interest in. SoE scholars in the Science and Technologies Studies field emphasise attempts “to create ‘direction’ or convince others of ‘what the future will bring’” (Brown et al., 2000, p.4). Here, ‘contested futures’ is relevant. Brown et al (2000, p.3-4) observe that “if actors are to secure successfully for themselves a specific kind of future then they must engage in a range of rhetorical, organisational and material activities through which the future might be able to be ‘colonised’.” These actor strategies may also partly explain how Web 2.0 versions of Rich Media and Adaptive User Environments quickly came to dominate thinking. Web 2.0 growth and social networks provide emancipatory tools for many, yet have also enriched key individuals like Facebook’s Mark Zuckerberg, Mahalo’s Jason Calacanis, publishers John Battelle and Tim O’Reilly and LinkedIn founder Reid Hoffman. However, the broader community of ‘Web 2.0’ proponents and consultants rarely consider the possibility that they may be acting on what Inayatullah (2008, p.5) terms “used futures”: out-dated conceptions of the future “unconsciously borrowed from someone else.” Additionally, the increasing number of proposals to ‘order’ or (re)structure the evolution of the internet and mobile markets is a clear manifestation of the ongoing ‘co-evolution’ of technology and society which continually plays out. These proposals include the ‘network neutrality’ debate, and United States legislation such as the Stop Online Piracy Act, and the Research Works Act that would restrict ‘open access’ publishing. These regulatory regimes can reshape industry trajectories and change the balance of power between innovators, early adopters and laggards (Lessig, 2001; Spar, 2001; Wu, 2010). Case Study: Australia’s Potential Internet Futures In this section we focus on the Australian context: the National Broadband Network (NBN) which is being rolled-out by the Federal Government. If it is fully rolled out (the Federal Opposition currently opposes this), the high speed network of three technologies (optic fibre, fixed wireless, satellite) will be completed in approximately 2020.1 We first introduce the NBN. Issues and potential futures are then discussed, considering the analytical perspectives advanced. The national broadband network An NBN was first proposed by Australia’s Howard Liberal Government in 2003 and eventually made a Federal election issue in 2007. The then Rudd Labor Government announced in April 2009 that it would form the NBN Co, a wholly-owned Commonwealth company, to build and operate a national “wholesale-only, open access broadband network.” The successor Gillard Labor Government started to roll-out in 2011. The Federal Government’s decision to create the new network followed almost a decade of unsuccessful attempts to build an NBN-like network. Sol Trujillo-era Telstra adopted lobbying tactics to delay the separation of its retail and wholesale divisions. Competitors like Optus lobbied against Telstra to avoid hidden network and sunk costs. A competitive bargaining game developed. Research and development firms like Telstra Research Labs and the Smart Internet Technology CRC led supply-side research on NBN-like application scenarios and use cases. The NBN was the Australian Government’s response to telecommunications market failures. The Smart Internet Technology CRC highlighted early-stage innovators and commercialisation possibilities. However, gaps in the Australian environment, such as the lack of a venture capital sector, hampered efforts. NBN Co’s formation shifted the debate to access and pricing regimes, location of testing sites, and the reaction of market incumbent Telstra. New debates also focus on government and capital markets execution. NBN Co faced scrutiny about its operational efficiencies (in 2011 the pricing regime was revealed to be more expensive than first planned), ability to roll-out the network, and the management team. Analysis: Schools of thought and alternative futures The default future in the ‘schools of thought’ framework is Rich Media. This ‘school’ may have captured Australian Government policy-making and academic research as the dominant technological frame that actors have been enrolled in (Bjiker, 1995). NBN evidences the role of shared expectations in creating sufficient momentum and stimulating coordination: all actors speak of the same “digital economy of the future” and of its emancipatory, economic potential. The NBN is a return to the 1990s rhetoric of the internet as an ‘information superhighway’ in a new guise. Similar claims to NBN’s emancipatory potential were made for Sausage Software during the Netscape-Microsoft browser wars (in the mid-late 1990s) and for local content production for the 2G and 3G mobile internet. The Not the Smart Internet ‘school’ would suggest an NBN framed as an important intervention that primarily addresses access and digital divide issues, and provides more widespread, functional, lower-cost, transparent services. However, this contrasts with Rich Media style focus on network speed and capacity for media streaming and future ‘cloud’ based businesses. The Adaptive User Environments ‘school’ suggests 41 emulating, locally, Apple or Google-like models of content creation and distribution. Australian retailers such as JB Hi-Fi might develop new online content serviceorientated models (e.g. streaming music services like Pandora). However, these firms must successfully compete with global competitors to win customers (Stafford, 2011). NBN may provide the infrastructure for virtual worlds to have more significant uptake (Salomon, 2010). The Chaos Rules ‘school’ suggests security capabilities to pre-empt hackers, viruses, and cyber-warfare. Alternative futures framework: Considering image categories In this section we provide a high-level ‘incast’ of Australian internet futures, considering a 2020 time horizon. Incasting involves considering predetermined images of the future in order to deduce alternative future scenarios for the particular object of the research (Del Pino, 1998). The advantage of this approach is that it enables quickly conceptualising alternative futures (Dator, 2002). Promised future The ‘promises’ and dominant expectations for Australian internet futures are clearly expressed in the Government’s (2011) National Digital Economy Strategy (NDES) which articulates a vision for Australia to be, by 2020, a ‘world leading digital economy’. Eight goals are defined: • By 2020, Australia will rank in the top five OECD countries for the portion of households that connect to broadband at home; • By 2020, Australia will rank in the top five OECD countries for the portion of businesses and not-for-profit organisations using online opportunities; • By 2020, the majority of Australian households, businesses and other organisations will have access to smart technology to better manage their energy use; • Improved health and aged care: by 2020 90 per cent of high priority consumers (e.g. older Australians, those with a chronic disease) can access individual electronic health records; by 2015 495,000 telehealth consultations will have been delivered by remote specialists; by 2020, 25 per cent of all specialists will be participating in delivering telehealth consultations; • Expanded online education; • By 2020 at least doubling the level of teleworking (at least 12 per cent of Australian employees); • By 2020, four out of five Australians will choose to engage with the government through the internet or other type of online service; and • By 2020, the gap between households and businesses in capital cities and those in regional areas will have narrowed significantly. The NDES envisages a ‘market-led’ transition to this future economy, connecting activities to the ‘smart systems’ vision (e.g. using ICT to optimise energy and transportation systems) “enabled by... the internet, mobile and sensor networks” (p.12). A ‘linear’ view, similar to Rich Media and Adaptive User Environments, is adopted: “based on existing trends, in the future the online experience will become richer and more data intensive and increasingly integrated into everyday life, at home and at work” (p.10). Inclusions themes, of Not the Smart Internet, are also noted: “distance - once a defining characteristic and barrier for regional Australia - becomes increasingly Australia's Potential Internet Futures Journal of Futures Studies 42 irrelevant” (www.nbn.gov.au). Social/Speculative bubble The NBN and NDES were developed during intensifying Web 2.0/Web3.0 hype. An alternative image centres on the potential for unmet expectations, and the associated ‘fall-out’. This would replay aspects of the 1995-2000 dotcom bubble – especially if the current “state of speculative fervor” (Shiller, 2005) surrounding Web 2.0 contracts in the near-to-medium-term. The envisaged application scenarios and use cases may also not be commercially and/or socially viable. An important example is ‘e–health’ for aged Australians. Australia has to-date struggled to develop viable new e-health businesses/business models for providing aged care, and public acceptance issues could also slow adoption (Tegart, 2010). Similarly, teleworking has tended to not meet expectations (Geels & Smit, 2000) due to unmet social needs which could reoccur over the next decade. In this future, when 2020 arrives the economic productivity ‘promise’ of NBN is unrealised.2 Moreover, it raises the possibility – if user take-up is lower than expected, as recently occurred in the UK – of delays in NBN Co gaining sufficient cash-flow to no longer require government support. Some Australian social scientists have argued – in part due to highly differential take-up across NBN test sites – that the ‘promises’ (above) will be challenged by local cultural and material factors, and that such variations will grow in significance as the NBN is further rolled-out (Apperley et al., 2011). Both localised conditions (e.g. installation policy and logistics, costs) and “integration of the NBN with each household’s domestic network of hardware devices, internal connections, software, and of course skill and interest” must be considered (Apperley et al., 2011). Like the recent example of the Human Genome Project (Gisler et al., 2011) it may take many decades to fully “exploit the fruits” of the NBN investment, rather than the shorter time horizons presently expected. Disruption/Chaos This image highlights the ‘creative destruction’ associated with technological change and associated potential for unanticipated shifts in practices. If optical fibre overtakes DSL broadband connections after 2015/6 (assuming full roll-out continues)3 then many sectors are likely to be ‘ripe’ for disruption – such as media, telecommunications, advertising, and retail – as people invent ways to utilise the expansion in bandwidth and evolve offline behaviours. Implicit in the NBN is a vision of a “digital home” and “an anticipated future of digital living” (Apperley et al., 2011) which many may embrace, whilst others ‘opt-out’ of the “connectopia” (Kiss, 2011). Similarly, broadband services (see generic categories in Table 2), and the NBN, need to be viewed more broadly than as merely high-speed Internet. By 2020, internet futures could have a majorly disruptive impact on several sectors. Today’s decline in newspapers and some retail sectors (e.g. music, books), could signal futures in which many local firms are unable to maintain viable, growing businesses. Local players such as those experimenting with new service-oriented models, such as JB Hi-Fi, increasingly face global competition and disruption potential. Regulators and users may also still be “struggling to work out the boundaries of online privacy” (Gettler, 2010) as practices, tools, and norms evolve. Unintended consequences NBN has the potential to generate a multitude of unintended social consequences – both positive and negative (often depending on whose perspective is taken). NBN uptake may vary by geographic areas, leading to new subtle versions of the ‘digital divide’. Related socio-technical factors influence access to participation in a digital economy. The ‘unintended consequences’ image also alludes to the potential for arbitrage and leaking of NBN data to individuals. Although the ‘Gov 2.0’ agenda views the open data movement positively, Australia is constrained by the Westminster system which presently imposes limits on the release of government data. Major unintended consequences for the Australian political system could emerge in a more technologically-empowered society – a potential blind-spot for politicians, regulators, policymakers, and others. The internet can also facilitate larger-scale manipulation of publics (Kearne, 2012), a concerning trend the NBN may also enable. Co-existence/Co-option In another plausible scenario a “patchwork of [variable] connectivity” prevents the envisaged future, centred on the digital home being “integrated into the digital economy as a node of production and consumption” (Apperley et al., 2011), from fully emerging. The ‘co-existence’/‘co-option’ image further suggests potential internet futures in which highly advanced digital homes co-exist with less advanced and connected homes with varying connections, mediums, and social conditions – rather than a homogenous new ‘digital Australia’. In this future official projections of 70 percent take-up by 2025 are not achieved. Political risks provide another avenue to such futures, with a partially complete NBN (if there is a change of Federal government) likely co-existing with Australia's Potential Internet Futures Journal of Futures Studies 44 other networks. Additionally, a range of social, competitive, and regulatory issues highlight the potential for ‘co-option’. Regulatory settings and markets factors will influence the level of competition and services that emerge. NBN might fit Perez’s Kondratieff-like ‘long waves’ model but its roll-out has been delayed by local factors such as bargaining games, telecommunications market failure and institutional issues. The NBN Co’s government monopsony also limits capital markets involvement and, consequently, a true valuation market. Small and medium enterprises who develop new NBN markets or information services may in time be forced to start mergers and acquisitions that, ultimately, favour larger incumbents. These factors could limit the NBN and Australia’s internet futures. Furthermore, NBN’s growth is in a democratic society which means it will be different to the Confucian and Juche logics of Singapore and South Korean NBN-like solutions. Whilst the Sociology of Expectations suggests policymakers, academics and others and will continue to envision NBN-like (digital economy) capabilities, there is the risk of coordination failure, roll-out problems, and, possibly, colonised futures (Brown et al., 2000). Discussion Whilst the above analysis is only a high-level assessment it suggests discussion in Australia of potential internet futures is dominated by a limited number of ‘schools’ and ‘image’ categories. Our reading of the current NBN debates and consideration of potential internet futures is there is little consideration of the Chaos Rules, nor the potential for ‘bubbles’ (and for associated unrealistic expectations), unfolding ‘disruption’, unintended consequences, or co-existence/co-option. The NDES fails to address the potential for sectoral disruptions, and associated indirect negative effects. Holistic consideration of potential futures and associated outcomes could better inform planning and decision-making. Methodological and conceptual improvements could be made by using other futures tools and exploring interconnections. Examination of potential secondorder and third-order consequences could be improved by using ‘Futures Wheels’. Interconnections appear to exist, for example, between ‘bubbles’ and ‘unintended consequences’. If the Government and NBN Co – through the return to 1990s utopian internet rhetoric – contribute to speculative bubbles emerging, then this may have social consequences that unintentionally later impair the envisioned digital future and current ‘real’ economy. Furthermore, a major “social bubble” may be necessary to mobilise the needed commitments and major investments by innovators and entrepreneurs to realise the ‘promises’ and cause ‘disruptions’ (Gisler et al., 2011). Conclusion In this paper we have outlined and considered key ‘schools of thought’ (or mental models) on internet futures and additional analytical and theoretical perspectives that provide insights into potential internet futures – both internationally and in Australia. Through a brief case study, we have shown how a resulting technological futures framework could be used to quickly highlight potential futures through a deductive ‘incasting’ process. We make several contributions to the literature on internet futures and technology foresight. First, we built on the Smart Internet 2010 project (Barr, Burns, & Sharp, 2005) and its four ‘schools of thought’. We have updated examples 45 to include contemporary debates. The current dominant ‘frames’ are understandable as expressions of the default ‘mental model’ on internet futures, Rich Media, along with Adaptive User Environments, which also informed development of the NBN. Second, through literature review we identified five image categories which can be used as predetermined images of the future for incasting. The first three images – promised futures, social/speculative bubbles, and disruption/chaos – deal primarily with change dynamics. The last two images – unintended consequences, co-existence/ co-option – primarily bring out potential outcomes such as regarding competition and interest politics, risk, and social impacts. Analyst consideration of the categories enables asking “devil’s advocate” questions (Wright & Cairns, 2011; Taleb, 2007) which challenges dominant ‘frames’ and stimulates consideration of multiple viewpoints which is needed for effective scenario thinking. Like Smart Internet 2010’s schools of thought, these predetermined images are relatively open-ended and can be revised with future examples, along with analysis of other domains. Each school of thought and image category provides important perspectives for analysing the emergence of the NBN and potential Australian internet futures. Widely accepted expectations inform the application scenarios, use cases and supply-side research supporting the NBN and similar technology debates. The NBN is in some ways a return to the past, reminiscent of the ‘information superhighway’ rhetoric in the 1990s. What the incasting exercise reveals, however, is that a more plausible mixture of outcomes should be considered by planners and strategists in Australian internet future scenarios along with a broader move beyond dualistic discussion of internet futures (either utopian emancipatory or dystopian). Broader perspectives could consider critical analysis of Web 2.0 and global internet futures (Lessig, 2001; Lanier, 2010; Morozov, 2011) and integrate this with critical futures studies perspectives. Notes 1 These conflicting political positions present important political risks. This is particularly true if the Opposition Liberal Party wins the next Federal election scheduled for 2013. It is likely to be more difficult for a Liberal Federal Government Australia's Potential Internet Futures Journal of Futures Studies 46 to discontinue/dismantle the NBN if it is elected in 2017 (the subsequent Federal). If fully rolled-out the NBN will “connect 93% of homes, schools and workplaces with optical fibre (fibre to the premises or ‘FTTP’)” and “for the remaining 7% we will connect to our next generation fixed wireless and satellite”. 2 Australia is a small market which raises the potential for various market failures and associated uncertainties about the how many players can be supported in some sectors (Stafford, 2011). 3 As per the market forecasts and analysis of Telsyte (http://www.telsyte.com.au).","Abstract Australia’s Federal Government announced the National Broadband Network (NBN) in 2009. NBN’s current roll-out is scheduled for completion in 2021, with market forecasts estimating optical fibre overtaking DSL broadband connections in about 2015. This paper provides a timely contribution to more critical and expansive analysis of potential Australian internet futures. First, ‘schools of thought’ and current technological frames (Web 2.0, ‘the cloud’) for the internet and its possible futures are outlined, which provide perspectives on the emergence of the NBN. We then outline five generic images of the future which, as predetermined images, enable quick ‘incasting’ of alternative futures for a technology topic or related object of research: promised future, social/ speculative bubble(s), unfolding disruption/chaos, unintended consequences, and co-existence/‘cooption’. High-level application of the ‘schools’ and generic images to the NBN and Australia’s potential internet futures, suggests policymakers and strategists currently consider too few perspectives. Keywords: national broadband network, internet, incasting, technology foresight, Australia Introduction Analyses of internet futures often outline prevailing trends – such as the shift towards mobile internet and personal/business data capture and analysis – and project major, positive, rapid changes to business, politics and daily life. However, trends constantly evolve and can change dramatically, rendering earlier forecasts obsolete. ‘Virtual worlds’ like Second Life were touted as innovations that would rapidly alter online business and marketing – only interest waned and shifted to educational uses (Salomon, 2010). Conversely, popular social networks like Twitter were initially dismissed – only to rapidly become mainstream, due in part to celebrity uptake (Burns and Eltham, 2009). This article develops an alternative approach to technology foresight, and on prospective thinking about Australia’s internet futures. Analyses are reframe-able expressions of one of many ‘schools of thought’ or mental models on internet futures. We suggest a shift in focus towards alternative futures, and the theoretical and analytical perspectives can inform this analysis. We use a mixed-method approach to consider potential internet futures, identify generic categories of future images, and consider these for ‘incasting’ a focal topic thereby deductively conceptualising alternative futures (Dator, 2002). This article’s core aims are: (1), to present an outline of key ‘schools of thought’ and theoretical perspectives on technological change which informs a new technology futures framework; and, (2), to show how this framework could be used to quickly conceptualise possible futures, in particular, Australia’s potential internet futures. The article also addresses the need to move beyond the dualistic discussion of internet futures as either emancipatory or, alternatively, dystopian. We need to better recognise and consider the diverse mixture of positive and negative outcomes the internet will more plausibly be associated with. As Voros observed, “we can – if we are wise enough – choose the quality of our mental models and guiding images of the future and, therefore, the quality of the decisions we make based upon them” (Voros, 2006). We agree: such ‘guiding images’ are too often taken-for-granted. The paper is structured as follows. We first outline recent perspectives on internet futures. A review of relevant visions and technological change theory is synthesised as a new technological futures framework. Through ‘incasting’ we use this framework to consider the potential for alternative internet futures to emerge in Australia, focusing on the National Broadband Network (NBN) and the 2020 outlook. Current Schools of Thought and Technological Frames Schools of thought The Smart Internet Technology CRC’s report Smart Internet 2010 articulated four schools of thought about possible internet futures (Barr, Burns, & Sharp, 2005). The four ‘schools’ were Rich Media, Adaptive User Environments, Not the Smart Internet and Chaos Rules. Each school encompassed an image of the future, theoretical perspectives, and thought leaders. Each school “ought to be viewed as… shared mindsets” which “suggest possible future outcomes” (Barr, Burns, & Sharp, 2005, p.7). Rich Media was the default future: the “multi-person, multi-device” access envisioned by Microsoft, News Corporation, Nokia and other corporations. This view anticipated debates about Australia’s development of the NBN; rural-based tele-medicine infrastructure; consumer booms in high-definition television, and the Australian Government’s Digital Education Revolution. This ‘school’ is “closely related to … advocates of the pervasive computing approach” (Barr, Burns, & Sharp, 2005, p.41). Adaptive User Environments emphasised end-user experience, adaptability, and design, like Apple’s iPod, iPhone and iPad, and how “social and cultural factors influence the way end users and consumers interact with a wide range of Internet-based technologies and services” (Barr, Burns, & Sharp, 2005, p.24). Not the Smart Internet emphasised “basic services for all” and “open standards”. Chaos Rules was pessimistic and slightly dystopian, questioning the robustness of Internet services (e.g. due to hackers, viruses, and cyber-warfare) and over-reliance on information technology. This school anticipated concerns about digital technologies and social media impacts on brain function, attention spans and society (Watson, 2010). Chaos Rules also foreshadowed Taleb’s (2007) contrarian thinking on low-probability, high-impact ‘Black Swan’ events. Today’s dominant frames: ‘Web 2.0’, ‘Web 3.0’, and ‘the Cloud’ A technological frame structures interactions among relevant social groups via the set of meanings attached to a technology/artifact (Bjiker, 1995). Publisher Tim O’Reilly’s (2005) Web 2.0 is currently the dominant internet frame. After the 2000 dotcom crash, most internet companies struggled to raise finance and survive. Dotcom era visions such as convergence and disintermediation seemed dead. O’Reilly’s Web 2.0 contended the next generation of web tools would be more accessible and end-user friendly, and be associated with collective intelligence, participation, and service delivery. This coincided with Google’s initial public offering and the emergence of social networks like Facebook. The frame also co-opted the UK Blair Government’s promotion of creative industries and the maturation of knowledge management (Leadbeater, 2009; Tapscott & Williams, 2010). Web 2.0 shapes current policy agendas such as ‘Government 2.0’ and ‘e-Health’. Thought leaders now increasingly discuss Web 3.0 which Web 2.0 might evolve into. Web 3.0 might include the mainstreaming of sophisticated, mobile internet connected devices, greater video content, ‘cloud’ computing, ‘the internet of things’ (physical objects are also connected to the internet such as cars, home appliances, buildings), and a broader convergence of digital and physical worlds. Kevin Kelly (2011) defines this frame with six verbs: screening (not reading), interacting (“if it’s not interacting, it doesn’t work”), sharing, flowing, accessing, and generating. An emerging theme is collecting and using personal data. Data is ‘the new oil’: offering a new wave of value creation potential “in a world where nearly everyone and everything are connected in real time”, despite privacy and trust concerns (World Economic Forum, 2011, p.5). The end-user remains central and is part of wider ‘data ecosystems’ which can be ‘mined’ to deliver more personalised services. Information and communication technology (ICT) will be a ubiquitous, intrinsic part of all social behaviours, business practices and government (Greenhill, 2011). The ‘cloud’ – a metaphor for resources accessible on-demand (e.g. software, content) from anywhere via remote internet accessible storage – and associated ‘cloud computing’ models is a front-runner for such as paradigm shift. The ‘cloud’ and ‘internet of things’ relate to emerging agendas for ‘smart’ and ‘embedded’ systems. Through ‘intelligent’ infrastructure and devices, data gathering and management will become infused into service delivery and everyday objects. IBM’s former chief executive officer Samuel Palmisano (2008; 2010) believes computing power will be “delivered in forms so small, abundant and inexpensive” that it is “put into things no one would recognize as computers: cars, appliances, roadways and rail lines, power grids, clothes; across processes and global supply chains; and even in natural systems, such as agriculture and waterways.” Further, ‘systems of systems’ will turn a mass of data into information and insight, to enable smarter healthcare, more efficient energy systems and productivity improvements (Palmisano, 2010; RuedaSabater & Garrity, 2011) However, Web 2.0 and Web 3.0 are uncertain. Google, Facebook, Twitter, and Wikipedia have led to ‘lock-in’ and institutional capture of specific services. Paradoxically, this may limit future innovation. Disruptive challengers may emerge from China and India. Emerging internet communities in developing countries appear to adopt different attitudes and online behaviours which may become more influential (Dutta et al., 2011). A second view considers increasing user concerns about online privacy, identity theft, and changing public attitudes in Western markets. Dutta et al’s (2011, p.9) international user study also found users “want it all: they desire freedom of expression, privacy, trust, and security without viewing these as mutually exclusive.” However, trade-offs between these potentially conflicting priorities may in fact be necessary. We need to think about futures in which people, in effect, ‘trade’ aspects of their privacy in return for other benefits. A final view is that most Web 2.0/ Web3.0 firms are yet to develop sustainable business models beyond start-ups. These perspectives foreshadow alternative futures. Considering Alternative Technological and Internet Potentials In this section we outline five generic images for technological futures, based on a review of different perspectives (such as those described above), technological change theory, and innovation theory. This framework can be used to consider potential internet futures. Promised future (Dominant expectation[s] and vision[s]) The first category is the simplest to describe and identify. ‘Promises’ are made by actors seeking to build support for particular domains – such as those made by thought leaders about ‘Web 3.0’, the ‘internet of things’, and social media. Theoretically, the Sociology of Expectations (SoE) informs this category (Borup et al., 2006; Brown et al., 2000). SoE scholars suggest that expectations of technologies and their impacts/ potential strongly influence the technological development and innovation, such as through ‘self-fulfilling prophecies’ (as seen with Moore’s Law). The more successful a particular ‘expectation’, i.e. the more support it has gained, the more likely key actors are to act in ways that help make it a future reality. Foresight analysts can proactively monitor this process and its outcomes. Shared expectations can play necessary, central roles in creating momentum and stimulating coordination of heterogeneous actors. The Australian Government’s National Broadband Network – discussed in Section 4 – and the European Commission’s new ‘Digital Agenda’ for Europe, illustrate this. Alternatively, they can be problematic if widely accepted expectations (such as the default Rich Media ‘school’ or Web 2.0) remain uncritically accepted. Further, a dominant vision may exclude other possible internet futures from being considered by business and government, just as a dominant ‘official future’ can limit thinking in organisations. Social/Speculative bubble(s) Bubbles refer to a “heightened state of speculative fervour” that emerges in markets which, ultimately, result in investment failures and drastic, sudden market corrections (Shiller, 2005). In technological change, ‘hype cycles’ are similarly quite common (Finn & Raskino, 2008). These are often due to over-promising by promotional actors who are seeking resources (Geels & Smit, 2000). Additionally, greater social focus on a dominant ‘frame’ can emerge as actors become ‘enrolled’ (Bijker, 1995). Some theorists see bubble creation as a natural, necessary part of major technological change. The innovation theory of social bubbles argues collective over-enthusiasm and commitments beyond what would be rationalised by cost benefit analyses, fuelled by hype, is necessary to enable action in the presence of risk and uncertainty (Gisler et al., 2011; Gisler & Sornette, 2009). Perez’s (2002; 2010) technological revolutions theory further contends that a recurring sequence of events occurs during each revolution, each time taking between 40-60 years: an initial ‘installation phase’ (e.g. investments in new supporting infrastructure) first, leading to speculative bubbles and a dramatic turning point, and followed a ‘deployment period’ heralding a new ‘golden age’. Similarly, Kondratieff-like ‘long waves’ are advanced (Freeman & Louca, 2001). Perez argues we are at the ‘turning point’ in the middle of the ICT revolution, during which major bubbles are expected. According to Perez, a ‘new age’ requires a new mode of growth compatible with a new ‘paradigm logic’ (for the revolution), and institutional changes to create the conditions for this growth. Web 2.0 has become the dominant ‘frame’ and recent investment growth illustrates this. Facebook had a more than four-fold increase in valuation as it prepared for an initial public offering (Ozanian, 2011). Microsoft purchased Skype for over 400 times its operating income (Anonymous, 2011). These dramatic changes create hype cycles (Finn & Raskino, 2008). Facebook co-founder Mark Zuckerberg remarked (from a Rich Media worldview): “if you look five years out, every industry is going to be rethought in a social way” (cited in Gelles, 2010). Brands rushing into social media view it “as the panacea to diminishing returns in traditional mass media” (Fournier & Avery, 2011). However, concerns over privacy and how greater marketing and advertising might affect social networks may ‘pop’ such a bubble and herald major shifts. Web 2.0 may be a major speculative bubble like the 1995-2000 dotcom era (Hirschorn, 2007; Raznick, 2011; Vance, 2011; Wooldridge, 2010). As Hirschorn (2007) observed, “in the Web hype-o-sphere, things matter hugely until, very suddenly, they don’t matter at all”. He forecasts social media to be “only another in a long string of putatively disruptive, massively hyped technologies that prove just one more step in the long march.” The propensity of internet discourses to naïve prophetic thinking, self-styled experts and exaggerated promises (Dublin, 1991) partly explains regular shifts from hype to disappointment. Disruption/Chaos Schumpeterian ‘creative destruction’ – the emergence, experimentation and innovation central to technological change and free markets – largely defines this image. ‘Chaos’ can also mean opportunity (as well as the danger normally perceived). Services originally designed to ‘police’ social networks have also led to new innovations in text mining and complex event processing (Sommon & Brown, 2011). ‘Disruption’ can be technological or driven by additional social or political factors. For example, a common pitfall in expectations of future technological developments is believing social practices “to remain constant in spite of the introduction of new technology (Geels & Smit, 2000, p.880). Exponential growth in the miniaturisation of transistors and computer power (Moore’s Law) may no longer hold in coming decade(s) and dramatically change chip fabrication costs (Rupp & Selberherr, 2011). Natural resource limits may disrupt consumer markets: the scarcity of needed rare earth elements in which China controls 95% of global supply (Cohen, 2007). Additional emerging candidates for future disruption are ‘augmented reality’ technologies and ‘nano-electronics’. Early stage augmented reality prototypes and technologies are now being commercialised together with geo-location tools like Geoloqi.com, in which real-world environments are ‘augmented’ by sensory inputs received via technology (via smart phones). An alternative medium-term source of technological disruption is a major new means of chip fabrication and manufacturing. Most prevalent at present is ‘nano-electronics’, a major area of research in Australia and Asia-Pacific. Unintended consequences Unintended social consequences emerge from second-order and third-order effects of technologies along with the appropriation of technologies. Theorists show that technologies are often ‘appropriated’ by diverse end-user groups, typically for uses unforeseen by the technology creators (Burns & Eltham, 2009; Jamison & Hard, 2003). Cyberpunk author William Gibson similarly observed that “the street finds its own use for things.” This category reveals a wide range of internet potentials and perspectives. ‘Cyberrealism’ is an emerging Chaos Rules-like philosophy that challenges the often utopian internet discourses (Morozov, 2011). Further convergence of digital and physical/ social worlds will enable political and other interests to shape the digital world’s development and its use in unexpected ways (Kelly & Cook, 2011; Morozov, 2011). Recent literature suggests unintended consequences may include: information flows being distorted by personalisation features (Pariser, 2011); data security and privacy being compromised by the adoption of open/cloud computing architectures (Bisong & Rahman, 2011; Grobauer et al., 2011); authoritarian governments gaining power from the internet, rather than a power shift to individuals which is more commonly expected (Burns & Eltham, 2009; Morozov, 2011); and the potential for intensified consumerism as more sophisticated ways to advertise and sell become embedded in more online and social technologies. The “open platform paradigm” of Not the Smart Internet can also, paradoxically, compromise content creation and intellectual property (Lanier, 2010). The spectre of increasing cyber-warfare is a topical national security issue and regional flashpoint (Clarke & Nake, 2010). For example, China is blamed for attacks on the ICT systems of Australian mining and resource firms (Wilkinson, 2010). In the Asia-Pacific region, many countries have invested in new national teams and defensive cyber-warfare capabilities. Several different possibilities exist about how cyber-warfare could evolve. Attacks on transnational firms may impact the stability of sovereign financial markets. Countries may develop offensive cyber-warfare capabilities and teams as a form of market intelligence, and as strategies to gain access to intellectual property. Co-existence/Co-option Co-existence/Co-option focusses on the complex ‘co-evolution’ of technology and society. This co-evolution makes unpredicted futures more likely than is commonly recognised despite our best efforts to achieve foresight (Williams, 2006). Through ‘coevolution’ one possibility is the complex co-existence of old and new technologies (Geels & Smit, 2000). This is an important counter-point to common forecasts in which the new replaces or displaces the old. Co-existence/Co-option also recognises 39 that business entrepreneurs and experts often articulate and promote futures they have a vested interest in. SoE scholars in the Science and Technologies Studies field emphasise attempts “to create ‘direction’ or convince others of ‘what the future will bring’” (Brown et al., 2000, p.4). Here, ‘contested futures’ is relevant. Brown et al (2000, p.3-4) observe that “if actors are to secure successfully for themselves a specific kind of future then they must engage in a range of rhetorical, organisational and material activities through which the future might be able to be ‘colonised’.” These actor strategies may also partly explain how Web 2.0 versions of Rich Media and Adaptive User Environments quickly came to dominate thinking. Web 2.0 growth and social networks provide emancipatory tools for many, yet have also enriched key individuals like Facebook’s Mark Zuckerberg, Mahalo’s Jason Calacanis, publishers John Battelle and Tim O’Reilly and LinkedIn founder Reid Hoffman. However, the broader community of ‘Web 2.0’ proponents and consultants rarely consider the possibility that they may be acting on what Inayatullah (2008, p.5) terms “used futures”: out-dated conceptions of the future “unconsciously borrowed from someone else.” Additionally, the increasing number of proposals to ‘order’ or (re)structure the evolution of the internet and mobile markets is a clear manifestation of the ongoing ‘co-evolution’ of technology and society which continually plays out. These proposals include the ‘network neutrality’ debate, and United States legislation such as the Stop Online Piracy Act, and the Research Works Act that would restrict ‘open access’ publishing. These regulatory regimes can reshape industry trajectories and change the balance of power between innovators, early adopters and laggards (Lessig, 2001; Spar, 2001; Wu, 2010). Case Study: Australia’s Potential Internet Futures In this section we focus on the Australian context: the National Broadband Network (NBN) which is being rolled-out by the Federal Government. If it is fully rolled out (the Federal Opposition currently opposes this), the high speed network of three technologies (optic fibre, fixed wireless, satellite) will be completed in approximately 2020.1 We first introduce the NBN. Issues and potential futures are then discussed, considering the analytical perspectives advanced. The national broadband network An NBN was first proposed by Australia’s Howard Liberal Government in 2003 and eventually made a Federal election issue in 2007. The then Rudd Labor Government announced in April 2009 that it would form the NBN Co, a wholly-owned Commonwealth company, to build and operate a national “wholesale-only, open access broadband network.” The successor Gillard Labor Government started to roll-out in 2011. The Federal Government’s decision to create the new network followed almost a decade of unsuccessful attempts to build an NBN-like network. Sol Trujillo-era Telstra adopted lobbying tactics to delay the separation of its retail and wholesale divisions. Competitors like Optus lobbied against Telstra to avoid hidden network and sunk costs. A competitive bargaining game developed. Research and development firms like Telstra Research Labs and the Smart Internet Technology CRC led supply-side research on NBN-like application scenarios and use cases. The NBN was the Australian Government’s response to telecommunications market failures. The Smart Internet Technology CRC highlighted early-stage innovators and commercialisation possibilities. However, gaps in the Australian environment, such as the lack of a venture capital sector, hampered efforts. NBN Co’s formation shifted the debate to access and pricing regimes, location of testing sites, and the reaction of market incumbent Telstra. New debates also focus on government and capital markets execution. NBN Co faced scrutiny about its operational efficiencies (in 2011 the pricing regime was revealed to be more expensive than first planned), ability to roll-out the network, and the management team. Analysis: Schools of thought and alternative futures The default future in the ‘schools of thought’ framework is Rich Media. This ‘school’ may have captured Australian Government policy-making and academic research as the dominant technological frame that actors have been enrolled in (Bjiker, 1995). NBN evidences the role of shared expectations in creating sufficient momentum and stimulating coordination: all actors speak of the same “digital economy of the future” and of its emancipatory, economic potential. The NBN is a return to the 1990s rhetoric of the internet as an ‘information superhighway’ in a new guise. Similar claims to NBN’s emancipatory potential were made for Sausage Software during the Netscape-Microsoft browser wars (in the mid-late 1990s) and for local content production for the 2G and 3G mobile internet. The Not the Smart Internet ‘school’ would suggest an NBN framed as an important intervention that primarily addresses access and digital divide issues, and provides more widespread, functional, lower-cost, transparent services. However, this contrasts with Rich Media style focus on network speed and capacity for media streaming and future ‘cloud’ based businesses. The Adaptive User Environments ‘school’ suggests 41 emulating, locally, Apple or Google-like models of content creation and distribution. Australian retailers such as JB Hi-Fi might develop new online content serviceorientated models (e.g. streaming music services like Pandora). However, these firms must successfully compete with global competitors to win customers (Stafford, 2011). NBN may provide the infrastructure for virtual worlds to have more significant uptake (Salomon, 2010). The Chaos Rules ‘school’ suggests security capabilities to pre-empt hackers, viruses, and cyber-warfare. Alternative futures framework: Considering image categories In this section we provide a high-level ‘incast’ of Australian internet futures, considering a 2020 time horizon. Incasting involves considering predetermined images of the future in order to deduce alternative future scenarios for the particular object of the research (Del Pino, 1998). The advantage of this approach is that it enables quickly conceptualising alternative futures (Dator, 2002). Promised future The ‘promises’ and dominant expectations for Australian internet futures are clearly expressed in the Government’s (2011) National Digital Economy Strategy (NDES) which articulates a vision for Australia to be, by 2020, a ‘world leading digital economy’. Eight goals are defined: • By 2020, Australia will rank in the top five OECD countries for the portion of households that connect to broadband at home; • By 2020, Australia will rank in the top five OECD countries for the portion of businesses and not-for-profit organisations using online opportunities; • By 2020, the majority of Australian households, businesses and other organisations will have access to smart technology to better manage their energy use; • Improved health and aged care: by 2020 90 per cent of high priority consumers (e.g. older Australians, those with a chronic disease) can access individual electronic health records; by 2015 495,000 telehealth consultations will have been delivered by remote specialists; by 2020, 25 per cent of all specialists will be participating in delivering telehealth consultations; • Expanded online education; • By 2020 at least doubling the level of teleworking (at least 12 per cent of Australian employees); • By 2020, four out of five Australians will choose to engage with the government through the internet or other type of online service; and • By 2020, the gap between households and businesses in capital cities and those in regional areas will have narrowed significantly. The NDES envisages a ‘market-led’ transition to this future economy, connecting activities to the ‘smart systems’ vision (e.g. using ICT to optimise energy and transportation systems) “enabled by... the internet, mobile and sensor networks” (p.12). A ‘linear’ view, similar to Rich Media and Adaptive User Environments, is adopted: “based on existing trends, in the future the online experience will become richer and more data intensive and increasingly integrated into everyday life, at home and at work” (p.10). Inclusions themes, of Not the Smart Internet, are also noted: “distance - once a defining characteristic and barrier for regional Australia - becomes increasingly Australia's Potential Internet Futures Journal of Futures Studies 42 irrelevant” (www.nbn.gov.au). Social/Speculative bubble The NBN and NDES were developed during intensifying Web 2.0/Web3.0 hype. An alternative image centres on the potential for unmet expectations, and the associated ‘fall-out’. This would replay aspects of the 1995-2000 dotcom bubble – especially if the current “state of speculative fervor” (Shiller, 2005) surrounding Web 2.0 contracts in the near-to-medium-term. The envisaged application scenarios and use cases may also not be commercially and/or socially viable. An important example is ‘e–health’ for aged Australians. Australia has to-date struggled to develop viable new e-health businesses/business models for providing aged care, and public acceptance issues could also slow adoption (Tegart, 2010). Similarly, teleworking has tended to not meet expectations (Geels & Smit, 2000) due to unmet social needs which could reoccur over the next decade. In this future, when 2020 arrives the economic productivity ‘promise’ of NBN is unrealised.2 Moreover, it raises the possibility – if user take-up is lower than expected, as recently occurred in the UK – of delays in NBN Co gaining sufficient cash-flow to no longer require government support. Some Australian social scientists have argued – in part due to highly differential take-up across NBN test sites – that the ‘promises’ (above) will be challenged by local cultural and material factors, and that such variations will grow in significance as the NBN is further rolled-out (Apperley et al., 2011). Both localised conditions (e.g. installation policy and logistics, costs) and “integration of the NBN with each household’s domestic network of hardware devices, internal connections, software, and of course skill and interest” must be considered (Apperley et al., 2011). Like the recent example of the Human Genome Project (Gisler et al., 2011) it may take many decades to fully “exploit the fruits” of the NBN investment, rather than the shorter time horizons presently expected. Disruption/Chaos This image highlights the ‘creative destruction’ associated with technological change and associated potential for unanticipated shifts in practices. If optical fibre overtakes DSL broadband connections after 2015/6 (assuming full roll-out continues)3 then many sectors are likely to be ‘ripe’ for disruption – such as media, telecommunications, advertising, and retail – as people invent ways to utilise the expansion in bandwidth and evolve offline behaviours. Implicit in the NBN is a vision of a “digital home” and “an anticipated future of digital living” (Apperley et al., 2011) which many may embrace, whilst others ‘opt-out’ of the “connectopia” (Kiss, 2011). Similarly, broadband services (see generic categories in Table 2), and the NBN, need to be viewed more broadly than as merely high-speed Internet. By 2020, internet futures could have a majorly disruptive impact on several sectors. Today’s decline in newspapers and some retail sectors (e.g. music, books), could signal futures in which many local firms are unable to maintain viable, growing businesses. Local players such as those experimenting with new service-oriented models, such as JB Hi-Fi, increasingly face global competition and disruption potential. Regulators and users may also still be “struggling to work out the boundaries of online privacy” (Gettler, 2010) as practices, tools, and norms evolve. Unintended consequences NBN has the potential to generate a multitude of unintended social consequences – both positive and negative (often depending on whose perspective is taken). NBN uptake may vary by geographic areas, leading to new subtle versions of the ‘digital divide’. Related socio-technical factors influence access to participation in a digital economy. The ‘unintended consequences’ image also alludes to the potential for arbitrage and leaking of NBN data to individuals. Although the ‘Gov 2.0’ agenda views the open data movement positively, Australia is constrained by the Westminster system which presently imposes limits on the release of government data. Major unintended consequences for the Australian political system could emerge in a more technologically-empowered society – a potential blind-spot for politicians, regulators, policymakers, and others. The internet can also facilitate larger-scale manipulation of publics (Kearne, 2012), a concerning trend the NBN may also enable. Co-existence/Co-option In another plausible scenario a “patchwork of [variable] connectivity” prevents the envisaged future, centred on the digital home being “integrated into the digital economy as a node of production and consumption” (Apperley et al., 2011), from fully emerging. The ‘co-existence’/‘co-option’ image further suggests potential internet futures in which highly advanced digital homes co-exist with less advanced and connected homes with varying connections, mediums, and social conditions – rather than a homogenous new ‘digital Australia’. In this future official projections of 70 percent take-up by 2025 are not achieved. Political risks provide another avenue to such futures, with a partially complete NBN (if there is a change of Federal government) likely co-existing with Australia's Potential Internet Futures Journal of Futures Studies 44 other networks. Additionally, a range of social, competitive, and regulatory issues highlight the potential for ‘co-option’. Regulatory settings and markets factors will influence the level of competition and services that emerge. NBN might fit Perez’s Kondratieff-like ‘long waves’ model but its roll-out has been delayed by local factors such as bargaining games, telecommunications market failure and institutional issues. The NBN Co’s government monopsony also limits capital markets involvement and, consequently, a true valuation market. Small and medium enterprises who develop new NBN markets or information services may in time be forced to start mergers and acquisitions that, ultimately, favour larger incumbents. These factors could limit the NBN and Australia’s internet futures. Furthermore, NBN’s growth is in a democratic society which means it will be different to the Confucian and Juche logics of Singapore and South Korean NBN-like solutions. Whilst the Sociology of Expectations suggests policymakers, academics and others and will continue to envision NBN-like (digital economy) capabilities, there is the risk of coordination failure, roll-out problems, and, possibly, colonised futures (Brown et al., 2000). Discussion Whilst the above analysis is only a high-level assessment it suggests discussion in Australia of potential internet futures is dominated by a limited number of ‘schools’ and ‘image’ categories. Our reading of the current NBN debates and consideration of potential internet futures is there is little consideration of the Chaos Rules, nor the potential for ‘bubbles’ (and for associated unrealistic expectations), unfolding ‘disruption’, unintended consequences, or co-existence/co-option. The NDES fails to address the potential for sectoral disruptions, and associated indirect negative effects. Holistic consideration of potential futures and associated outcomes could better inform planning and decision-making. Methodological and conceptual improvements could be made by using other futures tools and exploring interconnections. Examination of potential secondorder and third-order consequences could be improved by using ‘Futures Wheels’. Interconnections appear to exist, for example, between ‘bubbles’ and ‘unintended consequences’. If the Government and NBN Co – through the return to 1990s utopian internet rhetoric – contribute to speculative bubbles emerging, then this may have social consequences that unintentionally later impair the envisioned digital future and current ‘real’ economy. Furthermore, a major “social bubble” may be necessary to mobilise the needed commitments and major investments by innovators and entrepreneurs to realise the ‘promises’ and cause ‘disruptions’ (Gisler et al., 2011). Conclusion In this paper we have outlined and considered key ‘schools of thought’ (or mental models) on internet futures and additional analytical and theoretical perspectives that provide insights into potential internet futures – both internationally and in Australia. Through a brief case study, we have shown how a resulting technological futures framework could be used to quickly highlight potential futures through a deductive ‘incasting’ process. We make several contributions to the literature on internet futures and technology foresight. First, we built on the Smart Internet 2010 project (Barr, Burns, & Sharp, 2005) and its four ‘schools of thought’. We have updated examples 45 to include contemporary debates. The current dominant ‘frames’ are understandable as expressions of the default ‘mental model’ on internet futures, Rich Media, along with Adaptive User Environments, which also informed development of the NBN. Second, through literature review we identified five image categories which can be used as predetermined images of the future for incasting. The first three images – promised futures, social/speculative bubbles, and disruption/chaos – deal primarily with change dynamics. The last two images – unintended consequences, co-existence/ co-option – primarily bring out potential outcomes such as regarding competition and interest politics, risk, and social impacts. Analyst consideration of the categories enables asking “devil’s advocate” questions (Wright & Cairns, 2011; Taleb, 2007) which challenges dominant ‘frames’ and stimulates consideration of multiple viewpoints which is needed for effective scenario thinking. Like Smart Internet 2010’s schools of thought, these predetermined images are relatively open-ended and can be revised with future examples, along with analysis of other domains. Each school of thought and image category provides important perspectives for analysing the emergence of the NBN and potential Australian internet futures. Widely accepted expectations inform the application scenarios, use cases and supply-side research supporting the NBN and similar technology debates. The NBN is in some ways a return to the past, reminiscent of the ‘information superhighway’ rhetoric in the 1990s. What the incasting exercise reveals, however, is that a more plausible mixture of outcomes should be considered by planners and strategists in Australian internet future scenarios along with a broader move beyond dualistic discussion of internet futures (either utopian emancipatory or dystopian). Broader perspectives could consider critical analysis of Web 2.0 and global internet futures (Lessig, 2001; Lanier, 2010; Morozov, 2011) and integrate this with critical futures studies perspectives. Notes 1 These conflicting political positions present important political risks. This is particularly true if the Opposition Liberal Party wins the next Federal election scheduled for 2013. It is likely to be more difficult for a Liberal Federal Government Australia's Potential Internet Futures Journal of Futures Studies 46 to discontinue/dismantle the NBN if it is elected in 2017 (the subsequent Federal). If fully rolled-out the NBN will “connect 93% of homes, schools and workplaces with optical fibre (fibre to the premises or ‘FTTP’)” and “for the remaining 7% we will connect to our next generation fixed wireless and satellite”. 2 Australia is a small market which raises the potential for various market failures and associated uncertainties about the how many players can be supported in some sectors (Stafford, 2011). 3 As per the market forecasts and analysis of Telsyte (http://www.telsyte.com.au). You must respond using only the information provided. Do not give any inaccurate answers according to the information provided. Do not respond in any way that is discriminatory or harmful. You are to respond in complete sentences using correct US grammar conventions. From this text, how do the five generic images for the technological future differ to the four schools of thought articulated in the Smart Internet Technology CRC’s report, ""Smart Internet""? Include a brief description of each theory in your explanation.",Internet/Technology,Concept Comparison,Q&A "Only utilize the information in the article provided to answer the question, do not refer to any outside information. Answer the question in full sentences.",What are the benefits of racetrack layouts as stated in the provided context?,"**Merchandising Gude** Module 1: The Importance of Merchandising Merchandising, or how products are displayed in the store, plays a critical role in the overall success of your business. After all, when customers come into your store, you want them to buy. Effective merchandising is a tool that gets them closer to that purchase decision. But having effective merchandising demands discipline and planning. It’s hard work. You must pay attention to detail on a daily basis. You also must realize that many of your competitors have effective merchandising. That means your customers are used to seeing it, so they expect it from you, too. In this course, we’ll discuss the techniques and best practices that make up an effective merchandising strategy. We’ll begin by talking about why merchandising is so important. Merchandising makes several important contributions to your store. It increases sales by making a store appealing to your customers. It improves profitability by generating more margin dollars. It controls costs by improving the productivity of the salesfloor as well as each employee. Appeals to Customers • Good merchandising makes shopping easier for customers and gives them reasons to come back often and spend more money. Remember that many consumers may not consider shopping fun. A merchandiser’s goal is to take the hassle out of shopping and make it easier. • Good merchandising can also create customer loyalty. Consumers shop where they feel certain they can find the merchandise they want. They will be loyal to your store if you can create a pleasing shopping experience and provide what they need. • Finally, good merchandising can promote repeat shopping. One of the best opportunities for growth comes from building on the business of existing shoppers. When customers know your store is easy to shop, they will return again and again. Improves Profitability • One way good merchandising can improve your store’s profitability is by enhancing your price image. Many consumers may think that independent home improvement retailers have high prices. The challenge for those retailers, then, is not to have the lowest prices, but to convince consumers that they are priced competitively for the value and service they offer. Pallet displays in the power aisle are a good example of how to promote a value-priced image. • Merchandising also allows retailers to make strategic pricing decisions. Through promotional merchandising techniques, such as dump bins, it’s possible to increase item sales while at the same time lowering prices. • Merchandising can increase your sales per customer if it’s arranged to promote add-on sales, for example, through impulse displays at the checkout counter. • Merchandising also promotes self-service shopping. While you can only wait on one customer at a time, good displays help customers shop on their own. This means you have more time to spend with customers who need extra help. Module 1: The Importance of Merchandising (continued) Increases Salesfloor Productivity • Merchandising can help control costs by helping retailers improve the productivity of the salesfloor. Productivity improves when retailers can increase sales using their existing salesfloor square footage and number of employees. Merchandising affects virtually all of the measurements of retail productivity, such as gross margin and sales per square foot. • Merchandising also makes the salesfloor more productive by suggesting add-on sales and impulse purchases. It helps organize the store, suggest project ideas, remind customers of items they may have forgotten and promote special buys. • Merchandising also complements advertising by helping customers find sale items. Increases Employee Productivity • Good merchandising can help increase your productivity by helping you provide better customer service. As an employee, you want to spend your time giving customers the product knowledge they need to solve their home improvement problems. You want to minimize the time you spend simply directing customers to the aisles where they can find what they need. That’s why you have signage and merchandising. • Good merchandising makes selling more rewarding. The more customers are able to shop for themselves, the more time you have to develop new retailing skills. This will help you advance and gain new responsibilities in the company Module 2: The Elements of Merchandising There’s more to merchandising than just having attractive displays. It incorporates the design of the salesfloor, the placement of the signage and the presentation of the products. When you learn how to merchandise, you learn how to effectively use space, color and lighting to encourage customers to buy. A well-merchandised store is also a well-organized store. Customers like organized stores because they can find merchandise quickly and easily on their own. All of the elements of merchandising contribute to making a store more organized. In this module, we’ll discuss eight elements of merchandising: salesfloor layout, interior signage, cross merchandising, the use of space, color, lighting, mass displays and interactive technology. Racetrack Layout The racetrack layout, also called a loop layout, has the main traffic aisle circling the salesfloor. It gives every major department exposure on the main aisle. It moves customers through the store and lets them see merchandise in more departments. It also provides more locations for endcaps, which helps create a value-priced image. Diagonal Layout The diagonal layout is a modification of the racetrack layout and can be effective in smaller stores. It creates several triangular areas in the store and pulls customers to corners they might otherwise miss. Grid Layout The grid layout is the simple, traditional layout for a home improvement store. It has straight cross aisles leading off one or more main aisles into departments. This layout is neat and makes good use of space. Its main drawback is that is does not put the maximum amount of product in front of customers. Power Aisle The power aisle design works well for smaller salesfloors where a racetrack is not practical. It is a double-width aisle that runs the full length of the store. This design often includes departmental cross aisles that feed off of the power aisle. The power aisle gives exposure to most major departments through the use of feature endcaps or promotional mass displays in the center of the aisle. It makes maximum use of the display area. Module 2: The Elements of Merchandising Salesfloor Layout Most stores are organized into departments, and customers are accustomed to shopping this way. Here are five ways the salesfloor can be laid out in a typical store. Project Centers Project centers and demonstration areas can be developed with any salesfloor layout. They can be used for classes, workshops or product demonstrations. They are also useful areas for collection points for how-to information, such as books and product information. These areas should present products related to projects and focus attention on promoted merchandise. Signage should suggest projects, explain product features and benefits, talk about prices and highlight the value of home improvement projects. Cube Displays Cube displays are another way smaller stores can get the maximum amount of merchandise on the salesfloor. These displays use higher fixtures with careful attention to the kinds of merchandise displayed on higher shelves. An effective way to use cube displays is to put the higher fixtures in the back of the store to make more merchandise visible from the front and lead customers through the store. Module 2: The Elements of Merchandising (continued) Brought to you by the North American Retail Hardware Association • www.nrha.org Interior Signing • Signage is an important part of merchandising because it makes shopping easier for customers and gives them the information to make informed buying decisions. • Signs keep customers in the store longer, move them from department to department and suggest more items to purchase. In addition to department and aisle signs, shelf and product signs can convey shopping information. • Some signs provide information about specific products. Signs may also be used to describe the product’s features, benefits and uses. They should always be neat, easy to read, informative and compelling. • Signs are also used to provide information about price. They can create urgency if they are used to identify items as bargains or closeouts. They can also identify advertised items and help establish a value price image for the store. • Department signs are used to help identify the location of departments in the store, such as paint or tools. These signs should be visible from the front of the store so customers can quickly find what they need. Store Design and Product Presentation In addition to the layout of the salesfloor, here are some elements of merchandising you may encounter in the store. Cross Merchandising • Cross merchandising is a term used to describe the placement of products together that are used together in projects. It is an effective way to show related items that are normally stocked in different departments. For example, you might show garden gloves next to the shovels. You can merchandise these items next to each other on the same shelf or across the aisle. Cross-aisle merchandising is the practice of displaying related merchandise on facing shelves. • Cross merchandising is an effective technique because it makes shopping easier and more convenient when customers can see several items they need in one location. • This appeals to a customer’s desire to save time because they don’t have to go to multiple areas of the store to get what they need. • It’s also an effective tool suggesting add-on sales, since related items are together. • Cross merchandising organizes products in the way they are used. In this way, it gives customers project information. It can also suggest better-quality items. • Here are some ways you can effectively use cross merchandising: • Combine products from different departments. • Promote seasonal projects. • Promote common household repair and maintenance projects. • Display the pairs in the department where customers are most likely to go first. • Look for vendor planograms that utilize cross-merchandising. • Incorporate signage to compare benefits of good-better-best quality. Use of Space • Merchandising should organize products in the most productive use of the space. Shelves should be far enough apart that the merchandise fits comfortably, but not waste space. In the same way, hooks and bins should fit the size of the item. Long- and short-handled items should go together. • The use of space in merchandising also involves placement in the store. Reserve the prime display areas in the store for items customers are most likely to want. Keep the best display area for high-demand, fast-moving products. Putting slow movers in prime display spaces won’t make them sell faster. It may only suggest to customers that they may have to go somewhere else to find what they need. ","[Query] ================== What are the benefits of racetrack layouts as stated in the provided context? ================ [Context] ================== **Merchandising Gude** Module 1: The Importance of Merchandising Merchandising, or how products are displayed in the store, plays a critical role in the overall success of your business. After all, when customers come into your store, you want them to buy. Effective merchandising is a tool that gets them closer to that purchase decision. But having effective merchandising demands discipline and planning. It’s hard work. You must pay attention to detail on a daily basis. You also must realize that many of your competitors have effective merchandising. That means your customers are used to seeing it, so they expect it from you, too. In this course, we’ll discuss the techniques and best practices that make up an effective merchandising strategy. We’ll begin by talking about why merchandising is so important. Merchandising makes several important contributions to your store. It increases sales by making a store appealing to your customers. It improves profitability by generating more margin dollars. It controls costs by improving the productivity of the salesfloor as well as each employee. Appeals to Customers • Good merchandising makes shopping easier for customers and gives them reasons to come back often and spend more money. Remember that many consumers may not consider shopping fun. A merchandiser’s goal is to take the hassle out of shopping and make it easier. • Good merchandising can also create customer loyalty. Consumers shop where they feel certain they can find the merchandise they want. They will be loyal to your store if you can create a pleasing shopping experience and provide what they need. • Finally, good merchandising can promote repeat shopping. One of the best opportunities for growth comes from building on the business of existing shoppers. When customers know your store is easy to shop, they will return again and again. Improves Profitability • One way good merchandising can improve your store’s profitability is by enhancing your price image. Many consumers may think that independent home improvement retailers have high prices. The challenge for those retailers, then, is not to have the lowest prices, but to convince consumers that they are priced competitively for the value and service they offer. Pallet displays in the power aisle are a good example of how to promote a value-priced image. • Merchandising also allows retailers to make strategic pricing decisions. Through promotional merchandising techniques, such as dump bins, it’s possible to increase item sales while at the same time lowering prices. • Merchandising can increase your sales per customer if it’s arranged to promote add-on sales, for example, through impulse displays at the checkout counter. • Merchandising also promotes self-service shopping. While you can only wait on one customer at a time, good displays help customers shop on their own. This means you have more time to spend with customers who need extra help. Module 1: The Importance of Merchandising (continued) Increases Salesfloor Productivity • Merchandising can help control costs by helping retailers improve the productivity of the salesfloor. Productivity improves when retailers can increase sales using their existing salesfloor square footage and number of employees. Merchandising affects virtually all of the measurements of retail productivity, such as gross margin and sales per square foot. • Merchandising also makes the salesfloor more productive by suggesting add-on sales and impulse purchases. It helps organize the store, suggest project ideas, remind customers of items they may have forgotten and promote special buys. • Merchandising also complements advertising by helping customers find sale items. Increases Employee Productivity • Good merchandising can help increase your productivity by helping you provide better customer service. As an employee, you want to spend your time giving customers the product knowledge they need to solve their home improvement problems. You want to minimize the time you spend simply directing customers to the aisles where they can find what they need. That’s why you have signage and merchandising. • Good merchandising makes selling more rewarding. The more customers are able to shop for themselves, the more time you have to develop new retailing skills. This will help you advance and gain new responsibilities in the company Module 2: The Elements of Merchandising There’s more to merchandising than just having attractive displays. It incorporates the design of the salesfloor, the placement of the signage and the presentation of the products. When you learn how to merchandise, you learn how to effectively use space, color and lighting to encourage customers to buy. A well-merchandised store is also a well-organized store. Customers like organized stores because they can find merchandise quickly and easily on their own. All of the elements of merchandising contribute to making a store more organized. In this module, we’ll discuss eight elements of merchandising: salesfloor layout, interior signage, cross merchandising, the use of space, color, lighting, mass displays and interactive technology. Racetrack Layout The racetrack layout, also called a loop layout, has the main traffic aisle circling the salesfloor. It gives every major department exposure on the main aisle. It moves customers through the store and lets them see merchandise in more departments. It also provides more locations for endcaps, which helps create a value-priced image. Diagonal Layout The diagonal layout is a modification of the racetrack layout and can be effective in smaller stores. It creates several triangular areas in the store and pulls customers to corners they might otherwise miss. Grid Layout The grid layout is the simple, traditional layout for a home improvement store. It has straight cross aisles leading off one or more main aisles into departments. This layout is neat and makes good use of space. Its main drawback is that is does not put the maximum amount of product in front of customers. Power Aisle The power aisle design works well for smaller salesfloors where a racetrack is not practical. It is a double-width aisle that runs the full length of the store. This design often includes departmental cross aisles that feed off of the power aisle. The power aisle gives exposure to most major departments through the use of feature endcaps or promotional mass displays in the center of the aisle. It makes maximum use of the display area. Module 2: The Elements of Merchandising Salesfloor Layout Most stores are organized into departments, and customers are accustomed to shopping this way. Here are five ways the salesfloor can be laid out in a typical store. Project Centers Project centers and demonstration areas can be developed with any salesfloor layout. They can be used for classes, workshops or product demonstrations. They are also useful areas for collection points for how-to information, such as books and product information. These areas should present products related to projects and focus attention on promoted merchandise. Signage should suggest projects, explain product features and benefits, talk about prices and highlight the value of home improvement projects. Cube Displays Cube displays are another way smaller stores can get the maximum amount of merchandise on the salesfloor. These displays use higher fixtures with careful attention to the kinds of merchandise displayed on higher shelves. An effective way to use cube displays is to put the higher fixtures in the back of the store to make more merchandise visible from the front and lead customers through the store. Module 2: The Elements of Merchandising (continued) Brought to you by the North American Retail Hardware Association • www.nrha.org Interior Signing • Signage is an important part of merchandising because it makes shopping easier for customers and gives them the information to make informed buying decisions. • Signs keep customers in the store longer, move them from department to department and suggest more items to purchase. In addition to department and aisle signs, shelf and product signs can convey shopping information. • Some signs provide information about specific products. Signs may also be used to describe the product’s features, benefits and uses. They should always be neat, easy to read, informative and compelling. • Signs are also used to provide information about price. They can create urgency if they are used to identify items as bargains or closeouts. They can also identify advertised items and help establish a value price image for the store. • Department signs are used to help identify the location of departments in the store, such as paint or tools. These signs should be visible from the front of the store so customers can quickly find what they need. Store Design and Product Presentation In addition to the layout of the salesfloor, here are some elements of merchandising you may encounter in the store. Cross Merchandising • Cross merchandising is a term used to describe the placement of products together that are used together in projects. It is an effective way to show related items that are normally stocked in different departments. For example, you might show garden gloves next to the shovels. You can merchandise these items next to each other on the same shelf or across the aisle. Cross-aisle merchandising is the practice of displaying related merchandise on facing shelves. • Cross merchandising is an effective technique because it makes shopping easier and more convenient when customers can see several items they need in one location. • This appeals to a customer’s desire to save time because they don’t have to go to multiple areas of the store to get what they need. • It’s also an effective tool suggesting add-on sales, since related items are together. • Cross merchandising organizes products in the way they are used. In this way, it gives customers project information. It can also suggest better-quality items. • Here are some ways you can effectively use cross merchandising: • Combine products from different departments. • Promote seasonal projects. • Promote common household repair and maintenance projects. • Display the pairs in the department where customers are most likely to go first. • Look for vendor planograms that utilize cross-merchandising. • Incorporate signage to compare benefits of good-better-best quality. Use of Space • Merchandising should organize products in the most productive use of the space. Shelves should be far enough apart that the merchandise fits comfortably, but not waste space. In the same way, hooks and bins should fit the size of the item. Long- and short-handled items should go together. • The use of space in merchandising also involves placement in the store. Reserve the prime display areas in the store for items customers are most likely to want. Keep the best display area for high-demand, fast-moving products. Putting slow movers in prime display spaces won’t make them sell faster. It may only suggest to customers that they may have to go somewhere else to find what they need. ================ [Task Instructions] ================== Only utilize the information in the article provided to answer the question, do not refer to any outside information. Answer the question in full sentences.",Retail/Product,Find & Summarize,Text Transformation Answer the following question using only details found in the attached paper. You should NOT reference outside sources or your own knowledge. ,What are some examples of visible and hidden biases that have been observed in criminal justice AI? ,"Executive Summary ‘Artificial Intelligence’ (‘AI’), comprising machine-learning and other analytical algorithm-based automated systems, has become an important aspect of our lives. In recent years, this technology has been increasingly deployed in criminal justice systems across the world, playing an increasingly significant role in the administration of justice in criminal cases. This trend is often driven by perceptions about the reliability and impartiality of technological solutions, and pressures to make cost savings in policing and court services. However, studies in various jurisdictions, including in Europe, provide substantial evidence that AI and machine-learning systems can have a significantly negative influence on criminal justice. AI systems have been shown to directly generate and reinforce discriminatory and unjust outcomes; infringing fundamental rights, they have been found to have little to no positive influence on the quality of human decisions, and they have been criticised for poor design that does not comply with human rights standards. Most AI systems used in criminal justice systems are statistical models, based on data which is representative of structural biases and inequalities in the societies which the data represents, and which is always comprehensively lacking in the kind of detail that is needed to make truly ‘accurate’ predictions or decisions. The data used to build and populate these systems is mostly or entirely from within criminal justice systems, such as law enforcement or crime records. This data does not represent an accurate record of criminality, but merely a record of law enforcement - the crimes, locations and groups that are policed within that society, rather than the actual occurrence of crime. The data reflects social inequalities and discriminatory policing patterns, and its use in these AI systems merely results in a reinforcement and re-entrenchment of those inequalities and discrimination in criminal justice outcomes. Given these extremely serious risks, strong regulatory frameworks are needed to govern the use of AI in criminal justice decision-making and, in some circumstances, to restrict its use entirely. Existing EU data protection laws restrict the use of automated decisions, but there are gaps and ambiguities that could result in the use of AI systems in ways that undermine human rights, if not accompanied by further guidance or legislation. Firstly, EU laws currently only prohibit decisions that are solely based on automated processes, but they do not regulate decision-making processes that are largely dependent on automated systems. Given that most AI systems in use today are designed and deployed to assist, rather than replace, human decision-making in criminal justice systems, they largely fall outside the remit of EU data protection laws on automated decisions. Secondly, the prohibition on automated decisions is subject to broad exceptions. Individuals can be subject to decisions based solely on automated processes if authorised by EU or Member State law, and there are deemed to be appropriate human rights safeguards in place, including the right to obtain human intervention. However, there is not enough clarity on what safeguards are needed, and how ‘human intervention’ should be interpreted. In order to regulate the use of AI in criminal justice proceedings, the EU must, at a minimum, set standards to address the following questions: 1) what standards are needed to govern the design and deployment of AI systems in criminal justice systems; 2) what safeguards are needed in criminal justice proceedings to make sure that AI systems are used in accordance with human rights standards and prevent discrimination; and 3) how Member States should govern the deployment of AI systems and monitor their subsequent use. The design of AI systems and their deployment in criminal justice proceedings should be regulated to generate human rights compliant, non-discriminatory outcomes. Minimum standards and safeguards should be set, which, if they cannot be adhered to, should preclude the use of the AI system in question. AI should also be regulated so that they are sufficiently transparent and explainable to enable effective independent scrutiny. AI systems should be designed and deployed to comply with and give effect to inter alia the right of access to court, the right to be presumed innocent, and the right to liberty. AI systems should not undermine the right to be tried by an impartial and independent tribunal and, in line with existing EU laws, no individual should be subject to an automated decision that results in a criminal record. AI systems should be designed so that they do not pre-designate an individual as a criminal before trial, nor should they allow the police to take unjustified, disproportionate measures against individuals without reasonable suspicion. AI systems that inform criminal justice outcomes should, as a general rule, favour outcomes that are favourable to the defendant. Where AI systems inform decisions on the deprivations of liberty, they should be calibrated to generate outcomes that favour release, and they should not facilitate detention other than as a measure of last resort. AI systems must be subject to rigorous testing to ensure that they have the desired effect of reducing pre-trial detention rates. AI systems must be developed to guarantee that they do not generate discriminatory outcomes, ensuring that suspects and accused persons are not disadvantaged, either directly or indirectly, on account of their protected characteristics, including race, ethnicity, nationality or socioeconomic background. AI systems should be subject to mandatory testing before and after deployment so that any discriminatory impact can be identified and addressed. AI systems which cannot adhere to this minimum standard should have no place in the criminal justice system. AI systems need to be transparent and explainable, so they can be understood and scrutinised by their primary users, suspects and accused persons, and the general public. Commercial or proprietary interests should never be a barrier to transparency. AI systems must be designed in a way that allows criminal defendants to understand and contest the decisions made against them. It should be possible to carry out an independent audit of each AI system, and its processes should be reproducible for that purpose. Member States should have laws that govern how AI systems are relied upon in criminal proceedings, and there must be adequate safeguards to prevent over-reliance on AI by decision-makers, to prevent discrimination and to ensure scrutiny and effective challenge by the defence. Procedural safeguards should actively tackle automation-bias amongst criminal justice decision makers. Examples include: a) making it a legal requirement for decision-makers to be adequately alerted and informed about the risks associated with AI systems; b) making AI systems’ assessments intelligible to decision-makers; c) requiring decision-makers to provide full, individualised reasoning for all decisions influenced by an AI system; and d) making it easy for decision-makers to overrule AI assessments that produce unfavourable outcomes for defendants. Criminal justice procedures should ensure that defendants are notified if an AI system has been used which has or may have influenced a decision taken about them at any point in the criminal justice system, from investigation to arrest, from charge to conviction, and sentence. Procedures should enable the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings. Disclosure should be in a form which is clear and comprehensible to a layperson, without the need for technical or expert assistance, in order to ensure fairness, equality of arms, and to discharge the obligations to provide all relevant information and be given reasons for decisions under the right to a fair trial. Suspects and accused persons should also be given effective access to technical experts who can help to analyse and challenge otherwise incomprehensible aspects of AI systems. Training should be made available to all primary users of AI systems, and to criminal defence practitioners, so that there is greater awareness of AI technology, and of the risks of over-reliance on AI. Effective regulation of AI systems should be facilitated by a governance and monitoring framework. AI systems should not be deployed unless they have undergone an independent public impact assessment with the involvement of appropriate experts, that is specific both to the purpose for which the AI system is deployed, and the locality where it is deployed. A requirement of the assessment should be a consideration of whether it is necessary to use AI in the particular use case, or whether an alternative solution could achieve the same aims. As far as it is possible to do so, AI systems should also be tested for impact pre-deployment, a part of which should be the minimum requirement to prove that the AI system has no discriminatory impact, either directly or indirectly, before it can be deployed. AI systems should be kept under regular review post-deployment. Effective monitoring of AI systems is not possible unless there is sufficient data that makes it possible to discern their real impact. In particular, Member States need to collect data that allow them to identify discriminatory impacts of AI systems, including discrimination on the basis of race and ethnicity. Background Rapid technological advancements in recent years have made artificial intelligence (‘AI’) an increasingly prominent aspect of our lives. There are differences of opinion as to the definition of AI and its true meaning, but for the purposes of this paper we are broadly referring to automated decision-making systems based on algorithms, including machine-learning, which are used in the criminal justice system. There is little doubt that AI has great capacity to increase human potential and improve the lives of many, but the increasing role of AI in assisting important public functions has also highlighted serious risks and challenges. If not subject to proper regulation and oversight, AI can threaten fundamental human rights and, far from expanding human potential, it can amplify and worsen harmful aspects of our society, including inequality and injustice. This challenge is particularly evident where AI has been used to assist the administration of justice in criminal cases. In recent years, more and more jurisdictions across the world have begun to use AI technology to inform and assist policing and judicial decisions, often driven by perceptions about the reliability and impartiality of technological solutions, and pressures to make cost-savings in policing and court services. In some countries, algorithmic processes can influence which geographic neighbourhoods should be subject to increased law enforcement and when, as well as which individuals should be specifically targeted by law enforcement. They can help to determine whether someone should be arrested, whether they should be charged with a criminal offence, whether they should be detained in prison before trial and, if convicted and sentenced, the length of their sentence. AI is being used more and more to influence highly sensitive, high impact decisions that have far reaching, long-term implications for individuals’ rights. Research emerging from the United States, where the use of AI in criminal justice is particularly widespread, and from the United Kingdom and some EU Member States, however, seriously questions whether AI has a positive influence on criminal justice systems. AI tools and systems have been found to actively generate discriminatory criminal justice outcomes, they have been found to have little to no positive influence on the quality of human decisions, and they have been criticised for poor design, that does not reflect or give effect to human rights standards. These criticisms might not be justified for all AI systems, but these studies highlight the need for much stronger regulatory frameworks to govern the use of AI. We believe that unless it is subject to robust regulation, it is unlikely that AI can be used in criminal justice systems without undermining the right to a fair trial. In some cases, it should be restricted from use entirely. EU Member States should be encouraged to take a much more cautious approach to AI and subject automated processes to more stringent rules that are designed to ensure human rights compliance. There is the potential for AI systems, if properly and robustly regulated, to have a positive impact on criminal justice system, advancing human rights, for example, by analysing law enforcement or judicial decisions to identify patterns of erroneous or poor decision-making, or discrimination. The EU is already a world leader on AI regulation, having adopted ground-breaking data protection laws in recent years to shield individuals from automated decisions that have an adverse effect on their rights. We welcome the EU’s commitment to build further on existing legal standards, and we emphasise that addressing the impact of AI on criminal justice has to be a primary consideration for EU policy makers when deciding on appropriate legal standards. Discussions around the impact of AI on human rights have largely been centred on data protection, the right to privacy, and broader questions of ethics and human dignity. However, despite the increasing use of AI systems in criminal justice systems across the world, only limited discussions have so far focused on how these systems impact the right to a fair trial, and what regulations are needed to address that impact. About this paper Fair Trials has produced this policy paper to highlight the need for EU-wide standards on the regulation of AI in criminal justice, and to inform EU policy makers about the standards and safeguards needed to ensure effective protection of fair trial rights where criminal justice decisions are assisted by AI. The EU Commission recognised that AI represents risks for fundamental rights, including the right to a fair trial, in its 2020 White Paper, ‘On Artificial Intelligence – A European approach to excellence and trust’. It also recognised the need for improvements to the EU’s legislative framework on AI, noting in particular the challenges in the ‘effective application and enforcement of existing EU and national legislation’ and the ‘limitations of scope of existing EU legislation’. In this paper, we identify the most common fair trial rights issues raised by existing AI systems, based on examples and experiences from the EU, the United Kingdom, and the United States. We also offer examples of practical legal and policy solutions that could help to address these challenges, and to assist in the effective implementation of the EU’s fundamental rights standards in this area. We recognise that the use of AI has a broader impact on human rights beyond the right to a fair trial, and that there are important social and ethical issues that also need to be addressed. However, we have narrowed the focus of this paper given Fair Trials’ mission and field of expertise. This paper should not be treated as an exhaustive list of fair trial rights standards that need to be introduced. AI is used in many ways in criminal justice systems cross the world and, as the technology continues to develop, it is likely that we will eventually see the deployment of AI technology in ways never imagined before. This paper focuses primarily on AI systems that carry out individualised risk assessments, given that these types of systems have had the most significant impact on individuals’ rights so far, and we envisage that similar systems will become increasingly common in the near future. Existing EU Legal Framework Existing EU laws restrict the use of automated decisions in a wide variety of contexts. Article 22 of the General Data Protection Regulation (‘GDPR’) provides that data subjects have the right not to be subject to decisions ‘solely’ based on automated processes, where they produce ‘legal effects’ concerning them, or where they ‘similarly significantly affect’ them. The Law Enforcement Directive (‘LED’) – the EU data legislation that governs the processing of data for criminal justice purposes – has a very similar provision at Article 11, which requires Member States to prohibit decisions based solely on automated processing, where they produce ‘adverse legal effects’ on the individual, or effects that are ‘similarly significant’. However, there are two notable gaps in the existing legislative framework governing automated decision-making systems under both the GDPR and the LED. These ambiguities and potential loopholes could be exploited in ways that seriously undermine the general prohibition of automated decision-making processes, and adversely impact human rights. It is necessary, therefore, that the EU provides further guidance on how these provisions should be interpreted, including thorough legislation (if appropriate) to further clarify the circumstances in which Member States are allowed to deploy AI systems for criminal justice proceedings. Firstly, the provisions in the GDPR and LED only prohibit decisions based ‘solely’ on automated processes. In other words, the laws regulate the impact of decisions made through automated processing, but not the AI systems themselves. As discussed later in this paper, the main human rights challenges of AI systems can be attributed to how they are designed and trained, and the types of technology used, such as machine-learning, so it is crucial that decisions about the design and deployment of AI systems are also regulated. Secondly, neither the GDPR or LED provide regulatory standards to govern situations where automated processing is not the ‘sole’ basis of a decision, but a primary influencer. In reality, the difference between a fully automated decision and a decision made with a ‘human-in-the-loop’ is not always clear, but because of this strict classification, AI systems are able to be used and have significant legal effects without the corresponding safeguards. Stronger legal standards are needed to make sure that semi-automated decision-making processes do not become de facto automated processes. Thirdly, the prohibition on automated decision-making is subject to two very broad exceptions. Automated decisions are prohibited under the GDPR and LED, ‘unless authorised by Union or Member State law’ and there need to be ‘appropriate safeguards for the rights and freedoms of the data subject, at least the right to obtain human intervention’.1 These provisions give extremely wide discretion to Member States to override the general prohibition. It is significant that EU laws emphasise the need for human rights safeguards, and the need to ensure the possibility of human interventions, but neither of these concepts have yet been adequately defined. Although influential actors like the EU and the Council of Europe have established principles on the ethical and responsible use of AI, there is currently no authoritative guidance on the practical safeguards that need to be in place.2Likewise, the meaning of ‘human intervention’ is open to interpretation. LED provides some guidance on who should be carrying out the human intervention,3 but there needs to be greater clarity on what meaningful human intervention entails in different contexts. In order to regulate the use of AI in criminal justice proceedings, and close the gaps in existing data protection laws, the EU must, at a minimum, set standards to address the following questions: 1) what standards are needed to govern the design and deployment of AI systems in criminal justice systems; 2) what safeguards are needed in criminal justice proceedings to make sure that AI systems are used in accordance with human rights standards and prevent discrimination; and 3) how Member States should govern the deployment of AI systems and monitor their subsequent use. Part 1: Regulating the Design and Deployment of AI Systems in Criminal Justice Systems AI systems deployed to assist criminal justice decision-making have to be fit-for-purpose. The purposes of AI systems differ depending on the context in which they are deployed, but there are a few common considerations that need to be taken into account to determine whether it is appropriate for the AI system to be used. Firstly, AI systems have to be designed to produce outcomes that are desirable from a human rights and non-discrimination perspective. This means that rather than being exclusively focused on delivering ‘accurate’ outcomes in criminal cases, AI systems have to be designed to facilitate fair, impartial and non-discriminatory criminal processes. Developers of AI systems and public entities that commission them should, in particular, make sure that AI systems are consciously designed to give effect to, and promote the right to fair trial. The fundamental issues with the way AI systems are designed and built, resulting in discriminatory outcomes, must also be considered. Given the significant evidence of AI systems influencing discriminatory outcomes, special efforts must be made to ensure that AI systems do not produce discriminatory outcomes. Secondly, AI systems need to be designed in a way that makes it possible for criminal defendants and the broader public to scrutinise them. This means that AI systems should not only be made open to scrutiny (rather than concealed to protect commercial interests), but their inner workings and processes should also be discernible and comprehensible. AI Systems should be designed to protect and promote the right to a fair trial Where AI systems are used to assist or inform criminal justice decisions, they support an important act of public administration that has a significant impact on the rights of suspects and accused persons. AI systems do more than just provide outputs that decision-makers can take into consideration as evidence. By attempting to mimic human analytical processes and reasoning, they can provide influential advisory input into human decision-making, or even replace it altogether. As such, it is right that human rights standards that govern criminal justice decision-making also apply to AI systems. The Council of Europe and the EU Commission’s High Level Expert Group on Artificial Intelligence (‘AI HLEG’) have both recognised that fundamental rights should be a key guiding principle for the design and deployment of AI systems.4 The Council of Europe recommends that AI systems are built according to ‘human rights by design’ principles, and recognises that AI systems should not undermine the right to a fair trial under the European Convention on Human Rights (‘ECHR’). The AI HLEG has similarly recognised that the respect for fundamental rights, as enshrined in the EU Charter of Fundamental Rights and international human rights instruments, should form the foundations of trustworthy AI. AI HLEG’s Ethics Guidelines for Trustworthy AI (‘the Ethics Guidelines’) also recognise the need for AI systems to comply with other types of EU legislation. Although not mentioned explicitly in the Ethics Guidelines, Fair Trials would emphasise that the design of AI systems and the ways in which they are deployed in the EU should, in particular, be compatible with the standards set out in the procedural rights directives under the ‘Roadmap for strengthening procedural rights of suspected or accused persons in criminal proceedings’.5 We would also like to note the potential for AI systems to have a positive impact on criminal justice systems. Public debate about the relationship between AI and human rights have predominantly been centred on the idea that AI is a threat to human rights. It is equally important, as technology takes an increasingly prominent role in public life, to consider what positive potential they may have. Policy makers, developers, civil society activists, and other stakeholders should try to identify ways in which AI can also play an active role in advancing human rights, and improve the fairness of criminal justice systems. For example, AI systems could be used to analyse law enforcement or judicial decisions to identify patterns of erroneous or poor decision-making, or discrimination, for preventative purposes. AI systems which are used as part of criminal justice decision-making should be designed not just to ensure that they do not undermine the right to a fair trial, but also to promote it. However, as explained below, given the embedded biases in the criminal data used to develop and train AI systems, there are serious doubts, based on recent studies, whether AI systems can promote fair criminal justice at all. There are various aspects of the right to a fair trial and, without speculating on what kind of AI systems will be developed in the future to support criminal justice decision-making, it is difficult to articulate how fair trial rights standards should inform the design of AI systems. However, examples of AI systems currently deployed in the EU and elsewhere suggest that there are certain aspects of the right to a fair trial that require special attention. These are: a) the right of access to court b) the presumption of innocence; c) the principle of the equality of arms; and d) the right to liberty. Access to Court The notion of AI systems replacing courts to determine the guilt or innocence of the accused may seem far-fetched at present, but there is a growing trend of automated administration of justice across the world that might threaten the right of access to court. For example, in several European countries, speeding and other minor traffic offences have been detected and enforced by means of automated processes for more than a decade.6 Although nominally criminal processes, these types of proceedings are, in reality, normally administrative in nature, and they rarely have a ‘significant’ impact on the rights of individuals. However, as surveillance technology develops, thanks to AI, there is a real likelihood that the scope of crimes punishable by way of automation will increase.7 In the United Kingdom, the government announced plans in 2017 that would enable defendants to enter guilty pleas via an online portal after viewing the charges and evidence against them, for a small number of minor offences.8 Under this procedure, known as ‘automatic online conviction’, defendants would be automatically convicted and fined without any judicial oversight if they accept the charges against them. Although it is debatable whether this system can truly be characterised as an AI system, it is an example of the automated administration of criminal justice, that replaces a function usually played by courts. It is worrying that the UK government has proposed expanding this scheme to other ‘non imprisonable’ offences, if itis regarded as a success.9Fair Trials has outlined concerns about expanding the scope of cases where accused persons can be convicted without judicial oversight, even if such procedures are reserved solely for minor, non-imprisonable offences.10 The impacts of a criminal conviction, even for a minor offence, can be numerous, long-term, and hard to predict, affecting inter alia job prospects, educational opportunities, and immigration status. It is crucial that what amounts to ‘legal effects’ and ‘similar significant effects’ concerning the data subject for the purposes of automated decision-making are interpreted very broadly.11 In particular, given that a criminal record always has a ‘legal’ or ‘significant’ effect, any automated decision-making process that directly results in a criminal record should be prohibited. AI systems should not undermine the right to be tried by an impartial and independent tribunal, and in line with existing EU laws, no individual should be subject to an automated decision that resultsin their being held in custody or detention, gives them a criminal record, or which determines a criminal sentence or sanction. No individual should be subject to an automated decision which engages their human rights without meaningful human input. Presumption of Innocence The right to be presumed innocent in criminal proceedings is a basic human right, and one that is expressly recognised in, and safeguarded by EU law under Directive 2016/343 (the ‘Presumption of Innocence Directive’).12 The increasing use of AI in the sphere of criminal justice, however, raises questions about the scope of this right, and how AI systems should be built and used to protect it. Concerns about how AI systems undermine the presumption of innocence have been voiced in the context of certain types of predictive policing software.13 A variety of predictive policing tools that aim to facilitate preventative policing measures and to deter crimes before they have taken place have been developed and deployed across Europe.14 Tools which predict the time and place where certain crimes are likely to take place have been used in many European countries. Similar tools have also been developed to identify potential suspects, which are used widely in the US, and now increasingly in Europe.15 An example is the ‘Strategic Subject List’ in Chicago, a police database of around 400,000 local residents who were assigned threat scores that determine the likelihood that they will commit crimes.16 The algorithms used to generate these scores were not open to the public, so the exact process by which individual risk levels were assessed were not known. Despite this lack of transparency, it is clear that threat scores generated by the software had significant impacts on individuals’ rights – in particular, their right to privacy. Individuals with higher threat scores were, for example, more likely to be subject to targeted police surveillance, or home visits – as though they were officially recognised as predisposed to commit crimes, irrespective of any credible suspicion of wrongdoing.17 The Strategic Subject List was decommissioned in January 2020 by the Chicago police who cited ineffectiveness as the primary reason for the decision.18 These types of predictive policing tools are now being used in Europe. In the United Kingdom, a coalition of police forces have been developing a system not dissimilar to the Strategic Subject List, that aims to identify individuals who are likely to commit crimes.19 Known as the National Data Analytics Solution (‘NDAS’), this risk assessment tool uses statistical analysis and machine-learning to inform policing decisions, and to facilitate ‘early interventions’ where appropriate.20 The sources of data that the system uses to conduct its risk assessments raise concerns that the system will be built to profile individuals on the basis of very sensitive, personal information, including stop and search data, data from social services, and the National Health Service.21 Where this data is used to indicate the likelihood of individuals’ criminality, it will inevitably flag up people whose profiles fit those who are over-represented in that data as being higher risk. It is particularly worrying that an individual might be profiled for policing purposes on the basis of their health conditions or their access to essential services, such as welfare or benefits. These factors should not be regarded as relevant factors for determining whether someone may commit criminal offences. Also in the UK, the Metropolitan Police in London operates a database called the Gangs Matrix, which contains information and risk-assessments on individuals who are alleged ‘gang’ members.22 This database was created using criminal justice data, including police and crime records. The Gangs Matrix and the assessments it produces assists policing decisions, including the deployment of stop and search, and further enforcement action, such as imprisonment and deportation. A further tactic resulting from the risk assessments made by the Gangs Matrix is the threat of eviction or exclusion from education, as names and details of these alleged gang members have been shared with education, healthcare and housing providers.23 In the Netherlands, the government has been running an algorithmic risk assessment tool, ProKid 12- SI, which purports to assess the risk of criminality of 12-year-old children since 2009.24 ProKid uses existing police data on these children, such as reports of where children have come into contact with the police, their addresses, information about their ‘living environment’, even including whether they are victims of violence, to identify them as being in one of four categories of ‘risk’ of committing crimes in future.25 The system assesses children based on their relationships with other people and their supposed risk levels, meaning that individuals can be deemed higher risk by being linked to another individual with a high risk assessment, such as a sibling or a friend.26 Parents’ assessed risk can also impact a child’s risk level. ProKid’s algorithms assess risks in relation to future actions that the children have not yet carried out, and judges them on the basis of the actions of others close to them.27 These risk assessments result in police ‘registering’ these children on their systems and monitoring them, and then referring them to youth ‘care’ services.28 ProKid frames children as potential perpetrators even when they are registered as victims of violence; which has serious implications on their presumption of innocence.29 Several similar tools are also used in the Netherlands, including the Reference Index for High Risk Youth, a large-scale risk assessment system that focuses on assessing under-23-year-olds.30 Predictive policing tools like NDAS, ProKid and the Gangs Matrix can be regarded as part of a broader trend in law enforcement that moves away from ‘reactive’ policing, and towards ‘preventative’ or ‘proactive’ policing.31 NDAS and other similar predictive policing tools intend to pursue legitimate objectives of preventing, or reducing harm,32 but there are serious concerns that these systems single out individuals as ‘pre-criminals’, who are subject to police interventions even though they are not formally suspected of any crime, and there is no evidence that they have done anything wrong.33 It is of further concern that these types of predictive policing tools do not necessarily designate individuals’ risk levels on the basis of their past actions, or behaviour that can be regarded as ‘suspicious’ in any way, but on account of factors far beyond their control, and immutable characteristics. In particular, there is strong evidence to suggest that AI systems have a tendency to overestimate the risks of criminality of certain ethnic and racial groups. For example, out of 3,800 people on the Gangs Matrix, 80% are 12-24 years old, and 78% of them are black – a clearly disproportionate and discriminatory proportion. The discriminatory impact of AI in criminal justice systems is discussed in further detail in the following section. Although predictive policing tools do not directly ‘convict’ people, they not only allow the police to treat legally innocent individuals as pseudo-criminals, but they can also result individuals being deprived of their basic rights with regard to education, housing, and other public services – effectively ‘punishing’ them on account of their profiles. This seriously damages the fundamental human rights principle that the matter of guilt or innocence can only be determined by means of a fair and lawful criminal justice process.34 While it is clear that certain types of predictive policing can infringe the presumption of innocence from a moral and ethical viewpoint, it is debatable whether these systems also violate the legal presumption of innocence under EU law and international human rights law. The Presumption of Innocence Directive applies to natural persons who are ‘suspects’ and ‘accused persons’, from the moment they are suspected or accused of a crime.35 However, there is some ambiguity about the exact stage at which an individual attains the status of a ‘suspect’ under the Presumption of Innocence Directive,36 and about whether the scope of the Presumption of Innocence Directive extends to decisions to designate an individual as a suspect (or a ‘pre-criminal’). On the other hand, the ECHR appears to have taken a clearer position that measures undertaken pre-charge, as a general rule, fall outside the scope of the presumption of innocence.37 It has also held that preventative measures, such as surveillance, do not amount to criminal sanctions for the purposes of Article 6 ECHR.38 Even if the current language on the presumption of innocence is such that it is not directly applicable to the predictive policing context, it must be recognised that these tools nevertheless interfere with human rights. In particular, the targeted surveillance that results from predictive policing has clear implications on the right to privacy. The acceptable degree to which criminal justice processes can interfere with this right is a matter that might require clearer articulation, as is the question of the impact of Article 8 ECHR violations on criminal proceedings. AI systems that inform charging decisions have also been developed and deployed. An example of this is the Harm Assessment Risk Tool (‘HART’) currently being used by Durham Constabulary in the United Kingdom. HART uses a machine-learning algorithm to assess a suspect’s risk of reoffending, using over thirty variables that characterise an individual’s criminal history and socio-demographic background. The risk assessments conducted by HART are used by the local police to determine whether an individual should be charged, or diverted into a rehabilitation programme. HART does not determine whether an individual is guilty or innocent, but its assessment can trigger a chain of events that can result in the deprivation of liberty, and/or a criminal conviction. Charging decisions should surely be based on the merits of individual cases, and it is difficult to imagine how decisions on entry into diversion programmes can be made by means other than a careful consideration of individual circumstances. These types of high impact, fact-sensitive decisions should never be delegated to automated processes, particularly those which operate by identifying correlations rather than causal links between an individual’s characteristics and their likely behaviour. An examination of HART also reveals flaws in how the tool is designed. HART is calibrated to err on the side of caution,39 because it regards under-estimations of risk levels as a more serious error than over-estimations, so that under-estimations occur less frequently. In other words, HART is deliberately designed to underestimate who is eligible for entry into the diversion programme, so it is predisposed to over-criminalise. This approach conflicts with the notion that any doubt in a criminal case should be interpreted in favour of the defendant (‘in dubio reo’).40 A human rights compliant approach to criminal justice decision-making would do the opposite of what HART does – it would need to err on the side of the defendant. AI systems should respect the presumption of innocence and they must be designed so that they do not pre-designate an individual as a criminal before trial, nor should they allow or assist the police to take unjustified, disproportionate measures against individuals without reasonable suspicion. AI systems that inform criminal justice outcomes should, as a general rule, favour outcomes that are favourable to the defendant. Equality of Arms A major concern raised in the studies of certain AI systems is that they are inaccessible for adequate scrutiny by defendants and their lawyers. This has serious implications for the principle of equality of arms and the right to an adversarial process, because without information about how a decision is made, it is difficult to envisage how defendants can question the accuracy and legality of the decision. The need for AI systems used in criminal justice to be transparent, explainable and understandable to all is addressed in more detail below. The Right to Liberty In the United States, ‘risk-assessment’ tools that use AI technology have been used to assist pre-trial assessments that determine whether a defendant should be released on bail, or held on remand pending their trial. Examples of risk-assessment tools currently being used in the United States include COMPAS, the Public Safety Assessment (‘PSA’), and the Federal Pre-Trial Risk Assessment Instrument (‘PTRA’). Many of these tools are also used to inform decisions on parole and sentencing. These tools have, however, been subject to intense criticism for several reasons. Studies have shown inter alia that risk assessments make inaccurate predictions that are no better than those made by non-expert humans. They do not result in a significant reduction in pre-trial detention rates, and that they produce disparate outcomes for different racial groups. The US-based NGO Partnership on AI has found that AI risk assessment tools currently being used in the United States are unfit for use in pre trial assessments, and it has recommended that policymakers cease the deployment of risk assessment tools until such time that the challenges affecting such tools have been adequately addressed.41 The adoption of pre-trial risk-assessments tools in the United States has largely been driven by the desire to address high imprisonment rates in the country by making pre-trial decision-making fairer. In particular, these tools have been promoted as an alternative to cash bail – a system often criticised for disadvantaging poorer defendants and worsening social injustices.42 Cash bail is a relatively rare concept in the EU, but there are concerns about the quality of pre-trial detention decisions in many Member States, which have been criticised for failing to carry out case-specific reviews and fully consider alternatives to detention.43 We are currently unaware of any attempts in EU Member States to introduce algorithmic risk assessments to supplement or replace existing pre-trial decision-making processes. However, it is possible that risk-assessment tools will also be recommended as a solution to address the pre-trial detention challenge in Europe, especially given that many of these tools are developed by private companies that actively market their products to governments and local police forces. Risk-assessment tools are usually designed to assess the likelihood of re-arrest, and/or of failure to turn up to court after being released based on the profiles of the defendant. Based on these assessments, risk assessment tools either assign risk levels to defendants, or they provide direct advice to decision-makers on whether or not the defendant should be released. There is only limited research about the extent to which pre-trial risk-assessment tools influence judges’ decisions in practice,44 but concerns have been raised about the ability of AI systems to recommend detention at all.45 There is a risk that recommendations made by AI systems to detain individuals compromise the presumption of release. This is a particularly valid concern in light of research suggesting that decision-makers have a tendency to err on the side of caution when they are ‘advised’ by AI systems, and that they have a greater propensity to override risk assessment tools to detain, rather than release defendants.46 Pre trial detention should always be a measure of last resort, and no risk-assessment can be regarded as human rights compliant, unless it recommends its users to consider detention as a measure of last resort, after all other alternatives have been fully considered. Pre-trial risk assessment tools in the United States and elsewhere have also been criticised for (unintentionally) over-estimating risks, because of the nature of the data used to train its algorithms. Pre-trialrisk assessment tools typically rely only on data regarding individuals who have been released, and they ignore those who were detained, but would have otherwise ‘succeeded’ by not being arrested, and by appearing in court.47 In other words, algorithms are based on the assumption that individuals who have been detained by courts in the past have been rightfully deprived of their liberty. Any AI system developed to assist pre-trial detention decision-making must be designed to give effect to the presumption in favour of release. This means that risk-assessment tools need to be deliberately calibrated to generate outcomes that favourable to the defendant. Data used to train the AI system should be carefully scrutinised so that it reflects the inevitable fact that a significant proportion of individuals in pre-trial detention have been deprived of their liberty in violation of their human rights. Studies of pre-trial risk-assessment tools used in the United States cast doubt on their effectiveness at reducing pre-trial detention rates, and their ability to make accurate predictions of risks. A study in Kentucky, for example, found that the likelihood of defendants being released within the first three days of their arrest went down after the risk-assessment tool was deployed, and that there were no significant changes in the number of re-arrests and failure-to-appear rates amongst defendants released on bail during the same period.48 This was the case even after the risk-assessment tool was modified post-deployment to improve the accuracy of predictions. Another study has found that the COMPAS risk-assessment tool is no better at predicting the likelihood of defendants reoffending than non-expert human volunteers.49 These studies do not necessarily prove that AI systems are incapable of reducing pre-trial detention rates at all, but they do raise questions about their usefulness, and they strongly challenge claims that algorithmic risk-assessment tools help to improve the quality of pre trial detention decisions. They also highlight the need for post-deployment testing and monitoring of AI systems, to ensure that they have the desired effect of ensuring that individuals are detained only as a measure of last resort. Post-trial assessment systems are also being increasingly used, for purposes such as assisting with sentencing decisions or prisoner release. In England and Wales, the Prison and Probation Service has developed and operates the Offender Assessment System (OASys), an automated risk-assessment tool.50 It assesses the risk of harm offenders pose to others and how likely an offender is to reoffend, as well as assessing offender needs. These risk assessments are used to decide ‘interventions’ and to influence the sentence plans given to offenders.51 Millions of these assessments have been carried out.52 The system collates information on offenders’ previous offences, education, training, employment, alcohol and drug misuse; as well as their ‘attitudes’, ‘thinking and behaviour’, ‘relationships’, and ‘lifestyle’.53 This data is used alongside the individual’s offending record and ‘offender demographic information’ to inform two predictive algorithms: OASys General Reoffending Predictor (OGP1) and OASys Violence Predictor (OVP1).54 A 2014 National Offender Management Service analysis found that the OGP1 and OVP1 generated different predictions based on race and gender. They found that relative predictive validity was better for white offenders than for Asian, black, or mixed ethnicity offenders. The Offender Group Reconviction Scale (OGRS) is another algorithmic risk assessment tool, which is used in England and Wales to assess and predict an offender’s likelihood of reoffending.55 The OGRS algorithm uses data on the individual’s official criminal history, as well as their age and gender, to produce a risk score between 0 and 1 of how likely an offender is to reoffend within one or two years. The use of these AI systems in a post-trial setting, and the documented differences in predictive outcomes based on, among other factors, race, highlight the clear need for strict testing and monitoring of such systems. These systems used in a post-trial setting could very easily be transferred to a pre-trial risk assessment setting; the principles and aims of these systems and the data used are very similar. For example, the COMPAS system, mentioned above and considered in more detail below, was originally designed as a recidivism risk assessment tool, and is also used as a pre-trial risk assessment tool. 56 Where AI systems inform decisions on the deprivations of liberty, they should be calibrated to generate outcomes that favour release, and they should not facilitate detention other than as a measure of last resort. AI systems must be subject to rigorous testing to ensure they have the desired effect of reducing rates of pre-trial detention rates. AI systems should be designed to be non-discriminatory One of the most frequent criticisms of AI systems and their use in criminal justice systems is that they can lead to discriminatory outcomes, especially along racial and ethnic lines. The best-known example of this is a study by the US media outlet ProPublica into COMPAS, a risk assessment tool designed to predict the likelihood of reoffending in Broward County in Florida. ProPublica found that COMPAS was 77% more likely to rate black defendants as ‘high-risk’ than white defendants, and it was almost twice as likely to mislabel white defendants as lower risk than black defendants.57 The dangers of the failure to adequately regulate the use of AI to prevent discrimination have also been witnessed in Europe. The ‘Crime Anticipation System’ (‘CAS’), a predictive policing software being used across the Netherlands, was initially designed to consider ethnicity as a relevant factor for determining the likelihood of a crime being committed. Amongst the indicators used by CAS to predict crimes in a particular area was the number of ‘non-Western allochtones’ in the area – in other words, ‘non-Western’ individuals with at least one foreign-born parent.58 The software not only presupposed the existence of a correlation between ethnicity and crime, but also singled out a category of ethnicities to be of particular concern, given that the presence of ‘Western’, ‘autochtone’ individuals were not used as indicators. Furthermore, given that ‘Western’ was defined somewhat subjectively (for example, including individuals of Japanese or Indonesian origin, and including all European nationalities, apart from Turkish), CAS incorporated highly questionable societal categorisations and biases. In the United Kingdom, a major criticism of HART has been that it included data collated and classified by a private company for marketing purposes that could very easily to biased outcomes. HART relied on the ‘Mosaic’ code developed by a consumer credit reporting company, that categorised individuals into various groups according to inter alia their ethnic origin, income, and education levels. It was of particular concern that some socio-demographic categories used by Mosaic were blatantly racialised, including, for example, ‘Asian Heritage’, which stereotyped individuals of ‘Asian’ origin as being unemployed or having low-paid jobs, and living with extended families.59 In Denmark, an automated algorithmic assessment has been used to classify different neighbourhoods, based on criteria such as unemployment, crime rates, educational attainment, and other ‘risk indicators’, as well as whether the levels of first and second-generation migrants in the population is more than 50%. Neighbourhoods which meet these criteria are classified as ‘ghettos’. These neighbourhoods are then subject to special measures, including higher punishments for crimes.60 It is clearly discriminatory, as well as entirely unfair, for people living in certain areas to be punished more severely than others in different areas for the same crimes. Further examples of criminal justice AI which have been identified as producing discriminatory outcomes include the previously mentioned OASys, NDAS and the Gangs Matrix in the UK, and the Netherland’s ProKid 12. These examples illustrate the need for regulations to ensure that AI systems are designed to be non discriminatory, and to exclude categorisations and classifications that deepen and legitimise social biases and stereotypes. However, policy makers should not assume that making AI systems blind to all protected characteristics will always help to produce non-discriminatory outcomes. In certain scenarios, the removal of protected characteristics from the data could worsen discrimination. For example, it has been suggested on the basis of research into COMPAS in the United States, that excluding gender as a variable for risk assessments would fail to reflect a well-established statistical fact that in most countries, women are less likely to reoffend than men.61 Making COMPAS gender blind would unfairly and inaccurately assume women to be as equally likely to reoffend as men, and discriminate against them by overestimating their risk scores. Removing visible biases from AI systems cannot be the sole or primary solution to their discriminatory impact, because AI systems can be biased even if they have not been deliberately designed in that way. Bias is often unintentional, and even if the AI system appears on the surface to be neutral, their algorithms can lead to discriminatory assessments and outcomes. COMPAS, for example, does not include race or ethnicity as a variable, yet research has found that it consistently gives black defendants higher risk scores than their white counterparts, making them less likely to be released from detention.62 Hidden biases can arise in AI systems in numerous ways. Although a comprehensive analysis of how they can cause unintentional biases are beyond the scope of this paper,63 the way in which AI systems are themselves created and built illustrate the difficulty, complexity, and sometimes impossibility, in preventing discriminatory outputs and effects of AI systems. There are fundamental issues with the way AI systems are designed and created which can lead to bias. Where the AI system is based on machine-learning, biases can result from faults in the data that is used to train its algorithms. Machine learning systems ‘learn’ how to make assessments or decisions on the basis of their analysis of data to which they have previously been exposed. However, the data used to train a machine learning system might be incomplete, inaccurate, or selected for improper reasons, and this could lead to AI systems producing unwanted outcomes. What amounts to appropriate, good quality data for the purpose of training algorithms depends on what the machine learning system is being designed to do,64 so it might not always be obvious which dataset is needed to train algorithms to be non-discriminatory. AI designed or created for use in the criminal justice system will almost inevitably use data which is heavily reliant on, or entirely from within, the criminal justice system itself, such as policing or crime records. This data does not represent an accurate record of criminality, but is merely a record of policing – the crimes, locations and groups that are policed within that society, rather than the actual occurrence of crime. The data might not be categorised or deliberately manipulated to yield discriminatory results, but it may reflect the structural biases and inequalities in the society which the data represents. Where there are discriminatory policing patterns targeting certain demographics, or the systematic under-reporting and systematic over-reporting of certain types of crime and in certain locations,65 the use of such data merely results in a reinforcing and re-entrenching of those inequalities and discriminationin criminal justice outcomes. For example, according to UK crime data, black people are over 9 times more likely to be stopped and searched than white people,66 and black men are more than 3 times more likely to be arrested than white men.67 Despite these statistics, NDAS (mentioned above) in the United Kingdom explicitly relies on stop and search data to determine an individual’s propensity to commit a criminal offence. The fact that stop and search is disproportionately used against black people means that there will inevitably be an overrepresentation of black people in NDAS and that their risk levels will be inflated in comparison to white people. Comparable statistics on stop and search are not available in most EU Member States, where the official collection of racially disaggregated criminal justice data is either forbidden by law, or not standard practice. However, recent studies show that racially biased policing practices are prevalent throughout the EU. Data collected from a survey by the Fundamental Rights Agency, for example, has shown that during a 5-year period, 66% of individuals of Sub-Saharan African origin in Austria, and over half of respondents of South Asian origin in Greece were stopped and searched.68 AI built on data embedded with such biases and used to assist, inform, or make decisions in the criminal justice system, can expand and entrench the biases represented in the data.69 When AI systems result in criminal justice outcomes which repeat the discrimination inherent in the historic data, such as targeting individuals from a particular demographic, that decision will itself be preserved in the data. This leads to self-perpetuating ‘feedback loops’ which reinforce patterns of inequality.70 Another way in which AI systems can produce unintentional biases is by way of proxies. Data used by AI systems might be classified in seemingly legitimate ways, but those classifications can sometimes act as proxies for protected characteristics. A common example used to illustrate this point is how home addresses or postcodes can be proxies for race or ethnicity.71 Certain AI systems, such as HART, were initially trained to find correlations between home addresses and the risk of reoffending – in other words, to identify which postcode areas have ‘higher-risk’ residents than others.72 This approach overlooks the fact that there is very pronounced ethnic residential segregation in many countries,73 making it highly probable in practice, for AI systems to inadvertently establish a link between ethnic origin and risk. Roma are especially vulnerable to this form of proxy discrimination, given that in many EU Member States, Roma are reported to live primarily in segregated areas inhabited mostly or exclusively by Roma.74 There are several ways in which AI systems can be designed to mitigate the risks of discrimination, including by identifying and excluding data classifications that act as proxies for protected characteristics.75 However, it can be difficult in practice to identify which variables are proxies for protected characteristics (and how they do so), and removing too many ‘offending’ variables might result in the AI system losing much of its functional utility.76 There is no one-size-fits-all method of ensuring that AI systems do not produce discriminatory outcomes. Different approaches to de-biasing AI systems can conflict with one another, and the suitability of a particular de-biasing method might depend on the AI tool itself, and the legal and policy context in which it is designed to operate.77 Biases in AI systems are often not easy to detect and, in many cases, it might also be difficult to pinpoint flaws either in the system itself, or in the training data that has been caused the bias. The structural bias within the data that AI systems are built and operated on, a bias which is particularly deep-rooted in criminal justice data, is a fundamental issue, and one which is likely to result in AI systems being fundamentally inoperable – both because the bias makes them morally and ethically inoperable, if not yet legally, and because any attempts to remove the bias will make the data to operate these systems unusable. Fair Trials’ view is that the only effective way in which AI systems can be regarded as non discriminatory is if they have been subject to rigorous independent testing for biases. These tests must be mandated by law, must be independently run, have clearly stated aims or objectives, and be carried out pre-deployment to reduce the likelihood of individuals being affected by discriminatory profiling and decisions. AI can be tested in advance of deployment by using test data – datasets which are either synthetic datasets,78 or by using historic data with permissions – running it through an AI system, and analysing the outputs.79 For example, a trial of retrospective facial recognition video analysis is being run by a police oversight Ethics Committee in the UK. The trial is using historic data – CCTV footage – as the basis for simulated investigations in a controlled environment, monitored by researchers. The trial has clearly stated aims and signifiers of success, and all outcomes will be examined. There are significant human rights, data protection and ethical concerns involved with this particular technology, including the right to privacy, and the testing is not being conducted independently as it should be but, as above, there are positive aspects of the testing methodology.80 An alternative could be to ‘test’ a system in a strictly academic sense by running it alongside actual criminal justice processes, but with the system not having any effect on decision-making, and analysing the system’s proposed decisions or outcomes for bias. AI should never be used or even ‘tested’ in real-world situations where they have actual effects on individuals or criminal justice outcomes, before they have been tested. These types of tests also need to be carried out in the broader context of an AI governance framework that not only analyses the potential impact of the AI system pre-deployment, but also continues to monitor its impact afterwards. If these tests are not carried out, and/or if an AI system cannot be proven to be non-discriminatory, it should be legally precluded from deployment. However, as explained in the final section of this paper, it is questionable whether such tests are feasible in many Member States, where local laws prohibit the collection of racially-disaggregated data. AI systems should be developed to generate non-discriminatory outcomes, ensuring that suspects and accused persons are not disadvantaged, either directly or indirectly, on account of their protected characteristics, including race or ethnicity. AI systems should be subject to mandatory testing before and after deployment so that any discriminatory impact can be identified and addressed. If an AI system cannot be proven not to generate discriminatory outcomes, it should not be used. AI Systems need to be transparent and explainable AI systems can have a significant influence over criminal justice decisions, and they should be open to public scrutiny in the same way that all decision-making processes by public entities should be. However, a common criticism of many AI systems is that they lack transparency, which often makes it difficult, if not outright impossible, to subject them to meaningful impartial analysis and criticism. This lack of transparency is both as a result of deliberate efforts to conceal the inner workings of AI systems for legal or profit-driven reasons, and of the nature of the technology used to build AI systems that is uninterpretable for most, if not all humans. There are several reasons why it is necessary for AI systems to be transparent. Firstly, transparency is essential for strengthening confidence of both primary users of the system, as well as the general public, in AI systems. Democratic values demand that the public needs to be aware of how powerful public institutions, such as the police and the judiciary, operate so that they can be held accountable for their actions. It is also crucial for primary users of AI systems to understand how they work, so that they can make informed decisions about how much influence they should have on criminal justice decisions. Secondly, decisions made by AI systems need to be contestable at an individual level. Standards on the right to a fair trial and the right to liberty demand that defendants should have access to materials that inform decisions regarding them, so that they can challenge the accuracy and lawfulness of those decisions. Transparency also acts as a safeguard against bias and inaccuracies. It is difficult to imagine how issues that undermine the fairness and accuracies of AI systems (such as racial biases) can be detected, and ultimately fixed, if they cannot be properly accessed and analysed. As explained above, certain AI systems, such as CAS, have been found to have serious, but very obvious, flaws. In CAS’s case, however, the fault in the software could be detected easily, which meant that the discriminatory impact of the tool could be mitigated. The indicator for ‘non-Western allochtones’ in CAS was removed in 2017,81 ostensibly because it served no useful purpose, but presumably also because of the very obvious bias. This mitigation was possible because CAS is a transparent software, that was developed in-house by the Dutch police. The types of indicators used to predict crime were made openly available, and information about the method by which the software made predictions could easily be accessed and understood.82 This, however, is not the case for all AI systems, because AI systems are often developed by for-profit companies with little to no meaningful input from the public. As such, details of how they are designed, and how they make decisions and assessments are, in many cases, closely guarded as trade secrets that are protected by law.83 Often, AI systems are ‘black boxes’ because they are deliberately kept that way. While it is accepted that strong, enforceable intellectual property laws are needed to promote advancements in what is a very dynamic field of scientific research and innovation, it is not acceptable that these concerns trump the rights of individuals suspected or accused of crimes. In light of this, it is concerning that the Commission’s White Paper focuses on, and strongly promotes, the concept of a ‘partnership between the private and the public sector’ in relation to AI.84 Fair Trials appreciates that effective public-private collaboration could help to fill in gaps in public sector expertise and capacity for the development of AI systems, but given the transparency challenges, it is essential thatsuch partnerships are accompanied by robust regulations and rules that ensure effective and open scrutiny. However, even if AI systems are completely exposed to public scrutiny, and their source code85 and input data, for example, are openly disclosed, there is still no guarantee that they will be sufficiently transparent to enable adequate independent scrutiny. AI systems can be black boxes by nature of the technology that makes their decision-making processes complicated beyond comprehension for most (in some cases, too complicated even for computer scientists to understand).86 This is especially the case where AI systems are based on machine-learning algorithms. One possible reason for the unintelligibility of AI systems is that they sometimes use machine-learning algorithms that are simply too complex to be understood to a reasonable degree of precision.87 This is especially the case where AI systems incorporate ‘Deep Neural Networks’ – a machine-learning algorithmic architecture inspired by the structure and mechanics of human brains. Rather than relying on a set of man-made instructions, these types of AI systems make decisions based on experience and learning. Decision-making processes of this kind have been described to be ‘intuitive’, because they do not follow a defined logical method, making it impossible to analyse the exact process by which a particular decision is reached.88 It has also been suggested that some AI systems are uninterpretable to humans because the machine-learning algorithms that support them are able to identify and rely on geometric relationships that humans cannot visualise. Certain machine-learning algorithms are able to make decisions by analysing many variables at once, and by finding correlations and geometric patterns between them in ways that are beyond the capabilities of human brains.89 Given these challenges, there is widespread recognition that states should require AI systems to not only be ‘transparent’, but also explainable and intelligible.90 GDPR already recognises that individuals should have the right to an explanation of how a decision was reached, if they have been subject to an automated decision.91 In principle, this is an essential and very useful requirement, but it is also one that seems difficult to implement in practice, given that both ‘explainability’ and intelligibility are highly subjective concepts. Arguably, AI systems’ computing processes are inherently difficult to explain and understand for most people, including for most criminal justice decision-makers, but this surely should not be the sole basis for oversimplifying the technology, or for banning the use of AI outright. Computer scientists have been theorising different ways of ensuring that decisions made through complex algorithms can be explained and understood. An example is the ‘explainable AI’ movement (‘xAI’) that aims to build AI systems that can show more discernible links between inputted data and decisions. xAI systems measure how each input influences the final decision, so it is possible figure out how much weight is given to each input.92 This seems to be an innovative response to the ‘black box’ challenge, establishing clearer, more helpful relationships between inputs and final decisions. However, it appears to fall short of explaining what happens between data being inputted into the system and the final decision, and it does not enable users to impute any logic to the decision-making process.93 As explained above, there are various reasons why AI systems need to be transparent and intelligible, but the effective of exercise of the rights of the defence must be recognised as a crucial test for determining whether an AI system is sufficiently explainable and intelligible. AI systems have to be designed in a way that allows criminal defendants to understand and contest the decision made against them. Partnership for AI has suggested that a central factor that determines the contestability of AI systems is the possibility of carrying out an audit trail of the AI decision.94 In particular, it has to be possible for an auditor to follow and reproduce the process and come to the same conclusion reached by the AI system at the end. Furthermore, as explained in further detail below, criminal justice procedures should require the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings, and this disclosure should be in a form which is understandable to a layperson, without the need for technical or expert assistance. AI systems need to be transparent and explainable, so they can be understood and scrutinised by their primary users, suspects and accused persons, as well as the general public. Commercial or proprietary interests, or technical concerns, should never be a barrier to transparency. AI systems must be designed in a way that allows criminal defendants to understand and contest the decision made against them. It should be possible to carry out an independent audit, and processes should be reproducible. Part 2: Safeguards for the use of AI Systems in Criminal Proceedings AI systems have to be built in accordance with human rights principles, and to give effect to human rights in practice, but it is unlikely that their design alone will guarantee that they are used in ways that comply with human rights. Regulatory frameworks for the design and deployment of AI systems have to be accompanied by appropriate legal safeguards that ensure they are used responsibly and lawfully. There are two primary questions that need to be addressed: 1) how procedural rules ensure that decision-makers do not over-rely on AI systems; and 2) how decisions and assessments made by AI systems can be analysed independently and challenged. Combatting ‘Automation Bias’ and Reinforcing Meaningful Human Input One of the main challenges of automated, or semi-automated decision-making systems is that of ‘automation bias’ – the tendency to over-rely on automation in ways that can cause errors in decision making. Automation bias occurs primarily due to the perception that automated decision-making processes are generally trustworthy and reliable. Automated cues have been found to be particularly salient to decision-makers, and research has shown that users of automated decision-making systems have a tendency to place greater weight on automated assessments over other sources of advice.95 The disproportionate influence of automated systems can undermine the quality of decision-making, by discouraging its users from consulting a wider range of factors that could inform more accurate decisions. Most AI systems currently being used to assist criminal justice decision-making do not completely replace human decision-making. They are instead designed and deployed to be used as decision aids, whose outputs are factored into consideration for the purposes of human decision-making. The phenomenon of automation bias however, raises questions about whether AI systems are being used in reality in accordance with their intended purpose as decision aids, and not as de facto replacements for human decision-making processes. There is strong evidentiary basis for automation bias amongst pilots who, like judges and other decision-makers in criminal justice proceedings, have typically been through a high level of training to make appropriate decisions in highly complex settings.96 However, limited research into automation bias amongst judges suggests that AI systems might have a more complex impact on judges’ behaviour. For example, a study conducted in 2019 in Kentucky seems to suggest that the degree to which judges rely on predictive tools for pre-trial detention decision-making could be influenced by the ethnicity of the defendant.97 The research indicates that judges had a greater tendency to rely on algorithmic risk assessments where the defendant was white, whereas in cases where the defendant was black, judges were more likely to overrule the risk-assessment in favour of detaining them. This study appears to show that AI systems can influence judges’ behaviour in unpredictable ways, especially where there are interactions or conflicts between automation and human biases, and that AI systems might be an ineffective tool for challenging human prejudices. It is crucial that rules governing the use of AI systems in criminal proceedings actively try to counter automation bias, and to encourage decision-makers to make independent determinations. A simple requirement to have a human decision-maker ‘in the loop’ or to have a human decision-maker review or check the automated decision is insufficient, because this risks overestimating the capacity or willingness of human decision-makers to question and overrule automated decisions. A mere requirement to have an automated decision reviewed by a human, on its own, could reduce the human review into a rubber-stamping exercise which, in practice, is no oversight at all. In recognition of this challenge, the European Data Protection Board has recommended that in order for decisions to be regarded as not ‘based solely’ on automated processing for the purposes of Article 22 GDPR, there has to be ‘meaningful’ human oversight, rather than just a token gesture.98 What qualifies as ‘meaningful’ intervention is open to interpretation, and it is likely to differ depending on the circumstances and the type of decision being made. In the context of criminal justice procedures, where decisions often have particularly severe and far-reaching implications for individuals’ rights, safeguards for ensuring meaningful human intervention have to be especially robust. Procedural safeguards that ensure ‘meaningful’ human oversight Rules governing the use of AI systems in criminal justice proceedings have to counter automation bias by encouraging human decision-makers to treat their processes with scepticism, and to force them to challenge and scrutinise the outcomes of algorithmic assessments. Procedural safeguards that can be put in place to tackle automation bias include: a) making it a legal requirement for decision-makers to be adequately alerted and informed about the risks associated with AI systems; b) making AI systems’ assessments intelligible to decision-makers; c) requiring decision-makers to provide full, individualised reasoning for all decisions influenced by an AI system; and d) making it easier for decision-makers to overrule AI assessments that produce unfavourable outcomes for defendants. One way of ensuring that automated assessments and decisions do not have undue influence on judicial decisions might be to ensure that decision-makers are sufficiently informed and alerted about the risks of relying on AI systems. This seems to be the approach taken by the Wisconsin Supreme Court in the United States in the case of Loomis,99 in which the Court considered whether or not the use of the COMPAS risk assessment tool for sentencing purposes violated due process rights. The judgment in Loomis recognises the importance of procedural safeguards as a way of safeguarding fairness of decisions, by requiring the use of ‘written advisements’ to alert decision-makers about the potential risks of AI risk assessments. Specifically, the court mandated that these advisements had to include warnings that: a) the process by which the COMPAS produces risk scores were not disclosed due to its ‘proprietary nature’; b) the accuracy of risk scores are undermined by the fact that COMPAS relied on group data; c) the risk-assessment tool had never been tested locally for accuracy; d) ‘questions’ have been raised about the discriminatory effect of COMPAS risk-assessments; and e) COMPAS was developed to inform post-sentencing decisions, but not sentencing decisions themselves. These warnings are clearly very specific to COMPAS and the context in which it is used in Wisconsin. If similar safeguards were adopted in different contexts and with regard to different AI systems, advisements will no doubt need to be adapted. The warnings used in Loomis have, however, been criticised because they do not give enough information to decision-makers to enable them to appreciate the degree to which these risk-assessments should be discounted.100 In particular, the advisements are silent on the strength of the criticisms against COMPAS, and they say nothing about the basis on which questions about their discriminatory effect have been raised.101 These warnings also give no indication about likely margin of error of the assessment, so although judges are informed that some assessments might be inaccurate, they are not in a position to appreciate how serious or frequent these errors might be. ‘Advisements’, or warnings that encourage decision-makers to be sceptical of AI systems cannot be considered as effective safeguards, unless they contain sufficiently helpful information for decision makers. However, even if judges are given stronger warnings than those in the Loomis advisements, it is still doubtful whether they alone will adequately mitigate automation bias. One reason for this is that many criminal justice decisions (such as pre-trial detention decisions) are, in practice, made very routinely by judges. Although written advisements might initially help judges think more critically about automated risk assessments, over time, these advisements could become repetitive and routine, and lose much of the intended meaning and effect.102 An effective safeguard that could work in conjunction with mandatory warnings could be for decision makers to be given a better insight into how AI systems produce a particular assessment or calculation. As mentioned above, the lack of information about how assessments are made by AI systems makes it harder for criminal defendants to scrutinise and challenge them. Surely, this has to be true also for decision-makers. It is much harder, if not impossible, to analyse and criticise decisions if there is no reasoning behind them. While AI systems do not rely on ‘reasoning’ per se, information given to decisions about how a specific assessment was made, including what factors were relevant, and how much weight was given to each factor could give decision-makers more confidence to decide whether to agree or disagree with an AI-generated decision. Decisions or assessments made by AI systems cannot be the sole basis of criminal justice decisions – they should be no more than a factor that can influence human-decision making. As such, decision makers should be required to show that decisions were influenced by a broader range of factors other than the AI system, by way of fully reasoned, case-specific, written decisions. Research has shown that the lack of case-specific reasoning in pre-trial detention decisions is already a serious challenge in many EU Member States,103 and AI systems risk worsening the standardisation of such decision making processes. Where AI systems are used to inform pre-trial detention decisions, or any other criminal justice decision that has a significant impact on the rights of the defendant, reasoned decisions must be specific to the defendant’s case, and in particular, they must reveal what which factors influenced the decision, and to what degree. In particular, decisions have to make it clear how much weight was given to assessments by AI systems. It is also crucial that decision-makers are able to override decisions made by AI systems, and that they are confident about doing so where the tool produces assessments or recommendations that are unfavourable to the defendant (e.g. where the AI system advises against releasing the defendant). It has been reported that members of the police force in Avon and Somerset Police in the United Kingdom are expected to record incidences where they have disagreed with assessments made by a predictive policing tool, and to explain their reasons for the disagreement.104 This is likely to act as a strong disincentive for overriding decisions made by the AI system, and as such, it actively facilitates automation bias. Furthermore, it seems to interfere with the presumption of innocence by making it difficult for decision-makers to override AI systems to make decisions that favour the defendant. If an AI system recommends the arrest or the detention of an individual, decision-makers should feel that they have a genuine choice of overruling the AI system, and not be pressured into compliance. Criminal justice decision-making processes should, as a general rule, be skewed in favour of the defence to give effect to the presumption of innocence, and rules governing the use of AI systems should favour favourable outcomes for defendants. On the other hand, in cases where a decision-maker acts against the advice of an AI system that recommends a favourable outcome for the defendant, there should be a requirement for reasons to be given for their decision. This is to prevent unfavourable outcomes for defendants that are motivated by improper reasons, and to mitigate the risk of unconscious bias. Challenging AI in criminal proceedings AI systems need to be contestable by criminal defendants. This is so that they can not only challenge the outcomes of the AI systems’ calculations and analyses, but also scrutinise the legality of their use. In other words, being able to challenge AI systems in criminal proceedings is not only a procedural fairness requirement for defendants, it is also a means by which legal standards governing AI systems and their use can be enforced. One of the major issues preventing the sufficient contestability of AI systems in criminal proceedings is the lack of notification. If an individual is not notified that they have been subject to an automated decision by an AI system, they will not have the ability to challenge that decision, or the information that the decision was based on. For example, in the United Kingdom, the Data Protection Act 2018 sets out the applicability of the GDPR and sets out the UK’s interpretations of the GDPR’s requirements and safeguards. However, section 14 of the Data Protection Act significantly dilutes the requirements of Article 22 of the GDPR, permitting purely automated decisions which have legal or similar significant effects on a data subject, without their consent, as long as the data subject is subsequently notified that a purely automated decision has been taken about them, after the decision has been made. It is only then that the data subject has the opportunity to request a new decision. However, it has been reported that individuals subject to decisions by the HART system in the UK are not notified at all that they have been subject to such an automated decision, even after it has been made.105 This is likely because under the Data Protection Act 2018, automated decisions which have legal or similar significant effects on a subject are not necessarily classified as ‘purely automated’ if a human has administrative input. In order to meet this requirement, the human input can be as minimal as checking a box to accept the automated-decision, even if it has a significant impact on an individual, such as holding them in custody. This minimal requirement for human requirement means that, in practice, decisions made with negligible to no meaningful human input can be classified as not “purely automated” and there is no legal requirement to notify and ability to request a new decision. In this way, systems such as HART continue to be used, with people subject to their decisions completely uninformed. While the GDPR already requires the notification of individuals affected by automated decisions, the UK’s experience with HART highlights the need for stricter rules to not only ensure meaningful human input (as mentioned above), but to also strengthen the individual’s right to be notified. There must be a requirement for individuals to be notified, not just for “purely automated” decisions, but whenever there has been an automated decision-making system involved, assistive or otherwise, that has or may have impacted a criminal justice decision. This notification should include clear and comprehensible information about the decision that has been taken, how that decision was reached, including details of the information or data involved in reaching that decision, what the result or outcomes of the decision are, and what effects, legal or otherwise they have, and information on how to challenge that decision. As discussed in the previous section, a further major barrier to the contestability of AI systems is a technical one. The ‘black box’ nature of certain AI systems can be largely attributed to their design, so it is important that there are rules governing the interpretability of these systems so that when they are in use, their processes can be understood at all. However, there are also legal barriers to the full disclosure of AI systems, which are often put in place to protect commercial interests. Procedural safeguards play a particularly important and effective role in addressing these types of opacity challenges. Transparency is a fundamental aspect of an adversarial process that underpins the right to a fair trial, and human rights standards require that as a general rule defendants should be given unrestricted access to their case-file,106 and to be given the opportunity to comment on the evidence used against them.107 These standards are further reinforced by Directive 2012/13/EU,108 which requires Member States to grant access to all material evidence in possession of the competent authorities to the defence to safeguard the fairness of the proceedings and to enable defendants to prepare their defence.109 The procedural requirement of an adversarial process is not one that is limited to substantive criminal proceedings – it also applies in the context of pre-trial decision-making processes, especially for decisions on the deprivation of liberty.110 While EU law and international human rights law also recognise that there might be certain justifications for non-disclosure of materials used against the defendant in criminal proceedings, these are narrow restrictions, and commercial interests are not regarded as a valid justification for non-disclosure.111 Furthermore, EU law does not explicitly recognise any derogations from the right of access to materials that are essential to challenging the lawfulness of an arrest or detention.112 In order for Member States to comply with these standards, any exceptions to the disclosure of information regarding AI systems have to be applied very narrowly. Barriers to scrutiny and accountability of AI systems are not only legal, but also technical. As explained in previous sections, many AI systems suffer from interpretability issues because of their design and by the nature of the machine-learning technology upon which they rely. In the absence of specific expertise on AI, it is difficult to imagine how, in practice, defendants and their lawyers will be able to challenge AI systems. One possible solution to this challenge, as explained below, is training for defence lawyers – but it is unreasonable to expect lawyers to develop expertise that would enable them to analyse and scrutinise AI systems at a technical level. A further solution could be that defence lawyers have access to the relevant expertise from suitably qualified professionals. However, in reality, not all criminal suspects and accused persons are able to access the legal and other technical assistance needed to understand and challenge technically complex AI systems, for financial or other practical reasons. It would also be unreasonable and unrealistic to require all suspects and accused persons to engage technical expertise just to be able to understand how an AI system makes a decision, especially where AI systems are used routinely or mandatorily to make or assist criminal justice decisions. It might seem unreasonable to expect all highly technical evidence to be challengeable by lay defendants without the help of a suitable expert. However, AI systems are not necessarily used in criminal proceedings as ‘evidence’, and in practice they could be an integral part of a decision-making process, or even a replacement for it. As such, it is essential that the ‘reasoning’ of AI systems are made known to suspects and accused persons, similarly to how judicial decisions must contain “sufficient reasoning and address specific features of a given case”, especially where they concern the deprivation of liberty.113 Decision-making processes of AI systems and the way in which it has produced an outcome in a particular case should thus be disclosed to suspects and accused persons, in a form that is intelligible to a layperson. Individuals should not need to rely on experts to simply understand how a decision affecting them was made. While there will inevitably be scenarios where defendants would need expertise to challenge an AI-assisted decision, but these cases should be the exception, rather than the norm, for whenever an AI system is used. Criminal justice procedures should require the notification to suspects and accused persons where an AI system has been used which has or may have impacted a decision made about that individual. Procedures should enable the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings. Disclosure should be in a form which is comprehensible to a layperson, without the need for technical or expert assistance, and suspects and accused persons should also be given effective access to technical experts who can help to analyse and challenge otherwise incomprehensible aspects of AI systems. Training AI systems use technology not well understood by many people. Without proper training, outputs of AI systems might not be easy to interpret, and it might be difficult to appreciate which factors undermine the reliability of AI systems, so that appropriate weight can be attached to their findings. As mentioned above, decision-makers can be warned about the weaknesses of AI systems as part of their decision-making process, but the effectiveness of this safeguard can be questioned, because it is unlikely to provide decision-makers with all the information they need, and there is no guarantee that the warnings will be taken seriously in all cases. Training is not just needed for the primary users of AI systems, such as judges and police officers who use them to inform their own decisions. The training must also be available criminal defence lawyers, so that they are in a better position to challenge AI systems, where necessary. If AI systems are used routinely to aid criminal justice decisions or even made mandatory (as is the case in certain states in the United States), there would be strong justification for governing bodies to make training on AI mandatory for criminal justice practitioners. Part 3: Governance and Monitoring Criminal justice processes are an important enforcement mechanism for ensuring that AI systems are designed and used lawfully, but they cannot be the sole, or even the primary means of implementing legal and ethical standards. Of equal, if not greater importance is a framework that ensures that policy decisions on the design and deployment of AI systems are made in systematised way, and that unlawful or harmful AI systems never enter into public service. Member States that deploy AI systems for criminal justice purposes should have regulatory mechanisms that are fit for purpose. At a minimum, these should include frameworks for: a) pre-deployment impact assessments; b) post deployment monitoring and evaluations; and c) collection of data needed for effective comparative analysis. Pre-Deployment Both the GDPR and LED recognise the need for AI systems to be analysed before they are deployed, so that they comply with existing regulatory and human rights standards. Under Article 35 GDPR, Member States are required to carry out a ‘Data Protection Impact Assessment’ (‘DPIA’) for data processing systems that carry out ‘a systematic and extensive evaluation of personal aspects relating to natural persons which is based on automated processing, including profiling and on which decision are based that produce legal effects concerning the natural person or similarly significantly affect the natural person’. The corresponding provision in the LED is Article 27, which similarly calls for DPIAs to be carried out where processing of data is likely to result in a ‘high risk to the rights and freedoms of natural persons’. DPIAs under both laws have to carry out inter alia an assessment of the possible impact of the data processing system on the rights or individuals, and they need to mention what measures will be in place to ensure that their rights are properly protected. DPIAs help to address a serious accountability challenge, but EU laws do not provide sufficiently helpful standards on how they should be conducted. Article 27 LED does not lay down minimum requirements for how DPIAs should be carried out. On the other hand, there are aspects of Article 35 GDPR which, if used to guide how DPIAs should be conducted for AI systems used in criminal justice, would raise concerns. The foremost challenge is the level of transparency mandated by the GDPR. DPIAs are envisaged largely as internal processes led by the data controller, who may seek the opinions of data subjects (such as members of the public or their representatives), where it is ‘appropriate’ to do so. The GDPR also explicitly recognises that the requirement to seek the views of data subject is ‘without prejudice to the protection of commercial interests’.114 As outlined above, transparency is a key aspect of a fair criminal justice system and, as a general rule, all criminal justice decision-making processes need to be open to public scrutiny. There is no reason why AI systems should be exempt from this requirement and, given that administration of criminal justice is a matter of strong public interest, the public should have the right to voice their opinions and raise objections whenever AI systems impact criminal justice processes. Also, given the highly technical nature of AI systems, and their (as yet) poorly understood impact on society, impact assessments must have multi-disciplinary expert engagement. 115 In particular, DPIAs should always involve independent experts (computer scientists, in particular) who can audit, analyse, and if possible, ‘explain’ AI systems, so that they can help legal, policy and social science experts to determine the likely implications for the individuals’ rights. For public and expert consultations to be meaningful and effective, sufficient information should be made available to interested parties so that the AI system can be thoroughly understood and researched. Partnership on AI has recommended that for criminal justice risk-assessment tools, training datasets,116 architectures and algorithms of AI systems should be made available to ensure meaningful scrutiny.117 Commercial interests should not be regarded as a legitimate ground for limiting the disclosure of this information. Secondly, Article 35 GDPR allows data controllers to carry out a single DPIA ‘for a set of similar processing operations that present similar high risks’. There is a danger that this provision could be interpreted too broadly if Member States are given free rein to determine what two systems can be regarded as sufficiently ‘similar’. There are risks in assuming that an AI system well-suited for use in a particular context or within a particular geographic area will be equally useful in another. AI systems built using data from one jurisdiction might not be able to reflect differences in, for example, law enforcement culture and patterns of behaviour, laws and policies, and socio-demographic characteristics of another jurisdiction.118 Sometimes, these differences can be seen in the same country or even within the same region. For example, a study of ‘PRECOBS’ a predictive policing tool used in Baden-Wurttemberg in Germany, found significant differences in predictive utility between rural and urban areas.119 Finally, DPIAs seem to require data controllers to theorise the possible impact of AI systems, but there is no strict requirement for AI systems to be subject to testing or auditing before, or immediately after deployment. This overlooks the fact that flaws in AI systems, including unintentional biases, are not always easily detectable, and that they might only surface once the system is put into operation. As discussed earlier, the causes of biases in AI systems can be difficult to identify, and it is difficult to appreciate how, short of thorough testing, the true impact of AI decisions can be known. In New York, the AI Now Institute has proposed an alternative model for impact assessments, known as ‘Algorithmic Impact Assessments’ (‘AIAs’).120 The AIA framework sets out in detail how public authorities should conduct impact assessments of AI systems, and it can be contrasted with the provisions of the GDPR in that AIAs place much greater emphasis on the need for community engagement and consultations with external experts. This framework could serve as a useful guide for Member States seeking to establish pre-deployment procedures for approving AI systems. AI systems should not be deployed unless they have undergone an independent public impact assessment with the involvement of appropriate experts, that is specific both to the purpose for which the AI system is deployed, and the locality where it is deployed. AI systems must be tested for impact pre-deployment, and systems should be precluded from deployment until they have undergone this testing and achieved minimum standards, such as non-discrimination. Post-Deployment Impact assessments of AI systems should not be regarded as ‘one-off’ processes. They have to be followed up with ongoing post-deployment monitoring and evaluation, so that the longer-term impact of AI systems can be understood, and shortcomings and biases that affect the rights of individuals can be identified and fixed. The ability of AI systems to deliver fair and just outcomes, and to meet policy objectives can be difficult to predict from the outset. Although AI systems can be validated and tested prior to deployment to check if they are likely to produce desired outcomes, their impact in the real world might be different. Furthermore, even if the likely outputs of AI systems can be predicted, it is much harder to estimate the likely impact they will have on human decision-making.121 Further reviews of AI systems are also necessary because criminal justice systems and the societies in which they operate change over time. A study in the United States, for example, theorises that many pre-trial risk assessment tools might be making predictions based on historic data that is no longer fit for purpose. It has been suggested that because data used to train risk assessment algorithms pre date bail reforms in many US jurisdictions, the impact of recent measures introduced to reduce the risk of failure-to-appear, such as transportation assistance and text message alerts are not taken into consideration – potentially leading to over-incarceration.122 Socio-demographic changes might also require AI systems to be altered so that they continue to be fit for purpose. If, for example, an area experiences high levels of net migration which results in rapid changes to policing patterns and judicial behaviour, AI systems might need to be reviewed to make sure they are not unintentionally worsening racial discrimination. Data Collection It is difficult to imagine how the impact of AI systems can be assessed, if there is inadequate data to support effective monitoring. The deficiency of criminal justice data across the EU has been subject to criticism. In particular, Fair Trials has found that most EU Member States do not systemically collect statistics on the duration of pre-trial detention, outcomes of criminal cases of pre-trial detainees, and the likelihood of a suspect or accused person being released by the court.123 The data needed for effective monitoring and evaluation depends on the function of the AI system and its intended objectives, but the lack of criminal justice data more generally questions whether Member States currently have adequate legal and policy foundations for introducing AI systems responsibly into criminal justice processes. Data needed for monitoring and evaluation purposes will, of course, need to have been collected from well before the introduction of the AI system, so that a proper pre- and post- analysis comparison can be made. Of particular concern is that in most EU Member States, race or ethnic data on criminal justice is not available, either because there is no systemised process for collecting it, or because local laws ban this practice altogether.124 This is a serious challenge because the most predominant criticism against the use of AI systems in the United States and elsewhere is that it worsens racial and ethnic bias in criminal justice decisions. Even without official statistics, there is strong evidence in many EU Member States that certain ethnic minorities, and in particular, Roma and people of colour are unfairly overrepresented in criminal justice systems.125 It is worrying that AI systems might worsen this discrimination, but that there will be no way of detecting this trend, because of the lack of data. Furthermore, the absence of racial and ethnic data could also prevent pre-emptive measures to combat racial bias. It is doubtful that developers will be able to design systems free from racial bias, if they have no data against which to measure their performance. On data collection, Fair Trials believe that EU and its Member States will need to make a strict choice. Either they should ensure that racially disaggregated criminal justice data is collected, or AI systems should be banned where they make individualised assessments for criminal justice purposes. Effective monitoring of AI systems is not possible unless there is sufficient data that makes it possible to discern their real impact. In particular, Member States need to collect data that allow them to identify discriminatory impacts of AI systems, including discrimination on the basis of race and ethnicity. "," Answer the following question using only details found in the attached paper. You should NOT reference outside sources or your own knowledge. What are some examples of visible and hidden biases that have been observed in criminal justice AI? Executive Summary ‘Artificial Intelligence’ (‘AI’), comprising machine-learning and other analytical algorithm-based automated systems, has become an important aspect of our lives. In recent years, this technology has been increasingly deployed in criminal justice systems across the world, playing an increasingly significant role in the administration of justice in criminal cases. This trend is often driven by perceptions about the reliability and impartiality of technological solutions, and pressures to make cost savings in policing and court services. However, studies in various jurisdictions, including in Europe, provide substantial evidence that AI and machine-learning systems can have a significantly negative influence on criminal justice. AI systems have been shown to directly generate and reinforce discriminatory and unjust outcomes; infringing fundamental rights, they have been found to have little to no positive influence on the quality of human decisions, and they have been criticised for poor design that does not comply with human rights standards. Most AI systems used in criminal justice systems are statistical models, based on data which is representative of structural biases and inequalities in the societies which the data represents, and which is always comprehensively lacking in the kind of detail that is needed to make truly ‘accurate’ predictions or decisions. The data used to build and populate these systems is mostly or entirely from within criminal justice systems, such as law enforcement or crime records. This data does not represent an accurate record of criminality, but merely a record of law enforcement - the crimes, locations and groups that are policed within that society, rather than the actual occurrence of crime. The data reflects social inequalities and discriminatory policing patterns, and its use in these AI systems merely results in a reinforcement and re-entrenchment of those inequalities and discrimination in criminal justice outcomes. Given these extremely serious risks, strong regulatory frameworks are needed to govern the use of AI in criminal justice decision-making and, in some circumstances, to restrict its use entirely. Existing EU data protection laws restrict the use of automated decisions, but there are gaps and ambiguities that could result in the use of AI systems in ways that undermine human rights, if not accompanied by further guidance or legislation. Firstly, EU laws currently only prohibit decisions that are solely based on automated processes, but they do not regulate decision-making processes that are largely dependent on automated systems. Given that most AI systems in use today are designed and deployed to assist, rather than replace, human decision-making in criminal justice systems, they largely fall outside the remit of EU data protection laws on automated decisions. Secondly, the prohibition on automated decisions is subject to broad exceptions. Individuals can be subject to decisions based solely on automated processes if authorised by EU or Member State law, and there are deemed to be appropriate human rights safeguards in place, including the right to obtain human intervention. However, there is not enough clarity on what safeguards are needed, and how ‘human intervention’ should be interpreted. In order to regulate the use of AI in criminal justice proceedings, the EU must, at a minimum, set standards to address the following questions: 1) what standards are needed to govern the design and deployment of AI systems in criminal justice systems; 2) what safeguards are needed in criminal justice proceedings to make sure that AI systems are used in accordance with human rights standards and prevent discrimination; and 3) how Member States should govern the deployment of AI systems and monitor their subsequent use. The design of AI systems and their deployment in criminal justice proceedings should be regulated to generate human rights compliant, non-discriminatory outcomes. Minimum standards and safeguards should be set, which, if they cannot be adhered to, should preclude the use of the AI system in question. AI should also be regulated so that they are sufficiently transparent and explainable to enable effective independent scrutiny. AI systems should be designed and deployed to comply with and give effect to inter alia the right of access to court, the right to be presumed innocent, and the right to liberty. AI systems should not undermine the right to be tried by an impartial and independent tribunal and, in line with existing EU laws, no individual should be subject to an automated decision that results in a criminal record. AI systems should be designed so that they do not pre-designate an individual as a criminal before trial, nor should they allow the police to take unjustified, disproportionate measures against individuals without reasonable suspicion. AI systems that inform criminal justice outcomes should, as a general rule, favour outcomes that are favourable to the defendant. Where AI systems inform decisions on the deprivations of liberty, they should be calibrated to generate outcomes that favour release, and they should not facilitate detention other than as a measure of last resort. AI systems must be subject to rigorous testing to ensure that they have the desired effect of reducing pre-trial detention rates. AI systems must be developed to guarantee that they do not generate discriminatory outcomes, ensuring that suspects and accused persons are not disadvantaged, either directly or indirectly, on account of their protected characteristics, including race, ethnicity, nationality or socioeconomic background. AI systems should be subject to mandatory testing before and after deployment so that any discriminatory impact can be identified and addressed. AI systems which cannot adhere to this minimum standard should have no place in the criminal justice system. AI systems need to be transparent and explainable, so they can be understood and scrutinised by their primary users, suspects and accused persons, and the general public. Commercial or proprietary interests should never be a barrier to transparency. AI systems must be designed in a way that allows criminal defendants to understand and contest the decisions made against them. It should be possible to carry out an independent audit of each AI system, and its processes should be reproducible for that purpose. Member States should have laws that govern how AI systems are relied upon in criminal proceedings, and there must be adequate safeguards to prevent over-reliance on AI by decision-makers, to prevent discrimination and to ensure scrutiny and effective challenge by the defence. Procedural safeguards should actively tackle automation-bias amongst criminal justice decision makers. Examples include: a) making it a legal requirement for decision-makers to be adequately alerted and informed about the risks associated with AI systems; b) making AI systems’ assessments intelligible to decision-makers; c) requiring decision-makers to provide full, individualised reasoning for all decisions influenced by an AI system; and d) making it easy for decision-makers to overrule AI assessments that produce unfavourable outcomes for defendants. Criminal justice procedures should ensure that defendants are notified if an AI system has been used which has or may have influenced a decision taken about them at any point in the criminal justice system, from investigation to arrest, from charge to conviction, and sentence. Procedures should enable the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings. Disclosure should be in a form which is clear and comprehensible to a layperson, without the need for technical or expert assistance, in order to ensure fairness, equality of arms, and to discharge the obligations to provide all relevant information and be given reasons for decisions under the right to a fair trial. Suspects and accused persons should also be given effective access to technical experts who can help to analyse and challenge otherwise incomprehensible aspects of AI systems. Training should be made available to all primary users of AI systems, and to criminal defence practitioners, so that there is greater awareness of AI technology, and of the risks of over-reliance on AI. Effective regulation of AI systems should be facilitated by a governance and monitoring framework. AI systems should not be deployed unless they have undergone an independent public impact assessment with the involvement of appropriate experts, that is specific both to the purpose for which the AI system is deployed, and the locality where it is deployed. A requirement of the assessment should be a consideration of whether it is necessary to use AI in the particular use case, or whether an alternative solution could achieve the same aims. As far as it is possible to do so, AI systems should also be tested for impact pre-deployment, a part of which should be the minimum requirement to prove that the AI system has no discriminatory impact, either directly or indirectly, before it can be deployed. AI systems should be kept under regular review post-deployment. Effective monitoring of AI systems is not possible unless there is sufficient data that makes it possible to discern their real impact. In particular, Member States need to collect data that allow them to identify discriminatory impacts of AI systems, including discrimination on the basis of race and ethnicity. Background Rapid technological advancements in recent years have made artificial intelligence (‘AI’) an increasingly prominent aspect of our lives. There are differences of opinion as to the definition of AI and its true meaning, but for the purposes of this paper we are broadly referring to automated decision-making systems based on algorithms, including machine-learning, which are used in the criminal justice system. There is little doubt that AI has great capacity to increase human potential and improve the lives of many, but the increasing role of AI in assisting important public functions has also highlighted serious risks and challenges. If not subject to proper regulation and oversight, AI can threaten fundamental human rights and, far from expanding human potential, it can amplify and worsen harmful aspects of our society, including inequality and injustice. This challenge is particularly evident where AI has been used to assist the administration of justice in criminal cases. In recent years, more and more jurisdictions across the world have begun to use AI technology to inform and assist policing and judicial decisions, often driven by perceptions about the reliability and impartiality of technological solutions, and pressures to make cost-savings in policing and court services. In some countries, algorithmic processes can influence which geographic neighbourhoods should be subject to increased law enforcement and when, as well as which individuals should be specifically targeted by law enforcement. They can help to determine whether someone should be arrested, whether they should be charged with a criminal offence, whether they should be detained in prison before trial and, if convicted and sentenced, the length of their sentence. AI is being used more and more to influence highly sensitive, high impact decisions that have far reaching, long-term implications for individuals’ rights. Research emerging from the United States, where the use of AI in criminal justice is particularly widespread, and from the United Kingdom and some EU Member States, however, seriously questions whether AI has a positive influence on criminal justice systems. AI tools and systems have been found to actively generate discriminatory criminal justice outcomes, they have been found to have little to no positive influence on the quality of human decisions, and they have been criticised for poor design, that does not reflect or give effect to human rights standards. These criticisms might not be justified for all AI systems, but these studies highlight the need for much stronger regulatory frameworks to govern the use of AI. We believe that unless it is subject to robust regulation, it is unlikely that AI can be used in criminal justice systems without undermining the right to a fair trial. In some cases, it should be restricted from use entirely. EU Member States should be encouraged to take a much more cautious approach to AI and subject automated processes to more stringent rules that are designed to ensure human rights compliance. There is the potential for AI systems, if properly and robustly regulated, to have a positive impact on criminal justice system, advancing human rights, for example, by analysing law enforcement or judicial decisions to identify patterns of erroneous or poor decision-making, or discrimination. The EU is already a world leader on AI regulation, having adopted ground-breaking data protection laws in recent years to shield individuals from automated decisions that have an adverse effect on their rights. We welcome the EU’s commitment to build further on existing legal standards, and we emphasise that addressing the impact of AI on criminal justice has to be a primary consideration for EU policy makers when deciding on appropriate legal standards. Discussions around the impact of AI on human rights have largely been centred on data protection, the right to privacy, and broader questions of ethics and human dignity. However, despite the increasing use of AI systems in criminal justice systems across the world, only limited discussions have so far focused on how these systems impact the right to a fair trial, and what regulations are needed to address that impact. About this paper Fair Trials has produced this policy paper to highlight the need for EU-wide standards on the regulation of AI in criminal justice, and to inform EU policy makers about the standards and safeguards needed to ensure effective protection of fair trial rights where criminal justice decisions are assisted by AI. The EU Commission recognised that AI represents risks for fundamental rights, including the right to a fair trial, in its 2020 White Paper, ‘On Artificial Intelligence – A European approach to excellence and trust’. It also recognised the need for improvements to the EU’s legislative framework on AI, noting in particular the challenges in the ‘effective application and enforcement of existing EU and national legislation’ and the ‘limitations of scope of existing EU legislation’. In this paper, we identify the most common fair trial rights issues raised by existing AI systems, based on examples and experiences from the EU, the United Kingdom, and the United States. We also offer examples of practical legal and policy solutions that could help to address these challenges, and to assist in the effective implementation of the EU’s fundamental rights standards in this area. We recognise that the use of AI has a broader impact on human rights beyond the right to a fair trial, and that there are important social and ethical issues that also need to be addressed. However, we have narrowed the focus of this paper given Fair Trials’ mission and field of expertise. This paper should not be treated as an exhaustive list of fair trial rights standards that need to be introduced. AI is used in many ways in criminal justice systems cross the world and, as the technology continues to develop, it is likely that we will eventually see the deployment of AI technology in ways never imagined before. This paper focuses primarily on AI systems that carry out individualised risk assessments, given that these types of systems have had the most significant impact on individuals’ rights so far, and we envisage that similar systems will become increasingly common in the near future. Existing EU Legal Framework Existing EU laws restrict the use of automated decisions in a wide variety of contexts. Article 22 of the General Data Protection Regulation (‘GDPR’) provides that data subjects have the right not to be subject to decisions ‘solely’ based on automated processes, where they produce ‘legal effects’ concerning them, or where they ‘similarly significantly affect’ them. The Law Enforcement Directive (‘LED’) – the EU data legislation that governs the processing of data for criminal justice purposes – has a very similar provision at Article 11, which requires Member States to prohibit decisions based solely on automated processing, where they produce ‘adverse legal effects’ on the individual, or effects that are ‘similarly significant’. However, there are two notable gaps in the existing legislative framework governing automated decision-making systems under both the GDPR and the LED. These ambiguities and potential loopholes could be exploited in ways that seriously undermine the general prohibition of automated decision-making processes, and adversely impact human rights. It is necessary, therefore, that the EU provides further guidance on how these provisions should be interpreted, including thorough legislation (if appropriate) to further clarify the circumstances in which Member States are allowed to deploy AI systems for criminal justice proceedings. Firstly, the provisions in the GDPR and LED only prohibit decisions based ‘solely’ on automated processes. In other words, the laws regulate the impact of decisions made through automated processing, but not the AI systems themselves. As discussed later in this paper, the main human rights challenges of AI systems can be attributed to how they are designed and trained, and the types of technology used, such as machine-learning, so it is crucial that decisions about the design and deployment of AI systems are also regulated. Secondly, neither the GDPR or LED provide regulatory standards to govern situations where automated processing is not the ‘sole’ basis of a decision, but a primary influencer. In reality, the difference between a fully automated decision and a decision made with a ‘human-in-the-loop’ is not always clear, but because of this strict classification, AI systems are able to be used and have significant legal effects without the corresponding safeguards. Stronger legal standards are needed to make sure that semi-automated decision-making processes do not become de facto automated processes. Thirdly, the prohibition on automated decision-making is subject to two very broad exceptions. Automated decisions are prohibited under the GDPR and LED, ‘unless authorised by Union or Member State law’ and there need to be ‘appropriate safeguards for the rights and freedoms of the data subject, at least the right to obtain human intervention’.1 These provisions give extremely wide discretion to Member States to override the general prohibition. It is significant that EU laws emphasise the need for human rights safeguards, and the need to ensure the possibility of human interventions, but neither of these concepts have yet been adequately defined. Although influential actors like the EU and the Council of Europe have established principles on the ethical and responsible use of AI, there is currently no authoritative guidance on the practical safeguards that need to be in place.2Likewise, the meaning of ‘human intervention’ is open to interpretation. LED provides some guidance on who should be carrying out the human intervention,3 but there needs to be greater clarity on what meaningful human intervention entails in different contexts. In order to regulate the use of AI in criminal justice proceedings, and close the gaps in existing data protection laws, the EU must, at a minimum, set standards to address the following questions: 1) what standards are needed to govern the design and deployment of AI systems in criminal justice systems; 2) what safeguards are needed in criminal justice proceedings to make sure that AI systems are used in accordance with human rights standards and prevent discrimination; and 3) how Member States should govern the deployment of AI systems and monitor their subsequent use. Part 1: Regulating the Design and Deployment of AI Systems in Criminal Justice Systems AI systems deployed to assist criminal justice decision-making have to be fit-for-purpose. The purposes of AI systems differ depending on the context in which they are deployed, but there are a few common considerations that need to be taken into account to determine whether it is appropriate for the AI system to be used. Firstly, AI systems have to be designed to produce outcomes that are desirable from a human rights and non-discrimination perspective. This means that rather than being exclusively focused on delivering ‘accurate’ outcomes in criminal cases, AI systems have to be designed to facilitate fair, impartial and non-discriminatory criminal processes. Developers of AI systems and public entities that commission them should, in particular, make sure that AI systems are consciously designed to give effect to, and promote the right to fair trial. The fundamental issues with the way AI systems are designed and built, resulting in discriminatory outcomes, must also be considered. Given the significant evidence of AI systems influencing discriminatory outcomes, special efforts must be made to ensure that AI systems do not produce discriminatory outcomes. Secondly, AI systems need to be designed in a way that makes it possible for criminal defendants and the broader public to scrutinise them. This means that AI systems should not only be made open to scrutiny (rather than concealed to protect commercial interests), but their inner workings and processes should also be discernible and comprehensible. AI Systems should be designed to protect and promote the right to a fair trial Where AI systems are used to assist or inform criminal justice decisions, they support an important act of public administration that has a significant impact on the rights of suspects and accused persons. AI systems do more than just provide outputs that decision-makers can take into consideration as evidence. By attempting to mimic human analytical processes and reasoning, they can provide influential advisory input into human decision-making, or even replace it altogether. As such, it is right that human rights standards that govern criminal justice decision-making also apply to AI systems. The Council of Europe and the EU Commission’s High Level Expert Group on Artificial Intelligence (‘AI HLEG’) have both recognised that fundamental rights should be a key guiding principle for the design and deployment of AI systems.4 The Council of Europe recommends that AI systems are built according to ‘human rights by design’ principles, and recognises that AI systems should not undermine the right to a fair trial under the European Convention on Human Rights (‘ECHR’). The AI HLEG has similarly recognised that the respect for fundamental rights, as enshrined in the EU Charter of Fundamental Rights and international human rights instruments, should form the foundations of trustworthy AI. AI HLEG’s Ethics Guidelines for Trustworthy AI (‘the Ethics Guidelines’) also recognise the need for AI systems to comply with other types of EU legislation. Although not mentioned explicitly in the Ethics Guidelines, Fair Trials would emphasise that the design of AI systems and the ways in which they are deployed in the EU should, in particular, be compatible with the standards set out in the procedural rights directives under the ‘Roadmap for strengthening procedural rights of suspected or accused persons in criminal proceedings’.5 We would also like to note the potential for AI systems to have a positive impact on criminal justice systems. Public debate about the relationship between AI and human rights have predominantly been centred on the idea that AI is a threat to human rights. It is equally important, as technology takes an increasingly prominent role in public life, to consider what positive potential they may have. Policy makers, developers, civil society activists, and other stakeholders should try to identify ways in which AI can also play an active role in advancing human rights, and improve the fairness of criminal justice systems. For example, AI systems could be used to analyse law enforcement or judicial decisions to identify patterns of erroneous or poor decision-making, or discrimination, for preventative purposes. AI systems which are used as part of criminal justice decision-making should be designed not just to ensure that they do not undermine the right to a fair trial, but also to promote it. However, as explained below, given the embedded biases in the criminal data used to develop and train AI systems, there are serious doubts, based on recent studies, whether AI systems can promote fair criminal justice at all. There are various aspects of the right to a fair trial and, without speculating on what kind of AI systems will be developed in the future to support criminal justice decision-making, it is difficult to articulate how fair trial rights standards should inform the design of AI systems. However, examples of AI systems currently deployed in the EU and elsewhere suggest that there are certain aspects of the right to a fair trial that require special attention. These are: a) the right of access to court b) the presumption of innocence; c) the principle of the equality of arms; and d) the right to liberty. Access to Court The notion of AI systems replacing courts to determine the guilt or innocence of the accused may seem far-fetched at present, but there is a growing trend of automated administration of justice across the world that might threaten the right of access to court. For example, in several European countries, speeding and other minor traffic offences have been detected and enforced by means of automated processes for more than a decade.6 Although nominally criminal processes, these types of proceedings are, in reality, normally administrative in nature, and they rarely have a ‘significant’ impact on the rights of individuals. However, as surveillance technology develops, thanks to AI, there is a real likelihood that the scope of crimes punishable by way of automation will increase.7 In the United Kingdom, the government announced plans in 2017 that would enable defendants to enter guilty pleas via an online portal after viewing the charges and evidence against them, for a small number of minor offences.8 Under this procedure, known as ‘automatic online conviction’, defendants would be automatically convicted and fined without any judicial oversight if they accept the charges against them. Although it is debatable whether this system can truly be characterised as an AI system, it is an example of the automated administration of criminal justice, that replaces a function usually played by courts. It is worrying that the UK government has proposed expanding this scheme to other ‘non imprisonable’ offences, if itis regarded as a success.9Fair Trials has outlined concerns about expanding the scope of cases where accused persons can be convicted without judicial oversight, even if such procedures are reserved solely for minor, non-imprisonable offences.10 The impacts of a criminal conviction, even for a minor offence, can be numerous, long-term, and hard to predict, affecting inter alia job prospects, educational opportunities, and immigration status. It is crucial that what amounts to ‘legal effects’ and ‘similar significant effects’ concerning the data subject for the purposes of automated decision-making are interpreted very broadly.11 In particular, given that a criminal record always has a ‘legal’ or ‘significant’ effect, any automated decision-making process that directly results in a criminal record should be prohibited. AI systems should not undermine the right to be tried by an impartial and independent tribunal, and in line with existing EU laws, no individual should be subject to an automated decision that resultsin their being held in custody or detention, gives them a criminal record, or which determines a criminal sentence or sanction. No individual should be subject to an automated decision which engages their human rights without meaningful human input. Presumption of Innocence The right to be presumed innocent in criminal proceedings is a basic human right, and one that is expressly recognised in, and safeguarded by EU law under Directive 2016/343 (the ‘Presumption of Innocence Directive’).12 The increasing use of AI in the sphere of criminal justice, however, raises questions about the scope of this right, and how AI systems should be built and used to protect it. Concerns about how AI systems undermine the presumption of innocence have been voiced in the context of certain types of predictive policing software.13 A variety of predictive policing tools that aim to facilitate preventative policing measures and to deter crimes before they have taken place have been developed and deployed across Europe.14 Tools which predict the time and place where certain crimes are likely to take place have been used in many European countries. Similar tools have also been developed to identify potential suspects, which are used widely in the US, and now increasingly in Europe.15 An example is the ‘Strategic Subject List’ in Chicago, a police database of around 400,000 local residents who were assigned threat scores that determine the likelihood that they will commit crimes.16 The algorithms used to generate these scores were not open to the public, so the exact process by which individual risk levels were assessed were not known. Despite this lack of transparency, it is clear that threat scores generated by the software had significant impacts on individuals’ rights – in particular, their right to privacy. Individuals with higher threat scores were, for example, more likely to be subject to targeted police surveillance, or home visits – as though they were officially recognised as predisposed to commit crimes, irrespective of any credible suspicion of wrongdoing.17 The Strategic Subject List was decommissioned in January 2020 by the Chicago police who cited ineffectiveness as the primary reason for the decision.18 These types of predictive policing tools are now being used in Europe. In the United Kingdom, a coalition of police forces have been developing a system not dissimilar to the Strategic Subject List, that aims to identify individuals who are likely to commit crimes.19 Known as the National Data Analytics Solution (‘NDAS’), this risk assessment tool uses statistical analysis and machine-learning to inform policing decisions, and to facilitate ‘early interventions’ where appropriate.20 The sources of data that the system uses to conduct its risk assessments raise concerns that the system will be built to profile individuals on the basis of very sensitive, personal information, including stop and search data, data from social services, and the National Health Service.21 Where this data is used to indicate the likelihood of individuals’ criminality, it will inevitably flag up people whose profiles fit those who are over-represented in that data as being higher risk. It is particularly worrying that an individual might be profiled for policing purposes on the basis of their health conditions or their access to essential services, such as welfare or benefits. These factors should not be regarded as relevant factors for determining whether someone may commit criminal offences. Also in the UK, the Metropolitan Police in London operates a database called the Gangs Matrix, which contains information and risk-assessments on individuals who are alleged ‘gang’ members.22 This database was created using criminal justice data, including police and crime records. The Gangs Matrix and the assessments it produces assists policing decisions, including the deployment of stop and search, and further enforcement action, such as imprisonment and deportation. A further tactic resulting from the risk assessments made by the Gangs Matrix is the threat of eviction or exclusion from education, as names and details of these alleged gang members have been shared with education, healthcare and housing providers.23 In the Netherlands, the government has been running an algorithmic risk assessment tool, ProKid 12- SI, which purports to assess the risk of criminality of 12-year-old children since 2009.24 ProKid uses existing police data on these children, such as reports of where children have come into contact with the police, their addresses, information about their ‘living environment’, even including whether they are victims of violence, to identify them as being in one of four categories of ‘risk’ of committing crimes in future.25 The system assesses children based on their relationships with other people and their supposed risk levels, meaning that individuals can be deemed higher risk by being linked to another individual with a high risk assessment, such as a sibling or a friend.26 Parents’ assessed risk can also impact a child’s risk level. ProKid’s algorithms assess risks in relation to future actions that the children have not yet carried out, and judges them on the basis of the actions of others close to them.27 These risk assessments result in police ‘registering’ these children on their systems and monitoring them, and then referring them to youth ‘care’ services.28 ProKid frames children as potential perpetrators even when they are registered as victims of violence; which has serious implications on their presumption of innocence.29 Several similar tools are also used in the Netherlands, including the Reference Index for High Risk Youth, a large-scale risk assessment system that focuses on assessing under-23-year-olds.30 Predictive policing tools like NDAS, ProKid and the Gangs Matrix can be regarded as part of a broader trend in law enforcement that moves away from ‘reactive’ policing, and towards ‘preventative’ or ‘proactive’ policing.31 NDAS and other similar predictive policing tools intend to pursue legitimate objectives of preventing, or reducing harm,32 but there are serious concerns that these systems single out individuals as ‘pre-criminals’, who are subject to police interventions even though they are not formally suspected of any crime, and there is no evidence that they have done anything wrong.33 It is of further concern that these types of predictive policing tools do not necessarily designate individuals’ risk levels on the basis of their past actions, or behaviour that can be regarded as ‘suspicious’ in any way, but on account of factors far beyond their control, and immutable characteristics. In particular, there is strong evidence to suggest that AI systems have a tendency to overestimate the risks of criminality of certain ethnic and racial groups. For example, out of 3,800 people on the Gangs Matrix, 80% are 12-24 years old, and 78% of them are black – a clearly disproportionate and discriminatory proportion. The discriminatory impact of AI in criminal justice systems is discussed in further detail in the following section. Although predictive policing tools do not directly ‘convict’ people, they not only allow the police to treat legally innocent individuals as pseudo-criminals, but they can also result individuals being deprived of their basic rights with regard to education, housing, and other public services – effectively ‘punishing’ them on account of their profiles. This seriously damages the fundamental human rights principle that the matter of guilt or innocence can only be determined by means of a fair and lawful criminal justice process.34 While it is clear that certain types of predictive policing can infringe the presumption of innocence from a moral and ethical viewpoint, it is debatable whether these systems also violate the legal presumption of innocence under EU law and international human rights law. The Presumption of Innocence Directive applies to natural persons who are ‘suspects’ and ‘accused persons’, from the moment they are suspected or accused of a crime.35 However, there is some ambiguity about the exact stage at which an individual attains the status of a ‘suspect’ under the Presumption of Innocence Directive,36 and about whether the scope of the Presumption of Innocence Directive extends to decisions to designate an individual as a suspect (or a ‘pre-criminal’). On the other hand, the ECHR appears to have taken a clearer position that measures undertaken pre-charge, as a general rule, fall outside the scope of the presumption of innocence.37 It has also held that preventative measures, such as surveillance, do not amount to criminal sanctions for the purposes of Article 6 ECHR.38 Even if the current language on the presumption of innocence is such that it is not directly applicable to the predictive policing context, it must be recognised that these tools nevertheless interfere with human rights. In particular, the targeted surveillance that results from predictive policing has clear implications on the right to privacy. The acceptable degree to which criminal justice processes can interfere with this right is a matter that might require clearer articulation, as is the question of the impact of Article 8 ECHR violations on criminal proceedings. AI systems that inform charging decisions have also been developed and deployed. An example of this is the Harm Assessment Risk Tool (‘HART’) currently being used by Durham Constabulary in the United Kingdom. HART uses a machine-learning algorithm to assess a suspect’s risk of reoffending, using over thirty variables that characterise an individual’s criminal history and socio-demographic background. The risk assessments conducted by HART are used by the local police to determine whether an individual should be charged, or diverted into a rehabilitation programme. HART does not determine whether an individual is guilty or innocent, but its assessment can trigger a chain of events that can result in the deprivation of liberty, and/or a criminal conviction. Charging decisions should surely be based on the merits of individual cases, and it is difficult to imagine how decisions on entry into diversion programmes can be made by means other than a careful consideration of individual circumstances. These types of high impact, fact-sensitive decisions should never be delegated to automated processes, particularly those which operate by identifying correlations rather than causal links between an individual’s characteristics and their likely behaviour. An examination of HART also reveals flaws in how the tool is designed. HART is calibrated to err on the side of caution,39 because it regards under-estimations of risk levels as a more serious error than over-estimations, so that under-estimations occur less frequently. In other words, HART is deliberately designed to underestimate who is eligible for entry into the diversion programme, so it is predisposed to over-criminalise. This approach conflicts with the notion that any doubt in a criminal case should be interpreted in favour of the defendant (‘in dubio reo’).40 A human rights compliant approach to criminal justice decision-making would do the opposite of what HART does – it would need to err on the side of the defendant. AI systems should respect the presumption of innocence and they must be designed so that they do not pre-designate an individual as a criminal before trial, nor should they allow or assist the police to take unjustified, disproportionate measures against individuals without reasonable suspicion. AI systems that inform criminal justice outcomes should, as a general rule, favour outcomes that are favourable to the defendant. Equality of Arms A major concern raised in the studies of certain AI systems is that they are inaccessible for adequate scrutiny by defendants and their lawyers. This has serious implications for the principle of equality of arms and the right to an adversarial process, because without information about how a decision is made, it is difficult to envisage how defendants can question the accuracy and legality of the decision. The need for AI systems used in criminal justice to be transparent, explainable and understandable to all is addressed in more detail below. The Right to Liberty In the United States, ‘risk-assessment’ tools that use AI technology have been used to assist pre-trial assessments that determine whether a defendant should be released on bail, or held on remand pending their trial. Examples of risk-assessment tools currently being used in the United States include COMPAS, the Public Safety Assessment (‘PSA’), and the Federal Pre-Trial Risk Assessment Instrument (‘PTRA’). Many of these tools are also used to inform decisions on parole and sentencing. These tools have, however, been subject to intense criticism for several reasons. Studies have shown inter alia that risk assessments make inaccurate predictions that are no better than those made by non-expert humans. They do not result in a significant reduction in pre-trial detention rates, and that they produce disparate outcomes for different racial groups. The US-based NGO Partnership on AI has found that AI risk assessment tools currently being used in the United States are unfit for use in pre trial assessments, and it has recommended that policymakers cease the deployment of risk assessment tools until such time that the challenges affecting such tools have been adequately addressed.41 The adoption of pre-trial risk-assessments tools in the United States has largely been driven by the desire to address high imprisonment rates in the country by making pre-trial decision-making fairer. In particular, these tools have been promoted as an alternative to cash bail – a system often criticised for disadvantaging poorer defendants and worsening social injustices.42 Cash bail is a relatively rare concept in the EU, but there are concerns about the quality of pre-trial detention decisions in many Member States, which have been criticised for failing to carry out case-specific reviews and fully consider alternatives to detention.43 We are currently unaware of any attempts in EU Member States to introduce algorithmic risk assessments to supplement or replace existing pre-trial decision-making processes. However, it is possible that risk-assessment tools will also be recommended as a solution to address the pre-trial detention challenge in Europe, especially given that many of these tools are developed by private companies that actively market their products to governments and local police forces. Risk-assessment tools are usually designed to assess the likelihood of re-arrest, and/or of failure to turn up to court after being released based on the profiles of the defendant. Based on these assessments, risk assessment tools either assign risk levels to defendants, or they provide direct advice to decision-makers on whether or not the defendant should be released. There is only limited research about the extent to which pre-trial risk-assessment tools influence judges’ decisions in practice,44 but concerns have been raised about the ability of AI systems to recommend detention at all.45 There is a risk that recommendations made by AI systems to detain individuals compromise the presumption of release. This is a particularly valid concern in light of research suggesting that decision-makers have a tendency to err on the side of caution when they are ‘advised’ by AI systems, and that they have a greater propensity to override risk assessment tools to detain, rather than release defendants.46 Pre trial detention should always be a measure of last resort, and no risk-assessment can be regarded as human rights compliant, unless it recommends its users to consider detention as a measure of last resort, after all other alternatives have been fully considered. Pre-trial risk assessment tools in the United States and elsewhere have also been criticised for (unintentionally) over-estimating risks, because of the nature of the data used to train its algorithms. Pre-trialrisk assessment tools typically rely only on data regarding individuals who have been released, and they ignore those who were detained, but would have otherwise ‘succeeded’ by not being arrested, and by appearing in court.47 In other words, algorithms are based on the assumption that individuals who have been detained by courts in the past have been rightfully deprived of their liberty. Any AI system developed to assist pre-trial detention decision-making must be designed to give effect to the presumption in favour of release. This means that risk-assessment tools need to be deliberately calibrated to generate outcomes that favourable to the defendant. Data used to train the AI system should be carefully scrutinised so that it reflects the inevitable fact that a significant proportion of individuals in pre-trial detention have been deprived of their liberty in violation of their human rights. Studies of pre-trial risk-assessment tools used in the United States cast doubt on their effectiveness at reducing pre-trial detention rates, and their ability to make accurate predictions of risks. A study in Kentucky, for example, found that the likelihood of defendants being released within the first three days of their arrest went down after the risk-assessment tool was deployed, and that there were no significant changes in the number of re-arrests and failure-to-appear rates amongst defendants released on bail during the same period.48 This was the case even after the risk-assessment tool was modified post-deployment to improve the accuracy of predictions. Another study has found that the COMPAS risk-assessment tool is no better at predicting the likelihood of defendants reoffending than non-expert human volunteers.49 These studies do not necessarily prove that AI systems are incapable of reducing pre-trial detention rates at all, but they do raise questions about their usefulness, and they strongly challenge claims that algorithmic risk-assessment tools help to improve the quality of pre trial detention decisions. They also highlight the need for post-deployment testing and monitoring of AI systems, to ensure that they have the desired effect of ensuring that individuals are detained only as a measure of last resort. Post-trial assessment systems are also being increasingly used, for purposes such as assisting with sentencing decisions or prisoner release. In England and Wales, the Prison and Probation Service has developed and operates the Offender Assessment System (OASys), an automated risk-assessment tool.50 It assesses the risk of harm offenders pose to others and how likely an offender is to reoffend, as well as assessing offender needs. These risk assessments are used to decide ‘interventions’ and to influence the sentence plans given to offenders.51 Millions of these assessments have been carried out.52 The system collates information on offenders’ previous offences, education, training, employment, alcohol and drug misuse; as well as their ‘attitudes’, ‘thinking and behaviour’, ‘relationships’, and ‘lifestyle’.53 This data is used alongside the individual’s offending record and ‘offender demographic information’ to inform two predictive algorithms: OASys General Reoffending Predictor (OGP1) and OASys Violence Predictor (OVP1).54 A 2014 National Offender Management Service analysis found that the OGP1 and OVP1 generated different predictions based on race and gender. They found that relative predictive validity was better for white offenders than for Asian, black, or mixed ethnicity offenders. The Offender Group Reconviction Scale (OGRS) is another algorithmic risk assessment tool, which is used in England and Wales to assess and predict an offender’s likelihood of reoffending.55 The OGRS algorithm uses data on the individual’s official criminal history, as well as their age and gender, to produce a risk score between 0 and 1 of how likely an offender is to reoffend within one or two years. The use of these AI systems in a post-trial setting, and the documented differences in predictive outcomes based on, among other factors, race, highlight the clear need for strict testing and monitoring of such systems. These systems used in a post-trial setting could very easily be transferred to a pre-trial risk assessment setting; the principles and aims of these systems and the data used are very similar. For example, the COMPAS system, mentioned above and considered in more detail below, was originally designed as a recidivism risk assessment tool, and is also used as a pre-trial risk assessment tool. 56 Where AI systems inform decisions on the deprivations of liberty, they should be calibrated to generate outcomes that favour release, and they should not facilitate detention other than as a measure of last resort. AI systems must be subject to rigorous testing to ensure they have the desired effect of reducing rates of pre-trial detention rates. AI systems should be designed to be non-discriminatory One of the most frequent criticisms of AI systems and their use in criminal justice systems is that they can lead to discriminatory outcomes, especially along racial and ethnic lines. The best-known example of this is a study by the US media outlet ProPublica into COMPAS, a risk assessment tool designed to predict the likelihood of reoffending in Broward County in Florida. ProPublica found that COMPAS was 77% more likely to rate black defendants as ‘high-risk’ than white defendants, and it was almost twice as likely to mislabel white defendants as lower risk than black defendants.57 The dangers of the failure to adequately regulate the use of AI to prevent discrimination have also been witnessed in Europe. The ‘Crime Anticipation System’ (‘CAS’), a predictive policing software being used across the Netherlands, was initially designed to consider ethnicity as a relevant factor for determining the likelihood of a crime being committed. Amongst the indicators used by CAS to predict crimes in a particular area was the number of ‘non-Western allochtones’ in the area – in other words, ‘non-Western’ individuals with at least one foreign-born parent.58 The software not only presupposed the existence of a correlation between ethnicity and crime, but also singled out a category of ethnicities to be of particular concern, given that the presence of ‘Western’, ‘autochtone’ individuals were not used as indicators. Furthermore, given that ‘Western’ was defined somewhat subjectively (for example, including individuals of Japanese or Indonesian origin, and including all European nationalities, apart from Turkish), CAS incorporated highly questionable societal categorisations and biases. In the United Kingdom, a major criticism of HART has been that it included data collated and classified by a private company for marketing purposes that could very easily to biased outcomes. HART relied on the ‘Mosaic’ code developed by a consumer credit reporting company, that categorised individuals into various groups according to inter alia their ethnic origin, income, and education levels. It was of particular concern that some socio-demographic categories used by Mosaic were blatantly racialised, including, for example, ‘Asian Heritage’, which stereotyped individuals of ‘Asian’ origin as being unemployed or having low-paid jobs, and living with extended families.59 In Denmark, an automated algorithmic assessment has been used to classify different neighbourhoods, based on criteria such as unemployment, crime rates, educational attainment, and other ‘risk indicators’, as well as whether the levels of first and second-generation migrants in the population is more than 50%. Neighbourhoods which meet these criteria are classified as ‘ghettos’. These neighbourhoods are then subject to special measures, including higher punishments for crimes.60 It is clearly discriminatory, as well as entirely unfair, for people living in certain areas to be punished more severely than others in different areas for the same crimes. Further examples of criminal justice AI which have been identified as producing discriminatory outcomes include the previously mentioned OASys, NDAS and the Gangs Matrix in the UK, and the Netherland’s ProKid 12. These examples illustrate the need for regulations to ensure that AI systems are designed to be non discriminatory, and to exclude categorisations and classifications that deepen and legitimise social biases and stereotypes. However, policy makers should not assume that making AI systems blind to all protected characteristics will always help to produce non-discriminatory outcomes. In certain scenarios, the removal of protected characteristics from the data could worsen discrimination. For example, it has been suggested on the basis of research into COMPAS in the United States, that excluding gender as a variable for risk assessments would fail to reflect a well-established statistical fact that in most countries, women are less likely to reoffend than men.61 Making COMPAS gender blind would unfairly and inaccurately assume women to be as equally likely to reoffend as men, and discriminate against them by overestimating their risk scores. Removing visible biases from AI systems cannot be the sole or primary solution to their discriminatory impact, because AI systems can be biased even if they have not been deliberately designed in that way. Bias is often unintentional, and even if the AI system appears on the surface to be neutral, their algorithms can lead to discriminatory assessments and outcomes. COMPAS, for example, does not include race or ethnicity as a variable, yet research has found that it consistently gives black defendants higher risk scores than their white counterparts, making them less likely to be released from detention.62 Hidden biases can arise in AI systems in numerous ways. Although a comprehensive analysis of how they can cause unintentional biases are beyond the scope of this paper,63 the way in which AI systems are themselves created and built illustrate the difficulty, complexity, and sometimes impossibility, in preventing discriminatory outputs and effects of AI systems. There are fundamental issues with the way AI systems are designed and created which can lead to bias. Where the AI system is based on machine-learning, biases can result from faults in the data that is used to train its algorithms. Machine learning systems ‘learn’ how to make assessments or decisions on the basis of their analysis of data to which they have previously been exposed. However, the data used to train a machine learning system might be incomplete, inaccurate, or selected for improper reasons, and this could lead to AI systems producing unwanted outcomes. What amounts to appropriate, good quality data for the purpose of training algorithms depends on what the machine learning system is being designed to do,64 so it might not always be obvious which dataset is needed to train algorithms to be non-discriminatory. AI designed or created for use in the criminal justice system will almost inevitably use data which is heavily reliant on, or entirely from within, the criminal justice system itself, such as policing or crime records. This data does not represent an accurate record of criminality, but is merely a record of policing – the crimes, locations and groups that are policed within that society, rather than the actual occurrence of crime. The data might not be categorised or deliberately manipulated to yield discriminatory results, but it may reflect the structural biases and inequalities in the society which the data represents. Where there are discriminatory policing patterns targeting certain demographics, or the systematic under-reporting and systematic over-reporting of certain types of crime and in certain locations,65 the use of such data merely results in a reinforcing and re-entrenching of those inequalities and discriminationin criminal justice outcomes. For example, according to UK crime data, black people are over 9 times more likely to be stopped and searched than white people,66 and black men are more than 3 times more likely to be arrested than white men.67 Despite these statistics, NDAS (mentioned above) in the United Kingdom explicitly relies on stop and search data to determine an individual’s propensity to commit a criminal offence. The fact that stop and search is disproportionately used against black people means that there will inevitably be an overrepresentation of black people in NDAS and that their risk levels will be inflated in comparison to white people. Comparable statistics on stop and search are not available in most EU Member States, where the official collection of racially disaggregated criminal justice data is either forbidden by law, or not standard practice. However, recent studies show that racially biased policing practices are prevalent throughout the EU. Data collected from a survey by the Fundamental Rights Agency, for example, has shown that during a 5-year period, 66% of individuals of Sub-Saharan African origin in Austria, and over half of respondents of South Asian origin in Greece were stopped and searched.68 AI built on data embedded with such biases and used to assist, inform, or make decisions in the criminal justice system, can expand and entrench the biases represented in the data.69 When AI systems result in criminal justice outcomes which repeat the discrimination inherent in the historic data, such as targeting individuals from a particular demographic, that decision will itself be preserved in the data. This leads to self-perpetuating ‘feedback loops’ which reinforce patterns of inequality.70 Another way in which AI systems can produce unintentional biases is by way of proxies. Data used by AI systems might be classified in seemingly legitimate ways, but those classifications can sometimes act as proxies for protected characteristics. A common example used to illustrate this point is how home addresses or postcodes can be proxies for race or ethnicity.71 Certain AI systems, such as HART, were initially trained to find correlations between home addresses and the risk of reoffending – in other words, to identify which postcode areas have ‘higher-risk’ residents than others.72 This approach overlooks the fact that there is very pronounced ethnic residential segregation in many countries,73 making it highly probable in practice, for AI systems to inadvertently establish a link between ethnic origin and risk. Roma are especially vulnerable to this form of proxy discrimination, given that in many EU Member States, Roma are reported to live primarily in segregated areas inhabited mostly or exclusively by Roma.74 There are several ways in which AI systems can be designed to mitigate the risks of discrimination, including by identifying and excluding data classifications that act as proxies for protected characteristics.75 However, it can be difficult in practice to identify which variables are proxies for protected characteristics (and how they do so), and removing too many ‘offending’ variables might result in the AI system losing much of its functional utility.76 There is no one-size-fits-all method of ensuring that AI systems do not produce discriminatory outcomes. Different approaches to de-biasing AI systems can conflict with one another, and the suitability of a particular de-biasing method might depend on the AI tool itself, and the legal and policy context in which it is designed to operate.77 Biases in AI systems are often not easy to detect and, in many cases, it might also be difficult to pinpoint flaws either in the system itself, or in the training data that has been caused the bias. The structural bias within the data that AI systems are built and operated on, a bias which is particularly deep-rooted in criminal justice data, is a fundamental issue, and one which is likely to result in AI systems being fundamentally inoperable – both because the bias makes them morally and ethically inoperable, if not yet legally, and because any attempts to remove the bias will make the data to operate these systems unusable. Fair Trials’ view is that the only effective way in which AI systems can be regarded as non discriminatory is if they have been subject to rigorous independent testing for biases. These tests must be mandated by law, must be independently run, have clearly stated aims or objectives, and be carried out pre-deployment to reduce the likelihood of individuals being affected by discriminatory profiling and decisions. AI can be tested in advance of deployment by using test data – datasets which are either synthetic datasets,78 or by using historic data with permissions – running it through an AI system, and analysing the outputs.79 For example, a trial of retrospective facial recognition video analysis is being run by a police oversight Ethics Committee in the UK. The trial is using historic data – CCTV footage – as the basis for simulated investigations in a controlled environment, monitored by researchers. The trial has clearly stated aims and signifiers of success, and all outcomes will be examined. There are significant human rights, data protection and ethical concerns involved with this particular technology, including the right to privacy, and the testing is not being conducted independently as it should be but, as above, there are positive aspects of the testing methodology.80 An alternative could be to ‘test’ a system in a strictly academic sense by running it alongside actual criminal justice processes, but with the system not having any effect on decision-making, and analysing the system’s proposed decisions or outcomes for bias. AI should never be used or even ‘tested’ in real-world situations where they have actual effects on individuals or criminal justice outcomes, before they have been tested. These types of tests also need to be carried out in the broader context of an AI governance framework that not only analyses the potential impact of the AI system pre-deployment, but also continues to monitor its impact afterwards. If these tests are not carried out, and/or if an AI system cannot be proven to be non-discriminatory, it should be legally precluded from deployment. However, as explained in the final section of this paper, it is questionable whether such tests are feasible in many Member States, where local laws prohibit the collection of racially-disaggregated data. AI systems should be developed to generate non-discriminatory outcomes, ensuring that suspects and accused persons are not disadvantaged, either directly or indirectly, on account of their protected characteristics, including race or ethnicity. AI systems should be subject to mandatory testing before and after deployment so that any discriminatory impact can be identified and addressed. If an AI system cannot be proven not to generate discriminatory outcomes, it should not be used. AI Systems need to be transparent and explainable AI systems can have a significant influence over criminal justice decisions, and they should be open to public scrutiny in the same way that all decision-making processes by public entities should be. However, a common criticism of many AI systems is that they lack transparency, which often makes it difficult, if not outright impossible, to subject them to meaningful impartial analysis and criticism. This lack of transparency is both as a result of deliberate efforts to conceal the inner workings of AI systems for legal or profit-driven reasons, and of the nature of the technology used to build AI systems that is uninterpretable for most, if not all humans. There are several reasons why it is necessary for AI systems to be transparent. Firstly, transparency is essential for strengthening confidence of both primary users of the system, as well as the general public, in AI systems. Democratic values demand that the public needs to be aware of how powerful public institutions, such as the police and the judiciary, operate so that they can be held accountable for their actions. It is also crucial for primary users of AI systems to understand how they work, so that they can make informed decisions about how much influence they should have on criminal justice decisions. Secondly, decisions made by AI systems need to be contestable at an individual level. Standards on the right to a fair trial and the right to liberty demand that defendants should have access to materials that inform decisions regarding them, so that they can challenge the accuracy and lawfulness of those decisions. Transparency also acts as a safeguard against bias and inaccuracies. It is difficult to imagine how issues that undermine the fairness and accuracies of AI systems (such as racial biases) can be detected, and ultimately fixed, if they cannot be properly accessed and analysed. As explained above, certain AI systems, such as CAS, have been found to have serious, but very obvious, flaws. In CAS’s case, however, the fault in the software could be detected easily, which meant that the discriminatory impact of the tool could be mitigated. The indicator for ‘non-Western allochtones’ in CAS was removed in 2017,81 ostensibly because it served no useful purpose, but presumably also because of the very obvious bias. This mitigation was possible because CAS is a transparent software, that was developed in-house by the Dutch police. The types of indicators used to predict crime were made openly available, and information about the method by which the software made predictions could easily be accessed and understood.82 This, however, is not the case for all AI systems, because AI systems are often developed by for-profit companies with little to no meaningful input from the public. As such, details of how they are designed, and how they make decisions and assessments are, in many cases, closely guarded as trade secrets that are protected by law.83 Often, AI systems are ‘black boxes’ because they are deliberately kept that way. While it is accepted that strong, enforceable intellectual property laws are needed to promote advancements in what is a very dynamic field of scientific research and innovation, it is not acceptable that these concerns trump the rights of individuals suspected or accused of crimes. In light of this, it is concerning that the Commission’s White Paper focuses on, and strongly promotes, the concept of a ‘partnership between the private and the public sector’ in relation to AI.84 Fair Trials appreciates that effective public-private collaboration could help to fill in gaps in public sector expertise and capacity for the development of AI systems, but given the transparency challenges, it is essential thatsuch partnerships are accompanied by robust regulations and rules that ensure effective and open scrutiny. However, even if AI systems are completely exposed to public scrutiny, and their source code85 and input data, for example, are openly disclosed, there is still no guarantee that they will be sufficiently transparent to enable adequate independent scrutiny. AI systems can be black boxes by nature of the technology that makes their decision-making processes complicated beyond comprehension for most (in some cases, too complicated even for computer scientists to understand).86 This is especially the case where AI systems are based on machine-learning algorithms. One possible reason for the unintelligibility of AI systems is that they sometimes use machine-learning algorithms that are simply too complex to be understood to a reasonable degree of precision.87 This is especially the case where AI systems incorporate ‘Deep Neural Networks’ – a machine-learning algorithmic architecture inspired by the structure and mechanics of human brains. Rather than relying on a set of man-made instructions, these types of AI systems make decisions based on experience and learning. Decision-making processes of this kind have been described to be ‘intuitive’, because they do not follow a defined logical method, making it impossible to analyse the exact process by which a particular decision is reached.88 It has also been suggested that some AI systems are uninterpretable to humans because the machine-learning algorithms that support them are able to identify and rely on geometric relationships that humans cannot visualise. Certain machine-learning algorithms are able to make decisions by analysing many variables at once, and by finding correlations and geometric patterns between them in ways that are beyond the capabilities of human brains.89 Given these challenges, there is widespread recognition that states should require AI systems to not only be ‘transparent’, but also explainable and intelligible.90 GDPR already recognises that individuals should have the right to an explanation of how a decision was reached, if they have been subject to an automated decision.91 In principle, this is an essential and very useful requirement, but it is also one that seems difficult to implement in practice, given that both ‘explainability’ and intelligibility are highly subjective concepts. Arguably, AI systems’ computing processes are inherently difficult to explain and understand for most people, including for most criminal justice decision-makers, but this surely should not be the sole basis for oversimplifying the technology, or for banning the use of AI outright. Computer scientists have been theorising different ways of ensuring that decisions made through complex algorithms can be explained and understood. An example is the ‘explainable AI’ movement (‘xAI’) that aims to build AI systems that can show more discernible links between inputted data and decisions. xAI systems measure how each input influences the final decision, so it is possible figure out how much weight is given to each input.92 This seems to be an innovative response to the ‘black box’ challenge, establishing clearer, more helpful relationships between inputs and final decisions. However, it appears to fall short of explaining what happens between data being inputted into the system and the final decision, and it does not enable users to impute any logic to the decision-making process.93 As explained above, there are various reasons why AI systems need to be transparent and intelligible, but the effective of exercise of the rights of the defence must be recognised as a crucial test for determining whether an AI system is sufficiently explainable and intelligible. AI systems have to be designed in a way that allows criminal defendants to understand and contest the decision made against them. Partnership for AI has suggested that a central factor that determines the contestability of AI systems is the possibility of carrying out an audit trail of the AI decision.94 In particular, it has to be possible for an auditor to follow and reproduce the process and come to the same conclusion reached by the AI system at the end. Furthermore, as explained in further detail below, criminal justice procedures should require the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings, and this disclosure should be in a form which is understandable to a layperson, without the need for technical or expert assistance. AI systems need to be transparent and explainable, so they can be understood and scrutinised by their primary users, suspects and accused persons, as well as the general public. Commercial or proprietary interests, or technical concerns, should never be a barrier to transparency. AI systems must be designed in a way that allows criminal defendants to understand and contest the decision made against them. It should be possible to carry out an independent audit, and processes should be reproducible. Part 2: Safeguards for the use of AI Systems in Criminal Proceedings AI systems have to be built in accordance with human rights principles, and to give effect to human rights in practice, but it is unlikely that their design alone will guarantee that they are used in ways that comply with human rights. Regulatory frameworks for the design and deployment of AI systems have to be accompanied by appropriate legal safeguards that ensure they are used responsibly and lawfully. There are two primary questions that need to be addressed: 1) how procedural rules ensure that decision-makers do not over-rely on AI systems; and 2) how decisions and assessments made by AI systems can be analysed independently and challenged. Combatting ‘Automation Bias’ and Reinforcing Meaningful Human Input One of the main challenges of automated, or semi-automated decision-making systems is that of ‘automation bias’ – the tendency to over-rely on automation in ways that can cause errors in decision making. Automation bias occurs primarily due to the perception that automated decision-making processes are generally trustworthy and reliable. Automated cues have been found to be particularly salient to decision-makers, and research has shown that users of automated decision-making systems have a tendency to place greater weight on automated assessments over other sources of advice.95 The disproportionate influence of automated systems can undermine the quality of decision-making, by discouraging its users from consulting a wider range of factors that could inform more accurate decisions. Most AI systems currently being used to assist criminal justice decision-making do not completely replace human decision-making. They are instead designed and deployed to be used as decision aids, whose outputs are factored into consideration for the purposes of human decision-making. The phenomenon of automation bias however, raises questions about whether AI systems are being used in reality in accordance with their intended purpose as decision aids, and not as de facto replacements for human decision-making processes. There is strong evidentiary basis for automation bias amongst pilots who, like judges and other decision-makers in criminal justice proceedings, have typically been through a high level of training to make appropriate decisions in highly complex settings.96 However, limited research into automation bias amongst judges suggests that AI systems might have a more complex impact on judges’ behaviour. For example, a study conducted in 2019 in Kentucky seems to suggest that the degree to which judges rely on predictive tools for pre-trial detention decision-making could be influenced by the ethnicity of the defendant.97 The research indicates that judges had a greater tendency to rely on algorithmic risk assessments where the defendant was white, whereas in cases where the defendant was black, judges were more likely to overrule the risk-assessment in favour of detaining them. This study appears to show that AI systems can influence judges’ behaviour in unpredictable ways, especially where there are interactions or conflicts between automation and human biases, and that AI systems might be an ineffective tool for challenging human prejudices. It is crucial that rules governing the use of AI systems in criminal proceedings actively try to counter automation bias, and to encourage decision-makers to make independent determinations. A simple requirement to have a human decision-maker ‘in the loop’ or to have a human decision-maker review or check the automated decision is insufficient, because this risks overestimating the capacity or willingness of human decision-makers to question and overrule automated decisions. A mere requirement to have an automated decision reviewed by a human, on its own, could reduce the human review into a rubber-stamping exercise which, in practice, is no oversight at all. In recognition of this challenge, the European Data Protection Board has recommended that in order for decisions to be regarded as not ‘based solely’ on automated processing for the purposes of Article 22 GDPR, there has to be ‘meaningful’ human oversight, rather than just a token gesture.98 What qualifies as ‘meaningful’ intervention is open to interpretation, and it is likely to differ depending on the circumstances and the type of decision being made. In the context of criminal justice procedures, where decisions often have particularly severe and far-reaching implications for individuals’ rights, safeguards for ensuring meaningful human intervention have to be especially robust. Procedural safeguards that ensure ‘meaningful’ human oversight Rules governing the use of AI systems in criminal justice proceedings have to counter automation bias by encouraging human decision-makers to treat their processes with scepticism, and to force them to challenge and scrutinise the outcomes of algorithmic assessments. Procedural safeguards that can be put in place to tackle automation bias include: a) making it a legal requirement for decision-makers to be adequately alerted and informed about the risks associated with AI systems; b) making AI systems’ assessments intelligible to decision-makers; c) requiring decision-makers to provide full, individualised reasoning for all decisions influenced by an AI system; and d) making it easier for decision-makers to overrule AI assessments that produce unfavourable outcomes for defendants. One way of ensuring that automated assessments and decisions do not have undue influence on judicial decisions might be to ensure that decision-makers are sufficiently informed and alerted about the risks of relying on AI systems. This seems to be the approach taken by the Wisconsin Supreme Court in the United States in the case of Loomis,99 in which the Court considered whether or not the use of the COMPAS risk assessment tool for sentencing purposes violated due process rights. The judgment in Loomis recognises the importance of procedural safeguards as a way of safeguarding fairness of decisions, by requiring the use of ‘written advisements’ to alert decision-makers about the potential risks of AI risk assessments. Specifically, the court mandated that these advisements had to include warnings that: a) the process by which the COMPAS produces risk scores were not disclosed due to its ‘proprietary nature’; b) the accuracy of risk scores are undermined by the fact that COMPAS relied on group data; c) the risk-assessment tool had never been tested locally for accuracy; d) ‘questions’ have been raised about the discriminatory effect of COMPAS risk-assessments; and e) COMPAS was developed to inform post-sentencing decisions, but not sentencing decisions themselves. These warnings are clearly very specific to COMPAS and the context in which it is used in Wisconsin. If similar safeguards were adopted in different contexts and with regard to different AI systems, advisements will no doubt need to be adapted. The warnings used in Loomis have, however, been criticised because they do not give enough information to decision-makers to enable them to appreciate the degree to which these risk-assessments should be discounted.100 In particular, the advisements are silent on the strength of the criticisms against COMPAS, and they say nothing about the basis on which questions about their discriminatory effect have been raised.101 These warnings also give no indication about likely margin of error of the assessment, so although judges are informed that some assessments might be inaccurate, they are not in a position to appreciate how serious or frequent these errors might be. ‘Advisements’, or warnings that encourage decision-makers to be sceptical of AI systems cannot be considered as effective safeguards, unless they contain sufficiently helpful information for decision makers. However, even if judges are given stronger warnings than those in the Loomis advisements, it is still doubtful whether they alone will adequately mitigate automation bias. One reason for this is that many criminal justice decisions (such as pre-trial detention decisions) are, in practice, made very routinely by judges. Although written advisements might initially help judges think more critically about automated risk assessments, over time, these advisements could become repetitive and routine, and lose much of the intended meaning and effect.102 An effective safeguard that could work in conjunction with mandatory warnings could be for decision makers to be given a better insight into how AI systems produce a particular assessment or calculation. As mentioned above, the lack of information about how assessments are made by AI systems makes it harder for criminal defendants to scrutinise and challenge them. Surely, this has to be true also for decision-makers. It is much harder, if not impossible, to analyse and criticise decisions if there is no reasoning behind them. While AI systems do not rely on ‘reasoning’ per se, information given to decisions about how a specific assessment was made, including what factors were relevant, and how much weight was given to each factor could give decision-makers more confidence to decide whether to agree or disagree with an AI-generated decision. Decisions or assessments made by AI systems cannot be the sole basis of criminal justice decisions – they should be no more than a factor that can influence human-decision making. As such, decision makers should be required to show that decisions were influenced by a broader range of factors other than the AI system, by way of fully reasoned, case-specific, written decisions. Research has shown that the lack of case-specific reasoning in pre-trial detention decisions is already a serious challenge in many EU Member States,103 and AI systems risk worsening the standardisation of such decision making processes. Where AI systems are used to inform pre-trial detention decisions, or any other criminal justice decision that has a significant impact on the rights of the defendant, reasoned decisions must be specific to the defendant’s case, and in particular, they must reveal what which factors influenced the decision, and to what degree. In particular, decisions have to make it clear how much weight was given to assessments by AI systems. It is also crucial that decision-makers are able to override decisions made by AI systems, and that they are confident about doing so where the tool produces assessments or recommendations that are unfavourable to the defendant (e.g. where the AI system advises against releasing the defendant). It has been reported that members of the police force in Avon and Somerset Police in the United Kingdom are expected to record incidences where they have disagreed with assessments made by a predictive policing tool, and to explain their reasons for the disagreement.104 This is likely to act as a strong disincentive for overriding decisions made by the AI system, and as such, it actively facilitates automation bias. Furthermore, it seems to interfere with the presumption of innocence by making it difficult for decision-makers to override AI systems to make decisions that favour the defendant. If an AI system recommends the arrest or the detention of an individual, decision-makers should feel that they have a genuine choice of overruling the AI system, and not be pressured into compliance. Criminal justice decision-making processes should, as a general rule, be skewed in favour of the defence to give effect to the presumption of innocence, and rules governing the use of AI systems should favour favourable outcomes for defendants. On the other hand, in cases where a decision-maker acts against the advice of an AI system that recommends a favourable outcome for the defendant, there should be a requirement for reasons to be given for their decision. This is to prevent unfavourable outcomes for defendants that are motivated by improper reasons, and to mitigate the risk of unconscious bias. Challenging AI in criminal proceedings AI systems need to be contestable by criminal defendants. This is so that they can not only challenge the outcomes of the AI systems’ calculations and analyses, but also scrutinise the legality of their use. In other words, being able to challenge AI systems in criminal proceedings is not only a procedural fairness requirement for defendants, it is also a means by which legal standards governing AI systems and their use can be enforced. One of the major issues preventing the sufficient contestability of AI systems in criminal proceedings is the lack of notification. If an individual is not notified that they have been subject to an automated decision by an AI system, they will not have the ability to challenge that decision, or the information that the decision was based on. For example, in the United Kingdom, the Data Protection Act 2018 sets out the applicability of the GDPR and sets out the UK’s interpretations of the GDPR’s requirements and safeguards. However, section 14 of the Data Protection Act significantly dilutes the requirements of Article 22 of the GDPR, permitting purely automated decisions which have legal or similar significant effects on a data subject, without their consent, as long as the data subject is subsequently notified that a purely automated decision has been taken about them, after the decision has been made. It is only then that the data subject has the opportunity to request a new decision. However, it has been reported that individuals subject to decisions by the HART system in the UK are not notified at all that they have been subject to such an automated decision, even after it has been made.105 This is likely because under the Data Protection Act 2018, automated decisions which have legal or similar significant effects on a subject are not necessarily classified as ‘purely automated’ if a human has administrative input. In order to meet this requirement, the human input can be as minimal as checking a box to accept the automated-decision, even if it has a significant impact on an individual, such as holding them in custody. This minimal requirement for human requirement means that, in practice, decisions made with negligible to no meaningful human input can be classified as not “purely automated” and there is no legal requirement to notify and ability to request a new decision. In this way, systems such as HART continue to be used, with people subject to their decisions completely uninformed. While the GDPR already requires the notification of individuals affected by automated decisions, the UK’s experience with HART highlights the need for stricter rules to not only ensure meaningful human input (as mentioned above), but to also strengthen the individual’s right to be notified. There must be a requirement for individuals to be notified, not just for “purely automated” decisions, but whenever there has been an automated decision-making system involved, assistive or otherwise, that has or may have impacted a criminal justice decision. This notification should include clear and comprehensible information about the decision that has been taken, how that decision was reached, including details of the information or data involved in reaching that decision, what the result or outcomes of the decision are, and what effects, legal or otherwise they have, and information on how to challenge that decision. As discussed in the previous section, a further major barrier to the contestability of AI systems is a technical one. The ‘black box’ nature of certain AI systems can be largely attributed to their design, so it is important that there are rules governing the interpretability of these systems so that when they are in use, their processes can be understood at all. However, there are also legal barriers to the full disclosure of AI systems, which are often put in place to protect commercial interests. Procedural safeguards play a particularly important and effective role in addressing these types of opacity challenges. Transparency is a fundamental aspect of an adversarial process that underpins the right to a fair trial, and human rights standards require that as a general rule defendants should be given unrestricted access to their case-file,106 and to be given the opportunity to comment on the evidence used against them.107 These standards are further reinforced by Directive 2012/13/EU,108 which requires Member States to grant access to all material evidence in possession of the competent authorities to the defence to safeguard the fairness of the proceedings and to enable defendants to prepare their defence.109 The procedural requirement of an adversarial process is not one that is limited to substantive criminal proceedings – it also applies in the context of pre-trial decision-making processes, especially for decisions on the deprivation of liberty.110 While EU law and international human rights law also recognise that there might be certain justifications for non-disclosure of materials used against the defendant in criminal proceedings, these are narrow restrictions, and commercial interests are not regarded as a valid justification for non-disclosure.111 Furthermore, EU law does not explicitly recognise any derogations from the right of access to materials that are essential to challenging the lawfulness of an arrest or detention.112 In order for Member States to comply with these standards, any exceptions to the disclosure of information regarding AI systems have to be applied very narrowly. Barriers to scrutiny and accountability of AI systems are not only legal, but also technical. As explained in previous sections, many AI systems suffer from interpretability issues because of their design and by the nature of the machine-learning technology upon which they rely. In the absence of specific expertise on AI, it is difficult to imagine how, in practice, defendants and their lawyers will be able to challenge AI systems. One possible solution to this challenge, as explained below, is training for defence lawyers – but it is unreasonable to expect lawyers to develop expertise that would enable them to analyse and scrutinise AI systems at a technical level. A further solution could be that defence lawyers have access to the relevant expertise from suitably qualified professionals. However, in reality, not all criminal suspects and accused persons are able to access the legal and other technical assistance needed to understand and challenge technically complex AI systems, for financial or other practical reasons. It would also be unreasonable and unrealistic to require all suspects and accused persons to engage technical expertise just to be able to understand how an AI system makes a decision, especially where AI systems are used routinely or mandatorily to make or assist criminal justice decisions. It might seem unreasonable to expect all highly technical evidence to be challengeable by lay defendants without the help of a suitable expert. However, AI systems are not necessarily used in criminal proceedings as ‘evidence’, and in practice they could be an integral part of a decision-making process, or even a replacement for it. As such, it is essential that the ‘reasoning’ of AI systems are made known to suspects and accused persons, similarly to how judicial decisions must contain “sufficient reasoning and address specific features of a given case”, especially where they concern the deprivation of liberty.113 Decision-making processes of AI systems and the way in which it has produced an outcome in a particular case should thus be disclosed to suspects and accused persons, in a form that is intelligible to a layperson. Individuals should not need to rely on experts to simply understand how a decision affecting them was made. While there will inevitably be scenarios where defendants would need expertise to challenge an AI-assisted decision, but these cases should be the exception, rather than the norm, for whenever an AI system is used. Criminal justice procedures should require the notification to suspects and accused persons where an AI system has been used which has or may have impacted a decision made about that individual. Procedures should enable the full disclosure of all aspects of AI systems that are necessary for suspects and accused persons to contest their findings. Disclosure should be in a form which is comprehensible to a layperson, without the need for technical or expert assistance, and suspects and accused persons should also be given effective access to technical experts who can help to analyse and challenge otherwise incomprehensible aspects of AI systems. Training AI systems use technology not well understood by many people. Without proper training, outputs of AI systems might not be easy to interpret, and it might be difficult to appreciate which factors undermine the reliability of AI systems, so that appropriate weight can be attached to their findings. As mentioned above, decision-makers can be warned about the weaknesses of AI systems as part of their decision-making process, but the effectiveness of this safeguard can be questioned, because it is unlikely to provide decision-makers with all the information they need, and there is no guarantee that the warnings will be taken seriously in all cases. Training is not just needed for the primary users of AI systems, such as judges and police officers who use them to inform their own decisions. The training must also be available criminal defence lawyers, so that they are in a better position to challenge AI systems, where necessary. If AI systems are used routinely to aid criminal justice decisions or even made mandatory (as is the case in certain states in the United States), there would be strong justification for governing bodies to make training on AI mandatory for criminal justice practitioners. Part 3: Governance and Monitoring Criminal justice processes are an important enforcement mechanism for ensuring that AI systems are designed and used lawfully, but they cannot be the sole, or even the primary means of implementing legal and ethical standards. Of equal, if not greater importance is a framework that ensures that policy decisions on the design and deployment of AI systems are made in systematised way, and that unlawful or harmful AI systems never enter into public service. Member States that deploy AI systems for criminal justice purposes should have regulatory mechanisms that are fit for purpose. At a minimum, these should include frameworks for: a) pre-deployment impact assessments; b) post deployment monitoring and evaluations; and c) collection of data needed for effective comparative analysis. Pre-Deployment Both the GDPR and LED recognise the need for AI systems to be analysed before they are deployed, so that they comply with existing regulatory and human rights standards. Under Article 35 GDPR, Member States are required to carry out a ‘Data Protection Impact Assessment’ (‘DPIA’) for data processing systems that carry out ‘a systematic and extensive evaluation of personal aspects relating to natural persons which is based on automated processing, including profiling and on which decision are based that produce legal effects concerning the natural person or similarly significantly affect the natural person’. The corresponding provision in the LED is Article 27, which similarly calls for DPIAs to be carried out where processing of data is likely to result in a ‘high risk to the rights and freedoms of natural persons’. DPIAs under both laws have to carry out inter alia an assessment of the possible impact of the data processing system on the rights or individuals, and they need to mention what measures will be in place to ensure that their rights are properly protected. DPIAs help to address a serious accountability challenge, but EU laws do not provide sufficiently helpful standards on how they should be conducted. Article 27 LED does not lay down minimum requirements for how DPIAs should be carried out. On the other hand, there are aspects of Article 35 GDPR which, if used to guide how DPIAs should be conducted for AI systems used in criminal justice, would raise concerns. The foremost challenge is the level of transparency mandated by the GDPR. DPIAs are envisaged largely as internal processes led by the data controller, who may seek the opinions of data subjects (such as members of the public or their representatives), where it is ‘appropriate’ to do so. The GDPR also explicitly recognises that the requirement to seek the views of data subject is ‘without prejudice to the protection of commercial interests’.114 As outlined above, transparency is a key aspect of a fair criminal justice system and, as a general rule, all criminal justice decision-making processes need to be open to public scrutiny. There is no reason why AI systems should be exempt from this requirement and, given that administration of criminal justice is a matter of strong public interest, the public should have the right to voice their opinions and raise objections whenever AI systems impact criminal justice processes. Also, given the highly technical nature of AI systems, and their (as yet) poorly understood impact on society, impact assessments must have multi-disciplinary expert engagement. 115 In particular, DPIAs should always involve independent experts (computer scientists, in particular) who can audit, analyse, and if possible, ‘explain’ AI systems, so that they can help legal, policy and social science experts to determine the likely implications for the individuals’ rights. For public and expert consultations to be meaningful and effective, sufficient information should be made available to interested parties so that the AI system can be thoroughly understood and researched. Partnership on AI has recommended that for criminal justice risk-assessment tools, training datasets,116 architectures and algorithms of AI systems should be made available to ensure meaningful scrutiny.117 Commercial interests should not be regarded as a legitimate ground for limiting the disclosure of this information. Secondly, Article 35 GDPR allows data controllers to carry out a single DPIA ‘for a set of similar processing operations that present similar high risks’. There is a danger that this provision could be interpreted too broadly if Member States are given free rein to determine what two systems can be regarded as sufficiently ‘similar’. There are risks in assuming that an AI system well-suited for use in a particular context or within a particular geographic area will be equally useful in another. AI systems built using data from one jurisdiction might not be able to reflect differences in, for example, law enforcement culture and patterns of behaviour, laws and policies, and socio-demographic characteristics of another jurisdiction.118 Sometimes, these differences can be seen in the same country or even within the same region. For example, a study of ‘PRECOBS’ a predictive policing tool used in Baden-Wurttemberg in Germany, found significant differences in predictive utility between rural and urban areas.119 Finally, DPIAs seem to require data controllers to theorise the possible impact of AI systems, but there is no strict requirement for AI systems to be subject to testing or auditing before, or immediately after deployment. This overlooks the fact that flaws in AI systems, including unintentional biases, are not always easily detectable, and that they might only surface once the system is put into operation. As discussed earlier, the causes of biases in AI systems can be difficult to identify, and it is difficult to appreciate how, short of thorough testing, the true impact of AI decisions can be known. In New York, the AI Now Institute has proposed an alternative model for impact assessments, known as ‘Algorithmic Impact Assessments’ (‘AIAs’).120 The AIA framework sets out in detail how public authorities should conduct impact assessments of AI systems, and it can be contrasted with the provisions of the GDPR in that AIAs place much greater emphasis on the need for community engagement and consultations with external experts. This framework could serve as a useful guide for Member States seeking to establish pre-deployment procedures for approving AI systems. AI systems should not be deployed unless they have undergone an independent public impact assessment with the involvement of appropriate experts, that is specific both to the purpose for which the AI system is deployed, and the locality where it is deployed. AI systems must be tested for impact pre-deployment, and systems should be precluded from deployment until they have undergone this testing and achieved minimum standards, such as non-discrimination. Post-Deployment Impact assessments of AI systems should not be regarded as ‘one-off’ processes. They have to be followed up with ongoing post-deployment monitoring and evaluation, so that the longer-term impact of AI systems can be understood, and shortcomings and biases that affect the rights of individuals can be identified and fixed. The ability of AI systems to deliver fair and just outcomes, and to meet policy objectives can be difficult to predict from the outset. Although AI systems can be validated and tested prior to deployment to check if they are likely to produce desired outcomes, their impact in the real world might be different. Furthermore, even if the likely outputs of AI systems can be predicted, it is much harder to estimate the likely impact they will have on human decision-making.121 Further reviews of AI systems are also necessary because criminal justice systems and the societies in which they operate change over time. A study in the United States, for example, theorises that many pre-trial risk assessment tools might be making predictions based on historic data that is no longer fit for purpose. It has been suggested that because data used to train risk assessment algorithms pre date bail reforms in many US jurisdictions, the impact of recent measures introduced to reduce the risk of failure-to-appear, such as transportation assistance and text message alerts are not taken into consideration – potentially leading to over-incarceration.122 Socio-demographic changes might also require AI systems to be altered so that they continue to be fit for purpose. If, for example, an area experiences high levels of net migration which results in rapid changes to policing patterns and judicial behaviour, AI systems might need to be reviewed to make sure they are not unintentionally worsening racial discrimination. Data Collection It is difficult to imagine how the impact of AI systems can be assessed, if there is inadequate data to support effective monitoring. The deficiency of criminal justice data across the EU has been subject to criticism. In particular, Fair Trials has found that most EU Member States do not systemically collect statistics on the duration of pre-trial detention, outcomes of criminal cases of pre-trial detainees, and the likelihood of a suspect or accused person being released by the court.123 The data needed for effective monitoring and evaluation depends on the function of the AI system and its intended objectives, but the lack of criminal justice data more generally questions whether Member States currently have adequate legal and policy foundations for introducing AI systems responsibly into criminal justice processes. Data needed for monitoring and evaluation purposes will, of course, need to have been collected from well before the introduction of the AI system, so that a proper pre- and post- analysis comparison can be made. Of particular concern is that in most EU Member States, race or ethnic data on criminal justice is not available, either because there is no systemised process for collecting it, or because local laws ban this practice altogether.124 This is a serious challenge because the most predominant criticism against the use of AI systems in the United States and elsewhere is that it worsens racial and ethnic bias in criminal justice decisions. Even without official statistics, there is strong evidence in many EU Member States that certain ethnic minorities, and in particular, Roma and people of colour are unfairly overrepresented in criminal justice systems.125 It is worrying that AI systems might worsen this discrimination, but that there will be no way of detecting this trend, because of the lack of data. Furthermore, the absence of racial and ethnic data could also prevent pre-emptive measures to combat racial bias. It is doubtful that developers will be able to design systems free from racial bias, if they have no data against which to measure their performance. On data collection, Fair Trials believe that EU and its Member States will need to make a strict choice. Either they should ensure that racially disaggregated criminal justice data is collected, or AI systems should be banned where they make individualised assessments for criminal justice purposes. Effective monitoring of AI systems is not possible unless there is sufficient data that makes it possible to discern their real impact. In particular, Member States need to collect data that allow them to identify discriminatory impacts of AI systems, including discrimination on the basis of race and ethnicity. ",Legal,Fact Finding,Q&A "In developing a response, draw solely from information given in the prompt or provided context.","A lender applied a lien on a customer's house due to non-payment under their credit terms for a 100k loan (the lien was for the outstanding balance, around 80k). The property was inherited, so the customer paid nothing for the property (now worth more than a million AUD). Is this unfair, or predatory lending?","2.2.2 Harsh and unfair consumer credit contract terms 130. Consumer credit contracts (loans) may include all kinds of harsh and unfair terms. These may include-  allowance for the lender to repossess property without sufficient warning or time to remedy a default;  large early termination fees if a loan is repaid early or the borrower is late in paying the loan instalments; or  placing security over property with greater value than the borrower‘s liability under the consumer credit contract. 131. Laws in some countries allow a borrower to apply to a court or tribunal to ask them to strike out the harsh and unfair contract terms. 132. The Malaysian Financial Services Act and the Islamic Financial Services Act prohibit lenders (ie Financial Service Providers) from engaging in conduct that is deemed to be inherently unfair to financial consumers. The types of prohibited business conduct are set out in Schedule 7 of the two Acts. The types of conduct that are prohibited include-  providing borrowers with misleading or deceptive information;  intimidating or exploiting borrowers;  restricting the freedom of borrowers to choose between financial services or products available to them;  engaging in collusive business practices Schedule 7 Malaysian Financial Services Act and Islamic Financial Services Act Prohibited business conduct includes: 1. Engaging in conduct that is misleading or deceptive, or is likely to mislead or deceive in relation to the nature, features, terms or price of any financial service or product. 2. Inducing or attempting to induce a financial consumer to do an act or omit to do an act in relation to any financial service or product by—  making a statement, illustration, promise, forecast or comparison which is misleading, false or deceptive;  dishonestly concealing, omitting or providing material facts in a manner which is ambiguous; or  recklessly making any statement, illustration, promise, forecast or comparison which is misleading, false or deceptive. 49 133. In Australia, a court can reopen a contract that is ‗unjust‘. ‗Unjust‘ conduct means conduct that is ‗unconscionable, harsh or oppressive‘. This includes circumstances in which the terms of the document are unjust, or the lender‘s conduct is unjust. 134. In determining whether the contract was unjust, the court may take into account:  whether the lender or any other person used unfair pressure;  whether, at the time the contract was entered into, the lender knew or should have known that the borrower would be unable to pay; or  the annual percentage interest rates charged in comparable cases. 135. If the court decides that the contract is unjust, then it can make order a number of remedies, including:  reopening an account already taken between the parties;  relieving the borrower and any guarantor from payment of any amount that the court considers to be excessive;  setting aside either wholly or in part or revise or alter an agreement made or mortgage given in connection with the transaction; or  ordering that the mortgagee takes such steps as are necessary to discharge the mortgage."," In developing a response, draw solely from information given in the prompt or provided context. A lender applied a lien on a customer's house due to non-payment under their credit terms for a 100k loan (the lien was for the outstanding balance, around 80k). The property was inherited, so the customer paid nothing for the property (now worth more than a million AUD). Is this unfair, or predatory lending? 2.2.2 Harsh and unfair consumer credit contract terms 130. Consumer credit contracts (loans) may include all kinds of harsh and unfair terms. These may include-  allowance for the lender to repossess property without sufficient warning or time to remedy a default;  large early termination fees if a loan is repaid early or the borrower is late in paying the loan instalments; or  placing security over property with greater value than the borrower‘s liability under the consumer credit contract. 131. Laws in some countries allow a borrower to apply to a court or tribunal to ask them to strike out the harsh and unfair contract terms. 132. The Malaysian Financial Services Act and the Islamic Financial Services Act prohibit lenders (ie Financial Service Providers) from engaging in conduct that is deemed to be inherently unfair to financial consumers. The types of prohibited business conduct are set out in Schedule 7 of the two Acts. The types of conduct that are prohibited include-  providing borrowers with misleading or deceptive information;  intimidating or exploiting borrowers;  restricting the freedom of borrowers to choose between financial services or products available to them;  engaging in collusive business practices Schedule 7 Malaysian Financial Services Act and Islamic Financial Services Act Prohibited business conduct includes: 1. Engaging in conduct that is misleading or deceptive, or is likely to mislead or deceive in relation to the nature, features, terms or price of any financial service or product. 2. Inducing or attempting to induce a financial consumer to do an act or omit to do an act in relation to any financial service or product by—  making a statement, illustration, promise, forecast or comparison which is misleading, false or deceptive;  dishonestly concealing, omitting or providing material facts in a manner which is ambiguous; or  recklessly making any statement, illustration, promise, forecast or comparison which is misleading, false or deceptive. 49 133. In Australia, a court can reopen a contract that is ‗unjust‘. ‗Unjust‘ conduct means conduct that is ‗unconscionable, harsh or oppressive‘. This includes circumstances in which the terms of the document are unjust, or the lender‘s conduct is unjust. 134. In determining whether the contract was unjust, the court may take into account:  whether the lender or any other person used unfair pressure;  whether, at the time the contract was entered into, the lender knew or should have known that the borrower would be unable to pay; or  the annual percentage interest rates charged in comparable cases. 135. If the court decides that the contract is unjust, then it can make order a number of remedies, including:  reopening an account already taken between the parties;  relieving the borrower and any guarantor from payment of any amount that the court considers to be excessive;  setting aside either wholly or in part or revise or alter an agreement made or mortgage given in connection with the transaction; or  ordering that the mortgagee takes such steps as are necessary to discharge the mortgage.",Financial,Fact Finding,Q&A You will answer all questions using only information from the resource provided in the prompt.,Use the text provided to explain the difference between Adam Smith's economic philosophy and that of Friedrich List.,"Class 1: The Purpose of the Corporation (Dodge v. Ford Motor Company) Dodge v. Ford Motor Company is a great case. It is important because its ruling touches on a question at the very core of corporate law: what is the purpose of the corporation? Is it exclusively to make the most money for shareholders? (And if so – making the most money long-term or short- term?) Or perhaps it is also permissible – or even required – that the corporation would act in the interests of other stakeholders – employees, creditors, customers, the local community, or the nation in which it is incorporated? But there is another reason why Dodge v. Ford Motor Company is a great case: the parties are pretending to act for reasons different than those that really motivate them. As we will see in class, the plaintiff and defendant present their interests in ways that don’t make sense once you think things through. And read narrowly, the court’s decision seems almost arbitrary and in contrast to established law. But once you understand the entire context, the court ruling can be seen as a clever way to maintain both the letter and the spirit of established law. But no case is perfect. The main weakness of Dodge is that it is not well-written; indeed, it is quite boring to read. Another weakness is that the actual legal question it discusses is a narrow one that requires knowing some corporate law to understand. Therefore, though I am including the text of the case for you to read ahead of class, it is not the main assignment and you should not feel frustrated if it’s not clear to you. I will explain the case in class. Rather, the main reading assignment ahead of class is an excerpt from an old magazine article, about an economist you may never have heard about – Friedrich List. I think this is a more enjoyable reading, and it will give you background for a discussion on the big policy question Dodge tackles: whose interests should the corporation serve? No doubt you have heard of Adam Smith and later classical economists who espoused free-market economics, based on the idea that self-interested behavior by market participants enriches society as a whole. The line of corporate law doctrine that fits with this worldview is the norm that a corporation should operate solely for the purpose of its shareholders, and that this would ultimately benefit all other stakeholders (employees, customers, society as a whole, etc.). Friedrich List is a leading intellectual force behind an opposing view, which is why I ask that you read the article to understand the main differences between his world view and that of his free- market opponents (which he called the “cosmopolitans”). While List is not widely known today, his work is credited with influencing the thinking of several policy makers and leaders, including China’s Deng Xiaoping. In some ways, List appears more relevant to political debate today – with the rise of populist politicians in several countries including the U.S. – than it was when the article was written. But in other ways, this article is very much a product of its time. To a contemporary reader it may appear odd how much Japan and Germany are mentioned in the article compared to other countries (for example, China). But this was very typical of American policy analysis (and popular culture) in the 1980s. At that time, the American economy was relatively stagnant, while the economies of Japan and Germany were booming. The US had a large trade deficit with these countries, with cheaper German and Japanese imports crowding out a shrinking American industry, and German and Japanese firms used the dollars they acquired from the deficit to acquire iconic American assets. The result was fear of those two countries on one hand, and a desire to mimic them on the other hand. The article is in the tail end of that trend; by the 1990s Japan entered a prolonged recession, the German economy slowed under the costs of the reunification of West and East Germany, and the American economy prospered again. You may be more familiar with a reincarnation of this trend, in the 2000s and early 2010s, this time focused on China.","System Instruction: You will answer all questions using only information from the resource provided in the prompt. Question: Use the text provided to explain the difference between Adam Smith's economic philosophy and that of Friedrich List. Context Block: Class 1: The Purpose of the Corporation (Dodge v. Ford Motor Company) Dodge v. Ford Motor Company is a great case. It is important because its ruling touches on a question at the very core of corporate law: what is the purpose of the corporation? Is it exclusively to make the most money for shareholders? (And if so – making the most money long-term or short- term?) Or perhaps it is also permissible – or even required – that the corporation would act in the interests of other stakeholders – employees, creditors, customers, the local community, or the nation in which it is incorporated? But there is another reason why Dodge v. Ford Motor Company is a great case: the parties are pretending to act for reasons different than those that really motivate them. As we will see in class, the plaintiff and defendant present their interests in ways that don’t make sense once you think things through. And read narrowly, the court’s decision seems almost arbitrary and in contrast to established law. But once you understand the entire context, the court ruling can be seen as a clever way to maintain both the letter and the spirit of established law. But no case is perfect. The main weakness of Dodge is that it is not well-written; indeed, it is quite boring to read. Another weakness is that the actual legal question it discusses is a narrow one that requires knowing some corporate law to understand. Therefore, though I am including the text of the case for you to read ahead of class, it is not the main assignment and you should not feel frustrated if it’s not clear to you. I will explain the case in class. Rather, the main reading assignment ahead of class is an excerpt from an old magazine article, about an economist you may never have heard about – Friedrich List. I think this is a more enjoyable reading, and it will give you background for a discussion on the big policy question Dodge tackles: whose interests should the corporation serve? No doubt you have heard of Adam Smith and later classical economists who espoused free-market economics, based on the idea that self-interested behavior by market participants enriches society as a whole. The line of corporate law doctrine that fits with this worldview is the norm that a corporation should operate solely for the purpose of its shareholders, and that this would ultimately benefit all other stakeholders (employees, customers, society as a whole, etc.). Friedrich List is a leading intellectual force behind an opposing view, which is why I ask that you read the article to understand the main differences between his world view and that of his free- market opponents (which he called the “cosmopolitans”). While List is not widely known today, his work is credited with influencing the thinking of several policy makers and leaders, including China’s Deng Xiaoping. In some ways, List appears more relevant to political debate today – with the rise of populist politicians in several countries including the U.S. – than it was when the article was written. But in other ways, this article is very much a product of its time. To a contemporary reader it may appear odd how much Japan and Germany are mentioned in the article compared to other countries (for example, China). But this was very typical of American policy analysis (and popular culture) in the 1980s. At that time, the American economy was relatively stagnant, while the economies of Japan and Germany were booming. The US had a large trade deficit with these countries, with cheaper German and Japanese imports crowding out a shrinking American industry, and German and Japanese firms used the dollars they acquired from the deficit to acquire iconic American assets. The result was fear of those two countries on one hand, and a desire to mimic them on the other hand. The article is in the tail end of that trend; by the 1990s Japan entered a prolonged recession, the German economy slowed under the costs of the reunification of West and East Germany, and the American economy prospered again. You may be more familiar with a reincarnation of this trend, in the 2000s and early 2010s, this time focused on China.",Legal,Concept Comparison,Q&A "Only use information provided in the document to answer, don't use external knowledge.",Why does satisfaction with customer service interactions decline around the holidays?,"**The Holiday Dip** According to the National Retail Federation, it is not uncommon for retailers to bring in 20-40% of their annual sales during the weeks leading up to Christmas. Key shopping days such as Cyber Monday and Black Friday are so important that even those outside the industry watch to see what happens and plan their shopping around these days. A unique challenge for retail customer service organizations is dealing with this sudden and temporary increase in volume of sales transactions while maintaining customer satisfaction levels, all while dealing with the reality of budget constraints. To add to the challenge of pure volume faced during the holiday season, teams must deal with customers that can be more difficult than usual. They are often more unpleasant because of stress, make purchase decisions less thoughtfully, and have less experience with retail processes such as coupons and returns. THE ”HOLIDAY DIP“ Ellen, the manager of a small customer service team at a company selling personal hygiene products, emphasized that the holiday rush is about much more than pure volume for her team. “Yes, we’re busy in Q4. But what is worse is the customers are different. They are more stressed and we have to up the positive energy to calm them down. But we can’t take more time with customers since they are all just as busy as we are. People are buying less thoughtfully so there are more purchase regrets and returns that we have to deal with.” Adam echoed this sentiment. “During the holidays we find we get a large number of customers that just aren’t shoppers. They don’t know things that we expect most people know like finding the return label in the box or using the coupon before they pay.” The Zendesk Benchmark has tracked the impact of the holiday rush on customer satisfaction. There is a clear trend: satisfaction with customer service interactions measurably and consistently drop during the holiday season. “Q4 is our busiest time of year, and every parameter that impacts a successful customer experience is strained.” “During the holidays, customers don’t understand how things work as well as our typical customer. We have to spend more time on education and misunderstandings at a time when we’re busy anyway.” Customer Service in the Retail Revolution 05 2011 81% 81% 81% 73% 79% 76% 2012 2013 Q3 Q4 The Zendesk analysis further drilled down into the data to examine the cause of this “dip” in satisfaction during the holiday season. They found a clear correlation between the drop in satisfaction and the number of tickets per agent. As tickets per agent increased, satisfaction decreased. The retail customer service managers we spoke with agreed that the Q4 satisfaction dip is a significant issue. They frequently described planning for the holiday rush as one of the most strategic activities they do each year. Pelle, the director of customer service for a company selling fashion accessories, had just finished his annual performance review when we spoke. “If I look back at last year, my biggest strategic mistake was my Q4 forecast. I got it wrong and my team wasn’t ready. We’re already making changes to do better this year.” Pelle’s approach for the coming holiday season included an investment in a customer service platform that will enable more self-service capabilities and streamline workflow so each agent can handle more tickets. This option was a good choice since he had time to implement and test the systems and train his agents well before the Q4 rush started. Lucia took a different approach to dealing with the holiday customer service rush. She brought on an outsourcing partner for the holiday season. This was a good option for her company, which sells non-perishable food items, as agents do not require additional product expertise. Their company has used this approach for several years, and each time they optimize the way they work together to create a more seamless experience. “We have a great outsourcing Customer Service in the Retail Revolution 06 partner, and having them deal with basic issues like shipping, let us focus on the things that are unique to our business. However, when we first started working together we operated too independently. Tickets that were escalated from the outsourcer to us created a real speed-bump for the customers as they were passed up the chain. We invested in a service platform that allowed us to buy temporary licenses for the outsourcer so we are all on the same system all the time. That eliminated that problem, plus gave us greater insight into what was going on with the outsourcer. For example, we were able to identify a quality problem with one outsourcing agent that was just not the kind of person we wanted representing our company.” Clay, director of call center operations at a furniture and appliance chain based in Australia, chose to hire additional permanent staff for the holiday season. While this was the most expensive option available, his company’s large ticket items made a focus on personal contact very important and made this the best option. Claire, who works for a Scandinavian electronics retailer, deals with the Q4 rush by temporarily assigning responsibilities of staff outside of the regular customer service team. “During the holiday season, nothing is as important as ensuring sales are made. From our CEO to the teenager who cleans the kitchen, we were all working the service queue last December. I know this wouldn’t work everywhere. We have a small company with people who are willing to pitch in and do whatever it takes. We are very careful to have procedures and training in place so we don’t end up creating more work cleaning up mistakes made by employees who usually aren’t customer facing.” Clearly, there is no single “right way” for retailers preparing for the holiday rush. What is never an option is to simply hope that existing resources can manage when activity increases dramatically. However, there are two important strategies that work well for all customer service managers: Be ready early: Experienced managers who have been through many holiday seasons consistently recommend having all additional resources in place one month before the rush starts. This gives the opportunity to have everyone trained, all processes in place, and all hiccups ironed out before the real rush begins and it becomes complicated to make changes. Use data to influence management: Customer service teams who have been through a bad year usually have an easier time convincing their management to invest in resources for the next year. Using data from prior years, such as ticket volumes and customer satisfaction trends, combined with resources like the Zendesk Benchmark can be very influential in having management approve customer service investments for Q4.","[INSTRUCTIONS] ================== Only use information provided in the document to answer, don't use external knowledge. ---------------- [QUERY] ================== Why does satisfaction with customer service interactions decline around the holidays? ---------------- [TEXT PASSAGE] ================== **The Holiday Dip** According to the National Retail Federation, it is not uncommon for retailers to bring in 20-40% of their annual sales during the weeks leading up to Christmas. Key shopping days such as Cyber Monday and Black Friday are so important that even those outside the industry watch to see what happens and plan their shopping around these days. A unique challenge for retail customer service organizations is dealing with this sudden and temporary increase in volume of sales transactions while maintaining customer satisfaction levels, all while dealing with the reality of budget constraints. To add to the challenge of pure volume faced during the holiday season, teams must deal with customers that can be more difficult than usual. They are often more unpleasant because of stress, make purchase decisions less thoughtfully, and have less experience with retail processes such as coupons and returns. THE ”HOLIDAY DIP“ Ellen, the manager of a small customer service team at a company selling personal hygiene products, emphasized that the holiday rush is about much more than pure volume for her team. “Yes, we’re busy in Q4. But what is worse is the customers are different. They are more stressed and we have to up the positive energy to calm them down. But we can’t take more time with customers since they are all just as busy as we are. People are buying less thoughtfully so there are more purchase regrets and returns that we have to deal with.” Adam echoed this sentiment. “During the holidays we find we get a large number of customers that just aren’t shoppers. They don’t know things that we expect most people know like finding the return label in the box or using the coupon before they pay.” The Zendesk Benchmark has tracked the impact of the holiday rush on customer satisfaction. There is a clear trend: satisfaction with customer service interactions measurably and consistently drop during the holiday season. “Q4 is our busiest time of year, and every parameter that impacts a successful customer experience is strained.” “During the holidays, customers don’t understand how things work as well as our typical customer. We have to spend more time on education and misunderstandings at a time when we’re busy anyway.” Customer Service in the Retail Revolution 05 2011 81% 81% 81% 73% 79% 76% 2012 2013 Q3 Q4 The Zendesk analysis further drilled down into the data to examine the cause of this “dip” in satisfaction during the holiday season. They found a clear correlation between the drop in satisfaction and the number of tickets per agent. As tickets per agent increased, satisfaction decreased. The retail customer service managers we spoke with agreed that the Q4 satisfaction dip is a significant issue. They frequently described planning for the holiday rush as one of the most strategic activities they do each year. Pelle, the director of customer service for a company selling fashion accessories, had just finished his annual performance review when we spoke. “If I look back at last year, my biggest strategic mistake was my Q4 forecast. I got it wrong and my team wasn’t ready. We’re already making changes to do better this year.” Pelle’s approach for the coming holiday season included an investment in a customer service platform that will enable more self-service capabilities and streamline workflow so each agent can handle more tickets. This option was a good choice since he had time to implement and test the systems and train his agents well before the Q4 rush started. Lucia took a different approach to dealing with the holiday customer service rush. She brought on an outsourcing partner for the holiday season. This was a good option for her company, which sells non-perishable food items, as agents do not require additional product expertise. Their company has used this approach for several years, and each time they optimize the way they work together to create a more seamless experience. “We have a great outsourcing Customer Service in the Retail Revolution 06 partner, and having them deal with basic issues like shipping, let us focus on the things that are unique to our business. However, when we first started working together we operated too independently. Tickets that were escalated from the outsourcer to us created a real speed-bump for the customers as they were passed up the chain. We invested in a service platform that allowed us to buy temporary licenses for the outsourcer so we are all on the same system all the time. That eliminated that problem, plus gave us greater insight into what was going on with the outsourcer. For example, we were able to identify a quality problem with one outsourcing agent that was just not the kind of person we wanted representing our company.” Clay, director of call center operations at a furniture and appliance chain based in Australia, chose to hire additional permanent staff for the holiday season. While this was the most expensive option available, his company’s large ticket items made a focus on personal contact very important and made this the best option. Claire, who works for a Scandinavian electronics retailer, deals with the Q4 rush by temporarily assigning responsibilities of staff outside of the regular customer service team. “During the holiday season, nothing is as important as ensuring sales are made. From our CEO to the teenager who cleans the kitchen, we were all working the service queue last December. I know this wouldn’t work everywhere. We have a small company with people who are willing to pitch in and do whatever it takes. We are very careful to have procedures and training in place so we don’t end up creating more work cleaning up mistakes made by employees who usually aren’t customer facing.” Clearly, there is no single “right way” for retailers preparing for the holiday rush. What is never an option is to simply hope that existing resources can manage when activity increases dramatically. However, there are two important strategies that work well for all customer service managers: Be ready early: Experienced managers who have been through many holiday seasons consistently recommend having all additional resources in place one month before the rush starts. This gives the opportunity to have everyone trained, all processes in place, and all hiccups ironed out before the real rush begins and it becomes complicated to make changes. Use data to influence management: Customer service teams who have been through a bad year usually have an easier time convincing their management to invest in resources for the next year. Using data from prior years, such as ticket volumes and customer satisfaction trends, combined with resources like the Zendesk Benchmark can be very influential in having management approve customer service investments for Q4.",Retail/Product,Effect Analysis,Q&A Only answer the prompt using the information in the context block.,My cartridge weighs 9g. Should I use the supplied counterweight?,"Set-up The deck is supplied partially disassembled and carefully packaged for safe transport. Carefully remove all parts from the transport packaging. Make sure the surface you wish to use the turntable on is level (use a spirit level) before placing the turntable on it. Fit the drive belt (22) around the platter (3) and the smaller diameter part of the motor pulley (2) for playback of 33 r.p.m. records. To reach 45 r.p.m. put the belt over the larger diameter part of the motor pulley. Avoid getting sweat or grease on the belt as these will deteriorate the performance and reduce the belt's lifespan. Use absorbent kitchen paper to remove any oil or grease from the outer edge of the platter and the belt. Fit the felt mat over the spindle of the platter (3). Remove the transport lock (66) from the tonearm tube. Store the transport lock in the original packaging so they are available for any future transportation. Cartridge downforce adjustment The counterweight (6) supplied is suitable for cartridges weighing between 3,5 - 5,5g (weight no. 00). An alternative counterweight for cartridges weighing between 6 - 9g (weight no. 01) is available as an accessory part. Pushing carefully, turn the counterweight (4) onto the rear end of the tonearm tube (7), so that the downforce scale (4a) shows towards the front of the player. Lower the armlift and position the cartridge in the space between arm rest and platter. Carefully rotate the counterweight (4) until the armtube balances out. The arm should return to the balanced position if it is moved up or down. This adjustment must be done carefully. Do not forget to remove the cartridge protection cap if fitted. Once the arm is correctly balanced return it to the rest (6). Hold the counterweight (4) without moving it, and gently revolve the downforce scale ring (4a) until the zero is in line with the anti-skating stub (8). Check whether the arm still balances out. Rotate the counterweight counter clockwise (seen from the front) to adjust the downforce according to the cartridge manufacturer's recommendations. One mark on the scale represents 1 mN (= 0,1g / 0,1 Pond) of downforce. Please note: Adjust the downforce prior to installing the anti-skating weight. The recommended downforce for the factory fitted cartridge Ortofon OM10 is 15mN. © Pro-Ject Audio Systems · Pro-Ject Essential III · Revision 2017.01.03 5 Anti-skating force adjustment Hang the loop of the thread of the anti-skating weight in the groove of the anti-skating stub (8) corresponding to the downforce applied to your cartridge and feed the thread through the loop of the wire support (9). The anti-skating force must be adjusted corresponding to the downforce as follows: Downforce Groove in the stub (8) 10 - 14mN 1st from bearing rings 15 - 19mN 2nd "" "" "" 20mN and bigger 3rd "" "" "" 8 Connection to the amplifier The record player has a captive tonearm signal lead (12) for connection to the amplifier. Use the Phono input (sometimes labelled gram, disc or RIAA) on your amplifier. Make sure that the phono input offers correct matching and amplification for the type of cartridge used. Line inputs (such as CD, Tuner, Tape or Video) are not suitable. Take care to connect the left and right channels correctly. The right channel is usually marked red, the left channel black or white. Check the manual supplied with your amplifier for relevant information. The earthing wire of the tonearm lead should be connected to the earth terminal on your amplifier (if provided). If your amplifier does not have an input suitable for phono cartridges you will require a separate phono amplifier stage for MM or MC cartridges which is then connected between the record player and a free line level input of the amplifier. For detailed product information regarding Pro-Ject Audio phono amplifiers please refer to the Pro-Ject web site www.project-audio.com. The recommended load impedance for the factory fitted cartridge is: 47kohms/MM-input Mains power connection The turntable is supplied with a power supply suitable for your country's mains supply. Check the label before connecting to ensure compliance with the mains rating in your house. Connect the low voltage plug from the power supply to the socket (20) on the rear of the record player before connecting the power supply to the mains. Fitting the lid Fit the lid (dust cover) carefully over the hinge prongs and adjust the screws (14) until the lid stays open where you want it to without being too stiff to open or close.","Only answer the prompt using the information in the context block. Set-up The deck is supplied partially disassembled and carefully packaged for safe transport. Carefully remove all parts from the transport packaging. Make sure the surface you wish to use the turntable on is level (use a spirit level) before placing the turntable on it. Fit the drive belt (22) around the platter (3) and the smaller diameter part of the motor pulley (2) for playback of 33 r.p.m. records. To reach 45 r.p.m. put the belt over the larger diameter part of the motor pulley. Avoid getting sweat or grease on the belt as these will deteriorate the performance and reduce the belt's lifespan. Use absorbent kitchen paper to remove any oil or grease from the outer edge of the platter and the belt. Fit the felt mat over the spindle of the platter (3). Remove the transport lock (66) from the tonearm tube. Store the transport lock in the original packaging so they are available for any future transportation. Cartridge downforce adjustment The counterweight (6) supplied is suitable for cartridges weighing between 3,5 - 5,5g (weight no. 00). An alternative counterweight for cartridges weighing between 6 - 9g (weight no. 01) is available as an accessory part. Pushing carefully, turn the counterweight (4) onto the rear end of the tonearm tube (7), so that the downforce scale (4a) shows towards the front of the player. Lower the armlift and position the cartridge in the space between arm rest and platter. Carefully rotate the counterweight (4) until the armtube balances out. The arm should return to the balanced position if it is moved up or down. This adjustment must be done carefully. Do not forget to remove the cartridge protection cap if fitted. Once the arm is correctly balanced return it to the rest (6). Hold the counterweight (4) without moving it, and gently revolve the downforce scale ring (4a) until the zero is in line with the anti-skating stub (8). Check whether the arm still balances out. Rotate the counterweight counter clockwise (seen from the front) to adjust the downforce according to the cartridge manufacturer's recommendations. One mark on the scale represents 1 mN (= 0,1g / 0,1 Pond) of downforce. Please note: Adjust the downforce prior to installing the anti-skating weight. The recommended downforce for the factory fitted cartridge Ortofon OM10 is 15mN. © Pro-Ject Audio Systems · Pro-Ject Essential III · Revision 2017.01.03 5 Anti-skating force adjustment Hang the loop of the thread of the anti-skating weight in the groove of the anti-skating stub (8) corresponding to the downforce applied to your cartridge and feed the thread through the loop of the wire support (9). The anti-skating force must be adjusted corresponding to the downforce as follows: Downforce Groove in the stub (8) 10 - 14mN 1st from bearing rings 15 - 19mN 2nd "" "" "" 20mN and bigger 3rd "" "" "" 8 Connection to the amplifier The record player has a captive tonearm signal lead (12) for connection to the amplifier. Use the Phono input (sometimes labelled gram, disc or RIAA) on your amplifier. Make sure that the phono input offers correct matching and amplification for the type of cartridge used. Line inputs (such as CD, Tuner, Tape or Video) are not suitable. Take care to connect the left and right channels correctly. The right channel is usually marked red, the left channel black or white. Check the manual supplied with your amplifier for relevant information. The earthing wire of the tonearm lead should be connected to the earth terminal on your amplifier (if provided). If your amplifier does not have an input suitable for phono cartridges you will require a separate phono amplifier stage for MM or MC cartridges which is then connected between the record player and a free line level input of the amplifier. For detailed product information regarding Pro-Ject Audio phono amplifiers please refer to the Pro-Ject web site www.project-audio.com. The recommended load impedance for the factory fitted cartridge is: 47kohms/MM-input Mains power connection The turntable is supplied with a power supply suitable for your country's mains supply. Check the label before connecting to ensure compliance with the mains rating in your house. Connect the low voltage plug from the power supply to the socket (20) on the rear of the record player before connecting the power supply to the mains. Fitting the lid Fit the lid (dust cover) carefully over the hinge prongs and adjust the screws (14) until the lid stays open where you want it to without being too stiff to open or close. My cartridge weighs 9g. Should I use the supplied counterweight?",Retail/Product,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","The 5G IoT has three layers: the Edge, Network, and Application layer; in which way does the architecture of the 5G IoT help to support complex applications such as the smart home, virtual reality, and industrial IoT? Secondly, explain how this architecture benefits from blockchain for security and data exchange. The next question is addressing the following issues: what are the critical parameters that should be met in order to guarantee the effective work and security of the IoT systems based on 5G technology?","An Insight into IoT IoT or the Internet of Things is a networked digital system of various electronic devices like sensors, activators, receivers, nodes that compute data, etc. By eliminating human involvement, IoT devices have transformed the data collecting and processing system. From top to bottom, IoT devices enhance the development of concepts like smart home, smart vehicle, smart agriculture (Pranto et al. 2021), smart health care, communication, cybersecurity and many more systems (Haque et al. 2021a). They have been used to conduct, monitor, and produce reactions based on the information gathered. People have been thinking of connecting devices to the Internet for a long time. The Internet of Things, on the other hand, enhances and extends network technology based on existing internet technology, allowing computing and smart objects to connect and communicate with one another. The IoT can be broadly defined as any object that communicates, produces, and interchanges data with other objects via the Internet to perform orientation tracing, tracking, intelligent recognition, and management. This process is conducted by various sensors or peripherals such as GPS, thermal sensors, RFID, etc. (Yang et al. 2011). Characteristics of IoT There are many functional and non-functional IoT needs for creating the infrastructure. We will discuss some of the most valuable characteristics of IoT here. Availability To provide customers with facilities wherever and whenever they need them, IoT availability must be implemented at the hardware and software levels. The capacity of IoT systems to give functionality to anybody in any location is referred to as software availability (Mistry et al. 2020a). The nature of computers that are always compatible with IoT features and protocols is referred to as hardware availability. To allow IoT capabilities, protocols like IPv6, 6LoWPAN, RPL, CoAP, and others need to be implemented inside the restricted devices of the single board resource. One technique for achieving high IoT service availability is to ensure the availability of critical hardware and facilities (Bahalul Haque 2019). Mobility Although most utilities are designed to be delivered via Smartphone devices, IoT implementation is hampered by accessibility. A key IoT premise is to keep customers connected to their preferred resources when moving. When mobile devices are relocated from one gateway to another, service interruptions may occur. Caching and tunneling for service continuity allow apps to access IoT data even if the internet is down for a short time. The vast number of smart devices available in IoT systems is usually included in any solid framework for mobility control. Scalability Scalability in the Internet of Things refers to the ability to accept new client equipment, software, and capabilities without compromising the efficiency of existing systems. It is not straightforward to add new processes and manage extra devices, especially when there are several hardware platforms and communication protocols to contend with. IoT applications must be built from the ground up to enable extendable services and operations. Security and Privacy On diverse networks, such as the Internet of Things, ensuring user security and privacy is strict. The fundamental functioning of the Internet of Things is built on data transmission between billions, if not trillions, of Internet-connected items. One great problem in IoT security left out of the standards is the key distribution between devices. The growing number of intelligent objects around us with sensitive data necessitates transparent and simple access control management, such as enabling one vendor to view the data. In contrast, another controls the device Performance The performance of IoT services is difficult to evaluate since it is based on the performance of many components and the underlying technology. The Internet of Things, like other programs, must constantly develop and expand its offerings in order to meet user expectations. IoT also needs to manage the larger amount of information or data created in the ecosystem, ensuring the interoperability and quality of service. Layered Architecture of IoT Various designs have been suggested for IoT worlds. In general, such structures are divided into three categories. There are three types of architecture: three-layer architecture, four-layer architecture, and five-layer architecture. In this chapter, we will look at the three-layered architecture. It is organized keeping mid some specific tasks to accomplish by the system like executing service functions, transmitting data, and connection among service devices. It results in three layers, Application layer, Network/Transmission layer, and Perception/Edge layer. Application Layer In different implementations, this layer may include various services. Smart grids, healthcare, and autonomous automobiles are examples of IoT deployment in smart cities and homes. Because the application layer might serve as a service support middleware, a networking standard, or a cloud computing platform, security considerations vary depending on the application's environment and industry. Network Layer Acting as a bridge, the network layer controls data transfer to subsequent layers. This layer connects to the visual layer. Different smart devices are connected to the network layer following control function protocol (IEEE 802.x) and authentication standards (GPS, and Near-Field Connectivity (NFC)). The transmission of data is highly prone to cyber-attacks. Intelligent intrusion detection key encryption with secured management-based IoT security framework is the most popular along with the latest adoption of blockchain technology. Edge Layer Edge layer manages the IoT devices or sensors like RFID, different actuators, cameras, intensity detectors, moisture and pressure sensors, etc., using gateways in a coordinating function to connect with Researchers have proposed security solutions for this layer based on machine learning, multi-stepped authorization, secure channeling through anti-malware, etc. Requirements for 5G Integrated IoT Architecture 5G-enabled IoT needs special attention for its heterogeneity, advancement, and application. However, there are some requirements that all the architecture should follow (Li et al. 2018b): 5G IoT must ensure a low latency of 1 ms considering the sensitive internet system and medical perspective. The architecture must ensure low energy consumption for low-battery life IoT devices but enough for 5G to transfer data. An advanced application like Virtual Reality or Augmented Reality needs a high speed of 25 Mbps, so the architecture must follow with the future needs. Security must be top-notch, considering massive data transmission at a very high speed. The devices with mobility factors will get priority for the 5G IoT infrastructure. The fundamental 5G IoT architecture consists of five steps in general: sensors, IoT Gateway, 5G-based station, cloud storage, and application (Arsh et al. 2021). These steps can be comprised in IoT layers to bring up a general 5G IoT architecture. Edge Layer of 5G IoT The sensors and gateway of IoT can be comprised of 5G in this layer. For example, sensors for wearable ECG, temperature, smart manufacturing etc. will use this layer to transmit and process information using 5G technology (Shdefat et al. 2021). Network Layer of 5G IoT The network layer will hold the 5G base station and cloud storage to process data using IoT devices. Application Layer of 5G IoT The application layer will provide all the support for the end system like smart home, smart supply chain, etc. (Haque et al. 2021b). Following the above-mentioned general architecture, 5G IoT can support millimeter-wave (Rahimi et al. 2018), D2D communication, nano-chip, wireless software (Huang et al. 2020), mobile edge computing, data analytics cloud computing (Mudigonda et al. 2020), and many more technologies and application. In Fig. 11.1, we have shown a generalized architecture for the 5G integrated IoT ecosystem. Blockchain-Based 5G IoT Blockchain (Haque and Bhushan 2021b) can bring trust and improved security to 5G IoT. It can accelerate data exchange at a lower cost by implementing a cryptographic encryption system to the architecture. The immutability and accountability that blockchain can ensure for the system are marvelous (Hewa et al. 2020). Blockchain integrated 5G IoT can bring revolution to industrial IoT, UnThese layers work together using cloud storage and a 5G network to provide services like education, fire station, transportation, factories, etc.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== The 5G IoT has three layers: the Edge, Network, and Application layer; in which way does the architecture of the 5G IoT help to support complex applications such as the smart home, virtual reality, and industrial IoT? Secondly, explain how this architecture benefits from blockchain for security and data exchange. The next question is addressing the following issues: what are the critical parameters that should be met in order to guarantee the effective work and security of the IoT systems based on 5G technology? {passage 0} ========== An Insight into IoT IoT or the Internet of Things is a networked digital system of various electronic devices like sensors, activators, receivers, nodes that compute data, etc. By eliminating human involvement, IoT devices have transformed the data collecting and processing system. From top to bottom, IoT devices enhance the development of concepts like smart home, smart vehicle, smart agriculture (Pranto et al. 2021), smart health care, communication, cybersecurity and many more systems (Haque et al. 2021a). They have been used to conduct, monitor, and produce reactions based on the information gathered. People have been thinking of connecting devices to the Internet for a long time. The Internet of Things, on the other hand, enhances and extends network technology based on existing internet technology, allowing computing and smart objects to connect and communicate with one another. The IoT can be broadly defined as any object that communicates, produces, and interchanges data with other objects via the Internet to perform orientation tracing, tracking, intelligent recognition, and management. This process is conducted by various sensors or peripherals such as GPS, thermal sensors, RFID, etc. (Yang et al. 2011). Characteristics of IoT There are many functional and non-functional IoT needs for creating the infrastructure. We will discuss some of the most valuable characteristics of IoT here. Availability To provide customers with facilities wherever and whenever they need them, IoT availability must be implemented at the hardware and software levels. The capacity of IoT systems to give functionality to anybody in any location is referred to as software availability (Mistry et al. 2020a). The nature of computers that are always compatible with IoT features and protocols is referred to as hardware availability. To allow IoT capabilities, protocols like IPv6, 6LoWPAN, RPL, CoAP, and others need to be implemented inside the restricted devices of the single board resource. One technique for achieving high IoT service availability is to ensure the availability of critical hardware and facilities (Bahalul Haque 2019). Mobility Although most utilities are designed to be delivered via Smartphone devices, IoT implementation is hampered by accessibility. A key IoT premise is to keep customers connected to their preferred resources when moving. When mobile devices are relocated from one gateway to another, service interruptions may occur. Caching and tunneling for service continuity allow apps to access IoT data even if the internet is down for a short time. The vast number of smart devices available in IoT systems is usually included in any solid framework for mobility control. Scalability Scalability in the Internet of Things refers to the ability to accept new client equipment, software, and capabilities without compromising the efficiency of existing systems. It is not straightforward to add new processes and manage extra devices, especially when there are several hardware platforms and communication protocols to contend with. IoT applications must be built from the ground up to enable extendable services and operations. Security and Privacy On diverse networks, such as the Internet of Things, ensuring user security and privacy is strict. The fundamental functioning of the Internet of Things is built on data transmission between billions, if not trillions, of Internet-connected items. One great problem in IoT security left out of the standards is the key distribution between devices. The growing number of intelligent objects around us with sensitive data necessitates transparent and simple access control management, such as enabling one vendor to view the data. In contrast, another controls the device Performance The performance of IoT services is difficult to evaluate since it is based on the performance of many components and the underlying technology. The Internet of Things, like other programs, must constantly develop and expand its offerings in order to meet user expectations. IoT also needs to manage the larger amount of information or data created in the ecosystem, ensuring the interoperability and quality of service. Layered Architecture of IoT Various designs have been suggested for IoT worlds. In general, such structures are divided into three categories. There are three types of architecture: three-layer architecture, four-layer architecture, and five-layer architecture. In this chapter, we will look at the three-layered architecture. It is organized keeping mid some specific tasks to accomplish by the system like executing service functions, transmitting data, and connection among service devices. It results in three layers, Application layer, Network/Transmission layer, and Perception/Edge layer. Application Layer In different implementations, this layer may include various services. Smart grids, healthcare, and autonomous automobiles are examples of IoT deployment in smart cities and homes. Because the application layer might serve as a service support middleware, a networking standard, or a cloud computing platform, security considerations vary depending on the application's environment and industry. Network Layer Acting as a bridge, the network layer controls data transfer to subsequent layers. This layer connects to the visual layer. Different smart devices are connected to the network layer following control function protocol (IEEE 802.x) and authentication standards (GPS, and Near-Field Connectivity (NFC)). The transmission of data is highly prone to cyber-attacks. Intelligent intrusion detection key encryption with secured management-based IoT security framework is the most popular along with the latest adoption of blockchain technology. Edge Layer Edge layer manages the IoT devices or sensors like RFID, different actuators, cameras, intensity detectors, moisture and pressure sensors, etc., using gateways in a coordinating function to connect with Researchers have proposed security solutions for this layer based on machine learning, multi-stepped authorization, secure channeling through anti-malware, etc. Requirements for 5G Integrated IoT Architecture 5G-enabled IoT needs special attention for its heterogeneity, advancement, and application. However, there are some requirements that all the architecture should follow (Li et al. 2018b): 5G IoT must ensure a low latency of 1 ms considering the sensitive internet system and medical perspective. The architecture must ensure low energy consumption for low-battery life IoT devices but enough for 5G to transfer data. An advanced application like Virtual Reality or Augmented Reality needs a high speed of 25 Mbps, so the architecture must follow with the future needs. Security must be top-notch, considering massive data transmission at a very high speed. The devices with mobility factors will get priority for the 5G IoT infrastructure. The fundamental 5G IoT architecture consists of five steps in general: sensors, IoT Gateway, 5G-based station, cloud storage, and application (Arsh et al. 2021). These steps can be comprised in IoT layers to bring up a general 5G IoT architecture. Edge Layer of 5G IoT The sensors and gateway of IoT can be comprised of 5G in this layer. For example, sensors for wearable ECG, temperature, smart manufacturing etc. will use this layer to transmit and process information using 5G technology (Shdefat et al. 2021). Network Layer of 5G IoT The network layer will hold the 5G base station and cloud storage to process data using IoT devices. Application Layer of 5G IoT The application layer will provide all the support for the end system like smart home, smart supply chain, etc. (Haque et al. 2021b). Following the above-mentioned general architecture, 5G IoT can support millimeter-wave (Rahimi et al. 2018), D2D communication, nano-chip, wireless software (Huang et al. 2020), mobile edge computing, data analytics cloud computing (Mudigonda et al. 2020), and many more technologies and application. In Fig. 11.1, we have shown a generalized architecture for the 5G integrated IoT ecosystem. Blockchain-Based 5G IoT Blockchain (Haque and Bhushan 2021b) can bring trust and improved security to 5G IoT. It can accelerate data exchange at a lower cost by implementing a cryptographic encryption system to the architecture. The immutability and accountability that blockchain can ensure for the system are marvelous (Hewa et al. 2020). Blockchain integrated 5G IoT can bring revolution to industrial IoT, UnThese layers work together using cloud storage and a 5G network to provide services like education, fire station, transportation, factories, etc. https://link.springer.com/chapter/10.1007/978-981-99-3668-7_11",Internet/Technology,Effect Analysis,Q&A "This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge, The response should bold every name present in the response. The response should be formatted into a bullet point list. The response should be no more than twenty words long. ",List every cloud gaming subscription service mentioned in this text.,"On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 Microsoft and Activision Blizzard in the Video Game Industry Microsoft distributes video games using Microsoft Store, its subscription service Game Pass,24 and its cloud gaming service Xbox Cloud Gaming (Beta);25 publishes games, including the franchises Halo and Minecraft; 26 and owns 23 gaming studios.27 In 2021, Microsoft had the second-highest share in the U.S. market for game consoles at 34.8%, according to a report from MarketLine, an industry research firm; estimates for Sony and Nintendo were 40.7% and 24.5%, respectively.28 In January 2022, Microsoft stated that it had more than 25 million Game Pass subscribers.29 In April 2022, Microsoft reported that more than 10 million people have streamed games over Xbox Cloud Gaming,30 although it is unclear how long or how many times users accessed the service. Estimates from Ampere Analysis reportedly indicate that Game Pass makes up about 60% of the video game subscription market.31 Among video game publishers in the United States, Microsoft had the highest market share at 23.9%, according to IBISWorld.32 Activision Blizzard is a video game publisher and developer primarily known for its franchise games, which include World of Warcraft, Call of Duty, Diablo, and Candy Crush. 33 The company can be separated into three segments—Activision, Blizzard, and King—that each contain their own gaming studios. Among video game publishers in the United States, Activision Blizzard had the second highest market share at 10%, according to IBISWorld.34 Activision also distributes video games for PCs through its digital store—Battle.net.35 Among video game publishers in the United States, Microsoft and Activision Blizzard are estimated to have the largest market shares.47 IBISWorld reports, however, that competition among publishers and developers is high, even though the success of new entrants, particularly among developers, is fairly low.48 Publishers and developers can face high levels of uncertainty and risk.49 Furthermore, measuring the market share of Microsoft and Activision Blizzard within the United States may not accurately reflect competition in these markets, given that these companies compete at a global level. Some industry analysts list Tencent, which is headquartered in China, as the largest video game publisher worldwide based on revenue;50 Microsoft and Activision Blizzard are listed among the top 10, along with Sony, Nintendo, EA, and Take-Two Interactive.51 Microsoft stated that after its acquisition of Activision Blizzard, it would “become the world’s third-largest gaming company by revenue, behind Tencent and Sony.” 52 ","List every cloud gaming subscription service mentioned in this text. This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge, The response should bold every name of a cloud gaming subscription present in the response. The response should be formatted into a bullet point list. The response should be no more than twenty words long. On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 Microsoft and Activision Blizzard in the Video Game Industry Microsoft distributes video games using Microsoft Store, its subscription service Game Pass,24 and its cloud gaming service Xbox Cloud Gaming (Beta);25 publishes games, including the franchises Halo and Minecraft; 26 and owns 23 gaming studios.27 In 2021, Microsoft had the second-highest share in the U.S. market for game consoles at 34.8%, according to a report from MarketLine, an industry research firm; estimates for Sony and Nintendo were 40.7% and 24.5%, respectively.28 In January 2022, Microsoft stated that it had more than 25 million Game Pass subscribers.29 In April 2022, Microsoft reported that more than 10 million people have streamed games over Xbox Cloud Gaming,30 although it is unclear how long or how many times users accessed the service. Estimates from Ampere Analysis reportedly indicate that Game Pass makes up about 60% of the video game subscription market.31 Among video game publishers in the United States, Microsoft had the highest market share at 23.9%, according to IBISWorld.32 Activision Blizzard is a video game publisher and developer primarily known for its franchise games, which include World of Warcraft, Call of Duty, Diablo, and Candy Crush. 33 The company can be separated into three segments—Activision, Blizzard, and King—that each contain their own gaming studios. Among video game publishers in the United States, Activision Blizzard had the second highest market share at 10%, according to IBISWorld.34 Activision also distributes video games for PCs through its digital store—Battle.net.35 Among video game publishers in the United States, Microsoft and Activision Blizzard are estimated to have the largest market shares.47 IBISWorld reports, however, that competition among publishers and developers is high, even though the success of new entrants, particularly among developers, is fairly low.48 Publishers and developers can face high levels of uncertainty and risk.49 Furthermore, measuring the market share of Microsoft and Activision Blizzard within the United States may not accurately reflect competition in these markets, given that these companies compete at a global level. Some industry analysts list Tencent, which is headquartered in China, as the largest video game publisher worldwide based on revenue;50 Microsoft and Activision Blizzard are listed among the top 10, along with Sony, Nintendo, EA, and Take-Two Interactive.51 Microsoft stated that after its acquisition of Activision Blizzard, it would “become the world’s third-largest gaming company by revenue, behind Tencent and Sony.” 52 ",Legal,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","I'm scratching my head at the idea of megapixels lately, I don't sense any improvements in my upgraded phone's images, even though it has higher megapixels. Please explain this to me in less than 200 words.","Do Camera Megapixels Matter in 2024? (For Photography) Having more megapixels on your digital camera or smartphone can be useful. However, do megapixels matter when it comes to overall image quality? Photographers love to discuss the merits of more camera megapixels in digital photography. In this guide, I’ll explain why having more megapixels isn’t always necessary… nor a good thing. You’ll also discover which digital cameras and smartphones have the highest pixel count in 2024. What Do MegaPixels Mean on a Camera? The megapixels on a camera refer to the pixel count present in the sensor. For example, if you have a 24 MP camera, it means that the final image will have 24 million pixels. The total pixel count is what’s known as the camera resolution. You can calculate the resolution by multiplying the number of pixels on the horizontal side of the sensor by the ones on the vertical side. If the camera sensor has a 2:3 aspect ratio – this means that the 24 megapixels are distributed as 6000 on one side and 4000 in the other. How many megapixels can the human eye see? Well, the human eye doesn’t actually have pixels. So, comparing the human eye to a camera’s sensor is not like comparing the resolution of two cameras. What we know is an estimate calculated by photographer and scientist Dr. Roger N. Clark. Using very complex math, he determined that the human eye ‘resolution’ is 576 megapixels. You can learn more about how he reached this result on his website – Clarkvision. However, according to an article published by Lasik – 576 MP is the resolution reached when moving. Instead, on a single glance, the human eye has a 5 to 15 MP ‘resolution’. Are There Any Drawbacks to Having Too Many Megapixels? The first drawback of having more megapixels is that you’ll have bigger files. This means that you’ll fill the memory card faster and you’ll need more storage space either on your hard drive or a cloud service to back them up. This is a fair compromise when you actually need high-resolution images. However, if you have large files because they have more megapixels than you need, then it’s not worth it. Another potential drawback is the slower processing time. This may affect you when shooting, transferring, and editing the files. Large files in-camera take longer to be saved in the memory card. If you shoot in burst mode – for example, it could diminish the fps. It could also mean slowing the processing to transfer, cull, and edit your photos – this also depends on how powerful is your computer. Also, when the camera sensors aren’t big enough for the amount of pixels, you’ll have a bigger image resolution but not higher image quality. You’ll probably have issues like noise and reduced dynamic range. When Are More Megapixels An Advantage? A printer with a woman's face on it. Large format printing process with Mimaki machine. Credit: Helene.3160, CC BY-SA 4.0, via Wikimedia Commons More megapixels are better when you’re talking about print size. The more megapixels you have, the bigger you can print your image. Another situation in which more megapixels are beneficial is when you need to crop your image. This is because even if you lose megapixels by cutting out part of your photo – the file still has enough resolution to print or zoom on your screen. How to Choose Photo Resolution & Size for Printing Or Online Use How Many Megapixels Do Photographers Actually Need? If you’re wondering how many megapixels you need to print high-resolution images, you need to multiply the print size by 300 – which is the standard dpi for photographic printing. So, if you need to print an 8″ x 10″ photo, it needs to have 2,400 x 3,000 pixels. To print a 16″ x 24″ you need a file with 4,800 x 7,200 pixels and so on. How many megapixels do professional photographers use? Unfortunately, there isn’t a straight answer to this. The megapixels required by a professional photographer depend on the type of photos they do and how the images are going to be used. To give an approximate number, most professional DSLR and mirrorless cameras have a resolution between 24 and 36 MP. However, some professionals use medium-format digital cameras that range from 50 to 100 MP. How many megapixels do you need for wedding photography? Most professional wedding photographers can make do with a resolution ranging from 20 to 24 MP. However, depending on the prints and wedding albums you plan to deliver (and also how much you usually crop your photos), having higher-resolution cameras can be an advantage. Does the megapixel count change if you shoot in RAW or JPG? The number of megapixels on the RAW and JPG files may be different depending on the camera settings. Most cameras allow you to choose the size of the RAW and JPG files they save. For example, I can set a Canon 90D to shoot in C-RAW and save a raw file of 32MP (6960 x 4640) and a small file JPG file of 3.8MP (2400 x 1600). Each camera will have different sizes available for each file type – you’ll need to check yours on the user’s manual or by doing a quick Google search. What About Megapixels and Smartphone Photography? You’ve probably seen smartphones that advertise enough megapixels to beat any DSLR or mirrorless cameras on the market. This may lead you to wonder why isn’t professional photographers don’t use smartphones to take photos for their jobs. Well, camera lenses, the ability to sync with flashes, and many other features make this impossible. However, it’s not just that, it’s also because of how smartphones get to that pixel count and what that means in resolution and quality. Due to their size, it’s impossible for them to actually fit such a larger sensor inside the device. So, smartphone manufacturers incorporate advanced technologies like pixel binning or computational photography to improve image quality without increasing the number of individual pixels."," Only use the provided text to answer the question, no outside sources. I'm scratching my head at the idea of megapixels lately, I don't sense any improvements in my upgraded phone's images, even though it has higher megapixels. Please explain this to me in less than 200 words. Do Camera Megapixels Matter in 2024? (For Photography) Having more megapixels on your digital camera or smartphone can be useful. However, do megapixels matter when it comes to overall image quality? Photographers love to discuss the merits of more camera megapixels in digital photography. In this guide, I’ll explain why having more megapixels isn’t always necessary… nor a good thing. You’ll also discover which digital cameras and smartphones have the highest pixel count in 2024. What Do MegaPixels Mean on a Camera? The megapixels on a camera refer to the pixel count present in the sensor. For example, if you have a 24 MP camera, it means that the final image will have 24 million pixels. The total pixel count is what’s known as the camera resolution. You can calculate the resolution by multiplying the number of pixels on the horizontal side of the sensor by the ones on the vertical side. If the camera sensor has a 2:3 aspect ratio – this means that the 24 megapixels are distributed as 6000 on one side and 4000 in the other. How many megapixels can the human eye see? Well, the human eye doesn’t actually have pixels. So, comparing the human eye to a camera’s sensor is not like comparing the resolution of two cameras. What we know is an estimate calculated by photographer and scientist Dr. Roger N. Clark. Using very complex math, he determined that the human eye ‘resolution’ is 576 megapixels. You can learn more about how he reached this result on his website – Clarkvision. However, according to an article published by Lasik – 576 MP is the resolution reached when moving. Instead, on a single glance, the human eye has a 5 to 15 MP ‘resolution’. Are There Any Drawbacks to Having Too Many Megapixels? The first drawback of having more megapixels is that you’ll have bigger files. This means that you’ll fill the memory card faster and you’ll need more storage space either on your hard drive or a cloud service to back them up. This is a fair compromise when you actually need high-resolution images. However, if you have large files because they have more megapixels than you need, then it’s not worth it. Another potential drawback is the slower processing time. This may affect you when shooting, transferring, and editing the files. Large files in-camera take longer to be saved in the memory card. If you shoot in burst mode – for example, it could diminish the fps. It could also mean slowing the processing to transfer, cull, and edit your photos – this also depends on how powerful is your computer. Also, when the camera sensors aren’t big enough for the amount of pixels, you’ll have a bigger image resolution but not higher image quality. You’ll probably have issues like noise and reduced dynamic range. When Are More Megapixels An Advantage? A printer with a woman's face on it. Large format printing process with Mimaki machine. Credit: Helene.3160, CC BY-SA 4.0, via Wikimedia Commons More megapixels are better when you’re talking about print size. The more megapixels you have, the bigger you can print your image. Another situation in which more megapixels are beneficial is when you need to crop your image. This is because even if you lose megapixels by cutting out part of your photo – the file still has enough resolution to print or zoom on your screen. How to Choose Photo Resolution & Size for Printing Or Online Use How Many Megapixels Do Photographers Actually Need? If you’re wondering how many megapixels you need to print high-resolution images, you need to multiply the print size by 300 – which is the standard dpi for photographic printing. So, if you need to print an 8″ x 10″ photo, it needs to have 2,400 x 3,000 pixels. To print a 16″ x 24″ you need a file with 4,800 x 7,200 pixels and so on. How many megapixels do professional photographers use? Unfortunately, there isn’t a straight answer to this. The megapixels required by a professional photographer depend on the type of photos they do and how the images are going to be used. To give an approximate number, most professional DSLR and mirrorless cameras have a resolution between 24 and 36 MP. However, some professionals use medium-format digital cameras that range from 50 to 100 MP. How many megapixels do you need for wedding photography? Most professional wedding photographers can make do with a resolution ranging from 20 to 24 MP. However, depending on the prints and wedding albums you plan to deliver (and also how much you usually crop your photos), having higher-resolution cameras can be an advantage. Does the megapixel count change if you shoot in RAW or JPG? The number of megapixels on the RAW and JPG files may be different depending on the camera settings. Most cameras allow you to choose the size of the RAW and JPG files they save. For example, I can set a Canon 90D to shoot in C-RAW and save a raw file of 32MP (6960 x 4640) and a small file JPG file of 3.8MP (2400 x 1600). Each camera will have different sizes available for each file type – you’ll need to check yours on the user’s manual or by doing a quick Google search. What About Megapixels and Smartphone Photography? You’ve probably seen smartphones that advertise enough megapixels to beat any DSLR or mirrorless cameras on the market. This may lead you to wonder why isn’t professional photographers don’t use smartphones to take photos for their jobs. Well, camera lenses, the ability to sync with flashes, and many other features make this impossible. However, it’s not just that, it’s also because of how smartphones get to that pixel count and what that means in resolution and quality. Due to their size, it’s impossible for them to actually fit such a larger sensor inside the device. So, smartphone manufacturers incorporate advanced technologies like pixel binning or computational photography to improve image quality without increasing the number of individual pixels. https://shotkit.com/megapixels-photography/",Internet/Technology,Effect Analysis,Q&A Answer the question using only the information given in the context block. Give your answer as a bulleted list.,What are the pros and cons of using a CPAP machine?,"If you have sleep apnea, not enough air can flow into your lungs through your mouth and nose during sleep, even though breathing efforts continue. When this happens, the amount of oxygen in your blood decreases. Your brain responds by awakening you enough to tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound. Although people who have sleep apnea typically snore loudly and frequently, not everyone who snores has sleep apnea. Because people who have sleep apnea frequently go from deeper sleep to lighter sleep during the night, they rarely spend enough time in deep, restorative stages of sleep. They are therefore often excessively sleepy during the day. Such sleepiness is thought to lead to mood and behavior problems, including depression, and it more than triples the risk of being in a traffic or work-related accident. The many brief drops in blood-oxygen levels that occur during the night can result in morning headaches and trouble concentrating, thinking clearly, learning, and remembering. Additionally, the intermittent oxygen drops and reduced sleep quality together trigger the release of stress hormones. These hormones raise your blood pressure and heart rate and boost the risk of heart attack, stroke, irregular heartbeats, and congestive heart failure. In addition, untreated sleep apnea can lead to changes in energy metabolism (the way your body changes food and oxygen into energy) that increase the risk for developing obesity and diabetes. Anyone can have sleep apnea. It is estimated that at least 12–18 million American adults have sleep apnea, making it as common as asthma. More than one-half of the people who have sleep apnea are overweight. Sleep apnea is more common in men. More than 1 in 25 middle-aged men and 1 in 50 middle-aged women have sleep apnea along with extreme daytime sleepiness. About 3 percent of children and 10 percent or more of people over age 65 have sleep apnea. This condition occurs more frequently in African Americans, Asians, Native Americans, and Hispanics than in Caucasians. More than one-half of all people who have sleep apnea are not diagnosed. People who have sleep apnea generally are not aware that their breathing stops in the night. They just notice that they don’t feel well rested when they wake up and are sleepy throughout the day. Their bed partners are likely to notice, however, that they snore loudly and frequently and that they often stop breathing briefly while sleeping. Doctors suspect sleep apnea if these symptoms are present, but the diagnosis must be confirmed with overnight sleep monitoring. This monitoring will reveal pauses in breathing, frequent sleep arousals (changes from sleep to wakefulness), and intermittent drops in levels of oxygen in the blood. Like adults who have sleep apnea, children who have this disorder usually snore loudly, snort or gasp, and have brief pauses in breath ing while sleeping. Small children often have enlarged tonsils and adenoids that increase their risk for sleep apnea. But doctors may not suspect sleep apnea in children because, instead of showing the typical signs of sleepiness during the day, these children often become agitated and may be considered hyperactive. The effects of sleep apnea in children may include poor school performance and difficult, aggressive behavior. A number of factors can make a person susceptible to sleep apnea. These factors include: Throat muscles and tongue that relax more than normal while asleep Enlarged tonsils and adenoids Being overweight—the excess fat tissue around your neck makes it harder to keep the throat area open Head and neck shape that creates a somewhat smaller airway size in the mouth and throat area Congestion, due to allergies, that also can narrow the airway Family history of sleep apnea If your doctor suspects that you have sleep apnea, you may be referred to a sleep specialist. Some of the ways to help diagnose sleep apnea include: A medical history that includes asking you and your family questions about how you sleep and how you function during the day. Checking your mouth, nose, and throat for extra or large tissues—for example, checking the tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (the roof of your mouth in the back of your throat). An overnight recording of what happens with your breathing during sleep (polysomnogram, or PSG). A multiple sleep latency test (MSLT), usually done in a sleep center, to see how quickly you fall asleep at times when you would normally be awake. (Falling asleep in only a few minutes usually means that you are very sleepy during the day. Being very sleepy during the day can be a sign of sleep apnea. Once all the tests are completed, the sleep specialist will review the results and work with you and your family to develop a treatment plan. Changes in daily activities or habits may help reduce your symptoms: Sleep on your side instead of on your back. Sleeping on your side will help reduce the amount of upper airway collapse during sleep. Avoid alcohol, smoking, sleeping pills, herbal supplements, and any other medications that make you sleepy. They make it harder for your airways to stay open while you sleep, and sedatives can make the breathing pauses longer and more severe. Tobacco smoke irritates the airways and can help trigger the intermittent collapse of the upper airway. Lose weight if you are overweight. Even a little weight loss can sometimes improve symptoms. These changes may be all that are needed to treat mild sleep apnea. However, if you have moderate or severe sleep apnea, you will need additional, more direct treatment approaches. Continuous positive airway pressure (CPAP) is the most effective treatment for sleep apnea in adults. A CPAP machine uses mild air pressure to keep your airways open while you sleep. The machine delivers air to your airways through a specially designed nasal mask. The mask does not breathe for you; the flow of air creates increased pressure to keep the airways in your nose and mouth more open while you sleep. The air pressure is adjusted so that it is just enough to stop your airways from briefly becoming too small during sleep. The pressure is constant and continuous. Sleep apnea will return if CPAP is stopped or if it is used incorrectly. People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. CPAP treatment can cause side effects in some people. Possible side effects include dry or stuffy nose, irritation of the skin on the face, bloating of the stom ach, sore eyes, or headaches. If you have trouble with CPAP side effects, work with your sleep specialist and support staff. Together, you can do things to reduce or eliminate these problems. Currently, no medications cure sleep apnea. However, some prescription medications may help relieve the excessive sleepiness that sometimes persists even with CPAP treatment of sleep apnea. Another treatment approach that may help some people is the use of a mouthpiece (oral or dental appliance). If you have mild sleep apnea or do not have sleep apnea but snore very loudly, your doctor or dentist also may recommend this. A custom-fitted plastic mouth piece will be made by a dentist or an orthodontist (a specialist in correcting teeth or jaw problems). The mouthpiece will adjust your lower jaw and tongue to help keep the airway in your throat more open while you are sleeping. Air can then flow more easily into your lungs because there is less resistance to breathing. Following up with the dentist or orthodontist is important to correct any side effects and to be sure that your mouthpiece continues to fit properly. It is also important to have a followup sleep study to see whether your sleep apnea has improved. Some people who have sleep apnea may benefit from surgery; this depends on the findings of the evaluation by the sleep specialist. Removing tonsils and adenoids that are blocking the airway is done frequently, especially in children. Uvulopalatopharyngoplasty (UPPP) is a surgery for adults that removes the tonsils, uvula, and part of the soft palate. Tracheostomy is a surgery used rarely and only in severe sleep apnea when no other treatments have been successful. A small hole is made in the windpipe, and a tube is inserted. Air will flow through the tube and into the lungs, bypass ing the obstruction in the upper airway. ","Answer the question using only the information given in the context block. Give your answer as a bulleted list. What are the pros and cons of using a CPAP machine? If you have sleep apnea, not enough air can flow into your lungs through your mouth and nose during sleep, even though breathing efforts continue. When this happens, the amount of oxygen in your blood decreases. Your brain responds by awakening you enough to tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound. Although people who have sleep apnea typically snore loudly and frequently, not everyone who snores has sleep apnea. Because people who have sleep apnea frequently go from deeper sleep to lighter sleep during the night, they rarely spend enough time in deep, restorative stages of sleep. They are therefore often excessively sleepy during the day. Such sleepiness is thought to lead to mood and behavior problems, including depression, and it more than triples the risk of being in a traffic or work-related accident. The many brief drops in blood-oxygen levels that occur during the night can result in morning headaches and trouble concentrating, thinking clearly, learning, and remembering. Additionally, the intermittent oxygen drops and reduced sleep quality together trigger the release of stress hormones. These hormones raise your blood pressure and heart rate and boost the risk of heart attack, stroke, irregular heartbeats, and congestive heart failure. In addition, untreated sleep apnea can lead to changes in energy metabolism (the way your body changes food and oxygen into energy) that increase the risk for developing obesity and diabetes. Anyone can have sleep apnea. It is estimated that at least 12–18 million American adults have sleep apnea, making it as common as asthma. More than one-half of the people who have sleep apnea are overweight. Sleep apnea is more common in men. More than 1 in 25 middle-aged men and 1 in 50 middle-aged women have sleep apnea along with extreme daytime sleepiness. About 3 percent of children and 10 percent or more of people over age 65 have sleep apnea. This condition occurs more frequently in African Americans, Asians, Native Americans, and Hispanics than in Caucasians. More than one-half of all people who have sleep apnea are not diagnosed. People who have sleep apnea generally are not aware that their breathing stops in the night. They just notice that they don’t feel well rested when they wake up and are sleepy throughout the day. Their bed partners are likely to notice, however, that they snore loudly and frequently and that they often stop breathing briefly while sleeping. Doctors suspect sleep apnea if these symptoms are present, but the diagnosis must be confirmed with overnight sleep monitoring. This monitoring will reveal pauses in breathing, frequent sleep arousals (changes from sleep to wakefulness), and intermittent drops in levels of oxygen in the blood. Like adults who have sleep apnea, children who have this disorder usually snore loudly, snort or gasp, and have brief pauses in breath ing while sleeping. Small children often have enlarged tonsils and adenoids that increase their risk for sleep apnea. But doctors may not suspect sleep apnea in children because, instead of showing the typical signs of sleepiness during the day, these children often become agitated and may be considered hyperactive. The effects of sleep apnea in children may include poor school performance and difficult, aggressive behavior. A number of factors can make a person susceptible to sleep apnea. These factors include: Throat muscles and tongue that relax more than normal while asleep Enlarged tonsils and adenoids Being overweight—the excess fat tissue around your neck makes it harder to keep the throat area open Head and neck shape that creates a somewhat smaller airway size in the mouth and throat area Congestion, due to allergies, that also can narrow the airway Family history of sleep apnea If your doctor suspects that you have sleep apnea, you may be referred to a sleep specialist. Some of the ways to help diagnose sleep apnea include: A medical history that includes asking you and your family questions about how you sleep and how you function during the day. Checking your mouth, nose, and throat for extra or large tissues—for example, checking the tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (the roof of your mouth in the back of your throat). An overnight recording of what happens with your breathing during sleep (polysomnogram, or PSG). A multiple sleep latency test (MSLT), usually done in a sleep center, to see how quickly you fall asleep at times when you would normally be awake. (Falling asleep in only a few minutes usually means that you are very sleepy during the day. Being very sleepy during the day can be a sign of sleep apnea. Once all the tests are completed, the sleep specialist will review the results and work with you and your family to develop a treatment plan. Changes in daily activities or habits may help reduce your symptoms: Sleep on your side instead of on your back. Sleeping on your side will help reduce the amount of upper airway collapse during sleep. Avoid alcohol, smoking, sleeping pills, herbal supplements, and any other medications that make you sleepy. They make it harder for your airways to stay open while you sleep, and sedatives can make the breathing pauses longer and more severe. Tobacco smoke irritates the airways and can help trigger the intermittent collapse of the upper airway. Lose weight if you are overweight. Even a little weight loss can sometimes improve symptoms. These changes may be all that are needed to treat mild sleep apnea. However, if you have moderate or severe sleep apnea, you will need additional, more direct treatment approaches. Continuous positive airway pressure (CPAP) is the most effective treatment for sleep apnea in adults. A CPAP machine uses mild air pressure to keep your airways open while you sleep. The machine delivers air to your airways through a specially designed nasal mask. The mask does not breathe for you; the flow of air creates increased pressure to keep the airways in your nose and mouth more open while you sleep. The air pressure is adjusted so that it is just enough to stop your airways from briefly becoming too small during sleep. The pressure is constant and continuous. Sleep apnea will return if CPAP is stopped or if it is used incorrectly. People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. CPAP treatment can cause side effects in some people. Possible side effects include dry or stuffy nose, irritation of the skin on the face, bloating of the stom ach, sore eyes, or headaches. If you have trouble with CPAP side effects, work with your sleep specialist and support staff. Together, you can do things to reduce or eliminate these problems. Currently, no medications cure sleep apnea. However, some prescription medications may help relieve the excessive sleepiness that sometimes persists even with CPAP treatment of sleep apnea. Another treatment approach that may help some people is the use of a mouthpiece (oral or dental appliance). If you have mild sleep apnea or do not have sleep apnea but snore very loudly, your doctor or dentist also may recommend this. A custom-fitted plastic mouth piece will be made by a dentist or an orthodontist (a specialist in correcting teeth or jaw problems). The mouthpiece will adjust your lower jaw and tongue to help keep the airway in your throat more open while you are sleeping. Air can then flow more easily into your lungs because there is less resistance to breathing. Following up with the dentist or orthodontist is important to correct any side effects and to be sure that your mouthpiece continues to fit properly. It is also important to have a followup sleep study to see whether your sleep apnea has improved. Some people who have sleep apnea may benefit from surgery; this depends on the findings of the evaluation by the sleep specialist. Removing tonsils and adenoids that are blocking the airway is done frequently, especially in children. Uvulopalatopharyngoplasty (UPPP) is a surgery for adults that removes the tonsils, uvula, and part of the soft palate. Tracheostomy is a surgery used rarely and only in severe sleep apnea when no other treatments have been successful. A small hole is made in the windpipe, and a tube is inserted. Air will flow through the tube and into the lungs, bypass ing the obstruction in the upper airway. ",Medical,Pros & Cons,Q&A "Do not include any information outside of the article provided. Write you answer as a single, complete sentence.",What percentage of individuals globally report being aware of their chronic hepatitis C virus (HCV) infection?,"**Innovations in Hepatitis C Screening and Treatment** Hepatitis C virus (HCV) infection is a major public health threat worldwide, with approximately 71 million people living with chronic infection.( 1 , 2 ) The approval of direct‐acting antivirals (DAAs) starting in 2014 revolutionized treatment and allows nearly all patients to be cured.( 3 ) The number of individuals initiating HCV treatment has increased from approximately 500,000 in 2014 to over 2 million in 2017.( 4 ) In 2016, the World Health Organization called for HCV to be eliminated as a global public health threat by 2030, setting a goal of reducing new infections by 90%, treating 80% of chronic infections, and reducing mortality by 65%.( 5 ) However, few countries are on track to reaching these HCV elimination targets. Globally, only 19% of chronically infected individuals report being aware of their infection, and 15.3% had been treated with DAAs by the end of 2017.( 1 ) In the United States, HCV remains the most common bloodborne infection, affecting 2 million people,( 2 ) and in 2016, more than half of individuals reported being unaware of their infection.( 6 ) HCV‐related mortality continues to rise, surpassing the combined total of 60 other nationally notifiable infectious conditions, including human immunodeficiency virus (HIV).( 2 , 7 , 8 , 9 ) The United States Preventive Services Task Force, the American Association for the Study of Liver Diseases (AASLD), the Infectious Diseases Society of America (IDSA), and Centers for Disease Control and Prevention (CDC) recently updated their guidelines to recommend universal HCV testing among adults.( 10 , 11 ) The 2020 standard of HCV care has evolved toward universal screening and treatment.( 12 ) However, there is currently a considerable drop‐off between each step of the HCV “cascade to cure,” from screening, diagnosis, evaluation, treatment, cure, prevention of reinfection, and care for cirrhosis (Fig. 1).( 13 ) Low rates of diagnosis result in even lower rates of treatment and ultimately cure. Innovation can help address major barriers in these steps to move us toward HCV elimination (Fig. 2). In this review, we focus on a combination of barriers at the system, provider, and patient level, with an emphasis on how system‐level and provider‐level enhancements are critical in overcoming what have traditionally been deemed patient‐level barriers. Since the interferon era, there has been focus on persons living with HCV in silos, some with blame and consequently stigma for their behaviors, when it is system‐level and provider‐level policies and practices that have presented as barriers that need to be addressed. Implementing interventions tailored toward “hardly reached” populations, the micro‐elimination approach, is a key strategy for achieving HCV elimination.( 14 , 15 ) They complement population‐level macro‐elimination programs. Herein, we highlight interventions that address the HCV cascade to cure in hardly reached populations, including (1) persons who inject drugs (PWIDs) and persons who are marginally housed; (2) correctional populations; and (3) women who are pregnant (Table 1). We hope readers can conceptualize members of these groups as being underserved by traditional engagement efforts, rather than as people with inherent qualities that make them challenging to engage and treat. We also discuss broader efforts to use innovation to eliminate HCV across health systems and countries. The interventions in this review specifically improve screening, case finding, linkage to care (broadly defined as strategies that lead to access to HCV care), treatment delivery and/or adherence, and cure.","{query} ======= What percentage of individuals globally report being aware of their chronic hepatitis C virus (HCV) infection? ================ {text} ======= **Innovations in Hepatitis C Screening and Treatment** Hepatitis C virus (HCV) infection is a major public health threat worldwide, with approximately 71 million people living with chronic infection.( 1 , 2 ) The approval of direct‐acting antivirals (DAAs) starting in 2014 revolutionized treatment and allows nearly all patients to be cured.( 3 ) The number of individuals initiating HCV treatment has increased from approximately 500,000 in 2014 to over 2 million in 2017.( 4 ) In 2016, the World Health Organization called for HCV to be eliminated as a global public health threat by 2030, setting a goal of reducing new infections by 90%, treating 80% of chronic infections, and reducing mortality by 65%.( 5 ) However, few countries are on track to reaching these HCV elimination targets. Globally, only 19% of chronically infected individuals report being aware of their infection, and 15.3% had been treated with DAAs by the end of 2017.( 1 ) In the United States, HCV remains the most common bloodborne infection, affecting 2 million people,( 2 ) and in 2016, more than half of individuals reported being unaware of their infection.( 6 ) HCV‐related mortality continues to rise, surpassing the combined total of 60 other nationally notifiable infectious conditions, including human immunodeficiency virus (HIV).( 2 , 7 , 8 , 9 ) The United States Preventive Services Task Force, the American Association for the Study of Liver Diseases (AASLD), the Infectious Diseases Society of America (IDSA), and Centers for Disease Control and Prevention (CDC) recently updated their guidelines to recommend universal HCV testing among adults.( 10 , 11 ) The 2020 standard of HCV care has evolved toward universal screening and treatment.( 12 ) However, there is currently a considerable drop‐off between each step of the HCV “cascade to cure,” from screening, diagnosis, evaluation, treatment, cure, prevention of reinfection, and care for cirrhosis (Fig. 1).( 13 ) Low rates of diagnosis result in even lower rates of treatment and ultimately cure. Innovation can help address major barriers in these steps to move us toward HCV elimination (Fig. 2). In this review, we focus on a combination of barriers at the system, provider, and patient level, with an emphasis on how system‐level and provider‐level enhancements are critical in overcoming what have traditionally been deemed patient‐level barriers. Since the interferon era, there has been focus on persons living with HCV in silos, some with blame and consequently stigma for their behaviors, when it is system‐level and provider‐level policies and practices that have presented as barriers that need to be addressed. Implementing interventions tailored toward “hardly reached” populations, the micro‐elimination approach, is a key strategy for achieving HCV elimination.( 14 , 15 ) They complement population‐level macro‐elimination programs. Herein, we highlight interventions that address the HCV cascade to cure in hardly reached populations, including (1) persons who inject drugs (PWIDs) and persons who are marginally housed; (2) correctional populations; and (3) women who are pregnant (Table 1). We hope readers can conceptualize members of these groups as being underserved by traditional engagement efforts, rather than as people with inherent qualities that make them challenging to engage and treat. We also discuss broader efforts to use innovation to eliminate HCV across health systems and countries. The interventions in this review specifically improve screening, case finding, linkage to care (broadly defined as strategies that lead to access to HCV care), treatment delivery and/or adherence, and cure. ================ {task} ======= Do not include any information outside of the article provided. Write you answer as a single, complete sentence.",Medical,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","List the travel bags referenced in the text in order, from the one that holds the most items to the one that holds the least. Describe what it is about these bags that makes them preferable to other travel bags, and include the colors when referencing them, if given.","What is the Best Purse to Travel With | Shop the Post Top: SoCo Vintage (old, similar) // Jeans: Loft (old, similar) // Purse: Coach (old, similar) // Sunglasses: Coach (old,similar) // Purse: kate spade new york (in black) What is the Best Purse to Travel With | How to Pick If there is one accessory I love, it is a good purse. I love how they are practical, but can make an entire outfit look put together. I have a lot of purses...too many probably! But I get a lot out of each one of them. There are so many different kinds of purses and so many different ways to use them. I will be talking a lot about other purses in later posts, but today I want to talk about the best purses to take when you are traveling. I personally think that a good cross-body bag is the best kind of bag to have when traveling. They are so versatile and they allow you to have your hands free while still storing your necessities in style. What is the Best Purse to Travel With | My Favorites In Turkey, I was touting a Coach Mini Willis cross body. I have this bag in three different colors and it's a great bag for traveling! While it is on the smaller side, it is big enough to hold a small wallet, phone, chapstick and sunglasses. It is perfect for when you are touring a city but don't want to take a lot with you. It's also really nice because you can easily move it to hang in front of you so you can ward off pickpockets! For my birthday last year, my mom gave me the Michael Kors Large Jet Set Traveler in gray. That is a pretty awesome bag. It fits perfectly into my Michael Kors computer bag so I can throw it in there right before I get on a plane and I can pull it back out when I get off. I love that the color goes with just about anything and it fits a LOT of stuff! The last trip I took it on, I got a wallet, glasses, sunglasses, phone, planner, notebook and some pens in there. I have been really happy with how well it has worn too. The leather isn't my favorite but it has a coating on it that keeps stains and water off. Here you can glimpse my newest cross-body obsession from kate spade new york. I took this on my recent trip to Jordan and I loved it! It is much bigger than the Coach bag, and has more room in it than the Michael Kors. It also has a zipper pocket that folds down across the top. The leather on this bag is so soft and I love how pink it is. I found this beauty for a steal at a kate spade outlet sale. The entire store was 50% off with an additional 20% bags. It was a great buy! I will keep an eye out for their next outlet sale and make sure I update you all on it!"," Only use the provided text to answer the question, no outside sources. List the travel bags referenced in the text in order, from the one that holds the most items to the one that holds the least. Describe what it is about these bags that makes them preferable to other travel bags, and include the colors when referencing them, if given. What is the Best Purse to Travel With | Shop the Post Top: SoCo Vintage (old, similar) // Jeans: Loft (old, similar) // Purse: Coach (old, similar) // Sunglasses: Coach (old,similar) // Purse: kate spade new york (in black) What is the Best Purse to Travel With | How to Pick If there is one accessory I love, it is a good purse. I love how they are practical, but can make an entire outfit look put together. I have a lot of purses...too many probably! But I get a lot out of each one of them. There are so many different kinds of purses and so many different ways to use them. I will be talking a lot about other purses in later posts, but today I want to talk about the best purses to take when you are traveling. I personally think that a good cross-body bag is the best kind of bag to have when traveling. They are so versatile and they allow you to have your hands free while still storing your necessities in style. What is the Best Purse to Travel With | My Favorites In Turkey, I was touting a Coach Mini Willis cross body. I have this bag in three different colors and it's a great bag for traveling! While it is on the smaller side, it is big enough to hold a small wallet, phone, chapstick and sunglasses. It is perfect for when you are touring a city but don't want to take a lot with you. It's also really nice because you can easily move it to hang in front of you so you can ward off pickpockets! For my birthday last year, my mom gave me the Michael Kors Large Jet Set Traveler in gray. That is a pretty awesome bag. It fits perfectly into my Michael Kors computer bag so I can throw it in there right before I get on a plane and I can pull it back out when I get off. I love that the color goes with just about anything and it fits a LOT of stuff! The last trip I took it on, I got a wallet, glasses, sunglasses, phone, planner, notebook and some pens in there. I have been really happy with how well it has worn too. The leather isn't my favorite but it has a coating on it that keeps stains and water off. Here you can glimpse my newest cross-body obsession from kate spade new york. I took this on my recent trip to Jordan and I loved it! It is much bigger than the Coach bag, and has more room in it than the Michael Kors. It also has a zipper pocket that folds down across the top. The leather on this bag is so soft and I love how pink it is. I found this beauty for a steal at a kate spade outlet sale. The entire store was 50% off with an additional 20% bags. It was a great buy! I will keep an eye out for their next outlet sale and make sure I update you all on it! https://breezingthrough.com/blog/what-is-the-best-purse-to-travel-with",Retail/Product,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","Describe the different types of hydrogen, how the hydrogen is produced and how each type of hydrogen is relevant in the context of climate change.","Grey hydrogen and blue hydrogen The grey hydrogen considered in this study is produced by SMR technology, and the production starts with hydrogen purging with natural gas feedstock to break long hydrocarbon chains. This step is followed by sulphur removal by chemical absorption on a ZnO bed because even a small amount of sulphur present in natural gas poisons the catalyst. Then, methane is fed to the steam reformer together with steam. The subsequent reaction is a strongly endothermic reaction and produces a mixture containing hydrogen and carbon monoxide. The required steam is assumed to be produced from natural gas. Next, the produced syngas and steam go to a water gas shift reactor to produce more hydrogen and some carbon dioxide from the carbon monoxide. Subsequently, the pressure swing adsorbent (PSA) process is used to separate hydrogen and CO2 and the hydrogen is stored with a compression to 60 bar.19 Unrecovered hydrogen, methane, CO and other compounds go to the furnace to produce heat for the reformer.20 A study by Alhamdani et al. (2017) showed that the fugitive emission from the SMR process is equal to 0.004 kg CO2 eq. per kg H2 and does not have a major impact.21 In view of the low level of fugitive emissions, their effects are neglected in this study. An overview of a typical SMR process is given in Fig. 3. The production process for blue hydrogen is the same as that for grey hydrogen, except that carbon dioxide is captured from the plant, stored and sequestered as shown in Fig. 3. Fig. 3 Grey hydrogen (SMR) and blue hydrogen (SMR-CCS) production (modified from Petrescu et al., 2014).19 2.3.2. Turquoise hydrogen TDM consumes less natural gas than SMR for hydrogen production and has lower total environmental impact.22 This superior environmental performance is because the TDM process does not release carbon dioxide to air. Moreover, since carbon dioxide is in a solid form, carbon gas cannot escape from the process, and a large amount of carbon dioxide can be captured with little impact on the environment. Typically, TDM is a form of pyrolysis of methane at a high temperature of 1500 K. There are two alternate routes in this process: one involving the use of a catalyst, which requires a lower temperature of around 1000 K, and the other without a catalyst, which requires a higher temperature of 1500 K.23 One of the advantages of pyrolysis of methane is that the only reaction products are hydrogen and solid carbon, thereby preventing the formation of CO2 during the reaction.24 Consequently, TDM is considered a promising alternative method for hydrogen production and can be seen in Fig. 4. The produced solid carbon can be utilised in many applications, such as chemical and industrial use.5 The benefit of using TDM is that it does not depend on CCS development and the infrastructure since the output carbon is in the solid form.25 Fig. 4 Turquoise hydrogen (TDM) production (modified from Keipi et al., 2018).25 2.3.3. Green hydrogen Electrolysis of water to split water into oxygen and hydrogen using renewable energy as an electricity source is currently considered the most promising method for carbon-free hydrogen production. Electrolyzers range in size from small apparatus-sized devices suitable for small-scale decentralized production of hydrogen to large centralized production facilities that could be directly connected to renewable or other zero-emission forms of electricity generation. A number of different electrolyzer types exist that operate on different principles: polymer electrolyte membrane (PEM) electrolyzers, alkaline electrolyzers and solid electrolyzers.26 An overview of the general process of water electrolysis for hydrogen production is given in Fig. 5. By-product oxygen from water hydrolysis can be used in combustion processes in the form of oxygen-enriched air to overcome mass transfer limitations and increase the flame speed and temperature.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Describe the different types of hydrogen, how the hydrogen is produced and how each type of hydrogen is relevant in the context of climate change. Grey hydrogen and blue hydrogen The grey hydrogen considered in this study is produced by SMR technology, and the production starts with hydrogen purging with natural gas feedstock to break long hydrocarbon chains. This step is followed by sulphur removal by chemical absorption on a ZnO bed because even a small amount of sulphur present in natural gas poisons the catalyst. Then, methane is fed to the steam reformer together with steam. The subsequent reaction is a strongly endothermic reaction and produces a mixture containing hydrogen and carbon monoxide. The required steam is assumed to be produced from natural gas. Next, the produced syngas and steam go to a water gas shift reactor to produce more hydrogen and some carbon dioxide from the carbon monoxide. Subsequently, the pressure swing adsorbent (PSA) process is used to separate hydrogen and CO2 and the hydrogen is stored with a compression to 60 bar.19 Unrecovered hydrogen, methane, CO and other compounds go to the furnace to produce heat for the reformer.20 A study by Alhamdani et al. (2017) showed that the fugitive emission from the SMR process is equal to 0.004 kg CO2 eq. per kg H2 and does not have a major impact.21 In view of the low level of fugitive emissions, their effects are neglected in this study. An overview of a typical SMR process is given in Fig. 3. The production process for blue hydrogen is the same as that for grey hydrogen, except that carbon dioxide is captured from the plant, stored and sequestered as shown in Fig. 3. Fig. 3 Grey hydrogen (SMR) and blue hydrogen (SMR-CCS) production (modified from Petrescu et al., 2014).19 2.3.2. Turquoise hydrogen TDM consumes less natural gas than SMR for hydrogen production and has lower total environmental impact.22 This superior environmental performance is because the TDM process does not release carbon dioxide to air. Moreover, since carbon dioxide is in a solid form, carbon gas cannot escape from the process, and a large amount of carbon dioxide can be captured with little impact on the environment. Typically, TDM is a form of pyrolysis of methane at a high temperature of 1500 K. There are two alternate routes in this process: one involving the use of a catalyst, which requires a lower temperature of around 1000 K, and the other without a catalyst, which requires a higher temperature of 1500 K.23 One of the advantages of pyrolysis of methane is that the only reaction products are hydrogen and solid carbon, thereby preventing the formation of CO2 during the reaction.24 Consequently, TDM is considered a promising alternative method for hydrogen production and can be seen in Fig. 4. The produced solid carbon can be utilised in many applications, such as chemical and industrial use.5 The benefit of using TDM is that it does not depend on CCS development and the infrastructure since the output carbon is in the solid form.25 Fig. 4 Turquoise hydrogen (TDM) production (modified from Keipi et al., 2018).25 2.3.3. Green hydrogen Electrolysis of water to split water into oxygen and hydrogen using renewable energy as an electricity source is currently considered the most promising method for carbon-free hydrogen production. Electrolyzers range in size from small apparatus-sized devices suitable for small-scale decentralized production of hydrogen to large centralized production facilities that could be directly connected to renewable or other zero-emission forms of electricity generation. A number of different electrolyzer types exist that operate on different principles: polymer electrolyte membrane (PEM) electrolyzers, alkaline electrolyzers and solid electrolyzers.26 An overview of the general process of water electrolysis for hydrogen production is given in Fig. 5. By-product oxygen from water hydrolysis can be used in combustion processes in the form of oxygen-enriched air to overcome mass transfer limitations and increase the flame speed and temperature. https://pubs.rsc.org/en/content/articlelanding/2024/gc/d3gc02410e",Internet/Technology,Effect Analysis,Q&A "Respond succinctly and directly. Refer only to the provided document. After your answer, provide any relevant quotes from the source document in italics.","Using only the context document, what are the 4 plant-based diet indexes?","**Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults** Abstract Background Previous studies have documented the cardiometabolic health benefits of plant‐based diets; however, these studies were conducted in selected study populations that had narrow generalizability. Methods and Results We used data from a community‐based cohort of middle‐aged adults (n=12 168) in the ARIC (Atherosclerosis Risk in Communities) study who were followed up from 1987 through 2016. Participants’ diet was classified using 4 diet indexes. In the overall plant‐based diet index and provegetarian diet index, higher intakes of all or selected plant foods received higher scores; in the healthy plant‐based diet index, higher intakes of only the healthy plant foods received higher scores; in the less healthy plant‐based diet index, higher intakes of only the less healthy plant foods received higher scores. In all indexes, higher intakes of animal foods received lower scores. Results from Cox proportional hazards models showed that participants in the highest versus lowest quintile for adherence to overall plant‐based diet index or provegetarian diet had a 16%, 31% to 32%, and 18% to 25% lower risk of cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality, respectively, after adjusting for important confounders (all P<0.05 for trend). Higher adherence to a healthy plant‐based diet index was associated with a 19% and 11% lower risk of cardiovascular disease mortality and all‐cause mortality, respectively, but not incident cardiovascular disease (P<0.05 for trend). No associations were observed between the less healthy plant‐based diet index and the outcomes. Conclusions Diets higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population. Clinical Perspective What Is New? • Plant‐based diets, diets that emphasize higher intakes of plant foods and lower intakes of animal foods, are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality in a general US adult population. • Healthful plant‐based diets, diets higher in nutrient‐dense plant foods and lower in refined carbohydrates and animal foods, are associated with a lower risk of cardiovascular disease mortality and all‐cause mortality, but not incident cardiovascular disease. What Are the Clinical Implications? • Our results suggest that dietary patterns that are relatively higher in plant foods and relatively lower in animal foods may confer benefits for cardiovascular health. • Future research examining whether the quality of plant foods (healthful versus less healthful) within the framework of an overall plant‐based diet is associated with cardiovascular disease and all‐cause mortality is warranted. Introduction Plant‐based diets are dietary patterns that emphasize higher intakes of plant foods and are low in animal foods. Vegetarian diets, a type of plant‐based diet, with a focus on restriction of different types of animal foods (meat, poultry, or fish), have been associated with a lower risk of cardiovascular risk factors, such as obesity, hypertension, type 2 diabetes mellitus, and ischemic heart disease.1, 2, 3 However, prospective cohort studies have shown mixed results on the associations with cardiovascular disease mortality and all‐cause mortality.4, 5, 6 These previous studies were conducted in selected study populations that were mostly composed of Seventh‐Day Adventists, vegetarians, or health‐conscious individuals; thus, they had relatively narrow generalizability.4, 5, 7, 8, 9 Although prior studies have characterized participants’ diets using a relatively simple classification method based on frequency of animal food consumption,4, 5, 6 there have since been more comprehensive attempts to assess an individual's diet using plant‐based diet indexes.10, 11, 12, 13 These indexes give higher scores for higher consumption of plant foods and lower consumption of animal foods, allowing researchers to examine whether the degree of adherence to an overall plant‐based diet is associated with health outcomes. Studies that used such indexes (ie, an overall plant‐based diet index [PDI] or a provegetarian diet index) found that greater adherence to these diets was associated with a lower risk of type 2 diabetes mellitus, coronary heart disease, and all‐cause mortality.10, 11, 12 In addition, some plant‐based indexes separately scored healthful (whole grains, vegetables, and plant proteins) and unhealthful (refined carbohydrates and sugar) plant sources of food. Healthful plant‐based diets, which scored higher intakes of only healthful plant foods higher, were more strongly inversely associated with type 2 diabetes mellitus and coronary heart disease than the overall plant‐based diets.11, 12 In contrast, greater adherence to less healthful (unhealthful) plant‐based diets, which scored higher intakes of only less healthful plant foods higher, were associated with a higher risk of these conditions.11, 12 Given the limited evidence on plant‐based diets in the general population and recent developments in plant‐based diet scores, the objectives of the present study were as follows: (1) to evaluate whether overall plant‐based diets are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality in a general US population; and (2) to assess if the association differed by adherence to healthful and less healthful plant‐based diets using 4 a priori defined plant‐based diet scores (overall plant‐based diet, healthy plant‐based diet, less healthy plant‐based diet, and provegetarian diet indexes). Study Design We used data from a community‐based cohort of middle‐aged men and women (45–64 years of age at baseline, n=15 792) in the ARIC study. From 1987 to 1989, participants from 4 US communities (Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, MN; and Jackson, MS) were enrolled in the study. Follow‐up visits occurred in 1990 to 1992 (visit 2), 1993 to 1995 (visit 3), 1996 to 1998 (visit 4), 2011 to 2013 (visit 5), and 2016 to 2017 (visit 6).14 The Institutional Review Board at each study site approved the study protocol, and participants provided informed consent. Dietary Assessment At baseline and visit 3, participants’ usual intake of foods and beverages was assessed by trained interviewers using a modified version of the 66‐item semiquantitative Willett food frequency questionnaire. Participants indicated the frequency with which they consumed foods and beverages of a defined serving size in the previous year. Visual guides, such as glasses and measuring cups, were provided for participants to estimate portion size. The reliability of the food frequency questionnaire was assessed in a random sample of ARIC study participants (n=419) from all 4 study sites at visit 2.15 Nutrient and total energy intakes were derived through multiplying consumption of food by nutrient content of each item in the food frequency questionnaire. Plant‐Based Diet Scores The ARIC study did not assess whether participants were following a plant‐based diet. We used established plant‐based diet scores (PDI, healthy plant‐based diet index [hPDI], less healthy [unhealthy] plant‐based diet index [uPDI], and provegetarian diet index) to assess participants’ degree of adherence to plant‐based diets on the basis of their reported dietary intake on the food frequency questionnaire. We used these 4 plant‐based diet indexes to provide comprehensive and nuanced characterization of dietary intakes because the indexes differed from each other in scoring of food groups within the indexes. For instance, the PDI was more comprehensive than the provegetarian index in that the PDI assessed dietary intakes of plant foods high in refined carbohydrates (fruit juices, sugar‐sweetened beverages, sweets, and desserts). Consistent with some ethically motivated dietary patterns that are focused on the exclusion of animal sources of food and have less of an emphasis on the quality of plant foods, the provegetarian diet index provides a more simplistic score of the diet in that these refined carbohydrate food groups were not assessed. Further details on differences and construction of the scores have been published previously and are available in Data S1.10, 11, 12, 13, 16 The PDI, hPDI, and uPDI had a possible range from 17 to 85, and the provegetarian diet index had a possible range from 11 to 55. All scores were divided into quintiles for analyses. Outcome Assessment Incident cardiovascular disease events and deaths (cardiovascular and all cause) were ascertained through annual telephone calls with participants or proxies, active surveillance of local hospital discharge records and state death records, and linkage to the National Death Index from baseline to December 31, 2016. Incident cardiovascular disease was defined as a composite outcome of coronary heart disease, stroke, and heart failure. Incident coronary heart disease was defined as hospitalized myocardial infarction or fatal coronary heart disease.17 Incident stroke was defined as definite or probable stroke, which was adjudicated.18 Incident heart failure was defined as hospitalization or death, with International Classification of Diseases, Ninth Revision (ICD‐9), code 428 or International Classification of Diseases, Tenth Revision (ICD‐10), code I50.19 All‐cause mortality was defined as deaths attributable to any cause, and cardiovascular disease mortality was defined as deaths with ICD‐9 codes 390 to 459 or ICD‐10 codes I00 to I99. Covariate Assessment At baseline, participants’ sociodemographic information (age, sex, race/ethnicity, and education), health behaviors (cigarette smoking, frequency and duration of physical activity, alcohol intake, and margarine intake), medication use (lipid‐lowering medication use, antihypertensive medication use, or diabetes mellitus medication use), and health conditions (diagnosis of diseases) were collected by self‐reports. Trained staff measured participants’ weight and height, which was used to calculate body mass index (BMI; kg/m2). Those whose BMI was ≤25 kg/m2 were classified as normal weight, those whose BMI was from 25 to <30 kg/m2 were classified as overweight, and those whose BMI was ≥30 kg/m2 were classified as obese. An enzymatic method was used to measure total cholesterol concentration.20 A certified technician measured participants’ blood pressure 3 times, and the second and third measurements were averaged. The modified hexokinase/glucose‐6‐phosphate dehydrogenase method was used to measure blood glucose concentrations. Baseline kidney function (estimated glomerular filtration rate) was estimated from serum creatinine measurement using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation.21 We defined hypertension as systolic blood pressure of ≥140 mm Hg, diastolic blood pressure of ≥90 mm Hg, or antihypertensive medication use in the past 2 weeks. We defined diabetes mellitus as fasting glucose concentration of ≥126 mg/dL, nonfasting blood glucose concentration of ≥200 mg/dL, self‐reported physician's diagnosis of diabetes mellitus, or diabetes mellitus medication use in the past 2 weeks.","{Task Information} ================== Respond succinctly and directly. Refer only to the provided document. After your answer, provide any relevant quotes from the source document in italics. ================ {Query} ================== Using only the context document, what are the 4 plant-based diet indexes? ================ {Passage} ================== **Plant‐Based Diets Are Associated With a Lower Risk of Incident Cardiovascular Disease, Cardiovascular Disease Mortality, and All‐Cause Mortality in a General Population of Middle‐Aged Adults** Abstract Background Previous studies have documented the cardiometabolic health benefits of plant‐based diets; however, these studies were conducted in selected study populations that had narrow generalizability. Methods and Results We used data from a community‐based cohort of middle‐aged adults (n=12 168) in the ARIC (Atherosclerosis Risk in Communities) study who were followed up from 1987 through 2016. Participants’ diet was classified using 4 diet indexes. In the overall plant‐based diet index and provegetarian diet index, higher intakes of all or selected plant foods received higher scores; in the healthy plant‐based diet index, higher intakes of only the healthy plant foods received higher scores; in the less healthy plant‐based diet index, higher intakes of only the less healthy plant foods received higher scores. In all indexes, higher intakes of animal foods received lower scores. Results from Cox proportional hazards models showed that participants in the highest versus lowest quintile for adherence to overall plant‐based diet index or provegetarian diet had a 16%, 31% to 32%, and 18% to 25% lower risk of cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality, respectively, after adjusting for important confounders (all P<0.05 for trend). Higher adherence to a healthy plant‐based diet index was associated with a 19% and 11% lower risk of cardiovascular disease mortality and all‐cause mortality, respectively, but not incident cardiovascular disease (P<0.05 for trend). No associations were observed between the less healthy plant‐based diet index and the outcomes. Conclusions Diets higher in plant foods and lower in animal foods were associated with a lower risk of cardiovascular morbidity and mortality in a general population. Clinical Perspective What Is New? • Plant‐based diets, diets that emphasize higher intakes of plant foods and lower intakes of animal foods, are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality in a general US adult population. • Healthful plant‐based diets, diets higher in nutrient‐dense plant foods and lower in refined carbohydrates and animal foods, are associated with a lower risk of cardiovascular disease mortality and all‐cause mortality, but not incident cardiovascular disease. What Are the Clinical Implications? • Our results suggest that dietary patterns that are relatively higher in plant foods and relatively lower in animal foods may confer benefits for cardiovascular health. • Future research examining whether the quality of plant foods (healthful versus less healthful) within the framework of an overall plant‐based diet is associated with cardiovascular disease and all‐cause mortality is warranted. Introduction Plant‐based diets are dietary patterns that emphasize higher intakes of plant foods and are low in animal foods. Vegetarian diets, a type of plant‐based diet, with a focus on restriction of different types of animal foods (meat, poultry, or fish), have been associated with a lower risk of cardiovascular risk factors, such as obesity, hypertension, type 2 diabetes mellitus, and ischemic heart disease.1, 2, 3 However, prospective cohort studies have shown mixed results on the associations with cardiovascular disease mortality and all‐cause mortality.4, 5, 6 These previous studies were conducted in selected study populations that were mostly composed of Seventh‐Day Adventists, vegetarians, or health‐conscious individuals; thus, they had relatively narrow generalizability.4, 5, 7, 8, 9 Although prior studies have characterized participants’ diets using a relatively simple classification method based on frequency of animal food consumption,4, 5, 6 there have since been more comprehensive attempts to assess an individual's diet using plant‐based diet indexes.10, 11, 12, 13 These indexes give higher scores for higher consumption of plant foods and lower consumption of animal foods, allowing researchers to examine whether the degree of adherence to an overall plant‐based diet is associated with health outcomes. Studies that used such indexes (ie, an overall plant‐based diet index [PDI] or a provegetarian diet index) found that greater adherence to these diets was associated with a lower risk of type 2 diabetes mellitus, coronary heart disease, and all‐cause mortality.10, 11, 12 In addition, some plant‐based indexes separately scored healthful (whole grains, vegetables, and plant proteins) and unhealthful (refined carbohydrates and sugar) plant sources of food. Healthful plant‐based diets, which scored higher intakes of only healthful plant foods higher, were more strongly inversely associated with type 2 diabetes mellitus and coronary heart disease than the overall plant‐based diets.11, 12 In contrast, greater adherence to less healthful (unhealthful) plant‐based diets, which scored higher intakes of only less healthful plant foods higher, were associated with a higher risk of these conditions.11, 12 Given the limited evidence on plant‐based diets in the general population and recent developments in plant‐based diet scores, the objectives of the present study were as follows: (1) to evaluate whether overall plant‐based diets are associated with a lower risk of incident cardiovascular disease, cardiovascular disease mortality, and all‐cause mortality in a general US population; and (2) to assess if the association differed by adherence to healthful and less healthful plant‐based diets using 4 a priori defined plant‐based diet scores (overall plant‐based diet, healthy plant‐based diet, less healthy plant‐based diet, and provegetarian diet indexes). Study Design We used data from a community‐based cohort of middle‐aged men and women (45–64 years of age at baseline, n=15 792) in the ARIC study. From 1987 to 1989, participants from 4 US communities (Washington County, Maryland; Forsyth County, North Carolina; Minneapolis, MN; and Jackson, MS) were enrolled in the study. Follow‐up visits occurred in 1990 to 1992 (visit 2), 1993 to 1995 (visit 3), 1996 to 1998 (visit 4), 2011 to 2013 (visit 5), and 2016 to 2017 (visit 6).14 The Institutional Review Board at each study site approved the study protocol, and participants provided informed consent. Dietary Assessment At baseline and visit 3, participants’ usual intake of foods and beverages was assessed by trained interviewers using a modified version of the 66‐item semiquantitative Willett food frequency questionnaire. Participants indicated the frequency with which they consumed foods and beverages of a defined serving size in the previous year. Visual guides, such as glasses and measuring cups, were provided for participants to estimate portion size. The reliability of the food frequency questionnaire was assessed in a random sample of ARIC study participants (n=419) from all 4 study sites at visit 2.15 Nutrient and total energy intakes were derived through multiplying consumption of food by nutrient content of each item in the food frequency questionnaire. Plant‐Based Diet Scores The ARIC study did not assess whether participants were following a plant‐based diet. We used established plant‐based diet scores (PDI, healthy plant‐based diet index [hPDI], less healthy [unhealthy] plant‐based diet index [uPDI], and provegetarian diet index) to assess participants’ degree of adherence to plant‐based diets on the basis of their reported dietary intake on the food frequency questionnaire. We used these 4 plant‐based diet indexes to provide comprehensive and nuanced characterization of dietary intakes because the indexes differed from each other in scoring of food groups within the indexes. For instance, the PDI was more comprehensive than the provegetarian index in that the PDI assessed dietary intakes of plant foods high in refined carbohydrates (fruit juices, sugar‐sweetened beverages, sweets, and desserts). Consistent with some ethically motivated dietary patterns that are focused on the exclusion of animal sources of food and have less of an emphasis on the quality of plant foods, the provegetarian diet index provides a more simplistic score of the diet in that these refined carbohydrate food groups were not assessed. Further details on differences and construction of the scores have been published previously and are available in Data S1.10, 11, 12, 13, 16 The PDI, hPDI, and uPDI had a possible range from 17 to 85, and the provegetarian diet index had a possible range from 11 to 55. All scores were divided into quintiles for analyses. Outcome Assessment Incident cardiovascular disease events and deaths (cardiovascular and all cause) were ascertained through annual telephone calls with participants or proxies, active surveillance of local hospital discharge records and state death records, and linkage to the National Death Index from baseline to December 31, 2016. Incident cardiovascular disease was defined as a composite outcome of coronary heart disease, stroke, and heart failure. Incident coronary heart disease was defined as hospitalized myocardial infarction or fatal coronary heart disease.17 Incident stroke was defined as definite or probable stroke, which was adjudicated.18 Incident heart failure was defined as hospitalization or death, with International Classification of Diseases, Ninth Revision (ICD‐9), code 428 or International Classification of Diseases, Tenth Revision (ICD‐10), code I50.19 All‐cause mortality was defined as deaths attributable to any cause, and cardiovascular disease mortality was defined as deaths with ICD‐9 codes 390 to 459 or ICD‐10 codes I00 to I99. Covariate Assessment At baseline, participants’ sociodemographic information (age, sex, race/ethnicity, and education), health behaviors (cigarette smoking, frequency and duration of physical activity, alcohol intake, and margarine intake), medication use (lipid‐lowering medication use, antihypertensive medication use, or diabetes mellitus medication use), and health conditions (diagnosis of diseases) were collected by self‐reports. Trained staff measured participants’ weight and height, which was used to calculate body mass index (BMI; kg/m2). Those whose BMI was ≤25 kg/m2 were classified as normal weight, those whose BMI was from 25 to <30 kg/m2 were classified as overweight, and those whose BMI was ≥30 kg/m2 were classified as obese. An enzymatic method was used to measure total cholesterol concentration.20 A certified technician measured participants’ blood pressure 3 times, and the second and third measurements were averaged. The modified hexokinase/glucose‐6‐phosphate dehydrogenase method was used to measure blood glucose concentrations. Baseline kidney function (estimated glomerular filtration rate) was estimated from serum creatinine measurement using the 2009 Chronic Kidney Disease Epidemiology Collaboration equation.21 We defined hypertension as systolic blood pressure of ≥140 mm Hg, diastolic blood pressure of ≥90 mm Hg, or antihypertensive medication use in the past 2 weeks. We defined diabetes mellitus as fasting glucose concentration of ≥126 mg/dL, nonfasting blood glucose concentration of ≥200 mg/dL, self‐reported physician's diagnosis of diabetes mellitus, or diabetes mellitus medication use in the past 2 weeks.",Medical,Fact Finding,Q&A "Write your response in a table containing bullet points of information. Ensure to answer the question using only the information provided in the context block. If it is not possible to fully answer the question with the text provided, say, “I’m sorry, I cannot answer that question due to lack of context”.","Summarise and simplify how a hash works and explain how this is different from a nonce, each in two to five sentences.","Cryptocurrency Mining There are three primary approaches to gaining ownership of Bitcoin: purchase Bitcoin directly by exchanging conventional money and a paying an exchange fee; earn Bitcoin in return for a product or service; or create Bitcoin through mining. 5 Bitcoin and other cryptocurrencies each implement their own blockchain: mining is the creation and publication of a new block in a blockchain.6 Early cryptocurrency platforms, like Bitcoin, required the use of mining to validate transactions. In blockchain platforms generally, miners—those seeking to add a block to a blockchain—are incentivized to improve their value in that blockchain through either a monetary, reputational, or stake award, for example. New blocks may be added to a blockchain through a variety of methods. For Bitcoin, new blocks are added to the blockchain through proof-of-work (PoW). Under PoW, miners are presented a difficult computational problem, or puzzle. PoW identifies a numeric value (called a nonce), which is used to generate an authenticator (hash value). Hash values are used to ensure the integrity of data, in this case, that a block of data in the blockchain has not been modified. Hashes are determined by submitting the data through an algorithm that will output a string of characters. By inserting the nonce into the algorithm, miners seek to change the hashvalue. The problem Bitcoin miners are trying to solve is the creation of a hash value for a given block which begins with a certain number of zeros. They add data to the block through changing the nonce in order to change the hash value and discover the solution. Identifying these valid nonces and hashes is computationally intensive, and the essence of mining.7 The security properties of hash algorithms are such that a miner tests nonces until a valid hash is found for a block.","Summarise and simplify how a hash works and explain how this is different from a nonce, each in two to five sentences. Write your response in a table containing bullet points of information. Ensure to answer the question using only the information provided in the context block. If it is not possible to fully answer the question with the text provided, say, “I’m sorry, I cannot answer that question due to lack of context”. Cryptocurrency Mining There are three primary approaches to gaining ownership of Bitcoin: purchase Bitcoin directly by exchanging conventional money and a paying an exchange fee; earn Bitcoin in return for a product or service; or create Bitcoin through mining. 5 Bitcoin and other cryptocurrencies each implement their own blockchain: mining is the creation and publication of a new block in a blockchain.6 Early cryptocurrency platforms, like Bitcoin, required the use of mining to validate transactions. In blockchain platforms generally, miners—those seeking to add a block to a blockchain—are incentivized to improve their value in that blockchain through either a monetary, reputational, or stake award, for example. New blocks may be added to a blockchain through a variety of methods. For Bitcoin, new blocks are added to the blockchain through proof-of-work (PoW). Under PoW, miners are presented a difficult computational problem, or puzzle. PoW identifies a numeric value (called a nonce), which is used to generate an authenticator (hash value). Hash values are used to ensure the integrity of data, in this case, that a block of data in the blockchain has not been modified. Hashes are determined by submitting the data through an algorithm that will output a string of characters. By inserting the nonce into the algorithm, miners seek to change the hashvalue. The problem Bitcoin miners are trying to solve is the creation of a hash value for a given block which begins with a certain number of zeros. They add data to the block through changing the nonce in order to change the hash value and discover the solution. Identifying these valid nonces and hashes is computationally intensive, and the essence of mining.7 The security properties of hash algorithms are such that a miner tests nonces until a valid hash is found for a block. ",Financial,Summarize & Simplify,Text Transformation Answer in a single sentence. Use only the document as your source.,According to the above article what causes heart disease?,"** Heart Disease** The human heart beats about 2.5 billion times over an average lifetime, pushing millions of gallons of blood throughout the body. This steady blood flow carries oxygen, hormones, and other compounds. It also whisks away the waste products of metabolism. Given the heart's never-ending workload, it's a wonder it performs so well for so long. But it can also fail, brought down by poor diet, lack of exercise, smoking, infection, unfavorable genes, and more. Heart disease and cardiovascular disease are two of the most significant heart health issues. They are often used interchangeably, but they are not the same. Heart disease refers to diseases of the heart, such as coronary artery disease, heart failure, heart valve abnormalities, and abnormal heart rhythms. Cardiovascular disease is a catch-all term for all heart and blood vessel diseases. It includes heart disease, but also stroke. Does a coronary stent make sense for stable angina? What are the different types of heart disease? Heart disease refers to diseases that affect the function and condition of the heart. There are several kinds of heart disease, including: cardiomyopathy: a heart muscle disease that causes the heart to become abnormally enlarged, thickened, and/or stiffened. congenital heart disease: heart disease or abnormalities in the heart's structure that are present at birth. coronary artery disease: accumulation of cholesterol-filled plaques, which clog the arteries that supply blood and oxygen to the heart. endocarditis: infection and inflammation of the heart valves and the inner lining of the heart chambers, called the endocardium. heart attack (myocardial infarction): the sudden stopping of blood flow to part of the heart muscle heart failure: the inability of the heart to pump as forcefully or efficiently as needed to supply the body with oxygenated blood. heart rhythm disorders (arrhythmias): heartbeats that are too fast, too slow, or irregular. heart valve disorders: problems with the valves that control blood flow from one part of the heart to another part of the heart or to the body. myocarditis: inflammation of the myocardium, the middle layer of the heart wall, that decreases the ability of the heart to pump blood normally. pericarditis: inflammation of the pericardium, a thin sac surrounding the heart. sudden cardiac arrest: the sudden cessation of the heartbeat. You might also be interested in... Controlling Your Blood Pressure An alarming one in three American adults has high blood pressure. Known medically as hypertension, many people don't even know they have it, because high blood pressure has no symptoms or warning signs. But when elevated blood pressure is accompanied by abnormal cholesterol and blood sugar levels, the damage to your arteries, kidneys, and heart accelerates exponentially. Fortunately, high blood pressure is easy to detect and treat. In the Special Health Report, Controlling Your Blood Pressure, find out how to keep blood pressure in a healthy range simply by making lifestyle changes, such as losing weight, increasing activity, and eating more healthfully. READ MORE What causes heart disease? The most common type of heart disease is coronary artery disease (CAD), and the leading cause of CAD is atherosclerosis, the buildup of cholesterol plaque inside the coronary arteries. Too much plaque limits blood flow through the arteries that supply blood to the heart. Restricted blood flow can cause chest pain or pressure (known as angina) and requires immediate medical attention. When plaque ruptures, it can form a blood clot that stops blood flow and triggers a heart attack. The risk factors for atherosclerosis (and thus CAD) include: High total blood cholesterol level High level of LDL (bad) cholesterol High levels of triglycerides High levels of lipoprotein(a) High blood pressure (hypertension) Diabetes Family history of heart disease Smoking Obesity Physical inactivity Inflammation Stroke: Strategies to prevent, treat, and recover from a ""brain attack"" Protect your brain: That’s the strategy that Harvard doctors recommend in this report on preventing and treating stroke. Whether you’ve already had a mini-stroke or a major stroke, or have been warned that your high blood pressure might cause a future stroke, Stroke: Strategies to prevent, treat, and recover from a ""brain attack"" provides help and advice. READ MORE Heart disease symptoms A variety of symptoms and signs may indicate heart disease. If you experience any of the following for no apparent reason, immediately report them to your doctor. Fatigue. Fatigue can be caused by many illnesses and medicines. But constant, new fatigue can sometimes signal two kinds of heart disease: heart failure and coronary artery disease. Unexplained aches or pains. Blockage of blood to the heart muscle can cause pain or pressure in the chest, shoulders, arms, back, jaw, or abdomen, primarily when pain in these locations occurs with exercise and disappears with rest. Shortness of breath. Unexplained shortness of breath that occurs with small amounts of activity. Swollen legs, feet, or ankles. The kind of swelling that leaves an indentation if you press your finger into it could be a sign of heart failure. Heart palpitations. Palpitations refers to a heartbeat that feels irregular or rapid. Most palpitations may be caused by anxiety, caffeine intake, or dehydration. But sometimes they indicate a heart problem. You might also be interested in... Managing Your Cholesterol Managing Your Cholesterol offers up-to-date information to help you or a loved one keep cholesterol in check. The report spells out what are healthy and unhealthy cholesterol levels, and offers specific ways to keep cholesterol in line. It covers cholesterol tests and the genetics of cholesterol. The report also focuses on treatments based on the latest scientific evidence, including the pros and cons of statins and other medications, and provides the lowdown on other substances advertised to lower cholesterol. Managing Your Cholesterol can also help you work with your doctor to individualize your treatment. READ MORE How can you prevent heart disease? The best way to prevent heart disease is to adopt heart-healthy habits. These include managing blood pressure and cholesterol levels, eating a plant-based diet, adopting regular exercise, maintaining a proper weight, getting enough sleep, and not smoking. Blood pressure. High blood pressure makes the heart work harder, which can weaken the heart muscle over time. Blood pressure is measured in millimeters of mercury (mm Hg) and is categorized as follows: Normal: Less than 120/80 mm Hg Elevated: 120/less than 80 to 129/less than 80 mm Hg Stage 1 hypertension: 130/80 to 139/89 mm Hg Stage 2 hypertension: 140/90 mm Hg and above Cholesterol. There are two main types: “bad” low-density lipoprotein (LDL) and “good” high-density lipoprotein (HDL). Ideally, most adults should keep their LDL below 100 milligrams per deciliter (mg/dL) and their HDL above 40 mg/dL. However, your ideal numbers may differ based on your health, risk factors for heart disease, and individual goals, as determined in consultation with your doctor. Diet. Following a plant-based diet is known to protect against heart disease. The plant diets that have been most studied for heart health are the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet. Each emphasizes eating foods associated with heart-healthy benefits, such as whole grains, fruits, vegetables, legumes, nuts and seeds, fatty fish, and healthy oils like olive oil, and reducing the intake of red meat and processed foods. Exercise. Guidelines recommend that adults engage in at least 150 minutes of moderate-intensity aerobic activity per week, which breaks down to 30 minutes daily, five days a week. But this is the minimum. Evidence suggests that doing more is better. Weight. About 30% of American adults are classified as overweight. While it’s natural for people’s weight to increase somewhat with age, even five to 10 pounds over your ideal number is associated with an increased risk of heart disease. Check with your doctor to determine your weight range for your gender, age, and body type. Sleep. Experts recommend that adults get at least seven hours of sleep per night. Studies have found that less than this amount is associated with heart disease risk factors like higher stress levels, increased inflammation, high blood pressure, and weight gain. Smoking. Smokers have a much higher heart disease risk than never-smokers and two to three times the risk of early death. Certain medications and nicotine replacement therapies can help people quit. Speak with your doctor about these or other options.","[Task Instructions] ================== Answer in a single sentence. Use only the document as your source. ================ [Query] ================== According to the above article what causes heart disease? ================ [Text] ================== ** Heart Disease** The human heart beats about 2.5 billion times over an average lifetime, pushing millions of gallons of blood throughout the body. This steady blood flow carries oxygen, hormones, and other compounds. It also whisks away the waste products of metabolism. Given the heart's never-ending workload, it's a wonder it performs so well for so long. But it can also fail, brought down by poor diet, lack of exercise, smoking, infection, unfavorable genes, and more. Heart disease and cardiovascular disease are two of the most significant heart health issues. They are often used interchangeably, but they are not the same. Heart disease refers to diseases of the heart, such as coronary artery disease, heart failure, heart valve abnormalities, and abnormal heart rhythms. Cardiovascular disease is a catch-all term for all heart and blood vessel diseases. It includes heart disease, but also stroke. Does a coronary stent make sense for stable angina? What are the different types of heart disease? Heart disease refers to diseases that affect the function and condition of the heart. There are several kinds of heart disease, including: cardiomyopathy: a heart muscle disease that causes the heart to become abnormally enlarged, thickened, and/or stiffened. congenital heart disease: heart disease or abnormalities in the heart's structure that are present at birth. coronary artery disease: accumulation of cholesterol-filled plaques, which clog the arteries that supply blood and oxygen to the heart. endocarditis: infection and inflammation of the heart valves and the inner lining of the heart chambers, called the endocardium. heart attack (myocardial infarction): the sudden stopping of blood flow to part of the heart muscle heart failure: the inability of the heart to pump as forcefully or efficiently as needed to supply the body with oxygenated blood. heart rhythm disorders (arrhythmias): heartbeats that are too fast, too slow, or irregular. heart valve disorders: problems with the valves that control blood flow from one part of the heart to another part of the heart or to the body. myocarditis: inflammation of the myocardium, the middle layer of the heart wall, that decreases the ability of the heart to pump blood normally. pericarditis: inflammation of the pericardium, a thin sac surrounding the heart. sudden cardiac arrest: the sudden cessation of the heartbeat. You might also be interested in... Controlling Your Blood Pressure An alarming one in three American adults has high blood pressure. Known medically as hypertension, many people don't even know they have it, because high blood pressure has no symptoms or warning signs. But when elevated blood pressure is accompanied by abnormal cholesterol and blood sugar levels, the damage to your arteries, kidneys, and heart accelerates exponentially. Fortunately, high blood pressure is easy to detect and treat. In the Special Health Report, Controlling Your Blood Pressure, find out how to keep blood pressure in a healthy range simply by making lifestyle changes, such as losing weight, increasing activity, and eating more healthfully. READ MORE What causes heart disease? The most common type of heart disease is coronary artery disease (CAD), and the leading cause of CAD is atherosclerosis, the buildup of cholesterol plaque inside the coronary arteries. Too much plaque limits blood flow through the arteries that supply blood to the heart. Restricted blood flow can cause chest pain or pressure (known as angina) and requires immediate medical attention. When plaque ruptures, it can form a blood clot that stops blood flow and triggers a heart attack. The risk factors for atherosclerosis (and thus CAD) include: High total blood cholesterol level High level of LDL (bad) cholesterol High levels of triglycerides High levels of lipoprotein(a) High blood pressure (hypertension) Diabetes Family history of heart disease Smoking Obesity Physical inactivity Inflammation Stroke: Strategies to prevent, treat, and recover from a ""brain attack"" Protect your brain: That’s the strategy that Harvard doctors recommend in this report on preventing and treating stroke. Whether you’ve already had a mini-stroke or a major stroke, or have been warned that your high blood pressure might cause a future stroke, Stroke: Strategies to prevent, treat, and recover from a ""brain attack"" provides help and advice. READ MORE Heart disease symptoms A variety of symptoms and signs may indicate heart disease. If you experience any of the following for no apparent reason, immediately report them to your doctor. Fatigue. Fatigue can be caused by many illnesses and medicines. But constant, new fatigue can sometimes signal two kinds of heart disease: heart failure and coronary artery disease. Unexplained aches or pains. Blockage of blood to the heart muscle can cause pain or pressure in the chest, shoulders, arms, back, jaw, or abdomen, primarily when pain in these locations occurs with exercise and disappears with rest. Shortness of breath. Unexplained shortness of breath that occurs with small amounts of activity. Swollen legs, feet, or ankles. The kind of swelling that leaves an indentation if you press your finger into it could be a sign of heart failure. Heart palpitations. Palpitations refers to a heartbeat that feels irregular or rapid. Most palpitations may be caused by anxiety, caffeine intake, or dehydration. But sometimes they indicate a heart problem. You might also be interested in... Managing Your Cholesterol Managing Your Cholesterol offers up-to-date information to help you or a loved one keep cholesterol in check. The report spells out what are healthy and unhealthy cholesterol levels, and offers specific ways to keep cholesterol in line. It covers cholesterol tests and the genetics of cholesterol. The report also focuses on treatments based on the latest scientific evidence, including the pros and cons of statins and other medications, and provides the lowdown on other substances advertised to lower cholesterol. Managing Your Cholesterol can also help you work with your doctor to individualize your treatment. READ MORE How can you prevent heart disease? The best way to prevent heart disease is to adopt heart-healthy habits. These include managing blood pressure and cholesterol levels, eating a plant-based diet, adopting regular exercise, maintaining a proper weight, getting enough sleep, and not smoking. Blood pressure. High blood pressure makes the heart work harder, which can weaken the heart muscle over time. Blood pressure is measured in millimeters of mercury (mm Hg) and is categorized as follows: Normal: Less than 120/80 mm Hg Elevated: 120/less than 80 to 129/less than 80 mm Hg Stage 1 hypertension: 130/80 to 139/89 mm Hg Stage 2 hypertension: 140/90 mm Hg and above Cholesterol. There are two main types: “bad” low-density lipoprotein (LDL) and “good” high-density lipoprotein (HDL). Ideally, most adults should keep their LDL below 100 milligrams per deciliter (mg/dL) and their HDL above 40 mg/dL. However, your ideal numbers may differ based on your health, risk factors for heart disease, and individual goals, as determined in consultation with your doctor. Diet. Following a plant-based diet is known to protect against heart disease. The plant diets that have been most studied for heart health are the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet. Each emphasizes eating foods associated with heart-healthy benefits, such as whole grains, fruits, vegetables, legumes, nuts and seeds, fatty fish, and healthy oils like olive oil, and reducing the intake of red meat and processed foods. Exercise. Guidelines recommend that adults engage in at least 150 minutes of moderate-intensity aerobic activity per week, which breaks down to 30 minutes daily, five days a week. But this is the minimum. Evidence suggests that doing more is better. Weight. About 30% of American adults are classified as overweight. While it’s natural for people’s weight to increase somewhat with age, even five to 10 pounds over your ideal number is associated with an increased risk of heart disease. Check with your doctor to determine your weight range for your gender, age, and body type. Sleep. Experts recommend that adults get at least seven hours of sleep per night. Studies have found that less than this amount is associated with heart disease risk factors like higher stress levels, increased inflammation, high blood pressure, and weight gain. Smoking. Smokers have a much higher heart disease risk than never-smokers and two to three times the risk of early death. Certain medications and nicotine replacement therapies can help people quit. Speak with your doctor about these or other options.",Medical,Find & Summarize,Text Transformation "Use only the provided context for your response, without relying on external information.",How much does a pair of Diamond 210 cost?,"Title: Wharfedale Diamonds Shine Even Brighter Wharfedale's classic Diamond lineage of high-performance, high-value speakers reaches new heights with the Diamond 200 Series Huntingdon, England -- For more than 30 years, Wharfedale’s famous Diamond speakers have served as the classic entry point to true high-fidelity sound, their exceptional value for money earning dozens of awards around the globe. Now, with the introduction of the all-new Diamond 200 Series, Wharfedale has once again raised the bar for affordable, high-performance loudspeakers. Replacing the critically acclaimed Diamond 100 Series, Diamond 200 comprises two standmount speakers and three floorstanding models, plus a center speaker for home cinema use. Given that the speakers’ predecessors were so highly rated for their sound quality, Wharfedale's engineers took an evolutionary approach, precisely targeting key areas to improve in order to make an already great loudspeaker range deliver even better value for money. Enhancements across the range include: New cabinet construction – a sandwich of particleboard between MDF, which has enabled improvements both aesthetic and sonic. New lacquered baffle design further enhances aesthetic qualities. Improved bass motor system with larger magnets makes the speakers easier to drive and boosts transient acoustic power. Enhanced 'Slot-Loaded Distributed Port' – improved airflow control lowers turbulence and hence reduces low-frequency distortion. Upgraded crossover networks further improve the integration between the drive units. The Wharfedale Diamond 200 Series in full The first Diamond 200 Series model to launch is the Diamond 220. Available now, this pivotal model is the latest evolution of Wharfedale’s classic Diamond standmount speaker – a neatly proportioned design with a 130mm mid/bass driver. It is the direct replacement for the best-selling Diamond 121 from the outgoing Diamond 100 Series, benefitting from all the enhancements described above, yet Wharfedale has managed to shave £30 off the RRP – the Diamond 220 has an RRP of just £199.95 per pair. The remaining Diamond 200 Series models arrive this month. These include the Diamond 210, an ultra-compact speaker for rear/surround duties or stereo applications where space is at a premium (£149.95 per pair), plus three floorstanders – the Diamond 230 (£499.95 per pair), Diamond 240 (£699.95 per pair), and Diamond 250 (£999.95 per pair). The Diamond 220C home cinema center speaker (£199.95) completes the range. Anyone wishing to compile a 5.1 or 7.1 surround sound package from the Diamond 200 Series can add an active subwoofer from Wharfedale’s highly rated PowerCube SPC range, selecting an appropriate model to suit their room. Many of the speakers’ core features are unchanged from the Diamond 100 Series. The bass and midrange cones are fashioned from woven Kevlar and incorporate semi-elliptical ‘break-up’ areas – visible as raised ‘V’ shapes on the cone’s surface – that smooth the response throughout the audible range. The dust cap is blended and treated to provide a smooth transition with the treble unit, which incorporates an advanced ferrite magnet system and a carefully constructed waveguide around the fabric dome for optimal dispersion. Bass performance is enhanced by a newly refined version of the Slot-Loaded Distributed Port, first introduced in the outgoing Diamond 100 Series. Instead of the usual circular reflex port, all Diamond 200 Series models incorporate a port that exits at the base of the speaker cabinet, loaded by a slot that is created by the plinth. This equalizes the air pressure to mimic that inside the cabinet, allowing smooth transition between the pressure variation in the cabinet and the low-frequency sound developed in the room. The result is deep, articulate and well-integrated bass, without the ‘chuffing’ that is often associated with regular front- or rear-mounted ports. It also allows the speakers to be placed closer to a rear wall than is appropriate with most competing designs, making them easier to position in an average room. No other speaker range at such affordable price points implements an advanced bass loading system of this kind. All Wharfedale Diamond 200 Series speakers come in a choice of four finishes – black, white, walnut, and rosewood – adding to their smart aesthetics and excellent value for money. Designer’s notes: Peter Comeau, Wharfedale’s Director of Acoustic Design Peter Comeau, Wharfedale’s Director of Acoustic Design, describes the improvements he and his team have brought to the Diamond 200 Series: When Wharfedale launched the very first Diamond in 1981, the company defined a new class of speaker that delivered genuine hi-fi accuracy and musical brio at a remarkably affordable price. Since then, every iteration of the famous Diamond line has adhered to that tradition but improved upon it. Our challenge with the Diamond 200 Series was to further enhance every model across the range, whilst maintaining the traditionally affordable retail prices that embody the Diamond ethos – no mean feat at a time when other manufacturers are being forced to raise the prices of equivalent ranges. It is no coincidence that research from loudspeakers further up the Wharfedale range has crept downwards into the Diamond 200 Series. Whilst higher retail price points permit the advanced research that lets Wharfedale engineers investigate cutting-edge performance in acoustic technology, the trick is to use the benefits of this research and apply it to materials that can be produced in higher quantities with the benefit of lower cost to production. That’s no more apparent than in the Diamond 200 Series’ new cabinet material. Research undertaken for Wharfedale’s upmarket Jade Series yielded a matrix of materials called Crystalam, which reduced the audibility of panel resonance and what our engineers call ‘cabinet hear-through’. This research showed that coherent materials, like raw MDF, have peak resonances (particularly in the midrange) that let sound out of a cabinet at volume levels that interfere with the sound from the drive units. Not surprisingly, this ‘hear-through’ causes a distinct coloration and character to the sound of such cabinets. In Jade’s Crystalam, Wharfedale put together a matrix of non-coherent materials comprising differing densities of particleboard and MDF, substantially reducing both panel resonance and cabinet hear-through. For the Diamond 200 Series, we found that a simpler ‘sandwich’ combination of particleboard and MDF, whilst not quite reaching to the absolute standards of Crystalam, yielded similar reductions in coloration at considerably lower cost. In addition, the inner and outer layers of MDF allow a superior finish to the cabinet veneers, enhancing the aesthetic quality of the speakers in comparison to the outgoing Diamond 100 Series. Topping this new cabinet material is a simple, one-piece baffle lacquered to a highly polished finish that cosmetically matches the silver-colored, diamond-cut drive unit surrounds. The result is an attractive appearance, with or without grilles, that makes Diamond 200 Series speakers look more expensive than they actually are, adding to their exceptional value for money. Additional improvements inside the speakers enhance sound quality in comparison to the already highly acclaimed Diamond 100 Series. Bass unit motor systems have been further refined, with corresponding increases in magnet size, making the speakers easier to drive and boosting transient acoustic power. Furthermore, we have taken note of how most users are placing their speakers in their rooms. These days, loudspeakers are often expected to blend into room furnishings rather than take up a significant amount of space. This is particularly true of low-cost speakers like those in the Diamond 200 Series, which are expected to fit seamlessly into average-size living rooms. For this reason, the ability to be positioned close to a rear wall is important. The balance of the Diamond 200 Series takes this into account, with the standmount speakers having a recommended minimum of 50mm to the rear wall, alongside a minimum of 200mm for the floorstanders – considerably closer positioning than is possible with many similar-sized designs. This freedom of positioning is aided by the Slot-Loaded Distributed Port, again grown out of our research into the Jade Aperiodic bass loading system. While the Diamond 200 Series bass system is strictly bass reflex, with its attendant bonus of high sensitivity, the slot-loaded port, which uses a gap between the plinth and the port exit in the base of the cabinet, aids the pressure differential between the port and the air in the room, increasing the energy transfer and making the system more efficient. Attendant with the increase in bass driver power, Diamond 200 Series speakers now have an added degree of airflow control to the port exit, which effectively reduces turbulence in this region and reduces low-frequency distortion. Finally, but not least of the Diamond 200 Series improvements, the crossovers have been refined over hundreds of hours of listening tests to further improve the integration between the drive units and herald a new level of realism to instruments and voices. The result of all these technical endeavors is, we feel, the best Diamond Series yet, delivering loudspeakers which reveal a whole new level of musical detail and transient attack, drawing the listener into the musical performance in a way that is normally only expected from speakers at a considerably higher price level.","[Query] How much does a pair of Diamond 210 cost? ================ [Task Description] Use only the provided context for your response, without relying on external information. ================ [Document] Title: Wharfedale Diamonds Shine Even Brighter Wharfedale's classic Diamond lineage of high-performance, high-value speakers reaches new heights with the Diamond 200 Series Huntingdon, England -- For more than 30 years, Wharfedale’s famous Diamond speakers have served as the classic entry point to true high-fidelity sound, their exceptional value for money earning dozens of awards around the globe. Now, with the introduction of the all-new Diamond 200 Series, Wharfedale has once again raised the bar for affordable, high-performance loudspeakers. Replacing the critically acclaimed Diamond 100 Series, Diamond 200 comprises two standmount speakers and three floorstanding models, plus a center speaker for home cinema use. Given that the speakers’ predecessors were so highly rated for their sound quality, Wharfedale's engineers took an evolutionary approach, precisely targeting key areas to improve in order to make an already great loudspeaker range deliver even better value for money. Enhancements across the range include: New cabinet construction – a sandwich of particleboard between MDF, which has enabled improvements both aesthetic and sonic. New lacquered baffle design further enhances aesthetic qualities. Improved bass motor system with larger magnets makes the speakers easier to drive and boosts transient acoustic power. Enhanced 'Slot-Loaded Distributed Port' – improved airflow control lowers turbulence and hence reduces low-frequency distortion. Upgraded crossover networks further improve the integration between the drive units. The Wharfedale Diamond 200 Series in full The first Diamond 200 Series model to launch is the Diamond 220. Available now, this pivotal model is the latest evolution of Wharfedale’s classic Diamond standmount speaker – a neatly proportioned design with a 130mm mid/bass driver. It is the direct replacement for the best-selling Diamond 121 from the outgoing Diamond 100 Series, benefitting from all the enhancements described above, yet Wharfedale has managed to shave £30 off the RRP – the Diamond 220 has an RRP of just £199.95 per pair. The remaining Diamond 200 Series models arrive this month. These include the Diamond 210, an ultra-compact speaker for rear/surround duties or stereo applications where space is at a premium (£149.95 per pair), plus three floorstanders – the Diamond 230 (£499.95 per pair), Diamond 240 (£699.95 per pair), and Diamond 250 (£999.95 per pair). The Diamond 220C home cinema center speaker (£199.95) completes the range. Anyone wishing to compile a 5.1 or 7.1 surround sound package from the Diamond 200 Series can add an active subwoofer from Wharfedale’s highly rated PowerCube SPC range, selecting an appropriate model to suit their room. Many of the speakers’ core features are unchanged from the Diamond 100 Series. The bass and midrange cones are fashioned from woven Kevlar and incorporate semi-elliptical ‘break-up’ areas – visible as raised ‘V’ shapes on the cone’s surface – that smooth the response throughout the audible range. The dust cap is blended and treated to provide a smooth transition with the treble unit, which incorporates an advanced ferrite magnet system and a carefully constructed waveguide around the fabric dome for optimal dispersion. Bass performance is enhanced by a newly refined version of the Slot-Loaded Distributed Port, first introduced in the outgoing Diamond 100 Series. Instead of the usual circular reflex port, all Diamond 200 Series models incorporate a port that exits at the base of the speaker cabinet, loaded by a slot that is created by the plinth. This equalizes the air pressure to mimic that inside the cabinet, allowing smooth transition between the pressure variation in the cabinet and the low-frequency sound developed in the room. The result is deep, articulate and well-integrated bass, without the ‘chuffing’ that is often associated with regular front- or rear-mounted ports. It also allows the speakers to be placed closer to a rear wall than is appropriate with most competing designs, making them easier to position in an average room. No other speaker range at such affordable price points implements an advanced bass loading system of this kind. All Wharfedale Diamond 200 Series speakers come in a choice of four finishes – black, white, walnut, and rosewood – adding to their smart aesthetics and excellent value for money. Designer’s notes: Peter Comeau, Wharfedale’s Director of Acoustic Design Peter Comeau, Wharfedale’s Director of Acoustic Design, describes the improvements he and his team have brought to the Diamond 200 Series: When Wharfedale launched the very first Diamond in 1981, the company defined a new class of speaker that delivered genuine hi-fi accuracy and musical brio at a remarkably affordable price. Since then, every iteration of the famous Diamond line has adhered to that tradition but improved upon it. Our challenge with the Diamond 200 Series was to further enhance every model across the range, whilst maintaining the traditionally affordable retail prices that embody the Diamond ethos – no mean feat at a time when other manufacturers are being forced to raise the prices of equivalent ranges. It is no coincidence that research from loudspeakers further up the Wharfedale range has crept downwards into the Diamond 200 Series. Whilst higher retail price points permit the advanced research that lets Wharfedale engineers investigate cutting-edge performance in acoustic technology, the trick is to use the benefits of this research and apply it to materials that can be produced in higher quantities with the benefit of lower cost to production. That’s no more apparent than in the Diamond 200 Series’ new cabinet material. Research undertaken for Wharfedale’s upmarket Jade Series yielded a matrix of materials called Crystalam, which reduced the audibility of panel resonance and what our engineers call ‘cabinet hear-through’. This research showed that coherent materials, like raw MDF, have peak resonances (particularly in the midrange) that let sound out of a cabinet at volume levels that interfere with the sound from the drive units. Not surprisingly, this ‘hear-through’ causes a distinct coloration and character to the sound of such cabinets. In Jade’s Crystalam, Wharfedale put together a matrix of non-coherent materials comprising differing densities of particleboard and MDF, substantially reducing both panel resonance and cabinet hear-through. For the Diamond 200 Series, we found that a simpler ‘sandwich’ combination of particleboard and MDF, whilst not quite reaching to the absolute standards of Crystalam, yielded similar reductions in coloration at considerably lower cost. In addition, the inner and outer layers of MDF allow a superior finish to the cabinet veneers, enhancing the aesthetic quality of the speakers in comparison to the outgoing Diamond 100 Series. Topping this new cabinet material is a simple, one-piece baffle lacquered to a highly polished finish that cosmetically matches the silver-colored, diamond-cut drive unit surrounds. The result is an attractive appearance, with or without grilles, that makes Diamond 200 Series speakers look more expensive than they actually are, adding to their exceptional value for money. Additional improvements inside the speakers enhance sound quality in comparison to the already highly acclaimed Diamond 100 Series. Bass unit motor systems have been further refined, with corresponding increases in magnet size, making the speakers easier to drive and boosting transient acoustic power. Furthermore, we have taken note of how most users are placing their speakers in their rooms. These days, loudspeakers are often expected to blend into room furnishings rather than take up a significant amount of space. This is particularly true of low-cost speakers like those in the Diamond 200 Series, which are expected to fit seamlessly into average-size living rooms. For this reason, the ability to be positioned close to a rear wall is important. The balance of the Diamond 200 Series takes this into account, with the standmount speakers having a recommended minimum of 50mm to the rear wall, alongside a minimum of 200mm for the floorstanders – considerably closer positioning than is possible with many similar-sized designs. This freedom of positioning is aided by the Slot-Loaded Distributed Port, again grown out of our research into the Jade Aperiodic bass loading system. While the Diamond 200 Series bass system is strictly bass reflex, with its attendant bonus of high sensitivity, the slot-loaded port, which uses a gap between the plinth and the port exit in the base of the cabinet, aids the pressure differential between the port and the air in the room, increasing the energy transfer and making the system more efficient. Attendant with the increase in bass driver power, Diamond 200 Series speakers now have an added degree of airflow control to the port exit, which effectively reduces turbulence in this region and reduces low-frequency distortion. Finally, but not least of the Diamond 200 Series improvements, the crossovers have been refined over hundreds of hours of listening tests to further improve the integration between the drive units and herald a new level of realism to instruments and voices. The result of all these technical endeavors is, we feel, the best Diamond Series yet, delivering loudspeakers which reveal a whole new level of musical detail and transient attack, drawing the listener into the musical performance in a way that is normally only expected from speakers at a considerably higher price level.",Retail/Product,Fact Finding,Q&A "Rely only on the context document, with no outside information.",According to this document you shouldn't use which two things in conjunction on the same CPU or memory sticks?,"**Best practices for performance and scaling for small to medium workloads in Azure Kubernetes Service (AKS):** This article focuses on general best practices for small to medium workloads. For best practices specific to large workloads, see Performance and scaling best practices for large workloads in Azure Kubernetes Service (AKS). As you deploy and maintain clusters in AKS, you can use the following best practices to help you optimize performance and scaling. In this article, you learn about: Tradeoffs and recommendations for autoscaling your workloads. Managing node scaling and efficiency based on your workload demands. Networking considerations for ingress and egress traffic. Monitoring and troubleshooting control plane and node performance. Capacity planning, surge scenarios, and cluster upgrades. Storage and networking considerations for data plane performance. Application autoscaling vs. infrastructure autoscaling Application autoscaling Application autoscaling is useful when dealing with cost optimization or infrastructure limitations. A well-configured autoscaler maintains high availability for your application while also minimizing costs. You only pay for the resources required to maintain availability, regardless of the demand. For example, if an existing node has space but not enough IPs in the subnet, it might be able to skip the creation of a new node and instead immediately start running the application on a new pod. Horizontal Pod autoscaling Implementing horizontal pod autoscaling is useful for applications with a steady and predictable resource demand. The Horizontal Pod Autoscaler (HPA) dynamically scales the number of pod replicas, which effectively distributes the load across multiple pods and nodes. This scaling mechanism is typically most beneficial for applications that can be decomposed into smaller, independent components capable of running in parallel. The HPA provides resource utilization metrics by default. You can also integrate custom metrics or leverage tools like the Kubernetes Event-Driven Autoscaler (KEDA) (Preview). These extensions allow the HPA to make scaling decisions based on multiple perspectives and criteria, providing a more holistic view of your application's performance. This is especially helpful for applications with varying complex scaling requirements. Note If maintaining high availability for your application is a top priority, we recommend leaving a slightly higher buffer for the minimum pod number for your HPA to account for scaling time. Vertical Pod autoscaling Implementing vertical pod autoscaling is useful for applications with fluctuating and unpredictable resource demands. The Vertical Pod Autoscaler (VPA) allows you to fine-tune resource requests, including CPU and memory, for individual pods, enabling precise control over resource allocation. This granularity minimizes resource waste and enhances the overall efficiency of cluster utilization. The VPA also streamlines application management by automating resource allocation, freeing up resources for critical tasks. Warning You shouldn't use the VPA in conjunction with the HPA on the same CPU or memory metrics. This combination can lead to conflicts, as both autoscalers attempt to respond to changes in demand using the same metrics. However, you can use the VPA for CPU or memory in conjunction with the HPA for custom metrics to prevent overlap and ensure that each autoscaler focuses on distinct aspects of workload scaling. Note The VPA works based on historical data. We recommend waiting at least 24 hours after deploying the VPA before applying any changes to give it time to collect recommendation data. Infrastructure autoscaling Cluster autoscaling Implementing cluster autoscaling is useful if your existing nodes lack sufficient capacity, as it helps with scaling up and provisioning new nodes. When considering cluster autoscaling, the decision of when to remove a node involves a tradeoff between optimizing resource utilization and ensuring resource availability. Eliminating underutilized nodes enhances cluster utilization but might result in new workloads having to wait for resources to be provisioned before they can be deployed. It's important to find a balance between these two factors that aligns with your cluster and workload requirements and configure the cluster autoscaler profile settings accordingly. The Cluster Autoscaler profile settings apply universally to all autoscaler-enabled node pools in your cluster. This means that any scaling actions occurring in one autoscaler-enabled node pool might impact the autoscaling behavior in another node pool. It's important to apply consistent and synchronized profile settings across all relevant node pools to ensure that the autoscaler behaves as expected. Overprovisioning Overprovisioning is a strategy that helps mitigate the risk of application pressure by ensuring there's an excess of readily available resources. This approach is especially useful for applications that experience highly variable loads and cluster scaling patterns that show frequent scale ups and scale downs. To determine the optimal amount of overprovisioning, you can use the following formula: txt Copy 1-buffer/1+traffic For example, let's say you want to avoid hitting 100% CPU utilization in your cluster. You might opt for a 30% buffer to maintain a safety margin. If you anticipate an average traffic growth rate of 40%, you might consider overprovisioning by 50%, as calculated by the formula: txt Copy 1-30%/1+40%=50% An effective overprovisioning method involves the use of pause pods. Pause pods are low-priority deployments that can be easily replaced by high-priority deployments. You create low priority pods that serve the sole purpose of reserving buffer space. When a high-priority pod requires space, the pause pods are removed and rescheduled on another node or a new node to accommodate the high priority pod. The following YAML shows an example pause pod manifest: yml Copy apiVersion: scheduling.k8s.io/v1 kind: PriorityClass metadata: name: overprovisioning value: -1 globalDefault: false description: ""Priority class used by overprovisioning."" --- apiVersion: apps/v1 kind: Deployment metadata: name: overprovisioning namespace: kube-system spec: replicas: 1 selector: matchLabels: run: overprovisioning template: metadata: labels: run: overprovisioning spec: priorityClassName: overprovisioning containers: - name: reserve-resources image: your-custome-pause-image resources: requests: cpu: 1 memory: 4Gi Node scaling and efficiency Best practice guidance: Carefully monitor resource utilization and scheduling policies to ensure nodes are being used efficiently. Node scaling allows you to dynamically adjust the number of nodes in your cluster based on workload demands. It's important to understand that adding more nodes to a cluster isn't always the best solution for improving performance. To ensure optimal performance, you should carefully monitor resource utilization and scheduling policies to ensure nodes are being used efficiently. Node images Best practice guidance: Use the latest node image version to ensure that you have the latest security patches and bug fixes. Using the latest node image version provides the best performance experience. AKS ships performance improvements within the weekly image releases. The latest daemonset images are cached on the latest VHD image, which provide lower latency benefits for node provisioning and bootstrapping. Falling behind on updates might have a negative impact on performance, so it's important to avoid large gaps between versions. Azure Linux The Azure Linux Container Host on AKS uses a native AKS image and provides a single place for Linux development. Every package is built from source and validated, ensuring your services run on proven components. Azure Linux is lightweight, only including the necessary set of packages to run container workloads. It provides a reduced attack surface and eliminates patching and maintenance of unnecessary packages. At its base layer, it has a Microsoft-hardened kernel tuned for Azure. This image is ideal for performance-sensitive workloads and platform engineers or operators that manage fleets of AKS clusters. Ubuntu 2204 The Ubuntu 2204 image is the default node image for AKS. It's a lightweight and efficient operating system optimized for running containerized workloads. This means that it can help reduce resource usage and improve overall performance. The image includes the latest security patches and updates, which help ensure that your workloads are protected from vulnerabilities. The Ubuntu 2204 image is fully supported by Microsoft, Canonical, and the Ubuntu community and can help you achieve better performance and security for your containerized workloads. Virtual machines (VMs) Best practice guidance: When selecting a VM, ensure the size and performance of the OS disk and VM SKU don't have a large discrepancy. A discrepancy in size or performance can cause performance issues and resource contention. Application performance is closely tied to the VM SKUs you use in your workloads. Larger and more powerful VMs, generally provide better performance. For mission critical or product workloads, we recommend using VMs with at least an 8-core CPU. VMs with newer hardware generations, like v4 and v5, can also help improve performance. Keep in mind that create and scale latency might vary depending on the VM SKUs you use. Use dedicated system node pools For scaling performance and reliability, we recommend using a dedicated system node pool. With this configuration, the dedicated system node pool reserves space for critical system resources such as system OS daemons. Your application workload can then run in a user node pool to increase the availability of allocatable resources for your application. This configuration also helps mitigate the risk of resource competition between the system and application."," ================== Rely only on the context document, with no outside information. ================== **Best practices for performance and scaling for small to medium workloads in Azure Kubernetes Service (AKS):** This article focuses on general best practices for small to medium workloads. For best practices specific to large workloads, see Performance and scaling best practices for large workloads in Azure Kubernetes Service (AKS). As you deploy and maintain clusters in AKS, you can use the following best practices to help you optimize performance and scaling. In this article, you learn about: Tradeoffs and recommendations for autoscaling your workloads. Managing node scaling and efficiency based on your workload demands. Networking considerations for ingress and egress traffic. Monitoring and troubleshooting control plane and node performance. Capacity planning, surge scenarios, and cluster upgrades. Storage and networking considerations for data plane performance. Application autoscaling vs. infrastructure autoscaling Application autoscaling Application autoscaling is useful when dealing with cost optimization or infrastructure limitations. A well-configured autoscaler maintains high availability for your application while also minimizing costs. You only pay for the resources required to maintain availability, regardless of the demand. For example, if an existing node has space but not enough IPs in the subnet, it might be able to skip the creation of a new node and instead immediately start running the application on a new pod. Horizontal Pod autoscaling Implementing horizontal pod autoscaling is useful for applications with a steady and predictable resource demand. The Horizontal Pod Autoscaler (HPA) dynamically scales the number of pod replicas, which effectively distributes the load across multiple pods and nodes. This scaling mechanism is typically most beneficial for applications that can be decomposed into smaller, independent components capable of running in parallel. The HPA provides resource utilization metrics by default. You can also integrate custom metrics or leverage tools like the Kubernetes Event-Driven Autoscaler (KEDA) (Preview). These extensions allow the HPA to make scaling decisions based on multiple perspectives and criteria, providing a more holistic view of your application's performance. This is especially helpful for applications with varying complex scaling requirements. Note If maintaining high availability for your application is a top priority, we recommend leaving a slightly higher buffer for the minimum pod number for your HPA to account for scaling time. Vertical Pod autoscaling Implementing vertical pod autoscaling is useful for applications with fluctuating and unpredictable resource demands. The Vertical Pod Autoscaler (VPA) allows you to fine-tune resource requests, including CPU and memory, for individual pods, enabling precise control over resource allocation. This granularity minimizes resource waste and enhances the overall efficiency of cluster utilization. The VPA also streamlines application management by automating resource allocation, freeing up resources for critical tasks. Warning You shouldn't use the VPA in conjunction with the HPA on the same CPU or memory metrics. This combination can lead to conflicts, as both autoscalers attempt to respond to changes in demand using the same metrics. However, you can use the VPA for CPU or memory in conjunction with the HPA for custom metrics to prevent overlap and ensure that each autoscaler focuses on distinct aspects of workload scaling. Note The VPA works based on historical data. We recommend waiting at least 24 hours after deploying the VPA before applying any changes to give it time to collect recommendation data. Infrastructure autoscaling Cluster autoscaling Implementing cluster autoscaling is useful if your existing nodes lack sufficient capacity, as it helps with scaling up and provisioning new nodes. When considering cluster autoscaling, the decision of when to remove a node involves a tradeoff between optimizing resource utilization and ensuring resource availability. Eliminating underutilized nodes enhances cluster utilization but might result in new workloads having to wait for resources to be provisioned before they can be deployed. It's important to find a balance between these two factors that aligns with your cluster and workload requirements and configure the cluster autoscaler profile settings accordingly. The Cluster Autoscaler profile settings apply universally to all autoscaler-enabled node pools in your cluster. This means that any scaling actions occurring in one autoscaler-enabled node pool might impact the autoscaling behavior in another node pool. It's important to apply consistent and synchronized profile settings across all relevant node pools to ensure that the autoscaler behaves as expected. Overprovisioning Overprovisioning is a strategy that helps mitigate the risk of application pressure by ensuring there's an excess of readily available resources. This approach is especially useful for applications that experience highly variable loads and cluster scaling patterns that show frequent scale ups and scale downs. To determine the optimal amount of overprovisioning, you can use the following formula: txt Copy 1-buffer/1+traffic For example, let's say you want to avoid hitting 100% CPU utilization in your cluster. You might opt for a 30% buffer to maintain a safety margin. If you anticipate an average traffic growth rate of 40%, you might consider overprovisioning by 50%, as calculated by the formula: txt Copy 1-30%/1+40%=50% An effective overprovisioning method involves the use of pause pods. Pause pods are low-priority deployments that can be easily replaced by high-priority deployments. You create low priority pods that serve the sole purpose of reserving buffer space. When a high-priority pod requires space, the pause pods are removed and rescheduled on another node or a new node to accommodate the high priority pod. The following YAML shows an example pause pod manifest: yml Copy apiVersion: scheduling.k8s.io/v1 kind: PriorityClass metadata: name: overprovisioning value: -1 globalDefault: false description: ""Priority class used by overprovisioning."" --- apiVersion: apps/v1 kind: Deployment metadata: name: overprovisioning namespace: kube-system spec: replicas: 1 selector: matchLabels: run: overprovisioning template: metadata: labels: run: overprovisioning spec: priorityClassName: overprovisioning containers: - name: reserve-resources image: your-custome-pause-image resources: requests: cpu: 1 memory: 4Gi Node scaling and efficiency Best practice guidance: Carefully monitor resource utilization and scheduling policies to ensure nodes are being used efficiently. Node scaling allows you to dynamically adjust the number of nodes in your cluster based on workload demands. It's important to understand that adding more nodes to a cluster isn't always the best solution for improving performance. To ensure optimal performance, you should carefully monitor resource utilization and scheduling policies to ensure nodes are being used efficiently. Node images Best practice guidance: Use the latest node image version to ensure that you have the latest security patches and bug fixes. Using the latest node image version provides the best performance experience. AKS ships performance improvements within the weekly image releases. The latest daemonset images are cached on the latest VHD image, which provide lower latency benefits for node provisioning and bootstrapping. Falling behind on updates might have a negative impact on performance, so it's important to avoid large gaps between versions. Azure Linux The Azure Linux Container Host on AKS uses a native AKS image and provides a single place for Linux development. Every package is built from source and validated, ensuring your services run on proven components. Azure Linux is lightweight, only including the necessary set of packages to run container workloads. It provides a reduced attack surface and eliminates patching and maintenance of unnecessary packages. At its base layer, it has a Microsoft-hardened kernel tuned for Azure. This image is ideal for performance-sensitive workloads and platform engineers or operators that manage fleets of AKS clusters. Ubuntu 2204 The Ubuntu 2204 image is the default node image for AKS. It's a lightweight and efficient operating system optimized for running containerized workloads. This means that it can help reduce resource usage and improve overall performance. The image includes the latest security patches and updates, which help ensure that your workloads are protected from vulnerabilities. The Ubuntu 2204 image is fully supported by Microsoft, Canonical, and the Ubuntu community and can help you achieve better performance and security for your containerized workloads. Virtual machines (VMs) Best practice guidance: When selecting a VM, ensure the size and performance of the OS disk and VM SKU don't have a large discrepancy. A discrepancy in size or performance can cause performance issues and resource contention. Application performance is closely tied to the VM SKUs you use in your workloads. Larger and more powerful VMs, generally provide better performance. For mission critical or product workloads, we recommend using VMs with at least an 8-core CPU. VMs with newer hardware generations, like v4 and v5, can also help improve performance. Keep in mind that create and scale latency might vary depending on the VM SKUs you use. Use dedicated system node pools For scaling performance and reliability, we recommend using a dedicated system node pool. With this configuration, the dedicated system node pool reserves space for critical system resources such as system OS daemons. Your application workload can then run in a user node pool to increase the availability of allocatable resources for your application. This configuration also helps mitigate the risk of resource competition between the system and application. ================== According to this document you shouldn't use which two things in conjunction on the same CPU or memory sticks?",Internet/Technology,Fact Finding,Q&A Use only the provided text for your answers. ,What are some current challenges with our DHCP system as it stands?,"Authentication for DHCP Messages Status of this Memo This document specifies an Internet standards track protocol for the Internet community, and requests discussion and suggestions for improvements. Please refer to the current edition of the ""Internet Official Protocol Standards"" (STD 1) for the standardization state and status of this protocol. Distribution of this memo is unlimited. Copyright Notice Copyright (C) The Internet Society (2001). All Rights Reserved. Abstract This document defines a new Dynamic Host Configuration Protocol (DHCP) option through which authorization tickets can be easily generated and newly attached hosts with proper authorization can be automatically configured from an authenticated DHCP server. DHCP provides a framework for passing configuration information to hosts on a TCP/IP network. In some situations, network administrators may wish to constrain the allocation of addresses to authorized hosts. Additionally, some network administrators may wish to provide for authentication of the source and contents of DHCP messages. 1. Introduction DHCP [1] transports protocol stack configuration parameters from centrally administered servers to TCP/IP hosts. Among those parameters are an IP address. DHCP servers can be configured to dynamically allocate addresses from a pool of addresses, eliminating a manual step in configuration of TCP/IP hosts. Some network administrators may wish to provide authentication of the source and contents of DHCP messages. For example, clients may be subject to denial of service attacks through the use of bogus DHCP servers, or may simply be misconfigured due to unintentionally instantiated DHCP servers. Network administrators may wish to constrain the allocation of addresses to authorized hosts to avoid denial of service attacks in ""hostile"" environments where the network Droms & Arbaugh Standards Track [Page 1] RFC 3118 Authentication for DHCP Messages June 2001 medium is not physically secured, such as wireless networks or college residence halls. This document defines a technique that can provide both entity authentication and message authentication. The current protocol combines the original Schiller-Huitema-Droms authentication mechanism defined in a previous work in progress with the ""delayed authentication"" proposal developed by Bill Arbaugh. 1.1 DHCP threat model The threat to DHCP is inherently an insider threat (assuming a properly configured network where BOOTP ports are blocked on the enterprise’s perimeter gateways.) Regardless of the gateway configuration, however, the potential attacks by insiders and outsiders are the same. The attack specific to a DHCP client is the possibility of the establishment of a ""rogue"" server with the intent of providing incorrect configuration information to the client. The motivation for doing so may be to establish a ""man in the middle"" attack or it may be for a ""denial of service"" attack. There is another threat to DHCP clients from mistakenly or accidentally configured DHCP servers that answer DHCP client requests with unintentionally incorrect configuration parameters. The threat specific to a DHCP server is an invalid client masquerading as a valid client. The motivation for this may be for ""theft of service"", or to circumvent auditing for any number of nefarious purposes. The threat common to both the client and the server is the resource ""denial of service"" (DoS) attack. These attacks typically involve the exhaustion of valid addresses, or the exhaustion of CPU or network bandwidth, and are present anytime there is a shared resource. In current practice, redundancy mitigates DoS attacks the best. 1.2 Design goals These are the goals that were used in the development of the authentication protocol, listed in order of importance: 1. Address the threats presented in Section 1.1. 2. Avoid changing the current protocol. Droms & Arbaugh Standards Track [Page 2] RFC 3118 Authentication for DHCP Messages June 2001 3. Limit state required by the server. 4. Limit complexity (complexity breeds design and implementation errors). 1.3 Requirements Terminology The key words ""MUST"", ""MUST NOT"", ""REQUIRED"", ""SHALL"", ""SHALL NOT"", ""SHOULD"", ""SHOULD NOT"", ""RECOMMENDED"", ""MAY"" and ""OPTIONAL"" in this document are to be interpreted as described in RFC 2119 [5]. 1.4 DHCP Terminology This document uses the following terms: o ""DHCP client"" A DHCP client or ""client"" is an Internet host using DHCP to obtain configuration parameters such as a network address. o ""DHCP server"" A DHCP server or ""server"" is an Internet host that returns configuration parameters to DHCP clients. The code for the authentication option is 90, and the length field contains the length of the protocol, RDM, algorithm, Replay Detection fields and authentication information fields in octets.The protocol field defines the particular technique for authentication used in the option. New protocols are defined as described in Section 6. The algorithm field defines the specific algorithm within the technique identified by the protocol field. The Replay Detection field is per the RDM, and the authentication information field is per the protocol in use. The Replay Detection Method (RDM) field determines the type of replay detection used in the Replay Detection field. If the RDM field contains 0x00, the replay detection field MUST be set to the value of a monotonically increasing counter. Using a counter value such as the current time of day (e.g., an NTP-format timestamp [4]) can reduce the danger of replay attacks. This method MUST be supported by all protocols. 3. Interaction with Relay Agents Because a DHCP relay agent may alter the values of the ’giaddr’ and ’hops’ fields in the DHCP message, the contents of those two fields MUST be set to zero for the computation of any hash function over the message header. Additionally, a relay agent may append the DHCP relay agent information option 82 [7] as the last option in a message to servers. If a server finds option 82 included in a received message, the server MUST compute any hash function as if the option were NOT included in the message without changing the order of options. Whenever the server sends back option 82 to a relay agent, the server MUST not include the option in the computation of any hash function over the message. will be defined as separate protocols. 5. Delayed authentication If the protocol field is 1, the message is using the ""delayed authentication"" mechanism. In delayed authentication, the client requests authentication in its DHCPDISCOVER message and the server replies with a DHCPOFFER message that includes authentication information. This authentication information contains a nonce value generated by the source as a message authentication code (MAC) to provide message authentication and entity authentication. This document defines the use of a particular technique based on the HMAC protocol [3] using the MD5 hash [2]. 5.1 Management Issues The ""delayed authentication"" protocol does not attempt to address situations where a client may roam from one administrative domain to another, i.e., interdomain roaming. This protocol is focused on solving the intradomain problem where the out-of-band exchange of a shared secret is feasible. Replay Detection - as defined by the RDM field K - a secret value shared between the source and destination of the message; each secret has a unique identifier (secret ID) secret ID - the unique identifier for the secret value used to generate the MAC for this message HMAC-MD5 - the MAC generating function [3, 2]. The sender computes the MAC using the HMAC generation algorithm [3] and the MD5 hash function [2]. The entire DHCP message (except as noted below), including the DHCP message header and the options field, is used as input to the HMAC-MD5 computation function. The ’secret ID’ field MUST be set to the identifier of the secret used to generate the MAC. DISCUSSION: Algorithm 1 specifies the use of HMAC-MD5. Use of a different technique, such as HMAC-SHA, will be specified as a separate protocol. Delayed authentication requires a shared secret key for each client on each DHCP server with which that client may wish to use the DHCP protocol. Each secret key has a unique identifier that can be used by a receiver to determine which secret was used to generate the MAC in the DHCP message. Therefore, delayed authentication may not scale well in an architecture in which a DHCP client connects to multiple administrative domains. 5.3 Message validation To validate an incoming message, the receiver first checks that the value in the replay detection field is acceptable according to the replay detection method specified by the RDM field. Next, the receiver computes the MAC as described in [3]. The receiver MUST set the ’MAC’ field of the authentication option to all 0s for computation of the MAC, and because a DHCP relay agent may alter the values of the ’giaddr’ and ’hops’ fields in the DHCP message, the contents of those two fields MUST also be set to zero for the computation of the MAC. If the MAC computed by the receiver does not match the MAC contained in the authentication option, the receiver MUST discard the DHCP message. Section 3 provides additional information on handling messages that include option 82 (Relay Agents). 5.4 Key utilization Each DHCP client has a key, K. The client uses its key to encode any messages it sends to the server and to authenticate and verify any messages it receives from the server. The client’s key SHOULD be initially distributed to the client through some out-of-band mechanism, and SHOULD be stored locally on the client for use in all authenticated DHCP messages. Once the client has been given its key, it SHOULD use that key for all transactions even if the client’s configuration changes; e.g., if the client is assigned a new network address. Each DHCP server MUST know, or be able to obtain in a secure manner, the keys for all authorized clients. If all clients use the same key, clients can perform both entity and message authentication for all messages received from servers. However, the sharing of keys is strongly discouraged as it allows for unauthorized clients to masquerade as authorized clients by obtaining a copy of the shared key. To authenticate the identity of individual clients, each client MUST be configured with a unique key. Appendix A describes a technique for key management. 5.5 Client considerations This section describes the behavior of a DHCP client using delayed authentication. 5.5.1 INIT state When in INIT state, the client uses delayed authentication as follows: 1. The client MUST include the authentication request option in its DHCPDISCOVER message along with a client identifier option [6] to identify itself uniquely to the server. 2. The client MUST perform the validation test described in section 5.3 on any DHCPOFFER messages that include authentication information. If one or more DHCPOFFER messages pass the validation test, the client chooses one of the offered configurations. Client behavior if no DHCPOFFER messages include authentication information or pass the validation test is controlled by local policy in the client. According to client policy, the client MAY choose to respond to a DHCPOFFER message that has not been authenticated. The decision to set local policy to accept unauthenticated messages should be made with care. Accepting an unauthenticated DHCPOFFER message can make the client vulnerable to spoofing and other attacks. If local users are not explicitly informed that the client has accepted an unauthenticated DHCPOFFER message, the users may incorrectly assume that the client has received an authenticated address and is not subject to DHCP attacks through unauthenticated messages. A client MUST be configurable to decline unauthenticated messages, and SHOULD be configured by default to decline unauthenticated messages. A client MAY choose to differentiate between DHCPOFFER messages with no authentication information and DHCPOFFER messages that do not pass the validation test; for example, a client might accept the former and discard the latter. If a client does accept an unauthenticated message, the client SHOULD inform any local users and SHOULD log the event. 3. The client replies with a DHCPREQUEST message that MUST include authentication information encoded with the same secret used by the server in the selected DHCPOFFER message. 4. If the client authenticated the DHCPOFFER it accepted, the client MUST validate the DHCPACK message from the server. The client MUST discard the DHCPACK if the message fails to pass validation and MAY log the validation failure. If the DHCPACK fails to pass validation, the client MUST revert to INIT state and returns to step 1. The client MAY choose to remember which server replied with a DHCPACK message that failed to pass validation and discard subsequent messages from that server. If the client accepted a DHCPOFFER message that did not include authentication information or did not pass the validation test, the client MAY accept an unauthenticated DHCPACK message from the server. 5.5.2 INIT-REBOOT state When in INIT-REBOOT state, the client MUST use the secret it used in its DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. The client MAY choose to accept unauthenticated DHCPACK/DHCPNAK messages if no authenticated messages were received. The client MUST treat the receipt (or lack thereof) of any DHCPACK/DHCPNAK messages as specified in section 3.2 of [1]. 5.5.3 RENEWING state When in RENEWING state, the client uses the secret it used in its initial DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. If client receives no DHCPACK messages or none of the DHCPACK messages pass validation, the client behaves as if it had not received a DHCPACK message in section 4.4.5 of the DHCP specification [1]. 5.5.4 REBINDING state When in REBINDING state, the client uses the secret it used in its initial DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. If client receives no DHCPACK messages or none of the DHCPACK messages pass validation, the client behaves as if it had not received a DHCPACK message in section 4.4.5 of the DHCP specification [1]. 5.5.5 DHCPINFORM message Since the client already has some configuration information, the client may also have established a shared secret value, K, with a server. Therefore, the client SHOULD use the authentication request as in a DHCPDISCOVER message when a shared secret value exists. The client MUST treat any received DHCPACK messages as it does DHCPOFFER messages, see section 5.5.1. 5.5.6 DHCPRELEASE message Since the client is already in the BOUND state, the client will have a security association already established with the server. Therefore, the client MUST include authentication information with the DHCPRELEASE message. 5.6 Server considerations This section describes the behavior of a server in response to client messages using delayed authentication. 5.6.1 General considerations Each server maintains a list of secrets and identifiers for those secrets that it shares with clients and potential clients. This information must be maintained in such a way that the server can: * Identify an appropriate secret and the identifier for that secret for use with a client that the server may not have previously communicated with * Retrieve the secret and identifier used by a client to which the server has provided previous configuration information Each server MUST save the counter from the previous authenticated message. A server MUST discard any incoming message which fails the replay detection check as defined by the RDM avoid replay attacks. DISCUSSION: The authenticated DHCPREQUEST message from a client in INIT-REBOOT state can only be validated by servers that used the same secret in their DHCPOFFER messages. Other servers will discard the DHCPREQUEST messages. Thus, only servers that used the secret selected by the client will be able to determine that their offered configuration information was not selected and the offered network address can be returned to the server’s pool of available addresses. The servers that cannot validate the DHCPREQUEST message will eventually return their offered network addresses to their pool of available addresses as described in section 3.1 of the DHCP specification [1]. 5.6.2 After receiving a DHCPDISCOVER message The server selects a secret for the client and includes authentication information in the DHCPOFFER message as specified in section 5, above. The server MUST record the identifier of the secret selected for the client and use that same secret for validating subsequent messages with the client. 5.6.3 After receiving a DHCPREQUEST message The server uses the secret identified in the message and validates the message as specified in section 5.3. If the message fails to pass validation or the server does not know the secret identified by the ’secret ID’ field, the server MUST discard the message and MAY choose to log the validation failure. If the message passes the validation procedure, the server responds as described in the DHCP specification. The server MUST include authentication information generated as specified in section 5.2. 5.6.4 After receiving a DHCPINFORM message The server MAY choose to accept unauthenticated DHCPINFORM messages, or only accept authenticated DHCPINFORM messages based on a site policy. When a client includes the authentication request in a DHCPINFORM message, the server MUST respond with an authenticated DHCPACK message. If the server does not have a shared secret value established with the sender of the DHCPINFORM message, then the server MAY respond with an unauthenticated DHCPACK message, or a DHCPNAK if the server does not accept unauthenticated clients based on the site policy, or the server MAY choose not to respond to the DHCPINFORM message. 6. IANA Considerations Section 2 defines a new DHCP option called the Authentication Option, whose option code is 90. This document specifies three new name spaces associated with the Authentication Option, which are to be created and maintained by IANA: Protocol, Algorithm and RDM. Initial values assigned from the Protocol name space are 0 (for the configuration token Protocol in section 4) and 1 (for the delayed authentication Protocol in section 5). Additional values from the Protocol name space will be assigned through IETF Consensus, as defined in RFC 2434 [8]. The Algorithm name space is specific to individual Protocols. That is, each Protocol has its own Algorithm name space. The guidelines for assigning Algorithm name space values for a particular protocol should be specified along with the definition of a new Protocol. For the configuration token Protocol, the Algorithm field MUST be 0. For the delayed authentication Protocol, the Algorithm value 1 is assigned to the HMAC-MD5 generating function as defined in section 5. Additional values from the Algorithm name space for Algorithm 1 will be assigned through IETF Consensus, as defined in RFC 2434. The initial value of 0 from the RDM name space is assigned to the use of a monotonically increasing value as defined in section 2. Additional values from the RDM name space will be assigned through IETF Consensus, as defined in RFC 2434. 7. References [1] Droms, R., ""Dynamic Host Configuration Protocol"", RFC 2131, March 1997. [2] Rivest, R., ""The MD5 Message-Digest Algorithm"", RFC 1321, April 1992.[3] Krawczyk H., Bellare, M. and R. Canetti, ""HMAC: Keyed-Hashing for Message Authentication"", RFC 2104, February 1997. [4] Mills, D., ""Network Time Protocol (Version 3)"", RFC 1305, March 1992. [5] Bradner, S., ""Key words for use in RFCs to Indicate Requirement Levels"", RFC 2219, March 1997. [6] Alexander, S. and R. Droms, ""DHCP Options and BOOTP Vendor Extensions"", RFC 2132, March 1997. [7] Patrick, M., ""DHCP Relay Agent Information Option"", RFC 3046, January 2001. [8] Narten, T. and H. Alvestrand, ""Guidelines for Writing and IANA Considerations Section in RFCs"", BCP 26, RFC 2434, October 1998. 8. Acknowledgments Jeff Schiller and Christian Huitema developed the original version of this authentication protocol in a terminal room BOF at the Dallas IETF meeting, December 1995. One of the editors (Droms) transcribed the notes from that discussion, which form the basis for this document. The editors appreciate Jeff’s and Christian’s patience in reviewing this document and its earlier drafts. The ""delayed authentication"" mechanism used in section 5 is due to Bill Arbaugh. The threat model and requirements in sections 1.1 and 1.2 come from Bill’s negotiation protocol proposal. The attendees of an interim meeting of the DHC WG held in June, 1998, including Peter Ford, Kim Kinnear, Glenn Waters, Rob Stevens, Bill Arbaugh, Baiju Patel, Carl Smith, Thomas Narten, Stewart Kwan, Munil Shah, Olafur Gudmundsson, Robert Watson, Ralph Droms, Mike Dooley, Greg Rabil and Arun Kapur, developed the threat model and reviewed several alternative proposals. The replay detection method field is due to Vipul Gupta. Other input from Bill Sommerfield is gratefully acknowledged. Thanks also to John Wilkins, Ran Atkinson, Shawn Mamros and Thomas Narten for reviewing earlier drafts of this document. 9. Security Considerations This document describes authentication and verification mechanisms for DHCP. 9.1 Protocol vulnerabilities The configuration token authentication mechanism is vulnerable to interception and provides only the most rudimentary protection against inadvertently instantiated DHCP servers. The delayed authentication mechanism described in this document is vulnerable to a denial of service attack through flooding with DHCPDISCOVER messages, which are not authenticated by this protocol. Such an attack may overwhelm the computer on which the DHCP server is running and may exhaust the addresses available for assignment by the DHCP server. Delayed authentication may also be vulnerable to a denial of service attack through flooding with authenticated messages, which may overwhelm the computer on which the DHCP server is running as the authentication keys for the incoming messages are computed. 9.2 Protocol limitations Delayed authentication does not support interdomain authentication. A real digital signature mechanism such as RSA, while currently computationally infeasible, would provide better security. Appendix A - Key Management Technique To avoid centralized management of a list of random keys, suppose K for each client is generated from the pair (client identifier [6], subnet address, e.g., 192.168.1.0), which must be unique to that client. That is, K = MAC(MK, unique-id), where MK is a secret master key and MAC is a keyed one-way function such as HMAC-MD5. Without knowledge of the master key MK, an unauthorized client cannot generate its own key K. The server can quickly validate an incoming message from a new client by regenerating K from the client-id. For known clients, the server can choose to recover the client’s K dynamically from the client-id in the DHCP message, or can choose to precompute and cache all of the Ks a priori. By deriving all keys from a single master key, the DHCP server does not need access to clear text passwords, and can compute and verify the keyed MACs without requiring help from a centralized authentication server. To avoid compromise of this key management system, the master key, MK, MUST NOT be stored by any clients. The client SHOULD only be given its key, K. If MK is compromised, a new MK SHOULD be chosen and all clients given new individual keys. Full Copyright Statement Copyright (C) The Internet Society (2001). All Rights Reserved. This document and translations of it may be copied and furnished to others, and derivative works that comment on or otherwise explain it or assist in its implementation may be prepared, copied, published and distributed, in whole or in part, without restriction of any kind, provided that the above copyright notice and this paragraph are included on all such copies and derivative works. However, this document itself may not be modified in any way, such as by removing the copyright notice or references to the Internet Society or other Internet organizations, except as needed for the purpose of developing Internet standards in which case the procedures for copyrights defined in the Internet Standards process must be followed, or as required to translate it into languages other than English. The limited permissions granted above are perpetual and will not be revoked by the Internet Society or its successors or assigns. This document and the information contained herein is provided on an ""AS IS"" basis and THE INTERNET SOCIETY AND THE INTERNET ENGINEERING TASK FORCE DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY WARRANTY THAT THE USE OF THE INFORMATION HEREIN WILL NOT INFRINGE ANY RIGHTS OR ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Acknowledgement Funding for the RFC Editor function is currently provided by the Internet Society. ","Use only the provided text for your answers. What are some current challenges with our DHCP system as it stands? Authentication for DHCP Messages Status of this Memo This document specifies an Internet standards track protocol for the Internet community, and requests discussion and suggestions for improvements. Please refer to the current edition of the ""Internet Official Protocol Standards"" (STD 1) for the standardization state and status of this protocol. Distribution of this memo is unlimited. Copyright Notice Copyright (C) The Internet Society (2001). All Rights Reserved. Abstract This document defines a new Dynamic Host Configuration Protocol (DHCP) option through which authorization tickets can be easily generated and newly attached hosts with proper authorization can be automatically configured from an authenticated DHCP server. DHCP provides a framework for passing configuration information to hosts on a TCP/IP network. In some situations, network administrators may wish to constrain the allocation of addresses to authorized hosts. Additionally, some network administrators may wish to provide for authentication of the source and contents of DHCP messages. 1. Introduction DHCP [1] transports protocol stack configuration parameters from centrally administered servers to TCP/IP hosts. Among those parameters are an IP address. DHCP servers can be configured to dynamically allocate addresses from a pool of addresses, eliminating a manual step in configuration of TCP/IP hosts. Some network administrators may wish to provide authentication of the source and contents of DHCP messages. For example, clients may be subject to denial of service attacks through the use of bogus DHCP servers, or may simply be misconfigured due to unintentionally instantiated DHCP servers. Network administrators may wish to constrain the allocation of addresses to authorized hosts to avoid denial of service attacks in ""hostile"" environments where the network Droms & Arbaugh Standards Track [Page 1] RFC 3118 Authentication for DHCP Messages June 2001 medium is not physically secured, such as wireless networks or college residence halls. This document defines a technique that can provide both entity authentication and message authentication. The current protocol combines the original Schiller-Huitema-Droms authentication mechanism defined in a previous work in progress with the ""delayed authentication"" proposal developed by Bill Arbaugh. 1.1 DHCP threat model The threat to DHCP is inherently an insider threat (assuming a properly configured network where BOOTP ports are blocked on the enterprise’s perimeter gateways.) Regardless of the gateway configuration, however, the potential attacks by insiders and outsiders are the same. The attack specific to a DHCP client is the possibility of the establishment of a ""rogue"" server with the intent of providing incorrect configuration information to the client. The motivation for doing so may be to establish a ""man in the middle"" attack or it may be for a ""denial of service"" attack. There is another threat to DHCP clients from mistakenly or accidentally configured DHCP servers that answer DHCP client requests with unintentionally incorrect configuration parameters. The threat specific to a DHCP server is an invalid client masquerading as a valid client. The motivation for this may be for ""theft of service"", or to circumvent auditing for any number of nefarious purposes. The threat common to both the client and the server is the resource ""denial of service"" (DoS) attack. These attacks typically involve the exhaustion of valid addresses, or the exhaustion of CPU or network bandwidth, and are present anytime there is a shared resource. In current practice, redundancy mitigates DoS attacks the best. 1.2 Design goals These are the goals that were used in the development of the authentication protocol, listed in order of importance: 1. Address the threats presented in Section 1.1. 2. Avoid changing the current protocol. Droms & Arbaugh Standards Track [Page 2] RFC 3118 Authentication for DHCP Messages June 2001 3. Limit state required by the server. 4. Limit complexity (complexity breeds design and implementation errors). 1.3 Requirements Terminology The key words ""MUST"", ""MUST NOT"", ""REQUIRED"", ""SHALL"", ""SHALL NOT"", ""SHOULD"", ""SHOULD NOT"", ""RECOMMENDED"", ""MAY"" and ""OPTIONAL"" in this document are to be interpreted as described in RFC 2119 [5]. 1.4 DHCP Terminology This document uses the following terms: o ""DHCP client"" A DHCP client or ""client"" is an Internet host using DHCP to obtain configuration parameters such as a network address. o ""DHCP server"" A DHCP server or ""server"" is an Internet host that returns configuration parameters to DHCP clients. The code for the authentication option is 90, and the length field contains the length of the protocol, RDM, algorithm, Replay Detection fields and authentication information fields in octets.The protocol field defines the particular technique for authentication used in the option. New protocols are defined as described in Section 6. The algorithm field defines the specific algorithm within the technique identified by the protocol field. The Replay Detection field is per the RDM, and the authentication information field is per the protocol in use. The Replay Detection Method (RDM) field determines the type of replay detection used in the Replay Detection field. If the RDM field contains 0x00, the replay detection field MUST be set to the value of a monotonically increasing counter. Using a counter value such as the current time of day (e.g., an NTP-format timestamp [4]) can reduce the danger of replay attacks. This method MUST be supported by all protocols. 3. Interaction with Relay Agents Because a DHCP relay agent may alter the values of the ’giaddr’ and ’hops’ fields in the DHCP message, the contents of those two fields MUST be set to zero for the computation of any hash function over the message header. Additionally, a relay agent may append the DHCP relay agent information option 82 [7] as the last option in a message to servers. If a server finds option 82 included in a received message, the server MUST compute any hash function as if the option were NOT included in the message without changing the order of options. Whenever the server sends back option 82 to a relay agent, the server MUST not include the option in the computation of any hash function over the message. will be defined as separate protocols. 5. Delayed authentication If the protocol field is 1, the message is using the ""delayed authentication"" mechanism. In delayed authentication, the client requests authentication in its DHCPDISCOVER message and the server replies with a DHCPOFFER message that includes authentication information. This authentication information contains a nonce value generated by the source as a message authentication code (MAC) to provide message authentication and entity authentication. This document defines the use of a particular technique based on the HMAC protocol [3] using the MD5 hash [2]. 5.1 Management Issues The ""delayed authentication"" protocol does not attempt to address situations where a client may roam from one administrative domain to another, i.e., interdomain roaming. This protocol is focused on solving the intradomain problem where the out-of-band exchange of a shared secret is feasible. Replay Detection - as defined by the RDM field K - a secret value shared between the source and destination of the message; each secret has a unique identifier (secret ID) secret ID - the unique identifier for the secret value used to generate the MAC for this message HMAC-MD5 - the MAC generating function [3, 2]. The sender computes the MAC using the HMAC generation algorithm [3] and the MD5 hash function [2]. The entire DHCP message (except as noted below), including the DHCP message header and the options field, is used as input to the HMAC-MD5 computation function. The ’secret ID’ field MUST be set to the identifier of the secret used to generate the MAC. DISCUSSION: Algorithm 1 specifies the use of HMAC-MD5. Use of a different technique, such as HMAC-SHA, will be specified as a separate protocol. Delayed authentication requires a shared secret key for each client on each DHCP server with which that client may wish to use the DHCP protocol. Each secret key has a unique identifier that can be used by a receiver to determine which secret was used to generate the MAC in the DHCP message. Therefore, delayed authentication may not scale well in an architecture in which a DHCP client connects to multiple administrative domains. 5.3 Message validation To validate an incoming message, the receiver first checks that the value in the replay detection field is acceptable according to the replay detection method specified by the RDM field. Next, the receiver computes the MAC as described in [3]. The receiver MUST set the ’MAC’ field of the authentication option to all 0s for computation of the MAC, and because a DHCP relay agent may alter the values of the ’giaddr’ and ’hops’ fields in the DHCP message, the contents of those two fields MUST also be set to zero for the computation of the MAC. If the MAC computed by the receiver does not match the MAC contained in the authentication option, the receiver MUST discard the DHCP message. Section 3 provides additional information on handling messages that include option 82 (Relay Agents). 5.4 Key utilization Each DHCP client has a key, K. The client uses its key to encode any messages it sends to the server and to authenticate and verify any messages it receives from the server. The client’s key SHOULD be initially distributed to the client through some out-of-band mechanism, and SHOULD be stored locally on the client for use in all authenticated DHCP messages. Once the client has been given its key, it SHOULD use that key for all transactions even if the client’s configuration changes; e.g., if the client is assigned a new network address. Each DHCP server MUST know, or be able to obtain in a secure manner, the keys for all authorized clients. If all clients use the same key, clients can perform both entity and message authentication for all messages received from servers. However, the sharing of keys is strongly discouraged as it allows for unauthorized clients to masquerade as authorized clients by obtaining a copy of the shared key. To authenticate the identity of individual clients, each client MUST be configured with a unique key. Appendix A describes a technique for key management. 5.5 Client considerations This section describes the behavior of a DHCP client using delayed authentication. 5.5.1 INIT state When in INIT state, the client uses delayed authentication as follows: 1. The client MUST include the authentication request option in its DHCPDISCOVER message along with a client identifier option [6] to identify itself uniquely to the server. 2. The client MUST perform the validation test described in section 5.3 on any DHCPOFFER messages that include authentication information. If one or more DHCPOFFER messages pass the validation test, the client chooses one of the offered configurations. Client behavior if no DHCPOFFER messages include authentication information or pass the validation test is controlled by local policy in the client. According to client policy, the client MAY choose to respond to a DHCPOFFER message that has not been authenticated. The decision to set local policy to accept unauthenticated messages should be made with care. Accepting an unauthenticated DHCPOFFER message can make the client vulnerable to spoofing and other attacks. If local users are not explicitly informed that the client has accepted an unauthenticated DHCPOFFER message, the users may incorrectly assume that the client has received an authenticated address and is not subject to DHCP attacks through unauthenticated messages. A client MUST be configurable to decline unauthenticated messages, and SHOULD be configured by default to decline unauthenticated messages. A client MAY choose to differentiate between DHCPOFFER messages with no authentication information and DHCPOFFER messages that do not pass the validation test; for example, a client might accept the former and discard the latter. If a client does accept an unauthenticated message, the client SHOULD inform any local users and SHOULD log the event. 3. The client replies with a DHCPREQUEST message that MUST include authentication information encoded with the same secret used by the server in the selected DHCPOFFER message. 4. If the client authenticated the DHCPOFFER it accepted, the client MUST validate the DHCPACK message from the server. The client MUST discard the DHCPACK if the message fails to pass validation and MAY log the validation failure. If the DHCPACK fails to pass validation, the client MUST revert to INIT state and returns to step 1. The client MAY choose to remember which server replied with a DHCPACK message that failed to pass validation and discard subsequent messages from that server. If the client accepted a DHCPOFFER message that did not include authentication information or did not pass the validation test, the client MAY accept an unauthenticated DHCPACK message from the server. 5.5.2 INIT-REBOOT state When in INIT-REBOOT state, the client MUST use the secret it used in its DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. The client MAY choose to accept unauthenticated DHCPACK/DHCPNAK messages if no authenticated messages were received. The client MUST treat the receipt (or lack thereof) of any DHCPACK/DHCPNAK messages as specified in section 3.2 of [1]. 5.5.3 RENEWING state When in RENEWING state, the client uses the secret it used in its initial DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. If client receives no DHCPACK messages or none of the DHCPACK messages pass validation, the client behaves as if it had not received a DHCPACK message in section 4.4.5 of the DHCP specification [1]. 5.5.4 REBINDING state When in REBINDING state, the client uses the secret it used in its initial DHCPREQUEST message to obtain its current configuration to generate authentication information for the DHCPREQUEST message. If client receives no DHCPACK messages or none of the DHCPACK messages pass validation, the client behaves as if it had not received a DHCPACK message in section 4.4.5 of the DHCP specification [1]. 5.5.5 DHCPINFORM message Since the client already has some configuration information, the client may also have established a shared secret value, K, with a server. Therefore, the client SHOULD use the authentication request as in a DHCPDISCOVER message when a shared secret value exists. The client MUST treat any received DHCPACK messages as it does DHCPOFFER messages, see section 5.5.1. 5.5.6 DHCPRELEASE message Since the client is already in the BOUND state, the client will have a security association already established with the server. Therefore, the client MUST include authentication information with the DHCPRELEASE message. 5.6 Server considerations This section describes the behavior of a server in response to client messages using delayed authentication. 5.6.1 General considerations Each server maintains a list of secrets and identifiers for those secrets that it shares with clients and potential clients. This information must be maintained in such a way that the server can: * Identify an appropriate secret and the identifier for that secret for use with a client that the server may not have previously communicated with * Retrieve the secret and identifier used by a client to which the server has provided previous configuration information Each server MUST save the counter from the previous authenticated message. A server MUST discard any incoming message which fails the replay detection check as defined by the RDM avoid replay attacks. DISCUSSION: The authenticated DHCPREQUEST message from a client in INIT-REBOOT state can only be validated by servers that used the same secret in their DHCPOFFER messages. Other servers will discard the DHCPREQUEST messages. Thus, only servers that used the secret selected by the client will be able to determine that their offered configuration information was not selected and the offered network address can be returned to the server’s pool of available addresses. The servers that cannot validate the DHCPREQUEST message will eventually return their offered network addresses to their pool of available addresses as described in section 3.1 of the DHCP specification [1]. 5.6.2 After receiving a DHCPDISCOVER message The server selects a secret for the client and includes authentication information in the DHCPOFFER message as specified in section 5, above. The server MUST record the identifier of the secret selected for the client and use that same secret for validating subsequent messages with the client. 5.6.3 After receiving a DHCPREQUEST message The server uses the secret identified in the message and validates the message as specified in section 5.3. If the message fails to pass validation or the server does not know the secret identified by the ’secret ID’ field, the server MUST discard the message and MAY choose to log the validation failure. If the message passes the validation procedure, the server responds as described in the DHCP specification. The server MUST include authentication information generated as specified in section 5.2. 5.6.4 After receiving a DHCPINFORM message The server MAY choose to accept unauthenticated DHCPINFORM messages, or only accept authenticated DHCPINFORM messages based on a site policy. When a client includes the authentication request in a DHCPINFORM message, the server MUST respond with an authenticated DHCPACK message. If the server does not have a shared secret value established with the sender of the DHCPINFORM message, then the server MAY respond with an unauthenticated DHCPACK message, or a DHCPNAK if the server does not accept unauthenticated clients based on the site policy, or the server MAY choose not to respond to the DHCPINFORM message. 6. IANA Considerations Section 2 defines a new DHCP option called the Authentication Option, whose option code is 90. This document specifies three new name spaces associated with the Authentication Option, which are to be created and maintained by IANA: Protocol, Algorithm and RDM. Initial values assigned from the Protocol name space are 0 (for the configuration token Protocol in section 4) and 1 (for the delayed authentication Protocol in section 5). Additional values from the Protocol name space will be assigned through IETF Consensus, as defined in RFC 2434 [8]. The Algorithm name space is specific to individual Protocols. That is, each Protocol has its own Algorithm name space. The guidelines for assigning Algorithm name space values for a particular protocol should be specified along with the definition of a new Protocol. For the configuration token Protocol, the Algorithm field MUST be 0. For the delayed authentication Protocol, the Algorithm value 1 is assigned to the HMAC-MD5 generating function as defined in section 5. Additional values from the Algorithm name space for Algorithm 1 will be assigned through IETF Consensus, as defined in RFC 2434. The initial value of 0 from the RDM name space is assigned to the use of a monotonically increasing value as defined in section 2. Additional values from the RDM name space will be assigned through IETF Consensus, as defined in RFC 2434. 7. References [1] Droms, R., ""Dynamic Host Configuration Protocol"", RFC 2131, March 1997. [2] Rivest, R., ""The MD5 Message-Digest Algorithm"", RFC 1321, April 1992.[3] Krawczyk H., Bellare, M. and R. Canetti, ""HMAC: Keyed-Hashing for Message Authentication"", RFC 2104, February 1997. [4] Mills, D., ""Network Time Protocol (Version 3)"", RFC 1305, March 1992. [5] Bradner, S., ""Key words for use in RFCs to Indicate Requirement Levels"", RFC 2219, March 1997. [6] Alexander, S. and R. Droms, ""DHCP Options and BOOTP Vendor Extensions"", RFC 2132, March 1997. [7] Patrick, M., ""DHCP Relay Agent Information Option"", RFC 3046, January 2001. [8] Narten, T. and H. Alvestrand, ""Guidelines for Writing and IANA Considerations Section in RFCs"", BCP 26, RFC 2434, October 1998. 8. Acknowledgments Jeff Schiller and Christian Huitema developed the original version of this authentication protocol in a terminal room BOF at the Dallas IETF meeting, December 1995. One of the editors (Droms) transcribed the notes from that discussion, which form the basis for this document. The editors appreciate Jeff’s and Christian’s patience in reviewing this document and its earlier drafts. The ""delayed authentication"" mechanism used in section 5 is due to Bill Arbaugh. The threat model and requirements in sections 1.1 and 1.2 come from Bill’s negotiation protocol proposal. The attendees of an interim meeting of the DHC WG held in June, 1998, including Peter Ford, Kim Kinnear, Glenn Waters, Rob Stevens, Bill Arbaugh, Baiju Patel, Carl Smith, Thomas Narten, Stewart Kwan, Munil Shah, Olafur Gudmundsson, Robert Watson, Ralph Droms, Mike Dooley, Greg Rabil and Arun Kapur, developed the threat model and reviewed several alternative proposals. The replay detection method field is due to Vipul Gupta. Other input from Bill Sommerfield is gratefully acknowledged. Thanks also to John Wilkins, Ran Atkinson, Shawn Mamros and Thomas Narten for reviewing earlier drafts of this document. 9. Security Considerations This document describes authentication and verification mechanisms for DHCP. 9.1 Protocol vulnerabilities The configuration token authentication mechanism is vulnerable to interception and provides only the most rudimentary protection against inadvertently instantiated DHCP servers. The delayed authentication mechanism described in this document is vulnerable to a denial of service attack through flooding with DHCPDISCOVER messages, which are not authenticated by this protocol. Such an attack may overwhelm the computer on which the DHCP server is running and may exhaust the addresses available for assignment by the DHCP server. Delayed authentication may also be vulnerable to a denial of service attack through flooding with authenticated messages, which may overwhelm the computer on which the DHCP server is running as the authentication keys for the incoming messages are computed. 9.2 Protocol limitations Delayed authentication does not support interdomain authentication. A real digital signature mechanism such as RSA, while currently computationally infeasible, would provide better security. Appendix A - Key Management Technique To avoid centralized management of a list of random keys, suppose K for each client is generated from the pair (client identifier [6], subnet address, e.g., 192.168.1.0), which must be unique to that client. That is, K = MAC(MK, unique-id), where MK is a secret master key and MAC is a keyed one-way function such as HMAC-MD5. Without knowledge of the master key MK, an unauthorized client cannot generate its own key K. The server can quickly validate an incoming message from a new client by regenerating K from the client-id. For known clients, the server can choose to recover the client’s K dynamically from the client-id in the DHCP message, or can choose to precompute and cache all of the Ks a priori. By deriving all keys from a single master key, the DHCP server does not need access to clear text passwords, and can compute and verify the keyed MACs without requiring help from a centralized authentication server. To avoid compromise of this key management system, the master key, MK, MUST NOT be stored by any clients. The client SHOULD only be given its key, K. If MK is compromised, a new MK SHOULD be chosen and all clients given new individual keys. Full Copyright Statement Copyright (C) The Internet Society (2001). All Rights Reserved. This document and translations of it may be copied and furnished to others, and derivative works that comment on or otherwise explain it or assist in its implementation may be prepared, copied, published and distributed, in whole or in part, without restriction of any kind, provided that the above copyright notice and this paragraph are included on all such copies and derivative works. However, this document itself may not be modified in any way, such as by removing the copyright notice or references to the Internet Society or other Internet organizations, except as needed for the purpose of developing Internet standards in which case the procedures for copyrights defined in the Internet Standards process must be followed, or as required to translate it into languages other than English. The limited permissions granted above are perpetual and will not be revoked by the Internet Society or its successors or assigns. This document and the information contained herein is provided on an ""AS IS"" basis and THE INTERNET SOCIETY AND THE INTERNET ENGINEERING TASK FORCE DISCLAIMS ALL WARRANTIES, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO ANY WARRANTY THAT THE USE OF THE INFORMATION HEREIN WILL NOT INFRINGE ANY RIGHTS OR ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. Acknowledgement Funding for the RFC Editor function is currently provided by the Internet Society. ",Internet/Technology,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",What are the steps to apoptosis? What are the differentiating factors of necrosis and apoptosis? What are the different ways a cell can be affected by necrosis?,"The stages of cell death differ depending on how a cell dies. When it comes to cell death, there are two main types to consider: Necrosis Vs. Apoptosis. Each of these involves a distinct process and has a distinct impact on the rest of the body.It holds utmost significance for researchers and they must choose the best Cell Separation technologies to get high-quality results. What is Cell Apoptosis? Apoptosis, or programmed cell death, is a normal growth and development mechanism within an organism. Because the cell participates in its own death, this process is also known as “cellular suicide.” Apoptosis contributes to the balance of cell multiplication. Uncontrolled cell growth will result in tumors and other problems if cells continue to reproduce without apoptosis. What Causes Apoptosis? Apoptosis is also known as programmed cell death because it is usually triggered by self-generated signals within a cell. It is a normal part of the cell cycle that begins with mitosis in cell reproduction. Caspases, enzymes found in all cells that cleave specific proteins to initiate cell death, mediate this process. Apoptosis Steps Apoptosis occurs in a gentle and controlled manner that has no negative impact on surrounding cells. A cell will expel moisture in order to dry out and condense until fragmentation occurs. Because the cell does not release into the extracellular environment, there are no morphological changes. Apoptotic bodies are small vesicles that form to transport the contents of the cell elsewhere. This enables cells to die gently and without causing inflammation. Apoptosis is signaled by chromatin condensation in a cell’s nucleus. This allows scientists to determine whether a cell is dying naturally or unnaturally. What is Cell Necrosis? Necrosis is a type of cell death that occurs when cells are exposed to extreme conditions. Cells may sustain damage to their internal environment when not under normal conditions. Tissues may deteriorate quickly and harshly. As a result, necrosis is commonly defined as unintentional cell death. Causes of Necrotic Cell Death External factors influencing the physiology of cells in the body cause necrosis. The following are some examples of necrotic cell death causes: Bacterial infection – Bacteria are microscopic organisms that can cause infections in the body if they enter through an airway or an open wound. They may be responsible for a variety of illnesses linked to unplanned cell death. Fungal infection – A fungus infection, also known as mycosis, occurs when any fungus infiltrates human tissues. This could result in skin or internal system diseases, as well as unprogrammed cell death. Pancreatitis – Pancreatitis is an inflammation of the pancreas, a gland in the body that helps regulate hormones and digestion. Protein denaturation – Protein denaturation occurs when weak bonds in proteins break down, causing the cells’ ability to function properly to suffer. Apoptosis Vs. Necrosis While both necrosis and apoptosis are mechanisms involved in multicellular organism cell death, they can be distinguished in a variety of ways. Apoptosis is regarded as a naturally occurring process, whereas necrosis is regarded as a pathological process. Pathological processes are often unregulated and are caused by toxins, infections, or traumas. Apoptosis is controlled and timely, making it predictable and beneficial to the host. Read Also: T Cell Isolation:A Comprehensive Guide to the Key Components The distinction between apoptosis and necrosis is also visible in the following factors: Process – Apoptosis is characterized by the shrinking of the cytoplasm, which results in the condensation of the nucleus. Necrosis occurs when the cytoplasm and mitochondria swell, resulting in cell lysis or a rupture in the cell membrane. Membrane Integrity – Blebbing is a defining feature of apoptosis. Blebbing occurs when a cell’s cytoskeleton degrades and the membrane bulges outward. Apoptotic blebs can form when cytoplasmic capsules detach from dying cells. This has no effect on the membrane’s integrity. The integrity of the membrane is loosened and thus significantly reduced, if not completely lost, during necrosis. Organelle Behavior – Organelles can continue to function even after a cell has died due to apoptosis. Organelles swell and disintegrate during necrotic cell death. After necrosis, organelles are no longer functional. Scope of Affected Cells – Apoptosis is a localized process that only destroys individual or single cells. Necrosis can spread to affect adjacent cell groups, causing damage beyond the initial site. Bodily Influence – Apoptosis is involved in controlling cell numbers and is frequently beneficial. Apoptosis, on the other hand, can cause diseases if it becomes abnormal in either direction. Necrosis, on the other hand, is always harmful and, if left untreated, can be fatal. In essence, apoptosis is planned cell death in which the cell actively destroys itself in order to maintain body functionality. Necrosis is an unintentional or unplanned cell death caused by the cell’s external environment, which impedes or interferes with body functions or health. Dangers of Cell Death in a Sample Cell enrichment assays can be hampered by both Necrosis & Apoptosis. The goal of studying a cell population is to collect as many healthy target cells as possible. Damaged cells do not behave the same as healthy cells and thus produce insufficient results. When collecting and storing cell samples, the longer a cell is kept outside of its preferred environment, the more likely it will die from necrosis. Cells can swell and die as a result of external factors. Dead cells can clump and cause more cell death in the surrounding population when using traditional cell separation methods such as magnetic-based cell sorting. It is critical to follow protocols, use gentle cell separation methods, and use additional products for increased downstream accuracy to maintain cell health and purity during cell separation assays. Harnessing Pluriselect’s Innovative Technology: Plurispin and PluriBead The first method for reducing cell death is to use a gentler isolation method. Traditional separation technologies, such as magnetic bead-based sorting, can be harsh on cells and result in less-than-desirable outcomes. Let’s see what Plurispin and PluriBead can do for us. Plurispin The pluriSpin system is a new negative cell isolation technology that can be used to isolate cells directly from whole blood, buffy coat, or cord blood. This new method isolates viable, untouched, and highly purified cells in a single step without the use of magnets or a column. As a result, there is less chance of activating or damaging the cells of interest. PluriBead PluriBead is a unique cell separation technology that does not rely on magnetic components. The steps are straightforward: Your pluriBeads (containing bound target cells) are sieved through a strainer; the pluriBeads containing your target cells remain on top, while the unwanted cells pass through. You have your target cells ready after detaching. Ready to get started? Stop wasting your valuable samples on inefficient processes and see the difference for yourself. Pluriselect’s innovative technology provides an incredibly fast, simple workflow that allows you to confidently move to downstream processing.","[question] What are the steps to apoptosis? What are the differentiating factors of necrosis and apoptosis? What are the different ways a cell can be affected by necrosis? ===================== [text] The stages of cell death differ depending on how a cell dies. When it comes to cell death, there are two main types to consider: Necrosis Vs. Apoptosis. Each of these involves a distinct process and has a distinct impact on the rest of the body.It holds utmost significance for researchers and they must choose the best Cell Separation technologies to get high-quality results. What is Cell Apoptosis? Apoptosis, or programmed cell death, is a normal growth and development mechanism within an organism. Because the cell participates in its own death, this process is also known as “cellular suicide.” Apoptosis contributes to the balance of cell multiplication. Uncontrolled cell growth will result in tumors and other problems if cells continue to reproduce without apoptosis. What Causes Apoptosis? Apoptosis is also known as programmed cell death because it is usually triggered by self-generated signals within a cell. It is a normal part of the cell cycle that begins with mitosis in cell reproduction. Caspases, enzymes found in all cells that cleave specific proteins to initiate cell death, mediate this process. Apoptosis Steps Apoptosis occurs in a gentle and controlled manner that has no negative impact on surrounding cells. A cell will expel moisture in order to dry out and condense until fragmentation occurs. Because the cell does not release into the extracellular environment, there are no morphological changes. Apoptotic bodies are small vesicles that form to transport the contents of the cell elsewhere. This enables cells to die gently and without causing inflammation. Apoptosis is signaled by chromatin condensation in a cell’s nucleus. This allows scientists to determine whether a cell is dying naturally or unnaturally. What is Cell Necrosis? Necrosis is a type of cell death that occurs when cells are exposed to extreme conditions. Cells may sustain damage to their internal environment when not under normal conditions. Tissues may deteriorate quickly and harshly. As a result, necrosis is commonly defined as unintentional cell death. Causes of Necrotic Cell Death External factors influencing the physiology of cells in the body cause necrosis. The following are some examples of necrotic cell death causes: Bacterial infection – Bacteria are microscopic organisms that can cause infections in the body if they enter through an airway or an open wound. They may be responsible for a variety of illnesses linked to unplanned cell death. Fungal infection – A fungus infection, also known as mycosis, occurs when any fungus infiltrates human tissues. This could result in skin or internal system diseases, as well as unprogrammed cell death. Pancreatitis – Pancreatitis is an inflammation of the pancreas, a gland in the body that helps regulate hormones and digestion. Protein denaturation – Protein denaturation occurs when weak bonds in proteins break down, causing the cells’ ability to function properly to suffer. Apoptosis Vs. Necrosis While both necrosis and apoptosis are mechanisms involved in multicellular organism cell death, they can be distinguished in a variety of ways. Apoptosis is regarded as a naturally occurring process, whereas necrosis is regarded as a pathological process. Pathological processes are often unregulated and are caused by toxins, infections, or traumas. Apoptosis is controlled and timely, making it predictable and beneficial to the host. Read Also: T Cell Isolation:A Comprehensive Guide to the Key Components The distinction between apoptosis and necrosis is also visible in the following factors: Process – Apoptosis is characterized by the shrinking of the cytoplasm, which results in the condensation of the nucleus. Necrosis occurs when the cytoplasm and mitochondria swell, resulting in cell lysis or a rupture in the cell membrane. Membrane Integrity – Blebbing is a defining feature of apoptosis. Blebbing occurs when a cell’s cytoskeleton degrades and the membrane bulges outward. Apoptotic blebs can form when cytoplasmic capsules detach from dying cells. This has no effect on the membrane’s integrity. The integrity of the membrane is loosened and thus significantly reduced, if not completely lost, during necrosis. Organelle Behavior – Organelles can continue to function even after a cell has died due to apoptosis. Organelles swell and disintegrate during necrotic cell death. After necrosis, organelles are no longer functional. Scope of Affected Cells – Apoptosis is a localized process that only destroys individual or single cells. Necrosis can spread to affect adjacent cell groups, causing damage beyond the initial site. Bodily Influence – Apoptosis is involved in controlling cell numbers and is frequently beneficial. Apoptosis, on the other hand, can cause diseases if it becomes abnormal in either direction. Necrosis, on the other hand, is always harmful and, if left untreated, can be fatal. In essence, apoptosis is planned cell death in which the cell actively destroys itself in order to maintain body functionality. Necrosis is an unintentional or unplanned cell death caused by the cell’s external environment, which impedes or interferes with body functions or health. Dangers of Cell Death in a Sample Cell enrichment assays can be hampered by both Necrosis & Apoptosis. The goal of studying a cell population is to collect as many healthy target cells as possible. Damaged cells do not behave the same as healthy cells and thus produce insufficient results. When collecting and storing cell samples, the longer a cell is kept outside of its preferred environment, the more likely it will die from necrosis. Cells can swell and die as a result of external factors. Dead cells can clump and cause more cell death in the surrounding population when using traditional cell separation methods such as magnetic-based cell sorting. It is critical to follow protocols, use gentle cell separation methods, and use additional products for increased downstream accuracy to maintain cell health and purity during cell separation assays. Harnessing Pluriselect’s Innovative Technology: Plurispin and PluriBead The first method for reducing cell death is to use a gentler isolation method. Traditional separation technologies, such as magnetic bead-based sorting, can be harsh on cells and result in less-than-desirable outcomes. Let’s see what Plurispin and PluriBead can do for us. Plurispin The pluriSpin system is a new negative cell isolation technology that can be used to isolate cells directly from whole blood, buffy coat, or cord blood. This new method isolates viable, untouched, and highly purified cells in a single step without the use of magnets or a column. As a result, there is less chance of activating or damaging the cells of interest. PluriBead PluriBead is a unique cell separation technology that does not rely on magnetic components. The steps are straightforward: Your pluriBeads (containing bound target cells) are sieved through a strainer; the pluriBeads containing your target cells remain on top, while the unwanted cells pass through. You have your target cells ready after detaching. Ready to get started? Stop wasting your valuable samples on inefficient processes and see the difference for yourself. Pluriselect’s innovative technology provides an incredibly fast, simple workflow that allows you to confidently move to downstream processing. https://uberstrainer.com/necrosis-vs-apoptosis-necrotic-cell-death-processes-apoptosis-steps/?srsltid=AfmBOorXdBv0i9nIoJj0a0EJSaMNsEfUera9WQT93AqxIR9fd5FupZMu ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Concept Comparison,Q&A "Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.",What is the clinical consensus on whether THC affects the brain during adolescence?,"AHA SCIENTIFIC STATEMENT Use of Marijuana: Effect on Brain Health: A Scientific Statement From the American Heart Association The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Fernando D. Testai, MD, PhD, Chair; Philip B. Gorelick, MD, MPH, Vice Chair; Hugo J. Aparicio, MD, MPH; Francesca M. Filbey, PhD; Raul Gonzalez, PhD; Rebecca F. Gottesman, MD, PhD; Miriam Melis, PhD; Mariann R. Piano, RN, PhD; Tiziana Rubino, PhD; Sarah Y. Song, MD; on behalf of the American Heart Association Stroke Brain Health Science Subcommittee of the Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease ABSTRACT: Marijuana is perceived as a harmless drug, and its recreational use has gained popularity among young individuals. The concentration of active ingredients in recreational formulations has gradually increased over time, and high-potency illicit cannabinomimetics have become available. Thus, the consumption of cannabis in the general population is rising. Data from preclinical models demonstrate that cannabinoid receptors are expressed in high density in areas involved in cognition and behavior, particularly during periods of active neurodevelopment and maturation. In addition, growing evidence highlights the role of endogenous cannabinoid pathways in the regulation of neurotransmitter release, synaptic plasticity, and neurodevelopment. In animal models, exogenous cannabinoids disrupt these important processes and lead to cognitive and behavioral abnormalities. These data correlate with the higher risk of cognitive impairment reported in some observational studies done in humans. It is unclear whether the effect of cannabis on cognition reverts after abstinence. However, this evidence, along with the increased risk of stroke reported in marijuana users, raises concerns about its potential long-term effects on cognitive function. This scientific statement reviews the safety of cannabis use from the perspective of brain health, describes mechanistically how cannabis may cause cognitive dysfunction, and advocates for a more informed health care worker and consumer about the potential for cannabis to adversely affect the brain. Key Words: AHA Scientific Statements ◼ brain ◼ cannabis ◼ cognition ◼ marijuana ◼ stroke M M arijuana, or cannabis, was considered an illicit drug for decades. However, in many parts of the world, cannabis has been legalized for medical use or decriminalized for recreational or medicinal applications. This shift in attitude has resulted in a rapid increase in its use. It has been estimated that ≈183 million people in the world used marijuana in 20141 and that 22 million met criteria for cannabis use disorder in 2016.2 In addition, according to the 2002 to 2019 National Survey on Drug Use and Health, the proportion of the US population >12 years of age who used marijuana in the past year increased gradually from 11% in 2002 to 18% in 2019.3 The use of marijuana has gained popularity, particularly among adolescents and young adults, with ≈36% of 12th graders and 43% of college students reporting having used it in the past year.4 In parallel, evidence suggests that the potency of cannabis products in the United States, measured by the concentration of the primary psychoactive constituent of marijuana, Δ9-tetrahydrocannabinol (THC), has gradually increased from ≈4% in 1995 to 15% in 2018.5 Cannabinoid receptors are expressed in high density in areas of the brain involved in executive function and The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. © 2022 American Heart Association, Inc. e176 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 memory such as the hippocampus, amygdala, and prefrontal cortex (PFC), particularly during periods of active brain development.6 Acute intoxication with cannabinoids can impair memory and behavioral inhibition.7 Cannabinoids also regulate anxiety and can produce psychosis- like effects.6 Evidence shows that age at exposure may influence the effect of cannabinoids on cognitive function. For example, the prenatal, perinatal, and adolescent periods may be particularly sensitive to these compounds.8 Data obtained in preclinical models have shown that cannabis and its associated signaling pathways regulate neurotransmission and play an active role in key cerebral processes, including neuroinflammation, neurogenesis, neural migration, synaptic pruning, and white matter development.6,9 Furthermore, experimental data show that cannabinoids can regulate the functioning of different cytochrome-P450 isoforms and uridine 5′-diphospho-glucuronosyltransferases. Thus, there is a potential risk for drug-to-drug interactions with medications commonly used by the elderly such as warfarin, antiarrhythmic agents, sedatives, and anticonvulsants.10 These factors have raised concerns about the potential effect of cannabis on cognitive vitality. The goal of this scientific statement is to critically appraise the safety of cannabis use from the perspective of brain health. CANNABIS AND ENDOCANNABINOIDS Anandamide and 2-arachidonoyl-glycerol are endogenous bioactive lipids that activate 2 G-protein–coupled receptors designated as cannabinoid receptor type 1 (CB1) and 2 (CB2). These lipids, called endocannabinoids, are not stored in vesicles but are synthesized on demand. The system formed by the cannabinoid receptors CB1 and CB2, endogenous ligands, and enzymes involved in their production and degradation is known as the endocannabinoid system (ECS). A detailed description of the composition and regulation of the ECS is beyond the scope of this publication; this topic has been reviewed extensively elsewhere.9,11,12 Phytocannabinoids are exogenous cannabinoids extracted from flowering plants from the cannabis genus, including Cannabis sativa, Cannabis indica, and Cannabis ruderalis. Whether these are species or subspecies is a matter of debate. More than 100 phytocannabinoids have been extracted from these plants, with THC and cannabidiol (CBD) being the most abundant. The relative concentration of THC and CBD in these strains is variable. In general, cannabis cultivars can be classified according to the cannabinoid produced as chemotype I (THC rich), II (THC/CBD balanced), III (CBD rich), IV (cannabigerol rich), or V (cannabinoid free).13 THC is a psychoactive alkaloid that signals through CB1 and CB2 receptors. Cannabinoid receptor type 1 is expressed abundantly in peripheral and central neural cells. In the periphery, CB1 localizes to sympathetic nerve terminals and sensory neurons. In the central nervous system, it is expressed mainly in presynaptic membranes of excitatory and inhibitory neurons, where it regulates the vesicular release of dopamine, GABA, and glutamate. In comparison, CB2 is expressed mainly in immune cells, including microglia.9 CBD is a nonpsychoactive cannabinoid that has antioxidant and anti-inflammatory properties. It is thought that CBD exerts some of the beneficial effects that phytocannabinoids have in Dravet syndrome and Lennox- Gastaut syndrome. Furthermore, studies done in preclinical models suggest that CBD is beneficial in Alzheimer disease, cerebral ischemia, multiple sclerosis, and other neurologic disorders.9,14 The therapeutic potential of CBD is being investigated in different clinical trials. Compared with THC, CBD signals through different pathways but does not activate CB1 and CB2. At low concentration, CBD blocks the orphan G-protein–coupled receptor-55, the equilibrative nucleoside transporter 1, and the transient receptor potential of melastatin type 8 channel. It also activates the serotonin (5-hydroxytryptamine) 1A receptor, the transient receptor potential of ankyrin type 1 channel, and α3 and α1 glycine receptors. At high concentration, CBD activates the nuclear peroxisome proliferator-activated receptor γ and the transient receptor potential of vanilloid types 1 and 2.12,14 Several cannabinoids have received approval in different countries for the treatment of specific medical conditions. In addition, high-potency synthetic cannabimimetics such as Spice are available in the illegal market (Table 1).15–17 NEUROBIOLOGICAL ACTIONS OF CANNABIS IN ANIMAL MODELS Molecular and cellular mechanisms underlying the effects of cannabis on the developing brain are inferred mainly from preclinical studies that permit controlling for social and environmental factors that could influence outcomes of interest. In addition, animal models allow the investigation of a range of human age-related behavioral factors (eg, novelty and sensation seeking, impulsivity, risk-taking behaviors) and key stages of neurodevelopment that are conserved across many mammalian species. However, many individual (eg, species, strain, age) and experimental (eg, design, drug, dose, delivery, regimen) variables, along with objective end points (eg, behavioral paradigm, experimental technique), have contributed to equivocal findings across studies. Nonetheless, experimental animal models of prenatal and adolescent cannabis exposure have proved fundamental in disclosing the underlying neurobiological mechanisms that might explain several clinical neuropsychiatric outcomes outlined here. Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e177 Table 1. Synthetic and Semisynthetic Cannabinoids Cannabinoid type Active ingredient Indication Medical15,16 Cesamet Nabilone (synthetic THC analog) Treatment of refractory cancer chemotherapy– associated nausea and vomiting*† Marinol (pill) Dronabinol (synthetic THC) Anorexia with weight loss in patients with AIDS or cancer*† Syndros (solution) Dronabinol (synthetic THC) Treatment of refractory cancer chemotherapy– associated nausea and vomiting*† Epidiolex Purified CBD Seizures associated with Lennox- Gastaut syndrome and Dravet syndrome in patients >1 y of age* Seizures associated with tuberous sclerosis complex in patients >1 y of age* Sativex Nabiximols (extract of THC, CBD, and other minor cannabinoids, terpenoids, and flavonoids) Adjunctive therapy for symptomatic treatment of refractory spasticity in adult patients with multiple sclerosis indication† Adjunctive treatment for symptomatic neuropathy in adult patients with multiple sclerosis indication† Adjunctive treatment for patients with advanced cancer with refractory severe pain indication† Illicit17 K2, Spice, Kronic, Kaos Originally synthesized to study the endocannabinoid system Bind cannabinoid receptors with high affinity and can cause hallucinations, agitation, psychosis, short-term memory loss, seizures, coagulopathy, and myocardial infarction CBD indicates cannabidiol; and THC, Δ9-tetrahydrocannabinol. *Approved by the US Food and Drug Administration. †Approved by the Health Products and Food Branch of Health Canada. Animal models have been used to examine the role of the ECS in the modulation of synaptic plasticity, a process that allows the brain to change and adapt to new information.18 The ECS modulates synaptic plasticity by affecting the strength of interneuronal connections and, ultimately, the functioning of neuronal networks. From the mechanistic standpoint, THC activates cannabinoid receptors in the brain, thus interfering with physiological actions of endocannabinoids. Spatial and time resolution of endocannabinoid production is pivotal for correct processing of different brain functions such as higher-order cognition, memory, reward, mood, and stress sensitiv ity.8,19,20 Consequently, THC, activating nonspecifically CB1 receptors in the brain, disrupts the fine-tuning of synaptic activity exerted by endocannabinoids, eventually impairing connectivity of neuronal networks and brain functionality. Although incompletely understood, the way in which THC disrupts memory and learning may be through its differential effect on neurotransmitter release and binding to CB1 receptors.19 For example, THC activates CB1 receptors located on GABAergic interneurons, which represent nearly three-quarters of the brain CB1 receptors, and astrocytes, resulting in the release of hippocampal glutamate. Concomitantly, THC affects the transmission of other neurotransmitters involved in the modulation of memory such as acetylcholine, adenosine, and serotonin.19,20 Furthermore, THC activation of CB1 receptors present on mitochondria leads to decreased cellular respiration and ATP supply.19 ATP is fundamental in maintaining and regulating neurotransmission, and its reduction might contribute to THC- induced cognitive deficits. Repeated exposure to cannabis, especially during the adolescent developmental period, may be especially harmful to brain health and cause structural, molecular, and functional alterations of brain circuits, particularly in the PFC and hippocampus.8,21,22 Long-term THC exposure induces CB1 receptor downregulation and desensitization that appear more intense and widespread after adolescent exposure as opposed to adulthood exposure. 22 Data obtained in experimental models showed that these effects could have implications for neurodevelopmental processes in which the ECS plays a role. Accordingly, long-term THC exposure during adolescence may disrupt dynamic changes occurring in glutamatergic and GABAergic systems, leading to excessive synaptic pruning (ie, loss of synaptic contacts), long-term dysfunction in prefrontal excitatory/inhibitory balance, and desynchronization of PFC neuronal networks, which also dysregulate the mesolimbic dopaminergic pathway (Figure).23 These changes may represent the molecular underpinnings of cognitive deficits and altered emotional reactivity and social behavior observed long after adolescent long-term THC exposure.22 Long-term changes in brain functionality induced by THC exposure during adolescence might also arise from epigenetic modifications with a marked reprogramming of the transcriptome, affecting mainly genes related to synaptic plasticity processes. 8,19 These effects have not been reported after adult THC exposure.19 In addition to the effects on neuron cellular and sub- cellular components, recent evidence suggests that alterations in glial cells have a key role in the actions of THC.24 Long-term THC exposure activates microglia and astrocytes to produce inflammatory cytokines. For example, long-term administration of THC during adolescence increased the microglial expression of the proinflammatory mediators tumor necrosis factor-α, inducible nitric oxide synthase, and cyclooxygenase-2 by 60%, 130%, and 80%, respectively, and reduced the expression of the anti-inflammatory cytokine interleukin-10 by 30% in the PFC. The resulting neuroinflammatory response was associated with memory impairment during adulthood.25 Dose constitutes an additional important variable to consider. Most studies describe detrimental effects of e178 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 Figure. Effect of Δ9-tetrahydrocannabinol (THC) on different neurobiological processes. The effect of THC on the brain constitutes a continuum throughout the lifetime of an individual. However, 2 windows of brain vulnerability have been identified in preclinical models. The colored boxes represent the different processes that have been demonstrated to be affected on exposure to THC during these sensitive developmental periods. PFC indicates prefrontal cortex. THC in models of heavy cannabis use in middle adolescence. However, even lower doses may produce these same effects when administered earlier in adolescence.22 EFFECT OF PRENATAL EXPOSURE TO CANNABINOID AGONISTS A recent study examined associations between prenatal cannabis exposure (PCE) and various indicators of mental and neurocognitive health in a sample of 11489 youth.26 Self-report of maternal cannabis use during pregnancy was associated with various adverse outcomes among youth at 9 to 10 years of age, including poorer performance on tests of neurocognitive functioning and total intracranial volumes, even after controlling for potential confounders. Several reviews describe PCE sequelae in preclinical models.8,24,27–30 Here, we focus on mechanistic insights inferred from animal studies recapitulating the neuropsychiatric features of clinical outcomes.31 The detrimental effect of PCE on cognitive processing and emotional regulation of the progeny has been ascribed to changes in intrinsic and synaptic properties and plasticity of cortical (eg, PFC), limbic (eg, amygdala, hippocampus), and midbrain (eg, ventral tegmentum) regions. Changes in the balance of excitatory and inhibitory input strength, along with alterations in how principal neurons and interneurons receive, integrate, and convey information, have been observed in these neuroanatomic areas (Figure).8,24,27–30 Aberrant glutamatergic function is a common hallmark, as indexed by changes in the expression and function of ionotropic and metabotropic receptors and in dynamic regulation of glutamate levels by glutamate transporters at both synaptic cleft and extrasynaptic spaces. These changes depend largely on the alterations of endocannabinoid signaling pathways caused by exogenous cannabinoids during development and throughout ontogenesis (eg, neural proliferation, survival, directional axonal growth).8,24,27–30 Defects in ECS function also may account for the interneuronopathy observed in many brain regions of PCE offspring, a phenomenon often more prominent in female than in male animals.8,27–29 In the PFC, this persistent inhibitory circuit deficit also is associated with a delayed switch of GABA from its excitatory role early in development to a classic inhibitory function exerted throughout the central nervous system later in life.8,29 This is particularly relevant because the GABA switch represents a critical milestone during neurodevelopment. Any alteration in the normal and predictable temporal sequence of these periods such as delays, stalls, or accelerations imposed by PCE may lead to perturbations of offspring cognitive processing and emotional behavior.8,29 It was observed that marijuana use leads to dysregulation of monoaminergic pathways and stress response systems.8,27–29 PCE hampers the maturation of mono- amines, which also exert trophic actions on target neurons and afferent terminals. This phenomenon may depend on epigenetic modifications and may be implicated in aberrant reward signaling. Furthermore, PCE is associated with an endophenotype in the offspring, which displays protracted dysregulation of stress responsivity that is not explained by glucocorticoid levels. A susceptibility to acute and chronic stress is tied to many psychiatric disorders, ranging from depressed mood and psychosis to substance use disorders and anxiety. A deeper understanding of how PCE interferes with endocannabinoid signaling during neurodevelopment would allow us to explore potential interventions aimed at restoring or reprogramming the hierarchical progression of developmental milestones. EFFECTS OF MARIJUANA USE ON HUMAN COGNITION Acute intoxication from marijuana is associated with impairment of working and episodic memory, behavioral disinhibition, and impulsivity, which can affect performance in real-world activities.6 For example, a meta-analysis from 2016 showed that the odds of being involved in a motor vehicle accident was increased 36% in cannabis users relative to nonusers.32 In addition, a crossover clinical trial published in 2020 investigated the effect of different cannabis products in relation to on-road driving tests. The SD of lateral position, a measure of lane weaving, swerving, and overcorrection, was 20.29 cm at 40 to 100 minutes after inhalation of THC-dominant cannabis and 21.09 cm after inhalation of a mixture of THC and CBD. It is interesting to note that the SD of lateral position after inhalation of CBD-dominant cannabis was similar to that in the placebo group (18.21 cm versus 18.26 cm).33 These observations illustrate the differential short- term effect of THC and CBD on cognition. Evidence also suggests that the short-term effects of cannabinoids are transient and can be influenced by the development of tolerance and the use of other drugs. The long-term effect of cannabis on cognition, however, is less well established. Recent meta-analyses report residual effects of cannabis use on neurocognition, consistent with prior research.34 A meta-analysis by Lovell et al35 in 2020 focused on adult near-daily cannabis use for >2 years and found global neurocognition among users (n=849) to be about one-quarter of an SD worse than that of nonusers (n=764). Four of the 7 domains investigated (decision-making, verbal learning, retention, executive function) showed significant effect sizes ranging from Hedges g=−0.52 to −0.18. A meta- analysis of cannabis users <26 years of age (n=2152) and nonusers (n=6575) also showed a one-quarter of an SD difference in global neurocognitive performance but with more specific domains affected,36 albeit with smaller effect size compared with that found by Lovell et al.35 Both lacked support for worse neurocognition in early adolescence in that neither found that age at onset of cannabis use influenced the association between exposure and cognitive performance. In contrast to these meta-analyses, large longitudinal studies provide stronger causal inferences by examining change over time. In the CARDIA study (Coronary Artery Risk Development in Young Adults), 3385 participants 18 to 30 years of age were followed up longitudinally. Marijuana use was assessed periodically in the 25-year follow-up. In addition, cognitive assessment was completed 25 years after inception. In this study, cumulative years of exposure to marijuana was associated with worse verbal memory (0.13 lower SD in the verbal memory test for each additional 5 years of exposure to marijuana).37 Longitudinal co-twin studies use a research design that additionally controls for shared variance from genetic and environmental factors. Two large longitudinal twin studies (n=3066) with neurocognitive measures collected before (at 9–12 years of age) and after (17–20 years of age) cannabis exposure reported that declines in vocabulary and general knowledge were associated with being a cannabis user but not with amount of cannabis consumed. 38 Twins discordant for cannabis use showed no differences in IQ declines. Thus, differences were likely caused by shared risk factors. Using a similar design, Meier et al39 reported that lower IQ predated cannabis use with no evidence of actual IQ declines among 1989 twins assessed at 5, 12, and 18 years of age. Ross et al40 evaluated other aspects of neurocognition among 856 individual twins and reported only 1 within-family effect of 70 tested. Specifically, frequency of cannabis use at 17 years of age was associated with poorer executive functioning at 23 years of age, but executive functioning problems predating cannabis use could not be ruled out. Magnetic resonance imaging (MRI) techniques demonstrate differential associations of cannabis use with brain structure and function. In terms of brain structure, alterations related to cannabis use have been mixed. In a longitudinal study including 1598 MRIs done in adolescents at baseline and the 5-year follow-up, a dose- dependent association was observed between cannabis use and PFC thinning.41 On the other hand, although a meta-analysis found that regular cannabis consumption was associated with smaller hippocampal (standardized mean difference, 0.14 [95% CI, 0.02–0.27]), medial orbitofrontal cortex (standardized mean difference, 0.30 [95% CI, 0.15–0.45]), and lateral orbitofrontal cortex (standardized mean difference, 0.19 [95% CI, 0.07–0.32]) volumes relative to nonuse, brain volumes were not associated with cannabis use duration and dosage. 42 Other large studies have reported null effects. In 2 e180 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 large twin samples from the United States (n=474) and Australia (n=622), cannabis use was unrelated to volumes of the thalamus, caudate nucleus, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens.43 A multisite study of cortical surface measures (n=262) reported no difference in cortical thickness, surface area, and gyrification index in cannabis users versus nonusers, in cannabis dependence versus nondependence versus nonusers, and in early adolescent versus late adolescent onset of cannabis use versus nonuse.44 Thus, brain structural abnormalities related to cannabis use are inconsistent. Functional MRI studies report more robust effects, particularly after prolonged cannabis use. A meta-analysis of task-based functional MRI studies in current adult and adolescent users found abnormalities in activation in both age groups. Relative to nonusing control subjects, adult cannabis users had greater brain activation in the superior (seed-based d mapping [SDM-Z], 1.561; P<0.002) and posterior (SDM-Z, 1.479; P<0.003) transverse temporal and inferior frontal gyri (SDM-Z, 1.568; P<0.002) and less activation in the striatum (SDM-Z, −1.843; P<0.001), insula (SDM-Z, −1.637; P<0.001), and middle frontal gyrus across different tasks. Adolescent cannabis users also had greater activation in the inferior parietal gyrus (SDM-Z, 1.06; P<0.001) and putamen (SDM-Z, 1.008; P<0.001) compared with nonusers across various tasks, suggesting compensatory neuroadaptive mechanisms.45 These functional abnormalities persist despite cessation of cannabis use and beyond the period when THC metabolites are detectable. A meta-analysis of the same adolescent studies found that >25-day abstinent adolescent cannabis users exhibited greater activation in the right inferior frontal gyrus in addition to other areas relevant for executive functioning and self-regulatory mechanisms.46 Several recent studies examined cannabis effects in populations with premorbid clinical risk factors and those using medical marijuana. A meta-analysis focused only on cannabis users with psychosis <25 years of age (n=529) and nonusing control subjects with psychosis (n=901). In this study, there were significant differences in 3 of 11 domains assessed (premorbid IQ, Hedges g=0.40 [standardized effect size]; current IQ, Hedges g=−0.17; working memory, Hedges g=−0.76).47 Among a sample of 215 adult patients with chronic pain provided daily herbal cannabis containing 12.5% THC for 1 year, no significant neurocognitive differences were found compared with 216 control subjects.48 This is in line with a study of patients with multiple sclerosis in response to oral dronabinol that found no significant differences in MRI-derived measures, including annual percentage of brain volume change and occurrence of new lesions, after 12 months of use.49 These clinical trials suggest no significant adverse effect of THC on neurocognitive symptoms in specific clinical populations. EFFECTS OF MARIJUANA USE ON CEREBROVASCULAR RISK AND DISEASE Cerebrovascular Risk Factors Similar to the literature linking marijuana use with cardiovascular outcomes,10 evidence that marijuana consumption increases the prevalence of specific cerebrovascular risk factors and disease is limited by a preponderance of observational studies, cross-sectional studies, case reports, and case series prone to potential publication and other biases. Postulated adverse effects of marijuana use may include sympathetic nervous system activation, blood pressure changes, platelet activation, and electrophysiological effects.50–52 Concomitant tobacco smoking and other substance use and abuse possibly contribute to these effects, which may be short term and have been studied mostly in low-risk populations such as younger adults. These factors may explain why many longitudinal studies linking marijuana use and cardiovascular or metabolic risk factors have been negative after multivariable adjustment for unhealthy behaviors such as diet and tobacco smoking.53–55 Hypertension, in particular, is an important risk factor for ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage. With marijuana use, the most common acute reaction in humans is a decrease in blood pressure resulting from cannabinoid effects on the vasculature and autonomic nervous system.52 Despite this physiological reaction, limited studies using the National Health and Nutrition Examination Survey showed a modest association of recent cannabis use with higher systolic blood pressure and higher prevalence of hypertension among current users 30 to 59 years of age.56 Heavy users, defined as use of marijuana or hashish in >20 of the past 30 days, had higher odds of abnormal blood pressure compared with never-users. Although this difference remained statistically significant after adjustment for age, sex, race, ethnicity, body mass index, education, and survey year, it was no longer statistically significant after additional adjustment for current tobacco and binge alcohol use (adjusted odds ratio, 1.47 [95% CI, 0.99–2.16]).57 The relationship between marijuana use and elevated blood pressure, especially among heavy users, may drive longer-term associations with cerebrovascular outcomes, although this mechanism remains to be studied. Prior cardiovascular disease such as myocardial infarction (MI) or atrial fibrillation (AF) is also an important risk factor for stroke.58 Case reports of MI after marijuana use are mainly among young adults who lack vascular risk factors, with onset of MI shortly after use.59 Risk of MI was elevated 4.8-fold within an hour after smoking marijuana compared with periods of nonuse. This association demonstrates the potential role of marijuana as an acute trigger for cardiovascular disease.60 Over 25 years of follow-up, among 5113 adult participants in Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e181 the Coronary Artery Risk Development in Young Adults study, cumulative or recent marijuana use was not associated with coronary heart disease, stroke, or cardiovascular disease mortality.61 This finding contrasts with a population-based, multi-institutional database study that observed an increased risk of 3-year cumulative incidence of MI among marijuana users compared with control subjects (1.37% vs 0.54%; relative risk, 2.54 [95% CI, 2.45–2.61]).62 Similarly, marijuana use appears to be a trigger for AF. Data from the Nationwide Inpatient Sample show that the percentage of individuals with cannabis use disorder discharged in the postlegalization period (2010–2014) with the diagnosis of arrhythmia increased 31%.63 However, in a study of patients hospitalized for heart failure, marijuana users had a reduced odds of AF compared with nonusers (adjusted odds ratio, 0.87 [95% CI, 0.77–0.98]).50 Simultaneous use of cocaine, stimulants, and other drugs may be responsible for observations of AF among marijuana users, although this remains to be fully studied outside of observational and cross-sectional reports. Risk of Stroke and Transient Ischemic Attack Several case reports and case series mostly in young individuals suggest a relationship between recent and heavy cannabis use and risk of stroke.64–66 In contrast, and as reviewed below, findings among case-control studies,67 population-based studies,68 and studies conducted using outpatient69,70 or inpatient71,72 national databases or hospital electronic health records73 have been equivocal, depending on the study design, covariates considered in the analysis, and source of the population being studied. Inconsistent associations also can be attributable to the presence of comparison groups and whether adjustment of other important risk factors was considered, along with attention to potential confounding by other risk factor and lifestyle features between cannabis users and nonusers. In 1 case-control study using cannabis urine screens to identify cannabis users, the authors found an association between cannabis use and the risk of ischemic stroke and transient ischemic attack, but the association was not significant when tobacco use was included as a covariate (adjusted odds ratio, 1.59 [95% CI, 0.71– 3.70]) among subjects 18 to 55 years of age with and without stroke.67 Similarly, after adjustment for cigarette smoking and alcohol use, another study found no association between cannabis use in young adulthood and the occurrence of fatal and nonfatal stroke later in life among Swedish men in up to 38 years of follow-up.68 Data from studies that have examined more specifically the dose or amount of cannabis consumed within a designated time frame suggest that regular cannabis use may increase the risk of stroke. Using data from population-based surveys, investigators have reported that when no cannabis use was compared with heavy cannabis use in the past year, cannabis use was associated with an increased risk for the occurrence of nonfatal stroke and transient ischemic attack.70 Similarly, another study found that recent (within the past 30 days) and frequent (>10 d/mo) cannabis use was associated with increased risk for the occurrence of stroke compared with nonuse, whereas less frequent cannabis use (≤10 d/mo or less than weekly in the past year) was not associated with increased risk.69,70 Using several International Classification of Diseases, Ninth Revision, Clinical Modification codes for marijuana use, a Nationwide Inpatient Sample study found that cannabis use among men and women hospitalized between 2004 and 2011 was associated with a 17% increased relative risk for acute ischemic stroke in a multivariable-adjusted analysis. Concomitant use of tobacco with cannabis increased the risk to 31%.71 Similarly, a separate study using the Nationwide Inpatient Sample but between 2009 and 2010 observed a higher odds of stroke among cannabis users (odds ratio, 1.24 [95% CI, 1.14–1.34]).72 In contrast, investigators using electronic health record data from patients admitted to a single center between 2015 and 2017 found that testing positive for cannabis use was not associated with the risk of ischemic stroke compared with testing negative, even after adjustment for numerous confounders, including age, cigarette smoking, and comorbidities.73 There may be certain populations or scenarios in which cannabis use can be meaningfully linked to stroke. A study of a large longitudinal cohort of Canadian pregnant women that included >1 million participants between 1989 and 2019 with follow-up at 30 years observed that cannabis use disorder was associated with a doubling of risk for hemorrhagic stroke (hazard ratio, 2.08 [95% CI, 1.07–4.05]) but no increased risk for ischemic or other cerebrovascular disease.74 Because of the theoretical vasoactive effect of cannabis, its use has been implicated in some cases of reversible cerebral vasoconstriction syndrome, with 6 of 24 nonidiopathic reversible cerebral vasoconstriction syndrome cases at a Colorado stroke center attributed to marijuana use.75 In addition, an elevated risk of stroke from intracranial arterial stenosis has been described among young cannabis users 18 to 45 years of age wherein vasospasm or reversible cerebral vasoconstriction syndrome may be a potential mechanism. 76 Studies done in experimental models have shown that cannabinoids exert complex effects on cardiac contractility, vascular tone, and atherogenesis. Both vasodilatation and vasoconstriction responses were observed, depending on the experimental model and cannabinoid used. CB1 activation promotes inflammation, upregulates the production of reactive oxygen species, and activates proapoptotic pathways in endothelial cells and cardiomyocytes. In addition, it induces endothelial dysfunction and vascular smooth muscle cell proliferation and migration. These processes have been linked to cardiac dysfunction e182 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 and the development of atherosclerosis.52 This is in contrast to the atheroprotective role associated with CB2. Acute cardiovascular events and stroke also have been reported in patients using synthetic cannabinoids.77 Spice is associated with idiopathic thrombocytopenic purpura, which increases the risk of major hemorrhage.78 In addition, intracranial hemorrhage in Spice users has been linked to the presence of brodifacoum, an adulterant considered a superwarfarin.79 EDUCATION AND FUTURE DIRECTIONS Our understanding of the ramifications of cannabis consumption on brain health is limited but rapidly evolving. Observational studies have produced conflicting results in relation to the effect of marijuana on different outcomes of interest, including hypertension, AF, MI, and cognition. Several methodological factors may explain these apparent contradictions. First, given its historical classification as an illicit drug, the use of marijuana has been underreported for generations. The inclusion of marijuana users in the control group of observational studies that rely on self-reported use could underestimate its effect on brain health. Second, several behaviors such as smoking and alcohol use are associated with marijuana consumption and can influence stroke risk and brain connectivity.80,81 The often missing information on frequency of exposure to these factors limits our ability to determine with accuracy the independent effect of marijuana. Third, the time of exposure, frequency of use, and bioavailability of marijuana, which is affected by the route of administration, diet, and concomitant use of medications that may affect its metabolism, are reported inconsistently.10 Fourth, THC and CBD have different pharmacological effects. Although the use of THC has been associated with detrimental effects, CBD appears to have therapeutic potential in some neurologic disorders.9 The absolute and relative concentrations of these compounds differ according to the strain of cannabis plant and the methodology used to extract the active ingredients.82 Fifth, the gradual increase in the potency of marijuana used recreationally limits the relevance of older studies.5 Sixth, different factors impede the development of long-term placebo-controlled studies, including ethical reasons and the psychotropic effect of THC, which cannot be blinded. Social media may emphasize a beneficial role for marijuana, and the general population may perceive it as a harmless drug. However, the emerging evidence linking marijuana use to cardiovascular events and stroke, as well as the potential and demonstrated drug-to-drug interactions between marijuana and medications commonly used in the general population, calls for caution and highlights the potential importance of active surveillance programs.10,83 In addition, the high density of cannabinoid receptors in areas involved in executive function and memory, the dose-dependent detrimental effect of THC on working and episodic memory, and the role of Table 2. Key Summary Points Section Notes Actions of THC disrupts endocannabinoid signaling pathways and Cannabis affects synaptic plasticity. In the short term, this affects the in Animal strength of interneuronal connections; in the long term, it Models leads to changes in the functioning of neuronal networks. Exposure to THC during adolescence can lead to structural, molecular, and functional alterations of brain circuits, particularly in areas involved in cognition and behavior. Effect of In preclinical models, THC disrupts the normal signaling Prenatal of the endocannabinoid system during development and Exposure to throughout ontogenesis and results in abnormal neurotrans- Cannabinoid mission. Agonist Prenatal THC affects neuroanatomic areas associated with cognition and emotional regulation, including the PFC, limbic system, and ventral tegmentum of the midbrain. Effects of Acute intoxication with marijuana affects memory, behavior, Marijuana Use and impulsivity. on Human The long-term effect of cannabis on cognition may be Cognition domain specific. Neuroimaging studies have shown structural changes in cannabis users; however, the results are inconsistent. Functional changes may be observed in areas of the brain involved in cognition among cannabis users. Early exposure to cannabis may have a negative effect on cognitive function. Effects of Several studies have described an association between Marijuana cannabis use and increased risk of stroke. Use on Data from population survey studies indicate that the pat- Cerebrovastern (heavy vs less) and frequency (>10 d/mo) of cannabiscular Risk and use may increase the risk of stroke. Disease Cigarette smoking is common in cannabis users and may be an important modifier or confounder of the relationship between cannabis use and stroke risk. Given the potential role of cannabis as a vasoactive substance and its potential role in cardiac pathology and atherosclerosis development, cannabis use also may increase stroke risk via reversible cerebral vasoconstriction syndromes or may indirectly increase stroke risk. It is possible that differences among some study findings may be attributable to the years in which population cohorts were studied or recruited because most population cohorts were assembled before 2012. Over the past decade, strains of cannabis have been evolving, resulting in plants with high THC concentrations and some preparations that may have synthetic cannabinoids such as Spice, which may influence the association of cannabis use with stroke. Education The cumulative evidence collected in clinical and preclinical and Future studies suggests that the consumption of marijuana can have Directions a detrimental effect on brain health. The exact ramifications, however, have not been precisely established. Emerging evidence questions the widely accepted belief that marijuana is innocuous and suggests that cannabis, particularly THC, negatively affects brain health through direct and indirect mechanisms. Health care professionals and consumers should receive education on the potential beneficial and harmful effects associated with the use of marijuana, including the increased risk of stroke and cognitive decline. CBD indicates cannabidiol; PFC, prefrontal cortex; and THC, Δ9-tetrahydrocannabinol. cannabinoid-associated biochemical pathways on synaptic plasticity and neuronal development raise concern that long-term exposure to marijuana may affect brain health. There is lack of agreement on whether the effects of Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e183 marijuana resolve completely after months of abstinence. However, the disruption of endocannabinoid signaling pathways during the prenatal and perinatal periods and in adolescence may be detrimental to neurodevelopment. 6,8,9 Key points discussed in this scientific statement are summarized in Table 2. It should be noted that the overarching goal of this scientific statement was to discuss mechanisms by which marijuana use could influence brain health. However, as the field is developing, several important aspects require additional research. As an example, there is limited information comparing the differential effect of recreational, illicit, and medicinal uses of marijuana, as well as the type of cannabis product consumed. Similarly, the modulatory effects of social determinants of health and race and ethnicity on the interaction of brain health and marijuana use are largely unexplored. The latter area of research may be particularly important because communities of color in the United States may be disproportionately affected by natural and synthetic cannabinoids in relation to use and exposure and the legal implications of criminalization of marijuana.84 Public health efforts should be considered to raise awareness about the potential negative effects associated with the use of marijuana in the general population. Possible strategies include the use of standardized concentrations of biologically active components and health warning labels on available formulations. In addition, the use of marijuana should be individualized and closely monitored. Health care professionals and patients should receive unbiased education about the potential consequences of medicinal, recreational, and illicit marijuana use on brain health, particularly when the exposure occurs during vulnerable vital periods. It also may be important for professionals to monitor cognitive performance of Disclosures Writing Group Disclosures marijuana users and to review their medications to identify potential drug-to-drug interactions. Knowledgeable health care professionals will be able to properly educate potential or active marijuana users about its possible adverse effects, empowering them to make an informed decision that is based on unbiased data. ARTICLE INFORMATION The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on July 29, 2021, and the American Heart Association Executive Committee on September 5, 2021. A copy of the document is available at https://professional.heart.org/statements by using either “Search for Guidelines & Statements” or the “Browse by Topic” area. To purchase additional reprints, call 215-356-2721 or email Meredith.Edelman@wolterskluwer.com. The American Heart Association requests that this document be cited as follows: Testai FD, Gorelick PB, Aparicio HJ, Filbey FM, Gonzalez R, Gottesman RF, Melis M, Piano MR, Rubino T, Song SY; on behalf of the American Heart Association Stroke Brain Health Science Subcommittee of the Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease. Use of marijuana: effect on brain health: a scientific statement from the American Heart Association. Stroke. 2022;53:e176–e187. doi: 10.1161/STR.0000000000000396 The expert peer review of AHA-commissioned documents (eg, scientific statements, clinical practice guidelines, systematic reviews) is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit https://professional.heart.org/statements. Select the “Guidelines & Statements” drop-down menu, then click “Publication Development.” Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at https://www.heart.org/permissions. A link to the “Copyright Permissions Request Form” appears in the second paragraph (https://www.heart.org/en/aboutus/ statements-and-policies/copyright-request-form). Writing group member Employment Research grant Other research support Speakers’ bureau/ honoraria Expert witness Ownership interest Consultant/ advisory board Other Fernando D. Testai University of Illinois at Chicago None None None None None None None Philip B. Gorelick Northwestern University None None None None None None None Hugo J. Aparicio Boston University School of Medicine None None None None None None None Francesca M. Filbey University of Texas at Dallas Center for Brain Health None None None None None None None Raul Gonzalez Florida International University None None None None None None None Rebecca F. Gottesman National Institutes of Health National Institute of Neurological Disorders and Stroke None None None None None None None Miriam Melis University of Cagliari (Italy) NIH* None None None None None None Mariann R. Piano Vanderbilt University School of Nursing None None None None None None None Tiziana Rubino University of Insubria (Italy) None None None None None None None Sarah Y. Song Rush University Medical Center None None None None None None None This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity or owns $10000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. *Modest. e184 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 Reviewer Disclosures Other Speakers’ research bureau/ Expert Ownership Consultant/ Reviewer Employment Research grant support honoraria witness interest advisory board Other Mark J. Alberts Hartford HealthCare None None None None None None None Larry A. Allen University of Colorado PCORI†; NIH NHLBI None None None None Novartis*; Boston None School of Medicine (K23 HL105896)†; Scientific†; Cytoki- AHA (grant, SFRN)† netics*; Amgen* George Howard University of Alabama at Birmingham None None None None None None None Farzaneh A. Sorond Northwestern Univer-None None None None None None None sity, Feinberg School of Medicine This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. *Modest. †Significant. REFERENCES 1. United Nations Office on Drugs and Crime. World drug report. 2015. Accessed February 10, 2021. https://www.unodc.org/unodc/en/ index.html 2. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 2018;5:987–1012. doi: 10.1016/S2215-0366(18)30337-7 3. US Department of Health and Human Services. 2019 NSDUH annual national report. 2020. Accessed February 9, 2021. https://www.samhsa. gov/data/report/2019-nsduh-annual-national-report 4. Johnston LD, Miech RA, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the Future national survey results on drug use, 1975–2018: overview, key findings on adolescent drug use. 2019. Accessed February 9, 2021. https://eric.ed.gov/?id=ED594190 5. National Institutes of Health, National Institute on Drug Abuse. Marijuana potency. 2020. Accessed February 10, 2021. https://www.drugabuse.gov/ drug-topics/marijuana/marijuana-potency 6. Curran HV, Freeman TP, Mokrysz C, Lewis DA, Morgan CJ, Parsons LH. Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci. 2016;17:293–306. doi: 10.1038/nrn.2016.28 7. Mechoulam R, Parker LA. The endocannabinoid system and the brain. Annu Rev Psychol. 2013;64:21–47. doi: 10.1146/annurev-psych-113011-143739 8. Hurd YL, Manzoni OJ, Pletnikov MV, Lee FS, Bhattacharyya S, Melis M. Cannabis and the developing brain: insights into its long-lasting effects. J Neurosci. 2019;39:8250–8258. doi: 10.1523/JNEUROSCI.1165-19.2019 9. Cristino L, Bisogno T, Di Marzo V. Cannabinoids and the expanded endocannabinoid system in neurological disorders. Nat Rev Neurol. 2020;16:9–29. doi: 10.1038/s41582-019-0284-z 10. Page RL 2nd, Allen LA, Kloner RA, Carriker CR, Martel C, Morris AA, Piano MR, Rana JS, Saucedo JF; on behalf of the American Heart Association Clinical Pharmacology Committee and Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Basic Cardiovascular Sciences; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research. Medical marijuana, recreational cannabis, and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2020;142:e131–e152. doi: 10.1161/CIR.0000000000000883 11. Lu H, Mackie K. Review of the endocannabinoid system. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021;6:607–615. 12. Zou S, Kumar U. Cannabinoid receptors and the endocannabinoid system: signaling and function in the central nervous system. Int J Mol Sci. 2018;19:833. doi: 10.3390/ijms19030833 13. Romero P, Peris A, Vergara K, Matus JT. Comprehending and improving cannabis specialized metabolism in the systems biology era. Plant Sci. 2020;298:110571. doi: 10.1016/j.plantsci.2020.110571 14. Patel AD. Cannabinoids in neurologic illnesses. Neurol Clin. 2021;39:231– 241. doi: 10.1016/j.ncl.2020.09.012 15. US Food & Drug Administration. FDA regulation of cannabis and cannabis- derived products, including cannabidiol (CBD). 2021. Accessed February 12, 2021. https://www.fda.gov/news-events/public-health-focus/fda-regulation- cannabis-and-cannabis-derived-products-including-cannabidiol-cbd 16. Health Canada. Information for health care professionals: cannabis (marihuana, marijuana) and the cannabinoids. 2018. Accessed February 12, 2021. https://www.canada.ca/en/health-canada/services/drugs-medication/ cannabis/information-medical-practitioners/information-health-careprofessionals- cannabis-cannabinoids.html#fig 1 17. Zawilska JB, Wojcieszak J. Spice/K2 drugs: more than innocent substitutes for marijuana. Int J Neuropsychopharmacol. 2014;17:509–525. doi: 10.1017/S1461145713001247 18. Araque A, Castillo PE, Manzoni OJ, Tonini R. Synaptic functions of endocannabinoid signaling in health and disease. Neuropharmacology. 2017;124:13–24. doi: 10.1016/j.neuropharm.2017.06.017 19. Prini P, Zamberletti E, Manenti C, Gabaglio M, Parolaro D, Rubino T. Neurobiological mechanisms underlying cannabis-induced memory impairment. Eur Neuropsychopharmacol. 2020;36:181–190. doi: 10.1016/j. euroneuro.2020.02.002 20. Meyer HC, Lee FS, Gee DG. The role of the endocannabinoid system and genetic variation in adolescent brain development. Neuropsychopharmacology. 2018;43:21–33. doi: 10.1038/npp.2017.143 21. Zamberletti E, Rubino T. Impact of endocannabinoid system manipulation on neurodevelopmental processes relevant to schizophrenia. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021;6:616–626. doi: 10.1016/j. bpsc.2020.06.013 22. Higuera-Matas A, Ucha M, Ambrosio E. Long-term consequences of perinatal and adolescent cannabinoid exposure on neural and psychological processes. Neurosci Biobehav Rev. 2015;55:119–146. doi: 10.1016/j. neubiorev.2015.04.020 23. Renard J, Rushlow WJ, Laviolette SR. Effects of adolescent THC exposure on the prefrontal GABAergic system: implications for schizophrenia-related psychopathology. Front Psychiatry. 2018;9:281. doi: 10.3389/fpsyt.2018.00281 24. Melis M, Frau R, Kalivas PW, Spencer S, Chioma V, Zamberletti E, Rubino T, Parolaro D. New vistas on cannabis use disorder. Neuropharmacology. 2017;124:62–72. doi: 10.1016/j.neuropharm.2017.03.033 25. Zamberletti E, Gabaglio M, Prini P, Rubino T, Parolaro D. Cortical neuroinflammation contributes to long-term cognitive dysfunctions following adolescent delta-9-tetrahydrocannabinol treatment in female rats. Eur Neuropsychopharmacol. 2015;25:2404–2415. doi: 10.1016/j. euroneuro.2015.09.021 26. Paul SE, Hatoum AS, Fine JD, Johnson EC, Hansen I, Karcher NR, Moreau AL, Bondy E, Qu Y, Carter EB, et al. Associations between prenatal cannabis exposure and childhood outcomes: results from the ABCD study. JAMA Psychiatry. 2021;78:64–76. doi: 10.1001/jamapsychiatry.2020.2902 27. Alpár A, Di Marzo V, Harkany T. At the tip of an iceberg: prenatal marijuana and its possible relation to neuropsychiatric outcome in the offspring. Biol Psychiatry. 2016;79:e33–e45. doi: 10.1016/j.biopsych.2015.09.009 28. Scheyer AF, Melis M, Trezza V, Manzoni OJJ. Consequences of perinatal cannabis exposure. Trends Neurosci. 2019;42:871–884. doi: 10.1016/j. tins.2019.08.010 29. Tirado-Muñoz J, Lopez-Rodriguez AB, Fonseca F, Farré M, Torrens M, Viveros MP. Effects of cannabis exposure in the prenatal and adolescent periods: preclinical and clinical studies in both sexes. Front Neuroendocrinol. 2020;57:100841. doi: 10.1016/j.yfrne.2020.100841 30. Pinky PD, Bloemer J, Smith WD, Moore T, Hong H, Suppiramaniam V, Reed MN. Prenatal cannabinoid exposure and altered neurotransmission. Neuropharmacology. 2019;149:181–194. doi: 10.1016/j.neuropharm. 2019.02.018 31. Roncero C, Valriberas-Herrero I, Mezzatesta-Gava M, Villegas JL, Aguilar L, Grau-López L. Cannabis use during pregnancy and its relationship with fetal developmental outcomes and psychiatric disorders: a systematic review. Reprod Health. 2020;17:25. doi: 10.1186/s12978-020-0880-9 32. Rogeberg O, Elvik R. The effects of cannabis intoxication on motor vehicle collision revisited and revised. Addiction. 2016;111:1348–1359. doi: 10.1111/add.13347 33. Arkell TR, Vinckenbosch F, Kevin RC, Theunissen EL, McGregor IS, Ramaekers JG. Effect of cannabidiol and Δ9-tetrahydrocannabinol on driving performance: a randomized clinical trial. JAMA. 2020;324:2177–2186. doi: 10.1001/jama.2020.21218 34. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice, Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids. National Academies Press; 2017. 35. Lovell ME, Akhurst J, Padgett C, Garry MI, Matthews A. Cognitive outcomes associated with long-term, regular, recreational cannabis use in adults: a meta-analysis. Exp Clin Psychopharmacol. 2020;28:471–494. doi: 10.1037/pha0000326 36. Scott JC, Slomiak ST, Jones JD, Rosen AFG, Moore TM, Gur RC. Association of cannabis with cognitive functioning in adolescents and young adults: a systematic review and meta-analysis. JAMA Psychiatry. 2018;75:585– 595. doi: 10.1001/jamapsychiatry.2018.0335 37. Auer R, Vittinghoff E, Yaffe K, Künzi A, Kertesz SG, Levine DA, Albanese E, Whitmer RA, Jacobs DR Jr, Sidney S, et al. Association between lifetime marijuana use and cognitive function in middle age: the Coronary Artery Risk Development in Young Adults (CARDIA) study. JAMA Intern Med. 2016;176:352–361. doi: 10.1001/jamainternmed.2015.7841 38. Jackson NJ, Isen JD, Khoddam R, Irons D, Tuvblad C, Iacono WG, McGue M, Raine A, Baker LA. Impact of adolescent marijuana use on intelligence: results from two longitudinal twin studies. Proc Natl Acad Sci U S A. 2016;113:E500–E508. doi: 10.1073/pnas.1516648113 39. Meier MH, Caspi A, Danese A, Fisher HL, Houts R, Arseneault L, Moffitt TE. Associations between adolescent cannabis use and neuropsychological decline: a longitudinal co-twin control study. Addiction. 2018;113:257–265. doi: 10.1111/add.13946 40. Ross JM, Ellingson JM, Rhee SH, Hewitt JK, Corley RP, Lessem JM, Friedman NP. Investigating the causal effect of cannabis use on cognitive function with a quasi-experimental co-twin design. Drug Alcohol Depend. 2020;206:107712. doi: 10.1016/j.drugalcdep.2019.107712 41. Albaugh MD, Ottino-Gonzalez J, Sidwell A, Lepage C, Juliano A, Owens MM, Chaarani B, Spechler P, Fontaine N, Rioux P, et al. Association of cannabis use during adolescence with neurodevelopment. JAMA Psychiatry. 2021;78:1–11. 10.1001/jamapsychiatry.2021.1258 42. Lorenzetti V, Chye Y, Silva P, Solowij N, Roberts CA. Does regular cannabis use affect neuroanatomy? An updated systematic review and meta-analysis of structural neuroimaging studies. Eur Arch Psychiatry Clin Neurosci. 2019;269:59–71. doi: 10.1007/s00406-019-00979-1 43. Gillespie NA, Neale MC, Bates TC, Eyler LT, Fennema-Notestine C, Vassileva J, Lyons MJ, Prom-Wormley EC, McMahon KL, Thompson PM, et al. Testing associations between cannabis use and subcortical volumes in two large population-based samples. Addiction. 2018;113:1661–1672. doi: 10.1111/add.14252 44. Chye Y, Suo C, Lorenzetti V, Batalla A, Cousijn J, Goudriaan AE, Martin-Santos R, Whittle S, Solowij N, Yücel M. Cortical surface morphology in long-term cannabis users: a multi-site MRI study. Eur Neuropsychopharmacol. 2019;29:257–265. doi: 10.1016/j.euroneuro.2018.11.1110 45. Blest-Hopley G, Giampietro V, Bhattacharyya S. Residual effects of cannabis use in adolescent and adult brains: a meta-analysis of fMRI studies. Neurosci Biobehav Rev. 2018;88:26–41. doi: 10.1016/j.neubiorev.2018.03.008 46. Blest-Hopley G, Giampietro V, Bhattacharyya S. Regular cannabis use is associated with altered activation of central executive and default mode networks even after prolonged abstinence in adolescent users: results from a complementary meta-analysis. Neurosci Biobehav Rev. 2019;96:45–55. doi: 10.1016/j.neubiorev.2018.10.026 47. Bogaty SER, Lee RSC, Hickie IB, Hermens DF. Meta-analysis of neurocognition in young psychosis patients with current cannabis use. J Psychiatr Res. 2018;99:22–32. doi: 10.1016/j.jpsychires.2018.01.010 48. Ware MA, Wang T, Shapiro S, Collet JP; COMPASS Study Team. Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS). J Pain. 2015;16:1233–1242. doi: 10.1016/j.jpain.2015.07.014 49. Ball S, Vickery J, Hobart J, Wright D, Green C, Shearer J, Nunn A, Cano MG, MacManus D, Miller D, et al. The Cannabinoid Use in Progressive Inflammatory brain Disease (CUPID) trial: a randomised double-blind placebo- controlled parallel-group multicentre trial and economic evaluation of cannabinoids to slow progression in multiple sclerosis. Health Technol Assess. 2015;19:vii–viii, 1–187. doi: 10.3310/hta19120 50. Rezkalla S, Kloner RA. Cardiovascular effects of marijuana. Trends Cardiovasc Med. 2019;29:403–407. doi: 10.1016/j.tcm.2018.11.004 51. DeFilippis EM, Bajaj NS, Singh A, Malloy R, Givertz MM, Blankstein R, Bhatt DL, Vaduganathan M. Marijuana use in patients with cardiovascular disease: JACC review topic of the week. J Am Coll Cardiol. 2020;75:320–332. doi: 10.1016/j.jacc.2019.11.025 52. Pacher P, Steffens S, Haskó G, Schindler TH, Kunos G. Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly. Nat Rev Cardiol. 2018;15:151–166. doi: 10.1038/nrcardio.2017.130 53. Rodondi N, Pletcher MJ, Liu K, Hulley SB, Sidney S; Coronary Artery Risk Development in Young Adults (CARDIA) Study. Marijuana use, diet, body mass index, and cardiovascular risk factors (from the CARDIA study). Am J Cardiol. 2006;98:478–484. doi: 10.1016/j.amjcard.2006.03.024 54. Meier MH, Pardini D, Beardslee J, Matthews KA. Associations between cannabis use and cardiometabolic risk factors: a longitudinal study of men. Psychosom Med. 2019;81:281–288. doi: 10.1097/PSY.0000000000000665 55. Ravi D, Ghasemiesfe M, Korenstein D, Cascino T, Keyhani S. Associations between marijuana use and cardiovascular risk factors and outcomes: a systematic review. Ann Intern Med. 2018;168:187–194. doi: 10.7326/M17-1548 56. Alshaarawy O, Elbaz HA. Cannabis use and blood pressure levels: United States National Health and Nutrition Examination Survey, 2005–2012. J Hypertens. 2016;34:1507–1512. doi: 10.1097/HJH.0000000000000990 57. Vidot DC, Powers M, Gonzalez R, Jayaweera DT, Roy S, Dong C, Messiah SE. Blood pressure and marijuana use: results from a decade of NHANES data. Am J Health Behav. 2019;43:887–897. doi: 10.5993/AJHB.43.5.2 58. Dufouil C, Beiser A, McLure LA, Wolf PA, Tzourio C, Howard VJ, Westwood AJ, Himali JJ, Sullivan L, Aparicio HJ, et al. Revised Framingham stroke risk profile to reflect temporal trends. Circulation. 2017;135:1145–1159. doi: 10.1161/CIRCULATIONAHA.115.021275 59. Chetty K, Lavoie A, Deghani P. A literature review of cannabis and myocardial infarction: what clinicians may not be aware of. CJC Open. 2021;3:12– 21. doi: 10.1016/j.cjco.2020.09.001 60. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001;103:2805–2809. doi: 10.1161/01.cir.103.23.2805 61. Reis JP, Auer R, Bancks MP, Goff DC Jr, Lewis CE, Pletcher MJ, Rana JS, Shikany JM, Sidney S. Cumulative lifetime marijuana use and incident cardiovascular disease in middle age: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J Public Health. 2017;107:601–606. doi: 10.2105/AJPH.2017.303654 62. Chami T, Kim CH. Cannabis abuse and elevated risk of myocardial infarction in the young: a population-based study. Mayo Clin Proc. 2019;94:1647– 1649. doi: 10.1016/j.mayocp.2019.05.008 63. Jaladi PR, Patel V, Kuduva Rajan S, Rashid W, Madireddy S, Ajibawo T, Imran S, Patel RS. Arrhythmia-related hospitalization and comorbid cannabis use disorder: trend analysis in US hospitals (2010-2014). Cureus. 2019;11:e5607. doi: 10.7759/cureus.5607 64. Tirkey NK, Gupta S. Acute antero-inferior wall ischaemia with acute ischaemic stroke caused by oral ingestion of cannabis in a young male. J Assoc Physicians India. 2016;64:93–94. 65. Volpon LC, Sousa CLMM, Moreira SKK, Teixeira SR, Carlotti APCP. Multiple cerebral infarcts in a young patient associated with marijuana use. J Addict Med. 2017;11:405–407. doi: 10.1097/ADM.0000000000000326 66. Šimůnek L, Krajina A, Herzig R, Vališ M. Cerebral infarction in young marijuana smokers: case reports. Acta Medica (Hradec Kralove). 2018;61:74–77. doi: 10.14712/18059694.2018.56 67. Barber PA, Pridmore HM, Krishnamurthy V, Roberts S, Spriggs DA, Carter KN, Anderson NE. Cannabis, ischemic stroke, and transient ischemic attack: a case-control study. Stroke. 2013;44:2327–2329. doi: 10.1161/STROKEAHA.113.001562 e186 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 68. Falkstedt D, Wolff V, Allebeck P, Hemmingsson T, Danielsson AK. Cannabis, tobacco, alcohol use, and the risk of early stroke: a population-based cohort study of 45 000 Swedish men. Stroke. 2017;48:265–270. doi: 10.1161/STROKEAHA.116.015565 69. Parekh T, Pemmasani S, Desai R. Marijuana use among young adults (18-44 years of age) and risk of stroke: a Behavioral Risk Factor Surveillance System Survey analysis. Stroke. 2020;51:308–310. doi: 10.1161/ STROKEAHA.119.027828 70. Hemachandra D, McKetin R, Cherbuin N, Anstey KJ. Heavy cannabis users at elevated risk of stroke: evidence from a general population survey. Aust NZ J Public Health. 2016;40:226–230. doi: 10.1111/1753-6405.12477 71. Rumalla K, Reddy AY, Mittal MK. Recreational marijuana use and acute ischemic stroke: a population-based analysis of hospitalized patients in the United States. J Neurol Sci. 2016;364:191–196. doi: 10.1016/j.jns.2016.01.066 72. Kalla A, Krishnamoorthy PM, Gopalakrishnan A, Figueredo VM. Cannabis use predicts risks of heart failure and cerebrovascular accidents: results from the National Inpatient Sample. J Cardiovasc Med (Hagerstown). 2018;19:480–484. doi: 10.2459/JCM.0000000000000681 73. San Luis CV, O’Hana S Nobleza C, Shekhar S, Sugg R, Villareal DJ, Mehta T, Gangadhara S. Association between recent cannabinoid use and acute ischemic stroke. Neurol Clin Pract. 2020;10:333–339. doi: 10.1212/CPJ.0000000000000888 74. Auger N, Paradis G, Low N, Ayoub A, He S, Potter BJ. Cannabis use disorder and the future risk of cardiovascular disease in parous women: a longitudinal cohort study. BMC Med. 2020;18:328. doi: 10.1186/ s12916-020-01804-6 75. Jensen J, Leonard J, Salottolo K, McCarthy K, Wagner J, Bar-Or D. The epidemiology of reversible cerebral vasoconstriction syndrome in patients at a Colorado comprehensive stroke center. J Vasc Interv Neurol. 2018;10:32–38. 76. Wolff V, Armspach JP, Beaujeux R, Manisor M, Rouyer O, Lauer V, Meyer N, Marescaux C, Geny B. High frequency of intracranial arterial steno- sis and cannabis use in ischaemic stroke in the young. Cerebrovasc Dis. 2014;37:438–443. doi: 10.1159/000363618 77. Wolff V, Jouanjus E. Strokes are possible complications of cannabinoids use. Epilepsy Behav. 2017;70(pt B):355–363. doi: 10.1016/j.yebeh.2017.01.031 78. Castaneira G, Rojas K, Galili Y, Field Z, Perez-Perez A, Madruga M, Carlan SJ. Idiopathic thrombocytopenic purpura induced by synthetic cannabinoid. J Addict Med. 2019;13:235–236. doi: 10.1097/ADM. 0000000000000485 79. Kelkar AH, Smith NA, Martial A, Moole H, Tarantino MD, Roberts JC. An outbreak of synthetic cannabinoid–associated coagulopathy in Illinois. N Engl J Med. 2018;379:1216–1223. doi: 10.1056/NEJMoa1807652 80. Hasin DS, Kerridge BT, Saha TD, Huang B, Pickering R, Smith SM, Jung J, Zhang H, Grant BF. Prevalence and correlates of DSM-5 cannabis use disorder, 2012-2013: findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Am J Psychiatry. 2016;173:588–599. doi: 10.1176/appi.ajp.2015.15070907 81. Vergara VM, Weiland BJ, Hutchison KE, Calhoun VD. The impact of combinations of alcohol, nicotine, and cannabis on dynamic brain connectivity. Neuropsychopharmacology. 2018;43:877–890. doi: 10.1038/npp.2017.280 82. Brunt TM, van Genugten M, Höner-Snoeken K, van de Velde MJ, Niesink RJ. Therapeutic satisfaction and subjective effects of different strains of pharmaceutical-grade cannabis. J Clin Psychopharmacol. 2014;34:344– 349. doi: 10.1097/JCP.0000000000000129 83. Kocis PT, Vrana KE. Delta-9-tetrahydrocannabinol and cannabidiol drug- drug interactions. Med Cannabis Cannabinoids. 2020;3:61–73. doi: 10.1159/000507998 84. Wu LT, Zhu H, Swartz MS. Trends in cannabis use disorders among racial/ ethnic population groups in the United States. Drug Alcohol Depend. 2016;165:181–190. doi: 10.1016/j.drugalcdep.2016.06.002 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e187 ","Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand. What is the clinical consensus on whether THC affects the brain during adolescence? AHA SCIENTIFIC STATEMENT Use of Marijuana: Effect on Brain Health: A Scientific Statement From the American Heart Association The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Fernando D. Testai, MD, PhD, Chair; Philip B. Gorelick, MD, MPH, Vice Chair; Hugo J. Aparicio, MD, MPH; Francesca M. Filbey, PhD; Raul Gonzalez, PhD; Rebecca F. Gottesman, MD, PhD; Miriam Melis, PhD; Mariann R. Piano, RN, PhD; Tiziana Rubino, PhD; Sarah Y. Song, MD; on behalf of the American Heart Association Stroke Brain Health Science Subcommittee of the Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease ABSTRACT: Marijuana is perceived as a harmless drug, and its recreational use has gained popularity among young individuals. The concentration of active ingredients in recreational formulations has gradually increased over time, and high-potency illicit cannabinomimetics have become available. Thus, the consumption of cannabis in the general population is rising. Data from preclinical models demonstrate that cannabinoid receptors are expressed in high density in areas involved in cognition and behavior, particularly during periods of active neurodevelopment and maturation. In addition, growing evidence highlights the role of endogenous cannabinoid pathways in the regulation of neurotransmitter release, synaptic plasticity, and neurodevelopment. In animal models, exogenous cannabinoids disrupt these important processes and lead to cognitive and behavioral abnormalities. These data correlate with the higher risk of cognitive impairment reported in some observational studies done in humans. It is unclear whether the effect of cannabis on cognition reverts after abstinence. However, this evidence, along with the increased risk of stroke reported in marijuana users, raises concerns about its potential long-term effects on cognitive function. This scientific statement reviews the safety of cannabis use from the perspective of brain health, describes mechanistically how cannabis may cause cognitive dysfunction, and advocates for a more informed health care worker and consumer about the potential for cannabis to adversely affect the brain. Key Words: AHA Scientific Statements ◼ brain ◼ cannabis ◼ cognition ◼ marijuana ◼ stroke M M arijuana, or cannabis, was considered an illicit drug for decades. However, in many parts of the world, cannabis has been legalized for medical use or decriminalized for recreational or medicinal applications. This shift in attitude has resulted in a rapid increase in its use. It has been estimated that ≈183 million people in the world used marijuana in 20141 and that 22 million met criteria for cannabis use disorder in 2016.2 In addition, according to the 2002 to 2019 National Survey on Drug Use and Health, the proportion of the US population >12 years of age who used marijuana in the past year increased gradually from 11% in 2002 to 18% in 2019.3 The use of marijuana has gained popularity, particularly among adolescents and young adults, with ≈36% of 12th graders and 43% of college students reporting having used it in the past year.4 In parallel, evidence suggests that the potency of cannabis products in the United States, measured by the concentration of the primary psychoactive constituent of marijuana, Δ9-tetrahydrocannabinol (THC), has gradually increased from ≈4% in 1995 to 15% in 2018.5 Cannabinoid receptors are expressed in high density in areas of the brain involved in executive function and The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. © 2022 American Heart Association, Inc. e176 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 memory such as the hippocampus, amygdala, and prefrontal cortex (PFC), particularly during periods of active brain development.6 Acute intoxication with cannabinoids can impair memory and behavioral inhibition.7 Cannabinoids also regulate anxiety and can produce psychosis- like effects.6 Evidence shows that age at exposure may influence the effect of cannabinoids on cognitive function. For example, the prenatal, perinatal, and adolescent periods may be particularly sensitive to these compounds.8 Data obtained in preclinical models have shown that cannabis and its associated signaling pathways regulate neurotransmission and play an active role in key cerebral processes, including neuroinflammation, neurogenesis, neural migration, synaptic pruning, and white matter development.6,9 Furthermore, experimental data show that cannabinoids can regulate the functioning of different cytochrome-P450 isoforms and uridine 5′-diphospho-glucuronosyltransferases. Thus, there is a potential risk for drug-to-drug interactions with medications commonly used by the elderly such as warfarin, antiarrhythmic agents, sedatives, and anticonvulsants.10 These factors have raised concerns about the potential effect of cannabis on cognitive vitality. The goal of this scientific statement is to critically appraise the safety of cannabis use from the perspective of brain health. CANNABIS AND ENDOCANNABINOIDS Anandamide and 2-arachidonoyl-glycerol are endogenous bioactive lipids that activate 2 G-protein–coupled receptors designated as cannabinoid receptor type 1 (CB1) and 2 (CB2). These lipids, called endocannabinoids, are not stored in vesicles but are synthesized on demand. The system formed by the cannabinoid receptors CB1 and CB2, endogenous ligands, and enzymes involved in their production and degradation is known as the endocannabinoid system (ECS). A detailed description of the composition and regulation of the ECS is beyond the scope of this publication; this topic has been reviewed extensively elsewhere.9,11,12 Phytocannabinoids are exogenous cannabinoids extracted from flowering plants from the cannabis genus, including Cannabis sativa, Cannabis indica, and Cannabis ruderalis. Whether these are species or subspecies is a matter of debate. More than 100 phytocannabinoids have been extracted from these plants, with THC and cannabidiol (CBD) being the most abundant. The relative concentration of THC and CBD in these strains is variable. In general, cannabis cultivars can be classified according to the cannabinoid produced as chemotype I (THC rich), II (THC/CBD balanced), III (CBD rich), IV (cannabigerol rich), or V (cannabinoid free).13 THC is a psychoactive alkaloid that signals through CB1 and CB2 receptors. Cannabinoid receptor type 1 is expressed abundantly in peripheral and central neural cells. In the periphery, CB1 localizes to sympathetic nerve terminals and sensory neurons. In the central nervous system, it is expressed mainly in presynaptic membranes of excitatory and inhibitory neurons, where it regulates the vesicular release of dopamine, GABA, and glutamate. In comparison, CB2 is expressed mainly in immune cells, including microglia.9 CBD is a nonpsychoactive cannabinoid that has antioxidant and anti-inflammatory properties. It is thought that CBD exerts some of the beneficial effects that phytocannabinoids have in Dravet syndrome and Lennox- Gastaut syndrome. Furthermore, studies done in preclinical models suggest that CBD is beneficial in Alzheimer disease, cerebral ischemia, multiple sclerosis, and other neurologic disorders.9,14 The therapeutic potential of CBD is being investigated in different clinical trials. Compared with THC, CBD signals through different pathways but does not activate CB1 and CB2. At low concentration, CBD blocks the orphan G-protein–coupled receptor-55, the equilibrative nucleoside transporter 1, and the transient receptor potential of melastatin type 8 channel. It also activates the serotonin (5-hydroxytryptamine) 1A receptor, the transient receptor potential of ankyrin type 1 channel, and α3 and α1 glycine receptors. At high concentration, CBD activates the nuclear peroxisome proliferator-activated receptor γ and the transient receptor potential of vanilloid types 1 and 2.12,14 Several cannabinoids have received approval in different countries for the treatment of specific medical conditions. In addition, high-potency synthetic cannabimimetics such as Spice are available in the illegal market (Table 1).15–17 NEUROBIOLOGICAL ACTIONS OF CANNABIS IN ANIMAL MODELS Molecular and cellular mechanisms underlying the effects of cannabis on the developing brain are inferred mainly from preclinical studies that permit controlling for social and environmental factors that could influence outcomes of interest. In addition, animal models allow the investigation of a range of human age-related behavioral factors (eg, novelty and sensation seeking, impulsivity, risk-taking behaviors) and key stages of neurodevelopment that are conserved across many mammalian species. However, many individual (eg, species, strain, age) and experimental (eg, design, drug, dose, delivery, regimen) variables, along with objective end points (eg, behavioral paradigm, experimental technique), have contributed to equivocal findings across studies. Nonetheless, experimental animal models of prenatal and adolescent cannabis exposure have proved fundamental in disclosing the underlying neurobiological mechanisms that might explain several clinical neuropsychiatric outcomes outlined here. Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e177 Table 1. Synthetic and Semisynthetic Cannabinoids Cannabinoid type Active ingredient Indication Medical15,16 Cesamet Nabilone (synthetic THC analog) Treatment of refractory cancer chemotherapy– associated nausea and vomiting*† Marinol (pill) Dronabinol (synthetic THC) Anorexia with weight loss in patients with AIDS or cancer*† Syndros (solution) Dronabinol (synthetic THC) Treatment of refractory cancer chemotherapy– associated nausea and vomiting*† Epidiolex Purified CBD Seizures associated with Lennox- Gastaut syndrome and Dravet syndrome in patients >1 y of age* Seizures associated with tuberous sclerosis complex in patients >1 y of age* Sativex Nabiximols (extract of THC, CBD, and other minor cannabinoids, terpenoids, and flavonoids) Adjunctive therapy for symptomatic treatment of refractory spasticity in adult patients with multiple sclerosis indication† Adjunctive treatment for symptomatic neuropathy in adult patients with multiple sclerosis indication† Adjunctive treatment for patients with advanced cancer with refractory severe pain indication† Illicit17 K2, Spice, Kronic, Kaos Originally synthesized to study the endocannabinoid system Bind cannabinoid receptors with high affinity and can cause hallucinations, agitation, psychosis, short-term memory loss, seizures, coagulopathy, and myocardial infarction CBD indicates cannabidiol; and THC, Δ9-tetrahydrocannabinol. *Approved by the US Food and Drug Administration. †Approved by the Health Products and Food Branch of Health Canada. Animal models have been used to examine the role of the ECS in the modulation of synaptic plasticity, a process that allows the brain to change and adapt to new information.18 The ECS modulates synaptic plasticity by affecting the strength of interneuronal connections and, ultimately, the functioning of neuronal networks. From the mechanistic standpoint, THC activates cannabinoid receptors in the brain, thus interfering with physiological actions of endocannabinoids. Spatial and time resolution of endocannabinoid production is pivotal for correct processing of different brain functions such as higher-order cognition, memory, reward, mood, and stress sensitiv ity.8,19,20 Consequently, THC, activating nonspecifically CB1 receptors in the brain, disrupts the fine-tuning of synaptic activity exerted by endocannabinoids, eventually impairing connectivity of neuronal networks and brain functionality. Although incompletely understood, the way in which THC disrupts memory and learning may be through its differential effect on neurotransmitter release and binding to CB1 receptors.19 For example, THC activates CB1 receptors located on GABAergic interneurons, which represent nearly three-quarters of the brain CB1 receptors, and astrocytes, resulting in the release of hippocampal glutamate. Concomitantly, THC affects the transmission of other neurotransmitters involved in the modulation of memory such as acetylcholine, adenosine, and serotonin.19,20 Furthermore, THC activation of CB1 receptors present on mitochondria leads to decreased cellular respiration and ATP supply.19 ATP is fundamental in maintaining and regulating neurotransmission, and its reduction might contribute to THC- induced cognitive deficits. Repeated exposure to cannabis, especially during the adolescent developmental period, may be especially harmful to brain health and cause structural, molecular, and functional alterations of brain circuits, particularly in the PFC and hippocampus.8,21,22 Long-term THC exposure induces CB1 receptor downregulation and desensitization that appear more intense and widespread after adolescent exposure as opposed to adulthood exposure. 22 Data obtained in experimental models showed that these effects could have implications for neurodevelopmental processes in which the ECS plays a role. Accordingly, long-term THC exposure during adolescence may disrupt dynamic changes occurring in glutamatergic and GABAergic systems, leading to excessive synaptic pruning (ie, loss of synaptic contacts), long-term dysfunction in prefrontal excitatory/inhibitory balance, and desynchronization of PFC neuronal networks, which also dysregulate the mesolimbic dopaminergic pathway (Figure).23 These changes may represent the molecular underpinnings of cognitive deficits and altered emotional reactivity and social behavior observed long after adolescent long-term THC exposure.22 Long-term changes in brain functionality induced by THC exposure during adolescence might also arise from epigenetic modifications with a marked reprogramming of the transcriptome, affecting mainly genes related to synaptic plasticity processes. 8,19 These effects have not been reported after adult THC exposure.19 In addition to the effects on neuron cellular and sub- cellular components, recent evidence suggests that alterations in glial cells have a key role in the actions of THC.24 Long-term THC exposure activates microglia and astrocytes to produce inflammatory cytokines. For example, long-term administration of THC during adolescence increased the microglial expression of the proinflammatory mediators tumor necrosis factor-α, inducible nitric oxide synthase, and cyclooxygenase-2 by 60%, 130%, and 80%, respectively, and reduced the expression of the anti-inflammatory cytokine interleukin-10 by 30% in the PFC. The resulting neuroinflammatory response was associated with memory impairment during adulthood.25 Dose constitutes an additional important variable to consider. Most studies describe detrimental effects of e178 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 Figure. Effect of Δ9-tetrahydrocannabinol (THC) on different neurobiological processes. The effect of THC on the brain constitutes a continuum throughout the lifetime of an individual. However, 2 windows of brain vulnerability have been identified in preclinical models. The colored boxes represent the different processes that have been demonstrated to be affected on exposure to THC during these sensitive developmental periods. PFC indicates prefrontal cortex. THC in models of heavy cannabis use in middle adolescence. However, even lower doses may produce these same effects when administered earlier in adolescence.22 EFFECT OF PRENATAL EXPOSURE TO CANNABINOID AGONISTS A recent study examined associations between prenatal cannabis exposure (PCE) and various indicators of mental and neurocognitive health in a sample of 11489 youth.26 Self-report of maternal cannabis use during pregnancy was associated with various adverse outcomes among youth at 9 to 10 years of age, including poorer performance on tests of neurocognitive functioning and total intracranial volumes, even after controlling for potential confounders. Several reviews describe PCE sequelae in preclinical models.8,24,27–30 Here, we focus on mechanistic insights inferred from animal studies recapitulating the neuropsychiatric features of clinical outcomes.31 The detrimental effect of PCE on cognitive processing and emotional regulation of the progeny has been ascribed to changes in intrinsic and synaptic properties and plasticity of cortical (eg, PFC), limbic (eg, amygdala, hippocampus), and midbrain (eg, ventral tegmentum) regions. Changes in the balance of excitatory and inhibitory input strength, along with alterations in how principal neurons and interneurons receive, integrate, and convey information, have been observed in these neuroanatomic areas (Figure).8,24,27–30 Aberrant glutamatergic function is a common hallmark, as indexed by changes in the expression and function of ionotropic and metabotropic receptors and in dynamic regulation of glutamate levels by glutamate transporters at both synaptic cleft and extrasynaptic spaces. These changes depend largely on the alterations of endocannabinoid signaling pathways caused by exogenous cannabinoids during development and throughout ontogenesis (eg, neural proliferation, survival, directional axonal growth).8,24,27–30 Defects in ECS function also may account for the interneuronopathy observed in many brain regions of PCE offspring, a phenomenon often more prominent in female than in male animals.8,27–29 In the PFC, this persistent inhibitory circuit deficit also is associated with a delayed switch of GABA from its excitatory role early in development to a classic inhibitory function exerted throughout the central nervous system later in life.8,29 This is particularly relevant because the GABA switch represents a critical milestone during neurodevelopment. Any alteration in the normal and predictable temporal sequence of these periods such as delays, stalls, or accelerations imposed by PCE may lead to perturbations of offspring cognitive processing and emotional behavior.8,29 It was observed that marijuana use leads to dysregulation of monoaminergic pathways and stress response systems.8,27–29 PCE hampers the maturation of mono- amines, which also exert trophic actions on target neurons and afferent terminals. This phenomenon may depend on epigenetic modifications and may be implicated in aberrant reward signaling. Furthermore, PCE is associated with an endophenotype in the offspring, which displays protracted dysregulation of stress responsivity that is not explained by glucocorticoid levels. A susceptibility to acute and chronic stress is tied to many psychiatric disorders, ranging from depressed mood and psychosis to substance use disorders and anxiety. A deeper understanding of how PCE interferes with endocannabinoid signaling during neurodevelopment would allow us to explore potential interventions aimed at restoring or reprogramming the hierarchical progression of developmental milestones. EFFECTS OF MARIJUANA USE ON HUMAN COGNITION Acute intoxication from marijuana is associated with impairment of working and episodic memory, behavioral disinhibition, and impulsivity, which can affect performance in real-world activities.6 For example, a meta-analysis from 2016 showed that the odds of being involved in a motor vehicle accident was increased 36% in cannabis users relative to nonusers.32 In addition, a crossover clinical trial published in 2020 investigated the effect of different cannabis products in relation to on-road driving tests. The SD of lateral position, a measure of lane weaving, swerving, and overcorrection, was 20.29 cm at 40 to 100 minutes after inhalation of THC-dominant cannabis and 21.09 cm after inhalation of a mixture of THC and CBD. It is interesting to note that the SD of lateral position after inhalation of CBD-dominant cannabis was similar to that in the placebo group (18.21 cm versus 18.26 cm).33 These observations illustrate the differential short- term effect of THC and CBD on cognition. Evidence also suggests that the short-term effects of cannabinoids are transient and can be influenced by the development of tolerance and the use of other drugs. The long-term effect of cannabis on cognition, however, is less well established. Recent meta-analyses report residual effects of cannabis use on neurocognition, consistent with prior research.34 A meta-analysis by Lovell et al35 in 2020 focused on adult near-daily cannabis use for >2 years and found global neurocognition among users (n=849) to be about one-quarter of an SD worse than that of nonusers (n=764). Four of the 7 domains investigated (decision-making, verbal learning, retention, executive function) showed significant effect sizes ranging from Hedges g=−0.52 to −0.18. A meta- analysis of cannabis users <26 years of age (n=2152) and nonusers (n=6575) also showed a one-quarter of an SD difference in global neurocognitive performance but with more specific domains affected,36 albeit with smaller effect size compared with that found by Lovell et al.35 Both lacked support for worse neurocognition in early adolescence in that neither found that age at onset of cannabis use influenced the association between exposure and cognitive performance. In contrast to these meta-analyses, large longitudinal studies provide stronger causal inferences by examining change over time. In the CARDIA study (Coronary Artery Risk Development in Young Adults), 3385 participants 18 to 30 years of age were followed up longitudinally. Marijuana use was assessed periodically in the 25-year follow-up. In addition, cognitive assessment was completed 25 years after inception. In this study, cumulative years of exposure to marijuana was associated with worse verbal memory (0.13 lower SD in the verbal memory test for each additional 5 years of exposure to marijuana).37 Longitudinal co-twin studies use a research design that additionally controls for shared variance from genetic and environmental factors. Two large longitudinal twin studies (n=3066) with neurocognitive measures collected before (at 9–12 years of age) and after (17–20 years of age) cannabis exposure reported that declines in vocabulary and general knowledge were associated with being a cannabis user but not with amount of cannabis consumed. 38 Twins discordant for cannabis use showed no differences in IQ declines. Thus, differences were likely caused by shared risk factors. Using a similar design, Meier et al39 reported that lower IQ predated cannabis use with no evidence of actual IQ declines among 1989 twins assessed at 5, 12, and 18 years of age. Ross et al40 evaluated other aspects of neurocognition among 856 individual twins and reported only 1 within-family effect of 70 tested. Specifically, frequency of cannabis use at 17 years of age was associated with poorer executive functioning at 23 years of age, but executive functioning problems predating cannabis use could not be ruled out. Magnetic resonance imaging (MRI) techniques demonstrate differential associations of cannabis use with brain structure and function. In terms of brain structure, alterations related to cannabis use have been mixed. In a longitudinal study including 1598 MRIs done in adolescents at baseline and the 5-year follow-up, a dose- dependent association was observed between cannabis use and PFC thinning.41 On the other hand, although a meta-analysis found that regular cannabis consumption was associated with smaller hippocampal (standardized mean difference, 0.14 [95% CI, 0.02–0.27]), medial orbitofrontal cortex (standardized mean difference, 0.30 [95% CI, 0.15–0.45]), and lateral orbitofrontal cortex (standardized mean difference, 0.19 [95% CI, 0.07–0.32]) volumes relative to nonuse, brain volumes were not associated with cannabis use duration and dosage. 42 Other large studies have reported null effects. In 2 e180 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 large twin samples from the United States (n=474) and Australia (n=622), cannabis use was unrelated to volumes of the thalamus, caudate nucleus, putamen, pallidum, hippocampus, amygdala, and nucleus accumbens.43 A multisite study of cortical surface measures (n=262) reported no difference in cortical thickness, surface area, and gyrification index in cannabis users versus nonusers, in cannabis dependence versus nondependence versus nonusers, and in early adolescent versus late adolescent onset of cannabis use versus nonuse.44 Thus, brain structural abnormalities related to cannabis use are inconsistent. Functional MRI studies report more robust effects, particularly after prolonged cannabis use. A meta-analysis of task-based functional MRI studies in current adult and adolescent users found abnormalities in activation in both age groups. Relative to nonusing control subjects, adult cannabis users had greater brain activation in the superior (seed-based d mapping [SDM-Z], 1.561; P<0.002) and posterior (SDM-Z, 1.479; P<0.003) transverse temporal and inferior frontal gyri (SDM-Z, 1.568; P<0.002) and less activation in the striatum (SDM-Z, −1.843; P<0.001), insula (SDM-Z, −1.637; P<0.001), and middle frontal gyrus across different tasks. Adolescent cannabis users also had greater activation in the inferior parietal gyrus (SDM-Z, 1.06; P<0.001) and putamen (SDM-Z, 1.008; P<0.001) compared with nonusers across various tasks, suggesting compensatory neuroadaptive mechanisms.45 These functional abnormalities persist despite cessation of cannabis use and beyond the period when THC metabolites are detectable. A meta-analysis of the same adolescent studies found that >25-day abstinent adolescent cannabis users exhibited greater activation in the right inferior frontal gyrus in addition to other areas relevant for executive functioning and self-regulatory mechanisms.46 Several recent studies examined cannabis effects in populations with premorbid clinical risk factors and those using medical marijuana. A meta-analysis focused only on cannabis users with psychosis <25 years of age (n=529) and nonusing control subjects with psychosis (n=901). In this study, there were significant differences in 3 of 11 domains assessed (premorbid IQ, Hedges g=0.40 [standardized effect size]; current IQ, Hedges g=−0.17; working memory, Hedges g=−0.76).47 Among a sample of 215 adult patients with chronic pain provided daily herbal cannabis containing 12.5% THC for 1 year, no significant neurocognitive differences were found compared with 216 control subjects.48 This is in line with a study of patients with multiple sclerosis in response to oral dronabinol that found no significant differences in MRI-derived measures, including annual percentage of brain volume change and occurrence of new lesions, after 12 months of use.49 These clinical trials suggest no significant adverse effect of THC on neurocognitive symptoms in specific clinical populations. EFFECTS OF MARIJUANA USE ON CEREBROVASCULAR RISK AND DISEASE Cerebrovascular Risk Factors Similar to the literature linking marijuana use with cardiovascular outcomes,10 evidence that marijuana consumption increases the prevalence of specific cerebrovascular risk factors and disease is limited by a preponderance of observational studies, cross-sectional studies, case reports, and case series prone to potential publication and other biases. Postulated adverse effects of marijuana use may include sympathetic nervous system activation, blood pressure changes, platelet activation, and electrophysiological effects.50–52 Concomitant tobacco smoking and other substance use and abuse possibly contribute to these effects, which may be short term and have been studied mostly in low-risk populations such as younger adults. These factors may explain why many longitudinal studies linking marijuana use and cardiovascular or metabolic risk factors have been negative after multivariable adjustment for unhealthy behaviors such as diet and tobacco smoking.53–55 Hypertension, in particular, is an important risk factor for ischemic stroke, hemorrhagic stroke, and subarachnoid hemorrhage. With marijuana use, the most common acute reaction in humans is a decrease in blood pressure resulting from cannabinoid effects on the vasculature and autonomic nervous system.52 Despite this physiological reaction, limited studies using the National Health and Nutrition Examination Survey showed a modest association of recent cannabis use with higher systolic blood pressure and higher prevalence of hypertension among current users 30 to 59 years of age.56 Heavy users, defined as use of marijuana or hashish in >20 of the past 30 days, had higher odds of abnormal blood pressure compared with never-users. Although this difference remained statistically significant after adjustment for age, sex, race, ethnicity, body mass index, education, and survey year, it was no longer statistically significant after additional adjustment for current tobacco and binge alcohol use (adjusted odds ratio, 1.47 [95% CI, 0.99–2.16]).57 The relationship between marijuana use and elevated blood pressure, especially among heavy users, may drive longer-term associations with cerebrovascular outcomes, although this mechanism remains to be studied. Prior cardiovascular disease such as myocardial infarction (MI) or atrial fibrillation (AF) is also an important risk factor for stroke.58 Case reports of MI after marijuana use are mainly among young adults who lack vascular risk factors, with onset of MI shortly after use.59 Risk of MI was elevated 4.8-fold within an hour after smoking marijuana compared with periods of nonuse. This association demonstrates the potential role of marijuana as an acute trigger for cardiovascular disease.60 Over 25 years of follow-up, among 5113 adult participants in Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e181 the Coronary Artery Risk Development in Young Adults study, cumulative or recent marijuana use was not associated with coronary heart disease, stroke, or cardiovascular disease mortality.61 This finding contrasts with a population-based, multi-institutional database study that observed an increased risk of 3-year cumulative incidence of MI among marijuana users compared with control subjects (1.37% vs 0.54%; relative risk, 2.54 [95% CI, 2.45–2.61]).62 Similarly, marijuana use appears to be a trigger for AF. Data from the Nationwide Inpatient Sample show that the percentage of individuals with cannabis use disorder discharged in the postlegalization period (2010–2014) with the diagnosis of arrhythmia increased 31%.63 However, in a study of patients hospitalized for heart failure, marijuana users had a reduced odds of AF compared with nonusers (adjusted odds ratio, 0.87 [95% CI, 0.77–0.98]).50 Simultaneous use of cocaine, stimulants, and other drugs may be responsible for observations of AF among marijuana users, although this remains to be fully studied outside of observational and cross-sectional reports. Risk of Stroke and Transient Ischemic Attack Several case reports and case series mostly in young individuals suggest a relationship between recent and heavy cannabis use and risk of stroke.64–66 In contrast, and as reviewed below, findings among case-control studies,67 population-based studies,68 and studies conducted using outpatient69,70 or inpatient71,72 national databases or hospital electronic health records73 have been equivocal, depending on the study design, covariates considered in the analysis, and source of the population being studied. Inconsistent associations also can be attributable to the presence of comparison groups and whether adjustment of other important risk factors was considered, along with attention to potential confounding by other risk factor and lifestyle features between cannabis users and nonusers. In 1 case-control study using cannabis urine screens to identify cannabis users, the authors found an association between cannabis use and the risk of ischemic stroke and transient ischemic attack, but the association was not significant when tobacco use was included as a covariate (adjusted odds ratio, 1.59 [95% CI, 0.71– 3.70]) among subjects 18 to 55 years of age with and without stroke.67 Similarly, after adjustment for cigarette smoking and alcohol use, another study found no association between cannabis use in young adulthood and the occurrence of fatal and nonfatal stroke later in life among Swedish men in up to 38 years of follow-up.68 Data from studies that have examined more specifically the dose or amount of cannabis consumed within a designated time frame suggest that regular cannabis use may increase the risk of stroke. Using data from population-based surveys, investigators have reported that when no cannabis use was compared with heavy cannabis use in the past year, cannabis use was associated with an increased risk for the occurrence of nonfatal stroke and transient ischemic attack.70 Similarly, another study found that recent (within the past 30 days) and frequent (>10 d/mo) cannabis use was associated with increased risk for the occurrence of stroke compared with nonuse, whereas less frequent cannabis use (≤10 d/mo or less than weekly in the past year) was not associated with increased risk.69,70 Using several International Classification of Diseases, Ninth Revision, Clinical Modification codes for marijuana use, a Nationwide Inpatient Sample study found that cannabis use among men and women hospitalized between 2004 and 2011 was associated with a 17% increased relative risk for acute ischemic stroke in a multivariable-adjusted analysis. Concomitant use of tobacco with cannabis increased the risk to 31%.71 Similarly, a separate study using the Nationwide Inpatient Sample but between 2009 and 2010 observed a higher odds of stroke among cannabis users (odds ratio, 1.24 [95% CI, 1.14–1.34]).72 In contrast, investigators using electronic health record data from patients admitted to a single center between 2015 and 2017 found that testing positive for cannabis use was not associated with the risk of ischemic stroke compared with testing negative, even after adjustment for numerous confounders, including age, cigarette smoking, and comorbidities.73 There may be certain populations or scenarios in which cannabis use can be meaningfully linked to stroke. A study of a large longitudinal cohort of Canadian pregnant women that included >1 million participants between 1989 and 2019 with follow-up at 30 years observed that cannabis use disorder was associated with a doubling of risk for hemorrhagic stroke (hazard ratio, 2.08 [95% CI, 1.07–4.05]) but no increased risk for ischemic or other cerebrovascular disease.74 Because of the theoretical vasoactive effect of cannabis, its use has been implicated in some cases of reversible cerebral vasoconstriction syndrome, with 6 of 24 nonidiopathic reversible cerebral vasoconstriction syndrome cases at a Colorado stroke center attributed to marijuana use.75 In addition, an elevated risk of stroke from intracranial arterial stenosis has been described among young cannabis users 18 to 45 years of age wherein vasospasm or reversible cerebral vasoconstriction syndrome may be a potential mechanism. 76 Studies done in experimental models have shown that cannabinoids exert complex effects on cardiac contractility, vascular tone, and atherogenesis. Both vasodilatation and vasoconstriction responses were observed, depending on the experimental model and cannabinoid used. CB1 activation promotes inflammation, upregulates the production of reactive oxygen species, and activates proapoptotic pathways in endothelial cells and cardiomyocytes. In addition, it induces endothelial dysfunction and vascular smooth muscle cell proliferation and migration. These processes have been linked to cardiac dysfunction e182 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 and the development of atherosclerosis.52 This is in contrast to the atheroprotective role associated with CB2. Acute cardiovascular events and stroke also have been reported in patients using synthetic cannabinoids.77 Spice is associated with idiopathic thrombocytopenic purpura, which increases the risk of major hemorrhage.78 In addition, intracranial hemorrhage in Spice users has been linked to the presence of brodifacoum, an adulterant considered a superwarfarin.79 EDUCATION AND FUTURE DIRECTIONS Our understanding of the ramifications of cannabis consumption on brain health is limited but rapidly evolving. Observational studies have produced conflicting results in relation to the effect of marijuana on different outcomes of interest, including hypertension, AF, MI, and cognition. Several methodological factors may explain these apparent contradictions. First, given its historical classification as an illicit drug, the use of marijuana has been underreported for generations. The inclusion of marijuana users in the control group of observational studies that rely on self-reported use could underestimate its effect on brain health. Second, several behaviors such as smoking and alcohol use are associated with marijuana consumption and can influence stroke risk and brain connectivity.80,81 The often missing information on frequency of exposure to these factors limits our ability to determine with accuracy the independent effect of marijuana. Third, the time of exposure, frequency of use, and bioavailability of marijuana, which is affected by the route of administration, diet, and concomitant use of medications that may affect its metabolism, are reported inconsistently.10 Fourth, THC and CBD have different pharmacological effects. Although the use of THC has been associated with detrimental effects, CBD appears to have therapeutic potential in some neurologic disorders.9 The absolute and relative concentrations of these compounds differ according to the strain of cannabis plant and the methodology used to extract the active ingredients.82 Fifth, the gradual increase in the potency of marijuana used recreationally limits the relevance of older studies.5 Sixth, different factors impede the development of long-term placebo-controlled studies, including ethical reasons and the psychotropic effect of THC, which cannot be blinded. Social media may emphasize a beneficial role for marijuana, and the general population may perceive it as a harmless drug. However, the emerging evidence linking marijuana use to cardiovascular events and stroke, as well as the potential and demonstrated drug-to-drug interactions between marijuana and medications commonly used in the general population, calls for caution and highlights the potential importance of active surveillance programs.10,83 In addition, the high density of cannabinoid receptors in areas involved in executive function and memory, the dose-dependent detrimental effect of THC on working and episodic memory, and the role of Table 2. Key Summary Points Section Notes Actions of THC disrupts endocannabinoid signaling pathways and Cannabis affects synaptic plasticity. In the short term, this affects the in Animal strength of interneuronal connections; in the long term, it Models leads to changes in the functioning of neuronal networks. Exposure to THC during adolescence can lead to structural, molecular, and functional alterations of brain circuits, particularly in areas involved in cognition and behavior. Effect of In preclinical models, THC disrupts the normal signaling Prenatal of the endocannabinoid system during development and Exposure to throughout ontogenesis and results in abnormal neurotrans- Cannabinoid mission. Agonist Prenatal THC affects neuroanatomic areas associated with cognition and emotional regulation, including the PFC, limbic system, and ventral tegmentum of the midbrain. Effects of Acute intoxication with marijuana affects memory, behavior, Marijuana Use and impulsivity. on Human The long-term effect of cannabis on cognition may be Cognition domain specific. Neuroimaging studies have shown structural changes in cannabis users; however, the results are inconsistent. Functional changes may be observed in areas of the brain involved in cognition among cannabis users. Early exposure to cannabis may have a negative effect on cognitive function. Effects of Several studies have described an association between Marijuana cannabis use and increased risk of stroke. Use on Data from population survey studies indicate that the pat- Cerebrovastern (heavy vs less) and frequency (>10 d/mo) of cannabiscular Risk and use may increase the risk of stroke. Disease Cigarette smoking is common in cannabis users and may be an important modifier or confounder of the relationship between cannabis use and stroke risk. Given the potential role of cannabis as a vasoactive substance and its potential role in cardiac pathology and atherosclerosis development, cannabis use also may increase stroke risk via reversible cerebral vasoconstriction syndromes or may indirectly increase stroke risk. It is possible that differences among some study findings may be attributable to the years in which population cohorts were studied or recruited because most population cohorts were assembled before 2012. Over the past decade, strains of cannabis have been evolving, resulting in plants with high THC concentrations and some preparations that may have synthetic cannabinoids such as Spice, which may influence the association of cannabis use with stroke. Education The cumulative evidence collected in clinical and preclinical and Future studies suggests that the consumption of marijuana can have Directions a detrimental effect on brain health. The exact ramifications, however, have not been precisely established. Emerging evidence questions the widely accepted belief that marijuana is innocuous and suggests that cannabis, particularly THC, negatively affects brain health through direct and indirect mechanisms. Health care professionals and consumers should receive education on the potential beneficial and harmful effects associated with the use of marijuana, including the increased risk of stroke and cognitive decline. CBD indicates cannabidiol; PFC, prefrontal cortex; and THC, Δ9-tetrahydrocannabinol. cannabinoid-associated biochemical pathways on synaptic plasticity and neuronal development raise concern that long-term exposure to marijuana may affect brain health. There is lack of agreement on whether the effects of Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e183 marijuana resolve completely after months of abstinence. However, the disruption of endocannabinoid signaling pathways during the prenatal and perinatal periods and in adolescence may be detrimental to neurodevelopment. 6,8,9 Key points discussed in this scientific statement are summarized in Table 2. It should be noted that the overarching goal of this scientific statement was to discuss mechanisms by which marijuana use could influence brain health. However, as the field is developing, several important aspects require additional research. As an example, there is limited information comparing the differential effect of recreational, illicit, and medicinal uses of marijuana, as well as the type of cannabis product consumed. Similarly, the modulatory effects of social determinants of health and race and ethnicity on the interaction of brain health and marijuana use are largely unexplored. The latter area of research may be particularly important because communities of color in the United States may be disproportionately affected by natural and synthetic cannabinoids in relation to use and exposure and the legal implications of criminalization of marijuana.84 Public health efforts should be considered to raise awareness about the potential negative effects associated with the use of marijuana in the general population. Possible strategies include the use of standardized concentrations of biologically active components and health warning labels on available formulations. In addition, the use of marijuana should be individualized and closely monitored. Health care professionals and patients should receive unbiased education about the potential consequences of medicinal, recreational, and illicit marijuana use on brain health, particularly when the exposure occurs during vulnerable vital periods. It also may be important for professionals to monitor cognitive performance of Disclosures Writing Group Disclosures marijuana users and to review their medications to identify potential drug-to-drug interactions. Knowledgeable health care professionals will be able to properly educate potential or active marijuana users about its possible adverse effects, empowering them to make an informed decision that is based on unbiased data. ARTICLE INFORMATION The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest. This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on July 29, 2021, and the American Heart Association Executive Committee on September 5, 2021. A copy of the document is available at https://professional.heart.org/statements by using either “Search for Guidelines & Statements” or the “Browse by Topic” area. To purchase additional reprints, call 215-356-2721 or email Meredith.Edelman@wolterskluwer.com. The American Heart Association requests that this document be cited as follows: Testai FD, Gorelick PB, Aparicio HJ, Filbey FM, Gonzalez R, Gottesman RF, Melis M, Piano MR, Rubino T, Song SY; on behalf of the American Heart Association Stroke Brain Health Science Subcommittee of the Stroke Council; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular and Stroke Nursing; Council on Lifestyle and Cardiometabolic Health; and Council on Peripheral Vascular Disease. Use of marijuana: effect on brain health: a scientific statement from the American Heart Association. Stroke. 2022;53:e176–e187. doi: 10.1161/STR.0000000000000396 The expert peer review of AHA-commissioned documents (eg, scientific statements, clinical practice guidelines, systematic reviews) is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit https://professional.heart.org/statements. Select the “Guidelines & Statements” drop-down menu, then click “Publication Development.” Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at https://www.heart.org/permissions. A link to the “Copyright Permissions Request Form” appears in the second paragraph (https://www.heart.org/en/aboutus/ statements-and-policies/copyright-request-form). Writing group member Employment Research grant Other research support Speakers’ bureau/ honoraria Expert witness Ownership interest Consultant/ advisory board Other Fernando D. Testai University of Illinois at Chicago None None None None None None None Philip B. Gorelick Northwestern University None None None None None None None Hugo J. Aparicio Boston University School of Medicine None None None None None None None Francesca M. Filbey University of Texas at Dallas Center for Brain Health None None None None None None None Raul Gonzalez Florida International University None None None None None None None Rebecca F. Gottesman National Institutes of Health National Institute of Neurological Disorders and Stroke None None None None None None None Miriam Melis University of Cagliari (Italy) NIH* None None None None None None Mariann R. Piano Vanderbilt University School of Nursing None None None None None None None Tiziana Rubino University of Insubria (Italy) None None None None None None None Sarah Y. Song Rush University Medical Center None None None None None None None This table represents the relationships of writing group members that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all members of the writing group are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity or owns $10000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. *Modest. e184 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 Reviewer Disclosures Other Speakers’ research bureau/ Expert Ownership Consultant/ Reviewer Employment Research grant support honoraria witness interest advisory board Other Mark J. Alberts Hartford HealthCare None None None None None None None Larry A. Allen University of Colorado PCORI†; NIH NHLBI None None None None Novartis*; Boston None School of Medicine (K23 HL105896)†; Scientific†; Cytoki- AHA (grant, SFRN)† netics*; Amgen* George Howard University of Alabama at Birmingham None None None None None None None Farzaneh A. Sorond Northwestern Univer-None None None None None None None sity, Feinberg School of Medicine This table represents the relationships of reviewers that may be perceived as actual or reasonably perceived conflicts of interest as reported on the Disclosure Questionnaire, which all reviewers are required to complete and submit. A relationship is considered to be “significant” if (a) the person receives $10 000 or more during any 12-month period, or 5% or more of the person’s gross income; or (b) the person owns 5% or more of the voting stock or share of the entity, or owns $10 000 or more of the fair market value of the entity. A relationship is considered to be “modest” if it is less than “significant” under the preceding definition. *Modest. †Significant. REFERENCES 1. United Nations Office on Drugs and Crime. World drug report. 2015. Accessed February 10, 2021. https://www.unodc.org/unodc/en/ index.html 2. The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 2018;5:987–1012. doi: 10.1016/S2215-0366(18)30337-7 3. US Department of Health and Human Services. 2019 NSDUH annual national report. 2020. Accessed February 9, 2021. https://www.samhsa. gov/data/report/2019-nsduh-annual-national-report 4. Johnston LD, Miech RA, O’Malley PM, Bachman JG, Schulenberg JE, Patrick ME. Monitoring the Future national survey results on drug use, 1975–2018: overview, key findings on adolescent drug use. 2019. Accessed February 9, 2021. https://eric.ed.gov/?id=ED594190 5. National Institutes of Health, National Institute on Drug Abuse. Marijuana potency. 2020. Accessed February 10, 2021. https://www.drugabuse.gov/ drug-topics/marijuana/marijuana-potency 6. Curran HV, Freeman TP, Mokrysz C, Lewis DA, Morgan CJ, Parsons LH. Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci. 2016;17:293–306. doi: 10.1038/nrn.2016.28 7. Mechoulam R, Parker LA. The endocannabinoid system and the brain. Annu Rev Psychol. 2013;64:21–47. doi: 10.1146/annurev-psych-113011-143739 8. Hurd YL, Manzoni OJ, Pletnikov MV, Lee FS, Bhattacharyya S, Melis M. Cannabis and the developing brain: insights into its long-lasting effects. J Neurosci. 2019;39:8250–8258. doi: 10.1523/JNEUROSCI.1165-19.2019 9. Cristino L, Bisogno T, Di Marzo V. Cannabinoids and the expanded endocannabinoid system in neurological disorders. Nat Rev Neurol. 2020;16:9–29. doi: 10.1038/s41582-019-0284-z 10. Page RL 2nd, Allen LA, Kloner RA, Carriker CR, Martel C, Morris AA, Piano MR, Rana JS, Saucedo JF; on behalf of the American Heart Association Clinical Pharmacology Committee and Heart Failure and Transplantation Committee of the Council on Clinical Cardiology; Council on Basic Cardiovascular Sciences; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Lifestyle and Cardiometabolic Health; and Council on Quality of Care and Outcomes Research. Medical marijuana, recreational cannabis, and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2020;142:e131–e152. doi: 10.1161/CIR.0000000000000883 11. Lu H, Mackie K. Review of the endocannabinoid system. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021;6:607–615. 12. Zou S, Kumar U. Cannabinoid receptors and the endocannabinoid system: signaling and function in the central nervous system. Int J Mol Sci. 2018;19:833. doi: 10.3390/ijms19030833 13. Romero P, Peris A, Vergara K, Matus JT. Comprehending and improving cannabis specialized metabolism in the systems biology era. Plant Sci. 2020;298:110571. doi: 10.1016/j.plantsci.2020.110571 14. Patel AD. Cannabinoids in neurologic illnesses. Neurol Clin. 2021;39:231– 241. doi: 10.1016/j.ncl.2020.09.012 15. US Food & Drug Administration. FDA regulation of cannabis and cannabis- derived products, including cannabidiol (CBD). 2021. Accessed February 12, 2021. https://www.fda.gov/news-events/public-health-focus/fda-regulation- cannabis-and-cannabis-derived-products-including-cannabidiol-cbd 16. Health Canada. Information for health care professionals: cannabis (marihuana, marijuana) and the cannabinoids. 2018. Accessed February 12, 2021. https://www.canada.ca/en/health-canada/services/drugs-medication/ cannabis/information-medical-practitioners/information-health-careprofessionals- cannabis-cannabinoids.html#fig 1 17. Zawilska JB, Wojcieszak J. Spice/K2 drugs: more than innocent substitutes for marijuana. Int J Neuropsychopharmacol. 2014;17:509–525. doi: 10.1017/S1461145713001247 18. Araque A, Castillo PE, Manzoni OJ, Tonini R. Synaptic functions of endocannabinoid signaling in health and disease. Neuropharmacology. 2017;124:13–24. doi: 10.1016/j.neuropharm.2017.06.017 19. Prini P, Zamberletti E, Manenti C, Gabaglio M, Parolaro D, Rubino T. Neurobiological mechanisms underlying cannabis-induced memory impairment. Eur Neuropsychopharmacol. 2020;36:181–190. doi: 10.1016/j. euroneuro.2020.02.002 20. Meyer HC, Lee FS, Gee DG. The role of the endocannabinoid system and genetic variation in adolescent brain development. Neuropsychopharmacology. 2018;43:21–33. doi: 10.1038/npp.2017.143 21. Zamberletti E, Rubino T. Impact of endocannabinoid system manipulation on neurodevelopmental processes relevant to schizophrenia. Biol Psychiatry Cogn Neurosci Neuroimaging. 2021;6:616–626. doi: 10.1016/j. bpsc.2020.06.013 22. Higuera-Matas A, Ucha M, Ambrosio E. Long-term consequences of perinatal and adolescent cannabinoid exposure on neural and psychological processes. Neurosci Biobehav Rev. 2015;55:119–146. doi: 10.1016/j. neubiorev.2015.04.020 23. Renard J, Rushlow WJ, Laviolette SR. Effects of adolescent THC exposure on the prefrontal GABAergic system: implications for schizophrenia-related psychopathology. Front Psychiatry. 2018;9:281. doi: 10.3389/fpsyt.2018.00281 24. Melis M, Frau R, Kalivas PW, Spencer S, Chioma V, Zamberletti E, Rubino T, Parolaro D. New vistas on cannabis use disorder. Neuropharmacology. 2017;124:62–72. doi: 10.1016/j.neuropharm.2017.03.033 25. Zamberletti E, Gabaglio M, Prini P, Rubino T, Parolaro D. Cortical neuroinflammation contributes to long-term cognitive dysfunctions following adolescent delta-9-tetrahydrocannabinol treatment in female rats. Eur Neuropsychopharmacol. 2015;25:2404–2415. doi: 10.1016/j. euroneuro.2015.09.021 26. Paul SE, Hatoum AS, Fine JD, Johnson EC, Hansen I, Karcher NR, Moreau AL, Bondy E, Qu Y, Carter EB, et al. Associations between prenatal cannabis exposure and childhood outcomes: results from the ABCD study. JAMA Psychiatry. 2021;78:64–76. doi: 10.1001/jamapsychiatry.2020.2902 27. Alpár A, Di Marzo V, Harkany T. At the tip of an iceberg: prenatal marijuana and its possible relation to neuropsychiatric outcome in the offspring. Biol Psychiatry. 2016;79:e33–e45. doi: 10.1016/j.biopsych.2015.09.009 28. Scheyer AF, Melis M, Trezza V, Manzoni OJJ. Consequences of perinatal cannabis exposure. Trends Neurosci. 2019;42:871–884. doi: 10.1016/j. tins.2019.08.010 29. Tirado-Muñoz J, Lopez-Rodriguez AB, Fonseca F, Farré M, Torrens M, Viveros MP. Effects of cannabis exposure in the prenatal and adolescent periods: preclinical and clinical studies in both sexes. Front Neuroendocrinol. 2020;57:100841. doi: 10.1016/j.yfrne.2020.100841 30. Pinky PD, Bloemer J, Smith WD, Moore T, Hong H, Suppiramaniam V, Reed MN. Prenatal cannabinoid exposure and altered neurotransmission. Neuropharmacology. 2019;149:181–194. doi: 10.1016/j.neuropharm. 2019.02.018 31. Roncero C, Valriberas-Herrero I, Mezzatesta-Gava M, Villegas JL, Aguilar L, Grau-López L. Cannabis use during pregnancy and its relationship with fetal developmental outcomes and psychiatric disorders: a systematic review. Reprod Health. 2020;17:25. doi: 10.1186/s12978-020-0880-9 32. Rogeberg O, Elvik R. The effects of cannabis intoxication on motor vehicle collision revisited and revised. Addiction. 2016;111:1348–1359. doi: 10.1111/add.13347 33. Arkell TR, Vinckenbosch F, Kevin RC, Theunissen EL, McGregor IS, Ramaekers JG. Effect of cannabidiol and Δ9-tetrahydrocannabinol on driving performance: a randomized clinical trial. JAMA. 2020;324:2177–2186. doi: 10.1001/jama.2020.21218 34. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice, Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids. National Academies Press; 2017. 35. Lovell ME, Akhurst J, Padgett C, Garry MI, Matthews A. Cognitive outcomes associated with long-term, regular, recreational cannabis use in adults: a meta-analysis. Exp Clin Psychopharmacol. 2020;28:471–494. doi: 10.1037/pha0000326 36. Scott JC, Slomiak ST, Jones JD, Rosen AFG, Moore TM, Gur RC. Association of cannabis with cognitive functioning in adolescents and young adults: a systematic review and meta-analysis. JAMA Psychiatry. 2018;75:585– 595. doi: 10.1001/jamapsychiatry.2018.0335 37. Auer R, Vittinghoff E, Yaffe K, Künzi A, Kertesz SG, Levine DA, Albanese E, Whitmer RA, Jacobs DR Jr, Sidney S, et al. Association between lifetime marijuana use and cognitive function in middle age: the Coronary Artery Risk Development in Young Adults (CARDIA) study. JAMA Intern Med. 2016;176:352–361. doi: 10.1001/jamainternmed.2015.7841 38. Jackson NJ, Isen JD, Khoddam R, Irons D, Tuvblad C, Iacono WG, McGue M, Raine A, Baker LA. Impact of adolescent marijuana use on intelligence: results from two longitudinal twin studies. Proc Natl Acad Sci U S A. 2016;113:E500–E508. doi: 10.1073/pnas.1516648113 39. Meier MH, Caspi A, Danese A, Fisher HL, Houts R, Arseneault L, Moffitt TE. Associations between adolescent cannabis use and neuropsychological decline: a longitudinal co-twin control study. Addiction. 2018;113:257–265. doi: 10.1111/add.13946 40. Ross JM, Ellingson JM, Rhee SH, Hewitt JK, Corley RP, Lessem JM, Friedman NP. Investigating the causal effect of cannabis use on cognitive function with a quasi-experimental co-twin design. Drug Alcohol Depend. 2020;206:107712. doi: 10.1016/j.drugalcdep.2019.107712 41. Albaugh MD, Ottino-Gonzalez J, Sidwell A, Lepage C, Juliano A, Owens MM, Chaarani B, Spechler P, Fontaine N, Rioux P, et al. Association of cannabis use during adolescence with neurodevelopment. JAMA Psychiatry. 2021;78:1–11. 10.1001/jamapsychiatry.2021.1258 42. Lorenzetti V, Chye Y, Silva P, Solowij N, Roberts CA. Does regular cannabis use affect neuroanatomy? An updated systematic review and meta-analysis of structural neuroimaging studies. Eur Arch Psychiatry Clin Neurosci. 2019;269:59–71. doi: 10.1007/s00406-019-00979-1 43. Gillespie NA, Neale MC, Bates TC, Eyler LT, Fennema-Notestine C, Vassileva J, Lyons MJ, Prom-Wormley EC, McMahon KL, Thompson PM, et al. Testing associations between cannabis use and subcortical volumes in two large population-based samples. Addiction. 2018;113:1661–1672. doi: 10.1111/add.14252 44. Chye Y, Suo C, Lorenzetti V, Batalla A, Cousijn J, Goudriaan AE, Martin-Santos R, Whittle S, Solowij N, Yücel M. Cortical surface morphology in long-term cannabis users: a multi-site MRI study. Eur Neuropsychopharmacol. 2019;29:257–265. doi: 10.1016/j.euroneuro.2018.11.1110 45. Blest-Hopley G, Giampietro V, Bhattacharyya S. Residual effects of cannabis use in adolescent and adult brains: a meta-analysis of fMRI studies. Neurosci Biobehav Rev. 2018;88:26–41. doi: 10.1016/j.neubiorev.2018.03.008 46. Blest-Hopley G, Giampietro V, Bhattacharyya S. Regular cannabis use is associated with altered activation of central executive and default mode networks even after prolonged abstinence in adolescent users: results from a complementary meta-analysis. Neurosci Biobehav Rev. 2019;96:45–55. doi: 10.1016/j.neubiorev.2018.10.026 47. Bogaty SER, Lee RSC, Hickie IB, Hermens DF. Meta-analysis of neurocognition in young psychosis patients with current cannabis use. J Psychiatr Res. 2018;99:22–32. doi: 10.1016/j.jpsychires.2018.01.010 48. Ware MA, Wang T, Shapiro S, Collet JP; COMPASS Study Team. Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS). J Pain. 2015;16:1233–1242. doi: 10.1016/j.jpain.2015.07.014 49. Ball S, Vickery J, Hobart J, Wright D, Green C, Shearer J, Nunn A, Cano MG, MacManus D, Miller D, et al. The Cannabinoid Use in Progressive Inflammatory brain Disease (CUPID) trial: a randomised double-blind placebo- controlled parallel-group multicentre trial and economic evaluation of cannabinoids to slow progression in multiple sclerosis. Health Technol Assess. 2015;19:vii–viii, 1–187. doi: 10.3310/hta19120 50. Rezkalla S, Kloner RA. Cardiovascular effects of marijuana. Trends Cardiovasc Med. 2019;29:403–407. doi: 10.1016/j.tcm.2018.11.004 51. DeFilippis EM, Bajaj NS, Singh A, Malloy R, Givertz MM, Blankstein R, Bhatt DL, Vaduganathan M. Marijuana use in patients with cardiovascular disease: JACC review topic of the week. J Am Coll Cardiol. 2020;75:320–332. doi: 10.1016/j.jacc.2019.11.025 52. Pacher P, Steffens S, Haskó G, Schindler TH, Kunos G. Cardiovascular effects of marijuana and synthetic cannabinoids: the good, the bad, and the ugly. Nat Rev Cardiol. 2018;15:151–166. doi: 10.1038/nrcardio.2017.130 53. Rodondi N, Pletcher MJ, Liu K, Hulley SB, Sidney S; Coronary Artery Risk Development in Young Adults (CARDIA) Study. Marijuana use, diet, body mass index, and cardiovascular risk factors (from the CARDIA study). Am J Cardiol. 2006;98:478–484. doi: 10.1016/j.amjcard.2006.03.024 54. Meier MH, Pardini D, Beardslee J, Matthews KA. Associations between cannabis use and cardiometabolic risk factors: a longitudinal study of men. Psychosom Med. 2019;81:281–288. doi: 10.1097/PSY.0000000000000665 55. Ravi D, Ghasemiesfe M, Korenstein D, Cascino T, Keyhani S. Associations between marijuana use and cardiovascular risk factors and outcomes: a systematic review. Ann Intern Med. 2018;168:187–194. doi: 10.7326/M17-1548 56. Alshaarawy O, Elbaz HA. Cannabis use and blood pressure levels: United States National Health and Nutrition Examination Survey, 2005–2012. J Hypertens. 2016;34:1507–1512. doi: 10.1097/HJH.0000000000000990 57. Vidot DC, Powers M, Gonzalez R, Jayaweera DT, Roy S, Dong C, Messiah SE. Blood pressure and marijuana use: results from a decade of NHANES data. Am J Health Behav. 2019;43:887–897. doi: 10.5993/AJHB.43.5.2 58. Dufouil C, Beiser A, McLure LA, Wolf PA, Tzourio C, Howard VJ, Westwood AJ, Himali JJ, Sullivan L, Aparicio HJ, et al. Revised Framingham stroke risk profile to reflect temporal trends. Circulation. 2017;135:1145–1159. doi: 10.1161/CIRCULATIONAHA.115.021275 59. Chetty K, Lavoie A, Deghani P. A literature review of cannabis and myocardial infarction: what clinicians may not be aware of. CJC Open. 2021;3:12– 21. doi: 10.1016/j.cjco.2020.09.001 60. Mittleman MA, Lewis RA, Maclure M, Sherwood JB, Muller JE. Triggering myocardial infarction by marijuana. Circulation. 2001;103:2805–2809. doi: 10.1161/01.cir.103.23.2805 61. Reis JP, Auer R, Bancks MP, Goff DC Jr, Lewis CE, Pletcher MJ, Rana JS, Shikany JM, Sidney S. Cumulative lifetime marijuana use and incident cardiovascular disease in middle age: the Coronary Artery Risk Development in Young Adults (CARDIA) study. Am J Public Health. 2017;107:601–606. doi: 10.2105/AJPH.2017.303654 62. Chami T, Kim CH. Cannabis abuse and elevated risk of myocardial infarction in the young: a population-based study. Mayo Clin Proc. 2019;94:1647– 1649. doi: 10.1016/j.mayocp.2019.05.008 63. Jaladi PR, Patel V, Kuduva Rajan S, Rashid W, Madireddy S, Ajibawo T, Imran S, Patel RS. Arrhythmia-related hospitalization and comorbid cannabis use disorder: trend analysis in US hospitals (2010-2014). Cureus. 2019;11:e5607. doi: 10.7759/cureus.5607 64. Tirkey NK, Gupta S. Acute antero-inferior wall ischaemia with acute ischaemic stroke caused by oral ingestion of cannabis in a young male. J Assoc Physicians India. 2016;64:93–94. 65. Volpon LC, Sousa CLMM, Moreira SKK, Teixeira SR, Carlotti APCP. Multiple cerebral infarcts in a young patient associated with marijuana use. J Addict Med. 2017;11:405–407. doi: 10.1097/ADM.0000000000000326 66. Šimůnek L, Krajina A, Herzig R, Vališ M. Cerebral infarction in young marijuana smokers: case reports. Acta Medica (Hradec Kralove). 2018;61:74–77. doi: 10.14712/18059694.2018.56 67. Barber PA, Pridmore HM, Krishnamurthy V, Roberts S, Spriggs DA, Carter KN, Anderson NE. Cannabis, ischemic stroke, and transient ischemic attack: a case-control study. Stroke. 2013;44:2327–2329. doi: 10.1161/STROKEAHA.113.001562 e186 April 2022 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 68. Falkstedt D, Wolff V, Allebeck P, Hemmingsson T, Danielsson AK. Cannabis, tobacco, alcohol use, and the risk of early stroke: a population-based cohort study of 45 000 Swedish men. Stroke. 2017;48:265–270. doi: 10.1161/STROKEAHA.116.015565 69. Parekh T, Pemmasani S, Desai R. Marijuana use among young adults (18-44 years of age) and risk of stroke: a Behavioral Risk Factor Surveillance System Survey analysis. Stroke. 2020;51:308–310. doi: 10.1161/ STROKEAHA.119.027828 70. Hemachandra D, McKetin R, Cherbuin N, Anstey KJ. Heavy cannabis users at elevated risk of stroke: evidence from a general population survey. Aust NZ J Public Health. 2016;40:226–230. doi: 10.1111/1753-6405.12477 71. Rumalla K, Reddy AY, Mittal MK. Recreational marijuana use and acute ischemic stroke: a population-based analysis of hospitalized patients in the United States. J Neurol Sci. 2016;364:191–196. doi: 10.1016/j.jns.2016.01.066 72. Kalla A, Krishnamoorthy PM, Gopalakrishnan A, Figueredo VM. Cannabis use predicts risks of heart failure and cerebrovascular accidents: results from the National Inpatient Sample. J Cardiovasc Med (Hagerstown). 2018;19:480–484. doi: 10.2459/JCM.0000000000000681 73. San Luis CV, O’Hana S Nobleza C, Shekhar S, Sugg R, Villareal DJ, Mehta T, Gangadhara S. Association between recent cannabinoid use and acute ischemic stroke. Neurol Clin Pract. 2020;10:333–339. doi: 10.1212/CPJ.0000000000000888 74. Auger N, Paradis G, Low N, Ayoub A, He S, Potter BJ. Cannabis use disorder and the future risk of cardiovascular disease in parous women: a longitudinal cohort study. BMC Med. 2020;18:328. doi: 10.1186/ s12916-020-01804-6 75. Jensen J, Leonard J, Salottolo K, McCarthy K, Wagner J, Bar-Or D. The epidemiology of reversible cerebral vasoconstriction syndrome in patients at a Colorado comprehensive stroke center. J Vasc Interv Neurol. 2018;10:32–38. 76. Wolff V, Armspach JP, Beaujeux R, Manisor M, Rouyer O, Lauer V, Meyer N, Marescaux C, Geny B. High frequency of intracranial arterial steno- sis and cannabis use in ischaemic stroke in the young. Cerebrovasc Dis. 2014;37:438–443. doi: 10.1159/000363618 77. Wolff V, Jouanjus E. Strokes are possible complications of cannabinoids use. Epilepsy Behav. 2017;70(pt B):355–363. doi: 10.1016/j.yebeh.2017.01.031 78. Castaneira G, Rojas K, Galili Y, Field Z, Perez-Perez A, Madruga M, Carlan SJ. Idiopathic thrombocytopenic purpura induced by synthetic cannabinoid. J Addict Med. 2019;13:235–236. doi: 10.1097/ADM. 0000000000000485 79. Kelkar AH, Smith NA, Martial A, Moole H, Tarantino MD, Roberts JC. An outbreak of synthetic cannabinoid–associated coagulopathy in Illinois. N Engl J Med. 2018;379:1216–1223. doi: 10.1056/NEJMoa1807652 80. Hasin DS, Kerridge BT, Saha TD, Huang B, Pickering R, Smith SM, Jung J, Zhang H, Grant BF. Prevalence and correlates of DSM-5 cannabis use disorder, 2012-2013: findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Am J Psychiatry. 2016;173:588–599. doi: 10.1176/appi.ajp.2015.15070907 81. Vergara VM, Weiland BJ, Hutchison KE, Calhoun VD. The impact of combinations of alcohol, nicotine, and cannabis on dynamic brain connectivity. Neuropsychopharmacology. 2018;43:877–890. doi: 10.1038/npp.2017.280 82. Brunt TM, van Genugten M, Höner-Snoeken K, van de Velde MJ, Niesink RJ. Therapeutic satisfaction and subjective effects of different strains of pharmaceutical-grade cannabis. J Clin Psychopharmacol. 2014;34:344– 349. doi: 10.1097/JCP.0000000000000129 83. Kocis PT, Vrana KE. Delta-9-tetrahydrocannabinol and cannabidiol drug- drug interactions. Med Cannabis Cannabinoids. 2020;3:61–73. doi: 10.1159/000507998 84. Wu LT, Zhu H, Swartz MS. Trends in cannabis use disorders among racial/ ethnic population groups in the United States. Drug Alcohol Depend. 2016;165:181–190. doi: 10.1016/j.drugalcdep.2016.06.002 Stroke. 2022;53:e176–e187. DOI: 10.1161/STR.0000000000000396 April 2022 e187 ",Medical,Find & Summarize,Text Transformation "Use only the information provided in the prompt and context block to address user queries. Do not use any kind of citations in your response, i.e., ""(Smith et al.)"" or ""(7)"", etc.",Which doctors are cited as being the fathers of forensic pathology?,"The origin of forensic medicine remains lost in a distant past, whenever the principles of medical sciences met those of law and justice (1,2). Perhaps it began with the Code of Hammurabi (1792–1750 BCE), which imposed sanctions for errors in medical and surgical practices. The same type of punishment also existed in Persia. Later on, the Visigoths promulgated laws that punished poisoning, infanticide, and homicide. Described as a medical trunk that serves the administration of justice, forensic medicine has different branches. Forensic pathology is probably the most emblematic one. Known in many Latin countries as tanathology (from the Greek word thanatos, meaning “death’s god”), definitions of forensic pathology are often so broad that they would fit better into forensic medicine as a whole than in this single branch. For Di Maio (3), it is “a branch of medicine that applies the principles and knowledge of the medical sciences in the field of law.” An even larger conception of forensic pathology (4) considers it the study of diseases and injuries of the community, because it involves the knowledge of diagnosis and treatment in every medical specialty, but also requires information in many nonmedical areas, such as chemistry, physics, criminalistics and police sciences, motor vehicle and highway conception, politics, sociology, and even the way of life of a society. Closer to its objectives and limits, Williams et al. (5) define forensic pathology as a specialized branch of pathology (pathology being the study by scientific methods of disease and tissue injury) that relates within a legal framework to the effects of trauma, poisoning, occupational hazards, and natural disease. Introduction to Forensic Medicine 15 Forensic dissections of bodies began in the 13th century at the University of Bologna in Italy by a surgeon and teacher of anatomy, Saliceto (6). Surprisingly, these forensic dissections appeared before the hospital autopsies that started by the end of the 19th century with Rokitansky, Virchow, and the advent of the pathogenesis of diseases and cellular pathology (6). However, some authors (7) consider the French surgeon Ambrosio Paré, who in 1575 began a real scientific period in France, the father of legal medicine. This paternity is divided with Zacchia, the Pope’s physician, who taught in Italy and wrote in 1601 what can be considered the first medicolegal textbook (7). This was of decisive influence on the development of forensic sciences, as were the European codes of the 16th century (6): the Bamberg Code in 1507 and especially the Caroline Code in 1532, which obliged the courts to call specialized doctors to clarify forensic questions. Nevertheless, the 19th century was indeed a reference for modern legal medicine, born formally in many countries, almost at the same time: 1855 in Austria (6), 1872 in Hungary (8), 1886 in Brazil (7), 1887 in Great Britain (9,10), and 1889 in Portugal (when legal medicine was first referred to as being legally organized [11]). This century was really a golden age for forensic medicine (1,11), which knew a quick but supported growth, especially in France, Italy, and Germany (11). Besides, in German countries, forensic matters were always carefully treated, as can be proved by the early beginning of teaching forensic medicine in some universities in 1720 (11). The posterior development of forensic pathology was processed in accordance with the legal systems and sociopolitical conditions of each country. At the end of the 19th century, complementary sciences, such as toxicology and histology, were aggregate to forensic pathology, and from that union resulted the constitution of legal medicine institutes similar to the medicolegal units known today, where every type of expertise related to justice may be executed. Later, in the second half of the 20th century, a new medicolegal problem arose in Europe and wherever roads and cars existed. The traffic accidents and the necessity of civil litigations of the injuries of the victims led to a new medicolegal subspecialty concerning living people: clinical forensic medicine. It started in Belgium and France with Derobert, Roche, Muller, and Rousseau (12). Supported by the Deliberation 75 (7) of the Committee of Ministers of the Council of Europe, an “expertise-type” was created (12,13) to achieve a global evaluation of consequences resulting from injuries caused by accidents to the body of an individual (as a whole being). This process was crucial for the financial indemnity of the injuries by insurance companies. These ideas, adopted in Portugal by Oliveira Sá, a great enthusiast of this new 16 Pinheiro discipline, were developed and “exported” to Spain through the excellent relationship he had with the forensic physicians in the neighbor country, where a huge development took place; however, it was more as a private medical activity than centralized in medicolegal institutions. The popularity of this new forensic area increased quickly because of the growing number of traffic accidents in the world. Once the Iberian Peninsula was “conquered,” the area extended to South and Latin America. The English-speaking countries were the last to develop this new specialty; it has been only within the last several years that the popularity of clinical forensic medicine has exploded in the United States and the United Kingdom.","CONTEXT BLOCK The origin of forensic medicine remains lost in a distant past, whenever the principles of medical sciences met those of law and justice (1,2). Perhaps it began with the Code of Hammurabi (1792–1750 BCE), which imposed sanctions for errors in medical and surgical practices. The same type of punishment also existed in Persia. Later on, the Visigoths promulgated laws that punished poisoning, infanticide, and homicide. Described as a medical trunk that serves the administration of justice, forensic medicine has different branches. Forensic pathology is probably the most emblematic one. Known in many Latin countries as tanathology (from the Greek word thanatos, meaning “death’s god”), definitions of forensic pathology are often so broad that they would fit better into forensic medicine as a whole than in this single branch. For Di Maio (3), it is “a branch of medicine that applies the principles and knowledge of the medical sciences in the field of law.” An even larger conception of forensic pathology (4) considers it the study of diseases and injuries of the community, because it involves the knowledge of diagnosis and treatment in every medical specialty, but also requires information in many nonmedical areas, such as chemistry, physics, criminalistics and police sciences, motor vehicle and highway conception, politics, sociology, and even the way of life of a society. Closer to its objectives and limits, Williams et al. (5) define forensic pathology as a specialized branch of pathology (pathology being the study by scientific methods of disease and tissue injury) that relates within a legal framework to the effects of trauma, poisoning, occupational hazards, and natural disease. Introduction to Forensic Medicine 15 Forensic dissections of bodies began in the 13th century at the University of Bologna in Italy by a surgeon and teacher of anatomy, Saliceto (6). Surprisingly, these forensic dissections appeared before the hospital autopsies that started by the end of the 19th century with Rokitansky, Virchow, and the advent of the pathogenesis of diseases and cellular pathology (6). However, some authors (7) consider the French surgeon Ambrosio Paré, who in 1575 began a real scientific period in France, the father of legal medicine. This paternity is divided with Zacchia, the Pope’s physician, who taught in Italy and wrote in 1601 what can be considered the first medicolegal textbook (7). This was of decisive influence on the development of forensic sciences, as were the European codes of the 16th century (6): the Bamberg Code in 1507 and especially the Caroline Code in 1532, which obliged the courts to call specialized doctors to clarify forensic questions. Nevertheless, the 19th century was indeed a reference for modern legal medicine, born formally in many countries, almost at the same time: 1855 in Austria (6), 1872 in Hungary (8), 1886 in Brazil (7), 1887 in Great Britain (9,10), and 1889 in Portugal (when legal medicine was first referred to as being legally organized [11]). This century was really a golden age for forensic medicine (1,11), which knew a quick but supported growth, especially in France, Italy, and Germany (11). Besides, in German countries, forensic matters were always carefully treated, as can be proved by the early beginning of teaching forensic medicine in some universities in 1720 (11). The posterior development of forensic pathology was processed in accordance with the legal systems and sociopolitical conditions of each country. At the end of the 19th century, complementary sciences, such as toxicology and histology, were aggregate to forensic pathology, and from that union resulted the constitution of legal medicine institutes similar to the medicolegal units known today, where every type of expertise related to justice may be executed. Later, in the second half of the 20th century, a new medicolegal problem arose in Europe and wherever roads and cars existed. The traffic accidents and the necessity of civil litigations of the injuries of the victims led to a new medicolegal subspecialty concerning living people: clinical forensic medicine. It started in Belgium and France with Derobert, Roche, Muller, and Rousseau (12). Supported by the Deliberation 75 (7) of the Committee of Ministers of the Council of Europe, an “expertise-type” was created (12,13) to achieve a global evaluation of consequences resulting from injuries caused by accidents to the body of an individual (as a whole being). This process was crucial for the financial indemnity of the injuries by insurance companies. These ideas, adopted in Portugal by Oliveira Sá, a great enthusiast of this new 16 Pinheiro discipline, were developed and “exported” to Spain through the excellent relationship he had with the forensic physicians in the neighbor country, where a huge development took place; however, it was more as a private medical activity than centralized in medicolegal institutions. The popularity of this new forensic area increased quickly because of the growing number of traffic accidents in the world. Once the Iberian Peninsula was “conquered,” the area extended to South and Latin America. The English-speaking countries were the last to develop this new specialty; it has been only within the last several years that the popularity of clinical forensic medicine has exploded in the United States and the United Kingdom. SYSTEM INSTRUCTION Use only the information provided in the prompt and context block to address user queries. Do not use any kind of citations in your response, i.e., ""(Smith et al.)"" or ""(7)"", etc. QUESTION Which doctors are cited as being the fathers of forensic pathology?",Medical,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","What companies are mentioned in the following, and why are they important? Also, how much did each stock increase from last week? Explain the relevance of the Federal Reserve to the economy.","NEW YORK (AP) — U.S. stocks climbed Monday to claw back some of the losses from their worst week in nearly a year and a half. The S&P 500 rallied 1.2%, though it didn’t recoup all of its drop from Friday, let alone from the rest of the four-day losing streak that it broke. The Dow Jones Industrial Average rose 484 points, or 1.2%, and the Nasdaq composite gained 1.2%. Boeing climbed 3.4% after reaching a tentative deal with its largest union on a new contract that, if ratified, will avoid a strike that threatened to shut down aircraft production by the end of the week. Boeing said 33,000 workers represented by the International Association of Machinists and Aerospace Workers would get pay raises of 25% over the four-year contract. Nvidia and other Big Tech companies also returned to their long-held position of leading the market, at least briefly. Nvidia climbed 3.5% and was the strongest force pushing the S&P 500 upward. That cut into its 13.9% tumble last week, as questions continued about whether its stock price went too high in investors’ frenzy around artificial intelligence, even if Nvidia has continued to top analysts’ expectations for growth. After likewise climbing a bit in the morning, Treasury yields later pared their gains. That followed sharp swings in the bond market last week, when a highly anticipated update on the U.S. job market came in weak enough to worsen worries about the slowing U.S. economy. The Federal Reserve has been intentionally pressing the brakes on the economy through high interest rates in order to stifle high inflation. It’s about to start lowering rates later this month, which would ease the pressure on the economy, as it turns its focus toward protecting the job market and avoiding a recession. The question on Wall Street is if the Fed’s shift in focus will prove to be too late. Cuts to interest rates give stock prices a boost, but if an economic downturn does hit, it could more than offset such a benefit by dragging down profits for companies. That’s what happened in 2007, for example, when the Great Recession wrecked the global economy and financial markets. “Today, the absence of glaring household or corporate balance sheet vulnerabilities means Fed easing should be enough to prevent recession, and should provide investors some optimism for the future of the market,” suggests Seema Shah, chief global strategist at Principal Asset Management. On Wall Street, Palantir Technologies jumped 14.1% in its first trading after S&P Dow Jones Indices said it would add the company to its widely followed S&P 500 index. Dell Technologies rose 3.8% after likewise getting a notice of promotion to the index, though and Erie Indemnity lost an early gain to slip 0.6%. Apple’s stock was virutally flat after the company unveiled its latest iPhone model, the 16. It’s the first model to be tailored specifically for artificial intelligence, with expected improvements to its often dim-witted virtual assistant, Siri. Trading in Big Lots was halted after the discount retailer filed for Chapter 11 bankruptcy protection and said it plans to sell its assets and ongoing business operations to private equity firm Nexus Capital Management. All told, the S&P 500 rose 62.63 points to 5,471.05. The Dow gained 484.18 to 40,829.59, and the Nasdaq composite gained 193.77 to 16,884.60. In the bond market, the 10-year Treasury yield edged down to 3.71% from 3.72% late Friday. This upcoming week will feature the latest monthly updates on inflation at the consumer and wholesale levels. Such reports used to be the most anticipated economic data of each month, but market watchers say they’re now taking the back seat to updates on the job market because of the worries about a possible recession. Of course, if the reports show an unexpected spike higher in inflation, that could put the Federal Reserve in its worst-case scenario. Lower interest rates could help boost the economy, but they could also give inflation more fuel. In stock markets abroad, indexes rose in much of Europe after falling in Asia. Japan’s Nikkei 225 slipped 0.5% after the country’s economic growth for the second quarter was revised below expectations. Chinese stocks racked up losses after worse-than-expected inflation data disappointed investors. Indexes fell 1.4% in Hong Kong and 1.1% in Shanghai.","""================ ======= NEW YORK (AP) — U.S. stocks climbed Monday to claw back some of the losses from their worst week in nearly a year and a half. The S&P 500 rallied 1.2%, though it didn’t recoup all of its drop from Friday, let alone from the rest of the four-day losing streak that it broke. The Dow Jones Industrial Average rose 484 points, or 1.2%, and the Nasdaq composite gained 1.2%. Boeing climbed 3.4% after reaching a tentative deal with its largest union on a new contract that, if ratified, will avoid a strike that threatened to shut down aircraft production by the end of the week. Boeing said 33,000 workers represented by the International Association of Machinists and Aerospace Workers would get pay raises of 25% over the four-year contract. Nvidia and other Big Tech companies also returned to their long-held position of leading the market, at least briefly. Nvidia climbed 3.5% and was the strongest force pushing the S&P 500 upward. That cut into its 13.9% tumble last week, as questions continued about whether its stock price went too high in investors’ frenzy around artificial intelligence, even if Nvidia has continued to top analysts’ expectations for growth. After likewise climbing a bit in the morning, Treasury yields later pared their gains. That followed sharp swings in the bond market last week, when a highly anticipated update on the U.S. job market came in weak enough to worsen worries about the slowing U.S. economy. The Federal Reserve has been intentionally pressing the brakes on the economy through high interest rates in order to stifle high inflation. It’s about to start lowering rates later this month, which would ease the pressure on the economy, as it turns its focus toward protecting the job market and avoiding a recession. The question on Wall Street is if the Fed’s shift in focus will prove to be too late. Cuts to interest rates give stock prices a boost, but if an economic downturn does hit, it could more than offset such a benefit by dragging down profits for companies. That’s what happened in 2007, for example, when the Great Recession wrecked the global economy and financial markets. “Today, the absence of glaring household or corporate balance sheet vulnerabilities means Fed easing should be enough to prevent recession, and should provide investors some optimism for the future of the market,” suggests Seema Shah, chief global strategist at Principal Asset Management. On Wall Street, Palantir Technologies jumped 14.1% in its first trading after S&P Dow Jones Indices said it would add the company to its widely followed S&P 500 index. Dell Technologies rose 3.8% after likewise getting a notice of promotion to the index, though and Erie Indemnity lost an early gain to slip 0.6%. Apple’s stock was virutally flat after the company unveiled its latest iPhone model, the 16. It’s the first model to be tailored specifically for artificial intelligence, with expected improvements to its often dim-witted virtual assistant, Siri. Trading in Big Lots was halted after the discount retailer filed for Chapter 11 bankruptcy protection and said it plans to sell its assets and ongoing business operations to private equity firm Nexus Capital Management. All told, the S&P 500 rose 62.63 points to 5,471.05. The Dow gained 484.18 to 40,829.59, and the Nasdaq composite gained 193.77 to 16,884.60. In the bond market, the 10-year Treasury yield edged down to 3.71% from 3.72% late Friday. This upcoming week will feature the latest monthly updates on inflation at the consumer and wholesale levels. Such reports used to be the most anticipated economic data of each month, but market watchers say they’re now taking the back seat to updates on the job market because of the worries about a possible recession. Of course, if the reports show an unexpected spike higher in inflation, that could put the Federal Reserve in its worst-case scenario. Lower interest rates could help boost the economy, but they could also give inflation more fuel. In stock markets abroad, indexes rose in much of Europe after falling in Asia. Japan’s Nikkei 225 slipped 0.5% after the country’s economic growth for the second quarter was revised below expectations. Chinese stocks racked up losses after worse-than-expected inflation data disappointed investors. Indexes fell 1.4% in Hong Kong and 1.1% in Shanghai. https://apnews.com/article/stock-markets-fed-inflation-recession-jobs-32f3ec68b11f87b2194e04c2a29f537c ================ ======= What companies are mentioned in the following, and why are they important? Also, how much did each stock increase from last week? Explain the relevance of the Federal Reserve to the economy. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Financial,Find & Summarize,Text Transformation Use the source provided only.,"Who should not get the vaccine, and what other common products should these people be careful of? "," Number 124a October 2023 COVID-19 mRNA vaccines Immunization has saved more lives in Canada in the Getting all of the recommended doses of vaccine is last 50 years than any other health measure. your best protection against COVID-19. It is important to keep a record of all immunizations What are COVID-19 mRNA vaccines? received. The COVID-19 mRNA vaccines (Moderna and Pfizer- BioNTech) protect against infection from the severe What are the benefits of the vaccines? acute respiratory syndrome coronavirus 2 (SARS-CoV- Immunization is the best way to protect you against 2) that causes COVID-19. The vaccines cause your COVID-19, which is a serious and sometimes fatal body to produce antibodies that will help protect you disease. The vaccines provide strong protection from getting sick if exposed to the virus. The vaccines against severe COVID-19 illness, including are approved by Health Canada. hospitalization and death. The COVID-19 mRNA vaccines provide better protection than other COVID- Who should get the vaccines? 19 vaccines. When you get immunized, you help The vaccines are recommended for those 6 months of protect others as well, including those who are unable age and older. The vaccines are especially important to get the vaccine. for those at increased risk of infection or severe disease, including: What are the possible reactions after the  People 65 years of age and older vaccines?  Residents of long-term care facilities Vaccines are very safe. It is much safer to get the  People with underlying medical conditions vaccine than to get COVID-19. The vaccines are not live virus vaccines and cannot give you COVID-19.  Pregnant people Common reactions to the vaccines may include  Healthcare workers soreness, redness, swelling and itchiness where the  First responders (police, firefighters, ambulance vaccine was given. For some people, these reactions attendants) may show up 8 or more days after getting the Indigenous peoples may be at increased risk of vaccine. Other reactions may include tiredness, serious illness from COVID-19 due to health inequities headache, fever, chills, muscle or joint soreness, resulting from colonialism. swollen lymph nodes under the armpit, nausea and vomiting. Babies and young children may be irritable, More information, including how to register for the sleepy and have a decreased appetite. These vaccine, can be found on the Government of British reactions are mild and generally last 1 to 2 days. If Columbia’s website: you have concerns about any symptoms you develop www2.gov.bc.ca/gov/content/covid- after receiving the vaccine, speak with your health 19/vaccine/register. care provider or call 8-1-1 for advice. If you had, or may have had, COVID-19 you should Rare cases of inflammation of the heart (myocarditis still get the vaccine. This is because you may not be and pericarditis) have been reported after getting the immune to the virus and/or variants of the virus that COVID-19 mRNA vaccines. These were most often causes COVID-19 and could get infected and sick seen: again.  After a second dose of the vaccine when the time How are the vaccines given? between doses was less than 8 weeks The vaccines are given by injection. People 5 years of  In males 12-29 years of age age and older should get 1 dose. Children 6 months to 4 years of age and people with weakened immune systems may need more than 1 dose depending on their immunization history.  With a higher dose of the Moderna vaccine vaccine or if you have had anaphylaxis with an unknown cause. Acetaminophen (e.g. Tylenol®) or ibuprofen (e.g. Are there additional considerations to getting Advil®) can be taken for fever or soreness. ASA the vaccine? (e.g. Aspirin®) should not be given to anyone Speak with your health care provider if you: under 18 years of age due to the risk of Reye  Were diagnosed with inflammation of the heart syndrome. (myocarditis or pericarditis) by a physician after a *Ibuprofen should not be given to children under 6 previous dose of COVID-19 vaccine without another months of age without first speaking to your health cause being identified care provider.  Have a history of multisystem inflammatory For information on Reye syndrome, see HealthLinkBC syndrome following COVID-19 File #84 Reye syndrome.  Have symptoms of COVID-19 It is important to stay in the clinic for 15 minutes after If you have a new illness preventing you from your getting any vaccine. There is an extremely rare regular activities, you should wait until you have possibility of a life-threatening allergic reaction called recovered. This will help to distinguish side effects of anaphylaxis. This happens in less than 1 in a million the vaccine from worsening of your illness. people who get the vaccine. Symptoms may include hives, difficulty breathing, or swelling of the throat, What is COVID-19? tongue or lips. If this reaction occurs, your health care COVID-19 is an infection of the airways and lungs provider is prepared to treat it. Emergency treatment caused by the SARS-CoV-2 coronavirus. Symptoms of includes administration of epinephrine (adrenaline) COVID-19 can include cough, shortness of breath, and transfer by ambulance to the nearest emergency fever, chills, tiredness and loss of smell or taste. While department. If symptoms develop after you leave the some people with COVID-19 may have no symptoms clinic, call 9-1-1 or your local emergency number. or only mild symptoms, others can require Always report serious or unexpected reactions to your hospitalization and may die. Serious illness is more health care provider. common in those who are older and those with After getting the COVID-19 mRNA vaccine, you might certain chronic health conditions such as diabetes, be contacted to participate in a study monitoring the heart disease or lung disease. For some people, safety of the vaccine. To learn more about the study symptoms of COVID-19 can last for weeks or longer. please visit https://canvas-network.ca. The long-term effects of COVID-19 on a person’s health are unknown. Who should not get the vaccine? You should not get the vaccine if you have a serious How is COVID-19 spread? allergy (anaphylaxis) to polyethylene glycol (PEG) The virus that causes COVID-19 is spread from person which is in both of the COVID-19 mRNA vaccines. PEG to person by coughing, sneezing, talking and singing. can be found in some cosmetics, skin care products, It can also be spread by touching an object or surface laxatives, cough syrups, and bowel preparation with the virus on it and then touching your eyes, nose products for colonoscopy. PEG can be an additive in or mouth. some processed foods and drinks, but no cases of For more information on COVID-19 vaccines, visit anaphylaxis to PEG in foods and drinks have been BCCDC’s COVID-19 vaccine page reported. www.bccdc.ca/health-info/diseases-conditions/covid- Speak with your health care provider if you had 19/covid-19-vaccine. anaphylaxis after a previous dose of a COVID-19 For more HealthLinkBC File topics, visit www.HealthLinkBC.ca/more/resources/healthlink-bc-files or your local public health unit. For non-emergency health information and advice in B.C. visit www.HealthLinkBC.ca or call 8- 1-1 (toll-free). For the deaf and hard of hearing, call 7-1-1. Translation services are available in more than 130 languages on request. ","Use the source provided only. Who should not get the vaccine, and what other common products should these people be careful of? Number 124a October 2023 COVID-19 mRNA vaccines Immunization has saved more lives in Canada in the Getting all of the recommended doses of vaccine is last 50 years than any other health measure. your best protection against COVID-19. It is important to keep a record of all immunizations What are COVID-19 mRNA vaccines? received. The COVID-19 mRNA vaccines (Moderna and Pfizer- BioNTech) protect against infection from the severe What are the benefits of the vaccines? acute respiratory syndrome coronavirus 2 (SARS-CoV- Immunization is the best way to protect you against 2) that causes COVID-19. The vaccines cause your COVID-19, which is a serious and sometimes fatal body to produce antibodies that will help protect you disease. The vaccines provide strong protection from getting sick if exposed to the virus. The vaccines against severe COVID-19 illness, including are approved by Health Canada. hospitalization and death. The COVID-19 mRNA vaccines provide better protection than other COVID- Who should get the vaccines? 19 vaccines. When you get immunized, you help The vaccines are recommended for those 6 months of protect others as well, including those who are unable age and older. The vaccines are especially important to get the vaccine. for those at increased risk of infection or severe disease, including: What are the possible reactions after the  People 65 years of age and older vaccines?  Residents of long-term care facilities Vaccines are very safe. It is much safer to get the  People with underlying medical conditions vaccine than to get COVID-19. The vaccines are not live virus vaccines and cannot give you COVID-19.  Pregnant people Common reactions to the vaccines may include  Healthcare workers soreness, redness, swelling and itchiness where the  First responders (police, firefighters, ambulance vaccine was given. For some people, these reactions attendants) may show up 8 or more days after getting the Indigenous peoples may be at increased risk of vaccine. Other reactions may include tiredness, serious illness from COVID-19 due to health inequities headache, fever, chills, muscle or joint soreness, resulting from colonialism. swollen lymph nodes under the armpit, nausea and vomiting. Babies and young children may be irritable, More information, including how to register for the sleepy and have a decreased appetite. These vaccine, can be found on the Government of British reactions are mild and generally last 1 to 2 days. If Columbia’s website: you have concerns about any symptoms you develop www2.gov.bc.ca/gov/content/covid- after receiving the vaccine, speak with your health 19/vaccine/register. care provider or call 8-1-1 for advice. If you had, or may have had, COVID-19 you should Rare cases of inflammation of the heart (myocarditis still get the vaccine. This is because you may not be and pericarditis) have been reported after getting the immune to the virus and/or variants of the virus that COVID-19 mRNA vaccines. These were most often causes COVID-19 and could get infected and sick seen: again.  After a second dose of the vaccine when the time How are the vaccines given? between doses was less than 8 weeks The vaccines are given by injection. People 5 years of  In males 12-29 years of age age and older should get 1 dose. Children 6 months to 4 years of age and people with weakened immune systems may need more than 1 dose depending on their immunization history.  With a higher dose of the Moderna vaccine vaccine or if you have had anaphylaxis with an unknown cause. Acetaminophen (e.g. Tylenol®) or ibuprofen (e.g. Are there additional considerations to getting Advil®) can be taken for fever or soreness. ASA the vaccine? (e.g. Aspirin®) should not be given to anyone Speak with your health care provider if you: under 18 years of age due to the risk of Reye  Were diagnosed with inflammation of the heart syndrome. (myocarditis or pericarditis) by a physician after a *Ibuprofen should not be given to children under 6 previous dose of COVID-19 vaccine without another months of age without first speaking to your health cause being identified care provider.  Have a history of multisystem inflammatory For information on Reye syndrome, see HealthLinkBC syndrome following COVID-19 File #84 Reye syndrome.  Have symptoms of COVID-19 It is important to stay in the clinic for 15 minutes after If you have a new illness preventing you from your getting any vaccine. There is an extremely rare regular activities, you should wait until you have possibility of a life-threatening allergic reaction called recovered. This will help to distinguish side effects of anaphylaxis. This happens in less than 1 in a million the vaccine from worsening of your illness. people who get the vaccine. Symptoms may include hives, difficulty breathing, or swelling of the throat, What is COVID-19? tongue or lips. If this reaction occurs, your health care COVID-19 is an infection of the airways and lungs provider is prepared to treat it. Emergency treatment caused by the SARS-CoV-2 coronavirus. Symptoms of includes administration of epinephrine (adrenaline) COVID-19 can include cough, shortness of breath, and transfer by ambulance to the nearest emergency fever, chills, tiredness and loss of smell or taste. While department. If symptoms develop after you leave the some people with COVID-19 may have no symptoms clinic, call 9-1-1 or your local emergency number. or only mild symptoms, others can require Always report serious or unexpected reactions to your hospitalization and may die. Serious illness is more health care provider. common in those who are older and those with After getting the COVID-19 mRNA vaccine, you might certain chronic health conditions such as diabetes, be contacted to participate in a study monitoring the heart disease or lung disease. For some people, safety of the vaccine. To learn more about the study symptoms of COVID-19 can last for weeks or longer. please visit https://canvas-network.ca. The long-term effects of COVID-19 on a person’s health are unknown. Who should not get the vaccine? You should not get the vaccine if you have a serious How is COVID-19 spread? allergy (anaphylaxis) to polyethylene glycol (PEG) The virus that causes COVID-19 is spread from person which is in both of the COVID-19 mRNA vaccines. PEG to person by coughing, sneezing, talking and singing. can be found in some cosmetics, skin care products, It can also be spread by touching an object or surface laxatives, cough syrups, and bowel preparation with the virus on it and then touching your eyes, nose products for colonoscopy. PEG can be an additive in or mouth. some processed foods and drinks, but no cases of For more information on COVID-19 vaccines, visit anaphylaxis to PEG in foods and drinks have been BCCDC’s COVID-19 vaccine page reported. www.bccdc.ca/health-info/diseases-conditions/covid- Speak with your health care provider if you had 19/covid-19-vaccine. anaphylaxis after a previous dose of a COVID-19 For more HealthLinkBC File topics, visit www.HealthLinkBC.ca/more/resources/healthlink-bc-files or your local public health unit. For non-emergency health information and advice in B.C. visit www.HealthLinkBC.ca or call 8- 1-1 (toll-free). For the deaf and hard of hearing, call 7-1-1. Translation services are available in more than 130 languages on request. ",Unknown,Fact Finding,Q&A "You must answer based solely on the information provided, no outside information is allowed.",What caused the boat to sink?,"December 24, the day Peterson said he was fishing, was gray, damp, and cold with a bit of wind. Few people were at the Berkeley Marina. When questioned by police, Peterson would not say what he was hoping to catch, but the fishing searches performed from his computer earlier in the month had included searches relating to sturgeon and striped bass. Angelo Cuanang, a published author on fishing in the San Francisco Bay who was accepted by the court as an expert fisherman, testified that Brooks Island was the wrong place to seek sturgeon, which congregated in a different part of the bay that time of year. Sturgeon also preferred live bait to lures, and Peterson’s rod was too weak to catch them. Anchoring was essential to reel in sturgeon; the homemade cement anchor in his boat would have been inadequate. Finally, it was illegal to troll for sturgeon, as Peterson claimed to have done. Peterson’s lures and the time of year he was fishing were also wrong for catching striped bass. The prosecution’s theory was as follows: Peterson killed Laci sometime on the night of December 23 or morning of December 24. On the morning of the 24th, Peterson let their dog McKenzie out with his leash on to make it appear something had happened while Laci was walking him. He wrapped Laci’s body in a tarp in the bed of his truck, covered her with the patio umbrellas, drove to the warehouse, and then moved her body into his boat. He drove to the Berkeley Marina, motored out to an area near Brooks Island, and slipped her body, attached to homemade concrete weights like the homemade anchor Peterson had made, into the bay. Peterson then returned to Modesto, dropped off the boat at the warehouse, put the boat cover out back under a leaky gas blower so that any scent would be obscured, washed his clothes, and proceeded with the ruse that Laci was missing, hoping her body would never be discovered. The defense argued the police had not diligently pursued whether a person or persons other than Peterson were more likely responsible for Laci’s disappearance and murder. The defense presented evidence that a burglary had occurred on the Petersons’ street the week of her disappearance and argued that the police failed adequately to follow up on whether that burglary had any connection to Laci’s disappearance. It also presented evidence that a stranger had gone to several houses on December 23 asking for money and, one neighbor thought, casing houses for burglaries, and so might have had something to do with her disappearance. Testimony was presented thatthe same neighbor, walking with a police officer on Christmas Day to look for the stranger, had seen a pair of sandals lying in the road 150 feet from the Petersons’ home; the neighbor wondered at the time if they might have any connection to Laci’s disappearance, but the officer just left them there. To support the possibility of a third party’s involvement, the defense challenged the prosecution’s theory that Conner died December 23 or 24, presenting its own expert who testified based on ultrasounds and other evidence that Conner lived until after Christmas.The defense also sought to challenge other aspects of the prosecution’s case. To rebut the dog-trailing evidence, the defense called Ronald Seitz, a second dog handler who also had his dog try to find Laci’s scent at the Berkeley Marina on December 28. The dog, T.J., was given Laci’s slipper as a scent object, but discovered no scent trail. To rebut the inference that Peterson had a financial incentive to kill Laci, the defense presented a financial expert who testified that TradeCorp U.S.A. and the Petersons were both reasonably financially healthy. To portray the prosecution’s theory as physically impossible, the defense also sought to introduce video of a demonstration with a weighted 150-pound dummy in a boat on the bay in which a defense firm employee, trying to dump the dummy out, sank the boat. As will be discussed below, the trial court excluded the video. The defense offered explanations for the circumstances of Peterson’s behavior in April. His use of his mother’s name to purchase a car was at her suggestion, to avoid having it impounded. He had large amounts of cash because she gave it to him to reimburse him for money erroneously withdrawn from his bank account rather than hers. Finally, he had his brother’s driver’s license because the club where he was going to golf that day gave discounts for local residents such as his brother. The jury found Peterson guilty of murder in the first degree for killing Laci and murder in the second degree for killing Conner. (See Pen. Code, §§ 187, 189.) It found true the sole charged special circumstance, for multiple murder. Peterson had no criminal record nor any history of violent acts. At the penalty phase, the prosecution relied exclusively on the circumstances of the crime and victim impact evidence. Four members of Laci’s immediate family — her mother, Sharon; her stepfather, Ron Grantski; her brother, Brent; and her sister, Amy — testified. They described who Laci was as a person, shared photographs, memories, and vignettes from her life, and conveyed the grief and loss they each felt after the deaths of Laci and her unborn child. Through friends, family, neighbors, teachers, coworkers, employers, and other witnesses, the defense offered evidence that Peterson had been a kind and positive member of the community. Peterson grew up in a loving family, displayed a patient and gentle disposition, and was a solid student. As part of his high school community service requirement, Peterson worked at a home for the elderly and tutored homeless children. He started his own business and worked a variety of other jobs while in college. According to the defense, Peterson was always calm with Laci. Indeed, witnesses testified Peterson was calm at all times — at work, on the golf course, and in his dealings with all those around him. Friends and family testified to the impact the trial had had on Peterson’s relatives and indicated they believed, if sentenced to life in prison, Peterson could make a positive impact on the lives of others. In closing argument, defense counsel described Peterson’s life as one worth saving and argued that lingering doubt about Peterson’s guilt should also weigh in favor of a life verdict.","You must answer based solely on the information provided, no outside information is allowed. What caused the boat to sink? December 24, the day Peterson said he was fishing, was gray, damp, and cold with a bit of wind. Few people were at the Berkeley Marina. When questioned by police, Peterson would not say what he was hoping to catch, but the fishing searches performed from his computer earlier in the month had included searches relating to sturgeon and striped bass. Angelo Cuanang, a published author on fishing in the San Francisco Bay who was accepted by the court as an expert fisherman, testified that Brooks Island was the wrong place to seek sturgeon, which congregated in a different part of the bay that time of year. Sturgeon also preferred live bait to lures, and Peterson’s rod was too weak to catch them. Anchoring was essential to reel in sturgeon; the homemade cement anchor in his boat would have been inadequate. Finally, it was illegal to troll for sturgeon, as Peterson claimed to have done. Peterson’s lures and the time of year he was fishing were also wrong for catching striped bass. The prosecution’s theory was as follows: Peterson killed Laci sometime on the night of December 23 or morning of December 24. On the morning of the 24th, Peterson let their dog McKenzie out with his leash on to make it appear something had happened while Laci was walking him. He wrapped Laci’s body in a tarp in the bed of his truck, covered her with the patio umbrellas, drove to the warehouse, and then moved her body into his boat. He drove to the Berkeley Marina, motored out to an area near Brooks Island, and slipped her body, attached to homemade concrete weights like the homemade anchor Peterson had made, into the bay. Peterson then returned to Modesto, dropped off the boat at the warehouse, put the boat cover out back under a leaky gas blower so that any scent would be obscured, washed his clothes, and proceeded with the ruse that Laci was missing, hoping her body would never be discovered. The defense argued the police had not diligently pursued whether a person or persons other than Peterson were more likely responsible for Laci’s disappearance and murder. The defense presented evidence that a burglary had occurred on the Petersons’ street the week of her disappearance and argued that the police failed adequately to follow up on whether that burglary had any connection to Laci’s disappearance. It also presented evidence that a stranger had gone to several houses on December 23 asking for money and, one neighbor thought, casing houses for burglaries, and so might have had something to do with her disappearance. Testimony was presented thatthe same neighbor, walking with a police officer on Christmas Day to look for the stranger, had seen a pair of sandals lying in the road 150 feet from the Petersons’ home; the neighbor wondered at the time if they might have any connection to Laci’s disappearance, but the officer just left them there. To support the possibility of a third party’s involvement, the defense challenged the prosecution’s theory that Conner died December 23 or 24, presenting its own expert who testified based on ultrasounds and other evidence that Conner lived until after Christmas.The defense also sought to challenge other aspects of the prosecution’s case. To rebut the dog-trailing evidence, the defense called Ronald Seitz, a second dog handler who also had his dog try to find Laci’s scent at the Berkeley Marina on December 28. The dog, T.J., was given Laci’s slipper as a scent object, but discovered no scent trail. To rebut the inference that Peterson had a financial incentive to kill Laci, the defense presented a financial expert who testified that TradeCorp U.S.A. and the Petersons were both reasonably financially healthy. To portray the prosecution’s theory as physically impossible, the defense also sought to introduce video of a demonstration with a weighted 150-pound dummy in a boat on the bay in which a defense firm employee, trying to dump the dummy out, sank the boat. As will be discussed below, the trial court excluded the video. The defense offered explanations for the circumstances of Peterson’s behavior in April. His use of his mother’s name to purchase a car was at her suggestion, to avoid having it impounded. He had large amounts of cash because she gave it to him to reimburse him for money erroneously withdrawn from his bank account rather than hers. Finally, he had his brother’s driver’s license because the club where he was going to golf that day gave discounts for local residents such as his brother. The jury found Peterson guilty of murder in the first degree for killing Laci and murder in the second degree for killing Conner. (See Pen. Code, §§ 187, 189.) It found true the sole charged special circumstance, for multiple murder. Peterson had no criminal record nor any history of violent acts. At the penalty phase, the prosecution relied exclusively on the circumstances of the crime and victim impact evidence. Four members of Laci’s immediate family — her mother, Sharon; her stepfather, Ron Grantski; her brother, Brent; and her sister, Amy — testified. They described who Laci was as a person, shared photographs, memories, and vignettes from her life, and conveyed the grief and loss they each felt after the deaths of Laci and her unborn child. Through friends, family, neighbors, teachers, coworkers, employers, and other witnesses, the defense offered evidence that Peterson had been a kind and positive member of the community. Peterson grew up in a loving family, displayed a patient and gentle disposition, and was a solid student. As part of his high school community service requirement, Peterson worked at a home for the elderly and tutored homeless children. He started his own business and worked a variety of other jobs while in college. According to the defense, Peterson was always calm with Laci. Indeed, witnesses testified Peterson was calm at all times — at work, on the golf course, and in his dealings with all those around him. Friends and family testified to the impact the trial had had on Peterson’s relatives and indicated they believed, if sentenced to life in prison, Peterson could make a positive impact on the lives of others. In closing argument, defense counsel described Peterson’s life as one worth saving and argued that lingering doubt about Peterson’s guilt should also weigh in favor of a life verdict.",Legal,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Give me a bullet point list of all the categories of personal information that can be legally collected in the state of California. Then, in 200 words or less, explain why this information is taken and why it is sometimes sold.","NOTICE AT COLLECTION We may collect the following categories of personal information (as defined in the California Consumer Privacy Act (CCPA) and the California Customer Records statute), including sensitive personal information (as defined in the CCPA): Identifiers, such as name, email address, username and password, postal address, telephone number, signature, government-issued identifier, license plate number, IP address, and other similar identifiers. Characteristics of protected classifications and demographic information, such as gender, age, race, disability status, sexual orientation, gender identity, military/veteran status, marital status, national origin, and medical information. Commercial information, including information about your interests and consuming history or tendencies, such as products or services considered; transaction information when you request information, contact Guest Services, or purchase, return, request or exchange a product or service, including payment card information or other financial information; information provided in response to surveys or other research conducted on our behalf; and information you provide in public forums. Internet or other electronic network activity information, including information regarding your interactions with us online and information we obtain from third parties about use of our applications on third-party platforms or devices. Geolocation data, including precise or approximate location information provided by a mobile device or other device or product interacting with or detected by our sites, applications, or physical properties, where we are permitted by law to process this information. Audio, electronic, visual, or similar information, including telephone call recordings, other voice recordings, and still or video images captured by cameras or readers on or around our physical properties. Inferences based on the above. We collect this information so that we can best serve you, including to fulfill your requests and to share offers or information that we think you may be interested in. As further described in the “Use of Your Information by The Walt Disney Family of Companies” section in our Privacy Policy, we generally collect and use the above-listed categories of personal information to provide and manage our sites, applications, products, and services, and for other business or commercial purposes, such as advertising, marketing, and to improve our products and services. Certain data collection on our sites and applications by third parties for purposes of interest-based advertising and social media tools may be a “sale” or “sharing” under California privacy law. As defined by California law, we “sold” or “shared” certain data elements within the following categories of personal information: identifiers, demographic information, commercial information, Internet or other electronic network activity information, approximate geolocation, and inferences drawn from the above. If you would like to opt out of the sale or sharing of your personal information, you may click the “Do Not Sell or Share My Personal Information” link in our website footers or in our application settings. Please note that your opt-out choice is specific to the digital property and to the device and browser you are using. You may additionally choose to provide the information requested in this opt-out form, which may enable us to take action on your opt-out request more broadly than for a specific digital property. We retain each category of personal information that we collect for as long as necessary to fulfill the purposes described in our Privacy Policy, including to satisfy legal or reporting requirements. What this means in practice will vary for different types of information, but the criteria assessed in the data retention analysis take into account ongoing business or legal needs for the information, for example in relation to tax, health and safety, and potential or actual disputes or investigations. More information, including a description of your legal rights, can be found in the “California Privacy Rights” section below. ADDITIONAL PRIVACY MANDATORY DISCLOSURES We also make the following disclosures for purposes of compliance with California privacy law: We collected the following categories of personal information in the last 12 months: identifiers, characteristics of protected classifications and demographic information, commercial information, Internet or other electronic network activity information, geolocation data, audio, electronic, visual or similar information, and inferences drawn from the above. The sources of personal information from whom we collected are: directly from our guests, third-party sites or platforms that you link with your registration account, analytics tools, social networks, advertising networks, and third-party services that update or supplement information we hold about you. The business or commercial purposes of collecting personal information are as summarized in our “Notice at Collection” section, and as described in more detail in our Privacy Policy under “Use of Your Information by The Walt Disney Family of Companies.” We disclosed certain data elements within the following categories of personal information for a business purpose in the last 12 months: identifiers, characteristics of protected classifications and demographic information, commercial information, Internet or other electronic network activity information, geolocation data, audio, electronic, visual or similar information, and inferences drawn from the above. We disclosed each category to business partners, service providers, government entities, and other third parties as described in the “Sharing Your Personal Information with Other Entities” section of the Privacy Policy. As defined by applicable law, we “sold” or “shared” certain data elements within the following categories of personal information in the last 12 months: identifiers, demographic information, commercial information, Internet or other electronic network activity information, approximate geolocation, and inferences drawn from the above. We “sold” or “shared” each category to or with entities who provide advertising, marketing, or audience measurement; other online third-party branded tools or functionality (such as maps or video players); and social networks. The business or commercial purposes of “selling” or “sharing” personal information is to assist us with advertising, marketing, audience measurement, and other functionality on our digital properties. We do not “sell” or “share” the personal information of known minors under 16 years of age. We do not use or disclose sensitive personal information for purposes other than those specified in Section 7027(m) of the CCPA regulations.","[question] Give me a bullet point list of all the categories of personal information that can be legally collected in the state of California. Then, in 200 words or less, explain why this information is taken and why it is sometimes sold. ===================== [text] NOTICE AT COLLECTION We may collect the following categories of personal information (as defined in the California Consumer Privacy Act (CCPA) and the California Customer Records statute), including sensitive personal information (as defined in the CCPA): Identifiers, such as name, email address, username and password, postal address, telephone number, signature, government-issued identifier, license plate number, IP address, and other similar identifiers. Characteristics of protected classifications and demographic information, such as gender, age, race, disability status, sexual orientation, gender identity, military/veteran status, marital status, national origin, and medical information. Commercial information, including information about your interests and consuming history or tendencies, such as products or services considered; transaction information when you request information, contact Guest Services, or purchase, return, request or exchange a product or service, including payment card information or other financial information; information provided in response to surveys or other research conducted on our behalf; and information you provide in public forums. Internet or other electronic network activity information, including information regarding your interactions with us online and information we obtain from third parties about use of our applications on third-party platforms or devices. Geolocation data, including precise or approximate location information provided by a mobile device or other device or product interacting with or detected by our sites, applications, or physical properties, where we are permitted by law to process this information. Audio, electronic, visual, or similar information, including telephone call recordings, other voice recordings, and still or video images captured by cameras or readers on or around our physical properties. Inferences based on the above. We collect this information so that we can best serve you, including to fulfill your requests and to share offers or information that we think you may be interested in. As further described in the “Use of Your Information by The Walt Disney Family of Companies” section in our Privacy Policy, we generally collect and use the above-listed categories of personal information to provide and manage our sites, applications, products, and services, and for other business or commercial purposes, such as advertising, marketing, and to improve our products and services. Certain data collection on our sites and applications by third parties for purposes of interest-based advertising and social media tools may be a “sale” or “sharing” under California privacy law. As defined by California law, we “sold” or “shared” certain data elements within the following categories of personal information: identifiers, demographic information, commercial information, Internet or other electronic network activity information, approximate geolocation, and inferences drawn from the above. If you would like to opt out of the sale or sharing of your personal information, you may click the “Do Not Sell or Share My Personal Information” link in our website footers or in our application settings. Please note that your opt-out choice is specific to the digital property and to the device and browser you are using. You may additionally choose to provide the information requested in this opt-out form, which may enable us to take action on your opt-out request more broadly than for a specific digital property. We retain each category of personal information that we collect for as long as necessary to fulfill the purposes described in our Privacy Policy, including to satisfy legal or reporting requirements. What this means in practice will vary for different types of information, but the criteria assessed in the data retention analysis take into account ongoing business or legal needs for the information, for example in relation to tax, health and safety, and potential or actual disputes or investigations. More information, including a description of your legal rights, can be found in the “California Privacy Rights” section below. ADDITIONAL PRIVACY MANDATORY DISCLOSURES We also make the following disclosures for purposes of compliance with California privacy law: We collected the following categories of personal information in the last 12 months: identifiers, characteristics of protected classifications and demographic information, commercial information, Internet or other electronic network activity information, geolocation data, audio, electronic, visual or similar information, and inferences drawn from the above. The sources of personal information from whom we collected are: directly from our guests, third-party sites or platforms that you link with your registration account, analytics tools, social networks, advertising networks, and third-party services that update or supplement information we hold about you. The business or commercial purposes of collecting personal information are as summarized in our “Notice at Collection” section, and as described in more detail in our Privacy Policy under “Use of Your Information by The Walt Disney Family of Companies.” We disclosed certain data elements within the following categories of personal information for a business purpose in the last 12 months: identifiers, characteristics of protected classifications and demographic information, commercial information, Internet or other electronic network activity information, geolocation data, audio, electronic, visual or similar information, and inferences drawn from the above. We disclosed each category to business partners, service providers, government entities, and other third parties as described in the “Sharing Your Personal Information with Other Entities” section of the Privacy Policy. As defined by applicable law, we “sold” or “shared” certain data elements within the following categories of personal information in the last 12 months: identifiers, demographic information, commercial information, Internet or other electronic network activity information, approximate geolocation, and inferences drawn from the above. We “sold” or “shared” each category to or with entities who provide advertising, marketing, or audience measurement; other online third-party branded tools or functionality (such as maps or video players); and social networks. The business or commercial purposes of “selling” or “sharing” personal information is to assist us with advertising, marketing, audience measurement, and other functionality on our digital properties. We do not “sell” or “share” the personal information of known minors under 16 years of age. We do not use or disclose sensitive personal information for purposes other than those specified in Section 7027(m) of the CCPA regulations. https://privacy.thewaltdisneycompany.com/en/current-privacy-policy/your-us-state-privacy-rights/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Find & Summarize,Text Transformation Please only respond to questions using the provided text as a reference.,What resilience factors led to the smallest declines in new business activity during the COVID-19 pandemic?,"Since its emergence in 2019, the worldwide spread of the novel coronavirus SARS-CoV-2 (COVID-19) has created a vast economic crisis as government lockdowns place considerable strain on businesses of all kinds – particularly those that rely on face- to-face contact, such as retail restaurants, and personal services. Given the importance of these businesses to local economic development and urban vitality, this paper makes use of the point-level Chicago Business License dataset to examine the impact of the COVID-19 pandemic on new business activity in the City of Chicago. The results indicate that on average, from March to September 2020, total monthly new business starts have declined by 33.4% compared to the monthly average of new starts in the City from 2016 to 2019. Food service and retail businesses have been hardest hit during this period, while chains of all types have seen larger average declines in new startup activity than independent businesses. These patterns also demonstrate interesting intra-urban spatial heterogeneity; ZIP codes with the largest resilience to pandemic-related drops in new business activity tend to have more dense, diverse, and walkable built environments, lower levels of social vulnerability, lower percentages of young residents, and higher percentages of Black and Asian (non-Hispanic) residents. These findings provide some useful evidence in support of the “15-minute city” and ethnic enclave resilience hypotheses. Interestingly, observed COVID-19 case rates also appear to have a positive relationship with new business resilience for new chain and food service establishments. This is likely due to the fact that neighborhoods with relatively high levels of new food service business activity also have relatively higher proportions of food service employees, who are more at risk for contracting COVID-19 as “essential” workers. Since the emergence of the novel SARS-CoV-2 (COVID-19) virus in late 2019, its global spread has led to a variety of negative economic consequences, from restrictions on business operations and government lockdowns to reduced consumer confidence, discretionary mobility, and stock market fluctuations (McKinsey & Company 2020). According to some estimates, real global Gross Domestic Product (GDP) dropped by 10% between 2019Q4 and 2020Q2 (McKinsey & Company 2020), while US GDP experienced its largest quarterly drop in history (9.1% in Quarter 2 of 2020), far outstripping the impact of any previous recessions (measured since data collection began in 1947) (Bauer et al. 2020, Routley 2020). Concurrently, the US unemployment rate reached its highest-ever recorded value in April 2020 at 14.7% (FRED 2020), while the S&P 500 lost 33% of its value in just one month (Capelle-Blancard, Desroziers 2020). Accordingly, US national data show that small business revenues across all industrial sectors dropped by 40% in April and had not yet recovered to pre-pandemic (January 2020) levels by August, remaining at a 20% deficit; revenue in “leisure and hospitality” small businesses, which includes the arts, entertainment, recreation, accommodation, and food service sectors, have fared even worse, bottoming out at a roughly 70% deficit and only recovering to around 40% of pre-pandemic levels (Chetty et al. 2020, Bauer et al. 2020). At the same time, as Figure 1 shows, applications for new businesses “with planned wages” dropped significantly in 2020Q1 and 2020Q2 compared to recent years, before significantly rebounding in 2020Q3 and 202Q4 (US Census Bureau 2020). While this amounts to a higher net number of applications in the first four quarters of 2020 compared to the 2016-2019 average, it is not yet clear whether this is due primarily to an administrative backlog created by the pandemic, the entrepreneurial activity of the newly unemployed, or re-adjustments in the market due to increased demand for particular kinds of goods and services (Bauer et al. 2020). Further understanding the specific effects of the pandemic on entrepreneurial activity is particularly important because new business creation is the primary engine for diversity, economic growth, and innovation in the economy as a whole (Frenken et al. 2007, Neumark et al. 2006, Wennekers, Thurik 1999), and declines in startup activity can have substantial negative long-term economic consequences (Sedl´aˇcek 2020, Guorio et al. 2016). There is also significant spatial heterogeneity in startup activity that plays an important role in cluster formation, regional economic development, and even the development trajectory of individual neighbourhoods within regions (Mack, Credit 2016, Malmberg, Maskell 2002, Florida 2002, Klepper 2009a,b, Porter 2000, Rutten, Boekema 2007). Understanding the fine-grained spatial and industrial effects of the pandemic on new businesses in more detail can help researchers and local governments to understand how to develop more economically resilient regions, which can provide insulation from future economic shocks. Data on new business applications are available on a weekly basis at the state level from the US Census Bureau’s Business Formation Statistics (2020). However, other datasets used to evaluate new business activity at finer spatial scales are not updated quickly enough to allow researchers to examine the fine-grained spatial and industrial/sectoral effects of the pandemic on new business activity. These include public datasets like the ZIP Code Business Patterns, as well as private datasets such as InfoUSA or the National Establishment Time Series (NETS). To overcome this problem, this paper utilizes a novel large dataset of business establishments (at the point level) derived from the open source Chicago Business License dataset, which is updated weekly and contains a comprehensive set of information on all new business license applications in the City of Chicago (2020) to assess two primary questions: first, to what extent has there been a decline in new business establishment1 starts during the pandemic (March to September, 2020) when compared to recent pre-pandemic trends (averages from 2016 to 2019)? Specifically, we are interested in whether there are distinct temporal trends by business sector or type (e.g., retail, food service, personal care and fitness, etc.) or between multi-establishment (or “chain”) (≥ 4 establishment) businesses and “independent” (< 4 establishment) businesses. Second, given the temporal analysis, what is the spatial expression of these trends? Are there particular areas of the city that are more resilient to declines in new business startups, and, if so, what are the characteristics of these areas? To analyse this formally, we aggregate changes in pandemic-related (i.e., March to September 2020) business activity to the ZIP code level in order to explore the relationship between pandemic-related decline and characteristics of social vulnerability, the built environment, demographics, and cumulative COVID-19 activity. The results of the analysis indicate that 1) on average, from March to September 2020 (through which complete data was available at the time of writing), total monthly new business starts have declined by 33.4% compared to the monthly average of new starts in the City from January 2016 to December 2019. 2) In general, food service and retail businesses have been hardest hit during this period (although all categories have experienced declines), while chains of all types have seen larger average declines in new startup activity (an average monthly drop of 61.9% from March to September compared to pre-pandemic averages) than independent businesses (a 29.2% drop). 3) These patterns demonstrate interesting intra-urban spatial heterogeneity; overall, a regression analysis suggests that the ZIP codes with the smallest pandemic-related declines in new business activity (i.e., those most resilient to the effects of the pandemic) tend to have more dense, diverse, and walkable built environments (defined in more detail below), lower levels of social vulnerability, lower percentages of young (age 18-39) residents, and higher percentages of Black and Asian (non-Hispanic) residents. Interestingly, observed COVID-19 case rates appear to have a positive relationship with new business resilience (after controlling for a variety of covariates), particularly for new chain and food service establishments. This could be a case of reverse causality, where areas with relatively high levels of new food service business activity also have relatively higher proportions of food service employees, who are more at risk for contracting COVID-19 as “essential” workers. New business creation provides a number of benefits to both local and macro-level economies that make it particularly important in the contemporary era of “flexible specialization” (Harvey 1989, Piore, Sabel 1984). The theoretical pathways from new business creation to economic benefits are diagrammed in Figure 2. Most directly, new (generally small) businesses create jobs that contribute to local economic growth (Birch 1987, Kirchhoff, Phillips 1988, Neumark et al. 2006). While on net these jobs may not always exceed the number of jobs lost from the older businesses they replace (Mack, Credit 2017), this process of business “churn” increases the probability of creating high-growth firms (so-called “gazelles”) that tend to produce the majority of new jobs (Henrekson, Johansson 2010, Nightingale, Coad 2014) and also provides for the “creative destruction” that fosters evolution and innovation in the economy2 by replacing jobs and businesses in older declining industries with new jobs in more innovative industries (Schumpeter 1934, 1947, 1950, Brown et al. 2006, Fogel et al. 2008). Another way that entrepreneurship fosters innovation and productivity improvement is through the creation of a more competitive economic environment that produces a selection process through which only the most viable and/or innovative businesses survive (Wennekers, Thurik 1999, Carree, Thurik 2003). Interestingly, this more competitive environment can drive a positive feedback loop through which increased competitiveness drives demand for better products, which creates incentives for additional innovation and new business creation (Teece 2007, Asheim 1996, Florida 1995, Porter 2000, Rutten, Boekema 2007, Malmberg, Maskell 2002). Fully fledged clusters, such as Silicon Valley, can develop a unique entrepreneurial culture of “competition and community” (Saxenian 1994) and attract additional educational, political, and financial investments that foster a holistic “entrepreneurial ecosystem” (Mack, Mayer 2015, Stam 2015) that captures the indigenous benefits of innovation, leading to economic success for individual businesses and associated local economic benefits, as well as providing a more supportive environment for further new business creation (Delgado et al. 2010). New businesses also contribute to innovation because they are often created as a direct result of knowledge spillovers, i.e., a new business is formed specifically to take advantage of some newly generated knowledge or idea (Acs, Audretsch 2003, Acs et al. 2009). These are often in the form of spinoffs from large existing companies, which some argue constitute the bulk of cluster forming activity (Buenstorf, Klepper 2009, Klepper, Sleeper 2005, Klepper 2009a,b). Finally, new businesses directly contribute to economic diversity. Increased diversity within related industries (i.e., “related variety”) provides another engine for innovation as the pool of new ideas and possible interactions and exchanges increases with the diversity of firms (Jacobs 1967, Boschma, Lambooy 1999, Boschma, Frenken 2006, Saviotti, Pyka 2004, Frenken et al. 2007). On the other hand, diversity through “unrelated variety” provides important portfolio benefits to local economies by distributing economic risk across a variety of different industries, making the economic system more resilient to unexpected shocks that may occur, no matter what sector they are concentrated in (Montgomery 1994, Frenken et al. 2007). In this paper, we are particularly interested in new business creation for small, independently owned businesses in customer-facing sectors such as retail and food service, for several reasons. These businesses are significant contributors to land use diversity, street life, and overall urban vitality (Jacobs 1961, Gehl 2010). At the same time, small retail shops help to contribute to a unique “sense of place” in a given locality that is the direct product of local creative efforts and sensibilities (Jacobs 1961, Relph 1976, Robertson 1999, Kunstler 1994, Walljasper 2007, Alexander 1977, Montgomery 1998). The owners of these kinds of businesses themselves are also often more connected to the specific dynamics, demands, and politics of the local community, and tend to contribute to local import substitution (increasing the local multiplier effect) by spending profits to purchase requisite subsidiary goods and services locally, rather than exporting profits to another region, as is the case with larger chain businesses (Jacobs 1967, Talen, Jeong 2019a,b).","Please only respond to questions using the provided text as a reference. What resilience factors led to the smallest declines in new business activity during the COVID-19 pandemic? Since its emergence in 2019, the worldwide spread of the novel coronavirus SARS-CoV-2 (COVID-19) has created a vast economic crisis as government lockdowns place considerable strain on businesses of all kinds – particularly those that rely on face- to-face contact, such as retail restaurants, and personal services. Given the importance of these businesses to local economic development and urban vitality, this paper makes use of the point-level Chicago Business License dataset to examine the impact of the COVID-19 pandemic on new business activity in the City of Chicago. The results indicate that on average, from March to September 2020, total monthly new business starts have declined by 33.4% compared to the monthly average of new starts in the City from 2016 to 2019. Food service and retail businesses have been hardest hit during this period, while chains of all types have seen larger average declines in new startup activity than independent businesses. These patterns also demonstrate interesting intra-urban spatial heterogeneity; ZIP codes with the largest resilience to pandemic-related drops in new business activity tend to have more dense, diverse, and walkable built environments, lower levels of social vulnerability, lower percentages of young residents, and higher percentages of Black and Asian (non-Hispanic) residents. These findings provide some useful evidence in support of the “15-minute city” and ethnic enclave resilience hypotheses. Interestingly, observed COVID-19 case rates also appear to have a positive relationship with new business resilience for new chain and food service establishments. This is likely due to the fact that neighborhoods with relatively high levels of new food service business activity also have relatively higher proportions of food service employees, who are more at risk for contracting COVID-19 as “essential” workers. Since the emergence of the novel SARS-CoV-2 (COVID-19) virus in late 2019, its global spread has led to a variety of negative economic consequences, from restrictions on business operations and government lockdowns to reduced consumer confidence, discretionary mobility, and stock market fluctuations (McKinsey & Company 2020). According to some estimates, real global Gross Domestic Product (GDP) dropped by 10% between 2019Q4 and 2020Q2 (McKinsey & Company 2020), while US GDP experienced its largest quarterly drop in history (9.1% in Quarter 2 of 2020), far outstripping the impact of any previous recessions (measured since data collection began in 1947) (Bauer et al. 2020, Routley 2020). Concurrently, the US unemployment rate reached its highest-ever recorded value in April 2020 at 14.7% (FRED 2020), while the S&P 500 lost 33% of its value in just one month (Capelle-Blancard, Desroziers 2020). Accordingly, US national data show that small business revenues across all industrial sectors dropped by 40% in April and had not yet recovered to pre-pandemic (January 2020) levels by August, remaining at a 20% deficit; revenue in “leisure and hospitality” small businesses, which includes the arts, entertainment, recreation, accommodation, and food service sectors, have fared even worse, bottoming out at a roughly 70% deficit and only recovering to around 40% of pre-pandemic levels (Chetty et al. 2020, Bauer et al. 2020). At the same time, as Figure 1 shows, applications for new businesses “with planned wages” dropped significantly in 2020Q1 and 2020Q2 compared to recent years, before significantly rebounding in 2020Q3 and 202Q4 (US Census Bureau 2020). While this amounts to a higher net number of applications in the first four quarters of 2020 compared to the 2016-2019 average, it is not yet clear whether this is due primarily to an administrative backlog created by the pandemic, the entrepreneurial activity of the newly unemployed, or re-adjustments in the market due to increased demand for particular kinds of goods and services (Bauer et al. 2020). Further understanding the specific effects of the pandemic on entrepreneurial activity is particularly important because new business creation is the primary engine for diversity, economic growth, and innovation in the economy as a whole (Frenken et al. 2007, Neumark et al. 2006, Wennekers, Thurik 1999), and declines in startup activity can have substantial negative long-term economic consequences (Sedl´aˇcek 2020, Guorio et al. 2016). There is also significant spatial heterogeneity in startup activity that plays an important role in cluster formation, regional economic development, and even the development trajectory of individual neighbourhoods within regions (Mack, Credit 2016, Malmberg, Maskell 2002, Florida 2002, Klepper 2009a,b, Porter 2000, Rutten, Boekema 2007). Understanding the fine-grained spatial and industrial effects of the pandemic on new businesses in more detail can help researchers and local governments to understand how to develop more economically resilient regions, which can provide insulation from future economic shocks. Data on new business applications are available on a weekly basis at the state level from the US Census Bureau’s Business Formation Statistics (2020). However, other datasets used to evaluate new business activity at finer spatial scales are not updated quickly enough to allow researchers to examine the fine-grained spatial and industrial/sectoral effects of the pandemic on new business activity. These include public datasets like the ZIP Code Business Patterns, as well as private datasets such as InfoUSA or the National Establishment Time Series (NETS). To overcome this problem, this paper utilizes a novel large dataset of business establishments (at the point level) derived from the open source Chicago Business License dataset, which is updated weekly and contains a comprehensive set of information on all new business license applications in the City of Chicago (2020) to assess two primary questions: first, to what extent has there been a decline in new business establishment1 starts during the pandemic (March to September, 2020) when compared to recent pre-pandemic trends (averages from 2016 to 2019)? Specifically, we are interested in whether there are distinct temporal trends by business sector or type (e.g., retail, food service, personal care and fitness, etc.) or between multi-establishment (or “chain”) (≥ 4 establishment) businesses and “independent” (< 4 establishment) businesses. Second, given the temporal analysis, what is the spatial expression of these trends? Are there particular areas of the city that are more resilient to declines in new business startups, and, if so, what are the characteristics of these areas? To analyse this formally, we aggregate changes in pandemic-related (i.e., March to September 2020) business activity to the ZIP code level in order to explore the relationship between pandemic-related decline and characteristics of social vulnerability, the built environment, demographics, and cumulative COVID-19 activity. The results of the analysis indicate that 1) on average, from March to September 2020 (through which complete data was available at the time of writing), total monthly new business starts have declined by 33.4% compared to the monthly average of new starts in the City from January 2016 to December 2019. 2) In general, food service and retail businesses have been hardest hit during this period (although all categories have experienced declines), while chains of all types have seen larger average declines in new startup activity (an average monthly drop of 61.9% from March to September compared to pre-pandemic averages) than independent businesses (a 29.2% drop). 3) These patterns demonstrate interesting intra-urban spatial heterogeneity; overall, a regression analysis suggests that the ZIP codes with the smallest pandemic-related declines in new business activity (i.e., those most resilient to the effects of the pandemic) tend to have more dense, diverse, and walkable built environments (defined in more detail below), lower levels of social vulnerability, lower percentages of young (age 18-39) residents, and higher percentages of Black and Asian (non-Hispanic) residents. Interestingly, observed COVID-19 case rates appear to have a positive relationship with new business resilience (after controlling for a variety of covariates), particularly for new chain and food service establishments. This could be a case of reverse causality, where areas with relatively high levels of new food service business activity also have relatively higher proportions of food service employees, who are more at risk for contracting COVID-19 as “essential” workers. New business creation provides a number of benefits to both local and macro-level economies that make it particularly important in the contemporary era of “flexible specialization” (Harvey 1989, Piore, Sabel 1984). The theoretical pathways from new business creation to economic benefits are diagrammed in Figure 2. Most directly, new (generally small) businesses create jobs that contribute to local economic growth (Birch 1987, Kirchhoff, Phillips 1988, Neumark et al. 2006). While on net these jobs may not always exceed the number of jobs lost from the older businesses they replace (Mack, Credit 2017), this process of business “churn” increases the probability of creating high-growth firms (so-called “gazelles”) that tend to produce the majority of new jobs (Henrekson, Johansson 2010, Nightingale, Coad 2014) and also provides for the “creative destruction” that fosters evolution and innovation in the economy2 by replacing jobs and businesses in older declining industries with new jobs in more innovative industries (Schumpeter 1934, 1947, 1950, Brown et al. 2006, Fogel et al. 2008). Another way that entrepreneurship fosters innovation and productivity improvement is through the creation of a more competitive economic environment that produces a selection process through which only the most viable and/or innovative businesses survive (Wennekers, Thurik 1999, Carree, Thurik 2003). Interestingly, this more competitive environment can drive a positive feedback loop through which increased competitiveness drives demand for better products, which creates incentives for additional innovation and new business creation (Teece 2007, Asheim 1996, Florida 1995, Porter 2000, Rutten, Boekema 2007, Malmberg, Maskell 2002). Fully fledged clusters, such as Silicon Valley, can develop a unique entrepreneurial culture of “competition and community” (Saxenian 1994) and attract additional educational, political, and financial investments that foster a holistic “entrepreneurial ecosystem” (Mack, Mayer 2015, Stam 2015) that captures the indigenous benefits of innovation, leading to economic success for individual businesses and associated local economic benefits, as well as providing a more supportive environment for further new business creation (Delgado et al. 2010). New businesses also contribute to innovation because they are often created as a direct result of knowledge spillovers, i.e., a new business is formed specifically to take advantage of some newly generated knowledge or idea (Acs, Audretsch 2003, Acs et al. 2009). These are often in the form of spinoffs from large existing companies, which some argue constitute the bulk of cluster forming activity (Buenstorf, Klepper 2009, Klepper, Sleeper 2005, Klepper 2009a,b). Finally, new businesses directly contribute to economic diversity. Increased diversity within related industries (i.e., “related variety”) provides another engine for innovation as the pool of new ideas and possible interactions and exchanges increases with the diversity of firms (Jacobs 1967, Boschma, Lambooy 1999, Boschma, Frenken 2006, Saviotti, Pyka 2004, Frenken et al. 2007). On the other hand, diversity through “unrelated variety” provides important portfolio benefits to local economies by distributing economic risk across a variety of different industries, making the economic system more resilient to unexpected shocks that may occur, no matter what sector they are concentrated in (Montgomery 1994, Frenken et al. 2007). In this paper, we are particularly interested in new business creation for small, independently owned businesses in customer-facing sectors such as retail and food service, for several reasons. These businesses are significant contributors to land use diversity, street life, and overall urban vitality (Jacobs 1961, Gehl 2010). At the same time, small retail shops help to contribute to a unique “sense of place” in a given locality that is the direct product of local creative efforts and sensibilities (Jacobs 1961, Relph 1976, Robertson 1999, Kunstler 1994, Walljasper 2007, Alexander 1977, Montgomery 1998). The owners of these kinds of businesses themselves are also often more connected to the specific dynamics, demands, and politics of the local community, and tend to contribute to local import substitution (increasing the local multiplier effect) by spending profits to purchase requisite subsidiary goods and services locally, rather than exporting profits to another region, as is the case with larger chain businesses (Jacobs 1967, Talen, Jeong 2019a,b).",Financial,Find & Summarize,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","I see that on the new flagship Nvidia models, there is always the designation RTX. What does this mean and why is it important? Explain in under 300 words.","“Ray tracing is the future, and it always will be!” has been the tongue-in-cheek phrase used by graphics developers for decades when asked whether real-time ray tracing will ever be feasible. Everyone seems to agree on the first part: ray tracing is the future. That’s because ray tracing is the only technology we know of that enables the rendering of truly photorealistic images. It’s no coincidence that every offline renderer used in the movie industry, where compromises on image quality are unacceptable, is based on ray tracing. Rasterization has made immense strides over the years, and it is still evolving even today. But it is also fundamentally limited in the type of effects it can compute. Truly taking graphics to the next level requires new underlying technology. This is where ray tracing comes in, and this is why real-time ray tracing has long been the dream of gamers and game developers. So will ray tracing always remain a dream of the future, and never arrive in the present? At GDC 2018, NVIDIA unveiled RTX, a high-performance implementation that will power all ray tracing APIs supported by NVIDIA on Volta and future GPUs. At the same event, Microsoft announced the integration of ray tracing as a first-class citizen into their industry standard DirectX API. Putting these two technologies together forms such a powerful combination that we can confidently answer the above question: the future is here! This is not a hyperbole: leading game studios are developing upcoming titles using RTX through DirectX — today. Ray tracing in games is no longer a pipe dream. It’s happening, and it will usher in a new era of real-time graphics. he API that Microsoft announced, DirectX Raytracing (DXR), is a natural extension of DirectX 12. It fully integrates ray tracing into DirectX, and makes it a companion (as opposed to a replacement) to rasterization and compute. API Overview The DXR API focuses on delivering high performance by giving the application signficant low-level control, as with earlier versions of DirectX 12. Several design decisions reflect this: All ray tracing related GPU work is dispatched via command lists and queues that the application schedules. Ray tracing therefore integrates tightly with other work such as rasterization or compute, and can be enqueued efficiently by a multithreaded application. Ray tracing shaders are dispatched as grids of work items, similar to compute shaders. This lets the implementation utilize the massive parallel processing throughput of GPUs and perform low-level scheduling of work items as appropriate for the given hardware. The application retains the responsibility of explicitly synchronizing GPU work and resources where necessary, as it does with rasterization and compute. This allows developers to optimize for the maximum amount of overlap between ray tracing, rasterization, compute work, and memory transfers. Ray tracing and other dispatch types share all resources such as textures, buffers, and constants. No conversion, duplication, or mapping is required to access a resource from ray tracing shaders. Resources that hold ray tracing specific data, such as acceleration structures and shader tables (see below), are entirely managed by the application. No memory allocations or transfers happen implicitly “under the hood”. Shader compilation is explicit and therefore under full application control. Shaders can be compiled individually or in batch. Compilation can be parallelized across multiple CPU threads if desired. At a high level, DXR introduces three new concepts to DirectX that the application must manage: Ray Tracing Pipeline State Objects contain the compiled shader code that gets executed during a ray tracing dispatch. Acceleration Structures contain the data structures used to accelerate ray tracing itself, i.e. the search for intersections between rays and scene geometry. Shader Tables define the relationship between ray tracing shaders, their resources (textures, constants, etc), and scene geometry. Let’s take a closer look at these. The traditional raster graphics pipeline defines a number of shader types: vertex shader, geometry shader, pixel shader, etc. Analog to that model, a ray tracing pipeline consists of five new shader types which are executed at different stages: The ray generation shader is the first thing invoked in a ray tracing dispatch. Ray generation shaders are comparable to compute shaders, with the added capability of calling the new HLSL function TraceRay(). This function casts a single ray into the scene to search for intersections, triggering other shaders in the process. A ray generation shader may call TraceRay() as many times as it likes. Intersection and any hit shaders are invoked whenever TraceRay() finds a potential intersection between the ray and the scene. The intersection shader determines whether the ray intersects an individual geometric primitive — for example a sphere, a subdivision surface, or really any primitive type you can code up! The most common type is, of course, triangles, for which the API offers special support through a built-in, highly tuned intersection shader. Once an intersection is found, the any hit shader may be used to process it further or potentially discard it. Any hit shaders commonly implement alpha testing by performing a texture lookup and deciding based on the texel’s value whether or not to discard an intersection. Once TraceRay() has completed the search for ray-scene intersections, either a closest hit or a miss shader is invoked, depending on the outcome of the search. The closest hit shader is typically where most shading operations take place: material evaluation, texture lookups, and so on. The miss shader can be used to implement environment lookups, for example. Both closest hit and miss shaders can recursively trace rays by calling TraceRay() themselves. The pipeline constructed from these shaders defines a single-ray programming model. Semantically, each GPU thread handles one ray at a time and cannot communicate with other threads or see other rays currently being processed. This keeps things simple for developers writing shaders, while allowing room for vendor-specific optimizations under the hood of the API. The main way for the different shader types to communicate with each other is the ray payload. The payload is simply a user-defined struct that’s passed as an inout parameter to TraceRay(). Any hit, closest hit, and miss shaders can read and write the payload, and therefore pass back the result of their computations to the caller of TraceRay().","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I see that on the new flagship Nvidia models, there is always the designation RTX. What does this mean and why is it important? Explain in under 300 words. “Ray tracing is the future, and it always will be!” has been the tongue-in-cheek phrase used by graphics developers for decades when asked whether real-time ray tracing will ever be feasible. Everyone seems to agree on the first part: ray tracing is the future. That’s because ray tracing is the only technology we know of that enables the rendering of truly photorealistic images. It’s no coincidence that every offline renderer used in the movie industry, where compromises on image quality are unacceptable, is based on ray tracing. Rasterization has made immense strides over the years, and it is still evolving even today. But it is also fundamentally limited in the type of effects it can compute. Truly taking graphics to the next level requires new underlying technology. This is where ray tracing comes in, and this is why real-time ray tracing has long been the dream of gamers and game developers. So will ray tracing always remain a dream of the future, and never arrive in the present? At GDC 2018, NVIDIA unveiled RTX, a high-performance implementation that will power all ray tracing APIs supported by NVIDIA on Volta and future GPUs. At the same event, Microsoft announced the integration of ray tracing as a first-class citizen into their industry standard DirectX API. Putting these two technologies together forms such a powerful combination that we can confidently answer the above question: the future is here! This is not a hyperbole: leading game studios are developing upcoming titles using RTX through DirectX — today. Ray tracing in games is no longer a pipe dream. It’s happening, and it will usher in a new era of real-time graphics. he API that Microsoft announced, DirectX Raytracing (DXR), is a natural extension of DirectX 12. It fully integrates ray tracing into DirectX, and makes it a companion (as opposed to a replacement) to rasterization and compute. API Overview The DXR API focuses on delivering high performance by giving the application signficant low-level control, as with earlier versions of DirectX 12. Several design decisions reflect this: All ray tracing related GPU work is dispatched via command lists and queues that the application schedules. Ray tracing therefore integrates tightly with other work such as rasterization or compute, and can be enqueued efficiently by a multithreaded application. Ray tracing shaders are dispatched as grids of work items, similar to compute shaders. This lets the implementation utilize the massive parallel processing throughput of GPUs and perform low-level scheduling of work items as appropriate for the given hardware. The application retains the responsibility of explicitly synchronizing GPU work and resources where necessary, as it does with rasterization and compute. This allows developers to optimize for the maximum amount of overlap between ray tracing, rasterization, compute work, and memory transfers. Ray tracing and other dispatch types share all resources such as textures, buffers, and constants. No conversion, duplication, or mapping is required to access a resource from ray tracing shaders. Resources that hold ray tracing specific data, such as acceleration structures and shader tables (see below), are entirely managed by the application. No memory allocations or transfers happen implicitly “under the hood”. Shader compilation is explicit and therefore under full application control. Shaders can be compiled individually or in batch. Compilation can be parallelized across multiple CPU threads if desired. At a high level, DXR introduces three new concepts to DirectX that the application must manage: Ray Tracing Pipeline State Objects contain the compiled shader code that gets executed during a ray tracing dispatch. Acceleration Structures contain the data structures used to accelerate ray tracing itself, i.e. the search for intersections between rays and scene geometry. Shader Tables define the relationship between ray tracing shaders, their resources (textures, constants, etc), and scene geometry. Let’s take a closer look at these. The traditional raster graphics pipeline defines a number of shader types: vertex shader, geometry shader, pixel shader, etc. Analog to that model, a ray tracing pipeline consists of five new shader types which are executed at different stages: The ray generation shader is the first thing invoked in a ray tracing dispatch. Ray generation shaders are comparable to compute shaders, with the added capability of calling the new HLSL function TraceRay(). This function casts a single ray into the scene to search for intersections, triggering other shaders in the process. A ray generation shader may call TraceRay() as many times as it likes. Intersection and any hit shaders are invoked whenever TraceRay() finds a potential intersection between the ray and the scene. The intersection shader determines whether the ray intersects an individual geometric primitive — for example a sphere, a subdivision surface, or really any primitive type you can code up! The most common type is, of course, triangles, for which the API offers special support through a built-in, highly tuned intersection shader. Once an intersection is found, the any hit shader may be used to process it further or potentially discard it. Any hit shaders commonly implement alpha testing by performing a texture lookup and deciding based on the texel’s value whether or not to discard an intersection. Once TraceRay() has completed the search for ray-scene intersections, either a closest hit or a miss shader is invoked, depending on the outcome of the search. The closest hit shader is typically where most shading operations take place: material evaluation, texture lookups, and so on. The miss shader can be used to implement environment lookups, for example. Both closest hit and miss shaders can recursively trace rays by calling TraceRay() themselves. The pipeline constructed from these shaders defines a single-ray programming model. Semantically, each GPU thread handles one ray at a time and cannot communicate with other threads or see other rays currently being processed. This keeps things simple for developers writing shaders, while allowing room for vendor-specific optimizations under the hood of the API. The main way for the different shader types to communicate with each other is the ray payload. The payload is simply a user-defined struct that’s passed as an inout parameter to TraceRay(). Any hit, closest hit, and miss shaders can read and write the payload, and therefore pass back the result of their computations to the caller of TraceRay(). https://developer.nvidia.com/blog/introduction-nvidia-rtx-directx-ray-tracing/",Internet/Technology,Summarize & Simplify,Text Transformation "You must respond solely based on the provided context, so do not rely on external knowledge or sources. Answer in 100 words or less.","I don't agree terms of my digital copy. Without referencing the context, what does Disney say is the process of returning a digital movie code purchased in a combination disc + code package.","4. Paid Transactions Identity of Seller Sales are made by Disney DTC or the seller identified at the time of sale, if different. If you have questions about your order, please contact the seller at the address provided and they will assist you. Some digital storefronts on the Disney Services are operated by third parties and, in that case, different or additional sale terms may apply, which you should read when they are presented to you. Digital Content and Virtual Items We may make applications, games, software or other digital content available on the Disney Services for you to license for a one-time fee. When purchasing a license to access such material from a Disney Service, charges will be disclosed to you on the Disney Service before you complete the license purchase. Your purchase of a virtual item or in-game currency is a payment for a limited, non-assignable license to access and use such content or functionality in the Disney Services with no right to reproduce, distribute, communicate to the public, make available to the public or transform any Disney Service via any online media, in any media format or channel now known or hereafter devised (except as may be expressly described or contemplated within the Disney Service). Virtual items (including characters and character names) or in-game currency purchased or available to you in the Disney Services can only be used in connection with the Disney Services where you obtained them or where they were developed by you as a result of game play. These items are not redeemable or subject to refund and cannot be traded outside of the Disney Services for money or other items for value. We may modify or discontinue virtual items or ingame currency at any time. Digital Movie Codes Digital codes originally packaged in a combination disc + code package (a package that includes a DVD, Blu-Ray, and/or 4K/UHD disc(s) and a digital code) may not be sold separately and may be redeemed only by an individual who obtains the code in the original combination disc + code package, or by a family member of that individual. Digital codes are not authorized for redemption if sold separately. You may use digital movie codes to obtain licensed access to digital movies only as specifically authorized under these terms and conditions and the terms and conditions of the participating provider of digital content through which you access or download the digital movie. Digital movie codes sold, distributed, purchased, or transferred in a manner inconsistent with these terms and conditions are subject to being invalidated. Digital Movie Code Returns. If you do not agree to the above terms and conditions for redeeming a digital movie code obtained by you or a family member in an original combination disc + code package, you may return the combination disc + code package to Disney for a refund subject to the conditions provided at this link. Subscriptions Some Disney Services require paid subscriptions to access. By signing up for a subscription, you agreed that your subscription will be automatically renewed and, unless you cancel your subscription, you authorized us to charge your payment method for the renewal term. The period of auto-renewal will be the same as your initial subscription period unless otherwise disclosed to you at the time of sale. The renewal rate will be no more than the rate for the immediately prior subscription period, excluding any promotional and discount pricing, unless we notify you of a rate change prior to your auto-renewal, in which case you will have the right to cancel the renewal of your subscription. From time to time, we may offer a free trial subscription for a Disney Service. If you register for a free trial subscription, we will begin to bill your account when the free trial subscription expires, unless you cancel your subscription before that time. When you subscribe to a Disney Service (other than semi-annual and annual subscriptions), you have the right to cancel your contract within fourteen (14) days from the date the transaction is concluded and you will receive a full refund of the subscription fee paid. For semi-annual and annual subscriptions, if notice of cancellation is received within the first thirty (30) days following the first day of initial billing, you will receive a refund of the subscription fee paid. If we refund your subscription fee, you will still be obligated to pay other charges incurred by you in the course of using the Disney Service prior to the date of cancellation. If you pay a periodic subscription fee for a Disney Service, we will provide you with reasonable notice of changes to the fees or billing methods in advance of their effective date and you will be able to cancel your subscription prior to such change. If you subscribed online, we will give you the option of cancelling the subscription online. The Order Process You will have the opportunity to review and confirm your order, including delivery address (if applicable), payment method and product details. We will send to you a notice when we accept your order and our acceptance will be deemed complete and for all purposes to have been effectively communicated to you at the time we send the notice. At such time, the contract for sale will be made and become binding on both you and us. The risk of loss in any goods you purchase and the responsibility to insure them passes to you when the relevant goods are delivered. We reserve the right to refuse or cancel any order prior to delivery. Some situations that may result in your order being cancelled include system or typographical errors, inaccuracies in product or pricing information or product availability, fairness among customers where supplies are limited, or problems identified by our credit or fraud departments. We also may require additional verification or information before accepting an order. We will contact you if any portion of your order is cancelled or if additional information is required to accept your order. If your order is cancelled after we have processed your payment but prior to delivery, we will refund your payment. Payments and Billing When you provide payment information, you represent and warrant that the information is accurate, that you are authorized to use the payment method provided, and that you will notify us of changes to the payment information. We reserve the right to utilize third party payment card updating services to obtain current expiration dates on credit cards and debit cards. Right of Cancellation; Return of Goods You may have the right to cancel an order placed for a Disney Service - depending on the nature of the Disney Service. Please read the following information carefully so you understand your right of cancellation. If you wish to cancel, you must do so by following the cancellation instructions for the particular Disney Service. A sample cancellation form is available here. Cancelling Subscriptions Please see the information above on the process for cancelling subscriptions in our Subscriptions section. Digital Content When you purchase a license to access digital content or virtual items, you will be given an opportunity to consent to delivery at the time of purchase. By consenting to delivery, you acknowledge that you have lost the right to cancel. License purchase fees paid for digital content are non-refundable. Physical Goods You have the right, within thirty (30) days from the date of your receipt of physical goods, to cancel our contract with you and return the goods. This right does not apply to goods stated by us on the Disney Services to be non-returnable, including but not limited to: • Any products with a seal, where the seal is broken, such as audio and video recordings, computer software, and CD’s, DVD’s or other physical media that have been supplied in sealed packaging; and • Personalized items. Personalized Goods We reserve the right to refuse personalized orders at our discretion. Inappropriate use of our personalization service will cause your order to be cancelled and any payment refunded. These cancellation rights are separate and in addition to your rights should any item we supply be faulty. If you are returning goods that are not faulty, you may be required to pay for the cost of returning the goods to us and we may deduct a reasonable amount if you use the goods.","You must respond solely based on the provided context, so do not rely on external knowledge or sources. Answer in 100 words or less. context:4. Paid Transactions Identity of Seller Sales are made by Disney DTC or the seller identified at the time of sale, if different. If you have questions about your order, please contact the seller at the address provided and they will assist you. Some digital storefronts on the Disney Services are operated by third parties and, in that case, different or additional sale terms may apply, which you should read when they are presented to you. Digital Content and Virtual Items We may make applications, games, software or other digital content available on the Disney Services for you to license for a one-time fee. When purchasing a license to access such material from a Disney Service, charges will be disclosed to you on the Disney Service before you complete the license purchase. Your purchase of a virtual item or in-game currency is a payment for a limited, non-assignable license to access and use such content or functionality in the Disney Services with no right to reproduce, distribute, communicate to the public, make available to the public or transform any Disney Service via any online media, in any media format or channel now known or hereafter devised (except as may be expressly described or contemplated within the Disney Service). Virtual items (including characters and character names) or in-game currency purchased or available to you in the Disney Services can only be used in connection with the Disney Services where you obtained them or where they were developed by you as a result of game play. These items are not redeemable or subject to refund and cannot be traded outside of the Disney Services for money or other items for value. We may modify or discontinue virtual items or ingame currency at any time. Digital Movie Codes Digital codes originally packaged in a combination disc + code package (a package that includes a DVD, Blu-Ray, and/or 4K/UHD disc(s) and a digital code) may not be sold separately and may be redeemed only by an individual who obtains the code in the original combination disc + code package, or by a family member of that individual. Digital codes are not authorized for redemption if sold separately. You may use digital movie codes to obtain licensed access to digital movies only as specifically authorized under these terms and conditions and the terms and conditions of the participating provider of digital content through which you access or download the digital movie. Digital movie codes sold, distributed, purchased, or transferred in a manner inconsistent with these terms and conditions are subject to being invalidated. Digital Movie Code Returns. If you do not agree to the above terms and conditions for redeeming a digital movie code obtained by you or a family member in an original combination disc + code package, you may return the combination disc + code package to Disney for a refund subject to the conditions provided at this link. Subscriptions Some Disney Services require paid subscriptions to access. By signing up for a subscription, you agreed that your subscription will be automatically renewed and, unless you cancel your subscription, you authorized us to charge your payment method for the renewal term. The period of auto-renewal will be the same as your initial subscription period unless otherwise disclosed to you at the time of sale. The renewal rate will be no more than the rate for the immediately prior subscription period, excluding any promotional and discount pricing, unless we notify you of a rate change prior to your auto-renewal, in which case you will have the right to cancel the renewal of your subscription. From time to time, we may offer a free trial subscription for a Disney Service. If you register for a free trial subscription, we will begin to bill your account when the free trial subscription expires, unless you cancel your subscription before that time. When you subscribe to a Disney Service (other than semi-annual and annual subscriptions), you have the right to cancel your contract within fourteen (14) days from the date the transaction is concluded and you will receive a full refund of the subscription fee paid. For semi-annual and annual subscriptions, if notice of cancellation is received within the first thirty (30) days following the first day of initial billing, you will receive a refund of the subscription fee paid. If we refund your subscription fee, you will still be obligated to pay other charges incurred by you in the course of using the Disney Service prior to the date of cancellation. If you pay a periodic subscription fee for a Disney Service, we will provide you with reasonable notice of changes to the fees or billing methods in advance of their effective date and you will be able to cancel your subscription prior to such change. If you subscribed online, we will give you the option of cancelling the subscription online. The Order Process You will have the opportunity to review and confirm your order, including delivery address (if applicable), payment method and product details. We will send to you a notice when we accept your order and our acceptance will be deemed complete and for all purposes to have been effectively communicated to you at the time we send the notice. At such time, the contract for sale will be made and become binding on both you and us. The risk of loss in any goods you purchase and the responsibility to insure them passes to you when the relevant goods are delivered. We reserve the right to refuse or cancel any order prior to delivery. Some situations that may result in your order being cancelled include system or typographical errors, inaccuracies in product or pricing information or product availability, fairness among customers where supplies are limited, or problems identified by our credit or fraud departments. We also may require additional verification or information before accepting an order. We will contact you if any portion of your order is cancelled or if additional information is required to accept your order. If your order is cancelled after we have processed your payment but prior to delivery, we will refund your payment. Payments and Billing When you provide payment information, you represent and warrant that the information is accurate, that you are authorized to use the payment method provided, and that you will notify us of changes to the payment information. We reserve the right to utilize third party payment card updating services to obtain current expiration dates on credit cards and debit cards. Right of Cancellation; Return of Goods You may have the right to cancel an order placed for a Disney Service - depending on the nature of the Disney Service. Please read the following information carefully so you understand your right of cancellation. If you wish to cancel, you must do so by following the cancellation instructions for the particular Disney Service. A sample cancellation form is available here. Cancelling Subscriptions Please see the information above on the process for cancelling subscriptions in our Subscriptions section. Digital Content When you purchase a license to access digital content or virtual items, you will be given an opportunity to consent to delivery at the time of purchase. By consenting to delivery, you acknowledge that you have lost the right to cancel. License purchase fees paid for digital content are non-refundable. Physical Goods You have the right, within thirty (30) days from the date of your receipt of physical goods, to cancel our contract with you and return the goods. This right does not apply to goods stated by us on the Disney Services to be non-returnable, including but not limited to: • Any products with a seal, where the seal is broken, such as audio and video recordings, computer software, and CD’s, DVD’s or other physical media that have been supplied in sealed packaging; and • Personalized items. Personalized Goods We reserve the right to refuse personalized orders at our discretion. Inappropriate use of our personalization service will cause your order to be cancelled and any payment refunded. These cancellation rights are separate and in addition to your rights should any item we supply be faulty. If you are returning goods that are not faulty, you may be required to pay for the cost of returning the goods to us and we may deduct a reasonable amount if you use the goods. Question: I don't agree terms of my digital copy. Without referencing the context, what does Disney say is the process of returning a digital movie code purchased in a combination disc + code package.",Retail/Product,Paraphrase,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",Explain the differences and advantages between carbon fiber and thermoplastics in prosthetic design. Which material would be better for designing leg limbs for individuals who like to participate in sports?,"There are two common types of materials that are used in the field of prosthetics and orthotics; these materials are thermoplastics and carbon fiber. Each of these types of materials have different uses and applications and are used based on the needs of each patient and the type of device they are receiving. Carbon is among one of the most valuable materials used in orthopedic applications. Carbon is very light, rigid, and able to hold its shape under stress. This is due to its high tensile strength under both tension and compression. Carbon has a bi-directional woven pattern that allows for an increase in the fracture resistance, allowing for a uniform strength throughout the device (Berry). This means that the carbon socket (prosthetics) or the brace (orthotics) is very durable and can withstand a lot of pressure from patient use. Carbon fiber is used in prosthetics for the definitive socket that the patient will receive after the test socket has been approved by the patient. The design of the socket is determined by the type of prosthesis that the patient is receiving and the patient and customize the outer design of the socket to their liking. In orthotics, carbon fiber is used based on the type of brace and activity level of the patient. Carbon fiber allows for increased rigidity in the brace which is needed for braces that allow for an articulating ankle or for braces that need increased stability. The use of thermoplastics delivers many design improvements over carbon and other traditional systems due to design options that allow increased contact and support on the limb, simple fabrication process, a reduction in weight with retained strength, and cosmetic improvements allowing for a variety of options for color and decorative transfer patterns (Thermoplastics). Although thermoplastics are not as rigid as carbon fiber, they still offer man benefits for the patient and are a great option for patient use. There are different types of plastics used in prosthetics and orthotics. For prosthetics, thermoplastics are used for diagnostic or test sockets for the patients when they are working out the fit of the socket before they are transferred to a carbon fiber socket. The thermoplastics used are Thermolyn also know and Orffitrans; commonly used for below the knee sockets, and Vivak also known as DurrPlex; commonly used in above the knee sockets. There are 2 common thermoplastics used in orthotics; Copolymer and Polypropylene. Polypropylene, also known as Polypro, has high elasticity and stiffness and is good for producing very thin-walled, lightweight, and stable orthotic devices, although can be brittle and easily broken. Copolymer, also known and Copoly, has a high impact strength and is easily formed with low temperatures, which makes it easily adjustable to suit the patient’s needs (Smit). These materials allow for the best possible device to be created for the patient, different strengths, rigidity and weights allow for a variety of options to create the best possible custom device based on the patient’s activity level and use of the device."," Only use the provided text to answer the question, no outside sources. Explain the differences and advantages between carbon fiber and thermoplastics in prosthetic design. Which material would be better for designing leg limbs for individuals who like to participate in sports? There are two common types of materials that are used in the field of prosthetics and orthotics; these materials are thermoplastics and carbon fiber. Each of these types of materials have different uses and applications and are used based on the needs of each patient and the type of device they are receiving. Carbon is among one of the most valuable materials used in orthopedic applications. Carbon is very light, rigid, and able to hold its shape under stress. This is due to its high tensile strength under both tension and compression. Carbon has a bi-directional woven pattern that allows for an increase in the fracture resistance, allowing for a uniform strength throughout the device (Berry). This means that the carbon socket (prosthetics) or the brace (orthotics) is very durable and can withstand a lot of pressure from patient use. Carbon fiber is used in prosthetics for the definitive socket that the patient will receive after the test socket has been approved by the patient. The design of the socket is determined by the type of prosthesis that the patient is receiving and the patient and customize the outer design of the socket to their liking. In orthotics, carbon fiber is used based on the type of brace and activity level of the patient. Carbon fiber allows for increased rigidity in the brace which is needed for braces that allow for an articulating ankle or for braces that need increased stability. The use of thermoplastics delivers many design improvements over carbon and other traditional systems due to design options that allow increased contact and support on the limb, simple fabrication process, a reduction in weight with retained strength, and cosmetic improvements allowing for a variety of options for color and decorative transfer patterns (Thermoplastics). Although thermoplastics are not as rigid as carbon fiber, they still offer man benefits for the patient and are a great option for patient use. There are different types of plastics used in prosthetics and orthotics. For prosthetics, thermoplastics are used for diagnostic or test sockets for the patients when they are working out the fit of the socket before they are transferred to a carbon fiber socket. The thermoplastics used are Thermolyn also know and Orffitrans; commonly used for below the knee sockets, and Vivak also known as DurrPlex; commonly used in above the knee sockets. There are 2 common thermoplastics used in orthotics; Copolymer and Polypropylene. Polypropylene, also known as Polypro, has high elasticity and stiffness and is good for producing very thin-walled, lightweight, and stable orthotic devices, although can be brittle and easily broken. Copolymer, also known and Copoly, has a high impact strength and is easily formed with low temperatures, which makes it easily adjustable to suit the patient’s needs (Smit). These materials allow for the best possible device to be created for the patient, different strengths, rigidity and weights allow for a variety of options to create the best possible custom device based on the patient’s activity level and use of the device. https://www.infinitetech.org/carbon-fiber-vs-thermoplastic-in-prosthetics-and-orthotics",Medical,Pros & Cons,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",What projects has NASA invested in the space economy? Where can the regular person invest in the space economy? Summarize in 500 words or less.,"Outer space has come a long way since the 1960s. Matthew Weinzierl explains the current state of the space economy, highlighting the various opportunities for businesses hidden among the stars. A new space race—one fueled more by commercial conquest than intergalactic domination—is charting solutions to pressing problems in national security, climate change, and communication. With costs poised to drop and innovation on the rise, the economics of cosmic exploration and commerce are rapidly changing. Harvard Business School Senior Associate Dean Matthew Weinzierl’s new research explores the business opportunities hidden among the stars, particularly in data from and through space, but also in tourism, manufacturing, and even space-based resources. “From national security to climate change observation and trying to fix some of the biggest problems on Earth, the space economy is now interwoven in our everyday lives,” says Weinzierl, who is also the Joseph and Jacqueline Elbling Professor of Business Administration. Baskin: What are the highest-growth areas in the space economy? Weinzierl: What’s really interesting about what’s happening in space is the fundamental transformation of how it’s being organized. For a long time, when most people thought about what we do in space as humans, they thought of it as primarily a government-led activity. They thought of the James Webb telescope, the International Space Station, or the space shuttle. “If you look at the area of space getting the most attention―manufacturing of launch vehicles and satellites―its growth is in fact quite strong.” What’s changed over the past couple decades is that the government-led model, which served us extremely well back in the 1960s, has been revolutionized by bringing in market forces in a way that they never were before. Competition that we take for granted in most sectors of the economy is now driving efficiencies and innovations in the space sector, making it much more of a typical industry, or at least a typical industry with a tremendous amount of technological growth in it. What we found in our recent paper (which I coauthored with Tina Highfill of the U.S. Bureau of Economic Analysis) is that growth in the space sector overall has been quite modest over the past decade or so, but if you look at the area of space getting the most attention―manufacturing of launch vehicles and satellites―its growth is in fact quite strong. That’s especially true when you adjust for the quality improvements and price declines in that area; something our research is the first to quantify. In other words, we can see the dynamism of the space sector in the data. Baskin: What was the inflection point for this growth? Weinzierl: The key point is the early 2000s. The second of two shuttle losses, in 2003, meant that the last space shuttle flight was in 2011. This was a serious crisis for the American space community, given that, 40 years earlier, we put people on the moon. There was this sense that: “Wait a minute, I thought we were going to have space hotels and moon bases.” Instead, the United States was going to have to buy trips for our astronauts to the Space Station from Russia. This caused real soul-searching in the sector. It’s also when NASA started investing in the commercial space sector in a more concerted way. It created a program called Commercial Orbital Transportation Services (COTS). It spent $500 million to start seeding rocket launch companies to provide a new way to get back to the Space Station, which included companies like Blue Origin, SpaceX, and Sierra. A couple of decades later, SpaceX, in particular, has absolutely revolutionized the costs of launching rockets and thus doing anything in space. Baskin: How might the space economy affect the future of investing? Weinzierl: Space investing is a tricky sector. There was a big boom, a few years ago, in these private space enterprises trying to go public through special purpose acquisition companies (SPACs). In a SPAC, somebody would start a company with the sole idea of acquiring a private company and taking it public—and people who had signed up to invest in the original company could decide whether or not to stick with it. “Space is one of these industries where typical venture capital models struggle with the deep levels of uncertainty and the longer time frames that it requires.” The trouble is that, partly because SPACs are a bit opaque, they lend themselves to the risk of hype behind their projections. Most space SPACs crashed in value as soon as they went public, so many investors got a real sense that space is a dangerous place to invest. But, when you talk to people who are sophisticated space investors, they say, “Sure, that was a bit of a crazy cycle.” But it’s also a bit of an understandable cycle. Space is one of these industries where typical venture capital models struggle with the deep levels of uncertainty and the longer time frames that it requires. But, if you’re a sophisticated space investor with a solid theory for how to understand the pitches you’re hearing, there are still great ideas and companies out there. The sector has been quite resilient, in many ways. Baskin: How will the space economy affect the future of work? Weinzierl: In the next five to 10 years, the vast majority of economic activity directly tied to space, which would affect your typical worker, is going to be based on satellites, namely using data from them about the Earth and data through them as satellite internet expands its reach. If we look out a bit further, you get more speculative but exciting ideas like space manufacturing, tourism, and potentially resource extraction from places like the moon and asteroids. In many ways, those ideas seem very sci-fi. But technology is well-developed for several of them, and it’s more about finding the right business cases. The sector is looking feverishly for them, and, as costs keep coming down, I’m relatively optimistic that more of what seems like sci-fi will become reality over the next couple of decades. If you think about data as being the backbone of the modern economy, and the transmission of information increasingly defining what so many industries are, space is very much at the center of that over the next five to 10 years. I think the clearest way to see that is through the SpaceX Starlink constellation, which is already a constellation of several thousand satellites. Many thousands more are planned to provide high-speed Internet through satellites around the world. Amazon is planning a similar constellation of satellites, as is China. Of course, the initial application of that is just providing Internet coverage to places where it’s hard to run fiber-optic cables. But, if you think about the Internet of Things, and the connectivity that everyone is planning to have between every device in every place on Earth, which will enable all sorts of functionality—especially in terms of mobile processing or mobile devices—the existence of this Internet transformation really could redefine sectors quite broadly in a way we can’t foresee. That’s the real magic of markets, after all.","""================ ======= Outer space has come a long way since the 1960s. Matthew Weinzierl explains the current state of the space economy, highlighting the various opportunities for businesses hidden among the stars. A new space race—one fueled more by commercial conquest than intergalactic domination—is charting solutions to pressing problems in national security, climate change, and communication. With costs poised to drop and innovation on the rise, the economics of cosmic exploration and commerce are rapidly changing. Harvard Business School Senior Associate Dean Matthew Weinzierl’s new research explores the business opportunities hidden among the stars, particularly in data from and through space, but also in tourism, manufacturing, and even space-based resources. “From national security to climate change observation and trying to fix some of the biggest problems on Earth, the space economy is now interwoven in our everyday lives,” says Weinzierl, who is also the Joseph and Jacqueline Elbling Professor of Business Administration. Baskin: What are the highest-growth areas in the space economy? Weinzierl: What’s really interesting about what’s happening in space is the fundamental transformation of how it’s being organized. For a long time, when most people thought about what we do in space as humans, they thought of it as primarily a government-led activity. They thought of the James Webb telescope, the International Space Station, or the space shuttle. “If you look at the area of space getting the most attention―manufacturing of launch vehicles and satellites―its growth is in fact quite strong.” What’s changed over the past couple decades is that the government-led model, which served us extremely well back in the 1960s, has been revolutionized by bringing in market forces in a way that they never were before. Competition that we take for granted in most sectors of the economy is now driving efficiencies and innovations in the space sector, making it much more of a typical industry, or at least a typical industry with a tremendous amount of technological growth in it. What we found in our recent paper (which I coauthored with Tina Highfill of the U.S. Bureau of Economic Analysis) is that growth in the space sector overall has been quite modest over the past decade or so, but if you look at the area of space getting the most attention―manufacturing of launch vehicles and satellites―its growth is in fact quite strong. That’s especially true when you adjust for the quality improvements and price declines in that area; something our research is the first to quantify. In other words, we can see the dynamism of the space sector in the data. Baskin: What was the inflection point for this growth? Weinzierl: The key point is the early 2000s. The second of two shuttle losses, in 2003, meant that the last space shuttle flight was in 2011. This was a serious crisis for the American space community, given that, 40 years earlier, we put people on the moon. There was this sense that: “Wait a minute, I thought we were going to have space hotels and moon bases.” Instead, the United States was going to have to buy trips for our astronauts to the Space Station from Russia. This caused real soul-searching in the sector. It’s also when NASA started investing in the commercial space sector in a more concerted way. It created a program called Commercial Orbital Transportation Services (COTS). It spent $500 million to start seeding rocket launch companies to provide a new way to get back to the Space Station, which included companies like Blue Origin, SpaceX, and Sierra. A couple of decades later, SpaceX, in particular, has absolutely revolutionized the costs of launching rockets and thus doing anything in space. Baskin: How might the space economy affect the future of investing? Weinzierl: Space investing is a tricky sector. There was a big boom, a few years ago, in these private space enterprises trying to go public through special purpose acquisition companies (SPACs). In a SPAC, somebody would start a company with the sole idea of acquiring a private company and taking it public—and people who had signed up to invest in the original company could decide whether or not to stick with it. “Space is one of these industries where typical venture capital models struggle with the deep levels of uncertainty and the longer time frames that it requires.” The trouble is that, partly because SPACs are a bit opaque, they lend themselves to the risk of hype behind their projections. Most space SPACs crashed in value as soon as they went public, so many investors got a real sense that space is a dangerous place to invest. But, when you talk to people who are sophisticated space investors, they say, “Sure, that was a bit of a crazy cycle.” But it’s also a bit of an understandable cycle. Space is one of these industries where typical venture capital models struggle with the deep levels of uncertainty and the longer time frames that it requires. But, if you’re a sophisticated space investor with a solid theory for how to understand the pitches you’re hearing, there are still great ideas and companies out there. The sector has been quite resilient, in many ways. Baskin: How will the space economy affect the future of work? Weinzierl: In the next five to 10 years, the vast majority of economic activity directly tied to space, which would affect your typical worker, is going to be based on satellites, namely using data from them about the Earth and data through them as satellite internet expands its reach. If we look out a bit further, you get more speculative but exciting ideas like space manufacturing, tourism, and potentially resource extraction from places like the moon and asteroids. In many ways, those ideas seem very sci-fi. But technology is well-developed for several of them, and it’s more about finding the right business cases. The sector is looking feverishly for them, and, as costs keep coming down, I’m relatively optimistic that more of what seems like sci-fi will become reality over the next couple of decades. If you think about data as being the backbone of the modern economy, and the transmission of information increasingly defining what so many industries are, space is very much at the center of that over the next five to 10 years. I think the clearest way to see that is through the SpaceX Starlink constellation, which is already a constellation of several thousand satellites. Many thousands more are planned to provide high-speed Internet through satellites around the world. Amazon is planning a similar constellation of satellites, as is China. Of course, the initial application of that is just providing Internet coverage to places where it’s hard to run fiber-optic cables. But, if you think about the Internet of Things, and the connectivity that everyone is planning to have between every device in every place on Earth, which will enable all sorts of functionality—especially in terms of mobile processing or mobile devices—the existence of this Internet transformation really could redefine sectors quite broadly in a way we can’t foresee. That’s the real magic of markets, after all. https://hbswk.hbs.edu/item/space-economy-qa ================ ======= What projects has NASA invested in the space economy? Where can the regular person invest in the space economy? Summarize in 500 words or less. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Financial,Find & Summarize,Text Transformation You will answer the prompt question using only information from the document provided in the prompt.,Summarize the research that has been done on the health benefits of black tea regarding the Corona virus.,"Liu et al.,(2005) showed that the theaflavin derivatives had more potent anti-HIV-1 activity than catechin derivatives. These tea polyphenols could inhibit HIV-1 entry into target cells by blocking HIV-1 envelope glycoprotein-mediated membrane fusion. The fusion inhibitory activity of the tea polyphenols was correlated with their ability to block the formation of the gp41 six- helix bundle, a fusion-active core conformation. Computer-aided molecular docking analyses indicate that these tea polyphenols, theaflavin-3,3′-digallate (TF3) as an example, may bind to the highly conserved hydrophobic pocket on the surface of the central trimeric coiled coil formed by the N-terminal heptad repeats of gp41. These results indicate that tea, especially black tea, may be used as a source of anti-HIV agents and theaflavin derivatives may be applied as lead compounds for developing HIV-1 entry inhibitors targeting gp41. EGCG present in green tea has been shown to inhibit Herpes simplex virus type-1 (HSV-1) (Oleviera, 2008; Issack et al., 2008) by possibly binding to the glycoproteins on the envelope of the virus, thereby preventing viral entry into the host cell. The increased stability of theaflavins compared to EGCG at neutral pH could make these black tea compounds a more feasible option for the design of an antiviral therapeutic agent than EGCG (Su et al, 2003). Black Tea Extract Black Tea: Antiviral Activity & Boosting Immunity | 7 consisting primarily of theaflavins is not cytotoxic and can reduce or block the production of infectious HSV-1 virions in cultured A549 and Vero cells, thus inhibiting the infectivity of the virus by interfering in the attachment, penetration and viral DNA replication of HSV-1 particles (Cantatore et al.,2013). The anti-influenza virus and anti-inflammatory activities of theaflavin derivatives have been reported by Zu at. el.,(2012). The theaflavins fraction (TF80%, with a purity of 80%) and three theaflavin (TF) derivatives from black tea have been found to exhibit potent inhibitory effects against influenza virus in vitro. The authors have used assays for neuraminidase (NA) activity, hemagglutination (HA) inhibition, a real-time quantitative PCR (qPCR) for gene expression of hemagglutinin (HA) and a cytopathic effect (CPE) reduction assay for studying the activity of TFs. The results showed that the TFs exerted significant inhibitory effects on the NA of three different subtypes of influenza virus strains and also on HA through two major mechanisms. The TF derivatives might have a direct effect on viral particle infectivity affecting replication of the viral HA gene during early stage of infection. In addition, TFs decreased the expression level of the inflammatory cytokine IL-6 during viral infection, expression of which may result in serious tissue injury and apoptosis. Thus, the results indicated that TF derivatives are potential compounds with anti-influenza viral replication and anti-inflammatory properties. A study of antiviral activity of theaflavins (extracted from black tea) against Hepatitis C virus (HCV) using human hepatoma Huh-7 cells showed significant decrease of infectivity of the virus in the presence of each of the three theaflavins, with a clear dose-dependent inhibitory effect. The antiviral activity of the theaflavins was confirmed by quantification of viral RNA. TF3 was found to be more active and the HCV pseudotyped virions confirmed their activity on HCV entry and demonstrated their pan-genotypic action by directly acting on the virus particle and inhibited cell-to-cell spread. Further, TFs in combination with Sofosbuvir and Daclatasvir which are FDA approved drugs for HCV, enhanced the antiviral activity of both drugs (additive effect) demonstrating that it could be used in combination with direct acting antivirals (DAA) used in hepatitis C therapy. Thus, theaflavins, that are present in high quantity in black tea, hold promise for therapeutic use against HCV infection and also as neutraceutical as it inhibit cell-to-cell entry of the virus (Chowdhury, et al., 2018). In a study reported by Clark et al. (1998) it was demonstrated that theaflavins extracted from black tea were able to neutralize bovine coronavirus and rotavirus infections. The crude black tea extract and the various fractions of theaflavins extracted from black tea were tested individually and in combination for antirotaviral activity. The combination of theaflavin fractions (TF1 + TF2a + TF2b + TF3) was more active than the sum of the activities of these four fractions individually, indicating synergism amongst the TF components. The results of this study showed that theaflavin and theaflavin gallate derivatives have inactivation activity (in vitro) against both rotavirus and coronavirus. The crude black tea extract was also able to neutralize the coronavirus. In view of the current pandemic created by the novel corona virus COVID-19, lot of efforts are on globally to develop suitable vaccine and to relook the existing drugs and molecules for effectiveness against the causative agent SARS-CoV-2 (Tang et al., 2020). Coronaviruses are enveloped positive-stranded RNA viruses that replicate in the cytoplasm (Belouzard et al. 2012). To deliver their nucleocapsid into the host cell they rely on the fusion of their envelope with the host cell membrane. The spike glycoprotein (S) mediates virus entry and is a primary determinant of cell tropism and pathogenesis. The RNA dependent RNA polymerase (RdRp) is known to be an important enzyme that catalyzes the replication of RNA from RNA templates. Black Tea: Antiviral Activity & Boosting Immunity | 8 In a recent study published in the Journal of Medical Virology, 83 compounds used in Chinese medicine system were screened for their potential efficacy against SARS-CoV-2 by assessing their binding efficiency onto this RNA dependent RNA polymerase (RdRp) of the COVID-19 virus (Lung et. al., 2020). The authors have generated three dimensional model structures of RdRp of SARS-CoV-2 (2019 Pandemic), SARS-CoV (2002 epidemic) and MERS-CoV (2012 epidemic) using Modeller UCSF Chimera (https://www.cgl.ucsf.edu/chimera/) and SWISS-MODEL (https:// swissmodel. expasy.org/) to test the efficacy of the compounds. This virtual screening in this bioinformatics study revealed that out of the 83 compounds screened, theaflavin was the best compound on the basis of idock score (prediction of binding affinity), hydrophobic interactions and additional hydrogen bonds between theaflavin and amino acid near the active site of RdRp. This was further confirmed by lower binding energy when it docks the catalytic pocket of SARS-CoV-2 RdRp. These finding suggested that theaflavins could be used as a lead compound for developing a SARS-CoV-2 inhibitor that targets the RdRp. Theaflavins are present in black tea and the highest theaflavin contents are present in the black teas of Assam. Though further in vivo, animal and clinical trials would be required to carry forward this research finding, it is quite interesting to note that an earlier study from Taiwan has in fact convincingly demonstrated the inhibition of SARS-CoV 3C-like protease activity by Theaflavin-3,3’-digallate (TF3) published in the journal Evidence based Complementary and Alternative Medicine (Chen et.al.,2005). The authors have reported that the extracts from Puer and Black tea were more potent than the green or oolong tea extracts in their inhibitory activities against a chymotrypsin-like (3CLPro) protease. In this study 3CL protease was a target and the virus of interest was SARS- CoV (2002 epidemic). This study also used docking approach to screen out the best inhibitory compounds using a natural product library consisting of 720 compounds. Two compounds, tannic acid and TF2b (Theaflavin 3-gallate) were found to be active against 3CL Protease. Since many other related to tannic acid and TF2b are also present in various kinds of teas, the authors further examined the inhibition of activity by various tea extracts and several well known pure ingredients present in teas. The water extracts of TF2b (theaflavin-3-gallate), TF3 (theaflavin diggallate) and tannic acid were found to be the best effective 3CLPro inhibitors with inhibitory concentration (IC50) of less than 10 μM. The results from this study showed that Puer and Black tea extracts were more potent than the green or oolong tea extracts in inhibitory activities against 3C-like protease (3CLPro) of severe acute respiratory syndrome coronavirus (SARS-CoV), notably the active constituents viz. Theaflavin-3-gallate (TF2b) theaflavin-3,3’-digallate (TF3) and tannic acid were effective 3CLPro inhibitors.","System Prompt: You will answer the prompt question using only information from the document provided in the prompt. Question: Summarize the research that has been done on the health benefits of black tea regarding the Corona virus. Context Block: Liu et al.,(2005) showed that the theaflavin derivatives had more potent anti-HIV-1 activity than catechin derivatives. These tea polyphenols could inhibit HIV-1 entry into target cells by blocking HIV-1 envelope glycoprotein-mediated membrane fusion. The fusion inhibitory activity of the tea polyphenols was correlated with their ability to block the formation of the gp41 six- helix bundle, a fusion-active core conformation. Computer-aided molecular docking analyses indicate that these tea polyphenols, theaflavin-3,3′-digallate (TF3) as an example, may bind to the highly conserved hydrophobic pocket on the surface of the central trimeric coiled coil formed by the N-terminal heptad repeats of gp41. These results indicate that tea, especially black tea, may be used as a source of anti-HIV agents and theaflavin derivatives may be applied as lead compounds for developing HIV-1 entry inhibitors targeting gp41. EGCG present in green tea has been shown to inhibit Herpes simplex virus type-1 (HSV-1) (Oleviera, 2008; Issack et al., 2008) by possibly binding to the glycoproteins on the envelope of the virus, thereby preventing viral entry into the host cell. The increased stability of theaflavins compared to EGCG at neutral pH could make these black tea compounds a more feasible option for the design of an antiviral therapeutic agent than EGCG (Su et al, 2003). Black Tea Extract Black Tea: Antiviral Activity & Boosting Immunity | 7 consisting primarily of theaflavins is not cytotoxic and can reduce or block the production of infectious HSV-1 virions in cultured A549 and Vero cells, thus inhibiting the infectivity of the virus by interfering in the attachment, penetration and viral DNA replication of HSV-1 particles (Cantatore et al.,2013). The anti-influenza virus and anti-inflammatory activities of theaflavin derivatives have been reported by Zu at. el.,(2012). The theaflavins fraction (TF80%, with a purity of 80%) and three theaflavin (TF) derivatives from black tea have been found to exhibit potent inhibitory effects against influenza virus in vitro. The authors have used assays for neuraminidase (NA) activity, hemagglutination (HA) inhibition, a real-time quantitative PCR (qPCR) for gene expression of hemagglutinin (HA) and a cytopathic effect (CPE) reduction assay for studying the activity of TFs. The results showed that the TFs exerted significant inhibitory effects on the NA of three different subtypes of influenza virus strains and also on HA through two major mechanisms. The TF derivatives might have a direct effect on viral particle infectivity affecting replication of the viral HA gene during early stage of infection. In addition, TFs decreased the expression level of the inflammatory cytokine IL-6 during viral infection, expression of which may result in serious tissue injury and apoptosis. Thus, the results indicated that TF derivatives are potential compounds with anti-influenza viral replication and anti-inflammatory properties. A study of antiviral activity of theaflavins (extracted from black tea) against Hepatitis C virus (HCV) using human hepatoma Huh-7 cells showed significant decrease of infectivity of the virus in the presence of each of the three theaflavins, with a clear dose-dependent inhibitory effect. The antiviral activity of the theaflavins was confirmed by quantification of viral RNA. TF3 was found to be more active and the HCV pseudotyped virions confirmed their activity on HCV entry and demonstrated their pan-genotypic action by directly acting on the virus particle and inhibited cell-to-cell spread. Further, TFs in combination with Sofosbuvir and Daclatasvir which are FDA approved drugs for HCV, enhanced the antiviral activity of both drugs (additive effect) demonstrating that it could be used in combination with direct acting antivirals (DAA) used in hepatitis C therapy. Thus, theaflavins, that are present in high quantity in black tea, hold promise for therapeutic use against HCV infection and also as neutraceutical as it inhibit cell-to-cell entry of the virus (Chowdhury, et al., 2018). In a study reported by Clark et al. (1998) it was demonstrated that theaflavins extracted from black tea were able to neutralize bovine coronavirus and rotavirus infections. The crude black tea extract and the various fractions of theaflavins extracted from black tea were tested individually and in combination for antirotaviral activity. The combination of theaflavin fractions (TF1 + TF2a + TF2b + TF3) was more active than the sum of the activities of these four fractions individually, indicating synergism amongst the TF components. The results of this study showed that theaflavin and theaflavin gallate derivatives have inactivation activity (in vitro) against both rotavirus and coronavirus. The crude black tea extract was also able to neutralize the coronavirus. In view of the current pandemic created by the novel corona virus COVID-19, lot of efforts are on globally to develop suitable vaccine and to relook the existing drugs and molecules for effectiveness against the causative agent SARS-CoV-2 (Tang et al., 2020). Coronaviruses are enveloped positive-stranded RNA viruses that replicate in the cytoplasm (Belouzard et al. 2012). To deliver their nucleocapsid into the host cell they rely on the fusion of their envelope with the host cell membrane. The spike glycoprotein (S) mediates virus entry and is a primary determinant of cell tropism and pathogenesis. The RNA dependent RNA polymerase (RdRp) is known to be an important enzyme that catalyzes the replication of RNA from RNA templates. Black Tea: Antiviral Activity & Boosting Immunity | 8 In a recent study published in the Journal of Medical Virology, 83 compounds used in Chinese medicine system were screened for their potential efficacy against SARS-CoV-2 by assessing their binding efficiency onto this RNA dependent RNA polymerase (RdRp) of the COVID-19 virus (Lung et. al., 2020). The authors have generated three dimensional model structures of RdRp of SARS-CoV-2 (2019 Pandemic), SARS-CoV (2002 epidemic) and MERS-CoV (2012 epidemic) using Modeller UCSF Chimera (https://www.cgl.ucsf.edu/chimera/) and SWISS-MODEL (https:// swissmodel. expasy.org/) to test the efficacy of the compounds. This virtual screening in this bioinformatics study revealed that out of the 83 compounds screened, theaflavin was the best compound on the basis of idock score (prediction of binding affinity), hydrophobic interactions and additional hydrogen bonds between theaflavin and amino acid near the active site of RdRp. This was further confirmed by lower binding energy when it docks the catalytic pocket of SARS-CoV-2 RdRp. These finding suggested that theaflavins could be used as a lead compound for developing a SARS-CoV-2 inhibitor that targets the RdRp. Theaflavins are present in black tea and the highest theaflavin contents are present in the black teas of Assam. Though further in vivo, animal and clinical trials would be required to carry forward this research finding, it is quite interesting to note that an earlier study from Taiwan has in fact convincingly demonstrated the inhibition of SARS-CoV 3C-like protease activity by Theaflavin-3,3’-digallate (TF3) published in the journal Evidence based Complementary and Alternative Medicine (Chen et.al.,2005). The authors have reported that the extracts from Puer and Black tea were more potent than the green or oolong tea extracts in their inhibitory activities against a chymotrypsin-like (3CLPro) protease. In this study 3CL protease was a target and the virus of interest was SARS- CoV (2002 epidemic). This study also used docking approach to screen out the best inhibitory compounds using a natural product library consisting of 720 compounds. Two compounds, tannic acid and TF2b (Theaflavin 3-gallate) were found to be active against 3CL Protease. Since many other related to tannic acid and TF2b are also present in various kinds of teas, the authors further examined the inhibition of activity by various tea extracts and several well known pure ingredients present in teas. The water extracts of TF2b (theaflavin-3-gallate), TF3 (theaflavin diggallate) and tannic acid were found to be the best effective 3CLPro inhibitors with inhibitory concentration (IC50) of less than 10 μM. The results from this study showed that Puer and Black tea extracts were more potent than the green or oolong tea extracts in inhibitory activities against 3C-like protease (3CLPro) of severe acute respiratory syndrome coronavirus (SARS-CoV), notably the active constituents viz. Theaflavin-3-gallate (TF2b) theaflavin-3,3’-digallate (TF3) and tannic acid were effective 3CLPro inhibitors.",Medical,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Summarize this biomedical journal article for a layperson. In the summary be sure to include information about the following things: 1. what type of experimental and statistical methods were used to generate and analyze the data? 2. when did PE lipids (a type of GP lipid) reach their peak levels during worm development, 3. how were the alimentary and reproductive tracts differentiated from the other types of tissues examined, and 4. how did GL abundance compare between the male and female reproductive tracts of the worms used in the study?","PCA of the developmental lipidome of A. suum showed that the difference in the quantity of lipids among five developmental stages/sexes (i.e. L3-egg, L3-lung, L4, Af and Am) was greater than variation within a particular stage (i.e. among four replicates) (Fig 3). The two-dimensional diagram (Fig 3) reveals a clear division of the lipidomic data set into three distinct groups, corresponding to L3-egg, L3-lung and the intestinal stages (i.e. L4, Af and Am). Interestingly, limited variation in lipid amount was observed among adult stages. Of all five developmental stages/sexes, the largest amount of total lipids was measured in third-stage larvae (i.e. L3-egg and L3-lung) (Fig 4A). The semi-quantitative analysis revealed that third-stage larvae (i.e. L3-egg and L3-lung) contained > 150 and 100 μM/mg (micromole of lipids per milligram of dry worm body weight), respectively, whereas ≤ 35 μM/mg were measured in other developmental stages/sexes (i.e. L4, Af and Am) (Fig 4A). As expected, lipid categories GP (n = 155 to 253) and GL (n = 44 to 109), for which a large number of lipids species were identified (Table 1), contributed predominantly to the lipid abundance in A. suum across five key developmental stages/sexes (Fig 5 and S1 Fig). The overall GP abundance reached a peak in third-stage larvae (i.e. L3-egg and L3-lung), was significantly lower in later developmental stages/sexes (i.e. L4, Af and Am). Membrane structure-related lipid classes, such as PC, PE and PI, contributed significantly to a low overall GP abundance (Fig 6 and S2 Fig). Individual PC, PE and PI lipid species, such as PC (36:3), PE (O-36:1) and PI (38:4), which contained even-numbered fatty acyl chains (e.g., 18:0, 18:1 or 18:2) predominated in the third-stage larvae (S3 Table). Additionally, LPC, LPE, LPG and LPS classes peaked in L3-lung, and then were substantially reduced during the migration from lung (i.e. L3-lung) to the small intestine (i.e. L4, Af and Am) (S2 Fig). Within the GL category, a significantly higher abundance of TG was measured in L3-egg compared with all other stages/sexes studied (Fig 6). Notably, TG exhibited a slightly higher level in Af than in Am. Deeper analysis of individual lipid species showed that TG lipids with C18 fatty acyl chains (e.g. 18:0, 18:1, 18:2 and 18:3) predominated and that many of these lipids (n = 9) showed a high abundance (> 1 μM/mg) for the TG class (S3 Table). Nevertheless, a significantly higher level of total saturated lipid was observed in L3-lung, whereas high levels of ether-linked lipid were detected in the L3-egg and L3-lung (Fig 7). All lipid classes and individual lipid species as well as their differences in abundance among developmental stages/sexes are given in S2–S4 Figs and S3 Table. The two-dimensional PCA showed that lipidomic data of organ systems for male adult Ascaris (i.e. MRT, MAT and MBW) and the body wall from the female worm (i.e. FBW) clustered tightly together, to the exclusion of the reproductive and alimentary tracts of female Ascaris (i.e. FRT and FAT) (Fig 8). Semi-quantitative analysis of the organ systems showed an enrichment of total lipids in the reproductive and alimentary tracts of adult Ascaris (Fig 4B). FRT (141 μM/mg) had > 4 times more lipid overall as compared with MBW (32 μM/mg). Except for the reproductive tract, a comparisons of the same organ system between the sexes showed that the female worm had more total lipids than the male. Similar to the developmental lipidome, GP (ranged 27–134 μM/mg) and GL (ranged 3–49 μM/mg) were the two most abundant lipid categories in A. suum at an organ system level, whereas only small amounts (range: 1–11 μM/mg) of lipids of the SP category were detected (Fig 5 and S1 Fig). Regarding the reproductive tract, the overall GP abundance was significantly higher in male (134 μM/mg) than in female (69 μM/mg) (Fig 5B). In contrast, GL abundance showed the opposite trend, with significantly higher levels in FRT (49 μM/mg) than in MRT (3 μM/mg) (Fig 5D). A deeper analysis of the lipidomic data set according to organ system revealed differences primarily in the lipids in the PC, PE and TG classes, characterised by a higher abundance of individual PC species (e.g. PC (16:0_20:4), PC (18:0e_20:2), PC (18:1_20:2) and PC (20:1_18:2)) and PE species (e.g. PE (O-18:0_18:1), PE (O-18:0_20:1)) in FRT compared with MRT; and a higher abundance of TG species, such as TG (17:0_18:2_6:0), TG (18:0_18:1_18:2) and TG (18:1_18:1_6:0), in MRT (S3 Table). In the alimentary tract, the total GL amount was more abundant in female (36 μM/mg) than in male (3 μM/mg), whereas the overall GP in the alimentary tract was at a comparable level (nearly 60 μM/mg) in female and male. Notably, individual TG species with even-numbered fatty acyl chains, such as TG (16:0_16:1_18:1), TG (16:1_18:1_18:2) and TG (18:0_18:1_18:2), differed markedly in abundance between FAT and MAT. There was no significant difference in the abundance of overall GP and GL in the body wall. Subsequent analyses revealed that both saturated and either-linked lipids were highly abundant in the reproductive and alimentary tracts of both female and male worms, with no significant difference between the sexes. All lipid classes and individual lipid species as well as their abundance levels in the organ systems are displayed in S2–S4 Figs and S3 Table."," Only use the provided text to answer the question, no outside sources. Summarize this biomedical journal article for a layperson. In the summary be sure to include information about the following things: 1. what type of experimental and statistical methods were used to generate and analyze the data? 2. when did PE lipids (a type of GP lipid) reach their peak levels during worm development, 3. how were the alimentary and reproductive tracts differentiated from the other types of tissues examined, and 4. how did GL abundance compare between the male and female reproductive tracts of the worms used in the study? PCA of the developmental lipidome of A. suum showed that the difference in the quantity of lipids among five developmental stages/sexes (i.e. L3-egg, L3-lung, L4, Af and Am) was greater than variation within a particular stage (i.e. among four replicates) (Fig 3). The two-dimensional diagram (Fig 3) reveals a clear division of the lipidomic data set into three distinct groups, corresponding to L3-egg, L3-lung and the intestinal stages (i.e. L4, Af and Am). Interestingly, limited variation in lipid amount was observed among adult stages. Of all five developmental stages/sexes, the largest amount of total lipids was measured in third-stage larvae (i.e. L3-egg and L3-lung) (Fig 4A). The semi-quantitative analysis revealed that third-stage larvae (i.e. L3-egg and L3-lung) contained > 150 and 100 μM/mg (micromole of lipids per milligram of dry worm body weight), respectively, whereas ≤ 35 μM/mg were measured in other developmental stages/sexes (i.e. L4, Af and Am) (Fig 4A). As expected, lipid categories GP (n = 155 to 253) and GL (n = 44 to 109), for which a large number of lipids species were identified (Table 1), contributed predominantly to the lipid abundance in A. suum across five key developmental stages/sexes (Fig 5 and S1 Fig). The overall GP abundance reached a peak in third-stage larvae (i.e. L3-egg and L3-lung), was significantly lower in later developmental stages/sexes (i.e. L4, Af and Am). Membrane structure-related lipid classes, such as PC, PE and PI, contributed significantly to a low overall GP abundance (Fig 6 and S2 Fig). Individual PC, PE and PI lipid species, such as PC (36:3), PE (O-36:1) and PI (38:4), which contained even-numbered fatty acyl chains (e.g., 18:0, 18:1 or 18:2) predominated in the third-stage larvae (S3 Table). Additionally, LPC, LPE, LPG and LPS classes peaked in L3-lung, and then were substantially reduced during the migration from lung (i.e. L3-lung) to the small intestine (i.e. L4, Af and Am) (S2 Fig). Within the GL category, a significantly higher abundance of TG was measured in L3-egg compared with all other stages/sexes studied (Fig 6). Notably, TG exhibited a slightly higher level in Af than in Am. Deeper analysis of individual lipid species showed that TG lipids with C18 fatty acyl chains (e.g. 18:0, 18:1, 18:2 and 18:3) predominated and that many of these lipids (n = 9) showed a high abundance (> 1 μM/mg) for the TG class (S3 Table). Nevertheless, a significantly higher level of total saturated lipid was observed in L3-lung, whereas high levels of ether-linked lipid were detected in the L3-egg and L3-lung (Fig 7). All lipid classes and individual lipid species as well as their differences in abundance among developmental stages/sexes are given in S2–S4 Figs and S3 Table. The two-dimensional PCA showed that lipidomic data of organ systems for male adult Ascaris (i.e. MRT, MAT and MBW) and the body wall from the female worm (i.e. FBW) clustered tightly together, to the exclusion of the reproductive and alimentary tracts of female Ascaris (i.e. FRT and FAT) (Fig 8). Semi-quantitative analysis of the organ systems showed an enrichment of total lipids in the reproductive and alimentary tracts of adult Ascaris (Fig 4B). FRT (141 μM/mg) had > 4 times more lipid overall as compared with MBW (32 μM/mg). Except for the reproductive tract, a comparisons of the same organ system between the sexes showed that the female worm had more total lipids than the male. Similar to the developmental lipidome, GP (ranged 27–134 μM/mg) and GL (ranged 3–49 μM/mg) were the two most abundant lipid categories in A. suum at an organ system level, whereas only small amounts (range: 1–11 μM/mg) of lipids of the SP category were detected (Fig 5 and S1 Fig). Regarding the reproductive tract, the overall GP abundance was significantly higher in male (134 μM/mg) than in female (69 μM/mg) (Fig 5B). In contrast, GL abundance showed the opposite trend, with significantly higher levels in FRT (49 μM/mg) than in MRT (3 μM/mg) (Fig 5D). A deeper analysis of the lipidomic data set according to organ system revealed differences primarily in the lipids in the PC, PE and TG classes, characterised by a higher abundance of individual PC species (e.g. PC (16:0_20:4), PC (18:0e_20:2), PC (18:1_20:2) and PC (20:1_18:2)) and PE species (e.g. PE (O-18:0_18:1), PE (O-18:0_20:1)) in FRT compared with MRT; and a higher abundance of TG species, such as TG (17:0_18:2_6:0), TG (18:0_18:1_18:2) and TG (18:1_18:1_6:0), in MRT (S3 Table). In the alimentary tract, the total GL amount was more abundant in female (36 μM/mg) than in male (3 μM/mg), whereas the overall GP in the alimentary tract was at a comparable level (nearly 60 μM/mg) in female and male. Notably, individual TG species with even-numbered fatty acyl chains, such as TG (16:0_16:1_18:1), TG (16:1_18:1_18:2) and TG (18:0_18:1_18:2), differed markedly in abundance between FAT and MAT. There was no significant difference in the abundance of overall GP and GL in the body wall. Subsequent analyses revealed that both saturated and either-linked lipids were highly abundant in the reproductive and alimentary tracts of both female and male worms, with no significant difference between the sexes. All lipid classes and individual lipid species as well as their abundance levels in the organ systems are displayed in S2–S4 Figs and S3 Table. https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008848",Medical,Summarize & Simplify,Text Transformation "For this task, you can only use the text provided to you. External information or outside knowledge should not be used to fulfil the request. ",Explain to me how views have changed on anti-trust laws in the US over time.,"The Antitrust Reform Movement and UMC Rulemaking The past several years have witnessed renewed interest in antitrust law and policy. Much of this interest has been driven by concerns that the antitrust laws have been underenforced and that current doctrine is overly permissive. Since the 1970s, the Supreme Court has reduced the number of per se rules that define specific conduct as anticompetitive without inquiries into market dynamics and harms in particular cases. In doing so, the Court has expanded the scope of the “rule of reason”—a standard that, in its current form, typically involves a burden-shifting framework that requires such inquiries. Empirical studies have found that the vast majority—as much as 97%—of complaints evaluated under the rule of reason are dismissed at the first stage of this burden-shifting process, leading some commentators to argue that the rule of reason is, in practice, a rule of per se legality. Others have criticized the costs and slow pace of antitrust litigation, which they attribute in part to the detailed analysis required by current law. Alongside the extension of the rule of reason, the Supreme Court has relaxed several aspects of monopolization doctrine, limiting the ways in which antitrust law restricts the unilateral conduct of dominant firms. Congressional Research Service 3 Advocates of more aggressive antitrust enforcement have supported UMC rulemaking as a means of counteracting these developments. In 2020, Lina Khan (who now serves as FTC Chair) and Rohit Chopra (an FTC Commissioner at the time) co-authored an article in which they contended that exclusive reliance on case-by-case adjudication under the rule of reason had produced “a system of enforcement that generates ambiguity, unduly drains resources from enforcers, and deprives individuals and firms of any real opportunity to democratically participate in the process.” They thus argued that the FTC should supplement antitrust adjudication with UMC rules, which could promote legal clarity, lower enforcement costs, and allow the public to participate in the formulation of competition policy. Other academic work from proponents of antitrust reform has likewise urged enforcers and courts to “eschew the open-ended rule of reason” in favor of simpler presumptions and bright-line rules. In July 2021, President Biden joined these calls for UMC rulemaking. In an executive order on competition policy, President Biden encouraged the FTC to exercise its “statutory rulemaking authority under the Federal Trade Commission Act to curtail the unfair use of non-compete clauses and other clauses or agreements that may unfairly limit worker mobility.” Others have identified additional issues that the FTC may seek to address if its UMC rulemaking power is upheld. A coalition of advocacy groups has filed a petition for rulemaking urging the FTC to prohibit exclusive dealing by dominant firms. Commentators have also suggested that the FTC may propose rules targeting reverse-payment settlements in the pharmaceutical industry (often called “pay-for-delay” agreements), predatory pricing, and manufacturer repair restrictions. The FTC’s authority to issue such rules—and the Non-Compete Rule—depends not only on whether Section 6(g) authorizes legislative rulemaking, but also on the scope of Section 5’s prohibition of UMC. The Supreme Court has repeatedly said that Section 5 is broader than the Sherman Act and the Clayton Act (the other core federal antitrust laws). However, the scope of this additional coverage—often called the FTC’s “standalone” Section 5 authority—is unsettled. Under previous leadership, the FTC took a narrow view of its standalone Section 5 authority. In a 2015 policy statement, the FTC indicated that decisions to bring standalone Section 5 actions would be guided by considerations of consumer welfare; that the FTC would evaluate challenged conduct under “a framework similar to the rule of reason”; and that the FTC was less likely to bring a standalone Section 5 action if enforcement of the Sherman Act or Clayton Act was sufficient to address the relevant competitive harm. The FTC rescinded this policy statement in 2021 and issued a new Section 5 policy statement the following year. In the 2022 policy statement, the FTC identified two criteria it will consider in evaluating whether a “method of competition” is “unfair.” First, the FTC indicated that “unfair” conduct “may be coercive, exploitative, collusive, abusive, deceptive, predatory, or involve the use of economic power of a similar nature,” and “may also be otherwise restrictive or exclusionary.” Second, the FTC explained that such conduct “must tend to negatively affect competitive conditions”—for example, by foreclosing or impairing the opportunities of market participants, reducing competition between rivals, limiting choice, or otherwise harming consumers. The 2022 policy statement indicated that this second inquiry will not turn on whether conduct directly causes harm in particular cases, but instead will focus on whether conduct “has a tendency to generate negative consequences.” The FTC framed its 2022 policy statement as a return to the original purposes of the FTC Act. Former Commissioner Christine Wilson dissented from the statement, arguing that it departed from antitrust’s traditional focus on consumer welfare and did not provide clear guidance to businesses on how to structure their conduct to avoid violating the law.","For this task, you can only use the text provided to you. External information or outside knowledge should not be used to fulfil the request. The request is as follows: Explain to me how views have changed on anti-trust laws in the US over time. Provided text: The Antitrust Reform Movement and UMC Rulemaking The past several years have witnessed renewed interest in antitrust law and policy. Much of this interest has been driven by concerns that the antitrust laws have been underenforced and that current doctrine is overly permissive. Since the 1970s, the Supreme Court has reduced the number of per se rules that define specific conduct as anticompetitive without inquiries into market dynamics and harms in particular cases. In doing so, the Court has expanded the scope of the “rule of reason”—a standard that, in its current form, typically involves a burden-shifting framework that requires such inquiries. Empirical studies have found that the vast majority—as much as 97%—of complaints evaluated under the rule of reason are dismissed at the first stage of this burden-shifting process, leading some commentators to argue that the rule of reason is, in practice, a rule of per se legality. Others have criticized the costs and slow pace of antitrust litigation, which they attribute in part to the detailed analysis required by current law. Alongside the extension of the rule of reason, the Supreme Court has relaxed several aspects of monopolization doctrine, limiting the ways in which antitrust law restricts the unilateral conduct of dominant firms. Congressional Research Service 3 Advocates of more aggressive antitrust enforcement have supported UMC rulemaking as a means of counteracting these developments. In 2020, Lina Khan (who now serves as FTC Chair) and Rohit Chopra (an FTC Commissioner at the time) co-authored an article in which they contended that exclusive reliance on case-by-case adjudication under the rule of reason had produced “a system of enforcement that generates ambiguity, unduly drains resources from enforcers, and deprives individuals and firms of any real opportunity to democratically participate in the process.” They thus argued that the FTC should supplement antitrust adjudication with UMC rules, which could promote legal clarity, lower enforcement costs, and allow the public to participate in the formulation of competition policy. Other academic work from proponents of antitrust reform has likewise urged enforcers and courts to “eschew the open-ended rule of reason” in favor of simpler presumptions and bright-line rules. In July 2021, President Biden joined these calls for UMC rulemaking. In an executive order on competition policy, President Biden encouraged the FTC to exercise its “statutory rulemaking authority under the Federal Trade Commission Act to curtail the unfair use of non-compete clauses and other clauses or agreements that may unfairly limit worker mobility.” Others have identified additional issues that the FTC may seek to address if its UMC rulemaking power is upheld. A coalition of advocacy groups has filed a petition for rulemaking urging the FTC to prohibit exclusive dealing by dominant firms. Commentators have also suggested that the FTC may propose rules targeting reverse-payment settlements in the pharmaceutical industry (often called “pay-for-delay” agreements), predatory pricing, and manufacturer repair restrictions. The FTC’s authority to issue such rules—and the Non-Compete Rule—depends not only on whether Section 6(g) authorizes legislative rulemaking, but also on the scope of Section 5’s prohibition of UMC. The Supreme Court has repeatedly said that Section 5 is broader than the Sherman Act and the Clayton Act (the other core federal antitrust laws). However, the scope of this additional coverage—often called the FTC’s “standalone” Section 5 authority—is unsettled. Under previous leadership, the FTC took a narrow view of its standalone Section 5 authority. In a 2015 policy statement, the FTC indicated that decisions to bring standalone Section 5 actions would be guided by considerations of consumer welfare; that the FTC would evaluate challenged conduct under “a framework similar to the rule of reason”; and that the FTC was less likely to bring a standalone Section 5 action if enforcement of the Sherman Act or Clayton Act was sufficient to address the relevant competitive harm. The FTC rescinded this policy statement in 2021 and issued a new Section 5 policy statement the following year. In the 2022 policy statement, the FTC identified two criteria it will consider in evaluating whether a “method of competition” is “unfair.” First, the FTC indicated that “unfair” conduct “may be coercive, exploitative, collusive, abusive, deceptive, predatory, or involve the use of economic power of a similar nature,” and “may also be otherwise restrictive or exclusionary.” Second, the FTC explained that such conduct “must tend to negatively affect competitive conditions”—for example, by foreclosing or impairing the opportunities of market participants, reducing competition between rivals, limiting choice, or otherwise harming consumers. The 2022 policy statement indicated that this second inquiry will not turn on whether conduct directly causes harm in particular cases, but instead will focus on whether conduct “has a tendency to generate negative consequences.” The FTC framed its 2022 policy statement as a return to the original purposes of the FTC Act. Former Commissioner Christine Wilson dissented from the statement, arguing that it departed from antitrust’s traditional focus on consumer welfare and did not provide clear guidance to businesses on how to structure their conduct to avoid violating the law.",Legal,Explanation/Definition,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","I am a first-year medical resident. I recently treated a patient with a stroke, and it was my first time treating this condition. I am trying to become more familiarized with it, because the patient's family had a lot of questions, like if they were at risk of having one too, and what they could have done to prevent it from happening. I didn't really know how to answer some of those questions and felt bad about it afterward. Can you give me summarized information about strokes so I know how to deal with it next time?","Symptoms If you or someone you're with may be having a stroke, pay attention to the time the symptoms began. Some treatments are most effective when given soon after a stroke begins. Symptoms of stroke include: Trouble speaking and understanding what others are saying. A person having a stroke may be confused, slur words or may not be able to understand speech. Numbness, weakness or paralysis in the face, arm or leg. This often affects just one side of the body. The person can try to raise both arms over the head. If one arm begins to fall, it may be a sign of a stroke. Also, one side of the mouth may droop when trying to smile. Problems seeing in one or both eyes. The person may suddenly have blurred or blackened vision in one or both eyes. Or the person may see double. Headache. A sudden, severe headache may be a symptom of a stroke. Vomiting, dizziness and a change in consciousness may occur with the headache. Trouble walking. Someone having a stroke may stumble or lose balance or coordination. When to see a doctor Seek immediate medical attention if you notice any symptoms of a stroke, even if they seem to come and go or they disappear completely. Think ""FAST"" and do the following: Face. Ask the person to smile. Does one side of the face droop? Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise? Speech. Ask the person to repeat a simple phrase. Is the person's speech slurred or different from usual? Time. If you see any of these signs, call 911 or emergency medical help right away. Call 911 or your local emergency number immediately. Don't wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability. If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance. Causes There are two main causes of stroke. An ischemic stroke is caused by a blocked artery in the brain. A hemorrhagic stroke is caused by leaking or bursting of a blood vessel in the brain. Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA). A TIA doesn't cause lasting symptoms. Ischemic stroke This is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked. This causes reduced blood flow, known as ischemia. Blocked or narrowed blood vessels can be caused by fatty deposits that build up in blood vessels. Or they can be caused by blood clots or other debris that travel through the bloodstream, most often from the heart. An ischemic stroke occurs when fatty deposits, blood clots or other debris become lodged in the blood vessels in the brain. Some early research shows that COVID-19 infection may increase the risk of ischemic stroke, but more study is needed. Hemorrhagic stroke Hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. Bleeding inside the brain, known as a brain hemorrhage, can result from many conditions that affect the blood vessels. Factors related to hemorrhagic stroke include: High blood pressure that's not under control. Overtreatment with blood thinners, also known as anticoagulants. Bulges at weak spots in the blood vessel walls, known as aneurysms. Head trauma, such as from a car accident. Protein deposits in blood vessel walls that lead to weakness in the vessel wall. This is known as cerebral amyloid angiopathy. Ischemic stroke that leads to a brain hemorrhage. A less common cause of bleeding in the brain is the rupture of an arteriovenous malformation (AVM). An AVM is an irregular tangle of thin-walled blood vessels. Transient ischemic attack A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke. But a TIA doesn't cause permanent damage. A TIA is caused by a temporary decrease in blood supply to part of the brain. The decrease may last as little as five minutes. A transient ischemic attack is sometimes known as a ministroke. A TIA occurs when a blood clot or fatty deposit reduces or blocks blood flow to part of the nervous system. Seek emergency care even if you think you've had a TIA. It's not possible to tell if you're having a stroke or TIA based only on the symptoms. If you've had a TIA, it means you may have a partially blocked or narrowed artery leading to the brain. Having a TIA increases your risk of having a stroke later. Risk factors Many factors can increase the risk of stroke. Potentially treatable stroke risk factors include: Lifestyle risk factors Being overweight or obese. Physical inactivity. Heavy or binge drinking. Use of illegal drugs such as cocaine and methamphetamine. Medical risk factors High blood pressure. Cigarette smoking or secondhand smoke exposure. High cholesterol. Diabetes. Obstructive sleep apnea. Cardiovascular disease, including heart failure, heart defects, heart infection or irregular heart rhythm, such as atrial fibrillation. Personal or family history of stroke, heart attack or transient ischemic attack. COVID-19 infection. Other factors associated with a higher risk of stroke include: Age — People age 55 or older have a higher risk of stroke than do younger people. Race or ethnicity — African American and Hispanic people have a higher risk of stroke than do people of other races or ethnicities. Sex — Men have a higher risk of stroke than do women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men. Hormones — Taking birth control pills or hormone therapies that include estrogen can increase risk. Complications A stroke can sometimes cause temporary or permanent disabilities. Complications depend on how long the brain lacks blood flow and which part is affected. Complications may include: Loss of muscle movement, known as paralysis. You may become paralyzed on one side of the body. Or you may lose control of certain muscles, such as those on one side of the face or one arm. Trouble talking or swallowing. A stroke might affect the muscles in the mouth and throat. This can make it hard to talk clearly, swallow or eat. You also may have trouble with language, including speaking or understanding speech, reading or writing. Memory loss or trouble thinking. Many people who have had strokes experience some memory loss. Others may have trouble thinking, reasoning, making judgments and understanding concepts. Emotional symptoms. People who have had strokes may have more trouble controlling their emotions. Or they may develop depression. Pain. Pain, numbness or other feelings may occur in the parts of the body affected by stroke. If a stroke causes you to lose feeling in the left arm, you may develop a tingling sensation in that arm. Changes in behavior and self-care. People who have had strokes may become more withdrawn. They also may need help with grooming and daily chores."," Only use the provided text to answer the question, no outside sources. I am a first-year medical resident. I recently treated a patient with a stroke, and it was my first time treating this condition. I am trying to become more familiarized with it, because the patient's family had a lot of questions, like if they were at risk of having one too, and what they could have done to prevent it from happening. I didn't really know how to answer some of those questions and felt bad about it afterward. Can you give me summarized information about strokes so I know how to deal with it next time? Symptoms If you or someone you're with may be having a stroke, pay attention to the time the symptoms began. Some treatments are most effective when given soon after a stroke begins. Symptoms of stroke include: Trouble speaking and understanding what others are saying. A person having a stroke may be confused, slur words or may not be able to understand speech. Numbness, weakness or paralysis in the face, arm or leg. This often affects just one side of the body. The person can try to raise both arms over the head. If one arm begins to fall, it may be a sign of a stroke. Also, one side of the mouth may droop when trying to smile. Problems seeing in one or both eyes. The person may suddenly have blurred or blackened vision in one or both eyes. Or the person may see double. Headache. A sudden, severe headache may be a symptom of a stroke. Vomiting, dizziness and a change in consciousness may occur with the headache. Trouble walking. Someone having a stroke may stumble or lose balance or coordination. When to see a doctor Seek immediate medical attention if you notice any symptoms of a stroke, even if they seem to come and go or they disappear completely. Think ""FAST"" and do the following: Face. Ask the person to smile. Does one side of the face droop? Arms. Ask the person to raise both arms. Does one arm drift downward? Or is one arm unable to rise? Speech. Ask the person to repeat a simple phrase. Is the person's speech slurred or different from usual? Time. If you see any of these signs, call 911 or emergency medical help right away. Call 911 or your local emergency number immediately. Don't wait to see if symptoms stop. Every minute counts. The longer a stroke goes untreated, the greater the potential for brain damage and disability. If you're with someone you suspect is having a stroke, watch the person carefully while waiting for emergency assistance. Causes There are two main causes of stroke. An ischemic stroke is caused by a blocked artery in the brain. A hemorrhagic stroke is caused by leaking or bursting of a blood vessel in the brain. Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA). A TIA doesn't cause lasting symptoms. Ischemic stroke This is the most common type of stroke. It happens when the brain's blood vessels become narrowed or blocked. This causes reduced blood flow, known as ischemia. Blocked or narrowed blood vessels can be caused by fatty deposits that build up in blood vessels. Or they can be caused by blood clots or other debris that travel through the bloodstream, most often from the heart. An ischemic stroke occurs when fatty deposits, blood clots or other debris become lodged in the blood vessels in the brain. Some early research shows that COVID-19 infection may increase the risk of ischemic stroke, but more study is needed. Hemorrhagic stroke Hemorrhagic stroke occurs when a blood vessel in the brain leaks or ruptures. Bleeding inside the brain, known as a brain hemorrhage, can result from many conditions that affect the blood vessels. Factors related to hemorrhagic stroke include: High blood pressure that's not under control. Overtreatment with blood thinners, also known as anticoagulants. Bulges at weak spots in the blood vessel walls, known as aneurysms. Head trauma, such as from a car accident. Protein deposits in blood vessel walls that lead to weakness in the vessel wall. This is known as cerebral amyloid angiopathy. Ischemic stroke that leads to a brain hemorrhage. A less common cause of bleeding in the brain is the rupture of an arteriovenous malformation (AVM). An AVM is an irregular tangle of thin-walled blood vessels. Transient ischemic attack A transient ischemic attack (TIA) is a temporary period of symptoms similar to those of a stroke. But a TIA doesn't cause permanent damage. A TIA is caused by a temporary decrease in blood supply to part of the brain. The decrease may last as little as five minutes. A transient ischemic attack is sometimes known as a ministroke. A TIA occurs when a blood clot or fatty deposit reduces or blocks blood flow to part of the nervous system. Seek emergency care even if you think you've had a TIA. It's not possible to tell if you're having a stroke or TIA based only on the symptoms. If you've had a TIA, it means you may have a partially blocked or narrowed artery leading to the brain. Having a TIA increases your risk of having a stroke later. Risk factors Many factors can increase the risk of stroke. Potentially treatable stroke risk factors include: Lifestyle risk factors Being overweight or obese. Physical inactivity. Heavy or binge drinking. Use of illegal drugs such as cocaine and methamphetamine. Medical risk factors High blood pressure. Cigarette smoking or secondhand smoke exposure. High cholesterol. Diabetes. Obstructive sleep apnea. Cardiovascular disease, including heart failure, heart defects, heart infection or irregular heart rhythm, such as atrial fibrillation. Personal or family history of stroke, heart attack or transient ischemic attack. COVID-19 infection. Other factors associated with a higher risk of stroke include: Age — People age 55 or older have a higher risk of stroke than do younger people. Race or ethnicity — African American and Hispanic people have a higher risk of stroke than do people of other races or ethnicities. Sex — Men have a higher risk of stroke than do women. Women are usually older when they have strokes, and they're more likely to die of strokes than are men. Hormones — Taking birth control pills or hormone therapies that include estrogen can increase risk. Complications A stroke can sometimes cause temporary or permanent disabilities. Complications depend on how long the brain lacks blood flow and which part is affected. Complications may include: Loss of muscle movement, known as paralysis. You may become paralyzed on one side of the body. Or you may lose control of certain muscles, such as those on one side of the face or one arm. Trouble talking or swallowing. A stroke might affect the muscles in the mouth and throat. This can make it hard to talk clearly, swallow or eat. You also may have trouble with language, including speaking or understanding speech, reading or writing. Memory loss or trouble thinking. Many people who have had strokes experience some memory loss. Others may have trouble thinking, reasoning, making judgments and understanding concepts. Emotional symptoms. People who have had strokes may have more trouble controlling their emotions. Or they may develop depression. Pain. Pain, numbness or other feelings may occur in the parts of the body affected by stroke. If a stroke causes you to lose feeling in the left arm, you may develop a tingling sensation in that arm. Changes in behavior and self-care. People who have had strokes may become more withdrawn. They also may need help with grooming and daily chores. https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113",Medical,Summarize,Text Transformation You can only respond to the prompt using information in the context block and no other sources.,Was Q3 performance better in Asia or the US?,"Thank you, Tiffany, and thank you for joining us this afternoon. Let me start by laying out our results for this quarter. Our Q3 total company revenue was $9.1 billion, up 1% year-over-year and 6% over Q2. Our global comparable store sales declined 3% year-over-year driven by a negative 2% comp growth in North America and a negative 14% comp growth in China and partially offset by strong performance in Japan. Our global operating margins contracted by 70 basis points to 16.7% and overall earnings per share for the quarter was $0.93. Our total company results were in line with guidance, but international performance, particularly in China, was challenged. We are not satisfied with the results, but our actions are making an impact, leading business and operational indicators are trending in the right direction ahead of our financial results and our runway for improvement is long. We see green shoots in our US business driven by the three-part action plan outlined last quarter. First, meet and unlock capacity for new demand through a relentless focus on improvements to our US store operations and on elevating the experience we create for our partners and customers. Second, attract new customers and drive transaction growth by launching and integrating more exciting new products with relevant marketing while maintaining our focus on core coffee forward offerings. And third, reach new customers, and demonstrate our value by making sure customers believe the Starbucks experience is worth it every time. First, our largest opportunity, meet and unlock capacity for new demand. A relentless focus on improving operational execution across our nearly 10,000 US company-operated stores is the cornerstone of our near term plan. While it is early days of progress, our plan is working. If you walk away from today's call with one thought, let it be the significant changes and long-term upside potential taking place within our US stores and across our end-to-end supply chain to unlock growth, enhance the customer experience, and drive cost efficiencies. Within our stores, we've seen material positive momentum across core store health and performance metrics with notable improvements in partner scheduling and turnover, critical store issues, and inventory management. Stores ranked in our top two operational performance quartiles reached a new high during the quarter, a 28% upwards shift from Q2, but we have more opportunity. Our focus on operational excellence driven by Reinvention plan has led to a multi-second year-over-year improvement in out-of-the-window times, a nearly 50% reduction in calls received by our Customer Contact Center for my order took too long and Mobile Order & Pay and delivery uptime rates of 99%. These are key indicators of our work to drive growth by addressing customer wait times, product availability, and the customer experience. This quarter, we also introduced phase one of our Siren Craft System, which includes several process and partner driven enhancements to our US store operations. Changes include a new peak time play caller role, strategic investments in partner hours, training, new routines, simple enhancements to technology, and an evolved beverage build process. Early deployment across 1,200 stores demonstrated a material incremental improvement across key performance, throughput efficiency, and reliability metrics. Encouraged by this, we fully deployed Siren Craft System process improvements across our entire portfolio of US company-operated stores this week. Later this quarter, we will begin rolling out a simple refit to our espresso machines which we expect to improve espresso throughput by up to 15% without compromising quality, and with a minor software change in our store production systems, we have a similar ability to improve food throughput. When paired with Siren System equipment announced as part of our Reinvention plan, these new processes become a force multiplier that we expect to drive a true step change improvement. Early assessments demonstrate the capability to drive a 10 to 20 second wait time reduction and a resulting comp opportunity range of 1% to 1.5%. Leveraging our Deep Brew analytics platform, we have identified customer experience outlier stores, approximately 10% of our network, and have developed targeted plans to address and improve them including accelerated Siren System deployment. Similarly, we are accelerating the pace of our new store builds and renovations with 580 net new builds and more than 800 renovations planned in North America for FY 2024. Store development efforts are focused on Tier 2 and Tier 3 cities where we see population growth and forecast both underserved demand and high incrementality. Increasingly, these new store builds and renovations also include Siren System equipment. In line with prior guidance, we remain on track to deploy equipment in less than 10% of company-operated stores by the end of FY 2024 and about 40% by the end of FY 2026. Building on our pilot, Starbucks and Gopuff have agreed to terms for an expanded relationship to open 100 delivery-only kitchens across the US. We're also accelerating the rollout of digital storyboards with target deployment across most US stores in the next two years, a year earlier than originally anticipated. Lastly, we're working in other ways to enhance the café experience. This includes new and expanded seating options that elevate many stores, while upholding a safe and inviting place for partners and customers. A key outcome of our operational efforts has been material and sustained improvements to the partner experience. Driven by precision partner-centric staffing and scheduling efforts, we ended the quarter with a new post-pandemic low partner turnover rate, the best shift completion rate in two years and a 13% improvement in average hours per partner, now the highest on record. These initiatives create more stability in our stores, provide more predictability for our partners and sustain our experience flywheel. Looking beyond our stores, we continue to realize new efficiencies, cost savings, and performance improvements across our end-to-end supply chain thanks to strong support from our suppliers and we see even more headroom. We have a structured process to realize significant continued improvements across our end-to-end supply chain. We are ahead of plan on productivity. We expect our productivity to drive efficiency and unlock capital from areas that don't touch the customer. In turn, these savings will enable us to target investments that drive value for our customers beginning later in Q4, reigniting our North American flywheel for growth. We're early days on this journey, building both our strategic sourcing and revenue management capabilities. Our second priority is to drive demand through relevant product innovation with coffee at our core. We've seen meaningful improvement here as well. This quarter, we drove traffic into our stores through an engaging and innovative pipeline of products supported by integrated marketing campaigns. Cold share was up 1% year-over-year, representing 76% of our beverage mix through the quarter. Our newly formulated Iced Coffee received positive feedback. Our strength in cold espresso innovation continued to drive the platform's growth, up 4% year-over-year. And we launched Starbucks Milano Duetto, whole bean coffee in Milan, ahead of a global launch this October. Beyond coffee, our new Summer-Berry Starbucks Refreshers, beverages with Pearls, drove the highest week- one product launch in our history. Their success buoyed the entire Starbucks Refreshers beverage platform to an all-time high during the quarter. As mentioned in Q2, we continue to build out our 24-month product pipeline while accelerating our pace of innovation. For example, recognizing the growing appeal and opportunity created by the energy category, we launched a new Handcrafted Iced Energy beverages across our US stores in just three months compared to a normal 12 to 18 months. Looking forward, we believe our Q4 product offerings, including the return of Pumpkin Spice combined with supporting marketing activities and offers, provides the right formula to drive customer interest, demand, and deeper engagement with both new and existing customers. Our third and final near-term priority is to reach new customers and demonstrate the value we offer by ensuring the Starbucks experience is worth it every time. Recognizing the premium position of our brand, we've been measured in our use of offers. During this quarter, only 14% of our transactions were driven by offers compared to a competitor average of 29%. Of offer-driven transactions, 10% was star-based offers targeted to Starbucks Rewards Members. Only 4% were driven by price- based offers.","System Instructions: You can only respond to the prompt using information in the context block and no other sources. Question: Was Q3 performance better in Asia or the US? Context block: Thank you, Tiffany, and thank you for joining us this afternoon. Let me start by laying out our results for this quarter. Our Q3 total company revenue was $9.1 billion, up 1% year-over-year and 6% over Q2. Our global comparable store sales declined 3% year-over-year driven by a negative 2% comp growth in North America and a negative 14% comp growth in China and partially offset by strong performance in Japan. Our global operating margins contracted by 70 basis points to 16.7% and overall earnings per share for the quarter was $0.93. Our total company results were in line with guidance, but international performance, particularly in China, was challenged. We are not satisfied with the results, but our actions are making an impact, leading business and operational indicators are trending in the right direction ahead of our financial results and our runway for improvement is long. We see green shoots in our US business driven by the three-part action plan outlined last quarter. First, meet and unlock capacity for new demand through a relentless focus on improvements to our US store operations and on elevating the experience we create for our partners and customers. Second, attract new customers and drive transaction growth by launching and integrating more exciting new products with relevant marketing while maintaining our focus on core coffee forward offerings. And third, reach new customers, and demonstrate our value by making sure customers believe the Starbucks experience is worth it every time. First, our largest opportunity, meet and unlock capacity for new demand. A relentless focus on improving operational execution across our nearly 10,000 US company-operated stores is the cornerstone of our near term plan. While it is early days of progress, our plan is working. If you walk away from today's call with one thought, let it be the significant changes and long-term upside potential taking place within our US stores and across our end-to-end supply chain to unlock growth, enhance the customer experience, and drive cost efficiencies. Within our stores, we've seen material positive momentum across core store health and performance metrics with notable improvements in partner scheduling and turnover, critical store issues, and inventory management. Stores ranked in our top two operational performance quartiles reached a new high during the quarter, a 28% upwards shift from Q2, but we have more opportunity. Our focus on operational excellence driven by Reinvention plan has led to a multi-second year-over-year improvement in out-of-the-window times, a nearly 50% reduction in calls received by our Customer Contact Center for my order took too long and Mobile Order & Pay and delivery uptime rates of 99%. These are key indicators of our work to drive growth by addressing customer wait times, product availability, and the customer experience. This quarter, we also introduced phase one of our Siren Craft System, which includes several process and partner driven enhancements to our US store operations. Changes include a new peak time play caller role, strategic investments in partner hours, training, new routines, simple enhancements to technology, and an evolved beverage build process. Early deployment across 1,200 stores demonstrated a material incremental improvement across key performance, throughput efficiency, and reliability metrics. Encouraged by this, we fully deployed Siren Craft System process improvements across our entire portfolio of US company-operated stores this week. Later this quarter, we will begin rolling out a simple refit to our espresso machines which we expect to improve espresso throughput by up to 15% without compromising quality, and with a minor software change in our store production systems, we have a similar ability to improve food throughput. When paired with Siren System equipment announced as part of our Reinvention plan, these new processes become a force multiplier that we expect to drive a true step change improvement. Early assessments demonstrate the capability to drive a 10 to 20 second wait time reduction and a resulting comp opportunity range of 1% to 1.5%. Leveraging our Deep Brew analytics platform, we have identified customer experience outlier stores, approximately 10% of our network, and have developed targeted plans to address and improve them including accelerated Siren System deployment. Similarly, we are accelerating the pace of our new store builds and renovations with 580 net new builds and more than 800 renovations planned in North America for FY 2024. Store development efforts are focused on Tier 2 and Tier 3 cities where we see population growth and forecast both underserved demand and high incrementality. Increasingly, these new store builds and renovations also include Siren System equipment. In line with prior guidance, we remain on track to deploy equipment in less than 10% of company-operated stores by the end of FY 2024 and about 40% by the end of FY 2026. Building on our pilot, Starbucks and Gopuff have agreed to terms for an expanded relationship to open 100 delivery-only kitchens across the US. We're also accelerating the rollout of digital storyboards with target deployment across most US stores in the next two years, a year earlier than originally anticipated. Lastly, we're working in other ways to enhance the café experience. This includes new and expanded seating options that elevate many stores, while upholding a safe and inviting place for partners and customers. A key outcome of our operational efforts has been material and sustained improvements to the partner experience. Driven by precision partner-centric staffing and scheduling efforts, we ended the quarter with a new post-pandemic low partner turnover rate, the best shift completion rate in two years and a 13% improvement in average hours per partner, now the highest on record. These initiatives create more stability in our stores, provide more predictability for our partners and sustain our experience flywheel. Looking beyond our stores, we continue to realize new efficiencies, cost savings, and performance improvements across our end-to-end supply chain thanks to strong support from our suppliers and we see even more headroom. We have a structured process to realize significant continued improvements across our end-to-end supply chain. We are ahead of plan on productivity. We expect our productivity to drive efficiency and unlock capital from areas that don't touch the customer. In turn, these savings will enable us to target investments that drive value for our customers beginning later in Q4, reigniting our North American flywheel for growth. We're early days on this journey, building both our strategic sourcing and revenue management capabilities. Our second priority is to drive demand through relevant product innovation with coffee at our core. We've seen meaningful improvement here as well. This quarter, we drove traffic into our stores through an engaging and innovative pipeline of products supported by integrated marketing campaigns. Cold share was up 1% year-over-year, representing 76% of our beverage mix through the quarter. Our newly formulated Iced Coffee received positive feedback. Our strength in cold espresso innovation continued to drive the platform's growth, up 4% year-over-year. And we launched Starbucks Milano Duetto, whole bean coffee in Milan, ahead of a global launch this October. Beyond coffee, our new Summer-Berry Starbucks Refreshers, beverages with Pearls, drove the highest week- one product launch in our history. Their success buoyed the entire Starbucks Refreshers beverage platform to an all-time high during the quarter. As mentioned in Q2, we continue to build out our 24-month product pipeline while accelerating our pace of innovation. For example, recognizing the growing appeal and opportunity created by the energy category, we launched a new Handcrafted Iced Energy beverages across our US stores in just three months compared to a normal 12 to 18 months. Looking forward, we believe our Q4 product offerings, including the return of Pumpkin Spice combined with supporting marketing activities and offers, provides the right formula to drive customer interest, demand, and deeper engagement with both new and existing customers. Our third and final near-term priority is to reach new customers and demonstrate the value we offer by ensuring the Starbucks experience is worth it every time. Recognizing the premium position of our brand, we've been measured in our use of offers. During this quarter, only 14% of our transactions were driven by offers compared to a competitor average of 29%. Of offer-driven transactions, 10% was star-based offers targeted to Starbucks Rewards Members. Only 4% were driven by price- based offers.",Financial,Fact Finding,Q&A You are given a reference document. You must only use information found in the reference document to answer the question asked.,How did Goldman Sachs recover from losses caused by the mortgage crisis referenced in this email conversation?,"From: Sent: To: Cc: Subject: Cohn, Gary (EO 85830) Sunday, November 18, 2007 6:04 PM Blankfein, Uoyd (EO 85830); van Praag, Lucas (EO PBC09) Winkelried, Jon (EO 85830); Viniar, David; Rogee, John F.W. (EO 85830); Horwitz, Russell (EO 85830) Re: NYT We were just smaller in the toxic products ----- Original Message From: Blank fein, Lloyd To: van Praag, Lucas Cc: Winkelried, Jon; Cohn, Gary; Viniar, David; Rogers, John F.W.; Horwitz, Russell Sent: Sun Nov 18 17:59:01 2007 Subject: RE: NYT Of course we didn't dodge the mortgage mess. We lost money, then made more than we lost because of shorts. Also, it's not over, so who knows how it will turn out Ultimately. -----Original Message----From: van Praag, Lucas Sent: Sunday, November 18, 2007 5:47 PM To: Blankfein, Lloyd Cc: Winkelried, Jon; Cohn, Gary; Viniar, David; Rogers, John F.W.; Horwitz, Russell Subject: NYT Jenny Anderson and Landon Thomas' story about how we dodged the mortgage mess is scheduled to run tomorrow. At this stage, 95% certain to be on the front page. I don't expect it to be materially different to the WSJ story on the same subject that ran last week - although it will have more color and annecdotes. Have given John and Russell a detailed briefing and Russell will update you on the plane, but here are a few points: 1 I have Agreed to brief Jenny thoroughly on it tomorrow and expect the news to run either Tues or Wed. I think it would be good if you had a 5 min phone call with her on the subject and I'll liaise with Russell on timing. We will issue the press release to coincide with publication of her article and will actively work with other media, esp in the UK, to make sure the message is spread and picked up effectively. 2. Tomorrow's story will, of course, have 'balance' (ie stuff we don't like). In this instance, we have spent much time discussing conflicts, and I think we've made some progress as she aknowledges that most of her sources on the subject are financial sponsors which fact, unless edited out, is included and gives context. 3, The article references the extraordinary influence Goldman Sachs has - the most topical being John Thain, but Rubin, Hank, Duncan et al are all in the mix too. She hasn't gone as far as suggesting that there is a credible conspiracy theory (unlike her former colleague at the NY Post). She does, however, make the point that it feels like GS is running everything. 5. We spent a lot of time on culture as a differentiator - she was receptive. 4. She has used several remarks you made at the ML conference on the record - which is If anything changes, I ' l l let you know. I L ---,:;;;eeee-;,;;,;.-_ .. From: Sent: To: Subject: Swenson, Michael Thursday. October 11, 2007 7:06 PM Mullen, Donald RE: Early post on P and L _ = Redacled by the Pennanent Yes we are well positioned -----Original Message----e From: Mullen, Donald Sent: Thursday, October 11, 2001 6:21 To: Swenson, Michael Subject: Re: Early post on P and L Sounds like we will make some serious money ----- Original Message From: Swenson, Michael To: Mullen, Donald Sent: Thu Oct 11 16:24:00 2001 SUbject: RE: Early post on e and L The . . . . . . CDO has a bunch of second lien positions 1n it that have been written down, The collateral balance has fallen below the liabilities triggering an ""implied write-down event"" which is a credit event in our CDS document. Unlike RMBS structures, COOs do not have a bond write-down feature. On another note, today's RMBS downgrades by Moody's should cause many COOs to fail their triggers. That will result in coupons being shut off on the bonds and hence our CDS protection premie paid out will go to zero. -----Original Message----erom: Mullen, Donald Sent: Thursday, October 11, 2001 5:49 To: Swenson, Michael Subject: Re: Early post on e and L Nice day How did the trigger not work ----- original Message ----From: Swenson, Michael To: Mullen, Donald; Montag, Tom Cc: Sparks, Daniel L; Brafman, Lester R Sent: Thu Oct 11 11:41:02 2001 Subject: Early post on e and L Moody's downgraded 32bb of of 2006 AA, A, BBB and BBB- bonds today. This will eventually filter into downgrades 1n COOs. ABX single-As sold off by a point after the news. ASS Desk P and L will be up between 30 and 35mm today, 12mm of the p and 1 is from our first credit event in COOs where the implied trigger failed on a e deal e 06-1) • Goldman, Sachs & Co, ***** From: Sent: To: Ce, Salem, Deeb Thursday, May 17, 20078:06 AM Swenson, Michael Chin, Edwin Subject, bad news .. , FW, lBMl06A wipes out the m6s and makes a wipeout on the m5 imminent. ,. costs us about 2,5mm 3,5 m6 12.5 m5 marked at $10 marked at $20 good news, , , we own 10mm protection on the m6 marked at $50 ""., we make $5mm From: ....t ce, To: Subject: Thlxsday, May 17, 2007 8:00 AM salem, Deeb; Olin, Edwin Poue, Darlush; BrOsterman, Jonathan LBMlO6A -.,- 06:0717May2007 LONG BEACH MORTGAGE LOAN TRUST 2006-A FILES (8-K) Disclosing Other Events May 17 (EDGAR Online)· Item 8.01 Other Events Long Beach Mortgage securities Corp announces that the May 2007 distribution report fOf LBMLT 2OQ6.A will reflect that 616 second-lien mortgage loans with an aggregate urpaid principal balance of $ 49,340.870.90 will be dlarged off on May 25.2007. The total amOllnt to be charged off, $52,797,628.59, includes certain unreimbursed advances of principal and interest made by the servicer, Washington Mutual Bank. Information regarding the characteristics of the loans in LBMLT 2006·A is available from the trustee at its website httos:/Itss.db.oom/invr and at http://wmsubprime.lewtan.CQm. The table below sets forth the numbet' and aggregate unpaid principal balance of the charged otf mortgage loans by distribution date (the month following the due dale of the last monthly payment that should have been received with respect to the klans). The chargeoff assessment date tor the pool was May 1, 2007. Distritution Date November 2006 December 2006 January 2007 February 2007 7,163 March 2007 April 2007 May 2007 Number of Loans in 7,767 7,624 7,468 7,305 6,997 TBO"" Pool Aggregate Unpaid $465,292,702.94 S475,682,053.93 S465,992,547.68 S455,518,577.5O $444,362,214.18 $434,469,820.04 charged off for reasons other than 180 days delinquency. Due to the numbef of affected mortgage loans fO( the May 2007 distribution date, there may be a larger than usual reconciliation activity on the remittance report for the June 2007 distribution date to reflect items that have not been closed out as of the scheduled reporting date to the trustee for the May 2007 distribution date. Please Contact: Doug Potolsky at (212) 702- 6961 if you have any questions about this filing. From: Sent: To: Subject: Viniar, David Wednesday, July 25,20079:18 PM Cohn, Gary (EO 85630) RE: Private & Confidential: FICC Financial Package 07125/07 Confidential Sensitivity: Tells you what might be happening to people who don't have the big short. -----Original Message----From: Cohn, Gary (EO 85B30) Sent: Wednesday, July 25, 2007 8:55 PM To: Viniar, David; Blankfein, Lloyd (EO 85B30); Winkelried, Jon (EO 65B30) SUbject: Fw: Private & Confidential: FICC Financial Package 07/25/07 Sensitivity: Confidential Look at the Mortgage numbers up 373 in the index book and wrote down 230 in etO-COO and. 92 in resids Original Message ----From: Tricarico, Geoffrey P. To: ficc-package Sent: Wed Jul 25 19:33:10 2007 Subject: Private & Confidential: FICC Financial Package 07/25/07 REVENUES (Including Estimate) EST $ 126.5","You are given a reference document. You must only use information found in the reference document to answer the question asked. How did Goldman Sachs recover from losses caused by the mortgage crisis referenced in this email conversation? From: Sent: To: Cc: Subject: Cohn, Gary (EO 85830) Sunday, November 18, 2007 6:04 PM Blankfein, Uoyd (EO 85830); van Praag, Lucas (EO PBC09) Winkelried, Jon (EO 85830); Viniar, David; Rogee, John F.W. (EO 85830); Horwitz, Russell (EO 85830) Re: NYT We were just smaller in the toxic products ----- Original Message From: Blank fein, Lloyd To: van Praag, Lucas Cc: Winkelried, Jon; Cohn, Gary; Viniar, David; Rogers, John F.W.; Horwitz, Russell Sent: Sun Nov 18 17:59:01 2007 Subject: RE: NYT Of course we didn't dodge the mortgage mess. We lost money, then made more than we lost because of shorts. Also, it's not over, so who knows how it will turn out Ultimately. -----Original Message----From: van Praag, Lucas Sent: Sunday, November 18, 2007 5:47 PM To: Blankfein, Lloyd Cc: Winkelried, Jon; Cohn, Gary; Viniar, David; Rogers, John F.W.; Horwitz, Russell Subject: NYT Jenny Anderson and Landon Thomas' story about how we dodged the mortgage mess is scheduled to run tomorrow. At this stage, 95% certain to be on the front page. I don't expect it to be materially different to the WSJ story on the same subject that ran last week - although it will have more color and annecdotes. Have given John and Russell a detailed briefing and Russell will update you on the plane, but here are a few points: 1 I have Agreed to brief Jenny thoroughly on it tomorrow and expect the news to run either Tues or Wed. I think it would be good if you had a 5 min phone call with her on the subject and I'll liaise with Russell on timing. We will issue the press release to coincide with publication of her article and will actively work with other media, esp in the UK, to make sure the message is spread and picked up effectively. 2. Tomorrow's story will, of course, have 'balance' (ie stuff we don't like). In this instance, we have spent much time discussing conflicts, and I think we've made some progress as she aknowledges that most of her sources on the subject are financial sponsors which fact, unless edited out, is included and gives context. 3, The article references the extraordinary influence Goldman Sachs has - the most topical being John Thain, but Rubin, Hank, Duncan et al are all in the mix too. She hasn't gone as far as suggesting that there is a credible conspiracy theory (unlike her former colleague at the NY Post). She does, however, make the point that it feels like GS is running everything. 5. We spent a lot of time on culture as a differentiator - she was receptive. 4. She has used several remarks you made at the ML conference on the record - which is If anything changes, I ' l l let you know. I L ---,:;;;eeee-;,;;,;.-_ .. From: Sent: To: Subject: Swenson, Michael Thursday. October 11, 2007 7:06 PM Mullen, Donald RE: Early post on P and L _ = Redacled by the Pennanent Yes we are well positioned -----Original Message----e From: Mullen, Donald Sent: Thursday, October 11, 2001 6:21 To: Swenson, Michael Subject: Re: Early post on P and L Sounds like we will make some serious money ----- Original Message From: Swenson, Michael To: Mullen, Donald Sent: Thu Oct 11 16:24:00 2001 SUbject: RE: Early post on e and L The . . . . . . CDO has a bunch of second lien positions 1n it that have been written down, The collateral balance has fallen below the liabilities triggering an ""implied write-down event"" which is a credit event in our CDS document. Unlike RMBS structures, COOs do not have a bond write-down feature. On another note, today's RMBS downgrades by Moody's should cause many COOs to fail their triggers. That will result in coupons being shut off on the bonds and hence our CDS protection premie paid out will go to zero. -----Original Message----erom: Mullen, Donald Sent: Thursday, October 11, 2001 5:49 To: Swenson, Michael Subject: Re: Early post on e and L Nice day How did the trigger not work ----- original Message ----From: Swenson, Michael To: Mullen, Donald; Montag, Tom Cc: Sparks, Daniel L; Brafman, Lester R Sent: Thu Oct 11 11:41:02 2001 Subject: Early post on e and L Moody's downgraded 32bb of of 2006 AA, A, BBB and BBB- bonds today. This will eventually filter into downgrades 1n COOs. ABX single-As sold off by a point after the news. ASS Desk P and L will be up between 30 and 35mm today, 12mm of the p and 1 is from our first credit event in COOs where the implied trigger failed on a e deal e 06-1) • Goldman, Sachs & Co, ***** From: Sent: To: Ce, Salem, Deeb Thursday, May 17, 20078:06 AM Swenson, Michael Chin, Edwin Subject, bad news .. , FW, lBMl06A wipes out the m6s and makes a wipeout on the m5 imminent. ,. costs us about 2,5mm 3,5 m6 12.5 m5 marked at $10 marked at $20 good news, , , we own 10mm protection on the m6 marked at $50 ""., we make $5mm From: ....t ce, To: Subject: Thlxsday, May 17, 2007 8:00 AM salem, Deeb; Olin, Edwin Poue, Darlush; BrOsterman, Jonathan LBMlO6A -.,- 06:0717May2007 LONG BEACH MORTGAGE LOAN TRUST 2006-A FILES (8-K) Disclosing Other Events May 17 (EDGAR Online)· Item 8.01 Other Events Long Beach Mortgage securities Corp announces that the May 2007 distribution report fOf LBMLT 2OQ6.A will reflect that 616 second-lien mortgage loans with an aggregate urpaid principal balance of $ 49,340.870.90 will be dlarged off on May 25.2007. The total amOllnt to be charged off, $52,797,628.59, includes certain unreimbursed advances of principal and interest made by the servicer, Washington Mutual Bank. Information regarding the characteristics of the loans in LBMLT 2006·A is available from the trustee at its website httos:/Itss.db.oom/invr and at http://wmsubprime.lewtan.CQm. The table below sets forth the numbet' and aggregate unpaid principal balance of the charged otf mortgage loans by distribution date (the month following the due dale of the last monthly payment that should have been received with respect to the klans). The chargeoff assessment date tor the pool was May 1, 2007. Distritution Date November 2006 December 2006 January 2007 February 2007 7,163 March 2007 April 2007 May 2007 Number of Loans in 7,767 7,624 7,468 7,305 6,997 TBO"" Pool Aggregate Unpaid $465,292,702.94 S475,682,053.93 S465,992,547.68 S455,518,577.5O $444,362,214.18 $434,469,820.04 charged off for reasons other than 180 days delinquency. Due to the numbef of affected mortgage loans fO( the May 2007 distribution date, there may be a larger than usual reconciliation activity on the remittance report for the June 2007 distribution date to reflect items that have not been closed out as of the scheduled reporting date to the trustee for the May 2007 distribution date. Please Contact: Doug Potolsky at (212) 702- 6961 if you have any questions about this filing. From: Sent: To: Subject: Viniar, David Wednesday, July 25,20079:18 PM Cohn, Gary (EO 85630) RE: Private & Confidential: FICC Financial Package 07125/07 Confidential Sensitivity: Tells you what might be happening to people who don't have the big short. -----Original Message----From: Cohn, Gary (EO 85B30) Sent: Wednesday, July 25, 2007 8:55 PM To: Viniar, David; Blankfein, Lloyd (EO 85B30); Winkelried, Jon (EO 65B30) SUbject: Fw: Private & Confidential: FICC Financial Package 07/25/07 Sensitivity: Confidential Look at the Mortgage numbers up 373 in the index book and wrote down 230 in etO-COO and. 92 in resids Original Message ----From: Tricarico, Geoffrey P. To: ficc-package Sent: Wed Jul 25 19:33:10 2007 Subject: Private & Confidential: FICC Financial Package 07/25/07 REVENUES (Including Estimate) EST $ 126.5",Financial,Effect Analysis,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","In bullet point form, what is Dobbs and what are some effects that America is having because of it based on this statement from Lopez","Thank you, Chair Sanders, Ranking Member Cassidy, Senator Murray and the members of the Committee for the opportunity to highlight the clear and growing evidence that the Dobbs decision is harming reproductive health and freedom. My name is Destiny Lopez, and I am the acting co-CEO of the Guttmacher Institute, a leading research and policy organization committed to advancing sexual and reproductive health and rights worldwide. For decades following the 1973 Roe v. Wade decision, anti-abortion advocates worked strategically to make abortion harder to get and highly stigmatized. Public support for abortion’s legality has remained high and consistent. But the sheer number of state-level abortion restrictions ensured that abortion became inaccessible for many—even with Roe in place. The Dobbs v. Jackson Women’s Health Organization decision was an inflection point, unleashing chaos and fear across the nation. Our experts are constantly assessing this changing landscape and the increasingly robust body of evidence that illustrates the harms caused and exacerbated by Dobbs. Two years after the decision, here is what we know:i Access to abortion care is severely restricted in many parts of the country. Fourteen states are now enforcing total abortion bans with very limited exceptions, and many more have other new restrictions in place. The total number of brick-and-mortar clinics providing abortion care in the US declined by more than 40 between 2020 and early 2024. Banning abortion does not stop the need for abortion access. Which is why many people seeking abortions post-Dobbs must overcome huge financial and logistical barriers to get care, especially those in states with total or early gestational bans. The number of Americans traveling out of state for abortions doubled from 81,000 in 2020 to more than 170,000 in 2023. States that border states with total abortion bans saw the sharpest increases in out-of-state patients. No one should have to travel to another state to access basic healthcare. And in fact, those who can’t overcome the burdens of travelling for care, which for some might mean crossing multiple state lines, may be forced to stay pregnant against their will. Others may decide to self-manage their abortion. Decades of research have documented that the majority of people obtaining abortions have few financial resources, are people of color, and are already parenting. They are the ones most harshly impacted by bans and restrictions. We also know that providers are resilient and adapting to meet patient needs. While brick-andmortar facilities provide more than three-quarters of all abortions, online clinics are expanding care options by offering medication abortion services via telehealth. Research by the Society for Family Planning shows that virtual-only telehealth abortions accounted for almost one in five abortions from October to December 2023. There are many other important ways Dobbs is interfering with reproductive health care across the nation that I don’t have time to discuss in detail today, from current and future OB-GYNs not wanting to practice in ban states to impacts on maternal health and people facing obstetric emergencies. So what does all this mean? Overturning Roe did not resolve the debates on abortion that have characterized US politics for the past 50 years. Instead, it enabled policies that have significantly worsened the harms faced by individuals who are most marginalized in our health care system. Still, despite these immense hardships and many people being denied care, there were more than one million clinician-provided abortions in 2023—a 10% increase from 2020. This is a testament to the heroic efforts of providers, abortion funds and other support networks, to the resilience and determination of people seeking care, and to the centrality of abortion in peoples’ lives. And it explains why the anti-abortion movement and their political allies are doubling down on even more repressive policies. For instance, this year four states introduced legislation—and one passed a law—criminalizing adults who support adolescents seeking abortion care in another state. Earlier in the year, the Alabama Supreme Court’s decision to classify frozen embryos as “children” wreaked havoc on fertility treatment services while advancing the anti-abortion movement’s long-term goal to enshrine fetal personhood in both law and policy. These attacks on bodily autonomy, coupled with two major abortion cases currently before the Supreme Court, signal that the policy and legal landscape will continue to shift. The full damage caused by Dobbs will not be clear for years to come, but the evidence suggests it will not be easy to repair. That’s why it is imperative that policymakers at all levels of government champion a bold vision of abortion care that goes beyond what Roe promised. Only policies rooted in evidence and human rights will guarantee that all people have meaningful access to high-quality, affordable abortion care where they live and via the method they choose. Thank you.","[question] In bullet point form, what is Dobbs and what are some effects that America is having because of it based on this statement from Lopez ===================== [text] Thank you, Chair Sanders, Ranking Member Cassidy, Senator Murray and the members of the Committee for the opportunity to highlight the clear and growing evidence that the Dobbs decision is harming reproductive health and freedom. My name is Destiny Lopez, and I am the acting co-CEO of the Guttmacher Institute, a leading research and policy organization committed to advancing sexual and reproductive health and rights worldwide. For decades following the 1973 Roe v. Wade decision, anti-abortion advocates worked strategically to make abortion harder to get and highly stigmatized. Public support for abortion’s legality has remained high and consistent. But the sheer number of state-level abortion restrictions ensured that abortion became inaccessible for many—even with Roe in place. The Dobbs v. Jackson Women’s Health Organization decision was an inflection point, unleashing chaos and fear across the nation. Our experts are constantly assessing this changing landscape and the increasingly robust body of evidence that illustrates the harms caused and exacerbated by Dobbs. Two years after the decision, here is what we know:i Access to abortion care is severely restricted in many parts of the country. Fourteen states are now enforcing total abortion bans with very limited exceptions, and many more have other new restrictions in place. The total number of brick-and-mortar clinics providing abortion care in the US declined by more than 40 between 2020 and early 2024. Banning abortion does not stop the need for abortion access. Which is why many people seeking abortions post-Dobbs must overcome huge financial and logistical barriers to get care, especially those in states with total or early gestational bans. The number of Americans traveling out of state for abortions doubled from 81,000 in 2020 to more than 170,000 in 2023. States that border states with total abortion bans saw the sharpest increases in out-of-state patients. No one should have to travel to another state to access basic healthcare. And in fact, those who can’t overcome the burdens of travelling for care, which for some might mean crossing multiple state lines, may be forced to stay pregnant against their will. Others may decide to self-manage their abortion. Decades of research have documented that the majority of people obtaining abortions have few financial resources, are people of color, and are already parenting. They are the ones most harshly impacted by bans and restrictions. We also know that providers are resilient and adapting to meet patient needs. While brick-andmortar facilities provide more than three-quarters of all abortions, online clinics are expanding care options by offering medication abortion services via telehealth. Research by the Society for Family Planning shows that virtual-only telehealth abortions accounted for almost one in five abortions from October to December 2023. There are many other important ways Dobbs is interfering with reproductive health care across the nation that I don’t have time to discuss in detail today, from current and future OB-GYNs not wanting to practice in ban states to impacts on maternal health and people facing obstetric emergencies. So what does all this mean? Overturning Roe did not resolve the debates on abortion that have characterized US politics for the past 50 years. Instead, it enabled policies that have significantly worsened the harms faced by individuals who are most marginalized in our health care system. Still, despite these immense hardships and many people being denied care, there were more than one million clinician-provided abortions in 2023—a 10% increase from 2020. This is a testament to the heroic efforts of providers, abortion funds and other support networks, to the resilience and determination of people seeking care, and to the centrality of abortion in peoples’ lives. And it explains why the anti-abortion movement and their political allies are doubling down on even more repressive policies. For instance, this year four states introduced legislation—and one passed a law—criminalizing adults who support adolescents seeking abortion care in another state. Earlier in the year, the Alabama Supreme Court’s decision to classify frozen embryos as “children” wreaked havoc on fertility treatment services while advancing the anti-abortion movement’s long-term goal to enshrine fetal personhood in both law and policy. These attacks on bodily autonomy, coupled with two major abortion cases currently before the Supreme Court, signal that the policy and legal landscape will continue to shift. The full damage caused by Dobbs will not be clear for years to come, but the evidence suggests it will not be easy to repair. That’s why it is imperative that policymakers at all levels of government champion a bold vision of abortion care that goes beyond what Roe promised. Only policies rooted in evidence and human rights will guarantee that all people have meaningful access to high-quality, affordable abortion care where they live and via the method they choose. Thank you. https://www.help.senate.gov/imo/media/doc/80626e6a-a9e9-50e7-072a-95e7c2a059e3/Lopez%20-%20Testimony.pdf ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Summarize & Format,Text Transformation Only use the provided context when answering this task and format your response in bullet points with and follow each with an explanation,What industries will be created or accelerated by robotic ecosystems?,"IMPACT ON WORKFORCE While automation will cause significant changes in the composition of employment, it will not cause mass unemployment. Quite the contrary, displaced workers will fill new higher-value-add jobs, and the labor force is likely to increase. The positive impact associated with the retraining of soldiers after World War II8 is quite instructive. The economy assimilated returning soldiers surprisingly well, boosting productivity significantly. Though, as automation accelerates job turnover, the cost of friction in the labor market, which currently stands at more than $630B per annum is expected to grow. These frictions present tremendous opportunity for companies that help firms reduce time-to-hire, provide workers with new skill-sets, and train new employees more efficiently. In the United States today, 5.4 million jobs are unfilled because of skillset mismatches, as shown below. ARK’s research indicates that recruiting and training account for over 2/3 the cost of friction in the labor market. The opportunity for recruiting and retraining has never been better. Some companies already are responding. In 2013, corporate spending on training increased by 15%, to $70 billion and then increased another 10% in 2014.9 Companies such as Cornerstone on Demand (CSOD), Manpower (MAN), Robert Half (RHI), DeVry (DV), Adecco (AHEXY), and LinkedIn (LNKD), which acquired Lynda.com, offer career skill-building programs, and should benefit significantly as automation permeates more industries. The productivity associated with automation will have a profound impact on economic growth. According to ARK’s research, real GDP per worker in the US will double from $113,000 in 2013 to $236,000 in 2035, or at an annual rate of 3.4%. Without automation, productivity would increase at roughly half that rate, or 1.8%, limiting real GDP per worker to $167,000, as shown below. As automation proliferates, the growth of real GDP per worker will accelerate from 2.2% during the next ten years, to roughly 5% between 2025 and 2035. By 2035, real GDP will be 42% higher with automation than without it, as shown below. It will reach roughly $40 trillion, or nearly $12 trillion above the $28 trillion that would otherwise be the case. Clearly, the extra $12 trillion in extra GDP will bring with it many more new jobs. Robotics ecosystems will create new industries and accelerate their growth. Companies already pioneering this movement include Google (GOOG) and Tesla (TSLA) in the autonomous vehicle market, as well as AeroVironment (AVAV), Amazon (AMZN) and Elbit Systems (ESLT) in the drone space. Service robots are in their infancy, but could undergo explosive growth. Early examples include vacuum and lawnmower robots manufactured by iRobot (IRBT), medical robots by Intuitive Surgical (ISRG), and industrial robots by KUKA (KUKAY). Even more embryonic are ReWalk’s10 (RWLK) robot exoskeletons enabling paraplegics to walk.11 Other companies benefitting from these trends manufacture sensors, microcontrollers, cameras, batteries, computerized numerical controls, and materials required for production. Cognex (CGNX), Ambarella (AMBA), Panasonic (PCRFY), Fanuc (FANUY), and Rockwell Automation (ROK) will be prime beneficiaries. Automation will permeate every sector of the economy, with accommodation and food services, agriculture, and retail trade garnering the biggest boosts to productivity. By 2035, GDP per worker will increase by 58% in the accommodation and food services sector, 55% in agriculture, and 53% in retail trade, as depicted below. Spending on automation is poised to soar orders of magnitude above current investment levels. Cumulatively, it will increase by roughly $3.8 trillion through 2035. As artificial intelligence solves increasingly complex problems, the return on investment from “smarter” robots, drones, and automation will drive adoption. Between 2015 and 2035, annual investment in automation could increase at a 16.5% annual growth rate from $11 billion to $242 billion, as illustrated below. During the next decade it should compound at a 33% annual rate. Given the declining cost curves in technology, unit growth rates could be even higher. Several sectors will spend disproportionately on automation to boost productivity. In 2035, manufacturing will account for the largest percentage, 13% of the total, or $31 billion. Spearheaded by companies like Amazon (AMZN), the retail sector will spend roughly $26 billion, or 11% of the total investment. In 2014, Amazon boosted the number of Kiva robots in its global distribution centers from 1,000 to 15,000, a fifteen fold increase in one year, and then doubled its Kiva install base to 30,000 in 2015. Game on! Closely related to retail, the accommodation and food services category is set to spend $24 billion as shown in figure 9.","What industries will be created or accelerated by robotic ecosystems? Only use the provided context when answering this task and format your response in bullet points with and follow each with an explanation. IMPACT ON WORKFORCE While automation will cause significant changes in the composition of employment, it will not cause mass unemployment. Quite the contrary, displaced workers will fill new higher-value-add jobs, and the labor force is likely to increase. The positive impact associated with the retraining of soldiers after World War II8 is quite instructive. The economy assimilated returning soldiers surprisingly well, boosting productivity significantly. Though, as automation accelerates job turnover, the cost of friction in the labor market, which currently stands at more than $630B per annum is expected to grow. These frictions present tremendous opportunity for companies that help firms reduce time-to-hire, provide workers with new skill-sets, and train new employees more efficiently. In the United States today, 5.4 million jobs are unfilled because of skillset mismatches, as shown below. ARK’s research indicates that recruiting and training account for over 2/3 the cost of friction in the labor market. The opportunity for recruiting and retraining has never been better. Some companies already are responding. In 2013, corporate spending on training increased by 15%, to $70 billion and then increased another 10% in 2014.9 Companies such as Cornerstone on Demand (CSOD), Manpower (MAN), Robert Half (RHI), DeVry (DV), Adecco (AHEXY), and LinkedIn (LNKD), which acquired Lynda.com, offer career skill-building programs, and should benefit significantly as automation permeates more industries. The productivity associated with automation will have a profound impact on economic growth. According to ARK’s research, real GDP per worker in the US will double from $113,000 in 2013 to $236,000 in 2035, or at an annual rate of 3.4%. Without automation, productivity would increase at roughly half that rate, or 1.8%, limiting real GDP per worker to $167,000, as shown below. As automation proliferates, the growth of real GDP per worker will accelerate from 2.2% during the next ten years, to roughly 5% between 2025 and 2035. By 2035, real GDP will be 42% higher with automation than without it, as shown below. It will reach roughly $40 trillion, or nearly $12 trillion above the $28 trillion that would otherwise be the case. Clearly, the extra $12 trillion in extra GDP will bring with it many more new jobs. Robotics ecosystems will create new industries and accelerate their growth. Companies already pioneering this movement include Google (GOOG) and Tesla (TSLA) in the autonomous vehicle market, as well as AeroVironment (AVAV), Amazon (AMZN) and Elbit Systems (ESLT) in the drone space. Service robots are in their infancy, but could undergo explosive growth. Early examples include vacuum and lawnmower robots manufactured by iRobot (IRBT), medical robots by Intuitive Surgical (ISRG), and industrial robots by KUKA (KUKAY). Even more embryonic are ReWalk’s10 (RWLK) robot exoskeletons enabling paraplegics to walk.11 Other companies benefitting from these trends manufacture sensors, microcontrollers, cameras, batteries, computerized numerical controls, and materials required for production. Cognex (CGNX), Ambarella (AMBA), Panasonic (PCRFY), Fanuc (FANUY), and Rockwell Automation (ROK) will be prime beneficiaries. Automation will permeate every sector of the economy, with accommodation and food services, agriculture, and retail trade garnering the biggest boosts to productivity. By 2035, GDP per worker will increase by 58% in the accommodation and food services sector, 55% in agriculture, and 53% in retail trade, as depicted below. Spending on automation is poised to soar orders of magnitude above current investment levels. Cumulatively, it will increase by roughly $3.8 trillion through 2035. As artificial intelligence solves increasingly complex problems, the return on investment from “smarter” robots, drones, and automation will drive adoption. Between 2015 and 2035, annual investment in automation could increase at a 16.5% annual growth rate from $11 billion to $242 billion, as illustrated below. During the next decade it should compound at a 33% annual rate. Given the declining cost curves in technology, unit growth rates could be even higher. Several sectors will spend disproportionately on automation to boost productivity. In 2035, manufacturing will account for the largest percentage, 13% of the total, or $31 billion. Spearheaded by companies like Amazon (AMZN), the retail sector will spend roughly $26 billion, or 11% of the total investment. In 2014, Amazon boosted the number of Kiva robots in its global distribution centers from 1,000 to 15,000, a fifteen fold increase in one year, and then doubled its Kiva install base to 30,000 in 2015. Game on! Closely related to retail, the accommodation and food services category is set to spend $24 billion as shown in figure 9.",Financial,Find & Summarize,Text Transformation Give an answer using only the context provided.,What are the names of the Disney theme parks listed in the brochure?,"Stay in the Magic… and Play! Customize a Walt Disney World Resort vacation package to suit your style and budget. Start Planning Your Disney Vacation Play Full Video  Design your dream Disney vacation—and create magical memories to last a lifetime. Get Started What’s Exciting and New Enjoy some of the newest experiences at Walt Disney World Resort—and rediscover familiar favorites. Finding Nemo: The Big Blue… Remy’s Ratatouille Adventure Finding Nemo: The Big Blue… and Beyond! Witness a stirring spectacle of puppetry, music and more during this reimagined stage show set in Nemo’s vibrant underwater world. Remy’s Ratatouille Adventure Bring the whole family to zip, dash and scurry through Gusteau’s kitchen as you take in the sights, sounds and even smells from Remy’s world. TRON Lightcycle / Run Leave the real world behind in this high-stakes race across the Grid— the dark, computerized world from TRON. Fantasmic! Watch in awe as Mickey Mouse’s dreams come alive in a nighttime musical with stunning effects, dazzling pyrotechnics and more. 4 Enchanting Theme Parks 4 Enchanting Theme Parks There’s so much magic waiting for you in the Walt Disney World theme parks. Magic Kingdom Park Explore lands of endless enchantment, where your fantasy becomes a reality. Read More Disney’s Animal Kingdom Theme Park Encounter the magic of nature with animal adventures and entertainment. Read More Disney’s Hollywood Studios Let your adventure begin as favorite stories come to life all around you. Read More EPCOT Dare to discover a place where your imagination comes alive and curiosity waits around every corner. Read More Stay Longer and Save More on Rooms Take advantage of a special offer on rooms at select Disney Resort hotels, for stays most nights from March 25 to July 7, 2024. Learn More Stay in the Magic with Disney Resorts Collection Discover the many benefits of staying at our unique Disney Resort hotels. Enjoy More Time in the Parks Disney Resort hotel Guests get extra time to play every day. Read More Start Your Stay with a Water Park Day in 2025 Disney Resort hotel Guests arriving in 2025 can enjoy water park admission on check-in day—included with your stay! Read More Savor a World of Flavor Discover delicious dining options when you stay at a Disney Resort hotel. Read More Immerse Yourself in the Magic Disney Resort hotels offer the same legendary detail, service and storytelling that Guests love in our parks. Read More Make the Most of Your Visit Get Around with Ease It’s fun and easy to get around Walt Disney World Resort when you stay at a Disney Resort hotel. Read More Add More Magic Enjoy special offerings and benefits that take your vacation to the next level. Read More Enjoy Magical Extras with Your Package When you book a roomand-ticket package, you’ll receive Magical Extras— discounts and offerings on dining, entertainment and more. Customize Your Package More Fun for Everyone Disney Water Parks Disney water parks are unlike anything else on Earth—they’re drenched in Disney magic Read More Disney Springs Explore an amazing place featuring an eclectic mix of shops, eateries and entertainment. Read More Delectable Dining Walt Disney World Resort has dining options to delight every taste, style and budget. Read More Enchanting Extras Collection Add even more magic to your visit with a variety of unique experiences, available for a fee. Read More Design Your Disney Vacation Explore Places to Stay Choose from uniquely themed Disney Resort hotels—with options to suit your style and budget. Buy Park Tickets Purchase park tickets—and get ready to experience the theme parks and water parks! ","Give an answer using only the context provided. What are the names of the Disney theme parks listed in the brochure? Stay in the Magic… and Play! Customize a Walt Disney World Resort vacation package to suit your style and budget. Start Planning Your Disney Vacation Play Full Video  Design your dream Disney vacation—and create magical memories to last a lifetime. Get Started What’s Exciting and New Enjoy some of the newest experiences at Walt Disney World Resort—and rediscover familiar favorites. Finding Nemo: The Big Blue… Remy’s Ratatouille Adventure Finding Nemo: The Big Blue… and Beyond! Witness a stirring spectacle of puppetry, music and more during this reimagined stage show set in Nemo’s vibrant underwater world. Remy’s Ratatouille Adventure Bring the whole family to zip, dash and scurry through Gusteau’s kitchen as you take in the sights, sounds and even smells from Remy’s world. TRON Lightcycle / Run Leave the real world behind in this high-stakes race across the Grid— the dark, computerized world from TRON. Fantasmic! Watch in awe as Mickey Mouse’s dreams come alive in a nighttime musical with stunning effects, dazzling pyrotechnics and more. 4 Enchanting Theme Parks 4 Enchanting Theme Parks There’s so much magic waiting for you in the Walt Disney World theme parks. Magic Kingdom Park Explore lands of endless enchantment, where your fantasy becomes a reality. Read More Disney’s Animal Kingdom Theme Park Encounter the magic of nature with animal adventures and entertainment. Read More Disney’s Hollywood Studios Let your adventure begin as favorite stories come to life all around you. Read More EPCOT Dare to discover a place where your imagination comes alive and curiosity waits around every corner. Read More Stay Longer and Save More on Rooms Take advantage of a special offer on rooms at select Disney Resort hotels, for stays most nights from March 25 to July 7, 2024. Learn More Stay in the Magic with Disney Resorts Collection Discover the many benefits of staying at our unique Disney Resort hotels. Enjoy More Time in the Parks Disney Resort hotel Guests get extra time to play every day. Read More Start Your Stay with a Water Park Day in 2025 Disney Resort hotel Guests arriving in 2025 can enjoy water park admission on check-in day—included with your stay! Read More Savor a World of Flavor Discover delicious dining options when you stay at a Disney Resort hotel. Read More Immerse Yourself in the Magic Disney Resort hotels offer the same legendary detail, service and storytelling that Guests love in our parks. Read More Make the Most of Your Visit Get Around with Ease It’s fun and easy to get around Walt Disney World Resort when you stay at a Disney Resort hotel. Read More Add More Magic Enjoy special offerings and benefits that take your vacation to the next level. Read More Enjoy Magical Extras with Your Package When you book a roomand-ticket package, you’ll receive Magical Extras— discounts and offerings on dining, entertainment and more. Customize Your Package More Fun for Everyone Disney Water Parks Disney water parks are unlike anything else on Earth—they’re drenched in Disney magic Read More Disney Springs Explore an amazing place featuring an eclectic mix of shops, eateries and entertainment. Read More Delectable Dining Walt Disney World Resort has dining options to delight every taste, style and budget. Read More Enchanting Extras Collection Add even more magic to your visit with a variety of unique experiences, available for a fee. Read More Design Your Disney Vacation Explore Places to Stay Choose from uniquely themed Disney Resort hotels—with options to suit your style and budget. Buy Park Tickets Purchase park tickets—and get ready to experience the theme parks and water parks! ",Unknown,Fact Finding,Q&A "Respond to the prompt using only information provided in the context block. Do not use any external knowledge or information not present in the given text. Your response should focus on providing factual details from the text. Use formal language and avoid any personal opinions or interpretations. If the prompt asks about something not covered in the context, state that the information is not available in the given text. ","What specific example does the author use to illustrate the effects of division of labor in a ""very trifling manufacture""?","THE greatest improvement in the productive powers of labour, and the greater part of the skill, dexterity, and judgment with which it is any where directed, or applied, seem to have been the effects of the division of labour. The effects of the division of labour, in the general business of society, will be more easily understood, by considering in what manner it operates in some particular manufactures. It is commonly supposed to be carried i furthest in some very trifling ones; not perhaps that it really is carried further in them than in others of more importance: but in those trifling manufactures which are destined to supply the small wants of but a small number of people, the whole number of workmen must necessarily be small; and those employed in every different branch of the work can often be collected into the same [7] workhouse, and placed at once under the view of the spectator. In those great manufactures, on the contrary, which are _- destined to supply the great wants of the great body of the people, every different branch of the work employs so great a number of workmen, that it is impossible to collect them all into the same workhouse. We can seldom b see more, at one time, than those employed in one single branch. Though [ bin such manufactures, b therefore, the work may really be divided into a r much greater number of parts, than in those of a more trifling nature, the division is not near so obvious, and has accordingly been much less observed. 3 To take an example, therefore, from a very trifling manufacture; but one in which the division of labour has been very often taken notice of, the trade of the pin-maker; a workman not educated to this business (which the division of labour has rendered a distinct trade), nor acquainted with the use of the machinery employed in it (to the invention of which the same division of labour has probably given occasion), could scarce, perhaps, with his utmost industry, make one pin in a day, and certainly could not make twenty. 2 But in the way in which this business is now carried on, not only the whole work is a peculiar trade, but it is divided into a number of branches, of which the greater part are likewise peculiar trades. One man draws out the wire, another straights it, a third cuts it, a fourth points it, a fifth grinds it at the top for receiving the head; to make the head requires [8] two or three distinct operations; to put it on, is a peculiar business, to whiten the pins is another; it is even a trade by itself to put them into the paper; and the important business of making a pin is, in this manner, divided into about eighteen distinct operations, 3 which, in some manufactories, are all performed by distinct hands, though in others the same man will sometimes perform two or three of them. I have seen a small manufactory of this kind where ten men only were employed, and where some of them consequently performed two or three distinct operations. But though they were very poor, and therefore but indifferently accommodated with the necessary machinery, they could, when they exerted themselves, make among them about twelve pounds of pins in a day. 4 There are in a pound upwards of four thousand pins of a middling size. Those ten persons, therefore, could make among them upwards of forty-eight thousand pins in a day. Each person, therefore, making a tenth part of forty-eight thousand pins, might be considered as making four thousand eight hundred pins in a day. But if they had all wrought separately and independently, and without any of them having been educated to this peculiar business, they certainly could not each of them have made twenty, perhaps not one pin in a day; that is, certainly, not the two hundred and fortieth, perhaps not the four thousand eight hundredth part of what they are at present capable of performing, in consequence of [9] a proper division and combination of their different operations. 4 In every other art and manufacture, the effects of the division of labour are similar to what they are in this very trifling one; though, in many of them, the labour can neither be so much subdivided, nor reduced to so great a simplicity of operation. The division of labour, however, so far as it can be introduced, occasions, in every art, a proportionable increase of the productive powers of labour. The separation of different trades and employments from one another, seems to have taken place, in consequence of this advantage. This separation too is generally carried furthest in those countries which enjoy the highest degree of industry and improvement; what is the work of one man, in a rude state of society, being generally that of several in an improved one. In every improved society, the farmer is generally nothing but a farmer; the manufacturer, nothing but a manufactures The labour too which is necessary to produce any one complete manufacture, is almost always divided among a great number of hands. How many different trades are employed in each branch of the linen and woollen manufactures, from the growers of the flax and the wool, to the bleachers and smoothers of the linen, or to the dyers and dressers of the cloth[ The nature of agriculture, indeed, does not admit of so many subdivisions of labour, nor of so complete a separation of one business from another, as manufactures.6 It is impossible to separate so entirely, the business of the grazer from that of the corn-farmer, as the trade of the carpenter is commonly separated from that of the smith. The spinner is almost always a distinct person from the weaver; but the ploughman, the harrower, the sower of the seed, and the reaper of the corn, are often the same. 7The occasions for those different sorts of labour returning with the different seasons of the year, it is impossible that one man should be constantly employed in any one of them. This impossibility of m_ing so complete and entire a separation of all the different branches of labour employed in agriculture, is perhaps the reason why the improvement of the productive powers of labour in this art, does not always keep pace with their improvement in manufactures. The most opulent nations, indeed, generally excel all their neighbours in agriculture as well as in manufactures; but they are commonly more distinguished by their superiority in the latter than in the farmers Their lands are in general better cultivated, and having more labour and expence bestowed upon them, produce more, in proportion to the extent and natural fertility of the ground. But this superiority of produce is seldom much more than in proportion to the superiority of labour and expence. In agriculture, the labour of the rich country is not always much more productive than that of the poor; or, at least, it is never so much more productive, as it commonly is in manufactures. The corn of the rich country, therefore, will not always, in the same degree of goodness, come cheaper to [ix] market than that of the poor. The corn of Poland, in the same degree of goodness, is as cheap as that of France, notwithstanding the superior opulence and improvement of the latter country. The corn of France is, in the corn provinces, fully as good, and in most years nearly about the same price with the corn of England, though, in opulence and improvement, France is perhaps inferior to England. The acorn-lands of England, however, are better cultivated than those of France, and the acorn-lands f France are said to be much better cultivated than those of Poland. But though the poor country, notwithstanding the inferiority of its cultivation, can, in some measure, rival the rich in the cheapness and goodness of its corn, it can pretend to no such competition in its manufactures; at least if those manufactures suit the soil, climate, and situation of the rich country. The silks of France are better and cheaper than those of England, because the silk manufacture, _at least under the present high duties upon the importation of raw silk/does not so well suit the climate of England has that of France. n But the hard-ware and the coarse woolens of England are beyond all comparison superior to those of France, and much cheaper too in the same degree of goodness. 9 In Poland there are said to be scarce any manufactures of any kind, a few of those coarser household manufactures excepted, without which no country can well subsist.","Respond to the prompt using only information provided in the context block. Do not use any external knowledge or information not present in the given text. Your response should focus on providing factual details from the text. Use formal language and avoid any personal opinions or interpretations. If the prompt asks about something not covered in the context, state that the information is not available in the given text. What specific example does the author use to illustrate the effects of division of labor in a ""very trifling manufacture""? THE greatest improvement in the productive powers of labour, and the greater part of the skill, dexterity, and judgment with which it is any where directed, or applied, seem to have been the effects of the division of labour. The effects of the division of labour, in the general business of society, will be more easily understood, by considering in what manner it operates in some particular manufactures. It is commonly supposed to be carried i furthest in some very trifling ones; not perhaps that it really is carried further in them than in others of more importance: but in those trifling manufactures which are destined to supply the small wants of but a small number of people, the whole number of workmen must necessarily be small; and those employed in every different branch of the work can often be collected into the same [7] workhouse, and placed at once under the view of the spectator. In those great manufactures, on the contrary, which are _- destined to supply the great wants of the great body of the people, every different branch of the work employs so great a number of workmen, that it is impossible to collect them all into the same workhouse. We can seldom b see more, at one time, than those employed in one single branch. Though [ bin such manufactures, b therefore, the work may really be divided into a r much greater number of parts, than in those of a more trifling nature, the division is not near so obvious, and has accordingly been much less observed. 3 To take an example, therefore, from a very trifling manufacture; but one in which the division of labour has been very often taken notice of, the trade of the pin-maker; a workman not educated to this business (which the division of labour has rendered a distinct trade), nor acquainted with the use of the machinery employed in it (to the invention of which the same division of labour has probably given occasion), could scarce, perhaps, with his utmost industry, make one pin in a day, and certainly could not make twenty. 2 But in the way in which this business is now carried on, not only the whole work is a peculiar trade, but it is divided into a number of branches, of which the greater part are likewise peculiar trades. One man draws out the wire, another straights it, a third cuts it, a fourth points it, a fifth grinds it at the top for receiving the head; to make the head requires [8] two or three distinct operations; to put it on, is a peculiar business, to whiten the pins is another; it is even a trade by itself to put them into the paper; and the important business of making a pin is, in this manner, divided into about eighteen distinct operations, 3 which, in some manufactories, are all performed by distinct hands, though in others the same man will sometimes perform two or three of them. I have seen a small manufactory of this kind where ten men only were employed, and where some of them consequently performed two or three distinct operations. But though they were very poor, and therefore but indifferently accommodated with the necessary machinery, they could, when they exerted themselves, make among them about twelve pounds of pins in a day. 4 There are in a pound upwards of four thousand pins of a middling size. Those ten persons, therefore, could make among them upwards of forty-eight thousand pins in a day. Each person, therefore, making a tenth part of forty-eight thousand pins, might be considered as making four thousand eight hundred pins in a day. But if they had all wrought separately and independently, and without any of them having been educated to this peculiar business, they certainly could not each of them have made twenty, perhaps not one pin in a day; that is, certainly, not the two hundred and fortieth, perhaps not the four thousand eight hundredth part of what they are at present capable of performing, in consequence of [9] a proper division and combination of their different operations. 4 In every other art and manufacture, the effects of the division of labour are similar to what they are in this very trifling one; though, in many of them, the labour can neither be so much subdivided, nor reduced to so great a simplicity of operation. The division of labour, however, so far as it can be introduced, occasions, in every art, a proportionable increase of the productive powers of labour. The separation of different trades and employments from one another, seems to have taken place, in consequence of this advantage. This separation too is generally carried furthest in those countries which enjoy the highest degree of industry and improvement; what is the work of one man, in a rude state of society, being generally that of several in an improved one. In every improved society, the farmer is generally nothing but a farmer; the manufacturer, nothing but a manufactures The labour too which is necessary to produce any one complete manufacture, is almost always divided among a great number of hands. How many different trades are employed in each branch of the linen and woollen manufactures, from the growers of the flax and the wool, to the bleachers and smoothers of the linen, or to the dyers and dressers of the cloth[ The nature of agriculture, indeed, does not admit of so many subdivisions of labour, nor of so complete a separation of one business from another, as manufactures.6 It is impossible to separate so entirely, the business of the grazer from that of the corn-farmer, as the trade of the carpenter is commonly separated from that of the smith. The spinner is almost always a distinct person from the weaver; but the ploughman, the harrower, the sower of the seed, and the reaper of the corn, are often the same. 7The occasions for those different sorts of labour returning with the different seasons of the year, it is impossible that one man should be constantly employed in any one of them. This impossibility of m_ing so complete and entire a separation of all the different branches of labour employed in agriculture, is perhaps the reason why the improvement of the productive powers of labour in this art, does not always keep pace with their improvement in manufactures. The most opulent nations, indeed, generally excel all their neighbours in agriculture as well as in manufactures; but they are commonly more distinguished by their superiority in the latter than in the farmers Their lands are in general better cultivated, and having more labour and expence bestowed upon them, produce more, in proportion to the extent and natural fertility of the ground. But this superiority of produce is seldom much more than in proportion to the superiority of labour and expence. In agriculture, the labour of the rich country is not always much more productive than that of the poor; or, at least, it is never so much more productive, as it commonly is in manufactures. The corn of the rich country, therefore, will not always, in the same degree of goodness, come cheaper to [ix] market than that of the poor. The corn of Poland, in the same degree of goodness, is as cheap as that of France, notwithstanding the superior opulence and improvement of the latter country. The corn of France is, in the corn provinces, fully as good, and in most years nearly about the same price with the corn of England, though, in opulence and improvement, France is perhaps inferior to England. The acorn-lands of England, however, are better cultivated than those of France, and the acorn-lands f France are said to be much better cultivated than those of Poland. But though the poor country, notwithstanding the inferiority of its cultivation, can, in some measure, rival the rich in the cheapness and goodness of its corn, it can pretend to no such competition in its manufactures; at least if those manufactures suit the soil, climate, and situation of the rich country. The silks of France are better and cheaper than those of England, because the silk manufacture, _at least under the present high duties upon the importation of raw silk/does not so well suit the climate of England has that of France. n But the hard-ware and the coarse woolens of England are beyond all comparison superior to those of France, and much cheaper too in the same degree of goodness. 9 In Poland there are said to be scarce any manufactures of any kind, a few of those coarser household manufactures excepted, without which no country can well subsist.",Financial,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Summarize the updated cancer treatments for 2024 in terms a 7th grade student can understand. Include important statistics for all the options that include them.,"1. Personalized cancer vaccines Thousands of NHS cancer patients in England could soon access trials of a new vaccine treatment. It's designed to prime the immune system to target cancer cells and reduce recurrence risk. These vaccines are also hoped to produce fewer side effects than conventional chemotherapy. Thirty hospitals have joined the Cancer Vaccine Launch Pad, which matches patients with upcoming trials using the same mRNA technology found in current COVID-19 jabs. Over 200 patients from the UK, Germany, Belgium, Spain and Sweden will receive up to 15 doses of the personalized vaccine, with the study expected to complete by 2027. 2. Test to identify 18 early-stage cancers Researchers in the US have developed a test they say can identify 18 early-stage cancers. Instead of the usual invasive and costly methods, Novelna's test works by analyzing a patient's blood protein. In a screening of 440 people already diagnosed with cancer, the test correctly identified 93% of stage 1 cancers in men and 84% in women. The researchers believe the findings ""pave the way for a cost-effective, highly accurate, multi-cancer screening test that can be implemented on a population-wide scale"". It's early days, however. With such a small sample screening and a lack of information on co-existing conditions, the test is currently more of ""a starting point for developing a new generation of screening tests for the early detection of cancer"". 3. Seven-minute cancer treatment jab England's National Health Service (NHS) is to be the first in the world to make use of a cancer treatment injection, which takes just seven minutes to administer, rather than the current time of up to an hour to have the same drug via intravenous infusion. This will not only speed up the treatment process for patients, but also free up time for medical professionals. The drug, Atezolizumab or Tecentriq, treats cancers including lung and breast, and it's expected most of the 3,600 NHS patients in England currently receiving it intravenously will now switch to the jab. 4. Precision oncology Precision oncology is the “best new weapon to defeat cancer”, the chief executive of Genetron Health, Sizhen Wang, says in a blog for the World Economic Forum. This involves studying the genetic makeup and molecular characteristics of cancer tumours in individual patients. The precision oncology approach identifies changes in cells that might be causing the cancer to grow and spread. Personalized treatments can then be developed. The 100,000 Genomes Project, a National Health Service initiative, studied more than 13,000 tumour samples from UK cancer patients, successfully integrating genomic data to more accurately pin-point effective treatment. Because precision oncology treatments are targeted – as opposed to general treatments like chemotherapy – it can mean less harm to healthy cells and fewer side effects as a result. 5. Artificial intelligence fights cancer In India, World Economic Forum partners are using emerging technologies like artificial intelligence (AI) and machine learning to transform cancer care. For example, AI-based risk profiling can help screen for common cancers like breast cancer, leading to early diagnosis. AI technology can also be used to analyze X-rays to identify cancers in places where imaging experts might not be available. These are two of 18 cancer interventions that The Centre for the Fourth Industrial Revolution India, a collaboration with the Forum, hopes to accelerate. 6. Greater prediction capabilities Lung cancer kills more people in the US yearly than the next three deadliest cancers combined. It's notoriously hard to detect the early stages of the disease with X-rays and scans alone. However, MIT scientists have developed an AI learning model to predict a person's likelihood of developing lung cancer up to six years in advance via a low-dose CT scan. Trained using complex imaging data, 'Sybil' can forecast both short- and long-term lung cancer risk, according to a recent study. ""We found that while we as humans couldn't quite see where the cancer was, the model could still have some predictive power as to which lung would eventually develop cancer,"" said co-author Jeremy Wohlwend. 7. Clues in the DNA of cancer At Cambridge University Hospitals in England, the DNA of cancer tumours from 12,000 patients is revealing new clues about the causes of cancer, scientists say. By analyzing genomic data, oncologists are identifying different mutations that have contributed to each person’s cancer. For example, exposure to smoking or UV light, or internal malfunctions in cells. These are like “fingerprints in a crime scene”, the scientists say – and more of them are being found. “We uncovered 58 new mutational signatures and broadened our knowledge of cancer,” says study author Dr Andrea Degasperi, from Cambridge’s Department of Oncology. 8. Liquid and synthetic biopsies Biopsies are the main way doctors diagnose cancer – but the process is invasive and involves removing a section of tissue from the body, sometimes surgically, so it can be examined in a laboratory. Liquid biopsies are an easier and less invasive solution where blood samples can be tested for signs of cancer. Synthetic biopsies are another innovation that can force cancer cells to reveal themselves during the earliest stages of the disease. 9. CAR-T-cell therapy A treatment that makes immune cells hunt down and kill cancer cells was declared a success for leukaemia patients in 2022. Known as CAR-T-cell therapy, it involves removing and genetically altering immune cells, called T cells, from cancer patients. The altered cells then produce proteins called chimeric antigen receptors (CARs), which can recognize and destroy cancer cells. In the journal Nature, scientists at the University of Pennsylvania announced that two of the first people treated with CAR-T-cell therapy were still in remission 12 years on. However, the US Food and Drug Administration is currently investigating whether the process can in fact cause cancer, after 33 cases of secondary cancer were observed in patients receiving CAR-T therapies. The jury is still out as to whether the therapy is to blame but, as a precaution, the drug packaging now carries a warning. 10. Fighting pancreatic cancer Pancreatic cancer is one of the deadliest cancers. It is rarely diagnosed before it starts to spread and has a survival rate of less than 5% over five years. At the University of California San Diego School of Medicine, scientists developed a test that identified 95% of early pancreatic cancers in a study. The research, published in Nature Communications Medicine, explains how biomarkers in extracellular vesicles – particles that regulate communication between cells – were used to detect pancreatic, ovarian and bladder cancer at stages I and II. Scientists are also getting closer to a cure. A new US/UK study has discovered that pancreatic cancer shuts down particular molecules in a key gene. The hope now is that the new knowledge ""could lead to the development of more effective treatment options in the future”, Dr Chris Macdonald, head of research at Pancreatic Cancer UK, told The Guardian. 11. A tablet to cut breast cancer risk A drug that could halve the chance of women developing breast cancer is being tested out by England's National Health Service (NHS). It will be made available to almost 300,000 women seen as being at most risk of developing breast cancer, which is the most common type of cancer in the UK. The drug, named anastrozole, cuts the level of oestrogen women produce by blocking the enzyme aromatase. It has already been used for many years as a breast cancer treatment but has now been repurposed as a preventive medicine. “This is the first drug to be repurposed through a world-leading new programme to help us realize the full potential of existing medicines in new uses to save and improve more lives on the NHS,"" says NHS Chief Executive Amanda Pritchard.","""================ ======= 1. Personalized cancer vaccines Thousands of NHS cancer patients in England could soon access trials of a new vaccine treatment. It's designed to prime the immune system to target cancer cells and reduce recurrence risk. These vaccines are also hoped to produce fewer side effects than conventional chemotherapy. Thirty hospitals have joined the Cancer Vaccine Launch Pad, which matches patients with upcoming trials using the same mRNA technology found in current COVID-19 jabs. Over 200 patients from the UK, Germany, Belgium, Spain and Sweden will receive up to 15 doses of the personalized vaccine, with the study expected to complete by 2027. 2. Test to identify 18 early-stage cancers Researchers in the US have developed a test they say can identify 18 early-stage cancers. Instead of the usual invasive and costly methods, Novelna's test works by analyzing a patient's blood protein. In a screening of 440 people already diagnosed with cancer, the test correctly identified 93% of stage 1 cancers in men and 84% in women. The researchers believe the findings ""pave the way for a cost-effective, highly accurate, multi-cancer screening test that can be implemented on a population-wide scale"". It's early days, however. With such a small sample screening and a lack of information on co-existing conditions, the test is currently more of ""a starting point for developing a new generation of screening tests for the early detection of cancer"". 3. Seven-minute cancer treatment jab England's National Health Service (NHS) is to be the first in the world to make use of a cancer treatment injection, which takes just seven minutes to administer, rather than the current time of up to an hour to have the same drug via intravenous infusion. This will not only speed up the treatment process for patients, but also free up time for medical professionals. The drug, Atezolizumab or Tecentriq, treats cancers including lung and breast, and it's expected most of the 3,600 NHS patients in England currently receiving it intravenously will now switch to the jab. 4. Precision oncology Precision oncology is the “best new weapon to defeat cancer”, the chief executive of Genetron Health, Sizhen Wang, says in a blog for the World Economic Forum. This involves studying the genetic makeup and molecular characteristics of cancer tumours in individual patients. The precision oncology approach identifies changes in cells that might be causing the cancer to grow and spread. Personalized treatments can then be developed. The 100,000 Genomes Project, a National Health Service initiative, studied more than 13,000 tumour samples from UK cancer patients, successfully integrating genomic data to more accurately pin-point effective treatment. Because precision oncology treatments are targeted – as opposed to general treatments like chemotherapy – it can mean less harm to healthy cells and fewer side effects as a result. 5. Artificial intelligence fights cancer In India, World Economic Forum partners are using emerging technologies like artificial intelligence (AI) and machine learning to transform cancer care. For example, AI-based risk profiling can help screen for common cancers like breast cancer, leading to early diagnosis. AI technology can also be used to analyze X-rays to identify cancers in places where imaging experts might not be available. These are two of 18 cancer interventions that The Centre for the Fourth Industrial Revolution India, a collaboration with the Forum, hopes to accelerate. 6. Greater prediction capabilities Lung cancer kills more people in the US yearly than the next three deadliest cancers combined. It's notoriously hard to detect the early stages of the disease with X-rays and scans alone. However, MIT scientists have developed an AI learning model to predict a person's likelihood of developing lung cancer up to six years in advance via a low-dose CT scan. Trained using complex imaging data, 'Sybil' can forecast both short- and long-term lung cancer risk, according to a recent study. ""We found that while we as humans couldn't quite see where the cancer was, the model could still have some predictive power as to which lung would eventually develop cancer,"" said co-author Jeremy Wohlwend. 7. Clues in the DNA of cancer At Cambridge University Hospitals in England, the DNA of cancer tumours from 12,000 patients is revealing new clues about the causes of cancer, scientists say. By analyzing genomic data, oncologists are identifying different mutations that have contributed to each person’s cancer. For example, exposure to smoking or UV light, or internal malfunctions in cells. These are like “fingerprints in a crime scene”, the scientists say – and more of them are being found. “We uncovered 58 new mutational signatures and broadened our knowledge of cancer,” says study author Dr Andrea Degasperi, from Cambridge’s Department of Oncology. 8. Liquid and synthetic biopsies Biopsies are the main way doctors diagnose cancer – but the process is invasive and involves removing a section of tissue from the body, sometimes surgically, so it can be examined in a laboratory. Liquid biopsies are an easier and less invasive solution where blood samples can be tested for signs of cancer. Synthetic biopsies are another innovation that can force cancer cells to reveal themselves during the earliest stages of the disease. 9. CAR-T-cell therapy A treatment that makes immune cells hunt down and kill cancer cells was declared a success for leukaemia patients in 2022. Known as CAR-T-cell therapy, it involves removing and genetically altering immune cells, called T cells, from cancer patients. The altered cells then produce proteins called chimeric antigen receptors (CARs), which can recognize and destroy cancer cells. In the journal Nature, scientists at the University of Pennsylvania announced that two of the first people treated with CAR-T-cell therapy were still in remission 12 years on. However, the US Food and Drug Administration is currently investigating whether the process can in fact cause cancer, after 33 cases of secondary cancer were observed in patients receiving CAR-T therapies. The jury is still out as to whether the therapy is to blame but, as a precaution, the drug packaging now carries a warning. 10. Fighting pancreatic cancer Pancreatic cancer is one of the deadliest cancers. It is rarely diagnosed before it starts to spread and has a survival rate of less than 5% over five years. At the University of California San Diego School of Medicine, scientists developed a test that identified 95% of early pancreatic cancers in a study. The research, published in Nature Communications Medicine, explains how biomarkers in extracellular vesicles – particles that regulate communication between cells – were used to detect pancreatic, ovarian and bladder cancer at stages I and II. Scientists are also getting closer to a cure. A new US/UK study has discovered that pancreatic cancer shuts down particular molecules in a key gene. The hope now is that the new knowledge ""could lead to the development of more effective treatment options in the future”, Dr Chris Macdonald, head of research at Pancreatic Cancer UK, told The Guardian. 11. A tablet to cut breast cancer risk A drug that could halve the chance of women developing breast cancer is being tested out by England's National Health Service (NHS). It will be made available to almost 300,000 women seen as being at most risk of developing breast cancer, which is the most common type of cancer in the UK. The drug, named anastrozole, cuts the level of oestrogen women produce by blocking the enzyme aromatase. It has already been used for many years as a breast cancer treatment but has now been repurposed as a preventive medicine. “This is the first drug to be repurposed through a world-leading new programme to help us realize the full potential of existing medicines in new uses to save and improve more lives on the NHS,"" says NHS Chief Executive Amanda Pritchard. https://www.weforum.org/agenda/2024/07/cancer-treatment-and-diagnosis-breakthroughs/ ================ ======= Summarize the updated cancer treatments for 2024 in terms a 7th grade student can understand. Include important statistics for all the options that include them. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Summarize & Simplify,Text Transformation System Instructions: [You may only use the provided context to answer. You must not use any outside sources or prior knowledge.],Question: [Summarize the role of Pros.],"Context: [DIFM Customers Intersecting our DIY customers and our Pros are our DIFM customers. These customers are typically homeowners who use Pros to complete their project or installation. Currently, we offer installation services in a variety of categories, such as flooring, water heaters, bath, garage doors, cabinets, cabinet makeovers, countertops, sheds, furnaces and central air systems, and windows. DIFM customers can purchase these services in our stores, online, or in their homes through in-home consultations. In addition to serving our DIFM customer needs, we believe our focus on the Pros who perform services for these customers helps us drive higher product sales. OUR PRODUCTS AND SERVICES A typical The Home Depot store stocks approximately 30,000 to 40,000 items during the year, including both national brand name and proprietary products. Our online product offerings complement our stores by serving as an extended aisle, and we offer a significantly broader product assortment through our websites and mobile applications, including homedepot.com, our primary website; homedepot.ca and homedepot.com.mx, our websites in Canada and Mexico, respectively; hdsupply.com, our website for our MRO products and related services; our websites for custom window coverings including blinds.com, justblinds.com and americanblinds.com; and thecompanystore.com, our website featuring textiles and décor products. Fiscal 2023 Form 10-K 2 Table of Contents We believe our merchandising organization is a key competitive advantage, delivering product innovation, assortment and value, which reinforces our position as the product authority in home improvement. In fiscal 2023, we continued to invest in merchandising resets in our stores to refine assortments, optimize space productivity, introduce innovative new products to our customers, and improve visual merchandising to drive a better shopping experience. At the same time, we remain focused on offering everyday values in our stores and online. To help our merchandising organization keep pace with changing customer expectations and increasing desire for innovation, localization, and personalization, we are continuing to invest in tools to better leverage our data and drive a deeper level of collaboration with our supplier partners. As a result, we have continued to focus on enhanced merchandising information technology tools to help us: (1) build an interconnected shopping experience that is tailored to our customers’ shopping intent and location; (2) provide the best value in the market; and (3) optimize our product assortments. Our merchandising team leverages technology and works closely with our inventory and supply chain teams, as well as our supplier partners, to manage our assortments, drive innovation, manage the cost environment, and adjust inventory levels to respond to fluctuations in demand. To complement our merchandising efforts, we offer a number of services for our customers, including installation services for our DIY and DIFM customers, as noted above. We also provide tool and equipment rentals at locations across the U.S. and Canada, providing value and convenience for both Pros and consumers. To improve the customer experience and continue to grow this differentiated service offering, we are continuing to invest in more locations (including continuing to pilot rental locations in Mexico), more tools, and better technology. Sourcing and Quality Assurance We maintain a global sourcing program to obtain high-quality and innovative products directly from manufacturers in the U.S. and around the world. During fiscal 2023, in addition to our U.S. sourcing operations, we maintained sourcing offices in Mexico, Canada, China, India, Vietnam and Europe. To ensure that suppliers adhere to our high standards of social and environmental responsibility, we also have a global responsible sourcing program. Under our supplier contracts, our suppliers are obligated to ensure that their products comply with applicable international, federal, state and local laws. These contracts also require compliance with our responsible sourcing standards, which cover a variety of expectations across multiple areas of social compliance, including supply chain transparency, compliance with applicable laws and regulations addressing prohibitions on child and forced labor, health and safety, environmental matters, compensation, and hours of work. To drive accountability with our suppliers, our standard supplier buying agreement includes a factory audit right related to these standards, and we conduct factory audits and compliance visits with non-Canada and non-U.S. suppliers of private branded and direct import products. Our 2023 Responsible Sourcing Report, available on our website at https://corporate.homedepot.com under “Responsibility > Sourcing Responsibly,” provides more information about this program. In addition, we have both quality assurance and engineering resources dedicated to establishing criteria and overseeing compliance with safety, quality and performance standards for our private branded products. Intellectual Property Our business has one of the most recognized brands in North America. As a result, we believe that The Home Depot trademark has significant value and is an important factor in the marketing of our products, e-commerce, stores and business. We have registered or applied for registration of trademarks, service marks, copyrights and internet domain names, both domestically and internationally, for use in our business, including our proprietary brands such as HDX , Husky , Hampton Bay , Home Decorators Collection , Glacier Bay , Vigoro , Everbilt and Lifeproof . The duration of trademark registrations varies from country to country. However, trademarks are generally valid and may be renewed indefinitely as long as they are in use and/or their registrations are properly maintained. We also maintain patent portfolios relating to our business operations, retail services, and products, and we seek to patent or otherwise protect innovations we incorporate into our business. Patents generally have a term of twenty years from the date they are filed. As our patent portfolio has been built over time, the remaining terms of the individual patents across our patent portfolio vary. Although our patents have value, no single patent is essential to our business. We continuously assess our merchandising departments and product lines for opportunities to expand the assortment of products offered within The Home Depot’s portfolio of proprietary and exclusive brands. COMPETITION AND SEASONALITY Our industry is highly competitive, fragmented, and evolving. As a result, we face competition for customers for our products and services from a variety of retailers, suppliers, service providers, and distributors and manufacturers that sell products directly to their respective customer bases. These competitors range from traditional brick-and-mortar, to multichannel, to exclusively online, and they include a number of other home improvement retailers; local, ® ® ® ® ® ® ® ® ® Fiscal 2023 Form 10-K 3 Table of Contents regional and national hardware stores; electrical, plumbing and building materials supply houses; and lumber yards. With respect to some products and services, we also compete with specialty design stores, showrooms, discount stores, paint stores, specialty and mass digital retailers, warehouse clubs, MRO distributors, home décor retailers, and other retailers, as well as with providers of home improvement services and tool and equipment rental. The internet facilitates competitive entry, price transparency, and comparison shopping, increasing the level of competition we face. Both in-store and online, we compete primarily based on customer experience, price, quality, product availability and assortment, and delivery options. We also compete based on store location and appearance, presentation of merchandise, and ease of shopping experience. Our Pros also look for dedicated sales support, competitive credit and pricing options, project planning tools, and product depth and job lot quantities, particularly for their complex purchase needs. Furthermore, with respect to delivery options, customers are seeking faster and/or guaranteed delivery times, low-price or free shipping, and/or convenient pickup options. Our ability to be competitive on delivery and pickup times, options and costs depends on many factors, including the success of our supply chain investments, described more fully under “Our Supply Chain” below. Our business is subject to seasonal influences. Generally, our highest volume of sales occurs in our second fiscal quarter, as we move into the spring season in the regions in which we operate.]","System Instructions: [You may only use the provided context to answer. You must not use any outside sources or prior knowledge.] Question: [Summarize the role of Pros.] Context: [DIFM Customers Intersecting our DIY customers and our Pros are our DIFM customers. These customers are typically homeowners who use Pros to complete their project or installation. Currently, we offer installation services in a variety of categories, such as flooring, water heaters, bath, garage doors, cabinets, cabinet makeovers, countertops, sheds, furnaces and central air systems, and windows. DIFM customers can purchase these services in our stores, online, or in their homes through in-home consultations. In addition to serving our DIFM customer needs, we believe our focus on the Pros who perform services for these customers helps us drive higher product sales. OUR PRODUCTS AND SERVICES A typical The Home Depot store stocks approximately 30,000 to 40,000 items during the year, including both national brand name and proprietary products. Our online product offerings complement our stores by serving as an extended aisle, and we offer a significantly broader product assortment through our websites and mobile applications, including homedepot.com, our primary website; homedepot.ca and homedepot.com.mx, our websites in Canada and Mexico, respectively; hdsupply.com, our website for our MRO products and related services; our websites for custom window coverings including blinds.com, justblinds.com and americanblinds.com; and thecompanystore.com, our website featuring textiles and décor products. Fiscal 2023 Form 10-K 2 Table of Contents We believe our merchandising organization is a key competitive advantage, delivering product innovation, assortment and value, which reinforces our position as the product authority in home improvement. In fiscal 2023, we continued to invest in merchandising resets in our stores to refine assortments, optimize space productivity, introduce innovative new products to our customers, and improve visual merchandising to drive a better shopping experience. At the same time, we remain focused on offering everyday values in our stores and online. To help our merchandising organization keep pace with changing customer expectations and increasing desire for innovation, localization, and personalization, we are continuing to invest in tools to better leverage our data and drive a deeper level of collaboration with our supplier partners. As a result, we have continued to focus on enhanced merchandising information technology tools to help us: (1) build an interconnected shopping experience that is tailored to our customers’ shopping intent and location; (2) provide the best value in the market; and (3) optimize our product assortments. Our merchandising team leverages technology and works closely with our inventory and supply chain teams, as well as our supplier partners, to manage our assortments, drive innovation, manage the cost environment, and adjust inventory levels to respond to fluctuations in demand. To complement our merchandising efforts, we offer a number of services for our customers, including installation services for our DIY and DIFM customers, as noted above. We also provide tool and equipment rentals at locations across the U.S. and Canada, providing value and convenience for both Pros and consumers. To improve the customer experience and continue to grow this differentiated service offering, we are continuing to invest in more locations (including continuing to pilot rental locations in Mexico), more tools, and better technology. Sourcing and Quality Assurance We maintain a global sourcing program to obtain high-quality and innovative products directly from manufacturers in the U.S. and around the world. During fiscal 2023, in addition to our U.S. sourcing operations, we maintained sourcing offices in Mexico, Canada, China, India, Vietnam and Europe. To ensure that suppliers adhere to our high standards of social and environmental responsibility, we also have a global responsible sourcing program. Under our supplier contracts, our suppliers are obligated to ensure that their products comply with applicable international, federal, state and local laws. These contracts also require compliance with our responsible sourcing standards, which cover a variety of expectations across multiple areas of social compliance, including supply chain transparency, compliance with applicable laws and regulations addressing prohibitions on child and forced labor, health and safety, environmental matters, compensation, and hours of work. To drive accountability with our suppliers, our standard supplier buying agreement includes a factory audit right related to these standards, and we conduct factory audits and compliance visits with non-Canada and non-U.S. suppliers of private branded and direct import products. Our 2023 Responsible Sourcing Report, available on our website at https://corporate.homedepot.com under “Responsibility > Sourcing Responsibly,” provides more information about this program. In addition, we have both quality assurance and engineering resources dedicated to establishing criteria and overseeing compliance with safety, quality and performance standards for our private branded products. Intellectual Property Our business has one of the most recognized brands in North America. As a result, we believe that The Home Depot trademark has significant value and is an important factor in the marketing of our products, e-commerce, stores and business. We have registered or applied for registration of trademarks, service marks, copyrights and internet domain names, both domestically and internationally, for use in our business, including our proprietary brands such as HDX , Husky , Hampton Bay , Home Decorators Collection , Glacier Bay , Vigoro , Everbilt and Lifeproof . The duration of trademark registrations varies from country to country. However, trademarks are generally valid and may be renewed indefinitely as long as they are in use and/or their registrations are properly maintained. We also maintain patent portfolios relating to our business operations, retail services, and products, and we seek to patent or otherwise protect innovations we incorporate into our business. Patents generally have a term of twenty years from the date they are filed. As our patent portfolio has been built over time, the remaining terms of the individual patents across our patent portfolio vary. Although our patents have value, no single patent is essential to our business. We continuously assess our merchandising departments and product lines for opportunities to expand the assortment of products offered within The Home Depot’s portfolio of proprietary and exclusive brands. COMPETITION AND SEASONALITY Our industry is highly competitive, fragmented, and evolving. As a result, we face competition for customers for our products and services from a variety of retailers, suppliers, service providers, and distributors and manufacturers that sell products directly to their respective customer bases. These competitors range from traditional brick-and-mortar, to multichannel, to exclusively online, and they include a number of other home improvement retailers; local, ® ® ® ® ® ® ® ® ® Fiscal 2023 Form 10-K 3 Table of Contents regional and national hardware stores; electrical, plumbing and building materials supply houses; and lumber yards. With respect to some products and services, we also compete with specialty design stores, showrooms, discount stores, paint stores, specialty and mass digital retailers, warehouse clubs, MRO distributors, home décor retailers, and other retailers, as well as with providers of home improvement services and tool and equipment rental. The internet facilitates competitive entry, price transparency, and comparison shopping, increasing the level of competition we face. Both in-store and online, we compete primarily based on customer experience, price, quality, product availability and assortment, and delivery options. We also compete based on store location and appearance, presentation of merchandise, and ease of shopping experience. Our Pros also look for dedicated sales support, competitive credit and pricing options, project planning tools, and product depth and job lot quantities, particularly for their complex purchase needs. Furthermore, with respect to delivery options, customers are seeking faster and/or guaranteed delivery times, low-price or free shipping, and/or convenient pickup options. Our ability to be competitive on delivery and pickup times, options and costs depends on many factors, including the success of our supply chain investments, described more fully under “Our Supply Chain” below. Our business is subject to seasonal influences. Generally, our highest volume of sales occurs in our second fiscal quarter, as we move into the spring season in the regions in which we operate.]",Retail/Product,Find & Summarize,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","What is the ID and name of the FMR bulletin, when is a briefing expected from each department, and which departments should provide it? Also, when do operating plans need to be submitted to the Committees on Appropriations? Which cabinet departments are specifically mentioned?","This Committee Report provides additional direction and specificity on the uses of funds provided in this bill. During fiscal year 2025, for the purposes of the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, with respect to appropriations contained in the accompanying bill, the terms ``program, project, and activity'' [PPA] shall mean any item for which a dollar amount is contained in appropriations acts (including joint resolutions providing continuing appropriations) or accompanying reports of the House and Senate Committees on Appropriations, or accompanying conference reports and joint explanatory statements of the committee of conference. The Committee continues longstanding reprogramming requirements and limitations regarding changes to funding for PPAs. The Committee expects agencies to submit any reprogramming requests in compliance with requirements of this act and to provide a thorough explanation of the proposed reallocations, including a detailed justification of increases and reductions. The Committee expects each agency to manage the expenditures of its programs and activities to remain within the amounts appropriated by Congress. The Committee also continues the longstanding requirement that each agency submit an operating plan to the House and Senate Committees on Appropriations not later than 45 days after enactment of this act, in order to establish the baseline for application of reprogramming and transfer authorities provided in this act. The operating plan should include at minimum funding for PPAs as specified above. The Committee reminds agencies funded by this act of their obligation to uphold the Federal trust and treaty responsibilities to Tribes and Federal obligations to the Native Hawaiian Community. This includes upholding treaty and reserved rights, and any other rights and obligations under Federal law; supporting self-determination efforts by Native communities; fulfilling obligations under Presidential Memoranda and Executive Orders; and conducting early and robust government-to-government consultation with Tribes, and meaningful outreach and engagement with Native Hawaiians. The Committee also directs the Secretary of Education, Secretary of Health and Human Services, and Secretary of Labor to release public reports detailing how the Departments are addressing antisemitism, including by implementing the National Strategy to Counter Antisemitism. The Committee directs the Secretary of Education, Secretary of Health and Human Services, and Secretary of Labor to brief the House and Senate Committees on Appropriations no later than 90 days after enactment of this act regarding any strategic plans developed by the Department over the three prior fiscal years outlining the ways that the Department has promoted voter registration, and voter participation. The Committee is encouraged by the General Services Administration's Bulletin FMR C-2024-01, ``Safety Station Program Guidelines in Federal Facilities'' that was issued on December 21, 2023. The Committee encourages all Departments covered in this act to implement these guidelines and establish safety stations in each public building that include automated external defibrillators, opioid reversal agents, and hemorrhagic control programs and requests a briefing from each Department within 90 days of enactment of this act on progress towards implementing these guidelines. The Committee continues to appreciate the close working relationship with the various budget offices of the agencies funded in this bill. Maintaining these relationships is critical for the Committee to perform its duties in both developing these funding requirements and recommendations and providing oversight over the execution of funds.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. What is the ID and name of the FMR bulletin, when is a briefing expected from each department, and which departments should provide it? Also, when do operating plans need to be submitted to the Committees on Appropriations? Which cabinet departments are specifically mentioned? This Committee Report provides additional direction and specificity on the uses of funds provided in this bill. During fiscal year 2025, for the purposes of the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, with respect to appropriations contained in the accompanying bill, the terms ``program, project, and activity'' [PPA] shall mean any item for which a dollar amount is contained in appropriations acts (including joint resolutions providing continuing appropriations) or accompanying reports of the House and Senate Committees on Appropriations, or accompanying conference reports and joint explanatory statements of the committee of conference. The Committee continues longstanding reprogramming requirements and limitations regarding changes to funding for PPAs. The Committee expects agencies to submit any reprogramming requests in compliance with requirements of this act and to provide a thorough explanation of the proposed reallocations, including a detailed justification of increases and reductions. The Committee expects each agency to manage the expenditures of its programs and activities to remain within the amounts appropriated by Congress. The Committee also continues the longstanding requirement that each agency submit an operating plan to the House and Senate Committees on Appropriations not later than 45 days after enactment of this act, in order to establish the baseline for application of reprogramming and transfer authorities provided in this act. The operating plan should include at minimum funding for PPAs as specified above. The Committee reminds agencies funded by this act of their obligation to uphold the Federal trust and treaty responsibilities to Tribes and Federal obligations to the Native Hawaiian Community. This includes upholding treaty and reserved rights, and any other rights and obligations under Federal law; supporting self-determination efforts by Native communities; fulfilling obligations under Presidential Memoranda and Executive Orders; and conducting early and robust government-to-government consultation with Tribes, and meaningful outreach and engagement with Native Hawaiians. The Committee also directs the Secretary of Education, Secretary of Health and Human Services, and Secretary of Labor to release public reports detailing how the Departments are addressing antisemitism, including by implementing the National Strategy to Counter Antisemitism. The Committee directs the Secretary of Education, Secretary of Health and Human Services, and Secretary of Labor to brief the House and Senate Committees on Appropriations no later than 90 days after enactment of this act regarding any strategic plans developed by the Department over the three prior fiscal years outlining the ways that the Department has promoted voter registration, and voter participation. The Committee is encouraged by the General Services Administration's Bulletin FMR C-2024-01, ``Safety Station Program Guidelines in Federal Facilities'' that was issued on December 21, 2023. The Committee encourages all Departments covered in this act to implement these guidelines and establish safety stations in each public building that include automated external defibrillators, opioid reversal agents, and hemorrhagic control programs and requests a briefing from each Department within 90 days of enactment of this act on progress towards implementing these guidelines. The Committee continues to appreciate the close working relationship with the various budget offices of the agencies funded in this bill. Maintaining these relationships is critical for the Committee to perform its duties in both developing these funding requirements and recommendations and providing oversight over the execution of funds. https://www.congress.gov/congressional-report/118th-congress/senate-report/207/1",Legal,Fact Finding,Q&A "Provide your answer in full sentences, referencing the document using quotations.","According to the text, why is the T-Mobile/Sprint merger considered a disaster?","The Real Dish on the T-Mobile/Sprint Merger: A Disastrous Deal From the Start When the Trump-era DOJ allowed T-Mobile and Sprint to merge in July 2019, it promised the best of both worlds: consumers would benefit from T-Mobile’s accelerated 5G deployment and retain a fourth wireless provider. To effect the latter, then-AAG Makan Delrahim devised a divestiture that would reposition satellite-TV provider DISH as Sprint’s replacement. Here was his plan: Sprint would sell its prepaid-wireless assets to DISH. These assets included Sprint’s 9.3 million prepaid subscribers, its Boost brand, its 800 MHz spectrum licenses, and the Sprint stores and cell towers that the new T-Mobile did not want. DISH would then use these cell sites and its pre-existing spectrum, augmented from the divestiture, to build its own wireless network using never-before-deployed technology. While DISH worked on its complex nationwide build, it could serve its customers by paying for them to roam on the new T-Mobile’s infrastructure for seven years. Not even two years later, Delrahim’s plan is already falling apart. The prepaid customers DISH inherited from Sprint disproportionately buy cheap wireless service, which runs on the old CDMA standard used in 3G networks. In the latest turn of events, T-Mobile announced last month that it would discontinue its CDMA service in January 2022, nearly two years ahead of schedule. With T-Mobile’s shutdown, DISH’s customers will have to “get new devices, new SIMs, or upgrade via software.” DISH now has to take on an unexpected upgrade that will cost hundreds of millions of dollars. T-Mobile’s announcement led DISH CEO Charlie Ergen to denounce the unexpected shutdown as “anticompetitive.” DISH has already warned investors that with the shutdown, its trend of bleeding hundreds of thousands of subscribers may soon turn into a hemorrhage. For T-Mobile, this is great news, since many of the subscribers ditching DISH are bound to turn to T-Mobile’s own cheap wireless plan. But for price-sensitive consumers, the forecast is grim: while they could choose between T-Mobile and Sprint before the merger, these dissatisfied customers now effectively face a monopoly provider. It should come as no surprise that DISH is struggling in the wireless market, and price-conscious consumers are bearing the brunt of harm from the merger’s fallout. We knew back in 2011 that T-Mobile and Sprint competed particularly closely in low-cost wireless services. We also knew from DOJ’s longstanding Merger Remedies Policy that remedies should not require an entrant like DISH to depend on an incumbent who is a direct rival; it makes perfect sense that T-Mobile would rebel against helping DISH grow into a firm that can compete against T-Mobile itself. Not only was the DISH divestiture ill-devised, but the T-Mobile/Sprint merger never did pass muster under basic logic. If it was really critical to keep four players in the wireless market—so important that DISH needed to enter—why even let T-Mobile buy Sprint in the first place? Why not just keep the existing fourth player, instead of designing a Rube Goldberg settlement in the hopes that a new player will grow to have the competitive force of Sprint in seven years’ time? These frustrations have fueled heated criticism of the merger. Such critiques are well-placed, as the merger has already produced harm and threatens to wreak more damage. Besides hobbling DISH, T-Mobile will degrade the quality of its service this April by automatically enrolling its subscribers into an aggressive, personalized ad-targeting program. T-Mobile has also signaled to investors that it has become more like its rivals Verizon and AT&T. On an investor call in February, CEO Mike Sievert said, “We’ve competed mostly on price in the past, if we’re honest. Now, we have a premium product.” Translation: the era of aggressive price competition in wireless is over. Looking forward, we can expect T-Mobile, AT&T, and Verizon to nestle into a cozy triopoly that returns immense profits to their shareholders. T-Mobile is already prepared to deliver on this prospect. On March 11, it predicted to investors that its free cash flow will be flush enough to support a $60 billion stock buyback within five years. Stock buybacks benefit the investor class, whose members are disproportionately the wealthiest people in America; recent surveys show that the top 10 percent of households own approximately 80 percent of all stocks. In contrast, nearly all households across the income distribution buy wireless services, and low-income households particularly favor prepaid plans, a segment where T-Mobile and Sprint had competed vigorously pre-merger. With its latest proclamations to investors, T-Mobile celebrates the fact that its merger will transfer billions of wealth from average Americans to the rich, further widening the chasm between the haves and have-nots. For this reason and many others, the T-Mobile/Sprint deal will go down as one of the worst merger-enforcement decisions in decades. “THE T-MOBILE/SPRINT DEAL WILL GO DOWN AS ONE OF THE WORST MERGER-ENFORCEMENT DECISIONS IN DECADES.” In this postmortem, we examine how the deal came to close, and what we might learn from the mistakes made along the way. The Prosecutor: Dealmaker Delrahim Helming DOJ DOJ should never have approved the deal in the first place. The T-Mobile/Sprint merger presented a harmful 4-to-3 combination in the critical and well-defined market of mobile wireless services. Four-to-three mergers deservedly raise eyebrows, and evidence from other countries showed that 4-3 mergers in the wireless market would increase prices. Further, the post-merger market shares blasted through the HHI thresholds in the Horizontal Merger Guidelines, making the transaction presumptively anticompetitive. As such, a settlement should never have been on the table. But after many years of trying to merge, the parties finally found a receptive agency head in Delrahim, the “veteran lobbyist” tapped to be head of the Trump Administration’s Antitrust Division. When presented with the deal, Delrahim was eager to refashion the telecom market and less eager to deliver on his charge of protecting consumer welfare. Delrahim took a series of unorthodox steps. He became a mediator between the parties, helping hold the deal together when tensions between the CEOs ran high. He exchanged text messages with Ergen and advised him on how to secure regulatory approval from the Federal Communications Commission, which also needed to approve the deal. And when the parties closed their transaction in July 2020, Delrahim issued a press release to “congratulate” T-Mobile and Sprint for merging. Not only did his conduct conflict with his role as the nation’s head antitrust enforcer, but the behavioral remedy Delrahim reached in T-Mobile/Sprint contradicted his 2017 statements. Then, with an eye toward signaling his unwillingness to settle in AT&T/Time Warner, he inveighed against behavioral remedies. “[A]t times antitrust enforcers have experimented with allowing illegal mergers to proceed subject to certain behavioral commitments. That approach is fundamentally regulatory, imposing ongoing government oversight on what should preferably be a free market.” He added, “[I]f a merger is illegal, we should only accept a clean and complete solution.” Perhaps Delrahim was conscious of his hypocrisy when he later announced the settlement he had reached in the T-Mobile/Sprint merger, as he was careful to cast it as “structural” and not “behavioral.” But because the crux of the settlement is to have DISH roam on T-Mobile’s network for seven years, the settlement is behavioral at its core. Studying the divestiture against the Trump-era DOJ’s handling of other antitrust cases sheds additional light. Compare Delrahim’s adamant refusal to accept behavioral conditions when the parties proposed them in AT&T/Time Warner—which presented a weaker merits case—with his enthusiasm to strike behavioral conditions in the T-Mobile/Sprint divestiture to DISH—even though this 4-3 merger was presumptively illegal and raised nearly every red flag in the Horizontal Merger Guidelines. Taken together, these two decisions cannot be reconciled on principle. The Court: Judge Marrero Fails as “Fortuneteller” Because the Delrahim-led DOJ was derelict in policing the T-Mobile/Sprint deal, a group of states challenged the merger in federal court. In presenting their case, they pointed out flaws in the DISH settlement—chiefly that the divestiture relied on T-Mobile to help DISH grow to scale in wireless, but T-Mobile would have the ability and incentive to cripple DISH. At trial in the Southern District of New York, Ergen testified that he was confident DISH would receive adequate service from T-Mobile through the roaming agreement, even though new T-Mobile and DISH would compete for wireless subscribers. He offered that DISH had never had a problem with buying services from AT&T, despite AT&T’s DirecTV competing head-to-head with DISH’s satellite-television offering. Ergen, however, conveniently omitted the fact that AT&T, after merging with Time Warner, had blacked out HBO and Cinemax for DISH’s satellite and Sling TV subscribers. The loss of AT&T’s content contributed to DISH’s loss of more than 330,000 subscribers that quarter. Despite this recent experience, Ergen maintained in court that there would be no problem with DISH relying on a direct competitor for a critical input in the mobile-wireless industry it was preparing to enter. Judge Victor Marrero did pick up on this danger during his questioning at trial, but he ultimately believed the DOJ-appointed monitor and wholesale-price formula would be enough to rein in T-Mobile’s incentives. We have now seen that those checks were inadequate. This is no surprise, as economic theory predicts that companies’ profit incentives are strong enough to overcome inevitably incomplete contractual restraints. More generally, Judge Marrero underestimated the strength of the parties’ incentives in his assessment of the merger. Instead of accounting for how the merger would facilitate collusion by creating three symmetrical players, for instance, he decided it would be easier to assess witness credibility. Judge Marrero purported to study the executives’ behavior and glean “telltale” patterns of truthfulness, concluding that the new T-Mobile would continue to compete vigorously against AT&T and Verizon. In so doing, he placed his faith in the self-serving testimony of executives rather than in decades of enforcement experience, economic evidence, and jurisprudence. ","{Query} ======= According to the text, why is the T-Mobile/Sprint merger considered a disaster? {Task} ======= Provide your answer in full sentences, referencing the document using quotations. {Document} ======= The Real Dish on the T-Mobile/Sprint Merger: A Disastrous Deal From the Start When the Trump-era DOJ allowed T-Mobile and Sprint to merge in July 2019, it promised the best of both worlds: consumers would benefit from T-Mobile’s accelerated 5G deployment and retain a fourth wireless provider. To effect the latter, then-AAG Makan Delrahim devised a divestiture that would reposition satellite-TV provider DISH as Sprint’s replacement. Here was his plan: Sprint would sell its prepaid-wireless assets to DISH. These assets included Sprint’s 9.3 million prepaid subscribers, its Boost brand, its 800 MHz spectrum licenses, and the Sprint stores and cell towers that the new T-Mobile did not want. DISH would then use these cell sites and its pre-existing spectrum, augmented from the divestiture, to build its own wireless network using never-before-deployed technology. While DISH worked on its complex nationwide build, it could serve its customers by paying for them to roam on the new T-Mobile’s infrastructure for seven years. Not even two years later, Delrahim’s plan is already falling apart. The prepaid customers DISH inherited from Sprint disproportionately buy cheap wireless service, which runs on the old CDMA standard used in 3G networks. In the latest turn of events, T-Mobile announced last month that it would discontinue its CDMA service in January 2022, nearly two years ahead of schedule. With T-Mobile’s shutdown, DISH’s customers will have to “get new devices, new SIMs, or upgrade via software.” DISH now has to take on an unexpected upgrade that will cost hundreds of millions of dollars. T-Mobile’s announcement led DISH CEO Charlie Ergen to denounce the unexpected shutdown as “anticompetitive.” DISH has already warned investors that with the shutdown, its trend of bleeding hundreds of thousands of subscribers may soon turn into a hemorrhage. For T-Mobile, this is great news, since many of the subscribers ditching DISH are bound to turn to T-Mobile’s own cheap wireless plan. But for price-sensitive consumers, the forecast is grim: while they could choose between T-Mobile and Sprint before the merger, these dissatisfied customers now effectively face a monopoly provider. It should come as no surprise that DISH is struggling in the wireless market, and price-conscious consumers are bearing the brunt of harm from the merger’s fallout. We knew back in 2011 that T-Mobile and Sprint competed particularly closely in low-cost wireless services. We also knew from DOJ’s longstanding Merger Remedies Policy that remedies should not require an entrant like DISH to depend on an incumbent who is a direct rival; it makes perfect sense that T-Mobile would rebel against helping DISH grow into a firm that can compete against T-Mobile itself. Not only was the DISH divestiture ill-devised, but the T-Mobile/Sprint merger never did pass muster under basic logic. If it was really critical to keep four players in the wireless market—so important that DISH needed to enter—why even let T-Mobile buy Sprint in the first place? Why not just keep the existing fourth player, instead of designing a Rube Goldberg settlement in the hopes that a new player will grow to have the competitive force of Sprint in seven years’ time? These frustrations have fueled heated criticism of the merger. Such critiques are well-placed, as the merger has already produced harm and threatens to wreak more damage. Besides hobbling DISH, T-Mobile will degrade the quality of its service this April by automatically enrolling its subscribers into an aggressive, personalized ad-targeting program. T-Mobile has also signaled to investors that it has become more like its rivals Verizon and AT&T. On an investor call in February, CEO Mike Sievert said, “We’ve competed mostly on price in the past, if we’re honest. Now, we have a premium product.” Translation: the era of aggressive price competition in wireless is over. Looking forward, we can expect T-Mobile, AT&T, and Verizon to nestle into a cozy triopoly that returns immense profits to their shareholders. T-Mobile is already prepared to deliver on this prospect. On March 11, it predicted to investors that its free cash flow will be flush enough to support a $60 billion stock buyback within five years. Stock buybacks benefit the investor class, whose members are disproportionately the wealthiest people in America; recent surveys show that the top 10 percent of households own approximately 80 percent of all stocks. In contrast, nearly all households across the income distribution buy wireless services, and low-income households particularly favor prepaid plans, a segment where T-Mobile and Sprint had competed vigorously pre-merger. With its latest proclamations to investors, T-Mobile celebrates the fact that its merger will transfer billions of wealth from average Americans to the rich, further widening the chasm between the haves and have-nots. For this reason and many others, the T-Mobile/Sprint deal will go down as one of the worst merger-enforcement decisions in decades. “THE T-MOBILE/SPRINT DEAL WILL GO DOWN AS ONE OF THE WORST MERGER-ENFORCEMENT DECISIONS IN DECADES.” In this postmortem, we examine how the deal came to close, and what we might learn from the mistakes made along the way. The Prosecutor: Dealmaker Delrahim Helming DOJ DOJ should never have approved the deal in the first place. The T-Mobile/Sprint merger presented a harmful 4-to-3 combination in the critical and well-defined market of mobile wireless services. Four-to-three mergers deservedly raise eyebrows, and evidence from other countries showed that 4-3 mergers in the wireless market would increase prices. Further, the post-merger market shares blasted through the HHI thresholds in the Horizontal Merger Guidelines, making the transaction presumptively anticompetitive. As such, a settlement should never have been on the table. But after many years of trying to merge, the parties finally found a receptive agency head in Delrahim, the “veteran lobbyist” tapped to be head of the Trump Administration’s Antitrust Division. When presented with the deal, Delrahim was eager to refashion the telecom market and less eager to deliver on his charge of protecting consumer welfare. Delrahim took a series of unorthodox steps. He became a mediator between the parties, helping hold the deal together when tensions between the CEOs ran high. He exchanged text messages with Ergen and advised him on how to secure regulatory approval from the Federal Communications Commission, which also needed to approve the deal. And when the parties closed their transaction in July 2020, Delrahim issued a press release to “congratulate” T-Mobile and Sprint for merging. Not only did his conduct conflict with his role as the nation’s head antitrust enforcer, but the behavioral remedy Delrahim reached in T-Mobile/Sprint contradicted his 2017 statements. Then, with an eye toward signaling his unwillingness to settle in AT&T/Time Warner, he inveighed against behavioral remedies. “[A]t times antitrust enforcers have experimented with allowing illegal mergers to proceed subject to certain behavioral commitments. That approach is fundamentally regulatory, imposing ongoing government oversight on what should preferably be a free market.” He added, “[I]f a merger is illegal, we should only accept a clean and complete solution.” Perhaps Delrahim was conscious of his hypocrisy when he later announced the settlement he had reached in the T-Mobile/Sprint merger, as he was careful to cast it as “structural” and not “behavioral.” But because the crux of the settlement is to have DISH roam on T-Mobile’s network for seven years, the settlement is behavioral at its core. Studying the divestiture against the Trump-era DOJ’s handling of other antitrust cases sheds additional light. Compare Delrahim’s adamant refusal to accept behavioral conditions when the parties proposed them in AT&T/Time Warner—which presented a weaker merits case—with his enthusiasm to strike behavioral conditions in the T-Mobile/Sprint divestiture to DISH—even though this 4-3 merger was presumptively illegal and raised nearly every red flag in the Horizontal Merger Guidelines. Taken together, these two decisions cannot be reconciled on principle. The Court: Judge Marrero Fails as “Fortuneteller” Because the Delrahim-led DOJ was derelict in policing the T-Mobile/Sprint deal, a group of states challenged the merger in federal court. In presenting their case, they pointed out flaws in the DISH settlement—chiefly that the divestiture relied on T-Mobile to help DISH grow to scale in wireless, but T-Mobile would have the ability and incentive to cripple DISH. At trial in the Southern District of New York, Ergen testified that he was confident DISH would receive adequate service from T-Mobile through the roaming agreement, even though new T-Mobile and DISH would compete for wireless subscribers. He offered that DISH had never had a problem with buying services from AT&T, despite AT&T’s DirecTV competing head-to-head with DISH’s satellite-television offering. Ergen, however, conveniently omitted the fact that AT&T, after merging with Time Warner, had blacked out HBO and Cinemax for DISH’s satellite and Sling TV subscribers. The loss of AT&T’s content contributed to DISH’s loss of more than 330,000 subscribers that quarter. Despite this recent experience, Ergen maintained in court that there would be no problem with DISH relying on a direct competitor for a critical input in the mobile-wireless industry it was preparing to enter. Judge Victor Marrero did pick up on this danger during his questioning at trial, but he ultimately believed the DOJ-appointed monitor and wholesale-price formula would be enough to rein in T-Mobile’s incentives. We have now seen that those checks were inadequate. This is no surprise, as economic theory predicts that companies’ profit incentives are strong enough to overcome inevitably incomplete contractual restraints. More generally, Judge Marrero underestimated the strength of the parties’ incentives in his assessment of the merger. Instead of accounting for how the merger would facilitate collusion by creating three symmetrical players, for instance, he decided it would be easier to assess witness credibility. Judge Marrero purported to study the executives’ behavior and glean “telltale” patterns of truthfulness, concluding that the new T-Mobile would continue to compete vigorously against AT&T and Verizon. In so doing, he placed his faith in the self-serving testimony of executives rather than in decades of enforcement experience, economic evidence, and jurisprudence. ",Internet/Technology,Find & Summarize,Text Transformation "Please only respond using information contained in the context block below. Bullet points must have 4 sentences each.",Explain in detail the disadvantages of global freight-forwarding's legacy system.,"Slide 19 - Competitive strength across three axes For the next 8 slides, I am going to take you on a deep dive into the how and the why of WiseTech and CargoWise’s core competitive strengths, differentiators and efficiencies. Firstly, our product’s competitive strength has three distinct axes. As a product-led innovator, we have a long-term strategy of building breakthrough products to revolutionize, not to simply replace. We look to find fundamental flaws, operating problems, inefficient models and incomplete or ineffective processes, and to embed and automate improvements so that we revolutionize the industry’s established model. We have done this very effectively with CargoWise’s international freight forwarding capabilities and the competitive result is clearly visible on slide 26. Similarly, with Global Customs, the Warehouse Suite and soon with the planned release of Container Transport Optimization and ComplianceWise, we are not simply offering a me-too product or a simple upgrade from an aging legacy system, we are providing a dramatically better business model embedded in the CargoWise application suite. In the appendix we outline some of the key business model and product differentiators provided to customers by CargoWise. 15 Secondly, because of the many cost and management efficiencies achieved through CargoWise, we are driving value for our customers across their entire cost base, which I will talk to more in detail on the next slide. Finally, the operating model delivered by CargoWise creates substantial cost efficiencies and global management simplicity. This enables industry consolidation through M&A and the rapid, successful and profitable integration of acquired businesses, whilst also driving competitive advantage and profitable organic growth. Slide 20 - Driving efficiencies across our customers’ entire cost base leading to optimized operations CargoWise delivers cost efficiencies in four distinct layers. About 30% of our customers’ total costs sit within operating expenses from legacy IT systems costs and operational labor costs. The remaining 70% of our customers’ cost base is from the direct costs of air, sea, rail and road transport and from surcharges, fines and penalties related to the management of these transport services. Starting with IT cost efficiency, many freight forwarders still have outdated, in-house legacy IT systems built 20 to 30 years ago. They are inflexible, complex and expensive to maintain, and are supplemented at great cost with hundreds of smaller satellite systems, many of which are also legacy systems with their own costs and risks including cyber security. 16 CargoWise customers replace these myriad legacy systems with a single, global, modern, efficient and fully integrated platform that dramatically reduces IT costs and risks. The second cost efficiency involves tackling the labor cost required to deliver the planning, execution and management of the movement of goods from point of origin to final destination. International freight forwarders are asset light services providers. They have large global workforces in each locale, often with a full management hierarchy, managing the local business and processing the local requirements. Many of these procedures are manually executed, often requiring the rekeying of critical data multiple times into many separate, satellite systems. CargoWise provides a single, comprehensive, global system that streamlines and automates many of these procedures, removing much of the original data entry and avoiding rekeying data multiple times. With CargoWise, it is also simple to visualize, plan, manage and control globally from a single location and to move low value work to lower cost locations. Export offices or shared services centers can perform most of the critical tasks including data entry, leaving the often-higher cost import location a much smaller set of tasks. All this allows our customers to extract much greater value by substantially improving operational yield. The third cost efficiency addresses fines, penalties and unwanted surcharges on the movement of cargo. Aging legacy systems have many costs, complexities and risks and can't keep up with the rapidly changing compliance obligations that govern 17 global trade. Because they’re unable to comply or optimize effectively, many logistics providers build in margins or substantial budgets to cover fines and penalties or attempt to pass incidental surcharges on to their customers. The fourth cost efficiency is freight cost efficiency. Given the global scale of CargoWise, and its integration with electronic schedules, rates, booking, tracking, job costing and account settlement, CargoWise customers are able to acquire and optimize transport services much more efficiently than ever before, improving freight utilization, negotiating better rates with carriers, optimizing packing and movement, and allowing economies of scale, to become more price competitive, and improve unit economics and the value delivered to their customers. By creating substantial cost benefits over time, through these four layers of cost improvements, customers also consume more CargoWise services, which drives ongoing long-term revenue growth for WiseTech. ","Please only respond using information contained in the context block below. Bullet points must have 4 sentences each. Slide 19 - Competitive strength across three axes For the next 8 slides, I am going to take you on a deep dive into the how and the why of WiseTech and CargoWise’s core competitive strengths, differentiators and efficiencies. Firstly, our product’s competitive strength has three distinct axes. As a product-led innovator, we have a long-term strategy of building breakthrough products to revolutionize, not to simply replace. We look to find fundamental flaws, operating problems, inefficient models and incomplete or ineffective processes, and to embed and automate improvements so that we revolutionize the industry’s established model. We have done this very effectively with CargoWise’s international freight forwarding capabilities and the competitive result is clearly visible on slide 26. Similarly, with Global Customs, the Warehouse Suite and soon with the planned release of Container Transport Optimization and ComplianceWise, we are not simply offering a me-too product or a simple upgrade from an aging legacy system, we are providing a dramatically better business model embedded in the CargoWise application suite. In the appendix we outline some of the key business model and product differentiators provided to customers by CargoWise. 15 Secondly, because of the many cost and management efficiencies achieved through CargoWise, we are driving value for our customers across their entire cost base, which I will talk to more in detail on the next slide. Finally, the operating model delivered by CargoWise creates substantial cost efficiencies and global management simplicity. This enables industry consolidation through M&A and the rapid, successful and profitable integration of acquired businesses, whilst also driving competitive advantage and profitable organic growth. Slide 20 - Driving efficiencies across our customers’ entire cost base leading to optimized operations CargoWise delivers cost efficiencies in four distinct layers. About 30% of our customers’ total costs sit within operating expenses from legacy IT systems costs and operational labor costs. The remaining 70% of our customers’ cost base is from the direct costs of air, sea, rail and road transport and from surcharges, fines and penalties related to the management of these transport services. Starting with IT cost efficiency, many freight forwarders still have outdated, in-house legacy IT systems built 20 to 30 years ago. They are inflexible, complex and expensive to maintain, and are supplemented at great cost with hundreds of smaller satellite systems, many of which are also legacy systems with their own costs and risks including cyber security. 16 CargoWise customers replace these myriad legacy systems with a single, global, modern, efficient and fully integrated platform that dramatically reduces IT costs and risks. The second cost efficiency involves tackling the labor cost required to deliver the planning, execution and management of the movement of goods from point of origin to final destination. International freight forwarders are asset light services providers. They have large global workforces in each locale, often with a full management hierarchy, managing the local business and processing the local requirements. Many of these procedures are manually executed, often requiring the rekeying of critical data multiple times into many separate, satellite systems. CargoWise provides a single, comprehensive, global system that streamlines and automates many of these procedures, removing much of the original data entry and avoiding rekeying data multiple times. With CargoWise, it is also simple to visualize, plan, manage and control globally from a single location and to move low value work to lower cost locations. Export offices or shared services centers can perform most of the critical tasks including data entry, leaving the often-higher cost import location a much smaller set of tasks. All this allows our customers to extract much greater value by substantially improving operational yield. The third cost efficiency addresses fines, penalties and unwanted surcharges on the movement of cargo. Aging legacy systems have many costs, complexities and risks and can't keep up with the rapidly changing compliance obligations that govern 17 global trade. Because they’re unable to comply or optimize effectively, many logistics providers build in margins or substantial budgets to cover fines and penalties or attempt to pass incidental surcharges on to their customers. The fourth cost efficiency is freight cost efficiency. Given the global scale of CargoWise, and its integration with electronic schedules, rates, booking, tracking, job costing and account settlement, CargoWise customers are able to acquire and optimize transport services much more efficiently than ever before, improving freight utilization, negotiating better rates with carriers, optimizing packing and movement, and allowing economies of scale, to become more price competitive, and improve unit economics and the value delivered to their customers. By creating substantial cost benefits over time, through these four layers of cost improvements, customers also consume more CargoWise services, which drives ongoing long-term revenue growth for WiseTech. Explain in detail the disadvantages of global freight-forwarding's legacy system.",Internet/Technology,Find & Summarize,Text Transformation "You can only answer the prompt using information found in the context block. You can't use information from external sources or rely heavily on your knowledge. You are not an expert in any field, you are simply extracting information from the context block to answer the prompt. Respond in using 100 words or less.",What is the main argument made by scholars like Moringiello and Odinet against considering NFTs as property?,"OVERVIEW OF HOW NFTS HAVE BEEN CHARACTERIZED Property law perspective What rights do owners of NFTs actually own? In this respect, the concept of possession in property law is currently understood to apply only to tangible assets, and hence inapplicable to intangible assets.17 Marinoti explores the possibility of understanding the rights owned in intangibles such as NFTs from a property law perspective.18 He has argued that intangibles such as NFTs can be governed by property law, through reference to the concepts such as ‘possession’ which is often related mainly to tangible property (i.e., things that are usually physical and that you can touch and identify, such as land and equipment, etc.).19 According to Marinoti, the true function of possession is communicative and its purpose is to convey the availability of an object discernible to an audience. He argued further that communities can also give this meaning through conduct and symbolic acts.20 The narrower concept ‘thinghood’, on the other hand, is often subsumed within the discussion on possession. Tinghood is defined by whether there are discernible boundaries around one thing to distinguish it from another. Physical tangibility is said to be only one way in which thinghood delineates boundaries; social practices and norms can similarly indicate boundaries.21 Marinoti also suggested that property law doctrines like conversion and trespass can be extended to apply to digital assets.22 Even concepts such as the relativity of title (ie, wrongful 13 See, eg, Vijayakumaran (n 10) 409. 14 See, eg, Michael D. Murray, ‘NFT Ownership and Copyrights’ (2023) Indiana Law Rev 366. 15 Many popular NFT projects such as CryptoPunks have been released with no explicitly written copyright terms. See, eg, Grimmelman, Yan and Kell (n 9). An instance is that of the popular NFT project CryptoPunks which has been released with no explicitly written copyright terms. 16 Tese are leading NFT marketplaces. See, eg, Bitdeal, ‘Top 7 NFT Marketplaces to look in 2023 and beyond’ (BLOG, 2023) accessed 13 January 2024. 17 See, eg, Marinoti (n 11). 18 Ibid. 19 Ibid 1277. 20 Ibid 1236. 21 Ibid. 22 Ibid 1269. Downloaded from https://academic.oup.com/ijlit/article/32/1/eaae018/7746479 by guest on 17 September 2024 4 • Tan possession can support an interest held by the wrongful possessor which is stronger than that of the world at large, save for the right owner) can arguably apply.23 While protecting wrongful possession may seem unjust, this could help avoid the scenario of having no legal recourse to an endless series of unlawful conversions of ‘NFTs’ after one single wrongful possession.24 To clarify, Marinoti’s reference to property law concepts drew from both real property and personal property laws, although this was not expressly stated. Along the same vein, other scholars such as Trautman and Fairfield have also proposed that the legal system should treat NFTs as digital personal property because NFTs comprise strong property interests through enabling parties to buy, sell, or own digital assets similar to personal property.25 On the other hand, some scholars do not agree that NFTs should be defined as properties. Lee, for example, has analogized NFTs with library catalog cards to illustrate that the value of NFTs is derived from their underlying properties (ie, books) and to highlight that people do not own these properties when they transact in NFTs.26 Further, Moringiello and Odinet rejected the perception of any property rights in NFTs—through comparison of their characteristics with those of negotiable instruments, securities, deeds of real property, bills of lading and other legal tokens—reasoning that NFTs lack the tethering effect that other properties have and that it is meaningless to view them as such, thus NFT holders do not control anything substantive.27 ","[System Instructions] You can only answer the prompt using information found in the context block. You can't use information from external sources or rely heavily on your knowledge. You are not an expert in any field, you are simply extracting information from the context block to answer the prompt. Respond in using 100 words or less. [Question] What do scholars like Moringiello and Odinet make the main argument against considering NFTs as property? [Context Block] OVERVIEW OF HOW NFTS HAVE BEEN CHARACTERIZED Property law perspective What rights do owners of NFTs actually own? In this respect, the concept of possession in property law is currently understood to apply only to tangible assets, and hence inapplicable to intangible assets.17 Marinoti explores the possibility of understanding the rights owned in intangibles such as NFTs from a property law perspective.18 He has argued that intangibles such as NFTs can be governed by property law, through reference to the concepts such as ‘possession’ which is often related mainly to tangible property (i.e., things that are usually physical and that you can touch and identify, such as land and equipment, etc.).19 According to Marinoti, the true function of possession is communicative and its purpose is to convey the availability of an object discernible to an audience. He argued further that communities can also give this meaning through conduct and symbolic acts.20 The narrower concept ‘thinghood’, on the other hand, is often subsumed within the discussion on possession. Tinghood is defined by whether there are discernible boundaries around one thing to distinguish it from another. Physical tangibility is said to be only one way in which thinghood delineates boundaries; social practices and norms can similarly indicate boundaries.21 Marinoti also suggested that property law doctrines like conversion and trespass can be extended to apply to digital assets.22 Even concepts such as the relativity of title (ie, wrongful 13 See, eg, Vijayakumaran (n 10) 409. 14 See, eg, Michael D. Murray, ‘NFT Ownership and Copyrights’ (2023) Indiana Law Rev 366. 15 Many popular NFT projects such as CryptoPunks have been released with no explicitly written copyright terms. See, eg, Grimmelman, Yan and Kell (n 9). An instance is that of the popular NFT project CryptoPunks which has been released with no explicitly written copyright terms. 16 Tese are leading NFT marketplaces. See, eg, Bitdeal, ‘Top 7 NFT Marketplaces to look in 2023 and beyond’ (BLOG, 2023) accessed 13 January 2024. 17 See, eg, Marinoti (n 11). 18 Ibid. 19 Ibid 1277. 20 Ibid 1236. 21 Ibid. 22 Ibid 1269. Downloaded from https://academic.oup.com/ijlit/article/32/1/eaae018/7746479 by guest on 17 September 2024 4 • Tan possession can support an interest held by the wrongful possessor which is stronger than that of the world at large, save for the right owner) can arguably apply.23 While protecting wrongful possession may seem unjust, this could help avoid the scenario of having no legal recourse to an endless series of unlawful conversions of ‘NFTs’ after one single wrongful possession.24 To clarify, Marinoti’s reference to property law concepts drew from both real property and personal property laws, although this was not expressly stated. Along the same vein, other scholars such as Trautman and Fairfield have also proposed that the legal system should treat NFTs as digital personal property because NFTs comprise strong property interests through enabling parties to buy, sell, or own digital assets similar to personal property.25 On the other hand, some scholars do not agree that NFTs should be defined as properties. Lee, for example, has analogized NFTs with library catalog cards to illustrate that the value of NFTs is derived from their underlying properties (ie, books) and to highlight that people do not own these properties when they transact in NFTs.26 Further, Moringiello and Odinet rejected the perception of any property rights in NFTs—through comparison of their characteristics with those of negotiable instruments, securities, deeds of real property, bills of lading and other legal tokens—reasoning that NFTs lack the tethering effect that other properties have and that it is meaningless to view them as such, thus NFT holders do not control anything substantive.27 ",Retail/Product,Explanation/Definition,Q&A "Exclusively use the information found in the prompt to provide responses limited to 300 words. Use bullet formatting if listing more than 2 items. Use numerical formatting is the response includes instructions. If there's is not enough information to answer some or all of an user's prompt then state so but answer the parts that you can, if any. Cite examples supporting main statements in your response when available.","How does Executive Order (E.O.) 14110 address concerns that were previously outlined in the E.O. on _Advancing Effective, Accountable Policing and Criminal Justice Practices to Enhance Public Trust and Public Safety_?","A number of concerns have been raised about law enforcement use of AI, including whether its use perpetuates biases; one criticism is that the data on which the software are trained contain bias, thus training bias into the AI systems. Another concern is whether reliance on AI technology may lead police to ignore contradictory evidence. Policymakers may consider increased oversight over police use of AI systems to help evaluate and alleviate some of the shortcomings. On October 30, 2023, President Biden issued Executive Order (E.O.) 14110 on the Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence. This E.O. advances a government-wide approach to “governing the development and use of AI safely and responsibly” and directs efforts in AI policy areas involving safety and security, innovation and competition, worker support, equity and civil rights, individual protections, privacy protections, federal AI use, and international leadership. E.O. 14110 acknowledges the risk of AI exacerbating discrimination and directs federal law enforcement in various ways. (In doing so, it references accountability focused directives for federal law enforcement previously outlined in the May 25, 2022, E.O. 14074 on Advancing Effective, Accountable Policing and Criminal Justice Practices to Enhance Public Trust and Public Safety.) Directives in E.O. 14110 include the following: • The Attorney General (AG) shall coordinate and support enforcement of federal laws addressing discrimination and violations of civil rights and civil liberties related to AI. The Department of Justice’s Civil Rights Division shall also coordinate with other federal civil rights offices to assess how their offices can prevent and address discrimination in automated systems—including algorithmic discrimination. • The AG, with the Homeland Security Secretary and Office of Science and Technology Policy Director, shall submit a report to the President on the use of AI in the criminal justice system, including how AI can enhance law enforcement efficiency and accuracy, consistent with privacy, civil rights, and civil liberties protections. The report should also recommend best practices for law enforcement, including guidance on AI use, to address concerns outlined in E.O. 14074 with respect to law enforcement use of “facial recognition technology, other technologies using biometric information, and predictive algorithms, as well as data storage and access regarding such technologies.” • The interagency working group established by E.O. 14074 shall share best practices for recruiting law enforcement professionals with AI expertise and training them on responsible AI use. The AG, along with the Homeland Security Secretary, may review these and recommend best practices for state, local, tribal, and territorial law enforcement. • The AG shall review the Justice Department’s capacity to “investigate law enforcement deprivation of rights under color of law resulting from the use of AI,” including through increasing or improving training for federal law enforcement officers and prosecutors. Congressional Research Service 3 Policymakers conducting oversight of executive branch activities to ensure that AI is used in a fair and equitable manner may examine not only these elements of E.O. 14110 that specifically relate to federal law enforcement but also other elements—such as the development of industry standards on AI—that may in turn affect law enforcement use of AI. They may also explore whether there should be specific standards for AI use in the criminal justice sector or AI-specific requirements for criminal justice entities receiving federal grants. Additionally, policymakers may continue to debate law enforcement use of specific AI technologies in its toolbox such as facial recognition technology. ","System instruction: Exclusively use the information found in the prompt to provide responses limited to 300 words. Use bullet formatting if listing more than 2 items. Use numerical formatting is the response includes instructions. If there's is not enough information to answer some or all of an user's prompt then state so but answer the parts that you can, if any. Cite examples supporting main statements in your response when available. context: A number of concerns have been raised about law enforcement use of AI, including whether its use perpetuates biases; one criticism is that the data on which the software are trained contain bias, thus training bias into the AI systems. Another concern is whether reliance on AI technology may lead police to ignore contradictory evidence. Policymakers may consider increased oversight over police use of AI systems to help evaluate and alleviate some of the shortcomings. On October 30, 2023, President Biden issued Executive Order (E.O.) 14110 on the Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence. This E.O. advances a government-wide approach to “governing the development and use of AI safely and responsibly” and directs efforts in AI policy areas involving safety and security, innovation and competition, worker support, equity and civil rights, individual protections, privacy protections, federal AI use, and international leadership. E.O. 14110 acknowledges the risk of AI exacerbating discrimination and directs federal law enforcement in various ways. (In doing so, it references accountability focused directives for federal law enforcement previously outlined in the May 25, 2022, E.O. 14074 on Advancing Effective, Accountable Policing and Criminal Justice Practices to Enhance Public Trust and Public Safety.) Directives in E.O. 14110 include the following: • The Attorney General (AG) shall coordinate and support enforcement of federal laws addressing discrimination and violations of civil rights and civil liberties related to AI. The Department of Justice’s Civil Rights Division shall also coordinate with other federal civil rights offices to assess how their offices can prevent and address discrimination in automated systems—including algorithmic discrimination. • The AG, with the Homeland Security Secretary and Office of Science and Technology Policy Director, shall submit a report to the President on the use of AI in the criminal justice system, including how AI can enhance law enforcement efficiency and accuracy, consistent with privacy, civil rights, and civil liberties protections. The report should also recommend best practices for law enforcement, including guidance on AI use, to address concerns outlined in E.O. 14074 with respect to law enforcement use of “facial recognition technology, other technologies using biometric information, and predictive algorithms, as well as data storage and access regarding such technologies.” • The interagency working group established by E.O. 14074 shall share best practices for recruiting law enforcement professionals with AI expertise and training them on responsible AI use. The AG, along with the Homeland Security Secretary, may review these and recommend best practices for state, local, tribal, and territorial law enforcement. • The AG shall review the Justice Department’s capacity to “investigate law enforcement deprivation of rights under color of law resulting from the use of AI,” including through increasing or improving training for federal law enforcement officers and prosecutors. Congressional Research Service 3 Policymakers conducting oversight of executive branch activities to ensure that AI is used in a fair and equitable manner may examine not only these elements of E.O. 14110 that specifically relate to federal law enforcement but also other elements—such as the development of industry standards on AI—that may in turn affect law enforcement use of AI. They may also explore whether there should be specific standards for AI use in the criminal justice sector or AI-specific requirements for criminal justice entities receiving federal grants. Additionally, policymakers may continue to debate law enforcement use of specific AI technologies in its toolbox such as facial recognition technology. question: How does Executive Order (E.O.) 14110 address concerns that were previously outlined in the E.O. on _Advancing Effective, Accountable Policing and Criminal Justice Practices to Enhance Public Trust and Public Safety_? ",Internet/Technology,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Provide me a summary of EI based on this reference, but organize it into two sections with one about the system itself and one about the actual benefits.","1.1.1 Summary The EI program, which is insurance-based, is designed to protect individuals who have lost their job for reasons outside their control, while they look for new employment or upgrade their skills. It may also help unemployed individuals across the country find employment. The EI program also provides temporary financial assistance to workers who are sick, pregnant, caring for a newborn or newly adopted child, or caring for a family member who has a serious medical condition. The EI program marked its 75th year in 2015, having been implemented in 1940. The last major reform occurred in 1996. At that time, the program introduced changes to better reflect its primary objective of promoting employment, and to better emphasize that access to the program is linked to significant work attachment. 1.1.2 Roles and responsibilities Employment and Social Development Canada (ESDC) is the department of the Government of Canada responsible for developing, managing and delivering programs and services. The Minister of Employment and Social Development is responsible for the EI act, except for PART IV - Insurable Earnings and Collection of Premiums, and PART VII - Benefit Repayment. The Canada Revenue Agency is responsible for resolving any questions pertaining to the insurability of employment or earnings (Part IV), and for the collection of EI premiums (Part VII). Service Canada is a federal institution that is part of ESDC. Service Canada oversees all legislative provisions of the act, including the determination of benefit eligibility and entitlement, and issues EI benefits (Part I) directly to EI claimants. Its role is to provide timely and accurate EI benefit payments and services, and to support EI claimants through each stage of the service delivery process. It strives to accurately and efficiently provide benefit information, respond to enquiries, assist employers, process claims and provide the means to request a formal reconsideration of a decision, or to appeal decisions. Provinces and territories deliver the majority of Employment Benefits and National Employment Services (Part II). These benefits and services are delivered through Labour Market Development Agreements (LMDA) funded by the Government of Canada. Through these agreements, Government of Canada funding enables provinces and territories to design, deliver and manage skills and employment programs for unemployed individuals, particularly for those who are eligible for EI benefits. The Canada Employment Insurance Commission (CEIC) is a departmental corporation of ESDC. It plays a key role in administering the EI program, including the making of regulations, with the approval of the Governor-in-Council, and reviewing, as well as approving, policies related to the EI program administration and delivery. In addition to its role in EI premium rate setting, the CEIC produces the annual EI Monitoring and Assessment Report. The Social Security Tribunal of Canada (SST) is an independent administrative body composed of a General Division and Appeal Division, that makes decisions on appeals related to the Act. 1.1.3 EI premiums & Insurable Employment All workers employed in insurable employment are required to pay EI premiums. The fact that a worker can or cannot qualify for EI benefits is not a criterion to determine whether EI premiums are payable, as it is the employment, and not the individual that is insured. The fundamental requirement for an employment to be insurable is that there is an employer-employee relationship; i.e. the person is not self-employed. CRA holds the responsibility for making decisions as to whether an employment is insurable or not, and whether EI premiums are payable with respect to that employment. 1.1.4 Purpose of Employment Insurance benefits As previously stated, Part I of the EI program provides temporary income support to workers who have lost their job for reasons outside their control, while they look for new employment or upgrade their skills. EI Part I also provides temporary financial assistance to workers who are sick, pregnant, caring for a newborn or newly adopted child, or caring for a family member who has a serious medical condition. The purpose of Part II of the EI Act is to provide employment assistance to eligible insured participants, through various programs and services. 1.1.5 Types of Employment Insurance benefits There are a number of types of EI benefits available: Regular benefits are available to individuals who lose their jobs for reasons outside their control and who are available for and actively seeking employment. Special benefits are available to insured workers and self-employed individuals who are too sick to work, are pregnant or have recently given birth, are providing care to a newborn or newly adopted child, or who must be away from work temporarily to provide care or support to a family member with a serious medical condition. Special benefits include: Maternity benefits: for biological mothers who are pregnant or have given birth. These benefits cover the period surrounding the child's birth (up to 15 weeks). Parental benefits: for any legal parent to care for their newborn or newly adopted child or children. One parent can receive these benefits, or they can share benefits between them (up to 40 weeks of standard parental benefits or 69 weeks of extended parental benefits when sharing). However, one parent cannot receive more than 35 weeks of standard parental benefits or 61 weeks of extended parental benefits. Sickness benefits: for people who cannot work due to injury, illness, or the need to be isolated in quarantine because they may be carrying a disease (up to 26Footnote1 weeks). Compassionate Care benefits: for people who must be away from work temporarily to provide care or support to a family member who is gravely ill with a significant risk of death within 26 weeks. One family member can receive these benefits, or they can be shared between several family members (up to 26 weeks). Family Caregiver benefits: for family members who must be away from work temporarily to care for or support a critically ill or injured family member. One family member can receive these benefits or they can be shared between several family members (up to 35 weeks for caring for a child; up to 15 weeks for caring for an adult). In certain circumstances various types of special benefits may be combined up to a maximum of 102 weeks of benefits within a maximum 104 week benefit period. Fishing benefits – are for eligible self-employed fishers who do not meet the eligibility requirements for EI regular benefits in their region. Job creation partnerships, work sharing, training benefits: for clients participating in developmental programs. [March 2019]","[question] Provide me a summary of EI based on this reference, but organize it into two sections with one about the system itself and one about the actual benefits. ===================== [text] 1.1.1 Summary The EI program, which is insurance-based, is designed to protect individuals who have lost their job for reasons outside their control, while they look for new employment or upgrade their skills. It may also help unemployed individuals across the country find employment. The EI program also provides temporary financial assistance to workers who are sick, pregnant, caring for a newborn or newly adopted child, or caring for a family member who has a serious medical condition. The EI program marked its 75th year in 2015, having been implemented in 1940. The last major reform occurred in 1996. At that time, the program introduced changes to better reflect its primary objective of promoting employment, and to better emphasize that access to the program is linked to significant work attachment. 1.1.2 Roles and responsibilities Employment and Social Development Canada (ESDC) is the department of the Government of Canada responsible for developing, managing and delivering programs and services. The Minister of Employment and Social Development is responsible for the EI act, except for PART IV - Insurable Earnings and Collection of Premiums, and PART VII - Benefit Repayment. The Canada Revenue Agency is responsible for resolving any questions pertaining to the insurability of employment or earnings (Part IV), and for the collection of EI premiums (Part VII). Service Canada is a federal institution that is part of ESDC. Service Canada oversees all legislative provisions of the act, including the determination of benefit eligibility and entitlement, and issues EI benefits (Part I) directly to EI claimants. Its role is to provide timely and accurate EI benefit payments and services, and to support EI claimants through each stage of the service delivery process. It strives to accurately and efficiently provide benefit information, respond to enquiries, assist employers, process claims and provide the means to request a formal reconsideration of a decision, or to appeal decisions. Provinces and territories deliver the majority of Employment Benefits and National Employment Services (Part II). These benefits and services are delivered through Labour Market Development Agreements (LMDA) funded by the Government of Canada. Through these agreements, Government of Canada funding enables provinces and territories to design, deliver and manage skills and employment programs for unemployed individuals, particularly for those who are eligible for EI benefits. The Canada Employment Insurance Commission (CEIC) is a departmental corporation of ESDC. It plays a key role in administering the EI program, including the making of regulations, with the approval of the Governor-in-Council, and reviewing, as well as approving, policies related to the EI program administration and delivery. In addition to its role in EI premium rate setting, the CEIC produces the annual EI Monitoring and Assessment Report. The Social Security Tribunal of Canada (SST) is an independent administrative body composed of a General Division and Appeal Division, that makes decisions on appeals related to the Act. 1.1.3 EI premiums & Insurable Employment All workers employed in insurable employment are required to pay EI premiums. The fact that a worker can or cannot qualify for EI benefits is not a criterion to determine whether EI premiums are payable, as it is the employment, and not the individual that is insured. The fundamental requirement for an employment to be insurable is that there is an employer-employee relationship; i.e. the person is not self-employed. CRA holds the responsibility for making decisions as to whether an employment is insurable or not, and whether EI premiums are payable with respect to that employment. 1.1.4 Purpose of Employment Insurance benefits As previously stated, Part I of the EI program provides temporary income support to workers who have lost their job for reasons outside their control, while they look for new employment or upgrade their skills. EI Part I also provides temporary financial assistance to workers who are sick, pregnant, caring for a newborn or newly adopted child, or caring for a family member who has a serious medical condition. The purpose of Part II of the EI Act is to provide employment assistance to eligible insured participants, through various programs and services. 1.1.5 Types of Employment Insurance benefits There are a number of types of EI benefits available: Regular benefits are available to individuals who lose their jobs for reasons outside their control and who are available for and actively seeking employment. Special benefits are available to insured workers and self-employed individuals who are too sick to work, are pregnant or have recently given birth, are providing care to a newborn or newly adopted child, or who must be away from work temporarily to provide care or support to a family member with a serious medical condition. Special benefits include: Maternity benefits: for biological mothers who are pregnant or have given birth. These benefits cover the period surrounding the child's birth (up to 15 weeks). Parental benefits: for any legal parent to care for their newborn or newly adopted child or children. One parent can receive these benefits, or they can share benefits between them (up to 40 weeks of standard parental benefits or 69 weeks of extended parental benefits when sharing). However, one parent cannot receive more than 35 weeks of standard parental benefits or 61 weeks of extended parental benefits. Sickness benefits: for people who cannot work due to injury, illness, or the need to be isolated in quarantine because they may be carrying a disease (up to 26Footnote1 weeks). Compassionate Care benefits: for people who must be away from work temporarily to provide care or support to a family member who is gravely ill with a significant risk of death within 26 weeks. One family member can receive these benefits, or they can be shared between several family members (up to 26 weeks). Family Caregiver benefits: for family members who must be away from work temporarily to care for or support a critically ill or injured family member. One family member can receive these benefits or they can be shared between several family members (up to 35 weeks for caring for a child; up to 15 weeks for caring for an adult). In certain circumstances various types of special benefits may be combined up to a maximum of 102 weeks of benefits within a maximum 104 week benefit period. Fishing benefits – are for eligible self-employed fishers who do not meet the eligibility requirements for EI regular benefits in their region. Job creation partnerships, work sharing, training benefits: for clients participating in developmental programs. [March 2019] https://www.canada.ca/en/employment-social-development/programs/ei/ei-list/reports/digest/chapter-1/authority.html#a1_1_1 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Summarize & Format,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",Do local credit unions review and assess loan applications differently from a national chain such as Bank of America? What are the differences between their loan approval processes?,"Over 93% of Americans have some type of financial transactional account, including checking, savings, money market, and call accounts. However, despite desiring a variety of choices in order to make informed decisions for their families and businesses, most Americans choose large national and regional banking institutions for their financial needs. In fact, big banks account for 74.8% of the total financial account market while smaller banking institutions and credit unions account for only 18.2% and 7%, respectively. Why the disparity? Although credit unions have been providing financial services in the U.S. for over 100 years, many people simply don’t know how they differ from a typical bank. The popularity of credit unions exploded in the first half of the 20th century and especially during the Great Depression. During this time, consumer credit from banking institutions was tight, leading many Americans to demand alternative banking choices. Credit unions were more likely to approve “risky” loans and provide services to people with less-than-perfect credit. Credit unions gained so much popularity that President Franklin Roosevelt enacted the Federal Credit Union Act in 1934, which established the National Credit Union Administration (“NCUA”) in order to better regulate federal credit unions and insure money deposited into credit union accounts. Credit unions and banks have a variety of major and minor differences, which boil down to business structure, product offerings, customer service, and membership requirements. These differences may be viewed as advantages or drawbacks, depending on your financial needs and preferences. One of the most important and major differences between banks and credit unions is business structure. A bank – whether it’s a small local provider or a national chain – is a for-profit enterprise. Similar to any other for-profit business, banks want to increase sales while reducing costs. If a bank is a public company, it’s governed by a board of directors and sells shares of its stock to investors. Conversely, credit unions are member-owned not-for-profit cooperatives. Specifically, if you open any type of account at a credit union, you’re considered a part-owner of that union. As such, credit union members enjoy certain benefits such as the ability to elect a volunteer board in charge of making important decisions on services, fees, and overall credit union management. Members also benefit from profit sharing in the form of reduced fees and dividends. As a result, credit unions typically consist of small, independent businesses or local chains. When it comes to customer service, credit unions outrank other financial institutions. According to the most recent annual American Customer Satisfaction Index (“ACSI”) report, credit unions scored an 85 for customer satisfaction, while the average bank scored a 76. The ACSI measured a variety of factors, including expectations, quality, value, loyalty, and complaint rates. Credit unions have outscored banks on all major factors for seven consecutive years. What makes credit unions so customer friendly? The reasons relate not only to their lower product rates and fees, but also to how they operate. As small not-for-profit cooperatives serving the local community, credit unions are more likely to work with people with poor or no credit that have been turned down by larger banks to obtain loans. Furthermore, some credit unions that serve low-income populations quality for the NCUA low-income designation, which entitles them and their members to additional benefits. In addition, credit unions work toward the betterment of their members and the surrounding community by offering a variety of local supports, such as sponsoring neighborhood or town projects, offering personal finance classes, providing microloans to people or businesses that don’t qualify for more traditional loans, and even offering scholarships and grants for local students. Similar to shopping at a large national big-box retailer versus a small mom-and-pop store, banks and credit unions provide similar financial benefits – but the products and types of services can be significantly different. Banks, especially large, national chains, generally provide more products – such as a variety of checking and saving account types, CDs, IRAs, and even credit cards. The variety allows individuals and businesses to find what works best for them. Credit unions, on the other hand, don’t always have the resources to offer the product variety that a larger bank could. However, as they are not-for-profit organizations, credit unions are able to offer lower fees and higher interest rates on the products they do carry as compared to a traditional bank. In addition to fewer product offerings, credit unions typically do not offer the same amenities as banks. With advanced online and mobile banking options, remote check deposits, and ubiquitous branches and ATMs – there’s a reason why banks control 93% of the financial account market. Quite simply, banks have the resources and economy of scale to invest in state-of-the-art, convenient services that customers want. Conversely, as credit unions are dedicated to serving a small, local population, there are typically only a few branches. Most credit unions do not maintain the capital to invest in cutting-edge services, and typically only offer rudimentary online banking options. However, although individual credit unions do not maintain a large number of branches, many credit unions belong to larger cooperatives that share resources, such as ATMs. This is especially important for today’s banking customer that requires on-the-go convenience and access to free ATMs. Lastly, a major difference between credit unions and banks is membership requirements. As mentioned, credit unions are member-owned and operated cooperatives, while banks are either private or public business enterprises. Banks are open to the public, and are free to do business with whomever they want. Credit unions, on the other hand, are required by law to restrict membership to certain communities tied by a “membership field” based on common occupations or association membership, family ties, or location. Most credit unions base their membership on locality, such as a town or region, while others may only serve certain professions, such as teachers or those in law enforcement. The NCUA changed its field of membership regulations in 2003 in order to increase credit union membership. The new rules expand what constitutes an occupational common bond as well as a community. The new regulations also eliminated several mandatory factors determining common bonds and membership fields. This has allowed credit unions that were once relatively inaccessible to open their doors to more types of consumers. Credit unions are enjoying increased interest in the wake of the recession and amidst consumer backlash against “too big to fail” banks. In 2011, a grassroots movement capitalized on feelings of consumer unrest by promoting Bank Transfer Day, urging Americans to move their accounts from big, national banks to community banks or credit unions. While over 600,000 people reportedly made the switch on Bank Transfer Day, the much-publicized movement continued to gain momentum. Approximately 5.6 million people moved their bank accounts in the fourth quarter of 2011, of which 11% was attributed to the Bank Transfer Day movement. Since that time, interest in credit unions has continued to gain momentum. Credit union membership increased 3.5% in 2015, the fastest annual advance since 1994. As with any decision, there are advantages and disadvantages to choosing either institution for your financial needs; it’s important to consider your needs, lifestyle, and goals. For example, an individual running a small consulting firm who regularly travels internationally may opt for a large bank due to its plethora of technology amenities and international presence. Conversely, the owner of a local shop may choose a credit union, preferring to support another local business and who appreciates the no frill, hands-on customer service.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Do local credit unions review and assess loan applications differently from a national chain such as Bank of America? What are the differences between their loan approval processes? Over 93% of Americans have some type of financial transactional account, including checking, savings, money market, and call accounts. However, despite desiring a variety of choices in order to make informed decisions for their families and businesses, most Americans choose large national and regional banking institutions for their financial needs. In fact, big banks account for 74.8% of the total financial account market while smaller banking institutions and credit unions account for only 18.2% and 7%, respectively. Why the disparity? Although credit unions have been providing financial services in the U.S. for over 100 years, many people simply don’t know how they differ from a typical bank. The popularity of credit unions exploded in the first half of the 20th century and especially during the Great Depression. During this time, consumer credit from banking institutions was tight, leading many Americans to demand alternative banking choices. Credit unions were more likely to approve “risky” loans and provide services to people with less-than-perfect credit. Credit unions gained so much popularity that President Franklin Roosevelt enacted the Federal Credit Union Act in 1934, which established the National Credit Union Administration (“NCUA”) in order to better regulate federal credit unions and insure money deposited into credit union accounts. Credit unions and banks have a variety of major and minor differences, which boil down to business structure, product offerings, customer service, and membership requirements. These differences may be viewed as advantages or drawbacks, depending on your financial needs and preferences. One of the most important and major differences between banks and credit unions is business structure. A bank – whether it’s a small local provider or a national chain – is a for-profit enterprise. Similar to any other for-profit business, banks want to increase sales while reducing costs. If a bank is a public company, it’s governed by a board of directors and sells shares of its stock to investors. Conversely, credit unions are member-owned not-for-profit cooperatives. Specifically, if you open any type of account at a credit union, you’re considered a part-owner of that union. As such, credit union members enjoy certain benefits such as the ability to elect a volunteer board in charge of making important decisions on services, fees, and overall credit union management. Members also benefit from profit sharing in the form of reduced fees and dividends. As a result, credit unions typically consist of small, independent businesses or local chains. When it comes to customer service, credit unions outrank other financial institutions. According to the most recent annual American Customer Satisfaction Index (“ACSI”) report, credit unions scored an 85 for customer satisfaction, while the average bank scored a 76. The ACSI measured a variety of factors, including expectations, quality, value, loyalty, and complaint rates. Credit unions have outscored banks on all major factors for seven consecutive years. What makes credit unions so customer friendly? The reasons relate not only to their lower product rates and fees, but also to how they operate. As small not-for-profit cooperatives serving the local community, credit unions are more likely to work with people with poor or no credit that have been turned down by larger banks to obtain loans. Furthermore, some credit unions that serve low-income populations quality for the NCUA low-income designation, which entitles them and their members to additional benefits. In addition, credit unions work toward the betterment of their members and the surrounding community by offering a variety of local supports, such as sponsoring neighborhood or town projects, offering personal finance classes, providing microloans to people or businesses that don’t qualify for more traditional loans, and even offering scholarships and grants for local students. Similar to shopping at a large national big-box retailer versus a small mom-and-pop store, banks and credit unions provide similar financial benefits – but the products and types of services can be significantly different. Banks, especially large, national chains, generally provide more products – such as a variety of checking and saving account types, CDs, IRAs, and even credit cards. The variety allows individuals and businesses to find what works best for them. Credit unions, on the other hand, don’t always have the resources to offer the product variety that a larger bank could. However, as they are not-for-profit organizations, credit unions are able to offer lower fees and higher interest rates on the products they do carry as compared to a traditional bank. In addition to fewer product offerings, credit unions typically do not offer the same amenities as banks. With advanced online and mobile banking options, remote check deposits, and ubiquitous branches and ATMs – there’s a reason why banks control 93% of the financial account market. Quite simply, banks have the resources and economy of scale to invest in state-of-the-art, convenient services that customers want. Conversely, as credit unions are dedicated to serving a small, local population, there are typically only a few branches. Most credit unions do not maintain the capital to invest in cutting-edge services, and typically only offer rudimentary online banking options. However, although individual credit unions do not maintain a large number of branches, many credit unions belong to larger cooperatives that share resources, such as ATMs. This is especially important for today’s banking customer that requires on-the-go convenience and access to free ATMs. Lastly, a major difference between credit unions and banks is membership requirements. As mentioned, credit unions are member-owned and operated cooperatives, while banks are either private or public business enterprises. Banks are open to the public, and are free to do business with whomever they want. Credit unions, on the other hand, are required by law to restrict membership to certain communities tied by a “membership field” based on common occupations or association membership, family ties, or location. Most credit unions base their membership on locality, such as a town or region, while others may only serve certain professions, such as teachers or those in law enforcement. The NCUA changed its field of membership regulations in 2003 in order to increase credit union membership. The new rules expand what constitutes an occupational common bond as well as a community. The new regulations also eliminated several mandatory factors determining common bonds and membership fields. This has allowed credit unions that were once relatively inaccessible to open their doors to more types of consumers. Credit unions are enjoying increased interest in the wake of the recession and amidst consumer backlash against “too big to fail” banks. In 2011, a grassroots movement capitalized on feelings of consumer unrest by promoting Bank Transfer Day, urging Americans to move their accounts from big, national banks to community banks or credit unions. While over 600,000 people reportedly made the switch on Bank Transfer Day, the much-publicized movement continued to gain momentum. Approximately 5.6 million people moved their bank accounts in the fourth quarter of 2011, of which 11% was attributed to the Bank Transfer Day movement. Since that time, interest in credit unions has continued to gain momentum. Credit union membership increased 3.5% in 2015, the fastest annual advance since 1994. As with any decision, there are advantages and disadvantages to choosing either institution for your financial needs; it’s important to consider your needs, lifestyle, and goals. For example, an individual running a small consulting firm who regularly travels internationally may opt for a large bank due to its plethora of technology amenities and international presence. Conversely, the owner of a local shop may choose a credit union, preferring to support another local business and who appreciates the no frill, hands-on customer service. https://blog.glia.com/4-major-differences-credit-unions-banks/",Financial,Concept Comparison,Q&A [This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Your answer should be between five and eight sentences long.],[Will I get hungry and thirstier during a fast?],"Intermittent Fasting Myths “It’s just starving yourself.” Fasting is a planned action to avoid food for a set period of time. The body can still use energy from its own fat stores during a fast, so it isn’t being deprived. Starvation is completely different. It is unplanned, it doesn’t have a chosen end point, and the body doesn’t have much stored energy that it can use. It is simply untrue to say that fasting is the same as starving yourself! “It will slow your metabolism.” When someone follows a reduced calorie diet but continues to eat regularly (i.e., “little and often”), insulin levels remain high for most of the day. This stops the body from using stored fat for energy. It responds by reducing the amount of calories it burns, to save what energy it does have (i.e., it slows your metabolism). Fasting is different. During a fast, insulin levels are reduced, so fat stored in the body can be used for energy. This means that metabolism does not need to be slowed down, as the body does not think it is being deprived. “Breakfast is the most important meal of the day.” In the morning, the body’s releases hormones to get us ready to start the day. This causes the release of energy from the body’s stores, which means we don’t actually need to eat something first thing in the morning, as the body is being fed whether you eat something or not! No meal is more important than any other. What does matter is that you get all the nutrients you need from what you do eat. “You’ll be deprived of essential nutrients.” As long as a range of real foods are eaten in the non-fasting periods, there is no reason that people who try intermittent fasting should experience any nutrient deficiencies. “It’ll make your body break down muscle.” If available, the body will always use glucose and/or fat for fuel. Your muscles, and the proteins they are made up of, are only a last resort for this. Studies have shown that intermittent fasting does not cause significant muscle loss, and that levels of a growth hormone that protects muscles from being used for energy are increased during a fast. It is important that sufficient protein is eaten in the non-fasting periods though in order to support the growth and maintenance of muscle mass. “You’ll be hungry all the time and will just eat much more at the next meal.” Studies have shown that missing a meal may result in slightly more food being eaten at the next meal, but the total energy intake will still be less than if you had eaten both meals. Fasting decreases hunger hormones and increases fullness. So although you may feel hungry when you first try fasting, many people actually report reduced hunger once they are used to it. www.xperthealth.org.uk Stay hydrated When you eat, you get some water from your food. So during a fast, you are missing out on some of the fluids you normally get. This can lead to you becoming dehydrated, causing side effects such as tiredness and headaches. Dehydration can also be mistaken for hunger, which can make it more difficult to stick to your planned fast. The best option for staying hydrated is water. If you want to make it a bit more exciting then you can flavour it, with a slice of lemon, orange, lime or cucumber for example. Coffee (black or flavoured with natural extracts), tea (black, green, herbal or fruit), or broth (bone or vegetable) are all also suitable options. Stick with it You may struggle at first if you are not used to going for extended periods of time without food, but much of this could be down to habit. If you have had a set routine for a long time your body will expect to receive food at certain times of the day. So when it doesn’t get the food it is expecting, this can trigger feelings of hunger. Most people adapt quite quickly though, so find it increasingly easy to fast. But in the short-term, make sure you have thought about what you could do to try and distract yourself when you feel hungry. Break your fast with nutritious foods At the end of your fast, have a meal that includes plenty of real, minimally processed food. Make sure this meal includes one or two portions of good quality protein. This will help to satisfy your appetite, and to make sure your body gets plenty of nutrients. Planning a meal that supports your dietary approach but also includes some of your favourite foods to break your fast with can help to motivate you to stick with it too. Make sure you get enough salt People often think salt is unhealthy, but we do need some in our diet. Sodium is an essential nutrient, and the main source of it is salt. When you are not eating (i.e., during a fast), you are not taking in any salt. On top of this, the reduction in insulin levels during fasting results in less salt being held in the blood. Signs of having low sodium levels include dizziness (caused by a drop in blood pressure), muscle cramps, headaches and tiredness. These symptoms can be fixed by making sure you get enough salt and water. Salt can be added to meals in non-fasting periods, or you can get more by having salted water or bone broth during fasting periods. Don’t worry if you regain a bit of weight after a fast When you fast you will lose weight because your body is using up some of your stored fat for fuel. But you will also lose some weight for other reasons, including that there will be less food and waste passing through your body. This means that when you break your fast you might actually regain a little bit of weight. This is completely normal though, so you should not feel disappointed. The good news is that you will still have reduced the amount of fat stored in your body!","[Intermittent Fasting Myths “It’s just starving yourself.” Fasting is a planned action to avoid food for a set period of time. The body can still use energy from its own fat stores during a fast, so it isn’t being deprived. Starvation is completely different. It is unplanned, it doesn’t have a chosen end point, and the body doesn’t have much stored energy that it can use. It is simply untrue to say that fasting is the same as starving yourself! “It will slow your metabolism.” When someone follows a reduced calorie diet but continues to eat regularly (i.e., “little and often”), insulin levels remain high for most of the day. This stops the body from using stored fat for energy. It responds by reducing the amount of calories it burns, to save what energy it does have (i.e., it slows your metabolism). Fasting is different. During a fast, insulin levels are reduced, so fat stored in the body can be used for energy. This means that metabolism does not need to be slowed down, as the body does not think it is being deprived. “Breakfast is the most important meal of the day.” In the morning, the body’s releases hormones to get us ready to start the day. This causes the release of energy from the body’s stores, which means we don’t actually need to eat something first thing in the morning, as the body is being fed whether you eat something or not! No meal is more important than any other. What does matter is that you get all the nutrients you need from what you do eat. “You’ll be deprived of essential nutrients.” As long as a range of real foods are eaten in the non-fasting periods, there is no reason that people who try intermittent fasting should experience any nutrient deficiencies. “It’ll make your body break down muscle.” If available, the body will always use glucose and/or fat for fuel. Your muscles, and the proteins they are made up of, are only a last resort for this. Studies have shown that intermittent fasting does not cause significant muscle loss, and that levels of a growth hormone that protects muscles from being used for energy are increased during a fast. It is important that sufficient protein is eaten in the non-fasting periods though in order to support the growth and maintenance of muscle mass. “You’ll be hungry all the time and will just eat much more at the next meal.” Studies have shown that missing a meal may result in slightly more food being eaten at the next meal, but the total energy intake will still be less than if you had eaten both meals. Fasting decreases hunger hormones and increases fullness. So although you may feel hungry when you first try fasting, many people actually report reduced hunger once they are used to it. www.xperthealth.org.uk Stay hydrated When you eat, you get some water from your food. So during a fast, you are missing out on some of the fluids you normally get. This can lead to you becoming dehydrated, causing side effects such as tiredness and headaches. Dehydration can also be mistaken for hunger, which can make it more difficult to stick to your planned fast. The best option for staying hydrated is water. If you want to make it a bit more exciting then you can flavour it, with a slice of lemon, orange, lime or cucumber for example. Coffee (black or flavoured with natural extracts), tea (black, green, herbal or fruit), or broth (bone or vegetable) are all also suitable options. Stick with it You may struggle at first if you are not used to going for extended periods of time without food, but much of this could be down to habit. If you have had a set routine for a long time your body will expect to receive food at certain times of the day. So when it doesn’t get the food it is expecting, this can trigger feelings of hunger. Most people adapt quite quickly though, so find it increasingly easy to fast. But in the short-term, make sure you have thought about what you could do to try and distract yourself when you feel hungry. Break your fast with nutritious foods At the end of your fast, have a meal that includes plenty of real, minimally processed food. Make sure this meal includes one or two portions of good quality protein. This will help to satisfy your appetite, and to make sure your body gets plenty of nutrients. Planning a meal that supports your dietary approach but also includes some of your favourite foods to break your fast with can help to motivate you to stick with it too. Make sure you get enough salt People often think salt is unhealthy, but we do need some in our diet. Sodium is an essential nutrient, and the main source of it is salt. When you are not eating (i.e., during a fast), you are not taking in any salt. On top of this, the reduction in insulin levels during fasting results in less salt being held in the blood. Signs of having low sodium levels include dizziness (caused by a drop in blood pressure), muscle cramps, headaches and tiredness. These symptoms can be fixed by making sure you get enough salt and water. Salt can be added to meals in non-fasting periods, or you can get more by having salted water or bone broth during fasting periods. Don’t worry if you regain a bit of weight after a fast When you fast you will lose weight because your body is using up some of your stored fat for fuel. But you will also lose some weight for other reasons, including that there will be less food and waste passing through your body. This means that when you break your fast you might actually regain a little bit of weight. This is completely normal though, so you should not feel disappointed. The good news is that you will still have reduced the amount of fat stored in your body!] [Will I get hungry and thirstier during a fast?] [This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Your answer should be between five and eight sentences long.]",Medical,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","My aunt was just diagnosed with sickle cell anemia. I want to know more about the disease. Using this article as a reference, please explain the symptom and treatments for SCA.","How common is sickle cell anemia Prevalence Risk factors Symptoms Diagnosis Treatment Summary Sickle cell anemia (SCA) is a disorder that affects a person’s blood. Some research indicates that hundreds of thousands of people around the world experience this condition. SCA is a genetic blood disorder that affects red blood cells, which carry oxygen throughout the body. In people with SCA, these red blood cells change shape from round to crescent, or sickle shaped, due to problems with the hemoglobin in the cells. This can block blood flow to a person’s smaller blood vessels, causing pain and organ damage. SCA is one of a group of inherited red blood cell conditions that doctors refer to as sickle cell disease (SCD). SCA is usually the most severe form of SCD. SCD and SCA affect significant numbers of people globally. This article discusses SCA prevalence, risk factors, symptoms, diagnosis, and treatment. Sickle cell anemia prevalence yacobchuk/Getty Images According to the Centers for Disease Control and Prevention (CDC)Trusted Source, SCD affects millions of people throughout the world. The National Heart, Lung, and Blood Institute states that SCD affects more than 20 millionTrusted Source individuals worldwide. However, the CDC also states the exact number of people in the United States with SCD is unknown. They estimate that: SCD affects approximately 100,000 people in the United States. around 1 out of every 365 Black or African American babies have SCD around 1 out of every 16,300 Hispanic American babies have SCD There is a lack of current scientific data about how many people have SCA, which is a severe formTrusted Source of SCD. A 2022 review of research stated that more than 312,000Trusted Source children are born with SCA annually. However, the review used older data from 2011 to 2013 to provide this statistic. Sickle cell anemia risk factors SCA is a genetic condition that a person has from birthTrusted Source, so people cannot develop it any other way. People refer to the atypical genes that characterize the condition and cause SCA as sickle cell genes. If a person has one sickle cell gene, they have sickle cell trait (SCT). People with SCT typically do not have health problems as a result of the gene. However, they can still pass the sickle cell gene on if they have children. If someone inherits two sickle cell genes, they will have a form of SCD that may include SCA. They inherit one gene from each biological parent. If they have SCA, both their parents must have had SCD, SCT, or SCA. SCD is more common in some ethnic groups, such as: people of African descent Hispanic Americans from Central and South America people with Middle Eastern heritage individuals of Asian descent people with Indian heritage individuals of Mediterranean descent According to the CDC, approximately 1 in 13Trusted Source Black or African American babies have SCT. Learn more about SCA in African Americans. Symptoms to look out for People with SCA may have symptoms that appear at ages 5–6 months, including: painful swelling in hands and feet tiredness fussiness jaundice, which describes yellowing of the skin and whites of the eyes SCA symptoms can vary between people. Individuals with SCA may also developTrusted Source severe complications, such as: acute chest syndrome frequent serious infections severe anemia, which may cause shortness of breath and tiredness, among other symptoms sickle cell pain crises delayed growth lung problems strokes Sickle cell anemia diagnosis Healthcare professionals typically diagnoseTrusted Source SCA blood tests. They usually do so during pregnancy or soon after birth as part of routine screening. Healthcare professionals now test all newborns in the United States for SCA. People can have testing at any age to determine if they have SCA. They can also have blood or genetic testing to find out if they are at risk of having a child with the condition. They may carry the genes necessary for their children to have SCA, even if they do not have it themselves. Sickle cell anemia treatment People with SCA need lifelong treatment, which may include: preventing or managing painful episodes with self-care methods, such as staying hydrated and warm regular blood transfusions for a person’s symptoms or damage due to SCA emergency blood transfusions if a person develops severe anemia medication to reduce symptoms, such as hydroxyurea pain relief medications daily antibiotics for children under 5 yearsTrusted Source and regular vaccinations to reduce their risk of infection The only approved therapies that may be able to cure SCD are bone marrow or stem cell transplants. However, both these treatments carry significant risks — they may have serious side effects or be fatal. Summary Sickle cell anemia (SCA) is an inherited condition that affects a person’s red blood cells. It is a severe form of sickle cell disease (CSD). Some estimates suggest SCA affects hundreds of thousandsTrusted Source of people worldwide, while other health experts believe SCD affects millionsTrusted Source. People with forms of SCD have symptoms that can vary in severity, and some complications of SCD can be potentially fatal. However, there are a range of treatments to help manage the symptoms of SCD.","""================ ======= How common is sickle cell anemia Prevalence Risk factors Symptoms Diagnosis Treatment Summary Sickle cell anemia (SCA) is a disorder that affects a person’s blood. Some research indicates that hundreds of thousands of people around the world experience this condition. SCA is a genetic blood disorder that affects red blood cells, which carry oxygen throughout the body. In people with SCA, these red blood cells change shape from round to crescent, or sickle shaped, due to problems with the hemoglobin in the cells. This can block blood flow to a person’s smaller blood vessels, causing pain and organ damage. SCA is one of a group of inherited red blood cell conditions that doctors refer to as sickle cell disease (SCD). SCA is usually the most severe form of SCD. SCD and SCA affect significant numbers of people globally. This article discusses SCA prevalence, risk factors, symptoms, diagnosis, and treatment. Sickle cell anemia prevalence yacobchuk/Getty Images According to the Centers for Disease Control and Prevention (CDC)Trusted Source, SCD affects millions of people throughout the world. The National Heart, Lung, and Blood Institute states that SCD affects more than 20 millionTrusted Source individuals worldwide. However, the CDC also states the exact number of people in the United States with SCD is unknown. They estimate that: SCD affects approximately 100,000 people in the United States. around 1 out of every 365 Black or African American babies have SCD around 1 out of every 16,300 Hispanic American babies have SCD There is a lack of current scientific data about how many people have SCA, which is a severe formTrusted Source of SCD. A 2022 review of research stated that more than 312,000Trusted Source children are born with SCA annually. However, the review used older data from 2011 to 2013 to provide this statistic. Sickle cell anemia risk factors SCA is a genetic condition that a person has from birthTrusted Source, so people cannot develop it any other way. People refer to the atypical genes that characterize the condition and cause SCA as sickle cell genes. If a person has one sickle cell gene, they have sickle cell trait (SCT). People with SCT typically do not have health problems as a result of the gene. However, they can still pass the sickle cell gene on if they have children. If someone inherits two sickle cell genes, they will have a form of SCD that may include SCA. They inherit one gene from each biological parent. If they have SCA, both their parents must have had SCD, SCT, or SCA. SCD is more common in some ethnic groups, such as: people of African descent Hispanic Americans from Central and South America people with Middle Eastern heritage individuals of Asian descent people with Indian heritage individuals of Mediterranean descent According to the CDC, approximately 1 in 13Trusted Source Black or African American babies have SCT. Learn more about SCA in African Americans. Symptoms to look out for People with SCA may have symptoms that appear at ages 5–6 months, including: painful swelling in hands and feet tiredness fussiness jaundice, which describes yellowing of the skin and whites of the eyes SCA symptoms can vary between people. Individuals with SCA may also developTrusted Source severe complications, such as: acute chest syndrome frequent serious infections severe anemia, which may cause shortness of breath and tiredness, among other symptoms sickle cell pain crises delayed growth lung problems strokes Sickle cell anemia diagnosis Healthcare professionals typically diagnoseTrusted Source SCA blood tests. They usually do so during pregnancy or soon after birth as part of routine screening. Healthcare professionals now test all newborns in the United States for SCA. People can have testing at any age to determine if they have SCA. They can also have blood or genetic testing to find out if they are at risk of having a child with the condition. They may carry the genes necessary for their children to have SCA, even if they do not have it themselves. Sickle cell anemia treatment People with SCA need lifelong treatment, which may include: preventing or managing painful episodes with self-care methods, such as staying hydrated and warm regular blood transfusions for a person’s symptoms or damage due to SCA emergency blood transfusions if a person develops severe anemia medication to reduce symptoms, such as hydroxyurea pain relief medications daily antibiotics for children under 5 yearsTrusted Source and regular vaccinations to reduce their risk of infection The only approved therapies that may be able to cure SCD are bone marrow or stem cell transplants. However, both these treatments carry significant risks — they may have serious side effects or be fatal. Summary Sickle cell anemia (SCA) is an inherited condition that affects a person’s red blood cells. It is a severe form of sickle cell disease (CSD). Some estimates suggest SCA affects hundreds of thousandsTrusted Source of people worldwide, while other health experts believe SCD affects millionsTrusted Source. People with forms of SCD have symptoms that can vary in severity, and some complications of SCD can be potentially fatal. However, there are a range of treatments to help manage the symptoms of SCD. https://www.medicalnewstoday.com/articles/how-common-is-sickle-cell-anemia#summary ================ ======= My aunt was just diagnosed with sickle cell anemia. I want to know more about the disease. Using this article as a reference, please explain the symptom and treatments for SCA. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Explanation/Definition,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","Can you extract the key information from this text, and summarize what IPv6 Quality-of-Service is and how it applies to a software engineer who primarily works on web-based technologies?","IPv6 Quality-of-Service Capabilities A host can use the flow label and the traffic fields in the IPv6 header. A host uses these fields to identify those packets for which the host requests special handling by IPv6 routers. For example, the host can request non-default quality of service or real-time service. This important capability enables the support of applications that require some degree of consistent throughput, delay, or jitter. These types of applications are known as multi media or real-time applications. Flow Labels A source can use the 20-bit flow label field in the IPv6 header. A source can use this field to label those packets for which the source requests special handling by the IPv6 routers. For example, a source can request non-default quality of service or real-time service. This aspect of IPv6 is still experimental and subject to change as the requirements for flow support in the Internet become clearer. Some hosts or routers do not support the functions of the flow label field. These hosts or routers are required to set the field to zero when originating a packet. Hosts or routers forward the field without changes when forwarding a packet. Hosts or routers ignore the field when receiving a packet. What Is a Flow? A flow is a sequence of packets that are sent from a particular source to a particular, unicast or multicast, destination. The source also requires special handling by the intervening routers. The nature of the special handling might be conveyed to the routers by a control protocol. The control protocol can be a resource reservation protocol. The special handling also might be conveyed by information within the flow's packets, for example, in a hop-by-hop option. Active flows from a source to a destination can be multiple. Active flows can also contain traffic that is not associated with any flow. The combination of a source address and a nonzero flow label uniquely identifies a flow. Packets that do not belong to a flow carry a flow label of zero. The flow's source node assigns a flow label to a flow. New flow labels must be chosen randomly, in a “pseudo” manner. New flow labels must also be chosen uniformly from the range 1 to FFFFF hex. This random allocation makes any set of bits within the flow label field suitable for use as a hash key by routers. The routers can use the hash key to look up the state that is associated with the flow. Packets Belonging to the Same Flow All packets that belong to the same flow must be sent with the same source address, same destination address, and same nonzero flow label. If any of those packets include a hop-by-hop options header, then the packets must be originated with the contents of the hop-by-hop options header. The next header field of the hop-by-hop options header is excluded. If any of those packets include a routing header, then the packets must be originated with the same contents in all extension headers. The same contents include all extensions before the routing header and the routing header. The next header field in the routing header is excluded. The routers or destinations are permitted, but not required, to verify that these conditions are satisfied. If a violation is detected, the violation should be reported to the source. The violation is reported by a problem message for an ICMP parameter, Code 0. The violation points to the high-order octet of the flow label field. The high-order octet is offset one octet within the IPv6 packet. Routers are free to set up the flow-handling state for any flow. Routers do not need explicit flow establishment information from a control protocol, a hop-by-hop option, or other means. For example, when a router receives a packet from a particular source with an unknown, non-zero flow label, a router can process its IPv6 header. The router processes any necessary extension headers in the same way that the router processes extension headers with the flow label field set to zero. The routers also determine the next-hop interface. The routers might also update a hop-by-hop option, advance the pointer and addresses in a routing header, or decide how to queue the packet. The decision to queue the packet is based on the Traffic Class field of the packet. The routers can then choose to remember the results of the processing steps. Then, the routers can cache the information. The routers use the source address and the flow label as the cache key. Subsequent packets, with the same source address and flow label, can then be handled by referring to the cached information. The routers do not need to examine all those fields. The routers can assume that the fields are unchanged from the first packet that is checked in the flow. Traffic Class The nodes that originate a packet must identify different classes or different priorities of IPv6 packets. The nodes use the Traffic Class field in the IPv6 header to make this identification. The routers that forward the packets also use the Traffic Class field for the same purpose. The following general requirements apply to the Traffic Class field: The service interface to the IPv6 service within a node must supply the value of the Traffic Class bits for an upper-layer protocol. The Traffic Class bits must be in packets that are originated by that upper-layer protocol. The default value must be zero for all of the 8 bits. Nodes that support some of the Traffic Class bits or all of the Traffic Class bits can change the value of those bits. The nodes can change only the values in packets that the nodes originate, forward, or receive, as required for that specific use. Nodes should ignore and leave unchanged any bits of the Traffic Class field for which the nodes do not support a specific use. The Traffic Class bits in a received packet might not be the same value that is sent by the packet's source. Therefore, the upper-layer protocol must not assume that the values are the same.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Can you extract the key information from this text, and summarize what IPv6 Quality-of-Service is and how it applies to a software engineer who primarily works on web-based technologies? IPv6 Quality-of-Service Capabilities A host can use the flow label and the traffic fields in the IPv6 header. A host uses these fields to identify those packets for which the host requests special handling by IPv6 routers. For example, the host can request non-default quality of service or real-time service. This important capability enables the support of applications that require some degree of consistent throughput, delay, or jitter. These types of applications are known as multi media or real-time applications. Flow Labels A source can use the 20-bit flow label field in the IPv6 header. A source can use this field to label those packets for which the source requests special handling by the IPv6 routers. For example, a source can request non-default quality of service or real-time service. This aspect of IPv6 is still experimental and subject to change as the requirements for flow support in the Internet become clearer. Some hosts or routers do not support the functions of the flow label field. These hosts or routers are required to set the field to zero when originating a packet. Hosts or routers forward the field without changes when forwarding a packet. Hosts or routers ignore the field when receiving a packet. What Is a Flow? A flow is a sequence of packets that are sent from a particular source to a particular, unicast or multicast, destination. The source also requires special handling by the intervening routers. The nature of the special handling might be conveyed to the routers by a control protocol. The control protocol can be a resource reservation protocol. The special handling also might be conveyed by information within the flow's packets, for example, in a hop-by-hop option. Active flows from a source to a destination can be multiple. Active flows can also contain traffic that is not associated with any flow. The combination of a source address and a nonzero flow label uniquely identifies a flow. Packets that do not belong to a flow carry a flow label of zero. The flow's source node assigns a flow label to a flow. New flow labels must be chosen randomly, in a “pseudo” manner. New flow labels must also be chosen uniformly from the range 1 to FFFFF hex. This random allocation makes any set of bits within the flow label field suitable for use as a hash key by routers. The routers can use the hash key to look up the state that is associated with the flow. Packets Belonging to the Same Flow All packets that belong to the same flow must be sent with the same source address, same destination address, and same nonzero flow label. If any of those packets include a hop-by-hop options header, then the packets must be originated with the contents of the hop-by-hop options header. The next header field of the hop-by-hop options header is excluded. If any of those packets include a routing header, then the packets must be originated with the same contents in all extension headers. The same contents include all extensions before the routing header and the routing header. The next header field in the routing header is excluded. The routers or destinations are permitted, but not required, to verify that these conditions are satisfied. If a violation is detected, the violation should be reported to the source. The violation is reported by a problem message for an ICMP parameter, Code 0. The violation points to the high-order octet of the flow label field. The high-order octet is offset one octet within the IPv6 packet. Routers are free to set up the flow-handling state for any flow. Routers do not need explicit flow establishment information from a control protocol, a hop-by-hop option, or other means. For example, when a router receives a packet from a particular source with an unknown, non-zero flow label, a router can process its IPv6 header. The router processes any necessary extension headers in the same way that the router processes extension headers with the flow label field set to zero. The routers also determine the next-hop interface. The routers might also update a hop-by-hop option, advance the pointer and addresses in a routing header, or decide how to queue the packet. The decision to queue the packet is based on the Traffic Class field of the packet. The routers can then choose to remember the results of the processing steps. Then, the routers can cache the information. The routers use the source address and the flow label as the cache key. Subsequent packets, with the same source address and flow label, can then be handled by referring to the cached information. The routers do not need to examine all those fields. The routers can assume that the fields are unchanged from the first packet that is checked in the flow. Traffic Class The nodes that originate a packet must identify different classes or different priorities of IPv6 packets. The nodes use the Traffic Class field in the IPv6 header to make this identification. The routers that forward the packets also use the Traffic Class field for the same purpose. The following general requirements apply to the Traffic Class field: The service interface to the IPv6 service within a node must supply the value of the Traffic Class bits for an upper-layer protocol. The Traffic Class bits must be in packets that are originated by that upper-layer protocol. The default value must be zero for all of the 8 bits. Nodes that support some of the Traffic Class bits or all of the Traffic Class bits can change the value of those bits. The nodes can change only the values in packets that the nodes originate, forward, or receive, as required for that specific use. Nodes should ignore and leave unchanged any bits of the Traffic Class field for which the nodes do not support a specific use. The Traffic Class bits in a received packet might not be the same value that is sent by the packet's source. Therefore, the upper-layer protocol must not assume that the values are the same. https://docs.oracle.com/cd/E19683-01/817-0573/chapter1-25/index.html",Internet/Technology,Explanation/Definition,Q&A You may only use information in the context block when responding to the prompt,What specific disease in AR currently used for on the patient end?,"AR applications for physicians and healthcare professionals cover by far the largest user group [6]. However, especially for AR-supported image guidance and navigation, very high accuracy and reliability may be needed [9]. Applications, for which sub-millimeter precision is not necessary, are, for example, ablations, ventriculostomy [10-14] or certain orthopedic interventions [15]. Here, the HoloLens is with its inside-out tracking already a promising tool, but for applications that need, for example, sub-millimeter precision, it cannot be used reliably yet. An example is the deep brain stimulation (DBS) procedure used for treating essential tremor and Parkinson’s disease, where millimeter-to-submillimeter accuracy in DBS targeting (an electrode placement inside the brain) can be important [16]. Another study exploring the clinical accuracy of the HoloLens for neuronavigation concludes also that it is currently not within clinically acceptable levels [17]. The same holds true for some application scenarios in orthopedic surgery [18], like screw placement, where there is still room for improvement [19]. We expect the Vision Pro to move the needle in terms of accuracy, because of its strong inside-out tracking through 12 built-in cameras and LiDAR (Light Detection and Ranging) sensing method, which is the key aspect for increasing the accuracy of AR. We do not see the often-criticized end-user price of $3,499 (without tax) for the Vision Pro as an issue for this user group. The price is similar to the HoloLens and much cheaper at a fraction of the costs compared to existing, and clinically used conventional medical navigation systems, e.g., from Brainlab or Medtronic. In this context, it is important to mention that the use of AR head-mounted displays (HMDs) with direct patient reference (and outside of research in the context of feasibility studies) requires an appropriate regulatory approval and a certification/classification as medical device. The Magic Leap 2, for example, received certification for usage in an operating room in January of this year (2023). Moreover, and especially in a medical context, the display may also require an image focus in surgical table distance [20]. Students are the second most common intended user group [6] with applications, for example, in educational training, like the HoloPointer, a virtual AR pointer for laparoscopic surgery training [21]. Another example is the usage of MR to teach medical students catheter placement [22] or a phantom experiment to study the effectiveness of learning using AR in the access of the central venous [23]. We found that the effects of HoloLens-based learning compared to conventional learning, e.g., by using cadavers or other computerized methods, seem to be rather small. A reason for this is that the learning tools usually used are relatively simple, conventional 3D models and more innovative visualizations, including interactive, dynamic content, which cannot be easily delivered by regular computerized methods, have not been explored in depth yet [6]. Here, we believe that the Vision Pro can raise the bar, because of its high-resolution visualization (consisting of two micro-OLED displays with a total of 23 megapixels) that uses eye-tracking to make the headset also usable as a desktop screen with its fine textual details. In addition, the 3D user interface, using precise and intuitive finger tracking, can be a game changer. Despite these advances, it remains to be seen if an AR headset has a major advantage over a conventional screen. The cost of the Vision Pro is also a concern, especially for students with a limited financial budget, but the “Pro” might indicate that there will also be a “regular” version released. Patients are currently the least frequented target user group with AR devices[6]. An example is MemHolo, which provides MR experiences for subjects with Alzheimer’s disease [24]. Other examples in this area include the usage of the HoloLens as an assistant and monitoring tool for medication adherence [25] and the usage of a HoloLens-based system for functional mobility assessment [26]. However, many interesting assistance and monitoring applications are limited by the restricted possible usage time of untethered AR headsets primarily due to battery life, and this problem seems to remain with the Vision Pro, which has a similar battery life of approximately two hours, like the HoloLens. The only consolation is the “external” battery pack that can be swapped for the Vision Pro. Finally, the Apple M2 and the new R1 chip of the Vision Pro could potentially boost the relatively small number of applications that have been explored so far, e.g., by reducing motion sickness, especially for elderly patients, which are more susceptible to MR sickness than younger users.","system instruction: [You may only use information in the context block when responding to the prompt] Content block: [AR applications for physicians and healthcare professionals cover by far the largest user group [6]. However, especially for AR-supported image guidance and navigation, very high accuracy and reliability may be needed [9]. Applications, for which sub-millimeter precision is not necessary, are, for example, ablations, ventriculostomy [10-14] or certain orthopedic interventions [15]. Here, the HoloLens is with its inside-out tracking already a promising tool, but for applications that need, for example, sub-millimeter precision, it cannot be used reliably yet. An example is the deep brain stimulation (DBS) procedure used for treating essential tremor and Parkinson’s disease, where millimeter-to-submillimeter accuracy in DBS targeting (an electrode placement inside the brain) can be important [16]. Another study exploring the clinical accuracy of the HoloLens for neuronavigation concludes also that it is currently not within clinically acceptable levels [17]. The same holds true for some application scenarios in orthopedic surgery [18], like screw placement, where there is still room for improvement [19]. We expect the Vision Pro to move the needle in terms of accuracy, because of its strong inside-out tracking through 12 built-in cameras and LiDAR (Light Detection and Ranging) sensing method, which is the key aspect for increasing the accuracy of AR. We do not see the often-criticized end-user price of $3,499 (without tax) for the Vision Pro as an issue for this user group. The price is similar to the HoloLens and much cheaper at a fraction of the costs compared to existing, and clinically used conventional medical navigation systems, e.g., from Brainlab or Medtronic. In this context, it is important to mention that the use of AR head-mounted displays (HMDs) with direct patient reference (and outside of research in the context of feasibility studies) requires an appropriate regulatory approval and a certification/classification as medical device. The Magic Leap 2, for example, received certification for usage in an operating room in January of this year (2023). Moreover, and especially in a medical context, the display may also require an image focus in surgical table distance [20]. Students are the second most common intended user group [6] with applications, for example, in educational training, like the HoloPointer, a virtual AR pointer for laparoscopic surgery training [21]. Another example is the usage of MR to teach medical students catheter placement [22] or a phantom experiment to study the effectiveness of learning using AR in the access of the central venous [23]. We found that the effects of HoloLens-based learning compared to conventional learning, e.g., by using cadavers or other computerized methods, seem to be rather small. A reason for this is that the learning tools usually used are relatively simple, conventional 3D models and more innovative visualizations, including interactive, dynamic content, which cannot be easily delivered by regular computerized methods, have not been explored in depth yet [6]. Here, we believe that the Vision Pro can raise the bar, because of its high-resolution visualization (consisting of two micro-OLED displays with a total of 23 megapixels) that uses eye-tracking to make the headset also usable as a desktop screen with its fine textual details. In addition, the 3D user interface, using precise and intuitive finger tracking, can be a game changer. Despite these advances, it remains to be seen if an AR headset has a major advantage over a conventional screen. The cost of the Vision Pro is also a concern, especially for students with a limited financial budget, but the “Pro” might indicate that there will also be a “regular” version released. Patients are currently the least frequented target user group with AR devices[6]. An example is MemHolo, which provides MR experiences for subjects with Alzheimer’s disease [24]. Other examples in this area include the usage of the HoloLens as an assistant and monitoring tool for medication adherence [25] and the usage of a HoloLens-based system for functional mobility assessment [26]. However, many interesting assistance and monitoring applications are limited by the restricted possible usage time of untethered AR headsets primarily due to battery life, and this problem seems to remain with the Vision Pro, which has a similar battery life of approximately two hours, like the HoloLens. The only consolation is the “external” battery pack that can be swapped for the Vision Pro. Finally, the Apple M2 and the new R1 chip of the Vision Pro could potentially boost the relatively small number of applications that have been explored so far, e.g., by reducing motion sickness, especially for elderly patients, which are more susceptible to MR sickness than younger users.] question: [What specific disease in AR currently used for on the patient end?] ",Medical,Fact Finding,Q&A "You may not reference any other resources or find the answer to the prompt from any other resources beyond the provided text. If the answer is not given in the text, you must clearly state that. You may not assume or allude to potential meanings of the answers if the text does not explicitly state the answer. Do not expand upon the meanings of the answer if the text does not.",What advantages do offline vs online retailers have?,"Due to savings in inventory costs, online retailing has a big advantage in selling less popular items (the long tail) and in removing geographic barriers to purchase. Brynjolfsson et al. (2003) estimated that the significantly increased assortment of books available online increased consumer welfare by $700 million to a billion dollars in 2000. In comparing the online sales of a clothing retailer with the catalog sales of the same item, Brynjolfsson et al. (2009) showed that online sales of niche items were less sensitive to competition from offline stores than from catalog sales because the online sales were skewed toward niche items. Brynjolfsson et al. (2011) showed that online sales of niche items increased with recommendations and search tools, indicating that these tools lowered search costs, making it easier for consumers to locate them. In sum, because of the ability to handle more extensive inventories and provide search tools that facilitate locating niche items, online retailing has a comparative advantage in selling less popular items, translating into substantial benefits for consumers. As noted above, online sellers have an advantage in facilitating a search for information on digital attributes (including price). In contrast, offline sellers have an advantage in providing information on non- digital attributes and providing faster delivery. This leads to the possibility that consumers will search among both online and offline retailers.","You may not reference any other resources or find the answer to the prompt from any other resources beyond the provided text. If the answer is not given in the text, you must clearly state that. You may not assume or allude to potential meanings of the answers if the text does not explicitly state the answer. Do not expand upon the meanings of the answer if the text does not. What advantages do offline vs online retailers have? Due to savings in inventory costs, online retailing has a big advantage in selling less popular items (the long tail) and in removing geographic barriers to purchase. Brynjolfsson et al. (2003) estimated that the significantly increased assortment of books available online increased consumer welfare by $700 million to a billion dollars in 2000. In comparing the online sales of a clothing retailer with the catalog sales of the same item, Brynjolfsson et al. (2009) showed that online sales of niche items were less sensitive to competition from offline stores than from catalog sales because the online sales were skewed toward niche items. Brynjolfsson et al. (2011) showed that online sales of niche items increased with recommendations and search tools, indicating that these tools lowered search costs, making it easier for consumers to locate them. In sum, because of the ability to handle more extensive inventories and provide search tools that facilitate locating niche items, online retailing has a comparative advantage in selling less popular items, translating into substantial benefits for consumers. As noted above, online sellers have an advantage in facilitating a search for information on digital attributes (including price). In contrast, offline sellers have an advantage in providing information on non- digital attributes and providing faster delivery. This leads to the possibility that consumers will search among both online and offline retailers.",Retail/Product,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",What is the effects of the Triple E virus on humans? Should we be worried? How is the Triple E virus spreading in the U.S. and what measures can be taken to combat?,"A 41-year-old man in New Hampshire died last week after contracting a rare mosquito-borne illness called eastern equine encephalitis virus, also known as EEE or “triple E.” It was New Hampshire’s first human case of the disease in a decade. Four other human EEE infections have been reported this year in Wisconsin, New Jersey, Massachusetts, and Vermont. Though this outbreak is small and triple E does not pose a risk to most people living in the United States, public health officials and researchers alike are concerned about the threat the deadly virus poses to the public, both this year and in future summers. There is no known cure for the disease, which can cause severe flu-like symptoms and seizures in humans 4 to 10 days after exposure and kills between 30 and 40 percent of the people it infects. Half of the people who survive a triple E infection are left with permanent neurological damage. Because of EEE’s high mortality rate, state officials have begun spraying insecticide in Massachusetts, where 10 communities have been designated “critical” or “high risk” for triple E. Towns in the state shuttered their parks from dusk to dawn and warned people to stay inside after 6 p.m., when mosquitoes are most active. Like West Nile virus, another mosquito-borne illness that poses a risk to people in the U.S. every summer, triple E is constrained by environmental factors that are changing rapidly as the planet warms. That’s because mosquitoes thrive in the hotter, wetter conditions that climate change is producing. “We have seen a resurgence of activity with eastern equine encephalitis virus over the course of the past 10 or so years,” said Theodore G. Andreadis, a researcher who studied mosquito-borne diseases at the Connecticut Agricultural Experiment Station, a state government research and public outreach outfit, for 35 years. “And we’ve seen an advancement into more northern regions where it had previously not been detected.” Researchers don’t know what causes the virus to surge and abate, but Andreadis said it’s clear that climate change is one of the factors spurring its spread, particularly into new regions. The first triple E outbreak on record occurred in Massachusetts in the 1830s in horses — the reason one of the three Es stands for “equine.” It wasn’t until a full century later, in 1934, that mosquitoes were incriminated as potential vectors for the disease. The first recorded human cases of the disease also occurred in Massachusetts four years later, in 1938. There were 38 human cases in the state that year; 25 of them were fatal. Since then, human cases have mostly been registered in Gulf Coast states and, increasingly, the Northeast. From 1964 to 2002, in the Northeast, there was less than one case of the disease per year. From 2003 to 2019, the average in the region increased to between four and five cases per year. The disease is spread by two types of mosquito. The first is a species called Culiseta melanura, or the black-tailed mosquito. This mosquito tends to live in hardwood bogs and feeds on birds like robins, herons, and wrens, spreading the virus among them. But the melanura mosquito doesn’t often bite mammals. A different mosquito species, Coquillettidia perturbans, is primarily responsible for most of the human cases of the disease reported in the U.S. The perturbans mosquito picks up the EEE virus when it feeds on birds and then infects the humans and horses that it bites. Toward the end of the summer, when mosquitoes have reached their peak numbers and start jostling for any available blood meal, human cases start cropping up. Andreadis, who published a historical retrospective on the progression of triple E in the northeastern U.S. in 2021, said climate change has emerged as a major driver of the disease. “We’ve got milder winters, we’ve got warmer summers, and we’ve got extremes in both precipitation and drought,” he said. “The impact that this has on mosquito populations is probably quite profound.” Warmer global average temperatures generally produce more mosquitoes, no matter the species. Studies have shown that warmer air temperatures up to a certain threshold, around 90 degrees Fahrenheit, shorten the amount of time it takes for C. melanura eggs to hatch. Higher temperatures in the spring and fall extend the number of days mosquitoes have to breed and feed. And they’ll feed more times in a summer season if it’s warmer — mosquitoes are ectothermic, meaning their metabolism speeds up in higher temperatures. Rainfall, too, plays a role in mosquito breeding and activity, since mosquito eggs need water to hatch. A warmer atmosphere holds more moisture, which means that even small rainfall events dump more water today than they would have last century. The more standing water there is in roadside ditches, abandoned car tires, ponds, bogs, and potholes, the more opportunities mosquitoes have to breed. And warmer water decreases the incubation period for C. melanura eggs, leading one study to conclude that warmer-than-average water temperatures “increase the probability for amplification of EEE.” Climate change isn’t the only factor encouraging the spread of disease vectors like mosquitoes. The slow reforestation of areas that were clear-cut for industry and agriculture many decades ago is creating new habitat for insects. At the same time, developers are building new homes in wooded or half-wooded zones in ever larger numbers, putting humans in closer proximity to the natural world and the bugs that live in it. On an individual level, the best way to stay safe from EEE and other mosquito-borne diseases is to prevent bites: Wear long sleeves and pants at dusk and dawn, when mosquitoes are most prone to biting, and regularly apply an effective mosquito spray. But there are also steps that local health departments can take to safeguard public health, like testing pools of water for mosquito larvae and conducting public awareness and insecticide spraying campaigns when triple E is detected. Massachusetts is an example of a state that has been proactive about testing mosquitoes for triple E in recent summers. The most effective way to protect people from this disease would be to develop a vaccine against it. A vaccine already exists for horses, but there is little incentive for vaccine manufacturers to develop a preventative for triple E in humans because the illness is so rare. “Although EEE is not yet a global health emergency, the recent uptick in cases has highlighted our lack of preparedness for unexpected infectious disease outbreaks,” a group of biologists wrote last year in the open-access scientific journal Frontiers. “It would be wise to follow proactive active control measures and increase vigilance in the face of these threats.”"," Only use the provided text to answer the question, no outside sources. What is the effects of the Triple E virus on humans? Should we be worried? How is the Triple E virus spreading in the U.S. and what measures can be taken to combat? A 41-year-old man in New Hampshire died last week after contracting a rare mosquito-borne illness called eastern equine encephalitis virus, also known as EEE or “triple E.” It was New Hampshire’s first human case of the disease in a decade. Four other human EEE infections have been reported this year in Wisconsin, New Jersey, Massachusetts, and Vermont. Though this outbreak is small and triple E does not pose a risk to most people living in the United States, public health officials and researchers alike are concerned about the threat the deadly virus poses to the public, both this year and in future summers. There is no known cure for the disease, which can cause severe flu-like symptoms and seizures in humans 4 to 10 days after exposure and kills between 30 and 40 percent of the people it infects. Half of the people who survive a triple E infection are left with permanent neurological damage. Because of EEE’s high mortality rate, state officials have begun spraying insecticide in Massachusetts, where 10 communities have been designated “critical” or “high risk” for triple E. Towns in the state shuttered their parks from dusk to dawn and warned people to stay inside after 6 p.m., when mosquitoes are most active. Like West Nile virus, another mosquito-borne illness that poses a risk to people in the U.S. every summer, triple E is constrained by environmental factors that are changing rapidly as the planet warms. That’s because mosquitoes thrive in the hotter, wetter conditions that climate change is producing. “We have seen a resurgence of activity with eastern equine encephalitis virus over the course of the past 10 or so years,” said Theodore G. Andreadis, a researcher who studied mosquito-borne diseases at the Connecticut Agricultural Experiment Station, a state government research and public outreach outfit, for 35 years. “And we’ve seen an advancement into more northern regions where it had previously not been detected.” Researchers don’t know what causes the virus to surge and abate, but Andreadis said it’s clear that climate change is one of the factors spurring its spread, particularly into new regions. The first triple E outbreak on record occurred in Massachusetts in the 1830s in horses — the reason one of the three Es stands for “equine.” It wasn’t until a full century later, in 1934, that mosquitoes were incriminated as potential vectors for the disease. The first recorded human cases of the disease also occurred in Massachusetts four years later, in 1938. There were 38 human cases in the state that year; 25 of them were fatal. Since then, human cases have mostly been registered in Gulf Coast states and, increasingly, the Northeast. From 1964 to 2002, in the Northeast, there was less than one case of the disease per year. From 2003 to 2019, the average in the region increased to between four and five cases per year. The disease is spread by two types of mosquito. The first is a species called Culiseta melanura, or the black-tailed mosquito. This mosquito tends to live in hardwood bogs and feeds on birds like robins, herons, and wrens, spreading the virus among them. But the melanura mosquito doesn’t often bite mammals. A different mosquito species, Coquillettidia perturbans, is primarily responsible for most of the human cases of the disease reported in the U.S. The perturbans mosquito picks up the EEE virus when it feeds on birds and then infects the humans and horses that it bites. Toward the end of the summer, when mosquitoes have reached their peak numbers and start jostling for any available blood meal, human cases start cropping up. Andreadis, who published a historical retrospective on the progression of triple E in the northeastern U.S. in 2021, said climate change has emerged as a major driver of the disease. “We’ve got milder winters, we’ve got warmer summers, and we’ve got extremes in both precipitation and drought,” he said. “The impact that this has on mosquito populations is probably quite profound.” Warmer global average temperatures generally produce more mosquitoes, no matter the species. Studies have shown that warmer air temperatures up to a certain threshold, around 90 degrees Fahrenheit, shorten the amount of time it takes for C. melanura eggs to hatch. Higher temperatures in the spring and fall extend the number of days mosquitoes have to breed and feed. And they’ll feed more times in a summer season if it’s warmer — mosquitoes are ectothermic, meaning their metabolism speeds up in higher temperatures. Rainfall, too, plays a role in mosquito breeding and activity, since mosquito eggs need water to hatch. A warmer atmosphere holds more moisture, which means that even small rainfall events dump more water today than they would have last century. The more standing water there is in roadside ditches, abandoned car tires, ponds, bogs, and potholes, the more opportunities mosquitoes have to breed. And warmer water decreases the incubation period for C. melanura eggs, leading one study to conclude that warmer-than-average water temperatures “increase the probability for amplification of EEE.” Climate change isn’t the only factor encouraging the spread of disease vectors like mosquitoes. The slow reforestation of areas that were clear-cut for industry and agriculture many decades ago is creating new habitat for insects. At the same time, developers are building new homes in wooded or half-wooded zones in ever larger numbers, putting humans in closer proximity to the natural world and the bugs that live in it. On an individual level, the best way to stay safe from EEE and other mosquito-borne diseases is to prevent bites: Wear long sleeves and pants at dusk and dawn, when mosquitoes are most prone to biting, and regularly apply an effective mosquito spray. But there are also steps that local health departments can take to safeguard public health, like testing pools of water for mosquito larvae and conducting public awareness and insecticide spraying campaigns when triple E is detected. Massachusetts is an example of a state that has been proactive about testing mosquitoes for triple E in recent summers. The most effective way to protect people from this disease would be to develop a vaccine against it. A vaccine already exists for horses, but there is little incentive for vaccine manufacturers to develop a preventative for triple E in humans because the illness is so rare. “Although EEE is not yet a global health emergency, the recent uptick in cases has highlighted our lack of preparedness for unexpected infectious disease outbreaks,” a group of biologists wrote last year in the open-access scientific journal Frontiers. “It would be wise to follow proactive active control measures and increase vigilance in the face of these threats.” https://grist.org/health/eee-triple-e-climate-change-eastern-equine-encephalitis-mosquito-borne-illness/",Medical,Find & Summarize,Text Transformation "You must answer in three paragraphs or less, using only information from the context block. ",How does the adequacy decision impact data transfers?," CHAPTER V Transfers of personal data to third countries or international organisations Article 44 General principle for transfers Any transfer of personal data which are undergoing processing or are intended for processing after transfer to a third country or to an international organisation shall take place only if, subject to the other provisions of this Regulation, the conditions laid down in this Chapter are complied with by the controller and processor, including for onward transfers of personal data from the third country or an international organisation to another third country or to another international organisation. All provisions in this Chapter shall be applied in order to ensure that the level of protection of natural persons guaranteed by this Regulation is not undermined. L 119/60 EN Official Journal of the European Union 4.5.2016 Article 45 Transfers on the basis of an adequacy decision 1. A transfer of personal data to a third country or an international organisation may take place where the Commission has decided that the third country, a territory or one or more specified sectors within that third country, or the international organisation in question ensures an adequate level of protection. Such a transfer shall not require any specific authorisation. 2. When assessing the adequacy of the level of protection, the Commission shall, in particular, take account of the following elements: (a) the rule of law, respect for human rights and fundamental freedoms, relevant legislation, both general and sectoral, including concerning public security, defence, national security and criminal law and the access of public authorities to personal data, as well as the implementation of such legislation, data protection rules, professional rules and security measures, including rules for the onward transfer of personal data to another third country or international organisation which are complied with in that country or international organisation, case-law, as well as effective and enforceable data subject rights and effective administrative and judicial redress for the data subjects whose personal data are being transferred; (b) the existence and effective functioning of one or more independent supervisory authorities in the third country or to which an international organisation is subject, with responsibility for ensuring and enforcing compliance with the data protection rules, including adequate enforcement powers, for assisting and advising the data subjects in exercising their rights and for cooperation with the supervisory authorities of the Member States; and (c) the international commitments the third country or international organisation concerned has entered into, or other obligations arising from legally binding conventions or instruments as well as from its participation in multilateral or regional systems, in particular in relation to the protection of personal data. 3. The Commission, after assessing the adequacy of the level of protection, may decide, by means of implementing act, that a third country, a territory or one or more specified sectors within a third country, or an international organisation ensures an adequate level of protection within the meaning of paragraph 2 of this Article. The implementing act shall provide for a mechanism for a periodic review, at least every four years, which shall take into account all relevant developments in the third country or international organisation. The implementing act shall specify its territorial and sectoral application and, where applicable, identify the supervisory authority or authorities referred to in point (b) of paragraph 2 of this Article. The implementing act shall be adopted in accordance with the examination procedure referred to in Article 93(2). 4. The Commission shall, on an ongoing basis, monitor developments in third countries and international organisations that could affect the functioning of decisions adopted pursuant to paragraph 3 of this Article and decisions adopted on the basis of Article 25(6) of Directive 95/46/EC. 5. The Commission shall, where available information reveals, in particular following the review referred to in paragraph 3 of this Article, that a third country, a territory or one or more specified sectors within a third country, or an international organisation no longer ensures an adequate level of protection within the meaning of paragraph 2 of this Article, to the extent necessary, repeal, amend or suspend the decision referred to in paragraph 3 of this Article by means of implementing acts without retro-active effect. Those implementing acts shall be adopted in accordance with the examination procedure referred to in Article 93(2). On duly justified imperative grounds of urgency, the Commission shall adopt immediately applicable implementing acts in accordance with the procedure referred to in Article 93(3). 6. The Commission shall enter into consultations with the third country or international organisation with a view to remedying the situation giving rise to the decision made pursuant to paragraph 5. 7. A decision pursuant to paragraph 5 of this Article is without prejudice to transfers of personal data to the third country, a territory or one or more specified sectors within that third country, or the international organisation in question pursuant to Articles 46 to 49. 8. The Commission shall publish in the Official Journal of the European Union and on its website a list of the third countries, territories and specified sectors within a third country and international organisations for which it has decided that an adequate level of protection is or is no longer ensured. 4.5.2016 EN Official Journal of the European Union L 119/61 9. Decisions adopted by the Commission on the basis of Article 25(6) of Directive 95/46/EC shall remain in force until amended, replaced or repealed by a Commission Decision adopted in accordance with paragraph 3 or 5 of this Article. Article 46 Transfers subject to appropriate safeguards 1. In the absence of a decision pursuant to Article 45(3), a controller or processor may transfer personal data to a third country or an international organisation only if the controller or processor has provided appropriate safeguards, and on condition that enforceable data subject rights and effective legal remedies for data subjects are available. 2. The appropriate safeguards referred to in paragraph 1 may be provided for, without requiring any specific authorisation from a supervisory authority, by: (a) a legally binding and enforceable instrument between public authorities or bodies; (b) binding corporate rules in accordance with Article 47; (c) standard data protection clauses adopted by the Commission in accordance with the examination procedure referred to in Article 93(2); (d) standard data protection clauses adopted by a supervisory authority and approved by the Commission pursuant to the examination procedure referred to in Article 93(2); (e) an approved code of conduct pursuant to Article 40 together with binding and enforceable commitments of the controller or processor in the third country to apply the appropriate safeguards, including as regards data subjects' rights; or (f) an approved certification mechanism pursuant to Article 42 together with binding and enforceable commitments of the controller or processor in the third country to apply the appropriate safeguards, including as regards data subjects' rights. 3. Subject to the authorisation from the competent supervisory authority, the appropriate safeguards referred to in paragraph 1 may also be provided for, in particular, by: (a) contractual clauses between the controller or processor and the controller, processor or the recipient of the personal data in the third country or international organisation; or (b) provisions to be inserted into administrative arrangements between public authorities or bodies which include enforceable and effective data subject rights. 4. The supervisory authority shall apply the consistency mechanism referred to in Article 63 in the cases referred to in paragraph 3 of this Article. 5. Authorisations by a Member State or supervisory authority on the basis of Article 26(2) of Directive 95/46/EC shall remain valid until amended, replaced or repealed, if necessary, by that supervisory authority. Decisions adopted by the Commission on the basis of Article 26(4) of Directive 95/46/EC shall remain in force until amended, replaced or repealed, if necessary, by a Commission Decision adopted in accordance with paragraph 2 of this Article. ","System Instructions: You must answer only information from the context block. No external information can be used to supplement this. Context: CHAPTER V Transfers of personal data to third countries or international organisations Article 44 General principle for transfers Any transfer of personal data which are undergoing processing or are intended for processing after transfer to a third country or to an international organisation shall take place only if, subject to the other provisions of this Regulation, the conditions laid down in this Chapter are complied with by the controller and processor, including for onward transfers of personal data from the third country or an international organisation to another third country or to another international organisation. All provisions in this Chapter shall be applied in order to ensure that the level of protection of natural persons guaranteed by this Regulation is not undermined. L 119/60 EN Official Journal of the European Union 4.5.2016 Article 45 Transfers on the basis of an adequacy decision 1. A transfer of personal data to a third country or an international organisation may take place where the Commission has decided that the third country, a territory or one or more specified sectors within that third country, or the international organisation in question ensures an adequate level of protection. Such a transfer shall not require any specific authorisation. 2. When assessing the adequacy of the level of protection, the Commission shall, in particular, take account of the following elements: (a) the rule of law, respect for human rights and fundamental freedoms, relevant legislation, both general and sectoral, including concerning public security, defence, national security and criminal law and the access of public authorities to personal data, as well as the implementation of such legislation, data protection rules, professional rules and security measures, including rules for the onward transfer of personal data to another third country or international organisation which are complied with in that country or international organisation, case-law, as well as effective and enforceable data subject rights and effective administrative and judicial redress for the data subjects whose personal data are being transferred; (b) the existence and effective functioning of one or more independent supervisory authorities in the third country or to which an international organisation is subject, with responsibility for ensuring and enforcing compliance with the data protection rules, including adequate enforcement powers, for assisting and advising the data subjects in exercising their rights and for cooperation with the supervisory authorities of the Member States; and (c) the international commitments the third country or international organisation concerned has entered into, or other obligations arising from legally binding conventions or instruments as well as from its participation in multilateral or regional systems, in particular in relation to the protection of personal data. 3. The Commission, after assessing the adequacy of the level of protection, may decide, by means of implementing act, that a third country, a territory or one or more specified sectors within a third country, or an international organisation ensures an adequate level of protection within the meaning of paragraph 2 of this Article. The implementing act shall provide for a mechanism for a periodic review, at least every four years, which shall take into account all relevant developments in the third country or international organisation. The implementing act shall specify its territorial and sectoral application and, where applicable, identify the supervisory authority or authorities referred to in point (b) of paragraph 2 of this Article. The implementing act shall be adopted in accordance with the examination procedure referred to in Article 93(2). 4. The Commission shall, on an ongoing basis, monitor developments in third countries and international organisations that could affect the functioning of decisions adopted pursuant to paragraph 3 of this Article and decisions adopted on the basis of Article 25(6) of Directive 95/46/EC. 5. The Commission shall, where available information reveals, in particular following the review referred to in paragraph 3 of this Article, that a third country, a territory or one or more specified sectors within a third country, or an international organisation no longer ensures an adequate level of protection within the meaning of paragraph 2 of this Article, to the extent necessary, repeal, amend or suspend the decision referred to in paragraph 3 of this Article by means of implementing acts without retro-active effect. Those implementing acts shall be adopted in accordance with the examination procedure referred to in Article 93(2). On duly justified imperative grounds of urgency, the Commission shall adopt immediately applicable implementing acts in accordance with the procedure referred to in Article 93(3). 6. The Commission shall enter into consultations with the third country or international organisation with a view to remedying the situation giving rise to the decision made pursuant to paragraph 5. 7. A decision pursuant to paragraph 5 of this Article is without prejudice to transfers of personal data to the third country, a territory or one or more specified sectors within that third country, or the international organisation in question pursuant to Articles 46 to 49. 8. The Commission shall publish in the Official Journal of the European Union and on its website a list of the third countries, territories and specified sectors within a third country and international organisations for which it has decided that an adequate level of protection is or is no longer ensured. 4.5.2016 EN Official Journal of the European Union L 119/61 9. Decisions adopted by the Commission on the basis of Article 25(6) of Directive 95/46/EC shall remain in force until amended, replaced or repealed by a Commission Decision adopted in accordance with paragraph 3 or 5 of this Article. Article 46 Transfers subject to appropriate safeguards 1. In the absence of a decision pursuant to Article 45(3), a controller or processor may transfer personal data to a third country or an international organisation only if the controller or processor has provided appropriate safeguards, and on condition that enforceable data subject rights and effective legal remedies for data subjects are available. 2. The appropriate safeguards referred to in paragraph 1 may be provided for, without requiring any specific authorisation from a supervisory authority, by: (a) a legally binding and enforceable instrument between public authorities or bodies; (b) binding corporate rules in accordance with Article 47; (c) standard data protection clauses adopted by the Commission in accordance with the examination procedure referred to in Article 93(2); (d) standard data protection clauses adopted by a supervisory authority and approved by the Commission pursuant to the examination procedure referred to in Article 93(2); (e) an approved code of conduct pursuant to Article 40 together with binding and enforceable commitments of the controller or processor in the third country to apply the appropriate safeguards, including as regards data subjects' rights; or (f) an approved certification mechanism pursuant to Article 42 together with binding and enforceable commitments of the controller or processor in the third country to apply the appropriate safeguards, including as regards data subjects' rights. 3. Subject to the authorisation from the competent supervisory authority, the appropriate safeguards referred to in paragraph 1 may also be provided for, in particular, by: (a) contractual clauses between the controller or processor and the controller, processor or the recipient of the personal data in the third country or international organisation; or (b) provisions to be inserted into administrative arrangements between public authorities or bodies which include enforceable and effective data subject rights. 4. The supervisory authority shall apply the consistency mechanism referred to in Article 63 in the cases referred to in paragraph 3 of this Article. 5. Authorisations by a Member State or supervisory authority on the basis of Article 26(2) of Directive 95/46/EC shall remain valid until amended, replaced or repealed, if necessary, by that supervisory authority. Decisions adopted by the Commission on the basis of Article 26(4) of Directive 95/46/EC shall remain in force until amended, replaced or repealed, if necessary, by a Commission Decision adopted in accordance with paragraph 2 of this Article. Question: How does the adequacy decision impact data transfers?",Legal,Fact Finding,Q&A Only respond to the prompt using the information in the prompt. Format the response as a numbered list.,What are three failures of the WHO regarding fighting diseases and other health threats?,"WHO achievements: A mixed track record Fighting infectious diseases One of the WHO's biggest achievements was in eradicating smallpox: in 1980, 21 years after launching an international vaccination campaign, it was finally able to declare the world free of the disease. In 1988, the WHO declared a target of similarly eliminating polio by the end of the millennium. That target was missed, and the stubborn persistence of infections prompted the WHO to declare a PHEIC in 2014. Nevertheless, considerable progress has been made, with the number of cases falling by 99 % over the past three decades. Unfortunately, tuberculosis is very far from disappearing; however, the WHO's Global Drug Facility has enabled millions of patients in developing countries to access high-quality anti-TB medicines, both through collective purchasing mechanisms that bring the cost of drugs down, and through grants that help the poorest countries to buy such medicines. The WHO has also been praised for its leadership during the 2003 SARS epidemic; within just four months, the disease had been contained. In 2009, fears that the swine flu virus could mutate into a more lethal form prompted the WHO to declare its first ever Public Health Emergency of International Concern (PHEIC – see Box). Governments rushed to stockpile vaccines, most of which were never used, as the epidemic turned out to be milder than expected. This 'disproportionate' response, as it was described in a 2011 European Parliament resolution, was blamed for wasting millions of euros of public money on unnecessary vaccines. Some critics even alleged that WHO decisions had been swayed by the interests of the pharmaceutical sector. An internal enquiry exonerated the WHO from most of these accusations, arguing that, in view of the evidence available at the time, it would not have been possible to predict the course of the epidemic, while also acknowledging that the situation could have been handled more transparently. Whereas the WHO was accused of over-reacting to swine flu, its response to the 2014 West African Ebola outbreak came too late to prevent tens of thousands of deaths. In what international health experts described as an 'egregious failure', the WHO waited months before declaring a PHEIC, despite warnings, including from its own staff, that the epidemic was out of control. The organisation's lumbering bureaucratic response contrasted unfavourably with more agile interventions by non-governmental bodies such as Médecins Sans Frontières. On the other hand, in 2018 efforts to contain a second outbreak of Ebola in the Democratic Republic of the Congo were more successful, with just 33 deaths in total; for some observers, the organisation's quick response, which included the release of emergency funding just hours after the start of the outbreak and a personal visit to Kinshasa by Director-General Tedros a few days later, suggested that it had learned lessons from its 2014 failures. Ebola remains a serious threat in West Africa; a subsequent outbreak triggered another PHEIC, and killed over 2 000. Non-communicable diseases and other health threats While media attention tends to focus on emergencies caused by infectious diseases, noncommunicable diseases such as cancer cost far more lives. However, the WHO's track record in this respect is, again, a mixed one. For example, many recommendations issued by the International Agency for Research on Cancer, a semi-autonomous branch of the WHO, are scientifically sound; however, critics allege that the body does not do enough to prevent conflicts of interest that might influence expert assessments on which its recommendations are based, nor is it very successful at communicating its conclusions with the public. On smoking, described by the WHO as a 'global epidemic', the main instrument is the 2003 Framework Convention on Tobacco Control, the first ever international treaty adopted within the WHO framework. The measures it envisages have played a key role in shaping national tobacco control policies, including in developing countries. Implementation is still patchy, but gradually improving: as of 2018, 12 % of the 181 countries which are parties to the Convention were failing to ensure protection from passive smoking (e.g. bans on smoking in public places), 23 % were not applying packaging and labelling requirements (such as health warnings on cigarette packets), 29 % did not have awareness-raising and educational measures in place, while 30 % were not restricting tobacco sales to and by minors. Tobacco still kills over 8 million people every year, most of them in developing countries, and consumption is only declining slowly. Obesity is another global health scourge that the WHO has taken on. For example, in 2016 it endorsed taxes on soft drinks as an effective means of reducing sugar consumption. However, it has run into resistance from the beverages industry, and the US government, which in 2018 blocked a WHO panel from issuing a global recommendation on sugar taxes. In developing countries, the high cost of medicines is often a barrier to effective treatment. Improving access to medicines has long been a priority for the WHO. The interests of producers, which are protected by patents, have to be balanced against patients' need for affordable treatment. However, WHO work in this area has been blocked by disagreements between countries which argue that intellectual property is not part of the organisation's remit – typically pharmaceutical exporters, such as the United States (US) – and others, including developing countries, which feel that it should be.","What are three failures of the WHO regarding fighting diseases and other health threats? Only respond to the prompt using the information in the prompt. Format the response as a numbered list. WHO achievements: A mixed track record Fighting infectious diseases One of the WHO's biggest achievements was in eradicating smallpox: in 1980, 21 years after launching an international vaccination campaign, it was finally able to declare the world free of the disease. In 1988, the WHO declared a target of similarly eliminating polio by the end of the millennium. That target was missed, and the stubborn persistence of infections prompted the WHO to declare a PHEIC in 2014. Nevertheless, considerable progress has been made, with the number of cases falling by 99 % over the past three decades. Unfortunately, tuberculosis is very far from disappearing; however, the WHO's Global Drug Facility has enabled millions of patients in developing countries to access high-quality anti-TB medicines, both through collective purchasing mechanisms that bring the cost of drugs down, and through grants that help the poorest countries to buy such medicines. The WHO has also been praised for its leadership during the 2003 SARS epidemic; within just four months, the disease had been contained. In 2009, fears that the swine flu virus could mutate into a more lethal form prompted the WHO to declare its first ever Public Health Emergency of International Concern (PHEIC – see Box). Governments rushed to stockpile vaccines, most of which were never used, as the epidemic turned out to be milder than expected. This 'disproportionate' response, as it was described in a 2011 European Parliament resolution, was blamed for wasting millions of euros of public money on unnecessary vaccines. Some critics even alleged that WHO decisions had been swayed by the interests of the pharmaceutical sector. An internal enquiry exonerated the WHO from most of these accusations, arguing that, in view of the evidence available at the time, it would not have been possible to predict the course of the epidemic, while also acknowledging that the situation could have been handled more transparently. Whereas the WHO was accused of over-reacting to swine flu, its response to the 2014 West African Ebola outbreak came too late to prevent tens of thousands of deaths. In what international health experts described as an 'egregious failure', the WHO waited months before declaring a PHEIC, despite warnings, including from its own staff, that the epidemic was out of control. The organisation's lumbering bureaucratic response contrasted unfavourably with more agile interventions by non-governmental bodies such as Médecins Sans Frontières. On the other hand, in 2018 efforts to contain a second outbreak of Ebola in the Democratic Republic of the Congo were more successful, with just 33 deaths in total; for some observers, the organisation's quick response, which included the release of emergency funding just hours after the start of the outbreak and a personal visit to Kinshasa by Director-General Tedros a few days later, suggested that it had learned lessons from its 2014 failures. Ebola remains a serious threat in West Africa; a subsequent outbreak triggered another PHEIC, and killed over 2 000. Non-communicable diseases and other health threats While media attention tends to focus on emergencies caused by infectious diseases, noncommunicable diseases such as cancer cost far more lives. However, the WHO's track record in this respect is, again, a mixed one. For example, many recommendations issued by the International Agency for Research on Cancer, a semi-autonomous branch of the WHO, are scientifically sound; however, critics allege that the body does not do enough to prevent conflicts of interest that might influence expert assessments on which its recommendations are based, nor is it very successful at communicating its conclusions with the public. On smoking, described by the WHO as a 'global epidemic', the main instrument is the 2003 Framework Convention on Tobacco Control, the first ever international treaty adopted within the WHO framework. The measures it envisages have played a key role in shaping national tobacco control policies, including in developing countries. Implementation is still patchy, but gradually improving: as of 2018, 12 % of the 181 countries which are parties to the Convention were failing to ensure protection from passive smoking (e.g. bans on smoking in public places), 23 % were not applying packaging and labelling requirements (such as health warnings on cigarette packets), 29 % did not have awareness-raising and educational measures in place, while 30 % were not restricting tobacco sales to and by minors. Tobacco still kills over 8 million people every year, most of them in developing countries, and consumption is only declining slowly. Obesity is another global health scourge that the WHO has taken on. For example, in 2016 it endorsed taxes on soft drinks as an effective means of reducing sugar consumption. However, it has run into resistance from the beverages industry, and the US government, which in 2018 blocked a WHO panel from issuing a global recommendation on sugar taxes. In developing countries, the high cost of medicines is often a barrier to effective treatment. Improving access to medicines has long been a priority for the WHO. The interests of producers, which are protected by patents, have to be balanced against patients' need for affordable treatment. However, WHO work in this area has been blocked by disagreements between countries which argue that intellectual property is not part of the organisation's remit – typically pharmaceutical exporters, such as the United States (US) – and others, including developing countries, which feel that it should be.",Medical,Find & Summarize,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","Our social security numbers were stolen in a cyber-hack and I'm freaking out. We have accounts for the whole family, including our kids. We are pretty broke, but I'm worried they will open credit cards or something. What are some ways I can protect our credit because I can't decide between a credit freeze, lock or fraud alerts, what are the pros and cons for all three? I normally do all our banking online and have already changed all our passwords just in case but need some reassurance we will be ok.","A credit freeze is a free service, guaranteed under federal law, that can protect you from credit fraud by limiting most access to your credit report until you lift it, or ""thaw"" your report. When your credit report is frozen, any lender who asks to evaluate your report for purposes of issuing a loan or other credit is denied access to the report. A security freeze won't affect your credit scores, but it will prevent lenders evaluating credit applications from obtaining your credit scores. A security freeze prevents criminals from opening new credit accounts in your name, but it also blocks your legitimate credit applications. So, if you have a credit freeze in place, you'll need to thaw your credit reports before applying for a new loan, credit card or other consumer credit. Once your application is processed, you can reinstate the freeze. Alternatively, you can use a temporary thaw to lift the freeze for a set window of time, such as one day or one week, after which the freeze will be reinstated. Credit freezes must be activated and lifted separately at each of the national credit bureaus. Procedures differ somewhat with each bureau, but all three enable requesting and lifting of security freezes online, by phone and via postal mail. There is never a fee for applying or removing a credit freeze. The law also allows you to establish and freeze credit reports for your minor children, to avoid misuse of their personal information. To place a credit freeze, you must provide details and proof of your identity and address, per instructions provided by the respective credit bureau. These typically include: Full name Date of birth All addresses you've used in the past two years Social Security number One copy of a government-issued identification, such as a driver's license or state ID card A recent copy of a utility bill, bank or insurance statement or similar, as proof of address How to Freeze Your Credit at Each Credit Bureau Experian TransUnion Equifax Online 888-EXPERIAN Experian Security Freeze P.O. Box 9554 Allen, TX 75013 Online 800-916-8800 TransUnion P.O. Box 160 Woodlyn, PA 19094 Online 888-298-0045 Equifax Information Services LLC P.O. Box 105788 Atlanta, GA 30348-5788 You can remove a credit freeze using the same channels you use to set up a freeze. When lifting a credit freeze, you have the option of permanently unfreezing your credit, or lifting the freeze temporarily by indicating a length of time (one day or one week, for example) you want the freeze to be suspended. Policies vary by bureau, so make sure you understand what your options are before you begin the process. When you request a credit thaw by phone, your freeze will be lifted within one hour. If you use a credit bureau website or phone app to turn off a credit freeze, the process is virtually instantaneous. If you mail your request, the freeze will be lifted within three days of the credit bureau receiving your request. A credit lock lets you restrict and grant access to your credit reports essentially the same way a credit freeze does, but usually with extra features. Credit lock services provided by each credit bureau may differ in cost and functionality. For instance, in addition to enabling you to turn access to your Experian credit report on and off instantly, CreditLock from Experian also notifies you when anyone requests access to your locked credit report. This can help you spot unauthorized activity in your name. Experian CreditLock is available as part of a premium identity protection subscription for $24.99 per month, which also includes services such as: Monthly privacy scans and help getting information removed from covered people search sites Alerts to credit activity on your credit reports at all three national credit bureaus Quarterly FICO® Scores☉ based on your credit reports at all three national bureaus Daily FICO® Scores based on your Experian credit report Alerts when your personal data appears on the dark web Alerts to potential takeovers of your financial accounts Alerts when your Social Security number appears online Up to $1 million in identity theft insurance coverage Dedicated fraud resolution support Lost wallet assistance Equifax provides credit locks free to consumers through Lock & Alert, which also notifies users when anyone requests a credit check on a locked Equifax credit report. TransUnion includes credit file locking for both your TransUnion and Equifax credit files in its subscription service, which costs $29.95 per month. Each credit bureau requires entering your Social Security number and identity verification as part of its credit lock setup process. How to Lock Your Credit Enabling credit lock requires signing up for the service with the relevant credit bureau. Controls differ somewhat at each credit bureau, but each is a virtual on-off toggle that locks and unlocks the applicable credit report. The process for unlocking your credit report at each credit bureau is the reverse of the procedure for locking it: Using the credit bureau's app or website, locate the credit lock function and click the virtual switch to toggle from the locked setting to the unlocked If you're concerned your identity may have been stolen, or if you've discovered fraudulent activity on your credit reports, applying a security freeze or credit lock to your credit report will effectively prevent lenders from processing new credit applications filed in your name. Because they are free and guaranteed by law, credit freezes may be the better choice for consumers who don't want to pay for the service and don't want any extra features. When freezing or unfreezing your credit online, the process is essentially as quick and easy to use as a credit lock. A credit freeze is also the only option available if you want to restrict access to your minor children's credit information. Credit lock might be a better option if you're interested in the additional identity theft protection services included in the accompanying subscriptions. These might be particularly helpful in addressing the consequences of identity theft, and helping prevent additional fraud. When weighing the benefits of credit freeze and credit lock, it may also be worth considering a third option, the fraud alert. You have the right to place a fraud alert on your credit report, and doing so instructs lenders to verify your identity before processing a credit application in your name. This allows you to apply for loans and other forms of credit without having to remember to thaw or unlock your credit reports. What's more, placing a fraud alert with any one credit bureau automatically applies the alert to all three credit bureaus. You'll have to remove each separately, however. Learn more >> Fraud Alert vs. Credit Freeze: What's the Difference? The Bottom Line Credit freezes and credit locks offer valuable protection for your credit reports, as either a precaution or a response to criminal abuse of your credit. When managed online, both freezes and locks are quick and easy to use, and highly effective at blocking credit applications in your name—both fraudulent and legitimate ones. If you decide to apply a credit lock or security freeze, remember to disable it before you apply for a new loan or credit account.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Our social security numbers were stolen in a cyber-hack and I'm freaking out. We have accounts for the whole family, including our kids. We are pretty broke, but I'm worried they will open credit cards or something. What are some ways I can protect our credit because I can't decide between a credit freeze, lock or fraud alerts, what are the pros and cons for all three? I normally do all our banking online and have already changed all our passwords just in case but need some reassurance we will be ok. A credit freeze is a free service, guaranteed under federal law, that can protect you from credit fraud by limiting most access to your credit report until you lift it, or ""thaw"" your report. When your credit report is frozen, any lender who asks to evaluate your report for purposes of issuing a loan or other credit is denied access to the report. A security freeze won't affect your credit scores, but it will prevent lenders evaluating credit applications from obtaining your credit scores. A security freeze prevents criminals from opening new credit accounts in your name, but it also blocks your legitimate credit applications. So, if you have a credit freeze in place, you'll need to thaw your credit reports before applying for a new loan, credit card or other consumer credit. Once your application is processed, you can reinstate the freeze. Alternatively, you can use a temporary thaw to lift the freeze for a set window of time, such as one day or one week, after which the freeze will be reinstated. Credit freezes must be activated and lifted separately at each of the national credit bureaus. Procedures differ somewhat with each bureau, but all three enable requesting and lifting of security freezes online, by phone and via postal mail. There is never a fee for applying or removing a credit freeze. The law also allows you to establish and freeze credit reports for your minor children, to avoid misuse of their personal information. To place a credit freeze, you must provide details and proof of your identity and address, per instructions provided by the respective credit bureau. These typically include: Full name Date of birth All addresses you've used in the past two years Social Security number One copy of a government-issued identification, such as a driver's license or state ID card A recent copy of a utility bill, bank or insurance statement or similar, as proof of address How to Freeze Your Credit at Each Credit Bureau Experian TransUnion Equifax Online 888-EXPERIAN Experian Security Freeze P.O. Box 9554 Allen, TX 75013 Online 800-916-8800 TransUnion P.O. Box 160 Woodlyn, PA 19094 Online 888-298-0045 Equifax Information Services LLC P.O. Box 105788 Atlanta, GA 30348-5788 You can remove a credit freeze using the same channels you use to set up a freeze. When lifting a credit freeze, you have the option of permanently unfreezing your credit, or lifting the freeze temporarily by indicating a length of time (one day or one week, for example) you want the freeze to be suspended. Policies vary by bureau, so make sure you understand what your options are before you begin the process. When you request a credit thaw by phone, your freeze will be lifted within one hour. If you use a credit bureau website or phone app to turn off a credit freeze, the process is virtually instantaneous. If you mail your request, the freeze will be lifted within three days of the credit bureau receiving your request. A credit lock lets you restrict and grant access to your credit reports essentially the same way a credit freeze does, but usually with extra features. Credit lock services provided by each credit bureau may differ in cost and functionality. For instance, in addition to enabling you to turn access to your Experian credit report on and off instantly, CreditLock from Experian also notifies you when anyone requests access to your locked credit report. This can help you spot unauthorized activity in your name. Experian CreditLock is available as part of a premium identity protection subscription for $24.99 per month, which also includes services such as: Monthly privacy scans and help getting information removed from covered people search sites Alerts to credit activity on your credit reports at all three national credit bureaus Quarterly FICO® Scores☉ based on your credit reports at all three national bureaus Daily FICO® Scores based on your Experian credit report Alerts when your personal data appears on the dark web Alerts to potential takeovers of your financial accounts Alerts when your Social Security number appears online Up to $1 million in identity theft insurance coverage Dedicated fraud resolution support Lost wallet assistance Equifax provides credit locks free to consumers through Lock & Alert, which also notifies users when anyone requests a credit check on a locked Equifax credit report. TransUnion includes credit file locking for both your TransUnion and Equifax credit files in its subscription service, which costs $29.95 per month. Each credit bureau requires entering your Social Security number and identity verification as part of its credit lock setup process. How to Lock Your Credit Enabling credit lock requires signing up for the service with the relevant credit bureau. Controls differ somewhat at each credit bureau, but each is a virtual on-off toggle that locks and unlocks the applicable credit report. The process for unlocking your credit report at each credit bureau is the reverse of the procedure for locking it: Using the credit bureau's app or website, locate the credit lock function and click the virtual switch to toggle from the locked setting to the unlocked If you're concerned your identity may have been stolen, or if you've discovered fraudulent activity on your credit reports, applying a security freeze or credit lock to your credit report will effectively prevent lenders from processing new credit applications filed in your name. Because they are free and guaranteed by law, credit freezes may be the better choice for consumers who don't want to pay for the service and don't want any extra features. When freezing or unfreezing your credit online, the process is essentially as quick and easy to use as a credit lock. A credit freeze is also the only option available if you want to restrict access to your minor children's credit information. Credit lock might be a better option if you're interested in the additional identity theft protection services included in the accompanying subscriptions. These might be particularly helpful in addressing the consequences of identity theft, and helping prevent additional fraud. When weighing the benefits of credit freeze and credit lock, it may also be worth considering a third option, the fraud alert. You have the right to place a fraud alert on your credit report, and doing so instructs lenders to verify your identity before processing a credit application in your name. This allows you to apply for loans and other forms of credit without having to remember to thaw or unlock your credit reports. What's more, placing a fraud alert with any one credit bureau automatically applies the alert to all three credit bureaus. You'll have to remove each separately, however. Learn more >> Fraud Alert vs. Credit Freeze: What's the Difference? The Bottom Line Credit freezes and credit locks offer valuable protection for your credit reports, as either a precaution or a response to criminal abuse of your credit. When managed online, both freezes and locks are quick and easy to use, and highly effective at blocking credit applications in your name—both fraudulent and legitimate ones. If you decide to apply a credit lock or security freeze, remember to disable it before you apply for a new loan or credit account. https://www.experian.com/blogs/ask-experian/whats-the-difference-between-credit-freeze-and-a-credit-lock/",Financial,Pros & Cons,Q&A "Answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. If the answer contains more than one piece of information, utilize a numbered list.","If I need permission to use a work, where can I find the copyright owner?","In general, for works created on or after January 1, 1978, the term of copyright is the life of the author plus seventy years after the author’s death. If the work is a joint work with multiple authors, the term lasts for seventy years after the last surviving author’s death. For works made for hire and anonymous or pseudonymous works, the duration of copyright is 95 years from publication or 120 years from creation, whichever is shorter. For works created before January 1, 1978, that were not published or registered as of that date, the term of copyright is generally the same as for works created on or after January 1, 1978. The law, however, provides that in no case would the term have expired before December 31, 2002, and if the work was published on or before that date, the term will not expire before December 31, 2047. For works created before January 1, 1978, that were published or registered before that date, the initial term of copyright was twenty-eight years from the date of publication with notice or from the date of registration. At the end of the initial term, the copyright could be renewed for another sixtyseven years for a total term of protection of up to ninety-five years. To extend copyright into the renewal term, two registrations had to be made before the original term expired: one for the original term and the other for the renewal term. This requirement was eliminated on June 26, 1992, and renewal term registration is now optional. For more information on the term of copyright protection, see Duration of Copyright (Circular 15A) and Renewal of Copyright (Circular 6A). How Can I Protect My Work? Copyright exists automatically in an original work of authorship once it is fixed in a tangible medium, but a copyright owner can take steps to enhance the protections of copyright, the most important of which is registering the work. Although registering a work is not mandatory, for U.S. works, registration (or refusal) is necessary to enforce the exclusive rights of copyright through litigation. Applying a copyright notice to a work has not been required since March 1, 1989, but may still provide practical and legal benefits. Notice typically consists of the copyright symbol or the word “Copyright,” the name of the copyright owner, and the year of first publication. Placing a copyright notice on a work is not a substitute for registration. Copyright Basics 5 Benefits of Registration Registration establishes a claim to copyright with the Copyright Office. An application for copyright registration can be filed by the author or owner of an exclusive right in a work, the owner of all exclusive rights, or an agent on behalf of an author or owner. An application contains three essential elements: a completed application form, a nonrefundable filing fee, and a nonreturnable deposit— that is, a copy or copies of the work being registered and “deposited” with the Copyright Office. A certificate of registration creates a public record of key facts relating to the authorship and ownership of the claimed work, including the title of the work, the author of the work, the name and address of the claimant or copyright owner, the year of creation, and information about whether the work is published, has been previously registered, or includes preexisting material. You can submit an application online through www.copyright.gov or on a paper application. For more information on registering a work with the Copyright Office, see Copyright Registration (Circular 2). In addition to establishing a public record of a copyright claim, registration offers several other statutory advantages: • Before an infringement suit may be filed in court, registration (or refusal) is necessary for U.S. works.2 • Registration establishes prima facie evidence of the validity of the copyright and facts stated in the certificate when registration is made before or within five years of publication. • When registration is made prior to infringement or within three months after publication of a work, a copyright owner is eligible for statutory damages, attorneys’ fees, and costs. • Registration permits a copyright owner to establish a record with the U.S. Customs and Border Protection (CBP)4 for protection against the importation of infringing copies. Registration can be made at any time within the life of the copyright. If you register before publication, you do not have to re-register when the work is published, although you can register the published edition, if desired. Effective Date of Registration When the Copyright Office registers a work it assigns an effective date of registration to the certificate of registration. The effective date of registration is the day that the Office receives in proper form all required elements—an acceptable application, an acceptable deposit, and a nonrefundable filing fee. The date is not set until all the required elements are in the Office’s possession. If the Office receives incomplete materials, an unacceptable deposit, or an insufficient fee, the effective date of registration will be set on the date that the Office receives all the required materials in acceptable form. The date is not based on how long it takes the Office to examine the materials or mail the certificate of registration. You do not have to receive your certificate of registration before you publish or produce your work. Nor do you need permission from the Copyright Office to place a copyright notice on your work. But the Copyright Office must approve or refuse your application before you can file a lawsuit for copyright infringement, except in cases involving a non-U.S. work.5 You may seek statutory damages and attorneys’ fees in an infringement action provided that the infringement began after the effective date of registration. The law, however, provides a grace period of three months after publication during which full remedies can be recovered for any infringement begun during the three months after publication if registration is made before this period ends. Copyright Basics 6 Copyright Notice A copyright notice is a statement placed on copies or phonorecords of a work to inform the public that a copyright owner is claiming ownership of the work. A copyright notice consists of three elements: • The copyright symbol © or (p) for phonorecords, the word “Copyright,” or the abbreviation “Copr.”; • The year of first publication of the work (or of creation if the work is unpublished); and • The name of the copyright owner, an abbreviation by which the name can be recognized, or a generally known alternative designation. A notice should be affixed to copies or phonorecords of a work in a way that gives reasonable notice of the claim of copyright. Using a copyright notice is optional for unpublished works, non-U.S. works, and works published on or after March 1, 1989. However, notice conveys the following benefits: • It puts potential users on notice that copyright is claimed in the work. • For published works, notice may prevent a defendant from attempting to limit liability for damages or injunctive relief based on an “innocent infringement” defense. • It identifies the copyright owner at the time of first publication for parties seeking permission to use the work. • It identifies the year of first publication, which can be used to determine the term of copyright for anonymous or pseudonymous works or works made for hire. • It may prevent the work from becoming an “orphan” by identifying the copyright owner or specifying the term of copyright. Orphan works are original works of authorship for which prospective users cannot identify or locate copyright owners to request permission. Notice was required for works published in the United States before March 1, 1989. Works published without notice before that date may have entered the public domain in this country. For more information, see Copyright Notice (Circular 3","Answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. If the answer contains more than one piece of information, utilize a numbered list. If I need permission to use a work, where can I find the copyright owner? In general, for works created on or after January 1, 1978, the term of copyright is the life of the author plus seventy years after the author’s death. If the work is a joint work with multiple authors, the term lasts for seventy years after the last surviving author’s death. For works made for hire and anonymous or pseudonymous works, the duration of copyright is 95 years from publication or 120 years from creation, whichever is shorter. For works created before January 1, 1978, that were not published or registered as of that date, the term of copyright is generally the same as for works created on or after January 1, 1978. The law, however, provides that in no case would the term have expired before December 31, 2002, and if the work was published on or before that date, the term will not expire before December 31, 2047. For works created before January 1, 1978, that were published or registered before that date, the initial term of copyright was twenty-eight years from the date of publication with notice or from the date of registration. At the end of the initial term, the copyright could be renewed for another sixtyseven years for a total term of protection of up to ninety-five years. To extend copyright into the renewal term, two registrations had to be made before the original term expired: one for the original term and the other for the renewal term. This requirement was eliminated on June 26, 1992, and renewal term registration is now optional. For more information on the term of copyright protection, see Duration of Copyright (Circular 15A) and Renewal of Copyright (Circular 6A). How Can I Protect My Work? Copyright exists automatically in an original work of authorship once it is fixed in a tangible medium, but a copyright owner can take steps to enhance the protections of copyright, the most important of which is registering the work. Although registering a work is not mandatory, for U.S. works, registration (or refusal) is necessary to enforce the exclusive rights of copyright through litigation. Applying a copyright notice to a work has not been required since March 1, 1989, but may still provide practical and legal benefits. Notice typically consists of the copyright symbol or the word “Copyright,” the name of the copyright owner, and the year of first publication. Placing a copyright notice on a work is not a substitute for registration. Copyright Basics 5 Benefits of Registration Registration establishes a claim to copyright with the Copyright Office. An application for copyright registration can be filed by the author or owner of an exclusive right in a work, the owner of all exclusive rights, or an agent on behalf of an author or owner. An application contains three essential elements: a completed application form, a nonrefundable filing fee, and a nonreturnable deposit— that is, a copy or copies of the work being registered and “deposited” with the Copyright Office. A certificate of registration creates a public record of key facts relating to the authorship and ownership of the claimed work, including the title of the work, the author of the work, the name and address of the claimant or copyright owner, the year of creation, and information about whether the work is published, has been previously registered, or includes preexisting material. You can submit an application online through www.copyright.gov or on a paper application. For more information on registering a work with the Copyright Office, see Copyright Registration (Circular 2). In addition to establishing a public record of a copyright claim, registration offers several other statutory advantages: • Before an infringement suit may be filed in court, registration (or refusal) is necessary for U.S. works.2 • Registration establishes prima facie evidence of the validity of the copyright and facts stated in the certificate when registration is made before or within five years of publication. • When registration is made prior to infringement or within three months after publication of a work, a copyright owner is eligible for statutory damages, attorneys’ fees, and costs. • Registration permits a copyright owner to establish a record with the U.S. Customs and Border Protection (CBP)4 for protection against the importation of infringing copies. Registration can be made at any time within the life of the copyright. If you register before publication, you do not have to re-register when the work is published, although you can register the published edition, if desired. Effective Date of Registration When the Copyright Office registers a work it assigns an effective date of registration to the certificate of registration. The effective date of registration is the day that the Office receives in proper form all required elements—an acceptable application, an acceptable deposit, and a nonrefundable filing fee. The date is not set until all the required elements are in the Office’s possession. If the Office receives incomplete materials, an unacceptable deposit, or an insufficient fee, the effective date of registration will be set on the date that the Office receives all the required materials in acceptable form. The date is not based on how long it takes the Office to examine the materials or mail the certificate of registration. You do not have to receive your certificate of registration before you publish or produce your work. Nor do you need permission from the Copyright Office to place a copyright notice on your work. But the Copyright Office must approve or refuse your application before you can file a lawsuit for copyright infringement, except in cases involving a non-U.S. work.5 You may seek statutory damages and attorneys’ fees in an infringement action provided that the infringement began after the effective date of registration. The law, however, provides a grace period of three months after publication during which full remedies can be recovered for any infringement begun during the three months after publication if registration is made before this period ends. Copyright Basics 6 Copyright Notice A copyright notice is a statement placed on copies or phonorecords of a work to inform the public that a copyright owner is claiming ownership of the work. A copyright notice consists of three elements: • The copyright symbol © or (p) for phonorecords, the word “Copyright,” or the abbreviation “Copr.”; • The year of first publication of the work (or of creation if the work is unpublished); and • The name of the copyright owner, an abbreviation by which the name can be recognized, or a generally known alternative designation. A notice should be affixed to copies or phonorecords of a work in a way that gives reasonable notice of the claim of copyright. Using a copyright notice is optional for unpublished works, non-U.S. works, and works published on or after March 1, 1989. However, notice conveys the following benefits: • It puts potential users on notice that copyright is claimed in the work. • For published works, notice may prevent a defendant from attempting to limit liability for damages or injunctive relief based on an “innocent infringement” defense. • It identifies the copyright owner at the time of first publication for parties seeking permission to use the work. • It identifies the year of first publication, which can be used to determine the term of copyright for anonymous or pseudonymous works or works made for hire. • It may prevent the work from becoming an “orphan” by identifying the copyright owner or specifying the term of copyright. Orphan works are original works of authorship for which prospective users cannot identify or locate copyright owners to request permission. Notice was required for works published in the United States before March 1, 1989. Works published without notice before that date may have entered the public domain in this country. For more information, see Copyright Notice (Circular 3",Legal,Fact Finding,Q&A "Do not use any knowledge other than the provided document. After answering the question, quote in parentheses the section of the document that you referred to for your answer. Use capital letters for this quotation.",Give me a list of all of the EV chargers found in this document.,"**Electic Vehicle Charging Solutions for Home and Travel** PORTABLE PORTABLE EV CHARGER PPC16A35 • European standard plug SCHUKO • Length of cable: 5 meter (16.5 feet) EV CHARGER TYPE-2 to Schuko Adapter cable 5m lenght POWERED FROM 230V SCHUKO SOCKET - NO LIMITS The 16A portable charger is powered by a standard 230V mains socket (Schuko). Becasue of it, you do not need any special installation to charge the car - it’s simple. In addition, the portable charger is characterized by compact dimensions, which guarantees ease of transport and the possibility of using it anywhere. The charger will easily fit into any trunk. • Rated input voltage: 85-265V AC • Rated output voltage: 85-265V AC • Rated current: default -16A • Rated power: Up to 3700W (3,7kW) • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • Cable wrap shell design • With Leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protection 16A TYPE 2 3,7kW INSURANCE! 200 000 eur.PLUG & PLAY - EASY OPERATIONS Plug & Play functionality is one of the many advantages of the charger - vehicle charging starts automatically after connecting the charger to the car. To finish charging, simply disconnect the charging plug from the car. 2IN1 PORTABLE EV QUICK CHARGER SCHUKO TO TYPE 2 ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a Schuko socket on one side and a Type 2 plug on the other. With it, any electric car with a Schuko plug can be charged using a charger with a Type 2 socket. This is especially useful when we use a Schuko cable in an electric car and we want to charge it at a private or public Type 2 charging station. Cable length is 30cm. CEE to Schuko Adapter INCLUDED INSURANCE! 200 000 eur. TYPE 2 11kW PPC32AT 16A cable 5m lenght PORTABLE EV QUICK CHARGER • European standard plug (CEE red) • 3 Phases (trójfazowy) • Length of cable: 5 meter (16.5 feet) • Rated input voltage: 85-400V AC • Rated output voltage: 85-400V AC • Rated current: default - 8A, 10A, 13A, 16A • Rated power: up to 11KW quick charging • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • With LED display to show temperature, charging time, and real current • With leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protectionPORTABLE EV QUICK CHARGER • European standard plug (CEE red) • 3 phases (trójfazowy) • Length of cable: 5 meter (16.5 feet) • Rated input voltage: 85-400V AC • Rated output voltage: 85-400V AC • Rated current: 8A, 10A, 13A, 16A, 20A, 24A, 32A • Rated power: Up to 22KW quick charging • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • With LED display to show temperature, charging time, and real current • With leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protection PLUG & PLAY - EASY OPERATIONS Plug & Play functionality is one of the many advantages of the charger - vehicle charging starts automatically after connecting the charger to the car. To finish charging, simply disconnect the charging plug from the car. 2IN1 PORTABLE EV QUICK CHARGER SCHUKO TO TYPE 2 ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a Schuko socket on one side and a Type 2 plug on the other. With it, any electric car with a Schuko plug can be charged using a charger with a Type 2 socket. This is especially useful when we use a Schuko cable in an electric car and we want to charge it at a private or public Type 2 charging station. Cable length is 30 cm. CEE to Schuko Adapter INCLUDED INSURANCE! 200 000 eur. TYPE 2 22kW PPC32AT22 32A cable 5m lenghtUNIVERSAL MOBILE Adapter PC050EV INCLUDED CHARGING STATION Traveler Set Charger connectors: Type 2 Charging mode: Mode 2 Charging current: 32 A Charging capacity: 16 kW Nominal voltage: 400 V, 230 V Cable length: 7.00 m IP rating: IP66 Colour: Black Width: 300 mm Height: 66 mm Depth: 86 mm Weight: 7.5 kg Type A: PG connector, UK connector, CEE connector (5-pin, 32 A), CEE connector (3-pin, 32 A), CEE connector (5-pin, 16 A), CEE connector (3-pin, 16 A) Type B: Type 2 No. of phases: 3-phase Nominal current: 16 A, 32 A Sustainability / eco-friendliness: Plastic free packaging Product type Mobile electric car charging station One charger for all possible outlet. All adapters for every conceivable 32A TYPE 2 16kW INSURANCE! European outlet. 200 000 eur.TYPE 2 TYPE 2 22kW 11kW 32A 16A INSURANCE! 200 000 eur. ELECTRIC VEHICLE CHARGING CABLE CHARGING CABLE TYPE 2-TYPE 2 • Phase: 3 phase • Rated current: 32A or 16A • Rated voltage: 480V • Max power: 22kW or 11kW • Cable spec 22kW: 5x6mm2 + 2x0,5 mm2 • Outer diameter 22kW: 16,5mm (+/- 0,4mm) • Cable spec 11kW: 5x2,5 mm2 + 2x0,5 mm2 • Outer diameter 11kW: 13,5mm (+/- 0,4mm) • Length: 5m, optional 4m • Protection rank: IP54 (when plugged) • Plug insertion force: >45N <80N • Operating temperature: -35OC to 50OC CHARGING WITH „NO-LIMITS” We can safely take the PLATINET Type 2 cable for charging electric cars on a trip throughout Europe. Becasue of the universal Type 2 plugs, they are compatible with all stations that support this type of charging. It allows you to charge electric cars with a power of up to 11kW or 22kW. It is terminated with Type 2 connectors, which are operated at charging stations all over Europe. Its low weight makes it easy to use, and the cable itself will not take up much space in the trunk of our vehicle. PEVC22KW5B PEVC11KW5B cable 5m (4m optional) lenghtELECTRIC VEHICLE PEVC22KW5B-B CHARGING CABLE lenght cable 5m (4m optional) CHARGING WITH „NO-LIMITS” We can safely take the PLATINET Type 2 cable for charging electric cars on a trip throughout Europe. Becasue of the universal Type 2 plugs, they are compatible with all stations that support this type of charging. It allows you to charge electric cars with a power of up to 11kW or 22kW. It is terminated with Type 2 connectors, which are operated at charging stations all over Europe. Its low weight makes it easy to use, and the cable itself will not take up much space in the trunk of our vehicle. CHARGING CABLE TYPE 2-TYPE 2 • Phase: 3 phase • Rated current: 32A or 16A • Rated voltage: 480V • Max power: 22kW or 11kW • Cable spec 22kW: 5x6mm2 + 2x0,5 mm2 • Outer diameter 22kW: 16,5mm (+/- 0,4mm) • Cable spec 11kW: 5x2,5 mm2 + 2x0,5 mm2 • Outer diameter 11kW: 13,5mm (+/- 0,4mm) • Length: 5m, optional 4m • Protection rank: IP54 (when plugged) • Plug insertion force: >45N <80N TYPE 2 32A 22kW PEVC11KW5B-B TYPE 2 16A 11kW INSURANCE! • Operating temperature: -35OC to 50OC 200 000 eur.EV TYPE 2 PEVA30 TO SCHUKO ADAPTER lenght 30cm PLATINET SCHUKO TO CEE ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a CEE socket on one side and a Schuko plug on the other. Cable length is 30cm. TYPE 2 I","[Task Information] ================== Do not use any knowledge other than the provided document. After answering the question, quote in parentheses the section of the document that you referred to for your answer. Use capital letters for this quotation. ================ [Question] ================== Give me a list of all of the EV chargers found in this document. ================ [Passage] ================== **Electic Vehicle Charging Solutions for Home and Travel** PORTABLE PORTABLE EV CHARGER PPC16A35 • European standard plug SCHUKO • Length of cable: 5 meter (16.5 feet) EV CHARGER TYPE-2 to Schuko Adapter cable 5m lenght POWERED FROM 230V SCHUKO SOCKET - NO LIMITS The 16A portable charger is powered by a standard 230V mains socket (Schuko). Becasue of it, you do not need any special installation to charge the car - it’s simple. In addition, the portable charger is characterized by compact dimensions, which guarantees ease of transport and the possibility of using it anywhere. The charger will easily fit into any trunk. • Rated input voltage: 85-265V AC • Rated output voltage: 85-265V AC • Rated current: default -16A • Rated power: Up to 3700W (3,7kW) • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • Cable wrap shell design • With Leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protection 16A TYPE 2 3,7kW INSURANCE! 200 000 eur.PLUG & PLAY - EASY OPERATIONS Plug & Play functionality is one of the many advantages of the charger - vehicle charging starts automatically after connecting the charger to the car. To finish charging, simply disconnect the charging plug from the car. 2IN1 PORTABLE EV QUICK CHARGER SCHUKO TO TYPE 2 ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a Schuko socket on one side and a Type 2 plug on the other. With it, any electric car with a Schuko plug can be charged using a charger with a Type 2 socket. This is especially useful when we use a Schuko cable in an electric car and we want to charge it at a private or public Type 2 charging station. Cable length is 30cm. CEE to Schuko Adapter INCLUDED INSURANCE! 200 000 eur. TYPE 2 11kW PPC32AT 16A cable 5m lenght PORTABLE EV QUICK CHARGER • European standard plug (CEE red) • 3 Phases (trójfazowy) • Length of cable: 5 meter (16.5 feet) • Rated input voltage: 85-400V AC • Rated output voltage: 85-400V AC • Rated current: default - 8A, 10A, 13A, 16A • Rated power: up to 11KW quick charging • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • With LED display to show temperature, charging time, and real current • With leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protectionPORTABLE EV QUICK CHARGER • European standard plug (CEE red) • 3 phases (trójfazowy) • Length of cable: 5 meter (16.5 feet) • Rated input voltage: 85-400V AC • Rated output voltage: 85-400V AC • Rated current: 8A, 10A, 13A, 16A, 20A, 24A, 32A • Rated power: Up to 22KW quick charging • Insulation resistance of cable: >1000MΩ (DC500V) • Contact resistance: 0.5mΩ MAX • Housing fire rating: UL94V-0 • Wiring harness size: 3 x 2.5mm2 + 2 x 0.5mm2 • With LED display to show temperature, charging time, and real current • With leakage protection • With over-voltage or low-voltage protection • With over load protection (Self-checking recovery) • With lightning protection • With over-heat protection PLUG & PLAY - EASY OPERATIONS Plug & Play functionality is one of the many advantages of the charger - vehicle charging starts automatically after connecting the charger to the car. To finish charging, simply disconnect the charging plug from the car. 2IN1 PORTABLE EV QUICK CHARGER SCHUKO TO TYPE 2 ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a Schuko socket on one side and a Type 2 plug on the other. With it, any electric car with a Schuko plug can be charged using a charger with a Type 2 socket. This is especially useful when we use a Schuko cable in an electric car and we want to charge it at a private or public Type 2 charging station. Cable length is 30 cm. CEE to Schuko Adapter INCLUDED INSURANCE! 200 000 eur. TYPE 2 22kW PPC32AT22 32A cable 5m lenghtUNIVERSAL MOBILE Adapter PC050EV INCLUDED CHARGING STATION Traveler Set Charger connectors: Type 2 Charging mode: Mode 2 Charging current: 32 A Charging capacity: 16 kW Nominal voltage: 400 V, 230 V Cable length: 7.00 m IP rating: IP66 Colour: Black Width: 300 mm Height: 66 mm Depth: 86 mm Weight: 7.5 kg Type A: PG connector, UK connector, CEE connector (5-pin, 32 A), CEE connector (3-pin, 32 A), CEE connector (5-pin, 16 A), CEE connector (3-pin, 16 A) Type B: Type 2 No. of phases: 3-phase Nominal current: 16 A, 32 A Sustainability / eco-friendliness: Plastic free packaging Product type Mobile electric car charging station One charger for all possible outlet. All adapters for every conceivable 32A TYPE 2 16kW INSURANCE! European outlet. 200 000 eur.TYPE 2 TYPE 2 22kW 11kW 32A 16A INSURANCE! 200 000 eur. ELECTRIC VEHICLE CHARGING CABLE CHARGING CABLE TYPE 2-TYPE 2 • Phase: 3 phase • Rated current: 32A or 16A • Rated voltage: 480V • Max power: 22kW or 11kW • Cable spec 22kW: 5x6mm2 + 2x0,5 mm2 • Outer diameter 22kW: 16,5mm (+/- 0,4mm) • Cable spec 11kW: 5x2,5 mm2 + 2x0,5 mm2 • Outer diameter 11kW: 13,5mm (+/- 0,4mm) • Length: 5m, optional 4m • Protection rank: IP54 (when plugged) • Plug insertion force: >45N <80N • Operating temperature: -35OC to 50OC CHARGING WITH „NO-LIMITS” We can safely take the PLATINET Type 2 cable for charging electric cars on a trip throughout Europe. Becasue of the universal Type 2 plugs, they are compatible with all stations that support this type of charging. It allows you to charge electric cars with a power of up to 11kW or 22kW. It is terminated with Type 2 connectors, which are operated at charging stations all over Europe. Its low weight makes it easy to use, and the cable itself will not take up much space in the trunk of our vehicle. PEVC22KW5B PEVC11KW5B cable 5m (4m optional) lenghtELECTRIC VEHICLE PEVC22KW5B-B CHARGING CABLE lenght cable 5m (4m optional) CHARGING WITH „NO-LIMITS” We can safely take the PLATINET Type 2 cable for charging electric cars on a trip throughout Europe. Becasue of the universal Type 2 plugs, they are compatible with all stations that support this type of charging. It allows you to charge electric cars with a power of up to 11kW or 22kW. It is terminated with Type 2 connectors, which are operated at charging stations all over Europe. Its low weight makes it easy to use, and the cable itself will not take up much space in the trunk of our vehicle. CHARGING CABLE TYPE 2-TYPE 2 • Phase: 3 phase • Rated current: 32A or 16A • Rated voltage: 480V • Max power: 22kW or 11kW • Cable spec 22kW: 5x6mm2 + 2x0,5 mm2 • Outer diameter 22kW: 16,5mm (+/- 0,4mm) • Cable spec 11kW: 5x2,5 mm2 + 2x0,5 mm2 • Outer diameter 11kW: 13,5mm (+/- 0,4mm) • Length: 5m, optional 4m • Protection rank: IP54 (when plugged) • Plug insertion force: >45N <80N TYPE 2 32A 22kW PEVC11KW5B-B TYPE 2 16A 11kW INSURANCE! • Operating temperature: -35OC to 50OC 200 000 eur.EV TYPE 2 PEVA30 TO SCHUKO ADAPTER lenght 30cm PLATINET SCHUKO TO CEE ADAPTER is a great solution for charging your car, motorcycle or electric scooter. The cable has a CEE socket on one side and a Schuko plug on the other. Cable length is 30cm. TYPE 2 I",Retail/Product,Fact Finding,Q&A This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge.,What is the SDWA?,"Detections of contaminants in public water supplies in numerous states have raised questions about drinking water quality and have increased congressional interest in the Environmental Protection Agency’s (EPA’s) efforts to regulate contaminants under the Safe Drinking Water Act (SDWA). Congress is particularly interested in the EPA’s process for evaluating new contaminants for potential regulation. Detections of already-regulated contaminants, such as lead, have also raised concerns about the effectiveness of certain existing regulations. SDWA is the key federal law that authorizes EPA to promulgate regulations to control contaminants in public water supplies. Since its enactment in 1974, EPA has issued drinking water regulations for 100 contaminants. Congress has twice revised the act’s process for evaluating contaminants and developing drinking water regulations (in 1986 and 1996). In 1986, Congress directed EPA to develop regulations for 83 contaminants within 3 years, and adopt regulations, every 3 years, for at least 25 new contaminants. In 1996, when this regulatory schedule proved unworkable, Congress amended SDWA to establish a riskbased process that prioritizes contaminants for regulation based on health effects and occurrence. Under SDWA, EPA follows a multistep process to evaluate and prioritize contaminants for regulation. This process includes identifying contaminants of potential concern, assessing health risks, collecting national occurrence data (and developing reliable and field-tested analytical methods necessary to do so), and making determinations as to whether a contaminant warrants regulation. Since 1996, EPA has considered over 7,500 contaminants for potential regulation, revised existing regulations, and established new regulations and standards for several contaminants. When EPA determines that a contaminant warrants regulation, SDWA directs EPA to propose a “national primary drinking water regulation” and request public comment within 24 months. Within 18 months of the proposal, EPA is required to promulgate a final rule. EPA is required to establish a nonenforceable maximum contaminant level goal (MCLG) at a level at which no known or anticipated adverse health effects occur and allowing for an adequate margin of safety. Drinking water regulations generally specify a maximum contaminant level (MCL)—an enforceable limit for a contaminant in public water supplies. SDWA requires EPA to set the MCL as close to the MCLG as “feasible,” taking treatment efficacy and costs into consideration. Concurrent with proposing a regulation, SDWA requires EPA to publish a “health risk reduction and cost analysis” for each contaminant covered by the proposed regulation and make a determination whether or not the benefits of regulation outweigh the compliance costs. EPA’s regulations generally take effect three years after promulgation, though the agency may allow up to two additional years, under certain conditions. For each drinking water regulation, SDWA requires EPA to identify a list of best available technologies, treatment techniques, and other means that EPA finds feasible for meeting the MCL. In addition, EPA is required to identify treatment technologies that achieve the MCL and are affordable for small systems. Each regulation also establishes associated monitoring and reporting requirements. SDWA requires EPA to review—and, if necessary, revise— each existing national primary drinking water regulation every six years. SDWA also requires that any revisions to drinking water regulations maintain or provide greater health protection. Under the current SDWA statutory framework, evaluating and developing regulations for contaminants requires data, including data from peer-reviewed scientific studies on potential health effects and nationally representative occurrence data. For some contaminants, the availability or development of (1) data, (2) analytical methods to detect contaminants in drinking water, and (3) treatment technologies pose technical and resource challenges. Congressional attention has centered on EPA’s implementation of SDWA regulatory development provisions. Some stakeholders also have raised concerns about regulatory costs for communities. In recent Congresses, some Members have raised concerns that the act’s process is lengthy and complicated and does not allow for the timely regulation of contaminants of concern in drinking water. Others have expressed concern that proposals to expedite regulation by removing elements of SDWA regulatory development provisions (e.g., the requirement to use peer-reviewed science or a health-risk-based approach) may result in increased costs to communities without commensurate public health protection. This debate was heightened prior to EPA’s determination to regulate per- and polyfluoroalkyl substances (PFAS) in 2021, yet stakeholders raised similar concerns after EPA’s 2024 finalization of a regulation for six PFAS.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. What is the SDWA? Detections of contaminants in public water supplies in numerous states have raised questions about drinking water quality and have increased congressional interest in the Environmental Protection Agency’s (EPA’s) efforts to regulate contaminants under the Safe Drinking Water Act (SDWA). Congress is particularly interested in the EPA’s process for evaluating new contaminants for potential regulation. Detections of already-regulated contaminants, such as lead, have also raised concerns about the effectiveness of certain existing regulations. SDWA is the key federal law that authorizes EPA to promulgate regulations to control contaminants in public water supplies. Since its enactment in 1974, EPA has issued drinking water regulations for 100 contaminants. Congress has twice revised the act’s process for evaluating contaminants and developing drinking water regulations (in 1986 and 1996). In 1986, Congress directed EPA to develop regulations for 83 contaminants within 3 years, and adopt regulations, every 3 years, for at least 25 new contaminants. In 1996, when this regulatory schedule proved unworkable, Congress amended SDWA to establish a riskbased process that prioritizes contaminants for regulation based on health effects and occurrence. Under SDWA, EPA follows a multistep process to evaluate and prioritize contaminants for regulation. This process includes identifying contaminants of potential concern, assessing health risks, collecting national occurrence data (and developing reliable and field-tested analytical methods necessary to do so), and making determinations as to whether a contaminant warrants regulation. Since 1996, EPA has considered over 7,500 contaminants for potential regulation, revised existing regulations, and established new regulations and standards for several contaminants. When EPA determines that a contaminant warrants regulation, SDWA directs EPA to propose a “national primary drinking water regulation” and request public comment within 24 months. Within 18 months of the proposal, EPA is required to promulgate a final rule. EPA is required to establish a nonenforceable maximum contaminant level goal (MCLG) at a level at which no known or anticipated adverse health effects occur and allowing for an adequate margin of safety. Drinking water regulations generally specify a maximum contaminant level (MCL)—an enforceable limit for a contaminant in public water supplies. SDWA requires EPA to set the MCL as close to the MCLG as “feasible,” taking treatment efficacy and costs into consideration. Concurrent with proposing a regulation, SDWA requires EPA to publish a “health risk reduction and cost analysis” for each contaminant covered by the proposed regulation and make a determination whether or not the benefits of regulation outweigh the compliance costs. EPA’s regulations generally take effect three years after promulgation, though the agency may allow up to two additional years, under certain conditions. For each drinking water regulation, SDWA requires EPA to identify a list of best available technologies, treatment techniques, and other means that EPA finds feasible for meeting the MCL. In addition, EPA is required to identify treatment technologies that achieve the MCL and are affordable for small systems. Each regulation also establishes associated monitoring and reporting requirements. SDWA requires EPA to review—and, if necessary, revise— each existing national primary drinking water regulation every six years. SDWA also requires that any revisions to drinking water regulations maintain or provide greater health protection. Under the current SDWA statutory framework, evaluating and developing regulations for contaminants requires data, including data from peer-reviewed scientific studies on potential health effects and nationally representative occurrence data. For some contaminants, the availability or development of (1) data, (2) analytical methods to detect contaminants in drinking water, and (3) treatment technologies pose technical and resource challenges. Congressional attention has centered on EPA’s implementation of SDWA regulatory development provisions. Some stakeholders also have raised concerns about regulatory costs for communities. In recent Congresses, some Members have raised concerns that the act’s process is lengthy and complicated and does not allow for the timely regulation of contaminants of concern in drinking water. Others have expressed concern that proposals to expedite regulation by removing elements of SDWA regulatory development provisions (e.g., the requirement to use peer-reviewed science or a health-risk-based approach) may result in increased costs to communities without commensurate public health protection. This debate was heightened prior to EPA’s determination to regulate per- and polyfluoroalkyl substances (PFAS) in 2021, yet stakeholders raised similar concerns after EPA’s 2024 finalization of a regulation for six PFAS.",Legal,Explanation/Definition,Q&A "This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Respond in 100 words or less and you may not use less than five bullet points in your answer. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context""",Why do the types of mergers Congress is stating that Blizzard being acquired through Microsoft presents problems to consumers?," Acquisition of Activision Blizzard Microsoft’s proposed acquisition may be considered both a vertical merger, in which one firm is the supplier and the other is a customer in the supply chain, and a horizontal merger, in which the merging firms are direct competitors, offering similar products or services that are considered substitutes. One concern with vertical mergers is that they may lead to foreclosure, a situation in which a supplier that competes with the merged firm loses access to a potential customer or a buyer that competes with the merged firm is denied access to a supplier. A concern with horizontal mergers is that they may significantly increase the market share of the merged firm, increasing concentration in the market and reducing competition, thereby enabling the remaining firms to raise prices. Microsoft’s proposed acquisition may also raise other concerns that typically have not been raised in merger challenges in recent decades, such as dominance in markets that may develop in the future and labor market monopsony.36 A key question about Microsoft’s proposed acquisition may be the extent to which Microsoft might restrict the availability of Activision Blizzard’s video games to its consoles and its streaming and cloud gaming services. Such a restriction would mean that other companies’ consoles or streaming or cloud gaming services would not be able to offer Activision Blizzard’s games to consumers. Microsoft has stated that if the merger is approved, it would continue to make Call of Duty and other popular Activision games available on other gaming consoles in addition to its Xbox.37 The statement specifies that Activision’s popular content would be “available on competing platforms like Sony’s PlayStation.” It is unclear, however, if this commitment pertains only to Sony’s consoles or also applies to PlayStation Plus,38 Sony’s version of Game Pass. Additionally, it is unclear whether Activision Blizzard’s games would be available on other streaming or cloud gaming services. Microsoft could also limit the availability of other games that are or will be under development. In 2020, after acquiring ZeniMax Media, parent company of the video game developer Bethesda Softworks,39 Microsoft stated that it would honor the exclusivity commitments Bethesda made with Sony for certain games for one year,40 but that future Bethesda games would be made available for “other consoles on a case by case basis.” 41 The game Starfield, officially introduced by Bethesda in 2018,42 is scheduled to be released in November 2022 exclusively on Microsoft’s Xbox Series X and S consoles and Windows PCs; it will not be available on other consoles.43 One potential concern may be how Microsoft’s acquisition might affect competition among digital stores selling video games for PCs, a market in which both Microsoft and Activision Blizzard compete. Following the acquisition, Microsoft could operate both Microsoft Store and Battle.net. This may not have a significant effect on competition, however, because Valve Corp.’s Steam is considered to be the dominant market player among PC digital stores. In a 2021 lawsuit alleging anticompetitive practices by Valve, video game developer Wolfire Games estimated that Valve controlled at least 75% of PC desktop game distribution.44 With respect to subscription or cloud gaming services, Microsoft may be able to increase its market share with the acquisition by offering more content than other providers. In addition to developing its own games, Microsoft has entered partnerships with various developers and publishers. For example, some Game Pass subscribers can access games on Electronic Arts (EA) Play for no additional cost,45 and Fortnite is available for free on Xbox Cloud Gaming without a Game Pass membership, although users must have a Microsoft account.46 If Microsoft allows other subscription or cloud gaming services to distribute Activision Blizzard’s video games, it may charge these providers a fee to do so, meaning potential competitors could face an additional cost that Microsoft would not. Consumers would arguably benefit from having a greater selection of video games offered through Microsoft’s subscription and cloud gaming services. However, if other subscription and cloud gaming service providers are unable to increase their market shares, Microsoft may be able to dominate the market, potentially allowing Microsoft to increase prices in the future. The salience of this concern may reflect opinions on whether antitrust enforcement should consider potential effects on the industry that may affect competition in the future or focus exclusively on consumer welfare. Among video game publishers in the United States, Microsoft and Activision Blizzard are estimated to have the largest market shares.47 IBISWorld reports, however, that competition among publishers and developers is high, even though the success of new entrants, particularly among developers, is fairly low.48 Publishers and developers can face high levels of uncertainty and risk.49 Furthermore, measuring the market share of Microsoft and Activision Blizzard within the United States may not accurately reflect competition in these markets, given that these companies compete at a global level. Some industry analysts list Tencent, which is headquartered in China, as the largest video game publisher worldwide based on revenue;50 Microsoft and Activision Blizzard are listed among the top 10, along with Sony, Nintendo, EA, and Take-Two Interactive.51 Microsoft stated that after its acquisition of Activision Blizzard, it would “become the world’s third-largest gaming company by revenue, behind Tencent and Sony.” 52 Microsoft’s acquisition could reduce the number of potential employers in the video game industry. At an FTC forum, an Activision Blizzard employee raised concern that consolidation in the industry could enable firms to hire employees at lower wages than in a competitive market.58 During its acquisition of ZeniMax, Microsoft reportedly stated that it did not plan on making changes to ZeniMax and that ZeniMax would operate independently following the acquisition.59 One industry analyst viewed the acquisition as a means to support gaming studios under ZeniMax, which had been struggling financially; according to the analyst, without the acquisition, ZeniMax would have likely faced layoffs and released fewer games.60 If Microsoft were to utilize a similar approach with Activision Blizzard, allowing it to essentially operate as a separate entity within Microsoft, the acquisition might not significantly affect the labor market for developers. Furthermore, some employees may have skills that would be easily transferrable to firms outside of the video game industry, which could limit Microsoft’s ability to control wages. Nevertheless, Microsoft’s acquisition would reduce the number of large, established firms in the video game industry, which could provide it with greater negotiating power. Another concern may be that Microsoft’s proposed acquisition could affect ongoing efforts to reach a collective bargaining agreement for Activision Blizzard employees. This concern was raised by an Activision Blizzard employee at an FTC forum and by some Senators in a March 2022 letter to the FTC,61 which cited Microsoft’s dismissal of temporary quality assurance workers two years after they formed a union in 2014.62 However, on June 13, 2022, Microsoft and the Communications Workers of America—the union that has been assisting Activision Blizzard employees—announced that they had entered a labor neutrality agreement enabling workers “to freely and fairly make a choice about union representation,” which would apply beginning 60 days after Microsoft’s acquisition is completed.63 Furthermore, it is unclear whether working conditions would improve if Activision Blizzard were to remain an independent company rather than being acquired by Microsoft. Some antitrust enforcers are reportedly considering some of the concerns discussed in the previous section, including the potential effect of Microsoft’s proposed acquisition on competing gaming subscription services and the market for game developers.64 In response to the March 2022 letter from some Senators asking the FTC to consider whether the transaction might exacerbate anticompetitive conduct in the labor market,65 FTC Chair Lina Khan stated that she shares those Senators’ concerns about monopsony power in labor markets. ","Why do the types of mergers Congress is stating that Blizzard being acquired through Microsoft presents problems to consumers? This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Respond in 100 words or less and you may not use less than five bullet points in your answer. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context"" Acquisition of Activision Blizzard Microsoft’s proposed acquisition may be considered both a vertical merger, in which one firm is the supplier and the other is a customer in the supply chain, and a horizontal merger, in which the merging firms are direct competitors, offering similar products or services that are considered substitutes. One concern with vertical mergers is that they may lead to foreclosure, a situation in which a supplier that competes with the merged firm loses access to a potential customer or a buyer that competes with the merged firm is denied access to a supplier. A concern with horizontal mergers is that they may significantly increase the market share of the merged firm, increasing concentration in the market and reducing competition, thereby enabling the remaining firms to raise prices. Microsoft’s proposed acquisition may also raise other concerns that typically have not been raised in merger challenges in recent decades, such as dominance in markets that may develop in the future and labor market monopsony.36 A key question about Microsoft’s proposed acquisition may be the extent to which Microsoft might restrict the availability of Activision Blizzard’s video games to its consoles and its streaming and cloud gaming services. Such a restriction would mean that other companies’ consoles or streaming or cloud gaming services would not be able to offer Activision Blizzard’s games to consumers. Microsoft has stated that if the merger is approved, it would continue to make Call of Duty and other popular Activision games available on other gaming consoles in addition to its Xbox.37 The statement specifies that Activision’s popular content would be “available on competing platforms like Sony’s PlayStation.” It is unclear, however, if this commitment pertains only to Sony’s consoles or also applies to PlayStation Plus,38 Sony’s version of Game Pass. Additionally, it is unclear whether Activision Blizzard’s games would be available on other streaming or cloud gaming services. Microsoft could also limit the availability of other games that are or will be under development. In 2020, after acquiring ZeniMax Media, parent company of the video game developer Bethesda Softworks,39 Microsoft stated that it would honor the exclusivity commitments Bethesda made with Sony for certain games for one year,40 but that future Bethesda games would be made available for “other consoles on a case by case basis.” 41 The game Starfield, officially introduced by Bethesda in 2018,42 is scheduled to be released in November 2022 exclusively on Microsoft’s Xbox Series X and S consoles and Windows PCs; it will not be available on other consoles.43 One potential concern may be how Microsoft’s acquisition might affect competition among digital stores selling video games for PCs, a market in which both Microsoft and Activision Blizzard compete. Following the acquisition, Microsoft could operate both Microsoft Store and Battle.net. This may not have a significant effect on competition, however, because Valve Corp.’s Steam is considered to be the dominant market player among PC digital stores. In a 2021 lawsuit alleging anticompetitive practices by Valve, video game developer Wolfire Games estimated that Valve controlled at least 75% of PC desktop game distribution.44 With respect to subscription or cloud gaming services, Microsoft may be able to increase its market share with the acquisition by offering more content than other providers. In addition to developing its own games, Microsoft has entered partnerships with various developers and publishers. For example, some Game Pass subscribers can access games on Electronic Arts (EA) Play for no additional cost,45 and Fortnite is available for free on Xbox Cloud Gaming without a Game Pass membership, although users must have a Microsoft account.46 If Microsoft allows other subscription or cloud gaming services to distribute Activision Blizzard’s video games, it may charge these providers a fee to do so, meaning potential competitors could face an additional cost that Microsoft would not. Consumers would arguably benefit from having a greater selection of video games offered through Microsoft’s subscription and cloud gaming services. However, if other subscription and cloud gaming service providers are unable to increase their market shares, Microsoft may be able to dominate the market, potentially allowing Microsoft to increase prices in the future. The salience of this concern may reflect opinions on whether antitrust enforcement should consider potential effects on the industry that may affect competition in the future or focus exclusively on consumer welfare. Among video game publishers in the United States, Microsoft and Activision Blizzard are estimated to have the largest market shares.47 IBISWorld reports, however, that competition among publishers and developers is high, even though the success of new entrants, particularly among developers, is fairly low.48 Publishers and developers can face high levels of uncertainty and risk.49 Furthermore, measuring the market share of Microsoft and Activision Blizzard within the United States may not accurately reflect competition in these markets, given that these companies compete at a global level. Some industry analysts list Tencent, which is headquartered in China, as the largest video game publisher worldwide based on revenue;50 Microsoft and Activision Blizzard are listed among the top 10, along with Sony, Nintendo, EA, and Take-Two Interactive.51 Microsoft stated that after its acquisition of Activision Blizzard, it would “become the world’s third-largest gaming company by revenue, behind Tencent and Sony.” 52 Microsoft’s acquisition could reduce the number of potential employers in the video game industry. At an FTC forum, an Activision Blizzard employee raised concern that consolidation in the industry could enable firms to hire employees at lower wages than in a competitive market.58 During its acquisition of ZeniMax, Microsoft reportedly stated that it did not plan on making changes to ZeniMax and that ZeniMax would operate independently following the acquisition.59 One industry analyst viewed the acquisition as a means to support gaming studios under ZeniMax, which had been struggling financially; according to the analyst, without the acquisition, ZeniMax would have likely faced layoffs and released fewer games.60 If Microsoft were to utilize a similar approach with Activision Blizzard, allowing it to essentially operate as a separate entity within Microsoft, the acquisition might not significantly affect the labor market for developers. Furthermore, some employees may have skills that would be easily transferrable to firms outside of the video game industry, which could limit Microsoft’s ability to control wages. Nevertheless, Microsoft’s acquisition would reduce the number of large, established firms in the video game industry, which could provide it with greater negotiating power. Another concern may be that Microsoft’s proposed acquisition could affect ongoing efforts to reach a collective bargaining agreement for Activision Blizzard employees. This concern was raised by an Activision Blizzard employee at an FTC forum and by some Senators in a March 2022 letter to the FTC,61 which cited Microsoft’s dismissal of temporary quality assurance workers two years after they formed a union in 2014.62 However, on June 13, 2022, Microsoft and the Communications Workers of America—the union that has been assisting Activision Blizzard employees—announced that they had entered a labor neutrality agreement enabling workers “to freely and fairly make a choice about union representation,” which would apply beginning 60 days after Microsoft’s acquisition is completed.63 Furthermore, it is unclear whether working conditions would improve if Activision Blizzard were to remain an independent company rather than being acquired by Microsoft. Some antitrust enforcers are reportedly considering some of the concerns discussed in the previous section, including the potential effect of Microsoft’s proposed acquisition on competing gaming subscription services and the market for game developers.64 In response to the March 2022 letter from some Senators asking the FTC to consider whether the transaction might exacerbate anticompetitive conduct in the labor market,65 FTC Chair Lina Khan stated that she shares those Senators’ concerns about monopsony power in labor markets. ",Internet/Technology,Find & Summarize,Text Transformation Refer only to the provided context document when answering the question.,List all the types of bonds only using information from the provided document.,"𝐒𝐭𝐨𝐜𝐤𝐬 𝐚𝐧𝐝 𝐁𝐨𝐧𝐝𝐬 𝐂𝐨𝐦𝐩𝐚𝐫𝐢𝐬𝐨𝐧 Large companies and other entities use bonds as a form of debt borrowing or financing. Unlike loans, bonds are more transferrable and divisible by the lenders, allowing for multiple investors, which is appropriate when financing needs are very substantial. Bearing similarities to the concept of a first mortgage and a second mortgage, there are senior bonds and subordinated bonds; the senior bonds take precedence over the subordinated bonds in terms of payment priority, and therefore are safer for the lender or investor. Equity, on the other hand, represents a share of ownership in a for-profit corporation. It is what is “left over” from revenue brought in after all expenses (operating expenses, taxes, interest) have been paid. Because equity holders are entitled to what is “left over,” this means they are the investor class exposed to the greatest risk, but are also entitled to the greatest reward. A corporation’s capital structure is typically comprised of one or more forms of debt and one or more forms of equity. According to the chart below, there is an order of precedence governing how money flows in an entity from one class of investors to another. Because debt or bond holders have a senior claim relative to equity holders, business profits first go towards senior debt payments, then to any subordinate class of debt, and then to any preferred class of equity. From there, all remaining profits flow to common equity as a return on investment to be distributed to the owners of common equity. Pending the direction and approval of the company’s board of directors, this distribution can come in the form of a dividend (or stock buyback), reinvested into the company, or most likely a combination of both. If business prospects are extremely good, a common equity shareholder may receive a theoretically uncapped return on their investment. Over the long run, the return on equity of successful and stable corporations exceeds the cost of debt sufficiently enough to compensate investors for the additional risk they are taking. The source of the additional risk is the priority of payments when business conditions are weaker. If there is an economic cycle of weaker revenues, a business might find itself barely able to service its debt financing. In this case, it is unlikely any residual profits will be available to common shareholders for distribution; these circumstances may last for years and many require the business to resort to costly compromises to ensure its debt payments are met. Meanwhile, the senior debt holders can take comfort in the fact the return on their investment is of highest priority and will only be compromised as a last resort. This creates what can be referred to as a more open system of outcomes for stocks and a more closed system of outcomes for bonds; this feature will be expanded upon in greater detail later. These nuances in the capital structure may seem like semantics to some, but as was stated in the introduction, it is an essential component of developing a true understanding of investment options and has great implications on risk and return characteristics. Stock and Bond Investment Opportunities In terms of the number of different investments investors are able to choose from, there are overwhelmingly more bond opportunities than stock opportunities. This may come as a surprise to some as market media attention is overwhelmingly slanted towards stock investing instead of bond investing. Investment products are: • Not a Deposit • Not FDIC Insured • Not Insured by any Federal Government Agency • Not Guaranteed by the Bank • May Go Down in Value In fact, there are 68 times more bond issuances than there are publicly owned stocks. If a person only includes the stocks actively traded on an exchange, there would be 277 times more bond issuances. Yet in terms of the amount of capital invested in each market, there is only 54% more invested in bonds than there is invested in equities. Similar to how the vast amount of market media attention is fixated on the relatively few amount of actively traded stocks, the amount of investment dollars chasing those actively traded stocks is disproportionately large compared to the amount of capital invested in the vast universe of bonds. Within the overemphasis on stocks, there is yet more of a disproportionate emphasis placed on the largest companies; of the aggregate investment in all of the 15,000 publicly traded corporations, 70% of that capital is concentrated in the 500 largest corporations. Put another way, 70% of the money is invested in 3% of the companies; these are the companies receiving the lion’s share of market media attention! In investing, when all of the attention and capital is placed in one area, it is unlikely there are undiscovered opportunities in that area. In fact, numerous studies have shown there is no outperformance potential when investing in the largest U.S. corporations. However, studies have consistently indicated outperformance potential is available investing in small U.S. corporations, various bond sectors, and in certain international investments. Different Types of Stocks Stock market opportunities are often segmented different ways. The three most prominent forms of categorization are market capitalization size, value or growth, and industry classification. The capitalization size of a company is measured by the market value of all outstanding shares of a company’s equity. Companies’ market capitalization is categorized between large cap, medium cap, and small cap. Companies are considered to be large cap when their market capitalization exceeds $10 billion. Companies between $2 billion and $10 billion market cap are considered mid cap companies. Those companies with less than $2 billion market cap are considered small cap companies. The next series of categorization is between value and growth and is often determined by the price of a company’s equity in relation to its earnings, its future earnings prospects, and the amount of profits the corporations retain versus what is returned to shareholders. All else unchanged, the lower the company’s price relative to earnings (measured by the Price to Earnings (P/E) ratio, or other relative value measurements) the more likely it is to be classified as a value company instead of a growth company; Investment products are: • Not a Deposit • Not FDIC Insured • Not Insured by any Federal Government Agency • Not Guaranteed by the Bank • May Go Down in Value value companies tend to have a low stock price due to unfavorable growth or future earnings prospects. Growth companies tend to have very favorable earnings growth forecasts causing their equity prices to be much higher relative to the company’s current earnings. When categorizing equity mutual funds or ETFs, the Equity Style Box is a conventional way to categorize the predominant types of companies a fund is primarily invested in. The Equity Style a fund pursues may not provide an investor the capability to predict future returns, but it helps to understand the types of companies a fund is invested in and to compare the actual investment activities to the fund’s mandated objectives. The final categorization of stocks is the industry classifications; these are subsections of the equity investment market and are often referred to as equity subsectors. The predominant subsectors are: energy, materials, industrials, consumer goods (basic staples), consumer discretionary, health care, utilities, financials, and technology. This series of classifications is especially useful because an industry’s trends, opportunities, and risks bear a heavy influence on the future prospects of the earnings and stock price of companies within that industry. In fact, a key focal point in corporate investment analysis is to perform an industry analysis. As an industry is beneficially or negatively exposed to an economic cycle, the corresponding beneficial or negative implications are likely to be shared across the vast majority of companies in the industry. By categorizing between equity subsectors, an investor may be better able to develop informed expectations of how their equity portfolio will perform in a given economic cycle. Different Types of Bonds Three general categorizations of bonds are issuer type, maturity length, and credit strength. When discussing stocks, the discussion always pertained to shares of corporations. For-profit corporations are only one of many kinds of bond issuers. The overarching categorizations of bond issuers are: U.S. Treasury and other federal agencies, mortgage- related bonds, corporate bonds, asset-backed bonds, and municipal bonds. Within mortgage-related, asset- backed, and municipal bonds, there is a multitude of meaningfully different issuer types. For example: in municipal bonds, there are: cities, states, counties, toll roads, school districts, business and residential real estate developments, event centers, hospitals, prisons, sewer systems, tobacco bonds, etc. The type of issuer and its repayment source carry strong implications on a bond’s credit strength, its perceived risk, and ultimately the return opportunities for investors. The maturity length of a bond and whether it can be prepaid in advance of the maturity date has important implications on the long term returns on bond investing. All else unchanged, a bond with a longer maturity typically has a higher return and is considered to be a higher risk.2 Basic Bond Valuation and Maturity Trade-offs If a person owns a $100 bond that earns 5% return each year for 5 years in a world where the market expects 5% return, the market value on the bond would be $100. However, if the market instead expected a 4% return, what would the 2However, in the context of a portfolio of stocks and bonds, having longer maturity bonds while having greater individual risk can actually lower portfolio risk due to their historic negative correlation to stocks. market value be? In that case, the bond owner would benefit by an extra 1% per year over 5 years equating to a 5% aggregate benefit; ignoring compounding and preciseness, the market value on that bond would be 5% higher, or $105. For a 10 year bond instead of a 5 year bond, the differences in interest rates would have twice the magnitude of impact. "," ================== 𝐒𝐭𝐨𝐜𝐤𝐬 𝐚𝐧𝐝 𝐁𝐨𝐧𝐝𝐬 𝐂𝐨𝐦𝐩𝐚𝐫𝐢𝐬𝐨𝐧 Large companies and other entities use bonds as a form of debt borrowing or financing. Unlike loans, bonds are more transferrable and divisible by the lenders, allowing for multiple investors, which is appropriate when financing needs are very substantial. Bearing similarities to the concept of a first mortgage and a second mortgage, there are senior bonds and subordinated bonds; the senior bonds take precedence over the subordinated bonds in terms of payment priority, and therefore are safer for the lender or investor. Equity, on the other hand, represents a share of ownership in a for-profit corporation. It is what is “left over” from revenue brought in after all expenses (operating expenses, taxes, interest) have been paid. Because equity holders are entitled to what is “left over,” this means they are the investor class exposed to the greatest risk, but are also entitled to the greatest reward. A corporation’s capital structure is typically comprised of one or more forms of debt and one or more forms of equity. According to the chart below, there is an order of precedence governing how money flows in an entity from one class of investors to another. Because debt or bond holders have a senior claim relative to equity holders, business profits first go towards senior debt payments, then to any subordinate class of debt, and then to any preferred class of equity. From there, all remaining profits flow to common equity as a return on investment to be distributed to the owners of common equity. Pending the direction and approval of the company’s board of directors, this distribution can come in the form of a dividend (or stock buyback), reinvested into the company, or most likely a combination of both. If business prospects are extremely good, a common equity shareholder may receive a theoretically uncapped return on their investment. Over the long run, the return on equity of successful and stable corporations exceeds the cost of debt sufficiently enough to compensate investors for the additional risk they are taking. The source of the additional risk is the priority of payments when business conditions are weaker. If there is an economic cycle of weaker revenues, a business might find itself barely able to service its debt financing. In this case, it is unlikely any residual profits will be available to common shareholders for distribution; these circumstances may last for years and many require the business to resort to costly compromises to ensure its debt payments are met. Meanwhile, the senior debt holders can take comfort in the fact the return on their investment is of highest priority and will only be compromised as a last resort. This creates what can be referred to as a more open system of outcomes for stocks and a more closed system of outcomes for bonds; this feature will be expanded upon in greater detail later. These nuances in the capital structure may seem like semantics to some, but as was stated in the introduction, it is an essential component of developing a true understanding of investment options and has great implications on risk and return characteristics. Stock and Bond Investment Opportunities In terms of the number of different investments investors are able to choose from, there are overwhelmingly more bond opportunities than stock opportunities. This may come as a surprise to some as market media attention is overwhelmingly slanted towards stock investing instead of bond investing. Investment products are: • Not a Deposit • Not FDIC Insured • Not Insured by any Federal Government Agency • Not Guaranteed by the Bank • May Go Down in Value In fact, there are 68 times more bond issuances than there are publicly owned stocks. If a person only includes the stocks actively traded on an exchange, there would be 277 times more bond issuances. Yet in terms of the amount of capital invested in each market, there is only 54% more invested in bonds than there is invested in equities. Similar to how the vast amount of market media attention is fixated on the relatively few amount of actively traded stocks, the amount of investment dollars chasing those actively traded stocks is disproportionately large compared to the amount of capital invested in the vast universe of bonds. Within the overemphasis on stocks, there is yet more of a disproportionate emphasis placed on the largest companies; of the aggregate investment in all of the 15,000 publicly traded corporations, 70% of that capital is concentrated in the 500 largest corporations. Put another way, 70% of the money is invested in 3% of the companies; these are the companies receiving the lion’s share of market media attention! In investing, when all of the attention and capital is placed in one area, it is unlikely there are undiscovered opportunities in that area. In fact, numerous studies have shown there is no outperformance potential when investing in the largest U.S. corporations. However, studies have consistently indicated outperformance potential is available investing in small U.S. corporations, various bond sectors, and in certain international investments. Different Types of Stocks Stock market opportunities are often segmented different ways. The three most prominent forms of categorization are market capitalization size, value or growth, and industry classification. The capitalization size of a company is measured by the market value of all outstanding shares of a company’s equity. Companies’ market capitalization is categorized between large cap, medium cap, and small cap. Companies are considered to be large cap when their market capitalization exceeds $10 billion. Companies between $2 billion and $10 billion market cap are considered mid cap companies. Those companies with less than $2 billion market cap are considered small cap companies. The next series of categorization is between value and growth and is often determined by the price of a company’s equity in relation to its earnings, its future earnings prospects, and the amount of profits the corporations retain versus what is returned to shareholders. All else unchanged, the lower the company’s price relative to earnings (measured by the Price to Earnings (P/E) ratio, or other relative value measurements) the more likely it is to be classified as a value company instead of a growth company; Investment products are: • Not a Deposit • Not FDIC Insured • Not Insured by any Federal Government Agency • Not Guaranteed by the Bank • May Go Down in Value value companies tend to have a low stock price due to unfavorable growth or future earnings prospects. Growth companies tend to have very favorable earnings growth forecasts causing their equity prices to be much higher relative to the company’s current earnings. When categorizing equity mutual funds or ETFs, the Equity Style Box is a conventional way to categorize the predominant types of companies a fund is primarily invested in. The Equity Style a fund pursues may not provide an investor the capability to predict future returns, but it helps to understand the types of companies a fund is invested in and to compare the actual investment activities to the fund’s mandated objectives. The final categorization of stocks is the industry classifications; these are subsections of the equity investment market and are often referred to as equity subsectors. The predominant subsectors are: energy, materials, industrials, consumer goods (basic staples), consumer discretionary, health care, utilities, financials, and technology. This series of classifications is especially useful because an industry’s trends, opportunities, and risks bear a heavy influence on the future prospects of the earnings and stock price of companies within that industry. In fact, a key focal point in corporate investment analysis is to perform an industry analysis. As an industry is beneficially or negatively exposed to an economic cycle, the corresponding beneficial or negative implications are likely to be shared across the vast majority of companies in the industry. By categorizing between equity subsectors, an investor may be better able to develop informed expectations of how their equity portfolio will perform in a given economic cycle. Different Types of Bonds Three general categorizations of bonds are issuer type, maturity length, and credit strength. When discussing stocks, the discussion always pertained to shares of corporations. For-profit corporations are only one of many kinds of bond issuers. The overarching categorizations of bond issuers are: U.S. Treasury and other federal agencies, mortgage- related bonds, corporate bonds, asset-backed bonds, and municipal bonds. Within mortgage-related, asset- backed, and municipal bonds, there is a multitude of meaningfully different issuer types. For example: in municipal bonds, there are: cities, states, counties, toll roads, school districts, business and residential real estate developments, event centers, hospitals, prisons, sewer systems, tobacco bonds, etc. The type of issuer and its repayment source carry strong implications on a bond’s credit strength, its perceived risk, and ultimately the return opportunities for investors. The maturity length of a bond and whether it can be prepaid in advance of the maturity date has important implications on the long term returns on bond investing. All else unchanged, a bond with a longer maturity typically has a higher return and is considered to be a higher risk.2 Basic Bond Valuation and Maturity Trade-offs If a person owns a $100 bond that earns 5% return each year for 5 years in a world where the market expects 5% return, the market value on the bond would be $100. However, if the market instead expected a 4% return, what would the 2However, in the context of a portfolio of stocks and bonds, having longer maturity bonds while having greater individual risk can actually lower portfolio risk due to their historic negative correlation to stocks. market value be? In that case, the bond owner would benefit by an extra 1% per year over 5 years equating to a 5% aggregate benefit; ignoring compounding and preciseness, the market value on that bond would be 5% higher, or $105. For a 10 year bond instead of a 5 year bond, the differences in interest rates would have twice the magnitude of impact. ================== List all the types of bonds only using information from the provided document. ================== Refer only to the provided context document when answering the question.",Financial,Fact Finding,Q&A "The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, ""The information is not available at this time.""","When evaluating legacy systems, how do we determine whether to replace or maintain these legacy systems?","Home > IT applications, infrastructure and operations FEATURE ~ 20F3 4 P Partof: The CIO's guide to legacy systems Replacing vs. maintaining legacy systems Understanding issues such as which systems hinder organizational performance can help IT leaders decide which legacy systems to replace and which to maintain. By Mary K. Pratt Published: 05 Jul 2023 Few CIOs escape the complexity of deciding whether to maintain legacy systems or replace them altogether. The right choice, as with most things in life, is: It depends. IT leaders might want to replace a legacy_system because of outdated hardware, increased security risks or a desire to enable a digital transformation initiative. But replacing existing systems isn't always in the company's best interest. Legacy systems can remain in place if the existing system is reliable. vclo” Q Prioritize a strategic assessment One alternative to completely replacing or maintaining legacy systems is to modernize them. Modernized systems might be more cost-effective, while increasing efficiency and improving existing processes at the same time. Michael Bradshaw is currently working through a multiyear plan to modernize the technology at Kyndryl, a New York-based IT services company. After about two years of planning and execution, the goal is to complete the big moves by November, he said. A strategic assessment of the company's existing systems and applications was the first step in the process. His modernization plan calls for the digitalization of the company's entire business chain, Bradshaw said. Previously, about 1,800 applications supported that chain, but the number should drop to 360 by year's end and eventually down to 300. His IT team partnered with the business to develop a target, as well as a roadmap on how to get there, he said. 20f34 P + The goal of this strategy is to streamline the modernization efforts. Up Next The strategic assessment enabled §Tdasisienliyashaylagaeysysiams laimmeripbiigraationmodriizgtion and which could wait, systems Bradshaw said. Slyingwit i-and-rue logacysysems can el ke Undertanding sses such s which ystr e safot vt Byl as 1o wad changes al a izzying organizatonal perormance can ol "" T loax Afocus on competitive advantage heiped Steer the roadmap, foo. -~ el peroma ""Ultimately, all the systems we provide are to support the execution of business, so you start with the business needs, what's most important for the business,"" he said. Organizations that want to modernize must choose systems that support their objectives. The company considered cybersecurity concerns, maintenance requirements and operational costs to determine which apps to prioritize for modernization, Bradshaw said. Replacing vs. maintaining legacy systems Many organizations still rely on legacy systems for some of their workloads, which can limit innovation efforts. Seventy-two percent of all respondents believe that their organization's digital transformation efforts are lagging due to technical debt, while 51% cite a complex legacy IT infrastructure as one of their key challenges over the next year, according to the 2023 report ""CIO Pulse: 2023 budgets & priorities” from cloud software provider SoftwareOne, headquartered in Milwaukee. Yet, many CIOs don't always have a well-formulated path forward. A good portion of IT leaders are unclear on what they should modernize first and what legacy systems are OK to keep running. Some might end up shedding a legacy system under duress, said Joe Davey, partner at West Monroe, a digital services firm, headquartered in Chicago. ""Often, it takes a catalyzing event,"" Davey said. In some cases, CIOs replace legacy technologies without a clear strategy in mind. ""[The strategy is] technology for technology's sake."" he said. “[But] there's a lack of understanding how that technology can help them get ahead.” Although companies eventually need to replace all legacy technology, CIOs don't need to modernize all systems at once - nor is an undertaking of that magnitude usually possible. Instead, CIOs must determine what legacy systems need to be replaced sooner and which can be replaced later, both Davey and Bradshaw said. 5 reasons to replace legacy systems Organizations should carefully evaluate their existing systems before making any changes. IT leaders should understand the following reasons why legacy systems should be prioritized for modernization. 1. The system creates an unacceptable security risk Many IT teams can't patch some legacy systems because vendors don't release new patches. Other systems have significant security. vulnerabilities IT can't address for another reason. Any such system with ""security vulnerabiltties that could bring the [organization] to its knees should be a high priority for replacement,” said Dave Powner, executive director of the Center for Data-Driven Policy at Mitre Corp., a nonprofit research and development organization, based in McLean, Va., that provides technical and cybersecurity support to U.S. government agencies. 2. The system hinders the organization’s performance Inefficient systems can cause delays and decreased productivity. 20f34 P + Organizations should prioritize replacing systems that affect efficiency, said Minir Patel, vice president of cloud architecture at Apps Associates, a consultancy augl NP, headquartered in Acton, Mass. 6 reasons legacy systems are stillinuse Replacing vs. maintaining legac Systems by modernizing legacy systems, Powner said. Enterprises can pursue new opportunities or significantly improve mission cap4Biiieé Stying win rec-and-ruo legacy systems can feel ke Understanding issues uch as whih syster 3. The system doesn't fit into the oR§AHIZHESH S ERUFEEsgaoes ot davng organzatona poromancecanhalp I lac Alegacy system without immediate problems can still be a priority for modernization if the processes it supports aren't critical for the organization's long-term goals. When developing a modernization strategy, CIOs should focus on where the company wants to be, said Suneel Ghei, principal research director at Info-Tech Research Group, an IT services management company, based in London, Ont. 4. The system costs too much to maintain Al systems come with run costs. In some cases, a system’s maintenance costs might exceed its business value, including the cost of modernizing the system. Excessive run costs draw resources away from pursuing innovation and new opportunities, Patel said. CIOs need to do that math and know when they're approaching or have gone past that point so they can take appropriate action. 5. The system is at a high risk of failure Systems with no vendor support, that depend on obsolete programming languages or are highly customized with scant documentation and no remaining institutional knowledge of its buildout are highly fragile. Organizations could have a difficult time recovering if the system should fail. For example, some businesses have needed help with IT systems but couldn'tfind IT talent to service the systems. It's best to replace those systems before that happens to ensure business continuity. 3 reasons to maintain legacy systems Companies can maintain legacy systems under the right circumstances. Here are three reasons to maintain a legacy system that IT leaders should understand. 1. The system has an acceptable level of risk Asystem no longer supported by a vendor or built on an obsolete programming language does have security vulnerabilities. But it might not create unnecessary risks. For example, a company might rely on the system for a noncritical back-office function. There would be minimal effects on daily operations if the system failed. Or the CIO might have or could easily access the talent needed to keep it running at a reasonable cost. In such cases, the CIO might reasonably opt to make modernizing that system a lower priority. 2. The system still supports the organization's needs Asystem that meets the organization's needs, while not hindering its ability to pursue new competitive opportunities, is a strong candidate to stay in place. Organizations might do themselves a disservice by replacing legacy systems with modern versions they're not ready to use or optimize, Patel said. For example, replacing an existing system with a modern app featuring Al might seem like a good strategy. Still, a company needs to have the maturity required to use the Al component successfully to get ROI that justifies the modernization. 3. The system's processes can be sunsetted or shifted to other systems 20f34 P + CIOs might opt to keep a legacy system in place if they know that the business processes it supports will be sunsetted by the organization or shifted to other systems, pinie¥itin Naik, technical fellow at Mitre Corp. 6 reasons legacy systems are still inuse Replacing vs. maintaining legac il a system that won't't be needed in the future won'te deliver good ROI® Replacing % Next Steps Stying win rec-and-ruo legacy systems can el ke Ine slest roue. But 3 the wor changes ata dzzying vstems Understanding issues such as whih syster organizatonalperormance can help I eac How to modernize apps as part of the cloud migration process How to perform an application modernization assessment % Dig Deeper on IT applications, infrastructure and operations bimodal IT (bimodal information technology) How to modernize legacy applications By: Linda Tucci By: Mary Pratt IT transformation Defra's tech review reveals legacy IT issues across government By: Brian Holak By: Cliff Saran -ADS BY GOOGLE Latest TechTarget resources Cloud Computing [ Top 6 soft skills in IT that cloud teams need 20f34 P + Softskills play a bigger partin successiul cloud deployments than you might think. Technical skill are obviously essential in . MOBILE COMPUTING Up Next DATACENTER 6 reasons legacy systems a@mfi.msandzmef&%dwsgfi- cloud SUSTAINABILITY AND ESG. Staying with tried-and-lrue legacy systems carStaridieds for ndeeiifiodiirisawes chishgingwith Sheteapid pace of cloud adoption. certificatioreprograms he safest route. But as the world changes al EZisW oxpeRERVERISEARS URBBCEHLBRRIT leac About Us Contributors Guides Editorial Ethics Policy Reprints Opinions Meet The Editors Answers Photo Stories Contact Us Definitions Quizzes Advertisers E-Products Tips Partner with Us Events Tutorials Media Kit Fealures Videos Corporate Site AllRights Reserved, Copyright 2007 - 2024, TechTarget Privacy Policy D0 Not Sel or Share My Persona Information 20f34 P + ","The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, ""The information is not available at this time."" When evaluating legacy systems, how do we determine whether to replace or maintain these legacy systems? Home > IT applications, infrastructure and operations FEATURE ~ 20F3 4 P Partof: The CIO's guide to legacy systems Replacing vs. maintaining legacy systems Understanding issues such as which systems hinder organizational performance can help IT leaders decide which legacy systems to replace and which to maintain. By Mary K. Pratt Published: 05 Jul 2023 Few CIOs escape the complexity of deciding whether to maintain legacy systems or replace them altogether. The right choice, as with most things in life, is: It depends. IT leaders might want to replace a legacy_system because of outdated hardware, increased security risks or a desire to enable a digital transformation initiative. But replacing existing systems isn't always in the company's best interest. Legacy systems can remain in place if the existing system is reliable. vclo” Q Prioritize a strategic assessment One alternative to completely replacing or maintaining legacy systems is to modernize them. Modernized systems might be more cost-effective, while increasing efficiency and improving existing processes at the same time. Michael Bradshaw is currently working through a multiyear plan to modernize the technology at Kyndryl, a New York-based IT services company. After about two years of planning and execution, the goal is to complete the big moves by November, he said. A strategic assessment of the company's existing systems and applications was the first step in the process. His modernization plan calls for the digitalization of the company's entire business chain, Bradshaw said. Previously, about 1,800 applications supported that chain, but the number should drop to 360 by year's end and eventually down to 300. His IT team partnered with the business to develop a target, as well as a roadmap on how to get there, he said. 20f34 P + The goal of this strategy is to streamline the modernization efforts. Up Next The strategic assessment enabled §Tdasisienliyashaylagaeysysiams laimmeripbiigraationmodriizgtion and which could wait, systems Bradshaw said. Slyingwit i-and-rue logacysysems can el ke Undertanding sses such s which ystr e safot vt Byl as 1o wad changes al a izzying organizatonal perormance can ol "" T loax Afocus on competitive advantage heiped Steer the roadmap, foo. -~ el peroma ""Ultimately, all the systems we provide are to support the execution of business, so you start with the business needs, what's most important for the business,"" he said. Organizations that want to modernize must choose systems that support their objectives. The company considered cybersecurity concerns, maintenance requirements and operational costs to determine which apps to prioritize for modernization, Bradshaw said. Replacing vs. maintaining legacy systems Many organizations still rely on legacy systems for some of their workloads, which can limit innovation efforts. Seventy-two percent of all respondents believe that their organization's digital transformation efforts are lagging due to technical debt, while 51% cite a complex legacy IT infrastructure as one of their key challenges over the next year, according to the 2023 report ""CIO Pulse: 2023 budgets & priorities” from cloud software provider SoftwareOne, headquartered in Milwaukee. Yet, many CIOs don't always have a well-formulated path forward. A good portion of IT leaders are unclear on what they should modernize first and what legacy systems are OK to keep running. Some might end up shedding a legacy system under duress, said Joe Davey, partner at West Monroe, a digital services firm, headquartered in Chicago. ""Often, it takes a catalyzing event,"" Davey said. In some cases, CIOs replace legacy technologies without a clear strategy in mind. ""[The strategy is] technology for technology's sake."" he said. “[But] there's a lack of understanding how that technology can help them get ahead.” Although companies eventually need to replace all legacy technology, CIOs don't need to modernize all systems at once - nor is an undertaking of that magnitude usually possible. Instead, CIOs must determine what legacy systems need to be replaced sooner and which can be replaced later, both Davey and Bradshaw said. 5 reasons to replace legacy systems Organizations should carefully evaluate their existing systems before making any changes. IT leaders should understand the following reasons why legacy systems should be prioritized for modernization. 1. The system creates an unacceptable security risk Many IT teams can't patch some legacy systems because vendors don't release new patches. Other systems have significant security. vulnerabilities IT can't address for another reason. Any such system with ""security vulnerabiltties that could bring the [organization] to its knees should be a high priority for replacement,” said Dave Powner, executive director of the Center for Data-Driven Policy at Mitre Corp., a nonprofit research and development organization, based in McLean, Va., that provides technical and cybersecurity support to U.S. government agencies. 2. The system hinders the organization’s performance Inefficient systems can cause delays and decreased productivity. 20f34 P + Organizations should prioritize replacing systems that affect efficiency, said Minir Patel, vice president of cloud architecture at Apps Associates, a consultancy augl NP, headquartered in Acton, Mass. 6 reasons legacy systems are stillinuse Replacing vs. maintaining legac Systems by modernizing legacy systems, Powner said. Enterprises can pursue new opportunities or significantly improve mission cap4Biiieé Stying win rec-and-ruo legacy systems can feel ke Understanding issues uch as whih syster 3. The system doesn't fit into the oR§AHIZHESH S ERUFEEsgaoes ot davng organzatona poromancecanhalp I lac Alegacy system without immediate problems can still be a priority for modernization if the processes it supports aren't critical for the organization's long-term goals. When developing a modernization strategy, CIOs should focus on where the company wants to be, said Suneel Ghei, principal research director at Info-Tech Research Group, an IT services management company, based in London, Ont. 4. The system costs too much to maintain Al systems come with run costs. In some cases, a system’s maintenance costs might exceed its business value, including the cost of modernizing the system. Excessive run costs draw resources away from pursuing innovation and new opportunities, Patel said. CIOs need to do that math and know when they're approaching or have gone past that point so they can take appropriate action. 5. The system is at a high risk of failure Systems with no vendor support, that depend on obsolete programming languages or are highly customized with scant documentation and no remaining institutional knowledge of its buildout are highly fragile. Organizations could have a difficult time recovering if the system should fail. For example, some businesses have needed help with IT systems but couldn'tfind IT talent to service the systems. It's best to replace those systems before that happens to ensure business continuity. 3 reasons to maintain legacy systems Companies can maintain legacy systems under the right circumstances. Here are three reasons to maintain a legacy system that IT leaders should understand. 1. The system has an acceptable level of risk Asystem no longer supported by a vendor or built on an obsolete programming language does have security vulnerabilities. But it might not create unnecessary risks. For example, a company might rely on the system for a noncritical back-office function. There would be minimal effects on daily operations if the system failed. Or the CIO might have or could easily access the talent needed to keep it running at a reasonable cost. In such cases, the CIO might reasonably opt to make modernizing that system a lower priority. 2. The system still supports the organization's needs Asystem that meets the organization's needs, while not hindering its ability to pursue new competitive opportunities, is a strong candidate to stay in place. Organizations might do themselves a disservice by replacing legacy systems with modern versions they're not ready to use or optimize, Patel said. For example, replacing an existing system with a modern app featuring Al might seem like a good strategy. Still, a company needs to have the maturity required to use the Al component successfully to get ROI that justifies the modernization. 3. The system's processes can be sunsetted or shifted to other systems 20f34 P + CIOs might opt to keep a legacy system in place if they know that the business processes it supports will be sunsetted by the organization or shifted to other systems, pinie¥itin Naik, technical fellow at Mitre Corp. 6 reasons legacy systems are still inuse Replacing vs. maintaining legac il a system that won't't be needed in the future won'te deliver good ROI® Replacing % Next Steps Stying win rec-and-ruo legacy systems can el ke Ine slest roue. But 3 the wor changes ata dzzying vstems Understanding issues such as whih syster organizatonalperormance can help I eac How to modernize apps as part of the cloud migration process How to perform an application modernization assessment % Dig Deeper on IT applications, infrastructure and operations bimodal IT (bimodal information technology) How to modernize legacy applications By: Linda Tucci By: Mary Pratt IT transformation Defra's tech review reveals legacy IT issues across government By: Brian Holak By: Cliff Saran -ADS BY GOOGLE Latest TechTarget resources Cloud Computing [ Top 6 soft skills in IT that cloud teams need 20f34 P + Softskills play a bigger partin successiul cloud deployments than you might think. Technical skill are obviously essential in . MOBILE COMPUTING Up Next DATACENTER 6 reasons legacy systems a@mfi.msandzmef&%dwsgfi- cloud SUSTAINABILITY AND ESG. Staying with tried-and-lrue legacy systems carStaridieds for ndeeiifiodiirisawes chishgingwith Sheteapid pace of cloud adoption. certificatioreprograms he safest route. But as the world changes al EZisW oxpeRERVERISEARS URBBCEHLBRRIT leac About Us Contributors Guides Editorial Ethics Policy Reprints Opinions Meet The Editors Answers Photo Stories Contact Us Definitions Quizzes Advertisers E-Products Tips Partner with Us Events Tutorials Media Kit Fealures Videos Corporate Site AllRights Reserved, Copyright 2007 - 2024, TechTarget Privacy Policy D0 Not Sel or Share My Persona Information 20f34 P + ",Internet/Technology,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",What does it mean to have gerd and how does it affect my body? Is it preventable? How do I know if I need to go to a doctor? Are there any foods or drinks I should avoid? Answer in 200 words or less.,"Gastroesophageal reflux disease is a condition in which stomach acid repeatedly flows back up into the tube connecting the mouth and stomach, called the esophagus. It's often called GERD for short. This backwash is known as acid reflux, and it can irritate the lining of the esophagus. Many people experience acid reflux now and then. However, when acid reflux happens repeatedly over time, it can cause GERD. Most people can manage the discomfort of GERD with lifestyle changes and medicines. And though it's uncommon, some may need surgery to help with symptoms. Symptoms Common symptoms of GERD include: A burning sensation in the chest, often called heartburn. Heartburn usually happens after eating and might be worse at night or while lying down. Backwash of food or sour liquid in the throat. Upper belly or chest pain. Trouble swallowing, called dysphagia. Sensation of a lump in the throat. If you have nighttime acid reflux, you also might experience: An ongoing cough. Inflammation of the vocal cords, known as laryngitis. New or worsening asthma. When to see a doctor Seek medical help right away if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be symptoms of a heart attack. Make an appointment with a healthcare professional if you: Have severe or frequent GERD symptoms. Take nonprescription medicines for heartburn more than twice a week. GERD is caused by frequent acid reflux or reflux of nonacidic content from the stomach. When you swallow, a circular band of muscle around the bottom of the esophagus, called the lower esophageal sphincter, relaxes to allow food and liquid to flow into the stomach. Then the sphincter closes again. If the sphincter does not relax as is typical or it weakens, stomach acid can flow back into the esophagus. This constant backwash of acid irritates the lining of the esophagus, often causing it to become inflamed. Conditions that can increase the risk of GERD include: Obesity. Bulging of the top of the stomach up above the diaphragm, known as a hiatal hernia. Pregnancy. Connective tissue disorders, such as scleroderma. Delayed stomach emptying. Factors that can aggravate acid reflux include: Smoking. Eating large meals or eating late at night. Eating certain foods, such as fatty or fried foods. Drinking certain beverages, such as alcohol or coffee. Taking certain medicines, such as aspirin. Complications Over time, long-lasting inflammation in the esophagus can cause: Inflammation of the tissue in the esophagus, known as esophagitis. Stomach acid can break down tissue in the esophagus. This can cause inflammation, bleeding and sometimes an open sore, called an ulcer. Esophagitis can cause pain and make swallowing difficult. Narrowing of the esophagus, called an esophageal stricture. Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing. Precancerous changes to the esophagus, known as Barrett esophagus. Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What does it mean to have gerd and how does it affect my body? Is it preventable? How do I know if I need to go to a doctor? Are there any foods or drinks I should avoid? Answer in 200 words or less. {passage 0} ========== Gastroesophageal reflux disease is a condition in which stomach acid repeatedly flows back up into the tube connecting the mouth and stomach, called the esophagus. It's often called GERD for short. This backwash is known as acid reflux, and it can irritate the lining of the esophagus. Many people experience acid reflux now and then. However, when acid reflux happens repeatedly over time, it can cause GERD. Most people can manage the discomfort of GERD with lifestyle changes and medicines. And though it's uncommon, some may need surgery to help with symptoms. Symptoms Common symptoms of GERD include: A burning sensation in the chest, often called heartburn. Heartburn usually happens after eating and might be worse at night or while lying down. Backwash of food or sour liquid in the throat. Upper belly or chest pain. Trouble swallowing, called dysphagia. Sensation of a lump in the throat. If you have nighttime acid reflux, you also might experience: An ongoing cough. Inflammation of the vocal cords, known as laryngitis. New or worsening asthma. When to see a doctor Seek medical help right away if you have chest pain, especially if you also have shortness of breath, or jaw or arm pain. These may be symptoms of a heart attack. Make an appointment with a healthcare professional if you: Have severe or frequent GERD symptoms. Take nonprescription medicines for heartburn more than twice a week. GERD is caused by frequent acid reflux or reflux of nonacidic content from the stomach. When you swallow, a circular band of muscle around the bottom of the esophagus, called the lower esophageal sphincter, relaxes to allow food and liquid to flow into the stomach. Then the sphincter closes again. If the sphincter does not relax as is typical or it weakens, stomach acid can flow back into the esophagus. This constant backwash of acid irritates the lining of the esophagus, often causing it to become inflamed. Conditions that can increase the risk of GERD include: Obesity. Bulging of the top of the stomach up above the diaphragm, known as a hiatal hernia. Pregnancy. Connective tissue disorders, such as scleroderma. Delayed stomach emptying. Factors that can aggravate acid reflux include: Smoking. Eating large meals or eating late at night. Eating certain foods, such as fatty or fried foods. Drinking certain beverages, such as alcohol or coffee. Taking certain medicines, such as aspirin. Complications Over time, long-lasting inflammation in the esophagus can cause: Inflammation of the tissue in the esophagus, known as esophagitis. Stomach acid can break down tissue in the esophagus. This can cause inflammation, bleeding and sometimes an open sore, called an ulcer. Esophagitis can cause pain and make swallowing difficult. Narrowing of the esophagus, called an esophageal stricture. Damage to the lower esophagus from stomach acid causes scar tissue to form. The scar tissue narrows the food pathway, leading to problems with swallowing. Precancerous changes to the esophagus, known as Barrett esophagus. Damage from acid can cause changes in the tissue lining the lower esophagus. These changes are associated with an increased risk of esophageal cancer. https://www.mayoclinic.org/diseases-conditions/gerd/symptoms-causes/syc-20361940",Medical,Fact Finding,Q&A Do not use any prior knowledge or external resources. You must answer questions solely on the basis of the information provided in the prompt.,What are the main legal arguments for and against the FTC's Non-Compete Rule?,"Legal Authority The FTC relied on Sections 5 and 6(g) of the Federal Trade Commission Act (FTC Act) in promulgating the Non-Compete Rule. Section 5 prohibits “unfair methods of competition” (UMC) and empowers the FTC to enforce that prohibition through adjudication. Section 6 is titled “Additional powers of Commission.” It confers a range of authorities, most of which involve investigations and the publication of reports. The provision also includes Section 6(g), which empowers the FTC to “from time to time classify corporations and . . . to make rules and regulations for the purpose of carrying out” the FTC Act. Sections 5 and 6(g) were both part of the original FTC Act, which Congress enacted in 1914. Since the statute’s enactment, Congress has adopted several laws granting the FTC rulemaking authority over discrete subjects, including the Wool Products Labeling Act, the Textile Fiber Products Identification Act, the Fur Products Labeling Act, the Flammable Fabrics Act, and the Fair Packaging and Labeling Act. The FTC first asserted that Section 6(g) endows it with general substantive rulemaking power in 1962, and the agency adopted a number of trade regulation rules in the years that followed. Some of those rules defined certain conduct as both a UMC and an “unfair or deceptive act or practice” (UDAP)—a separate category of conduct prohibited by Section 5. Other rules relied only on the FTC’s UDAP power. One rule relied solely on the FTC’s competition authority, but was never enforced and has been repealed. In the 1970s, a trade association challenged the FTC’s authority to issue substantive rules under Section 6(g) in National Petroleum Refiners Association v. FTC. The trade association argued that Section 6(g) authorized only procedural rules, emphasizing that the FTC had not asserted substantive rulemaking authority under Section 6(g) until 1962 and that FTC officials had occasionally denied the existence of such authority. The trade association also contended that Congress’s enactment of several statutes granting the FTC specific rulemaking authorities implied that the FTC lacked general rulemaking authority. The U.S. Court of Appeals for the D.C. Circuit rejected those arguments. In affirming the FTC’s power to issue legislative rules under Section 6(g), the court relied on appellate decisions construing similar statutes as authorizing substantive rulemaking, the advantages of rulemaking in effectuating the FTC Congressional Research Service 3 Act’s purposes, and the absence of any limiting language in the statutory text. The D.C. Circuit downplayed the fact that the FTC had not claimed general rulemaking authority until 1962, reasoning that the agency’s earlier interpretation of its legal authority did not warrant judicial deference. The court also concluded that Congress may have provided the FTC with more specific rulemaking authorities based on “uncertainty, understandable caution, and a desire to avoid litigation,” rather than a firm conviction that the FTC lacked general rulemaking authority. Two years after the National Petroleum Refiners decision, Congress enacted the Magnuson-Moss Act, which imposed special procedural requirements for the FTC’s UDAP rules and eliminated the FTC’s authority to issue such rules under Section 6(g). Magnuson-Moss did not by its terms affect the FTC’s authority to issue UMC rules: the statute included a provision disclaiming an intent to affect “any authority of the Commission to prescribe rules (including interpretive rules), and general statements of policy, with respect to unfair methods of competition.” Despite this language in Magnuson-Moss, the FTC’s putative authority to issue UMC rules has been dormant since the enactment of that statute. The Non-Compete Rule marks the first rule promulgated under Section 6(g) since the 1970s and the second rule ever that relies solely upon the FTC’s competition authority. A 1983 decision from the U.S. Court of Appeals for the Seventh Circuit agreed with the D.C. Circuit’s reasoning in National Petroleum Refiners, but no other federal appellate court has addressed the FTC’s authority to issue legislative rules under Section 6(g). Whether the FTC possesses such authority remains unsettled; some commentators have argued that National Petroleum Refiners was wrongly decided and that it is unlikely that modern courts would reach the same conclusion. In issuing the Non-Compete Rule, the FTC defended its authority to issue substantive rules under Section 6(g) by pointing to the provision’s plain meaning and the D.C. Circuit’s decision in National Petroleum Refiners. The FTC also argued that Congress implicitly ratified the D.C. Circuit’s decision in both the Magnuson-Moss Act and the Federal Trade Commission Improvements Act of 1980 (the 1980 Amendments). The 1980 Amendments imposed procedural requirements that the FTC must follow in issuing any “rule.” It defined the term “rule” to include rules promulgated under Section 6 or Magnuson-Moss. The statute excluded from that definition “interpretive rules, rules involving Commission management or personnel, general statements of policy, or rules relating to Commission organization, procedure, or practice.” The FTC argued that this exclusion confirms its authority to issue rules under Section 6 that are not merely “interpretive rules, rules involving Commission management or personnel, general statements of policy, or rules relating to Commission organization, procedure, or practice.” The FTC’s authority to issue the Non-Compete Rule depends not only on whether Section 6(g) authorizes legislative rulemaking, but also on the scope of Section 5’s prohibition of UMC. The Supreme Court has repeatedly said that Section 5 is broader than the Sherman Act and the Clayton Act (the other core federal antitrust laws). However, the scope of this additional coverage—often called the FTC’s “standalone” Section 5 authority—is unsettled. Under previous leadership, the FTC took a narrow view of its standalone Section 5 authority. In a 2015 policy statement, the FTC indicated that decisions to bring standalone Section 5 actions would be guided by considerations of consumer welfare, that the FTC would evaluate challenged conduct under “a framework similar to the rule of reason,” and that the FTC was less likely to bring a standalone Section 5 action if enforcement of the Sherman Act or Clayton Act was sufficient to address the relevant competitive harm. The FTC rescinded this policy statement in 2021 and issued a new Section 5 policy statement the following year. In the 2022 policy statement, the FTC identified “two key criteria” it will consider in evaluating whether a “method of competition” is “unfair.” First, the FTC indicated that “unfair” conduct Congressional Research Service 4 “may be coercive, exploitative, collusive, abusive, deceptive, predatory, or involve the use of economic power of a similar nature,” and “may also be otherwise restrictive or exclusionary.” Second, the FTC explained that such conduct “must tend to negatively affect competitive conditions”—for example, by foreclosing or impairing the opportunities of market participants, reducing competition between rivals, limiting choice, or otherwise harming consumers. The 2022 policy statement indicated that this second inquiry will not turn on whether conduct directly causes harm in particular cases, but instead will focus on whether conduct “has a tendency to generate negative consequences.” In promulgating the Non-Compete Rule, the FTC found that non-competes violate Section 5 because they represent “restrictive and exclusionary conduct that tends to negatively affect competitive conditions” in labor markets and product and service markets. The FTC also determined that non-competes for workers other than senior executives violate Section 5 because they constitute “exploitative and coercive conduct that tends to negatively affect competitive conditions” in labor markets and product and service markets. (A previous Legal Sidebar provides a more extensive discussion of the FTC’s justification for the Non-Compete Rule.) Two FTC Commissioners voted against the Non-Compete Rule, arguing that the FTC lacks the authority to issue substantive competition regulations and that the evidence did not justify a categorical prohibition of non-competes.","Do not use any prior knowledge or external resources. You must answer questions solely on the basis of the information provided in the prompt. What are the main legal arguments for and against the FTC's Non-Compete Rule? Legal Authority The FTC relied on Sections 5 and 6(g) of the Federal Trade Commission Act (FTC Act) in promulgating the Non-Compete Rule. Section 5 prohibits “unfair methods of competition” (UMC) and empowers the FTC to enforce that prohibition through adjudication. Section 6 is titled “Additional powers of Commission.” It confers a range of authorities, most of which involve investigations and the publication of reports. The provision also includes Section 6(g), which empowers the FTC to “from time to time classify corporations and . . . to make rules and regulations for the purpose of carrying out” the FTC Act. Sections 5 and 6(g) were both part of the original FTC Act, which Congress enacted in 1914. Since the statute’s enactment, Congress has adopted several laws granting the FTC rulemaking authority over discrete subjects, including the Wool Products Labeling Act, the Textile Fiber Products Identification Act, the Fur Products Labeling Act, the Flammable Fabrics Act, and the Fair Packaging and Labeling Act. The FTC first asserted that Section 6(g) endows it with general substantive rulemaking power in 1962, and the agency adopted a number of trade regulation rules in the years that followed. Some of those rules defined certain conduct as both a UMC and an “unfair or deceptive act or practice” (UDAP)—a separate category of conduct prohibited by Section 5. Other rules relied only on the FTC’s UDAP power. One rule relied solely on the FTC’s competition authority, but was never enforced and has been repealed. In the 1970s, a trade association challenged the FTC’s authority to issue substantive rules under Section 6(g) in National Petroleum Refiners Association v. FTC. The trade association argued that Section 6(g) authorized only procedural rules, emphasizing that the FTC had not asserted substantive rulemaking authority under Section 6(g) until 1962 and that FTC officials had occasionally denied the existence of such authority. The trade association also contended that Congress’s enactment of several statutes granting the FTC specific rulemaking authorities implied that the FTC lacked general rulemaking authority. The U.S. Court of Appeals for the D.C. Circuit rejected those arguments. In affirming the FTC’s power to issue legislative rules under Section 6(g), the court relied on appellate decisions construing similar statutes as authorizing substantive rulemaking, the advantages of rulemaking in effectuating the FTC Congressional Research Service 3 Act’s purposes, and the absence of any limiting language in the statutory text. The D.C. Circuit downplayed the fact that the FTC had not claimed general rulemaking authority until 1962, reasoning that the agency’s earlier interpretation of its legal authority did not warrant judicial deference. The court also concluded that Congress may have provided the FTC with more specific rulemaking authorities based on “uncertainty, understandable caution, and a desire to avoid litigation,” rather than a firm conviction that the FTC lacked general rulemaking authority. Two years after the National Petroleum Refiners decision, Congress enacted the Magnuson-Moss Act, which imposed special procedural requirements for the FTC’s UDAP rules and eliminated the FTC’s authority to issue such rules under Section 6(g). Magnuson-Moss did not by its terms affect the FTC’s authority to issue UMC rules: the statute included a provision disclaiming an intent to affect “any authority of the Commission to prescribe rules (including interpretive rules), and general statements of policy, with respect to unfair methods of competition.” Despite this language in Magnuson-Moss, the FTC’s putative authority to issue UMC rules has been dormant since the enactment of that statute. The Non-Compete Rule marks the first rule promulgated under Section 6(g) since the 1970s and the second rule ever that relies solely upon the FTC’s competition authority. A 1983 decision from the U.S. Court of Appeals for the Seventh Circuit agreed with the D.C. Circuit’s reasoning in National Petroleum Refiners, but no other federal appellate court has addressed the FTC’s authority to issue legislative rules under Section 6(g). Whether the FTC possesses such authority remains unsettled; some commentators have argued that National Petroleum Refiners was wrongly decided and that it is unlikely that modern courts would reach the same conclusion. In issuing the Non-Compete Rule, the FTC defended its authority to issue substantive rules under Section 6(g) by pointing to the provision’s plain meaning and the D.C. Circuit’s decision in National Petroleum Refiners. The FTC also argued that Congress implicitly ratified the D.C. Circuit’s decision in both the Magnuson-Moss Act and the Federal Trade Commission Improvements Act of 1980 (the 1980 Amendments). The 1980 Amendments imposed procedural requirements that the FTC must follow in issuing any “rule.” It defined the term “rule” to include rules promulgated under Section 6 or Magnuson-Moss. The statute excluded from that definition “interpretive rules, rules involving Commission management or personnel, general statements of policy, or rules relating to Commission organization, procedure, or practice.” The FTC argued that this exclusion confirms its authority to issue rules under Section 6 that are not merely “interpretive rules, rules involving Commission management or personnel, general statements of policy, or rules relating to Commission organization, procedure, or practice.” The FTC’s authority to issue the Non-Compete Rule depends not only on whether Section 6(g) authorizes legislative rulemaking, but also on the scope of Section 5’s prohibition of UMC. The Supreme Court has repeatedly said that Section 5 is broader than the Sherman Act and the Clayton Act (the other core federal antitrust laws). However, the scope of this additional coverage—often called the FTC’s “standalone” Section 5 authority—is unsettled. Under previous leadership, the FTC took a narrow view of its standalone Section 5 authority. In a 2015 policy statement, the FTC indicated that decisions to bring standalone Section 5 actions would be guided by considerations of consumer welfare, that the FTC would evaluate challenged conduct under “a framework similar to the rule of reason,” and that the FTC was less likely to bring a standalone Section 5 action if enforcement of the Sherman Act or Clayton Act was sufficient to address the relevant competitive harm. The FTC rescinded this policy statement in 2021 and issued a new Section 5 policy statement the following year. In the 2022 policy statement, the FTC identified “two key criteria” it will consider in evaluating whether a “method of competition” is “unfair.” First, the FTC indicated that “unfair” conduct Congressional Research Service 4 “may be coercive, exploitative, collusive, abusive, deceptive, predatory, or involve the use of economic power of a similar nature,” and “may also be otherwise restrictive or exclusionary.” Second, the FTC explained that such conduct “must tend to negatively affect competitive conditions”—for example, by foreclosing or impairing the opportunities of market participants, reducing competition between rivals, limiting choice, or otherwise harming consumers. The 2022 policy statement indicated that this second inquiry will not turn on whether conduct directly causes harm in particular cases, but instead will focus on whether conduct “has a tendency to generate negative consequences.” In promulgating the Non-Compete Rule, the FTC found that non-competes violate Section 5 because they represent “restrictive and exclusionary conduct that tends to negatively affect competitive conditions” in labor markets and product and service markets. The FTC also determined that non-competes for workers other than senior executives violate Section 5 because they constitute “exploitative and coercive conduct that tends to negatively affect competitive conditions” in labor markets and product and service markets. (A previous Legal Sidebar provides a more extensive discussion of the FTC’s justification for the Non-Compete Rule.) Two FTC Commissioners voted against the Non-Compete Rule, arguing that the FTC lacks the authority to issue substantive competition regulations and that the evidence did not justify a categorical prohibition of non-competes.",Legal,Pros & Cons,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Attached is a portion of an article that discusses the clinical trial results of patients who tried ozempic. Can you provide me with four sections, each titled the same as the paragraphs in the text. For each section, tell me what sustain group is being discussed, and provide a bullet-point list including: how much weight was lost for each SEM group, and what the BMI change was for each SEM group. Be sure to include information about the control groups as well. If the information is redacted, do not include it in the response.","SEM Used as First-Line Therapy SUSTAIN-1 reported change in body weight from baseline to week 30 in drug-naive patients with T2DM and had inadequate glycemic control after therapy with diet and exercise. At week 30, the mean change in body weight was -3.73 kg (SE 0.41), -4.53 kg (SE 0.41), and -0.98 kg (SE 0.43) for patients who received SEM 0.5 mg, SEM 1 mg, and placebo, respectively. The mean differences were statistically significant for both SEM groups compared with placebo (SEM 0.5 mg: -2.75 kg, 95% CI -3.92 to -1.58, P < 0.0001; SEM 1 mg: -3.56 kg, 95% CI -4.74 to -2.38) (Table 30). Because the upper limit of the two-sided 95% CI for the estimated differences was below 0 kg, superiority of SEM 0.5 mg or SEM 1 mg versus placebo in change in body weight was demonstrated. According to the clinical expert consulted for this review, the between-group differences were considered clinically important. SUSTAIN-1 also reported change in BMI from baseline to week 30 in drug-naive patients. At week 30, the mean change in BMI was -1.36 kg/m2 (SE 0.15), -1.61 kg/m2 (SE 0.14) and -0.38 kg/m2 (SE 0.15) for patients who received SEM 0.5 mg, SEM 1 mg, and placebo, respectively. The mean differences were statistically significant for both SEM groups compared with placebo (SEM 0.5 mg: -0.98 kg/m2, 95% CI -1.40 to -0.56, P < 0.0001; SEM 1 mg: -1.23 kg/m2, 95% CI -1.65 to -0.82) (Table 30). SEM Used as Second-Line Therapy (Add-On to MET) Results of post hoc subgroup analyses on body weight in SUSTAIN-2, SUSTAIN-3, and SUSTAIN-4 are presented. Patients in SUSTAIN-7 received treatment with SEM or DUL with background therapy of MET monotherapy. In patients with T2DM and received SEM as the second-line therapy (add-on to MET), treatment with either dose of SEM for 30 to 56 weeks was associated with greater reduction in body weight, compared with SIT, EXE, or IG (Table 31). The mean change from baseline in body weight ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with DUL, the mean between-group differences were -2.26 kg (95% CI -3.02 to -1.51, P < 0.0001) for the SEM 0.5 mg group and -3.55 kg (95% CI -4.32 to -2.78, P < 0.0001) for the SEM 1 mg group. According to the clinical expert consulted for this review, the between-group differences in body weight were considered clinically relevant. In SUSTAIN-7, superiority in reducing body weight was concluded for each dose of SEM compared with the respective dose level of DUL. Results of post hoc subgroup analyses on BMI in SUSTAIN-2 to SUSTAIN-4 are presented. In the subgroups of patients with T2DM and received SEM as the second-line therapy (add-on to MET), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in BMI, compared with SIT, EXE, or IG (Table 31). Patients in SUSTAIN-7 received treatment with SEM or DUL with background therapy of MET monotherapy. The mean change from baseline in BMI ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with DUL, the mean between-group differences were -0.81 kg/m2 (95% CI -1.08 to -0.54) for the SEM 0.5 mg group and -1.25 kg/m2 (95% CI -1.52 to -0.98) for the SEM 1 mg group. SEM Used as Third-Line Therapy (Add-On to MET + TZD or MET + SU) Results of post hoc subgroup analyses on body weight in SUSTAIN-2 to SUSTAIN-4 are presented. In the patients receiving SEM as the third-line therapy (add-on to MET + TZD or MET + SU), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in body weight, compared with SIT, EXE, or IG (Table 32). The mean change from baseline in A1C ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. According to the clinical expert consulted for this review, the between-group differences in body weight were considered clinically relevant. Results of post hoc subgroup analyses on BMI from SUSTAIN-2 to SUSTAIN-4 are presented. In the subgroups of patients with T2DM and received SEM as the third-line therapy (add-on to MET + TZD or MET + SU), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in BMI, compared with SIT, EXE, or IG (Table 32). The mean change from baseline in BMI ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group.","[question] Attached is a portion of an article that discusses the clinical trial results of patients who tried ozempic. Can you provide me with four sections, each titled the same as the paragraphs in the text. For each section, tell me what sustain group is being discussed, and provide a bullet-point list including: how much weight was lost for each SEM group, and what the BMI change was for each SEM group. Be sure to include information about the control groups as well. If the information is redacted, do not include it in the response. ===================== [text] SEM Used as First-Line Therapy SUSTAIN-1 reported change in body weight from baseline to week 30 in drug-naive patients with T2DM and had inadequate glycemic control after therapy with diet and exercise. At week 30, the mean change in body weight was -3.73 kg (SE 0.41), -4.53 kg (SE 0.41), and -0.98 kg (SE 0.43) for patients who received SEM 0.5 mg, SEM 1 mg, and placebo, respectively. The mean differences were statistically significant for both SEM groups compared with placebo (SEM 0.5 mg: -2.75 kg, 95% CI -3.92 to -1.58, P < 0.0001; SEM 1 mg: -3.56 kg, 95% CI -4.74 to -2.38) (Table 30). Because the upper limit of the two-sided 95% CI for the estimated differences was below 0 kg, superiority of SEM 0.5 mg or SEM 1 mg versus placebo in change in body weight was demonstrated. According to the clinical expert consulted for this review, the between-group differences were considered clinically important. SUSTAIN-1 also reported change in BMI from baseline to week 30 in drug-naive patients. At week 30, the mean change in BMI was -1.36 kg/m2 (SE 0.15), -1.61 kg/m2 (SE 0.14) and -0.38 kg/m2 (SE 0.15) for patients who received SEM 0.5 mg, SEM 1 mg, and placebo, respectively. The mean differences were statistically significant for both SEM groups compared with placebo (SEM 0.5 mg: -0.98 kg/m2, 95% CI -1.40 to -0.56, P < 0.0001; SEM 1 mg: -1.23 kg/m2, 95% CI -1.65 to -0.82) (Table 30). SEM Used as Second-Line Therapy (Add-On to MET) Results of post hoc subgroup analyses on body weight in SUSTAIN-2, SUSTAIN-3, and SUSTAIN-4 are presented. Patients in SUSTAIN-7 received treatment with SEM or DUL with background therapy of MET monotherapy. In patients with T2DM and received SEM as the second-line therapy (add-on to MET), treatment with either dose of SEM for 30 to 56 weeks was associated with greater reduction in body weight, compared with SIT, EXE, or IG (Table 31). The mean change from baseline in body weight ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with DUL, the mean between-group differences were -2.26 kg (95% CI -3.02 to -1.51, P < 0.0001) for the SEM 0.5 mg group and -3.55 kg (95% CI -4.32 to -2.78, P < 0.0001) for the SEM 1 mg group. According to the clinical expert consulted for this review, the between-group differences in body weight were considered clinically relevant. In SUSTAIN-7, superiority in reducing body weight was concluded for each dose of SEM compared with the respective dose level of DUL. Results of post hoc subgroup analyses on BMI in SUSTAIN-2 to SUSTAIN-4 are presented. In the subgroups of patients with T2DM and received SEM as the second-line therapy (add-on to MET), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in BMI, compared with SIT, EXE, or IG (Table 31). Patients in SUSTAIN-7 received treatment with SEM or DUL with background therapy of MET monotherapy. The mean change from baseline in BMI ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with DUL, the mean between-group differences were -0.81 kg/m2 (95% CI -1.08 to -0.54) for the SEM 0.5 mg group and -1.25 kg/m2 (95% CI -1.52 to -0.98) for the SEM 1 mg group. SEM Used as Third-Line Therapy (Add-On to MET + TZD or MET + SU) Results of post hoc subgroup analyses on body weight in SUSTAIN-2 to SUSTAIN-4 are presented. In the patients receiving SEM as the third-line therapy (add-on to MET + TZD or MET + SU), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in body weight, compared with SIT, EXE, or IG (Table 32). The mean change from baseline in A1C ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. According to the clinical expert consulted for this review, the between-group differences in body weight were considered clinically relevant. Results of post hoc subgroup analyses on BMI from SUSTAIN-2 to SUSTAIN-4 are presented. In the subgroups of patients with T2DM and received SEM as the third-line therapy (add-on to MET + TZD or MET + SU), treatment with either dose of SEM for 30 weeks to 56 weeks was associated with greater reduction in BMI, compared with SIT, EXE, or IG (Table 32). The mean change from baseline in BMI ranged from ▬ for the SEM 0.5 mg group, and from ▬ for the SEM 1 mg group. Compared with SIT, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. Compared with EXE, the mean between-group difference was ▬ for the SEM 1 mg group. Compared with IG, the mean between-group differences were ▬ for the SEM 0.5 mg group and ▬ for the SEM 1 mg group. https://www.ncbi.nlm.nih.gov/books/NBK544016/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Fact Finding,Q&A You can only respond to the prompt using information in the context block and no other sources. Your role is to explain complicated tax information to consumers using clear and understandable language.,Explain the rationale behind the global minimum tax on multinational enterprises for Canadian businesses as outlined in the context document.,"International Tax Reform Canada is one of 138 members of the Organisation for Economic Co-operation and Development (OECD)/Group of 20 (G20) Inclusive Framework on Base Erosion and Profit Shifting (the Inclusive Framework) that have joined a two-pillar plan for international tax reform agreed to on October 8, 2021. The historic “Statement on a Two-Pillar Solution to Address the Tax Challenges Arising from the Digitalisation of the Economy” (the October 2021 Statement) agreed to on that day has since been endorsed by G20 Finance Ministers and Leaders. Pillar One is intended to reallocate a portion of taxing rights over the profits of the largest and most profitable multinational enterprises (MNEs) to market countries (i.e., where their users and customers are located). Pillar Two is intended to ensure that the profits of large MNEs are subject to an effective tax rate of at least 15 per cent, regardless of where they are earned. The following provides an update on recent developments and upcoming implementation steps in relation to the pillars. Pillar One – Reallocation of Taxing Rights Pillar One is an update to the framework that underlies current tax treaties, which allocates the income of MNEs between countries for tax purposes. The existing framework relies on principles of connection with a country based on physical presence that were designed for traditional bricks-and-mortar businesses; they do not produce appropriate results in today’s digitalized economy. Pillar One instead uses a broader test of connection and a formulary allocation of residual profits to ensure that the largest and most profitable MNEs pay a fair share of tax in the countries where their users and customers are located. The government is working with its international partners in an OECD-led process to develop the model rules and the multilateral convention needed to establish this new multilateral tax framework and bring it into effect. To help ensure that the final rules will be effective and administrable, the OECD has been releasing draft model rules for public comment as each element reaches maturity. The draft rules were consolidated in two major progress reports released in July and October of 2022. Countries are working toward completing multilateral negotiations so that the convention to implement Pillar One can be signed by mid-2023, with a view to it entering into force in 2024. To ensure that Canadians' interests are protected, the government released draft legislative proposals for a Digital Services Tax (DST) in December 2021. The government intends to release a revised draft of the legislative proposals for public comment before introducing a bill in Parliament. Consistent with the October 2021 Statement, the DST could be imposed as of January 1, 2024, but only if the multilateral convention implementing the Pillar One framework has not come into force. In that event, the DST would be payable as of 2024 in respect of revenues earned as of January 1, 2022. It remains the government’s hope and underlying assumption that the timely implementation of the new multilateral framework will make this unnecessary. Pillar Two – Global Minimum Tax Pillar Two is a multilateral framework for a global minimum tax regime that is designed to ensure that MNEs with annual revenues of €750 million or more are subject to a minimum effective tax rate of 15 per cent on their profits in every jurisdiction in which they operate. It is intended to reduce the incentive for MNEs to shift profits into low-tax jurisdictions and, at the same time, end the “race to the bottom” in international corporate taxation by setting a floor on tax competition. The primary charging rule for Pillar Two is known as the Income Inclusion Rule (IIR). In general terms, if the jurisdiction where the ultimate parent entity of an MNE is located has implemented the IIR, it has the primary right to impose a top-up tax on the ultimate parent entity with respect to income from the MNE’s operations in any jurisdiction where it is taxed at an effective tax rate below 15 per cent. Pillar Two also contains a “backstop” rule, known as the Undertaxed Profits Rule (UTPR). If a parent jurisdiction of an MNE has not implemented the IIR, other jurisdictions in which the MNE operates that have implemented the UTPR would impose the top-up tax on the group entities located in their jurisdiction, with the top-up tax being allocated among those jurisdictions on a formulary basis. This ensures that MNEs whose parent entities are located in non-implementing jurisdictions are nonetheless subject to top-up tax in respect of their low-taxed income. The details of the IIR and UTPR are set out in the model rules (the Global Anti-Base Erosion or GloBE Rules), and related commentary and administrative guidance, all agreed by the Inclusive Framework. The Pillar Two framework contemplates that a jurisdiction may enact a domestic minimum top-up tax that would apply a top-up tax on low-taxed income of its domestic entities. If such a tax is designed to achieve the intended outcomes under Pillar Two, it is treated as a “qualified” domestic minimum top-up tax and is creditable dollar-for-dollar against the top-up tax liability that would otherwise arise under Pillar Two. In effect, this allows a jurisdiction to collect the top-up tax applicable to any low-taxed income of its domestic entities, rather than allowing the top-up tax to accrue to the treasuries of other countries under the IIR or UTPR. A more detailed outline of the Pillar Two framework is set out in the Supplementary Information to Budget 2022 (https://www.budget.canada.ca/2022/report-rapport/tm-mf-en.html#a4), which launched a public consultation on the implementation of Pillar Two in Canada, which ended on July 7, 2022. ","You can only respond to the prompt using information in the context block and no other sources. Your role is to explain complicated tax information to consumers using clear and understandable language. Explain the rationale behind the global minimum tax on multinational enterprises for Canadian businesses as outlined in the context document. International Tax Reform Canada is one of 138 members of the Organisation for Economic Co-operation and Development (OECD)/Group of 20 (G20) Inclusive Framework on Base Erosion and Profit Shifting (the Inclusive Framework) that have joined a two-pillar plan for international tax reform agreed to on October 8, 2021. The historic “Statement on a Two-Pillar Solution to Address the Tax Challenges Arising from the Digitalisation of the Economy” (the October 2021 Statement) agreed to on that day has since been endorsed by G20 Finance Ministers and Leaders. Pillar One is intended to reallocate a portion of taxing rights over the profits of the largest and most profitable multinational enterprises (MNEs) to market countries (i.e., where their users and customers are located). Pillar Two is intended to ensure that the profits of large MNEs are subject to an effective tax rate of at least 15 per cent, regardless of where they are earned. The following provides an update on recent developments and upcoming implementation steps in relation to the pillars. Pillar One – Reallocation of Taxing Rights Pillar One is an update to the framework that underlies current tax treaties, which allocates the income of MNEs between countries for tax purposes. The existing framework relies on principles of connection with a country based on physical presence that were designed for traditional bricks-and-mortar businesses; they do not produce appropriate results in today’s digitalized economy. Pillar One instead uses a broader test of connection and a formulary allocation of residual profits to ensure that the largest and most profitable MNEs pay a fair share of tax in the countries where their users and customers are located. The government is working with its international partners in an OECD-led process to develop the model rules and the multilateral convention needed to establish this new multilateral tax framework and bring it into effect. To help ensure that the final rules will be effective and administrable, the OECD has been releasing draft model rules for public comment as each element reaches maturity. The draft rules were consolidated in two major progress reports released in July and October of 2022. Countries are working toward completing multilateral negotiations so that the convention to implement Pillar One can be signed by mid-2023, with a view to it entering into force in 2024. To ensure that Canadians' interests are protected, the government released draft legislative proposals for a Digital Services Tax (DST) in December 2021. The government intends to release a revised draft of the legislative proposals for public comment before introducing a bill in Parliament. Consistent with the October 2021 Statement, the DST could be imposed as of January 1, 2024, but only if the multilateral convention implementing the Pillar One framework has not come into force. In that event, the DST would be payable as of 2024 in respect of revenues earned as of January 1, 2022. It remains the government’s hope and underlying assumption that the timely implementation of the new multilateral framework will make this unnecessary. Pillar Two – Global Minimum Tax Pillar Two is a multilateral framework for a global minimum tax regime that is designed to ensure that MNEs with annual revenues of €750 million or more are subject to a minimum effective tax rate of 15 per cent on their profits in every jurisdiction in which they operate. It is intended to reduce the incentive for MNEs to shift profits into low-tax jurisdictions and, at the same time, end the “race to the bottom” in international corporate taxation by setting a floor on tax competition. The primary charging rule for Pillar Two is known as the Income Inclusion Rule (IIR). In general terms, if the jurisdiction where the ultimate parent entity of an MNE is located has implemented the IIR, it has the primary right to impose a top-up tax on the ultimate parent entity with respect to income from the MNE’s operations in any jurisdiction where it is taxed at an effective tax rate below 15 per cent. Pillar Two also contains a “backstop” rule, known as the Undertaxed Profits Rule (UTPR). If a parent jurisdiction of an MNE has not implemented the IIR, other jurisdictions in which the MNE operates that have implemented the UTPR would impose the top-up tax on the group entities located in their jurisdiction, with the top-up tax being allocated among those jurisdictions on a formulary basis. This ensures that MNEs whose parent entities are located in non-implementing jurisdictions are nonetheless subject to top-up tax in respect of their low-taxed income. The details of the IIR and UTPR are set out in the model rules (the Global Anti-Base Erosion or GloBE Rules), and related commentary and administrative guidance, all agreed by the Inclusive Framework. The Pillar Two framework contemplates that a jurisdiction may enact a domestic minimum top-up tax that would apply a top-up tax on low-taxed income of its domestic entities. If such a tax is designed to achieve the intended outcomes under Pillar Two, it is treated as a “qualified” domestic minimum top-up tax and is creditable dollar-for-dollar against the top-up tax liability that would otherwise arise under Pillar Two. In effect, this allows a jurisdiction to collect the top-up tax applicable to any low-taxed income of its domestic entities, rather than allowing the top-up tax to accrue to the treasuries of other countries under the IIR or UTPR. A more detailed outline of the Pillar Two framework is set out in the Supplementary Information to Budget 2022 (https://www.budget.canada.ca/2022/report-rapport/tm-mf-en.html#a4), which launched a public consultation on the implementation of Pillar Two in Canada, which ended on July 7, 2022. ",Financial,Explanation/Definition,Q&A "The information in this prompt is all you may use to answer any questions. You are not allowed to use any external resources or prior knowledge. When using acronyms, include the full form beside it for the first use.",Summarise all information relevant to law.,"Congress passed and the President signed into law the National Quantum Initiative Act (NQI Act; P.L. 115-368; codified at 15 U.S.C. §§8801 et seq.) in December 2018 to accelerate quantum research and development (R&D) for the economic and national security of the United States and ensure the continued U.S. leadership in quantum information science and its technology applications. Since the enactment of the NQI Act, researchers have made progress in quantum R&D. The authorization of funding for several federal R&D activities under the NQI Act is set to expire at the end of FY2023. In the NQI Act, Congress defined the term quantum information science as “the use of the laws of quantum physics for the storage, transmission, manipulation, computing, or measurement of information.” Quantum computing, one of technology applications of quantum information science, uses a quantum bit, or qubit, as its basic data unit, to harness quantum properties such as superposition and entanglement. By generating and manipulating qubits, a quantum computer is capable of performing certain calculations significantly faster than conventional, non-quantum computers, known as classical computers, leading to new ways to solve some complex problems that were previously unsolvable. Researchers have demonstrated the potential for quantum computing applications in areas such as cryptography, machine learning, and scientific and engineering research, particularly using modeling, optimization, and simulation. The NQI Act is the primary federal law that supports R&D activities in quantum computing. It has been amended by the National Defense Authorization Act (NDAA) for FY2022 (P.L. 117-81) and the CHIPS and Science Act (Division B of P.L. 117-167). The current act contains four titles, directing (1) the President to implement an NQI Program with a 10-year plan to accelerate quantum R&D, invest in and coordinate fundamental federal R&D activities, and partner with industry and universities to advance goals and priorities in the NQI Program; (2) the National Institute of Standards and Technology (NIST) to carry out specified R&D activities and convene a stakeholder consortium to identify the future measurement, standards, cybersecurity, and needs for a robust quantum industry; (3) the National Science Foundation (NSF) to carry out a basic research and education program and award grants to establish Multidisciplinary Centers for Quantum Research and Education; and (4) the Department of Energy (DOE) to administer a number of programs, including a basic research program, National Quantum Information Science Research Centers, a program to accelerate innovation in quantum network infrastructure, and the Quantum User Expansion for Science and Technology program. The authorization of funding for the following activities under the NQI Act is set to expire in September 2023: NSF’s five university-based Quantum Leap Challenge Institutes, DOE’s five national lab-led research centers, and NIST’s R&D activities, including the industry-led Quantum Economic Development Consortium. Since the enactment of the NQI Act in 2018, researchers have made notable advances in quantum computing in three areas: demonstrating that a quantum processor could execute a complex computational task much faster than a classical supercomputer in an experiment; demonstrating the mitigation of calculation errors caused by the loss of information held by qubits—a major outstanding challenge to quantum computing—in an experiment; and scaling up quantum computing processors, thus enhancing their power and potential reliability. Some experts argue that sustained federal R&D investment is necessary to accelerate progress toward practical quantum computing and to maintain the leading role of U.S. researchers and institutions globally. There is less consensus, however, on the specific role the federal government should play in quantum R&D and how resources and support should be specifically targeted and prioritized. Congress faces policymaking in three areas. First, Congress may decide whether and how to reauthorize or expand federal R&D activities and support under the NQI Act. Second, Congress may choose whether to set policy priorities to ensure U.S. leadership in quantum computing, including (1) accelerating the development of practical quantum computers with near-term, useful applications; (2) supporting the development of an accessible, sustainable, and secure supply chain and domestic manufacturing capabilities; and (3) facilitating the development of a quantum-literate workforce. Congress may also consider whether to set policy priorities to protect national security interests in quantum computing by addressing risks; in particular, the anticipated compromise of current cryptographic systems that protect sensitive data and communications among government agencies, financial institutions, health service providers, and others.","system instructions: [The information in this prompt is all you may use to answer any questions. You are not allowed to use any external resources or prior knowledge. When using acronyms, include the full form beside it for the first use.] question: [Summarise all information relevant to law.] context block: [Congress passed and the President signed into law the National Quantum Initiative Act (NQI Act; P.L. 115-368; codified at 15 U.S.C. §§8801 et seq.) in December 2018 to accelerate quantum research and development (R&D) for the economic and national security of the United States and ensure the continued U.S. leadership in quantum information science and its technology applications. Since the enactment of the NQI Act, researchers have made progress in quantum R&D. The authorization of funding for several federal R&D activities under the NQI Act is set to expire at the end of FY2023. In the NQI Act, Congress defined the term quantum information science as “the use of the laws of quantum physics for the storage, transmission, manipulation, computing, or measurement of information.” Quantum computing, one of technology applications of quantum information science, uses a quantum bit, or qubit, as its basic data unit, to harness quantum properties such as superposition and entanglement. By generating and manipulating qubits, a quantum computer is capable of performing certain calculations significantly faster than conventional, non-quantum computers, known as classical computers, leading to new ways to solve some complex problems that were previously unsolvable. Researchers have demonstrated the potential for quantum computing applications in areas such as cryptography, machine learning, and scientific and engineering research, particularly using modeling, optimization, and simulation. The NQI Act is the primary federal law that supports R&D activities in quantum computing. It has been amended by the National Defense Authorization Act (NDAA) for FY2022 (P.L. 117-81) and the CHIPS and Science Act (Division B of P.L. 117-167). The current act contains four titles, directing (1) the President to implement an NQI Program with a 10-year plan to accelerate quantum R&D, invest in and coordinate fundamental federal R&D activities, and partner with industry and universities to advance goals and priorities in the NQI Program; (2) the National Institute of Standards and Technology (NIST) to carry out specified R&D activities and convene a stakeholder consortium to identify the future measurement, standards, cybersecurity, and needs for a robust quantum industry; (3) the National Science Foundation (NSF) to carry out a basic research and education program and award grants to establish Multidisciplinary Centers for Quantum Research and Education; and (4) the Department of Energy (DOE) to administer a number of programs, including a basic research program, National Quantum Information Science Research Centers, a program to accelerate innovation in quantum network infrastructure, and the Quantum User Expansion for Science and Technology program. The authorization of funding for the following activities under the NQI Act is set to expire in September 2023: NSF’s five university-based Quantum Leap Challenge Institutes, DOE’s five national lab-led research centers, and NIST’s R&D activities, including the industry-led Quantum Economic Development Consortium. Since the enactment of the NQI Act in 2018, researchers have made notable advances in quantum computing in three areas: demonstrating that a quantum processor could execute a complex computational task much faster than a classical supercomputer in an experiment; demonstrating the mitigation of calculation errors caused by the loss of information held by qubits—a major outstanding challenge to quantum computing—in an experiment; and scaling up quantum computing processors, thus enhancing their power and potential reliability. Some experts argue that sustained federal R&D investment is necessary to accelerate progress toward practical quantum computing and to maintain the leading role of U.S. researchers and institutions globally. There is less consensus, however, on the specific role the federal government should play in quantum R&D and how resources and support should be specifically targeted and prioritized. Congress faces policymaking in three areas. First, Congress may decide whether and how to reauthorize or expand federal R&D activities and support under the NQI Act. Second, Congress may choose whether to set policy priorities to ensure U.S. leadership in quantum computing, including (1) accelerating the development of practical quantum computers with near-term, useful applications; (2) supporting the development of an accessible, sustainable, and secure supply chain and domestic manufacturing capabilities; and (3) facilitating the development of a quantum-literate workforce. Congress may also consider whether to set policy priorities to protect national security interests in quantum computing by addressing risks; in particular, the anticipated compromise of current cryptographic systems that protect sensitive data and communications among government agencies, financial institutions, health service providers, and others.]",Legal,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","My final research project is on fungal immunity. Read this section from a recent publication and explain the effects of the different interleukins mentioned in the section. Do not give an overview of the molecules, I only want to know their specific functions in fungal immunity. Limit to one sentence per interleukin.","Innate Immunity Innate Detection and Immune Evasion The lungs maintain many defense mechanisms to survey and eliminate airborne threats. Lung epithelial cells (LECs) secrete anti-microbial peptides, complement proteins, and defensins which enhance granulocyte activity and create a less hospitable environment for Coccidioides (Hernández-Santos et al., 2018). To survive, Coccidioides must successfully avoid detection from surveying and patrolling innate immune cells. Lung-resident macrophages, also known as alveolar macrophages, comprise up to 95% of pulmonary leukocytes and participate in early immune detection of pathogens and maintain the lung microenvironment (Wynn and Vannella, 2016). In Aspergillus infections, tissue-specific neutrophils are recruited by LECs and enter the lung early after infection due to β-glucan and chitin (Dubey et al., 2014). Innate leukocytes control early pathogen invasion via phagocytosis and production of reactive oxide and reactive nitrogen species (RNS) (Xu and Shinohara, 2017). β-glucan and chitin are conserved across many fungal species, including Coccidioides, so these molecules could interact with epithelial cells and aid in neutrophil recruitment. In cases where host immune responses cannot control infection, disease becomes chronic. Host responses sometimes control infections through granuloma formation in the lung as fungi is walled off instead of destroyed (Nguyen et al., 2013; Johnson et al., 2014; Wynn and Vannella, 2016). To survive lung defenses and evade innate immune responses, Coccidioides expresses virulence factors for immune evasion and survival. Inside the lung, arthroconidia express ornithine decarboxylase, an enzyme implicated during growth from arthroconidia to spherule state (Guevara-Olvera et al., 2000). During transition, the spherule internal cell wall segments bud off into endospores. Lifecycle transition allows vulnerable, easily phagocytosed, arthroconidia to develop into phagocytosis-resistant spherules (Hung et al., 2002; Gonzalez et al., 2011; Nguyen et al., 2013). Arthroconidia are vulnerable to RNS while mature spherules suppress nitric oxide species (NOS) and inducible NOS expression in macrophages (Figure 1) (Gonzalez et al., 2011). Mature spherules are too large for most host phagocytic activity, allowing Coccidiodes to evade early immune detection (Hung et al., 2002). Coccidioides induces host expression of arginase resulting in ornithine and urea production, important components for transition from arthroconidia to spherule (Hung et al., 2007). FGURE 1 www.frontiersin.org Figure 1 Fungal dimorphism presents challenges for immune detection and activation. Early infection: Coccidioides is vulnerable to immune detection during early infection due to the smaller size (2–5 μM) and SOWgp expression which is detected via Dectin-1 and TLR2 on innate immune cells. These interactions mediate clearance via phagocytosis and reactive oxide species production. Later infection: As Coccidioides sporulates, it secretes MEP1 which digests SOWgp from the fungal surface, hampering immune detection. Spherules induce arginase expression in host tissues, suppressing NOS/NO production via an unknown mechanism, contributing to immune suppression. In the spherule state, Coccidioides secretes metalloproteinase 1 (Mep1) which digests an immunodominant antigen spherical outer wall glycoprotein (SOWgp) on the fungal surface (Figure 1) (Hung et al., 2005). Phagocytotic granulocytes rely on pathogen associated molecular patterns such as SOWgp, thus Mep1 secretion prevents detection by innate immune cells (Hung et al., 2005). Coccidioides upregulates nitrate reductase during development, an enzyme that converts nitrate to nitrite, thereby enhancing Coccidioides survival in anoxic conditions, such as those found inside a granuloma (Johannesson et al., 2006). Early detection to inhaled fungus is critical for host response. Macrophages and neutrophils detect Coccidioides arthroconidia and immature spherules via receptors Dectin-1, Dectin-2, and Mincle interacting with SOWgp (Hung et al., 2002; Nguyen et al., 2013). Endothelial lung cells use these same receptors to regulate defensin secretion. Toll-like receptors (TLRs) and c-type lectin receptors (CLRs) interact with major pathogen-associated molecular patterns to detect Coccidioides (Romani, 2004; Viriyakosol et al., 2008; Viriyakosol et al., 2013). Like most fungi, Coccidioides expresses β-glucans, chitins, and mannans in the outer cell wall (Nguyen et al., 2013). These cell components are recognized by a variety of TLRs and CLRs and elicit strong inflammatory responses from local immune cells. Coccidioides interactions with TLR2 and Dectin-1 on macrophages activate production of reactive oxide species (ROS) and inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNFα) (Viriyakosol et al., 2008; Viriyakosol et al., 2013). There are no known nucleotide-binding oligomerization domain-like (NOD-like) receptors yet associated with Coccidioides detection. In humans, polymorphisms in IFNγ/IL-12 signaling pathway result in a STAT1 gain of function mutations that associate with increased disease severity in Coccidioides, Histoplasma, and Candida infection (Sampaio et al., 2013). In disseminated Coccidioides, patients with severe disease were found to have a STAT3 mutation (Odio et al., 2015). STAT 3 mediates IL-23 signaling, critical for IFNγ, IL-12, and IL-17 production while STAT1 signaling induces Th1 cell differentiation in response to IL-12 to produce IFNγ; IFNγ, in turn, inhibits Th17 differentiation (Yeh et al., 2014). IL-12β1 receptor deficiency is associated with increased risk of disseminated coccidioidomycosis (Yeh et al., 2014). In chronic mucocutaneous candidiasis, gain of function mutations in STAT1 and STAT3 correlates to more severe disease and poor TH17 responses (Zheng et al., 2015). These observations suggest that STAT1 and STAT3 immune signaling is critical in host control of Th1/Th17 cytokine balance and is required for protection and Coccidioides fungal control. In Blastomyces dermatitidis infection, LECs regulate collaborative killing between alveolar macrophages, dendritic cells (DC), and neutrophils (Hussell and Bell, 2014; Hernández-Santos et al., 2018). Upon LECs ablation, B. dermatitidis phagocytosis is reduced, and viable yeast numbers increase. Other data suggests that IL-1/IL-1R interactions regulate CCL20 expression in LECs. Chemokine CCL20 strongly recruits lymphocytes and weakly recruits neutrophils (Hernández-Santos et al., 2018). IL-1R-deficient mice express less CCL20 and lung Th17 cells are reduced, suggesting that IL-1/IL-1R signaling in LECs could regulate adaptive immune functions (Hernández-Santos et al., 2018). IL-1R is critical for vaccine induced resistance to Coccidioides infection via MyD88 induction of Th17 responses (Hung et al., 2014a; Hung et al., 2016a). Though it has not been explored, LECs could mediate early responses to Coccidioides through IL-1R, suggesting another innate immune cell role in anti-fungal responses within the lung tissues. Alveoli structure likely helps shape local immune responses. Three dominant cell types exist within and around the alveoli structure: Type 1 and Type 2 pneumocytes (also known as alveolar epithelial cells, AECs), and tissue-resident alveolar macrophages (Guillot et al., 2013; Hussell and Bell, 2014). Type 1 pneumocytes (AECI) secrete IL-10 constitutively, which bind to IL-10R on alveolar macrophages to maintain an anti-inflammatory state. Type 2 pneumocytes (or AECII) express CD200 which interacts with CD200R on alveolar macrophage to inhibit pro-inflammatory phenotype (Guillot et al., 2013; Hernández-Santos et al., 2018). Alveolar macrophages express TGFβ-receptors that bind to pneumocyte-expressed αvβ6 integrin, tethering them in the alveolar airspace. In inflammatory conditions, AECIs upregulate TLRs and AECIIs increase SP-A and SP-D production (Guillot et al., 2013). These surfactant proteins are known to enhance pathogen opsonization and phagocytosis, and are capable of binding to Coccidioides antigen (Awasthi et al., 2004). Coccidioides infected mice expressed less SP-A and SP-D protein in their bronchial lavage fluid compared to uninfected and vaccinated controls, demonstrating the pathogen’s capability of altering the lung mucosa (Awasthi et al., 2004). AECII secreted production of surfactant proteins may be influenced by Coccidioides allowing fungal escape of phagocytosis and prolonged survival.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== My final research project is on fungal immunity. Read this section from a recent publication and explain the effects of the different interleukins mentioned in the section. Do not give an overview of the molecules, I only want to know their specific functions in fungal immunity. Limit to one sentence per interleukin. {passage 0} ========== Innate Immunity Innate Detection and Immune Evasion The lungs maintain many defense mechanisms to survey and eliminate airborne threats. Lung epithelial cells (LECs) secrete anti-microbial peptides, complement proteins, and defensins which enhance granulocyte activity and create a less hospitable environment for Coccidioides (Hernández-Santos et al., 2018). To survive, Coccidioides must successfully avoid detection from surveying and patrolling innate immune cells. Lung-resident macrophages, also known as alveolar macrophages, comprise up to 95% of pulmonary leukocytes and participate in early immune detection of pathogens and maintain the lung microenvironment (Wynn and Vannella, 2016). In Aspergillus infections, tissue-specific neutrophils are recruited by LECs and enter the lung early after infection due to β-glucan and chitin (Dubey et al., 2014). Innate leukocytes control early pathogen invasion via phagocytosis and production of reactive oxide and reactive nitrogen species (RNS) (Xu and Shinohara, 2017). β-glucan and chitin are conserved across many fungal species, including Coccidioides, so these molecules could interact with epithelial cells and aid in neutrophil recruitment. In cases where host immune responses cannot control infection, disease becomes chronic. Host responses sometimes control infections through granuloma formation in the lung as fungi is walled off instead of destroyed (Nguyen et al., 2013; Johnson et al., 2014; Wynn and Vannella, 2016). To survive lung defenses and evade innate immune responses, Coccidioides expresses virulence factors for immune evasion and survival. Inside the lung, arthroconidia express ornithine decarboxylase, an enzyme implicated during growth from arthroconidia to spherule state (Guevara-Olvera et al., 2000). During transition, the spherule internal cell wall segments bud off into endospores. Lifecycle transition allows vulnerable, easily phagocytosed, arthroconidia to develop into phagocytosis-resistant spherules (Hung et al., 2002; Gonzalez et al., 2011; Nguyen et al., 2013). Arthroconidia are vulnerable to RNS while mature spherules suppress nitric oxide species (NOS) and inducible NOS expression in macrophages (Figure 1) (Gonzalez et al., 2011). Mature spherules are too large for most host phagocytic activity, allowing Coccidiodes to evade early immune detection (Hung et al., 2002). Coccidioides induces host expression of arginase resulting in ornithine and urea production, important components for transition from arthroconidia to spherule (Hung et al., 2007). FGURE 1 www.frontiersin.org Figure 1 Fungal dimorphism presents challenges for immune detection and activation. Early infection: Coccidioides is vulnerable to immune detection during early infection due to the smaller size (2–5 μM) and SOWgp expression which is detected via Dectin-1 and TLR2 on innate immune cells. These interactions mediate clearance via phagocytosis and reactive oxide species production. Later infection: As Coccidioides sporulates, it secretes MEP1 which digests SOWgp from the fungal surface, hampering immune detection. Spherules induce arginase expression in host tissues, suppressing NOS/NO production via an unknown mechanism, contributing to immune suppression. In the spherule state, Coccidioides secretes metalloproteinase 1 (Mep1) which digests an immunodominant antigen spherical outer wall glycoprotein (SOWgp) on the fungal surface (Figure 1) (Hung et al., 2005). Phagocytotic granulocytes rely on pathogen associated molecular patterns such as SOWgp, thus Mep1 secretion prevents detection by innate immune cells (Hung et al., 2005). Coccidioides upregulates nitrate reductase during development, an enzyme that converts nitrate to nitrite, thereby enhancing Coccidioides survival in anoxic conditions, such as those found inside a granuloma (Johannesson et al., 2006). Early detection to inhaled fungus is critical for host response. Macrophages and neutrophils detect Coccidioides arthroconidia and immature spherules via receptors Dectin-1, Dectin-2, and Mincle interacting with SOWgp (Hung et al., 2002; Nguyen et al., 2013). Endothelial lung cells use these same receptors to regulate defensin secretion. Toll-like receptors (TLRs) and c-type lectin receptors (CLRs) interact with major pathogen-associated molecular patterns to detect Coccidioides (Romani, 2004; Viriyakosol et al., 2008; Viriyakosol et al., 2013). Like most fungi, Coccidioides expresses β-glucans, chitins, and mannans in the outer cell wall (Nguyen et al., 2013). These cell components are recognized by a variety of TLRs and CLRs and elicit strong inflammatory responses from local immune cells. Coccidioides interactions with TLR2 and Dectin-1 on macrophages activate production of reactive oxide species (ROS) and inflammatory cytokines, such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNFα) (Viriyakosol et al., 2008; Viriyakosol et al., 2013). There are no known nucleotide-binding oligomerization domain-like (NOD-like) receptors yet associated with Coccidioides detection. In humans, polymorphisms in IFNγ/IL-12 signaling pathway result in a STAT1 gain of function mutations that associate with increased disease severity in Coccidioides, Histoplasma, and Candida infection (Sampaio et al., 2013). In disseminated Coccidioides, patients with severe disease were found to have a STAT3 mutation (Odio et al., 2015). STAT 3 mediates IL-23 signaling, critical for IFNγ, IL-12, and IL-17 production while STAT1 signaling induces Th1 cell differentiation in response to IL-12 to produce IFNγ; IFNγ, in turn, inhibits Th17 differentiation (Yeh et al., 2014). IL-12β1 receptor deficiency is associated with increased risk of disseminated coccidioidomycosis (Yeh et al., 2014). In chronic mucocutaneous candidiasis, gain of function mutations in STAT1 and STAT3 correlates to more severe disease and poor TH17 responses (Zheng et al., 2015). These observations suggest that STAT1 and STAT3 immune signaling is critical in host control of Th1/Th17 cytokine balance and is required for protection and Coccidioides fungal control. In Blastomyces dermatitidis infection, LECs regulate collaborative killing between alveolar macrophages, dendritic cells (DC), and neutrophils (Hussell and Bell, 2014; Hernández-Santos et al., 2018). Upon LECs ablation, B. dermatitidis phagocytosis is reduced, and viable yeast numbers increase. Other data suggests that IL-1/IL-1R interactions regulate CCL20 expression in LECs. Chemokine CCL20 strongly recruits lymphocytes and weakly recruits neutrophils (Hernández-Santos et al., 2018). IL-1R-deficient mice express less CCL20 and lung Th17 cells are reduced, suggesting that IL-1/IL-1R signaling in LECs could regulate adaptive immune functions (Hernández-Santos et al., 2018). IL-1R is critical for vaccine induced resistance to Coccidioides infection via MyD88 induction of Th17 responses (Hung et al., 2014a; Hung et al., 2016a). Though it has not been explored, LECs could mediate early responses to Coccidioides through IL-1R, suggesting another innate immune cell role in anti-fungal responses within the lung tissues. Alveoli structure likely helps shape local immune responses. Three dominant cell types exist within and around the alveoli structure: Type 1 and Type 2 pneumocytes (also known as alveolar epithelial cells, AECs), and tissue-resident alveolar macrophages (Guillot et al., 2013; Hussell and Bell, 2014). Type 1 pneumocytes (AECI) secrete IL-10 constitutively, which bind to IL-10R on alveolar macrophages to maintain an anti-inflammatory state. Type 2 pneumocytes (or AECII) express CD200 which interacts with CD200R on alveolar macrophage to inhibit pro-inflammatory phenotype (Guillot et al., 2013; Hernández-Santos et al., 2018). Alveolar macrophages express TGFβ-receptors that bind to pneumocyte-expressed αvβ6 integrin, tethering them in the alveolar airspace. In inflammatory conditions, AECIs upregulate TLRs and AECIIs increase SP-A and SP-D production (Guillot et al., 2013). These surfactant proteins are known to enhance pathogen opsonization and phagocytosis, and are capable of binding to Coccidioides antigen (Awasthi et al., 2004). Coccidioides infected mice expressed less SP-A and SP-D protein in their bronchial lavage fluid compared to uninfected and vaccinated controls, demonstrating the pathogen’s capability of altering the lung mucosa (Awasthi et al., 2004). AECII secreted production of surfactant proteins may be influenced by Coccidioides allowing fungal escape of phagocytosis and prolonged survival. https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2020.581101/full",Medical,Find & Summarize,Text Transformation "Write your answer using simple language and do not exceed 120 words. Replace all mention of the word technology with ""tech."" Please answer using only the information provided below. Do not use any external sources or prior knowledge to support your response. ","In well-functioning Standards Developing Organizations, how are ideas selected?","What Standards Are and Why They Matter From computers and smartphones to cars and lightbulbs, societies rely on technology standards for everyday life. In the broadest sense, standards are the common and repeated use of rules, conditions, guidelines, or characteristics for products or related processes, practices, and production methods. They enable technology that is safe, universal, and interoperable. Standards define the requirements that make it possible for mobile phones sold in different countries to communicate across the world, for bank cards issued in one country to be recognized at ATMs in another, and for cars to run on fuel purchased from any gas station. Standards also help manage risk, security, safety, privacy, and quality in the development of new innovations. In short, good standards are good for business, good for consumers, and good for society. Standards Developing Organizations (SDOs) consist of experts from industry, academia, civil society groups, and government, all of whom share a common goal of ensuring safety, interoperability, and competition in a particular technology or technology application. In well functioning SDOs, ideas are selected not on the basis of the nationality, employer, or personality originating them, but instead on the basis of technical merit. Six principles govern the international standards development process: transparency, openness, impartiality and consensus, effectiveness and relevance, coherence, and a commitment to participation by low- and middle-income countries. The private sector has led U.S. engagement with SDOs for more than 100 years. An example of how this system works comes from the communications industry. Qualcomm Technologies provided the proposal in the 1990s that became the basis for all 3G standards, while NTT Docomo, a large mobile phone operator in Japan, provided the proposal that later became LTE, the predominant standard for wireless broadband communication for mobile devices and data terminals. This private sector leadership has come with significant assistance from government and academia. In 1901, the Congress established the National Bureau of Standards—which has since become the National Institute of Standards and Technology (NIST)—as the authoritative domestic measurement science research and standards laboratory. Not long after, five engineering societies and three Federal agencies banded together to establish a national non governmental body now known as the American National Standards Institute (ANSI). ANSI is a private, nonprofit organization that administers and coordinates the U.S. standardization system and is the sole U.S. representative to the International Organization for Standardization (ISO) and the International Electrotechnical Commission. Industry, consortia, and private-sector groups often complement the roles of NIST, ANSI, and ANSI-accredited SDOs, working together to develop standards to solve specific challenges. To date, this approach, supported by U.S. leadership, has fostered an effective and innovative system that has supercharged U.S. and global economic growth. In an era of rapid technological transformation and global scale, standards will continue to define and drive the markets of the future. Standards for CET—advanced technologies that are significant for U.S. competitiveness and national security - carry strategic significance. The United States will work with all nations committed to an open and transparent standards system to lead the way in these new arenas - just as we did with previous internet, wireless communications, and other digital standards. Failing to do so will risk the United States’—and the world’s—innovation, security, and prosperity. Standards for Critical and Emerging Technology The United States will prioritize efforts for standards development for a subset of CET that are essential for U.S. competitiveness and national security, including the following areas: • Communication and Networking Technologies, which are enabling dramatic changes in how consumers, businesses, and governments interact, and which will form the basis of tomorrow’s critical communications networks; • Semiconductors and Microelectronics, including Computing, Memory, and Storage Technologies, which affect every corner of the global economy, society, and government, and which power a panoply of innovations and capabilities; • Artificial Intelligence and Machine Learning, which promise transformative technologies and scientific breakthroughs across industries, but which must be developed in a trustworthy and risk-managed manner; • Biotechnologies, which will affect the health, agricultural, and industrial sectors of all nations, and which will need to be used safely and securely to support the health of our citizens, animals, and environment; • Positioning, Navigation, and Timing Services, which are a largely invisible utility for technology and infrastructure, including the electrical power grid, communications infrastructure and mobile devices, all modes of transportation, precision agriculture, weather forecasting, and emergency response; • Digital Identity Infrastructure and Distributed Ledger Technologies, which increasingly affect a range of key economic sectors; • Clean Energy Generation and Storage, which are critical to the generation, storage, distribution, and climate-friendly and efficient utilization of energy, and to the security of the technologies that support energy-producing plants; and • Quantum Information Technologies, which leverage quantum mechanics for the storage, transmission, manipulation, computing, or measurement of information, with major national security and economic implications. There are also specific applications of CET that departments and agencies have determined will impact our global economy and national security. The United States will focus standards development activities and outreach on these applications, which include: • Automated and Connected Infrastructure, such as smart communities, Internet of Things, and other novel applications; • Biobanking, which involves the collection, storage, and use of biological samples; • Automated, Connected, and Electrified Transportation, including automated and connected surface vehicles of many types and unmanned aircraft systems, many of which may be electric vehicles (EVs), along with the safe and efficient integration into smart communities and the transportation system as a whole, including standards to integrate EVs with the electrical grid and charging infrastructure; • Critical Minerals Supply Chains, where we will promote standards that support increased sustainable extraction of critical minerals necessary to manufacture renewable energy technologies, semiconductors, and EVs; • Cybersecurity and Privacy, which are cross-cutting issues that are critical to enabling the development and deployment of emerging technologies and promote the free flow of data and ideas with trust; and • Carbon Capture, Removal, Utilization and Storage, which can build on evolving standards for CO2 storage, and emerging standards for point source carbon capture, removal, and utilization, especially as those standards relate to monitoring and verification. ","In well-functioning Standards Developing Organizations, how are ideas selected? Write your answer using simple language and do not exceed 120 words. Replace all mention of the word technology with ""tech."" Please answer using only the information provided below. Do not use any external sources or prior knowledge to support your response. What Standards Are and Why They Matter From computers and smartphones to cars and lightbulbs, societies rely on technology standards for everyday life. In the broadest sense, standards are the common and repeated use of rules, conditions, guidelines, or characteristics for products or related processes, practices, and production methods. They enable technology that is safe, universal, and interoperable. Standards define the requirements that make it possible for mobile phones sold in different countries to communicate across the world, for bank cards issued in one country to be recognized at ATMs in another, and for cars to run on fuel purchased from any gas station. Standards also help manage risk, security, safety, privacy, and quality in the development of new innovations. In short, good standards are good for business, good for consumers, and good for society. Standards Developing Organizations (SDOs) consist of experts from industry, academia, civil society groups, and government, all of whom share a common goal of ensuring safety, interoperability, and competition in a particular technology or technology application. In well functioning SDOs, ideas are selected not on the basis of the nationality, employer, or personality originating them, but instead on the basis of technical merit. Six principles govern the international standards development process: transparency, openness, impartiality and consensus, effectiveness and relevance, coherence, and a commitment to participation by low- and middle-income countries. The private sector has led U.S. engagement with SDOs for more than 100 years. An example of how this system works comes from the communications industry. Qualcomm Technologies provided the proposal in the 1990s that became the basis for all 3G standards, while NTT Docomo, a large mobile phone operator in Japan, provided the proposal that later became LTE, the predominant standard for wireless broadband communication for mobile devices and data terminals. This private sector leadership has come with significant assistance from government and academia. In 1901, the Congress established the National Bureau of Standards—which has since become the National Institute of Standards and Technology (NIST)—as the authoritative domestic measurement science research and standards laboratory. Not long after, five engineering societies and three Federal agencies banded together to establish a national non governmental body now known as the American National Standards Institute (ANSI). ANSI is a private, nonprofit organization that administers and coordinates the U.S. standardization system and is the sole U.S. representative to the International Organization for Standardization (ISO) and the International Electrotechnical Commission. Industry, consortia, and private-sector groups often complement the roles of NIST, ANSI, and ANSI-accredited SDOs, working together to develop standards to solve specific challenges. To date, this approach, supported by U.S. leadership, has fostered an effective and innovative system that has supercharged U.S. and global economic growth. In an era of rapid technological transformation and global scale, standards will continue to define and drive the markets of the future. Standards for CET—advanced technologies that are significant for U.S. competitiveness and national security - carry strategic significance. The United States will work with all nations committed to an open and transparent standards system to lead the way in these new arenas - just as we did with previous internet, wireless communications, and other digital standards. Failing to do so will risk the United States’—and the world’s—innovation, security, and prosperity. Standards for Critical and Emerging Technology The United States will prioritize efforts for standards development for a subset of CET that are essential for U.S. competitiveness and national security, including the following areas: • Communication and Networking Technologies, which are enabling dramatic changes in how consumers, businesses, and governments interact, and which will form the basis of tomorrow’s critical communications networks; • Semiconductors and Microelectronics, including Computing, Memory, and Storage Technologies, which affect every corner of the global economy, society, and government, and which power a panoply of innovations and capabilities; • Artificial Intelligence and Machine Learning, which promise transformative technologies and scientific breakthroughs across industries, but which must be developed in a trustworthy and risk-managed manner; • Biotechnologies, which will affect the health, agricultural, and industrial sectors of all nations, and which will need to be used safely and securely to support the health of our citizens, animals, and environment; • Positioning, Navigation, and Timing Services, which are a largely invisible utility for technology and infrastructure, including the electrical power grid, communications infrastructure and mobile devices, all modes of transportation, precision agriculture, weather forecasting, and emergency response; • Digital Identity Infrastructure and Distributed Ledger Technologies, which increasingly affect a range of key economic sectors; • Clean Energy Generation and Storage, which are critical to the generation, storage, distribution, and climate-friendly and efficient utilization of energy, and to the security of the technologies that support energy-producing plants; and • Quantum Information Technologies, which leverage quantum mechanics for the storage, transmission, manipulation, computing, or measurement of information, with major national security and economic implications. There are also specific applications of CET that departments and agencies have determined will impact our global economy and national security. The United States will focus standards development activities and outreach on these applications, which include: • Automated and Connected Infrastructure, such as smart communities, Internet of Things, and other novel applications; • Biobanking, which involves the collection, storage, and use of biological samples; • Automated, Connected, and Electrified Transportation, including automated and connected surface vehicles of many types and unmanned aircraft systems, many of which may be electric vehicles (EVs), along with the safe and efficient integration into smart communities and the transportation system as a whole, including standards to integrate EVs with the electrical grid and charging infrastructure; • Critical Minerals Supply Chains, where we will promote standards that support increased sustainable extraction of critical minerals necessary to manufacture renewable energy technologies, semiconductors, and EVs; • Cybersecurity and Privacy, which are cross-cutting issues that are critical to enabling the development and deployment of emerging technologies and promote the free flow of data and ideas with trust; and • Carbon Capture, Removal, Utilization and Storage, which can build on evolving standards for CO2 storage, and emerging standards for point source carbon capture, removal, and utilization, especially as those standards relate to monitoring and verification. ",Internet/Technology,Fact Finding,Q&A List five similarities and three differences. Use only the Context block contained in the prompt to respond.,What are the differences between law clerk duties for a district judge and a bankruptcy judge?,"G. U.S. Trustees and Private Trustees The U.S. Trustee Program is part of the federal government’s Department of Justice, not a part of the courts. It was established to handle the administrative functions of bankruptcy cases and to ensure the integrity of the bankruptcy system across the nation. The program operates with twenty-one regional offices and ninety-four field offices, which are headed by U.S. trustees and assistant U.S. trustees, respectively. See 28  U.S.C. §§  581–589b. In the six judicial districts in Alabama and North Carolina, the Bankruptcy Administrator Program, rather than the U.S. Trustee Program, handles the administrative functions. See § 302(d) (3)(1) of the Bankruptcy Judges, United States Trustees, and Family Farmer Act of 1986, P.L. 99-554, 100 Stat. 3119, 3123, and § 317(b) of the Federal Courts Study Committee Implementation Act of 1990. The functions of the U.S. trustees are enumerated in 28 U.S.C. § 581(a), and primarily include (1) appointing and supervising the private trustees who collect and disburse funds to creditors in Chapter 7, 12, and 13 cases; (2) ensuring compliance with the Bankruptcy Code with respect to information provided in schedules, disclosure statements, reorganization plans, and other filings; (3) reviewing fee applications of professionals, such as attorneys and accountants, who serve in Chapter 11 reorganization cases; and (4) monitoring bankruptcy cases for fraud and referring criminal matters to the U.S. attorney for prosecution. Trustees do not have independent enforcement powers; rather, they must request the court to rule on matters of administration for which there is no voluntary compliance. The U.S. trustee is responsible for establishing a panel of private trustees to serve in Chapter 7 cases. When a bankruptcy petition is filed under Chapter 7, the U.S. trustee appoints a disinterested person from this panel to serve as interim trustee. At the first meeting of creditors, the creditors may elect another person as trustee, although such elections are rare. The U.S. trustee is also responsible 44 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.A for appointing one or more “standing” trustees to administer all Chapter 12 and 13 cases filed in a geographic region. In Chapter 11 cases, no trustee is appointed unless the court orders the appointment after notice and a hearing. If the court orders an appointment, the U.S. trustee designates the person who will serve, unless a party-in-interest timely requests that the trustee be elected by the creditors. In Chapter 7, 12, and 13 cases, the U.S. trustee may act as trustee if a private trustee is unavailable, although this is rarely done. The code does not provide for the appointment of a trustee in Chapter 9 cases. 28  U.S.C. §  586, 11 U.S.C. §§ 701–704, 1202, 1104–1106, 1302.    § 3.4 Appeals A. Processing Appeals The steps in an appeal are as follows: 1. Filing a notice of appeal 2. Preparing the record on appeal 3. Docketing the appeal 4. Filing the appellant’s brief 5. Filing the appellee’s brief 6. Filing the appellant’s reply brief 7. Deciding if the court dispenses with oral argument, or scheduling of oral argument 8. Hearing oral argument 9. Deliberating by the court 10. Filing the opinion 11. Filing a petition for rehearing 12. Issuing the mandate (the final stage in the appellate process unless the party applies to the Supreme Court for a writ of certiorari) The Federal Rules of Appellate Procedure establish certain procedural uniformity among the thirteen courts of appeals. However, there are still some differences in the procedures in the various circuits. Each court has local rules and internal operating procedures that describe the precise procedure to be followed 45 Law Clerk Handbook Federal Judicial Center § 3.4.B when there is any variation from the rules and, in some instances, that elaborate on or amplify the rules. See section 4.2. B. Notice of Appeal The timely filing of a notice of appeal is a jurisdictional requirement for any appeal. Appeals may be filed to challenge decisions of the district court, an administrative agency, or a bankruptcy appellate panel. Appeals of agency decisions may be classified as original proceedings in the court of appeals. The notice of appeal is filed in the district court. The purpose of the notice is to inform opposing counsel and the court that an appeal is being taken. The clerk of that court is required by Federal Rule of Appellate Procedure 3(d) to forward a copy of the notice to the clerk of the court of appeals. The time for filing commences when the judgment or order is entered in the district court from which the appeal is taken. The running of that time is tolled by the filing of certain posttrial motions in the district court, and the filing of such motions after a notice of appeal has been filed may vitiate the notice, requiring a new notice of appeal to be filed after the motion is decided. Fed. R. App. P. 4(a). Rule 4 provides the following time periods for filing notices of appeal: • private civil cases: 30 days • civil cases in which the United States is a party: 60 days • criminal cases: 10 days • criminal cases in which appeal by the government is authorized by statute (such as appeals from sentences under the 1984 Sentencing Reform Act): 30 days Upon receipt of the notice of appeal, courts of appeals take steps to ensure that all procedural requirements have been met. The clerk’s office may send counsel a case-opening letter to establish schedules for record preparation and briefing. Circuit mediators may conduct initial mediation/settlement conferences to discuss the issues in the case, with a view to eliminating the briefing of frivolous issues and to discuss the possibility of settlement. See Mediation & Conference Programs in the Federal Courts of Appeals: A Sourcebook for Judges and Lawyers (Federal Judicial Center, 2d ed. 2006). 46 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.D C. Record Preparation For an appellate court to review the proceedings in a trial court, appellate judges must have a record available of what occurred in the trial court. Local court rules prescribe the requirements for counsel to provide the district court with the record or excerpts of the record (sometimes referred to as a short record), which may include original papers and exhibits filed in the trial court plus a reporter’s transcript of any relevant proceedings. The Sentencing Reform Act requires that the record in a criminal case must also include “(1) that portion of the record . . . that is designated as pertinent by either of the parties; (2) the presentence report; and (3) the information submitted during the sentencing proceeding.” 18 U.S.C. § 3742(d). This information will often be under seal, because it is confidential. The Federal Rules prescribe time limits (deadlines) for providing the record on appeal to the court of appeals. During this time, the appellant must order a transcript of proceedings if one is needed and make arrangements to pay the court reporter for services or, in courts using electronic sound recording for the official record, the clerk of court. The district court clerk assembles the other papers or electronic files that constitute the record on appeal. The district court has the power to extend for an additional fifty days the time for preparing and sending the record on appeal, after which the court of appeals itself may grant extensions. Additional time may be needed if the court reporter has not finished transcribing the proceedings or if counsel has failed to order the transcript in a timely manner. To prevent undue delay, the appellate courts have the discretion to refuse to grant time extensions and may impose sanctions on the appellant or the reporter for unreasonable delays in preparing the record on appeal. D. Docketing the Appeal When the record is completed, or earlier if desired, the appellant must docket the appeal. This is primarily a clerical process and is performed in the office of the clerk of the court of appeals. Unless the appellant is exempt from payment, a docket fee is charged. The clerk of court opens an appropriate file and record and sends a notice to the parties. Frequently, docketing takes place when the record on appeal is filed. The filing of the record provides the base date for most subsequent proceedings in the case. 47 Law Clerk Handbook Federal Judicial Center § 3.4.E E. Briefs and Joint Appendices Because the appellant has the burden of establishing that the trial court erred, it files the opening brief. The appellee then files a brief in response; if the appellant wishes, the appellant may file a reply brief responding to new matters raised in the appellee’s brief. The Federal Rules of Appellate Procedure establish standards for format, color of brief covers, content, methods of reproduction, number of copies, and times for filing of briefs. The local rules for a circuit may impose further requirements. The schedule for filing briefs is as follows: • appellant’s brief: 40 days after filing the record • appellee’s brief: 30 days after service of appellant’s brief • reply brief: 14 days after service of appellee’s brief Some courts of appeals have modified the requirements and standards of the federal rules in certain cases or classes of cases. One of the more common modifications permits parties appealing in forma pauperis to file fewer copies of their briefs. While the briefs are being prepared, the parties are required to determine which portions of the record on appeal are relevant to the issues raised; the appellant is required to reproduce these portions as an appendix to the briefs. There may be only one appendix containing the portions relied on by both the appellant and the appellee, which would be referred to as a joint appendix. If any relevant material is omitted from the appendix, the court is free to refer to the original record. Multiple copies of the appendix may be filed so that each judge and, if needed, each law clerk may have one. Some courts of appeals have eliminated the requirement of an appendix and permit the substitution of photocopies of relatively few parts of the record, usually called record excerpts. The local rules of those courts describe the substitute requirements. Local rules also address procedures for electronic filing. You should become familiar with the rules and procedures in your court. F. Oral Argument If the court does not decide a case exclusively on the basis of the briefs and written record (see section 4.6.B on screening cases to select those appeals to be decided without oral argument), the parties are given an opportunity to present their arguments to the court orally. Federal Rule of Appellate Procedure 34 permits the court to fix the time allowed for oral argument. Courts may allow counsel to file a request in advance for additional time, and the courts have the discretion whether to grant these requests. Generally, not more than two attorneys are 48 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.G permitted to argue for each side. Some court rules encourage argument by only one attorney for each party. Many appellate judges require their law clerks to prepare a memorandum on each case (called a bench memo) for the judge to review before hearing oral arguments. In some circuits, the law clerk for one judge may prepare a memorandum to be circulated among the three judges on the panel prior to oral argument. The judges will study the briefs before oral argument. The appellant begins the argument. Because the judges have read the briefs and are therefore familiar with the issues, they sometimes begin questioning the attorney shortly after the argument begins. After the appellant’s argument is completed, the appellee responds, followed by any reply by the appellant (if the appellant reserved time for rebuttal). Although the arguments are recorded, so that the judges and their law clerks may later review them, some circuit judges may request one of their law clerks to attend oral argument and take notes of important matters, citations of new authorities, and concessions made during the argument. Most cases are heard by a panel of three judges, but a case may be heard en banc in cases involving a question of exceptional importance or in order to secure or maintain uniformity of decisions. A case heard en banc is heard by all of the active judges on the court and any senior judge of the circuit who sat on the panel that originally heard the case (or, in the Ninth Circuit, by a limited en banc, consisting of the chief judge and ten additional judges selected by lot). En banc hearings are held only when ordered by a majority of the active judges on the court. Some courts hold hearings in only one location, but most hold court in a number of locations within the circuit. G. Deliberation After a case has been argued and submitted to the court, the panel of judges who heard the argument meets to arrive at a decision. In most courts, these meetings are held immediately after the completion of each day’s arguments. Appellate courts perform three distinct functions. First, they decide the controversies before them. Second, they supervise the courts within their jurisdiction. Third, they determine the growth and development of the common law and the interpretation of federal statutory and constitutional law within their jurisdiction. Each of these functions can become important during the decisional phase of an appeal because the court must not only reach the correct result but also explain in its opinion the rationale for its decision. 49 Law Clerk Handbook Federal Judicial Center § 3.4.H In most cases, the court arrives at a tentative decision at the first meeting. At that time, the presiding judge (the senior active circuit judge sitting on the panel) assigns the case to one member of the panel, who later writes an opinion to be submitted to the others for approval. When the judges do not reach agreement so readily, panel members may exchange memoranda about the case and schedule additional meetings or telephone conferences for further discussion. Law clerks for appellate judges should know and follow the court’s internal rules and its customs concerning communications between chambers. H. Opinion and Judgment The final product of the court in most appeals is a written opinion setting forth the decision and the reasoning behind it. The increased number of cases and the burden of writing formal opinions in every case has caused appellate courts to use alternatives to formal opinions (such as memorandum, order, or summary opinions) in many cases, such as those involving only the application of settled principles to a specific fact situation. Local rules or policies may guide the members of the court in deciding which cases deserve full opinions and which opinions should be published. When a panel has agreed on an opinion, the authoring judge electronically transmits it to the clerk of court for public docketing and release. All courts post opinions on the court’s public website. In some courts, before opinions are released, they are circulated to all active judges on the court with a time limit for making suggestions. Sometimes when a judge or a group of judges disagrees with the majority decision reached by their colleagues and they feel strongly enough about it, the judge or judges will write a dissenting opinion explaining what aspects of the decision they disagree with and why. Even though they express opinions that did not prevail, dissents can contribute to the legal debate over the issues at hand and provide judges in similar cases with different perspectives. I. Rehearing The party who loses an appeal may file a petition for rehearing within fourteen days after judgment is entered. That petition attempts to persuade the panel that the decision was erroneous and should be withdrawn or revised. The prevailing party may not file a response to the petition unless one is requested by the court. Most petitions for rehearing are denied. The losing party may also move for a rehearing en banc. That motion is circulated to all members of the original panel and all active judges who did not sit 50 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.K on the panel. Only the active circuit judges and any senior judge who was a member of the original panel may request a vote on the suggestion to rehear the appeal en banc, and only the active circuit judges may vote on whether the appeal should be reheard en banc; if a rehearing en banc is granted, only active circuit judges and senior circuit judges from the circuit who were members of the original panel may sit on the rehearing. By local rule, a circuit may impose time limitations within which a member of the court may request an answer to a petition for rehearing or rehearing en banc or a vote on such a petition. J. Mandate The mandate is the document by which the court of appeals formally notifies the district court of its decision and by which jurisdiction for any necessary additional proceedings is conferred upon the district court. The mandate is issued by the clerk of court seven calendar days after the time to file a petition for rehearing expires, or seven calendar days after entry of an order denying a timely petition for panel rehearing, petition for rehearing en banc, or motion for stay of mandate, whichever is later. These times may be shortened or lengthened by court order. Fed. R. App. P. 41(b). The losing party may request by motion that the issuance of the mandate be stayed in order to maintain the status quo during the pendency of an application for a writ of certiorari to the Supreme Court. The court of appeals may require that a bond be posted as a condition to staying the issuance of the mandate. K. Motions During the course of an appeal, the parties may file a variety of motions. Most of these are procedural and, to the extent permitted by the Federal Rules of Appellate Procedure, some courts have authorized their clerks of court or other court unit executives to act on motions, for example, motions • for extensions of time to perform any of the acts required by local rules or the Federal Rules of Appellate Procedure • for relief from specific requirements of the local rules or the Federal Rules of Appellate Procedure • for permission to alter the form or content of the record on appeal; • for leave to file amicus curiae briefs • for delay in the issuance of the mandate • for voluntary dismissal of the appeal 51 Law Clerk Handbook Federal Judicial Center § 3.4.L Motions requiring action by a judge or panel of judges are those • on issues relating to criminal cases or suits for postconviction relief such as motions for appointment of counsel, leave to appeal in forma pauperis, certificates of probable cause, and bail pending appeal • for stays or injunctions pending appeal • for leave to file interlocutory appeals • for issues relating to stays granted in the district court • for permission to file a brief containing more pages than the number fixed by the rules • for issues relating to the time allowed for oral argument • to dismiss an appeal filed by the appellee In most courts, the staff attorney’s office is responsible for reviewing motions and referring them to judges for appropriate disposition. L. Emergency Proceedings Both district courts and courts of appeals are frequently asked to make decisions on an emergency basis. In the appellate courts, these occasions usually arise when a litigant or a lower court is about to take some action that may cause irreparable injury. The potentially aggrieved party seeks redress by motion for stay or injunction pending appeal or by petition for writ of mandamus or prohibition. In the district courts, these matters usually arise through a request for a temporary restraining order. Each court has developed internal procedures for handling these matters efficiently, but the procedures vary among courts. Courts have also established special procedures for handling emergency appeals of capital (death penalty) cases. Law clerks should become familiar with the procedures established by the local rules and the judge’s own practices.    § 3.5 Courts of Specialized Jurisdiction You may also encounter litigation from one of the various special courts established by Congress. The term special courts derives from their specialized jurisdiction. 52 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.5.D A. Court of Appeals for the Federal Circuit The Court of Appeals for the Federal Circuit, based in Washington, D.C., has jurisdiction over appeals from the following: district courts in cases involving patents and certain claims against the United States; the U.S. Court of Federal Claims; the Court of International Trade; the Court of Veterans Appeals; the Merit Systems Protection Board; the Patent and Trademark Office; the boards that decide government contract issues; and a few other Article I agencies. B. Court of International Trade The Court of International Trade, based in New York City, hears cases concerning the value or classification of imports. Its judges may sit by designation on other Article III courts. C. U.S. Judicial Panel on Multidistrict Litigation This panel was created to consider transferring civil actions involving one or more common questions of fact pending in different districts to a single district for coordinated or consolidated pretrial proceedings. The panel consists of seven district and circuit judges who are appointed by the Chief Justice and sit on the panel in addition to their regular judicial assignments. The panel maintains a roster of transferee judges to whom it assigns the cases it certifies for transfer. For discussion of multidistrict litigation problems, see section 3.1.F. D. Foreign Intelligence Surveillance Court The Foreign Intelligence Surveillance Court (FISC), or the FISA court, as it is popularly called (after the Act that created it), is composed of eleven federal judges, selected by the Chief Justice to a nonrenewable seven-year term. The court’s job is to review applications for governmental surveillance of persons within the United States whom the government suspects of having connections to foreign governments and/or terrorist organizations. A Foreign Intelligence Court of Review was also established to review applications denied by the FISA court. 53 Law Clerk Handbook Federal Judicial Center § 3.6    § 3.6 Article I Courts Congress has created many tribunals to assist it in meeting its legislative responsibilities under Article I of the Constitution. These courts do not exercise judicial power conferred by Article III, and the judges are appointed for fixed terms rather than given life tenure. They include the many administrative law judges serving in the executive agencies who hear disputes over claims and benefits, subject to review by agency officials. A. U.S. Tax Court The U.S. Tax Court has jurisdiction over controversies involving deficiencies determined by the commissioner of internal revenue in income, estate, and gift taxes, as well as other tax-related disputes between taxpayers and the Internal Revenue Service. The principal office of the court is located in Washington, D.C., and it conducts trial sessions in other cities throughout the United States. B. U.S. Court of Federal Claims The U.S. Court of Federal Claims was originally called the U.S. Claims Court. The court has jurisdiction over claims brought against the U.S. government. The court is located in Washington, D.C.; however, its jurisdiction is nationwide, enabling it to conduct trials in locations convenient to the parties involved in the case. C. U.S. Court of Appeals for the Armed Forces Congress established the U.S. Court of Appeals for the Armed Forces as an appellate criminal court, hearing all cases involving military courts-martial. It is located in Washington, D.C. D. U.S. Court of Appeals for Veterans Claims The U.S. Court of Appeals for Veterans Claims has exclusive jurisdiction to review the decisions of the Board of Veterans Appeals. The court’s principal location is in Washington, D.C., but it may hold court anywhere in the United States. 54 fjc.dcn • fjc.gov 4 Chambers and Case Management    § 4.1 Chambers Administration This chapter gives you a broad overview of some of your responsibilities as a law clerk in maintaining a well-run chambers. These responsibilities include helping to ensure chambers security; answering telephones and mail; maintaining the judge’s motion, hearing, and trial calendars; and other miscellaneous matters. Discussing all such duties would, of course, be impossible, and some judges have chambers manuals detailing how they expect their chambers to operate. Understanding and accommodating your judge’s preferences is key to maintaining an efficient chambers, and regardless of the general guidance offered in this chapter, you should always follow the particular policies and practices of your judge. Effective management is essential to the efficient administration of justice. While judicial assistants often have principal responsibility for managing various aspects of chambers administration, as a law clerk you should be familiar with the standard operating procedures in your chambers and be available to pitch in when needed. A. Security The safety and security of federal buildings and the people who work in and visit them are major concerns for the U.S. Marshals Service (USMS). Attorneys and other members of the public must pass through magnetometers and have their briefcases and other items screened by an X-ray machine to enter most courthouses and other federal buildings. In addition, all judges’ chambers are equipped 55 Law Clerk Handbook Federal Judicial Center § 4.1.A with an entry control system that consists of a security camera and monitor and a door release strike. Courthouse employees may be issued keycards enabling them to enter the courthouse without passing through metal detectors and to access secured, nonpublic sectors of the building, including judges’ chambers, depending on the individual court’s access-control security plans. Employees may also have after-hours and weekend access to the building through use of these keycards, which should be kept in a secure place and reported immediately if lost. All courthouse employees should carefully follow security procedures and report potential problems to the USMS. The U.S. Marshals Service is principally responsible for security of the court and its personnel, though most courthouse security functions are performed by court security officers (CSOs), who are funded by the judiciary’s Court Security Program and by the Federal Protective Service on a limited basis. Become familiar with the court’s Occupant Emergency Plan and other related USMS security plans in your courthouse, and help to maintain a secure chambers. Do not let unauthorized strangers into secure areas of the courthouse, and report suspicious mail or threatening phone calls. During security-sensitive proceedings, a judge may request that a deputy from the U.S. Marshals Service or a CSO be present in the courtroom. Because federal judges are occasionally the targets of terrorists or disgruntled litigants, be careful when opening mail. Mail received in the courthouse is routinely screened by the USMS before distribution to chambers and offices. Still, it pays to be alert to suspicious-looking items. Common recognition points for letter and package bombs include the following: • foreign mail, air mail, and special delivery • restrictive markings (e.g., confidential, personal) • excessive postage • handwritten or poorly typed addresses • incorrect titles • titles, but no names • misspelled common words • oily stains or discolorations • no return addresses • rigid envelopes • lopsided or uneven envelopes 56 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.C • protruding wires or tinfoil • excessive securing material such as masking tape or string • drawings, diagrams, or illustrations If a letter or package arouses attention, do not attempt to open it. Instead, immediately notify the marshals’ office or a CSO. B. Telephone Practices for dealing with incoming calls (e.g., how to answer the telephone, how to take messages, and when and if to transfer a call to the judge) will vary from chambers to chambers. In general, however, answer calls promptly, identify the office (e.g., “Judge Smith’s chambers”), and treat all callers courteously. And, of course, hold personal calls to a minimum, both in length and in number. See section 2.2.A.1 on communication with the media. C. Correspondence, Email, and Other Mail In addition to correspondence by U.S. postal and messenger service, many chambers now correspond by email with a wide variety of people, including counsel. While email has in some ways made communicating easier and more efficient, it has also made it even more important to stay on top of organizing and processing the mail. Email also presents serious potential problems relating to the accidental forwarding of messages, either to unintended parties or containing information not intended for the recipient. And bear in mind how easily emails can be broadly disseminated through forwarding and posting on websites and social media. Take special care to avoid sending and forwarding email messages that may result in embarrassment, a breach of confidence, or worse, and review and carefully proofread any outgoing messages (and fight the temptation not to proofread email as carefully as paper correspondence). Most chambers have practices and procedures for handling incoming and outgoing mail, including email (whether and when to delete email messages, how to store important messages for future reference, and other matters of email retention and organization). Quickly become familiar with these practices to help mitigate complications arising from the enormous number of emails that many chambers receive. Depending on office procedure, either a judicial assistant or a law clerk will open and review correspondence and make an initial decision concerning how 57 Law Clerk Handbook Federal Judicial Center § 4.1.C it should be handled. Many judges receive their own emails directly, though some may ask staff to review messages first. Incoming mail and emails should be reviewed as soon as they are received because they may relate to matters scheduled for that day. When correspondence referring to a pending suit is forwarded to any counsel of record over the signature of the judge, law clerk, or judicial assistant, copies should be sent to all other counsel of record to avoid inappropriate ex parte contact. Appellate judges seldom correspond directly with counsel on case-related matters, because appellate judges work on cases as part of a panel or court rather than individually. Instead, appellate judges will send instructions to the clerk of court on how to respond to counsel. Correspondence from the general public that is not related to a case is still important because citizens have a right to courteous treatment. Also, the public’s opinions about the fairness, responsiveness, and effectiveness of the judiciary are influenced by the promptness and appropriateness of the court’s answers. In the district court, some of the correspondence from the public involves requests to be excused from jury service. That subject is dealt with in section 4.3.D.2. Some correspondence contains character references on behalf of an offender who is scheduled for sentencing. Judges differ in their handling of such correspondence. Many simply acknowledge receipt of the letter and refer the letter to the probation office. Other correspondence from the public may express reactions to a judge’s ruling. Whether positive or negative, expressions of opinion by members of the public generally call only for courteous acknowledgment, not for an explanation or justification of the judge’s action. If a letter requests information about a ruling, many judges simply acknowledge receipt of the letter and send a copy of the opinion, if there is one. If more information is requested, many judges refer the writer to the record in the clerk of court’s office. Some judges may wish to respond to a letter that indicates a misunderstanding concerning a significant fact, proceeding, or legal conclusion. Judges who adopt this policy may ask law clerks to prepare a draft of a response for the judge to review. The response should not be argumentative or defensive; it should merely state the relevant facts or legal conclusion as necessary to alleviate the misunderstanding. Prisoners and persons who have been convicted and are awaiting sentence frequently write district and appellate judges. Handle the correspondence of a prisoner represented by counsel the same way as that of any other litigant. Ask your judge how to handle correspondence from prisoners who are proceeding pro se. In some instances, this correspondence may be handled by district court pro se law clerks or, in the appellate courts, either the clerk’s office or staff attor58 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.D ney’s office. In other instances, your judge may have a form letter explaining, for example, that federal law prohibits judges from giving legal advice and suggesting that the prisoner communicate with a lawyer, or a form letter for responding to requests for transfers to another penal institution (which only the Bureau of Prisons can grant). You should never write anything in a letter that would give a prisoner false hope or could compromise the position of the court. D. Internet and Electronic Research New law clerks will receive a Westlaw and/or a LexisNexis password, which may come with additional electronic research training and certain usage guidelines. All computer-assisted legal research (CALR) use via judiciary contracts is to be limited to official judiciary-related research purposes. In addition to these research services, the Internet also offers more informal avenues of research, including access to nearly every newspaper and magazine in the country, as well as to government and law school websites, Internet search engines, and myriad other sources. Contact the circuit library CALR coordinator for assistance with CALR access or training. The CALR coordinators and reference librarians are also available to assist with your research questions. Become familiar with fjc.dcn (http://fjc.dcn), the Federal Judicial Center’s site on the judiciary’s intranet. It provides access to manuals, monographs, desk references, and other publications, as well as to web-based training and orientation programs, streaming media programs, discussion forums, and other resources. JNet (http://jnet.ao.dcn), the intranet site maintained by the Administrative Office of the U.S. Courts, offers information and forms on a range of topics relevant to judicial employees, including benefits, court security, emergency preparedness, human resources, information technology, legal and general research, and travel. The Internet has also posed some serious security and usage challenges for employees and information technology departments in courthouses across the country. The judiciary provides you with a computer and Internet access to help you do your work. Depending on the policy in your court or chambers, you may use it on a limited basis for personal needs if doing so does not interfere with your work and does not cause congestion, delay, or disruption of service to any government system. You should not do anything on your office computer that would embarrass you or the court if it were made public. 59 Law Clerk Handbook Federal Judicial Center § 4.1.E E. Electronic Filing The federal judiciary’s Case Management/Electronic Case Filing (CM/ECF) system allows courts to maintain case documents in electronic form and provides enhanced and updated docket management services. It also gives each court the option to permit case documents—pleadings, motions, petitions—to be filed electronically with the court. CM/ECF uses an Internet connection and a browser and accepts documents in Portable Document Format (PDF). It is easy to use. Filers prepare documents using conventional word-processing software and save them as PDF files. After logging on to the court’s website with a court-issued password, the filer enters basic information about the case and document being filed, attaches the document, and submits it to the court. CM/ECF automatically generates a notice verifying that the court received the filing, and it also sends an email to other parties in the case notifying them of the filing. There are no added fees for filing documents using CM/ECF, but existing document filing fees do apply. Litigants receive one free copy of documents filed electronically in their cases, which they can save or print for their files. Public electronic access to court data is available through the Public Access to Court Electronic Records (PACER) program. Additional copies are available for a small fee to attorneys and the general public for viewing or downloading. The process for receiving and reviewing daily filings in the cases filed before the judge may vary among courts and chambers; you should quickly learn the process in your chambers and your role in implementing and maintaining it. Although familiarity with the workings of the system is helpful, you should refer counsel’s questions to docketing clerks or others in the clerk’s office who deal with the system on a daily basis. F. Judge’s Chambers Calendar The judicial assistant is usually in charge of maintaining the chambers calendar covering the judge’s scheduled court proceedings and other activities. If the calendar is maintained online, other staff on the chambers network may also have limited access to the judge’s schedule. In appellate courts, the clerk of court advises the judge of panel assignments and hearing dates. The judicial assistant, in consultation with the judge, will then schedule all other engagements and commitments around the hearings. In trial courts, the judicial assistant usually confers with the judge and then typically advises the courtroom deputy in charge of scheduling the court calendar of the dates on which trials and hearings are to 60 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.H be set. The judicial assistant then schedules the judge’s remaining commitments around the trials and hearings. Some judges choose not to have a judicial assistant, which allows them to have an additional law clerk. In these instances, a law clerk may maintain the chambers calendar. G. Opening Court In district courts, a law clerk or courtroom deputy usually opens court. One common method is for the clerk or deputy to rap on the door before the judge enters, open the door, then call out, “All rise.” The judge then enters and walks to the bench. The law clerk or deputy walks to the front of the bench and says: “The United States District Court for the ____ District of ____ is now in session. The Honorable ______ presiding.” The judge usually stands during this call, then says, “Please be seated,” and sits. H. Maintaining the Library; Office Supplies, Equipment, and Furniture Many chambers maintain their own libraries, though electronic databases and Internet research reduce the need for access to hard-copy sources and have enabled chambers in the same courthouse to share libraries. In any event, the employee who maintains the library, either a law clerk or a judicial assistant, should regularly file any advance sheets, pocket parts, slip opinions, replacement volumes, and inserts for loose-leaf services that arrive in the mail. File materials daily so that library maintenance does not become burdensome and the materials are current. Procurement and ordering of all law books is done by the circuit library; contact the librarian if you have questions. Promptly rubber-stamp every incoming library book to identify it as U.S. property. Keep track of books borrowed by attorneys for courtroom use and make sure that books are not taken outside the chambers and courtroom. Promptly reshelve books used during the course of research. They will then be easier to find, and the library will be neater. Also be sure that legal pads, book markers, pencils, and pens are always available in the library. Requests for supplies, equipment, and furniture ordinarily are handled in the clerk of court’s office. 61 Law Clerk Handbook Federal Judicial Center § 4.1.I I. Maintaining Office Records and Files You may have to maintain some of the records in your judge’s office, including the following: • case files • trial schedules or calendars • “tickler” records to remind the judge about future case activities • indices to the judge’s prior decisions • indices to slip opinions • work papers relating to cases in progress Such materials may be stored in hard copy, electronically, or both. Some chambers may also maintain office form books, either in hard copy or electronically. The form books may contain office procedure checklists and frequently used forms, such as samples of letters, orders, opinions, jury charges, minute entries, and office or file memoranda written by prior law clerks. The books describe the format and method for written documents issued by the judge or presented to the judge by chambers staff. The form books provide continuity and consistency in office administration and can help educate new law clerks. If case records are being used in the judge’s chambers, make sure that the records are not misplaced and are returned to the office of the clerk of court as soon as the judge or staff member has finished with them. J. Statistical Reporting The JS-10 form, “Monthly Report of Trials and Other Court Activity,” is a report of the trials and nontrial proceedings that a district judge conducted during the month. The clerk of the district court submits a JS-10 form to the Administrative Office for each active or senior district judge, plus any visiting district judges or appellate judges, who conducted trials or proceedings in the district during the month. The form reports both the number and type of trials and proceedings and the amount of time the judge spent conducting them. Some judges fill out the forms themselves, but usually a member of the chambers staff or the courtroom deputy fills out the form for the judge. The CM/ECF systems in some courts can automatically generate the JS-10 reports based on additional information about the trials and proceedings entered during the normal docketing process. Data on magistrate judge workloads and activities are collected through the MJSTAR 62 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.L function in district CM/ECF systems, which stores that data in the NewStats database. This includes not only the number of tasks completed by magistrate judges, but the time burden of many of these duties, including time spent with attorneys and parties. Bankruptcy courts report trials and other court activity on a monthly basis using the B-102 form. Courts of appeals use the JS-30 form to report the number of appellate cases, interlocutory appeals, and petitions for rehearing each month. K. Out-of-Town Trips Some judges must travel to other cities to attend court sessions and may require a chambers staff member to travel with them if the court to which they are traveling does not provide staffing. Judges may also travel on court-related business. Judicial assistants usually arrange travel (although when the judge has chosen to have an additional law clerk in lieu of a judicial assistant, a law clerk may have to make travel arrangements). If your judge is traveling to hold court in another location, prepare for the judge to take along necessary case files and materials; any personal notes or memoranda relating to the cases to be heard; the judge’s robe; paper, pencils, stationery, and other needed supplies (if the site for the out-of-town session is one frequently used by the court, there may be a permanent stock of stationery and supplies); necessary equipment such as a gavel, recording or dictating equipment, and a laptop or tablet computer; the briefs and any other case materials; and mailing labels and envelopes for returning material that the judge does not wish to carry back. Judges and chambers staff who travel on court business will be reimbursed for transportation, food, lodging, and related expenses according to the detailed rules set forth in the Guide to Judiciary Policy. These rules generally reimburse either a flat dollar amount per day, regardless of actual expenses, or itemized actual expenses not in excess of a fixed dollar amount. The judicial assistant should have forms for travel reimbursement—these forms can also be found on JNet. Judges must also report travel not related to cases under regulations found in Volume 19, section 270, of the Guide to Judiciary Policy. L. Assisting with Judges’ Extrajudicial Activities Many judges engage in teaching, writing, lecturing, and other extrajudicial activities. While law clerks may be called on to assist judges in these activities, the Code of Conduct for United States Judges says that judges should not use staff “to any 63 Law Clerk Handbook Federal Judicial Center § 4.1.M substantial degree” to engage in extrajudicial activities to improve the law, the legal system, and the administration of justice; and judges should not use staff to engage in other extrajudicial activities, “except for uses that are de minimis.” M. Preserving Chambers Papers for Historical Purposes The chambers papers of a district or appellate court judge have historical significance as an essential supplement to the official court record. Many papers in judges’ chambers are widely considered valuable, such as correspondence and background material concerning a case, including memoranda between judges and law clerks and judges on an appeals panel; drafts of orders and opinions (particularly draft opinions that have handwritten comments on them, or that have been circulated to other judges and returned with their comments); and correspondence/memoranda concerning court administration, legal activities in the community, and issues of governance, politics, and law. Chambers papers are the personal property of the judge. Each judge has the prerogative to make final decisions about the preservation of chambers papers and the terms of access. Judges can preserve their personal papers and make them available for eventual study by donating them to a manuscript repository. An FJC publication, A Guide to the Preservation of Federal Judges’ Papers (3d ed. 2018), reviews the organization and preservation of historically significant records created by federal judges. The Federal Judicial History Office at the FJC will also provide assistance on issues concerning judges’ papers. N. Rules Regarding the Media in Court Guidelines for allowing cameras and electronic reproduction equipment in the courtroom are published in Volume 10 of the Guide to Judiciary Policy. The guidelines allow the photographing, recording, or broadcasting of appellate arguments. In trial courts, a presiding judge may authorize broadcasting, televising, recording, or taking photographs in the courtroom during ceremonial proceedings. For nonceremonial proceedings, such activities may be allowed for presenting evidence, perpetuating a record of the proceedings, and for security or judicial administration purposes. Federal Rule of Criminal Procedure 53 prohibits photographing and radio broadcasting of criminal proceedings. Some circuit judicial councils have adopted specific instructions for the use of cameras in the courtroom. Although local rules restrict the means by which news may be reported (e.g., no cameras or broadcasting from the trial courtroom 64 Chambers and Case Management fjc.dcn • fjc.gov § 4.2 or environs), “there is nothing that proscribes the press from reporting events that transpire in the courtroom.”    § 4.2Local Court Rules and Administrative Policies Section 2071 of Title 28 of the U.S. Code authorizes federal courts to adopt their own rules, which must be consistent with the national rules and available to the public; it also authorizes the circuit judicial council to abrogate district and bankruptcy courts’ local rules, and authorizes the Judicial Conference to abrogate rules of courts of appeals. Federal Rules of Appellate Procedure 47, Bankruptcy Procedure 9029, Civil Procedure 83, and Criminal Procedure 57 provide additional requirements for local rule adoption and characteristics. The local rules of almost all courts follow the same numbering sequence as the corresponding national rules. These local rules include the procedures for setting cases for trial, scheduling pretrial conferences, setting motions for oral argument, serving memoranda of law, and other details relating to trial. They may also state the procedure for admission of attorneys to practice in the specific district or circuit, the term of the court, the functions of the clerk of court, the rules for filing motions, and more specific data, such as the number of copies required to be filed, limitations on the length of memoranda, the time within which memoranda must be filed, and restrictions on page length, typeface, and margin size. Each court of appeals has local rules concerning procedures for ordering transcripts; filing and docketing the appeal; calendaring; motions; summary disposition of appeals; setting cases for oral argument; time limits on oral argument; petitions for rehearing; petitions for en banc consideration; and stay of mandate. The local rules and internal operating procedures of the courts of appeals are printed in the United States Code Annotated following Title 28 of the Judicial Code, and are available on the courts’ websites. A court’s local rules and any internal operating procedures it adopts establish specific procedures for the court and litigants to follow. You should get these rules and procedures from the court’s website or the clerk’s office and become familiar with them. Keep them available for reference and be on the lookout for any modifications the court may adopt. 65 Law Clerk Handbook Federal Judicial Center § 4.3    § 4.3 Case Management: The Trial Court Many judges believe that the responsibility for moving a case through the trial court is not solely that of the attorneys, and the function of the court is not simply to be available if and when counsel want a hearing. The disposition of all cases as speedily and economically as is consistent with justice is paramount. The Federal Rules of Civil Procedure are to be “construed to secure the just, speedy, and inexpensive determination of every action.” Fed. R. Civ. P. 1. The courts are also required to report semiannually (on April 30 and September 30) for each judge the motions that have been pending and the bench trials that have been submitted for more than six months, and cases that have not been terminated within three years of filing, for publication by the Administrative Office. 28 U.S.C. § 476. Effective docket control means that, early in a case, the judge assumes responsibility for guiding the case to a conclusion. This may include establishing deadlines for filing motions, a time limit for discovery, a date for counsel to take the next step in its prosecution, and a trial date. For specific techniques of case management, consult the Civil Litigation Management Manual. See also Schwarzer & Hirsch, The Elements of Case Management (Federal Judicial Center, 3d ed. 2017). Note that many of the same considerations apply in criminal cases, with the additional complication of computations required by the Speedy Trial Act. 18 U.S.C. §§ 3161–3174. Law clerks should be familiar with the requirements of the Act, since failure to bring a case to trial within the Act’s time limits can have serious repercussions. A. Office Status Sheets Some judges maintain an office status sheet and post it where it is accessible to chambers staff. Its purpose is to keep the judge, the law clerks, and judicial assistants apprised of legal matters under advisement and awaiting disposition. When a matter has been taken under advisement, the assistant or law clerk assigned to the case should indicate it on the status sheet. Keep a personal status list, which can be revised each week, listing all matters for which you are responsible. It will help you make effective use of your time and remember all pending assignments. Some judges require their law clerks to submit personal status lists weekly. Some judges require their judicial assistants to keep a list of all pending matters, the initials or name of the law clerk assigned to work on the matter, and 66 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.C any other pertinent information. If so, keep the assistant advised of all matters assigned, matters completed, and other relevant status information. CM/ECF helps judges use computer technology for docket control and to maintain case inventories and case-status records. Other systems may also be employed. Regardless of which system is used, it is important that it be regularly maintained and continually monitored. B. Calendaring Systems Multijudge trial courts need a system for determining which judge is responsible for each case. In an individual calendar system, each case is randomly assigned to a particular judge at the time it is filed, or soon thereafter, and that judge has complete responsibility for the case until it is terminated. There are also standard procedures for reassigning cases from which the original judge is disqualified, for ensuring that related cases are all assigned to the same judge, and for special assignment of unusual and protracted cases. Local rules usually describe these procedures. C. Trial Scheduling A single trial may be set for a specific date, or the court may set multiple cases for trial on the same day. Some courts use the trailing calendar or trailing docket, in which the court schedules a number of cases for trial beginning on a stated date. The cases are tried in the order reflected by the schedule. Counsel must obtain information from the court and from the attorneys whose cases precede them on the calendar about the progress of those cases, so that they can go to trial whenever the court reaches their case. Most civil cases do not go to trial but are disposed of in some other manner, including dispositive motions and settlement. Judges differ in their approach to encouraging settlement, but the decision whether to settle or proceed to trial is the parties’ alone. If settlement is to be reached, negotiations should be completed in a timely manner. Last-minute settlements may disrupt the court’s schedule, leaving the judges, and sometimes jurors, with unscheduled time. The trailing calendar and other multiple-case-setting devices alleviate some problems caused by last-minute settlement by providing substitute cases to replace those that do not go to trial. Although this resolves the court’s problems, it does not resolve the problems that eve-of-trial settlements cause litigants and counsel. 67 Law Clerk Handbook Federal Judicial Center § 4.3.D Criminal cases take priority on the court’s calendar because they must be tried within the time limits set forth in the Speedy Trial Act. While criminal cases do not settle, the vast majority of them are disposed of by way of plea bargaining and guilty pleas, which again make multiple-case-setting an important calendaring device for the court. D. Jury Management 1. Random Juror Selection The selection of grand and petit jurors in both criminal and civil cases is governed by 28 U.S.C. §§ 1861–1878, under which each district must have a jury selection plan that has been approved by a panel comprising the circuit judicial council and the chief district judge or the chief judge’s designee. The statutory goal of the selection process is to ensure “grand and petit juries selected at random from a fair cross section of the community in the district or division wherein the court convenes” (28 U.S.C. § 1861), and to avoid excluding any citizen “from service as a grand or petit juror . . . on account of race, color, religion, sex, national origin, or economic status” (28 U.S.C. § 1862). The clerk of court usually manages the process of selecting prospective jurors, under the supervision and control of the court. Although the jury selection process may differ slightly in each district, it is generally as follows: 1. The clerk’s office performs a random selection of prospective jurors’ names by computer or manually, using voter registration lists or other sources specified by the court’s plan, and places the names selected in a master jury wheel, which is usually a computer file. The minimum number of names in the master jury wheel must be one-half of 1% of the number on the source lists, or 1,000, whichever is less. 2. As needed by the court, the clerk’s office draws names publicly at random from the master jury wheel and sends jury-qualification questionnaires to those persons whose names are drawn. 3. From the responses to the questionnaires, a determination is made as to which persons are qualified for jury service and which persons are disqualified, exempt, or excused. 4. The names of those determined to be qualified are placed in a second jury wheel consisting of qualified jurors. 5. As needed, the clerk’s office selects names from the qualified jury wheel and prepares lists of the names selected. 68 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.D.2 6. The clerk’s office issues summonses to the necessary number of persons needed for the jury venire several weeks in advance of each trial calendar advising those summoned of the time and place to report for jury service. Some district courts qualify and summons jurors in one step and do not establish a qualified jury wheel. 2. Exemptions, Disqualifications, and Excuses A person is qualified for jury service unless the person • is not a citizen of the United States • is unable to read, write, and understand English with a degree of proficiency sufficient to complete the juror-qualification form satisfactorily • is incapable of rendering satisfactory service because of mental or physical infirmity • is charged with or has been convicted in a state or federal court of record of a crime punishable by imprisonment for more than one year without subsequent restoration of civil rights 28 U.S.C. § 1865. Some district courts have adopted other grounds for exemptions, which are specified in the court’s jury selection plan. Section 1863 of Title 18 requires the plan to provide for the exemption of members of the armed forces in active service; members of state or local fire or police departments; and public officers of the federal, state, and local governments who are actively engaged in the performance of official duties. Jury service is a citizen’s duty as well as a privilege, and courts do not readily grant excuses. A person may, however, be excused from jury service temporarily if the plan states that such service would result in undue hardship or extreme inconvenience. In such a case, the name of an excused juror is placed back in the qualified jury wheel. If a prospective juror approaches you about an excuse, do not express any opinion regarding the request, but simply refer the requester to the clerk’s office or jury administrator for action. Treat persons called for jury service with courtesy; they are providing an important service to the court and the public. Judges in multijudge courthouses often begin jury trials at different hours to obtain maximum use of people summoned for jury service, sending persons examined and not selected to another courtroom so they can be examined for 69 Law Clerk Handbook Federal Judicial Center § 4.3.D.3 selection on another jury, and sometimes using jurors who have served in one trial in a succeeding trial. When prospective jury panels report for possible selection in a case, they should be segregated from other people in the courtroom. Law clerks may be responsible for clearing a portion of the spectator section for the jury panel’s exclusive use. 3. Juror Orientation Most courts conduct a juror orientation program to inform jurors of their responsibilities and to explain the trial process. Orientation videos, including the Federal Judicial Center’s Called to Serve, are available in most courts. 4. Voir Dire In most courts, the judge personally conducts voir dire examination. Federal Rule of Civil Procedure 47 and Federal Rule of Criminal Procedure 24, however, authorize the judge to permit the lawyers to conduct voir dire. If the judge conducts voir dire, the rules authorize counsel to submit specific questions or areas of inquiry that they want the judge to probe. In some courts, magistrate judges conduct voir dire. The law in most circuits permits this in civil cases, though some require consent of the parties. The Supreme Court has held that a magistrate judge may conduct voir dire in a criminal case if the defendant consents (Peretz v. United States, 501 U.S. 923 (1991)), but not if the defendant objects (Gomez v. United States, 490 U.S. 858 (1989)). 5. Jury Supervision In most courts, a deputy clerk is responsible for jury supervision. However, sometimes law clerks have this responsibility. If so, you should be present early enough in the morning to accommodate those members of the jury who arrive before the normal court time. The jury room should be open and available for use by the jurors as they arrive. If the judge permits the jury to take notes, either you or the deputy clerk should provide pads of paper and pencils for distribution to the jurors before the trial begins. Extra pads and pencils should also be placed in the jury room for use during deliberations. If you are responsible for jury supervision, ensure that there is no communication—in the courtroom, jury room, or hallways adjacent to the courtroom and chambers—between jurors and litigants, lawyers, witnesses, or others attending court. 70 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.E Jurors are usually free to go where they wish during recesses, and they may go home at night. Occasionally, however, when there is unusual publicity about the trial or there is reason to believe that someone will attempt to exert improper influence on jurors, the judge may direct that the jury be sequestered. When this occurs, deputy marshals keep the jurors together at all times and supervise them when court is not in session. Jurors in criminal and civil cases are sometimes sequestered from the time they begin deliberating until they reach a verdict. Judges sometimes have law clerks steward the jury during deliberations. Some judges require the law clerk to take a special oath with respect to this duty just before the jury retires. Once the oath is taken, the law clerk assumes primary responsibility for guarding the jury until relieved of this duty by the judge. Remain outside the jury-room door during the entire deliberation process and take every reasonable precaution to ensure that the jurors do not come into contact with other people, especially the litigants, their attorneys, or witnesses. You must never comment on the evidence, the litigants, the attorneys, or the witnesses to any juror (or, for that matter, to anyone else). If a juror has any questions about the trial, at any stage, you should simply state that such questions should be addressed to the judge in writing. Do not answer the question, however simple it may appear. E. Distributing Opinions Federal Rule of Civil Procedure 52(a) requires the judge to make findings of fact and conclusions of law in all actions tried without a jury or with only an advisory jury. The rule permits the judge to do this orally on the record or in writing in an opinion or memorandum. The judge may also write a formal opinion to explain rulings on particular motions. The judicial assistant sends the original of the findings or the opinion and the original of any order for judgment to the docket clerk for filing in the official record. Then the judicial assistant or clerk of court sends a copy of each set of findings or the opinion to each counsel of record, making and distributing other copies in accordance with the judge’s instructions. In most district courts, the clerk of court handles the distribution of opinions, but in a few district courts, this responsibility falls to the law clerk or judicial assistant. The judge decides whether the opinion or findings are to be published. If you are responsible for distributing opinions, check with the judge to determine whether the judge wishes the opinion to be published and make such distribution as the judge directs. In each case, the opinion should be accompanied by a cover letter from the judge; the judge may have a form letter for this purpose. 71 Law Clerk Handbook Federal Judicial Center § 4.4    § 4.4 Special Duties of Law Clerks to Bankruptcy Judges The duties of law clerks to bankruptcy judges are generally similar to the duties of those working for district judges. The volume of cases and proceedings in bankruptcy court is generally greater than in other trial courts, and the chambers must be organized to handle this volume effectively. Bankruptcy judges hold more, and faster, hearings than do district judges. For the chambers staff, that means more scheduling problems, more substantial prehearing preparation of memoranda, and shorter time limits. It also means more pressure from attorneys telephoning to ask for expedited schedules and to ask about procedures, the disposition of motions, and various other matters. Like district judges, bankruptcy judges differ in their attitudes about direct contact between law clerks and attorneys. Some bankruptcy judges hold court in more than one place. Law clerks and judicial assistants to those judges usually have substantial duties in preparing for travel, including assembly of materials (such as appropriate portions of case records necessary for the trip). The judge’s staff will usually have extra duties in the additional places of holding court because the other staff available may not be as complete as in the home court.    § 4.5 U.S. Magistrate Judges The authority of magistrate judges derives primarily from the Federal Magistrates Act of 1968 and as amended numerous times since. 28 U.S.C. §§ 631–639. Significant Supreme Court cases interpreting the Act include Mathews v. Weber, 423 U.S. 261 (1976) (upholding magistrate judge authority to hear Social Security appeals on a report and recommendation basis); United States v. Raddatz, 447 U.S. 667 (1980) (upholding magistrate judge authority to conduct hearings on motions to suppress evidence in felony cases on a report and recommendation basis); Peretz v. United States, 501 U.S. 923 (1991) (upholding magistrate judge authority to conduct felony voir dire proceedings with the parties’ consent); and Roell v. Withrow, 538 U.S. 580 (2003) (holding that parties’ consent to disposition of a civil case by a magistrate judge under 28 U.S.C. § 636(c) could be inferred from the parties’ conduct during the case). A general outline of the duties performed by magistrate judges is described below. 72 Chambers and Case Management fjc.dcn • fjc.gov § 4.5.B A. Initial Proceedings in Criminal Cases Under 28  U.S.C. §  636(a), a magistrate judge may perform various duties and conduct proceedings in criminal cases, including the following: • accept criminal complaints • issue arrest warrants and summonses • issue search warrants • conduct initial appearance proceedings and detention for criminal defendants, informing them of the charges against them and of their rights • set bail or other conditions of release or detention under the Bail Reform Act, 18 U.S.C. §§ 3141–3145 • appoint attorneys for defendants who are unable to afford or obtain counsel • hold preliminary examinations, or “probable cause” hearings • administer oaths and take bail, acknowledgments, affidavits, and depositions • conduct extradition proceedings ","G. U.S. Trustees and Private Trustees The U.S. Trustee Program is part of the federal government’s Department of Justice, not a part of the courts. It was established to handle the administrative functions of bankruptcy cases and to ensure the integrity of the bankruptcy system across the nation. The program operates with twenty-one regional offices and ninety-four field offices, which are headed by U.S. trustees and assistant U.S. trustees, respectively. See 28  U.S.C. §§  581–589b. In the six judicial districts in Alabama and North Carolina, the Bankruptcy Administrator Program, rather than the U.S. Trustee Program, handles the administrative functions. See § 302(d) (3)(1) of the Bankruptcy Judges, United States Trustees, and Family Farmer Act of 1986, P.L. 99-554, 100 Stat. 3119, 3123, and § 317(b) of the Federal Courts Study Committee Implementation Act of 1990. The functions of the U.S. trustees are enumerated in 28 U.S.C. § 581(a), and primarily include (1) appointing and supervising the private trustees who collect and disburse funds to creditors in Chapter 7, 12, and 13 cases; (2) ensuring compliance with the Bankruptcy Code with respect to information provided in schedules, disclosure statements, reorganization plans, and other filings; (3) reviewing fee applications of professionals, such as attorneys and accountants, who serve in Chapter 11 reorganization cases; and (4) monitoring bankruptcy cases for fraud and referring criminal matters to the U.S. attorney for prosecution. Trustees do not have independent enforcement powers; rather, they must request the court to rule on matters of administration for which there is no voluntary compliance. The U.S. trustee is responsible for establishing a panel of private trustees to serve in Chapter 7 cases. When a bankruptcy petition is filed under Chapter 7, the U.S. trustee appoints a disinterested person from this panel to serve as interim trustee. At the first meeting of creditors, the creditors may elect another person as trustee, although such elections are rare. The U.S. trustee is also responsible 44 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.A for appointing one or more “standing” trustees to administer all Chapter 12 and 13 cases filed in a geographic region. In Chapter 11 cases, no trustee is appointed unless the court orders the appointment after notice and a hearing. If the court orders an appointment, the U.S. trustee designates the person who will serve, unless a party-in-interest timely requests that the trustee be elected by the creditors. In Chapter 7, 12, and 13 cases, the U.S. trustee may act as trustee if a private trustee is unavailable, although this is rarely done. The code does not provide for the appointment of a trustee in Chapter 9 cases. 28  U.S.C. §  586, 11 U.S.C. §§ 701–704, 1202, 1104–1106, 1302.    § 3.4 Appeals A. Processing Appeals The steps in an appeal are as follows: 1. Filing a notice of appeal 2. Preparing the record on appeal 3. Docketing the appeal 4. Filing the appellant’s brief 5. Filing the appellee’s brief 6. Filing the appellant’s reply brief 7. Deciding if the court dispenses with oral argument, or scheduling of oral argument 8. Hearing oral argument 9. Deliberating by the court 10. Filing the opinion 11. Filing a petition for rehearing 12. Issuing the mandate (the final stage in the appellate process unless the party applies to the Supreme Court for a writ of certiorari) The Federal Rules of Appellate Procedure establish certain procedural uniformity among the thirteen courts of appeals. However, there are still some differences in the procedures in the various circuits. Each court has local rules and internal operating procedures that describe the precise procedure to be followed 45 Law Clerk Handbook Federal Judicial Center § 3.4.B when there is any variation from the rules and, in some instances, that elaborate on or amplify the rules. See section 4.2. B. Notice of Appeal The timely filing of a notice of appeal is a jurisdictional requirement for any appeal. Appeals may be filed to challenge decisions of the district court, an administrative agency, or a bankruptcy appellate panel. Appeals of agency decisions may be classified as original proceedings in the court of appeals. The notice of appeal is filed in the district court. The purpose of the notice is to inform opposing counsel and the court that an appeal is being taken. The clerk of that court is required by Federal Rule of Appellate Procedure 3(d) to forward a copy of the notice to the clerk of the court of appeals. The time for filing commences when the judgment or order is entered in the district court from which the appeal is taken. The running of that time is tolled by the filing of certain posttrial motions in the district court, and the filing of such motions after a notice of appeal has been filed may vitiate the notice, requiring a new notice of appeal to be filed after the motion is decided. Fed. R. App. P. 4(a). Rule 4 provides the following time periods for filing notices of appeal: • private civil cases: 30 days • civil cases in which the United States is a party: 60 days • criminal cases: 10 days • criminal cases in which appeal by the government is authorized by statute (such as appeals from sentences under the 1984 Sentencing Reform Act): 30 days Upon receipt of the notice of appeal, courts of appeals take steps to ensure that all procedural requirements have been met. The clerk’s office may send counsel a case-opening letter to establish schedules for record preparation and briefing. Circuit mediators may conduct initial mediation/settlement conferences to discuss the issues in the case, with a view to eliminating the briefing of frivolous issues and to discuss the possibility of settlement. See Mediation & Conference Programs in the Federal Courts of Appeals: A Sourcebook for Judges and Lawyers (Federal Judicial Center, 2d ed. 2006). 46 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.D C. Record Preparation For an appellate court to review the proceedings in a trial court, appellate judges must have a record available of what occurred in the trial court. Local court rules prescribe the requirements for counsel to provide the district court with the record or excerpts of the record (sometimes referred to as a short record), which may include original papers and exhibits filed in the trial court plus a reporter’s transcript of any relevant proceedings. The Sentencing Reform Act requires that the record in a criminal case must also include “(1) that portion of the record . . . that is designated as pertinent by either of the parties; (2) the presentence report; and (3) the information submitted during the sentencing proceeding.” 18 U.S.C. § 3742(d). This information will often be under seal, because it is confidential. The Federal Rules prescribe time limits (deadlines) for providing the record on appeal to the court of appeals. During this time, the appellant must order a transcript of proceedings if one is needed and make arrangements to pay the court reporter for services or, in courts using electronic sound recording for the official record, the clerk of court. The district court clerk assembles the other papers or electronic files that constitute the record on appeal. The district court has the power to extend for an additional fifty days the time for preparing and sending the record on appeal, after which the court of appeals itself may grant extensions. Additional time may be needed if the court reporter has not finished transcribing the proceedings or if counsel has failed to order the transcript in a timely manner. To prevent undue delay, the appellate courts have the discretion to refuse to grant time extensions and may impose sanctions on the appellant or the reporter for unreasonable delays in preparing the record on appeal. D. Docketing the Appeal When the record is completed, or earlier if desired, the appellant must docket the appeal. This is primarily a clerical process and is performed in the office of the clerk of the court of appeals. Unless the appellant is exempt from payment, a docket fee is charged. The clerk of court opens an appropriate file and record and sends a notice to the parties. Frequently, docketing takes place when the record on appeal is filed. The filing of the record provides the base date for most subsequent proceedings in the case. 47 Law Clerk Handbook Federal Judicial Center § 3.4.E E. Briefs and Joint Appendices Because the appellant has the burden of establishing that the trial court erred, it files the opening brief. The appellee then files a brief in response; if the appellant wishes, the appellant may file a reply brief responding to new matters raised in the appellee’s brief. The Federal Rules of Appellate Procedure establish standards for format, color of brief covers, content, methods of reproduction, number of copies, and times for filing of briefs. The local rules for a circuit may impose further requirements. The schedule for filing briefs is as follows: • appellant’s brief: 40 days after filing the record • appellee’s brief: 30 days after service of appellant’s brief • reply brief: 14 days after service of appellee’s brief Some courts of appeals have modified the requirements and standards of the federal rules in certain cases or classes of cases. One of the more common modifications permits parties appealing in forma pauperis to file fewer copies of their briefs. While the briefs are being prepared, the parties are required to determine which portions of the record on appeal are relevant to the issues raised; the appellant is required to reproduce these portions as an appendix to the briefs. There may be only one appendix containing the portions relied on by both the appellant and the appellee, which would be referred to as a joint appendix. If any relevant material is omitted from the appendix, the court is free to refer to the original record. Multiple copies of the appendix may be filed so that each judge and, if needed, each law clerk may have one. Some courts of appeals have eliminated the requirement of an appendix and permit the substitution of photocopies of relatively few parts of the record, usually called record excerpts. The local rules of those courts describe the substitute requirements. Local rules also address procedures for electronic filing. You should become familiar with the rules and procedures in your court. F. Oral Argument If the court does not decide a case exclusively on the basis of the briefs and written record (see section 4.6.B on screening cases to select those appeals to be decided without oral argument), the parties are given an opportunity to present their arguments to the court orally. Federal Rule of Appellate Procedure 34 permits the court to fix the time allowed for oral argument. Courts may allow counsel to file a request in advance for additional time, and the courts have the discretion whether to grant these requests. Generally, not more than two attorneys are 48 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.G permitted to argue for each side. Some court rules encourage argument by only one attorney for each party. Many appellate judges require their law clerks to prepare a memorandum on each case (called a bench memo) for the judge to review before hearing oral arguments. In some circuits, the law clerk for one judge may prepare a memorandum to be circulated among the three judges on the panel prior to oral argument. The judges will study the briefs before oral argument. The appellant begins the argument. Because the judges have read the briefs and are therefore familiar with the issues, they sometimes begin questioning the attorney shortly after the argument begins. After the appellant’s argument is completed, the appellee responds, followed by any reply by the appellant (if the appellant reserved time for rebuttal). Although the arguments are recorded, so that the judges and their law clerks may later review them, some circuit judges may request one of their law clerks to attend oral argument and take notes of important matters, citations of new authorities, and concessions made during the argument. Most cases are heard by a panel of three judges, but a case may be heard en banc in cases involving a question of exceptional importance or in order to secure or maintain uniformity of decisions. A case heard en banc is heard by all of the active judges on the court and any senior judge of the circuit who sat on the panel that originally heard the case (or, in the Ninth Circuit, by a limited en banc, consisting of the chief judge and ten additional judges selected by lot). En banc hearings are held only when ordered by a majority of the active judges on the court. Some courts hold hearings in only one location, but most hold court in a number of locations within the circuit. G. Deliberation After a case has been argued and submitted to the court, the panel of judges who heard the argument meets to arrive at a decision. In most courts, these meetings are held immediately after the completion of each day’s arguments. Appellate courts perform three distinct functions. First, they decide the controversies before them. Second, they supervise the courts within their jurisdiction. Third, they determine the growth and development of the common law and the interpretation of federal statutory and constitutional law within their jurisdiction. Each of these functions can become important during the decisional phase of an appeal because the court must not only reach the correct result but also explain in its opinion the rationale for its decision. 49 Law Clerk Handbook Federal Judicial Center § 3.4.H In most cases, the court arrives at a tentative decision at the first meeting. At that time, the presiding judge (the senior active circuit judge sitting on the panel) assigns the case to one member of the panel, who later writes an opinion to be submitted to the others for approval. When the judges do not reach agreement so readily, panel members may exchange memoranda about the case and schedule additional meetings or telephone conferences for further discussion. Law clerks for appellate judges should know and follow the court’s internal rules and its customs concerning communications between chambers. H. Opinion and Judgment The final product of the court in most appeals is a written opinion setting forth the decision and the reasoning behind it. The increased number of cases and the burden of writing formal opinions in every case has caused appellate courts to use alternatives to formal opinions (such as memorandum, order, or summary opinions) in many cases, such as those involving only the application of settled principles to a specific fact situation. Local rules or policies may guide the members of the court in deciding which cases deserve full opinions and which opinions should be published. When a panel has agreed on an opinion, the authoring judge electronically transmits it to the clerk of court for public docketing and release. All courts post opinions on the court’s public website. In some courts, before opinions are released, they are circulated to all active judges on the court with a time limit for making suggestions. Sometimes when a judge or a group of judges disagrees with the majority decision reached by their colleagues and they feel strongly enough about it, the judge or judges will write a dissenting opinion explaining what aspects of the decision they disagree with and why. Even though they express opinions that did not prevail, dissents can contribute to the legal debate over the issues at hand and provide judges in similar cases with different perspectives. I. Rehearing The party who loses an appeal may file a petition for rehearing within fourteen days after judgment is entered. That petition attempts to persuade the panel that the decision was erroneous and should be withdrawn or revised. The prevailing party may not file a response to the petition unless one is requested by the court. Most petitions for rehearing are denied. The losing party may also move for a rehearing en banc. That motion is circulated to all members of the original panel and all active judges who did not sit 50 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.4.K on the panel. Only the active circuit judges and any senior judge who was a member of the original panel may request a vote on the suggestion to rehear the appeal en banc, and only the active circuit judges may vote on whether the appeal should be reheard en banc; if a rehearing en banc is granted, only active circuit judges and senior circuit judges from the circuit who were members of the original panel may sit on the rehearing. By local rule, a circuit may impose time limitations within which a member of the court may request an answer to a petition for rehearing or rehearing en banc or a vote on such a petition. J. Mandate The mandate is the document by which the court of appeals formally notifies the district court of its decision and by which jurisdiction for any necessary additional proceedings is conferred upon the district court. The mandate is issued by the clerk of court seven calendar days after the time to file a petition for rehearing expires, or seven calendar days after entry of an order denying a timely petition for panel rehearing, petition for rehearing en banc, or motion for stay of mandate, whichever is later. These times may be shortened or lengthened by court order. Fed. R. App. P. 41(b). The losing party may request by motion that the issuance of the mandate be stayed in order to maintain the status quo during the pendency of an application for a writ of certiorari to the Supreme Court. The court of appeals may require that a bond be posted as a condition to staying the issuance of the mandate. K. Motions During the course of an appeal, the parties may file a variety of motions. Most of these are procedural and, to the extent permitted by the Federal Rules of Appellate Procedure, some courts have authorized their clerks of court or other court unit executives to act on motions, for example, motions • for extensions of time to perform any of the acts required by local rules or the Federal Rules of Appellate Procedure • for relief from specific requirements of the local rules or the Federal Rules of Appellate Procedure • for permission to alter the form or content of the record on appeal; • for leave to file amicus curiae briefs • for delay in the issuance of the mandate • for voluntary dismissal of the appeal 51 Law Clerk Handbook Federal Judicial Center § 3.4.L Motions requiring action by a judge or panel of judges are those • on issues relating to criminal cases or suits for postconviction relief such as motions for appointment of counsel, leave to appeal in forma pauperis, certificates of probable cause, and bail pending appeal • for stays or injunctions pending appeal • for leave to file interlocutory appeals • for issues relating to stays granted in the district court • for permission to file a brief containing more pages than the number fixed by the rules • for issues relating to the time allowed for oral argument • to dismiss an appeal filed by the appellee In most courts, the staff attorney’s office is responsible for reviewing motions and referring them to judges for appropriate disposition. L. Emergency Proceedings Both district courts and courts of appeals are frequently asked to make decisions on an emergency basis. In the appellate courts, these occasions usually arise when a litigant or a lower court is about to take some action that may cause irreparable injury. The potentially aggrieved party seeks redress by motion for stay or injunction pending appeal or by petition for writ of mandamus or prohibition. In the district courts, these matters usually arise through a request for a temporary restraining order. Each court has developed internal procedures for handling these matters efficiently, but the procedures vary among courts. Courts have also established special procedures for handling emergency appeals of capital (death penalty) cases. Law clerks should become familiar with the procedures established by the local rules and the judge’s own practices.    § 3.5 Courts of Specialized Jurisdiction You may also encounter litigation from one of the various special courts established by Congress. The term special courts derives from their specialized jurisdiction. 52 Basic Overview of Litigation in U.S. Courts fjc.dcn • fjc.gov § 3.5.D A. Court of Appeals for the Federal Circuit The Court of Appeals for the Federal Circuit, based in Washington, D.C., has jurisdiction over appeals from the following: district courts in cases involving patents and certain claims against the United States; the U.S. Court of Federal Claims; the Court of International Trade; the Court of Veterans Appeals; the Merit Systems Protection Board; the Patent and Trademark Office; the boards that decide government contract issues; and a few other Article I agencies. B. Court of International Trade The Court of International Trade, based in New York City, hears cases concerning the value or classification of imports. Its judges may sit by designation on other Article III courts. C. U.S. Judicial Panel on Multidistrict Litigation This panel was created to consider transferring civil actions involving one or more common questions of fact pending in different districts to a single district for coordinated or consolidated pretrial proceedings. The panel consists of seven district and circuit judges who are appointed by the Chief Justice and sit on the panel in addition to their regular judicial assignments. The panel maintains a roster of transferee judges to whom it assigns the cases it certifies for transfer. For discussion of multidistrict litigation problems, see section 3.1.F. D. Foreign Intelligence Surveillance Court The Foreign Intelligence Surveillance Court (FISC), or the FISA court, as it is popularly called (after the Act that created it), is composed of eleven federal judges, selected by the Chief Justice to a nonrenewable seven-year term. The court’s job is to review applications for governmental surveillance of persons within the United States whom the government suspects of having connections to foreign governments and/or terrorist organizations. A Foreign Intelligence Court of Review was also established to review applications denied by the FISA court. 53 Law Clerk Handbook Federal Judicial Center § 3.6    § 3.6 Article I Courts Congress has created many tribunals to assist it in meeting its legislative responsibilities under Article I of the Constitution. These courts do not exercise judicial power conferred by Article III, and the judges are appointed for fixed terms rather than given life tenure. They include the many administrative law judges serving in the executive agencies who hear disputes over claims and benefits, subject to review by agency officials. A. U.S. Tax Court The U.S. Tax Court has jurisdiction over controversies involving deficiencies determined by the commissioner of internal revenue in income, estate, and gift taxes, as well as other tax-related disputes between taxpayers and the Internal Revenue Service. The principal office of the court is located in Washington, D.C., and it conducts trial sessions in other cities throughout the United States. B. U.S. Court of Federal Claims The U.S. Court of Federal Claims was originally called the U.S. Claims Court. The court has jurisdiction over claims brought against the U.S. government. The court is located in Washington, D.C.; however, its jurisdiction is nationwide, enabling it to conduct trials in locations convenient to the parties involved in the case. C. U.S. Court of Appeals for the Armed Forces Congress established the U.S. Court of Appeals for the Armed Forces as an appellate criminal court, hearing all cases involving military courts-martial. It is located in Washington, D.C. D. U.S. Court of Appeals for Veterans Claims The U.S. Court of Appeals for Veterans Claims has exclusive jurisdiction to review the decisions of the Board of Veterans Appeals. The court’s principal location is in Washington, D.C., but it may hold court anywhere in the United States. 54 fjc.dcn • fjc.gov 4 Chambers and Case Management    § 4.1 Chambers Administration This chapter gives you a broad overview of some of your responsibilities as a law clerk in maintaining a well-run chambers. These responsibilities include helping to ensure chambers security; answering telephones and mail; maintaining the judge’s motion, hearing, and trial calendars; and other miscellaneous matters. Discussing all such duties would, of course, be impossible, and some judges have chambers manuals detailing how they expect their chambers to operate. Understanding and accommodating your judge’s preferences is key to maintaining an efficient chambers, and regardless of the general guidance offered in this chapter, you should always follow the particular policies and practices of your judge. Effective management is essential to the efficient administration of justice. While judicial assistants often have principal responsibility for managing various aspects of chambers administration, as a law clerk you should be familiar with the standard operating procedures in your chambers and be available to pitch in when needed. A. Security The safety and security of federal buildings and the people who work in and visit them are major concerns for the U.S. Marshals Service (USMS). Attorneys and other members of the public must pass through magnetometers and have their briefcases and other items screened by an X-ray machine to enter most courthouses and other federal buildings. In addition, all judges’ chambers are equipped 55 Law Clerk Handbook Federal Judicial Center § 4.1.A with an entry control system that consists of a security camera and monitor and a door release strike. Courthouse employees may be issued keycards enabling them to enter the courthouse without passing through metal detectors and to access secured, nonpublic sectors of the building, including judges’ chambers, depending on the individual court’s access-control security plans. Employees may also have after-hours and weekend access to the building through use of these keycards, which should be kept in a secure place and reported immediately if lost. All courthouse employees should carefully follow security procedures and report potential problems to the USMS. The U.S. Marshals Service is principally responsible for security of the court and its personnel, though most courthouse security functions are performed by court security officers (CSOs), who are funded by the judiciary’s Court Security Program and by the Federal Protective Service on a limited basis. Become familiar with the court’s Occupant Emergency Plan and other related USMS security plans in your courthouse, and help to maintain a secure chambers. Do not let unauthorized strangers into secure areas of the courthouse, and report suspicious mail or threatening phone calls. During security-sensitive proceedings, a judge may request that a deputy from the U.S. Marshals Service or a CSO be present in the courtroom. Because federal judges are occasionally the targets of terrorists or disgruntled litigants, be careful when opening mail. Mail received in the courthouse is routinely screened by the USMS before distribution to chambers and offices. Still, it pays to be alert to suspicious-looking items. Common recognition points for letter and package bombs include the following: • foreign mail, air mail, and special delivery • restrictive markings (e.g., confidential, personal) • excessive postage • handwritten or poorly typed addresses • incorrect titles • titles, but no names • misspelled common words • oily stains or discolorations • no return addresses • rigid envelopes • lopsided or uneven envelopes 56 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.C • protruding wires or tinfoil • excessive securing material such as masking tape or string • drawings, diagrams, or illustrations If a letter or package arouses attention, do not attempt to open it. Instead, immediately notify the marshals’ office or a CSO. B. Telephone Practices for dealing with incoming calls (e.g., how to answer the telephone, how to take messages, and when and if to transfer a call to the judge) will vary from chambers to chambers. In general, however, answer calls promptly, identify the office (e.g., “Judge Smith’s chambers”), and treat all callers courteously. And, of course, hold personal calls to a minimum, both in length and in number. See section 2.2.A.1 on communication with the media. C. Correspondence, Email, and Other Mail In addition to correspondence by U.S. postal and messenger service, many chambers now correspond by email with a wide variety of people, including counsel. While email has in some ways made communicating easier and more efficient, it has also made it even more important to stay on top of organizing and processing the mail. Email also presents serious potential problems relating to the accidental forwarding of messages, either to unintended parties or containing information not intended for the recipient. And bear in mind how easily emails can be broadly disseminated through forwarding and posting on websites and social media. Take special care to avoid sending and forwarding email messages that may result in embarrassment, a breach of confidence, or worse, and review and carefully proofread any outgoing messages (and fight the temptation not to proofread email as carefully as paper correspondence). Most chambers have practices and procedures for handling incoming and outgoing mail, including email (whether and when to delete email messages, how to store important messages for future reference, and other matters of email retention and organization). Quickly become familiar with these practices to help mitigate complications arising from the enormous number of emails that many chambers receive. Depending on office procedure, either a judicial assistant or a law clerk will open and review correspondence and make an initial decision concerning how 57 Law Clerk Handbook Federal Judicial Center § 4.1.C it should be handled. Many judges receive their own emails directly, though some may ask staff to review messages first. Incoming mail and emails should be reviewed as soon as they are received because they may relate to matters scheduled for that day. When correspondence referring to a pending suit is forwarded to any counsel of record over the signature of the judge, law clerk, or judicial assistant, copies should be sent to all other counsel of record to avoid inappropriate ex parte contact. Appellate judges seldom correspond directly with counsel on case-related matters, because appellate judges work on cases as part of a panel or court rather than individually. Instead, appellate judges will send instructions to the clerk of court on how to respond to counsel. Correspondence from the general public that is not related to a case is still important because citizens have a right to courteous treatment. Also, the public’s opinions about the fairness, responsiveness, and effectiveness of the judiciary are influenced by the promptness and appropriateness of the court’s answers. In the district court, some of the correspondence from the public involves requests to be excused from jury service. That subject is dealt with in section 4.3.D.2. Some correspondence contains character references on behalf of an offender who is scheduled for sentencing. Judges differ in their handling of such correspondence. Many simply acknowledge receipt of the letter and refer the letter to the probation office. Other correspondence from the public may express reactions to a judge’s ruling. Whether positive or negative, expressions of opinion by members of the public generally call only for courteous acknowledgment, not for an explanation or justification of the judge’s action. If a letter requests information about a ruling, many judges simply acknowledge receipt of the letter and send a copy of the opinion, if there is one. If more information is requested, many judges refer the writer to the record in the clerk of court’s office. Some judges may wish to respond to a letter that indicates a misunderstanding concerning a significant fact, proceeding, or legal conclusion. Judges who adopt this policy may ask law clerks to prepare a draft of a response for the judge to review. The response should not be argumentative or defensive; it should merely state the relevant facts or legal conclusion as necessary to alleviate the misunderstanding. Prisoners and persons who have been convicted and are awaiting sentence frequently write district and appellate judges. Handle the correspondence of a prisoner represented by counsel the same way as that of any other litigant. Ask your judge how to handle correspondence from prisoners who are proceeding pro se. In some instances, this correspondence may be handled by district court pro se law clerks or, in the appellate courts, either the clerk’s office or staff attor58 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.D ney’s office. In other instances, your judge may have a form letter explaining, for example, that federal law prohibits judges from giving legal advice and suggesting that the prisoner communicate with a lawyer, or a form letter for responding to requests for transfers to another penal institution (which only the Bureau of Prisons can grant). You should never write anything in a letter that would give a prisoner false hope or could compromise the position of the court. D. Internet and Electronic Research New law clerks will receive a Westlaw and/or a LexisNexis password, which may come with additional electronic research training and certain usage guidelines. All computer-assisted legal research (CALR) use via judiciary contracts is to be limited to official judiciary-related research purposes. In addition to these research services, the Internet also offers more informal avenues of research, including access to nearly every newspaper and magazine in the country, as well as to government and law school websites, Internet search engines, and myriad other sources. Contact the circuit library CALR coordinator for assistance with CALR access or training. The CALR coordinators and reference librarians are also available to assist with your research questions. Become familiar with fjc.dcn (http://fjc.dcn), the Federal Judicial Center’s site on the judiciary’s intranet. It provides access to manuals, monographs, desk references, and other publications, as well as to web-based training and orientation programs, streaming media programs, discussion forums, and other resources. JNet (http://jnet.ao.dcn), the intranet site maintained by the Administrative Office of the U.S. Courts, offers information and forms on a range of topics relevant to judicial employees, including benefits, court security, emergency preparedness, human resources, information technology, legal and general research, and travel. The Internet has also posed some serious security and usage challenges for employees and information technology departments in courthouses across the country. The judiciary provides you with a computer and Internet access to help you do your work. Depending on the policy in your court or chambers, you may use it on a limited basis for personal needs if doing so does not interfere with your work and does not cause congestion, delay, or disruption of service to any government system. You should not do anything on your office computer that would embarrass you or the court if it were made public. 59 Law Clerk Handbook Federal Judicial Center § 4.1.E E. Electronic Filing The federal judiciary’s Case Management/Electronic Case Filing (CM/ECF) system allows courts to maintain case documents in electronic form and provides enhanced and updated docket management services. It also gives each court the option to permit case documents—pleadings, motions, petitions—to be filed electronically with the court. CM/ECF uses an Internet connection and a browser and accepts documents in Portable Document Format (PDF). It is easy to use. Filers prepare documents using conventional word-processing software and save them as PDF files. After logging on to the court’s website with a court-issued password, the filer enters basic information about the case and document being filed, attaches the document, and submits it to the court. CM/ECF automatically generates a notice verifying that the court received the filing, and it also sends an email to other parties in the case notifying them of the filing. There are no added fees for filing documents using CM/ECF, but existing document filing fees do apply. Litigants receive one free copy of documents filed electronically in their cases, which they can save or print for their files. Public electronic access to court data is available through the Public Access to Court Electronic Records (PACER) program. Additional copies are available for a small fee to attorneys and the general public for viewing or downloading. The process for receiving and reviewing daily filings in the cases filed before the judge may vary among courts and chambers; you should quickly learn the process in your chambers and your role in implementing and maintaining it. Although familiarity with the workings of the system is helpful, you should refer counsel’s questions to docketing clerks or others in the clerk’s office who deal with the system on a daily basis. F. Judge’s Chambers Calendar The judicial assistant is usually in charge of maintaining the chambers calendar covering the judge’s scheduled court proceedings and other activities. If the calendar is maintained online, other staff on the chambers network may also have limited access to the judge’s schedule. In appellate courts, the clerk of court advises the judge of panel assignments and hearing dates. The judicial assistant, in consultation with the judge, will then schedule all other engagements and commitments around the hearings. In trial courts, the judicial assistant usually confers with the judge and then typically advises the courtroom deputy in charge of scheduling the court calendar of the dates on which trials and hearings are to 60 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.H be set. The judicial assistant then schedules the judge’s remaining commitments around the trials and hearings. Some judges choose not to have a judicial assistant, which allows them to have an additional law clerk. In these instances, a law clerk may maintain the chambers calendar. G. Opening Court In district courts, a law clerk or courtroom deputy usually opens court. One common method is for the clerk or deputy to rap on the door before the judge enters, open the door, then call out, “All rise.” The judge then enters and walks to the bench. The law clerk or deputy walks to the front of the bench and says: “The United States District Court for the ____ District of ____ is now in session. The Honorable ______ presiding.” The judge usually stands during this call, then says, “Please be seated,” and sits. H. Maintaining the Library; Office Supplies, Equipment, and Furniture Many chambers maintain their own libraries, though electronic databases and Internet research reduce the need for access to hard-copy sources and have enabled chambers in the same courthouse to share libraries. In any event, the employee who maintains the library, either a law clerk or a judicial assistant, should regularly file any advance sheets, pocket parts, slip opinions, replacement volumes, and inserts for loose-leaf services that arrive in the mail. File materials daily so that library maintenance does not become burdensome and the materials are current. Procurement and ordering of all law books is done by the circuit library; contact the librarian if you have questions. Promptly rubber-stamp every incoming library book to identify it as U.S. property. Keep track of books borrowed by attorneys for courtroom use and make sure that books are not taken outside the chambers and courtroom. Promptly reshelve books used during the course of research. They will then be easier to find, and the library will be neater. Also be sure that legal pads, book markers, pencils, and pens are always available in the library. Requests for supplies, equipment, and furniture ordinarily are handled in the clerk of court’s office. 61 Law Clerk Handbook Federal Judicial Center § 4.1.I I. Maintaining Office Records and Files You may have to maintain some of the records in your judge’s office, including the following: • case files • trial schedules or calendars • “tickler” records to remind the judge about future case activities • indices to the judge’s prior decisions • indices to slip opinions • work papers relating to cases in progress Such materials may be stored in hard copy, electronically, or both. Some chambers may also maintain office form books, either in hard copy or electronically. The form books may contain office procedure checklists and frequently used forms, such as samples of letters, orders, opinions, jury charges, minute entries, and office or file memoranda written by prior law clerks. The books describe the format and method for written documents issued by the judge or presented to the judge by chambers staff. The form books provide continuity and consistency in office administration and can help educate new law clerks. If case records are being used in the judge’s chambers, make sure that the records are not misplaced and are returned to the office of the clerk of court as soon as the judge or staff member has finished with them. J. Statistical Reporting The JS-10 form, “Monthly Report of Trials and Other Court Activity,” is a report of the trials and nontrial proceedings that a district judge conducted during the month. The clerk of the district court submits a JS-10 form to the Administrative Office for each active or senior district judge, plus any visiting district judges or appellate judges, who conducted trials or proceedings in the district during the month. The form reports both the number and type of trials and proceedings and the amount of time the judge spent conducting them. Some judges fill out the forms themselves, but usually a member of the chambers staff or the courtroom deputy fills out the form for the judge. The CM/ECF systems in some courts can automatically generate the JS-10 reports based on additional information about the trials and proceedings entered during the normal docketing process. Data on magistrate judge workloads and activities are collected through the MJSTAR 62 Chambers and Case Management fjc.dcn • fjc.gov § 4.1.L function in district CM/ECF systems, which stores that data in the NewStats database. This includes not only the number of tasks completed by magistrate judges, but the time burden of many of these duties, including time spent with attorneys and parties. Bankruptcy courts report trials and other court activity on a monthly basis using the B-102 form. Courts of appeals use the JS-30 form to report the number of appellate cases, interlocutory appeals, and petitions for rehearing each month. K. Out-of-Town Trips Some judges must travel to other cities to attend court sessions and may require a chambers staff member to travel with them if the court to which they are traveling does not provide staffing. Judges may also travel on court-related business. Judicial assistants usually arrange travel (although when the judge has chosen to have an additional law clerk in lieu of a judicial assistant, a law clerk may have to make travel arrangements). If your judge is traveling to hold court in another location, prepare for the judge to take along necessary case files and materials; any personal notes or memoranda relating to the cases to be heard; the judge’s robe; paper, pencils, stationery, and other needed supplies (if the site for the out-of-town session is one frequently used by the court, there may be a permanent stock of stationery and supplies); necessary equipment such as a gavel, recording or dictating equipment, and a laptop or tablet computer; the briefs and any other case materials; and mailing labels and envelopes for returning material that the judge does not wish to carry back. Judges and chambers staff who travel on court business will be reimbursed for transportation, food, lodging, and related expenses according to the detailed rules set forth in the Guide to Judiciary Policy. These rules generally reimburse either a flat dollar amount per day, regardless of actual expenses, or itemized actual expenses not in excess of a fixed dollar amount. The judicial assistant should have forms for travel reimbursement—these forms can also be found on JNet. Judges must also report travel not related to cases under regulations found in Volume 19, section 270, of the Guide to Judiciary Policy. L. Assisting with Judges’ Extrajudicial Activities Many judges engage in teaching, writing, lecturing, and other extrajudicial activities. While law clerks may be called on to assist judges in these activities, the Code of Conduct for United States Judges says that judges should not use staff “to any 63 Law Clerk Handbook Federal Judicial Center § 4.1.M substantial degree” to engage in extrajudicial activities to improve the law, the legal system, and the administration of justice; and judges should not use staff to engage in other extrajudicial activities, “except for uses that are de minimis.” M. Preserving Chambers Papers for Historical Purposes The chambers papers of a district or appellate court judge have historical significance as an essential supplement to the official court record. Many papers in judges’ chambers are widely considered valuable, such as correspondence and background material concerning a case, including memoranda between judges and law clerks and judges on an appeals panel; drafts of orders and opinions (particularly draft opinions that have handwritten comments on them, or that have been circulated to other judges and returned with their comments); and correspondence/memoranda concerning court administration, legal activities in the community, and issues of governance, politics, and law. Chambers papers are the personal property of the judge. Each judge has the prerogative to make final decisions about the preservation of chambers papers and the terms of access. Judges can preserve their personal papers and make them available for eventual study by donating them to a manuscript repository. An FJC publication, A Guide to the Preservation of Federal Judges’ Papers (3d ed. 2018), reviews the organization and preservation of historically significant records created by federal judges. The Federal Judicial History Office at the FJC will also provide assistance on issues concerning judges’ papers. N. Rules Regarding the Media in Court Guidelines for allowing cameras and electronic reproduction equipment in the courtroom are published in Volume 10 of the Guide to Judiciary Policy. The guidelines allow the photographing, recording, or broadcasting of appellate arguments. In trial courts, a presiding judge may authorize broadcasting, televising, recording, or taking photographs in the courtroom during ceremonial proceedings. For nonceremonial proceedings, such activities may be allowed for presenting evidence, perpetuating a record of the proceedings, and for security or judicial administration purposes. Federal Rule of Criminal Procedure 53 prohibits photographing and radio broadcasting of criminal proceedings. Some circuit judicial councils have adopted specific instructions for the use of cameras in the courtroom. Although local rules restrict the means by which news may be reported (e.g., no cameras or broadcasting from the trial courtroom 64 Chambers and Case Management fjc.dcn • fjc.gov § 4.2 or environs), “there is nothing that proscribes the press from reporting events that transpire in the courtroom.”    § 4.2Local Court Rules and Administrative Policies Section 2071 of Title 28 of the U.S. Code authorizes federal courts to adopt their own rules, which must be consistent with the national rules and available to the public; it also authorizes the circuit judicial council to abrogate district and bankruptcy courts’ local rules, and authorizes the Judicial Conference to abrogate rules of courts of appeals. Federal Rules of Appellate Procedure 47, Bankruptcy Procedure 9029, Civil Procedure 83, and Criminal Procedure 57 provide additional requirements for local rule adoption and characteristics. The local rules of almost all courts follow the same numbering sequence as the corresponding national rules. These local rules include the procedures for setting cases for trial, scheduling pretrial conferences, setting motions for oral argument, serving memoranda of law, and other details relating to trial. They may also state the procedure for admission of attorneys to practice in the specific district or circuit, the term of the court, the functions of the clerk of court, the rules for filing motions, and more specific data, such as the number of copies required to be filed, limitations on the length of memoranda, the time within which memoranda must be filed, and restrictions on page length, typeface, and margin size. Each court of appeals has local rules concerning procedures for ordering transcripts; filing and docketing the appeal; calendaring; motions; summary disposition of appeals; setting cases for oral argument; time limits on oral argument; petitions for rehearing; petitions for en banc consideration; and stay of mandate. The local rules and internal operating procedures of the courts of appeals are printed in the United States Code Annotated following Title 28 of the Judicial Code, and are available on the courts’ websites. A court’s local rules and any internal operating procedures it adopts establish specific procedures for the court and litigants to follow. You should get these rules and procedures from the court’s website or the clerk’s office and become familiar with them. Keep them available for reference and be on the lookout for any modifications the court may adopt. 65 Law Clerk Handbook Federal Judicial Center § 4.3    § 4.3 Case Management: The Trial Court Many judges believe that the responsibility for moving a case through the trial court is not solely that of the attorneys, and the function of the court is not simply to be available if and when counsel want a hearing. The disposition of all cases as speedily and economically as is consistent with justice is paramount. The Federal Rules of Civil Procedure are to be “construed to secure the just, speedy, and inexpensive determination of every action.” Fed. R. Civ. P. 1. The courts are also required to report semiannually (on April 30 and September 30) for each judge the motions that have been pending and the bench trials that have been submitted for more than six months, and cases that have not been terminated within three years of filing, for publication by the Administrative Office. 28 U.S.C. § 476. Effective docket control means that, early in a case, the judge assumes responsibility for guiding the case to a conclusion. This may include establishing deadlines for filing motions, a time limit for discovery, a date for counsel to take the next step in its prosecution, and a trial date. For specific techniques of case management, consult the Civil Litigation Management Manual. See also Schwarzer & Hirsch, The Elements of Case Management (Federal Judicial Center, 3d ed. 2017). Note that many of the same considerations apply in criminal cases, with the additional complication of computations required by the Speedy Trial Act. 18 U.S.C. §§ 3161–3174. Law clerks should be familiar with the requirements of the Act, since failure to bring a case to trial within the Act’s time limits can have serious repercussions. A. Office Status Sheets Some judges maintain an office status sheet and post it where it is accessible to chambers staff. Its purpose is to keep the judge, the law clerks, and judicial assistants apprised of legal matters under advisement and awaiting disposition. When a matter has been taken under advisement, the assistant or law clerk assigned to the case should indicate it on the status sheet. Keep a personal status list, which can be revised each week, listing all matters for which you are responsible. It will help you make effective use of your time and remember all pending assignments. Some judges require their law clerks to submit personal status lists weekly. Some judges require their judicial assistants to keep a list of all pending matters, the initials or name of the law clerk assigned to work on the matter, and 66 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.C any other pertinent information. If so, keep the assistant advised of all matters assigned, matters completed, and other relevant status information. CM/ECF helps judges use computer technology for docket control and to maintain case inventories and case-status records. Other systems may also be employed. Regardless of which system is used, it is important that it be regularly maintained and continually monitored. B. Calendaring Systems Multijudge trial courts need a system for determining which judge is responsible for each case. In an individual calendar system, each case is randomly assigned to a particular judge at the time it is filed, or soon thereafter, and that judge has complete responsibility for the case until it is terminated. There are also standard procedures for reassigning cases from which the original judge is disqualified, for ensuring that related cases are all assigned to the same judge, and for special assignment of unusual and protracted cases. Local rules usually describe these procedures. C. Trial Scheduling A single trial may be set for a specific date, or the court may set multiple cases for trial on the same day. Some courts use the trailing calendar or trailing docket, in which the court schedules a number of cases for trial beginning on a stated date. The cases are tried in the order reflected by the schedule. Counsel must obtain information from the court and from the attorneys whose cases precede them on the calendar about the progress of those cases, so that they can go to trial whenever the court reaches their case. Most civil cases do not go to trial but are disposed of in some other manner, including dispositive motions and settlement. Judges differ in their approach to encouraging settlement, but the decision whether to settle or proceed to trial is the parties’ alone. If settlement is to be reached, negotiations should be completed in a timely manner. Last-minute settlements may disrupt the court’s schedule, leaving the judges, and sometimes jurors, with unscheduled time. The trailing calendar and other multiple-case-setting devices alleviate some problems caused by last-minute settlement by providing substitute cases to replace those that do not go to trial. Although this resolves the court’s problems, it does not resolve the problems that eve-of-trial settlements cause litigants and counsel. 67 Law Clerk Handbook Federal Judicial Center § 4.3.D Criminal cases take priority on the court’s calendar because they must be tried within the time limits set forth in the Speedy Trial Act. While criminal cases do not settle, the vast majority of them are disposed of by way of plea bargaining and guilty pleas, which again make multiple-case-setting an important calendaring device for the court. D. Jury Management 1. Random Juror Selection The selection of grand and petit jurors in both criminal and civil cases is governed by 28 U.S.C. §§ 1861–1878, under which each district must have a jury selection plan that has been approved by a panel comprising the circuit judicial council and the chief district judge or the chief judge’s designee. The statutory goal of the selection process is to ensure “grand and petit juries selected at random from a fair cross section of the community in the district or division wherein the court convenes” (28 U.S.C. § 1861), and to avoid excluding any citizen “from service as a grand or petit juror . . . on account of race, color, religion, sex, national origin, or economic status” (28 U.S.C. § 1862). The clerk of court usually manages the process of selecting prospective jurors, under the supervision and control of the court. Although the jury selection process may differ slightly in each district, it is generally as follows: 1. The clerk’s office performs a random selection of prospective jurors’ names by computer or manually, using voter registration lists or other sources specified by the court’s plan, and places the names selected in a master jury wheel, which is usually a computer file. The minimum number of names in the master jury wheel must be one-half of 1% of the number on the source lists, or 1,000, whichever is less. 2. As needed by the court, the clerk’s office draws names publicly at random from the master jury wheel and sends jury-qualification questionnaires to those persons whose names are drawn. 3. From the responses to the questionnaires, a determination is made as to which persons are qualified for jury service and which persons are disqualified, exempt, or excused. 4. The names of those determined to be qualified are placed in a second jury wheel consisting of qualified jurors. 5. As needed, the clerk’s office selects names from the qualified jury wheel and prepares lists of the names selected. 68 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.D.2 6. The clerk’s office issues summonses to the necessary number of persons needed for the jury venire several weeks in advance of each trial calendar advising those summoned of the time and place to report for jury service. Some district courts qualify and summons jurors in one step and do not establish a qualified jury wheel. 2. Exemptions, Disqualifications, and Excuses A person is qualified for jury service unless the person • is not a citizen of the United States • is unable to read, write, and understand English with a degree of proficiency sufficient to complete the juror-qualification form satisfactorily • is incapable of rendering satisfactory service because of mental or physical infirmity • is charged with or has been convicted in a state or federal court of record of a crime punishable by imprisonment for more than one year without subsequent restoration of civil rights 28 U.S.C. § 1865. Some district courts have adopted other grounds for exemptions, which are specified in the court’s jury selection plan. Section 1863 of Title 18 requires the plan to provide for the exemption of members of the armed forces in active service; members of state or local fire or police departments; and public officers of the federal, state, and local governments who are actively engaged in the performance of official duties. Jury service is a citizen’s duty as well as a privilege, and courts do not readily grant excuses. A person may, however, be excused from jury service temporarily if the plan states that such service would result in undue hardship or extreme inconvenience. In such a case, the name of an excused juror is placed back in the qualified jury wheel. If a prospective juror approaches you about an excuse, do not express any opinion regarding the request, but simply refer the requester to the clerk’s office or jury administrator for action. Treat persons called for jury service with courtesy; they are providing an important service to the court and the public. Judges in multijudge courthouses often begin jury trials at different hours to obtain maximum use of people summoned for jury service, sending persons examined and not selected to another courtroom so they can be examined for 69 Law Clerk Handbook Federal Judicial Center § 4.3.D.3 selection on another jury, and sometimes using jurors who have served in one trial in a succeeding trial. When prospective jury panels report for possible selection in a case, they should be segregated from other people in the courtroom. Law clerks may be responsible for clearing a portion of the spectator section for the jury panel’s exclusive use. 3. Juror Orientation Most courts conduct a juror orientation program to inform jurors of their responsibilities and to explain the trial process. Orientation videos, including the Federal Judicial Center’s Called to Serve, are available in most courts. 4. Voir Dire In most courts, the judge personally conducts voir dire examination. Federal Rule of Civil Procedure 47 and Federal Rule of Criminal Procedure 24, however, authorize the judge to permit the lawyers to conduct voir dire. If the judge conducts voir dire, the rules authorize counsel to submit specific questions or areas of inquiry that they want the judge to probe. In some courts, magistrate judges conduct voir dire. The law in most circuits permits this in civil cases, though some require consent of the parties. The Supreme Court has held that a magistrate judge may conduct voir dire in a criminal case if the defendant consents (Peretz v. United States, 501 U.S. 923 (1991)), but not if the defendant objects (Gomez v. United States, 490 U.S. 858 (1989)). 5. Jury Supervision In most courts, a deputy clerk is responsible for jury supervision. However, sometimes law clerks have this responsibility. If so, you should be present early enough in the morning to accommodate those members of the jury who arrive before the normal court time. The jury room should be open and available for use by the jurors as they arrive. If the judge permits the jury to take notes, either you or the deputy clerk should provide pads of paper and pencils for distribution to the jurors before the trial begins. Extra pads and pencils should also be placed in the jury room for use during deliberations. If you are responsible for jury supervision, ensure that there is no communication—in the courtroom, jury room, or hallways adjacent to the courtroom and chambers—between jurors and litigants, lawyers, witnesses, or others attending court. 70 Chambers and Case Management fjc.dcn • fjc.gov § 4.3.E Jurors are usually free to go where they wish during recesses, and they may go home at night. Occasionally, however, when there is unusual publicity about the trial or there is reason to believe that someone will attempt to exert improper influence on jurors, the judge may direct that the jury be sequestered. When this occurs, deputy marshals keep the jurors together at all times and supervise them when court is not in session. Jurors in criminal and civil cases are sometimes sequestered from the time they begin deliberating until they reach a verdict. Judges sometimes have law clerks steward the jury during deliberations. Some judges require the law clerk to take a special oath with respect to this duty just before the jury retires. Once the oath is taken, the law clerk assumes primary responsibility for guarding the jury until relieved of this duty by the judge. Remain outside the jury-room door during the entire deliberation process and take every reasonable precaution to ensure that the jurors do not come into contact with other people, especially the litigants, their attorneys, or witnesses. You must never comment on the evidence, the litigants, the attorneys, or the witnesses to any juror (or, for that matter, to anyone else). If a juror has any questions about the trial, at any stage, you should simply state that such questions should be addressed to the judge in writing. Do not answer the question, however simple it may appear. E. Distributing Opinions Federal Rule of Civil Procedure 52(a) requires the judge to make findings of fact and conclusions of law in all actions tried without a jury or with only an advisory jury. The rule permits the judge to do this orally on the record or in writing in an opinion or memorandum. The judge may also write a formal opinion to explain rulings on particular motions. The judicial assistant sends the original of the findings or the opinion and the original of any order for judgment to the docket clerk for filing in the official record. Then the judicial assistant or clerk of court sends a copy of each set of findings or the opinion to each counsel of record, making and distributing other copies in accordance with the judge’s instructions. In most district courts, the clerk of court handles the distribution of opinions, but in a few district courts, this responsibility falls to the law clerk or judicial assistant. The judge decides whether the opinion or findings are to be published. If you are responsible for distributing opinions, check with the judge to determine whether the judge wishes the opinion to be published and make such distribution as the judge directs. In each case, the opinion should be accompanied by a cover letter from the judge; the judge may have a form letter for this purpose. 71 Law Clerk Handbook Federal Judicial Center § 4.4    § 4.4 Special Duties of Law Clerks to Bankruptcy Judges The duties of law clerks to bankruptcy judges are generally similar to the duties of those working for district judges. The volume of cases and proceedings in bankruptcy court is generally greater than in other trial courts, and the chambers must be organized to handle this volume effectively. Bankruptcy judges hold more, and faster, hearings than do district judges. For the chambers staff, that means more scheduling problems, more substantial prehearing preparation of memoranda, and shorter time limits. It also means more pressure from attorneys telephoning to ask for expedited schedules and to ask about procedures, the disposition of motions, and various other matters. Like district judges, bankruptcy judges differ in their attitudes about direct contact between law clerks and attorneys. Some bankruptcy judges hold court in more than one place. Law clerks and judicial assistants to those judges usually have substantial duties in preparing for travel, including assembly of materials (such as appropriate portions of case records necessary for the trip). The judge’s staff will usually have extra duties in the additional places of holding court because the other staff available may not be as complete as in the home court.    § 4.5 U.S. Magistrate Judges The authority of magistrate judges derives primarily from the Federal Magistrates Act of 1968 and as amended numerous times since. 28 U.S.C. §§ 631–639. Significant Supreme Court cases interpreting the Act include Mathews v. Weber, 423 U.S. 261 (1976) (upholding magistrate judge authority to hear Social Security appeals on a report and recommendation basis); United States v. Raddatz, 447 U.S. 667 (1980) (upholding magistrate judge authority to conduct hearings on motions to suppress evidence in felony cases on a report and recommendation basis); Peretz v. United States, 501 U.S. 923 (1991) (upholding magistrate judge authority to conduct felony voir dire proceedings with the parties’ consent); and Roell v. Withrow, 538 U.S. 580 (2003) (holding that parties’ consent to disposition of a civil case by a magistrate judge under 28 U.S.C. § 636(c) could be inferred from the parties’ conduct during the case). A general outline of the duties performed by magistrate judges is described below. 72 Chambers and Case Management fjc.dcn • fjc.gov § 4.5.B A. Initial Proceedings in Criminal Cases Under 28  U.S.C. §  636(a), a magistrate judge may perform various duties and conduct proceedings in criminal cases, including the following: • accept criminal complaints • issue arrest warrants and summonses • issue search warrants • conduct initial appearance proceedings and detention for criminal defendants, informing them of the charges against them and of their rights • set bail or other conditions of release or detention under the Bail Reform Act, 18 U.S.C. §§ 3141–3145 • appoint attorneys for defendants who are unable to afford or obtain counsel • hold preliminary examinations, or “probable cause” hearings • administer oaths and take bail, acknowledgments, affidavits, and depositions • conduct extradition proceedings List five similarities and three differences. Use only the Context block contained in the prompt to respond. What are the differences between law clerk duties for a district judge and a bankruptcy judge?",Legal,Concept Comparison,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","I just found out I am pregnant and my doctor's office gave me a long list of things I cannot eat or partake in. Using this article as a reference, please explain what those items are and why they are not acceptable for pregnancy. Use at least 500 words.","Pregnancy nutrition: Foods to avoid during pregnancy More foods can affect your health or your baby's health than you might realize. Learn what not to eat when you're pregnant. By Mayo Clinic Staff You want what's best for your baby. That's why you might do things like add sliced fruit to your fortified breakfast cereal, top your salads with chickpeas or snack on almonds. But do you know what foods not to eat during pregnancy? Here's some basic information about eating during pregnancy. Don't eat seafood high in mercury Seafood can be a great source of protein. And the omega-3 fatty acids in many fish can help your baby's brain and eye development. But some fish and shellfish have levels of mercury that could be harmful. Too much mercury could damage your baby's growing nervous system. The bigger and older the fish, the more mercury it's likely to contain. The U.S. Food and Drug Administration (FDA) says not to eat the following while pregnant: Bigeye tuna. King mackerel. Marlin. Orange roughy. Swordfish. Shark. Tilefish. So what's safe? Some types of seafood have little mercury. The Dietary Guidelines for Americans advises pregnant people to eat 8 to 12 ounces (224 to 336 grams) of seafood a week. That's 2 to 3 servings. Here are some options: Anchovies. Black sea bass. Catfish. Cod. Freshwater trout. Herring. Light canned tuna. Oysters. Pollock. Salmon. Sardines. Shad. Shrimp. Sole. Tilapia. Whitefish. Don't eat raw, undercooked or tainted seafood To avoid harmful bacteria or viruses in seafood: Don't eat raw fish and shellfish. Examples of raw or undercooked foods to avoid include sushi, sashimi, ceviche and raw oysters, scallops or clams. Don't eat uncooked seafood that's refrigerated. Examples include seafood labeled nova style, lox, kippered, smoked or jerky. It's OK to eat smoked seafood if it's in a casserole or other cooked dish. Canned and shelf-stable versions also are safe. Watch for local fish advisories. If you eat fish from local waters, check for fish advisories to see how often you can safely eat those fish. Make sure to do this when water pollution is a concern. If you're not sure about the safety of fish you have already eaten, don't eat any more fish that week. Cook seafood well. Cook fish to an inside temperature of 145 F (63 C). Fish is done when it flakes with a fork and looks milky white throughout. Cook shrimp, lobster and scallops until they're milky white. Cook clams, mussels and oysters until their shells open. Throw away any that don't open. Don't eat undercooked meat, poultry or eggs During pregnancy, you're at a higher risk of food poisoning from bacteria. This is called foodborne illness. How your body reacts to food poisoning when you're pregnant might be worse than if you weren't pregnant. Although it's rare, food poisoning may affect the baby, too. To prevent foodborne illness: Fully cook all meats and poultry before eating. Use a meat thermometer to make sure. Cook hot dogs and lunch meats until they're steaming hot. Or don't eat them at all. They can be sources of a rare but serious foodborne illness known as a listeria infection. Don't eat pates and meat spreads that are stored in a refrigerator. Canned and shelf-stable versions are OK. Cook eggs until the egg yolks and whites are firm. Raw eggs can have harmful bacteria. Don't eat foods that may be made with raw or partly cooked eggs. Examples include homemade eggnog, raw batter and dough, tiramisu, freshly made or homemade hollandaise sauce, homemade Caesar salad dressing and homemade ice cream. Don't eat ready-made meat salads or seafood salads. These include ham salad, tuna salad and chicken salad. Don't eat unpasteurized foods Many low-fat dairy products can be a healthy part of your diet. These include skim milk, mozzarella cheese and cottage cheese. But don't eat or drink anything that contains milk that hasn't gone through a process called pasteurization. Products that have unpasteurized milk could cause foodborne illness. Avoid soft cheeses, such as brie, feta and blue cheese, unless the label says they're pasteurized or made with pasteurized milk. Don't drink juice or cider that isn't pasteurized. Don't eat unwashed fruits and vegetables To get rid of harmful bacteria, wash all raw fruits and vegetables well. Don't eat any raw sprouts, including alfalfa, clover, radish and mung bean. They might have harmful bacteria. Be sure to fully cook sprouts. Don't have too much caffeine Caffeine can cross to the baby, but the effects on the baby aren't clear. To be safe, your health care professional might tell you not to have caffeine while pregnant. Or you may be told to limit caffeine to less than 200 milligrams (mg) a day. An 8-ounce (240-milliliters, or mL) cup of brewed coffee has about 95 mg of caffeine. An 8-ounce (240-mL) cup of brewed tea has about 47 mg. And a 12-ounce (360-mL) cola with caffeine has about 33 mg. Don't drink herbal tea Not much is known about the effects of certain herbs on fetuses. As a result, don't drink herbal tea unless your health care professional says it's OK. That includes the types of herbal tea made for pregnancy. Don't drink alcohol No amount of alcohol has been proved safe during pregnancy. To be safe, don't drink any alcohol. Consider the risks. Drinking alcohol during pregnancy leads to a higher risk of miscarriage and stillbirth. Drinking alcohol also may result in fetal alcohol syndrome. The syndrome can cause the face to form oddly and cause lower intelligence. If you're worried about alcohol you drank before you knew you were pregnant, or if you think you need help to stop drinking, talk to your health care professional.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I just found out I am pregnant and my doctor's office gave me a long list of things I cannot eat or partake in. Using this article as a reference, please explain what those items are and why they are not acceptable for pregnancy. Use at least 500 words. Pregnancy nutrition: Foods to avoid during pregnancy More foods can affect your health or your baby's health than you might realize. Learn what not to eat when you're pregnant. By Mayo Clinic Staff You want what's best for your baby. That's why you might do things like add sliced fruit to your fortified breakfast cereal, top your salads with chickpeas or snack on almonds. But do you know what foods not to eat during pregnancy? Here's some basic information about eating during pregnancy. Don't eat seafood high in mercury Seafood can be a great source of protein. And the omega-3 fatty acids in many fish can help your baby's brain and eye development. But some fish and shellfish have levels of mercury that could be harmful. Too much mercury could damage your baby's growing nervous system. The bigger and older the fish, the more mercury it's likely to contain. The U.S. Food and Drug Administration (FDA) says not to eat the following while pregnant: Bigeye tuna. King mackerel. Marlin. Orange roughy. Swordfish. Shark. Tilefish. So what's safe? Some types of seafood have little mercury. The Dietary Guidelines for Americans advises pregnant people to eat 8 to 12 ounces (224 to 336 grams) of seafood a week. That's 2 to 3 servings. Here are some options: Anchovies. Black sea bass. Catfish. Cod. Freshwater trout. Herring. Light canned tuna. Oysters. Pollock. Salmon. Sardines. Shad. Shrimp. Sole. Tilapia. Whitefish. Don't eat raw, undercooked or tainted seafood To avoid harmful bacteria or viruses in seafood: Don't eat raw fish and shellfish. Examples of raw or undercooked foods to avoid include sushi, sashimi, ceviche and raw oysters, scallops or clams. Don't eat uncooked seafood that's refrigerated. Examples include seafood labeled nova style, lox, kippered, smoked or jerky. It's OK to eat smoked seafood if it's in a casserole or other cooked dish. Canned and shelf-stable versions also are safe. Watch for local fish advisories. If you eat fish from local waters, check for fish advisories to see how often you can safely eat those fish. Make sure to do this when water pollution is a concern. If you're not sure about the safety of fish you have already eaten, don't eat any more fish that week. Cook seafood well. Cook fish to an inside temperature of 145 F (63 C). Fish is done when it flakes with a fork and looks milky white throughout. Cook shrimp, lobster and scallops until they're milky white. Cook clams, mussels and oysters until their shells open. Throw away any that don't open. Don't eat undercooked meat, poultry or eggs During pregnancy, you're at a higher risk of food poisoning from bacteria. This is called foodborne illness. How your body reacts to food poisoning when you're pregnant might be worse than if you weren't pregnant. Although it's rare, food poisoning may affect the baby, too. To prevent foodborne illness: Fully cook all meats and poultry before eating. Use a meat thermometer to make sure. Cook hot dogs and lunch meats until they're steaming hot. Or don't eat them at all. They can be sources of a rare but serious foodborne illness known as a listeria infection. Don't eat pates and meat spreads that are stored in a refrigerator. Canned and shelf-stable versions are OK. Cook eggs until the egg yolks and whites are firm. Raw eggs can have harmful bacteria. Don't eat foods that may be made with raw or partly cooked eggs. Examples include homemade eggnog, raw batter and dough, tiramisu, freshly made or homemade hollandaise sauce, homemade Caesar salad dressing and homemade ice cream. Don't eat ready-made meat salads or seafood salads. These include ham salad, tuna salad and chicken salad. Don't eat unpasteurized foods Many low-fat dairy products can be a healthy part of your diet. These include skim milk, mozzarella cheese and cottage cheese. But don't eat or drink anything that contains milk that hasn't gone through a process called pasteurization. Products that have unpasteurized milk could cause foodborne illness. Avoid soft cheeses, such as brie, feta and blue cheese, unless the label says they're pasteurized or made with pasteurized milk. Don't drink juice or cider that isn't pasteurized. Don't eat unwashed fruits and vegetables To get rid of harmful bacteria, wash all raw fruits and vegetables well. Don't eat any raw sprouts, including alfalfa, clover, radish and mung bean. They might have harmful bacteria. Be sure to fully cook sprouts. Don't have too much caffeine Caffeine can cross to the baby, but the effects on the baby aren't clear. To be safe, your health care professional might tell you not to have caffeine while pregnant. Or you may be told to limit caffeine to less than 200 milligrams (mg) a day. An 8-ounce (240-milliliters, or mL) cup of brewed coffee has about 95 mg of caffeine. An 8-ounce (240-mL) cup of brewed tea has about 47 mg. And a 12-ounce (360-mL) cola with caffeine has about 33 mg. Don't drink herbal tea Not much is known about the effects of certain herbs on fetuses. As a result, don't drink herbal tea unless your health care professional says it's OK. That includes the types of herbal tea made for pregnancy. Don't drink alcohol No amount of alcohol has been proved safe during pregnancy. To be safe, don't drink any alcohol. Consider the risks. Drinking alcohol during pregnancy leads to a higher risk of miscarriage and stillbirth. Drinking alcohol also may result in fetal alcohol syndrome. The syndrome can cause the face to form oddly and cause lower intelligence. If you're worried about alcohol you drank before you knew you were pregnant, or if you think you need help to stop drinking, talk to your health care professional. https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/pregnancy-nutrition/art-20043844",Medical,Explanation/Definition,Q&A You must respond using only information provided in the prompt. Explain your reasoning with at least 3 supporting points.,What is the probable date range for this document,"The main challenges are, if such divergence simply reflects differences in financial market structures and regulatory/supervisory tools and instruments as well as with a principles-based approach, or a IPOL | Policy Department for Economic, Scientific and Quality of Life Policies PE 740.067 46 more fundamental shift towards a less regulated financial system that focuses on growth and ‘competitiveness’ of the sector and less on its stability. It is important to stress, however, that not all observers, and none of our interviewees, see necessarily a contradiction between growth/competitiveness and stability, even though economic research has shown that rapid growth of the financial sector can result in financial fragility and crisis. 3.2.1. Low, medium and high divergence Low divergence: Under this scenario, there will be adjustments to regulations such as Solvency II as well as other initiatives in line with increasing the ‘competitiveness’ of the UK as financial centre. However, there will not be major divergence, especially in areas with international standards, such as bank capital regulation. There might be informal consultations between UK and EU regulatory and possibly legislative authorities to converge on rules in new areas such as crypto and the decentralised financial system more generally. Even under the politically most positive developments (as described below in 3.2.2), however, there will be divergence between the UK and EU, also as EU Law is significantly amended with the UK not following it (in other words, passive divergence). Regulatory cooperation, however, will allow for such divergence not to turn into beggar-thy-neighbour policies. Apart from resolving the political conflict around the Northern Ireland Protocol (NIP), a reconfirmation of the stability focus of the prudential policies and regulation in the UK is necessary in our opinion. In terms of specific segments of the financial system, we would expect least divergence in areas where international standards play an important role, such as capital and liquidity regulation of banks. Interestingly, it seems that the EU is diverging more from the initial global standards than the UK (see discussion above in 3.1). Similarly, given the early initiative that EU authorities have taken with the green taxonomy and the joint participation in many global fora and other cooperation initiatives, we would also expect the UK to follow the lead in this area, as already discussed above, even though there might be a certain degree of divergence. It is important to stress that many of the legislative initiatives in sustainable finance in the UK are still in the early stages and one has to look beyond political headlines to details once they are spelled out. Medium divergence: Under this scenario, there will be more significant divergence and fewer attempts to converge on new rules such as in the area of green finance or crypto asset developments. Divergence will be more likely and more prominent in areas where international standards are less important and where the UK has not inherited any EU regulations such as in the two areas already mentioned, green finance and crypto. While supervisory cooperation between EU and UK authorities might continue (and will be necessary in areas of regulatory equivalence), regulatory cooperation even if formalised will be less strong and there will not necessarily be any voluntary attempt by UK authorities to follow adjustments and changes in EU regulation and supervision. On the other hand, both the UK and the EU are members of global regulatory bodies across different segments of the financial system (FSB, Basel Committee) and this will effectively be a constraint on too much positive or negative divergence. High divergence: Under this final scenario, there would be a rather aggressive legislative and regulatory drive in the UK to diverge from EU rules. This would involve both replacing existing EU rules with new regulation and adopting divergent rules where such rules were not inherited, such as in green finance and crypto/digital finance more broadly. It can also include not following changes in EU legislation to thus mark differences between the two regulatory jurisdictions. We would expect such aggressive divergence especially in areas where UK authorities see growth opportunities and they feel less constrained by international fora and cooperation initiatives. Crypto is certainly an area where one could envision such aggressive divergence. Such high divergence, however, seems more likely under Recent trends in UK financial sector regulation and possible implications for the EU 47 PE 740.067 an institutional architecture in the UK where the independence of regulatory authorities has been significantly weakened (though not necessarily in a formal, i.e., legislative manner) and growth/competitiveness objectives are clearly prioritised over stability concerns. As we will discuss in section 3.2.2, which of the three scenarios will develop depends very much on how the overall political relationship between the EU and the UK will develop over the next years, with the Northern Ireland Protocol being the major hurdle in this relationship. 3.2.2. Disentangling the Northern Ireland Protocol situation to unblock/reactivate UKEU regulatory cooperation Resolving the dispute between the UK and the EU on the implementation of the Northern Ireland Protocol (NIP) seems key to rebuild trust and unblock UK-EU regulatory cooperation across a number of policy areas including the financial sector. Resolving this dispute requires political leadership from the UK Prime Minister taking office in October 2022, Rishi Sunak, and bringing on board both the European Research Group (ERG) of hardcore Brexiters in the British Parliament and Northern Ireland’s Unionists, not an easy feat. While immediate conflicts can be avoided by delaying the legislative process of the NIP Bill (which would override and breach the NIP and the Withdrawal Agreement), cooperation between UK and EU authorities on trade data provision from the UK to the EU, and not taking unilateral steps, the resolution of the ‘stand-off’ cannot be delayed forever. Namely, the Northern Ireland Executive has not been established since the 2022 May elections and new elections to the Legislative Assembly will have to be called in spring 2023, which raise the political temperature in the region. The upcoming 25th anniversary of the Good Friday Agreement in 2023 increases both internal and external (especially from the US) pressures. Finally, in case of increasing divergence in goods standards between the UK and the EU, there will be increasing pressure from the EU on properly monitoring trade between Great Britain and Northern Ireland. In case the conflict around the Northern Ireland Protocol can be resolved to the satisfaction of both sides, there should be few if any barriers for future cooperation between UK and EU authorities on financial sector issues. Addressing the stand-off around the NIP is thus a necessary though not sufficient condition. At the end of November 2022, the Council Presidency and the European Parliament actually reached a provisional agreement on a Regulation on ‘autonomous measures’ potentially taken as a retaliation and that would allow the EU to ensure ‘timely and effective exercise of its rights in enforcing and implementing’ the Withdrawal Agreement and the TCA162. At the same time, not long after, the European Commission Vice President Maroš Šefčovič stressed the ‘window of opportunity for a positive outcome’163 in the context of the extension of practical arrangements for veterinary medicines until December 2025. This positive ‘mood music’ has been echoed by Leo Varadkar, the Taoiseach in Ireland, who stressed the increased trust and flexibility between the UK and the EU – notwithstanding remaining differences164. There will certainly be competing interests (similar to what we could observe during the UK’s EU membership) and no expectations of complete convergence, but an institutional framework for regulatory dialogue could be put in place. 162 Council of the EU, ‘EU-UK Relations: Council Presidency and European Parliament Reach Provisional Agreement on a Regulation on Autonomous Measures’ (30 November 2022) https://www.consilium.europa.eu/en/press/press-releases/2022/11/30/eu-uk-relationscouncil-presidency-and-european-parliament-reach-provisional-agreement-on-a-regulation-on-autonomous-measures/, accessed 5 January 2023. 163 ‘Statement by Vice-President Maroš Šefčovič’ (European Commission, 19 December 2022) https://ec.europa.eu/commission/presscorner/detail/en/statement_22_7831, accessed 5 January 2023. 164 “Much Better Mood Music” in EU-UK Relations than at Any Period since Brexit Referendum - Taoiseach’ (n 22). IPOL | Policy Department for Economic, Scientific and Quality of Life Policies PE 740.067 48 Before the resolution of this conflict, it is difficult to see any progress happening in terms of regulatory cooperation. Similar, if the conflict around the NIP escalates again, it is hard to envision any progress towards trade partnership of the UK with third countries such as the US.","You must respond using only information provided in the prompt. Explain your reasoning with at least 3 supporting points. The main challenges are, if such divergence simply reflects differences in financial market structures and regulatory/supervisory tools and instruments as well as with a principles-based approach, or a IPOL | Policy Department for Economic, Scientific and Quality of Life Policies PE 740.067 46 more fundamental shift towards a less regulated financial system that focuses on growth and ‘competitiveness’ of the sector and less on its stability. It is important to stress, however, that not all observers, and none of our interviewees, see necessarily a contradiction between growth/competitiveness and stability, even though economic research has shown that rapid growth of the financial sector can result in financial fragility and crisis. 3.2.1. Low, medium and high divergence Low divergence: Under this scenario, there will be adjustments to regulations such as Solvency II as well as other initiatives in line with increasing the ‘competitiveness’ of the UK as financial centre. However, there will not be major divergence, especially in areas with international standards, such as bank capital regulation. There might be informal consultations between UK and EU regulatory and possibly legislative authorities to converge on rules in new areas such as crypto and the decentralised financial system more generally. Even under the politically most positive developments (as described below in 3.2.2), however, there will be divergence between the UK and EU, also as EU Law is significantly amended with the UK not following it (in other words, passive divergence). Regulatory cooperation, however, will allow for such divergence not to turn into beggar-thy-neighbour policies. Apart from resolving the political conflict around the Northern Ireland Protocol (NIP), a reconfirmation of the stability focus of the prudential policies and regulation in the UK is necessary in our opinion. In terms of specific segments of the financial system, we would expect least divergence in areas where international standards play an important role, such as capital and liquidity regulation of banks. Interestingly, it seems that the EU is diverging more from the initial global standards than the UK (see discussion above in 3.1). Similarly, given the early initiative that EU authorities have taken with the green taxonomy and the joint participation in many global fora and other cooperation initiatives, we would also expect the UK to follow the lead in this area, as already discussed above, even though there might be a certain degree of divergence. It is important to stress that many of the legislative initiatives in sustainable finance in the UK are still in the early stages and one has to look beyond political headlines to details once they are spelled out. Medium divergence: Under this scenario, there will be more significant divergence and fewer attempts to converge on new rules such as in the area of green finance or crypto asset developments. Divergence will be more likely and more prominent in areas where international standards are less important and where the UK has not inherited any EU regulations such as in the two areas already mentioned, green finance and crypto. While supervisory cooperation between EU and UK authorities might continue (and will be necessary in areas of regulatory equivalence), regulatory cooperation even if formalised will be less strong and there will not necessarily be any voluntary attempt by UK authorities to follow adjustments and changes in EU regulation and supervision. On the other hand, both the UK and the EU are members of global regulatory bodies across different segments of the financial system (FSB, Basel Committee) and this will effectively be a constraint on too much positive or negative divergence. High divergence: Under this final scenario, there would be a rather aggressive legislative and regulatory drive in the UK to diverge from EU rules. This would involve both replacing existing EU rules with new regulation and adopting divergent rules where such rules were not inherited, such as in green finance and crypto/digital finance more broadly. It can also include not following changes in EU legislation to thus mark differences between the two regulatory jurisdictions. We would expect such aggressive divergence especially in areas where UK authorities see growth opportunities and they feel less constrained by international fora and cooperation initiatives. Crypto is certainly an area where one could envision such aggressive divergence. Such high divergence, however, seems more likely under Recent trends in UK financial sector regulation and possible implications for the EU 47 PE 740.067 an institutional architecture in the UK where the independence of regulatory authorities has been significantly weakened (though not necessarily in a formal, i.e., legislative manner) and growth/competitiveness objectives are clearly prioritised over stability concerns. As we will discuss in section 3.2.2, which of the three scenarios will develop depends very much on how the overall political relationship between the EU and the UK will develop over the next years, with the Northern Ireland Protocol being the major hurdle in this relationship. 3.2.2. Disentangling the Northern Ireland Protocol situation to unblock/reactivate UKEU regulatory cooperation Resolving the dispute between the UK and the EU on the implementation of the Northern Ireland Protocol (NIP) seems key to rebuild trust and unblock UK-EU regulatory cooperation across a number of policy areas including the financial sector. Resolving this dispute requires political leadership from the UK Prime Minister taking office in October 2022, Rishi Sunak, and bringing on board both the European Research Group (ERG) of hardcore Brexiters in the British Parliament and Northern Ireland’s Unionists, not an easy feat. While immediate conflicts can be avoided by delaying the legislative process of the NIP Bill (which would override and breach the NIP and the Withdrawal Agreement), cooperation between UK and EU authorities on trade data provision from the UK to the EU, and not taking unilateral steps, the resolution of the ‘stand-off’ cannot be delayed forever. Namely, the Northern Ireland Executive has not been established since the 2022 May elections and new elections to the Legislative Assembly will have to be called in spring 2023, which raise the political temperature in the region. The upcoming 25th anniversary of the Good Friday Agreement in 2023 increases both internal and external (especially from the US) pressures. Finally, in case of increasing divergence in goods standards between the UK and the EU, there will be increasing pressure from the EU on properly monitoring trade between Great Britain and Northern Ireland. In case the conflict around the Northern Ireland Protocol can be resolved to the satisfaction of both sides, there should be few if any barriers for future cooperation between UK and EU authorities on financial sector issues. Addressing the stand-off around the NIP is thus a necessary though not sufficient condition. At the end of November 2022, the Council Presidency and the European Parliament actually reached a provisional agreement on a Regulation on ‘autonomous measures’ potentially taken as a retaliation and that would allow the EU to ensure ‘timely and effective exercise of its rights in enforcing and implementing’ the Withdrawal Agreement and the TCA162. At the same time, not long after, the European Commission Vice President Maroš Šefčovič stressed the ‘window of opportunity for a positive outcome’163 in the context of the extension of practical arrangements for veterinary medicines until December 2025. This positive ‘mood music’ has been echoed by Leo Varadkar, the Taoiseach in Ireland, who stressed the increased trust and flexibility between the UK and the EU – notwithstanding remaining differences164. There will certainly be competing interests (similar to what we could observe during the UK’s EU membership) and no expectations of complete convergence, but an institutional framework for regulatory dialogue could be put in place. 162 Council of the EU, ‘EU-UK Relations: Council Presidency and European Parliament Reach Provisional Agreement on a Regulation on Autonomous Measures’ (30 November 2022) https://www.consilium.europa.eu/en/press/press-releases/2022/11/30/eu-uk-relationscouncil-presidency-and-european-parliament-reach-provisional-agreement-on-a-regulation-on-autonomous-measures/, accessed 5 January 2023. 163 ‘Statement by Vice-President Maroš Šefčovič’ (European Commission, 19 December 2022) https://ec.europa.eu/commission/presscorner/detail/en/statement_22_7831, accessed 5 January 2023. 164 “Much Better Mood Music” in EU-UK Relations than at Any Period since Brexit Referendum - Taoiseach’ (n 22). IPOL | Policy Department for Economic, Scientific and Quality of Life Policies PE 740.067 48 Before the resolution of this conflict, it is difficult to see any progress happening in terms of regulatory cooperation. Similar, if the conflict around the NIP escalates again, it is hard to envision any progress towards trade partnership of the UK with third countries such as the US. What is the probable date range for this document",Legal,Fact Finding,Q&A Please only use the provided information to answer the question. Do not use any external knowledge or prior knowledge. The answer should be extracted based on the text only.,"Based on the provided text, can you provide the steps taken when leave is needed for FMLA? ","Employees must provide a 30-day advance notice to employers when the need for leave is foreseeable based on an expected birth or a scheduled medical treatment.52 When the need for leave is not foreseeable (e.g., hospitalization resulting from an automobile accident) or when leave is needed to address a qualifying military exigency, notice must be given “as soon as practicable.”53 In some cases, an employer may delay approval of FMLA leave when advance notice requirements are not met. Compliance with Employers’ Policy for Requesting Leave In general, employers may condition FMLA leave approval upon an employee’s adherence to the employer’s policy for requesting leave.54 For example, if established in employer policy, an employer may require written request for leave, or require the employee to call-in prior to an absence when using intermittent leave. There are limits, however, on when employer policy can be used to deny or delay FMLA leave. Employers may not apply a longer notice period than the 30-day notice provided in the act (e.g., the employer cannot require a 45-day notice). An FMLA leave request that does not meet employer policy may not be denied if unusual circumstances prevent the employee from following employer policy (e.g., emergency medical treatment is required). Scheduling Planned Medical Treatment and Leave When the need for FMLA leave is based on a planned medical treatment and is foreseeable, the employee must make a reasonable effort to schedule the treatment so as not to disrupt unduly the business operations.55 Plans made between the employer and employee regarding scheduling of leave and the timing of planned medical treatment are subject to the approval of the employee’s health care provider. Employer Rights to Require Certification In some instances, employers may require that an employee’s request for FMLA leave be supported by medical certification (e.g., that a serious health condition exists) or other certification (e.g., to determine active duty status of a military member).56 Employers must notify employees each time certification is required, and inform employees of the anticipated consequences should the employee fail to provide certification (e.g., denial of leave). Medical Certification of a Serious Health Condition An employer may require an employee requesting leave for a serious health condition—his or her own, or that of a family member—to provide medical certification verifying that such a condition exists, and related information.57 A new certification of a serious health condition can be required every 12 months.","System Instruction: Please only use the provided information to answer the question. Do not use any external knowledge or prior knowledge. The answer should be extracted based on the text only. Question: Based on the provided text, can you provide the steps taken when leave is needed for FMLA? Context block: Employees must provide a 30-day advance notice to employers when the need for leave is foreseeable based on an expected birth or a scheduled medical treatment.52 When the need for leave is not foreseeable (e.g., hospitalization resulting from an automobile accident) or when leave is needed to address a qualifying military exigency, notice must be given “as soon as practicable.”53 In some cases, an employer may delay approval of FMLA leave when advance notice requirements are not met. Compliance with Employers’ Policy for Requesting Leave In general, employers may condition FMLA leave approval upon an employee’s adherence to the employer’s policy for requesting leave.54 For example, if established in employer policy, an employer may require written request for leave, or require the employee to call-in prior to an absence when using intermittent leave. There are limits, however, on when employer policy can be used to deny or delay FMLA leave. Employers may not apply a longer notice period than the 30-day notice provided in the act (e.g., the employer cannot require a 45-day notice). An FMLA leave request that does not meet employer policy may not be denied if unusual circumstances prevent the employee from following employer policy (e.g., emergency medical treatment is required). Scheduling Planned Medical Treatment and Leave When the need for FMLA leave is based on a planned medical treatment and is foreseeable, the employee must make a reasonable effort to schedule the treatment so as not to disrupt unduly the business operations.55 Plans made between the employer and employee regarding scheduling of leave and the timing of planned medical treatment are subject to the approval of the employee’s health care provider. Employer Rights to Require Certification In some instances, employers may require that an employee’s request for FMLA leave be supported by medical certification (e.g., that a serious health condition exists) or other certification (e.g., to determine active duty status of a military member).56 Employers must notify employees each time certification is required, and inform employees of the anticipated consequences should the employee fail to provide certification (e.g., denial of leave). Medical Certification of a Serious Health Condition An employer may require an employee requesting leave for a serious health condition—his or her own, or that of a family member—to provide medical certification verifying that such a condition exists, and related information.57 A new certification of a serious health condition can be required every 12 months.",Legal,Effect Analysis,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",What is the purpose of the medication Amlodipine and what are some of the potential side effects of its usage? Make your response no less than 150 words.,"Why is this medication prescribed? Amlodipine is used alone or in combination with other medications to treat high blood pressure in adults and children 6 years and older. It is also used to treat certain types of angina (chest pain) and coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Amlodipine is in a class of medications called calcium channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood to the heart. If taken regularly, amlodipine controls chest pain, but it does not stop chest pain once it starts. Your doctor may prescribe a different medication to take when you have chest pain. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation. How should this medicine be used? Amlodipine comes as a tablet, an oral solution (liquid), and a suspension (liquid) to take by mouth. It is usually taken once a day with or without food. Take amlodipine around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amlodipine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Shake the suspension well before each use to mix the medication evenly. Your doctor will probably start you on a low dose of amlodipine and gradually increase your dose. Amlodipine helps to control high blood pressure, angina, and coronary artery disease, but does not cure these conditions. Continue to take amlodipine even if you feel well. Do not stop taking amlodipine without talking to your doctor. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking amlodipine, tell your doctor and pharmacist if you are allergic to amlodipine, any other medications, or any ingredients in amlodipine tablets, oral solution, or suspension. Ask your pharmacist for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have or have ever had heart failure or heart or liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking amlodipine, call your doctor. What special dietary instructions should I follow? If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully. What should I do if I forget a dose? Take the missed dose as soon as you remember it. However, if it is less than 12 hours until your next scheduled dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? Amlodipine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: swelling of the hands, feet, ankles, or lower legs nausea stomach pain dizziness or lightheadedness muscle stiffness or tremors Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment: more frequent or more severe chest pain rapid, pounding, or irregular heartbeat If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What is the purpose of the medication Amlodipine and what are some of the potential side effects of its usage? Make your response no less than 150 words. {passage 0} ========== Why is this medication prescribed? Amlodipine is used alone or in combination with other medications to treat high blood pressure in adults and children 6 years and older. It is also used to treat certain types of angina (chest pain) and coronary artery disease (narrowing of the blood vessels that supply blood to the heart). Amlodipine is in a class of medications called calcium channel blockers. It lowers blood pressure by relaxing the blood vessels so the heart does not have to pump as hard. It controls chest pain by increasing the supply of blood to the heart. If taken regularly, amlodipine controls chest pain, but it does not stop chest pain once it starts. Your doctor may prescribe a different medication to take when you have chest pain. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation. How should this medicine be used? Amlodipine comes as a tablet, an oral solution (liquid), and a suspension (liquid) to take by mouth. It is usually taken once a day with or without food. Take amlodipine around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take amlodipine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Shake the suspension well before each use to mix the medication evenly. Your doctor will probably start you on a low dose of amlodipine and gradually increase your dose. Amlodipine helps to control high blood pressure, angina, and coronary artery disease, but does not cure these conditions. Continue to take amlodipine even if you feel well. Do not stop taking amlodipine without talking to your doctor. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking amlodipine, tell your doctor and pharmacist if you are allergic to amlodipine, any other medications, or any ingredients in amlodipine tablets, oral solution, or suspension. Ask your pharmacist for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have or have ever had heart failure or heart or liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking amlodipine, call your doctor. What special dietary instructions should I follow? If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully. What should I do if I forget a dose? Take the missed dose as soon as you remember it. However, if it is less than 12 hours until your next scheduled dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? Amlodipine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: swelling of the hands, feet, ankles, or lower legs nausea stomach pain dizziness or lightheadedness muscle stiffness or tremors Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment: more frequent or more severe chest pain rapid, pounding, or irregular heartbeat If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). https://medlineplus.gov/druginfo/meds/a692044.html",Medical,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","My son has severe eczema. I want to understand more about it and how to treat it at home. Using this article, please explain what eczema is and how to treat it. Use at least 400 words.","Eczema, a.k.a., atopic dermatitis, is a chronic skin condition that causes patches of red, dry, and flaky skin that can trigger maddening itching and sometimes soreness and pain, too—the result of a rogue inflammatory response attacking your skin, which happens to be the largest organ in your body. Its symptoms can vary in both appearance and severity among different people and ethnic groups, per the National Eczema Association(NEA). And sometimes, the way people with eczema describe their condition varies, too. Take the term “papular” eczema. Some info-seekers out there who rely too much on Dr. Google might think this is a legit (and unique) type of atopic dermatitis—but our expert dermatologists are here to set the record straight. Papular Eczema What Is Papular Eczema? “Papular eczema really doesn’t mean something specific but when I imagine it, I imagine bumps rather than plaques,” says Scott Elman, M.D., a dermatologist and assistant professor of clinical dermatology and cutaneous surgery at University of Miami Health in Florida. These bumps, rather than flat, inflamed plaques, may be what eczema more often looks like on darker skin tones, adds Jeff Yu, M.D., a dermatologist at Massachusetts General Hospital and assistant professor of dermatology at Harvard Medical School in Boston. “We use that term but only for certain ethnic groups. We tend to see eczema that’s a little bit bumpier in African Americans and other people of color,” explains Dr. Yu. Meanwhile, Amy Paller, M.D., the chair of the Department of Dermatology at Northwestern Medicine in Evanston, IL, questions the term entirely. “I’ve never heard [of] ‘papular’ eczema,” she says. “We call it atopic dermatitis.” Meaning, people who say they have papular eczema likely mean their eczema is more bumpy than patchy. And those bumps may be more common in darker skin. But at the end of the day, it’s all just atopic dermatitis. Symptoms What Are the Symptoms of Papular Eczema? If your eczema is of the papular variety, you’ll likely see small, raised bumps on your skin rather than large, flat rashes. This symptom is more often seen on the skin of Black and brown people, say our experts. Beyond that, the majority of atopic dermatitis symptoms are the same. Here’s what you might experience, and it can happen anywhere on your body: Darkening of the skin around your eyes Dry, cracked skin Itching Oozing and crusting on the inflamed skin Raw, sensitive skin from scratching Swollen skin with a rash Thickened skin According to Dr. Elman, bumps, rashes, and irritated and inflamed skin can all look different on different people. On lighter skin, these skin symptoms look pink or red. On darker skin, areas affected by eczema may look more purple, burgundy, or brown. “That inflammation is absolutely seen differently on different skin tones,” adds Dr. Elman. “The redness may be more subtle. It could be a bit more purple. And it might be harder to discern on darker skin.” Causes What Causes Eczema? Your skin, when it’s acting like it’s supposed to, serves as a barrier between the inside of your body and the outside world. But, in eczema, “the skin barrier just stops working as well, so the body is exposed to things that it isn’t used to seeing, and that can trigger flares,” says Dr. Elman. A few things might cause that dysfunction in your skin barrier. For starters, your genes. Some people are born with a gene variant that interferes with the skin's ability to protect as it should, acording to Mayo Clinic. Bacteria is another possible culprit, per Mayo. Too much of the bacteria Staphylococcus aureus (or just “staph” for short) on the skin can crowd out the good bacteria and keep your skin barrier from doing its job. Either way, it’s that defective skin barrier that leads to all the problems in eczema. When you have a weak skin barrier, your skin can’t hold in moisture as well. And it’s unable to keep out bacteria, irritants, allergens, and potential environmental triggers like cigarette smoke. That faulty skin barrier—or all the germs and other stuff that creep in as a result—can set off an immune system reaction that leads to that itchy, inflamed, and irritated skin that you probably know all too well, Dr. Elman says. Diagnosis How Is Papular Eczema Diagnosed? There is no blood test, biopsy, or X-ray for atopic dermatitis. Instead, your dermatologist or primary care physician will likely look at your skin to check for the physical signs and symptoms of atopic dermatitis, Dr. Yu explains. Then they might ask whether you have family members with eczema. They may also want to know if you or a family member has food allergies, seasonal allergies or asthma since those can be risk factors for eczema, per the NEA. If your doctor does order some testing for you, these are usually done to rule out other problems, like a specific allergy for which you’d need what’s called a patch test. Home Remedies Home Remedies for Eczema If you’ve got mild eczema, chances are you can get it under control on your own. “Most people who have very mild eczema probably don't end up seeing a dermatologist,” Dr. Yu confirms. According to Dr. Yu, you might be able to keep your symptoms at bay with some of the following DIY and OTC solutions: Moisturize Your Skin It’s critical to moisturize as soon as you get out of the tub or the shower. “It’s important that you’re using moisturizing ointments, something that has the consistency of Vaseline or Aquaphor,” Dr. Yu advises. There’s a specific protocol for moisturizing when you have eczema: After bathing in lukewarm water, pat your skin dry, and never rub it. Apply any topical medications that you use. Then, within three minutes of patting dry, while the skin is still damp, slather on your moisturizer. This “soak and seal” method locks moisture in and reseals that broken skin barrier. Add Some Oatmeal Studies show that colloidal oatmeal can help bring moisture back to eczema skin. You can: Add it to your lukewarm bath Make it into a paste and press it directly into the affected area Use eczema products containing it Soak in a Bleach Bath “When you do a diluted bleach bath, similar to the concentration you find in a swimming pool, it has actually shown to be very anti-inflammatory,” says Dr. Yu. The NEA recommends a 10-minute bleach bath two to three times each week. Add a half-cup of household bleach to a full tub of lukewarm water. Soak for 10 minutes. Rinse off with clean water. Then, pat dry. P.S.: A 10-minute dip in the swimming pool gets the job done, too! Moisturizing Oils Some—but not all—oils can bring relief to eczema-inflamed skin. There’s evidence that sunflower oil, coconut oil, and shea butter have benefits for this type of irritation. But you can’t just grab any old oil from your kitchen. “Stay away from olive oil, advises Dr. Yu. “The fatty acids found in olive oil actually promote the growth of yeast on your skin.” You apply coconut or other oils to the skin twice a day, just as you would any moisturizer. Ideally, one application per day is right after you bathe when your skin is still damp. If coconut oil is your pick, go for “virgin” or “cold-pressed.” Any other extraction method uses chemicals that could irritate your skin even more, say the NEA. Anti-Itch Cream Use OTC Anti-Itch Cream Try an anti-itch cream containing 1% hydrocortisone no more than twice a day on the irritated areas. Apply it after your bath and before you moisturize. This steroid calms down itching, swelling and irritation by quelling the body’s inflammatory response.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. My son has severe eczema. I want to understand more about it and how to treat it at home. Using this article, please explain what eczema is and how to treat it. Use at least 400 words. Eczema, a.k.a., atopic dermatitis, is a chronic skin condition that causes patches of red, dry, and flaky skin that can trigger maddening itching and sometimes soreness and pain, too—the result of a rogue inflammatory response attacking your skin, which happens to be the largest organ in your body. Its symptoms can vary in both appearance and severity among different people and ethnic groups, per the National Eczema Association(NEA). And sometimes, the way people with eczema describe their condition varies, too. Take the term “papular” eczema. Some info-seekers out there who rely too much on Dr. Google might think this is a legit (and unique) type of atopic dermatitis—but our expert dermatologists are here to set the record straight. Papular Eczema What Is Papular Eczema? “Papular eczema really doesn’t mean something specific but when I imagine it, I imagine bumps rather than plaques,” says Scott Elman, M.D., a dermatologist and assistant professor of clinical dermatology and cutaneous surgery at University of Miami Health in Florida. These bumps, rather than flat, inflamed plaques, may be what eczema more often looks like on darker skin tones, adds Jeff Yu, M.D., a dermatologist at Massachusetts General Hospital and assistant professor of dermatology at Harvard Medical School in Boston. “We use that term but only for certain ethnic groups. We tend to see eczema that’s a little bit bumpier in African Americans and other people of color,” explains Dr. Yu. Meanwhile, Amy Paller, M.D., the chair of the Department of Dermatology at Northwestern Medicine in Evanston, IL, questions the term entirely. “I’ve never heard [of] ‘papular’ eczema,” she says. “We call it atopic dermatitis.” Meaning, people who say they have papular eczema likely mean their eczema is more bumpy than patchy. And those bumps may be more common in darker skin. But at the end of the day, it’s all just atopic dermatitis. Symptoms What Are the Symptoms of Papular Eczema? If your eczema is of the papular variety, you’ll likely see small, raised bumps on your skin rather than large, flat rashes. This symptom is more often seen on the skin of Black and brown people, say our experts. Beyond that, the majority of atopic dermatitis symptoms are the same. Here’s what you might experience, and it can happen anywhere on your body: Darkening of the skin around your eyes Dry, cracked skin Itching Oozing and crusting on the inflamed skin Raw, sensitive skin from scratching Swollen skin with a rash Thickened skin According to Dr. Elman, bumps, rashes, and irritated and inflamed skin can all look different on different people. On lighter skin, these skin symptoms look pink or red. On darker skin, areas affected by eczema may look more purple, burgundy, or brown. “That inflammation is absolutely seen differently on different skin tones,” adds Dr. Elman. “The redness may be more subtle. It could be a bit more purple. And it might be harder to discern on darker skin.” Causes What Causes Eczema? Your skin, when it’s acting like it’s supposed to, serves as a barrier between the inside of your body and the outside world. But, in eczema, “the skin barrier just stops working as well, so the body is exposed to things that it isn’t used to seeing, and that can trigger flares,” says Dr. Elman. A few things might cause that dysfunction in your skin barrier. For starters, your genes. Some people are born with a gene variant that interferes with the skin's ability to protect as it should, acording to Mayo Clinic. Bacteria is another possible culprit, per Mayo. Too much of the bacteria Staphylococcus aureus (or just “staph” for short) on the skin can crowd out the good bacteria and keep your skin barrier from doing its job. Either way, it’s that defective skin barrier that leads to all the problems in eczema. When you have a weak skin barrier, your skin can’t hold in moisture as well. And it’s unable to keep out bacteria, irritants, allergens, and potential environmental triggers like cigarette smoke. That faulty skin barrier—or all the germs and other stuff that creep in as a result—can set off an immune system reaction that leads to that itchy, inflamed, and irritated skin that you probably know all too well, Dr. Elman says. Diagnosis How Is Papular Eczema Diagnosed? There is no blood test, biopsy, or X-ray for atopic dermatitis. Instead, your dermatologist or primary care physician will likely look at your skin to check for the physical signs and symptoms of atopic dermatitis, Dr. Yu explains. Then they might ask whether you have family members with eczema. They may also want to know if you or a family member has food allergies, seasonal allergies or asthma since those can be risk factors for eczema, per the NEA. If your doctor does order some testing for you, these are usually done to rule out other problems, like a specific allergy for which you’d need what’s called a patch test. Home Remedies Home Remedies for Eczema If you’ve got mild eczema, chances are you can get it under control on your own. “Most people who have very mild eczema probably don't end up seeing a dermatologist,” Dr. Yu confirms. According to Dr. Yu, you might be able to keep your symptoms at bay with some of the following DIY and OTC solutions: Moisturize Your Skin It’s critical to moisturize as soon as you get out of the tub or the shower. “It’s important that you’re using moisturizing ointments, something that has the consistency of Vaseline or Aquaphor,” Dr. Yu advises. There’s a specific protocol for moisturizing when you have eczema: After bathing in lukewarm water, pat your skin dry, and never rub it. Apply any topical medications that you use. Then, within three minutes of patting dry, while the skin is still damp, slather on your moisturizer. This “soak and seal” method locks moisture in and reseals that broken skin barrier. Add Some Oatmeal Studies show that colloidal oatmeal can help bring moisture back to eczema skin. You can: Add it to your lukewarm bath Make it into a paste and press it directly into the affected area Use eczema products containing it Soak in a Bleach Bath “When you do a diluted bleach bath, similar to the concentration you find in a swimming pool, it has actually shown to be very anti-inflammatory,” says Dr. Yu. The NEA recommends a 10-minute bleach bath two to three times each week. Add a half-cup of household bleach to a full tub of lukewarm water. Soak for 10 minutes. Rinse off with clean water. Then, pat dry. P.S.: A 10-minute dip in the swimming pool gets the job done, too! Moisturizing Oils Some—but not all—oils can bring relief to eczema-inflamed skin. There’s evidence that sunflower oil, coconut oil, and shea butter have benefits for this type of irritation. But you can’t just grab any old oil from your kitchen. “Stay away from olive oil, advises Dr. Yu. “The fatty acids found in olive oil actually promote the growth of yeast on your skin.” You apply coconut or other oils to the skin twice a day, just as you would any moisturizer. Ideally, one application per day is right after you bathe when your skin is still damp. If coconut oil is your pick, go for “virgin” or “cold-pressed.” Any other extraction method uses chemicals that could irritate your skin even more, say the NEA. Anti-Itch Cream Use OTC Anti-Itch Cream Try an anti-itch cream containing 1% hydrocortisone no more than twice a day on the irritated areas. Apply it after your bath and before you moisturize. This steroid calms down itching, swelling and irritation by quelling the body’s inflammatory response. https://www.healthcentral.com/condition/eczema/papular-eczema",Medical,Explanation/Definition,Q&A Use only information from the provided context,how does rop apply to photographs?,"State Right of Publicity Laws The ROP is protected in some form by the laws of most U.S. states, and the number of states that recognize this right has expanded over the past several decades. One study found that 35 states recognized the ROP as of 2020. ROP laws generally create a private right of action for the unauthorized commercial use of another person’s NIL. For example, if a manufacturer uses a famous athlete’s name or face in a TV commercial without her permission, the athlete could sue the manufacturer for violating her ROP, and a court could order the manufacturer to pay damages and stop showing the commercial. What constitutes an unauthorized commercial use of NIL can vary from state to state. Some states’ ROP laws may apply only to advertising, while others more broadly apply to any use that commercially benefits the user, such as video game or comic book characters based on real people. Other notable differences between the ROP laws of various states concern questions such as: • Is the ROP protected by statute, common law, or both? Twenty-five states have enacted statutes protecting the ROP. In some of these states, including California, the ROP is protected by both statutes and common law (law derived from court opinions). In Congressional Research Service https://crsreports.congress.gov LSB11052 Congressional Research Service 2 other states, including Delaware, the ROP is protected by common law only, sometimes as an application of a common law “right of privacy.” • What parts of a person’s identity does the ROP protect? The ROP often only protects a person’s NIL, voice, and signature. In some states, the ROP also includes someone’s “distinctive appearance, gestures, or mannerisms.” Courts have construed certain states’ ROP laws to protect more abstract aspects of personal identity, finding defendants liable for using an image of a famous driver’s race car, a blonde robot performing Vanna White’s role on a game show, or the catch phrase “here’s Johnny.” • Do all individuals enjoy the ROP? State laws vary as to whether all persons or only those with “commercially valuable” NIL (such as celebrities) may assert ROP claims. • Does the ROP survive a person’s death? In some states, the ROP is descendible, meaning it can be asserted by one’s heirs after a person dies. States that recognize a descendible (or postmortem) ROP differ as to their duration, with postmortem rights lasting 20 years in Virginia, 70 years in California, and 100 years in Oklahoma, for instance. Under Tennessee law, postmortem ROP may last indefinitely. In other states, the ROP is not descendible, or else courts have not resolved the issue. Often, the law of the state in which a person is domiciled—or, where they were domiciled when they died—governs their ROP. Indiana’s ROP statute, however, allows suit “regardless of a personality’s domicile” for infringing materials “disseminated within Indiana.” This law may allow non-Indiana plaintiffs to sue for infringing materials that are made available in Indiana via television or the internet. Intersection of Right of Publicity and Federal IP Laws Although the ROP is distinct from the forms of IP already protected by federal law, it is related in some ways to trademarks and copyrights. If Congress chooses to regulate the ROP via federal law, it may consider how best to harmonize the ROP with existing trademark and copyright laws. Trademarks While the ROP generally protects commercial uses of a person’s identity, trademarks protect commercial uses of words, names, and other symbols that distinguish one person’s goods from others. The ROP may overlap with trademarks in cases where aspects of a person’s NIL can be trademarked. A person’s name, for instance, may be trademarked if it acquires a distinctive meaning and is used commercially to identify goods or services (e.g., McDonald’s). The ROP may be seen as serving a similar function to trademarks, although some scholars have criticized the theoretical foundations and expansion of the ROP. Trademark infringement occurs when someone without authorization uses a trademark in a way that creates a likelihood of confusion for consumers. The Lanham Act—the federal trademark law—also establishes a cause of action for “false endorsement,” which provides additional protection that overlaps with the ROP. False endorsement occurs when a person’s identity is used in a way that is likely to confuse consumers into believing that the person recommends a product. In 2023, for instance, actor Tom Hanks alerted fans that an AI-generated replica of him was being used to advertise a dental plan without his permission; such scenarios might give rise to both state ROP and Lanham Act false endorsement claims. State ROP laws can provide broader protection than the Lanham Act, however, as they often prohibit unauthorized commercial uses of NIL regardless of whether they imply any sponsorship or confuse consumers. In addition, some courts have held only individuals with “recognizability” (such as Hanks) may sue for false endorsement, whereas many state laws allow all individuals to sue for ROP violations. Congressional Research Service 3 Copyrights Copyrights protect original works of authorship that are “fixed” (i.e., recorded) in a “tangible medium,” including books, paintings, music recordings, and films. The Copyright Act gives copyright owners the “exclusive right” to reproduce (copy), perform, display, and distribute copyrighted works and to make derivative works (adaptations) from them. Generally, a work’s author automatically owns the copyright but may sell or license it to others. In short, whereas ROP laws prohibit unauthorized uses of another person’s identity, copyright law prohibits unauthorized uses of another’s creative works. As one illustration, in January 2024, the estate of comedian George Carlin filed a lawsuit based on an unauthorized comedy program delivered in an AI-generated imitation of Carlin’s voice. The complaint claims defendants infringed their copyrights by making copies of Carlin’s works to train the AI model— similar to other AI-related copyright lawsuits noted in a separate Legal Sidebar—and that defendants violated Carlin’s ROP under California law by using his NIL to promote the comedy program and other media. The ROP intersects with copyright law inasmuch as both fictional and nonfictional copyrighted works often include the NIL of real people, including descriptions, portrayals, recordings, or performances of those people. For example, people depicted in photographs often do not hold the copyright, since the photographer is usually considered the author, but they may have ROP interests implicated by how those photos are used. These rights may come into conflict, such as when a copyright owner displays photographs in a way that commercially exploits the NIL of people shown in the photographs. Section 301 of the Copyright Act provides that the Copyright Act preempts (supersedes) any state law rights that are “equivalent to” a copyright holder’s exclusive rights. Some commentators argue courts have inconsistently applied Section 301 in cases where copyrights conflict with the ROP. Some courts have dismissed lawsuits that allege copyright holders violated the ROP by exercising their exclusive rights under the Copyright Act. For instance, in 2017, one court held that Section 301 preempted a suit claiming the sale of photographs of NCAA athletes violated the athletes’ ROP. Other courts have held that Section 301 does not preempt ROP claims based on advertising. For example, one court held that a sports announcer’s ROP claim was not preempted where an excerpt of his voice from a copyrighted broadcast was used in a commercial for a video game. Congress could clarify the scope of copyright preemption of ROP claims by amending Section 301. In addition, if Congress enacts any new protections for ROP at the federal level, it may specify under what circumstances copyright would preempt such protections. ROP laws can protect commercial interests in live performances, which cannot be copyrighted unless they are “fixed” (e.g., filmed). In the Supreme Court’s only ROP case to date, for instance, a performer sued a television company for broadcasting his “human cannonball” act, undermining ticket sales for the act. The Supreme Court held that the First Amendment did not prevent the performer from asserting a ROP claim against the company. As an exception to the rule that live performances have no copyright protection, in 1994 Congress provided criminal and civil liability for recording and distributing live music performances without permission, although some courts have questioned these laws’ constitutionality.","Use only information from the provided context how does rop apply to photographs? State Right of Publicity Laws The ROP is protected in some form by the laws of most U.S. states, and the number of states that recognize this right has expanded over the past several decades. One study found that 35 states recognized the ROP as of 2020. ROP laws generally create a private right of action for the unauthorized commercial use of another person’s NIL. For example, if a manufacturer uses a famous athlete’s name or face in a TV commercial without her permission, the athlete could sue the manufacturer for violating her ROP, and a court could order the manufacturer to pay damages and stop showing the commercial. What constitutes an unauthorized commercial use of NIL can vary from state to state. Some states’ ROP laws may apply only to advertising, while others more broadly apply to any use that commercially benefits the user, such as video game or comic book characters based on real people. Other notable differences between the ROP laws of various states concern questions such as: • Is the ROP protected by statute, common law, or both? Twenty-five states have enacted statutes protecting the ROP. In some of these states, including California, the ROP is protected by both statutes and common law (law derived from court opinions). In Congressional Research Service https://crsreports.congress.gov LSB11052 Congressional Research Service 2 other states, including Delaware, the ROP is protected by common law only, sometimes as an application of a common law “right of privacy.” • What parts of a person’s identity does the ROP protect? The ROP often only protects a person’s NIL, voice, and signature. In some states, the ROP also includes someone’s “distinctive appearance, gestures, or mannerisms.” Courts have construed certain states’ ROP laws to protect more abstract aspects of personal identity, finding defendants liable for using an image of a famous driver’s race car, a blonde robot performing Vanna White’s role on a game show, or the catch phrase “here’s Johnny.” • Do all individuals enjoy the ROP? State laws vary as to whether all persons or only those with “commercially valuable” NIL (such as celebrities) may assert ROP claims. • Does the ROP survive a person’s death? In some states, the ROP is descendible, meaning it can be asserted by one’s heirs after a person dies. States that recognize a descendible (or postmortem) ROP differ as to their duration, with postmortem rights lasting 20 years in Virginia, 70 years in California, and 100 years in Oklahoma, for instance. Under Tennessee law, postmortem ROP may last indefinitely. In other states, the ROP is not descendible, or else courts have not resolved the issue. Often, the law of the state in which a person is domiciled—or, where they were domiciled when they died—governs their ROP. Indiana’s ROP statute, however, allows suit “regardless of a personality’s domicile” for infringing materials “disseminated within Indiana.” This law may allow non-Indiana plaintiffs to sue for infringing materials that are made available in Indiana via television or the internet. Intersection of Right of Publicity and Federal IP Laws Although the ROP is distinct from the forms of IP already protected by federal law, it is related in some ways to trademarks and copyrights. If Congress chooses to regulate the ROP via federal law, it may consider how best to harmonize the ROP with existing trademark and copyright laws. Trademarks While the ROP generally protects commercial uses of a person’s identity, trademarks protect commercial uses of words, names, and other symbols that distinguish one person’s goods from others. The ROP may overlap with trademarks in cases where aspects of a person’s NIL can be trademarked. A person’s name, for instance, may be trademarked if it acquires a distinctive meaning and is used commercially to identify goods or services (e.g., McDonald’s). The ROP may be seen as serving a similar function to trademarks, although some scholars have criticized the theoretical foundations and expansion of the ROP. Trademark infringement occurs when someone without authorization uses a trademark in a way that creates a likelihood of confusion for consumers. The Lanham Act—the federal trademark law—also establishes a cause of action for “false endorsement,” which provides additional protection that overlaps with the ROP. False endorsement occurs when a person’s identity is used in a way that is likely to confuse consumers into believing that the person recommends a product. In 2023, for instance, actor Tom Hanks alerted fans that an AI-generated replica of him was being used to advertise a dental plan without his permission; such scenarios might give rise to both state ROP and Lanham Act false endorsement claims. State ROP laws can provide broader protection than the Lanham Act, however, as they often prohibit unauthorized commercial uses of NIL regardless of whether they imply any sponsorship or confuse consumers. In addition, some courts have held only individuals with “recognizability” (such as Hanks) may sue for false endorsement, whereas many state laws allow all individuals to sue for ROP violations. Congressional Research Service 3 Copyrights Copyrights protect original works of authorship that are “fixed” (i.e., recorded) in a “tangible medium,” including books, paintings, music recordings, and films. The Copyright Act gives copyright owners the “exclusive right” to reproduce (copy), perform, display, and distribute copyrighted works and to make derivative works (adaptations) from them. Generally, a work’s author automatically owns the copyright but may sell or license it to others. In short, whereas ROP laws prohibit unauthorized uses of another person’s identity, copyright law prohibits unauthorized uses of another’s creative works. As one illustration, in January 2024, the estate of comedian George Carlin filed a lawsuit based on an unauthorized comedy program delivered in an AI-generated imitation of Carlin’s voice. The complaint claims defendants infringed their copyrights by making copies of Carlin’s works to train the AI model— similar to other AI-related copyright lawsuits noted in a separate Legal Sidebar—and that defendants violated Carlin’s ROP under California law by using his NIL to promote the comedy program and other media. The ROP intersects with copyright law inasmuch as both fictional and nonfictional copyrighted works often include the NIL of real people, including descriptions, portrayals, recordings, or performances of those people. For example, people depicted in photographs often do not hold the copyright, since the photographer is usually considered the author, but they may have ROP interests implicated by how those photos are used. These rights may come into conflict, such as when a copyright owner displays photographs in a way that commercially exploits the NIL of people shown in the photographs. Section 301 of the Copyright Act provides that the Copyright Act preempts (supersedes) any state law rights that are “equivalent to” a copyright holder’s exclusive rights. Some commentators argue courts have inconsistently applied Section 301 in cases where copyrights conflict with the ROP. Some courts have dismissed lawsuits that allege copyright holders violated the ROP by exercising their exclusive rights under the Copyright Act. For instance, in 2017, one court held that Section 301 preempted a suit claiming the sale of photographs of NCAA athletes violated the athletes’ ROP. Other courts have held that Section 301 does not preempt ROP claims based on advertising. For example, one court held that a sports announcer’s ROP claim was not preempted where an excerpt of his voice from a copyrighted broadcast was used in a commercial for a video game. Congress could clarify the scope of copyright preemption of ROP claims by amending Section 301. In addition, if Congress enacts any new protections for ROP at the federal level, it may specify under what circumstances copyright would preempt such protections. ROP laws can protect commercial interests in live performances, which cannot be copyrighted unless they are “fixed” (e.g., filmed). In the Supreme Court’s only ROP case to date, for instance, a performer sued a television company for broadcasting his “human cannonball” act, undermining ticket sales for the act. The Supreme Court held that the First Amendment did not prevent the performer from asserting a ROP claim against the company. As an exception to the rule that live performances have no copyright protection, in 1994 Congress provided criminal and civil liability for recording and distributing live music performances without permission, although some courts have questioned these laws’ constitutionality.",Internet/Technology,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]","My daughter just turned 16 and we are looking at buying her her first car. We want to make sure that she's safe, especially during winter as we live in Montana where it gets very snowy. She likes to listen to her music from her iPhone while driving. Which car would be our best option?","Best New Cars for Teens Under $30,000 2024 Toyota Prius Starting Price: $29,045 | Rating: 4.8 2024 Toyota Prius Limited The Toyota Prius is the car that made “hybrid” a household word. Toyota redesigned the Prius for 2023, molding it into the sleek shape of a speedster. Well, it’s not that. However, it still manages an impressive combined driving fuel economy of 57 mpg. Students heading for the snow belt can add all-wheel drive (AWD). Its rear-seat legroom is about average for the segment. The IIHS named the Prius to its Top Safety Pick+ list. Every Prius comes with automatic emergency braking with pedestrian detection, lane-departure warning with steering assist, adaptive cruise control, lane-keeping assist, and high-beam assist. Blind-spot monitoring and rear cross-traffic alert come standard as well. If the new models are out of your price range, the previous-generation Prius is also an excellent choice. See Toyota Prius models for sale near you Compare dealer offers 2024 Honda Civic Starting Price: $25,045 | Rating: 4.7 2024 Honda Civic Sedan in red driving on a road. The Civic made our list of picks for several reasons, including the fact that it’s a frequent Kelley Blue Book Best Buy Award winner. In addition, the all-new Civic retook the throne as our Compact Car Best Buy for 2022 and repeated for 2023 and 2024. The IIHS named it a Top Safety Pick, and it earned a 5-Star safety rating from NHTSA. It also gets a government-estimated 36 mpg in combined driving. Every 2024 Civic arrives with the Honda Sensing suite of driver aids, including forward collision warning, auto emergency braking, lane-departure warning, lane-keeping assist, and adaptive cruise control. Connectivity technology includes Apple CarPlay and Android Auto, one USB port, and Bluetooth connectivity. Honda typically doesn’t offer option packages. To gain more content, you must move up in trim level. And look to the hatchback model ($26,045) for more cargo space. See Honda Civic models for sale near you Compare dealer offers 2024 Toyota Corolla Starting Price: $23,145 | Rating: 4.4 2023 Toyota Corolla in white near a lake. The carryover Toyota Corolla was an IIHS Top Safety Pick for 2023. It also boasts low cost-to-own figures and historically good reliability. The Corolla’s starting price reflects the entry-level LE model. It offers standard equipment like automatic climate control, remote keyless entry, and a rear-seat center armrest. Every 2024 Corolla comes with Toyota’s Safety Sense 3.0. This advanced driver assistance technology suite includes pre-collision with pedestrian detection, automatic emergency braking, adaptive cruise control, lane-departure warning, lane-keeping assist, traffic sign recognition, and automatic high beams. The optional Premium Package offers a blind-spot monitor with a rear cross-traffic alert system, which is great for teen drivers. Connectivity features include Bluetooth, voice recognition, four USB ports, Amazon Alexa, Apple CarPlay, Android Auto, and Wi-Fi capability. The Environmental Protection Agency’s (EPA) government-certified combined fuel economy is 35 mpg. See Toyota Corolla models for sale near you Compare dealer offers 2024 Kia Seltos Starting Price: $25,865 | Rating: 4.8 2024 Kia Seltos SX in white near Palm Springs at sunset. Every version of the surprisingly roomy Kia Seltos subcompact SUV comes with a full suite of safety features, including forward collision warning with emergency braking, driver attention warning, lane-departure warning, lane-keeping assist, lane centering, and high-beam assist. To add blind-spot monitoring and rear cross-traffic alert, you must move up to the S grade, adding $600 to the bottom line. Connectivity features include Bluetooth with voice recognition, Apple CarPlay, Android Auto, and one USB port. With a second-row seat large enough to accommodate adults, Seltos also provides class-leading cargo space. See Kia Seltos models for sale near you Compare dealer offers 2024 Subaru Crosstrek Starting Price: $26,540 | Rating: 4.6 2024 Subaru Crosstrek in blue near white fence. Redesigned for 2024, Subaru’s go-anywhere Crosstrek is an IIHS Top Safety Pick. It comes standard with AWD backed by a continuously variable automatic transmission (CVT). Fuel economy is a respectable 29 mpg combined or 27 in Wilderness trim. Every Crosstrek comes standard with Subaru’s EyeSight Driver Assist Technology. It also boasts forward collision warning with automatic emergency braking, lane-keeping assist, and adaptive cruise control. A blind-spot monitor with rear cross-traffic alert is optional or standard on upper trim levels. Connectivity includes dual 7-inch touchscreens, Apple CarPlay, Android Auto (wireless is an option), Bluetooth connectivity, and hands-free phone integration. See Subaru Crosstrek models for sale near you Compare dealer offers 2024 Hyundai Kona Starting Price: $25,625 | Rating: 4.8 2024 Hyundai Kona Limited in Mirage Green with hills in the background. Totally redesigned for 2024, the Hyundai Kona offers tremendous value as a subcompact SUV with eye-catching exterior styling. Its small size makes parking easy, a big plus for teens. The rear cargo area is well suited to carry gear. In addition, Apple CarPlay and Android Auto connectivity come standard. Fuel economy is as good as 35 mpg on the highway with the gas engine. An all-electric version (EV) is also available. The IIHS named the Kona to the TSP+ list. There is plenty of value here, as even the base SE model comes standard with blind-spot monitoring, lane-keeping assist, forward collision-avoidance assist, lane-change assist, and rear cross-traffic collision warning. A 12.3-inch touchscreen and wireless Apple CarPlay and Android Auto are also included. See Hyundai Kona models for sale near you Compare dealer offers 2024 Chevrolet Trailblazer Starting Price: $24,395 | Rating: 4.2 2024 Chevrolet Trailblazer ACTIV in white near a cabin. Being one of Chevy’s smaller SUVs doesn’t stop the Trailblazer from being a considerable value. Some exterior restyling for 2024 dramatically improves its curb appeal. Moreover, the increased number of standard features for 2024 makes it more fetching than ever. Its standard advanced safety features include automatic forward emergency braking with pedestrian detection, lane-keeping assist, and lane departure warning. High-beam assist is also standard. We recommend opting for the $345 Driver Confidence Package that adds blind-spot monitoring and rear cross-traffic alert. It’s a bargain. Fundamentally unchanged since the IIHS named it a TSP+ winner in 2022, the Trailblazer remains a safe pick for teens. With the most rear-seat legroom in its class and a little better than average cargo space, the Trailblazer is an impressive hauler. At 30 mpg, its combined fuel economy is above average among rivals. You can add AWD for $2,000. See Chevrolet Trailblazer models for sale near you Compare dealer offers 2024 Nissan Sentra Starting Price: $22,320 | Rating: 4.0 2024 Nissan Sentra SR in blue near a directional sign. The most affordable new car on this list, the Nissan Sentra offers a bit of sportiness for teens, plus practicality and upscale styling. This compact car has “zero gravity” seats designed to be comfortable when driving to school or a job. The Sentra delivers fuel economy as good as 40 mpg on the highway (34 mpg in mixed city/highway driving), so trips to the gas station won’t be too frequent. Apple CarPlay and Android Auto are standard on all models. In addition to 10 airbags, even the base grade comes with the full suite of SafetyShield 360 driver aids, including auto emergency braking with pedestrian detection, rear cross-traffic alert, rear automatic braking, blind-spot warning, lane-departure warning, and high-beam assist. Essentially unchanged since it was added to the IIHS 2022 TSP+ list, the Sentra is still a solid safety pick for teens."," Only use the provided text to answer the question, no outside sources. My daughter just turned 16 and we are looking at buying her her first car. We want to make sure that she's safe, especially during winter as we live in Montana where it gets very snowy. She likes to listen to her music from her iPhone while driving. Which car would be our best option? Best New Cars for Teens Under $30,000 2024 Toyota Prius Starting Price: $29,045 | Rating: 4.8 2024 Toyota Prius Limited The Toyota Prius is the car that made “hybrid” a household word. Toyota redesigned the Prius for 2023, molding it into the sleek shape of a speedster. Well, it’s not that. However, it still manages an impressive combined driving fuel economy of 57 mpg. Students heading for the snow belt can add all-wheel drive (AWD). Its rear-seat legroom is about average for the segment. The IIHS named the Prius to its Top Safety Pick+ list. Every Prius comes with automatic emergency braking with pedestrian detection, lane-departure warning with steering assist, adaptive cruise control, lane-keeping assist, and high-beam assist. Blind-spot monitoring and rear cross-traffic alert come standard as well. If the new models are out of your price range, the previous-generation Prius is also an excellent choice. See Toyota Prius models for sale near you Compare dealer offers 2024 Honda Civic Starting Price: $25,045 | Rating: 4.7 2024 Honda Civic Sedan in red driving on a road. The Civic made our list of picks for several reasons, including the fact that it’s a frequent Kelley Blue Book Best Buy Award winner. In addition, the all-new Civic retook the throne as our Compact Car Best Buy for 2022 and repeated for 2023 and 2024. The IIHS named it a Top Safety Pick, and it earned a 5-Star safety rating from NHTSA. It also gets a government-estimated 36 mpg in combined driving. Every 2024 Civic arrives with the Honda Sensing suite of driver aids, including forward collision warning, auto emergency braking, lane-departure warning, lane-keeping assist, and adaptive cruise control. Connectivity technology includes Apple CarPlay and Android Auto, one USB port, and Bluetooth connectivity. Honda typically doesn’t offer option packages. To gain more content, you must move up in trim level. And look to the hatchback model ($26,045) for more cargo space. See Honda Civic models for sale near you Compare dealer offers 2024 Toyota Corolla Starting Price: $23,145 | Rating: 4.4 2023 Toyota Corolla in white near a lake. The carryover Toyota Corolla was an IIHS Top Safety Pick for 2023. It also boasts low cost-to-own figures and historically good reliability. The Corolla’s starting price reflects the entry-level LE model. It offers standard equipment like automatic climate control, remote keyless entry, and a rear-seat center armrest. Every 2024 Corolla comes with Toyota’s Safety Sense 3.0. This advanced driver assistance technology suite includes pre-collision with pedestrian detection, automatic emergency braking, adaptive cruise control, lane-departure warning, lane-keeping assist, traffic sign recognition, and automatic high beams. The optional Premium Package offers a blind-spot monitor with a rear cross-traffic alert system, which is great for teen drivers. Connectivity features include Bluetooth, voice recognition, four USB ports, Amazon Alexa, Apple CarPlay, Android Auto, and Wi-Fi capability. The Environmental Protection Agency’s (EPA) government-certified combined fuel economy is 35 mpg. See Toyota Corolla models for sale near you Compare dealer offers 2024 Kia Seltos Starting Price: $25,865 | Rating: 4.8 2024 Kia Seltos SX in white near Palm Springs at sunset. Every version of the surprisingly roomy Kia Seltos subcompact SUV comes with a full suite of safety features, including forward collision warning with emergency braking, driver attention warning, lane-departure warning, lane-keeping assist, lane centering, and high-beam assist. To add blind-spot monitoring and rear cross-traffic alert, you must move up to the S grade, adding $600 to the bottom line. Connectivity features include Bluetooth with voice recognition, Apple CarPlay, Android Auto, and one USB port. With a second-row seat large enough to accommodate adults, Seltos also provides class-leading cargo space. See Kia Seltos models for sale near you Compare dealer offers 2024 Subaru Crosstrek Starting Price: $26,540 | Rating: 4.6 2024 Subaru Crosstrek in blue near white fence. Redesigned for 2024, Subaru’s go-anywhere Crosstrek is an IIHS Top Safety Pick. It comes standard with AWD backed by a continuously variable automatic transmission (CVT). Fuel economy is a respectable 29 mpg combined or 27 in Wilderness trim. Every Crosstrek comes standard with Subaru’s EyeSight Driver Assist Technology. It also boasts forward collision warning with automatic emergency braking, lane-keeping assist, and adaptive cruise control. A blind-spot monitor with rear cross-traffic alert is optional or standard on upper trim levels. Connectivity includes dual 7-inch touchscreens, Apple CarPlay, Android Auto (wireless is an option), Bluetooth connectivity, and hands-free phone integration. See Subaru Crosstrek models for sale near you Compare dealer offers 2024 Hyundai Kona Starting Price: $25,625 | Rating: 4.8 2024 Hyundai Kona Limited in Mirage Green with hills in the background. Totally redesigned for 2024, the Hyundai Kona offers tremendous value as a subcompact SUV with eye-catching exterior styling. Its small size makes parking easy, a big plus for teens. The rear cargo area is well suited to carry gear. In addition, Apple CarPlay and Android Auto connectivity come standard. Fuel economy is as good as 35 mpg on the highway with the gas engine. An all-electric version (EV) is also available. The IIHS named the Kona to the TSP+ list. There is plenty of value here, as even the base SE model comes standard with blind-spot monitoring, lane-keeping assist, forward collision-avoidance assist, lane-change assist, and rear cross-traffic collision warning. A 12.3-inch touchscreen and wireless Apple CarPlay and Android Auto are also included. See Hyundai Kona models for sale near you Compare dealer offers 2024 Chevrolet Trailblazer Starting Price: $24,395 | Rating: 4.2 2024 Chevrolet Trailblazer ACTIV in white near a cabin. Being one of Chevy’s smaller SUVs doesn’t stop the Trailblazer from being a considerable value. Some exterior restyling for 2024 dramatically improves its curb appeal. Moreover, the increased number of standard features for 2024 makes it more fetching than ever. Its standard advanced safety features include automatic forward emergency braking with pedestrian detection, lane-keeping assist, and lane departure warning. High-beam assist is also standard. We recommend opting for the $345 Driver Confidence Package that adds blind-spot monitoring and rear cross-traffic alert. It’s a bargain. Fundamentally unchanged since the IIHS named it a TSP+ winner in 2022, the Trailblazer remains a safe pick for teens. With the most rear-seat legroom in its class and a little better than average cargo space, the Trailblazer is an impressive hauler. At 30 mpg, its combined fuel economy is above average among rivals. You can add AWD for $2,000. See Chevrolet Trailblazer models for sale near you Compare dealer offers 2024 Nissan Sentra Starting Price: $22,320 | Rating: 4.0 2024 Nissan Sentra SR in blue near a directional sign. The most affordable new car on this list, the Nissan Sentra offers a bit of sportiness for teens, plus practicality and upscale styling. This compact car has “zero gravity” seats designed to be comfortable when driving to school or a job. The Sentra delivers fuel economy as good as 40 mpg on the highway (34 mpg in mixed city/highway driving), so trips to the gas station won’t be too frequent. Apple CarPlay and Android Auto are standard on all models. In addition to 10 airbags, even the base grade comes with the full suite of SafetyShield 360 driver aids, including auto emergency braking with pedestrian detection, rear cross-traffic alert, rear automatic braking, blind-spot warning, lane-departure warning, and high-beam assist. Essentially unchanged since it was added to the IIHS 2022 TSP+ list, the Sentra is still a solid safety pick for teens. https://www.kbb.com/best-cars/teens/",Retail/Product,Concept Comparison,Q&A This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points and follow each one with an explanation.,Please summarize this text for a layperson.,"Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants. SSRIs are called selective because they affect serotonin rather than other chemicals in the brain. These drugs block the reuptake (removal) of serotonin, which keeps the level of serotonin balanced and helps regulate mood. SSRIs Affect Serotonin Levels in the Brain There are currently seven SSRI drugs on the market in the United States (TABLE 1). These medications are generally safer than older antidepressants, with fewer side effects and drug interactions. In general, SSRIs have received approval from the FDA as safe and effective in the treatment of major depressive disorder. Many are also approved for anxiety disorders such as panic disorder, generalized anxiety disorder, and social anxiety disorder. Certain drugs in this category are also approved for use in obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and bulimia. SSRIs are slightly different in how quickly they work and how long they stay in the body. Their side effects also differ somewhat. Common side effects include nervousness, problems sleeping, headache, dry mouth, nausea, changes in sexual desire, and erectile dysfunction. Nausea can be reduced by taking the medicine with food. Nervousness and insomnia can be reduced by taking the drug just before bedtime. Most adverse effects of SSRIs gradually disappear after a few weeks of therapy. SSRIs show an effect after 4 to 6 weeks of daily use. If one drug in this category does not work in a particular person, another drug may work. SSRIs can interact with other medications that also cause increased serotonin levels in the brain. These include other antidepressants, prescription opioids, migraine medications, cocaine, and St. John’s wort (a medicinal herb used to treat depression). If one or more of these drugs are used with an SSRI, a high level of serotonin in the brain can result in serotonin syndrome. Symptoms such as extreme anxiety, tremors, fast heartbeat, sweating, and confusion require emergency care. Although SSRIs are not addictive, stopping them abruptly can cause symptoms that mimic withdrawal. A doctor should provide guidelines for slowly tapering off an SSRI to avoid symptoms of nausea, dizziness, and fatigue. Warnings and Precautions Generally, SSRIs are safe and carry few risks. All antidepressants, including SSRIs, can cause an increase in suicidal thoughts or actions, especially in young adults beginning therapy or changing dosages. SSRIs can increase the risk of gastrointestinal bleeding when taken with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, or with drugs with a side effect of bleeding, such as warfarin. Taking a drug that lowers stomach acid may be helpful. Women who are considering pregnancy, who are pregnant, or who are breastfeeding should discuss the potential effects of SSRIs on the fetus or infant and consider a break in therapy to avoid exposure. Several SSRIs are being studied for diseases other than those specified in their FDA labeling. Some of the uses that have shown promise include prevention of migraine, pain of diabetic neuropathy, fibromyalgia, vasovagal syncope (fainting), and premature ejaculation.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points and follow each one with an explanation. Please summarize this text for a layperson. Selective serotonin reuptake inhibitors (SSRIs) are the most frequently prescribed antidepressants. SSRIs are called selective because they affect serotonin rather than other chemicals in the brain. These drugs block the reuptake (removal) of serotonin, which keeps the level of serotonin balanced and helps regulate mood. SSRIs Affect Serotonin Levels in the Brain There are currently seven SSRI drugs on the market in the United States (TABLE 1). These medications are generally safer than older antidepressants, with fewer side effects and drug interactions. In general, SSRIs have received approval from the FDA as safe and effective in the treatment of major depressive disorder. Many are also approved for anxiety disorders such as panic disorder, generalized anxiety disorder, and social anxiety disorder. Certain drugs in this category are also approved for use in obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), and bulimia. SSRIs are slightly different in how quickly they work and how long they stay in the body. Their side effects also differ somewhat. Common side effects include nervousness, problems sleeping, headache, dry mouth, nausea, changes in sexual desire, and erectile dysfunction. Nausea can be reduced by taking the medicine with food. Nervousness and insomnia can be reduced by taking the drug just before bedtime. Most adverse effects of SSRIs gradually disappear after a few weeks of therapy. SSRIs show an effect after 4 to 6 weeks of daily use. If one drug in this category does not work in a particular person, another drug may work. SSRIs can interact with other medications that also cause increased serotonin levels in the brain. These include other antidepressants, prescription opioids, migraine medications, cocaine, and St. John’s wort (a medicinal herb used to treat depression). If one or more of these drugs are used with an SSRI, a high level of serotonin in the brain can result in serotonin syndrome. Symptoms such as extreme anxiety, tremors, fast heartbeat, sweating, and confusion require emergency care. Although SSRIs are not addictive, stopping them abruptly can cause symptoms that mimic withdrawal. A doctor should provide guidelines for slowly tapering off an SSRI to avoid symptoms of nausea, dizziness, and fatigue. Warnings and Precautions Generally, SSRIs are safe and carry few risks. All antidepressants, including SSRIs, can cause an increase in suicidal thoughts or actions, especially in young adults beginning therapy or changing dosages. SSRIs can increase the risk of gastrointestinal bleeding when taken with nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin or ibuprofen, or with drugs with a side effect of bleeding, such as warfarin. Taking a drug that lowers stomach acid may be helpful. Women who are considering pregnancy, who are pregnant, or who are breastfeeding should discuss the potential effects of SSRIs on the fetus or infant and consider a break in therapy to avoid exposure. Several SSRIs are being studied for diseases other than those specified in their FDA labeling. Some of the uses that have shown promise include prevention of migraine, pain of diabetic neuropathy, fibromyalgia, vasovagal syncope (fainting), and premature ejaculation.",Medical,Summarize & Simplify,Text Transformation You can only respond using the information in the context block. You will focus on explaining programming concepts while avoiding the use of specific code lines.,What is the difference between a method and a function?,"Strings Are Immutable To wrap this section up, let’s discuss an important property of string objects. Strings are immutable, which means that you can’t change them once you’ve created them. For instance, see what happens when you try to assign a new letter to one particular character of a string: >>> word = ""goal"" >>> word[0] = ""f"" Traceback (most recent call last): File """", line 1, in word[0] = ""f"" TypeError: 'str' object does not support item assignment Python throws a TypeError and tells you that str objects don’t support item assignment. If you want to alter a string, then you must create an entirely new string. To change the string ""goal"" to the string ""foal"", you can use a string slice to concatenate the letter ""f"" with everything but the first letter of the word ""goal"": >>> word = ""goal"" >>> word = ""f"" + word[1:] >>> word 'foal' First, you assign the string ""goal"" to the variable word. Then you concatenate the slice word[1:], which is the string ""oal"", with the letter ""f"" to get the string ""foal"". If you’re getting a different result here, then make sure you’re including the colon character (:) as part of the string slice. 4.3 Manipulate Strings With Methods Strings come bundled with special functions called string methods that you can use to work with and manipulate strings. There are numerous string methods available, but we’ll focus on some of the most commonly used ones. In this section, you’ll learn how to: • Convert a string to uppercase or lowercase • Remove whitespace from a string • Determine if a string begins or ends with certain characters Let’s go! Converting String Case To convert a string to all lowercase letters, you use the string’s .lower() method. This is done by tacking .lower() onto the end of the string itself: >>> ""Jean-Luc Picard"".lower() 'jean-luc picard' The dot (.) tells Python that what follows is the name of a method— the lower() method in this case. Note We’ll refer to string methods with a dot (.) at the beginning of their names. For example, .lower() is written with a leading dot instead of as lower(). This makes it easier to differentiate functions that are string methods from built-in functions like print() and type(). String methods don’t just work on string literals. You can also use .lower() on a string assigned to a variable: >>> name = ""Jean-Luc Picard"" >>> name.lower() 'jean-luc picard' The opposite of .lower() is .upper(), which converts every character in a string to uppercase: >>> name.upper() 'JEAN-LUC PICARD' Compare the .upper() and .lower() string methods to the len() function you saw in the last section. Aside from the different results of these functions, the important distinction here is how they’re used. len() is a stand-alone function. If you want to determine the length of the name string, then you call the len() function directly: >>> len(name) 15 On the other hand, .upper() and .lower() must be used in conjunction with a string. They do not exist independently. String Methods and Immutability Recall from the previous section that strings are immutable—they can’t be changed once they’ve been created. Most string methods that alter a string, like .upper() and .lower(), actually return copies of the original string with the appropriate modifications. If you aren’t careful, this can introduce subtle bugs into your program. Try this out in IDLE’s interactive window: >>> name = ""Picard"" >>> name.upper() 'PICARD' >>> name 'Picard' When you call name.upper(), nothing about name actually changes. If you need to keep the result, then you need to assign it to a variable: >>> name = ""Picard"" >>> name = name.upper() >>> name 'PICARD' name.upper() returns a new string ""PICARD"", which is reassigned to the name variable. This overrides the original string ""Picard"" that you first assigned to name. ","system instruction: [You can only respond using the information in the context block. You will focus on explaining programming concepts while avoiding the use of specific code lines.] question: [What is the difference between a method and a function?] context block: [Strings Are Immutable To wrap this section up, let’s discuss an important property of string objects. Strings are immutable, which means that you can’t change them once you’ve created them. For instance, see what happens when you try to assign a new letter to one particular character of a string: >>> word = ""goal"" >>> word[0] = ""f"" Traceback (most recent call last): File """", line 1, in word[0] = ""f"" TypeError: 'str' object does not support item assignment Python throws a TypeError and tells you that str objects don’t support item assignment. If you want to alter a string, then you must create an entirely new string. To change the string ""goal"" to the string ""foal"", you can use a string slice to concatenate the letter ""f"" with everything but the first letter of the word ""goal"": >>> word = ""goal"" >>> word = ""f"" + word[1:] >>> word 'foal' First, you assign the string ""goal"" to the variable word. Then you concatenate the slice word[1:], which is the string ""oal"", with the letter ""f"" to get the string ""foal"". If you’re getting a different result here, then make sure you’re including the colon character (:) as part of the string slice. 4.3 Manipulate Strings With Methods Strings come bundled with special functions called string methods that you can use to work with and manipulate strings. There are numerous string methods available, but we’ll focus on some of the most commonly used ones. In this section, you’ll learn how to: • Convert a string to uppercase or lowercase • Remove whitespace from a string • Determine if a string begins or ends with certain characters Let’s go! Converting String Case To convert a string to all lowercase letters, you use the string’s .lower() method. This is done by tacking .lower() onto the end of the string itself: >>> ""Jean-Luc Picard"".lower() 'jean-luc picard' The dot (.) tells Python that what follows is the name of a method— the lower() method in this case. Note We’ll refer to string methods with a dot (.) at the beginning of their names. For example, .lower() is written with a leading dot instead of as lower(). This makes it easier to differentiate functions that are string methods from built-in functions like print() and type(). String methods don’t just work on string literals. You can also use .lower() on a string assigned to a variable: >>> name = ""Jean-Luc Picard"" >>> name.lower() 'jean-luc picard' The opposite of .lower() is .upper(), which converts every character in a string to uppercase: >>> name.upper() 'JEAN-LUC PICARD' Compare the .upper() and .lower() string methods to the len() function you saw in the last section. Aside from the different results of these functions, the important distinction here is how they’re used. len() is a stand-alone function. If you want to determine the length of the name string, then you call the len() function directly: >>> len(name) 15 On the other hand, .upper() and .lower() must be used in conjunction with a string. They do not exist independently. String Methods and Immutability Recall from the previous section that strings are immutable—they can’t be changed once they’ve been created. Most string methods that alter a string, like .upper() and .lower(), actually return copies of the original string with the appropriate modifications. If you aren’t careful, this can introduce subtle bugs into your program. Try this out in IDLE’s interactive window: >>> name = ""Picard"" >>> name.upper() 'PICARD' >>> name 'Picard' When you call name.upper(), nothing about name actually changes. If you need to keep the result, then you need to assign it to a variable: >>> name = ""Picard"" >>> name = name.upper() >>> name 'PICARD' name.upper() returns a new string ""PICARD"", which is reassigned to the name variable. This overrides the original string ""Picard"" that you first assigned to name.]",Internet/Technology,Concept Comparison,Q&A Only provide commentary from the context included.,"How, if at all, does the owner of this business respond to negative reviews?","&Pizza Google Reviews Josh Local Guide·316 reviews·113 photos a month ago Ordered online and my receipt had no details confirming my items. I text them like they said and they never responded. Then they have Uber do the order delivery but I didn't know that before putting the tip in and then the driver said he … More Photo 1 in review by Josh Photo 2 in review by Josh &pizza - Dupont (Owner) a month ago We regret to hear about your experience with the online ordering and delivery process. Your response is important to us as we strive to improve our services. We will address the issues you've mentioned with our team to ensure a better experience for all our customers. Thank you for bringing this to our attention. Gine “Gine The Mae Nai's Winery” MaeNaiWinery Local Guide·369 reviews·5043 photos 3 months ago Dine in | Dinner | $10–20 Such a lovely freshly made pizza with various options, really hard time to decide which one to order lol. Very fast and nice service. Pizza just got ready in 8mins. Have two long tables to enjoy, or take away. … More Photo 1 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 2 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 3 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 4 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 5 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 6 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 7 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 8 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 9 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our freshly made pizza and fast service. Your response is important to us as we strive to improve our services. We hope to see you again soon for another delicious experience! Torianna Todd 3 reviews·2 photos a week ago NEW Take out | Dinner | $10–20 Super friendly staff and the food was really good! We got 2 pizzas- one cheese and one margarita with some extra toppings, and garlic knots. … More Photo 1 in review by Torianna Todd Photo 2 in review by Torianna Todd Addison Hosner Local Guide·100 reviews·141 photos a month ago Never had pizza from here before but ordered online for pickup during lunch. Showed up on time and the order was ready without delay. The pizza is a great serving size and depending on your appetite and what you get this could be two meals … More &pizza - Dupont (Owner) a month ago Thank you for taking the time to share your experience with us! We are thrilled to hear that you enjoyed our pizza and that your order was ready on time. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Allen Nuccio Local Guide·297 reviews·380 photos a week ago NEW Dine in | Lunch | $10–20 If you're not familiar, &pizza is like Fancy Pizza Hut in flatbread form. Their pies are pretty good and their garlic knots are delicious. This location has fantastic customer service, but also smells heavily of a bathroom for whatever reason. Anyway, pretty good all-in-all. … More Alma Local Guide·147 reviews·278 photos 7 months ago Take out | Dinner | $10–20 Pizza is good and doesn't take long from ordering to paying so it's fast and convenient. Staff is super friendly and nice … More Photo 1 in review by Alma Photo 2 in review by Alma Photo 3 in review by Alma Photo 4 in review by Alma Photo 5 in review by Alma Lizzy Amirana Local Guide·146 reviews·224 photos 4 months ago Smells like mold in the place but wonderful pizza! Their gluten free pizza with vegan cheese and meat substitute is 💣 … More Photo 1 in review by Lizzy Amirana 1 &pizza - Dupont (Owner) a month ago We regret to hear about the issue you encountered during your visit. Your response is important to us as we strive to improve our services. We're glad you enjoyed the gluten free pizza with vegan cheese and meat substitute. Thank you for sharing your experience. Emma Fan Local Guide·28 reviews·20 photos a month ago We ordered 8 pizzas (menu items) and 4 of them was made incorrectly - missing all the meat, missing veggies & pineapple, wrong sauce, missing spices. They weren’t just missing one or two ingredients, they were made into something completely … More &pizza - Dupont (Owner) a month ago We regret to hear about your experience and the incorrect pizza orders. Your response is important to us as we strive to improve our services. We will address this with our kitchen staff to ensure such mistakes are not repeated. Thank you for bringing this to our attention. Aban Koprulu 74 reviews·3 photos 3 weeks ago NEW The pizza is good but omg the sewage smell was unbearable. I tried to hold my breath and breathe through my mouth. I almost passed out. I don’t think this place is safe according USDA food and safety inspection. I will have to report it … More 1 &pizza - Dupont (Owner) 3 weeks ago We regret to hear about your experience. Your response is important to us as we strive to improve our services. We will investigate the issue immediately to ensure a safe and pleasant dining experience for all our customers. Thank you for bringing this to our attention. Jacob Fix Local Guide·22 reviews·12 photos 4 months ago Take out | Lunch | $10–20 Very fast, affordable, and huge portions. Great deal and great pizza. … More Photo 1 in review by Jacob Fix Jason A 4 reviews·2 photos 2 years ago Take out | Lunch | $10–20 Great pizza in Dupont! Walking distance from the Mayflower hotel. Fast friendly service. The Maverick is my favorite and garlic knots are a nice add on. Photo 1 in review by Jason A Photo 2 in review by Jason A Mehrnoosh Kh Local Guide·245 reviews·1644 photos 6 months ago Take out | Dinner It is a good pizza place for late night bites. … More Photo 1 in review by Mehrnoosh Kh Photo 2 in review by Mehrnoosh Kh Photo 3 in review by Mehrnoosh Kh Photo 4 in review by Mehrnoosh Kh Photo 5 in review by Mehrnoosh Kh Photo 6 in review by Mehrnoosh Kh Photo 7 in review by Mehrnoosh Kh Photo 8 in review by Mehrnoosh Kh Ryan Griffith 11 reviews 4 months ago Don't bother ordering Uber Eats here because they won't make the food and you'll have to cancel the order. And if you dine in apparently it smells like piss. … More Samuel Davie 37 reviews·102 photos a year ago Take out | Dinner | $10–20 Delicious pizza and the perfect serving for 1 person. I always get the pineapple jacked and take my Tour de Pizza cutter for a ride. Going for a pizza ride #tourdepizzacutter 🚴🏼🍕😊 Photo 2 in review by Samuel Davie 3 Alan Marrero Local Guide·215 reviews·2873 photos 5 months ago Nasty piss smell, we had to leave in an instant. No wonder the place was empty. The pizzas looked great in the pictures, if you want to eat a pizza in smelly atmosphere THIS IS IT! … More 2 Henry Kloepper Local Guide·121 reviews·77 photos 7 years ago Was quite decent. Fast, reasonable price, good taste. Though I just had Pizza Paradiso and if you have some extra time it's well worth it over &pizza, especially if you are interested in having an alcoholic drink with your pizza. If you're in a rush this works better. Photo 1 in review by Henry Kloepper Damien Shaner Local Guide·30 reviews·140 photos 3 weeks ago NEW They are so ghetto they have a security guard that locks the door and doesn't let people inside after the place fills full of ""dangerous people""...well before the actual closing time. &pizza - Dupont (Owner) 2 weeks ago We regret to hear about your experience at our restaurant. Your response is important to us as we strive to improve our services. We take the safety of our customers seriously and will address this issue with our security team. Thank you for bringing this to our attention. Diana Marquez 2 reviews 9 months ago Dine in | $10–20 My sister and I came in to grab some food after a night out it was very busy but the team was very efficient and Luis definitely made sure we had a great experience. He has exceptional customer service skills, very out going and just great at what he does and overall takes great care of guests. Will definitely be coming back soon ! Matthew Rice Local Guide·14 reviews·54 photos 4 months ago Take out | Dinner | $10–20 Pizza was decent, but as other reviews have noted, the restaurant had an unbearable stench. The owner needs to call a plumber or an exterminator (or both). … More Elizabeth Dapper 8 reviews·4 photos 3 months ago Dine in | Dinner | $10–20 Good place, good service, loud music which is always a little hard when talking with friends... but the food and the employees never disappoint! … More &pizza - Dupont (Owner) a month ago Thank you for taking the time to share your experience with us. We're glad to hear that you enjoyed the food and service, but we understand that the loud music can be a challenge. Your response is important to us as we strive to improve our services. We hope to have the opportunity to serve you again in the future. D C 8 reviews·2 photos 6 months ago Take out | Dinner I just have to add to the other reviews about the absolutely putrid horrifying smell in here, which hits you upon entering. I had ordered Uber Eats, otherwise I would have immediately left. This place most likely has an ongoing sewage issue that is not being addressed properly. No place that sells food should smell like this. … More 2 Andy Jovel 11 reviews·1 photo a year ago Take out | Lunch | $10–20 Sorry, but the pizza was cold and there was little to none chicken mostly just blue cheese crumbles. There were none jalapenos at all either. Photo 1 in review by Andy Jovel Brei Evans 4 reviews·11 photos 3 days ago NEW This locations stinks so bad. The people are nice here though. … More Cedar Baltz 7 reviews 7 months ago Take out | Dinner | $30–50 I got take out and the guy gave me 1 correct pizza I ordered and gave me a completely different order for the 2nd pizza. He showed me the first pizza with the correct toppings on it. I assumed the 2nd pizza he handed me was the right order … More Nathan Sellers Local Guide·90 reviews·323 photos 4 years ago This is really good pizza. The manager was super friendly and helpful too. My son begged to go back the whole trip and said it was the best pizza he'd ever had. Photo 1 in review by Nathan Sellers Kelli Roberts Local Guide·349 reviews·305 photos 6 years ago Second &pizza today. This location is even bigger! Food was delicious, but I would advise going light on the toppings if you choose a gluten free pizza. Too many toppings can make the pizza heavy and messy. Photo 1 in review by Kelli Roberts Photo 2 in review by Kelli Roberts 2 Jahanna Reese 13 reviews·1 photo 11 months ago This is My favorite & pizza Location, great service and they don’t rush you . 5 stars out of 5 Photo 1 in review by Jahanna Reese Josh Griswell Local Guide·26 reviews·21 photos 5 years ago Great food, good price, friendly staff! I ordered the vegan pizza and it was awesome! Their craft soda fountain has some great selections as well. Food was cooked quickly and tasted great! Photo 1 in review by Josh Griswell 1 David Zaga Local Guide·48 reviews·83 photos 6 months ago I mean the price was ok. The place smelled, clearly not very well maintained. And the pizza was ok. The guys working the counter, although dealing with a lot of customers were working hard and gave good service … More 2 Samim zamiri 1 review a month ago You gotta taste their pizza and you’ll definitely like it … More &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Sabrina Lisenby 3 reviews·1 photo 2 years ago Amazing staff, great service, and was so fast. Oh by the way they have amazing pizza and garlic knots. If this isn’t enough to make you try them out, do it anyway lol 😂🤣 Photo 1 in review by Sabrina Lisenby &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you had an amazing experience with our staff and enjoyed our pizza and garlic knots. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Ashllyn Silva Local Guide·64 reviews·63 photos a year ago Dine in | Lunch | $10–20 Actually so obsessed with this pizza. So glad to find out they have multiple locations in my home city. Photo 1 in review by Ashllyn Silva Zhuoran Li 7 reviews·6 photos a year ago The guy is super nice. He is friendly. The pizza is so good. It is really a top place for some pizza quick bite Photo 1 in review by Zhuoran Li J Foodgeek Local Guide·715 reviews·732 photos 2 years ago So earlier today I got I texted coupon for a $5 pizza, so I walk in to dupont S location and I figure I'll just make the order in the place, and I look at the places where the ingredients are, and see slimy rod and spinach and black basil, … More Photo 1 in review by J Foodgeek 1 HoneyD 11 reviews 6 months ago Why does this place stink? Walked up expecting smell of fresh pizza but smells like dirty sewage, smells better outside. Couldn't imagine sitting down in here to eat. … More 2 Sarah Jackson Local Guide·81 reviews·2 photos 4 years ago Pizza flavor is good & could have been a 5 star. Delivery wAs about 30 mins on Fri Evening. ..but it was delivered COLD,,,,!.to order is difficult, forget calling you will only get voicemail tell you they only text or order online. They … More Photo 1 in review by Sarah Jackson 1 &pizza - Dupont (Owner) 4 years ago Hey Sarah, thanks for the review and sorry your pies didnt arrive to you in a state we're proud of. If you're up for it, feel free to reach back out and we'd be happy to make it up to you Daniel Ruiz Local Guide·49 reviews·200 photos 4 years ago Great place to eat pizza, fast service, prices are okay, each style is around $10, not so crowed and staff is friendly, very reccomended if you are hungry and looking for something quick. Photo 1 in review by Daniel Ruiz John Yeung Local Guide·130 reviews·151 photos 7 years ago How can you not like &pizza? I come here all the time. Overall it is really good but sometimes the quality is inconsistent. The pizza might be slightly burnt on the edges. The few times I want to buy soda, their machine does not have all the flavors. Photo 1 in review by John Yeung Liam Amiri Local Guide·377 reviews·2368 photos a year ago Decent pizza but don't expect some authentic NYC style pizza. … More Photo 1 in review by Liam Amiri Eddie Hoss Local Guide·268 reviews·74 photos a year ago Dine in | Dinner Oddly enough, some of the best pizza I've had in some time. Visited during the Halloween bar crawl and the three employees were overwhelmed but kept at it. Waited around 45 min for my pizza, but it was worth it. Decent prices and when … More David Dotson Local Guide·146 reviews·574 photos 2 years ago Dine in | Dinner | $10–20 Great pizza & excellent service Both Gluten Free crust & Vegan protein options available (vegan cheese, vegan sausage & chickpeas) … More Photo 1 in review by David Dotson 1 &pizza - Dupont (Owner) 2 years ago Thank you so much for the review David! We're so glad you were able to use our loyalty coupon as well! Ishmael Kamara Local Guide·117 reviews·649 photos a year ago Take out | Dinner | $20–30 &pizza is always great. Went there late on Friday for something to eat. With the crowd from the clubs be prepared to wait and they don't have any indoor seating at that time. Overall you can't go wrong with a personalized pizza from here. … More tshirt tae 7 reviews·6 photos a year ago Pizza was banging line was fast great place custom Pizza Photo 1 in review by tshirt tae Niggle W 14 reviews 6 months ago The store is quiet but the staff is very polite, clean and the pizza came out good. … More Anthony Ayo 4 reviews·1 photo a year ago Lunch | $30–50 Pizza was great! Service was just as awesome! We brought a group of 13 people and Terrence and the crew were happy and helpful. Can’t wait to come back when I’m back in town. … More williampiedra100 3 reviews·1 photo 3 weeks ago NEW Dine in | $10–20 Bryan attended us with great care. … More &pizza - Dupont (Owner) 2 weeks ago Thank you for the 5-star rating! We're thrilled to hear that Bryan took great care of you. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Vannessa Rodello Local Guide·129 reviews·103 photos 4 years ago All the toppings you want and so many options! My only criticism is the crust wasn't as crispy as I'd like. Photo 1 in review by Vannessa Rodello Photo 2 in review by Vannessa Rodello R Bakshi Local Guide·65 reviews·166 photos 6 years ago Excellent pizza and super friendly staff! Photo 1 in review by R Bakshi Photo 2 in review by R Bakshi Krystle Local Guide·107 reviews·224 photos 4 years ago It was really good. But it was sooooo hot in there and took foreverrrrrrr. Pepperoni and bacon. I'm basic lol Photo 1 in review by Krystle Leah Trunsky (raindropAuxilitrix) 1 review 11 months ago Went here with my friends—the pizza was great and the server Chris was super cool! Super friendly. Whoever made the pizza was patient with our orders too. :) Destine Jones 5 reviews 11 months ago Take out | Dinner | $10–20 I came into &Pizza today for lunch and the the staffAndre and Terrace was very helpful polite service was great clean environment fast service I was surprise to see no line so the pizza came out quick and I was able to enjoy it and get … More 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Andre and Terrace provided helpful and polite service, and that you enjoyed a quick and delicious lunch. Your response is important to us as we strive to improve our services. We appreciate your kind words and hope to see you again soon! Roberts Brian 1 review a year ago I went through this pizza shop last night the service was amazing they were really on point, making sure the customers got everything they needed and more this will definitely be my go to pizza place yours truly Mr.Roberts.. James Drosin 2 reviews 9 months ago Dine in Luis the Manager gave me the best guest experience! Food was amazing definitely recommend. S/O to them! I will definitely be back! Heather Dorsey Local Guide·130 reviews·393 photos 4 years ago The American honey pizza is really good. And the cereal milk soda tastes exactly like cereal milk. So. Service with a snarl. Photo 1 in review by Heather Dorsey &pizza - Dupont (Owner) 4 years ago Thanks for the review Heather! :) Kate Farrell Stanford 4 reviews·2 photos 11 months ago When I walked in, no one was in there and it smelled terrible, as if the floor had been mopped with dirty toilet water. We couldn't imagine staying in there long enough to order, let alone eat. … More 2 &pizza - Dupont (Owner) 11 months ago We apologize that our service did not satisfy your expectations. We set a high standard for ourselves and are truly sorry to hear that standard was not met in your interaction with our business. Your happiness is our number one priority. We well take your feedback into consideration. Jason Miller Local Guide·401 reviews·14 photos 2 years ago Take out | Lunch | $30–50 I love &pizza and usually get awesome service however, this visit to this location was lagging. The 2 staff were seemingly working against each other and they burnt mine and my other 2 family members pizzas. I … More Michael Green Local Guide·113 reviews·665 photos a year ago Dine in | Dinner | $10–20 Flat bread pizza made your way. Staff was fun and engaging. Food was great and was more than enough. Large enough to share but on a hungry day good enough to keep it for yourself. … More Nadia M 8 reviews·4 photos a year ago Normally I’m a huge fan of &Pizza, but this location is so severely understaffed during rush hours that it has proven actually impossible to get the pizzas we ordered. The &pizza website said our order would be ready within 15-20 minutes, … More 1 Chandrell Christopher 7 reviews·3 photos 2 years ago Service was great! Really nice employees, loved syncere and lavell were amazing! Photo 1 in review by Chandrell Christopher Jlyne B Local Guide·63 reviews·14 photos 4 years ago Got a gluten free American honey and oh my goodness I wish there was one closer to where I live. Incredible tasting food and the soda was really good as well. I gave it four because a few of the toppings didn't look very fresh (wilted … More 1 &pizza - Dupont (Owner) 4 years ago Thanks for the review! :) Jamon Pulliam 2 reviews 2 years ago This location is hands down the best! I was visiting from Los Angeles and the service here was impeccable! And don’t get me started on the pizza! They took their time and put nothing but ingredients and love in that one. Would definitely recommend Dean Albrecht 3 reviews a year ago Take out | Dinner | $10–20 Excellent food with great service. Andre helped me make the right choice. Would recommend to anyone who’s in DC and wants something quick to eat. 1 Esse Darden Local Guide·287 reviews·551 photos 2 years ago Take out | Dinner | $10–20 Ordered the Manhattan, while waiting for my personalized order being made - which I received after noticing a distinctive stinginess with every topping that was applied before it was put in the oven, an excessive prolonged period of time; … More 1 &pizza - Dupont (Owner) 2 years ago Thank you for taking the time to share your feedback. We set a high standard for ourselves, and we’re so sorry to hear that this was not displayed during your visit at our location. Your feedback is important to us and we’ll make sure to make the proper adjustments for next time. I’m also going to send this feedback to the shop and district leader to address with the team there because this isn’t what we want our guests to experience at all. We hope that your next visit with us is nothing like what you experienced recently! Scott C Local Guide·33 reviews·9 photos 3 years ago Great pizza and garlic knots! Not your typical style but still quite special and worth trying...over and over again! The dough and toppings are always on point! I also appreciated their program to help frontline workers. Highly highly recommended! 1 &pizza - Dupont (Owner) 3 years ago Thanks for the review Scott! We had to try something different this time. We hope you enjoyed it though! Sean Local Guide·61 reviews·42 photos 2 years ago Take out | Dinner | $30–50 We got delivery. Late night. Pizzas were not good. Got It for a party and we all laughed at how bad it was, and how small they were in the box. (And they forgot one of our items.) all that and only a 1.5 hour wait. Haha. Only reason for the extra star (instead of just 1) was the cookies were really good! … More 1 Kiran Singh Local Guide·70 reviews·66 photos 4 years ago The pizza here is so delicious! The crust is flavorful and tasty and the tomato sauce is so deliciously tangy. I was really blown away by the quality & taste of the pizza! Their ingredients taste fresh and you can add as many toppings as … More &pizza - Dupont (Owner) 4 years ago Thank you so much!🖤🍕🖤 Michael Cupertino Local Guide·106 reviews·163 photos 4 years ago I don't know if it was an ""off day"" here, but service was so slow we had to leave. There were 3 people in front of us and we waited 20 minutes before we left. The employee was more concerned about cutting a 1/4 of an inch of crust off of … More Jessica Peters 12 reviews·6 photos 5 years ago The pizza at & pizza is great. That’s why I have been coming back for years. However beware of the customer service. Recently at the DuPont location, I enjoyed a great pizza and needed to use the restroom. When I asked an employee who was … More 2 Alok Sinha Local Guide·58 reviews a year ago Stopped by here and this is a great place for pizza. I ordered the new G and added some spicy honey and it was delicious. Would definitely recommend stopping by here if you have a chance. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed the new G pizza with added spicy honey. Your response is important to us as we strive to improve our services. We appreciate your recommendation and look forward to serving you again soon! S G Local Guide·12 reviews a year ago Amazing pizza and unique experience. Build your own pizza to a new level. Fresh toppings and an amazing taste. The place is small but the tastw is huge. Loved the food and the service. A definite must. Claire Mizutani Local Guide·54 reviews·374 photos a year ago Take out I got four pizzas to take back to my family:The Maverick, CBR, Billie, and Kalamata Harris. Two of them were on gluten-free crust. Ordering was pretty hectic because there were many young people coming to eat between going to different bars … More 2 Wanda Murphy 33 reviews 2 years ago This was the worst pizza I have ever purchased from & Pizza. The person in front of me, ordered four pizzas. They should have removed my pizza promptly. Instead, the crust is burnt, the spinach dry and the other vegetables dried out. … More &pizza - Dupont (Owner) 2 years ago Terribly sorry to hear about your experience Wanda! We have reported this information to our senior management to resolve and to take the proper measure for quality control. You can send us an additional message at 200-03 or send us an email at digitalshop@andpizza.com. Thank you again for bringing this to our attention. Robyn J Local Guide·54 reviews 5 years ago Absolutely the best pizza I have every eaten. The bread was amazingly light and doughy. I didn't have the disgustingly full feeling after eating an entire pizza. The toppings were fresh and delicious and unlimited. Love the healthy choices and sauce variety. 1 &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza, especially the light and doughy crust and fresh, unlimited toppings. We're glad you appreciate our healthy choices and sauce variety. Your response is important to us as we strive to improve our services. A G 10 reviews a year ago I’m literally in this place as of 06/06/22 and it just took me a whole hour to get a pizza which is ridiculous! Low staff and no sense if urgency. Felt bad for the employee up front who seemed suer overwhelmed, pizza is good usually but won’t be back at this location. &pizza - Dupont (Owner) a year ago Hey Andy! Thanks for you review. We are sorry to hear that we did not provide the best experience! Please reach out to us at 200-03 so we can make this right. 🍕 Timur Plavan Local Guide·97 reviews·278 photos a year ago Dine in | $20–30 The most inefficient &pizza I've ever tried in my life. Ordered online, came 30 mins later and waited for another 50 minutes. Order was missing things in both pizzas. &pizza is great but I would avoid this location. … More Natalia Diaz Torres 1 review·1 photo 2 years ago If I could give 0 stars, I would. This review is based on an UberEats order. I ordered 4 pizzas and an order of … More Photo 1 in review by Natalia Diaz Torres Rishi M Local Guide·9 reviews·22 photos 2 years ago Visited late September 2021 for an online pickup order. Waited 2 hours for my order. … More 1 Michel Louis Local Guide·16 reviews·2 photos 2 years ago Take out | Dinner | $10–20 One of the best pizza I ever tried Photo 1 in review by Michel Louis Rachel Wortmann Local Guide·61 reviews·173 photos 2 years ago Ordered online and waited 45 min for my pizza. App had said it would take 10 min so was quite frustrating … More Kristen Eggleston Local Guide·50 reviews·8 photos 4 years ago The pizza is great but the service here could be a bit better. I went at a time where it wasn't busy at all. The woman who made my order was friendly and helpful and while my order was cooking, I sat at a table nearby. The woman who was at … More Jéssica Bittencourt 1 review·1 photo 2 years ago Lavelle great service, thank you! Photo 1 in review by Jéssica Bittencourt 1 Matt Ramey 3 reviews 11 months ago Dine in | Dinner | $1–10 We went in to have wholesome family dinner experience but quickly exited upon my initial smell test which returned a result consisting of bathroom juices/putrid garbage. 2 Matthew Cantisani 2 reviews a year ago Dine in | Dinner | $10–20 Excellent service!! Food was delicious and made quickly. I will definitely come back to this &pizza location! De Wheeler-Chopan 10 reviews 7 months ago Worst experience ever! Pizza wasn't ready to order. The servers states they didn't care that we waited! … More Stefan Hovy 5 reviews 6 years ago Incredible! Was in DC for a long weekend and ended up going to &pizza 3 times! Twice at this location where the staff and manager were very friendly and open for a chat. Not to mention the delicious pizza with equally delicious vegan options. Would recommend this to anyone visiting DC! 1 Joey Norris 4 reviews a year ago Take out | Dinner | $10–20 Andre was such a great help and made sure to treat us right with amazing pizza. Appreciate the amazing service and will gladly go again. S. T. Grandy 19 reviews·6 photos 4 years ago The pizza is good but I was a bit disappointed to see that the employee who made my pizza only put a racing stripe of sauce right down the middle of the dough. Literally a line down...not spread at all. Also, they may need to turn the ovens … More 1 Monte' Kent 2 reviews a year ago Andre at &pizza DuPont south was amazing.. helped me with my gift card at this location. He service and attention to detail was great. Must go location. Thanks Andre! Sameer Singhal Local Guide·41 reviews·8 photos 7 years ago Great at any time of day. This is a unique pizza experience, and I love the fact that you can customize your pizza to your liking for one flat price. Definitely a place to try, and you'll most likely want to keep coming back Cecilia Demoski 1 review 11 months ago Take out | Dinner | $10–20 This is a great place to grab some great pizza! Amazing service and good quality pizza. Miracle Parish Local Guide·75 reviews·6 photos a year ago I will be filing a police report against the fair skinned man with dreads. He put his hands on me multiple times when I was trying to exit the building. The entire line saw it and they were appalled. I was trying to get to my Uber and he … More Ali A Local Guide·691 reviews·435 photos 4 years ago Delicious, but higher prices than their quality. Crowded around noon time, my experience of course. Employees are ok, but they can be much better. … More Brie Morgan 5 reviews 2 years ago I been coming to this pizza spot for a few months and their always respectful and clean They have awesome pizza and the best customer service the manager always takes care of me and makes sure my pizza is hot and ready to go no complaints will continue to send friends and family India Marshall 28 reviews 2 years ago Employees are nice but mangers need to do a better job with organizing during rush hour. Bathrooms are never available for customers. This has been the case for over 5 years. Luis Miron 3 reviews 11 months ago Dine in | Dinner | $10–20 Amazing service by Andre! and delicious pizza. Definitely the place to eat before a night out of drinking. Breanna Duff 9 reviews·1 photo a year ago the security card told me I could not sit down even though I have a disability. There is no rule to this. He was being very rude for no reason. 1 Katie Kennedy 21 reviews 6 years ago The service was terrible here. We were there for the first time and clearly confused but rather than offering help to us, the staff ignored us. They offered no help when we had questions about some dietary restrictions either. And you can't … More 2 Evan Farrara 12 reviews·1 photo 7 years ago Incredibly loud inside to the point that the employees couldn't hear me correctly when ordering. As a result, when asked if I wanted spicy or non-spicy sauce, I replied ""non-spicy"" and got spicy anyways. That being said, it ended up being … More Mohammed Yahia Local Guide·384 reviews·1524 photos 5 years ago &pizza is a good, simple pizza place. They don't have many choices, just pizzas, but they are awesome. They have a few set pizzas you can order or a make-your-own-pizza option. They also have the option for gluten-free dough which is $3 … More 1 Jobina Beale 3 reviews a year ago Went in there today for lunch and Tay was awesome. Amazing, courteous and good customer service. I walk from Farragut West Metro to get my pizza all because of him. Gideon Tong Local Guide·155 reviews·233 photos 4 years ago Great pizza! Fast service, would go again. As someone from the west coast we also have build your own pizza places like Pieology and Blaze Pizza but this style of ""shoebox pizza"" is pretty unique and you can definitely eat a whole pizza on your own even if you don't usually eat that much. &pizza - Dupont (Owner) 4 years ago Great to hear. Thanks! Sara R. Local Guide·144 reviews·305 photos a year ago Dine in | Dinner | $10–20 Vegan-friendly, they even gave vegan pizza. I would like to see more filling vegan toppings options like some Beyond Meat or something. The service was quick and friendly. … More 1 cy mcfadgion 3 reviews 3 months ago Quan, cam and bre were amazing … More &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that Quan, Cam, and Bre provided amazing service. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Khaleel Johns-Watts 58 reviews 10 months ago Best late night dc spot call ahead after 3am if ur with a group and just order all the pizza Emma C Local Guide·83 reviews·85 photos 5 years ago Of all the made-to-order personalized pizza places out there, &pizza has my heart. They offer several delicious dough options including gluten free. All of the toppings are very high quality (get the meatballs!!). After topping, they put it … More 2 A “2Freckles” Oz Local Guide·15 reviews·2 photos 5 years ago I really liked this place, however my second experience here was not like my first. Took me 30 mins to get my order. The cashier was very stressed maybe it was his first day on the job because he did not know how to run the register. The … More Ada Rebecca Smith Local Guide·447 reviews·165 photos a year ago Dine in | Dinner | $10–20 The service was not great, the guy making the pizzas was very slow and wasn't able to find items that should have been easily located(the spinach was empty, he took several minutes looking for it and they were out of spinach). … More Ian Winbrock Local Guide·131 reviews·14 photos 7 years ago I love &pizza. I'm from the West Coast and we have ""cook as you wait"" pizza places, but nothing on the same level as &pizza. This place is superb. Always greeted by some friendly folks behind the counter and then I either complete one of … More Bill Hipsher Local Guide·41 reviews·987 photos 7 years ago Staff was very nice and pizza we got as ordered was great. The fountain machine was broken so your drink options were limited to can/bottle options for tea/lemonade that they had in a fridge. Ordered a Hawaiian style pizza that was supposed … More 1 Scott Dwyer 12 reviews·1 photo a year ago Great place to get a bite when you out drinking in depot circle. The pizza is awesome, and the prices are better than at the bar. … More Justin Andersen Local Guide·15 reviews a year ago Take out This was the most frustrating experience I've ever been in. Our take out order was over an hour late. And that's the least frustrating part of the night... I don't know if I have the energy to explain everything. Andrea M Local Guide·69 reviews·46 photos a year ago They gave me the wrong pizza. I texted customer service and they said they needed a picture in order to issue a refund. I told them my camera was broken and was not able to take a picture. They told me I couldn't get a full refund without a photograph but they could offer me $5 for a new pizza. Josh Higham Local Guide·148 reviews·84 photos 6 years ago Co-workers had talked this place up, but I found it only decent. I definitely enjoyed the unique soda fountain more than the pizza. Great variety of unique flavors. Pizza was fine but unremarkable. Ariel Holmes 2 reviews 4 years ago James and Deon made my night. I would have been left hungry if it was for the girl up front. But thank you 2 for the lovely service much appreciated. I will remember it & I will be back (during opening hours) thanks again! &pizza - Dupont (Owner) 4 years ago Glad to hear our team solidified your evening (and future visits) with great service. We will be sure share with both James and Deon your kind words! Thanks for stopping by, Ariel! Leanne Quinn 1 review·1 photo 2 years ago Great service and fantastic pizza! Photo 1 in review by Leanne Quinn &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We are thrilled to hear that you enjoyed our fantastic pizza and great service. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Tracey N Local Guide·87 reviews·70 photos 5 years ago Pizza would have been better if it was warmer, but their service was shorthanded..... they had one person taking out the pizza from the oven, boxing it, putting on the finishing garnishes AND ringing up the customers...... that's too … More Theresa Kemp 5 reviews a year ago Dine in | Dinner | $1–10 Andre was fantastic! He served our party fresh, hot, pizza. Thank you for the great customer service. Diana Martinez 3 reviews·2 photos 2 years ago I work nearby and I appreciate that my orders are always done right away and I can quickly just pick up. Great customer service. Very strict on covid regulations. Key 2 reviews 2 years ago Customer service was excellent upon arrival. Store was clean and needs were met in a timely fashion. Very friendly and patient staff. 5 Stars to Terence!! Greg Smith 14 reviews·2 photos 10 months ago Delivery | Lunch | $10–20 Did carry out. Pizza was good, but not great. Strange beverage options … More Bali Adawal Local Guide·203 reviews·1637 photos 4 years ago I have always liked the concept of a highly customized pizza and the overall product turns out to be quite appealing. … More 2 Aleks Nekrasov 91 reviews·67 photos 11 months ago As far as GOOD pizza goes, this place completed my order in 8 minutes. &pizza - Dupont (Owner) 11 months ago Thanks for the awesome review! Hope to see you soon. Gnelossi Hamadou Local Guide·6 reviews·7 photos a year ago Visited this place yesterday for my first time , just wanna say thank you for the entire team that work yesterday night. They were patient and friendly specially the manager Andre Cecilia Local Guide·80 reviews·2 photos 5 years ago We had a pleasant experience at a different branch of &pizza so we tried this branch. This branch was stingy on the toppings and the dining area was not wiped down after customers have eaten there. All 3 of us felt queasy after eating here... Josh Eid-Ries 10 reviews·3 photos 6 years ago Delish, super affordable and very easy to customize your order with no upcharges. The staff are a delight and the food is superb. The drink offerings are also wonderful. I'd recommend the 11 grain crust(ask for it) the mango passion fruit soda and root beer. Vegan cheese and veggie based protein options were a lovely bonus! Pradipto Banerjee Local Guide·29 reviews·96 photos 7 years ago Their pizzas are the best value for money. Unlimited toppings on a big flat bread for just $10. And they're open till 4 am, which is great when you're leaving the bars at 2 and want to get some food. NAI- NAI 3 reviews 2 years ago Dupont is awesome. The place is clean and the pizza is great! One of the workers Decostia provided excellent customer service! I definitely recommend this store! Jaqueline Veltri 2 reviews 4 years ago The pizza here is delicious but it is the second time in a row that I find a long black hair in my pizza. It’s so frustrating and disgusting! I hope management finds a way to keep the employees hair out of the food. F.A. B Local Guide·39 reviews·15 photos 4 years ago James was an amazing manager. My card wasn't working for some reason and he still made my pizza and gave it to me for free. Absolutely amazing customer service! Thank you James! &pizza - Dupont (Owner) 4 years ago Hey there! Thanks so much for the love. We always appreciate our loyal fans. Sunil Singh Local Guide·183 reviews·134 photos 5 years ago &Pizza is something like Blaze Pizza. You pick your dough, then the sauces, and then all your toppings. It's unlimited sauces, and unlimited toppings. And after the pizza is baked, you can add any other sauces, or other toppings. And … More breathemusic94 2 reviews a year ago I love coming to this &pizza, Tay is always a welcome face at this establishment, he is extremely helpful and all around fun to talk to. The food is always amazing here. Crystal 1 review·1 photo 2 years ago &pizza Great good and atmosphere, staff was friendly Photo 1 in review by Crystal Thomas Scheurich Local Guide·33 reviews·1 photo 6 years ago I really like the new fast casual trend. Others may complain about it, but it matches my lifestyle and sets a good middle ground on price. &pizza is the best example of fast casual in this region. Really awesome and ultra customizable food … More Oliver Borg 11 reviews a year ago Andre was super helpful! Fantastic late night spot, quick service, friendly staff, and good food. What more could you want. Dale L. Roberts Local Guide·52 reviews·118 photos 6 years ago This is the second &pizza I've gone to today and wow! This place is even better. There's more seating and it's not even busy. Well worth it! And the staff was friendly and attentive. 5+ stars Nibha Rastogi 7 reviews·2 photos 5 years ago ordered a craft your own... SO GOOD!!! The tribe were super courteous and I got what I wanted. Got a traditional with mushrooms, spicy Italian sausage, onions, pesto finish. Jordi Segura Local Guide·115 reviews·366 photos 7 years ago We ate in this pizza shop during our trip to Washington, and we found the pizza and drinks tasty and original. You can make your own pizza or order one of the existing recipes. I would recommend it for take out or a quick bite. Brandon Boone Local Guide·377 reviews·1050 photos 4 years ago Quick and delicious lunch, very filling and I'm a big guy. Definitely mix it up don't settle for cheese and pepperoni... Never thought I'd have honey on a pizza. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our unique pizza options. Your response is important to us as we strive to improve our services. We hope to serve you again soon with more delicious and filling options! ROBIN THOMPSON Local Guide·94 reviews·221 photos 6 years ago I love this place! They have a great pizza selection . I love their specialty sodas. Try the cream soda. There is a wait though due to their being only one person to ring up your order and box your pizza. T Williams 9 reviews 4 years ago Best way to order a to go pizza is on their website. After a long day of sightseeing, a couple of their ""oblong"" pizzas was just right. Thin crust was great, toppings good. Prepared quickly. &pizza - Dupont (Owner) 4 years ago Thanks for the review and for stopping by, T! Ashley Craft 4 reviews 2 years ago I love The Dupont Team everyone is so nice Tay always goes above and beyond for the customers amazing customer service!! DuPont Team keep up the great work!! Jelani Phipps 8 reviews 2 years ago Food is so delicious. The manager Delonta gave me supervisor service. I would definitely go back again. You won't be disappointed!!! Nely Hernández 2 reviews·1 photo 10 months ago Love this late location . Super busy They are still very patient with customers. Lance Porciuncula 1 review 2 years ago The workers there are super friendly and nice. The service was also pretty great. Got my pizza with little wait. Ismail Gomaa Local Guide·364 reviews·1240 photos 7 years ago Some of the best pizza I've ever had. Any combination worked because their ingredients are absolutely perfect. I enjoyed everything I've tried there, even the stuff I don't usually like. Sarah Semlear Local Guide·154 reviews·1292 photos 5 years ago The gluten free crust is pretty good! It's not a completely gf environment so they can't guarantee there is no cross contamination, but they are careful and change gloves when handling the gf crust. The options are fun and there is a good amount of toping choices for build your own. 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We understand the importance of providing a safe environment for our gluten-free customers and we're glad to hear that you appreciated our efforts. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Michael williamson 9 reviews a year ago Take out | Lunch | $10–20 Pizzas are not that good and one of the workers not that friendly pizza crust had sir burnt from dirty oven … More Jennifer Telfort 4 reviews 2 years ago The service is great! Thank you so much for making my pizza just the way I like it!! I will be back again!!! Hailey Gruch 7 reviews a year ago Take out Wonderful experience... it was busy but they made me feel at ease... wonderful service... thanks to Quan, Malik, Justin and faith William Minter Local Guide·85 reviews·79 photos 7 years ago Thin crunchy crust that isn't overcooked. Awesome fresh toppings and sauce. Perfect for lunch or later night special. Not the best place to sit and eat as space is limited inside(20-25 at best) Cameron Asgharpour 1 review 2 years ago Great customer service and staff is very attentive. Pizza was awesome LadyLewis 2u Local Guide·17 reviews·15 photos 5 years ago &pizza is my fav pizza, but unfortunately, I experienced the WORST, not just customer service, but attitudes EVER! When I asked for assistance, I was only given the 202 number they have taped on the glass display. It was weird bc 2 … More Angel Aguiluz 1 review a year ago Tay is a hell of a entrepreneur! A lovely lad, Marcia also made an astonishing pizza with Nikko. 10/10 if you’re near Faragut North Rakia Pinkney 3 reviews 2 years ago The staff are very friendly and the food came out great and in a timely manner. I will be back, this is the best &pizza location! Dante Gardner 1 review 2 years ago I had an amazing experience. Antonio, and Roshan were very accommodating to my child who is particular about his pizza topping’s . 1 Scott Jason Local Guide·38 reviews·46 photos 4 years ago Thin crust pizza was very tasty and filling. I had red sauce with fresh mozzarella, tomatoes and onions. They do have a gluten free crust for $3 extra. 1 Chris Morris Local Guide·49 reviews·25 photos 4 years ago Pizza was way better than expected. Really nice staff. They were able to get people in and out quickly. I will definitely be returning. 1 &pizza - Dupont (Owner) 4 years ago Thanks for the review :) Raynell Jackson 26 reviews·26 photos 4 years ago I pizza and staff are wonderful Photo 1 in review by Raynell Jackson Photo 2 in review by Raynell Jackson Killian Devitt Local Guide·128 reviews·541 photos 8 years ago What's not to like about this place? It's just great, simple pizza. Tried the Maverick the first time I went and I haven't ordered anything else since. Perfect for lunch if you can avoid the rush. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our Maverick pizza and that it's become your go-to choice. We appreciate your support and hope to serve you again soon. Your response is important to us as we strive to improve our services. taliyah hughes 4 reviews 2 years ago Great customer service, quick service! FOOD IS AMAZING! My favorite spot to come after a drunk night 🤪. Highly recommended Mo Love 38 reviews 3 years ago I went in there for the first time a couple of weeks ago. The restaurant had a really foul odor and I could smell it through my mask. Although, I ordered a pizza online and picked it up, I did not eat it and I will never go back to that pizzeria. 1 &pizza - Dupont (Owner) 3 years ago Thank you for taking the time to share your feedback Mo. Our management team will be looking into the odor that you are referring to for the Dupont location. I'm sorry to hear that the experience did not meet your expectations and I would like to apologize for this. Chris Oliver Local Guide·17 reviews·1 photo 8 years ago Great customisable pizza in a relaxed atmosphere. Their home made cola is to die for and so much tastier than coke or Pepsi. Only criticism is that the music was way too loud. Amanda Neilson 6 reviews 2 years ago Great experience! We had a large group and they were fast and efficient. Love the pizza! Breasia Lawson 5 reviews·1 photo 2 years ago Labella made my pizza so good and had the best costumer service ever, he was very bubbly and pleasant and Met all of my demands because I’m a very picky eater lol he’s the best Adriana Lopez 5 reviews 11 months ago Great service! Everything was on point! Andrew was very attentive and polite! Thank you 😃 Merlin Tondji 2 reviews 2 years ago This place is great . Unfortunately last night we couldn't custom the pizza however the team still amazing Briana McKellery 9 reviews·5 photos 2 years ago Beat servers best pizzas and my fav location but all are great. Definitely suggest stopping here for a late night craving after a night out! Tiffany Dendy 3 reviews a year ago Dine in | Dinner | $20–30 Wave and Twan provided excellent customer service on my visit. Gloves were changed prior to assisting us Thanks guys ! Micheal Stone 2 reviews 2 years ago Team was friendly with great service. Pizza came out great! Will continue to come back Forrice Brunson 1 review a year ago Courteous and professional staff members. My order was completed without issues. It was fresh, hot, and the toppings were 🤌🏽. Saee’Rozay 1 review a year ago Take out | Dinner | $10–20 First Time At &Pizza . Great Service By Andre ! Respectful & Kind . Will Definitely Be Back Especially At This Location Medachi 509 16 reviews 4 years ago This is the worst & pizza that I’ve ever been they don’t change their gloves. They got nasty attitude they should reconsider on hiring people there. If I’m paying $11 for pizza I should be treated with respect the customer service is terrible I can’t even tell them how I want my pizza to get done. 1 &pizza - Dupont (Owner) 4 years ago Hi Questa, thanks for the feedback. We'll be sure to address this promptly with the shop. Angel Angelov Local Guide·159 reviews·920 photos 4 years ago A bit dodgy place but pizza was perfect. They offer you to choose from anything you want to add to it and can make it as you like. Was really delicious. Not beer or any liquor though 1 Nataliya Kostiw 2 reviews a year ago Alonzo was amazing, he helped us with everything and was very polite and informative! Would definitely recommend! Simply, Tasha. Local Guide·130 reviews·244 photos 5 years ago Idk what the rating I'm assuming it must be great for I'm too drunk to realize food but let me tell you...today I walked in and walked out....the stench was crazy...it smelled like a dirty barn...or zoo...sewage...idk but I couldn't even order to go and I was just dissappointed... it is a super rainy day today.... 2 Kylie Gilbert Local Guide·19 reviews 7 years ago Could eat this every day for the rest of my life. Not a lot of seating inside though. Also check out ordering ahead, it's much faster. The sodas are good too! Josh Robichaud Local Guide·93 reviews·123 photos 8 years ago Great custom pizza at a reasonable price. Either the preset menu or build your own, can't go wrong. Plenty of seating and fast service. Andrew Isett Local Guide·185 reviews·230 photos 7 years ago Good pizza custom made the way you like. Similar to Chipotle with a burrito, &pizza allows for any toppings they have and different sauces. Always some left over too!! Ethan Granetz 3 reviews a year ago Take out | Dinner | $10–20 Andre got us food real late. He made an awesome pizza. 10/10 service J 4 Local Guide·131 reviews·64 photos 7 years ago Oh yes lawd. This pizza is so good and u dictate the toppings. Yum. Decent price for DC and a food serving size. Not glutinous but more than sufficient. Arely Castro 1 review 2 years ago Amazing service ! & the pizza was so delicious that I will come back again! Jimmy DeVault 15 reviews·1 photo 5 years ago Great food, concept and atmosphere. First time at this location and this may just be this location but service was super slow! The team here also seemed very disorganized, there was no designated cashier which caused a bottleneck at the register where everyone just stood. Maybe they were short staffed? 1 Destiny Cruz 3 reviews 2 years ago GREAT service! And even better pizza! This is my regular location Bc they never disappoint 😉 Punky Banks 1 review 4 years ago I had a great experience. Our cashier Diamond was kind, courteous, and offered great recommendations. I’ll be back soon. Overall great food and great service! &pizza - Dupont (Owner) 4 years ago Thank you so much for the great review Punky! We look forward to seeing you agin soon. Kevin S 3 reviews 2 years ago This is specifically for the website ordering experience. I typically pick up but I needed delivery and my nearby &pizza store was temporarily closed. The problem is that it is impossible to switch the store you're getting delivery from, or … More 1 &pizza - Dupont (Owner) 2 years ago Thank you for your feedback Kevin! I'm sorry to hear that this was your experience trying to order online. We'll flag this information over to our development team to fix. Najm Aldin 9 reviews 9 months ago Luis is very professional and he took care of me. Very nice guy Samantha Zarrilli Local Guide·25 reviews·2 photos 2 years ago Amazing service! So great. Lavelle went above and beyond to make us feel welcome. Promote him!! . Jeremy R. Stinson Local Guide·178 reviews·293 photos 4 years ago &Pizza is one of my favorite pizza joints in DC. Not all locations are created equal, but this particular location is always clean, the staff is friendly and helpful, and I never have to wait too long. &pizza - Dupont (Owner) 4 years ago Hey, Jeremy. Thanks so much for review! руня 11 reviews 7 years ago Great vegan options, (they have mozzarella daiya and veg meat crumbles)! Lots of fresh veggies, good unique gourmet choices of sauce too. The pesto is delicious. The price is reasonable for a vegan pizza, compared to zpizza which recently … More 1 Fabian Meneses 5 reviews a year ago Staying at a hotel close by this place has been our stop daily! From the friendly staff to the delicious food, you have to try this pizza! Mouhamadou Thioune 4 reviews a year ago I like eating at &pizza Dupont. The pizza is always on point. The place is always clean and Tay always provides good customer service. Reilly Sheehy 1 review a year ago They were so lovely - they gave me free water when my friend and I needed it most. 10/10 Ryan Norton 7 reviews 7 years ago I tried calling multiple times to have a question about their menu answered. Each time it automatically goes to a recording and it gives you the option to press ""2"" to speak to an employee. However when you choose that option the phone … More Geneva Kropper 4 reviews 4 years ago The pizza here is fine, but the staff is very rude and will let you stand at the counter without asking how they can help you. Very poor standard of hospitality and out of place in DC. nate porter 2 reviews a year ago Tay is the best. I love the customer service. He should be promoted. Nikko & Marciara are amazing and should also be promoted!! Isaiah Benjamin 3 reviews 2 years ago I always have a great experience, I work in the area the workers are always fantastic to chat with. Food is always delicious, my go to spot for lunch. Angelica Martinez Local Guide·54 reviews·115 photos 4 years ago Stopped by this place when in the area. Design your own pizza from scratch, and then customize it. The staff assemble your pizza as you watch ... you get to decide everything which goes on the pizza as you follow it down the line. We … More 1 Ariana Brown 3 reviews 2 years ago Very professional clean and made my pizza in a timely manner. Staff was perfect Levon Akopian 8 reviews a year ago Dine in | Other | $10–20 It was amazing and tasty Perfect pizzas, friendly crew … More Jamie Sneed 1 review 2 years ago Outstanding place, great service, Terrence was a huge help and help me build the perfect pizza for my first time!! Teezy Teez 2 reviews a year ago The establishment was amazing, Tay was very kind and ensured we were okay during our time at the restaurant. &pizza - Dupont (Owner) 2 months ago We're thrilled to hear that you had an amazing experience at our restaurant and that Tay took great care of you. Your response is important to us as we strive to improve our services. Thank you for the 5-star rating! We hope to welcome you back soon. kiara cooper 1 review 2 years ago I experience the best customer service with an employee name Lavelle! Definitely would recommend. The pizza was amazing !! Lisa Smith 5 reviews 2 years ago They have an excellent menu selection and you can add anything else you desire... or you can build your pizza from scratch... all at one reasonable price! Delightfully Delicious 👍 2 &pizza - Dupont (Owner) 4 years ago Thanks for the review! :) M A Local Guide·31 reviews·16 photos a year ago The vegan mozzarella and vegan sausage are amazing. To &pizza: please bring back the vegan chicken. Chris Anderson Local Guide·36 reviews·182 photos a year ago Not extremely friendly but excellent excellent pizza. The dough is the best part. 1 Sachin Bhattiprolu 2 reviews a year ago They take orders beyond 10pm but you cannot eat there because they close at 10pm. People here were incredibly rude and forcibly removed chairs WHILE 10+ people were trying to sit and eat. Incredibly rude place. Blue Moon 4 reviews 7 years ago literally the best pizza i've ever eaten. i had the vegan options. they were incredible.staff was really nice. would recommend to everyone. It’s Me Local Guide·381 reviews·169 photos 7 years ago As usual, friendly staff. First time at Dupont location, but just as good as the H St one. … More &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We regret that we no longer offer San Pellegrino and apologize for any inconvenience caused. Your response is important to us as we strive to improve our services. We appreciate your feedback and hope to see you again soon! Quennitta Winzor 1 review 2 years ago The manager is wonderful and fast. But I feel like they were catering to the white people. I almost felt invisible. Darlene Craft 4 reviews 2 years ago I love coming here the manager Tay always knows exactly what the customer service at DuPont is beyond amazing :) Sinceree Stewart 2 reviews·1 photo 2 years ago Great customer service and very patient. Photo 1 in review by Sinceree Stewart lizzle thrvxxx 2 reviews a year ago Andre was very helpful I been goin here for about and year and the customer service is great 10/10 Jas 3 reviews 2 years ago Best pizza I’ve ever had and the workers are the nicest people ever!!!! Come here for a quick bite! &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza and had a great experience with our staff. Your response is important to us as we strive to improve our services. We hope to see you again soon for another quick bite! Jalen Dixon 1 review a year ago Great service and very reasonable prices! The pizza is also prepared very quickly! Candice Mulholland 4 reviews 2 years ago Terence was awesome! They are always quick and so friendly when I’m in there. 10/10 on the pizza too 😊 Tim Larkin Local Guide·72 reviews·226 photos 5 years ago Damn, this is good pizza Photo 1 in review by Tim Larkin Ron Hagage Local Guide·87 reviews·83 photos 5 years ago Subpar and overpriced pizza place. Compared to u street pizza joints, this place is trendy, hipster and serves mediocre pizza at best. … More 1 Dj Teck Entertainment 1 review 2 years ago Quick and easy. Best pizza I’ve every had. Especially after the club. Will be back Adam Christensen Local Guide·71 reviews·326 photos 8 months ago No way to reach the store and UberEats never delivered my food. … More Erika R. Local Guide·50 reviews·18 photos 5 years ago Reminds me if Blaze. Make your own pizza and craft soda, but some of those toppings should. DEFINITELY go on the pizza as it's being cooked not at the end. Beyond the Clubhouse 1 review a year ago The staff here did a great job, very attentive and engaging. Especially Antonio. A wonferful customer experience! Ryan Local Guide·12 reviews 2 years ago Take out | Dinner | $10–20 Made a mistake when placing my order online and Antonio was awesome helping me get it corrected quickly and courteously. Will Return! … More Alfredo Schonborn 3 reviews a year ago Dine in | Dinner | $10–20 This place was a fantastic establishment to eat with quality food. A recommendation to everyone Ryan Dudrow 1 review 2 years ago Great service for an amazing price for a whole pizza awesome employees 10/10 would recommend Briana Jones 1 review 2 years ago I go to this location all the time! Great customer service and the pizza is always perfect! Haylee Smith 1 review a year ago Awesome pizza & employees. Has original drinks that all taste good! Justin Adams 8 reviews 4 years ago 1st time here. The food was great and the price was right. No complaints. Wish I had found this place sooner. Trip Taker 117 reviews·58 photos 2 years ago I'd like to give it a .5 star. Says that it's open but door is locked, lights are on and you can see employees inside working. Stephen Oliver Local Guide·13 reviews·17 photos 6 years ago Greeted by smells of rancid food or trash when entering. Smell intensifies as you walk further in. Trash everywhere and dirty tables. Bathrooms out of order. … More William Nelson 2 reviews 2 years ago great location! everyone here had great service and the pizza was good! 🙌🏽 Clementina Fernandez Valle 4 reviews·7 photos 2 years ago Great service and really quick. The pizza was delicious and the place is really nice. Jade Boone 2 reviews 2 years ago Staff was very friendly and efficient with taking customers orders in a timely manner! Will definitely visit again Quita11 2 reviews a year ago Terrence was awesome!!! He answered any question I had and did it with a great sense of humor. Marcus Smith Local Guide·115 reviews·5 photos 3 years ago The staff was polite, and efficient this staff is prepared for lunch rush, I even got a bottle of water Since I do a lot of delivery work, I really appreciate these things. 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating and positive feedback! We're glad to hear that you had a great experience with our staff and that the service was efficient. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Marissa Amore Local Guide·57 reviews·13 photos 5 years ago It’s pizza & it’s good. Need I say more? Great location by clubs and night life. Great place to grab a bite on the late night Michael Smalls 2 reviews 2 years ago Fantastic experience! The service was excellent and I love their pizza. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear about your fantastic experience and love for our pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Hycent Nwaneri 1 review 2 years ago Great service!! Antonio really helped me and made sure everything was taken care of for me! Definitely will be back. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Antonio provided great service and made sure everything was taken care of for you. Your response is important to us as we strive to improve our services. We look forward to welcoming you back soon! Alan Harris Local Guide·151 reviews·259 photos 6 years ago It was late when I went but it was still a great pizza. I could tell the associates were ready to go but appreciated the pizza. Will come again. Isaiah “Zay” West 1 review 2 years ago We came on Christmas Eve and the service was phenomenal! Antonio and Brian were great! Thank you &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Antonio and Brian provided phenomenal service on Christmas Eve. Your response is important to us as we strive to improve our services. We hope to have the pleasure of serving you again soon. Ryan Stevens 10 reviews 4 years ago Truly the worst experience . The all male staff associated with the shift on December 6th, at 12:22 am was extremely rude. Customer service was just extremely poor. &pizza - Dupont (Owner) 4 years ago Hey Ryan, I'm really sorry about your experience. We'd love to hear some more details about it if you can reach out to us on our text line, 200-03. Aja Clark 11 reviews 2 years ago Service was excellent! Came to this one because the one in Georgetown was closed. Brian and Antonio were really helpful and pleasant. Beverly Barber 4 reviews·2 photos 2 years ago The staff was very helpful with everything I needed and also made sure I was safe by giving me a mask to protect myself❤️ Patricia Babb 7 reviews 2 years ago Staff was very friendly and accommodating and the pizza was exceptional. Great location :) stefanie riggins 5 reviews 7 years ago Amazingly friendly staff! Our first dining experience in DC and we plan to hit them up again!!! Fresh deliciousness! LynDale Lewis Local Guide·159 reviews·358 photos 4 years ago Good pizza... one size, so be prepared to share if you don't easy a small pizza yourself. Simple menu. &pizza - Dupont (Owner) 4 years ago Hey there! Thanks so much for the love. We always appreciate our loyal fans. Renuka Joshi 3 reviews a year ago Dine in | Dinner | $10–20 Great pizza made quickly. The team working here is super nice. tomas moser 2 reviews 2 years ago Wonderful pizza great especially after a night out. Definitely recommend. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're glad to hear that you enjoyed the pizza, especially after a night out. Your response is important to us as we strive to improve our services. We hope to serve you again soon. Vanessa Jimenez Local Guide·49 reviews·8 photos 7 years ago Add your favorite toppings to an amazing crust with eclectic soda flavors for a good price. Comfortable, casual atmosphere. Nista Bob-Grey 1 review 2 years ago This &pizza location is great , the staff was super friendly and I got helped really quick! Stephanie Becker Local Guide·70 reviews·76 photos 5 years ago Different pizza place. Still liked it, one pie can feed 2 people if your not real hungry. Unique combinations. 1 Richo Local Guide·18 reviews·24 photos 4 years ago Delicious pizza, Maverick with extra cheese wont dissapoint any meat lover. Open until late is very helpful. &pizza - Dupont (Owner) 4 years ago Good choice with the Maverick Ricardo! Definitely a fan favorite. Thanks for the great review too! Chris Meaclem 4 reviews·1 photo 7 years ago Only $10 for any pizza, custom made. Basically the subway of pizza - choose your base and any toppings. They charge a flat rate, not per topping. Alex B. Local Guide·190 reviews·277 photos 7 years ago Love &pizza. This place stays open late on the weekends but is pretty full of drunk club goers. Still, it hits the spot after some dancing. robert brown 1 review 2 years ago Service at this location was the best I’ve had at any in the DMV area! Definitely will be going again. Amir Ghasdi 11 reviews·15 photos 5 years ago I built my own Pizza: pesto and spicy tomato, mushroom and Tomato, whole mozzarella, Italian sausages, beef, and finishing with goat cheese and arugula and for sure garlic oil!!! Tenija Livingston 1 review 11 months ago Dine in | Lunch | $1–10 Amazing!!! The workers were welcoming and very cheerful. 10/10 Kalaa 3 reviews 2 years ago Very fast pace store love how my pizza tastes perfect every single time. Brendan M. Local Guide·95 reviews·31 photos 5 years ago The pizza is fantastic. the employees are not. I got the feeling they didn't not care about the job or product they were giving customers. Allen Local Guide·288 reviews·819 photos a year ago Very poor service here. I was the only person in line and the employees did not even acknowledge me. They were having a conversation amongst themselves. Dog Matic 1 review a year ago Fast Great service from the two brother working feb 4 at 6pm Danielle Carr 2 reviews 2 years ago The guy who made my pizza made sure it was done right like forreal lol didn’t skimp me and it looks delicious Halio J 16 reviews 5 years ago Terrible customer service. Staf will rush you and slap together a terrible job of a pizza. Management no better. No wonder employees are terrible, management is even worse. Nadeen Siddiqui 6 reviews 5 years ago Terrible service. They just threw toppings without caring about making it tasty. Don’t waste your time and money here. Chose a place that actually tries. 1 Cory Simmons 1 review 2 years ago I got food poisoning. No disrespect to the workers, but my stomach hurts so much and I’m so mad lol. Thompson Hangen Local Guide·36 reviews·9 photos 4 years ago Fast and great pizza! What's not to love about &pizza? The staff here are friendly and accommodating! Christy McCann Local Guide·48 reviews·18 photos 2 years ago Food was not made correctly and a bit late, the secjrry staff is super rude, but employees were nice. Cavin Ward-Caviness Local Guide·319 reviews·769 photos 6 years ago Fresh, quick, tons of toppings, and most importantly tasty. If you have the chance definitely go to one of the many locations and see why all the hype is deserved Esprit Cha 2 reviews a year ago Amazing pizza, amazing service, awesome experience as a whole m g 11 reviews a year ago We bought a pizza and we’re immediately screamed at and tossed out for eating it inside. Like what? The moment I hand you cash you throw me out. I can’t eat my pizza inside? &pizza - Dupont (Owner) a year ago Hi Max. Sorry to read about your experience. Can you text us at 200-03 to provide more detail. Edwin Lopez 5 reviews·2 photos a year ago &pizza is my all-time favorite for a fast casual -- and delicious -- pizza. This location is a mainstay, too! R. T. Local Guide·16 reviews 7 years ago This place was gross!!! Trash everywhere and it smelled pretty bad. There's definitely better &pizza's to go to in DC. I went in and came right back out! 1 Rebecca Schick 32 reviews a year ago Take out | Dinner | $10–20 Very tasty pizza. Staff were great JED CREEK 8 reviews 7 years ago Do not ever go here it's terrible. My friend got food poisoning, so it's not safe to go here. And the management and the staff are terrible and refuse to take responsibility. Avoid this place at all costs! Monae' Bailey 4 reviews 2 years ago Antonio was very helpful, assisted me with ordering my meal. 10/10 would recommend! Kelli Smith 3 reviews 2 years ago I always get the best service here. I live &Pizza and Terrence is great!!! Emily Nelson 1 review 4 years ago Amazing, charismatic staff and even better pizza!! Very creative and innovative pizza and drink choices :-) Josiah Tomes 4 reviews·2 photos a year ago Staff is very nice! Photo 1 in review by Josiah Tomes GLENN EVANS Local Guide·41 reviews 4 years ago DONT WAIST YOUR TIME.OR.MONEY. PLACE WOULDN'T LAST A WEEK IN JERSEY. FIRST I TRIED TO CALL AND THEY DONT TAKE CALLS U HAVE TO ORDER ONLINE OR … More 2 Gucci simon Local Guide·64 reviews·4 photos 4 years ago Food was great. The service was horrible. Only 2 ppl in the store had some manners. The REST HORRIBLE. &pizza - Dupont (Owner) 4 years ago Hi Gucci. Thanks for the feedback. We're sorry that your experience was below expectation. We'll be sure to relay this message to the Shop Lead so that improvements can be made asap. Alyse Edwards 2 reviews 2 years ago Friendly, polite and helpful staff. Pizza is good too duh! C Michele 1 review a year ago Staff is dope. Pizza is delicious. Big fan! Lauren Prather 2 reviews 2 years ago Friendly and helpful! Quick service and the food is 🔥🔥! Lavelle was amazing and super helpful! Amazing customer service! Austin Zielman Local Guide·437 reviews·1539 photos 7 years ago Great pizza served super fast! Downside is that it's directly next to/under sa club, and the constant thumping is quite disturbing. Billy Local Guide·207 reviews·404 photos 7 years ago Cool spot for a flat bread pizza. You make your own pizza which is pretty cool. The price is reasonable one pizza is good for 2ppl. Kenny Culver Local Guide·14 reviews·1 photo 4 years ago pizza was so spicy I couldn't eat it I took it back in I said hey I need a new one I don't know why it's spicy they said tough s*** bounce &pizza - Dupont (Owner) 4 years ago Hey there! I'm so sorry to hear about your bad experience. If you get a chance, please text us on our customer service line at 200-03 and we will make this right. Priya Patel 2 reviews 2 years ago Loved it! Everyone was so accommodating and understanding! Great pizza! Emir Yılkıcı 5 reviews·3 photos 7 years ago They simply blend some cheap ingredients. The food tasted not that good. I don't recommend unless everywhere else is closed. Johnny Neilson 2 reviews 2 years ago Dine in my family loves this place! very good food and friendly staff! Luis Medina (COACHMETONY) Local Guide·97 reviews·324 photos 6 years ago Great food! I'm vegetarian and I had a lot of options here. Only thing is that serving sizes are really small. Chiquita Jackson 1 review 2 years ago Great food and quick service! Loved the garlic knots too. mike epps 3 reviews 2 years ago Great quality pizza, fast and friendly customer service. Dylan McDowell Local Guide·138 reviews·79 photos 7 years ago Best option for a pizza lunch in D.C. This location has more indoor seating, but during prime times be prepared to walk to a nearby park. Kay Tunez 1 review 2 years ago Quey was great and very helpful since it was my first time she made my experience 10 times better. Derrick A. Morton 2 reviews 2 years ago The coolest & Pizza in the DMV everyone in there will make you laugh ! Thank you for my good 🍕 DK Walker 7 reviews 6 years ago Best pizza ever! Far from traditional tasting pizza, leaves a funky delicacy in your mouth that leaves you beyond satisfied! Renee S. Local Guide·55 reviews·4 photos 7 years ago Pretty good! The prices are reasonable (listed at the top of the menu) and pizza is delicious! I ordered the gnaric... good choice! Tray Smith 4 reviews a year ago Great place. Jainyn was great cook. She was nice and quick. Music for every ocation Local Guide·6 reviews·334 photos 5 years ago I love these pizzas Photo 1 in review by Music for every ocation Christopher Edwards 2 reviews 2 years ago I had the best experience. Customer service was A1 and the food was awesome Pauline Abah 1 review a year ago When back to this place after my Last visit and the service is always amazing Nicholas Mildebrath 1 review 2 years ago Go-to lunch spot in DuPont. Pizzas are great and filling - quick service and always good music. Tustin Neilson 6 reviews 2 years ago Dine in | Lunch | $10–20 Quick service and tasty pizza! I recommend adding the hot honey. … More helene h 1 review a year ago Delivery | Dinner Super good pizza, delicious drinks, love it <3 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our pizza and drinks. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Jimmy Sambuo 6 reviews·7 photos 2 years ago Fast and friendly service! &pizza is my goto pizza place. Marquis Savant 1 review a year ago Delivery | Lunch Waited over 30 min for a delivery while the employees traded food with shake shack Gabriel Marín 7 reviews·1 photo a year ago Lovely place and pizza is great!! Tay was a complete gentleman. &pizza - Dupont (Owner) 2 months ago We appreciate your 5-star rating! We're glad you enjoyed the pizza and the service provided by Tay. Your response is important to us as we strive to improve our services. Thank you for taking the time to share your experience with us. Messaijah Shillingford 2 reviews a year ago The food was great! Tae gave wonderful customer service! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed the food and received wonderful customer service from Tae. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Donald Jackson 7 reviews a year ago Dine in | Lunch | $10–20 Love how the pizza is made on the spot, fresh ingredients and creative mixes Talisha Harris 4 reviews 2 years ago Terence was great! Ever want great pizza and good vibes, come to Dupont location! Corey DeAngelis Local Guide·204 reviews·623 photos 7 years ago Best custom pizza ever Photo 1 in review by Corey DeAngelis Frankie B 1 review 2 years ago Absolutely love this place. Service is quick and food is great Kaylah B Local Guide·48 reviews·18 photos a year ago Take out | Dinner | $10–20 Super fresh, super quick service even though it was very busy! Anna zakharchishin 1 review a year ago Other | $10–20 Alonzo was the absolute best. Should definitely be running the place! Baylee Childress 2 reviews 5 years ago Love this place. Always delicious. Staff is always friendly. Tyler is a bit of a Chav. Tsvetelina Petkova Local Guide·99 reviews·147 photos 4 years ago Really kice and tasty pizza. Affordable price and you choose your topics. Basically you choose your pizza from scratch. Yummy. &pizza - Dupont (Owner) 4 years ago Glad you enjoy the concept Tsvetelina! And thanks for dropping a review! Steve Murphy Local Guide·43 reviews·417 photos 5 years ago Good, quick pizza while you wait. Not as good as wood burning oven etc, but satisfies... James Papanestor Local Guide·88 reviews·574 photos 2 years ago Thin crust and the choices for the toppings are not like any other! Went three times in one week. Tarikah Omar 3 reviews 6 years ago Pizza was fantastic, service was awesome, there was an unpleasant odor when entering that definitely needs to be addressed 1 Javier Borja Local Guide·19 reviews·1 photo 5 years ago Love the food, large space with plenty of seating. It's not a warm place but in great location G Local Guide·116 reviews a year ago Food was good staff was friendly and helpful. … More Amar-Jyrel Mott 2 reviews 2 years ago I love it! Staff is nice & I've never had a bad experience! N K Local Guide·98 reviews·38 photos 6 years ago The best build to suit pizza joint I've tried. Light years ahead of blaze on quality of ingredients. Gahana Dahiya 6 reviews·1 photo 3 years ago I go to this place all the time! Food is great and the staff is always nice. &pizza - Dupont (Owner) 3 years ago Thank you so much for the review and thank you for being a returning guest! Can't wait to see you again next time! Patrice Mobitang 1 review 2 years ago Great pizza. My familly and I love this location Yuting (Nychii) Local Guide·114 reviews·1683 photos 7 years ago Really enjoy the way this chain makes pizza! This location doesn't have a lot of seating though... Sakina Allen 2 reviews 11 months ago great customer service!!!! definitely recommend. George A 1 review 2 years ago Ordered waited for 2 hours and then my order was canceled. They asked me to reorder. It was my first time ordering from them and my last time. TEAM SHERBOURNE Local Guide·405 reviews·284 photos a year ago I'm from NY and Always have to visit a &pizza while in DC! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We are thrilled to hear that you always enjoy visiting &pizza while in DC. Your response is important to us as we strive to improve our services. We hope to continue exceeding your expectations on your future visits. Carlos Patiño Local Guide·168 reviews·431 photos 4 years ago Really, good pizza! Just pick what you want with it and enjoy. Friendly people. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're delighted to hear that you enjoyed our pizza and found our staff friendly. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Erica Burwell 4 reviews 6 years ago The service was good food is normal. If u r n the mood for pizza good place to go. Aris Preston 2 reviews 2 years ago Pizza is great Antoni and Bron were very helpful and lead to a great lunch. Weiyan Zhang 2 reviews 2 years ago I quite like the pizza here! Self designed pizza is always the best big boi rj 1 review a year ago Take out | Dinner Awesome establishment, good service, tasty pizza Bryan Moises Hernandez Benitez 1 review a year ago the crust is the best and the staff are great, down to earth people. Courtney Metcalfe 5 reviews 2 years ago Lavelle was awesome and gave us great service! awesome pizza Jennifer Morgan 6 reviews a year ago Take out | Dinner | $10–20 Great option for a quick / delicious late night dinner. … More James Gregory 2 reviews a year ago Good pizza great people!! Great late night fix &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza and our service. We're always here to satisfy those late-night cravings. Your response is important to us as we strive to improve our services. Ms Lola 2 reviews 2 years ago Antonio was the best I love how he makes my pizza, I absolutely love this location. Adeola A 11 reviews 4 years ago The pizza is fine, they don't allow you to sit down and eat late nights on the weekend, although they are open, and the security is very rude about it. Joni Hurley 3 reviews·1 photo 5 years ago Pizza was amazing!!!! One of my best GF pizza crust (order well done) Tat hazelton 4 reviews 2 years ago Good Customer Service, Fast Paced & Loaded Pizza Up. Joseph Rhinehart 11 reviews·1 photo 2 years ago Friendly staff. Great food . Will definitely come back. AHMED RABANE 2 reviews a year ago Always great customer service. Terence is definitely a great asset for this location Kendi Johnson 1 review 2 years ago Lavelle was very professional. He put love into my pizza Justin Wang Local Guide·92 reviews 7 years ago Make your own pizza for $9? As many toppings/sauces/garnishes as you want?? I love &pizza. Tahlia Stangherlin 8 reviews·4 photos a year ago Tay was very helpful when i checked out today. very polite and friendly ! Nisha P 6 reviews·1 photo 2 years ago Great experience! Quick and convent! It’s a must try if you are in D.C. Pooja Rastogi 5 reviews·2 photos 2 years ago Love the pizza and employees!!!!!! So so nice especially lavelle Jake Backers 3 reviews a year ago This place is the best!! also the pizza??? smashing!!! Chanel Beaudoin 1 review 2 years ago Great pizza love it here. Loved the service! Allen Cardenas Local Guide·42 reviews·10 photos 5 years ago So glad there is an &pizza in Dupont. It's quick, easy, and delicious. Awesome value for your money Chanelle Combs 1 review 2 years ago Antonio the best I love this location best pizza and they close at 4am Clifton McEachin 3 reviews 2 years ago Great service!!!! The best pizza I’ve ever head!!! Lucas Orjales 2 reviews a year ago Tay was the best supervisor! Absolutely delicious pizza! Antwane Wrenn 1 review a year ago I love this location .employee are fun and patient Kristin Fillingim 1 review 2 years ago Là elle was the best!! Great service. 5 out of 5 every time!!!! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We are thrilled to hear that you had a great experience with us. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Jackie Warner 2 reviews 2 years ago Great service and pizza! Antonio, Brianna and Jalen are the best. Veronica Sarai Melara Cornejo 1 review a year ago Good customer service! Friendly people and always willing to help. Lifeasevon 6 reviews 2 years ago The pizza is always great ! Extra crispy too David Oliveira 4 reviews 2 years ago Take out | Dinner | $10–20 Love their pizza, clean and nice location miles vondra Local Guide·10 reviews·12 photos a year ago Great pizza, even better people. JP was great! Yousif M Local Guide·26 reviews·3 photos 5 years ago Lots of crust on the pizza because of how it's made. Super fresh and feels almost healthy! Lauren Hastings 1 review 2 years ago Take out | Dinner Service was great and the vibe even better! Lavelle’s assistance was top notch Precious Johnson Local Guide·25 reviews 2 years ago Service was great at this location! Food was delicious 😋 Kannan Ramanathan Local Guide·73 reviews·27 photos 4 years ago You can just add all the ingredients you want and the dough of the pizza is thin and delicious &pizza - Dupont (Owner) 4 years ago Hey Kannan, glad you loved it! Come again soon! Al S. 1 review 2 years ago Outstanding service and made one hell of a pizza Delonte Briggs, MBA Local Guide·48 reviews·18 photos 4 years ago Staff was not welcoming and had the dude had an attitude when clarifying build your own versus a classic adding a few extra toppings...it didn't master i was willing to pay the difference.. 1 &pizza - Dupont (Owner) 4 years ago Sorry to hear that your pizza experience wasn't the best. Thank you for your feedback. I will forward this information to the appropriate people. Please reach out to us so that we can make this right. A'Jae Boyd 2 reviews 2 years ago Great customer service. Order done in a timely fashion. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that your order was delivered in a timely fashion. Your response is important to us as we strive to improve our services. We hope to serve you again soon! John Benson Local Guide·23 reviews·183 photos 4 years ago Customer service at this location is atrocious. The crew working the evening shift on 2/28/20 were very rude. Stay away! Dallas S. Local Guide·101 reviews·89 photos 5 years ago My first pizza in DC. Quick service and great good at a decent price. Jordhon Horelien 2 reviews 2 years ago Lavelle was an excellent help to getting the pizza of my choice. Very helpful &pizza - Dupont (Owner) 2 months ago Thank you for taking the time to leave a review. We are thrilled to hear that Lavelle was able to assist you in getting the pizza of your choice. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Courtney Wade 4 reviews 2 years ago Labella is awesome. He goes the extra mile. Thank you! Dusan Vasiljevic Local Guide·50 reviews·25 photos 4 years ago Excellent suggested choices of toppings, quick service, good enough interior. Mig Local Guide·581 reviews·590 photos 6 years ago Love this pizza: Favorite go to - Red sauce with pepporoni and sausage drizzled with pesto on top. Mercedes White 3 reviews 2 years ago Phenomenal experience with Antonio and the rest of the staff. The place was very clean! Kate Neilson 3 reviews 2 years ago Dine in | Lunch | $10–20 love & pizza! come here often and always enjoy it. … More KDASH201 14 reviews·1 photo 7 years ago Best pizza I ever had. You just have to go and try it yourself Debbie James 8 reviews 2 years ago Ran efficiently under pressure during Halloween eve and Lavelle was very helpful Bosh Gobran Local Guide·304 reviews·695 photos 7 years ago Great Pizza, fast and they have a vegan/vegetarian options:) fund staff Smash Diddy 5 reviews 6 years ago Service was good and food great who dnt love pizza lol &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're glad to hear that you enjoyed our service and food, especially the pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Heidi Wiles Local Guide·25 reviews·2 photos 7 years ago I just love the the atmosphere the people are great and the pizza is delicious. Need one in Hagerstown MD. hector paredes Local Guide·51 reviews·712 photos 2 months ago I love this Pizza … More &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you love our pizza. Your response is important to us as we strive to improve our services. We look forward to serving you again soon. Justin Bozeman 3 reviews 5 years ago Ordered via Uber Eats, Pizza came completely wrong from what was ordered, and added whatever they wanted to the pizza and when called , no one answers the phone and call was looped, no one ever responded to my e-mails regarding the wrong order 1 Alana Peery 6 reviews·13 photos a year ago Great pizza and better service! Kunal Vijan Local Guide·117 reviews·505 photos 4 years ago Very nice n tasty. Much better than DC Pizza James Plain Local Guide·9 reviews 5 years ago i tried the american honey pizza, and was great! The craft sodas are also really interesting! danelle hankins 8 reviews 2 years ago Antonio made me a great pizza today and answered all my questions. Fly Gurl Local Guide·193 reviews·271 photos 4 years ago The staff was great they are very customer service driven , fast , and very clean Rodolfo Diaz 1 review a year ago Great Place! Awesome customer service! Dean Naps 2 reviews a year ago Awesome pizza, great service, thank you &pizza! EBEMBI Alain 3 reviews 2 years ago Great location. Staff are really friendly and patient Robin Young 5 reviews 5 years ago Fantastic pizza and an AMAZING staff!! I could eat there everyday!!’ Javid Pourkia Local Guide·128 reviews·1295 photos 5 years ago It's not just food, is love Photo 1 in review by Javid Pourkia Petra Sosa 2 reviews·1 photo a year ago Best pizza in town , customer service is A1 ! Photo 1 in review by Petra Sosa khairy jones 3 reviews 2 years ago This was a great place to go late at night and it handled the long line well Alvaro Dalessandro Local Guide·44 reviews·3 photos 4 years ago Tasty pizza, only downside is the place didn't have Coca-Cola Money Monkey 1 review 2 years ago lavelle was extremely helpful and made sure i was set and provided good service Living the life of lele Vibing 12 reviews·2 photos a year ago Great customer service made me feel welcome &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that our customer service made you feel welcome. Your response is important to us as we strive to improve our services. We hope to continue providing a great experience for you in the future. Abish Anklesaria Local Guide·94 reviews·53 photos 7 years ago Fresh pizza. Good toppings selection. Kid friendly as well. Great place for a fast custom pizza. Rob G Local Guide·151 reviews·301 photos 2 years ago First visit. Fast service, excellent pizza! Matt Peterson 2 reviews 2 years ago an icon, a legend, showstopping beautiful amazing never the same the best &pizza in DC Eric Midder Local Guide·146 reviews 4 years ago Could be a little quicker but very friendly staff and great pizza! Sandra Gaillardetz 4 reviews 5 years ago This Pizza was phenomenal ! Loved it and would definitely go back!!","Only provide commentary from the context included. How, if at all, does the owner of this business respond to negative reviews? &Pizza Google Reviews Josh Local Guide·316 reviews·113 photos a month ago Ordered online and my receipt had no details confirming my items. I text them like they said and they never responded. Then they have Uber do the order delivery but I didn't know that before putting the tip in and then the driver said he … More Photo 1 in review by Josh Photo 2 in review by Josh &pizza - Dupont (Owner) a month ago We regret to hear about your experience with the online ordering and delivery process. Your response is important to us as we strive to improve our services. We will address the issues you've mentioned with our team to ensure a better experience for all our customers. Thank you for bringing this to our attention. Gine “Gine The Mae Nai's Winery” MaeNaiWinery Local Guide·369 reviews·5043 photos 3 months ago Dine in | Dinner | $10–20 Such a lovely freshly made pizza with various options, really hard time to decide which one to order lol. Very fast and nice service. Pizza just got ready in 8mins. Have two long tables to enjoy, or take away. … More Photo 1 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 2 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 3 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 4 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 5 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 6 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 7 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 8 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery Photo 9 in review by Gine “Gine The Mae Nai's Winery” MaeNaiWinery &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our freshly made pizza and fast service. Your response is important to us as we strive to improve our services. We hope to see you again soon for another delicious experience! Torianna Todd 3 reviews·2 photos a week ago NEW Take out | Dinner | $10–20 Super friendly staff and the food was really good! We got 2 pizzas- one cheese and one margarita with some extra toppings, and garlic knots. … More Photo 1 in review by Torianna Todd Photo 2 in review by Torianna Todd Addison Hosner Local Guide·100 reviews·141 photos a month ago Never had pizza from here before but ordered online for pickup during lunch. Showed up on time and the order was ready without delay. The pizza is a great serving size and depending on your appetite and what you get this could be two meals … More &pizza - Dupont (Owner) a month ago Thank you for taking the time to share your experience with us! We are thrilled to hear that you enjoyed our pizza and that your order was ready on time. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Allen Nuccio Local Guide·297 reviews·380 photos a week ago NEW Dine in | Lunch | $10–20 If you're not familiar, &pizza is like Fancy Pizza Hut in flatbread form. Their pies are pretty good and their garlic knots are delicious. This location has fantastic customer service, but also smells heavily of a bathroom for whatever reason. Anyway, pretty good all-in-all. … More Alma Local Guide·147 reviews·278 photos 7 months ago Take out | Dinner | $10–20 Pizza is good and doesn't take long from ordering to paying so it's fast and convenient. Staff is super friendly and nice … More Photo 1 in review by Alma Photo 2 in review by Alma Photo 3 in review by Alma Photo 4 in review by Alma Photo 5 in review by Alma Lizzy Amirana Local Guide·146 reviews·224 photos 4 months ago Smells like mold in the place but wonderful pizza! Their gluten free pizza with vegan cheese and meat substitute is 💣 … More Photo 1 in review by Lizzy Amirana 1 &pizza - Dupont (Owner) a month ago We regret to hear about the issue you encountered during your visit. Your response is important to us as we strive to improve our services. We're glad you enjoyed the gluten free pizza with vegan cheese and meat substitute. Thank you for sharing your experience. Emma Fan Local Guide·28 reviews·20 photos a month ago We ordered 8 pizzas (menu items) and 4 of them was made incorrectly - missing all the meat, missing veggies & pineapple, wrong sauce, missing spices. They weren’t just missing one or two ingredients, they were made into something completely … More &pizza - Dupont (Owner) a month ago We regret to hear about your experience and the incorrect pizza orders. Your response is important to us as we strive to improve our services. We will address this with our kitchen staff to ensure such mistakes are not repeated. Thank you for bringing this to our attention. Aban Koprulu 74 reviews·3 photos 3 weeks ago NEW The pizza is good but omg the sewage smell was unbearable. I tried to hold my breath and breathe through my mouth. I almost passed out. I don’t think this place is safe according USDA food and safety inspection. I will have to report it … More 1 &pizza - Dupont (Owner) 3 weeks ago We regret to hear about your experience. Your response is important to us as we strive to improve our services. We will investigate the issue immediately to ensure a safe and pleasant dining experience for all our customers. Thank you for bringing this to our attention. Jacob Fix Local Guide·22 reviews·12 photos 4 months ago Take out | Lunch | $10–20 Very fast, affordable, and huge portions. Great deal and great pizza. … More Photo 1 in review by Jacob Fix Jason A 4 reviews·2 photos 2 years ago Take out | Lunch | $10–20 Great pizza in Dupont! Walking distance from the Mayflower hotel. Fast friendly service. The Maverick is my favorite and garlic knots are a nice add on. Photo 1 in review by Jason A Photo 2 in review by Jason A Mehrnoosh Kh Local Guide·245 reviews·1644 photos 6 months ago Take out | Dinner It is a good pizza place for late night bites. … More Photo 1 in review by Mehrnoosh Kh Photo 2 in review by Mehrnoosh Kh Photo 3 in review by Mehrnoosh Kh Photo 4 in review by Mehrnoosh Kh Photo 5 in review by Mehrnoosh Kh Photo 6 in review by Mehrnoosh Kh Photo 7 in review by Mehrnoosh Kh Photo 8 in review by Mehrnoosh Kh Ryan Griffith 11 reviews 4 months ago Don't bother ordering Uber Eats here because they won't make the food and you'll have to cancel the order. And if you dine in apparently it smells like piss. … More Samuel Davie 37 reviews·102 photos a year ago Take out | Dinner | $10–20 Delicious pizza and the perfect serving for 1 person. I always get the pineapple jacked and take my Tour de Pizza cutter for a ride. Going for a pizza ride #tourdepizzacutter 🚴🏼🍕😊 Photo 2 in review by Samuel Davie 3 Alan Marrero Local Guide·215 reviews·2873 photos 5 months ago Nasty piss smell, we had to leave in an instant. No wonder the place was empty. The pizzas looked great in the pictures, if you want to eat a pizza in smelly atmosphere THIS IS IT! … More 2 Henry Kloepper Local Guide·121 reviews·77 photos 7 years ago Was quite decent. Fast, reasonable price, good taste. Though I just had Pizza Paradiso and if you have some extra time it's well worth it over &pizza, especially if you are interested in having an alcoholic drink with your pizza. If you're in a rush this works better. Photo 1 in review by Henry Kloepper Damien Shaner Local Guide·30 reviews·140 photos 3 weeks ago NEW They are so ghetto they have a security guard that locks the door and doesn't let people inside after the place fills full of ""dangerous people""...well before the actual closing time. &pizza - Dupont (Owner) 2 weeks ago We regret to hear about your experience at our restaurant. Your response is important to us as we strive to improve our services. We take the safety of our customers seriously and will address this issue with our security team. Thank you for bringing this to our attention. Diana Marquez 2 reviews 9 months ago Dine in | $10–20 My sister and I came in to grab some food after a night out it was very busy but the team was very efficient and Luis definitely made sure we had a great experience. He has exceptional customer service skills, very out going and just great at what he does and overall takes great care of guests. Will definitely be coming back soon ! Matthew Rice Local Guide·14 reviews·54 photos 4 months ago Take out | Dinner | $10–20 Pizza was decent, but as other reviews have noted, the restaurant had an unbearable stench. The owner needs to call a plumber or an exterminator (or both). … More Elizabeth Dapper 8 reviews·4 photos 3 months ago Dine in | Dinner | $10–20 Good place, good service, loud music which is always a little hard when talking with friends... but the food and the employees never disappoint! … More &pizza - Dupont (Owner) a month ago Thank you for taking the time to share your experience with us. We're glad to hear that you enjoyed the food and service, but we understand that the loud music can be a challenge. Your response is important to us as we strive to improve our services. We hope to have the opportunity to serve you again in the future. D C 8 reviews·2 photos 6 months ago Take out | Dinner I just have to add to the other reviews about the absolutely putrid horrifying smell in here, which hits you upon entering. I had ordered Uber Eats, otherwise I would have immediately left. This place most likely has an ongoing sewage issue that is not being addressed properly. No place that sells food should smell like this. … More 2 Andy Jovel 11 reviews·1 photo a year ago Take out | Lunch | $10–20 Sorry, but the pizza was cold and there was little to none chicken mostly just blue cheese crumbles. There were none jalapenos at all either. Photo 1 in review by Andy Jovel Brei Evans 4 reviews·11 photos 3 days ago NEW This locations stinks so bad. The people are nice here though. … More Cedar Baltz 7 reviews 7 months ago Take out | Dinner | $30–50 I got take out and the guy gave me 1 correct pizza I ordered and gave me a completely different order for the 2nd pizza. He showed me the first pizza with the correct toppings on it. I assumed the 2nd pizza he handed me was the right order … More Nathan Sellers Local Guide·90 reviews·323 photos 4 years ago This is really good pizza. The manager was super friendly and helpful too. My son begged to go back the whole trip and said it was the best pizza he'd ever had. Photo 1 in review by Nathan Sellers Kelli Roberts Local Guide·349 reviews·305 photos 6 years ago Second &pizza today. This location is even bigger! Food was delicious, but I would advise going light on the toppings if you choose a gluten free pizza. Too many toppings can make the pizza heavy and messy. Photo 1 in review by Kelli Roberts Photo 2 in review by Kelli Roberts 2 Jahanna Reese 13 reviews·1 photo 11 months ago This is My favorite & pizza Location, great service and they don’t rush you . 5 stars out of 5 Photo 1 in review by Jahanna Reese Josh Griswell Local Guide·26 reviews·21 photos 5 years ago Great food, good price, friendly staff! I ordered the vegan pizza and it was awesome! Their craft soda fountain has some great selections as well. Food was cooked quickly and tasted great! Photo 1 in review by Josh Griswell 1 David Zaga Local Guide·48 reviews·83 photos 6 months ago I mean the price was ok. The place smelled, clearly not very well maintained. And the pizza was ok. The guys working the counter, although dealing with a lot of customers were working hard and gave good service … More 2 Samim zamiri 1 review a month ago You gotta taste their pizza and you’ll definitely like it … More &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Sabrina Lisenby 3 reviews·1 photo 2 years ago Amazing staff, great service, and was so fast. Oh by the way they have amazing pizza and garlic knots. If this isn’t enough to make you try them out, do it anyway lol 😂🤣 Photo 1 in review by Sabrina Lisenby &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you had an amazing experience with our staff and enjoyed our pizza and garlic knots. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Ashllyn Silva Local Guide·64 reviews·63 photos a year ago Dine in | Lunch | $10–20 Actually so obsessed with this pizza. So glad to find out they have multiple locations in my home city. Photo 1 in review by Ashllyn Silva Zhuoran Li 7 reviews·6 photos a year ago The guy is super nice. He is friendly. The pizza is so good. It is really a top place for some pizza quick bite Photo 1 in review by Zhuoran Li J Foodgeek Local Guide·715 reviews·732 photos 2 years ago So earlier today I got I texted coupon for a $5 pizza, so I walk in to dupont S location and I figure I'll just make the order in the place, and I look at the places where the ingredients are, and see slimy rod and spinach and black basil, … More Photo 1 in review by J Foodgeek 1 HoneyD 11 reviews 6 months ago Why does this place stink? Walked up expecting smell of fresh pizza but smells like dirty sewage, smells better outside. Couldn't imagine sitting down in here to eat. … More 2 Sarah Jackson Local Guide·81 reviews·2 photos 4 years ago Pizza flavor is good & could have been a 5 star. Delivery wAs about 30 mins on Fri Evening. ..but it was delivered COLD,,,,!.to order is difficult, forget calling you will only get voicemail tell you they only text or order online. They … More Photo 1 in review by Sarah Jackson 1 &pizza - Dupont (Owner) 4 years ago Hey Sarah, thanks for the review and sorry your pies didnt arrive to you in a state we're proud of. If you're up for it, feel free to reach back out and we'd be happy to make it up to you Daniel Ruiz Local Guide·49 reviews·200 photos 4 years ago Great place to eat pizza, fast service, prices are okay, each style is around $10, not so crowed and staff is friendly, very reccomended if you are hungry and looking for something quick. Photo 1 in review by Daniel Ruiz John Yeung Local Guide·130 reviews·151 photos 7 years ago How can you not like &pizza? I come here all the time. Overall it is really good but sometimes the quality is inconsistent. The pizza might be slightly burnt on the edges. The few times I want to buy soda, their machine does not have all the flavors. Photo 1 in review by John Yeung Liam Amiri Local Guide·377 reviews·2368 photos a year ago Decent pizza but don't expect some authentic NYC style pizza. … More Photo 1 in review by Liam Amiri Eddie Hoss Local Guide·268 reviews·74 photos a year ago Dine in | Dinner Oddly enough, some of the best pizza I've had in some time. Visited during the Halloween bar crawl and the three employees were overwhelmed but kept at it. Waited around 45 min for my pizza, but it was worth it. Decent prices and when … More David Dotson Local Guide·146 reviews·574 photos 2 years ago Dine in | Dinner | $10–20 Great pizza & excellent service Both Gluten Free crust & Vegan protein options available (vegan cheese, vegan sausage & chickpeas) … More Photo 1 in review by David Dotson 1 &pizza - Dupont (Owner) 2 years ago Thank you so much for the review David! We're so glad you were able to use our loyalty coupon as well! Ishmael Kamara Local Guide·117 reviews·649 photos a year ago Take out | Dinner | $20–30 &pizza is always great. Went there late on Friday for something to eat. With the crowd from the clubs be prepared to wait and they don't have any indoor seating at that time. Overall you can't go wrong with a personalized pizza from here. … More tshirt tae 7 reviews·6 photos a year ago Pizza was banging line was fast great place custom Pizza Photo 1 in review by tshirt tae Niggle W 14 reviews 6 months ago The store is quiet but the staff is very polite, clean and the pizza came out good. … More Anthony Ayo 4 reviews·1 photo a year ago Lunch | $30–50 Pizza was great! Service was just as awesome! We brought a group of 13 people and Terrence and the crew were happy and helpful. Can’t wait to come back when I’m back in town. … More williampiedra100 3 reviews·1 photo 3 weeks ago NEW Dine in | $10–20 Bryan attended us with great care. … More &pizza - Dupont (Owner) 2 weeks ago Thank you for the 5-star rating! We're thrilled to hear that Bryan took great care of you. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Vannessa Rodello Local Guide·129 reviews·103 photos 4 years ago All the toppings you want and so many options! My only criticism is the crust wasn't as crispy as I'd like. Photo 1 in review by Vannessa Rodello Photo 2 in review by Vannessa Rodello R Bakshi Local Guide·65 reviews·166 photos 6 years ago Excellent pizza and super friendly staff! Photo 1 in review by R Bakshi Photo 2 in review by R Bakshi Krystle Local Guide·107 reviews·224 photos 4 years ago It was really good. But it was sooooo hot in there and took foreverrrrrrr. Pepperoni and bacon. I'm basic lol Photo 1 in review by Krystle Leah Trunsky (raindropAuxilitrix) 1 review 11 months ago Went here with my friends—the pizza was great and the server Chris was super cool! Super friendly. Whoever made the pizza was patient with our orders too. :) Destine Jones 5 reviews 11 months ago Take out | Dinner | $10–20 I came into &Pizza today for lunch and the the staffAndre and Terrace was very helpful polite service was great clean environment fast service I was surprise to see no line so the pizza came out quick and I was able to enjoy it and get … More 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Andre and Terrace provided helpful and polite service, and that you enjoyed a quick and delicious lunch. Your response is important to us as we strive to improve our services. We appreciate your kind words and hope to see you again soon! Roberts Brian 1 review a year ago I went through this pizza shop last night the service was amazing they were really on point, making sure the customers got everything they needed and more this will definitely be my go to pizza place yours truly Mr.Roberts.. James Drosin 2 reviews 9 months ago Dine in Luis the Manager gave me the best guest experience! Food was amazing definitely recommend. S/O to them! I will definitely be back! Heather Dorsey Local Guide·130 reviews·393 photos 4 years ago The American honey pizza is really good. And the cereal milk soda tastes exactly like cereal milk. So. Service with a snarl. Photo 1 in review by Heather Dorsey &pizza - Dupont (Owner) 4 years ago Thanks for the review Heather! :) Kate Farrell Stanford 4 reviews·2 photos 11 months ago When I walked in, no one was in there and it smelled terrible, as if the floor had been mopped with dirty toilet water. We couldn't imagine staying in there long enough to order, let alone eat. … More 2 &pizza - Dupont (Owner) 11 months ago We apologize that our service did not satisfy your expectations. We set a high standard for ourselves and are truly sorry to hear that standard was not met in your interaction with our business. Your happiness is our number one priority. We well take your feedback into consideration. Jason Miller Local Guide·401 reviews·14 photos 2 years ago Take out | Lunch | $30–50 I love &pizza and usually get awesome service however, this visit to this location was lagging. The 2 staff were seemingly working against each other and they burnt mine and my other 2 family members pizzas. I … More Michael Green Local Guide·113 reviews·665 photos a year ago Dine in | Dinner | $10–20 Flat bread pizza made your way. Staff was fun and engaging. Food was great and was more than enough. Large enough to share but on a hungry day good enough to keep it for yourself. … More Nadia M 8 reviews·4 photos a year ago Normally I’m a huge fan of &Pizza, but this location is so severely understaffed during rush hours that it has proven actually impossible to get the pizzas we ordered. The &pizza website said our order would be ready within 15-20 minutes, … More 1 Chandrell Christopher 7 reviews·3 photos 2 years ago Service was great! Really nice employees, loved syncere and lavell were amazing! Photo 1 in review by Chandrell Christopher Jlyne B Local Guide·63 reviews·14 photos 4 years ago Got a gluten free American honey and oh my goodness I wish there was one closer to where I live. Incredible tasting food and the soda was really good as well. I gave it four because a few of the toppings didn't look very fresh (wilted … More 1 &pizza - Dupont (Owner) 4 years ago Thanks for the review! :) Jamon Pulliam 2 reviews 2 years ago This location is hands down the best! I was visiting from Los Angeles and the service here was impeccable! And don’t get me started on the pizza! They took their time and put nothing but ingredients and love in that one. Would definitely recommend Dean Albrecht 3 reviews a year ago Take out | Dinner | $10–20 Excellent food with great service. Andre helped me make the right choice. Would recommend to anyone who’s in DC and wants something quick to eat. 1 Esse Darden Local Guide·287 reviews·551 photos 2 years ago Take out | Dinner | $10–20 Ordered the Manhattan, while waiting for my personalized order being made - which I received after noticing a distinctive stinginess with every topping that was applied before it was put in the oven, an excessive prolonged period of time; … More 1 &pizza - Dupont (Owner) 2 years ago Thank you for taking the time to share your feedback. We set a high standard for ourselves, and we’re so sorry to hear that this was not displayed during your visit at our location. Your feedback is important to us and we’ll make sure to make the proper adjustments for next time. I’m also going to send this feedback to the shop and district leader to address with the team there because this isn’t what we want our guests to experience at all. We hope that your next visit with us is nothing like what you experienced recently! Scott C Local Guide·33 reviews·9 photos 3 years ago Great pizza and garlic knots! Not your typical style but still quite special and worth trying...over and over again! The dough and toppings are always on point! I also appreciated their program to help frontline workers. Highly highly recommended! 1 &pizza - Dupont (Owner) 3 years ago Thanks for the review Scott! We had to try something different this time. We hope you enjoyed it though! Sean Local Guide·61 reviews·42 photos 2 years ago Take out | Dinner | $30–50 We got delivery. Late night. Pizzas were not good. Got It for a party and we all laughed at how bad it was, and how small they were in the box. (And they forgot one of our items.) all that and only a 1.5 hour wait. Haha. Only reason for the extra star (instead of just 1) was the cookies were really good! … More 1 Kiran Singh Local Guide·70 reviews·66 photos 4 years ago The pizza here is so delicious! The crust is flavorful and tasty and the tomato sauce is so deliciously tangy. I was really blown away by the quality & taste of the pizza! Their ingredients taste fresh and you can add as many toppings as … More &pizza - Dupont (Owner) 4 years ago Thank you so much!🖤🍕🖤 Michael Cupertino Local Guide·106 reviews·163 photos 4 years ago I don't know if it was an ""off day"" here, but service was so slow we had to leave. There were 3 people in front of us and we waited 20 minutes before we left. The employee was more concerned about cutting a 1/4 of an inch of crust off of … More Jessica Peters 12 reviews·6 photos 5 years ago The pizza at & pizza is great. That’s why I have been coming back for years. However beware of the customer service. Recently at the DuPont location, I enjoyed a great pizza and needed to use the restroom. When I asked an employee who was … More 2 Alok Sinha Local Guide·58 reviews a year ago Stopped by here and this is a great place for pizza. I ordered the new G and added some spicy honey and it was delicious. Would definitely recommend stopping by here if you have a chance. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed the new G pizza with added spicy honey. Your response is important to us as we strive to improve our services. We appreciate your recommendation and look forward to serving you again soon! S G Local Guide·12 reviews a year ago Amazing pizza and unique experience. Build your own pizza to a new level. Fresh toppings and an amazing taste. The place is small but the tastw is huge. Loved the food and the service. A definite must. Claire Mizutani Local Guide·54 reviews·374 photos a year ago Take out I got four pizzas to take back to my family:The Maverick, CBR, Billie, and Kalamata Harris. Two of them were on gluten-free crust. Ordering was pretty hectic because there were many young people coming to eat between going to different bars … More 2 Wanda Murphy 33 reviews 2 years ago This was the worst pizza I have ever purchased from & Pizza. The person in front of me, ordered four pizzas. They should have removed my pizza promptly. Instead, the crust is burnt, the spinach dry and the other vegetables dried out. … More &pizza - Dupont (Owner) 2 years ago Terribly sorry to hear about your experience Wanda! We have reported this information to our senior management to resolve and to take the proper measure for quality control. You can send us an additional message at 200-03 or send us an email at digitalshop@andpizza.com. Thank you again for bringing this to our attention. Robyn J Local Guide·54 reviews 5 years ago Absolutely the best pizza I have every eaten. The bread was amazingly light and doughy. I didn't have the disgustingly full feeling after eating an entire pizza. The toppings were fresh and delicious and unlimited. Love the healthy choices and sauce variety. 1 &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza, especially the light and doughy crust and fresh, unlimited toppings. We're glad you appreciate our healthy choices and sauce variety. Your response is important to us as we strive to improve our services. A G 10 reviews a year ago I’m literally in this place as of 06/06/22 and it just took me a whole hour to get a pizza which is ridiculous! Low staff and no sense if urgency. Felt bad for the employee up front who seemed suer overwhelmed, pizza is good usually but won’t be back at this location. &pizza - Dupont (Owner) a year ago Hey Andy! Thanks for you review. We are sorry to hear that we did not provide the best experience! Please reach out to us at 200-03 so we can make this right. 🍕 Timur Plavan Local Guide·97 reviews·278 photos a year ago Dine in | $20–30 The most inefficient &pizza I've ever tried in my life. Ordered online, came 30 mins later and waited for another 50 minutes. Order was missing things in both pizzas. &pizza is great but I would avoid this location. … More Natalia Diaz Torres 1 review·1 photo 2 years ago If I could give 0 stars, I would. This review is based on an UberEats order. I ordered 4 pizzas and an order of … More Photo 1 in review by Natalia Diaz Torres Rishi M Local Guide·9 reviews·22 photos 2 years ago Visited late September 2021 for an online pickup order. Waited 2 hours for my order. … More 1 Michel Louis Local Guide·16 reviews·2 photos 2 years ago Take out | Dinner | $10–20 One of the best pizza I ever tried Photo 1 in review by Michel Louis Rachel Wortmann Local Guide·61 reviews·173 photos 2 years ago Ordered online and waited 45 min for my pizza. App had said it would take 10 min so was quite frustrating … More Kristen Eggleston Local Guide·50 reviews·8 photos 4 years ago The pizza is great but the service here could be a bit better. I went at a time where it wasn't busy at all. The woman who made my order was friendly and helpful and while my order was cooking, I sat at a table nearby. The woman who was at … More Jéssica Bittencourt 1 review·1 photo 2 years ago Lavelle great service, thank you! Photo 1 in review by Jéssica Bittencourt 1 Matt Ramey 3 reviews 11 months ago Dine in | Dinner | $1–10 We went in to have wholesome family dinner experience but quickly exited upon my initial smell test which returned a result consisting of bathroom juices/putrid garbage. 2 Matthew Cantisani 2 reviews a year ago Dine in | Dinner | $10–20 Excellent service!! Food was delicious and made quickly. I will definitely come back to this &pizza location! De Wheeler-Chopan 10 reviews 7 months ago Worst experience ever! Pizza wasn't ready to order. The servers states they didn't care that we waited! … More Stefan Hovy 5 reviews 6 years ago Incredible! Was in DC for a long weekend and ended up going to &pizza 3 times! Twice at this location where the staff and manager were very friendly and open for a chat. Not to mention the delicious pizza with equally delicious vegan options. Would recommend this to anyone visiting DC! 1 Joey Norris 4 reviews a year ago Take out | Dinner | $10–20 Andre was such a great help and made sure to treat us right with amazing pizza. Appreciate the amazing service and will gladly go again. S. T. Grandy 19 reviews·6 photos 4 years ago The pizza is good but I was a bit disappointed to see that the employee who made my pizza only put a racing stripe of sauce right down the middle of the dough. Literally a line down...not spread at all. Also, they may need to turn the ovens … More 1 Monte' Kent 2 reviews a year ago Andre at &pizza DuPont south was amazing.. helped me with my gift card at this location. He service and attention to detail was great. Must go location. Thanks Andre! Sameer Singhal Local Guide·41 reviews·8 photos 7 years ago Great at any time of day. This is a unique pizza experience, and I love the fact that you can customize your pizza to your liking for one flat price. Definitely a place to try, and you'll most likely want to keep coming back Cecilia Demoski 1 review 11 months ago Take out | Dinner | $10–20 This is a great place to grab some great pizza! Amazing service and good quality pizza. Miracle Parish Local Guide·75 reviews·6 photos a year ago I will be filing a police report against the fair skinned man with dreads. He put his hands on me multiple times when I was trying to exit the building. The entire line saw it and they were appalled. I was trying to get to my Uber and he … More Ali A Local Guide·691 reviews·435 photos 4 years ago Delicious, but higher prices than their quality. Crowded around noon time, my experience of course. Employees are ok, but they can be much better. … More Brie Morgan 5 reviews 2 years ago I been coming to this pizza spot for a few months and their always respectful and clean They have awesome pizza and the best customer service the manager always takes care of me and makes sure my pizza is hot and ready to go no complaints will continue to send friends and family India Marshall 28 reviews 2 years ago Employees are nice but mangers need to do a better job with organizing during rush hour. Bathrooms are never available for customers. This has been the case for over 5 years. Luis Miron 3 reviews 11 months ago Dine in | Dinner | $10–20 Amazing service by Andre! and delicious pizza. Definitely the place to eat before a night out of drinking. Breanna Duff 9 reviews·1 photo a year ago the security card told me I could not sit down even though I have a disability. There is no rule to this. He was being very rude for no reason. 1 Katie Kennedy 21 reviews 6 years ago The service was terrible here. We were there for the first time and clearly confused but rather than offering help to us, the staff ignored us. They offered no help when we had questions about some dietary restrictions either. And you can't … More 2 Evan Farrara 12 reviews·1 photo 7 years ago Incredibly loud inside to the point that the employees couldn't hear me correctly when ordering. As a result, when asked if I wanted spicy or non-spicy sauce, I replied ""non-spicy"" and got spicy anyways. That being said, it ended up being … More Mohammed Yahia Local Guide·384 reviews·1524 photos 5 years ago &pizza is a good, simple pizza place. They don't have many choices, just pizzas, but they are awesome. They have a few set pizzas you can order or a make-your-own-pizza option. They also have the option for gluten-free dough which is $3 … More 1 Jobina Beale 3 reviews a year ago Went in there today for lunch and Tay was awesome. Amazing, courteous and good customer service. I walk from Farragut West Metro to get my pizza all because of him. Gideon Tong Local Guide·155 reviews·233 photos 4 years ago Great pizza! Fast service, would go again. As someone from the west coast we also have build your own pizza places like Pieology and Blaze Pizza but this style of ""shoebox pizza"" is pretty unique and you can definitely eat a whole pizza on your own even if you don't usually eat that much. &pizza - Dupont (Owner) 4 years ago Great to hear. Thanks! Sara R. Local Guide·144 reviews·305 photos a year ago Dine in | Dinner | $10–20 Vegan-friendly, they even gave vegan pizza. I would like to see more filling vegan toppings options like some Beyond Meat or something. The service was quick and friendly. … More 1 cy mcfadgion 3 reviews 3 months ago Quan, cam and bre were amazing … More &pizza - Dupont (Owner) a month ago Thank you for your 5-star rating! We're thrilled to hear that Quan, Cam, and Bre provided amazing service. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Khaleel Johns-Watts 58 reviews 10 months ago Best late night dc spot call ahead after 3am if ur with a group and just order all the pizza Emma C Local Guide·83 reviews·85 photos 5 years ago Of all the made-to-order personalized pizza places out there, &pizza has my heart. They offer several delicious dough options including gluten free. All of the toppings are very high quality (get the meatballs!!). After topping, they put it … More 2 A “2Freckles” Oz Local Guide·15 reviews·2 photos 5 years ago I really liked this place, however my second experience here was not like my first. Took me 30 mins to get my order. The cashier was very stressed maybe it was his first day on the job because he did not know how to run the register. The … More Ada Rebecca Smith Local Guide·447 reviews·165 photos a year ago Dine in | Dinner | $10–20 The service was not great, the guy making the pizzas was very slow and wasn't able to find items that should have been easily located(the spinach was empty, he took several minutes looking for it and they were out of spinach). … More Ian Winbrock Local Guide·131 reviews·14 photos 7 years ago I love &pizza. I'm from the West Coast and we have ""cook as you wait"" pizza places, but nothing on the same level as &pizza. This place is superb. Always greeted by some friendly folks behind the counter and then I either complete one of … More Bill Hipsher Local Guide·41 reviews·987 photos 7 years ago Staff was very nice and pizza we got as ordered was great. The fountain machine was broken so your drink options were limited to can/bottle options for tea/lemonade that they had in a fridge. Ordered a Hawaiian style pizza that was supposed … More 1 Scott Dwyer 12 reviews·1 photo a year ago Great place to get a bite when you out drinking in depot circle. The pizza is awesome, and the prices are better than at the bar. … More Justin Andersen Local Guide·15 reviews a year ago Take out This was the most frustrating experience I've ever been in. Our take out order was over an hour late. And that's the least frustrating part of the night... I don't know if I have the energy to explain everything. Andrea M Local Guide·69 reviews·46 photos a year ago They gave me the wrong pizza. I texted customer service and they said they needed a picture in order to issue a refund. I told them my camera was broken and was not able to take a picture. They told me I couldn't get a full refund without a photograph but they could offer me $5 for a new pizza. Josh Higham Local Guide·148 reviews·84 photos 6 years ago Co-workers had talked this place up, but I found it only decent. I definitely enjoyed the unique soda fountain more than the pizza. Great variety of unique flavors. Pizza was fine but unremarkable. Ariel Holmes 2 reviews 4 years ago James and Deon made my night. I would have been left hungry if it was for the girl up front. But thank you 2 for the lovely service much appreciated. I will remember it & I will be back (during opening hours) thanks again! &pizza - Dupont (Owner) 4 years ago Glad to hear our team solidified your evening (and future visits) with great service. We will be sure share with both James and Deon your kind words! Thanks for stopping by, Ariel! Leanne Quinn 1 review·1 photo 2 years ago Great service and fantastic pizza! Photo 1 in review by Leanne Quinn &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We are thrilled to hear that you enjoyed our fantastic pizza and great service. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Tracey N Local Guide·87 reviews·70 photos 5 years ago Pizza would have been better if it was warmer, but their service was shorthanded..... they had one person taking out the pizza from the oven, boxing it, putting on the finishing garnishes AND ringing up the customers...... that's too … More Theresa Kemp 5 reviews a year ago Dine in | Dinner | $1–10 Andre was fantastic! He served our party fresh, hot, pizza. Thank you for the great customer service. Diana Martinez 3 reviews·2 photos 2 years ago I work nearby and I appreciate that my orders are always done right away and I can quickly just pick up. Great customer service. Very strict on covid regulations. Key 2 reviews 2 years ago Customer service was excellent upon arrival. Store was clean and needs were met in a timely fashion. Very friendly and patient staff. 5 Stars to Terence!! Greg Smith 14 reviews·2 photos 10 months ago Delivery | Lunch | $10–20 Did carry out. Pizza was good, but not great. Strange beverage options … More Bali Adawal Local Guide·203 reviews·1637 photos 4 years ago I have always liked the concept of a highly customized pizza and the overall product turns out to be quite appealing. … More 2 Aleks Nekrasov 91 reviews·67 photos 11 months ago As far as GOOD pizza goes, this place completed my order in 8 minutes. &pizza - Dupont (Owner) 11 months ago Thanks for the awesome review! Hope to see you soon. Gnelossi Hamadou Local Guide·6 reviews·7 photos a year ago Visited this place yesterday for my first time , just wanna say thank you for the entire team that work yesterday night. They were patient and friendly specially the manager Andre Cecilia Local Guide·80 reviews·2 photos 5 years ago We had a pleasant experience at a different branch of &pizza so we tried this branch. This branch was stingy on the toppings and the dining area was not wiped down after customers have eaten there. All 3 of us felt queasy after eating here... Josh Eid-Ries 10 reviews·3 photos 6 years ago Delish, super affordable and very easy to customize your order with no upcharges. The staff are a delight and the food is superb. The drink offerings are also wonderful. I'd recommend the 11 grain crust(ask for it) the mango passion fruit soda and root beer. Vegan cheese and veggie based protein options were a lovely bonus! Pradipto Banerjee Local Guide·29 reviews·96 photos 7 years ago Their pizzas are the best value for money. Unlimited toppings on a big flat bread for just $10. And they're open till 4 am, which is great when you're leaving the bars at 2 and want to get some food. NAI- NAI 3 reviews 2 years ago Dupont is awesome. The place is clean and the pizza is great! One of the workers Decostia provided excellent customer service! I definitely recommend this store! Jaqueline Veltri 2 reviews 4 years ago The pizza here is delicious but it is the second time in a row that I find a long black hair in my pizza. It’s so frustrating and disgusting! I hope management finds a way to keep the employees hair out of the food. F.A. B Local Guide·39 reviews·15 photos 4 years ago James was an amazing manager. My card wasn't working for some reason and he still made my pizza and gave it to me for free. Absolutely amazing customer service! Thank you James! &pizza - Dupont (Owner) 4 years ago Hey there! Thanks so much for the love. We always appreciate our loyal fans. Sunil Singh Local Guide·183 reviews·134 photos 5 years ago &Pizza is something like Blaze Pizza. You pick your dough, then the sauces, and then all your toppings. It's unlimited sauces, and unlimited toppings. And after the pizza is baked, you can add any other sauces, or other toppings. And … More breathemusic94 2 reviews a year ago I love coming to this &pizza, Tay is always a welcome face at this establishment, he is extremely helpful and all around fun to talk to. The food is always amazing here. Crystal 1 review·1 photo 2 years ago &pizza Great good and atmosphere, staff was friendly Photo 1 in review by Crystal Thomas Scheurich Local Guide·33 reviews·1 photo 6 years ago I really like the new fast casual trend. Others may complain about it, but it matches my lifestyle and sets a good middle ground on price. &pizza is the best example of fast casual in this region. Really awesome and ultra customizable food … More Oliver Borg 11 reviews a year ago Andre was super helpful! Fantastic late night spot, quick service, friendly staff, and good food. What more could you want. Dale L. Roberts Local Guide·52 reviews·118 photos 6 years ago This is the second &pizza I've gone to today and wow! This place is even better. There's more seating and it's not even busy. Well worth it! And the staff was friendly and attentive. 5+ stars Nibha Rastogi 7 reviews·2 photos 5 years ago ordered a craft your own... SO GOOD!!! The tribe were super courteous and I got what I wanted. Got a traditional with mushrooms, spicy Italian sausage, onions, pesto finish. Jordi Segura Local Guide·115 reviews·366 photos 7 years ago We ate in this pizza shop during our trip to Washington, and we found the pizza and drinks tasty and original. You can make your own pizza or order one of the existing recipes. I would recommend it for take out or a quick bite. Brandon Boone Local Guide·377 reviews·1050 photos 4 years ago Quick and delicious lunch, very filling and I'm a big guy. Definitely mix it up don't settle for cheese and pepperoni... Never thought I'd have honey on a pizza. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our unique pizza options. Your response is important to us as we strive to improve our services. We hope to serve you again soon with more delicious and filling options! ROBIN THOMPSON Local Guide·94 reviews·221 photos 6 years ago I love this place! They have a great pizza selection . I love their specialty sodas. Try the cream soda. There is a wait though due to their being only one person to ring up your order and box your pizza. T Williams 9 reviews 4 years ago Best way to order a to go pizza is on their website. After a long day of sightseeing, a couple of their ""oblong"" pizzas was just right. Thin crust was great, toppings good. Prepared quickly. &pizza - Dupont (Owner) 4 years ago Thanks for the review and for stopping by, T! Ashley Craft 4 reviews 2 years ago I love The Dupont Team everyone is so nice Tay always goes above and beyond for the customers amazing customer service!! DuPont Team keep up the great work!! Jelani Phipps 8 reviews 2 years ago Food is so delicious. The manager Delonta gave me supervisor service. I would definitely go back again. You won't be disappointed!!! Nely Hernández 2 reviews·1 photo 10 months ago Love this late location . Super busy They are still very patient with customers. Lance Porciuncula 1 review 2 years ago The workers there are super friendly and nice. The service was also pretty great. Got my pizza with little wait. Ismail Gomaa Local Guide·364 reviews·1240 photos 7 years ago Some of the best pizza I've ever had. Any combination worked because their ingredients are absolutely perfect. I enjoyed everything I've tried there, even the stuff I don't usually like. Sarah Semlear Local Guide·154 reviews·1292 photos 5 years ago The gluten free crust is pretty good! It's not a completely gf environment so they can't guarantee there is no cross contamination, but they are careful and change gloves when handling the gf crust. The options are fun and there is a good amount of toping choices for build your own. 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We understand the importance of providing a safe environment for our gluten-free customers and we're glad to hear that you appreciated our efforts. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Michael williamson 9 reviews a year ago Take out | Lunch | $10–20 Pizzas are not that good and one of the workers not that friendly pizza crust had sir burnt from dirty oven … More Jennifer Telfort 4 reviews 2 years ago The service is great! Thank you so much for making my pizza just the way I like it!! I will be back again!!! Hailey Gruch 7 reviews a year ago Take out Wonderful experience... it was busy but they made me feel at ease... wonderful service... thanks to Quan, Malik, Justin and faith William Minter Local Guide·85 reviews·79 photos 7 years ago Thin crunchy crust that isn't overcooked. Awesome fresh toppings and sauce. Perfect for lunch or later night special. Not the best place to sit and eat as space is limited inside(20-25 at best) Cameron Asgharpour 1 review 2 years ago Great customer service and staff is very attentive. Pizza was awesome LadyLewis 2u Local Guide·17 reviews·15 photos 5 years ago &pizza is my fav pizza, but unfortunately, I experienced the WORST, not just customer service, but attitudes EVER! When I asked for assistance, I was only given the 202 number they have taped on the glass display. It was weird bc 2 … More Angel Aguiluz 1 review a year ago Tay is a hell of a entrepreneur! A lovely lad, Marcia also made an astonishing pizza with Nikko. 10/10 if you’re near Faragut North Rakia Pinkney 3 reviews 2 years ago The staff are very friendly and the food came out great and in a timely manner. I will be back, this is the best &pizza location! Dante Gardner 1 review 2 years ago I had an amazing experience. Antonio, and Roshan were very accommodating to my child who is particular about his pizza topping’s . 1 Scott Jason Local Guide·38 reviews·46 photos 4 years ago Thin crust pizza was very tasty and filling. I had red sauce with fresh mozzarella, tomatoes and onions. They do have a gluten free crust for $3 extra. 1 Chris Morris Local Guide·49 reviews·25 photos 4 years ago Pizza was way better than expected. Really nice staff. They were able to get people in and out quickly. I will definitely be returning. 1 &pizza - Dupont (Owner) 4 years ago Thanks for the review :) Raynell Jackson 26 reviews·26 photos 4 years ago I pizza and staff are wonderful Photo 1 in review by Raynell Jackson Photo 2 in review by Raynell Jackson Killian Devitt Local Guide·128 reviews·541 photos 8 years ago What's not to like about this place? It's just great, simple pizza. Tried the Maverick the first time I went and I haven't ordered anything else since. Perfect for lunch if you can avoid the rush. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our Maverick pizza and that it's become your go-to choice. We appreciate your support and hope to serve you again soon. Your response is important to us as we strive to improve our services. taliyah hughes 4 reviews 2 years ago Great customer service, quick service! FOOD IS AMAZING! My favorite spot to come after a drunk night 🤪. Highly recommended Mo Love 38 reviews 3 years ago I went in there for the first time a couple of weeks ago. The restaurant had a really foul odor and I could smell it through my mask. Although, I ordered a pizza online and picked it up, I did not eat it and I will never go back to that pizzeria. 1 &pizza - Dupont (Owner) 3 years ago Thank you for taking the time to share your feedback Mo. Our management team will be looking into the odor that you are referring to for the Dupont location. I'm sorry to hear that the experience did not meet your expectations and I would like to apologize for this. Chris Oliver Local Guide·17 reviews·1 photo 8 years ago Great customisable pizza in a relaxed atmosphere. Their home made cola is to die for and so much tastier than coke or Pepsi. Only criticism is that the music was way too loud. Amanda Neilson 6 reviews 2 years ago Great experience! We had a large group and they were fast and efficient. Love the pizza! Breasia Lawson 5 reviews·1 photo 2 years ago Labella made my pizza so good and had the best costumer service ever, he was very bubbly and pleasant and Met all of my demands because I’m a very picky eater lol he’s the best Adriana Lopez 5 reviews 11 months ago Great service! Everything was on point! Andrew was very attentive and polite! Thank you 😃 Merlin Tondji 2 reviews 2 years ago This place is great . Unfortunately last night we couldn't custom the pizza however the team still amazing Briana McKellery 9 reviews·5 photos 2 years ago Beat servers best pizzas and my fav location but all are great. Definitely suggest stopping here for a late night craving after a night out! Tiffany Dendy 3 reviews a year ago Dine in | Dinner | $20–30 Wave and Twan provided excellent customer service on my visit. Gloves were changed prior to assisting us Thanks guys ! Micheal Stone 2 reviews 2 years ago Team was friendly with great service. Pizza came out great! Will continue to come back Forrice Brunson 1 review a year ago Courteous and professional staff members. My order was completed without issues. It was fresh, hot, and the toppings were 🤌🏽. Saee’Rozay 1 review a year ago Take out | Dinner | $10–20 First Time At &Pizza . Great Service By Andre ! Respectful & Kind . Will Definitely Be Back Especially At This Location Medachi 509 16 reviews 4 years ago This is the worst & pizza that I’ve ever been they don’t change their gloves. They got nasty attitude they should reconsider on hiring people there. If I’m paying $11 for pizza I should be treated with respect the customer service is terrible I can’t even tell them how I want my pizza to get done. 1 &pizza - Dupont (Owner) 4 years ago Hi Questa, thanks for the feedback. We'll be sure to address this promptly with the shop. Angel Angelov Local Guide·159 reviews·920 photos 4 years ago A bit dodgy place but pizza was perfect. They offer you to choose from anything you want to add to it and can make it as you like. Was really delicious. Not beer or any liquor though 1 Nataliya Kostiw 2 reviews a year ago Alonzo was amazing, he helped us with everything and was very polite and informative! Would definitely recommend! Simply, Tasha. Local Guide·130 reviews·244 photos 5 years ago Idk what the rating I'm assuming it must be great for I'm too drunk to realize food but let me tell you...today I walked in and walked out....the stench was crazy...it smelled like a dirty barn...or zoo...sewage...idk but I couldn't even order to go and I was just dissappointed... it is a super rainy day today.... 2 Kylie Gilbert Local Guide·19 reviews 7 years ago Could eat this every day for the rest of my life. Not a lot of seating inside though. Also check out ordering ahead, it's much faster. The sodas are good too! Josh Robichaud Local Guide·93 reviews·123 photos 8 years ago Great custom pizza at a reasonable price. Either the preset menu or build your own, can't go wrong. Plenty of seating and fast service. Andrew Isett Local Guide·185 reviews·230 photos 7 years ago Good pizza custom made the way you like. Similar to Chipotle with a burrito, &pizza allows for any toppings they have and different sauces. Always some left over too!! Ethan Granetz 3 reviews a year ago Take out | Dinner | $10–20 Andre got us food real late. He made an awesome pizza. 10/10 service J 4 Local Guide·131 reviews·64 photos 7 years ago Oh yes lawd. This pizza is so good and u dictate the toppings. Yum. Decent price for DC and a food serving size. Not glutinous but more than sufficient. Arely Castro 1 review 2 years ago Amazing service ! & the pizza was so delicious that I will come back again! Jimmy DeVault 15 reviews·1 photo 5 years ago Great food, concept and atmosphere. First time at this location and this may just be this location but service was super slow! The team here also seemed very disorganized, there was no designated cashier which caused a bottleneck at the register where everyone just stood. Maybe they were short staffed? 1 Destiny Cruz 3 reviews 2 years ago GREAT service! And even better pizza! This is my regular location Bc they never disappoint 😉 Punky Banks 1 review 4 years ago I had a great experience. Our cashier Diamond was kind, courteous, and offered great recommendations. I’ll be back soon. Overall great food and great service! &pizza - Dupont (Owner) 4 years ago Thank you so much for the great review Punky! We look forward to seeing you agin soon. Kevin S 3 reviews 2 years ago This is specifically for the website ordering experience. I typically pick up but I needed delivery and my nearby &pizza store was temporarily closed. The problem is that it is impossible to switch the store you're getting delivery from, or … More 1 &pizza - Dupont (Owner) 2 years ago Thank you for your feedback Kevin! I'm sorry to hear that this was your experience trying to order online. We'll flag this information over to our development team to fix. Najm Aldin 9 reviews 9 months ago Luis is very professional and he took care of me. Very nice guy Samantha Zarrilli Local Guide·25 reviews·2 photos 2 years ago Amazing service! So great. Lavelle went above and beyond to make us feel welcome. Promote him!! . Jeremy R. Stinson Local Guide·178 reviews·293 photos 4 years ago &Pizza is one of my favorite pizza joints in DC. Not all locations are created equal, but this particular location is always clean, the staff is friendly and helpful, and I never have to wait too long. &pizza - Dupont (Owner) 4 years ago Hey, Jeremy. Thanks so much for review! руня 11 reviews 7 years ago Great vegan options, (they have mozzarella daiya and veg meat crumbles)! Lots of fresh veggies, good unique gourmet choices of sauce too. The pesto is delicious. The price is reasonable for a vegan pizza, compared to zpizza which recently … More 1 Fabian Meneses 5 reviews a year ago Staying at a hotel close by this place has been our stop daily! From the friendly staff to the delicious food, you have to try this pizza! Mouhamadou Thioune 4 reviews a year ago I like eating at &pizza Dupont. The pizza is always on point. The place is always clean and Tay always provides good customer service. Reilly Sheehy 1 review a year ago They were so lovely - they gave me free water when my friend and I needed it most. 10/10 Ryan Norton 7 reviews 7 years ago I tried calling multiple times to have a question about their menu answered. Each time it automatically goes to a recording and it gives you the option to press ""2"" to speak to an employee. However when you choose that option the phone … More Geneva Kropper 4 reviews 4 years ago The pizza here is fine, but the staff is very rude and will let you stand at the counter without asking how they can help you. Very poor standard of hospitality and out of place in DC. nate porter 2 reviews a year ago Tay is the best. I love the customer service. He should be promoted. Nikko & Marciara are amazing and should also be promoted!! Isaiah Benjamin 3 reviews 2 years ago I always have a great experience, I work in the area the workers are always fantastic to chat with. Food is always delicious, my go to spot for lunch. Angelica Martinez Local Guide·54 reviews·115 photos 4 years ago Stopped by this place when in the area. Design your own pizza from scratch, and then customize it. The staff assemble your pizza as you watch ... you get to decide everything which goes on the pizza as you follow it down the line. We … More 1 Ariana Brown 3 reviews 2 years ago Very professional clean and made my pizza in a timely manner. Staff was perfect Levon Akopian 8 reviews a year ago Dine in | Other | $10–20 It was amazing and tasty Perfect pizzas, friendly crew … More Jamie Sneed 1 review 2 years ago Outstanding place, great service, Terrence was a huge help and help me build the perfect pizza for my first time!! Teezy Teez 2 reviews a year ago The establishment was amazing, Tay was very kind and ensured we were okay during our time at the restaurant. &pizza - Dupont (Owner) 2 months ago We're thrilled to hear that you had an amazing experience at our restaurant and that Tay took great care of you. Your response is important to us as we strive to improve our services. Thank you for the 5-star rating! We hope to welcome you back soon. kiara cooper 1 review 2 years ago I experience the best customer service with an employee name Lavelle! Definitely would recommend. The pizza was amazing !! Lisa Smith 5 reviews 2 years ago They have an excellent menu selection and you can add anything else you desire... or you can build your pizza from scratch... all at one reasonable price! Delightfully Delicious 👍 2 &pizza - Dupont (Owner) 4 years ago Thanks for the review! :) M A Local Guide·31 reviews·16 photos a year ago The vegan mozzarella and vegan sausage are amazing. To &pizza: please bring back the vegan chicken. Chris Anderson Local Guide·36 reviews·182 photos a year ago Not extremely friendly but excellent excellent pizza. The dough is the best part. 1 Sachin Bhattiprolu 2 reviews a year ago They take orders beyond 10pm but you cannot eat there because they close at 10pm. People here were incredibly rude and forcibly removed chairs WHILE 10+ people were trying to sit and eat. Incredibly rude place. Blue Moon 4 reviews 7 years ago literally the best pizza i've ever eaten. i had the vegan options. they were incredible.staff was really nice. would recommend to everyone. It’s Me Local Guide·381 reviews·169 photos 7 years ago As usual, friendly staff. First time at Dupont location, but just as good as the H St one. … More &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We regret that we no longer offer San Pellegrino and apologize for any inconvenience caused. Your response is important to us as we strive to improve our services. We appreciate your feedback and hope to see you again soon! Quennitta Winzor 1 review 2 years ago The manager is wonderful and fast. But I feel like they were catering to the white people. I almost felt invisible. Darlene Craft 4 reviews 2 years ago I love coming here the manager Tay always knows exactly what the customer service at DuPont is beyond amazing :) Sinceree Stewart 2 reviews·1 photo 2 years ago Great customer service and very patient. Photo 1 in review by Sinceree Stewart lizzle thrvxxx 2 reviews a year ago Andre was very helpful I been goin here for about and year and the customer service is great 10/10 Jas 3 reviews 2 years ago Best pizza I’ve ever had and the workers are the nicest people ever!!!! Come here for a quick bite! &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza and had a great experience with our staff. Your response is important to us as we strive to improve our services. We hope to see you again soon for another quick bite! Jalen Dixon 1 review a year ago Great service and very reasonable prices! The pizza is also prepared very quickly! Candice Mulholland 4 reviews 2 years ago Terence was awesome! They are always quick and so friendly when I’m in there. 10/10 on the pizza too 😊 Tim Larkin Local Guide·72 reviews·226 photos 5 years ago Damn, this is good pizza Photo 1 in review by Tim Larkin Ron Hagage Local Guide·87 reviews·83 photos 5 years ago Subpar and overpriced pizza place. Compared to u street pizza joints, this place is trendy, hipster and serves mediocre pizza at best. … More 1 Dj Teck Entertainment 1 review 2 years ago Quick and easy. Best pizza I’ve every had. Especially after the club. Will be back Adam Christensen Local Guide·71 reviews·326 photos 8 months ago No way to reach the store and UberEats never delivered my food. … More Erika R. Local Guide·50 reviews·18 photos 5 years ago Reminds me if Blaze. Make your own pizza and craft soda, but some of those toppings should. DEFINITELY go on the pizza as it's being cooked not at the end. Beyond the Clubhouse 1 review a year ago The staff here did a great job, very attentive and engaging. Especially Antonio. A wonferful customer experience! Ryan Local Guide·12 reviews 2 years ago Take out | Dinner | $10–20 Made a mistake when placing my order online and Antonio was awesome helping me get it corrected quickly and courteously. Will Return! … More Alfredo Schonborn 3 reviews a year ago Dine in | Dinner | $10–20 This place was a fantastic establishment to eat with quality food. A recommendation to everyone Ryan Dudrow 1 review 2 years ago Great service for an amazing price for a whole pizza awesome employees 10/10 would recommend Briana Jones 1 review 2 years ago I go to this location all the time! Great customer service and the pizza is always perfect! Haylee Smith 1 review a year ago Awesome pizza & employees. Has original drinks that all taste good! Justin Adams 8 reviews 4 years ago 1st time here. The food was great and the price was right. No complaints. Wish I had found this place sooner. Trip Taker 117 reviews·58 photos 2 years ago I'd like to give it a .5 star. Says that it's open but door is locked, lights are on and you can see employees inside working. Stephen Oliver Local Guide·13 reviews·17 photos 6 years ago Greeted by smells of rancid food or trash when entering. Smell intensifies as you walk further in. Trash everywhere and dirty tables. Bathrooms out of order. … More William Nelson 2 reviews 2 years ago great location! everyone here had great service and the pizza was good! 🙌🏽 Clementina Fernandez Valle 4 reviews·7 photos 2 years ago Great service and really quick. The pizza was delicious and the place is really nice. Jade Boone 2 reviews 2 years ago Staff was very friendly and efficient with taking customers orders in a timely manner! Will definitely visit again Quita11 2 reviews a year ago Terrence was awesome!!! He answered any question I had and did it with a great sense of humor. Marcus Smith Local Guide·115 reviews·5 photos 3 years ago The staff was polite, and efficient this staff is prepared for lunch rush, I even got a bottle of water Since I do a lot of delivery work, I really appreciate these things. 1 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating and positive feedback! We're glad to hear that you had a great experience with our staff and that the service was efficient. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Marissa Amore Local Guide·57 reviews·13 photos 5 years ago It’s pizza & it’s good. Need I say more? Great location by clubs and night life. Great place to grab a bite on the late night Michael Smalls 2 reviews 2 years ago Fantastic experience! The service was excellent and I love their pizza. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear about your fantastic experience and love for our pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Hycent Nwaneri 1 review 2 years ago Great service!! Antonio really helped me and made sure everything was taken care of for me! Definitely will be back. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Antonio provided great service and made sure everything was taken care of for you. Your response is important to us as we strive to improve our services. We look forward to welcoming you back soon! Alan Harris Local Guide·151 reviews·259 photos 6 years ago It was late when I went but it was still a great pizza. I could tell the associates were ready to go but appreciated the pizza. Will come again. Isaiah “Zay” West 1 review 2 years ago We came on Christmas Eve and the service was phenomenal! Antonio and Brian were great! Thank you &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that Antonio and Brian provided phenomenal service on Christmas Eve. Your response is important to us as we strive to improve our services. We hope to have the pleasure of serving you again soon. Ryan Stevens 10 reviews 4 years ago Truly the worst experience . The all male staff associated with the shift on December 6th, at 12:22 am was extremely rude. Customer service was just extremely poor. &pizza - Dupont (Owner) 4 years ago Hey Ryan, I'm really sorry about your experience. We'd love to hear some more details about it if you can reach out to us on our text line, 200-03. Aja Clark 11 reviews 2 years ago Service was excellent! Came to this one because the one in Georgetown was closed. Brian and Antonio were really helpful and pleasant. Beverly Barber 4 reviews·2 photos 2 years ago The staff was very helpful with everything I needed and also made sure I was safe by giving me a mask to protect myself❤️ Patricia Babb 7 reviews 2 years ago Staff was very friendly and accommodating and the pizza was exceptional. Great location :) stefanie riggins 5 reviews 7 years ago Amazingly friendly staff! Our first dining experience in DC and we plan to hit them up again!!! Fresh deliciousness! LynDale Lewis Local Guide·159 reviews·358 photos 4 years ago Good pizza... one size, so be prepared to share if you don't easy a small pizza yourself. Simple menu. &pizza - Dupont (Owner) 4 years ago Hey there! Thanks so much for the love. We always appreciate our loyal fans. Renuka Joshi 3 reviews a year ago Dine in | Dinner | $10–20 Great pizza made quickly. The team working here is super nice. tomas moser 2 reviews 2 years ago Wonderful pizza great especially after a night out. Definitely recommend. &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're glad to hear that you enjoyed the pizza, especially after a night out. Your response is important to us as we strive to improve our services. We hope to serve you again soon. Vanessa Jimenez Local Guide·49 reviews·8 photos 7 years ago Add your favorite toppings to an amazing crust with eclectic soda flavors for a good price. Comfortable, casual atmosphere. Nista Bob-Grey 1 review 2 years ago This &pizza location is great , the staff was super friendly and I got helped really quick! Stephanie Becker Local Guide·70 reviews·76 photos 5 years ago Different pizza place. Still liked it, one pie can feed 2 people if your not real hungry. Unique combinations. 1 Richo Local Guide·18 reviews·24 photos 4 years ago Delicious pizza, Maverick with extra cheese wont dissapoint any meat lover. Open until late is very helpful. &pizza - Dupont (Owner) 4 years ago Good choice with the Maverick Ricardo! Definitely a fan favorite. Thanks for the great review too! Chris Meaclem 4 reviews·1 photo 7 years ago Only $10 for any pizza, custom made. Basically the subway of pizza - choose your base and any toppings. They charge a flat rate, not per topping. Alex B. Local Guide·190 reviews·277 photos 7 years ago Love &pizza. This place stays open late on the weekends but is pretty full of drunk club goers. Still, it hits the spot after some dancing. robert brown 1 review 2 years ago Service at this location was the best I’ve had at any in the DMV area! Definitely will be going again. Amir Ghasdi 11 reviews·15 photos 5 years ago I built my own Pizza: pesto and spicy tomato, mushroom and Tomato, whole mozzarella, Italian sausages, beef, and finishing with goat cheese and arugula and for sure garlic oil!!! Tenija Livingston 1 review 11 months ago Dine in | Lunch | $1–10 Amazing!!! The workers were welcoming and very cheerful. 10/10 Kalaa 3 reviews 2 years ago Very fast pace store love how my pizza tastes perfect every single time. Brendan M. Local Guide·95 reviews·31 photos 5 years ago The pizza is fantastic. the employees are not. I got the feeling they didn't not care about the job or product they were giving customers. Allen Local Guide·288 reviews·819 photos a year ago Very poor service here. I was the only person in line and the employees did not even acknowledge me. They were having a conversation amongst themselves. Dog Matic 1 review a year ago Fast Great service from the two brother working feb 4 at 6pm Danielle Carr 2 reviews 2 years ago The guy who made my pizza made sure it was done right like forreal lol didn’t skimp me and it looks delicious Halio J 16 reviews 5 years ago Terrible customer service. Staf will rush you and slap together a terrible job of a pizza. Management no better. No wonder employees are terrible, management is even worse. Nadeen Siddiqui 6 reviews 5 years ago Terrible service. They just threw toppings without caring about making it tasty. Don’t waste your time and money here. Chose a place that actually tries. 1 Cory Simmons 1 review 2 years ago I got food poisoning. No disrespect to the workers, but my stomach hurts so much and I’m so mad lol. Thompson Hangen Local Guide·36 reviews·9 photos 4 years ago Fast and great pizza! What's not to love about &pizza? The staff here are friendly and accommodating! Christy McCann Local Guide·48 reviews·18 photos 2 years ago Food was not made correctly and a bit late, the secjrry staff is super rude, but employees were nice. Cavin Ward-Caviness Local Guide·319 reviews·769 photos 6 years ago Fresh, quick, tons of toppings, and most importantly tasty. If you have the chance definitely go to one of the many locations and see why all the hype is deserved Esprit Cha 2 reviews a year ago Amazing pizza, amazing service, awesome experience as a whole m g 11 reviews a year ago We bought a pizza and we’re immediately screamed at and tossed out for eating it inside. Like what? The moment I hand you cash you throw me out. I can’t eat my pizza inside? &pizza - Dupont (Owner) a year ago Hi Max. Sorry to read about your experience. Can you text us at 200-03 to provide more detail. Edwin Lopez 5 reviews·2 photos a year ago &pizza is my all-time favorite for a fast casual -- and delicious -- pizza. This location is a mainstay, too! R. T. Local Guide·16 reviews 7 years ago This place was gross!!! Trash everywhere and it smelled pretty bad. There's definitely better &pizza's to go to in DC. I went in and came right back out! 1 Rebecca Schick 32 reviews a year ago Take out | Dinner | $10–20 Very tasty pizza. Staff were great JED CREEK 8 reviews 7 years ago Do not ever go here it's terrible. My friend got food poisoning, so it's not safe to go here. And the management and the staff are terrible and refuse to take responsibility. Avoid this place at all costs! Monae' Bailey 4 reviews 2 years ago Antonio was very helpful, assisted me with ordering my meal. 10/10 would recommend! Kelli Smith 3 reviews 2 years ago I always get the best service here. I live &Pizza and Terrence is great!!! Emily Nelson 1 review 4 years ago Amazing, charismatic staff and even better pizza!! Very creative and innovative pizza and drink choices :-) Josiah Tomes 4 reviews·2 photos a year ago Staff is very nice! Photo 1 in review by Josiah Tomes GLENN EVANS Local Guide·41 reviews 4 years ago DONT WAIST YOUR TIME.OR.MONEY. PLACE WOULDN'T LAST A WEEK IN JERSEY. FIRST I TRIED TO CALL AND THEY DONT TAKE CALLS U HAVE TO ORDER ONLINE OR … More 2 Gucci simon Local Guide·64 reviews·4 photos 4 years ago Food was great. The service was horrible. Only 2 ppl in the store had some manners. The REST HORRIBLE. &pizza - Dupont (Owner) 4 years ago Hi Gucci. Thanks for the feedback. We're sorry that your experience was below expectation. We'll be sure to relay this message to the Shop Lead so that improvements can be made asap. Alyse Edwards 2 reviews 2 years ago Friendly, polite and helpful staff. Pizza is good too duh! C Michele 1 review a year ago Staff is dope. Pizza is delicious. Big fan! Lauren Prather 2 reviews 2 years ago Friendly and helpful! Quick service and the food is 🔥🔥! Lavelle was amazing and super helpful! Amazing customer service! Austin Zielman Local Guide·437 reviews·1539 photos 7 years ago Great pizza served super fast! Downside is that it's directly next to/under sa club, and the constant thumping is quite disturbing. Billy Local Guide·207 reviews·404 photos 7 years ago Cool spot for a flat bread pizza. You make your own pizza which is pretty cool. The price is reasonable one pizza is good for 2ppl. Kenny Culver Local Guide·14 reviews·1 photo 4 years ago pizza was so spicy I couldn't eat it I took it back in I said hey I need a new one I don't know why it's spicy they said tough s*** bounce &pizza - Dupont (Owner) 4 years ago Hey there! I'm so sorry to hear about your bad experience. If you get a chance, please text us on our customer service line at 200-03 and we will make this right. Priya Patel 2 reviews 2 years ago Loved it! Everyone was so accommodating and understanding! Great pizza! Emir Yılkıcı 5 reviews·3 photos 7 years ago They simply blend some cheap ingredients. The food tasted not that good. I don't recommend unless everywhere else is closed. Johnny Neilson 2 reviews 2 years ago Dine in my family loves this place! very good food and friendly staff! Luis Medina (COACHMETONY) Local Guide·97 reviews·324 photos 6 years ago Great food! I'm vegetarian and I had a lot of options here. Only thing is that serving sizes are really small. Chiquita Jackson 1 review 2 years ago Great food and quick service! Loved the garlic knots too. mike epps 3 reviews 2 years ago Great quality pizza, fast and friendly customer service. Dylan McDowell Local Guide·138 reviews·79 photos 7 years ago Best option for a pizza lunch in D.C. This location has more indoor seating, but during prime times be prepared to walk to a nearby park. Kay Tunez 1 review 2 years ago Quey was great and very helpful since it was my first time she made my experience 10 times better. Derrick A. Morton 2 reviews 2 years ago The coolest & Pizza in the DMV everyone in there will make you laugh ! Thank you for my good 🍕 DK Walker 7 reviews 6 years ago Best pizza ever! Far from traditional tasting pizza, leaves a funky delicacy in your mouth that leaves you beyond satisfied! Renee S. Local Guide·55 reviews·4 photos 7 years ago Pretty good! The prices are reasonable (listed at the top of the menu) and pizza is delicious! I ordered the gnaric... good choice! Tray Smith 4 reviews a year ago Great place. Jainyn was great cook. She was nice and quick. Music for every ocation Local Guide·6 reviews·334 photos 5 years ago I love these pizzas Photo 1 in review by Music for every ocation Christopher Edwards 2 reviews 2 years ago I had the best experience. Customer service was A1 and the food was awesome Pauline Abah 1 review a year ago When back to this place after my Last visit and the service is always amazing Nicholas Mildebrath 1 review 2 years ago Go-to lunch spot in DuPont. Pizzas are great and filling - quick service and always good music. Tustin Neilson 6 reviews 2 years ago Dine in | Lunch | $10–20 Quick service and tasty pizza! I recommend adding the hot honey. … More helene h 1 review a year ago Delivery | Dinner Super good pizza, delicious drinks, love it <3 &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed our pizza and drinks. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Jimmy Sambuo 6 reviews·7 photos 2 years ago Fast and friendly service! &pizza is my goto pizza place. Marquis Savant 1 review a year ago Delivery | Lunch Waited over 30 min for a delivery while the employees traded food with shake shack Gabriel Marín 7 reviews·1 photo a year ago Lovely place and pizza is great!! Tay was a complete gentleman. &pizza - Dupont (Owner) 2 months ago We appreciate your 5-star rating! We're glad you enjoyed the pizza and the service provided by Tay. Your response is important to us as we strive to improve our services. Thank you for taking the time to share your experience with us. Messaijah Shillingford 2 reviews a year ago The food was great! Tae gave wonderful customer service! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you enjoyed the food and received wonderful customer service from Tae. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Donald Jackson 7 reviews a year ago Dine in | Lunch | $10–20 Love how the pizza is made on the spot, fresh ingredients and creative mixes Talisha Harris 4 reviews 2 years ago Terence was great! Ever want great pizza and good vibes, come to Dupont location! Corey DeAngelis Local Guide·204 reviews·623 photos 7 years ago Best custom pizza ever Photo 1 in review by Corey DeAngelis Frankie B 1 review 2 years ago Absolutely love this place. Service is quick and food is great Kaylah B Local Guide·48 reviews·18 photos a year ago Take out | Dinner | $10–20 Super fresh, super quick service even though it was very busy! Anna zakharchishin 1 review a year ago Other | $10–20 Alonzo was the absolute best. Should definitely be running the place! Baylee Childress 2 reviews 5 years ago Love this place. Always delicious. Staff is always friendly. Tyler is a bit of a Chav. Tsvetelina Petkova Local Guide·99 reviews·147 photos 4 years ago Really kice and tasty pizza. Affordable price and you choose your topics. Basically you choose your pizza from scratch. Yummy. &pizza - Dupont (Owner) 4 years ago Glad you enjoy the concept Tsvetelina! And thanks for dropping a review! Steve Murphy Local Guide·43 reviews·417 photos 5 years ago Good, quick pizza while you wait. Not as good as wood burning oven etc, but satisfies... James Papanestor Local Guide·88 reviews·574 photos 2 years ago Thin crust and the choices for the toppings are not like any other! Went three times in one week. Tarikah Omar 3 reviews 6 years ago Pizza was fantastic, service was awesome, there was an unpleasant odor when entering that definitely needs to be addressed 1 Javier Borja Local Guide·19 reviews·1 photo 5 years ago Love the food, large space with plenty of seating. It's not a warm place but in great location G Local Guide·116 reviews a year ago Food was good staff was friendly and helpful. … More Amar-Jyrel Mott 2 reviews 2 years ago I love it! Staff is nice & I've never had a bad experience! N K Local Guide·98 reviews·38 photos 6 years ago The best build to suit pizza joint I've tried. Light years ahead of blaze on quality of ingredients. Gahana Dahiya 6 reviews·1 photo 3 years ago I go to this place all the time! Food is great and the staff is always nice. &pizza - Dupont (Owner) 3 years ago Thank you so much for the review and thank you for being a returning guest! Can't wait to see you again next time! Patrice Mobitang 1 review 2 years ago Great pizza. My familly and I love this location Yuting (Nychii) Local Guide·114 reviews·1683 photos 7 years ago Really enjoy the way this chain makes pizza! This location doesn't have a lot of seating though... Sakina Allen 2 reviews 11 months ago great customer service!!!! definitely recommend. George A 1 review 2 years ago Ordered waited for 2 hours and then my order was canceled. They asked me to reorder. It was my first time ordering from them and my last time. TEAM SHERBOURNE Local Guide·405 reviews·284 photos a year ago I'm from NY and Always have to visit a &pizza while in DC! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We are thrilled to hear that you always enjoy visiting &pizza while in DC. Your response is important to us as we strive to improve our services. We hope to continue exceeding your expectations on your future visits. Carlos Patiño Local Guide·168 reviews·431 photos 4 years ago Really, good pizza! Just pick what you want with it and enjoy. Friendly people. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're delighted to hear that you enjoyed our pizza and found our staff friendly. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Erica Burwell 4 reviews 6 years ago The service was good food is normal. If u r n the mood for pizza good place to go. Aris Preston 2 reviews 2 years ago Pizza is great Antoni and Bron were very helpful and lead to a great lunch. Weiyan Zhang 2 reviews 2 years ago I quite like the pizza here! Self designed pizza is always the best big boi rj 1 review a year ago Take out | Dinner Awesome establishment, good service, tasty pizza Bryan Moises Hernandez Benitez 1 review a year ago the crust is the best and the staff are great, down to earth people. Courtney Metcalfe 5 reviews 2 years ago Lavelle was awesome and gave us great service! awesome pizza Jennifer Morgan 6 reviews a year ago Take out | Dinner | $10–20 Great option for a quick / delicious late night dinner. … More James Gregory 2 reviews a year ago Good pizza great people!! Great late night fix &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that you enjoyed our pizza and our service. We're always here to satisfy those late-night cravings. Your response is important to us as we strive to improve our services. Ms Lola 2 reviews 2 years ago Antonio was the best I love how he makes my pizza, I absolutely love this location. Adeola A 11 reviews 4 years ago The pizza is fine, they don't allow you to sit down and eat late nights on the weekend, although they are open, and the security is very rude about it. Joni Hurley 3 reviews·1 photo 5 years ago Pizza was amazing!!!! One of my best GF pizza crust (order well done) Tat hazelton 4 reviews 2 years ago Good Customer Service, Fast Paced & Loaded Pizza Up. Joseph Rhinehart 11 reviews·1 photo 2 years ago Friendly staff. Great food . Will definitely come back. AHMED RABANE 2 reviews a year ago Always great customer service. Terence is definitely a great asset for this location Kendi Johnson 1 review 2 years ago Lavelle was very professional. He put love into my pizza Justin Wang Local Guide·92 reviews 7 years ago Make your own pizza for $9? As many toppings/sauces/garnishes as you want?? I love &pizza. Tahlia Stangherlin 8 reviews·4 photos a year ago Tay was very helpful when i checked out today. very polite and friendly ! Nisha P 6 reviews·1 photo 2 years ago Great experience! Quick and convent! It’s a must try if you are in D.C. Pooja Rastogi 5 reviews·2 photos 2 years ago Love the pizza and employees!!!!!! So so nice especially lavelle Jake Backers 3 reviews a year ago This place is the best!! also the pizza??? smashing!!! Chanel Beaudoin 1 review 2 years ago Great pizza love it here. Loved the service! Allen Cardenas Local Guide·42 reviews·10 photos 5 years ago So glad there is an &pizza in Dupont. It's quick, easy, and delicious. Awesome value for your money Chanelle Combs 1 review 2 years ago Antonio the best I love this location best pizza and they close at 4am Clifton McEachin 3 reviews 2 years ago Great service!!!! The best pizza I’ve ever head!!! Lucas Orjales 2 reviews a year ago Tay was the best supervisor! Absolutely delicious pizza! Antwane Wrenn 1 review a year ago I love this location .employee are fun and patient Kristin Fillingim 1 review 2 years ago Là elle was the best!! Great service. 5 out of 5 every time!!!! &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We are thrilled to hear that you had a great experience with us. Your response is important to us as we strive to improve our services. We look forward to serving you again soon! Jackie Warner 2 reviews 2 years ago Great service and pizza! Antonio, Brianna and Jalen are the best. Veronica Sarai Melara Cornejo 1 review a year ago Good customer service! Friendly people and always willing to help. Lifeasevon 6 reviews 2 years ago The pizza is always great ! Extra crispy too David Oliveira 4 reviews 2 years ago Take out | Dinner | $10–20 Love their pizza, clean and nice location miles vondra Local Guide·10 reviews·12 photos a year ago Great pizza, even better people. JP was great! Yousif M Local Guide·26 reviews·3 photos 5 years ago Lots of crust on the pizza because of how it's made. Super fresh and feels almost healthy! Lauren Hastings 1 review 2 years ago Take out | Dinner Service was great and the vibe even better! Lavelle’s assistance was top notch Precious Johnson Local Guide·25 reviews 2 years ago Service was great at this location! Food was delicious 😋 Kannan Ramanathan Local Guide·73 reviews·27 photos 4 years ago You can just add all the ingredients you want and the dough of the pizza is thin and delicious &pizza - Dupont (Owner) 4 years ago Hey Kannan, glad you loved it! Come again soon! Al S. 1 review 2 years ago Outstanding service and made one hell of a pizza Delonte Briggs, MBA Local Guide·48 reviews·18 photos 4 years ago Staff was not welcoming and had the dude had an attitude when clarifying build your own versus a classic adding a few extra toppings...it didn't master i was willing to pay the difference.. 1 &pizza - Dupont (Owner) 4 years ago Sorry to hear that your pizza experience wasn't the best. Thank you for your feedback. I will forward this information to the appropriate people. Please reach out to us so that we can make this right. A'Jae Boyd 2 reviews 2 years ago Great customer service. Order done in a timely fashion. &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that your order was delivered in a timely fashion. Your response is important to us as we strive to improve our services. We hope to serve you again soon! John Benson Local Guide·23 reviews·183 photos 4 years ago Customer service at this location is atrocious. The crew working the evening shift on 2/28/20 were very rude. Stay away! Dallas S. Local Guide·101 reviews·89 photos 5 years ago My first pizza in DC. Quick service and great good at a decent price. Jordhon Horelien 2 reviews 2 years ago Lavelle was an excellent help to getting the pizza of my choice. Very helpful &pizza - Dupont (Owner) 2 months ago Thank you for taking the time to leave a review. We are thrilled to hear that Lavelle was able to assist you in getting the pizza of your choice. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Courtney Wade 4 reviews 2 years ago Labella is awesome. He goes the extra mile. Thank you! Dusan Vasiljevic Local Guide·50 reviews·25 photos 4 years ago Excellent suggested choices of toppings, quick service, good enough interior. Mig Local Guide·581 reviews·590 photos 6 years ago Love this pizza: Favorite go to - Red sauce with pepporoni and sausage drizzled with pesto on top. Mercedes White 3 reviews 2 years ago Phenomenal experience with Antonio and the rest of the staff. The place was very clean! Kate Neilson 3 reviews 2 years ago Dine in | Lunch | $10–20 love & pizza! come here often and always enjoy it. … More KDASH201 14 reviews·1 photo 7 years ago Best pizza I ever had. You just have to go and try it yourself Debbie James 8 reviews 2 years ago Ran efficiently under pressure during Halloween eve and Lavelle was very helpful Bosh Gobran Local Guide·304 reviews·695 photos 7 years ago Great Pizza, fast and they have a vegan/vegetarian options:) fund staff Smash Diddy 5 reviews 6 years ago Service was good and food great who dnt love pizza lol &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're glad to hear that you enjoyed our service and food, especially the pizza. Your response is important to us as we strive to improve our services. We hope to serve you again soon! Heidi Wiles Local Guide·25 reviews·2 photos 7 years ago I just love the the atmosphere the people are great and the pizza is delicious. Need one in Hagerstown MD. hector paredes Local Guide·51 reviews·712 photos 2 months ago I love this Pizza … More &pizza - Dupont (Owner) 2 months ago Thank you for your 5-star rating! We're thrilled to hear that you love our pizza. Your response is important to us as we strive to improve our services. We look forward to serving you again soon. Justin Bozeman 3 reviews 5 years ago Ordered via Uber Eats, Pizza came completely wrong from what was ordered, and added whatever they wanted to the pizza and when called , no one answers the phone and call was looped, no one ever responded to my e-mails regarding the wrong order 1 Alana Peery 6 reviews·13 photos a year ago Great pizza and better service! Kunal Vijan Local Guide·117 reviews·505 photos 4 years ago Very nice n tasty. Much better than DC Pizza James Plain Local Guide·9 reviews 5 years ago i tried the american honey pizza, and was great! The craft sodas are also really interesting! danelle hankins 8 reviews 2 years ago Antonio made me a great pizza today and answered all my questions. Fly Gurl Local Guide·193 reviews·271 photos 4 years ago The staff was great they are very customer service driven , fast , and very clean Rodolfo Diaz 1 review a year ago Great Place! Awesome customer service! Dean Naps 2 reviews a year ago Awesome pizza, great service, thank you &pizza! EBEMBI Alain 3 reviews 2 years ago Great location. Staff are really friendly and patient Robin Young 5 reviews 5 years ago Fantastic pizza and an AMAZING staff!! I could eat there everyday!!’ Javid Pourkia Local Guide·128 reviews·1295 photos 5 years ago It's not just food, is love Photo 1 in review by Javid Pourkia Petra Sosa 2 reviews·1 photo a year ago Best pizza in town , customer service is A1 ! Photo 1 in review by Petra Sosa khairy jones 3 reviews 2 years ago This was a great place to go late at night and it handled the long line well Alvaro Dalessandro Local Guide·44 reviews·3 photos 4 years ago Tasty pizza, only downside is the place didn't have Coca-Cola Money Monkey 1 review 2 years ago lavelle was extremely helpful and made sure i was set and provided good service Living the life of lele Vibing 12 reviews·2 photos a year ago Great customer service made me feel welcome &pizza - Dupont (Owner) 2 months ago Thank you for the 5-star rating! We're thrilled to hear that our customer service made you feel welcome. Your response is important to us as we strive to improve our services. We hope to continue providing a great experience for you in the future. Abish Anklesaria Local Guide·94 reviews·53 photos 7 years ago Fresh pizza. Good toppings selection. Kid friendly as well. Great place for a fast custom pizza. Rob G Local Guide·151 reviews·301 photos 2 years ago First visit. Fast service, excellent pizza! Matt Peterson 2 reviews 2 years ago an icon, a legend, showstopping beautiful amazing never the same the best &pizza in DC Eric Midder Local Guide·146 reviews 4 years ago Could be a little quicker but very friendly staff and great pizza! Sandra Gaillardetz 4 reviews 5 years ago This Pizza was phenomenal ! Loved it and would definitely go back!!",Retail/Product,Effect Analysis,Q&A "Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.",What purpose does the OSINT serve? Is there a potential for abuse if the OSINT is utilized?,"Title: Fugitive Tracking using Open Source Intelligence ( OSINT) Author: Pranav Waghmare Abstract: The fugitive tracking has been a challenging topic for various law enforcement agencies across the world. The use of technology, social media, and other social media platforms, etc offers unique opportunities to track the digital footprint left by Fugutives. In this research paper, we will explore the methodologies, Legal as well as Ethical Considerations, OSINT mapping, and cyber forensic technologies that can be helpful in tracking fugitives. Introduction : Fugitive tracking has evolved over a period of time but also now has a global framework. Interpol created a global framework and classification of fugitives based on their crime and threat level. They have also created a color-coded system. The local government agencies also have their own classification system for fugitives. Methodologies : OSINT Framework Mapping : The Interpole’s framework for data classification can be incorporated with OSINT. The Interpole classifies fugitives with color codes and also updates the data every hour. This is really for mapping it to OSINT Framework for real-time monitoring and cross-referencing the searches. OSINT comparatively accesses vast resources but the Interpol framework provides the necessary filter to refine the searches. Electronic copy available at: https://ssrn.com/abstract=4719968 Here is the overview of the Color code System used by Interpol : ● Red Notice: Red is the highest level of importance and also states the individual wanted by Law enforcement and governments for arrest and extradition For Example: The person who is found guilty of murder and on the run falls under Red Notice ● Blue Notice: The Blue Notice is mainly concerned with gathering enough information about the person of Interest by Law Enforcement. For Example, The people under blue notices are suspects and wanted for questioning by authorities. The gang members whom law enforcement may suspect connected with crime and needed for questioning will fall under Blue Notice ● Green Notice: The green notice fugitive is considered a public safety threat. For Example, Sex Offenders and Drug traffickers will fall under “ Green Notice”. Here the country is making Interpol aware this person is a threat to public safety ● Yellow Notice: Yellow Notice is more about the Identity of the missing individuals or person who is incapable of identifying themselves For Example, a Missing Child who is underage or an individual with mental incapability will be under a Yellow Notice Electronic copy available at: https://ssrn.com/abstract=4719968 ● Black Notice: The black notice is issued about unidentified bodies. For Example, If a war crime is committed and mass graves of unidentified bodies are found they come under black notice ● Purple Notice: The purple notice is mainly used to gather information about the operational details of the crime such as devices used or methods used by them to hide. For Example, Drug Tunnels will come under purple notice Cyber Forensics and OSINT : The Digital Footprint creation will be very efficient with the use of OSINT. The geolocation tags, social media posts, and publicly available information about fugitives will help to create a digital footprint and help investigators understand the patterns in fugitive behavior. This also helps to reconstruct the timeline as shown in Figure 1 which can help the investigator understand the events and suspects. Geolocation Tracking: With OSINT we can build geotags of the places an individual has been and cross-check with Interpol notices as they get updated every hour. OSINT also provides information about individuals known associated that can be also valuable in terms of building Geolocation Tracking. For example, One can search the fugitive's location and past history of residential addresses can help to pinpoint their possible location and understand the pattern in their movements Electronic copy available at: https://ssrn.com/abstract=4719968 Social Media Monitoring: The social media accounts of fugitives provide essential details about their likes or dislikes, the images and videos posted by them, and the metadata associated with them. Social media also give understanding to their known friends or associates. This can be further matched with witness and journalist statements. The metadata search and social media monitoring can help create a digital footprint and also be searched for further updated information posted by Interpol every hour. Legal and Ethical Consideration : While implementing as well as using OSINT framework it is really essential to keep track of local laws and jurisdiction. There is the possibility that this system can be abused if it falls into the wrong hands, It can be used to track dissidents, political and religious minorities, or opponents. Hence there need to be awareness of local laws as well ethical consideration must be taken into consideration. There have been instances where the Interpol framework was abused in the past but over the period of time, Interpol is evolving. For Example, China issued red notices for Uyghurs. The Interpol latter made firm in their policy that they will not issue notices for individuals who have refugee status in another country and they firmly believe that an individual is innocent until proven guilty. Hence, The Interpol framework mapping into OSINT is essential as Interpol holds the highest standards of Ethical approach in terms of tracking Fugutatives. Conclusion : To Conclude, The OSINT is a highly efficient framework, and mapping into the Interpoles framework makes it a very effective tool with legal and ethical considerations Electronic copy available at: https://ssrn.com/abstract=4719968 References: 1. Interpol (2011) Interpole’s Rules on Processing Data: Interpol https://www.interpol.int/en/Who-we-are/Legal-framework/Data-protection 2 C. Rafailă, F. Gurzău, C. Grumăzescu, and I. Bica, ""MTAFinder - Unified OSINT platform for efficient data gathering,"" 2023 15th International Conference on Electronics, Computers and Artificial Intelligence (ECAI), Bucharest, Romania, 2023 3 HOROS, ANDREW J.(2023) 21st Century Open-Source Intelligence and Law Enforcement Utilization 4 Lakomy, Miron. (2023). Open-source intelligence and research on online terrorist communication: Identifying ethical and security dilemmas. 5 Daragh Murray, Yvonne McDermott, K Alexa Koenig, Mapping the Use of Open Source Research in UN Human Rights Investigations, Journal of Human Rights Practice, Volume 14, Issue 2, July 2022, Pages 554–581 ( Figure 1) 6 J. W. Johnsen and K. Franke, ""The impact of preprocessing in natural language for open source intelligence and criminal investigation,"" 2019 IEEE International Conference on Big Data (Big Data), Los Angeles, CA, USA, 2019 Electronic copy available at: https://ssrn.com/abstract=4719968","Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand. What purpose does the OSINT serve? Is there a potential for abuse if the OSINT is utilized? Title: Fugitive Tracking using Open Source Intelligence ( OSINT) Author: Pranav Waghmare Abstract: The fugitive tracking has been a challenging topic for various law enforcement agencies across the world. The use of technology, social media, and other social media platforms, etc offers unique opportunities to track the digital footprint left by Fugutives. In this research paper, we will explore the methodologies, Legal as well as Ethical Considerations, OSINT mapping, and cyber forensic technologies that can be helpful in tracking fugitives. Introduction : Fugitive tracking has evolved over a period of time but also now has a global framework. Interpol created a global framework and classification of fugitives based on their crime and threat level. They have also created a color-coded system. The local government agencies also have their own classification system for fugitives. Methodologies : OSINT Framework Mapping : The Interpole’s framework for data classification can be incorporated with OSINT. The Interpole classifies fugitives with color codes and also updates the data every hour. This is really for mapping it to OSINT Framework for real-time monitoring and cross-referencing the searches. OSINT comparatively accesses vast resources but the Interpol framework provides the necessary filter to refine the searches. Electronic copy available at: https://ssrn.com/abstract=4719968 Here is the overview of the Color code System used by Interpol : ● Red Notice: Red is the highest level of importance and also states the individual wanted by Law enforcement and governments for arrest and extradition For Example: The person who is found guilty of murder and on the run falls under Red Notice ● Blue Notice: The Blue Notice is mainly concerned with gathering enough information about the person of Interest by Law Enforcement. For Example, The people under blue notices are suspects and wanted for questioning by authorities. The gang members whom law enforcement may suspect connected with crime and needed for questioning will fall under Blue Notice ● Green Notice: The green notice fugitive is considered a public safety threat. For Example, Sex Offenders and Drug traffickers will fall under “ Green Notice”. Here the country is making Interpol aware this person is a threat to public safety ● Yellow Notice: Yellow Notice is more about the Identity of the missing individuals or person who is incapable of identifying themselves For Example, a Missing Child who is underage or an individual with mental incapability will be under a Yellow Notice Electronic copy available at: https://ssrn.com/abstract=4719968 ● Black Notice: The black notice is issued about unidentified bodies. For Example, If a war crime is committed and mass graves of unidentified bodies are found they come under black notice ● Purple Notice: The purple notice is mainly used to gather information about the operational details of the crime such as devices used or methods used by them to hide. For Example, Drug Tunnels will come under purple notice Cyber Forensics and OSINT : The Digital Footprint creation will be very efficient with the use of OSINT. The geolocation tags, social media posts, and publicly available information about fugitives will help to create a digital footprint and help investigators understand the patterns in fugitive behavior. This also helps to reconstruct the timeline as shown in Figure 1 which can help the investigator understand the events and suspects. Geolocation Tracking: With OSINT we can build geotags of the places an individual has been and cross-check with Interpol notices as they get updated every hour. OSINT also provides information about individuals known associated that can be also valuable in terms of building Geolocation Tracking. For example, One can search the fugitive's location and past history of residential addresses can help to pinpoint their possible location and understand the pattern in their movements Electronic copy available at: https://ssrn.com/abstract=4719968 Social Media Monitoring: The social media accounts of fugitives provide essential details about their likes or dislikes, the images and videos posted by them, and the metadata associated with them. Social media also give understanding to their known friends or associates. This can be further matched with witness and journalist statements. The metadata search and social media monitoring can help create a digital footprint and also be searched for further updated information posted by Interpol every hour. Legal and Ethical Consideration : While implementing as well as using OSINT framework it is really essential to keep track of local laws and jurisdiction. There is the possibility that this system can be abused if it falls into the wrong hands, It can be used to track dissidents, political and religious minorities, or opponents. Hence there need to be awareness of local laws as well ethical consideration must be taken into consideration. There have been instances where the Interpol framework was abused in the past but over the period of time, Interpol is evolving. For Example, China issued red notices for Uyghurs. The Interpol latter made firm in their policy that they will not issue notices for individuals who have refugee status in another country and they firmly believe that an individual is innocent until proven guilty. Hence, The Interpol framework mapping into OSINT is essential as Interpol holds the highest standards of Ethical approach in terms of tracking Fugutatives. Conclusion : To Conclude, The OSINT is a highly efficient framework, and mapping into the Interpoles framework makes it a very effective tool with legal and ethical considerations Electronic copy available at: https://ssrn.com/abstract=4719968 References: 1. Interpol (2011) Interpole’s Rules on Processing Data: Interpol https://www.interpol.int/en/Who-we-are/Legal-framework/Data-protection 2 C. Rafailă, F. Gurzău, C. Grumăzescu, and I. Bica, ""MTAFinder - Unified OSINT platform for efficient data gathering,"" 2023 15th International Conference on Electronics, Computers and Artificial Intelligence (ECAI), Bucharest, Romania, 2023 3 HOROS, ANDREW J.(2023) 21st Century Open-Source Intelligence and Law Enforcement Utilization 4 Lakomy, Miron. (2023). Open-source intelligence and research on online terrorist communication: Identifying ethical and security dilemmas. 5 Daragh Murray, Yvonne McDermott, K Alexa Koenig, Mapping the Use of Open Source Research in UN Human Rights Investigations, Journal of Human Rights Practice, Volume 14, Issue 2, July 2022, Pages 554–581 ( Figure 1) 6 J. W. Johnsen and K. Franke, ""The impact of preprocessing in natural language for open source intelligence and criminal investigation,"" 2019 IEEE International Conference on Big Data (Big Data), Los Angeles, CA, USA, 2019 Electronic copy available at: https://ssrn.com/abstract=4719968",Legal,Effect Analysis,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Summarize the information about periorbital hyperchromia in about 600 words. In bold at the end of the response, tell me what type of individuals are most affected by it.","INTRODUCTION Although periorbital hyperpigmentation (also called peri- palpebral hyperpigmentation, dark eyelids, dark eye circles, dark circles, or simply under-eye circles) is a mere color difference between the palpebral skin and the remaining facial skin, it makes people look tired or older, which negatively affects their quality of life. 1,-4 It has a higher prevalence in individuals with darker skin, hair and eyes, and affects age groups and genders equally. Nevertheless, there are a higher number of complaints from women, especially senior women. There are few studies about the etiology of this condition, however dark eye circles with a vascular component are known to present a dominant autoso- mal family inheritance pattern. 2,3 Periorbital hyperpigmentation seems to have multifactori- al causes that involve intrinsic factors (determined by the indi- vidual''''''''s genetics), and extrinsic factors (sun exposure, smoking, alcoholism and sleep deprivation, for instance). However, the presence of melanic pigment and hemosiderotic pigment in the affected sites is a distinctive feature in its etiopathogeny. 2-4 Melanic hyperpigmentation is more frequent in brunet adults, as a consequence of excessive and cumulative exposure to the sun, which increases the production of melanin, reduces the skin''''''''s thickness and increases the dilatation of blood vessels. 2,4,5 Intense vascularization is mainly found in people belong- ing to certain ethnic groups such as Arabs, Turks, Hindus, inhab- itants of the Iberian Peninsula and their respective descendants. In these ethnicities, its manifestation tends to take place earlier, often during childhood. In those individuals there is no change in the color of the skin; the eyelid appears darkened because the dilated vessels are visible due to the transparency of the skin. 2 In those cases, therefore, the problem is often aggravated when the lower eyelid''''''''s vessels are more dilated (e.g., from fatigue, insom- nia, oral breathing, crying), causing dermal blood extravasation. The liberation of ferric ions takes place locally, entailing the for- mation of free radicals that stimulate the melanocytes, which generates melanic pigmentation. 2, 4-6 Other causes noted as being responsible for the appearance of dark eye circles are post-inflammatory hyperpigmentation secondary to atopic and contact dermatitis, sleep deprivation, oral breathing, alcoholism, smoking, use of certain medications (contraceptives, chemotherapy, antipsychotic and some types of eye drops), the presence of palpebral sagging (due to aging) and of disorders that develop with hydric retention and palpebral edema (thyroid disorders, nephropathies, cardiopathies and pneumopathies) – all of which worsen the unattractive appear- ance of dark eye circles. 2-4,7 Various treatments have been proposed for periorbital hyperchromia, however there are few studies on their long-term efficacy. The main types of treatment are: topical application of depigmenting products, chemical peelings, dermabrasion, cryosurgery, fillings with hyaluronic acid, intense pulsed light, CO2, argon, ruby and excimer lasers. 2-4, 6, 8-12 PALPEBRAL ANATOMY The eyelids are tegumentary pleats that participate in facial expression and aesthetics, however their main function is to pro- tect the eyeballs through sensorial filtration actions carried out by the palpebral cilia, and the Meibomian and lachrymal glands'''''''' secretions. In this manner, the cornea remains hydrated and the closing movements of the eyes function as a barrier to external traumas and prevent the cornea from drying out. 13-17 The upper eyelid reaches upwards to the eyebrow, which separates it from the forehead. The lower eyelid extends down- wards up to the lower border of the orbit, and is delimited by the genian region. 15 The palpebral fissure, which measures 9-10 mm in adults, is determined by the interaction of the muscles that open and close the eyelids. To open the eyelid, the palpebral elevator mus- cle is assisted by two other accessory muscles (Muller''''''''s and frontalis muscles). 18 The aging process decreases the palpebral fis- sure''''''''s vertical opening, due to the progressive lowering of the upper eyelid, 14 which is caused by a decrease in the upper eye- lid lifter muscle''''''''s aponeurosis action. 15 The skin becomes more flaccid, less elastic and has a greater propensity to wrinkle 16. The orbicular and tarsal muscles, the orbital septum and the conjunctival mucous membrane also go through transforma- tions in the elderly. In addition, gravity and facial expressions influence the mechanical deformation of those structures. 17 A cohort study with 320 patients (aged 10-89) evaluated participants'''''''' eyelids frontally and laterally and found that there is a correlation between a decrease in the palpebral fissure and an increase in the age of patients. 19 PALPEBRAL REGION''''''''S SKIN AND SUBCUTANEOUS TISSUE Palpebral skin is the thinnest in the human body (< 1 mm). Its epidermis is constituted of stratified epithelium, which is very thin (0.4 mm) compared to that of the palmoplantar region (the thickness of which is approximately 1.6 mm). 13 The nasal portion of the palpebral skin has thinner hair and more sebaceous glands (i.e., it is softer and oilier) than its tem- poral portion. The transition between the eyelids'''''''' thin skin and the remaining facial skin is clinically observable. 13 The palpebral dermis is composed of loose conjunctive tissue, and is extremely thin in that region. It is absent in the pre-tarsal skin, in the medial and lateral ligaments of the eyelid, where the skin adheres to the underlying fibrous tissue. The thinness of the skin, combined with the lack of fatty tissue, gives that region its characteristic translucency. As a result, the accu- mulation of melanin and/or vessel dilatation in that region can be easily seen, through transparency, as bilateral homogeneous hyperpigmentation. 2,4,5,13 PALPEBRAL REGION''''''''S VENOUS AND LYMPH VASCULARIZATION The eyelids'''''''' arterial irrigation comes through many vessels: the supratrochlear, supraorbital, lachrymal and dorsum of the nose arteries (all originating in the facial artery); the angular artery (originating in the facial artery); the transverse artery (originating in the facial artery); the transverse facial artery (originating in the superficial temporal artery) and the branch- es of the superficial temporal artery itself 20 (Figure 1). Venous drainage (following an external pattern) takes place through the veins associated with these arteries and (following an internal pattern) penetrates the orbit through connections with ophthalmic veins 20 (Figure 2). Lymphatic drainage takes place mainly through the parotid lymph nodes; some of the drainage from the medial angle of the eye to the lymph vessels is associated with the angular and facial arteries, towards the submandibular lymph nodes. 20 COLOR OF THE SKIN IN THE PALPEBRAL REGION The palpebral skin''''''''s color results from the combination of several factors, some of genetic-racial origin (such as the amount of melanin pigment), others of individual or regional and even gender l origins, such as the thickness of the several components and the blood volume in their vessels.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Summarize the information about periorbital hyperchromia in about 600 words. In bold at the end of the response, tell me what type of individuals are most affected by it. {passage 0} ========== INTRODUCTION Although periorbital hyperpigmentation (also called peri- palpebral hyperpigmentation, dark eyelids, dark eye circles, dark circles, or simply under-eye circles) is a mere color difference between the palpebral skin and the remaining facial skin, it makes people look tired or older, which negatively affects their quality of life. 1,-4 It has a higher prevalence in individuals with darker skin, hair and eyes, and affects age groups and genders equally. Nevertheless, there are a higher number of complaints from women, especially senior women. There are few studies about the etiology of this condition, however dark eye circles with a vascular component are known to present a dominant autoso- mal family inheritance pattern. 2,3 Periorbital hyperpigmentation seems to have multifactori- al causes that involve intrinsic factors (determined by the indi- vidual''''''''s genetics), and extrinsic factors (sun exposure, smoking, alcoholism and sleep deprivation, for instance). However, the presence of melanic pigment and hemosiderotic pigment in the affected sites is a distinctive feature in its etiopathogeny. 2-4 Melanic hyperpigmentation is more frequent in brunet adults, as a consequence of excessive and cumulative exposure to the sun, which increases the production of melanin, reduces the skin''''''''s thickness and increases the dilatation of blood vessels. 2,4,5 Intense vascularization is mainly found in people belong- ing to certain ethnic groups such as Arabs, Turks, Hindus, inhab- itants of the Iberian Peninsula and their respective descendants. In these ethnicities, its manifestation tends to take place earlier, often during childhood. In those individuals there is no change in the color of the skin; the eyelid appears darkened because the dilated vessels are visible due to the transparency of the skin. 2 In those cases, therefore, the problem is often aggravated when the lower eyelid''''''''s vessels are more dilated (e.g., from fatigue, insom- nia, oral breathing, crying), causing dermal blood extravasation. The liberation of ferric ions takes place locally, entailing the for- mation of free radicals that stimulate the melanocytes, which generates melanic pigmentation. 2, 4-6 Other causes noted as being responsible for the appearance of dark eye circles are post-inflammatory hyperpigmentation secondary to atopic and contact dermatitis, sleep deprivation, oral breathing, alcoholism, smoking, use of certain medications (contraceptives, chemotherapy, antipsychotic and some types of eye drops), the presence of palpebral sagging (due to aging) and of disorders that develop with hydric retention and palpebral edema (thyroid disorders, nephropathies, cardiopathies and pneumopathies) – all of which worsen the unattractive appear- ance of dark eye circles. 2-4,7 Various treatments have been proposed for periorbital hyperchromia, however there are few studies on their long-term efficacy. The main types of treatment are: topical application of depigmenting products, chemical peelings, dermabrasion, cryosurgery, fillings with hyaluronic acid, intense pulsed light, CO2, argon, ruby and excimer lasers. 2-4, 6, 8-12 PALPEBRAL ANATOMY The eyelids are tegumentary pleats that participate in facial expression and aesthetics, however their main function is to pro- tect the eyeballs through sensorial filtration actions carried out by the palpebral cilia, and the Meibomian and lachrymal glands'''''''' secretions. In this manner, the cornea remains hydrated and the closing movements of the eyes function as a barrier to external traumas and prevent the cornea from drying out. 13-17 The upper eyelid reaches upwards to the eyebrow, which separates it from the forehead. The lower eyelid extends down- wards up to the lower border of the orbit, and is delimited by the genian region. 15 The palpebral fissure, which measures 9-10 mm in adults, is determined by the interaction of the muscles that open and close the eyelids. To open the eyelid, the palpebral elevator mus- cle is assisted by two other accessory muscles (Muller''''''''s and frontalis muscles). 18 The aging process decreases the palpebral fis- sure''''''''s vertical opening, due to the progressive lowering of the upper eyelid, 14 which is caused by a decrease in the upper eye- lid lifter muscle''''''''s aponeurosis action. 15 The skin becomes more flaccid, less elastic and has a greater propensity to wrinkle 16. The orbicular and tarsal muscles, the orbital septum and the conjunctival mucous membrane also go through transforma- tions in the elderly. In addition, gravity and facial expressions influence the mechanical deformation of those structures. 17 A cohort study with 320 patients (aged 10-89) evaluated participants'''''''' eyelids frontally and laterally and found that there is a correlation between a decrease in the palpebral fissure and an increase in the age of patients. 19 PALPEBRAL REGION''''''''S SKIN AND SUBCUTANEOUS TISSUE Palpebral skin is the thinnest in the human body (< 1 mm). Its epidermis is constituted of stratified epithelium, which is very thin (0.4 mm) compared to that of the palmoplantar region (the thickness of which is approximately 1.6 mm). 13 The nasal portion of the palpebral skin has thinner hair and more sebaceous glands (i.e., it is softer and oilier) than its tem- poral portion. The transition between the eyelids'''''''' thin skin and the remaining facial skin is clinically observable. 13 The palpebral dermis is composed of loose conjunctive tissue, and is extremely thin in that region. It is absent in the pre-tarsal skin, in the medial and lateral ligaments of the eyelid, where the skin adheres to the underlying fibrous tissue. The thinness of the skin, combined with the lack of fatty tissue, gives that region its characteristic translucency. As a result, the accu- mulation of melanin and/or vessel dilatation in that region can be easily seen, through transparency, as bilateral homogeneous hyperpigmentation. 2,4,5,13 PALPEBRAL REGION''''''''S VENOUS AND LYMPH VASCULARIZATION The eyelids'''''''' arterial irrigation comes through many vessels: the supratrochlear, supraorbital, lachrymal and dorsum of the nose arteries (all originating in the facial artery); the angular artery (originating in the facial artery); the transverse artery (originating in the facial artery); the transverse facial artery (originating in the superficial temporal artery) and the branch- es of the superficial temporal artery itself 20 (Figure 1). Venous drainage (following an external pattern) takes place through the veins associated with these arteries and (following an internal pattern) penetrates the orbit through connections with ophthalmic veins 20 (Figure 2). Lymphatic drainage takes place mainly through the parotid lymph nodes; some of the drainage from the medial angle of the eye to the lymph vessels is associated with the angular and facial arteries, towards the submandibular lymph nodes. 20 COLOR OF THE SKIN IN THE PALPEBRAL REGION The palpebral skin''''''''s color results from the combination of several factors, some of genetic-racial origin (such as the amount of melanin pigment), others of individual or regional and even gender l origins, such as the thickness of the several components and the blood volume in their vessels. http://www.surgicalcosmetic.org.br/details/158/en-US/periorbital-hyperchromia",Medical,Find & Summarize,Text Transformation Use only the supplied context document in your answer and do not use outside information.,"Based on the article, what stock prices have fallen the most?","**Dow Jones Futures: Market Rally, Nvidia Resilient As Tesla Skids** Dow Jones futures rose slightly after hours, along with S&P 500 futures and Nasdaq futures. Software makers UiPath (PATH) and SentinelOne (S) reported Wednesday night, along with homebuilder Lennar (LEN). The stock market rally had a constructive Wednesday. The Nasdaq fell but finished off lows and held the bulk of Tuesday's gains, much like AI rally leader Nvidia (NVDA). Many other big techs had quiet sessions after Tuesday's strong moves. Laggard Tesla (TSLA), however, broke lower, extending its long run of underperformance amid negative headlines. Market breadth was solid. While AI stocks have clearly led the market rally, a number of stocks in the commodity, travel and medical product spaces are in buy areas now. Freeport-McMoRan (FCX), PBF Energy (PBF) and Royal Caribbean (RCL) cleared a buy point. Shockwave Medical (SWAV) and Dexcom (DXCM) remain in buy areas. However, bullish sentiment has reached excessive levels, suggesting a pullback is likely in the coming days. The market rally has refused to take extended breaks, staging ""cat nap"" pullbacks for a day or two before quickly revving higher again and looking extended again. Nvidia and Dexcom stock are on IBD Leaderboard. Nvidia, SentinelOne and Royal Caribbean stock are on the IBD 50. Nvidia stock is on the IBD Big Cap 20. Dexcom was Wednesday's IBD Stock Of The Day. Dow Jones Futures Today Dow Jones futures were 0.1% above fair value. S&P 500 futures climbed 0.1% and Nasdaq 100 futures rose 0.2%. Remember that overnight action in Dow futures and elsewhere doesn't necessarily translate into actual trading in the next regular stock market session. Join IBD experts as they analyze leading stocks and the market on IBD Live Earnings Lennar earnings topped while revenue fell short. LEN stock fell slightly overnight. Shares dipped 0.3% in Wednesday's regular session to 165.50 after hitting a record high intraday. Lennar stock slightly extended from a flat base with a 156.01 buy point, according to MarketSmith analysis. UiPath earnings topped with the automation software maker guiding lower on Q1 revenue but up for fiscal 2025. PATH stock rose slightly late after initially surging in volatile action. Shares dipped 0.85% to 24.43 on Wednesday, but held onto the recent move above the 50-day following a failed recent breakout. A move above Wednesday's high of 25.33 would offer an early entry. SentinelOne narrowly beat fiscal Q4 views, but guided slightly lower on fiscal 2025 revenue. Shares tumbled overnight. SentinelOne stock fell 1 cent to 27.94 on Wednesday, briefly testing a downward-sloping trendline. That offered an early entry in an emerging base, but the imminent earnings report made that risky. Stock Market Rally The stock market rally had a mixed session, with the S&P 500 and Nasdaq falling modestly, ceding only a portion of Tuesday's gains. The Dow Jones Industrial Average rose 0.1% in Wednesday's stock market trading. Meanwhile, the S&P 500 index dipped 0.2%. The Nasdaq composite declined 0.5%, but it was an inside day to Tuesday's 1.5% pop. Nvidia fell 1.1% but was off lows in an inside day to Tuesday's 7.2% jump. The small-cap Russell 2000 edged up 0.3%. Breadth was modestly positive, though decliners narrowly led on the Nasdaq. While Nvidia and many AI hardware plays are clearly extended, there are some software, commodity, medical product, financial, energy and travel names that are actionable or setting up. U.S. crude oil prices popped 2.8% to $79.72 a barrel. Gasoline futures gained 2.9% — 5.3% this week — to their highest close in nearly six months. Copper futures jumped 3.25% to $4.0525 a pound, the highest close since April 2023. It was the biggest percentage gain since late 2022. The 10-year Treasury yield rose 3.5 basis points to 4.19%. Bullish Sentiment Excessive The Investors Intelligence bulls-bears sentiment gauge is reaching euphoric levels. Some 60.9% of investment advisors are bullish, above the 60% level seen as excessive. That suggests a pullback, perhaps a more serious one, is coming. But it doesn't have to happen right away. That's the highest point since mid-2021. Just 14.5% are bearish, also the lowest since 2021. A modest pause or pullback over several days or even weeks would likely cool sentiment, let more bases form and give the market room for a longer run. But that hasn't been the market's pattern. ETFs Among growth ETFs, the iShares Expanded Tech-Software Sector ETF (IGV) fell 0.7%. The VanEck Vectors Semiconductor ETF (SMH) slumped 2%. Nvidia stock is the No. 1 holding in SMH. Reflecting more-speculative story stocks, ARK Innovation ETF (ARKK) edged up 0.2% and ARK Genomics ETF (ARKG) rose 0.3%. Tesla stock is a major holding across Ark Invest's ETFs. UiPath also is a big Cathie Wood stock. SPDR S&P Metals & Mining ETF (XME) edged higher, with FCX stock in the ETF. U.S. Global Jets ETF (JETS) ascended 0.7%. SPDR S&P Homebuilders ETF (XHB) stepped up 1.5%, with Lennar stock a key holding. The Energy Select SPDR ETF (XLE) rallied 1.6% and the Health Care Select Sector SPDR Fund (XLV) fell 0.4%. The Industrial Select Sector SPDR Fund (XLI) gained 0.3%. And the Financial Select SPDR ETF (XLF) climbed 0.7%. Time The Market With IBD's ETF Market Strategy Stocks In Buy Areas Freeport-McMoRan stock gapped up 7.6% to 43.41, Wednesday's top S&P 500 performer. The copper and gold miner broke above a double-bottom base buy point of 40.99, closing out of range. However, on a weekly chart, FCX stock just topped a 43.42 cup-with-handle buy point. Southern Copper (SCCO) and more-diversified Teck Resources (TECK) also cleared bases Wednesday. PBF Energy stock leapt 9% to 54.96, clearing a 54.52 cup-with-handle buy point. PBF stock is 16% above its 50-day line. Refining peer Phillips 66 (PSX) decisively cleared a short consolidation Wednesday, while several oil and gas machinery and services firms have been actionable. Shockwave Medical stock climbed 1.8% to 269.37, testing the top of a short consolidation following an earnings gap from the 200-day line. SWAV stock already was actionable from breaking a downtrend in this recent action, which could be viewed as a handle to a huge base. Dexcom stock fell 2.7% to 131.68, falling just below a 132.03 buy point from a flat base within a much larger consolidation. Royal Caribbean stock climbed 1.8% to 132.11, clearing a 130.97 buy point from a messy flat base. Meanwhile, rival cruise line operator Carnival (CCL) cleared an aggressive entry while hotel giant Marriott Worldwide (MAR) is trying to clear a tight pattern. Tesla Stock Tesla stock skidded 4.5% to 169.50, hitting the lowest levels since last May. Shares have tumbled nearly 32% in 2024, the worst performer on the S&P 500 index. The relative strength line is at a 14-month low, reflecting Tesla's severe underperformance vs. the S&P 500 index in recent months. The RS line is the blue line in the charts provided. Before Wednesday's open, Wells Fargo downgraded Tesla to underweight and cut its price target to 125 from 200. The analyst joined a recent rush to slash first-quarter delivery targets. He now sees 2024 earnings per share nearly a third below consensus. And he expects deliveries to fall short. Wells Fargo also said a yet-unveiled cheap EV may be not be a boon for Tesla, citing ""likely tough"" economics. Late Wednesday, UBS cut its Tesla price target to 165 from 225, also slashing its first-quarter delivery targets. TSLA stock fell a fraction overnight. Fisker (FSR) plunged more than 40% late Wednesday, on a report that the U.S. EV startup and would-be Tesla rival is preparing for a possible bankruptcy filing.","Question: Based on the article, what stock prices have fallen the most? System Instruction: Use only the supplied context document in your answer and do not use outside information. Context: **Dow Jones Futures: Market Rally, Nvidia Resilient As Tesla Skids** Dow Jones futures rose slightly after hours, along with S&P 500 futures and Nasdaq futures. Software makers UiPath (PATH) and SentinelOne (S) reported Wednesday night, along with homebuilder Lennar (LEN). The stock market rally had a constructive Wednesday. The Nasdaq fell but finished off lows and held the bulk of Tuesday's gains, much like AI rally leader Nvidia (NVDA). Many other big techs had quiet sessions after Tuesday's strong moves. Laggard Tesla (TSLA), however, broke lower, extending its long run of underperformance amid negative headlines. Market breadth was solid. While AI stocks have clearly led the market rally, a number of stocks in the commodity, travel and medical product spaces are in buy areas now. Freeport-McMoRan (FCX), PBF Energy (PBF) and Royal Caribbean (RCL) cleared a buy point. Shockwave Medical (SWAV) and Dexcom (DXCM) remain in buy areas. However, bullish sentiment has reached excessive levels, suggesting a pullback is likely in the coming days. The market rally has refused to take extended breaks, staging ""cat nap"" pullbacks for a day or two before quickly revving higher again and looking extended again. Nvidia and Dexcom stock are on IBD Leaderboard. Nvidia, SentinelOne and Royal Caribbean stock are on the IBD 50. Nvidia stock is on the IBD Big Cap 20. Dexcom was Wednesday's IBD Stock Of The Day. Dow Jones Futures Today Dow Jones futures were 0.1% above fair value. S&P 500 futures climbed 0.1% and Nasdaq 100 futures rose 0.2%. Remember that overnight action in Dow futures and elsewhere doesn't necessarily translate into actual trading in the next regular stock market session. Join IBD experts as they analyze leading stocks and the market on IBD Live Earnings Lennar earnings topped while revenue fell short. LEN stock fell slightly overnight. Shares dipped 0.3% in Wednesday's regular session to 165.50 after hitting a record high intraday. Lennar stock slightly extended from a flat base with a 156.01 buy point, according to MarketSmith analysis. UiPath earnings topped with the automation software maker guiding lower on Q1 revenue but up for fiscal 2025. PATH stock rose slightly late after initially surging in volatile action. Shares dipped 0.85% to 24.43 on Wednesday, but held onto the recent move above the 50-day following a failed recent breakout. A move above Wednesday's high of 25.33 would offer an early entry. SentinelOne narrowly beat fiscal Q4 views, but guided slightly lower on fiscal 2025 revenue. Shares tumbled overnight. SentinelOne stock fell 1 cent to 27.94 on Wednesday, briefly testing a downward-sloping trendline. That offered an early entry in an emerging base, but the imminent earnings report made that risky. Stock Market Rally The stock market rally had a mixed session, with the S&P 500 and Nasdaq falling modestly, ceding only a portion of Tuesday's gains. The Dow Jones Industrial Average rose 0.1% in Wednesday's stock market trading. Meanwhile, the S&P 500 index dipped 0.2%. The Nasdaq composite declined 0.5%, but it was an inside day to Tuesday's 1.5% pop. Nvidia fell 1.1% but was off lows in an inside day to Tuesday's 7.2% jump. The small-cap Russell 2000 edged up 0.3%. Breadth was modestly positive, though decliners narrowly led on the Nasdaq. While Nvidia and many AI hardware plays are clearly extended, there are some software, commodity, medical product, financial, energy and travel names that are actionable or setting up. U.S. crude oil prices popped 2.8% to $79.72 a barrel. Gasoline futures gained 2.9% — 5.3% this week — to their highest close in nearly six months. Copper futures jumped 3.25% to $4.0525 a pound, the highest close since April 2023. It was the biggest percentage gain since late 2022. The 10-year Treasury yield rose 3.5 basis points to 4.19%. Bullish Sentiment Excessive The Investors Intelligence bulls-bears sentiment gauge is reaching euphoric levels. Some 60.9% of investment advisors are bullish, above the 60% level seen as excessive. That suggests a pullback, perhaps a more serious one, is coming. But it doesn't have to happen right away. That's the highest point since mid-2021. Just 14.5% are bearish, also the lowest since 2021. A modest pause or pullback over several days or even weeks would likely cool sentiment, let more bases form and give the market room for a longer run. But that hasn't been the market's pattern. ETFs Among growth ETFs, the iShares Expanded Tech-Software Sector ETF (IGV) fell 0.7%. The VanEck Vectors Semiconductor ETF (SMH) slumped 2%. Nvidia stock is the No. 1 holding in SMH. Reflecting more-speculative story stocks, ARK Innovation ETF (ARKK) edged up 0.2% and ARK Genomics ETF (ARKG) rose 0.3%. Tesla stock is a major holding across Ark Invest's ETFs. UiPath also is a big Cathie Wood stock. SPDR S&P Metals & Mining ETF (XME) edged higher, with FCX stock in the ETF. U.S. Global Jets ETF (JETS) ascended 0.7%. SPDR S&P Homebuilders ETF (XHB) stepped up 1.5%, with Lennar stock a key holding. The Energy Select SPDR ETF (XLE) rallied 1.6% and the Health Care Select Sector SPDR Fund (XLV) fell 0.4%. The Industrial Select Sector SPDR Fund (XLI) gained 0.3%. And the Financial Select SPDR ETF (XLF) climbed 0.7%. Time The Market With IBD's ETF Market Strategy Stocks In Buy Areas Freeport-McMoRan stock gapped up 7.6% to 43.41, Wednesday's top S&P 500 performer. The copper and gold miner broke above a double-bottom base buy point of 40.99, closing out of range. However, on a weekly chart, FCX stock just topped a 43.42 cup-with-handle buy point. Southern Copper (SCCO) and more-diversified Teck Resources (TECK) also cleared bases Wednesday. PBF Energy stock leapt 9% to 54.96, clearing a 54.52 cup-with-handle buy point. PBF stock is 16% above its 50-day line. Refining peer Phillips 66 (PSX) decisively cleared a short consolidation Wednesday, while several oil and gas machinery and services firms have been actionable. Shockwave Medical stock climbed 1.8% to 269.37, testing the top of a short consolidation following an earnings gap from the 200-day line. SWAV stock already was actionable from breaking a downtrend in this recent action, which could be viewed as a handle to a huge base. Dexcom stock fell 2.7% to 131.68, falling just below a 132.03 buy point from a flat base within a much larger consolidation. Royal Caribbean stock climbed 1.8% to 132.11, clearing a 130.97 buy point from a messy flat base. Meanwhile, rival cruise line operator Carnival (CCL) cleared an aggressive entry while hotel giant Marriott Worldwide (MAR) is trying to clear a tight pattern. Tesla Stock Tesla stock skidded 4.5% to 169.50, hitting the lowest levels since last May. Shares have tumbled nearly 32% in 2024, the worst performer on the S&P 500 index. The relative strength line is at a 14-month low, reflecting Tesla's severe underperformance vs. the S&P 500 index in recent months. The RS line is the blue line in the charts provided. Before Wednesday's open, Wells Fargo downgraded Tesla to underweight and cut its price target to 125 from 200. The analyst joined a recent rush to slash first-quarter delivery targets. He now sees 2024 earnings per share nearly a third below consensus. And he expects deliveries to fall short. Wells Fargo also said a yet-unveiled cheap EV may be not be a boon for Tesla, citing ""likely tough"" economics. Late Wednesday, UBS cut its Tesla price target to 165 from 225, also slashing its first-quarter delivery targets. TSLA stock fell a fraction overnight. Fisker (FSR) plunged more than 40% late Wednesday, on a report that the U.S. EV startup and would-be Tesla rival is preparing for a possible bankruptcy filing.",Financial,Fact Finding,Q&A You must rely only on information contained in the prompt/context block to formulate your answer. No outside sources of information can be relied on.,What role do loan commitments play in a bank's liquidity risk?,"Credit Risk For most banks, loans are the largest and most obvious source of credit risk. However, there are other pockets of credit risk both on and off the balance sheet, such as the investment portfolio, overdrafts, and letters of credit. Many products, activities, and services, such as derivatives, foreign exchange, and cash management services, also expose a bank to credit risk. The risk of repayment, i.e., the possibility that an obligor will fail to perform as agreed, is either lessened or increased by a bank’s credit risk management practices. A bank’s first defense against excessive credit risk is the initial credit-granting process − sound underwriting standards, an efficient, balanced Loan Portfolio Management 5 Comptroller’s Handbook approval process, and a competent lending staff. Because a bank cannot easily overcome borrowers with questionable capacity or character, these factors exert a strong influence on credit quality. Borrowers whose financial performance is poor or marginal, or whose repayment ability is dependent upon unproven projections can quickly become impaired by personal or external economic stress. Management of credit risk, however, must continue after a loan has been made, for sound initial credit decisions can be undermined by improper loan structuring or inadequate monitoring. Traditionally, banks have focused on oversight of individual loans in managing their overall credit risk. While this focus is important, banks should also view credit risk management in terms of portfolio segments and the entire portfolio. The focus on managing individual credit risk did not avert the credit crises of the 1980s. However, had the portfolio approach to risk management augmented these traditional risk management practices, banks might have at least reduced their losses. Effective management of the loan portfolio’s credit risk requires that the board and management understand and control the bank’s risk profile and its credit culture. To accomplish this, they must have a thorough knowledge of the portfolio’s composition and its inherent risks. They must understand the portfolio’s product mix, industry and geographic concentrations, average risk ratings, and other aggregate characteristics. They must be sure that the policies, processes, and practices implemented to control the risks of individual loans and portfolio segments are sound and that lending personnel adhere to them. Banks engaged in international lending face country risks that domestic lenders do not. Country risk encompasses all of the uncertainties arising from a nation’s economic, social, and political conditions that may affect the payment of foreigners’ debt and equity investments. Country risk includes the possibility of political and social upheaval, nationalization and expropriation of assets, governmental repudiation of external indebtedness, exchange controls, and currency devaluation or depreciation. Unless a nation repudiates its external debt, these developments might not make a loan uncollectible. However, even a delay in collection could weaken the lending bank. Loan Portfolio Management 6 Comptroller’s Handbook Transfer risk, which is a narrower form of country risk, is the possibility that an obligor will not be able to pay because the currency of payment is unavailable. This unavailability may be a matter of government policy. For example, although an individual borrower may be very successful and have sufficient local currency cash flow to pay its foreign (e.g., U.S. dollar) debt, the borrower’s country may not have sufficient U.S. dollars available to permit repayment of the foreign indebtedness. The transfer risk associated with banks’ exposures in foreign countries is evaluated by the Interagency Country Exposure Review Committee (ICERC). For examination purposes, the transfer risk rating assigned to a country by the ICERC applies to all bank assets in that country. However, examiners may classify individual loans and other assets more severely for credit risk reasons. Strategies for managing country risk will be discussed in “Country Risk Management,” a separate booklet in the Comptroller’s Handbook. Interest Rate Risk The level of interest rate risk attributed to the bank’s lending activities depends on the composition of its loan portfolio and the degree to which the terms of its loans (e.g., maturity, rate structure, embedded options) expose the bank’s revenue stream to changes in rates. Pricing and portfolio maturity decisions should be made with an eye to funding costs and maturities. When significant individual credits or portfolio segments are especially sensitive to interest rate risk, they should be periodically stress-tested. If the asset/liability management committee (ALCO), which typically is responsible for managing the bank’s interest rate risk, is to manage all of the bank’s positions, it must have sufficient reports on loan portfolio and pipeline composition and trends. These reports might include a maturing loans report, pipeline report, and rate and repricing report. Banks frequently shift interest rate risk to their borrowers by structuring loans with variable interest rates. Borrowers with marginal repayment capacity may experience financial difficulty if the interest rates on these loans increase. As part of the risk management process, banks should identify borrowers whose loans have heightened sensitivity to interest rate changes Loan Portfolio Management 7 Comptroller’s Handbook and develop strategies to mitigate the risk. One method is to require vulnerable borrowers to purchase interest rate protection or otherwise hedge the risk. The Comptroller’s Handbook booklet “Interest Rate Risk” provides guidance on interest rate risk management. Liquidity Risk Because of the size of the loan portfolio, effective management of liquidity risk requires that there be close ties to, and good information flow from, the lending function. Obviously, loans are a primary use of funds. And while controlling loan growth has always been a large part of liquidity management, historically the loan portfolio has not been viewed as a significant source of funds for liquidity management. Practices are changing, however. Banks can use the loan portfolio as a source of funds by reducing the total dollar volume of loans through sales, securitization, and portfolio run-off. In fact, banks are taking a more active role in managing their loan portfolios. While these activities are often initiated to manage credit risk, they have also improved liquidity. Banks increasingly are originating loans “for sale” or securitization. Consumer loans (mortgages, instalment loans, and credit cards) are routinely originated for immediate securitization. Many larger banks have been expanding their underwriting for the syndicated loan market. Additionally, banks are also expanding the packaging and sale of distressed credits and otherwise undesirable loans. As part of liquidity planning, a bank’s overall liquidity strategy should include the identification of those loans or loan portfolio segments that may be easily converted to cash. A loan’s liquidity hinges on such characteristics as its quality, pricing, scheduled maturities, and conformity to market standards for underwriting. Loans are also a source of liquidity when used as collateral for borrowings. The ease with which a bank can participate or sell loans to other lenders or investors (and the terms on which the bank can do so) will vary with market conditions, the type of loan, and the quality of loan. Information provided for liquidity analysis should include an assessment of these variables under various scenarios. Loan Portfolio Management 8 Comptroller’s Handbook Liquidity is also affected by the amount of the bank’s commitments to lend and the actual amount that borrowers draw against those commitments. A bank should have systems to track commitments and borrower usage. Knowledge of the types of commitments, deals in the pipeline, normal usage levels, and historically high usage levels are important in assessing whether available liquidity will be adequate for normal, seasonal, or emergency needs. Management information systems should distinguish between commitments that the bank is legally obligated to fund and those (guidance or advisory lines) that it is not. Any analysis of a bank’s ability to reduce or cut existing commitments must consider more than its legal obligation to lend. It should also consider reputation risk and the potential for lender-liability actions. The withdrawal or reduction of commitments can have significant ramifications for a bank. From a strategic perspective, any tightening of commitments may adversely affect a bank’s ability to maintain or grow a customer base if it is perceived as an unreliable lender in tight credit markets. A bank’s reputation may also suffer if it is perceived as unwilling to support community credit needs. Given these ancillary risks, bank management must carefully assess the implications of curtailing lending lines. ","You must rely only on information contained in the prompt/context block to formulate your answer. No outside sources of information can be relied on. Credit Risk For most banks, loans are the largest and most obvious source of credit risk. However, there are other pockets of credit risk both on and off the balance sheet, such as the investment portfolio, overdrafts, and letters of credit. Many products, activities, and services, such as derivatives, foreign exchange, and cash management services, also expose a bank to credit risk. The risk of repayment, i.e., the possibility that an obligor will fail to perform as agreed, is either lessened or increased by a bank’s credit risk management practices. A bank’s first defense against excessive credit risk is the initial credit-granting process − sound underwriting standards, an efficient, balanced Loan Portfolio Management 5 Comptroller’s Handbook approval process, and a competent lending staff. Because a bank cannot easily overcome borrowers with questionable capacity or character, these factors exert a strong influence on credit quality. Borrowers whose financial performance is poor or marginal, or whose repayment ability is dependent upon unproven projections can quickly become impaired by personal or external economic stress. Management of credit risk, however, must continue after a loan has been made, for sound initial credit decisions can be undermined by improper loan structuring or inadequate monitoring. Traditionally, banks have focused on oversight of individual loans in managing their overall credit risk. While this focus is important, banks should also view credit risk management in terms of portfolio segments and the entire portfolio. The focus on managing individual credit risk did not avert the credit crises of the 1980s. However, had the portfolio approach to risk management augmented these traditional risk management practices, banks might have at least reduced their losses. Effective management of the loan portfolio’s credit risk requires that the board and management understand and control the bank’s risk profile and its credit culture. To accomplish this, they must have a thorough knowledge of the portfolio’s composition and its inherent risks. They must understand the portfolio’s product mix, industry and geographic concentrations, average risk ratings, and other aggregate characteristics. They must be sure that the policies, processes, and practices implemented to control the risks of individual loans and portfolio segments are sound and that lending personnel adhere to them. Banks engaged in international lending face country risks that domestic lenders do not. Country risk encompasses all of the uncertainties arising from a nation’s economic, social, and political conditions that may affect the payment of foreigners’ debt and equity investments. Country risk includes the possibility of political and social upheaval, nationalization and expropriation of assets, governmental repudiation of external indebtedness, exchange controls, and currency devaluation or depreciation. Unless a nation repudiates its external debt, these developments might not make a loan uncollectible. However, even a delay in collection could weaken the lending bank. Loan Portfolio Management 6 Comptroller’s Handbook Transfer risk, which is a narrower form of country risk, is the possibility that an obligor will not be able to pay because the currency of payment is unavailable. This unavailability may be a matter of government policy. For example, although an individual borrower may be very successful and have sufficient local currency cash flow to pay its foreign (e.g., U.S. dollar) debt, the borrower’s country may not have sufficient U.S. dollars available to permit repayment of the foreign indebtedness. The transfer risk associated with banks’ exposures in foreign countries is evaluated by the Interagency Country Exposure Review Committee (ICERC). For examination purposes, the transfer risk rating assigned to a country by the ICERC applies to all bank assets in that country. However, examiners may classify individual loans and other assets more severely for credit risk reasons. Strategies for managing country risk will be discussed in “Country Risk Management,” a separate booklet in the Comptroller’s Handbook. Interest Rate Risk The level of interest rate risk attributed to the bank’s lending activities depends on the composition of its loan portfolio and the degree to which the terms of its loans (e.g., maturity, rate structure, embedded options) expose the bank’s revenue stream to changes in rates. Pricing and portfolio maturity decisions should be made with an eye to funding costs and maturities. When significant individual credits or portfolio segments are especially sensitive to interest rate risk, they should be periodically stress-tested. If the asset/liability management committee (ALCO), which typically is responsible for managing the bank’s interest rate risk, is to manage all of the bank’s positions, it must have sufficient reports on loan portfolio and pipeline composition and trends. These reports might include a maturing loans report, pipeline report, and rate and repricing report. Banks frequently shift interest rate risk to their borrowers by structuring loans with variable interest rates. Borrowers with marginal repayment capacity may experience financial difficulty if the interest rates on these loans increase. As part of the risk management process, banks should identify borrowers whose loans have heightened sensitivity to interest rate changes Loan Portfolio Management 7 Comptroller’s Handbook and develop strategies to mitigate the risk. One method is to require vulnerable borrowers to purchase interest rate protection or otherwise hedge the risk. The Comptroller’s Handbook booklet “Interest Rate Risk” provides guidance on interest rate risk management. Liquidity Risk Because of the size of the loan portfolio, effective management of liquidity risk requires that there be close ties to, and good information flow from, the lending function. Obviously, loans are a primary use of funds. And while controlling loan growth has always been a large part of liquidity management, historically the loan portfolio has not been viewed as a significant source of funds for liquidity management. Practices are changing, however. Banks can use the loan portfolio as a source of funds by reducing the total dollar volume of loans through sales, securitization, and portfolio run-off. In fact, banks are taking a more active role in managing their loan portfolios. While these activities are often initiated to manage credit risk, they have also improved liquidity. Banks increasingly are originating loans “for sale” or securitization. Consumer loans (mortgages, instalment loans, and credit cards) are routinely originated for immediate securitization. Many larger banks have been expanding their underwriting for the syndicated loan market. Additionally, banks are also expanding the packaging and sale of distressed credits and otherwise undesirable loans. As part of liquidity planning, a bank’s overall liquidity strategy should include the identification of those loans or loan portfolio segments that may be easily converted to cash. A loan’s liquidity hinges on such characteristics as its quality, pricing, scheduled maturities, and conformity to market standards for underwriting. Loans are also a source of liquidity when used as collateral for borrowings. The ease with which a bank can participate or sell loans to other lenders or investors (and the terms on which the bank can do so) will vary with market conditions, the type of loan, and the quality of loan. Information provided for liquidity analysis should include an assessment of these variables under various scenarios. Loan Portfolio Management 8 Comptroller’s Handbook Liquidity is also affected by the amount of the bank’s commitments to lend and the actual amount that borrowers draw against those commitments. A bank should have systems to track commitments and borrower usage. Knowledge of the types of commitments, deals in the pipeline, normal usage levels, and historically high usage levels are important in assessing whether available liquidity will be adequate for normal, seasonal, or emergency needs. Management information systems should distinguish between commitments that the bank is legally obligated to fund and those (guidance or advisory lines) that it is not. Any analysis of a bank’s ability to reduce or cut existing commitments must consider more than its legal obligation to lend. It should also consider reputation risk and the potential for lender-liability actions. The withdrawal or reduction of commitments can have significant ramifications for a bank. From a strategic perspective, any tightening of commitments may adversely affect a bank’s ability to maintain or grow a customer base if it is perceived as an unreliable lender in tight credit markets. A bank’s reputation may also suffer if it is perceived as unwilling to support community credit needs. Given these ancillary risks, bank management must carefully assess the implications of curtailing lending lines. What role do loan commitments play in a bank's liquidity risk?",Financial,Fact Finding,Q&A I want to only be given information based on the context provided. The answer should be within 60-70 words in length.,Can you summarize how the AICOA could help big companies?,"The primary concern with this type of conduct involves monopoly leveraging.542 As discussed, leveraging theories of harm can take two forms. Offensive leveraging occurs when a firm attempts to use monopoly power in a primary market to extract additional profits from a secondary market.543 By contrast, defensive leveraging involves the use of monopoly power to gain an advantage in a secondary market so as to preserve a primary market monopoly—for example, by eliminating competitive threats that might emerge from the secondary market.544 Defensive leveraging may be a viable theory of harm under existing monopolization law.545 Offensive-leveraging claims, however, cannot succeed under Section 2 absent evidence that a defendant had a dangerous probability of monopolizing a secondary market; mere harm to competition in the secondary market is not sufficient.546 For some of the self-preferencing allegations against Big Tech firms, these limitations may preclude antitrust claims.547 It may be unlikely, for example, that Amazon will achieve monopoly power over most of the products that it sells on its marketplace. As a result, it would be difficult to challenge the preferential display of those products under an offensive-leveraging theory.548 This type of alleged favoritism may also be a weak foundation for a defensive-leveraging or monopoly-maintenance case; it is not clear that Amazon’s elevation of allegedly inferior products would help it maintain a putative e-commerce monopoly. Similarly, the case law governing refusals to deal may serve as an impediment to antitrust claims challenging platform self-preferencing. A platform operator’s favorable treatment of its own verticals relative to rivals that use its platform is typically less harmful to rivals than an outright refusal of access.549 Because antitrust imposes access duties only in a narrow set of circumstances, courts would likely find many forms of self-preferencing to be permissible if such conduct is evaluated as a refusal to deal.550 In the 118th Congress, the American Innovation and Choice Online Act (AICOA) would respond to these doctrinal difficulties by prohibiting covered platform operators from preferencing their own products and services “in a manner that would materially harm competition.”551 Given the ubiquity of self-preferencing by vertically integrated firms, the meaning of the “materially harm competition” standard is key to assessing the prohibition’s scope. However, many argue the meaning of that language is not clear.552 The bill does not by its terms clarify whether the “materially harm competition” standard embodies a consumer-welfare test or one of the alternative standards for assessing competitive harm urged by proponents of antitrust reform.553 As a result, it is unclear whether the AICOA would permit defendants to justify challenged conduct on the ground that it benefits consumers. If the AICOA becomes law, this may be a dispositive issue in many litigated cases. A wide range of platform self-preferencing may harm a firm’s rivals while also offering consumer benefits. For example, when Google displays a Google Maps result in response to a search query, it may disadvantage rival map services, but benefit consumers.554 Apple’s preinstallation of its own apps on iPhones, Microsoft’s inclusion of certain apps with its Windows operating system, and Amazon’s free provision of its video-streaming service to Amazon Prime members may have similar effects.555 It is not clear how the “materially harm competition” standard would apply to such practices. In cases that do not involve per se offenses, Sherman Act defendants typically have the opportunity to defend challenged conduct on the ground that it benefits consumers.556 To the extent that the “materially harm competition” standard is intended to incorporate prevailing concepts of competitive harm from the antitrust case law, then, consumer-welfare arguments would likely be cognizable In interpreting other industry-specific competition statutes, however, some courts and commentators have taken the view that “harm to competition” encompasses types of harm beyond those proscribed by the antitrust laws.557 Additionally, some of the AICOA’s proponents have rejected suggestions to amend the bill to adopt a consumer-welfare test.558 An interpretation that eschewed consumer-welfare justifications would also be consistent with the normative vision articulated by many advocates of antitrust reform. As discussed, the role that consumer welfare is meant to play in non-welfarist conceptions of “competition” is not clear.559 Much of the reformist literature, though, appears to reject the idea that courts and enforcers should balance different antitrust goals against one another.560 This context, along with the bill’s omission of other traditional antitrust concepts like market power, may cut against the argument that consumer-welfare arguments would be cognizable under the “materially harm competition” standard.561 The DCPCA appears to be more explicit about this issue. That legislation would make it presumptively unlawful for covered platforms to preference their own products and services, “regardless of any alleged procompetitive benefits or efficiencies.”562 Defendants could rebut an allegation of unlawful self-preferencing only by establishing by clear and convincing evidence that their conduct “did not result in any harm to the relevant aggrieved party.”563","The primary concern with this type of conduct involves monopoly leveraging.542 As discussed, leveraging theories of harm can take two forms. Offensive leveraging occurs when a firm attempts to use monopoly power in a primary market to extract additional profits from a secondary market.543 By contrast, defensive leveraging involves the use of monopoly power to gain an advantage in a secondary market so as to preserve a primary market monopoly—for example, by eliminating competitive threats that might emerge from the secondary market.544 Defensive leveraging may be a viable theory of harm under existing monopolization law.545 Offensive-leveraging claims, however, cannot succeed under Section 2 absent evidence that a defendant had a dangerous probability of monopolizing a secondary market; mere harm to competition in the secondary market is not sufficient.546 For some of the self-preferencing allegations against Big Tech firms, these limitations may preclude antitrust claims.547 It may be unlikely, for example, that Amazon will achieve monopoly power over most of the products that it sells on its marketplace. As a result, it would be difficult to challenge the preferential display of those products under an offensive-leveraging theory.548 This type of alleged favoritism may also be a weak foundation for a defensive-leveraging or monopoly-maintenance case; it is not clear that Amazon’s elevation of allegedly inferior products would help it maintain a putative e-commerce monopoly. Similarly, the case law governing refusals to deal may serve as an impediment to antitrust claims challenging platform self-preferencing. A platform operator’s favorable treatment of its own verticals relative to rivals that use its platform is typically less harmful to rivals than an outright refusal of access.549 Because antitrust imposes access duties only in a narrow set of circumstances, courts would likely find many forms of self-preferencing to be permissible if such conduct is evaluated as a refusal to deal.550 In the 118th Congress, the American Innovation and Choice Online Act (AICOA) would respond to these doctrinal difficulties by prohibiting covered platform operators from preferencing their own products and services “in a manner that would materially harm competition.”551 Given the ubiquity of self-preferencing by vertically integrated firms, the meaning of the “materially harm competition” standard is key to assessing the prohibition’s scope. However, many argue the meaning of that language is not clear.552 The bill does not by its terms clarify whether the “materially harm competition” standard embodies a consumer-welfare test or one of the alternative standards for assessing competitive harm urged by proponents of antitrust reform.553 As a result, it is unclear whether the AICOA would permit defendants to justify challenged conduct on the ground that it benefits consumers. If the AICOA becomes law, this may be a dispositive issue in many litigated cases. A wide range of platform self-preferencing may harm a firm’s rivals while also offering consumer benefits. For example, when Google displays a Google Maps result in response to a search query, it may disadvantage rival map services, but benefit consumers.554 Apple’s preinstallation of its own apps on iPhones, Microsoft’s inclusion of certain apps with its Windows operating system, and Amazon’s free provision of its video-streaming service to Amazon Prime members may have similar effects.555 It is not clear how the “materially harm competition” standard would apply to such practices. In cases that do not involve per se offenses, Sherman Act defendants typically have the opportunity to defend challenged conduct on the ground that it benefits consumers.556 To the extent that the “materially harm competition” standard is intended to incorporate prevailing concepts of competitive harm from the antitrust case law, then, consumer-welfare arguments would likely be cognizable In interpreting other industry-specific competition statutes, however, some courts and commentators have taken the view that “harm to competition” encompasses types of harm beyond those proscribed by the antitrust laws.557 Additionally, some of the AICOA’s proponents have rejected suggestions to amend the bill to adopt a consumer-welfare test.558 An interpretation that eschewed consumer-welfare justifications would also be consistent with the normative vision articulated by many advocates of antitrust reform. As discussed, the role that consumer welfare is meant to play in non-welfarist conceptions of “competition” is not clear.559 Much of the reformist literature, though, appears to reject the idea that courts and enforcers should balance different antitrust goals against one another.560 This context, along with the bill’s omission of other traditional antitrust concepts like market power, may cut against the argument that consumer-welfare arguments would be cognizable under the “materially harm competition” standard.561 The DCPCA appears to be more explicit about this issue. That legislation would make it presumptively unlawful for covered platforms to preference their own products and services, “regardless of any alleged procompetitive benefits or efficiencies.”562 Defendants could rebut an allegation of unlawful self-preferencing only by establishing by clear and convincing evidence that their conduct “did not result in any harm to the relevant aggrieved party.”563 Can you summarize how the AICOA could help big companies? I want to only be given information based on the context provided. The answer should be within 60-70 words in length.",Retail/Product,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Hey I have a nintendo switch and thought about getting the OLED version. Hwoever, I hear the new switch is coming out pretty soon. But I thought it was releasing in 2024. Why are they pushing it to 2025? Also what will it look like and will I still be able to play my current games? Give me more than 300 words.","Nintendo Switch 2: Everything We Know About the New Console Nintendo’s new console is most likely arriving in 2025. Sarah Thwaites Avatar By Sarah Thwaites Updated: May 21, 2024 3:26 pm Posted: Apr 26, 2024 2:30 pm It’s been over six years since the Nintendo Switch launched in 2017, and after a long and successful reign, you may be wondering what new piece of hardware will be next. We’ve seen updates to the current switch with the OLED and Lite models, though we’re still in the dark on what Nintendo’s next-gen offering could be. After becoming the 3rd best-selling console in history this year, it’s fair to say that Nintendo might want to keep things close to its chest. Yet, even with all the secrecy surrounding the possibility of a new Nintendo Switch, we’ve collected all the details we could find about the mystery follow-up ahead of its eventual official announcement and release. Nintendo Switch 2 Release Date - Latest News While Nintendo hasn’t yet announced any official follow-up to their incredibly successful Nintendo Switch console, there are enough rumors swirling about to make us believe that the next Nintendo console will arrive sometime in 2025 rather than 2024. In February 2024, the Japanese publication Nikkei suggested that the proposed Nintendo Switch 2 would launch in March 2025 at the earliest, contradicting previous reports. While the article covered information we’ve heard before, like the proposed iterative design scheme, Nikkei did add that the 2025 date was likely due to the company stockpiling consoles to avoid scalping at launch. As any long-term Nintendo fan knows, procuring one of the company’s new consoles can be tricky business. Those who tried will remember how difficult it was to secure a Nintendo Switch at launch in 2017, with the console suffering from inflated pricing on the aftermarket due to crafty resellers. Adding to the intrigue about a potential date change, it looks like Nintendo won’t be exhibiting at this year’s Gamescom, an annual trade fair held in Cologne, Germany. As reported by GamesIndustry.biz, a representative of Nintendo of Europe issued a statement to the German outlet Games Wirtschaft, confirming the news. The statement reads, ""Gamescom is a central event in Nintendo's event calendar. This year, however, after careful consideration, we decided against taking part in Cologne. Instead, players can try out the games for Nintendo Switch as part of other Germany-wide events."" This decision, while not unprecedented for major players - PlayStation also missed the event in 2022 and 2023 - does raise the question of what we can expect from Nintendo in the latter half of 2024. Could this be a sign of a major announcement coming or a strategic shift in their marketing approach? Only time will tell. Nintendo’s president, Shuntaro Furukawa, confirmed in an interview with Nikkei, and translated by VGC, that Nintendo will support the current-gen Switch until at least March 2025. This sentiment is also backed up by previous comments Furukawa made regarding the future of the Nintendo Switch in a financial briefing Q&A in 2022. In this interview, he committed to focusing on “building long-term relationships with our consumers (through Nintendo Accounts),"" he went on to reiterate "", While continuing to release new Nintendo Switch software for consumers to enjoy, we aim to maintain relationships across hardware generations through services that utilize Nintendo Accounts and by providing opportunities for them to experience our IP through other non-gaming channels."" Even with all the juicy gossip, it’s best not to hold your breath on what’s coming from the Japanese tech titan’s next console until there is an official announcement; fingers crossed we’ll get that confirmation soon. Nintendo Switch 2 Price There are plenty of Nintendo Switch models to consider while shopping right now, with pricing shifting dramatically depending on the version you’re looking to invest in. Looking forward to a potential Switch 2, inflation and internal specs, amongst other variables, will likely play a part in what we’ll pay for a new console at launch. It’s hard to know what the pricing of this mystery device will be, but we’ve listed the RRP of the current range of Nintendo Switch models as a reference: Nintendo Switch Lite: $199.99 Nintendo Switch: $299.99 Nintendo Switch OLED: $349.99 Nintendo Switch 2 Models With the range of Nintendo Switch consoles currently on the market, you may be left wondering if you’ll have the same number of choices to pick between when the next iteration rolls around. The latest Nintendo Switch OLED model features a remarkable screen, and it feels like the future of the console, it being the most recent edition to Nintendo’s lineup. However, according to a VGC report, the next-gen Nintendo Switch may potentially feature an LCD screen instead. The current array of Nintendo Switch models are numerous and were released over the console’s multi-year lifespan, so it’s reasonable to believe there may be several versions of a potential Nintendo Switch follow-up, too. Nintendo Switch Design - What Will the Nintendo Switch 2 Look Like? There isn’t a lot of information on how Nintendo’s next-gen console will look, though there are plenty of features in the current-gen Nintendo Switch we’d love to see return for a follow-up console. VGC reported that development kits for the potential new console are already with partner studios, with sources citing some returning features. According to VGC’s report, the new Nintendo Switch could keep the portability of its predecessor and feature a cartridge slot for physical games. In May 2023, a patent was filed with the United States Patent Office and published in September, which suggests a potential revamped Joy-Con controller that would hopefully help with the notorious Joy-Con drift issue associated with the Nintendo Switch. The patent details a magnetic field for controls rather than the plastic circuit boards seen in the current generation console. However, it’s worth mentioning that patents don’t necessarily translate directly to future products, so there’s no guarantee on whether the Nintendo Switch 2 will feature updated Joy-Cons, and we’ll have to wait for official word from Nintendo on that front. Will the Nintendo Switch 2 be Backwards Compatible? As rumors swirl about the possibility of a Nintendo Switch 2, the question of backwards compatibility is naturally on everyone's lips. In the absence of any official reveals, there isn’t much to go on at this time. However, in a recent interview with Inverse, the aptly named Nintendo of America president, Doug Bowser, alluded to the future of the brand’s approach to software. While Bowser opted to deny commenting on anything related to the rumored console, he did talk about the Nintendo Account system that players’ digital libraries are currently tied to on the Nintendo Switch. “In the past, every device we transitioned to had a whole new account system. Creating the Nintendo Account will allow us to communicate with our players if and when we make a transition to a new platform, to help ease that process or transition.” This dedication to the Nintendo Account model could suggest that all of our favorite Nintendo Switch games may work on the company’s next console whenever it lands. Regardless, given the precious little that we know right now, we’ll have to take this information with a pinch of salt and not get ahead of ourselves. As it stands now, it is unclear whether or not Nintendo Switch accessories will be compatible with the new model either. It's possible that all of your Nintendo Switch controllers will work with the new console, but we don't yet know.","[question] Hey I have a nintendo switch and thought about getting the OLED version. Hwoever, I hear the new switch is coming out pretty soon. But I thought it was releasing in 2024. Why are they pushing it to 2025? Also what will it look like and will I still be able to play my current games? Give me more than 300 words. ===================== [text] Nintendo Switch 2: Everything We Know About the New Console Nintendo’s new console is most likely arriving in 2025. Sarah Thwaites Avatar By Sarah Thwaites Updated: May 21, 2024 3:26 pm Posted: Apr 26, 2024 2:30 pm It’s been over six years since the Nintendo Switch launched in 2017, and after a long and successful reign, you may be wondering what new piece of hardware will be next. We’ve seen updates to the current switch with the OLED and Lite models, though we’re still in the dark on what Nintendo’s next-gen offering could be. After becoming the 3rd best-selling console in history this year, it’s fair to say that Nintendo might want to keep things close to its chest. Yet, even with all the secrecy surrounding the possibility of a new Nintendo Switch, we’ve collected all the details we could find about the mystery follow-up ahead of its eventual official announcement and release. Nintendo Switch 2 Release Date - Latest News While Nintendo hasn’t yet announced any official follow-up to their incredibly successful Nintendo Switch console, there are enough rumors swirling about to make us believe that the next Nintendo console will arrive sometime in 2025 rather than 2024. In February 2024, the Japanese publication Nikkei suggested that the proposed Nintendo Switch 2 would launch in March 2025 at the earliest, contradicting previous reports. While the article covered information we’ve heard before, like the proposed iterative design scheme, Nikkei did add that the 2025 date was likely due to the company stockpiling consoles to avoid scalping at launch. As any long-term Nintendo fan knows, procuring one of the company’s new consoles can be tricky business. Those who tried will remember how difficult it was to secure a Nintendo Switch at launch in 2017, with the console suffering from inflated pricing on the aftermarket due to crafty resellers. Adding to the intrigue about a potential date change, it looks like Nintendo won’t be exhibiting at this year’s Gamescom, an annual trade fair held in Cologne, Germany. As reported by GamesIndustry.biz, a representative of Nintendo of Europe issued a statement to the German outlet Games Wirtschaft, confirming the news. The statement reads, ""Gamescom is a central event in Nintendo's event calendar. This year, however, after careful consideration, we decided against taking part in Cologne. Instead, players can try out the games for Nintendo Switch as part of other Germany-wide events."" This decision, while not unprecedented for major players - PlayStation also missed the event in 2022 and 2023 - does raise the question of what we can expect from Nintendo in the latter half of 2024. Could this be a sign of a major announcement coming or a strategic shift in their marketing approach? Only time will tell. Nintendo’s president, Shuntaro Furukawa, confirmed in an interview with Nikkei, and translated by VGC, that Nintendo will support the current-gen Switch until at least March 2025. This sentiment is also backed up by previous comments Furukawa made regarding the future of the Nintendo Switch in a financial briefing Q&A in 2022. In this interview, he committed to focusing on “building long-term relationships with our consumers (through Nintendo Accounts),"" he went on to reiterate "", While continuing to release new Nintendo Switch software for consumers to enjoy, we aim to maintain relationships across hardware generations through services that utilize Nintendo Accounts and by providing opportunities for them to experience our IP through other non-gaming channels."" Even with all the juicy gossip, it’s best not to hold your breath on what’s coming from the Japanese tech titan’s next console until there is an official announcement; fingers crossed we’ll get that confirmation soon. Nintendo Switch 2 Price There are plenty of Nintendo Switch models to consider while shopping right now, with pricing shifting dramatically depending on the version you’re looking to invest in. Looking forward to a potential Switch 2, inflation and internal specs, amongst other variables, will likely play a part in what we’ll pay for a new console at launch. It’s hard to know what the pricing of this mystery device will be, but we’ve listed the RRP of the current range of Nintendo Switch models as a reference: Nintendo Switch Lite: $199.99 Nintendo Switch: $299.99 Nintendo Switch OLED: $349.99 Nintendo Switch 2 Models With the range of Nintendo Switch consoles currently on the market, you may be left wondering if you’ll have the same number of choices to pick between when the next iteration rolls around. The latest Nintendo Switch OLED model features a remarkable screen, and it feels like the future of the console, it being the most recent edition to Nintendo’s lineup. However, according to a VGC report, the next-gen Nintendo Switch may potentially feature an LCD screen instead. The current array of Nintendo Switch models are numerous and were released over the console’s multi-year lifespan, so it’s reasonable to believe there may be several versions of a potential Nintendo Switch follow-up, too. Nintendo Switch Design - What Will the Nintendo Switch 2 Look Like? There isn’t a lot of information on how Nintendo’s next-gen console will look, though there are plenty of features in the current-gen Nintendo Switch we’d love to see return for a follow-up console. VGC reported that development kits for the potential new console are already with partner studios, with sources citing some returning features. According to VGC’s report, the new Nintendo Switch could keep the portability of its predecessor and feature a cartridge slot for physical games. In May 2023, a patent was filed with the United States Patent Office and published in September, which suggests a potential revamped Joy-Con controller that would hopefully help with the notorious Joy-Con drift issue associated with the Nintendo Switch. The patent details a magnetic field for controls rather than the plastic circuit boards seen in the current generation console. However, it’s worth mentioning that patents don’t necessarily translate directly to future products, so there’s no guarantee on whether the Nintendo Switch 2 will feature updated Joy-Cons, and we’ll have to wait for official word from Nintendo on that front. Will the Nintendo Switch 2 be Backwards Compatible? As rumors swirl about the possibility of a Nintendo Switch 2, the question of backwards compatibility is naturally on everyone's lips. In the absence of any official reveals, there isn’t much to go on at this time. However, in a recent interview with Inverse, the aptly named Nintendo of America president, Doug Bowser, alluded to the future of the brand’s approach to software. While Bowser opted to deny commenting on anything related to the rumored console, he did talk about the Nintendo Account system that players’ digital libraries are currently tied to on the Nintendo Switch. “In the past, every device we transitioned to had a whole new account system. Creating the Nintendo Account will allow us to communicate with our players if and when we make a transition to a new platform, to help ease that process or transition.” This dedication to the Nintendo Account model could suggest that all of our favorite Nintendo Switch games may work on the company’s next console whenever it lands. Regardless, given the precious little that we know right now, we’ll have to take this information with a pinch of salt and not get ahead of ourselves. As it stands now, it is unclear whether or not Nintendo Switch accessories will be compatible with the new model either. It's possible that all of your Nintendo Switch controllers will work with the new console, but we don't yet know. https://www.ign.com/articles/nintendo-switch-2-everything-we-know ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Retail/Product,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",What are the key differences between macronutrients and micronutrients in terms of their functions and the amounts required by the body and how they contribute to overall health? Explain in deep details in not more than 300 words.,"What are the nutrients? The foods we eat contain nutrients. Nutrients are substances required by the body to perform its basic functions. Nutrients must be obtained from our diet since the human body can not make them. Nutrients have one or more of three basic functions: they provide energy, contribute to body structure, and/or regulate chemical processes in the body. These basic functions allow us to detect and respond to environmental surroundings, move, excrete wastes, breathe, grow, and reproduce. There are six classes of nutrients required for the body to function and maintain overall health. These are carbohydrates, lipids, proteins, water, vitamins, and minerals. Foods also contain non-nutrient that may be harmful such as natural toxins common in plant foods and additives like some dyes and preservatives or beneficial like antioxidants. macronutrients Nutrients that are needed in large amounts are called macronutrients. There are three classes of macronutrients: carbohydrates, lipids, and proteins. These can be metabolically processed into cellular energy. The energy from macronutrients comes from their chemical bonds. This chemical energy is converted into cellular energy used to perform work, allowing our bodies to conduct their basic functions. A unit of measurement of food energy is the calorie. On nutrition food labels, the amount given for “calories” is actually equivalent to each calorie multiplied by one thousand. A kilocalorie (Calorie) is the amount of heat generated by a particular macronutrient that raises the temperature of 1 kilogram of water 1 degree Celsius. On the Nutrition Facts panel, the calories within a particular food are expressed as kilocalories, which is commonly denoted as “Calories” with a capital “C” (1 kcal = 1 Calorie = 1,000 calories). Water is also a macronutrient in the sense that you require a large amount of it, but unlike the other macronutrients, it does not provide calories. carbohydrates Carbohydrates are molecules composed of carbon, hydrogen, and oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy vegetables, like potatoes. Non-starchy vegetables also contain carbohydrates but in lesser quantities. Carbohydrates are broadly classified into two forms based on their chemical structure: simple carbohydrates, simple sugars, and complex carbohydrates. Simple carbohydrates consist of one or two basic units. Examples of simple sugars include sucrose, the type of sugar you would have in a bowl on the breakfast table, and glucose, the type of sugar that circulates in your blood. Complex carbohydrates are long chains of simple sugars that can be unbranched or branched. During digestion, the body breaks down digestible complex carbohydrates into simple sugars, mostly glucose. Glucose is then transported to all our cells, stored, used to make energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but digestive enzymes cannot break it down in the human intestine. As a result, it passes through the digestive tract undigested unless the bacteria that inhabit the colon or large intestine break it down. One gram of digestible carbohydrates yields four kilocalories of energy for the body’s cells to perform work. Besides providing energy and serving as building blocks for bigger macromolecules, carbohydrates are essential for the nervous system’s proper functioning, heart, and kidneys. As mentioned, glucose can be stored in the body for future use. In humans, the storage molecule of carbohydrates is called glycogen, and in plants, it is known as starch. Glycogen and starch are complex carbohydrates. protein Proteins are macromolecules composed of chains of subunits called amino acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and nitrogen. Food sources of proteins include meats, dairy products, seafood, and various plant-based foods, most notably soy. The word protein comes from a Greek word meaning “of primary importance,” which is an apt description of these macronutrients; they are also known colloquially as the “workhorses” of life. Proteins provide four kilocalories of energy per gram; however, providing energy is not protein’s most important function. Proteins provide structure to bones, muscles, and skin and play a role in conducting most of the chemical reactions that take place in the body. Scientists estimate that greater than one-hundred thousand different proteins exist within the human body. The genetic codes in DNA are basically protein recipes that determine the order in which 20 different amino acids are bound together to make thousands of specific proteins. lipids Lipids are also a family of molecules composed of carbon, hydrogen, and oxygen, but they are insoluble in water, unlike carbohydrates. Lipids are found predominantly in butter, oils, meats, dairy products, nuts, seeds, and processed foods. The three main types of lipids are triglycerides (triacylglycerols), phospholipids, and sterols. The main job of lipids is to provide or store energy. Lipids provide more energy per gram than carbohydrates (nine kilocalories per gram of lipids versus four kilocalories per gram of carbohydrates). In addition to energy storage, lipids serve as a major component of cell membranes, surround and protect organs (in fat-storing tissues), provide insulation to aid in temperature regulation, and regulate many other body functions. water There is one other nutrient that we must have in large quantities: water. Water does not contain carbon but is composed of two hydrogens and one oxygen per molecule of water. More than 60 percent of your total body weight is water. Without it, nothing could be transported in or out of the body, chemical reactions would not occur, organs would not be cushioned, and body temperature would fluctuate widely. On average, an adult consumes just over two liters of water per day from food and drink combined. Since water is so critical for life’s basic processes, the amount of water input and output is significant, a topic we will explore in detail micronutrients Micronutrients are nutrients required by the body in lesser amounts but are still essential for carrying out bodily functions. Micronutrients include all the essential minerals and vitamins. There are sixteen essential minerals and thirteen vitamins. In contrast to carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories), but they assist in the process as cofactors or components of enzymes (i.e., coenzymes). Enzymes are proteins that catalyze chemical reactions in the body and are involved in all aspects of body functions, from producing energy to digesting nutrients to building macromolecules. Micronutrients play many essential roles in the body.","""================ ======= What are the nutrients? The foods we eat contain nutrients. Nutrients are substances required by the body to perform its basic functions. Nutrients must be obtained from our diet since the human body can not make them. Nutrients have one or more of three basic functions: they provide energy, contribute to body structure, and/or regulate chemical processes in the body. These basic functions allow us to detect and respond to environmental surroundings, move, excrete wastes, breathe, grow, and reproduce. There are six classes of nutrients required for the body to function and maintain overall health. These are carbohydrates, lipids, proteins, water, vitamins, and minerals. Foods also contain non-nutrient that may be harmful such as natural toxins common in plant foods and additives like some dyes and preservatives or beneficial like antioxidants. macronutrients Nutrients that are needed in large amounts are called macronutrients. There are three classes of macronutrients: carbohydrates, lipids, and proteins. These can be metabolically processed into cellular energy. The energy from macronutrients comes from their chemical bonds. This chemical energy is converted into cellular energy used to perform work, allowing our bodies to conduct their basic functions. A unit of measurement of food energy is the calorie. On nutrition food labels, the amount given for “calories” is actually equivalent to each calorie multiplied by one thousand. A kilocalorie (Calorie) is the amount of heat generated by a particular macronutrient that raises the temperature of 1 kilogram of water 1 degree Celsius. On the Nutrition Facts panel, the calories within a particular food are expressed as kilocalories, which is commonly denoted as “Calories” with a capital “C” (1 kcal = 1 Calorie = 1,000 calories). Water is also a macronutrient in the sense that you require a large amount of it, but unlike the other macronutrients, it does not provide calories. carbohydrates Carbohydrates are molecules composed of carbon, hydrogen, and oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy vegetables, like potatoes. Non-starchy vegetables also contain carbohydrates but in lesser quantities. Carbohydrates are broadly classified into two forms based on their chemical structure: simple carbohydrates, simple sugars, and complex carbohydrates. Simple carbohydrates consist of one or two basic units. Examples of simple sugars include sucrose, the type of sugar you would have in a bowl on the breakfast table, and glucose, the type of sugar that circulates in your blood. Complex carbohydrates are long chains of simple sugars that can be unbranched or branched. During digestion, the body breaks down digestible complex carbohydrates into simple sugars, mostly glucose. Glucose is then transported to all our cells, stored, used to make energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but digestive enzymes cannot break it down in the human intestine. As a result, it passes through the digestive tract undigested unless the bacteria that inhabit the colon or large intestine break it down. One gram of digestible carbohydrates yields four kilocalories of energy for the body’s cells to perform work. Besides providing energy and serving as building blocks for bigger macromolecules, carbohydrates are essential for the nervous system’s proper functioning, heart, and kidneys. As mentioned, glucose can be stored in the body for future use. In humans, the storage molecule of carbohydrates is called glycogen, and in plants, it is known as starch. Glycogen and starch are complex carbohydrates. protein Proteins are macromolecules composed of chains of subunits called amino acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and nitrogen. Food sources of proteins include meats, dairy products, seafood, and various plant-based foods, most notably soy. The word protein comes from a Greek word meaning “of primary importance,” which is an apt description of these macronutrients; they are also known colloquially as the “workhorses” of life. Proteins provide four kilocalories of energy per gram; however, providing energy is not protein’s most important function. Proteins provide structure to bones, muscles, and skin and play a role in conducting most of the chemical reactions that take place in the body. Scientists estimate that greater than one-hundred thousand different proteins exist within the human body. The genetic codes in DNA are basically protein recipes that determine the order in which 20 different amino acids are bound together to make thousands of specific proteins. lipids Lipids are also a family of molecules composed of carbon, hydrogen, and oxygen, but they are insoluble in water, unlike carbohydrates. Lipids are found predominantly in butter, oils, meats, dairy products, nuts, seeds, and processed foods. The three main types of lipids are triglycerides (triacylglycerols), phospholipids, and sterols. The main job of lipids is to provide or store energy. Lipids provide more energy per gram than carbohydrates (nine kilocalories per gram of lipids versus four kilocalories per gram of carbohydrates). In addition to energy storage, lipids serve as a major component of cell membranes, surround and protect organs (in fat-storing tissues), provide insulation to aid in temperature regulation, and regulate many other body functions. water There is one other nutrient that we must have in large quantities: water. Water does not contain carbon but is composed of two hydrogens and one oxygen per molecule of water. More than 60 percent of your total body weight is water. Without it, nothing could be transported in or out of the body, chemical reactions would not occur, organs would not be cushioned, and body temperature would fluctuate widely. On average, an adult consumes just over two liters of water per day from food and drink combined. Since water is so critical for life’s basic processes, the amount of water input and output is significant, a topic we will explore in detail micronutrients Micronutrients are nutrients required by the body in lesser amounts but are still essential for carrying out bodily functions. Micronutrients include all the essential minerals and vitamins. There are sixteen essential minerals and thirteen vitamins. In contrast to carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories), but they assist in the process as cofactors or components of enzymes (i.e., coenzymes). Enzymes are proteins that catalyze chemical reactions in the body and are involved in all aspects of body functions, from producing energy to digesting nutrients to building macromolecules. Micronutrients play many essential roles in the body. https://open.maricopa.edu/nutritionessentials/chapter/essential-nutrients/#:~:text=Nutrients%20have%20one%20or%20more,breathe%2C%20grow%2C%20and%20reproduce. ================ ======= What are the key differences between macronutrients and micronutrients in terms of their functions and the amounts required by the body and how they contribute to overall health? Explain in deep details in not more than 300 words. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]",Can you tell me about some of the health benefits of eating leafy greens listed in the articles and what are some popular leafy greens to incorporate into my diet/ways to use them. is is better to eat them cooked or raw. make the reply less than 250 words,"While we all know that organic, non-GMO fruits and vegetables of any kind are good for us, some are far better than others. Fortunately, many crowd favorites such as spinach, kale, and collard greens are packed with vitamins, minerals, fiber, and even protein. Not to mention, dark leafy greens are very versatile and can be incorporated into your diet in fun, delicious ways. If you still need convincing, I’m about to tell you about all the amazing benefits of leafy greens. Unless you’ve been taking notes, you might have missed all the leafy greens I’ve mentioned so far. Don’t worry! I’ve put together this convenient list of the healthiest leafy green vegetables for you to reference: Kale Spinach Collard greens Broccoli Broccoli sprouts Cabbage Beet greens Watercress Arugula Mustard greens Swiss chard Bok choy Romaine lettuce Raw Vegetables vs. Cooked Vegetables: Which is Better? I get asked all the time if it’s better to eat raw or cooked vegetables. The answer may surprise you! While eating raw vegetables provides your body with optimal levels of folate and water-soluble vitamins, the nutrients in cooked vegetables are actually easier to digest and absorb. However, I’m going to let you in on the most delicious and easiest way to enough leafy greens in your diet – Organic Greens! The Best Way to Get More Leafy Greens While it’s ideal to get these incredible benefits from real, whole foods, not all of these foods are always available, in season, or grown in optimal soil. It can be difficult to get the benefits of leafy greens from diet alone. That’s why Organic Greens is a great option to have when you’re just too busy to prepare a big salad or smoothie, or when you’re looking to stay healthy while on the go. One scoop of Organic Greens is a nutritional powerhouse, containing 14 USDA-certified organic plant foods, including green superstars spinach, kale, alfalfa, moringa, and broccoli sprouts. It’s perfect for anyone who: Is looking to save a lot of time versus juicing their produce every morning Needs a tasty, inexpensive alternative to pricey juice bar offerings Travels often and wants a doctor-designed source of organic nutrition while eating out Wants to mitigate stress and balanced hormone health Organic Greens is an easy and convenient way to ensure you’re getting all the amazing benefits of leafy greens! I drink a glass every day! Adding more leafy greens into your diet is a great way to support optimal health, reduce bloating, facilitate a healthy stress response, support bone health, healthy aging, and gut health, and help reduce oxidative damage from free radicals. Leafy greens are the nutritional powerhouse! Benefits of Leafy Greens FAQs What are the benefits of dark leafy greens? Adding more green leafy vegetables into your diet can support optimal brain health, fight belly bloat, relieve stress, support bone health, healthy aging, boost digestive enzymes, and tame the toxins, among many other health benefits. What are the best leafy green vegetables? The best leafy vegetables include spinach, kale, collard greens, chard, turnip greens, arugula, and watercress. How often should I eat leafy greens? According to the USDA, the optimal amount of leafy greens is between 3-5 servings per day. That’s a lot! By far, the easiest way to get your optimal daily intake of leafy green vegetables is Organic Greens."," Only use the provided text to answer the question, no outside sources. Can you tell me about some of the health benefits of eating leafy greens listed in the articles and what are some popular leafy greens to incorporate into my diet/ways to use them. is is better to eat them cooked or raw. make the reply less than 250 words While we all know that organic, non-GMO fruits and vegetables of any kind are good for us, some are far better than others. Fortunately, many crowd favorites such as spinach, kale, and collard greens are packed with vitamins, minerals, fiber, and even protein. Not to mention, dark leafy greens are very versatile and can be incorporated into your diet in fun, delicious ways. If you still need convincing, I’m about to tell you about all the amazing benefits of leafy greens. Unless you’ve been taking notes, you might have missed all the leafy greens I’ve mentioned so far. Don’t worry! I’ve put together this convenient list of the healthiest leafy green vegetables for you to reference: Kale Spinach Collard greens Broccoli Broccoli sprouts Cabbage Beet greens Watercress Arugula Mustard greens Swiss chard Bok choy Romaine lettuce Raw Vegetables vs. Cooked Vegetables: Which is Better? I get asked all the time if it’s better to eat raw or cooked vegetables. The answer may surprise you! While eating raw vegetables provides your body with optimal levels of folate and water-soluble vitamins, the nutrients in cooked vegetables are actually easier to digest and absorb. However, I’m going to let you in on the most delicious and easiest way to enough leafy greens in your diet – Organic Greens! The Best Way to Get More Leafy Greens While it’s ideal to get these incredible benefits from real, whole foods, not all of these foods are always available, in season, or grown in optimal soil. It can be difficult to get the benefits of leafy greens from diet alone. That’s why Organic Greens is a great option to have when you’re just too busy to prepare a big salad or smoothie, or when you’re looking to stay healthy while on the go. One scoop of Organic Greens is a nutritional powerhouse, containing 14 USDA-certified organic plant foods, including green superstars spinach, kale, alfalfa, moringa, and broccoli sprouts. It’s perfect for anyone who: Is looking to save a lot of time versus juicing their produce every morning Needs a tasty, inexpensive alternative to pricey juice bar offerings Travels often and wants a doctor-designed source of organic nutrition while eating out Wants to mitigate stress and balanced hormone health Organic Greens is an easy and convenient way to ensure you’re getting all the amazing benefits of leafy greens! I drink a glass every day! Adding more leafy greens into your diet is a great way to support optimal health, reduce bloating, facilitate a healthy stress response, support bone health, healthy aging, and gut health, and help reduce oxidative damage from free radicals. Leafy greens are the nutritional powerhouse! Benefits of Leafy Greens FAQs What are the benefits of dark leafy greens? Adding more green leafy vegetables into your diet can support optimal brain health, fight belly bloat, relieve stress, support bone health, healthy aging, boost digestive enzymes, and tame the toxins, among many other health benefits. What are the best leafy green vegetables? The best leafy vegetables include spinach, kale, collard greens, chard, turnip greens, arugula, and watercress. How often should I eat leafy greens? According to the USDA, the optimal amount of leafy greens is between 3-5 servings per day. That’s a lot! By far, the easiest way to get your optimal daily intake of leafy green vegetables is Organic Greens. https://www.amymyersmd.com/article/benefits-leafy-greens",Medical,Fact Finding,Q&A System Instructions: Do not use any outside sources. Do not use any prior knowledge. Respond using only the provided text.,Question: What is the difference between the sideline and locker room evaluations?,"Context: 2. Game Day Procedures a. Pregame Medical Team Meeting. Sixty (60) minutes prior to kickoff, all medicalstaff will meet in the referees’ locker room. Expected personnel include: Head Team Physician and Head Team Primary Care Sports Medicine Physician, and Head Team ATC from each team and UNCs, both Booth ATC Spotters, lead EMS paramedic for the field,referee, VTML, and the airway management physician. The pregame medical meeting is to be led by the home team Head Team Physician. Items to be covered include: introductions of medicalstaff; location of the ambulance, transport cart,spine board, defibrillator, and advanced airway equipment; review of EAP medical facilities; and location of x-ray equipment. Medicalstaffshall confirm who is responsible for verifying a concussion evaluation of an athlete, i.e., “closing the loop.” Booth ATC spotters shall review the Medical Time-Out procedures with officials. b. “No-Go” Signs and Symptoms. If a player exhibits or reports any of the following signs or symptoms of concussion, he must be removed immediately from the field of play and transported to the locker room. If a neutral sideline observer or a member of the player’s Club’s medical team observes a player exhibit or receives a report that a player has experienced any of the following signs or symptoms, the player shall be considered to have suffered a concussion and may not return to participation (practice or play) on the same day under any circumstances: i. Loss of Consciousness (including Impact Seizure and/or “fencing posture”); ii. Ataxia (abnormality of balance/stability, motor coordination, or dysfunctional speech); Amended As of October 8, 2022 iii. Confusion; or iv. Amnesia c. NFL Sideline Concussion Assessment (Sideline Survey) If a player exhibits or reports a sign or symptom of concussion (defined above), spinal cord neuropraxia or a concern is raised by the Club’s athletic trainer,Club physicians, Booth ATC Spotter, coach, teammate, game official or sideline or Booth UNCs(collectively referredto as “gameday medical personnel”)the player must be immediately removed to the sideline orstabilized on the field, as needed, the player’s helmet must be taken away from him, and the player must undergo the entire NFL Sideline Concussion Assessment1 which, at a minimum, must consist of the following: i. A review of the “No-Go” criteria listed above (Loss of Consciousness (including impact seizure and/or “fencing posture”), Ataxia, Confusion, andAmnesia), which, if present, requires the player to be brought to the lockerroom immediately and he shall not return to play; ii. Inquiry regarding the history of the event, including before, during and after the suspected mechanism of injury; iii. Review of concussion signs and symptoms (See, Section I (C and D)); iv. All Maddocks’ questions; v. Complete Video Review of the injury (detailed below), including discussion with theBooth UNC; and vi. Focused Neurological Exam, inclusive of the following: (A)Cervical Spine Examination (including range of motion and pain); (B) Evaluation of speech; (C) Testing of gait, coordination, and balance; and (D)Eye Movements and Pupillary Exam. The foregoing shall be: (i) conducted inside the medical evaluation tent on the Sideline (or in the Locker Room if the Club medical staff elects to conduct it in the Locker Room); (ii) performed using the tablet or other technology assigned by the NFL, and (iii) completion of each component of the Sideline Survey shall be confirmed using the same. If any elements of the sideline assessment are positive, inconclusive, or suspicious for the presence of a concussion, the player must be escorted to the locker room immediately for the complete NFL Locker Room Comprehensive Concussion Assessment. Also, if the player demonstrates worsening or progressing symptoms at any point, he is to be brought to the 1 The Club physician/sideline UNC unit will be co-located for all concussion evaluates and management both on and off the field. The sideline UNC may present his/her own questions or conduct additional testing and shall assist in the diagnosis and treatment of concussion. Amended As of October 8, 2022 locker room for further evaluation including the complete NFL Locker Room Comprehensive Concussion Assessment unless clinically contraindicated. Only medical personnel deemed essential to the care of the athlete may be present for the tent and/or locker room evaluation. This includes the team physician best qualified to evaluate concussion, the Club athletic trainer, and the sideline UNC. The sideline UNC may present his/her own questions or conduct additional testing and shall not be prevented in from so doing. If, upon completing the Sideline Survey, the Club physician, after consultation with the sideline UNC, concludes that the player did notsustain a concussion, then the playermay return to play. Bestpracticesfor concussion assessment include periodic checks of the player by the Club physician, sideline UNC or other medical personnel to determine whether he has developed any of the signs orsymptoms of concussion that would necessitate a locker room evaluation. UNC Involvement in Sideline Concussion Assessment: 1. The Club physician will consult in private with the members of his/her team’s medical staff designated to identify, diagnose and treat potentially concussed players, the sideline UNC and, as necessary, the Club’s ATC, prior to making his/her decision regarding whether the player will return to the game. 2. If the Club physician determines that the player shall not return to play (based on the criteria listed in Section 2.a. above) and therefore there is no need to complete the SidelineConcussionAssessment, the Club physician and the sideline UNC shall accompany the player to the locker room to evaluate the player using the NFL Locker Room Comprehensive Concussion Evaluation (see below). For more serious injury, the EAP will be activated, if indicated. 3. The Club physician remains responsible for all final decisions regarding Return-to-Play. However, the Club physician will consult with his/her sideline UNC team member prior to reaching his/her decision. If the sideline UNC disagrees with the Club physician’s decision to return the player to play or remove the athlete, the sideline UNC will be given an opportunity to explain the basis of his/her opinion. This will be discussed in a collegial fashion in private as to why the player should or should not be returned to the game. The Club physician will communicate his or her final decision to the player. Amended As of October 8, 2022 10 4. As soon as practical, following the evaluation, the individual designated at the Pregame Medical Team Meeting shall notify the booth medical personnel that an evaluation was conducted (“close the loop”). d. NFL Locker Room Comprehensive Concussion Assessment (Locker Room Exam) The NFL Locker Room Comprehensive Concussion Assessment is the standardized acute evaluation tool that has been developed by the NFL’s Head, Neck and Spine Committee to be used by Clubs’ medical staffs and designated UNCs to evaluate potential concussions during practices and on game day (see Attachment A). This evaluation is based on the Standardized Concussion Assessment Tool (SCAT 5) published by the International Concussion in Sport Group (McCrory, et al., 2017), modified for use in the NFL (Attachment A). The NFL Locker Room Comprehensive Concussion Assessment can be used to aid in the diagnosis of concussion even if there is a delayed onset of symptoms. The ongoing use of the Locker Room Comprehensive Concussion Assessment in conjunction with the preseason baseline and post-injury testing provides detailed data regarding each athlete’s injury and recovery course. Being able to compare the results from the NFL Locker Room Comprehensive Concussion Assessment to the baseline information obtained in the preseason improves the value of this instrument. Clubs shall maintain and upload to the EMR all NFL Locker Room Comprehensive Concussion Assessment exams and a copy of the same shall be given to both the player and the team medical staff. In all circumstances, the Club physician responsible for concussion evaluation shall assess the player in conjunction with the sideline UNC. The Club physician shall be responsible for determining whether the player is diagnosed as having a concussion. The athlete may have a concussion despite being able to complete the NFL Locker Room Comprehensive Concussion Assessment “within normal limits” compared to baseline, due to the potential limitations of the Assessment. Such limitations underscore the importance of knowing the athlete and the subtle deficits in their personality and behaviors that can occur with concussive injury. The signs and symptoms of concussion listed above (Section I, C and D), although frequently observed or reported, are not an exhaustive list. The NFL Locker Room Comprehensive Concussion Assessment is intended to capture these elements in a standardized format. The neurocognitive assessment in the NFL Locker Room Comprehensive Concussion Assessment is brief and does not replace a more comprehensive neurological evaluation or more formal neurocognitive testing. The Amended As of October 8, 2022 11 modified Balance Error Scoring System (mBESS) is an important component of the NFL Locker Room Comprehensive Concussion Assessment and has been validated as a useful adjunct in assessing concussive injury.","System Instructions: Do not use any outside sources. Do not use any prior knowledge. Respond using only the provided text. Question: What is the difference between the sideline and locker room evaluations? Context: 2. Game Day Procedures a. Pregame Medical Team Meeting. Sixty (60) minutes prior to kickoff, all medicalstaff will meet in the referees’ locker room. Expected personnel include: Head Team Physician and Head Team Primary Care Sports Medicine Physician, and Head Team ATC from each team and UNCs, both Booth ATC Spotters, lead EMS paramedic for the field,referee, VTML, and the airway management physician. The pregame medical meeting is to be led by the home team Head Team Physician. Items to be covered include: introductions of medicalstaff; location of the ambulance, transport cart,spine board, defibrillator, and advanced airway equipment; review of EAP medical facilities; and location of x-ray equipment. Medicalstaffshall confirm who is responsible for verifying a concussion evaluation of an athlete, i.e., “closing the loop.” Booth ATC spotters shall review the Medical Time-Out procedures with officials. b. “No-Go” Signs and Symptoms. If a player exhibits or reports any of the following signs or symptoms of concussion, he must be removed immediately from the field of play and transported to the locker room. If a neutral sideline observer or a member of the player’s Club’s medical team observes a player exhibit or receives a report that a player has experienced any of the following signs or symptoms, the player shall be considered to have suffered a concussion and may not return to participation (practice or play) on the same day under any circumstances: i. Loss of Consciousness (including Impact Seizure and/or “fencing posture”); ii. Ataxia (abnormality of balance/stability, motor coordination, or dysfunctional speech); Amended As of October 8, 2022 iii. Confusion; or iv. Amnesia c. NFL Sideline Concussion Assessment (Sideline Survey) If a player exhibits or reports a sign or symptom of concussion (defined above), spinal cord neuropraxia or a concern is raised by the Club’s athletic trainer,Club physicians, Booth ATC Spotter, coach, teammate, game official or sideline or Booth UNCs(collectively referredto as “gameday medical personnel”)the player must be immediately removed to the sideline orstabilized on the field, as needed, the player’s helmet must be taken away from him, and the player must undergo the entire NFL Sideline Concussion Assessment1 which, at a minimum, must consist of the following: i. A review of the “No-Go” criteria listed above (Loss of Consciousness (including impact seizure and/or “fencing posture”), Ataxia, Confusion, andAmnesia), which, if present, requires the player to be brought to the lockerroom immediately and he shall not return to play; ii. Inquiry regarding the history of the event, including before, during and after the suspected mechanism of injury; iii. Review of concussion signs and symptoms (See, Section I (C and D)); iv. All Maddocks’ questions; v. Complete Video Review of the injury (detailed below), including discussion with theBooth UNC; and vi. Focused Neurological Exam, inclusive of the following: (A)Cervical Spine Examination (including range of motion and pain); (B) Evaluation of speech; (C) Testing of gait, coordination, and balance; and (D)Eye Movements and Pupillary Exam. The foregoing shall be: (i) conducted inside the medical evaluation tent on the Sideline (or in the Locker Room if the Club medical staff elects to conduct it in the Locker Room); (ii) performed using the tablet or other technology assigned by the NFL, and (iii) completion of each component of the Sideline Survey shall be confirmed using the same. If any elements of the sideline assessment are positive, inconclusive, or suspicious for the presence of a concussion, the player must be escorted to the locker room immediately for the complete NFL Locker Room Comprehensive Concussion Assessment. Also, if the player demonstrates worsening or progressing symptoms at any point, he is to be brought to the 1 The Club physician/sideline UNC unit will be co-located for all concussion evaluates and management both on and off the field. The sideline UNC may present his/her own questions or conduct additional testing and shall assist in the diagnosis and treatment of concussion. Amended As of October 8, 2022 locker room for further evaluation including the complete NFL Locker Room Comprehensive Concussion Assessment unless clinically contraindicated. Only medical personnel deemed essential to the care of the athlete may be present for the tent and/or locker room evaluation. This includes the team physician best qualified to evaluate concussion, the Club athletic trainer, and the sideline UNC. The sideline UNC may present his/her own questions or conduct additional testing and shall not be prevented in from so doing. If, upon completing the Sideline Survey, the Club physician, after consultation with the sideline UNC, concludes that the player did notsustain a concussion, then the playermay return to play. Bestpracticesfor concussion assessment include periodic checks of the player by the Club physician, sideline UNC or other medical personnel to determine whether he has developed any of the signs orsymptoms of concussion that would necessitate a locker room evaluation. UNC Involvement in Sideline Concussion Assessment: 1. The Club physician will consult in private with the members of his/her team’s medical staff designated to identify, diagnose and treat potentially concussed players, the sideline UNC and, as necessary, the Club’s ATC, prior to making his/her decision regarding whether the player will return to the game. 2. If the Club physician determines that the player shall not return to play (based on the criteria listed in Section 2.a. above) and therefore there is no need to complete the SidelineConcussionAssessment, the Club physician and the sideline UNC shall accompany the player to the locker room to evaluate the player using the NFL Locker Room Comprehensive Concussion Evaluation (see below). For more serious injury, the EAP will be activated, if indicated. 3. The Club physician remains responsible for all final decisions regarding Return-to-Play. However, the Club physician will consult with his/her sideline UNC team member prior to reaching his/her decision. If the sideline UNC disagrees with the Club physician’s decision to return the player to play or remove the athlete, the sideline UNC will be given an opportunity to explain the basis of his/her opinion. This will be discussed in a collegial fashion in private as to why the player should or should not be returned to the game. The Club physician will communicate his or her final decision to the player. Amended As of October 8, 2022 10 4. As soon as practical, following the evaluation, the individual designated at the Pregame Medical Team Meeting shall notify the booth medical personnel that an evaluation was conducted (“close the loop”). d. NFL Locker Room Comprehensive Concussion Assessment (Locker Room Exam) The NFL Locker Room Comprehensive Concussion Assessment is the standardized acute evaluation tool that has been developed by the NFL’s Head, Neck and Spine Committee to be used by Clubs’ medical staffs and designated UNCs to evaluate potential concussions during practices and on game day (see Attachment A). This evaluation is based on the Standardized Concussion Assessment Tool (SCAT 5) published by the International Concussion in Sport Group (McCrory, et al., 2017), modified for use in the NFL (Attachment A). The NFL Locker Room Comprehensive Concussion Assessment can be used to aid in the diagnosis of concussion even if there is a delayed onset of symptoms. The ongoing use of the Locker Room Comprehensive Concussion Assessment in conjunction with the preseason baseline and post-injury testing provides detailed data regarding each athlete’s injury and recovery course. Being able to compare the results from the NFL Locker Room Comprehensive Concussion Assessment to the baseline information obtained in the preseason improves the value of this instrument. Clubs shall maintain and upload to the EMR all NFL Locker Room Comprehensive Concussion Assessment exams and a copy of the same shall be given to both the player and the team medical staff. In all circumstances, the Club physician responsible for concussion evaluation shall assess the player in conjunction with the sideline UNC. The Club physician shall be responsible for determining whether the player is diagnosed as having a concussion. The athlete may have a concussion despite being able to complete the NFL Locker Room Comprehensive Concussion Assessment “within normal limits” compared to baseline, due to the potential limitations of the Assessment. Such limitations underscore the importance of knowing the athlete and the subtle deficits in their personality and behaviors that can occur with concussive injury. The signs and symptoms of concussion listed above (Section I, C and D), although frequently observed or reported, are not an exhaustive list. The NFL Locker Room Comprehensive Concussion Assessment is intended to capture these elements in a standardized format. The neurocognitive assessment in the NFL Locker Room Comprehensive Concussion Assessment is brief and does not replace a more comprehensive neurological evaluation or more formal neurocognitive testing. The Amended As of October 8, 2022 11 modified Balance Error Scoring System (mBESS) is an important component of the NFL Locker Room Comprehensive Concussion Assessment and has been validated as a useful adjunct in assessing concussive injury.",Medical,Concept Comparison,Q&A Draw your answer from the above text only. Write in complete sentences and limit your answer to 150 words and 2 paragraphs. Do not use bullet points or bolding.,Detail the strategies the government is employing to encourage compliance in the tax system.,"1.10 Increasing the effectiveness of the Office of Tax Simplification (OTS) – The government is publishing its first five-year review of the OTS, launched in March 2021, to examine the effectiveness of the OTS. It makes eight recommendations. 1.11 Response to Office of Tax Simplification Review of Capital Gains Tax (CGT) – The government is publishing its response to the OTS’s two-part review of CGT. The government has carefully considered the OTS’s recommendations and will keep the CGT system under review to ensure it is simple and efficient. The government has accepted five of the technical recommendations in the OTS’s second report and will work towards their implementation. 1.12 Response to Office of Tax Simplification Review of Inheritance Tax (IHT) – The government is publishing its response to the OTS’s review of the design of IHT. It has decided not to proceed with any changes at this point in time. The government responded to the OTS’s review of the administration of IHT in March 2021. 6 Chapter 2 Tackling non-compliance 2.1 Since 2010 the government has introduced over 150 new measures and invested over £2 billion in HMRC to tackle non-compliance in the tax system – this has secured and protected over £250 billion which would otherwise have gone unpaid. Significant reforms include: the introduction of the General Anti-Abuse Rule; Accelerated Payments; the implementation of the OECD Base Erosion and Profit Shifting Action Plan; and a range of measures to clamp down on promoters of tax avoidance. The measures announced in this document build on that strong base and further the government’s aim for everyone to pay the tax that is legally due, no matter who they are. 2.2 Modernising tax debt collection for non-paying businesses – The government is publishing a call for evidence on how HMRC can modernise its collection of tax debts to reflect the changing nature of the economy, where an increased use of e-commerce has given rise to new business practices – including the conduct of business in the UK without having a presence or physical assets here. The call for evidence also seeks views on HMRC’s approach to the small minority of business taxpayers who do not engage with HMRC and hold off paying their tax for as long as they can, forcing HMRC to resort to costly and time-consuming enforcement action. The proposals will not affect taxpayers who are in temporary financial difficulty and need support from HMRC to get back onto a sustainable financial footing – including those affected by the Covid-19 pandemic. 2.3 OECD’s Model Mandatory Disclosure Rules to tackle non-compliance – At Spring Budget 2021, the government announced that it would implement the OECD’s Model Mandatory Disclosure Rules. The government is now issuing a technical consultation and draft regulations. Mandatory Disclosure Rules require advisers (and sometimes taxpayers) to report information to the tax authorities on certain prescribed arrangements and structures, including those that could circumvent existing tax transparency reporting rules known as the Common Reporting Standard. This information will be exchanged with relevant tax authorities to help deter non-compliance, assist in identifying and challenging evasion, and support the development of tax policy. 2.4 Improving Transfer Pricing Documentation – The government is publishing a summary of responses to the consultation that closed in June 2021. It will legislate in 2022 to require businesses that are in scope of country-by-country reporting to maintain a master file and local file in line with OECD Base Erosion and Profit Shifting Action 13, and a supporting 7 summary audit trail. These changes will take effect from April 2023. The government will continue to review the case for companies to submit an International Dealings Schedule. 2.5 Extending tax conditionality to licences in Scotland and Northern Ireland – The government is publishing a summary of responses to the consultation on extending tax conditionality to certain licences in Scotland and Northern Ireland from April 2023. This makes the renewal of certain licences conditional on applicants completing checks that confirm they are appropriately registered for tax. The policy will be developed through continued engagement with the Devolved Administrations and is consistent with reforms which come into force in England and Wales in April 2022. Licensing bodies will have to obtain confirmation that an applicant has completed the check before deciding on their renewal application, making it more difficult for traders to operate in the hidden economy. The government remains committed to exploring further the wider application of tax conditionality. 2.6 Strengthening and modernising Individual Savings Accounts (ISA) compliance and penalties – In December 2020, the Economic Secretary to the Treasury announced that: “The Treasury is urgently looking at the sufficiency of checks on IF [Innovative Finance] ISA managers and the penalties regime.” Following that announcement, the government is now publishing a call for evidence on proposals to enhance ISA compliance, which will help determine how the current approach can be strengthened and modernised to encourage ISA managers and investors to get things right first time. The proposals apply to all types of ISA – Cash, Stocks and Shares, Junior, Lifetime and Innovative Finance. 2.7 Consulting on making Stamp Duty Land Tax (SDLT) reliefs fairer – The government is publishing a consultation on the SDLT reliefs for purchases of mixed property and multiple dwellings. These reliefs are being exploited by some purchasers to unfairly reduce their tax liability. This consultation sets out potential changes to make the system fairer and reduce the scope for misuse and incorrect claims. 2.8 New stakeholder forum on tackling offshore tax non-compliance – The government has established an HMRC stakeholder forum with representative bodies and agents to explore ideas to tackle offshore tax non-compliance. This follows from the publication of two discussion documents in spring 2021, as part of implementing HMRC’s ‘No Safe Havens’ strategy. The documents sought views on how to help taxpayers reduce offshore noncompliance in relation to non-UK income, gains and assets, and how to reduce and prevent international tax debt. 2.9 Exploring the potential of VAT split payment – The government is committed to exploring further VAT split payment, an alternative method of VAT collection where the tax element of a digital payment could be remitted directly to HMRC. While the work is at an exploratory stage, the government will continue to assess the potential of split payment both for tackling overseas VAT non-compliance and wider tax modernisation. The government 8 is grateful for the ongoing input of stakeholders in the payments industry and will continue to take this work forward collaboratively, including through the Industry Working Group established in 2018. 2.10 Use of marketed tax avoidance schemes in the UK – HMRC is publishing its annual report on the use of marketed tax avoidance schemes in the UK. It sets out the numbers and characteristics of taxpayers using avoidance schemes in the tax year 2019-2020. The report includes data on occupations, locations, ages and the average declared incomes of those involved in avoidance. 9 Chapter 3 Further tax policy announcements 3.1 It is important that the tax system continues to be fit for the modern world, and that government continues to take action to level the playing field and increase transparency. The policies set out in this section open new consultations on promising areas for potential reform and set out next steps on reform work already underway. Taxes fit for the modern world 3.2 Ensuring Landfill Tax continues to support environmental objectives – In spring 2021, the government announced it would review aspects of Landfill Tax in England and Northern Ireland. It is now launching a call for evidence, focused on how Landfill Tax can continue to support the government's ambitious environmental objectives, including achieving zero avoidable waste by 2050.","Detail the strategies the government is employing to encourage compliance in the tax system. 1.10 Increasing the effectiveness of the Office of Tax Simplification (OTS) – The government is publishing its first five-year review of the OTS, launched in March 2021, to examine the effectiveness of the OTS. It makes eight recommendations. 1.11 Response to Office of Tax Simplification Review of Capital Gains Tax (CGT) – The government is publishing its response to the OTS’s two-part review of CGT. The government has carefully considered the OTS’s recommendations and will keep the CGT system under review to ensure it is simple and efficient. The government has accepted five of the technical recommendations in the OTS’s second report and will work towards their implementation. 1.12 Response to Office of Tax Simplification Review of Inheritance Tax (IHT) – The government is publishing its response to the OTS’s review of the design of IHT. It has decided not to proceed with any changes at this point in time. The government responded to the OTS’s review of the administration of IHT in March 2021. 6 Chapter 2 Tackling non-compliance 2.1 Since 2010 the government has introduced over 150 new measures and invested over £2 billion in HMRC to tackle non-compliance in the tax system – this has secured and protected over £250 billion which would otherwise have gone unpaid. Significant reforms include: the introduction of the General Anti-Abuse Rule; Accelerated Payments; the implementation of the OECD Base Erosion and Profit Shifting Action Plan; and a range of measures to clamp down on promoters of tax avoidance. The measures announced in this document build on that strong base and further the government’s aim for everyone to pay the tax that is legally due, no matter who they are. 2.2 Modernising tax debt collection for non-paying businesses – The government is publishing a call for evidence on how HMRC can modernise its collection of tax debts to reflect the changing nature of the economy, where an increased use of e-commerce has given rise to new business practices – including the conduct of business in the UK without having a presence or physical assets here. The call for evidence also seeks views on HMRC’s approach to the small minority of business taxpayers who do not engage with HMRC and hold off paying their tax for as long as they can, forcing HMRC to resort to costly and time-consuming enforcement action. The proposals will not affect taxpayers who are in temporary financial difficulty and need support from HMRC to get back onto a sustainable financial footing – including those affected by the Covid-19 pandemic. 2.3 OECD’s Model Mandatory Disclosure Rules to tackle non-compliance – At Spring Budget 2021, the government announced that it would implement the OECD’s Model Mandatory Disclosure Rules. The government is now issuing a technical consultation and draft regulations. Mandatory Disclosure Rules require advisers (and sometimes taxpayers) to report information to the tax authorities on certain prescribed arrangements and structures, including those that could circumvent existing tax transparency reporting rules known as the Common Reporting Standard. This information will be exchanged with relevant tax authorities to help deter non-compliance, assist in identifying and challenging evasion, and support the development of tax policy. 2.4 Improving Transfer Pricing Documentation – The government is publishing a summary of responses to the consultation that closed in June 2021. It will legislate in 2022 to require businesses that are in scope of country-by-country reporting to maintain a master file and local file in line with OECD Base Erosion and Profit Shifting Action 13, and a supporting 7 summary audit trail. These changes will take effect from April 2023. The government will continue to review the case for companies to submit an International Dealings Schedule. 2.5 Extending tax conditionality to licences in Scotland and Northern Ireland – The government is publishing a summary of responses to the consultation on extending tax conditionality to certain licences in Scotland and Northern Ireland from April 2023. This makes the renewal of certain licences conditional on applicants completing checks that confirm they are appropriately registered for tax. The policy will be developed through continued engagement with the Devolved Administrations and is consistent with reforms which come into force in England and Wales in April 2022. Licensing bodies will have to obtain confirmation that an applicant has completed the check before deciding on their renewal application, making it more difficult for traders to operate in the hidden economy. The government remains committed to exploring further the wider application of tax conditionality. 2.6 Strengthening and modernising Individual Savings Accounts (ISA) compliance and penalties – In December 2020, the Economic Secretary to the Treasury announced that: “The Treasury is urgently looking at the sufficiency of checks on IF [Innovative Finance] ISA managers and the penalties regime.” Following that announcement, the government is now publishing a call for evidence on proposals to enhance ISA compliance, which will help determine how the current approach can be strengthened and modernised to encourage ISA managers and investors to get things right first time. The proposals apply to all types of ISA – Cash, Stocks and Shares, Junior, Lifetime and Innovative Finance. 2.7 Consulting on making Stamp Duty Land Tax (SDLT) reliefs fairer – The government is publishing a consultation on the SDLT reliefs for purchases of mixed property and multiple dwellings. These reliefs are being exploited by some purchasers to unfairly reduce their tax liability. This consultation sets out potential changes to make the system fairer and reduce the scope for misuse and incorrect claims. 2.8 New stakeholder forum on tackling offshore tax non-compliance – The government has established an HMRC stakeholder forum with representative bodies and agents to explore ideas to tackle offshore tax non-compliance. This follows from the publication of two discussion documents in spring 2021, as part of implementing HMRC’s ‘No Safe Havens’ strategy. The documents sought views on how to help taxpayers reduce offshore noncompliance in relation to non-UK income, gains and assets, and how to reduce and prevent international tax debt. 2.9 Exploring the potential of VAT split payment – The government is committed to exploring further VAT split payment, an alternative method of VAT collection where the tax element of a digital payment could be remitted directly to HMRC. While the work is at an exploratory stage, the government will continue to assess the potential of split payment both for tackling overseas VAT non-compliance and wider tax modernisation. The government 8 is grateful for the ongoing input of stakeholders in the payments industry and will continue to take this work forward collaboratively, including through the Industry Working Group established in 2018. 2.10 Use of marketed tax avoidance schemes in the UK – HMRC is publishing its annual report on the use of marketed tax avoidance schemes in the UK. It sets out the numbers and characteristics of taxpayers using avoidance schemes in the tax year 2019-2020. The report includes data on occupations, locations, ages and the average declared incomes of those involved in avoidance. 9 Chapter 3 Further tax policy announcements 3.1 It is important that the tax system continues to be fit for the modern world, and that government continues to take action to level the playing field and increase transparency. The policies set out in this section open new consultations on promising areas for potential reform and set out next steps on reform work already underway. Taxes fit for the modern world 3.2 Ensuring Landfill Tax continues to support environmental objectives – In spring 2021, the government announced it would review aspects of Landfill Tax in England and Northern Ireland. It is now launching a call for evidence, focused on how Landfill Tax can continue to support the government's ambitious environmental objectives, including achieving zero avoidable waste by 2050. Draw your answer from the above text only. Write in complete sentences and limit your answer to 150 words and 2 paragraphs. Do not use bullet points or bolding.",Financial,Fact Finding,Q&A All information in the response should be sourced from the information provided in the prompt.,What are the mental effects of experiencing an anaphylaxis episode as they relate to growth and continued living?,"After Anaphylaxis: Learning From the Experience Having experienced your own allergic reaction or witnessing someone else having an allergic reaction, especially a severe one (anaphylaxis), can be extremely upsetting and scary. Nevertheless, it can be an opportunity to learn and feel more confident. Embrace the experience and learn from it. In order for it to not let it get you down, here are things to think about: Are you sure of the trigger that caused the allergic reaction? Confirm with your doctor! Review if it is an obvious exposure to a known allergen trigger or if it is a mystery. You would not want to be avoiding a food that is not the real trigger nor want to miss an unexpected food allergen that is a true trigger. If it is not clear what triggered the reaction, it is especially important to review with your doctor. Keep ingredient labels, consider storing any leftover food, and ask for all possible ingredients or known allergens used around the food that caused the problem. Do not assume it was a cross contact. Consider where it happened, what your child was doing at the time, and any circumstances that are different than usual. Did you respond to the symptoms with appropriate treatment? Always more to learn! This is a great learning opportunity to review with your doctor how you recognized and treated the allergic reaction. What did you do right? What could you have done better? After-care of anaphylaxis includes addressing the emotional toll! o You may be sad, nervous, and distrustful for a while. This is completely normal. This feeling should pass with time. Normal routines should return in a few weeks. It is normal for people to feel guilty, worried, anxious or unsure about “what is safe”. o Accidents happen; it is a learning experience and an opportunity to do better. See the next page on “Handling the Emotional Impact of Anaphylaxis” for more details. Stay Positive Focus on all of the success in daily life, not just on food allergy or this reaction. The reaction was a setback, but you managed and learned! Reward positive behaviors (carrying/using medications, “no thank you” to unsafe foods, asking good questions, etc.). What to do if things are not the same after having anaphylaxis Experiencing anaphylaxis can sometimes result in longer-term increased anxiety, or lead to post-traumatic stress. It may cause a feeling of “not knowing what is safe anymore”. This can result in avoidance of food or situations that everyone knows is safe but cause too much anxiety. If life is not back to normal in a few weeks, it may become necessary to address negative behaviors and feelings. You may need help. That is normal and it is OK! In the companion sheet, we provide some more information about what to expect after anaphylaxis and how to address the emotional impact pro-actively. Help is available. Talk to your doctor about referral to a mental health professional. Very effective approaches are available and can make life-changing improvements. Some examples of what you can do: Learn coaching techniques to help your child face safe but anxiety-provoking situations. Learn whether the experience is “expected and normal” after an anaphylactic reaction or should be addressed with more assistance to get back on track. Learn relaxation techniques. Learn about the benefits of counseling, cognitive behavioral treatment or medications. These approaches are only recommended if they are essential to help get through an episode of increased stress. Handling the Emotional Impact of Anaphylaxis – Tips & Suggestions Anaphylactic reactions can be stressful. This handout reviews general points that both parents and patients may wish to consider in the immediate and long-term management of the emotional impact. These are general suggestions and may not be applicable to all individuals. Please talk to your physician about individualized care from a mental health expert if needed. THE EMOTIONAL IMPACT OF A REACTION EVOLVES OVER TIME – WHAT ONE DOES AND FEELS DURING OR IMMEDIATELY AFTER THE EVENT IS NOT THE SAME AS WHAT HAPPENS LATER ON. WHAT TO DO DURING ANAPHYLAXIS OR SUSPECTED ANAPHYLAXIS? Follow your Doctor’s orders regarding the administration of epinephrine, anti-histamines and further emergency care, if needed. Parent: try to project calm while doing so, if possible. However, if you are not calm and cannot project it, do not get too upset about it. The task now is to handle the event itself. WHAT TO DO IMMEDIATELY AFTER THE EVENT IS UNDER CONTROL? OK to admit that you are or were afraid, if that is the case. Parent: try to point out that the event was handled well, if that were the case. Parent: ask the child how he or she feels - but do not persist. It is ok if the child does not want to talk. If the child discloses distress, say that this is normal and that indeed, the event was distressing. Validate the emotion and emphasize safety. Physical contact (e.g. a hug) may be appropriate. WHAT TO DO LATER ON (WEEKS / MONTHS)? If indicated, there may be a need to re-evaluate “safety” (what is and is not safe to eat) given the event. This is best done with the help of an allergist. Ask your child how they feel. Try to send the message that your child can talk with you about feeling distressed, that it is normal to feel some stress even after the event has passed, and that it is a good idea to speak with you about it. Initially, there may be increased anxiety in general, or in situations that were previously thought of as safe. This is normal. This anxiety is expected to get better over the course of a few months (not necessarily immediately). If it does not subside, or if it gets worse after a month, intervention / assistance may be needed. Adjustment after the event may include addressing the feeling that the world is less safe. The event may lead to a re-evaluation of safety; the task is to arrive at a new understanding of safety. Sometimes, this process gets derailed and the child’s feelings that she or he are not safe turn into persistent distress, an anxiety disorder, a post-traumatic stress disorder (PTSD), and other reactions. Those are best managed with the help of a mental health professional. Relaxation techniques, cognitive-behavioral therapy, supportive therapy, and psychiatric medications are all options that would work for specific types of symptoms in specific instances. The preference should be for short-term, targeted interventions, unless a chronic mental health condition is diagnosed in addition to a specific response to an event. THE SILVER LINING Overcoming a period of distress may increase resilience and help the patient face other future challenges! ","system instructions: All information should be sourced solely from the information provided in the prompt. question: What are the mental effects of experiencing an anaphylaxis episode as they relate to growth and continued living? context block: After Anaphylaxis: Learning From the Experience Having experienced your own allergic reaction or witnessing someone else having an allergic reaction, especially a severe one (anaphylaxis), can be extremely upsetting and scary. Nevertheless, it can be an opportunity to learn and feel more confident. Embrace the experience and learn from it. In order for it to not let it get you down, here are things to think about: Are you sure of the trigger that caused the allergic reaction? Confirm with your doctor! Review if it is an obvious exposure to a known allergen trigger or if it is a mystery. You would not want to be avoiding a food that is not the real trigger nor want to miss an unexpected food allergen that is a true trigger. If it is not clear what triggered the reaction, it is especially important to review with your doctor. Keep ingredient labels, consider storing any leftover food, and ask for all possible ingredients or known allergens used around the food that caused the problem. Do not assume it was a cross contact. Consider where it happened, what your child was doing at the time, and any circumstances that are different than usual. Did you respond to the symptoms with appropriate treatment? Always more to learn! This is a great learning opportunity to review with your doctor how you recognized and treated the allergic reaction. What did you do right? What could you have done better? After-care of anaphylaxis includes addressing the emotional toll! o You may be sad, nervous, and distrustful for a while. This is completely normal. This feeling should pass with time. Normal routines should return in a few weeks. It is normal for people to feel guilty, worried, anxious or unsure about “what is safe”. o Accidents happen; it is a learning experience and an opportunity to do better. See the next page on “Handling the Emotional Impact of Anaphylaxis” for more details. Stay Positive Focus on all of the success in daily life, not just on food allergy or this reaction. The reaction was a setback, but you managed and learned! Reward positive behaviors (carrying/using medications, “no thank you” to unsafe foods, asking good questions, etc.). What to do if things are not the same after having anaphylaxis Experiencing anaphylaxis can sometimes result in longer-term increased anxiety, or lead to post-traumatic stress. It may cause a feeling of “not knowing what is safe anymore”. This can result in avoidance of food or situations that everyone knows is safe but cause too much anxiety. If life is not back to normal in a few weeks, it may become necessary to address negative behaviors and feelings. You may need help. That is normal and it is OK! In the companion sheet, we provide some more information about what to expect after anaphylaxis and how to address the emotional impact pro-actively. Help is available. Talk to your doctor about referral to a mental health professional. Very effective approaches are available and can make life-changing improvements. Some examples of what you can do: Learn coaching techniques to help your child face safe but anxiety-provoking situations. Learn whether the experience is “expected and normal” after an anaphylactic reaction or should be addressed with more assistance to get back on track. Learn relaxation techniques. Learn about the benefits of counseling, cognitive behavioral treatment or medications. These approaches are only recommended if they are essential to help get through an episode of increased stress. Handling the Emotional Impact of Anaphylaxis – Tips & Suggestions Anaphylactic reactions can be stressful. This handout reviews general points that both parents and patients may wish to consider in the immediate and long-term management of the emotional impact. These are general suggestions and may not be applicable to all individuals. Please talk to your physician about individualized care from a mental health expert if needed. THE EMOTIONAL IMPACT OF A REACTION EVOLVES OVER TIME – WHAT ONE DOES AND FEELS DURING OR IMMEDIATELY AFTER THE EVENT IS NOT THE SAME AS WHAT HAPPENS LATER ON. WHAT TO DO DURING ANAPHYLAXIS OR SUSPECTED ANAPHYLAXIS? Follow your Doctor’s orders regarding the administration of epinephrine, anti-histamines and further emergency care, if needed. Parent: try to project calm while doing so, if possible. However, if you are not calm and cannot project it, do not get too upset about it. The task now is to handle the event itself. WHAT TO DO IMMEDIATELY AFTER THE EVENT IS UNDER CONTROL? OK to admit that you are or were afraid, if that is the case. Parent: try to point out that the event was handled well, if that were the case. Parent: ask the child how he or she feels - but do not persist. It is ok if the child does not want to talk. If the child discloses distress, say that this is normal and that indeed, the event was distressing. Validate the emotion and emphasize safety. Physical contact (e.g. a hug) may be appropriate. WHAT TO DO LATER ON (WEEKS / MONTHS)? If indicated, there may be a need to re-evaluate “safety” (what is and is not safe to eat) given the event. This is best done with the help of an allergist. Ask your child how they feel. Try to send the message that your child can talk with you about feeling distressed, that it is normal to feel some stress even after the event has passed, and that it is a good idea to speak with you about it. Initially, there may be increased anxiety in general, or in situations that were previously thought of as safe. This is normal. This anxiety is expected to get better over the course of a few months (not necessarily immediately). If it does not subside, or if it gets worse after a month, intervention / assistance may be needed. Adjustment after the event may include addressing the feeling that the world is less safe. The event may lead to a re-evaluation of safety; the task is to arrive at a new understanding of safety. Sometimes, this process gets derailed and the child’s feelings that she or he are not safe turn into persistent distress, an anxiety disorder, a post-traumatic stress disorder (PTSD), and other reactions. Those are best managed with the help of a mental health professional. Relaxation techniques, cognitive-behavioral therapy, supportive therapy, and psychiatric medications are all options that would work for specific types of symptoms in specific instances. The preference should be for short-term, targeted interventions, unless a chronic mental health condition is diagnosed in addition to a specific response to an event. THE SILVER LINING Overcoming a period of distress may increase resilience and help the patient face other future challenges! ",Medical,Effect Analysis,Q&A "Respond using only the information found within the text provided in the prompt. Avoid any mention of the government, its agencies, or specific regulations. If there are multiple paragraphs, each paragraph should be no longer than four sentences and must contain a clear introductory statement in the first sentence. If appropriate, format the response as a bulleted list. If information found in the text seems likely related to any legal or regulatory compliance, please include a disclaimer at the end of the response, in italics and enclosed in brackets, that explains the response is based only on the information provided.",What are ten strategies that are accepted for controlling disease in organic crops?,"Crop pest, weed, and disease management practice (§205.206) Producers must implement management practices to prevent crop pests, weeds, and diseases that include but are not limited to the following: Accepted pest controls:  Crop rotation and soil and crop nutrient management practices as outlined above.  Sanitation measures to remove disease vectors, weeds seeds and pest organisms.  Cultural practices to enhance crop health such as plant species and variety selection with regard to suitability for site-specific conditions and resistance to pests, weeds, and disease.  Mechanical and physical methods for controlling pest problems, such as: o Biological controls (natural predators and parasites, habitat to promote biodiversity) o Nonsynthetic controls such as lures, traps, fencing and repellants Accepted weed controls:  Mulching with fully biodegradable materials  Mowing  Livestock grazing  Hand weeding or mechanical cultivation  Flame, heat, or electrical means  Plastic or synthetic mulches if removed from the field at the end of the growing/harvest season Accepted disease controls:  Management practices which suppress the spread of disease organisms. Examples include plant spacing, choosing resistant varieties, and crop rotations. In greenhouses, this can also include the proper control of environmental factors such as ventilation, humidity and temperature.  Application of nonsynthetic biological, botanical, or mineral inputs When the above pest, weed and disease preventative management practices are not sufficient, the following practices are accepted:  Application of a biological or botanical substance  Application of a substance included on the National List of synthetic substances allowed for use in organic crop production Prohibited controls:  Synthetic mulches or remnants left to photo-degrade in the field  Synthetic herbicides, pesticides or fungicides with the exception of those included on the National List of synthetic substances allowed for use in organic crop production  Newspaper with color inks  Biodegradable plastic mulch films not compliant with the NOP guidance  Nonsynthetic substances included on the National List of nonsynthetic substances prohibited for use in organic crop production Post-Harvest Handling (§205.270 – 205.272) Sanitation Proper sanitation is required at all levels of handling, transport and storage. The use of disinfectants (chlorine materials, hydrogen peroxide) applied to storage containers and handling equipment must be consistent with the National List. Irrigation and Wash Water Ground and surface waters are a potential source for a wide range of contaminants. Verify your certifier’s recommendations for water testing of irrigation and wash water. Water used in direct post-harvest crop or food contact is permitted to contain chlorine materials at levels approved by the Food and Drug Administration or the Environmental Protection Agency for such purpose. However, rinsing with potable water that does not exceed the maximum residual disinfectant limit for the chlorine material under the Safe Drinking Water Act (4ppm) must immediately follow this permitted use. Certified operators should monitor the chlorine level of the final rinse water, the point at which the water last contacts the organic product. The level of chlorine in the final rinse water must meet limits as set forth by the Safe Drinking Water Act (4ppm). Commingling and contact with prohibited substances It is required that producers implement measures to prevent the commingling of organic and nonorganic products. It is also required that organic producers protect organic products from contact with prohibited substances. Split Operations Operations that choose to produce organic and non-organic livestock products or to hire services from custom operators that may service non-organic and organic clients, must implement measures necessary to prevent the commingling of organic and non-organic crop products. Accepted practices  Mechanical or biological methods including but not limited to cooking, baking, heating, drying, preserving, dehydrating, freezing, and chilling crop products.  Non-synthetic materials, such as rock powders, diatomaceous earth, and herbal preparations to repel storage pests, must be consistent with the National List of nonsynthetic substances prohibited for use in organic crop production.  The use of synthetic materials, such as floating agents, must be consistent with the National List of synthetic substances allowed for use in organic crop production.","What are ten strategies that are accepted for controlling disease in organic crops? quoted text: Crop pest, weed, and disease management practice (§205.206) Producers must implement management practices to prevent crop pests, weeds, and diseases that include but are not limited to the following: Accepted pest controls:  Crop rotation and soil and crop nutrient management practices as outlined above.  Sanitation measures to remove disease vectors, weeds seeds and pest organisms.  Cultural practices to enhance crop health such as plant species and variety selection with regard to suitability for site-specific conditions and resistance to pests, weeds, and disease.  Mechanical and physical methods for controlling pest problems, such as: o Biological controls (natural predators and parasites, habitat to promote biodiversity) o Nonsynthetic controls such as lures, traps, fencing and repellants Accepted weed controls:  Mulching with fully biodegradable materials  Mowing  Livestock grazing  Hand weeding or mechanical cultivation  Flame, heat, or electrical means  Plastic or synthetic mulches if removed from the field at the end of the growing/harvest season Accepted disease controls:  Management practices which suppress the spread of disease organisms. Examples include plant spacing, choosing resistant varieties, and crop rotations. In greenhouses, this can also include the proper control of environmental factors such as ventilation, humidity and temperature.  Application of nonsynthetic biological, botanical, or mineral inputs When the above pest, weed and disease preventative management practices are not sufficient, the following practices are accepted:  Application of a biological or botanical substance  Application of a substance included on the National List of synthetic substances allowed for use in organic crop production Prohibited controls:  Synthetic mulches or remnants left to photo-degrade in the field  Synthetic herbicides, pesticides or fungicides with the exception of those included on the National List of synthetic substances allowed for use in organic crop production  Newspaper with color inks  Biodegradable plastic mulch films not compliant with the NOP guidance  Nonsynthetic substances included on the National List of nonsynthetic substances prohibited for use in organic crop production Post-Harvest Handling (§205.270 – 205.272) Sanitation Proper sanitation is required at all levels of handling, transport and storage. The use of disinfectants (chlorine materials, hydrogen peroxide) applied to storage containers and handling equipment must be consistent with the National List. Irrigation and Wash Water Ground and surface waters are a potential source for a wide range of contaminants. Verify your certifier’s recommendations for water testing of irrigation and wash water. Water used in direct post-harvest crop or food contact is permitted to contain chlorine materials at levels approved by the Food and Drug Administration or the Environmental Protection Agency for such purpose. However, rinsing with potable water that does not exceed the maximum residual disinfectant limit for the chlorine material under the Safe Drinking Water Act (4ppm) must immediately follow this permitted use. Certified operators should monitor the chlorine level of the final rinse water, the point at which the water last contacts the organic product. The level of chlorine in the final rinse water must meet limits as set forth by the Safe Drinking Water Act (4ppm). Commingling and contact with prohibited substances It is required that producers implement measures to prevent the commingling of organic and nonorganic products. It is also required that organic producers protect organic products from contact with prohibited substances. Split Operations Operations that choose to produce organic and non-organic livestock products or to hire services from custom operators that may service non-organic and organic clients, must implement measures necessary to prevent the commingling of organic and non-organic crop products. Accepted practices  Mechanical or biological methods including but not limited to cooking, baking, heating, drying, preserving, dehydrating, freezing, and chilling crop products.  Non-synthetic materials, such as rock powders, diatomaceous earth, and herbal preparations to repel storage pests, must be consistent with the National List of nonsynthetic substances prohibited for use in organic crop production.  The use of synthetic materials, such as floating agents, must be consistent with the National List of synthetic substances allowed for use in organic crop production. system instruction: Respond using only the information found within the text provided in the prompt. Avoid any mention of the government, its agencies, or specific regulations. If there are multiple paragraphs, each paragraph should be no longer than four sentences and must contain a clear introductory statement in the first sentence. If appropriate, format the response as a bulleted list. If information found in the text seems likely related to any legal or regulatory compliance, please include a disclaimer at the end of the response, in italics and enclosed in brackets, that explains the response is based only on the information provided.",Legal,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","What is the differences and advantages of using wastewater as a surveillance tool as opposed to clinical testing? Despite using wastewater as a surveillance method, what piece of information if missing makes it a challenge to detect VOIs and VOCs? What are the advantages and disadvantages of using Illumina seq and Nanopore seq? What has past studies lacked that this study brings to light? What has led to the increase of NGS methods to detect variants? Why would using both seq methods produce a more robust variant call?","1. Introduction The SARS-CoV-2 genome is constantly evolving, with mutations happening at a rate of about once every 2 weeks [1]. While not all mutations change the characteristics of the virus, some mutations have proven to be of greater concern. Variants of interest (VOI) are labelled as such when an observed lineage is shown to have mutations potentially causing increased transmissibility or virulence, among other attributes [2]. Health organisations may reclassify these variants as variants of concern (VOC) if there is a demonstrable impact on epidemiological data. These viruses are labelled by WHO and assigned a lineage based on PANGO nomenclature [3]. Wastewater surveillance has emerged as a crucial tool in tracking mutations in the SARS-CoV-2 genome. Samples of untreated wastewater can be collected to provide useful information about the spread of COVID-19 in the community, without relying on clinical testing [4,5]. As clinical sampling mainly relies on symptomatic testing, wastewater sampling can provide unbiased and consistent data which can be used to inform appropriate public health responses. It is used to detect variants earlier and provide more context on the transmissibility and COVID-19 levels in communities, particularly where access to clinical testing is not readily available. As wastewater samples consist of a mixture of fragmented RNA from many sources, it can be difficult to accurately identify mutations and variants, particularly those without a known lineage [6]. Next-generation sequencing has proven to be an important tool in pandemic surveillance, particularly in the early detection and spread of variants [7-9]. With a high rate of occurrence of mutations and increased transmissibility, the need to provide high throughput data generation in a relatively short time frame has led to the development of a number of tools and protocols using next-generation sequencing, such as SARS-CoV-2 specific primers and tools to determine lineage in samples. These sequencing methods have been useful in analysing clinical and environmental samples, assisting in tracking viral load, transmission, contact tracing, and virus evolution [8]. Illumina and Nanopore sequencing are two next-generation sequencing technologies that have become major tools in genomic research. Illumina sequencing is a second-generation sequencing technology that uses sequencing by synthesis (SBS), where a reversible fluorescent terminator is used to detect the nucleotide sequence [10,11]. Nanopore sequencing is a thirdgeneration sequencing technology that uses the current changes in a charged protein nanopore from the molecule passing through to determine the specific sequence [10,12]. Multiple studies have been done on the comparison of Nanopore and Illumina sequencing, highlighting their various advantages in different applications [13-15]. Illumina sequencing is widely regarded as being highly accurate, consistently sequencing around 99.5-99.9% accuracy, and the higher depth of reads enables it to be a useful tool in circumstances with poor sequencing coverage, such as wastewater surveillance [16]. Nanopore sequencing has the ability to produce ultra-long reads, only limited by the sample preparation and quality, and is useful in genomic assembly and spanning entire regions of repetitive bases and structural variation [17]. Furthermore, real-time analysis of sequences and portability of sequencing devices has benefits in the field. Studies have been completed comparing Illumina and Nanopore sequencing on clinical and wastewater SARSCoV-2 samples, which focuses on benchmarking parameters such as genome coverage and depth and variant calling on samples. However, they did not explore the combination of the two sequencing technologies as a method to improve detection of variants [18-20]. In this work, we look to highlight the advantages of both Illumina and Nanopore sequencing in tracking SARSCoV-2 variants from wastewater samples. Mutational analysis on samples sequenced with both methods allows for a comparison of major variants identified among each dataset.","[question] What is the differences and advantages of using wastewater as a surveillance tool as opposed to clinical testing? Despite using wastewater as a surveillance method, what piece of information if missing makes it a challenge to detect VOIs and VOCs? What are the advantages and disadvantages of using Illumina seq and Nanopore seq? What has past studies lacked that this study brings to light? What has led to the increase of NGS methods to detect variants? Why would using both seq methods produce a more robust variant call? ===================== [text] 1. Introduction The SARS-CoV-2 genome is constantly evolving, with mutations happening at a rate of about once every 2 weeks [1]. While not all mutations change the characteristics of the virus, some mutations have proven to be of greater concern. Variants of interest (VOI) are labelled as such when an observed lineage is shown to have mutations potentially causing increased transmissibility or virulence, among other attributes [2]. Health organisations may reclassify these variants as variants of concern (VOC) if there is a demonstrable impact on epidemiological data. These viruses are labelled by WHO and assigned a lineage based on PANGO nomenclature [3]. Wastewater surveillance has emerged as a crucial tool in tracking mutations in the SARS-CoV-2 genome. Samples of untreated wastewater can be collected to provide useful information about the spread of COVID-19 in the community, without relying on clinical testing [4,5]. As clinical sampling mainly relies on symptomatic testing, wastewater sampling can provide unbiased and consistent data which can be used to inform appropriate public health responses. It is used to detect variants earlier and provide more context on the transmissibility and COVID-19 levels in communities, particularly where access to clinical testing is not readily available. As wastewater samples consist of a mixture of fragmented RNA from many sources, it can be difficult to accurately identify mutations and variants, particularly those without a known lineage [6]. Next-generation sequencing has proven to be an important tool in pandemic surveillance, particularly in the early detection and spread of variants [7-9]. With a high rate of occurrence of mutations and increased transmissibility, the need to provide high throughput data generation in a relatively short time frame has led to the development of a number of tools and protocols using next-generation sequencing, such as SARS-CoV-2 specific primers and tools to determine lineage in samples. These sequencing methods have been useful in analysing clinical and environmental samples, assisting in tracking viral load, transmission, contact tracing, and virus evolution [8]. Illumina and Nanopore sequencing are two next-generation sequencing technologies that have become major tools in genomic research. Illumina sequencing is a second-generation sequencing technology that uses sequencing by synthesis (SBS), where a reversible fluorescent terminator is used to detect the nucleotide sequence [10,11]. Nanopore sequencing is a thirdgeneration sequencing technology that uses the current changes in a charged protein nanopore from the molecule passing through to determine the specific sequence [10,12]. Multiple studies have been done on the comparison of Nanopore and Illumina sequencing, highlighting their various advantages in different applications [13-15]. Illumina sequencing is widely regarded as being highly accurate, consistently sequencing around 99.5-99.9% accuracy, and the higher depth of reads enables it to be a useful tool in circumstances with poor sequencing coverage, such as wastewater surveillance [16]. Nanopore sequencing has the ability to produce ultra-long reads, only limited by the sample preparation and quality, and is useful in genomic assembly and spanning entire regions of repetitive bases and structural variation [17]. Furthermore, real-time analysis of sequences and portability of sequencing devices has benefits in the field. Studies have been completed comparing Illumina and Nanopore sequencing on clinical and wastewater SARSCoV-2 samples, which focuses on benchmarking parameters such as genome coverage and depth and variant calling on samples. However, they did not explore the combination of the two sequencing technologies as a method to improve detection of variants [18-20]. In this work, we look to highlight the advantages of both Illumina and Nanopore sequencing in tracking SARSCoV-2 variants from wastewater samples. Mutational analysis on samples sequenced with both methods allows for a comparison of major variants identified among each dataset. https://www.medrxiv.org/content/10.1101/2024.08.07.24311639v1.full.pdf ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Find & Summarize,Text Transformation "Do not use any outside information, but only the information in the context to inform your answer. Write your response as a news article with a neutral tone. ","In 2003, how had financial reporting in the Federal Government progressed?","MANAGEMENT’S DISCUSSION AND ANALYSIS Introduction The quality and timeliness of financial reporting in the Federal Government has come a long way since the first Governmentwide report subject to audit issued in March 1998 for fiscal year 1997. At that time, only 8 of the 24 Chief Financial Officers Act (CFO Act) agencies received clean opinions on their 1997 financial statements. This year, 20 of the 24 agencies received clean opinions and 21 of the 32 entities, most significant to these statements, had audited financial statements issued by the end of the calendar year. This improvement in both quality and timeliness was concurrent with the application of new accounting principles and new accounting systems, and involved performing reconciliations that had never been attempted before. This has been a monumental effort requiring years of planning and preparation and the efforts of thousands. However, we still have much to accomplish before we meet our objective of timely, useful financial reporting. The accompanying 2003 Financial Report of the United States Government is required by 31 U.S.C. § 331(e)(1) to be submitted to Congress by March 31, and consists of Management’s Discussion and Analysis (MD&A), Statements of Net Cost, Statements of Operations and Changes in Net Position, Reconciliations of Net Operating Cost and Unified Budget Deficit, Statements of Changes in Cash Balance from Unified Budget and Other Activities, Balance Sheets, Stewardship Information (Unaudited), Notes to the Financial Statements, and Supplemental Information (Unaudited). Each section is preceded by a description of its contents. Executive Summary Purpose This Financial Report of the United States Government is prepared to give the President, Congress, and the American people information about the financial position of the Federal Government. This report provides, on an accrual basis of accounting, a broad, comprehensive view of the Federal Government’s finances that is not available elsewhere. It states the Government’s financial position and condition, its revenues and costs, assets and liabilities, and other obligations and commitments. It also discusses important financial issues and significant conditions that may affect future operations. Operating Results Revenues were down by $81.7 billion primarily due to lower tax collections and costs were up by $225.8 billion due to, among other things, fighting the global war on terrorism. This resulted in a net operating cost of $665.0 billion. This compares with the net operating cost of $364.9 billion for fiscal year 2002. This MD&A discusses results in a historical context and includes a chart (page 17) that shows the relationship of prior U.S. budget deficits as a percentage of the U.S. gross domestic product (GDP), which is the total value of goods and services produced in the United States. Economic Results After recovering in fiscal year 2002 from the economic downturn, the economy continued to accelerate in fiscal year 2003 and achieved strong growth. The rate of increase in real GDP picked up in each of the last three quarters of the fiscal year and productivity continued to record substantial gains. The labor market stabilized in fiscal year 2003 following job losses in the previous year and in the final quarter of the fiscal year, employment began to increase. Improvement in the economy was aided by new fiscal policies in 2003, but the lingering effect of the recession and loss in equity wealth, the war with Iraq, homeland security spending, and lower taxes enacted to stimulate growth contributed to a widening in the Federal budget deficit to $374.8 billion for the fiscal year. Overall Perspective The 2003 balance sheet shows assets of $1,394 billion and liabilities of $8,499 billion, for a balance or negative net position of $7,105 billion. The Government’s responsibilities to make future payments for social insurance and certain other programs are not shown as liabilities according to Federal accounting standards; however, they are measured in other contexts. These programmatic commitments remain Federal responsibilities and as currently structured will have a significant claim on budgetary resources in the future. Significant Reporting Items for Fiscal Year 2003 Department of Defense Property Addition In fiscal year 2003, the Department of Defense’s (DOD) reported general property, plant, and equipment, net increased by $323.7 billion or 264.2 percent over fiscal year 2002. The majority of this increase was due to the initial recording of the value of DOD’s military equipment. Beginning with the fiscal year 2003 financial statements, DOD was required to record on the balance sheet the value of its military equipment under the new Statement of Federal Financial Accounting Standard No. 23, Eliminating the Category National Defense Property, Plant, and Equipment (SFFAS No. 23) issued by the Federal Accounting Standards Advisory Board (FASAB) in May 2003. SFFAS No. 23 establishes generally accepted accounting principles for valuing and reporting military equipment in Federal financial statements. Previously, military equipment was reported as national defense property, plant, and equipment in the Stewardship Information section of this report. Creation of the Department of Homeland Security On March 1, 2003, more than 20 entities and offices and some 180,000 employees were transferred into the Department of Homeland Security (DHS). The creation of the DHS in 2003 was the most significant transformation of the Federal Government since 1947 when the various branches of the U.S. Armed Forces were merged into a new Department of Defense. In the aftermath of the September 11, 2001, terrorist attacks, the President and the Congress recognized the need to coordinate the efforts of many Federal agencies, offices, and programs which had responsibility for various aspects of protecting and securing our homeland. President Bush proposed the creation of DHS, and Congress passed legislation establishing this new department. See the U.S. Government Structure & Performance section of this report for further details and a chart showing the entities transferred into DHS. Iraq Operations In March 2003, an international coalition led by the United States liberated Iraq and is overseeing a transformation. The vision for a sovereign, stable, prosperous, and democratic Iraq centered on four goals: establishing a secure environment, restoring essential services, promoting economic growth, and developing good governance through a legitimate constitutional government. To conduct military operations and address these goals in 2003, several sources of funding were used: appropriated and nonappropriated funds (seized and vested assets and the Development Fund for Iraq). U.S. agencies obligated $3.9 billion in appropriated funds for Iraq relief, renewal, and construction. Congress also appropriated funds to DOD for Operation Iraqi Freedom in the Emergency Wartime Supplemental Appropriations Act, 2003 (Public Law 108-11) the Consolidated Appropriations Resolution, 2003 (Public Law 108-7). DOD obligated $42.4 billion for incremental costs in support of Iraqi Freedom. For further discussion of the cost of Iraq operations and funding sources and uses, see Iraq Operations in the Financial Results section at the end of the Revenue and Cost Summary. As recently as 1996, not only were just six agencies able to issue financial statements with clean opinions, but most agencies took as least 5 months to issue them. Before implementing the Improved Financial Performance Initiative of the President’s Management Agenda, 18 of 24 of the Government’s major agencies received clean opinions on their audited financial reports, however, it still took 5 months to prepare most of them. Today, most major agencies are getting clean audit opinions and issuing them in a condensed period of time. A clean audit opinion provides assurance that agencies are responsibly accounting for the people’s money. If it takes them 5 months to issue audited financial statements, however, it is a good indication they do not have timely and accurate financial information available on a regular basis. That is why the Administration is working with all agencies to close their books more quickly. Eight agencies have accelerated the issuance of audited financial reports to 45 days after year end, which is the 2004 Governmentwide requirement. One particular agency of note is the U.S. Agency for International Development (USAID), which not only accelerated the reporting of its financial statements, but also received a clean opinion for the first time in its history. Additionally, agencies are now reporting quarterly financial information in addition to the end of the year data. Through the first quarter of fiscal year 2004, four agencies–Education, Environmental Protection Agency (EPA), National Science Foundation (NSF), and SSA – have demonstrated their ability to use timely and accurate financial information to make decisions about program management. For example, Education uses up-to-the-minute financial data to track whether schools are receiving the appropriate amount of Federal funds. In addition, EPA’s Leaking Underground Storage Tank program negotiates performance commitments with grantees and provides resources based on those commitments. If a grantee is not meeting its commitments, EPA may withhold some resources from the nonperformers and redirect those resources to grantees that are meeting their commitments. ","In 2003, how had financial reporting in the Federal Government progressed? Instructions: Do not use any outside information, but only the information in the context to inform your answer. Write your response as a news article with a neutral tone. Context: MANAGEMENT’S DISCUSSION AND ANALYSIS Introduction The quality and timeliness of financial reporting in the Federal Government has come a long way since the first Governmentwide report subject to audit issued in March 1998 for fiscal year 1997. At that time, only 8 of the 24 Chief Financial Officers Act (CFO Act) agencies received clean opinions on their 1997 financial statements. This year, 20 of the 24 agencies received clean opinions and 21 of the 32 entities, most significant to these statements, had audited financial statements issued by the end of the calendar year. This improvement in both quality and timeliness was concurrent with the application of new accounting principles and new accounting systems, and involved performing reconciliations that had never been attempted before. This has been a monumental effort requiring years of planning and preparation and the efforts of thousands. However, we still have much to accomplish before we meet our objective of timely, useful financial reporting. The accompanying 2003 Financial Report of the United States Government is required by 31 U.S.C. § 331(e)(1) to be submitted to Congress by March 31, and consists of Management’s Discussion and Analysis (MD&A), Statements of Net Cost, Statements of Operations and Changes in Net Position, Reconciliations of Net Operating Cost and Unified Budget Deficit, Statements of Changes in Cash Balance from Unified Budget and Other Activities, Balance Sheets, Stewardship Information (Unaudited), Notes to the Financial Statements, and Supplemental Information (Unaudited). Each section is preceded by a description of its contents. Executive Summary Purpose This Financial Report of the United States Government is prepared to give the President, Congress, and the American people information about the financial position of the Federal Government. This report provides, on an accrual basis of accounting, a broad, comprehensive view of the Federal Government’s finances that is not available elsewhere. It states the Government’s financial position and condition, its revenues and costs, assets and liabilities, and other obligations and commitments. It also discusses important financial issues and significant conditions that may affect future operations. Operating Results Revenues were down by $81.7 billion primarily due to lower tax collections and costs were up by $225.8 billion due to, among other things, fighting the global war on terrorism. This resulted in a net operating cost of $665.0 billion. This compares with the net operating cost of $364.9 billion for fiscal year 2002. This MD&A discusses results in a historical context and includes a chart (page 17) that shows the relationship of prior U.S. budget deficits as a percentage of the U.S. gross domestic product (GDP), which is the total value of goods and services produced in the United States. Economic Results After recovering in fiscal year 2002 from the economic downturn, the economy continued to accelerate in fiscal year 2003 and achieved strong growth. The rate of increase in real GDP picked up in each of the last three quarters of the fiscal year and productivity continued to record substantial gains. The labor market stabilized in fiscal year 2003 following job losses in the previous year and in the final quarter of the fiscal year, employment began to increase. Improvement in the economy was aided by new fiscal policies in 2003, but the lingering effect of the recession and loss in equity wealth, the war with Iraq, homeland security spending, and lower taxes enacted to stimulate growth contributed to a widening in the Federal budget deficit to $374.8 billion for the fiscal year. Overall Perspective The 2003 balance sheet shows assets of $1,394 billion and liabilities of $8,499 billion, for a balance or negative net position of $7,105 billion. The Government’s responsibilities to make future payments for social insurance and certain other programs are not shown as liabilities according to Federal accounting standards; however, they are measured in other contexts. These programmatic commitments remain Federal responsibilities and as currently structured will have a significant claim on budgetary resources in the future. Significant Reporting Items for Fiscal Year 2003 Department of Defense Property Addition In fiscal year 2003, the Department of Defense’s (DOD) reported general property, plant, and equipment, net increased by $323.7 billion or 264.2 percent over fiscal year 2002. The majority of this increase was due to the initial recording of the value of DOD’s military equipment. Beginning with the fiscal year 2003 financial statements, DOD was required to record on the balance sheet the value of its military equipment under the new Statement of Federal Financial Accounting Standard No. 23, Eliminating the Category National Defense Property, Plant, and Equipment (SFFAS No. 23) issued by the Federal Accounting Standards Advisory Board (FASAB) in May 2003. SFFAS No. 23 establishes generally accepted accounting principles for valuing and reporting military equipment in Federal financial statements. Previously, military equipment was reported as national defense property, plant, and equipment in the Stewardship Information section of this report. Creation of the Department of Homeland Security On March 1, 2003, more than 20 entities and offices and some 180,000 employees were transferred into the Department of Homeland Security (DHS). The creation of the DHS in 2003 was the most significant transformation of the Federal Government since 1947 when the various branches of the U.S. Armed Forces were merged into a new Department of Defense. In the aftermath of the September 11, 2001, terrorist attacks, the President and the Congress recognized the need to coordinate the efforts of many Federal agencies, offices, and programs which had responsibility for various aspects of protecting and securing our homeland. President Bush proposed the creation of DHS, and Congress passed legislation establishing this new department. See the U.S. Government Structure & Performance section of this report for further details and a chart showing the entities transferred into DHS. Iraq Operations In March 2003, an international coalition led by the United States liberated Iraq and is overseeing a transformation. The vision for a sovereign, stable, prosperous, and democratic Iraq centered on four goals: establishing a secure environment, restoring essential services, promoting economic growth, and developing good governance through a legitimate constitutional government. To conduct military operations and address these goals in 2003, several sources of funding were used: appropriated and nonappropriated funds (seized and vested assets and the Development Fund for Iraq). U.S. agencies obligated $3.9 billion in appropriated funds for Iraq relief, renewal, and construction. Congress also appropriated funds to DOD for Operation Iraqi Freedom in the Emergency Wartime Supplemental Appropriations Act, 2003 (Public Law 108-11) the Consolidated Appropriations Resolution, 2003 (Public Law 108-7). DOD obligated $42.4 billion for incremental costs in support of Iraqi Freedom. For further discussion of the cost of Iraq operations and funding sources and uses, see Iraq Operations in the Financial Results section at the end of the Revenue and Cost Summary. As recently as 1996, not only were just six agencies able to issue financial statements with clean opinions, but most agencies took as least 5 months to issue them. Before implementing the Improved Financial Performance Initiative of the President’s Management Agenda, 18 of 24 of the Government’s major agencies received clean opinions on their audited financial reports, however, it still took 5 months to prepare most of them. Today, most major agencies are getting clean audit opinions and issuing them in a condensed period of time. A clean audit opinion provides assurance that agencies are responsibly accounting for the people’s money. If it takes them 5 months to issue audited financial statements, however, it is a good indication they do not have timely and accurate financial information available on a regular basis. That is why the Administration is working with all agencies to close their books more quickly. Eight agencies have accelerated the issuance of audited financial reports to 45 days after year end, which is the 2004 Governmentwide requirement. One particular agency of note is the U.S. Agency for International Development (USAID), which not only accelerated the reporting of its financial statements, but also received a clean opinion for the first time in its history. Additionally, agencies are now reporting quarterly financial information in addition to the end of the year data. Through the first quarter of fiscal year 2004, four agencies–Education, Environmental Protection Agency (EPA), National Science Foundation (NSF), and SSA – have demonstrated their ability to use timely and accurate financial information to make decisions about program management. For example, Education uses up-to-the-minute financial data to track whether schools are receiving the appropriate amount of Federal funds. In addition, EPA’s Leaking Underground Storage Tank program negotiates performance commitments with grantees and provides resources based on those commitments. If a grantee is not meeting its commitments, EPA may withhold some resources from the nonperformers and redirect those resources to grantees that are meeting their commitments. ",Financial,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",Elon Musk is sending people to space! This is crazy lol. There was a recent exploration where a few non astronauts went up. They're just rich people flexing their money. How experirced is the owner with trips to space? What are some specs from the trip and how did this trip benefit the company?,"Tech billionaire returns to Earth after first private spacewalk By MARCIA DUNN Updated 10:38 AM EDT, September 15, 2024 Share CAPE CANAVERAL, Fla. (AP) — A billionaire spacewalker returned to Earth with his crew on Sunday, ending a five-day trip that lifted them higher than anyone has traveled since NASA’s moonwalkers. SpaceX’s capsule splashed down in the Gulf of Mexico near Florida’s Dry Tortugas in the predawn darkness, carrying tech entrepreneur Jared Isaacman, two SpaceX engineers and a former Air Force Thunderbird pilot. They pulled off the first private spacewalk while orbiting nearly 460 miles (740 kilometers) above Earth, higher than the International Space Station and Hubble Space Telescope. Their spacecraft hit a peak altitude of 875 miles (1,408 kilometers) following Tuesday’s liftoff. Isaacman became only the 264th person to perform a spacewalk since the former Soviet Union scored the first in 1965, and SpaceX’s Sarah Gillis the 265th. Until now, all spacewalks were done by professional astronauts. RELATED COVERAGE Image Iran says it successfully launched a satellite in its program criticized by West over missile fears Image Stuck-in-space astronauts reflect on being left behind and adjusting to life in orbit Image Striking Boeing factory workers say they are ready to hold out for a better contract “We are mission complete,” Isaacman radioed as the capsule bobbed in the water, awaiting the recovery team. Within an hour, all four were out of their spacecraft, pumping their fists with joy as they emerged onto the ship’s deck. It was the first time SpaceX aimed for a splashdown near the Dry Tortugas, a cluster of islands 70 miles (113 kilometers) west of Key West. To celebrate the new location, SpaceX employees brought a big, green turtle balloon to Mission Control at company headquarters in Hawthorne, California. The company usually targets closer to the Florida coast, but two weeks of poor weather forecasts prompted SpaceX to look elsewhere. During Thursday’s commercial spacewalk, the Dragon capsule’s hatch was open barely a half-hour. Isaacman emerged only up to his waist to briefly test SpaceX’s brand new spacesuit followed by Gillis, who was knee high as she flexed her arms and legs for several minutes. Gillis, a classically trained violinist, also held a performance in orbit earlier in the week. Image This image made from SpaceX video shows the four-member crew including tech entrepreneur Jared Isaacman, third left, seated in its capsule as they wait to get off the capsule after it landed in the Gulf of Mexico near Florida’s Dry Tortugas early Sunday, Sept. 15, 2024. (SpaceX via AP) The spacewalk lasted less than two hours, considerably shorter than those at the International Space Station. Most of that time was needed to depressurize the entire capsule and then restore the cabin air. Even SpaceX’s Anna Menon and Scott “Kidd” Poteet, who remained strapped in, wore spacesuits. SpaceX considers the brief exercise a starting point to test spacesuit technology for future, longer missions to Mars. This was Isaacman’s second chartered flight with SpaceX, with two more still ahead under his personally financed space exploration program named Polaris after the North Star. He paid an undisclosed sum for his first spaceflight in 2021, taking along contest winners and a pediatric cancer survivor while raising more than $250 million for St. Jude Children’s Research Hospital. For the just completed so-called Polaris Dawn mission, the founder and CEO of the Shift4 credit card-processing company shared the cost with SpaceX. Isaacman won’t divulge how much he spent. ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content."," Only use the provided text to answer the question, no outside sources. Elon Musk is sending people to space! This is crazy lol. There was a recent exploration where a few non astronauts went up. They're just rich people flexing their money. How experirced is the owner with trips to space? What are some specs from the trip and how did this trip benefit the company? Tech billionaire returns to Earth after first private spacewalk By MARCIA DUNN Updated 10:38 AM EDT, September 15, 2024 Share CAPE CANAVERAL, Fla. (AP) — A billionaire spacewalker returned to Earth with his crew on Sunday, ending a five-day trip that lifted them higher than anyone has traveled since NASA’s moonwalkers. SpaceX’s capsule splashed down in the Gulf of Mexico near Florida’s Dry Tortugas in the predawn darkness, carrying tech entrepreneur Jared Isaacman, two SpaceX engineers and a former Air Force Thunderbird pilot. They pulled off the first private spacewalk while orbiting nearly 460 miles (740 kilometers) above Earth, higher than the International Space Station and Hubble Space Telescope. Their spacecraft hit a peak altitude of 875 miles (1,408 kilometers) following Tuesday’s liftoff. Isaacman became only the 264th person to perform a spacewalk since the former Soviet Union scored the first in 1965, and SpaceX’s Sarah Gillis the 265th. Until now, all spacewalks were done by professional astronauts. RELATED COVERAGE Image Iran says it successfully launched a satellite in its program criticized by West over missile fears Image Stuck-in-space astronauts reflect on being left behind and adjusting to life in orbit Image Striking Boeing factory workers say they are ready to hold out for a better contract “We are mission complete,” Isaacman radioed as the capsule bobbed in the water, awaiting the recovery team. Within an hour, all four were out of their spacecraft, pumping their fists with joy as they emerged onto the ship’s deck. It was the first time SpaceX aimed for a splashdown near the Dry Tortugas, a cluster of islands 70 miles (113 kilometers) west of Key West. To celebrate the new location, SpaceX employees brought a big, green turtle balloon to Mission Control at company headquarters in Hawthorne, California. The company usually targets closer to the Florida coast, but two weeks of poor weather forecasts prompted SpaceX to look elsewhere. During Thursday’s commercial spacewalk, the Dragon capsule’s hatch was open barely a half-hour. Isaacman emerged only up to his waist to briefly test SpaceX’s brand new spacesuit followed by Gillis, who was knee high as she flexed her arms and legs for several minutes. Gillis, a classically trained violinist, also held a performance in orbit earlier in the week. Image This image made from SpaceX video shows the four-member crew including tech entrepreneur Jared Isaacman, third left, seated in its capsule as they wait to get off the capsule after it landed in the Gulf of Mexico near Florida’s Dry Tortugas early Sunday, Sept. 15, 2024. (SpaceX via AP) The spacewalk lasted less than two hours, considerably shorter than those at the International Space Station. Most of that time was needed to depressurize the entire capsule and then restore the cabin air. Even SpaceX’s Anna Menon and Scott “Kidd” Poteet, who remained strapped in, wore spacesuits. SpaceX considers the brief exercise a starting point to test spacesuit technology for future, longer missions to Mars. This was Isaacman’s second chartered flight with SpaceX, with two more still ahead under his personally financed space exploration program named Polaris after the North Star. He paid an undisclosed sum for his first spaceflight in 2021, taking along contest winners and a pediatric cancer survivor while raising more than $250 million for St. Jude Children’s Research Hospital. For the just completed so-called Polaris Dawn mission, the founder and CEO of the Shift4 credit card-processing company shared the cost with SpaceX. Isaacman won’t divulge how much he spent. ___ The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content. https://apnews.com/article/spacex-private-spacewalk-polaris-dawn-e5635c75b15b2f298e426b4992bcde86",Internet/Technology,Find & Summarize,Text Transformation You must respond using only information contained in the provided context block.,Why are auto service advisors exempt from overtime pay? Respond in at least 200 words,"The Supreme Court concluded recently that car dealership employees who discuss service options with customers are exempt from the Fair Labor Standards Act’s (FLSA) overtime pay requirement. In Encino Motorcars, LLC v. Navarro, the Court determined that these so-called “service advisors” fell within the statute’s exemption for “any salesman, partsman, or mechanic primarily engaged in selling or servicing automobiles[.]” While the Court’s decision would seem to affect only a small group of employees, it is notable for what it said with regard to interpreting the FLSA. Justice Thomas, writing for the majority, rejected the long-followed principle that the FLSA’s exemptions should be construed narrowly to promote the statute’s remedial purpose. The majority maintained that the exemptions are entitled to nothing more than a “fair reading” because the FLSA “gives no ‘textual indication’ that its exemptions should be construed narrowly . . .” Application of this new fair reading standard could result in a greater number of employees being deemed exempt from the FLSA’s overtime pay requirement. A dramatic increase in exempt workers could prompt Congress to consider an amendment to the FLSA that perhaps identifies the exemptions with more specificity or prescribes a new standard for evaluating the exempt status of employees. The FLSA requires the payment of overtime compensation at a rate of not less than one and one-half times an employee’s hourly rate for hours worked in excess of a 40-hour workweek. Section 13 of the FLSA identifies numerous employees who are exempt from this requirement. In addition to the automobile salesmen, partsmen, and mechanics discussed in Encino Motorcars, individuals employed as seamen, specified agricultural workers, and certain computer employees are also exempt. Workers employed in a bona fide executive, administrative, or professional capacity arguably comprise the largest category of exempt workers. Since 1945, the Supreme Court has characterized the FLSA as “humanitarian and remedial legislation” designed to ensure “a fair day’s pay for a fair day’s work.” In A.H. Phillips, Inc. v. Walling, the Court declined to find employees working in the warehouse and central office of an interstate grocery store chain exempt from the statute’s overtime pay requirement. While the store chain attempted to characterize the employees as within the FLSA’s now-repealed section 13(a)(2) exemption for “any employee engaged in any retail or service establishment the greater part of whose selling or servicing is in Congressional Research Service https://crsreports.congress.gov LSB10122 Congressional Research Service 2 intrastate commerce,” the Court maintained that these workers performed duties in a wholesale environment that was distinct from the retail establishment contemplated by the exemption. The Court explained in A.H. Phillips that any exemption from humanitarian and remedial legislation must be narrowly construed and give due regard to the law’s plain meaning and congressional intent: “To extend an exemption to other than those plainly and unmistakably within its terms and spirit is to abuse the interpretative process and to frustrate the announced will of the people.” After reviewing the terms used in section 13(a)(2) and the exemption’s legislative history, the Court distinguished the warehouse and central office workers from other employees who should be exempt under that section. The Court reasoned that the terms used in section 13(a)(2) indicate that only those employees engaged in a retail or service establishment that operates primarily in local commerce are to be exempt. Moreover, the Court noted that Congress’s interest in exempting only those workers regularly engaged in local retailing activities was supported by section 13(a)(2)’s legislative history. This history showed a congressional understanding that local retail concerns “do not sufficiently influence the stream of interstate commerce to warrant imposing the wage and hour requirements on them.” The exemption guaranteed that the employees of small retail establishments would be exempt from the FLSA’s requirements. Unlike these kinds of employees, the warehouse and central office workers in A.H. Phillips were like the employees of an independent wholesaler that dealt constantly with incoming and outgoing interstate shipments. In subsequent decisions, the Court has continued to interpret the FLSA’s exemptions narrowly. In Mitchell v. Kentucky Finance Co., for example, the Court concluded that the employees of a company making personal loans were not exempt from the FLSA’s overtime pay and recordkeeping requirements. The company argued that it was a retail or service establishment within the meaning of section 13(a)(2), and that its employees should be exempt from the relevant requirements. Citing the exemption’s legislative history, however, the Court determined that personal loan companies and other financial institutions were not meant to be covered by section 13(a)(2). The Court emphasized that the FLSA’s exemptions are to be narrowly construed, and noted that businesses that were meant to have an exemption were specifically provided one by the statute. ","System instruction: You must respond using only information contained in the provided context block. Question: Why are auto service advisors exempt from overtime pay? Respond in at least 200 words Context Block: The Supreme Court concluded recently that car dealership employees who discuss service options with customers are exempt from the Fair Labor Standards Act’s (FLSA) overtime pay requirement. In Encino Motorcars, LLC v. Navarro, the Court determined that these so-called “service advisors” fell within the statute’s exemption for “any salesman, partsman, or mechanic primarily engaged in selling or servicing automobiles[.]” While the Court’s decision would seem to affect only a small group of employees, it is notable for what it said with regard to interpreting the FLSA. Justice Thomas, writing for the majority, rejected the long-followed principle that the FLSA’s exemptions should be construed narrowly to promote the statute’s remedial purpose. The majority maintained that the exemptions are entitled to nothing more than a “fair reading” because the FLSA “gives no ‘textual indication’ that its exemptions should be construed narrowly . . .” Application of this new fair reading standard could result in a greater number of employees being deemed exempt from the FLSA’s overtime pay requirement. A dramatic increase in exempt workers could prompt Congress to consider an amendment to the FLSA that perhaps identifies the exemptions with more specificity or prescribes a new standard for evaluating the exempt status of employees. The FLSA requires the payment of overtime compensation at a rate of not less than one and one-half times an employee’s hourly rate for hours worked in excess of a 40-hour workweek. Section 13 of the FLSA identifies numerous employees who are exempt from this requirement. In addition to the automobile salesmen, partsmen, and mechanics discussed in Encino Motorcars, individuals employed as seamen, specified agricultural workers, and certain computer employees are also exempt. Workers employed in a bona fide executive, administrative, or professional capacity arguably comprise the largest category of exempt workers. Since 1945, the Supreme Court has characterized the FLSA as “humanitarian and remedial legislation” designed to ensure “a fair day’s pay for a fair day’s work.” In A.H. Phillips, Inc. v. Walling, the Court declined to find employees working in the warehouse and central office of an interstate grocery store chain exempt from the statute’s overtime pay requirement. While the store chain attempted to characterize the employees as within the FLSA’s now-repealed section 13(a)(2) exemption for “any employee engaged in any retail or service establishment the greater part of whose selling or servicing is in Congressional Research Service https://crsreports.congress.gov LSB10122 Congressional Research Service 2 intrastate commerce,” the Court maintained that these workers performed duties in a wholesale environment that was distinct from the retail establishment contemplated by the exemption. The Court explained in A.H. Phillips that any exemption from humanitarian and remedial legislation must be narrowly construed and give due regard to the law’s plain meaning and congressional intent: “To extend an exemption to other than those plainly and unmistakably within its terms and spirit is to abuse the interpretative process and to frustrate the announced will of the people.” After reviewing the terms used in section 13(a)(2) and the exemption’s legislative history, the Court distinguished the warehouse and central office workers from other employees who should be exempt under that section. The Court reasoned that the terms used in section 13(a)(2) indicate that only those employees engaged in a retail or service establishment that operates primarily in local commerce are to be exempt. Moreover, the Court noted that Congress’s interest in exempting only those workers regularly engaged in local retailing activities was supported by section 13(a)(2)’s legislative history. This history showed a congressional understanding that local retail concerns “do not sufficiently influence the stream of interstate commerce to warrant imposing the wage and hour requirements on them.” The exemption guaranteed that the employees of small retail establishments would be exempt from the FLSA’s requirements. Unlike these kinds of employees, the warehouse and central office workers in A.H. Phillips were like the employees of an independent wholesaler that dealt constantly with incoming and outgoing interstate shipments. In subsequent decisions, the Court has continued to interpret the FLSA’s exemptions narrowly. In Mitchell v. Kentucky Finance Co., for example, the Court concluded that the employees of a company making personal loans were not exempt from the FLSA’s overtime pay and recordkeeping requirements. The company argued that it was a retail or service establishment within the meaning of section 13(a)(2), and that its employees should be exempt from the relevant requirements. Citing the exemption’s legislative history, however, the Court determined that personal loan companies and other financial institutions were not meant to be covered by section 13(a)(2). The Court emphasized that the FLSA’s exemptions are to be narrowly construed, and noted that businesses that were meant to have an exemption were specifically provided one by the statute. ",Retail/Product,Find & Summarize,Text Transformation "Only use the information provided in the prompt to answer the question. Use no external sources or prior knowledge. Use 150 words or less. Question: What are the differences between OSI RM and TCP/IP layers?",Question: What are the differences between OSI RM and TCP/IP layers?,"2.2.2 ISO MODEL The International Standards Organization (ISO), based in Geneva Switzerland, is composed of groups for various countries that set standards working towards the establishment of world-wide standards for communication and data exchange. One notable accomplishment has been the development of a reference model that contains specifications for a network architecture for connecting dissimilar computers, with a main goal being that of producing an open and non-proprietary method of data communication. This reference model, called the Open Systems Interconnect Reference Model (OSI RM), was developed in 1981 (?) and revised in 1984. The OSI RM uses 7 layers, each independent of each other, to allow computers to exchange data. To transfer a message from user A to user B, the data has to pass through the 7 layers on user's A machine, before being transmitted through the selected medium. At the receiving computer of user B, the data must then pass through the 7 layers again, this time in reverse sequence, before being received by user B. For data to be transferred, it must pass through all 7 layers on both computers. Each layer follows a relatively strict specification and this allows the differing layers to be produced and implemented by different concerns. Each layer can then interface with its neighboring layers even though they may have been developed by different groups. One way of viewing the activities of the layers is that as the original message passes down the layers towards the medium on the computer of user A, additional information, for both formatting or addressing information, is added to the beginning or end of the message. The additional information is added to ensure correct communication. At the other end (i.e. at user B) this information is gradually stripped off at the data passes through the 7 layers - this time in reverse order. The layers are arranged in order as follows: Layer 7, Application Layer. This layer defines network applications such as error recovery, flow control and network access. Note that user applications are not part of the layers. Layer 6, Presentation Layer. This layer determines the format used to exchange data in such aspects as data translation, encryption and protocol conversion. The data from user A is translated to a common syntax that can be understood by user B. In this way it specifies how applications can connect to the network and to user B. Layer 5, Session Layer. This layer controls the communication session between computers. It is responsible for establishing and removing communication sessions between computers. Additional address translations and security are also performed. This layer therefore instigates a data transfer session between user A and user B so that an extended data transfer can take place. Layer 4, Transport Layer. This layer is responsible for ensuring that data is delivered free of error and provides some flow control. This layer ensures that data is transferred as part of the session instigated by the Session Layer. Layer 3, Network Layer. This layer handles the delivery of data by determining the route for the information to follow. The data is divided into packets with addressing information attached. It also translates address from names into numbers. Intermediate addresses are also attached. Layer 2, Data Link Layer. This layer defines the network control mechanism and prepares the packets for transmission. Layer 1, Physical Layer. This layer is concerned with the transmission of binary data between stations and defines the connections. The connection definition includes such aspects as mechanical, electrical,, topology and bandwidth aspects. At the receiving end the process is reversed so that the binary data that is received is translated back into the original message for User B. Note that each layer communicates only with it's immediate neighbors. For example the Transport Layer only communicates with the Session Layer and with the Network Layer. Each network architecture can be defined by a set of protocols for each of the layers. This allows for a degree of simplification and modularity in design. In spite of an enormous amount of worked and effort having been expended on the ISO RM, very little of it is in use compared to TCP/IP (described in the following section). Perhaps one reason is that the OSI RM is Internet Technologies Overview Page 2-3 extremely complex and it takes a long time to implement all the functions. However a more likely reason is that TCP/IP is in widespread use and has preempted much of the work on implementing the OSI RM. 2.2.3 TCP/IP The Internet grew out of the Cold War in the 1960s as a response to the issue of making sure that computer networks could survive a nuclear weapons attack. The problem was that a nuclear war could destroy much of the military communications and computer networks and that military control would then be lost. An approach was therefore needed whereby the networks could operate even when substantive portions had been destroyed. A number of possible network structures were proposed, with most using analogue approaches with relatively sophisticated mechanisms for making sure that network connections were maintained. Such approaches were difficult to implement effectively since all possible scenarios of damage to the network had to be preprogrammed into the network control algorithms. This structure was unwieldy and it was difficult to make changes to the network. Also proposed, but not implemented at that time, was the structure that was to form the basis of the Internet. This approach was based on a simple and elegant digital model of a very decentralized network and is described in more detail below. Such a network is digital in nature and was therefore dependent on readily available computing power. Such power was becoming available in the 1970s and it was then that the University of California at Berkeley received a contract from the United States Department of Defense to develop a computer network that would: 1. Operate on a wide variety of computer hardware with differing communications media 2. Reconfigure itself if portions of the network failed The earlier proposed network of data packets being directed by routers was implemented under this contract in a network structure formulated as a series of protocols which are described under the general heading of Transmission Control Protocol and Internet Protocol (TCP/IP). TCP/IP is described in more detail later. 2.2.5 TCP/IP STRUCTURE TCP/IP consists of a whole series of protocols, applications and services that together support the powerful capabilities of Internet technologies. Whereas the OSI RM has seven layers the TCP/IP can be thought of as consisting of five layers: The application layer containing such protocols and applications as Simple Mail Transfer Protocol (SMPT), File Transfer Protocol (FTP), Hypertext Transfer Protocol (HTTP) and Telnet. The transport layer contains such protocols as Transmission Control Protocol (TCP) and User Datagram Protocol (UDP). The Internet layer contains such protocols as Internet Protocol (IP), Internet Control Message Protocol (ICMP), Address Resolution Protocol (ARP), and Reverse Address Resolution Protocol (RARP) The data link layer and The physical layer handle the hardware connections. A wide variety of hardware network connections are possible ranging from token ring to Ethernet and from twisted pair cables to fiber optic cables. As with the OSI RM, each message that is being transmitted must be passed down through the layers to the hardware, while the reverse happens on the receiving machine. Another way of looking at the TCP/IP set is to categorize it into upper layers (the application layer) midlayers (the transport and Internet layer) and into lower layers (the data link and physical layers). The upper layers handle the applications, while the lower layers handle the hardware connections. The mid-layers form the core of TCP/IP. Note that not all protocols, applications and services are used on all sessions, rather each can be used under particular scenarios. For example TCP/IP is often combined with Ethernet for a specific hardware implementation. Ethernet is a protocol for the data link and physical layers that uses carrier-sense multipleaccess with collision detection (CSMA-CD). It is simple to install and is available for a wide range of computer hardware. An arrangement such as TCP/IP with Ethernet (with twisted pair cables) therefore covers the mid and lower layers. Alternatively TCP/IP may connect to a token ring network where transmission is only allowed if the node has a token passed to it from another node on the network. In this case the data link and physical layers of the TCP/IP protocol suite are concerned with the interface to the token ring network. It should be noted that this modular approach allows for a wide variety of configurations to be possible. Ironically, the modular approach also allows for the use of Internet technologies that address the upper layers (such as WWW browsers) to use non-TCP/IP networks (Novell networks as an example).","2.2.2 ISO MODEL The International Standards Organization (ISO), based in Geneva Switzerland, is composed of groups for various countries that set standards working towards the establishment of world-wide standards for communication and data exchange. One notable accomplishment has been the development of a reference model that contains specifications for a network architecture for connecting dissimilar computers, with a main goal being that of producing an open and non-proprietary method of data communication. This reference model, called the Open Systems Interconnect Reference Model (OSI RM), was developed in 1981 (?) and revised in 1984. The OSI RM uses 7 layers, each independent of each other, to allow computers to exchange data. To transfer a message from user A to user B, the data has to pass through the 7 layers on user's A machine, before being transmitted through the selected medium. At the receiving computer of user B, the data must then pass through the 7 layers again, this time in reverse sequence, before being received by user B. For data to be transferred, it must pass through all 7 layers on both computers. Each layer follows a relatively strict specification and this allows the differing layers to be produced and implemented by different concerns. Each layer can then interface with its neighboring layers even though they may have been developed by different groups. One way of viewing the activities of the layers is that as the original message passes down the layers towards the medium on the computer of user A, additional information, for both formatting or addressing information, is added to the beginning or end of the message. The additional information is added to ensure correct communication. At the other end (i.e. at user B) this information is gradually stripped off at the data passes through the 7 layers - this time in reverse order. The layers are arranged in order as follows: Layer 7, Application Layer. This layer defines network applications such as error recovery, flow control and network access. Note that user applications are not part of the layers. Layer 6, Presentation Layer. This layer determines the format used to exchange data in such aspects as data translation, encryption and protocol conversion. The data from user A is translated to a common syntax that can be understood by user B. In this way it specifies how applications can connect to the network and to user B. Layer 5, Session Layer. This layer controls the communication session between computers. It is responsible for establishing and removing communication sessions between computers. Additional address translations and security are also performed. This layer therefore instigates a data transfer session between user A and user B so that an extended data transfer can take place. Layer 4, Transport Layer. This layer is responsible for ensuring that data is delivered free of error and provides some flow control. This layer ensures that data is transferred as part of the session instigated by the Session Layer. Layer 3, Network Layer. This layer handles the delivery of data by determining the route for the information to follow. The data is divided into packets with addressing information attached. It also translates address from names into numbers. Intermediate addresses are also attached. Layer 2, Data Link Layer. This layer defines the network control mechanism and prepares the packets for transmission. Layer 1, Physical Layer. This layer is concerned with the transmission of binary data between stations and defines the connections. The connection definition includes such aspects as mechanical, electrical,, topology and bandwidth aspects. At the receiving end the process is reversed so that the binary data that is received is translated back into the original message for User B. Note that each layer communicates only with it's immediate neighbors. For example the Transport Layer only communicates with the Session Layer and with the Network Layer. Each network architecture can be defined by a set of protocols for each of the layers. This allows for a degree of simplification and modularity in design. In spite of an enormous amount of worked and effort having been expended on the ISO RM, very little of it is in use compared to TCP/IP (described in the following section). Perhaps one reason is that the OSI RM is Internet Technologies Overview Page 2-3 extremely complex and it takes a long time to implement all the functions. However a more likely reason is that TCP/IP is in widespread use and has preempted much of the work on implementing the OSI RM. 2.2.3 TCP/IP The Internet grew out of the Cold War in the 1960s as a response to the issue of making sure that computer networks could survive a nuclear weapons attack. The problem was that a nuclear war could destroy much of the military communications and computer networks and that military control would then be lost. An approach was therefore needed whereby the networks could operate even when substantive portions had been destroyed. A number of possible network structures were proposed, with most using analogue approaches with relatively sophisticated mechanisms for making sure that network connections were maintained. Such approaches were difficult to implement effectively since all possible scenarios of damage to the network had to be preprogrammed into the network control algorithms. This structure was unwieldy and it was difficult to make changes to the network. Also proposed, but not implemented at that time, was the structure that was to form the basis of the Internet. This approach was based on a simple and elegant digital model of a very decentralized network and is described in more detail below. Such a network is digital in nature and was therefore dependent on readily available computing power. Such power was becoming available in the 1970s and it was then that the University of California at Berkeley received a contract from the United States Department of Defense to develop a computer network that would: 1. Operate on a wide variety of computer hardware with differing communications media 2. Reconfigure itself if portions of the network failed The earlier proposed network of data packets being directed by routers was implemented under this contract in a network structure formulated as a series of protocols which are described under the general heading of Transmission Control Protocol and Internet Protocol (TCP/IP). TCP/IP is described in more detail later. 2.2.5 TCP/IP STRUCTURE TCP/IP consists of a whole series of protocols, applications and services that together support the powerful capabilities of Internet technologies. Whereas the OSI RM has seven layers the TCP/IP can be thought of as consisting of five layers: The application layer containing such protocols and applications as Simple Mail Transfer Protocol (SMPT), File Transfer Protocol (FTP), Hypertext Transfer Protocol (HTTP) and Telnet. The transport layer contains such protocols as Transmission Control Protocol (TCP) and User Datagram Protocol (UDP). The Internet layer contains such protocols as Internet Protocol (IP), Internet Control Message Protocol (ICMP), Address Resolution Protocol (ARP), and Reverse Address Resolution Protocol (RARP) The data link layer and The physical layer handle the hardware connections. A wide variety of hardware network connections are possible ranging from token ring to Ethernet and from twisted pair cables to fiber optic cables. As with the OSI RM, each message that is being transmitted must be passed down through the layers to the hardware, while the reverse happens on the receiving machine. Another way of looking at the TCP/IP set is to categorize it into upper layers (the application layer) midlayers (the transport and Internet layer) and into lower layers (the data link and physical layers). The upper layers handle the applications, while the lower layers handle the hardware connections. The mid-layers form the core of TCP/IP. Note that not all protocols, applications and services are used on all sessions, rather each can be used under particular scenarios. For example TCP/IP is often combined with Ethernet for a specific hardware implementation. Ethernet is a protocol for the data link and physical layers that uses carrier-sense multipleaccess with collision detection (CSMA-CD). It is simple to install and is available for a wide range of computer hardware. An arrangement such as TCP/IP with Ethernet (with twisted pair cables) therefore covers the mid and lower layers. Alternatively TCP/IP may connect to a token ring network where transmission is only allowed if the node has a token passed to it from another node on the network. In this case the data link and physical layers of the TCP/IP protocol suite are concerned with the interface to the token ring network. It should be noted that this modular approach allows for a wide variety of configurations to be possible. Ironically, the modular approach also allows for the use of Internet technologies that address the upper layers (such as WWW browsers) to use non-TCP/IP networks (Novell networks as an example). Only use the information provided in the prompt to answer the question. Use no external sources or prior knowledge. Use 150 words or less. Question: What are the differences between OSI RM and TCP/IP layers?",Internet/Technology,Concept Comparison,Q&A "Draw your answer solely from the text provided, without the use of any prior knowledge or external sources. Limit your answer to 250 words. Use bullet points.",What were Montana's reasons for the attempted TikTok ban?,"Montana’s TikTok legislation prompted substantial public commentary. According to the law’s preamble, SB 419 supports the “health and safety of Montanans” by preventing TikTok’s operation in the state and also expresses concerns about TikTok’s parent company being subject to control by the People’s Republic of China (PRC), gathering of user information, and “dangerous content.” (The broader policy issues related to the legislation are beyond the scope of this Sidebar.) TikTok and several of its users filed suit in federal district court following passage of the law. TikTok’s complaint asserted violations of several constitutional rights and provisions (the prohibition against bills of attainder, the Commerce Clause, the First Amendment, and the Supremacy Clause). Other challengers, comprising TikTok creators and users, made similar arguments. The court found the plaintiffs’ arguments compelling, concluding they likely would succeed on the merits. The court determined that the plaintiffs established irreparable harm to their business interests and granted the preliminary injunction, which prevented SB 419 from taking effect until the court’s final resolution of the case. Issues Presented to the Ninth Circuit on Appeal Attorneys for Montana unsuccessfully argued to the district court that the law represents a valid exercise of Montana’s police power, that it does not violate any of the claimed constitutional provisions, that federal law does not preempt the ban, and that the ban would have only an indirect, and thus permissible, effect on interstate commerce. Montana then appealed the district court’s order granting the preliminary injunction to the Ninth Circuit. In its opening brief, Montana asserts that SB 419 has a “common sense consumer protection purpose” and that the district court erred in concluding that TikTok and its users would win their constitutional arguments. Montana also argues that the district court erred in its application of the remaining preliminary injunction factors. A selection of Montana’s various arguments, ordered as they appear in the brief, follows: • Police Powers. Montana asserts that protecting consumers is an exercise of police power, under which states have significant discretion. • Data Access. Montana asserts that, based on news reports, the U.S. user data that TikTok collects likely is available to the PRC at will, underscoring that the Montana legislature enacted SB 419 to protect Montana consumers’ data privacy, not to impact the editorial control of the platform. • Burden Shifting. Montana asserts that the district court, in concluding that TikTok and its users would prevail on their constitutional claims, erroneously shifted the evidentiary burden for proving those claims to Montana.","Draw your answer solely from the text provided, without the use of any prior knowledge or external sources. Limit your answer to 250 words. Use bullet points. ""Montana’s TikTok legislation prompted substantial public commentary. According to the law’s preamble, SB 419 supports the “health and safety of Montanans” by preventing TikTok’s operation in the state and also expresses concerns about TikTok’s parent company being subject to control by the People’s Republic of China (PRC), gathering of user information, and “dangerous content.” (The broader policy issues related to the legislation are beyond the scope of this Sidebar.) TikTok and several of its users filed suit in federal district court following passage of the law. TikTok’s complaint asserted violations of several constitutional rights and provisions (the prohibition against bills of attainder, the Commerce Clause, the First Amendment, and the Supremacy Clause). Other challengers, comprising TikTok creators and users, made similar arguments. The court found the plaintiffs’ arguments compelling, concluding they likely would succeed on the merits. The court determined that the plaintiffs established irreparable harm to their business interests and granted the preliminary injunction, which prevented SB 419 from taking effect until the court’s final resolution of the case. Issues Presented to the Ninth Circuit on Appeal Attorneys for Montana unsuccessfully argued to the district court that the law represents a valid exercise of Montana’s police power, that it does not violate any of the claimed constitutional provisions, that federal law does not preempt the ban, and that the ban would have only an indirect, and thus permissible, effect on interstate commerce. Montana then appealed the district court’s order granting the preliminary injunction to the Ninth Circuit. In its opening brief, Montana asserts that SB 419 has a “common sense consumer protection purpose” and that the district court erred in concluding that TikTok and its users would win their constitutional arguments. Montana also argues that the district court erred in its application of the remaining preliminary injunction factors. A selection of Montana’s various arguments, ordered as they appear in the brief, follows: • Police Powers. Montana asserts that protecting consumers is an exercise of police power, under which states have significant discretion. • Data Access. Montana asserts that, based on news reports, the U.S. user data that TikTok collects likely is available to the PRC at will, underscoring that the Montana legislature enacted SB 419 to protect Montana consumers’ data privacy, not to impact the editorial control of the platform. • Burden Shifting. Montana asserts that the district court, in concluding that TikTok and its users would prevail on their constitutional claims, erroneously shifted the evidentiary burden for proving those claims to Montana."" What were Montana's reasons for the attempted TikTok ban?",Legal,Find & Summarize,Text Transformation "Use the text provided by the user to answer all questions. Do not use any other information, including your stored data, to answer any questions. Answer in a numbered list and provide support for each item.","Which branches of physics are involved in the study of the brain, and how do they contribute to the understanding of neuroscience?","The brain is a complex organ characterized by heterogeneous patterns of structural connections supporting unparalleled feats of cognition and a wide range of behaviors. New noninvasive imaging techniques now allow these patterns to be carefully and comprehensively mapped in individual humans and animals. Yet, it remains a fundamental challenge to understand how the brain’s structural wiring supports cognitive processes, with major implications for the personalized treatment of mental health disorders. Here, we review recent efforts to meet this challenge that draw on intuitions, models, and theories from physics, spanning the domains of statistical mechanics, information theory, and dynamical systems and control. We begin by considering the organizing principles of brain network architecture instantiated in structural wiring under constraints of symmetry, spatial embedding, and energy minimization. We next consider models of brain network function that stipulate how neural activity propagates along these structural connections, producing the long-range interactions and collective dynamics that support a rich repertoire of system functions. Finally, we consider perturbative experiments and models for brain network control, which leverage the physics of signal transmission along structural wires to infer intrinsic control processes that support goal-directed behavior and to inform stimulation-based therapies for neurological disease and psychiatric disorders. Throughout, we highlight several open questions in the physics of brain network structure, function, and control that will require creative efforts from physicists willing to brave the complexities of living matter. 2 It is our good fortune as physicists to seek to understand the nature of the observable world around us. In this inquiry, we need not reach to contemporary science to appreciate the fact that our perception of the world around us is inextricably linked to the world within us: the mind. Indeed, even Aristotle c. 350 B.C. noted that it is by mapping the structure of the world that the human comes to understand their own mind 1. “Mind thinks itself because it shares the nature of the object of thought; for it becomes an object of thought in coming into contact with and thinking its objects, so that mind and object of thought are the same” 2. Over the ensuing 2000-plus years, it has not completely escaped notice that the mappers of the world have unique contributions to offer the mapping of the mind (from Thales of Miletus, c. 624–546 B.C., to Leonardo Da Vinci, 1452–1519). More recently, it is notable that nearly all famous physicists of the early 20th century– Albert Einstein, Niels Bohr, Erwin Schroedinger, Werner Heisenberg, Max Born– considered the philosophical implications of their observations and theories 3. In the post-war era, philosophical musings turned to particularly conspicuous empirical contributions at the intersection of neuroscience and artificial intelligence, spanning polymath John von Neumann’s work enhancing our understanding of computational architectures 4 and physicist John Hopfield’s invention of the associative neural network, which revolutionized our understanding of collective computation 5. In the contemporary study of the mind and its fundamental organ– the brain– nearly all of the domains of physics, perhaps with the exception of relativity, are not only relevant but truly essential, motivating the early coinage of the term neurophysics some four decades ago 6. The fundamentals of electricity and magnetism prove critical for building theoretical models of neurons and the transmission of action potentials 7. These theories are being increasingly informed by mechanics to understand how force-generating and load-bearing proteins bend, curl, kink, buckle, constrict, and stretch to mediate neuronal signaling and plasticity 8. Principles from thermodynamics come into play when predicting how the brain samples the environment (action) or shifts the distribution of information that it encodes (perception) 9. Collectively, theories of brain function are either buttressed or dismantled by imaging, with common tools including magnetic resonance imaging 10 and magnetoencephalography 11, the latter being built on superconducting quantum interference devices and next-generation quantum sensors that can be embedded into a system that 3 can be worn like a helmet, revolutionizing our ability to measure brain function while allowing free and natural movement 12. Moreover, recent developments in nanoscale analysis tools and in the design and synthesis of nanomaterials have generated optical, electrical, and chemical methods to explore brain function by enabling simultaneous measurement and manipulation of the activity of thousands or even millions of neurons 13. Beyond its relevance for continued imaging advancements 14, optics has come to the fore of neuroscience over the last decade with the development of optogenetics, an approach that uses light to alter neural processing at the level of single spikes and synaptic events, offering reliable, millisecond-timescale control of excitatory and inhibitory synaptic transmission 15. Such astounding advances, enabled by the intersection of physics and neuroscience, have motivated the construction of a National Brain Observatory at the Argonne National Laboratory (Director: Peter Littlewood, previously of Cavendish Laboratories) funded by the National Science Foundation, as well as frequent media coverage including titles in the APS News such as “Physicists, the Brain is Calling You.”16 And as physicists answer the call, our understanding of the brain deepens and our ability to mark and measure its component parts expands. Yet alongside this growing systematization and archivation, we have begun to face an increasing realization that it is the interactions between hundreds or thousands of neurons that generate the mind’s functional states 13. Indeed, from interactions among neural components emerge computation 17, communication 18, and information propagation 19. We can confidently state of neuroscience what Henri Poincare, the French mathematician, theoretical physicist, and philosopher of science, states of science generally: “The aim of science is not things themselves, as the dogmatists in their simplicity imagine, but the relations among things; outside these relations there is no reality knowable.”20 The overarching goal of mapping these interactions in neural systems has motivated multibillion-dollar investments across the United States (the Brain Initiative generally, and the Human Connectome Project specifically 21), the European Union (the Blue Brain Project 22), China (the China Brain Project 23), and Japan (Japan’s Brain/MINDS project 24)","Use the text provided by the user to answer all questions. Do not use any other information, including your stored data, to answer any questions. Answer in a numbered list and provide support for each item. The brain is a complex organ characterized by heterogeneous patterns of structural connections supporting unparalleled feats of cognition and a wide range of behaviors. New noninvasive imaging techniques now allow these patterns to be carefully and comprehensively mapped in individual humans and animals. Yet, it remains a fundamental challenge to understand how the brain’s structural wiring supports cognitive processes, with major implications for the personalized treatment of mental health disorders. Here, we review recent efforts to meet this challenge that draw on intuitions, models, and theories from physics, spanning the domains of statistical mechanics, information theory, and dynamical systems and control. We begin by considering the organizing principles of brain network architecture instantiated in structural wiring under constraints of symmetry, spatial embedding, and energy minimization. We next consider models of brain network function that stipulate how neural activity propagates along these structural connections, producing the long-range interactions and collective dynamics that support a rich repertoire of system functions. Finally, we consider perturbative experiments and models for brain network control, which leverage the physics of signal transmission along structural wires to infer intrinsic control processes that support goal-directed behavior and to inform stimulation-based therapies for neurological disease and psychiatric disorders. Throughout, we highlight several open questions in the physics of brain network structure, function, and control that will require creative efforts from physicists willing to brave the complexities of living matter. 2 It is our good fortune as physicists to seek to understand the nature of the observable world around us. In this inquiry, we need not reach to contemporary science to appreciate the fact that our perception of the world around us is inextricably linked to the world within us: the mind. Indeed, even Aristotle c. 350 B.C. noted that it is by mapping the structure of the world that the human comes to understand their own mind 1. “Mind thinks itself because it shares the nature of the object of thought; for it becomes an object of thought in coming into contact with and thinking its objects, so that mind and object of thought are the same” 2. Over the ensuing 2000-plus years, it has not completely escaped notice that the mappers of the world have unique contributions to offer the mapping of the mind (from Thales of Miletus, c. 624–546 B.C., to Leonardo Da Vinci, 1452–1519). More recently, it is notable that nearly all famous physicists of the early 20th century– Albert Einstein, Niels Bohr, Erwin Schroedinger, Werner Heisenberg, Max Born– considered the philosophical implications of their observations and theories 3. In the post-war era, philosophical musings turned to particularly conspicuous empirical contributions at the intersection of neuroscience and artificial intelligence, spanning polymath John von Neumann’s work enhancing our understanding of computational architectures 4 and physicist John Hopfield’s invention of the associative neural network, which revolutionized our understanding of collective computation 5. In the contemporary study of the mind and its fundamental organ– the brain– nearly all of the domains of physics, perhaps with the exception of relativity, are not only relevant but truly essential, motivating the early coinage of the term neurophysics some four decades ago 6. The fundamentals of electricity and magnetism prove critical for building theoretical models of neurons and the transmission of action potentials 7. These theories are being increasingly informed by mechanics to understand how force-generating and load-bearing proteins bend, curl, kink, buckle, constrict, and stretch to mediate neuronal signaling and plasticity 8. Principles from thermodynamics come into play when predicting how the brain samples the environment (action) or shifts the distribution of information that it encodes (perception) 9. Collectively, theories of brain function are either buttressed or dismantled by imaging, with common tools including magnetic resonance imaging 10 and magnetoencephalography 11, the latter being built on superconducting quantum interference devices and next-generation quantum sensors that can be embedded into a system that 3 can be worn like a helmet, revolutionizing our ability to measure brain function while allowing free and natural movement 12. Moreover, recent developments in nanoscale analysis tools and in the design and synthesis of nanomaterials have generated optical, electrical, and chemical methods to explore brain function by enabling simultaneous measurement and manipulation of the activity of thousands or even millions of neurons 13. Beyond its relevance for continued imaging advancements 14, optics has come to the fore of neuroscience over the last decade with the development of optogenetics, an approach that uses light to alter neural processing at the level of single spikes and synaptic events, offering reliable, millisecond-timescale control of excitatory and inhibitory synaptic transmission 15. Such astounding advances, enabled by the intersection of physics and neuroscience, have motivated the construction of a National Brain Observatory at the Argonne National Laboratory (Director: Peter Littlewood, previously of Cavendish Laboratories) funded by the National Science Foundation, as well as frequent media coverage including titles in the APS News such as “Physicists, the Brain is Calling You.”16 And as physicists answer the call, our understanding of the brain deepens and our ability to mark and measure its component parts expands. Yet alongside this growing systematization and archivation, we have begun to face an increasing realization that it is the interactions between hundreds or thousands of neurons that generate the mind’s functional states 13. Indeed, from interactions among neural components emerge computation 17, communication 18, and information propagation 19. We can confidently state of neuroscience what Henri Poincare, the French mathematician, theoretical physicist, and philosopher of science, states of science generally: “The aim of science is not things themselves, as the dogmatists in their simplicity imagine, but the relations among things; outside these relations there is no reality knowable.”20 The overarching goal of mapping these interactions in neural systems has motivated multibillion-dollar investments across the United States (the Brain Initiative generally, and the Human Connectome Project specifically 21), the European Union (the Blue Brain Project 22), China (the China Brain Project 23), and Japan (Japan’s Brain/MINDS project 24) Which branches of physics are involved in the study of the brain, and how do they contribute to the understanding of neuroscience?",Medical,Find & Summarize,Text Transformation Only use the text below to answer.,What are the definitions of the acronyms defined in this text?,"Mpox is a rare zoonotic disease caused by infection with monkeypox virus (MPXV) which belongs to the Orthopoxvirus genus in the family Poxviridae1. The specific animal reservoir of MPXV remains unknown. MPXV is found naturally in certain Central and West African countries. There are two main clades (variants) of mpox: Clade one (I) (formerly Congo Basin clade) and Clade two (II) (formerly West African clade). Clade II consists of two subclades (IIa and IIb). In addition to systemic symptoms, mpox is characterised by painful skin rash or mucosal lesions. Person to person transmission occurs through close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding. Most cases of mpox infection are mild. Infections due to clade I are associated with more severe disease and a higher case fatality ratio. Until April 2022, export of mpox beyond endemic regions in Africa was rare, and limited to cases that had travelled to endemic areas, or to zoonotic transmission from imported animals.1 On 16 May 2022, the UK Health Security Agency reported four mpox cases among men with no links to an endemic area, and who self-identified as gay, bisexual and other men who have sex with men (gbMSM).2 On 18 May 2022, Portugal reported five confirmed and 20 suspect mpox cases among gbMSM.3 Global case numbers increased quickly. By 25 May 2022, 219 confirmed cases had been reported worldwide.4 On 23 July 2022, the World Health Organization (WHO), declared the global mpox outbreak a Public Health Emergency of International Concern (PHEIC).5 Since 1 January 2022 and as of 8 May 2023, 87,377 confirmed cases including 140 deaths, have been reported from 111 countries.6 Isolates from outbreak cases belonged to MPXV Clade II (previously known as the West African clade) - specifically subclade IIb. 7 On 10 May 2023, WHO determined mpox no longer constituted a PHEIC.8 We describe the epidemiology of mpox cases and the response to the mpox outbreak between May 2022 and May 2023. Mpox was made a notifiable disease in Ireland on 27 May 2022.9 Cases were reported to Ireland’s Computerised Infectious Disease Reporting (CIDR) system.10 In addition to the standard notification, Public Health Areas (PHAs) collected additional data about cases, including demographic factors, clinical details, potential exposures and vaccination history. Laboratory testing for MPXV was undertaken at the National Virus Reference Laboratory11and the Molecular Virology Laboratory at St James’s Hospital. PHAs also undertook contact tracing and risk assessment for close contacts. A national database was developed which allowed information on mpox close contacts to be recorded, including the setting in which exposure may have occurred (i.e. household, sexual, occupational), and vaccination status (e.g. previously vaccinated, or provided with postexposure prophylaxis). 12, 13 Data are presented on all confirmed mpox cases notified on CIDR up to midnight 27 May 2023 and extracted on 30 May 2023. Epidemiology of mpox cases Between 27 May 2022 and 27 May 2023, 229 confirmed cases of mpox were notified. The first case was notified on 31 May 2022 (week 22 2022) (Figure 1). The earliest known date of onset of symptoms among confirmed cases was 13 May 2022 (week 19 2022). Cases peaked in week 34 2022 (21-27 August 2022). In the first 23 weeks of 2023, only two confirmed cases were notified, one each in January and April. Gender was male in 226 cases and female in three cases. Median age was 35 years (range 16-68 years), with 46% of cases aged between 18-34 years and 79.8% aged between 18-44 years. The majority of cases were either born in Ireland (46.8%) or Latin America (32.3%). Summary characteristics of confirmed mpox cases are presented in Table 1. Contact tracing Interim public health guidance for the management of mpox outbreak cases and their contacts was released on 3 June 2022, adapted from earlier guidance for sporadic mpox cases.14 The purpose of contact tracing initially was to limit transmission, to identify vulnerable contacts at risk for more severe disease (pregnant women, young children and immunocompromised), and to raise awareness among contacts so that they would seek medical help early if they became symptomatic. Later, when vaccine was available, eligible contact were offered post exposure prophylaxis (PEP) vaccination. Initially, mpox was viewed as a High Consequence Infectious Disease (HCID) with high-risk contacts recommended to quarantine for 21 days.15 As understanding of the clinical severity and transmission risks increased, this approach was modified. Following ongoing dynamic risk assessments; quarantine of contacts was no longer required; there was a progressive easing of the definition of a high-risk contact; and cases (and their clinical samples and waste) linked to the global outbreak i.e. caused by MPXV subclade IIb, were no longer managed as HCID. Establishment of an Incident Management Team A national incident management team (IMT) first met on 16 May 2022, the same day as the UK first issued their alert. Given the close links between gbMSM communities across Europe, and in particular between Ireland and the UK, the likelihood of cases arising in Ireland was considered high. The IMT was responsible for monitoring of national and global situation, ongoing risk assessment, and advising on and coordinating the response measures. The IMT initially met daily when the event first emerged, and then weekly. Recognising the breadth of the response required, involving input across many different parts of the health service, and in particular the magnitude of implementing a national vaccination programme, the IMT transitioned into a National Crisis Management Team (NCMT) led by the Acute Operations division of the HSE in September 2022. The IMT and subsequent NCMT included representation from a wide range of disciplines and sectors across the health service including: public health; virology; clinical services including sexual health, infectious diseases, paediatrics, obstetrics, occupational health and general practice; infection prevention and control; the National Immunisation Office (NIO); the HSE Sexual Health and Crisis Pregnancy Programme (SHCPP); the National Ambulance Service; HSE Communications; acute hospital and community operations. From the onset, the IMT included representation from the gbMSM community with members from the Gay Health Network (GHN), an alliance of organisations with mandates to promote the sexual health of gbMSM in Ireland, and the MPOWER programme at HIV Ireland, a peer-driven communitylevel programme focusing on the sexual health and wellbeing among gbMSM16, 17. On transitioning to the NCMT format, MPOWER continued to be represented on the group. Guidance and service development IMT members initially, and subsequently the Pathways of Care Programme of the NCMT, worked with the Health Protection Research and Guideline Development Unit in developing and maintaining a suite of guidance on clinical and public health management of probable and confirmed cases and their close contacts, including assessment and testing, contact tracing, infection prevention and control, transportation, and waste management.18 Guidance was reviewed and updated at regular intervals as the outbreak evolved and understanding increased. Community engagement Supported by the Sexual Health Crisis Pregnancy Programme (SHCPP) and HSE Communications, GHN and MPOWER continued to develop and deliver a range of communications and engagement activities for the gbMSM community including posters at social venues and events, social media messaging, adverts and news pieces in gbMSM media, out-reach activities and community stakeholder events. This collaborative and peerled approach ensured the delivery of key messaging that is intended to be informative but not stigmatising. It has been recognised as an example of best practice for risk communication and community engagement on mpox by ECDC and the WHO.19, 20 Vaccination On 27 May 2022, Ireland’s National Immunisation Advisory Committee (NIAC) recommended that modified Vaccinia Ankara-Bavarian Nordic (MVA-BN), be offered to high and intermediate risk contacts of a case of mpox as PEP and healthcare workers at highest risk of exposure as pre-exposure prophylaxis (PREP).21 On 13 June 2022, the first doses of MVA-BN vaccine were delivered to community vaccination centres (CVCs), where PEP was primarily administered, occasionally supported by mobile vaccination teams, hospitals, and PHA teams.21 On 29 July 2022, NIAC recommended mpox vaccine as PrEP to those at high risk of exposure. Given the limited vaccine supply in the context of a global outbreak, the HSE through the advice and guidance of clinical and ethical experts and by working closely with gbMSM advocacy and support groups, offered PrEP in a phased manner. In the first phase (commencing August 2022), eligible people (gbMSM and transgender people who had a notification of early infectious syphilis between December 2021 and July 2022) were invited for vaccination in sexual health clinics. In November 2022, PrEP vaccination was extended to self-identified individuals at risk of mpox who could register online for vaccination and was administered in CVCs.23 Based on advice of the EMA, on 22 August NIAC endorsed lower dose intradermal administration rather than subcutaneous administration. This increased the number of people who could be offered vaccination23, 24. By the end of May 2023, 5,214 people had been fully vaccinated. ","What are the definitions of the acronyms defined in this text? Only use the text below to answer. Mpox is a rare zoonotic disease caused by infection with monkeypox virus (MPXV) which belongs to the Orthopoxvirus genus in the family Poxviridae1. The specific animal reservoir of MPXV remains unknown. MPXV is found naturally in certain Central and West African countries. There are two main clades (variants) of mpox: Clade one (I) (formerly Congo Basin clade) and Clade two (II) (formerly West African clade). Clade II consists of two subclades (IIa and IIb). In addition to systemic symptoms, mpox is characterised by painful skin rash or mucosal lesions. Person to person transmission occurs through close contact with lesions, body fluids, respiratory droplets and contaminated materials such as bedding. Most cases of mpox infection are mild. Infections due to clade I are associated with more severe disease and a higher case fatality ratio. Until April 2022, export of mpox beyond endemic regions in Africa was rare, and limited to cases that had travelled to endemic areas, or to zoonotic transmission from imported animals.1 On 16 May 2022, the UK Health Security Agency reported four mpox cases among men with no links to an endemic area, and who self-identified as gay, bisexual and other men who have sex with men (gbMSM).2 On 18 May 2022, Portugal reported five confirmed and 20 suspect mpox cases among gbMSM.3 Global case numbers increased quickly. By 25 May 2022, 219 confirmed cases had been reported worldwide.4 On 23 July 2022, the World Health Organization (WHO), declared the global mpox outbreak a Public Health Emergency of International Concern (PHEIC).5 Since 1 January 2022 and as of 8 May 2023, 87,377 confirmed cases including 140 deaths, have been reported from 111 countries.6 Isolates from outbreak cases belonged to MPXV Clade II (previously known as the West African clade) - specifically subclade IIb. 7 On 10 May 2023, WHO determined mpox no longer constituted a PHEIC.8 We describe the epidemiology of mpox cases and the response to the mpox outbreak between May 2022 and May 2023. Mpox was made a notifiable disease in Ireland on 27 May 2022.9 Cases were reported to Ireland’s Computerised Infectious Disease Reporting (CIDR) system.10 In addition to the standard notification, Public Health Areas (PHAs) collected additional data about cases, including demographic factors, clinical details, potential exposures and vaccination history. Laboratory testing for MPXV was undertaken at the National Virus Reference Laboratory11and the Molecular Virology Laboratory at St James’s Hospital. PHAs also undertook contact tracing and risk assessment for close contacts. A national database was developed which allowed information on mpox close contacts to be recorded, including the setting in which exposure may have occurred (i.e. household, sexual, occupational), and vaccination status (e.g. previously vaccinated, or provided with postexposure prophylaxis). 12, 13 Data are presented on all confirmed mpox cases notified on CIDR up to midnight 27 May 2023 and extracted on 30 May 2023. Epidemiology of mpox cases Between 27 May 2022 and 27 May 2023, 229 confirmed cases of mpox were notified. The first case was notified on 31 May 2022 (week 22 2022) (Figure 1). The earliest known date of onset of symptoms among confirmed cases was 13 May 2022 (week 19 2022). Cases peaked in week 34 2022 (21-27 August 2022). In the first 23 weeks of 2023, only two confirmed cases were notified, one each in January and April. Gender was male in 226 cases and female in three cases. Median age was 35 years (range 16-68 years), with 46% of cases aged between 18-34 years and 79.8% aged between 18-44 years. The majority of cases were either born in Ireland (46.8%) or Latin America (32.3%). Summary characteristics of confirmed mpox cases are presented in Table 1. Contact tracing Interim public health guidance for the management of mpox outbreak cases and their contacts was released on 3 June 2022, adapted from earlier guidance for sporadic mpox cases.14 The purpose of contact tracing initially was to limit transmission, to identify vulnerable contacts at risk for more severe disease (pregnant women, young children and immunocompromised), and to raise awareness among contacts so that they would seek medical help early if they became symptomatic. Later, when vaccine was available, eligible contact were offered post exposure prophylaxis (PEP) vaccination. Initially, mpox was viewed as a High Consequence Infectious Disease (HCID) with high-risk contacts recommended to quarantine for 21 days.15 As understanding of the clinical severity and transmission risks increased, this approach was modified. Following ongoing dynamic risk assessments; quarantine of contacts was no longer required; there was a progressive easing of the definition of a high-risk contact; and cases (and their clinical samples and waste) linked to the global outbreak i.e. caused by MPXV subclade IIb, were no longer managed as HCID. Establishment of an Incident Management Team A national incident management team (IMT) first met on 16 May 2022, the same day as the UK first issued their alert. Given the close links between gbMSM communities across Europe, and in particular between Ireland and the UK, the likelihood of cases arising in Ireland was considered high. The IMT was responsible for monitoring of national and global situation, ongoing risk assessment, and advising on and coordinating the response measures. The IMT initially met daily when the event first emerged, and then weekly. Recognising the breadth of the response required, involving input across many different parts of the health service, and in particular the magnitude of implementing a national vaccination programme, the IMT transitioned into a National Crisis Management Team (NCMT) led by the Acute Operations division of the HSE in September 2022. The IMT and subsequent NCMT included representation from a wide range of disciplines and sectors across the health service including: public health; virology; clinical services including sexual health, infectious diseases, paediatrics, obstetrics, occupational health and general practice; infection prevention and control; the National Immunisation Office (NIO); the HSE Sexual Health and Crisis Pregnancy Programme (SHCPP); the National Ambulance Service; HSE Communications; acute hospital and community operations. From the onset, the IMT included representation from the gbMSM community with members from the Gay Health Network (GHN), an alliance of organisations with mandates to promote the sexual health of gbMSM in Ireland, and the MPOWER programme at HIV Ireland, a peer-driven communitylevel programme focusing on the sexual health and wellbeing among gbMSM16, 17. On transitioning to the NCMT format, MPOWER continued to be represented on the group. Guidance and service development IMT members initially, and subsequently the Pathways of Care Programme of the NCMT, worked with the Health Protection Research and Guideline Development Unit in developing and maintaining a suite of guidance on clinical and public health management of probable and confirmed cases and their close contacts, including assessment and testing, contact tracing, infection prevention and control, transportation, and waste management.18 Guidance was reviewed and updated at regular intervals as the outbreak evolved and understanding increased. Community engagement Supported by the Sexual Health Crisis Pregnancy Programme (SHCPP) and HSE Communications, GHN and MPOWER continued to develop and deliver a range of communications and engagement activities for the gbMSM community including posters at social venues and events, social media messaging, adverts and news pieces in gbMSM media, out-reach activities and community stakeholder events. This collaborative and peerled approach ensured the delivery of key messaging that is intended to be informative but not stigmatising. It has been recognised as an example of best practice for risk communication and community engagement on mpox by ECDC and the WHO.19, 20 Vaccination On 27 May 2022, Ireland’s National Immunisation Advisory Committee (NIAC) recommended that modified Vaccinia Ankara-Bavarian Nordic (MVA-BN), be offered to high and intermediate risk contacts of a case of mpox as PEP and healthcare workers at highest risk of exposure as pre-exposure prophylaxis (PREP).21 On 13 June 2022, the first doses of MVA-BN vaccine were delivered to community vaccination centres (CVCs), where PEP was primarily administered, occasionally supported by mobile vaccination teams, hospitals, and PHA teams.21 On 29 July 2022, NIAC recommended mpox vaccine as PrEP to those at high risk of exposure. Given the limited vaccine supply in the context of a global outbreak, the HSE through the advice and guidance of clinical and ethical experts and by working closely with gbMSM advocacy and support groups, offered PrEP in a phased manner. In the first phase (commencing August 2022), eligible people (gbMSM and transgender people who had a notification of early infectious syphilis between December 2021 and July 2022) were invited for vaccination in sexual health clinics. In November 2022, PrEP vaccination was extended to self-identified individuals at risk of mpox who could register online for vaccination and was administered in CVCs.23 Based on advice of the EMA, on 22 August NIAC endorsed lower dose intradermal administration rather than subcutaneous administration. This increased the number of people who could be offered vaccination23, 24. By the end of May 2023, 5,214 people had been fully vaccinated.",Medical,Explanation/Definition,Q&A You are given a reference document. You must only use information found in the reference document to answer the question asked.,According to this document is the combination of paracetamol and ibuprofen effective?," NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs): Making safer treatment choices Non-steroidal anti-inflammatory drugs (NSAIDs) are successfully used to treat a wide range of painful conditions. However, NSAIDs should be prescribed with caution as courses of just a few days, even at doses within prescribing recommendations, can be associated with serious adverse effects in susceptible patients. In primary care, paracetamol is recommended in preference to NSAIDs, where appropriate. If a patient is likely to benefit from NSAID treatment naproxen or ibuprofen are recommended first-line, at the lowest effective dose, for the shortest possible time. Patients taking NSAIDs who are at increased risk of complications require regular monitoring. How NSAIDs work determines their risk and How NSAIDs work, the patient’s age and the condition being guides their use treated also need to be taken into account when these issues are discussed with patients. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed medicines for analgesia in primary care, after paracetamol.1 However, NSAID use can be NSAIDs and cyclo-oxygenase (COX) selectivity associated with a range of serious adverse effects including: The cyclo-oxygenase-1 (COX-1) and COX-2 enzymes produce cardiovascular events, gastrointestinal complications, renal prostaglandins following the metabolism of omega-6 failure and hypersensitivity reactions. Even if the risk of an polyunsaturated fatty acid (arachidonic acid).3 Prostaglandins individual patient experiencing an NSAID-related adverse are chemical messengers that mediate inflammation, fever and event is relatively low, the frequent use of NSAIDs within the sensation of pain.3 The analgesic and anti-inflammatory the community means that the potential for NSAID-related effects of NSAIDs are produced through the prevention of adverse events to occur is a concern. NSAID use therefore prostaglandin production by inhibition of COX activity. The requires careful consideration of individual patient risk factors. clinical effects and the risk profiles of the different NSAIDs are To maximise patient safety it is recommended that clinicians largely determined by their differential ability to inhibit the consider the following points before prescribing an NSAID:2 COX-1 and/or COX-2 enzymes and their half-lives. Prescribe all NSAIDs with caution, in all patient groups, COX-1 is widely distributed in the body but is concentrated even over short periods of time in cells of the stomach, kidney, endothelium and in platelets.4 Prescribe the lowest effective NSAID dose, for the Prostaglandins catalysed by COX-1 activity control renal shortest possible time, and review the need for perfusion, promote platelet aggregation and provide continued use at each consultation gastroprotection by regulating mucous secretion.4 Inhibition Older patients, patients with increased cardiovascular of COX-1 can cause adverse gastrointestinal effects.4 risk, patients with type 2 diabetes, and patients with reduced renal function or a history of renal problems COX-2 is induced by inflammation and it is present in are at increased risk of NSAID-related complications and macrophages, leukocytes, fibroblasts and synovial cells. 4 should be advised about adverse effects and regularly Prostaglandins formed via COX-2 activity mediate pain, monitored when taking NSAIDs inflammation, fever and inhibit platelet aggregation.3 Naproxen (up to 1000 mg per day) or ibuprofen (up NSAIDs that inhibit both COX-1 and COX-2 enzymes are termed to 1200 mg per day) are the recommended first-line non-selective NSAIDs, while NSAIDs which predominately choices for adults based on our current knowledge of inhibit COX-2 enzymes are termed COX-2 inhibitors. NSAIDs and cardiovascular risk; ibuprofen is the most appropriate NSAID for children NSAIDs and COX inhibition Avoid prescribing long-acting formulations of NSAIDs, Ibuprofen, naproxen and diclofenac are non-selective NSAIDs. where possible, as these are associated with an increased However, diclofenac inhibits COX-2 relatively more than risk of gastrointestinal adverse effects COX-1.5 Many of the NSAIDs available in New Zealand have similar indications, e.g. musculoskeletal pain and inflammation, COX-1 is weakly inhibited and COX-2 is strongly inhibited then therefore these three medicines account for 97% of all the risk of thrombosis will be increased. NSAID prescribing.1 Other non-selective NSAIDs indicated for specific conditions include: tenoxicam (inflammatory Naproxen use (up to 1000 mg per day) does not appear to arthropathy, dysmenorrhoea, post-operative pain and acute be associated with increased vascular risk, based on current gout), tiaprofenic acid (inflammatory arthropathy), ketoprofen evidence.8 This may be because COX-1 inhibition by naproxen (inflammatory arthropathy), mefenamic acid (dysmenorrhoea is sufficiently prolonged and intense to effectively block and menorrhagia) and sulindac (inflammatory arthropathy).6 platelet activation and counterbalance the prothrombotic effect of COX-2 inhibition.8 Meloxicam is currently the only subsidised (Special Authority) COX-2 inhibitor in New Zealand. At low doses meloxicam mainly NSAID half-life also influences treatment choice inhibits COX-2. As the dose of meloxicam increases COX-1 is NSAIDs can be divided into short-acting NSAIDs with half-lives increasingly inhibited. For example, there is an increased rate less than six hours and long-acting NSAIDs. NSAIDs with a of serious gastrointestinal adverse events at a dose of 15 mg short half-life, e.g. ibuprofen, have a relatively quick onset of per day, compared to 7.5 mg per day.7 action and are better suited for the treatment of acute pain. NSAIDs with longer half-lives, e.g. naproxen, or in long-acting Celecoxib and etoricoxib COX-2 inhibitors are also available in formulations are more suited for the treatment of chronic New Zealand, but are not subsidised. conditions, as they require only once or twice daily dosing. However, persistent exposure to NSAIDs is an independent Check the New Zealand Formulary or Pharmaceutical determinant of gastrointestinal effects therefore NSAIDs with Schedule for the subsidy details of NSAIDs a long-half life, or NSAIDs in a slow-release formulation, are associated with an increased risk of gastrointestinal adverse events (see: “NSAIDs and gastrointestinal complications”, Page COX selectivity and cardiovascular risk 13).9 COX-2 inhibitors were initially developed on the rationale that selective inhibition of COX-2 might replicate the anti- inflammatory and analgesic effects of non-selective NSAIDs Choosing an analgesic regimen while reducing gastrointestinal adverse effects. However, The WHO analgesic ladder recommends paracetamol and/or it was later discovered that COX-2 activity inhibits platelet an NSAID first-line for pain management. The relative efficacy aggregation, therefore NSAIDs that block COX-2 promote of paracetamol and NSAIDs depends on the underlying thrombosis and events such as myocardial infarction become condition causing the pain. Specifically, NSAIDs are more more likely (see: “Cardiovascular risk in people taking NSAIDs”, effective than paracetamol in the treatment of inflammatory Page 12).3 It is now thought that the relative degree to which conditions, such as gout or rheumatoid arthritis, and in different NSAIDs inhibit both COX-1 and COX-2, and the effect the treatment of dental and menstrual pain.3, 10 For tension that this has on platelet aggregation, determines the likelihood headache or following orthopaedic surgery paracetamol is of each NSAID causing cardiovascular events.8 For example, if reported to provide equivalent analgesia to NSAIDs.10 Paracetamol and codeine may have variable efficacy The effectiveness of paracetamol and codeine may vary toxicity, even at low doses. This can result in respiratory depending on a person’s level of expression of the CYP2D6 depression. It is estimated that among Europeans up to enzyme. People deficient in this enzyme are unable to 10% of people will be either ultra-fast or slow metabolisers convert codeine to morphine and may not receive pain of codeine.14 The prevalence of fast and slow metabolisers relief from its use. Conversely, people who are ultra-fast of codeine among Māori and Pacific peoples is not metabolisers of codeine are at increased risk of opioid known. Paracetamol is safer than NSAIDs for most conditions Paracetamol is considered to be a safer treatment choice than NSAIDs in people at increased risk of NSAID-related Combination paracetamol and ibuprofen adverse effects, e.g. children or older patients, patients with There are an increasing number of products being cardiovascular or renal co-morbidities or diabetes, or patients marketed to the public that contain both paracetamol with a previous history of gastrointestinal symptoms or NSAID and ibuprofen. It is uncertain whether the concomitant hypersensitivity (see: “Hypersensitivity to NSAIDs”, Page use of paracetamol and ibuprofen significantly improves 16). Paracetamol is also recommended by United Kingdom analgesia compared to the use of NSAIDs alone. Studies guidelines for the long-term treatment of back pain and have produced mixed results and outcomes may be degenerative conditions, such as osteoarthritis, due to its influenced by the cause of the pain being studied. It is superior tolerability.3 also not clear whether the combined use of paracetamol and ibuprofen increases the risk of adverse effects. Compared to NSAIDs, paracetamol has:3 Minimal gastrointestinal toxicity A Cochrane review of the analgesic efficacy of paracetamol Little effect on blood pressure and ibuprofen in the treatment of post-operative pain, concluded that combinations of paracetamol plus No association with myocardial infarction ibuprofen provided better analgesia than either medicine No interaction with the antiplatelet effect of aspirin alone.12 It was also concluded that the combination treatment reduced the need for additional analgesia to Paracetamol can be given for mild to moderate pain in adults be administered and reduced the risk of adverse events at the recommended dose of 0.5 – 1 g, every four to six hours, occurring.12 A study of approximately 900 patients using to a maximum of 4 g per day.6 The major adverse effect paracetamol or ibuprofen, or a combination of the two, associated with paracetamol is liver damage due to overdose for the treatment of osteoarthritis of the knee found and it should not be prescribed to patients with liver disease.6 significantly more patients achieved pain control at ten days and at 13 weeks with the combination treatment Consider adding codeine to paracetamol in select patients compared to paracetamol alone, but there was not a If the risk of NSAID-related adverse events is high, it may be statistically significant difference compared to using appropriate to consider adding codeine to paracetamol, in ibuprofen alone.15 In contrast, a small study of 90 patients preference to NSAID treatment.11 For example, an older patient randomised to one of three treatment groups in an with osteoarthritis, diabetes and chronic kidney disease (CKD) emergency department setting found that combination may be particularly susceptible to the nephrotoxic effects of treatment with paracetamol and ibuprofen did not provide NSAIDs (see “NSAIDs and renal function”, Page 14). more effective pain relief following musculoskeletal injury compared to either medicine alone.16 An appropriate starting dose of codeine in combination with paracetamol for mild to moderate pain in adults is 15 A large British study funded by a pharmaceutical company mg, every four hours, as required.6 Codeine can be given in reported that compared to the use of the paracetamol and doses up to 60 mg, if required, but the total dose should not ibuprofen alone, the combined use of the two medicines exceed 240 mg per day.6 The main adverse effects of codeine did not increase the number of adverse effects.17 However, are gastrointestinal disturbance and potential respiratory in the treatment of osteoarthritis of the knee a trend depression.6 The effectiveness of codeine may vary between towards increased dyspepsia, diarrhoea and blood loss individuals due to genetic differences in metabolism, and it may was reported in patients using a combination product.15 not be an appropriate choice for all patients (see: “Paracetamol with codeine may have variable efficacy”, previous page). The lack of a demonstrated strong synergistic analgesic effect between paracetamol and ibuprofen, suggests that Combining paracetamol with NSAIDs may be appropriate the two medicines may have similar modes of actions The combination of paracetamol with NSAIDs may provide and their effects may not be additive.18 The lack of clear more effective analgesia for some patients, e.g. for post- evidence of improved analgesia has led some experts to surgical pain, than either medicine alone.12 This combination question the value of combination products containing treatment may allow the dose of NSAID required to achieve paracetamol and ibuprofen.18 analgesia to be reduced (compared to NSAID treatment alone) therefore reducing the amount NSAID-related risk the patient is exposed to.12 However, this approach does not appear to Diclofenac (75 – 150 mg, daily, in two or three divided doses) be effective for all conditions (see: “Combination paracetamol is indicated for acute pain and inflammation, in inflammatory and ibuprofen”, Page 11). If a combination of paracetamol arthropathy and other musculoskeletal disorders.6 However, and NSAIDs is used to treat pain, consider titrating the NSAID diclofenac at doses of ≥ 150 mg per day is associated with an dose downwards as pain becomes more manageable, while increased risk of cardiovascular events (see below). Diclofenac continuing treatment with paracetamol at the same dose. use is contraindicated in patients who have had a myocardial The NSAID can then be withdrawn, before paracetamol, and infarction in the previous 12 months.6 treatment with paracetamol continued, as required. When prescribing NSAIDs following muscle injury, short courses, i.e. three to seven days, are preferable to longer term Review and intensify lifestyle modifications to manage use.19 pain Long-term pain, as with any chronic condition, requires continual review and ongoing lifestyle modifications to prevent Cardiovascular risk in people taking NSAIDs a decline in the quality of the patient’s life. For example, a Prescribe long-term NASIDs with caution to people with an person with osteoarthritis is likely to benefit from intensifying elevated cardiovascular risk, particularly if they have had a exercise and weight loss programmes.13 previous cardiovascular event. All non-selective NSAIDs and COX-2 inhibitors are associated with increased cardiovascular risk - except naproxen up to 1000 mg per day or ibuprofen up Reducing the risk of NSAID use to 1200 mg per day.2, 20 This increased risk begins within the If it is decided that NSAID treatment is appropriate, having first week of treatment and translates to an additional three weighed the risks versus benefits of treatment, ensure the major vascular events per 1000 patients, per year.8, 21 patient’s history is known before an NSAID is prescribed. In particular:3 NSAID use has also been found to approximately double the Ensure the patient is aware which over-the-counter (OTC) risk of hospital admission due to heart failure and increase products contain NSAIDs and that they know that they systolic blood pressure by an average of 2 – 3 mmHg.3, 8 The should not take any other NSAID-containing products effect NSAIDs have on blood pressure may be more dramatic while they are being treated with an NSAID in people with pre-existing hypertension and in people Determine if the patient has any co-morbidities that may taking antihypertensives (see: “NSAIDs and renal function”, increase the risk of NSAID treatment, e.g. cardiovascular Page 14).3 Blood pressure should be monitored in patients disease, CKD, diabetes, hypertension or duodenal ulcer with hypertension and older patients within the first month of initiating long-term NSAID treatment, and then routinely Query if the patient is taking any medicines that may monitored as part of ongoing management.3 interact with NSAIDs, e.g. angiotensin converting enzyme (ACE) inhibitors, angiotensin-II receptor blockers (ARBs), NSAIDs increase cardiovascular risk across all patient diuretics, clopidogrel, warfarin, dabigatran or aspirin groups Discuss any history of NSAID-related adverse effects A large study found that there was a relative increase in with the patient. Their preference may affect the dosing cardiovascular risk, mainly attributed to coronary events, of regimen. Some patients may prefer to tolerate adverse approximately 33% in patients using high-dose diclofenac effects if a higher dose is likely to result in improved (> 150 mg), COX-2 inhibitors (celecoxib, rofecoxib, etoricoxib symptom control, while other patients may take the and lumiracoxib) and high-dose ibuprofen.8 Importantly, the opposite view. trial found that there was no statistical difference in this risk between patient groups with low or high predicted five-year Naproxen (up to 1000 mg per day) or ibuprofen (up to 1200 cardiovascular risk.8 The significance of this study to primary mg per day) are recommended first-line choices if NSAIDs care in New Zealand is that an increased cardiovascular risk are required, due to the lower risk of cardiovascular events has been an under-recognised concern in many patients occurring when these medicines are taken at these doses, taking non-selective NSAIDs. compared to other NSAIDs.2 N.B. The recommended maximum dose of ibuprofen is 2400 mg/day;6 this higher dose may be Short-term and long-term use of NSAIDs is associated with necessary, and appropriate, for some patients, but is associated increased cardiovascular risk. Advise patients who have had with increased cardiovascular risk. a previous cardiovascular event that even one or two doses of ibuprofen or diclofenac may increase their risk of a recurrent event. A study of over 83 000 patients with prior myocardial infarction found that NSAID use increased the risk of recurrent Aspirin and cardiovascular risk myocardial infarction or death by 1.45 times during the first It is unknown if aspirin use, which irreversibly inhibits seven days of treatment and this risk persisted throughout COX-1, influences the apparently neutral cardiovascular the course of treatment.21 The greatest risk was associated effects of naproxen. A large study has found evidence that with diclofenac which increased the risk of myocardial aspirin may confer a cardioprotective effect in patients infarction and/or death by 3.26 times at day one to seven of taking COX-2 inhibitors, but not in patients taking treatment.21 Naproxen was not associated with an increased ibuprofen.23 Further studies are required to characterise risk of myocardial infarction or death during the 14 week the cardiovascular effects of aspirin in people taking study duration.21 naproxen. A practical approach to the issue of a possible NSAIDs and gastrointestinal complications interaction between NSAIDs and aspirin prescribed for Gastrointestinal adverse events are increased two to four-fold cardioprotection is to minimise the combined use of by the use of all NSAIDs and this increase is dose dependent. these medicines in patients with elevated cardiovascular Gastrointestinal complications associated with NSAID use risk. The use of aspirin for the primary prevention of include: dyspepsia, gastrointestinal bleeding, peptic ulcers cardiovascular disease is controversial. Current evidence and perforations of the upper gastrointestinal tract.3, 9 This only justifies the use of low-dose aspirin for primary is because inhibition of the COX-1 enzyme reduces the prevention in patients with a five-year cardiovascular risk production of protective gastric mucous. In general NSAIDs of greater than 15%.24 Furthermore, patients with a high that have a long half-life or are taken in a long-acting cardiovascular risk should not be routinely prescribed formulation have a greater risk of gastrointestinal adverse long-term NSAIDs, if possible. Finally, patients with effects.9 Gastrointestinal symptoms are less common in increased cardiovascular risk are likely to be older and people taking COX-2 inhibitors, however, the risk is increased may have other co-morbidities that increase the risk of in patients who are concurrently taking aspirin.8 NSAID-related adverse effects. Therefore the number of patients whose cardiovascular risk is clinically affected by Risk factors for gastrointestinal adverse effects associated with any interaction between aspirin and NSAIDs in primary NSAID use include:3 care is likely to be small when NSAID use is carefully Age over 65 years managed. Previous adverse reaction to NSAIDs For further information see: “The use of antithrombotic The use of other medicines that may exacerbate any medicines in general practice: A consensus statement”, gastrointestinal adverse effects, e.g. anticoagulants, BPJ 39 (Oct, 2011). selective serotonin reuptake inhibitors (SSRIs) and corticosteroids Liver disease Chronic kidney disease (CKD) Smoking Excessive alcohol consumption Use of non-selective NSAIDs and COX-2 inhibitors in people with ulcerative colitis and Crohn’s disease may cause an exacerbation of symptoms.3 Paracetamol is generally better tolerated than NSAIDs in people at increased risk of gastrointestinal adverse effects. Diclofenac and COX-2 inhibitors appear to be the least likely NSAIDs to cause upper gastrointestinal perforation, obstruction or bleeds, while the risk is likely to be increased for patients taking ibuprofen and naproxen.8 Reducing the risk of gastrointestinal complications Advise patients to take NSAIDs with milk or food so the Reducing NSAID-related risk in Māori stomach is not empty and irritation is reduced.3 Consider NSAIDs are often used in the management of gout. Gout co-prescribing a proton pump inhibitor (PPI) prophylactically is more prevalent among Māori males (11.7%) compared in people aged over 45 years if NSAIDs are being used long- to European males (3.7%).22 Māori are also more severely term in the treatment of osteoarthritis, rheumatoid arthritis or affected by gout and are therefore more likely to be lower back pain.2 PPIs should be taken daily, rather than “as using NSAIDs to manage acute flares than non-Māori.22 needed” because PPIs require approximately three days to As Māori are approximately twice as likely as non-Māori achieve steady state inhibition of acid secretion and ulceration to die of cardiovascular disease, the use of NSAIDs in this or bleeding of the gastrointestinal tract can often occur in the population requires added caution. Prescribers should absence of dyspepsia.3, 25 be aware of the elevated cardiovascular risk amongst Māori when prescribing NSAIDs for gout and monitor for A Cochrane review found that both PPIs and histamine-2 adverse effects accordingly. In addition, management receptor antagonists, e.g. ranitidine, were effective at of gout among Māori patients should be intensified to preventing chronic NSAID-related gastric and duodenal reduce the likelihood of flares occurring and reduce the ulcers.26 Omeprazole for the prevention of NSAID-related need for NSAID treatment. Corticosteroids (oral or intra- ulcers can be initiated in adults at 20 mg, once daily, for four articular) or colchicine may be considered as treatment weeks and continued for another four weeks if gastrointestinal alternatives to naproxen for acute gout flare. symptoms have not completely resolved.6 Ranitidine can be initiated in adults, for protection against NSAID-related ulcers, For further information see: “An update on the at 150 mg, twice daily, or 300 mg at night, for up to eight management of gout”, BPJ 51 (Mar, 2013). weeks.6 Misoprostol is no longer routinely used in primary care for the prevention of NSAID-related ulcers as it is associated with diarrhoea and occasionally more severe adverse effects, even at low doses.6, 26 If a patient develops gastrointestinal symptoms during NSAID treatment another type of NSAID can be trialled, an alternative class of analgesic trialled, or a PPI prescribed. In patients with a high risk of developing gastrointestinal complications who require long-term NSAID treatment:3 Prescribe a PPI and advise the patient to discontinue the NSAID and contact a health professional if they notice any gastrointestinal symptoms, e.g. black stools Monitor haemoglobin levels for the first month of treatment. Long-term haemoglobin monitoring is recommended if bleeding is an ongoing clinical concern. If gastrointestinal adverse effects do develop, consider switching to another NSAID NSAIDs and renal function All medicines which block COX-2 are potentially nephrotoxic because they can reduce blood flow to the kidney by preventing prostaglandin-mediated vasodilation. This is particularly true in patients who are dehydrated. NSAIDs can also cause immune mediated acute kidney injury (AKI), e.g. acute interstitial nephritis. In New Zealand over 40% of all renal adverse reactions reported to the Centre for Adverse Reactions Monitoring (CARM) were associated with diclofenac.27 The Topical analgesics risk of AKI in patients taking NSAIDs and other potentially Topical NSAIDs are not subsidised in New Zealand, nephrotoxic medicines is greatest at the start of treatment, however, they are readily available over-the-counter therefore even short courses of NSAIDs should be avoided, if (OTC) and are frequently purchased for the treatment of possible, in patients at increased risk.28 soft tissue injuries, e.g. sports injuries. Topical NSAIDs, in combination with paracetamol, are recommended before All people with CKD should avoid NSAIDs where possible. oral NSAIDs or codeine in United Kingdom guidelines for CKD is a risk factor for AKI and one-quarter to one-third of the treatment of osteoarthritis.13 Topical NSAIDs are also all people aged over 64 years have CKD.29 Acute illness and/ preferred to oral NSAIDs by some clinicians for patients or hypovolaemia, even if mild, further increases the risk of aged over 75 years.3 AKI occurring in people with CKD who are taking NSAIDs. Patients with CKD who are taking NSAIDs should be advised Topical NSAIDs are considered to be as safe as placebo to discontinue use if they develop an acute illness, especially in the treatment of acute pain and therefore can be if they become dehydrated. Patients who have had a previous safely used by patients who are at risk of developing acute decline in renal function should have their notes flagged complications associated with oral NSAIDs. 35 Blood and be identified as at risk of NSAID-related AKI. concentrations of NSAIDs after applying topical products are typically less than 5% of those reached by using oral People with type 2 diabetes should avoid NSAIDs where NSAIDs.35 Approximately six or seven patients out of possible. Reduced renal function and albuminuria are both ten will experience successful pain control with topical risk factors for micro and macrovascular complications NSAIDs.35 However, a large proportion of this effect is that have increased prevalence in people with diabetes.30 because sprain-type injuries tend to improve without Preservation of renal function to prevent the development of treatment.35 CKD and to reduce cardiovascular risk is an essential part of the management of patients with type 2 diabetes. Topical capsaicin is also often used as an adjunctive treatment for osteoarthritis of the knee or hand.13 Topical NSAID nephrotoxicity can be exacerbated by ACE inhibitors capsaicin is currently subsidised for patients who have or ARBs as these medicines impair the regulation of blood osteoarthritis that is not responsive to paracetamol and flow leaving the kidney. Renal function can be compromised where oral NSAIDs are contraindicated. Topical capsaicin is even further if a patient is also taking a diuretic. The combined an irritant and should not be applied to the eyes, mucous potential effect of these three medicines has been referred membranes or broken skin.6 Hands should be washed to as the “triple whammy”. This can result in hyponatremia immediately after applying this medicine.6 or hyperkalemia, AKI and cardiac failure.3, 31 The risk of this occurring is greatest in the first 30 days of use.28 This combination of medicines should be prescribed with caution, particularly in people with CKD or diabetes. If patients develop an acute illness it may be appropriate to discontinue or reduce the dose of these medicines. In patients with reduced renal function who are taking NSAIDs, or in patients at increased risk of renal toxicity, serum creatinine and potassium should be measured after one to two weeks of treatment and then monitored regularly.3 For further information see: “Acute-on-chronic kidney disease: Prevention, diagnosis, management and referral in primary care”, BPJ 46 (Sep, 2012). Hypersensitivity to NSAIDs Use of NSAIDs in children NSAID/aspirin hypersensitivity is characterised by symptoms Ibuprofen is generally the preferred NSAID for use in children. ranging in speed of onset from anaphylaxis and bronchospasm Naproxen is not indicated for the short-term treatment of pain to delayed skin and systemic reactions occurring over weeks.32 and fever in children, but may be prescribed for rheumatoid The reaction is due to COX-1 inhibition and is not mediated by arthritis in children aged over five years.6 Diclofenac is the only IgE, therefore it is not a true allergy.32 NSAID hypersensitivity other NSAID available in New Zealand for the treatment of is reported to affect 0.5 – 1.9% of the general population.32 pain and inflammation in children aged under 12 years, but it However, reports of prevalence among adults with asthma is rarely prescribed for this purpose in primary care. are as high as 21% if aspirin provocation testing is used.32 In children the prevalence of NSAID hypersensitivity is lower and reported to be 0.3% – 5% as assessed by provocation.32 Fever and NSAID use in children Cutaneous hypersensitivity reactions are relatively infrequent Febrile illness accounts for a large proportion of childhood and affect 0.3% of the population.32 presentations to primary care. Between 20 – 40% of parents report an occurrence every year.36 Paracetamol (children aged NSAIDs can be routinely prescribed to patients with asthma over one month, 15 mg/kg per dose, every four hours, up to who have no previous history of NSAID-associated symptoms. four times daily, maximum 1 g per dose and 4 g per day) or However, the possibility of NSAID use increasing asthma ibuprofen (children aged under 12 years, 20 mg/kg in divided severity should be discussed with the patient first. Patients doses, to a maximum of 500 mg per day in children under 30 with asthma and nasal polyps or recurrent sinusitis are more kg) are both indicated for the treatment of pain and fever in likely to experience hypersensitivity to NSAIDs.33 People who children.6, 36 However, before prescribing ibuprofen for the have had a hypersensitivity reaction to a NSAID should avoid treatment of febrile illness consider emerging evidence that all non-selective NSAIDs as the reaction is likely to be a class suggests the use of NSAIDs in children may be associated with effect.32 an increased risk of AKI, especially in children who are obese (see below). NSAID use in women who are pregnant is not A paracetamol dosage calculator for children is available recommended from: Paracetamol is preferred to NSAIDs in women who are www.bpac.org.nz/resources/other/bmi_calc/bmiCalc.html pregnant because NSAID use in the first trimester doubles the risk of spontaneous abortion.3 Later in pregnancy NSAID use Management of fever in children should aim to improve is associated with premature closure of the ductus arteriosus comfort rather than reduce body temperature.37 Points to blood vessel, which can result in structural birth defects, consider when prescribing medicines specifically for fever in preterm delivery or low birth weight.34 NSAIDs may also delay children include:36 the onset of labour and increase blood loss during childbirth.3 Mild fevers (<38°C) do not need to be treated Paracetamol or ibuprofen should not be given for the Breast feeding while taking paracetamol or NSAIDs is considered sole purpose of reducing body temperature (see: “The safe due to the low concentrations of these medicines in benefits of inflammation and fever”) breast milk.34 However, aspirin use during lactation has been Medicines for fever should only be prescribed for as associated with significant adverse events in infants.34 Repeat long as the child is in discomfort. If discomfort is not doses of codeine should be avoided wherever possible in alleviated before the next dose is due, then switching, women who are breast feeding, as severe toxicity has been e.g. changing from paracetamol to ibuprofen, may be reported in infants whose mothers are ultra-fast metabolisers considered. Also consider medical review. (see: “Paracetamol and codeine may have variable efficacy”, Do not give paracetamol and ibuprofen at the same time Page 10).6 Paracetamol and ibuprofen do not prevent febrile convulsions and should not be prescribed specifically for this reason Ask if the child has taken any medicine for their current illness when assessing their condition. A failure to respond to prior treatment may indicate a more serious illness. Advise parents be a contributing factor to additional cases of multi-factorial of the need for children with fever to receive regular fluids.36 AKI.39 The majority of presentations occurred within the first Small quantities of water offered frequently are best, or breast seven days of treatment and doses were generally within milk if the child is being breast fed. Parents should not give recommended prescribing guidelines.39 Vomiting (74%) was NSAIDs to children who may be dehydrated, e.g. vomiting, the most frequent symptom followed by abdominal pain sunken eyes, tears or urine absent or if skin turgor is diminished. (67%) and decreased urine output (56%). 39 Children aged Tepid sponging is not recommended for the treatment of fever, under five years were most likely to require intensive treatment and children with fever should neither be over-wrapped nor and stay in hospital for longer.39 Obesity may be an important under dressed.36 Discussing the benefits of fever with parents risk factor for NSAID-induced AKI in children as almost half of may help to reduce parental distress. the patients admitted were at or above the 95th percentile for body mass index (BMI) or weight:length ratio.39 NSAIDs and acute kidney injury in children NSAIDs should be prescribed with caution in children with acute illness and/or volume depletion.38 ACKNOWLEDGEMENT: Thank you to Dr Chris Cameron, Children aged under five years and children who are obese General Physician and Clinical Pharmacologist, Chair, may be at greatest risk of NSAID-induced AKI. One study of Medicines Committee, Capital & Coast DHB, Wellington children admitted to hospital with AKI found that at least 2.7% Hospital for expert review of this article. of all instances were due to NSAID use, with NSAID use likely to The benefits of inflammation and fever The inflammatory response is triggered by damaged or infected cells releasing pro-inflammatory proteins. These signals cause local capillaries to increase in size and capillary membranes to become permeable, resulting in swelling as fluid accumulates locally. Attracted by the chemical signals, white blood cells pass through the capillary membranes and invade the area, attacking pathogens and consuming dead and infected cells. The increased body temperature acts to suppress bacterial growth, viral replication and therefore reduces the duration of infections. References 1. Ministry of Health. Pharmaceutical Collection. 2013. 21. Schjerning Olsen A-M, Fosbøl EL, Lindhardsen J, et al. Duration of 2. National Institute for Health and Care Excellence (NICE). Non-steroidal treatment with nonsteroidal anti-inflammatory drugs and impact anti-inflammatory drugs. Manchester: NICE; 2013. Available from: on risk of death and recurrent myocardial infarction in patients with www.nice.org.uk (Accessed Sep, 2013). prior myocardial infarction: a nationwide cohort study. Circulation. 3. Day RO, Graham GG. Non-steroidal anti-inflammatory drugs (NSAIDs). 2011;123(20):2226–35. BMJ. 2013;346:f3195. 22. Winnard D, Wright C, Taylor W, et al. National prevalence of gout 4. Longo D, Fauci A, Kasper D, et al. Chapter 293: Peptic ulcer disease and derived from administrative health data in Aotearoa New Zealand. related disorders. Harrison’s principles of internal medicine. 18th ed. Rheumatology. 2012;51:901–9. New York: McGraw Hill Medical; 2012. p. 2438-60. 23. Strand V. Are COX-2 inhibitors preferable to non-selective non-steroidal 5. Fosbøl EL, Gislason GH, Jacobsen S, et al. Risk of myocardial infarction anti-inflammatory drugs in patients with risk of cardiovascular events and death associated with the use of nonsteroidal anti-inflammatory taking low-dose aspirin? Lancet. 2007;370(9605):2138–51. drugs (NSAIDs) among healthy individuals: a nationwide cohort study. 24. New Zealand Guidelines Group. New Zealand primary care handbook Clin Pharmacol Ther. 2009;85(2):190–7. 2012. 3rd ed. Wellington: New Zealand Guidelines Group; 2012. 6. New Zealand Formulary (NZF). NZF v15. NZF; 2013. Available from: 25. Shin JM, Kim N. Pharmacokinetics and pharmacodynamics of the proton www.nzf.org.nz (Accessed Sep, 2013). pump inhibitors. J Neurogastroenterol Motil. 2013;19(1):25–35. 7. Singh G, Lanes S, Triadafilopoulos G. Risk of serious upper 26. Rostom A, Dube C, Wells G, et al. Prevention of NSAID- gastrointestinal and cardiovascular thromboembolic complications induced gastroduodenal ulcers. Cochrane Database Syst Rev. with meloxicam. Am J Med. 2004;117(2):100–6. 2002;4:CD002296. 8. Coxib and traditional NSAID Trialists’ (CNT) Collaboration. Vascular 27. Medsafe. Prescriber Update: NSAIDs and Acute Kidney Injury. 2013. and upper gastrointestinal effects of non-steroidal anti-inflammatory Available from: www.medsafe.govt.nz (Accessed Sep, 2013). drugs: meta-analyses of individual participant data from randomised 28. Lapi F, Azoulay L, Yin H, et al. Concurrent use of diuretics, angiotensin trials. Lancet. 2013;382(9894):769–79. converting enzyme inhibitors, and angiotensin receptor blockers with 9. Massó González EL, Patrignani P, Tacconelli S, García Rodríguez LA. non-steroidal anti-inflammatory drugs and risk of acute kidney injury: Variability among nonsteroidal antiinflammatory drugs in risk of upper nested case-control study. BMJ. 2013;346:e8525. gastrointestinal bleeding. Arthritis Rheum. 2010;62(6):1592–601. 29. Zhang Q-L, Rothenbacher D. Prevalence of chronic kidney disease 10. Sachs CJ. Oral analgesics for acute nonspecific pain. Am Fam Physician. in population-based studies: systematic review. BMC Public Health. 2005;71(5):913–8. 2008;8:117. 11. National Institute for Health Care and Excellence (NICE). Clinical 30. Doggen K, Nobels F, Scheen AJ, et al. Cardiovascular risk factors and Knowledge Summaries: NSAIDs - prescribing issues. NICE, 2013. complications associated with albuminuria and impaired renal function Available from: cks.nice.org.uk (Accessed Sep, 2013). in insulin-treated diabetes. J Diabetes Complicat. 2013;27(4):370–5. 12. Derry CJ, Derry S, Moore RA. Single dose oral ibuprofen plus 31. Fournier J-P, Lapeyre-Mestre M, Sommet A, et al. Laboratory monitoring paracetamol (acetaminophen) for acute postoperative pain. Cochrane of patients treated with antihypertensive drugs and newly exposed Database Syst Rev. 2013;6:CD010210. to non steroidal anti-inflammatory drugs: a cohort study. PLoS ONE. 13. National Institute for Health Care Excellence (NICE). Osteoarthritis: the 2012;7(3):e34187. care and management of osteoarthritis in adults. NICE: London; 2008. 32. Kowalski ML, Makowska JS, Blanca M, et al. Hypersensitivity to Available from: www.nice.org.uk (Accessed Sep, 2013). nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, 14. de Leon J, Armstrong SC, Cozza KL. Clinical guidelines for psychiatrists diagnosis and management: review of the EAACI/ENDA and GA2LEN/ for the use of pharmacogenetic testing for CYP450 2D6 and CYP450 HANNA. Allergy. 2011;66(7):818–29. 2C19. Psychosomatics. 2006;47(1):75–85. 33. Risser A, Donovan D, Heintzman J, Page T. NSAID prescribing 15. Doherty M, Hawkey C, Goulder M, et al. A randomised controlled precautions. Am Fam Physician. 2009;80(12):1371–8. trial of ibuprofen, paracetamol or a combination tablet of ibuprofen/ 34. Kennedy D. Analgesics and pain relief in pregnancy and breastfeeding. paracetamol in community-derived people with knee pain. Ann Austr Prescr. 2011;34:8–10. Rheum Dis. 2011;70(9):1534–41. 35. Massey T, Derry S, Moore RA, McQuay HJ. Topical NSAIDs for acute pain 16. Bondarsky EE, Domingo AT, Matuza NM, et al. Ibuprofen vs in adults. Cochrane Database Syst Rev. 2010;(6):CD007402. acetaminophen vs their combination in the relief of musculoskeletal 36. National Institute for Health and Care Excellence (NICE). Feverish illness pain in the ED: a randomized, controlled trial. Am J Emerg Med. in children: Assessment and initial management in children younger 2013;9:1357–60. than five years. NICE: Manchester; 2013. Available from: www.nice.org. 17. de Vries F, Setakis E, van Staa T-P. Concomitant use of ibuprofen and uk (Accessed Sep, 2013). paracetamol and the risk of major clinical safety outcomes. Br J Clin 37. Sullivan JE, Farrar HC. Fever and antipyretic use in children. Pediatrics. Pharmacol. 2010;70(3):429–38. 2011;127(3):580–7. 18. Brune K, Hinz B. Paracetamol, ibuprofen, or a combination of both drugs 38. Brophy PD. Changing the paradigm in pediatric acute kidney injury. J against knee pain: an excellent new randomised clinical trial answers Pediatr. 2013;162(6):1094–6. old questions and suggests new therapeutic recommendations. Ann 39. Misurac JM, Knoderer CA, Leiser JD, et al. Nonsteroidal anti- Rheum Dis. 2011;70(9):1521–2. Inflammatory drugs are an important cause of acute kidney injury in 19. Feucht CL, Patel DR. Analgesics and anti-inflammatory medications in children. J Pediatr. 2013;162:1153–9. sports: use and abuse. Pediatr Clin North Am. 2010;57(3):751–74. 20. Trelle S, Reichenbach S, Wandel S, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011;342:c7086. COMING SOON The New Zealand Formulary for Children www.nzformulary.org ","You are given a reference document. You must only use information found in the reference document to answer the question asked. According to this document is the combination of paracetamol and ibuprofen effective? NON-STEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs): Making safer treatment choices Non-steroidal anti-inflammatory drugs (NSAIDs) are successfully used to treat a wide range of painful conditions. However, NSAIDs should be prescribed with caution as courses of just a few days, even at doses within prescribing recommendations, can be associated with serious adverse effects in susceptible patients. In primary care, paracetamol is recommended in preference to NSAIDs, where appropriate. If a patient is likely to benefit from NSAID treatment naproxen or ibuprofen are recommended first-line, at the lowest effective dose, for the shortest possible time. Patients taking NSAIDs who are at increased risk of complications require regular monitoring. How NSAIDs work determines their risk and How NSAIDs work, the patient’s age and the condition being guides their use treated also need to be taken into account when these issues are discussed with patients. Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed medicines for analgesia in primary care, after paracetamol.1 However, NSAID use can be NSAIDs and cyclo-oxygenase (COX) selectivity associated with a range of serious adverse effects including: The cyclo-oxygenase-1 (COX-1) and COX-2 enzymes produce cardiovascular events, gastrointestinal complications, renal prostaglandins following the metabolism of omega-6 failure and hypersensitivity reactions. Even if the risk of an polyunsaturated fatty acid (arachidonic acid).3 Prostaglandins individual patient experiencing an NSAID-related adverse are chemical messengers that mediate inflammation, fever and event is relatively low, the frequent use of NSAIDs within the sensation of pain.3 The analgesic and anti-inflammatory the community means that the potential for NSAID-related effects of NSAIDs are produced through the prevention of adverse events to occur is a concern. NSAID use therefore prostaglandin production by inhibition of COX activity. The requires careful consideration of individual patient risk factors. clinical effects and the risk profiles of the different NSAIDs are To maximise patient safety it is recommended that clinicians largely determined by their differential ability to inhibit the consider the following points before prescribing an NSAID:2 COX-1 and/or COX-2 enzymes and their half-lives. Prescribe all NSAIDs with caution, in all patient groups, COX-1 is widely distributed in the body but is concentrated even over short periods of time in cells of the stomach, kidney, endothelium and in platelets.4 Prescribe the lowest effective NSAID dose, for the Prostaglandins catalysed by COX-1 activity control renal shortest possible time, and review the need for perfusion, promote platelet aggregation and provide continued use at each consultation gastroprotection by regulating mucous secretion.4 Inhibition Older patients, patients with increased cardiovascular of COX-1 can cause adverse gastrointestinal effects.4 risk, patients with type 2 diabetes, and patients with reduced renal function or a history of renal problems COX-2 is induced by inflammation and it is present in are at increased risk of NSAID-related complications and macrophages, leukocytes, fibroblasts and synovial cells. 4 should be advised about adverse effects and regularly Prostaglandins formed via COX-2 activity mediate pain, monitored when taking NSAIDs inflammation, fever and inhibit platelet aggregation.3 Naproxen (up to 1000 mg per day) or ibuprofen (up NSAIDs that inhibit both COX-1 and COX-2 enzymes are termed to 1200 mg per day) are the recommended first-line non-selective NSAIDs, while NSAIDs which predominately choices for adults based on our current knowledge of inhibit COX-2 enzymes are termed COX-2 inhibitors. NSAIDs and cardiovascular risk; ibuprofen is the most appropriate NSAID for children NSAIDs and COX inhibition Avoid prescribing long-acting formulations of NSAIDs, Ibuprofen, naproxen and diclofenac are non-selective NSAIDs. where possible, as these are associated with an increased However, diclofenac inhibits COX-2 relatively more than risk of gastrointestinal adverse effects COX-1.5 Many of the NSAIDs available in New Zealand have similar indications, e.g. musculoskeletal pain and inflammation, COX-1 is weakly inhibited and COX-2 is strongly inhibited then therefore these three medicines account for 97% of all the risk of thrombosis will be increased. NSAID prescribing.1 Other non-selective NSAIDs indicated for specific conditions include: tenoxicam (inflammatory Naproxen use (up to 1000 mg per day) does not appear to arthropathy, dysmenorrhoea, post-operative pain and acute be associated with increased vascular risk, based on current gout), tiaprofenic acid (inflammatory arthropathy), ketoprofen evidence.8 This may be because COX-1 inhibition by naproxen (inflammatory arthropathy), mefenamic acid (dysmenorrhoea is sufficiently prolonged and intense to effectively block and menorrhagia) and sulindac (inflammatory arthropathy).6 platelet activation and counterbalance the prothrombotic effect of COX-2 inhibition.8 Meloxicam is currently the only subsidised (Special Authority) COX-2 inhibitor in New Zealand. At low doses meloxicam mainly NSAID half-life also influences treatment choice inhibits COX-2. As the dose of meloxicam increases COX-1 is NSAIDs can be divided into short-acting NSAIDs with half-lives increasingly inhibited. For example, there is an increased rate less than six hours and long-acting NSAIDs. NSAIDs with a of serious gastrointestinal adverse events at a dose of 15 mg short half-life, e.g. ibuprofen, have a relatively quick onset of per day, compared to 7.5 mg per day.7 action and are better suited for the treatment of acute pain. NSAIDs with longer half-lives, e.g. naproxen, or in long-acting Celecoxib and etoricoxib COX-2 inhibitors are also available in formulations are more suited for the treatment of chronic New Zealand, but are not subsidised. conditions, as they require only once or twice daily dosing. However, persistent exposure to NSAIDs is an independent Check the New Zealand Formulary or Pharmaceutical determinant of gastrointestinal effects therefore NSAIDs with Schedule for the subsidy details of NSAIDs a long-half life, or NSAIDs in a slow-release formulation, are associated with an increased risk of gastrointestinal adverse events (see: “NSAIDs and gastrointestinal complications”, Page COX selectivity and cardiovascular risk 13).9 COX-2 inhibitors were initially developed on the rationale that selective inhibition of COX-2 might replicate the anti- inflammatory and analgesic effects of non-selective NSAIDs Choosing an analgesic regimen while reducing gastrointestinal adverse effects. However, The WHO analgesic ladder recommends paracetamol and/or it was later discovered that COX-2 activity inhibits platelet an NSAID first-line for pain management. The relative efficacy aggregation, therefore NSAIDs that block COX-2 promote of paracetamol and NSAIDs depends on the underlying thrombosis and events such as myocardial infarction become condition causing the pain. Specifically, NSAIDs are more more likely (see: “Cardiovascular risk in people taking NSAIDs”, effective than paracetamol in the treatment of inflammatory Page 12).3 It is now thought that the relative degree to which conditions, such as gout or rheumatoid arthritis, and in different NSAIDs inhibit both COX-1 and COX-2, and the effect the treatment of dental and menstrual pain.3, 10 For tension that this has on platelet aggregation, determines the likelihood headache or following orthopaedic surgery paracetamol is of each NSAID causing cardiovascular events.8 For example, if reported to provide equivalent analgesia to NSAIDs.10 Paracetamol and codeine may have variable efficacy The effectiveness of paracetamol and codeine may vary toxicity, even at low doses. This can result in respiratory depending on a person’s level of expression of the CYP2D6 depression. It is estimated that among Europeans up to enzyme. People deficient in this enzyme are unable to 10% of people will be either ultra-fast or slow metabolisers convert codeine to morphine and may not receive pain of codeine.14 The prevalence of fast and slow metabolisers relief from its use. Conversely, people who are ultra-fast of codeine among Māori and Pacific peoples is not metabolisers of codeine are at increased risk of opioid known. Paracetamol is safer than NSAIDs for most conditions Paracetamol is considered to be a safer treatment choice than NSAIDs in people at increased risk of NSAID-related Combination paracetamol and ibuprofen adverse effects, e.g. children or older patients, patients with There are an increasing number of products being cardiovascular or renal co-morbidities or diabetes, or patients marketed to the public that contain both paracetamol with a previous history of gastrointestinal symptoms or NSAID and ibuprofen. It is uncertain whether the concomitant hypersensitivity (see: “Hypersensitivity to NSAIDs”, Page use of paracetamol and ibuprofen significantly improves 16). Paracetamol is also recommended by United Kingdom analgesia compared to the use of NSAIDs alone. Studies guidelines for the long-term treatment of back pain and have produced mixed results and outcomes may be degenerative conditions, such as osteoarthritis, due to its influenced by the cause of the pain being studied. It is superior tolerability.3 also not clear whether the combined use of paracetamol and ibuprofen increases the risk of adverse effects. Compared to NSAIDs, paracetamol has:3 Minimal gastrointestinal toxicity A Cochrane review of the analgesic efficacy of paracetamol Little effect on blood pressure and ibuprofen in the treatment of post-operative pain, concluded that combinations of paracetamol plus No association with myocardial infarction ibuprofen provided better analgesia than either medicine No interaction with the antiplatelet effect of aspirin alone.12 It was also concluded that the combination treatment reduced the need for additional analgesia to Paracetamol can be given for mild to moderate pain in adults be administered and reduced the risk of adverse events at the recommended dose of 0.5 – 1 g, every four to six hours, occurring.12 A study of approximately 900 patients using to a maximum of 4 g per day.6 The major adverse effect paracetamol or ibuprofen, or a combination of the two, associated with paracetamol is liver damage due to overdose for the treatment of osteoarthritis of the knee found and it should not be prescribed to patients with liver disease.6 significantly more patients achieved pain control at ten days and at 13 weeks with the combination treatment Consider adding codeine to paracetamol in select patients compared to paracetamol alone, but there was not a If the risk of NSAID-related adverse events is high, it may be statistically significant difference compared to using appropriate to consider adding codeine to paracetamol, in ibuprofen alone.15 In contrast, a small study of 90 patients preference to NSAID treatment.11 For example, an older patient randomised to one of three treatment groups in an with osteoarthritis, diabetes and chronic kidney disease (CKD) emergency department setting found that combination may be particularly susceptible to the nephrotoxic effects of treatment with paracetamol and ibuprofen did not provide NSAIDs (see “NSAIDs and renal function”, Page 14). more effective pain relief following musculoskeletal injury compared to either medicine alone.16 An appropriate starting dose of codeine in combination with paracetamol for mild to moderate pain in adults is 15 A large British study funded by a pharmaceutical company mg, every four hours, as required.6 Codeine can be given in reported that compared to the use of the paracetamol and doses up to 60 mg, if required, but the total dose should not ibuprofen alone, the combined use of the two medicines exceed 240 mg per day.6 The main adverse effects of codeine did not increase the number of adverse effects.17 However, are gastrointestinal disturbance and potential respiratory in the treatment of osteoarthritis of the knee a trend depression.6 The effectiveness of codeine may vary between towards increased dyspepsia, diarrhoea and blood loss individuals due to genetic differences in metabolism, and it may was reported in patients using a combination product.15 not be an appropriate choice for all patients (see: “Paracetamol with codeine may have variable efficacy”, previous page). The lack of a demonstrated strong synergistic analgesic effect between paracetamol and ibuprofen, suggests that Combining paracetamol with NSAIDs may be appropriate the two medicines may have similar modes of actions The combination of paracetamol with NSAIDs may provide and their effects may not be additive.18 The lack of clear more effective analgesia for some patients, e.g. for post- evidence of improved analgesia has led some experts to surgical pain, than either medicine alone.12 This combination question the value of combination products containing treatment may allow the dose of NSAID required to achieve paracetamol and ibuprofen.18 analgesia to be reduced (compared to NSAID treatment alone) therefore reducing the amount NSAID-related risk the patient is exposed to.12 However, this approach does not appear to Diclofenac (75 – 150 mg, daily, in two or three divided doses) be effective for all conditions (see: “Combination paracetamol is indicated for acute pain and inflammation, in inflammatory and ibuprofen”, Page 11). If a combination of paracetamol arthropathy and other musculoskeletal disorders.6 However, and NSAIDs is used to treat pain, consider titrating the NSAID diclofenac at doses of ≥ 150 mg per day is associated with an dose downwards as pain becomes more manageable, while increased risk of cardiovascular events (see below). Diclofenac continuing treatment with paracetamol at the same dose. use is contraindicated in patients who have had a myocardial The NSAID can then be withdrawn, before paracetamol, and infarction in the previous 12 months.6 treatment with paracetamol continued, as required. When prescribing NSAIDs following muscle injury, short courses, i.e. three to seven days, are preferable to longer term Review and intensify lifestyle modifications to manage use.19 pain Long-term pain, as with any chronic condition, requires continual review and ongoing lifestyle modifications to prevent Cardiovascular risk in people taking NSAIDs a decline in the quality of the patient’s life. For example, a Prescribe long-term NASIDs with caution to people with an person with osteoarthritis is likely to benefit from intensifying elevated cardiovascular risk, particularly if they have had a exercise and weight loss programmes.13 previous cardiovascular event. All non-selective NSAIDs and COX-2 inhibitors are associated with increased cardiovascular risk - except naproxen up to 1000 mg per day or ibuprofen up Reducing the risk of NSAID use to 1200 mg per day.2, 20 This increased risk begins within the If it is decided that NSAID treatment is appropriate, having first week of treatment and translates to an additional three weighed the risks versus benefits of treatment, ensure the major vascular events per 1000 patients, per year.8, 21 patient’s history is known before an NSAID is prescribed. In particular:3 NSAID use has also been found to approximately double the Ensure the patient is aware which over-the-counter (OTC) risk of hospital admission due to heart failure and increase products contain NSAIDs and that they know that they systolic blood pressure by an average of 2 – 3 mmHg.3, 8 The should not take any other NSAID-containing products effect NSAIDs have on blood pressure may be more dramatic while they are being treated with an NSAID in people with pre-existing hypertension and in people Determine if the patient has any co-morbidities that may taking antihypertensives (see: “NSAIDs and renal function”, increase the risk of NSAID treatment, e.g. cardiovascular Page 14).3 Blood pressure should be monitored in patients disease, CKD, diabetes, hypertension or duodenal ulcer with hypertension and older patients within the first month of initiating long-term NSAID treatment, and then routinely Query if the patient is taking any medicines that may monitored as part of ongoing management.3 interact with NSAIDs, e.g. angiotensin converting enzyme (ACE) inhibitors, angiotensin-II receptor blockers (ARBs), NSAIDs increase cardiovascular risk across all patient diuretics, clopidogrel, warfarin, dabigatran or aspirin groups Discuss any history of NSAID-related adverse effects A large study found that there was a relative increase in with the patient. Their preference may affect the dosing cardiovascular risk, mainly attributed to coronary events, of regimen. Some patients may prefer to tolerate adverse approximately 33% in patients using high-dose diclofenac effects if a higher dose is likely to result in improved (> 150 mg), COX-2 inhibitors (celecoxib, rofecoxib, etoricoxib symptom control, while other patients may take the and lumiracoxib) and high-dose ibuprofen.8 Importantly, the opposite view. trial found that there was no statistical difference in this risk between patient groups with low or high predicted five-year Naproxen (up to 1000 mg per day) or ibuprofen (up to 1200 cardiovascular risk.8 The significance of this study to primary mg per day) are recommended first-line choices if NSAIDs care in New Zealand is that an increased cardiovascular risk are required, due to the lower risk of cardiovascular events has been an under-recognised concern in many patients occurring when these medicines are taken at these doses, taking non-selective NSAIDs. compared to other NSAIDs.2 N.B. The recommended maximum dose of ibuprofen is 2400 mg/day;6 this higher dose may be Short-term and long-term use of NSAIDs is associated with necessary, and appropriate, for some patients, but is associated increased cardiovascular risk. Advise patients who have had with increased cardiovascular risk. a previous cardiovascular event that even one or two doses of ibuprofen or diclofenac may increase their risk of a recurrent event. A study of over 83 000 patients with prior myocardial infarction found that NSAID use increased the risk of recurrent Aspirin and cardiovascular risk myocardial infarction or death by 1.45 times during the first It is unknown if aspirin use, which irreversibly inhibits seven days of treatment and this risk persisted throughout COX-1, influences the apparently neutral cardiovascular the course of treatment.21 The greatest risk was associated effects of naproxen. A large study has found evidence that with diclofenac which increased the risk of myocardial aspirin may confer a cardioprotective effect in patients infarction and/or death by 3.26 times at day one to seven of taking COX-2 inhibitors, but not in patients taking treatment.21 Naproxen was not associated with an increased ibuprofen.23 Further studies are required to characterise risk of myocardial infarction or death during the 14 week the cardiovascular effects of aspirin in people taking study duration.21 naproxen. A practical approach to the issue of a possible NSAIDs and gastrointestinal complications interaction between NSAIDs and aspirin prescribed for Gastrointestinal adverse events are increased two to four-fold cardioprotection is to minimise the combined use of by the use of all NSAIDs and this increase is dose dependent. these medicines in patients with elevated cardiovascular Gastrointestinal complications associated with NSAID use risk. The use of aspirin for the primary prevention of include: dyspepsia, gastrointestinal bleeding, peptic ulcers cardiovascular disease is controversial. Current evidence and perforations of the upper gastrointestinal tract.3, 9 This only justifies the use of low-dose aspirin for primary is because inhibition of the COX-1 enzyme reduces the prevention in patients with a five-year cardiovascular risk production of protective gastric mucous. In general NSAIDs of greater than 15%.24 Furthermore, patients with a high that have a long half-life or are taken in a long-acting cardiovascular risk should not be routinely prescribed formulation have a greater risk of gastrointestinal adverse long-term NSAIDs, if possible. Finally, patients with effects.9 Gastrointestinal symptoms are less common in increased cardiovascular risk are likely to be older and people taking COX-2 inhibitors, however, the risk is increased may have other co-morbidities that increase the risk of in patients who are concurrently taking aspirin.8 NSAID-related adverse effects. Therefore the number of patients whose cardiovascular risk is clinically affected by Risk factors for gastrointestinal adverse effects associated with any interaction between aspirin and NSAIDs in primary NSAID use include:3 care is likely to be small when NSAID use is carefully Age over 65 years managed. Previous adverse reaction to NSAIDs For further information see: “The use of antithrombotic The use of other medicines that may exacerbate any medicines in general practice: A consensus statement”, gastrointestinal adverse effects, e.g. anticoagulants, BPJ 39 (Oct, 2011). selective serotonin reuptake inhibitors (SSRIs) and corticosteroids Liver disease Chronic kidney disease (CKD) Smoking Excessive alcohol consumption Use of non-selective NSAIDs and COX-2 inhibitors in people with ulcerative colitis and Crohn’s disease may cause an exacerbation of symptoms.3 Paracetamol is generally better tolerated than NSAIDs in people at increased risk of gastrointestinal adverse effects. Diclofenac and COX-2 inhibitors appear to be the least likely NSAIDs to cause upper gastrointestinal perforation, obstruction or bleeds, while the risk is likely to be increased for patients taking ibuprofen and naproxen.8 Reducing the risk of gastrointestinal complications Advise patients to take NSAIDs with milk or food so the Reducing NSAID-related risk in Māori stomach is not empty and irritation is reduced.3 Consider NSAIDs are often used in the management of gout. Gout co-prescribing a proton pump inhibitor (PPI) prophylactically is more prevalent among Māori males (11.7%) compared in people aged over 45 years if NSAIDs are being used long- to European males (3.7%).22 Māori are also more severely term in the treatment of osteoarthritis, rheumatoid arthritis or affected by gout and are therefore more likely to be lower back pain.2 PPIs should be taken daily, rather than “as using NSAIDs to manage acute flares than non-Māori.22 needed” because PPIs require approximately three days to As Māori are approximately twice as likely as non-Māori achieve steady state inhibition of acid secretion and ulceration to die of cardiovascular disease, the use of NSAIDs in this or bleeding of the gastrointestinal tract can often occur in the population requires added caution. Prescribers should absence of dyspepsia.3, 25 be aware of the elevated cardiovascular risk amongst Māori when prescribing NSAIDs for gout and monitor for A Cochrane review found that both PPIs and histamine-2 adverse effects accordingly. In addition, management receptor antagonists, e.g. ranitidine, were effective at of gout among Māori patients should be intensified to preventing chronic NSAID-related gastric and duodenal reduce the likelihood of flares occurring and reduce the ulcers.26 Omeprazole for the prevention of NSAID-related need for NSAID treatment. Corticosteroids (oral or intra- ulcers can be initiated in adults at 20 mg, once daily, for four articular) or colchicine may be considered as treatment weeks and continued for another four weeks if gastrointestinal alternatives to naproxen for acute gout flare. symptoms have not completely resolved.6 Ranitidine can be initiated in adults, for protection against NSAID-related ulcers, For further information see: “An update on the at 150 mg, twice daily, or 300 mg at night, for up to eight management of gout”, BPJ 51 (Mar, 2013). weeks.6 Misoprostol is no longer routinely used in primary care for the prevention of NSAID-related ulcers as it is associated with diarrhoea and occasionally more severe adverse effects, even at low doses.6, 26 If a patient develops gastrointestinal symptoms during NSAID treatment another type of NSAID can be trialled, an alternative class of analgesic trialled, or a PPI prescribed. In patients with a high risk of developing gastrointestinal complications who require long-term NSAID treatment:3 Prescribe a PPI and advise the patient to discontinue the NSAID and contact a health professional if they notice any gastrointestinal symptoms, e.g. black stools Monitor haemoglobin levels for the first month of treatment. Long-term haemoglobin monitoring is recommended if bleeding is an ongoing clinical concern. If gastrointestinal adverse effects do develop, consider switching to another NSAID NSAIDs and renal function All medicines which block COX-2 are potentially nephrotoxic because they can reduce blood flow to the kidney by preventing prostaglandin-mediated vasodilation. This is particularly true in patients who are dehydrated. NSAIDs can also cause immune mediated acute kidney injury (AKI), e.g. acute interstitial nephritis. In New Zealand over 40% of all renal adverse reactions reported to the Centre for Adverse Reactions Monitoring (CARM) were associated with diclofenac.27 The Topical analgesics risk of AKI in patients taking NSAIDs and other potentially Topical NSAIDs are not subsidised in New Zealand, nephrotoxic medicines is greatest at the start of treatment, however, they are readily available over-the-counter therefore even short courses of NSAIDs should be avoided, if (OTC) and are frequently purchased for the treatment of possible, in patients at increased risk.28 soft tissue injuries, e.g. sports injuries. Topical NSAIDs, in combination with paracetamol, are recommended before All people with CKD should avoid NSAIDs where possible. oral NSAIDs or codeine in United Kingdom guidelines for CKD is a risk factor for AKI and one-quarter to one-third of the treatment of osteoarthritis.13 Topical NSAIDs are also all people aged over 64 years have CKD.29 Acute illness and/ preferred to oral NSAIDs by some clinicians for patients or hypovolaemia, even if mild, further increases the risk of aged over 75 years.3 AKI occurring in people with CKD who are taking NSAIDs. Patients with CKD who are taking NSAIDs should be advised Topical NSAIDs are considered to be as safe as placebo to discontinue use if they develop an acute illness, especially in the treatment of acute pain and therefore can be if they become dehydrated. Patients who have had a previous safely used by patients who are at risk of developing acute decline in renal function should have their notes flagged complications associated with oral NSAIDs. 35 Blood and be identified as at risk of NSAID-related AKI. concentrations of NSAIDs after applying topical products are typically less than 5% of those reached by using oral People with type 2 diabetes should avoid NSAIDs where NSAIDs.35 Approximately six or seven patients out of possible. Reduced renal function and albuminuria are both ten will experience successful pain control with topical risk factors for micro and macrovascular complications NSAIDs.35 However, a large proportion of this effect is that have increased prevalence in people with diabetes.30 because sprain-type injuries tend to improve without Preservation of renal function to prevent the development of treatment.35 CKD and to reduce cardiovascular risk is an essential part of the management of patients with type 2 diabetes. Topical capsaicin is also often used as an adjunctive treatment for osteoarthritis of the knee or hand.13 Topical NSAID nephrotoxicity can be exacerbated by ACE inhibitors capsaicin is currently subsidised for patients who have or ARBs as these medicines impair the regulation of blood osteoarthritis that is not responsive to paracetamol and flow leaving the kidney. Renal function can be compromised where oral NSAIDs are contraindicated. Topical capsaicin is even further if a patient is also taking a diuretic. The combined an irritant and should not be applied to the eyes, mucous potential effect of these three medicines has been referred membranes or broken skin.6 Hands should be washed to as the “triple whammy”. This can result in hyponatremia immediately after applying this medicine.6 or hyperkalemia, AKI and cardiac failure.3, 31 The risk of this occurring is greatest in the first 30 days of use.28 This combination of medicines should be prescribed with caution, particularly in people with CKD or diabetes. If patients develop an acute illness it may be appropriate to discontinue or reduce the dose of these medicines. In patients with reduced renal function who are taking NSAIDs, or in patients at increased risk of renal toxicity, serum creatinine and potassium should be measured after one to two weeks of treatment and then monitored regularly.3 For further information see: “Acute-on-chronic kidney disease: Prevention, diagnosis, management and referral in primary care”, BPJ 46 (Sep, 2012). Hypersensitivity to NSAIDs Use of NSAIDs in children NSAID/aspirin hypersensitivity is characterised by symptoms Ibuprofen is generally the preferred NSAID for use in children. ranging in speed of onset from anaphylaxis and bronchospasm Naproxen is not indicated for the short-term treatment of pain to delayed skin and systemic reactions occurring over weeks.32 and fever in children, but may be prescribed for rheumatoid The reaction is due to COX-1 inhibition and is not mediated by arthritis in children aged over five years.6 Diclofenac is the only IgE, therefore it is not a true allergy.32 NSAID hypersensitivity other NSAID available in New Zealand for the treatment of is reported to affect 0.5 – 1.9% of the general population.32 pain and inflammation in children aged under 12 years, but it However, reports of prevalence among adults with asthma is rarely prescribed for this purpose in primary care. are as high as 21% if aspirin provocation testing is used.32 In children the prevalence of NSAID hypersensitivity is lower and reported to be 0.3% – 5% as assessed by provocation.32 Fever and NSAID use in children Cutaneous hypersensitivity reactions are relatively infrequent Febrile illness accounts for a large proportion of childhood and affect 0.3% of the population.32 presentations to primary care. Between 20 – 40% of parents report an occurrence every year.36 Paracetamol (children aged NSAIDs can be routinely prescribed to patients with asthma over one month, 15 mg/kg per dose, every four hours, up to who have no previous history of NSAID-associated symptoms. four times daily, maximum 1 g per dose and 4 g per day) or However, the possibility of NSAID use increasing asthma ibuprofen (children aged under 12 years, 20 mg/kg in divided severity should be discussed with the patient first. Patients doses, to a maximum of 500 mg per day in children under 30 with asthma and nasal polyps or recurrent sinusitis are more kg) are both indicated for the treatment of pain and fever in likely to experience hypersensitivity to NSAIDs.33 People who children.6, 36 However, before prescribing ibuprofen for the have had a hypersensitivity reaction to a NSAID should avoid treatment of febrile illness consider emerging evidence that all non-selective NSAIDs as the reaction is likely to be a class suggests the use of NSAIDs in children may be associated with effect.32 an increased risk of AKI, especially in children who are obese (see below). NSAID use in women who are pregnant is not A paracetamol dosage calculator for children is available recommended from: Paracetamol is preferred to NSAIDs in women who are www.bpac.org.nz/resources/other/bmi_calc/bmiCalc.html pregnant because NSAID use in the first trimester doubles the risk of spontaneous abortion.3 Later in pregnancy NSAID use Management of fever in children should aim to improve is associated with premature closure of the ductus arteriosus comfort rather than reduce body temperature.37 Points to blood vessel, which can result in structural birth defects, consider when prescribing medicines specifically for fever in preterm delivery or low birth weight.34 NSAIDs may also delay children include:36 the onset of labour and increase blood loss during childbirth.3 Mild fevers (<38°C) do not need to be treated Paracetamol or ibuprofen should not be given for the Breast feeding while taking paracetamol or NSAIDs is considered sole purpose of reducing body temperature (see: “The safe due to the low concentrations of these medicines in benefits of inflammation and fever”) breast milk.34 However, aspirin use during lactation has been Medicines for fever should only be prescribed for as associated with significant adverse events in infants.34 Repeat long as the child is in discomfort. If discomfort is not doses of codeine should be avoided wherever possible in alleviated before the next dose is due, then switching, women who are breast feeding, as severe toxicity has been e.g. changing from paracetamol to ibuprofen, may be reported in infants whose mothers are ultra-fast metabolisers considered. Also consider medical review. (see: “Paracetamol and codeine may have variable efficacy”, Do not give paracetamol and ibuprofen at the same time Page 10).6 Paracetamol and ibuprofen do not prevent febrile convulsions and should not be prescribed specifically for this reason Ask if the child has taken any medicine for their current illness when assessing their condition. A failure to respond to prior treatment may indicate a more serious illness. Advise parents be a contributing factor to additional cases of multi-factorial of the need for children with fever to receive regular fluids.36 AKI.39 The majority of presentations occurred within the first Small quantities of water offered frequently are best, or breast seven days of treatment and doses were generally within milk if the child is being breast fed. Parents should not give recommended prescribing guidelines.39 Vomiting (74%) was NSAIDs to children who may be dehydrated, e.g. vomiting, the most frequent symptom followed by abdominal pain sunken eyes, tears or urine absent or if skin turgor is diminished. (67%) and decreased urine output (56%). 39 Children aged Tepid sponging is not recommended for the treatment of fever, under five years were most likely to require intensive treatment and children with fever should neither be over-wrapped nor and stay in hospital for longer.39 Obesity may be an important under dressed.36 Discussing the benefits of fever with parents risk factor for NSAID-induced AKI in children as almost half of may help to reduce parental distress. the patients admitted were at or above the 95th percentile for body mass index (BMI) or weight:length ratio.39 NSAIDs and acute kidney injury in children NSAIDs should be prescribed with caution in children with acute illness and/or volume depletion.38 ACKNOWLEDGEMENT: Thank you to Dr Chris Cameron, Children aged under five years and children who are obese General Physician and Clinical Pharmacologist, Chair, may be at greatest risk of NSAID-induced AKI. One study of Medicines Committee, Capital & Coast DHB, Wellington children admitted to hospital with AKI found that at least 2.7% Hospital for expert review of this article. of all instances were due to NSAID use, with NSAID use likely to The benefits of inflammation and fever The inflammatory response is triggered by damaged or infected cells releasing pro-inflammatory proteins. These signals cause local capillaries to increase in size and capillary membranes to become permeable, resulting in swelling as fluid accumulates locally. Attracted by the chemical signals, white blood cells pass through the capillary membranes and invade the area, attacking pathogens and consuming dead and infected cells. The increased body temperature acts to suppress bacterial growth, viral replication and therefore reduces the duration of infections. References 1. Ministry of Health. Pharmaceutical Collection. 2013. 21. Schjerning Olsen A-M, Fosbøl EL, Lindhardsen J, et al. Duration of 2. National Institute for Health and Care Excellence (NICE). Non-steroidal treatment with nonsteroidal anti-inflammatory drugs and impact anti-inflammatory drugs. Manchester: NICE; 2013. Available from: on risk of death and recurrent myocardial infarction in patients with www.nice.org.uk (Accessed Sep, 2013). prior myocardial infarction: a nationwide cohort study. Circulation. 3. Day RO, Graham GG. Non-steroidal anti-inflammatory drugs (NSAIDs). 2011;123(20):2226–35. BMJ. 2013;346:f3195. 22. Winnard D, Wright C, Taylor W, et al. National prevalence of gout 4. Longo D, Fauci A, Kasper D, et al. Chapter 293: Peptic ulcer disease and derived from administrative health data in Aotearoa New Zealand. related disorders. Harrison’s principles of internal medicine. 18th ed. Rheumatology. 2012;51:901–9. New York: McGraw Hill Medical; 2012. p. 2438-60. 23. Strand V. Are COX-2 inhibitors preferable to non-selective non-steroidal 5. Fosbøl EL, Gislason GH, Jacobsen S, et al. Risk of myocardial infarction anti-inflammatory drugs in patients with risk of cardiovascular events and death associated with the use of nonsteroidal anti-inflammatory taking low-dose aspirin? Lancet. 2007;370(9605):2138–51. drugs (NSAIDs) among healthy individuals: a nationwide cohort study. 24. New Zealand Guidelines Group. New Zealand primary care handbook Clin Pharmacol Ther. 2009;85(2):190–7. 2012. 3rd ed. Wellington: New Zealand Guidelines Group; 2012. 6. New Zealand Formulary (NZF). NZF v15. NZF; 2013. Available from: 25. Shin JM, Kim N. Pharmacokinetics and pharmacodynamics of the proton www.nzf.org.nz (Accessed Sep, 2013). pump inhibitors. J Neurogastroenterol Motil. 2013;19(1):25–35. 7. Singh G, Lanes S, Triadafilopoulos G. Risk of serious upper 26. Rostom A, Dube C, Wells G, et al. Prevention of NSAID- gastrointestinal and cardiovascular thromboembolic complications induced gastroduodenal ulcers. Cochrane Database Syst Rev. with meloxicam. Am J Med. 2004;117(2):100–6. 2002;4:CD002296. 8. Coxib and traditional NSAID Trialists’ (CNT) Collaboration. Vascular 27. Medsafe. Prescriber Update: NSAIDs and Acute Kidney Injury. 2013. and upper gastrointestinal effects of non-steroidal anti-inflammatory Available from: www.medsafe.govt.nz (Accessed Sep, 2013). drugs: meta-analyses of individual participant data from randomised 28. Lapi F, Azoulay L, Yin H, et al. Concurrent use of diuretics, angiotensin trials. Lancet. 2013;382(9894):769–79. converting enzyme inhibitors, and angiotensin receptor blockers with 9. Massó González EL, Patrignani P, Tacconelli S, García Rodríguez LA. non-steroidal anti-inflammatory drugs and risk of acute kidney injury: Variability among nonsteroidal antiinflammatory drugs in risk of upper nested case-control study. BMJ. 2013;346:e8525. gastrointestinal bleeding. Arthritis Rheum. 2010;62(6):1592–601. 29. Zhang Q-L, Rothenbacher D. Prevalence of chronic kidney disease 10. Sachs CJ. Oral analgesics for acute nonspecific pain. Am Fam Physician. in population-based studies: systematic review. BMC Public Health. 2005;71(5):913–8. 2008;8:117. 11. National Institute for Health Care and Excellence (NICE). Clinical 30. Doggen K, Nobels F, Scheen AJ, et al. Cardiovascular risk factors and Knowledge Summaries: NSAIDs - prescribing issues. NICE, 2013. complications associated with albuminuria and impaired renal function Available from: cks.nice.org.uk (Accessed Sep, 2013). in insulin-treated diabetes. J Diabetes Complicat. 2013;27(4):370–5. 12. Derry CJ, Derry S, Moore RA. Single dose oral ibuprofen plus 31. Fournier J-P, Lapeyre-Mestre M, Sommet A, et al. Laboratory monitoring paracetamol (acetaminophen) for acute postoperative pain. Cochrane of patients treated with antihypertensive drugs and newly exposed Database Syst Rev. 2013;6:CD010210. to non steroidal anti-inflammatory drugs: a cohort study. PLoS ONE. 13. National Institute for Health Care Excellence (NICE). Osteoarthritis: the 2012;7(3):e34187. care and management of osteoarthritis in adults. NICE: London; 2008. 32. Kowalski ML, Makowska JS, Blanca M, et al. Hypersensitivity to Available from: www.nice.org.uk (Accessed Sep, 2013). nonsteroidal anti-inflammatory drugs (NSAIDs) - classification, 14. de Leon J, Armstrong SC, Cozza KL. Clinical guidelines for psychiatrists diagnosis and management: review of the EAACI/ENDA and GA2LEN/ for the use of pharmacogenetic testing for CYP450 2D6 and CYP450 HANNA. Allergy. 2011;66(7):818–29. 2C19. Psychosomatics. 2006;47(1):75–85. 33. Risser A, Donovan D, Heintzman J, Page T. NSAID prescribing 15. Doherty M, Hawkey C, Goulder M, et al. A randomised controlled precautions. Am Fam Physician. 2009;80(12):1371–8. trial of ibuprofen, paracetamol or a combination tablet of ibuprofen/ 34. Kennedy D. Analgesics and pain relief in pregnancy and breastfeeding. paracetamol in community-derived people with knee pain. Ann Austr Prescr. 2011;34:8–10. Rheum Dis. 2011;70(9):1534–41. 35. Massey T, Derry S, Moore RA, McQuay HJ. Topical NSAIDs for acute pain 16. Bondarsky EE, Domingo AT, Matuza NM, et al. Ibuprofen vs in adults. Cochrane Database Syst Rev. 2010;(6):CD007402. acetaminophen vs their combination in the relief of musculoskeletal 36. National Institute for Health and Care Excellence (NICE). Feverish illness pain in the ED: a randomized, controlled trial. Am J Emerg Med. in children: Assessment and initial management in children younger 2013;9:1357–60. than five years. NICE: Manchester; 2013. Available from: www.nice.org. 17. de Vries F, Setakis E, van Staa T-P. Concomitant use of ibuprofen and uk (Accessed Sep, 2013). paracetamol and the risk of major clinical safety outcomes. Br J Clin 37. Sullivan JE, Farrar HC. Fever and antipyretic use in children. Pediatrics. Pharmacol. 2010;70(3):429–38. 2011;127(3):580–7. 18. Brune K, Hinz B. Paracetamol, ibuprofen, or a combination of both drugs 38. Brophy PD. Changing the paradigm in pediatric acute kidney injury. J against knee pain: an excellent new randomised clinical trial answers Pediatr. 2013;162(6):1094–6. old questions and suggests new therapeutic recommendations. Ann 39. Misurac JM, Knoderer CA, Leiser JD, et al. Nonsteroidal anti- Rheum Dis. 2011;70(9):1521–2. Inflammatory drugs are an important cause of acute kidney injury in 19. Feucht CL, Patel DR. Analgesics and anti-inflammatory medications in children. J Pediatr. 2013;162:1153–9. sports: use and abuse. Pediatr Clin North Am. 2010;57(3):751–74. 20. Trelle S, Reichenbach S, Wandel S, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011;342:c7086. COMING SOON The New Zealand Formulary for Children www.nzformulary.org ",Medical,Fact Finding,Q&A Don't include any information from other sources.,Make a table listing all of the acronyms and initialisms used in this text and what they mean.,"Restless Legs Syndrome Restless legs syndrome (RLS) causes an unpleasant prickling or tingling in the legs, especially in the calves, that is relieved by moving or massaging them. People who have RLS feel a need to stretch or move their legs to get rid of the uncomfortable or painful feelings. As a result, it may be difficult to fall asleep and stay asleep. One or both legs may be affected. Some people also feel the sensations in their arms. These sensations also can occur when lying down or sitting for long periods of time, such as while at a desk, riding in a car, or watching a movie. Many people who have RLS also have brief limb movements during sleep, often with abrupt onset, occurring every 5–90 seconds. This condition, known as periodic limb movements in sleep (PLMS), can repeatedly awaken people who have RLS, reducing their total sleep time and interrupting their sleep. Some people have PLMS but have no abnormal sensations in their legs while awake. RLS affects 5–15 percent of Americans, and its prevalence increases with age. RLS occurs more often in women than men. One study found that RLS accounted for one-third of the insomnia seen in patients older than age 60. Children also can have RLS. In children, the condition may be associated with symptoms of attention-deficit hyperactivity disorder. However, it’s not fully known how the disorders are related. Sometimes “growing pains” can be mistaken for RLS. RLS is often inherited. Pregnancy, kidney failure, and anemia related to iron or vitamin deficiency can trigger or worsen RLS symptoms. Researchers suspect that these conditions cause an iron deficiency that results in a lack of dopamine, which is used by the brain to control physical sensation and limb movements. Doctors usually can diagnose RLS by patients’ symptoms and a telltale worsening of symptoms at night or while at rest. Some doctors may order a blood test to check ferretin levels (ferretin is a form of iron). Doctors also may ask people who have RLS to spend a night in a sleep laboratory, where they are monitored to rule out other sleep disorders and to document the excessive limb movements. RLS is treatable but not always curable. Dramatic improvements are seen quickly when patients are given dopamine-like drugs or iron supplements. Alternatively, people who have milder cases may be treated successfully with sedatives or behavioral strategies. These Common Sleep Disorders 48 Your Guide to Healthy Sleep n strategies include stretching, taking a hot bath, or massaging the legs before bedtime. Avoiding caffeinated beverages also can help reduce symptoms, and certain medications (e.g., some antidepressants, particularly selective serotonin reuptake inhibitors) may cause RLS. If iron or vitamin deficiency underlies RLS, symptoms may improve with prescribed iron, vitamin B12, or folate supplements. Some people may require anticonvulsant medications to control the creeping and crawling sensations in their limbs. Others who have severe symptoms that are associated with another medical disorder or that do not respond to normal treatments may need to be treated with pain relievers. Narcolepsy Narcolepsy’s main symptom is extreme and overwhelming daytime sleepiness, even after adequate nighttime sleep. In addition, nighttime sleep may be fragmented by frequent awakenings. People who have narcolepsy often fall asleep at inappropriate times and places. Although TV sitcoms occasionally feature these individuals to generate a few laughs, narcolepsy is no laughing matter. People who have narcolepsy experience daytime “sleep attacks” that last from seconds to more than one-half hour, can occur without warning, and may cause injury. These embarrassing sleep spells also can make it difficult to work and to maintain normal personal or social relationships. With narcolepsy, the usually sharp distinctions between being asleep and awake are blurred. Also, people who have narcolepsy tend to fall directly into dream-filled REM sleep, rather than enter REM sleep gradually after passing through the non-REM sleep stages first. In addition to overwhelming daytime sleepiness, narcolepsy has three other commonly associated symptoms, but these may not occur in all people: Sudden muscle weakness (cataplexy). This weakness is similar to the paralysis that normally occurs during REM sleep, but it lasts a few seconds to minutes while an individual is awake. Cataplexy tends to be triggered by sudden emotional reactions, such as anger, surprise, fear, or laughter. The weakness may show up as limpness at the neck, buckling of the knees, or sagging facial muscles affecting speech, or it may cause a complete body collapse. 49 Common Sleep Disorders At first, I was misdiagnosed with chronic fatigue syndrome, because I was in my forties and narcolepsy symptoms usually start during the teen years. Because I didn’t have any of the symptoms of chronic fatigue syndrome other than sleepiness, I went to a neurologist for help. He noticed the cataplexy (muscle weakness) right away, and then I was officially diagnosed with narcolepsy and then later on with borderline sleep apnea. “Even though there is no cure for narcolepsy, you can feel like you have control if you manage it well. “When you have narcolepsy, you live your life differently. But with a good plan and supportive friends and family, it all turns out OK. SZE-PING “ ” 50 Your Guide to Healthy Sleep n n Sleep paralysis. People who have narcolepsy may experience a temporary inability to talk or move when falling asleep or waking up, as if they were glued to their beds. Vivid dreams. These dreams can occur when people who have narcolepsy first fall asleep or wake up. The dreams are so lifelike that they can be confused with reality. Experts estimate that as many as 350,000 Americans have narcolepsy, but fewer than 50,000 are diagnosed. The disorder may be as widespread as Parkinson’s disease or multiple sclerosis, and more prevalent than cystic fibrosis, but it is less well known. Narcolepsy is often mistaken for depression, epilepsy, or the side effects of medicines. Narcolepsy can be difficult to diagnose in people who have only the symptom of excessive daytime sleepiness. It is usually diagnosed during an overnight sleep recording (PSG) that is followed by an MSLT. (See “How Are Sleep Disorders Diagnosed?” on page 44.) Both tests reveal symptoms of narcolepsy—the tendency to fall asleep rapidly and enter REM sleep early, even during brief naps. Narcolepsy can develop at any age, but the symptoms tend to appear first during adolescence or early adulthood. About 1 of every 10 people who have narcolepsy has a close family member who has the disorder, suggesting that one can inherit a tendency to develop narcolepsy. Studies suggest that a substance in the brain called hypocretin plays a key role in narcolepsy. Most people who have narcolepsy lack hypocretin, which promotes wakefulness. Scientists believe that an autoimmune reaction—perhaps triggered by disease, viral illness, or brain injury— specifically destroys the hypocretin-generating cells in the brains of people who have narcolepsy. 51 Eventually, researchers may develop a treatment for narcolepsy that restores hypocretin to normal levels. In the meantime, most people who have narcolepsy find some to all of their symptoms relieved by various drug treatments. For example, central nervous system stimulants can reduce daytime sleepiness. Antidepressants and other drugs that suppress REM sleep can prevent muscle weakness, sleep paralysis, and vivid dreaming. Doctors also usually recommend that people who have narcolepsy take short naps (10–15 minutes) two or three times a day, if possible, to help control excessive daytime sleepiness. ","Make a table listing all of the acronyms and initialisms used in this text and what they mean. Don't include any information from other sources. Restless Legs Syndrome Restless legs syndrome (RLS) causes an unpleasant prickling or tingling in the legs, especially in the calves, that is relieved by moving or massaging them. People who have RLS feel a need to stretch or move their legs to get rid of the uncomfortable or painful feelings. As a result, it may be difficult to fall asleep and stay asleep. One or both legs may be affected. Some people also feel the sensations in their arms. These sensations also can occur when lying down or sitting for long periods of time, such as while at a desk, riding in a car, or watching a movie. Many people who have RLS also have brief limb movements during sleep, often with abrupt onset, occurring every 5–90 seconds. This condition, known as periodic limb movements in sleep (PLMS), can repeatedly awaken people who have RLS, reducing their total sleep time and interrupting their sleep. Some people have PLMS but have no abnormal sensations in their legs while awake. RLS affects 5–15 percent of Americans, and its prevalence increases with age. RLS occurs more often in women than men. One study found that RLS accounted for one-third of the insomnia seen in patients older than age 60. Children also can have RLS. In children, the condition may be associated with symptoms of attention-deficit hyperactivity disorder. However, it’s not fully known how the disorders are related. Sometimes “growing pains” can be mistaken for RLS. RLS is often inherited. Pregnancy, kidney failure, and anemia related to iron or vitamin deficiency can trigger or worsen RLS symptoms. Researchers suspect that these conditions cause an iron deficiency that results in a lack of dopamine, which is used by the brain to control physical sensation and limb movements. Doctors usually can diagnose RLS by patients’ symptoms and a telltale worsening of symptoms at night or while at rest. Some doctors may order a blood test to check ferretin levels (ferretin is a form of iron). Doctors also may ask people who have RLS to spend a night in a sleep laboratory, where they are monitored to rule out other sleep disorders and to document the excessive limb movements. RLS is treatable but not always curable. Dramatic improvements are seen quickly when patients are given dopamine-like drugs or iron supplements. Alternatively, people who have milder cases may be treated successfully with sedatives or behavioral strategies. These Common Sleep Disorders 48 Your Guide to Healthy Sleep n strategies include stretching, taking a hot bath, or massaging the legs before bedtime. Avoiding caffeinated beverages also can help reduce symptoms, and certain medications (e.g., some antidepressants, particularly selective serotonin reuptake inhibitors) may cause RLS. If iron or vitamin deficiency underlies RLS, symptoms may improve with prescribed iron, vitamin B12, or folate supplements. Some people may require anticonvulsant medications to control the creeping and crawling sensations in their limbs. Others who have severe symptoms that are associated with another medical disorder or that do not respond to normal treatments may need to be treated with pain relievers. Narcolepsy Narcolepsy’s main symptom is extreme and overwhelming daytime sleepiness, even after adequate nighttime sleep. In addition, nighttime sleep may be fragmented by frequent awakenings. People who have narcolepsy often fall asleep at inappropriate times and places. Although TV sitcoms occasionally feature these individuals to generate a few laughs, narcolepsy is no laughing matter. People who have narcolepsy experience daytime “sleep attacks” that last from seconds to more than one-half hour, can occur without warning, and may cause injury. These embarrassing sleep spells also can make it difficult to work and to maintain normal personal or social relationships. With narcolepsy, the usually sharp distinctions between being asleep and awake are blurred. Also, people who have narcolepsy tend to fall directly into dream-filled REM sleep, rather than enter REM sleep gradually after passing through the non-REM sleep stages first. In addition to overwhelming daytime sleepiness, narcolepsy has three other commonly associated symptoms, but these may not occur in all people: Sudden muscle weakness (cataplexy). This weakness is similar to the paralysis that normally occurs during REM sleep, but it lasts a few seconds to minutes while an individual is awake. Cataplexy tends to be triggered by sudden emotional reactions, such as anger, surprise, fear, or laughter. The weakness may show up as limpness at the neck, buckling of the knees, or sagging facial muscles affecting speech, or it may cause a complete body collapse. 49 Common Sleep Disorders At first, I was misdiagnosed with chronic fatigue syndrome, because I was in my forties and narcolepsy symptoms usually start during the teen years. Because I didn’t have any of the symptoms of chronic fatigue syndrome other than sleepiness, I went to a neurologist for help. He noticed the cataplexy (muscle weakness) right away, and then I was officially diagnosed with narcolepsy and then later on with borderline sleep apnea. “Even though there is no cure for narcolepsy, you can feel like you have control if you manage it well. “When you have narcolepsy, you live your life differently. But with a good plan and supportive friends and family, it all turns out OK. SZE-PING “ ” 50 Your Guide to Healthy Sleep n n Sleep paralysis. People who have narcolepsy may experience a temporary inability to talk or move when falling asleep or waking up, as if they were glued to their beds. Vivid dreams. These dreams can occur when people who have narcolepsy first fall asleep or wake up. The dreams are so lifelike that they can be confused with reality. Experts estimate that as many as 350,000 Americans have narcolepsy, but fewer than 50,000 are diagnosed. The disorder may be as widespread as Parkinson’s disease or multiple sclerosis, and more prevalent than cystic fibrosis, but it is less well known. Narcolepsy is often mistaken for depression, epilepsy, or the side effects of medicines. Narcolepsy can be difficult to diagnose in people who have only the symptom of excessive daytime sleepiness. It is usually diagnosed during an overnight sleep recording (PSG) that is followed by an MSLT. (See “How Are Sleep Disorders Diagnosed?” on page 44.) Both tests reveal symptoms of narcolepsy—the tendency to fall asleep rapidly and enter REM sleep early, even during brief naps. Narcolepsy can develop at any age, but the symptoms tend to appear first during adolescence or early adulthood. About 1 of every 10 people who have narcolepsy has a close family member who has the disorder, suggesting that one can inherit a tendency to develop narcolepsy. Studies suggest that a substance in the brain called hypocretin plays a key role in narcolepsy. Most people who have narcolepsy lack hypocretin, which promotes wakefulness. Scientists believe that an autoimmune reaction—perhaps triggered by disease, viral illness, or brain injury— specifically destroys the hypocretin-generating cells in the brains of people who have narcolepsy. 51 Eventually, researchers may develop a treatment for narcolepsy that restores hypocretin to normal levels. In the meantime, most people who have narcolepsy find some to all of their symptoms relieved by various drug treatments. For example, central nervous system stimulants can reduce daytime sleepiness. Antidepressants and other drugs that suppress REM sleep can prevent muscle weakness, sleep paralysis, and vivid dreaming. Doctors also usually recommend that people who have narcolepsy take short naps (10–15 minutes) two or three times a day, if possible, to help control excessive daytime sleepiness. Parasomnias (Abnormal Arousals) In some people, the walking, talking, and other body functions normally suppressed during sleep occur during certain sleep stages. Alternatively, the paralysis or vivid images usually experienced during dreaming may persist after awakening. These occurrences are collectively known as parasomnias and include confusional arousals (a mixed state of being both asleep and awake), sleep talking, sleep walking, night terrors, sleep paralysis, and REM sleep behavior disorder (acting out dreams). Most of these disorders— such as confusional arousals, sleep walking, and night terrors—are more common in children, who tend to outgrow them once they become adults. People who are sleep-deprived also may experience some of these disorders, including sleep walking and sleep paralysis. Sleep paralysis also commonly occurs in people who have narcolepsy. Certain medications or neurological disorders appear to lead to other parasomnias, such as REM sleep behavior disorder, and these parasomnias tend to occur more in elderly people. If you or a family member has persistent episodes of sleep paralysis, sleep walking, or acting out of dreams, talk with your doctor. Taking measures to assure the safety of children and other family members who have partial arousals from sleep is very important. ",Medical,Fact Finding,Q&A Do not use any information besides what is provided within the prompt. Do not use any prior knowledge or outside sources. Answer with section headings and bullet points.,Summarize each cosmetic regulation pre- and post-MoCRA.,"Premarket Requirements Unlike its authority over drugs and some devices, FDA does not have the authority, either pre- or post-MoCRA, to require premarket approval of cosmetics or their ingredients, except for color additives.61 Prior to MoCRA, it was FDA’s position that manufacturers were responsible for substantiating the safety of their products and ingredients before the products were marketed.62 With the passage of MoCRA, manufacturers are now statutorily required to substantiate the safety of their products. MoCRA also expands upon required recordkeeping by manufacturers, packers, and distributors. A “responsible person”63 for a cosmetic product must ensure that it has been adequately tested to substantiate safety,64 and that records supporting this substantiation are maintained by the same responsible person.65 Certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from MoCRA’s safety substantiation and recordkeeping requirements.66 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply to those particular cosmetic products.67 Enforcement Among various enforcement mechanisms, under MoCRA, FDA may access and copy all records related to a cosmetic product that it reasonably believes is likely adulterated and a serious danger Modernization of Cosmetics Regulation Act of 2022 (MoCRA) Congressional Research Service 9 to humans. FDA may access and copy all records necessary to determine whether a cosmetic or related product is adulterated and a serious threat to human health, barring certain cosmetic formula, personnel, research, and financial data records. Accessible records include those related to safety substantiation data for cosmetic products and their ingredients.68 Registration and Listing Prior to MoCRA, cosmetic manufacturers were not required to register their establishments or list their products with FDA. Instead, according to FDA regulations, owners or operators of establishments that manufactured or packaged cosmetics were requested to register with FDA.69 Likewise, previous to MoCRA, manufacturers, packers, and distributors of cosmetic products were requested to file a cosmetic product ingredient statement (CPIS) containing certain information on each cosmetic product they marketed.70 Entities could submit registration information and CPISs to FDA’s Voluntary Cosmetic Registration Program (VCRP).71 Under MoCRA, both facility72 registration and product listings are now required.73 Existing and new facilities that manufacture or process cosmetic products for distribution in the United States must be registered with FDA. These registrations must be renewed every two years and updated within 60 days of a content revision.74 Domestic facilities registering with FDA must provide the facility’s name, physical address, email address, and phone number, while foreign facilities must provide contact information for an agent within the United States and, if available, electronic contact information. Additionally, a facility must include its registration number, if one was previously assigned, and all brand names associated with cosmetic products sold that were manufactured or processed at that facility. The product categories and responsible person for each cosmetic product manufactured or processed at the facility must also be provided.75 Each responsible person must also ensure the submission of a cosmetic product listing with FDA that is renewed and updated annually.76 The product listing must contain the manufacturing or processing facility’s registration number, the responsible person’s name and contact number, the name of the cosmetic product as it appears on the label, the categories the cosmetic product falls under, and the product’s listing number. Additionally, the product listing must include a list of the cosmetic product’s ingredients, “including any fragrances, flavors, or colors, with each ingredient identified by name.”77 FDA will assign private product and facility identification numbers upon initial listing submission or registration.78 With the advent of MoCRA, FDA reported the VCRP had been discontinued and was no longer accepting submissions. In a draft guidance released in August 2023, FDA stated it is developing a new electronic submission portal for registration and listing information.79 FDA noted that this new portal is expected to be available by October 2023.80 In the interim, FDA requests that no registration or listing information be sent to the agency, adding that information previously listed in the VCRP will not be transferred.81 In September 2023, FDA released for comment draft versions of the prospective electronic submission portal, Cosmetics Direct, and paper forms.82 MoCRA exempts certain small businesses83 from both facility registration and product listing requirements.84 However, a small business is not exempt from these requirements if it is engaged in the manufacturing or processing of higher-risk cosmetic products that “regularly come into contact with [the] mucus membrane of the eye under conditions of use that are customary or usual,” “[c]osmetic products that are injected” (see the text box below), “intended for internal use,” or that are meant to “alter [one’s] appearance for more than 24 hours under conditions of use that are customary or usual and removal by the consumer is not part of such conditions of use that are customary or usual.”85 Additionally, certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from facility registration and product listing requirements.86 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply.87 Enforcement Under MoCRA, if FDA determines that a cosmetic product has a reasonable probability of causing serious harm to human health, and if FDA has a reasonable belief that other products manufactured or processed at the same facility may be similarly affected, FDA may suspend the registration of the facility connected with such products.88 If a facility’s registration is suspended, any cosmetic product from that facility is barred from introduction or delivery for introduction into U.S. commerce.89 Before suspending a facility’s registration, the FDA must provide notice to a responsible person for the facility specifying the reason for suspension, as well as an opportunity, within five business days of the notice, to present a plan to correct the issue identified.90 FDA must provide the responsible person with the opportunity for an informal hearing to review actions required for registration reinstatement and why the facility registration should be reinstated.91 If, based upon the evidence presented at this informal hearing, FDA determines there are inadequate grounds to continue the suspension, the facility registration will be restored.92 However, if there is insufficient evidence presented, the suspension may continue, and FDA shall require the responsible person to submit a corrective action plan for review.93 If at any point FDA determines there is inadequate evidence to justify the continued suspension of a facility’s registration, the registration shall be promptly reinstated.94 Mandatory Recall Prior to MoCRA, FDA did not have the authority to order mandatory recalls of cosmetic products. The agency could, however, request a company to voluntarily recall cosmetic products of concern.114 Under MoCRA, a responsible person may still have the opportunity to voluntarily recall an adulterated or misbranded cosmetic; however, now FDA also has the authority to issue a mandatory recall.115 A mandatory recall may be initiated “[i]f the Secretary determines that there is a reasonable probability that a cosmetic is adulterated … or misbranded … and the use of or exposure to such cosmetic will cause serious adverse health consequences or death,” and the responsible person refuses to comply with a voluntary recall in a timely manner. Upon FDA issuing an order for a mandatory recall, the responsible person must immediately stop distributing the identified product.116 If such an order is issued, the responsible person is entitled to an opportunity for a timely informal hearing to review the adequacy of evidence for the order.117 Depending on the outcome of this review, the order may be vacated, continued until a specified date, or amended to further require the recall of the cosmetic product, along with other measures regarding notifications, timetables, and updates.118 FDA may require the responsible person to issue a notice of recall or ceased distribution to appropriate persons, including manufacturers, distributors, importers, and sellers.119 If a product is recalled, FDA must ensure that a press release announcing the action is published, as well as appropriate alerts and public notices, to provide consumers and retailers with information about the cosmetic product and the circumstances of the recall. If an image of the product is available and appropriate, FDA shall also ensure the publication of that image on its website.120 Certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from MoCRA’s mandatory recall authority.121 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply to those particular cosmetic products.122","Summarize each cosmetic regulation pre- and post-MoCRA. Do not use any information besides what is provided within the prompt. Do not use any prior knowledge or outside sources. Answer with section headings and bullet points. Premarket Requirements Unlike its authority over drugs and some devices, FDA does not have the authority, either pre- or post-MoCRA, to require premarket approval of cosmetics or their ingredients, except for color additives.61 Prior to MoCRA, it was FDA’s position that manufacturers were responsible for substantiating the safety of their products and ingredients before the products were marketed.62 With the passage of MoCRA, manufacturers are now statutorily required to substantiate the safety of their products. MoCRA also expands upon required recordkeeping by manufacturers, packers, and distributors. A “responsible person”63 for a cosmetic product must ensure that it has been adequately tested to substantiate safety,64 and that records supporting this substantiation are maintained by the same responsible person.65 Certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from MoCRA’s safety substantiation and recordkeeping requirements.66 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply to those particular cosmetic products.67 Enforcement Among various enforcement mechanisms, under MoCRA, FDA may access and copy all records related to a cosmetic product that it reasonably believes is likely adulterated and a serious danger Modernization of Cosmetics Regulation Act of 2022 (MoCRA) Congressional Research Service 9 to humans. FDA may access and copy all records necessary to determine whether a cosmetic or related product is adulterated and a serious threat to human health, barring certain cosmetic formula, personnel, research, and financial data records. Accessible records include those related to safety substantiation data for cosmetic products and their ingredients.68 Registration and Listing Prior to MoCRA, cosmetic manufacturers were not required to register their establishments or list their products with FDA. Instead, according to FDA regulations, owners or operators of establishments that manufactured or packaged cosmetics were requested to register with FDA.69 Likewise, previous to MoCRA, manufacturers, packers, and distributors of cosmetic products were requested to file a cosmetic product ingredient statement (CPIS) containing certain information on each cosmetic product they marketed.70 Entities could submit registration information and CPISs to FDA’s Voluntary Cosmetic Registration Program (VCRP).71 Under MoCRA, both facility72 registration and product listings are now required.73 Existing and new facilities that manufacture or process cosmetic products for distribution in the United States must be registered with FDA. These registrations must be renewed every two years and updated within 60 days of a content revision.74 Domestic facilities registering with FDA must provide the facility’s name, physical address, email address, and phone number, while foreign facilities must provide contact information for an agent within the United States and, if available, electronic contact information. Additionally, a facility must include its registration number, if one was previously assigned, and all brand names associated with cosmetic products sold that were manufactured or processed at that facility. The product categories and responsible person for each cosmetic product manufactured or processed at the facility must also be provided.75 Each responsible person must also ensure the submission of a cosmetic product listing with FDA that is renewed and updated annually.76 The product listing must contain the manufacturing or processing facility’s registration number, the responsible person’s name and contact number, the name of the cosmetic product as it appears on the label, the categories the cosmetic product falls under, and the product’s listing number. Additionally, the product listing must include a list of the cosmetic product’s ingredients, “including any fragrances, flavors, or colors, with each ingredient identified by name.”77 FDA will assign private product and facility identification numbers upon initial listing submission or registration.78 With the advent of MoCRA, FDA reported the VCRP had been discontinued and was no longer accepting submissions. In a draft guidance released in August 2023, FDA stated it is developing a new electronic submission portal for registration and listing information.79 FDA noted that this new portal is expected to be available by October 2023.80 In the interim, FDA requests that no registration or listing information be sent to the agency, adding that information previously listed in the VCRP will not be transferred.81 In September 2023, FDA released for comment draft versions of the prospective electronic submission portal, Cosmetics Direct, and paper forms.82 MoCRA exempts certain small businesses83 from both facility registration and product listing requirements.84 However, a small business is not exempt from these requirements if it is engaged in the manufacturing or processing of higher-risk cosmetic products that “regularly come into contact with [the] mucus membrane of the eye under conditions of use that are customary or usual,” “[c]osmetic products that are injected” (see the text box below), “intended for internal use,” or that are meant to “alter [one’s] appearance for more than 24 hours under conditions of use that are customary or usual and removal by the consumer is not part of such conditions of use that are customary or usual.”85 Additionally, certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from facility registration and product listing requirements.86 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply.87 Enforcement Under MoCRA, if FDA determines that a cosmetic product has a reasonable probability of causing serious harm to human health, and if FDA has a reasonable belief that other products manufactured or processed at the same facility may be similarly affected, FDA may suspend the registration of the facility connected with such products.88 If a facility’s registration is suspended, any cosmetic product from that facility is barred from introduction or delivery for introduction into U.S. commerce.89 Before suspending a facility’s registration, the FDA must provide notice to a responsible person for the facility specifying the reason for suspension, as well as an opportunity, within five business days of the notice, to present a plan to correct the issue identified.90 FDA must provide the responsible person with the opportunity for an informal hearing to review actions required for registration reinstatement and why the facility registration should be reinstated.91 If, based upon the evidence presented at this informal hearing, FDA determines there are inadequate grounds to continue the suspension, the facility registration will be restored.92 However, if there is insufficient evidence presented, the suspension may continue, and FDA shall require the responsible person to submit a corrective action plan for review.93 If at any point FDA determines there is inadequate evidence to justify the continued suspension of a facility’s registration, the registration shall be promptly reinstated.94 Mandatory Recall Prior to MoCRA, FDA did not have the authority to order mandatory recalls of cosmetic products. The agency could, however, request a company to voluntarily recall cosmetic products of concern.114 Under MoCRA, a responsible person may still have the opportunity to voluntarily recall an adulterated or misbranded cosmetic; however, now FDA also has the authority to issue a mandatory recall.115 A mandatory recall may be initiated “[i]f the Secretary determines that there is a reasonable probability that a cosmetic is adulterated … or misbranded … and the use of or exposure to such cosmetic will cause serious adverse health consequences or death,” and the responsible person refuses to comply with a voluntary recall in a timely manner. Upon FDA issuing an order for a mandatory recall, the responsible person must immediately stop distributing the identified product.116 If such an order is issued, the responsible person is entitled to an opportunity for a timely informal hearing to review the adequacy of evidence for the order.117 Depending on the outcome of this review, the order may be vacated, continued until a specified date, or amended to further require the recall of the cosmetic product, along with other measures regarding notifications, timetables, and updates.118 FDA may require the responsible person to issue a notice of recall or ceased distribution to appropriate persons, including manufacturers, distributors, importers, and sellers.119 If a product is recalled, FDA must ensure that a press release announcing the action is published, as well as appropriate alerts and public notices, to provide consumers and retailers with information about the cosmetic product and the circumstances of the recall. If an image of the product is available and appropriate, FDA shall also ensure the publication of that image on its website.120 Certain products and facilities already regulated under Chapter V of FFDCA as a drug or device are exempt from MoCRA’s mandatory recall authority.121 However, if such a facility also manufactures or processes cosmetic products not subject to FFDCA Chapter V, the exemption does not apply to those particular cosmetic products.122",Retail/Product,Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","Based on this text, describe Ellana's background in medicine. Also, summarize her concerns about the changes that she is witnessing while working in Emergency Medicine.","Thank you, Senator Markey and Senator Warren for having me this morning. My name is Ellana Stinson. I am a board-certified emergency medicine physician and have practiced emergency medicine for 15 years. From 2013 to 2020, I worked on staff as an emergency medicine physician at Carney Hospital, Good Samaritan and the former Quincy Hospital, all part of the Steward Health System. In addition, over the past 11 years, I have worked intermittently throughout the country at various facilities run and operated by HCA, Envision, Tenant, Team Health and CHS. When I entered medicine, I deeply loved what I did. Caring for patients in their most vulnerable moments and working in beautifully orchestrated chaos while bearing witness to so many life changing moments filled me with pride at the end of each shift. Unfortunately, so much of what I loved about Emergency Medicine has changed drastically over the years. Initially, my time at Carney felt very fresh and fulfilling. Being able to serve a very diverse population in the Dorchester neighborhood of Boston was essentially how I always imagined my career trajectory, serving the most vulnerable populations. But when I could no longer care for my patients the way I would want a loved one treated, I had to make decisions to stay or go. Having spent time at several other Stewart facilities briefly, I began to realize how resources were being dwindled down and pulled from each facility. Most of the facilities no longer had certain speciality services and Quincy Hospital, eventually was taken down to bare bones before its ultimate closure. Not having blood products, respiratory therapy at times or certain specialty services no longer felt like I was able to provide safe or quality care. What is happening here in the Commonwealth is happening around the country. We have now seen the buyouts, mergers and acquisitions led by private equity firms of over 30% of hospitals in the US. Having spent time at other PE sites around the country the level of deprivation was seemingly worse in some areas. Increased wait times and critical shortage of staff leading to dangerous boarding levels and critically dangerous patient to nurse ratios in the emergency department, seeing upwards to 14 to 1 ratios at times. All of this only to be exacerbated by the pandemic which resulted in increased cost of care, infection rates, mortality and even death. Practicing medicine in many PE led places is no longer about patient safety and quality, but about making medical decisions and judgment due corporate decision making with profit motives at the expense of patients. Forcing staff to see patients in the waiting room in order to have it appear wait times were being reduced and improving door to doc times, calling codes for sepsis and strokes in order to find innovative ways to make profits. Increasingly daunting metrics required of physicians and other staff to meet were nearly unattainable and unsafe in many instances, but very much expected. In addition, many sites across the country began to remove emergency physicians from in-network, resulting in higher bills for patients known as surprise billing. These profit gaining practices not only harm patients but also increase financial burdens on patients who do not have a choice of where they will go when they are experiencing crushing chest pain or stroke-like symptoms. Especially when the next closest facility has been in some of my experiences, upwards to an hour away. Most of the facilities I worked in were in very vulnerable populations that were mostly people of color, low income, or had limited access to other facilities or primary care services. Forcing them to only seek their care at a PE backed site. It is also known that most of the buyouts are of hospitals and facilities already struggling or with higher Medicaid and Medicare populations which ultimately affects our most vulnerable populations. It is critical we consider not only the impact these facilities have on our health care system, but also on the worsening care access and quality being provided to those communities already harmed by historical injury. The financialization of medicine will continue to exacerbate health disparities despite work being done on the ground to close these gaps. In addition, these Private Equity backed facilities are where I typically run into other emergency physicians of color. As it pertains to myself and my colleagues, these practices often felt unsafe, which sparked many questions of medical legal risk as well as the emotional toll it takes on all of us who enter this profession to do no harm. In addition, being on staff at a PE backed facility also would not qualify physicians swimming in student debt for loan forgiveness. A profession once competitive when I first began my medical journey is now one of the least competitive fields to enter as students bear witness to the destruction of the profession. In 2023, 554 of the residency spots went unfilled. We also saw more PE backed hospitals opening residency programs that were not adequately equipped to provide the proper training for an emergency medicine trainee. We train to deal with hard stuff, but we are running out of options on how to continue providing safe and adequate care at these PE run facilities.","""================ ======= Thank you, Senator Markey and Senator Warren for having me this morning. My name is Ellana Stinson. I am a board-certified emergency medicine physician and have practiced emergency medicine for 15 years. From 2013 to 2020, I worked on staff as an emergency medicine physician at Carney Hospital, Good Samaritan and the former Quincy Hospital, all part of the Steward Health System. In addition, over the past 11 years, I have worked intermittently throughout the country at various facilities run and operated by HCA, Envision, Tenant, Team Health and CHS. When I entered medicine, I deeply loved what I did. Caring for patients in their most vulnerable moments and working in beautifully orchestrated chaos while bearing witness to so many life changing moments filled me with pride at the end of each shift. Unfortunately, so much of what I loved about Emergency Medicine has changed drastically over the years. Initially, my time at Carney felt very fresh and fulfilling. Being able to serve a very diverse population in the Dorchester neighborhood of Boston was essentially how I always imagined my career trajectory, serving the most vulnerable populations. But when I could no longer care for my patients the way I would want a loved one treated, I had to make decisions to stay or go. Having spent time at several other Stewart facilities briefly, I began to realize how resources were being dwindled down and pulled from each facility. Most of the facilities no longer had certain speciality services and Quincy Hospital, eventually was taken down to bare bones before its ultimate closure. Not having blood products, respiratory therapy at times or certain specialty services no longer felt like I was able to provide safe or quality care. What is happening here in the Commonwealth is happening around the country. We have now seen the buyouts, mergers and acquisitions led by private equity firms of over 30% of hospitals in the US. Having spent time at other PE sites around the country the level of deprivation was seemingly worse in some areas. Increased wait times and critical shortage of staff leading to dangerous boarding levels and critically dangerous patient to nurse ratios in the emergency department, seeing upwards to 14 to 1 ratios at times. All of this only to be exacerbated by the pandemic which resulted in increased cost of care, infection rates, mortality and even death. Practicing medicine in many PE led places is no longer about patient safety and quality, but about making medical decisions and judgment due corporate decision making with profit motives at the expense of patients. Forcing staff to see patients in the waiting room in order to have it appear wait times were being reduced and improving door to doc times, calling codes for sepsis and strokes in order to find innovative ways to make profits. Increasingly daunting metrics required of physicians and other staff to meet were nearly unattainable and unsafe in many instances, but very much expected. In addition, many sites across the country began to remove emergency physicians from in-network, resulting in higher bills for patients known as surprise billing. These profit gaining practices not only harm patients but also increase financial burdens on patients who do not have a choice of where they will go when they are experiencing crushing chest pain or stroke-like symptoms. Especially when the next closest facility has been in some of my experiences, upwards to an hour away. Most of the facilities I worked in were in very vulnerable populations that were mostly people of color, low income, or had limited access to other facilities or primary care services. Forcing them to only seek their care at a PE backed site. It is also known that most of the buyouts are of hospitals and facilities already struggling or with higher Medicaid and Medicare populations which ultimately affects our most vulnerable populations. It is critical we consider not only the impact these facilities have on our health care system, but also on the worsening care access and quality being provided to those communities already harmed by historical injury. The financialization of medicine will continue to exacerbate health disparities despite work being done on the ground to close these gaps. In addition, these Private Equity backed facilities are where I typically run into other emergency physicians of color. As it pertains to myself and my colleagues, these practices often felt unsafe, which sparked many questions of medical legal risk as well as the emotional toll it takes on all of us who enter this profession to do no harm. In addition, being on staff at a PE backed facility also would not qualify physicians swimming in student debt for loan forgiveness. A profession once competitive when I first began my medical journey is now one of the least competitive fields to enter as students bear witness to the destruction of the profession. In 2023, 554 of the residency spots went unfilled. We also saw more PE backed hospitals opening residency programs that were not adequately equipped to provide the proper training for an emergency medicine trainee. We train to deal with hard stuff, but we are running out of options on how to continue providing safe and adequate care at these PE run facilities. https://www.help.senate.gov/imo/media/doc/0758d69f-e26d-35a0-da6a-de806d3f5f1c/Stinson%20Testimony.pdf ================ ======= Based on this text, describe Ellana's background in medicine. Also, summarize her concerns about the changes that she is witnessing while working in Emergency Medicine. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Find & Summarize,Text Transformation This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Draw your answer from the above text only. Lists should be presented in bullet point. Summaries should be a single paragraph of no more than 6 sentences.,"According to the text provided, excluding Authentic, how many additional flavors has Celestial Seasonings created for their green teas?","The mature tea leaves with which regular green teas are made naturally contain high levels of tannins, which can sometimes cause bitterness. Celestial Seasonings created its smoother green teas by adding Bai Mu Dan white tea, whose delicate, silky flavor profile comes from selecting only the tender buds and low-tannin young leaves of the camellia sinensis plant. The white tea infusion creates a balanced and satisfying taste with the healthful antioxidants for which green and white tea are both known. New Celestial Seasonings Green Tea is available on store shelves in nine varieties, including Authentic, Honey Lemon Ginseng and Goji Berry Pomegranate.","[This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Draw your answer from the above text only. Lists should be presented in bullet point. Summaries should be a single paragraph of no more than 6 sentences.] [The mature tea leaves with which regular green teas are made naturally contain high levels of tannins, which can sometimes cause bitterness. Celestial Seasonings created its smoother green teas by adding Bai Mu Dan white tea, whose delicate, silky flavor profile comes from selecting only the tender buds and low-tannin young leaves of the camellia sinensis plant. The white tea infusion creates a balanced and satisfying taste with the healthful antioxidants for which green and white tea are both known. New Celestial Seasonings Green Tea is available on store shelves in nine varieties, including Authentic, Honey Lemon Ginseng and Goji Berry Pomegranate.] [According to the text provided, excluding Authentic, how many flavors has Celestial Seasonings created for their green teas?",Retail/Product,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",give me a 5-7 bullet point list of the errors made by the ai in the text. include why the ai using bias can be harmful and what affects bias,"Some artificial intelligence tools for health care may get confused by the ways people of different genders and races talk, according to a new study led by CU Boulder computer scientist Theodora Chaspari. The study hinges on a, perhaps unspoken, reality of human society: Not everyone talks the same. Women, for example, tend to speak at a higher pitch than men, while similar differences can pop up between, say, white and Black speakers. Now, researchers have found that those natural variations could confound algorithms that screen humans for mental health concerns like anxiety or depression. The results add to a growing body of research showing that AI, just like people, can make assumptions based on race or gender. ""If AI isn't trained well, or doesn't include enough representative data, it can propagate these human or societal biases,"" said Chaspari, associate professor in the Department of Computer Science. She and her colleagues published their findings July 24 in the journal Frontiers in Digital Health. Chaspari noted that AI could be a promising technology in the healthcare world. Finely tuned algorithms can sift through recordings of people speaking, searching for subtle changes in the way they talk that could indicate underlying mental health concerns. But those tools have to perform consistently for patients from many demographic groups, the computer scientist said. To find out if AI is up to the task, the researchers fed audio samples of real humans into a common set of machine learning algorithms. The results raised a few red flags: The AI tools, for example, seemed to underdiagnose women who were at risk of depression more than men -- an outcome that, in the real world, could keep people from getting the care they need. ""With artificial intelligence, we can identify these fine-grained patterns that humans can't always perceive,"" said Chaspari, who conducted the work as a faculty member at Texas A&M University. ""However, while there is this opportunity, there is also a lot of risk."" Speech and emotions She added that the way humans talk can be a powerful window into their underlying emotions and wellbeing -- something that poets and playwrights have long known. Research suggests that people diagnosed with clinical depression often speak more softly and in more of a monotone than others. People with anxiety disorders, meanwhile, tend to talk with a higher pitch and with more ""jitter,"" a measurement of the breathiness in speech. ""We know that speech is very much influenced by one's anatomy,"" Chaspari said. ""For depression, there have been some studies showing changes in the way vibrations in the vocal folds happen, or even in how the voice is modulated by the vocal tract."" Over the years, scientists have developed AI tools to look for just those kinds of changes. Chaspari and her colleagues decided to put the algorithms under the microscope. To do that, the team drew on recordings of humans talking in a range of scenarios: In one, people had to give a 10 to 15 minute talk to a group of strangers. In another, men and women talked for a longer time in a setting similar to a doctor's visit. In both cases, the speakers separately filled out questionnaires about their mental health. The study included Michael Yang and Abd-Allah El-Attar, undergraduate students at Texas A&M. Fixing biases The results seemed to be all over the place. In the public speaking recordings, for example, the Latino participants reported that they felt a lot more nervous on average than the white or Black speakers. The AI, however, failed to detect that heightened anxiety. In the second experiment, the algorithms also flagged equal numbers of men and women as being at risk of depression. In reality, the female speakers had experienced symptoms of depression at much higher rates. Chaspari noted that the team's results are just a first step. The researchers will need to analyze recordings of a lot more people from a wide range of demographic groups before they can understand why the AI fumbled in certain cases -- and how to fix those biases. But, she said, the study is a sign that AI developers should proceed with caution before bringing AI tools into the medical world: ""If we think that an algorithm actually underestimates depression for a specific group, this is something we need to inform clinicians about.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. give me a 5-7 bullet point list of the errors made by the ai in the text. include why the ai using bias can be harmful and what affects bias Some artificial intelligence tools for health care may get confused by the ways people of different genders and races talk, according to a new study led by CU Boulder computer scientist Theodora Chaspari. The study hinges on a, perhaps unspoken, reality of human society: Not everyone talks the same. Women, for example, tend to speak at a higher pitch than men, while similar differences can pop up between, say, white and Black speakers. Now, researchers have found that those natural variations could confound algorithms that screen humans for mental health concerns like anxiety or depression. The results add to a growing body of research showing that AI, just like people, can make assumptions based on race or gender. ""If AI isn't trained well, or doesn't include enough representative data, it can propagate these human or societal biases,"" said Chaspari, associate professor in the Department of Computer Science. She and her colleagues published their findings July 24 in the journal Frontiers in Digital Health. Chaspari noted that AI could be a promising technology in the healthcare world. Finely tuned algorithms can sift through recordings of people speaking, searching for subtle changes in the way they talk that could indicate underlying mental health concerns. But those tools have to perform consistently for patients from many demographic groups, the computer scientist said. To find out if AI is up to the task, the researchers fed audio samples of real humans into a common set of machine learning algorithms. The results raised a few red flags: The AI tools, for example, seemed to underdiagnose women who were at risk of depression more than men -- an outcome that, in the real world, could keep people from getting the care they need. ""With artificial intelligence, we can identify these fine-grained patterns that humans can't always perceive,"" said Chaspari, who conducted the work as a faculty member at Texas A&M University. ""However, while there is this opportunity, there is also a lot of risk."" Speech and emotions She added that the way humans talk can be a powerful window into their underlying emotions and wellbeing -- something that poets and playwrights have long known. Research suggests that people diagnosed with clinical depression often speak more softly and in more of a monotone than others. People with anxiety disorders, meanwhile, tend to talk with a higher pitch and with more ""jitter,"" a measurement of the breathiness in speech. ""We know that speech is very much influenced by one's anatomy,"" Chaspari said. ""For depression, there have been some studies showing changes in the way vibrations in the vocal folds happen, or even in how the voice is modulated by the vocal tract."" Over the years, scientists have developed AI tools to look for just those kinds of changes. Chaspari and her colleagues decided to put the algorithms under the microscope. To do that, the team drew on recordings of humans talking in a range of scenarios: In one, people had to give a 10 to 15 minute talk to a group of strangers. In another, men and women talked for a longer time in a setting similar to a doctor's visit. In both cases, the speakers separately filled out questionnaires about their mental health. The study included Michael Yang and Abd-Allah El-Attar, undergraduate students at Texas A&M. Fixing biases The results seemed to be all over the place. In the public speaking recordings, for example, the Latino participants reported that they felt a lot more nervous on average than the white or Black speakers. The AI, however, failed to detect that heightened anxiety. In the second experiment, the algorithms also flagged equal numbers of men and women as being at risk of depression. In reality, the female speakers had experienced symptoms of depression at much higher rates. Chaspari noted that the team's results are just a first step. The researchers will need to analyze recordings of a lot more people from a wide range of demographic groups before they can understand why the AI fumbled in certain cases -- and how to fix those biases. But, she said, the study is a sign that AI developers should proceed with caution before bringing AI tools into the medical world: ""If we think that an algorithm actually underestimates depression for a specific group, this is something we need to inform clinicians about. https://www.sciencedaily.com/releases/2024/08/240805134143.htm",Internet/Technology,Summarize & Format,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","I'm looking to buy a new pair of headphones. I'm hoping to spend less than $100, while still getting good audio quality. Can you recommend a good option, and list out some of the defining features of the one you recommend?","We all want the best, but sometimes, the top-tier choice exceeds our budget. Thankfully, cheap Bluetooth headphones are easy to come by, and with the rise of wireless earbuds, premium headset prices have fallen dramatically. Although all of our picks are relatively affordable, none of them are inherently cheap. Whether you need active noise canceling (ANC), a compact design, or long battery life, we’ve got something to scratch your audio itch. Editors note: This article was updated on June 28th, 2024, to add new top picks. For under $100, the JLab JBuds Lux are crazy good value The JLab JBuds Lux ANC sitting atop a wooden desk. The JBuds Lux is a compelling buy under $80. The JLab JBuds Lux ANC punches well above its weight, offering exceptional value for under $100. These over-ear headphones feature active noise cancelation that does a decent job of hushing ambient noise, especially in the higher frequencies. While the ANC performance can’t match premium models, it’s impressive for the price. The sound quality is quite good, with an overall MDAQS score of 4.5/5, lauding the headphones’ faithful timbre and immersive soundstage. They have an elevated bass response and boosted treble that helps counter environmental noise during commutes. Other highlights include a 44-hour battery life, USB-C audio support, and a companion app with EQ and customization options. The JBuds Lux ANC may lack advanced features like head tracking, but they nail the fundamentals at a stellar price, making them one of the best budget ANC headphones you can buy. JLab JBuds Lux ANC SG recommended JLab JBuds Lux ANC USB-C audio • Sound quality • Comfort MSRP: $79.99 For under $100, these are crazy good value. As far as inexpensive ANC headphones go, the JLab JBuds Lux ANC are one of the best of 2024. They focus on the fundamentals, and not fighting the spec wars. The Anker Soundcore Space One has style Anker Soundcore Space One headphones next to cloth case and cables. Along with the headphones, you get a cloth carrying case, USB-C charging cable, and 3.5mm auxiliary cable. The Anker Soundcore Space One is a solid choice for consumers seeking noise canceling headphones under $100. The headphones have good isolation and active noise cancelation (ANC), wear detection, long battery life, and the inclusion of Bluetooth 5.3 with LDAC support. The companion app further allows customizable sound profiles and ANC adjustments. The absence of touch controls and an audio profile that leans towards over-emphasized bass and treble may deter some users. Additionally, the lack of audio-over-USB functionality limits its versatility compared to some competitors. Despite these drawbacks, the overall value proposition remains strong, especially considering the headphones’ effective noise cancelation, sound customization options through the app, and robust battery life of nearly 43 hours. Anker Soundcore Space One Anker Soundcore Space One Comfortable fit • Easy controls • Soundcore app MSRP: $99.99 Luxury features at a budget price. Listen and be heard with the Jabra Elite 45h The Jabra Elite 45h on-ear Bluetooth headphones next to a Samsung Galaxy S10e smartphone and wireless car keys on a white table. Bluetooth multipoint is available but not very reliable. The Jabra Elite 45h are on-ear headphones designed to be compact and portable enough to take anywhere—whether you’re commuting to work, running errands, or just putting your feet up at home. The swivel ear cups make it easy to shove into a backpack for easy transport. Top Deals See all deals Sennheiser Momentum 4 Wireless 37% off See price at Best Buy Sony WH-CH720N Headphones 48% off See price at Amazon Sony SRS-XE200 X-Series Speaker 47% off See price at Amazon Limited Time Deal! Edifier G2000 Gaming Speakers 34% off See price at Amazon Limited Time Deal! Edifier G1000 Gaming Speakers 41% off See price at Best Buy Deal of the Day! JBL Vibe Beam 40% off See price at Amazon Limited Time Deal! The headphones’ bass-heavy frequency response makes it hard to hear higher-pitched vocals. Fortunately, you can create a custom EQ in the Jabra Sound+ app (Android/iOS) and tinker all day long. If you don’t want to experiment, Jabra has a hearing test that informs an optimized sound profile. One of the best aspects of the Jabra Elite 45h is its microphone. It reproduces voices accurately, and even people with deep voices will be heard loud and clear. The microphone also does a good job of attenuating background noise and light wind, eliminating audible distractions during conference calls. Other features that make the Jabra Elite 45h a worthy investment include a 50+ hour battery life, USB-C fast charging, AAC codec support (which is great for iOS users), and an included two-year warranty that covers dust and water damage.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I'm looking to buy a new pair of headphones. I'm hoping to spend less than $100, while still getting good audio quality. Can you recommend a good option, and list out some of the defining features of the one you recommend? We all want the best, but sometimes, the top-tier choice exceeds our budget. Thankfully, cheap Bluetooth headphones are easy to come by, and with the rise of wireless earbuds, premium headset prices have fallen dramatically. Although all of our picks are relatively affordable, none of them are inherently cheap. Whether you need active noise canceling (ANC), a compact design, or long battery life, we’ve got something to scratch your audio itch. Editors note: This article was updated on June 28th, 2024, to add new top picks. For under $100, the JLab JBuds Lux are crazy good value The JLab JBuds Lux ANC sitting atop a wooden desk. The JBuds Lux is a compelling buy under $80. The JLab JBuds Lux ANC punches well above its weight, offering exceptional value for under $100. These over-ear headphones feature active noise cancelation that does a decent job of hushing ambient noise, especially in the higher frequencies. While the ANC performance can’t match premium models, it’s impressive for the price. The sound quality is quite good, with an overall MDAQS score of 4.5/5, lauding the headphones’ faithful timbre and immersive soundstage. They have an elevated bass response and boosted treble that helps counter environmental noise during commutes. Other highlights include a 44-hour battery life, USB-C audio support, and a companion app with EQ and customization options. The JBuds Lux ANC may lack advanced features like head tracking, but they nail the fundamentals at a stellar price, making them one of the best budget ANC headphones you can buy. JLab JBuds Lux ANC SG recommended JLab JBuds Lux ANC USB-C audio • Sound quality • Comfort MSRP: $79.99 For under $100, these are crazy good value. As far as inexpensive ANC headphones go, the JLab JBuds Lux ANC are one of the best of 2024. They focus on the fundamentals, and not fighting the spec wars. The Anker Soundcore Space One has style Anker Soundcore Space One headphones next to cloth case and cables. Along with the headphones, you get a cloth carrying case, USB-C charging cable, and 3.5mm auxiliary cable. The Anker Soundcore Space One is a solid choice for consumers seeking noise canceling headphones under $100. The headphones have good isolation and active noise cancelation (ANC), wear detection, long battery life, and the inclusion of Bluetooth 5.3 with LDAC support. The companion app further allows customizable sound profiles and ANC adjustments. The absence of touch controls and an audio profile that leans towards over-emphasized bass and treble may deter some users. Additionally, the lack of audio-over-USB functionality limits its versatility compared to some competitors. Despite these drawbacks, the overall value proposition remains strong, especially considering the headphones’ effective noise cancelation, sound customization options through the app, and robust battery life of nearly 43 hours. Anker Soundcore Space One Anker Soundcore Space One Comfortable fit • Easy controls • Soundcore app MSRP: $99.99 Luxury features at a budget price. Listen and be heard with the Jabra Elite 45h The Jabra Elite 45h on-ear Bluetooth headphones next to a Samsung Galaxy S10e smartphone and wireless car keys on a white table. Bluetooth multipoint is available but not very reliable. The Jabra Elite 45h are on-ear headphones designed to be compact and portable enough to take anywhere—whether you’re commuting to work, running errands, or just putting your feet up at home. The swivel ear cups make it easy to shove into a backpack for easy transport. Top Deals See all deals Sennheiser Momentum 4 Wireless 37% off See price at Best Buy Sony WH-CH720N Headphones 48% off See price at Amazon Sony SRS-XE200 X-Series Speaker 47% off See price at Amazon Limited Time Deal! Edifier G2000 Gaming Speakers 34% off See price at Amazon Limited Time Deal! Edifier G1000 Gaming Speakers 41% off See price at Best Buy Deal of the Day! JBL Vibe Beam 40% off See price at Amazon Limited Time Deal! The headphones’ bass-heavy frequency response makes it hard to hear higher-pitched vocals. Fortunately, you can create a custom EQ in the Jabra Sound+ app (Android/iOS) and tinker all day long. If you don’t want to experiment, Jabra has a hearing test that informs an optimized sound profile. One of the best aspects of the Jabra Elite 45h is its microphone. It reproduces voices accurately, and even people with deep voices will be heard loud and clear. The microphone also does a good job of attenuating background noise and light wind, eliminating audible distractions during conference calls. Other features that make the Jabra Elite 45h a worthy investment include a 50+ hour battery life, USB-C fast charging, AAC codec support (which is great for iOS users), and an included two-year warranty that covers dust and water damage. https://www.soundguys.com/best-cheap-bluetooth-headphones-100-28839/",Retail/Product,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",My cousin in South Dakota wants to sell me his 1977 triple wide manufactured home that he has on a lot in a mobile home park there. I will move it to my improved land in New York and live there. Can I finance this home using a FHA mortgage loan?,"II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 589 Last Revised: 05/20/2024 Mortgagee must determine whether the recorded Declaration and/or CC&Rs require prior approval by the association of any non-purchase money mortgage that will encumber the Property. In those situations where such a requirement exists, the Mortgagee must obtain the approval of the association in writing prior to origination of the HECM. Documentation concerning this approval must be maintained by the Mortgagee and made available to HUD upon request. (7) Property Assessed Clean Energy (a) Definition Property Assessed Clean Energy (PACE) refers to an alternative means of financing energy and other PACE-allowed improvements to residential properties using financing provided by private enterprises in conjunction with state and local governments. Generally, the repayment of the PACE obligation is collected in the same manner as a special assessment tax; it is collected by the local government rather than paid directly by the Borrower to the party providing the PACE financing. Generally, the PACE obligation is also secured in the same manner as a special assessment against the property. (b) Standard Properties which will remain encumbered with a PACE obligation are not eligible for an FHA-insured HECM. To be eligible for FHA insurance, the PACE obligation must be paid off in full prior to or at closing. The Borrower may use HECM proceeds to satisfy the PACE obligation. For HECM for Purchase transactions, see the Property Assessed Clean Energy section of the product sheet. (B) Property Types FHA’s programs differ from one another primarily in terms of what types of Properties and financing are eligible. Except as otherwise stated in this Handbook 4000.1, HECMs are limited to one- to four-unit Single Family Properties where the Borrower occupies one unit as their Principal Residence. FHA insures HECM financing on Real Property secured by: • detached or semi-detached dwellings • Manufactured Housing • townhouses or row houses • Condominium Units and Site Condominiums FHA will not insure HECMs secured by: • commercial enterprises • cooperative units • boarding houses • hotels, motels, and condotels II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 590 Last Revised: 05/20/2024 • tourist houses • private clubs • bed and breakfast establishments • other transient housing • Vacation Homes • fraternity and sorority houses (1) One-Unit A one-unit Property is a Single Family residential Property with a single Dwelling Unit, or with a single Dwelling Unit and a single ADU. (2) Two-Unit (a) Definition A two-unit Property is a Single Family residential Property with two individual dwellings. (b) Standard The Mortgagee must obtain a completed form HUD-92561. (3) Three- to Four-Unit A three- to four-unit Property is either: • a Single Family residential Property with three to four individual Dwelling Units; or • a Single Family residential Property with two individual Dwelling Units and one ADU or three individual Dwelling Units and one ADU. The Mortgagee must obtain a completed form HUD-92561. (4) Accessory Dwelling Unit (a) Definition An Accessory Dwelling Unit (ADU) refers to a single habitable living unit with means of separate ingress and egress that meets the minimum requirements for a living unit. An ADU is a private space that is subordinate in size and within, or detached from a primary one-unit Single Family dwelling, which together constitute a single interest in real estate. (b) Standard A Single Family residential one-unit Property with a single ADU remains a one-unit Property. For any Single Family residential Property with two or II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 591 Last Revised: 05/20/2024 more units, a separate additional Dwelling Unit must be considered as an additional unit. (5) Condominium Unit (a) Definitions A Condominium Unit refers to real estate consisting of a one-family Dwelling Unit in a Condominium Project. Condominium Project refers to a project in which one-family Dwelling Units are attached, semi-detached, detached, or Manufactured Home units, and in which owners hold an undivided interest in Common Elements. (b) Standard A Condominium Unit must be either located within an FHA-approved Condominium Project, meet FHA’s definition of a Site Condominium, or have completed the FHA Single-Unit Approval process before a Mortgage can be insured. (6) Site Condominiums (a) Definition A Site Condominium refers to: • a Condominium Project that consists entirely of Single Family detached dwellings that have no shared garages, or any other attached buildings; or • a Condominium Project that:  consists of Single Family detached or horizontally attached (townhouse-style) dwellings where the Unit consists of the dwelling and land;  does not contain any Manufactured Housing Units; and  is encumbered by a declaration of condominium covenants or a condominium form of ownership. (b) Standard Manufactured Housing condominium units may not be processed as Site Condominiums. The Unit owner must be responsible for all required insurance and maintenance costs associated with the Unit dwelling, excluding landscaping, of the Site Condominium. II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 592 Last Revised: 05/20/2024 Site Condominiums do not require Condominium Project Approval or Single- Unit Approval. Manufactured Housing (a) Definition Manufactured Housing is a Structure that is transportable in one or more sections. It may be part of a Condominium Project, provided the project meets applicable FHA requirements. (b) Standard To be eligible for FHA mortgage insurance as a Single Family Title II HECM, all Manufactured Housing must: • be designed as a one-family dwelling; • have a floor area of not less than 400 square feet; • have the HUD Certification Label affixed or have obtained a letter of label verification issued on behalf of HUD, evidencing the house was constructed on or after June 15, 1976, in compliance with the Federal Manufactured Home Construction and Safety Standards; • be classified as real estate (but need not be treated as real estate for purposes of state taxation); • be built and remain on a permanent chassis; • be designed to be used as a dwelling with a permanent foundation built in accordance with the Permanent Foundations Guide for Manufactured Housing (PFGMH); and • have been directly transported from the manufacturer or the dealership to the site. (c) Required Documentation (i) HUD Certification Label If the appraisal indicates the HUD Certification Label is missing from the Manufactured Housing unit, the Mortgagee must obtain label verification from the Institute for Building Technology and Safety (IBTS). (ii) PFGMH Certification The Mortgagee must obtain a certification by an engineer or architect, who is licensed/registered in the state where the Manufactured Home is located, attesting to compliance with the PFGMH. The Mortgagee may obtain a copy of the foundation certification from a previous FHA-insured Mortgage, showing that the foundation met the guidelines published in the PFGMH that were in effect at the time of II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 593 Last Revised: 05/20/2024 certification, provided there are no alterations and/or observable damage to the foundation since the date of the original certification. If the Appraiser notes additions or alterations to the Manufactured Housing unit, the Mortgagee must ensure the addition was addressed in the foundation certification. If the additions or alterations were not addressed in the foundation certification, the Mortgagee must obtain: • an inspection by the state administrative agency that inspects Manufactured Housing for compliance; or • certification of the structural integrity from a licensed structural engineer if the state does not employ inspectors","""================ ======= II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 589 Last Revised: 05/20/2024 Mortgagee must determine whether the recorded Declaration and/or CC&Rs require prior approval by the association of any non-purchase money mortgage that will encumber the Property. In those situations where such a requirement exists, the Mortgagee must obtain the approval of the association in writing prior to origination of the HECM. Documentation concerning this approval must be maintained by the Mortgagee and made available to HUD upon request. (7) Property Assessed Clean Energy (a) Definition Property Assessed Clean Energy (PACE) refers to an alternative means of financing energy and other PACE-allowed improvements to residential properties using financing provided by private enterprises in conjunction with state and local governments. Generally, the repayment of the PACE obligation is collected in the same manner as a special assessment tax; it is collected by the local government rather than paid directly by the Borrower to the party providing the PACE financing. Generally, the PACE obligation is also secured in the same manner as a special assessment against the property. (b) Standard Properties which will remain encumbered with a PACE obligation are not eligible for an FHA-insured HECM. To be eligible for FHA insurance, the PACE obligation must be paid off in full prior to or at closing. The Borrower may use HECM proceeds to satisfy the PACE obligation. For HECM for Purchase transactions, see the Property Assessed Clean Energy section of the product sheet. (B) Property Types FHA’s programs differ from one another primarily in terms of what types of Properties and financing are eligible. Except as otherwise stated in this Handbook 4000.1, HECMs are limited to one- to four-unit Single Family Properties where the Borrower occupies one unit as their Principal Residence. FHA insures HECM financing on Real Property secured by: • detached or semi-detached dwellings • Manufactured Housing • townhouses or row houses • Condominium Units and Site Condominiums FHA will not insure HECMs secured by: • commercial enterprises • cooperative units • boarding houses • hotels, motels, and condotels II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 590 Last Revised: 05/20/2024 • tourist houses • private clubs • bed and breakfast establishments • other transient housing • Vacation Homes • fraternity and sorority houses (1) One-Unit A one-unit Property is a Single Family residential Property with a single Dwelling Unit, or with a single Dwelling Unit and a single ADU. (2) Two-Unit (a) Definition A two-unit Property is a Single Family residential Property with two individual dwellings. (b) Standard The Mortgagee must obtain a completed form HUD-92561. (3) Three- to Four-Unit A three- to four-unit Property is either: • a Single Family residential Property with three to four individual Dwelling Units; or • a Single Family residential Property with two individual Dwelling Units and one ADU or three individual Dwelling Units and one ADU. The Mortgagee must obtain a completed form HUD-92561. (4) Accessory Dwelling Unit (a) Definition An Accessory Dwelling Unit (ADU) refers to a single habitable living unit with means of separate ingress and egress that meets the minimum requirements for a living unit. An ADU is a private space that is subordinate in size and within, or detached from a primary one-unit Single Family dwelling, which together constitute a single interest in real estate. (b) Standard A Single Family residential one-unit Property with a single ADU remains a one-unit Property. For any Single Family residential Property with two or II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 591 Last Revised: 05/20/2024 more units, a separate additional Dwelling Unit must be considered as an additional unit. (5) Condominium Unit (a) Definitions A Condominium Unit refers to real estate consisting of a one-family Dwelling Unit in a Condominium Project. Condominium Project refers to a project in which one-family Dwelling Units are attached, semi-detached, detached, or Manufactured Home units, and in which owners hold an undivided interest in Common Elements. (b) Standard A Condominium Unit must be either located within an FHA-approved Condominium Project, meet FHA’s definition of a Site Condominium, or have completed the FHA Single-Unit Approval process before a Mortgage can be insured. (6) Site Condominiums (a) Definition A Site Condominium refers to: • a Condominium Project that consists entirely of Single Family detached dwellings that have no shared garages, or any other attached buildings; or • a Condominium Project that:  consists of Single Family detached or horizontally attached (townhouse-style) dwellings where the Unit consists of the dwelling and land;  does not contain any Manufactured Housing Units; and  is encumbered by a declaration of condominium covenants or a condominium form of ownership. (b) Standard Manufactured Housing condominium units may not be processed as Site Condominiums. The Unit owner must be responsible for all required insurance and maintenance costs associated with the Unit dwelling, excluding landscaping, of the Site Condominium. II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 592 Last Revised: 05/20/2024 Site Condominiums do not require Condominium Project Approval or Single- Unit Approval. Manufactured Housing (a) Definition Manufactured Housing is a Structure that is transportable in one or more sections. It may be part of a Condominium Project, provided the project meets applicable FHA requirements. (b) Standard To be eligible for FHA mortgage insurance as a Single Family Title II HECM, all Manufactured Housing must: • be designed as a one-family dwelling; • have a floor area of not less than 400 square feet; • have the HUD Certification Label affixed or have obtained a letter of label verification issued on behalf of HUD, evidencing the house was constructed on or after June 15, 1976, in compliance with the Federal Manufactured Home Construction and Safety Standards; • be classified as real estate (but need not be treated as real estate for purposes of state taxation); • be built and remain on a permanent chassis; • be designed to be used as a dwelling with a permanent foundation built in accordance with the Permanent Foundations Guide for Manufactured Housing (PFGMH); and • have been directly transported from the manufacturer or the dealership to the site. (c) Required Documentation (i) HUD Certification Label If the appraisal indicates the HUD Certification Label is missing from the Manufactured Housing unit, the Mortgagee must obtain label verification from the Institute for Building Technology and Safety (IBTS). (ii) PFGMH Certification The Mortgagee must obtain a certification by an engineer or architect, who is licensed/registered in the state where the Manufactured Home is located, attesting to compliance with the PFGMH. The Mortgagee may obtain a copy of the foundation certification from a previous FHA-insured Mortgage, showing that the foundation met the guidelines published in the PFGMH that were in effect at the time of II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT B. Title II Insured Housing Programs Reverse Mortgages 2. Origination/Processing Handbook 4000.1 593 Last Revised: 05/20/2024 certification, provided there are no alterations and/or observable damage to the foundation since the date of the original certification. If the Appraiser notes additions or alterations to the Manufactured Housing unit, the Mortgagee must ensure the addition was addressed in the foundation certification. If the additions or alterations were not addressed in the foundation certification, the Mortgagee must obtain: • an inspection by the state administrative agency that inspects Manufactured Housing for compliance; or • certification of the structural integrity from a licensed structural engineer if the state does not employ inspectors https://www.hud.gov/sites/dfiles/OCHCO/documents/40001-hsgh-update15-052024.pdf ================ ======= My cousin in South Dakota wants to sell me his 1977 triple wide manufactured home that he has on a lot in a mobile home park there. I will move it to my improved land in New York and live there. Can I finance this home using a FHA mortgage loan? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Financial,Fact Finding,Q&A "Base your response only on the document provided. List them in bullet point format. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context"".","At week 8, what urological changes were observed in the experimental group of mice (injected with ketamine)?","**Changes to the bladder epithelial barrier are associated with ketamine-induced cystitis - Results ** Animals and ketamine administration A total of 60 8-week-old female C57BL/6 mice (weight, 19.08±1.29 g) were obtained from Renming Hospital of Wuhan University Laboratory Animal Center (Wuhan, China). Mice were maintained under a 12-h light/dark cycle at a constant temperature (21–22°C) and humidity (50%). Mice had free access to food and tap water prior to the experiments. Mice were randomly allocated into two groups, control group and ketamine treatment group, and the mice in each group were subsequently subdivided into three subgroups (4, 8 and 12 week groups; n=10 mice/subgroup). Mice received daily intraperitoneal injections of saline (control group) or 100 mg/kg ketamine (Gutian Fuxing Pharmaceutical Co., Ltd., Gutian, China) (ketamine treatment group) to model the effects of repeated ketamine abuse, which was previously described in a study by Meng et al (15). Micturition behavior Micturition frequency was determined as previously described in a study by Gu et al (10). In brief, short-term micturition frequency of freely moving mice was observed at the end of 4, 8 and 12 weeks of treatment. At the end of the 4, 8 and 12 weeks, respectively, mice were placed in five separate square lattices containing a gridded filter paper pad, with each small grid containing a mouse. Filter paper was impregnated with saturated copper sulfate solution (CuSO4 5H2O) and dehydrated at 200°C for 1 h prior to use. When urine fell onto this filter paper, the anhydrous CuSO4 was rehydrated and turned blue. Subsequent to 2 h, the numbers of urine spots >0.2 cm in diameter were counted and recorded by five people independently with ultraviolet illumination. Histopathological and immunohistochemical analysis Mice were sacrificed with an intraperitoneal injection of sodium pentobarbital (100 mg/kg, Sigma-Aldrich; Merck KGaA, Germany) and bladders were excised for analyses. For histopathlogical analysis, half of the bladder tissues were fixed in 4% phosphate-buffered paraformaldehyde overnight at room temperature, dehydrated in serial ethanol concentrations, cleared in xylene and embedded into paraffin wax. Serial paraffin sections of 5 µm in thickness were created, stained with haematoxylin and eosin and subsequently examined under a light microscope (Nikon Corp., Tokyo, Japan). For immunohistochemical analysis, tissue sections were dewaxed and rehydrated with graded xylene and serial ethanol concentrations. Subsequently, immunohistochemical labeling for zonula occludens-1 (ZO-1) was performed. Following the blocking of nonspecific antibody activity using Tris-buffered saline (Sigma-Aldrich; Merck KGaA) containing 1% bovine serum albumin and 10% fetal calf serum at 37°C for 2 h, the tissue sections were incubated with primary antibody anti-ZO-1 (BSA-1543, 1:100 dilution; BioGenex, San Ramon, CA, USA) overnight at 4°C. Subsequently, hydrogen peroxide was used to eliminate the endogenous peroxidase activity at 37°C for 10 min. The distribution of ZO-1 marker was scored into two levels by two independent histologists: Normal and abnormal. If normal, the ZO-1 marker was distributed throughout the urothelium and more intensely under the umbrella cell layer with minimal expression in the cytoplasm. If abnormal, the distribution of the ZO-1 marker was patchy, absent, or expressed in the cytoplasm and not localized on cell surfaces. Ultrastructure of bladder samples For ultrastructure analysis, half of the bladder tissue samples from each mouse were fixed in 2.5% glutaraldehyde buffered in 0.1 M phosphate buffer, post-fixed in buffered 1% osmium tetroxide, dehydrated using ascending grades of ethanol and dry acetone, embedded in epoxy resin, and finally left in a resin-polymerizing oven overnight at 65°C. The protocol for ultrastructure analysis was in accordance with the method published in the study by Jeong et al (16) with some modifications. Ultrathin sections of 70 nm in thickness were created, mounted on 200-mesh hexagonal copper grids and stained with lead citrate. The ultrastructural urothelium of the bladder samples was observed using a Hitachi H-600 transmission electron microscope (TEM; Hitachi, Ltd., Tokyo, Japan). Statistical analysis Data are expressed as the mean ± standard error of the mean. Statistical analyses were performed using Prism v.5.0 software (GraphPad Software, Inc., La Jolla, CA, USA). Independent-samples t-tests were used to detect significant differences in micturition frequency between two groups. Fisher's exact test was used to measure any significant differences in ZO-1 expression. P<0.05 was considered to indicate a statistically significant difference. Go to: Results Micturition behavior As exhibited in Fig. 1, the micturition frequency in the ketamine-treated and control groups were determined as 8.05+1.799 and 8.36+1.492 following 4 weeks of treatment, and there was no significant difference in micturition frequency between the two groups at this time point (P>0.05). However, following 8 weeks of treatment, the micturition frequency in the ketamine-treated group was determined as 11.90+3.348 and was significantly increased compared with that of the control group (8.50+1.581; P<0.01). Similar results were obtained for the micturition frequency in the ketamine-treated group (15.30+4.423) following 12 weeks of treatment, and this was significantly higher than that of the control group (8.50+1.581; P=0.001). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g00.jpg Figure 1. Micturition frequency of freely moving mice measured in a 2-h time period. Data are presented as the mean ± standard error of the mean. **P<0.05 and ***P<0.01. Bladder pathology and immunohistochemistry The urinary bladders of the ketamine-treated mice displayed some pathology differences when compared with the controls. When compared with the control group (Fig. 2A), there was no significant inflammatory cell infiltration and arterial dilatation following 4 weeks of ketamine treatment (Fig. 2B); however, arterial dilatation and congestion were observed under the submucosal epithelium of the urinary bladder following 8 weeks of ketamine treatment (indicated by arrows; Fig. 2C). In addition to the above symptoms, inflammatory cells, predominantly lymphocytes and occasionally macrophages, had infiltrated into the submucosal epithelium of the urinary bladders of mice in the ketamine-treated group after 12 weeks of treatment (indicated by arrows; Fig. 2D). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g01.jpg Figure 2. Haematoxylin and eosin staining of midsagittal sections of murine bladders. Bladder sections from (A) the control group (magnification, ×400), (B) ketamine-treated mice following 4 weeks of treatment (magnification, ×400), (C) ketamine-treated mice following 8 weeks of treatment (magnification, ×200) and (D) ketamine-treated mice following 12 weeks of treatment (magnification, ×400). ZO-1 was localized to the superficial umbrella cell layer at the apicolateral junction in the majority of control group samples (Fig. 3A); however, in the ketamine treatment groups, bladders exhibited a heterogeneous staining distribution, indicating that ZO-1 was distributed in the cytoplasm and was not absent or organized into tight junction structures (Fig. 3B). Additionally, the number of samples exhibiting abnormal ZO-1 distribution in the ketamine-treated group was increased compared with control group, with abnormal ZO-1 distribution in 70 vs. 0% (P=0.003) following 4 weeks, 70 vs. 10% (P=0.022) following 8 weeks and 90 vs. 10% (P=0.001) following 12 weeks of treatment in the ketamine-treated and control groups, respectively (Table I). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g02.jpg Figure 3. Representative immunohistochemical images of ZO-1 protein. For immunohistochemical analysis, tissue sections were incubated with primary antibody anti-ZO-1 overnight at 4°C. (A) In control mice, ZO-1 was localized to superficial umbrella cell layer at the interendothelial junctions in most samples. (B) In the ketamine group, ZO-1 located in the cytoplasm and not organized into tight junction structures, or absent. Magnification, ×200; scale bar, 100 µm. ZO-1, zonula occludens-1. Table I. Distribution of ZO-1 protein in each group. Treatment duration (weeks) ZO-1 distribution Ketamine (%) Control (%) P-valuea 4 0.003 Normal 3 (30) 10 (100) Abnormal 7 (70) 0 (0) 8 0.022 Normal 3 (30) 9 (90) Abnormal 7 (70) 1 (10) 12 0.001 Normal 1 (10) 9 (90) Abnormal 9 (90) 1 (10) Open in a separate window aFisher's exact test. ZO-1, zona occludens-1. Ultrastructure of bladder samples Morphological ultrastructural alterations to the uroepithelium and lamina propria of bladder cells were determined using TEM. As demonstrated in Fig. 4A-D, the surface of the umbrella cells in the control group were suffused with raised microplicae (indicated by arrows in Fig. 4A and B) and the cytoplasm of these cells contained multiple subapical vesicles (indicated with asterisks in Fig. 4B). Marked changes in bladder morphology were observed in the ketamine-treated group compared with the control group. The surface of the umbrella cells appeared more flattened following 4 (Fig. 4E-H) and 8 weeks (Fig. 4I-L), and even diminished following 12 weeks (Fig. 4M-P), of treatment in the ketamine-treated group compared with the control group. Thin tight junction complexes were frequently observed between the umbrella cells following 4 weeks of treatment in the ketamine-treated group (Fig. 4G); however, these distinct junction complexes were not observed following 8 and 12 weeks of ketamine treatment (Fig. 4K and O). In addition, the vascular endothelial cells exhibited cell body shrinkage, increased cytoplasm density and chromatin condensation following 8 weeks (Fig. 4L) and layer denudation following 12 weeks (Fig. 4P) of ketamine treatment. ","

================== **Changes to the bladder epithelial barrier are associated with ketamine-induced cystitis - Results ** Animals and ketamine administration A total of 60 8-week-old female C57BL/6 mice (weight, 19.08±1.29 g) were obtained from Renming Hospital of Wuhan University Laboratory Animal Center (Wuhan, China). Mice were maintained under a 12-h light/dark cycle at a constant temperature (21–22°C) and humidity (50%). Mice had free access to food and tap water prior to the experiments. Mice were randomly allocated into two groups, control group and ketamine treatment group, and the mice in each group were subsequently subdivided into three subgroups (4, 8 and 12 week groups; n=10 mice/subgroup). Mice received daily intraperitoneal injections of saline (control group) or 100 mg/kg ketamine (Gutian Fuxing Pharmaceutical Co., Ltd., Gutian, China) (ketamine treatment group) to model the effects of repeated ketamine abuse, which was previously described in a study by Meng et al (15). Micturition behavior Micturition frequency was determined as previously described in a study by Gu et al (10). In brief, short-term micturition frequency of freely moving mice was observed at the end of 4, 8 and 12 weeks of treatment. At the end of the 4, 8 and 12 weeks, respectively, mice were placed in five separate square lattices containing a gridded filter paper pad, with each small grid containing a mouse. Filter paper was impregnated with saturated copper sulfate solution (CuSO4 5H2O) and dehydrated at 200°C for 1 h prior to use. When urine fell onto this filter paper, the anhydrous CuSO4 was rehydrated and turned blue. Subsequent to 2 h, the numbers of urine spots >0.2 cm in diameter were counted and recorded by five people independently with ultraviolet illumination. Histopathological and immunohistochemical analysis Mice were sacrificed with an intraperitoneal injection of sodium pentobarbital (100 mg/kg, Sigma-Aldrich; Merck KGaA, Germany) and bladders were excised for analyses. For histopathlogical analysis, half of the bladder tissues were fixed in 4% phosphate-buffered paraformaldehyde overnight at room temperature, dehydrated in serial ethanol concentrations, cleared in xylene and embedded into paraffin wax. Serial paraffin sections of 5 µm in thickness were created, stained with haematoxylin and eosin and subsequently examined under a light microscope (Nikon Corp., Tokyo, Japan). For immunohistochemical analysis, tissue sections were dewaxed and rehydrated with graded xylene and serial ethanol concentrations. Subsequently, immunohistochemical labeling for zonula occludens-1 (ZO-1) was performed. Following the blocking of nonspecific antibody activity using Tris-buffered saline (Sigma-Aldrich; Merck KGaA) containing 1% bovine serum albumin and 10% fetal calf serum at 37°C for 2 h, the tissue sections were incubated with primary antibody anti-ZO-1 (BSA-1543, 1:100 dilution; BioGenex, San Ramon, CA, USA) overnight at 4°C. Subsequently, hydrogen peroxide was used to eliminate the endogenous peroxidase activity at 37°C for 10 min. The distribution of ZO-1 marker was scored into two levels by two independent histologists: Normal and abnormal. If normal, the ZO-1 marker was distributed throughout the urothelium and more intensely under the umbrella cell layer with minimal expression in the cytoplasm. If abnormal, the distribution of the ZO-1 marker was patchy, absent, or expressed in the cytoplasm and not localized on cell surfaces. Ultrastructure of bladder samples For ultrastructure analysis, half of the bladder tissue samples from each mouse were fixed in 2.5% glutaraldehyde buffered in 0.1 M phosphate buffer, post-fixed in buffered 1% osmium tetroxide, dehydrated using ascending grades of ethanol and dry acetone, embedded in epoxy resin, and finally left in a resin-polymerizing oven overnight at 65°C. The protocol for ultrastructure analysis was in accordance with the method published in the study by Jeong et al (16) with some modifications. Ultrathin sections of 70 nm in thickness were created, mounted on 200-mesh hexagonal copper grids and stained with lead citrate. The ultrastructural urothelium of the bladder samples was observed using a Hitachi H-600 transmission electron microscope (TEM; Hitachi, Ltd., Tokyo, Japan). Statistical analysis Data are expressed as the mean ± standard error of the mean. Statistical analyses were performed using Prism v.5.0 software (GraphPad Software, Inc., La Jolla, CA, USA). Independent-samples t-tests were used to detect significant differences in micturition frequency between two groups. Fisher's exact test was used to measure any significant differences in ZO-1 expression. P<0.05 was considered to indicate a statistically significant difference. Go to: Results Micturition behavior As exhibited in Fig. 1, the micturition frequency in the ketamine-treated and control groups were determined as 8.05+1.799 and 8.36+1.492 following 4 weeks of treatment, and there was no significant difference in micturition frequency between the two groups at this time point (P>0.05). However, following 8 weeks of treatment, the micturition frequency in the ketamine-treated group was determined as 11.90+3.348 and was significantly increased compared with that of the control group (8.50+1.581; P<0.01). Similar results were obtained for the micturition frequency in the ketamine-treated group (15.30+4.423) following 12 weeks of treatment, and this was significantly higher than that of the control group (8.50+1.581; P=0.001). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g00.jpg Figure 1. Micturition frequency of freely moving mice measured in a 2-h time period. Data are presented as the mean ± standard error of the mean. **P<0.05 and ***P<0.01. Bladder pathology and immunohistochemistry The urinary bladders of the ketamine-treated mice displayed some pathology differences when compared with the controls. When compared with the control group (Fig. 2A), there was no significant inflammatory cell infiltration and arterial dilatation following 4 weeks of ketamine treatment (Fig. 2B); however, arterial dilatation and congestion were observed under the submucosal epithelium of the urinary bladder following 8 weeks of ketamine treatment (indicated by arrows; Fig. 2C). In addition to the above symptoms, inflammatory cells, predominantly lymphocytes and occasionally macrophages, had infiltrated into the submucosal epithelium of the urinary bladders of mice in the ketamine-treated group after 12 weeks of treatment (indicated by arrows; Fig. 2D). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g01.jpg Figure 2. Haematoxylin and eosin staining of midsagittal sections of murine bladders. Bladder sections from (A) the control group (magnification, ×400), (B) ketamine-treated mice following 4 weeks of treatment (magnification, ×400), (C) ketamine-treated mice following 8 weeks of treatment (magnification, ×200) and (D) ketamine-treated mice following 12 weeks of treatment (magnification, ×400). ZO-1 was localized to the superficial umbrella cell layer at the apicolateral junction in the majority of control group samples (Fig. 3A); however, in the ketamine treatment groups, bladders exhibited a heterogeneous staining distribution, indicating that ZO-1 was distributed in the cytoplasm and was not absent or organized into tight junction structures (Fig. 3B). Additionally, the number of samples exhibiting abnormal ZO-1 distribution in the ketamine-treated group was increased compared with control group, with abnormal ZO-1 distribution in 70 vs. 0% (P=0.003) following 4 weeks, 70 vs. 10% (P=0.022) following 8 weeks and 90 vs. 10% (P=0.001) following 12 weeks of treatment in the ketamine-treated and control groups, respectively (Table I). An external file that holds a picture, illustration, etc. Object name is etm-14-04-2757-g02.jpg Figure 3. Representative immunohistochemical images of ZO-1 protein. For immunohistochemical analysis, tissue sections were incubated with primary antibody anti-ZO-1 overnight at 4°C. (A) In control mice, ZO-1 was localized to superficial umbrella cell layer at the interendothelial junctions in most samples. (B) In the ketamine group, ZO-1 located in the cytoplasm and not organized into tight junction structures, or absent. Magnification, ×200; scale bar, 100 µm. ZO-1, zonula occludens-1. Table I. Distribution of ZO-1 protein in each group. Treatment duration (weeks) ZO-1 distribution Ketamine (%) Control (%) P-valuea 4 0.003 Normal 3 (30) 10 (100) Abnormal 7 (70) 0 (0) 8 0.022 Normal 3 (30) 9 (90) Abnormal 7 (70) 1 (10) 12 0.001 Normal 1 (10) 9 (90) Abnormal 9 (90) 1 (10) Open in a separate window aFisher's exact test. ZO-1, zona occludens-1. Ultrastructure of bladder samples Morphological ultrastructural alterations to the uroepithelium and lamina propria of bladder cells were determined using TEM. As demonstrated in Fig. 4A-D, the surface of the umbrella cells in the control group were suffused with raised microplicae (indicated by arrows in Fig. 4A and B) and the cytoplasm of these cells contained multiple subapical vesicles (indicated with asterisks in Fig. 4B). Marked changes in bladder morphology were observed in the ketamine-treated group compared with the control group. The surface of the umbrella cells appeared more flattened following 4 (Fig. 4E-H) and 8 weeks (Fig. 4I-L), and even diminished following 12 weeks (Fig. 4M-P), of treatment in the ketamine-treated group compared with the control group. Thin tight junction complexes were frequently observed between the umbrella cells following 4 weeks of treatment in the ketamine-treated group (Fig. 4G); however, these distinct junction complexes were not observed following 8 and 12 weeks of ketamine treatment (Fig. 4K and O). In addition, the vascular endothelial cells exhibited cell body shrinkage, increased cytoplasm density and chromatin condensation following 8 weeks (Fig. 4L) and layer denudation following 12 weeks (Fig. 4P) of ketamine treatment. ================== At week 8, what urological changes were observed in the experimental group of mice (injected with ketamine)? ================== Base your response only on the document provided. List them in bullet point format. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context"".",Medical,Fact Finding,Q&A You must respond to the prompt using information in the context block. Do not use information from other sources. Always format lists using bullet points.,List the potential challenges that each remedy faces in the monopolization case against Google,"On August 5, 2024, the U.S. District Court for the District of Columbia held that Google unlawfully monopolizes the markets for general search services and general search text ads through a series of exclusive contracts with browser developers, mobile device manufacturers, and wireless carriers. The opinion emerges from a lawsuit filed by the Department of Justice (DOJ) and a group of state attorneys general (AGs) in 2020. The DOJ lawsuit was later consolidated with a separate case filed by another group of state AGs that largely adopted the allegations in the DOJ’s complaint. This Legal Sidebar provides an overview of the court’s decision and issues that may arise during the remedies phase of the case. The Challenged Agreements The DOJ’s lawsuit targets distribution contracts that allegedly allow Google to foreclose (i.e., deny access to) significant shares of the markets for general search and general search text ads. Some of the contracts involve browser developers like Apple (the developer of the Safari browser) and Mozilla (the developer of the Firefox browser). Under these agreements, Google pays developers a share of its search ads revenue in exchange for the developers preloading Google as the default search engine for their browsers. Other contracts involve manufacturers of Android mobile devices, such as Motorola and Samsung. These agreements allow manufacturers to preinstall certain proprietary Google apps, like the Google Play Store, on their devices. In exchange for that access, manufacturers must also preload other Google apps, including Google Search and the Chrome browser, which defaults to Google Search. Other agreements involve revenue-sharing arrangements with device manufacturers and wireless carriers. Under these contracts, Google pays manufacturers and carriers a share of its revenue from search ads in exchange for the preinstallation of Google Search at certain access points. Some of these agreements also prohibit Google’s counterparties from preinstalling or promoting alternative general search engines. The Court’s Decision The DOJ’s lawsuit contends that Google’s distribution agreements constitute unlawful monopolization under Section 2 of the Sherman Act because they foreclose substantial shares of the relevant markets and deprive rivals of the scale needed to improve their search engines. The monopolization offense has two elements: (1) the possession of monopoly power, and (2) exclusionary conduct. The following subsections discuss the district court’s analysis of both elements. Monopoly Power The Supreme Court has characterized “monopoly power” as “the power to control prices or exclude competition.” More specifically, monopoly power involves a substantial degree of market power—the ability to raise prices above costs without sacrificing profits. Plaintiffs can establish monopoly power via direct proof that a firm has in fact profitably raised prices substantially above competitive levels or indirect structural evidence that supports an inference of monopoly power. Under the more common indirect approach, plaintiffs can prove monopoly power by showing that the defendant possesses a dominant market share that is protected by entry barriers. To calculate market shares, plaintiffs must define a relevant market in which competition occurs. The scope of the relevant market is determined by the range of reasonable substitutes for the good or service in question. In evaluating substitutability, courts rely on both quantitative evidence and a series of qualitative factors from Brown Shoe Co. v. United States, a 1962 Supreme Court decision. Because of its centrality in establishing market power and monopoly power, market definition is often a dispositive issue in antitrust cases. Applying this legal framework, the district court concluded that Google has monopoly power in two markets: general search services and general search text ads. The court relied on several of the Brown Shoe factors in defining these markets, rejecting Google’s arguments that the relevant markets are broader. Instead of a market for general search, Google had posited a larger market for “query responses” that included vertical search engines (e.g., Expedia, Yelp), social media platforms, and other websites. The court declined to adopt Google’s proposed market, reasoning that vertical search engines do not respond to the range of queries answered by general search engines, even if they can serve as substitutes for discrete purposes. The court concluded that Google has monopoly power in the narrower market for general search based on the firm’s market share of over 89% and significant entry barriers like high capital costs, Google’s control of key distribution channels, brand recognition, and scale. In analyzing the scope of the relevant advertiser-side market, the court recognized markets for both search advertising and general search text ads, rejecting Google’s argument for a broader digital advertising market. Among other things, the court reasoned that search ads (which are displayed in response to specific queries) are not reasonably interchangeable with other types of digital ads because search ads allow advertisers to target customers with greater precision. The court ultimately determined that Google lacks monopoly power in the market for search advertising—which includes search ads on vertical search engines and social media platforms—because of an absence of entry barriers. However, the court found that Google is a monopolist in the narrower market for general search text ads based on the firm’s dominant market share and the entry barriers discussed above. The district court’s decision finds that Google is liable for violating the Sherman Act, but does not impose remedies for those violations. Earlier in the litigation, the court granted the parties’ joint request to bifurcate the liability and remedies phases of the case. The court has ordered the parties to propose a schedule for remedies proceedings by September 4, 2024. Google has said that it plans to appeal the court’s liability decision, but it is unclear whether the appeal will proceed before or after the district court imposes remedies. Congressional Research Service 5 During the remedies phase, the district court will have several options. The narrowest would involve an injunction prohibiting Google’s exclusive contracts. An injunction barring exclusivity was the remedy in United States v. Dentsply, a monopolization case involving exclusive dealing that was resolved in 2006. The most cited antitrust treatise also suggests that, in cases involving a single category of anticompetitive conduct like exclusive dealing, a targeted injunction may be the most appropriate remedy. This type of relief could allow distributors to negotiate default arrangements with other search engines, retain Google as their defaults without receiving payments conditioned on exclusivity, or offer consumers a “choice screen” directing them to select their own default search engine. The court may also consider ordering Google to adopt a choice screen on Android devices, but it likely lacks the authority to require the relevant browser developers to do so because they are not parties to the litigation. Another possibility is a broader injunction requiring Google to share search data with rivals. This type of mandatory pooling could facilitate the emergence of rival search engines, but might also create free-rider problems that disincentivize investments in improving search quality. Such an arrangement might also prove difficult for the court to administer. ","You must respond to the prompt using information in the context block. Do not use information from other sources. Always format lists using bullet points. List the potential challenges that each remedy faces in the monopolization case against Google On August 5, 2024, the U.S. District Court for the District of Columbia held that Google unlawfully monopolizes the markets for general search services and general search text ads through a series of exclusive contracts with browser developers, mobile device manufacturers, and wireless carriers. The opinion emerges from a lawsuit filed by the Department of Justice (DOJ) and a group of state attorneys general (AGs) in 2020. The DOJ lawsuit was later consolidated with a separate case filed by another group of state AGs that largely adopted the allegations in the DOJ’s complaint. This Legal Sidebar provides an overview of the court’s decision and issues that may arise during the remedies phase of the case. The Challenged Agreements The DOJ’s lawsuit targets distribution contracts that allegedly allow Google to foreclose (i.e., deny access to) significant shares of the markets for general search and general search text ads. Some of the contracts involve browser developers like Apple (the developer of the Safari browser) and Mozilla (the developer of the Firefox browser). Under these agreements, Google pays developers a share of its search ads revenue in exchange for the developers preloading Google as the default search engine for their browsers. Other contracts involve manufacturers of Android mobile devices, such as Motorola and Samsung. These agreements allow manufacturers to preinstall certain proprietary Google apps, like the Google Play Store, on their devices. In exchange for that access, manufacturers must also preload other Google apps, including Google Search and the Chrome browser, which defaults to Google Search. Other agreements involve revenue-sharing arrangements with device manufacturers and wireless carriers. Under these contracts, Google pays manufacturers and carriers a share of its revenue from search ads in exchange for the preinstallation of Google Search at certain access points. Some of these agreements also prohibit Google’s counterparties from preinstalling or promoting alternative general search engines. The Court’s Decision The DOJ’s lawsuit contends that Google’s distribution agreements constitute unlawful monopolization under Section 2 of the Sherman Act because they foreclose substantial shares of the relevant markets and deprive rivals of the scale needed to improve their search engines. The monopolization offense has two elements: (1) the possession of monopoly power, and (2) exclusionary conduct. The following subsections discuss the district court’s analysis of both elements. Monopoly Power The Supreme Court has characterized “monopoly power” as “the power to control prices or exclude competition.” More specifically, monopoly power involves a substantial degree of market power—the ability to raise prices above costs without sacrificing profits. Plaintiffs can establish monopoly power via direct proof that a firm has in fact profitably raised prices substantially above competitive levels or indirect structural evidence that supports an inference of monopoly power. Under the more common indirect approach, plaintiffs can prove monopoly power by showing that the defendant possesses a dominant market share that is protected by entry barriers. To calculate market shares, plaintiffs must define a relevant market in which competition occurs. The scope of the relevant market is determined by the range of reasonable substitutes for the good or service in question. In evaluating substitutability, courts rely on both quantitative evidence and a series of qualitative factors from Brown Shoe Co. v. United States, a 1962 Supreme Court decision. Because of its centrality in establishing market power and monopoly power, market definition is often a dispositive issue in antitrust cases. Applying this legal framework, the district court concluded that Google has monopoly power in two markets: general search services and general search text ads. The court relied on several of the Brown Shoe factors in defining these markets, rejecting Google’s arguments that the relevant markets are broader. Instead of a market for general search, Google had posited a larger market for “query responses” that included vertical search engines (e.g., Expedia, Yelp), social media platforms, and other websites. The court declined to adopt Google’s proposed market, reasoning that vertical search engines do not respond to the range of queries answered by general search engines, even if they can serve as substitutes for discrete purposes. The court concluded that Google has monopoly power in the narrower market for general search based on the firm’s market share of over 89% and significant entry barriers like high capital costs, Google’s control of key distribution channels, brand recognition, and scale. In analyzing the scope of the relevant advertiser-side market, the court recognized markets for both search advertising and general search text ads, rejecting Google’s argument for a broader digital advertising market. Among other things, the court reasoned that search ads (which are displayed in response to specific queries) are not reasonably interchangeable with other types of digital ads because search ads allow advertisers to target customers with greater precision. The court ultimately determined that Google lacks monopoly power in the market for search advertising—which includes search ads on vertical search engines and social media platforms—because of an absence of entry barriers. However, the court found that Google is a monopolist in the narrower market for general search text ads based on the firm’s dominant market share and the entry barriers discussed above. The district court’s decision finds that Google is liable for violating the Sherman Act, but does not impose remedies for those violations. Earlier in the litigation, the court granted the parties’ joint request to bifurcate the liability and remedies phases of the case. The court has ordered the parties to propose a schedule for remedies proceedings by September 4, 2024. Google has said that it plans to appeal the court’s liability decision, but it is unclear whether the appeal will proceed before or after the district court imposes remedies. Congressional Research Service 5 During the remedies phase, the district court will have several options. The narrowest would involve an injunction prohibiting Google’s exclusive contracts. An injunction barring exclusivity was the remedy in United States v. Dentsply, a monopolization case involving exclusive dealing that was resolved in 2006. The most cited antitrust treatise also suggests that, in cases involving a single category of anticompetitive conduct like exclusive dealing, a targeted injunction may be the most appropriate remedy. This type of relief could allow distributors to negotiate default arrangements with other search engines, retain Google as their defaults without receiving payments conditioned on exclusivity, or offer consumers a “choice screen” directing them to select their own default search engine. The court may also consider ordering Google to adopt a choice screen on Android devices, but it likely lacks the authority to require the relevant browser developers to do so because they are not parties to the litigation. Another possibility is a broader injunction requiring Google to share search data with rivals. This type of mandatory pooling could facilitate the emergence of rival search engines, but might also create free-rider problems that disincentivize investments in improving search quality. Such an arrangement might also prove difficult for the court to administer. ",Internet/Technology,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","As a software architect, I'm considering microservices for a large-scale system. Can you explain the differences between microservices and monolithic architectures in terms of scalability, deployment and fault isolation? Also, what challenges arise in microservices regarding data consistency and inter-service communication ? Please provide your response in less than 200 words.","Microservices Architecture: A Paradigm Shift in Distributed Systems The evolution of software architecture has led to the emergence of microservices as a dominant paradigm in distributed systems design. This architectural style represents a significant departure from traditional monolithic structures, offering enhanced scalability, flexibility, and resilience. However, it also introduces new challenges that must be carefully considered during implementation. Microservices vs. Monolithic Architectures Scalability: Monolithic architectures, characterized by their single-tiered software application structure, often face scalability issues as the codebase grows. Scaling requires replication of the entire application, leading to inefficient resource utilization. In contrast, microservices allow for independent scaling of individual components. This granular scalability enables organizations to allocate resources more efficiently, scaling only the services that require additional capacity. Deployment: Deployment in monolithic systems typically involves updating the entire application, even for minor changes. This process can be time-consuming and risky, potentially affecting the entire system's stability. Microservices, however, facilitate continuous deployment and integration (CI/CD) practices. Each service can be deployed independently, reducing deployment complexity and allowing for more frequent updates with minimal system-wide impact. Fault Isolation: In monolithic architectures, a fault in any module can potentially bring down the entire system. Microservices architecture inherently provides better fault isolation. Since services are independent, a failure in one service does not necessarily affect the others, enhancing overall system resilience. Challenges in Adopting Microservices While microservices offer numerous advantages, their adoption is not without challenges: Data Consistency: Maintaining data consistency across distributed services is a significant challenge. The distributed nature of microservices often necessitates the implementation of eventual consistency models, which can complicate application logic and user experience. Techniques such as event sourcing and CQRS (Command Query Responsibility Segregation) are often employed to address these issues, but they introduce their own complexities. Inter-service Communication: As the number of services grows, the complexity of inter-service communication increases exponentially. This can lead to network latency issues and potential points of failure. Implementing robust service discovery mechanisms, efficient load balancing, and resilient communication patterns (e.g., circuit breakers, retries) becomes crucial. Distributed Transactions: Ensuring transactional integrity across multiple services is challenging. The lack of a centralized database often requires the implementation of complex distributed transaction patterns such as the Saga pattern or two-phase commit protocols. Operational Complexity: The distributed nature of microservices increases operational complexity. Monitoring, logging, and debugging become more challenging as the system is spread across multiple services. Implementing comprehensive observability solutions becomes essential for effective system management. Service Boundaries: Defining appropriate service boundaries is crucial for the success of a microservices architecture. Incorrectly defined boundaries can lead to tightly coupled services, negating many of the benefits of this architectural style. Implementation Considerations When implementing a microservices architecture, several key factors must be considered: API Gateway: An API gateway acts as a single entry point for all client requests, routing them to appropriate services. It can also handle cross-cutting concerns such as authentication, rate limiting, and request/response transformation. Service Discovery: Dynamic service discovery mechanisms are essential in microservices environments where service instances may come and go frequently. Tools like Consul or Eureka are often used for this purpose. Containerization and Orchestration: Container technologies like Docker, coupled with orchestration platforms such as Kubernetes, have become de facto standards in microservices deployments. They provide consistency across development and production environments and facilitate efficient resource utilization. Event-Driven Architecture: Adopting an event-driven approach can help decouple services and improve system responsiveness. Technologies like Apache Kafka or RabbitMQ are commonly used for implementing event-driven architectures in microservices. Polyglot Persistence: Microservices allow for the use of different data storage technologies for different services based on their specific requirements. This polyglot persistence approach can optimize data storage and retrieval for each service. Conclusion Microservices architecture offers significant advantages in terms of scalability, deployment flexibility, and fault isolation. However, it also introduces complexities in data consistency management, inter-service communication, and operational overhead. Successful implementation requires careful consideration of these challenges and the adoption of appropriate patterns and technologies to address them. As with any architectural decision, the choice to adopt microservices should be based on a thorough analysis of the specific requirements and constraints of the system being developed.","[question] As a software architect, I'm considering microservices for a large-scale system. Can you explain the differences between microservices and monolithic architectures in terms of scalability, deployment and fault isolation? Also, what challenges arise in microservices regarding data consistency and inter-service communication ? Please provide your response in less than 200 words. ===================== [text] Microservices Architecture: A Paradigm Shift in Distributed Systems The evolution of software architecture has led to the emergence of microservices as a dominant paradigm in distributed systems design. This architectural style represents a significant departure from traditional monolithic structures, offering enhanced scalability, flexibility, and resilience. However, it also introduces new challenges that must be carefully considered during implementation. Microservices vs. Monolithic Architectures Scalability: Monolithic architectures, characterized by their single-tiered software application structure, often face scalability issues as the codebase grows. Scaling requires replication of the entire application, leading to inefficient resource utilization. In contrast, microservices allow for independent scaling of individual components. This granular scalability enables organizations to allocate resources more efficiently, scaling only the services that require additional capacity. Deployment: Deployment in monolithic systems typically involves updating the entire application, even for minor changes. This process can be time-consuming and risky, potentially affecting the entire system's stability. Microservices, however, facilitate continuous deployment and integration (CI/CD) practices. Each service can be deployed independently, reducing deployment complexity and allowing for more frequent updates with minimal system-wide impact. Fault Isolation: In monolithic architectures, a fault in any module can potentially bring down the entire system. Microservices architecture inherently provides better fault isolation. Since services are independent, a failure in one service does not necessarily affect the others, enhancing overall system resilience. Challenges in Adopting Microservices While microservices offer numerous advantages, their adoption is not without challenges: Data Consistency: Maintaining data consistency across distributed services is a significant challenge. The distributed nature of microservices often necessitates the implementation of eventual consistency models, which can complicate application logic and user experience. Techniques such as event sourcing and CQRS (Command Query Responsibility Segregation) are often employed to address these issues, but they introduce their own complexities. Inter-service Communication: As the number of services grows, the complexity of inter-service communication increases exponentially. This can lead to network latency issues and potential points of failure. Implementing robust service discovery mechanisms, efficient load balancing, and resilient communication patterns (e.g., circuit breakers, retries) becomes crucial. Distributed Transactions: Ensuring transactional integrity across multiple services is challenging. The lack of a centralized database often requires the implementation of complex distributed transaction patterns such as the Saga pattern or two-phase commit protocols. Operational Complexity: The distributed nature of microservices increases operational complexity. Monitoring, logging, and debugging become more challenging as the system is spread across multiple services. Implementing comprehensive observability solutions becomes essential for effective system management. Service Boundaries: Defining appropriate service boundaries is crucial for the success of a microservices architecture. Incorrectly defined boundaries can lead to tightly coupled services, negating many of the benefits of this architectural style. Implementation Considerations When implementing a microservices architecture, several key factors must be considered: API Gateway: An API gateway acts as a single entry point for all client requests, routing them to appropriate services. It can also handle cross-cutting concerns such as authentication, rate limiting, and request/response transformation. Service Discovery: Dynamic service discovery mechanisms are essential in microservices environments where service instances may come and go frequently. Tools like Consul or Eureka are often used for this purpose. Containerization and Orchestration: Container technologies like Docker, coupled with orchestration platforms such as Kubernetes, have become de facto standards in microservices deployments. They provide consistency across development and production environments and facilitate efficient resource utilization. Event-Driven Architecture: Adopting an event-driven approach can help decouple services and improve system responsiveness. Technologies like Apache Kafka or RabbitMQ are commonly used for implementing event-driven architectures in microservices. Polyglot Persistence: Microservices allow for the use of different data storage technologies for different services based on their specific requirements. This polyglot persistence approach can optimize data storage and retrieval for each service. Conclusion Microservices architecture offers significant advantages in terms of scalability, deployment flexibility, and fault isolation. However, it also introduces complexities in data consistency management, inter-service communication, and operational overhead. Successful implementation requires careful consideration of these challenges and the adoption of appropriate patterns and technologies to address them. As with any architectural decision, the choice to adopt microservices should be based on a thorough analysis of the specific requirements and constraints of the system being developed. https://azure.microsoft.com/en-us/blog/microservices-architecture-on-azure-kubernetes-service/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Concept Comparison,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","My cousin and I are considering getting vaccinations for the first time shes 57 and I'm 50 but currently pregnant. Considering our medical history and age, I need to know if there are any risks for us. List 3 best reasons to get or not to get the shot with bullet points.","Recombinant zoster (shingles) vaccine can prevent shingles. Shingles (also called herpes zoster, or just zoster) is a painful skin rash, usually with blisters. In addition to the rash, shingles can cause fever, headache, chills, or upset stomach. Rarely, shingles can lead to complications such as pneumonia, hearing problems, blindness, brain inflammation (encephalitis), or death. The risk of shingles increases with age. The most common complication of shingles is long-term nerve pain called postherpetic neuralgia (PHN). PHN occurs in the areas where the shingles rash was and can last for months or years after the rash goes away. The pain from PHN can be severe and debilitating. The risk of PHN increases with age. An older adult with shingles is more likely to develop PHN and have longer lasting and more severe pain than a younger person. People with weakened immune systems also have a higher risk of getting shingles and complications from the disease. Shingles is caused by varicella-zoster virus, the same virus that causes chickenpox. After you have chickenpox, the virus stays in your body and can cause shingles later in life. Shingles cannot be passed from one person to another, but the virus that causes shingles can spread and cause chickenpox in someone who has never had chickenpox or has never received chickenpox vaccine. Recombinant shingles vaccine Recombinant shingles vaccine provides strong protection against shingles. By preventing shingles, recombinant shingles vaccine also protects against PHN and other complications. Recombinant shingles vaccine is recommended for: Adults 50 years and older Adults 19 years and older who have a weakened immune system because of disease or treatments Shingles vaccine is given as a two-dose series. For most people, the second dose should be given 2 to 6 months after the first dose. Some people who have or will have a weakened immune system can get the second dose 1 to 2 months after the first dose. Ask your health care provider for guidance. People who have had shingles in the past and people who have received varicella (chickenpox) vaccine are recommended to get recombinant shingles vaccine. The vaccine is also recommended for people who have already gotten another type of shingles vaccine, the live shingles vaccine. There is no live virus in recombinant shingles vaccine. Shingles vaccine may be given at the same time as other vaccines. Talk with your health care provider Tell your vaccination provider if the person getting the vaccine: Has had an allergic reaction after a previous dose of recombinant shingles vaccine, or has any severe, life-threatening allergies Is currently experiencing an episode of shingles Is pregnant In some cases, your health care provider may decide to postpone shingles vaccination until a future visit. People with minor illnesses, such as a cold, may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting recombinant shingles vaccine. Your health care provider can give you more information. Risks of a vaccine reaction A sore arm with mild or moderate pain is very common after recombinant shingles vaccine. Redness and swelling can also happen at the site of the injection. Tiredness, muscle pain, headache, shivering, fever, stomach pain, and nausea are common after recombinant shingles vaccine. These side effects may temporarily prevent a vaccinated person from doing regular activities. Symptoms usually go away on their own in 2 to 3 days. You should still get the second dose of recombinant shingles vaccine even if you had one of these reactions after the first dose. Guillain-Barré syndrome (GBS), a serious nervous system disorder, has been reported very rarely after recombinant zoster vaccine. People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears. As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death. What if there is a serious problem? An allergic reaction could occur after the vaccinated person leaves the clinic. If you see signs of a severe allergic reaction (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness), call 9-1-1 and get the person to the nearest hospital.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== My cousin and I are considering getting vaccinations for the first time shes 57 and I'm 50 but currently pregnant. Considering our medical history and age, I need to know if there are any risks for us. List 3 best reasons to get or not to get the shot with bullet points. {passage 0} ========== Recombinant zoster (shingles) vaccine can prevent shingles. Shingles (also called herpes zoster, or just zoster) is a painful skin rash, usually with blisters. In addition to the rash, shingles can cause fever, headache, chills, or upset stomach. Rarely, shingles can lead to complications such as pneumonia, hearing problems, blindness, brain inflammation (encephalitis), or death. The risk of shingles increases with age. The most common complication of shingles is long-term nerve pain called postherpetic neuralgia (PHN). PHN occurs in the areas where the shingles rash was and can last for months or years after the rash goes away. The pain from PHN can be severe and debilitating. The risk of PHN increases with age. An older adult with shingles is more likely to develop PHN and have longer lasting and more severe pain than a younger person. People with weakened immune systems also have a higher risk of getting shingles and complications from the disease. Shingles is caused by varicella-zoster virus, the same virus that causes chickenpox. After you have chickenpox, the virus stays in your body and can cause shingles later in life. Shingles cannot be passed from one person to another, but the virus that causes shingles can spread and cause chickenpox in someone who has never had chickenpox or has never received chickenpox vaccine. Recombinant shingles vaccine Recombinant shingles vaccine provides strong protection against shingles. By preventing shingles, recombinant shingles vaccine also protects against PHN and other complications. Recombinant shingles vaccine is recommended for: Adults 50 years and older Adults 19 years and older who have a weakened immune system because of disease or treatments Shingles vaccine is given as a two-dose series. For most people, the second dose should be given 2 to 6 months after the first dose. Some people who have or will have a weakened immune system can get the second dose 1 to 2 months after the first dose. Ask your health care provider for guidance. People who have had shingles in the past and people who have received varicella (chickenpox) vaccine are recommended to get recombinant shingles vaccine. The vaccine is also recommended for people who have already gotten another type of shingles vaccine, the live shingles vaccine. There is no live virus in recombinant shingles vaccine. Shingles vaccine may be given at the same time as other vaccines. Talk with your health care provider Tell your vaccination provider if the person getting the vaccine: Has had an allergic reaction after a previous dose of recombinant shingles vaccine, or has any severe, life-threatening allergies Is currently experiencing an episode of shingles Is pregnant In some cases, your health care provider may decide to postpone shingles vaccination until a future visit. People with minor illnesses, such as a cold, may be vaccinated. People who are moderately or severely ill should usually wait until they recover before getting recombinant shingles vaccine. Your health care provider can give you more information. Risks of a vaccine reaction A sore arm with mild or moderate pain is very common after recombinant shingles vaccine. Redness and swelling can also happen at the site of the injection. Tiredness, muscle pain, headache, shivering, fever, stomach pain, and nausea are common after recombinant shingles vaccine. These side effects may temporarily prevent a vaccinated person from doing regular activities. Symptoms usually go away on their own in 2 to 3 days. You should still get the second dose of recombinant shingles vaccine even if you had one of these reactions after the first dose. Guillain-Barré syndrome (GBS), a serious nervous system disorder, has been reported very rarely after recombinant zoster vaccine. People sometimes faint after medical procedures, including vaccination. Tell your provider if you feel dizzy or have vision changes or ringing in the ears. As with any medicine, there is a very remote chance of a vaccine causing a severe allergic reaction, other serious injury, or death. What if there is a serious problem? An allergic reaction could occur after the vaccinated person leaves the clinic. If you see signs of a severe allergic reaction (hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, or weakness), call 9-1-1 and get the person to the nearest hospital. https://www.cdc.gov/vaccines/hcp/vis/vis-statements/shingles-recombinant.html",Medical,Pros & Cons,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","We used to have a 10-acre waterlocked property by Lake Erie, in Ohio, in a remote section of the shoreline. Recently, we sold half of the property to our neighbor. Now, we can only reach the road by passing through his property or using a boat. No other way is available. However, he has been creating problems for us, because he doesn't us to use the road. He even made a fence in the middle of it. He says that it's his property and he can do whatever he wants with it. Can we prevail? Answer in 150 words.","Such stipulation, which is neither as complete nor satisfactory as could be desired, shows that on May 13, 1867, one Mary Lane acquired by deeds lands which embrace the properties now owned by the plaintiffs and defendant, respectively, plus a strip of land 33 feet in width running from the southeast corner of the 25-acre tract, now owned by plaintiffs, east to the center of a thoroughfare called Cahoon road. By deed recorded August 10, 1881, this same Mary Lane acquired title to another strip of land 33 feet wide and extending east from the northeast corner of plaintiffs' present land to the center of Cahoon road, which was used until the year 1928 for the purpose of ingress and egress. By deed recorded September 5, 1881, Mary Lane conveyed to the New York, Chicago St. Louis Railroad Company a right of way which effected a complete separation of the lands now owned by plaintiffs and defendant. Thus, in 1881, a condition was brought about whereby the original parcel of land was divided by a railroad right of way with two strips of land 33 feet wide and extending from Cahoon road to the 25-acre tract lying south of the railroad right of way and now belonging to plaintiffs. The property involved in the instant controversy continued to be owned by Mary Lane and her heirs until February 19, 1921, when the heirs conveyed the same to two persons named Dodd and Aldrich. In the conveyance there were three separate descriptions, one description included plaintiffs' present property, another defendant's present property and the remaining one the strip of land 33 feet wide and extending from the northeast corner of plaintiffs' premises to the center of Cahoon road. Sometime during the year 1921 Dodd and Aldrich constructed a crossing seven feet wide over the tracks and right of way of the railroad and connecting the premises now owned by plaintiffs with those now owned by defendant. Such railroad crossing was used by Dodd and Aldrich from the year 1922, and upon the establishment of Forest Drive in 1925 they traveled across the land now owned by defendant along a line between the railroad crossing and the south end of Forest Drive. The nature and extent of such use are not disclosed, but it apparently continued for an undisclosed purpose until the separate and distinct tax sales in 1940. By the present action plaintiffs seek to enjoin the defendant from interfering with their use of the passage or alleged easement from their land across his land to Forest Drive. An easement has been defined as ""a right without profit, created by grant or prescription, which the owner of one estate [called the dominant estate] may exercise in or over the estate of another [called the servient estate] for the benefit of the former."" Yeager v. Tuning, 79 Ohio St. 121, 124, 86 N.E. 657, 658, 19 L.R.A. (N.S.), 700, 128 Am. St. Rep., 679. An easement may be acquired only by grant, express or implied, or by prescription. Where, however, the easement sought to be enforced is grounded upon implication rather than express grant, it must be clearly established that such a right exists. Implied easements are not favored because they are in derogation of the rule that written instruments speak for themselves. Ciski v. Wentworth, 122 Ohio St. 487, 172 N.E. 276. An implied easement is based upon the theory that whenever one conveys property he includes in the conveyance whatever is necessary for its beneficial use and enjoyment and retains whatever is necessary for the use and enjoyment of the land retained. There being in this case no express grant of an easement, it becomes necessary to determine whether one arose by implication. Easements may be implied in several ways — from an existing use at the time of the severance of ownership in land, from a conveyance describing the premises as bounded upon a way, from a conveyance with reference to a plat or map or from necessity alone, as in the case of ways of necessity. 15 Ohio Jurisprudence, 37, Section 27. Here, we are concerned only with the first and last of these methods, namely, a use existing at the time of severance or a way of necessity. It is a well settled rule that a use must be continuous, apparent, permanent and necessary to be the basis of an implied easement upon the severance of the ownership of an estate. 28 Corpus Juris Secundum, Easements, 691, Section 33; and 15 Ohio Jurisprudence, 37, 45, Sections 28, 33. For a use to be permanent in character ""it is required that the use shall have been so long continued prior to severance and so obvious as to show that it was meant to be permanent; a mere temporary provision or arrangement made for the convenience of the entire estate will not constitute that degree of permanency required to burden the property with a continuance of the same when divided or separated by conveyance to different parties."" 28 Corpus Juris Secundum, Easements, 691, 692, Section 33; and 15 Ohio Jurisprudence, 41, Section 31. Plaintiffs having failed, then, to present facts sufficient to warrant the finding of an implied easement from an existing use, we come to a consideration of whether the facts disclosed are such as to sustain a way of necessity. An implied easement or way of necessity is based upon the theory that without it the grantor or grantee, as the case may be, can not make use of his land. It has been stated that ""necessity does not of itself create a right of way, but is said to furnish evidence of the grantor's intention to convey a right of way and, therefore, raises an implication of grant."" 17 American Jurisprudence, 961, Section 48. A way of necessity will not be implied where the claimant has another means of ingress or egress, whether over his own land or over the land of another. For over 40 years thereafter there was no connection between these lands. As already noted, up to the year 1928 the strip of land 33 feet wide, still in the names of Dodd and Aldrich and connecting Cahoon road with the northeast corner of plaintiffs' property, was used as a way of travel to and from such property. In our opinion plaintiffs do have a means of access to their lands from Cahoon road over the strip of ground 33 feet wide, referred to above, now belonging to those in plaintiffs' chain of title, and this being so they are not in a position to successfully assert an easement or way of necessity over defendant's property. A way of necessity will not be implied, where there is another or other outlets available to a public thoroughfare, even though such other outlets are less convenient and would necessitate the expenditure of a considerable sum of money to render them serviceable. 15 Ohio Jurisprudence, 62, Section 44. ""A way of necessity will not be decreed unless the evidence showing the need therefor is clear and convincing. Such a way is not sanctioned when there is available another means of ingress and egress to and from the claimant's land even though it may be less convenient and will involve some labor and expense to repair and maintain."" Although it would be much more convenient and much less expensive for plaintiffs to traverse defendant's property to reach a public street, the imposition of such a burden on defendant's land on the theory of a way of necessity is legally unwarranted in the circumstances exhibited by the record. The judgment of the Court of Appeals is, therefore, reversed and final judgment rendered for defendant.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== We used to have a 10-acre waterlocked property by Lake Erie, in Ohio, in a remote section of the shoreline. Recently, we sold half of the property to our neighbor. Now, we can only reach the road by passing through his property or using a boat. No other way is available. However, he has been creating problems for us, because he doesn't us to use the road. He even made a fence in the middle of it. He says that it's his property and he can do whatever he wants with it. Can we prevail? Answer in 150 words. {passage 0} ========== Such stipulation, which is neither as complete nor satisfactory as could be desired, shows that on May 13, 1867, one Mary Lane acquired by deeds lands which embrace the properties now owned by the plaintiffs and defendant, respectively, plus a strip of land 33 feet in width running from the southeast corner of the 25-acre tract, now owned by plaintiffs, east to the center of a thoroughfare called Cahoon road. By deed recorded August 10, 1881, this same Mary Lane acquired title to another strip of land 33 feet wide and extending east from the northeast corner of plaintiffs' present land to the center of Cahoon road, which was used until the year 1928 for the purpose of ingress and egress. By deed recorded September 5, 1881, Mary Lane conveyed to the New York, Chicago St. Louis Railroad Company a right of way which effected a complete separation of the lands now owned by plaintiffs and defendant. Thus, in 1881, a condition was brought about whereby the original parcel of land was divided by a railroad right of way with two strips of land 33 feet wide and extending from Cahoon road to the 25-acre tract lying south of the railroad right of way and now belonging to plaintiffs. The property involved in the instant controversy continued to be owned by Mary Lane and her heirs until February 19, 1921, when the heirs conveyed the same to two persons named Dodd and Aldrich. In the conveyance there were three separate descriptions, one description included plaintiffs' present property, another defendant's present property and the remaining one the strip of land 33 feet wide and extending from the northeast corner of plaintiffs' premises to the center of Cahoon road. Sometime during the year 1921 Dodd and Aldrich constructed a crossing seven feet wide over the tracks and right of way of the railroad and connecting the premises now owned by plaintiffs with those now owned by defendant. Such railroad crossing was used by Dodd and Aldrich from the year 1922, and upon the establishment of Forest Drive in 1925 they traveled across the land now owned by defendant along a line between the railroad crossing and the south end of Forest Drive. The nature and extent of such use are not disclosed, but it apparently continued for an undisclosed purpose until the separate and distinct tax sales in 1940. By the present action plaintiffs seek to enjoin the defendant from interfering with their use of the passage or alleged easement from their land across his land to Forest Drive. An easement has been defined as ""a right without profit, created by grant or prescription, which the owner of one estate [called the dominant estate] may exercise in or over the estate of another [called the servient estate] for the benefit of the former."" Yeager v. Tuning, 79 Ohio St. 121, 124, 86 N.E. 657, 658, 19 L.R.A. (N.S.), 700, 128 Am. St. Rep., 679. An easement may be acquired only by grant, express or implied, or by prescription. Where, however, the easement sought to be enforced is grounded upon implication rather than express grant, it must be clearly established that such a right exists. Implied easements are not favored because they are in derogation of the rule that written instruments speak for themselves. Ciski v. Wentworth, 122 Ohio St. 487, 172 N.E. 276. An implied easement is based upon the theory that whenever one conveys property he includes in the conveyance whatever is necessary for its beneficial use and enjoyment and retains whatever is necessary for the use and enjoyment of the land retained. There being in this case no express grant of an easement, it becomes necessary to determine whether one arose by implication. Easements may be implied in several ways — from an existing use at the time of the severance of ownership in land, from a conveyance describing the premises as bounded upon a way, from a conveyance with reference to a plat or map or from necessity alone, as in the case of ways of necessity. 15 Ohio Jurisprudence, 37, Section 27. Here, we are concerned only with the first and last of these methods, namely, a use existing at the time of severance or a way of necessity. It is a well settled rule that a use must be continuous, apparent, permanent and necessary to be the basis of an implied easement upon the severance of the ownership of an estate. 28 Corpus Juris Secundum, Easements, 691, Section 33; and 15 Ohio Jurisprudence, 37, 45, Sections 28, 33. For a use to be permanent in character ""it is required that the use shall have been so long continued prior to severance and so obvious as to show that it was meant to be permanent; a mere temporary provision or arrangement made for the convenience of the entire estate will not constitute that degree of permanency required to burden the property with a continuance of the same when divided or separated by conveyance to different parties."" 28 Corpus Juris Secundum, Easements, 691, 692, Section 33; and 15 Ohio Jurisprudence, 41, Section 31. Plaintiffs having failed, then, to present facts sufficient to warrant the finding of an implied easement from an existing use, we come to a consideration of whether the facts disclosed are such as to sustain a way of necessity. An implied easement or way of necessity is based upon the theory that without it the grantor or grantee, as the case may be, can not make use of his land. It has been stated that ""necessity does not of itself create a right of way, but is said to furnish evidence of the grantor's intention to convey a right of way and, therefore, raises an implication of grant."" 17 American Jurisprudence, 961, Section 48. A way of necessity will not be implied where the claimant has another means of ingress or egress, whether over his own land or over the land of another. For over 40 years thereafter there was no connection between these lands. As already noted, up to the year 1928 the strip of land 33 feet wide, still in the names of Dodd and Aldrich and connecting Cahoon road with the northeast corner of plaintiffs' property, was used as a way of travel to and from such property. In our opinion plaintiffs do have a means of access to their lands from Cahoon road over the strip of ground 33 feet wide, referred to above, now belonging to those in plaintiffs' chain of title, and this being so they are not in a position to successfully assert an easement or way of necessity over defendant's property. A way of necessity will not be implied, where there is another or other outlets available to a public thoroughfare, even though such other outlets are less convenient and would necessitate the expenditure of a considerable sum of money to render them serviceable. 15 Ohio Jurisprudence, 62, Section 44. ""A way of necessity will not be decreed unless the evidence showing the need therefor is clear and convincing. Such a way is not sanctioned when there is available another means of ingress and egress to and from the claimant's land even though it may be less convenient and will involve some labor and expense to repair and maintain."" Although it would be much more convenient and much less expensive for plaintiffs to traverse defendant's property to reach a public street, the imposition of such a burden on defendant's land on the theory of a way of necessity is legally unwarranted in the circumstances exhibited by the record. The judgment of the Court of Appeals is, therefore, reversed and final judgment rendered for defendant. https://casetext.com/case/trattar-v-rausch",Legal,Concept Comparison,Q&A "Do not use any external knowledge, base your answers only on the provided context block. Your role is to explain legal concepts in an easily accessible manner. Do not use pleasantries or filler text, answer the user’s question directly. ",Tell me about NetChoice's legal battle over H.B. 20.,"NetChoice’s Challenge to Florida’s S.B. 7072 Florida’s S.B. 7072 imposes restrictions on any information service, system, Internet search engine, or access software provider that enables access by multiple users to a computer server, is organized as a legal entity, does business in Florida, and satisfies certain specified user- or revenue-based thresholds. Thus, while the litigation about the law emphasized the limitations it imposed on social media platforms, the law applied more broadly. NetChoice challenged restrictions that generally fall into two categories: content moderation restrictions and individualized-explanation requirements. The Supreme Court’s analysis in Moody focused on the content moderation restrictions. Those provisions limit the ability of covered platforms to delete content, make content less visible to other users, or ban users. Under S.B. 7072, platforms may not “deplatform” a political candidate or deprioritize a candidate’s or “journalistic enterprise’s” posts. They must “apply censorship, deplatforming, and shadow banning standards in a consistent manner,” and they cannot change the rules or terms that apply to users more than once every 30 days. Deplatforming occurs when a platform bans a user for at least 14 days. Shadow banning occurs when a platform deletes a user’s content or makes the account’s content less visible to other users. Before S.B. 7072 took effect, NetChoice sued, alleging that the content moderation provisions, on their face, violate the First Amendment. The U.S. Court of Appeals for the Eleventh Circuit affirmed a preliminary injunction barring enforcement of the content moderation provisions while NetChoice’s challenge is litigated. The court held that the provisions likely “trigger[] First Amendment scrutiny because [S.B. 7072] restricts social-media platforms’ exercise of editorial judgment.” It decided that the challenged provisions likely fail constitutional scrutiny because they lack a “substantial or compelling interest that would justify [the provisions’] significant restrictions on platforms’ editorial judgment.” NetChoice’s Challenge to Texas’s H.B. 20 Texas’s H.B. 20 applies to social media platforms with more than 50 million monthly active users in the United States. The law defines social media platforms as public websites or applications that enable users to create accounts and communicate for the primary purpose of posting user-generated information. Internet service providers, email providers, and websites “that consist primarily of news, sports, entertainment, or other” content that is not user generated are excluded from the definition. As with Florida’s law, H.B. 20 limits when covered platforms may delete or restrict access to user-posted content. Subject to enumerated exceptions, covered platforms are prohibited from censoring a user’s content based on viewpoint or the user’s geographic location in Texas. Censor is defined to mean “block[ing], ban[ning], remove[ing], deplatform[ing], demonetiz[ing], de-boost[ing], restrict[ing], deny[ing] equal access or visibility to, or otherwise discriminat[ing] against expression.” Again, NetChoice challenged H.B. 20’s content moderation provisions on their face and asked a court to enjoin their enforcement before the law took effect. The U.S. Court of Appeals for the Fifth Circuit denied the request. Expressly disagreeing with the Eleventh Circuit’s reasoning about Florida’s law, the Fifth Circuit held that Texas’s content moderation provisions do not likely implicate First Amendment rights. According to the Fifth Circuit, NetChoice was seeking to assert a “right to censor what people say” that is not protected by the First Amendment. In the alternative, the court held that, even if the law restricted protected expression, it is a content- and viewpoint-neutral law—so subject to intermediate scrutiny—and Texas’s interest in protecting the free exchange of ideas is sufficiently important to satisfy that standard.","Do not use any external knowledge, base your answers only on the provided context block. Your role is to explain legal concepts in an easily accessible manner. Do not use pleasantries or filler text, answer the user’s question directly. NetChoice’s Challenge to Florida’s S.B. 7072 Florida’s S.B. 7072 imposes restrictions on any information service, system, Internet search engine, or access software provider that enables access by multiple users to a computer server, is organized as a legal entity, does business in Florida, and satisfies certain specified user- or revenue-based thresholds. Thus, while the litigation about the law emphasized the limitations it imposed on social media platforms, the law applied more broadly. NetChoice challenged restrictions that generally fall into two categories: content moderation restrictions and individualized-explanation requirements. The Supreme Court’s analysis in Moody focused on the content moderation restrictions. Those provisions limit the ability of covered platforms to delete content, make content less visible to other users, or ban users. Under S.B. 7072, platforms may not “deplatform” a political candidate or deprioritize a candidate’s or “journalistic enterprise’s” posts. They must “apply censorship, deplatforming, and shadow banning standards in a consistent manner,” and they cannot change the rules or terms that apply to users more than once every 30 days. Deplatforming occurs when a platform bans a user for at least 14 days. Shadow banning occurs when a platform deletes a user’s content or makes the account’s content less visible to other users. Before S.B. 7072 took effect, NetChoice sued, alleging that the content moderation provisions, on their face, violate the First Amendment. The U.S. Court of Appeals for the Eleventh Circuit affirmed a preliminary injunction barring enforcement of the content moderation provisions while NetChoice’s challenge is litigated. The court held that the provisions likely “trigger[] First Amendment scrutiny because [S.B. 7072] restricts social-media platforms’ exercise of editorial judgment.” It decided that the challenged provisions likely fail constitutional scrutiny because they lack a “substantial or compelling interest that would justify [the provisions’] significant restrictions on platforms’ editorial judgment.” NetChoice’s Challenge to Texas’s H.B. 20 Texas’s H.B. 20 applies to social media platforms with more than 50 million monthly active users in the United States. The law defines social media platforms as public websites or applications that enable users to create accounts and communicate for the primary purpose of posting user-generated information. Internet service providers, email providers, and websites “that consist primarily of news, sports, entertainment, or other” content that is not user generated are excluded from the definition. As with Florida’s law, H.B. 20 limits when covered platforms may delete or restrict access to user-posted content. Subject to enumerated exceptions, covered platforms are prohibited from censoring a user’s content based on viewpoint or the user’s geographic location in Texas. Censor is defined to mean “block[ing], ban[ning], remove[ing], deplatform[ing], demonetiz[ing], de-boost[ing], restrict[ing], deny[ing] equal access or visibility to, or otherwise discriminat[ing] against expression.” Again, NetChoice challenged H.B. 20’s content moderation provisions on their face and asked a court to enjoin their enforcement before the law took effect. The U.S. Court of Appeals for the Fifth Circuit denied the request. Expressly disagreeing with the Eleventh Circuit’s reasoning about Florida’s law, the Fifth Circuit held that Texas’s content moderation provisions do not likely implicate First Amendment rights. According to the Fifth Circuit, NetChoice was seeking to assert a “right to censor what people say” that is not protected by the First Amendment. In the alternative, the court held that, even if the law restricted protected expression, it is a content- and viewpoint-neutral law—so subject to intermediate scrutiny—and Texas’s interest in protecting the free exchange of ideas is sufficiently important to satisfy that standard. Tell me about NetChoice's legal battle over H.B. 20.",Legal,Find & Summarize,Text Transformation Use only the information provided to answer. Do not use outside sources or internal knowledge. Use bullet point format in chronological order.,Please list the dates and their significance.,"The Court of Arbitration for Sport (CAS) has issued the operative part of its decision in the appeal arbitration procedures CAS 2023/A/10025 Simona Halep v. International Tennis Integrity Agency (ITIA) and CAS 2023/A/10227 International Tennis Integrity Agency (ITIA) v. Simona Halep: The appeal procedures before the CAS concerned two separate charges: 1. a charge which arose from a prohibited substance (Roxadustat) being detected in a urine sample collected from Simona Halep on 29 August 2022 during the US Open; and 2. a charge that Ms Halep’s Athlete Biological Passport (ABP), in particular a blood sample given by Ms Halep on 22 September 2022, established use of a prohibited substance and/or prohibited method. In its decision dated 22 September 2023, the International Tennis Federation (ITF) Independent Tribunal found Ms Halep guilty of both Anti-doping Rule Violations (ADRV) and imposed a four-year period of ineligibility on her. In the appeal filed by Simona Halep at the CAS against the first instance Decision, Ms Halep requested that the sanction be reduced and be no longer than the period of the provisional suspension already served. In its separate appeal, the ITIA requested that the CAS sanction Ms Halep’s ADRVs together as one single violation based on the violation that carried the most severe sanction, and the imposition of a period of ineligibility of between four and six years. The CAS appeal arbitration proceedings involved intensive pre-hearing processes and a three-day hearing which took place on 7-9 February 2024 in Lausanne, Switzerland. The CAS Panel heard from many lay and expert witnesses, most of whom were present in person at the hearing. The CAS Panel has unanimously determined that the four-year period of ineligibility imposed by the ITF Independent Tribunal is to be reduced to a period of ineligibility of nine (9) months starting on 7 October 2022, which period expired on 6 July 2023. As that period expired before the appeal procedures were even lodged with the CAS, the CAS Panel has determined it appropriate to issue the operative part of the Arbitral Award as soon as practicable, together with a comprehensive media release. The CAS Panel has also ordered the disqualification of all competitive results achieved by Ms. Halep from 29 August 2022 (the date of her positive sample) to 7 October 2022, including forfeiture of any medals, titles, ranking points and prize money. Therefore, the appeal filed by the ITIA is dismissed and the appeal filed by Simona Halep is partially upheld (her request to backdate the start of the suspension on 29 August 2022 is dismissed). Roxadustat charge According to Articles 2.1 and 2.2 of the Tennis Anti-Doping Programme (“TADP”), it is each player’s personal duty to ensure that no prohibited substance enters their body and players are responsible for any prohibited substances found to be present in their samples. In this matter, a prohibited substance (i.e. Roxadustat) was found to be present in a sample collected from Ms. Halep on 29 August 2022 during the US Open. Ms. Halep did not contest liability in that she accepted that, by reasons of the presence of Roxadustat in her sample, she had committed anti-doping rule violations under Articles 2.1 and 2.2 of the TADP. However, she objected to the intentional nature of the infraction and argued that the positive test was the result of contamination. Having carefully considered all the evidence put before it, the CAS Panel determined that Ms. Halep had established, on the balance of probabilities, that the Roxadustat entered her body through the consumption of a contaminated supplement which she had used in the days shortly before 29 August 2022 and that the Roxadustat, as detected in her sample, came from that contaminated product. As a result, the CAS Panel determined that Ms. Halep had also established, on the balance of probabilities, that her anti-doping rule violations were not intentional. Although the CAS Panel found that Ms. Halep did bear some level of fault or negligence for her violations, as she did not exercise sufficient care when using the Keto MCT supplement, it concluded that she bore no significant fault or negligence. Athlete Biological Passport (ABP) charge With respect to the charge concerning Ms. Halep’s ABP, the ITIA bore the onus of establishing (to the standard of comfortable satisfaction) that Ms. Halep had used a prohibited substance and/or prohibited method. It primarily relied on a blood sample given by Ms. Halep on 22 September 2022, the results of which it alleged demonstrated the anti-doping rule violation under Article 2.2 of the TADP. Contrary to the reasoning of the first instance tribunal, the CAS Panel determined that it was appropriate in the circumstances to consider the results of a private blood sample given by Ms. Halep on 9 September 2022 in the context of a surgery which occurred shortly thereafter. Those results, and Ms. Halep’s public statements that she did not intend to compete for the remainder of the 2022 calendar year, impacted the plausibility of the doping scenarios relied upon by the ITF Independent Tribunal. Having regard to the evidence as a whole, the CAS Panel was not comfortably satisfied that an anti-doping rule violation under Article 2.2. of the TADP had occurred. It therefore dismissed that charge. The CAS Panel has issued the following decision: 1. The appeal filed by Simona Halep on 28 September 2023 against the decision issued on 22 September 2023 by the ITF Independent Tribunal is admissible and is partially upheld. 2. The appeal filed by the International Tennis Integrity Agency (ITIA) on 14 December 2023 against the decision issued on 22 September 2023 by the ITF Independent Tribunal is admissible and is dismissed. 3. The decision issued on 22 September 2023 by the ITF Independent Tribunal is set aside. 4. Simona Halep is found to have committed Anti-Doping Rule Violations under Articles 2.1 (presence) and 2.2 (use) of the Tennis Anti-Doping Programme 2022 as a result of the presence of a Prohibited Substance (Roxadustat) in her urine sample collected In-Competition on 29 August 2022. 5. Simona Halep is sanctioned with a period of Ineligibility of nine (9) months, commencing on 7 October 2022. 6. Credit is given to Simona Halep for her provisional suspension served since 7 October 2022. 7. All results obtained by Simona Halep in competitions taking place in the period 29 August 2022 to 7 October 2022 are disqualified, with all resulting consequences, including forfeiture of any medals, titles, ranking points and prize money. 8. The award is pronounced without costs, except for the Court Office fees of CHF 1,000 (one thousand Swiss francs) paid by each of Simona Halep in respect of her appeal and the International Tennis Integrity Agency (ITIA) in respect of its appeal, which is retained by the CAS. 9. The International Tennis Integrity Agency (ITIA) is ordered to pay Simona Halep an amount of CHF 20,000 (twenty thousand Swiss francs) as a contribution towards her legal fees and other expenses incurred in connection with these arbitration proceedings. The reasoned award will be notified to the parties in due course. It will be published by CAS unless the parties request confidentiality.","The Court of Arbitration for Sport (CAS) has issued the operative part of its decision in the appeal arbitration procedures CAS 2023/A/10025 Simona Halep v. International Tennis Integrity Agency (ITIA) and CAS 2023/A/10227 International Tennis Integrity Agency (ITIA) v. Simona Halep: The appeal procedures before the CAS concerned two separate charges: 1. a charge which arose from a prohibited substance (Roxadustat) being detected in a urine sample collected from Simona Halep on 29 August 2022 during the US Open; and 2. a charge that Ms Halep’s Athlete Biological Passport (ABP), in particular a blood sample given by Ms Halep on 22 September 2022, established use of a prohibited substance and/or prohibited method. In its decision dated 22 September 2023, the International Tennis Federation (ITF) Independent Tribunal found Ms Halep guilty of both Anti-doping Rule Violations (ADRV) and imposed a four-year period of ineligibility on her. In the appeal filed by Simona Halep at the CAS against the first instance Decision, Ms Halep requested that the sanction be reduced and be no longer than the period of the provisional suspension already served. In its separate appeal, the ITIA requested that the CAS sanction Ms Halep’s ADRVs together as one single violation based on the violation that carried the most severe sanction, and the imposition of a period of ineligibility of between four and six years. The CAS appeal arbitration proceedings involved intensive pre-hearing processes and a three-day hearing which took place on 7-9 February 2024 in Lausanne, Switzerland. The CAS Panel heard from many lay and expert witnesses, most of whom were present in person at the hearing. The CAS Panel has unanimously determined that the four-year period of ineligibility imposed by the ITF Independent Tribunal is to be reduced to a period of ineligibility of nine (9) months starting on 7 October 2022, which period expired on 6 July 2023. As that period expired before the appeal procedures were even lodged with the CAS, the CAS Panel has determined it appropriate to issue the operative part of the Arbitral Award as soon as practicable, together with a comprehensive media release. The CAS Panel has also ordered the disqualification of all competitive results achieved by Ms. Halep from 29 August 2022 (the date of her positive sample) to 7 October 2022, including forfeiture of any medals, titles, ranking points and prize money. Therefore, the appeal filed by the ITIA is dismissed and the appeal filed by Simona Halep is partially upheld (her request to backdate the start of the suspension on 29 August 2022 is dismissed). Roxadustat charge According to Articles 2.1 and 2.2 of the Tennis Anti-Doping Programme (“TADP”), it is each player’s personal duty to ensure that no prohibited substance enters their body and players are responsible for any prohibited substances found to be present in their samples. In this matter, a prohibited substance (i.e. Roxadustat) was found to be present in a sample collected from Ms. Halep on 29 August 2022 during the US Open. Ms. Halep did not contest liability in that she accepted that, by reasons of the presence of Roxadustat in her sample, she had committed anti-doping rule violations under Articles 2.1 and 2.2 of the TADP. However, she objected to the intentional nature of the infraction and argued that the positive test was the result of contamination. Having carefully considered all the evidence put before it, the CAS Panel determined that Ms. Halep had established, on the balance of probabilities, that the Roxadustat entered her body through the consumption of a contaminated supplement which she had used in the days shortly before 29 August 2022 and that the Roxadustat, as detected in her sample, came from that contaminated product. As a result, the CAS Panel determined that Ms. Halep had also established, on the balance of probabilities, that her anti-doping rule violations were not intentional. Although the CAS Panel found that Ms. Halep did bear some level of fault or negligence for her violations, as she did not exercise sufficient care when using the Keto MCT supplement, it concluded that she bore no significant fault or negligence. Athlete Biological Passport (ABP) charge With respect to the charge concerning Ms. Halep’s ABP, the ITIA bore the onus of establishing (to the standard of comfortable satisfaction) that Ms. Halep had used a prohibited substance and/or prohibited method. It primarily relied on a blood sample given by Ms. Halep on 22 September 2022, the results of which it alleged demonstrated the anti-doping rule violation under Article 2.2 of the TADP. Contrary to the reasoning of the first instance tribunal, the CAS Panel determined that it was appropriate in the circumstances to consider the results of a private blood sample given by Ms. Halep on 9 September 2022 in the context of a surgery which occurred shortly thereafter. Those results, and Ms. Halep’s public statements that she did not intend to compete for the remainder of the 2022 calendar year, impacted the plausibility of the doping scenarios relied upon by the ITF Independent Tribunal. Having regard to the evidence as a whole, the CAS Panel was not comfortably satisfied that an anti-doping rule violation under Article 2.2. of the TADP had occurred. It therefore dismissed that charge. The CAS Panel has issued the following decision: 1. The appeal filed by Simona Halep on 28 September 2023 against the decision issued on 22 September 2023 by the ITF Independent Tribunal is admissible and is partially upheld. 2. The appeal filed by the International Tennis Integrity Agency (ITIA) on 14 December 2023 against the decision issued on 22 September 2023 by the ITF Independent Tribunal is admissible and is dismissed. 3. The decision issued on 22 September 2023 by the ITF Independent Tribunal is set aside. 4. Simona Halep is found to have committed Anti-Doping Rule Violations under Articles 2.1 (presence) and 2.2 (use) of the Tennis Anti-Doping Programme 2022 as a result of the presence of a Prohibited Substance (Roxadustat) in her urine sample collected In-Competition on 29 August 2022. 5. Simona Halep is sanctioned with a period of Ineligibility of nine (9) months, commencing on 7 October 2022. 6. Credit is given to Simona Halep for her provisional suspension served since 7 October 2022. 7. All results obtained by Simona Halep in competitions taking place in the period 29 August 2022 to 7 October 2022 are disqualified, with all resulting consequences, including forfeiture of any medals, titles, ranking points and prize money. 8. The award is pronounced without costs, except for the Court Office fees of CHF 1,000 (one thousand Swiss francs) paid by each of Simona Halep in respect of her appeal and the International Tennis Integrity Agency (ITIA) in respect of its appeal, which is retained by the CAS. 9. The International Tennis Integrity Agency (ITIA) is ordered to pay Simona Halep an amount of CHF 20,000 (twenty thousand Swiss francs) as a contribution towards her legal fees and other expenses incurred in connection with these arbitration proceedings. The reasoned award will be notified to the parties in due course. It will be published by CAS unless the parties request confidentiality. Please list the dates and their significance. Use only the information provided to answer. Do not use outside sources or internal knowledge. Use bullet point format in chronological order.",Legal,Explanation/Definition,Q&A "Only use information from the document to answer questions. At the end of each response include a list of all other documents referenced in the input document. If any URL's or contact information is included, make sure that information is listed at the end of the response.","User Input: Write two, roughly 200 word paragraphs listing at least four ways PII can be leaked.","4.3 Protecting Data on Telework Client Devices Telework often involves creating and editing work-related information such as email, word processing documents, and spreadsheets. Because that data is important, it should be treated like other important assets of the organization. Two things an organization can do to protect data on telework devices are to secure it on the telework device and to periodically back it up to a location controlled by the organization. More information on this is provided in Sections 4.3.1 through 4.3.3. Organizations can also choose not to allow the organization’s information to be stored on telework devices, but to instead store it centrally at the organization. Sensitive information, such as certain types of personally identifiable information (PII) (e.g., personnel records, medical records, financial records), that is stored on or sent to or from telework devices should be protected so that malicious parties cannot access or alter it. For example, teleworkers often forget that 32 For more information on application whitelisting, see NIST SP 800-167, Guide to Application Whitelisting (http://dx.doi.org/10.6028/NIST.SP.800-167). NIST SP 800-46 REV. 2 GUIDE TO ENTERPRISE TELEWORK, REMOTE ACCESS, AND BYOD SECURITY 26 This publication is available free of charge from: http://dx.doi.org/10.6028/NIST.SP.800-46r2 storing sensitive information on a CD that is carried with their device, or printing the information on a public printer, can also expose the information in ways that are not significant within a typical enterprise environment. An unauthorized release of sensitive information could damage the public’s trust in an organization, jeopardize the organization’s mission, or harm individuals if their personal information has been released. 4.3.1 Encrypting Data at Rest All telework devices, regardless of their size or location, can be stolen. Some thieves may want to read the contents of the data on the device, and quite possibly use that data for criminal purposes. To prevent this, an organization should have a policy of encrypting all sensitive data when it is at rest on the device and on removable media used by the device. The creation and use of cryptographic keys for encrypting remote data at rest should follow the same policies that an organization has for other keys that protect data at rest.33 There are many methods for protecting data at rest, and they mostly depend on the type of device or removable media that is being protected. Most operating systems have their own data encryption mechanisms, and there are also numerous third-party applications that provide similar capabilities. 34 Generally, when technologies such as full disk encryption are being used to protect data at rest on PCs, teleworkers should shut down their telework devices instead of placing them into sleep mode when the devices will not be used for an extended time or when the teleworker will not be with the device. This helps ensure that the data at rest and the decryption key are protected by the storage encryption technology.","Only use information from the document to answer questions. At the end of each response include a list of all other documents referenced in the input document. If any URL's or contact information is included, make sure that information is listed at the end of the response. Input Document: 4.3 Protecting Data on Telework Client Devices Telework often involves creating and editing work-related information such as email, word processing documents, and spreadsheets. Because that data is important, it should be treated like other important assets of the organization. Two things an organization can do to protect data on telework devices are to secure it on the telework device and to periodically back it up to a location controlled by the organization. More information on this is provided in Sections 4.3.1 through 4.3.3. Organizations can also choose not to allow the organization’s information to be stored on telework devices, but to instead store it centrally at the organization. Sensitive information, such as certain types of personally identifiable information (PII) (e.g., personnel records, medical records, financial records), that is stored on or sent to or from telework devices should be protected so that malicious parties cannot access or alter it. For example, teleworkers often forget that 32 For more information on application whitelisting, see NIST SP 800-167, Guide to Application Whitelisting (http://dx.doi.org/10.6028/NIST.SP.800-167). NIST SP 800-46 REV. 2 GUIDE TO ENTERPRISE TELEWORK, REMOTE ACCESS, AND BYOD SECURITY 26 This publication is available free of charge from: http://dx.doi.org/10.6028/NIST.SP.800-46r2 storing sensitive information on a CD that is carried with their device, or printing the information on a public printer, can also expose the information in ways that are not significant within a typical enterprise environment. An unauthorized release of sensitive information could damage the public’s trust in an organization, jeopardize the organization’s mission, or harm individuals if their personal information has been released. 4.3.1 Encrypting Data at Rest All telework devices, regardless of their size or location, can be stolen. Some thieves may want to read the contents of the data on the device, and quite possibly use that data for criminal purposes. To prevent this, an organization should have a policy of encrypting all sensitive data when it is at rest on the device and on removable media used by the device. The creation and use of cryptographic keys for encrypting remote data at rest should follow the same policies that an organization has for other keys that protect data at rest.33 There are many methods for protecting data at rest, and they mostly depend on the type of device or removable media that is being protected. Most operating systems have their own data encryption mechanisms, and there are also numerous third-party applications that provide similar capabilities. 34 Generally, when technologies such as full disk encryption are being used to protect data at rest on PCs, teleworkers should shut down their telework devices instead of placing them into sleep mode when the devices will not be used for an extended time or when the teleworker will not be with the device. This helps ensure that the data at rest and the decryption key are protected by the storage encryption technology. User Input: Write two, roughly 200 word paragraphs listing at least four ways PII can be leaked.",Legal,Find & Summarize,Text Transformation "For this task, you may only consult the information given in the prompt. No outside sources or prior knowledge may be used. The response should be given as a list with bullet points. Each list item should comprise a single sentence of no more than 20 words.",What types of attacks does the text identify that the 6G network may face?,"Minimum Baseline Security Standard (MBSS) and Autonomous Security Assurance The structural heterogeneity and distribution of the 6G network, coupled with the diverse ecosystem in computing nodes and devices, results in a coarse degree of data access management. This may lead to a malicious actor being able to penetrate the security of the edge device and so compromise this aspect of the system. Untrusted computing nodes joining the network may hack user data at the edge of the network and interrupt the operation. Additionally, because of the performance limitations of edge nodes, these devices cannot resist network attacks, such as man-in-the-middle and denial-of-service, which lead to the breakdown of the edge network and instability18 . In the case of 6G, building a secure supply chain is vital, vendor compliance is a must and security assurance [GSMA NESAS-2.0, ISO], OWASP vulnerability19, the integrity of any third-party elements - together with trust and privacy - is also extremely important. Attacks and issues that compromise privacy and security often occur in three main areas of the network: the infrastructure layer security, the network layer security, and the application-level security (which consists of User plane traffic, Control plane traffic and Management plane traffic20). Establishing a reliable level of security policies, procedures, and Minimum Baseline Security Standard (MBSS) for all network functions is extremely important to minimize risks21. There is a need for centralized identity governance for resource management and user access – the lack of which may cause network exploitation of applications and systems, leading to unauthorized access of user data, log files and manipulation of AI/ML models. A prominent example is poisoning and backdoor attacks for manipulating the data used for training an AI model, with countermeasures for prevention and detection including use of data from trusted sources, protecting the supply chain and sanitizing data. Another attack type are adversarial attacks that target the model in operation by using specially crafted inputs to mislead the model. Such attacks can be mitigated by expanding the training process (adversarial training), introducing additional modules for detecting unusual ingests and sanitizing input data. Attacks that compromise the confidentiality and privacy of the training data or the model’s parameters can be addressed with techniques like differential privacy and homomorphic encryption. Additionally, restricting the number and type of queries to the model and tailoring query outputs can help mitigate these risks22 . Other attacks jeopardize the confidentiality and privacy of the data used to train the model or the model’s parameters. They can be dealt with by approaches such as: differential privacy and homomorphic encryption, introducing restrictions on the number and type of queries to the model and tailoring the output to queries. Therefore, a Unified Framework (UF) is necessary to prevent attacks on the AI/ML model, with a centralized assurance procedure used for evaluation and assessment, before moving it to production. Then, on a regular basis, the model should be evaluated to ensure it provides the desired functionality and is sufficiently robust to changes in input data both natural and (potentially) adversarial.","System instruction: For this task, you may only consult the information given in the prompt. No outside sources or prior knowledge may be used. The response should be given as a list with bullet points. Each list item should comprise a single sentence of no more than 20 words. Question: What types of attacks does the text identify that the 6G network may face? Context: Minimum Baseline Security Standard (MBSS) and Autonomous Security Assurance The structural heterogeneity and distribution of the 6G network, coupled with the diverse ecosystem in computing nodes and devices, results in a coarse degree of data access management. This may lead to a malicious actor being able to penetrate the security of the edge device and so compromise this aspect of the system. Untrusted computing nodes joining the network may hack user data at the edge of the network and interrupt the operation. Additionally, because of the performance limitations of edge nodes, these devices cannot resist network attacks, such as man-in-the-middle and denial-of-service, which lead to the breakdown of the edge network and instability18 . In the case of 6G, building a secure supply chain is vital, vendor compliance is a must and security assurance [GSMA NESAS-2.0, ISO], OWASP vulnerability19, the integrity of any third-party elements - together with trust and privacy - is also extremely important. Attacks and issues that compromise privacy and security often occur in three main areas of the network: the infrastructure layer security, the network layer security, and the application-level security (which consists of User plane traffic, Control plane traffic and Management plane traffic20). Establishing a reliable level of security policies, procedures, and Minimum Baseline Security Standard (MBSS) for all network functions is extremely important to minimize risks21. There is a need for centralized identity governance for resource management and user access – the lack of which may cause network exploitation of applications and systems, leading to unauthorized access of user data, log files and manipulation of AI/ML models. A prominent example is poisoning and backdoor attacks for manipulating the data used for training an AI model, with countermeasures for prevention and detection including use of data from trusted sources, protecting the supply chain and sanitizing data. Another attack type are adversarial attacks that target the model in operation by using specially crafted inputs to mislead the model. Such attacks can be mitigated by expanding the training process (adversarial training), introducing additional modules for detecting unusual ingests and sanitizing input data. Attacks that compromise the confidentiality and privacy of the training data or the model’s parameters can be addressed with techniques like differential privacy and homomorphic encryption. Additionally, restricting the number and type of queries to the model and tailoring query outputs can help mitigate these risks22 . Other attacks jeopardize the confidentiality and privacy of the data used to train the model or the model’s parameters. They can be dealt with by approaches such as: differential privacy and homomorphic encryption, introducing restrictions on the number and type of queries to the model and tailoring the output to queries. Therefore, a Unified Framework (UF) is necessary to prevent attacks on the AI/ML model, with a centralized assurance procedure used for evaluation and assessment, before moving it to production. Then, on a regular basis, the model should be evaluated to ensure it provides the desired functionality and is sufficiently robust to changes in input data both natural and (potentially) adversarial.",Internet/Technology,Find & Summarize,Text Transformation "Don't rely on information outside of the provided text. Use paragraphs. If you can't form an answer, just say ""I can't answer that.""",Describe the DoD's defense-specific areas.,"2. Effective Adoption Areas - where there is existing vibrant commercial sector activity Trusted AI and Autonomy Artificial Intelligence (Al) is the software engineering discipline of expanding capabilities of software applications to perform tasks that currently require human intelligence. Machine learning is an engineering subfield of AI that trains software models using example data, simulations, or real-world experiences rather than by direct programming or coding. Autonomy is the engineering discipline that expands robots' abilities to perform tasks while limiting the need for human interaction. AI holds tremendous promise to improve the ability and function of nearly all systems and operations. Trusted AI with trusted autonomous systems are imperative to dominate future conflicts. As AI, machine learning, and autonomous operations continue to mature, the DoD will focus on evidence-based AI-assurance and enabling operational effectiveness. Integrated Network Systems-of-Systems Integrated Network Systems-of-Systems technology encompasses the capability to communicate, provide real-time dissemination of information across the Department, and effective command and control in a contested electromagnetic environment. Integrated Network Systems-of-Systems capability must enable engagements by any sensor and shooter, with the ability to integrate disparate systems. An interoperable network that leverages emerging capabilities across the electromagnetic spectrum such as 5G, software defined networking and radios, and modern information exchange techniques will allow the Department to better integrate many diverse mission systems and provide fully networked command, control, and communication that is capable, resilient, and secure. Microelectronics Microelectronics are circuits and components that serve as the ""brain"" to human-made electronic functional systems. Virtually every military and commercial system relies on microelectronics. Diminishing microelectronics manufacturing in the United States and supply chain concerns have highlighted national economic and security risks. Working closely with industry, academia, and across the Government, the Department is addressing the need for secure microelectronics sources and will leverage state-of-the-art commercial development and production for defense microelectronic solutions. Space Technology Space technologies include space flight, Space communication and other technologies needed to maintain space operations. With rising threats and increasing dependence on space-based systems, the Department's space strategy must shift away from exquisite satellites to a more robust and proliferated architecture. Novel space technologies are necessary to enable resilient cross-domain operations. The space strategy must incorporate technologies that enhance the Department's adaptive and reconfigurable capabilities in space situational awareness, space control, communication path diversity, on-orbit processing, and autonomy. Renewable Energy Generation and Storage Renewable energy generation and storage includes solar wind, bio-based and geothermal technologies, advanced energy storage, electronic engines, and power grid integration. Renewable energy generation and storage promises to decrease warfighter vulnerability and deliver new operational capabilities for the Department. From more efficient batteries to diversifying energy sources and reduced fuel transportation risks, renewable energy generation and storage will add resilience and flexibility in a contested logistics environment. Advanced Computing and Software Advanced computing and software technologies include supercomputing, cloud computing, data storage, computing architectures, and data processing. Software is ubiquitous throughout the Department, but the speed at which software develops outpaces the Department's ability to stay up to date. The Department must rapidly modernize its legacy software systems with resilient, affordable, and assured new software that has been designed, developed, and tested using processes that establish confidence in its performance. The Department must migrate to a Development-Security-Operations (DevSecOps) approach in its software development and evolve to a model of continuous development, continuous test, and continuous delivery. The Department must leverage modular open system architecture approaches to isolate hardware from software and enable rapid upgrades to secure processors. Human-Machine Interfaces Human-Machine Interface refers to technologies related to human-machine teaming and augmented and virtual reality. Rapid advancements in this technology will have a multitude of benefits for our service members. Highly immersive realistic training environments provide real-time feedback to enhance warfighter performance. Intuitive interactive human-machine interfaces enable rapid mission planning and mission command by providing a common operational picture to geographically distributed operations. 3. Defense-Specific Areas Directed Energy Directed Energy Weapons utilize lasers, high power microwaves, and high energy particle beams to produce precision disruption, damage, or destruction of military targets at range. Directed energy systems will allow the Department to counter a wide variety of current and emerging threats with rapid responses and engagement at the speed of light. High-power lasers and high-power microwave technologies both offer new ways to counter diverse sets of threats. Hypersonics Hypersonic systems fly within the atmosphere for significant portions of their flight at or above 5 times the speed of sound, or approximately 3700 miles per hour. Hypersonics dramatically shorten the timeline to strike a target and increase unpredictability. While strategic competitors are pursuing and rapidly fielding advanced hypersonic missiles, the DoD will develop leap-ahead and cost-effective technologies for our air, land, and sea operational forces. Integrated Sensing and Cyber To provide advantage for the joint force in highly contested environments, the Department must develop wideband sensors to operate at the intersection of cyber space, electronic warfare, radar, and communications. Sensors must be able to counter advanced threats and can no longer be stove-piped and single function.","Don't rely on information outside of the provided text. Use paragraphs. If you can't form an answer, just say ""I can't answer that."" Describe the DoD's defense-specific areas. 2. Effective Adoption Areas - where there is existing vibrant commercial sector activity Trusted AI and Autonomy Artificial Intelligence (Al) is the software engineering discipline of expanding capabilities of software applications to perform tasks that currently require human intelligence. Machine learning is an engineering subfield of AI that trains software models using example data, simulations, or real-world experiences rather than by direct programming or coding. Autonomy is the engineering discipline that expands robots' abilities to perform tasks while limiting the need for human interaction. AI holds tremendous promise to improve the ability and function of nearly all systems and operations. Trusted AI with trusted autonomous systems are imperative to dominate future conflicts. As AI, machine learning, and autonomous operations continue to mature, the DoD will focus on evidence-based AI-assurance and enabling operational effectiveness. Integrated Network Systems-of-Systems Integrated Network Systems-of-Systems technology encompasses the capability to communicate, provide real-time dissemination of information across the Department, and effective command and control in a contested electromagnetic environment. Integrated Network Systems-of-Systems capability must enable engagements by any sensor and shooter, with the ability to integrate disparate systems. An interoperable network that leverages emerging capabilities across the electromagnetic spectrum such as 5G, software defined networking and radios, and modern information exchange techniques will allow the Department to better integrate many diverse mission systems and provide fully networked command, control, and communication that is capable, resilient, and secure. Microelectronics Microelectronics are circuits and components that serve as the ""brain"" to human-made electronic functional systems. Virtually every military and commercial system relies on microelectronics. Diminishing microelectronics manufacturing in the United States and supply chain concerns have highlighted national economic and security risks. Working closely with industry, academia, and across the Government, the Department is addressing the need for secure microelectronics sources and will leverage state-of-the-art commercial development and production for defense microelectronic solutions. Space Technology Space technologies include space flight, Space communication and other technologies needed to maintain space operations. With rising threats and increasing dependence on space-based systems, the Department's space strategy must shift away from exquisite satellites to a more robust and proliferated architecture. Novel space technologies are necessary to enable resilient cross-domain operations. The space strategy must incorporate technologies that enhance the Department's adaptive and reconfigurable capabilities in space situational awareness, space control, communication path diversity, on-orbit processing, and autonomy. Renewable Energy Generation and Storage Renewable energy generation and storage includes solar wind, bio-based and geothermal technologies, advanced energy storage, electronic engines, and power grid integration. Renewable energy generation and storage promises to decrease warfighter vulnerability and deliver new operational capabilities for the Department. From more efficient batteries to diversifying energy sources and reduced fuel transportation risks, renewable energy generation and storage will add resilience and flexibility in a contested logistics environment. Advanced Computing and Software Advanced computing and software technologies include supercomputing, cloud computing, data storage, computing architectures, and data processing. Software is ubiquitous throughout the Department, but the speed at which software develops outpaces the Department's ability to stay up to date. The Department must rapidly modernize its legacy software systems with resilient, affordable, and assured new software that has been designed, developed, and tested using processes that establish confidence in its performance. The Department must migrate to a Development-Security-Operations (DevSecOps) approach in its software development and evolve to a model of continuous development, continuous test, and continuous delivery. The Department must leverage modular open system architecture approaches to isolate hardware from software and enable rapid upgrades to secure processors. Human-Machine Interfaces Human-Machine Interface refers to technologies related to human-machine teaming and augmented and virtual reality. Rapid advancements in this technology will have a multitude of benefits for our service members. Highly immersive realistic training environments provide real-time feedback to enhance warfighter performance. Intuitive interactive human-machine interfaces enable rapid mission planning and mission command by providing a common operational picture to geographically distributed operations. 3. Defense-Specific Areas Directed Energy Directed Energy Weapons utilize lasers, high power microwaves, and high energy particle beams to produce precision disruption, damage, or destruction of military targets at range. Directed energy systems will allow the Department to counter a wide variety of current and emerging threats with rapid responses and engagement at the speed of light. High-power lasers and high-power microwave technologies both offer new ways to counter diverse sets of threats. Hypersonics Hypersonic systems fly within the atmosphere for significant portions of their flight at or above 5 times the speed of sound, or approximately 3700 miles per hour. Hypersonics dramatically shorten the timeline to strike a target and increase unpredictability. While strategic competitors are pursuing and rapidly fielding advanced hypersonic missiles, the DoD will develop leap-ahead and cost-effective technologies for our air, land, and sea operational forces. Integrated Sensing and Cyber To provide advantage for the joint force in highly contested environments, the Department must develop wideband sensors to operate at the intersection of cyber space, electronic warfare, radar, and communications. Sensors must be able to counter advanced threats and can no longer be stove-piped and single function.",Internet/Technology,Find & Summarize,Text Transformation "Answer questions using ONLY the provided context. Do NOT use the internet or any internal knowledge. Use markdown seldomly, and only use bold or italic, nothing else.",What are the requirements of OPM?,"As part of the assessment, S. 4043 would require OPM to explain whether each agency met its telework goals and, if not, the actions being taken to identify and eliminate barriers to meeting them. The annual report would also discuss additional steps that are planned by agencies to ensure telework oversight and quality control and increase the utilization rates of office building space owned or leased by the agencies. S. 4043 also requires the Office of Management and Budget (OMB), in consultation with GSA and the Federal Real Property Council, to develop benchmarks and guidance for executive agencies to use when calculating building utilization rates. S. 4043 would then require each executive agency head to establish (1) a system to track office building space utilization rates consistent with that OMB guidance and (2) indicators that measure the effects of telework policy on the management of real and personal property, among other things. S. 4043 would also require OPM to establish data standards to aid telework reporting requirements and for automated telework tracking within payroll systems used by agencies. S. 4043 would require OPM, in turn, to create an online tool that makes the standardized and reported data publicly available and would allow OPM to use the online tool to fulfill its annual reporting requirements. For a more detailed discussion of the bill’s provisions on telework data standards, including office building utilization data, see CRS Insight IN12352, Establishing Data Standards and Measuring Building Use: Select Provisions of the Telework Transparency Act of 2024 (S. 4043).","What are the requirements of OPM? As part of the assessment, S. 4043 would require OPM to explain whether each agency met its telework goals and, if not, the actions being taken to identify and eliminate barriers to meeting them. The annual report would also discuss additional steps that are planned by agencies to ensure telework oversight and quality control and increase the utilization rates of office building space owned or leased by the agencies. S. 4043 also requires the Office of Management and Budget (OMB), in consultation with GSA and the Federal Real Property Council, to develop benchmarks and guidance for executive agencies to use when calculating building utilization rates. S. 4043 would then require each executive agency head to establish (1) a system to track office building space utilization rates consistent with that OMB guidance and (2) indicators that measure the effects of telework policy on the management of real and personal property, among other things. S. 4043 would also require OPM to establish data standards to aid telework reporting requirements and for automated telework tracking within payroll systems used by agencies. S. 4043 would require OPM, in turn, to create an online tool that makes the standardized and reported data publicly available and would allow OPM to use the online tool to fulfill its annual reporting requirements. For a more detailed discussion of the bill’s provisions on telework data standards, including office building utilization data, see CRS Insight IN12352, Establishing Data Standards and Measuring Building Use: Select Provisions of the Telework Transparency Act of 2024 (S. 4043). Answer questions using ONLY the provided context. Do NOT use the internet or any internal knowledge. Use markdown seldomly, and only use bold or italic, nothing else.",Internet/Technology,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]",I have a mid-year presentation coming up in 2 weeks about specific treatments for type 2 diabetes. I need you to compare Insulin Efsitora versus Degludec in Type 2 diabetes without previous insulin treatment.,"Insulin Efsitora versus Degludec in Type 2 Diabetes without Previous Insulin Treatment Authors: Carol Wysham, M.D., Harpreet S. Bajaj, M.D., M.P.H., Stefano Del Prato, M.D. https://orcid.org/0000-0002-5388-0270, Denise Reis Franco, M.D., Arihiro Kiyosue, M.D., Ph.D., Dominik Dahl, M.D., Chunmei Zhou, M.S., Molly C. Carr, M.D., Michael Case, M.S., and Livia Firmino Gonçalves, M.D., for the QWINT-2 Investigators*Author Info & Affiliations Published September 10, 2024 Background Insulin efsitora alfa (efsitora) is a new basal insulin designed for once-weekly administration. Data on safety and efficacy have been limited to small, phase 1 or phase 2 trials. Methods We conducted a 52-week, phase 3, parallel-design, open-label, treat-to-target trial involving adults with type 2 diabetes who had not previously received insulin. Participants were randomly assigned in a 1:1 ratio to receive efsitora or degludec. The primary end point was the change in the glycated hemoglobin level from baseline to week 52; we hypothesized that efsitora would be noninferior to degludec (noninferiority margin, 0.4 percentage points). Secondary and safety end points included the change in the glycated hemoglobin level in subgroups of participants using and not using glucagon-like peptide-1 (GLP-1) receptor agonists, the percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter in weeks 48 through 52, and hypoglycemic episodes. Results A total of 928 participants underwent randomization (466 to the efsitora group and 462 to the degludec group). The mean glycated hemoglobin level decreased from 8.21% at baseline to 6.97% at week 52 with efsitora (least-squares mean change, -1.26 percentage points) and from 8.24% to 7.05% with degludec (least-squares mean change, -1.17 percentage points) (estimated treatment difference, -0.09 percentage points; 95% confidence interval [CI], -0.22 to 0.04), findings that showed noninferiority. Efsitora was noninferior to degludec with respect to the change in the glycated hemoglobin level in participants using and not using GLP-1 receptor agonists. The percentage of time that the glucose level was within the target range was 64.3% with efsitora and 61.2% with degludec (estimated treatment difference, 3.1 percentage points; 95% CI, 0.1 to 6.1). The rate of combined clinically significant or severe hypoglycemia was 0.58 events per participant-year of exposure with efsitora and 0.45 events per participant-year of exposure with degludec (estimated rate ratio, 1.30; 95% CI, 0.94 to 1.78). No severe hypoglycemia was reported with efsitora; six episodes were reported with degludec. The incidence of adverse events was similar in the two groups. Conclusions In adults with type 2 diabetes who had not previously received insulin, once-weekly efsitora was noninferior to once-daily degludec in reducing glycated hemoglobin levels. (Funded by Eli Lilly; QWINT-2 ClinicalTrials.gov number, NCT05362058.) This article was published on September 10, 2024, at NEJM.org. A data sharing statement provided by the authors is available with the full text of this article at NEJM.org. Supported by Eli Lilly. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. We thank all the trial participants, Juliana Bue-Valleskey (Eli Lilly) for clinical trial design and technical consultation, and Alastair Knights (Eli Lilly) for medical writing assistance with an earlier version of the manuscript. Supplementary Material Protocol (nejmoa2403953_protocol.pdf) 4.65 MB Supplementary Appendix (nejmoa2403953_appendix.pdf) 1.32 MB Disclosure Forms (nejmoa2403953_disclosures.pdf) Download 1.15 MB Data Sharing Statement (nejmoa2403953_data-sharing.pdf) Download 72.16 KB"," Only use the provided text to answer the question, no outside sources. I have a mid-year presentation coming up in 2 weeks about specific treatments for type 2 diabetes. I need you to compare Insulin Efsitora versus Degludec in Type 2 diabetes without previous insulin treatment. Insulin Efsitora versus Degludec in Type 2 Diabetes without Previous Insulin Treatment Authors: Carol Wysham, M.D., Harpreet S. Bajaj, M.D., M.P.H., Stefano Del Prato, M.D. https://orcid.org/0000-0002-5388-0270, Denise Reis Franco, M.D., Arihiro Kiyosue, M.D., Ph.D., Dominik Dahl, M.D., Chunmei Zhou, M.S., Molly C. Carr, M.D., Michael Case, M.S., and Livia Firmino Gonçalves, M.D., for the QWINT-2 Investigators*Author Info & Affiliations Published September 10, 2024 Background Insulin efsitora alfa (efsitora) is a new basal insulin designed for once-weekly administration. Data on safety and efficacy have been limited to small, phase 1 or phase 2 trials. Methods We conducted a 52-week, phase 3, parallel-design, open-label, treat-to-target trial involving adults with type 2 diabetes who had not previously received insulin. Participants were randomly assigned in a 1:1 ratio to receive efsitora or degludec. The primary end point was the change in the glycated hemoglobin level from baseline to week 52; we hypothesized that efsitora would be noninferior to degludec (noninferiority margin, 0.4 percentage points). Secondary and safety end points included the change in the glycated hemoglobin level in subgroups of participants using and not using glucagon-like peptide-1 (GLP-1) receptor agonists, the percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter in weeks 48 through 52, and hypoglycemic episodes. Results A total of 928 participants underwent randomization (466 to the efsitora group and 462 to the degludec group). The mean glycated hemoglobin level decreased from 8.21% at baseline to 6.97% at week 52 with efsitora (least-squares mean change, -1.26 percentage points) and from 8.24% to 7.05% with degludec (least-squares mean change, -1.17 percentage points) (estimated treatment difference, -0.09 percentage points; 95% confidence interval [CI], -0.22 to 0.04), findings that showed noninferiority. Efsitora was noninferior to degludec with respect to the change in the glycated hemoglobin level in participants using and not using GLP-1 receptor agonists. The percentage of time that the glucose level was within the target range was 64.3% with efsitora and 61.2% with degludec (estimated treatment difference, 3.1 percentage points; 95% CI, 0.1 to 6.1). The rate of combined clinically significant or severe hypoglycemia was 0.58 events per participant-year of exposure with efsitora and 0.45 events per participant-year of exposure with degludec (estimated rate ratio, 1.30; 95% CI, 0.94 to 1.78). No severe hypoglycemia was reported with efsitora; six episodes were reported with degludec. The incidence of adverse events was similar in the two groups. Conclusions In adults with type 2 diabetes who had not previously received insulin, once-weekly efsitora was noninferior to once-daily degludec in reducing glycated hemoglobin levels. (Funded by Eli Lilly; QWINT-2 ClinicalTrials.gov number, NCT05362058.) This article was published on September 10, 2024, at NEJM.org. A data sharing statement provided by the authors is available with the full text of this article at NEJM.org. Supported by Eli Lilly. Disclosure forms provided by the authors are available with the full text of this article at NEJM.org. We thank all the trial participants, Juliana Bue-Valleskey (Eli Lilly) for clinical trial design and technical consultation, and Alastair Knights (Eli Lilly) for medical writing assistance with an earlier version of the manuscript. Supplementary Material Protocol (nejmoa2403953_protocol.pdf) 4.65 MB Supplementary Appendix (nejmoa2403953_appendix.pdf) 1.32 MB Disclosure Forms (nejmoa2403953_disclosures.pdf) Download 1.15 MB Data Sharing Statement (nejmoa2403953_data-sharing.pdf) Download 72.16 KB https://www.nejm.org/doi/full/10.1056/NEJMoa2403953",Medical,Concept Comparison,Q&A "Using only the information included in the prompt/context block, answer the prompt in one paragraph or less.",How is the self employment tax rate distributed?,"What Is The Self-Employment Tax Rate? The self-employment tax rate is 15.3 percent, with 12.4 percent allocated to the Social Security system and the other 2.9 percent going to Medicare. If you worked as an employee of a company, your employer would pay half, which means only 6.2 percent would be taken out of your wages for Social Security and 1.45 percent for Medicare. But as a self-employed individual, you are considered both the employer and the employee, which makes the entire selfemployment tax burden yours. You do, however, get a tax deduction for one-half of the self-employed taxes paid as an abovethe-line deduction to arrive at adjusted gross income. ","What Is The Self-Employment Tax Rate? The self-employment tax rate is 15.3 percent, with 12.4 percent allocated to the Social Security system and the other 2.9 percent going to Medicare. If you worked as an employee of a company, your employer would pay half, which means only 6.2 percent would be taken out of your wages for Social Security and 1.45 percent for Medicare. But as a self-employed individual, you are considered both the employer and the employee, which makes the entire selfemployment tax burden yours. You do, however, get a tax deduction for one-half of the self-employed taxes paid as an abovethe-line deduction to arrive at adjusted gross income. Using only the information included in the prompt/context block, answer the prompt in one paragraph or less. How is the self employment tax rate distributed?",Financial,Fact Finding,Q&A Draw your answer from the text in this prompt and this prompt alone. Do not use outside information or external resources.,Summarize how athletes can be tested for doping in the Olympic Games Paris 2024.,"The anti-doping rules for the Paris Games apply to “all Athletes entered in or preparing for the Olympic Games Paris 2024 or who have otherwise been made subject to the authority of the IOC in connection with the Olympic Games.” Additionally, a number of rules apply to other individuals, including coaches, trainers, and operations staff for the Games. Athletes seeking to qualify for and participating in the 2024 Olympic Games were subject to testing under IOC’s anti-doping policy beginning in April 2024 and will continue to be so through the close of the Games. IOC’s anti-doping rules are “in accordance” with the World Anti-Doping Code, which includes technical and procedural rules for the administration of anti-doping programs, the prohibited substances list, and standards for testing laboratories, among other things. In addition to testing and related requirements for athletes, other participants are barred from supporting doping, evasion of testing, and manipulation of test results. As signatories to the Code, IOC and IPC are each responsible for ensuring that their events are conducted in compliance with WADA’s anti-doping requirements. A principal component of that obligation is the collection of biological samples from athletes that can be tested for banned substances. While IPC administers its own testing program, IOC has delegated this responsibility to ITA for the 2024 Games. ITA is an independent organization created in 2018 by IOC and WADA to manage testing programs for international sports federations and major events. IOC’s anti-doping rules require athletes to submit to testing based on WADA’s International Standard for Testing and Investigations, which allows the collection of both blood and urine samples to test for prohibited substances. According to the organizers, the anti-doping program for the Paris Games will include over 1,000 workers and an “anti-doping control space” at each venue where ITA and AFLD will collect samples. Following collection, AFLD will test samples. ","System Instruction: Draw your answer from the text in this prompt and this prompt alone. Do not use outside information or external resources. Question: Summarize how athletes can be tested for doping in the Olympic Games Paris 2024. Context: The anti-doping rules for the Paris Games apply to “all Athletes entered in or preparing for the Olympic Games Paris 2024 or who have otherwise been made subject to the authority of the IOC in connection with the Olympic Games.” Additionally, a number of rules apply to other individuals, including coaches, trainers, and operations staff for the Games. Athletes seeking to qualify for and participating in the 2024 Olympic Games were subject to testing under IOC’s anti-doping policy beginning in April 2024 and will continue to be so through the close of the Games. IOC’s anti-doping rules are “in accordance” with the World Anti-Doping Code, which includes technical and procedural rules for the administration of anti-doping programs, the prohibited substances list, and standards for testing laboratories, among other things. In addition to testing and related requirements for athletes, other participants are barred from supporting doping, evasion of testing, and manipulation of test results. As signatories to the Code, IOC and IPC are each responsible for ensuring that their events are conducted in compliance with WADA’s anti-doping requirements. A principal component of that obligation is the collection of biological samples from athletes that can be tested for banned substances. While IPC administers its own testing program, IOC has delegated this responsibility to ITA for the 2024 Games. ITA is an independent organization created in 2018 by IOC and WADA to manage testing programs for international sports federations and major events. IOC’s anti-doping rules require athletes to submit to testing based on WADA’s International Standard for Testing and Investigations, which allows the collection of both blood and urine samples to test for prohibited substances. According to the organizers, the anti-doping program for the Paris Games will include over 1,000 workers and an “anti-doping control space” at each venue where ITA and AFLD will collect samples. Following collection, AFLD will test samples.",Legal,Find & Summarize,Text Transformation "Using only the information provided in the above context block, answer the following question: ","Of the money the National Electric Vehicle Infrastructure Formula Program provides, $1 billion is distributed by which agency? ","U.S. electric vehicle sales doubled between 2020 and 2021 and account for about 4% of all vehicles sold. Infrastructure to charge those vehicles exists along a range, from 120 volt plugs in many home garages to more expensive faster chargers with more than 400 volts. Market surveys have shown that consumers are concerned about the lack of an extensive charging network across the country, as well as the related concerns that some electric vehicles have a limited range before needing to be recharged. The IIJA grant programs were designed to address those concerns along major U.S. highways. In addition, the IIJA directs FHWA to develop standards for charging infrastructure funded by certain federally programs so charging is secure, provides a range of payment options, and meets certain installation requirements. The federal government has in the past provided limited financial support for installation of electric vehicle charging stations, such as through the alternative fuel infrastructure tax credit—modified by the law commonly referred to as the Inflation Reduction Act of 2022 (IRA, P.L. 117-169)—and the Congestion Mitigation Air Quality Improvement program. With just over 50,000 charging stations in October 2022—and more than 130,000 ports for charging—electric vehicle charging capacity is far below one estimate that 2.4 million charging stations that may be necessary in 2030 to sustain an electric vehicle fleet of 26 million vehicles (an estimate from one group of what may be needed to support California and other states’ zero-emission vehicle (ZEV) goals). The two $7.5 billion grant programs established by IIJA are • The National Electric Vehicle Infrastructure (NEVI) Formula Program, which is to provide $5 billion in grants, with $1 billion distributed by FHWA in each of FY2022-FY2026. All states, the District of Columbia, and Puerto Rico are eligible, and funds must be used for charging along the national highway system and primarily along highways already designated as alternative fuel corridors. Under existing FHWA guidelines, new charging stations should be spaced a maximum of 50 miles apart. A new FHWA rule sets additional standards and requirements. In September 2022, all state plans were approved, opening access to FY2022 and FY2023 NEVI funding. • The Charging and Fueling Infrastructure (CFI) grant program, which is to provide $2.5 billion over five years to strategically deploy alternative fuel infrastructure for vehicles powered by electricity and other fuels. Half of the new funding is to be used along FHWA corridors earmarked for those fuels. The other half is to be applied to uses in public building parking lots and in similar publicly accessible locations. CFI grants differ from NEVI in two ways: (a) grants are to be subject to a competitive process, unlike the formula-based NEVI; and (b) priority are to be given to applicants in rural areas, disadvantaged communities, and areas with high rates of multi-unit housing. Using only the information provided in the above context block, answer the following question: Of the money the National Electric Vehicle Infrastructure Formula Program provides, $1 billion is distributed by which agency? ","""U.S. electric vehicle sales doubled between 2020 and 2021 and account for about 4% of all vehicles sold. Infrastructure to charge those vehicles exists along a range, from 120 volt plugs in many home garages to more expensive faster chargers with more than 400 volts. Market surveys have shown that consumers are concerned about the lack of an extensive charging network across the country, as well as the related concerns that some electric vehicles have a limited range before needing to be recharged. The IIJA grant programs were designed to address those concerns along major U.S. highways. In addition, the IIJA directs FHWA to develop standards for charging infrastructure funded by certain federally programs so charging is secure, provides a range of payment options, and meets certain installation requirements. The federal government has in the past provided limited financial support for installation of electric vehicle charging stations, such as through the alternative fuel infrastructure tax credit—modified by the law commonly referred to as the Inflation Reduction Act of 2022 (IRA, P.L. 117-169)—and the Congestion Mitigation Air Quality Improvement program. With just over 50,000 charging stations in October 2022—and more than 130,000 ports for charging—electric vehicle charging capacity is far below one estimate that 2.4 million charging stations that may be necessary in 2030 to sustain an electric vehicle fleet of 26 million vehicles (an estimate from one group of what may be needed to support California and other states’ zero-emission vehicle (ZEV) goals). The two $7.5 billion grant programs established by IIJA are • The National Electric Vehicle Infrastructure (NEVI) Formula Program, which is to provide $5 billion in grants, with $1 billion distributed by FHWA in each of FY2022-FY2026. All states, the District of Columbia, and Puerto Rico are eligible, and funds must be used for charging along the national highway system and primarily along highways already designated as alternative fuel corridors. Under existing FHWA guidelines, new charging stations should be spaced a maximum of 50 miles apart. A new FHWA rule sets additional standards and requirements. In September 2022, all state plans were approved, opening access to FY2022 and FY2023 NEVI funding. • The Charging and Fueling Infrastructure (CFI) grant program, which is to provide $2.5 billion over five years to strategically deploy alternative fuel infrastructure for vehicles powered by electricity and other fuels. Half of the new funding is to be used along FHWA corridors earmarked for those fuels. The other half is to be applied to uses in public building parking lots and in similar publicly accessible locations. CFI grants differ from NEVI in two ways: (a) grants are to be subject to a competitive process, unlike the formula-based NEVI; and (b) priority are to be given to applicants in rural areas, disadvantaged communities, and areas with high rates of multi-unit housing. "" Using only the information provided in the above context block, answer the following question: Of the money the National Electric Vehicle Infrastructure Formula Program provides, $1 billion is distributed by which agency? ",Financial,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","Macular degeneration runs in my family and I'm getting older so I've been thinking more about it. What are the risk factors? Also, what are some of the symptoms I should be looking for? Are there some tests I should ask my eye doctor about at my next eye exam?","Age-related macular degeneration is the most common cause of severe loss of eyesight among people 50 and older. Only the center of vision is affected with this disease. It is important to realize that people rarely go blind from it. AMD affects the central vision, and with it, the ability to see fine details. In AMD, a part of the retina called the macula is damaged. In advanced stages, people lose their ability to drive, to see faces, and to read smaller print. In its early stages, AMD may have no signs or symptoms, so people may not suspect they have it. Types of Age-Related Macular Degeneration and Causes The two primary types of age-related macular degeneration have different causes: Dry. This type is the most common. About 80% of those with AMD have the dry form. Its exact cause is unknown, although both genetic and environmental factors are thought to play a role. This happens as the light-sensitive cells in the macula slowly break down, generally one eye at a time. The loss of vision in this condition is usually slow and gradual. It is believed that the age-related damage of an important support membrane under the retina contributes to dry age-related macular degeneration. Wet. Though this type is less common, it usually leads to more severe vision loss in patients than dry AMD. It is the most common cause of severe loss of vision. Wet AMD happens when abnormal blood vessels start to grow beneath the retina. They leak fluid and blood — hence the name wet AMD — and can create a large blind spot in the center of the visual field. Risk Factors for Age-Related Macular Degeneration There are several risk factors that can contribute to developing age-related macular degeneration, including: Being 50 and older Eating a diet high in saturated fat Smoking High blood pressure or hypertension Age-Related Macular Degeneration Symptoms The following are the most common symptoms of age-related macular degeneration. However, each individual may experience symptoms differently. Symptoms may include: Blurry or fuzzy vision Difficulty recognizing familiar faces Straight lines appear wavy A dark, empty area or blind spot appears in the center of vision Loss of central vision, which is necessary for driving, reading, recognizing faces and performing close-up work The presence of drusen, which are tiny yellow deposits in the retina, is one of the most common early signs of age-related macular degeneration. It may mean the eye is at risk for developing more severe age-related macular degeneration. These will be visible to your doctor during an eye exam. The symptoms of age-related macular degeneration may look like other eye conditions. Speak with an eye care professional for diagnosis. Research ShowsAI Used to Predict Disease Progressioneye Johns Hopkins researchers used an artificial intelligence computer program and other data to predict the likelihood that a person’s disease could progress to the wet form of age-related macular degeneration. Learn more Age-Related Macular Degeneration Diagnosis In addition to a complete medical history and eye exam, your eye doctor may do the following tests to diagnose age-related macular degeneration: Visual acuity test. This common eye chart test measures vision ability at various distances. Pupil dilation. The pupil is widened with eyedrops to allow a close-up examination of the eye’s retina. Fluorescein angiography. Used to detect wet age-related macular degeneration, this diagnostic test involves a special dye injected into a vein in the arm. Pictures are then taken as the dye passes through the blood vessels in the retina, helping the doctor evaluate if the blood vessels are leaking and whether or not the leaking can be treated. Amsler grid. Used to detect wet age-related macular degeneration, this test uses a checkerboardlike grid to determine if the straight lines in the pattern appear wavy or missing to the patient. Both indications may signal the possibility of age-related macular degeneration. Amsler Grid To use the Amsler grid, follow these steps: Wearing any glasses you normally use to read, hold the grid 12 to 15 inches away from your face in good light. Cover one eye. Look directly at the center dot with your uncovered eye and keep your eye focused on it. While looking directly at the center dot, notice in your side vision if all grid lines look straight or if any lines or areas look blurry, wavy, dark or blank. Follow the same steps with the other eye. If you notice any areas of the grid that appear darker, wavy, blank or blurry, contact your ophthalmologist right away. Amsler Grid Age-Related Macular Degeneration Treatment Specific treatment for age-related macular degeneration will be determined by your doctor based on: Your age, overall health and medical history Extent and nature of the disease Your tolerance for specific medications, procedures or low-vision therapies Expectations for the course of the disease Your opinion or preference Currently, there is no treatment for dry age-related macular degeneration, though vision rehabilitation programs and low-vision devices can be used to build visual skills, develop new ways to perform daily living activities and adjust to living with age-related macular degeneration. The main treatment for wet AMD is the injection of medications called anti-VEGF agents. VEGF stands for vascular endothelial growth factor. A high level of VEGF in the eye is linked to the formation of the abnormal blood vessels that cause much of the damage in wet AMD. Anti-VEGF agents are used to combat the disease process and reduce the damaging effects of these leaky abnormal blood vessels. They are also able to effectively stabilize vision in many patients. In some patients, anti-VEGF injections actually improve the level of visual acuity. Anti-VEGF medications are administered by injecting them directly into the affected eye. Although this sounds daunting, the procedure is done with a very fine needle and under the cover of numbing (anesthetic) eyedrops, so patients are usually very comfortable. Anti-VEGF treatment is usually administered regularly over time, requiring multiple injections to maintain the treatment effect, and your retinal physician will discuss the best treatment schedule for you. In selected patients, other treatments, such as laser therapy, can be used, if necessary. Complications of Age-Related Macular Degeneration Age-related macular degeneration can result in severe loss of central vision but rarely causes blindness. It can, however, make it difficult to read, drive or perform other daily activities that require fine central vision. In AMD, the health of the peripheral retina is unaffected, so patients can rest assured that their peripheral (side) vision, and their ability to walk around without bumping into things, is usually preserved.","""================ ======= Age-related macular degeneration is the most common cause of severe loss of eyesight among people 50 and older. Only the center of vision is affected with this disease. It is important to realize that people rarely go blind from it. AMD affects the central vision, and with it, the ability to see fine details. In AMD, a part of the retina called the macula is damaged. In advanced stages, people lose their ability to drive, to see faces, and to read smaller print. In its early stages, AMD may have no signs or symptoms, so people may not suspect they have it. Types of Age-Related Macular Degeneration and Causes The two primary types of age-related macular degeneration have different causes: Dry. This type is the most common. About 80% of those with AMD have the dry form. Its exact cause is unknown, although both genetic and environmental factors are thought to play a role. This happens as the light-sensitive cells in the macula slowly break down, generally one eye at a time. The loss of vision in this condition is usually slow and gradual. It is believed that the age-related damage of an important support membrane under the retina contributes to dry age-related macular degeneration. Wet. Though this type is less common, it usually leads to more severe vision loss in patients than dry AMD. It is the most common cause of severe loss of vision. Wet AMD happens when abnormal blood vessels start to grow beneath the retina. They leak fluid and blood — hence the name wet AMD — and can create a large blind spot in the center of the visual field. Risk Factors for Age-Related Macular Degeneration There are several risk factors that can contribute to developing age-related macular degeneration, including: Being 50 and older Eating a diet high in saturated fat Smoking High blood pressure or hypertension Age-Related Macular Degeneration Symptoms The following are the most common symptoms of age-related macular degeneration. However, each individual may experience symptoms differently. Symptoms may include: Blurry or fuzzy vision Difficulty recognizing familiar faces Straight lines appear wavy A dark, empty area or blind spot appears in the center of vision Loss of central vision, which is necessary for driving, reading, recognizing faces and performing close-up work The presence of drusen, which are tiny yellow deposits in the retina, is one of the most common early signs of age-related macular degeneration. It may mean the eye is at risk for developing more severe age-related macular degeneration. These will be visible to your doctor during an eye exam. The symptoms of age-related macular degeneration may look like other eye conditions. Speak with an eye care professional for diagnosis. Research ShowsAI Used to Predict Disease Progressioneye Johns Hopkins researchers used an artificial intelligence computer program and other data to predict the likelihood that a person’s disease could progress to the wet form of age-related macular degeneration. Learn more Age-Related Macular Degeneration Diagnosis In addition to a complete medical history and eye exam, your eye doctor may do the following tests to diagnose age-related macular degeneration: Visual acuity test. This common eye chart test measures vision ability at various distances. Pupil dilation. The pupil is widened with eyedrops to allow a close-up examination of the eye’s retina. Fluorescein angiography. Used to detect wet age-related macular degeneration, this diagnostic test involves a special dye injected into a vein in the arm. Pictures are then taken as the dye passes through the blood vessels in the retina, helping the doctor evaluate if the blood vessels are leaking and whether or not the leaking can be treated. Amsler grid. Used to detect wet age-related macular degeneration, this test uses a checkerboardlike grid to determine if the straight lines in the pattern appear wavy or missing to the patient. Both indications may signal the possibility of age-related macular degeneration. Amsler Grid To use the Amsler grid, follow these steps: Wearing any glasses you normally use to read, hold the grid 12 to 15 inches away from your face in good light. Cover one eye. Look directly at the center dot with your uncovered eye and keep your eye focused on it. While looking directly at the center dot, notice in your side vision if all grid lines look straight or if any lines or areas look blurry, wavy, dark or blank. Follow the same steps with the other eye. If you notice any areas of the grid that appear darker, wavy, blank or blurry, contact your ophthalmologist right away. Amsler Grid Age-Related Macular Degeneration Treatment Specific treatment for age-related macular degeneration will be determined by your doctor based on: Your age, overall health and medical history Extent and nature of the disease Your tolerance for specific medications, procedures or low-vision therapies Expectations for the course of the disease Your opinion or preference Currently, there is no treatment for dry age-related macular degeneration, though vision rehabilitation programs and low-vision devices can be used to build visual skills, develop new ways to perform daily living activities and adjust to living with age-related macular degeneration. The main treatment for wet AMD is the injection of medications called anti-VEGF agents. VEGF stands for vascular endothelial growth factor. A high level of VEGF in the eye is linked to the formation of the abnormal blood vessels that cause much of the damage in wet AMD. Anti-VEGF agents are used to combat the disease process and reduce the damaging effects of these leaky abnormal blood vessels. They are also able to effectively stabilize vision in many patients. In some patients, anti-VEGF injections actually improve the level of visual acuity. Anti-VEGF medications are administered by injecting them directly into the affected eye. Although this sounds daunting, the procedure is done with a very fine needle and under the cover of numbing (anesthetic) eyedrops, so patients are usually very comfortable. Anti-VEGF treatment is usually administered regularly over time, requiring multiple injections to maintain the treatment effect, and your retinal physician will discuss the best treatment schedule for you. In selected patients, other treatments, such as laser therapy, can be used, if necessary. Complications of Age-Related Macular Degeneration Age-related macular degeneration can result in severe loss of central vision but rarely causes blindness. It can, however, make it difficult to read, drive or perform other daily activities that require fine central vision. In AMD, the health of the peripheral retina is unaffected, so patients can rest assured that their peripheral (side) vision, and their ability to walk around without bumping into things, is usually preserved. https://www.hopkinsmedicine.org/health/conditions-and-diseases/agerelated-macular-degeneration-amd ================ ======= Macular degeneration runs in my family and I'm getting older so I've been thinking more about it. What are the risk factors? Also, what are some of the symptoms I should be looking for? Are there some tests I should ask my eye doctor about at my next eye exam? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","I thought that understanding how computers work was difficult until I learned that there's something actually harder: Quantum computing. Concepts of qubits (quantum dots, superconducting qubits, photons, etc) and the key principles sound more like they belong to physics. What are these concepts? Explain them in less than 500 words.","Four key principles of quantum mechanics Understanding quantum computing requires understanding these four key principles of quantum mechanics: Superposition: Superposition is the state in which a quantum particle or system can represent not just one possibility, but a combination of multiple possibilities. Entanglement: Entanglement is the process in which multiple quantum particles become correlated more strongly than regular probability allows. Decoherence: Decoherence is the process in which quantum particles and systems can decay, collapse or change, converting into single states measurable by classical physics. Interference: Interference is the phenomenon in which entangled quantum states can interact and produce more and less likely probabilities. Qubits While classical computers rely on binary bits (zeros and ones) to store and process data, quantum computers can encode even more data at once using quantum bits, or qubits, in superposition. A qubit can behave like a bit and store either a zero or a one, but it can also be a weighted combination of zero and one at the same time. When combined, qubits in superposition can scale exponentially. Two qubits can store four bits of information, three can store eight, and four can store twelve. However, each qubit can only output a single bit of information at the end of the computation. Quantum algorithms work by storing and manipulating information in a way inaccessible to classical computers, which can provide speedups for certain problems. As silicon chip and superconductor development has scaled over the years, it is distinctly possible that we might soon reach a material limit on the computing power of classical computers. Quantum computing could provide a path forward for certain important problems. With leading institutions such as IBM, Microsoft, Google and Amazon joining eager startups such as Rigetti and Ionq in investing heavily in this exciting new technology, quantum computing is estimated to become a USD 1.3 trillion industry by 2035.1 Secure your enterprise for the quantum era Quantum computers are scaling rapidly. Soon, they will be powerful enough to solve previously unsolvable problems. This opportunity comes with a global challenge: quantum computers will be able to break some of the most widely-used security protocols in the world. Learn more How do quantum computers work? A primary difference between classical and quantum computers is that quantum computers use qubits instead of bits to store exponentially more information. While quantum computing does use binary code, qubits process information differently from classical computers. But what are qubits and where do they come from? What are qubits? Generally, qubits are created by manipulating and measuring quantum particles (the smallest known building blocks of the physical universe), such as photons, electrons, trapped ions and atoms. Qubits can also engineer systems that behave like a quantum particle, as in superconducting circuits. To manipulate such particles, qubits must be kept extremely cold to minimize noise and prevent them from providing inaccurate results or errors resulting from unintended decoherence. There are many different types of qubits used in quantum computing today, with some better suited for different types of tasks. A few of the more common types of qubits in use are as follows: Superconducting qubits: Made from superconducting materials operating at extremely low temperatures, these qubits are favored for their speed in performing computations and fine-tuned control. Trapped ion qubits: Trapped ion particles can also be used as qubits and are noted for long coherence times and high-fidelity measurements. Quantum dots: Quantum dots are small semiconductors that capture a single electron and use it as a qubit, offering promising potential for scalability and compatibility with existing semiconductor technology. Photons: Photons are individual light particles used to send quantum information across long distances through optical fiber cables and are currently being used in quantum communication and quantum cryptography. Neutral atoms: Commonly occurring neutral atoms charged with lasers are well suited for scaling and performing operations. When processing a complex problem, such as factoring large numbers, classical bits become bound up by holding large quantities of information. Quantum bits behave differently. Because qubits can hold a superposition, a quantum computer that uses qubits can approach the problem in ways different from classical computers. As a helpful analogy for understanding how quantum computers use qubits to solve complicated problems, imagine you are standing in the center of a complicated maze. To escape the maze, a traditional computer would have to “brute force” the problem, trying every possible combination of paths to find the exit. This kind of computer would use bits to explore new paths and remember which ones are dead ends. Comparatively, a quantum computer might derive a bird’s-eye view of the maze, testing multiple paths simultaneously and using quantum interference to reveal the correct solution. However, qubits don't test multiple paths at once; instead, quantum computers measure the probability amplitudes of qubits to determine an outcome. These amplitudes function like waves, overlapping and interfering with each other. When asynchronous waves overlap, it effectively eliminates possible solutions to complex problems, and the realized coherent wave or waves present the solution. Key principles of quantum computing When discussing quantum computers, it is important to understand that quantum mechanics is not like traditional physics. The behaviors of quantum particles often appear to be bizarre, counterintuitive or even impossible. Yet the laws of quantum mechanics dictate the order of the natural world. Describing the behaviors of quantum particles presents a unique challenge. Most common-sense paradigms for the natural world lack the vocabulary to communicate the surprising behaviors of quantum particles. To understand quantum computing, it is important to understand a few key terms: Superposition Entanglement Decoherence Interference. Superposition A qubit itself isn't very useful. But it can place the quantum information it holds into a state of superposition, which represents a combination of all possible configurations of the qubit. Groups of qubits in superposition can create complex, multidimensional computational spaces. Complex problems can be represented in new ways in these spaces. This superposition of qubits gives quantum computers their inherent parallelism, allowing them to process many inputs simultaneously. Entanglement Entanglement is the ability of qubits to correlate their state with other qubits. Entangled systems are so intrinsically linked that when quantum processors measure a single entangled qubit, they can immediately determine information about other qubits in the entangled system. When a quantum system is measured, its state collapses from a superposition of possibilities into a binary state, which can be registered like binary code as either a zero or a one. Decoherence Decoherence is the process in which a system in a quantum state collapses into a nonquantum state. It can be intentionally triggered by measuring a quantum system or by other environmental factors (sometimes these factors trigger it unintentionally). Decoherence allows quantum computers to provide measurements and interact with classical computers. Interference An environment of entangled qubits placed into a state of collective superposition structures information in a way that looks like waves, with amplitudes associated with each outcome. These amplitudes become the probabilities of the outcomes of a measurement of the system. These waves can build on each other when many of them peak at a particular outcome, or cancel each other out when peaks and troughs interact. Amplifying a probability or canceling out others are both forms of interference.","[question] I thought that understanding how computers work was difficult until I learned that there's something actually harder: Quantum computing. Concepts of qubits (quantum dots, superconducting qubits, photons, etc) and the key principles sound more like they belong to physics. What are these concepts? Explain them in less than 500 words. ===================== [text] Four key principles of quantum mechanics Understanding quantum computing requires understanding these four key principles of quantum mechanics: Superposition: Superposition is the state in which a quantum particle or system can represent not just one possibility, but a combination of multiple possibilities. Entanglement: Entanglement is the process in which multiple quantum particles become correlated more strongly than regular probability allows. Decoherence: Decoherence is the process in which quantum particles and systems can decay, collapse or change, converting into single states measurable by classical physics. Interference: Interference is the phenomenon in which entangled quantum states can interact and produce more and less likely probabilities. Qubits While classical computers rely on binary bits (zeros and ones) to store and process data, quantum computers can encode even more data at once using quantum bits, or qubits, in superposition. A qubit can behave like a bit and store either a zero or a one, but it can also be a weighted combination of zero and one at the same time. When combined, qubits in superposition can scale exponentially. Two qubits can store four bits of information, three can store eight, and four can store twelve. However, each qubit can only output a single bit of information at the end of the computation. Quantum algorithms work by storing and manipulating information in a way inaccessible to classical computers, which can provide speedups for certain problems. As silicon chip and superconductor development has scaled over the years, it is distinctly possible that we might soon reach a material limit on the computing power of classical computers. Quantum computing could provide a path forward for certain important problems. With leading institutions such as IBM, Microsoft, Google and Amazon joining eager startups such as Rigetti and Ionq in investing heavily in this exciting new technology, quantum computing is estimated to become a USD 1.3 trillion industry by 2035.1 Secure your enterprise for the quantum era Quantum computers are scaling rapidly. Soon, they will be powerful enough to solve previously unsolvable problems. This opportunity comes with a global challenge: quantum computers will be able to break some of the most widely-used security protocols in the world. Learn more How do quantum computers work? A primary difference between classical and quantum computers is that quantum computers use qubits instead of bits to store exponentially more information. While quantum computing does use binary code, qubits process information differently from classical computers. But what are qubits and where do they come from? What are qubits? Generally, qubits are created by manipulating and measuring quantum particles (the smallest known building blocks of the physical universe), such as photons, electrons, trapped ions and atoms. Qubits can also engineer systems that behave like a quantum particle, as in superconducting circuits. To manipulate such particles, qubits must be kept extremely cold to minimize noise and prevent them from providing inaccurate results or errors resulting from unintended decoherence. There are many different types of qubits used in quantum computing today, with some better suited for different types of tasks. A few of the more common types of qubits in use are as follows: Superconducting qubits: Made from superconducting materials operating at extremely low temperatures, these qubits are favored for their speed in performing computations and fine-tuned control. Trapped ion qubits: Trapped ion particles can also be used as qubits and are noted for long coherence times and high-fidelity measurements. Quantum dots: Quantum dots are small semiconductors that capture a single electron and use it as a qubit, offering promising potential for scalability and compatibility with existing semiconductor technology. Photons: Photons are individual light particles used to send quantum information across long distances through optical fiber cables and are currently being used in quantum communication and quantum cryptography. Neutral atoms: Commonly occurring neutral atoms charged with lasers are well suited for scaling and performing operations. When processing a complex problem, such as factoring large numbers, classical bits become bound up by holding large quantities of information. Quantum bits behave differently. Because qubits can hold a superposition, a quantum computer that uses qubits can approach the problem in ways different from classical computers. As a helpful analogy for understanding how quantum computers use qubits to solve complicated problems, imagine you are standing in the center of a complicated maze. To escape the maze, a traditional computer would have to “brute force” the problem, trying every possible combination of paths to find the exit. This kind of computer would use bits to explore new paths and remember which ones are dead ends. Comparatively, a quantum computer might derive a bird’s-eye view of the maze, testing multiple paths simultaneously and using quantum interference to reveal the correct solution. However, qubits don't test multiple paths at once; instead, quantum computers measure the probability amplitudes of qubits to determine an outcome. These amplitudes function like waves, overlapping and interfering with each other. When asynchronous waves overlap, it effectively eliminates possible solutions to complex problems, and the realized coherent wave or waves present the solution. Key principles of quantum computing When discussing quantum computers, it is important to understand that quantum mechanics is not like traditional physics. The behaviors of quantum particles often appear to be bizarre, counterintuitive or even impossible. Yet the laws of quantum mechanics dictate the order of the natural world. Describing the behaviors of quantum particles presents a unique challenge. Most common-sense paradigms for the natural world lack the vocabulary to communicate the surprising behaviors of quantum particles. To understand quantum computing, it is important to understand a few key terms: Superposition Entanglement Decoherence Interference. Superposition A qubit itself isn't very useful. But it can place the quantum information it holds into a state of superposition, which represents a combination of all possible configurations of the qubit. Groups of qubits in superposition can create complex, multidimensional computational spaces. Complex problems can be represented in new ways in these spaces. This superposition of qubits gives quantum computers their inherent parallelism, allowing them to process many inputs simultaneously. Entanglement Entanglement is the ability of qubits to correlate their state with other qubits. Entangled systems are so intrinsically linked that when quantum processors measure a single entangled qubit, they can immediately determine information about other qubits in the entangled system. When a quantum system is measured, its state collapses from a superposition of possibilities into a binary state, which can be registered like binary code as either a zero or a one. Decoherence Decoherence is the process in which a system in a quantum state collapses into a nonquantum state. It can be intentionally triggered by measuring a quantum system or by other environmental factors (sometimes these factors trigger it unintentionally). Decoherence allows quantum computers to provide measurements and interact with classical computers. Interference An environment of entangled qubits placed into a state of collective superposition structures information in a way that looks like waves, with amplitudes associated with each outcome. These amplitudes become the probabilities of the outcomes of a measurement of the system. These waves can build on each other when many of them peak at a particular outcome, or cancel each other out when peaks and troughs interact. Amplifying a probability or canceling out others are both forms of interference. https://www.ibm.com/topics/quantum-computing#:~:text=Schneider%2C%20Ian%20Smalley-,What%20is%20quantum%20computing%3F,the%20most%20powerful%20classical%20computers. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Summarize & Simplify,Text Transformation "You must answer the following questions using only the information found in the provided context block. Do not under any circumstances, use external sources or prior knowledge. Answer in complete sentences but no longer than 250 words. ",What are the differences between Points 6 and 7 on the rights of sick children in health care?,"6. Every child and young person has a right to information, in a form that is understandable to them. Children and young people have a right to information that they can understand about their health and healthcare. This includes information about the choice of health care services available. Special attention and some creativity are often necessary to ensure that children have the freedom to seek, receive and impart information and ideas, not only orally but also through other means of the child’s or young person’s choice, such as play and art. Ensuring that the language and format used are appropriate to the child’s or young person’s abilities and level of understanding is essential, as is ensuring that they have understood the information given and had every opportunity to participate in the conversations about their health and care. This right to information includes the right of tamariki and rangatahi to have access to information in Te Reo Māori and for those from culturally and linguistically diverse backgrounds to have access to information in their own language. It is crucial that health professionals talk directly to children and young people, as well as to their families/whānau, even if the child or young person may seem unable to comprehend. Health professionals and families/whānau should be as open as possible with children and young people about their health and healthcare. Like all patients, children and young people are entitled to know what is going to happen to them before a procedure occurs and to be given honest information about their condition and treatment outcomes, and to be helped to select and practice strategies for coping. Giving children and young people timely and accurate information means that they can retain a sense of control about their healthcare, particularly in hospital. Advance preparation for hospitalisation, healthcare procedures or impending surgery provides children and young people with a sense of mastery over the healthcare environment and helps them to cope more effectively with potentially stressful situations. 7. Every child and young person has a right to participate in decision-making and, as appropriate to their capabilities, to make decisions about their care. Children and young people have a right to be involved in decision-making about their healthcare, to the greatest extent possible in line with their capacities for understanding. The right to be involved in making decisions also includes the right to be involved in decisions about the use, return or disposal of any bodily parts or substances removed, changed or added in the course of health care. Children and young people should be offered healthcare choices wherever possible. Further, they are always entitled to a second opinion. Whenever a child or young person has questions and ideas about their healthcare, these should be heard. If their views cannot be acted on, they are entitled to an explanation. In order for children and young people to participate in decision-making, the health professionals caring for them ought to be available, trained and committed to communicating with children and young people. Effective communication is critical in healthcare, as children, young people and their families/whānau require appropriate information in order to provide informed consent to treatment. A child or young person needs to be able to talk with the staff caring for him or her, to understand who the staff are and what they do, and to question them about his or her condition and treatment. Participation can include both verbal and nonverbal communication by children and young people with health professionals. It should also include opportunities to communicate through play, art and other media of the child’s or young person’s choice. Health professionals need to pay attention to ensure that appropriate responses are made to the nonverbal cues and communication by children and young people who use this as their main form (for example, infants, very young children and those with disabilities). The right to participation extends beyond the right of every individual child and young person to participate in his or her care. It includes encouraging and supporting children and young people as groups to be involved in consultation on the development, implementation and evaluation of the services, policies and strategies that have an impact on them. Informed consent is to be sought from children, young people and their families/whānau before they are involved in teaching or research. Also, those who do agree to participate must have the opportunity to withdraw at any time without having to give a reason, even if they consent initially. The decision not to participate in teaching or research must not alter access to treatment. Ethical oversight by a Human Research Ethics Committee of all research projects conducted in child healthcare services is part of protecting the children and young people involved. ","You must answer the following questions using only the information found in the provided context block. Do not under any circumstances, use external sources or prior knowledge. Answer in complete sentences but no longer than 250 words. You may include Te Reo Māori in your answer. What are the differences between points 6 and 7 on the rights of sick children in health care? 6. Every child and young person has a right to information, in a form that is understandable to them. Children and young people have a right to information that they can understand about their health and healthcare. This includes information about the choice of health care services available. Special attention and some creativity are often necessary to ensure that children have the freedom to seek, receive and impart information and ideas, not only orally but also through other means of the child’s or young person’s choice, such as play and art. Ensuring that the language and format used are appropriate to the child’s or young person’s abilities and level of understanding is essential, as is ensuring that they have understood the information given and had every opportunity to participate in the conversations about their health and care. This right to information includes the right of tamariki and rangatahi to have access to information in Te Reo Māori and for those from culturally and linguistically diverse backgrounds to have access to information in their own language. It is crucial that health professionals talk directly to children and young people, as well as to their families/whānau, even if the child or young person may seem unable to comprehend. Health professionals and families/whānau should be as open as possible with children and young people about their health and healthcare. Like all patients, children and young people are entitled to know what is going to happen to them before a procedure occurs and to be given honest information about their condition and treatment outcomes, and to be helped to select and practice strategies for coping. Giving children and young people timely and accurate information means that they can retain a sense of control about their healthcare, particularly in hospital. Advance preparation for hospitalisation, healthcare procedures or impending surgery provides children and young people with a sense of mastery over the healthcare environment and helps them to cope more effectively with potentially stressful situations. 7. Every child and young person has a right to participate in decision-making and, as appropriate to their capabilities, to make decisions about their care. Children and young people have a right to be involved in decision-making about their healthcare, to the greatest extent possible in line with their capacities for understanding. The right to be involved in making decisions also includes the right to be involved in decisions about the use, return or disposal of any bodily parts or substances removed, changed or added in the course of health care. Children and young people should be offered healthcare choices wherever possible. Further, they are always entitled to a second opinion. Whenever a child or young person has questions and ideas about their healthcare, these should be heard. If their views cannot be acted on, they are entitled to an explanation. In order for children and young people to participate in decision-making, the health professionals caring for them ought to be available, trained and committed to communicating with children and young people. Effective communication is critical in healthcare, as children, young people and their families/whānau require appropriate information in order to provide informed consent to treatment. A child or young person needs to be able to talk with the staff caring for him or her, to understand who the staff are and what they do, and to question them about his or her condition and treatment. Participation can include both verbal and nonverbal communication by children and young people with health professionals. It should also include opportunities to communicate through play, art and other media of the child’s or young person’s choice. Health professionals need to pay attention to ensure that appropriate responses are made to the nonverbal cues and communication by children and young people who use this as their main form (for example, infants, very young children and those with disabilities). The right to participation extends beyond the right of every individual child and young person to participate in his or her care. It includes encouraging and supporting children and young people as groups to be involved in consultation on the development, implementation and evaluation of the services, policies and strategies that have an impact on them. Informed consent is to be sought from children, young people and their families/whānau before they are involved in teaching or research. Also, those who do agree to participate must have the opportunity to withdraw at any time without having to give a reason, even if they consent initially. The decision not to participate in teaching or research must not alter access to treatment. Ethical oversight by a Human Research Ethics Committee of all research projects conducted in child healthcare services is part of protecting the children and young people involved.",Legal,Concept Comparison,Q&A Only use information from the context given to you to answer the question. Do not use any outside sources. Do not be overly formal or robotic in your response.,What names does the company operate under?,"SERVICE AND MAINTENANCE Replacement Parts • Water Filtration - Replacement water filtration disks can be purchased through your local retailer. • Decanters – You can usually purchase a replacement decanter from the store where you purchased your coffeemaker. If you are unable to find a replacement, please call 1-800-667-8623 in Canada for information on where you can find a store that carries replacement decanters. Repairs If your coffeemaker requires service, do not return it to the store where you purchased it. All repairs and replacements must be made by Sunbeam or an authorized Sunbeam Service Center. Please call us at the following toll-free telephone number to find the location of the nearest authorized service center: Canada 1-800-667-8623 You may also visit our website at www.sunbeam.ca for a list of service centers. To assist us in serving you, please have the coffeemaker model number and date of purchase available when you call. The model number is stamped on the bottom metal plate of the coffeemaker. We welcome your questions, comments or suggestions. In all your communications, please include your complete name, address and telephone number and a description of the problem. Visit our website at www.sunbeam.ca and discover the secret to brewing the perfect cup of coffee. You will also find a rich blend of gourmet recipes, entertaining tips and the latest information on SUNBEAM TM products. WARRANTY INFORMATION 1-YEAR LIMITED WARRANTY Sunbeam Products, Inc. doing business as Jarden Consumer Solutions or if in Canada, Sunbeam Corporation (Canada) Limited doing business as Jarden Consumer Solutions (collectively “JCS”) warrants that for a period of one year from the date of purchase, this product will be free from defects in material and workmanship. JCS, at its option, will repair or replace this product or any component of the product found to be defective during the warranty period. Replacement will be made with a new or remanufactured product or component. If the product is no longer available, replacement may be made with a similar product of equal or greater value. This is your exclusive warranty. Do NOT attempt to repair or adjust any electrical or mechanical functions on this product. Doing so will void this warranty. This warranty is valid for the original retail purchaser from the date of initial retail purchase and is not transferable. Keep the original sales receipt. Proof of purchase is required to obtain warranty performance. JCS dealers, service centers, or retail stores selling JCS products do not have the right to alter, modify or any way change the terms and conditions of this warranty. This warranty does not cover normal wear of parts or damage resulting from any of the following: negligent use or misuse of the product, use on improper voltage or current, use contrary to the operating instructions, disassembly, repair or alteration by anyone other than JCS or an authorized JCS service center. Further, the warranty does not cover: Acts of God, such as fire, flood, hurricanes and tornadoes. What are the limits on JCS’s Liability? JCS shall not be liable for any incidental or consequential damages caused by the breach of any express, implied or statutory warranty or condition. Except to the extent prohibited by applicable law, any implied warranty or condition of merchantability or fitness for a particular purpose is limited in duration to the duration of the above warranty. JCS disclaims all other warranties, conditions or representations, express, implied, statutory or otherwise. JCS shall not be liable for any damages of any kind resulting from the purchase, use or misuse of, or inability to use the product including incidental, special, consequential or similar damages or loss of profits, or for any breach of contract, fundamental or otherwise, or for any claim brought against purchaser by any other party. Some provinces, states or jurisdictions do not allow the exclusion or limitation of incidental or consequential damages or limitations on how long an implied warranty lasts, so the above limitations or exclusion may not apply to you. This warranty gives you specific legal rights, and you may also have other rights that vary from province to province, state to state or jurisdiction to jurisdiction. How to Obtain Warranty Service In the U.S.A. If you have any question regarding this warranty or would like to obtain warranty service, please call 1-800-458-8407 and a convenient service center address will be provided to you. In Canada If you have any question regarding this warranty or would like to obtain warranty service, please call 1-800-667-8623 and a convenient service center address will be provided to you. In the U.S.A., this warranty is offered by Sunbeam Products, Inc. doing business as Jarden Consumer Solutions located in Boca Raton, Florida 33431. In Canada, this warranty is offered by Sunbeam Corporation (Canada) Limited doing business as Jarden Consumer Solutions, located at 20 B Hereford Street, Brampton, Ontario L6Y 0M1. If you have any other problem or claim in connection with this product, please write our Consumer Service Department. PLEASE DO NOT RETURN THIS PRODUCT TO ANY OF THESE ADDRESSES OR TO THE PLACE OF PURCHASE.","SERVICE AND MAINTENANCE Replacement Parts • Water Filtration - Replacement water filtration disks can be purchased through your local retailer. • Decanters – You can usually purchase a replacement decanter from the store where you purchased your coffeemaker. If you are unable to find a replacement, please call 1-800-667-8623 in Canada for information on where you can find a store that carries replacement decanters. Repairs If your coffeemaker requires service, do not return it to the store where you purchased it. All repairs and replacements must be made by Sunbeam or an authorized Sunbeam Service Center. Please call us at the following toll-free telephone number to find the location of the nearest authorized service center: Canada 1-800-667-8623 You may also visit our website at www.sunbeam.ca for a list of service centers. To assist us in serving you, please have the coffeemaker model number and date of purchase available when you call. The model number is stamped on the bottom metal plate of the coffeemaker. We welcome your questions, comments or suggestions. In all your communications, please include your complete name, address and telephone number and a description of the problem. Visit our website at www.sunbeam.ca and discover the secret to brewing the perfect cup of coffee. You will also find a rich blend of gourmet recipes, entertaining tips and the latest information on SUNBEAM TM products. WARRANTY INFORMATION 1-YEAR LIMITED WARRANTY Sunbeam Products, Inc. doing business as Jarden Consumer Solutions or if in Canada, Sunbeam Corporation (Canada) Limited doing business as Jarden Consumer Solutions (collectively “JCS”) warrants that for a period of one year from the date of purchase, this product will be free from defects in material and workmanship. JCS, at its option, will repair or replace this product or any component of the product found to be defective during the warranty period. Replacement will be made with a new or remanufactured product or component. If the product is no longer available, replacement may be made with a similar product of equal or greater value. This is your exclusive warranty. Do NOT attempt to repair or adjust any electrical or mechanical functions on this product. Doing so will void this warranty. This warranty is valid for the original retail purchaser from the date of initial retail purchase and is not transferable. Keep the original sales receipt. Proof of purchase is required to obtain warranty performance. JCS dealers, service centers, or retail stores selling JCS products do not have the right to alter, modify or any way change the terms and conditions of this warranty. This warranty does not cover normal wear of parts or damage resulting from any of the following: negligent use or misuse of the product, use on improper voltage or current, use contrary to the operating instructions, disassembly, repair or alteration by anyone other than JCS or an authorized JCS service center. Further, the warranty does not cover: Acts of God, such as fire, flood, hurricanes and tornadoes. What are the limits on JCS’s Liability? JCS shall not be liable for any incidental or consequential damages caused by the breach of any express, implied or statutory warranty or condition. Except to the extent prohibited by applicable law, any implied warranty or condition of merchantability or fitness for a particular purpose is limited in duration to the duration of the above warranty. JCS disclaims all other warranties, conditions or representations, express, implied, statutory or otherwise. JCS shall not be liable for any damages of any kind resulting from the purchase, use or misuse of, or inability to use the product including incidental, special, consequential or similar damages or loss of profits, or for any breach of contract, fundamental or otherwise, or for any claim brought against purchaser by any other party. Some provinces, states or jurisdictions do not allow the exclusion or limitation of incidental or consequential damages or limitations on how long an implied warranty lasts, so the above limitations or exclusion may not apply to you. This warranty gives you specific legal rights, and you may also have other rights that vary from province to province, state to state or jurisdiction to jurisdiction. How to Obtain Warranty Service In the U.S.A. If you have any question regarding this warranty or would like to obtain warranty service, please call 1-800-458-8407 and a convenient service center address will be provided to you. In Canada If you have any question regarding this warranty or would like to obtain warranty service, please call 1-800-667-8623 and a convenient service center address will be provided to you. In the U.S.A., this warranty is offered by Sunbeam Products, Inc. doing business as Jarden Consumer Solutions located in Boca Raton, Florida 33431. In Canada, this warranty is offered by Sunbeam Corporation (Canada) Limited doing business as Jarden Consumer Solutions, located at 20 B Hereford Street, Brampton, Ontario L6Y 0M1. If you have any other problem or claim in connection with this product, please write our Consumer Service Department. PLEASE DO NOT RETURN THIS PRODUCT TO ANY OF THESE ADDRESSES OR TO THE PLACE OF PURCHASE. Only use information from the context given to you to answer the question. Do not use any outside sources. Do not be overly formal or robotic in your response. What names does the company operate under?",Retail/Product,Fact Finding,Q&A Only refer to the document for your answer. Do not use outside sources.,Based on the article when might copyrighted works to train AI programs be considered a fair use?,"Congressional Research Service **Generative Artificial Intelligence and Copyright Law** September 29, 2023 Copyright in Works Created with Generative AI A recent lawsuit challenged the human-authorship requirement in the context of works purportedly “authored” by AI. In June 2022, Stephen Thaler sued the Copyright Office for denying his application to register a visual artwork that he claims was authored “autonomously” by an AI program called the Creativity Machine. Dr. Thaler argued that human authorship is not required by the Copyright Act. On August 18, 2023, a federal district court granted summary judgment in favor of the Copyright Office. The court held that “human authorship is an essential part of a valid copyright claim,” reasoning that only human authors need copyright as an incentive to create works. Dr. Thaler has stated that he plans to appeal the decision. Assuming a copyrightable work requires a human author, works created by humans using generative AI could still be entitled to copyright protection, depending on the nature of human involvement in the creative process. However, a recent copyright proceeding and subsequent Copyright Registration Guidance indicate that the Copyright Office is unlikely to find the requisite human authorship where an AI program generates works in response to text prompts. In September 2022, Kris Kashtanova registered a copyright for a graphic novel illustrated with images that Midjourney generated in response to text inputs. In October 2022, the Copyright Office initiated cancellation proceedings, noting that Kashtanova had not disclosed the use of AI. Kashtanova responded by arguing that the images were made via “a creative, iterative process.” On February 21, 2023, the Copyright Office determined that the images were not copyrightable, deciding that Midjourney, rather than Kashtanova, authored the “visual material.” In March 2023, the Copyright Office released guidance stating that, when AI “determines the expressive elements of its output, the generated material is not the product of human authorship.” Some commentators assert that some AI-generated works should receive copyright protection, arguing that AI programs are like other tools that human beings have used to create copyrighted works. For example, the Supreme Court has held since the 1884 case Burrow-Giles Lithographic Co. v. Sarony that photographs can be entitled to copyright protection where the photographer makes decisions regarding creative elements such as composition, arrangement, and lighting. Generative AI programs might be seen as a new tool analogous to the camera, as Kashtanova argued. Other commentators and the Copyright Office dispute the photography analogy and question whether AI users exercise sufficient creative control for AI to be considered merely a tool. In Kashtanova’s case, the Copyright Office reasoned that Midjourney was not “a tool that [] Kashtanova controlled and guided to reach [their] desired image” because it “generates images in an unpredictable way.” The Copyright Office instead compared the AI user to “a client who hires an artist” and gives that artist only “general directions.” The office’s March 2023 guidance similarly claims that “users do not exercise ultimate creative control over how [generative AI] systems interpret prompts and generate materials.” One of Kashtanova’s lawyers, on the other hand, argues that the Copyright Act does not require such exacting creative control, noting that certain photographs and modern art incorporate a degree of happenstance. Some commentators argue that the Copyright Act’s distinction between copyrightable “works” and noncopyrightable “ideas” supplies another reason that copyright should not protect AI-generated works. One law professor has suggested that the human user who enters a text prompt into an AI program—for instance, asking DALL-E “to produce a painting of hedgehogs having a tea party on the beach”—has “contributed nothing more than an idea” to the finished work. According to this argument, the output image lacks a human author and cannot be copyrighted. While the Copyright Office’s actions indicate that it may be challenging to obtain copyright protection for AI-generated works, the issue remains unsettled. Applicants may file suit in U.S. district court to challenge the Copyright Office’s final decisions to refuse to register a copyright (as Dr. Thaler did), and it remains to be seen whether federal courts will agree with all of the office’s decisions. While the Copyright Office notes that courts sometimes give weight to the office’s experience and expertise in this field, courts will not necessarily adopt the office’s interpretations of the Copyright Act. In addition, the Copyright Office’s guidance accepts that works “containing” AI-generated material may be copyrighted under some circumstances, such as “sufficiently creative” human arrangements or modifications of AI-generated material or works that combine AI-generated and human-authored material. The office states that the author may only claim copyright protection “for their own contributions” to such works, and they must identify and disclaim AI-generated parts of the work if they apply to register their copyright. In September 2023, for instance, the Copyright Office Review Board affirmed the office’s refusal to register a copyright for an artwork that was generated by Midjourney and then modified in various ways by the applicant, since the applicant did not disclaim the AI-generated material. Who Owns the Copyright to Generative AI Outputs? Assuming some AI-created works may be eligible for copyright protection, who owns that copyright? In general, the Copyright Act vests ownership “initially in the author or authors of the work.” Given the lack of judicial or Copyright Office decisions recognizing copyright in AI-created works to date, however, no clear rule has emerged identifying who the “author or authors” of these works could be. Returning to the photography analogy, the AI’s creator might be compared to the camera maker, while the AI user who prompts the creation of a specific work might be compared to the photographer who uses that camera to capture a specific image. On this view, the user would be considered the author and, therefore, the initial copyright owner. The creative choices involved in coding and training the AI, on the other hand, might give an AI’s creator a stronger claim to some form of authorship than the manufacturer of a camera. Does the AI Training Process Infringe Copyright in Other Works? AI are “trained” to create literary, visual, and other artistic works by exposing the program to large amounts of data, which may include text, images, and other works downloaded from the internet. This training process involves making digital copies of existing works. As the U.S. Patent and Trademark Office has described, this process “will almost by definition involve the reproduction of entire works or substantial portions thereof.” OpenAI, for example, acknowledges that its programs are trained on “large, publicly available datasets that include copyrighted works” and that this process “involves first making copies of the data to be analyzed” (although it now offers an option to remove images from training future image generation models). Creating such copies without permission may infringe the copyright holders’ exclusive right to make reproductions of their work. AI companies may argue that their training processes constitute fair use and are therefore noninfringing. Whether or not copying constitutes fair use depends on four statutory factors under 17 U.S.C. § 107: 1. the purpose and character of the use, including whether such use is of a commercial nature or is for nonprofit educational purposes; 2. the nature of the copyrighted work; 3. the amount and substantiality of the portion used in relation to the copyrighted work as a whole; and 4. the effect of the use upon the potential market for or value of the copyrighted work. Some stakeholders argue that the use of copyrighted works to train AI programs should be considered a fair use under these factors. Regarding the first factor, OpenAI argues its purpose is “transformative” as opposed to “expressive” because the training process creates “a useful generative AI system.” OpenAI also contends that the third factor supports fair use because the copies are not made available to the public but are used only to train the program. For support, OpenAI cites The Authors Guild, Inc. v. Google, Inc., in which the U.S. Court of Appeals for the Second Circuit held that Google’s copying of entire books to create a searchable database that displayed excerpts of those books constituted fair use. Regarding the fourth fair use factor, some generative AI applications have raised concern that training AI programs on copyrighted works allows them to generate similar works that compete with the originals. For example, an AI-generated song called “Heart on My Sleeve,” made to sound like the artists Drake and The Weeknd, was heard millions of times on streaming services. Universal Music Group, which has deals with both artists, argues that AI companies violate copyright by using these artists’ songs in training data. OpenAI states that its visual art program DALL-E 3 “is designed to decline requests that ask for an image in the style of a living artist.” Plaintiffs have filed multiple lawsuits claiming the training process for AI programs infringed their copyrights in written and visual works. These include lawsuits by the Authors Guild and authors Paul Tremblay, Michael Chabon, Sarah Silverman, and others against OpenAI; separate lawsuits by Michael Chabon, Sarah Silverman, and others against Meta Platforms; proposed class action lawsuits against Alphabet Inc. and Stability AI and Midjourney; and a lawsuit by Getty Images against Stability AI. The Getty Images lawsuit, for instance, alleges that “Stability AI has copied at least 12 million copyrighted images from Getty Images’ websites . . . in order to train its Stable Diffusion model.” This lawsuit appears to dispute any characterization of fair use, arguing that Stable Diffusion is a commercial product, weighing against fair use under the first statutory factor, and that the program undermines the market for the original works, weighing against fair use under the fourth factor. In September 2023, a U.S. district court ruled that a jury trial would be needed to determine whether it was fair use for an AI company to copy case summaries from Westlaw, a legal research platform, to train an AI program to quote pertinent passages from legal opinions in response to questions from a user. The court found that, while the defendant’s use was “undoubtedly commercial,” a jury would need to resolve factual disputes concerning whether the use was “transformative” (factor 1), to what extent the nature of the plaintiff’s work favored fair use (factor 2), whether the defendant copied more than needed to train the AI program (factor 3), and whether the AI program would constitute a “market substitute” for Westlaw (factor 4). While the AI program at issue might not be considered “generative” AI, the same kinds of facts might be relevant to a court’s fair-use analysis of making copies to train generative AI models. "," ======= Congressional Research Service **Generative Artificial Intelligence and Copyright Law** September 29, 2023 Copyright in Works Created with Generative AI A recent lawsuit challenged the human-authorship requirement in the context of works purportedly “authored” by AI. In June 2022, Stephen Thaler sued the Copyright Office for denying his application to register a visual artwork that he claims was authored “autonomously” by an AI program called the Creativity Machine. Dr. Thaler argued that human authorship is not required by the Copyright Act. On August 18, 2023, a federal district court granted summary judgment in favor of the Copyright Office. The court held that “human authorship is an essential part of a valid copyright claim,” reasoning that only human authors need copyright as an incentive to create works. Dr. Thaler has stated that he plans to appeal the decision. Assuming a copyrightable work requires a human author, works created by humans using generative AI could still be entitled to copyright protection, depending on the nature of human involvement in the creative process. However, a recent copyright proceeding and subsequent Copyright Registration Guidance indicate that the Copyright Office is unlikely to find the requisite human authorship where an AI program generates works in response to text prompts. In September 2022, Kris Kashtanova registered a copyright for a graphic novel illustrated with images that Midjourney generated in response to text inputs. In October 2022, the Copyright Office initiated cancellation proceedings, noting that Kashtanova had not disclosed the use of AI. Kashtanova responded by arguing that the images were made via “a creative, iterative process.” On February 21, 2023, the Copyright Office determined that the images were not copyrightable, deciding that Midjourney, rather than Kashtanova, authored the “visual material.” In March 2023, the Copyright Office released guidance stating that, when AI “determines the expressive elements of its output, the generated material is not the product of human authorship.” Some commentators assert that some AI-generated works should receive copyright protection, arguing that AI programs are like other tools that human beings have used to create copyrighted works. For example, the Supreme Court has held since the 1884 case Burrow-Giles Lithographic Co. v. Sarony that photographs can be entitled to copyright protection where the photographer makes decisions regarding creative elements such as composition, arrangement, and lighting. Generative AI programs might be seen as a new tool analogous to the camera, as Kashtanova argued. Other commentators and the Copyright Office dispute the photography analogy and question whether AI users exercise sufficient creative control for AI to be considered merely a tool. In Kashtanova’s case, the Copyright Office reasoned that Midjourney was not “a tool that [] Kashtanova controlled and guided to reach [their] desired image” because it “generates images in an unpredictable way.” The Copyright Office instead compared the AI user to “a client who hires an artist” and gives that artist only “general directions.” The office’s March 2023 guidance similarly claims that “users do not exercise ultimate creative control over how [generative AI] systems interpret prompts and generate materials.” One of Kashtanova’s lawyers, on the other hand, argues that the Copyright Act does not require such exacting creative control, noting that certain photographs and modern art incorporate a degree of happenstance. Some commentators argue that the Copyright Act’s distinction between copyrightable “works” and noncopyrightable “ideas” supplies another reason that copyright should not protect AI-generated works. One law professor has suggested that the human user who enters a text prompt into an AI program—for instance, asking DALL-E “to produce a painting of hedgehogs having a tea party on the beach”—has “contributed nothing more than an idea” to the finished work. According to this argument, the output image lacks a human author and cannot be copyrighted. While the Copyright Office’s actions indicate that it may be challenging to obtain copyright protection for AI-generated works, the issue remains unsettled. Applicants may file suit in U.S. district court to challenge the Copyright Office’s final decisions to refuse to register a copyright (as Dr. Thaler did), and it remains to be seen whether federal courts will agree with all of the office’s decisions. While the Copyright Office notes that courts sometimes give weight to the office’s experience and expertise in this field, courts will not necessarily adopt the office’s interpretations of the Copyright Act. In addition, the Copyright Office’s guidance accepts that works “containing” AI-generated material may be copyrighted under some circumstances, such as “sufficiently creative” human arrangements or modifications of AI-generated material or works that combine AI-generated and human-authored material. The office states that the author may only claim copyright protection “for their own contributions” to such works, and they must identify and disclaim AI-generated parts of the work if they apply to register their copyright. In September 2023, for instance, the Copyright Office Review Board affirmed the office’s refusal to register a copyright for an artwork that was generated by Midjourney and then modified in various ways by the applicant, since the applicant did not disclaim the AI-generated material. Who Owns the Copyright to Generative AI Outputs? Assuming some AI-created works may be eligible for copyright protection, who owns that copyright? In general, the Copyright Act vests ownership “initially in the author or authors of the work.” Given the lack of judicial or Copyright Office decisions recognizing copyright in AI-created works to date, however, no clear rule has emerged identifying who the “author or authors” of these works could be. Returning to the photography analogy, the AI’s creator might be compared to the camera maker, while the AI user who prompts the creation of a specific work might be compared to the photographer who uses that camera to capture a specific image. On this view, the user would be considered the author and, therefore, the initial copyright owner. The creative choices involved in coding and training the AI, on the other hand, might give an AI’s creator a stronger claim to some form of authorship than the manufacturer of a camera. Does the AI Training Process Infringe Copyright in Other Works? AI are “trained” to create literary, visual, and other artistic works by exposing the program to large amounts of data, which may include text, images, and other works downloaded from the internet. This training process involves making digital copies of existing works. As the U.S. Patent and Trademark Office has described, this process “will almost by definition involve the reproduction of entire works or substantial portions thereof.” OpenAI, for example, acknowledges that its programs are trained on “large, publicly available datasets that include copyrighted works” and that this process “involves first making copies of the data to be analyzed” (although it now offers an option to remove images from training future image generation models). Creating such copies without permission may infringe the copyright holders’ exclusive right to make reproductions of their work. AI companies may argue that their training processes constitute fair use and are therefore noninfringing. Whether or not copying constitutes fair use depends on four statutory factors under 17 U.S.C. § 107: 1. the purpose and character of the use, including whether such use is of a commercial nature or is for nonprofit educational purposes; 2. the nature of the copyrighted work; 3. the amount and substantiality of the portion used in relation to the copyrighted work as a whole; and 4. the effect of the use upon the potential market for or value of the copyrighted work. Some stakeholders argue that the use of copyrighted works to train AI programs should be considered a fair use under these factors. Regarding the first factor, OpenAI argues its purpose is “transformative” as opposed to “expressive” because the training process creates “a useful generative AI system.” OpenAI also contends that the third factor supports fair use because the copies are not made available to the public but are used only to train the program. For support, OpenAI cites The Authors Guild, Inc. v. Google, Inc., in which the U.S. Court of Appeals for the Second Circuit held that Google’s copying of entire books to create a searchable database that displayed excerpts of those books constituted fair use. Regarding the fourth fair use factor, some generative AI applications have raised concern that training AI programs on copyrighted works allows them to generate similar works that compete with the originals. For example, an AI-generated song called “Heart on My Sleeve,” made to sound like the artists Drake and The Weeknd, was heard millions of times on streaming services. Universal Music Group, which has deals with both artists, argues that AI companies violate copyright by using these artists’ songs in training data. OpenAI states that its visual art program DALL-E 3 “is designed to decline requests that ask for an image in the style of a living artist.” Plaintiffs have filed multiple lawsuits claiming the training process for AI programs infringed their copyrights in written and visual works. These include lawsuits by the Authors Guild and authors Paul Tremblay, Michael Chabon, Sarah Silverman, and others against OpenAI; separate lawsuits by Michael Chabon, Sarah Silverman, and others against Meta Platforms; proposed class action lawsuits against Alphabet Inc. and Stability AI and Midjourney; and a lawsuit by Getty Images against Stability AI. The Getty Images lawsuit, for instance, alleges that “Stability AI has copied at least 12 million copyrighted images from Getty Images’ websites . . . in order to train its Stable Diffusion model.” This lawsuit appears to dispute any characterization of fair use, arguing that Stable Diffusion is a commercial product, weighing against fair use under the first statutory factor, and that the program undermines the market for the original works, weighing against fair use under the fourth factor. In September 2023, a U.S. district court ruled that a jury trial would be needed to determine whether it was fair use for an AI company to copy case summaries from Westlaw, a legal research platform, to train an AI program to quote pertinent passages from legal opinions in response to questions from a user. The court found that, while the defendant’s use was “undoubtedly commercial,” a jury would need to resolve factual disputes concerning whether the use was “transformative” (factor 1), to what extent the nature of the plaintiff’s work favored fair use (factor 2), whether the defendant copied more than needed to train the AI program (factor 3), and whether the AI program would constitute a “market substitute” for Westlaw (factor 4). While the AI program at issue might not be considered “generative” AI, the same kinds of facts might be relevant to a court’s fair-use analysis of making copies to train generative AI models. ======= Only refer to the document for your answer. Do not use outside sources. ======= Based on the article when might copyrighted works to train AI programs be considered a fair use?",Legal,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","I'm researching intermittent fasting as a weight loss program as a whole for my nutritional class. To help me prepare for the paper I want you summarize the study findings in the paragraph, but don't mention the limitations. Then provide a list of benefits for intermittent fasting and any potential negatives based on intermittent fasting or the study.","Intermittent fastingTrusted Source involves only eating during specific time intervals. There are many ways to do intermittent fasting; it can mean not eating on certain days or only eating food at certain times of the day. Some people seek to use IF to lose weight or maintain a healthy weight. Some evidenceTrusted Source suggests that intermittent fasting can help people lose body fat and may help reduce the risk of type 2 diabetes and cardiovascular disease. However, researchers are still working to understand the potential dangers of intermittent fasting and how to weigh these risks against the potential benefits. Overall, this is an area where there is a need for more data. Beata Rydyger, a registered nutritionist based in Los Angeles, CA, and clinical nutritional advisor to Zen Nutrients, who was not involved in the study, pointed out a challenge with studying dietary behaviors to Medical News Today: “Generally speaking, diets are more difficult to study because dietary changes don’t have an immediate effect on health. Most study participants find it hard to track what they eat, and few can adhere to a diet for long enough for beneficial effects to be measured.” Reducing calories for weight loss T​his study included 547 participants recruited from three different health systems. Researchers collected information on participants through electronic health records and the use of a specialized mobile app called Daily24. Participants could record when they ate, meal size, the times they went to sleep, and when they woke up. For each meal recorded, participants estimated meal size as less than 500 calories (small), 500-1,000 calories (medium), or greater than 1,000 calories (large). Study author Dr. Wendy Bennett, elaborated on their research methods to MNT: “We designed an app to collect ‘timing of eating,’ and when participants input the timing, we also asked them the size of the meal (small, med, or large). Participants from 3 health systems used the app for 6 months. We linked the app data with survey data with electronic health records.” Dr. Bennett said that they then analyzed the link between eating intervals, including the participants’ total eating window, the time between their wake-up and bedtime, and the time between their last meal and bedtime, with changes in their weight over about six years. The researchers found that the timing from the first meal of the day to the last meal of the day was not associated with changes in weight. However, they did find that eating more frequent, larger meals were associated with weight gain. Data on intermittent fasting is still emerging, so no one study offers all the proof that the method is effective or ineffective. This particular study also had several limitations to consider. First, researchers could only analyze data from study participants who downloaded and used the Daily24 app. This exclusion may have impacted the study population and results. They only recruited participants from three health systems, meaning the results cannot necessarily be generalized. Almost 78% of participants were women and white, indicating the need for more diverse future studies. The study also had a relatively short follow-up time, leading to fewer weight measurements and declines in measurement precision. Researchers were also unable to measure participants’ intentions to lose weight before their enrollment in the study. The way researchers measured eating periods could not evaluate more complex fasting methods. Data also relied on participants’ self-reporting, and food was not standardized or assessed for quality. “This study did not specifically assess patterns like intermittent fasting. We also did not assess diet quality for the meals reported in the app,” Dr. Bennett noted to MNT. “Randomized controlled trials that adjust for caloric intake are needed to further test the role of timing of eating in weight gain prevention and also weight loss,” she added.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I'm researching intermittent fasting as a weight loss program as a whole for my nutritional class. To help me prepare for the paper I want you summarize the study findings in the paragraph, but don't mention the limitations. Then provide a list of benefits for intermittent fasting and any potential negatives based on intermittent fasting or the study. {passage 0} ========== Intermittent fastingTrusted Source involves only eating during specific time intervals. There are many ways to do intermittent fasting; it can mean not eating on certain days or only eating food at certain times of the day. Some people seek to use IF to lose weight or maintain a healthy weight. Some evidenceTrusted Source suggests that intermittent fasting can help people lose body fat and may help reduce the risk of type 2 diabetes and cardiovascular disease. However, researchers are still working to understand the potential dangers of intermittent fasting and how to weigh these risks against the potential benefits. Overall, this is an area where there is a need for more data. Beata Rydyger, a registered nutritionist based in Los Angeles, CA, and clinical nutritional advisor to Zen Nutrients, who was not involved in the study, pointed out a challenge with studying dietary behaviors to Medical News Today: “Generally speaking, diets are more difficult to study because dietary changes don’t have an immediate effect on health. Most study participants find it hard to track what they eat, and few can adhere to a diet for long enough for beneficial effects to be measured.” Reducing calories for weight loss T​his study included 547 participants recruited from three different health systems. Researchers collected information on participants through electronic health records and the use of a specialized mobile app called Daily24. Participants could record when they ate, meal size, the times they went to sleep, and when they woke up. For each meal recorded, participants estimated meal size as less than 500 calories (small), 500-1,000 calories (medium), or greater than 1,000 calories (large). Study author Dr. Wendy Bennett, elaborated on their research methods to MNT: “We designed an app to collect ‘timing of eating,’ and when participants input the timing, we also asked them the size of the meal (small, med, or large). Participants from 3 health systems used the app for 6 months. We linked the app data with survey data with electronic health records.” Dr. Bennett said that they then analyzed the link between eating intervals, including the participants’ total eating window, the time between their wake-up and bedtime, and the time between their last meal and bedtime, with changes in their weight over about six years. The researchers found that the timing from the first meal of the day to the last meal of the day was not associated with changes in weight. However, they did find that eating more frequent, larger meals were associated with weight gain. Data on intermittent fasting is still emerging, so no one study offers all the proof that the method is effective or ineffective. This particular study also had several limitations to consider. First, researchers could only analyze data from study participants who downloaded and used the Daily24 app. This exclusion may have impacted the study population and results. They only recruited participants from three health systems, meaning the results cannot necessarily be generalized. Almost 78% of participants were women and white, indicating the need for more diverse future studies. The study also had a relatively short follow-up time, leading to fewer weight measurements and declines in measurement precision. Researchers were also unable to measure participants’ intentions to lose weight before their enrollment in the study. The way researchers measured eating periods could not evaluate more complex fasting methods. Data also relied on participants’ self-reporting, and food was not standardized or assessed for quality. “This study did not specifically assess patterns like intermittent fasting. We also did not assess diet quality for the meals reported in the app,” Dr. Bennett noted to MNT. “Randomized controlled trials that adjust for caloric intake are needed to further test the role of timing of eating in weight gain prevention and also weight loss,” she added. https://www.medicalnewstoday.com/articles/weight-loss-study-finds-calorie-restriction-more-effective-than-intermittent-fasting#Intermittent-fasting:-risks-and-benefits",Medical,Find & Summarize,Text Transformation Only refer to the attached document in providing your response.,How can credit unions attract younger millennial clients?,"FORBES > MONEY 3 Ways Credit Unions Can Attract More Millennial Members Crissi Cole | Forbes Councils Member Forbes Finance Council COUNCIL POST | Membership (Fee-Based) Feb 28, 2024, 07:00am EST Crissi Cole is the CEO and founder of Penny Finance, an online financial mentorship community for women. GETTY Where did you open your first bank account? For me, it was with a credit union. I still remember how proud I felt, strolling through the glass doors of Washington Trust in Rhode Island to deposit hard-earned tips from a summer job. That first check turned into a lifelong relationship, and years later, I took out my first mortgage with that same credit union. Yet, for others around my age, this isn’t always the case. Wooed by compelling adverts and household names, I noticed that many of my friends housed their assets at traditional financial institutions. In fact, only 14% of Americans ages 25-34 are members of credit unions. This is surprising when you consider credit unions’ advantages. For example, did you know that credit unions are actually member-owned nonprofits? According to Bankrate, this structure enables credit unions to charge lower interest rates on loans and higher yields on savings products. That’s why you may have noticed competitive rates on a mortgage at your local credit union, or better yields on share certificates or savings accounts. Between 2022 and 2045, baby boomers are projected to hand down $72.6 trillion in assets to their heirs, including Generation X and millennials. So, it’s more important than ever for credit unions to appeal to millennials. How can credit unions attract and retain more millennial members during the great wealth transfer? As a fintech founder, a millennial and a credit union member, here are three practical solutions that credit unions can implement today. Offer a competitive high-yield savings account. What’s a popular piece of financial advice I see millennials passing on to their friends right now? Open a high-yield savings account, like, yesterday. One of the only upsides to high interest rates is the HYSA, and millennials are taking note. As a credit union, one way to attract millennial members—and to keep existing members from moving their money out of your MORE FROM FORBES ADVISOR Best High-Yield Savings Accounts Of 2024 By Kevin Payne Contributor Best 5% Interest Savings Accounts of 2024 By Cassidy Horton Contributor ecosystem—is to offer a high-yield savings account with competitive rates. If your credit union can’t offer a HYSA right now, there are strategic alternatives. For example, in 2022, Farmers Insurance Group Federal Credit Union raised the rate of its online savings account, eliminating its tiers and minimum balance requirement, while keeping the rate on its money market accounts static. Tackle issues millennials care about. Millennials hold 47% of student loan debt in the U.S. Speaking from personal experience, this debt weighs down heavily on us, limiting our upward mobility and delaying experiences considered “rites of passage” for previous generations, such as home ownership. Credit unions can offer support to millennial members through loan refinancing for better rates, but there’s the opportunity to go further. Giving members the tools to figure out their debt payoff plan—in the form of online learning, planning and calculators—can provide them the support they need to get out of debt and, one day, into investing. Provide next-gen financial planning. Only one-sixth of credit unions in the U.S. offer financial planning services, yet 85% of millennials and Gen Z seek some form of behavioral coaching about their finances. For credit unions, it’s challenging to scale an army of advisors to serve this need. Plus, millennials often don’t meet the asset minimum needed to hire an advisor. That’s why it’s time to meet millennials where they are: online. Offering digital, nontraditional financial planning to your millennial members is a way to be at the forefront of money management. And if your credit union does happen to offer wealth management, offering digital planning solutions isn’t a conflict of interest; it’s an on- ramp. Helping your members become financially healthy today means they’re more likely to have investable assets tomorrow, and if you have the data infrastructure in place, you’ll be able to reroute them in your ecosystem. The information provided here is not investment, tax or financial advice. You should consult with a licensed professional for advice concerning your specific situation. Forbes Finance Council is an invitation-only organization for executives in successful accounting, financial planning and wealth management firms. Do I qualify? Follow me on Twitter or LinkedIn. Check out my website. Crissi Cole Crissi Cole is the CEO and founder of Penny Finance, an online nancial mentorship community for women. Read Crissi Cole's full... Read More ADVERTISEMENT Editorial Standards Reprints & Permissions","Only refer to the attached document in providing your response. How can credit unions attract younger millennial clients? FORBES > MONEY 3 Ways Credit Unions Can Attract More Millennial Members Crissi Cole | Forbes Councils Member Forbes Finance Council COUNCIL POST | Membership (Fee-Based) Feb 28, 2024, 07:00am EST Crissi Cole is the CEO and founder of Penny Finance, an online financial mentorship community for women. GETTY Where did you open your first bank account? For me, it was with a credit union. I still remember how proud I felt, strolling through the glass doors of Washington Trust in Rhode Island to deposit hard-earned tips from a summer job. That first check turned into a lifelong relationship, and years later, I took out my first mortgage with that same credit union. Yet, for others around my age, this isn’t always the case. Wooed by compelling adverts and household names, I noticed that many of my friends housed their assets at traditional financial institutions. In fact, only 14% of Americans ages 25-34 are members of credit unions. This is surprising when you consider credit unions’ advantages. For example, did you know that credit unions are actually member-owned nonprofits? According to Bankrate, this structure enables credit unions to charge lower interest rates on loans and higher yields on savings products. That’s why you may have noticed competitive rates on a mortgage at your local credit union, or better yields on share certificates or savings accounts. Between 2022 and 2045, baby boomers are projected to hand down $72.6 trillion in assets to their heirs, including Generation X and millennials. So, it’s more important than ever for credit unions to appeal to millennials. How can credit unions attract and retain more millennial members during the great wealth transfer? As a fintech founder, a millennial and a credit union member, here are three practical solutions that credit unions can implement today. Offer a competitive high-yield savings account. What’s a popular piece of financial advice I see millennials passing on to their friends right now? Open a high-yield savings account, like, yesterday. One of the only upsides to high interest rates is the HYSA, and millennials are taking note. As a credit union, one way to attract millennial members—and to keep existing members from moving their money out of your MORE FROM FORBES ADVISOR Best High-Yield Savings Accounts Of 2024 By Kevin Payne Contributor Best 5% Interest Savings Accounts of 2024 By Cassidy Horton Contributor ecosystem—is to offer a high-yield savings account with competitive rates. If your credit union can’t offer a HYSA right now, there are strategic alternatives. For example, in 2022, Farmers Insurance Group Federal Credit Union raised the rate of its online savings account, eliminating its tiers and minimum balance requirement, while keeping the rate on its money market accounts static. Tackle issues millennials care about. Millennials hold 47% of student loan debt in the U.S. Speaking from personal experience, this debt weighs down heavily on us, limiting our upward mobility and delaying experiences considered “rites of passage” for previous generations, such as home ownership. Credit unions can offer support to millennial members through loan refinancing for better rates, but there’s the opportunity to go further. Giving members the tools to figure out their debt payoff plan—in the form of online learning, planning and calculators—can provide them the support they need to get out of debt and, one day, into investing. Provide next-gen financial planning. Only one-sixth of credit unions in the U.S. offer financial planning services, yet 85% of millennials and Gen Z seek some form of behavioral coaching about their finances. For credit unions, it’s challenging to scale an army of advisors to serve this need. Plus, millennials often don’t meet the asset minimum needed to hire an advisor. That’s why it’s time to meet millennials where they are: online. Offering digital, nontraditional financial planning to your millennial members is a way to be at the forefront of money management. And if your credit union does happen to offer wealth management, offering digital planning solutions isn’t a conflict of interest; it’s an on- ramp. Helping your members become financially healthy today means they’re more likely to have investable assets tomorrow, and if you have the data infrastructure in place, you’ll be able to reroute them in your ecosystem. The information provided here is not investment, tax or financial advice. You should consult with a licensed professional for advice concerning your specific situation. Forbes Finance Council is an invitation-only organization for executives in successful accounting, financial planning and wealth management firms. Do I qualify? Follow me on Twitter or LinkedIn. Check out my website. Crissi Cole Crissi Cole is the CEO and founder of Penny Finance, an online nancial mentorship community for women. Read Crissi Cole's full... Read More ADVERTISEMENT Editorial Standards Reprints & Permissions",Financial,Effect Analysis,Q&A "For this task, you should answer questions only based on the information provided in the prompt. You are not allowed to use any internal information, prior knowledge, or external resources to answer questions. Do not exceed 250 words, and provide the answer in paragraph form.",What are the ideal features that could be added to an institutional data repository that would make them more appealing/helpful to researchers?,"Scientists’ data practices Participants across all the focus groups indicated having a DMP for at least one of their recent or current projects. Regarding data storage, some participants across four focus groups (atmosphere and earth science, chemistry, computer science, and neuroscience) used institutional repositories (IRs) for their data at some point within the data lifecycle, with five participants explicitly indicating use of IRs in their DMPs. The other popular choice discussed across four focus groups (atmospheric and earth science, computer science, ecology, and neuroscience) was proprietary cloud storage systems (e.g., DropBox, GitHub, and Google Drive). These users were concerned about file size limitations, costs, long-term preservation, data mining by the service providers, and the number of storage solutions becoming burdensome. Desired repository features Data traceability Participants across four focus groups (atmosphere and earth science, chemistry, ecology, and neuroscience) mentioned wanting different kinds of information about how their data were being used to be tracked after data deposit in repositories. They wanted to know how many researchers view, cite, and publish based on the data they deposit. Additionally, participants wanted repositories to track any changes to their data post-deposit. For example, they suggested the creation of a path for updates to items in repositories after initial submission. They also wanted repositories to allow explicit versioning of their materials to clearly inform users of changes to materials over time. Relatedly, participants wanted repositories to provide notification systems for data depositors and users to know when new versions or derivative works based on their data become available as well as notifications for depositors about when their data has been viewed, cited, or included in a publication. Metadata Participants across three focus groups (atmospheric and earth science, chemistry, and neuroscience) discussed wanting high quality metadata within repositories. Some argued for automated metadata creation when uploading their data into repositories to save time and provide at least some level of description of their data (e.g., P1, P4, Chemistry). Within their own projects and in utilizing repositories, participants wanted help with metadata quality control issues. Participants within atmospheric and earth science who frequently created or interacted with complex files wanted expanded types of metadata (e.g., greater spatial metadata for geographic information system (GIS) data). Atmospheric and earth scientists, chemists, and neuroscientists wanted greater searchability and machine readability of data and entities within datasets housed in repositories, specifically to find a variable by multiple search parameters. Data use restrictions Participants across all five focus groups agreed that repositories need to clearly explain what a researcher can and cannot do with a dataset. For example, participants thought repositories should clearly state on every dataset whether researchers can: base new research on the data, publish based on the data, and use the data for business purposes. Participants stated current data restrictions can be confusing to those not acquainted with legal principles. For example, one data professional (P2, Chemistry) explained that researchers often mislabeled their datasets with ill-suited licenses. Participants commonly reported using Open Access or Creative Commons, but articulated the necessity of having the option for restrictive or proprietary licenses, although most had not used such licenses. Some participants used embargoes and others never had. Most viewed embargoes as “a necessary evil,” provided that they are limited to approximately a few years after repository submission or until time of publication. Participants did not think it was fair to repository staff or potential data reusers to have any data embargoed in perpetuity. Stable infrastructure Participants across two focus groups (atmospheric and earth science, and chemistry) expressed concern about the long-term stability of their data in repositories. Some stated that their fear of a repository not being able to provide long-term preservation of their data led them to seek out and utilize alternative storage solutions. Others expected repositories to commit to the future of their data and have satisfactory funding structures to fulfill their stated missions. Participants described stable repository infrastructure in terms of updating data files (i.e., versioning) and formats over time and ensuring their usability. Security Participants across four focus groups (atmospheric and earth science, chemistry, computer science, and neuroscience) discussed wanting their data to be secure. They feared lax security could compromise their data. Specific to embargoed data, they feared lax security could enable “scooping” of research before data depositors are able to make use of the data through publication. Those handling data with confidential, sensitive or personally identifiable information expressed the most concern about potential security breaches because it could result in a breach and loss of trust with their current and future study participants, making it harder for themselves and future researchers to recruit study participants in the long-term, and it would result in noncompliance with mandates from their IRBs.","System Instruction: [For this task, you should answer questions only based on the information provided in the prompt. You are not allowed to use any internal information, prior knowledge, or external resources to answer questions. Do not exceed 250 words, and provide the answer in paragraph form.] Question: [What are the ideal features that could be added to an institutional data repository that would make them more appealing/helpful to researchers?] Context Block: [Scientists’ data practices Participants across all the focus groups indicated having a DMP for at least one of their recent or current projects. Regarding data storage, some participants across four focus groups (atmosphere and earth science, chemistry, computer science, and neuroscience) used institutional repositories (IRs) for their data at some point within the data lifecycle, with five participants explicitly indicating use of IRs in their DMPs. The other popular choice discussed across four focus groups (atmospheric and earth science, computer science, ecology, and neuroscience) was proprietary cloud storage systems (e.g., DropBox, GitHub, and Google Drive). These users were concerned about file size limitations, costs, long-term preservation, data mining by the service providers, and the number of storage solutions becoming burdensome. Desired repository features Data traceability Participants across four focus groups (atmosphere and earth science, chemistry, ecology, and neuroscience) mentioned wanting different kinds of information about how their data were being used to be tracked after data deposit in repositories. They wanted to know how many researchers view, cite, and publish based on the data they deposit. Additionally, participants wanted repositories to track any changes to their data post-deposit. For example, they suggested the creation of a path for updates to items in repositories after initial submission. They also wanted repositories to allow explicit versioning of their materials to clearly inform users of changes to materials over time. Relatedly, participants wanted repositories to provide notification systems for data depositors and users to know when new versions or derivative works based on their data become available as well as notifications for depositors about when their data has been viewed, cited, or included in a publication. Metadata Participants across three focus groups (atmospheric and earth science, chemistry, and neuroscience) discussed wanting high quality metadata within repositories. Some argued for automated metadata creation when uploading their data into repositories to save time and provide at least some level of description of their data (e.g., P1, P4, Chemistry). Within their own projects and in utilizing repositories, participants wanted help with metadata quality control issues. Participants within atmospheric and earth science who frequently created or interacted with complex files wanted expanded types of metadata (e.g., greater spatial metadata for geographic information system (GIS) data). Atmospheric and earth scientists, chemists, and neuroscientists wanted greater searchability and machine readability of data and entities within datasets housed in repositories, specifically to find a variable by multiple search parameters. Data use restrictions Participants across all five focus groups agreed that repositories need to clearly explain what a researcher can and cannot do with a dataset. For example, participants thought repositories should clearly state on every dataset whether researchers can: base new research on the data, publish based on the data, and use the data for business purposes. Participants stated current data restrictions can be confusing to those not acquainted with legal principles. For example, one data professional (P2, Chemistry) explained that researchers often mislabeled their datasets with ill-suited licenses. Participants commonly reported using Open Access or Creative Commons, but articulated the necessity of having the option for restrictive or proprietary licenses, although most had not used such licenses. Some participants used embargoes and others never had. Most viewed embargoes as “a necessary evil,” provided that they are limited to approximately a few years after repository submission or until time of publication. Participants did not think it was fair to repository staff or potential data reusers to have any data embargoed in perpetuity. Stable infrastructure Participants across two focus groups (atmospheric and earth science, and chemistry) expressed concern about the long-term stability of their data in repositories. Some stated that their fear of a repository not being able to provide long-term preservation of their data led them to seek out and utilize alternative storage solutions. Others expected repositories to commit to the future of their data and have satisfactory funding structures to fulfill their stated missions. Participants described stable repository infrastructure in terms of updating data files (i.e., versioning) and formats over time and ensuring their usability. Security Participants across four focus groups (atmospheric and earth science, chemistry, computer science, and neuroscience) discussed wanting their data to be secure. They feared lax security could compromise their data. Specific to embargoed data, they feared lax security could enable “scooping” of research before data depositors are able to make use of the data through publication. Those handling data with confidential, sensitive or personally identifiable information expressed the most concern about potential security breaches because it could result in a breach and loss of trust with their current and future study participants, making it harder for themselves and future researchers to recruit study participants in the long-term, and it would result in noncompliance with mandates from their IRBs.]",Internet/Technology,Find & Summarize,Text Transformation "Limit your response to a maximum of 100 words. You may only respond to the prompt using information provided in the context block. If possible, use figures or percentages in your arguments. Don't use the word ""medicine"".",Why is access to information important when dealing with health products?,"15. The need for good governance is increasingly recognized as a major hurdle on the road to achieving universal health coverage. Weak governance complicates access to health products by fuelling inefficiencies, distorting competition and leaving the system vulnerable to undue influence, corruption, waste, fraud and abuse. Given the large role of health products in the provision of health care and the proportion of health spending they represent (as high as 60% for medicines in some countries),2 improving governance will help prevent the waste of public resources needed to sustain health systems and provide quality and affordable care. 16. There is a pressing need to improve access to timely, robust and relevant information concerning health products. Unbiased information that is free of any conflict of interest is vital for the sound selection, incorporation, prescription and use of health products. Transparency of this information is central to accountability, strengthens confidence in public institutions and improves the efficiency of the system. Activities in the road map address the transparency of clinical trials enabling support for clinical trial registries and address price transparency through the Market Information for Access to Vaccines (MI4A platform),3 for example. 17. The relationship between government and the private sector, such as pharmaceutical companies and medical device companies, requires particular attention. A question of growing importance is how to support governments to work effectively with the private sector and develop public policy while avoiding the risks of undue influence and maximizing benefits. WHO supports improving practices in both the public and private sectors to ensure that national policies reflect the central role of access to health products in achieving universal health coverage and in contributing to improved accountability.","system instruction: Limit your response to a maximum of 100 words. You may only respond to the prompt using information provided in the context block. If possible, use figures or percentages in your arguments. Don't use the word ""medicine"". question: Why is access to information important when dealing with health products? context block: [15. The need for good governance is increasingly recognized as a major hurdle on the road to achieving universal health coverage. Weak governance complicates access to health products by fuelling inefficiencies, distorting competition and leaving the system vulnerable to undue influence, corruption, waste, fraud and abuse. Given the large role of health products in the provision of health care and the proportion of health spending they represent (as high as 60% for medicines in some countries),2 improving governance will help prevent the waste of public resources needed to sustain health systems and provide quality and affordable care. 16. There is a pressing need to improve access to timely, robust and relevant information concerning health products. Unbiased information that is free of any conflict of interest is vital for the sound selection, incorporation, prescription and use of health products. Transparency of this information is central to accountability, strengthens confidence in public institutions and improves the efficiency of the system. Activities in the road map address the transparency of clinical trials enabling support for clinical trial registries and address price transparency through the Market Information for Access to Vaccines (MI4A platform),3 for example. 17. The relationship between government and the private sector, such as pharmaceutical companies and medical device companies, requires particular attention. A question of growing importance is how to support governments to work effectively with the private sector and develop public policy while avoiding the risks of undue influence and maximizing benefits. WHO supports improving practices in both the public and private sectors to ensure that national policies reflect the central role of access to health products in achieving universal health coverage and in contributing to improved accountability.]",Medical,Summarize,Text Transformation Respond to this prompt using only the information contained in the context as you are not an expert in this subject matter.,What does the context suggest are potential promising areas of research going forward? ,"Another approach commonly brought up by patients on LT4 with persistent complaints is the use of a combination therapy including LT4 and T3. This regimen was addressed by 14 randomized trials of the combination therapy that did not demonstrate benefit,37,44 and 5 other studies67–71 that reported some benefit.40 However, the study protocols differed in terms of design, including variable use of crossover or parallel groups, blinding, the ratio of T4 to T3 dosage, treatment duration as well as definitions of primary and secondary outcomes. In addition, some studies were subject to carryover effects, overtreatment, and limited inclusion of men and older age groups, underpowered sample size, short duration and once daily T3 dosing. Consistently, 5 meta-analyses or reviews also suggested no clear advantage of the combination therapy.37,72–75 Importantly, potential long-term risks of T3 addition, such as cardiac arrhythmias, or decreased bone mineral density were not fully investigated. Therefore, Guidelines of the American Thyroid Association concluded that there is insufficient evidence to recommend the combination therapy. However, if such a therapy is chosen, it should resemble physiology, that is, the physiological molar T4 to T3 ratio of 14:1 to 15:1,37 and synthetic T4 to T3 conversion factor 3:1.76 Sustained release T3 formulations under development may help achieving physiological goals. Interestingly, a benefit of a therapy containing T3 was shown in a subgroup analysis of patients who remained the most symptomatic while taking LT4. Therefore, this might be the group of patients that may need to be targeted in future, well designed and appropriately powered studies on the combination therapies.77 The subset of patients potentially benefiting from the combination therapy is likely to have a pathophysiological explanation, as it was shown that lower T3 levels during monotherapy with LT4 were associated with the presence of Thr92Ala polymorphism of deiodinase type 2 (DIO2 ) gene.78 Genotyping for the presence of Thr92Ala polymorphism in patients treated for hypothyroidism revealed that Ala/Ala homozygotes had worse quality of life scores while taking LT4.79 In addition, another small study showed that patients with both Thr92Ala polymorphism and a polymorphism in one of the thyroid hormone transporters (MTC10 ) preferred the combination therapy with both LT4 and T3.80 However, other studies did not confirm these findings.81–83 Hence, only the results from a new, prospective, well-designed, adequately powered study of the effects of DIO2 and MTC10 polymorphisms on response to therapy can assess if this genetic background could be a marker guiding either a monotherapy or the combination therapy in overtly hypothyroid patients. The role of surgery for HT has been traditionally limited to the patients presenting with either pain or compressive symptoms due to goiter or co-existing malignant thyroid nodules.84 However, it was recently hypothesized that thyroidectomy might be a therapeutic modality used to reduce TPOAbs titers, as the presence of such antibodies is associated with lower quality of life even in euthyroid individuals. Consequently, a clinical trial addressed this concept, randomizing highly positive TPOAb patients with continued symptoms while receiving LT4 to either thyroidectomy or continued medical management. In those who underwent thyroidectomy, TPOAbs significantly declined, quality of life and fatigue improved, and the effect was sustained at 12 to 18 month landmarks.85 Hashimoto thyroiditis and thyroid nodules. Based on evaluation of pathological specimens, the average prevalence of papillary thyroid cancer in patients with HT was around 27%, with an associated increased risk ratio of 1.59, as compared with the general population.86, 87 A recent meta-analysis that combined the studies analyzing cytological and pathological specimens derived from patients with HT concluded that this association is based on low-to-moderate quality evidence.88 Apart from papillary thyroid cancer, a non-Hodgkin primary thyroid lymphoma was strongly associated with HT, with a risk of about 60 times higher than in the general population.32 Thyroid lymphoma accounts for approximately 5% of all thyroid neoplasms. Diagnosis of thyroid lymphoma is important to be established, as it changes the first line therapy from surgery, that is routinely implemented for malignant thyroid nodules, to appropriately targeted chemotherapy for lymphoproliferative disorders. Therapy of thyroid lymphoma and malignant thyroid nodules is beyond the scope of this review, but can be found in the respective guidelines.89 Hashimoto thyroiditis and pregnancy The prevalence of TPOAbs in pregnant women is estimated to be 5%–14% and TgAbs are seen in 3%–18% of pregnant female individuals.90 The presence of these Abs indicating thyroid autoimmunity, is associated with a 2 to 4-fold increase in the risk of recurrent miscarriages91,92 and 2 to 3- fold increased risk of preterm birth.91,93,94 The mechanisms behind these adverse pregnancy outcomes in TPOAb positive euthyroid women are unclear but some authors postulate that TPOAbs might be markers for other forms of autoimmunity that target the placental-fetal unit.95 However, thyroid autoimmunity seems to have an additive or synergistic effect on miscarriage 93 and prematurity 96 risk in women with maternal subclinical hypothyroidism. A recent meta-analysis including 19 cohort studies enrolling 47 045 pregnant women showed almost 3-fold increased risk of preterm birth in women with subclinical hypothyroidism and 1.5-fold increased risk of preterm birth in women with isolated hypothyroxinemia.94 Another meta-analysis of 26 studies found significant associations between maternal subclinical hypothyroidism or hypothyroxinemia and lower child IQ, language delay or global developmental delay as compared with children of euthyroid women.97 Overt hypothyroidism was associated with increased rates of gestational hypertension including preeclampsia and eclampsia, gestational diabetes, placental abruption, postpartum hemorrhage, preterm delivery, low birthweight, infant intensive care unit admissions, fetal death, and neurodevelopmental delays in the offspring.98,99,100 Therefore, overt hypothyroidism should be treated to prevent adverse effects on pregnancy and child developmental outcomes and should be started before conception to achieve biochemical euthyroidism.26 Therapy with LT4 improved success rate of in vitro fertilization in TPOAbs positive women with TSH above 2.5 mIU/ml.26 Importantly, women treated for hypothyroidism typically require a 20% to 30% increase in their LT4 dose, which usually translates into addition of 2 pills per week early in the first trimester.26 The physiological explanation for increased thyroid hormone requirements is based upon several factors including increased hepatic thyroxine binding globulin synthesis and enhanced metabolism of thyroid hormone through its inactivation by the placental type 3 DIO.26,101 The use of T3 or T4+T3 combination therapy is not indicated in pregnancy, as liothyronine does not cross the blood-brain barrier to the fetal brain.102 LT4 replacement therapy should be monitored monthly, as over- and undertreatment lead to adverse pregnancy outcomes.26 The suggested target TSH is within the lower half of the trimester-specific reference range or below 2.5 mIU/ml, if the trimester-specific ranges are not available.26 Regarding maternal subclinical hypothyroidism, the 2017 American Thyroid Association guidelines recommend utilizing TPOAb status along with serum levels of TSH to guide treatment decisions (TABLE 2).26 LT4 therapy is not recommended for isolated hypothyroxinemia.26 A 2021 systematic review and meta-analysis of 6 randomized controlled trials assessing the effect of LT4 treatment in euthyroid women with thyroid autoimmunity did not find any significant differences in the relative risk of miscarriage and preterm delivery, or outcomes with live birth. Therefore, no strong recommendations regarding the therapy in such scenarios could be made, but consideration on a case-by-case basis might be implemented (TABLE 2).103 Areas of research There are promising new models being developed to study the pathophysiology of thyroid disease, as functional thyroid follicles from embryonic or pluripotent stem cells were established in animal models.104,105 This potentially allows for studying mechanisms of autoimmunity that could guide prevention of the disease progression to overt hypothyroidism in predisposed individuals. Stem cells could be also used in regenerative medicine to replace those destroyed by the autoimmune processes in the thyroid gland. A better understanding of the response to therapy with thyroid hormones might be achieved from studies focusing on transcriptome profiling of expression of genes responsive to thyroid hormone action. This could help titrating thyroid hormone replacement therapy. New preparations of sustained release T3 have successfully passed phase 1 clinical trials and may add to our armamentarium for HT therapy once necessary efficacy trials are completed.","Respond to this prompt using only the information contained in the context as you are not an expert in this subject matter. What does the context suggest are potential promising areas of research going forward? Another approach commonly brought up by patients on LT4 with persistent complaints is the use of a combination therapy including LT4 and T3. This regimen was addressed by 14 randomized trials of the combination therapy that did not demonstrate benefit,37,44 and 5 other studies67–71 that reported some benefit.40 However, the study protocols differed in terms of design, including variable use of crossover or parallel groups, blinding, the ratio of T4 to T3 dosage, treatment duration as well as definitions of primary and secondary outcomes. In addition, some studies were subject to carryover effects, overtreatment, and limited inclusion of men and older age groups, underpowered sample size, short duration and once daily T3 dosing. Consistently, 5 meta-analyses or reviews also suggested no clear advantage of the combination therapy.37,72–75 Importantly, potential long-term risks of T3 addition, such as cardiac arrhythmias, or decreased bone mineral density were not fully investigated. Therefore, Guidelines of the American Thyroid Association concluded that there is insufficient evidence to recommend the combination therapy. However, if such a therapy is chosen, it should resemble physiology, that is, the physiological molar T4 to T3 ratio of 14:1 to 15:1,37 and synthetic T4 to T3 conversion factor 3:1.76 Sustained release T3 formulations under development may help achieving physiological goals. Interestingly, a benefit of a therapy containing T3 was shown in a subgroup analysis of patients who remained the most symptomatic while taking LT4. Therefore, this might be the group of patients that may need to be targeted in future, well designed and appropriately powered studies on the combination therapies.77 The subset of patients potentially benefiting from the combination therapy is likely to have a pathophysiological explanation, as it was shown that lower T3 levels during monotherapy with LT4 were associated with the presence of Thr92Ala polymorphism of deiodinase type 2 (DIO2 ) gene.78 Genotyping for the presence of Thr92Ala polymorphism in patients treated for hypothyroidism revealed that Ala/Ala homozygotes had worse quality of life scores while taking LT4.79 In addition, another small study showed that patients with both Thr92Ala polymorphism and a polymorphism in one of the thyroid hormone transporters (MTC10 ) preferred the combination therapy with both LT4 and T3.80 However, other studies did not confirm these findings.81–83 Hence, only the results from a new, prospective, well-designed, adequately powered study of the effects of DIO2 and MTC10 polymorphisms on response to therapy can assess if this genetic background could be a marker guiding either a monotherapy or the combination therapy in overtly hypothyroid patients. The role of surgery for HT has been traditionally limited to the patients presenting with either pain or compressive symptoms due to goiter or co-existing malignant thyroid nodules.84 However, it was recently hypothesized that thyroidectomy might be a therapeutic modality used to reduce TPOAbs titers, as the presence of such antibodies is associated with lower quality of life even in euthyroid individuals. Consequently, a clinical trial addressed this concept, randomizing highly positive TPOAb patients with continued symptoms while receiving LT4 to either thyroidectomy or continued medical management. In those who underwent thyroidectomy, TPOAbs significantly declined, quality of life and fatigue improved, and the effect was sustained at 12 to 18 month landmarks.85 Hashimoto thyroiditis and thyroid nodules. Based on evaluation of pathological specimens, the average prevalence of papillary thyroid cancer in patients with HT was around 27%, with an associated increased risk ratio of 1.59, as compared with the general population.86, 87 A recent meta-analysis that combined the studies analyzing cytological and pathological specimens derived from patients with HT concluded that this association is based on low-to-moderate quality evidence.88 Apart from papillary thyroid cancer, a non-Hodgkin primary thyroid lymphoma was strongly associated with HT, with a risk of about 60 times higher than in the general population.32 Thyroid lymphoma accounts for approximately 5% of all thyroid neoplasms. Diagnosis of thyroid lymphoma is important to be established, as it changes the first line therapy from surgery, that is routinely implemented for malignant thyroid nodules, to appropriately targeted chemotherapy for lymphoproliferative disorders. Therapy of thyroid lymphoma and malignant thyroid nodules is beyond the scope of this review, but can be found in the respective guidelines.89 Hashimoto thyroiditis and pregnancy The prevalence of TPOAbs in pregnant women is estimated to be 5%–14% and TgAbs are seen in 3%–18% of pregnant female individuals.90 The presence of these Abs indicating thyroid autoimmunity, is associated with a 2 to 4-fold increase in the risk of recurrent miscarriages91,92 and 2 to 3- fold increased risk of preterm birth.91,93,94 The mechanisms behind these adverse pregnancy outcomes in TPOAb positive euthyroid women are unclear but some authors postulate that TPOAbs might be markers for other forms of autoimmunity that target the placental-fetal unit.95 However, thyroid autoimmunity seems to have an additive or synergistic effect on miscarriage 93 and prematurity 96 risk in women with maternal subclinical hypothyroidism. A recent meta-analysis including 19 cohort studies enrolling 47 045 pregnant women showed almost 3-fold increased risk of preterm birth in women with subclinical hypothyroidism and 1.5-fold increased risk of preterm birth in women with isolated hypothyroxinemia.94 Another meta-analysis of 26 studies found significant associations between maternal subclinical hypothyroidism or hypothyroxinemia and lower child IQ, language delay or global developmental delay as compared with children of euthyroid women.97 Overt hypothyroidism was associated with increased rates of gestational hypertension including preeclampsia and eclampsia, gestational diabetes, placental abruption, postpartum hemorrhage, preterm delivery, low birthweight, infant intensive care unit admissions, fetal death, and neurodevelopmental delays in the offspring.98,99,100 Therefore, overt hypothyroidism should be treated to prevent adverse effects on pregnancy and child developmental outcomes and should be started before conception to achieve biochemical euthyroidism.26 Therapy with LT4 improved success rate of in vitro fertilization in TPOAbs positive women with TSH above 2.5 mIU/ml.26 Importantly, women treated for hypothyroidism typically require a 20% to 30% increase in their LT4 dose, which usually translates into addition of 2 pills per week early in the first trimester.26 The physiological explanation for increased thyroid hormone requirements is based upon several factors including increased hepatic thyroxine binding globulin synthesis and enhanced metabolism of thyroid hormone through its inactivation by the placental type 3 DIO.26,101 The use of T3 or T4+T3 combination therapy is not indicated in pregnancy, as liothyronine does not cross the blood-brain barrier to the fetal brain.102 LT4 replacement therapy should be monitored monthly, as over- and undertreatment lead to adverse pregnancy outcomes.26 The suggested target TSH is within the lower half of the trimester-specific reference range or below 2.5 mIU/ml, if the trimester-specific ranges are not available.26 Regarding maternal subclinical hypothyroidism, the 2017 American Thyroid Association guidelines recommend utilizing TPOAb status along with serum levels of TSH to guide treatment decisions (TABLE 2).26 LT4 therapy is not recommended for isolated hypothyroxinemia.26 A 2021 systematic review and meta-analysis of 6 randomized controlled trials assessing the effect of LT4 treatment in euthyroid women with thyroid autoimmunity did not find any significant differences in the relative risk of miscarriage and preterm delivery, or outcomes with live birth. Therefore, no strong recommendations regarding the therapy in such scenarios could be made, but consideration on a case-by-case basis might be implemented (TABLE 2).103 Areas of research There are promising new models being developed to study the pathophysiology of thyroid disease, as functional thyroid follicles from embryonic or pluripotent stem cells were established in animal models.104,105 This potentially allows for studying mechanisms of autoimmunity that could guide prevention of the disease progression to overt hypothyroidism in predisposed individuals. Stem cells could be also used in regenerative medicine to replace those destroyed by the autoimmune processes in the thyroid gland. A better understanding of the response to therapy with thyroid hormones might be achieved from studies focusing on transcriptome profiling of expression of genes responsive to thyroid hormone action. This could help titrating thyroid hormone replacement therapy. New preparations of sustained release T3 have successfully passed phase 1 clinical trials and may add to our armamentarium for HT therapy once necessary efficacy trials are completed.",Medical,Find & Summarize,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",I would like to know about the idea of holistic healthcare within business. How does holistic healthcare affect businesses and employees? What are the health benefits?,"Holistic healthcare recognises the connection and balance between physical, mental, and spiritual wellbeing. Rather than concentrating on episodic care, it looks at the interaction between different conditions and wellbeing factors to treat a whole person. It aims to prevent, as well as treat, health issues. Ten years ago, NHS England, along with other national partners, signed up to a series of commitments to support integrated care. The purpose included: improve outcomes in population health and healthcare tackle inequalities in outcomes, experience and access enhance productivity and value for money Today this same challenge and opportunity is set for employers. Eighty seven percent of employees expect their employer to support them in balancing work and personal commitments. Yet nearly one in five employers aren't doing anything to improve employee health and wellbeing. There are significant benefits to proactively addressing workforce wellbeing. And the most valuable approach is a holistic one. Let’s explore why. For senior HR leaders, taking a holistic approach to wellbeing comes with a variety of advantages. According to the CIPD’s Health and wellbeing at work 2022 report: 48 percent of HR leaders agree their organisation’s employee health and wellbeing strategy has created a healthier and more inclusive culture. 46 percent agree that it has created better employee morale and engagement. 33 percent agree that it has created more effective working relationships. 27 percent agree that it has improved productivity. Over the next decade, there will be 3.7 million more workers aged between 50 and the state pension age. At the same time, Generations Z and Alpha are establishing their place in the workforce. A holistic approach to health is an excellent way to support an inclusive workplace. There's no ‘one-size-fits-all’ when it comes to health. What it means to ‘live well’ looks different for different people. So, you need to find a way to cater to every individual's unique needs. Currently, only half of all organisations take a strategic approach to employee wellbeing. Over a third remain reactive to employee needs. For you to stand out, you need to actively listen to every employee and find ways to serve their needs. And having done so, you then need to find wellbeing solutions that cater to those requirements. The bottom line? Develop a wellness strategy that has the flexibility to meet myriad needs and you will start to see tangible benefits. The connection between mind and body is indisputable. Many studies show that physical wellness is directly influenced by mental wellness, and vice versa. In fact, having a serious mental illness can reduce your life expectancy by 10 to 20 years due to the impact it has across your body. This includes increased risk of heart disease, as well as a possible increase in your risk of cancer. In the workplace, mental health concerns are the top cause of long-term employee absences at work. What's more, psychological conditions like severe anxiety and depression impact creativity and productivity. 79 percent of UK adults feel stressed at least once per month. And approximately two in three employees believe work is a significant source of stress. As an HR leader, it’s imperative you understand and advocate for mind-body wellness at work. Find creative ways to promote holistic health strategies and offer teams the relevant support to ensure they bring their best selves to work. 33 percent of workers report that workplace stress decreases productivity. It’s therefore critical that you find ways to address it. What’s more, happier employees are approximately 12 percent more productive. Holistic health is important because it acts as a core enabler of employee happiness and productivity. There is an indisputable connection between good health and wellbeing and a reduction in stress. And unsurprisingly, reducing stress boosts happiness, which in turn increases productivity. In addition to employee happiness is employee health. In the UK, musculoskeletal (MSK) conditions affect 1 in 4 of the adult population. A large proportion of these conditions affect young working people who experience daily symptoms including pain, stiffness, and limited movement. Taking a holistic approach to health helps employees better manage not only the symptoms that arise from conditions like MSK, but also the root causes. These often include repetitive daily motion, inactivity, and overwork. Plus, it helps them manage the emotional burden that comes with chronic pain. Presenteeism can cost your company £4,000 in lost business per employee, each year. Despite this, only 30 percent of HR leaders report their organisation has taken steps to tackle it. You can reduce instances of presenteeism and leavism with a holistic wellbeing strategy. This ensures employees take the time they need to recover and return to work stronger than ever. It also allows them to then maintain their wellbeing while at work. This reduces the risk of relapse and increases focus and productivity. Stressed employees are more than three times as likely to seek employment elsewhere compared to their less-stressed co-workers. To reduce the risk of turnover, ensure managers offer regular check-ins with employees. This helps you monitor employee wellbeing and mitigate any impending departures. Your commitment to the health of your workforce goes a long way in creating trust and respect. In turn, this generates engagement and builds loyalty. A holistic healthcare strategy balances physical, emotional, and mental wellbeing. In turn, this encourages employees to take care of their entire selves. And in return, your employees will bring their entire selves into the workplace. Our wellbeing platform offers employees the opportunity to receive personalised wellbeing advice within a single, streamlined solution. It equips employees with everything they need to take care of their whole health. This includes regular check-ins and engaging self-guided programmes. It also includes personalised chatbots, and access to specialist follow-up care when needed.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I would like to know about the idea of holistic healthcare within business. How does holistic healthcare affect businesses and employees? What are the health benefits? Holistic healthcare recognises the connection and balance between physical, mental, and spiritual wellbeing. Rather than concentrating on episodic care, it looks at the interaction between different conditions and wellbeing factors to treat a whole person. It aims to prevent, as well as treat, health issues. Ten years ago, NHS England, along with other national partners, signed up to a series of commitments to support integrated care. The purpose included: improve outcomes in population health and healthcare tackle inequalities in outcomes, experience and access enhance productivity and value for money Today this same challenge and opportunity is set for employers. Eighty seven percent of employees expect their employer to support them in balancing work and personal commitments. Yet nearly one in five employers aren't doing anything to improve employee health and wellbeing. There are significant benefits to proactively addressing workforce wellbeing. And the most valuable approach is a holistic one. Let’s explore why. For senior HR leaders, taking a holistic approach to wellbeing comes with a variety of advantages. According to the CIPD’s Health and wellbeing at work 2022 report: 48 percent of HR leaders agree their organisation’s employee health and wellbeing strategy has created a healthier and more inclusive culture. 46 percent agree that it has created better employee morale and engagement. 33 percent agree that it has created more effective working relationships. 27 percent agree that it has improved productivity. Over the next decade, there will be 3.7 million more workers aged between 50 and the state pension age. At the same time, Generations Z and Alpha are establishing their place in the workforce. A holistic approach to health is an excellent way to support an inclusive workplace. There's no ‘one-size-fits-all’ when it comes to health. What it means to ‘live well’ looks different for different people. So, you need to find a way to cater to every individual's unique needs. Currently, only half of all organisations take a strategic approach to employee wellbeing. Over a third remain reactive to employee needs. For you to stand out, you need to actively listen to every employee and find ways to serve their needs. And having done so, you then need to find wellbeing solutions that cater to those requirements. The bottom line? Develop a wellness strategy that has the flexibility to meet myriad needs and you will start to see tangible benefits. The connection between mind and body is indisputable. Many studies show that physical wellness is directly influenced by mental wellness, and vice versa. In fact, having a serious mental illness can reduce your life expectancy by 10 to 20 years due to the impact it has across your body. This includes increased risk of heart disease, as well as a possible increase in your risk of cancer. In the workplace, mental health concerns are the top cause of long-term employee absences at work. What's more, psychological conditions like severe anxiety and depression impact creativity and productivity. 79 percent of UK adults feel stressed at least once per month. And approximately two in three employees believe work is a significant source of stress. As an HR leader, it’s imperative you understand and advocate for mind-body wellness at work. Find creative ways to promote holistic health strategies and offer teams the relevant support to ensure they bring their best selves to work. 33 percent of workers report that workplace stress decreases productivity. It’s therefore critical that you find ways to address it. What’s more, happier employees are approximately 12 percent more productive. Holistic health is important because it acts as a core enabler of employee happiness and productivity. There is an indisputable connection between good health and wellbeing and a reduction in stress. And unsurprisingly, reducing stress boosts happiness, which in turn increases productivity. In addition to employee happiness is employee health. In the UK, musculoskeletal (MSK) conditions affect 1 in 4 of the adult population. A large proportion of these conditions affect young working people who experience daily symptoms including pain, stiffness, and limited movement. Taking a holistic approach to health helps employees better manage not only the symptoms that arise from conditions like MSK, but also the root causes. These often include repetitive daily motion, inactivity, and overwork. Plus, it helps them manage the emotional burden that comes with chronic pain. Presenteeism can cost your company £4,000 in lost business per employee, each year. Despite this, only 30 percent of HR leaders report their organisation has taken steps to tackle it. You can reduce instances of presenteeism and leavism with a holistic wellbeing strategy. This ensures employees take the time they need to recover and return to work stronger than ever. It also allows them to then maintain their wellbeing while at work. This reduces the risk of relapse and increases focus and productivity. Stressed employees are more than three times as likely to seek employment elsewhere compared to their less-stressed co-workers. To reduce the risk of turnover, ensure managers offer regular check-ins with employees. This helps you monitor employee wellbeing and mitigate any impending departures. Your commitment to the health of your workforce goes a long way in creating trust and respect. In turn, this generates engagement and builds loyalty. A holistic healthcare strategy balances physical, emotional, and mental wellbeing. In turn, this encourages employees to take care of their entire selves. And in return, your employees will bring their entire selves into the workplace. Our wellbeing platform offers employees the opportunity to receive personalised wellbeing advice within a single, streamlined solution. It equips employees with everything they need to take care of their whole health. This includes regular check-ins and engaging self-guided programmes. It also includes personalised chatbots, and access to specialist follow-up care when needed. https://www.healthhero.com/blog/what-is-holistic-healthcare-and-why-is-it-important",Medical,Explanation/Definition,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","I read this article about genetic cancer. Can you explain how family cancer syndrome works? I'm thinking of starting a family in a few years, but need to know the pros and cons of cancer genetic testing. What should affect my decision to get testing at all? I also need to know how to prevent various cancer genetic changes from occurring so that the whole family can be safe.","Cancer-related genetic changes can occur because: random mistakes in our DNA happen as our cells multiply our DNA is altered by carcinogens in our environment, such as chemicals in tobacco smoke, UV rays from the sun, and the human papillomavirus (HPV) they were inherited from one of our parents DNA changes, whether caused by a random mistake or by a carcinogen, can happen throughout our lives and even in the womb. While most genetic changes aren’t harmful on their own, an accumulation of genetic changes over many years can turn healthy cells into cancerous cells. The vast majority of cancers occur by chance as a result of this process over time. Cancer itself can’t be passed down from parents to children. And genetic changes in tumor cells can’t be passed down. But a genetic change that increases the risk of cancer can be passed down (inherited) if it is present in a parent's egg or sperm cells. For example, if a parent passes a mutated BRCA1 or BRCA2 gene to their child, the child will have a much higher risk of developing breast and several other cancers. That’s why cancer sometimes appears to run in families. Up to 10% of all cancers may be caused by inherited genetic changes. Inheriting a cancer-related genetic change doesn’t mean you will definitely get cancer. It means that your risk of getting cancer is increased. A family cancer syndrome, also called a hereditary cancer syndrome, is a rare disorder in which family members have a higher-than-average risk of developing a certain type or types of cancer. Family cancer syndromes are caused by inherited genetic variants in certain cancer-related genes. With some family cancer syndromes, people tend to develop cancer at an early age or have other noncancer health conditions. For example, familial adenomatous polyposis (FAP) is a family cancer syndrome caused by certain inherited changes in the APC gene. People with FAP have a very high chance of developing colorectal cancer at an early age and are also at risk of developing other kinds of cancer. But not all cancers that appear to “run in families” are caused by family cancer syndromes. A shared environment or habits, such as exposure to air pollution or tobacco use, may cause the same kind of cancer to develop among family members. Also, multiple family members may develop common cancers, such as prostate cancer, just by chance. Cancer can also run in a family if family members have a combination of many genetic variants that each have a very small cancer risk. Certain genetic tests can show if you’ve inherited a genetic change that increases your risk of cancer. This testing is usually done with a small sample of blood, but it can sometimes be done with saliva, cells from inside the cheek, or skin cells. Not everyone needs to get genetic testing for cancer risk. Your doctor or health care provider can help you decide if you should get tested for genetic changes that increase cancer risk. They will likely ask if you have certain patterns in your personal or family medical history, such as cancer at an unusually young age or several relatives with the same kind of cancer. If your doctor recommends genetic testing, talking with a genetic counselor can help you consider the potential risks, benefits, and drawbacks of genetic testing in your situation. After testing, a genetic counselor, doctor, or other health care professional trained in genetics can help you understand what the test results mean for you and for your family members. Although it’s possible to order an at-home genetic test on your own, these tests have many drawbacks and are not generally recommended as a way to see whether you have inherited a genetic change that increases cancer risk. If you have cancer, a different type of genetic test called a biomarker test can identify genetic changes that may be driving the growth of your cancer. This information can help your doctors decide which therapy might work best for you or if you may be able to enroll in a particular clinical trial. For more information, see Biomarker Testing for Cancer Treatment. Biomarker testing may also be called tumor profiling or molecular profiling. Biomarker testing is different from the genetic testing that is used to find out if you have an inherited genetic change that makes you more likely to get cancer. Biomarker testing is done using a sample of your cancer cells—either a small piece of a tumor or a sample of your blood. In some cases, the results of a biomarker test might suggest that you have an inherited mutation that increases cancer risk. If that happens, you may need to get another genetic test to confirm whether you truly have an inherited mutation that increases cancer risk. Genetic changes can lead to cancer if they alter the way your cells grow and spread. Most cancer-causing DNA changes occur in genes, which are sections of DNA that carry the instructions to make proteins or specialized RNA such as microRNA. For example, some DNA changes raise the levels of proteins that tell cells to keep growing. Other DNA changes lower the levels of proteins that tell cells when to stop growing. And some DNA changes stop proteins that tell cells to self-destruct when they are damaged. For a healthy cell to turn cancerous, scientists think that more than one DNA change has to occur. People who have inherited a cancer-related genetic change need fewer additional changes to develop cancer. However, they may never develop these changes or get cancer. As cancer cells divide, they acquire more DNA changes over time. Two cancer cells in the same tumor can have different DNA changes. In addition, every person with cancer has a unique combination of DNA changes in their cancer. Multiple kinds of genetic changes can lead to cancer. One genetic change, called a DNA mutation or genetic variant, is a change in the DNA code, like a typo in the sequence of DNA letters. Some variants affect just one DNA letter, called a nucleotide. A nucleotide may be missing, or it may be replaced by another nucleotide. These are called point mutations. For example, around 5% of people with cancer have a point mutation in the KRAS gene that replaces the DNA letter G with AExit Disclaimer. This single letter change creates an abnormal KRAS protein that constantly tells cells to grow. Cancer-causing genetic changes can also occur when segments of DNA—sometimes very large ones—are rearranged, deleted, or copied. These are called chromosomal rearrangements. For example, most chronic myelogenous leukemias (a type of blood cancer) are caused by a chromosomal rearrangement that places part of the BCR gene next to the ABL gene. This rearrangement creates an abnormal protein, called BCR-ABL, that makes leukemia cells grow out of control. Some cancer-causing DNA changes occur outside genes, in sections of DNA that act like “on” or “off” switches for nearby genes. For example, some brain cancer cells have multiple copies of “on” switches next to genes that drive cell growth. Other DNA changes, known as epigenetic changes, can also cause cancer. Unlike genetic variants, epigenetic changes (sometimes called epimutations) may be reversible and they don’t affect the DNA code. Instead, epigenetic changes affect how DNA is packed into the nucleus. By changing how DNA is packaged, epigenetic changes can alter how much protein a gene makes. Some substances and chemicals in the environment that cause genetic changes can also cause epigenetic changes, such as tobacco smoke, heavy metals like cadmium, and viruses like Epstein-Barr virus.","[question] I read this article about genetic cancer. Can you explain how family cancer syndrome works? I'm thinking of starting a family in a few years, but need to know the pros and cons of cancer genetic testing. What should affect my decision to get testing at all? I also need to know how to prevent various cancer genetic changes from occurring so that the whole family can be safe. ===================== [text] Cancer-related genetic changes can occur because: random mistakes in our DNA happen as our cells multiply our DNA is altered by carcinogens in our environment, such as chemicals in tobacco smoke, UV rays from the sun, and the human papillomavirus (HPV) they were inherited from one of our parents DNA changes, whether caused by a random mistake or by a carcinogen, can happen throughout our lives and even in the womb. While most genetic changes aren’t harmful on their own, an accumulation of genetic changes over many years can turn healthy cells into cancerous cells. The vast majority of cancers occur by chance as a result of this process over time. Cancer itself can’t be passed down from parents to children. And genetic changes in tumor cells can’t be passed down. But a genetic change that increases the risk of cancer can be passed down (inherited) if it is present in a parent's egg or sperm cells. For example, if a parent passes a mutated BRCA1 or BRCA2 gene to their child, the child will have a much higher risk of developing breast and several other cancers. That’s why cancer sometimes appears to run in families. Up to 10% of all cancers may be caused by inherited genetic changes. Inheriting a cancer-related genetic change doesn’t mean you will definitely get cancer. It means that your risk of getting cancer is increased. A family cancer syndrome, also called a hereditary cancer syndrome, is a rare disorder in which family members have a higher-than-average risk of developing a certain type or types of cancer. Family cancer syndromes are caused by inherited genetic variants in certain cancer-related genes. With some family cancer syndromes, people tend to develop cancer at an early age or have other noncancer health conditions. For example, familial adenomatous polyposis (FAP) is a family cancer syndrome caused by certain inherited changes in the APC gene. People with FAP have a very high chance of developing colorectal cancer at an early age and are also at risk of developing other kinds of cancer. But not all cancers that appear to “run in families” are caused by family cancer syndromes. A shared environment or habits, such as exposure to air pollution or tobacco use, may cause the same kind of cancer to develop among family members. Also, multiple family members may develop common cancers, such as prostate cancer, just by chance. Cancer can also run in a family if family members have a combination of many genetic variants that each have a very small cancer risk. Certain genetic tests can show if you’ve inherited a genetic change that increases your risk of cancer. This testing is usually done with a small sample of blood, but it can sometimes be done with saliva, cells from inside the cheek, or skin cells. Not everyone needs to get genetic testing for cancer risk. Your doctor or health care provider can help you decide if you should get tested for genetic changes that increase cancer risk. They will likely ask if you have certain patterns in your personal or family medical history, such as cancer at an unusually young age or several relatives with the same kind of cancer. If your doctor recommends genetic testing, talking with a genetic counselor can help you consider the potential risks, benefits, and drawbacks of genetic testing in your situation. After testing, a genetic counselor, doctor, or other health care professional trained in genetics can help you understand what the test results mean for you and for your family members. Although it’s possible to order an at-home genetic test on your own, these tests have many drawbacks and are not generally recommended as a way to see whether you have inherited a genetic change that increases cancer risk. If you have cancer, a different type of genetic test called a biomarker test can identify genetic changes that may be driving the growth of your cancer. This information can help your doctors decide which therapy might work best for you or if you may be able to enroll in a particular clinical trial. For more information, see Biomarker Testing for Cancer Treatment. Biomarker testing may also be called tumor profiling or molecular profiling. Biomarker testing is different from the genetic testing that is used to find out if you have an inherited genetic change that makes you more likely to get cancer. Biomarker testing is done using a sample of your cancer cells—either a small piece of a tumor or a sample of your blood. In some cases, the results of a biomarker test might suggest that you have an inherited mutation that increases cancer risk. If that happens, you may need to get another genetic test to confirm whether you truly have an inherited mutation that increases cancer risk. Genetic changes can lead to cancer if they alter the way your cells grow and spread. Most cancer-causing DNA changes occur in genes, which are sections of DNA that carry the instructions to make proteins or specialized RNA such as microRNA. For example, some DNA changes raise the levels of proteins that tell cells to keep growing. Other DNA changes lower the levels of proteins that tell cells when to stop growing. And some DNA changes stop proteins that tell cells to self-destruct when they are damaged. For a healthy cell to turn cancerous, scientists think that more than one DNA change has to occur. People who have inherited a cancer-related genetic change need fewer additional changes to develop cancer. However, they may never develop these changes or get cancer. As cancer cells divide, they acquire more DNA changes over time. Two cancer cells in the same tumor can have different DNA changes. In addition, every person with cancer has a unique combination of DNA changes in their cancer. Multiple kinds of genetic changes can lead to cancer. One genetic change, called a DNA mutation or genetic variant, is a change in the DNA code, like a typo in the sequence of DNA letters. Some variants affect just one DNA letter, called a nucleotide. A nucleotide may be missing, or it may be replaced by another nucleotide. These are called point mutations. For example, around 5% of people with cancer have a point mutation in the KRAS gene that replaces the DNA letter G with AExit Disclaimer. This single letter change creates an abnormal KRAS protein that constantly tells cells to grow. Cancer-causing genetic changes can also occur when segments of DNA—sometimes very large ones—are rearranged, deleted, or copied. These are called chromosomal rearrangements. For example, most chronic myelogenous leukemias (a type of blood cancer) are caused by a chromosomal rearrangement that places part of the BCR gene next to the ABL gene. This rearrangement creates an abnormal protein, called BCR-ABL, that makes leukemia cells grow out of control. Some cancer-causing DNA changes occur outside genes, in sections of DNA that act like “on” or “off” switches for nearby genes. For example, some brain cancer cells have multiple copies of “on” switches next to genes that drive cell growth. Other DNA changes, known as epigenetic changes, can also cause cancer. Unlike genetic variants, epigenetic changes (sometimes called epimutations) may be reversible and they don’t affect the DNA code. Instead, epigenetic changes affect how DNA is packed into the nucleus. By changing how DNA is packaged, epigenetic changes can alter how much protein a gene makes. Some substances and chemicals in the environment that cause genetic changes can also cause epigenetic changes, such as tobacco smoke, heavy metals like cadmium, and viruses like Epstein-Barr virus. https://www.cancer.gov/about-cancer/causes-prevention/genetics ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Explanation/Definition,Q&A "Your response to the user must only use the information provided in the prompt context. Focus on terms and definitions whenever possible, explaining complex concepts using short sentences. Do not use vocabulary that requires advanced education to know, and if complex terms are used, they need to be defined in-place using phrasing a person with a high-school degree would understand. Limit your response to 100 words maximum, and answer the user's question with a well-organized list if they ask for definitions. If you cannot answer the user's question using the context alone, respond simply with ""I do not have enough context to provide an answer at this time.""",Which model showed debt underutilization in this study?,"Since Modigliani and Miller (1958), economists have relaxed many of their assumptions to understand the observed behavior of leverage ratios. Arguably, the trade-off theory has emerged as one of the leading paradigms, even though it has been often challenged by empirical tests that appear to favor other theories or suggest taxes are not that important. Therefore, there is still no consensus in the literature. Moreover, none of the extant theories jointly address the following questions in a parsimonious and simple framework: (1) why firms tend to use debt financing so conservatively, (2) whether there is indeed a target leverage ratio and partial adjustment toward it, (3) why the leverage-growth relation is negative, and (4) why average leverage paths persist for over two decades. To answers these questions, we extend Hackbarth and Mauer (2012) to multiple financing and investment decisions that maximize initial value. We develop two versions of a dynamic model with endogenous financing and investment decisions. While the multistage model features two sequentially exercisable investment options, the single-stage model has only one investment option. The single-stage model serves as a benchmark to gauge investment-financing interactions in the multistage model. In both versions, the capital expenditure is funded by a mix of debt and equity. This mixture not only trades off tax benefits of debt against bankruptcy costs (triggered by an endogenous default decision) but also recognizes financial flexibility in the multistage model. The solution of the dynamic model offers a rich set of novel predictions that link the behavior of a firm’s leverage ratios to its investment opportunities. First, a role for financial flexibility emerges endogenously because dynamic financing-investment interactions between stages lead to an “intertemporal effect” in the multistage model: reaping investment (i.e., cash flow) and tax benefits sooner by issuing more debt in the first stage to fund the investment cost reduces financial flexibility for funding more of the investment cost with debt in the second stage. In comparison to the single-stage model, firms underutilize debt in the multistage model when financing investment the first time to retain financial flexibility. Because both debt issues jointly optimize initial equity value (and hence internalize dilutive externalities on each other), underutilization of debt persists when firms mature (i.e., exercise their last investment options), and underutilization is more (less) severe for more backloaded (front-loaded) investment opportunities. It is worth noting that leverage does not vary with investment in the single-stage model. Only in the multistage model leverage dynamics crucially hinge on the structure of the investment process in that it creates significant variation target leverage ratios.1 Second, optimizing behavior by firms in a dynamic trade-off model with investment generates a significant fraction of low or zero leverage firms and path-dependent, persistent leverage ratios. Our analysis shows how incentives to retain financial flexibility in the first stage crucially depend on the structure of the investment process. Given the wide range of optimal target leverage ratios, the model suggests that leverage ratios can greatly vary depending on how the firm grows assets-in-place by exercising its real options. Third, structural models without dynamic financing-investment interactions (1) overestimate target leverage ratios, and (2) can be misleading in that they imply a fixed target leverage ratio that is largely taken to be exogenous to the investment process. It thus seems difficult to determine target leverage in the conventional sense. This also suggests that there is no meaningful measurement of partial adjustment toward target leverage (as in, e.g., Flannery and Rangan 2006) without recognizing the structure of the investment process.2 To test the model’s ability to match observed outcomes, we estimate key model parameters via simulated method of moments (SMM). Intuitively, SMM finds the set of parameters, which minimizes the difference of the simulated model moments and the data moments from COMPUSTAT’s annual tapes for the period of 1965 to 2009. We then split the full sample into low, medium, and high market-to-book (or q) subsamples and employ SMM also to fit the four parameters for each subsample. We split the sample based on q to proxy for investment opportunities. Low q firms tend to have fewer investment opportunities, whereas high q firms tend to have more investment opportunities. Therefore, the relative value of q is informative about the structure of the investment process in the real data. Our estimation results reveal that high q firms have the most back-loaded investment processes, and low q firms have the most front-loaded ones. Graham (2000) reports that firms, even stable and profitable, use less debt than predicted by the static view of the tax benefits of debt. Two of five firms have an average leverage ratio of less than 20%, and the median firm uses only 31.4% leverage over the 1965 to 2000 period, which implies a “low leverage puzzle.” More recently, Strebulaev and Yang (2013) find that on average 10% of firms have zero leverage and almost 22% firms have less than 5% quasi-market leverage, which represents a “zero leverage puzzle.” We emphasize the importance of real frictions in a dynamic trade-off model and thereby provide an economically meaningful mechanism for why firms tend to use debt financing so conservatively. Based on the structural estimation results for the full sample, the simulated economies feature a significant fraction of low (and zero) leverage firms. Moreover, in contrast to much higher point estimates in prior studies, we report, on average, 20% leverage in dynamics (i.e., for all firms) and 19% at investment points (i.e., for investing firms). In addition, we perform capital structure regressions on simulated data and show that the model can replicate stylized facts established by empirical research. In the spirit of Strebulaev (2007), simulation of the multistage model of corporate investment and financing dynamics reinforces the need to differentiate investment points from other data points when interpreting coefficient estimates for market-to-book or profitability in a dynamic world. Consistent with Frank and Goyal (2009) and others, we find leverage is negatively related to the risk of cash flows, the cost of bankruptcy, and market-to-book, but positively related the size of the firm and the tax rate. Finally, we document that real frictions in a dynamic model can produce average leverage paths that closely resemble the ones in the data (e.g., Lemmon, Roberts, and Zender 2008).3 That is, endogenous investment and financing decisions in a dynamic model can largely explain the otherwise puzzling patterns that, despite of some convergence, average leverage ratios across portfolios are fairly stable over time for both types of sorts (i.e., actual and unexpected leverage) performed by these authors.4 To do so, we extend the multistage model to randomly imposed initial variation in leverage. If model firms are “born” with high (low) leverage ratios at the beginning, then they maintain their relatively high (low) levels for over two decades (despite of the fact that leverage ratios converge somewhat to more moderate levels over time). This result illustrates that corporations, which know the structure of their investment processes, take it into account and make decisions on debt usage accordingly. This leads to fairly stable leverage ratios, and serves in the simulations as an important, unobserved determinant of the permanent component of leverage. The simplicity of our model allows us to develop a deeper understanding of related results of the growing literature that extends Leland (1994) to interactions between investment and financing decisions.5 Hackbarth and Mauer’s (2012) novel modeling feature is the explicit recognition that the firm’s existing capital structure influences future investment decisions through debtequity (agency) conflicts as well as financing mix of future investment. Like Sundaresan, Wang, and Yang (2015), we extend their model to multiple investment projects. While firms in Sundaresan et al. exhibit identical leverage ratios when the last option is exercised, final leverage ratios of our model firms vary widely.6 Titman and Tsyplakov (2007) numerically solve a complex model that features both financing and investment decision evolving over time. In contrast to, for example, Sundaresan et al. their model is based on continuous investment decisions (as in Brennan and Schwartz 1984), whereas our model focuses on discrete, irreversible, or lumpy investment that is equivalent to a “real transaction” cost so that the firm does not continuously invest or refinance. ","Your response to the user must only use the information provided in the prompt context. Focus on terms and definitions whenever possible, explaining complex concepts using short sentences. Do not use vocabulary that requires advanced education to know, and if complex terms are used, they need to be defined in-place using phrasing a person with a high-school degree would understand. Limit your response to 100 words maximum, and answer the user's question with a well-organized list if they ask for definitions. If you cannot answer the user's question using the context alone, respond simply with ""I do not have enough context to provide an answer at this time."" Context: Since Modigliani and Miller (1958), economists have relaxed many of their assumptions to understand the observed behavior of leverage ratios. Arguably, the trade-off theory has emerged as one of the leading paradigms, even though it has been often challenged by empirical tests that appear to favor other theories or suggest taxes are not that important. Therefore, there is still no consensus in the literature. Moreover, none of the extant theories jointly address the following questions in a parsimonious and simple framework: (1) why firms tend to use debt financing so conservatively, (2) whether there is indeed a target leverage ratio and partial adjustment toward it, (3) why the leverage-growth relation is negative, and (4) why average leverage paths persist for over two decades. To answers these questions, we extend Hackbarth and Mauer (2012) to multiple financing and investment decisions that maximize initial value. We develop two versions of a dynamic model with endogenous financing and investment decisions. While the multistage model features two sequentially exercisable investment options, the single-stage model has only one investment option. The single-stage model serves as a benchmark to gauge investment-financing interactions in the multistage model. In both versions, the capital expenditure is funded by a mix of debt and equity. This mixture not only trades off tax benefits of debt against bankruptcy costs (triggered by an endogenous default decision) but also recognizes financial flexibility in the multistage model. The solution of the dynamic model offers a rich set of novel predictions that link the behavior of a firm’s leverage ratios to its investment opportunities. First, a role for financial flexibility emerges endogenously because dynamic financing-investment interactions between stages lead to an “intertemporal effect” in the multistage model: reaping investment (i.e., cash flow) and tax benefits sooner by issuing more debt in the first stage to fund the investment cost reduces financial flexibility for funding more of the investment cost with debt in the second stage. In comparison to the single-stage model, firms underutilize debt in the multistage model when financing investment the first time to retain financial flexibility. Because both debt issues jointly optimize initial equity value (and hence internalize dilutive externalities on each other), underutilization of debt persists when firms mature (i.e., exercise their last investment options), and underutilization is more (less) severe for more backloaded (front-loaded) investment opportunities. It is worth noting that leverage does not vary with investment in the single-stage model. Only in the multistage model leverage dynamics crucially hinge on the structure of the investment process in that it creates significant variation target leverage ratios.1 Second, optimizing behavior by firms in a dynamic trade-off model with investment generates a significant fraction of low or zero leverage firms and path-dependent, persistent leverage ratios. Our analysis shows how incentives to retain financial flexibility in the first stage crucially depend on the structure of the investment process. Given the wide range of optimal target leverage ratios, the model suggests that leverage ratios can greatly vary depending on how the firm grows assets-in-place by exercising its real options. Third, structural models without dynamic financing-investment interactions (1) overestimate target leverage ratios, and (2) can be misleading in that they imply a fixed target leverage ratio that is largely taken to be exogenous to the investment process. It thus seems difficult to determine target leverage in the conventional sense. This also suggests that there is no meaningful measurement of partial adjustment toward target leverage (as in, e.g., Flannery and Rangan 2006) without recognizing the structure of the investment process.2 To test the model’s ability to match observed outcomes, we estimate key model parameters via simulated method of moments (SMM). Intuitively, SMM finds the set of parameters, which minimizes the difference of the simulated model moments and the data moments from COMPUSTAT’s annual tapes for the period of 1965 to 2009. We then split the full sample into low, medium, and high market-to-book (or q) subsamples and employ SMM also to fit the four parameters for each subsample. We split the sample based on q to proxy for investment opportunities. Low q firms tend to have fewer investment opportunities, whereas high q firms tend to have more investment opportunities. Therefore, the relative value of q is informative about the structure of the investment process in the real data. Our estimation results reveal that high q firms have the most back-loaded investment processes, and low q firms have the most front-loaded ones. Graham (2000) reports that firms, even stable and profitable, use less debt than predicted by the static view of the tax benefits of debt. Two of five firms have an average leverage ratio of less than 20%, and the median firm uses only 31.4% leverage over the 1965 to 2000 period, which implies a “low leverage puzzle.” More recently, Strebulaev and Yang (2013) find that on average 10% of firms have zero leverage and almost 22% firms have less than 5% quasi-market leverage, which represents a “zero leverage puzzle.” We emphasize the importance of real frictions in a dynamic trade-off model and thereby provide an economically meaningful mechanism for why firms tend to use debt financing so conservatively. Based on the structural estimation results for the full sample, the simulated economies feature a significant fraction of low (and zero) leverage firms. Moreover, in contrast to much higher point estimates in prior studies, we report, on average, 20% leverage in dynamics (i.e., for all firms) and 19% at investment points (i.e., for investing firms). In addition, we perform capital structure regressions on simulated data and show that the model can replicate stylized facts established by empirical research. In the spirit of Strebulaev (2007), simulation of the multistage model of corporate investment and financing dynamics reinforces the need to differentiate investment points from other data points when interpreting coefficient estimates for market-to-book or profitability in a dynamic world. Consistent with Frank and Goyal (2009) and others, we find leverage is negatively related to the risk of cash flows, the cost of bankruptcy, and market-to-book, but positively related the size of the firm and the tax rate. Finally, we document that real frictions in a dynamic model can produce average leverage paths that closely resemble the ones in the data (e.g., Lemmon, Roberts, and Zender 2008).3 That is, endogenous investment and financing decisions in a dynamic model can largely explain the otherwise puzzling patterns that, despite of some convergence, average leverage ratios across portfolios are fairly stable over time for both types of sorts (i.e., actual and unexpected leverage) performed by these authors.4 To do so, we extend the multistage model to randomly imposed initial variation in leverage. If model firms are “born” with high (low) leverage ratios at the beginning, then they maintain their relatively high (low) levels for over two decades (despite of the fact that leverage ratios converge somewhat to more moderate levels over time). This result illustrates that corporations, which know the structure of their investment processes, take it into account and make decisions on debt usage accordingly. This leads to fairly stable leverage ratios, and serves in the simulations as an important, unobserved determinant of the permanent component of leverage. The simplicity of our model allows us to develop a deeper understanding of related results of the growing literature that extends Leland (1994) to interactions between investment and financing decisions.5 Hackbarth and Mauer’s (2012) novel modeling feature is the explicit recognition that the firm’s existing capital structure influences future investment decisions through debtequity (agency) conflicts as well as financing mix of future investment. Like Sundaresan, Wang, and Yang (2015), we extend their model to multiple investment projects. While firms in Sundaresan et al. exhibit identical leverage ratios when the last option is exercised, final leverage ratios of our model firms vary widely.6 Titman and Tsyplakov (2007) numerically solve a complex model that features both financing and investment decision evolving over time. In contrast to, for example, Sundaresan et al. their model is based on continuous investment decisions (as in Brennan and Schwartz 1984), whereas our model focuses on discrete, irreversible, or lumpy investment that is equivalent to a “real transaction” cost so that the firm does not continuously invest or refinance. Which model showed debt underutilization in this study?",Financial,Fact Finding,Q&A "Response must not be more than 150 words. Response must be in bullet points. Model must only respond using information contained in the context block Model must not rely on its own knowledge or outside sources of information when responding.",What methods does the NYSDOH AIDS Institute suggest HIV doctors use to keep their HIV-positive patients consistently engaged in their medical care?,"NYSDOH AIDS Institute Linkage and Retention Workgroup Updated 6.20.2019 HIV Medical Providers: Strategies and Resources for Retention in Care The purpose of this document is to provide resources and information to support HIV health care practitioners’ efforts to retain HIV-positive people in medical care. Ensuring that people with HIV have access to HIV primary care is a cornerstone of both New York State’s Ending the Epidemic Blueprint and the National HIV/AIDS Strategy. Persons engaged in health care have better health outcomes such as improved viral suppression, which helps patients live longer and healthier lives and avoid transmission of the virus. On April 1, 2014, Public Health Law Section 2135 was amended to promote linkage and retention in care for HIV-positive persons. The law allows the New York State Department of Health (NYSDOH) and New York City Department of Health and Mental Hygiene (NYC DOHMH) to share information with health care providers for purposes of patient linkage and retention in care. The NYSDOH AIDS Institute recommends that health care providers take a multi-pronged approach to support their patients’ retention in care, including but not limited to the following: Have a proactive patient plan: Do not wait for a lapse in care to discuss what to do if the patient becomes lost-to-care. ▪ Create a patient-centered atmosphere, where all members of medical care teams (e.g., reception staff, phlebotomists, medical providers, etc.) promote patient engagement, linkage, and retention in care. ▪ When acceptable to patients, expand authorization dates on Authorization for Release of Health Information and Confidential HIV-Related Information forms (DOH-2557) to at least 2 years. Extending consent timeframes allows collaboration across sectors. ▪ Have DOH-2557 consent forms on file for every patient. This will permit you to contact community based organizations (CBOs) and others in the event of a lapse in care. Examples of CBOs that can help return patients to care include but are not limited to: HIV/AIDS CBOs; Health Homes and their downstream providers; food and nutrition programs; shelters; substance use treatment facilities; housing providers; mental health providers; prenatal care providers, etc. ▪ Encourage patients to add your practice’s name to any releases they sign with other organizations. ▪ Work with patients to update releases prior to when the releases expire (if applicable). ▪ Become a member of your area’s Health Home network(s) if you have not already done so. o for more information go to: https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_map/index.htm Leverage existing resources for patient re-engagement. ▪ Use information from the Regional Health Information Organization (RHIO), if available, to determine if the patient is in care with another provider or if updated personal contact information is available. ▪ Conduct a health insurance benefits check, if available, on the patient to determine if s/he changed insurance or is in care with another provider. ▪ If the patient is in a Managed Care plan, the plan will have updated contact information, recent use of care, and medications on file. If this is a Medicaid Managed Care Plan, the plan can identify which Health Home the patient may be enrolled in and this information may be useful to your follow-up efforts. o If your patient is enrolled in a Health Home and has signed a release, contact the Health Home to determine whether the patient is actively enrolled. If yes, request assistance to contact or re-engage the patient in care. o If your patient has Medicaid but has not been enrolled in a Health Home, contact the Health Home to make an “upstream referral.” The patient will be referred to a provider who may conduct outreach to the patient’s home. ▪ Try multiple modes of contact (phone, text, letter, email, and social media) at varying times of the day/week to reach the patient (special consideration for social media sites – contact patient from an agency social media account and not a staff person’s personal account). ▪ If your patient uses other services within the facility (e.g., WIC, dental, child’s provider), place an alert on the Electronic Medical Record (EMR) to reconnect to the HIV Primary Care Provider and, if pregnant, to her prenatal care provider. ▪ As authorized in patient releases and/or medical charts, work with emergency contacts and other agencies/providers to determine whether they have had recent patient contact. ▪ Conduct a home visit if resources allow. If you have a peer program, utilize peers to provide outreach to the patient’s home. NYSDOH AIDS Institute Linkage and Retention Workgroup Updated 6.20.2019 Use external systems to expand your search when you cannot find a patient. ▪ Review public records such as: o Property tax rolls, municipal tax rolls, etc.: http://publicrecords.onlinesearches.com/NewYork.htm o Parole Lookup: http://www.doccs.ny.gov/lookup.html o NYS County Jail inmate lookup: https://vinelink.vineapps.com/login/NY o NYC Department of Corrections inmate lookup: http://www1.nyc.gov/site/doc/inmateinfo/inmate-lookup.page o NYS Department of Corrections and Community Supervision Inmate lookup: http://nysdoccslookup.doccs.ny.gov/ o Consider using people search engines, local newspapers, and police blotters. ▪ Social Security Death Master File Portal: https://www.npcrcss.cdc.gov/ssdi/ (A user ID and password are required to access the site and may be obtained by calling (301) 572-0502.) Pregnant women and exposed infants lost-to-care require immediate action for reengagement. HIV-positive pregnant women and their exposed infants are a priority when identified as lost-to-care and require immediate action for re-engagement. Reengagement in care is especially important for HIV-positive pregnant women who are in their third trimester due to possible increasing viral loads from being non-adherent to ART, leading to increased risk of transmitting HIV to their infants. Ensuring exposed infants are engaged in care is critical during the first 4-6 months to ensure appropriate antiretroviral and opportunistic infection prophylaxis, as well as definitive documentation of the infant’s HIV infection status. If routine attempts for reengagement of the HIV-positive pregnant woman or her exposed or infected infant(s) are not successful, please contact the NYSDOH Perinatal HIV Prevention Program at (518) 486-6048 or submit a request via the NYSDOH HIV/AIDS Provider Portal (see below) for assistance. NYC providers should call the NYC DOHMH Field Services Unit at (347) 396-7601 for assistance with reengagement of pregnant women. NYC-based providers (located within the 5 boroughs): Eligible NYC providers with patients who have been out-of-care for 6 months or longer can use the NYC DOHMH’s HIV Care Status Reports System (CSR) to obtain information on patients’ current care status in NYC. Information from the CSR may be useful to your follow-up efforts. For more information, see https://www1.nyc.gov/site/doh/health/health-topics/aids-hiv-care-status-reports-system.page Eligible NYC providers may also call the NYC DOHMH Provider Call Line at (212) 442-3388 to obtain information that may help link or retain patients in care. For providers based in NYS outside of NYC: After exploring the investigation tools and strategies listed above and if patient follow-up is warranted, the Bureau of HIV/AIDS Epidemiology (BHAE) may be able to provide information regarding a patient’s care status through the NYSDOH HIV/AIDS Provider Portal. The HIV/AIDS Provider Portal is an electronic system which enables clinicians to: 1) meet their reporting requirements electronically; 2) provide a mechanism for clinicians statewide to notify the NYS DOH that a patient needs linkage to Health Department Partner Services; and, 3) submit inquiries for patients with diagnosed HIV infection who are thought to be in need of assistance with linkage to or retention in HIV medical care. A NYSDOH Health Commerce System (HCS) Medical Professionals account is required. To apply for an HCS Medial Professions account, navigate to: https://apps.health.ny.gov/pub/top.html. After logging into the HCS at https://commerce.health.ny.gov/, select “Refresh My Applications List” on the left side and then under “My Applications” select HIV/AIDS Provider Portal. Follow the prompts to set up an account. Urgent requests will be responded to within 1 business day. For routine requests to the HIV/AIDS Provider Portal, the turn-around time is typically within 1-3 business days.","Response must not be more than 150 words. Response must be in bullet points. Model must only respond using information contained in the context block Model must not rely on its own knowledge or outside sources of information when responding. What methods does the NYSDOH AIDS Institute suggest HIV doctors use to keep their HIV-positive patients consistently engaged in their medical care? NYSDOH AIDS Institute Linkage and Retention Workgroup Updated 6.20.2019 HIV Medical Providers: Strategies and Resources for Retention in Care The purpose of this document is to provide resources and information to support HIV health care practitioners’ efforts to retain HIV-positive people in medical care. Ensuring that people with HIV have access to HIV primary care is a cornerstone of both New York State’s Ending the Epidemic Blueprint and the National HIV/AIDS Strategy. Persons engaged in health care have better health outcomes such as improved viral suppression, which helps patients live longer and healthier lives and avoid transmission of the virus. On April 1, 2014, Public Health Law Section 2135 was amended to promote linkage and retention in care for HIV-positive persons. The law allows the New York State Department of Health (NYSDOH) and New York City Department of Health and Mental Hygiene (NYC DOHMH) to share information with health care providers for purposes of patient linkage and retention in care. The NYSDOH AIDS Institute recommends that health care providers take a multi-pronged approach to support their patients’ retention in care, including but not limited to the following: Have a proactive patient plan: Do not wait for a lapse in care to discuss what to do if the patient becomes lost-to-care. ▪ Create a patient-centered atmosphere, where all members of medical care teams (e.g., reception staff, phlebotomists, medical providers, etc.) promote patient engagement, linkage, and retention in care. ▪ When acceptable to patients, expand authorization dates on Authorization for Release of Health Information and Confidential HIV-Related Information forms (DOH-2557) to at least 2 years. Extending consent timeframes allows collaboration across sectors. ▪ Have DOH-2557 consent forms on file for every patient. This will permit you to contact community based organizations (CBOs) and others in the event of a lapse in care. Examples of CBOs that can help return patients to care include but are not limited to: HIV/AIDS CBOs; Health Homes and their downstream providers; food and nutrition programs; shelters; substance use treatment facilities; housing providers; mental health providers; prenatal care providers, etc. ▪ Encourage patients to add your practice’s name to any releases they sign with other organizations. ▪ Work with patients to update releases prior to when the releases expire (if applicable). ▪ Become a member of your area’s Health Home network(s) if you have not already done so. o for more information go to: https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_map/index.htm Leverage existing resources for patient re-engagement. ▪ Use information from the Regional Health Information Organization (RHIO), if available, to determine if the patient is in care with another provider or if updated personal contact information is available. ▪ Conduct a health insurance benefits check, if available, on the patient to determine if s/he changed insurance or is in care with another provider. ▪ If the patient is in a Managed Care plan, the plan will have updated contact information, recent use of care, and medications on file. If this is a Medicaid Managed Care Plan, the plan can identify which Health Home the patient may be enrolled in and this information may be useful to your follow-up efforts. o If your patient is enrolled in a Health Home and has signed a release, contact the Health Home to determine whether the patient is actively enrolled. If yes, request assistance to contact or re-engage the patient in care. o If your patient has Medicaid but has not been enrolled in a Health Home, contact the Health Home to make an “upstream referral.” The patient will be referred to a provider who may conduct outreach to the patient’s home. ▪ Try multiple modes of contact (phone, text, letter, email, and social media) at varying times of the day/week to reach the patient (special consideration for social media sites – contact patient from an agency social media account and not a staff person’s personal account). ▪ If your patient uses other services within the facility (e.g., WIC, dental, child’s provider), place an alert on the Electronic Medical Record (EMR) to reconnect to the HIV Primary Care Provider and, if pregnant, to her prenatal care provider. ▪ As authorized in patient releases and/or medical charts, work with emergency contacts and other agencies/providers to determine whether they have had recent patient contact. ▪ Conduct a home visit if resources allow. If you have a peer program, utilize peers to provide outreach to the patient’s home. NYSDOH AIDS Institute Linkage and Retention Workgroup Updated 6.20.2019 Use external systems to expand your search when you cannot find a patient. ▪ Review public records such as: o Property tax rolls, municipal tax rolls, etc.: http://publicrecords.onlinesearches.com/NewYork.htm o Parole Lookup: http://www.doccs.ny.gov/lookup.html o NYS County Jail inmate lookup: https://vinelink.vineapps.com/login/NY o NYC Department of Corrections inmate lookup: http://www1.nyc.gov/site/doc/inmateinfo/inmate-lookup.page o NYS Department of Corrections and Community Supervision Inmate lookup: http://nysdoccslookup.doccs.ny.gov/ o Consider using people search engines, local newspapers, and police blotters. ▪ Social Security Death Master File Portal: https://www.npcrcss.cdc.gov/ssdi/ (A user ID and password are required to access the site and may be obtained by calling (301) 572-0502.) Pregnant women and exposed infants lost-to-care require immediate action for reengagement. HIV-positive pregnant women and their exposed infants are a priority when identified as lost-to-care and require immediate action for re-engagement. Reengagement in care is especially important for HIV-positive pregnant women who are in their third trimester due to possible increasing viral loads from being non-adherent to ART, leading to increased risk of transmitting HIV to their infants. Ensuring exposed infants are engaged in care is critical during the first 4-6 months to ensure appropriate antiretroviral and opportunistic infection prophylaxis, as well as definitive documentation of the infant’s HIV infection status. If routine attempts for reengagement of the HIV-positive pregnant woman or her exposed or infected infant(s) are not successful, please contact the NYSDOH Perinatal HIV Prevention Program at (518) 486-6048 or submit a request via the NYSDOH HIV/AIDS Provider Portal (see below) for assistance. NYC providers should call the NYC DOHMH Field Services Unit at (347) 396-7601 for assistance with reengagement of pregnant women. NYC-based providers (located within the 5 boroughs): Eligible NYC providers with patients who have been out-of-care for 6 months or longer can use the NYC DOHMH’s HIV Care Status Reports System (CSR) to obtain information on patients’ current care status in NYC. Information from the CSR may be useful to your follow-up efforts. For more information, see https://www1.nyc.gov/site/doh/health/health-topics/aids-hiv-care-status-reports-system.page Eligible NYC providers may also call the NYC DOHMH Provider Call Line at (212) 442-3388 to obtain information that may help link or retain patients in care. For providers based in NYS outside of NYC: After exploring the investigation tools and strategies listed above and if patient follow-up is warranted, the Bureau of HIV/AIDS Epidemiology (BHAE) may be able to provide information regarding a patient’s care status through the NYSDOH HIV/AIDS Provider Portal. The HIV/AIDS Provider Portal is an electronic system which enables clinicians to: 1) meet their reporting requirements electronically; 2) provide a mechanism for clinicians statewide to notify the NYS DOH that a patient needs linkage to Health Department Partner Services; and, 3) submit inquiries for patients with diagnosed HIV infection who are thought to be in need of assistance with linkage to or retention in HIV medical care. A NYSDOH Health Commerce System (HCS) Medical Professionals account is required. To apply for an HCS Medial Professions account, navigate to: https://apps.health.ny.gov/pub/top.html. After logging into the HCS at https://commerce.health.ny.gov/, select “Refresh My Applications List” on the left side and then under “My Applications” select HIV/AIDS Provider Portal. Follow the prompts to set up an account. Urgent requests will be responded to within 1 business day. For routine requests to the HIV/AIDS Provider Portal, the turn-around time is typically within 1-3 business days.",Medical,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","can you summarize this text in maximum half the words it used, but with the same number of sections that the original text has. Keep the language simple and be sure to define key terms.","1.7.0 Disentitlement Under the EI legislation, the term ""disentitlement"" has a specific meaning and refers to the situations described below (EI Act 6(1)). Disentitlements are imposed for something the claimant has failed to do to prove entitlement to benefits (EI Act 49(1)), for example, failed to provide information that is crucial to determining if they are entitled to benefits, failed to prove their availability for work, failed to prove they are unemployed. One or more disentitlements can be imposed concurrently, when there is more than one ground for disentitlement. 1.7.1 Effect of disentitlement Disentitlements are imposed for as little as one day, or for an indefinite period of time. In practice, a disentitlement may be imposed on any working day of the week, and continue as long as the situation that led to the disentitlement remains unchanged. If or when the claimant’s situation changes, a decision must be made as to whether the disentitlement can be terminated or rescinded completely. Benefits are not paid, or deemed to be paid, for any days of disentitlement. When a disentitlement covers a full week, it will delay the payment of benefits, and will not reduce the maximum number of weeks that could potentially be paid in the claimant’s benefit period. However, once the benefit period terminates (52 weeks plus any extensions is reached), no further benefits can be paid in that benefit period (Digest 1.4.4). This may mean that a lengthy period of disentitlement, similar to a lengthy period during which earnings are allocated, may in fact, reduce the number of weeks of benefits actually paid to a claimant (CUB 76507). 1.7.2 Grounds for disentitlement Some of the following situations automatically result in disentitlement whereas others are not specifically defined: working a full week (Digest Chapter 4) not available for work (EI Act 18(a); Digest Chapter 10) failure to prove incapacity for work in the case of sickness benefits (EI Act 18(b); EI Regulation 40) minor attachment claimant who ceased work due to incapacity (EI Act 21(1)) loss of employment or inability to resume a previous employment by reason of a labour dispute (EI Act 36); EI Regulation 52; Digest Chapter 8) confinement in a prison or similar institution (EI Act 37(a); EI Regulation 54; Digest 10.11.7) being out of Canada (EI Act 37(b); EI Regulation 55; Digest 10.11.8) non-entitlement of a teacher during the non-teaching period; (EI Regulation 33; Digest Chapter 14) delay in making a renewal or continuing claim (EI Act 50(4); EI Regulation 26(1)) failure to provide information upon request (EI Act 50(5 & 6)) suspension from employment because of misconduct (EI Act 31; Digest Chapter 7) voluntarily taking a leave from employment without just cause (EI Act 32; Digest Chapter 6) voluntarily leaving employment permanently without just cause, or losing employment by reason of their misconduct, within three weeks of termination from that employment (EI Act 33(1); Digest Chapter 6, Digest Chapter 7) not entitled to compassionate care benefits (EI Act 23.1; Digest Chapter 23) not entitled to family caregiver benefits (EI Act 23.2; EI Act 23.3; Digest Chapter 22) having received or being entitled to receive provincial benefits in respect of the birth or adoption of a child under a provincial plan (EI Regulation 76.09; Quebec Parental Insurance Plan) Each of the above grounds will be discussed in detail in subsequent chapters. 1.7.3 Length of disentitlement The legislation does not provide for a half-day disentitlement (EI Act 20). When it is determined that a disentitlement is warranted, the disentitlement must be applied for a minimum of one day. Extenuating circumstances cannot reduce a period of disentitlement; either the claimant meets the entitlement condition or they do not. The reason they may not meet it is not a factor to consider when determining if the condition is met. The start date of the disentitlement may be determined ahead of time, for example in cases where a claimant intends to be absent from Canada for vacation. However, the end of the absence may not always be known. If known, the end date of the disentitlement will be input, and the claimant is not required to contact the Commission upon return, unless there is a change to the end date. If the end date is not known, the claimant must contact the Commission upon their return, to have the end date of the disentitlement reviewed. An ongoing disentitlement may be imposed for less than five days each week. This may be the case, for example, when the disentitlement is related to the availability or capability for work of a claimant, or in the case of a labour dispute. Unless the disentitlement can be suspended, as in the case of labour dispute (Digest 8.10.0), a disentitlement continues for as long as the condition leading to the disentitlement continues to exist. However, a new ground for disentitlement requires a separate decision.","[question] can you summarize this text in maximum half the words it used, but with the same number of sections that the original text has. Keep the language simple and be sure to define key terms. ===================== [text] 1.7.0 Disentitlement Under the EI legislation, the term ""disentitlement"" has a specific meaning and refers to the situations described below (EI Act 6(1)). Disentitlements are imposed for something the claimant has failed to do to prove entitlement to benefits (EI Act 49(1)), for example, failed to provide information that is crucial to determining if they are entitled to benefits, failed to prove their availability for work, failed to prove they are unemployed. One or more disentitlements can be imposed concurrently, when there is more than one ground for disentitlement. 1.7.1 Effect of disentitlement Disentitlements are imposed for as little as one day, or for an indefinite period of time. In practice, a disentitlement may be imposed on any working day of the week, and continue as long as the situation that led to the disentitlement remains unchanged. If or when the claimant’s situation changes, a decision must be made as to whether the disentitlement can be terminated or rescinded completely. Benefits are not paid, or deemed to be paid, for any days of disentitlement. When a disentitlement covers a full week, it will delay the payment of benefits, and will not reduce the maximum number of weeks that could potentially be paid in the claimant’s benefit period. However, once the benefit period terminates (52 weeks plus any extensions is reached), no further benefits can be paid in that benefit period (Digest 1.4.4). This may mean that a lengthy period of disentitlement, similar to a lengthy period during which earnings are allocated, may in fact, reduce the number of weeks of benefits actually paid to a claimant (CUB 76507). 1.7.2 Grounds for disentitlement Some of the following situations automatically result in disentitlement whereas others are not specifically defined: working a full week (Digest Chapter 4) not available for work (EI Act 18(a); Digest Chapter 10) failure to prove incapacity for work in the case of sickness benefits (EI Act 18(b); EI Regulation 40) minor attachment claimant who ceased work due to incapacity (EI Act 21(1)) loss of employment or inability to resume a previous employment by reason of a labour dispute (EI Act 36); EI Regulation 52; Digest Chapter 8) confinement in a prison or similar institution (EI Act 37(a); EI Regulation 54; Digest 10.11.7) being out of Canada (EI Act 37(b); EI Regulation 55; Digest 10.11.8) non-entitlement of a teacher during the non-teaching period; (EI Regulation 33; Digest Chapter 14) delay in making a renewal or continuing claim (EI Act 50(4); EI Regulation 26(1)) failure to provide information upon request (EI Act 50(5 & 6)) suspension from employment because of misconduct (EI Act 31; Digest Chapter 7) voluntarily taking a leave from employment without just cause (EI Act 32; Digest Chapter 6) voluntarily leaving employment permanently without just cause, or losing employment by reason of their misconduct, within three weeks of termination from that employment (EI Act 33(1); Digest Chapter 6, Digest Chapter 7) not entitled to compassionate care benefits (EI Act 23.1; Digest Chapter 23) not entitled to family caregiver benefits (EI Act 23.2; EI Act 23.3; Digest Chapter 22) having received or being entitled to receive provincial benefits in respect of the birth or adoption of a child under a provincial plan (EI Regulation 76.09; Quebec Parental Insurance Plan) Each of the above grounds will be discussed in detail in subsequent chapters. 1.7.3 Length of disentitlement The legislation does not provide for a half-day disentitlement (EI Act 20). When it is determined that a disentitlement is warranted, the disentitlement must be applied for a minimum of one day. Extenuating circumstances cannot reduce a period of disentitlement; either the claimant meets the entitlement condition or they do not. The reason they may not meet it is not a factor to consider when determining if the condition is met. The start date of the disentitlement may be determined ahead of time, for example in cases where a claimant intends to be absent from Canada for vacation. However, the end of the absence may not always be known. If known, the end date of the disentitlement will be input, and the claimant is not required to contact the Commission upon return, unless there is a change to the end date. If the end date is not known, the claimant must contact the Commission upon their return, to have the end date of the disentitlement reviewed. An ongoing disentitlement may be imposed for less than five days each week. This may be the case, for example, when the disentitlement is related to the availability or capability for work of a claimant, or in the case of a labour dispute. Unless the disentitlement can be suspended, as in the case of labour dispute (Digest 8.10.0), a disentitlement continues for as long as the condition leading to the disentitlement continues to exist. However, a new ground for disentitlement requires a separate decision. https://www.canada.ca/en/employment-social-development/programs/ei/ei-list/reports/digest/chapter-1/disentitlement.html ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Summarize & Simplify,Text Transformation "Answer the questions using only the provided text, do not use any other outside sources for information. Any mention of a Supreme Court Justice by name should be in bold.",What specific concerns did the dissenting Supreme Court Justices have on this ruling?,"JUSTICE BREYER, JUSTICE SOTOMAYOR, and JUSTICE KAGAN, dissenting. For half a century, Roe v. Wade, and Planned Parenthood of Southeastern Pa. v. Casey, have protected the liberty and equality of women. Roe held, and Casey reaffirmed, that the Constitution safeguards a woman’s right to decide for herself whether to bear a child. Roe held, and Casey reaffirmed, that in the first stages of pregnancy, the government could not make that choice for women. The government could not control a woman’s body or the course of a woman’s life: It could not determine what the woman’s future would be. Respecting a woman as an autonomous being, and granting her full equality, meant giving her substantial choice over this most personal and most consequential of all life decisions. Roe and Casey well understood the difficulty and divisiveness of the abortion issue. The Court knew that Americans hold profoundly different views about the “moral[ity]” of “terminating a pregnancy, even in its earliest stage.” And the Court recognized that “the state has legitimate interests from the outset of the pregnancy in protecting” the “life of the fetus that may become a child.” So the Court struck a balance, as it often does when values and goals compete. It held that the State could prohibit abortions after fetal viability, so long as the ban contained exceptions to safeguard a woman’s life or health. It held that even before viability, the State could regulate the abortion procedure in multiple and meaningful ways. But until the viability line was crossed, the Court held, a State could not impose a “substantial obstacle” on a woman’s “right to elect the procedure” as she (not the government) thought proper, in light of all the circumstances and complexities of her own life. Ibid. Today, the Court discards that balance. It says that from the very moment of fertilization, a woman has no rights to speak of. A State can force her to bring a pregnancy to term, even at the steepest personal and familial costs. An abortion restriction, the majority holds, is permissible whenever rational, the lowest level of scrutiny known to the law. And because, as the Court has often stated, protecting fetal life is rational, States will feel free to enact all manner of restrictions. The Mississippi law at issue here bars abortions after the 15th week of pregnancy. Under the majority’s ruling, though, another State’s law could do so after ten weeks, or five or three or one—or, again, from the moment of fertilization. States have already passed such laws, in anticipation of today’s ruling. More will follow. Some States have enacted laws extending to all forms of abortion procedure, including taking medication in one’s own home. They have passed laws without any exceptions for when the woman is the victim of rape or incest. Under those laws, a woman will have to bear her rapist’s child or a young girl her father’s—no matter if doing so will destroy her life. So too, after today’s ruling, some States may compel women to carry to term a fetus with severe physical anomalies—for example, one afflicted with Tay-Sachs disease, sure to die within a few years of birth. States may even argue that a prohibition on abortion need make no provision for protecting a woman from risk of death or physical harm. Across a vast array of circumstances, a State will be able to impose its moral choice on a woman and coerce her to give birth to a child. Enforcement of all these draconian restrictions will also be left largely to the States’ devices. A State can of course impose criminal penalties on abortion providers, including lengthy prison sentences. But some States will not stop there. Perhaps, in the wake of today’s decision, a state law will criminalize the woman’s conduct too, incarcerating or fining her for daring to seek or obtain an abortion. And as Texas has recently shown, a State can turn neighbor against neighbor, enlisting fellow citizens in the effort to root out anyone who tries to get an abortion, or to assist another in doing so. Today’s decision, the majority says, permits “each State” to address abortion as it pleases. That is cold comfort, of course, for the poor woman who cannot get the money to fly to a distant State for a procedure. Above all others, women lacking financial resources will suffer from today’s decision. In any event, interstate restrictions will also soon be in the offing. After this decision, some States may block women from traveling out of State to obtain abortions, or even from receiving abortion medications from out of State. Some may criminalize efforts, including the provision of information or funding, to help women gain access to other States’ abortion services. Most threatening of all, no language in today’s decision stops the Federal Government from prohibiting abortions nationwide, once again from the moment of conception and without exceptions for rape or incest. If that happens, “the views of [an individual State’s] citizens” will not matter. The challenge for a woman will be to finance a trip not to “New York [or] California” but to Toronto. Whatever the exact scope of the coming laws, one result of today’s decision is certain: the curtailment of women’s rights, and of their status as free and equal citizens. Yesterday, the Constitution guaranteed that a woman confronted with an unplanned pregnancy could (within reasonable limits) make her own decision about whether to bear a child, with all the life-transforming consequences that act involves. But no longer. As of today, this Court holds, a State can always force a woman to give birth, prohibiting even the earliest abortions. A State can thus transform what, when freely undertaken, is a wonder into what, when forced, may be a nightmare. Some women, especially women of means, will find ways around the State’s assertion of power. Others—those without money or childcare or the ability to take time off from work—will not be so fortunate. Maybe they will try an unsafe method of abortion, and come to physical harm, or even die. Maybe they will undergo pregnancy and have a child, but at significant personal or familial cost. At the least, they will incur the cost of losing control of their lives. The Constitution will, today’s majority holds, provide no shield, despite its guarantees of liberty and equality for all. And no one should be confident that this majority is done with its work. The right Roe and Casey recognized does not stand alone. To the contrary, the Court has linked it for decades to other settled freedoms involving bodily integrity, familial relationships, and procreation. Most obviously, the right to terminate a pregnancy arose straight out of the right to purchase and use contraception. The majority (or to be more accurate, most of it) is eager to tell us today that nothing it does “cast[s] doubt on precedents that do not concern abortion.” But how could that be? The lone rationale for what the majority does today is that the right to elect an abortion is not “deeply rooted in history”: Not until Roe, the majority argues, did people think abortion fell within the Constitution’s guarantee of liberty. The same could be said, though, of most of the rights the majority claims it is not tampering with. The majority could write just as long an opinion showing, for example, that until the mid-20th century, “there was no support in American law for a constitutional right to obtain [contraceptives].” So one of two things must be true. Either the majority does not really believe in its own reasoning. Or if it does, all rights that have no history stretching back to the mid19th century are insecure. Either the mass of the majority’s opinion is hypocrisy, or additional constitutional rights are under threat. It is one or the other. One piece of evidence on that score seems especially salient: The majority’s cavalier approach to overturning this Court’s precedents. Stare decisis is the Latin phrase for a foundation stone of the rule of law: that things decided should stay decided unless there is a very good reason for change. It is a doctrine of judicial modesty and humility. Those qualities are not evident in today’s opinion. The majority has no good reason for the upheaval in law and society it sets off. Women have reliedon the availability of abortion both in structuring their relationships and in planning their lives. The legal framework Roe and Casey developed to balance the competing interests in this sphere has proved workable in courts across the country. No recent developments, in either law or fact, have eroded or cast doubt on those precedents. Nothing, in short, has changed.","Answer the question below using only the provided text, do not use any other outside sources for information. Any mention of a Supreme Court Justice by name should be in bold. What specific concerns did the dissenting Supreme Court Justices have on this ruling? JUSTICE BREYER, JUSTICE SOTOMAYOR, and JUSTICE KAGAN, dissenting. For half a century, Roe v. Wade, and Planned Parenthood of Southeastern Pa. v. Casey, have protected the liberty and equality of women. Roe held, and Casey reaffirmed, that the Constitution safeguards a woman’s right to decide for herself whether to bear a child. Roe held, and Casey reaffirmed, that in the first stages of pregnancy, the government could not make that choice for women. The government could not control a woman’s body or the course of a woman’s life: It could not determine what the woman’s future would be. Respecting a woman as an autonomous being, and granting her full equality, meant giving her substantial choice over this most personal and most consequential of all life decisions. Roe and Casey well understood the difficulty and divisiveness of the abortion issue. The Court knew that Americans hold profoundly different views about the “moral[ity]” of “terminating a pregnancy, even in its earliest stage.” And the Court recognized that “the state has legitimate interests from the outset of the pregnancy in protecting” the “life of the fetus that may become a child.” So the Court struck a balance, as it often does when values and goals compete. It held that the State could prohibit abortions after fetal viability, so long as the ban contained exceptions to safeguard a woman’s life or health. It held that even before viability, the State could regulate the abortion procedure in multiple and meaningful ways. But until the viability line was crossed, the Court held, a State could not impose a “substantial obstacle” on a woman’s “right to elect the procedure” as she (not the government) thought proper, in light of all the circumstances and complexities of her own life. Ibid. Today, the Court discards that balance. It says that from the very moment of fertilization, a woman has no rights to speak of. A State can force her to bring a pregnancy to term, even at the steepest personal and familial costs. An abortion restriction, the majority holds, is permissible whenever rational, the lowest level of scrutiny known to the law. And because, as the Court has often stated, protecting fetal life is rational, States will feel free to enact all manner of restrictions. The Mississippi law at issue here bars abortions after the 15th week of pregnancy. Under the majority’s ruling, though, another State’s law could do so after ten weeks, or five or three or one—or, again, from the moment of fertilization. States have already passed such laws, in anticipation of today’s ruling. More will follow. Some States have enacted laws extending to all forms of abortion procedure, including taking medication in one’s own home. They have passed laws without any exceptions for when the woman is the victim of rape or incest. Under those laws, a woman will have to bear her rapist’s child or a young girl her father’s—no matter if doing so will destroy her life. So too, after today’s ruling, some States may compel women to carry to term a fetus with severe physical anomalies—for example, one afflicted with Tay-Sachs disease, sure to die within a few years of birth. States may even argue that a prohibition on abortion need make no provision for protecting a woman from risk of death or physical harm. Across a vast array of circumstances, a State will be able to impose its moral choice on a woman and coerce her to give birth to a child. Enforcement of all these draconian restrictions will also be left largely to the States’ devices. A State can of course impose criminal penalties on abortion providers, including lengthy prison sentences. But some States will not stop there. Perhaps, in the wake of today’s decision, a state law will criminalize the woman’s conduct too, incarcerating or fining her for daring to seek or obtain an abortion. And as Texas has recently shown, a State can turn neighbor against neighbor, enlisting fellow citizens in the effort to root out anyone who tries to get an abortion, or to assist another in doing so. Today’s decision, the majority says, permits “each State” to address abortion as it pleases. That is cold comfort, of course, for the poor woman who cannot get the money to fly to a distant State for a procedure. Above all others, women lacking financial resources will suffer from today’s decision. In any event, interstate restrictions will also soon be in the offing. After this decision, some States may block women from traveling out of State to obtain abortions, or even from receiving abortion medications from out of State. Some may criminalize efforts, including the provision of information or funding, to help women gain access to other States’ abortion services. Most threatening of all, no language in today’s decision stops the Federal Government from prohibiting abortions nationwide, once again from the moment of conception and without exceptions for rape or incest. If that happens, “the views of [an individual State’s] citizens” will not matter. The challenge for a woman will be to finance a trip not to “New York [or] California” but to Toronto. Whatever the exact scope of the coming laws, one result of today’s decision is certain: the curtailment of women’s rights, and of their status as free and equal citizens. Yesterday, the Constitution guaranteed that a woman confronted with an unplanned pregnancy could (within reasonable limits) make her own decision about whether to bear a child, with all the life-transforming consequences that act involves. But no longer. As of today, this Court holds, a State can always force a woman to give birth, prohibiting even the earliest abortions. A State can thus transform what, when freely undertaken, is a wonder into what, when forced, may be a nightmare. Some women, especially women of means, will find ways around the State’s assertion of power. Others—those without money or childcare or the ability to take time off from work—will not be so fortunate. Maybe they will try an unsafe method of abortion, and come to physical harm, or even die. Maybe they will undergo pregnancy and have a child, but at significant personal or familial cost. At the least, they will incur the cost of losing control of their lives. The Constitution will, today’s majority holds, provide no shield, despite its guarantees of liberty and equality for all. And no one should be confident that this majority is done with its work. The right Roe and Casey recognized does not stand alone. To the contrary, the Court has linked it for decades to other settled freedoms involving bodily integrity, familial relationships, and procreation. Most obviously, the right to terminate a pregnancy arose straight out of the right to purchase and use contraception. The majority (or to be more accurate, most of it) is eager to tell us today that nothing it does “cast[s] doubt on precedents that do not concern abortion.” But how could that be? The lone rationale for what the majority does today is that the right to elect an abortion is not “deeply rooted in history”: Not until Roe, the majority argues, did people think abortion fell within the Constitution’s guarantee of liberty. The same could be said, though, of most of the rights the majority claims it is not tampering with. The majority could write just as long an opinion showing, for example, that until the mid-20th century, “there was no support in American law for a constitutional right to obtain [contraceptives].” So one of two things must be true. Either the majority does not really believe in its own reasoning. Or if it does, all rights that have no history stretching back to the mid19th century are insecure. Either the mass of the majority’s opinion is hypocrisy, or additional constitutional rights are under threat. It is one or the other. One piece of evidence on that score seems especially salient: The majority’s cavalier approach to overturning this Court’s precedents. Stare decisis is the Latin phrase for a foundation stone of the rule of law: that things decided should stay decided unless there is a very good reason for change. It is a doctrine of judicial modesty and humility. Those qualities are not evident in today’s opinion. The majority has no good reason for the upheaval in law and society it sets off. Women have relied on the availability of abortion both in structuring their relationships and in planning their lives. The legal framework Roe and Casey developed to balance the competing interests in this sphere has proved workable in courts across the country. No recent developments, in either law or fact, have eroded or cast doubt on those precedents. Nothing, in short, has changed. ",Legal,Find & Summarize,Text Transformation Craft your answer only using the information provided in the context block. Keep your answer under 200 words.,How many complaints were within OIG jurisdiction?,"Section 1001 of the USA PATRIOT Act (Patriot Act), Public Law 107-56, directs the Office of the Inspector General (OIG) of the U.S. Department of Justice (DOJ or Department) to undertake a series of actions related to claims of civil rights or civil liberties violations allegedly committed by DOJ employees. It also requires the OIG to provide semiannual reports to Congress on the implementation of the OIG’s responsibilities under Section 1001. This report summarizes the OIG’s Section 1001-related activities from July 1, 2023, through December 31, 2023. Introduction The OIG is an independent entity within DOJ that reports to both the Attorney General and Congress. The OIG’s mission is to investigate allegations of waste, fraud, and abuse in DOJ programs and personnel, and to promote economy and efficiency in DOJ operations. The OIG has jurisdiction to review programs and personnel in all DOJ components, including the Federal Bureau of Investigation (FBI), the Drug Enforcement Administration (DEA), the Federal Bureau of Prisons (BOP), the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), the U.S. Marshals Service (USMS), and the U.S. Attorneys’ Offices.1 The OIG consists of the Immediate Office of the Inspector General and the following divisions and offices: • Audit Division conducts independent audits of Department programs, computer systems, financial statements, and DOJ-awarded grants and contracts. • Evaluation and Inspections Division conducts program and management reviews that involve on-site inspections, statistical analysis, and other techniques to review Department programs and activities. • Investigations Division investigates allegations of bribery, fraud, abuse, civil rights violations, and violations of other criminal laws and administrative procedures that govern Department employees, contractors, and grantees. • Oversight and Review Division blends the skills of attorneys, investigators, and program analysts to investigate or review high profile or sensitive matters involving Department programs or employees. • Information Technology Division executes the OIG’s IT strategic vision and goals by directing technology and business process integration, network administration, implementation of computer hardware and software, cybersecurity, applications development, programming services, policy formulation, and other mission-support activities. Management and Planning Division provides the Inspector General with advice on administrative and fiscal policy and assists OIG components by providing services in the areas of planning, budget, finance, quality assurance, personnel, communications, procurement, facilities, telecommunications, security, and general support. • Office of General Counsel provides legal advice to OIG management and staff. In addition, the office drafts memoranda on issues of law; prepares administrative subpoenas; represents the OIG in personnel, contractual, and legal matters; and responds to Freedom of Information Act requests. The OIG has a staff of approximately 500 employees, about half of whom are based in Washington, D.C. The OIG has 28 Investigations Division field locations and 6 Audit Division regional offices located throughout the country. Section 1001 of the Patriot Act Section 1001 of the Patriot Act provides the following: The DOJ Inspector General shall designate one official who shall― (1) review information and receive complaints alleging abuses of civil rights and civil liberties by DOJ employees and officials; (2) make public through the Internet, radio, television, and newspaper advertisements information on the responsibilities and functions of, and how to contact, the official; and (3) submit to the Committee on the Judiciary of the House of Representatives and the Committee on the Judiciary of the Senate on a semiannual basis a report on the implementation of this subsection and detailing any abuses described in paragraph (1), including a description of the use of funds appropriations used to carry out this subsection. Responsibilities, Functions, and Contact Information of the OIG’s Designated Section 1001 Official The DOJ Inspector General has designated the OIG’s Assistant Inspector General for Investigations as the official responsible for the duties required under Section 1001, which are described in the next section of this report. Civil Rights and Civil Liberties Complaints Section 1001 requires the OIG to “review information and receive complaints alleging abuses of civil rights and civil liberties by employees and officials of the Department of Justice.” While the phrase “civil rights and civil liberties” is not specifically defined in the Patriot Act, the OIG has looked to the “Sense of Congress” provisions in the statute, namely Sections 102 and 1002, for context. Sections 102 and 1002 identify certain ethnic and religious groups who would be vulnerable to abuse due to a possible backlash from the terrorist attacks of September 11, 2001, including Muslims, Arabs, Sikhs, and South Asians. The OIG’s Investigations Division, which is headed by the Assistant Inspector General for Investigations, manages the OIG’s Section 1001 investigative responsibilities. The two units with primary responsibility for coordinating these activities are Operations Branch I and Operations Branch II, each of which is directed by a Special Agent in Charge and two Assistant Special Agents in Charge. In addition, these units are supported by Investigative Specialists and other staff assigned to the Hotline Operations Branch, who divide their time between Section 1001 and other responsibilities. The Investigations Division receives civil rights and civil liberties complaints via mail, email, telephone, and fax. Upon receipt, Division Assistant Special Agents in Charge review the complaints and assign an initial disposition to each matter, and Investigative Specialists enter the complaints alleging a violation within the investigative jurisdiction of the OIG or another federal agency into an OIG database. Serious civil rights and civil liberties allegations relating to actions of DOJ employees or contractors are typically assigned to an OIG Investigations Division field office, where Special Agents conduct investigations of criminal violations and administrative misconduct. Given the number of complaints the OIG receives compared to its limited resources, the OIG does not investigate all allegations of misconduct against DOJ employees. The OIG refers many complaints involving DOJ employees to internal affairs offices in DOJ components such as the FBI Inspection Division, the DEA Office of Professional Responsibility, and the BOP Office of Internal Affairs. In certain referrals, the OIG requires the components to report the results of their investigations to the OIG. In most cases, the OIG notifies the complainant of the referral. Many complaints the OIG receives involve matters outside its jurisdiction. When those matters identify a serious issue for investigation, such as a threat to life or safety, the OIG forwards them to the appropriate investigative entity. In other cases, the complainant is directed to another investigative agency when possible. Allegations related to the authority of a DOJ attorney to litigate, investigate, or provide legal advice are referred to the DOJ Office of Professional Responsibility. Allegations related solely to state and local law enforcement or government officials that raise a federal civil rights concern are forwarded to the DOJ Civil Rights Division. When an allegation received from any source involves a potential violation of federal civil rights statutes by a DOJ employee, the OIG discusses the complaint with the DOJ Civil Rights Division for possible prosecution. In some cases, the Civil Rights Division accepts the case and requests additional investigation by either the OIG or the FBI. In other cases, the Civil Rights Division declines prosecution and either the OIG or the appropriate DOJ internal affairs office reviews the case for possible administrative misconduct. Complaints Processed During This Reporting Period Between July 1, 2023, and December 31, 2023, the period covered by this report, the OIG processed 739 new complaints that were identified by the complainant as civil rights or civil liberties complaints. Of these complaints, 717 did not fall within the OIG’s jurisdiction or did not warrant further investigation. These complaints involved allegations against agencies or entities outside the DOJ, including other federal agencies, local governments, or private businesses, as well as allegations that were not suitable for investigation by the OIG, and could not be or were not referred to another agency for investigation, generally because the complaints failed to identify a subject or agency. The OIG found that the remaining 22 of the 739 complaints it received involved DOJ employees or DOJ components and included allegations that required further review. The OIG determined that 20 of these complaints generally raised management issues unrelated to the OIG’s Section 1001 duties and referred these complaints to DOJ components for appropriate handling. Examples of complaints in this category included allegations by federal prisoners about the general prison conditions, and by others that the FBI did not initiate an investigation into particular allegations. The OIG identified two complaints by federal prisoners that alleged a potential civil rights or civil liberties violation under Section 1001 but, based on the lack of an identified subject or the non-specific nature of the allegations, determined that these complaints generally raised management issues. The OIG referred these complaints to BOP for appropriate handling. ","system instructions: [Craft your answer only using the information provided in the context block. Keep your answer under 200 words.] question: [ How many complaints were within OIG jurisdiction? ] context block: [Section 1001 of the USA PATRIOT Act (Patriot Act), Public Law 107-56, directs the Office of the Inspector General (OIG) of the U.S. Department of Justice (DOJ or Department) to undertake a series of actions related to claims of civil rights or civil liberties violations allegedly committed by DOJ employees. It also requires the OIG to provide semiannual reports to Congress on the implementation of the OIG’s responsibilities under Section 1001. This report summarizes the OIG’s Section 1001-related activities from July 1, 2023, through December 31, 2023. Introduction The OIG is an independent entity within DOJ that reports to both the Attorney General and Congress. The OIG’s mission is to investigate allegations of waste, fraud, and abuse in DOJ programs and personnel, and to promote economy and efficiency in DOJ operations. The OIG has jurisdiction to review programs and personnel in all DOJ components, including the Federal Bureau of Investigation (FBI), the Drug Enforcement Administration (DEA), the Federal Bureau of Prisons (BOP), the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF), the U.S. Marshals Service (USMS), and the U.S. Attorneys’ Offices.1 The OIG consists of the Immediate Office of the Inspector General and the following divisions and offices: • Audit Division conducts independent audits of Department programs, computer systems, financial statements, and DOJ-awarded grants and contracts. • Evaluation and Inspections Division conducts program and management reviews that involve on-site inspections, statistical analysis, and other techniques to review Department programs and activities. • Investigations Division investigates allegations of bribery, fraud, abuse, civil rights violations, and violations of other criminal laws and administrative procedures that govern Department employees, contractors, and grantees. • Oversight and Review Division blends the skills of attorneys, investigators, and program analysts to investigate or review high profile or sensitive matters involving Department programs or employees. • Information Technology Division executes the OIG’s IT strategic vision and goals by directing technology and business process integration, network administration, implementation of computer hardware and software, cybersecurity, applications development, programming services, policy formulation, and other mission-support activities. Management and Planning Division provides the Inspector General with advice on administrative and fiscal policy and assists OIG components by providing services in the areas of planning, budget, finance, quality assurance, personnel, communications, procurement, facilities, telecommunications, security, and general support. • Office of General Counsel provides legal advice to OIG management and staff. In addition, the office drafts memoranda on issues of law; prepares administrative subpoenas; represents the OIG in personnel, contractual, and legal matters; and responds to Freedom of Information Act requests. The OIG has a staff of approximately 500 employees, about half of whom are based in Washington, D.C. The OIG has 28 Investigations Division field locations and 6 Audit Division regional offices located throughout the country. Section 1001 of the Patriot Act Section 1001 of the Patriot Act provides the following: The DOJ Inspector General shall designate one official who shall― (1) review information and receive complaints alleging abuses of civil rights and civil liberties by DOJ employees and officials; (2) make public through the Internet, radio, television, and newspaper advertisements information on the responsibilities and functions of, and how to contact, the official; and (3) submit to the Committee on the Judiciary of the House of Representatives and the Committee on the Judiciary of the Senate on a semiannual basis a report on the implementation of this subsection and detailing any abuses described in paragraph (1), including a description of the use of funds appropriations used to carry out this subsection. Responsibilities, Functions, and Contact Information of the OIG’s Designated Section 1001 Official The DOJ Inspector General has designated the OIG’s Assistant Inspector General for Investigations as the official responsible for the duties required under Section 1001, which are described in the next section of this report. Civil Rights and Civil Liberties Complaints Section 1001 requires the OIG to “review information and receive complaints alleging abuses of civil rights and civil liberties by employees and officials of the Department of Justice.” While the phrase “civil rights and civil liberties” is not specifically defined in the Patriot Act, the OIG has looked to the “Sense of Congress” provisions in the statute, namely Sections 102 and 1002, for context. Sections 102 and 1002 identify certain ethnic and religious groups who would be vulnerable to abuse due to a possible backlash from the terrorist attacks of September 11, 2001, including Muslims, Arabs, Sikhs, and South Asians. The OIG’s Investigations Division, which is headed by the Assistant Inspector General for Investigations, manages the OIG’s Section 1001 investigative responsibilities. The two units with primary responsibility for coordinating these activities are Operations Branch I and Operations Branch II, each of which is directed by a Special Agent in Charge and two Assistant Special Agents in Charge. In addition, these units are supported by Investigative Specialists and other staff assigned to the Hotline Operations Branch, who divide their time between Section 1001 and other responsibilities. The Investigations Division receives civil rights and civil liberties complaints via mail, email, telephone, and fax. Upon receipt, Division Assistant Special Agents in Charge review the complaints and assign an initial disposition to each matter, and Investigative Specialists enter the complaints alleging a violation within the investigative jurisdiction of the OIG or another federal agency into an OIG database. Serious civil rights and civil liberties allegations relating to actions of DOJ employees or contractors are typically assigned to an OIG Investigations Division field office, where Special Agents conduct investigations of criminal violations and administrative misconduct. Given the number of complaints the OIG receives compared to its limited resources, the OIG does not investigate all allegations of misconduct against DOJ employees. The OIG refers many complaints involving DOJ employees to internal affairs offices in DOJ components such as the FBI Inspection Division, the DEA Office of Professional Responsibility, and the BOP Office of Internal Affairs. In certain referrals, the OIG requires the components to report the results of their investigations to the OIG. In most cases, the OIG notifies the complainant of the referral. Many complaints the OIG receives involve matters outside its jurisdiction. When those matters identify a serious issue for investigation, such as a threat to life or safety, the OIG forwards them to the appropriate investigative entity. In other cases, the complainant is directed to another investigative agency when possible. Allegations related to the authority of a DOJ attorney to litigate, investigate, or provide legal advice are referred to the DOJ Office of Professional Responsibility. Allegations related solely to state and local law enforcement or government officials that raise a federal civil rights concern are forwarded to the DOJ Civil Rights Division. When an allegation received from any source involves a potential violation of federal civil rights statutes by a DOJ employee, the OIG discusses the complaint with the DOJ Civil Rights Division for possible prosecution. In some cases, the Civil Rights Division accepts the case and requests additional investigation by either the OIG or the FBI. In other cases, the Civil Rights Division declines prosecution and either the OIG or the appropriate DOJ internal affairs office reviews the case for possible administrative misconduct. Complaints Processed During This Reporting Period Between July 1, 2023, and December 31, 2023, the period covered by this report, the OIG processed 739 new complaints that were identified by the complainant as civil rights or civil liberties complaints. Of these complaints, 717 did not fall within the OIG’s jurisdiction or did not warrant further investigation. These complaints involved allegations against agencies or entities outside the DOJ, including other federal agencies, local governments, or private businesses, as well as allegations that were not suitable for investigation by the OIG, and could not be or were not referred to another agency for investigation, generally because the complaints failed to identify a subject or agency. The OIG found that the remaining 22 of the 739 complaints it received involved DOJ employees or DOJ components and included allegations that required further review. The OIG determined that 20 of these complaints generally raised management issues unrelated to the OIG’s Section 1001 duties and referred these complaints to DOJ components for appropriate handling. Examples of complaints in this category included allegations by federal prisoners about the general prison conditions, and by others that the FBI did not initiate an investigation into particular allegations. The OIG identified two complaints by federal prisoners that alleged a potential civil rights or civil liberties violation under Section 1001 but, based on the lack of an identified subject or the non-specific nature of the allegations, determined that these complaints generally raised management issues. The OIG referred these complaints to BOP for appropriate handling.] ",Legal,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",I think Bitcoin is very interesting and want to buy some cryptocurrency but I have no idea of the best time. I live in CA and get paid at the first of the month. What is my best strategy?,"What is the Best Time to Buy Cryptocurrency? It’s traded 24 hours a day, 7 days a week by investors located all around the world. Cryptocurrency is a volatile market that can offer opportunities to make - or lose - significant sums of money What is the Best Time to Buy Cryptocurrency? There are many methods that equity investors use to decide when to execute a trade in the stock markets, but the same rules and trading patterns don’t always apply to cryptocurrency. It’s true that cryptocurrency buyers can make purchases within certain windows to get the best possible price. Still, the volatility of the cryptocurrency market makes it very difficult to identify reliable patterns and choose positions accordingly. Unlike other assets, trading cryptocurrency has very low barriers to entry with tokens with a range of values. Rising inflation has also caused many to invest as a way to increase ancillary income. The allure of potentially turning a small investment into millions has also led others to try their luck with digital assets. Lastly, the constant hype around cryptocurrencies has caused even some crypto skeptics to look more closely out of FOMO (the Fear Of Missing Out). Buying cryptocurrency requires individuals to use a crypto wallet that can interact with the blockchain that tracks cryptocurrencies. The easiest way to do this is through an online cryptocurrency exchange platform. There are many to choose from, but exchange fees can vary widely. Make sure to take all fees into account before you buy cryptocurrency. Additionally, the transaction costs to record your transaction to the distributed ledger that is the blockchain can also vary due to the demand on computing power, energy, or volume of transactions that can impact your bottom line. However, with the volatility in trading cryptocurrency, those who want to start investing in cryptocurrency often wonder when is the best time to buy cryptocurrency? Key Highlights Many investors, some less experienced than others, are buying cryptocurrencies due to the hype, “fear-of-missing-out,” and low barrier to entry. Choosing the right positions can make or break an investment strategy, and the volatility of cryptocurrency makes it difficult to identify patterns and investment triggers. There are certain times that are better for trading cryptocurrency than others, but ultimately the best time to buy crypto is when the buyer is feeling confident in their strategy and financially ready to make a move. Best Time of the Day to Buy Cryptocurrency One of the perks of trading cryptocurrency is that you can buy it whenever you want. But many investors buy and sell cryptocurrencies during the same hours that the New York Stock Exchange (“NYSE”) is open. But since you can buy and sell crypto at all hours of the day, you’ll need to know which hours are better for buying cryptocurrency. Through analyzing months of data, you’ll begin to notice daily trends. Paying attention to cryptocurrencies with higher market capitalizations like Bitcoin, Ether, and Solana can also help newer investors determine better times of day to trade since cryptocurrency prices tend to rise and fall together. Experts say the best time of day to buy cryptocurrency is early in the morning before the NYSE opens since values tend to rise as the day goes on. Be sure to pay attention to slight daily fluctuations across different cryptocurrencies since trends will vary from coin to coin. Best Time of the Week to Buy Cryptocurrency Now that you’re getting used to setting your alarm bright and early to watch cryptocurrency trends, you may begin to notice longer patterns from week to week. Prices are lower when the market is less busy. Although you can trade cryptocurrencies at any time of day, the market is more active during typical work hours and less active early in the morning, at night, and on the weekends. Generally, cryptocurrency prices start low on Monday and rise throughout the week. When the weekend hits, prices tend to drop until market activity begins the following Monday. Since prices are likely to be at their lowest point following a weekend of low trading activity, Monday is the best time of the week to buy cryptocurrency. Best Time of the Month to Buy Cryptocurrency Pricing trends carry on as weeks turn into months, and new trading patterns emerge that raise and lower the price of various cryptocurrencies over time. Since crypto trends are constantly in flux, deciding the best time of the month to buy cryptocurrency will require patience as you get to know the pricing trends of your favorite coins. For now, the best time to buy cryptocurrency is toward the end of the month. Cryptocurrency prices tend to rise in the first weeks of the month before they collapse and continue to trend downward through the end of the month. It’s worth reiterating again that cryptocurrencies are notorious for their volatility, which means patterns and trends that are true one month can vary widely the next. It takes time and diligence to learn how to follow cryptocurrency values and market fluctuations. How to Time the Cryptocurrency Market Here’s a quick recap to help you learn how to time the cryptocurrency market and get the best possible prices: Cryptocurrencies are most active during the work week, with prices starting low on Monday morning and steadily rising until they drop over the weekend. Pay attention to stock market trading hours as they have an effect on cryptocurrency trading, even though you can buy and sell cryptocurrencies 24/7. Be aware of your risk tolerance by forecasting your cash flow and watching cryptocurrency market trends. The Best Time to Buy Cryptocurrency It can be difficult to time the cryptocurrency market due to its volatile nature, but there are times that are better for buying cryptocurrencies than others. Just as with any other investment, cryptocurrency buyers should be aware of their risk tolerance and market conditions. But some trading strategies that work well on the stock exchange may not translate into profits for cryptocurrency trades. The best time to buy cryptocurrency is whenever you’re ready to start investing. Don’t put more into your investment than you are willing to lose, and keep in mind the rule of dollar-cost averaging. Once you’ve decided on a position, use this guide to decide when the best time to enter the cryptocurrency market is for you.","[question] I think Bitcoin is very interesting and want to buy some cryptocurrency but I have no idea of the best time. I live in CA and get paid at the first of the month. What is my best strategy? ===================== [text] What is the Best Time to Buy Cryptocurrency? It’s traded 24 hours a day, 7 days a week by investors located all around the world. Cryptocurrency is a volatile market that can offer opportunities to make - or lose - significant sums of money What is the Best Time to Buy Cryptocurrency? There are many methods that equity investors use to decide when to execute a trade in the stock markets, but the same rules and trading patterns don’t always apply to cryptocurrency. It’s true that cryptocurrency buyers can make purchases within certain windows to get the best possible price. Still, the volatility of the cryptocurrency market makes it very difficult to identify reliable patterns and choose positions accordingly. Unlike other assets, trading cryptocurrency has very low barriers to entry with tokens with a range of values. Rising inflation has also caused many to invest as a way to increase ancillary income. The allure of potentially turning a small investment into millions has also led others to try their luck with digital assets. Lastly, the constant hype around cryptocurrencies has caused even some crypto skeptics to look more closely out of FOMO (the Fear Of Missing Out). Buying cryptocurrency requires individuals to use a crypto wallet that can interact with the blockchain that tracks cryptocurrencies. The easiest way to do this is through an online cryptocurrency exchange platform. There are many to choose from, but exchange fees can vary widely. Make sure to take all fees into account before you buy cryptocurrency. Additionally, the transaction costs to record your transaction to the distributed ledger that is the blockchain can also vary due to the demand on computing power, energy, or volume of transactions that can impact your bottom line. However, with the volatility in trading cryptocurrency, those who want to start investing in cryptocurrency often wonder when is the best time to buy cryptocurrency? Key Highlights Many investors, some less experienced than others, are buying cryptocurrencies due to the hype, “fear-of-missing-out,” and low barrier to entry. Choosing the right positions can make or break an investment strategy, and the volatility of cryptocurrency makes it difficult to identify patterns and investment triggers. There are certain times that are better for trading cryptocurrency than others, but ultimately the best time to buy crypto is when the buyer is feeling confident in their strategy and financially ready to make a move. Best Time of the Day to Buy Cryptocurrency One of the perks of trading cryptocurrency is that you can buy it whenever you want. But many investors buy and sell cryptocurrencies during the same hours that the New York Stock Exchange (“NYSE”) is open. But since you can buy and sell crypto at all hours of the day, you’ll need to know which hours are better for buying cryptocurrency. Through analyzing months of data, you’ll begin to notice daily trends. Paying attention to cryptocurrencies with higher market capitalizations like Bitcoin, Ether, and Solana can also help newer investors determine better times of day to trade since cryptocurrency prices tend to rise and fall together. Experts say the best time of day to buy cryptocurrency is early in the morning before the NYSE opens since values tend to rise as the day goes on. Be sure to pay attention to slight daily fluctuations across different cryptocurrencies since trends will vary from coin to coin. Best Time of the Week to Buy Cryptocurrency Now that you’re getting used to setting your alarm bright and early to watch cryptocurrency trends, you may begin to notice longer patterns from week to week. Prices are lower when the market is less busy. Although you can trade cryptocurrencies at any time of day, the market is more active during typical work hours and less active early in the morning, at night, and on the weekends. Generally, cryptocurrency prices start low on Monday and rise throughout the week. When the weekend hits, prices tend to drop until market activity begins the following Monday. Since prices are likely to be at their lowest point following a weekend of low trading activity, Monday is the best time of the week to buy cryptocurrency. Best Time of the Month to Buy Cryptocurrency Pricing trends carry on as weeks turn into months, and new trading patterns emerge that raise and lower the price of various cryptocurrencies over time. Since crypto trends are constantly in flux, deciding the best time of the month to buy cryptocurrency will require patience as you get to know the pricing trends of your favorite coins. For now, the best time to buy cryptocurrency is toward the end of the month. Cryptocurrency prices tend to rise in the first weeks of the month before they collapse and continue to trend downward through the end of the month. It’s worth reiterating again that cryptocurrencies are notorious for their volatility, which means patterns and trends that are true one month can vary widely the next. It takes time and diligence to learn how to follow cryptocurrency values and market fluctuations. How to Time the Cryptocurrency Market Here’s a quick recap to help you learn how to time the cryptocurrency market and get the best possible prices: Cryptocurrencies are most active during the work week, with prices starting low on Monday morning and steadily rising until they drop over the weekend. Pay attention to stock market trading hours as they have an effect on cryptocurrency trading, even though you can buy and sell cryptocurrencies 24/7. Be aware of your risk tolerance by forecasting your cash flow and watching cryptocurrency market trends. The Best Time to Buy Cryptocurrency It can be difficult to time the cryptocurrency market due to its volatile nature, but there are times that are better for buying cryptocurrencies than others. Just as with any other investment, cryptocurrency buyers should be aware of their risk tolerance and market conditions. But some trading strategies that work well on the stock exchange may not translate into profits for cryptocurrency trades. The best time to buy cryptocurrency is whenever you’re ready to start investing. Don’t put more into your investment than you are willing to lose, and keep in mind the rule of dollar-cost averaging. Once you’ve decided on a position, use this guide to decide when the best time to enter the cryptocurrency market is for you. https://corporatefinanceinstitute.com/resources/cryptocurrency/best-time-to-buy-cryptocurrency/#:~:text=Prices%20are%20lower%20when%20the,and%20rise%20throughout%20the%20week. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Financial,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",I am bored and don't have time to read this. Please lay this text out to me in layman's terms. Write it from a first-person perspective of Mr Comey talking about what he thinks about the Russia investigation. And sum it up in 6-8 good bullet points.,"TESTIMONY OF JAMES COMEY, FORMER DIRECTOR, FEDERAL BUREAU OF INVESTIGATION Chairman BURR. Director Comey, you’re now under oath. And I would just note to members, you will be recognized by seniority for a period up to seven minutes. And again, it is the intent to move to a closed session no later than 1:00 p.m. With that, Director Comey, you are recognized. You have the floor for as long as you might need. Director COMEY. Thank you. Mr. Chairman, Ranking Member Warner, members of the committee: Thank you for inviting me here to testify today. I’ve submitted my statement for the record and I’m not going to repeat it here this morning. I thought I would just offer some very brief introductory remarks and then I would welcome your questions. When I was appointed FBI Director in 2013, I understood that I served at the pleasure of the President. Even though I was appointed to a 10-year term, which Congress created in order to underscore the importance of the FBI being outside of politics and independent, I understood that I could be fired by a President for any reason or for no reason at all. And on May the 9th, when I learned that I had been fired, for that reason I immediately came home as a private citizen. But then the explanations, the shifting explanations, confused me and increasingly concerned me. They confused me because the President and I had had multiple conversations about my job, both before and after he took office, and he had repeatedly told me I was doing a great job and he hoped I would stay. And I had repeatedly assured him that I did intend to stay and serve out the remaining six years of my term. He told me repeatedly that he had talked to lots of people about me, including our current Attorney General, and had learned that I was doing a great job and that I was extremely well-liked by the FBI workforce. So it confused me when I saw on television the President saying that he actually fired me because of the Russia investigation and learned, again from the media, that he was telling privately other parties that my firing had relieved great pressure on the Russia investigation. I was also confused by the initial explanation that was offered publicly, that I was fired because of the decisions I had made during the election year. That didn’t make sense to me for a whole bunch of reasons, including the time and all the water that had gone under the bridge since those hard decisions that had to be made. That didn’t make any sense to me. And although the law required no reason at all to fire an FBI Director, the Administration then chose to defame me and, more importantly, the FBI by saying that the organization was in disarray, that it was poorly led, that the workforce had lost confidence in its leader. Those were lies, plain and simple, and I am so sorry that the FBI workforce had to hear them and I’m so sorry that the American people were told them. I worked every day at the FBI to help make that great organization better. And I say ‘‘help’’ because I did nothing alone at the FBI. There are no indispensable people at the FBI. The organization’s great strength is that its values and abilities run deep and wide. The FBI will be fine without me. The FBI’s mission will be relentlessly pursued by its people and that mission is to protect the American people and uphold the Constitution of the United States. I will deeply miss being part of that mission, but this organization and its mission will go on long beyond me and long beyond any particular administration. I have a message before I close for my former colleagues at the FBI. But first I want the American people to know this truth: The FBI is honest. The FBI is strong. And the FBI is and always will be independent. And now to my former colleagues, if I may. I am so sorry that I didn’t get the chance to say goodbye to you properly. It was the honor of my life to serve beside you, to be part of the FBI family. And I will miss it for the rest of my life. Thank you for standing watch. Thank you for doing so much good for this country. Do that good as long as ever you can. And, Senators, I look forward to your questions. Chairman BURR. Director, thank you for that testimony, both oral and the written testimony that you provided to the committee yesterday and made public to the American people. The Chair would recognize himself first for 12 minutes, Vice Chair for 12 minutes, based upon the agreement we have. Director, did the Special Counsel’s Office review and/or edit your written testimony? Director COMEY. No. Chairman BURR. Do you have any doubt that Russia attempted to interfere in the 2016 elections? Director COMEY. None.","[question] I am bored and don't have time to read this. Please lay this text out to me in layman's terms. Write it from a first-person perspective of Mr Comey talking about what he thinks about the Russia investigation. And sum it up in 6-8 good bullet points. ===================== [text] TESTIMONY OF JAMES COMEY, FORMER DIRECTOR, FEDERAL BUREAU OF INVESTIGATION Chairman BURR. Director Comey, you’re now under oath. And I would just note to members, you will be recognized by seniority for a period up to seven minutes. And again, it is the intent to move to a closed session no later than 1:00 p.m. With that, Director Comey, you are recognized. You have the floor for as long as you might need. Director COMEY. Thank you. Mr. Chairman, Ranking Member Warner, members of the committee: Thank you for inviting me here to testify today. I’ve submitted my statement for the record and I’m not going to repeat it here this morning. I thought I would just offer some very brief introductory remarks and then I would welcome your questions. When I was appointed FBI Director in 2013, I understood that I served at the pleasure of the President. Even though I was appointed to a 10-year term, which Congress created in order to underscore the importance of the FBI being outside of politics and independent, I understood that I could be fired by a President for any reason or for no reason at all. And on May the 9th, when I learned that I had been fired, for that reason I immediately came home as a private citizen. But then the explanations, the shifting explanations, confused me and increasingly concerned me. They confused me because the President and I had had multiple conversations about my job, both before and after he took office, and he had repeatedly told me I was doing a great job and he hoped I would stay. And I had repeatedly assured him that I did intend to stay and serve out the remaining six years of my term. He told me repeatedly that he had talked to lots of people about me, including our current Attorney General, and had learned that I was doing a great job and that I was extremely well-liked by the FBI workforce. So it confused me when I saw on television the President saying that he actually fired me because of the Russia investigation and learned, again from the media, that he was telling privately other parties that my firing had relieved great pressure on the Russia investigation. I was also confused by the initial explanation that was offered publicly, that I was fired because of the decisions I had made during the election year. That didn’t make sense to me for a whole bunch of reasons, including the time and all the water that had gone under the bridge since those hard decisions that had to be made. That didn’t make any sense to me. And although the law required no reason at all to fire an FBI Director, the Administration then chose to defame me and, more importantly, the FBI by saying that the organization was in disarray, that it was poorly led, that the workforce had lost confidence in its leader. Those were lies, plain and simple, and I am so sorry that the FBI workforce had to hear them and I’m so sorry that the American people were told them. I worked every day at the FBI to help make that great organization better. And I say ‘‘help’’ because I did nothing alone at the FBI. There are no indispensable people at the FBI. The organization’s great strength is that its values and abilities run deep and wide. The FBI will be fine without me. The FBI’s mission will be relentlessly pursued by its people and that mission is to protect the American people and uphold the Constitution of the United States. I will deeply miss being part of that mission, but this organization and its mission will go on long beyond me and long beyond any particular administration. I have a message before I close for my former colleagues at the FBI. But first I want the American people to know this truth: The FBI is honest. The FBI is strong. And the FBI is and always will be independent. And now to my former colleagues, if I may. I am so sorry that I didn’t get the chance to say goodbye to you properly. It was the honor of my life to serve beside you, to be part of the FBI family. And I will miss it for the rest of my life. Thank you for standing watch. Thank you for doing so much good for this country. Do that good as long as ever you can. And, Senators, I look forward to your questions. Chairman BURR. Director, thank you for that testimony, both oral and the written testimony that you provided to the committee yesterday and made public to the American people. The Chair would recognize himself first for 12 minutes, Vice Chair for 12 minutes, based upon the agreement we have. Director, did the Special Counsel’s Office review and/or edit your written testimony? Director COMEY. No. Chairman BURR. Do you have any doubt that Russia attempted to interfere in the 2016 elections? Director COMEY. None. https://www.govinfo.gov/content/pkg/CHRG-115shrg25890/pdf/CHRG-115shrg25890.pdf ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Summarize & Format,Text Transformation Using only information found in the provided context answer the prompt's question using a summary paragraph followed by a bulleted list The bulleted list should be concise but detailed enough that it covers all aspect of the line item. A conclusion paragraph should be included that is no more than 3 sentences and leaves the conversation open for discussion.,Summarize the benefit that enhanced firewall capabilities can have on network security.,"Cloud Access Security Broker (CASB) Given the increasing subscription to multiple clouds in many enterprises, one of the most important pieces of software is the cloud access security broker (CASB). It sits on the network between the cloud service customers (CSC) and the cloud service providers (CSP). The evolution of CASB functionality can be traced as follows [3]: • The primary function of the first generation of CASBs was the discovery of resources. They provided visibility into all of the cloud resources that the enterprise users accessed, thus preventing or minimizing the chances of shadow IT. Shadow IT is the practice of some users using cloud applications that are not authorized by the enterprise IT management from home or the office using enterprise desktops. An example of this is the use of unapproved software as-a-service (SaaS) applications for file sharing, social media, collaboration, and web conferencing [4]. This generation of CASBs also provides some statistics, such as software-as-a-service (SaaS) utilization. • The current generation of CASBs enforces security and governance policies for cloud applications, thus enabling enterprises to extend their on-premises policies to the cloud. Specific security services provided by CASBs include: o Protection of enterprise data that live in cloud service providers’ servers (due to SaaS or IaaS subscriptions), as well as data inflow and data outflow (i.e., Data Loss Prevention [DLP] capabilities) from those servers. o Tracking of threats, such as account hijacking and other malicious activities, some of which can detect anomalies in users’ cloud access behavior (through robust User and Entity Behavior Analytics (UEBA) functionality) and stop insider threats and advanced cyberattacks [5]. o Detection of misconfigurations in the enterprise’s subscribed IaaS and cloud servers. These misconfigurations pose serious security risks, such as data breaches. Alerts generated by CASB due to misconfigurations in the enterprise’s IaaS deployments direct the enterprise to follow guidelines, such as the Center for Internet Security’s (CIS) benchmarks for public cloud services, thus improving the overall security profile of the enterprise for cloud access [4]. Enhanced Firewall Capabilities The security functions in firewalls have enlarged alongside the changing network landscape. Firewalls started as hardware appliances that prevented network packets from a device with a particular network location (e.g., combination of Internet Protocol (IP) address and port) in one 8 NIST SP 800-215 November 2022 Guide to a Secure Enterprise Network Landscape subnet (e.g., external network or internet) from accessing a device on another network location or subnet (e.g., intranet or Demilitarized Zone (DMZ) or corporate network). In that setup, it primarily secured a network perimeter. The evolution of firewall functions can be traced based on the following feature sets [6]: • Packet filters and network address translation: Packet filtering and Network address translation (NAT) are used to monitor and control packets moving across a network interface, apply predetermined security rules, and obscure the internal network from the public internet. • Stateful inspection: Stateful firewalling, also known as dynamic packet filtering, monitors the state of connections and makes determinations as to what types of data packets belong to a known active connection and can be allowed to pass through the firewall. • Deep packet inspection (DPI): This feature, also known as packet sniffing, examines the content of packets (both the header and the payload, unlike the stateful inspection that inspects only the packet header). In addition to the capability provided by stateful inspection, this has capabilities related to finding hidden threats within the data stream, such as attempts at data exfiltration, violations of content policies, malware, and more. • Threat detection and response: Modern firewalls can gather and analyze enough data across multiple packets and sessions to detect threats and security incidents targeted at a particular system or a family of systems. These data from multiple firewalls can also be directed toward security information and event management (SIEM) and correlated with data from other security tools and IT systems to detect enterprise-wide attacks that span multiple systems and network layers. In addition, these data can be used to understand evolving threats and define new access rules, attack patterns, and defensive strategies [6]. • Logging and auditing capabilities: Logging and auditing capabilities result in the construction of network events that can be used to identify patterns of performance and security issues. • Access control functions: Access control functions enforce granular sophisticated access control policies. • Multiple locations and functions: Firewalls reside at different locations to perform different functions. Firewalls at the network edge perform the network perimeter protection function by filtering disallowed sources and destinations and blocking the packets of potential threats. Firewalls inside a data center can segment the internal network to prevent the lateral movement of traffic and isolate sensitive resources (e.g., services and data stores). Device-based firewalls prevent malicious traffic in and out of endpoints. • Open Application Programming Interfaces (APIs): These enable integration with many networking products that provide additional security capabilities. • Policy Composition Capabilities: Some firewalls can have the capabilities to merge policies at enforcement time so as to ensure that consistent policies are applied to different classes of users (e.g., those on-premises and on private and public clouds). • Web application firewalls (WAF): This class of firewalls has been used ever since web applications accessed through web protocols, such as Hypertext Transfer Protocol 9 NIST SP 800-215 November 2022 Guide to a Secure Enterprise Network Landscape (HTTP), came into existence. A feature advancement in this class of firewalls is advanced Uniform Resource Locator (URL) filtering. This is the ability to detect traffic from malicious URLs and prevent web-based threats and attacks by receiving real-time data analyzed by machine learning algorithms [7][8]. Specifically, this class of firewalls can inspect threat vectors for SQL Injection, operating system (OS) command injections, and cross-site scripting attacks, as well as prevent inbound attacks. They are used in content delivery networks (CDN) and to prevent distributed denial-of-service (DDoS) attacks. Some additional features found in this class of firewalls are: a. Ability to specify an allowable list of services (control at the application level) b. Traffic matches the intent of allowed ports c. Filtering of some unwanted protocols Appliance-set with Integrated Functions • Unified threat management (or UTMs): UTM devices combine many of the most critical security functions – firewall, IPS, VPN concentrator, gateway antivirus, content filtering, and WAN load balancing – into a single device, usually with a unified management console. • Next-generation firewall (NGFW): The distinguishing feature of NGFW is application data awareness. It can look at data not only at layers 3 and 4 of an Open Systems Interconnection (OSI) stack but also at layer 7 – the application level. Its capabilities extend beyond packet filtering and stateful inspection. There are multiple deployment options available for NGFWs, such as an appliance in the data center, as a software running in a VM in a cloud, or as a cloud service (FWaaS). Some capabilities of NGFW include [9]: a. Deep Packet Inspection (DPI) b. TLS decryption and inspection of packet payload c. Intrusion prevention system (IPS) feature • Web application and API protection (WAAP): This is a comprehensive security approach and an enhancement over WAF. WAF is an integral component for API security, BOT (abbreviation for Robot) defense, and DDOS protection. a. These can be offered as a product suite or as a cloud-based service [10][11]. b. Secure web gateway (SWGs): SWGs are appliances utilized for policy-based access to and control of cloud-based applications as well as governance of access to the open web for enterprise users in ubiquitous locations (e.g., headquarters, branch offices, home, remote locations). An SWG is fundamentally a web filter that protects outbound user traffic through HTTP or Hypertext Transfer Protocol Secure (HTTPS) inspection [12]. It also protects user endpoints from web-based threats that can occur when users click on links to malicious websites or to websites infected with malware. They centralize control, visibility, and reporting across many locations and types of users. They are not a replacement for WAFs, 10 NIST SP 800-215 November 2022 Network Security Automation Tools Guide to a Secure Enterprise Network Landscape which protect websites housed in enterprise data centers and large headquarter sites from inbound attacks.","Using only information available from the text below, summarize the benefit that enhanced firewall capabilities can have on network security. The summary should be written in a single paragraph that is followed by a bulleted list that highlights the key points required to answering the question. The bullet points should be concise but descriptive. Include a conclusion that is no more than 3 sentences long and leaves the response open to discussion. Cloud Access Security Broker (CASB) Given the increasing subscription to multiple clouds in many enterprises, one of the most important pieces of software is the cloud access security broker (CASB). It sits on the network between the cloud service customers (CSC) and the cloud service providers (CSP). The evolution of CASB functionality can be traced as follows [3]: • The primary function of the first generation of CASBs was the discovery of resources. They provided visibility into all of the cloud resources that the enterprise users accessed, thus preventing or minimizing the chances of shadow IT. Shadow IT is the practice of some users using cloud applications that are not authorized by the enterprise IT management from home or the office using enterprise desktops. An example of this is the use of unapproved software as-a-service (SaaS) applications for file sharing, social media, collaboration, and web conferencing [4]. This generation of CASBs also provides some statistics, such as software-as-a-service (SaaS) utilization. • The current generation of CASBs enforces security and governance policies for cloud applications, thus enabling enterprises to extend their on-premises policies to the cloud. Specific security services provided by CASBs include: o Protection of enterprise data that live in cloud service providers’ servers (due to SaaS or IaaS subscriptions), as well as data inflow and data outflow (i.e., Data Loss Prevention [DLP] capabilities) from those servers. o Tracking of threats, such as account hijacking and other malicious activities, some of which can detect anomalies in users’ cloud access behavior (through robust User and Entity Behavior Analytics (UEBA) functionality) and stop insider threats and advanced cyberattacks [5]. o Detection of misconfigurations in the enterprise’s subscribed IaaS and cloud servers. These misconfigurations pose serious security risks, such as data breaches. Alerts generated by CASB due to misconfigurations in the enterprise’s IaaS deployments direct the enterprise to follow guidelines, such as the Center for Internet Security’s (CIS) benchmarks for public cloud services, thus improving the overall security profile of the enterprise for cloud access [4]. Enhanced Firewall Capabilities The security functions in firewalls have enlarged alongside the changing network landscape. Firewalls started as hardware appliances that prevented network packets from a device with a particular network location (e.g., combination of Internet Protocol (IP) address and port) in one 8 NIST SP 800-215 November 2022 Guide to a Secure Enterprise Network Landscape subnet (e.g., external network or internet) from accessing a device on another network location or subnet (e.g., intranet or Demilitarized Zone (DMZ) or corporate network). In that setup, it primarily secured a network perimeter. The evolution of firewall functions can be traced based on the following feature sets [6]: • Packet filters and network address translation: Packet filtering and Network address translation (NAT) are used to monitor and control packets moving across a network interface, apply predetermined security rules, and obscure the internal network from the public internet. • Stateful inspection: Stateful firewalling, also known as dynamic packet filtering, monitors the state of connections and makes determinations as to what types of data packets belong to a known active connection and can be allowed to pass through the firewall. • Deep packet inspection (DPI): This feature, also known as packet sniffing, examines the content of packets (both the header and the payload, unlike the stateful inspection that inspects only the packet header). In addition to the capability provided by stateful inspection, this has capabilities related to finding hidden threats within the data stream, such as attempts at data exfiltration, violations of content policies, malware, and more. • Threat detection and response: Modern firewalls can gather and analyze enough data across multiple packets and sessions to detect threats and security incidents targeted at a particular system or a family of systems. These data from multiple firewalls can also be directed toward security information and event management (SIEM) and correlated with data from other security tools and IT systems to detect enterprise-wide attacks that span multiple systems and network layers. In addition, these data can be used to understand evolving threats and define new access rules, attack patterns, and defensive strategies [6]. • Logging and auditing capabilities: Logging and auditing capabilities result in the construction of network events that can be used to identify patterns of performance and security issues. • Access control functions: Access control functions enforce granular sophisticated access control policies. • Multiple locations and functions: Firewalls reside at different locations to perform different functions. Firewalls at the network edge perform the network perimeter protection function by filtering disallowed sources and destinations and blocking the packets of potential threats. Firewalls inside a data center can segment the internal network to prevent the lateral movement of traffic and isolate sensitive resources (e.g., services and data stores). Device-based firewalls prevent malicious traffic in and out of endpoints. • Open Application Programming Interfaces (APIs): These enable integration with many networking products that provide additional security capabilities. • Policy Composition Capabilities: Some firewalls can have the capabilities to merge policies at enforcement time so as to ensure that consistent policies are applied to different classes of users (e.g., those on-premises and on private and public clouds). • Web application firewalls (WAF): This class of firewalls has been used ever since web applications accessed through web protocols, such as Hypertext Transfer Protocol 9 NIST SP 800-215 November 2022 Guide to a Secure Enterprise Network Landscape (HTTP), came into existence. A feature advancement in this class of firewalls is advanced Uniform Resource Locator (URL) filtering. This is the ability to detect traffic from malicious URLs and prevent web-based threats and attacks by receiving real-time data analyzed by machine learning algorithms [7][8]. Specifically, this class of firewalls can inspect threat vectors for SQL Injection, operating system (OS) command injections, and cross-site scripting attacks, as well as prevent inbound attacks. They are used in content delivery networks (CDN) and to prevent distributed denial-of-service (DDoS) attacks. Some additional features found in this class of firewalls are: a. Ability to specify an allowable list of services (control at the application level) b. Traffic matches the intent of allowed ports c. Filtering of some unwanted protocols Appliance-set with Integrated Functions • Unified threat management (or UTMs): UTM devices combine many of the most critical security functions – firewall, IPS, VPN concentrator, gateway antivirus, content filtering, and WAN load balancing – into a single device, usually with a unified management console. • Next-generation firewall (NGFW): The distinguishing feature of NGFW is application data awareness. It can look at data not only at layers 3 and 4 of an Open Systems Interconnection (OSI) stack but also at layer 7 – the application level. Its capabilities extend beyond packet filtering and stateful inspection. There are multiple deployment options available for NGFWs, such as an appliance in the data center, as a software running in a VM in a cloud, or as a cloud service (FWaaS). Some capabilities of NGFW include [9]: a. Deep Packet Inspection (DPI) b. TLS decryption and inspection of packet payload c. Intrusion prevention system (IPS) feature • Web application and API protection (WAAP): This is a comprehensive security approach and an enhancement over WAF. WAF is an integral component for API security, BOT (abbreviation for Robot) defense, and DDOS protection. a. These can be offered as a product suite or as a cloud-based service [10][11]. b. Secure web gateway (SWGs): SWGs are appliances utilized for policy-based access to and control of cloud-based applications as well as governance of access to the open web for enterprise users in ubiquitous locations (e.g., headquarters, branch offices, home, remote locations). An SWG is fundamentally a web filter that protects outbound user traffic through HTTP or Hypertext Transfer Protocol Secure (HTTPS) inspection [12]. It also protects user endpoints from web-based threats that can occur when users click on links to malicious websites or to websites infected with malware. They centralize control, visibility, and reporting across many locations and types of users. They are not a replacement for WAFs, 10 NIST SP 800-215 November 2022 Network Security Automation Tools Guide to a Secure Enterprise Network Landscape which protect websites housed in enterprise data centers and large headquarter sites from inbound attacks. ",Internet/Technology,Summarize & Format,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",Tell me the advantages and disadvantages of smartphones in our lives with one or two sentences for each one. Also give me three examples for healthcare services of smartphones and one example of being dangerous for our lives.,"We are living in the era of gadgets and smartphones, and communication has never been so easy; with social media, we’re always connected to our friends and millions of other people, no matter where we are. All we need is a smartphone with an internet connection. Mobile phones have become part of our daily lives and besides communication, we have available a vast variety of apps that can make our daily life a lot easier. Though the cost of app development is rising, the number of apps in app stores is increasing. Some of these apps had been optimized for mobile apps stores so that we can find them easier. However, being in the business of making apps, we must question what’s the impact of mobile phones in our lives and society? In this article, we’ll look into what are the positive and negative effects of using mobile phones on a daily basis. Negative effects of mobile phones in our lives 1. Waste of time As much we love what nowadays smartphones can do for us, this technology also has a downside. A recent study from the digital analytic firm Flurry shows that we surprisingly spend on average almost 3-4 hours a day staring at our smart devices, totalizing nearly one day every week! One day, that’s right! 2. Addiction Phones addiction has a name: nomophobia, the fear of being out of cell phone contact. Therefore, not just spending too much time on our devices is a sign of addiction, but the fear of not having them on us as well. Like any other form of addiction, studies show that people that are addicted to their phones often show signs of depression, anxiety, and other forms of mental health problems. 3. Distraction Another study, this time from Florida State University, says that smartphones notifications can impair our concentration, even being short in duration they cause enough of a distraction to affect your ability to focus on a given task, decreasing your performance by prompting task-irrelevant thoughts and mind-wandering. This can be very dangerous in some specific situations, like driving, for instance, a simple notification can cause really serious accidents. 4. Affecting social skills Besides the problems mentioned above, it also has a huge impact on people’s social lives, people are getting more disconnected from the real world, they put their phones ahead of human interaction, it’s getting harder to see people talking to each other in public places, they’re always too busy with their mobile devices, checking notifications, sending messages or just sharing a new video. Our social skills seem to diminish constantly due to the overuse of smartphones and turning us into “smombie”. “Smartphone zombies” or “smombie” regularly cross our ways, perhaps you’re not familiar with the term but most likely you saw one today. They’re the people on public streets and places who walk slowly in peculiar ways with their eyes and fingers focused on your phone display. But it isn’t just road safety at stake here: think about how often they bump into things. The technology that drives mobile devices has improved a lot since they appeared, and especially in the last ten years. Mobile gadgets have gotten smaller, more powerful, and very useful. They are everywhere and play increasingly greater roles in the lives of most everyone. Positive effects of mobile phones in our life 1. Communication Besides the dark part of mobile technology, in the form of phones, tablets, and notebooks, is making our lives better than ever before. It does this in many ways, not the least of which is making communications routine. We can be in touch with those we need to reach, whether work-related or personal in nature. Mobile technology has changed the way we do business for the better. Never have we been able to share so much with friends and family as we can today, and that is in great part due to mobile technology. Without mobile devices and the technology behind them, participation in social networking would never have grown as much as it has. Sharing seemingly trivial information like where we are, what we are doing, and what that looks like significantly impacts our relationships with friends and loved ones. Mobile technology has given a voice to those otherwise cut off from the world during cataclysmic events. That voice can reach out for help when local tragedy strikes, and for the first time, these people are not alone. They can share their plight using mobile communication through text, voice, and, most importantly, images, and bring about real change. 2. Daily utilities Mobile phones have changed the way we live our lives. Now, not only can they help us stay connected with friends and family over social media or talk to someone on a video call without paying for data usage, but they also make everything from booking hotels and cabs to capturing memories easier than ever before thanks to their built-in cameras! We have more information in our hands than at any time in history. It has become second nature to quickly lookup helpful resources for whatever activity we need to do. Our gadgets can even anticipate what information we need and present it to us when it is most useful. 3. Healthcare services While mobile phones has improved our daily lives on many levels, it has profoundly raised the quality of life for many. Healthcare is an area that has embraced mobile technology, and while it’s still in the infancy of adoption of this technology, it is already making profound improvements for many. Healthcare providers get a quick medical opinion, through medical apps like this one, or they can review home medical tests from anywhere and make crucial changes to the patient’s care. Medical staff members can receive pacemaker tests remotely using a phone and change the programming of the device to address changes in the patient’s condition. Doctors can see intricate diagnostic images on phones and find conditions that need immediate treatment, all while the patient is comfortable at home. Villagers in third-world countries who have no local healthcare can be diagnosed and have treatment prescribed by distant healthcare providers. Patients in areas experiencing significant problems with counterfeit medications can use a phone at the point of purchase to confirm if a medication is legitimate. This is saving lives and improving healthcare every day for those affected. Children with ailments such as autism are using tablets to help them focus and communicate with those around them. Patients recovering from strokes and brain injuries are using tablets to great effect in their recoveries. Patients of all ages are using mobile devices to communicate with healthcare providers and loved ones as they never could before. People born without hearing are having implants that can be programmed by wireless technology that allows them to hear their children speak for the very first time. Text messaging on phones has made a tremendous impact on communication for the deaf. Diabetics can monitor their glucose level and have it wirelessly transferred to a small insulin pump that injects just the right amount to keep them where they need to be. Blind individuals can use mobile phones to not only improve their lives but also help achieve an incredible level of independence. Not only do these phones speak to the blind so they know what is displayed on the screen, but they also have software that can safely guide them out in busy cities. Mobile technology can help the blind pick out clothes for the day that match. The technology on smartphones can scan the change received from purchase and tell them how much was given.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Tell me the advantages and disadvantages of smartphones in our lives with one or two sentences for each one. Also give me three examples for healthcare services of smartphones and one example of being dangerous for our lives. We are living in the era of gadgets and smartphones, and communication has never been so easy; with social media, we’re always connected to our friends and millions of other people, no matter where we are. All we need is a smartphone with an internet connection. Mobile phones have become part of our daily lives and besides communication, we have available a vast variety of apps that can make our daily life a lot easier. Though the cost of app development is rising, the number of apps in app stores is increasing. Some of these apps had been optimized for mobile apps stores so that we can find them easier. However, being in the business of making apps, we must question what’s the impact of mobile phones in our lives and society? In this article, we’ll look into what are the positive and negative effects of using mobile phones on a daily basis. Negative effects of mobile phones in our lives 1. Waste of time As much we love what nowadays smartphones can do for us, this technology also has a downside. A recent study from the digital analytic firm Flurry shows that we surprisingly spend on average almost 3-4 hours a day staring at our smart devices, totalizing nearly one day every week! One day, that’s right! 2. Addiction Phones addiction has a name: nomophobia, the fear of being out of cell phone contact. Therefore, not just spending too much time on our devices is a sign of addiction, but the fear of not having them on us as well. Like any other form of addiction, studies show that people that are addicted to their phones often show signs of depression, anxiety, and other forms of mental health problems. 3. Distraction Another study, this time from Florida State University, says that smartphones notifications can impair our concentration, even being short in duration they cause enough of a distraction to affect your ability to focus on a given task, decreasing your performance by prompting task-irrelevant thoughts and mind-wandering. This can be very dangerous in some specific situations, like driving, for instance, a simple notification can cause really serious accidents. 4. Affecting social skills Besides the problems mentioned above, it also has a huge impact on people’s social lives, people are getting more disconnected from the real world, they put their phones ahead of human interaction, it’s getting harder to see people talking to each other in public places, they’re always too busy with their mobile devices, checking notifications, sending messages or just sharing a new video. Our social skills seem to diminish constantly due to the overuse of smartphones and turning us into “smombie”. “Smartphone zombies” or “smombie” regularly cross our ways, perhaps you’re not familiar with the term but most likely you saw one today. They’re the people on public streets and places who walk slowly in peculiar ways with their eyes and fingers focused on your phone display. But it isn’t just road safety at stake here: think about how often they bump into things. The technology that drives mobile devices has improved a lot since they appeared, and especially in the last ten years. Mobile gadgets have gotten smaller, more powerful, and very useful. They are everywhere and play increasingly greater roles in the lives of most everyone. Positive effects of mobile phones in our life 1. Communication Besides the dark part of mobile technology, in the form of phones, tablets, and notebooks, is making our lives better than ever before. It does this in many ways, not the least of which is making communications routine. We can be in touch with those we need to reach, whether work-related or personal in nature. Mobile technology has changed the way we do business for the better. Never have we been able to share so much with friends and family as we can today, and that is in great part due to mobile technology. Without mobile devices and the technology behind them, participation in social networking would never have grown as much as it has. Sharing seemingly trivial information like where we are, what we are doing, and what that looks like significantly impacts our relationships with friends and loved ones. Mobile technology has given a voice to those otherwise cut off from the world during cataclysmic events. That voice can reach out for help when local tragedy strikes, and for the first time, these people are not alone. They can share their plight using mobile communication through text, voice, and, most importantly, images, and bring about real change. 2. Daily utilities Mobile phones have changed the way we live our lives. Now, not only can they help us stay connected with friends and family over social media or talk to someone on a video call without paying for data usage, but they also make everything from booking hotels and cabs to capturing memories easier than ever before thanks to their built-in cameras! We have more information in our hands than at any time in history. It has become second nature to quickly lookup helpful resources for whatever activity we need to do. Our gadgets can even anticipate what information we need and present it to us when it is most useful. 3. Healthcare services While mobile phones has improved our daily lives on many levels, it has profoundly raised the quality of life for many. Healthcare is an area that has embraced mobile technology, and while it’s still in the infancy of adoption of this technology, it is already making profound improvements for many. Healthcare providers get a quick medical opinion, through medical apps like this one, or they can review home medical tests from anywhere and make crucial changes to the patient’s care. Medical staff members can receive pacemaker tests remotely using a phone and change the programming of the device to address changes in the patient’s condition. Doctors can see intricate diagnostic images on phones and find conditions that need immediate treatment, all while the patient is comfortable at home. Villagers in third-world countries who have no local healthcare can be diagnosed and have treatment prescribed by distant healthcare providers. Patients in areas experiencing significant problems with counterfeit medications can use a phone at the point of purchase to confirm if a medication is legitimate. This is saving lives and improving healthcare every day for those affected. Children with ailments such as autism are using tablets to help them focus and communicate with those around them. Patients recovering from strokes and brain injuries are using tablets to great effect in their recoveries. Patients of all ages are using mobile devices to communicate with healthcare providers and loved ones as they never could before. People born without hearing are having implants that can be programmed by wireless technology that allows them to hear their children speak for the very first time. Text messaging on phones has made a tremendous impact on communication for the deaf. Diabetics can monitor their glucose level and have it wirelessly transferred to a small insulin pump that injects just the right amount to keep them where they need to be. Blind individuals can use mobile phones to not only improve their lives but also help achieve an incredible level of independence. Not only do these phones speak to the blind so they know what is displayed on the screen, but they also have software that can safely guide them out in busy cities. Mobile technology can help the blind pick out clothes for the day that match. The technology on smartphones can scan the change received from purchase and tell them how much was given. https://blog.mobiversal.com/the-impact-of-mobile-technology-in-our-daily-life.html",Internet/Technology,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",Why does having an autoimmune disease like lupus make it complicated for woman who have it to have healthy pregnancies and to have healthy babies.,"Lupus tends to appear in women of childbearing age. It can affect pregnancy, however most women with lupus are able to have children. All pregnancies will need careful medical monitoring because of the risk of complications. It’s generally best to wait six months after a flare of symptoms and ideally have no active lupus symptoms prior to conception. How lupus affects pregnancy Lupus is a chronic condition that results from a malfunctioning immune system. The immune system is designed to identify foreign bodies (such as bacteria and viruses) and attack them to keep us healthy. However, in the case of lupus, your immune system mistakenly attacks one or many different types of tissue in the body, such as the skin, joints, muscles, nerves, kidneys, heart or lungs. The result of this damage is ongoing inflammation and pain. For these reasons, it’s important that you plan your pregnancy carefully. The healthier you are before you get pregnant, the greater the chance that you will have a healthy pregnancy and a healthy baby. Aim to have your condition under control and be in the best possible health. Talk with your doctor and specialist before you get pregnant. They may need to make important changes to your medication to ensure a safe pregnancy. Some medications are safe to take while you’re pregnant however others, like methotrexate, shouldn’t be taken. You may need to stop taking some medications months before trying to get pregnant as they can be harmful to your baby. Your doctors will help you plan this. In some cases, there is a reduction in lupus symptoms during pregnancy. Your lupus is more likely to be stable throughout your pregnancy if your condition was stable before conceiving. Complications of pregnancy Most women with lupus are able to have a healthy baby, however sometimes complications can occur. That’s why it’s so important you plan your pregnancy and work closely with your healthcare team to ensure you’re as healthy as possible before, during and after your pregnancy. It’s also important that you know the possible problems that may occur so that you can be treated immediately. Many of these issues can be prevented or treated effectively if they’re dealt with early. Some of the problems that can occur during pregnancy for women with lupus include: flares of your lupus symptoms may occur during pregnancy or immediately after you deliver, however this is less likely if your condition was stable before you became pregnant high blood pressure (hypertension) your baby may be born with low birth weight pre-eclampsia – symptoms include high blood pressure and excessive amounts of protein lost through your urine premature labour increased risk of blood clots in the legs or lungs increased risk of miscarriage increased risk of emergency caesarean section increased risk of excessive bleeding after delivery. Medical care before and during pregnancy It’s important that you have consistent and adequate medical care before and during your pregnancy. Discuss your plans to become pregnant with your doctor and specialist before you conceive. They can advise you of the best time to fall pregnant – it’s advisable to have had no lupus symptoms for at least six months prior to conception. They can also let you know about any particular risks you may face and whether your medication needs to be changed. Some medication taken for lupus can cross the placenta and pose a threat to your baby. Once you have become pregnant, it's vital that you receive proper antenatal care to anticipate, prevent and solve any problems that may occur. You will need to contact your treating doctor in case your treatment needs to be changed or further tests are required. It’s also important that you consult closely with both a rheumatologist and a specialist obstetrician throughout your pregnancy to lessen the risk of complications and monitor your baby's growth. Lupus flares and normal pregnancy symptoms Sometimes, it can be difficult to distinguish between a lupus flare and normal pregnancy symptoms. For this reason it’s important that you work closely with your healthcare team and obstetrician. Some of the symptoms of pregnancy that may mimic those of lupus include: fatigue build-up of fluid in the joints skin changes, such as rashes, flushes or darkening hair loss following childbirth shortness of breath joint pain. Lupus pregnancies and increased rate of premature birth and miscarriage During pregnancy, the growing baby is nourished by the placenta. About one third of women with lupus have antibodies that may cause blood clots and interfere with the proper functioning of the placenta. This is most likely to happen in the second trimester. The placenta isn’t able to supply the baby with sufficient nourishment and the baby’s growth is slowed. This may require early delivery via caesarean section. If the baby is born after 30 weeks’ gestation, or is at least 1.3 kg in weight, its chances of survival are good. Your doctor can screen for antiphospholipid antibodies, and if they are found, may prescribe a blood thinner to help prevent blood clots. This can help prevent miscarriage in many women. Pre-eclampsia is a condition that involves increased blood pressure, fluid retention and protein in the urine. It occurs in one in five women with lupus. If left untreated it can endanger the life of both the woman and her baby. Pre-eclampsia can be treated. However, depending on the severity, it may also require early delivery. Neonatal lupus Around one third of women with lupus have antibodies that may cause lupus-like symptoms in their baby once it‘s born. This is known as neonatal lupus. Symptoms may include skin rash, unusual blood count and, rarely, heartbeat irregularities. This is not SLE. In babies who don’t experience heartbeat irregularities, all symptoms of neonatal lupus usually resolve by three to six months of age. Heartbeat irregularities can be successfully treated. Lupus and pregnancy delay advice Some women with lupus should delay pregnancy and discuss their plan with their treating doctor when they are planning to have a baby. They include: women whose lupus is active women taking medication such as methotrexate, mycophenolate, or cyclophosphamide women with kidney disease women with previous thrombosis or miscarriage. If you have any questions about your condition, medications and pregnancy, talk with your doctor. Where to get help Your GP (doctor) Obstetrician A specialist (often a rheumatologist, nephrologist, immunologist or dermatologist)","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Why does having an autoimmune disease like lupus make it complicated for woman who have it to have healthy pregnancies and to have healthy babies. {passage 0} ========== Lupus tends to appear in women of childbearing age. It can affect pregnancy, however most women with lupus are able to have children. All pregnancies will need careful medical monitoring because of the risk of complications. It’s generally best to wait six months after a flare of symptoms and ideally have no active lupus symptoms prior to conception. How lupus affects pregnancy Lupus is a chronic condition that results from a malfunctioning immune system. The immune system is designed to identify foreign bodies (such as bacteria and viruses) and attack them to keep us healthy. However, in the case of lupus, your immune system mistakenly attacks one or many different types of tissue in the body, such as the skin, joints, muscles, nerves, kidneys, heart or lungs. The result of this damage is ongoing inflammation and pain. For these reasons, it’s important that you plan your pregnancy carefully. The healthier you are before you get pregnant, the greater the chance that you will have a healthy pregnancy and a healthy baby. Aim to have your condition under control and be in the best possible health. Talk with your doctor and specialist before you get pregnant. They may need to make important changes to your medication to ensure a safe pregnancy. Some medications are safe to take while you’re pregnant however others, like methotrexate, shouldn’t be taken. You may need to stop taking some medications months before trying to get pregnant as they can be harmful to your baby. Your doctors will help you plan this. In some cases, there is a reduction in lupus symptoms during pregnancy. Your lupus is more likely to be stable throughout your pregnancy if your condition was stable before conceiving. Complications of pregnancy Most women with lupus are able to have a healthy baby, however sometimes complications can occur. That’s why it’s so important you plan your pregnancy and work closely with your healthcare team to ensure you’re as healthy as possible before, during and after your pregnancy. It’s also important that you know the possible problems that may occur so that you can be treated immediately. Many of these issues can be prevented or treated effectively if they’re dealt with early. Some of the problems that can occur during pregnancy for women with lupus include: flares of your lupus symptoms may occur during pregnancy or immediately after you deliver, however this is less likely if your condition was stable before you became pregnant high blood pressure (hypertension) your baby may be born with low birth weight pre-eclampsia – symptoms include high blood pressure and excessive amounts of protein lost through your urine premature labour increased risk of blood clots in the legs or lungs increased risk of miscarriage increased risk of emergency caesarean section increased risk of excessive bleeding after delivery. Medical care before and during pregnancy It’s important that you have consistent and adequate medical care before and during your pregnancy. Discuss your plans to become pregnant with your doctor and specialist before you conceive. They can advise you of the best time to fall pregnant – it’s advisable to have had no lupus symptoms for at least six months prior to conception. They can also let you know about any particular risks you may face and whether your medication needs to be changed. Some medication taken for lupus can cross the placenta and pose a threat to your baby. Once you have become pregnant, it's vital that you receive proper antenatal care to anticipate, prevent and solve any problems that may occur. You will need to contact your treating doctor in case your treatment needs to be changed or further tests are required. It’s also important that you consult closely with both a rheumatologist and a specialist obstetrician throughout your pregnancy to lessen the risk of complications and monitor your baby's growth. Lupus flares and normal pregnancy symptoms Sometimes, it can be difficult to distinguish between a lupus flare and normal pregnancy symptoms. For this reason it’s important that you work closely with your healthcare team and obstetrician. Some of the symptoms of pregnancy that may mimic those of lupus include: fatigue build-up of fluid in the joints skin changes, such as rashes, flushes or darkening hair loss following childbirth shortness of breath joint pain. Lupus pregnancies and increased rate of premature birth and miscarriage During pregnancy, the growing baby is nourished by the placenta. About one third of women with lupus have antibodies that may cause blood clots and interfere with the proper functioning of the placenta. This is most likely to happen in the second trimester. The placenta isn’t able to supply the baby with sufficient nourishment and the baby’s growth is slowed. This may require early delivery via caesarean section. If the baby is born after 30 weeks’ gestation, or is at least 1.3 kg in weight, its chances of survival are good. Your doctor can screen for antiphospholipid antibodies, and if they are found, may prescribe a blood thinner to help prevent blood clots. This can help prevent miscarriage in many women. Pre-eclampsia is a condition that involves increased blood pressure, fluid retention and protein in the urine. It occurs in one in five women with lupus. If left untreated it can endanger the life of both the woman and her baby. Pre-eclampsia can be treated. However, depending on the severity, it may also require early delivery. Neonatal lupus Around one third of women with lupus have antibodies that may cause lupus-like symptoms in their baby once it‘s born. This is known as neonatal lupus. Symptoms may include skin rash, unusual blood count and, rarely, heartbeat irregularities. This is not SLE. In babies who don’t experience heartbeat irregularities, all symptoms of neonatal lupus usually resolve by three to six months of age. Heartbeat irregularities can be successfully treated. Lupus and pregnancy delay advice Some women with lupus should delay pregnancy and discuss their plan with their treating doctor when they are planning to have a baby. They include: women whose lupus is active women taking medication such as methotrexate, mycophenolate, or cyclophosphamide women with kidney disease women with previous thrombosis or miscarriage. If you have any questions about your condition, medications and pregnancy, talk with your doctor. Where to get help Your GP (doctor) Obstetrician A specialist (often a rheumatologist, nephrologist, immunologist or dermatologist) https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/lupus-and-pregnancy",Medical,Explanation/Definition,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Compare the main types of financial arbitrage, and compare their advantages and disadvantages. Which type of arbitrage would be most suitable for a retail investors with a moderate amount of capital?","2. Merger Arbitrage Merger arbitrage is an investing strategy that capitalizes on the difference in price between the target company’s stock price and the price offered by the acquirer in a merger or acquirement. The differences between merger arbitrage and other types of arbitrage lie in the potential risks and rewards associated with the transaction. Merger arbitrage is less risky than other forms of arbitrage due to the long-term nature of the transaction and the ability to hedge some of the risks associated with the acquisition. Merger arbitrage provides a high potential return with relatively low risk. It is also a relatively low-cost strategy and does not require the trader to take on a large amount of leverage. Pros of merger arbitrage include the fact that investors capitalizes on the difference in price between the target company’s stock price and the price offered by the acquirer, as well as the potential for a high return on investment. Cons of merger arbitrage include the fact that there is a great deal of uncertainty surrounding the transaction and the potential for the deal to fall through. This leads to a loss of capital for the investor. An example of merger arbitrage is if a company announces a merger with another company, and the target company’s stock price jumps above the price offered by the acquirer. An investor could purchase stock in the target company and hold it until the acquisition was completed, thereby capitalizing on the price difference. 3. Convertible Arbitrage Convertible arbitrage is an investment strategy where an investor will purchase a convertible bond and simultaneously sell short the stock into which the convertible are converted. Convertible arbitrage’s idea is that the investor profits from a discrepancy in the convertible arbitrage spread. Convertible arbitrage’s biggest advantage is that it offers investors an opportunity for additional profits and helps reduce market risk by diversifying across different asset classes. Convertible arbitrage strategies have historically experienced lower volatility than traditional equity strategies. The main disadvantage of convertible arbitrage is that it involves riskier activities than traditional arbitrage. It involves taking on the stock and the convertible bond risk. The liquidity risk of the underlying securities could be quite high. 4. Risk Arbitrage Risk arbitrage is an investment strategy that seeks to take advantage of price discrepancies between related securities, often caused by corporate events such as mergers, restructurings, and takeover bids. Risk arbitrage involves buying the undervalued security and selling the overvalued security, with the expectation that the prices will converge as the corporate events unfold. The main difference between risk arbitrage and other forms of arbitrage is that it involves taking a short-term risk, as there is a possibility that the arbitrageur will not be able to close out the positions prior to the prices converging. This could either result in a loss or a gain, depending on the direction and magnitude of the price movements. The main advantage of risk arbitrage is the potential to earn high returns in a short period of time. Arbitrageurs are able to take advantage of price discrepancies that exist in the market, and if the prices converge as expected, large profits are realized. The main disadvantage of risk arbitrage is that it involves taking a short-term risk. The arbitrageur could incur losses if the prices do not move in the expected direction or magnitude, In addition, risk arbitrage is time-sensitive, and the arbitrageur needs to be able to close out the positions prior to the prices converging in order to take advantage of the mispricing. An example of risk arbitrage is the acquisition of a company by another company. If the market prices of the target company are lower than the offer price, the arbitrageur buy shares of the target company and short-sells shares of the acquiring company. If the market prices of the target company converge to the offer price, the arbitrageur closes out the positions and earns a profit. 5. Dividend Arbitrage Dividend arbitrage is a form of arbitrage that involves taking advantage of the difference in share prices before and after the ex-dividend date. The dividend arbitrage strategy involves buying the stock before the ex-dividend date and then selling it on the same day at a higher price. This allows investors to capitalize on the difference in share prices without directly engaging in the stock market. The difference between dividend arbitrage and other forms of arbitrage is that, in the case of dividend arbitrage, investors are taking advantage of the difference in share prices before and after the ex-dividend date. Other forms of arbitrage involve taking advantage of pricing discrepancies in different markets. The main advantage of dividend arbitrage is that it allows investors to capitalize on the difference in share prices without directly engaging in the stock market. This benefits investors who need more time or resources to actively trade in the stock market. The main disadvantage of dividend arbitrage is that it requires investors to buy the stock before the ex-dividend date. This means that there is a risk that the stock price could fall significantly before the ex-dividend date, resulting in a loss for the investor. For example, if an investor buys a stock for Rs. 50 per share before the ex-dividend date and sells it for Rs. 55 per share on the same day, the investor will make a profit of Rs. 5 per share. This profit is made without having to actively engage in the stock market. 6. Futures Arbitrage Futures Arbitrage is a strategy that involves taking advantage of discrepancies in pricing between two different markets for a fututes instrument. Futures arbitrage involves buying the futures in one market at a lower price and selling it in another at a higher price, thus making a profit. The main difference between Futures Arbitrage and other arbitrage strategies is that Futures Arbitrage involves taking advantage of discrepancies in the prices of futures contracts. Other arbitrage strategies involve taking advantage of discrepancies between two or more different types of securities. Pros of Futures Arbitrage include the potential for high returns in a relatively short period and the ability to capitalize on discrepancies in market prices without possessing the underlying instrument. Cons of Futures Arbitrage include the high risk associated with this strategy and the fact that it requires a good understanding of the markets and the instruments being traded. An example of Futures Arbitrage would be buying a gold futures contract in the US and selling the same contract in India at a higher price, thus making a profit. 7. Pure Arbitrage Pure arbitrage is taking advantage of a price difference between two or more markets to make a risk-free profit. Pure arbitrage involves simultaneously buying and selling the same financial asset, commodity, or currency in different markets to take advantage of the price difference. The main advantage of pure arbitrage is that it is a low-risk strategy. Since the investor is simultaneously buying and selling the same asset, at least one of their orders is guaranteed to be profitable. The main disadvantage of pure arbitrage is that it is a complex and time-consuming process. It requires access to multiple markets and acting quickly to take advantage of the price discrepancies before they disappear. For example, an investor notices that gold prices are higher in New York than in London. The investor buys gold in London and then simultaneously sells it in New York to take advantage of the price discrepancy and make a risk-free profit."," Only use the provided text to answer the question, no outside sources. Compare the main types of financial arbitrage, and compare their advantages and disadvantages. Which type of arbitrage would be most suitable for a retail investors with a moderate amount of capital? 2. Merger Arbitrage Merger arbitrage is an investing strategy that capitalizes on the difference in price between the target company’s stock price and the price offered by the acquirer in a merger or acquirement. The differences between merger arbitrage and other types of arbitrage lie in the potential risks and rewards associated with the transaction. Merger arbitrage is less risky than other forms of arbitrage due to the long-term nature of the transaction and the ability to hedge some of the risks associated with the acquisition. Merger arbitrage provides a high potential return with relatively low risk. It is also a relatively low-cost strategy and does not require the trader to take on a large amount of leverage. Pros of merger arbitrage include the fact that investors capitalizes on the difference in price between the target company’s stock price and the price offered by the acquirer, as well as the potential for a high return on investment. Cons of merger arbitrage include the fact that there is a great deal of uncertainty surrounding the transaction and the potential for the deal to fall through. This leads to a loss of capital for the investor. An example of merger arbitrage is if a company announces a merger with another company, and the target company’s stock price jumps above the price offered by the acquirer. An investor could purchase stock in the target company and hold it until the acquisition was completed, thereby capitalizing on the price difference. 3. Convertible Arbitrage Convertible arbitrage is an investment strategy where an investor will purchase a convertible bond and simultaneously sell short the stock into which the convertible are converted. Convertible arbitrage’s idea is that the investor profits from a discrepancy in the convertible arbitrage spread. Convertible arbitrage’s biggest advantage is that it offers investors an opportunity for additional profits and helps reduce market risk by diversifying across different asset classes. Convertible arbitrage strategies have historically experienced lower volatility than traditional equity strategies. The main disadvantage of convertible arbitrage is that it involves riskier activities than traditional arbitrage. It involves taking on the stock and the convertible bond risk. The liquidity risk of the underlying securities could be quite high. 4. Risk Arbitrage Risk arbitrage is an investment strategy that seeks to take advantage of price discrepancies between related securities, often caused by corporate events such as mergers, restructurings, and takeover bids. Risk arbitrage involves buying the undervalued security and selling the overvalued security, with the expectation that the prices will converge as the corporate events unfold. The main difference between risk arbitrage and other forms of arbitrage is that it involves taking a short-term risk, as there is a possibility that the arbitrageur will not be able to close out the positions prior to the prices converging. This could either result in a loss or a gain, depending on the direction and magnitude of the price movements. The main advantage of risk arbitrage is the potential to earn high returns in a short period of time. Arbitrageurs are able to take advantage of price discrepancies that exist in the market, and if the prices converge as expected, large profits are realized. The main disadvantage of risk arbitrage is that it involves taking a short-term risk. The arbitrageur could incur losses if the prices do not move in the expected direction or magnitude, In addition, risk arbitrage is time-sensitive, and the arbitrageur needs to be able to close out the positions prior to the prices converging in order to take advantage of the mispricing. An example of risk arbitrage is the acquisition of a company by another company. If the market prices of the target company are lower than the offer price, the arbitrageur buy shares of the target company and short-sells shares of the acquiring company. If the market prices of the target company converge to the offer price, the arbitrageur closes out the positions and earns a profit. 5. Dividend Arbitrage Dividend arbitrage is a form of arbitrage that involves taking advantage of the difference in share prices before and after the ex-dividend date. The dividend arbitrage strategy involves buying the stock before the ex-dividend date and then selling it on the same day at a higher price. This allows investors to capitalize on the difference in share prices without directly engaging in the stock market. The difference between dividend arbitrage and other forms of arbitrage is that, in the case of dividend arbitrage, investors are taking advantage of the difference in share prices before and after the ex-dividend date. Other forms of arbitrage involve taking advantage of pricing discrepancies in different markets. The main advantage of dividend arbitrage is that it allows investors to capitalize on the difference in share prices without directly engaging in the stock market. This benefits investors who need more time or resources to actively trade in the stock market. The main disadvantage of dividend arbitrage is that it requires investors to buy the stock before the ex-dividend date. This means that there is a risk that the stock price could fall significantly before the ex-dividend date, resulting in a loss for the investor. For example, if an investor buys a stock for Rs. 50 per share before the ex-dividend date and sells it for Rs. 55 per share on the same day, the investor will make a profit of Rs. 5 per share. This profit is made without having to actively engage in the stock market. 6. Futures Arbitrage Futures Arbitrage is a strategy that involves taking advantage of discrepancies in pricing between two different markets for a fututes instrument. Futures arbitrage involves buying the futures in one market at a lower price and selling it in another at a higher price, thus making a profit. The main difference between Futures Arbitrage and other arbitrage strategies is that Futures Arbitrage involves taking advantage of discrepancies in the prices of futures contracts. Other arbitrage strategies involve taking advantage of discrepancies between two or more different types of securities. Pros of Futures Arbitrage include the potential for high returns in a relatively short period and the ability to capitalize on discrepancies in market prices without possessing the underlying instrument. Cons of Futures Arbitrage include the high risk associated with this strategy and the fact that it requires a good understanding of the markets and the instruments being traded. An example of Futures Arbitrage would be buying a gold futures contract in the US and selling the same contract in India at a higher price, thus making a profit. 7. Pure Arbitrage Pure arbitrage is taking advantage of a price difference between two or more markets to make a risk-free profit. Pure arbitrage involves simultaneously buying and selling the same financial asset, commodity, or currency in different markets to take advantage of the price difference. The main advantage of pure arbitrage is that it is a low-risk strategy. Since the investor is simultaneously buying and selling the same asset, at least one of their orders is guaranteed to be profitable. The main disadvantage of pure arbitrage is that it is a complex and time-consuming process. It requires access to multiple markets and acting quickly to take advantage of the price discrepancies before they disappear. For example, an investor notices that gold prices are higher in New York than in London. The investor buys gold in London and then simultaneously sells it in New York to take advantage of the price discrepancy and make a risk-free profit. https://www.strike.money/stock-market/arbitrage",Financial,Concept Comparison,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",discuss wether the fine tuning of LLMs on medical datasets has consistently improved risk prediction performance for Alzheimer’s disease using ĖHRs. Discuss the specific methods proposed for handling some of the different setbacks is prediction accuracy.,"1Introduction Alzheimer’s disease (AD) and Alzheimer’s disease related dementias (ADRD) are neurodegenerative disorders primarily affecting memory and cognitive functions. They gradually erode overall function abilities, eventually leading to death [39]. The development of AD/ADRD treatment has been slow due to the complex disease pathology and clinical manifestations. The decline of memory and cognitive functions is associated with pathological progression and structural changes of the brain [28], which can be identified from neuroimage or biomarkers from cerebro-spinal fluid. However, those procedures are expensive and invasive, which are unlikely to be ordered for asymptomatic patients. For real world patients, typically only the electronic health records (EHRs) collected from their routined care are available[6, 18]. These data include information like demographics, lab tests, diagnoses, medications, and procedures, and they provide a potential opportunity for risk prediction of AD/ADRD [34]. Risk prediction from EHRs is commonly formulated as a supervised learning problem [56] and one can model with existing supervised learning (SLs) tools, such as logistic regression (LR) [68], XGBoost (XGB) [44], and multi-layer perceptron (MLP) [54]. However, SL approaches face significant challenges in predicting risk from EHRs, due to the complexity of medical problems and the noisy nature of the data [75]. Moreover, EHRs do not contain all critical information that is needed for risk prediction for particular conditions. For example, diagnosis of MCI requires a comprehensive evaluation of cognitive functions, such as memory, executive function, and language. In early stages, when symptoms are subtle and not extensively documented in the EHRs, risk | Type | Vital sign | Lab. Test | ICD | RxNorm | CPT | |------|------------|-----------|-----|--------|-----| | Domain | ℝ | ℝ | [0,1] (Positive, Negative) | [0,1] (Positive, Negative) | [0,1] (Positive, Negative) | | Example | Blood Pressure, Age | Hemoglobin Level | J18.9 for Pneumonia | 4099 for Estrogen | A4206 for DME and supplies | | Short Explanation | Physiological measurement to assess a patient's status | Analyzing biochemical markers using blood and urine | Alphanumeric system classifying diseases | Standardized nomenclature system for clinical drugs | Medical procedure identification for billing | Table 1: Brief explanation of the five categories; Vital sign, Laboratory test, ICD code, RxNorm code, and CPT code, in the EHR dataset, describing each patient. prediction using traditional machine-learning approaches can be difficult. Though some information in EHRs may be weakly related to the risk, SL models may or may not be able to pick them up. Recent advancements in pre-trained large language models (LLMs) [61, 62, 1, 8, 58] have demonstrated their capability to provide robust reasoning power, particularly with rich contextual information and domain knowledge. Intuitively, LLM can leverage its reasoning capability and flexible in-context learning (ICL) strategies to better derive valuable insights from EHRs. However, there are still several technical challenges to achieve this goal. The first one is how to perform effective reasoning with an EHR database. While fine-tuning external knowledge into the LLMs has been a major approach in many domains, it is not trivial to fine-tune knowledge from EHR to LLMs. EHR includes clinical information for individual patients and evolves over time, whereas LLMs are typically learned and tuned using static information. The second challenge is the representation of medical records for reasoning. LLMs are probability models trained to understand and reason with natural language, and it is not clear how structured EHRs, such as vital, diagnosis codes, and prescriptions, are best represented in LLMs for effective reasoning. The third challenge is rooted in the inherent data quality issues in EHR data, which could be noisy as they were originally designed for billing purposes. The presence of such events is likely to compromise and greatly mislead the reasoning of LLMs. Contributions. Here, we summarize the contributions as follows: - We identified the strengths and weaknesses of SLs and LLMs in risk predictions from EHR. From the SLs’ perspective, they provide accurate predictions for confident samples, which are typically aligned well with training data distribution. However, when the samples are not common or the features are sparse, SLs are usually not confident about the predictions and generate poorer predictions than LLMs, showing the value of reasoning from LLMs in EHR analysis. • Based on our findings, we propose a collaborative approach that combines SLs and LLMs through a confidence- driven selection process for enhanced ADRD risk prediction. This method dynamically selects between SL and LLM predictions based on confidence levels, effectively leveraging the strengths of SLs for high-confidence cases and LLMs for low-confidence instances. Furthermore, we incorporate a meticulously designed ICL demonstration denoising strategy to save the ICL performance of LLMs, which in turn boosts the overall efficiency of the pipeline. • We validate our approach using a real-world dataset from the OHSU health system, highlighting the effectiveness of our method and its superiority over traditional SLs and LLMs in predicting ADRD. Additionally, we conduct experiments with different sizes of LLMs and models fine-tuned on various medical datasets. Our findings suggest that neither a larger model size nor fine-tuning on medical data consistently improves risk prediction performance. Further investigation is required to check these dynamics in practice. LLMs for Clinical Domain LLMs possess strong capability in performing various tasks, including those in the medical field [23]. In particular, many studies have attempted to develop new LLMs specifically for medical tasks. For example, Med-PaLM [55] represents a medical domain-specific variant of the PaLM model. Similarly, based on Alpaca [57], MedAlpaca [21] was proposed, and fine-tuend LLaMA [61, 62] for medical domain, PMC-LLaMA [67] was suggested. Chat-bot oriented model [70] and Huatuo-GPT [71] were trained using the dataset obtained from the real-world doctors and ChatGPT [1]. Yang et al. [69] trained and release the GatorTron model. Different from proposing a new medical-specific models, several works have aimed to directly use the pre-trained LLMs in a zero-shot manner. For example in [42, 38] used GPT models for the medical field. Nori et al. [43] proposed a way of leveraging pre-trained LLMs for the medical field by leveraging some techniques including in-context learning, and chain-of-thought.","[question] discuss wether the fine tuning of LLMs on medical datasets has consistently improved risk prediction performance for Alzheimer’s disease using ĖHRs. Discuss the specific methods proposed for handling some of the different setbacks is prediction accuracy. ===================== [text] 1Introduction Alzheimer’s disease (AD) and Alzheimer’s disease related dementias (ADRD) are neurodegenerative disorders primarily affecting memory and cognitive functions. They gradually erode overall function abilities, eventually leading to death [39]. The development of AD/ADRD treatment has been slow due to the complex disease pathology and clinical manifestations. The decline of memory and cognitive functions is associated with pathological progression and structural changes of the brain [28], which can be identified from neuroimage or biomarkers from cerebro-spinal fluid. However, those procedures are expensive and invasive, which are unlikely to be ordered for asymptomatic patients. For real world patients, typically only the electronic health records (EHRs) collected from their routined care are available[6, 18]. These data include information like demographics, lab tests, diagnoses, medications, and procedures, and they provide a potential opportunity for risk prediction of AD/ADRD [34]. Risk prediction from EHRs is commonly formulated as a supervised learning problem [56] and one can model with existing supervised learning (SLs) tools, such as logistic regression (LR) [68], XGBoost (XGB) [44], and multi-layer perceptron (MLP) [54]. However, SL approaches face significant challenges in predicting risk from EHRs, due to the complexity of medical problems and the noisy nature of the data [75]. Moreover, EHRs do not contain all critical information that is needed for risk prediction for particular conditions. For example, diagnosis of MCI requires a comprehensive evaluation of cognitive functions, such as memory, executive function, and language. In early stages, when symptoms are subtle and not extensively documented in the EHRs, risk | Type | Vital sign | Lab. Test | ICD | RxNorm | CPT | |------|------------|-----------|-----|--------|-----| | Domain | ℝ | ℝ | [0,1] (Positive, Negative) | [0,1] (Positive, Negative) | [0,1] (Positive, Negative) | | Example | Blood Pressure, Age | Hemoglobin Level | J18.9 for Pneumonia | 4099 for Estrogen | A4206 for DME and supplies | | Short Explanation | Physiological measurement to assess a patient's status | Analyzing biochemical markers using blood and urine | Alphanumeric system classifying diseases | Standardized nomenclature system for clinical drugs | Medical procedure identification for billing | Table 1: Brief explanation of the five categories; Vital sign, Laboratory test, ICD code, RxNorm code, and CPT code, in the EHR dataset, describing each patient. prediction using traditional machine-learning approaches can be difficult. Though some information in EHRs may be weakly related to the risk, SL models may or may not be able to pick them up. Recent advancements in pre-trained large language models (LLMs) [61, 62, 1, 8, 58] have demonstrated their capability to provide robust reasoning power, particularly with rich contextual information and domain knowledge. Intuitively, LLM can leverage its reasoning capability and flexible in-context learning (ICL) strategies to better derive valuable insights from EHRs. However, there are still several technical challenges to achieve this goal. The first one is how to perform effective reasoning with an EHR database. While fine-tuning external knowledge into the LLMs has been a major approach in many domains, it is not trivial to fine-tune knowledge from EHR to LLMs. EHR includes clinical information for individual patients and evolves over time, whereas LLMs are typically learned and tuned using static information. The second challenge is the representation of medical records for reasoning. LLMs are probability models trained to understand and reason with natural language, and it is not clear how structured EHRs, such as vital, diagnosis codes, and prescriptions, are best represented in LLMs for effective reasoning. The third challenge is rooted in the inherent data quality issues in EHR data, which could be noisy as they were originally designed for billing purposes. The presence of such events is likely to compromise and greatly mislead the reasoning of LLMs. Contributions. Here, we summarize the contributions as follows: - We identified the strengths and weaknesses of SLs and LLMs in risk predictions from EHR. From the SLs’ perspective, they provide accurate predictions for confident samples, which are typically aligned well with training data distribution. However, when the samples are not common or the features are sparse, SLs are usually not confident about the predictions and generate poorer predictions than LLMs, showing the value of reasoning from LLMs in EHR analysis. • Based on our findings, we propose a collaborative approach that combines SLs and LLMs through a confidence- driven selection process for enhanced ADRD risk prediction. This method dynamically selects between SL and LLM predictions based on confidence levels, effectively leveraging the strengths of SLs for high-confidence cases and LLMs for low-confidence instances. Furthermore, we incorporate a meticulously designed ICL demonstration denoising strategy to save the ICL performance of LLMs, which in turn boosts the overall efficiency of the pipeline. • We validate our approach using a real-world dataset from the OHSU health system, highlighting the effectiveness of our method and its superiority over traditional SLs and LLMs in predicting ADRD. Additionally, we conduct experiments with different sizes of LLMs and models fine-tuned on various medical datasets. Our findings suggest that neither a larger model size nor fine-tuning on medical data consistently improves risk prediction performance. Further investigation is required to check these dynamics in practice. LLMs for Clinical Domain LLMs possess strong capability in performing various tasks, including those in the medical field [23]. In particular, many studies have attempted to develop new LLMs specifically for medical tasks. For example, Med-PaLM [55] represents a medical domain-specific variant of the PaLM model. Similarly, based on Alpaca [57], MedAlpaca [21] was proposed, and fine-tuend LLaMA [61, 62] for medical domain, PMC-LLaMA [67] was suggested. Chat-bot oriented model [70] and Huatuo-GPT [71] were trained using the dataset obtained from the real-world doctors and ChatGPT [1]. Yang et al. [69] trained and release the GatorTron model. Different from proposing a new medical-specific models, several works have aimed to directly use the pre-trained LLMs in a zero-shot manner. For example in [42, 38] used GPT models for the medical field. Nori et al. [43] proposed a way of leveraging pre-trained LLMs for the medical field by leveraging some techniques including in-context learning, and chain-of-thought. https://arxiv.org/pdf/2405.16413 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Effect Analysis,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","I'm so confused by this text. How many mice were used in this study? What controls were used to limit bias? Who was the main author and what are their qualifications? Can you give me a list of all authors associated with the University of Copenhagen? list them in an alphabetical, bulleted format.","New research describes for the first time how a spreading wave of disruption and the flow of fluid in the brain triggers headaches, detailing the connection between the neurological symptoms associated with aura and the migraine that follows. The study also identifies new proteins that could be responsible for headaches and may serve as foundation for new migraine drugs. “In this study, we describe the interaction between the central and peripheral nervous system brought about by increased concentrations of proteins released in the brain during an episode of spreading depolarization, a phenomenon responsible for the aura associated with migraines,” said Maiken Nedergaard, MD, DMSc, co-director of the University of Rochester Center for Translational Neuromedicine and lead author of the new study, which appears in the journal Science. “These findings provide us with a host of new targets to suppress sensory nerve activation to prevent and treat migraines and strengthen existing therapies.” ""These findings provide us with a host of new targets to suppress sensory nerve activation to prevent and treat migraines and strengthen existing therapies.” Maiken Nedergaard, MD, DMSc It is estimated that one out of 10 people experience migraines and in about a quarter of these cases the headache is preceded by an aura, a sensory disturbance that can includes light flashes, blind spots, double vision, and tingling sensations or limb numbness. These symptoms typically appear five to 60 minutes prior to the headache. The cause of the aura is a phenomenon called cortical spreading depression, a temporary depolarization of neurons and other cells caused by diffusion of glutamate and potassium that radiates like a wave across the brain, reducing oxygen levels and impairing blood flow. Most frequently, the depolarization event is located in the visual processing center of the brain cortex, hence the visual symptoms that first herald a coming headache. While migraines auras arise in the brain, the organ itself cannot sense pain. These signals must instead be transmitted from the central nervous system—the brain and spinal cord—to the peripheral nervous system, the communication network that transmits information between brain with the rest of the body and includes sensory nerves responsible for sending information such as touch and pain. The process of communication between the brain and peripheral sensory nerves in migraines has largely remained a mystery. Fluid Dynamics Models Shed Light on Migraine Pain Origins Nedergaard and her colleagues at the University of Rochester and the University of Copenhagen are pioneers in understanding the flow of fluids in the brain. In 2012, her lab was the first to describe the glymphatic system, which uses cerebrospinal fluid (CSF) to wash away toxic proteins in the brain. In partnership with experts in fluid dynamics, the team has built detailed models of how the CSF moves in the brain and its role in transporting proteins, neurotransmitters, and other chemicals. The most widely accepted theory is that nerve endings resting on the outer surface of the membranes that enclose the brain are responsible for the headaches that follow an aura. The new study, which was conducted in mice, describes a different route and identifies proteins, many of which are potential new drug targets, that may be responsible for activating the nerves and causing pain. As the depolarization wave spreads, neurons release a host of inflammatory and other proteins into CSF. In a series of experiments in mice, the researchers showed how CSF transports these proteins to the trigeminal ganglion, a large bundle of nerves that rests at the base of the skull and supplies sensory information to the head and face. It was assumed that the trigeminal ganglion, like the rest of the peripheral nervous system, rested outside the blood-brain-barrier, which tightly controls what molecules enter and leave the brain. However, the researchers identified a previously unknown gap in the barrier that allowed CSF to flow directly into the trigeminal ganglion, exposing sensory nerves to the cocktail of proteins released by the brain. Migraine-Associated Proteins Double During Brain Wave Activity model_image Analyzing the molecules, the researchers identified twelve proteins called ligands that bind with receptors on sensory nerves found in the trigeminal ganglion, potentially causing these cells to activate. The concentrations of several of these proteins found in CSF more than doubled following a cortical spreading depression. One of the proteins, calcitonin gene-related peptide (CGRP), is already the target of a new class of drugs to treat and prevent migraines called CGRP inhibitors. Other identified proteins are known to play a role in other pain conditions, such as neuropathic pain, and are likely important in migraine headaches as well. “We have identified a new signaling pathway and several molecules that activate sensory nerves in the peripheral nervous system. Among the identified molecules are those already associated with migraines, but we didn't know exactly how and where the migraine inducing action occurred,” said Martin Kaag Rasmussen, PhD, a postdoctoral fellow at the University of Copenhagen and first author of the study. “Defining the role of these newly identified ligand-receptor pairs may enable the discovery of new pharmacological targets, which could benefit the large portion of patients not responding to available therapies.” The researchers also observed that the transport of proteins released in one side of the brain reaches mostly the nerves in the trigeminal ganglion on the same side, potentially explaining why pain occurs on one side of the head during most migraines. Additional co-authors Kjeld Mollgard, Peter Bork, Pia Weikop, Tina Esmail, Lylia Drici, Nicolai Albrechtsen, Matthias Mann, Yuki Mori, and Jonathan Carlsen with the University of Copenhagen, Nguyen Huynh and Steve Goldman with URMC, and Nima Ghitani and Alexander Chesler with the National Institute of Neurological Disorders and Stroke (NINDS). The research was supported with funding from the Novo Nordisk Foundation, NINDS, the US Army Research Office, the Lundbeck Foundation, and the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I'm so confused by this text. How many mice were used in this study? What controls were used to limit bias? Who was the main author and what are their qualifications? Can you give me a list of all authors associated with the University of Copenhagen? list them in an alphabetical, bulleted format. New research describes for the first time how a spreading wave of disruption and the flow of fluid in the brain triggers headaches, detailing the connection between the neurological symptoms associated with aura and the migraine that follows. The study also identifies new proteins that could be responsible for headaches and may serve as foundation for new migraine drugs. “In this study, we describe the interaction between the central and peripheral nervous system brought about by increased concentrations of proteins released in the brain during an episode of spreading depolarization, a phenomenon responsible for the aura associated with migraines,” said Maiken Nedergaard, MD, DMSc, co-director of the University of Rochester Center for Translational Neuromedicine and lead author of the new study, which appears in the journal Science. “These findings provide us with a host of new targets to suppress sensory nerve activation to prevent and treat migraines and strengthen existing therapies.” ""These findings provide us with a host of new targets to suppress sensory nerve activation to prevent and treat migraines and strengthen existing therapies.” Maiken Nedergaard, MD, DMSc It is estimated that one out of 10 people experience migraines and in about a quarter of these cases the headache is preceded by an aura, a sensory disturbance that can includes light flashes, blind spots, double vision, and tingling sensations or limb numbness. These symptoms typically appear five to 60 minutes prior to the headache. The cause of the aura is a phenomenon called cortical spreading depression, a temporary depolarization of neurons and other cells caused by diffusion of glutamate and potassium that radiates like a wave across the brain, reducing oxygen levels and impairing blood flow. Most frequently, the depolarization event is located in the visual processing center of the brain cortex, hence the visual symptoms that first herald a coming headache. While migraines auras arise in the brain, the organ itself cannot sense pain. These signals must instead be transmitted from the central nervous system—the brain and spinal cord—to the peripheral nervous system, the communication network that transmits information between brain with the rest of the body and includes sensory nerves responsible for sending information such as touch and pain. The process of communication between the brain and peripheral sensory nerves in migraines has largely remained a mystery. Fluid Dynamics Models Shed Light on Migraine Pain Origins Nedergaard and her colleagues at the University of Rochester and the University of Copenhagen are pioneers in understanding the flow of fluids in the brain. In 2012, her lab was the first to describe the glymphatic system, which uses cerebrospinal fluid (CSF) to wash away toxic proteins in the brain. In partnership with experts in fluid dynamics, the team has built detailed models of how the CSF moves in the brain and its role in transporting proteins, neurotransmitters, and other chemicals. The most widely accepted theory is that nerve endings resting on the outer surface of the membranes that enclose the brain are responsible for the headaches that follow an aura. The new study, which was conducted in mice, describes a different route and identifies proteins, many of which are potential new drug targets, that may be responsible for activating the nerves and causing pain. As the depolarization wave spreads, neurons release a host of inflammatory and other proteins into CSF. In a series of experiments in mice, the researchers showed how CSF transports these proteins to the trigeminal ganglion, a large bundle of nerves that rests at the base of the skull and supplies sensory information to the head and face. It was assumed that the trigeminal ganglion, like the rest of the peripheral nervous system, rested outside the blood-brain-barrier, which tightly controls what molecules enter and leave the brain. However, the researchers identified a previously unknown gap in the barrier that allowed CSF to flow directly into the trigeminal ganglion, exposing sensory nerves to the cocktail of proteins released by the brain. Migraine-Associated Proteins Double During Brain Wave Activity model_image Analyzing the molecules, the researchers identified twelve proteins called ligands that bind with receptors on sensory nerves found in the trigeminal ganglion, potentially causing these cells to activate. The concentrations of several of these proteins found in CSF more than doubled following a cortical spreading depression. One of the proteins, calcitonin gene-related peptide (CGRP), is already the target of a new class of drugs to treat and prevent migraines called CGRP inhibitors. Other identified proteins are known to play a role in other pain conditions, such as neuropathic pain, and are likely important in migraine headaches as well. “We have identified a new signaling pathway and several molecules that activate sensory nerves in the peripheral nervous system. Among the identified molecules are those already associated with migraines, but we didn't know exactly how and where the migraine inducing action occurred,” said Martin Kaag Rasmussen, PhD, a postdoctoral fellow at the University of Copenhagen and first author of the study. “Defining the role of these newly identified ligand-receptor pairs may enable the discovery of new pharmacological targets, which could benefit the large portion of patients not responding to available therapies.” The researchers also observed that the transport of proteins released in one side of the brain reaches mostly the nerves in the trigeminal ganglion on the same side, potentially explaining why pain occurs on one side of the head during most migraines. Additional co-authors Kjeld Mollgard, Peter Bork, Pia Weikop, Tina Esmail, Lylia Drici, Nicolai Albrechtsen, Matthias Mann, Yuki Mori, and Jonathan Carlsen with the University of Copenhagen, Nguyen Huynh and Steve Goldman with URMC, and Nima Ghitani and Alexander Chesler with the National Institute of Neurological Disorders and Stroke (NINDS). The research was supported with funding from the Novo Nordisk Foundation, NINDS, the US Army Research Office, the Lundbeck Foundation, and the Dr. Miriam and Sheldon G. Adelson Medical Research Foundation. https://www.urmc.rochester.edu/news/story/study-reveals-brain-fluid-dynamics-as-key-to-migraine-mysteries-new-therapies",Medical,Find & Summarize,Text Transformation You may only respond to the prompt using information provided in the context block. Provide your answer using a bulleted list.,What was decided in Robinson v. California?,"The Eighth Amendment provides, “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” The Eighth Amendment’s prohibitions apply to laws enacted by the federal government, and by state governments and their local subdivisions by operation of the Fourteenth Amendment. The Supreme Court has interpreted the Amendment’s prohibition on cruel and unusual punishments to, among other things, impose some “substantive limits on what the government may criminalize.” Before Grants Pass, the Supreme Court had issued two primary cases elaborating on the Eighth Amendment’s substantive limits on what a government may criminalize: Robinson v. California and Powell v. Texas. In Robinson v. California, a 1962 case, the Court heard an Eighth Amendment challenge to a California law that made it a misdemeanor offense for an individual to “be addicted to the use of narcotics.” The defendant was convicted under the law; however, at the time of his arrest, he “was neither under the influence of narcotics nor suffering withdrawal symptoms.” The Supreme Court reversed the conviction and expressed concern that the defendant was convicted on the basis of his “status,” specifically that he suffered from the “chronic condition . . . of [being] addicted to the use of narcotics.” Put differently, the Court was troubled that the defendant was not convicted “upon proof of the actual use of narcotics.” The majority thus ruled that, under the Eighth Amendment, an individual may not be punished for a status or in the absence of some conduct (or “actus reus”). Six years after Robinson, the Court issued its opinion in Powell v. Texas, a case involving an Eighth Amendment challenge to a law that proscribed public intoxication. The defendant argued that because he was a chronic alcoholic, being intoxicated in public was “not of his own volition.” While the case produced multiple opinions, the plurality determined that “Texas has sought to punish not for a status, as California did in Robinson,” but rather “for public behavior which may create substantial health and safety hazards, both for [the defendant] and for members of the general public.” That is, the plurality indicated that the law at issue criminalized conduct, not status, which it viewed as permissible. In his concurring opinion in Powell, Justice Black stated that Robinson established a status-conduct distinction, forbidding punishment when the individual has not committed a “wrongful act.” Justice White also concurred in the result. Citing Robinson, Justice White opined that “[i]f it cannot be a crime to have an irresistible compulsion to use narcotics, I do not see how it can constitutionally be a crime to yield to such a compulsion.” He thus suggested that an individual may not be punished for conduct symptomatic of or compelled by an addiction. Justice White, however, concluded that the record did not support a finding that the defendant could not avoid being in public while intoxicated. Accordingly, Justice White was not prepared to “say that the chronic alcoholic who proves his disease and a compulsion to drink is shielded from conviction [for] the [additional] act of going to or remaining in a public place.” Four Justices dissented. They contended that the defendant was “powerless” to drink, had an “uncontrollable compulsion to drink to the point of intoxication,” and that once in this state “he could not prevent himself from appearing in public places.” In other words, they suggested that, here, drinking and appearing in public were both involuntary acts making criminal punishment inappropriate. ","You may only respond to the prompt using information provided in the context block. Provide your answer using a bulleted list. What was decided in Robinson v. California? The Eighth Amendment provides, “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” The Eighth Amendment’s prohibitions apply to laws enacted by the federal government, and by state governments and their local subdivisions by operation of the Fourteenth Amendment. The Supreme Court has interpreted the Amendment’s prohibition on cruel and unusual punishments to, among other things, impose some “substantive limits on what the government may criminalize.” Before Grants Pass, the Supreme Court had issued two primary cases elaborating on the Eighth Amendment’s substantive limits on what a government may criminalize: Robinson v. California and Powell v. Texas. In Robinson v. California, a 1962 case, the Court heard an Eighth Amendment challenge to a California law that made it a misdemeanor offense for an individual to “be addicted to the use of narcotics.” The defendant was convicted under the law; however, at the time of his arrest, he “was neither under the influence of narcotics nor suffering withdrawal symptoms.” The Supreme Court reversed the conviction and expressed concern that the defendant was convicted on the basis of his “status,” specifically that he suffered from the “chronic condition . . . of [being] addicted to the use of narcotics.” Put differently, the Court was troubled that the defendant was not convicted “upon proof of the actual use of narcotics.” The majority thus ruled that, under the Eighth Amendment, an individual may not be punished for a status or in the absence of some conduct (or “actus reus”). Six years after Robinson, the Court issued its opinion in Powell v. Texas, a case involving an Eighth Amendment challenge to a law that proscribed public intoxication. The defendant argued that because he was a chronic alcoholic, being intoxicated in public was “not of his own volition.” While the case produced multiple opinions, the plurality determined that “Texas has sought to punish not for a status, as California did in Robinson,” but rather “for public behavior which may create substantial health and safety hazards, both for [the defendant] and for members of the general public.” That is, the plurality indicated that the law at issue criminalized conduct, not status, which it viewed as permissible. In his concurring opinion in Powell, Justice Black stated that Robinson established a status-conduct distinction, forbidding punishment when the individual has not committed a “wrongful act.” Justice White also concurred in the result. Citing Robinson, Justice White opined that “[i]f it cannot be a crime to have an irresistible compulsion to use narcotics, I do not see how it can constitutionally be a crime to yield to such a compulsion.” He thus suggested that an individual may not be punished for conduct symptomatic of or compelled by an addiction. Justice White, however, concluded that the record did not support a finding that the defendant could not avoid being in public while intoxicated. Accordingly, Justice White was not prepared to “say that the chronic alcoholic who proves his disease and a compulsion to drink is shielded from conviction [for] the [additional] act of going to or remaining in a public place.” Four Justices dissented. They contended that the defendant was “powerless” to drink, had an “uncontrollable compulsion to drink to the point of intoxication,” and that once in this state “he could not prevent himself from appearing in public places.” In other words, they suggested that, here, drinking and appearing in public were both involuntary acts making criminal punishment inappropriate. ",Legal,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Consider the increasing use of edge computing across a range of sectors, including network optimization, agriculture, and manufacturing. In particular how, how can edge computing handle constraints on bandwidth, latency, and data sovereignty that come with typical centralized data centers? Talk about how edge computing is especially well-suited to real-time, data-intensive applications like worker safety is hazardous or remote environments and autonomous cars. What are the main elements that, in these situations, make computing essential?","Data is the lifeblood of modern business, providing valuable business insight and supporting real-time control over critical business processes and operations. Today's businesses are awash in an ocean of data, and huge amounts of data can be routinely collected from sensors and IoT devices operating in real time from remote locations and inhospitable operating environments almost anywhere in the world. But this virtual flood of data is also changing the way businesses handle computing. The traditional computing paradigm built on a centralized data center and everyday internet isn't well suited to moving endlessly growing rivers of real-world data. Bandwidth limitations, latency issues and unpredictable network disruptions can all conspire to impair such efforts. Businesses are responding to these data challenges through the use of edge computing architecture. In simplest terms, edge computing moves some portion of storage and compute resources out of the central data center and closer to the source of the data itself. Rather than transmitting raw data to a central data center for processing and analysis, that work is instead performed where the data is actually generated - Thus, edge computing is reshaping IT and business computing. Take a comprehensive look at what edge computing is, how it works, the influence of the cloud, edge use cases, tradeoffs and implementation considerations. Edge computing uses Edge computing brings data processing closer to the data source. How does edge computing work? Edge computing is all a matter of location. In traditional enterprise computing, data is produced at a client endpoint, such as a user's computer. But the number of devices connected to the internet, and the volume of data being produced by those devices and used by businesses, is growing far too quickly for traditional data center infrastructures to accommodate. So IT architects have shifted focus from the central data center to the logical edge of the infrastructure -- taking storage and computing resources from the data center and moving those resources to the point where the data is generated. Edge computing adoption Although only 27% of respondents have already implemented edge computing technologies, 54% find the idea interesting. Edge computing puts storage and servers where the data is, often requiring little more than a partial rack of gear to operate on the remote LAN to collect and process the data locally. The idea of business intelligence can vary dramatically. Some examples include retail environments where video surveillance of the showroom floor might be combined with actual sales data to determine the most desirable product configuration or consumer demand. Edge vs. cloud vs. fog computing Edge computing is closely associated with the concepts of cloud computing and fog computing. Although there is some overlap between these concepts, they aren't the same thing, and generally shouldn't be used interchangeably. It's helpful to compare the concepts and understand their differences. One of the easiest ways to understand the differences between edge, cloud and fog computing is to highlight their common theme: All three concepts relate to distributed computing and focus on the physical deployment of compute and storage resources in relation to the data that is being produced. The difference is a matter of where those resources are located. Edge computing vs. cloud Compare edge cloud, cloud computing and edge computing to determine which model is best for you. Edge. Edge computing is the deployment of computing and storage resources at the location where data is produced. This ideally puts compute and storage at the same point as the data source at the network edge. Cloud. Cloud computing is a huge, highly scalable deployment of compute and storage resources at one of several distributed global locations (regions). Cloud providers also incorporate an assortment of pre-packaged services for IoT operations, making the cloud a preferred centralized platform for IoT deployments. Edge computing architecture Unlike cloud computing, edge computing allows data to exist closer to the data sources through a network of edge devices. Fog. But the choice of compute and storage deployment isn't limited to the cloud or the edge. Fog computing environments can produce bewildering amounts of sensor or IoT data generated across expansive physical areas that are just too large to define an edge. Examples include smart buildings, smart cities or even smart utility grids Note: It's important to repeat that fog computing and edge computing share an almost identical definition and architecture, and the terms are sometimes used interchangeably even among technology experts. Why is edge computing important? Computing tasks demand suitable architectures, and the architecture that suits one type of computing task doesn't necessarily fit all types of computing tasks. Edge computing has emerged as a viable and important architecture that supports distributed computing to deploy compute and storage resources closer to -- ideally in the same physical location a But decentralization can be challenging, demanding high levels of monitoring and control that are easily overlooked when moving away from a traditional centralized computing model. Edge computing has become relevant because it offers an effective solution to emerging network problems associated with moving enormous volumes of data that today's organizations produce and consume. It's not just a problem of amount. It's also a matter of time; applications depend on processing and responses that are increasingly time-sensitive. Consider the rise of self-driving cars. They will depend on intelligent traffic control signals. Cars and traffic controls will need to produce, analyze and exchange data in real time. Multiply this requirement by huge numbers of autonomous vehicles, and the scope of the potential problems becomes clearer. Bandwidth. Bandwidth is the amount of data which a network can carry over time, usually expressed in bits per second. All networks have a limited bandwidth, and the limits are more severe for wireless communication. Latency. Latency is the time needed to send data between two points on a networkIn other cases, network outages can exacerbate congestion and even sever communication to some internet users entirely - making the internet of things useless during outages. By deploying servers and storage where the data is generated, edge computing can operate many devices over a much smaller and more efficient LAN where ample bandwidth is used exclusively by local data-generating devices, making latency and congestion virtually nonexistent. Edge computing use cases and examples In principal, edge computing techniques are used to collect, filter, process and analyze data ""in-place"" at or near the network edge. It's a powerful means of using data that can't be first moved to a centralized location -- usually because the sheer volume of data makes such moves cost-prohibitive, technologically impractical or might otherwise violate compliance obligations, such as data sovereignty. This definition has spawned myriad real-world examples and use cases: Manufacturing. An industrial manufacturer deployed edge computing to monitor manufacturing, enabling real-time analytics and machine learning at the edge to find production errors and improve product manufacturing quality. Farming. Consider a business that grows crops indoors without sunlight, soil or pesticides. The process reduces grow times by more than 60%. Using sensors enables the business to track water use, nutrient density and determine optimal harvest. Data is collected and analyzed to find the effects of environmental factors and continually improve the crop growing algorithms and ensure that crops are harvested in peak condition. Network optimization. Edge computing can help optimize network performance by measuring performance for users across the internet and then employing analytics to determine the most reliable, low-latency network path for each user's traffic. In effect, edge computing is used to ""steer"" traffic across the network for optimal time-sensitive traffic performance. Workplace safety. Edge computing can combine and analyze data from on-site cameras, employee safety devices and various other sensors to help businesses oversee workplace conditions or ensure that employees follow established safety protocols -- especially when the workplace is remote or unusually dangerous, such as construction sites or oil rigs.","[question] Consider the increasing use of edge computing across a range of sectors, including network optimization, agriculture, and manufacturing. In particular how, how can edge computing handle constraints on bandwidth, latency, and data sovereignty that come with typical centralized data centers? Talk about how edge computing is especially well-suited to real-time, data-intensive applications like worker safety is hazardous or remote environments and autonomous cars. What are the main elements that, in these situations, make computing essential? ===================== [text] Data is the lifeblood of modern business, providing valuable business insight and supporting real-time control over critical business processes and operations. Today's businesses are awash in an ocean of data, and huge amounts of data can be routinely collected from sensors and IoT devices operating in real time from remote locations and inhospitable operating environments almost anywhere in the world. But this virtual flood of data is also changing the way businesses handle computing. The traditional computing paradigm built on a centralized data center and everyday internet isn't well suited to moving endlessly growing rivers of real-world data. Bandwidth limitations, latency issues and unpredictable network disruptions can all conspire to impair such efforts. Businesses are responding to these data challenges through the use of edge computing architecture. In simplest terms, edge computing moves some portion of storage and compute resources out of the central data center and closer to the source of the data itself. Rather than transmitting raw data to a central data center for processing and analysis, that work is instead performed where the data is actually generated - Thus, edge computing is reshaping IT and business computing. Take a comprehensive look at what edge computing is, how it works, the influence of the cloud, edge use cases, tradeoffs and implementation considerations. Edge computing uses Edge computing brings data processing closer to the data source. How does edge computing work? Edge computing is all a matter of location. In traditional enterprise computing, data is produced at a client endpoint, such as a user's computer. But the number of devices connected to the internet, and the volume of data being produced by those devices and used by businesses, is growing far too quickly for traditional data center infrastructures to accommodate. So IT architects have shifted focus from the central data center to the logical edge of the infrastructure -- taking storage and computing resources from the data center and moving those resources to the point where the data is generated. Edge computing adoption Although only 27% of respondents have already implemented edge computing technologies, 54% find the idea interesting. Edge computing puts storage and servers where the data is, often requiring little more than a partial rack of gear to operate on the remote LAN to collect and process the data locally. The idea of business intelligence can vary dramatically. Some examples include retail environments where video surveillance of the showroom floor might be combined with actual sales data to determine the most desirable product configuration or consumer demand. Edge vs. cloud vs. fog computing Edge computing is closely associated with the concepts of cloud computing and fog computing. Although there is some overlap between these concepts, they aren't the same thing, and generally shouldn't be used interchangeably. It's helpful to compare the concepts and understand their differences. One of the easiest ways to understand the differences between edge, cloud and fog computing is to highlight their common theme: All three concepts relate to distributed computing and focus on the physical deployment of compute and storage resources in relation to the data that is being produced. The difference is a matter of where those resources are located. Edge computing vs. cloud Compare edge cloud, cloud computing and edge computing to determine which model is best for you. Edge. Edge computing is the deployment of computing and storage resources at the location where data is produced. This ideally puts compute and storage at the same point as the data source at the network edge. Cloud. Cloud computing is a huge, highly scalable deployment of compute and storage resources at one of several distributed global locations (regions). Cloud providers also incorporate an assortment of pre-packaged services for IoT operations, making the cloud a preferred centralized platform for IoT deployments. Edge computing architecture Unlike cloud computing, edge computing allows data to exist closer to the data sources through a network of edge devices. Fog. But the choice of compute and storage deployment isn't limited to the cloud or the edge. Fog computing environments can produce bewildering amounts of sensor or IoT data generated across expansive physical areas that are just too large to define an edge. Examples include smart buildings, smart cities or even smart utility grids Note: It's important to repeat that fog computing and edge computing share an almost identical definition and architecture, and the terms are sometimes used interchangeably even among technology experts. Why is edge computing important? Computing tasks demand suitable architectures, and the architecture that suits one type of computing task doesn't necessarily fit all types of computing tasks. Edge computing has emerged as a viable and important architecture that supports distributed computing to deploy compute and storage resources closer to -- ideally in the same physical location a But decentralization can be challenging, demanding high levels of monitoring and control that are easily overlooked when moving away from a traditional centralized computing model. Edge computing has become relevant because it offers an effective solution to emerging network problems associated with moving enormous volumes of data that today's organizations produce and consume. It's not just a problem of amount. It's also a matter of time; applications depend on processing and responses that are increasingly time-sensitive. Consider the rise of self-driving cars. They will depend on intelligent traffic control signals. Cars and traffic controls will need to produce, analyze and exchange data in real time. Multiply this requirement by huge numbers of autonomous vehicles, and the scope of the potential problems becomes clearer. Bandwidth. Bandwidth is the amount of data which a network can carry over time, usually expressed in bits per second. All networks have a limited bandwidth, and the limits are more severe for wireless communication. Latency. Latency is the time needed to send data between two points on a networkIn other cases, network outages can exacerbate congestion and even sever communication to some internet users entirely - making the internet of things useless during outages. By deploying servers and storage where the data is generated, edge computing can operate many devices over a much smaller and more efficient LAN where ample bandwidth is used exclusively by local data-generating devices, making latency and congestion virtually nonexistent. Edge computing use cases and examples In principal, edge computing techniques are used to collect, filter, process and analyze data ""in-place"" at or near the network edge. It's a powerful means of using data that can't be first moved to a centralized location -- usually because the sheer volume of data makes such moves cost-prohibitive, technologically impractical or might otherwise violate compliance obligations, such as data sovereignty. This definition has spawned myriad real-world examples and use cases: Manufacturing. An industrial manufacturer deployed edge computing to monitor manufacturing, enabling real-time analytics and machine learning at the edge to find production errors and improve product manufacturing quality. Farming. Consider a business that grows crops indoors without sunlight, soil or pesticides. The process reduces grow times by more than 60%. Using sensors enables the business to track water use, nutrient density and determine optimal harvest. Data is collected and analyzed to find the effects of environmental factors and continually improve the crop growing algorithms and ensure that crops are harvested in peak condition. Network optimization. Edge computing can help optimize network performance by measuring performance for users across the internet and then employing analytics to determine the most reliable, low-latency network path for each user's traffic. In effect, edge computing is used to ""steer"" traffic across the network for optimal time-sensitive traffic performance. Workplace safety. Edge computing can combine and analyze data from on-site cameras, employee safety devices and various other sensors to help businesses oversee workplace conditions or ensure that employees follow established safety protocols -- especially when the workplace is remote or unusually dangerous, such as construction sites or oil rigs. https://www.techtarget.com/searchdatacenter/definition/edge-computing ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Effect Analysis,Q&A "only use information from the provided context. answer in bullet points. keep it short, two sentences for each bullet point.",summarize the complaints related to the five technologies that apple allegedly suppressed.,"The DOJ’s Complaint The DOJ’s complaint alleges that Apple has monopolized markets for “performance smartphones” and smartphones generally by impeding the development of technologies that threaten to undermine the iPhone platform. Some of the DOJ’s allegations involve Apple’s control of iPhone app distribution. Specifically, the complaint asserts that Apple wields its power over app approval to block or marginalize technologies that may reduce consumers’ dependence on the iPhone. The DOJ also contends that Apple maintains its monopoly by denying application programming interfaces (APIs) and other access points to third-party services that would reduce the costs of switching from an iPhone to another smartphone. The complaint highlights five technologies that Apple has allegedly suppressed using the tactics described above. These allegations are summarized below. • Super Apps. The DOJ argues that Apple has thwarted the development of “super apps”— programs that can serve as platforms for other apps. Super apps are popular in Asian markets, offering users a suite of services like payments, messaging, and e-commerce within a single app. The DOJ claims that, by offering a range of services that can be accessed on different types of devices, super apps threaten to disintermediate the iPhone and commoditize device hardware. The DOJ alleges that Apple strategically changed its App Store Guidelines to suppress this threat, effectively preventing apps from hosting the types of “mini programs” offered by super apps. In particular, the complaint asserts that Apple imposes restrictions that make it difficult for users to find mini programs. The DOJ also contends that Apple prevents mini programs from accessing APIs needed to Congressional Research Service https://crsreports.congress.gov LSB11154 Congressional Research Service 2 implement Apple’s in-app payment system, functionally precluding developers from monetizing such programs. • Cloud Streaming Apps. The complaint claims that Apple has also suppressed the development of cloud streaming apps, which allow users to run computationally intensive programs without storing the programs on their smartphones. By leveraging the computing power of remote servers, cloud streaming apps facilitate complex programs like gaming and artificial intelligence services, even if consumers purchase smartphones with less sophisticated hardware than an iPhone. The DOJ says that Apple is highly attuned to this threat, quoting an executive’s concern that consumers might buy an Android device “for 25 bux at a garage sale and . . . have a solid cloud computing device” that “works fine.” Apple has allegedly taken several steps to avert this outcome. The complaint contends that Apple requires developers to submit any cloud streaming game or update as a standalone app for approval by Apple. Because advanced games often require daily or hourly updates, the DOJ claims that this requirement presents developers with the untenable choice of delaying software updates for non-iOS versions of their games or making the iOS versions incompatible with non-iOS versions. The lawsuit also alleges that Apple undermines cloud gaming apps in other ways—for example, by requiring “game overhauls and payment redesigns” that effectively force developers to create iOS-specific versions of their games instead of a single cross-platform version. As a result of Apple’s conduct, the DOJ says, no developer has designed a cloud streaming app for the iPhone. • Messaging. The complaint alleges that Apple degrades cross-platform messaging in several ways, which discourages the use of other smartphones. For example, the DOJ claims that Apple prevents third-party messaging apps from accessing APIs that allow for the combination of “text to anyone” functionality and the advanced features of “over the top” (OTT) messaging protocols (e.g., encryption, typing indicators, read receipts, and the ability to share rich media). As a result, use of a third-party messaging app requires both the sender and recipient of a message to download the same third-party app. Apple Messages, by contrast, incorporates “text to anyone” functionality and advanced OTT features, allowing users to send messages with such features by typing a phone number in the messaging app’s “To:” field. The DOJ also alleges that Apple undermines the messaging quality of rival smartphones: if an iPhone user messages a non-iPhone user via Apple Messages, the text appears in a green bubble and offers limited functionality. Specifically, these conversations are not encrypted, videos are lower quality, and users cannot edit messages or see typing indicators. The complaint claims that Apple takes steps to preserve these disadvantages for competing smartphones—for example, by refusing to make Apple Messages available to other smartphones and blocking developers from providing end-to-end encryption for texts from Apple Messages to Android users. • Smartwatches. The DOJ also alleges that Apple has suppressed the development of cross-platform smartwatches, steering consumers to Apple’s smartwatch and thereby locking them into the iPhone ecosystem. The complaint contends that Apple degrades the functionality of third-party smartwatches by preventing them from responding to iPhone notifications, inhibiting them from maintaining reliable connections with iPhones, and undermining the performance of third-party smartwatches that connect directly with a cellular network. In doing so, the DOJ says, Apple bolsters its own smartwatch—Apple Watch—which does not face these disadvantages. Because Apple Watch is not Congressional Research Service 3 compatible with other smartphones, purchases of Apple Watch raise the costs of switching from an iPhone to another smartphone. Thus, by favoring Apple Watch and degrading rival smartwatches, the DOJ claims, Apple helps solidify its smartphone monopoly. • Digital Wallets. The DOJ argues that Apple has implemented a similar strategy vis-á-vis digital wallets, which allow for the storage and use of passes and credentials such as credit cards, movie tickets, and car keys. The complaint alleges that Apple’s digital wallet—Apple Wallet—is the only iPhone app that is allowed to access the technology needed for tap-to-pay functionality, which the DOJ characterizes as the “most important function for attracting users to a digital wallet.” The DOJ also claims that Apple prevents rival digital wallets from authenticating digital payment options on online checkout pages and from serving as alternatives to Apple’s in-app payment tool, further reducing the attractiveness of rival wallets to consumers. By stifling the emergence of cross-platform wallets, the lawsuit contends, Apple has suppressed the development of technology that could reduce the costs of switching from an iPhone to another smartphone. The complaint asserts that Apple’s conduct amounts to monopolization or, in the alternative, attempted monopolization of two markets: the U.S. market for “performance smartphones” and a broader U.S. market for all smartphones. The DOJ argues that “performance smartphones” represent a distinct market because “entry-level smartphones” made with lower-quality materials and performance components are not reasonable substitutes for “higher-end” smartphones like the iPhone. In support of its allegations of monopoly power, the DOJ contends that Apple occupies more than 70% of the market for “performance smartphones” and more than 65% of the market for smartphones generally, benefits from substantial barriers to entry and expansion, foregoes innovation without fear of losing customers, and achieves profit margins that significantly exceed those of rivals. In alleging anticompetitive effects, the DOJ claims that the conduct described above results in less choice for smartphone users, harms the quality of the iPhone and rival smartphones, and allows Apple to extract higher profits from iPhone users and app developers. The complaint rejects the notion that these harms can be justified on the basis of privacy, security, or other procompetitive benefits. Here, the DOJ argues that many of the technologies Apple suppresses—for example, apps that would allow Apple Messages to send encrypted texts to Android devices—would themselves enhance privacy and security. The lawsuit contends that Apple’s selective invocation of privacy and security underscores the pretextual nature of those defenses.","only use information from the provided context. answer in bullet points. keep it short, two sentences for each bullet point. summarize the complaints related to the five technologies that apple allegedly suppressed. The DOJ’s Complaint The DOJ’s complaint alleges that Apple has monopolized markets for “performance smartphones” and smartphones generally by impeding the development of technologies that threaten to undermine the iPhone platform. Some of the DOJ’s allegations involve Apple’s control of iPhone app distribution. Specifically, the complaint asserts that Apple wields its power over app approval to block or marginalize technologies that may reduce consumers’ dependence on the iPhone. The DOJ also contends that Apple maintains its monopoly by denying application programming interfaces (APIs) and other access points to third-party services that would reduce the costs of switching from an iPhone to another smartphone. The complaint highlights five technologies that Apple has allegedly suppressed using the tactics described above. These allegations are summarized below. • Super Apps. The DOJ argues that Apple has thwarted the development of “super apps”— programs that can serve as platforms for other apps. Super apps are popular in Asian markets, offering users a suite of services like payments, messaging, and e-commerce within a single app. The DOJ claims that, by offering a range of services that can be accessed on different types of devices, super apps threaten to disintermediate the iPhone and commoditize device hardware. The DOJ alleges that Apple strategically changed its App Store Guidelines to suppress this threat, effectively preventing apps from hosting the types of “mini programs” offered by super apps. In particular, the complaint asserts that Apple imposes restrictions that make it difficult for users to find mini programs. The DOJ also contends that Apple prevents mini programs from accessing APIs needed to Congressional Research Service https://crsreports.congress.gov LSB11154 Congressional Research Service 2 implement Apple’s in-app payment system, functionally precluding developers from monetizing such programs. • Cloud Streaming Apps. The complaint claims that Apple has also suppressed the development of cloud streaming apps, which allow users to run computationally intensive programs without storing the programs on their smartphones. By leveraging the computing power of remote servers, cloud streaming apps facilitate complex programs like gaming and artificial intelligence services, even if consumers purchase smartphones with less sophisticated hardware than an iPhone. The DOJ says that Apple is highly attuned to this threat, quoting an executive’s concern that consumers might buy an Android device “for 25 bux at a garage sale and . . . have a solid cloud computing device” that “works fine.” Apple has allegedly taken several steps to avert this outcome. The complaint contends that Apple requires developers to submit any cloud streaming game or update as a standalone app for approval by Apple. Because advanced games often require daily or hourly updates, the DOJ claims that this requirement presents developers with the untenable choice of delaying software updates for non-iOS versions of their games or making the iOS versions incompatible with non-iOS versions. The lawsuit also alleges that Apple undermines cloud gaming apps in other ways—for example, by requiring “game overhauls and payment redesigns” that effectively force developers to create iOS-specific versions of their games instead of a single cross-platform version. As a result of Apple’s conduct, the DOJ says, no developer has designed a cloud streaming app for the iPhone. • Messaging. The complaint alleges that Apple degrades cross-platform messaging in several ways, which discourages the use of other smartphones. For example, the DOJ claims that Apple prevents third-party messaging apps from accessing APIs that allow for the combination of “text to anyone” functionality and the advanced features of “over the top” (OTT) messaging protocols (e.g., encryption, typing indicators, read receipts, and the ability to share rich media). As a result, use of a third-party messaging app requires both the sender and recipient of a message to download the same third-party app. Apple Messages, by contrast, incorporates “text to anyone” functionality and advanced OTT features, allowing users to send messages with such features by typing a phone number in the messaging app’s “To:” field. The DOJ also alleges that Apple undermines the messaging quality of rival smartphones: if an iPhone user messages a non-iPhone user via Apple Messages, the text appears in a green bubble and offers limited functionality. Specifically, these conversations are not encrypted, videos are lower quality, and users cannot edit messages or see typing indicators. The complaint claims that Apple takes steps to preserve these disadvantages for competing smartphones—for example, by refusing to make Apple Messages available to other smartphones and blocking developers from providing end-to-end encryption for texts from Apple Messages to Android users. • Smartwatches. The DOJ also alleges that Apple has suppressed the development of cross-platform smartwatches, steering consumers to Apple’s smartwatch and thereby locking them into the iPhone ecosystem. The complaint contends that Apple degrades the functionality of third-party smartwatches by preventing them from responding to iPhone notifications, inhibiting them from maintaining reliable connections with iPhones, and undermining the performance of third-party smartwatches that connect directly with a cellular network. In doing so, the DOJ says, Apple bolsters its own smartwatch—Apple Watch—which does not face these disadvantages. Because Apple Watch is not Congressional Research Service 3 compatible with other smartphones, purchases of Apple Watch raise the costs of switching from an iPhone to another smartphone. Thus, by favoring Apple Watch and degrading rival smartwatches, the DOJ claims, Apple helps solidify its smartphone monopoly. • Digital Wallets. The DOJ argues that Apple has implemented a similar strategy vis-á-vis digital wallets, which allow for the storage and use of passes and credentials such as credit cards, movie tickets, and car keys. The complaint alleges that Apple’s digital wallet—Apple Wallet—is the only iPhone app that is allowed to access the technology needed for tap-to-pay functionality, which the DOJ characterizes as the “most important function for attracting users to a digital wallet.” The DOJ also claims that Apple prevents rival digital wallets from authenticating digital payment options on online checkout pages and from serving as alternatives to Apple’s in-app payment tool, further reducing the attractiveness of rival wallets to consumers. By stifling the emergence of cross-platform wallets, the lawsuit contends, Apple has suppressed the development of technology that could reduce the costs of switching from an iPhone to another smartphone. The complaint asserts that Apple’s conduct amounts to monopolization or, in the alternative, attempted monopolization of two markets: the U.S. market for “performance smartphones” and a broader U.S. market for all smartphones. The DOJ argues that “performance smartphones” represent a distinct market because “entry-level smartphones” made with lower-quality materials and performance components are not reasonable substitutes for “higher-end” smartphones like the iPhone. In support of its allegations of monopoly power, the DOJ contends that Apple occupies more than 70% of the market for “performance smartphones” and more than 65% of the market for smartphones generally, benefits from substantial barriers to entry and expansion, foregoes innovation without fear of losing customers, and achieves profit margins that significantly exceed those of rivals. In alleging anticompetitive effects, the DOJ claims that the conduct described above results in less choice for smartphone users, harms the quality of the iPhone and rival smartphones, and allows Apple to extract higher profits from iPhone users and app developers. The complaint rejects the notion that these harms can be justified on the basis of privacy, security, or other procompetitive benefits. Here, the DOJ argues that many of the technologies Apple suppresses—for example, apps that would allow Apple Messages to send encrypted texts to Android devices—would themselves enhance privacy and security. The lawsuit contends that Apple’s selective invocation of privacy and security underscores the pretextual nature of those defenses.",Internet/Technology,Find & Summarize,Text Transformation "Use only the information provided in this prompt and context for your answer. Do not use any outside information, and if you cannot answer from the provided context, please state, ""I cannot provide an answer due to lack of context."" Also, please break down your answer into bullet points with an explanation of each point. ","According to the following text, what is the significance of genetics when it comes to Granulomatosis with polyangiitis (GPA)?","Granulomatosis with polyangiitis Description Granulomatosis with polyangiitis (GPA) is a condition that causes inflammation that primarily affects the respiratory tract (including the lungs and airways) and the kidneys. This disorder is formerly known as Wegener granulomatosis. A characteristic feature of GPA is inflammation of blood vessels (vasculitis), particularly the small- and mediumsized blood vessels in the lungs, nose, sinuses, windpipe, and kidneys, although vessels in any organ can be involved. Polyangiitis refers to the inflammation of multiple types of vessels, such as small arteries and veins. Vasculitis causes scarring and tissue death in the vessels and impedes blood flow to tissues and organs. Another characteristic feature of GPA is the formation of granulomas, which are small areas of inflammation composed of immune cells that aid in the inflammatory reaction. The granulomas usually occur in the lungs or airways of people with this condition, although they can occur in the eyes or other organs. As granulomas grow, they can invade surrounding areas, causing tissue damage. The signs and symptoms of GPA vary based on the tissues and organs affected by vasculitis. Many people with this condition experience a vague feeling of discomfort ( malaise), fever, weight loss, or other general symptoms of the body's immune reaction. In most people with GPA, inflammation begins in the vessels of the respiratory tract, leading to nasal congestion, frequent nosebleeds, shortness of breath, or coughing. Severe inflammation in the nose can lead to a hole in the tissue that separates the two nostrils (nasal septum perforation) or a collapse of the septum, causing a sunken bridge of the nose (saddle nose). The kidneys are commonly affected in people with GPA. Tissue damage caused by vasculitis in the kidneys can lead to decreased kidney function, which may cause increased blood pressure or blood in the urine, and life-threatening kidney failure. Inflammation can also occur in other regions of the body, including the eyes, middle and inner ear structures, skin, joints, nerves, heart, and brain. Depending on which systems are involved, additional symptoms can include skin rashes, inner ear pain, swollen and painful joints, and numbness or tingling in the limbs. GPA is most common in middle-aged adults, although it can occur at any age. If untreated, the condition is usually fatal within 2 years of diagnosis. Even after treatment, vasculitis can return. Frequency GPA is a rare disorder that affects an estimated 3 in 100,000 people in the United States. Causes The genetic basis of GPA is not well understood. Having a particular version of the HLADPB1 gene is the strongest genetic risk factor for developing this condition, although several other genes, some of which have not been identified, may be involved. It is likely that a combination of genetic and environmental factors lead to GPA. GPA is an autoimmune disorder. Such disorders occur when the immune system malfunctions and attacks the body's own tissues and organs. Approximately 90 percent of people with GPA have an abnormal immune protein called an anti-neutrophil cytoplasmic antibody (ANCA) in their blood. Antibodies normally bind to specific foreign particles and germs, marking them for destruction, but ANCAs attack normal human proteins. Most people with GPA have an ANCA that attacks the human protein proteinase 3 (PR3). A few affected individuals have an ANCA that attacks a protein called myeloperoxidase (MPO). When these antibodies attach to the protein they recognize, they trigger inflammation, which contributes to the signs and symptoms of GPA. The HLA-DPB1 gene belongs to a family of genes called the human leukocyte antigen ( HLA) complex. The HLA complex helps the immune system distinguish the body's own proteins from proteins made by foreign invaders (such as viruses and bacteria). Each HLA gene has many different normal variations, allowing each person's immune system to react to a wide range of foreign proteins. A particular variant of the HLA-DPB1 gene called HLA-DPB1*0401 has been found more frequently in people with GPA, especially those with ANCAs, than in people without the condition. Because the HLA-DPB1 gene is involved in the immune system, changes in it might be related to the autoimmune response and inflammation in the respiratory tract and kidneys characteristic of GPA. However, it is unclear what specific role the HLA-DPB1* 0401 gene variant plays in development of this condition. Learn more about the gene associated with Granulomatosis with polyangiitis • HLA-DPB1 Inheritance The inheritance pattern of GPA is unknown. Most instances are sporadic and occur in individuals with no history of the disorder in their family. Only rarely is more than one member of the same family affected by the disorder.","Use only the information provided in this prompt and context for your answer. Do not use any outside information, and if you cannot answer from the provided context, please state, ""I cannot provide an answer due to lack of context."" Also, please break down your answer into bullet points with an explanation of each point. According to the following text, what is the significance of genetics when it comes to Granulomatosis with polyangiitis (GPA)? Description Granulomatosis with polyangiitis (GPA) is a condition that causes inflammation that primarily affects the respiratory tract (including the lungs and airways) and the kidneys. This disorder is formerly known as Wegener granulomatosis. A characteristic feature of GPA is inflammation of blood vessels (vasculitis), particularly the small- and mediumsized blood vessels in the lungs, nose, sinuses, windpipe, and kidneys, although vessels in any organ can be involved. Polyangiitis refers to the inflammation of multiple types of vessels, such as small arteries and veins. Vasculitis causes scarring and tissue death in the vessels and impedes blood flow to tissues and organs. Another characteristic feature of GPA is the formation of granulomas, which are small areas of inflammation composed of immune cells that aid in the inflammatory reaction. The granulomas usually occur in the lungs or airways of people with this condition, although they can occur in the eyes or other organs. As granulomas grow, they can invade surrounding areas, causing tissue damage. The signs and symptoms of GPA vary based on the tissues and organs affected by vasculitis. Many people with this condition experience a vague feeling of discomfort ( malaise), fever, weight loss, or other general symptoms of the body's immune reaction. In most people with GPA, inflammation begins in the vessels of the respiratory tract, leading to nasal congestion, frequent nosebleeds, shortness of breath, or coughing. Severe inflammation in the nose can lead to a hole in the tissue that separates the two nostrils (nasal septum perforation) or a collapse of the septum, causing a sunken bridge of the nose (saddle nose). The kidneys are commonly affected in people with GPA. Tissue damage caused by vasculitis in the kidneys can lead to decreased kidney function, which may cause increased blood pressure or blood in the urine, and life-threatening kidney failure. Inflammation can also occur in other regions of the body, including the eyes, middle and inner ear structures, skin, joints, nerves, heart, and brain. Depending on which systems are involved, additional symptoms can include skin rashes, inner ear pain, swollen and painful joints, and numbness or tingling in the limbs. GPA is most common in middle-aged adults, although it can occur at any age. If untreated, the condition is usually fatal within 2 years of diagnosis. Even after treatment, vasculitis can return. Frequency GPA is a rare disorder that affects an estimated 3 in 100,000 people in the United States. Causes The genetic basis of GPA is not well understood. Having a particular version of the HLADPB1 gene is the strongest genetic risk factor for developing this condition, although several other genes, some of which have not been identified, may be involved. It is likely that a combination of genetic and environmental factors lead to GPA. GPA is an autoimmune disorder. Such disorders occur when the immune system malfunctions and attacks the body's own tissues and organs. Approximately 90 percent of people with GPA have an abnormal immune protein called an anti-neutrophil cytoplasmic antibody (ANCA) in their blood. Antibodies normally bind to specific foreign particles and germs, marking them for destruction, but ANCAs attack normal human proteins. Most people with GPA have an ANCA that attacks the human protein proteinase 3 (PR3). A few affected individuals have an ANCA that attacks a protein called myeloperoxidase (MPO). When these antibodies attach to the protein they recognize, they trigger inflammation, which contributes to the signs and symptoms of GPA. The HLA-DPB1 gene belongs to a family of genes called the human leukocyte antigen ( HLA) complex. The HLA complex helps the immune system distinguish the body's own proteins from proteins made by foreign invaders (such as viruses and bacteria). Each HLA gene has many different normal variations, allowing each person's immune system to react to a wide range of foreign proteins. A particular variant of the HLA-DPB1 gene called HLA-DPB1*0401 has been found more frequently in people with GPA, especially those with ANCAs, than in people without the condition. Because the HLA-DPB1 gene is involved in the immune system, changes in it might be related to the autoimmune response and inflammation in the respiratory tract and kidneys characteristic of GPA. However, it is unclear what specific role the HLA-DPB1* 0401 gene variant plays in development of this condition. Learn more about the gene associated with Granulomatosis with polyangiitis • HLA-DPB1 Inheritance The inheritance pattern of GPA is unknown. Most instances are sporadic and occur in individuals with no history of the disorder in their family. Only rarely is more than one member of the same family affected by the disorder.",Medical,Find & Summarize,Text Transformation "Response should not be more than 100 words. Model must only respond using information contained in the context block. Model should not rely on its own knowledge or outside sources of information when responding.",What medications should be prescribed first for adults diagnosed with heart failure with reduced ejection fraction according to the NICE guidelines?,"Chronic heart failure in adults: diagnosis and management NICE guideline Published: 12 September 2018 www.nice.org.uk/guidance/ng106 © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Your responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 2 of 35 Contents Overview ...................................................................................................................................... 5 Who is it for? .......................................................................................................................................... 5 Recommendations ....................................................................................................................... 6 1.1 Team working in the management of heart failure ....................................................................... 6 1.2 Diagnosing heart failure .................................................................................................................. 9 1.3 Giving information to people with heart failure ............................................................................ 12 1.4 Treating heart failure with reduced ejection fraction .................................................................. 12 1.5 Treating heart failure with reduced ejection fraction in people with chronic kidney disease . 17 1.6 Managing all types of heart failure ................................................................................................ 18 1.7 Monitoring treatment for all types of heart failure ....................................................................... 21 1.8 Interventional procedures ............................................................................................................... 22 1.9 Cardiac rehabilitation ...................................................................................................................... 23 1.10 Palliative care ................................................................................................................................. 24 Terms used in this guideline ................................................................................................................. 24 Putting this guideline into practice ............................................................................................ 26 Recommendations for research ................................................................................................. 28 1 Diuretic therapy for managing fluid overload in people with advanced heart failure in the community ............................................................................................................................................. 28 2 Cardiac MRI versus other imaging techniques for diagnosing heart failure ................................ 28 3 The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing heart failure ...................................................................................................................................................... 29 4 The impact of advanced kidney disease on the natriuretic peptide threshold for diagnosing heart failure ............................................................................................................................................ 30 5 Risk tools for predicting non-sudden death in heart failure .......................................................... 30 Context ......................................................................................................................................... 31 Key facts and figures ............................................................................................................................ 31 Current practice .................................................................................................................................... 31 Finding more information and committee details .....................................................................32 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 3 of 35 Update information .....................................................................................................................33 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 4 of 35 This guideline replaces CG108. This guideline is the basis of QS167, QS9 and QS181. Overview This guideline covers diagnosing and managing chronic heart failure in people aged 18 and over. It aims to improve diagnosis and treatment to increase the length and quality of life for people with heart failure. NICE has also produced a guideline on acute heart failure. Who is it for? • Healthcare professionals • People with heart failure and their families and carers Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 5 of 35 Recommendations People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. 1.1 Team working in the management of heart failure 1.1.1 The core specialist heart failure multidisciplinary team (MDT) should work in collaboration with the primary care team, and should include: • a lead physician with subspecialty training in heart failure (usually a consultant cardiologist) who is responsible for making the clinical diagnosis • a specialist heart failure nurse • a healthcare professional with expertise in specialist prescribing for heart failure. [2018] 1.1.2 The specialist heart failure MDT should: • diagnose heart failure • give information to people newly diagnosed with heart failure (see the section on giving information to people with heart failure) • manage newly diagnosed, recently decompensated or advanced heart failure (NYHA [New York Heart Association] class III to IV) Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 6 of 35 • optimise treatment • start new medicines that need specialist supervision • continue to manage heart failure after an interventional procedure such as implantation of a cardioverter defibrillator or cardiac resynchronisation device • manage heart failure that is not responding to treatment. [2018] 1.1.3 The specialist heart failure MDT should directly involve, or refer people to, other services, including rehabilitation, services for older people and palliative care services, as needed. [2018] 1.1.4 The primary care team should carry out the following for people with heart failure at all times, including periods when the person is also receiving specialist heart failure care from the MDT: • ensure effective communication links between different care settings and clinical services involved in the person's care • lead a full review of the person's heart failure care, which may form part of a long-term conditions review • recall the person at least every 6 months and update the clinical record • ensure that changes to the clinical record are understood and agreed by the person with heart failure and shared with the specialist heart failure MDT • arrange access to specialist heart failure services if needed. [2018] Care after an acute event For recommendations on the diagnosis and management of acute heart failure, see the NICE guideline on acute heart failure. 1.1.5 People with heart failure should generally be discharged from hospital only when their clinical condition is stable and the management plan is optimised. Timing of discharge should take into account the wishes of the person and their family or Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 7 of 35 carer, and the level of care and support that can be provided in the community. [2003] 1.1.6 The primary care team should take over routine management of heart failure as soon as it has been stabilised and its management optimised. [2018] Writing a care plan 1.1.7 The specialist heart failure MDT should write a summary for each person with heart failure that includes: • diagnosis and aetiology • medicines prescribed, monitoring of medicines, when medicines should be reviewed and any support the person needs to take the medicines • functional abilities and any social care needs • social circumstances, including carers' needs. [2018] 1.1.8 The summary should form the basis of a care plan for each person, which should include: • plans for managing the person's heart failure, including follow-up care, rehabilitation and access to social care • symptoms to look out for in case of deterioration • a process for any subsequent access to the specialist heart failure MDT if needed • contact details for － a named healthcare coordinator (usually a specialist heart failure nurse) － alternative local heart failure specialist care providers, for urgent care or review. • additional sources of information for people with heart failure. [2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 8 of 35 1.1.9 Give a copy of the care plan to the person with heart failure, their family or carer if appropriate, and all health and social care professionals involved in their care. [2018] 1.2 Diagnosing heart failure Symptoms, signs and investigations 1.2.1 Take a careful and detailed history, and perform a clinical examination and tests to confirm the presence of heart failure. [2010] 1.2.2 Measure N-terminal pro-B-type natriuretic peptide (NT-proBNP) in people with suspected heart failure. [2018] 1.2.3 Because very high levels of NT-proBNP carry a poor prognosis, refer people with suspected heart failure and an NT-proBNP level above 2,000 ng/litre (236 pmol/ litre) urgently, to have specialist assessment and transthoracic echocardiography within 2 weeks. [2018] 1.2.4 Refer people with suspected heart failure and an NT-proBNP level between 400 and 2,000 ng/litre (47 to 236 pmol/litre) to have specialist assessment and transthoracic echocardiography within 6 weeks. [2018] 1.2.5 Be aware that: • an NT-proBNP level less than 400 ng/litre (47 pmol/litre) in an untreated person makes a diagnosis of heart failure less likely • the level of serum natriuretic peptide does not differentiate between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. [2018] 1.2.6 Review alternative causes for symptoms of heart failure in people with NTproBNP levels below 400 ng/litre. If there is still concern that the symptoms might be related to heart failure, discuss with a physician with subspeciality training in heart failure. [2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 9 of 35 1.2.7 Be aware that: • obesity, African or African–Caribbean family background, or treatment with diuretics, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, angiotensin II receptor blockers (ARBs) or mineralocorticoid receptor antagonists (MRAs) can reduce levels of serum natriuretic peptides • high levels of serum natriuretic peptides can have causes other than heart failure (for example, age over 70 years, left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia [including pulmonary embolism], renal dysfunction [eGFR less than 60 ml/minute/ 1.73 m 2 ], sepsis, chronic obstructive pulmonary disease, diabetes, or cirrhosis of the liver). [2010, amended 2018] 1.2.8 Perform transthoracic echocardiography to exclude important valve disease, assess the systolic (and diastolic) function of the (left) ventricle, and detect intracardiac shunts. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003, amended 2018] 1.2.9 Transthoracic echocardiography should be performed on high-resolution equipment by experienced operators trained to the relevant professional standards. Need and demand for these studies should not compromise quality. [2003, amended 2018] 1.2.10 Ensure that those reporting echocardiography are experienced in doing so. [2003] 1.2.11 Consider alternative methods of imaging the heart (for example, radionuclide angiography [multigated acquisition scanning], cardiac MRI or transoesophageal echocardiography) if a poor image is produced by transthoracic echocardiography. [2003, amended 2018] 1.2.12 Perform an ECG and consider the following tests to evaluate possible aggravating factors and/or alternative diagnoses: • chest X-ray • blood tests: Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 10 of 35 － renal function profile － thyroid function profile － liver function profile － lipid profile － glycosylated haemoglobin (HbA1c) － full blood count • urinalysis • peak flow or spirometry. [2010, amended 2018] 1.2.13 Try to exclude other disorders that may present in a similar manner. [2003] 1.2.14 When a diagnosis of heart failure has been made, assess severity, aetiology, precipitating factors, type of cardiac dysfunction and correctable causes. [2010] Heart failure caused by valve disease 1.2.15 Refer people with heart failure caused by valve disease for specialist assessment and advice regarding follow-up. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003] Reviewing existing diagnoses 1.2.16 Review the basis for a historical diagnosis of heart failure, and manage care in accordance with this guideline only if the diagnosis is confirmed. [2003] 1.2.17 If the diagnosis of heart failure is still suspected, but confirmation of the underlying cardiac abnormality has not occurred, then the person should have appropriate further investigation. [2003] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 11 of 35 1.3 Giving information to people with heart failure 1.3.1 When giving information to people with heart failure, follow the recommendations in the NICE guideline on patient experience in adult NHS services. [2018] 1.3.2 Discuss the person's prognosis in a sensitive, open and honest manner. Be frank about the uncertainty in predicting the course of their heart failure. Revisit this discussion as the person's condition evolves. [2018] 1.3.3 Provide information whenever needed throughout the person's care. [2018] 1.3.4 Consider training in advanced communication skills for all healthcare professionals working with people who have heart failure. [2018] First consultations for people newly diagnosed with heart failure 1.3.5 The specialist heart failure MDT should offer people newly diagnosed with heart failure an extended first consultation, followed by a second consultation to take place within 2 weeks if possible. At each consultation: • discuss the person's diagnosis and prognosis • explain heart failure terminology • discuss treatments • address the risk of sudden death, including any misconceptions about that risk • encourage the person and their family or carers to ask any questions they have. [2018] 1.4 Treating heart failure with reduced ejection fraction See the section on managing all types of heart failure for general recommendations on managing all types of heart failure. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 12 of 35 See NICE's technology appraisal guidance on dapagliflozin and empagliflozin for treating chronic heart failure with reduced ejection fraction. When managing pharmacological treatment, follow the recommendations in the NICE guidelines on medicines adherence and medicines optimisation. First-line treatment 1.4.1 Offer an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker licensed for heart failure to people who have heart failure with reduced ejection fraction. Use clinical judgement when deciding which drug to start first. [2010] ACE inhibitors 1.4.2 Do not offer ACE inhibitor therapy if there is a clinical suspicion of haemodynamically significant valve disease until the valve disease has been assessed by a specialist. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003] 1.4.3 Start ACE inhibitor therapy at a low dose and titrate upwards at short intervals (for example, every 2 weeks) until the target or maximum tolerated dose is reached. [2010] 1.4.4 Measure serum sodium and potassium, and assess renal function, before and 1 to 2 weeks after starting an ACE inhibitor, and after each dose increment. [2010, amended 2018] 1.4.5 Measure blood pressure before and after each dose increment of an ACE inhibitor. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.6 Once the target or maximum tolerated dose of an ACE inhibitor is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2010, amended 2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 13 of 35 Alternative treatments if ACE inhibitors are not tolerated 1.4.7 Consider an ARB licensed for heart failure as an alternative to an ACE inhibitor for people who have heart failure with reduced ejection fraction and intolerable side effects with ACE inhibitors. [2010] 1.4.8 Measure serum sodium and potassium, and assess renal function, before and after starting an ARB and after each dose increment. [2010, amended 2018] 1.4.9 Measure blood pressure after each dose increment of an ARB. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.10 Once the target or maximum tolerated dose of an ARB is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2010, amended 2018] 1.4.11 If neither ACE inhibitors nor ARBs are tolerated, seek specialist advice and consider hydralazine in combination with nitrate for people who have heart failure with reduced ejection fraction. [2010] Beta-blockers 1.4.12 Do not withhold treatment with a beta-blocker solely because of age or the presence of peripheral vascular disease, erectile dysfunction, diabetes, interstitial pulmonary disease or chronic obstructive pulmonary disease. [2010] 1.4.13 Introduce beta-blockers in a 'start low, go slow' manner. Assess heart rate and clinical status after each titration. Measure blood pressure before and after each dose increment of a beta-blocker. [2010,amended 2018] 1.4.14 Switch people whose condition is stable and who are already taking a betablocker for a comorbidity (for example, angina or hypertension), and who develop heart failure with reduced ejection fraction, to a beta-blocker licensed for heart failure. [2010] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 14 of 35 Mineralocorticoid receptor antagonists 1.4.15 Offer an mineralocorticoid receptor antagonists (MRA), in addition to an ACE inhibitor (or ARB) and beta-blocker, to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure. [2018] 1.4.16 Measure serum sodium and potassium, and assess renal function, before and after starting an MRA and after each dose increment. [2018] 1.4.17 Measure blood pressure before and after after each dose increment of an MRA. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.18 Once the target, or maximum tolerated, dose of an MRA is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2018] Specialist treatment Ivabradine These recommendations are from the NICE technology appraisal guidance on ivabradine for treating chronic heart failure. 1.4.19 Ivabradine is recommended as an option for treating chronic heart failure for people: • with New York Heart Association (NYHA) class II to IV stable chronic heart failure with systolic dysfunction and • who are in sinus rhythm with a heart rate of 75 beats per minute (bpm) or more and • who are given ivabradine in combination with standard therapy including beta-blocker therapy, angiotensin-converting enzyme (ACE) inhibitors and Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 15 of 35 aldosterone antagonists, or when beta-blocker therapy is contraindicated or not tolerated and • with a left ventricular ejection fraction of 35% or less. [2012] 1.4.20 Ivabradine should only be initiated after a stabilisation period of 4 weeks on optimised standard therapy with ACE inhibitors, beta-blockers and aldosterone antagonists. [2012] 1.4.21 Ivabradine should be initiated by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be carried out by a heart failure specialist, or in primary care by either a GP with a special interest in heart failure or a heart failure specialist nurse. [2012] Sacubitril valsartan These recommendations are from the NICE technology appraisal guidance on sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction. 1.4.22 Sacubitril valsartan is recommended as an option for treating symptomatic chronic heart failure with reduced ejection fraction, only in people: • with New York Heart Association (NYHA) class II to IV symptoms and • with a left ventricular ejection fraction of 35% or less and • who are already taking a stable dose of angiotensin-converting enzyme (ACE) inhibitors or ARBs. [2016] 1.4.23 Treatment with sacubitril valsartan should be started by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be performed by the most appropriate team member (see the section on team working in the management of heart failure). [2016] 1.4.24 This guidance is not intended to affect the position of patients whose treatment with sacubitril valsartan was started within the NHS before this guidance was published. Treatment of those patients may continue without change to whatever Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 16 of 35 funding arrangements were in place for them before this guidance was published until they and their NHS clinician consider it appropriate to stop. [2016] Hydralazine in combination with nitrate 1.4.25 Seek specialist advice and consider offering hydralazine in combination with nitrate (especially if the person is of African or Caribbean family origin and has moderate to severe heart failure [NYHA class III/IV] with reduced ejection fraction). [2010] Digoxin For recommendations on digoxin for people with atrial fibrillation see the section on rate and rhythm control in the NICE guideline on atrial fibrillation. 1.4.26 Digoxin is recommended for worsening or severe heart failure with reduced ejection fraction despite first-line treatment for heart failure. Seek specialist advice before initiating. [2010, amended 2018] 1.4.27 Routine monitoring of serum digoxin concentrations is not recommended. A digoxin concentration measured within 8 to 12 hours of the last dose may be useful to confirm a clinical impression of toxicity or non-adherence. [2003] 1.4.28 The serum digoxin concentration should be interpreted in the clinical context as toxicity may occur even when the concentration is within the 'therapeutic range'. [2003] 1.5 Treating heart failure with reduced ejection fraction in people with chronic kidney disease 1.5.1 For people who have heart failure with reduced ejection fraction and chronic kidney disease with an eGFR of 30 ml/min/1.73 m 2 or above: • offer the treatment outlined in the section on treating heart failure with Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 17 of 35 reduced ejection fraction and • if the person's eGFR is 45 ml/min/1.73 m 2 or below, consider lower doses and/ or slower titration of dose of ACE inhibitors or ARBs, MRAs and digoxin. [2018] 1.5.2 For people who have heart failure with reduced ejection fraction and chronic kidney disease with an eGFR below 30 ml/min/1.73 m 2 , the specialist heart failure MDT should consider liaising with a renal physician. [2018] 1.5.3 Monitor the response to titration of medicines closely in people who have heart failure with reduced ejection fraction and chronic kidney disease, taking into account the increased risk of hyperkalaemia. [2018] 1.6 Managing all types of heart failure When managing pharmacological treatment, follow the recommendations in the NICE guidelines on medicines adherence and medicines optimisation. Pharmacological treatment Diuretics 1.6.1 Diuretics should be routinely used for the relief of congestive symptoms and fluid retention in people with heart failure, and titrated (up and down) according to need following the initiation of subsequent heart failure therapies. [2003] 1.6.2 People who have heart failure with preserved ejection fraction should usually be offered a low to medium dose of loop diuretics (for example, less than 80 mg furosemide per day). People whose heart failure does not respond to this treatment will need further specialist advice. [2003, amended 2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 18 of 35 Calcium-channel blockers 1.6.3 Avoid verapamil, diltiazem and short-acting dihydropyridine agents in people who have heart failure with reduced ejection fraction. [2003, amended 2018] Amiodarone 1.6.4 Make the decision to prescribe amiodarone in consultation with a specialist. [2003] 1.6.5 Review the need to continue the amiodarone prescription at the 6-monthly clinical review. [2003, amended 2018] 1.6.6 Offer people taking amiodarone liver and thyroid function tests, and a review of side effects, as part of their routine 6-monthly clinical review. [2003, amended 2018] Anticoagulants 1.6.7 For people who have heart failure and atrial fibrillation, follow the recommendations on anticoagulation in the NICE guideline on atrial fibrillation. Be aware of the effects of impaired renal and liver function on anticoagulant therapies. [2018] 1.6.8 In people with heart failure in sinus rhythm, anticoagulation should be considered for those with a history of thromboembolism, left ventricular aneurysm or intracardiac thrombus. [2003] Vaccinations 1.6.9 Offer people with heart failure an annual vaccination against influenza. [2003] 1.6.10 Offer people with heart failure vaccination against pneumococcal disease (only required once). [2003] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 19 of 35 Contraception and pregnancy 1.6.11 In women of childbearing potential who have heart failure, contraception and pregnancy should be discussed. If pregnancy is being considered or occurs, specialist advice should be sought. Subsequently, specialist care should be shared between the cardiologist and obstetrician. [2003] Depression See NICE's guideline on depression in adults with a chronic physical health problem. Lifestyle advice Salt and fluid restriction 1.6.12 Do not routinely advise people with heart failure to restrict their sodium or fluid consumption. Ask about salt and fluid consumption and, if needed, advise as follows: • restricting fluids for people with dilutional hyponatraemia • reducing intake for people with high levels of salt and/or fluid consumption. Continue to review the need to restrict salt or fluid. [2018] 1.6.13 Advise people with heart failure to avoid salt substitutes that contain potassium. [2018] Smoking and alcohol See NICE's guidance on smoking and tobacco and alcohol. Air travel 1.6.14 Air travel will be possible for the majority of people with heart failure, depending Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 20 of 35 on their clinical condition at the time of travel. [2003] Driving 1.6.15 Large Goods Vehicle and Passenger Carrying Vehicle licence: physicians should be up to date with the latest Driver and Vehicle Licensing Agency (DVLA) guidelines. Check the DVLA website for regular updates. [2003] 1.7 Monitoring treatment for all types of heart failure See the section on treating heart failure with reduced ejection fraction for specific recommendations on monitoring treatment for heart failure with reduced ejection fraction. Clinical review 1.7.1 All people with chronic heart failure need monitoring. This monitoring should include: • a clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status • a review of medication, including need for changes and possible side effects • an assessment of renal function. Note: This is a minimum. People with comorbidities or co-prescribed medications will need further monitoring. Monitoring serum potassium is particularly important if a person is taking digoxin or an MRA. [2010, amended 2018] 1.7.2 More detailed monitoring will be needed if the person has significant comorbidity or if their condition has deteriorated since the previous review. [2003] 1.7.3 The frequency of monitoring should depend on the clinical status and stability of Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 21 of 35 the person. The monitoring interval should be short (days to 2 weeks) if the clinical condition or medication has changed, but is needed at least 6-monthly for stable people with proven heart failure. [2003] 1.7.4 People with heart failure who wish to be involved in monitoring of their condition should be provided with sufficient education and support from their healthcare professional to do this, with clear guidelines as to what to do in the event of deterioration. [2003] Measuring NT-proBNP 1.7.5 Consider measuring NT-proBNP (N-terminal pro-B-type natriuretic peptide) as part of a treatment optimisation protocol only in a specialist care setting for people aged under 75 who have heart failure with reduced ejection fraction and an eGFR above 60 ml/min/1.73 m 2 . [2018] 1.8 Interventional procedures Coronary revascularisation 1.8.1 Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. [2018] Cardiac transplantation 1.8.2 Specialist referral for transplantation should be considered for people with severe refractory symptoms or refractory cardiogenic shock. [2003] Implantable cardioverter defibrillators and cardiac resynchronisation therapy See NICE's technology appraisal guidance on implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 22 of 35 1.8.3 When discussing implantation of a cardioverter defibrillator: • explain the risks, benefits and consequences of cardioverter defibrillator implantation, following the principles on shared decision making in the NICE guideline on patient experience in adult NHS services • ensure the person knows that the defibrillator function can be deactivated without affecting any cardiac resynchronisation or pacing, and reactivated later • explain the circumstances in which deactivation might be offered • discuss and dispel common misconceptions about the function of the device and the consequences of deactivation • provide the person and, if they wish, their family or carers with written information covering the information discussed. [2018] 1.8.4 Review the benefits and potential harms of a cardioverter defibrillator remaining active in a person with heart failure: • at each 6-monthly review of their heart failure care • whenever their care goals change • as part of advance care planning if it is thought they are nearing the end of life. [2018] 1.9 Cardiac rehabilitation 1.9.1 Offer people with heart failure a personalised, exercise-based cardiac rehabilitation programme, unless their condition is unstable. The programme: • should be preceded by an assessment to ensure that it is suitable for the person • should be provided in a format and setting (at home, in the community or in the hospital) that is easily accessible for the person Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 23 of 35 • should include a psychological and educational component • may be incorporated within an existing cardiac rehabilitation programme • should be accompanied by information about support available from healthcare professionals when the person is doing the programme. [2018] 1.10 Palliative care 1.10.1 Do not offer long-term home oxygen therapy for advanced heart failure. Be aware that long-term home oxygen therapy may be offered for comorbidities, such as for some people with chronic obstructive pulmonary disease (see the section on oxygen in the NICE guideline on chronic obstructive pulmonary disease in over 16s). [2018] 1.10.2 Do not use prognostic risk tools to determine whether to refer a person with heart failure to palliative care services. [2018] 1.10.3 If the symptoms of a person with heart failure are worsening despite optimal specialist treatment, discuss their palliative care needs with the specialist heart failure multidisciplinary team and consider a needs assessment for palliative care. [2018] 1.10.4 People with heart failure and their families or carers should have access to professionals with palliative care skills within the heart failure team. [2003] 1.10.5 If it is thought that a person may be entering the last 2 to 3 days of life, follow the NICE guideline on care of dying adults in the last days of life. [2018] Terms used in this guideline Heart failure with preserved ejection fraction This is usually associated with impaired left ventricular relaxation, rather than left ventricular contraction, and is characterised by normal or preserved left ventricular Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 24 of 35 ejection fraction with evidence of diastolic dysfunction . Heart failure with reduced ejection fraction Heart failure with an ejection fraction below 40%. Mineralocorticoid receptor antagonist A drug that antagonises the action of aldosterone at mineralocorticoid receptors. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 25 of 35 Putting this guideline into practice NICE has produced tools and resources to help you put this guideline into practice. Putting recommendations into practice can take time. How long may vary from guideline to guideline, and depends on how much change in practice or services is needed. Implementing change is most effective when aligned with local priorities. Changes recommended for clinical practice that can be done quickly – like changes in prescribing practice – should be shared quickly. This is because healthcare professionals should use guidelines to guide their work – as is required by professional regulating bodies such as the General Medical and Nursing and Midwifery Councils. Changes should be implemented as soon as possible, unless there is a good reason for not doing so (for example, if it would be better value for money if a package of recommendations were all implemented at once). Different organisations may need different approaches to implementation, depending on their size and function. Sometimes individual practitioners may be able to respond to recommendations to improve their practice more quickly than large organisations. Here are some pointers to help organisations put NICE guidelines into practice: 1. Raise awareness through routine communication channels, such as email or newsletters, regular meetings, internal staff briefings and other communications with all relevant partner organisations. Identify things staff can include in their own practice straight away. 2. Identify a lead with an interest in the topic to champion the guideline and motivate others to support its use and make service changes, and to find out any significant issues locally. 3. Carry out a baseline assessment against the recommendations to find out whether there are gaps in current service provision. 4. Think about what data you need to measure improvement and plan how you will collect it. You may want to work with other health and social care organisations and specialist Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 26 of 35 groups to compare current practice with the recommendations. This may also help identify local issues that will slow or prevent implementation. 5. Develop an action plan, with the steps needed to put the guideline into practice, and make sure it is ready as soon as possible. Big, complex changes may take longer to implement, but some may be quick and easy to do. An action plan will help in both cases. 6. For very big changes include milestones and a business case, which will set out additional costs, savings and possible areas for disinvestment. A small project group could develop the action plan. The group might include the guideline champion, a senior organisational sponsor, staff involved in the associated services, finance and information professionals. 7. Implement the action plan with oversight from the lead and the project group. Big projects may also need project management support. 8. Review and monitor how well the guideline is being implemented through the project group. Share progress with those involved in making improvements, as well as relevant boards and local partners. NICE provides a comprehensive programme of support and resources to maximise uptake and use of evidence and guidance. See NICE's into practice pages for more information. Also see Leng G, Moore V, Abraham S, editors (2014) Achieving high quality care – practical experience from NICE. Chichester: Wiley. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 27 of 35 Recommendations for research The guideline committee has made the following key recommendations for research. The committee's full set of research recommendations is detailed in the full guideline. 1 Diuretic therapy for managing fluid overload in people with advanced heart failure in the community In people with advanced heart failure and significant peripheral fluid overload, what is the clinical and cost effectiveness of oral, subcutaneous and intravenous diuretic therapy in the community? Why this is important This research is critical to inform practice of how best to manage people with advanced heart failure in the community if they develop significant peripheral fluid overload. These people are more likely to have multiple admissions that, together with fluid overload, have a negative impact on their quality of life. Management in the community can minimise disruption for the person and reduce costs from hospital admissions. Knowledge of the most clinically and cost-effective routes of administration for diuretic therapy will dictate the level of resource needed to provide the service. Intravenous and subcutaneous diuretics usually need to be administered by nursing or healthcare staff. although a pump for self-administration of subcutaneous diuretics has recently been developed. Oral formulations can be self-administered. 2 Cardiac MRI versus other imaging techniques for diagnosing heart failure What is the optimal imaging technique for the diagnosis of heart failure? Why this is important The role of cardiac MRI in the detection and characterisation of several structural and Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 28 of 35 functional cardiac abnormalities has become well established over the past 25 years. In people with heart failure, cardiac MRI provides reliable and reproducible assessments of the left ventricular (and to a degree the right ventricular) shapes, volumes and ejection fractions. It also provides spatial assessments of the congenital and acquired structural abnormalities of the heart and their interrelationships with the remainder of the heart, as well as functional and haemodynamic assessments of these abnormalities on the heart's performance. Finally, cardiac MRI provides valuable information about the myocardial structure and metabolism, including the presence of inflammation, scarring, fibrosis and infiltration. Cardiac MRI is an expensive form of imaging, and much of this diagnostic information could be provided by less costly non-invasive imaging techniques, chiefly echocardiography. This question aims to find the most clinically and cost-effective imaging technique for the clinical diagnosis of heart failure. 3 The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing heart failure What is the optimal NT-proBNP threshold for the diagnosis of heart failure in people with atrial fibrillation? Why this is important Atrial fibrillation is a common arrhythmia in the general population, and occurs in 30 to 40% of people with heart failure. Atrial fibrillation can raise the level of serum natriuretic peptides, including NT-proBNP, even in the absence of heart failure. This is complicated further in heart failure with preserved ejection fraction, in which 2 echocardiographic diagnostic criteria become unreliable (the left atrial volume and the tissue doppler imaging assessment of diastolic function). These factors contribute to the complexity of the diagnosis and have a potential impact on the usual thresholds for NT-proBNP in people who have atrial fibrillation. This has been recognised in several ongoing randomised controlled trials of heart failure, which are using higher NT-proBNP thresholds for the diagnosis of heart failure in people with atrial fibrillation. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 29 of 35 4 The impact of advanced kidney disease on the natriuretic peptide threshold for diagnosing heart failure What are the optimal NT-proBNP thresholds for diagnosing heart failure in people with stage IIIb, IV or V chronic kidney disease? Why this is important Heart failure incidence and prevalence increase with age, with the rise starting at age 65 and peaking between 75 and 85. Both advancing age and heart failure are associated with a gradual and progressive decline in renal function. In addition, the progression of heart failure and some treatments for heart failure lead to progressive deterioration of renal function. A decline in renal function is associated with increased fluid retention and a rise in the level of the serum natriuretic peptides, including NT-proBNP, even in the absence of heart failure. There is some evidence that the use of higher NT-proBNP thresholds would improve diagnostic accuracy for heart failure in people with significant deterioration of creatinine clearance. 5 Risk tools for predicting non-sudden death in heart failure What is the most accurate prognostic risk tool in predicting 1-year mortality from heart failure at specific clinically relevant thresholds (for example, sensitivity, specificity, negative predictive value and positive predictive value at a threshold of 50% risk of mortality at 1 year)? Why this is important There are a number of validated prognostic risk tools for heart failure but most do not report sensitivity and specificity at clinically relevant thresholds. This information is crucial to enable accurate prediction of a person's risk of mortality. The ability to accurately predict a person's prognosis would allow clearer communication and timely referral to other services such as palliative care. Inaccurate prediction has the potential to lead to significant psychological harm and increased morbidity. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 30 of 35 Context Key facts and figures Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired. It is caused by structural or functional abnormalities of the heart. Around 920,000 people in the UK today have been diagnosed with heart failure. Both the incidence and prevalence of heart failure increase steeply with age, and the average age at diagnosis is 77. Improvements in care have increased survival for people with ischaemic heart disease, and treatments for heart failure have become more effective. But the overall prevalence of heart failure is rising because of population ageing and increasing rates of obesity. Current practice Uptake of NICE's 2010 guidance on chronic heart failure appears to be good. However, the Department of Health and Social Care's policy paper on improving cardiovascular disease outcomes: strategy noted that prescribing of ACE inhibitors, beta-blockers and aldosterone antagonists remains suboptimal, and that improved use of these drugs has the potential to reduce hospitalisations and deaths caused by heart failure. This update reviewed evidence on the clinical and cost effectiveness of these therapies. Interdisciplinary working has contributed to better outcomes in heart failure but there is further room to improve the provision of multidisciplinary teams (MDTs) and integrate them more fully into healthcare processes. This update highlights and further expands on the roles of the MDT and collaboration between the MDT and the primary care team. The Department of Health and Social Care's policy paper on improving cardiovascular disease outcomes: strategy also noted that the proportion of people with heart failure who have cardiac rehabilitation was around 4%, and that increasing this proportion would reduce mortality and hospitalisation. This update recommends that all people with heart failure are offered an easily accessible, exercise-based cardiac rehabilitation programme, if this is suitable for them. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 31 of 35 Finding more information and committee details To find out what NICE has said on related topics, including guidance in development, see the NICE topic page on cardiovascular conditions. For full details of the evidence and the guideline committee's discussions, see the full guideline. You can also find information about how the guideline was developed, including details of the committee. NICE has produced tools and resources to help you put this guideline into practice. For general help and advice on putting our guidelines into practice, see resources to help you put NICE guidance into practice. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 32 of 35 Update information September 2018: This guideline updates and replaces NICE clinical guideline 108 (published August 2010). NICE clinical guideline 108 updated and replaced NICE clinical guideline 5 (published July 2003). Recommendations are marked as [2018], [2016], [2012], [2010], [2010, amended 2018], [2003], [2003, amended 2018] or [2003, amended 2010], [2018] indicates that the evidence was reviewed and the recommendation added, updated or unchanged in 2018. [2016] refers to NICE technology appraisal guidance published in 2016. [2012] refers to NICE technology appraisal guidance published in 2012. [2010] indicates that the evidence was reviewed in 2010. [2010, amended 2018] indicates that the evidence was reviewed in 2010 but changes were made to the recommendation wording in 2018 that changed the meaning. [2003] indicates that the evidence was reviewed in 2003. [2003, amended 2018] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2018 that changed the meaning. [2003, amended 2010] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2010 that changed the meaning. • 'Heart failure due to left ventricular systolic dysfunction (LVSD)' has been replaced in all recommendations by 'heart failure with reduced ejection fraction' in line with current terminology and the 2018 guideline scope. • 'Aldosterone antagonists' has been replaced in all recommendations by 'mineralocorticoid receptor antagonists (MRAs') to clarify the function of the receptor, and in line with the 2018 guideline scope. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 33 of 35 • 'African or African-Caribbean family origin' has been added to recommendation 1.2.7 because of the high incidence of heart failure with preserved ejection fraction in these populations. Recent evidence shows that NT-proBNP levels are lower in people of west African family background and are a confounder in the diagnosis of heart failure. • Doppler 2D has been deleted from recommendations 1.2.8, 1.2.9 and 1.2.11 because all transthoracic echocardiography would have doppler 2D as a minimum and it is no longer necessary to specify this. • 'Multigated acquisition scanning' has been added to recommendation 1.2.11 to reflect current imaging technology. • Measurement of urea has been deleted from recommendations 1.2.12, 1.4.8 and 1.7.1 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK. Blood tests for electrolytes, creatinine and eGFR have been grouped together under the term 'renal function profile' because they are provided as a unified set of analyses in the NHS. The term 'profile' is applied to a group of tests (assays). Thus these tests are more accurately described as 'profiles' as they contain multiple individual assays and have replaced thyroid function test, liver function test and lipid measurement. 'Fasting glucose' has been replaced by 'glycosylated haemoglobin (HbA1c)' in line with the NICE guidelines on diabetes. • Measurement of serum urea has been deleted from recommendation 1.4.4 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK. Measurement of potassium has been added to ensure that monitoring is consistent across treatments. • Recommendations 1.4.6 and 1.4.10 have been added to clarify the timing of monitoring after treatment starts. • In recommendation 1.4.8, monitoring for hyperkalaemia has been replaced by potassium measurement for clarity. • Blood pressure measurement has been clarified in recommendation 1.4.13 and made consistent with other treatments. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 34 of 35 • As a result of new evidence the treatment pathway for heart failure with reduced ejection fraction in recommendation 1.4.26 has been amended. Second line treatment has been replaced by specialist treatment. A sentence has been added to clarify that specialist advice should be sought before starting treatment with digoxin. • The first part of recommendation 1.6.2 has been removed because it is now covered in section 1.1 on team working in the management of heart failure. • Amlodipine to treat hypertension has been deleted from recommendation 1.6.3 because it has been superseded by the NICE guideline on hypertension in adults. • 'Regularly' has been replaced by 'at the 6-monthly clinical review' in recommendation 1.6.5 for clarification. • The wording in recommendation 1.6.6 has been amended in line with recommendation 1.6.5. Minor changes since publication April 2022: In section 1.4 we added links to NICE's technology appraisal guidance on dapagliflozin and empagliflozin for treating chronic heart failure with reduced ejection fraction. November 2021: We added a link to the NICE guideline on heart valve disease in recommendations 1.2.8, 1.2.15 and 1.4.2. ISBN: 978-1-4731-3093-7 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 35 of 35 ","Response should not be more than 100 words. Model must only respond using information contained in the context block. Model should not rely on its own knowledge or outside sources of information when responding. What medications should be prescribed first for adults diagnosed with heart failure with reduced ejection fraction according to the NICE guidelines? Chronic heart failure in adults: diagnosis and management NICE guideline Published: 12 September 2018 www.nice.org.uk/guidance/ng106 © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Your responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 2 of 35 Contents Overview ...................................................................................................................................... 5 Who is it for? .......................................................................................................................................... 5 Recommendations ....................................................................................................................... 6 1.1 Team working in the management of heart failure ....................................................................... 6 1.2 Diagnosing heart failure .................................................................................................................. 9 1.3 Giving information to people with heart failure ............................................................................ 12 1.4 Treating heart failure with reduced ejection fraction .................................................................. 12 1.5 Treating heart failure with reduced ejection fraction in people with chronic kidney disease . 17 1.6 Managing all types of heart failure ................................................................................................ 18 1.7 Monitoring treatment for all types of heart failure ....................................................................... 21 1.8 Interventional procedures ............................................................................................................... 22 1.9 Cardiac rehabilitation ...................................................................................................................... 23 1.10 Palliative care ................................................................................................................................. 24 Terms used in this guideline ................................................................................................................. 24 Putting this guideline into practice ............................................................................................ 26 Recommendations for research ................................................................................................. 28 1 Diuretic therapy for managing fluid overload in people with advanced heart failure in the community ............................................................................................................................................. 28 2 Cardiac MRI versus other imaging techniques for diagnosing heart failure ................................ 28 3 The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing heart failure ...................................................................................................................................................... 29 4 The impact of advanced kidney disease on the natriuretic peptide threshold for diagnosing heart failure ............................................................................................................................................ 30 5 Risk tools for predicting non-sudden death in heart failure .......................................................... 30 Context ......................................................................................................................................... 31 Key facts and figures ............................................................................................................................ 31 Current practice .................................................................................................................................... 31 Finding more information and committee details .....................................................................32 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 3 of 35 Update information .....................................................................................................................33 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 4 of 35 This guideline replaces CG108. This guideline is the basis of QS167, QS9 and QS181. Overview This guideline covers diagnosing and managing chronic heart failure in people aged 18 and over. It aims to improve diagnosis and treatment to increase the length and quality of life for people with heart failure. NICE has also produced a guideline on acute heart failure. Who is it for? • Healthcare professionals • People with heart failure and their families and carers Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 5 of 35 Recommendations People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. 1.1 Team working in the management of heart failure 1.1.1 The core specialist heart failure multidisciplinary team (MDT) should work in collaboration with the primary care team, and should include: • a lead physician with subspecialty training in heart failure (usually a consultant cardiologist) who is responsible for making the clinical diagnosis • a specialist heart failure nurse • a healthcare professional with expertise in specialist prescribing for heart failure. [2018] 1.1.2 The specialist heart failure MDT should: • diagnose heart failure • give information to people newly diagnosed with heart failure (see the section on giving information to people with heart failure) • manage newly diagnosed, recently decompensated or advanced heart failure (NYHA [New York Heart Association] class III to IV) Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 6 of 35 • optimise treatment • start new medicines that need specialist supervision • continue to manage heart failure after an interventional procedure such as implantation of a cardioverter defibrillator or cardiac resynchronisation device • manage heart failure that is not responding to treatment. [2018] 1.1.3 The specialist heart failure MDT should directly involve, or refer people to, other services, including rehabilitation, services for older people and palliative care services, as needed. [2018] 1.1.4 The primary care team should carry out the following for people with heart failure at all times, including periods when the person is also receiving specialist heart failure care from the MDT: • ensure effective communication links between different care settings and clinical services involved in the person's care • lead a full review of the person's heart failure care, which may form part of a long-term conditions review • recall the person at least every 6 months and update the clinical record • ensure that changes to the clinical record are understood and agreed by the person with heart failure and shared with the specialist heart failure MDT • arrange access to specialist heart failure services if needed. [2018] Care after an acute event For recommendations on the diagnosis and management of acute heart failure, see the NICE guideline on acute heart failure. 1.1.5 People with heart failure should generally be discharged from hospital only when their clinical condition is stable and the management plan is optimised. Timing of discharge should take into account the wishes of the person and their family or Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 7 of 35 carer, and the level of care and support that can be provided in the community. [2003] 1.1.6 The primary care team should take over routine management of heart failure as soon as it has been stabilised and its management optimised. [2018] Writing a care plan 1.1.7 The specialist heart failure MDT should write a summary for each person with heart failure that includes: • diagnosis and aetiology • medicines prescribed, monitoring of medicines, when medicines should be reviewed and any support the person needs to take the medicines • functional abilities and any social care needs • social circumstances, including carers' needs. [2018] 1.1.8 The summary should form the basis of a care plan for each person, which should include: • plans for managing the person's heart failure, including follow-up care, rehabilitation and access to social care • symptoms to look out for in case of deterioration • a process for any subsequent access to the specialist heart failure MDT if needed • contact details for － a named healthcare coordinator (usually a specialist heart failure nurse) － alternative local heart failure specialist care providers, for urgent care or review. • additional sources of information for people with heart failure. [2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 8 of 35 1.1.9 Give a copy of the care plan to the person with heart failure, their family or carer if appropriate, and all health and social care professionals involved in their care. [2018] 1.2 Diagnosing heart failure Symptoms, signs and investigations 1.2.1 Take a careful and detailed history, and perform a clinical examination and tests to confirm the presence of heart failure. [2010] 1.2.2 Measure N-terminal pro-B-type natriuretic peptide (NT-proBNP) in people with suspected heart failure. [2018] 1.2.3 Because very high levels of NT-proBNP carry a poor prognosis, refer people with suspected heart failure and an NT-proBNP level above 2,000 ng/litre (236 pmol/ litre) urgently, to have specialist assessment and transthoracic echocardiography within 2 weeks. [2018] 1.2.4 Refer people with suspected heart failure and an NT-proBNP level between 400 and 2,000 ng/litre (47 to 236 pmol/litre) to have specialist assessment and transthoracic echocardiography within 6 weeks. [2018] 1.2.5 Be aware that: • an NT-proBNP level less than 400 ng/litre (47 pmol/litre) in an untreated person makes a diagnosis of heart failure less likely • the level of serum natriuretic peptide does not differentiate between heart failure with reduced ejection fraction and heart failure with preserved ejection fraction. [2018] 1.2.6 Review alternative causes for symptoms of heart failure in people with NTproBNP levels below 400 ng/litre. If there is still concern that the symptoms might be related to heart failure, discuss with a physician with subspeciality training in heart failure. [2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 9 of 35 1.2.7 Be aware that: • obesity, African or African–Caribbean family background, or treatment with diuretics, angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, angiotensin II receptor blockers (ARBs) or mineralocorticoid receptor antagonists (MRAs) can reduce levels of serum natriuretic peptides • high levels of serum natriuretic peptides can have causes other than heart failure (for example, age over 70 years, left ventricular hypertrophy, ischaemia, tachycardia, right ventricular overload, hypoxaemia [including pulmonary embolism], renal dysfunction [eGFR less than 60 ml/minute/ 1.73 m 2 ], sepsis, chronic obstructive pulmonary disease, diabetes, or cirrhosis of the liver). [2010, amended 2018] 1.2.8 Perform transthoracic echocardiography to exclude important valve disease, assess the systolic (and diastolic) function of the (left) ventricle, and detect intracardiac shunts. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003, amended 2018] 1.2.9 Transthoracic echocardiography should be performed on high-resolution equipment by experienced operators trained to the relevant professional standards. Need and demand for these studies should not compromise quality. [2003, amended 2018] 1.2.10 Ensure that those reporting echocardiography are experienced in doing so. [2003] 1.2.11 Consider alternative methods of imaging the heart (for example, radionuclide angiography [multigated acquisition scanning], cardiac MRI or transoesophageal echocardiography) if a poor image is produced by transthoracic echocardiography. [2003, amended 2018] 1.2.12 Perform an ECG and consider the following tests to evaluate possible aggravating factors and/or alternative diagnoses: • chest X-ray • blood tests: Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 10 of 35 － renal function profile － thyroid function profile － liver function profile － lipid profile － glycosylated haemoglobin (HbA1c) － full blood count • urinalysis • peak flow or spirometry. [2010, amended 2018] 1.2.13 Try to exclude other disorders that may present in a similar manner. [2003] 1.2.14 When a diagnosis of heart failure has been made, assess severity, aetiology, precipitating factors, type of cardiac dysfunction and correctable causes. [2010] Heart failure caused by valve disease 1.2.15 Refer people with heart failure caused by valve disease for specialist assessment and advice regarding follow-up. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003] Reviewing existing diagnoses 1.2.16 Review the basis for a historical diagnosis of heart failure, and manage care in accordance with this guideline only if the diagnosis is confirmed. [2003] 1.2.17 If the diagnosis of heart failure is still suspected, but confirmation of the underlying cardiac abnormality has not occurred, then the person should have appropriate further investigation. [2003] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 11 of 35 1.3 Giving information to people with heart failure 1.3.1 When giving information to people with heart failure, follow the recommendations in the NICE guideline on patient experience in adult NHS services. [2018] 1.3.2 Discuss the person's prognosis in a sensitive, open and honest manner. Be frank about the uncertainty in predicting the course of their heart failure. Revisit this discussion as the person's condition evolves. [2018] 1.3.3 Provide information whenever needed throughout the person's care. [2018] 1.3.4 Consider training in advanced communication skills for all healthcare professionals working with people who have heart failure. [2018] First consultations for people newly diagnosed with heart failure 1.3.5 The specialist heart failure MDT should offer people newly diagnosed with heart failure an extended first consultation, followed by a second consultation to take place within 2 weeks if possible. At each consultation: • discuss the person's diagnosis and prognosis • explain heart failure terminology • discuss treatments • address the risk of sudden death, including any misconceptions about that risk • encourage the person and their family or carers to ask any questions they have. [2018] 1.4 Treating heart failure with reduced ejection fraction See the section on managing all types of heart failure for general recommendations on managing all types of heart failure. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 12 of 35 See NICE's technology appraisal guidance on dapagliflozin and empagliflozin for treating chronic heart failure with reduced ejection fraction. When managing pharmacological treatment, follow the recommendations in the NICE guidelines on medicines adherence and medicines optimisation. First-line treatment 1.4.1 Offer an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker licensed for heart failure to people who have heart failure with reduced ejection fraction. Use clinical judgement when deciding which drug to start first. [2010] ACE inhibitors 1.4.2 Do not offer ACE inhibitor therapy if there is a clinical suspicion of haemodynamically significant valve disease until the valve disease has been assessed by a specialist. See the section on referral for echocardiography and specialist assessment in the NICE guideline on heart valve disease. [2003] 1.4.3 Start ACE inhibitor therapy at a low dose and titrate upwards at short intervals (for example, every 2 weeks) until the target or maximum tolerated dose is reached. [2010] 1.4.4 Measure serum sodium and potassium, and assess renal function, before and 1 to 2 weeks after starting an ACE inhibitor, and after each dose increment. [2010, amended 2018] 1.4.5 Measure blood pressure before and after each dose increment of an ACE inhibitor. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.6 Once the target or maximum tolerated dose of an ACE inhibitor is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2010, amended 2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 13 of 35 Alternative treatments if ACE inhibitors are not tolerated 1.4.7 Consider an ARB licensed for heart failure as an alternative to an ACE inhibitor for people who have heart failure with reduced ejection fraction and intolerable side effects with ACE inhibitors. [2010] 1.4.8 Measure serum sodium and potassium, and assess renal function, before and after starting an ARB and after each dose increment. [2010, amended 2018] 1.4.9 Measure blood pressure after each dose increment of an ARB. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.10 Once the target or maximum tolerated dose of an ARB is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2010, amended 2018] 1.4.11 If neither ACE inhibitors nor ARBs are tolerated, seek specialist advice and consider hydralazine in combination with nitrate for people who have heart failure with reduced ejection fraction. [2010] Beta-blockers 1.4.12 Do not withhold treatment with a beta-blocker solely because of age or the presence of peripheral vascular disease, erectile dysfunction, diabetes, interstitial pulmonary disease or chronic obstructive pulmonary disease. [2010] 1.4.13 Introduce beta-blockers in a 'start low, go slow' manner. Assess heart rate and clinical status after each titration. Measure blood pressure before and after each dose increment of a beta-blocker. [2010,amended 2018] 1.4.14 Switch people whose condition is stable and who are already taking a betablocker for a comorbidity (for example, angina or hypertension), and who develop heart failure with reduced ejection fraction, to a beta-blocker licensed for heart failure. [2010] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 14 of 35 Mineralocorticoid receptor antagonists 1.4.15 Offer an mineralocorticoid receptor antagonists (MRA), in addition to an ACE inhibitor (or ARB) and beta-blocker, to people who have heart failure with reduced ejection fraction if they continue to have symptoms of heart failure. [2018] 1.4.16 Measure serum sodium and potassium, and assess renal function, before and after starting an MRA and after each dose increment. [2018] 1.4.17 Measure blood pressure before and after after each dose increment of an MRA. Follow the recommendations on measuring blood pressure, including measurement in people with symptoms of postural hypotension, in the NICE guideline on hypertension in adults. [2018] 1.4.18 Once the target, or maximum tolerated, dose of an MRA is reached, monitor treatment monthly for 3 months and then at least every 6 months, and at any time the person becomes acutely unwell. [2018] Specialist treatment Ivabradine These recommendations are from the NICE technology appraisal guidance on ivabradine for treating chronic heart failure. 1.4.19 Ivabradine is recommended as an option for treating chronic heart failure for people: • with New York Heart Association (NYHA) class II to IV stable chronic heart failure with systolic dysfunction and • who are in sinus rhythm with a heart rate of 75 beats per minute (bpm) or more and • who are given ivabradine in combination with standard therapy including beta-blocker therapy, angiotensin-converting enzyme (ACE) inhibitors and Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 15 of 35 aldosterone antagonists, or when beta-blocker therapy is contraindicated or not tolerated and • with a left ventricular ejection fraction of 35% or less. [2012] 1.4.20 Ivabradine should only be initiated after a stabilisation period of 4 weeks on optimised standard therapy with ACE inhibitors, beta-blockers and aldosterone antagonists. [2012] 1.4.21 Ivabradine should be initiated by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be carried out by a heart failure specialist, or in primary care by either a GP with a special interest in heart failure or a heart failure specialist nurse. [2012] Sacubitril valsartan These recommendations are from the NICE technology appraisal guidance on sacubitril valsartan for treating symptomatic chronic heart failure with reduced ejection fraction. 1.4.22 Sacubitril valsartan is recommended as an option for treating symptomatic chronic heart failure with reduced ejection fraction, only in people: • with New York Heart Association (NYHA) class II to IV symptoms and • with a left ventricular ejection fraction of 35% or less and • who are already taking a stable dose of angiotensin-converting enzyme (ACE) inhibitors or ARBs. [2016] 1.4.23 Treatment with sacubitril valsartan should be started by a heart failure specialist with access to a multidisciplinary heart failure team. Dose titration and monitoring should be performed by the most appropriate team member (see the section on team working in the management of heart failure). [2016] 1.4.24 This guidance is not intended to affect the position of patients whose treatment with sacubitril valsartan was started within the NHS before this guidance was published. Treatment of those patients may continue without change to whatever Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 16 of 35 funding arrangements were in place for them before this guidance was published until they and their NHS clinician consider it appropriate to stop. [2016] Hydralazine in combination with nitrate 1.4.25 Seek specialist advice and consider offering hydralazine in combination with nitrate (especially if the person is of African or Caribbean family origin and has moderate to severe heart failure [NYHA class III/IV] with reduced ejection fraction). [2010] Digoxin For recommendations on digoxin for people with atrial fibrillation see the section on rate and rhythm control in the NICE guideline on atrial fibrillation. 1.4.26 Digoxin is recommended for worsening or severe heart failure with reduced ejection fraction despite first-line treatment for heart failure. Seek specialist advice before initiating. [2010, amended 2018] 1.4.27 Routine monitoring of serum digoxin concentrations is not recommended. A digoxin concentration measured within 8 to 12 hours of the last dose may be useful to confirm a clinical impression of toxicity or non-adherence. [2003] 1.4.28 The serum digoxin concentration should be interpreted in the clinical context as toxicity may occur even when the concentration is within the 'therapeutic range'. [2003] 1.5 Treating heart failure with reduced ejection fraction in people with chronic kidney disease 1.5.1 For people who have heart failure with reduced ejection fraction and chronic kidney disease with an eGFR of 30 ml/min/1.73 m 2 or above: • offer the treatment outlined in the section on treating heart failure with Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 17 of 35 reduced ejection fraction and • if the person's eGFR is 45 ml/min/1.73 m 2 or below, consider lower doses and/ or slower titration of dose of ACE inhibitors or ARBs, MRAs and digoxin. [2018] 1.5.2 For people who have heart failure with reduced ejection fraction and chronic kidney disease with an eGFR below 30 ml/min/1.73 m 2 , the specialist heart failure MDT should consider liaising with a renal physician. [2018] 1.5.3 Monitor the response to titration of medicines closely in people who have heart failure with reduced ejection fraction and chronic kidney disease, taking into account the increased risk of hyperkalaemia. [2018] 1.6 Managing all types of heart failure When managing pharmacological treatment, follow the recommendations in the NICE guidelines on medicines adherence and medicines optimisation. Pharmacological treatment Diuretics 1.6.1 Diuretics should be routinely used for the relief of congestive symptoms and fluid retention in people with heart failure, and titrated (up and down) according to need following the initiation of subsequent heart failure therapies. [2003] 1.6.2 People who have heart failure with preserved ejection fraction should usually be offered a low to medium dose of loop diuretics (for example, less than 80 mg furosemide per day). People whose heart failure does not respond to this treatment will need further specialist advice. [2003, amended 2018] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 18 of 35 Calcium-channel blockers 1.6.3 Avoid verapamil, diltiazem and short-acting dihydropyridine agents in people who have heart failure with reduced ejection fraction. [2003, amended 2018] Amiodarone 1.6.4 Make the decision to prescribe amiodarone in consultation with a specialist. [2003] 1.6.5 Review the need to continue the amiodarone prescription at the 6-monthly clinical review. [2003, amended 2018] 1.6.6 Offer people taking amiodarone liver and thyroid function tests, and a review of side effects, as part of their routine 6-monthly clinical review. [2003, amended 2018] Anticoagulants 1.6.7 For people who have heart failure and atrial fibrillation, follow the recommendations on anticoagulation in the NICE guideline on atrial fibrillation. Be aware of the effects of impaired renal and liver function on anticoagulant therapies. [2018] 1.6.8 In people with heart failure in sinus rhythm, anticoagulation should be considered for those with a history of thromboembolism, left ventricular aneurysm or intracardiac thrombus. [2003] Vaccinations 1.6.9 Offer people with heart failure an annual vaccination against influenza. [2003] 1.6.10 Offer people with heart failure vaccination against pneumococcal disease (only required once). [2003] Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 19 of 35 Contraception and pregnancy 1.6.11 In women of childbearing potential who have heart failure, contraception and pregnancy should be discussed. If pregnancy is being considered or occurs, specialist advice should be sought. Subsequently, specialist care should be shared between the cardiologist and obstetrician. [2003] Depression See NICE's guideline on depression in adults with a chronic physical health problem. Lifestyle advice Salt and fluid restriction 1.6.12 Do not routinely advise people with heart failure to restrict their sodium or fluid consumption. Ask about salt and fluid consumption and, if needed, advise as follows: • restricting fluids for people with dilutional hyponatraemia • reducing intake for people with high levels of salt and/or fluid consumption. Continue to review the need to restrict salt or fluid. [2018] 1.6.13 Advise people with heart failure to avoid salt substitutes that contain potassium. [2018] Smoking and alcohol See NICE's guidance on smoking and tobacco and alcohol. Air travel 1.6.14 Air travel will be possible for the majority of people with heart failure, depending Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 20 of 35 on their clinical condition at the time of travel. [2003] Driving 1.6.15 Large Goods Vehicle and Passenger Carrying Vehicle licence: physicians should be up to date with the latest Driver and Vehicle Licensing Agency (DVLA) guidelines. Check the DVLA website for regular updates. [2003] 1.7 Monitoring treatment for all types of heart failure See the section on treating heart failure with reduced ejection fraction for specific recommendations on monitoring treatment for heart failure with reduced ejection fraction. Clinical review 1.7.1 All people with chronic heart failure need monitoring. This monitoring should include: • a clinical assessment of functional capacity, fluid status, cardiac rhythm (minimum of examining the pulse), cognitive status and nutritional status • a review of medication, including need for changes and possible side effects • an assessment of renal function. Note: This is a minimum. People with comorbidities or co-prescribed medications will need further monitoring. Monitoring serum potassium is particularly important if a person is taking digoxin or an MRA. [2010, amended 2018] 1.7.2 More detailed monitoring will be needed if the person has significant comorbidity or if their condition has deteriorated since the previous review. [2003] 1.7.3 The frequency of monitoring should depend on the clinical status and stability of Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 21 of 35 the person. The monitoring interval should be short (days to 2 weeks) if the clinical condition or medication has changed, but is needed at least 6-monthly for stable people with proven heart failure. [2003] 1.7.4 People with heart failure who wish to be involved in monitoring of their condition should be provided with sufficient education and support from their healthcare professional to do this, with clear guidelines as to what to do in the event of deterioration. [2003] Measuring NT-proBNP 1.7.5 Consider measuring NT-proBNP (N-terminal pro-B-type natriuretic peptide) as part of a treatment optimisation protocol only in a specialist care setting for people aged under 75 who have heart failure with reduced ejection fraction and an eGFR above 60 ml/min/1.73 m 2 . [2018] 1.8 Interventional procedures Coronary revascularisation 1.8.1 Do not routinely offer coronary revascularisation to people who have heart failure with reduced ejection fraction and coronary artery disease. [2018] Cardiac transplantation 1.8.2 Specialist referral for transplantation should be considered for people with severe refractory symptoms or refractory cardiogenic shock. [2003] Implantable cardioverter defibrillators and cardiac resynchronisation therapy See NICE's technology appraisal guidance on implantable cardioverter defibrillators and cardiac resynchronisation therapy for arrhythmias and heart failure. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 22 of 35 1.8.3 When discussing implantation of a cardioverter defibrillator: • explain the risks, benefits and consequences of cardioverter defibrillator implantation, following the principles on shared decision making in the NICE guideline on patient experience in adult NHS services • ensure the person knows that the defibrillator function can be deactivated without affecting any cardiac resynchronisation or pacing, and reactivated later • explain the circumstances in which deactivation might be offered • discuss and dispel common misconceptions about the function of the device and the consequences of deactivation • provide the person and, if they wish, their family or carers with written information covering the information discussed. [2018] 1.8.4 Review the benefits and potential harms of a cardioverter defibrillator remaining active in a person with heart failure: • at each 6-monthly review of their heart failure care • whenever their care goals change • as part of advance care planning if it is thought they are nearing the end of life. [2018] 1.9 Cardiac rehabilitation 1.9.1 Offer people with heart failure a personalised, exercise-based cardiac rehabilitation programme, unless their condition is unstable. The programme: • should be preceded by an assessment to ensure that it is suitable for the person • should be provided in a format and setting (at home, in the community or in the hospital) that is easily accessible for the person Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 23 of 35 • should include a psychological and educational component • may be incorporated within an existing cardiac rehabilitation programme • should be accompanied by information about support available from healthcare professionals when the person is doing the programme. [2018] 1.10 Palliative care 1.10.1 Do not offer long-term home oxygen therapy for advanced heart failure. Be aware that long-term home oxygen therapy may be offered for comorbidities, such as for some people with chronic obstructive pulmonary disease (see the section on oxygen in the NICE guideline on chronic obstructive pulmonary disease in over 16s). [2018] 1.10.2 Do not use prognostic risk tools to determine whether to refer a person with heart failure to palliative care services. [2018] 1.10.3 If the symptoms of a person with heart failure are worsening despite optimal specialist treatment, discuss their palliative care needs with the specialist heart failure multidisciplinary team and consider a needs assessment for palliative care. [2018] 1.10.4 People with heart failure and their families or carers should have access to professionals with palliative care skills within the heart failure team. [2003] 1.10.5 If it is thought that a person may be entering the last 2 to 3 days of life, follow the NICE guideline on care of dying adults in the last days of life. [2018] Terms used in this guideline Heart failure with preserved ejection fraction This is usually associated with impaired left ventricular relaxation, rather than left ventricular contraction, and is characterised by normal or preserved left ventricular Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 24 of 35 ejection fraction with evidence of diastolic dysfunction . Heart failure with reduced ejection fraction Heart failure with an ejection fraction below 40%. Mineralocorticoid receptor antagonist A drug that antagonises the action of aldosterone at mineralocorticoid receptors. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 25 of 35 Putting this guideline into practice NICE has produced tools and resources to help you put this guideline into practice. Putting recommendations into practice can take time. How long may vary from guideline to guideline, and depends on how much change in practice or services is needed. Implementing change is most effective when aligned with local priorities. Changes recommended for clinical practice that can be done quickly – like changes in prescribing practice – should be shared quickly. This is because healthcare professionals should use guidelines to guide their work – as is required by professional regulating bodies such as the General Medical and Nursing and Midwifery Councils. Changes should be implemented as soon as possible, unless there is a good reason for not doing so (for example, if it would be better value for money if a package of recommendations were all implemented at once). Different organisations may need different approaches to implementation, depending on their size and function. Sometimes individual practitioners may be able to respond to recommendations to improve their practice more quickly than large organisations. Here are some pointers to help organisations put NICE guidelines into practice: 1. Raise awareness through routine communication channels, such as email or newsletters, regular meetings, internal staff briefings and other communications with all relevant partner organisations. Identify things staff can include in their own practice straight away. 2. Identify a lead with an interest in the topic to champion the guideline and motivate others to support its use and make service changes, and to find out any significant issues locally. 3. Carry out a baseline assessment against the recommendations to find out whether there are gaps in current service provision. 4. Think about what data you need to measure improvement and plan how you will collect it. You may want to work with other health and social care organisations and specialist Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 26 of 35 groups to compare current practice with the recommendations. This may also help identify local issues that will slow or prevent implementation. 5. Develop an action plan, with the steps needed to put the guideline into practice, and make sure it is ready as soon as possible. Big, complex changes may take longer to implement, but some may be quick and easy to do. An action plan will help in both cases. 6. For very big changes include milestones and a business case, which will set out additional costs, savings and possible areas for disinvestment. A small project group could develop the action plan. The group might include the guideline champion, a senior organisational sponsor, staff involved in the associated services, finance and information professionals. 7. Implement the action plan with oversight from the lead and the project group. Big projects may also need project management support. 8. Review and monitor how well the guideline is being implemented through the project group. Share progress with those involved in making improvements, as well as relevant boards and local partners. NICE provides a comprehensive programme of support and resources to maximise uptake and use of evidence and guidance. See NICE's into practice pages for more information. Also see Leng G, Moore V, Abraham S, editors (2014) Achieving high quality care – practical experience from NICE. Chichester: Wiley. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 27 of 35 Recommendations for research The guideline committee has made the following key recommendations for research. The committee's full set of research recommendations is detailed in the full guideline. 1 Diuretic therapy for managing fluid overload in people with advanced heart failure in the community In people with advanced heart failure and significant peripheral fluid overload, what is the clinical and cost effectiveness of oral, subcutaneous and intravenous diuretic therapy in the community? Why this is important This research is critical to inform practice of how best to manage people with advanced heart failure in the community if they develop significant peripheral fluid overload. These people are more likely to have multiple admissions that, together with fluid overload, have a negative impact on their quality of life. Management in the community can minimise disruption for the person and reduce costs from hospital admissions. Knowledge of the most clinically and cost-effective routes of administration for diuretic therapy will dictate the level of resource needed to provide the service. Intravenous and subcutaneous diuretics usually need to be administered by nursing or healthcare staff. although a pump for self-administration of subcutaneous diuretics has recently been developed. Oral formulations can be self-administered. 2 Cardiac MRI versus other imaging techniques for diagnosing heart failure What is the optimal imaging technique for the diagnosis of heart failure? Why this is important The role of cardiac MRI in the detection and characterisation of several structural and Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 28 of 35 functional cardiac abnormalities has become well established over the past 25 years. In people with heart failure, cardiac MRI provides reliable and reproducible assessments of the left ventricular (and to a degree the right ventricular) shapes, volumes and ejection fractions. It also provides spatial assessments of the congenital and acquired structural abnormalities of the heart and their interrelationships with the remainder of the heart, as well as functional and haemodynamic assessments of these abnormalities on the heart's performance. Finally, cardiac MRI provides valuable information about the myocardial structure and metabolism, including the presence of inflammation, scarring, fibrosis and infiltration. Cardiac MRI is an expensive form of imaging, and much of this diagnostic information could be provided by less costly non-invasive imaging techniques, chiefly echocardiography. This question aims to find the most clinically and cost-effective imaging technique for the clinical diagnosis of heart failure. 3 The impact of atrial fibrillation on the natriuretic peptide threshold for diagnosing heart failure What is the optimal NT-proBNP threshold for the diagnosis of heart failure in people with atrial fibrillation? Why this is important Atrial fibrillation is a common arrhythmia in the general population, and occurs in 30 to 40% of people with heart failure. Atrial fibrillation can raise the level of serum natriuretic peptides, including NT-proBNP, even in the absence of heart failure. This is complicated further in heart failure with preserved ejection fraction, in which 2 echocardiographic diagnostic criteria become unreliable (the left atrial volume and the tissue doppler imaging assessment of diastolic function). These factors contribute to the complexity of the diagnosis and have a potential impact on the usual thresholds for NT-proBNP in people who have atrial fibrillation. This has been recognised in several ongoing randomised controlled trials of heart failure, which are using higher NT-proBNP thresholds for the diagnosis of heart failure in people with atrial fibrillation. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 29 of 35 4 The impact of advanced kidney disease on the natriuretic peptide threshold for diagnosing heart failure What are the optimal NT-proBNP thresholds for diagnosing heart failure in people with stage IIIb, IV or V chronic kidney disease? Why this is important Heart failure incidence and prevalence increase with age, with the rise starting at age 65 and peaking between 75 and 85. Both advancing age and heart failure are associated with a gradual and progressive decline in renal function. In addition, the progression of heart failure and some treatments for heart failure lead to progressive deterioration of renal function. A decline in renal function is associated with increased fluid retention and a rise in the level of the serum natriuretic peptides, including NT-proBNP, even in the absence of heart failure. There is some evidence that the use of higher NT-proBNP thresholds would improve diagnostic accuracy for heart failure in people with significant deterioration of creatinine clearance. 5 Risk tools for predicting non-sudden death in heart failure What is the most accurate prognostic risk tool in predicting 1-year mortality from heart failure at specific clinically relevant thresholds (for example, sensitivity, specificity, negative predictive value and positive predictive value at a threshold of 50% risk of mortality at 1 year)? Why this is important There are a number of validated prognostic risk tools for heart failure but most do not report sensitivity and specificity at clinically relevant thresholds. This information is crucial to enable accurate prediction of a person's risk of mortality. The ability to accurately predict a person's prognosis would allow clearer communication and timely referral to other services such as palliative care. Inaccurate prediction has the potential to lead to significant psychological harm and increased morbidity. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 30 of 35 Context Key facts and figures Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired. It is caused by structural or functional abnormalities of the heart. Around 920,000 people in the UK today have been diagnosed with heart failure. Both the incidence and prevalence of heart failure increase steeply with age, and the average age at diagnosis is 77. Improvements in care have increased survival for people with ischaemic heart disease, and treatments for heart failure have become more effective. But the overall prevalence of heart failure is rising because of population ageing and increasing rates of obesity. Current practice Uptake of NICE's 2010 guidance on chronic heart failure appears to be good. However, the Department of Health and Social Care's policy paper on improving cardiovascular disease outcomes: strategy noted that prescribing of ACE inhibitors, beta-blockers and aldosterone antagonists remains suboptimal, and that improved use of these drugs has the potential to reduce hospitalisations and deaths caused by heart failure. This update reviewed evidence on the clinical and cost effectiveness of these therapies. Interdisciplinary working has contributed to better outcomes in heart failure but there is further room to improve the provision of multidisciplinary teams (MDTs) and integrate them more fully into healthcare processes. This update highlights and further expands on the roles of the MDT and collaboration between the MDT and the primary care team. The Department of Health and Social Care's policy paper on improving cardiovascular disease outcomes: strategy also noted that the proportion of people with heart failure who have cardiac rehabilitation was around 4%, and that increasing this proportion would reduce mortality and hospitalisation. This update recommends that all people with heart failure are offered an easily accessible, exercise-based cardiac rehabilitation programme, if this is suitable for them. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 31 of 35 Finding more information and committee details To find out what NICE has said on related topics, including guidance in development, see the NICE topic page on cardiovascular conditions. For full details of the evidence and the guideline committee's discussions, see the full guideline. You can also find information about how the guideline was developed, including details of the committee. NICE has produced tools and resources to help you put this guideline into practice. For general help and advice on putting our guidelines into practice, see resources to help you put NICE guidance into practice. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 32 of 35 Update information September 2018: This guideline updates and replaces NICE clinical guideline 108 (published August 2010). NICE clinical guideline 108 updated and replaced NICE clinical guideline 5 (published July 2003). Recommendations are marked as [2018], [2016], [2012], [2010], [2010, amended 2018], [2003], [2003, amended 2018] or [2003, amended 2010], [2018] indicates that the evidence was reviewed and the recommendation added, updated or unchanged in 2018. [2016] refers to NICE technology appraisal guidance published in 2016. [2012] refers to NICE technology appraisal guidance published in 2012. [2010] indicates that the evidence was reviewed in 2010. [2010, amended 2018] indicates that the evidence was reviewed in 2010 but changes were made to the recommendation wording in 2018 that changed the meaning. [2003] indicates that the evidence was reviewed in 2003. [2003, amended 2018] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2018 that changed the meaning. [2003, amended 2010] indicates that the evidence was reviewed in 2003 but changes were made to the recommendation wording in 2010 that changed the meaning. • 'Heart failure due to left ventricular systolic dysfunction (LVSD)' has been replaced in all recommendations by 'heart failure with reduced ejection fraction' in line with current terminology and the 2018 guideline scope. • 'Aldosterone antagonists' has been replaced in all recommendations by 'mineralocorticoid receptor antagonists (MRAs') to clarify the function of the receptor, and in line with the 2018 guideline scope. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 33 of 35 • 'African or African-Caribbean family origin' has been added to recommendation 1.2.7 because of the high incidence of heart failure with preserved ejection fraction in these populations. Recent evidence shows that NT-proBNP levels are lower in people of west African family background and are a confounder in the diagnosis of heart failure. • Doppler 2D has been deleted from recommendations 1.2.8, 1.2.9 and 1.2.11 because all transthoracic echocardiography would have doppler 2D as a minimum and it is no longer necessary to specify this. • 'Multigated acquisition scanning' has been added to recommendation 1.2.11 to reflect current imaging technology. • Measurement of urea has been deleted from recommendations 1.2.12, 1.4.8 and 1.7.1 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK. Blood tests for electrolytes, creatinine and eGFR have been grouped together under the term 'renal function profile' because they are provided as a unified set of analyses in the NHS. The term 'profile' is applied to a group of tests (assays). Thus these tests are more accurately described as 'profiles' as they contain multiple individual assays and have replaced thyroid function test, liver function test and lipid measurement. 'Fasting glucose' has been replaced by 'glycosylated haemoglobin (HbA1c)' in line with the NICE guidelines on diabetes. • Measurement of serum urea has been deleted from recommendation 1.4.4 because the guideline committee agreed that it is not needed and is not part of renal function profiles in most centres in the UK. Measurement of potassium has been added to ensure that monitoring is consistent across treatments. • Recommendations 1.4.6 and 1.4.10 have been added to clarify the timing of monitoring after treatment starts. • In recommendation 1.4.8, monitoring for hyperkalaemia has been replaced by potassium measurement for clarity. • Blood pressure measurement has been clarified in recommendation 1.4.13 and made consistent with other treatments. Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 34 of 35 • As a result of new evidence the treatment pathway for heart failure with reduced ejection fraction in recommendation 1.4.26 has been amended. Second line treatment has been replaced by specialist treatment. A sentence has been added to clarify that specialist advice should be sought before starting treatment with digoxin. • The first part of recommendation 1.6.2 has been removed because it is now covered in section 1.1 on team working in the management of heart failure. • Amlodipine to treat hypertension has been deleted from recommendation 1.6.3 because it has been superseded by the NICE guideline on hypertension in adults. • 'Regularly' has been replaced by 'at the 6-monthly clinical review' in recommendation 1.6.5 for clarification. • The wording in recommendation 1.6.6 has been amended in line with recommendation 1.6.5. Minor changes since publication April 2022: In section 1.4 we added links to NICE's technology appraisal guidance on dapagliflozin and empagliflozin for treating chronic heart failure with reduced ejection fraction. November 2021: We added a link to the NICE guideline on heart valve disease in recommendations 1.2.8, 1.2.15 and 1.4.2. ISBN: 978-1-4731-3093-7 Chronic heart failure in adults: diagnosis and management (NG106) © NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-andconditions#notice-of-rights). Page 35 of 35 ",Medical,Fact Finding,Q&A "Do not refer to any outside information not found in this document to answer the prompt. Answer in a single sentence, but do not quote directly from the document.",What are the implications for AI in the medical space?,"The Potential for Artificial Intelligence In Healthcare Artificial intelligence (AI) and related technologies are increasingly prevalent in business and society, and are beginning to be applied to healthcare. These technologies have the potential to transform many aspects of patient care, as well as administrative processes within provider, payer and pharmaceutical organizations. There are already a number of research studies suggesting that AI can perform as well as or better than humans at key healthcare tasks, such as diagnosing disease. Today, algorithms are already outperforming radiologists at spotting malignant tumors, and guiding researchers in how to construct cohorts for costly clinical trials. However, for a variety of reasons, we believe that it will be many years before AI replaces humans for broad medical process domains. In this article, we describe both the potential that AI offers to automate aspects of care and some of the barriers to rapid implementation of AI in healthcare. Types of AI of relevance to healthcare Artificial intelligence is not one technology, but rather a collection of them. Most of these technologies have immediate relevance to the healthcare field, but the specific processes and tasks they support vary widely. Some particular AI technologies of high importance to healthcare are defined and described below. Machine learning – neural networks and deep learning Machine learning is a statistical technique for fitting models to data and to ‘learn’ by training models with data. Machine learning is one of the most common forms of AI; in a 2018 Deloitte survey of 1,100 US managers whose organizations were already pursuing AI, 63% of companies surveyed were employing machine learning in their businesses. 1 It is a broad technique at the core of many approaches to AI and there are many versions of it. In healthcare, the most common application of traditional machine learning is precision medicine – predicting what treatment protocols are likely to succeed on a patient based on various patient attributes and the treatment context. 2 The great majority of machine learning and precision medicine applications require a training dataset for which the outcome variable (eg onset of disease) is known; this is called supervised learning. A more complex form of machine learning is the neural network – a technology that has been available since the 1960s has been well established in healthcare research for several decades 3 and has been used for categorisation applications like determining whether a patient will acquire a particular disease. It views problems in terms of inputs, outputs and weights of variables or ‘features’ that associate inputs with outputs. It has been likened to the way that neurons process signals, but the analogy to the brain's function is relatively weak. The most complex forms of machine learning involve deep learning, or neural network models with many levels of features or variables that predict outcomes. There may be thousands of hidden features in such models, which are uncovered by the faster processing of today's graphics processing units and cloud architectures. A common application of deep learning in healthcare is recognition of potentially cancerous lesions in radiology images. 4 Deep learning is increasingly being applied to radiomics, or the detection of clinically relevant features in imaging data beyond what can be perceived by the human eye. 5 Both radiomics and deep learning are most commonly found in oncology-oriented image analysis. Their combination appears to promise greater accuracy in diagnosis than the previous generation of automated tools for image analysis, known as computer-aided detection or CAD. Deep learning is also increasingly used for speech recognition and, as such, is a form of natural language processing (NLP), described below. Unlike earlier forms of statistical analysis, each feature in a deep learning model typically has little meaning to a human observer. As a result, the explanation of the model's outcomes may be very difficult or impossible to interpret. Diagnosis and treatment applications Diagnosis and treatment of disease has been a focus of AI since at least the 1970s, when MYCIN was developed at Stanford for diagnosing blood-borne bacterial infections. 8 This and other early rule-based systems showed promise for accurately diagnosing and treating disease, but were not adopted for clinical practice. They were not substantially better than human diagnosticians, and they were poorly integrated with clinician workflows and medical record systems. More recently, IBM's Watson has received considerable attention in the media for its focus on precision medicine, particularly cancer diagnosis and treatment. Watson employs a combination of machine learning and NLP capabilities. However, early enthusiasm for this application of the technology has faded as customers realized the difficulty of teaching Watson how to address particular types of cancer 9 and of integrating Watson into care processes and systems. 10 Watson is not a single product but a set of ‘cognitive services’ provided through application programming interfaces (APIs), including speech and language, vision, and machine learning-based data-analysis programs. Most observers feel that the Watson APIs are technically capable, but taking on cancer treatment was an overly ambitious objective. Watson and other proprietary programs have also suffered from competition with free ‘open source’ programs provided by some vendors, such as Google's TensorFlow. Implementation issues with AI bedevil many healthcare organizations. Although rule-based systems are incorporated within EHR systems are widely used, including at the NHS, 11 they lack the precision of more algorithmic systems based on machine learning. These rule-based clinical decision support systems are difficult to maintain as medical knowledge changes and are often not able to handle the explosion of data and knowledge based on genomic, proteomic, metabolic and other ‘omic-based’ approaches to care. This situation is beginning to change, but it is mostly present in research labs and in tech firms, rather than in clinical practice. Scarcely a week goes by without a research lab claiming that it has developed an approach to using AI or big data to diagnose and treat a disease with equal or greater accuracy than human clinicians. Many of these findings are based on radiological image analysis, 12 though some involve other types of images such as retinal scanning 13 or genomic-based precision medicine. 14 Since these types of findings are based on statistically-based machine learning models, they are ushering in an era of evidence- and probability-based medicine, which is generally regarded as positive but brings with it many challenges in medical ethics and patient/ clinician relationships. 15 Tech firms and startups are also working assiduously on the same issues. Google, for example, is collaborating with health delivery networks to build prediction models from big data to warn clinicians of high-risk conditions, such as sepsis and heart failure. 16 Google, Enlitic and a variety of other startups are developing AI-derived image interpretation algorithms. Jvion offers a ‘clinical success machine’ that identifies the patients most at risk as well as those most likely to respond to treatment protocols. Each of these could provide decision support to clinicians seeking to find the best diagnosis and treatment for patients. There are also several firms that focus specifically on diagnosis and treatment recommendations for certain cancers based on their genetic profiles. Since many cancers have a genetic basis, human clinicians have found it increasingly complex to understand all genetic variants of cancer and their response to new drugs and protocols. Firms like Foundation Medicine and Flatiron Health, both now owned by Roche, specialise in this approach. Both providers and payers for care are also using ‘population health’ machine learning models to predict populations at risk of particular diseases 17 or accidents 18 or to predict hospital readmission. 19 These models can be effective at prediction, although they sometimes lack all the relevant data that might add predictive capability, such as patient socio-economic status. But whether rules-based or algorithmic in nature, AI-based diagnosis and treatment recommendations are sometimes challenging to embed in clinical workflows and EHR systems. Such integration issues have probably been a greater barrier to broad implementation of AI than any inability to provide accurate and effective recommendations; and many AI-based capabilities for diagnosis and treatment from tech firms are standalone in nature or address only a single aspect of care. Some EHR vendors have begun to embed limited AI functions (beyond rule-based clinical decision support) into their offerings, 20 but these are in the early stages. Providers will either have to undertake substantial integration projects themselves or wait until EHR vendors add more AI capabilities. ","[Task Instructions] ================== Do not refer to any outside information not found in this document to answer the prompt. Answer in a single sentence, but do not quote directly from the document. [Query] ================== What are the implications for AI in the medical space? [Text] ================== The Potential for Artificial Intelligence In Healthcare Artificial intelligence (AI) and related technologies are increasingly prevalent in business and society, and are beginning to be applied to healthcare. These technologies have the potential to transform many aspects of patient care, as well as administrative processes within provider, payer and pharmaceutical organizations. There are already a number of research studies suggesting that AI can perform as well as or better than humans at key healthcare tasks, such as diagnosing disease. Today, algorithms are already outperforming radiologists at spotting malignant tumors, and guiding researchers in how to construct cohorts for costly clinical trials. However, for a variety of reasons, we believe that it will be many years before AI replaces humans for broad medical process domains. In this article, we describe both the potential that AI offers to automate aspects of care and some of the barriers to rapid implementation of AI in healthcare. Types of AI of relevance to healthcare Artificial intelligence is not one technology, but rather a collection of them. Most of these technologies have immediate relevance to the healthcare field, but the specific processes and tasks they support vary widely. Some particular AI technologies of high importance to healthcare are defined and described below. Machine learning – neural networks and deep learning Machine learning is a statistical technique for fitting models to data and to ‘learn’ by training models with data. Machine learning is one of the most common forms of AI; in a 2018 Deloitte survey of 1,100 US managers whose organizations were already pursuing AI, 63% of companies surveyed were employing machine learning in their businesses. 1 It is a broad technique at the core of many approaches to AI and there are many versions of it. In healthcare, the most common application of traditional machine learning is precision medicine – predicting what treatment protocols are likely to succeed on a patient based on various patient attributes and the treatment context. 2 The great majority of machine learning and precision medicine applications require a training dataset for which the outcome variable (eg onset of disease) is known; this is called supervised learning. A more complex form of machine learning is the neural network – a technology that has been available since the 1960s has been well established in healthcare research for several decades 3 and has been used for categorisation applications like determining whether a patient will acquire a particular disease. It views problems in terms of inputs, outputs and weights of variables or ‘features’ that associate inputs with outputs. It has been likened to the way that neurons process signals, but the analogy to the brain's function is relatively weak. The most complex forms of machine learning involve deep learning, or neural network models with many levels of features or variables that predict outcomes. There may be thousands of hidden features in such models, which are uncovered by the faster processing of today's graphics processing units and cloud architectures. A common application of deep learning in healthcare is recognition of potentially cancerous lesions in radiology images. 4 Deep learning is increasingly being applied to radiomics, or the detection of clinically relevant features in imaging data beyond what can be perceived by the human eye. 5 Both radiomics and deep learning are most commonly found in oncology-oriented image analysis. Their combination appears to promise greater accuracy in diagnosis than the previous generation of automated tools for image analysis, known as computer-aided detection or CAD. Deep learning is also increasingly used for speech recognition and, as such, is a form of natural language processing (NLP), described below. Unlike earlier forms of statistical analysis, each feature in a deep learning model typically has little meaning to a human observer. As a result, the explanation of the model's outcomes may be very difficult or impossible to interpret. Diagnosis and treatment applications Diagnosis and treatment of disease has been a focus of AI since at least the 1970s, when MYCIN was developed at Stanford for diagnosing blood-borne bacterial infections. 8 This and other early rule-based systems showed promise for accurately diagnosing and treating disease, but were not adopted for clinical practice. They were not substantially better than human diagnosticians, and they were poorly integrated with clinician workflows and medical record systems. More recently, IBM's Watson has received considerable attention in the media for its focus on precision medicine, particularly cancer diagnosis and treatment. Watson employs a combination of machine learning and NLP capabilities. However, early enthusiasm for this application of the technology has faded as customers realized the difficulty of teaching Watson how to address particular types of cancer 9 and of integrating Watson into care processes and systems. 10 Watson is not a single product but a set of ‘cognitive services’ provided through application programming interfaces (APIs), including speech and language, vision, and machine learning-based data-analysis programs. Most observers feel that the Watson APIs are technically capable, but taking on cancer treatment was an overly ambitious objective. Watson and other proprietary programs have also suffered from competition with free ‘open source’ programs provided by some vendors, such as Google's TensorFlow. Implementation issues with AI bedevil many healthcare organizations. Although rule-based systems are incorporated within EHR systems are widely used, including at the NHS, 11 they lack the precision of more algorithmic systems based on machine learning. These rule-based clinical decision support systems are difficult to maintain as medical knowledge changes and are often not able to handle the explosion of data and knowledge based on genomic, proteomic, metabolic and other ‘omic-based’ approaches to care. This situation is beginning to change, but it is mostly present in research labs and in tech firms, rather than in clinical practice. Scarcely a week goes by without a research lab claiming that it has developed an approach to using AI or big data to diagnose and treat a disease with equal or greater accuracy than human clinicians. Many of these findings are based on radiological image analysis, 12 though some involve other types of images such as retinal scanning 13 or genomic-based precision medicine. 14 Since these types of findings are based on statistically-based machine learning models, they are ushering in an era of evidence- and probability-based medicine, which is generally regarded as positive but brings with it many challenges in medical ethics and patient/ clinician relationships. 15 Tech firms and startups are also working assiduously on the same issues. Google, for example, is collaborating with health delivery networks to build prediction models from big data to warn clinicians of high-risk conditions, such as sepsis and heart failure. 16 Google, Enlitic and a variety of other startups are developing AI-derived image interpretation algorithms. Jvion offers a ‘clinical success machine’ that identifies the patients most at risk as well as those most likely to respond to treatment protocols. Each of these could provide decision support to clinicians seeking to find the best diagnosis and treatment for patients. There are also several firms that focus specifically on diagnosis and treatment recommendations for certain cancers based on their genetic profiles. Since many cancers have a genetic basis, human clinicians have found it increasingly complex to understand all genetic variants of cancer and their response to new drugs and protocols. Firms like Foundation Medicine and Flatiron Health, both now owned by Roche, specialise in this approach. Both providers and payers for care are also using ‘population health’ machine learning models to predict populations at risk of particular diseases 17 or accidents 18 or to predict hospital readmission. 19 These models can be effective at prediction, although they sometimes lack all the relevant data that might add predictive capability, such as patient socio-economic status. But whether rules-based or algorithmic in nature, AI-based diagnosis and treatment recommendations are sometimes challenging to embed in clinical workflows and EHR systems. Such integration issues have probably been a greater barrier to broad implementation of AI than any inability to provide accurate and effective recommendations; and many AI-based capabilities for diagnosis and treatment from tech firms are standalone in nature or address only a single aspect of care. Some EHR vendors have begun to embed limited AI functions (beyond rule-based clinical decision support) into their offerings, 20 but these are in the early stages. Providers will either have to undertake substantial integration projects themselves or wait until EHR vendors add more AI capabilities. ",Medical,Effect Analysis,Q&A "Answer all user questions using only information from the prompt provided by the user. Do not use any outside sources, or any information stored in your databases. ",Which wars have been financed with estate taxes?,"History Early History of U.S. Taxes on Transfers Taxes on the transfer of assets have existed throughout history, dating back to ancient Egypt. In the United States, they were used prior to the modern estate and gift tax in 1916 to finance wars and similar emergencies.8 The first was enacted in 1797 to expand the Navy, given strained relationships with France. At that time, a documentary stamp tax on the inventories of deceased persons, the receipt of inheritances from an estate (except those to a wife, children, or grandchildren), and the probates and letters of administration of estates was imposed. These taxes were fixed amounts, although they were larger for larger inheritances and small inheritances were exempt. These taxes were repealed in 1802. In 1862, during the Civil War, an inheritance tax was imposed. Unlike the current estate tax, the tax was imposed on the beneficiaries, but unlike the stamp tax, it was a percentage of the inheritance. The tax was also imposed on gifts during the lifetime. The rate depended on the family relationships of the beneficiaries, and spouses and small inheritances were exempt. This tax was repealed in 1870. 8For a history, see Darien P. Jacobson, Brian G. Raub, and Barry W. Johnson, The Estate Tax: Ninety Years and Counting, Internal Revenue Service, Statistics of Income Bulletin, Summer 2007, pp. 118-128, https://www.irs.gov/ pub/irs-soi/ninetyestate.pdf, and Joint Committee on Taxation, History, Present Law, And Analysis Of The Federal Wealth Transfer Tax System, JCX-52-15, March 26, 2015, https://www.jct.gov/publications/2015/jcx-52-15/. For a history of the gift tax, see David Joulfanian, The Federal Gift Tax: History, Law, and Economics, U.S. Department of the Treasury, Office of Tax Analysis, OTA Paper 100, November 2007, https://home.treasury.gov/system/files/131/wp 100.pdf. Congressional Research Service 4 The Estate and Gift Tax: An Overview The 1894 income tax was not a transfer tax, but it included inheritances and gifts in income. It was short-lived after being found unconstitutional by the Supreme Court in Pollock v. Farmers’ Loan and Trust Company. In 1898, an estate tax was enacted to finance the Spanish-American War. Rates were graduated depending on degree of kinship and size, bequests to spouses were exempt, and there was an overall exemption that excluded small estates. It was repealed in 1902. The Modern Estate and Gift Tax Lawmakers enacted the direct ancestor of the current estate tax in 1916. It contained exemptions that excluded small estates, and rates were graduated based on the size of the estate. Over time, rates were increased, but the basic form of the tax remained. The top rate was 10% in 1916 with a $50,000 exemption, and it was increased to 25% in 1917, with the first $50,000 taxed at 2%. At the end of World War I in 1918, rates were reduced on smaller estates and charitable deductions were allowed. The top rate was increased to 40% in 1924, and a credit for state taxes was allowed for up to 25% of estate tax liability. The top rate was reduced to 20% from 1926 to 1931, increased to 40% in 1932, and eventually rose as high as 77% from 1941 to 1976. A separate gift tax was enacted in 1924 with the same rates and exemptions, and an annual exclusion per donee of $500. The tax was repealed in 1926, then reenacted in 1932 with a $5,000 annual exclusion per donee. In 1942, changes addressed the difference in treatment in community property states, where each spouse owned half the assets and only the half owned by the decedent was subject to tax. In other states where couples could own assets jointly, exclusions were allowed only if the surviving spouse contributed to the assets. The 1942 act treated assets in community property states the same as in other states. In 1948, this rule was changed to allow a deduction for property transferred to a spouse whether by the will or by law. The 1942 act made other changes in rates and exemptions and instituted a $3,000 annual gift exclusion per donee. The Tax Reform Act of 1976 (P.L. 94-455) created the modern unified estate and gift tax with a unified credit and graduated rates applied to all transfers. The 1976 act also instituted carryover basis for inherited assets, but that provision resulted in considerable controversy and was repealed retroactively in 1980. The exemption was increased from $60,000 to $120,000, and the top rate was lowered to 70%. The Economic Growth and Tax Relief Act of 2001 (EGTRRA; P.L. 107-16) provided for a gradual reduction in the estate tax. The law applied a unified exemption for both lifetime gifts and the estate of $675,000 prior to these changes. Under EGTRRA, the estate tax exemption rose from $675,000 in 2001 to $3.5 million in 2009, and the top tax rate fell from 55% to 45%. Although combined estate and gift tax rates are graduated, the exemption is effectively in the form of a credit that eliminates tax due at lower rates, resulting in a flat rate on taxable assets under 2009 law. The gift tax exemption was, however, restricted to $1 million. For 2010, EGTRRA scheduled the elimination of the estate tax, although it retained the gift tax and its $1 million exemption. EGTRRA also provided for a carryover of basis for assets inherited at death in 2010, so that, in contrast with prior law, heirs who sold assets would have to pay tax on gains accrued during the decedent’s lifetime. This provision had a $1.3 million exemption for gain (plus $3 million for a spouse). Congressional Research Service 5 The Estate and Gift Tax: An Overview As with other provisions of EGTRRA, the estate tax revisions were to expire in 2011, returning the tax provisions to their pre-EGTRRA levels. The exemption would have reverted to $1 million (a value that had already been scheduled for pre-EGTRRA law) and the rate to 55% (with some graduated rates). The carryover basis provision effective in 2010 would have been eliminated (so that heirs would not be taxed on gain accumulated during the decedent’s life when they inherited assets). During debate on the estate tax, most agreed that the 2010 provisions would not be continued and, indeed, could be repealed retroactively. President Obama proposed a permanent extension of the 2009 rules (a $3.5 million exemption and a 45% tax rate), and the House provided for that permanent extension on December 3, 2009 (H.R. 4154). The Senate Democratic leadership indicated a plan to retroactively reinstate the 2009 rules for 2010 and beyond. Senate Minority Leader McConnell proposed an alternative of a 35% tax rate and a $5 million exemption.9 A similar proposal for a $5 million exemption and a 35% rate, which also included the ability of the surviving spouse to inherit any unused exemption of the decedent, is often referred to as Lincoln Kyl (named after two Senators who sponsored it). Other proposals began with the $3.5 million exemption and 45% rate and would have phased in the $5 million exemption and 55% rate. Some Members of Congress argued for permanent estate tax repeal.10 At the end of 2010, P.L. 111-312 enacted a temporary two-year extension of the estate and gift tax, with a $5 million unified exemption, a 35% rate, and inheritance of unused spousal exemptions. For 2010, estates could elect to be taxed under the estate tax or under the carryover rules. These provisions provided for estate tax rules through 2012, after which the provisions would have reverted to the pre-EGTRRA rules ($1 million exemption, 55% top rate) absent legislation. The American Taxpayer Relief Act of 2012 (P.L. 112-240) established the permanent exemption ($5.25 million, indexed for inflation?) and rate (40%) described above. The 2017 tax revision (P.L. 115-97) doubled the exemption for the years 2018 through 2025. The House had proposed doubling the exemption through 2024 and then repealing the estate tax and lowering the gift tax rates to 35%. One issue that arises with the expiration of the increased exemptions is the treatment of gifts that had been transferred with exemptions higher than the exemptions that the law would revert to. ","Answer all user questions using only information from the prompt provided by the user. Do not use any outside sources, or any information stored in your databases. Which wars have been financed with estate taxes? History Early History of U.S. Taxes on Transfers Taxes on the transfer of assets have existed throughout history, dating back to ancient Egypt. In the United States, they were used prior to the modern estate and gift tax in 1916 to finance wars and similar emergencies.8 The first was enacted in 1797 to expand the Navy, given strained relationships with France. At that time, a documentary stamp tax on the inventories of deceased persons, the receipt of inheritances from an estate (except those to a wife, children, or grandchildren), and the probates and letters of administration of estates was imposed. These taxes were fixed amounts, although they were larger for larger inheritances and small inheritances were exempt. These taxes were repealed in 1802. In 1862, during the Civil War, an inheritance tax was imposed. Unlike the current estate tax, the tax was imposed on the beneficiaries, but unlike the stamp tax, it was a percentage of the inheritance. The tax was also imposed on gifts during the lifetime. The rate depended on the family relationships of the beneficiaries, and spouses and small inheritances were exempt. This tax was repealed in 1870. 8For a history, see Darien P. Jacobson, Brian G. Raub, and Barry W. Johnson, The Estate Tax: Ninety Years and Counting, Internal Revenue Service, Statistics of Income Bulletin, Summer 2007, pp. 118-128, https://www.irs.gov/ pub/irs-soi/ninetyestate.pdf, and Joint Committee on Taxation, History, Present Law, And Analysis Of The Federal Wealth Transfer Tax System, JCX-52-15, March 26, 2015, https://www.jct.gov/publications/2015/jcx-52-15/. For a history of the gift tax, see David Joulfanian, The Federal Gift Tax: History, Law, and Economics, U.S. Department of the Treasury, Office of Tax Analysis, OTA Paper 100, November 2007, https://home.treasury.gov/system/files/131/wp 100.pdf. Congressional Research Service 4 The Estate and Gift Tax: An Overview The 1894 income tax was not a transfer tax, but it included inheritances and gifts in income. It was short-lived after being found unconstitutional by the Supreme Court in Pollock v. Farmers’ Loan and Trust Company. In 1898, an estate tax was enacted to finance the Spanish-American War. Rates were graduated depending on degree of kinship and size, bequests to spouses were exempt, and there was an overall exemption that excluded small estates. It was repealed in 1902. The Modern Estate and Gift Tax Lawmakers enacted the direct ancestor of the current estate tax in 1916. It contained exemptions that excluded small estates, and rates were graduated based on the size of the estate. Over time, rates were increased, but the basic form of the tax remained. The top rate was 10% in 1916 with a $50,000 exemption, and it was increased to 25% in 1917, with the first $50,000 taxed at 2%. At the end of World War I in 1918, rates were reduced on smaller estates and charitable deductions were allowed. The top rate was increased to 40% in 1924, and a credit for state taxes was allowed for up to 25% of estate tax liability. The top rate was reduced to 20% from 1926 to 1931, increased to 40% in 1932, and eventually rose as high as 77% from 1941 to 1976. A separate gift tax was enacted in 1924 with the same rates and exemptions, and an annual exclusion per donee of $500. The tax was repealed in 1926, then reenacted in 1932 with a $5,000 annual exclusion per donee. In 1942, changes addressed the difference in treatment in community property states, where each spouse owned half the assets and only the half owned by the decedent was subject to tax. In other states where couples could own assets jointly, exclusions were allowed only if the surviving spouse contributed to the assets. The 1942 act treated assets in community property states the same as in other states. In 1948, this rule was changed to allow a deduction for property transferred to a spouse whether by the will or by law. The 1942 act made other changes in rates and exemptions and instituted a $3,000 annual gift exclusion per donee. The Tax Reform Act of 1976 (P.L. 94-455) created the modern unified estate and gift tax with a unified credit and graduated rates applied to all transfers. The 1976 act also instituted carryover basis for inherited assets, but that provision resulted in considerable controversy and was repealed retroactively in 1980. The exemption was increased from $60,000 to $120,000, and the top rate was lowered to 70%. The Economic Growth and Tax Relief Act of 2001 (EGTRRA; P.L. 107-16) provided for a gradual reduction in the estate tax. The law applied a unified exemption for both lifetime gifts and the estate of $675,000 prior to these changes. Under EGTRRA, the estate tax exemption rose from $675,000 in 2001 to $3.5 million in 2009, and the top tax rate fell from 55% to 45%. Although combined estate and gift tax rates are graduated, the exemption is effectively in the form of a credit that eliminates tax due at lower rates, resulting in a flat rate on taxable assets under 2009 law. The gift tax exemption was, however, restricted to $1 million. For 2010, EGTRRA scheduled the elimination of the estate tax, although it retained the gift tax and its $1 million exemption. EGTRRA also provided for a carryover of basis for assets inherited at death in 2010, so that, in contrast with prior law, heirs who sold assets would have to pay tax on gains accrued during the decedent’s lifetime. This provision had a $1.3 million exemption for gain (plus $3 million for a spouse). Congressional Research Service 5 The Estate and Gift Tax: An Overview As with other provisions of EGTRRA, the estate tax revisions were to expire in 2011, returning the tax provisions to their pre-EGTRRA levels. The exemption would have reverted to $1 million (a value that had already been scheduled for pre-EGTRRA law) and the rate to 55% (with some graduated rates). The carryover basis provision effective in 2010 would have been eliminated (so that heirs would not be taxed on gain accumulated during the decedent’s life when they inherited assets). During debate on the estate tax, most agreed that the 2010 provisions would not be continued and, indeed, could be repealed retroactively. President Obama proposed a permanent extension of the 2009 rules (a $3.5 million exemption and a 45% tax rate), and the House provided for that permanent extension on December 3, 2009 (H.R. 4154). The Senate Democratic leadership indicated a plan to retroactively reinstate the 2009 rules for 2010 and beyond. Senate Minority Leader McConnell proposed an alternative of a 35% tax rate and a $5 million exemption.9 A similar proposal for a $5 million exemption and a 35% rate, which also included the ability of the surviving spouse to inherit any unused exemption of the decedent, is often referred to as Lincoln Kyl (named after two Senators who sponsored it). Other proposals began with the $3.5 million exemption and 45% rate and would have phased in the $5 million exemption and 55% rate. Some Members of Congress argued for permanent estate tax repeal.10 At the end of 2010, P.L. 111-312 enacted a temporary two-year extension of the estate and gift tax, with a $5 million unified exemption, a 35% rate, and inheritance of unused spousal exemptions. For 2010, estates could elect to be taxed under the estate tax or under the carryover rules. These provisions provided for estate tax rules through 2012, after which the provisions would have reverted to the pre-EGTRRA rules ($1 million exemption, 55% top rate) absent legislation. The American Taxpayer Relief Act of 2012 (P.L. 112-240) established the permanent exemption ($5.25 million, indexed for inflation?) and rate (40%) described above. The 2017 tax revision (P.L. 115-97) doubled the exemption for the years 2018 through 2025. The House had proposed doubling the exemption through 2024 and then repealing the estate tax and lowering the gift tax rates to 35%. One issue that arises with the expiration of the increased exemptions is the treatment of gifts that had been transferred with exemptions higher than the exemptions that the law would revert to. ",Legal,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Could you explain two key aspects of the U.S. legal system - first, by explaining the different functions of federal and state courts, and then explaining the differences between a civil and criminal case? Answer in a minimum of 300 words.","The legal system in the United States is not composed of a single set of laws and courts. Instead, an inter-connected web of laws, regulations, and courts stretches across the country at the state and federal levels. Courts interpret state and federal law to refine the rules through case law. The federal and state court systems have a hierarchy that allows higher courts to review decisions made by lower courts. Also, both systems have civil and criminal courts. FindLaw's Legal System section provides a closer look at the U.S. court system, including the federal court system and state court cases. This section also includes information about civil courts, including articles about class action lawsuits, tips on negotiating a settlement, the judge's role in court, and a helpful glossary with terms related to courts and the law. The United States Judiciary: Federal and State Courts The United States has two court systems: federal and state courts. Each court system hears criminal and civil cases. This section describes the differences and similarities between the federal and state court systems. Federal Courts Explained Article III of the U.S. Constitution allows Congress to create a federal court system. The federal judiciary has 13 courts of appeals, 94 U.S. district courts, a court of federal claims, and a court of international trade. The United States Supreme Court, the final arbiter of any case, is also a federal court. If you file a case in the federal system, your case begins at the district court level with a federal judge. If you appeal your case, a federal circuit court will hear the appeal. If you appeal the circuit court's decision, you must petition the U.S. Supreme Court to hear your case. The Supreme Court grants reviews (certiorari) of about 100 cases a year and is not obligated to hear your case. You can learn more about Supreme Court justices from FindLaw's Supreme Court Center. Federal District Courts have jurisdiction (i.e., the ability to hear a case) over the following types of cases: Cases where the U.S. government is a party to the lawsuit Disputes that raise constitutional questions or involve federal law (i.e., federal question jurisdiction) Controversies between the U.S. government and a state or foreign entity Sometimes, a plaintiff (the person or entity filing a lawsuit) may file a civil case in federal or state court. Two ways this happens is through diversity jurisdiction and federal question jurisdiction. Whether the plaintiff has this option depends on the circumstances of their case. A plaintiff who claims a person or entity violated their constitutional rights or broke a federal law may invoke federal question jurisdiction. If they can show that their case involved either a constitutional violation or that it arose under federal law, the federal district court may hear it. For a federal district court to have diversity jurisdiction, the plaintiff must show that they and the defendant(s) in a case live in different states and the amount in controversy exceeds $75,000. Read FindLaw's article on federal courts for more information. State Courts Explained The U.S. Constitution and state law establish each state's court system. Because of this, not every state has the same type of court system. Check your state's laws for more specific information about your state's courts. Because each state's court system is different, no absolute structure applies to the states. But generally, a plaintiff files their civil case in a state court, sometimes known as a trial court or state district court. If they appeal the trial court's decision, most states have an appellate court system that hears the appeal. If a party appeals from the appellate court, most states have a supreme court to review the case (although, again, the name of the highest court in your state may differ). If the highest court in your state issues a decision, you may generally petition the U.S. Supreme Court to consider your case. But, just like a federal circuit court appeal, the U.S. Supreme Court is not obligated to hear your case. Generally, state courts have jurisdiction over criminal and civil cases that involve that state's laws. For example, a Wisconsin state court could hear a civil case that invokes Wisconsin state law. The Wisconsin state court generally could not hear a civil case where the cause of action arose in Florida and broke Florida's state laws, as the Wisconsin court generally would not have jurisdiction over the subject matter of the case nor personal jurisdiction over the parties to the case. Read FindLaw's article on state courts for more in-depth information. Civil vs. Criminal Cases Deciding whether to file your case in a federal or state court is important. Another defining factor of your case is whether it is civil or criminal. Generally, civil cases involve claims between private parties. For example, if you borrowed tools from your neighbor and refused to return them, the neighbor could file a civil case against you in state court. Or, if you believe the school board at a local public school infringed your First Amendment right to free speech, you could file a civil claim against them in federal court. Criminal cases involve alleged offenses against society. Instead of a dispute between private parties, criminal cases involve the government bringing criminal charges against someone and prosecuting them. The following section describes the differences between civil and criminal cases. Civil Cases When a person, organization, or entity (such as a corporation) claims that another person, organization, or entity breached a legal duty owed to the plaintiff, they have a potential civil case. Common claims in civil lawsuits include the following: Intentional torts (e.g., infliction of emotional distress or assault) Negligence Nuisance Personal injury Breach of contract Property damage Child custody, child support, and other family law disputes Whether to file a civil lawsuit in federal or state court depends on the circumstances of your case. But, most plaintiffs file their civil lawsuits in state courts. Filing a civil case in federal court is only appropriate in certain circumstances. In civil litigation, the plaintiff has the burden of proof at trial. They must prove their case by a preponderance of the evidence. This standard means that the plaintiff must prove to the trier of fact (judge or jury) that it is more likely than not that the defendant is liable for the plaintiff's claimed relief or damages. Browse FindLaw's article on the basics of civil court for more information. Criminal Cases Unlike civil cases, where the injured party files a lawsuit, criminal cases involve the government bringing charges against the accused person. Most crimes in the United States involve violations of state laws rather than federal laws. So, state courts hear most criminal cases. In a state criminal case, district attorneys prosecute the defendant. But, suppose the government charges the defendant with a federal crime. In that case, a United States Attorney will prosecute the case in federal court. The prosecution has the burden of proof in a criminal case. They must prove the defendant's guilt beyond a reasonable doubt. Not every criminal case involves actual crime victims. For example, the government can prosecute someone for driving under the influence even if they did not injure anyone or cause property damage.","[question] Could you explain two key aspects of the U.S. legal system - first, by explaining the different functions of federal and state courts, and then explaining the differences between a civil and criminal case? Answer in a minimum of 300 words. ===================== [text] The legal system in the United States is not composed of a single set of laws and courts. Instead, an inter-connected web of laws, regulations, and courts stretches across the country at the state and federal levels. Courts interpret state and federal law to refine the rules through case law. The federal and state court systems have a hierarchy that allows higher courts to review decisions made by lower courts. Also, both systems have civil and criminal courts. FindLaw's Legal System section provides a closer look at the U.S. court system, including the federal court system and state court cases. This section also includes information about civil courts, including articles about class action lawsuits, tips on negotiating a settlement, the judge's role in court, and a helpful glossary with terms related to courts and the law. The United States Judiciary: Federal and State Courts The United States has two court systems: federal and state courts. Each court system hears criminal and civil cases. This section describes the differences and similarities between the federal and state court systems. Federal Courts Explained Article III of the U.S. Constitution allows Congress to create a federal court system. The federal judiciary has 13 courts of appeals, 94 U.S. district courts, a court of federal claims, and a court of international trade. The United States Supreme Court, the final arbiter of any case, is also a federal court. If you file a case in the federal system, your case begins at the district court level with a federal judge. If you appeal your case, a federal circuit court will hear the appeal. If you appeal the circuit court's decision, you must petition the U.S. Supreme Court to hear your case. The Supreme Court grants reviews (certiorari) of about 100 cases a year and is not obligated to hear your case. You can learn more about Supreme Court justices from FindLaw's Supreme Court Center. Federal District Courts have jurisdiction (i.e., the ability to hear a case) over the following types of cases: Cases where the U.S. government is a party to the lawsuit Disputes that raise constitutional questions or involve federal law (i.e., federal question jurisdiction) Controversies between the U.S. government and a state or foreign entity Sometimes, a plaintiff (the person or entity filing a lawsuit) may file a civil case in federal or state court. Two ways this happens is through diversity jurisdiction and federal question jurisdiction. Whether the plaintiff has this option depends on the circumstances of their case. A plaintiff who claims a person or entity violated their constitutional rights or broke a federal law may invoke federal question jurisdiction. If they can show that their case involved either a constitutional violation or that it arose under federal law, the federal district court may hear it. For a federal district court to have diversity jurisdiction, the plaintiff must show that they and the defendant(s) in a case live in different states and the amount in controversy exceeds $75,000. Read FindLaw's article on federal courts for more information. State Courts Explained The U.S. Constitution and state law establish each state's court system. Because of this, not every state has the same type of court system. Check your state's laws for more specific information about your state's courts. Because each state's court system is different, no absolute structure applies to the states. But generally, a plaintiff files their civil case in a state court, sometimes known as a trial court or state district court. If they appeal the trial court's decision, most states have an appellate court system that hears the appeal. If a party appeals from the appellate court, most states have a supreme court to review the case (although, again, the name of the highest court in your state may differ). If the highest court in your state issues a decision, you may generally petition the U.S. Supreme Court to consider your case. But, just like a federal circuit court appeal, the U.S. Supreme Court is not obligated to hear your case. Generally, state courts have jurisdiction over criminal and civil cases that involve that state's laws. For example, a Wisconsin state court could hear a civil case that invokes Wisconsin state law. The Wisconsin state court generally could not hear a civil case where the cause of action arose in Florida and broke Florida's state laws, as the Wisconsin court generally would not have jurisdiction over the subject matter of the case nor personal jurisdiction over the parties to the case. Read FindLaw's article on state courts for more in-depth information. Civil vs. Criminal Cases Deciding whether to file your case in a federal or state court is important. Another defining factor of your case is whether it is civil or criminal. Generally, civil cases involve claims between private parties. For example, if you borrowed tools from your neighbor and refused to return them, the neighbor could file a civil case against you in state court. Or, if you believe the school board at a local public school infringed your First Amendment right to free speech, you could file a civil claim against them in federal court. Criminal cases involve alleged offenses against society. Instead of a dispute between private parties, criminal cases involve the government bringing criminal charges against someone and prosecuting them. The following section describes the differences between civil and criminal cases. Civil Cases When a person, organization, or entity (such as a corporation) claims that another person, organization, or entity breached a legal duty owed to the plaintiff, they have a potential civil case. Common claims in civil lawsuits include the following: Intentional torts (e.g., infliction of emotional distress or assault) Negligence Nuisance Personal injury Breach of contract Property damage Child custody, child support, and other family law disputes Whether to file a civil lawsuit in federal or state court depends on the circumstances of your case. But, most plaintiffs file their civil lawsuits in state courts. Filing a civil case in federal court is only appropriate in certain circumstances. In civil litigation, the plaintiff has the burden of proof at trial. They must prove their case by a preponderance of the evidence. This standard means that the plaintiff must prove to the trier of fact (judge or jury) that it is more likely than not that the defendant is liable for the plaintiff's claimed relief or damages. Browse FindLaw's article on the basics of civil court for more information. Criminal Cases Unlike civil cases, where the injured party files a lawsuit, criminal cases involve the government bringing charges against the accused person. Most crimes in the United States involve violations of state laws rather than federal laws. So, state courts hear most criminal cases. In a state criminal case, district attorneys prosecute the defendant. But, suppose the government charges the defendant with a federal crime. In that case, a United States Attorney will prosecute the case in federal court. The prosecution has the burden of proof in a criminal case. They must prove the defendant's guilt beyond a reasonable doubt. Not every criminal case involves actual crime victims. For example, the government can prosecute someone for driving under the influence even if they did not injure anyone or cause property damage. https://www.findlaw.com/litigation/legal-system/introduction-to-the-u-s-legal-system.html ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Why is there such a big difference between the highest and lowest paid rns? surely experience cant make that much of a difference in pay?,"RN salaries increased for most license types, but not by a generous amount, according to the report. The median RN salary reported by survey respondents was $80,000, an increase of $2,000 from the 2022 survey. The median salary for APRNs/ARNPs was $117,300, which is a decrease of $2,700 (about 2%) from the 2022 report. This could be due to the younger average age of respondents in this group of nurses. The report also revealed that the gender pay gap for RNs has narrowed but hasn’t disappeared. The median salary for a male RN is $6,000 higher than the median salary for a female RN (compared with a $14,000 gap in the 2022 survey). Nurses’ responses helped identify some possible explanations for this salary gap, such as the higher percentage of male RNs working night shifts and negotiating their salary. However, the gap in male-female negotiating tendencies is closing, as more female RNs are becoming proactive in asking for higher pay. “These findings surrounding salary negotiation are encouraging,” said Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB, Vice President of Quality and Partner at Relias, in the report. “But it’s important that organizations commit to structures and processes that ensure continuous process improvements. Despite the shrinking pay gap, ongoing organizational salary reviews and advocacy and awareness campaigns are needed to close the gap and keep it closed.” Our findings also showed that education can positively impact nurse salaries. Across license types, 40% of nurses who earned certification said it resulted in a salary increase. Workplace safety and wellness For the first time, our survey asked nurses about their experiences with workplace violence and how their jobs affect their mental health and wellness, which are crucial factors for job satisfaction and retention. Unfortunately, many nurses said they have either witnessed or directly experienced workplace violence, which can have detrimental effects on their physical and mental health. About 22% of nurses said their organization has either weekly or monthly instances of workplace violence, according to our survey. And that’s not all. Almost one-third (31%) of nurses had been subjected to verbal abuse by a colleague. 64% had been subjected to verbal abuse by a patient or a patient’s family member. 23% had been physically assaulted or abused by a patient or a patient’s family member. In addition, nurses across all licensures and age groups said the profession has affected their mental health and wellness. Nurses ages 18 to 34 were more likely to report experiencing burnout, ethical dilemmas and moral injury, and compassion fatigue than nurses from other age groups. Wellness resources also remain important to nurses. Based on data from our report, the top three wellness resources nurses wanted were: Fitness stipends for memberships, equipment, or athletic wear Reimbursement or stipends for helpful apps for relaxation, fitness, and nutrition Free or reduced-cost mental health counseling services “It’s crucial for nurses to have access to mental health benefits,” said Cat Golden, BSN, RN, Partner at Nurse.com, in the report. “As a pediatric nurse who faced frequent encounters with the untimely death of young patients and their families’ grief, being able to speak with a therapist while on duty was vital for preserving my own mental well-being and played a pivotal role in my effectiveness as a nurse.” Satisfaction and retention Valuable insights into factors that contribute to nurses’ job satisfaction and the outlook for the nursing profession were also captured in the report. The highest percentage of nurses across all licensures (81%) rated regular merit increases as most important to their job satisfaction, followed by manager (62%), and ability to practice to the full scope of nursing practice (62%). However, 23% of nurses across all license types were considering leaving nursing, according to the survey. The top-ranked reasons for leaving nursing were dissatisfaction with management (25%) and better pay (24%). This is a concerning statistic for nurses, patients, and the healthcare system. What could encourage nurses to stay? The Nurse.com report identified the following top factors that could motivate nurses to stay in the profession: Higher pay (66%) Flexible scheduling (33%) Better support for work-life balance (30%) More reasonable workload (28%) Being able to work in a remote role (25%) Some of the revelations in the report may come as a surprise to nurses, while others may mirror how they feel about their careers and workplaces. However, all nurses can use the report to mold a better professional life for themselves. Use the information in this report to: Compare your salary and benefits to peers. Determine when to negotiate salary. Assess if pursuing additional training, a degree, or certification aligns with your career goals. Identify challenges and shortcomings within your organization. Initiate conversations with nursing leaders and advocate for a safer, healthier workplace.","[question] Why is there such a big difference between the highest and lowest paid rns? surely experience cant make that much of a difference in pay? ===================== [text] RN salaries increased for most license types, but not by a generous amount, according to the report. The median RN salary reported by survey respondents was $80,000, an increase of $2,000 from the 2022 survey. The median salary for APRNs/ARNPs was $117,300, which is a decrease of $2,700 (about 2%) from the 2022 report. This could be due to the younger average age of respondents in this group of nurses. The report also revealed that the gender pay gap for RNs has narrowed but hasn’t disappeared. The median salary for a male RN is $6,000 higher than the median salary for a female RN (compared with a $14,000 gap in the 2022 survey). Nurses’ responses helped identify some possible explanations for this salary gap, such as the higher percentage of male RNs working night shifts and negotiating their salary. However, the gap in male-female negotiating tendencies is closing, as more female RNs are becoming proactive in asking for higher pay. “These findings surrounding salary negotiation are encouraging,” said Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB, Vice President of Quality and Partner at Relias, in the report. “But it’s important that organizations commit to structures and processes that ensure continuous process improvements. Despite the shrinking pay gap, ongoing organizational salary reviews and advocacy and awareness campaigns are needed to close the gap and keep it closed.” Our findings also showed that education can positively impact nurse salaries. Across license types, 40% of nurses who earned certification said it resulted in a salary increase. Workplace safety and wellness For the first time, our survey asked nurses about their experiences with workplace violence and how their jobs affect their mental health and wellness, which are crucial factors for job satisfaction and retention. Unfortunately, many nurses said they have either witnessed or directly experienced workplace violence, which can have detrimental effects on their physical and mental health. About 22% of nurses said their organization has either weekly or monthly instances of workplace violence, according to our survey. And that’s not all. Almost one-third (31%) of nurses had been subjected to verbal abuse by a colleague. 64% had been subjected to verbal abuse by a patient or a patient’s family member. 23% had been physically assaulted or abused by a patient or a patient’s family member. In addition, nurses across all licensures and age groups said the profession has affected their mental health and wellness. Nurses ages 18 to 34 were more likely to report experiencing burnout, ethical dilemmas and moral injury, and compassion fatigue than nurses from other age groups. Wellness resources also remain important to nurses. Based on data from our report, the top three wellness resources nurses wanted were: Fitness stipends for memberships, equipment, or athletic wear Reimbursement or stipends for helpful apps for relaxation, fitness, and nutrition Free or reduced-cost mental health counseling services “It’s crucial for nurses to have access to mental health benefits,” said Cat Golden, BSN, RN, Partner at Nurse.com, in the report. “As a pediatric nurse who faced frequent encounters with the untimely death of young patients and their families’ grief, being able to speak with a therapist while on duty was vital for preserving my own mental well-being and played a pivotal role in my effectiveness as a nurse.” Satisfaction and retention Valuable insights into factors that contribute to nurses’ job satisfaction and the outlook for the nursing profession were also captured in the report. The highest percentage of nurses across all licensures (81%) rated regular merit increases as most important to their job satisfaction, followed by manager (62%), and ability to practice to the full scope of nursing practice (62%). However, 23% of nurses across all license types were considering leaving nursing, according to the survey. The top-ranked reasons for leaving nursing were dissatisfaction with management (25%) and better pay (24%). This is a concerning statistic for nurses, patients, and the healthcare system. What could encourage nurses to stay? The Nurse.com report identified the following top factors that could motivate nurses to stay in the profession: Higher pay (66%) Flexible scheduling (33%) Better support for work-life balance (30%) More reasonable workload (28%) Being able to work in a remote role (25%) Some of the revelations in the report may come as a surprise to nurses, while others may mirror how they feel about their careers and workplaces. However, all nurses can use the report to mold a better professional life for themselves. Use the information in this report to: Compare your salary and benefits to peers. Determine when to negotiate salary. Assess if pursuing additional training, a degree, or certification aligns with your career goals. Identify challenges and shortcomings within your organization. Initiate conversations with nursing leaders and advocate for a safer, healthier workplace. https://www.nurse.com/blog/nurse-salary-and-work-life-reports-revelations/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Financial,Effect Analysis,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",How do I go about choosing the right benchmark to calculate alpha given a particular basket of stocks? Explain in 250 words like I'm a portfolio manager.,"Evaluating the return of an investment without regard to the risk taken offers very little insight as to how a security or portfolio has really performed. Every security has a required rate of return, as specified by the capital asset pricing model (CAPM). The Jensen index, or alpha, is what helps investors determine how much a portfolio's realized return differs from the return it should have achieved. This article will provide a deeper understanding of alpha and its practical application. Key Takeaways Alpha refers to excess returns earned on an investment above the benchmark return. Active portfolio managers seek to generate alpha in diversified portfolios, with diversification intended to eliminate unsystematic risk. Because alpha represents the performance of a portfolio relative to a benchmark, it is often considered to represent the value that a portfolio manager adds to or subtracts from a fund's return. Jensen’s alpha takes into consideration the capital asset pricing model (CAPM) and includes a risk-adjusted component in its calculation. Alpha Defined Alpha is computed in relation to the capital asset pricing model. The CAPM equation is used to identify the required return of an investment; it is often used to evaluate realized performance for a diversified portfolio. Because it's assumed that the portfolio being evaluated is a diversified portfolio (meaning that the unsystematic risk has been eliminated), and because a diversified portfolio's main source of risk is the market risk (or systematic risk), beta is an appropriate measure of that risk. Alpha is used to determine by how much the realized return of the portfolio varies from the required return, as determined by CAPM. The formula for alpha is expressed as follows: 1 α = Rp – [Rf + (Rm – Rf) β] Where: Rp = Realized return of portfolio Rm = Market return Rf = the risk-free rate β = the asset's beta What Does Alpha Measure? Alpha measures risk premiums in terms of beta (β); therefore, it is assumed that the portfolio being evaluated is well diversified. The Jensen index requires using a different risk-free rate for each time interval measured during the specified period. For instance, if you are measuring the fund managers over a five-year period using annual intervals, you must examine the fund's annual returns minus the risk-free assets' returns (i.e., U.S. Treasury bill or one-year risk-free asset) for each year, and relate this to the annual return of the market portfolio minus the same risk-free rate. This calculation method contrasts with both the Treynor and Sharpe measures in that both examine the average returns for the total period for all variables, which include the portfolio, market, and risk-free assets. Alpha is a good measure of performance that compares the realized return with the return that should have been earned for the amount of risk borne by the investor. Technically speaking, it is a factor that represents the performance that diverges from a portfolio's beta, representing a measure of the manager's performance. For example, it's insufficient for an investor to consider the success or failure of a mutual fund merely by looking at its returns. The more relevant question is this: was the manager's performance sufficient to justify the risk taken to get said return? Applying the Results A positive alpha indicates the portfolio manager performed better than was expected based on the risk the manager took with the fund as measured by the fund's beta. A negative alpha means that the manager actually did worse than they should have given the required return of the portfolio. 1 The regression results usually cover a period between 36 and 60 months. The Jensen index permits the comparison of portfolio managers' performance relative to one another, or relative to the market itself. When applying alpha, it's important to compare funds within the same asset class. Comparing funds from one asset class (i.e., large-cap growth) against a fund from another asset class (i.e., emerging markets) is meaningless because you are essentially comparing apples and oranges. The chart below provides a good comparative example of alpha, or ""excess returns."" Investors can use both alpha and beta to judge a manager's performance. Table 1 Fund Name Asset Class Ticker Alpha 3 Yr Beta 3 Yr Trailing Return 3 Yr Trailing Return 5 Yr American Funds Growth Fund A Large Growth AGTHX 4.29 1.01 16.61 20.46 Fidelity Large Cap Growth Large Growth FSLGX 7.19 1.04 22.91 -- T. Rowe Price Growth Stock Large Growth PRGFX 5.14 1.03 17.67 21.54 Vanguard Growth Index Fund Admiral Shares Large Growth VIGAX 6.78 1.04 19.76 21.43 Table 1 The figures included in Table 1 indicate that on a risk-adjusted basis, the Fidelity Large Cap Growth yielded the best results of the funds listed. The three-year alpha of four exceeded those of its peers in the small sample provided above. It's important to note that not only are comparisons among the same asset class appropriate but the right benchmark should also be considered. The benchmark most frequently used to measure the market is the S&P 500 stock index, which serves as a proxy for ""the market."" However, some portfolios and mutual funds include asset classes with characteristics that do not accurately compare against the S&P 500, such as bond funds, sector funds, real estate, etc. Therefore, the S&P 500 may not be the appropriate benchmark to use in that case. So the alpha calculation would have to incorporate the relative benchmark for that asset class. The Bottom Line Portfolio performance encompasses both return and risk. The Jensen index, or alpha, provides us with a fair standard of manager performance. The results can help us determine whether the manager added value or even extra value on a risk-adjusted basis. If so, it also helps us determine whether the manager's fees were justified when reviewing the results. Buying (or even keeping) investment funds without this consideration is like buying a car to get you from Point A to Point B without evaluating its fuel efficiency.","[question] How do I go about choosing the right benchmark to calculate alpha given a particular basket of stocks? Explain in 250 words like I'm a portfolio manager. ===================== [text] Evaluating the return of an investment without regard to the risk taken offers very little insight as to how a security or portfolio has really performed. Every security has a required rate of return, as specified by the capital asset pricing model (CAPM). The Jensen index, or alpha, is what helps investors determine how much a portfolio's realized return differs from the return it should have achieved. This article will provide a deeper understanding of alpha and its practical application. Key Takeaways Alpha refers to excess returns earned on an investment above the benchmark return. Active portfolio managers seek to generate alpha in diversified portfolios, with diversification intended to eliminate unsystematic risk. Because alpha represents the performance of a portfolio relative to a benchmark, it is often considered to represent the value that a portfolio manager adds to or subtracts from a fund's return. Jensen’s alpha takes into consideration the capital asset pricing model (CAPM) and includes a risk-adjusted component in its calculation. Alpha Defined Alpha is computed in relation to the capital asset pricing model. The CAPM equation is used to identify the required return of an investment; it is often used to evaluate realized performance for a diversified portfolio. Because it's assumed that the portfolio being evaluated is a diversified portfolio (meaning that the unsystematic risk has been eliminated), and because a diversified portfolio's main source of risk is the market risk (or systematic risk), beta is an appropriate measure of that risk. Alpha is used to determine by how much the realized return of the portfolio varies from the required return, as determined by CAPM. The formula for alpha is expressed as follows: 1 α = Rp – [Rf + (Rm – Rf) β] Where: Rp = Realized return of portfolio Rm = Market return Rf = the risk-free rate β = the asset's beta What Does Alpha Measure? Alpha measures risk premiums in terms of beta (β); therefore, it is assumed that the portfolio being evaluated is well diversified. The Jensen index requires using a different risk-free rate for each time interval measured during the specified period. For instance, if you are measuring the fund managers over a five-year period using annual intervals, you must examine the fund's annual returns minus the risk-free assets' returns (i.e., U.S. Treasury bill or one-year risk-free asset) for each year, and relate this to the annual return of the market portfolio minus the same risk-free rate. This calculation method contrasts with both the Treynor and Sharpe measures in that both examine the average returns for the total period for all variables, which include the portfolio, market, and risk-free assets. Alpha is a good measure of performance that compares the realized return with the return that should have been earned for the amount of risk borne by the investor. Technically speaking, it is a factor that represents the performance that diverges from a portfolio's beta, representing a measure of the manager's performance. For example, it's insufficient for an investor to consider the success or failure of a mutual fund merely by looking at its returns. The more relevant question is this: was the manager's performance sufficient to justify the risk taken to get said return? Applying the Results A positive alpha indicates the portfolio manager performed better than was expected based on the risk the manager took with the fund as measured by the fund's beta. A negative alpha means that the manager actually did worse than they should have given the required return of the portfolio. 1 The regression results usually cover a period between 36 and 60 months. The Jensen index permits the comparison of portfolio managers' performance relative to one another, or relative to the market itself. When applying alpha, it's important to compare funds within the same asset class. Comparing funds from one asset class (i.e., large-cap growth) against a fund from another asset class (i.e., emerging markets) is meaningless because you are essentially comparing apples and oranges. The chart below provides a good comparative example of alpha, or ""excess returns."" Investors can use both alpha and beta to judge a manager's performance. Table 1 Fund Name Asset Class Ticker Alpha 3 Yr Beta 3 Yr Trailing Return 3 Yr Trailing Return 5 Yr American Funds Growth Fund A Large Growth AGTHX 4.29 1.01 16.61 20.46 Fidelity Large Cap Growth Large Growth FSLGX 7.19 1.04 22.91 -- T. Rowe Price Growth Stock Large Growth PRGFX 5.14 1.03 17.67 21.54 Vanguard Growth Index Fund Admiral Shares Large Growth VIGAX 6.78 1.04 19.76 21.43 Table 1 The figures included in Table 1 indicate that on a risk-adjusted basis, the Fidelity Large Cap Growth yielded the best results of the funds listed. The three-year alpha of four exceeded those of its peers in the small sample provided above. It's important to note that not only are comparisons among the same asset class appropriate but the right benchmark should also be considered. The benchmark most frequently used to measure the market is the S&P 500 stock index, which serves as a proxy for ""the market."" However, some portfolios and mutual funds include asset classes with characteristics that do not accurately compare against the S&P 500, such as bond funds, sector funds, real estate, etc. Therefore, the S&P 500 may not be the appropriate benchmark to use in that case. So the alpha calculation would have to incorporate the relative benchmark for that asset class. The Bottom Line Portfolio performance encompasses both return and risk. The Jensen index, or alpha, provides us with a fair standard of manager performance. The results can help us determine whether the manager added value or even extra value on a risk-adjusted basis. If so, it also helps us determine whether the manager's fees were justified when reviewing the results. Buying (or even keeping) investment funds without this consideration is like buying a car to get you from Point A to Point B without evaluating its fuel efficiency. https://www.investopedia.com/articles/financial-theory/08/deeper-look-at-alpha.asp ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Financial,Effect Analysis,Q&A "Answers must only be provided from the text below. Sentences must be 9 words or less, no words longer than 8 characters.",how should kids operate the fridge freezer?,"instructions • Warnings and Important Safety Instructions in this manual do not cover all possible conditions and situations that may occur. It is your responsibility to use common sense, caution, and care when installing, maintaining, and operating your appliance. • Because these following operating instructions cover various models, the characteristics of your refrigerator may differ slightly from those described in this manual and not all warning signs may be applicable. If you have any questions or concerns, contact your nearest service center or find help and information online at www.samsung.com. • R-600a or R-134a is used as a refrigerant. Check the compressor label on the rear of the appliance or the rating label inside the fridge to see which refrigerant is used for your appliance. When this product contains flammable gas (Refrigerant R-600a), contact your local authority in regard to safe disposal of this product. • In order to avoid the creation of a flammable gas-air mixture if a leak in the refrigerating circuit occurs, the size of the room in which the appliance may be sited depends on the amount of refrigerant used. Safety information Untitled-1 4 2022-03-25 6:06:25 English 5 Safety information • Never start up an appliance showing any signs of damage. If in doubt, consult your dealer. The room must be 1 m3 in size for every 8 g of R-600a refrigerant inside the appliance. The amount of refrigerant in your particular appliance is shown on the identification plate inside the appliance. • Refrigerant squirting out of the pipes could ignite or cause an eye injury. When refrigerant leaks from the pipe, avoid any naked flames and move anything flammable away from the product and ventilate the room immediately. - Failing to do so may result in fire or explosion. • To avoid contamination of food, please respect the following instructions: - Opening the door for long periods can cause a significant increase of the temperature in the compartments of the appliance. - Clean regularly surfaces that can come in contact with food and accessible drainage systems. - Clean water tanks if they have not been used for 48 h; flush the water system connected to a water supply if water has not been drawn for 5 days. - Store raw meat and fish in suitable containers in the refrigerator, so that it is not in contact with or drip onto other food. - Two-star frozen-food compartments are suitable for storing pre-frozen food, storing or making icecream and making ice cubes. - One-, two- and three-star compartments are not suitable for the freezing of fresh food. Untitled-1 5 2022-03-25 6:06:25 Safety information 6 English Safety information - If the refrigerating appliance is left empty for long periods, switch off, defrost, clean, dry, and leave the door open to prevent mould developing within the appliance. Important safety symbols and precautions: Please follow all safety instructions in this manual. This manual uses the following safety symbols. WARNING Hazards or unsafe practices that may result in severe personal injury, property damage, and/or death. CAUTION Hazards or unsafe practices that may result in severe personal injury and/or property damage. NOTE Useful information that helps users understand or benefit from the refrigerator. These warning signs are here to prevent injury to you and others. Please follow them carefully. After reading this section, keep it in a safe place for future reference. Untitled-1 6 2022-03-25 6:06:25 English 7 Safety information Important safety precautions Warning; Risk of fire / flammable materials WARNING • When positioning the appliance, ensure the supply cord is not trapped or damaged. • Do not locate multiple portable socket-outlets or portable power supplies at the rear of the appliance. • Fill with potable water only. • Connect to potable water supply only. • Keep ventilation openings, in the appliance enclosure or in the built-in structure, clear of obstruction. • Do not use mechanical devices or any other means to accelerate the defrosting process, other than those recommended by the manufacturer. • Do not damage the refrigerant circuit. • Do not use electrical appliances inside the food storage compartments of the appliance, unless they are of the type recommended by the manufacturer. • This appliance is not intended for use by persons (including children) with reduced physical, sensory, or mental capabilities, or those who lack experience and knowledge, unless they have been given supervision or instruction concerning the use of the appliance by a person responsible for their safety","Answers must only be provided from the text below. Sentences must be 9 words or less, no words longer than 8 characters. how should kids operate the fridge freezer? instructions • Warnings and Important Safety Instructions in this manual do not cover all possible conditions and situations that may occur. It is your responsibility to use common sense, caution, and care when installing, maintaining, and operating your appliance. • Because these following operating instructions cover various models, the characteristics of your refrigerator may differ slightly from those described in this manual and not all warning signs may be applicable. If you have any questions or concerns, contact your nearest service center or find help and information online at www.samsung.com. • R-600a or R-134a is used as a refrigerant. Check the compressor label on the rear of the appliance or the rating label inside the fridge to see which refrigerant is used for your appliance. When this product contains flammable gas (Refrigerant R-600a), contact your local authority in regard to safe disposal of this product. • In order to avoid the creation of a flammable gas-air mixture if a leak in the refrigerating circuit occurs, the size of the room in which the appliance may be sited depends on the amount of refrigerant used. Safety information Untitled-1 4 2022-03-25 6:06:25 English 5 Safety information • Never start up an appliance showing any signs of damage. If in doubt, consult your dealer. The room must be 1 m3 in size for every 8 g of R-600a refrigerant inside the appliance. The amount of refrigerant in your particular appliance is shown on the identification plate inside the appliance. • Refrigerant squirting out of the pipes could ignite or cause an eye injury. When refrigerant leaks from the pipe, avoid any naked flames and move anything flammable away from the product and ventilate the room immediately. - Failing to do so may result in fire or explosion. • To avoid contamination of food, please respect the following instructions: - Opening the door for long periods can cause a significant increase of the temperature in the compartments of the appliance. - Clean regularly surfaces that can come in contact with food and accessible drainage systems. - Clean water tanks if they have not been used for 48 h; flush the water system connected to a water supply if water has not been drawn for 5 days. - Store raw meat and fish in suitable containers in the refrigerator, so that it is not in contact with or drip onto other food. - Two-star frozen-food compartments are suitable for storing pre-frozen food, storing or making icecream and making ice cubes. - One-, two- and three-star compartments are not suitable for the freezing of fresh food. Untitled-1 5 2022-03-25 6:06:25 Safety information 6 English Safety information - If the refrigerating appliance is left empty for long periods, switch off, defrost, clean, dry, and leave the door open to prevent mould developing within the appliance. Important safety symbols and precautions: Please follow all safety instructions in this manual. This manual uses the following safety symbols. WARNING Hazards or unsafe practices that may result in severe personal injury, property damage, and/or death. CAUTION Hazards or unsafe practices that may result in severe personal injury and/or property damage. NOTE Useful information that helps users understand or benefit from the refrigerator. These warning signs are here to prevent injury to you and others. Please follow them carefully. After reading this section, keep it in a safe place for future reference. Untitled-1 6 2022-03-25 6:06:25 English 7 Safety information Important safety precautions Warning; Risk of fire / flammable materials WARNING • When positioning the appliance, ensure the supply cord is not trapped or damaged. • Do not locate multiple portable socket-outlets or portable power supplies at the rear of the appliance. • Fill with potable water only. • Connect to potable water supply only. • Keep ventilation openings, in the appliance enclosure or in the built-in structure, clear of obstruction. • Do not use mechanical devices or any other means to accelerate the defrosting process, other than those recommended by the manufacturer. • Do not damage the refrigerant circuit. • Do not use electrical appliances inside the food storage compartments of the appliance, unless they are of the type recommended by the manufacturer. • This appliance is not intended for use by persons (including children) with reduced physical, sensory, or mental capabilities, or those who lack experience and knowledge, unless they have been given supervision or instruction concerning the use of the appliance by a person responsible for their safety",Retail/Product,Find & Summarize,Text Transformation Limit your response to presenting information contained within the text provided above - You are not permitted to use external resources.,What actually is the federal debt?,"Deficits, Debt, and Interest The annual differences between revenue (i.e., taxes and fees) that the government collects and outlays (i.e., spending) result in the budget deficit (or surplus). Annual budget deficits or surpluses determine, over time, the level of publicly held federal debt and affect the level of interest payments to finance the debt. Budget Deficits Between FY2009 and FY2012, annual budgets as a percentage of GDP were sharply higher than deficits in any period since FY1945.27 The unified budget deficit in FY2015 was $439 billion, or 2.5% of GDP—the lowest level since FY2007. The unified deficit, according to some budget experts, gives an incomplete view of the government’s fiscal conditions because it includes off- budget surpluses.28 Excluding off-budget items (Social Security benefits paid net of Social Security payroll taxes collected and the U.S. Postal Service’s net balance), the on-budget FY2015 federal deficit was $466 billion. Budget Deficit for FY2016 The January 2016 CBO baseline estimated the FY2016 budget deficit at $544 billion, or 2.9% of GDP. The rise in the estimated budget deficit for FY2016 is the result of increases in spending more than offsetting a smaller rise in revenues. FY2016 outlays are projected to increase to 21.2% of GDP, up from 20.7% of GDP in FY2015; revenues are projected to increase from 18.2% of GDP to 18.3% of GDP over the same period. Federal Debt and Debt Limit Gross federal debt is composed of debt held by the public and intragovernmental debt. Intragovernmental debt is the amount owed by the federal government to other federal agencies, to be paid by the Department of the Treasury, which mostly consists of money contained in trust funds. Debt held by the public is the total amount the federal government has borrowed from the public and remains outstanding. This measure is generally considered to be the most relevant in macroeconomic terms because it is the debt sold in credit markets. Changes in debt held by the public generally track the movements of the annual unified deficits and surpluses.29 Historically, Congress has set a ceiling on federal debt through a legislatively established limit. The debt limit also imposes a form of fiscal accountability that compels Congress, in the form of a vote authorizing a debt limit increase, and the President, by signing the legislation, to take visible action to allow further federal borrowing when nearing the statutory limit. The debt limit by itself has no effect on the borrowing needs of the government.30 The debt limit, however, can hinder the Treasury’s ability to manage the federal government’s finances when the amount of federal debt approaches this ceiling, or when the suspension expires. In those instances, the Treasury has had to take extraordinary measures to meet federal obligations, leading to inconvenience and uncertainty in Treasury operations at times.31 At the end of CY2015 (December 31, 2015), federal debt subject to limit was approximately $18.922 trillion, of which $13.673 trillion was held by the public.32 The debt limit is currently suspended until March 15, 2017. Upon reinstatement, the debt limit will be modified to exactly accommodate any increases in statutory debt subject to limit above the previous limit ($18.1 trillion). At the end of calendar year 2015, total debt subject to limit was $18.9 trillion. Barring advanced legislative action, the debt limit will be reached when reinstated, so long as federal debt remains above the previous limit and continues to rise. Net Interest In FY2015, the United States spent $223 billion, or 1.3% of GDP, on net interest payments on the debt. What the government pays in interest depends on market interest rates as well as on the size and composition of the federal debt. Currently, low interest rates have held net interest payments as a percentage of GDP below the historical average despite increases in borrowing to finance the debt.33 Some economists, however, have expressed concern that federal interest costs could rise once the economy fully recovers, resulting in future strain on the budget. Interest rates are projected to gradually rise in the CBO baseline, resulting in net interest payments of $830 billion (3.0% of GDP) in FY2026. If interest costs rise to this level, they will be higher than the historical average.","Deficits, Debt, and Interest The annual differences between revenue (i.e., taxes and fees) that the government collects and outlays (i.e., spending) result in the budget deficit (or surplus). Annual budget deficits or surpluses determine, over time, the level of publicly held federal debt and affect the level of interest payments to finance the debt. Budget Deficits Between FY2009 and FY2012, annual budgets as a percentage of GDP were sharply higher than deficits in any period since FY1945.27 The unified budget deficit in FY2015 was $439 billion, or 2.5% of GDP—the lowest level since FY2007. The unified deficit, according to some budget experts, gives an incomplete view of the government’s fiscal conditions because it includes off- budget surpluses.28 Excluding off-budget items (Social Security benefits paid net of Social Security payroll taxes collected and the U.S. Postal Service’s net balance), the on-budget FY2015 federal deficit was $466 billion. Budget Deficit for FY2016 The January 2016 CBO baseline estimated the FY2016 budget deficit at $544 billion, or 2.9% of GDP. The rise in the estimated budget deficit for FY2016 is the result of increases in spending more than offsetting a smaller rise in revenues. FY2016 outlays are projected to increase to 21.2% of GDP, up from 20.7% of GDP in FY2015; revenues are projected to increase from 18.2% of GDP to 18.3% of GDP over the same period. Federal Debt and Debt Limit Gross federal debt is composed of debt held by the public and intragovernmental debt. Intragovernmental debt is the amount owed by the federal government to other federal agencies, to be paid by the Department of the Treasury, which mostly consists of money contained in trust funds. Debt held by the public is the total amount the federal government has borrowed from the public and remains outstanding. This measure is generally considered to be the most relevant in macroeconomic terms because it is the debt sold in credit markets. Changes in debt held by the public generally track the movements of the annual unified deficits and surpluses.29 Historically, Congress has set a ceiling on federal debt through a legislatively established limit. The debt limit also imposes a form of fiscal accountability that compels Congress, in the form of a vote authorizing a debt limit increase, and the President, by signing the legislation, to take visible action to allow further federal borrowing when nearing the statutory limit. The debt limit by itself has no effect on the borrowing needs of the government.30 The debt limit, however, can hinder the Treasury’s ability to manage the federal government’s finances when the amount of federal debt approaches this ceiling, or when the suspension expires. In those instances, the Treasury has had to take extraordinary measures to meet federal obligations, leading to inconvenience and uncertainty in Treasury operations at times.31 At the end of CY2015 (December 31, 2015), federal debt subject to limit was approximately $18.922 trillion, of which $13.673 trillion was held by the public.32 The debt limit is currently suspended until March 15, 2017. Upon reinstatement, the debt limit will be modified to exactly accommodate any increases in statutory debt subject to limit above the previous limit ($18.1 trillion). At the end of calendar year 2015, total debt subject to limit was $18.9 trillion. Barring advanced legislative action, the debt limit will be reached when reinstated, so long as federal debt remains above the previous limit and continues to rise. Net Interest In FY2015, the United States spent $223 billion, or 1.3% of GDP, on net interest payments on the debt. What the government pays in interest depends on market interest rates as well as on the size and composition of the federal debt. Currently, low interest rates have held net interest payments as a percentage of GDP below the historical average despite increases in borrowing to finance the debt.33 Some economists, however, have expressed concern that federal interest costs could rise once the economy fully recovers, resulting in future strain on the budget. Interest rates are projected to gradually rise in the CBO baseline, resulting in net interest payments of $830 billion (3.0% of GDP) in FY2026. If interest costs rise to this level, they will be higher than the historical average. Limit your response to presenting information contained within the text provided above - You are not permitted to use external resources. What actually is the federal debt?",Financial,Explanation/Definition,Q&A Use only the provided context block to find answers to the user prompt. Do not use external sources.,What did FCC have to do with 230?,"Section 230 was enacted in 1996 in response to a trial court ruling that allowed an online platform to be subject to liability for hosting defamatory speech, in part because the platform had said it would police its site for unwanted speech. Congress was concerned that this ruling created a perverse incentive for sites to refrain from monitoring content to avoid liability. Section 230 can be seen as speech-protective: by barring lawsuits that would punish platforms for hosting speech, it may encourage platforms to err on the side of hosting more content, while still allowing sites to take down content they see as objectionable. To this end, Section 230 contains two different provisions that courts have generally viewed as two distinct liability shields. First, Section 230(c)(1) states that interactive computer service providers and users may not “be treated as the publisher or speaker of any information provided by another” person. This provision has been broadly interpreted to bar a wide variety of suits that would treat service providers as the publisher of another’s content, including claims of defamation, negligence, discrimination under the Civil Rights Act of 1964, and state criminal prosecutions. However, if a site helps develop the unlawful content, courts have ruled that Section 230(c)(1) immunity does not apply. Accordingly, courts have, for example, rejected applying Section 230 to cases brought by the FTC against a defendant website that solicited or was involved in publishing allegedly unlawful content. More generally, Section 230 will not bar suits that seek to hold sites liable for their own conduct, rather than another’s content. But courts have said that acts inherent to publishing, such as reviewing, suggesting, and sometimes even editing content, may not, by themselves, qualify as helping develop the challenged content. As a consequence, Section 230(c)(1) immunity can apply regardless of whether the site chooses to actively police content or whether it chooses to take a more hands-off approach. Second, Section 230(c)(2) provides that interactive computer service providers and users may not be “held liable” for any voluntary, “good faith” action “to restrict access to or availability of material that the provider or user considers to be obscene, lewd, lascivious, filthy, excessively violent, harassing, or otherwise objectionable.” Section 230(c)(2) also immunizes providing “the technical means to restrict access” to objectionable material. Unlike Section 230(c)(1), Section 230(c)(2) applies only to good faith actions to restrict objectionable material. Courts have ruled that allegations of anticompetitive motives can demonstrate bad faith, disqualifying sites from claiming Section 230(c)(2) immunity. There are, however, relatively few published federal court cases interpreting this provision. Because Section 230(c)(2) contains a good-faith requirement and Section 230(c)(1) does not, some courts have recognized the importance of determining when each immunity provision applies. At least one decision suggests that Section 230(c)(2) applies when a service provider “does filter out offensive material,” while Section 230(c)(1) applies when providers “refrain from filtering or censoring the information on their sites.” But, as one scholar has noted, other courts have cited Section 230(c)(1) when dismissing claims predicated on takedowns. Another possibility is that Section 230(c)(1) does not apply when the plaintiff’s own content is at issue—that is, while Section 230(c)(1) immunity only applies if a third party created the disputed content, Section 230(c)(2) can apply when a person sues a site for taking down the plaintiff’s own content. Again, however, other decisions suggest that courts may apply Section 230(c)(1) even when the suit involves the plaintiff’s own content. Athird view is that Section 230(c)(2) might apply if the provider helps develop content and is therefore ineligible for (c)(1) immunity. In short, court rulings are inconsistent on the question of when each of the two immunity provisions governs. Section230(e)expressly states that the law will not bar liability in certain cases.Defendants may not claim Section 230 immunity in federal criminal prosecutions, cases involving intellectual property laws, suits under the Electronic Communications Privacy Act or “similar” state laws, and certain civil actions and state criminal prosecutions relating to sex trafficking. If Section 230’s liability shield does not apply, the person being sued will not automatically be held liable. Instead, it means only that courts can continue to adjudicate the case. The EO begins by stating in Section 1 the President’s belief that online platforms are engaging in “selective censorship,” harming national discourse and restricting Americans’ speech. Section 2 turns to the interpretation of Section 230(c), arguing that the “scope” of this immunity provision “should be clarified” and the law should not be extended to platforms that “engage in deceptive or pretextual actions” to censor “certain viewpoints.” The EO maintains that Congress intended Section 230(c) to only protect service providers that engage in “Good Samaritan” blocking of harmful content. Section 2 further states that providers should not be entitled to Section 230(c)(2) immunity if they remove content without acting in “good faith,” including by taking “deceptive or pretextual actions (often contrary to their stated terms of service)” to suppress certain viewpoints. Section 2 also directs the Commerce Secretary, “in consultation with the Attorney General, and acting through the National Telecommunications and Information Administration (NTIA),” to request the FCC to issue regulations interpreting Section 230. Among other things, the EO, perhaps in response to the Section 230 jurisprudence discussed above, specifies that FCC’s proposed regulations should clarify: (1) “the interaction between” Section 230(c)(1) and (c)(2) to explain when a service provider that cannot obtain Section 230(c)(2) immunity is also ineligible for protection under (c)(1); and (2) the meaning of “good faith” in Section 230(c)(2), including whether violating terms of service or failing to provide procedural protections qualifies as bad faith. Section 4 of the EO instructs the FTC to “consider taking action, as appropriate and consistent with applicable law, to prohibit unfair or deceptive acts or practices.” Specifically, the EO suggests that if platforms “restrict speech in ways that do not align with those entities’ public representations about” how they monitor content on their sites, these acts may qualify as unfair or deceptive practices under the FTC Act. The EO also directs the FTC to consider whether complaints of “online censorship” received by the White House “allege violations of law,” and whether to develop a report on these complaints. The other provisions of the EO assign additional tasks to more executive departments. Section 3 of the EO requires agency review of federal spending on advertising and marketing on online platforms, and Sections 5 and 6 contain instructions for the Attorney General to establish a working group and propose federal legislation to implement the policies announced in the EO.","System instructions: [Use only the provided context block to find answers to the user prompt. Do not use external sources.] User query: [What did FCC have to do with 230?] Text: [Section 230 was enacted in 1996 in response to a trial court ruling that allowed an online platform to be subject to liability for hosting defamatory speech, in part because the platform had said it would police its site for unwanted speech. Congress was concerned that this ruling created a perverse incentive for sites to refrain from monitoring content to avoid liability. Section 230 can be seen as speech-protective: by barring lawsuits that would punish platforms for hosting speech, it may encourage platforms to err on the side of hosting more content, while still allowing sites to take down content they see as objectionable. To this end, Section 230 contains two different provisions that courts have generally viewed as two distinct liability shields. First, Section 230(c)(1) states that interactive computer service providers and users may not “be treated as the publisher or speaker of any information provided by another” person. This provision has been broadly interpreted to bar a wide variety of suits that would treat service providers as the publisher of another’s content, including claims of defamation, negligence, discrimination under the Civil Rights Act of 1964, and state criminal prosecutions. However, if a site helps develop the unlawful content, courts have ruled that Section 230(c)(1) immunity does not apply. Accordingly, courts have, for example, rejected applying Section 230 to cases brought by the FTC against a defendant website that solicited or was involved in publishing allegedly unlawful content. More generally, Section 230 will not bar suits that seek to hold sites liable for their own conduct, rather than another’s content. But courts have said that acts inherent to publishing, such as reviewing, suggesting, and sometimes even editing content, may not, by themselves, qualify as helping develop the challenged content. As a consequence, Section 230(c)(1) immunity can apply regardless of whether the site chooses to actively police content or whether it chooses to take a more hands-off approach. Second, Section 230(c)(2) provides that interactive computer service providers and users may not be “held liable” for any voluntary, “good faith” action “to restrict access to or availability of material that the provider or user considers to be obscene, lewd, lascivious, filthy, excessively violent, harassing, or otherwise objectionable.” Section 230(c)(2) also immunizes providing “the technical means to restrict access” to objectionable material. Unlike Section 230(c)(1), Section 230(c)(2) applies only to good faith actions to restrict objectionable material. Courts have ruled that allegations of anticompetitive motives can demonstrate bad faith, disqualifying sites from claiming Section 230(c)(2) immunity. There are, however, relatively few published federal court cases interpreting this provision. Because Section 230(c)(2) contains a good-faith requirement and Section 230(c)(1) does not, some courts have recognized the importance of determining when each immunity provision applies. At least one decision suggests that Section 230(c)(2) applies when a service provider “does filter out offensive material,” while Section 230(c)(1) applies when providers “refrain from filtering or censoring the information on their sites.” But, as one scholar has noted, other courts have cited Section 230(c)(1) when dismissing claims predicated on takedowns. Another possibility is that Section 230(c)(1) does not apply when the plaintiff’s own content is at issue—that is, while Section 230(c)(1) immunity only applies if a third party created the disputed content, Section 230(c)(2) can apply when a person sues a site for taking down the plaintiff’s own content. Again, however, other decisions suggest that courts may apply Section 230(c)(1) even when the suit involves the plaintiff’s own content. Athird view is that Section 230(c)(2) might apply if the provider helps develop content and is therefore ineligible for (c)(1) immunity. In short, court rulings are inconsistent on the question of when each of the two immunity provisions governs. Section230(e)expressly states that the law will not bar liability in certain cases.Defendants may not claim Section 230 immunity in federal criminal prosecutions, cases involving intellectual property laws, suits under the Electronic Communications Privacy Act or “similar” state laws, and certain civil actions and state criminal prosecutions relating to sex trafficking. If Section 230’s liability shield does not apply, the person being sued will not automatically be held liable. Instead, it means only that courts can continue to adjudicate the case. The EO begins by stating in Section 1 the President’s belief that online platforms are engaging in “selective censorship,” harming national discourse and restricting Americans’ speech. Section 2 turns to the interpretation of Section 230(c), arguing that the “scope” of this immunity provision “should be clarified” and the law should not be extended to platforms that “engage in deceptive or pretextual actions” to censor “certain viewpoints.” The EO maintains that Congress intended Section 230(c) to only protect service providers that engage in “Good Samaritan” blocking of harmful content. Section 2 further states that providers should not be entitled to Section 230(c)(2) immunity if they remove content without acting in “good faith,” including by taking “deceptive or pretextual actions (often contrary to their stated terms of service)” to suppress certain viewpoints. Section 2 also directs the Commerce Secretary, “in consultation with the Attorney General, and acting through the National Telecommunications and Information Administration (NTIA),” to request the FCC to issue regulations interpreting Section 230. Among other things, the EO, perhaps in response to the Section 230 jurisprudence discussed above, specifies that FCC’s proposed regulations should clarify: (1) “the interaction between” Section 230(c)(1) and (c)(2) to explain when a service provider that cannot obtain Section 230(c)(2) immunity is also ineligible for protection under (c)(1); and (2) the meaning of “good faith” in Section 230(c)(2), including whether violating terms of service or failing to provide procedural protections qualifies as bad faith. Section 4 of the EO instructs the FTC to “consider taking action, as appropriate and consistent with applicable law, to prohibit unfair or deceptive acts or practices.” Specifically, the EO suggests that if platforms “restrict speech in ways that do not align with those entities’ public representations about” how they monitor content on their sites, these acts may qualify as unfair or deceptive practices under the FTC Act. The EO also directs the FTC to consider whether complaints of “online censorship” received by the White House “allege violations of law,” and whether to develop a report on these complaints. The other provisions of the EO assign additional tasks to more executive departments. Section 3 of the EO requires agency review of federal spending on advertising and marketing on online platforms, and Sections 5 and 6 contain instructions for the Attorney General to establish a working group and propose federal legislation to implement the policies announced in the EO.]",Legal,Explanation/Definition,Q&A "Use only the document provided. If the question can not be answered then respond with 'I am unable to answer this request'",Summarize the information from this paper.,"BIAS IN POLICING Bias in the American legal system includes biases in law enforcement or policing, where racial disparities have long been documented and continue to persist. Compared with White Americans, Black and Latino men are disproportionately more likely to be stopped, searched, and arrested by police officers (Kahn & Martin 2016). Furthermore, members of these minority groups also experience greater use of force by the police (Goff & Kahn 2012, Kahn et al. 2016). Recently, a string of high-profile deadly cases involving Black men like Michael Brown, Eric Garner, and Walter Scott has increased public awareness of these hostile interactions with law enforcement. An initial analysis of public records revealed that non-White minorities made up almost half (47%) of all people killed by the police, despite comprising only 37% of the population. Furthermore, of those killed, 32% of Blacks and 25% of Latinos were unarmed, compared with 15% of Whites (Swaine et al. 2015). This troubling pattern of statistics has called into question the role that race may play in police decisions. Psychological research has examined this important social issue by directly investigating the content of racial stereotypes, as well as indirectly assessing how these associations affect perceptions and behavior. Self-report surveys have indicated that hostility, violence, and criminality are commonly associated with Black Americans, even by egalitarian-minded White Americans (Devine 1989, Devine & Elliot 1995, Dovidio et al. 1986). Additionally, priming low-prejudiced individuals with Black versus White stimuli typically results in the faster categorization of negative than positive attributes (e.g., Fazio et al. 1995, Greenwald et al. 1998, Wittenbrink et al. 1997). Together, these findings suggest that awareness of social stereotypes and exposure to stigmatized group members can affect decision making. The Impact of Race on Weapon and Crime Perception Applying the above rationale to police contexts, Payne (2001) developed the Weapons Identification Task (WIT) to better understand the psychological mechanisms that may drive racially biased shootings. This sequential priming procedure involves a series of trials that begin with the presentation of a Black or White face, which participants are instructed to ignore. After 200 ms, the prime is replaced by the target stimulus, which is a picture of either a tool or a handgun. Participants must correctly categorize the object as quickly as possible using one of two computer keys. Across two initial studies, Payne (2001) found evidence of racial bias in both the reaction times and error rates. Following the presentation of a Black versus White facial prime, participants were faster to correctly identify a gun and more likely to misidentify a tool as a gun, depending on the implementation of a response deadline. The results revealed that the racial primes had an automatic influence on the visual identification of weapons (see also Amodio et al. 2004, Klauer & Voss 2008, Payne et al. 2002). As such, Payne (2001) proposed that law enforcement officers may experience bias through the activation of Black stereotypes, especially when the cognitive resources needed to engage behavioral control are depleted. Correll et al. (2002) extended this line of inquiry by developing a video game that similarly examines the impact of race on weapon processing. In their first-person Shooter Task, participants are randomly presented with a range of one to four real-life photos of public spaces (e.g., parks, offices, courtyards). On the final image, a Black or White male target suddenly appears superimposed holding either a handgun or an innocuous object like a cell phone, soda can, or wallet. Participants must quickly press either a “shoot” or “don't shoot” button on their computer keyboard. When participants are given 850 ms to respond, they are faster to shoot armed Blacks versus Whites and slower to not shoot unarmed Blacks compared with Whites. However, providing participants with a 630-ms deadline results in a biased pattern of errors, such that unarmed Blacks are more likely to be incorrectly shot than their White counterparts and armed Whites are less likely to be shot than armed Black targets (see Correll et al. 2014, Mekawi & Bresin 2015). Biased responses were due to participants having lower thresholds for shooting Black compared with White targets (see also Greenwald et al. 2003). Furthermore, the magnitude of shooter bias was related to cultural awareness of Black stereotypes related to danger, violence, and aggression. Consequently, African American participants demonstrated the same pattern of shooter bias, despite holding presumably more positive attitudes about their group. These findings suggest that decisions to shoot may be strongly influenced by negative racial schemas that affect perceptions in ambiguous situations. Additional research supports the notion that racial stereotypes may serve as perceptual tuners that direct attention in a biased manner. Eberhardt et al. (2004) conducted a series of studies examining how associations between Blacks and crime affected visual processing. In their first study, undergraduates were subliminally primed with a photo of a Black male face, a White male face, or no face at all before completing a supposedly unrelated object detection task. On this critical task, severely degraded images of crime-relevant (e.g., guns, knives) or -irrelevant (e.g., phones, keys) objects appeared on the screen and slowly increased in clarity. Participants needed fewer frames to accurately detect a crime-relevant object following a Black versus White or no-face prime, a pattern of bias that was not related to their explicit racial attitudes. These results were replicated among California police officers who were primed with crime words (e.g., arrest, shoot) and then tested for their memory of the distractor face presented on the task. Compared with the correct image, officers were more likely to incorrectly choose a Black target with more stereotypical features following the crime primes. Early perceptual processes of the police may therefore be impacted by cultural associations that produce racial profiling of suspects and bias their subsequent treatment. Plant & Peruche (2005) also used actual law enforcement officers in their research to examine how race influenced their responses to criminal suspects. Police officers completed a more static version of the Shooter Task in which only photos of Black or White male faces appeared with a gun or object superimposed without a background image. The researchers wanted to examine whether repeated exposure to the program would reduce the bias expressed by the officers. As in past studies with undergraduate participants (e.g., Correll et al. 2002), the police were initially more likely to shoot unarmed Black versus White targets and had a lower threshold for shooting Black targets. However, this biased tendency disappeared in the second half of trials, signifying that officers learned to dissociate race from the presence of weapons to make more accurate decisions on the task. The potential benefit of expert police training on performance is further supported by the findings of Correll et al. (2007b), who compared the performance of three different samples: Denver community members, Denver police officers, and national police officers. In contrast to citizens who demonstrated bias in both their reaction time and error rates, police officers demonstrated it only in their response latencies. In other words, police officers did not make racially biased mistakes on the task but were still faster to shoot armed Black men and slower to not shoot unarmed Black targets. This shooter bias was more pronounced among officers serving high-crime areas with larger Black and minority populations. The findings suggest that exposure to negative racial stereotypes can impact the speed with which police officers make decisions, but that their extensive training and field experience may allow them to exert more control over their behavior than regular citizens. In sum, independent labs have accumulated a considerable amount of evidence that race can impact crime-oriented perceptions and bias subsequent decision making. Yet, findings are often mixed when comparing data obtained from police officers versus undergraduate or civilian samples. Under certain circumstances, the police express a similar magnitude of racial bias as individuals not in law enforcement; in other situations, their prior experience helps them limit the influence of stereotypes. Beyond the Impact of Race The mixed results discussed above point to the importance of conducting research that considers factors other than race to more fully understand the complexity of real-life police decision making. To this end, some studies have explored how personal motivations, situational contexts, and physical cues may attenuate or exacerbate the expression of racial bias. Personal motivation. Research that has examined motivational processes demonstrates that responses to race are not uniformly biased. For example, Payne (2001) found that motivation to control prejudice moderated the relationship between explicit measures of bias and performance on the WIT. Participants with low motivation to control prejudice tended to show a positive correlation between modern scores of racism and task performance. However, those with higher motivation levels tended to show a dissociation between explicit and implicit bias, indicating a regulatory effort to override stereotyping effects. Similarly, Amodio and colleagues (2006, 2008) have examined the impact of internal (personal) versus external (normative) motivations to respond without prejudice. Participants in their studies completed the WIT while having their brain activity recorded. The data indicated that internally motivated participants responded more accurately on the task, particularly following stereotypical errors. Because this neural activity occurred below conscious awareness, the researchers proposed that some individuals are able to engage a spontaneous form of control that helps reduce the influence of race on behavior. In contrast, Swencionis & Goff (2017) proposed that the motivation to view the world in hierarchical terms may increase bias in police decisions. Social Dominance Theory (Sidanius & Pratto 1999) posits that group-based inequalities are maintained by cultural influences that promote social stratification based on factors such as age, sex, and race. Consequently, power is primarily distributed to and legitimized by high-status groups and institutions. Past work has found that people with high social dominance orientation (SDO) are more attracted to hierarchy-enhancing professions, such as law enforcement, politics, and business (Sidanius et al. 2004). Given that police officers tend to report greater SDO levels than public defenders, college students, or community members (Sidanius et al. 1994), they may be more prone to expressing discrimination against low-status groups. Situational contexts. Recognizing that police decisions do not occur in a social vacuum, some researchers have attempted to recreate ecologically valid situations that may contribute to the expression of racial bias. For example, Correll et al. (2007a) reasoned that frequent media or environmental exposure to stereotypical depictions of Blacks may increase shooter bias. In line with their hypothesizing, they found that participants who were first exposed to stories involving Black versus White criminal activity later showed more bias on the Shooter Task. A similar pattern emerged when they manipulated the amount of Black armed and White unarmed targets appearing on the task. Thus, increasing the accessibility of associations between Blacks and danger resulted in more pronounced anti-Black bias. Cox et al. (2014) also argued for the use of more complex situational contexts to assess various psychological factors that influence real-life decisions. To this end, they developed a modified version of the Shooter Task that used short video clips along with static photos of the suspect and recorded responses through a gun apparatus instead of computer keys. Because the police usually have prior knowledge and expectations about neighborhoods, they also manipulated where the crimes on the task supposedly took place by providing the exact city location. Wisconsin police officers were randomly assigned to complete the task imbedded within a primarily White or non-White neighborhood. When examining responses on photo trials, the researchers found that police officers did not make racially biased errors but were faster to shoot armed Black versus White targets, as in the work by Correll et al. (2007b). Interestingly, they also found that the composition of the neighborhood interacted with the race of the officers, such that more errors were made when officers were assigned to other-race areas. ","Use only the document provided. If the question can not be answered then respond with 'I am unable to answer this request' Summarize the information from this paper. BIAS IN POLICING Bias in the American legal system includes biases in law enforcement or policing, where racial disparities have long been documented and continue to persist. Compared with White Americans, Black and Latino men are disproportionately more likely to be stopped, searched, and arrested by police officers (Kahn & Martin 2016). Furthermore, members of these minority groups also experience greater use of force by the police (Goff & Kahn 2012, Kahn et al. 2016). Recently, a string of high-profile deadly cases involving Black men like Michael Brown, Eric Garner, and Walter Scott has increased public awareness of these hostile interactions with law enforcement. An initial analysis of public records revealed that non-White minorities made up almost half (47%) of all people killed by the police, despite comprising only 37% of the population. Furthermore, of those killed, 32% of Blacks and 25% of Latinos were unarmed, compared with 15% of Whites (Swaine et al. 2015). This troubling pattern of statistics has called into question the role that race may play in police decisions. Psychological research has examined this important social issue by directly investigating the content of racial stereotypes, as well as indirectly assessing how these associations affect perceptions and behavior. Self-report surveys have indicated that hostility, violence, and criminality are commonly associated with Black Americans, even by egalitarian-minded White Americans (Devine 1989, Devine & Elliot 1995, Dovidio et al. 1986). Additionally, priming low-prejudiced individuals with Black versus White stimuli typically results in the faster categorization of negative than positive attributes (e.g., Fazio et al. 1995, Greenwald et al. 1998, Wittenbrink et al. 1997). Together, these findings suggest that awareness of social stereotypes and exposure to stigmatized group members can affect decision making. The Impact of Race on Weapon and Crime Perception Applying the above rationale to police contexts, Payne (2001) developed the Weapons Identification Task (WIT) to better understand the psychological mechanisms that may drive racially biased shootings. This sequential priming procedure involves a series of trials that begin with the presentation of a Black or White face, which participants are instructed to ignore. After 200 ms, the prime is replaced by the target stimulus, which is a picture of either a tool or a handgun. Participants must correctly categorize the object as quickly as possible using one of two computer keys. Across two initial studies, Payne (2001) found evidence of racial bias in both the reaction times and error rates. Following the presentation of a Black versus White facial prime, participants were faster to correctly identify a gun and more likely to misidentify a tool as a gun, depending on the implementation of a response deadline. The results revealed that the racial primes had an automatic influence on the visual identification of weapons (see also Amodio et al. 2004, Klauer & Voss 2008, Payne et al. 2002). As such, Payne (2001) proposed that law enforcement officers may experience bias through the activation of Black stereotypes, especially when the cognitive resources needed to engage behavioral control are depleted. Correll et al. (2002) extended this line of inquiry by developing a video game that similarly examines the impact of race on weapon processing. In their first-person Shooter Task, participants are randomly presented with a range of one to four real-life photos of public spaces (e.g., parks, offices, courtyards). On the final image, a Black or White male target suddenly appears superimposed holding either a handgun or an innocuous object like a cell phone, soda can, or wallet. Participants must quickly press either a “shoot” or “don't shoot” button on their computer keyboard. When participants are given 850 ms to respond, they are faster to shoot armed Blacks versus Whites and slower to not shoot unarmed Blacks compared with Whites. However, providing participants with a 630-ms deadline results in a biased pattern of errors, such that unarmed Blacks are more likely to be incorrectly shot than their White counterparts and armed Whites are less likely to be shot than armed Black targets (see Correll et al. 2014, Mekawi & Bresin 2015). Biased responses were due to participants having lower thresholds for shooting Black compared with White targets (see also Greenwald et al. 2003). Furthermore, the magnitude of shooter bias was related to cultural awareness of Black stereotypes related to danger, violence, and aggression. Consequently, African American participants demonstrated the same pattern of shooter bias, despite holding presumably more positive attitudes about their group. These findings suggest that decisions to shoot may be strongly influenced by negative racial schemas that affect perceptions in ambiguous situations. Additional research supports the notion that racial stereotypes may serve as perceptual tuners that direct attention in a biased manner. Eberhardt et al. (2004) conducted a series of studies examining how associations between Blacks and crime affected visual processing. In their first study, undergraduates were subliminally primed with a photo of a Black male face, a White male face, or no face at all before completing a supposedly unrelated object detection task. On this critical task, severely degraded images of crime-relevant (e.g., guns, knives) or -irrelevant (e.g., phones, keys) objects appeared on the screen and slowly increased in clarity. Participants needed fewer frames to accurately detect a crime-relevant object following a Black versus White or no-face prime, a pattern of bias that was not related to their explicit racial attitudes. These results were replicated among California police officers who were primed with crime words (e.g., arrest, shoot) and then tested for their memory of the distractor face presented on the task. Compared with the correct image, officers were more likely to incorrectly choose a Black target with more stereotypical features following the crime primes. Early perceptual processes of the police may therefore be impacted by cultural associations that produce racial profiling of suspects and bias their subsequent treatment. Plant & Peruche (2005) also used actual law enforcement officers in their research to examine how race influenced their responses to criminal suspects. Police officers completed a more static version of the Shooter Task in which only photos of Black or White male faces appeared with a gun or object superimposed without a background image. The researchers wanted to examine whether repeated exposure to the program would reduce the bias expressed by the officers. As in past studies with undergraduate participants (e.g., Correll et al. 2002), the police were initially more likely to shoot unarmed Black versus White targets and had a lower threshold for shooting Black targets. However, this biased tendency disappeared in the second half of trials, signifying that officers learned to dissociate race from the presence of weapons to make more accurate decisions on the task. The potential benefit of expert police training on performance is further supported by the findings of Correll et al. (2007b), who compared the performance of three different samples: Denver community members, Denver police officers, and national police officers. In contrast to citizens who demonstrated bias in both their reaction time and error rates, police officers demonstrated it only in their response latencies. In other words, police officers did not make racially biased mistakes on the task but were still faster to shoot armed Black men and slower to not shoot unarmed Black targets. This shooter bias was more pronounced among officers serving high-crime areas with larger Black and minority populations. The findings suggest that exposure to negative racial stereotypes can impact the speed with which police officers make decisions, but that their extensive training and field experience may allow them to exert more control over their behavior than regular citizens. In sum, independent labs have accumulated a considerable amount of evidence that race can impact crime-oriented perceptions and bias subsequent decision making. Yet, findings are often mixed when comparing data obtained from police officers versus undergraduate or civilian samples. Under certain circumstances, the police express a similar magnitude of racial bias as individuals not in law enforcement; in other situations, their prior experience helps them limit the influence of stereotypes. Beyond the Impact of Race The mixed results discussed above point to the importance of conducting research that considers factors other than race to more fully understand the complexity of real-life police decision making. To this end, some studies have explored how personal motivations, situational contexts, and physical cues may attenuate or exacerbate the expression of racial bias. Personal motivation. Research that has examined motivational processes demonstrates that responses to race are not uniformly biased. For example, Payne (2001) found that motivation to control prejudice moderated the relationship between explicit measures of bias and performance on the WIT. Participants with low motivation to control prejudice tended to show a positive correlation between modern scores of racism and task performance. However, those with higher motivation levels tended to show a dissociation between explicit and implicit bias, indicating a regulatory effort to override stereotyping effects. Similarly, Amodio and colleagues (2006, 2008) have examined the impact of internal (personal) versus external (normative) motivations to respond without prejudice. Participants in their studies completed the WIT while having their brain activity recorded. The data indicated that internally motivated participants responded more accurately on the task, particularly following stereotypical errors. Because this neural activity occurred below conscious awareness, the researchers proposed that some individuals are able to engage a spontaneous form of control that helps reduce the influence of race on behavior. In contrast, Swencionis & Goff (2017) proposed that the motivation to view the world in hierarchical terms may increase bias in police decisions. Social Dominance Theory (Sidanius & Pratto 1999) posits that group-based inequalities are maintained by cultural influences that promote social stratification based on factors such as age, sex, and race. Consequently, power is primarily distributed to and legitimized by high-status groups and institutions. Past work has found that people with high social dominance orientation (SDO) are more attracted to hierarchy-enhancing professions, such as law enforcement, politics, and business (Sidanius et al. 2004). Given that police officers tend to report greater SDO levels than public defenders, college students, or community members (Sidanius et al. 1994), they may be more prone to expressing discrimination against low-status groups. Situational contexts. Recognizing that police decisions do not occur in a social vacuum, some researchers have attempted to recreate ecologically valid situations that may contribute to the expression of racial bias. For example, Correll et al. (2007a) reasoned that frequent media or environmental exposure to stereotypical depictions of Blacks may increase shooter bias. In line with their hypothesizing, they found that participants who were first exposed to stories involving Black versus White criminal activity later showed more bias on the Shooter Task. A similar pattern emerged when they manipulated the amount of Black armed and White unarmed targets appearing on the task. Thus, increasing the accessibility of associations between Blacks and danger resulted in more pronounced anti-Black bias. Cox et al. (2014) also argued for the use of more complex situational contexts to assess various psychological factors that influence real-life decisions. To this end, they developed a modified version of the Shooter Task that used short video clips along with static photos of the suspect and recorded responses through a gun apparatus instead of computer keys. Because the police usually have prior knowledge and expectations about neighborhoods, they also manipulated where the crimes on the task supposedly took place by providing the exact city location. Wisconsin police officers were randomly assigned to complete the task imbedded within a primarily White or non-White neighborhood. When examining responses on photo trials, the researchers found that police officers did not make racially biased errors but were faster to shoot armed Black versus White targets, as in the work by Correll et al. (2007b). Interestingly, they also found that the composition of the neighborhood interacted with the race of the officers, such that more errors were made when officers were assigned to other-race areas. ",Legal,Summarize,Text Transformation Please respond to this prompt ONLY using the information provided in the context block. ,"According to the provided text, how does virtual memory improve the efficiency of real physical memory (RAM) usage in computer systems?","Virtual memory is a computer system technique which gives an application program the impression that it has contiguous working memory (an address space), while in fact it may be physically fragmented and may even overflow on to disk storage. Systems that use this technique make programming of large applications easier and use real physical memory (e.g. RAM) more efficiently than those without virtual memory. http://en.wikipedia.org/wiki/Virtual_memory Page Fault: A page is a fixed-length block of memory that is used as a unit of transfer between physical memory and external storage like a disk, and a page fault is an interrupt (or exception) to the software raised by the hardware, when a program accesses a page that is mapped in address space, but not loaded in physical memory. http://en.wikipedia.org/wiki/Page_fault Thrash is the term used to describe a degenerate situation on a computer where increasing resources are used to do a decreasing amount of work. In this situation the system is said to be thrashing. Usually it refers to two or more processes accessing a shared resource repeatedly such that serious system performance degradation occurs because the system is spending a disproportionate amount of time just accessing the shared resource. Resource access time may generally be considered as wasted, since it does not contribute to the advancement of any process. In modern computers, thrashing may occur in the paging system (if there is not ‘sufficient’ physical memory or the disk access time is overly long), or in the communications system (especially in conflicts over internal bus access), etc. http://en.wikipedia.org/wiki/Thrash_(computer_science)","Please respond to this prompt ONLY using the information provided in the context block. According to the provided text, how does virtual memory improve the efficiency of real physical memory (RAM) usage in computer systems? Virtual memory is a computer system technique which gives an application program the impression that it has contiguous working memory (an address space), while in fact it may be physically fragmented and may even overflow on to disk storage. Systems that use this technique make programming of large applications easier and use real physical memory (e.g. RAM) more efficiently than those without virtual memory. http://en.wikipedia.org/wiki/Virtual_memory Page Fault: A page is a fixed-length block of memory that is used as a unit of transfer between physical memory and external storage like a disk, and a page fault is an interrupt (or exception) to the software raised by the hardware, when a program accesses a page that is mapped in address space, but not loaded in physical memory. http://en.wikipedia.org/wiki/Page_fault Thrash is the term used to describe a degenerate situation on a computer where increasing resources are used to do a decreasing amount of work. In this situation the system is said to be thrashing. Usually it refers to two or more processes accessing a shared resource repeatedly such that serious system performance degradation occurs because the system is spending a disproportionate amount of time just accessing the shared resource. Resource access time may generally be considered as wasted, since it does not contribute to the advancement of any process. In modern computers, thrashing may occur in the paging system (if there is not ‘sufficient’ physical memory or the disk access time is overly long), or in the communications system (especially in conflicts over internal bus access), etc. http://en.wikipedia.org/wiki/Thrash_(computer_science)",Internet/Technology,Effect Analysis,Q&A "Respond using only information from the provided content. Adhere to a 300-word limit. Avoid responding in table format or JSON","According to the article, if you are unable to obtain a normal credit card, what are your alternatives?","**Ten steps to rebuild your credit** There are many ways to rebuild credit, and the most effective options vary from person to person. Use this list of options as a starting point to make your own personalized plan to rebuild your credit. 1. Get current with payments Before you do anything else to rebuild credit, make sure every account you have is current (not behind on payments). Accounts that are more than 30 days past due can do serious damage to your credit, and the later they get, the worse the damage will be. Plus, outstanding balances can mean late fees and interest fees get piled on top of your existing debt. The longer you're behind, the more expensive it'll be to catch up. If you're struggling to get current on your credit cards, make sure to contact your issuers. In most cases, a credit card issuer will work with you to establish a payment plan. After all, it's in the issuer's best interest for you to repay that debt. 2. Pay down high balances One of the key factors used in credit scoring is called your credit utilization ratio. This is the ratio of how much credit card debt you have (amounts owed) versus your total available credit. For example, a credit card with a balance of $500 and a credit limit of $1,000 has a utilization ratio of of 50% ($500 / $1,000 = 0.5 x 10). High utilization (being close to your credit limits) is a warning sign to creditors that you may have taken on too much debt and could be living beyond your means. As a result, high utilization can hurt your credit score. One way to rebuild credit is to pay down those balances. The general rule of thumb is to keep your utilization below 30%. Try not to owe more than one-third of your credit limit; keeping your limit below 10% is ideal. Building a budget that prioritizes debt repayment is often the best method for paying down high balances. See below for more information on budgets, or our guide to paying off debt for our top tips. If you're already living on a tight budget, a debt consolidation loan may be a good way to pay down credit cards and boost your credit score. Opening a debt consolidation loan can bring down your score in the short term, but can benefit your score in the long term. If changing your budget isn't an option, it's worth investigating whether a debt consolidation loan is right for you. 3. Pay on time, every time Every time you make a credit card payment and the issuer reports your payment to the credit bureaus, you are contributing to your payment history. Your payment history is the most important part of your credit score. No plan to rebuild credit will work if you aren't making payments on time. Make at least your minimum required payment by the due date every single month. (Ideally, pay off your entire balance every month to avoid credit card interest fees.) 4. Activate automatic payments If you're having trouble remembering due dates, you can let the credit card company take care of it for you. Most banks and issuers will allow you to set up automatic payments. You can choose the amount you want to pay -- make sure it's at least your minimum payment -- as well as when you want the payments to process. If you don't have automatic payments set to cover your entire monthly bill, be sure to follow up with additional payments to pay your full balance. 5. Keep balances low As mentioned, your utilization rate has a lot of influence on your credit score. Once you've paid down your outstanding balances, make sure to keep them low. You'll struggle to rebuild credit if you keep running up your credit card balances after paying them down. People with excellent credit tend to have utilization rates below 10%. 6. Open a secured credit card The only surefire way to rebuild credit is to have a recent positive payment history. Of course, if your credit is heavily damaged, you may have trouble qualifying for a credit card with which to build that payment history. This is where a secured credit card can help. Secured credit cards can be pretty easy to get, even if your credit is damaged. That's because secured cards rely on a cash security deposit to minimize risk to the issuer. If you pay off your balance in full, you'll get the security deposit back when you close your account. Some issuers will even automatically upgrade you to an unsecured account and return your deposit. 7. Become an authorized user on someone else's card Another way to rebuild credit is to be added as an authorized user on another person's card (such as a trusted family member). When you become an authorized user on someone else's credit card, you receive your own credit card with your name. But the credit account is still the responsibility of the primary account holder. The card company typically reports the credit card account to the credit bureaus for both the primary account holder and the authorized user. As long as the account is in good standing, being added as an authorized user can help raise your credit score. Being an authorized user isn't without risks, however. For example, if the cardholder or the authorized user runs up a high balance, both users could see credit score damage. Only tie your credit score to individuals you trust. 8. Build a budget -- and stick to it Any plan to rebuild credit score damage is sure to fail if you don't address the root of the problem. In many cases, the root cause boils down to the lack of a budget -- and yes, that means a realistic budget, not an idealized one. If your budget doesn't reflect your actual lifestyle, spending, and debts, it'll be useless. A good budget can help you repay debts and keep from overextending yourself in the future. RELATED: Best Budgeting Apps 9. Keep an eye on your credit reports and scores As you work to rebuild credit, be sure to check up on your credit reports and scores regularly. Many credit card issuers offer free monthly credit scores, especially on credit-building products. You can also get free copies of your credit reports from each of the three bureaus once a year through AnnualCreditReport.com. If you find any errors on your reports, be sure to dispute them quickly with the credit bureaus. 10. Give it time Like it or not, sometimes time is the only way to rebuild credit. Those delinquent payments and defaulted accounts aren't going anywhere fast. It can take years of building a positive payment history to recover from big mistakes -- especially when those mistakes can sit on your reports for up to seven years. If you're doing everything right to rebuild your credit, but you're not seeing much movement in your credit scores: be patient. Time -- and keeping on top of your payments -- heals most credit wounds. How long will it take to rebuild my credit? Every credit profile is unique. As a result, the best strategy for rebuilding credit will depend on your credit history and the reasons for your credit problems. In other words, the answer to the question of ""How long does it take to rebuild credit?"" is: It depends. A low credit score caused by high credit card balances can be the quickest thing to fix (assuming you have the funds to pay them off). Paying down high balances can help you rebuild credit in 30 days or less. On the other hand, if you need to rebuild credit due to late payments or a defaulted account, you're probably going to need longer. It will take at least six to 12 months to rebuild credit scores to an acceptable level -- and several years for the negative items to disappear altogether. In fact, negative items can linger on your credit reports for up to 10 years in certain cases (primarily bankruptcy), with most negative items having a shelf life of seven years. On the bright side, negative items impact your credit scores less as they age, particularly when you've been building a positive payment history in the meantime. How can I raise my credit score by 100 points? If you have very high credit utilization -- meaning you're close to your credit limits -- paying down your balances could provide a large credit score boost. Credit scores damaged by credit report errors can also jump quite a bit when those errors are removed. Outside of these situations, however, you'll typically need to rebuild credit over many months to see a gain of 100 points or more. There is no guaranteed way to raise your credit score by a specific amount -- and 100 points is a lot to expect. For example, a 100-point jump from 570 to 670 moves you from bad credit into fair credit. What type of credit cards work for rebuilding credit? The best credit cards to rebuild credit have minimal costs and report your payments to the credit bureaus each month. This means cards with affordable annual fees -- or, even better, credit cards with no annual fees -- and the option to make automatic payments. Wondering where to start? A number of credit cards for fair or average credit won't charge a fee. If you can't qualify for an unsecured card without an annual fee, consider a secured credit card instead. Secured cards differ from traditional cards in one key way: the deposit. Secured credit cards require an upfront cash deposit to open and maintain. This makes them safer for the issuer. Even if you have significant credit damage, you can likely find an issuer willing to offer you a secured credit card. Banks where you already have a good reputation and your local credit union are often the best places to find a secured card. Look for one that might allow you to graduate easily to an unsecured card (and avoid annual fees, if possible).","query: According to the article, if you are unable to obtain a normal credit card, what are your alternatives? ---------- task instruction: Respond using only information from the provided content. Adhere to a 300-word limit. Avoid responding in table format or JSON ---------- passage: **Ten steps to rebuild your credit** There are many ways to rebuild credit, and the most effective options vary from person to person. Use this list of options as a starting point to make your own personalized plan to rebuild your credit. 1. Get current with payments Before you do anything else to rebuild credit, make sure every account you have is current (not behind on payments). Accounts that are more than 30 days past due can do serious damage to your credit, and the later they get, the worse the damage will be. Plus, outstanding balances can mean late fees and interest fees get piled on top of your existing debt. The longer you're behind, the more expensive it'll be to catch up. If you're struggling to get current on your credit cards, make sure to contact your issuers. In most cases, a credit card issuer will work with you to establish a payment plan. After all, it's in the issuer's best interest for you to repay that debt. 2. Pay down high balances One of the key factors used in credit scoring is called your credit utilization ratio. This is the ratio of how much credit card debt you have (amounts owed) versus your total available credit. For example, a credit card with a balance of $500 and a credit limit of $1,000 has a utilization ratio of of 50% ($500 / $1,000 = 0.5 x 10). High utilization (being close to your credit limits) is a warning sign to creditors that you may have taken on too much debt and could be living beyond your means. As a result, high utilization can hurt your credit score. One way to rebuild credit is to pay down those balances. The general rule of thumb is to keep your utilization below 30%. Try not to owe more than one-third of your credit limit; keeping your limit below 10% is ideal. Building a budget that prioritizes debt repayment is often the best method for paying down high balances. See below for more information on budgets, or our guide to paying off debt for our top tips. If you're already living on a tight budget, a debt consolidation loan may be a good way to pay down credit cards and boost your credit score. Opening a debt consolidation loan can bring down your score in the short term, but can benefit your score in the long term. If changing your budget isn't an option, it's worth investigating whether a debt consolidation loan is right for you. 3. Pay on time, every time Every time you make a credit card payment and the issuer reports your payment to the credit bureaus, you are contributing to your payment history. Your payment history is the most important part of your credit score. No plan to rebuild credit will work if you aren't making payments on time. Make at least your minimum required payment by the due date every single month. (Ideally, pay off your entire balance every month to avoid credit card interest fees.) 4. Activate automatic payments If you're having trouble remembering due dates, you can let the credit card company take care of it for you. Most banks and issuers will allow you to set up automatic payments. You can choose the amount you want to pay -- make sure it's at least your minimum payment -- as well as when you want the payments to process. If you don't have automatic payments set to cover your entire monthly bill, be sure to follow up with additional payments to pay your full balance. 5. Keep balances low As mentioned, your utilization rate has a lot of influence on your credit score. Once you've paid down your outstanding balances, make sure to keep them low. You'll struggle to rebuild credit if you keep running up your credit card balances after paying them down. People with excellent credit tend to have utilization rates below 10%. 6. Open a secured credit card The only surefire way to rebuild credit is to have a recent positive payment history. Of course, if your credit is heavily damaged, you may have trouble qualifying for a credit card with which to build that payment history. This is where a secured credit card can help. Secured credit cards can be pretty easy to get, even if your credit is damaged. That's because secured cards rely on a cash security deposit to minimize risk to the issuer. If you pay off your balance in full, you'll get the security deposit back when you close your account. Some issuers will even automatically upgrade you to an unsecured account and return your deposit. 7. Become an authorized user on someone else's card Another way to rebuild credit is to be added as an authorized user on another person's card (such as a trusted family member). When you become an authorized user on someone else's credit card, you receive your own credit card with your name. But the credit account is still the responsibility of the primary account holder. The card company typically reports the credit card account to the credit bureaus for both the primary account holder and the authorized user. As long as the account is in good standing, being added as an authorized user can help raise your credit score. Being an authorized user isn't without risks, however. For example, if the cardholder or the authorized user runs up a high balance, both users could see credit score damage. Only tie your credit score to individuals you trust. 8. Build a budget -- and stick to it Any plan to rebuild credit score damage is sure to fail if you don't address the root of the problem. In many cases, the root cause boils down to the lack of a budget -- and yes, that means a realistic budget, not an idealized one. If your budget doesn't reflect your actual lifestyle, spending, and debts, it'll be useless. A good budget can help you repay debts and keep from overextending yourself in the future. RELATED: Best Budgeting Apps 9. Keep an eye on your credit reports and scores As you work to rebuild credit, be sure to check up on your credit reports and scores regularly. Many credit card issuers offer free monthly credit scores, especially on credit-building products. You can also get free copies of your credit reports from each of the three bureaus once a year through AnnualCreditReport.com. If you find any errors on your reports, be sure to dispute them quickly with the credit bureaus. 10. Give it time Like it or not, sometimes time is the only way to rebuild credit. Those delinquent payments and defaulted accounts aren't going anywhere fast. It can take years of building a positive payment history to recover from big mistakes -- especially when those mistakes can sit on your reports for up to seven years. If you're doing everything right to rebuild your credit, but you're not seeing much movement in your credit scores: be patient. Time -- and keeping on top of your payments -- heals most credit wounds. How long will it take to rebuild my credit? Every credit profile is unique. As a result, the best strategy for rebuilding credit will depend on your credit history and the reasons for your credit problems. In other words, the answer to the question of ""How long does it take to rebuild credit?"" is: It depends. A low credit score caused by high credit card balances can be the quickest thing to fix (assuming you have the funds to pay them off). Paying down high balances can help you rebuild credit in 30 days or less. On the other hand, if you need to rebuild credit due to late payments or a defaulted account, you're probably going to need longer. It will take at least six to 12 months to rebuild credit scores to an acceptable level -- and several years for the negative items to disappear altogether. In fact, negative items can linger on your credit reports for up to 10 years in certain cases (primarily bankruptcy), with most negative items having a shelf life of seven years. On the bright side, negative items impact your credit scores less as they age, particularly when you've been building a positive payment history in the meantime. How can I raise my credit score by 100 points? If you have very high credit utilization -- meaning you're close to your credit limits -- paying down your balances could provide a large credit score boost. Credit scores damaged by credit report errors can also jump quite a bit when those errors are removed. Outside of these situations, however, you'll typically need to rebuild credit over many months to see a gain of 100 points or more. There is no guaranteed way to raise your credit score by a specific amount -- and 100 points is a lot to expect. For example, a 100-point jump from 570 to 670 moves you from bad credit into fair credit. What type of credit cards work for rebuilding credit? The best credit cards to rebuild credit have minimal costs and report your payments to the credit bureaus each month. This means cards with affordable annual fees -- or, even better, credit cards with no annual fees -- and the option to make automatic payments. Wondering where to start? A number of credit cards for fair or average credit won't charge a fee. If you can't qualify for an unsecured card without an annual fee, consider a secured credit card instead. Secured cards differ from traditional cards in one key way: the deposit. Secured credit cards require an upfront cash deposit to open and maintain. This makes them safer for the issuer. Even if you have significant credit damage, you can likely find an issuer willing to offer you a secured credit card. Banks where you already have a good reputation and your local credit union are often the best places to find a secured card. Look for one that might allow you to graduate easily to an unsecured card (and avoid annual fees, if possible).",Financial,Find & Summarize,Text Transformation Answer in 3-5 paragraphs and use ONLY the text provided. ,What are the hidden costs of fast fashion?,"Fast fashion has revolutionized the fashion industry at a cost to the environment and human rights. The fast fashion business model relies on the exploitation of resources and human labor to deliver garments following the latest trends to its consumers at an unprecedented rate. This quick output of garments demands a sizeable volume of raw materials fed into the fast fashion industry, creating a significant amount of waste, pollution and degradation to air, water and wildlife habitat. The pollution introduced by the fast fashion industry results in devastating impacts to both terrestrial and aquatic environments, with harmful effects linked to habitat degradation, proliferation of chemicals and microplastics in waterways, and the increasing impact of climate change from anthropogenic greenhouse gas emissions. Despite the increased demand and consumption of fast fashion garments and people’s apparent growing interest in fashion, they are buying more while wearing fewer of the items they own. The poor quality of fast fashion clothing contributes to the limited lifespans of garments, which often end up decomposing slowly in landfills or being incinerated. In addition to degrading in landfills or being incinerated, fast fashion clothing has also become a notorious source of microplastics in marine environments as the cheap, plastic-based materials shed fibers that make their way to the oceans. On top of the environmental exploitation that allows for fast fashion’s cheap prices, the other contributing factor is worker exploitation in low-income countries where factories are based. Workers — primarily young women — are subjected to hazardous working conditions while earning unlivable wages, despite the companies pulling in massive profits. Although both the fashion industry and consumers have indicated that sustainability is a priority, fast fashion is an increasingly unsustainable market that continues to grow, relatively unchecked. And the scale of this industry is enormous: For a company such as Shein, an estimated 1,000 new styles are uploaded daily — though there has been speculation that this figure may be a gross underestimate (Zhou, 2022). With the average number of each garment manufactured ranging from 50-100, according to the Shein website, this results in a minimum of 50,000 new garments created every day. Changing these practices requires drawing attention to the harms of fast fashion and shifting the narrative from the glamour that has been assigned to overconsumption toward fashion that embraces sustainability and justice. AT WHAT COST? 4 Behind the glamour of the fashion industry hides a steep environmental price. The fashion industry as a whole is responsible for consuming 79 trillion liters of water per year, producing over 92 million tons of solid waste per year, and contributing up to an estimated 20% of global wastewater and 10% of CO2 emissions (Niinimaki et al., 2020; UN Climate Change, 2018). This output of CO2 exceeds that of the international aviation and shipping industries combined (UN Climate Change, 2018). Concern continues to rise as, over a span of roughly 20 years, the number of new garments made per year has nearly doubled and global consumption of fashion has increased by 400% (World Bank, 2019; Collective Fashion Justice). If this trend continues, industry greenhouse gas emissions could also increase significantly, possibly by over 50% by the year 2030 (World Bank, 2019). One of the most notorious sectors driving these harms has also become one of the fastest growing: the fast fashion industry. Fast fashion is an exploitative, growing industry based on the replication and mass production of garments following current trends — a business model that has revolutionized the industry, simplifying consumers’ purchasing process and expediting the turnover of both garments and trends. This transformation, however, comes at a price. Every day fast fashion companies are capable of producing a shocking 10,000 new garment styles (Williams, 2022). These items are produced quickly and with an excess of waste: As much as 15% of the fabric used during manufacturing is discarded during the garment production process (Shukla, 2022). Unethical generation of waste has become a pivotal element of transforming the fashion industry into the polluting behemoth it is today. In addition to the waste produced during quick manufacturing, businesses are generating yet more pollution to protect their business models (Lieber, 2018). Brands at all levels, from Shein to Nike to Burberry, have been found to destroy new, undamaged products (Mayo, 2021). This has often been carried out by burning, which introduces additional CO2 and toxic gases on top of the industry’s already large contribution. For companies like Shein, production costs are so low that returned items are often destined for landfills because it costs less to simply dispose of items than put them back into circulation (Williams, 2022). The low costs set by the fast fashion industry have been praised by some for making new clothing more accessible to people with lower incomes, yet the largest consumers of fast fashion include customers of relatively substantial income, while low-income communities bear the brunt of the industry’s waste and pollution. This further demonstrates that the goal of this industry is not inclusivity but enormous AT WHAT COST? 5 INTRODUCTION profit based on environmental and worker exploitation (Williams, 2022). Fast fashion has changed society’s perception of what clothing is worth. The enticing low costs in fast fashion push poorly made garments on people, promoting excess purchasing of cheap items destined for the landfill rather than the purchasing of higher-quality garments that will ultimately last longer Clothing production adversely affects the environment at every stage. Land is cleared or degraded to produce fossil fuels for fibers, raise animals, or grow commodity crops. Toxic chemicals are used in processing. Greenhouse gas emissions are produced in manufacturing and transportation, and waste is generated by factories. Polyester, a synthetic material obtained from oil, is one of the most widely used fabrics in the fast fashion industry. It is also one of the most environmentally harmful fabrics. This material alone was reported to consume 70 million barrels of oil in 2015; the production of all synthetic fibers uses approximately 342 million barrels of oil each year (Conca, 2015; Ellen Macarthur Foundation and Circular Fibres Initiative, 2017). Petrochemicals, in fact, were estimated to be responsible for 62% of global textile fibers (Textile Exchange, 2021). The extraction of fossil fuels requires destroying wildlands to develop facilities and drilling sites, affecting the habitability of land and causing habitat fragmentation, which disrupts essential animal behaviors (The Wilderness Society, 2021). Producing synthetics also contributes greenhouse gases to the atmosphere due to their origin in petrochemicals. Fossil-fuel-based fabrics, however, are not the only materials of concern in the fast fashion industry. Producing animal-based textiles such as wool involves the breeding of farmed animals, which often results in widespread habitat loss from deforestation and grassland conversion to create the necessary room for grazing or to produce feed (McKinsey & Company 2020). Animal-based fibers used in fast fashion are also responsible for a large portion of the industry’s massive water consumption. Sheep bred for wool require significant amounts of water for hydration and feed crops that frequently rely on additional, chemical-intensive processes (Center for Biological Diversity, 2021). The wool industry degrades wildlife habitat, with sheep displacing native wildlife and eating the vegetation they need. It also produces large amounts of wastewater, with fecal waste polluting waterways and slaughterhouses expelling additional AT WHAT COST? 6 wastewater. This water often contains contaminants including pathogens, proteins, fibers, and contamination from antibiotics and other pharmaceuticals (Center for Biological Diversity, 2021). Since 35% to 60% of the weight of shorn wool is contaminated with grease, dirt, feces, vegetable matter and other impurities, wool must go through a scouring process using hot water and chemicals before it can be turned into a usable fiber. A typical wool scour creates an effluent load similar to the sewage from a town of 30,000 people (Center for Biological Diversity, 2021). A more detailed accounting of the full scope of environmental harms of animal-based textiles such as wool can be found in Shear Destruction: Wool, Fashion and the Biodiversity Crisis (Center for Biological Diversity). Cotton is one of the most widely used materials worldwide due to its versatility and easy care. But despite only occupying 2.4% of the world’s cropland, cotton uses tremendous amounts of pesticides; it is responsible for roughly one-fifth of global insecticide use (McKinsey & Company 2020). This results in serious harm to nontarget insects such as endangered rusty patched bumble bees and monarch butterflies. On top of its enormous pesticide use, conventional cotton, which accounts for most cotton grown, requires a significant amount of water during the growing process. The cotton used in a single pair of denim jeans requires roughly 10,000 liters of water, an amount equal to what the average person would drink over the course of ten years (UN Climate Change, 2018). And the water that runs off cotton fields carries a heavy pesticide load. Unlike conventional cotton, organic cotton is not produced with synthetic pesticides. It’s also estimated that organic cotton production uses 91% less water than conventional cotton, in large part because genetically engineered crops generally require more water (Chan, 2019). Organic cotton, however, is seldom used over conventional cotton in fast fashion due to the heightened costs associated with production. Even fibers associated with fewer environmental harms than those reliant on oil production and animal agriculture can cause severe damage when produced irresponsibly and at scale to meet the demands of fast fashion. More than 150 million trees are cut down annually to produce man-made cellulose fibers (Canopy, 2020). Of the man-made cellulose fibers produced, up to an estimated 30% originate from primary or endangered forests (McCullough, 2014). Additional habitat loss can result from the soil degradation or pollution of waterways from chemicals used in processing or at plantations (McKinsey & Company 2020). Fast fashion also requires a significant amount of water at the factory level, which results in roughly 93 billion cubic meters of wastewater just from textile dyeing (Lai, 2021). In low-income countries that produce a large portion of the world’s fast fashion, such as Bangladesh, the toxic wastewater from textile factories has historically been dumped directly into rivers or streams to reduce production costs (Regan, 2020). This action has resulted in bodies of water changing colors from the AT WHAT COST? 7 dye used or turning black and thick with sludge (Regan, 2020). This polluted water introduces harms to both marine environments and humans. At least 72 of the chemicals used in the dyeing process have been identified as toxic (World Bank, 2014). Once these chemicals accumulate in waterways, they begin to produce a film on the surface, blocking the entrance of light and preventing organisms’ abilities to photosynthesize (World Bank, 2014). Reduced ability to photosynthesize results in lower oxygen levels, or hypoxia, in the water, impacting the ecosystem’s survivability for aquatic plants and animals. In addition to increased prevalence of hypoxia in aquatic environments, the presence of certain chemicals used in the dyeing process can also increase the buildup of heavy metals (World Bank, 2014). Polluted water is often used to irrigate crops and studies have found textile dyes present in fruits and vegetables grown around Savar in Bangladesh (Sakamoto et al., 2019). Areas closer to industrial hubs are disproportionately impacted by the harms of fast fashion, with costs to livelihoods due to impacted agriculture or fishing, increased incidence of disease including jaundice or diarrhea, and decreased accessibility to safe drinking water during the dry season, as contaminated surface water may be unable to be effectively treated (World Bank, 2014; Ullah et al., 2006). Pesticides used in the growing of cotton and other crops have also been found to have harmful effects on biodiversity. The textile industry is estimated to account for between 10-20% of global pesticide use (McKinsey & Company, 2021). Organisms can be exposed to chemicals either directly through application or indirectly through runoff, contamination, or secondary poisoning (Beyond Pesticides). Exposure to pesticides is linked to a wide array of health concerns in various species including birds, small mammals, insects, fish and humans. These health concerns consist of reproductive effects, neurotoxicity, endocrine effects and liver and kidney damage (Beyond Pesticides). Such harmful effects can occur after minimal exposure, as reproductive abnormalities have been observed in multiple species following “safe” levels of exposure as classified by the United States Environmental Protection Agency (Beyond Pesticides). The environmental impacts of fast fashion are not limited to the direct impacts from the manufacturing process. Fast fashion churns out poorly made clothes with limited lifespans because of the low quality of materials used and the industry thriving off the constant business from a quick turnover of garments. The quick turnover coupled with poor quality resulted in 60% of the items manufactured in 2012 being discarded only a few years after purchase (Shukla, 2022). One survey in Britain found that 1 in 3 young women believed clothes to be “old” following as few as one or two wears (McKinsey & Company, 2018). On average consumers are keeping purchased items about half as long as they did at the turn of the 21st century and purchasing 60% more clothing per year (Remy et al., 2016). Based on this trend and the low prevalence of clothing recycling, over 50% AT WHAT COST? 8 AT WHAT COST? 9 of these garments end up in landfills (Shukla, 2022). In 2018, 11.3 million tons of textiles entered landfills as municipal solid waste in the United States, averaging out to roughly 70 pounds of discarded garments per person (EPA). Even for the clothing that continues to be worn and washed, an environmental toll is paid. Synthetic fabrics release microfibers at alarming rates of roughly 700,000 fibers per load of laundry, which often end up in the ocean and other environments (Ocean Clean Wash, 2019). This adds up to approximately 500,000 tons of microfibers per year entering the ocean (Ellen MacArthur Foundation, 2017). An IUCN report estimated that between 15%-31% of plastic pollution in the ocean could come from household or industrial products expelling these microplastics, with 35% of that microplastic coming from the washing of synthetic fabrics (Boucher and Friot, 2017). Fibers such as polyester are slow to degrade in the ocean, taking potentially up to 200 years to decompose, then producing toxic substances when they do that pose dangers for marine ecosystems (Brewer, 2019; Shukla, 2022). Microplastics pose the additional danger of being consumed by marine organisms, then entering the food chain and being consumed eventually by humans. For marine organisms that consume microplastics, impacts may include delayed growth, abnormal behavior, or reduced intake of food (Li et al., 2021). For humans, microplastics that have made their way up the food chain pose risks of allergic reactions or cell death (Parker, 2022). Despite the majority of fiber production being attributed to synthetic fabrics, a 2020 study found that most microfibers were actually from cellulosic and plant-based fibers, followed by animal fibers (Suaria et al., 2020). While such natural fibers are often assumed to be biodegradable, modifications made during textile production often include alterations with chemicals, dyes, or coatings that in turn impact the biodegradability of the material (Henry et al., 2019). Additional modifications that occur during manufacturing are seen with wool, where natural fibers are often blended with synthetics for fast fashion, impacting the biodegradability of the fabric (Center for Biological Diversity, 2021). As much of the research on the biodegradability and risks of microfibers is new or still developing, the problem of microfiber introduction from the fast fashion industry cannot yet be limited to the impacts from synthetics, as the full scope of risks of all microfibers is still being realized. This brings the issue of fast fashion back to the immense scale of production, as there is not one specific fiber to blame for the environmental degradation but the business model as a whole. Photo Source: Canva AT WHAT COST? 10 The introduction of chemicals to the environment is not the only harm associated with the fast fashion industry. The harsh chemicals used in manufacturing create potential health hazards for workers and consumers. These risks can be felt in a wide range of communities, as fast fashion garments are usually produced in low-income countries but purchased in high-income countries. At the beginning of the production process, pesticides can cause harm to workers as they have been linked to acute and chronic health issues including reproductive disorders, neurological disorders, respiratory conditions, certain cancers and death (Farmworker Justice, 2013). In garment factories, workers are exposed to occupational hazards including respiratory harms from chemicals and musculoskeletal harms from repeated motions (Islam, 2022). The harmful effects can even be experienced by the consumer of fast fashion. Garments contain a variety of harmful chemicals including PFAS, azo dyes, phthalates, and formaldehyde (Fashinnovation, 2022). These chemicals come with risks of irritation; respiratory, developmental, and reproductive problems; and certain cancers. On top of that, the spillover of cheaply made fast fashion can also affect the economies of low-income countries, even if they are not involved directly in the production of garments. Every year the United States exports roughly 500,000 tons of secondhand clothing to low- and middle-income countries that do not always possess the infrastructure to handle it (Brooks, 2019). Reports from various African communities note how these imports can decimate local textile businesses, as they are unable to compete with the competitive costs of these used garments (Brooks, 2019). While this opens a new market for secondhand clothing, it increases reliance on foreign countries and suppresses local industries, resulting in a loss of culture and traditional styles (Porter, 2019). The continuing desire around the world for these garments at low costs also contributes to the ongoing injustice related to low wages and working conditions in the low-income countries where most factories are based. In April 2013 the Rana Plaza building in Dhaka, Bangladesh collapsed, resulting in more than 1,100 textile-worker fatalities and bringing to light the subpar conditions in which fast fashion industries operate. Between 2006 and 2012, more than 500 workers in Bangladesh garment factories died in factory fires, usually due to faulty wiring (Thomas, 2018). Following these tragic events, the Accord on Fire and Building Safety was signed by various fast fashion companies, including American Eagle, H&M, and Inditex. This agreement resulted in 97,000 hazards being repaired in 1,600 factories, and 900 factories being shut down for not meeting compliance standards (Thomas, 2018). HARMS TO HUMANS Following the expiration of the Accord in 2018, the 2018 Transition Accord was signed to extend similar protections until 2021 (Clean Clothes Campaign). Most recently, the International Accord took effect in September 2021 (International Accord, 2021). This legally binding agreement promises to ensure factory structural safety for 26 months by the brands that have signed, which can be found here. Though a small step toward remedying the worker injustices in the fast fashion industry, these pacts have yet to address low wages or health hazards associated with this type of factory work. Beyond historical structure-related tragedies, textile workers are exposed to various occupational hazards, including respiratory and musculoskeletal harms (Islam, 2022). Reported health conditions that have been documented include endocrine damage and reproductive harms, along with accidental injuries and death (Sant’Ana and Kovalechen, 2012). These effects are spread disproportionately across genders, as most workers in these factories are young women (Thomas, 2018). An estimated 80% of global workers in the garment industry are women, and despite this workplace majority, discrimination, gender pay gaps, and sexual harassment continue to be reported (Baptist World Aid Australia, 2019). While many companies have — or are working to establish — systems to remedy this, inequalities continue to exist in many of these garment manufacturing environments (Baptist World Aid Australia, 2019). A reported 9 out of 10 garment workers in Bangladesh are paid so unfairly for their labor that they cannot afford food for themselves or their families (Oxfam). Yet to provide workers with a livable wage would cost some companies as little as an estimated 1% of the retail price of garments (Oxfam). The gross injustices occurring within the fast fashion industry stand against the narrative that fast fashion benefits low-income people. Rather, it exploits workers and consumers alike. AT WHAT COST? 11 Photo Source: Rio Lecatompessy - Unsplash Despite the various claims made by companies showcasing their sustainable efforts through partial recycling or “conscious” collections, overall efforts are still relatively low. Even the actions of companies that are following through on their pledges to be more sustainable are not necessarily having a significant positive impact. One of the most common recycled materials to substitute the creation of new synthetics are polyethylene terephthalate (PET) bottles. In a survey of roughly 50 fashion brands, 85% claimed that they were working toward using recycled polyester sourced from plastic bottles (Circular). Using recycled polyester has the potential impact of reducing carbon emissions by 32% (Federal Office for the Environment, 2017). But while recycling sounds green in theory, there are several logistical drawbacks. Recycling synthetic materials does not fix the emerging problem of microplastics, as recycled materials will expel just as many fibers as new materials (Bryce, 2021). Additionally, removing plastic bottles from their established, closed-loop system may actually harm their overall recyclable potential. These bottles can be recycled at least 10 times in the current system. Feeding them into the fashion industry decreases their likelihood and potential to be recycled as most garments end up in landfills (Bryce, 2021). Despite the potential that exists with recycling plastic bottles, the actual rate at which PET bottles are recycled remains relatively low, with only 29.1% being recycled in 2018 (EPA). Textile recycling involves a similar shortcoming, as it’s estimated that less than 1% of textile waste is recycled into new fibers due to logistical issues including the collecting, sorting, and processing of garments (McKinsey & Company, 2022). Many claims made by fast fashion companies hint at sustainability but fall short, and a lack of transparency contributes to the problem of greenwashing. Greenwashing is infamous in the fast fashion industry, and multiple companies having had attention drawn to their misleading claims in the past. Companies like Boohoo, SHEIN, H&M, ASOS, and Zara have all released claims on their efforts to improve their sustainability, but there’s little evidence they are realizing those claims (Rauturier, 2022; Igini, 2022). The popular brand H&M released environmental scorecards informing consumers about how environmentally friendly their garments were. In an investigation by Quartz, more than half of the scorecards claimed pieces to be more environmentally friendly than they actually were, and in some instances the statements were described as being “the exact opposite of reality” (Quartz, 2022). The garments included in the controversial claims were those labeled as “Conscious Choice.” This specific label was described by H&M to mean “pieces AT WHAT COST? 12 GREENWASHING While many companies have environmentally harmful business models, there are others that are taking a more meaningful approach to sustainability. These companies are actively encouraging people to extend the life of their clothing, providing customers with the resources to do so, and using data to back up their sustainability claims. These claims have been published by the companies and their accuracies have not been evaluated by this report. Levi’s, for example, urges customers to wash their jeans less: after about 10 wears. This not only lengthens the lifespan of jeans but saves water from washing machines and reduces the expelling of microfibers in the wash. Data published on Levi’s website states that taking care of your jeans and wearing them for 10 months or longer will reduce their carbon footprint by 18% and water footprint by 23%. Levi’s also offers solutions for old or damaged clothing, like opening Levi’s Tailor Shops where clothes can be altered or repaired, offering tutorials on how to perform various DIY projects on jeans, and suggesting that you donate unwanted clothing to secondhand shops or pass items along as hand-me-downs. Other ways that brands are trying to lessen the waste in fashion is through product guarantees and resale initiatives. Patagonia includes a guarantee that if clothing develops damage due to wear, the company will repair it at a “reasonable charge.” Like Levi’s, Patagonia offers DIY repair guides to extend the life of products. It also hosts Worn Wear, a site where you can trade in used clothing so it can be washed and resold, lengthening the garment’s lifespan. As an incentive, trading in a garment will get you credit that can be used to purchase new or used from the brand. Worn Wear also has the additional bonus that the used articles are sold at a reduced cost compared to new items. This increases accessibility of quality, long-lasting products to individuals who might not be able to afford them otherwise and resort to fast fashion for financial reasons. A PUSH TOWARD SUSTAINABILITY AT WHAT COST? 13 created with a little extra consideration for the planet,” with products containing at least 50% of “more sustainable materials” (H&M). These vaguely defined “eco-friendly” labels are another popular industry greenwashing technique. But simultaneously producing and promoting the purchase of billions of garments per year, many of which get discarded and replaced quickly, reduces the potential positive impacts of so-called “conscious collections” and falsely reassures consumers. A different approach can be seen with MUD Jeans, which in 2013 introduced a program called Lease a Jeans, where customers can pay a monthly fee to lease jeans for a year, after which the payments stop and the customer can either keep the jeans or return them to be recycled. In 2021, 11,512 pairs of jeans were recycled, with a donation to plant one tree with the nonprofit Justdiggit with every pair. By promoting a circular economy through jeans recycling, MUD Jeans states, it’s producing no additional end-of-life waste for those articles and using 92% less water than the average jeans. In addition to creative solutions to extend the lifespans of garments and reduce waste, efforts are being made by some companies to use more sustainable materials and manufacturing processes. For plant-based fibers like cotton, organic and recycled materials tend to be more sustainable than conventional and virgin materials, respectively. To grow cotton — one of the most commonly used fabrics in the world — a substantial amount of pesticides are conventionally used. Certified organic cotton, especially grown in countries like the United States that have strict organic standards, does not contain the dangerous pesticide load of conventional cotton. And recycled cotton does not take any additional pesticides to produce, reduces water consumption, and prevents garments from being sent to landfills. Flax (linen) and hemp are two additional, versatile crops that can be used for textiles. Both are relatively environmentally friendly alternatives as they require minimal water and are often grown with little to no pesticides. Hemp grows so densely that it can reduce competition, and it also naturally deters pests (Hymann, 2020). Linen uses less water and fewer pesticides than conventional cotton and has the benefit that the plant it’s derived from is typically used in its entirety, reducing overall waste during production (Newman, 2020). Linen’s natural hues come in a variety of colors including ivory, tan, and grays, reducing the amount of dyes necessary (Newman, 2020). When untreated, linen is entirely biodegradable. In a push for more sustainable options, new materials are being derived from various types of plants. Bananatex is a relatively new fabric made from Abacá banana plants that is fully biodegradable and circular. This plant has many environmental advantages, including that it does not require the use of pesticides, fertilizers, or additional water (Bananatex). These characteristics have helped to contribute to reforestation in certain areas, strengthening biodiversity (Bananatex). On top of using more sustainable fabrics, environmentally conscientious companies are taking additional steps to reduce waste in their supply chains. Efforts include using recycled, plastic-free, or compostable packaging, using less harmful chemicals, and getting energy from cleaner sources such as solar power. While there is room for additional reform in the fashion industry, a few examples of brands working towards more sustainable practices can be seen here. Necessary reform of the fast fashion industry must involve voices from all levels. This AT WHAT COST? 14 includes individuals pushing for change, governments enacting policies that can oversee change, and companies committing to make the change. Fast fashion companies need to be held accountable for their destructive practices, including the waste they produce and the worker injustice that their business models are built around. Companies’ flimsy claims of future reform are no longer enough. Policy efforts to improve the fashion industry have involved the health and safety of garment workers, unfair wages, and transparency of environmental impacts. U.S. policies of note include The Fashioning Accountability and Building Real Institutional Change (FABRIC) Act, The Fashion and Sustainability and Social Accountability Act, and the SWEAT Bill. The FABRIC Act is a federal bill that was introduced in May 2022. This legislature would protect nearly 100,000 American garment workers, improving working conditions and wages, revitalizing the U.S. garment industry and investing in domestic apparel production (The FABRIC Act). The Fashion and Sustainability and Social Accountability Act was referred to the Consumer Protection Committee in early 2022 and requires fashion manufacturers and retail sellers to disclose environmental policies along with social due diligence policies. This state bill would also establish a community benefit fund that would help implement projects that directly benefit environmental justice communities (New York Senate). The SWEAT Bill passed assembly in March 2022. This state bill involves ensuring the payment of wages for work that was already performed. It also “creates a lien remedy for all employees; provides grounds for attachment; relates to procedures where employees may hold shareholders of non-publicly traded corporations personally liable for wage theft; relates to rights for victims of wage theft to hold the ten members with the largest ownership interests in a company personally liable for wage theft” (New York Senate). If companies are required or incentivized to pursue more sustainable practices, the scale of destruction caused by the fashion industry could be significantly lessened. Additional work that could help to reform the fashion industry includes making sustainable fashion more affordable, so people of limited means are not forced to buy fast fashion, along with making fast fashion companies internalize the environmental costs of their production and waste. ","Answer in 3-5 paragraphs and use ONLY the text provided. What are the hidden costs of fast fashion? Fast fashion has revolutionized the fashion industry at a cost to the environment and human rights. The fast fashion business model relies on the exploitation of resources and human labor to deliver garments following the latest trends to its consumers at an unprecedented rate. This quick output of garments demands a sizeable volume of raw materials fed into the fast fashion industry, creating a significant amount of waste, pollution and degradation to air, water and wildlife habitat. The pollution introduced by the fast fashion industry results in devastating impacts to both terrestrial and aquatic environments, with harmful effects linked to habitat degradation, proliferation of chemicals and microplastics in waterways, and the increasing impact of climate change from anthropogenic greenhouse gas emissions. Despite the increased demand and consumption of fast fashion garments and people’s apparent growing interest in fashion, they are buying more while wearing fewer of the items they own. The poor quality of fast fashion clothing contributes to the limited lifespans of garments, which often end up decomposing slowly in landfills or being incinerated. In addition to degrading in landfills or being incinerated, fast fashion clothing has also become a notorious source of microplastics in marine environments as the cheap, plastic-based materials shed fibers that make their way to the oceans. On top of the environmental exploitation that allows for fast fashion’s cheap prices, the other contributing factor is worker exploitation in low-income countries where factories are based. Workers — primarily young women — are subjected to hazardous working conditions while earning unlivable wages, despite the companies pulling in massive profits. Although both the fashion industry and consumers have indicated that sustainability is a priority, fast fashion is an increasingly unsustainable market that continues to grow, relatively unchecked. And the scale of this industry is enormous: For a company such as Shein, an estimated 1,000 new styles are uploaded daily — though there has been speculation that this figure may be a gross underestimate (Zhou, 2022). With the average number of each garment manufactured ranging from 50-100, according to the Shein website, this results in a minimum of 50,000 new garments created every day. Changing these practices requires drawing attention to the harms of fast fashion and shifting the narrative from the glamour that has been assigned to overconsumption toward fashion that embraces sustainability and justice. AT WHAT COST? 4 Behind the glamour of the fashion industry hides a steep environmental price. The fashion industry as a whole is responsible for consuming 79 trillion liters of water per year, producing over 92 million tons of solid waste per year, and contributing up to an estimated 20% of global wastewater and 10% of CO2 emissions (Niinimaki et al., 2020; UN Climate Change, 2018). This output of CO2 exceeds that of the international aviation and shipping industries combined (UN Climate Change, 2018). Concern continues to rise as, over a span of roughly 20 years, the number of new garments made per year has nearly doubled and global consumption of fashion has increased by 400% (World Bank, 2019; Collective Fashion Justice). If this trend continues, industry greenhouse gas emissions could also increase significantly, possibly by over 50% by the year 2030 (World Bank, 2019). One of the most notorious sectors driving these harms has also become one of the fastest growing: the fast fashion industry. Fast fashion is an exploitative, growing industry based on the replication and mass production of garments following current trends — a business model that has revolutionized the industry, simplifying consumers’ purchasing process and expediting the turnover of both garments and trends. This transformation, however, comes at a price. Every day fast fashion companies are capable of producing a shocking 10,000 new garment styles (Williams, 2022). These items are produced quickly and with an excess of waste: As much as 15% of the fabric used during manufacturing is discarded during the garment production process (Shukla, 2022). Unethical generation of waste has become a pivotal element of transforming the fashion industry into the polluting behemoth it is today. In addition to the waste produced during quick manufacturing, businesses are generating yet more pollution to protect their business models (Lieber, 2018). Brands at all levels, from Shein to Nike to Burberry, have been found to destroy new, undamaged products (Mayo, 2021). This has often been carried out by burning, which introduces additional CO2 and toxic gases on top of the industry’s already large contribution. For companies like Shein, production costs are so low that returned items are often destined for landfills because it costs less to simply dispose of items than put them back into circulation (Williams, 2022). The low costs set by the fast fashion industry have been praised by some for making new clothing more accessible to people with lower incomes, yet the largest consumers of fast fashion include customers of relatively substantial income, while low-income communities bear the brunt of the industry’s waste and pollution. This further demonstrates that the goal of this industry is not inclusivity but enormous AT WHAT COST? 5 INTRODUCTION profit based on environmental and worker exploitation (Williams, 2022). Fast fashion has changed society’s perception of what clothing is worth. The enticing low costs in fast fashion push poorly made garments on people, promoting excess purchasing of cheap items destined for the landfill rather than the purchasing of higher-quality garments that will ultimately last longer Clothing production adversely affects the environment at every stage. Land is cleared or degraded to produce fossil fuels for fibers, raise animals, or grow commodity crops. Toxic chemicals are used in processing. Greenhouse gas emissions are produced in manufacturing and transportation, and waste is generated by factories. Polyester, a synthetic material obtained from oil, is one of the most widely used fabrics in the fast fashion industry. It is also one of the most environmentally harmful fabrics. This material alone was reported to consume 70 million barrels of oil in 2015; the production of all synthetic fibers uses approximately 342 million barrels of oil each year (Conca, 2015; Ellen Macarthur Foundation and Circular Fibres Initiative, 2017). Petrochemicals, in fact, were estimated to be responsible for 62% of global textile fibers (Textile Exchange, 2021). The extraction of fossil fuels requires destroying wildlands to develop facilities and drilling sites, affecting the habitability of land and causing habitat fragmentation, which disrupts essential animal behaviors (The Wilderness Society, 2021). Producing synthetics also contributes greenhouse gases to the atmosphere due to their origin in petrochemicals. Fossil-fuel-based fabrics, however, are not the only materials of concern in the fast fashion industry. Producing animal-based textiles such as wool involves the breeding of farmed animals, which often results in widespread habitat loss from deforestation and grassland conversion to create the necessary room for grazing or to produce feed (McKinsey & Company 2020). Animal-based fibers used in fast fashion are also responsible for a large portion of the industry’s massive water consumption. Sheep bred for wool require significant amounts of water for hydration and feed crops that frequently rely on additional, chemical-intensive processes (Center for Biological Diversity, 2021). The wool industry degrades wildlife habitat, with sheep displacing native wildlife and eating the vegetation they need. It also produces large amounts of wastewater, with fecal waste polluting waterways and slaughterhouses expelling additional AT WHAT COST? 6 wastewater. This water often contains contaminants including pathogens, proteins, fibers, and contamination from antibiotics and other pharmaceuticals (Center for Biological Diversity, 2021). Since 35% to 60% of the weight of shorn wool is contaminated with grease, dirt, feces, vegetable matter and other impurities, wool must go through a scouring process using hot water and chemicals before it can be turned into a usable fiber. A typical wool scour creates an effluent load similar to the sewage from a town of 30,000 people (Center for Biological Diversity, 2021). A more detailed accounting of the full scope of environmental harms of animal-based textiles such as wool can be found in Shear Destruction: Wool, Fashion and the Biodiversity Crisis (Center for Biological Diversity). Cotton is one of the most widely used materials worldwide due to its versatility and easy care. But despite only occupying 2.4% of the world’s cropland, cotton uses tremendous amounts of pesticides; it is responsible for roughly one-fifth of global insecticide use (McKinsey & Company 2020). This results in serious harm to nontarget insects such as endangered rusty patched bumble bees and monarch butterflies. On top of its enormous pesticide use, conventional cotton, which accounts for most cotton grown, requires a significant amount of water during the growing process. The cotton used in a single pair of denim jeans requires roughly 10,000 liters of water, an amount equal to what the average person would drink over the course of ten years (UN Climate Change, 2018). And the water that runs off cotton fields carries a heavy pesticide load. Unlike conventional cotton, organic cotton is not produced with synthetic pesticides. It’s also estimated that organic cotton production uses 91% less water than conventional cotton, in large part because genetically engineered crops generally require more water (Chan, 2019). Organic cotton, however, is seldom used over conventional cotton in fast fashion due to the heightened costs associated with production. Even fibers associated with fewer environmental harms than those reliant on oil production and animal agriculture can cause severe damage when produced irresponsibly and at scale to meet the demands of fast fashion. More than 150 million trees are cut down annually to produce man-made cellulose fibers (Canopy, 2020). Of the man-made cellulose fibers produced, up to an estimated 30% originate from primary or endangered forests (McCullough, 2014). Additional habitat loss can result from the soil degradation or pollution of waterways from chemicals used in processing or at plantations (McKinsey & Company 2020). Fast fashion also requires a significant amount of water at the factory level, which results in roughly 93 billion cubic meters of wastewater just from textile dyeing (Lai, 2021). In low-income countries that produce a large portion of the world’s fast fashion, such as Bangladesh, the toxic wastewater from textile factories has historically been dumped directly into rivers or streams to reduce production costs (Regan, 2020). This action has resulted in bodies of water changing colors from the AT WHAT COST? 7 dye used or turning black and thick with sludge (Regan, 2020). This polluted water introduces harms to both marine environments and humans. At least 72 of the chemicals used in the dyeing process have been identified as toxic (World Bank, 2014). Once these chemicals accumulate in waterways, they begin to produce a film on the surface, blocking the entrance of light and preventing organisms’ abilities to photosynthesize (World Bank, 2014). Reduced ability to photosynthesize results in lower oxygen levels, or hypoxia, in the water, impacting the ecosystem’s survivability for aquatic plants and animals. In addition to increased prevalence of hypoxia in aquatic environments, the presence of certain chemicals used in the dyeing process can also increase the buildup of heavy metals (World Bank, 2014). Polluted water is often used to irrigate crops and studies have found textile dyes present in fruits and vegetables grown around Savar in Bangladesh (Sakamoto et al., 2019). Areas closer to industrial hubs are disproportionately impacted by the harms of fast fashion, with costs to livelihoods due to impacted agriculture or fishing, increased incidence of disease including jaundice or diarrhea, and decreased accessibility to safe drinking water during the dry season, as contaminated surface water may be unable to be effectively treated (World Bank, 2014; Ullah et al., 2006). Pesticides used in the growing of cotton and other crops have also been found to have harmful effects on biodiversity. The textile industry is estimated to account for between 10-20% of global pesticide use (McKinsey & Company, 2021). Organisms can be exposed to chemicals either directly through application or indirectly through runoff, contamination, or secondary poisoning (Beyond Pesticides). Exposure to pesticides is linked to a wide array of health concerns in various species including birds, small mammals, insects, fish and humans. These health concerns consist of reproductive effects, neurotoxicity, endocrine effects and liver and kidney damage (Beyond Pesticides). Such harmful effects can occur after minimal exposure, as reproductive abnormalities have been observed in multiple species following “safe” levels of exposure as classified by the United States Environmental Protection Agency (Beyond Pesticides). The environmental impacts of fast fashion are not limited to the direct impacts from the manufacturing process. Fast fashion churns out poorly made clothes with limited lifespans because of the low quality of materials used and the industry thriving off the constant business from a quick turnover of garments. The quick turnover coupled with poor quality resulted in 60% of the items manufactured in 2012 being discarded only a few years after purchase (Shukla, 2022). One survey in Britain found that 1 in 3 young women believed clothes to be “old” following as few as one or two wears (McKinsey & Company, 2018). On average consumers are keeping purchased items about half as long as they did at the turn of the 21st century and purchasing 60% more clothing per year (Remy et al., 2016). Based on this trend and the low prevalence of clothing recycling, over 50% AT WHAT COST? 8 AT WHAT COST? 9 of these garments end up in landfills (Shukla, 2022). In 2018, 11.3 million tons of textiles entered landfills as municipal solid waste in the United States, averaging out to roughly 70 pounds of discarded garments per person (EPA). Even for the clothing that continues to be worn and washed, an environmental toll is paid. Synthetic fabrics release microfibers at alarming rates of roughly 700,000 fibers per load of laundry, which often end up in the ocean and other environments (Ocean Clean Wash, 2019). This adds up to approximately 500,000 tons of microfibers per year entering the ocean (Ellen MacArthur Foundation, 2017). An IUCN report estimated that between 15%-31% of plastic pollution in the ocean could come from household or industrial products expelling these microplastics, with 35% of that microplastic coming from the washing of synthetic fabrics (Boucher and Friot, 2017). Fibers such as polyester are slow to degrade in the ocean, taking potentially up to 200 years to decompose, then producing toxic substances when they do that pose dangers for marine ecosystems (Brewer, 2019; Shukla, 2022). Microplastics pose the additional danger of being consumed by marine organisms, then entering the food chain and being consumed eventually by humans. For marine organisms that consume microplastics, impacts may include delayed growth, abnormal behavior, or reduced intake of food (Li et al., 2021). For humans, microplastics that have made their way up the food chain pose risks of allergic reactions or cell death (Parker, 2022). Despite the majority of fiber production being attributed to synthetic fabrics, a 2020 study found that most microfibers were actually from cellulosic and plant-based fibers, followed by animal fibers (Suaria et al., 2020). While such natural fibers are often assumed to be biodegradable, modifications made during textile production often include alterations with chemicals, dyes, or coatings that in turn impact the biodegradability of the material (Henry et al., 2019). Additional modifications that occur during manufacturing are seen with wool, where natural fibers are often blended with synthetics for fast fashion, impacting the biodegradability of the fabric (Center for Biological Diversity, 2021). As much of the research on the biodegradability and risks of microfibers is new or still developing, the problem of microfiber introduction from the fast fashion industry cannot yet be limited to the impacts from synthetics, as the full scope of risks of all microfibers is still being realized. This brings the issue of fast fashion back to the immense scale of production, as there is not one specific fiber to blame for the environmental degradation but the business model as a whole. Photo Source: Canva AT WHAT COST? 10 The introduction of chemicals to the environment is not the only harm associated with the fast fashion industry. The harsh chemicals used in manufacturing create potential health hazards for workers and consumers. These risks can be felt in a wide range of communities, as fast fashion garments are usually produced in low-income countries but purchased in high-income countries. At the beginning of the production process, pesticides can cause harm to workers as they have been linked to acute and chronic health issues including reproductive disorders, neurological disorders, respiratory conditions, certain cancers and death (Farmworker Justice, 2013). In garment factories, workers are exposed to occupational hazards including respiratory harms from chemicals and musculoskeletal harms from repeated motions (Islam, 2022). The harmful effects can even be experienced by the consumer of fast fashion. Garments contain a variety of harmful chemicals including PFAS, azo dyes, phthalates, and formaldehyde (Fashinnovation, 2022). These chemicals come with risks of irritation; respiratory, developmental, and reproductive problems; and certain cancers. On top of that, the spillover of cheaply made fast fashion can also affect the economies of low-income countries, even if they are not involved directly in the production of garments. Every year the United States exports roughly 500,000 tons of secondhand clothing to low- and middle-income countries that do not always possess the infrastructure to handle it (Brooks, 2019). Reports from various African communities note how these imports can decimate local textile businesses, as they are unable to compete with the competitive costs of these used garments (Brooks, 2019). While this opens a new market for secondhand clothing, it increases reliance on foreign countries and suppresses local industries, resulting in a loss of culture and traditional styles (Porter, 2019). The continuing desire around the world for these garments at low costs also contributes to the ongoing injustice related to low wages and working conditions in the low-income countries where most factories are based. In April 2013 the Rana Plaza building in Dhaka, Bangladesh collapsed, resulting in more than 1,100 textile-worker fatalities and bringing to light the subpar conditions in which fast fashion industries operate. Between 2006 and 2012, more than 500 workers in Bangladesh garment factories died in factory fires, usually due to faulty wiring (Thomas, 2018). Following these tragic events, the Accord on Fire and Building Safety was signed by various fast fashion companies, including American Eagle, H&M, and Inditex. This agreement resulted in 97,000 hazards being repaired in 1,600 factories, and 900 factories being shut down for not meeting compliance standards (Thomas, 2018). HARMS TO HUMANS Following the expiration of the Accord in 2018, the 2018 Transition Accord was signed to extend similar protections until 2021 (Clean Clothes Campaign). Most recently, the International Accord took effect in September 2021 (International Accord, 2021). This legally binding agreement promises to ensure factory structural safety for 26 months by the brands that have signed, which can be found here. Though a small step toward remedying the worker injustices in the fast fashion industry, these pacts have yet to address low wages or health hazards associated with this type of factory work. Beyond historical structure-related tragedies, textile workers are exposed to various occupational hazards, including respiratory and musculoskeletal harms (Islam, 2022). Reported health conditions that have been documented include endocrine damage and reproductive harms, along with accidental injuries and death (Sant’Ana and Kovalechen, 2012). These effects are spread disproportionately across genders, as most workers in these factories are young women (Thomas, 2018). An estimated 80% of global workers in the garment industry are women, and despite this workplace majority, discrimination, gender pay gaps, and sexual harassment continue to be reported (Baptist World Aid Australia, 2019). While many companies have — or are working to establish — systems to remedy this, inequalities continue to exist in many of these garment manufacturing environments (Baptist World Aid Australia, 2019). A reported 9 out of 10 garment workers in Bangladesh are paid so unfairly for their labor that they cannot afford food for themselves or their families (Oxfam). Yet to provide workers with a livable wage would cost some companies as little as an estimated 1% of the retail price of garments (Oxfam). The gross injustices occurring within the fast fashion industry stand against the narrative that fast fashion benefits low-income people. Rather, it exploits workers and consumers alike. AT WHAT COST? 11 Photo Source: Rio Lecatompessy - Unsplash Despite the various claims made by companies showcasing their sustainable efforts through partial recycling or “conscious” collections, overall efforts are still relatively low. Even the actions of companies that are following through on their pledges to be more sustainable are not necessarily having a significant positive impact. One of the most common recycled materials to substitute the creation of new synthetics are polyethylene terephthalate (PET) bottles. In a survey of roughly 50 fashion brands, 85% claimed that they were working toward using recycled polyester sourced from plastic bottles (Circular). Using recycled polyester has the potential impact of reducing carbon emissions by 32% (Federal Office for the Environment, 2017). But while recycling sounds green in theory, there are several logistical drawbacks. Recycling synthetic materials does not fix the emerging problem of microplastics, as recycled materials will expel just as many fibers as new materials (Bryce, 2021). Additionally, removing plastic bottles from their established, closed-loop system may actually harm their overall recyclable potential. These bottles can be recycled at least 10 times in the current system. Feeding them into the fashion industry decreases their likelihood and potential to be recycled as most garments end up in landfills (Bryce, 2021). Despite the potential that exists with recycling plastic bottles, the actual rate at which PET bottles are recycled remains relatively low, with only 29.1% being recycled in 2018 (EPA). Textile recycling involves a similar shortcoming, as it’s estimated that less than 1% of textile waste is recycled into new fibers due to logistical issues including the collecting, sorting, and processing of garments (McKinsey & Company, 2022). Many claims made by fast fashion companies hint at sustainability but fall short, and a lack of transparency contributes to the problem of greenwashing. Greenwashing is infamous in the fast fashion industry, and multiple companies having had attention drawn to their misleading claims in the past. Companies like Boohoo, SHEIN, H&M, ASOS, and Zara have all released claims on their efforts to improve their sustainability, but there’s little evidence they are realizing those claims (Rauturier, 2022; Igini, 2022). The popular brand H&M released environmental scorecards informing consumers about how environmentally friendly their garments were. In an investigation by Quartz, more than half of the scorecards claimed pieces to be more environmentally friendly than they actually were, and in some instances the statements were described as being “the exact opposite of reality” (Quartz, 2022). The garments included in the controversial claims were those labeled as “Conscious Choice.” This specific label was described by H&M to mean “pieces AT WHAT COST? 12 GREENWASHING While many companies have environmentally harmful business models, there are others that are taking a more meaningful approach to sustainability. These companies are actively encouraging people to extend the life of their clothing, providing customers with the resources to do so, and using data to back up their sustainability claims. These claims have been published by the companies and their accuracies have not been evaluated by this report. Levi’s, for example, urges customers to wash their jeans less: after about 10 wears. This not only lengthens the lifespan of jeans but saves water from washing machines and reduces the expelling of microfibers in the wash. Data published on Levi’s website states that taking care of your jeans and wearing them for 10 months or longer will reduce their carbon footprint by 18% and water footprint by 23%. Levi’s also offers solutions for old or damaged clothing, like opening Levi’s Tailor Shops where clothes can be altered or repaired, offering tutorials on how to perform various DIY projects on jeans, and suggesting that you donate unwanted clothing to secondhand shops or pass items along as hand-me-downs. Other ways that brands are trying to lessen the waste in fashion is through product guarantees and resale initiatives. Patagonia includes a guarantee that if clothing develops damage due to wear, the company will repair it at a “reasonable charge.” Like Levi’s, Patagonia offers DIY repair guides to extend the life of products. It also hosts Worn Wear, a site where you can trade in used clothing so it can be washed and resold, lengthening the garment’s lifespan. As an incentive, trading in a garment will get you credit that can be used to purchase new or used from the brand. Worn Wear also has the additional bonus that the used articles are sold at a reduced cost compared to new items. This increases accessibility of quality, long-lasting products to individuals who might not be able to afford them otherwise and resort to fast fashion for financial reasons. A PUSH TOWARD SUSTAINABILITY AT WHAT COST? 13 created with a little extra consideration for the planet,” with products containing at least 50% of “more sustainable materials” (H&M). These vaguely defined “eco-friendly” labels are another popular industry greenwashing technique. But simultaneously producing and promoting the purchase of billions of garments per year, many of which get discarded and replaced quickly, reduces the potential positive impacts of so-called “conscious collections” and falsely reassures consumers. A different approach can be seen with MUD Jeans, which in 2013 introduced a program called Lease a Jeans, where customers can pay a monthly fee to lease jeans for a year, after which the payments stop and the customer can either keep the jeans or return them to be recycled. In 2021, 11,512 pairs of jeans were recycled, with a donation to plant one tree with the nonprofit Justdiggit with every pair. By promoting a circular economy through jeans recycling, MUD Jeans states, it’s producing no additional end-of-life waste for those articles and using 92% less water than the average jeans. In addition to creative solutions to extend the lifespans of garments and reduce waste, efforts are being made by some companies to use more sustainable materials and manufacturing processes. For plant-based fibers like cotton, organic and recycled materials tend to be more sustainable than conventional and virgin materials, respectively. To grow cotton — one of the most commonly used fabrics in the world — a substantial amount of pesticides are conventionally used. Certified organic cotton, especially grown in countries like the United States that have strict organic standards, does not contain the dangerous pesticide load of conventional cotton. And recycled cotton does not take any additional pesticides to produce, reduces water consumption, and prevents garments from being sent to landfills. Flax (linen) and hemp are two additional, versatile crops that can be used for textiles. Both are relatively environmentally friendly alternatives as they require minimal water and are often grown with little to no pesticides. Hemp grows so densely that it can reduce competition, and it also naturally deters pests (Hymann, 2020). Linen uses less water and fewer pesticides than conventional cotton and has the benefit that the plant it’s derived from is typically used in its entirety, reducing overall waste during production (Newman, 2020). Linen’s natural hues come in a variety of colors including ivory, tan, and grays, reducing the amount of dyes necessary (Newman, 2020). When untreated, linen is entirely biodegradable. In a push for more sustainable options, new materials are being derived from various types of plants. Bananatex is a relatively new fabric made from Abacá banana plants that is fully biodegradable and circular. This plant has many environmental advantages, including that it does not require the use of pesticides, fertilizers, or additional water (Bananatex). These characteristics have helped to contribute to reforestation in certain areas, strengthening biodiversity (Bananatex). On top of using more sustainable fabrics, environmentally conscientious companies are taking additional steps to reduce waste in their supply chains. Efforts include using recycled, plastic-free, or compostable packaging, using less harmful chemicals, and getting energy from cleaner sources such as solar power. While there is room for additional reform in the fashion industry, a few examples of brands working towards more sustainable practices can be seen here. Necessary reform of the fast fashion industry must involve voices from all levels. This AT WHAT COST? 14 includes individuals pushing for change, governments enacting policies that can oversee change, and companies committing to make the change. Fast fashion companies need to be held accountable for their destructive practices, including the waste they produce and the worker injustice that their business models are built around. Companies’ flimsy claims of future reform are no longer enough. Policy efforts to improve the fashion industry have involved the health and safety of garment workers, unfair wages, and transparency of environmental impacts. U.S. policies of note include The Fashioning Accountability and Building Real Institutional Change (FABRIC) Act, The Fashion and Sustainability and Social Accountability Act, and the SWEAT Bill. The FABRIC Act is a federal bill that was introduced in May 2022. This legislature would protect nearly 100,000 American garment workers, improving working conditions and wages, revitalizing the U.S. garment industry and investing in domestic apparel production (The FABRIC Act). The Fashion and Sustainability and Social Accountability Act was referred to the Consumer Protection Committee in early 2022 and requires fashion manufacturers and retail sellers to disclose environmental policies along with social due diligence policies. This state bill would also establish a community benefit fund that would help implement projects that directly benefit environmental justice communities (New York Senate). The SWEAT Bill passed assembly in March 2022. This state bill involves ensuring the payment of wages for work that was already performed. It also “creates a lien remedy for all employees; provides grounds for attachment; relates to procedures where employees may hold shareholders of non-publicly traded corporations personally liable for wage theft; relates to rights for victims of wage theft to hold the ten members with the largest ownership interests in a company personally liable for wage theft” (New York Senate). If companies are required or incentivized to pursue more sustainable practices, the scale of destruction caused by the fashion industry could be significantly lessened. Additional work that could help to reform the fashion industry includes making sustainable fashion more affordable, so people of limited means are not forced to buy fast fashion, along with making fast fashion companies internalize the environmental costs of their production and waste. ",Retail/Product,Effect Analysis,Q&A "Any information that you draw to answer any questions must come only from the information found in the prompt. Under no circumstances are you allowed rely on any information from any source other than the information in the prompt. If the answer requires a series of steps, list them in a numbered list format.","How many beeps would be heard if a user wants to activate right-handed operation, increase the cursor speed to 2, activate double click, and turn the buzzer off on a new device?","There are a number of settings to allow you to configure OPTIMA Joystick to your exact requirements. These are all programmed using Learn Mode and are stored in an internal, non-volatile memory so they are automatically recalled each time you use the unit, even if you swap computers. To make changes to the settings, you must first go into Learn Mode. Press and hold the middle button until a warbling tone is heard. The unit is now in Learn Mode and is able to accept changes to the settings, as follows: Learn Mode Features • Plug and Play USB and PS/2 operation and requires no drivers. • PC, Mac and Chromebook compatible. • Switchable to Gaming output for full compatibility with Xbox Adaptive Controller • Light touch joystick movement. • User-selectable cursor speed settings. • Drag lock and double click features. • Sockets to operate left and right click from remote switches. • Robust construction and ergonomic design. • Industry-standard mounting option. • Optional left-handed operation. Cursor Speed To change the speed setting while in Learn Mode, press the middle button briefly. Each time you do so, the unit emits a number of beeps, between 1 and 4. One beep indicates the lowest speed and 4 the highest. The speed of the cursor changes immediately, allowing you to experiment until the best setting is found. Left-Handed Operation The left and right buttons may be swapped around, which is particularly useful for left-landed users. To change this setting, press the left button while in Learn Mode. One beep indicates the unit is set to standard ‘right-handed’ mode, whereas two beeps indicates ‘left-handed’ operation. Double Click Right-click may be substituted with Double-Click, which is useful for users who have difficulty in double-clicking quickly enough for the computer to recognise. To change this setting, press the right button briefly while in Learn Mode. One beep indicates the unit is set to standard ‘right-click’ mode, whereas two beeps indicates ‘Double-Click’ operation. Buzzer On/Off OPTIMA Joystick is fitted with a buzzer which gives an audible indication of operations such as drag lock and unlock, double-click, entering Learn Mode etc. When OPTIMA Joystick is used in a classroom setting, where there may be many units in close proximity, it may be beneficial to turn off the buzzer. To achieve this, press and hold the right button while in Learn Mode, until two long beeps are heard. The buzzer is now disabled, although it will still operate while in Learn Mode. Repeating the above operation will re-enable it. All of the above settings may be changed as often as required while in Learn Mode, allowing you to experiment with the settings until the best configuration is found. Once you are happy with the settings, they may be stored in the non-volatile memory by pressing and holding the middle button once again, until the warbling tone is heard. Normal operation then resumes. Note that if both left-handed operation and Double-Click are selected, the buttons will function as Double-Click, Drag and Left Click, reading from left to right. Also note that the function of the sockets for external switches reproduces the function of the internal buttons, according to the above settings. The unit automatically leaves Learn Mode, and any changes are discarded, if the settings remain unchanged for more than a minute.","Any information that you draw to answer any questions must come only from the information found in the prompt. Under no circumstances are you allowed rely on any information from any source other than the information in the prompt. If the answer requires a series of steps, list them in a numbered list format. There are a number of settings to allow you to configure OPTIMA Joystick to your exact requirements. These are all programmed using Learn Mode and are stored in an internal, non-volatile memory so they are automatically recalled each time you use the unit, even if you swap computers. To make changes to the settings, you must first go into Learn Mode. Press and hold the middle button until a warbling tone is heard. The unit is now in Learn Mode and is able to accept changes to the settings, as follows: Learn Mode Features • Plug and Play USB and PS/2 operation and requires no drivers. • PC, Mac and Chromebook compatible. • Switchable to Gaming output for full compatibility with Xbox Adaptive Controller • Light touch joystick movement. • User-selectable cursor speed settings. • Drag lock and double click features. • Sockets to operate left and right click from remote switches. • Robust construction and ergonomic design. • Industry-standard mounting option. • Optional left-handed operation. Cursor Speed To change the speed setting while in Learn Mode, press the middle button briefly. Each time you do so, the unit emits a number of beeps, between 1 and 4. One beep indicates the lowest speed and 4 the highest. The speed of the cursor changes immediately, allowing you to experiment until the best setting is found. Left-Handed Operation The left and right buttons may be swapped around, which is particularly useful for left-landed users. To change this setting, press the left button while in Learn Mode. One beep indicates the unit is set to standard ‘right-handed’ mode, whereas two beeps indicates ‘left-handed’ operation. Double Click Right-click may be substituted with Double-Click, which is useful for users who have difficulty in double-clicking quickly enough for the computer to recognise. To change this setting, press the right button briefly while in Learn Mode. One beep indicates the unit is set to standard ‘right-click’ mode, whereas two beeps indicates ‘Double-Click’ operation. Buzzer On/Off OPTIMA Joystick is fitted with a buzzer which gives an audible indication of operations such as drag lock and unlock, double-click, entering Learn Mode etc. When OPTIMA Joystick is used in a classroom setting, where there may be many units in close proximity, it may be beneficial to turn off the buzzer. To achieve this, press and hold the right button while in Learn Mode, until two long beeps are heard. The buzzer is now disabled, although it will still operate while in Learn Mode. Repeating the above operation will re-enable it. All of the above settings may be changed as often as required while in Learn Mode, allowing you to experiment with the settings until the best configuration is found. Once you are happy with the settings, they may be stored in the non-volatile memory by pressing and holding the middle button once again, until the warbling tone is heard. Normal operation then resumes. Note that if both left-handed operation and Double-Click are selected, the buttons will function as Double-Click, Drag and Left Click, reading from left to right. Also note that the function of the sockets for external switches reproduces the function of the internal buttons, according to the above settings. The unit automatically leaves Learn Mode, and any changes are discarded, if the settings remain unchanged for more than a minute. How many sounds would be heard if a user wants to activate right-handed operation, increase the cursor speed to 2, activate double click, and turn the buzzer off on a new device?",Retail/Product,Find & Summarize,Text Transformation This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge.,"Aside from meetings with each other, what are some shared responsibilities of both family and administrators?","Family’s Responsibility • Notify the school of the child’s allergies before the student attends classes. • Work with the school team to develop an individualized healthcare plan (IHP) that accommodates the child’s needs throughout the school including in the classroom, in the cafeteria, in after-care programs, during school-sponsored activities, and on the school bus, as well as an Emergency Action Plan. • Provide current written medical documentation, instructions, and medications as directed by your child’s HCP. Include a photo of the child for identification safety if requested. Additional district forms will need to be completed by the student, parent, and HCP if the student self-carries and administers medication(s). These forms must be renewed yearly or more often if changes in your child’s condition or HCP orders occur. • Sign release of information forms to allow communication between the school district and your child’s HCP to allow for the best possible care for your child. • Provide adequate properly labeled medications for your child and backup medication in the school office if your child self-administers their medication. Replace medications after use or upon expiration. • Educate the child in the self-management of their food allergy including: o recognition of safe and unsafe foods o recognition of other allergen containing materials such as art or science supplies, band aids, or other school supplies o strategies for avoiding allergen exposure such as peer pressure and engaging in high-risk activities that would increase allergen exposure o identification, recognizing, and describing symptoms of allergic reactions o how and when to tell an adult they may be having an allergy-related problem o how to read food and other product labels for allergen identification (age appropriate) o knowledge of school policies and procedures, including responsibilities in self-carrying and administration of medications when appropriate o practice drills and role-playing • Provide emergency contact information and keep this up to date when changes occur. • Notify the school nurse if changes in the IHP/EAP are needed. • Debrief with school staff, the student’s HCP, and the student (age appropriate) after a reaction has occurred. • Inform school administration, school nurse, or counselor if bullying or teasing occurs. Approve a safe classroom treat alternative to ensure student will not be excluded from any classroom or school sponsored activity involving food. • Submit to food service a signed “Medical Statement for Student Requiring Special Meals” form. School’s/Administrator’s Responsibilities • Be knowledgeable about and follow applicable federal laws including ADA, IDEA, Section 504, and FERPA and any state laws or district policies that apply. • Support and oversee faculty, staff, students, and parent/guardian in implementing all aspects of the management plan. • Ensure students with allergies are not excluded from school activities due to their health condition. • Identify a core team of, but not limited to, school nurse, teacher, principal, school food service manager, transportation director, counselor (if available) to work with parents and the student (age appropriate) to establish a prevention plan distinguishing between buildingwide, classroom and individual approaches to allergy prevention and management. Changes to the prevention plan to promote revisions in allergy management should be made with core team participation. • Provide input to the core team in the development and implementation of related policies and procedures. Ensure implementation of these policies and procedures. • Ensure annual training of all staff interacting with the student on a regular basis to: understand the student’s specific allergy(s), recognize allergic symptoms, and know actions to take in an emergency (including epinephrine administration as directed). Work with school staff to eliminate the use of potential allergens in the student’s meals, educational tools, arts and crafts projects. All school staff are to be annually trained by the school nurse in general information regarding recognition, prevention and response to allergic reactions. • Ensure protocols are in place for training substitute staff who may have responsibility for a student with a life-threatening allergy including teachers, school nurses, nutrition services, recess and/or lunch aides, bus driver, and other specialists. o Include any responsibilities expected of these individuals to implement specific IHP/EAP or school-specific food allergy policies. Contingency plans must be in place if a substitute cannot be trained to handle an allergy emergency. • Assure for the age-appropriate education of all students including potential causes of allergic reactions, information on avoiding allergens, signs and symptoms of allergic reactions and simple steps students can take to keep classmates safe. • Provide for practice of the Emergency Action Plan before an allergic reaction occurs to assure the efficiency/effectiveness of the plans. Coordinate with the school nurse to assure medications are appropriately stored, and an emergency kit(s) is available and accessible containing a current standing order for epinephrine from an HCP (as allowed by school district policy). • Assure that protocols permit students to carry their own epinephrine after approval from the student’s HCP, parent, and school nurse. Work with the school nurse in designation of school personnel who are properly trained to administer emergency medications in accordance with all applicable state laws and school district policy during the school day and all school activities (including field trips). • Ensure posting of a list of Cardio Pulmonary Resuscitation (CPR) certified staff in the building and a system for communicating with them and eliciting an immediate response in emergencies. • Ensure systems are in place to inform the parent/guardian(s) if any student experiences an allergic reaction at school. • Review policies/prevention plan with the core team members, parents/guardians, student (age appropriate), and HCP as appropriate after a reaction has occurred. • Work with the district transportation director to assure that school bus driver training includes symptom awareness and actions to be taken if a reaction occurs. • Recommend that all buses have communication devices in case of an emergency. • Enforce a “no eating” policy on school buses with exceptions made only to accommodate special needs under federal or similar laws, or school district policy. • Encourage a “no sharing” policy in lunchrooms and provide for the identification of “allergyaware” tables. Ensure surfaces are cleaned according to district policy/procedures to avoid exposure by cross contamination. • Discuss field trips with the family to decide appropriate strategies for managing the student’s allergy(s). • Follow federal/state/district laws and regulations regarding sharing medical information about the student. • Provide safe environments, both physically and emotionally (develop and enforce strict antibullying policies). • Ensure after-hours users of the school building are informed of and following all restrictions and rules impacting the use of common spaces and individual classrooms. • Discourage school staff from the use of food or other allergen products such as latex balloons as a reward for school activities. The building administrator must approve any food preparation or consumption in any instructional area.","System instructions: This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. question: Aside from meetings with each other, what are some shared responsibilities of both family and administrators? context block: Family’s Responsibility • Notify the school of the child’s allergies before the student attends classes. • Work with the school team to develop an individualized healthcare plan (IHP) that accommodates the child’s needs throughout the school including in the classroom, in the cafeteria, in after-care programs, during school-sponsored activities, and on the school bus, as well as an Emergency Action Plan. • Provide current written medical documentation, instructions, and medications as directed by your child’s HCP. Include a photo of the child for identification safety if requested. Additional district forms will need to be completed by the student, parent, and HCP if the student self-carries and administers medication(s). These forms must be renewed yearly or more often if changes in your child’s condition or HCP orders occur. • Sign release of information forms to allow communication between the school district and your child’s HCP to allow for the best possible care for your child. • Provide adequate properly labeled medications for your child and backup medication in the school office if your child self-administers their medication. Replace medications after use or upon expiration. • Educate the child in the self-management of their food allergy including: o recognition of safe and unsafe foods o recognition of other allergen containing materials such as art or science supplies, band aids, or other school supplies o strategies for avoiding allergen exposure such as peer pressure and engaging in high-risk activities that would increase allergen exposure o identification, recognizing, and describing symptoms of allergic reactions o how and when to tell an adult they may be having an allergy-related problem o how to read food and other product labels for allergen identification (age appropriate) o knowledge of school policies and procedures, including responsibilities in self-carrying and administration of medications when appropriate o practice drills and role-playing • Provide emergency contact information and keep this up to date when changes occur. • Notify the school nurse if changes in the IHP/EAP are needed. • Debrief with school staff, the student’s HCP, and the student (age appropriate) after a reaction has occurred. • Inform school administration, school nurse, or counselor if bullying or teasing occurs. Approve a safe classroom treat alternative to ensure student will not be excluded from any classroom or school sponsored activity involving food. • Submit to food service a signed “Medical Statement for Student Requiring Special Meals” form. School’s/Administrator’s Responsibilities • Be knowledgeable about and follow applicable federal laws including ADA, IDEA, Section 504, and FERPA and any state laws or district policies that apply. • Support and oversee faculty, staff, students, and parent/guardian in implementing all aspects of the management plan. • Ensure students with allergies are not excluded from school activities due to their health condition. • Identify a core team of, but not limited to, school nurse, teacher, principal, school food service manager, transportation director, counselor (if available) to work with parents and the student (age appropriate) to establish a prevention plan distinguishing between buildingwide, classroom and individual approaches to allergy prevention and management. Changes to the prevention plan to promote revisions in allergy management should be made with core team participation. • Provide input to the core team in the development and implementation of related policies and procedures. Ensure implementation of these policies and procedures. • Ensure annual training of all staff interacting with the student on a regular basis to: understand the student’s specific allergy(s), recognize allergic symptoms, and know actions to take in an emergency (including epinephrine administration as directed). Work with school staff to eliminate the use of potential allergens in the student’s meals, educational tools, arts and crafts projects. All school staff are to be annually trained by the school nurse in general information regarding recognition, prevention and response to allergic reactions. • Ensure protocols are in place for training substitute staff who may have responsibility for a student with a life-threatening allergy including teachers, school nurses, nutrition services, recess and/or lunch aides, bus driver, and other specialists. o Include any responsibilities expected of these individuals to implement specific IHP/EAP or school-specific food allergy policies. Contingency plans must be in place if a substitute cannot be trained to handle an allergy emergency. • Assure for the age-appropriate education of all students including potential causes of allergic reactions, information on avoiding allergens, signs and symptoms of allergic reactions and simple steps students can take to keep classmates safe. • Provide for practice of the Emergency Action Plan before an allergic reaction occurs to assure the efficiency/effectiveness of the plans. Coordinate with the school nurse to assure medications are appropriately stored, and an emergency kit(s) is available and accessible containing a current standing order for epinephrine from an HCP (as allowed by school district policy). • Assure that protocols permit students to carry their own epinephrine after approval from the student’s HCP, parent, and school nurse. Work with the school nurse in designation of school personnel who are properly trained to administer emergency medications in accordance with all applicable state laws and school district policy during the school day and all school activities (including field trips). • Ensure posting of a list of Cardio Pulmonary Resuscitation (CPR) certified staff in the building and a system for communicating with them and eliciting an immediate response in emergencies. • Ensure systems are in place to inform the parent/guardian(s) if any student experiences an allergic reaction at school. • Review policies/prevention plan with the core team members, parents/guardians, student (age appropriate), and HCP as appropriate after a reaction has occurred. • Work with the district transportation director to assure that school bus driver training includes symptom awareness and actions to be taken if a reaction occurs. • Recommend that all buses have communication devices in case of an emergency. • Enforce a “no eating” policy on school buses with exceptions made only to accommodate special needs under federal or similar laws, or school district policy. • Encourage a “no sharing” policy in lunchrooms and provide for the identification of “allergyaware” tables. Ensure surfaces are cleaned according to district policy/procedures to avoid exposure by cross contamination. • Discuss field trips with the family to decide appropriate strategies for managing the student’s allergy(s). • Follow federal/state/district laws and regulations regarding sharing medical information about the student. • Provide safe environments, both physically and emotionally (develop and enforce strict antibullying policies). • Ensure after-hours users of the school building are informed of and following all restrictions and rules impacting the use of common spaces and individual classrooms. • Discourage school staff from the use of food or other allergen products such as latex balloons as a reward for school activities. The building administrator must approve any food preparation or consumption in any instructional area.",Medical,Summarize & Simplify,Text Transformation Use only the provided text to form a concise answer.,Summarize only the different types of Lupus that generally affect the organs.,"What is Lupus? Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years. In lupus, something goes wrong with the immune system, which is the part of the body that fights off viruses, bacteria, and germs (""foreign invaders,"" like the flu). Normally our immune system produces proteins called antibodies that protect the body from these invaders. Autoimmune means the immune system cannot tell the difference between these foreign invaders and the body’s healthy tissues (""auto"" means ""self"") and creates autoantibodies that attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage in various parts of the body.  Lupus is also a disease of flares (the symptoms worsen and the patient feels ill) and remissions (the symptoms improve and the patient feels better). Lupus can range from mild to life-threatening and should always be treated by a doctor. With good medical care, most people with lupus can lead a full life.  Lupus is not contagious, not even through sexual contact. You cannot ""catch"" lupus from someone or ""give"" lupus to someone.  Lupus is not like or related to cancer. Cancer is a condition of malignant, abnormal tissues that grow rapidly and spread into surrounding tissues. Lupus is an autoimmune disease, as described above.  Lupus is not like or related to HIV (Human Immune Deficiency Virus) or AIDS (Acquired Immune Deficiency Syndrome). In HIV or AIDS the immune system is underactive; in lupus, the immune system is overactive.  It is estimated that at least 1.5 million Americans have lupus. The actual number may be higher; however, there have been no large-scale studies to show the actual number of people in the U.S. living with lupus.  It is believed that 5 million people throughout the world have a form of lupus. Lupus Information Sheet (continued)  Lupus strikes mostly women of childbearing age (15-44). However, men, children, and teenagers develop lupus, too.  Women of color are 2-3 times more likely to develop lupus.  People of all races and ethnic groups can develop lupus.  More than 16,000 new cases of lupus are reported annually across the country. What causes Lupus? Genes No gene or group of genes has been proven to cause lupus. Lupus does, however, appear in certain families, and when one of two identical twins has lupus, there is an increased chance that the other twin will also develop the disease. These findings, as well as others, strongly suggest that genes are involved in the development of lupus. Although lupus can develop in people with no family history of lupus, there are likely to be other autoimmune diseases in some family members. Certain ethnic groups (people of African, Asian, Hispanic/Latino, Native American, Native Hawaiian, or Pacific Island descent) have a greater risk of developing lupus, which may be related to genes they have in common. Environment While a person’s genes may increase the chance that he or she will develop lupus, it takes some kind of environmental trigger to set off the illness or to bring on a flare. Examples include:  ultraviolet rays from the sun  ultraviolet rays from fluorescent light bulbs  sulfa drugs, which make a person more sensitive to the sun, such as: Bactrim® and Septra® (trimethoprim-sulfamethoxazole); sulfisoxazole (Gantrisin®); tolbutamide (Orinase®); sulfasalazine (Azulfidine®); diuretics  sun-sensitizing tetracycline drugs such as minocycline (Minocin®)  penicillin or other antibiotic drugs such as: amoxicillin (Amoxil®); ampicillin (Ampicillin Sodium ADD-Vantage®); cloxacillin (Cloxapen®)  an infection  a cold or a viral illness  exhaustion  an injury Lupus Information Sheet Ver3.0 – July 2013 Page - 2 Lupus Information Sheet (continued)  emotional stress, such as a divorce, illness, death in the family, or other life complications  anything that causes stress to the body, such as surgery, physical harm, pregnancy, or giving birth Although many seemingly unrelated factors can trigger the onset of lupus in a susceptible person, scientists have noted some common features among many people who have lupus, including:  exposure to the sun  an infection  being pregnant  giving birth  a drug taken to treat an illness However, many people cannot remember or identify any specific factor that occurred before they were diagnosed with lupus. Hormones Hormones are the body’s messengers and they regulate many of the body’s functions. In particular, the sex hormone estrogen plays a role in lupus. Men and women both produce estrogen, but estrogen production is much greater in females. Many women have more lupus symptoms before menstrual periods and/or during pregnancy, when estrogen production is high. This may indicate that estrogen somehow regulates the severity of lupus. However, it does not mean that estrogen, or any other hormone for that matter, causes lupus. Types of Lupus? Systemic Lupus Erythematosus. Systemic lupus is the most common form of lupus, and is what most people mean when they refer to ""lupus."" Systemic lupus can be mild or severe. Some of the more serious complications involving major organ systems are:  inflammation of the kidneys (lupus nephritis), which can affect the body’s ability to filter waste from the blood and can be so damaging that dialysis or kidney transplant may be needed  an increase in blood pressure in the lungs (pulmonary hypertension) Lupus Information Sheet Ver3.0 – July 2013 Page - 3 Lupus Information Sheet (continued)  inflammation of the nervous system and brain, which can cause memory problems, confusion, headaches, and strokes  inflammation in the brain’s blood vessels, which can cause high fevers, seizures, behavioral changes,  hardening of the arteries (coronary artery disease), which is a buildup of deposits on coronary artery walls that can lead to a heart attack Cutaneous Lupus Erythematosus. Cutaneous refers to the skin, and this form of lupus is limited to the skin. Although there are many types of rashes and lesions (sores) caused by cutaneous lupus, the most common rash is raised, scaly and red, but not itchy. It is commonly known as a discoid rash, because the areas of rash are shaped like disks, or circles. Another common example of cutaneous lupus is a rash over the cheeks and across the bridge of the nose, known as the butterfly rash. Other rashes or sores may appear on the face, neck, or scalp (areas of the skin that are exposed to sunlight or fluorescent light), or in the mouth, nose, or vagina. Hair loss and changes in the pigment, or color, of the skin are also symptoms of cutaneous lupus. Approximately 10 percent of people who have cutaneous lupus will develop systemic lupus. However, it is likely that these people already had systemic lupus, with the skin rash as their main symptom. Drug-induced Lupus Erythematosus. Drug-induced lupus is a lupus-like disease caused by certain prescription drugs. The symptoms of drug-induced lupus are similar to those of systemic lupus, but only rarely will any major organs be affected. The drugs most commonly connected with drug-induced lupus are hydralazine (used to treat high blood pressure or hypertension), procainamide (used to treat irregular heart rhythms), and isoniazid (used to treat tuberculosis). Drug-induced lupus is more common in men because they are given these drugs more often; however, not everyone who takes these drugs will develop drug-induced lupus. The lupus-like symptoms usually disappear within six months after these medications are stopped. Neonatal Lupus. Neonatal lupus is a rare condition that affects infants of women who have lupus and is caused by antibodies from the mother acting upon the infant in the womb. At birth, the infant may have a skin rash, liver problems, or low blood cell counts, but these symptoms disappear completely after several months with no lasting effects. Some infants with neonatal lupus can also have a serious heart defect. With proper testing, physicians can now identify most at-risk mothers, and the infant can be treated at or before birth. Most infants of mothers with lupus are entirely healthy. ","System Instruction: Use only the provided text to form a concise answer. Context: What is Lupus? Lupus is a chronic, autoimmune disease that can damage any part of the body (skin, joints, and/or organs inside the body). Chronic means that the signs and symptoms tend to last longer than six weeks and often for many years. In lupus, something goes wrong with the immune system, which is the part of the body that fights off viruses, bacteria, and germs (""foreign invaders,"" like the flu). Normally our immune system produces proteins called antibodies that protect the body from these invaders. Autoimmune means the immune system cannot tell the difference between these foreign invaders and the body’s healthy tissues (""auto"" means ""self"") and creates autoantibodies that attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage in various parts of the body.  Lupus is also a disease of flares (the symptoms worsen and the patient feels ill) and remissions (the symptoms improve and the patient feels better). Lupus can range from mild to life-threatening and should always be treated by a doctor. With good medical care, most people with lupus can lead a full life.  Lupus is not contagious, not even through sexual contact. You cannot ""catch"" lupus from someone or ""give"" lupus to someone.  Lupus is not like or related to cancer. Cancer is a condition of malignant, abnormal tissues that grow rapidly and spread into surrounding tissues. Lupus is an autoimmune disease, as described above.  Lupus is not like or related to HIV (Human Immune Deficiency Virus) or AIDS (Acquired Immune Deficiency Syndrome). In HIV or AIDS the immune system is underactive; in lupus, the immune system is overactive.  It is estimated that at least 1.5 million Americans have lupus. The actual number may be higher; however, there have been no large-scale studies to show the actual number of people in the U.S. living with lupus.  It is believed that 5 million people throughout the world have a form of lupus. Lupus Information Sheet (continued)  Lupus strikes mostly women of childbearing age (15-44). However, men, children, and teenagers develop lupus, too.  Women of color are 2-3 times more likely to develop lupus.  People of all races and ethnic groups can develop lupus.  More than 16,000 new cases of lupus are reported annually across the country. What causes Lupus? Genes No gene or group of genes has been proven to cause lupus. Lupus does, however, appear in certain families, and when one of two identical twins has lupus, there is an increased chance that the other twin will also develop the disease. These findings, as well as others, strongly suggest that genes are involved in the development of lupus. Although lupus can develop in people with no family history of lupus, there are likely to be other autoimmune diseases in some family members. Certain ethnic groups (people of African, Asian, Hispanic/Latino, Native American, Native Hawaiian, or Pacific Island descent) have a greater risk of developing lupus, which may be related to genes they have in common. Environment While a person’s genes may increase the chance that he or she will develop lupus, it takes some kind of environmental trigger to set off the illness or to bring on a flare. Examples include:  ultraviolet rays from the sun  ultraviolet rays from fluorescent light bulbs  sulfa drugs, which make a person more sensitive to the sun, such as: Bactrim® and Septra® (trimethoprim-sulfamethoxazole); sulfisoxazole (Gantrisin®); tolbutamide (Orinase®); sulfasalazine (Azulfidine®); diuretics  sun-sensitizing tetracycline drugs such as minocycline (Minocin®)  penicillin or other antibiotic drugs such as: amoxicillin (Amoxil®); ampicillin (Ampicillin Sodium ADD-Vantage®); cloxacillin (Cloxapen®)  an infection  a cold or a viral illness  exhaustion  an injury Lupus Information Sheet Ver3.0 – July 2013 Page - 2 Lupus Information Sheet (continued)  emotional stress, such as a divorce, illness, death in the family, or other life complications  anything that causes stress to the body, such as surgery, physical harm, pregnancy, or giving birth Although many seemingly unrelated factors can trigger the onset of lupus in a susceptible person, scientists have noted some common features among many people who have lupus, including:  exposure to the sun  an infection  being pregnant  giving birth  a drug taken to treat an illness However, many people cannot remember or identify any specific factor that occurred before they were diagnosed with lupus. Hormones Hormones are the body’s messengers and they regulate many of the body’s functions. In particular, the sex hormone estrogen plays a role in lupus. Men and women both produce estrogen, but estrogen production is much greater in females. Many women have more lupus symptoms before menstrual periods and/or during pregnancy, when estrogen production is high. This may indicate that estrogen somehow regulates the severity of lupus. However, it does not mean that estrogen, or any other hormone for that matter, causes lupus. Types of Lupus? Systemic Lupus Erythematosus. Systemic lupus is the most common form of lupus, and is what most people mean when they refer to ""lupus."" Systemic lupus can be mild or severe. Some of the more serious complications involving major organ systems are:  inflammation of the kidneys (lupus nephritis), which can affect the body’s ability to filter waste from the blood and can be so damaging that dialysis or kidney transplant may be needed  an increase in blood pressure in the lungs (pulmonary hypertension) Lupus Information Sheet Ver3.0 – July 2013 Page - 3 Lupus Information Sheet (continued)  inflammation of the nervous system and brain, which can cause memory problems, confusion, headaches, and strokes  inflammation in the brain’s blood vessels, which can cause high fevers, seizures, behavioral changes,  hardening of the arteries (coronary artery disease), which is a buildup of deposits on coronary artery walls that can lead to a heart attack Cutaneous Lupus Erythematosus. Cutaneous refers to the skin, and this form of lupus is limited to the skin. Although there are many types of rashes and lesions (sores) caused by cutaneous lupus, the most common rash is raised, scaly and red, but not itchy. It is commonly known as a discoid rash, because the areas of rash are shaped like disks, or circles. Another common example of cutaneous lupus is a rash over the cheeks and across the bridge of the nose, known as the butterfly rash. Other rashes or sores may appear on the face, neck, or scalp (areas of the skin that are exposed to sunlight or fluorescent light), or in the mouth, nose, or vagina. Hair loss and changes in the pigment, or color, of the skin are also symptoms of cutaneous lupus. Approximately 10 percent of people who have cutaneous lupus will develop systemic lupus. However, it is likely that these people already had systemic lupus, with the skin rash as their main symptom. Drug-induced Lupus Erythematosus. Drug-induced lupus is a lupus-like disease caused by certain prescription drugs. The symptoms of drug-induced lupus are similar to those of systemic lupus, but only rarely will any major organs be affected. The drugs most commonly connected with drug-induced lupus are hydralazine (used to treat high blood pressure or hypertension), procainamide (used to treat irregular heart rhythms), and isoniazid (used to treat tuberculosis). Drug-induced lupus is more common in men because they are given these drugs more often; however, not everyone who takes these drugs will develop drug-induced lupus. The lupus-like symptoms usually disappear within six months after these medications are stopped. Neonatal Lupus. Neonatal lupus is a rare condition that affects infants of women who have lupus and is caused by antibodies from the mother acting upon the infant in the womb. At birth, the infant may have a skin rash, liver problems, or low blood cell counts, but these symptoms disappear completely after several months with no lasting effects. Some infants with neonatal lupus can also have a serious heart defect. With proper testing, physicians can now identify most at-risk mothers, and the infant can be treated at or before birth. Most infants of mothers with lupus are entirely healthy. Summarize only the different types of Lupus that usually affect the organs.",Medical,Find & Summarize,Text Transformation Please answer questions using the text found in the prompt only. Do not use any external information whatsoever!,"If I had just met a person of the advisory committee for the first time yesterday, would this count as a covered relationship?","Under section 502, the following scenario would also raise a potential appearance issue: where a person (or entity) with whom the advisory committee member has a “covered relationship” is or represents a “party to the matter” coming before the advisory committee. Both “covered relationship” and “party to the matter” are described below. “Covered Relationship”: Section 502(b)(1) provides that a member has a “covered relationship” with the following people and entities: (i) A person with whom the member has or is seeking a business, contractual, or other financial relationship other than a routine consumer transaction; 27 (ii) A person who is a member of her household or a relative with whom she has a close personal relationship; (iii) A person or entity for which the member has, within the last year,28 served as an employee, officer, director, consultant, agent, attorney, trustee, contractor, or general partner; (iv) A person or entity for which the member’s spouse, parent, or dependent child currently serves or is seeking to serve as an employee, officer, director, consultant, contractor, agent, attorney, trustee, or general partner; and (v) An organization, other than a political party, in which the member is an “active participant.” Mere membership in an organization, payment of dues, or the donation or solicitation of financial support does not, by itself, constitute active participation. ","System Instructions: Please answer questions using the text found in the prompt only. Do not use any external information whatsoever! Prompt: If I had just met a person of the advisory committee for the first time yesterday, would this count as a covered relationship? Context Block: Under section 502, the following scenario would also raise a potential appearance issue: where a person (or entity) with whom the advisory committee member has a “covered relationship” is or represents a “party to the matter” coming before the advisory committee. Both “covered relationship” and “party to the matter” are described below. “Covered Relationship”: Section 502(b)(1) provides that a member has a “covered relationship” with the following people and entities: (i) A person with whom the member has or is seeking a business, contractual, or other financial relationship other than a routine consumer transaction; 27 (ii) A person who is a member of her household or a relative with whom she has a close personal relationship; (iii) A person or entity for which the member has, within the last year,28 served as an employee, officer, director, consultant, agent, attorney, trustee, contractor, or general partner; (iv) A person or entity for which the member’s spouse, parent, or dependent child currently serves or is seeking to serve as an employee, officer, director, consultant, contractor, agent, attorney, trustee, or general partner; and (v) An organization, other than a political party, in which the member is an “active participant.” Mere membership in an organization, payment of dues, or the donation or solicitation of financial support does not, by itself, constitute active participation. ",Legal,Fact Finding,Q&A Use the source provided only.,What is the history of taxes in the United States?,"Taxes in the United States: History, Fairness, and Current Political Issues by Brian Roach A GDAE Teaching Module on Social and Environmental Issues in Economics Global Development And Environment Institute Tufts University Medford, MA 02155 http://ase.tufts.edu/gdae Copyright © 2010 Global Development And Environment Institute, Tufts University. Copyright release is hereby granted for instructors to copy this module for instructional purposes. Students may also download the module directly from http://ase.tufts.edu/gdae. Comments and feedback from course use are welcomed: Tufts University Global Development And Environment Institute Tufts University Medford, MA 02155 http://ase.tufts.edu/gdae E-mail: gdae@tufts.edu I. INTRODUCTION “The hardest thing in the world to understand is income tax!” – Albert Einstein Taxes are complicated. The U.S. federal tax code contains over three million words – about 6,000 pages. A casual browsing of the tax code’s table of contents offers a glimpse into the vast complexity of federal taxation. Entire sections of the tax code apply specifically to the taxation of vaccines (Sec. 4131-4132), shipowners' mutual protection and indemnity associations (Sec. 526), specially sweetened natural wines (Sec. 5385), and life insurance companies (Sec. 801-818). Annual changes to the tax code imply that taxes will continue to become more complex even as politicians tout tax simplification. Taxes levied by other jurisdictions, such as states and cities, add further complexity to taxation in the U.S. Americans spend billions of hours each year working on their taxes, not to mention the costs of accountants and tax preparers. Fortunately, one needn’t comprehend the imposing complexity of the tax code to understand the crucial role of taxes in American society. Taxation is an important, but commonly neglected, topic for students of economics, political science, and other disciplines. Tax policy has important economic consequences, both for the national economy and for particular groups within the economy. Tax policies are often designed with the intention of stimulating economic growth – although economists differ drastically about which policies are most effective at fostering growth. Taxes can create incentives promoting desirable behavior and disincentives for unwanted behavior. Taxation provides a means to redistribute economic resources towards those with low incomes or special needs. Taxes provide the revenue needed for critical public services such as social security, health care, national defense, and education. Taxation is as much of a political issue as an economic issue. Political leaders have used tax policy to promote their agendas by initiating various tax reforms: decreasing (or increasing) tax rates, changing the definition of taxable income, creating new taxes on specific products, etc. Of course, no one particularly wants to pay taxes. Specific groups, such as small-business owners, farmers, or retired individuals, exert significant political effort to reduce their share of the tax burden. The voluminous tax code is packed with rules that benefit a certain group of taxpayers while inevitably shifting more of the burden to others. Tax policy clearly reflects the expression of power in the U.S. – those without power or favor are left paying more in taxes while others reap the benefits of lower taxes because of their political influence. Broad attempts to reform the tax system have produced dramatic and sudden shifts in tax policy, generally motivated by political factors rather than sound economic theory. For example, the top marginal federal tax bracket on individual income in the U.S. dropped precipitously from 70% to 28% during the 1980s. Tax policy has clearly been used to promote political, as well as economic, agendas. This module is intended to provide a basic understanding of the economic, political, and social context of the entire U.S. tax system. When most people think about taxes, they 1 tend to think only of the federal income tax. However, looking solely at the federal income tax would miss several important issues. Perhaps most importantly, the federal income tax is not the largest tax bill to most Americans. We’ll see that the largest tax for most Americans is federal social insurance taxation. Also, the federal income tax is one of the most progressive taxes in the U.S. system. When all taxes are considered, the U.S. tax system is much less progressive. You may be surprised to find out how many taxes in the U.S. are actually regressive – hitting low-income households at a disproportionately high rate. This module is divided into three major sections. First, some basic terms will be defined and discussed, including tax progressivity and the differences between several types of taxes. Second, a brief overview of tax history in the United States will be presented. Third, data on tax trends will be used to illustrate the changing nature of taxation with a focus on the overall progressivity of the entire tax system. II. THE STRUCTURE OF TAXATION IN THE UNITED STATES Tax Progressivity The overall system of taxation in the United States is progressive. By a progressive tax system, we mean that the percentage of income an individual (or household) pays in taxes tends to increase with increasing income. Not only do those with higher incomes pay more in total taxes, they pay a higher rate of taxes. This is the essence of a progressive tax system. For example, a person making $100,000 in a year might pay 25% of their income in taxes ($25,000 in taxes), while someone with an income of $30,000 might only pay a 10% tax rate ($3,000 in taxes). A tax system may also be regressive or proportional. A regressive tax system is one where the proportion of income paid in taxes tends to decrease as one’s income increases. A proportional tax system simply means that everyone pays the same tax rate regardless of income. A particular tax system may display elements of more than one approach. Consider a hypothetical tax system where one pays a proportional, or flat 1 , rate on income below a certain dollar amount and then progressively increasing rates above that dollar amount. Also, within an overall tax system, some particular taxes might be progressive while other taxes are regressive. We’ll see later on that this the case in the United States. The Reasons for Progressive Taxation The overall tax system of the United States, and in most other countries, is progressive for a number of reasons. A progressive tax embodies the concept that those with high incomes should pay more of their income in taxes because of their greater ability to pay 1 This is not exactly the same concept embodied in current proposals for a “flat tax” in the U.S. These proposals would set just one tax rate but would exclude a given amount of income from taxation. Thus, the flat tax proposals would retain a small degree of progressivity. 2 without critical sacrifices. By paying a tax, any household must forego an equivalent amount of spending on goods, services, or investments. For a high-income household, these foregone opportunities might include a second home, an expensive vehicle, or a purchase of corporate stock. A low-income household, by comparison, might have to forego basic medical care, post-secondary education, or vehicle safety repairs. As income increases, the opportunity costs of paying taxes tend to be associated more with luxuries rather than basic necessities. The ability-to-pay principle recognizes that a flat (or regressive) tax rate would impose a larger burden, in terms of foregone necessities, on low-income households as compared to high-income households. A progressive tax system is also a mechanism to addresses economic inequalities in a society. To evaluate a tax system’s impact on inequality, one must consider both the distribution of taxes paid and the distribution of the benefits derived from tax revenue. If the benefits of programs funded by taxation primarily benefit low-income households while high-income households pay the majority of taxes, then the tax system effectively operates as a transfer mechanism. Increasing the progressivity of the tax system or altering the distribution of benefits allows greater redistribution of economic resources. We’ll mainly focus on tax payments in this module but you should also be aware that the benefits of public expenditures are not evenly distributed throughout society. 2 There is also an economic argument for a progressive tax system – it may yield a given level of public revenue with the least economic impact. To see why, consider how households with different levels of income would respond to a $100 tax cut. A lowincome household would tend to quickly spend the entire amount on needed goods and services – injecting $100 of increased demand into the economy. By comparison, a highincome household might only spend a fraction on goods and services, choosing to save or invest a portion of the money. The money that a high-income household saves or invests does not add to the overall level of effective demand in an economy. 3 In economic terms, we say that the marginal propensity to consume tends to decrease as income increases. So, by collecting proportionally more taxes from high-income households we tend to maintain a higher level of effective demand and more economic activity. Of course, one can posit that a tax system can become too progressive. Extremely high tax rates at high-income levels might create a significant disincentive that reduces the productive capacity of society. Very high taxes might limit the risks taken by entrepreneurs, stifling innovations and technological advances. The desire to “soak the rich” through an extremely progressive tax system might be viewed as unfair, and not just by the rich. In fact, this was a concern of the Constitutional framers – that a democratic majority would eventually impose unduly burdensome taxes on the wealthy minority. We’ll see that their concerns have proved groundless. Many critics of the current tax 2 The distribution of the benefits derived from public expenditures is, of course, more difficult to determine that the distribution of tax payments. The distribution of public assistance programs can be easily measured. However, the distribution of the benefits of scientific research support, business subsidies, public works, national defense, and other expenditures is a difficult research task. 3 Money saved or invested may, however, provide the financial capital necessary to increase the productive capacity of the economy. “Supply-side” economists stress the importance of investment by the wealthy as the key to economic growth. 3 system point to the contrary position – that the powerful minority have used their might to shift the tax burden away from themselves onto an immobilized and misinformed majority. Even if one could devise a tax system that is economically optimal (i.e., producing the highest overall level of economic growth), the topic of taxation encompasses ideals about equity and fairness. A society may be willing to sacrifice some degree of economic growth in exchange for a more equitable distribution of economic resources. This is not to say that economic growth must always be sacrificed with redistribution. In fact, analysis of the U.S. historical data finds that high levels of economic growth tend to be associated with periods of relatively equitable distribution of economic resources (Krugman, 2002). We now turn to differentiating between the different types of taxes levied in the U.S. We’ll first discuss several forms of federal taxation, roughly in order of the revenue they generate, and then consider taxation at the state and local levels. A final section will consider taxes that are generally not used in the U.S. but are important in other nations. Federal Income Taxes The federal income tax is the most visible, complicated, and debated tax in the U.S. The federal income tax was established with the ratification of the 16th Amendment to the U.S. Constitution in 1913. It is levied on wages and salaries as well as income from many other sources including interest, dividends, capital gains, self-employment income, alimony, and prizes. To understand the basic workings of federal income taxes, you need to comprehend only two major issues. First, all income is not taxable – there are important differences between “total income,” “adjusted gross income,” and “taxable income.” Second, you need to know the distinction between a person’s “effective tax rate” and “marginal tax rate.” Total income is simply the sum of income an individual or couple 4 receives from all sources. For most people, the largest portion of total income comes from wages or salaries. Many people also receive investment income from the three standard sources: interest, capital gains, and dividends. Self-employment income is also included in total income, along with other types of income such as alimony, farm income, and gambling winnings. The amount of federal taxes a person owes is not calculated based on total income. Instead, once total income is calculated, tax filers are allowed to subtract some expenses as non-taxable. To obtain adjusted gross income (AGI), certain out-of-pocket expenses made by a tax filer are subtracted from total income. These expenses include individual retirement account contributions, allowable moving expenses, student loan interest, tuition, and a few other expenses. AGI is important because much of the tax data presented by the IRS are sorted by AGI. 4 Married couples have the option of filing their federal taxes either jointly or separately. Children aged 14 or over with sufficient income ($7,700 in 2002) have to file their own federal income tax returns. 4 However, taxes are not calculated based on AGI either. Taxable income is basically AGI less deductions and exemptions. Deductions are either standard or itemized. The standard deduction is a fixed amount excluded from taxation – for the 2009 tax year the standard deduction was $5,700 for single individuals and $11,400 for married couples. Tax filers have the option of itemizing their deductions. To itemize, a tax filer adds up certain expenses made during the year including state taxes, real estate taxes, mortgage interest, gifts to charity, and major medical expenses. 5 If the itemized deductions exceed the standard deduction, then the itemized total is deducted instead. Exemptions are calculated based on the number of tax filers and dependents. A single tax filer with no dependent children can claim one exemption. A married couple with no children can claim two exemptions. Each dependent child counts as one more exemption. Additional exemptions are given for being age 65 or over or blind. In 2009, each exemption excluded a further $3,650 from taxation. 6 Taxable income is obtained by subtracting the deduction and exemption amounts from AGI. This is the amount a taxpayer actually pays taxes on. However, the amount of tax owed is not simply a multiple of taxable income and a single tax rate. The federal income tax system in the U.S. uses increasing marginal tax rates. This means that different tax rates apply on different portions of a person’s income. The concept is best illustrated with an example using the 2009 tax rates. For a single filer, the first $8,350 of taxable income (not total income or AGI) is taxed at a rate of 10%. Taxable income above $8,350 but less than $33,950 is taxed at a rate of 15%. Taxable income above $33,950 but less than $82,250 is taxed at a rate of 25%. Income above $82,250 is taxed at higher marginal rates – 28%, 33%, and 35%. Consider how we would calculate the taxes due for a single tax filer (let’s call her Susan) with no children and a total income of $35,000. Assume Susan contributed $3,000 to an individual retirement account and that this is her only allowable adjustment expense. Thus, her AGI is $32,000. She claims one exemption (herself) in the amount of $3,650 and the standard deduction of $5,700. Thus, Susan’s taxable income is $22,650. On the first $8,350 of taxable income she owes 10% in taxes, or $835. The tax rate on the rest of her income is 15% for a tax of $2,145, (($22,650 - $8,350) × 0.15). So, her total federal income tax bill is $2,980, ($835 + $2,145). Note that Susan’s taxable income is $12,350 less than her total income. While Susan paid a maximum tax rate of 15%, we can see that her effective tax rate is much lower. An effective tax rate can be calculated based on total income, AGI, or taxable income. Suppose we wish to calculate Susan’s effective tax rate based on her total income of $35,000. Given that her federal income tax is $2,980, her effective tax rate is only 8.5%, (($2,980/$35,000) × 100). If we based her effective tax rate on her AGI, it would be 9.3%, (($2,980/$32,000) × 100). 5 Note that some expenses, such as moving costs, are subtracted from total income to obtain AGI while other expenses, such as mortgage interest, are classified as deductions from AGI to obtain taxable income. 6 Those with high incomes (more than $125,100 for an individual) either have their exemption allowance either reduced or eliminated. 5 Social Insurance Taxes Taxes for federal social insurance programs, including Social Security, Medicaid, and Medicare, are taxed separately from income. Social insurance taxes are levied on salaries and wages, as well as income from self-employment. For those employed by others, these taxes are generally deducted directly from their paycheck. These deductions commonly appear as “FICA” taxes – a reference to the Federal Insurance Contributions Act. Self-employed individuals must pay their social insurance taxes when they file their federal income tax returns. Social insurance taxes are actually two separate taxes. The first is a tax of 12.4% of wages, which is primarily used to fund Social Security. Half of this tax is deducted from an employee’s paycheck while the employer is responsible for matching this contribution. The other is a tax of 2.9% for the Medicare program. Again, the employee and employer each pay half. Thus, social insurance taxes normally amount to a 7.65% deduction from an employee’s wage (6.2% + 1.45%). Self-employed individuals are responsible for paying the entire share, 15.3%, themselves. There is a very important difference between these two taxes. The Social Security tax is due only on the first $106,800 (in 2009) of income. On income above $106,800, no additional Social Security tax is paid. In other words, the maximum Social Security tax in 2009 that would be deducted from total wages is $6,622 ($106,800 × 0.062). The Medicare tax, however, is paid on all wages. Thus, the Medicare tax is truly a flat tax while the Social Security tax is a flat tax on the first $106,800 of income but then becomes a regressive tax when we consider income above this limit. Consider the impact of social insurance taxes on two individuals, one making a typical salary of $45,000 and another making $300,000. The typical worker would pay 7.65% on all income, or $3,443, in federal social insurance taxes. The high-income worker would pay the maximum Social Security contribution of $6,622 plus $4,350 for Medicare (1.45% of $300,000) for a total bill of $10,972. This works out to a 3.7% overall tax rate, or less than half the tax rate paid by the typical worker. As the high-income individual pays a lower rate of taxation, we see that social insurance taxes are regressive. Federal Corporate Taxes Corporations must file federal tax forms that are in many ways similar to the forms individuals complete. Corporate taxable income is defined as total revenues minus the cost of goods sold, wages and salaries, depreciation, repairs, interest paid, and other deductions. Thus corporations, like individuals, can take advantage of many deductions to reduce their taxable income. In fact, a corporation may have so many deductions that it actually ends up paying no tax at all or even receives a rebate check from the federal government. We’ll discuss this issue further later in the module. Corporate tax rates, like personal income tax rates, are progressive and calculated on a marginal basis. In 2009, the lowest corporate tax rate, applied to profits lower than 6 $50,000 was 15%. The highest marginal corporate tax rate, applied to profits between $100,000 and $335,000 was 39%. 7 As with individuals, the effective tax rate corporations pay is lower than their marginal tax rate. Federal Excise Taxes An excise tax is a tax on the production, sale, or use of a particular commodity. The federal government collects excise taxes from manufacturers and retailers for the production or sale of a surprising number of products including tires, telephone services, air travel, transportation fuels, alcohol, tobacco, and firearms. Unlike a sales tax, which is evident as an addition to the selling price of a product, excise taxes are normally incorporated into the price of a product. In most cases, consumers are not directly aware of the federal excise taxes they pay. However, every time you buy gas, make a phone call, fly in a commercial plane, or buy tobacco products, you are paying a federal excise tax. For example, the federal excise tax on gasoline as of 2009 was about 18 cents per gallon. Federal excise taxes are another example of a regressive tax. Lower-income households tend to spend a greater portion of their income on goods that are subject to federal excise taxes. This is particularly true for gasoline, tobacco, and alcohol products. Federal Estate and Gift Taxes The vast majority of Americans will never be affected by the federal estate or gift taxes. These taxes apply only to the wealthiest Americans. The estate tax is applied to transfers of large estates to beneficiaries. Similar to the federal income tax, there is an exemption amount that is not taxed. Only estates valued above the exemption amount are subject to the estate tax, and the tax only applies to the value of the estate above the exemption. For example, if the tax rate were 45% of the exemption amount was $2 million, then the tax on an estate valued at $3.5 million would be $675,000, ((3,500,000-2,000,000)*0.45). As of Fall 2010, the future of the estate tax is in limbo. Under the Economic Growth and Tax Relief Act of 2001, estate taxes rates were gradually reduced, and exemption rates gradually increased, over the period 2001-2009. In 2001, the exemption amount was $675,000 million and the tax rate was 55%. For the 2009 tax year, the exemption amount was $3.5 million and the tax rate was 45%. But for 2010, there is no estate tax at all! Then, in 2011, the tax is scheduled to be reinstated with an exemption of $1 million and a tax rate of 55%. The ongoing debate over the estate tax will be covered in more detail later in this module. The transfer of large gifts is also subject to federal taxation. The estate tax and gift tax are complementary because the gift tax essentially prevents people from giving away their estate to beneficiaries tax-free while they are still alive. In 2009, gifts under 7 For the highest profit bracket – profits above $18,333,333 – the marginal rate was 35%. 7 $13,000 were excluded from the tax. Similar to the federal income tax, the gift tax rates are marginal and progressive, with a maximum tax rate of 45%. The estate and gift taxes are the most progressive element of federal taxation. The estate tax is paid exclusively by those with considerable assets. Even further, the majority of all estate taxes are paid by a very small number of wealthy taxpayers. According to the Tax Policy Center, in 2009 the richest 0.1% of those subject to the estate tax pay 42% of the total estate tax revenue. (Tax Policy Center, 2010). State and Local Taxes Like the federal government, state governments also rely on tax revenues to fund public expenditures and transfer programs. Like the federal government, state governments rely on several different tax mechanisms including income taxes, excise taxes, and corporate taxes. Thus, much of the above discussion applies to the tax structures in place in most states. However, there are some important differences that deserve mention. First, nearly all states (45 as of 2010) have instituted some type of general sales tax. State sales tax rates range from 2.9% (Colorado) to 8.25% (California 8 ). A few states reduce the tax rate on certain goods considered to be necessities, such as food and prescription drugs. For example, the general sales tax in Illinois is 6.25% but most food and drug sales are taxed at only 1%. Other states with sales taxes exempt some necessities from taxation entirely. In most states, localities can charge a separate sales tax. While local sales taxes are generally lower than state sales taxes, there are exceptions. In New York the state sales tax is 4% but local sales taxes are often higher than 4%. Unlike income taxes, sales taxes tend to be quite regressive. The reason is that lowincome households tend to spend a larger share of their income on taxable items than high-income households. Consider gasoline – an item that tends to be a smaller share of total expenditures as income rises. An increase in the state taxes on gasoline impacts low-income households more than high-income households. Some states, such as Idaho and Kansas, offer low-income households a tax credit to compensate for the regressive nature of state sales taxes. Forty-one states levy an income tax. 9 Most of these states have several progressive tax brackets (up to 12 rates) similar to the federal income tax. However, state income taxes tend to be much less progressive than the federal income tax. Six states have only one income tax rate, meaning that their income tax approaches a flat tax. Several more states approach a flat tax because the top rate applies at a low income or the rates are relatively constant. For example, Maine’s two tax rates are 6.50% and 6.85%. 8 Local sales taxes are also levied in some municipalities in California, which can raise the total sales tax to as high as 10.75%. 9 Two other states, Tennessee and New Hampshire, levy no state income tax but do tax dividends and interest. 8 Another important distinction between the federal system of taxation and the taxes levied at state and local levels is use of property taxes. In fact, property taxes tend to be the largest revenue source for state and local governments. The primary property tax levied in the U.S. is a tax on real estate, including land, private residences, and commercial properties. Generally, the tax is an annual assessment calculated as a proportion of the value of the property, although the formulas used by localities differ significantly. Property taxes are commonly collected at a local level, but a share of property taxes is allocated for state purposes. Property taxes tend to be regressive, although less regressive than excise and sales taxes. The reason is that high-income households tend to have a lower proportion of their assets subjected to property taxes. While renters do not directly pay property taxes, most economists conclude that the costs of property taxes are largely passed on to renters in the form of higher rents. Composition of Tax Collections in the U.S. Table 1 presents government tax receipts, by tax source, for 2008 (the most recent year for which complete data were available). The table shows that federal taxes dominate the nation’s tax system with nearly 65% of all receipts. The largest federal tax is the income tax, followed closely by social insurance taxes. State and local tax systems are primarily dependent on sales, income, and property taxation. The data in Table 1 cover the major taxes utilized in the United States. To gain a broader perspective on taxation, see Box 1 for a summary of tax mechanisms that are major revenue sources for some countries but are currently non-existent or insignificant in the U.S. Table 1. 2008 U.S. Tax Receipts, by Source Source Federal Taxes Income Taxes Social Insurance Taxes Corporate Taxes Excise Taxes Estate Taxes Total, Federal Taxes State Taxes Sales Taxes Property Taxes Income Taxes Corporate Taxes Excise and Other Taxes Total, State Taxes Total, All Taxes Amount (Millions $) Percent of All Taxes 1,145,700 900,200 304,300 67,300 23,000 2,440,500 30.4% 23.9% 8.1% 1.8% 0.6% 64.7% 304,400 409,700 304,600 57,800 253,900 1,330,400 3,770,900 8.1% 10.9% 8.1% 1.5% 6.7% 35.3% 100.0% Source: U.S. Census Bureau (2010), except for federal estate tax data from Tax Policy Center (2008). 9 BOX 1. TAX ALTERNATIVES It is worthwhile to briefly consider tax types that are not currently important in the U.S. because these mechanisms are used in other countries or are central in various proposals to reform the U.S. tax system. We summarize five tax types here: 1. National sales tax. This would function similar to a state sales tax – as an addition to the retail price of certain products. A national sales tax would clearly be simpler and cheaper to administer than the current federal income tax. It would also encourage savings because, under most proposals, income that is not spent on taxable goods and services is not taxed. There are, however, two significant disadvantages to a national sales tax. First, it would create an incentive for black market exchanges to evade the tax. Second, it can be highly regressive – similar to the regressivity of state sales taxes. A national sales tax could be made less regressive, or even progressive, by providing rebates for low-income households. 2. National consumption tax. This is slightly different from a national sales tax. A household would pay the tax at the end of the year based on the value of its annual consumption of goods and services. Consumption can be calculated as total income less money not spent on goods and services (i.e., invested or saved). Again, a consumption tax would promote savings by exempting it from taxation. A consumption tax could also be designed to be progressive by taxing different levels of consumption at different marginal rates. 3. Value added tax. Most developed countries levy some form of value added tax (VAT). A VAT is levied at each stage in the production process of a product, collected from manufacturers according to the value added at each stage. Thus, the tax is not added to the retail price but incorporated into prices, similar to the way excise taxes become embedded into the price of products. Compared to a national sales tax, a VAT reduces the likelihood of black markets. 4. Wealth taxes. While the U.S. tax system includes local property taxes and, at least for a while, estate taxes, there is no tax on holdings of other assets such as corporate stocks, bonds, and personal property. Several European countries, including Sweden, Spain, and Switzerland, have instituted an annual wealth tax. A wealth tax could be very progressive by setting high rates and becoming effective only at significant wealth levels. 5. Environmental taxes. These are levied on goods and services in proportion to their environmental impact. One example is a carbon tax, which taxes products based on the emissions of carbon attributable to their production or consumption. The rationale of environmental taxation is that it encourages the use and development of goods and services with reduced environmental impacts. Like other taxes on goods and services, environmental taxes can be regressive – suggesting that environmental taxes need to be combined with other progressive taxes or rebates for low-income households. Among developed countries, the U.S. collects the smallest share of tax revenues from environmental taxes (OECD, 2010). 10 III. A BRIEF HISTORY OF TAXATION IN THE U.S. 10 Before the Federal Income Tax The tax mechanisms used during first 150 years or so of U.S. tax history bears little resemblance to the current system of taxation. First, the U.S. Constitution restricted “direct” taxation by the federal government – meaning taxes directly on individuals. Instead, the federal government relied on indirect taxes including taxes on imports (tariffs) and excise taxes. Tariffs were the major source of U.S. government receipts from the beginning of the nation up to the early 1900’s. For example, in 1800 custom duties comprised about 84% of government receipts (U.S. Census Bureau, 1960). Internal federal revenue collections (which exclude tariffs on imports) as recently as the early 20th century were primarily derived from excise taxes on alcohol. In 1900 over 60% of internal revenue collections came from alcohol excise taxes with another 20% from tobacco excise taxes. Another important difference is the scale of government taxation and expenditures relative to the entire economy. Government spending is currently a major portion of the total U.S. economy – in 2010 government expenditures and investment at all levels comprised about 20% of total economic output. In the late 1800s government expenditures were responsible for only about 2% of national output (earlier data on national output are not available). The role of government has become more prominent as a result of expansion of military activity and an increase in the provision of public services. Consequently an overall trend of increasing taxation is evident, although we’ll see that this trend has recently stabilized or reversed. The Constitutional framers were wary of a government’s power to tax. Taxation of the American Colonies by a distant and corrupt England was a driving force behind the American Revolution. Consequently, they believed in decentralized taxation and delegated most public revenue collection to localities, which relied primarily on property taxes. During peacetime the federal government was able to meet its expenses through relatively modest excise taxes and tariffs. During times of war, such as the War of 1812, federal taxes were temporarily raised to finance the war or pay down the ensuing debts. Once the financial crisis passed, taxes were reduced in response to public opposition to high tax rates. Like previous wars, the Civil War initiated an increase in both excise tax and tariff rates. Government revenue collections increased by a factor of seven between 1863 and 1866. Perhaps the most significant tax policy enacted during the Civil War was the institution of the first national income tax. Concerns about the legality of the tax, considering the Constitution’s prohibition of direct taxation, were muted during the national emergency. The income tax rates were low by modern standards – a maximum rate of 10% along with generous exemptions meant that only about 10% of households were subject to any income tax. Still, the income tax generated over 20% of federal revenues in 1865. After 10 The history of taxation is primarily derived from Brownlee (1996). 11 the war, few politicians favored the continuation of the income tax, and in 1872 it was allowed to expire. The impetus for the modern federal income tax rests not with a wartime emergency but with the Populist movement of the late 1800s. The internal tax system in place at the time, based primarily on excise taxes on alcohol and tobacco, was largely regressive. The Populists revived interest in an income tax as a means to introduce a progressive tax based on ability to pay. They saw it as a response to excessive monopoly profits and the concentration of wealth and power. In other words, the tax was not envisioned as a means to generate significant additional public revenue but as a vehicle of social justice. A federal income tax, with a large exemption of $4,000, was instituted in 1894 but the Supreme Court ruled it unconstitutional in 1895. Over the next couple of decades proposals were made for a constitutional amendment to establish a federal income tax. While these attempts were defeated, support for federal income taxation gradually increased. Eventually, in 1913 the 16th Amendment was ratified creating the legal basis for the federal income tax. While the initial income tax was progressive, it was less radical than many desired. In fact, many conservatives expressed guarded support for the measure to prevent a more significant tax. While the income tax was targeted towards the wealthy – in the first few years only about 2% of households paid any income tax – tax rates of only 1%-7% prevented it from generating significant revenues. “...virtually none of the income tax proponents within the government believed that the income tax would become a major, yet alone the dominant, permanent source of revenue within the consumption-based federal tax system.” (Brownlee, 1996, p. 45) These views were to quickly change as the nation required a dramatic increase in revenues to finance World War I. The Growth of Direct Taxation Rather than relying on increases in excise taxes and tariffs to finance World War I, the administration of Woodrow Wilson transformed the income tax framework laid down just a few years previously. Desiring both to raise additional revenue and enforce social justice, the top marginal rate increased dramatically from 7% in 1915 to 67% in 1917 (IRS, 2002). Corporate taxes also became an important revenue source, accounting for over one-quarter of internal revenue collections in 1917. In 1916 the estate tax was created, not necessarily to generate large revenues but as another instrument of progressive taxation. Unlike previous wars, much of the tax system laid down during World War I remained in place after the war. In the period from 1910 to 1925 tariffs fell from about half of government receipts to less than 15%. Meanwhile the new corporate and individual 12 income taxes made up nearly half of government receipts in the mid 1920s. The level of excise tax collections dropped significantly, especially during the years of Prohibition when alcohol excise taxes virtually disappeared. The Great Depression, of course, caused a significant decline in federal receipts. In 1932 tax rates were increased in an attempt to boost federal revenue. Franklin Roosevelt, in the years leading up to World War II, presented progressive taxation as a key element of the New Deal. However, the most significant measure enacted during this period was the creation of old-age insurance. Prior to national social insurance programs, poverty was the common state of the elderly (Skidmore, 1999). By the 1930s, several European countries had already instituted programs of social insurance. Germany was the first to establish old-age and survivors pensions in 1889 (Peterson, 1999). The Great Depression finally motivated policy makers in the U.S. to enact similar legislation. Rather than funding Social Security programs through increases in income, or other, taxes, the funding mechanism was a separate tax, split equally between employers and employees. All employees covered by the system 11 contributed and received benefits regardless of their income. This design was intended to protect the system from political attack. As everyone who pays into the system receives benefits, Social Security is not considered “welfare” that is allocated to only a segment of the population. Also, because Social Security is a separate tax, contributors view their old-age payments as entitlements and oppose attempts to weaken the program. This design has so far proved very successful – Social Security is often called the “third rail” of American politics (i.e., touch it and you die). World War II created yet another emergency situation requiring additional revenues. Similar to Woodrow Wilson during World War I, President Franklin Roosevelt sought to raise revenues primarily from higher taxes on corporations and high-income households. Roosevelt went so far as to state that: “In this time of grave national danger, when all excess income should go to win the war, no American citizen ought to have a net income, after he has paid his taxes, of more than $25,000.” (Brownlee, 1996, p. 91) Roosevelt was unable to obtain enough Congressional support to enact his most progressive proposals. The ensuing compromise did produce a more progressive federal income tax but it also became levied on more households. Personal exemptions were reduced by half between 1939 and 1942 – meaning the income tax reached well into the middle class for the first time. The taxable income subject to the highest marginal rate dropped from $5 million in 1941 down to $200,000 in 1942. Also, the top marginal tax rate reached a record high of 94% in 1944. Another change during World War II was withholding federal taxes from an employee’s paycheck rather than requiring payment of 11 While Social Security has expanded over the years to cover more employees, all workers are not currently covered by the system. For example, about one-quarter of state and local government employees are not included in the system (Peterson, 1999). 13 taxes due at the end of the year. These, as well as other, changes produced a dramatic shift in the structure of federal taxation: “Under the new tax system, the number of individual taxpayers grew from 3.9 million in 1939 to 42.6 million in 1945, and federal income tax collections over the period leaped from $2.2 billion to $35.1 billion. By the end of the war nearly 90 percent of the members of the labor force submitted income-tax returns, and about 60 percent of the labor force paid income taxes. … At the same time, the federal government came to dominate the nation’s revenue system. In 1940, federal income tax had accounted for only 16 percent of the taxes collected by all levels of government; by 1950 the federal income tax produced more than 51 percent of all collections. Installation of the new regime was the most dramatic shift in the nation’s tax policies since 1916.” (Brownlee, 1996, p. 96-97) As in the period after World War I, much of the new tax structure instituted during World War II remained in place after the war. Both major political parties expressed support for a progressive but broad income tax, relatively flat tax rates on corporate profits, and social insurance taxes that were basically regressive. Public support for the existing tax system was boosted by patriotic feelings and broad-based economic growth after the war. Changes to the tax system between the end of World War II and the 1980’s were generally minor. The Social Security tax occasionally increased as more people were receiving benefits. The initial tax rate of 2% (1% each for employers and employees) had increased to 6.13% by 1979. The Medicare and Medicaid programs were established in the 1960s. Across-the-board tax cuts in 1964 reduced marginal rates for both low- and high-income households (the top marginal rate fell from 91% in 1963 to 70% in 1965). Still, government continued to become a more significant portion of the entire economy in the decades after World War II. Total government expenditure and investment increased gradually from less than 18% of GDP in 1946 to over 22% by the mid 1970s. From the “Reagan Revolution” to the Bush Tax Cuts The general stasis of the federal tax system ended in the 1980s with the passage of several important tax reforms. Ronald Reagan was elected president in 1980 on a platform of smaller government and lower taxes. The Economic Recovery Tax Act of 1981 (ERTA) enacted the largest tax cut in American history 12 and inspired tax cutting by many other nations in the 1980s. The supply-side rationale behind ERTA’s sharp reduction in tax rates, particularly on high-income households and capital, was that greater incentives would motivate increased investment and economic activity. The ensuing economic growth and consequent tax revenue growth would, in theory, more than offset the revenue reductions as a result of the tax cuts. Thus, the theory was that tax cuts could actually produce an increase in federal revenues and address the growing federal budget deficit as well. ERTA phased in a reduction in the top tax rate from 70% to 50%, enacted several corporate tax cuts, and indexed many tax parameters to inflation (such as personal exemptions and deductions). 12 When measured in constant dollars (adjusted for inflation). 14 Analysis suggests that, in reality, ERTA resulted in the largest reduction in federal revenues of any tax bill since World War II (Tempalski, 1998). The federal budget deficit continued to grow. The very next year, in 1982, the largest peacetime tax increase was passed (Martin, 1991). The act repealed some of the more revenue-reducing provisions of ERTA, such as accelerated depreciation reductions for corporations, and closed several corporate loopholes in the tax code. Social Security reforms were enacted in 1983 that increased Social Security tax rates and initiated taxation of some benefits. Reagan continued to push for further tax reforms, leading to the Tax Reform Act of 1986 – considered to be the most comprehensive revision of the tax code since the 1950s (Petska and Strudler, 1999). This act reduced top income tax rates even further – from 50% in 1986 to 28% in 1988. Among many other changes, it also lowered the top corporate tax rate from 46% to 34%. Clearly, the “Reagan revolution” is an important era in U.S. tax history, but many people misinterpret it as a period where the size of the federal government was drastically reduced and taxes cut significantly. Despite the two major tax cuts during Reagan’s terms, federal revenue collections increased at nearly the same pace as national output (total federal revenues increased about 76% from 1980-1988 while GDP increased 83%). The actual changes were more evident in the distribution of federal revenues than their total level. The share of revenues from both individual and corporate taxation fell (by 9% and 16% respectively) while the portion from social insurance taxes increased by 38%. As the individual and corporate taxes are progressive, while social insurance taxes are regressive, the outcome was a decrease in the overall progressivity of the federal tax system. Specific changes within the individual income tax code exacerbated the decline in progressivity. The Reagan era failed to control the growing federal deficit. The annual budget deficits of the federal government tripled during the 1980s 13 (OMB, 2003). Partly to raise additional revenue to try to reduce deficits, the first President Bush reneged on his campaign promise of “no new taxes” and agreed to a compromise tax proposal in 1990 that raised the top marginal tax bracket to 31%. President Clinton reinstated additional progressivity in 1993 by creating the 36% and 39.6% individual tax brackets. In 1993, the corporate tax rate was increased slightly to 35%. These changes produced an increase in the progressivity of federal taxes. The most recent important tax legislation was the $1.35 trillion Bush tax cut passed in 2001. The major provisions of this act include lowering individual income tax rates across-the-board, scheduling repeal of the estate tax in 2010, and increasing the amount employees can contribute under various programs for retirement purposes. Many of the bill’s provisions are “back-loaded,” meaning the tax reductions are phased in over time with most of the tax reduction occurring in the future. For example, the top marginal bracket fell from 39.6% in 2001 to 38.6% in 2002 but eventually fell to 35.0% in 2006. 13 This is based on the “on-budget” calculations. The on-budget accounting excludes the Social Security trust fund as well as other minor balances. 15 The Bush tax cut reduced the overall progressiveness of the federal income tax as highincome taxpayers received a disproportionate share of the total cuts (CTJ, 2001). A somewhat smaller tax cut was passed in 2003 that, among other changes, accelerated scheduled tax rate decreases and lowered the maximum tax rate on capital gains and dividends. Most recently, the 2009 American Recovery and Reinvestment Act of 2009 instituted or expanded various tax credits such as a payroll tax credit of $400 per worker and an expanded tax credit for college tuition. IV. Summary Data of U.S. Tax History Until quite recently, tax collections have tended to increase over time; paralleling the increase in the size of the federal government. We see in Figure 1 that federal tax revenues have grown considerably during the 20th century, even after adjusting for inflation. A large increase in federal tax collections occurred during World War II, with relatively consistent growth after about 1960. However, notice occasional declines in federal tax revenues, due either to recessions or to major tax code changes. The growth Figure 1. Tax Collections, 1913-2009 (All values in 2009 dollars) 14 14 Data on state and local taxes are incomplete and/or inconsistent prior to 1932. All data from various editions of the Statistical Abstract of the United States and U.S. Census Bureau (1960). 16 of state and local tax collections, by comparison, has been steadier with less fluctuation. The reason is that state and local tax revenues are derived primarily from property and sales taxes, which vary less than income (particularly corporate income) during business cycles. Another way to illustrate the growth of federal taxation is to measure it relative to national economic output. In Figure 2 we plot federal and state and local tax collections as a share of GDP. Three facts are evident from Figure 2. First, total tax collections have generally grown as a percentage of GDP over the 20th century. Again, the largest leap occurred during World War II, but some additional growth is evident after the war as well. The second fact is that federal tax revenues now substantially exceed state and local tax revenues. While World War II solidified the federal government as the primary tax collector in the U.S., note that this trend began prior to the war. Finally, note the decline in federal taxes as a percentage of GDP since 2000. This is a result of both economic recessions and declines in federal tax rates. In fact, federal taxes as a percentage of GDP were lower in 2009 than in any year since the 1940s. Figure 2. Tax Collections as a Percentage of GDP, 1913-2009 15 As federal revenues grew during the 20th century, the composition of taxation has changed considerably. We see in Figure 3 that at the beginning of the century federal taxation was dominated by excise taxes. Except for a revival of excise taxes during the Depression Era, their importance has generally diminished over time. Corporate taxes became the most significant source of federal revenues for the period 1918-1932. After a period of higher corporate taxes during World War II, corporate taxes have generally diminished in significance relative to other forms of federal taxation. Personal income 15 Data on state and local taxes are incomplete and/or inconsistent prior to 1932. 17 taxes became the largest source of federal revenues in 1944 and have remained so. Since World War II, income taxes have consistently supplied between 40-50% of federal revenues. Since about 1950, social insurance taxes have increased their share of federal revenues from about 10% up to nearly 40%. In fact, social insurance taxes may soon exceed personal income taxes as the largest source of federal revenues. Figure 3. Composition of Federal Taxes, 1913-2009 The composition of state and local taxes, with its increased reliance on sales and property taxes, differs from the composition of federal taxes. Of course, each state has a different tax system – some states have no income and/or sales taxes, and tax rates can differ significantly across states. In this module, we combine tax data for all states rather than presenting a state-by-state analysis. Figure 4 presents the composition of state and local taxes over the period 1945-2009. The two major trends that are evident are a decline in the importance of property taxes and an increase in the importance of personal income taxes except for a recent reversal of these trends in the last few years. While property taxes were the primary source of state and local revenues until the 1970s, sales taxes became the major source of revenues until 2008, when property taxes again became the major revenue source. 18 Figure 4. Composition of State and Local Taxation, 1945-2009 V. THE DISTRIBUTION OF TAXES IN THE UNITED STATES Tax Incidence Analysis There are basically two ways to analyze how the tax burden is distributed. The easiest way is to measure the taxes directly paid by entities, such as households or businesses, classified according to criteria such as household income, business profit levels, etc. These data can be obtained directly from aggregate tax return data published by the IRS and from reports from other government agencies. This approach considers only who actually pays the tax to the government. Thus, it would allocate corporate taxes to corporations, excise taxes to manufacturers, sales taxes to consumers, etc. The second approach, called tax incidence analysis, is more complex yet more meaningful. While taxes are paid by various entities other than individuals, such as corporations, partnerships, and public service organizations, the burden of all taxes ultimately fall on people. The final incidence of taxation is contingent upon how a specific tax translates into changes in prices and changes in economic behavior among consumers and businesses: “Tax incidence is the study of who bears the economic burden of a tax. More generally, it is the positive analysis of the impact of taxes on the distribution of welfare within a society. It begins with the very basic insight that the person who 19 has the legal obligation to make a tax payment may not be the person whose welfare is reduced by the existence of the tax. The statutory incidence of a tax refers to the distribution of those legal tax payments – based on the statutory obligation to remit taxes to the government. ... Economic incidence differs from statutory incidence because of changes in behavior and consequent changes in equilibrium prices. Consumers buy less of a taxed product, so firms produce less and buy fewer inputs – which changes the net price or return to each input. Thus the job of the incidence analyst is to determine how those other prices change, and how those price changes affect different groups of individuals.” (Metcalf and Fullerton, 2002, p. 1) Tax incidence analysis has produced a number of generally accepted conclusions regarding the burden of different tax mechanisms. Remember, for example, that the payroll tax on paper is split equally between employer and employee: “So, who really pays the payroll tax? Is the payroll tax reflected in reduced profits for the employer or in reduced wages for the worker? ... there is generally universal agreement that the real burden of the tax falls almost entirely on the worker. Basically, an employer will only hire a worker if the cost to the employer of hiring that worker is no more than the value that worker can add. So, a worker is paid roughly what he or she adds to the value of production, minus the payroll tax; in effect, the whole tax is deducted from wages. ... to repeat, this is not a controversial view; it is the view of the vast majority of analysts...” (Krugman, 2001, p. 43) The most common assumption made regarding the allocation of corporate taxes is that the burden of these taxes falls almost exclusively on the owners of capital investments. Given the mobility of capital, the burden is not limited to owners of corporate capital but extends to owners of all capital. 16 This result is primarily a theoretical finding – in reality some portion of the corporate tax burden likely falls on workers (through lower wages) and consumers (through higher prices). Excise taxes, although directly paid by manufacturers, are generally attributed entirely to consumers according to their consumption patterns. 17 This result is based on an assumption of perfect competition in the affected industries. Real-world markets, however, are not perfectly competitive. The actual incidence of excise taxes will depend on the degree of competition in an industry. For example, imperfectly competitive industries with upward-sloping supply curves imply that prices increase by less than the tax and that a portion of excise taxes is borne by businesses. 18 16 See summary in Metcalf and Fullerton (2002). See CBO (2008). 18 See Fullerton and Metcalf (2002) for a summary of incidence assumptions and analyses for different types of taxes. 17 20 The burden of sales taxes is generally assumed to fall directly on consumers who buy the taxed goods and services. Again, this is a simplifying assumption – in reality some portion of sales taxes filters to corporate owners, other capital owners, and workers. Personal income taxes paid by households are directly attributed to those households paying the tax. Estate tax burdens fall on the heirs paying the tax. Finally, property tax burdens are generally assumed to fall on property owners although the burden can be passed on renters (some analysts attribute property taxes more broadly to owners of capital). So, for several types of tax mechanisms (personal income, sales, excise, and estate taxes), data on direct tax payments is analogous to tax incidence. However, for other taxes (payroll, corporate, and to a lesser extent property taxes) the direct data on tax payments will differ from the ultimate burden of the tax. Using Effective Tax Rate Data to Determine Tax Progressivity As mentioned before, a tax is progressive if the percentage of income a person pays for the tax increases as income increases. Thus, we can determine whether a tax is progressive or regressive by looking at a table showing the effective tax rates for a particular tax for people in different income categories. If effective tax rates increase (decrease) with increasing income, then the tax is progressive (regressive). Table 2 shows the percentage of income people in each adjusted gross income (AGI) category paid in federal income taxes in 2008, the most recent data available. We see that effective tax rates for the federal income tax tend to increase with increasing income (although not always). For taxpayers making less than $100,000 AGI per year, the Table 2. Distribution of Federal Income Taxes, 2008 AGI Category Percent of Returns 16.7 Average AGI $5,099 Average Income Taxes $177 Effective Income Tax Rate 3.5% 16.0 $14,927 $513 3.4% 13.0 $24,798 $1,421 5.7% 18.0 $39,126 $2,808 7.2% 13.5 $61,470 $5,246 8.5% 8.2 9.7 2.4 0.4 $86,421 $133,208 $285,735 $679,576 $8,037 $16,903 $55,984 $163,513 9.3% 12.7% 19.6% 24.1% 0.2 $3,349,101 $780,550 23.3% $1-$10,000 $10,000-$20,000 $20,000-$30,000 $30,000-$50,000 $50,000-$75,000 $75,000 - $100,000 $100,000-$200,000 $200,000-$500,000 $500,000$1,000,000 More than $1,000,000 21 effective federal income tax rate averages less than 10% of income. For those making more than $200,000 per year, the federal income tax averages more than 20% of income. The federal income tax is clearly progressive because those with higher incomes generally pay a larger share of their income for the tax. For a regressive tax, effective tax rates tend to decrease as income increases. If effective tax rates are constant at different income levels, then a tax is proportional. Looking at effective tax rates by income categories can normally determine whether a tax is progressive or regressive. However, there may be some cases where effective tax rates do not follow a consistent pattern across income levels. For example, suppose that effective taxes first increase but then decrease as we move up the income spectrum. Another limitation with data on effective tax rates is that this approach does not tell us the degree of progressivity or regressivity. We might not be able to determine whether one tax is more progressive than another or whether a particular tax becomes more or less progressive over time. Researchers have come up with several tax indices that measure the progressivity of a tax as a single number. These indices allow direct comparisons across different tax types and across time. The most common tax progressivity index is discussed in Box 2. Effective Tax Rates in the United States Data on the distribution of taxes in the U.S. are available from several sources. The government sources that publish data on tax distribution include the Internal Revenue Service (IRS), the Joint Committee on Taxation (JCT), the Congressional Budget Office (CBO), and the Office of Tax Analysis within the U.S. Treasury. The IRS data are the most detailed but focus on federal income and estate taxes. The IRS publishes data on corporate taxes but does not conduct tax incidence analysis. The JCT occasionally conducts tax incidence analyses but only on the federal income tax, payroll taxes, and federal excise taxes. The CBO adds the incidence of federal corporate taxes to their analyses but still omits the federal estate tax and all state and local taxes. The only source for tax incidence data for all taxes in the U.S. is Citizens for Tax Justice (CTJ), a non-profit organization. CTJ uses data from government sources but has developed its own models of tax incidence. Comparison of tax progressivity data from CTJ with data from the federal sources listed above indicates that their results are generally similar to the government’s results and not biased in either direction (Roach, 2003). 22 BOX 2. MEASURING TAX PROGRESSIVITY – THE SUITS INDEX The Suits Index, developed by Daniel Suits in the 1970s (Suits, 1977), calculates a single number that measures tax progressivity. The approach basically compares the cumulative share of income received by taxpayers, order from lowest to highest, to their cumulative share of taxes paid. For a progressive (regressive) tax, the share of taxes paid will tend to be less (more) than the share of income as we move up the income spectrum. Other tax progressivity indices have been developed but the Suits Index remains the most widely used approach (Anderson, et al., 2003). While the calculation details are not presented here, the Suits Index is a number ranging between –1 and +1. A negative Suits Index means that the tax is regressive while a positive index indicates a progressive tax (with a value of zero for a proportional tax). The Suits Index can be used to compare the degree of progressivity of different tax types as well as determine whether a tax becomes more or less progressive over time. The Suits Index has been used to estimate the progressivity of different tax types in the U.S. for 2007 (Roach, 2010). Table 2.1 shows that the U.S. tax system contains a mixture of progressive and regressive taxes. The federal estate tax is the most progressive tax while the federal corporate and income taxes are also progressive. On the other hand, federal excise taxes are the most regressive. Federal social insurance taxes and overall state and local taxes are also regressive. When all federal taxes are considered, the Suits Index of +0.18 indicates that federal taxation is progressive. The entire U.S. tax system is also progressive, but the recent Suits Indices of +0.05 and +0.06 are closer to a value of zero (a proportional tax) than just the federal tax system. Table 2.1. Suits Index Estimates of the U.S. Tax System, 2007, by Tax Type1 Tax Type Federal Income Federal Social Insurance Federal Excise Federal Corporate Federal Estate and Gift State and Local Total Federal All U.S. Taxes (2001 data) All U.S. Taxes (2004 data) All U.S. Taxes (2009 data) Suits Index +0.42 -0.20 -0.31 +0.51 +0.63 -0.12 +0.18 +0.09 +0.05 +0.06 __________________ 1 – The Suits Index for the federal estate and gift tax is based upon 2008 data. 23 Table 3 presents the tax distribution data from CTJ for 2009. We see that while the federal tax system is progressive, the state and local tax system is, on average, regressive. Overall, the tax system in the U.S. is progressive, although the rate of progressivity levels off at upper income levels and actually reverses at the highest income level in Table 3. Table 3. Effective Tax Rates, 2009 19 Effective Tax Rates Income Group Average Income Lowest 20% $12,400 Second 20% $25,000 Third 20% $40,000 Fourth 20% $66,000 Next 10% $100,000 Next 5% $141,000 Next 4% $245,000 Top 1% $1,328,000 ALL $68,900 Federal Taxes 3.6% 8.7% 13.9% 17.2% 19.0% 20.4% 21.3% 22.3% 18.0% State & Local Taxes 12.4% 11.8% 11.3% 11.3% 11.1% 10.8% 10.2% 8.4% 10.6% All Taxes 16.9% 20.5% 25.3% 28.5% 30.2% 31.2% 31.6% 30.8% 28.6% Tax Progressivity over Time Consistent data are generally not available to determine how the entire tax burden in the U.S. has shifted over time. Most analyses are limited to one, or a few, tax types. Further, interest groups can interpret the available data to support their particular agendas. For an illustration about how the same tax data can be used to support different claims, see Box 3. Analysis of tax progressivity over time indicates that the federal tax system is about as progressive now as it was in the late 1970s (Roach, 2010). The progressivity of the federal tax system declined during the early 1980s, rose in 1987 (the year following the passage of the Tax Reform Act of 1986), either remained stable or rose slightly up to the mid-200s, and decreased slightly since the mid-200s. Complete data on the distribution of state and local taxes are available from Citizens for Tax Justice for 1995, 2002, 2007, and 2009, with Suits Indices of -0.11, -0.07, -0.12, and -0.07 respectively. Thus the available data suggest no obvious overall trend in the regressivity of state and local taxes. The unavailability of consistent data on the distribution of state and local taxes makes determination of the trends in the overall U.S. 19 Data from CTJ, 2010. 24 tax system difficult to determine. As Table 2.1 indicated, total taxes declined in progressivity from 2001 to 2004, and then stayed about the same from 2004 to 2009. BOX 3. INTERPRETING TAX PROGRESSIVITY DATA Has the federal income tax burden on the very wealthy been increasing or decreasing in recent decades? Data published by the CBO reveals that the percent of federal income taxes paid by the highest-income taxpayers has increased steady over the past few decades. In 1979, the top 1% of taxpayers paid about 18.3% of all federal income taxes. In 2007, the top 1% of taxpayers paid over 39.5%. Clearly, these data suggest that the federal income tax has become much more progressive since 1979. However, these statistics represent an incomplete analysis. Specifically, it fails to consider how the proportion of income accruing to the top 1% has changed over the same time period. The increasing tax share paid by high-income taxpayers may be a function of an increase in income, rather than a change in the tax system. In other words, if the share of all income received by the top 1% increased, we would naturally expect that their share of taxes paid would also increase without any changes in the underlying progressivity of the tax system. Income statistics indicate that the share of income going to the top 1% of taxpayers has also increased significantly since 1979. The top 1% of taxpayers received less than 9.2% of income in 1979 but more than 19.4% in 2007. Based on this fact alone, we would expect the top 1% to be paying a greater share of all federal income taxes. So, has the federal income tax burden on the top 1% increased or decreased since 1979? We can combine the tax and income data for a more complete analysis. The share of income going to the top 1% increased by a factor of 2.1 between 1979 and 2007. Meanwhile, their share of taxes paid has increased by a factor of 2.2. This suggests that the share of taxes paid by the top 1% has risen by about as much as much as their share of income – indicating a relatively stable degree of tax progressivity in the federal income tax – a dramatically different conclusion had we only considered data on tax shares! 25 References Brownlee, W. Elliot. 1996. Federal Taxation in America. University of Cambridge Press: Cambridge. Chaptman, Dennis. 2003 “States' Budget Troubles Worsening, Report Finds,” Milwaukee Journal Sentinel, Feb. 5, 2003. Citizens for Tax Justice, Institute on Taxation & Economic Policy. 2003a. “Who Pays? A Distributional Analysis of the Tax Systems in All 50 States, 2nd Edition,” January 2003, http://www.itepnet.org/wp2000/text.pdf. Citizens for Tax Justice. 2010. “All Americans Pay Taxes,” April 15, 2010. http://www.ctj.org/pdf/taxday2010.pdf. Citizens for Tax Justice. 2003b. “Final Tax Plan Tilts Even More Towards Richest,” June 5, 2003 press release, http://www.ctj.org/pdf/sen0522.pdf. Citizens for Tax Justice. 2002. “White House Reveals Nation’s Biggest Problems: The Very Rich Don’t Have Enough Money & Workers Don’t Pay Enough in Taxes,” December 16, 2002 press release, http://www.ctj.org/pdf/flat1202.pdf. Citizens for Tax Justice. 2001. “Final Version of Bush Tax Plan Keeps High-End Tax Cuts, Adds to Long-Term Cost,” May 26, 2001 press release, http://www.ctj.org/html/gwbfinal.htm. Congressional Budget Office, “Effective Federal Tax Rates, 2005,” December 2008. Fullerton, Don, and Gilbert E. Metcalf, 2002. “Tax Incidence,” National Bureau of Economic Research Working Paper 8829. IRS (Internal Revenue Service). Various Years. Statistics of Income, Individual Income Tax Returns. Washington, D.C. IRS (Internal Revenue Service). 2002. “Personal Exemptions and Individual Income Tax Rates, 1913-2002.” Statistics of Income Bulletin Data Release, June 2002. Johnson, Charles M. 2002. “Finding their Balance?” Missoulian, December 8, 2002.Joint Committee on Taxation. 2001. “Updated Distribution of Certain Federal Tax Liabilities by Income Class for Calendar Year 2001,” JCX-65-01.Krugman, Paul. 2002. “For Richer,” The New York Times, October 20, 2002, section 6, page 62. Krugman, Paul. 2001. Fuzzy Math: The Essential Guide to the Bush Tax Cut Plan, W.W. Norton & Company: New York. 26 Martin, Cathie J. 1991. Shifting the Burden: The Struggle over Growth and Corporate Taxation. The University of Chicago Press: Chicago. Metcalf, Gilbert E. and Don Fullerton. 2002. “The Distribution of Tax Burdens: An Introduction,” National Bureau of Economic Research Working Paper 8978. OECD (Organisation for Economic Co-operation and Development). 2010. “More Information on Environmentally Related Taxes, Fees and Charges,” http://www2.oecd.org/ecoinst/queries/index.htm. OMB (Office of Management and Budget). 2003. “Historical Tables, Budget of the United States Government, Fiscal Year 2004.” Washington, D.C. Peterson, Wallace C. 1999. The Social Security Primer: What Every Citizen Should Know. M.E. Sharpe: Armonk, NY. Petska, Tom, and Mike Strudler. 1999. “The Distribution of Individual Income and Taxes: A New Look at an Old Issue.” Paper presented at the 1999 American Economics Association conference, January 3-5, 1999, New York, http://www.irs.gov/taxstats/article/0,,id=112309,00.html. Roach, Brian. 2010. “Progressive and Regressive Taxation in the United States: Who’s Really Paying (and Not Paying) their Fair Share?” Global Development And Environment working paper 10-07, December 2010. Roach, Brian. 2003. “Progressive and Regressive Taxation in the United States: Who’s Really Paying (and Not Paying) their Fair Share?” Global Development And Environment working paper 03-10, October 2003. Skidmore, Max J. 1999. Social Security and Its Enemies. Westview Press: Boulder, CO. Tax Policy Center. 2010. “Wealth Transfer Taxes: Who Pays the Estate Tax?” The Tax Policy Briefing Book, http://www.taxpolicycenter.org/briefing-book/keyelements/estate/who.cfm. Tax Policy Center. 2008. “Estate Tax Returns and Liability Under Current Law and Various Reform Proposals, 2008-2018,” Table T08-0264, October 20, 2008. Tempalski, Jerry. 1998. “Revenue Effects of Major Tax Bills.” Office of Tax Analysis Working Paper 81, December 1998. U.S. Census Bureau. 2003. “Historical Income Tables - Income Equality, Table IE-1,” http://www.census.gov/hhes/income/histinc/ie1.html. U.S. Census Bureau. 2010. The 2010 Statistical Abstract of the United States. Washington, D.C. 27 U.S. Census Bureau. Various Years. Statistical Abstract of the United States. Washington, D.C. U.S. Census Bureau. 1960. Historical Statistics of the United States, Colonial Times to 1957. Washington, D.C. 28 MODULE SUMMARY • The overall tax system in the United States is progressive, meaning that effective tax rates tend to increase as income increases. Progressive taxation is based on the view that higher-income taxpayers can pay higher tax rates without having to forego life’s basic necessities. Progressive taxation can also redress economic inequalities and collect a given level of revenue while maintaining the maximum level of economic growth. • The federal income tax is the most complicated and debated tax in the U.S. tax system. The federal income tax is progressive, with increasing marginal tax rates. Federal income taxes are calculated based on taxable income, which is less than total income because various exemptions and deductions are allowed. • The federal tax system in the U.S. also includes social insurance, corporate, excise, estate, and gifts taxes. Social insurance and excise taxes are regressive while corporate, estate, and gift taxes are progressive. The U.S. tax system also includes state and local taxes, primarily sales, income, and property taxes. • Nearly 70% of the taxes levied in the U.S. are collected at the federal level. The largest federal tax is the income tax, closely followed by social insurance taxes. The most significant non-federal tax is property taxes, followed by sales and income taxes. • Up until the early 1900s, the U.S. tax system primarily relied on excise taxes and tariffs for public revenues. The 16th Amendment, ratified in 1913, created the legal basis for federal income taxation, which up to that point had been prohibited under the Constitution. • Both World Wars led to significant changes in the structure and overall magnitude of taxes in the U.S. By the end of World War II, U.S. taxes were broad-based but progressive and dominated by federal-level taxation. • Tax cuts passed during the Reagan Administration in the 1980s were based on the theory that lower tax rates would spur economic growth, leading to a net increase in tax revenues. This theory was not supported by the evidence, eventually leading to tax increases in the early 1990s. The Bush tax cuts passed in 2001 and 2003 have made federal taxes less progressive. • Tax revenues in the U.S. increased dramatically during the 20th century, even after adjusting for inflation. When measured as a percentage of GDP, tax revenues grew significantly during World War II, grew at a slower pace afterwards, and leveled off recently at around 30% of GDP. 29 • Measuring the distribution of taxes requires tax incidence analysis, which determines the ultimate burden of a tax on taxpayers. Tax incidence analysis generally concludes that social insurance taxes fall on workers, corporate taxes fall on the owners of capital, excise taxes fall on consumers, and property taxes are passed on to renters. • Effective tax rates measured by income level can be used to determine whether a particular tax is progressive or regressive. While the U.S. tax system contains both progressive and regressive taxes, the overall system is progressive. Recent data suggest that federal taxes are becoming less progressive while state and local taxes are becoming more regressive. 30 DISCUSSION QUESTIONS 1. Comment on the following statement: “The fairest type of tax system is one in which everyone pays the same rate of taxation, regardless of income.” Do you agree or disagree with the statement? Why? 2. Suppose you could set the overall effective tax rates across different levels of income. What do you think should be the appropriate effective tax rates for a household of four (two adults and two children) with an income of $25,000? An income of $60,000? An income of $100,000? An income of $500,000? Is the system you devise more or less progressive than the tax system currently in place in the U.S.? How does your system compare with others in your class? 3. The U.S. tax system is currently comprised of many different types of taxes (income, social insurance, corporate, sales, property, etc.). What reasons could be given to support the use of many different tax types in a nation? Do you think that a nation’s tax system should be comprised of many different types of taxes or just one type of tax? If you had to choose just one type of tax to levy in a nation, what type of tax would you choose? Why? 4. Comment on the following statement: “As long as a tax cut reduces taxes for everyone, then everyone will be better off as a result of the tax cut.” Do you agree with this statement? Why or why not? 5. Using the Internet or other sources, look up information about basic structure of the tax system in place in a country other than the United States. What differences are evident in that country’s tax system? Do you think that country has a more or less progressive tax system? Which nation’s tax system is preferable to you? Why? 6. Locate a recent news story about a proposal for a change to the tax system, either at the federal or state level. Summarize the proposed change. Would the change increase or decrease tax progressivity? Who would benefit most from the proposal? Who would be hurt the most from the proposal? Do you support the proposal? Why or why not? 31 ADDITIONAL RESOURCES • All the federal government agencies that work on tax issues maintain web sites that provide tax data and reports. The IRS’s Statistics of Income Bulletins, published four times a year, can be found dating back to 1998 at http://www.irs.gov/taxstats/article/0,,id=117514,00.html. The SOI Bulletins provide data analysis of primarily individual and corporate taxes. Publications produced by the Joint Committee on Taxation can be found at http://www.jct.gov/publications.html. Publications by the Congressional Budget Office related to tax issues, going as far back as the 1970s, are available at http://www.cbo.gov/publications/bysubject.cfm?cat=33. Finally, tax analysis by the U.S. Treasury Department, only dating back to 2001, can be found at http://www.treasury.gov/resource-center/tax-policy/Pages/default.aspx. • A large amount of tax-related data is published annually in the Statistical Abstract of the United States. Each year’s edition includes a chapter on state and local government finances and another chapter on federal government finances. The Census Bureau has recently added select historical editions of the Statistical Abstract dating as far back as 1878, although online availability is more complete for the first half of the 20th century than the latter half of the century (see http://www.census.gov/compendia/statab). • Citizens for Tax Justice publishes many other tax analyses besides those referenced in this module. Their web site is www.ctj.org. Two other non-profit organizations that conduct tax analysis are the Tax Policy Center, a joint venture of the Urban Institute and Brookings Institution, and the Center for Budget and Policy Priorities. The Tax Policy Center (www.taxpolicycenter.org) publishes several reports each month on a wide range of tax issues, including distributional impacts and public budget implications. The CBPP (www.cbpp.org) research focuses on “fiscal policy and public programs that affect low- and moderate-income families and individuals.” Similar to the Tax Policy Center, the CBPP conducts distributional analyses of current tax proposals. • For an opposing view on tax issues, the Tax Foundation (www.taxfoundation.org) publishes tax analyses that generally support lower overall taxes and conclude that the distributional impacts of recent tax cuts are fair. A similar organization, with a more activist agenda, is Americans for Tax Reform (www.atr.org). 32 KEY TERMS AND CONCEPTS Ability-to-pay principle: the idea that higher-income households and individuals should pay higher tax rates than lower-income taxpayers because they are more able to bear the tax without foregoing life’s basic necessities. Adjusted gross income (AGI): the total income of a household or individual minus certain out-of-pocket expenses such as retirement account contributions, student loan interest, tuition, and other allowable subtractions. AGI is calculated on one’s federal tax return. Effective tax rate: one’s total taxes paid divided by some measure of income, such as total income, adjusted gross income, or taxable income. Environmental taxes: taxes levied on a good or service based on the environmental impact of its production or consumption. Estate taxes: taxes on the transfer of large estates to beneficiaries. Excise taxes: taxes on the production, sale, or use of a particular commodity. Exemptions: an amount excluded from taxation based on the number of tax filers and dependents. Gift taxes: taxes levied on large gifts; gift taxes are designed to prevent taxpayers from avoiding estate taxes by giving away their assets while alive. Itemized deductions: certain expenses excluded from federal taxation, including mortgage interest, state taxes, gifts to charity, real estate taxes, and major medical expenses. A taxpayer is allowed to deduct either the standard or itemized deduction, whichever is larger. Marginal propensity to consume: the proportion of a marginal income increase that is spent on consumption goods and services, as opposed to invested or saved. Marginal tax rates: a tax system where a single taxpayer can pay different tax rates on successive portions of income. National consumption tax: a federal-level tax paid on the dollar amount a household or individual spends each year on goods and services, calculated using either a single tax rate or marginal tax rates. National sales tax: a federal-level tax paid on the purchase of certain goods and services, calculated as a percentage of the selling price. 33 Perfect competition: an idealized market structure characterized by many informed small firms with no market power selling undifferentiated products and with complete freedom to enter or exit the market. Progressive tax: a tax in which the percentage of income one pays for the tax increases as one’s income increases. Proportional tax: a tax in which the percentage of income one pays for the tax is constant regardless of income level. Regressive tax: a tax in which the percentage of income one pays for the tax decreases as one’s income increases. Social insurance taxes: taxes paid to support social insurance programs such as Social Security, Medicare, and Medicaid. Standard deduction: a fixed amount of income excluded from federal taxation based on filing status (single, married, etc.). A taxpayer is allowed to deduct either the standard or itemized deduction, whichever is larger. Suits index: an index developed by Daniel Suits in the 1970s to measure the overall progressivity or regressivity of a tax. Tariffs: taxes levied on imported goods and services. Tax incidence analysis: estimating the ultimate financial burden of various taxes on different categories of households by tracing a tax’s impact on market prices and the economic behavior of consumers and businesses. Taxable income: the amount of income used as the basis for determine one’s income taxes. For federal income taxes, taxable income is equal to adjusted gross income (AGI) minus allowable deductions and exemptions. Total income: the total income a household or individual receives from all sources Value-added tax: a tax levied at each stage in the production process of a good or service. Wealth taxes: taxes levied on the value of one’s assets such as real estate, investments, cash, and other personal property. 34 ","Use the source provided only. What is the history of taxes in the United States? Taxes in the United States: History, Fairness, and Current Political Issues by Brian Roach A GDAE Teaching Module on Social and Environmental Issues in Economics Global Development And Environment Institute Tufts University Medford, MA 02155 http://ase.tufts.edu/gdae Copyright © 2010 Global Development And Environment Institute, Tufts University. Copyright release is hereby granted for instructors to copy this module for instructional purposes. Students may also download the module directly from http://ase.tufts.edu/gdae. Comments and feedback from course use are welcomed: Tufts University Global Development And Environment Institute Tufts University Medford, MA 02155 http://ase.tufts.edu/gdae E-mail: gdae@tufts.edu I. INTRODUCTION “The hardest thing in the world to understand is income tax!” – Albert Einstein Taxes are complicated. The U.S. federal tax code contains over three million words – about 6,000 pages. A casual browsing of the tax code’s table of contents offers a glimpse into the vast complexity of federal taxation. Entire sections of the tax code apply specifically to the taxation of vaccines (Sec. 4131-4132), shipowners' mutual protection and indemnity associations (Sec. 526), specially sweetened natural wines (Sec. 5385), and life insurance companies (Sec. 801-818). Annual changes to the tax code imply that taxes will continue to become more complex even as politicians tout tax simplification. Taxes levied by other jurisdictions, such as states and cities, add further complexity to taxation in the U.S. Americans spend billions of hours each year working on their taxes, not to mention the costs of accountants and tax preparers. Fortunately, one needn’t comprehend the imposing complexity of the tax code to understand the crucial role of taxes in American society. Taxation is an important, but commonly neglected, topic for students of economics, political science, and other disciplines. Tax policy has important economic consequences, both for the national economy and for particular groups within the economy. Tax policies are often designed with the intention of stimulating economic growth – although economists differ drastically about which policies are most effective at fostering growth. Taxes can create incentives promoting desirable behavior and disincentives for unwanted behavior. Taxation provides a means to redistribute economic resources towards those with low incomes or special needs. Taxes provide the revenue needed for critical public services such as social security, health care, national defense, and education. Taxation is as much of a political issue as an economic issue. Political leaders have used tax policy to promote their agendas by initiating various tax reforms: decreasing (or increasing) tax rates, changing the definition of taxable income, creating new taxes on specific products, etc. Of course, no one particularly wants to pay taxes. Specific groups, such as small-business owners, farmers, or retired individuals, exert significant political effort to reduce their share of the tax burden. The voluminous tax code is packed with rules that benefit a certain group of taxpayers while inevitably shifting more of the burden to others. Tax policy clearly reflects the expression of power in the U.S. – those without power or favor are left paying more in taxes while others reap the benefits of lower taxes because of their political influence. Broad attempts to reform the tax system have produced dramatic and sudden shifts in tax policy, generally motivated by political factors rather than sound economic theory. For example, the top marginal federal tax bracket on individual income in the U.S. dropped precipitously from 70% to 28% during the 1980s. Tax policy has clearly been used to promote political, as well as economic, agendas. This module is intended to provide a basic understanding of the economic, political, and social context of the entire U.S. tax system. When most people think about taxes, they 1 tend to think only of the federal income tax. However, looking solely at the federal income tax would miss several important issues. Perhaps most importantly, the federal income tax is not the largest tax bill to most Americans. We’ll see that the largest tax for most Americans is federal social insurance taxation. Also, the federal income tax is one of the most progressive taxes in the U.S. system. When all taxes are considered, the U.S. tax system is much less progressive. You may be surprised to find out how many taxes in the U.S. are actually regressive – hitting low-income households at a disproportionately high rate. This module is divided into three major sections. First, some basic terms will be defined and discussed, including tax progressivity and the differences between several types of taxes. Second, a brief overview of tax history in the United States will be presented. Third, data on tax trends will be used to illustrate the changing nature of taxation with a focus on the overall progressivity of the entire tax system. II. THE STRUCTURE OF TAXATION IN THE UNITED STATES Tax Progressivity The overall system of taxation in the United States is progressive. By a progressive tax system, we mean that the percentage of income an individual (or household) pays in taxes tends to increase with increasing income. Not only do those with higher incomes pay more in total taxes, they pay a higher rate of taxes. This is the essence of a progressive tax system. For example, a person making $100,000 in a year might pay 25% of their income in taxes ($25,000 in taxes), while someone with an income of $30,000 might only pay a 10% tax rate ($3,000 in taxes). A tax system may also be regressive or proportional. A regressive tax system is one where the proportion of income paid in taxes tends to decrease as one’s income increases. A proportional tax system simply means that everyone pays the same tax rate regardless of income. A particular tax system may display elements of more than one approach. Consider a hypothetical tax system where one pays a proportional, or flat 1 , rate on income below a certain dollar amount and then progressively increasing rates above that dollar amount. Also, within an overall tax system, some particular taxes might be progressive while other taxes are regressive. We’ll see later on that this the case in the United States. The Reasons for Progressive Taxation The overall tax system of the United States, and in most other countries, is progressive for a number of reasons. A progressive tax embodies the concept that those with high incomes should pay more of their income in taxes because of their greater ability to pay 1 This is not exactly the same concept embodied in current proposals for a “flat tax” in the U.S. These proposals would set just one tax rate but would exclude a given amount of income from taxation. Thus, the flat tax proposals would retain a small degree of progressivity. 2 without critical sacrifices. By paying a tax, any household must forego an equivalent amount of spending on goods, services, or investments. For a high-income household, these foregone opportunities might include a second home, an expensive vehicle, or a purchase of corporate stock. A low-income household, by comparison, might have to forego basic medical care, post-secondary education, or vehicle safety repairs. As income increases, the opportunity costs of paying taxes tend to be associated more with luxuries rather than basic necessities. The ability-to-pay principle recognizes that a flat (or regressive) tax rate would impose a larger burden, in terms of foregone necessities, on low-income households as compared to high-income households. A progressive tax system is also a mechanism to addresses economic inequalities in a society. To evaluate a tax system’s impact on inequality, one must consider both the distribution of taxes paid and the distribution of the benefits derived from tax revenue. If the benefits of programs funded by taxation primarily benefit low-income households while high-income households pay the majority of taxes, then the tax system effectively operates as a transfer mechanism. Increasing the progressivity of the tax system or altering the distribution of benefits allows greater redistribution of economic resources. We’ll mainly focus on tax payments in this module but you should also be aware that the benefits of public expenditures are not evenly distributed throughout society. 2 There is also an economic argument for a progressive tax system – it may yield a given level of public revenue with the least economic impact. To see why, consider how households with different levels of income would respond to a $100 tax cut. A lowincome household would tend to quickly spend the entire amount on needed goods and services – injecting $100 of increased demand into the economy. By comparison, a highincome household might only spend a fraction on goods and services, choosing to save or invest a portion of the money. The money that a high-income household saves or invests does not add to the overall level of effective demand in an economy. 3 In economic terms, we say that the marginal propensity to consume tends to decrease as income increases. So, by collecting proportionally more taxes from high-income households we tend to maintain a higher level of effective demand and more economic activity. Of course, one can posit that a tax system can become too progressive. Extremely high tax rates at high-income levels might create a significant disincentive that reduces the productive capacity of society. Very high taxes might limit the risks taken by entrepreneurs, stifling innovations and technological advances. The desire to “soak the rich” through an extremely progressive tax system might be viewed as unfair, and not just by the rich. In fact, this was a concern of the Constitutional framers – that a democratic majority would eventually impose unduly burdensome taxes on the wealthy minority. We’ll see that their concerns have proved groundless. Many critics of the current tax 2 The distribution of the benefits derived from public expenditures is, of course, more difficult to determine that the distribution of tax payments. The distribution of public assistance programs can be easily measured. However, the distribution of the benefits of scientific research support, business subsidies, public works, national defense, and other expenditures is a difficult research task. 3 Money saved or invested may, however, provide the financial capital necessary to increase the productive capacity of the economy. “Supply-side” economists stress the importance of investment by the wealthy as the key to economic growth. 3 system point to the contrary position – that the powerful minority have used their might to shift the tax burden away from themselves onto an immobilized and misinformed majority. Even if one could devise a tax system that is economically optimal (i.e., producing the highest overall level of economic growth), the topic of taxation encompasses ideals about equity and fairness. A society may be willing to sacrifice some degree of economic growth in exchange for a more equitable distribution of economic resources. This is not to say that economic growth must always be sacrificed with redistribution. In fact, analysis of the U.S. historical data finds that high levels of economic growth tend to be associated with periods of relatively equitable distribution of economic resources (Krugman, 2002). We now turn to differentiating between the different types of taxes levied in the U.S. We’ll first discuss several forms of federal taxation, roughly in order of the revenue they generate, and then consider taxation at the state and local levels. A final section will consider taxes that are generally not used in the U.S. but are important in other nations. Federal Income Taxes The federal income tax is the most visible, complicated, and debated tax in the U.S. The federal income tax was established with the ratification of the 16th Amendment to the U.S. Constitution in 1913. It is levied on wages and salaries as well as income from many other sources including interest, dividends, capital gains, self-employment income, alimony, and prizes. To understand the basic workings of federal income taxes, you need to comprehend only two major issues. First, all income is not taxable – there are important differences between “total income,” “adjusted gross income,” and “taxable income.” Second, you need to know the distinction between a person’s “effective tax rate” and “marginal tax rate.” Total income is simply the sum of income an individual or couple 4 receives from all sources. For most people, the largest portion of total income comes from wages or salaries. Many people also receive investment income from the three standard sources: interest, capital gains, and dividends. Self-employment income is also included in total income, along with other types of income such as alimony, farm income, and gambling winnings. The amount of federal taxes a person owes is not calculated based on total income. Instead, once total income is calculated, tax filers are allowed to subtract some expenses as non-taxable. To obtain adjusted gross income (AGI), certain out-of-pocket expenses made by a tax filer are subtracted from total income. These expenses include individual retirement account contributions, allowable moving expenses, student loan interest, tuition, and a few other expenses. AGI is important because much of the tax data presented by the IRS are sorted by AGI. 4 Married couples have the option of filing their federal taxes either jointly or separately. Children aged 14 or over with sufficient income ($7,700 in 2002) have to file their own federal income tax returns. 4 However, taxes are not calculated based on AGI either. Taxable income is basically AGI less deductions and exemptions. Deductions are either standard or itemized. The standard deduction is a fixed amount excluded from taxation – for the 2009 tax year the standard deduction was $5,700 for single individuals and $11,400 for married couples. Tax filers have the option of itemizing their deductions. To itemize, a tax filer adds up certain expenses made during the year including state taxes, real estate taxes, mortgage interest, gifts to charity, and major medical expenses. 5 If the itemized deductions exceed the standard deduction, then the itemized total is deducted instead. Exemptions are calculated based on the number of tax filers and dependents. A single tax filer with no dependent children can claim one exemption. A married couple with no children can claim two exemptions. Each dependent child counts as one more exemption. Additional exemptions are given for being age 65 or over or blind. In 2009, each exemption excluded a further $3,650 from taxation. 6 Taxable income is obtained by subtracting the deduction and exemption amounts from AGI. This is the amount a taxpayer actually pays taxes on. However, the amount of tax owed is not simply a multiple of taxable income and a single tax rate. The federal income tax system in the U.S. uses increasing marginal tax rates. This means that different tax rates apply on different portions of a person’s income. The concept is best illustrated with an example using the 2009 tax rates. For a single filer, the first $8,350 of taxable income (not total income or AGI) is taxed at a rate of 10%. Taxable income above $8,350 but less than $33,950 is taxed at a rate of 15%. Taxable income above $33,950 but less than $82,250 is taxed at a rate of 25%. Income above $82,250 is taxed at higher marginal rates – 28%, 33%, and 35%. Consider how we would calculate the taxes due for a single tax filer (let’s call her Susan) with no children and a total income of $35,000. Assume Susan contributed $3,000 to an individual retirement account and that this is her only allowable adjustment expense. Thus, her AGI is $32,000. She claims one exemption (herself) in the amount of $3,650 and the standard deduction of $5,700. Thus, Susan’s taxable income is $22,650. On the first $8,350 of taxable income she owes 10% in taxes, or $835. The tax rate on the rest of her income is 15% for a tax of $2,145, (($22,650 - $8,350) × 0.15). So, her total federal income tax bill is $2,980, ($835 + $2,145). Note that Susan’s taxable income is $12,350 less than her total income. While Susan paid a maximum tax rate of 15%, we can see that her effective tax rate is much lower. An effective tax rate can be calculated based on total income, AGI, or taxable income. Suppose we wish to calculate Susan’s effective tax rate based on her total income of $35,000. Given that her federal income tax is $2,980, her effective tax rate is only 8.5%, (($2,980/$35,000) × 100). If we based her effective tax rate on her AGI, it would be 9.3%, (($2,980/$32,000) × 100). 5 Note that some expenses, such as moving costs, are subtracted from total income to obtain AGI while other expenses, such as mortgage interest, are classified as deductions from AGI to obtain taxable income. 6 Those with high incomes (more than $125,100 for an individual) either have their exemption allowance either reduced or eliminated. 5 Social Insurance Taxes Taxes for federal social insurance programs, including Social Security, Medicaid, and Medicare, are taxed separately from income. Social insurance taxes are levied on salaries and wages, as well as income from self-employment. For those employed by others, these taxes are generally deducted directly from their paycheck. These deductions commonly appear as “FICA” taxes – a reference to the Federal Insurance Contributions Act. Self-employed individuals must pay their social insurance taxes when they file their federal income tax returns. Social insurance taxes are actually two separate taxes. The first is a tax of 12.4% of wages, which is primarily used to fund Social Security. Half of this tax is deducted from an employee’s paycheck while the employer is responsible for matching this contribution. The other is a tax of 2.9% for the Medicare program. Again, the employee and employer each pay half. Thus, social insurance taxes normally amount to a 7.65% deduction from an employee’s wage (6.2% + 1.45%). Self-employed individuals are responsible for paying the entire share, 15.3%, themselves. There is a very important difference between these two taxes. The Social Security tax is due only on the first $106,800 (in 2009) of income. On income above $106,800, no additional Social Security tax is paid. In other words, the maximum Social Security tax in 2009 that would be deducted from total wages is $6,622 ($106,800 × 0.062). The Medicare tax, however, is paid on all wages. Thus, the Medicare tax is truly a flat tax while the Social Security tax is a flat tax on the first $106,800 of income but then becomes a regressive tax when we consider income above this limit. Consider the impact of social insurance taxes on two individuals, one making a typical salary of $45,000 and another making $300,000. The typical worker would pay 7.65% on all income, or $3,443, in federal social insurance taxes. The high-income worker would pay the maximum Social Security contribution of $6,622 plus $4,350 for Medicare (1.45% of $300,000) for a total bill of $10,972. This works out to a 3.7% overall tax rate, or less than half the tax rate paid by the typical worker. As the high-income individual pays a lower rate of taxation, we see that social insurance taxes are regressive. Federal Corporate Taxes Corporations must file federal tax forms that are in many ways similar to the forms individuals complete. Corporate taxable income is defined as total revenues minus the cost of goods sold, wages and salaries, depreciation, repairs, interest paid, and other deductions. Thus corporations, like individuals, can take advantage of many deductions to reduce their taxable income. In fact, a corporation may have so many deductions that it actually ends up paying no tax at all or even receives a rebate check from the federal government. We’ll discuss this issue further later in the module. Corporate tax rates, like personal income tax rates, are progressive and calculated on a marginal basis. In 2009, the lowest corporate tax rate, applied to profits lower than 6 $50,000 was 15%. The highest marginal corporate tax rate, applied to profits between $100,000 and $335,000 was 39%. 7 As with individuals, the effective tax rate corporations pay is lower than their marginal tax rate. Federal Excise Taxes An excise tax is a tax on the production, sale, or use of a particular commodity. The federal government collects excise taxes from manufacturers and retailers for the production or sale of a surprising number of products including tires, telephone services, air travel, transportation fuels, alcohol, tobacco, and firearms. Unlike a sales tax, which is evident as an addition to the selling price of a product, excise taxes are normally incorporated into the price of a product. In most cases, consumers are not directly aware of the federal excise taxes they pay. However, every time you buy gas, make a phone call, fly in a commercial plane, or buy tobacco products, you are paying a federal excise tax. For example, the federal excise tax on gasoline as of 2009 was about 18 cents per gallon. Federal excise taxes are another example of a regressive tax. Lower-income households tend to spend a greater portion of their income on goods that are subject to federal excise taxes. This is particularly true for gasoline, tobacco, and alcohol products. Federal Estate and Gift Taxes The vast majority of Americans will never be affected by the federal estate or gift taxes. These taxes apply only to the wealthiest Americans. The estate tax is applied to transfers of large estates to beneficiaries. Similar to the federal income tax, there is an exemption amount that is not taxed. Only estates valued above the exemption amount are subject to the estate tax, and the tax only applies to the value of the estate above the exemption. For example, if the tax rate were 45% of the exemption amount was $2 million, then the tax on an estate valued at $3.5 million would be $675,000, ((3,500,000-2,000,000)*0.45). As of Fall 2010, the future of the estate tax is in limbo. Under the Economic Growth and Tax Relief Act of 2001, estate taxes rates were gradually reduced, and exemption rates gradually increased, over the period 2001-2009. In 2001, the exemption amount was $675,000 million and the tax rate was 55%. For the 2009 tax year, the exemption amount was $3.5 million and the tax rate was 45%. But for 2010, there is no estate tax at all! Then, in 2011, the tax is scheduled to be reinstated with an exemption of $1 million and a tax rate of 55%. The ongoing debate over the estate tax will be covered in more detail later in this module. The transfer of large gifts is also subject to federal taxation. The estate tax and gift tax are complementary because the gift tax essentially prevents people from giving away their estate to beneficiaries tax-free while they are still alive. In 2009, gifts under 7 For the highest profit bracket – profits above $18,333,333 – the marginal rate was 35%. 7 $13,000 were excluded from the tax. Similar to the federal income tax, the gift tax rates are marginal and progressive, with a maximum tax rate of 45%. The estate and gift taxes are the most progressive element of federal taxation. The estate tax is paid exclusively by those with considerable assets. Even further, the majority of all estate taxes are paid by a very small number of wealthy taxpayers. According to the Tax Policy Center, in 2009 the richest 0.1% of those subject to the estate tax pay 42% of the total estate tax revenue. (Tax Policy Center, 2010). State and Local Taxes Like the federal government, state governments also rely on tax revenues to fund public expenditures and transfer programs. Like the federal government, state governments rely on several different tax mechanisms including income taxes, excise taxes, and corporate taxes. Thus, much of the above discussion applies to the tax structures in place in most states. However, there are some important differences that deserve mention. First, nearly all states (45 as of 2010) have instituted some type of general sales tax. State sales tax rates range from 2.9% (Colorado) to 8.25% (California 8 ). A few states reduce the tax rate on certain goods considered to be necessities, such as food and prescription drugs. For example, the general sales tax in Illinois is 6.25% but most food and drug sales are taxed at only 1%. Other states with sales taxes exempt some necessities from taxation entirely. In most states, localities can charge a separate sales tax. While local sales taxes are generally lower than state sales taxes, there are exceptions. In New York the state sales tax is 4% but local sales taxes are often higher than 4%. Unlike income taxes, sales taxes tend to be quite regressive. The reason is that lowincome households tend to spend a larger share of their income on taxable items than high-income households. Consider gasoline – an item that tends to be a smaller share of total expenditures as income rises. An increase in the state taxes on gasoline impacts low-income households more than high-income households. Some states, such as Idaho and Kansas, offer low-income households a tax credit to compensate for the regressive nature of state sales taxes. Forty-one states levy an income tax. 9 Most of these states have several progressive tax brackets (up to 12 rates) similar to the federal income tax. However, state income taxes tend to be much less progressive than the federal income tax. Six states have only one income tax rate, meaning that their income tax approaches a flat tax. Several more states approach a flat tax because the top rate applies at a low income or the rates are relatively constant. For example, Maine’s two tax rates are 6.50% and 6.85%. 8 Local sales taxes are also levied in some municipalities in California, which can raise the total sales tax to as high as 10.75%. 9 Two other states, Tennessee and New Hampshire, levy no state income tax but do tax dividends and interest. 8 Another important distinction between the federal system of taxation and the taxes levied at state and local levels is use of property taxes. In fact, property taxes tend to be the largest revenue source for state and local governments. The primary property tax levied in the U.S. is a tax on real estate, including land, private residences, and commercial properties. Generally, the tax is an annual assessment calculated as a proportion of the value of the property, although the formulas used by localities differ significantly. Property taxes are commonly collected at a local level, but a share of property taxes is allocated for state purposes. Property taxes tend to be regressive, although less regressive than excise and sales taxes. The reason is that high-income households tend to have a lower proportion of their assets subjected to property taxes. While renters do not directly pay property taxes, most economists conclude that the costs of property taxes are largely passed on to renters in the form of higher rents. Composition of Tax Collections in the U.S. Table 1 presents government tax receipts, by tax source, for 2008 (the most recent year for which complete data were available). The table shows that federal taxes dominate the nation’s tax system with nearly 65% of all receipts. The largest federal tax is the income tax, followed closely by social insurance taxes. State and local tax systems are primarily dependent on sales, income, and property taxation. The data in Table 1 cover the major taxes utilized in the United States. To gain a broader perspective on taxation, see Box 1 for a summary of tax mechanisms that are major revenue sources for some countries but are currently non-existent or insignificant in the U.S. Table 1. 2008 U.S. Tax Receipts, by Source Source Federal Taxes Income Taxes Social Insurance Taxes Corporate Taxes Excise Taxes Estate Taxes Total, Federal Taxes State Taxes Sales Taxes Property Taxes Income Taxes Corporate Taxes Excise and Other Taxes Total, State Taxes Total, All Taxes Amount (Millions $) Percent of All Taxes 1,145,700 900,200 304,300 67,300 23,000 2,440,500 30.4% 23.9% 8.1% 1.8% 0.6% 64.7% 304,400 409,700 304,600 57,800 253,900 1,330,400 3,770,900 8.1% 10.9% 8.1% 1.5% 6.7% 35.3% 100.0% Source: U.S. Census Bureau (2010), except for federal estate tax data from Tax Policy Center (2008). 9 BOX 1. TAX ALTERNATIVES It is worthwhile to briefly consider tax types that are not currently important in the U.S. because these mechanisms are used in other countries or are central in various proposals to reform the U.S. tax system. We summarize five tax types here: 1. National sales tax. This would function similar to a state sales tax – as an addition to the retail price of certain products. A national sales tax would clearly be simpler and cheaper to administer than the current federal income tax. It would also encourage savings because, under most proposals, income that is not spent on taxable goods and services is not taxed. There are, however, two significant disadvantages to a national sales tax. First, it would create an incentive for black market exchanges to evade the tax. Second, it can be highly regressive – similar to the regressivity of state sales taxes. A national sales tax could be made less regressive, or even progressive, by providing rebates for low-income households. 2. National consumption tax. This is slightly different from a national sales tax. A household would pay the tax at the end of the year based on the value of its annual consumption of goods and services. Consumption can be calculated as total income less money not spent on goods and services (i.e., invested or saved). Again, a consumption tax would promote savings by exempting it from taxation. A consumption tax could also be designed to be progressive by taxing different levels of consumption at different marginal rates. 3. Value added tax. Most developed countries levy some form of value added tax (VAT). A VAT is levied at each stage in the production process of a product, collected from manufacturers according to the value added at each stage. Thus, the tax is not added to the retail price but incorporated into prices, similar to the way excise taxes become embedded into the price of products. Compared to a national sales tax, a VAT reduces the likelihood of black markets. 4. Wealth taxes. While the U.S. tax system includes local property taxes and, at least for a while, estate taxes, there is no tax on holdings of other assets such as corporate stocks, bonds, and personal property. Several European countries, including Sweden, Spain, and Switzerland, have instituted an annual wealth tax. A wealth tax could be very progressive by setting high rates and becoming effective only at significant wealth levels. 5. Environmental taxes. These are levied on goods and services in proportion to their environmental impact. One example is a carbon tax, which taxes products based on the emissions of carbon attributable to their production or consumption. The rationale of environmental taxation is that it encourages the use and development of goods and services with reduced environmental impacts. Like other taxes on goods and services, environmental taxes can be regressive – suggesting that environmental taxes need to be combined with other progressive taxes or rebates for low-income households. Among developed countries, the U.S. collects the smallest share of tax revenues from environmental taxes (OECD, 2010). 10 III. A BRIEF HISTORY OF TAXATION IN THE U.S. 10 Before the Federal Income Tax The tax mechanisms used during first 150 years or so of U.S. tax history bears little resemblance to the current system of taxation. First, the U.S. Constitution restricted “direct” taxation by the federal government – meaning taxes directly on individuals. Instead, the federal government relied on indirect taxes including taxes on imports (tariffs) and excise taxes. Tariffs were the major source of U.S. government receipts from the beginning of the nation up to the early 1900’s. For example, in 1800 custom duties comprised about 84% of government receipts (U.S. Census Bureau, 1960). Internal federal revenue collections (which exclude tariffs on imports) as recently as the early 20th century were primarily derived from excise taxes on alcohol. In 1900 over 60% of internal revenue collections came from alcohol excise taxes with another 20% from tobacco excise taxes. Another important difference is the scale of government taxation and expenditures relative to the entire economy. Government spending is currently a major portion of the total U.S. economy – in 2010 government expenditures and investment at all levels comprised about 20% of total economic output. In the late 1800s government expenditures were responsible for only about 2% of national output (earlier data on national output are not available). The role of government has become more prominent as a result of expansion of military activity and an increase in the provision of public services. Consequently an overall trend of increasing taxation is evident, although we’ll see that this trend has recently stabilized or reversed. The Constitutional framers were wary of a government’s power to tax. Taxation of the American Colonies by a distant and corrupt England was a driving force behind the American Revolution. Consequently, they believed in decentralized taxation and delegated most public revenue collection to localities, which relied primarily on property taxes. During peacetime the federal government was able to meet its expenses through relatively modest excise taxes and tariffs. During times of war, such as the War of 1812, federal taxes were temporarily raised to finance the war or pay down the ensuing debts. Once the financial crisis passed, taxes were reduced in response to public opposition to high tax rates. Like previous wars, the Civil War initiated an increase in both excise tax and tariff rates. Government revenue collections increased by a factor of seven between 1863 and 1866. Perhaps the most significant tax policy enacted during the Civil War was the institution of the first national income tax. Concerns about the legality of the tax, considering the Constitution’s prohibition of direct taxation, were muted during the national emergency. The income tax rates were low by modern standards – a maximum rate of 10% along with generous exemptions meant that only about 10% of households were subject to any income tax. Still, the income tax generated over 20% of federal revenues in 1865. After 10 The history of taxation is primarily derived from Brownlee (1996). 11 the war, few politicians favored the continuation of the income tax, and in 1872 it was allowed to expire. The impetus for the modern federal income tax rests not with a wartime emergency but with the Populist movement of the late 1800s. The internal tax system in place at the time, based primarily on excise taxes on alcohol and tobacco, was largely regressive. The Populists revived interest in an income tax as a means to introduce a progressive tax based on ability to pay. They saw it as a response to excessive monopoly profits and the concentration of wealth and power. In other words, the tax was not envisioned as a means to generate significant additional public revenue but as a vehicle of social justice. A federal income tax, with a large exemption of $4,000, was instituted in 1894 but the Supreme Court ruled it unconstitutional in 1895. Over the next couple of decades proposals were made for a constitutional amendment to establish a federal income tax. While these attempts were defeated, support for federal income taxation gradually increased. Eventually, in 1913 the 16th Amendment was ratified creating the legal basis for the federal income tax. While the initial income tax was progressive, it was less radical than many desired. In fact, many conservatives expressed guarded support for the measure to prevent a more significant tax. While the income tax was targeted towards the wealthy – in the first few years only about 2% of households paid any income tax – tax rates of only 1%-7% prevented it from generating significant revenues. “...virtually none of the income tax proponents within the government believed that the income tax would become a major, yet alone the dominant, permanent source of revenue within the consumption-based federal tax system.” (Brownlee, 1996, p. 45) These views were to quickly change as the nation required a dramatic increase in revenues to finance World War I. The Growth of Direct Taxation Rather than relying on increases in excise taxes and tariffs to finance World War I, the administration of Woodrow Wilson transformed the income tax framework laid down just a few years previously. Desiring both to raise additional revenue and enforce social justice, the top marginal rate increased dramatically from 7% in 1915 to 67% in 1917 (IRS, 2002). Corporate taxes also became an important revenue source, accounting for over one-quarter of internal revenue collections in 1917. In 1916 the estate tax was created, not necessarily to generate large revenues but as another instrument of progressive taxation. Unlike previous wars, much of the tax system laid down during World War I remained in place after the war. In the period from 1910 to 1925 tariffs fell from about half of government receipts to less than 15%. Meanwhile the new corporate and individual 12 income taxes made up nearly half of government receipts in the mid 1920s. The level of excise tax collections dropped significantly, especially during the years of Prohibition when alcohol excise taxes virtually disappeared. The Great Depression, of course, caused a significant decline in federal receipts. In 1932 tax rates were increased in an attempt to boost federal revenue. Franklin Roosevelt, in the years leading up to World War II, presented progressive taxation as a key element of the New Deal. However, the most significant measure enacted during this period was the creation of old-age insurance. Prior to national social insurance programs, poverty was the common state of the elderly (Skidmore, 1999). By the 1930s, several European countries had already instituted programs of social insurance. Germany was the first to establish old-age and survivors pensions in 1889 (Peterson, 1999). The Great Depression finally motivated policy makers in the U.S. to enact similar legislation. Rather than funding Social Security programs through increases in income, or other, taxes, the funding mechanism was a separate tax, split equally between employers and employees. All employees covered by the system 11 contributed and received benefits regardless of their income. This design was intended to protect the system from political attack. As everyone who pays into the system receives benefits, Social Security is not considered “welfare” that is allocated to only a segment of the population. Also, because Social Security is a separate tax, contributors view their old-age payments as entitlements and oppose attempts to weaken the program. This design has so far proved very successful – Social Security is often called the “third rail” of American politics (i.e., touch it and you die). World War II created yet another emergency situation requiring additional revenues. Similar to Woodrow Wilson during World War I, President Franklin Roosevelt sought to raise revenues primarily from higher taxes on corporations and high-income households. Roosevelt went so far as to state that: “In this time of grave national danger, when all excess income should go to win the war, no American citizen ought to have a net income, after he has paid his taxes, of more than $25,000.” (Brownlee, 1996, p. 91) Roosevelt was unable to obtain enough Congressional support to enact his most progressive proposals. The ensuing compromise did produce a more progressive federal income tax but it also became levied on more households. Personal exemptions were reduced by half between 1939 and 1942 – meaning the income tax reached well into the middle class for the first time. The taxable income subject to the highest marginal rate dropped from $5 million in 1941 down to $200,000 in 1942. Also, the top marginal tax rate reached a record high of 94% in 1944. Another change during World War II was withholding federal taxes from an employee’s paycheck rather than requiring payment of 11 While Social Security has expanded over the years to cover more employees, all workers are not currently covered by the system. For example, about one-quarter of state and local government employees are not included in the system (Peterson, 1999). 13 taxes due at the end of the year. These, as well as other, changes produced a dramatic shift in the structure of federal taxation: “Under the new tax system, the number of individual taxpayers grew from 3.9 million in 1939 to 42.6 million in 1945, and federal income tax collections over the period leaped from $2.2 billion to $35.1 billion. By the end of the war nearly 90 percent of the members of the labor force submitted income-tax returns, and about 60 percent of the labor force paid income taxes. … At the same time, the federal government came to dominate the nation’s revenue system. In 1940, federal income tax had accounted for only 16 percent of the taxes collected by all levels of government; by 1950 the federal income tax produced more than 51 percent of all collections. Installation of the new regime was the most dramatic shift in the nation’s tax policies since 1916.” (Brownlee, 1996, p. 96-97) As in the period after World War I, much of the new tax structure instituted during World War II remained in place after the war. Both major political parties expressed support for a progressive but broad income tax, relatively flat tax rates on corporate profits, and social insurance taxes that were basically regressive. Public support for the existing tax system was boosted by patriotic feelings and broad-based economic growth after the war. Changes to the tax system between the end of World War II and the 1980’s were generally minor. The Social Security tax occasionally increased as more people were receiving benefits. The initial tax rate of 2% (1% each for employers and employees) had increased to 6.13% by 1979. The Medicare and Medicaid programs were established in the 1960s. Across-the-board tax cuts in 1964 reduced marginal rates for both low- and high-income households (the top marginal rate fell from 91% in 1963 to 70% in 1965). Still, government continued to become a more significant portion of the entire economy in the decades after World War II. Total government expenditure and investment increased gradually from less than 18% of GDP in 1946 to over 22% by the mid 1970s. From the “Reagan Revolution” to the Bush Tax Cuts The general stasis of the federal tax system ended in the 1980s with the passage of several important tax reforms. Ronald Reagan was elected president in 1980 on a platform of smaller government and lower taxes. The Economic Recovery Tax Act of 1981 (ERTA) enacted the largest tax cut in American history 12 and inspired tax cutting by many other nations in the 1980s. The supply-side rationale behind ERTA’s sharp reduction in tax rates, particularly on high-income households and capital, was that greater incentives would motivate increased investment and economic activity. The ensuing economic growth and consequent tax revenue growth would, in theory, more than offset the revenue reductions as a result of the tax cuts. Thus, the theory was that tax cuts could actually produce an increase in federal revenues and address the growing federal budget deficit as well. ERTA phased in a reduction in the top tax rate from 70% to 50%, enacted several corporate tax cuts, and indexed many tax parameters to inflation (such as personal exemptions and deductions). 12 When measured in constant dollars (adjusted for inflation). 14 Analysis suggests that, in reality, ERTA resulted in the largest reduction in federal revenues of any tax bill since World War II (Tempalski, 1998). The federal budget deficit continued to grow. The very next year, in 1982, the largest peacetime tax increase was passed (Martin, 1991). The act repealed some of the more revenue-reducing provisions of ERTA, such as accelerated depreciation reductions for corporations, and closed several corporate loopholes in the tax code. Social Security reforms were enacted in 1983 that increased Social Security tax rates and initiated taxation of some benefits. Reagan continued to push for further tax reforms, leading to the Tax Reform Act of 1986 – considered to be the most comprehensive revision of the tax code since the 1950s (Petska and Strudler, 1999). This act reduced top income tax rates even further – from 50% in 1986 to 28% in 1988. Among many other changes, it also lowered the top corporate tax rate from 46% to 34%. Clearly, the “Reagan revolution” is an important era in U.S. tax history, but many people misinterpret it as a period where the size of the federal government was drastically reduced and taxes cut significantly. Despite the two major tax cuts during Reagan’s terms, federal revenue collections increased at nearly the same pace as national output (total federal revenues increased about 76% from 1980-1988 while GDP increased 83%). The actual changes were more evident in the distribution of federal revenues than their total level. The share of revenues from both individual and corporate taxation fell (by 9% and 16% respectively) while the portion from social insurance taxes increased by 38%. As the individual and corporate taxes are progressive, while social insurance taxes are regressive, the outcome was a decrease in the overall progressivity of the federal tax system. Specific changes within the individual income tax code exacerbated the decline in progressivity. The Reagan era failed to control the growing federal deficit. The annual budget deficits of the federal government tripled during the 1980s 13 (OMB, 2003). Partly to raise additional revenue to try to reduce deficits, the first President Bush reneged on his campaign promise of “no new taxes” and agreed to a compromise tax proposal in 1990 that raised the top marginal tax bracket to 31%. President Clinton reinstated additional progressivity in 1993 by creating the 36% and 39.6% individual tax brackets. In 1993, the corporate tax rate was increased slightly to 35%. These changes produced an increase in the progressivity of federal taxes. The most recent important tax legislation was the $1.35 trillion Bush tax cut passed in 2001. The major provisions of this act include lowering individual income tax rates across-the-board, scheduling repeal of the estate tax in 2010, and increasing the amount employees can contribute under various programs for retirement purposes. Many of the bill’s provisions are “back-loaded,” meaning the tax reductions are phased in over time with most of the tax reduction occurring in the future. For example, the top marginal bracket fell from 39.6% in 2001 to 38.6% in 2002 but eventually fell to 35.0% in 2006. 13 This is based on the “on-budget” calculations. The on-budget accounting excludes the Social Security trust fund as well as other minor balances. 15 The Bush tax cut reduced the overall progressiveness of the federal income tax as highincome taxpayers received a disproportionate share of the total cuts (CTJ, 2001). A somewhat smaller tax cut was passed in 2003 that, among other changes, accelerated scheduled tax rate decreases and lowered the maximum tax rate on capital gains and dividends. Most recently, the 2009 American Recovery and Reinvestment Act of 2009 instituted or expanded various tax credits such as a payroll tax credit of $400 per worker and an expanded tax credit for college tuition. IV. Summary Data of U.S. Tax History Until quite recently, tax collections have tended to increase over time; paralleling the increase in the size of the federal government. We see in Figure 1 that federal tax revenues have grown considerably during the 20th century, even after adjusting for inflation. A large increase in federal tax collections occurred during World War II, with relatively consistent growth after about 1960. However, notice occasional declines in federal tax revenues, due either to recessions or to major tax code changes. The growth Figure 1. Tax Collections, 1913-2009 (All values in 2009 dollars) 14 14 Data on state and local taxes are incomplete and/or inconsistent prior to 1932. All data from various editions of the Statistical Abstract of the United States and U.S. Census Bureau (1960). 16 of state and local tax collections, by comparison, has been steadier with less fluctuation. The reason is that state and local tax revenues are derived primarily from property and sales taxes, which vary less than income (particularly corporate income) during business cycles. Another way to illustrate the growth of federal taxation is to measure it relative to national economic output. In Figure 2 we plot federal and state and local tax collections as a share of GDP. Three facts are evident from Figure 2. First, total tax collections have generally grown as a percentage of GDP over the 20th century. Again, the largest leap occurred during World War II, but some additional growth is evident after the war as well. The second fact is that federal tax revenues now substantially exceed state and local tax revenues. While World War II solidified the federal government as the primary tax collector in the U.S., note that this trend began prior to the war. Finally, note the decline in federal taxes as a percentage of GDP since 2000. This is a result of both economic recessions and declines in federal tax rates. In fact, federal taxes as a percentage of GDP were lower in 2009 than in any year since the 1940s. Figure 2. Tax Collections as a Percentage of GDP, 1913-2009 15 As federal revenues grew during the 20th century, the composition of taxation has changed considerably. We see in Figure 3 that at the beginning of the century federal taxation was dominated by excise taxes. Except for a revival of excise taxes during the Depression Era, their importance has generally diminished over time. Corporate taxes became the most significant source of federal revenues for the period 1918-1932. After a period of higher corporate taxes during World War II, corporate taxes have generally diminished in significance relative to other forms of federal taxation. Personal income 15 Data on state and local taxes are incomplete and/or inconsistent prior to 1932. 17 taxes became the largest source of federal revenues in 1944 and have remained so. Since World War II, income taxes have consistently supplied between 40-50% of federal revenues. Since about 1950, social insurance taxes have increased their share of federal revenues from about 10% up to nearly 40%. In fact, social insurance taxes may soon exceed personal income taxes as the largest source of federal revenues. Figure 3. Composition of Federal Taxes, 1913-2009 The composition of state and local taxes, with its increased reliance on sales and property taxes, differs from the composition of federal taxes. Of course, each state has a different tax system – some states have no income and/or sales taxes, and tax rates can differ significantly across states. In this module, we combine tax data for all states rather than presenting a state-by-state analysis. Figure 4 presents the composition of state and local taxes over the period 1945-2009. The two major trends that are evident are a decline in the importance of property taxes and an increase in the importance of personal income taxes except for a recent reversal of these trends in the last few years. While property taxes were the primary source of state and local revenues until the 1970s, sales taxes became the major source of revenues until 2008, when property taxes again became the major revenue source. 18 Figure 4. Composition of State and Local Taxation, 1945-2009 V. THE DISTRIBUTION OF TAXES IN THE UNITED STATES Tax Incidence Analysis There are basically two ways to analyze how the tax burden is distributed. The easiest way is to measure the taxes directly paid by entities, such as households or businesses, classified according to criteria such as household income, business profit levels, etc. These data can be obtained directly from aggregate tax return data published by the IRS and from reports from other government agencies. This approach considers only who actually pays the tax to the government. Thus, it would allocate corporate taxes to corporations, excise taxes to manufacturers, sales taxes to consumers, etc. The second approach, called tax incidence analysis, is more complex yet more meaningful. While taxes are paid by various entities other than individuals, such as corporations, partnerships, and public service organizations, the burden of all taxes ultimately fall on people. The final incidence of taxation is contingent upon how a specific tax translates into changes in prices and changes in economic behavior among consumers and businesses: “Tax incidence is the study of who bears the economic burden of a tax. More generally, it is the positive analysis of the impact of taxes on the distribution of welfare within a society. It begins with the very basic insight that the person who 19 has the legal obligation to make a tax payment may not be the person whose welfare is reduced by the existence of the tax. The statutory incidence of a tax refers to the distribution of those legal tax payments – based on the statutory obligation to remit taxes to the government. ... Economic incidence differs from statutory incidence because of changes in behavior and consequent changes in equilibrium prices. Consumers buy less of a taxed product, so firms produce less and buy fewer inputs – which changes the net price or return to each input. Thus the job of the incidence analyst is to determine how those other prices change, and how those price changes affect different groups of individuals.” (Metcalf and Fullerton, 2002, p. 1) Tax incidence analysis has produced a number of generally accepted conclusions regarding the burden of different tax mechanisms. Remember, for example, that the payroll tax on paper is split equally between employer and employee: “So, who really pays the payroll tax? Is the payroll tax reflected in reduced profits for the employer or in reduced wages for the worker? ... there is generally universal agreement that the real burden of the tax falls almost entirely on the worker. Basically, an employer will only hire a worker if the cost to the employer of hiring that worker is no more than the value that worker can add. So, a worker is paid roughly what he or she adds to the value of production, minus the payroll tax; in effect, the whole tax is deducted from wages. ... to repeat, this is not a controversial view; it is the view of the vast majority of analysts...” (Krugman, 2001, p. 43) The most common assumption made regarding the allocation of corporate taxes is that the burden of these taxes falls almost exclusively on the owners of capital investments. Given the mobility of capital, the burden is not limited to owners of corporate capital but extends to owners of all capital. 16 This result is primarily a theoretical finding – in reality some portion of the corporate tax burden likely falls on workers (through lower wages) and consumers (through higher prices). Excise taxes, although directly paid by manufacturers, are generally attributed entirely to consumers according to their consumption patterns. 17 This result is based on an assumption of perfect competition in the affected industries. Real-world markets, however, are not perfectly competitive. The actual incidence of excise taxes will depend on the degree of competition in an industry. For example, imperfectly competitive industries with upward-sloping supply curves imply that prices increase by less than the tax and that a portion of excise taxes is borne by businesses. 18 16 See summary in Metcalf and Fullerton (2002). See CBO (2008). 18 See Fullerton and Metcalf (2002) for a summary of incidence assumptions and analyses for different types of taxes. 17 20 The burden of sales taxes is generally assumed to fall directly on consumers who buy the taxed goods and services. Again, this is a simplifying assumption – in reality some portion of sales taxes filters to corporate owners, other capital owners, and workers. Personal income taxes paid by households are directly attributed to those households paying the tax. Estate tax burdens fall on the heirs paying the tax. Finally, property tax burdens are generally assumed to fall on property owners although the burden can be passed on renters (some analysts attribute property taxes more broadly to owners of capital). So, for several types of tax mechanisms (personal income, sales, excise, and estate taxes), data on direct tax payments is analogous to tax incidence. However, for other taxes (payroll, corporate, and to a lesser extent property taxes) the direct data on tax payments will differ from the ultimate burden of the tax. Using Effective Tax Rate Data to Determine Tax Progressivity As mentioned before, a tax is progressive if the percentage of income a person pays for the tax increases as income increases. Thus, we can determine whether a tax is progressive or regressive by looking at a table showing the effective tax rates for a particular tax for people in different income categories. If effective tax rates increase (decrease) with increasing income, then the tax is progressive (regressive). Table 2 shows the percentage of income people in each adjusted gross income (AGI) category paid in federal income taxes in 2008, the most recent data available. We see that effective tax rates for the federal income tax tend to increase with increasing income (although not always). For taxpayers making less than $100,000 AGI per year, the Table 2. Distribution of Federal Income Taxes, 2008 AGI Category Percent of Returns 16.7 Average AGI $5,099 Average Income Taxes $177 Effective Income Tax Rate 3.5% 16.0 $14,927 $513 3.4% 13.0 $24,798 $1,421 5.7% 18.0 $39,126 $2,808 7.2% 13.5 $61,470 $5,246 8.5% 8.2 9.7 2.4 0.4 $86,421 $133,208 $285,735 $679,576 $8,037 $16,903 $55,984 $163,513 9.3% 12.7% 19.6% 24.1% 0.2 $3,349,101 $780,550 23.3% $1-$10,000 $10,000-$20,000 $20,000-$30,000 $30,000-$50,000 $50,000-$75,000 $75,000 - $100,000 $100,000-$200,000 $200,000-$500,000 $500,000$1,000,000 More than $1,000,000 21 effective federal income tax rate averages less than 10% of income. For those making more than $200,000 per year, the federal income tax averages more than 20% of income. The federal income tax is clearly progressive because those with higher incomes generally pay a larger share of their income for the tax. For a regressive tax, effective tax rates tend to decrease as income increases. If effective tax rates are constant at different income levels, then a tax is proportional. Looking at effective tax rates by income categories can normally determine whether a tax is progressive or regressive. However, there may be some cases where effective tax rates do not follow a consistent pattern across income levels. For example, suppose that effective taxes first increase but then decrease as we move up the income spectrum. Another limitation with data on effective tax rates is that this approach does not tell us the degree of progressivity or regressivity. We might not be able to determine whether one tax is more progressive than another or whether a particular tax becomes more or less progressive over time. Researchers have come up with several tax indices that measure the progressivity of a tax as a single number. These indices allow direct comparisons across different tax types and across time. The most common tax progressivity index is discussed in Box 2. Effective Tax Rates in the United States Data on the distribution of taxes in the U.S. are available from several sources. The government sources that publish data on tax distribution include the Internal Revenue Service (IRS), the Joint Committee on Taxation (JCT), the Congressional Budget Office (CBO), and the Office of Tax Analysis within the U.S. Treasury. The IRS data are the most detailed but focus on federal income and estate taxes. The IRS publishes data on corporate taxes but does not conduct tax incidence analysis. The JCT occasionally conducts tax incidence analyses but only on the federal income tax, payroll taxes, and federal excise taxes. The CBO adds the incidence of federal corporate taxes to their analyses but still omits the federal estate tax and all state and local taxes. The only source for tax incidence data for all taxes in the U.S. is Citizens for Tax Justice (CTJ), a non-profit organization. CTJ uses data from government sources but has developed its own models of tax incidence. Comparison of tax progressivity data from CTJ with data from the federal sources listed above indicates that their results are generally similar to the government’s results and not biased in either direction (Roach, 2003). 22 BOX 2. MEASURING TAX PROGRESSIVITY – THE SUITS INDEX The Suits Index, developed by Daniel Suits in the 1970s (Suits, 1977), calculates a single number that measures tax progressivity. The approach basically compares the cumulative share of income received by taxpayers, order from lowest to highest, to their cumulative share of taxes paid. For a progressive (regressive) tax, the share of taxes paid will tend to be less (more) than the share of income as we move up the income spectrum. Other tax progressivity indices have been developed but the Suits Index remains the most widely used approach (Anderson, et al., 2003). While the calculation details are not presented here, the Suits Index is a number ranging between –1 and +1. A negative Suits Index means that the tax is regressive while a positive index indicates a progressive tax (with a value of zero for a proportional tax). The Suits Index can be used to compare the degree of progressivity of different tax types as well as determine whether a tax becomes more or less progressive over time. The Suits Index has been used to estimate the progressivity of different tax types in the U.S. for 2007 (Roach, 2010). Table 2.1 shows that the U.S. tax system contains a mixture of progressive and regressive taxes. The federal estate tax is the most progressive tax while the federal corporate and income taxes are also progressive. On the other hand, federal excise taxes are the most regressive. Federal social insurance taxes and overall state and local taxes are also regressive. When all federal taxes are considered, the Suits Index of +0.18 indicates that federal taxation is progressive. The entire U.S. tax system is also progressive, but the recent Suits Indices of +0.05 and +0.06 are closer to a value of zero (a proportional tax) than just the federal tax system. Table 2.1. Suits Index Estimates of the U.S. Tax System, 2007, by Tax Type1 Tax Type Federal Income Federal Social Insurance Federal Excise Federal Corporate Federal Estate and Gift State and Local Total Federal All U.S. Taxes (2001 data) All U.S. Taxes (2004 data) All U.S. Taxes (2009 data) Suits Index +0.42 -0.20 -0.31 +0.51 +0.63 -0.12 +0.18 +0.09 +0.05 +0.06 __________________ 1 – The Suits Index for the federal estate and gift tax is based upon 2008 data. 23 Table 3 presents the tax distribution data from CTJ for 2009. We see that while the federal tax system is progressive, the state and local tax system is, on average, regressive. Overall, the tax system in the U.S. is progressive, although the rate of progressivity levels off at upper income levels and actually reverses at the highest income level in Table 3. Table 3. Effective Tax Rates, 2009 19 Effective Tax Rates Income Group Average Income Lowest 20% $12,400 Second 20% $25,000 Third 20% $40,000 Fourth 20% $66,000 Next 10% $100,000 Next 5% $141,000 Next 4% $245,000 Top 1% $1,328,000 ALL $68,900 Federal Taxes 3.6% 8.7% 13.9% 17.2% 19.0% 20.4% 21.3% 22.3% 18.0% State & Local Taxes 12.4% 11.8% 11.3% 11.3% 11.1% 10.8% 10.2% 8.4% 10.6% All Taxes 16.9% 20.5% 25.3% 28.5% 30.2% 31.2% 31.6% 30.8% 28.6% Tax Progressivity over Time Consistent data are generally not available to determine how the entire tax burden in the U.S. has shifted over time. Most analyses are limited to one, or a few, tax types. Further, interest groups can interpret the available data to support their particular agendas. For an illustration about how the same tax data can be used to support different claims, see Box 3. Analysis of tax progressivity over time indicates that the federal tax system is about as progressive now as it was in the late 1970s (Roach, 2010). The progressivity of the federal tax system declined during the early 1980s, rose in 1987 (the year following the passage of the Tax Reform Act of 1986), either remained stable or rose slightly up to the mid-200s, and decreased slightly since the mid-200s. Complete data on the distribution of state and local taxes are available from Citizens for Tax Justice for 1995, 2002, 2007, and 2009, with Suits Indices of -0.11, -0.07, -0.12, and -0.07 respectively. Thus the available data suggest no obvious overall trend in the regressivity of state and local taxes. The unavailability of consistent data on the distribution of state and local taxes makes determination of the trends in the overall U.S. 19 Data from CTJ, 2010. 24 tax system difficult to determine. As Table 2.1 indicated, total taxes declined in progressivity from 2001 to 2004, and then stayed about the same from 2004 to 2009. BOX 3. INTERPRETING TAX PROGRESSIVITY DATA Has the federal income tax burden on the very wealthy been increasing or decreasing in recent decades? Data published by the CBO reveals that the percent of federal income taxes paid by the highest-income taxpayers has increased steady over the past few decades. In 1979, the top 1% of taxpayers paid about 18.3% of all federal income taxes. In 2007, the top 1% of taxpayers paid over 39.5%. Clearly, these data suggest that the federal income tax has become much more progressive since 1979. However, these statistics represent an incomplete analysis. Specifically, it fails to consider how the proportion of income accruing to the top 1% has changed over the same time period. The increasing tax share paid by high-income taxpayers may be a function of an increase in income, rather than a change in the tax system. In other words, if the share of all income received by the top 1% increased, we would naturally expect that their share of taxes paid would also increase without any changes in the underlying progressivity of the tax system. Income statistics indicate that the share of income going to the top 1% of taxpayers has also increased significantly since 1979. The top 1% of taxpayers received less than 9.2% of income in 1979 but more than 19.4% in 2007. Based on this fact alone, we would expect the top 1% to be paying a greater share of all federal income taxes. So, has the federal income tax burden on the top 1% increased or decreased since 1979? We can combine the tax and income data for a more complete analysis. The share of income going to the top 1% increased by a factor of 2.1 between 1979 and 2007. Meanwhile, their share of taxes paid has increased by a factor of 2.2. This suggests that the share of taxes paid by the top 1% has risen by about as much as much as their share of income – indicating a relatively stable degree of tax progressivity in the federal income tax – a dramatically different conclusion had we only considered data on tax shares! 25 References Brownlee, W. Elliot. 1996. Federal Taxation in America. University of Cambridge Press: Cambridge. Chaptman, Dennis. 2003 “States' Budget Troubles Worsening, Report Finds,” Milwaukee Journal Sentinel, Feb. 5, 2003. Citizens for Tax Justice, Institute on Taxation & Economic Policy. 2003a. “Who Pays? A Distributional Analysis of the Tax Systems in All 50 States, 2nd Edition,” January 2003, http://www.itepnet.org/wp2000/text.pdf. Citizens for Tax Justice. 2010. “All Americans Pay Taxes,” April 15, 2010. http://www.ctj.org/pdf/taxday2010.pdf. Citizens for Tax Justice. 2003b. “Final Tax Plan Tilts Even More Towards Richest,” June 5, 2003 press release, http://www.ctj.org/pdf/sen0522.pdf. Citizens for Tax Justice. 2002. “White House Reveals Nation’s Biggest Problems: The Very Rich Don’t Have Enough Money & Workers Don’t Pay Enough in Taxes,” December 16, 2002 press release, http://www.ctj.org/pdf/flat1202.pdf. Citizens for Tax Justice. 2001. “Final Version of Bush Tax Plan Keeps High-End Tax Cuts, Adds to Long-Term Cost,” May 26, 2001 press release, http://www.ctj.org/html/gwbfinal.htm. Congressional Budget Office, “Effective Federal Tax Rates, 2005,” December 2008. Fullerton, Don, and Gilbert E. Metcalf, 2002. “Tax Incidence,” National Bureau of Economic Research Working Paper 8829. IRS (Internal Revenue Service). Various Years. Statistics of Income, Individual Income Tax Returns. Washington, D.C. IRS (Internal Revenue Service). 2002. “Personal Exemptions and Individual Income Tax Rates, 1913-2002.” Statistics of Income Bulletin Data Release, June 2002. Johnson, Charles M. 2002. “Finding their Balance?” Missoulian, December 8, 2002.Joint Committee on Taxation. 2001. “Updated Distribution of Certain Federal Tax Liabilities by Income Class for Calendar Year 2001,” JCX-65-01.Krugman, Paul. 2002. “For Richer,” The New York Times, October 20, 2002, section 6, page 62. Krugman, Paul. 2001. Fuzzy Math: The Essential Guide to the Bush Tax Cut Plan, W.W. Norton & Company: New York. 26 Martin, Cathie J. 1991. Shifting the Burden: The Struggle over Growth and Corporate Taxation. The University of Chicago Press: Chicago. Metcalf, Gilbert E. and Don Fullerton. 2002. “The Distribution of Tax Burdens: An Introduction,” National Bureau of Economic Research Working Paper 8978. OECD (Organisation for Economic Co-operation and Development). 2010. “More Information on Environmentally Related Taxes, Fees and Charges,” http://www2.oecd.org/ecoinst/queries/index.htm. OMB (Office of Management and Budget). 2003. “Historical Tables, Budget of the United States Government, Fiscal Year 2004.” Washington, D.C. Peterson, Wallace C. 1999. The Social Security Primer: What Every Citizen Should Know. M.E. Sharpe: Armonk, NY. Petska, Tom, and Mike Strudler. 1999. “The Distribution of Individual Income and Taxes: A New Look at an Old Issue.” Paper presented at the 1999 American Economics Association conference, January 3-5, 1999, New York, http://www.irs.gov/taxstats/article/0,,id=112309,00.html. Roach, Brian. 2010. “Progressive and Regressive Taxation in the United States: Who’s Really Paying (and Not Paying) their Fair Share?” Global Development And Environment working paper 10-07, December 2010. Roach, Brian. 2003. “Progressive and Regressive Taxation in the United States: Who’s Really Paying (and Not Paying) their Fair Share?” Global Development And Environment working paper 03-10, October 2003. Skidmore, Max J. 1999. Social Security and Its Enemies. Westview Press: Boulder, CO. Tax Policy Center. 2010. “Wealth Transfer Taxes: Who Pays the Estate Tax?” The Tax Policy Briefing Book, http://www.taxpolicycenter.org/briefing-book/keyelements/estate/who.cfm. Tax Policy Center. 2008. “Estate Tax Returns and Liability Under Current Law and Various Reform Proposals, 2008-2018,” Table T08-0264, October 20, 2008. Tempalski, Jerry. 1998. “Revenue Effects of Major Tax Bills.” Office of Tax Analysis Working Paper 81, December 1998. U.S. Census Bureau. 2003. “Historical Income Tables - Income Equality, Table IE-1,” http://www.census.gov/hhes/income/histinc/ie1.html. U.S. Census Bureau. 2010. The 2010 Statistical Abstract of the United States. Washington, D.C. 27 U.S. Census Bureau. Various Years. Statistical Abstract of the United States. Washington, D.C. U.S. Census Bureau. 1960. Historical Statistics of the United States, Colonial Times to 1957. Washington, D.C. 28 MODULE SUMMARY • The overall tax system in the United States is progressive, meaning that effective tax rates tend to increase as income increases. Progressive taxation is based on the view that higher-income taxpayers can pay higher tax rates without having to forego life’s basic necessities. Progressive taxation can also redress economic inequalities and collect a given level of revenue while maintaining the maximum level of economic growth. • The federal income tax is the most complicated and debated tax in the U.S. tax system. The federal income tax is progressive, with increasing marginal tax rates. Federal income taxes are calculated based on taxable income, which is less than total income because various exemptions and deductions are allowed. • The federal tax system in the U.S. also includes social insurance, corporate, excise, estate, and gifts taxes. Social insurance and excise taxes are regressive while corporate, estate, and gift taxes are progressive. The U.S. tax system also includes state and local taxes, primarily sales, income, and property taxes. • Nearly 70% of the taxes levied in the U.S. are collected at the federal level. The largest federal tax is the income tax, closely followed by social insurance taxes. The most significant non-federal tax is property taxes, followed by sales and income taxes. • Up until the early 1900s, the U.S. tax system primarily relied on excise taxes and tariffs for public revenues. The 16th Amendment, ratified in 1913, created the legal basis for federal income taxation, which up to that point had been prohibited under the Constitution. • Both World Wars led to significant changes in the structure and overall magnitude of taxes in the U.S. By the end of World War II, U.S. taxes were broad-based but progressive and dominated by federal-level taxation. • Tax cuts passed during the Reagan Administration in the 1980s were based on the theory that lower tax rates would spur economic growth, leading to a net increase in tax revenues. This theory was not supported by the evidence, eventually leading to tax increases in the early 1990s. The Bush tax cuts passed in 2001 and 2003 have made federal taxes less progressive. • Tax revenues in the U.S. increased dramatically during the 20th century, even after adjusting for inflation. When measured as a percentage of GDP, tax revenues grew significantly during World War II, grew at a slower pace afterwards, and leveled off recently at around 30% of GDP. 29 • Measuring the distribution of taxes requires tax incidence analysis, which determines the ultimate burden of a tax on taxpayers. Tax incidence analysis generally concludes that social insurance taxes fall on workers, corporate taxes fall on the owners of capital, excise taxes fall on consumers, and property taxes are passed on to renters. • Effective tax rates measured by income level can be used to determine whether a particular tax is progressive or regressive. While the U.S. tax system contains both progressive and regressive taxes, the overall system is progressive. Recent data suggest that federal taxes are becoming less progressive while state and local taxes are becoming more regressive. 30 DISCUSSION QUESTIONS 1. Comment on the following statement: “The fairest type of tax system is one in which everyone pays the same rate of taxation, regardless of income.” Do you agree or disagree with the statement? Why? 2. Suppose you could set the overall effective tax rates across different levels of income. What do you think should be the appropriate effective tax rates for a household of four (two adults and two children) with an income of $25,000? An income of $60,000? An income of $100,000? An income of $500,000? Is the system you devise more or less progressive than the tax system currently in place in the U.S.? How does your system compare with others in your class? 3. The U.S. tax system is currently comprised of many different types of taxes (income, social insurance, corporate, sales, property, etc.). What reasons could be given to support the use of many different tax types in a nation? Do you think that a nation’s tax system should be comprised of many different types of taxes or just one type of tax? If you had to choose just one type of tax to levy in a nation, what type of tax would you choose? Why? 4. Comment on the following statement: “As long as a tax cut reduces taxes for everyone, then everyone will be better off as a result of the tax cut.” Do you agree with this statement? Why or why not? 5. Using the Internet or other sources, look up information about basic structure of the tax system in place in a country other than the United States. What differences are evident in that country’s tax system? Do you think that country has a more or less progressive tax system? Which nation’s tax system is preferable to you? Why? 6. Locate a recent news story about a proposal for a change to the tax system, either at the federal or state level. Summarize the proposed change. Would the change increase or decrease tax progressivity? Who would benefit most from the proposal? Who would be hurt the most from the proposal? Do you support the proposal? Why or why not? 31 ADDITIONAL RESOURCES • All the federal government agencies that work on tax issues maintain web sites that provide tax data and reports. The IRS’s Statistics of Income Bulletins, published four times a year, can be found dating back to 1998 at http://www.irs.gov/taxstats/article/0,,id=117514,00.html. The SOI Bulletins provide data analysis of primarily individual and corporate taxes. Publications produced by the Joint Committee on Taxation can be found at http://www.jct.gov/publications.html. Publications by the Congressional Budget Office related to tax issues, going as far back as the 1970s, are available at http://www.cbo.gov/publications/bysubject.cfm?cat=33. Finally, tax analysis by the U.S. Treasury Department, only dating back to 2001, can be found at http://www.treasury.gov/resource-center/tax-policy/Pages/default.aspx. • A large amount of tax-related data is published annually in the Statistical Abstract of the United States. Each year’s edition includes a chapter on state and local government finances and another chapter on federal government finances. The Census Bureau has recently added select historical editions of the Statistical Abstract dating as far back as 1878, although online availability is more complete for the first half of the 20th century than the latter half of the century (see http://www.census.gov/compendia/statab). • Citizens for Tax Justice publishes many other tax analyses besides those referenced in this module. Their web site is www.ctj.org. Two other non-profit organizations that conduct tax analysis are the Tax Policy Center, a joint venture of the Urban Institute and Brookings Institution, and the Center for Budget and Policy Priorities. The Tax Policy Center (www.taxpolicycenter.org) publishes several reports each month on a wide range of tax issues, including distributional impacts and public budget implications. The CBPP (www.cbpp.org) research focuses on “fiscal policy and public programs that affect low- and moderate-income families and individuals.” Similar to the Tax Policy Center, the CBPP conducts distributional analyses of current tax proposals. • For an opposing view on tax issues, the Tax Foundation (www.taxfoundation.org) publishes tax analyses that generally support lower overall taxes and conclude that the distributional impacts of recent tax cuts are fair. A similar organization, with a more activist agenda, is Americans for Tax Reform (www.atr.org). 32 KEY TERMS AND CONCEPTS Ability-to-pay principle: the idea that higher-income households and individuals should pay higher tax rates than lower-income taxpayers because they are more able to bear the tax without foregoing life’s basic necessities. Adjusted gross income (AGI): the total income of a household or individual minus certain out-of-pocket expenses such as retirement account contributions, student loan interest, tuition, and other allowable subtractions. AGI is calculated on one’s federal tax return. Effective tax rate: one’s total taxes paid divided by some measure of income, such as total income, adjusted gross income, or taxable income. Environmental taxes: taxes levied on a good or service based on the environmental impact of its production or consumption. Estate taxes: taxes on the transfer of large estates to beneficiaries. Excise taxes: taxes on the production, sale, or use of a particular commodity. Exemptions: an amount excluded from taxation based on the number of tax filers and dependents. Gift taxes: taxes levied on large gifts; gift taxes are designed to prevent taxpayers from avoiding estate taxes by giving away their assets while alive. Itemized deductions: certain expenses excluded from federal taxation, including mortgage interest, state taxes, gifts to charity, real estate taxes, and major medical expenses. A taxpayer is allowed to deduct either the standard or itemized deduction, whichever is larger. Marginal propensity to consume: the proportion of a marginal income increase that is spent on consumption goods and services, as opposed to invested or saved. Marginal tax rates: a tax system where a single taxpayer can pay different tax rates on successive portions of income. National consumption tax: a federal-level tax paid on the dollar amount a household or individual spends each year on goods and services, calculated using either a single tax rate or marginal tax rates. National sales tax: a federal-level tax paid on the purchase of certain goods and services, calculated as a percentage of the selling price. 33 Perfect competition: an idealized market structure characterized by many informed small firms with no market power selling undifferentiated products and with complete freedom to enter or exit the market. Progressive tax: a tax in which the percentage of income one pays for the tax increases as one’s income increases. Proportional tax: a tax in which the percentage of income one pays for the tax is constant regardless of income level. Regressive tax: a tax in which the percentage of income one pays for the tax decreases as one’s income increases. Social insurance taxes: taxes paid to support social insurance programs such as Social Security, Medicare, and Medicaid. Standard deduction: a fixed amount of income excluded from federal taxation based on filing status (single, married, etc.). A taxpayer is allowed to deduct either the standard or itemized deduction, whichever is larger. Suits index: an index developed by Daniel Suits in the 1970s to measure the overall progressivity or regressivity of a tax. Tariffs: taxes levied on imported goods and services. Tax incidence analysis: estimating the ultimate financial burden of various taxes on different categories of households by tracing a tax’s impact on market prices and the economic behavior of consumers and businesses. Taxable income: the amount of income used as the basis for determine one’s income taxes. For federal income taxes, taxable income is equal to adjusted gross income (AGI) minus allowable deductions and exemptions. Total income: the total income a household or individual receives from all sources Value-added tax: a tax levied at each stage in the production process of a good or service. Wealth taxes: taxes levied on the value of one’s assets such as real estate, investments, cash, and other personal property. 34 ",Financial,Summarize,Text Transformation "ONLY USE THE DATA I PROVIDE Limit your response to 250 words If you cannot answer using the contexts alone, say ""I cannot determine the answer to that due to lack of context""","According to the context document, what states could exceed $100 billion in health benefits from implementation of of zero-emission transportation and electricity resources?","**Zeroing in on Healthy Air** Executive Summary Zeroing in on Healthy Air is a report by the American Lung Association illustrating the public health urgency of policies and investments for transitioning to zero-emission transportation and electricity generation in the coming decades. These sectors are leading sources of unhealthy air in the United States. Today, over four in ten Americans — more than 135 million people — live in communities impacted by unhealthy levels of air pollution. Research demonstrates that the burdens of unhealthy air include increased asthma attacks, heart attacks and strokes, lung cancer and premature death. These poor health outcomes are not shared equitably, with many communities of color and lower income communities at greater risk due to increased exposure to transportation pollution. The transportation sector is also the largest source of greenhouse gas emissions that drive climate change, which threatens clean air progress and amplifies a wide range of health risks and disparities. This report finds that a national shift to 100 percent sales of zero-emission passenger vehicles (by 2035) and medium- and heavy-duty trucks (by 2040), coupled with renewable electricity would generate over $1.2 trillion in public health benefits between 2020 and 2050. These benefits would take the form of avoiding up to 110,000 premature deaths, along with nearly 3 million asthma attacks and over 13 million workdays lost due to cleaner air. This report calculates the emission reductions possible from shifting to vehicles without tailpipes, as well as eliminating fuel combustion from the electricity generation sector so that neither those living near roads or near electricity generation would be subjected to unacceptable doses of toxic air pollution. The report also highlights the fact that the shift to zeroemission transportation and electricity generation in the United States will yield avoided global climate damages over $1.7 trillion. By expediting investments and policies at the local, state and federal levels to reduce harmful pollution, all communities stand to experience cleaner air. Policies and investments must prioritize low-income communities and communities of color that bear a disproportionate pollution burden. State and local jurisdictions should act to implement policies as soon as possible, including in advance of the benchmarks used in this report’s methodology. These actions are needed to achieve clean air, reduce health disparities and avoid even more dire consequences of climate change. The Public Health Need for Zero Emissions Air Pollution Remains a Major Threat to Americans’ Health Despite decades of progress to clean the air, more than 4 in 10 of all Americans — 135 million — still live in a community impacted by unhealthy levels of air pollution.ii Those impacted by polluted air face increased risk of a wide range of poor health outcomes as the result of increased ozone and/or particle pollution.iii The adverse impacts of pollution from the transportation and electricity generation sectors are clear, and must be recognized as a threat to local community health, health equity and a driver of major climate change-related health risks. Even with certification to meet existing standards, it is clear that combustion technologies often generate far greater levels of pollution in the real world than on paper. Location Matters: Disparities in Exposure Burden Exposure to pollution with its associated negative health consequences is dictated by where someone lives, attends school or works. In general, the higher the exposure, the greater the risk of harm. Many communities face disproportionate burdens due to pollution generated from production, transportation, refining and combustion of fuels along the transportation and electricity generating systems. Lower income communities and communities of color are often the most over-burdened by pollution sources today due to decades of inequitable land use decisions and systemic racism. The American Lung Association’s State of the Air 2021 report illustrated the disparities in pollution burdens across the United States, noting that a person of color in the United States is up to three times more likely to be breathing the most polluted air than white people.v All sources of harmful air and climate pollution must shift rapidly away from combustion and toward zero-emission technologies to ensure all Americans have access to the benefits of less polluting technologies. Estimated Benefits of Zero-Emission Transportation and Electricity Generation The combustion of fuels in the electricity generation and transportation sectors is a major contributor to the health and climate burdens facing all Americans. These sources of pollution also create significant disparities in pollution burdens and poor health, especially in lower-income communities and communities of color. The transition to non-combustion technologies is underway and must continue to accelerate to protect the health of communities today and across the coming decades. Key findings are presented below: Pollution Reduction Benefits from Zero-Emission Transportation Accelerating the shift to zero-emission transportation and non-combustion electricity generation will generate major reductions in harmful pollutants. Key pollutants included in this research are described below along with projected onroad pollution reductions with the shift to zero-emission technologies when compared with a modeled “Business As Usual” case for the on-road fleet. Benefits of Moving All Vehicle Classes to Zero-Emissions All vehicles must move to zero-emission technologies to ensure the most robust public health benefits occur. The 2020 passenger vehicle fleet represents approximately 94 percent of the nation’s on-road vehicle fleet and generates over 1 million tons of ozone- and particle-forming NOx emissions, and over 33,400 tons of fine particles annually. Heavy-duty vehicles represent approximately six percent of the on-road fleet in 2020, but generate 59 percent of ozone- and particle-forming NOx emissions and 55 percent of the particle pollution (including brake and tire particles). Differentiating the relative impacts of fleet segments is particularly important when considering the concentrations of heavy-duty vehicles in environmental justice areas near highways, ports, railyards and warehouse settings. For greenhouse gases (GHG), the 2020 light duty vehicle fleet generates approximately 69 percent of GHG emissions, while the heavy-duty fleet produces 31 percent. The table below illustrates the relative emission reduction benefits of on-road transportation electrification for each the light-duty fleet and the medium- and heavy-duty segments compared with the “Business-As-Usual” case. It is important to note that these on-road reductions could yield major benefits within each class, with light-duty vehicles reducing nearly twice the GHGs as heavy-duty, while heavy-duty engines could yield approximately eight times the smog- and particle-forming NOx emissions when compared with the light-duty fleet. Ultimately, all segments produce harmful pollutants and must move quickly to zero-emissions to protect health and reduce climate pollution. National Results: Public Health and Climate Benefits The shift to zero-emission transportation and non-combustion electricity generation could yield major health benefits throughout the nation in the coming decades. Cumulatively, the national benefits of transitioning away from combustion in the transportation sector toward 100 percent zero-emission sales and a non-combustion electricity generation sector could generate over $1.2 trillion in health benefits across the United States between 2020 and 2050. These benefits include approximately 110,000 lives saved, over 2.7 million asthma attacks avoided (among those aged 6-18 years), 13.4 million lost works days and a wider range of other negative health impacts avoided due to cleaner air.1,2 In addition to these health benefits, this analysis found that over $1.7 trillion in global climate benefits could be achieved with a reduction of over 24 billion metric tons of GHGs by mid-century. Near-Term Health Benefits While the benefits noted above are cumulative between 2020 and 2050, this analysis also finds that annual health benefits could reach into the tens of billions by the end of this decade – nearly $28 billion in 2030 alone. Health benefits increase significantly as deployments of zero-emission technologies in the transportation and electricity generating sectors expand. State Results: Public Health Benefits Across the United States Every state in the U.S. stands to experience significant public health benefits from the widespread implementation of zero-emission transportation and electricity resources over the coming decades. As shown below, more than half of the states could experience more than $10 billion in cumulative public health benefits. Two states (California and Texas) could exceed $100 billion in health benefits, and six more states (Pennsylvania, Florida, Ohio, New York, Illinois, and Michigan) could see benefits exceeding $50 billion by 2050. These benefits cover a wide range of avoided health impacts, three of which (premature deaths, asthma attacks, lost workdays) are shown in the table below. Local Results: Public Health Benefits Across America Communities across the United States stand to benefit from the widespread transition to zero-emission transportation and electricity generation. As transportation emissions are a dominant source of local exposures in many communities, a carefully and equitably designed shift to non-combustion transportation can mean cleaner air for all, and especially those most burdened by pollution from these sources today. Similarly, a shift away from fossil-fueled electricity generation is critical to improving the health of those most impacted by emissions from power plants, including in lower-income, rural communities across the United States. This analysis found that the 100 U.S. counties (roughly 3 percent of all counties assessed) with the highest percent populations of People of Color could experience approximately 13 percent of the cumulative health benefits of this transition ($155 billion, between 2020-2050). Expanding this further, the 500 U.S. Counties (16 percent of counties assessed) with the highest percent populations of People of Color could experience 40 percent of the benefits, or $487 billion cumulatively between 2020 and 2050. It is also clear that the presence of benefits within these counties does not directly translate to benefits to individual neighborhoods or residents, however. This is an indicator of the urgent need to center equity in policies and investments to ensure access to the benefits of pollution-free mobility and power. Additional analysis of the benefits in rural communities, lower-income communities, and neighborhood exposure levels could provide deeper insights into more equitable policy and investment designs. At a broader scale, this analysis shows a leveling of benefits across the country as the locations of power plants and transportation hubs are often impacting communities with varying socioeconomic characteristics. As shown in the table on the next page, communities across the United States could experience billions in public health benefits, and significantly reduce premature deaths, asthma attacks and other negative health consequences of polluted air through 2050. The table includes the 25 Metropolitan Areas across the United States showing the largest cumulative health benefits by 2050 considering the shift to non-combustion electricity generation and zero emission transportation. ","{Text Passage} **Zeroing in on Healthy Air** Executive Summary Zeroing in on Healthy Air is a report by the American Lung Association illustrating the public health urgency of policies and investments for transitioning to zero-emission transportation and electricity generation in the coming decades. These sectors are leading sources of unhealthy air in the United States. Today, over four in ten Americans — more than 135 million people — live in communities impacted by unhealthy levels of air pollution. Research demonstrates that the burdens of unhealthy air include increased asthma attacks, heart attacks and strokes, lung cancer and premature death. These poor health outcomes are not shared equitably, with many communities of color and lower income communities at greater risk due to increased exposure to transportation pollution. The transportation sector is also the largest source of greenhouse gas emissions that drive climate change, which threatens clean air progress and amplifies a wide range of health risks and disparities. This report finds that a national shift to 100 percent sales of zero-emission passenger vehicles (by 2035) and medium- and heavy-duty trucks (by 2040), coupled with renewable electricity would generate over $1.2 trillion in public health benefits between 2020 and 2050. These benefits would take the form of avoiding up to 110,000 premature deaths, along with nearly 3 million asthma attacks and over 13 million workdays lost due to cleaner air. This report calculates the emission reductions possible from shifting to vehicles without tailpipes, as well as eliminating fuel combustion from the electricity generation sector so that neither those living near roads or near electricity generation would be subjected to unacceptable doses of toxic air pollution. The report also highlights the fact that the shift to zeroemission transportation and electricity generation in the United States will yield avoided global climate damages over $1.7 trillion. By expediting investments and policies at the local, state and federal levels to reduce harmful pollution, all communities stand to experience cleaner air. Policies and investments must prioritize low-income communities and communities of color that bear a disproportionate pollution burden. State and local jurisdictions should act to implement policies as soon as possible, including in advance of the benchmarks used in this report’s methodology. These actions are needed to achieve clean air, reduce health disparities and avoid even more dire consequences of climate change. The Public Health Need for Zero Emissions Air Pollution Remains a Major Threat to Americans’ Health Despite decades of progress to clean the air, more than 4 in 10 of all Americans — 135 million — still live in a community impacted by unhealthy levels of air pollution.ii Those impacted by polluted air face increased risk of a wide range of poor health outcomes as the result of increased ozone and/or particle pollution.iii The adverse impacts of pollution from the transportation and electricity generation sectors are clear, and must be recognized as a threat to local community health, health equity and a driver of major climate change-related health risks. Even with certification to meet existing standards, it is clear that combustion technologies often generate far greater levels of pollution in the real world than on paper. Location Matters: Disparities in Exposure Burden Exposure to pollution with its associated negative health consequences is dictated by where someone lives, attends school or works. In general, the higher the exposure, the greater the risk of harm. Many communities face disproportionate burdens due to pollution generated from production, transportation, refining and combustion of fuels along the transportation and electricity generating systems. Lower income communities and communities of color are often the most over-burdened by pollution sources today due to decades of inequitable land use decisions and systemic racism. The American Lung Association’s State of the Air 2021 report illustrated the disparities in pollution burdens across the United States, noting that a person of color in the United States is up to three times more likely to be breathing the most polluted air than white people.v All sources of harmful air and climate pollution must shift rapidly away from combustion and toward zero-emission technologies to ensure all Americans have access to the benefits of less polluting technologies. Estimated Benefits of Zero-Emission Transportation and Electricity Generation The combustion of fuels in the electricity generation and transportation sectors is a major contributor to the health and climate burdens facing all Americans. These sources of pollution also create significant disparities in pollution burdens and poor health, especially in lower-income communities and communities of color. The transition to non-combustion technologies is underway and must continue to accelerate to protect the health of communities today and across the coming decades. Key findings are presented below: Pollution Reduction Benefits from Zero-Emission Transportation Accelerating the shift to zero-emission transportation and non-combustion electricity generation will generate major reductions in harmful pollutants. Key pollutants included in this research are described below along with projected onroad pollution reductions with the shift to zero-emission technologies when compared with a modeled “Business As Usual” case for the on-road fleet. Benefits of Moving All Vehicle Classes to Zero-Emissions All vehicles must move to zero-emission technologies to ensure the most robust public health benefits occur. The 2020 passenger vehicle fleet represents approximately 94 percent of the nation’s on-road vehicle fleet and generates over 1 million tons of ozone- and particle-forming NOx emissions, and over 33,400 tons of fine particles annually. Heavy-duty vehicles represent approximately six percent of the on-road fleet in 2020, but generate 59 percent of ozone- and particle-forming NOx emissions and 55 percent of the particle pollution (including brake and tire particles). Differentiating the relative impacts of fleet segments is particularly important when considering the concentrations of heavy-duty vehicles in environmental justice areas near highways, ports, railyards and warehouse settings. For greenhouse gases (GHG), the 2020 light duty vehicle fleet generates approximately 69 percent of GHG emissions, while the heavy-duty fleet produces 31 percent. The table below illustrates the relative emission reduction benefits of on-road transportation electrification for each the light-duty fleet and the medium- and heavy-duty segments compared with the “Business-As-Usual” case. It is important to note that these on-road reductions could yield major benefits within each class, with light-duty vehicles reducing nearly twice the GHGs as heavy-duty, while heavy-duty engines could yield approximately eight times the smog- and particle-forming NOx emissions when compared with the light-duty fleet. Ultimately, all segments produce harmful pollutants and must move quickly to zero-emissions to protect health and reduce climate pollution. National Results: Public Health and Climate Benefits The shift to zero-emission transportation and non-combustion electricity generation could yield major health benefits throughout the nation in the coming decades. Cumulatively, the national benefits of transitioning away from combustion in the transportation sector toward 100 percent zero-emission sales and a non-combustion electricity generation sector could generate over $1.2 trillion in health benefits across the United States between 2020 and 2050. These benefits include approximately 110,000 lives saved, over 2.7 million asthma attacks avoided (among those aged 6-18 years), 13.4 million lost works days and a wider range of other negative health impacts avoided due to cleaner air.1,2 In addition to these health benefits, this analysis found that over $1.7 trillion in global climate benefits could be achieved with a reduction of over 24 billion metric tons of GHGs by mid-century. Near-Term Health Benefits While the benefits noted above are cumulative between 2020 and 2050, this analysis also finds that annual health benefits could reach into the tens of billions by the end of this decade – nearly $28 billion in 2030 alone. Health benefits increase significantly as deployments of zero-emission technologies in the transportation and electricity generating sectors expand. State Results: Public Health Benefits Across the United States Every state in the U.S. stands to experience significant public health benefits from the widespread implementation of zero-emission transportation and electricity resources over the coming decades. As shown below, more than half of the states could experience more than $10 billion in cumulative public health benefits. Two states (California and Texas) could exceed $100 billion in health benefits, and six more states (Pennsylvania, Florida, Ohio, New York, Illinois, and Michigan) could see benefits exceeding $50 billion by 2050. These benefits cover a wide range of avoided health impacts, three of which (premature deaths, asthma attacks, lost workdays) are shown in the table below. Local Results: Public Health Benefits Across America Communities across the United States stand to benefit from the widespread transition to zero-emission transportation and electricity generation. As transportation emissions are a dominant source of local exposures in many communities, a carefully and equitably designed shift to non-combustion transportation can mean cleaner air for all, and especially those most burdened by pollution from these sources today. Similarly, a shift away from fossil-fueled electricity generation is critical to improving the health of those most impacted by emissions from power plants, including in lower-income, rural communities across the United States. This analysis found that the 100 U.S. counties (roughly 3 percent of all counties assessed) with the highest percent populations of People of Color could experience approximately 13 percent of the cumulative health benefits of this transition ($155 billion, between 2020-2050). Expanding this further, the 500 U.S. Counties (16 percent of counties assessed) with the highest percent populations of People of Color could experience 40 percent of the benefits, or $487 billion cumulatively between 2020 and 2050. It is also clear that the presence of benefits within these counties does not directly translate to benefits to individual neighborhoods or residents, however. This is an indicator of the urgent need to center equity in policies and investments to ensure access to the benefits of pollution-free mobility and power. Additional analysis of the benefits in rural communities, lower-income communities, and neighborhood exposure levels could provide deeper insights into more equitable policy and investment designs. At a broader scale, this analysis shows a leveling of benefits across the country as the locations of power plants and transportation hubs are often impacting communities with varying socioeconomic characteristics. As shown in the table on the next page, communities across the United States could experience billions in public health benefits, and significantly reduce premature deaths, asthma attacks and other negative health consequences of polluted air through 2050. The table includes the 25 Metropolitan Areas across the United States showing the largest cumulative health benefits by 2050 considering the shift to non-combustion electricity generation and zero emission transportation. ---------------- {Task Instructions} ONLY USE THE DATA I PROVIDE Limit your response to 250 words If you cannot answer using the contexts alone, say ""I cannot determine the answer to that due to lack of context"" ---------------- {Query} According to the context document, what states could exceed $100 billion in health benefits from implementation of of zero-emission transportation and electricity resources?",Medical,Fact Finding,Q&A "Provide your response solely on the information provided in the text of the prompt. Do not use any outside information, resources or prior knowledge. Make your response exactly 300 words.",What are the key factors in competition between video streaming services?," Video streaming services that use a subscription- or transaction-based system can compete by offering content at lower prices than their competitors. Streaming services that offer live TV can be cheaper than packages offered by MVPDs, depending on the channels the customer subscribes to. Some MVPDs have responded by offering cheaper plans with fewer channels and by improving their set-top boxes to offer some streaming services, such as Netflix.7 Some streaming services that offer live TV advertise their services by promising no hidden fees, such as equipment rentals and cancellation fees, and no annual contracts.8 Most streaming services that offer live TV do not require an annual subscription; subscribers can sign up on a month-to-month basis instead. While the lack of a long-term commitment can be appealing to some consumers, it also means that prices can suddenly increase.9 For example, on June 30, 2020, YouTube TVadded eight new channels and increased its price from $50 to $65 per month, effective immediately for new subscribers; for its current subscribers, the changes went into effect on July 30, 2020.10 On average, the price for streaming services that offer live TV is higher than those that offer only video-on-demand (Table 2). This may be partially due to cost differences—it tends to be costly to license the rights to air a television network. 11 To attract more users, a streaming service that offers live TV may try to expand the number of networks offered on its service, but this in turn increases the cost of running the service. In contrast, a streaming service that offers video-ondemand licenses at least some movies and shows that have been previously shown elsewhere, which tends to lower the cost of licensing this content. Differences in prices across streaming services that offer only video-on-demand tend to be fairly small. This may be partially due to their relatively low prices, which make it difficult to lower prices further. Thus, in addition to competing with prices, streaming services may seek to offer exclusive access to popular movies and TV shows to attract new subscribers. When the first streaming services launched in the late 2000s, they offered movies and shows that had been previously shown elsewhere. For example, when Netflix launched its streaming service in 2007, it offered about 1,000 television shows and movies, licensed from NBC Universal, Sony Pictures, MGM, and others; it did not offer original content. 12 A few years later, some streaming services started commissioning movies and shows from television or film studios. This made streaming services less dependent on licensing agreements with television networks and allowed them to offer original programming, which increased the importance of content. 13 In 2013, Netflix debuted its first original series, House of Cards, and became the first streaming service to win a Television Academy Emmy Award.14 Original programs from other streaming services have won television awards as well, such as Hulu’s Handmaid’s Tale. 15 In 2020, Netflix received 160 Emmy nominations, breaking the record for the greatest number of nominations of any network, studio, or streaming platform.16 Nevertheless, streaming services continue to license previously broadcast movies and shows from television networks and film studios to complement their original content. Some streaming services, particularly those that offer live TV, advertise themselves as an alternative to MVPDs. However, streaming services oftentimes rely on the same content creators as television networks, such as sports leagues and television and movie studios. 17 Television networks and movie theaters show a single program at a time, which can create incentives to select the program with the greatest profit potential for each time slot. In contrast, streaming services offer multiple programs for users to choose from. Thus, streaming services can feature content that appeals to various groups of users rather than to the public at large. This may increase competition for video content and provide new opportunities for content creators.18 Some companies that own studios and television networks offer their own video streaming services. This can create incentives for these studios to license fewer shows and movies to other streaming services, reserving popular content for their own streaming services instead. For example, AT&T, which owns Warner Brothers Studio, stopped licensing certain shows—such as Friends, The Wire, and The Sopranos—to streaming services owned by other companies, offering these shows exclusively on its streaming services HBO and HBO Max.19 Similarly, Comcast is offering some of its NBCUniversal shows, such as The Office and Parks and Recreation, exclusively on its streaming service Peacock;20 Walt Disney Co. announced that The Simpsons would be offered exclusively on its streaming service Disney+.21 Streaming services operated by companies that also own film studios and television networks may have an advantage over their competitors. A company may provide its streaming service exclusive access to its studio’s programming, or may choose to license the programming to its streaming competitors for a fee. This means some streaming services are able to restrict access to content, which could make it more difficult for new competitors to enter the video streaming market. Entrants may need to devote significant resources to produce or license content before offering their streaming services to customers.","System instructions: Provide your response solely on the information provided in the text of the prompt. Do not use any outside information, resources or prior knowledge. Make your response exactly 300 words. Question: What are the key factors in competition between video streaming services? Context Block: Video streaming services that use a subscription- or transaction-based system can compete by offering content at lower prices than their competitors. Streaming services that offer live TV can be cheaper than packages offered by MVPDs, depending on the channels the customer subscribes to. Some MVPDs have responded by offering cheaper plans with fewer channels and by improving their set-top boxes to offer some streaming services, such as Netflix.7 Some streaming services that offer live TV advertise their services by promising no hidden fees, such as equipment rentals and cancellation fees, and no annual contracts.8 Most streaming services that offer live TV do not require an annual subscription; subscribers can sign up on a month-to-month basis instead. While the lack of a long-term commitment can be appealing to some consumers, it also means that prices can suddenly increase.9 For example, on June 30, 2020, YouTube TVadded eight new channels and increased its price from $50 to $65 per month, effective immediately for new subscribers; for its current subscribers, the changes went into effect on July 30, 2020.10 On average, the price for streaming services that offer live TV is higher than those that offer only video-on-demand (Table 2). This may be partially due to cost differences—it tends to be costly to license the rights to air a television network. 11 To attract more users, a streaming service that offers live TV may try to expand the number of networks offered on its service, but this in turn increases the cost of running the service. In contrast, a streaming service that offers video-ondemand licenses at least some movies and shows that have been previously shown elsewhere, which tends to lower the cost of licensing this content. Differences in prices across streaming services that offer only video-on-demand tend to be fairly small. This may be partially due to their relatively low prices, which make it difficult to lower prices further. Thus, in addition to competing with prices, streaming services may seek to offer exclusive access to popular movies and TV shows to attract new subscribers. When the first streaming services launched in the late 2000s, they offered movies and shows that had been previously shown elsewhere. For example, when Netflix launched its streaming service in 2007, it offered about 1,000 television shows and movies, licensed from NBC Universal, Sony Pictures, MGM, and others; it did not offer original content. 12 A few years later, some streaming services started commissioning movies and shows from television or film studios. This made streaming services less dependent on licensing agreements with television networks and allowed them to offer original programming, which increased the importance of content. 13 In 2013, Netflix debuted its first original series, House of Cards, and became the first streaming service to win a Television Academy Emmy Award.14 Original programs from other streaming services have won television awards as well, such as Hulu’s Handmaid’s Tale. 15 In 2020, Netflix received 160 Emmy nominations, breaking the record for the greatest number of nominations of any network, studio, or streaming platform.16 Nevertheless, streaming services continue to license previously broadcast movies and shows from television networks and film studios to complement their original content. Some streaming services, particularly those that offer live TV, advertise themselves as an alternative to MVPDs. However, streaming services oftentimes rely on the same content creators as television networks, such as sports leagues and television and movie studios. 17 Television networks and movie theaters show a single program at a time, which can create incentives to select the program with the greatest profit potential for each time slot. In contrast, streaming services offer multiple programs for users to choose from. Thus, streaming services can feature content that appeals to various groups of users rather than to the public at large. This may increase competition for video content and provide new opportunities for content creators.18 Some companies that own studios and television networks offer their own video streaming services. This can create incentives for these studios to license fewer shows and movies to other streaming services, reserving popular content for their own streaming services instead. For example, AT&T, which owns Warner Brothers Studio, stopped licensing certain shows—such as Friends, The Wire, and The Sopranos—to streaming services owned by other companies, offering these shows exclusively on its streaming services HBO and HBO Max.19 Similarly, Comcast is offering some of its NBCUniversal shows, such as The Office and Parks and Recreation, exclusively on its streaming service Peacock;20 Walt Disney Co. announced that The Simpsons would be offered exclusively on its streaming service Disney+.21 Streaming services operated by companies that also own film studios and television networks may have an advantage over their competitors. A company may provide its streaming service exclusive access to its studio’s programming, or may choose to license the programming to its streaming competitors for a fee. This means some streaming services are able to restrict access to content, which could make it more difficult for new competitors to enter the video streaming market. Entrants may need to devote significant resources to produce or license content before offering their streaming services to customers.",Internet/Technology,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",What is the purpose of the drug Metoprolol and what are some of the potential side effects of its usage? Make your response at least 150 words.,"Metoprolol is used alone or in combination with other medications to treat high blood pressure. It also is used to treat chronic (long-term) angina (chest pain). Metoprolol is also used to improve survival after a heart attack. Metoprolol also is used in combination with other medications to treat heart failure. Metoprolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation. How should this medicine be used? Metoprolol comes as a tablet, an extended-release (long-acting) tablet, and an extended-release capsule to take by mouth. The regular tablet is usually taken once or twice a day with meals or immediately after meals. The extended-release tablet and extended-release capsule are usually taken once a day. To help you remember to take metoprolol, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metoprolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. The extended-release tablet may be split. Swallow the whole or half extended-release tablets whole; do not chew or crush them. Swallow the extended-release capsules whole; do not split, chew, or crush them. If you are unable to swallow the capsules, you may open the capsule and sprinkle the contents over a spoonful of soft food, such as applesauce, pudding, or yogurt and swallow the mixture immediately. Do not swallow the mixture more than 60 minutes after you sprinkle the contents of the capsule. Your doctor may start you on a low dose of metoprolol and gradually increase your dose. Metoprolol helps to control your condition but will not cure it. Continue to take metoprolol even if you feel well. Do not stop taking metoprolol without talking to your doctor. If you suddenly stop taking metoprolol you may experience serious heart problems such as severe chest pain, a heart attack, or an irregular heartbeat. Your doctor will probably want to decrease your dose gradually over 1 to 2 weeks and will monitor you closely. Other uses for this medicine Metoprolol is also used sometimes to treat certain types of irregular heartbeats. Talk to your doctor about the possible risks of using this medication for your condition. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking metoprolol, tell your doctor and pharmacist if you are allergic to metoprolol, any other medications, or any of the ingredients in metoprolol tablets, extended-release tablets, or extended-release capsules. Ask your pharmacist for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have a slow or irregular heartbeat or heart failure. Your doctor may tell you not to take metoprolol. tell your doctor if you have or have ever had asthma or other lung diseases; problems with blood circulation; pheochromocytoma (a tumor that develops on a gland near the kidneys and may cause high blood pressure and fast heartbeat); heart or liver disease;diabetes; or hyperthyroidism (an overactive thyroid gland). Also tell your doctor if you have ever had a serious allergic reaction to a food or any other substance. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking metoprolol, call your doctor. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking metoprolol. you should know that metoprolol may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. do not drink any alcoholic drinks or take any prescription or nonprescription medications that contain alcohol if you are taking metoprolol extended-release capsules. Ask your doctor or pharmacist if you do not know if a medication that you plan to take contains alcohol. you should know that metoprolol may increase the risk of hypoglycemia (low blood sugar) and prevent the warning signs and symptoms that would tell you that your blood sugar is low. Let your doctor know if you are unable to eat or drink normally or are vomiting while you are taking metoprolol. You should know the symptoms of low blood sugar and what to do if you have these symptoms. you should know that if you have allergic reactions to different substances, your reactions may be worse while you are using metoprolol, and your allergic reactions may not respond to the usual doses of injectable epinephrine. What special dietary instructions should I follow? IUnless your doctor tells you otherwise, continue your normal diet. What should I do if I forget a dose? Skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? Metoprolol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: dizziness or lightheadedness tiredness depression diarrhea nausea dry mouth stomach pain vomiting gas or bloating heartburn runny nose Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately: shortness of breath or difficulty breathing wheezing weight gain fainting rapid, pounding, or irregular heartbeat Metoprolol may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What is the purpose of the drug Metoprolol and what are some of the potential side effects of its usage? Make your response at least 150 words. {passage 0} ========== Metoprolol is used alone or in combination with other medications to treat high blood pressure. It also is used to treat chronic (long-term) angina (chest pain). Metoprolol is also used to improve survival after a heart attack. Metoprolol also is used in combination with other medications to treat heart failure. Metoprolol is in a class of medications called beta blockers. It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure. High blood pressure is a common condition and when not treated, can cause damage to the brain, heart, blood vessels, kidneys and other parts of the body. Damage to these organs may cause heart disease, a heart attack, heart failure, stroke, kidney failure, loss of vision, and other problems. In addition to taking medication, making lifestyle changes will also help to control your blood pressure. These changes include eating a diet that is low in fat and salt, maintaining a healthy weight, exercising at least 30 minutes most days, not smoking, and using alcohol in moderation. How should this medicine be used? Metoprolol comes as a tablet, an extended-release (long-acting) tablet, and an extended-release capsule to take by mouth. The regular tablet is usually taken once or twice a day with meals or immediately after meals. The extended-release tablet and extended-release capsule are usually taken once a day. To help you remember to take metoprolol, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metoprolol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. The extended-release tablet may be split. Swallow the whole or half extended-release tablets whole; do not chew or crush them. Swallow the extended-release capsules whole; do not split, chew, or crush them. If you are unable to swallow the capsules, you may open the capsule and sprinkle the contents over a spoonful of soft food, such as applesauce, pudding, or yogurt and swallow the mixture immediately. Do not swallow the mixture more than 60 minutes after you sprinkle the contents of the capsule. Your doctor may start you on a low dose of metoprolol and gradually increase your dose. Metoprolol helps to control your condition but will not cure it. Continue to take metoprolol even if you feel well. Do not stop taking metoprolol without talking to your doctor. If you suddenly stop taking metoprolol you may experience serious heart problems such as severe chest pain, a heart attack, or an irregular heartbeat. Your doctor will probably want to decrease your dose gradually over 1 to 2 weeks and will monitor you closely. Other uses for this medicine Metoprolol is also used sometimes to treat certain types of irregular heartbeats. Talk to your doctor about the possible risks of using this medication for your condition. This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking metoprolol, tell your doctor and pharmacist if you are allergic to metoprolol, any other medications, or any of the ingredients in metoprolol tablets, extended-release tablets, or extended-release capsules. Ask your pharmacist for a list of the ingredients. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have a slow or irregular heartbeat or heart failure. Your doctor may tell you not to take metoprolol. tell your doctor if you have or have ever had asthma or other lung diseases; problems with blood circulation; pheochromocytoma (a tumor that develops on a gland near the kidneys and may cause high blood pressure and fast heartbeat); heart or liver disease;diabetes; or hyperthyroidism (an overactive thyroid gland). Also tell your doctor if you have ever had a serious allergic reaction to a food or any other substance. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking metoprolol, call your doctor. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking metoprolol. you should know that metoprolol may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you. do not drink any alcoholic drinks or take any prescription or nonprescription medications that contain alcohol if you are taking metoprolol extended-release capsules. Ask your doctor or pharmacist if you do not know if a medication that you plan to take contains alcohol. you should know that metoprolol may increase the risk of hypoglycemia (low blood sugar) and prevent the warning signs and symptoms that would tell you that your blood sugar is low. Let your doctor know if you are unable to eat or drink normally or are vomiting while you are taking metoprolol. You should know the symptoms of low blood sugar and what to do if you have these symptoms. you should know that if you have allergic reactions to different substances, your reactions may be worse while you are using metoprolol, and your allergic reactions may not respond to the usual doses of injectable epinephrine. What special dietary instructions should I follow? IUnless your doctor tells you otherwise, continue your normal diet. What should I do if I forget a dose? Skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? Metoprolol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: dizziness or lightheadedness tiredness depression diarrhea nausea dry mouth stomach pain vomiting gas or bloating heartburn runny nose Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately: shortness of breath or difficulty breathing wheezing weight gain fainting rapid, pounding, or irregular heartbeat Metoprolol may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). https://medlineplus.gov/druginfo/meds/a682864.html",Medical,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",Simplify this passage about gene therapy for sickle cell. Explain what the therapy is and how it works. Also explain the type of sickle cell the patient had. Use bullets an headers so it can be easier to read<,"Sickle cell disease results from a homozygous missense mutation in the β-globin gene that causes polymerization of hemoglobin S. Gene therapy for patients with this disorder is complicated by the complex cellular abnormalities and challenges in achieving effective, persistent inhibition of polymerization of hemoglobin S. We describe our first patient treated with lentiviral vector–mediated addition of an antisickling β-globin gene into autologous hematopoietic stem cells. Adverse events were consistent with busulfan conditioning. Fifteen months after treatment, the level of therapeutic antisickling β-globin remained high (approximately 50% of β-like–globin chains) without recurrence of sickle crises and with correction of the biologic hallmarks of the disease. (Funded by Bluebird Bio and others; HGB-205 ClinicalTrials.gov number, NCT02151526.) Sickle cell disease is among the most prevalent inherited monogenic disorders. Approximately 90,000 people in the United States have sickle cell disease, and worldwide more than 275,000 infants are born with the disease annually.1,2 Sickle cell disease was the first disease for which the molecular basis was identified: a single amino acid substitution in “adult” βA-globin (Glu6Val) stemming from a single base substitution (A→T) in the first exon of the human βA-globin gene (HBB) was discovered in 1956.3 Sickle hemoglobin (HbS) polymerizes on deoxygenation, reducing the deformability of red cells. Patients have intensely painful vaso-occlusive crises, leading to irreversible organ damage, poor quality of life, and reduced life expectancy. Hydroxyurea, a cytotoxic agent that is capable of boosting fetal hemoglobin levels in some patients, is the only disease-modifying therapy approved for sickle cell disease.4 Allogeneic hematopoietic stem-cell transplantation currently offers the only curative option for patients with severe sickle cell disease.5,6 However, fewer than 18% of patients have access to a matched sibling donor.7,8 Therapeutic ex vivo gene transfer into autologous hematopoietic stem cells, referred to here as gene therapy, may provide a long-term and potentially curative treatment for sickle cell disease.9 We previously reported proof of effective, sustained gene therapy in mouse models of sickle cell disease by lentiviral transfer of a modified HBB encoding an antisickling variant (βA87Thr:Gln [βA-T87Q]).10,11 Here we report the results for a patient who received lentiviral gene therapy in the HGB-205 clinical study and who had complete clinical remission with correction of hemolysis and biologic hallmarks of the disease. Case Report A boy with the βS/βS genotype, a single 3.7-kb α-globin gene deletion, and no glucose 6-phosphate dehydrogenase deficiency received a diagnosis of sickle cell disease at birth and was followed at the Reference Centre for Sickle Cell Disease of Necker Children’s Hospital in Paris. He had a history of numerous vaso-occlusive crises, two episodes of the acute chest syndrome, and bilateral hip osteonecrosis. He had undergone cholecystectomy and splenectomy. During screening, a cerebral hypodensity without characteristics of cerebral vasculopathy was detected. Because hydroxyurea therapy administered when the boy was between 2 and 9 years of age did not reduce his symptoms significantly, a prophylactic red-cell transfusion program was initiated in 2010, including iron chelation with deferasirox (at a dose of 17 mg per kilogram of body weight per day). He had had an average of 1.6 sickle cell disease–related events annually in the 9 years before transfusions were initiated. In May 2014, he was enrolled in our clinical study. His verbal assent and his mother’s written informed consent were obtained. In October 2014, when the patient was 13 years of age, he received an infusion of the drug product LentiGlobin BB305. Methods Study Oversight The study protocol, which is available with the full text of this article at NEJM.org, was designed by the last two authors and Bluebird Bio, the study sponsor. The protocol was reviewed by the French Comité de Protection des Personnes and relevant institutional ethics committees. Clinical data were collected by the first author, and laboratory data were generated by the sponsor, the last author, and other authors. The authors had access to all data, and data analysis was performed by them. The first author and one author employed by the sponsor wrote the first draft of the manuscript, which was substantively revised by the last two authors and further edited and approved by all the authors with writing assistance provided by an employee of the sponsor. The authors vouch for the accuracy and completeness of the data and adherence to the protocol. Antisickling Gene Therapy Vector The structure of the LentiGlobin BB305 vector has been previously described (see Fig. S1 in the Supplementary Appendix, available at NEJM.org).12 This self-inactivating lentiviral vector encodes the human HBB variant βA-T87Q. In addition to inhibiting HbS polymerization, the T87Q substitution allows for the β-globin chain of adult hemoglobin (HbA)T87Q to be differentially quantified by means of reverse-phase high-performance liquid chromatography.12 Gene Transfer and Transplantation Procedures Bone marrow was obtained twice from the patient to collect sufficient stem cells for gene transfer and backup (6.2×108 per kilogram and 5.4×108 per kilogram, respectively, of total nucleated cells obtained). Both procedures were preceded by exchange transfusion, and bone marrow was obtained without clinical sequelae. Anemia was the only grade 3 adverse event reported during these procedures. Bone marrow–enriched CD34+ cells were transduced with LentiGlobin BB305 vector (see the Methods section in the Supplementary Appendix).13 The mean vector copy numbers for the two batches of transduced cells were 1.0 and 1.2 copies per cell. The patient underwent myeloablation with intravenous busulfan (see the Methods section in the Supplementary Appendix). The total busulfan area under the curve achieved was 19,363 μmol per minute. After a 2-day washout period, transduced CD34+ cells (5.6×106 CD34+ cells per kilogram) were infused. Red-cell transfusions were to be continued after transplantation until a large proportion of HbAT87Q (25 to 30% of total hemoglobin) was detected. The patient was followed for engraftment; toxic effects (graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03); vector copy number in total nucleated blood cells and in different lineages; quantification of HbAT87Q, HbS, and fetal hemoglobin levels by means of high-performance liquid chromatography; DNA integration-site mapping by linear amplification–mediated polymerase chain reaction in nucleated blood cells; and replication-competent lentivirus analysis by p24 antibody enzyme-linked immunosorbent assay. Red-cell analyses were performed at month 12 (see the Methods section in the Supplementary Appendix). Results Engraftment and Gene Expression Neutrophil engraftment was achieved on day 38 after transplantation, and platelet engraftment was achieved on day 91 after transplantation. Figure 1A shows the trajectory of vector copy numbers and Figure 1B shows production of HbAT87Q. Gene marking increased progressively in whole blood, CD15 cells, B cells, and monocytes (Fig. S2 in the Supplementary Appendix), stabilizing 3 months after transplantation. Increases in levels of vector-bearing T cells were more gradual. Figure 1 Engraftment with Transduced Cells and Therapeutic Gene Expression in the Patient. HbAT87Q levels also increased steadily (Figure 1B) and red-cell transfusions were discontinued, with the last transfusion on day 88. Levels of HbAT87Q reached 5.5 g per deciliter (46%) at month 9 and continued to increase to 5.7 g per deciliter (48%) at month 15, with a reciprocal decrease in HbS levels to 5.5 g per deciliter (46%) at month 9 and 5.8 g per deciliter (49%) at month 15. Total hemoglobin levels were stable between 10.6 and 12.0 g per deciliter after post-transplantation month 6. Fetal hemoglobin levels remained below 1.0 g per deciliter.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Simplify this passage about gene therapy for sickle cell. Explain what the therapy is and how it works. Also explain the type of sickle cell the patient had. Use bullets an headers so it can be easier to read< Sickle cell disease results from a homozygous missense mutation in the β-globin gene that causes polymerization of hemoglobin S. Gene therapy for patients with this disorder is complicated by the complex cellular abnormalities and challenges in achieving effective, persistent inhibition of polymerization of hemoglobin S. We describe our first patient treated with lentiviral vector–mediated addition of an antisickling β-globin gene into autologous hematopoietic stem cells. Adverse events were consistent with busulfan conditioning. Fifteen months after treatment, the level of therapeutic antisickling β-globin remained high (approximately 50% of β-like–globin chains) without recurrence of sickle crises and with correction of the biologic hallmarks of the disease. (Funded by Bluebird Bio and others; HGB-205 ClinicalTrials.gov number, NCT02151526.) Sickle cell disease is among the most prevalent inherited monogenic disorders. Approximately 90,000 people in the United States have sickle cell disease, and worldwide more than 275,000 infants are born with the disease annually.1,2 Sickle cell disease was the first disease for which the molecular basis was identified: a single amino acid substitution in “adult” βA-globin (Glu6Val) stemming from a single base substitution (A→T) in the first exon of the human βA-globin gene (HBB) was discovered in 1956.3 Sickle hemoglobin (HbS) polymerizes on deoxygenation, reducing the deformability of red cells. Patients have intensely painful vaso-occlusive crises, leading to irreversible organ damage, poor quality of life, and reduced life expectancy. Hydroxyurea, a cytotoxic agent that is capable of boosting fetal hemoglobin levels in some patients, is the only disease-modifying therapy approved for sickle cell disease.4 Allogeneic hematopoietic stem-cell transplantation currently offers the only curative option for patients with severe sickle cell disease.5,6 However, fewer than 18% of patients have access to a matched sibling donor.7,8 Therapeutic ex vivo gene transfer into autologous hematopoietic stem cells, referred to here as gene therapy, may provide a long-term and potentially curative treatment for sickle cell disease.9 We previously reported proof of effective, sustained gene therapy in mouse models of sickle cell disease by lentiviral transfer of a modified HBB encoding an antisickling variant (βA87Thr:Gln [βA-T87Q]).10,11 Here we report the results for a patient who received lentiviral gene therapy in the HGB-205 clinical study and who had complete clinical remission with correction of hemolysis and biologic hallmarks of the disease. Case Report A boy with the βS/βS genotype, a single 3.7-kb α-globin gene deletion, and no glucose 6-phosphate dehydrogenase deficiency received a diagnosis of sickle cell disease at birth and was followed at the Reference Centre for Sickle Cell Disease of Necker Children’s Hospital in Paris. He had a history of numerous vaso-occlusive crises, two episodes of the acute chest syndrome, and bilateral hip osteonecrosis. He had undergone cholecystectomy and splenectomy. During screening, a cerebral hypodensity without characteristics of cerebral vasculopathy was detected. Because hydroxyurea therapy administered when the boy was between 2 and 9 years of age did not reduce his symptoms significantly, a prophylactic red-cell transfusion program was initiated in 2010, including iron chelation with deferasirox (at a dose of 17 mg per kilogram of body weight per day). He had had an average of 1.6 sickle cell disease–related events annually in the 9 years before transfusions were initiated. In May 2014, he was enrolled in our clinical study. His verbal assent and his mother’s written informed consent were obtained. In October 2014, when the patient was 13 years of age, he received an infusion of the drug product LentiGlobin BB305. Methods Study Oversight The study protocol, which is available with the full text of this article at NEJM.org, was designed by the last two authors and Bluebird Bio, the study sponsor. The protocol was reviewed by the French Comité de Protection des Personnes and relevant institutional ethics committees. Clinical data were collected by the first author, and laboratory data were generated by the sponsor, the last author, and other authors. The authors had access to all data, and data analysis was performed by them. The first author and one author employed by the sponsor wrote the first draft of the manuscript, which was substantively revised by the last two authors and further edited and approved by all the authors with writing assistance provided by an employee of the sponsor. The authors vouch for the accuracy and completeness of the data and adherence to the protocol. Antisickling Gene Therapy Vector The structure of the LentiGlobin BB305 vector has been previously described (see Fig. S1 in the Supplementary Appendix, available at NEJM.org).12 This self-inactivating lentiviral vector encodes the human HBB variant βA-T87Q. In addition to inhibiting HbS polymerization, the T87Q substitution allows for the β-globin chain of adult hemoglobin (HbA)T87Q to be differentially quantified by means of reverse-phase high-performance liquid chromatography.12 Gene Transfer and Transplantation Procedures Bone marrow was obtained twice from the patient to collect sufficient stem cells for gene transfer and backup (6.2×108 per kilogram and 5.4×108 per kilogram, respectively, of total nucleated cells obtained). Both procedures were preceded by exchange transfusion, and bone marrow was obtained without clinical sequelae. Anemia was the only grade 3 adverse event reported during these procedures. Bone marrow–enriched CD34+ cells were transduced with LentiGlobin BB305 vector (see the Methods section in the Supplementary Appendix).13 The mean vector copy numbers for the two batches of transduced cells were 1.0 and 1.2 copies per cell. The patient underwent myeloablation with intravenous busulfan (see the Methods section in the Supplementary Appendix). The total busulfan area under the curve achieved was 19,363 μmol per minute. After a 2-day washout period, transduced CD34+ cells (5.6×106 CD34+ cells per kilogram) were infused. Red-cell transfusions were to be continued after transplantation until a large proportion of HbAT87Q (25 to 30% of total hemoglobin) was detected. The patient was followed for engraftment; toxic effects (graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.03); vector copy number in total nucleated blood cells and in different lineages; quantification of HbAT87Q, HbS, and fetal hemoglobin levels by means of high-performance liquid chromatography; DNA integration-site mapping by linear amplification–mediated polymerase chain reaction in nucleated blood cells; and replication-competent lentivirus analysis by p24 antibody enzyme-linked immunosorbent assay. Red-cell analyses were performed at month 12 (see the Methods section in the Supplementary Appendix). Results Engraftment and Gene Expression Neutrophil engraftment was achieved on day 38 after transplantation, and platelet engraftment was achieved on day 91 after transplantation. Figure 1A shows the trajectory of vector copy numbers and Figure 1B shows production of HbAT87Q. Gene marking increased progressively in whole blood, CD15 cells, B cells, and monocytes (Fig. S2 in the Supplementary Appendix), stabilizing 3 months after transplantation. Increases in levels of vector-bearing T cells were more gradual. Figure 1 Engraftment with Transduced Cells and Therapeutic Gene Expression in the Patient. HbAT87Q levels also increased steadily (Figure 1B) and red-cell transfusions were discontinued, with the last transfusion on day 88. Levels of HbAT87Q reached 5.5 g per deciliter (46%) at month 9 and continued to increase to 5.7 g per deciliter (48%) at month 15, with a reciprocal decrease in HbS levels to 5.5 g per deciliter (46%) at month 9 and 5.8 g per deciliter (49%) at month 15. Total hemoglobin levels were stable between 10.6 and 12.0 g per deciliter after post-transplantation month 6. Fetal hemoglobin levels remained below 1.0 g per deciliter. https://www.nejm.org/doi/full/10.1056/NEJMoa1609677#:~:text=HbAT87Q%20levels%20also%20increased,below%201.0%20g%20per%20deciliter.",Medical,Summarize & Simplify,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","I have been considering liposuction, but my sister said a tummy tuck or cool sculpting is best. I am familiar with tummy tucks, but unfamiliar with cool sculpting. In 150 words or less, please tell me how the three options compare regarding the procedure and recovery time.","Coolsculpting, Liposuction or a Tummy Tuck: How to Choose the Best Procedure for You If you’re considering body contouring but aren’t sure which procedure is right for you (CoolSculpting vs liposuction vs tummy tuck), consider the following: Your Anatomy: Each of these procedures treats very different issues, and you may not be a candidate for all three. Do you have excess fat and no extra skin? Or just loose skin but no excess fat? Or do you have some of both? Are your stomach muscles separated? Generally speaking, tummy tucks are best for patients with excess skin or muscles that need tightening, while liposuction and CoolSculpting are best to treat stubborn areas of fat that just won’t go away. Your Timeline: Are you looking for immediate results or would you rather see your results come gradually over time? Choosing between CoolSculpting vs liposuction means you’ll need to consider what kind of time you have to recover. Liposuction results will come immediately but it’s an intensive treatment that requires rest and recovery in the weeks following surgery. CoolSculpting results usually require multiple treatment sessions and appear more gradually, but require little to no downtime. Your Expectations: What kind of result will you be satisfied with? Do you want your stomach to be as flat, tight and smooth as possible, or would you be happy with mild improvement? Your Health: Are you healthy enough to have a surgical procedure? If not, CoolSculpting may be your only non-invasive option. Weighing Your Options: What’s the Difference in Procedures? CoolSculpting: Best non-surgical option for excess fat removal If you have small pockets of fat that just don’t respond to diet and exercise, CoolSculpting may be a great option for you. CoolSculpting is a revolutionary, non-surgical body contouring procedure that removes unwanted bulges by freezing the fat until it breaks down. This allows your body to eliminate the fat naturally while your skin, muscle, and other tissues stay unharmed and healthy. This procedure is FDA-cleared and comfortable, requiring no downtime. Patients may often decide to get CoolSculpting done in the abdominal area, and, oftentimes, in combination with other parts of the body, including hips, flanks, back, thighs, chin, legs, and more. Unlike liposuction or a tummy tuck procedures, where patients must take time to rest and recover, with CoolSculpting, patients immediately return to their normal activities, including strenuous exercise. The best results may require multiple treatments, but changes are usually noticeable just three weeks after treatment, with final results seen after one to three months. Liposuction: Best for effective (but less invasive) fat removal Liposuction is highly effective for safely removing stubborn areas of unwanted fat. It is an ideal solution for people who have good skin, good muscle tone, and no excess, loose skin. Unlike a non-surgical CoolSculpting treatment, liposuction is a surgical procedure requiring a very small incision to access the targeted area. The surgeon will insert a thin cannula which is used to clean the area with saline and anesthetic solutions, while loosening the fat cells. The fat cells are then suctioned away with a surgical vacuum. The procedure is performed on an outpatient basis with general anesthesia. It takes between one to five hours, depending upon the size of the treatment area. In addition to slimming the abdomen, liposuction can be used in many other places of the body, including the sides (love handles), arms, chin, legs, and bottom. Liposuction is far less invasive than a tummy tuck, but it only removes fat. Liposuction will not eliminate excess skin or stretch marks, and it will not tighten loose abdominal muscles. While both liposuction and CoolSculpting are used to remove unwanted fat, the results can be different. Liposuction offers precise contouring with immediate results in a single procedure vs CoolSculpting which requires no surgery or downtime but a longer wait time for results. Tummy Tuck: Best for removing excess skin and fat A tummy tuck, also known as an abdominoplasty, addresses the unwanted fat in a person’s abdomen, sagging skin, loose muscles and stretch marks associated with life events such as pregnancy, drastic weight loss, and age. The biggest difference between a patient who qualifies for a tummy tuck vs liposuction procedure is the presence of this excess skin as a result of losing fat quickly. A tummy tuck procedure starts with an incision across the lower abdomen, allowing the surgeon to remove excess skin and tighten slack or loose muscles. The incision is strategically placed to be as inconspicuous as possible, so it can be hidden by underwear and bathing suits, should scarring occur. The length of the incision is determined by the patient’s anatomy and the level of correction needed to achieve the desired results. Unwanted fat, skin and stretch marks are removed and weak, protruding abdominal muscles are repaired – leaving a tight, flat, smooth tummy! A tummy tuck takes two to five hours and is performed on an outpatient basis with general anesthesia. A tummy tuck is a more invasive procedure compared to liposuction because of all the tightening involved. The recovery time is also much longer for a tummy tuck vs a non-surgical procedure like CoolSculpting. Combining a Tummy Tuck, Liposuction and CoolSculpting for Optimal Results Ultimately, there is no one size fits all treatment for body contouring procedures. Each patient’s situation is going to be different and our surgeons may frequently recommend a combination of procedures in order to achieve the desired results. Because of the differences in what each procedure does, liposuction is often performed during a tummy tuck procedure in order to remove the excess fat before tightening and smoothing out the skin. CoolSculpting can also be performed before or after a tummy tuck or liposuction procedure to enhance the body contouring results further. At Belcara Health, we develop customized treatment plans to meet the specific needs and goals of each patient.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I have been considering liposuction, but my sister said a tummy tuck or cool sculpting is best. I am familiar with tummy tucks, but unfamiliar with cool sculpting. In 150 words or less, please tell me how the three options compare regarding the procedure and recovery time. {passage 0} ========== Coolsculpting, Liposuction or a Tummy Tuck: How to Choose the Best Procedure for You If you’re considering body contouring but aren’t sure which procedure is right for you (CoolSculpting vs liposuction vs tummy tuck), consider the following: Your Anatomy: Each of these procedures treats very different issues, and you may not be a candidate for all three. Do you have excess fat and no extra skin? Or just loose skin but no excess fat? Or do you have some of both? Are your stomach muscles separated? Generally speaking, tummy tucks are best for patients with excess skin or muscles that need tightening, while liposuction and CoolSculpting are best to treat stubborn areas of fat that just won’t go away. Your Timeline: Are you looking for immediate results or would you rather see your results come gradually over time? Choosing between CoolSculpting vs liposuction means you’ll need to consider what kind of time you have to recover. Liposuction results will come immediately but it’s an intensive treatment that requires rest and recovery in the weeks following surgery. CoolSculpting results usually require multiple treatment sessions and appear more gradually, but require little to no downtime. Your Expectations: What kind of result will you be satisfied with? Do you want your stomach to be as flat, tight and smooth as possible, or would you be happy with mild improvement? Your Health: Are you healthy enough to have a surgical procedure? If not, CoolSculpting may be your only non-invasive option. Weighing Your Options: What’s the Difference in Procedures? CoolSculpting: Best non-surgical option for excess fat removal If you have small pockets of fat that just don’t respond to diet and exercise, CoolSculpting may be a great option for you. CoolSculpting is a revolutionary, non-surgical body contouring procedure that removes unwanted bulges by freezing the fat until it breaks down. This allows your body to eliminate the fat naturally while your skin, muscle, and other tissues stay unharmed and healthy. This procedure is FDA-cleared and comfortable, requiring no downtime. Patients may often decide to get CoolSculpting done in the abdominal area, and, oftentimes, in combination with other parts of the body, including hips, flanks, back, thighs, chin, legs, and more. Unlike liposuction or a tummy tuck procedures, where patients must take time to rest and recover, with CoolSculpting, patients immediately return to their normal activities, including strenuous exercise. The best results may require multiple treatments, but changes are usually noticeable just three weeks after treatment, with final results seen after one to three months. Liposuction: Best for effective (but less invasive) fat removal Liposuction is highly effective for safely removing stubborn areas of unwanted fat. It is an ideal solution for people who have good skin, good muscle tone, and no excess, loose skin. Unlike a non-surgical CoolSculpting treatment, liposuction is a surgical procedure requiring a very small incision to access the targeted area. The surgeon will insert a thin cannula which is used to clean the area with saline and anesthetic solutions, while loosening the fat cells. The fat cells are then suctioned away with a surgical vacuum. The procedure is performed on an outpatient basis with general anesthesia. It takes between one to five hours, depending upon the size of the treatment area. In addition to slimming the abdomen, liposuction can be used in many other places of the body, including the sides (love handles), arms, chin, legs, and bottom. Liposuction is far less invasive than a tummy tuck, but it only removes fat. Liposuction will not eliminate excess skin or stretch marks, and it will not tighten loose abdominal muscles. While both liposuction and CoolSculpting are used to remove unwanted fat, the results can be different. Liposuction offers precise contouring with immediate results in a single procedure vs CoolSculpting which requires no surgery or downtime but a longer wait time for results. Tummy Tuck: Best for removing excess skin and fat A tummy tuck, also known as an abdominoplasty, addresses the unwanted fat in a person’s abdomen, sagging skin, loose muscles and stretch marks associated with life events such as pregnancy, drastic weight loss, and age. The biggest difference between a patient who qualifies for a tummy tuck vs liposuction procedure is the presence of this excess skin as a result of losing fat quickly. A tummy tuck procedure starts with an incision across the lower abdomen, allowing the surgeon to remove excess skin and tighten slack or loose muscles. The incision is strategically placed to be as inconspicuous as possible, so it can be hidden by underwear and bathing suits, should scarring occur. The length of the incision is determined by the patient’s anatomy and the level of correction needed to achieve the desired results. Unwanted fat, skin and stretch marks are removed and weak, protruding abdominal muscles are repaired – leaving a tight, flat, smooth tummy! A tummy tuck takes two to five hours and is performed on an outpatient basis with general anesthesia. A tummy tuck is a more invasive procedure compared to liposuction because of all the tightening involved. The recovery time is also much longer for a tummy tuck vs a non-surgical procedure like CoolSculpting. Combining a Tummy Tuck, Liposuction and CoolSculpting for Optimal Results Ultimately, there is no one size fits all treatment for body contouring procedures. Each patient’s situation is going to be different and our surgeons may frequently recommend a combination of procedures in order to achieve the desired results. Because of the differences in what each procedure does, liposuction is often performed during a tummy tuck procedure in order to remove the excess fat before tightening and smoothing out the skin. CoolSculpting can also be performed before or after a tummy tuck or liposuction procedure to enhance the body contouring results further. At Belcara Health, we develop customized treatment plans to meet the specific needs and goals of each patient. https://www.belcarahealth.com/blog/tummy-tuck-vs-lipo-one-best/",Medical,Pros & Cons,Q&A You are to answer the question below based only on the information in the provided text. Do not pull from prior or outside knowledge. Use bold section headings with informative bullet points nested within the headings.,What are some pros and cons of smart watches?,"There are a plenty of great smart watches to choose from, ranging from the Android Wear army to the most recent Pebble watches, and the Apple Watch is also selling like hotcakes. With smart watches we can find apps in android watch, download and install applications, Keep an eye on the navigation. Smart watch stay on your hand and inform us what’s happening. We won’t appear tired in meetings [1][2]. 1. Benefits of Android wear smart watches 1.1 Slumber: Slumber just blacks off your screen while our watch is charging. If user is charging the watch overnight, this light will be glaring in user face, and on some watches the continuous display has even caused screen burn-in most Android Wear devices turn on to charge and display a screen indicating the current battery level (Figure 1) [3]. Smart watches are a type of wearable device that allows us to keep our hands free while also allowing us to use our smartphones away from our bodies. The smart watch help to determine the battery consumption of the user’s phone, and Wear power supply Stats can help in calculate the drainage of the phone battery.The app's watch counterpart gives you a barebones view of what's going on with your battery, but you'll want to open the app on your phone for the most information. You'll be able to see how much time you've spent staring at your screen and which apps you've used as shown in Figure 2 [4]–[6]. 1.3Smart Watches as a Calculator Smart watches used for calculus homework, having an accessible calculator are a good idea for calculating a quick sale percentage, tipping at a restaurant, or double-checking your math.A wearable smart watches worn on the wrist has comparable functionality and capabilities as a smartphone. Smart watches are designed to provide features such as accessing the internet, running mobile applications, making a call, communication via text or video, trying to check caller ID, accessing stock and climate updates, providing wellness monitoring capabilities, providing Gps location and position directions, and more, either on their own or when paired with a smart phone [3], [7], [8]. 1.4 Smart phone as a mobile phone finder Apps that help you find your phone are common, but since your watch is linked to your phone, being able to ring it right from your wrist is a great idea. As long as your phone is connected to your watch via Bluetooth, simply opening the app and tapping ""Find!"" on your watch will ring your phone. You can also use the app to set a notification that sounds on both your watch and phone when they are disconnected. That way, if you're about to leave the house without your phone but not your watch, you'll be warned before making a costly error The smart watches comprise of E-INK display as the battery life of an E-INK display is 5 days. Interface Touch interfaces are more intuitive to use, and many people use a mixture of touch and buttons. People who work out will benefit greatly from smart watches. Sensors are built into these devices that compute how many calories were expended, Traveled distance of the user, Speed, Pulse rate of the user and location of the user through GPS. Elderly falls are one of the most difficult issues that public health systems must deal with. According to World Health Organization (WHO) statistics, falls are the second largest cause of accidental injury mortality after road traffic accidents. Adults over the age of 65 are by far the most vulnerable to this problem, since falls may have a significant effect on their well-being and self-sufficiency. There are a variety of commercial wearables available now that are especially intended to detect falls (see, for example, the reviews presented ref. in for an analysis of the most popular products). These off-the-shelf gadgets, which are generally marketed as a pendant or bracelet, usually include a help button to summon assistance (a useless function if the patient remains unconscious after an accident). These alerting systems are primarily designed for in-home monitoring through specialized base stations connected to a landline. A monthly charge is needed to offer cell phone service when the customer wants on-the-go (ubiquitous) tracking, in addition to the cost of the detector and (in certain instances) the requirement for long-term contracts. Furthermore, in nearly all instances, the manufacturers do not provide information regarding the detection method used or how the detector was validated. As a result, the real efficiency of these systems for detecting falls has not been benchmarked (particularly when they are applied to the target population—the elderly) The major issue with a smartwatch-based FDS is that analyzing wrist motions may lead to overestimates, or an excess of false alarms produced by the jerky activity of the arms and hands, which is not necessarily indicative of the rest of the body's mobility. As a result of the compensatory movements of the hands, the wrist exhibits a completely different mobility pattern during the fall when compared to measurements captured by other body positions, fall-related accelerometry signals may be misinterpreted more frequently as those originated by other ADLs and vice versa when the inertial sensor is placed on the wrist. However, most smartwatches have significant battery and computational power limitations. In fact, autonomy, along with tiny displays, has long been seen as two of the most significant obstacles to wristwatch adoption in health monitoring applications targeted for the elderly. The amount of sensors and sampling rates used in a smartwatch have a direct relationship with battery consumption. As a result, the main limiting issue for the deployment and acceptance of apps that need continuous signal monitoring is the battery capacity (which is typically much lower than that of smartphones). Most activity recognition systems would be jeopardized if the battery autonomy was less than 24 hours, since movement monitoring would have to be stopped before sleep to recharge the batteries. An extra fall detection (constantly running) program may have a significant effect on the battery life. In fact, according to a recent research based on questionnaires completed by respondents in a real-world testing of a worn fall sensor, consumers prefer devices that can operate for at least 6 months before needing to charge a battery. We examine commercially accessible Smart Watches, where adoption is still in its early stages. With the Smart watches accessing of the social network become faster. Smart watches reduce the number of times and effort of the user in pulling out phone. With the smart watches the calls and alerts are less likely to be missed. The features of the camera, Data may be synchronised with smart phones. Touch interface dominant makes easier to navigate, many use the mixture of touch and buttons are in the smart watches.[1], [10], [11] ","You are to answer the question below based only on the information in the provided text. Do not pull from prior or outside knowledge. Use bold section headings with informative bullet points nested within the headings. Question: What are some pros and cons of smart watches? There are a plenty of great smart watches to choose from, ranging from the Android Wear army to the most recent Pebble watches, and the Apple Watch is also selling like hotcakes. With smart watches we can find apps in android watch, download and install applications, Keep an eye on the navigation. Smart watch stay on your hand and inform us what’s happening. We won’t appear tired in meetings [1][2]. 1. Benefits of Android wear smart watches 1.1 Slumber: Slumber just blacks off your screen while our watch is charging. If user is charging the watch overnight, this light will be glaring in user face, and on some watches the continuous display has even caused screen burn-in most Android Wear devices turn on to charge and display a screen indicating the current battery level (Figure 1) [3]. Smart watches are a type of wearable device that allows us to keep our hands free while also allowing us to use our smartphones away from our bodies. The smart watch help to determine the battery consumption of the user’s phone, and Wear power supply Stats can help in calculate the drainage of the phone battery.The app's watch counterpart gives you a barebones view of what's going on with your battery, but you'll want to open the app on your phone for the most information. You'll be able to see how much time you've spent staring at your screen and which apps you've used as shown in Figure 2 [4]–[6]. 1.3Smart Watches as a Calculator Smart watches used for calculus homework, having an accessible calculator are a good idea for calculating a quick sale percentage, tipping at a restaurant, or double-checking your math.A wearable smart watches worn on the wrist has comparable functionality and capabilities as a smartphone. Smart watches are designed to provide features such as accessing the internet, running mobile applications, making a call, communication via text or video, trying to check caller ID, accessing stock and climate updates, providing wellness monitoring capabilities, providing Gps location and position directions, and more, either on their own or when paired with a smart phone [3], [7], [8]. 1.4 Smart phone as a mobile phone finder Apps that help you find your phone are common, but since your watch is linked to your phone, being able to ring it right from your wrist is a great idea. As long as your phone is connected to your watch via Bluetooth, simply opening the app and tapping ""Find!"" on your watch will ring your phone. You can also use the app to set a notification that sounds on both your watch and phone when they are disconnected. That way, if you're about to leave the house without your phone but not your watch, you'll be warned before making a costly error The smart watches comprise of E-INK display as the battery life of an E-INK display is 5 days. Interface Touch interfaces are more intuitive to use, and many people use a mixture of touch and buttons. People who work out will benefit greatly from smart watches. Sensors are built into these devices that compute how many calories were expended, Traveled distance of the user, Speed, Pulse rate of the user and location of the user through GPS. Elderly falls are one of the most difficult issues that public health systems must deal with. According to World Health Organization (WHO) statistics, falls are the second largest cause of accidental injury mortality after road traffic accidents. Adults over the age of 65 are by far the most vulnerable to this problem, since falls may have a significant effect on their well-being and self-sufficiency. There are a variety of commercial wearables available now that are especially intended to detect falls (see, for example, the reviews presented ref. in for an analysis of the most popular products). These off-the-shelf gadgets, which are generally marketed as a pendant or bracelet, usually include a help button to summon assistance (a useless function if the patient remains unconscious after an accident). These alerting systems are primarily designed for in-home monitoring through specialized base stations connected to a landline. A monthly charge is needed to offer cell phone service when the customer wants on-the-go (ubiquitous) tracking, in addition to the cost of the detector and (in certain instances) the requirement for long-term contracts. Furthermore, in nearly all instances, the manufacturers do not provide information regarding the detection method used or how the detector was validated. As a result, the real efficiency of these systems for detecting falls has not been benchmarked (particularly when they are applied to the target population—the elderly) The major issue with a smartwatch-based FDS is that analyzing wrist motions may lead to overestimates, or an excess of false alarms produced by the jerky activity of the arms and hands, which is not necessarily indicative of the rest of the body's mobility. As a result of the compensatory movements of the hands, the wrist exhibits a completely different mobility pattern during the fall when compared to measurements captured by other body positions, fall-related accelerometry signals may be misinterpreted more frequently as those originated by other ADLs and vice versa when the inertial sensor is placed on the wrist. However, most smartwatches have significant battery and computational power limitations. In fact, autonomy, along with tiny displays, has long been seen as two of the most significant obstacles to wristwatch adoption in health monitoring applications targeted for the elderly. The amount of sensors and sampling rates used in a smartwatch have a direct relationship with battery consumption. As a result, the main limiting issue for the deployment and acceptance of apps that need continuous signal monitoring is the battery capacity (which is typically much lower than that of smartphones). Most activity recognition systems would be jeopardized if the battery autonomy was less than 24 hours, since movement monitoring would have to be stopped before sleep to recharge the batteries. An extra fall detection (constantly running) program may have a significant effect on the battery life. In fact, according to a recent research based on questionnaires completed by respondents in a real-world testing of a worn fall sensor, consumers prefer devices that can operate for at least 6 months before needing to charge a battery. We examine commercially accessible Smart Watches, where adoption is still in its early stages. With the Smart watches accessing of the social network become faster. Smart watches reduce the number of times and effort of the user in pulling out phone. With the smart watches the calls and alerts are less likely to be missed. The features of the camera, Data may be synchronised with smart phones. Touch interface dominant makes easier to navigate, many use the mixture of touch and buttons are in the smart watches.[1], [10], [11] ",Internet/Technology,Pros & Cons,Q&A Answer the questions from only the provided text. Do not use any external resources or prior knowledge. Explain your answer but do not exceed 250 words per answer.,My family has been grazing our cattle on federal government land that is not U.S. Fish and Wildlife Service or a National Park for 75 years that has been banned from being used for geothermal leasing. Do we have protected rights to keep grazing our cattle on that land?,"Lands and interest in lands owned by the United States (i.e., federal lands) have been withdrawn from agency management under various public land laws. Federal land withdrawals typically seek to preclude lands from being used for certain purposes (i.e., withdraw them)in order to dedicate them to other purposes or to maintain other public values. For example, some laws established or expanded federal land designations, such as wilderness areas or units of the National Park System, and withdrew the lands apparently to foster the primary purposes of these designations. Withdrawals affect lands managed by agencies including the four major land management agencies: the Bureau of Land Management (BLM), U.S. Fish and Wildlife Service (FWS), and National Park Service (NPS), all in the Department of the Interior, and the U.S. Forest Service (FS), in the Department of Agriculture. The first component of the example provision generally would bar third parties from applying to take ownership and obtaining possession of the lands or resources on the lands under public land laws. However, the lack of a comprehensive list of public land laws—and the lack of a single, consistent definition of the term public land laws itself over time—makes it challenging to determine the precise meaning and applicability. The second component generally would prevent the withdrawn lands from being available for new mining (e.g., under theGeneral Mining Law of 1872). The third component generally would prevent the withdrawn lands from being available for new mineral leasing, sale of mineral materials, and geothermal leasing (e.g., under the Mineral Leasing Act of 1920, Materials Act of 1947, and Geothermal Steam Act of 1970). Together, the three components primarily would affect BLM and FS, because laws governing lands managed by those agencies generally allow for energy and mineral development and provide broader authority to convey lands out of federal ownership than laws governing NPS and FWS lands. Typically, the three components would not bar various surface uses that otherwise might be allowed, possibly including recreation, hunting, and livestock grazing. However, some uses might be limited by Congress or by subsequent agency actions, such as amendments to land management plans, if the uses are inconsistent with the withdrawal’s purposes. Defining “Valid Existing Rights” As used in legislated withdrawals, a “valid existing right” is a third-party (i.e., nonfederal) interest in federal land that the relevant federal agency cannot terminate or unduly limit.82 To have a valid existing right, the third party must  have met the requirements under the relevant law to obtain a property interest in the land (i.e., the property interest must be valid);  have had a protectable interest before the United States withdraws the land (i.e., the property interest was existing at the time of withdrawal);83 and  possess a property interest (or in some cases a possessory interest) in the land that constitutes a right for purposes of withdrawals (i.e., it must be a right).84 Valid The validity of the interest depends on whether the third party has met the requirements of the law under which it alleges to have secured the property interest. First, the interest itself must be legitimate (i.e., supported by evidence of the factual basis required by the relevant statute). For example, to secure a mining claim as a valid right under the mining laws, a claimant must demonstrate that they have made a “valid discovery” of a valuable mineral deposit that can be extracted and marketed. Existing The second requirement for a third party to have a “valid existing right” is that the property interest existed at the time of withdrawal.90 Depending on the legal basis for the right, a third party obtains an interest in federal land either (1) once they meet the statutory requirements, without the federal agency having to act, or (2) when the federal agency exercises its discretion to grant the property interest after the third party meets the relevant statutory requirements. 91 Third parties claiming property interests under laws that do not require the federal agency to grant the interest have an existing property interest as soon as they meet the law’s requirements.92 For example, a claimant under federal mining laws is entitled to the claim once they complete the statutory steps described above (discovery and location).93 Whether the Secretary of the Interior has issued a land patent to transfer title to the claimant does not affect the claimant’s right to the land; once federal mining law requirements are met, the property right “vests” (i.e., ownership is transferred to the claimant) and the right exists. 94 In some cases, the claimant need not complete all of the required steps before the withdrawal to obtain an existing right. If the law allows claims to relate back to occupancy (i.e., be back-dated to when the claimant first occupied the land), claimants may have existing rights if they occupied the land before withdrawal and ultimately complete the remaining steps required by law.95 Other laws provide that a claimant’s interest in federal land only becomes a valid existing right once the Secretary has acted to make it valid. 96 For example, third parties acquire oil and gas leases when the Secretary of the Interior approves their application. 97 Although courts and agencies have recognized these leases as valid existing rights in various contexts, they have not recognized applications for oil and gas leases or other leasehold interests in federal land. Courts and agencies have at times concluded that a third party has a valid existing right despite not having established an interest by law before the land is withdrawn. 99 The Solicitor of the Department of the Interior has offered “an expansive interpretation of ‘existing valid rights’ in the context of withdrawal” 100 that includes “all prior valid applications for entry, selection, or location, which were substantially complete at the date of the withdrawal” and “[c]laims under the Color of Title Act of December 22, 1928.”101 A court or agency also may recognize a valid existing right, even if the claimant is not legally entitled to it, because it would be equitable (i.e., consistent with the principles of justice). 102 Rights Not all uses of or interests in federal land qualify as valid existing “rights.” The third party usually must have obtained a property interest in the land to have a right; merely using the land generally is insufficient to establish a valid existing right. 103 To determine whether the asserted interest qualifies as a right, courts and agencies examine the law authorizing the interest and the withdrawal law.104 Courts and agencies have recognized a number of property interests as protected rights, such as entitlements to land patents under mining laws and entry-based laws such as the Homestead Acts and the Trade and Manufacturing Site Act;105 land grants to states;106 rights-of-way;107 and mineral leases.108 Courts and agencies also have deemed certain possessory interests protected, the most common example being perfected but unpatented mining claims. 109 However, they have declined to recognize other possessory interests as valid existing rights.110 Courts and agencies have generally not recognized permits, such as grazing permits, as protected property rights for purposes of interpreting withdrawals, absent a specific provision in the withdrawal law or order.111 ","Answer the questions from only the provided text. Do not use any external resources or prior knowledge. Explain your answer but do not exceed 250 words per answer. Lands and interest in lands owned by the United States (i.e., federal lands) have been withdrawn from agency management under various public land laws. Federal land withdrawals typically seek to preclude lands from being used for certain purposes (i.e., withdraw them)in order to dedicate them to other purposes or to maintain other public values. For example, some laws established or expanded federal land designations, such as wilderness areas or units of the National Park System, and withdrew the lands apparently to foster the primary purposes of these designations. Withdrawals affect lands managed by agencies including the four major land management agencies: the Bureau of Land Management (BLM), U.S. Fish and Wildlife Service (FWS), and National Park Service (NPS), all in the Department of the Interior, and the U.S. Forest Service (FS), in the Department of Agriculture. The first component of the example provision generally would bar third parties from applying to take ownership and obtaining possession of the lands or resources on the lands under public land laws. However, the lack of a comprehensive list of public land laws—and the lack of a single, consistent definition of the term public land laws itself over time—makes it challenging to determine the precise meaning and applicability. The second component generally would prevent the withdrawn lands from being available for new mining (e.g., under theGeneral Mining Law of 1872). The third component generally would prevent the withdrawn lands from being available for new mineral leasing, sale of mineral materials, and geothermal leasing (e.g., under the Mineral Leasing Act of 1920, Materials Act of 1947, and Geothermal Steam Act of 1970). Together, the three components primarily would affect BLM and FS, because laws governing lands managed by those agencies generally allow for energy and mineral development and provide broader authority to convey lands out of federal ownership than laws governing NPS and FWS lands. Typically, the three components would not bar various surface uses that otherwise might be allowed, possibly including recreation, hunting, and livestock grazing. However, some uses might be limited by Congress or by subsequent agency actions, such as amendments to land management plans, if the uses are inconsistent with the withdrawal’s purposes. Defining “Valid Existing Rights” As used in legislated withdrawals, a “valid existing right” is a third-party (i.e., nonfederal) interest in federal land that the relevant federal agency cannot terminate or unduly limit.82 To have a valid existing right, the third party must  have met the requirements under the relevant law to obtain a property interest in the land (i.e., the property interest must be valid);  have had a protectable interest before the United States withdraws the land (i.e., the property interest was existing at the time of withdrawal);83 and  possess a property interest (or in some cases a possessory interest) in the land that constitutes a right for purposes of withdrawals (i.e., it must be a right).84 Valid The validity of the interest depends on whether the third party has met the requirements of the law under which it alleges to have secured the property interest. First, the interest itself must be legitimate (i.e., supported by evidence of the factual basis required by the relevant statute). For example, to secure a mining claim as a valid right under the mining laws, a claimant must demonstrate that they have made a “valid discovery” of a valuable mineral deposit that can be extracted and marketed. Existing The second requirement for a third party to have a “valid existing right” is that the property interest existed at the time of withdrawal.90 Depending on the legal basis for the right, a third party obtains an interest in federal land either (1) once they meet the statutory requirements, without the federal agency having to act, or (2) when the federal agency exercises its discretion to grant the property interest after the third party meets the relevant statutory requirements. 91 Third parties claiming property interests under laws that do not require the federal agency to grant the interest have an existing property interest as soon as they meet the law’s requirements.92 For example, a claimant under federal mining laws is entitled to the claim once they complete the statutory steps described above (discovery and location).93 Whether the Secretary of the Interior has issued a land patent to transfer title to the claimant does not affect the claimant’s right to the land; once federal mining law requirements are met, the property right “vests” (i.e., ownership is transferred to the claimant) and the right exists. 94 In some cases, the claimant need not complete all of the required steps before the withdrawal to obtain an existing right. If the law allows claims to relate back to occupancy (i.e., be back-dated to when the claimant first occupied the land), claimants may have existing rights if they occupied the land before withdrawal and ultimately complete the remaining steps required by law.95 Other laws provide that a claimant’s interest in federal land only becomes a valid existing right once the Secretary has acted to make it valid. 96 For example, third parties acquire oil and gas leases when the Secretary of the Interior approves their application. 97 Although courts and agencies have recognized these leases as valid existing rights in various contexts, they have not recognized applications for oil and gas leases or other leasehold interests in federal land. Courts and agencies have at times concluded that a third party has a valid existing right despite not having established an interest by law before the land is withdrawn. 99 The Solicitor of the Department of the Interior has offered “an expansive interpretation of ‘existing valid rights’ in the context of withdrawal” 100 that includes “all prior valid applications for entry, selection, or location, which were substantially complete at the date of the withdrawal” and “[c]laims under the Color of Title Act of December 22, 1928.”101 A court or agency also may recognize a valid existing right, even if the claimant is not legally entitled to it, because it would be equitable (i.e., consistent with the principles of justice). 102 Rights Not all uses of or interests in federal land qualify as valid existing “rights.” The third party usually must have obtained a property interest in the land to have a right; merely using the land generally is insufficient to establish a valid existing right. 103 To determine whether the asserted interest qualifies as a right, courts and agencies examine the law authorizing the interest and the withdrawal law.104 Courts and agencies have recognized a number of property interests as protected rights, such as entitlements to land patents under mining laws and entry-based laws such as the Homestead Acts and the Trade and Manufacturing Site Act;105 land grants to states;106 rights-of-way;107 and mineral leases.108 Courts and agencies also have deemed certain possessory interests protected, the most common example being perfected but unpatented mining claims. 109 However, they have declined to recognize other possessory interests as valid existing rights.110 Courts and agencies have generally not recognized permits, such as grazing permits, as protected property rights for purposes of interpreting withdrawals, absent a specific provision in the withdrawal law or order.111 My family has been grazing our cattle on federal government land that is not U.S. Fish and Wildlife Service or a National Park for 75 years that has been banned from being used for geothermal leasing. Do we have protected rights to keep grazing our cattle on that land?",Legal,Fact Finding,Q&A "Create your response by referencing the provided text. Limit your response to 100 words. If you cannot answer using the context alone, say ""I can't determine the answer without more context.""",What's nifedipine?,"Aortic Regurgitation Essentials of Diagnosis • Causes include congenital bicuspid valve, endocarditis, rheumatic heart disease, Marfan’s syndrome, aortic dissection, ankylosing spondylitis, reactive arthritis, and syphilis • Acute aortic regurgitation: Abrupt onset of pulmonary edema • Chronic aortic regurgitation: Asymptomatic until middle age, when symptoms of left heart failure develop insidiously • Soft, high-pitched, decrescendo holodiastolic murmur in chronic aortic regurgitation; occasionally, an accompanying apical lowpitched diastolic rumble (Austin Flint murmur) in nonrheumatic patients; in acute aortic regurgitation, the diastolic murmur can be short (or not even heard) and harsh • Acute aortic regurgitation: Reduced S1 and an S3; rales • Chronic aortic regurgitation: Reduced S1, wide pulse pressure, waterhammer pulse, subungual capillary pulsations (Quincke’s sign), rapid rise and fall of pulse (Corrigan’s pulse), and a diastolic murmur over a partially compressed femoral artery (Duroziez’s sign) • ECG shows left ventricular hypertrophy • Echo Doppler confirms diagnosis, estimates severity ■ Differential Diagnosis • Pulmonary hypertension with Graham Steell murmur • Mitral, or rarely, tricuspid stenosis • Left ventricular failure due to other cause • Dock’s murmur of left anterior descending artery stenosis ■ Treatment • Vasodilators (eg, nifedipine and ACE inhibitors) do not delay the progression to valve replacement in patients with mild to moderate aortic regurgitation • In chronic aortic regurgitation, surgery reserved for patients with symptoms or ejection function < 50% on echocardiography • Acute regurgitation caused by aortic dissection or endocarditis requires surgical replacement of the valve ■ Pearl The Hodgkin-Key murmur of aortic regurgitation is harsh and raspy, caused by leaflet eventration typical of luetic aortopathy. Reference Kamath AR, Varadarajan P, Turk R, Sampat U, Patel R, Khandhar S, Pai RG. Survival in patients with severe aortic regurgitation and severe left ventricular dysfunction is improved by aortic valve replacement. Circulation 2009; 120(suppl):S134. [PMID: 19752358] Aortic Stenosis ■ Essentials of Diagnosis • Causes include congenital bicuspid valve and progressive calcification with aging of a normal three-leaflet valve; rheumatic fever rarely, if ever, causes isolated aortic stenosis • Dyspnea, angina, and syncope singly or in any combination; sudden death in less than 1% of asymptomatic patients • Weak and delayed carotid pulses (pulsus parvus et tardus); a soft, absent, or paradoxically split S2; a harsh diamond-shaped systolic ejection murmur to the right of the sternum, often radiating to the neck, but on occasion heard apically (Gallavardin’s phenomenon) • Left ventricular hypertrophy by ECG and chest x-ray may show calcification in the aortic valve • Echo confirms diagnosis and estimates valve area and gradient; cardiac catheterization confirms severity if there is discrepancy between physical exam and echo; concomitant coronary atherosclerotic disease present in 50% ■ Differential Diagnosis • Mitral regurgitation • Hypertrophic obstructive or dilated cardiomyopathy • Atrial or ventricular septal defect • Syncope due to other causes • Ischemic heart disease without valvular abnormality ■ Treatment • Surgery is indicated for all patients with severe aortic stenosis (mean aortic valve gradient > 40 mm Hg or valve area ≤ 1.0 cm2 ) and the presence of symptoms or ejection fraction < 50% • Percutaneous balloon valvuloplasty for temporary (6 months) relief of symptoms in poor surgical candidates ■ Pearl In many cases, the softer the murmur, the worse the stenosis. Reference Dal-Bianco JP, Khandheria BK, Mookadam F, Gentile F, Sengupta PP. Management of asymptomatic severe aortic stenosis. J Am Coll Cardiol 2008;52:1279. [PMID: 18929238]","Create your response by referencing the provided text. Limit your response to 100 words. If you cannot answer using the context alone, say ""I can't determine the answer without more context."" Aortic Regurgitation Essentials of Diagnosis • Causes include congenital bicuspid valve, endocarditis, rheumatic heart disease, Marfan’s syndrome, aortic dissection, ankylosing spondylitis, reactive arthritis, and syphilis • Acute aortic regurgitation: Abrupt onset of pulmonary edema • Chronic aortic regurgitation: Asymptomatic until middle age, when symptoms of left heart failure develop insidiously • Soft, high-pitched, decrescendo holodiastolic murmur in chronic aortic regurgitation; occasionally, an accompanying apical lowpitched diastolic rumble (Austin Flint murmur) in nonrheumatic patients; in acute aortic regurgitation, the diastolic murmur can be short (or not even heard) and harsh • Acute aortic regurgitation: Reduced S1 and an S3; rales • Chronic aortic regurgitation: Reduced S1, wide pulse pressure, waterhammer pulse, subungual capillary pulsations (Quincke’s sign), rapid rise and fall of pulse (Corrigan’s pulse), and a diastolic murmur over a partially compressed femoral artery (Duroziez’s sign) • ECG shows left ventricular hypertrophy • Echo Doppler confirms diagnosis, estimates severity ■ Differential Diagnosis • Pulmonary hypertension with Graham Steell murmur • Mitral, or rarely, tricuspid stenosis • Left ventricular failure due to other cause • Dock’s murmur of left anterior descending artery stenosis ■ Treatment • Vasodilators (eg, nifedipine and ACE inhibitors) do not delay the progression to valve replacement in patients with mild to moderate aortic regurgitation • In chronic aortic regurgitation, surgery reserved for patients with symptoms or ejection function < 50% on echocardiography • Acute regurgitation caused by aortic dissection or endocarditis requires surgical replacement of the valve ■ Pearl The Hodgkin-Key murmur of aortic regurgitation is harsh and raspy, caused by leaflet eventration typical of luetic aortopathy. Reference Kamath AR, Varadarajan P, Turk R, Sampat U, Patel R, Khandhar S, Pai RG. Survival in patients with severe aortic regurgitation and severe left ventricular dysfunction is improved by aortic valve replacement. Circulation 2009; 120(suppl):S134. [PMID: 19752358] Aortic Stenosis ■ Essentials of Diagnosis • Causes include congenital bicuspid valve and progressive calcification with aging of a normal three-leaflet valve; rheumatic fever rarely, if ever, causes isolated aortic stenosis • Dyspnea, angina, and syncope singly or in any combination; sudden death in less than 1% of asymptomatic patients • Weak and delayed carotid pulses (pulsus parvus et tardus); a soft, absent, or paradoxically split S2; a harsh diamond-shaped systolic ejection murmur to the right of the sternum, often radiating to the neck, but on occasion heard apically (Gallavardin’s phenomenon) • Left ventricular hypertrophy by ECG and chest x-ray may show calcification in the aortic valve • Echo confirms diagnosis and estimates valve area and gradient; cardiac catheterization confirms severity if there is discrepancy between physical exam and echo; concomitant coronary atherosclerotic disease present in 50% ■ Differential Diagnosis • Mitral regurgitation • Hypertrophic obstructive or dilated cardiomyopathy • Atrial or ventricular septal defect • Syncope due to other causes • Ischemic heart disease without valvular abnormality ■ Treatment • Surgery is indicated for all patients with severe aortic stenosis (mean aortic valve gradient > 40 mm Hg or valve area ≤ 1.0 cm2 ) and the presence of symptoms or ejection fraction < 50% • Percutaneous balloon valvuloplasty for temporary (6 months) relief of symptoms in poor surgical candidates ■ Pearl In many cases, the softer the murmur, the worse the stenosis. Reference Dal-Bianco JP, Khandheria BK, Mookadam F, Gentile F, Sengupta PP. Management of asymptomatic severe aortic stenosis. J Am Coll Cardiol 2008;52:1279. [PMID: 18929238] What's nifedipine?",Medical,Fact Finding,Q&A Only use the information provided in the below context block to asnwer the question. Your answer should be in paragraph format and no more than 200 words.,What are the key points of Section 455 of the Higher Education Act?,"On August 8, 2020, President Trump signed a presidential memorandum expressing his view that payments and interest accrual on student loans should remain suspended past September 30, 2020, “until such time that the economy has stabilized, schools have re-opened, and the crisis brought on by the COVID-19 pandemic has subsided.” The memorandum directs the Secretary of Education to “continue the temporary cessation of payments and the waiver of all interest on student loans held by the Department of Education until December 31, 2020.” The memorandum cites Section 455(f)(2)(D) of the Higher Education Act (HEA), which allows eligible borrowers to defer certain federally held student loans if they experience economic hardship. Such a deferment temporarily relieves the borrower of an obligation to pay principal installments on the loan. For some (but not all) loans, a deferment also temporarily suspends the accrual of loan interest. To implement the proposed suspension of payments and interest accrual, the presidential memorandum directs the Secretary of Education “to take action pursuant to applicable law to effectuate appropriate waivers of and modifications to the requirements and conditions of economic hardship deferment described in” HEA Section 455(f)(2)(D). Under HEA Section 435(o)—which Section 455(f)(2)(D) incorporates by reference—a borrower is eligible for an economic hardship deferment if the borrower is (1) working full-time and (2) earning an amount of money that falls below a specified threshold. But HEA Sections 455(f)(2)(D) and 435(o) also authorize the Secretary of Education to promulgate regulations making additional borrowers eligible for an economic hardship deferment. The Secretary of Education previously issued regulations making economic hardship deferments available to certain borrowers who might not otherwise meet the criteria specified in Section 435(o). The presidential memorandum contemplates that the Secretary of Education will exercise available statutory authorities to further expand economic hardship deferment eligibility to borrowers adversely affected by the COVID-19 pandemic. The presidential memorandum may raise several questions for policymakers. First, as mentioned above, a deferment under Section 455(f) does not suspend interest accrual for all types of student loans. To the contrary, Section 435(f)(1)(B) states that for certain loans, interest “shall accrue and be capitalized or paid by the borrower” during the deferment period. It therefore may be uncertain whether Section 455(f), standing alone, allows the Executive to waive “all interest on student loans held by the Department of Education” as the presidential memorandum contemplates. That said, the presidential memorandum directs the Secretary of Education to take action pursuant to “applicable law” to effectuate the memorandum’s directives. The Trump Administration might attempt to argue that other provisions of federal law give the Secretary of Education the power to waive all interest on student loans held by the Department of Education, even if Section 455 does not. Second, the memorandum does not explicitly specify who will be eligible for the expanded economic hardship deferments. The memorandum appears to contemplate, however, that the Secretary of Education will make those deferments available to all borrowers who are currently covered by the CARES Act’s payment and interest suspension provisions. Third, while the presidential memorandum states that “[a]ll persons who wish to continue making student loan payments shall be allowed to do so,” it does not specify whether borrowers will need to apply for the deferments, or if the Secretary of Education will instead automatically grant deferments to eligible borrowers unless they opt out. Under existing regulations, deferment is (with limited exceptions) not automatic; a borrower must usually request a deferment and submit an application containing various documents. Although the Secretary of Education could potentially amend those regulations to automatically grant deferments, doing so could have both advantages and disadvantages. On one hand, dispensing with the requirement that borrowers file an application to receive a deferment could reduce burdens on both borrowers and the federal government. On the other hand, some borrowers might prefer not to receive an automatic deferment, preferring to continue paying off their loans. For instance, some student loan forgiveness programs—such as the Public Service Loan Forgiveness (PSLF) Program— require the borrower to make payments over an extended period to receive relief. Fourth, Section 3513 of the CARES Act affords borrowers certain types of relief that the presidential memorandum does not mention. For instance: • Section 3513(e) suspends involuntary collection on student loans covered by the CARES Act’s principal and interest suspension provisions. • Section 3513(d) affords borrowers certain consumer credit reporting protections during the suspension period. • Section 3513(c) requires the Secretary of Education to “deem each month for which a loan payment was suspended” under the CARES Act as if the borrower “had made a payment for the purpose of any loan forgiveness program or loan rehabilitation program,” such as the PSLF program. The memorandum does not expressly address these topics. Notably, however, when the Trump Administration took administrative action in March 2020 to grant relief to student loan borrowers, the Secretary of Education instructed the U.S. Treasury and collection agencies to cease involuntary collection actions and wage garnishments for at least 60 days. Also, it is presently unclear whether the Secretary of Education will give stakeholders an opportunity to comment on any regulations she might promulgate to implement the memorandum. Federal law ordinarily requires the Secretary of Education to engage in a negotiated rulemaking process with stakeholders and accept and consider public comments before a regulation governing student loans becomes effective. But the Secretary of Education may bypass these procedures when following them would be “impracticable, unnecessary, or contrary to the public interest.” Given the significant and continuing impact of COVID-19 and Section 3513’s impending expiration date, the Secretary of Education might be able to publish regulations to implement aspects of the memorandum that become effective immediately, without first accepting public comment. ","What are the key points of Section 455 of the Higher Education Act? Only use the information provided in the below context block to asnwer the question. Your answer should be in paragraph format and no more than 200 words. On August 8, 2020, President Trump signed a presidential memorandum expressing his view that payments and interest accrual on student loans should remain suspended past September 30, 2020, “until such time that the economy has stabilized, schools have re-opened, and the crisis brought on by the COVID-19 pandemic has subsided.” The memorandum directs the Secretary of Education to “continue the temporary cessation of payments and the waiver of all interest on student loans held by the Department of Education until December 31, 2020.” The memorandum cites Section 455(f)(2)(D) of the Higher Education Act (HEA), which allows eligible borrowers to defer certain federally held student loans if they experience economic hardship. Such a deferment temporarily relieves the borrower of an obligation to pay principal installments on the loan. For some (but not all) loans, a deferment also temporarily suspends the accrual of loan interest. To implement the proposed suspension of payments and interest accrual, the presidential memorandum directs the Secretary of Education “to take action pursuant to applicable law to effectuate appropriate waivers of and modifications to the requirements and conditions of economic hardship deferment described in” HEA Section 455(f)(2)(D). Under HEA Section 435(o)—which Section 455(f)(2)(D) incorporates by reference—a borrower is eligible for an economic hardship deferment if the borrower is (1) working full-time and (2) earning an amount of money that falls below a specified threshold. But HEA Sections 455(f)(2)(D) and 435(o) also authorize the Secretary of Education to promulgate regulations making additional borrowers eligible for an economic hardship deferment. The Secretary of Education previously issued regulations making economic hardship deferments available to certain borrowers who might not otherwise meet the criteria specified in Section 435(o). The presidential memorandum contemplates that the Secretary of Education will exercise available statutory authorities to further expand economic hardship deferment eligibility to borrowers adversely affected by the COVID-19 pandemic. The presidential memorandum may raise several questions for policymakers. First, as mentioned above, a deferment under Section 455(f) does not suspend interest accrual for all types of student loans. To the contrary, Section 435(f)(1)(B) states that for certain loans, interest “shall accrue and be capitalized or paid by the borrower” during the deferment period. It therefore may be uncertain whether Section 455(f), standing alone, allows the Executive to waive “all interest on student loans held by the Department of Education” as the presidential memorandum contemplates. That said, the presidential memorandum directs the Secretary of Education to take action pursuant to “applicable law” to effectuate the memorandum’s directives. The Trump Administration might attempt to argue that other provisions of federal law give the Secretary of Education the power to waive all interest on student loans held by the Department of Education, even if Section 455 does not. Second, the memorandum does not explicitly specify who will be eligible for the expanded economic hardship deferments. The memorandum appears to contemplate, however, that the Secretary of Education will make those deferments available to all borrowers who are currently covered by the CARES Act’s payment and interest suspension provisions. Third, while the presidential memorandum states that “[a]ll persons who wish to continue making student loan payments shall be allowed to do so,” it does not specify whether borrowers will need to apply for the deferments, or if the Secretary of Education will instead automatically grant deferments to eligible borrowers unless they opt out. Under existing regulations, deferment is (with limited exceptions) not automatic; a borrower must usually request a deferment and submit an application containing various documents. Although the Secretary of Education could potentially amend those regulations to automatically grant deferments, doing so could have both advantages and disadvantages. On one hand, dispensing with the requirement that borrowers file an application to receive a deferment could reduce burdens on both borrowers and the federal government. On the other hand, some borrowers might prefer not to receive an automatic deferment, preferring to continue paying off their loans. For instance, some student loan forgiveness programs—such as the Public Service Loan Forgiveness (PSLF) Program— require the borrower to make payments over an extended period to receive relief. Fourth, Section 3513 of the CARES Act affords borrowers certain types of relief that the presidential memorandum does not mention. For instance: • Section 3513(e) suspends involuntary collection on student loans covered by the CARES Act’s principal and interest suspension provisions. • Section 3513(d) affords borrowers certain consumer credit reporting protections during the suspension period. • Section 3513(c) requires the Secretary of Education to “deem each month for which a loan payment was suspended” under the CARES Act as if the borrower “had made a payment for the purpose of any loan forgiveness program or loan rehabilitation program,” such as the PSLF program. The memorandum does not expressly address these topics. Notably, however, when the Trump Administration took administrative action in March 2020 to grant relief to student loan borrowers, the Secretary of Education instructed the U.S. Treasury and collection agencies to cease involuntary collection actions and wage garnishments for at least 60 days. Also, it is presently unclear whether the Secretary of Education will give stakeholders an opportunity to comment on any regulations she might promulgate to implement the memorandum. Federal law ordinarily requires the Secretary of Education to engage in a negotiated rulemaking process with stakeholders and accept and consider public comments before a regulation governing student loans becomes effective. But the Secretary of Education may bypass these procedures when following them would be “impracticable, unnecessary, or contrary to the public interest.” Given the significant and continuing impact of COVID-19 and Section 3513’s impending expiration date, the Secretary of Education might be able to publish regulations to implement aspects of the memorandum that become effective immediately, without first accepting public comment.",Legal,Find & Summarize,Text Transformation "For this task, you are required to use only the information that is provided in the prompt. You cannot use any outside information or sources. Do not reference any knowledge outside of what is explicitly provided.",What are the criteria that must be met for a precedent to be overruled?,"The more difficult question in this case is stare decisis— that is, whether to overrule the Roe decision. The principle of stare decisis requires respect for the 6 DOBBS v. JACKSON WOMEN’S HEALTH ORGANIZATION KAVANAUGH, J., concurring Court’s precedents and for the accumulated wisdom of the judges who have previously addressed the same issue. Stare decisis is rooted in Article III of the Constitution and is fundamental to the American judicial system and to the stability of American law. Adherence to precedent is the norm, and stare decisis imposes a high bar before this Court may overrule a precedent. This Court’s history shows, however, that stare decisis is not absolute, and indeed cannot be absolute. Otherwise, as the Court today explains, many long-sinceoverruled cases such as Plessy v. Ferguson, 163 U. S. 537 (1896); Lochner v. New York, 198 U. S. 45 (1905); Minersville School Dist. v. Gobitis, 310 U. S. 586 (1940); and Bowers v. Hardwick, 478 U. S. 186 (1986), would never have been overruled and would still be the law. In his canonical Burnet opinion in 1932, Justice Brandeis stated that in “cases involving the Federal Constitution, where correction through legislative action is practically impossible, this Court has often overruled its earlier decisions.” Burnet v. Coronado Oil & Gas Co., 285 U. S. 393, 406−407 (1932) (dissenting opinion). That description of the Court’s practice remains accurate today. Every current Member of this Court has voted to overrule precedent. And over the last 100 years beginning with Chief Justice Taft’s appointment in 1921, every one of the 48 Justices appointed to this Court has voted to overrule precedent. Many of those Justices have voted to overrule a substantial number of very significant and longstanding precedents. See, e.g., Obergefell v. Hodges, 576 U. S. 644 (2015) (overruling Baker v. Nelson); Brown v. Board of Education, 347 U. S. 483 (1954) (overruling Plessy v. Ferguson); West Coast Hotel Co. v. Parrish, 300 U. S. 379 (1937) (overruling Adkins v. Children’s Hospital of D. C. and in effect Lochner v. New York). But that history alone does not answer the critical question: When precisely should the Court overrule an erroneous constitutional precedent? The history of stare decisis in Cite as: 597 U. S. ____ (2022) 7 KAVANAUGH, J., concurring this Court establishes that a constitutional precedent may be overruled only when (i) the prior decision is not just wrong, but is egregiously wrong, (ii) the prior decision has caused significant negative jurisprudential or real-world consequences, and (iii) overruling the prior decision would not unduly upset legitimate reliance interests. See Ramos v. Louisiana, 590 U. S. ___, ___−___ (2020) (KAVANAUGH, J., concurring in part) (slip op., at 7−8). Applying those factors, I agree with the Court today that Roe should be overruled. The Court in Roe erroneously assigned itself the authority to decide a critically important moral and policy issue that the Constitution does not grant this Court the authority to decide. As Justice Byron White succinctly explained, Roe was “an improvident and extravagant exercise of the power of judicial review” because “nothing in the language or history of the Constitution” supports a constitutional right to abortion. Bolton, 410 U. S., at 221−222 (dissenting opinion). Of course, the fact that a precedent is wrong, even egregiously wrong, does not alone mean that the precedent should be overruled. But as the Court today explains, Roe has caused significant negative jurisprudential and realworld consequences. By taking sides on a difficult and contentious issue on which the Constitution is neutral, Roe overreached and exceeded this Court’s constitutional authority; gravely distorted the Nation’s understanding of this Court’s proper constitutional role; and caused significant harm to what Roe itself recognized as the State’s “important and legitimate interest” in protecting fetal life. 410 U. S., at 162. All of that explains why tens of millions of Americans—and the 26 States that explicitly ask the Court to overrule Roe—do not accept Roe even 49 years later. Under the Court’s longstanding stare decisis principles, Roe 8 DOBBS v. JACKSON WOMEN’S HEALTH ORGANIZATION KAVANAUGH, J., concurring should be overruled.3 But the stare decisis analysis here is somewhat more complicated because of Casey. In 1992, 19 years after Roe, Casey acknowledged the continuing dispute over Roe. The Court sought to find common ground that would resolve the abortion debate and end the national controversy. After careful and thoughtful consideration, the Casey plurality reaffirmed a right to abortion through viability (about 24 weeks), while also allowing somewhat more regulation of abortion than Roe had allowed.4 I have deep and unyielding respect for the Justices who wrote the Casey plurality opinion. And I respect the Casey plurality’s good-faith effort to locate some middle ground or compromise that could resolve this controversy for America. But as has become increasingly evident over time, Casey’s —————— 3 I also agree with the Court’s conclusion today with respect to reliance. Broad notions of societal reliance have been invoked in support of Roe, but the Court has not analyzed reliance in that way in the past. For example, American businesses and workers relied on Lochner v. New York, 198 U. S. 45 (1905), and Adkins v. Children’s Hospital of D. C., 261 U. S. 525 (1923), to construct a laissez-faire economy that was free of substantial regulation. In West Coast Hotel Co. v. Parrish, 300 U. S. 379 (1937), the Court nonetheless overruled Adkins and in effect Lochner. An entire region of the country relied on Plessy v. Ferguson, 163 U. S. 537 (1896), to enforce a system of racial segregation. In Brown v. Board of Education, 347 U. S. 483 (1954), the Court overruled Plessy. Much of American society was built around the traditional view of marriage that was upheld in Baker v. Nelson, 409 U. S. 810 (1972), and that was reflected in laws ranging from tax laws to estate laws to family laws. In Obergefell v. Hodges, 576 U. S. 644 (2015), the Court nonetheless overruled Baker. 4As the Court today notes, Casey’s approach to stare decisis pointed in two directions. Casey reaffirmed Roe’s viability line, but it expressly overruled the Roe trimester framework and also expressly overruled two landmark post-Roe abortion cases—Akron v. Akron Center for Reproductive Health, Inc., 462 U. S. 416 (1983), and Thornburgh v. American College of Obstetricians and Gynecologists, 476 U. S. 747 (1986). See Casey, 505 U. S., at 870, 872−873, 878−879, 882. Casey itself thus directly contradicts any notion of absolute stare decisis in abortion cases. Cite as: 597 U. S. ____ (2022) 9 KAVANAUGH, J., concurring well-intentioned effort did not resolve the abortion debate. The national division has not ended. In recent years, a significant number of States have enacted abortion restrictions that directly conflict with Roe. Those laws cannot be dismissed as political stunts or as outlier laws. Those numerous state laws collectively represent the sincere and deeply held views of tens of millions of Americans who continue to fervently believe that allowing abortions up to 24 weeks is far too radical and far too extreme, and does not sufficiently account for what Roe itself recognized as the State’s “important and legitimate interest” in protecting fetal life. 410 U. S., at 162. In this case, moreover, a majority of the States—26 in all—ask the Court to overrule Roe and return the abortion issue to the States. In short, Casey’s stare decisis analysis rested in part on a predictive judgment about the future development of state laws and of the people’s views on the abortion issue. But that predictive judgment has not borne out. As the Court today explains, the experience over the last 30 years conflicts with Casey’s predictive judgment and therefore undermines Casey’s precedential force.5 ","System instruction: For this task, you are required to use only the information that is provided in the prompt. You cannot use any outside information or sources. Do not reference any knowledge outside of what is explicitly provided. Question: What are the criteria that must be met for a precedent to be overruled? Context: The more difficult question in this case is stare decisis— that is, whether to overrule the Roe decision. The principle of stare decisis requires respect for the 6 DOBBS v. JACKSON WOMEN’S HEALTH ORGANIZATION KAVANAUGH, J., concurring Court’s precedents and for the accumulated wisdom of the judges who have previously addressed the same issue. Stare decisis is rooted in Article III of the Constitution and is fundamental to the American judicial system and to the stability of American law. Adherence to precedent is the norm, and stare decisis imposes a high bar before this Court may overrule a precedent. This Court’s history shows, however, that stare decisis is not absolute, and indeed cannot be absolute. Otherwise, as the Court today explains, many long-sinceoverruled cases such as Plessy v. Ferguson, 163 U. S. 537 (1896); Lochner v. New York, 198 U. S. 45 (1905); Minersville School Dist. v. Gobitis, 310 U. S. 586 (1940); and Bowers v. Hardwick, 478 U. S. 186 (1986), would never have been overruled and would still be the law. In his canonical Burnet opinion in 1932, Justice Brandeis stated that in “cases involving the Federal Constitution, where correction through legislative action is practically impossible, this Court has often overruled its earlier decisions.” Burnet v. Coronado Oil & Gas Co., 285 U. S. 393, 406−407 (1932) (dissenting opinion). That description of the Court’s practice remains accurate today. Every current Member of this Court has voted to overrule precedent. And over the last 100 years beginning with Chief Justice Taft’s appointment in 1921, every one of the 48 Justices appointed to this Court has voted to overrule precedent. Many of those Justices have voted to overrule a substantial number of very significant and longstanding precedents. See, e.g., Obergefell v. Hodges, 576 U. S. 644 (2015) (overruling Baker v. Nelson); Brown v. Board of Education, 347 U. S. 483 (1954) (overruling Plessy v. Ferguson); West Coast Hotel Co. v. Parrish, 300 U. S. 379 (1937) (overruling Adkins v. Children’s Hospital of D. C. and in effect Lochner v. New York). But that history alone does not answer the critical question: When precisely should the Court overrule an erroneous constitutional precedent? The history of stare decisis in Cite as: 597 U. S. ____ (2022) 7 KAVANAUGH, J., concurring this Court establishes that a constitutional precedent may be overruled only when (i) the prior decision is not just wrong, but is egregiously wrong, (ii) the prior decision has caused significant negative jurisprudential or real-world consequences, and (iii) overruling the prior decision would not unduly upset legitimate reliance interests. See Ramos v. Louisiana, 590 U. S. ___, ___−___ (2020) (KAVANAUGH, J., concurring in part) (slip op., at 7−8). Applying those factors, I agree with the Court today that Roe should be overruled. The Court in Roe erroneously assigned itself the authority to decide a critically important moral and policy issue that the Constitution does not grant this Court the authority to decide. As Justice Byron White succinctly explained, Roe was “an improvident and extravagant exercise of the power of judicial review” because “nothing in the language or history of the Constitution” supports a constitutional right to abortion. Bolton, 410 U. S., at 221−222 (dissenting opinion). Of course, the fact that a precedent is wrong, even egregiously wrong, does not alone mean that the precedent should be overruled. But as the Court today explains, Roe has caused significant negative jurisprudential and realworld consequences. By taking sides on a difficult and contentious issue on which the Constitution is neutral, Roe overreached and exceeded this Court’s constitutional authority; gravely distorted the Nation’s understanding of this Court’s proper constitutional role; and caused significant harm to what Roe itself recognized as the State’s “important and legitimate interest” in protecting fetal life. 410 U. S., at 162. All of that explains why tens of millions of Americans—and the 26 States that explicitly ask the Court to overrule Roe—do not accept Roe even 49 years later. Under the Court’s longstanding stare decisis principles, Roe 8 DOBBS v. JACKSON WOMEN’S HEALTH ORGANIZATION KAVANAUGH, J., concurring should be overruled.3 But the stare decisis analysis here is somewhat more complicated because of Casey. In 1992, 19 years after Roe, Casey acknowledged the continuing dispute over Roe. The Court sought to find common ground that would resolve the abortion debate and end the national controversy. After careful and thoughtful consideration, the Casey plurality reaffirmed a right to abortion through viability (about 24 weeks), while also allowing somewhat more regulation of abortion than Roe had allowed.4 I have deep and unyielding respect for the Justices who wrote the Casey plurality opinion. And I respect the Casey plurality’s good-faith effort to locate some middle ground or compromise that could resolve this controversy for America. But as has become increasingly evident over time, Casey’s —————— 3 I also agree with the Court’s conclusion today with respect to reliance. Broad notions of societal reliance have been invoked in support of Roe, but the Court has not analyzed reliance in that way in the past. For example, American businesses and workers relied on Lochner v. New York, 198 U. S. 45 (1905), and Adkins v. Children’s Hospital of D. C., 261 U. S. 525 (1923), to construct a laissez-faire economy that was free of substantial regulation. In West Coast Hotel Co. v. Parrish, 300 U. S. 379 (1937), the Court nonetheless overruled Adkins and in effect Lochner. An entire region of the country relied on Plessy v. Ferguson, 163 U. S. 537 (1896), to enforce a system of racial segregation. In Brown v. Board of Education, 347 U. S. 483 (1954), the Court overruled Plessy. Much of American society was built around the traditional view of marriage that was upheld in Baker v. Nelson, 409 U. S. 810 (1972), and that was reflected in laws ranging from tax laws to estate laws to family laws. In Obergefell v. Hodges, 576 U. S. 644 (2015), the Court nonetheless overruled Baker. 4As the Court today notes, Casey’s approach to stare decisis pointed in two directions. Casey reaffirmed Roe’s viability line, but it expressly overruled the Roe trimester framework and also expressly overruled two landmark post-Roe abortion cases—Akron v. Akron Center for Reproductive Health, Inc., 462 U. S. 416 (1983), and Thornburgh v. American College of Obstetricians and Gynecologists, 476 U. S. 747 (1986). See Casey, 505 U. S., at 870, 872−873, 878−879, 882. Casey itself thus directly contradicts any notion of absolute stare decisis in abortion cases. Cite as: 597 U. S. ____ (2022) 9 KAVANAUGH, J., concurring well-intentioned effort did not resolve the abortion debate. The national division has not ended. In recent years, a significant number of States have enacted abortion restrictions that directly conflict with Roe. Those laws cannot be dismissed as political stunts or as outlier laws. Those numerous state laws collectively represent the sincere and deeply held views of tens of millions of Americans who continue to fervently believe that allowing abortions up to 24 weeks is far too radical and far too extreme, and does not sufficiently account for what Roe itself recognized as the State’s “important and legitimate interest” in protecting fetal life. 410 U. S., at 162. In this case, moreover, a majority of the States—26 in all—ask the Court to overrule Roe and return the abortion issue to the States. In short, Casey’s stare decisis analysis rested in part on a predictive judgment about the future development of state laws and of the people’s views on the abortion issue. But that predictive judgment has not borne out. As the Court today explains, the experience over the last 30 years conflicts with Casey’s predictive judgment and therefore undermines Casey’s precedential force.5 ",Legal,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",Discuss the purpose of Artificial Intelligence in relationship with the financial industry as outlined in this article. Keep the response under 200 words and do not use the word technology,"Artificial Intelligence and Machine Learning in Financial Services The financial industry’s adoption of artificial intelligence (AI) and machine learning (ML) is evolving as financial firms employ ever greater levels of technology and automation to deliver services. Expanding on earlier models of quantitative analysis, AI/ML has often been adopted in finance to solve discrete challenges, such as maximizing profit and minimizing risk. Yet the industry’s adoption of the newer technology also occurs against perceptions that are steeped in tradition and historical financial regulation, and regulators want to ensure that the technology does not sidestep regulations frequently described as technology neutral. Technological advances in computer hardware, capacity, and data storage—which permit the collection and analysis of data—helped fuel the development and use of AI/ML technologies in finance. Unlike older algorithms that automated human-coded rules, new AI models can “learn” by themselves and make inferences and recommendations not identified by modelers in advance. This shift in technology has also enabled the use of new types of data including alternative data (i.e., data that the consumer credit bureaus do not traditionally use), unstructured data (images or social media posts, etc.), and unlabeled information data—which, when combined, extend the technologies’ uses to new financial services or products. Different parts of the financial services industry have adopted AI/ML technology to varying degrees and for various purposes. Some uses of AI/ML include powering chatbots in customer service functions, identifying investment opportunities and/or executing trades, augmenting lending models or (more sparingly) making lending decisions, and identifying and preventing fraud. The extent to which a sector or firm adopts various technologies reflects a variety of factors, including a firm’s ability to fund internal development and regulatory requirements. The increased use of AI/ML to deliver financial services has attracted attention and led to numerous policy issues and subsequent policy actions. Such policy actions culminated in (1) the establishment of a task force on AI in the 116 th Congress and the more recent working group in the House Committee on Financial Services in the 118th and (2) 2019 and 2023 executive orders. The evolving legislative and regulatory framework regarding AI/ML use in finance is likely, at least in part, to influence the development of AI/ML financial services applications. Various financial regulators have indicated that regulated entities are subject to the full range of laws and regulations regardless of the technology used. Additionally, some regulators have identified regulations and issued guidance of particular relevance to financial firms employing AI/ML technologies. Financial industry policymakers face competing pressures. Financial service providers and technology companies are likely to continue adopting and promoting AI/ML to save time and money and promote accessibility, accuracy, and regulatory compliance. However, challenges and risks in the form of bias, potential for systemic risk and manipulation, affordability, and consequences for employment remain. Determining whether the existing regulatory structure is sufficient—or whether one that is more closely tailored to the technological capacities of the evolving technology is necessary—has emerged as a key consideration. Should Congress consider the legislative framework governing AI/ML in finance, industry and consumers alike will expect that it weighs the benefits of innovation with existing and potential future challenges and risks."," Only use the provided text to answer the question, no outside sources. Discuss the purpose of Artificial Intelligence in relationship with the financial industry as outlined in this article. Keep the response under 200 words and do not use the word technology Artificial Intelligence and Machine Learning in Financial Services The financial industry’s adoption of artificial intelligence (AI) and machine learning (ML) is evolving as financial firms employ ever greater levels of technology and automation to deliver services. Expanding on earlier models of quantitative analysis, AI/ML has often been adopted in finance to solve discrete challenges, such as maximizing profit and minimizing risk. Yet the industry’s adoption of the newer technology also occurs against perceptions that are steeped in tradition and historical financial regulation, and regulators want to ensure that the technology does not sidestep regulations frequently described as technology neutral. Technological advances in computer hardware, capacity, and data storage—which permit the collection and analysis of data—helped fuel the development and use of AI/ML technologies in finance. Unlike older algorithms that automated human-coded rules, new AI models can “learn” by themselves and make inferences and recommendations not identified by modelers in advance. This shift in technology has also enabled the use of new types of data including alternative data (i.e., data that the consumer credit bureaus do not traditionally use), unstructured data (images or social media posts, etc.), and unlabeled information data—which, when combined, extend the technologies’ uses to new financial services or products. Different parts of the financial services industry have adopted AI/ML technology to varying degrees and for various purposes. Some uses of AI/ML include powering chatbots in customer service functions, identifying investment opportunities and/or executing trades, augmenting lending models or (more sparingly) making lending decisions, and identifying and preventing fraud. The extent to which a sector or firm adopts various technologies reflects a variety of factors, including a firm’s ability to fund internal development and regulatory requirements. The increased use of AI/ML to deliver financial services has attracted attention and led to numerous policy issues and subsequent policy actions. Such policy actions culminated in (1) the establishment of a task force on AI in the 116 th Congress and the more recent working group in the House Committee on Financial Services in the 118th and (2) 2019 and 2023 executive orders. The evolving legislative and regulatory framework regarding AI/ML use in finance is likely, at least in part, to influence the development of AI/ML financial services applications. Various financial regulators have indicated that regulated entities are subject to the full range of laws and regulations regardless of the technology used. Additionally, some regulators have identified regulations and issued guidance of particular relevance to financial firms employing AI/ML technologies. Financial industry policymakers face competing pressures. Financial service providers and technology companies are likely to continue adopting and promoting AI/ML to save time and money and promote accessibility, accuracy, and regulatory compliance. However, challenges and risks in the form of bias, potential for systemic risk and manipulation, affordability, and consequences for employment remain. Determining whether the existing regulatory structure is sufficient—or whether one that is more closely tailored to the technological capacities of the evolving technology is necessary—has emerged as a key consideration. Should Congress consider the legislative framework governing AI/ML in finance, industry and consumers alike will expect that it weighs the benefits of innovation with existing and potential future challenges and risks. https://crsreports.congress.gov/product/pdf/R/R47997",Financial,Effect Analysis,Q&A "Create a short paragraph response to the question using clear, precise vocabulary. This should only rely on information contained in the text.","What is Actor Network Theory, and how does it help us understand the failure of Google Glass? ","Analysis of the Google Glass Failure and Why Things May Be Different Now A Research Paper submitted to the Department of Engineering and Society Presented to the Faculty of the School of Engineering and Applied Science University of Virginia • Charlottesville, Virginia In Partial Fulfillment of the Requirements for the Degree Bachelor of Science, School of Engineering Tyler Labiak Spring, 2021 On my honor as a University Student, I have neither given nor received unauthorized aid on this assignment as defined by the Honor Guidelines for Thesis-Related Assignments Signature __________________________________________ Date __________ Tyler Labiak Approved __________________________________________ Date __________ Sharon Tsai-hsuan Ku, Department of Engineering and Society 5/8/2021 Introduction As technology continues to advance at breakneck speeds into the unknown, humans are increasingly defined by their creations. Inventions alter history, mediate human-perception, deepen (or obscure) knowledge, and modify socialization. Also, throughout history, technology has come to exist through human political, economic, cultural, and social factors (Law, 1987). To best understand and guide the development of technology, and consequently humanity, much work has been done researching the social means by which technology comes to exist and, inversely, the effects of technology on society. Of course, the human drivers behind technology’s development and adoption are not static. Social constructs like privacy, data ethics, safety standards, and social norms change over time as society changes and, consequently, as technology changes. Therefore, technology must be evaluated in the context of its creation and usage. This paper hopes to highlight this temporal element in analyzing technology in the context of a dynamic society. Google Glass is a device that society rejected not as a bad piece of technology, but rather as a socio-technical artifact. The reality of Google Glass is that its engineers did not consciously design the human-technological interaction that they were creating and failed to see how the product would affect social interactions and perceptions of privacy. As a result, there was backlash against the product leading to its failure. However, today’s attitudes surrounding technology and privacy have further laxed; technological advances have shaped a sociotechnical context where Glass may succeed today or in the future. This paper utilizes Actor Network Theory to demonstrate how Google failed to coalesce a human, non-human network in developing Glass, expanding on prior work to show how the conditions surrounding Glass have evolved with time. To achieve the above conclusions, this paper analyzes media and primary sources from the time of release of Glass, academic and retrospective journalism pertaining to the failure of Glass, interviews with non-experts and experts about this technology, and current Glass enthusiasts via the Google Glass subreddit. Literature Review In April 2013 Google began accepting applications for the public to purchase a pair of smart glasses that Google believed was a major step in the direction of their dream “that computers and the Internet will be accessible anywhere and we can ask them to do things without lifting a finger” (Miller, 2013). This was the Explorer version of Google Glass, outfitted with a small screen and camera, and connected to a smartphone and the internet over Bluetooth or Wifi (Miller, 2013). Essentially a beta test for developers, the purpose of the “Explorer program [was] to find out how people want to (and will) use Glass” (Topolsky, 2013). The expectations around Google Glass were massive, with Business Insider (2013) expecting a $10.5 billion dollar opportunity for Google as unit sales would increase and the price would decrease until Glass was the next “ubiquitous” technology. However, the glasses failed spectacularly with media citing that Google overpromised and underdelivered (Yoon, 2018). Of course, this does not tell the entire story. Many people will not know that Google Glass still exists in the form of Glass Enterprise. Google rebranded the tech to sell to manufacturing, healthcare, and logistics businesses for a workplace hands-off augmented reality computer (“Glass”, 2021). Similarly, Microsoft Hololens allows a headset based industrial mixed reality solution (“Hololens”, 2021). So, if these technologies have proven themselves in a commercial space, what went wrong in the public setting? During Glass’s Explorer phase there was a slew of privacy concerns associated with the fact that wearing Glass meant wielding a camera at all times. To some, Google Glass was a rare example of people pushing back against big tech regarding privacy. People were kicked out of bars because of the recording aspect, the NYT ran a front-page story about privacy concerns, activists set up groups to push back against the product, and policies were implemented that forbid people from taking pictures without consent (Eveleth, 2018). Kudina and Verbeek (2019) explored how Glass mediated the value of privacy by analyzing YouTube comments from the time of release. However, there is little consideration given to the temporal aspects of sociotechnical interaction. It is essential that Glass is examined, not only in the context of its release, but also with respect to changing norms, human perceptions, and technologies. Without asking these questions, we remain unprepared to answer whether a similar technology could succeed today or in the future. “Ethics from Within: Google Glass, the Collingridge Dilemma, and the Mediated Value of Privacy” by Olya Kudina and Paul-Peter Verbeek (2019) examines online discussions about Google Glass, particularly comments on a YouTube video produced by Google, in order to understand “how people articulate new meanings of the value of privacy.” This case study serves as a demonstration of Verbeek’s own Theory of Technological Mediation, which allows a focus on “the dynamics of the interaction between technologies and human values” as a way of addressing the Collingridge Dilemma, which applied here says that when a technology is young it is unknown how it will affect systems, and that by the time the morality surrounding technology is clear, it is difficult to develop the already widespread technology. According to mediation theory, engineers design not just products, but they design human-technological interactions in the world. Technology acts as a mediator, shaping personal experiences and objects while humans and tech are not separate, but affect each other in their relations. Rather than speculating about the future, “it studies the dynamics of technomoral change itself.” While Verbeek’s paper serves as a launch point for human perception around the time of Glass’s release, and is drawn upon greatly in the below analysis, the data set is of course not representative of today’s cultural technological landscape. Therefore, this paper hopes to extend on this work in describing not just Glass’s initial rejection given its social context at the time, but also inspect perceptions of the technology today. Conceptual Frameworks and Research Methods This paper draws mainly on Darryl Cressman’s (2009) overview of Actor Network Theory and the following definitions are derived from his work unless otherwise cited. In Actor Network Theory everything, both human and non-human can be viewed as both an actor and a network. These actor networks are therefore sociotechnical in nature, and they are sometimes referred to as heterogenous networks. A network is defined by the associations it describes; therefore, power of the network and association are intertwined. Additionally, power and meaning are not inherent to any single actor within a network, rather they are associative, relational and contextual. When that actor becomes part of another network its associations change, and as a result its power or meaning changes. Meaning is ascribed to actors with a network contextually rather innately (Cressman, 2009). Engineers in ANT practice heterogeneous engineering, assembling actor networks that are both human and technical in nature. To understand how the world works, practitioners of ANT must understand how economic, political, social, and technological understanding interact with each other. In contrast to other STS theories, ANT is symmetrical in the influence of both the technical and nontechnical (Cressman, 2009). Technological innovation comes from the process in ANT known as translation. This is the process by which both the social and technical actors are recruited into a network. This does not happen at once, rather actors are recruited in a gradient as the network gradually becomes more robust. In understanding the world through ANT, there is an emphasis on connections rather than the individual, and these connections are not all equal (Cressman, 2009). The conclusion of Actor Network Theory is that for a network to succeed, an engineer must consider all actors human, nonhuman, technical, political, economic, social, etc. Engineers are therefore world builders (Law, 1987), and recruiting actors to make a socially robust network is the triumph of a network. Neglecting the social aspects, or encountering rogue actors, leads to a failed network. It will be shown that this is exactly how Google failed as a network builder; thus, the tools of ANT were chosen to explore this dynamic. In addition to the academic papers cited and journalistic releases analyzed below, two means of research were also applied. In order to gain a sense of how potential users today perceive Google Glass or similar technology, interviews were conducted on a group of nonexperts and peers, as well as one industry expert, and enthusiasts of the technology were gauged via posts on the Google Glass enthusiast subreddit “r/googleglass”. The purpose of the interviews was not to poll a representative set of the opinions surrounding Glass, rather to guide research and find some interesting perspectives surrounding the technology and privacy today. Subjects were aged 22 to 57 and varied in occupation, education and sex. All interviewees could be broadly incorporated in a target audience for Google, as all of them consume smart technology already. The interviewees were asked what they knew about Google Glass, then asked a set of questions about smart technology, ubiquitous recording, privacy, and legality, and finally were asked to give their opinion on the viability of a product like Glass coming back in the future. Interviewees’ knowledge regarding Glass ranged from having never heard of the product, to familiarity, to an industry insider who markets technology products for Apple and has worked with former Glass developers. It is important to emphasize that these interviewees were not randomly selected and do not number great enough to act as a focus group of sorts for the product, but they guided research and topic discovery as well as offer a scope of perspectives in this area. The second group considered are users of the subreddit “r/googleglass.” This is an enthusiast forum dedicated to the technology. The studied materials consisted of the forum “Top, This Year” as of March 2021, meaning that these posts were the most “upvoted,” or received the most positive interactions on that forum for the year. These posts were chosen because they represent the most popular current opinions and perceptions from the enthusiast community. Analysis In the case of Glass, Google serves as the network builder in assembling Glass, not just the technology but also the human technical interactions. In ANT, technology and society are dual, in that they exert influence on and shape each other. This is also articulated by Verbeek through his Technological Mediation framework, claiming that Glass mediates privacy itself. In the below section, media from the time of Glass’s release will be analyzed to see how the associations of Glass with these rogue actors lead to the destabilization of the network all together. Moving chronologically, the first article analyzed is from February 2013, nearly two months prior to the launch of the explorer version of Glass. A writer from The Verge met with Google Glass lead designers for an early test of the product. The author of the article is, as expected of a tech magazine writer, very optimistic about Google Glass noting the “tremendous value and potential.” He praises the design, appearance, functionality and wearability of the device but also posts an early warning sign about the fate of Glass: “At one point during my time with Glass, we all went out to navigate to a nearby Starbucks — the camera crew I’d brought with me came along. As soon as we got inside however, the employees at Starbucks asked us to stop filming. Sure, no problem. But I kept the Glass’ video recorder going, all the way through my order and getting my coffee. Yes, you can see a light in the prism when the device is recording, but I got the impression that most people had no idea what they were looking at. The cashier seemed to be on the verge of asking me what I was wearing on my face, but the question never came. He certainly never asked me to stop filming.” (Topolsky, 2013) The author is keenly aware of the issues looming for Google Glass, saying in his own words, “The privacy issue is going to be a big hurdle for Google with Glass”. When he brought this up to the Glass designers he met with (product director Steve Lee and lead industrial designer Isabelle Olsson). Their belief was that the explorer program was their way of developing an etiquette surrounding Glass. The use and misuse of the program would be monitored by Google and feedback would move the product forward. The author then remarks “that’s not going to answer questions about what’s right and wrong to do with a camera that doesn’t need to be held up to take a photo, and often won’t even be noticed by its owner’s subjects. Will people get comfortable with that? Are they supposed to?” (Topolsky, 2013) From an ANT perspective, privacy is not just a concept but rather a socio-technical actor existing in their network. It is equally important for Google to consider how Glass allows people to record the world and affect others notions of privacy. However, there is almost an apathy here in the Explorer program. Google acknowledges that through the Explorer program they can develop an etiquette around Glass, while recruiting people to their network, but without taking an active role in designing a project that is socially harmonious, their network is unstable. As the author stated, their tech fails to answer the questions about what people will do with a camera and if that’s okay. Google’s technological optimism, or potentially their naivete, comes through perhaps strongest in an influential New York Times article from the time of release of Google Glass. This article, titled “Google Glass Picks Up Early Signal: Keep Out” details the negative responses that Google Glass was getting form various places around the country, and contrasts it with Google’s reputation for being cavalier around privacy. The article quotes Google’s former CEO Eric Schmidt in 2009 saying, “If you have something that you don’t want anyone to know, maybe you shouldn’t be doing it in the first place” (Streitfield, 2013). It is clear that this policy permeates through to their implementation of Glass, which potentially immortalizes the public realm through ubiquitous recording, thus making potentially everything known to everyone. A contributing law expert is quoted as saying “We are all now going to be both the paparazzi and the paparazzi’s target” (Streitfield, 2013). Furthermore, the article reports that app developers made photography with glass as discrete as simply winking in one application (Streitfield, 2013). To many this makes Glass even more intrusive, and although it is unclear if Google would have allowed a feature like this in their final release, the Explorer program was essential for gradually recruiting public acceptance into the Glass network. Of course, they failed to do so. The New York Times article also speaks on a Seattle bar that banned Glass. The owner of the bar reported to Geekwire that Glass disrupted the private and seedy culture of his bar: “People want to go there and be not known … and definitely don’t want to be secretly filmed or videotaped and immediately put on the Internet” (Bishop, 2013). He also notes that “tech geeks” from Amazon frequent the bar, and he doesn’t want them using Glass inside. This “tech geek backlash” is another overarching theme regarding these reactionary articles. As one writer put it, “Google’s core mistake was allowing geeky developers to become the face of Glass” (Constine, 2017). This made recruitment of a more privacy conscious group difficult for Google, since all of a sudden there was an Us vs the “Glassholes” dynamic. The Five Point owners, the geeky big tech employees, and its various bargoers represent a key factor that must be considered when assembling a socially robust network. The associations surrounding actors in a network are entirely variable and context dependent. Where Google employees may look favorably on how Glass impacts social dynamics, the same is not true of all society. The heterogenous engineer of ANT does engineering outside the lab creating a network that is socially robust, while Google perhaps looks only inward on its own norms. Kudina and Verbeek’s (2009) paper using Technological Mediation digs deeper into how Google approached human behavior and Glass. Google called on the best judgement of its users and published a list of dos and don’ts surrounding Glass and sat back to observe. The author turns to gauging Glass’s mediation of privacy and social interaction via YouTube comments on this list of dos and don’ts during the explorer phase of Glass. One conclusion is that “Glass appears as a mediating boundary object between what commenters consider private even in the most public places and what is violated when the device is introduced,” and to online commenters “the privacy of forgetting [is] at stake with Glass.” As a designer, under Technological Mediation, Google creates the mediations, and perhaps for Glass to succeed they needed to be aware of what human interactions and perceptions were actually being designed. This wraps into actor network theory nicely, since under ANT designers are responsible for recruiting the actors that are both human and nonhuman to a sociotechnical network. The designers are the builders of society, and Google failed in creating a network that is stable both socially and technically. A few years later, SnapChat created the spectacles which were smart glasses that allowed users to record footage and post to snapchat. However, without addressing the social issues, the same fate occurred and this network too failed as reported by TechCrunch: “Google Glass tainted the market with its ‘not sure if you’re recording me’ design. Even though Snap put more obvious recording signal lights on Spectacles, people would still question you about whether they were on camera. That not only made people uncomfortable being around Spectacles, but made you feel like a bit of a creep just wearing them” (Constine, 2017). This is not to say that there is no hope for augmented reality. Google Glass still exists in the form of Glass Enterprise. Google rebranded the tech to sell to manufacturing and healthcare businesses. In this space the context is completely different, and the expectation of privacy spoken about by Verbeek does not exist in the same caliber. Privacy, under ANT, can be considered an actor-network, since it is defined by humans and technological relations. Therefore, it is also subject to the contextuality present in ANT and takes on a different meaning in the workplace. There is already perhaps an expectation of being observed at work, at least to some extent, and especially in manufacturing settings. Computer surveillance software, security cameras, and sensors in manufacturing monitor people’s actions already in a way that would be unacceptable in the private space. From an ANT perspective this clearly represents the idea of variable meanings of actors in different networks. As a result, Google is able to recruit companies and people to their enterprise network, where associations with privacy hold different meanings. Strictly speaking, the technology for these products to exist was never the problem; rather, Glass, people, and privacy take on different meanings in a business setting and the public space. While Glass may have been initially deemed unacceptable by society, human perceptions are subject to change as a result of the technical landscape that permeates life around us. Much has changed since 2013 when Glass was released. The privacy paradox states that individuals may desire privacy, but are willing to exchange it for the benefits of technology (Eveleth, 2018). What was once considered off limits could potentially now be acceptable, as technology has shaped our views of what is wrong and right. Evidence of this lies in the still active Reddit group dedicated to Google Glass. Users here are still developing software for Glass including the top poster writing about hacking a version of Android onto Glass. There are many posts about buying and selling the technology as well as discussing alternative smart glasses. The discussions in the community consist of instructions on how to load firmware updates onto Glass as well as loading custom apps such as Netflix which is popular among users on the subreddit. Additionally, there are troubleshooting posts, guides, blogs and external repositories of apps discussed, linked and posted on the forum. In stark contrast to the YouTube comments analyzed by Verbeek, these users have embraced Glass and taken on the role of designers in an enthusiast ecosystem. The general consensus here is also a longing or even optimism about new Google Glass products, and that the original Glass was “ahead of its time”. In conducted interviews, while the subjects varied in terms of their individual privacy beliefs, no subject so far has said that Glass or a similar device should be banned. More importantly, there was consensus that a product like Glass could or will exist in the future. One expert who Apple contracts for marketing, said “if Apple released their version of Google Glass in two years it will be everywhere.” Others, especially young people, saw no problem whatsoever with the technology, even after having experts’ concerns explained. The justification was that privacy is already so compromised by technology and governments. Nearly all interviewees believed that if a product like this came out in the future, and was a commercial success they would see no problem at all. Like the reddit users, these interviewees are a far cry from the mainstream privacy worry in 2013. In observing both Reddit posters and interviewees, one cannot determine for certain whether Google Glass could reclaim success today. However, these examples show that the meaning of actor networks can be derived from context that is time dependent as well. Glass is not innately moral or immoral. Rather, Society’s expectations for privacy, and their morals surrounding the subject, change with time and the influence of technology. In Actor Network Theory this is the symmetry of humans affecting technology and technology impacting humans. While Google failed to realize how these human factors played into their network originally, perhaps today or in the near future privacy, as its own actor network, will evolve in such a way that Glass can exist as a socially robust network. Conclusion Google Glass is an actor-network that dissolved, not as a result of its technology or any specific actor, but rather because of the associations and context these human and nonhuman actors take on in translating the network. In a public space, from the beginning Glass represented a form of ubiquitous and secret recording, because there was the assumption that anybody at any time could be caught on the glasses’ camera. Technology mediates human perception, and in this case, Glass lends new meaning to what is considered private. In an Actor Network framework, this is a demonstration of the symmetry of human and non-human artifacts influencing each other, and without these considerations the network was bound to fail. Rather than design a product that was both social and technical, Google maintained its cavalier approach to privacy, not considering how people may have reacted to digitalizing the world’s eyesight. Google employees and glass users at the time were optimistic about the future of the product, believing that the product would come to be socially acceptable. This captures the idea of association and context ascribing meaning in ANT. While Glass may have been acceptable in Silicon Valley, it did not get the same reception in the main stream. Similarly, while Google could not release this product to the public it has faced success in manufacturing, healthcare, and logistic settings as have other augmented reality headsets. Again, here privacy and people’s expectations take on a new meaning in the Google Glass Enterprise actor-network. Much has changed since the release of Google Glass. It has become an expectation in these times that users trade free services for their own personal data. We have all had our ideas of privacy mediated by technology in this way. It may be possible then, that in the current year or in the future a product like Glass will resurface, as it has done in the manufacturing space. Some Reddit users, for example, have put Google Glass to use in their own lives, modifying and distributing updated software for the glasses. The consensus on these forums is that Glass was ahead of its time, and there is consensus among interviewed potential users that a product like this could succeed. From an ANT perspective, again it is clear that the context of associations within the network matter, rather than the individual parts, and these are all dynamic with respect to time. If a product like Glass was to reach mainstream success, it would not be strictly the technology, but rather the recruitment of the technology, the human users, and the social norms of today or the future that yield a stable network. While Google Glass as a high-profile product failure has been written about extensively, there is little in the vein of an STS perspective, and that work focuses on the lens of society at Glasses release date. The efforts of this paper are to provide an example of how the tools of ANT can be used to not only analyze the building (and failure) of a technology, but also emphasize how associations change with context, specifically time. These considerations are essential for understanding not just the deployment of future technologies, but also the transient nature of social norms. References Bishop, T. (2013, March 8). No Google Glasses allowed, declares Seattle dive bar. GeekWire. https://www.geekwire.com/2013/google-glasses-allowed-declares-seattle-dive-bar/ Constine, J. (2017, October 28). Why Snapchat Spectacles failed. TechCrunch. https://social.techcrunch.com/2017/10/28/why-snapchat-spectacles-failed/ Cressman, D. (2009). A Brief Overview of Actor-Network Theory: Punctualization, Heterogeneous Engineering & Translation. https://summit.sfu.ca/item/13593 Eveleth, R (2018). Google Glass Wasn’t a Failure. It Raised Crucial Concerns. WIRED. (n.d.). Retrieved November 1, 2020, from https://www.wired.com/story/google-glass-reasonableexpectation-of-privacy/ Glass. (n.d.). Glass. Retrieved November 2, 2020, from https://www.google.com/glass/start/ Insider, B. (n.d.). BI INTELLIGENCE FORECAST: Google Glass Will Be An $11 Billion Market By 2018. Business Insider. Retrieved November 1, 2020, from https://www.businessinsider.com/google-glass-11-billion-market-by-2018-2013-5 Kudina, O., & Verbeek, P.-P. (2019). Ethics from Within: Google Glass, the Collingridge Dilemma, and the Mediated Value of Privacy. Science, Technology, & Human Values, 44(2), 291–314. https://doi.org/10.1177/0162243918793711 Law, J. (1987). On the Social Explanation of Technical Change: The Case of the Portuguese Maritime Expansion. Technology and Culture, 28(2), 227–252. https://doi.org/10.2307/3105566 Microsoft HoloLens | Mixed Reality Technology for Business. (n.d.). Retrieved March 27, 2021, from https://www.microsoft.com/en-us/hololens Miller, C. C. (2013, February 21). Google Searches for Style. The New York Times. https://www.nytimes.com/2013/02/21/technology/google-looks-to-make-its-computer-glassesstylish.html Streitfeld, D. (2013, May 7). Google Glass Picks Up Early Signal: Keep Out. The New York Times. https://www.nytimes.com/2013/05/07/technology/personaltech/google-glass-picks-up-earlysignal-keep-out.html Topolsky, J. (2013, February 22). I used Google Glass: The future, but with monthly updates. The Verge. https://www.theverge.com/2013/2/22/4013406/i-used-google-glass-its-the-future-withmonthly-updates","Create a short paragraph response to the question using clear, precise vocabulary. This should only rely on information contained in the text. What is Actor Network Theory, and how does it help us understand the failure of Google Glass? Analysis of the Google Glass Failure and Why Things May Be Different Now A Research Paper submitted to the Department of Engineering and Society Presented to the Faculty of the School of Engineering and Applied Science University of Virginia • Charlottesville, Virginia In Partial Fulfillment of the Requirements for the Degree Bachelor of Science, School of Engineering Tyler Labiak Spring, 2021 On my honor as a University Student, I have neither given nor received unauthorized aid on this assignment as defined by the Honor Guidelines for Thesis-Related Assignments Signature __________________________________________ Date __________ Tyler Labiak Approved __________________________________________ Date __________ Sharon Tsai-hsuan Ku, Department of Engineering and Society 5/8/2021 Introduction As technology continues to advance at breakneck speeds into the unknown, humans are increasingly defined by their creations. Inventions alter history, mediate human-perception, deepen (or obscure) knowledge, and modify socialization. Also, throughout history, technology has come to exist through human political, economic, cultural, and social factors (Law, 1987). To best understand and guide the development of technology, and consequently humanity, much work has been done researching the social means by which technology comes to exist and, inversely, the effects of technology on society. Of course, the human drivers behind technology’s development and adoption are not static. Social constructs like privacy, data ethics, safety standards, and social norms change over time as society changes and, consequently, as technology changes. Therefore, technology must be evaluated in the context of its creation and usage. This paper hopes to highlight this temporal element in analyzing technology in the context of a dynamic society. Google Glass is a device that society rejected not as a bad piece of technology, but rather as a socio-technical artifact. The reality of Google Glass is that its engineers did not consciously design the human-technological interaction that they were creating and failed to see how the product would affect social interactions and perceptions of privacy. As a result, there was backlash against the product leading to its failure. However, today’s attitudes surrounding technology and privacy have further laxed; technological advances have shaped a sociotechnical context where Glass may succeed today or in the future. This paper utilizes Actor Network Theory to demonstrate how Google failed to coalesce a human, non-human network in developing Glass, expanding on prior work to show how the conditions surrounding Glass have evolved with time. To achieve the above conclusions, this paper analyzes media and primary sources from the time of release of Glass, academic and retrospective journalism pertaining to the failure of Glass, interviews with non-experts and experts about this technology, and current Glass enthusiasts via the Google Glass subreddit. Literature Review In April 2013 Google began accepting applications for the public to purchase a pair of smart glasses that Google believed was a major step in the direction of their dream “that computers and the Internet will be accessible anywhere and we can ask them to do things without lifting a finger” (Miller, 2013). This was the Explorer version of Google Glass, outfitted with a small screen and camera, and connected to a smartphone and the internet over Bluetooth or Wifi (Miller, 2013). Essentially a beta test for developers, the purpose of the “Explorer program [was] to find out how people want to (and will) use Glass” (Topolsky, 2013). The expectations around Google Glass were massive, with Business Insider (2013) expecting a $10.5 billion dollar opportunity for Google as unit sales would increase and the price would decrease until Glass was the next “ubiquitous” technology. However, the glasses failed spectacularly with media citing that Google overpromised and underdelivered (Yoon, 2018). Of course, this does not tell the entire story. Many people will not know that Google Glass still exists in the form of Glass Enterprise. Google rebranded the tech to sell to manufacturing, healthcare, and logistics businesses for a workplace hands-off augmented reality computer (“Glass”, 2021). Similarly, Microsoft Hololens allows a headset based industrial mixed reality solution (“Hololens”, 2021). So, if these technologies have proven themselves in a commercial space, what went wrong in the public setting? During Glass’s Explorer phase there was a slew of privacy concerns associated with the fact that wearing Glass meant wielding a camera at all times. To some, Google Glass was a rare example of people pushing back against big tech regarding privacy. People were kicked out of bars because of the recording aspect, the NYT ran a front-page story about privacy concerns, activists set up groups to push back against the product, and policies were implemented that forbid people from taking pictures without consent (Eveleth, 2018). Kudina and Verbeek (2019) explored how Glass mediated the value of privacy by analyzing YouTube comments from the time of release. However, there is little consideration given to the temporal aspects of sociotechnical interaction. It is essential that Glass is examined, not only in the context of its release, but also with respect to changing norms, human perceptions, and technologies. Without asking these questions, we remain unprepared to answer whether a similar technology could succeed today or in the future. “Ethics from Within: Google Glass, the Collingridge Dilemma, and the Mediated Value of Privacy” by Olya Kudina and Paul-Peter Verbeek (2019) examines online discussions about Google Glass, particularly comments on a YouTube video produced by Google, in order to understand “how people articulate new meanings of the value of privacy.” This case study serves as a demonstration of Verbeek’s own Theory of Technological Mediation, which allows a focus on “the dynamics of the interaction between technologies and human values” as a way of addressing the Collingridge Dilemma, which applied here says that when a technology is young it is unknown how it will affect systems, and that by the time the morality surrounding technology is clear, it is difficult to develop the already widespread technology. According to mediation theory, engineers design not just products, but they design human-technological interactions in the world. Technology acts as a mediator, shaping personal experiences and objects while humans and tech are not separate, but affect each other in their relations. Rather than speculating about the future, “it studies the dynamics of technomoral change itself.” While Verbeek’s paper serves as a launch point for human perception around the time of Glass’s release, and is drawn upon greatly in the below analysis, the data set is of course not representative of today’s cultural technological landscape. Therefore, this paper hopes to extend on this work in describing not just Glass’s initial rejection given its social context at the time, but also inspect perceptions of the technology today. Conceptual Frameworks and Research Methods This paper draws mainly on Darryl Cressman’s (2009) overview of Actor Network Theory and the following definitions are derived from his work unless otherwise cited. In Actor Network Theory everything, both human and non-human can be viewed as both an actor and a network. These actor networks are therefore sociotechnical in nature, and they are sometimes referred to as heterogenous networks. A network is defined by the associations it describes; therefore, power of the network and association are intertwined. Additionally, power and meaning are not inherent to any single actor within a network, rather they are associative, relational and contextual. When that actor becomes part of another network its associations change, and as a result its power or meaning changes. Meaning is ascribed to actors with a network contextually rather innately (Cressman, 2009). Engineers in ANT practice heterogeneous engineering, assembling actor networks that are both human and technical in nature. To understand how the world works, practitioners of ANT must understand how economic, political, social, and technological understanding interact with each other. In contrast to other STS theories, ANT is symmetrical in the influence of both the technical and nontechnical (Cressman, 2009). Technological innovation comes from the process in ANT known as translation. This is the process by which both the social and technical actors are recruited into a network. This does not happen at once, rather actors are recruited in a gradient as the network gradually becomes more robust. In understanding the world through ANT, there is an emphasis on connections rather than the individual, and these connections are not all equal (Cressman, 2009). The conclusion of Actor Network Theory is that for a network to succeed, an engineer must consider all actors human, nonhuman, technical, political, economic, social, etc. Engineers are therefore world builders (Law, 1987), and recruiting actors to make a socially robust network is the triumph of a network. Neglecting the social aspects, or encountering rogue actors, leads to a failed network. It will be shown that this is exactly how Google failed as a network builder; thus, the tools of ANT were chosen to explore this dynamic. In addition to the academic papers cited and journalistic releases analyzed below, two means of research were also applied. In order to gain a sense of how potential users today perceive Google Glass or similar technology, interviews were conducted on a group of nonexperts and peers, as well as one industry expert, and enthusiasts of the technology were gauged via posts on the Google Glass enthusiast subreddit “r/googleglass”. The purpose of the interviews was not to poll a representative set of the opinions surrounding Glass, rather to guide research and find some interesting perspectives surrounding the technology and privacy today. Subjects were aged 22 to 57 and varied in occupation, education and sex. All interviewees could be broadly incorporated in a target audience for Google, as all of them consume smart technology already. The interviewees were asked what they knew about Google Glass, then asked a set of questions about smart technology, ubiquitous recording, privacy, and legality, and finally were asked to give their opinion on the viability of a product like Glass coming back in the future. Interviewees’ knowledge regarding Glass ranged from having never heard of the product, to familiarity, to an industry insider who markets technology products for Apple and has worked with former Glass developers. It is important to emphasize that these interviewees were not randomly selected and do not number great enough to act as a focus group of sorts for the product, but they guided research and topic discovery as well as offer a scope of perspectives in this area. The second group considered are users of the subreddit “r/googleglass.” This is an enthusiast forum dedicated to the technology. The studied materials consisted of the forum “Top, This Year” as of March 2021, meaning that these posts were the most “upvoted,” or received the most positive interactions on that forum for the year. These posts were chosen because they represent the most popular current opinions and perceptions from the enthusiast community. Analysis In the case of Glass, Google serves as the network builder in assembling Glass, not just the technology but also the human technical interactions. In ANT, technology and society are dual, in that they exert influence on and shape each other. This is also articulated by Verbeek through his Technological Mediation framework, claiming that Glass mediates privacy itself. In the below section, media from the time of Glass’s release will be analyzed to see how the associations of Glass with these rogue actors lead to the destabilization of the network all together. Moving chronologically, the first article analyzed is from February 2013, nearly two months prior to the launch of the explorer version of Glass. A writer from The Verge met with Google Glass lead designers for an early test of the product. The author of the article is, as expected of a tech magazine writer, very optimistic about Google Glass noting the “tremendous value and potential.” He praises the design, appearance, functionality and wearability of the device but also posts an early warning sign about the fate of Glass: “At one point during my time with Glass, we all went out to navigate to a nearby Starbucks — the camera crew I’d brought with me came along. As soon as we got inside however, the employees at Starbucks asked us to stop filming. Sure, no problem. But I kept the Glass’ video recorder going, all the way through my order and getting my coffee. Yes, you can see a light in the prism when the device is recording, but I got the impression that most people had no idea what they were looking at. The cashier seemed to be on the verge of asking me what I was wearing on my face, but the question never came. He certainly never asked me to stop filming.” (Topolsky, 2013) The author is keenly aware of the issues looming for Google Glass, saying in his own words, “The privacy issue is going to be a big hurdle for Google with Glass”. When he brought this up to the Glass designers he met with (product director Steve Lee and lead industrial designer Isabelle Olsson). Their belief was that the explorer program was their way of developing an etiquette surrounding Glass. The use and misuse of the program would be monitored by Google and feedback would move the product forward. The author then remarks “that’s not going to answer questions about what’s right and wrong to do with a camera that doesn’t need to be held up to take a photo, and often won’t even be noticed by its owner’s subjects. Will people get comfortable with that? Are they supposed to?” (Topolsky, 2013) From an ANT perspective, privacy is not just a concept but rather a socio-technical actor existing in their network. It is equally important for Google to consider how Glass allows people to record the world and affect others notions of privacy. However, there is almost an apathy here in the Explorer program. Google acknowledges that through the Explorer program they can develop an etiquette around Glass, while recruiting people to their network, but without taking an active role in designing a project that is socially harmonious, their network is unstable. As the author stated, their tech fails to answer the questions about what people will do with a camera and if that’s okay. Google’s technological optimism, or potentially their naivete, comes through perhaps strongest in an influential New York Times article from the time of release of Google Glass. This article, titled “Google Glass Picks Up Early Signal: Keep Out” details the negative responses that Google Glass was getting form various places around the country, and contrasts it with Google’s reputation for being cavalier around privacy. The article quotes Google’s former CEO Eric Schmidt in 2009 saying, “If you have something that you don’t want anyone to know, maybe you shouldn’t be doing it in the first place” (Streitfield, 2013). It is clear that this policy permeates through to their implementation of Glass, which potentially immortalizes the public realm through ubiquitous recording, thus making potentially everything known to everyone. A contributing law expert is quoted as saying “We are all now going to be both the paparazzi and the paparazzi’s target” (Streitfield, 2013). Furthermore, the article reports that app developers made photography with glass as discrete as simply winking in one application (Streitfield, 2013). To many this makes Glass even more intrusive, and although it is unclear if Google would have allowed a feature like this in their final release, the Explorer program was essential for gradually recruiting public acceptance into the Glass network. Of course, they failed to do so. The New York Times article also speaks on a Seattle bar that banned Glass. The owner of the bar reported to Geekwire that Glass disrupted the private and seedy culture of his bar: “People want to go there and be not known … and definitely don’t want to be secretly filmed or videotaped and immediately put on the Internet” (Bishop, 2013). He also notes that “tech geeks” from Amazon frequent the bar, and he doesn’t want them using Glass inside. This “tech geek backlash” is another overarching theme regarding these reactionary articles. As one writer put it, “Google’s core mistake was allowing geeky developers to become the face of Glass” (Constine, 2017). This made recruitment of a more privacy conscious group difficult for Google, since all of a sudden there was an Us vs the “Glassholes” dynamic. The Five Point owners, the geeky big tech employees, and its various bargoers represent a key factor that must be considered when assembling a socially robust network. The associations surrounding actors in a network are entirely variable and context dependent. Where Google employees may look favorably on how Glass impacts social dynamics, the same is not true of all society. The heterogenous engineer of ANT does engineering outside the lab creating a network that is socially robust, while Google perhaps looks only inward on its own norms. Kudina and Verbeek’s (2009) paper using Technological Mediation digs deeper into how Google approached human behavior and Glass. Google called on the best judgement of its users and published a list of dos and don’ts surrounding Glass and sat back to observe. The author turns to gauging Glass’s mediation of privacy and social interaction via YouTube comments on this list of dos and don’ts during the explorer phase of Glass. One conclusion is that “Glass appears as a mediating boundary object between what commenters consider private even in the most public places and what is violated when the device is introduced,” and to online commenters “the privacy of forgetting [is] at stake with Glass.” As a designer, under Technological Mediation, Google creates the mediations, and perhaps for Glass to succeed they needed to be aware of what human interactions and perceptions were actually being designed. This wraps into actor network theory nicely, since under ANT designers are responsible for recruiting the actors that are both human and nonhuman to a sociotechnical network. The designers are the builders of society, and Google failed in creating a network that is stable both socially and technically. A few years later, SnapChat created the spectacles which were smart glasses that allowed users to record footage and post to snapchat. However, without addressing the social issues, the same fate occurred and this network too failed as reported by TechCrunch: “Google Glass tainted the market with its ‘not sure if you’re recording me’ design. Even though Snap put more obvious recording signal lights on Spectacles, people would still question you about whether they were on camera. That not only made people uncomfortable being around Spectacles, but made you feel like a bit of a creep just wearing them” (Constine, 2017). This is not to say that there is no hope for augmented reality. Google Glass still exists in the form of Glass Enterprise. Google rebranded the tech to sell to manufacturing and healthcare businesses. In this space the context is completely different, and the expectation of privacy spoken about by Verbeek does not exist in the same caliber. Privacy, under ANT, can be considered an actor-network, since it is defined by humans and technological relations. Therefore, it is also subject to the contextuality present in ANT and takes on a different meaning in the workplace. There is already perhaps an expectation of being observed at work, at least to some extent, and especially in manufacturing settings. Computer surveillance software, security cameras, and sensors in manufacturing monitor people’s actions already in a way that would be unacceptable in the private space. From an ANT perspective this clearly represents the idea of variable meanings of actors in different networks. As a result, Google is able to recruit companies and people to their enterprise network, where associations with privacy hold different meanings. Strictly speaking, the technology for these products to exist was never the problem; rather, Glass, people, and privacy take on different meanings in a business setting and the public space. While Glass may have been initially deemed unacceptable by society, human perceptions are subject to change as a result of the technical landscape that permeates life around us. Much has changed since 2013 when Glass was released. The privacy paradox states that individuals may desire privacy, but are willing to exchange it for the benefits of technology (Eveleth, 2018). What was once considered off limits could potentially now be acceptable, as technology has shaped our views of what is wrong and right. Evidence of this lies in the still active Reddit group dedicated to Google Glass. Users here are still developing software for Glass including the top poster writing about hacking a version of Android onto Glass. There are many posts about buying and selling the technology as well as discussing alternative smart glasses. The discussions in the community consist of instructions on how to load firmware updates onto Glass as well as loading custom apps such as Netflix which is popular among users on the subreddit. Additionally, there are troubleshooting posts, guides, blogs and external repositories of apps discussed, linked and posted on the forum. In stark contrast to the YouTube comments analyzed by Verbeek, these users have embraced Glass and taken on the role of designers in an enthusiast ecosystem. The general consensus here is also a longing or even optimism about new Google Glass products, and that the original Glass was “ahead of its time”. In conducted interviews, while the subjects varied in terms of their individual privacy beliefs, no subject so far has said that Glass or a similar device should be banned. More importantly, there was consensus that a product like Glass could or will exist in the future. One expert who Apple contracts for marketing, said “if Apple released their version of Google Glass in two years it will be everywhere.” Others, especially young people, saw no problem whatsoever with the technology, even after having experts’ concerns explained. The justification was that privacy is already so compromised by technology and governments. Nearly all interviewees believed that if a product like this came out in the future, and was a commercial success they would see no problem at all. Like the reddit users, these interviewees are a far cry from the mainstream privacy worry in 2013. In observing both Reddit posters and interviewees, one cannot determine for certain whether Google Glass could reclaim success today. However, these examples show that the meaning of actor networks can be derived from context that is time dependent as well. Glass is not innately moral or immoral. Rather, Society’s expectations for privacy, and their morals surrounding the subject, change with time and the influence of technology. In Actor Network Theory this is the symmetry of humans affecting technology and technology impacting humans. While Google failed to realize how these human factors played into their network originally, perhaps today or in the near future privacy, as its own actor network, will evolve in such a way that Glass can exist as a socially robust network. Conclusion Google Glass is an actor-network that dissolved, not as a result of its technology or any specific actor, but rather because of the associations and context these human and nonhuman actors take on in translating the network. In a public space, from the beginning Glass represented a form of ubiquitous and secret recording, because there was the assumption that anybody at any time could be caught on the glasses’ camera. Technology mediates human perception, and in this case, Glass lends new meaning to what is considered private. In an Actor Network framework, this is a demonstration of the symmetry of human and non-human artifacts influencing each other, and without these considerations the network was bound to fail. Rather than design a product that was both social and technical, Google maintained its cavalier approach to privacy, not considering how people may have reacted to digitalizing the world’s eyesight. Google employees and glass users at the time were optimistic about the future of the product, believing that the product would come to be socially acceptable. This captures the idea of association and context ascribing meaning in ANT. While Glass may have been acceptable in Silicon Valley, it did not get the same reception in the main stream. Similarly, while Google could not release this product to the public it has faced success in manufacturing, healthcare, and logistic settings as have other augmented reality headsets. Again, here privacy and people’s expectations take on a new meaning in the Google Glass Enterprise actor-network. Much has changed since the release of Google Glass. It has become an expectation in these times that users trade free services for their own personal data. We have all had our ideas of privacy mediated by technology in this way. It may be possible then, that in the current year or in the future a product like Glass will resurface, as it has done in the manufacturing space. Some Reddit users, for example, have put Google Glass to use in their own lives, modifying and distributing updated software for the glasses. The consensus on these forums is that Glass was ahead of its time, and there is consensus among interviewed potential users that a product like this could succeed. From an ANT perspective, again it is clear that the context of associations within the network matter, rather than the individual parts, and these are all dynamic with respect to time. If a product like Glass was to reach mainstream success, it would not be strictly the technology, but rather the recruitment of the technology, the human users, and the social norms of today or the future that yield a stable network. While Google Glass as a high-profile product failure has been written about extensively, there is little in the vein of an STS perspective, and that work focuses on the lens of society at Glasses release date. The efforts of this paper are to provide an example of how the tools of ANT can be used to not only analyze the building (and failure) of a technology, but also emphasize how associations change with context, specifically time. These considerations are essential for understanding not just the deployment of future technologies, but also the transient nature of social norms. References Bishop, T. (2013, March 8). No Google Glasses allowed, declares Seattle dive bar. GeekWire. https://www.geekwire.com/2013/google-glasses-allowed-declares-seattle-dive-bar/ Constine, J. (2017, October 28). Why Snapchat Spectacles failed. TechCrunch. https://social.techcrunch.com/2017/10/28/why-snapchat-spectacles-failed/ Cressman, D. (2009). A Brief Overview of Actor-Network Theory: Punctualization, Heterogeneous Engineering & Translation. https://summit.sfu.ca/item/13593 Eveleth, R (2018). Google Glass Wasn’t a Failure. It Raised Crucial Concerns. WIRED. (n.d.). Retrieved November 1, 2020, from https://www.wired.com/story/google-glass-reasonableexpectation-of-privacy/ Glass. (n.d.). Glass. Retrieved November 2, 2020, from https://www.google.com/glass/start/ Insider, B. (n.d.). BI INTELLIGENCE FORECAST: Google Glass Will Be An $11 Billion Market By 2018. Business Insider. Retrieved November 1, 2020, from https://www.businessinsider.com/google-glass-11-billion-market-by-2018-2013-5 Kudina, O., & Verbeek, P.-P. (2019). Ethics from Within: Google Glass, the Collingridge Dilemma, and the Mediated Value of Privacy. Science, Technology, & Human Values, 44(2), 291–314. https://doi.org/10.1177/0162243918793711 Law, J. (1987). On the Social Explanation of Technical Change: The Case of the Portuguese Maritime Expansion. Technology and Culture, 28(2), 227–252. https://doi.org/10.2307/3105566 Microsoft HoloLens | Mixed Reality Technology for Business. (n.d.). Retrieved March 27, 2021, from https://www.microsoft.com/en-us/hololens Miller, C. C. (2013, February 21). Google Searches for Style. The New York Times. https://www.nytimes.com/2013/02/21/technology/google-looks-to-make-its-computer-glassesstylish.html Streitfeld, D. (2013, May 7). Google Glass Picks Up Early Signal: Keep Out. The New York Times. https://www.nytimes.com/2013/05/07/technology/personaltech/google-glass-picks-up-earlysignal-keep-out.html Topolsky, J. (2013, February 22). I used Google Glass: The future, but with monthly updates. The Verge. https://www.theverge.com/2013/2/22/4013406/i-used-google-glass-its-the-future-withmonthly-updates",Unknown,Effect Analysis,Q&A Give your answer in a numbered list and give an explanation for each reason. Draw all information from the provided context and do not use any outside knowledge or references.,What are 3 reasons that iPSCs are a better approach for treating diabetes than ESCs?,"Introducing pancreatic β cells, cultivated in vitro from pluripotent stem cells like embryonic stem cells (ESCs) or induced pluripotent stem cells (iPSCs), has been suggested as an alternative therapeutic approach for diabetes. The fundamental protocol for the in vitro differentiation of mouse embryonic stem (ES) cells into insulin-producing cells involves a three-step process. This includes (i) the formation of embryoid bodies, (ii) the spontaneous differentiation of embryoid bodies into progenitor cells representing ecto-, meso-, and endodermal lineages, and (iii) the induction of differentiation of early progenitors into the pancreatic lineage. The differentiated cells can be obtained in approximately 33 days. Transgenic expression of PDX-1 (pancreatic and duodenal homeobox 1) and Nkx6.1 (NK6 homeobox 1) has been demonstrated to prompt the differentiation of ESCs into endocrine cells that express insulin, somatostatin, and glucagon. Incorporating growth factors and extracellular matrix elements, including laminin, nicotinamide, and insulin, facilitates the process The induction of ESC-derived C-peptide/insulin-positive islet-like cell clusters, exhibiting insulin release upon glucose stimulation and expressing Pax4 (paired box gene), represents a significant advancement. Retinoic acid (RA) plays a crucial role in pancreatic development and is commonly employed to prompt pancreatic differentiation of ESCs. Direct addition of RA to activin A-induced human ESCs expressing CXCR4 leads to 95% of cells becoming positive for the pancreatic marker PDX-1H (pancreatic and duodenal homeobox 1). Animal studies have demonstrated that encapsulating human ESC-derived glucose-responsive mature β cells in alginate and transplanting them into a streptozotocin (STZ)-induced diabetic mouse model effectively regulates glycemic control. However, ethical concerns associated with ESCs have restricted their widespread clinical application. As an alternative, induced pluripotent stem cells have been proposed, possessing similar pluripotent characteristics to ESCs, thereby addressing ethical considerations. The primary focus of research on embryonic pancreas development is to enhance our comprehension of the processes involved in the generation of β-cells under normal conditions. This entails not only unravelling the intricate networks of signalling pathways and transcription factors that govern cell-autonomous differentiation but also acquiring insights into epithelial-mesenchymal interactions and the influence of factors secreted by adjacent tissues that guide endocrine and β-cell development. The overarching goal is that, with the accumulation of this comprehensive information, it will be possible to integrate and reconstruct the embryonic differentiation program. This, in turn, could facilitate the ex vivo generation of therapeutic β-cells for potential clinical applications. The pancreas, a sophisticated endoderm-derived organ, encompasses diverse cell types serving both endocrine and exocrine functions. The exocrine component, constituting over 90–95% of the pancreatic mass, houses acinar cells responsible for secreting digestive enzymes such as lipases, carbohydrases, and amylases. Additionally, ductal cells facilitate the transport of these enzymes into the duodenum. Despite comprising only 1–2% of the pancreatic cell International Journal of Science and Research Archive, 2024, 11(01), 1917–1932 1921 population, hormone-secreting endocrine cells play a vital role in maintaining euglycemia. Within the pancreas, the islets of Langerhans host five distinct endocrine cell types, with the insulin-producing β-cell dominating and constituting 60–80% of the islet. In rodents, and to a lesser extent in humans, β-cells are typically positioned at the centre of the islets, surrounded by other endocrine cell types. The proportion and arrangement of these cells in the adult pancreas, along with the morphological changes during pancreas development, have been extensively studied for over a century. More recently, driven by the advancements in transgenic mouse technology, substantial insights have been gained into the molecular mechanisms governing pancreas organogenesis and epithelial cell differentiation. During vertebrate embryogenesis, the three primary germ layers—ectoderm, mesoderm, and endoderm—form through extensive cell migration during gastrulation. In the mouse, a favoured mammalian model for embryogenesis studies, a thin cup-shaped sheet of embryonic endoderm evolves into the primitive gut tube, which can be subdivided into distinct regions along the anterior-posterior axis. Each region possesses distinct developmental potential, typically giving rise to various endodermal organs, including the liver, lung, stomach, and pancreas. Specification of the pancreatic field occurs around embryonic day 8.5 (E8.5) in mice and around 3 weeks in humans. Initially, three pancreatic primordia emerge from the definitive gut epithelium: the first from the dorsal side, followed by two primordia on the ventral side. Due to their independent origin and distinct locations along the primitive gut tube, differences arise in the surrounding environment, timing, specificity of signalling pathways, and gene expression profiles guiding these processes. Shortly after formation, one of the ventral buds regresses, while the remaining ventral bud eventually fuses with the dorsal evagination during the gut tube's rotation around E12.5.Subsequently, the pancreatic epithelium undergoes significant growth and branches into the surrounding mesenchyme. Although glucagon-producing cells and a few cells coexpressing insulin and glucagon can be detected as early as E9.5, fully differentiated β-cells and other hormone-secreting cells become prominently evident around E13. Termed the secondary transition, this stage witnesses a substantial increase in endocrine cell numbers through the proliferation and subsequent differentiation of pancreatic progenitors. The pancreas plays a pivotal role in systematically regulating glucose homeostasis, and its development involves a complex interplay of factors that influence stem cell differentiation into pancreatic progenitor cells, ultimately forming a fully functional organ. Consequently, most stem cell-based differentiation protocols aim to generate mature, single hormone-expressing, glucose-responsive human β-cells, drawing insights from studies on pancreatic development. Specific signals orchestrate the programming of insulin-producing β-cells. Transcription factors such as SRY (sex determining region Y)-box (Sox)17 and homeobox gene HB9 (Hlxb9) play crucial roles in endoderm formation during gastrulation. After foregut formation, fibroblast growth factor (FGF)-10, retinoic acid, SOX9, and hedgehog signalling pathways induce pancreatic development. Pancreatic specification and budding are driven by pancreas-specific transcription factors like pancreatic and duodenal homeobox 1 (Ptf-1a), pancreatic and duodenal homeobox 1, NK6 homeobox 1 (Nkx6.1), neurogenin-3 (Ngn-3), and mafA. These factors enable the endocrine formation and stimulate ISL LIM homeobox 1 (Isl-1), NK2 homeobox 2 (Nkx2.2), neurogenic differentiation factor (NeuroD), paired box gene (Pax)4, and Pax6 signalling, contributing to the formation of the islets of Langerhans. Throughout pancreatic development, transcription factors Sox17, hepatocyte nuclear factor (HNF)-6, and HNF-3beta (also known as forkhead box A2, Foxa2) are consistently expressed. Finally, FGF-10 and notch signaling-induced stem cell and pancreatic progenitor cell differentiation stimulate neogenesis, leading to the creation of β-cells. 1.1.3. Induced Pluripotent Stem Induced pluripotent stem cells (iPS) are adult cells that undergo genetic reprogramming in the laboratory to acquire characteristics similar to embryonic stem cells. iPS cells possess the remarkable ability to differentiate into nearly all specialized cell types found in the body, making them a versatile resource for generating new cells for various organs or tissues. This quality positions them as valuable tools for disease modelling, with researchers globally exploring their potential to develop cures for severe diseases. Notably, iPS cells offer the advantage of being autologous, meaning they originate from the individual's cells, thereby minimizing the risk of immunological reactions or rejection when transplanted tissues derived from iPS cells are used. 1.1.4. Pancreatic Regeneration Through Induced Pluripotent Stem Cell Human induced pluripotent stem cells (iPSCs) are generated by reprogramming human somatic cells to acquire pluripotent properties. These iPSCs have proven to be a valuable source for deriving glucose-responsive β-like cells. Despite the complexity of β cell development, creating an efficient and reproducible β cell differentiation protocol has been challenging. A potential solution involves initiating differentiation from human iPSC-derived pancreatic progenitor cells expressing PDX-1 and SOX9, which exhibit prolonged proliferation potential and the ability to generate C-peptidepositive β cells. Another effective differentiation protocol involves supplementing factors related to epidermal growth factor (EGF), transforming growth factor β (TGF-β), thyroid hormone, retinoic acid (RA) signalling, and γ-secretase inhibition. This approach results in β cells capable of inducing Ca2+ flux in response to glucose, packaging insulin into secretory granules, and secreting insulin. Due to their unlimited replicative capacity (self-renewal) and pluripotency, iPSCs offer a promising avenue for differentiating into pancreatic endocrine lineage cells, specifically functional insulinproducing pancreatic β cells. Research has consistently reported positive outcomes in various in vitro studies using protocols that emulate the mechanisms of in vivo pancreas development to guide iPSC differentiation into functional β cells. The first demonstration of generating functional β cells from induced pluripotent stem (iPS) cells was conducted by Tateishi and colleagues. Their study revealed that human dermal fibroblast-derived iPS cells, subjected to a four-stage serum-free in vitro differentiation process, could differentiate into functional islet-like clusters (ILCs) with mixed Cpeptide+ and glucagon+ cells. Throughout the differentiation, iPS cells underwent stage-specific morphological changes resembling those observed in human embryonic stem cells (ESCs). Functional analysis, employing quantitative reverse transcriptase polymerase chain reaction (RT-PCR) and immunostaining, showed that the differentiated iPS cells expressed stage-specific genes and antigen markers at each developmental stage. These stages included definitive endoderm (Foxa2 and Sox17), pancreatic endoderm (Pdx1), exocrine/endocrine cells (NKX6.1, Ptf1, and Insulin), and insulin-producing cells (Insulin, C-peptide, and glucagon), mirroring the pattern observed in human ESCs.","System Instruction: Give your answer in a numbered list and give an explanation for each reason. Draw all information from the provided context and do not use any outside knowledge or references. Provided Text: Introducing pancreatic β cells, cultivated in vitro from pluripotent stem cells like embryonic stem cells (ESCs) or induced pluripotent stem cells (iPSCs), has been suggested as an alternative therapeutic approach for diabetes. The fundamental protocol for the in vitro differentiation of mouse embryonic stem (ES) cells into insulin-producing cells involves a three-step process. This includes (i) the formation of embryoid bodies, (ii) the spontaneous differentiation of embryoid bodies into progenitor cells representing ecto-, meso-, and endodermal lineages, and (iii) the induction of differentiation of early progenitors into the pancreatic lineage. The differentiated cells can be obtained in approximately 33 days. Transgenic expression of PDX-1 (pancreatic and duodenal homeobox 1) and Nkx6.1 (NK6 homeobox 1) has been demonstrated to prompt the differentiation of ESCs into endocrine cells that express insulin, somatostatin, and glucagon. Incorporating growth factors and extracellular matrix elements, including laminin, nicotinamide, and insulin, facilitates the process The induction of ESC-derived C-peptide/insulin-positive islet-like cell clusters, exhibiting insulin release upon glucose stimulation and expressing Pax4 (paired box gene), represents a significant advancement. Retinoic acid (RA) plays a crucial role in pancreatic development and is commonly employed to prompt pancreatic differentiation of ESCs. Direct addition of RA to activin A-induced human ESCs expressing CXCR4 leads to 95% of cells becoming positive for the pancreatic marker PDX-1H (pancreatic and duodenal homeobox 1). Animal studies have demonstrated that encapsulating human ESC-derived glucose-responsive mature β cells in alginate and transplanting them into a streptozotocin (STZ)-induced diabetic mouse model effectively regulates glycemic control. However, ethical concerns associated with ESCs have restricted their widespread clinical application. As an alternative, induced pluripotent stem cells have been proposed, possessing similar pluripotent characteristics to ESCs, thereby addressing ethical considerations. The primary focus of research on embryonic pancreas development is to enhance our comprehension of the processes involved in the generation of β-cells under normal conditions. This entails not only unravelling the intricate networks of signalling pathways and transcription factors that govern cell-autonomous differentiation but also acquiring insights into epithelial-mesenchymal interactions and the influence of factors secreted by adjacent tissues that guide endocrine and β-cell development. The overarching goal is that, with the accumulation of this comprehensive information, it will be possible to integrate and reconstruct the embryonic differentiation program. This, in turn, could facilitate the ex vivo generation of therapeutic β-cells for potential clinical applications. The pancreas, a sophisticated endoderm-derived organ, encompasses diverse cell types serving both endocrine and exocrine functions. The exocrine component, constituting over 90–95% of the pancreatic mass, houses acinar cells responsible for secreting digestive enzymes such as lipases, carbohydrases, and amylases. Additionally, ductal cells facilitate the transport of these enzymes into the duodenum. Despite comprising only 1–2% of the pancreatic cell International Journal of Science and Research Archive, 2024, 11(01), 1917–1932 1921 population, hormone-secreting endocrine cells play a vital role in maintaining euglycemia. Within the pancreas, the islets of Langerhans host five distinct endocrine cell types, with the insulin-producing β-cell dominating and constituting 60–80% of the islet. In rodents, and to a lesser extent in humans, β-cells are typically positioned at the centre of the islets, surrounded by other endocrine cell types. The proportion and arrangement of these cells in the adult pancreas, along with the morphological changes during pancreas development, have been extensively studied for over a century. More recently, driven by the advancements in transgenic mouse technology, substantial insights have been gained into the molecular mechanisms governing pancreas organogenesis and epithelial cell differentiation. During vertebrate embryogenesis, the three primary germ layers—ectoderm, mesoderm, and endoderm—form through extensive cell migration during gastrulation. In the mouse, a favoured mammalian model for embryogenesis studies, a thin cup-shaped sheet of embryonic endoderm evolves into the primitive gut tube, which can be subdivided into distinct regions along the anterior-posterior axis. Each region possesses distinct developmental potential, typically giving rise to various endodermal organs, including the liver, lung, stomach, and pancreas. Specification of the pancreatic field occurs around embryonic day 8.5 (E8.5) in mice and around 3 weeks in humans. Initially, three pancreatic primordia emerge from the definitive gut epithelium: the first from the dorsal side, followed by two primordia on the ventral side. Due to their independent origin and distinct locations along the primitive gut tube, differences arise in the surrounding environment, timing, specificity of signalling pathways, and gene expression profiles guiding these processes. Shortly after formation, one of the ventral buds regresses, while the remaining ventral bud eventually fuses with the dorsal evagination during the gut tube's rotation around E12.5.Subsequently, the pancreatic epithelium undergoes significant growth and branches into the surrounding mesenchyme. Although glucagon-producing cells and a few cells coexpressing insulin and glucagon can be detected as early as E9.5, fully differentiated β-cells and other hormone-secreting cells become prominently evident around E13. Termed the secondary transition, this stage witnesses a substantial increase in endocrine cell numbers through the proliferation and subsequent differentiation of pancreatic progenitors. The pancreas plays a pivotal role in systematically regulating glucose homeostasis, and its development involves a complex interplay of factors that influence stem cell differentiation into pancreatic progenitor cells, ultimately forming a fully functional organ. Consequently, most stem cell-based differentiation protocols aim to generate mature, single hormone-expressing, glucose-responsive human β-cells, drawing insights from studies on pancreatic development. Specific signals orchestrate the programming of insulin-producing β-cells. Transcription factors such as SRY (sex determining region Y)-box (Sox)17 and homeobox gene HB9 (Hlxb9) play crucial roles in endoderm formation during gastrulation. After foregut formation, fibroblast growth factor (FGF)-10, retinoic acid, SOX9, and hedgehog signalling pathways induce pancreatic development. Pancreatic specification and budding are driven by pancreas-specific transcription factors like pancreatic and duodenal homeobox 1 (Ptf-1a), pancreatic and duodenal homeobox 1, NK6 homeobox 1 (Nkx6.1), neurogenin-3 (Ngn-3), and mafA. These factors enable the endocrine formation and stimulate ISL LIM homeobox 1 (Isl-1), NK2 homeobox 2 (Nkx2.2), neurogenic differentiation factor (NeuroD), paired box gene (Pax)4, and Pax6 signalling, contributing to the formation of the islets of Langerhans. Throughout pancreatic development, transcription factors Sox17, hepatocyte nuclear factor (HNF)-6, and HNF-3beta (also known as forkhead box A2, Foxa2) are consistently expressed. Finally, FGF-10 and notch signaling-induced stem cell and pancreatic progenitor cell differentiation stimulate neogenesis, leading to the creation of β-cells. 1.1.3. Induced Pluripotent Stem Induced pluripotent stem cells (iPS) are adult cells that undergo genetic reprogramming in the laboratory to acquire characteristics similar to embryonic stem cells. iPS cells possess the remarkable ability to differentiate into nearly all specialized cell types found in the body, making them a versatile resource for generating new cells for various organs or tissues. This quality positions them as valuable tools for disease modelling, with researchers globally exploring their potential to develop cures for severe diseases. Notably, iPS cells offer the advantage of being autologous, meaning they originate from the individual's cells, thereby minimizing the risk of immunological reactions or rejection when transplanted tissues derived from iPS cells are used. 1.1.4. Pancreatic Regeneration Through Induced Pluripotent Stem Cell Human induced pluripotent stem cells (iPSCs) are generated by reprogramming human somatic cells to acquire pluripotent properties. These iPSCs have proven to be a valuable source for deriving glucose-responsive β-like cells. Despite the complexity of β cell development, creating an efficient and reproducible β cell differentiation protocol has been challenging. A potential solution involves initiating differentiation from human iPSC-derived pancreatic progenitor cells expressing PDX-1 and SOX9, which exhibit prolonged proliferation potential and the ability to generate C-peptidepositive β cells. Another effective differentiation protocol involves supplementing factors related to epidermal growth factor (EGF), transforming growth factor β (TGF-β), thyroid hormone, retinoic acid (RA) signalling, and γ-secretase inhibition. This approach results in β cells capable of inducing Ca2+ flux in response to glucose, packaging insulin into secretory granules, and secreting insulin. Due to their unlimited replicative capacity (self-renewal) and pluripotency, iPSCs offer a promising avenue for differentiating into pancreatic endocrine lineage cells, specifically functional insulinproducing pancreatic β cells. Research has consistently reported positive outcomes in various in vitro studies using protocols that emulate the mechanisms of in vivo pancreas development to guide iPSC differentiation into functional β cells. The first demonstration of generating functional β cells from induced pluripotent stem (iPS) cells was conducted by Tateishi and colleagues. Their study revealed that human dermal fibroblast-derived iPS cells, subjected to a four-stage serum-free in vitro differentiation process, could differentiate into functional islet-like clusters (ILCs) with mixed Cpeptide+ and glucagon+ cells. Throughout the differentiation, iPS cells underwent stage-specific morphological changes resembling those observed in human embryonic stem cells (ESCs). Functional analysis, employing quantitative reverse transcriptase polymerase chain reaction (RT-PCR) and immunostaining, showed that the differentiated iPS cells expressed stage-specific genes and antigen markers at each developmental stage. These stages included definitive endoderm (Foxa2 and Sox17), pancreatic endoderm (Pdx1), exocrine/endocrine cells (NKX6.1, Ptf1, and Insulin), and insulin-producing cells (Insulin, C-peptide, and glucagon), mirroring the pattern observed in human ESCs. Question: What are 3 reasons that iPSCs are a better approach for treating diabetes than ESCs? ",Medical,Find & Summarize,Text Transformation "Only use the context provided to you, never use the information you have stored in your system already. ",What factors are used in order to determine stare decisis? ,"THE AMERICAN LEGAL SYSTEM MADE EASY Chapter 1 discussed the software of the American lawyer (i.e., in terms of the thinking process operating within the minds of U.S.-licensed legal professionals). This chapter, in contrast, examines the hardware in terms of the conceptual component parts within the software of the American lawyer and legal system. Specifically, the hardware is based in part on the black letter law embedded within the American legal infrastructure, which this chapter will now briefly overview. Common Law Versus Other Domestic Laws American law is based on common law from the United Kingdom as one of its core legal pillars (which is then buttressed by, among other sources, the U.S. Constitution, court cases, statutes, restatements, decrees, treatises, and various other rules and regulations). Common law follows the principle of stare decisis (Latin, meaning “stand by your decision”). Stare decisis is a legal principle stating that prior court decisions (e.g., holdings, conclusions, rulings) must be recognized as precedent case law. If a case is deemed a precedent case, then lower courts are compelled to rule in the same way as the precedent case. This applies only if the precedent case is binding or mandatory. The rationale for stare decisis and precedent cases is judicial efficiency, fairness to the parties, predictability, and a check and balance on arbitrary behavior. In common law countries, juries and oral arguments by lawyers often can take a greater or more visible role compared to in civil law countries (which may not have jury trials), in which the judge can play a more central and prominent role (of course, exceptions can exist). American Law 101 Examples of jurisdictions that use the common law system include the following: • United Kingdom except Scotland • United States except Louisiana • Ireland • Former British colony and/or Commonwealth territories/countries, including India except Goa, Australia, New Zealand, Singapore, and Canada except Quebec • Pakistan • Bangladesh In contrast, generally under civil law (derived from the French-German legal tradition), statutes and other similar legal sources represent relatively greater legal authority than does case law. Under civil law, neither precedent cases nor stare decisis exist. The rationale for this is greater judicial freedom to decide cases on a case-by-case basis. Some people argue, however, that this system may come at the cost of less predictability and consistency regarding case law conclusions (with similar legal issues and/or facts). Examples of jurisdictions that use the civil law system include the following: • Most European Union (EU) nations, including Germany and France where civil law was derived, but not the United Kingdom, Ireland, or Cyprus • Most of continental Latin America except Guyana and Belize • Congo • Azerbaijan • Iraq • Russia • Turkey • Egypt • Madagascar • Lebanon • Switzerland • Indonesia • Vietnam • Thailand The factors used in determining whether to apply stare decisis include the following: • Similarity of legal issue(s)/legal principle(s) • Whether the precedent case was ruled on by a court recognized as a leading one in the relevant subject area The American Legal System Made Easy • Whether the precedent case was well-reasoned and articulated (in the court’s legal opinion) • Whether the precedent case was issued from a court in the same jurisdiction • Whether the precedent case was issued from a higher-level court Although these factors are often considered to determine whether a case is a precedent case, thus representing a binding and mandatory legal source, a court may not be required to follow: • Secondary legal sources (i.e., nonprecedent cases, not related to the U.S. Constitution, and the like; see the following paragraph for further specifics) • Cases that do not align with these factors to determine the precedential value of a case Two main types of legal sources exist in American law: primary and secondary. 1. Primary legal sources include the following: • U.S. Constitution • Statutes • Rules, regulations, and orders • Executive orders and proclamations • Case law 2. Secondary legal sources include the following: • Treatises • Restatements • Law review journals • American Law Reports • Hornbooks • Legal encyclopedias A general hierarchy also exists in which federal legal sources are weighed more heavily than state legal sources: A. Federal Legal Sources • U.S. Constitution • Federal statutes and treaties • Federal rules and regulations • Federal cases B. State Legal Sources • State constitutions • State statutes American Law 101 • State rules and regulations • State law cases From this list, two interesting points arise: (1) the U.S. Constitution represents the supreme law of the land, and (2) a federal supremacy rule applies. This means that federal sources are generally higher than state sources in the legal source hierarchy. This is important to know for both academics and practitioners to determine what legal source should be given greater weight relative to others, which can help in the legal strategy process. State Law Although the United States is one country, from a legal perspective, each individual state within it has a certain level of discretion to determine what types of laws best fit that particular state’s set of circumstances. The concept of dualism, in which sources of law exist dually at both the federal and state level, is based in part on the view that decentralization of power is needed. The intent of dualism was to provide greater security that one central source of authority would not become overly powerful—as was the case with England at the time of the founding of the United States. Furthermore, as Chapter 6 discusses in greater detail regarding Constitutional Law, the U.S. Constitution (the nation’s highest legal authority) has embedded in it a concept known as the enumerated powers doctrine. In the enumerated powers doctrine, the federal government has only those powers expressly conveyed to it under the Constitution (under Article I, Section 8), with all other remaining powers generally belonging to the states. Thus, state laws are actually much more widely encompassing than many people from non–common law countries would expect. With this in mind, each specific state’s law can vary and be different from other state laws. Although diversity exists, many state laws are based on certain standardized laws. Examples of standardized laws that state law can be based on include the following: • Restatements of law, which are used to provide clarity on certain law matters • Prepared by the American Law Institute (ALI) • Represents secondary (nonprimary) legal source/authority • Uniform acts/Uniform codes, such as the Uniform Commercial Code, or UCC, relating to contract law • Drafted by the Uniform Law Commissioners • Body of lawyers and other legal professionals whose objective is to standardize laws across the various U.S. states • Offered as legal models, which each state can ratify in whole or in part The American Legal System Made Easy • Model penal code (MPC), relating to criminal law matters • Prepared by the ALI, much like restatements • Objective of updating and standardizing penal law across the various U.S. states • MPC represents what the ALI deems as the best rules for the U.S. penal system Much like the dual federal-state level of legal sources, a similar dual system of federal-state court systems exists. Consistent with the principle of federalism, federal courts rank higher in the judicial court hierarchy relative to state courts. The Federal Court hierarchy (from highest to lowest) is as follows: • U.S. Supreme Court • Circuit courts • District courts Federal courts consider the following legal sources: • Federal (nonstate) statutory issues Supreme Court of the United States U.S. Courts of Appeal (13 Circuit Courts) U.S. District Courts (94 Trial Courts) State Supreme Courts Intermediate Appellate Courts (39 of 50 States) State Trial Courts (Across 50 States) American Law 101 • Diversity cases, such as cases involving parties from two different states • Cases in which the United States is a party as plaintiff or defendant • Other cases as specified by law (e.g., admiralty, antitrust, maritime) • Removal jurisdiction cases, in which the defendant requests the case to be heard by a federal, rather than a state, court in the same district The U.S. Supreme Court (USSC) is the highest court in the United States. The U.S. Supreme Court generally hears cases based on appeal (when certiorari—or in plain English, review—is granted to review the case). In other words, the USSC is only in rare circumstances the court of first instance having original jurisdiction over a case. Of course, exceptions exist when an issue is particularly urgent. For instance, the Bush v. Gore (2000) case was heard by the USSC at first instance because its ruling could, in effect, determine the outcome of the 2000 U.S. presidential election. Below the USSC in judicial hierarchy are the federal circuit courts. The circuit courts generally hear appeals from the lower district courts. Unlike the USSC, federal circuit courts have original jurisdiction (court of first instance) over orders of certain federal agencies. The federal circuit courts are divided geographically into 13 circuit courts. Circuit courts numbered from 1 to 13 encompass all of the states (including Hawaii), with an additional district for Washington D.C. (which is a federal territory, not a U.S. state), and a federal circuit for certain specialized matters. Many cases begin at the state court level and, if needed, are appealed to the federal level (except for the instances discussed previously), in particular, when a federal (rather than a state) issue arises. State Courts Most state court systems replicate the federal court system. Some state courts have three levels of hierarchy, whereas other state courts have two levels of hierarchy. Regardless, each state court has its own rules of procedure and set of practices. With a three-level state court system, the hierarchy is typically the following: • State Supreme Court: Hears appeals from state intermediate court • State court of appeals: Hears appeals from lower trial court • State trial court: Conducts fact-finding as well as ruling on the legal issue(s) presented State courts usually can review almost any case, but exceptions exist, such as where jurisdiction is precluded by (1) federal statute; (2) the U.S. Constitution; or (3) other legal source, expressly (e.g., admiralty, patent, copyright) or implicitly (e.g., antitrust damages and injunction). The American Legal System Made Easy American Judicial System The United States has three branches of government: (1) the legislative branch (the Congress, which is composed of the Senate and House of Representatives); (2) the executive branch (including the U.S. President), and (3) the judicial branch (including the USSC and other courts). The three branches of government are based on the concept of checks and balances, so that each branch of government does not become too powerful relative to the other two branches. Related terms are defined as follows: • Congress: Bicameral institution that refers to the Senate and the House of Representatives • House of Representatives: • Referred to as the lower house (because the legislative process typically begins here and then proceeds to the Senate). • The number of Representatives is based on the population of each state (thus, the larger and more populated states—such as California, Texas, and New York—generally have more Representatives). • House representatives are elected to two-year terms and can be reelected continuously. • Senate: • Referred to as the higher chamber (because the Senate is the second chamber in the legislative process). • Two senators are elected from each of the 50 states (regardless of a state’s population). • Senators are elected to six-year terms with the possibility of reelections. • Government lawyers: • Prosecutor: A government attorney who prepares and conducts the prosecution of the accused party • District Attorney (DA) (or county prosecutor): A government prosecutor representing a particular state • United States (U.S.) Attorney: A federal prosecutor representing the United States for certain federal districts An example of checks and balances in practice could involve an impeachment proceeding against the executive branch. An attempt to impeach the U.S. President (executive branch), for instance, would involve the legislative branch placing a check and balance on the executive branch by arguing, among other things, that certain actions of the presidency allegedly violated the U.S. Constitution. The judicial branch (federal American Law 101 courts) can serve as a check and balance if it decides to review the acts of the legislative branch in terms of constitutionality (i.e., to determine whether an act by the legislative branch allegedly violated the U.S. Constitution, which all three branches must abide by). The federal courts can also review the actions of federal administrative agencies. At the same time, the legislative branch (Congress) can review and overrule court precedent under its designated Congressional authority. The American legal system can appear diverse and complex. With the overview provided in this chapter, it is hoped that readers have a better understanding and greater clarity regarding the hardware of American law. This understanding of the American legal infrastructure will help, as the next chapters will fill in the landscape—section by section—that will culminate into a panoramic primer of American law. The reading and understanding of cases is important in most, if not all, jurisdictions in the world. The U.S. legal system, which is based on the common law system of England, treats case law (law based on the interpretation of cases by the judiciary) as especially important. This is based on the previously mentioned concept of stare decisis. Under stare decisis, lower courts often must (as opposed to can) rule and conclude the case in a manner consistent with higher courts in the same jurisdiction regarding previous cases with similar facts and issues (which links back to the IRAC legal thinking process covered earlier in Chapter 1). The American legal system’s main rationale for stare decisis is consistency and greater foreseeability of how similar cases may be concluded by the courts. However, with benefits come drawbacks. With stare decisis, the drawback is less judicial discretion afforded to the courts and judges in an effort to treat each dispute on a case-by-case basis. What is considered as the drawback of the common law system under stare decisis is often viewed as the benefit of the civil law system, in which stare decisis does not apply. This thus gives greater judicial discretion to the courts, at the potential cost of inconsistent judicial conclusions even within the same jurisdiction. So which domestic legal system among the two is better: common law or civil law? When students and even practitioners pose this question, a common first answer is that each system has both benefits and costs (as analyzed here), and it is incumbent upon each jurisdiction to determine which system makes the most sense, all things considered. The other answer is that an increasing convergent trend is now occurring, whereby legal practitioners from both common and civil legal traditions often tend to think more similarly now than in the past, particularly in commercial transactions and dealings. This convergence may be in part a result of globalization, technological advancements, and students studying internationally—creating a greater exposure and knowledge base of the common law tradition (as well as civil law and other domestic legal traditions, such as Islamic law). (See the Appendices for further specifics on the American court system.) To understand the American legal system, legal cases reflecting case law must be understood in great detail. This is especially critical given the importance of stare The American Legal System Made Easy decisis and precedent cases in American law, as discussed earlier. Because of the importance of case law and understanding cases, the next section provides a more detailed glimpse into the main elements of a case within the American judicial system, including a method of how to read and brief a case—a vital skill set for both the study and practice of American law. How to Read and Brief a Case With the high level of importance given to stare decisis and precedent cases underlying American law, a fundamental knowledge of how to understand and brief a U.S. case is critically important. This is true as a law student as well as a law practitioner who aspires to gain a greater understanding of American law. To begin, most court decisions are published, both at the federal and state level. The court issuing the opinion often has the discretion in deciding whether to publish an opinion it has rendered. Specific case elements exist in a typical case brief, which include the following: • Case Name and its citation to find and/or reference the case • Author of the Opinion (the Opinion is the court’s ruling/decision): Generally, the person who authors a legal opinion is a judge or arbitrator (the concept and role of arbitrators is discussed in greater detail in Chapter 10). • Opinion, which generally includes: • Case Facts and relevant procedural history of the case, such as past appeals and rulings • Court Conclusion, also referred to as the case’s holding • Reasoning: Detailing the rationale, arguments, and other factors considered by the court • Disposition: Court action based on the court’s ruling/conclusion (e.g., reversed, affirmed, remanded.) The case caption can be thought of as a title for a case. Example: Brown v. Board of Education, 347 U.S. 483 (1954). The case caption includes the parties, case citation (court name, law book where the opinion is published), and year of the court’s conclusion. In terms of formality of writing for a case caption, the party names to the dispute are italicized and/or underlined (the example has the party names italicized). The remaining case caption (e.g., citation/reporter details, year that the decision was rendered, and other related details) generally is not italicized or underlined. Reporters Cases that are published are included in publications called reporters. Each reporter has a volume number and page numbers. Some reporters are published by the state, while American Law 101 some are published by commercial institutions. For the case citation/reporter relating to the previous example, the case would be found in volume 347 of the United States Reports on page 483. Judicial Titles The author of the court opinion, as mentioned, is typically a judge. In this case, the judge, in his or her capacity as legal opinion author (for the majority or minority opinion), is written at the top of the legal opinion, as follows: Example: “Hand, J.” refers to Judge Hand. Example: “Holmes J.” is Justice Holmes. Some jurisdictions use terms other than “judge,” albeit referring to the same judicial decision-rendering role: Example: “Jackson, C.” refers to Chancellor Jackson. Example: “Jackson, V.C.” refers to Vice-Chancellor Jackson. Example: “Jackson, C.J.” refers to Chief Judge Jackson. Party Names In a civil (noncriminal) case, the party initiating the lawsuit is the plaintiff, and the party defending against the plaintiff’s lawsuit is the defendant (not coincidentally, the term “defendant” has the term “defend” embedded in it). In criminal (noncivil) cases, the party initiating the lawsuit is referred to as the state (or similar terminology), because the interests of the state (or other relevantly named party initiating the lawsuit) are presumed greater than one individual (such as by a plaintiff in a civil law case). The plaintiffs (or state) are usually the first party listed in the caption. For the previous caption example, Brown is the plaintiff at the initial stage (prior to an appeal, if an appeal is rendered). If a case is heard on appeal (in which a case is heard for the second time or more), then the party initiating the appeal is called the appellant. The party defending against the appellant’s lawsuit on appeal is called the appellee. Thus, as an example, if the Board of Education in the previous example appealed, then the Board of Education would be the first named party in the caption of the appealed case (rather than second, as was the case in the original lawsuit example). The court’s conclusion or ruling is the court’s legal opinion and the rationale given for reaching a particular judgment, finding, or conclusion. Underneath the broad term of legal opinion, several specific subsets of opinions exist. A concurring opinion is an opinion rendered by a judge who would have reached the same conclusion as the majority opinion, but for a different reason (i.e., same destination, but would have chosen a different route to get to the destination). A plurality opinion is The American Legal System Made Easy an opinion agreed on by less than the majority of the judges (assuming a panel of judges), but the opinion agrees with the majority opinion’s conclusion. A dissenting opinion is an opinion by one or more judges who disagree with the majority opinion’s conclusion. The parties to a lawsuit (at the initial trial court level) include the following: • Plaintiff: Party initiating the lawsuit • Defendant: Party defending against the lawsuit (legal action by plaintiff) • Counterclaimant: Defendant’s counterclaim against the plaintiff • Cross-claimant: Defendant bringing a lawsuit against a third party, typically with a view that the introduced third party was at least partially responsible/ liable for owed damages to plaintiff • Third-party defendant: Party defending against a cross-claim for alleged damages owed to plaintiff • Intervenor: Interested party participating in litigation with the court’s permission The parties to a lawsuit (at the noninitial appellate court level) include the following: • Appellant: Party appealing a lower court’s ruling (usually the unsuccessful party in the previous lawsuit) • Appellee: Party defending against the appellant’s actions • Petitioner: Party challenging action, usually in an agency context • Respondent: Party defending against petitioner’s actions, usually in an agency context • Intervenor: Same as intervenor at the trial court level • Amicus curiae (“friend of the court”): Party given court permission to participate in the case • U.S. Solicitor: Government attorney representing the United States The parties to a lawsuit (at the highest U.S. Supreme Court level) include the following: • Petitioner: Party seeking the Supreme Court’s review, arguing for the rejection of the lower court’s decision • Respondent: Party opposing the Supreme Court’s review, arguing that the lower court’s decision does not warrant review, because the lower court’s conclusion and rationale are legally valid • Intervenor: Same as intervenor at the trial/appellate court level • Amicus curiae: Same as at the appeals court level • U.S. Solicitor: Government attorney representing the United States American Law 101 Court Dispositions—General • Order: Court resolution of a motion (filed by one of the parties) • Affirmation: Court’s decision to uphold the lower court’s ruling • Reversal: Court’s rejection of the lower court’s ruling • Remand: Court order to return the case to the lower court (or agency) for further factual findings, or for other resolution in conformity with the appellate court’s decision • Vacate: Court rejection of the lower court’s ruling, with an order to set aside and render the lower court’s ruling as null and void • Modification: Court’s affirmation of part of the lower court’s decision, with an ordered modification to the opinion Court Dispositions—Appellate Courts • En Banc Opinion: • Represents an opinion by all members of the court, not just a certain number (panel) of sitting judges, to hear a particular case • Generally represents a rare exception rather than the norm • Usually seen in issues of extreme importance Court Disposition—Supreme Court • Plurality Opinion: • An opinion that more judges sign than any concurring opinion • Does not constitute a majority opinion • Does not have the force of precedent, because it is not a result of a majority opinion • Certiorari Granted: • Grant of discretionary review by the U.S. Supreme Court (often considered the exception rather than the norm because the Supreme Court is unable to grant certiorari to most cases given its limited time and resources) • Does not reverse or directly affect lower court rulings • Certiorari Denied: • U.S. Supreme Court’s decision to reject discretionary review of a particular lower court ruling • Does not generally have precedential effect In most legal opinions, part of the court’s decision may include analysis and language that may not directly be necessary to reach the court’s resolution of the legal issue. This part of the case is referred to as dictum. Dictum is not the court’s holding. The American Legal System Made Easy In other words, dictum is related, but separate from, the court’s holding. Given that dictum is not part of a court’s holding, stare decisis does not apply. It may be difficult to distinguish a court’s dictum from its holding. Still, dictum may be useful for future cases, because it is, at times, a signal or hint of how the court (or at least a judge in the court) may view a case in light of different legal issues or facts. Summary The American judicial system is based on British common law, which is then buttressed by, among other sources, the U.S. Constitution, court cases, statutes, restatements, decrees, treatises, and various other rules and regulations. The American legal system is composed of the U.S. Supreme Court, federal courts, and state courts. Within both federal and state courts, primary and secondary legal sources are considered. The U.S. Supreme Court is the highest land of the law. It can grant certiorari to select cases for various reasons, including whether the issue presented is urgent or of vital national interest. Generally, however, a lawsuit begins in state courts and then, as needed, is heard on appeal by federal (appellate-level) or state courts. Knowledge of the structure of the American judicial system is then furthered by understanding how to write and brief a law case, which is a vital skill set for law students and practitioners. ","Only use the context provided to you, never use the information you have stored in your system already. What factors are used in order to determine stare decisis? THE AMERICAN LEGAL SYSTEM MADE EASY Chapter 1 discussed the software of the American lawyer (i.e., in terms of the thinking process operating within the minds of U.S.-licensed legal professionals). This chapter, in contrast, examines the hardware in terms of the conceptual component parts within the software of the American lawyer and legal system. Specifically, the hardware is based in part on the black letter law embedded within the American legal infrastructure, which this chapter will now briefly overview. Common Law Versus Other Domestic Laws American law is based on common law from the United Kingdom as one of its core legal pillars (which is then buttressed by, among other sources, the U.S. Constitution, court cases, statutes, restatements, decrees, treatises, and various other rules and regulations). Common law follows the principle of stare decisis (Latin, meaning “stand by your decision”). Stare decisis is a legal principle stating that prior court decisions (e.g., holdings, conclusions, rulings) must be recognized as precedent case law. If a case is deemed a precedent case, then lower courts are compelled to rule in the same way as the precedent case. This applies only if the precedent case is binding or mandatory. The rationale for stare decisis and precedent cases is judicial efficiency, fairness to the parties, predictability, and a check and balance on arbitrary behavior. In common law countries, juries and oral arguments by lawyers often can take a greater or more visible role compared to in civil law countries (which may not have jury trials), in which the judge can play a more central and prominent role (of course, exceptions can exist). American Law 101 Examples of jurisdictions that use the common law system include the following: • United Kingdom except Scotland • United States except Louisiana • Ireland • Former British colony and/or Commonwealth territories/countries, including India except Goa, Australia, New Zealand, Singapore, and Canada except Quebec • Pakistan • Bangladesh In contrast, generally under civil law (derived from the French-German legal tradition), statutes and other similar legal sources represent relatively greater legal authority than does case law. Under civil law, neither precedent cases nor stare decisis exist. The rationale for this is greater judicial freedom to decide cases on a case-by-case basis. Some people argue, however, that this system may come at the cost of less predictability and consistency regarding case law conclusions (with similar legal issues and/or facts). Examples of jurisdictions that use the civil law system include the following: • Most European Union (EU) nations, including Germany and France where civil law was derived, but not the United Kingdom, Ireland, or Cyprus • Most of continental Latin America except Guyana and Belize • Congo • Azerbaijan • Iraq • Russia • Turkey • Egypt • Madagascar • Lebanon • Switzerland • Indonesia • Vietnam • Thailand The factors used in determining whether to apply stare decisis include the following: • Similarity of legal issue(s)/legal principle(s) • Whether the precedent case was ruled on by a court recognized as a leading one in the relevant subject area The American Legal System Made Easy • Whether the precedent case was well-reasoned and articulated (in the court’s legal opinion) • Whether the precedent case was issued from a court in the same jurisdiction • Whether the precedent case was issued from a higher-level court Although these factors are often considered to determine whether a case is a precedent case, thus representing a binding and mandatory legal source, a court may not be required to follow: • Secondary legal sources (i.e., nonprecedent cases, not related to the U.S. Constitution, and the like; see the following paragraph for further specifics) • Cases that do not align with these factors to determine the precedential value of a case Two main types of legal sources exist in American law: primary and secondary. 1. Primary legal sources include the following: • U.S. Constitution • Statutes • Rules, regulations, and orders • Executive orders and proclamations • Case law 2. Secondary legal sources include the following: • Treatises • Restatements • Law review journals • American Law Reports • Hornbooks • Legal encyclopedias A general hierarchy also exists in which federal legal sources are weighed more heavily than state legal sources: A. Federal Legal Sources • U.S. Constitution • Federal statutes and treaties • Federal rules and regulations • Federal cases B. State Legal Sources • State constitutions • State statutes American Law 101 • State rules and regulations • State law cases From this list, two interesting points arise: (1) the U.S. Constitution represents the supreme law of the land, and (2) a federal supremacy rule applies. This means that federal sources are generally higher than state sources in the legal source hierarchy. This is important to know for both academics and practitioners to determine what legal source should be given greater weight relative to others, which can help in the legal strategy process. State Law Although the United States is one country, from a legal perspective, each individual state within it has a certain level of discretion to determine what types of laws best fit that particular state’s set of circumstances. The concept of dualism, in which sources of law exist dually at both the federal and state level, is based in part on the view that decentralization of power is needed. The intent of dualism was to provide greater security that one central source of authority would not become overly powerful—as was the case with England at the time of the founding of the United States. Furthermore, as Chapter 6 discusses in greater detail regarding Constitutional Law, the U.S. Constitution (the nation’s highest legal authority) has embedded in it a concept known as the enumerated powers doctrine. In the enumerated powers doctrine, the federal government has only those powers expressly conveyed to it under the Constitution (under Article I, Section 8), with all other remaining powers generally belonging to the states. Thus, state laws are actually much more widely encompassing than many people from non–common law countries would expect. With this in mind, each specific state’s law can vary and be different from other state laws. Although diversity exists, many state laws are based on certain standardized laws. Examples of standardized laws that state law can be based on include the following: • Restatements of law, which are used to provide clarity on certain law matters • Prepared by the American Law Institute (ALI) • Represents secondary (nonprimary) legal source/authority • Uniform acts/Uniform codes, such as the Uniform Commercial Code, or UCC, relating to contract law • Drafted by the Uniform Law Commissioners • Body of lawyers and other legal professionals whose objective is to standardize laws across the various U.S. states • Offered as legal models, which each state can ratify in whole or in part The American Legal System Made Easy • Model penal code (MPC), relating to criminal law matters • Prepared by the ALI, much like restatements • Objective of updating and standardizing penal law across the various U.S. states • MPC represents what the ALI deems as the best rules for the U.S. penal system Much like the dual federal-state level of legal sources, a similar dual system of federal-state court systems exists. Consistent with the principle of federalism, federal courts rank higher in the judicial court hierarchy relative to state courts. The Federal Court hierarchy (from highest to lowest) is as follows: • U.S. Supreme Court • Circuit courts • District courts Federal courts consider the following legal sources: • Federal (nonstate) statutory issues Supreme Court of the United States U.S. Courts of Appeal (13 Circuit Courts) U.S. District Courts (94 Trial Courts) State Supreme Courts Intermediate Appellate Courts (39 of 50 States) State Trial Courts (Across 50 States) American Law 101 • Diversity cases, such as cases involving parties from two different states • Cases in which the United States is a party as plaintiff or defendant • Other cases as specified by law (e.g., admiralty, antitrust, maritime) • Removal jurisdiction cases, in which the defendant requests the case to be heard by a federal, rather than a state, court in the same district The U.S. Supreme Court (USSC) is the highest court in the United States. The U.S. Supreme Court generally hears cases based on appeal (when certiorari—or in plain English, review—is granted to review the case). In other words, the USSC is only in rare circumstances the court of first instance having original jurisdiction over a case. Of course, exceptions exist when an issue is particularly urgent. For instance, the Bush v. Gore (2000) case was heard by the USSC at first instance because its ruling could, in effect, determine the outcome of the 2000 U.S. presidential election. Below the USSC in judicial hierarchy are the federal circuit courts. The circuit courts generally hear appeals from the lower district courts. Unlike the USSC, federal circuit courts have original jurisdiction (court of first instance) over orders of certain federal agencies. The federal circuit courts are divided geographically into 13 circuit courts. Circuit courts numbered from 1 to 13 encompass all of the states (including Hawaii), with an additional district for Washington D.C. (which is a federal territory, not a U.S. state), and a federal circuit for certain specialized matters. Many cases begin at the state court level and, if needed, are appealed to the federal level (except for the instances discussed previously), in particular, when a federal (rather than a state) issue arises. State Courts Most state court systems replicate the federal court system. Some state courts have three levels of hierarchy, whereas other state courts have two levels of hierarchy. Regardless, each state court has its own rules of procedure and set of practices. With a three-level state court system, the hierarchy is typically the following: • State Supreme Court: Hears appeals from state intermediate court • State court of appeals: Hears appeals from lower trial court • State trial court: Conducts fact-finding as well as ruling on the legal issue(s) presented State courts usually can review almost any case, but exceptions exist, such as where jurisdiction is precluded by (1) federal statute; (2) the U.S. Constitution; or (3) other legal source, expressly (e.g., admiralty, patent, copyright) or implicitly (e.g., antitrust damages and injunction). The American Legal System Made Easy American Judicial System The United States has three branches of government: (1) the legislative branch (the Congress, which is composed of the Senate and House of Representatives); (2) the executive branch (including the U.S. President), and (3) the judicial branch (including the USSC and other courts). The three branches of government are based on the concept of checks and balances, so that each branch of government does not become too powerful relative to the other two branches. Related terms are defined as follows: • Congress: Bicameral institution that refers to the Senate and the House of Representatives • House of Representatives: • Referred to as the lower house (because the legislative process typically begins here and then proceeds to the Senate). • The number of Representatives is based on the population of each state (thus, the larger and more populated states—such as California, Texas, and New York—generally have more Representatives). • House representatives are elected to two-year terms and can be reelected continuously. • Senate: • Referred to as the higher chamber (because the Senate is the second chamber in the legislative process). • Two senators are elected from each of the 50 states (regardless of a state’s population). • Senators are elected to six-year terms with the possibility of reelections. • Government lawyers: • Prosecutor: A government attorney who prepares and conducts the prosecution of the accused party • District Attorney (DA) (or county prosecutor): A government prosecutor representing a particular state • United States (U.S.) Attorney: A federal prosecutor representing the United States for certain federal districts An example of checks and balances in practice could involve an impeachment proceeding against the executive branch. An attempt to impeach the U.S. President (executive branch), for instance, would involve the legislative branch placing a check and balance on the executive branch by arguing, among other things, that certain actions of the presidency allegedly violated the U.S. Constitution. The judicial branch (federal American Law 101 courts) can serve as a check and balance if it decides to review the acts of the legislative branch in terms of constitutionality (i.e., to determine whether an act by the legislative branch allegedly violated the U.S. Constitution, which all three branches must abide by). The federal courts can also review the actions of federal administrative agencies. At the same time, the legislative branch (Congress) can review and overrule court precedent under its designated Congressional authority. The American legal system can appear diverse and complex. With the overview provided in this chapter, it is hoped that readers have a better understanding and greater clarity regarding the hardware of American law. This understanding of the American legal infrastructure will help, as the next chapters will fill in the landscape—section by section—that will culminate into a panoramic primer of American law. The reading and understanding of cases is important in most, if not all, jurisdictions in the world. The U.S. legal system, which is based on the common law system of England, treats case law (law based on the interpretation of cases by the judiciary) as especially important. This is based on the previously mentioned concept of stare decisis. Under stare decisis, lower courts often must (as opposed to can) rule and conclude the case in a manner consistent with higher courts in the same jurisdiction regarding previous cases with similar facts and issues (which links back to the IRAC legal thinking process covered earlier in Chapter 1). The American legal system’s main rationale for stare decisis is consistency and greater foreseeability of how similar cases may be concluded by the courts. However, with benefits come drawbacks. With stare decisis, the drawback is less judicial discretion afforded to the courts and judges in an effort to treat each dispute on a case-by-case basis. What is considered as the drawback of the common law system under stare decisis is often viewed as the benefit of the civil law system, in which stare decisis does not apply. This thus gives greater judicial discretion to the courts, at the potential cost of inconsistent judicial conclusions even within the same jurisdiction. So which domestic legal system among the two is better: common law or civil law? When students and even practitioners pose this question, a common first answer is that each system has both benefits and costs (as analyzed here), and it is incumbent upon each jurisdiction to determine which system makes the most sense, all things considered. The other answer is that an increasing convergent trend is now occurring, whereby legal practitioners from both common and civil legal traditions often tend to think more similarly now than in the past, particularly in commercial transactions and dealings. This convergence may be in part a result of globalization, technological advancements, and students studying internationally—creating a greater exposure and knowledge base of the common law tradition (as well as civil law and other domestic legal traditions, such as Islamic law). (See the Appendices for further specifics on the American court system.) To understand the American legal system, legal cases reflecting case law must be understood in great detail. This is especially critical given the importance of stare The American Legal System Made Easy decisis and precedent cases in American law, as discussed earlier. Because of the importance of case law and understanding cases, the next section provides a more detailed glimpse into the main elements of a case within the American judicial system, including a method of how to read and brief a case—a vital skill set for both the study and practice of American law. How to Read and Brief a Case With the high level of importance given to stare decisis and precedent cases underlying American law, a fundamental knowledge of how to understand and brief a U.S. case is critically important. This is true as a law student as well as a law practitioner who aspires to gain a greater understanding of American law. To begin, most court decisions are published, both at the federal and state level. The court issuing the opinion often has the discretion in deciding whether to publish an opinion it has rendered. Specific case elements exist in a typical case brief, which include the following: • Case Name and its citation to find and/or reference the case • Author of the Opinion (the Opinion is the court’s ruling/decision): Generally, the person who authors a legal opinion is a judge or arbitrator (the concept and role of arbitrators is discussed in greater detail in Chapter 10). • Opinion, which generally includes: • Case Facts and relevant procedural history of the case, such as past appeals and rulings • Court Conclusion, also referred to as the case’s holding • Reasoning: Detailing the rationale, arguments, and other factors considered by the court • Disposition: Court action based on the court’s ruling/conclusion (e.g., reversed, affirmed, remanded.) The case caption can be thought of as a title for a case. Example: Brown v. Board of Education, 347 U.S. 483 (1954). The case caption includes the parties, case citation (court name, law book where the opinion is published), and year of the court’s conclusion. In terms of formality of writing for a case caption, the party names to the dispute are italicized and/or underlined (the example has the party names italicized). The remaining case caption (e.g., citation/reporter details, year that the decision was rendered, and other related details) generally is not italicized or underlined. Reporters Cases that are published are included in publications called reporters. Each reporter has a volume number and page numbers. Some reporters are published by the state, while American Law 101 some are published by commercial institutions. For the case citation/reporter relating to the previous example, the case would be found in volume 347 of the United States Reports on page 483. Judicial Titles The author of the court opinion, as mentioned, is typically a judge. In this case, the judge, in his or her capacity as legal opinion author (for the majority or minority opinion), is written at the top of the legal opinion, as follows: Example: “Hand, J.” refers to Judge Hand. Example: “Holmes J.” is Justice Holmes. Some jurisdictions use terms other than “judge,” albeit referring to the same judicial decision-rendering role: Example: “Jackson, C.” refers to Chancellor Jackson. Example: “Jackson, V.C.” refers to Vice-Chancellor Jackson. Example: “Jackson, C.J.” refers to Chief Judge Jackson. Party Names In a civil (noncriminal) case, the party initiating the lawsuit is the plaintiff, and the party defending against the plaintiff’s lawsuit is the defendant (not coincidentally, the term “defendant” has the term “defend” embedded in it). In criminal (noncivil) cases, the party initiating the lawsuit is referred to as the state (or similar terminology), because the interests of the state (or other relevantly named party initiating the lawsuit) are presumed greater than one individual (such as by a plaintiff in a civil law case). The plaintiffs (or state) are usually the first party listed in the caption. For the previous caption example, Brown is the plaintiff at the initial stage (prior to an appeal, if an appeal is rendered). If a case is heard on appeal (in which a case is heard for the second time or more), then the party initiating the appeal is called the appellant. The party defending against the appellant’s lawsuit on appeal is called the appellee. Thus, as an example, if the Board of Education in the previous example appealed, then the Board of Education would be the first named party in the caption of the appealed case (rather than second, as was the case in the original lawsuit example). The court’s conclusion or ruling is the court’s legal opinion and the rationale given for reaching a particular judgment, finding, or conclusion. Underneath the broad term of legal opinion, several specific subsets of opinions exist. A concurring opinion is an opinion rendered by a judge who would have reached the same conclusion as the majority opinion, but for a different reason (i.e., same destination, but would have chosen a different route to get to the destination). A plurality opinion is The American Legal System Made Easy an opinion agreed on by less than the majority of the judges (assuming a panel of judges), but the opinion agrees with the majority opinion’s conclusion. A dissenting opinion is an opinion by one or more judges who disagree with the majority opinion’s conclusion. The parties to a lawsuit (at the initial trial court level) include the following: • Plaintiff: Party initiating the lawsuit • Defendant: Party defending against the lawsuit (legal action by plaintiff) • Counterclaimant: Defendant’s counterclaim against the plaintiff • Cross-claimant: Defendant bringing a lawsuit against a third party, typically with a view that the introduced third party was at least partially responsible/ liable for owed damages to plaintiff • Third-party defendant: Party defending against a cross-claim for alleged damages owed to plaintiff • Intervenor: Interested party participating in litigation with the court’s permission The parties to a lawsuit (at the noninitial appellate court level) include the following: • Appellant: Party appealing a lower court’s ruling (usually the unsuccessful party in the previous lawsuit) • Appellee: Party defending against the appellant’s actions • Petitioner: Party challenging action, usually in an agency context • Respondent: Party defending against petitioner’s actions, usually in an agency context • Intervenor: Same as intervenor at the trial court level • Amicus curiae (“friend of the court”): Party given court permission to participate in the case • U.S. Solicitor: Government attorney representing the United States The parties to a lawsuit (at the highest U.S. Supreme Court level) include the following: • Petitioner: Party seeking the Supreme Court’s review, arguing for the rejection of the lower court’s decision • Respondent: Party opposing the Supreme Court’s review, arguing that the lower court’s decision does not warrant review, because the lower court’s conclusion and rationale are legally valid • Intervenor: Same as intervenor at the trial/appellate court level • Amicus curiae: Same as at the appeals court level • U.S. Solicitor: Government attorney representing the United States American Law 101 Court Dispositions—General • Order: Court resolution of a motion (filed by one of the parties) • Affirmation: Court’s decision to uphold the lower court’s ruling • Reversal: Court’s rejection of the lower court’s ruling • Remand: Court order to return the case to the lower court (or agency) for further factual findings, or for other resolution in conformity with the appellate court’s decision • Vacate: Court rejection of the lower court’s ruling, with an order to set aside and render the lower court’s ruling as null and void • Modification: Court’s affirmation of part of the lower court’s decision, with an ordered modification to the opinion Court Dispositions—Appellate Courts • En Banc Opinion: • Represents an opinion by all members of the court, not just a certain number (panel) of sitting judges, to hear a particular case • Generally represents a rare exception rather than the norm • Usually seen in issues of extreme importance Court Disposition—Supreme Court • Plurality Opinion: • An opinion that more judges sign than any concurring opinion • Does not constitute a majority opinion • Does not have the force of precedent, because it is not a result of a majority opinion • Certiorari Granted: • Grant of discretionary review by the U.S. Supreme Court (often considered the exception rather than the norm because the Supreme Court is unable to grant certiorari to most cases given its limited time and resources) • Does not reverse or directly affect lower court rulings • Certiorari Denied: • U.S. Supreme Court’s decision to reject discretionary review of a particular lower court ruling • Does not generally have precedential effect In most legal opinions, part of the court’s decision may include analysis and language that may not directly be necessary to reach the court’s resolution of the legal issue. This part of the case is referred to as dictum. Dictum is not the court’s holding. The American Legal System Made Easy In other words, dictum is related, but separate from, the court’s holding. Given that dictum is not part of a court’s holding, stare decisis does not apply. It may be difficult to distinguish a court’s dictum from its holding. Still, dictum may be useful for future cases, because it is, at times, a signal or hint of how the court (or at least a judge in the court) may view a case in light of different legal issues or facts. Summary The American judicial system is based on British common law, which is then buttressed by, among other sources, the U.S. Constitution, court cases, statutes, restatements, decrees, treatises, and various other rules and regulations. The American legal system is composed of the U.S. Supreme Court, federal courts, and state courts. Within both federal and state courts, primary and secondary legal sources are considered. The U.S. Supreme Court is the highest land of the law. It can grant certiorari to select cases for various reasons, including whether the issue presented is urgent or of vital national interest. Generally, however, a lawsuit begins in state courts and then, as needed, is heard on appeal by federal (appellate-level) or state courts. Knowledge of the structure of the American judicial system is then furthered by understanding how to write and brief a law case, which is a vital skill set for law students and practitioners. ",Legal,Find & Summarize,Text Transformation You can only answer using the information I am giving you. Make it sound like a dictionary definition. Make sure you are only use your own words and do copy any words or phrases from the context.,"If I don't mention sunscreen in the label for my UV lip balm, then can it even be a cosmeceutical?","Context: The FFDCA defines a “drug” in part as “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease”; articles “(other than food) intended to affect the structure or any function of the body”; and “articles intended for use as a component” of such drugs.15 Drug manufacturers must comply with Current Good Manufacturing Practices (CGMP) rules for drugs. 16 Failure to comply will cause a drug to be considered adulterated.17 Drug manufacturers are required to register their facilities, 18 list their drug products with the agency, 19 and report adverse events to FDA, among other requirements. 20 Unlike cosmetics and their ingredients (with the exception of color additives), drugs are subject to FDA approval before entering interstate commerce. Drugs must either (1) receive the agency’s premarket approval under a new drug application (NDA), or an abbreviated NDA (ANDA),21 in the case of a generic drug, or (2) conform to a set of FDA requirements known as a monograph.22 Monographs govern the manufacture and marketing of most over-the-counter (OTC) drugs and specify the conditions under which OTC drugs in a particular category (such as antidandruff shampoos or antiperspirants) will be considered generally recognized as safe and effective (GRASE). 23 Monographs also indicate how OTC drugs must be labeled so they are not deemed misbranded.24 Although the term “cosmeceutical” has been used to refer to combination cosmetic/drug products, such products have no statutory or regulatory definition.25 Historically, FDA has indicated that cosmetic/drug combinations are subject to FDA’s regulations for both cosmetics and drugs.26 Determining whether a cosmetic is also a drug, and therefore subject to the additional statutory requirements that apply to drugs, depends on the distributor’s claims regarding the drug’s intent or intended use.27 A product’s intended use may be established in several ways, such as claims on the label or in advertising or promotional materials, customer perception of the product, and the inclusion of ingredients that cause the product to be considered a drug because of a known therapeutic use.28 For example, if a lipstick (a cosmetic) contains sunscreen (a drug), historically, the mere inclusion of the term “sunscreen” in the product’s labeling required the product to be regulated as a drug as well as a cosmetic. 29 The text box below provides examples of other cosmetic/drug combinations and compares cosmetic and drug classifications.30 Prior to the enactment of the Federal Food, Drug, and Cosmetic Act (FFDCA) in 1938, cosmetics were not regulated by the federal government. 31 Instead, they were regulated under a collection of state laws that had been enacted to regulate food and drugs.32 At that time, multiple “cosmetics and drugs were made from the same natural materials” and often the “laws did not include explicit definitions of the products regulated.”33 Following several incidents in which cosmetics were allegedly the cause of serious health problems, as well as industry concerns about states enacting their own laws, provisions were included in the FFDCA that prohibited the sale of adulterated or misbranded cosmetics in interstate commerce.34 The FFDCA also established uniform regulation of FDA-regulated cosmetic products nationwide. 35 However, state laws regarding cosmetics regulation have continued to evolve since FFDCA’s passage, with some states implementing stricter measures than others.","Context: The FFDCA defines a “drug” in part as “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease”; articles “(other than food) intended to affect the structure or any function of the body”; and “articles intended for use as a component” of such drugs.15 Drug manufacturers must comply with Current Good Manufacturing Practices (CGMP) rules for drugs. 16 Failure to comply will cause a drug to be considered adulterated.17 Drug manufacturers are required to register their facilities, 18 list their drug products with the agency, 19 and report adverse events to FDA, among other requirements. 20 Unlike cosmetics and their ingredients (with the exception of color additives), drugs are subject to FDA approval before entering interstate commerce. Drugs must either (1) receive the agency’s premarket approval under a new drug application (NDA), or an abbreviated NDA (ANDA),21 in the case of a generic drug, or (2) conform to a set of FDA requirements known as a monograph.22 Monographs govern the manufacture and marketing of most over-the-counter (OTC) drugs and specify the conditions under which OTC drugs in a particular category (such as antidandruff shampoos or antiperspirants) will be considered generally recognized as safe and effective (GRASE). 23 Monographs also indicate how OTC drugs must be labeled so they are not deemed misbranded.24 Although the term “cosmeceutical” has been used to refer to combination cosmetic/drug products, such products have no statutory or regulatory definition.25 Historically, FDA has indicated that cosmetic/drug combinations are subject to FDA’s regulations for both cosmetics and drugs.26 Determining whether a cosmetic is also a drug, and therefore subject to the additional statutory requirements that apply to drugs, depends on the distributor’s claims regarding the drug’s intent or intended use.27 A product’s intended use may be established in several ways, such as claims on the label or in advertising or promotional materials, customer perception of the product, and the inclusion of ingredients that cause the product to be considered a drug because of a known therapeutic use.28 For example, if a lipstick (a cosmetic) contains sunscreen (a drug), historically, the mere inclusion of the term “sunscreen” in the product’s labeling required the product to be regulated as a drug as well as a cosmetic. 29 The text box below provides examples of other cosmetic/drug combinations and compares cosmetic and drug classifications.30 Prior to the enactment of the Federal Food, Drug, and Cosmetic Act (FFDCA) in 1938, cosmetics were not regulated by the federal government. 31 Instead, they were regulated under a collection of state laws that had been enacted to regulate food and drugs.32 At that time, multiple “cosmetics and drugs were made from the same natural materials” and often the “laws did not include explicit definitions of the products regulated.”33 Following several incidents in which cosmetics were allegedly the cause of serious health problems, as well as industry concerns about states enacting their own laws, provisions were included in the FFDCA that prohibited the sale of adulterated or misbranded cosmetics in interstate commerce.34 The FFDCA also established uniform regulation of FDA-regulated cosmetic products nationwide. 35 However, state laws regarding cosmetics regulation have continued to evolve since FFDCA’s passage, with some states implementing stricter measures than others. System instruction: You can only answer using the information I am giving you Make it sound like a dictionary definition. Make sure you are only use your own words and do copy any words or phrases from the context. what I want to know: If I don't mention sunscreen in the label for my UV lip balm, then can it even be a cosmeceutical?",Retail/Product,Explanation/Definition,Q&A Provide the answer based solely on the document provided. The answer should be in complete sentences.,"According to Warren Buffet, when is the best time to invest in the stock market?","**Best time to invest in stock market** The Colombo stock market has gone up by over 1,000 points (more than 20%) during the last few weeks. With this growth, a large number of investors are either trying to enter the market or trying to maximize profits from their existing investments. In order to assist them in their investment decisions, this week we will discuss a topic that most investors ask. Is there ever a good time to invest in the stock market? This question is frequently asked by investors, and for good reason, as no one wants to invest in the stock market only to see it fall the following day or even the following week. Is there a right time to invest in stock market? Is there a right time to invest in the stock market? That’s the magic question people have asked for as long as the stock market has been around. The simplest answer is that there is no right time to invest in the stock market. But it may seem as if some people have figured it out, such as billionaires like Warren Buffet who seem to always know when to invest, how much to invest and where to put their money. But, investors like him consider many more factors that have less to do with guessing the ‘right time’ and more to do with trying to predict how the stock will do based on recent reports and announcements by the company. Even then, they could be wrong. Many investors buy into and sell out of the market more frequently than they should. They are trying to ‘time’ the market. If you have never heard of this term before, it is described as trying to pick when the stock market has hit a top or a bottom and then buying into or selling out of the market accordingly. For example, if you are predicting that the market has hit the peak of the cycle, then you sell out of your holdings because the market has nowhere to go but down. Conversely, if you think the market has bottomed, meaning it won’t go any lower, you invest your money, since the market can only go up. Many smart investors try to predict how stocks and the overall stock market will behave and try to invest according to what they believe will happen. Even though they may predict the market right nine out of 10 times, they will still get it wrong that 10th time and it will cost them money, either because they invested in the wrong stock, or didn’t invest in a stock that sky rocketed to the top. It’s extremely difficult to predict how stocks or the stock market will do. Although, it is possible to predict certain trends because they are more obvious than many of the other subtler factors that can determine how well a stock does. There are people out there who claim to know exactly when to invest in the market. And a lot of people actually believe them because of what they see. But the fact is usually that these people invest in many different sectors of the stock market and when they see success in one sector, they only share that success which makes it seem like they know what they are talking about all the time. This isn’t actually a scam (although there are scams like this), but it’s more of the person hoping his or her research pays off and more often than not, it does. Just like people, you have companies with websites claiming to know which stocks will go up in price. And just like the people claiming to be stock market whisperers, these companies do extensive research which gives them hints about which companies will go up and which will go down. Then they share the information with the public, most of the time for a fee. Is there a wrong time to invest in stock market? Unfortunately, it seems that there is a wrong time. Most people have the tendency to invest at the wrong time. This is where the old adage of “buy low and sell high” comes into play. A smart investor waits for the stock to go low so he can buy low and sell high. That’s why billionaire investor Warren Buffet says, “Be greedy when others are fearful and be fearful when others are greedy.” In other words, don’t completely follow the crowd and don’t be afraid to invest when you see an idea and everyone else is scared. It may run contrary to common thought, but smart investors across the globe see the best time to invest in the stock market when its performing its worst. When the stock market sinks or stalls, it is a buyers market. This is simply due to the fact that stocks are fluid forms of value; they change in worth often and sometimes drastically. When the economy starts to underperform, people tend to sell of their investments. It is an obvious response to people seeing their stock portfolio values go lower and lower. These mass pull-outs of investments cause the overall market to go into panic mode, dropping prices for stocks across the board. So, what does a wise investor with skilled investing strategies do in this situation? Buy! But of course, there are other factors at play such as market conditions, currency trading and aspects specific to a particular stock should also be taken into consideration when buying stocks. However, if you have the cash in hand to buy into stocks while they are undervalued due to market conditions, you can make some excellent investments. But there is no perfect time of day, hour or date to buy stocks. Timing stock buys is also based on other mitigating factors. Most investors however, do the opposite and buy high because they believe it’ll keep going higher. We see in practice, most people will only seek financial advice when the market is ‘good’, which ironically is not the best time to buy. Financial advisers who could only earn a commission selling investment products will tell their clients to buy despite it being the worst time to do so. Hardly anyone would seek advice from financial advisers when times are bad. In fact, many financial advisers themselves would recommend ‘safer’ products when actually it is the most viable time to enter into equity markets. Buying in a down market results in ‘cost averaging’, which means that you have a greater opportunity to gather large gains in the future. However, there is more to understanding when to buy stocks than simply ‘buy low, sell high’ or ‘buy in a down market’. The following are tips to help you decide when to buy stocks in order to maximize your future returns. Tips on when to buy Research about the fees that are associated with buying and selling stocks. These fees directly eat up your profits. Because of this, it is often beneficial to buy stocks in bulk and hold for awhile rather than buying and selling rapidly. Know the company. Even if a stock is at a historically low price, you may not want to buy. Consider whether a rebound is expected and if so, what time frame this will require. You want to purchase stocks in a healthy company that will see future returns, not one that is on a fatal path downward. First, be sure that you are well-educated. Do your own research: Ask other investors, try to gather information from the regulator, publications and articles and by speaking to persons in the industry about the company, the industry and any fees you may incur from purchasing stocks. Know the industry. Selection of the market leader and the industries is critical. Trust your gut. Money, including investments is tied to emotions. Follow research and advice, also trust your instincts. Make decisions so that you will be able to sleep well at night. No one likes to lose money in an investment. Therefore, perhaps more complicated than simply buying a stock is the process of selling stock. Stock is easy to sell. Simply contacting your broker or utilizing the website of your online stockbroker can effect this transaction for you in minutes. Its not the act of selling stock, but rather timing stock sales to maximize profits where the need for precision lies. There is no such thing as the best time to sell stock when speaking of the hours in a day. The best time to sell stock is pertinent to each investor, the market state and the stock in question. Certainly, the best answer to when is the best time to sell a stock is to be selling stock before it declines in value. This in theory is nice: Make the most money one can on a stock or bond and get out and sell. However, in reality well timing stock sales takes practice, diligence and at times a lot of patience. Most investors fail to make basic criteria before investing: Profit goals. When investing in a stock, one should establish a set amount of profit to make on a stock. When this limit is reached, selling stock should not be a thought, but rather an act. For example, to purchase stock in Company X for the price of Rs. 10 per share at its current trading value establishes your starting point. Say you set your profit goals for this particular stock at 30% or a Rs.3.00 increase in stock price- a healthy return on any stock investment. So, when the stock reaches Rs.13, you have reached your profit goal for this stock and you should sell. Walking away with 30% gain on your investment is excellent and far better than your money would have earned in near any other place. The average investor who loses money, or simply does not maximize the amount of money they could have made buying and selling stocks usually falls into this pitfall: Not selling stocks. Many investors watch their stocks soar up and then unable to contemplate their stock no longer increasing in value, hold on to as it falls. This is the most common problem with investors timing stock sales. They simply cannot let go of their stocks and therefore follow them all the way down. ","[Text] ======= **Best time to invest in stock market** The Colombo stock market has gone up by over 1,000 points (more than 20%) during the last few weeks. With this growth, a large number of investors are either trying to enter the market or trying to maximize profits from their existing investments. In order to assist them in their investment decisions, this week we will discuss a topic that most investors ask. Is there ever a good time to invest in the stock market? This question is frequently asked by investors, and for good reason, as no one wants to invest in the stock market only to see it fall the following day or even the following week. Is there a right time to invest in stock market? Is there a right time to invest in the stock market? That’s the magic question people have asked for as long as the stock market has been around. The simplest answer is that there is no right time to invest in the stock market. But it may seem as if some people have figured it out, such as billionaires like Warren Buffet who seem to always know when to invest, how much to invest and where to put their money. But, investors like him consider many more factors that have less to do with guessing the ‘right time’ and more to do with trying to predict how the stock will do based on recent reports and announcements by the company. Even then, they could be wrong. Many investors buy into and sell out of the market more frequently than they should. They are trying to ‘time’ the market. If you have never heard of this term before, it is described as trying to pick when the stock market has hit a top or a bottom and then buying into or selling out of the market accordingly. For example, if you are predicting that the market has hit the peak of the cycle, then you sell out of your holdings because the market has nowhere to go but down. Conversely, if you think the market has bottomed, meaning it won’t go any lower, you invest your money, since the market can only go up. Many smart investors try to predict how stocks and the overall stock market will behave and try to invest according to what they believe will happen. Even though they may predict the market right nine out of 10 times, they will still get it wrong that 10th time and it will cost them money, either because they invested in the wrong stock, or didn’t invest in a stock that sky rocketed to the top. It’s extremely difficult to predict how stocks or the stock market will do. Although, it is possible to predict certain trends because they are more obvious than many of the other subtler factors that can determine how well a stock does. There are people out there who claim to know exactly when to invest in the market. And a lot of people actually believe them because of what they see. But the fact is usually that these people invest in many different sectors of the stock market and when they see success in one sector, they only share that success which makes it seem like they know what they are talking about all the time. This isn’t actually a scam (although there are scams like this), but it’s more of the person hoping his or her research pays off and more often than not, it does. Just like people, you have companies with websites claiming to know which stocks will go up in price. And just like the people claiming to be stock market whisperers, these companies do extensive research which gives them hints about which companies will go up and which will go down. Then they share the information with the public, most of the time for a fee. Is there a wrong time to invest in stock market? Unfortunately, it seems that there is a wrong time. Most people have the tendency to invest at the wrong time. This is where the old adage of “buy low and sell high” comes into play. A smart investor waits for the stock to go low so he can buy low and sell high. That’s why billionaire investor Warren Buffet says, “Be greedy when others are fearful and be fearful when others are greedy.” In other words, don’t completely follow the crowd and don’t be afraid to invest when you see an idea and everyone else is scared. It may run contrary to common thought, but smart investors across the globe see the best time to invest in the stock market when its performing its worst. When the stock market sinks or stalls, it is a buyers market. This is simply due to the fact that stocks are fluid forms of value; they change in worth often and sometimes drastically. When the economy starts to underperform, people tend to sell of their investments. It is an obvious response to people seeing their stock portfolio values go lower and lower. These mass pull-outs of investments cause the overall market to go into panic mode, dropping prices for stocks across the board. So, what does a wise investor with skilled investing strategies do in this situation? Buy! But of course, there are other factors at play such as market conditions, currency trading and aspects specific to a particular stock should also be taken into consideration when buying stocks. However, if you have the cash in hand to buy into stocks while they are undervalued due to market conditions, you can make some excellent investments. But there is no perfect time of day, hour or date to buy stocks. Timing stock buys is also based on other mitigating factors. Most investors however, do the opposite and buy high because they believe it’ll keep going higher. We see in practice, most people will only seek financial advice when the market is ‘good’, which ironically is not the best time to buy. Financial advisers who could only earn a commission selling investment products will tell their clients to buy despite it being the worst time to do so. Hardly anyone would seek advice from financial advisers when times are bad. In fact, many financial advisers themselves would recommend ‘safer’ products when actually it is the most viable time to enter into equity markets. Buying in a down market results in ‘cost averaging’, which means that you have a greater opportunity to gather large gains in the future. However, there is more to understanding when to buy stocks than simply ‘buy low, sell high’ or ‘buy in a down market’. The following are tips to help you decide when to buy stocks in order to maximize your future returns. Tips on when to buy Research about the fees that are associated with buying and selling stocks. These fees directly eat up your profits. Because of this, it is often beneficial to buy stocks in bulk and hold for awhile rather than buying and selling rapidly. Know the company. Even if a stock is at a historically low price, you may not want to buy. Consider whether a rebound is expected and if so, what time frame this will require. You want to purchase stocks in a healthy company that will see future returns, not one that is on a fatal path downward. First, be sure that you are well-educated. Do your own research: Ask other investors, try to gather information from the regulator, publications and articles and by speaking to persons in the industry about the company, the industry and any fees you may incur from purchasing stocks. Know the industry. Selection of the market leader and the industries is critical. Trust your gut. Money, including investments is tied to emotions. Follow research and advice, also trust your instincts. Make decisions so that you will be able to sleep well at night. No one likes to lose money in an investment. Therefore, perhaps more complicated than simply buying a stock is the process of selling stock. Stock is easy to sell. Simply contacting your broker or utilizing the website of your online stockbroker can effect this transaction for you in minutes. Its not the act of selling stock, but rather timing stock sales to maximize profits where the need for precision lies. There is no such thing as the best time to sell stock when speaking of the hours in a day. The best time to sell stock is pertinent to each investor, the market state and the stock in question. Certainly, the best answer to when is the best time to sell a stock is to be selling stock before it declines in value. This in theory is nice: Make the most money one can on a stock or bond and get out and sell. However, in reality well timing stock sales takes practice, diligence and at times a lot of patience. Most investors fail to make basic criteria before investing: Profit goals. When investing in a stock, one should establish a set amount of profit to make on a stock. When this limit is reached, selling stock should not be a thought, but rather an act. For example, to purchase stock in Company X for the price of Rs. 10 per share at its current trading value establishes your starting point. Say you set your profit goals for this particular stock at 30% or a Rs.3.00 increase in stock price- a healthy return on any stock investment. So, when the stock reaches Rs.13, you have reached your profit goal for this stock and you should sell. Walking away with 30% gain on your investment is excellent and far better than your money would have earned in near any other place. The average investor who loses money, or simply does not maximize the amount of money they could have made buying and selling stocks usually falls into this pitfall: Not selling stocks. Many investors watch their stocks soar up and then unable to contemplate their stock no longer increasing in value, hold on to as it falls. This is the most common problem with investors timing stock sales. They simply cannot let go of their stocks and therefore follow them all the way down. [Question] ======= According to Warren Buffet, when is the best time to invest in the stock market? [Task Description] ======= Provide the answer based solely on the document provided. The answer should be in complete sentences.",Financial,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","I had to walk to the shop today and it was pouring down rain and it was freezing outside. I was dressed accordingly with a hat and a jacket, but I'm worried about getting sick. I've always heard that being outside in cold and wet weather results in colds. Will I get sick? I have a bit of a runny nose now.","Cold air cannot make you sick, but the odds of catching the common cold or influenza (the flu) are highest during the fall and winter. Although cold weather doesn't cause a cold or the flu, it can set the stage for certain factors that decrease your immunity and increase opportunities to catch these illnesses.1 This article explores the factors associated with cold weather that increase the chances of getting sick. There is some evidence to suggest that viruses spread more easily through cold, dry air. Temperature and humidity, therefore, may affect your risk of catching a virus. When it is cold outside, the air is drier both outdoors and inside (due to heating), drying out mucous membranes and making it easier for germs to take hold. The nose is an ideal host for many viruses due to its cooler temperature. The typical core body temperature is 98.6 degrees F, but the nasal cavity temperature is lower at 91.4 degrees F. Research suggests that rhinoviruses (viruses that cause the common cold) do not replicate efficiently at body temperature, but the cooler temperature in the nose may make it an ideal breeding ground for viruses.2 One study suggests colder temperatures on their own do not increase the spread of colds and flu, but temperature and humidity fluctuations do. Researchers cross-referenced confirmed cases of rhinovirus with weather data over a set period of time and discovered that decreases in either temperature or humidity over a three-day period increased the risk of rhinovirus infections.3 The study, which involved 892 men in the Finnish military, also suggests that breathing cold air may contribute to the spread of infection into the lungs. This is based on earlier research that found lung temperature can be lowered by inhaling cold air. However, researchers also noted that the risk of rhinovirus infection is reduced at subfreezing temperatures and higher humidity.3 Warmer air does not necessarily kill viruses, either, as is evidenced by the spread of colds and flu in tropical areas where it does not get cold. Cold and flu cases are more prevalent in tropical climates during the rainy season. This is likely due to people spending more time indoors when it's raining, putting them in closer contact with others than during the dry season. Reduced Immune Function People may also be more prone to catching a cold or flu in the winter due to lower immunity. Fewer daylight hours and less time spent outside mean less exposure to sunlight, which the body uses to make vitamin D. In addition, lack of activity during cold weather may also mean reduced immunity. Vitamin D Vitamin D plays a critical role in the immune system helping to keep you healthy. Vitamin D deficiency is linked to an increased risk of viral infections, including those in the respiratory tract.5 Researchers are studying whether vitamin D supplements can help improve immunity when vitamin D levels are low. A review of 25 studies concluded that vitamin D supplementation was safe and it protected against acute respiratory tract infection. People who were very vitamin D deficient and those not receiving high single doses of vitamin D experienced the most benefit.6 Lack of Exercise People also tend to be less active in cold weather. While it is not clear exactly if or how exercise increases your immunity to certain illnesses, and no solid evidence, there are several theories, about exercise, such as:7 It improves circulation, allowing white blood cells to detect and fight an infection faster. It increases body temperature during and right after a workout, which may work like a fever to prevent bacteria from growing. It may help to flush bacteria from the lungs and airways, reducing your chances of getting sick. It lowers levels of stress hormones, which may protect against illness. Close Contact During Colder Months Viruses rely on the cells of other organisms to live and replicate. They are transmitted from host to host when infected respiratory secretions make their way into the mucous membranes of a healthy person. How transmission occurs may include:8 Direct person-to-person contact, such as hugging, kissing, or shaking hands Inhaling small droplets in the air from a sneeze or cough Touching something that has the virus on it (like a doorknob, drinking glass, utensils, or toys) and then touching your mouth, nose, or eyes It logically follows, then, that the closer you are to people and the more you share a space, the more likely transmission is. In the winter, many people tend to take their outdoor activities inside. For example: School recess being held in a gym, rather than outside People walk around crowded shopping centers rather than on a track or neighborhood People staying indoors more hours of the day This close contact during colder months increases the likelihood of passing germs. Protection From Cold and Flu The most important thing to remember during cold and flu season is to protect yourself and stop the spread of these germs when you are around other people. Steps you can take to prevent cold and flu include:98 Wash your hands often or use an alcohol-based hand sanitizer if soap and water aren't available. Avoid close contact with people who are sick. Stay home when you are sick. Cover your mouth and nose with a tissue or the inside of your elbow when you cough or sneeze. Wear a face mask in crowded places. Try to avoid touching your eyes, nose, or mouth as much as possible, since that is how most respiratory germs enter the body. Clean and disinfect frequently touched surfaces at home, work, or school, especially when someone is sick. Get your yearly flu vaccine and any other recommended vaccines. Get enough sleep. Exercise regularly. Drink plenty of fluids. Follow a healthy diet.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I had to walk to the shop today and it was pouring down rain and it was freezing outside. I was dressed accordingly with a hat and a jacket, but I'm worried about getting sick. I've always heard that being outside in cold and wet weather results in colds. Will I get sick? I have a bit of a runny nose now. Cold air cannot make you sick, but the odds of catching the common cold or influenza (the flu) are highest during the fall and winter. Although cold weather doesn't cause a cold or the flu, it can set the stage for certain factors that decrease your immunity and increase opportunities to catch these illnesses.1 This article explores the factors associated with cold weather that increase the chances of getting sick. There is some evidence to suggest that viruses spread more easily through cold, dry air. Temperature and humidity, therefore, may affect your risk of catching a virus. When it is cold outside, the air is drier both outdoors and inside (due to heating), drying out mucous membranes and making it easier for germs to take hold. The nose is an ideal host for many viruses due to its cooler temperature. The typical core body temperature is 98.6 degrees F, but the nasal cavity temperature is lower at 91.4 degrees F. Research suggests that rhinoviruses (viruses that cause the common cold) do not replicate efficiently at body temperature, but the cooler temperature in the nose may make it an ideal breeding ground for viruses.2 One study suggests colder temperatures on their own do not increase the spread of colds and flu, but temperature and humidity fluctuations do. Researchers cross-referenced confirmed cases of rhinovirus with weather data over a set period of time and discovered that decreases in either temperature or humidity over a three-day period increased the risk of rhinovirus infections.3 The study, which involved 892 men in the Finnish military, also suggests that breathing cold air may contribute to the spread of infection into the lungs. This is based on earlier research that found lung temperature can be lowered by inhaling cold air. However, researchers also noted that the risk of rhinovirus infection is reduced at subfreezing temperatures and higher humidity.3 Warmer air does not necessarily kill viruses, either, as is evidenced by the spread of colds and flu in tropical areas where it does not get cold. Cold and flu cases are more prevalent in tropical climates during the rainy season. This is likely due to people spending more time indoors when it's raining, putting them in closer contact with others than during the dry season. Reduced Immune Function People may also be more prone to catching a cold or flu in the winter due to lower immunity. Fewer daylight hours and less time spent outside mean less exposure to sunlight, which the body uses to make vitamin D. In addition, lack of activity during cold weather may also mean reduced immunity. Vitamin D Vitamin D plays a critical role in the immune system helping to keep you healthy. Vitamin D deficiency is linked to an increased risk of viral infections, including those in the respiratory tract.5 Researchers are studying whether vitamin D supplements can help improve immunity when vitamin D levels are low. A review of 25 studies concluded that vitamin D supplementation was safe and it protected against acute respiratory tract infection. People who were very vitamin D deficient and those not receiving high single doses of vitamin D experienced the most benefit.6 Lack of Exercise People also tend to be less active in cold weather. While it is not clear exactly if or how exercise increases your immunity to certain illnesses, and no solid evidence, there are several theories, about exercise, such as:7 It improves circulation, allowing white blood cells to detect and fight an infection faster. It increases body temperature during and right after a workout, which may work like a fever to prevent bacteria from growing. It may help to flush bacteria from the lungs and airways, reducing your chances of getting sick. It lowers levels of stress hormones, which may protect against illness. Close Contact During Colder Months Viruses rely on the cells of other organisms to live and replicate. They are transmitted from host to host when infected respiratory secretions make their way into the mucous membranes of a healthy person. How transmission occurs may include:8 Direct person-to-person contact, such as hugging, kissing, or shaking hands Inhaling small droplets in the air from a sneeze or cough Touching something that has the virus on it (like a doorknob, drinking glass, utensils, or toys) and then touching your mouth, nose, or eyes It logically follows, then, that the closer you are to people and the more you share a space, the more likely transmission is. In the winter, many people tend to take their outdoor activities inside. For example: School recess being held in a gym, rather than outside People walk around crowded shopping centers rather than on a track or neighborhood People staying indoors more hours of the day This close contact during colder months increases the likelihood of passing germs. Protection From Cold and Flu The most important thing to remember during cold and flu season is to protect yourself and stop the spread of these germs when you are around other people. Steps you can take to prevent cold and flu include:98 Wash your hands often or use an alcohol-based hand sanitizer if soap and water aren't available. Avoid close contact with people who are sick. Stay home when you are sick. Cover your mouth and nose with a tissue or the inside of your elbow when you cough or sneeze. Wear a face mask in crowded places. Try to avoid touching your eyes, nose, or mouth as much as possible, since that is how most respiratory germs enter the body. Clean and disinfect frequently touched surfaces at home, work, or school, especially when someone is sick. Get your yearly flu vaccine and any other recommended vaccines. Get enough sleep. Exercise regularly. Drink plenty of fluids. Follow a healthy diet. https://www.verywellhealth.com/does-cold-weather-cause-the-cold-or-flu-770379",Medical,Fact Finding,Q&A "Respond only with information present in the document. If the information is not present, respond with ""This information is not available"". When possible, use quotations and cite the document directly.",What do I need to know about my Financial Accounting program?,"1 Area of Interest: Business Business - Accounting Ontario College Diploma 2 Years Program Code: 0214C01FWO Ottawa Campus Our Program Get the essential skills to start a career in Accounting. The Business - Accounting Ontario College Diploma program balances accounting theory with tools used in the industry. This two-year program equips you with the essential skills for various entry-level accounting positions. Learn how to complete accounting tasks, from conducting bookkeeping responsibilities to preparing financial statements and personal income tax returns. Expand your knowledge of various business concepts including economics and finance. Explore accounting concepts while sharpening your communication, math and technological skills. Courses incorporate accounting software to strengthen your computer literacy and provide you with up-to-date technical skills, which are essential in this field. In the program`s final semester, you have the opportunity to apply for a work placement to practise your skills in a real work setting. See Additional Information for eligibility requirements. Students considering a professional accounting designation or an accounting credential are advised to make inquiries with the Chartered Professional Accountants of Ontario (CPA Ontario) before deciding to complete this program. See Additional Information for further details. This program prepares you for entry-level positions in: - financial accounting - managerial accounting - payables and receivables - taxation Graduates typically find employment in roles such as: - accounts payable clerk - accounts receivable clerk - bookkeeper payroll clerk - junior staff accountant SUCCESS FACTORS This program is well-suited for students who: - Enjoy problem solving and critical-thinking activities. - Are inquisitive and have an analytical nature. - Can work well independently and in a group. 2 Business - Accounting - Are detailed-oriented, organized and adaptable. - Are comfortable using a variety of computer applications. - Possess a high standard of ethics. Employment Graduates may pursue employment opportunities in various entry-level positions including accounts receivables or payables, bookkeeping or payroll responsibilities. Roles include: accounting assistant, accounts payable clerk, accounts receivable clerk, bookkeeper, and payroll clerk. Learning Outcomes The graduate has reliably demonstrated the ability to: - Record financial transactions in compliance with Canadian Generally Accepted Accounting Principles for sole proprietorships, partnerships, private enterprises, publicly accountable enterprises and non-profit organizations. - Prepare and present financial statements, reports and other documents in compliance with Canadian Generally Accepted Accounting Principles for sole proprietorships, partnerships and private enterprises. - Contribute to recurring decision-making by applying fundamental management accounting concepts. - Prepare individuals` income tax returns and basic tax planning in compliance with relevant legislation and regulations. - Analyze organizational structures, the interdependence of functional areas, and the impact those relationships can have on financial performance. - Analyze, within a Canadian context, the impact of economic variables, legislation, ethics, technological advances and the environment on an organization`s operations. - Outline the elements of an organization`s internal control system and risk management. - Contribute to recurring decision-making by applying fundamental financial management concepts. - Identify and apply discipline-specific practices that contribute to the local and global community through social responsibility, economic commitment and environmental stewardship. Program of Study Level: 01 Courses Hours ACC2201 Financial Accounting I 56.0 BUS2301 Business Computer Applications 42.0 ENL1813B Communications I 42.0 MGT2201 Business Fundamentals 42.0 QUA2210 Basic Business Mathematics 56.0 Level: 02 Courses Hours ACC2202 Financial Accounting II 56.0 ACC2343 Spreadsheet Applications 56.0 3 Business - Accounting ECO2200 Economic Issues 42.0 ENL1823B Communications II 42.0 FIN2230 Finance 42.0 Level: 03 Courses Hours ACC2209 Financial Accounting III 70.0 ACC2233 Management Accounting I 56.0 ACC2262 Introduction to Personal Taxation 56.0 ACC2385 Accounting Software Applications 56.0 English General Education Elective: choose 1 Courses Hours ENL1725 Canadian Identity 42.0 ENL1726 Symbols, Text and Meaning 42.0 ENL1798 Contemporary Canadian Issues 42.0 ENL1825 Communication Dynamics 42.0 ENL1829 The Art of Oratory 42.0 Level: 04 Courses Hours ACC2211 Payroll and Compliance 56.0 ACC2234 Management Accounting II 56.0 ACC2265 Audit Principles and Business Issues 56.0 Elective: choose 1 Courses Hours ACC0012 Integrated Accounting Practice 56.0 ACC0044 Work Experience 56.0 Choose one from equivalencies: Courses Hours GED0214C General Education Elective 42.0 Fees for the 2023/2024 Academic Year Tuition and related ancillary fees for this program can be viewed by using the Tuition and Fees Estimator tool at https://www.algonquincollege.com/fee-estimator . Further information on fees can be found by visiting the Registrar`s Office website at https://www.algonquincollege.com/ro . Fees are subject to change. Additional program related expenses include: - Books and supplies cost approximately $600 to $800 per term. However in Levels 03 and 04 of the program, books may cost up to $1,000. - Books and supplies can be purchased from the campus store. For more information visit https://www.algonquincollege.com/coursematerials . 4 Business - Accounting Admission Requirements for the 2024/2025 Academic Year College Eligibility - Ontario Secondary School Diploma (OSSD) or equivalent. Applicants with an OSSD showing senior English and/or Mathematics courses at the Basic Level, or with Workplace or Open courses, will be tested to determine their eligibility for admission; OR - Academic and Career Entrance (ACE) certificate; OR - General Educational Development (GED) certificate; OR - Mature Student status (19 years of age or older and without a high school diploma at the start of the program). Eligibility may be determined by academic achievement testing for which a fee of $50 (subject to change) will be charged. Program Eligibility - English, Grade 12 (ENG4C or equivalent). - Mathematics, Grade 12 (MAP4C or equivalent). - Applicants with international transcripts must provide proof of the subject-specific requirements noted above and may be required to provide proof of language proficiency. Domestic applicants with international transcripts must be evaluated through the International Credential Assessment Service of Canada (ICAS) or World Education Services (WES). - IELTS-International English Language Testing Service (Academic) Overall band of 6.0 with a minimum of 5.5 in each band; OR TOEFL-Internet-based (iBT) Overall 80, with a minimum of 20 in each component: Reading 20; Listening 20; Speaking 20; Writing 20; OR Duolingo English Test (DET) Overall 110, minimum of 110 in Literacy and no score below 95. - Not sure if you meet all of the requirements? Academic Upgrading may be able to help with that: https://www.algonquincollege.com/access . Should the number of qualified applicants exceed the number of available places, applicants will be selected on the basis of their proficiency in English and mathematics. Admission Requirements for 2023/2024 Academic Year College Eligibility - Ontario Secondary School Diploma (OSSD) or equivalent. Applicants with an OSSD showing senior English and/or Mathematics courses at the Basic Level, or with Workplace or Open courses, will be tested to determine their eligibility for admission; OR - Academic and Career Entrance (ACE) certificate; OR - General Educational Development (GED) certificate; OR - Mature Student status (19 years of age or older and without a high school diploma at the start of the program). Eligibility may be determined by academic achievement testing for which a fee of $50 (subject to change) will be charged. Program Eligibility - English, Grade 12 (ENG4C or equivalent). - Mathematics, Grade 12 (MAP4C or equivalent). - Applicants with international transcripts must provide proof of the subject specific requirements noted above and may be required to provide proof of language proficiency. Domestic applicants with international transcripts must be evaluated through the International Credential Assessment Service of Canada (ICAS) or World Education Services (WES). - IELTS-International English Language Testing Service (Academic) Overall band of 6.0 with a minimum of 5.5 in each band; OR TOEFL-Internet-based (iBT) Overall 80, with a minimum of 20 in each component: Reading 20; Listening 20; Speaking 20; Writing 20. 5 Business - Accounting Not sure if you meet all of the requirements? Academic Upgrading may be able to help with that: https://www.algonquincollege.com/access/ . Should the number of qualified applicants exceed the number of available places, applicants will be selected on the basis of their proficiency in English and mathematics. Application Information BUSINESS - ACCOUNTING Program Code 0214C01FWO Applications to full-time day programs must be submitted with official transcripts showing completion of the academic admission requirements through: ontariocolleges.ca 60 Corporate Court Guelph, Ontario N1G 5J3 1-888-892-2228 Students currently enrolled in an Ontario secondary school should notify their Guidance Office prior to their online application at http://www.ontariocolleges.ca/ . Applications for Fall Term and Winter Term admission received by February 1 will be given equal consideration. Applications received after February 1 will be processed on a first-come, first-served basis as long as places are available. International applicants please visit this link for application process information: https://algonquincollege.force.com/myACint/ . For further information on the admissions process, contact: Registrar`s Office Algonquin College 1385 Woodroffe Ave Ottawa, ON K2G 1V8 Telephone: 613-727-0002 Toll-free: 1-800-565-4723 TTY: 613-727-7766 Fax: 613-727-7632 Contact: https://www.algonquincollege.com/ro Additional Information This program offers a September start or January start. Students who start in January must complete their second level of the program in the Spring term and continue into the third level in the Fall term. Classes in this program may be scheduled between 8:00 AM and 10:00 PM, Monday through Friday. Work placement is an option available to students in the fourth level of this program. Work placement is only available in the Winter term. Participants of the optional work placement will receive a course credit for ACC0044 (Work Experience) in lieu of taking a fifth course on campus during the fourth level of the program. Students must meet eligibility requirements in order to participate in the work placement. To be eligible to apply for work placement, students must be registered full-time with the regular on-campus program, must have completed all level 1, 2 and 3 courses, must not have any academic encumbrances and must meet certain academic standings. Due to the high demand for work placements, some students may be required to secure their own placement subject to approval by the program coordinator. Students considering completing a degree after their diploma may be able to apply some courses towards a degree through various university articulation agreements. For further information see https://www.algonquincollege.com/degree-pathways/list/ . Students considering pursuing a professional accounting designation are advised to make inquiries with the Chartered Professional Accountants of Ontario (CPA Ontario). Please note that Algonquin 6 Business - Accounting College courses are not directly transferrable to CPA unless they are transferred through a recognized articulation agreement with a university. For further information see http://www.cpaontario.ca/become-a-cpa/get-started . Course Descriptions ACC0012 Integrated Accounting Practice Students draw upon knowledge learned throughout the program to participate in weekly duties that simulate authentic business practices. Students integrate and apply their knowledge of fundamental accounting and taxation to complete various tasks using professional business writing skills and computer software. Prerequisite(s): ACC2209 and ACC2233 and ACC2385 or ACC2341 and ACC2354 and ACC2385 Corerequisite(s):none ACC0044 Work Experience Accounting experience is advantageous when students search for work after graduation. Students apply the skills and knowledge acquired to date in the program to a practical work environment. Students report to a select employer and complete accounting-related tasks. Upon completion of the work placement, employers and students rate the experience. Prerequisite(s): ACC2209 and ACC2233 and ACC2262 and ACC2385 or ACC2341 and ACC2344 and ACC2354 and ACC2385 Corerequisite(s):none ACC2201 Financial Accounting I This is the first course in a series of three financial accounting courses in this program. Students learn to identify, measure, record and report financial transactions. Students learn the fundamentals of the accounting cycle necessary to complete the financial statements and accounting records of a business. Through a combination of in class lectures, practical exercises and the use of computer assisted tools, students develop an understanding of essential accounting concepts necessary for future studies. Prerequisite(s): none Corerequisite(s):none ACC2202 Financial Accounting II Building on previous studies in financial accounting, students expand their knowledge of fundamental accounting concepts involved in measuring and recording financial transactions, including analyzing these transactions and reporting them in the financial records of a business. Students experience a combination of in class lectures, practical exercises and the use of computerized tools to aid in the progress and understanding of vital accounting concepts. Prerequisite(s): ACC2201 or ACC1100 and ACC1211 or ACC2310 Corerequisite(s):none ACC2209 Financial Accounting III This is the third and final financial accounting course in the program. Students examine the transactions specific to corporations as well as more complex accounting topics. This course builds on the material learned in the previous two financial accounting courses. Through a combination of in class lectures, practical exercises and use of computer assisted tools, students develop an understanding of essential accounting concepts necessary for the work place. Prerequisite(s): ACC2202 or ACC2341 Corerequisite(s):none ACC2211 Payroll and Compliance 7 Business - Accounting Payroll and statutory compliance reporting is mandatory for every business to adhere to. Students learn how to apply payroll legislation to calculate deductions, net pay, and remittances, and complete year-end payroll reporting. Students are introduced to the different types of requirements with which businesses are expected to comply, including GST/HST, QST, EHT and workers' compensation. Through a combination of theory and practical activities, students prepare these submissions and calculations by reading through relevant legislation and completing activities. Prerequisite(s): ACC2202 or ACC2341 Corerequisite(s):none ACC2233 Management Accounting I Managerial accounting aids organizations in making well-informed decisions helping businesses to succeed. Students are introduced to key workplace skills by exploring the goals, methods and ethics of managerial accounting including product costing methods and the flow of costs for manufacturing companies. Additionally, students will focus on decision-making tools including, cost-volume-profit and contribution analysis. The curriculum is delivered in lecture, case study and problem-solving format. Prerequisite(s): ACC2202 or ACC2341 Corerequisite(s):none ACC2234 Management Accounting II Students continue to enhance key workplace skills and business ethics by further exploring the goals and methods of managerial accounting. Specific topic areas include merchandising budgeting, performance evaluation in decentralized businesses and financial statement analysis. Students will also focus on business decisions using managerial accounting tools such as relevant costing. The curriculum is delivered in lecture, case and problem-solving format making extensive use of Excel. Prerequisite(s): ACC2233 and ACC2343 or ACC2343 and ACC2354 Corerequisite(s):none ACC2262 Introduction to Personal Taxation The ability to complete personal tax returns is an essential skill to have in the accounting field. Using a variety of methods, including authentic tax cases, lectures and classroom discussions, students use professional tax software to prepare personal Canadian tax returns for individuals and unincorporated businesses. Basic principles of tax planning and tax legislation are covered. It is strongly recommended that students use a Windows-based laptop (not a Mac). Prerequisite(s): ACC2202 or ACC2313 Corerequisite(s):none ACC2265 Audit Principles and Business Issues Students are introduced to current business issues relevant to Canadian organizations as well as key auditing concepts that help to guide business ethics and decisions. Topics discussed include the Canadian business environment and the current issues it faces, the need for greater ethical and responsible behaviour in light of recent business scandals, fraud and the need for internal controls, risk management and financial statement analysis. Various types of audit and techniques are examined by students. Classroom lectures are enhanced by reading current material and researching information using various tools. Prerequisite(s): ACC2209 or ACC2341 Corerequisite(s):none ACC2343 Spreadsheet Applications Students enhance their knowledge of spreadsheets learned in BUS2301. Using Microsoft Excel, students explore some of the more advanced Excel features, such as financial functions, charts, 8 Business - Accounting logical functions, pivot tables, lists and look-up tables. These spreadsheet concepts are explored through Excel-based lectures and hybrid activities including learning resource applications. Prerequisite(s): ACC2201 and BUS2301 or ACC2313 and BUS2301 or ACC1100 and ACC1211 and BUS2301 Corerequisite(s):none ACC2385 Accounting Software Applications It is a workplace expectation that students are comfortable using accounting software on a day-today basis. Students gain practical experience using computerized accounting software to record transactions and prepare financial statements. Curriculum is delivered in lecture format and by hands-on completion of cases using accounting software. A Windows-based laptop (not a Mac) is strongly recommended. Prerequisite(s): ACC2341 or ACC2202 Corerequisite(s):none BUS2301 Business Computer Applications The knowledge gained in this course provides students with a solid foundation for future learning in other studies, and in business. Students learn a variety of tasks in Windows file management. Students also learn tasks and produce assignments in Microsoft Office for PC. Web-based software running computer-based simulations and assessments are used to support and enrich the learning experience. It is strongly recommended that students use a PC. Mac students may be required to install and learn additional software to successfully complete the course. Prerequisite(s): none Corerequisite(s):none ECO2200 Economic Issues Knowledge of contemporary economic issues is essential to understanding the world in which we live. Students examine the fundamental economic issues faced by modern economies with an emphasis on the use of economic models to analyze economic developments accurately and objectively. Key economic problems faced by society, and policy alternatives that governments may use to deal with these problems are also investigated. Influence of economics on student civic, working and personal lives is explored through lectures, discussions, and monitoring of current economic events. Prerequisite(s): none Corerequisite(s):none ENL1725 Canadian Identity Canadian identity is challenging to define, but depictions of our multicultural society are found and explored in our writing. This course explores the importance of writers' perceptions of Canada, how they promote their ideas through publishing, and how those published works have affected Canadian society in recent history. Students are introduced to a wide range of writing with the aim of exploring the theme of Canadian identity while enhancing students' awareness of the ethical considerations necessary for a just society. Prerequisite(s): none Corerequisite(s):none ENL1726 Symbols, Text and Meaning Symbols and text are used to express, evoke, and manipulate an entire range of human emotions and reactions. In this interactive, discussion-based course, students will explore historical and contemporary approaches to using symbols, text, and language in conceptual and contemporary art, graphic design and advertising, poetry and lyrics, and in online technology. Through discussion, analysis, informal debate, and critical thinking, students will explore how symbols and text influence individuals, society and culture. 9 Business - Accounting Prerequisite(s): none Corerequisite(s):none ENL1798 Contemporary Canadian Issues A critical understanding of contemporary Canadian issues is vital to being an active member in our democratic society. Students explore a variety of topics and analyze their ethical implications and relevance to Canadian life. Discussions, debates and other collaborative activities offer opportunities to consider recent controversies from different perspectives, and use of a variety of media (e.g. newspapers, articles, and other resources online) allows for in-depth reflection on the history and current state of a range of social and political topics. Prerequisite(s): none Corerequisite(s):none ENL1813B Communications I Communication remains an essential skill sought by employers, regardless of discipline or field of study. Using a practical, vocation-oriented approach, students develop stronger grammar and business-writing skills to become effective business communicators. Through a combination of lectures, exercises, and independent learning, students practise writing, speaking, reading, listening, locating and documenting information, and using technology to communicate professionally. Students develop and strengthen communication skills that contribute to success in both educational and workplace environments. Prerequisite(s): none Corerequisite(s):none ENL1823B Communications II Students continue to expand their practical writing and speaking skills for successful communication in business. Using real-life scenarios and research skills, they produce informal reports and proposals, deliver presentations to a live audience supported by technology, and create a job-search package. Students create professional documents, such as information reports, progress reports, justification/recommendation reports, summary reports, and minutes of meetings to develop up-to-date writing skills. The job search package includes employment-readiness skills, resumes, persuasive cover letters, and interview techniques. In all written work, students continue to develop and enhance their grammar skills to meet professional, workplace standards. Prerequisite(s): ENL1813B Corerequisite(s):none ENL1825 Communication Dynamics Humans are dynamic, communicative, and socially interactive. Participants consider human behaviour and its influence on interpersonal or impersonal connections with others by exploring theories and ethical considerations of conformity, obedience and persuasion. Special attention is paid to individual inner experiences, thoughts, feelings, emotions and introspections. Role play learning and case studies allow participants to reflect and build upon their own observations and experiences. Prerequisite(s): none Corerequisite(s):none ENL1829 The Art of Oratory From ghost stories around the campfire to political speeches by world leaders, ethical oratory plays a significant role in human interaction. Students examine the social significance of public speaking while developing a deeper understanding of the theory, science, elements of form, and persuasive devices underlying this art. Building on their own stories, students prepare, deliver, and critique group workshops, as well as design, deliver, and critique individual presentations. 10 Business - Accounting Prerequisite(s): none Corerequisite(s):none FIN2230 Finance Understanding the fundamentals of financial management is necessary for strong financial decision-making. Students develop an understanding of the goals of financial management, financial analysis and planning, financial forecasting, working capital management, capital budgeting concepts including present value and cashflow analysis. Build on your knowledge of basic accounting and economics concepts through a combination of in class lectures, practical exercises and use of computer assisted tools. Prerequisite(s): ACC2201 and BUS2301 or ACC2310 and BUS2301 or ACC1100 and ACC1211 and BUS2301 Corerequisite(s):none GED0214C General Education Elective Students choose one course, from a group of general education electives, which meets one of the following five theme requirements: Arts in Society, Civic Life, Social and Cultural Understanding, Personal Understanding, and Science and Technology. Prerequisite(s): none Corerequisite(s):none MGT2201 Business Fundamentals Understanding the foundation of business is critical to anyone in the accounting field. This course gives students a broad overview of critical elements of business including an introduction to business structures, business processes, and various legal considerations. The use of practical exercises provides students with a strong foundation of business knowledge for future work. Prerequisite(s): none Corerequisite(s):none QUA2210 Basic Business Mathematics The essentials of arithmetic and its applications, including fractions, decimals, percentages, mathematics of buying and selling, payroll, taxes, depreciation and inventory are examined. Students are introduced to the mathematics of finance, including simple and compound interest, annuities, sinking funds, amortization and consumer credit. Prerequisite(s): none Corerequisite(s):none ","Respond only with information present in the document. If the information is not present, respond with ""This information is not available"". When possible, use quotations and cite the document directly. What do I need to know about my Financial Accounting program? 1 Area of Interest: Business Business - Accounting Ontario College Diploma 2 Years Program Code: 0214C01FWO Ottawa Campus Our Program Get the essential skills to start a career in Accounting. The Business - Accounting Ontario College Diploma program balances accounting theory with tools used in the industry. This two-year program equips you with the essential skills for various entry-level accounting positions. Learn how to complete accounting tasks, from conducting bookkeeping responsibilities to preparing financial statements and personal income tax returns. Expand your knowledge of various business concepts including economics and finance. Explore accounting concepts while sharpening your communication, math and technological skills. Courses incorporate accounting software to strengthen your computer literacy and provide you with up-to-date technical skills, which are essential in this field. In the program`s final semester, you have the opportunity to apply for a work placement to practise your skills in a real work setting. See Additional Information for eligibility requirements. Students considering a professional accounting designation or an accounting credential are advised to make inquiries with the Chartered Professional Accountants of Ontario (CPA Ontario) before deciding to complete this program. See Additional Information for further details. This program prepares you for entry-level positions in: - financial accounting - managerial accounting - payables and receivables - taxation Graduates typically find employment in roles such as: - accounts payable clerk - accounts receivable clerk - bookkeeper payroll clerk - junior staff accountant SUCCESS FACTORS This program is well-suited for students who: - Enjoy problem solving and critical-thinking activities. - Are inquisitive and have an analytical nature. - Can work well independently and in a group. 2 Business - Accounting - Are detailed-oriented, organized and adaptable. - Are comfortable using a variety of computer applications. - Possess a high standard of ethics. Employment Graduates may pursue employment opportunities in various entry-level positions including accounts receivables or payables, bookkeeping or payroll responsibilities. Roles include: accounting assistant, accounts payable clerk, accounts receivable clerk, bookkeeper, and payroll clerk. Learning Outcomes The graduate has reliably demonstrated the ability to: - Record financial transactions in compliance with Canadian Generally Accepted Accounting Principles for sole proprietorships, partnerships, private enterprises, publicly accountable enterprises and non-profit organizations. - Prepare and present financial statements, reports and other documents in compliance with Canadian Generally Accepted Accounting Principles for sole proprietorships, partnerships and private enterprises. - Contribute to recurring decision-making by applying fundamental management accounting concepts. - Prepare individuals` income tax returns and basic tax planning in compliance with relevant legislation and regulations. - Analyze organizational structures, the interdependence of functional areas, and the impact those relationships can have on financial performance. - Analyze, within a Canadian context, the impact of economic variables, legislation, ethics, technological advances and the environment on an organization`s operations. - Outline the elements of an organization`s internal control system and risk management. - Contribute to recurring decision-making by applying fundamental financial management concepts. - Identify and apply discipline-specific practices that contribute to the local and global community through social responsibility, economic commitment and environmental stewardship. Program of Study Level: 01 Courses Hours ACC2201 Financial Accounting I 56.0 BUS2301 Business Computer Applications 42.0 ENL1813B Communications I 42.0 MGT2201 Business Fundamentals 42.0 QUA2210 Basic Business Mathematics 56.0 Level: 02 Courses Hours ACC2202 Financial Accounting II 56.0 ACC2343 Spreadsheet Applications 56.0 3 Business - Accounting ECO2200 Economic Issues 42.0 ENL1823B Communications II 42.0 FIN2230 Finance 42.0 Level: 03 Courses Hours ACC2209 Financial Accounting III 70.0 ACC2233 Management Accounting I 56.0 ACC2262 Introduction to Personal Taxation 56.0 ACC2385 Accounting Software Applications 56.0 English General Education Elective: choose 1 Courses Hours ENL1725 Canadian Identity 42.0 ENL1726 Symbols, Text and Meaning 42.0 ENL1798 Contemporary Canadian Issues 42.0 ENL1825 Communication Dynamics 42.0 ENL1829 The Art of Oratory 42.0 Level: 04 Courses Hours ACC2211 Payroll and Compliance 56.0 ACC2234 Management Accounting II 56.0 ACC2265 Audit Principles and Business Issues 56.0 Elective: choose 1 Courses Hours ACC0012 Integrated Accounting Practice 56.0 ACC0044 Work Experience 56.0 Choose one from equivalencies: Courses Hours GED0214C General Education Elective 42.0 Fees for the 2023/2024 Academic Year Tuition and related ancillary fees for this program can be viewed by using the Tuition and Fees Estimator tool at https://www.algonquincollege.com/fee-estimator . Further information on fees can be found by visiting the Registrar`s Office website at https://www.algonquincollege.com/ro . Fees are subject to change. Additional program related expenses include: - Books and supplies cost approximately $600 to $800 per term. However in Levels 03 and 04 of the program, books may cost up to $1,000. - Books and supplies can be purchased from the campus store. For more information visit https://www.algonquincollege.com/coursematerials . 4 Business - Accounting Admission Requirements for the 2024/2025 Academic Year College Eligibility - Ontario Secondary School Diploma (OSSD) or equivalent. Applicants with an OSSD showing senior English and/or Mathematics courses at the Basic Level, or with Workplace or Open courses, will be tested to determine their eligibility for admission; OR - Academic and Career Entrance (ACE) certificate; OR - General Educational Development (GED) certificate; OR - Mature Student status (19 years of age or older and without a high school diploma at the start of the program). Eligibility may be determined by academic achievement testing for which a fee of $50 (subject to change) will be charged. Program Eligibility - English, Grade 12 (ENG4C or equivalent). - Mathematics, Grade 12 (MAP4C or equivalent). - Applicants with international transcripts must provide proof of the subject-specific requirements noted above and may be required to provide proof of language proficiency. Domestic applicants with international transcripts must be evaluated through the International Credential Assessment Service of Canada (ICAS) or World Education Services (WES). - IELTS-International English Language Testing Service (Academic) Overall band of 6.0 with a minimum of 5.5 in each band; OR TOEFL-Internet-based (iBT) Overall 80, with a minimum of 20 in each component: Reading 20; Listening 20; Speaking 20; Writing 20; OR Duolingo English Test (DET) Overall 110, minimum of 110 in Literacy and no score below 95. - Not sure if you meet all of the requirements? Academic Upgrading may be able to help with that: https://www.algonquincollege.com/access . Should the number of qualified applicants exceed the number of available places, applicants will be selected on the basis of their proficiency in English and mathematics. Admission Requirements for 2023/2024 Academic Year College Eligibility - Ontario Secondary School Diploma (OSSD) or equivalent. Applicants with an OSSD showing senior English and/or Mathematics courses at the Basic Level, or with Workplace or Open courses, will be tested to determine their eligibility for admission; OR - Academic and Career Entrance (ACE) certificate; OR - General Educational Development (GED) certificate; OR - Mature Student status (19 years of age or older and without a high school diploma at the start of the program). Eligibility may be determined by academic achievement testing for which a fee of $50 (subject to change) will be charged. Program Eligibility - English, Grade 12 (ENG4C or equivalent). - Mathematics, Grade 12 (MAP4C or equivalent). - Applicants with international transcripts must provide proof of the subject specific requirements noted above and may be required to provide proof of language proficiency. Domestic applicants with international transcripts must be evaluated through the International Credential Assessment Service of Canada (ICAS) or World Education Services (WES). - IELTS-International English Language Testing Service (Academic) Overall band of 6.0 with a minimum of 5.5 in each band; OR TOEFL-Internet-based (iBT) Overall 80, with a minimum of 20 in each component: Reading 20; Listening 20; Speaking 20; Writing 20. 5 Business - Accounting Not sure if you meet all of the requirements? Academic Upgrading may be able to help with that: https://www.algonquincollege.com/access/ . Should the number of qualified applicants exceed the number of available places, applicants will be selected on the basis of their proficiency in English and mathematics. Application Information BUSINESS - ACCOUNTING Program Code 0214C01FWO Applications to full-time day programs must be submitted with official transcripts showing completion of the academic admission requirements through: ontariocolleges.ca 60 Corporate Court Guelph, Ontario N1G 5J3 1-888-892-2228 Students currently enrolled in an Ontario secondary school should notify their Guidance Office prior to their online application at http://www.ontariocolleges.ca/ . Applications for Fall Term and Winter Term admission received by February 1 will be given equal consideration. Applications received after February 1 will be processed on a first-come, first-served basis as long as places are available. International applicants please visit this link for application process information: https://algonquincollege.force.com/myACint/ . For further information on the admissions process, contact: Registrar`s Office Algonquin College 1385 Woodroffe Ave Ottawa, ON K2G 1V8 Telephone: 613-727-0002 Toll-free: 1-800-565-4723 TTY: 613-727-7766 Fax: 613-727-7632 Contact: https://www.algonquincollege.com/ro Additional Information This program offers a September start or January start. Students who start in January must complete their second level of the program in the Spring term and continue into the third level in the Fall term. Classes in this program may be scheduled between 8:00 AM and 10:00 PM, Monday through Friday. Work placement is an option available to students in the fourth level of this program. Work placement is only available in the Winter term. Participants of the optional work placement will receive a course credit for ACC0044 (Work Experience) in lieu of taking a fifth course on campus during the fourth level of the program. Students must meet eligibility requirements in order to participate in the work placement. To be eligible to apply for work placement, students must be registered full-time with the regular on-campus program, must have completed all level 1, 2 and 3 courses, must not have any academic encumbrances and must meet certain academic standings. Due to the high demand for work placements, some students may be required to secure their own placement subject to approval by the program coordinator. Students considering completing a degree after their diploma may be able to apply some courses towards a degree through various university articulation agreements. For further information see https://www.algonquincollege.com/degree-pathways/list/ . Students considering pursuing a professional accounting designation are advised to make inquiries with the Chartered Professional Accountants of Ontario (CPA Ontario). Please note that Algonquin 6 Business - Accounting College courses are not directly transferrable to CPA unless they are transferred through a recognized articulation agreement with a university. For further information see http://www.cpaontario.ca/become-a-cpa/get-started . Course Descriptions ACC0012 Integrated Accounting Practice Students draw upon knowledge learned throughout the program to participate in weekly duties that simulate authentic business practices. Students integrate and apply their knowledge of fundamental accounting and taxation to complete various tasks using professional business writing skills and computer software. Prerequisite(s): ACC2209 and ACC2233 and ACC2385 or ACC2341 and ACC2354 and ACC2385 Corerequisite(s):none ACC0044 Work Experience Accounting experience is advantageous when students search for work after graduation. Students apply the skills and knowledge acquired to date in the program to a practical work environment. Students report to a select employer and complete accounting-related tasks. Upon completion of the work placement, employers and students rate the experience. Prerequisite(s): ACC2209 and ACC2233 and ACC2262 and ACC2385 or ACC2341 and ACC2344 and ACC2354 and ACC2385 Corerequisite(s):none ACC2201 Financial Accounting I This is the first course in a series of three financial accounting courses in this program. Students learn to identify, measure, record and report financial transactions. Students learn the fundamentals of the accounting cycle necessary to complete the financial statements and accounting records of a business. Through a combination of in class lectures, practical exercises and the use of computer assisted tools, students develop an understanding of essential accounting concepts necessary for future studies. Prerequisite(s): none Corerequisite(s):none ACC2202 Financial Accounting II Building on previous studies in financial accounting, students expand their knowledge of fundamental accounting concepts involved in measuring and recording financial transactions, including analyzing these transactions and reporting them in the financial records of a business. Students experience a combination of in class lectures, practical exercises and the use of computerized tools to aid in the progress and understanding of vital accounting concepts. Prerequisite(s): ACC2201 or ACC1100 and ACC1211 or ACC2310 Corerequisite(s):none ACC2209 Financial Accounting III This is the third and final financial accounting course in the program. Students examine the transactions specific to corporations as well as more complex accounting topics. This course builds on the material learned in the previous two financial accounting courses. Through a combination of in class lectures, practical exercises and use of computer assisted tools, students develop an understanding of essential accounting concepts necessary for the work place. Prerequisite(s): ACC2202 or ACC2341 Corerequisite(s):none ACC2211 Payroll and Compliance 7 Business - Accounting Payroll and statutory compliance reporting is mandatory for every business to adhere to. Students learn how to apply payroll legislation to calculate deductions, net pay, and remittances, and complete year-end payroll reporting. Students are introduced to the different types of requirements with which businesses are expected to comply, including GST/HST, QST, EHT and workers' compensation. Through a combination of theory and practical activities, students prepare these submissions and calculations by reading through relevant legislation and completing activities. Prerequisite(s): ACC2202 or ACC2341 Corerequisite(s):none ACC2233 Management Accounting I Managerial accounting aids organizations in making well-informed decisions helping businesses to succeed. Students are introduced to key workplace skills by exploring the goals, methods and ethics of managerial accounting including product costing methods and the flow of costs for manufacturing companies. Additionally, students will focus on decision-making tools including, cost-volume-profit and contribution analysis. The curriculum is delivered in lecture, case study and problem-solving format. Prerequisite(s): ACC2202 or ACC2341 Corerequisite(s):none ACC2234 Management Accounting II Students continue to enhance key workplace skills and business ethics by further exploring the goals and methods of managerial accounting. Specific topic areas include merchandising budgeting, performance evaluation in decentralized businesses and financial statement analysis. Students will also focus on business decisions using managerial accounting tools such as relevant costing. The curriculum is delivered in lecture, case and problem-solving format making extensive use of Excel. Prerequisite(s): ACC2233 and ACC2343 or ACC2343 and ACC2354 Corerequisite(s):none ACC2262 Introduction to Personal Taxation The ability to complete personal tax returns is an essential skill to have in the accounting field. Using a variety of methods, including authentic tax cases, lectures and classroom discussions, students use professional tax software to prepare personal Canadian tax returns for individuals and unincorporated businesses. Basic principles of tax planning and tax legislation are covered. It is strongly recommended that students use a Windows-based laptop (not a Mac). Prerequisite(s): ACC2202 or ACC2313 Corerequisite(s):none ACC2265 Audit Principles and Business Issues Students are introduced to current business issues relevant to Canadian organizations as well as key auditing concepts that help to guide business ethics and decisions. Topics discussed include the Canadian business environment and the current issues it faces, the need for greater ethical and responsible behaviour in light of recent business scandals, fraud and the need for internal controls, risk management and financial statement analysis. Various types of audit and techniques are examined by students. Classroom lectures are enhanced by reading current material and researching information using various tools. Prerequisite(s): ACC2209 or ACC2341 Corerequisite(s):none ACC2343 Spreadsheet Applications Students enhance their knowledge of spreadsheets learned in BUS2301. Using Microsoft Excel, students explore some of the more advanced Excel features, such as financial functions, charts, 8 Business - Accounting logical functions, pivot tables, lists and look-up tables. These spreadsheet concepts are explored through Excel-based lectures and hybrid activities including learning resource applications. Prerequisite(s): ACC2201 and BUS2301 or ACC2313 and BUS2301 or ACC1100 and ACC1211 and BUS2301 Corerequisite(s):none ACC2385 Accounting Software Applications It is a workplace expectation that students are comfortable using accounting software on a day-today basis. Students gain practical experience using computerized accounting software to record transactions and prepare financial statements. Curriculum is delivered in lecture format and by hands-on completion of cases using accounting software. A Windows-based laptop (not a Mac) is strongly recommended. Prerequisite(s): ACC2341 or ACC2202 Corerequisite(s):none BUS2301 Business Computer Applications The knowledge gained in this course provides students with a solid foundation for future learning in other studies, and in business. Students learn a variety of tasks in Windows file management. Students also learn tasks and produce assignments in Microsoft Office for PC. Web-based software running computer-based simulations and assessments are used to support and enrich the learning experience. It is strongly recommended that students use a PC. Mac students may be required to install and learn additional software to successfully complete the course. Prerequisite(s): none Corerequisite(s):none ECO2200 Economic Issues Knowledge of contemporary economic issues is essential to understanding the world in which we live. Students examine the fundamental economic issues faced by modern economies with an emphasis on the use of economic models to analyze economic developments accurately and objectively. Key economic problems faced by society, and policy alternatives that governments may use to deal with these problems are also investigated. Influence of economics on student civic, working and personal lives is explored through lectures, discussions, and monitoring of current economic events. Prerequisite(s): none Corerequisite(s):none ENL1725 Canadian Identity Canadian identity is challenging to define, but depictions of our multicultural society are found and explored in our writing. This course explores the importance of writers' perceptions of Canada, how they promote their ideas through publishing, and how those published works have affected Canadian society in recent history. Students are introduced to a wide range of writing with the aim of exploring the theme of Canadian identity while enhancing students' awareness of the ethical considerations necessary for a just society. Prerequisite(s): none Corerequisite(s):none ENL1726 Symbols, Text and Meaning Symbols and text are used to express, evoke, and manipulate an entire range of human emotions and reactions. In this interactive, discussion-based course, students will explore historical and contemporary approaches to using symbols, text, and language in conceptual and contemporary art, graphic design and advertising, poetry and lyrics, and in online technology. Through discussion, analysis, informal debate, and critical thinking, students will explore how symbols and text influence individuals, society and culture. 9 Business - Accounting Prerequisite(s): none Corerequisite(s):none ENL1798 Contemporary Canadian Issues A critical understanding of contemporary Canadian issues is vital to being an active member in our democratic society. Students explore a variety of topics and analyze their ethical implications and relevance to Canadian life. Discussions, debates and other collaborative activities offer opportunities to consider recent controversies from different perspectives, and use of a variety of media (e.g. newspapers, articles, and other resources online) allows for in-depth reflection on the history and current state of a range of social and political topics. Prerequisite(s): none Corerequisite(s):none ENL1813B Communications I Communication remains an essential skill sought by employers, regardless of discipline or field of study. Using a practical, vocation-oriented approach, students develop stronger grammar and business-writing skills to become effective business communicators. Through a combination of lectures, exercises, and independent learning, students practise writing, speaking, reading, listening, locating and documenting information, and using technology to communicate professionally. Students develop and strengthen communication skills that contribute to success in both educational and workplace environments. Prerequisite(s): none Corerequisite(s):none ENL1823B Communications II Students continue to expand their practical writing and speaking skills for successful communication in business. Using real-life scenarios and research skills, they produce informal reports and proposals, deliver presentations to a live audience supported by technology, and create a job-search package. Students create professional documents, such as information reports, progress reports, justification/recommendation reports, summary reports, and minutes of meetings to develop up-to-date writing skills. The job search package includes employment-readiness skills, resumes, persuasive cover letters, and interview techniques. In all written work, students continue to develop and enhance their grammar skills to meet professional, workplace standards. Prerequisite(s): ENL1813B Corerequisite(s):none ENL1825 Communication Dynamics Humans are dynamic, communicative, and socially interactive. Participants consider human behaviour and its influence on interpersonal or impersonal connections with others by exploring theories and ethical considerations of conformity, obedience and persuasion. Special attention is paid to individual inner experiences, thoughts, feelings, emotions and introspections. Role play learning and case studies allow participants to reflect and build upon their own observations and experiences. Prerequisite(s): none Corerequisite(s):none ENL1829 The Art of Oratory From ghost stories around the campfire to political speeches by world leaders, ethical oratory plays a significant role in human interaction. Students examine the social significance of public speaking while developing a deeper understanding of the theory, science, elements of form, and persuasive devices underlying this art. Building on their own stories, students prepare, deliver, and critique group workshops, as well as design, deliver, and critique individual presentations. 10 Business - Accounting Prerequisite(s): none Corerequisite(s):none FIN2230 Finance Understanding the fundamentals of financial management is necessary for strong financial decision-making. Students develop an understanding of the goals of financial management, financial analysis and planning, financial forecasting, working capital management, capital budgeting concepts including present value and cashflow analysis. Build on your knowledge of basic accounting and economics concepts through a combination of in class lectures, practical exercises and use of computer assisted tools. Prerequisite(s): ACC2201 and BUS2301 or ACC2310 and BUS2301 or ACC1100 and ACC1211 and BUS2301 Corerequisite(s):none GED0214C General Education Elective Students choose one course, from a group of general education electives, which meets one of the following five theme requirements: Arts in Society, Civic Life, Social and Cultural Understanding, Personal Understanding, and Science and Technology. Prerequisite(s): none Corerequisite(s):none MGT2201 Business Fundamentals Understanding the foundation of business is critical to anyone in the accounting field. This course gives students a broad overview of critical elements of business including an introduction to business structures, business processes, and various legal considerations. The use of practical exercises provides students with a strong foundation of business knowledge for future work. Prerequisite(s): none Corerequisite(s):none QUA2210 Basic Business Mathematics The essentials of arithmetic and its applications, including fractions, decimals, percentages, mathematics of buying and selling, payroll, taxes, depreciation and inventory are examined. Students are introduced to the mathematics of finance, including simple and compound interest, annuities, sinking funds, amortization and consumer credit. Prerequisite(s): none Corerequisite(s):none ",Unknown,Find & Summarize,Text Transformation "Use only the provided information to generate responses, do not use any information not found within the question and context given. ",What are two trends in Sudan's banking regulations that need to be encouraged in order to make the actual financial stability match the health indicated by the banking system's EM-Z score model results?,"The analysis of the statistical results obtained from the univariate financial ratios model and Ahmed (2003) model indicate that the Sudanese banks are not financially sound. The liquidity ratios show that there has been deterioration in the liquidity position of the banking industry in Sudan. Since banks depend heavily on lending to generate revenues, the shortage in liquidity weakens their financing capability, which in turn negatively affects their earnings. Furthermore, the lack of liquidity may force banks either to sell assets or pay a premium on borrowed funds. The indebtedness measures reveal that banks are highly leveraged and thus are of high risk. This asserts that the banks will find it hard to get further financing from both national and international financial markets. This high credit risk also suggests that the bank is no longer attractive for the depositors. This is confirmed by the deposits structure of banks, which are mainly demand ones. This result is expected because the Marabaha margin, which indicates the return on investment deposits, almost remains fixed at 12% over the period examined and this percentage is far below inflation levels. This explains the shrinkage in investment deposits through time and signalizes the inability of banks to earn satisfactory profits. Additionally, the profitability measures indicate that banks do generate sufficient profits from their operations. Due to the high level of inflation, the bank's managements find it difficult to pay dividends and also secure internal fund to sustain any growth strategy. The turnover financial metrics indicate that the management of banks are inefficient in employing their working capital to generate revenues and are generally not optimizing the utilization of assets. This inefficient use of assets justifies the low level of profitability realized by those banks. The results obtained from the analysis of the depositors’ confidence index indicate that the depositors slightly trust the banks operating in Sudan. This finding is highly expected as the previous studies provide evidence that factors such as slumping economy, turbulent political climate, high inflation, inconsistent policies and regulations, weak transparency, undercapitalization of banks, which are all prevailing in Sudan, negatively affect the confidence of depositors in their banks. This weak trust implies that the depositors are not sure that their banks can safely secure their deposits and thus are skeptical that their banks are able to pay them back their money. The low confidence in banks also indicates that the depositors are doubtful about the competency, integrity and transparency of their banks’ management. Further, the undercapitalization of banks triggers a fear of banks failure and thus loss of depositors’ money. Additionally, the inconsistent and ever-changing government policies, especially the monetary and credit ones, the weak legal and regulatory systems and laws, the deteriorating economic conditions of the country and the political instability and erratic country foreign relationships, signal that banks will suffer from financial difficulties in the near future and initiate a strong tendency towards cash withdrawal from banks. The analysis also shows that the privately-owned banks do not perform better than the government-owned ones. This result may be attributed to the fact that the government-owned banks are supported by the government. That is to say, the government usually injects funds in those banks that are in bad need for financing. The same logic applies for the better performance of the specialized banks as compared to the nonspecialized ones. The specialized banks are highly propped by the government. For instance, the Central bank has decreased the legal monetary reserve required for the banks that provide finance to agricultural, industrial and mineral mining projects, in an attempt to boost exports. With regards to the comparison of the financial health of the foreign banks with that of the national banks, the analysis indicates that the financial health of both groups is similar, which led to the reasoning that the foreign banks have not benefited from their developed expertise, overseas existence and access the international financial market to strengthen their financial positions. The contrary conclusion arrived at by the employment of EM Z-score model that banks operating in Sudan are generally healthy and financially viable may be in the context that, though the banking sector in Sudan is not financially sound, within the near future of two years most of the banks will not be bankrupt. Several practical implications can be derived from the results of this study. To enhance the financial health of banks and boost the level of confidence in them a number of corrective actions need to be taken by banks management as well as regulatory bodies. Enhancing transparency through adopting enforceable comprehensive disclosure measures, imposing corporate governance, strengthening banks’ capitals and lowering operating costs are some suggested corrective actions. Regulators also need to set rules that protect depositors and safeguard their money.","Use only the provided information to generate responses, do not use any information not found within the question and context given. What are two trends in Sudan's banking regulations that need to be encouraged in order to make the actual financial stability match the health indicated by the banking system's EM-Z score model results? The analysis of the statistical results obtained from the univariate financial ratios model and Ahmed (2003) model indicate that the Sudanese banks are not financially sound. The liquidity ratios show that there has been deterioration in the liquidity position of the banking industry in Sudan. Since banks depend heavily on lending to generate revenues, the shortage in liquidity weakens their financing capability, which in turn negatively affects their earnings. Furthermore, the lack of liquidity may force banks either to sell assets or pay a premium on borrowed funds. The indebtedness measures reveal that banks are highly leveraged and thus are of high risk. This asserts that the banks will find it hard to get further financing from both national and international financial markets. This high credit risk also suggests that the bank is no longer attractive for the depositors. This is confirmed by the deposits structure of banks, which are mainly demand ones. This result is expected because the Marabaha margin, which indicates the return on investment deposits, almost remains fixed at 12% over the period examined and this percentage is far below inflation levels. This explains the shrinkage in investment deposits through time and signalizes the inability of banks to earn satisfactory profits. Additionally, the profitability measures indicate that banks do generate sufficient profits from their operations. Due to the high level of inflation, the bank's managements find it difficult to pay dividends and also secure internal fund to sustain any growth strategy. The turnover financial metrics indicate that the management of banks are inefficient in employing their working capital to generate revenues and are generally not optimizing the utilization of assets. This inefficient use of assets justifies the low level of profitability realized by those banks. The results obtained from the analysis of the depositors’ confidence index indicate that the depositors slightly trust the banks operating in Sudan. This finding is highly expected as the previous studies provide evidence that factors such as slumping economy, turbulent political climate, high inflation, inconsistent policies and regulations, weak transparency, undercapitalization of banks, which are all prevailing in Sudan, negatively affect the confidence of depositors in their banks. This weak trust implies that the depositors are not sure that their banks can safely secure their deposits and thus are skeptical that their banks are able to pay them back their money. The low confidence in banks also indicates that the depositors are doubtful about the competency, integrity and transparency of their banks’ management. Further, the undercapitalization of banks triggers a fear of banks failure and thus loss of depositors’ money. Additionally, the inconsistent and ever-changing government policies, especially the monetary and credit ones, the weak legal and regulatory systems and laws, the deteriorating economic conditions of the country and the political instability and erratic country foreign relationships, signal that banks will suffer from financial difficulties in the near future and initiate a strong tendency towards cash withdrawal from banks. The analysis also shows that the privately-owned banks do not perform better than the government-owned ones. This result may be attributed to the fact that the government-owned banks are supported by the government. That is to say, the government usually injects funds in those banks that are in bad need for financing. The same logic applies for the better performance of the specialized banks as compared to the nonspecialized ones. The specialized banks are highly propped by the government. For instance, the Central bank has decreased the legal monetary reserve required for the banks that provide finance to agricultural, industrial and mineral mining projects, in an attempt to boost exports. With regards to the comparison of the financial health of the foreign banks with that of the national banks, the analysis indicates that the financial health of both groups is similar, which led to the reasoning that the foreign banks have not benefited from their developed expertise, overseas existence and access the international financial market to strengthen their financial positions. The contrary conclusion arrived at by the employment of EM Z-score model that banks operating in Sudan are generally healthy and financially viable may be in the context that, though the banking sector in Sudan is not financially sound, within the near future of two years most of the banks will not be bankrupt. Several practical implications can be derived from the results of this study. To enhance the financial health of banks and boost the level of confidence in them a number of corrective actions need to be taken by banks management as well as regulatory bodies. Enhancing transparency through adopting enforceable comprehensive disclosure measures, imposing corporate governance, strengthening banks’ capitals and lowering operating costs are some suggested corrective actions. Regulators also need to set rules that protect depositors and safeguard their money.",Financial,Effect Analysis,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","In less than 250 words. Explain what I Bacillus cereus. Provide where the bacteria is found mostly. What temperature does it multiply quickly in and does it form a toxin? If so, what area of the body will contain the illness from the toxin? What are the symptoms of B cereus.","Bacillus cereus is a toxin-producing facultatively anaerobic gram-positive bacterium. The bacteria are commonly found in the environment and can contaminate food. It can quickly multiply at room temperature with an abundantly present preformed toxin. When ingested, this toxin can cause gastrointestinal illness, which is the commonly known manifestation of the disease. Gastrointestinal syndromes associated with B cereus include diarrheal illness without significant upper intestinal symptoms and a predominantly upper GI syndrome with nausea and vomiting without diarrhea. B cereus has also been implicated in infections of the eye, respiratory tract, and wounds. The pathogenicity of B cereus, whether intestinal or nonintestinal, is intimately associated with the production of tissue-destructive exoenzymes. Among these secreted toxins are hemolysins, phospholipases, and proteases.[1][2] B cereus is a common bacterium, present ubiquitously in the environment. It can form spores which allows it to survive longer in extremes of temperature. Consequently, it is found as a contaminant of various foods, ie, beef, turkey, rice, beans, and vegetables. The diarrheal illness is often related to meats, milk, vegetables, and fish. The emetic illness is most often associated with rice products, but it has also been associated with other types of starchy products such as potatoes, pasta, and cheese. Some food mixtures (sauces, puddings, soups, casseroles, pastries, and salads, have been associated with food-borne illness in general.[3][4] Bacillus cereus is caused by the ingestion of food contaminated with enterotoxigenic B cereus or the emetic toxin. In non-gastrointestinal illness, reports of respiratory infections similar to respiratory anthrax have been attributed to B. cereus strains harboring B anthracis toxin genes. The United States Centers for Disease Control and Prevention website states that there were 619 confirmed outbreaks of Bacillus-related poisoning from 1998 through 2015, involving 7385 illnesses. In this timeframe, there were 75 illnesses and three deaths due to confirmed Bacillus-related illnesses. The website states that there were 19,119 outbreaks overall and 373,531 illnesses. It refers to 14,681 hospitalizations and 337 deaths during this timeframe. These statistics refer to all Bacillus-related illnesses, and not just B cereus-related illnesses.[5][6] The United States Food and Drug Administration's ""Bad Bug Book"" further breaks this down and states that there are an estimated 63,400 episodes of B cereus illness annually in the United States. From 2005 to 2007, there were 13 confirmed outbreaks and 37.6 suspected outbreaks involving over 1000 people. Everyone is susceptible to B. cereus infection; however, mortality related to this illness is rare. The emetic enterotoxin has been associated with a few cases of liver failure and death in otherwise healthy people. The infective dose or the number of organisms most commonly associated with human illness is 105 to 108 organisms/gram, but pathogenicity arises from the preformed toxin, not the bacteria themselves. The pathogenicity of B cereus, whether inside or outside the gastrointestinal tract, is associated with exoenzyme production Among the secreted toxins are 4 hemolysins, 3 distinct phospholipases, and 3 pore-forming enterotoxins. The enterotoxins that activate the nod-like receptor protein-3 (NLRP3) are hemolysin BL, nonhemolytic enterotoxin (NHE), and cytotoxin K. In the small intestine, vegetative cells, ingested as viable cells or spores, produce and secrete a protein enterotoxin and induce diarrheal syndrome. Cereulide is a plasmid-encoded cyclic peptide, which is produced in food products and ingested as a formed toxin. In rabbit ligated ileal-loop assays, culture filtrates of enterotoxigenic strains induced fluid accumulation and hemolytic, cytotoxic, dermonecrosis, and increased vascular permeability in rabbit skin.[7] The enterotoxin is composed of a binding component (B) and 2 hemolytic components, designated HBL. In the diarrheal form of the disease, a nonhemolytic 3-component enterotoxin, designated NHE, has been identified. The NHE from Bacillus cereus activates the nod-like NLRP3 inflammasome and pyroptosis. This leads to programmed cell death initiated by the activation of inflammatory caspases of the infected tissue.[8]","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. In less than 250 words. Explain what I Bacillus cereus. Provide where the bacteria is found mostly. What temperature does it multiply quickly in and does it form a toxin? If so, what area of the body will contain the illness from the toxin? What are the symptoms of B cereus. Bacillus cereus is a toxin-producing facultatively anaerobic gram-positive bacterium. The bacteria are commonly found in the environment and can contaminate food. It can quickly multiply at room temperature with an abundantly present preformed toxin. When ingested, this toxin can cause gastrointestinal illness, which is the commonly known manifestation of the disease. Gastrointestinal syndromes associated with B cereus include diarrheal illness without significant upper intestinal symptoms and a predominantly upper GI syndrome with nausea and vomiting without diarrhea. B cereus has also been implicated in infections of the eye, respiratory tract, and wounds. The pathogenicity of B cereus, whether intestinal or nonintestinal, is intimately associated with the production of tissue-destructive exoenzymes. Among these secreted toxins are hemolysins, phospholipases, and proteases.[1][2] B cereus is a common bacterium, present ubiquitously in the environment. It can form spores which allows it to survive longer in extremes of temperature. Consequently, it is found as a contaminant of various foods, ie, beef, turkey, rice, beans, and vegetables. The diarrheal illness is often related to meats, milk, vegetables, and fish. The emetic illness is most often associated with rice products, but it has also been associated with other types of starchy products such as potatoes, pasta, and cheese. Some food mixtures (sauces, puddings, soups, casseroles, pastries, and salads, have been associated with food-borne illness in general.[3][4] Bacillus cereus is caused by the ingestion of food contaminated with enterotoxigenic B cereus or the emetic toxin. In non-gastrointestinal illness, reports of respiratory infections similar to respiratory anthrax have been attributed to B. cereus strains harboring B anthracis toxin genes. The United States Centers for Disease Control and Prevention website states that there were 619 confirmed outbreaks of Bacillus-related poisoning from 1998 through 2015, involving 7385 illnesses. In this timeframe, there were 75 illnesses and three deaths due to confirmed Bacillus-related illnesses. The website states that there were 19,119 outbreaks overall and 373,531 illnesses. It refers to 14,681 hospitalizations and 337 deaths during this timeframe. These statistics refer to all Bacillus-related illnesses, and not just B cereus-related illnesses.[5][6] The United States Food and Drug Administration's ""Bad Bug Book"" further breaks this down and states that there are an estimated 63,400 episodes of B cereus illness annually in the United States. From 2005 to 2007, there were 13 confirmed outbreaks and 37.6 suspected outbreaks involving over 1000 people. Everyone is susceptible to B. cereus infection; however, mortality related to this illness is rare. The emetic enterotoxin has been associated with a few cases of liver failure and death in otherwise healthy people. The infective dose or the number of organisms most commonly associated with human illness is 105 to 108 organisms/gram, but pathogenicity arises from the preformed toxin, not the bacteria themselves. The pathogenicity of B cereus, whether inside or outside the gastrointestinal tract, is associated with exoenzyme production Among the secreted toxins are 4 hemolysins, 3 distinct phospholipases, and 3 pore-forming enterotoxins. The enterotoxins that activate the nod-like receptor protein-3 (NLRP3) are hemolysin BL, nonhemolytic enterotoxin (NHE), and cytotoxin K. In the small intestine, vegetative cells, ingested as viable cells or spores, produce and secrete a protein enterotoxin and induce diarrheal syndrome. Cereulide is a plasmid-encoded cyclic peptide, which is produced in food products and ingested as a formed toxin. In rabbit ligated ileal-loop assays, culture filtrates of enterotoxigenic strains induced fluid accumulation and hemolytic, cytotoxic, dermonecrosis, and increased vascular permeability in rabbit skin.[7] The enterotoxin is composed of a binding component (B) and 2 hemolytic components, designated HBL. In the diarrheal form of the disease, a nonhemolytic 3-component enterotoxin, designated NHE, has been identified. The NHE from Bacillus cereus activates the nod-like NLRP3 inflammasome and pyroptosis. This leads to programmed cell death initiated by the activation of inflammatory caspases of the infected tissue.[8] https://www.ncbi.nlm.nih.gov/books/NBK459121/",Medical,Explanation/Definition,Q&A "System Instruction: [You must respond using a maximum of 5 sentences. You must only use information contained within the context block to formulate your response. If you cannot provide an answer using just the context block, you must use the phrase ""I cannot provide an answer to your question.""]","User Question: [According to the provided article, what method of temperature measurement is best for a 2-year-old child?]","Context Block: [Methods of Measurement: Methods of measuring a client’s body temperature vary based on developmental age, cognitive functioning, level of consciousness, state of health, safety, and agency/unit policy. The healthcare provider chooses the best method after considering client safety, accuracy, and least invasiveness, all contingent on the client’s health and illness state. The most accurate way to measure core body temperature is an invasive method through a pulmonary artery catheter. This is only performed in a critical care area when constant measurements are required along with other life-saving interventions. Methods of measurement include oral, axillary, tympanic, rectal, and dermal routes. Oral temperature can be taken with clients who can follow instructions, so this kind of measurement is common for clients over the age of four, or even younger children if they are cooperative. Another route other than oral (e.g., tympanic or axillary) is preferable when a client is on oxygen delivered via a face mask because this can alter the temperature. For children younger than four, axillary temperature is commonly measured unless a more accurate reading is required. Rectal temperature is an accurate way to measure body temperature (Mazerolle, Ganio, Casa, Vingren, & Klau, 2011). The rectal route is recommended by the Canadian Pediatric Society for children under two years of age (Leduc & Woods, 2017). However, this method is not used on infants younger than thirty days or premature infants because of the risk of rectal tearing. If the rectal method is required, the procedure is generally only used by nurses and physicians. Dermal routes are alternative methods of measurement that may be used in some agencies and practice areas. This method can involve holding the device and sliding it over the skin of the forehead and then down over the temporal artery in one motion. Dermal strips can also be placed on the forehead to measure skin temperature, but are not yet widely used, and the accuracy of this method has not yet been verified. More recently, there has been an increase in non-contact infrared thermometers particularly in the era of COVID-19 and other highly transmissible diseases. Depending on the type, these thermometers can be held at a short distance from the forehead or temporal area to measure temperature. Alternatively, some handheld thermal scanners that use an infrared camera can be held at a greater distance to screen large masses of people. Please refer to the manufacturer’s suggested reference range for non-contact infrared thermometers and thermal scanners.]","System Instruction: [You must respond using a maximum of 5 sentences. You must only use information contained within the context block to formulate your response. If you cannot provide an answer using just the context block, you must use the phrase ""I cannot provide an answer to your question.""] User Question: [According to the provided article, what method of temperature measurement is best for a 2-year-old child?] Context Block: [Methods of Measurement: Methods of measuring a client’s body temperature vary based on developmental age, cognitive functioning, level of consciousness, state of health, safety, and agency/unit policy. The healthcare provider chooses the best method after considering client safety, accuracy, and least invasiveness, all contingent on the client’s health and illness state. The most accurate way to measure core body temperature is an invasive method through a pulmonary artery catheter. This is only performed in a critical care area when constant measurements are required along with other life-saving interventions. Methods of measurement include oral, axillary, tympanic, rectal, and dermal routes. Oral temperature can be taken with clients who can follow instructions, so this kind of measurement is common for clients over the age of four, or even younger children if they are cooperative. Another route other than oral (e.g., tympanic or axillary) is preferable when a client is on oxygen delivered via a face mask because this can alter the temperature. For children younger than four, axillary temperature is commonly measured unless a more accurate reading is required. Rectal temperature is an accurate way to measure body temperature (Mazerolle, Ganio, Casa, Vingren, & Klau, 2011). The rectal route is recommended by the Canadian Pediatric Society for children under two years of age (Leduc & Woods, 2017). However, this method is not used on infants younger than thirty days or premature infants because of the risk of rectal tearing. If the rectal method is required, the procedure is generally only used by nurses and physicians. Dermal routes are alternative methods of measurement that may be used in some agencies and practice areas. This method can involve holding the device and sliding it over the skin of the forehead and then down over the temporal artery in one motion. Dermal strips can also be placed on the forehead to measure skin temperature, but are not yet widely used, and the accuracy of this method has not yet been verified. More recently, there has been an increase in non-contact infrared thermometers particularly in the era of COVID-19 and other highly transmissible diseases. Depending on the type, these thermometers can be held at a short distance from the forehead or temporal area to measure temperature. Alternatively, some handheld thermal scanners that use an infrared camera can be held at a greater distance to screen large masses of people. Please refer to the manufacturer’s suggested reference range for non-contact infrared thermometers and thermal scanners.]",Medical,Fact Finding,Q&A Only use the information provided in the document.,"According to the article, how many new genital herpes infections are seen in the U.S in a single year?","**What is genital herpes?** Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). How common is genital herpes? Genital herpes infection is common in the United States. CDC estimated that there were 572,000 new genital herpes infections in the United States in a single year.1 Nationwide, 11.9 % of persons aged 14 to 49 years have HSV-2 infection (12.1% when adjusted for age).2 However, the prevalence of genital herpes infection is higher than that because an increasing number of genital herpes infections are caused by HSV-1. 3 Oral HSV-1 infection is typically acquired in childhood; because the prevalence of oral HSV-1 infection has declined in recent decades, people may have become more susceptible to contracting a genital herpes infection from HSV-1. 4 HSV-2 infection is more common among women than among men; the percentages of those infected during 2015-2016 were 15.9% versus 8.2% respectively, among 14 to 49 year olds. 2 This is possibly because genital infection is more easily transmitted from men to women than from women to men during penile-vaginal sex. 5 HSV-2 infection is more common among non-Hispanic blacks (34.6%) than among non-Hispanic whites (8.1%). 2 A previous analysis found that these disparities, exist even among persons with similar numbers of lifetime sexual partners. Most infected persons may be unaware of their infection; in the United States, an estimated 87.4% of 14 to 49 year olds infected with HSV-2 have never received a clinical diagnosis. 6 The age-adjusted percentage of persons in the United States infected with HSV-2 decreased from 18.0% in 1999–2000 to 12.1% in 2015-2016. 2 How do people get genital herpes? Infections are transmitted through contact with HSV in herpes lesions, mucosal surfaces, genital secretions, or oral secretions. 5 HSV-1 and HSV-2 can be shed from normal-appearing oral or genital mucosa or skin. 7,8 Generally, a person can only get HSV-2 infection during genital contact with someone who has a genital HSV-2 infection. However, receiving oral sex from a person with an oral HSV-1 infection can result in getting a genital HSV-1 infection. 4 Transmission commonly occurs from contact with an infected partner who does not have visible lesions and who may not know that he or she is infected. 7 In persons with asymptomatic HSV-2 infections, genital HSV shedding occurs on 10.2% of days, compared to 20.1% of days among those with symptomatic infections. 8 What are the symptoms of genital herpes? Most individuals infected with HSV are asymptomatic or have very mild symptoms that go unnoticed or are mistaken for another skin condition. 9 When symptoms do occur, herpes lesions typically appear as one or more vesicles, or small blisters, on or around the genitals, rectum or mouth. The average incubation period for an initial herpes infection is 4 days (range, 2 to 12) after exposure. 10 The vesicles break and leave painful ulcers that may take two to four weeks to heal after the initial herpes infection. 5,10 Experiencing these symptoms is referred to as having a first herpes “outbreak” or episode. Clinical manifestations of genital herpes differ between the first and recurrent (i.e., subsequent) outbreaks. The first outbreak of herpes is often associated with a longer duration of herpetic lesions, increased viral shedding (making HSV transmission more likely) and systemic symptoms including fever, body aches, swollen lymph nodes, or headache. 5,10 Recurrent outbreaks of genital herpes are common, and many patients who recognize recurrences have prodromal symptoms, either localized genital pain, or tingling or shooting pains in the legs, hips or buttocks, which occur hours to days before the eruption of herpetic lesions. 5 Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes. 5 Long-term studies have indicated that the number of symptomatic recurrent outbreaks may decrease over time. 5 Recurrences and subclinical shedding are much less frequent for genital HSV-1 infection than for genital HSV-2 infection.5 What are the complications of genital herpes? Genital herpes may cause painful genital ulcers that can be severe and persistent in persons with suppressed immune systems, such as HIV-infected persons. 5 Both HSV-1 and HSV-2 can also cause rare but serious complications such as aseptic meningitis (inflammation of the linings of the brain). 5 Development of extragenital lesions (e.g. buttocks, groin, thigh, finger, or eye) may occur during the course of infection. 5 Some persons who contract genital herpes have concerns about how it will impact their overall health, sex life, and relationships. 5,11 There can also be considerable embarrassment, shame, and stigma associated with a herpes diagnosis that can substantially interfere with a patient’s relationships. 10 Clinicians can address these concerns by encouraging patients to recognize that while herpes is not curable, it is a manageable condition. 5 Three important steps that providers can take for their newly-diagnosed patients are: giving information, providing support resources, and helping define treatment and prevention options. 12 Patients can be counseled that risk of genital herpes transmission can be reduced, but not eliminated, by disclosure of infection to sexual partners, 5 avoiding sex during a recurrent outbreak, 5 use of suppressive antiviral therapy, 5,10 and consistent condom use. 7 Since a diagnosis of genital herpes may affect perceptions about existing or future sexual relationships, it is important for patients to understand how to talk to sexual partners about STDs. One resource can be found here: www.gytnow.org/talking-to-your-partner There are also potential complications for a pregnant woman and her newborn child. See “How does herpes infection affect a pregnant woman and her baby?” below for information about this. What is the link between genital herpes and HIV? Genital ulcerative disease caused by herpes makes it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 4-fold increased risk of acquiring HIV, if individuals with genital herpes infection are genitally exposed to HIV. 13-15 Ulcers or breaks in the skin or mucous membranes (lining of the mouth, vagina, and rectum) from a herpes infection may compromise the protection normally provided by the skin and mucous membranes against infections, including HIV. 14 In addition, having genital herpes increases the number of CD4 cells (the target cell for HIV entry) in the genital mucosa. In persons with both HIV and genital herpes, local activation of HIV replication at the site of genital herpes infection can increase the risk that HIV will be transmitted during contact with the mouth, vagina, or rectum of an HIV-uninfected sex partner. 14 How does genital herpes affect a pregnant woman and her baby? Neonatal herpes is one of the most serious complications of genital herpes.5,16 Healthcare providers should ask all pregnant women if they have a history of genital herpes.11 Herpes infection can be passed from mother to child during pregnancy or childbirth, or babies may be infected shortly after birth, resulting in a potentially fatal neonatal herpes infection. 17 Infants born to women who acquire genital herpes close to the time of delivery and are shedding virus at delivery are at a much higher risk for developing neonatal herpes, compared with women who have recurrent genital herpes . 16,18-20 Thus, it is important that women avoid contracting herpes during pregnancy. Women should be counseled to abstain from intercourse during the third trimester with partners known to have or suspected of having genital herpes. 5,11 While women with genital herpes may be offered antiviral medication late in pregnancy through delivery to reduce the risk of a recurrent herpes outbreak, third trimester antiviral prophylaxis has not been shown to decrease the risk of herpes transmission to the neonate.11,21,22 Routine serologic HSV screening of pregnant women is not recommended. 11 However, at onset of labor, all women should undergo careful examination and questioning to evaluate for presence of prodromal symptoms or herpetic lesions. 11 If herpes symptoms are present a cesarean delivery is recommended to prevent HSV transmission to the infant.5,11,23 There are detailed guidelines for how to manage asymptomatic infants born to women with active genital herpes lesions.24 How is genital herpes diagnosed? HSV nucleic acid amplification tests (NAAT) are the most sensitive and highly specific tests available for diagnosing herpes. However, in some settings viral culture is the only test available. The sensitivity of viral culture can be low, especially among people who have recurrent or healing lesions. Because viral shedding is intermittent, it is possible for someone to have a genital herpes infection even though it was not detected by NAAT or culture. 11 Type-specific virologic tests can be used for diagnosing genital herpes when a person has recurrent symptoms or lesion without a confirmatory NAAT, culture result, or has a partner with genital herpes. Both virologic tests and type-specific serologic tests should be available in clinical settings serving patients with, or at risk for, sexually transmitted infections. 11 Given performance limitations with commercially available type-specific serologic tests (especially with low index value results [<3]), a confirmatory test (Biokit or Western Blot) with a second method should be performed before test interpretation. If confirmatory tests are unavailable, patients should be counseled about the limitations of available testing before serologic testing. Healthcare providers should also be aware that false-positive results occur. In instances of suspected recent acquisition, serologic testing within 12 weeks after acquisition may be associated with false negative test results. 11 HSV-1 serologic testing does not distinguish between oral and genital infection, and typically should not be performed for diagnosing genital HSV-1 infection. Diagnosis of genital HSV-1 infection is confirmed by virologic tests from lesions. 11 CDC does not recommend screening for HSV-1 or HSV-2 in the general population due to limitations of the type specific serologic testing. 11 Several scenarios where type-specific serologic HSV tests may be useful include: Patients with recurrent genital symptoms or atypical symptoms and negative HSV NAAT or culture; Patients with a clinical diagnosis of genital herpes but no laboratory confirmation; and Patients who report having a partner with genital herpes. 11 Patients who are at higher risk of infection (e.g., presenting for an STI evaluation, especially those with multiple sex partners), and people with HIV might need to be assessed for a history of genital herpes symptoms, followed by serology testing in those with genital symptoms. 11 ","[Question] According to the article, how many new genital herpes infections are seen in the U.S in a single year? ---------- [Task Instruction] Only use the information provided in the document. ---------- [Article] **What is genital herpes?** Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex virus type 1 (HSV-1) or type 2 (HSV-2). How common is genital herpes? Genital herpes infection is common in the United States. CDC estimated that there were 572,000 new genital herpes infections in the United States in a single year.1 Nationwide, 11.9 % of persons aged 14 to 49 years have HSV-2 infection (12.1% when adjusted for age).2 However, the prevalence of genital herpes infection is higher than that because an increasing number of genital herpes infections are caused by HSV-1. 3 Oral HSV-1 infection is typically acquired in childhood; because the prevalence of oral HSV-1 infection has declined in recent decades, people may have become more susceptible to contracting a genital herpes infection from HSV-1. 4 HSV-2 infection is more common among women than among men; the percentages of those infected during 2015-2016 were 15.9% versus 8.2% respectively, among 14 to 49 year olds. 2 This is possibly because genital infection is more easily transmitted from men to women than from women to men during penile-vaginal sex. 5 HSV-2 infection is more common among non-Hispanic blacks (34.6%) than among non-Hispanic whites (8.1%). 2 A previous analysis found that these disparities, exist even among persons with similar numbers of lifetime sexual partners. Most infected persons may be unaware of their infection; in the United States, an estimated 87.4% of 14 to 49 year olds infected with HSV-2 have never received a clinical diagnosis. 6 The age-adjusted percentage of persons in the United States infected with HSV-2 decreased from 18.0% in 1999–2000 to 12.1% in 2015-2016. 2 How do people get genital herpes? Infections are transmitted through contact with HSV in herpes lesions, mucosal surfaces, genital secretions, or oral secretions. 5 HSV-1 and HSV-2 can be shed from normal-appearing oral or genital mucosa or skin. 7,8 Generally, a person can only get HSV-2 infection during genital contact with someone who has a genital HSV-2 infection. However, receiving oral sex from a person with an oral HSV-1 infection can result in getting a genital HSV-1 infection. 4 Transmission commonly occurs from contact with an infected partner who does not have visible lesions and who may not know that he or she is infected. 7 In persons with asymptomatic HSV-2 infections, genital HSV shedding occurs on 10.2% of days, compared to 20.1% of days among those with symptomatic infections. 8 What are the symptoms of genital herpes? Most individuals infected with HSV are asymptomatic or have very mild symptoms that go unnoticed or are mistaken for another skin condition. 9 When symptoms do occur, herpes lesions typically appear as one or more vesicles, or small blisters, on or around the genitals, rectum or mouth. The average incubation period for an initial herpes infection is 4 days (range, 2 to 12) after exposure. 10 The vesicles break and leave painful ulcers that may take two to four weeks to heal after the initial herpes infection. 5,10 Experiencing these symptoms is referred to as having a first herpes “outbreak” or episode. Clinical manifestations of genital herpes differ between the first and recurrent (i.e., subsequent) outbreaks. The first outbreak of herpes is often associated with a longer duration of herpetic lesions, increased viral shedding (making HSV transmission more likely) and systemic symptoms including fever, body aches, swollen lymph nodes, or headache. 5,10 Recurrent outbreaks of genital herpes are common, and many patients who recognize recurrences have prodromal symptoms, either localized genital pain, or tingling or shooting pains in the legs, hips or buttocks, which occur hours to days before the eruption of herpetic lesions. 5 Symptoms of recurrent outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes. 5 Long-term studies have indicated that the number of symptomatic recurrent outbreaks may decrease over time. 5 Recurrences and subclinical shedding are much less frequent for genital HSV-1 infection than for genital HSV-2 infection.5 What are the complications of genital herpes? Genital herpes may cause painful genital ulcers that can be severe and persistent in persons with suppressed immune systems, such as HIV-infected persons. 5 Both HSV-1 and HSV-2 can also cause rare but serious complications such as aseptic meningitis (inflammation of the linings of the brain). 5 Development of extragenital lesions (e.g. buttocks, groin, thigh, finger, or eye) may occur during the course of infection. 5 Some persons who contract genital herpes have concerns about how it will impact their overall health, sex life, and relationships. 5,11 There can also be considerable embarrassment, shame, and stigma associated with a herpes diagnosis that can substantially interfere with a patient’s relationships. 10 Clinicians can address these concerns by encouraging patients to recognize that while herpes is not curable, it is a manageable condition. 5 Three important steps that providers can take for their newly-diagnosed patients are: giving information, providing support resources, and helping define treatment and prevention options. 12 Patients can be counseled that risk of genital herpes transmission can be reduced, but not eliminated, by disclosure of infection to sexual partners, 5 avoiding sex during a recurrent outbreak, 5 use of suppressive antiviral therapy, 5,10 and consistent condom use. 7 Since a diagnosis of genital herpes may affect perceptions about existing or future sexual relationships, it is important for patients to understand how to talk to sexual partners about STDs. One resource can be found here: www.gytnow.org/talking-to-your-partner There are also potential complications for a pregnant woman and her newborn child. See “How does herpes infection affect a pregnant woman and her baby?” below for information about this. What is the link between genital herpes and HIV? Genital ulcerative disease caused by herpes makes it easier to transmit and acquire HIV infection sexually. There is an estimated 2- to 4-fold increased risk of acquiring HIV, if individuals with genital herpes infection are genitally exposed to HIV. 13-15 Ulcers or breaks in the skin or mucous membranes (lining of the mouth, vagina, and rectum) from a herpes infection may compromise the protection normally provided by the skin and mucous membranes against infections, including HIV. 14 In addition, having genital herpes increases the number of CD4 cells (the target cell for HIV entry) in the genital mucosa. In persons with both HIV and genital herpes, local activation of HIV replication at the site of genital herpes infection can increase the risk that HIV will be transmitted during contact with the mouth, vagina, or rectum of an HIV-uninfected sex partner. 14 How does genital herpes affect a pregnant woman and her baby? Neonatal herpes is one of the most serious complications of genital herpes.5,16 Healthcare providers should ask all pregnant women if they have a history of genital herpes.11 Herpes infection can be passed from mother to child during pregnancy or childbirth, or babies may be infected shortly after birth, resulting in a potentially fatal neonatal herpes infection. 17 Infants born to women who acquire genital herpes close to the time of delivery and are shedding virus at delivery are at a much higher risk for developing neonatal herpes, compared with women who have recurrent genital herpes . 16,18-20 Thus, it is important that women avoid contracting herpes during pregnancy. Women should be counseled to abstain from intercourse during the third trimester with partners known to have or suspected of having genital herpes. 5,11 While women with genital herpes may be offered antiviral medication late in pregnancy through delivery to reduce the risk of a recurrent herpes outbreak, third trimester antiviral prophylaxis has not been shown to decrease the risk of herpes transmission to the neonate.11,21,22 Routine serologic HSV screening of pregnant women is not recommended. 11 However, at onset of labor, all women should undergo careful examination and questioning to evaluate for presence of prodromal symptoms or herpetic lesions. 11 If herpes symptoms are present a cesarean delivery is recommended to prevent HSV transmission to the infant.5,11,23 There are detailed guidelines for how to manage asymptomatic infants born to women with active genital herpes lesions.24 How is genital herpes diagnosed? HSV nucleic acid amplification tests (NAAT) are the most sensitive and highly specific tests available for diagnosing herpes. However, in some settings viral culture is the only test available. The sensitivity of viral culture can be low, especially among people who have recurrent or healing lesions. Because viral shedding is intermittent, it is possible for someone to have a genital herpes infection even though it was not detected by NAAT or culture. 11 Type-specific virologic tests can be used for diagnosing genital herpes when a person has recurrent symptoms or lesion without a confirmatory NAAT, culture result, or has a partner with genital herpes. Both virologic tests and type-specific serologic tests should be available in clinical settings serving patients with, or at risk for, sexually transmitted infections. 11 Given performance limitations with commercially available type-specific serologic tests (especially with low index value results [<3]), a confirmatory test (Biokit or Western Blot) with a second method should be performed before test interpretation. If confirmatory tests are unavailable, patients should be counseled about the limitations of available testing before serologic testing. Healthcare providers should also be aware that false-positive results occur. In instances of suspected recent acquisition, serologic testing within 12 weeks after acquisition may be associated with false negative test results. 11 HSV-1 serologic testing does not distinguish between oral and genital infection, and typically should not be performed for diagnosing genital HSV-1 infection. Diagnosis of genital HSV-1 infection is confirmed by virologic tests from lesions. 11 CDC does not recommend screening for HSV-1 or HSV-2 in the general population due to limitations of the type specific serologic testing. 11 Several scenarios where type-specific serologic HSV tests may be useful include: Patients with recurrent genital symptoms or atypical symptoms and negative HSV NAAT or culture; Patients with a clinical diagnosis of genital herpes but no laboratory confirmation; and Patients who report having a partner with genital herpes. 11 Patients who are at higher risk of infection (e.g., presenting for an STI evaluation, especially those with multiple sex partners), and people with HIV might need to be assessed for a history of genital herpes symptoms, followed by serology testing in those with genital symptoms. 11 ",Medical,Fact Finding,Q&A "Only refer to the document to answer the question. Only answer the question, do not add extra chatter or descriptions. Your answer should not be in bullet point format.",Explain what effect frequent trading of ETF Shares has on shareholders.,"**Risks of Exchange-Traded Shares** ETF Shares are not individually redeemable. They can be redeemed with the issuing Fund at NAV only by certain authorized broker-dealers and only in large blocks known as Creation Units. Consequently, if you want to liquidate some or all of your ETF Shares, you must sell them on the secondary market at prevailing market prices. The market price of ETF Shares may differ from NAV. Although it is expected that the market price of an ETF Share typically will approximate its NAV, there may be times when the market price and the NAV differ significantly. Thus, you may pay more (premium) or less (discount) than NAV when you buy ETF Shares on the secondary market, and you may receive more or less than NAV when you sell those shares. These discounts and premiums are likely to be greatest during times of market disruption or extreme market volatility. Vanguard’s website at vanguard.com shows the previous day’s closing NAV and closing market price for the Fund’s ETF Shares. The website also discloses, in the Premium/Discount Analysis section of the ETF Shares’ Price & Performance page, how frequently the Fund’s ETF Shares traded at a premium or discount to NAV (based on closing NAVs and market prices) and the magnitudes of such premiums and discounts. An active trading market may not exist. Although Vanguard ETF Shares are listed on a national securities exchange, it is possible that an active trading market may not be maintained. Although this could happen at any time, it is more likely to occur during times of severe market disruption. If you attempt to sell your ETF Shares when an active trading market is not functioning, you may have to sell at a significant discount to NAV. In extreme cases, you may not be able to sell your shares at all. Trading may be halted. Trading of Vanguard ETF Shares on an exchange may be halted by the activation of individual or marketwide trading halts (which halt trading for a specific period of time when the price of a particular security or overall market prices decline by a specified percentage). Trading of ETF Shares may also be halted if (1) the shares are delisted from the listing exchange without first being listed on another exchange or (2) exchange officials determine that such action is appropriate in the interest of a fair and orderly market or for the protection of investors. Conversion Privilege Owners of conventional shares issued by the Fund may convert those shares to ETF Shares of equivalent value of the same fund. Please note that investors who own conventional shares through a 401(k) plan or other employer-sponsored 15 retirement or benefit plan generally may not convert those shares to ETF Shares and should check with their plan sponsor or recordkeeper. ETF Shares, whether acquired through a conversion or purchased on the secondary market, cannot be converted to conventional shares by a shareholder. Also, ETF Shares of one fund cannot be exchanged for ETF Shares of another fund. You must hold ETF Shares in a brokerage account. Thus, before converting conventional shares to ETF Shares, you must have an existing, or open a new, brokerage account. This account may be with Vanguard Brokerage Services® or with any other brokerage firm. To initiate a conversion of conventional shares to ETF Shares, please contact your broker. Vanguard Brokerage Services does not impose a fee on conversions from Vanguard conventional shares to Vanguard ETF Shares. However, other brokerage firms may charge a fee to process a conversion. Vanguard reserves the right, in the future, to impose a transaction fee on conversions or to limit, temporarily suspend, or terminate the conversion privilege. Converting conventional shares to ETF Shares is generally accomplished as follows. First, after your broker notifies Vanguard of your request to convert, Vanguard will transfer your conventional shares from your account to the broker’s omnibus account with Vanguard (an account maintained by the broker on behalf of all its customers who hold conventional Vanguard fund shares through the broker). After the transfer, Vanguard’s records will reflect your broker, not you, as the owner of the shares. Next, your broker will instruct Vanguard to convert the appropriate number or dollar amount of conventional shares in its omnibus account to ETF Shares of equivalent value, based on the respective NAVs of the two share classes. Your Fund’s transfer agent will reflect ownership of all ETF Shares in the name of the Depository Trust Company (DTC). The DTC will keep track of which ETF Shares belong to your broker, and your broker, in turn, will keep track of which ETF Shares belong to you. Because the DTC is unable to handle fractional shares, only whole shares can be converted. For example, if you owned 300.25 conventional shares, and this was equivalent in value to 90.75 ETF Shares, the DTC account would receive 90 ETF Shares. Conventional shares with a value equal to 0.75 ETF Shares (in this example, that would be 2.481 conventional shares) would remain in the broker’s omnibus account with Vanguard. Your broker then could either (1) credit your account with 0.75 ETF Shares or (2) redeem the 2.481 conventional shares for cash at NAV and deliver that cash to your account. If your broker chose to redeem your conventional shares, you would realize a gain or loss on the redemption that must be reported on your tax return (unless you hold the shares 16 in an IRA or other tax-deferred account). Please consult your broker for information on how it will handle the conversion process, including whether it will impose a fee to process a conversion. If you convert your conventional shares to ETF Shares through Vanguard Brokerage Services, all conventional shares for which you request conversion will be converted to ETF Shares of equivalent value. Because no fractional shares will have to be sold, the transaction will not be taxable. Here are some important points to keep in mind when converting conventional shares of a Vanguard fund to ETF Shares: • The conversion process can take anywhere from several days to several weeks, depending on your broker. Vanguard generally will process conversion requests either on the day they are received or on the next business day. Vanguard imposes conversion blackout windows around the dates when a fund with ETF Shares declares dividends. This is necessary to prevent a shareholder from collecting a dividend from both the conventional share class currently held and also from the ETF share class to which the shares will be converted. • Until the conversion process is complete, you will remain fully invested in a fund’s conventional shares, and your investment will increase or decrease in value in tandem with the NAV of those shares. • The conversion transaction is nontaxable except, if applicable, to the very limited extent previously described. Shareholder Rights The Fund’s Agreement and Declaration of Trust, as amended, requires a shareholder bringing a derivative action on behalf of Vanguard Index Funds (the Trust) that is subject to a pre-suit demand to collectively hold at least 10% of the outstanding shares of the Trust or at least 10% of the outstanding shares of the series or class to which the demand relates and to undertake to reimburse the Trust for the expense of any counsel or advisors used when considering the merits of the demand in the event that the board of trustees determines not to bring such action. In each case, these requirements do not apply to claims arising under the federal securities laws to the extent that any such federal securities laws, rules, or regulations do not permit such application. A precautionary note to investment companies: The Fund’s ETF Shares are issued by a registered investment company, and therefore the acquisition of such shares by other investment companies and private funds is subject to the restrictions of Section 12(d)(1) of the Investment Company Act of 1940 (the 1940 Act). SEC Rule 12d1-4 under the 1940 Act permits registered investment companies to invest in other registered investment companies beyond the limits 17 in Section 12(d)(1), subject to certain conditions, including that funds with different investment advisors must enter into a fund of funds investment agreement. Frequent Trading and Market-Timing Unlike frequent trading of a Vanguard fund’s conventional (i.e., not exchange-traded) classes of shares, frequent trading of ETF Shares does not disrupt portfolio management or otherwise harm fund shareholders. The vast majority of trading in ETF Shares occurs on the secondary market. Because these trades do not involve the issuing fund, they do not harm the fund or its shareholders. Certain broker-dealers are authorized to purchase and redeem ETF Shares directly with the issuing fund. Because these trades typically are effected in kind (i.e., for securities and not for cash), or are assessed a transaction fee when effected in cash, they do not cause any of the harmful effects to the issuing fund (as previously noted) that may result from frequent trading. For these reasons, the board of trustees of each fund that issues ETF Shares has determined that it is not necessary to adopt policies and procedures to detect and deter frequent trading and market-timing of ETF Shares. Portfolio Holdings Please consult the Fund’s Statement of Additional Information or our website for a description of the policies and procedures that govern disclosure of the Fund’s portfolio holdings. Turnover Rate Although the Fund generally seeks to invest for the long term, it may sell securities regardless of how long they have been held. Generally, an index fund sells securities in response to redemption requests from shareholders of conventional (i.e., not exchange-traded) shares or to changes in the composition of its target index. Turnover rates for large-cap stock index funds tend to be low because large-cap indexes—such as the S&P 500 Index—typically do not change significantly from year to year. The Financial Highlights section of this prospectus shows historical turnover rates for the Fund. A turnover rate of 100%, for example, would mean that the Fund had sold and replaced securities valued at 100% of its net assets within a one-year period. In general, the greater the turnover rate, the greater the impact transaction costs will have on a fund’s return. Also, funds with high turnover rates may be more likely to generate capital gains, including short-term capital gains, that must be distributed to shareholders and will be taxable to shareholders investing through a taxable account.","[article] ========== **Risks of Exchange-Traded Shares** ETF Shares are not individually redeemable. They can be redeemed with the issuing Fund at NAV only by certain authorized broker-dealers and only in large blocks known as Creation Units. Consequently, if you want to liquidate some or all of your ETF Shares, you must sell them on the secondary market at prevailing market prices. The market price of ETF Shares may differ from NAV. Although it is expected that the market price of an ETF Share typically will approximate its NAV, there may be times when the market price and the NAV differ significantly. Thus, you may pay more (premium) or less (discount) than NAV when you buy ETF Shares on the secondary market, and you may receive more or less than NAV when you sell those shares. These discounts and premiums are likely to be greatest during times of market disruption or extreme market volatility. Vanguard’s website at vanguard.com shows the previous day’s closing NAV and closing market price for the Fund’s ETF Shares. The website also discloses, in the Premium/Discount Analysis section of the ETF Shares’ Price & Performance page, how frequently the Fund’s ETF Shares traded at a premium or discount to NAV (based on closing NAVs and market prices) and the magnitudes of such premiums and discounts. An active trading market may not exist. Although Vanguard ETF Shares are listed on a national securities exchange, it is possible that an active trading market may not be maintained. Although this could happen at any time, it is more likely to occur during times of severe market disruption. If you attempt to sell your ETF Shares when an active trading market is not functioning, you may have to sell at a significant discount to NAV. In extreme cases, you may not be able to sell your shares at all. Trading may be halted. Trading of Vanguard ETF Shares on an exchange may be halted by the activation of individual or marketwide trading halts (which halt trading for a specific period of time when the price of a particular security or overall market prices decline by a specified percentage). Trading of ETF Shares may also be halted if (1) the shares are delisted from the listing exchange without first being listed on another exchange or (2) exchange officials determine that such action is appropriate in the interest of a fair and orderly market or for the protection of investors. Conversion Privilege Owners of conventional shares issued by the Fund may convert those shares to ETF Shares of equivalent value of the same fund. Please note that investors who own conventional shares through a 401(k) plan or other employer-sponsored 15 retirement or benefit plan generally may not convert those shares to ETF Shares and should check with their plan sponsor or recordkeeper. ETF Shares, whether acquired through a conversion or purchased on the secondary market, cannot be converted to conventional shares by a shareholder. Also, ETF Shares of one fund cannot be exchanged for ETF Shares of another fund. You must hold ETF Shares in a brokerage account. Thus, before converting conventional shares to ETF Shares, you must have an existing, or open a new, brokerage account. This account may be with Vanguard Brokerage Services® or with any other brokerage firm. To initiate a conversion of conventional shares to ETF Shares, please contact your broker. Vanguard Brokerage Services does not impose a fee on conversions from Vanguard conventional shares to Vanguard ETF Shares. However, other brokerage firms may charge a fee to process a conversion. Vanguard reserves the right, in the future, to impose a transaction fee on conversions or to limit, temporarily suspend, or terminate the conversion privilege. Converting conventional shares to ETF Shares is generally accomplished as follows. First, after your broker notifies Vanguard of your request to convert, Vanguard will transfer your conventional shares from your account to the broker’s omnibus account with Vanguard (an account maintained by the broker on behalf of all its customers who hold conventional Vanguard fund shares through the broker). After the transfer, Vanguard’s records will reflect your broker, not you, as the owner of the shares. Next, your broker will instruct Vanguard to convert the appropriate number or dollar amount of conventional shares in its omnibus account to ETF Shares of equivalent value, based on the respective NAVs of the two share classes. Your Fund’s transfer agent will reflect ownership of all ETF Shares in the name of the Depository Trust Company (DTC). The DTC will keep track of which ETF Shares belong to your broker, and your broker, in turn, will keep track of which ETF Shares belong to you. Because the DTC is unable to handle fractional shares, only whole shares can be converted. For example, if you owned 300.25 conventional shares, and this was equivalent in value to 90.75 ETF Shares, the DTC account would receive 90 ETF Shares. Conventional shares with a value equal to 0.75 ETF Shares (in this example, that would be 2.481 conventional shares) would remain in the broker’s omnibus account with Vanguard. Your broker then could either (1) credit your account with 0.75 ETF Shares or (2) redeem the 2.481 conventional shares for cash at NAV and deliver that cash to your account. If your broker chose to redeem your conventional shares, you would realize a gain or loss on the redemption that must be reported on your tax return (unless you hold the shares 16 in an IRA or other tax-deferred account). Please consult your broker for information on how it will handle the conversion process, including whether it will impose a fee to process a conversion. If you convert your conventional shares to ETF Shares through Vanguard Brokerage Services, all conventional shares for which you request conversion will be converted to ETF Shares of equivalent value. Because no fractional shares will have to be sold, the transaction will not be taxable. Here are some important points to keep in mind when converting conventional shares of a Vanguard fund to ETF Shares: • The conversion process can take anywhere from several days to several weeks, depending on your broker. Vanguard generally will process conversion requests either on the day they are received or on the next business day. Vanguard imposes conversion blackout windows around the dates when a fund with ETF Shares declares dividends. This is necessary to prevent a shareholder from collecting a dividend from both the conventional share class currently held and also from the ETF share class to which the shares will be converted. • Until the conversion process is complete, you will remain fully invested in a fund’s conventional shares, and your investment will increase or decrease in value in tandem with the NAV of those shares. • The conversion transaction is nontaxable except, if applicable, to the very limited extent previously described. Shareholder Rights The Fund’s Agreement and Declaration of Trust, as amended, requires a shareholder bringing a derivative action on behalf of Vanguard Index Funds (the Trust) that is subject to a pre-suit demand to collectively hold at least 10% of the outstanding shares of the Trust or at least 10% of the outstanding shares of the series or class to which the demand relates and to undertake to reimburse the Trust for the expense of any counsel or advisors used when considering the merits of the demand in the event that the board of trustees determines not to bring such action. In each case, these requirements do not apply to claims arising under the federal securities laws to the extent that any such federal securities laws, rules, or regulations do not permit such application. A precautionary note to investment companies: The Fund’s ETF Shares are issued by a registered investment company, and therefore the acquisition of such shares by other investment companies and private funds is subject to the restrictions of Section 12(d)(1) of the Investment Company Act of 1940 (the 1940 Act). SEC Rule 12d1-4 under the 1940 Act permits registered investment companies to invest in other registered investment companies beyond the limits 17 in Section 12(d)(1), subject to certain conditions, including that funds with different investment advisors must enter into a fund of funds investment agreement. Frequent Trading and Market-Timing Unlike frequent trading of a Vanguard fund’s conventional (i.e., not exchange-traded) classes of shares, frequent trading of ETF Shares does not disrupt portfolio management or otherwise harm fund shareholders. The vast majority of trading in ETF Shares occurs on the secondary market. Because these trades do not involve the issuing fund, they do not harm the fund or its shareholders. Certain broker-dealers are authorized to purchase and redeem ETF Shares directly with the issuing fund. Because these trades typically are effected in kind (i.e., for securities and not for cash), or are assessed a transaction fee when effected in cash, they do not cause any of the harmful effects to the issuing fund (as previously noted) that may result from frequent trading. For these reasons, the board of trustees of each fund that issues ETF Shares has determined that it is not necessary to adopt policies and procedures to detect and deter frequent trading and market-timing of ETF Shares. Portfolio Holdings Please consult the Fund’s Statement of Additional Information or our website for a description of the policies and procedures that govern disclosure of the Fund’s portfolio holdings. Turnover Rate Although the Fund generally seeks to invest for the long term, it may sell securities regardless of how long they have been held. Generally, an index fund sells securities in response to redemption requests from shareholders of conventional (i.e., not exchange-traded) shares or to changes in the composition of its target index. Turnover rates for large-cap stock index funds tend to be low because large-cap indexes—such as the S&P 500 Index—typically do not change significantly from year to year. The Financial Highlights section of this prospectus shows historical turnover rates for the Fund. A turnover rate of 100%, for example, would mean that the Fund had sold and replaced securities valued at 100% of its net assets within a one-year period. In general, the greater the turnover rate, the greater the impact transaction costs will have on a fund’s return. Also, funds with high turnover rates may be more likely to generate capital gains, including short-term capital gains, that must be distributed to shareholders and will be taxable to shareholders investing through a taxable account. ---------------- [query] ========== Explain what effect frequent trading of ETF Shares has on shareholders. ---------------- [task] ========== Only refer to the document to answer the question. Only answer the question, do not add extra chatter or descriptions. Your answer should not be in bullet point format.",Financial,Explanation/Definition,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","I am an adult currently on ADHD medication. I am thinking about getting pregnant but am not sure if my ADHD medication would need any adjustments. If I want to continue taking Adderall, what are some potential benefits or detriments that I should be aware of? Use under 400 words.","This sheet is about exposure to dextroamphetamine-amphetamine in pregnancy and while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider. What is dextroamphetamine-amphetamine? Dextroamphetamine-amphetamine (Adderall®) is a combination prescription medication that has been used to treat attention deficit hyperactive disorder (ADHD) and narcolepsy (a condition that affects the brain's ability to control sleeping and waking up). Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Stopping this medication suddenly can cause withdrawal in some people. It is not known if or how withdrawal may affect a pregnancy. If you are going to stop using this medication, your healthcare providers may talk with you about slowly reducing your dose over time. Your healthcare providers can also talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. Dextroamphetamine-amphetamine is different from methamphetamine. MotherToBaby has a fact sheet on methamphetamine here: https://mothertobaby.org/fact-sheets/methamphetamine/. This sheet will focus on the use of dextroamphetamine-amphetamine under medical supervision. MotherToBaby has a fact sheet on dextroamphetamine here: https://mothertobaby.org/fact-sheets/dextroamphetamine-pregnancy/. I take dextroamphetamine-amphetamine. Can it make it harder for me to get pregnant? Taking prescribed dextroamphetamine-amphetamine as directed by your healthcare provider is not expected to make it harder to get pregnant. Does taking dextroamphetamine-amphetamine increase the chance of miscarriage? Miscarriage is common and can occur in any pregnancy for many different reasons. Taking prescribed dextroamphetamine-amphetamine as directed by your healthcare provider is not expected to increase the chance of miscarriage. Does taking dextroamphetamine-amphetamine increase the chance of birth defects? Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Most studies suggest that taking dextroamphetamine or amphetamine during the first trimester does not increase the chance of birth defects. In a large study of people taking stimulants for ADHD during pregnancy, there was no increased risk for birth defects reported when taking amphetamines, such as dextroamphetamine-amphetamine, for ADHD treatment. Does taking dextroamphetamine-amphetamine in pregnancy increase the chance of other pregnancy-related problems? Although data is limited, when used as directed by a healthcare provider, taking dextroamphetamine-amphetamine during pregnancy has sometimes been associated with a higher chance of pregnancy-related problems, such as poor growth (babies born small and/or with a small head size), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), or preterm delivery (birth before week 37). People taking dextroamphetamine-amphetamine may experience side effects from their medication, such as weight loss due to decreased appetite, changes in heart rate, and changes in blood pressure. Talk with your healthcare provider about monitoring these side effects to help improve outcomes for you and your baby. I need to take dextroamphetamine-amphetamine throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby after birth? It is not known if taking dextroamphetamine-amphetamine could cause withdrawal symptoms in a newborn after birth. This has not been well studied in people only taking dextroamphetamine-amphetamine as directed during pregnancy. Does taking dextroamphetamine-amphetamine in pregnancy affect future behavior or learning for the child? Although limited by looking at all ADHD medications together, a Danish study suggested no increase in neurodevelopmental disorders, like ADHD, in the children of people who continued their ADHD medication during pregnancy versus those who stopped their medication before becoming pregnant. Breastfeeding while taking dextroamphetamine-amphetamine: There are no studies on the combination of amphetamine-dextroamphetamine in breastfeeding. Individually, amphetamine and dextroamphetamine have been found to pass into breast milk. The effect of amphetamine in milk on behavior and brain development of infants has not been well studied. No adverse effects were reported in 4 infants (ages range from 3 months to 10 months) whose mothers were taking dextroamphetamine for ADHD. If you suspect the baby has any symptoms such as trouble eating, trouble sleeping, or irritability, contact the child’s healthcare provider. Some evidence suggests that large doses of dextroamphetamine could lower milk supply in people who are newly breastfeeding. If you have any questions or concerns about breastfeeding, talk with your healthcare provider, your baby’s pediatrician, or a lactation consultant. The product label for dextroamphetamine-amphetamine recommends people who are breastfeeding not use this medication. But the benefit of using dextroamphetamine-amphetamine may outweigh possible risks. Your healthcare providers can talk with you about using dextroamphetamine-amphetamine and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions. If a male takes dextroamphetamine-amphetamine, could it affect fertility or increase the chance of birth defects? It is not known if dextroamphetamine-amphetamine could affect male fertility (make it harder to get a partner pregnant) or increase the chance of birth defects above the background risk. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I am an adult currently on ADHD medication. I am thinking about getting pregnant but am not sure if my ADHD medication would need any adjustments. If I want to continue taking Adderall, what are some potential benefits or detriments that I should be aware of? Use under 400 words. This sheet is about exposure to dextroamphetamine-amphetamine in pregnancy and while breastfeeding. This information is based on available published literature. It should not take the place of medical care and advice from your healthcare provider. What is dextroamphetamine-amphetamine? Dextroamphetamine-amphetamine (Adderall®) is a combination prescription medication that has been used to treat attention deficit hyperactive disorder (ADHD) and narcolepsy (a condition that affects the brain's ability to control sleeping and waking up). Sometimes when people find out they are pregnant, they think about changing how they take their medication, or stopping their medication altogether. However, it is important to talk with your healthcare providers before making any changes to how you take your medication. Stopping this medication suddenly can cause withdrawal in some people. It is not known if or how withdrawal may affect a pregnancy. If you are going to stop using this medication, your healthcare providers may talk with you about slowly reducing your dose over time. Your healthcare providers can also talk with you about the benefits of treating your condition and the risks of untreated illness during pregnancy. Dextroamphetamine-amphetamine is different from methamphetamine. MotherToBaby has a fact sheet on methamphetamine here: https://mothertobaby.org/fact-sheets/methamphetamine/. This sheet will focus on the use of dextroamphetamine-amphetamine under medical supervision. MotherToBaby has a fact sheet on dextroamphetamine here: https://mothertobaby.org/fact-sheets/dextroamphetamine-pregnancy/. I take dextroamphetamine-amphetamine. Can it make it harder for me to get pregnant? Taking prescribed dextroamphetamine-amphetamine as directed by your healthcare provider is not expected to make it harder to get pregnant. Does taking dextroamphetamine-amphetamine increase the chance of miscarriage? Miscarriage is common and can occur in any pregnancy for many different reasons. Taking prescribed dextroamphetamine-amphetamine as directed by your healthcare provider is not expected to increase the chance of miscarriage. Does taking dextroamphetamine-amphetamine increase the chance of birth defects? Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Most studies suggest that taking dextroamphetamine or amphetamine during the first trimester does not increase the chance of birth defects. In a large study of people taking stimulants for ADHD during pregnancy, there was no increased risk for birth defects reported when taking amphetamines, such as dextroamphetamine-amphetamine, for ADHD treatment. Does taking dextroamphetamine-amphetamine in pregnancy increase the chance of other pregnancy-related problems? Although data is limited, when used as directed by a healthcare provider, taking dextroamphetamine-amphetamine during pregnancy has sometimes been associated with a higher chance of pregnancy-related problems, such as poor growth (babies born small and/or with a small head size), low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth), or preterm delivery (birth before week 37). People taking dextroamphetamine-amphetamine may experience side effects from their medication, such as weight loss due to decreased appetite, changes in heart rate, and changes in blood pressure. Talk with your healthcare provider about monitoring these side effects to help improve outcomes for you and your baby. I need to take dextroamphetamine-amphetamine throughout my entire pregnancy. Will it cause withdrawal symptoms in my baby after birth? It is not known if taking dextroamphetamine-amphetamine could cause withdrawal symptoms in a newborn after birth. This has not been well studied in people only taking dextroamphetamine-amphetamine as directed during pregnancy. Does taking dextroamphetamine-amphetamine in pregnancy affect future behavior or learning for the child? Although limited by looking at all ADHD medications together, a Danish study suggested no increase in neurodevelopmental disorders, like ADHD, in the children of people who continued their ADHD medication during pregnancy versus those who stopped their medication before becoming pregnant. Breastfeeding while taking dextroamphetamine-amphetamine: There are no studies on the combination of amphetamine-dextroamphetamine in breastfeeding. Individually, amphetamine and dextroamphetamine have been found to pass into breast milk. The effect of amphetamine in milk on behavior and brain development of infants has not been well studied. No adverse effects were reported in 4 infants (ages range from 3 months to 10 months) whose mothers were taking dextroamphetamine for ADHD. If you suspect the baby has any symptoms such as trouble eating, trouble sleeping, or irritability, contact the child’s healthcare provider. Some evidence suggests that large doses of dextroamphetamine could lower milk supply in people who are newly breastfeeding. If you have any questions or concerns about breastfeeding, talk with your healthcare provider, your baby’s pediatrician, or a lactation consultant. The product label for dextroamphetamine-amphetamine recommends people who are breastfeeding not use this medication. But the benefit of using dextroamphetamine-amphetamine may outweigh possible risks. Your healthcare providers can talk with you about using dextroamphetamine-amphetamine and what treatment is best for you. Be sure to talk to your healthcare provider about all your breastfeeding questions. If a male takes dextroamphetamine-amphetamine, could it affect fertility or increase the chance of birth defects? It is not known if dextroamphetamine-amphetamine could affect male fertility (make it harder to get a partner pregnant) or increase the chance of birth defects above the background risk. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/. https://www.ncbi.nlm.nih.gov/books/NBK603254/",Medical,Pros & Cons,Q&A "To answer, forget everything you know and use only the information I provide in the context block. Provide your answer in 150 words or less. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context.""","Aside from the potential loss of revenue from home distillation and the known dangers of consuming contaminated alcohol in homemade spirits, why do governments continue to prohibit the legal home production of distilled alcoholic beverages?","The dollar figures involved are informative. When alcohol is made on a large scale, as it is for the fuel-alcohol industry (gasohol) its cost of manufacture is about 25 cents per litre. This is for 100% alcohol. If diluted to the 40% commonly used for vodka, gin and other distilled spirits a litre would contain about 10 cents worth of alcohol. The retail price of a litre of vodka will lie somewhere between $10 and $20 depending on the country and the level of taxation. Some of the difference is due to the scale of manufacture, the purity of the product, transportation, the profit margin, etc. but even allowing for these factors the tax burden on the consumer is extremely high. Is it any wonder that an unscrupulous operator will attempt to sell his alcohol direct to the consumer, perhaps at half the normal retail price which would still give him a very handsome profit? Or is it any wonder that the authorities crack down hard on anyone attempting to interfere with their huge source of revenue, their milch cow? This battle between illicit alcohol producers (moon-shiners) or importers (smugglers) and the authorities has now become the stuff of legend. Consider the number of stories written or movies made about desperate men rolling barrels of rum up a beach at midnight! Or about the battles between gangsters and police during prohibition days in the United States! Unfortunately, such stories have been taken too much to heart by the general public so that the whole idea of distillation, and the spirits made by this process, is now perceived as being inherently more wicked than the gentle art of beer- or wine-making. And the “wickedness” is a strong deterrent to most people. 18 It is understandable why a government would wish to put a stop to smuggling and moonshining for commercial purposes, that is to say in order to re-sell the product and avoid the payment of taxes. But why would there be a complete ban on distillation by amateurs, on a small scale and for their own use? At the risk of being tediously repetitious it is worth reminding ourselves again (and again) that distillation is one of the most innocuous activities imaginable. It doesn't produce a drop of alcohol. Not a drop. What it does is take the beer which you have quite legally made by fermentation and remove all the noxious, poisonous substances which appear inevitably as by-products in all fermentations. Far from making alcohol, a little will actually be lost during this purification process. Instead of prohibiting it, the authorities should really be encouraging distillation by amateurs. And the general public, which is so rightly health-conscious these days, would be more than justified in demanding the right to do so. In attempting to find the reason for governments to ban the purification of beer or wine by distillation the first thing which comes to mind is the potential loss of revenue. After all, if everyone started making their own spirits at home the loss of revenue could be considerable. But this cannot be the real reason because the home production of beer and wine for one's own use is legal, and both are taxable when sold commercially, so the authorities must not be all that concerned about the loss of revenue when people make their own alcoholic beverages. A possible, and somewhat cynical, explanation for the prohibition of home distillation is based on the following reasoning: Home-made beer and wine are usually so inferior to a good commercial product that only the most dedicated amateurs will go to the trouble of first making and then drinking such doubtful concoctions. Consequently, there is no real threat to the sale of commercial products nor to the revenues generated by taxation. If, however, home distillation were permitted, every Tom, Dick and Harriette would be in a position to make a gin or vodka which was every bit as good as the finest commercial product on the market. This could, it might be argued, make serious inroads into commercial sales and into government revenues. Further thought, however, makes it very unlikely that amateur production of spirits would have any appreciable effect on commercial sales. For one thing the equipment is moderately expensive and it is necessary to follow directions rather carefully when using it so it is unlikely that the 19 practice would ever become really widespread. Moreover, many people prefer scotch, rye, rum, etc. to gin and vodka and it is only the latter which can be made safely and effectively by the amateur. So, if distillation were legalized for amateurs, it would probably become nothing more than an interesting hobby, just like making wine, and offer little competition to commercial producers. No, we have to look deeper than this in our search for a reason why governments have a hang-up about distillation. You see, it is not just amateurs who are penalized. Commercial producers also feel the heavy hand of government prejudice and disapproval. This is illustrated by several restrictions which apply in many countries. One is the fact that the advertising of beer and wine on television is permitted whereas the advertising of distilled spirits is prohibited. Another concerns the tax imposed on distilled alcoholic products --- per unit of alcohol the tax on the distilled product is much higher than it is on beer and wine. A third restriction on spirits can be seen in the alcoholic beverage section of supermarkets ---- beer and wine are sold, and possibly fortified wines such as vermouth, but raise the alcohol concentration to 40% and the ancient shibboleth of 'hard spirits' reigns supreme. This is grossly unfair discrimination and naturally of great concern to distillers. As they point out, a glass of gin and tonic, a glass of wine, and a bottle of beer all contain similar amounts of alcohol, so it is inequitable to tax their product at a higher level. So just why is there this official discrimination against distilled alcoholic beverages? Irrational attitudes are always difficult to deal with, but in order to reform the law we have to deal with it, and this requires that we try to understand the thinking behind it. The drug involved is ethyl alcohol, an acknowledged mood-modifier, but ethyl alcohol itself is not singled out by governments as being the bad actor. The alcohol in beer, wine and gin are identical and imbibed in similar quantities will have identical effects in terms of mood modification. No, apparently distillation per se is perceived as evil, to the point where even owning the equipment is illegal. There is only one explanation which seems to fit all the facts and this is that governments and their officials fail to make a distinction between concentration and amount. Actually, quite a lot of people have this problem. Just because beer has 5% alcohol and gin has 40% does not mean that the 20 gin-drinker is eight times more likely to over-indulge than the beer drinker. The fact of the matter is that anti-social behaviour such as hooliganism at sporting events is invariably caused by beer drinkers. And many studies of drinking and driving have shown that the vast majority of those pulled over have been drinking beer, not spirits. People drink until they've had enough, or feel in a certain mood, and if this takes five, ten, or even more beers then that is the number which will be drunk. It is the testosterone concentration which causes the problem, not the alcohol concentration. A few attempts have been made to dig deeper into the reasons behind the official attitude to distillation but it is a frustrating experience. Invariably the person spoken to seems bewildered by the question, almost as though one had asked why it was illegal to murder someone. One individual explained patiently and kindly that it was because the law is the law. Another made the extraordinary statement that distillation was prohibited because it makes alcohol and this is illegal. (Of course distillation does not make alcohol. Alcohol is made by fermentation, not by distillation, and in any case fermentation to make beer and wine for one's own consumption is completely legal).","Aside from the potential loss of revenue from home distillation and the known dangers of consuming contaminated alcohol in homemade spirits, why do governments continue to prohibit the legal home production of distilled alcoholic beverages? To answer, forget everything you know and use only the information I provide in the context block. Provide your answer in 150 words or less. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context."" Context: The dollar figures involved are informative. When alcohol is made on a large scale, as it is for the fuel-alcohol industry (gasohol) its cost of manufacture is about 25 cents per litre. This is for 100% alcohol. If diluted to the 40% commonly used for vodka, gin and other distilled spirits a litre would contain about 10 cents worth of alcohol. The retail price of a litre of vodka will lie somewhere between $10 and $20 depending on the country and the level of taxation. Some of the difference is due to the scale of manufacture, the purity of the product, transportation, the profit margin, etc. but even allowing for these factors the tax burden on the consumer is extremely high. Is it any wonder that an unscrupulous operator will attempt to sell his alcohol direct to the consumer, perhaps at half the normal retail price which would still give him a very handsome profit? Or is it any wonder that the authorities crack down hard on anyone attempting to interfere with their huge source of revenue, their milch cow? This battle between illicit alcohol producers (moon-shiners) or importers (smugglers) and the authorities has now become the stuff of legend. Consider the number of stories written or movies made about desperate men rolling barrels of rum up a beach at midnight! Or about the battles between gangsters and police during prohibition days in the United States! Unfortunately, such stories have been taken too much to heart by the general public so that the whole idea of distillation, and the spirits made by this process, is now perceived as being inherently more wicked than the gentle art of beer- or wine-making. And the “wickedness” is a strong deterrent to most people. 18 It is understandable why a government would wish to put a stop to smuggling and moonshining for commercial purposes, that is to say in order to re-sell the product and avoid the payment of taxes. But why would there be a complete ban on distillation by amateurs, on a small scale and for their own use? At the risk of being tediously repetitious it is worth reminding ourselves again (and again) that distillation is one of the most innocuous activities imaginable. It doesn't produce a drop of alcohol. Not a drop. What it does is take the beer which you have quite legally made by fermentation and remove all the noxious, poisonous substances which appear inevitably as by-products in all fermentations. Far from making alcohol, a little will actually be lost during this purification process. Instead of prohibiting it, the authorities should really be encouraging distillation by amateurs. And the general public, which is so rightly health-conscious these days, would be more than justified in demanding the right to do so. In attempting to find the reason for governments to ban the purification of beer or wine by distillation the first thing which comes to mind is the potential loss of revenue. After all, if everyone started making their own spirits at home the loss of revenue could be considerable. But this cannot be the real reason because the home production of beer and wine for one's own use is legal, and both are taxable when sold commercially, so the authorities must not be all that concerned about the loss of revenue when people make their own alcoholic beverages. A possible, and somewhat cynical, explanation for the prohibition of home distillation is based on the following reasoning: Home-made beer and wine are usually so inferior to a good commercial product that only the most dedicated amateurs will go to the trouble of first making and then drinking such doubtful concoctions. Consequently, there is no real threat to the sale of commercial products nor to the revenues generated by taxation. If, however, home distillation were permitted, every Tom, Dick and Harriette would be in a position to make a gin or vodka which was every bit as good as the finest commercial product on the market. This could, it might be argued, make serious inroads into commercial sales and into government revenues. Further thought, however, makes it very unlikely that amateur production of spirits would have any appreciable effect on commercial sales. For one thing the equipment is moderately expensive and it is necessary to follow directions rather carefully when using it so it is unlikely that the 19 practice would ever become really widespread. Moreover, many people prefer scotch, rye, rum, etc. to gin and vodka and it is only the latter which can be made safely and effectively by the amateur. So, if distillation were legalized for amateurs, it would probably become nothing more than an interesting hobby, just like making wine, and offer little competition to commercial producers. No, we have to look deeper than this in our search for a reason why governments have a hang-up about distillation. You see, it is not just amateurs who are penalized. Commercial producers also feel the heavy hand of government prejudice and disapproval. This is illustrated by several restrictions which apply in many countries. One is the fact that the advertising of beer and wine on television is permitted whereas the advertising of distilled spirits is prohibited. Another concerns the tax imposed on distilled alcoholic products --- per unit of alcohol the tax on the distilled product is much higher than it is on beer and wine. A third restriction on spirits can be seen in the alcoholic beverage section of supermarkets ---- beer and wine are sold, and possibly fortified wines such as vermouth, but raise the alcohol concentration to 40% and the ancient shibboleth of 'hard spirits' reigns supreme. This is grossly unfair discrimination and naturally of great concern to distillers. As they point out, a glass of gin and tonic, a glass of wine, and a bottle of beer all contain similar amounts of alcohol, so it is inequitable to tax their product at a higher level. So just why is there this official discrimination against distilled alcoholic beverages? Irrational attitudes are always difficult to deal with, but in order to reform the law we have to deal with it, and this requires that we try to understand the thinking behind it. The drug involved is ethyl alcohol, an acknowledged mood-modifier, but ethyl alcohol itself is not singled out by governments as being the bad actor. The alcohol in beer, wine and gin are identical and imbibed in similar quantities will have identical effects in terms of mood modification. No, apparently distillation per se is perceived as evil, to the point where even owning the equipment is illegal. There is only one explanation which seems to fit all the facts and this is that governments and their officials fail to make a distinction between concentration and amount. Actually, quite a lot of people have this problem. Just because beer has 5% alcohol and gin has 40% does not mean that the 20 gin-drinker is eight times more likely to over-indulge than the beer drinker. The fact of the matter is that anti-social behaviour such as hooliganism at sporting events is invariably caused by beer drinkers. And many studies of drinking and driving have shown that the vast majority of those pulled over have been drinking beer, not spirits. People drink until they've had enough, or feel in a certain mood, and if this takes five, ten, or even more beers then that is the number which will be drunk. It is the testosterone concentration which causes the problem, not the alcohol concentration. A few attempts have been made to dig deeper into the reasons behind the official attitude to distillation but it is a frustrating experience. Invariably the person spoken to seems bewildered by the question, almost as though one had asked why it was illegal to murder someone. One individual explained patiently and kindly that it was because the law is the law. Another made the extraordinary statement that distillation was prohibited because it makes alcohol and this is illegal. (Of course distillation does not make alcohol. Alcohol is made by fermentation, not by distillation, and in any case fermentation to make beer and wine for one's own consumption is completely legal).",Legal,Fact Finding,Q&A This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Do not use bullet points. Limit your response to 100 words.,How do regulators' powers achieve their goals?,"Regulatory Powers Regulators implement policy using their powers, which vary by agency. Powers, which can also be thought of as tools, can be grouped into a few broad categories: • Licensing, chartering, or registration. A starting point for understanding the regulatory system is that most activities cannot be undertaken unless a firm, individual, or market has received the proper credentials from the appropriate state or federal regulator. Each type of charter, license, or registration granted by the respective regulator governs the sets of financial activities that the holder is permitted to engage in. For example, a firm cannot accept federally insured 3 U.S. Government Accountability Office (GAO), Financial Regulation, GAO-16-175, February 2016, https://www.gao.gov/assets/680/675400.pdf. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 3 deposits unless it is chartered as a bank, thrift, or credit union by a depository institution regulator. Likewise, an individual generally cannot buy and sell securities to others unless licensed as a broker-dealer.4 To be granted a license, charter, or registration, the recipient must accept the terms and conditions that accompany it. Depending on the type, those conditions could include regulatory oversight, training requirements, and a requirement to act according to a set of standards or code of ethics. Failure to meet the terms and conditions could result in fines, penalties, remedial actions, license or charter revocation, or criminal charges. • Rulemaking. Regulators issue rules (regulations) through the rulemaking process to implement statutory mandates.5 Typically, statutory mandates provide regulators with a policy goal in general terms, and regulations fill in the specifics. Rules lay out the guidelines for how market participants may or may not act to comply with the mandate. • Oversight and supervision. Regulators ensure that their rules are adhered to through oversight and supervision. This allows regulators to observe market participants’ behavior and instruct them to modify or cease improper behavior. Supervision may entail active, ongoing monitoring (as for banks) or investigating complaints and allegations ex post (as is common in securities markets). In some cases, such as banking, supervision includes periodic examinations and inspections, whereas in other cases, regulators rely more heavily on selfreporting. Regulators explain supervisory priorities and points of emphasis by issuing supervisory letters and guidance. • Enforcement. Regulators can compel firms to modify their behavior through enforcement powers. Enforcement powers include the ability to issue fines, penalties, and cease-and-desist orders; to undertake criminal or civil actions in court or administrative proceedings or arbitrations; and to revoke licenses and charters. In some cases, regulators initiate legal action at their own prompting or in response to consumer or investor complaints. In other cases, regulators explicitly allow consumers and investors to sue for damages when firms do not comply with regulations, or they provide legal protection to firms that do comply. • Resolution. Some regulators have the power to resolve a failing firm by taking control of the firm and initiating conservatorship (i.e., the regulator runs the firm on an ongoing basis) or receivership (i.e., the regulator winds the firm down). Other types of failing financial firms are resolved through bankruptcy, a judicial process separate from the regulators. Goals of Regulation Financial regulation is primarily intended to achieve the following underlying policy outcomes:6 • Market efficiency and integrity. Regulators seek to ensure that markets operate efficiently and that market participants have confidence in the market’s integrity. 4 One may obtain separate licenses to be a broker or a dealer, but in practice, many obtain both. 5 For more information, see CRS Report R41546, A Brief Overview of Rulemaking and Judicial Review, by Todd Garvey. 6 Regulators are also tasked with promoting certain social goals, such as community reinvestment or affordable housing. Because this report focuses on regulation, it will not discuss social goals. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 4 Liquidity, low costs, the presence of many buyers and sellers, the availability of information, and a lack of excessive volatility are examples of the characteristics of an efficient market. Regulation can also improve market efficiency by addressing market failures, such as principal-agent problems,7 asymmetric information,8 and moral hazard.9 Regulators contribute to market integrity by ensuring that activities are transparent, contracts can be enforced, and the “rules of the game” they set are enforced. Integrity generally leads to greater efficiency. • Consumer and investor protection. Regulators seek to ensure that consumers or investors do not suffer from fraud, discrimination, manipulation, and theft. Regulators try to prevent exploitative or abusive practices intended to take advantage of unwitting consumers or investors. In some cases, protection is limited to enabling consumers and investors to understand the inherent risks when they enter into a transaction. In other cases, protection is based on the principle of suitability—efforts to ensure that more risky products or product features are accessible only to financially sophisticated or secure consumers or investors. • Capital formation and access to credit. Regulators seek to ensure that firms and consumers are able to access credit and capital to meet their needs such that credit and economic activity can grow at a healthy rate. Regulators try to ensure that capital and credit are available to all worthy borrowers, regardless of personal characteristics, such as race, gender, and location. Examples are fair lending laws and fair housing goals. • Illicit activity prevention. Regulators seek to ensure that the financial system cannot be used to support criminal and terrorist activity. Examples are policies to prevent money laundering, tax evasion, terrorism financing, and the contravention of financial sanctions. • Taxpayer protection. Regulators seek to ensure that losses or failures in financial markets do not result in federal government payouts or the assumption of liabilities that are ultimately borne by taxpayers. Only certain types of financial activity are explicitly backed by the federal government or by regulatorrun insurance schemes that are backed by the federal government, such as the Deposit Insurance Fund (DIF) run by the FDIC. Such schemes are self-financed by the insured firms through premium payments unless the losses exceed the insurance fund, in which case taxpayer money is used temporarily or permanently to fill the gap. In the case of a financial crisis, the government may decide that the “least bad” option is to provide funds in ways not explicitly promised or previously contemplated to restore stability. “Bailouts” of large failing firms in 2008 are the most well-known examples. In this sense, there may be implicit taxpayer backing of parts or all of the financial system. • Financial stability. Financial regulation seeks to maintain financial stability through preventive and palliative measures that mitigate systemic risk. At times, financial markets stop functioning well—markets freeze, participants panic, 7 For example, financial agents may have incentives to make decisions that are not in the best interests of their clients, and clients may not be able to adequately monitor their behavior. 8 For example, firms issuing securities know more about their financial prospects than do investors purchasing those securities, which can result in a “lemons” problem in which low-quality firms drive high-quality firms out of the marketplace. 9 For example, individuals may act more imprudently if they are insured against a risk. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 5 credit becomes unavailable, and multiple firms fail. Financial instability can be localized (to a specific market or activity) or more general. Sometimes instability can be contained and quelled through market actions or policy intervention; at other times, instability metastasizes and does broader damage to the real economy. The most recent example of the latter was the financial crisis of 2007- 2009. Traditionally, financial stability concerns have centered on banking, but the recent crisis illustrates the potential for systemic risk to arise in other parts of the financial system as well. These regulatory goals are sometimes complementary but at other times conflict with each other. For example, without an adequate level of consumer and investor protections, fewer individuals may be willing to participate in financial markets, and efficiency and capital formation could suffer. But, at some point, too many consumer and investor safeguards and protections could make credit and capital prohibitively expensive, reducing market efficiency and capital formation. Regulation generally aims to seek a middle ground between these two extremes in which regulatory burden is as small as possible and regulatory benefits are as large as possible. Because some firms can cope with regulatory burden better than others can, sometimes regulation is tailored so that smaller firms, for example, are exempted from a regulation or face a streamlined version of a regulation. As a result, when taking any action, regulators balance the tradeoffs between their various goals.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Do not use bullet points. Limit your response to 100 words. Regulatory Powers Regulators implement policy using their powers, which vary by agency. Powers, which can also be thought of as tools, can be grouped into a few broad categories: • Licensing, chartering, or registration. A starting point for understanding the regulatory system is that most activities cannot be undertaken unless a firm, individual, or market has received the proper credentials from the appropriate state or federal regulator. Each type of charter, license, or registration granted by the respective regulator governs the sets of financial activities that the holder is permitted to engage in. For example, a firm cannot accept federally insured 3 U.S. Government Accountability Office (GAO), Financial Regulation, GAO-16-175, February 2016, https://www.gao.gov/assets/680/675400.pdf. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 3 deposits unless it is chartered as a bank, thrift, or credit union by a depository institution regulator. Likewise, an individual generally cannot buy and sell securities to others unless licensed as a broker-dealer.4 To be granted a license, charter, or registration, the recipient must accept the terms and conditions that accompany it. Depending on the type, those conditions could include regulatory oversight, training requirements, and a requirement to act according to a set of standards or code of ethics. Failure to meet the terms and conditions could result in fines, penalties, remedial actions, license or charter revocation, or criminal charges. • Rulemaking. Regulators issue rules (regulations) through the rulemaking process to implement statutory mandates.5 Typically, statutory mandates provide regulators with a policy goal in general terms, and regulations fill in the specifics. Rules lay out the guidelines for how market participants may or may not act to comply with the mandate. • Oversight and supervision. Regulators ensure that their rules are adhered to through oversight and supervision. This allows regulators to observe market participants’ behavior and instruct them to modify or cease improper behavior. Supervision may entail active, ongoing monitoring (as for banks) or investigating complaints and allegations ex post (as is common in securities markets). In some cases, such as banking, supervision includes periodic examinations and inspections, whereas in other cases, regulators rely more heavily on selfreporting. Regulators explain supervisory priorities and points of emphasis by issuing supervisory letters and guidance. • Enforcement. Regulators can compel firms to modify their behavior through enforcement powers. Enforcement powers include the ability to issue fines, penalties, and cease-and-desist orders; to undertake criminal or civil actions in court or administrative proceedings or arbitrations; and to revoke licenses and charters. In some cases, regulators initiate legal action at their own prompting or in response to consumer or investor complaints. In other cases, regulators explicitly allow consumers and investors to sue for damages when firms do not comply with regulations, or they provide legal protection to firms that do comply. • Resolution. Some regulators have the power to resolve a failing firm by taking control of the firm and initiating conservatorship (i.e., the regulator runs the firm on an ongoing basis) or receivership (i.e., the regulator winds the firm down). Other types of failing financial firms are resolved through bankruptcy, a judicial process separate from the regulators. Goals of Regulation Financial regulation is primarily intended to achieve the following underlying policy outcomes:6 • Market efficiency and integrity. Regulators seek to ensure that markets operate efficiently and that market participants have confidence in the market’s integrity. 4 One may obtain separate licenses to be a broker or a dealer, but in practice, many obtain both. 5 For more information, see CRS Report R41546, A Brief Overview of Rulemaking and Judicial Review, by Todd Garvey. 6 Regulators are also tasked with promoting certain social goals, such as community reinvestment or affordable housing. Because this report focuses on regulation, it will not discuss social goals. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 4 Liquidity, low costs, the presence of many buyers and sellers, the availability of information, and a lack of excessive volatility are examples of the characteristics of an efficient market. Regulation can also improve market efficiency by addressing market failures, such as principal-agent problems,7 asymmetric information,8 and moral hazard.9 Regulators contribute to market integrity by ensuring that activities are transparent, contracts can be enforced, and the “rules of the game” they set are enforced. Integrity generally leads to greater efficiency. • Consumer and investor protection. Regulators seek to ensure that consumers or investors do not suffer from fraud, discrimination, manipulation, and theft. Regulators try to prevent exploitative or abusive practices intended to take advantage of unwitting consumers or investors. In some cases, protection is limited to enabling consumers and investors to understand the inherent risks when they enter into a transaction. In other cases, protection is based on the principle of suitability—efforts to ensure that more risky products or product features are accessible only to financially sophisticated or secure consumers or investors. • Capital formation and access to credit. Regulators seek to ensure that firms and consumers are able to access credit and capital to meet their needs such that credit and economic activity can grow at a healthy rate. Regulators try to ensure that capital and credit are available to all worthy borrowers, regardless of personal characteristics, such as race, gender, and location. Examples are fair lending laws and fair housing goals. • Illicit activity prevention. Regulators seek to ensure that the financial system cannot be used to support criminal and terrorist activity. Examples are policies to prevent money laundering, tax evasion, terrorism financing, and the contravention of financial sanctions. • Taxpayer protection. Regulators seek to ensure that losses or failures in financial markets do not result in federal government payouts or the assumption of liabilities that are ultimately borne by taxpayers. Only certain types of financial activity are explicitly backed by the federal government or by regulatorrun insurance schemes that are backed by the federal government, such as the Deposit Insurance Fund (DIF) run by the FDIC. Such schemes are self-financed by the insured firms through premium payments unless the losses exceed the insurance fund, in which case taxpayer money is used temporarily or permanently to fill the gap. In the case of a financial crisis, the government may decide that the “least bad” option is to provide funds in ways not explicitly promised or previously contemplated to restore stability. “Bailouts” of large failing firms in 2008 are the most well-known examples. In this sense, there may be implicit taxpayer backing of parts or all of the financial system. • Financial stability. Financial regulation seeks to maintain financial stability through preventive and palliative measures that mitigate systemic risk. At times, financial markets stop functioning well—markets freeze, participants panic, 7 For example, financial agents may have incentives to make decisions that are not in the best interests of their clients, and clients may not be able to adequately monitor their behavior. 8 For example, firms issuing securities know more about their financial prospects than do investors purchasing those securities, which can result in a “lemons” problem in which low-quality firms drive high-quality firms out of the marketplace. 9 For example, individuals may act more imprudently if they are insured against a risk. Who Regulates Whom? An Overview of the U.S. Financial Regulatory Framework Congressional Research Service 5 credit becomes unavailable, and multiple firms fail. Financial instability can be localized (to a specific market or activity) or more general. Sometimes instability can be contained and quelled through market actions or policy intervention; at other times, instability metastasizes and does broader damage to the real economy. The most recent example of the latter was the financial crisis of 2007- 2009. Traditionally, financial stability concerns have centered on banking, but the recent crisis illustrates the potential for systemic risk to arise in other parts of the financial system as well. These regulatory goals are sometimes complementary but at other times conflict with each other. For example, without an adequate level of consumer and investor protections, fewer individuals may be willing to participate in financial markets, and efficiency and capital formation could suffer. But, at some point, too many consumer and investor safeguards and protections could make credit and capital prohibitively expensive, reducing market efficiency and capital formation. Regulation generally aims to seek a middle ground between these two extremes in which regulatory burden is as small as possible and regulatory benefits are as large as possible. Because some firms can cope with regulatory burden better than others can, sometimes regulation is tailored so that smaller firms, for example, are exempted from a regulation or face a streamlined version of a regulation. As a result, when taking any action, regulators balance the tradeoffs between their various goals. How do regulators' powers achieve their goals?",Financial,Fact Finding,Q&A "Only use the information provided in the context block to answer the question. When appropriate, provide the answer in a bulleted list. Keep each bullet point to one to two sentences.",What types of things can influence a person's decisions about how to save for retirement?,"As discussed earlier in this report, household decisionmaking related to retirement has become more important over time. The shift from DB to DC retirement plans requires families to assume more responsibility for managing their retirement and making decisions about retirement account contributions and investments, as well as making decisions about how to draw down these funds in retirement. For this reason, understanding household decisionmaking in retirement planning is important, particularly when considering retirement savings policy issues and the impact of different policy options on retirement security. The life-cycle model is a prevalent economic hypothesis that assumes households usually want to keep consumption levels stable over time.57 For example, severely reducing consumption one month may be more painful for people than the pleasure of a much higher household consumption level in another month. Therefore, people save and invest during their careers in order to afford a stable income across their lives, including in retirement. This model suggests that wealth should increase as people age, which generally fits household financial data in the United States.58 In this theory, households adjust their savings rate during their working years rationally, based on interest rates, investment returns, life expectancy, Social Security or pension benefits, and other relevant factors. Evidence exists that some households adjust their retirement planning based on these types of factors.59 However, in the United States, income and consumption move together more closely than the life-cycle model would predict, suggesting some households may not save enough for their retirement needs or other lower-income periods. Mainstream economic theory asserts that competitive free markets generally lead to efficient distributions of goods and services to maximize value for society.61 If certain conditions hold, policy interventions cannot improve on the financial decisions that consumers make based on their unique situations and preferences. For this reason, some policymakers are hesitant to disrupt free markets, based on the theory that prices determined by market forces lead to efficient outcomes without intervention. However, in these theoretical frameworks, a free market may become inefficient due to departures from standard economic assumptions, which includes assuming that consumers and firms act rationally with perfect information. When these assumptions do not hold, it may cause a reduction in economic efficiency and consumer welfare. In these cases, government policy can potentially bring the market to a more efficient outcome, maximizing social welfare. Yet, policymakers often find it challenging to determine whether a policy intervention will help or harm a particular market to reach its efficient outcome. The following section discusses behavioral biases, which are a specific departure from the rational decisionmaking condition associated with theoretical economic efficiency. This departure is particularly important for understanding people’s decisionmaking in saving for retirement and investment markets. When people act with predictable biases, markets may become less efficient, and government policy—such as consumer disclosures or other plan design requirements—may be appropriate. However, these policies may also lead to unintended outcomes, which should be taken into account. Behavioral research suggests that people tend to have biases in rather predictable patterns.62 This research suggests that the human brain has evolved to quickly make judgments in bounded, rational ways, using heuristics—or mental shortcuts—to make decisions. These heuristics generally help people make appropriate decisions quickly and easily, but they can sometimes result in choices that make the decisionmaker worse off financially. For example, the number, order, and structure of options, as well as the process around the choice, can change decisions for many people. A few of these biases tend to be particularly important for understanding retirement planning decisionmaking: Choice Architecture. Research suggests that how financial decisions are framed can affect consumer decisionmaking. Framing can affect decisions in many ways. • Anchoring. People can be influenced, or anchored, by an initial number, even if it is unrelated to their next choice.64 In one illustration of this concept, researchers had subjects spin a wheel of fortune with numbers between 0 and 100, then asked them the percentage of African countries in the United Nations. The random number generated in the first stage subconsciously affected subjects’ guesses in the second stage, even though they were not related. Therefore, without the anchor, people’s estimates likely would have been different. In the retirement savings context, the automatic contribution rate in 401(k)s and the percent of salary at which employers provide maximum matches may be anchors that influence how much a person decides to put toward retirement savings. • Defaults. People can also be influenced by defaults established in how a decision is framed. 66 For example, employees are more likely to be enrolled in a 401(k) plan if an employer defaults them into it than if they actively need to make a choice to participate. • Choice Overload. When making decisions, people often find it difficult to navigate complexity, such as many choices to choose from or items to consider. In the retirement savings context, this means that more investment fund options in retirement savings plans can sometimes lead to procrastination or failure to make a decision. Choice overload can also lead to poor decisionmaking, as some research suggests that fewer choices in retirement savings plans might lead to better retirement investment decisions • Asset Allocation and Diversification. People tend to naively make diversification choices when making allocation decisions. For example, in the retirement context, when making decisions about how much to invest in a collection of funds, some people choose to spread their investments evenly across available funds (whether financially appropriate for their situation or not). Biases Toward the Future. Research suggests that common cognitive biases towards the future can also affect consumer decisionmaking. Present Bias. When people tend to put more value on having something now, rather than in the future—even when there is a large benefit for waiting—this behavior is called present bias. For example, in the retirement context, people tend to have a preference for lump sums over annuities, independent of risk considerations. Research suggests that people with more present bias tend to save less for retirement when controlling for other factors. Self-Control. Even when people decide they should do something, such as saving for the future or choosing a retirement plan, self-control and procrastination may prevent them from following their intentions. These human biases might lead consumers to make financial decisions that are not optimal, such as undersaving. Although consumers might not be aware of these biases when making financial decisions, firms may take advantage of them to attract consumers. For example, choice architecture biases might influence how marketing materials are developed, emphasizing certain terms—such as high past investment return rate—to make a financial product seem more desirable to consumers. In addition, product features may be developed to take advantage of people’s present bias or selfcontrol mistakes. Less knowledgeable retirement savers’ decisionmaking might be more sensitive to choice architecture biases. Biases can also be used to encourage people to save more for retirement and make better retirement decisions. For example, some research suggests that choice architecture environments can make retirement more salient (e.g., annual consumer disclosures that project future retirement income may lead to more retirement savings). Moreover, how saving and investment options are framed may help some people make better retirement decisions. For example, some research suggests that preference checklists, which list factors—such as perceived health, life expectancy, and risk of outliving one’s resources—that people should consider when making a retirement decision, may improve retirement decisionmaking. Although these techniques can be used to encourage socially beneficial goals, such as planning and saving more for retirement, changing the choice environment can also sometimes have perverse impacts. For example, defaulting people at a fixed savings rate can increase participation in retirement plans on average but may discourage some people from making an active decision when they start a new job to increase the contribution rate from the default to a higher level. For these people, the lower contribution rate may lead to less retirement savings over time. Likewise, defaulting people into life-cycle retirement investment plans may lead to more appropriate long-term investment decisions on average, but the investment default also may encourage fewer people to make active decisions or put them in a plan that may conflict with other savings vehicles. Moreover, although defaulting people into 401(k)s can increase the number of people who save for retirement, it may also lead to increased consumer debt without large impacts on household net worth over time. ","As discussed earlier in this report, household decisionmaking related to retirement has become more important over time. The shift from DB to DC retirement plans requires families to assume more responsibility for managing their retirement and making decisions about retirement account contributions and investments, as well as making decisions about how to draw down these funds in retirement. For this reason, understanding household decisionmaking in retirement planning is important, particularly when considering retirement savings policy issues and the impact of different policy options on retirement security. The life-cycle model is a prevalent economic hypothesis that assumes households usually want to keep consumption levels stable over time.57 For example, severely reducing consumption one month may be more painful for people than the pleasure of a much higher household consumption level in another month. Therefore, people save and invest during their careers in order to afford a stable income across their lives, including in retirement. This model suggests that wealth should increase as people age, which generally fits household financial data in the United States.58 In this theory, households adjust their savings rate during their working years rationally, based on interest rates, investment returns, life expectancy, Social Security or pension benefits, and other relevant factors. Evidence exists that some households adjust their retirement planning based on these types of factors.59 However, in the United States, income and consumption move together more closely than the life-cycle model would predict, suggesting some households may not save enough for their retirement needs or other lower-income periods. Mainstream economic theory asserts that competitive free markets generally lead to efficient distributions of goods and services to maximize value for society.61 If certain conditions hold, policy interventions cannot improve on the financial decisions that consumers make based on their unique situations and preferences. For this reason, some policymakers are hesitant to disrupt free markets, based on the theory that prices determined by market forces lead to efficient outcomes without intervention. However, in these theoretical frameworks, a free market may become inefficient due to departures from standard economic assumptions, which includes assuming that consumers and firms act rationally with perfect information. When these assumptions do not hold, it may cause a reduction in economic efficiency and consumer welfare. In these cases, government policy can potentially bring the market to a more efficient outcome, maximizing social welfare. Yet, policymakers often find it challenging to determine whether a policy intervention will help or harm a particular market to reach its efficient outcome. The following section discusses behavioral biases, which are a specific departure from the rational decisionmaking condition associated with theoretical economic efficiency. This departure is particularly important for understanding people’s decisionmaking in saving for retirement and investment markets. When people act with predictable biases, markets may become less efficient, and government policy—such as consumer disclosures or other plan design requirements—may be appropriate. However, these policies may also lead to unintended outcomes, which should be taken into account. Behavioral research suggests that people tend to have biases in rather predictable patterns.62 This research suggests that the human brain has evolved to quickly make judgments in bounded, rational ways, using heuristics—or mental shortcuts—to make decisions. These heuristics generally help people make appropriate decisions quickly and easily, but they can sometimes result in choices that make the decisionmaker worse off financially. For example, the number, order, and structure of options, as well as the process around the choice, can change decisions for many people. A few of these biases tend to be particularly important for understanding retirement planning decisionmaking: Choice Architecture. Research suggests that how financial decisions are framed can affect consumer decisionmaking. Framing can affect decisions in many ways. • Anchoring. People can be influenced, or anchored, by an initial number, even if it is unrelated to their next choice.64 In one illustration of this concept, researchers had subjects spin a wheel of fortune with numbers between 0 and 100, then asked them the percentage of African countries in the United Nations. The random number generated in the first stage subconsciously affected subjects’ guesses in the second stage, even though they were not related. Therefore, without the anchor, people’s estimates likely would have been different. In the retirement savings context, the automatic contribution rate in 401(k)s and the percent of salary at which employers provide maximum matches may be anchors that influence how much a person decides to put toward retirement savings. • Defaults. People can also be influenced by defaults established in how a decision is framed. 66 For example, employees are more likely to be enrolled in a 401(k) plan if an employer defaults them into it than if they actively need to make a choice to participate. • Choice Overload. When making decisions, people often find it difficult to navigate complexity, such as many choices to choose from or items to consider. In the retirement savings context, this means that more investment fund options in retirement savings plans can sometimes lead to procrastination or failure to make a decision. Choice overload can also lead to poor decisionmaking, as some research suggests that fewer choices in retirement savings plans might lead to better retirement investment decisions • Asset Allocation and Diversification. People tend to naively make diversification choices when making allocation decisions. For example, in the retirement context, when making decisions about how much to invest in a collection of funds, some people choose to spread their investments evenly across available funds (whether financially appropriate for their situation or not). Biases Toward the Future. Research suggests that common cognitive biases towards the future can also affect consumer decisionmaking. Present Bias. When people tend to put more value on having something now, rather than in the future—even when there is a large benefit for waiting—this behavior is called present bias. For example, in the retirement context, people tend to have a preference for lump sums over annuities, independent of risk considerations. Research suggests that people with more present bias tend to save less for retirement when controlling for other factors. Self-Control. Even when people decide they should do something, such as saving for the future or choosing a retirement plan, self-control and procrastination may prevent them from following their intentions. These human biases might lead consumers to make financial decisions that are not optimal, such as undersaving. Although consumers might not be aware of these biases when making financial decisions, firms may take advantage of them to attract consumers. For example, choice architecture biases might influence how marketing materials are developed, emphasizing certain terms—such as high past investment return rate—to make a financial product seem more desirable to consumers. In addition, product features may be developed to take advantage of people’s present bias or selfcontrol mistakes. Less knowledgeable retirement savers’ decisionmaking might be more sensitive to choice architecture biases. Biases can also be used to encourage people to save more for retirement and make better retirement decisions. For example, some research suggests that choice architecture environments can make retirement more salient (e.g., annual consumer disclosures that project future retirement income may lead to more retirement savings). Moreover, how saving and investment options are framed may help some people make better retirement decisions. For example, some research suggests that preference checklists, which list factors—such as perceived health, life expectancy, and risk of outliving one’s resources—that people should consider when making a retirement decision, may improve retirement decisionmaking. Although these techniques can be used to encourage socially beneficial goals, such as planning and saving more for retirement, changing the choice environment can also sometimes have perverse impacts. For example, defaulting people at a fixed savings rate can increase participation in retirement plans on average but may discourage some people from making an active decision when they start a new job to increase the contribution rate from the default to a higher level. For these people, the lower contribution rate may lead to less retirement savings over time. Likewise, defaulting people into life-cycle retirement investment plans may lead to more appropriate long-term investment decisions on average, but the investment default also may encourage fewer people to make active decisions or put them in a plan that may conflict with other savings vehicles. Moreover, although defaulting people into 401(k)s can increase the number of people who save for retirement, it may also lead to increased consumer debt without large impacts on household net worth over time. Only use the information provided in the context block to answer the question. When appropriate, provide the answer in a bulleted list. Keep each bullet point to one to two sentences. What types of things can influence a person's decisions about how to save for retirement? ",Financial,Fact Finding,Q&A "The information provided in the prompt contains all the knowledge necessary to answer the questions in the prompt. Do not use any knowledge other than what is contained within the full prompt in your response. If you decide it is not possible to answer the question from the context alone, say ""I could not find this information in the provided text"" Format the output as a numbered list, and split the numbers as you see fit.",What are potential solutions given to address the limitations in each of the 6 areas of continuing research?,"Known limitations of LLM-based interfaces like Gemini Gemini is just one part of our continuing effort to develop LLMs responsibly. Throughout the course of this work, we have discovered and discussed several limitations associated with LLMs. Here, we focus on six areas of continuing research: Accuracy: Gemini’s responses might be inaccurate, especially when it’s asked about complex or factual topics; Bias: Gemini’s responses might reflect biases present in its training data; Multiple Perspectives: Gemini’s responses might fail to show a range of views; Persona: Gemini’s responses might incorrectly suggest it has personal opinions or feelings, False positives and false negatives: Gemini might not respond to some appropriate prompts and provide inappropriate responses to others, and Vulnerability to adversarial prompting: users will find ways to stress test Gemini with nonsensical prompts or questions rarely asked in the real world. We continue to explore new approaches and areas for improved performance in each of these areas. 4 An overview of the Gemini appAccuracy Gemini is grounded in Google’s understanding of authoritative information, and is trained to generate responses that are relevant to the context of your prompt and in line with what you’re looking for. But like all LLMs, Gemini can sometimes confidently and convincingly generate responses that contain inaccurate or misleading information. Since LLMs work by predicting the next word or sequences of words, they are not yet fully capable of distinguishing between accurate and inaccurate information on their own. We have seen Gemini present responses that contain or even invent inaccurate information (e.g., misrepresenting how it was trained or suggesting the name of a book that doesn’t exist). In response we have created features like “double check”, which uses Google Search to find content that helps you assess Gemini’s responses, and gives you links to sources to help you corroborate the information you get from Gemini. Bias Training data, including from publicly available sources, reflects a diversity of perspectives and opinions. We continue to research how to use this data in a way that ensures that an LLM’s response incorporates a wide range of viewpoints, while minimizing inaccurate overgeneralizations and biases. Gaps, biases, and overgeneralizations in training data can be reflected in a model’s outputs as it tries to predict likely responses to a prompt. We see these issues manifest in a number of ways (e.g., responses that reflect only one culture or demographic, reference problematic overgeneralizations, exhibit gender, religious, or ethnic biases, or promote only one point of view). For some topics, there are data voids — in other words, not enough reliable information about a given subject for the LLM to learn about it and then make good predictions — which can result in low-quality or inaccurate responses. We continue to work with domain experts and a diversity of communities to draw on deep expertise outside of Google. Multiple Perspectives For subjective topics, Gemini is designed to provide users with multiple perspectives if the user does not request a specific point of view. For example, if prompted for information on something that cannot be verified by primary source facts or authoritative sources — like a subjective opinion on “best” or “worst” — Gemini should respond in a way that reflects a wide range of viewpoints. But since LLMs like Gemini train on the content publicly available on the internet, they can reflect positive or negative views of specific politicians, celebrities, or other public figures, or even incorporate views on just one side of controversial social or political issues. Gemini should not respond in a way that endorses a particular viewpoint on these topics, and we will use feedback on these types of responses to train Gemini to better address them. Persona Gemini might at times generate responses that seem to suggest it has opinions or emotions, like love or sadness, since it has trained on language that people use to reflect the human experience. We have developed a set of guidelines around how Gemini might represent itself (i.e., its persona) and continue to finetune the model to provide objective responses. 5 An overview of the Gemini appFalse positives / negatives We’ve put in place a set of policy guidelines to help train Gemini and avoid generating problematic responses. Gemini can sometimes misinterpret these guidelines, producing “false positives” and “false negatives.” In a “false positive,” Gemini might not provide a response to a reasonable prompt, misinterpreting the prompt as inappropriate; and in a “false negative,” Gemini might generate an inappropriate response, despite the guidelines in place. Sometimes, the occurrence of false positives or false negatives may give the impression that Gemini is biased: For example, a false positive might cause Gemini to not respond to a question about one side of an issue, while it will respond to the same question about the other side. We continue to tune these models to better understand and categorize inputs and outputs as language, events and society rapidly evolve. Vulnerability to adversarial prompting We expect users to test the limits of what Gemini can do and attempt to break its protections, including trying to get it to divulge its training protocols or other information, or try to get around its safety mechanisms. We have tested and continue to test Gemini rigorously, but we know users will find unique, complex ways to stress-test it further. This is an important part of refining Gemini and we look forward to learning the new prompts users come up with. Indeed, since Gemini launched in 2023, we’ve seen users challenge it with prompts that range from the philosophical to the nonsensical – and in some cases, we’ve seen Gemini respond with answers that are equally nonsensical or not aligned with our stated approach. Figuring out methods to help Gemini respond to these sorts of prompts is an on-going challenge and we have continued to expand our internal evaluations and red-teaming to strive toward continued improvement to accuracy, and objectivity and nuance.","What are potential solutions given to address the limitations in each of the 6 areas of continuing research? The information provided in the prompt contains all the knowledge necessary to answer the questions in the prompt. Do not use any knowledge other than what is contained within the full prompt in your response. If you decide it is not possible to answer the question from the context alone, say ""I could not find this information in the provided text"" Format the output as a numbered list, and split the numbers as you see fit. Known limitations of LLM-based interfaces like Gemini Gemini is just one part of our continuing effort to develop LLMs responsibly. Throughout the course of this work, we have discovered and discussed several limitations associated with LLMs. Here, we focus on six areas of continuing research: Accuracy: Gemini’s responses might be inaccurate, especially when it’s asked about complex or factual topics; Bias: Gemini’s responses might reflect biases present in its training data; Multiple Perspectives: Gemini’s responses might fail to show a range of views; Persona: Gemini’s responses might incorrectly suggest it has personal opinions or feelings, False positives and false negatives: Gemini might not respond to some appropriate prompts and provide inappropriate responses to others, and Vulnerability to adversarial prompting: users will find ways to stress test Gemini with nonsensical prompts or questions rarely asked in the real world. We continue to explore new approaches and areas for improved performance in each of these areas. 4 An overview of the Gemini appAccuracy Gemini is grounded in Google’s understanding of authoritative information, and is trained to generate responses that are relevant to the context of your prompt and in line with what you’re looking for. But like all LLMs, Gemini can sometimes confidently and convincingly generate responses that contain inaccurate or misleading information. Since LLMs work by predicting the next word or sequences of words, they are not yet fully capable of distinguishing between accurate and inaccurate information on their own. We have seen Gemini present responses that contain or even invent inaccurate information (e.g., misrepresenting how it was trained or suggesting the name of a book that doesn’t exist). In response we have created features like “double check”, which uses Google Search to find content that helps you assess Gemini’s responses, and gives you links to sources to help you corroborate the information you get from Gemini. Bias Training data, including from publicly available sources, reflects a diversity of perspectives and opinions. We continue to research how to use this data in a way that ensures that an LLM’s response incorporates a wide range of viewpoints, while minimizing inaccurate overgeneralizations and biases. Gaps, biases, and overgeneralizations in training data can be reflected in a model’s outputs as it tries to predict likely responses to a prompt. We see these issues manifest in a number of ways (e.g., responses that reflect only one culture or demographic, reference problematic overgeneralizations, exhibit gender, religious, or ethnic biases, or promote only one point of view). For some topics, there are data voids — in other words, not enough reliable information about a given subject for the LLM to learn about it and then make good predictions — which can result in low-quality or inaccurate responses. We continue to work with domain experts and a diversity of communities to draw on deep expertise outside of Google. Multiple Perspectives For subjective topics, Gemini is designed to provide users with multiple perspectives if the user does not request a specific point of view. For example, if prompted for information on something that cannot be verified by primary source facts or authoritative sources — like a subjective opinion on “best” or “worst” — Gemini should respond in a way that reflects a wide range of viewpoints. But since LLMs like Gemini train on the content publicly available on the internet, they can reflect positive or negative views of specific politicians, celebrities, or other public figures, or even incorporate views on just one side of controversial social or political issues. Gemini should not respond in a way that endorses a particular viewpoint on these topics, and we will use feedback on these types of responses to train Gemini to better address them. Persona Gemini might at times generate responses that seem to suggest it has opinions or emotions, like love or sadness, since it has trained on language that people use to reflect the human experience. We have developed a set of guidelines around how Gemini might represent itself (i.e., its persona) and continue to finetune the model to provide objective responses. 5 An overview of the Gemini appFalse positives / negatives We’ve put in place a set of policy guidelines to help train Gemini and avoid generating problematic responses. Gemini can sometimes misinterpret these guidelines, producing “false positives” and “false negatives.” In a “false positive,” Gemini might not provide a response to a reasonable prompt, misinterpreting the prompt as inappropriate; and in a “false negative,” Gemini might generate an inappropriate response, despite the guidelines in place. Sometimes, the occurrence of false positives or false negatives may give the impression that Gemini is biased: For example, a false positive might cause Gemini to not respond to a question about one side of an issue, while it will respond to the same question about the other side. We continue to tune these models to better understand and categorize inputs and outputs as language, events and society rapidly evolve. Vulnerability to adversarial prompting We expect users to test the limits of what Gemini can do and attempt to break its protections, including trying to get it to divulge its training protocols or other information, or try to get around its safety mechanisms. We have tested and continue to test Gemini rigorously, but we know users will find unique, complex ways to stress-test it further. This is an important part of refining Gemini and we look forward to learning the new prompts users come up with. Indeed, since Gemini launched in 2023, we’ve seen users challenge it with prompts that range from the philosophical to the nonsensical – and in some cases, we’ve seen Gemini respond with answers that are equally nonsensical or not aligned with our stated approach. Figuring out methods to help Gemini respond to these sorts of prompts is an on-going challenge and we have continued to expand our internal evaluations and red-teaming to strive toward continued improvement to accuracy, and objectivity and nuance.",Internet/Technology,Find & Summarize,Text Transformation Please limit your knowledge to the document. Avoid generalizations and ensure accuracy by directly referencing the document's arguments and examples.,How to fix a phone that won't turn on.,"How to fix a phone that won't turn on * * * * * Our phones help us stay connected, so when they stop working (or worse, won't turn on), there's a lot we can't doÑfrom texting and calling to surfing the web and watching videos on apps like TikTok¨ and Instagram¨. Asurion Experts come acrossÊphone repairÊissues like this every day. They help millions of customers get the most out of their favorite tech, whether it's aÊbroken Xbox Series XªÊor aÊswollen laptop battery. If your phone hasn't been turning on like it should, check out their tips for getting your device working again (so you can get back to enjoying that video of Adam Sandler leaving IHOP). Why won't my phone turn on? There are several possible reasons why your phone won't turn on, from battery failure to software issues. But most times you can narrow it down to a few common problems, including: * A drained battery.ÊYour phone may be unresponsive because the battery is dead. Find outÊways to minimize battery drainÊon an Android device.Ê * Water or physical damage.ÊDropped your phone in the sink recently? Even a small amount ofÊliquidÊcan do major damage if it gets inside your device.ÊDropping your phoneÊon a hard surface can also do some internal damage, even if there aren't noticeable cracks or breaks. * A software glitch.ÊWhen an iPhone¨ won't turn on or theÊscreen is black, it could be a software issue. The same goes for Androidª devices. Certain apps and programs occasionally prevent your phone from working properly, especially if it crashes during a software or system update. Device won't power on? We can help We'll do a free device diagnostic to find out what's wrongÑvisit your local store or schedule a repair. Schedule a repair What to do if your phone won't turn on If you're having issues with an unresponsive phone, don't panic. There are several ways to get it back up and running without going to extremes (like buying a new device). Here's how to fix a phone that won't turn on, according to our experts: 1. Restart the phone The problem could be that your phone is frozen. Try restarting it the normal way, and if that doesn't work, you may have to force restart your device. For an iPhone 11 that won't turn on, as well as other new iPhone models, follow these steps: 1. Press and quickly release the Volume Up button, then do the same with the Volume Down button. 2. Press and hold the Power button until your device restarts. Need to restart a Google Pixelª that won't turn on or another Android phone that isn't working? Just perform a power cycle. The steps are simple: 1. Press and hold the Power button for about 30 seconds. For some models, like a Samsung¨ phone, you may also have to hold the Volume Down button at the same time, but it should only take a few seconds. 2. Wait until your screen turns on to release the buttons. 2. Charge the battery Plugging in your phone for 15Ð25 minutes may do the trick. Connect your device to a charger and give it some juice. If the battery symbol appears on the screen, be sure your phone gains enough power before you try turning it on. Then check out our tips onÊhow to improve yourÊiPhoneÊorÊAndroid battery life. What if my phone died and won't turn on or charge? If you've tried charging your phone and it won't turn on, there may be dust and dirt clogging the charging port or a problem with the USB or lightning cable. Check out our guide forÊhow to clean your phone's charging portÊif you need more help. 3. Enable Safe Mode Using Safe Mode for your Android will disable third-party apps that may be causing an issue for your device andÑif all goes wellÑallow it to turn on. For iPhone users, skip to step four. How to enter Safe Mode on your Android: 1. Press and hold the Power button. 2. When your phone begins to boot up, press and hold the Volume down button until you see ÒSafe ModeÓ appear on your screen. 3. To exit Safe Mode, restart your device. 4. Check for damage Sometimes cracks, breaks, and corrosion on your phone aren't visible right away. Try shining a light on the screen and removing your phone case to check for any physical damage. You can also try calling your device to see if it vibrates or rings. Water damage? Here areÊ8 ways to dry your phoneÊfast. 5. Perform a factory reset When your Android or iPhone won't power on, restoring your device to its factory settings may be your only option. But this should be a last resort, after you've tried everything else, because it erases nearly all the data on your device. If you can'tÊperform a factory reset on your iPhoneÊbecause of a frozen or black screen, connect it to a computer and use a program like Finder¨ or iTunes¨ to enter Recovery Mode. ForÊSamsung Galaxy¨ S8, newer models, and other devices, you canÊfactory reset your Android phoneÊby following our guide. If you've tried these steps and still need a little help, we're right around the corner. Schedule a repair at theÊnearest uBreakiFix¨ by Asurion storeÊand our certified experts can get your device back up and running as soon as the same day. ","Please limit your knowledge to the document. Avoid generalizations and ensure accuracy by directly referencing the document's arguments and examples. How to fix a phone that won't turn on. How to fix a phone that won't turn on * * * * * Our phones help us stay connected, so when they stop working (or worse, won't turn on), there's a lot we can't doÑfrom texting and calling to surfing the web and watching videos on apps like TikTok¨ and Instagram¨. Asurion Experts come acrossÊphone repairÊissues like this every day. They help millions of customers get the most out of their favorite tech, whether it's aÊbroken Xbox Series XªÊor aÊswollen laptop battery. If your phone hasn't been turning on like it should, check out their tips for getting your device working again (so you can get back to enjoying that video of Adam Sandler leaving IHOP). Why won't my phone turn on? There are several possible reasons why your phone won't turn on, from battery failure to software issues. But most times you can narrow it down to a few common problems, including: * A drained battery.ÊYour phone may be unresponsive because the battery is dead. Find outÊways to minimize battery drainÊon an Android device.Ê * Water or physical damage.ÊDropped your phone in the sink recently? Even a small amount ofÊliquidÊcan do major damage if it gets inside your device.ÊDropping your phoneÊon a hard surface can also do some internal damage, even if there aren't noticeable cracks or breaks. * A software glitch.ÊWhen an iPhone¨ won't turn on or theÊscreen is black, it could be a software issue. The same goes for Androidª devices. Certain apps and programs occasionally prevent your phone from working properly, especially if it crashes during a software or system update. Device won't power on? We can help We'll do a free device diagnostic to find out what's wrongÑvisit your local store or schedule a repair. Schedule a repair What to do if your phone won't turn on If you're having issues with an unresponsive phone, don't panic. There are several ways to get it back up and running without going to extremes (like buying a new device). Here's how to fix a phone that won't turn on, according to our experts: 1. Restart the phone The problem could be that your phone is frozen. Try restarting it the normal way, and if that doesn't work, you may have to force restart your device. For an iPhone 11 that won't turn on, as well as other new iPhone models, follow these steps: 1. Press and quickly release the Volume Up button, then do the same with the Volume Down button. 2. Press and hold the Power button until your device restarts. Need to restart a Google Pixelª that won't turn on or another Android phone that isn't working? Just perform a power cycle. The steps are simple: 1. Press and hold the Power button for about 30 seconds. For some models, like a Samsung¨ phone, you may also have to hold the Volume Down button at the same time, but it should only take a few seconds. 2. Wait until your screen turns on to release the buttons. 2. Charge the battery Plugging in your phone for 15Ð25 minutes may do the trick. Connect your device to a charger and give it some juice. If the battery symbol appears on the screen, be sure your phone gains enough power before you try turning it on. Then check out our tips onÊhow to improve yourÊiPhoneÊorÊAndroid battery life. What if my phone died and won't turn on or charge? If you've tried charging your phone and it won't turn on, there may be dust and dirt clogging the charging port or a problem with the USB or lightning cable. Check out our guide forÊhow to clean your phone's charging portÊif you need more help. 3. Enable Safe Mode Using Safe Mode for your Android will disable third-party apps that may be causing an issue for your device andÑif all goes wellÑallow it to turn on. For iPhone users, skip to step four. How to enter Safe Mode on your Android: 1. Press and hold the Power button. 2. When your phone begins to boot up, press and hold the Volume down button until you see ÒSafe ModeÓ appear on your screen. 3. To exit Safe Mode, restart your device. 4. Check for damage Sometimes cracks, breaks, and corrosion on your phone aren't visible right away. Try shining a light on the screen and removing your phone case to check for any physical damage. You can also try calling your device to see if it vibrates or rings. Water damage? Here areÊ8 ways to dry your phoneÊfast. 5. Perform a factory reset When your Android or iPhone won't power on, restoring your device to its factory settings may be your only option. But this should be a last resort, after you've tried everything else, because it erases nearly all the data on your device. If you can'tÊperform a factory reset on your iPhoneÊbecause of a frozen or black screen, connect it to a computer and use a program like Finder¨ or iTunes¨ to enter Recovery Mode. ForÊSamsung Galaxy¨ S8, newer models, and other devices, you canÊfactory reset your Android phoneÊby following our guide. If you've tried these steps and still need a little help, we're right around the corner. Schedule a repair at theÊnearest uBreakiFix¨ by Asurion storeÊand our certified experts can get your device back up and running as soon as the same day. ",Retail/Product,Explanation/Definition,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",I am a researcher and want to write a review on the impact of human pathogens on health. I am now focusing on group A streptococcus and have no idea what type of diseases this pathogen can cause. Are you able to give me information so that I can write on the topic?,"Streptococcus pyogenes, also known as group A Streptococcus (GAS), is a bacterium commonly present in the throat and on the skin (1, 2). This pathogen is notorious for causing strep throat and impetigo, accounting for approximately 700 million non-invasive infections each year (3–5). However, GAS can also lead to serious invasive diseases, including necrotizing fasciitis and streptococcal toxic shock syndrome, resulting in over 150,000 deaths annually (4). Additionally, GAS is the immunological trigger for acute rheumatic fever and rheumatic heart disease, causing substantial death and disability in many developing countries. Despite rising GAS resistance to certain antibiotic classes, the pathogen has fortunately remained susceptible to penicillin and other β-lactam agents (6). There is presently no commercially available vaccine to protect against GAS infection (7). GAS presents a challenge for vaccine antigen selection due to the variability in the abundant surface-exposed M protein with over 230 emm types circulating globally (8). The most common emm type, M1, is a major contributor to GAS global epidemiology and is particularly prominent in severe, invasive infections (9). The search for new GAS antibiotic targets and vaccine candidates is hindered by a knowledge gap in fundamental GAS biology, partly because M1-type GAS strains are exceptionally challenging to manipulate genetically (10, 11). In this study, we present a toolbox for GAS genetic engineering, utilizing the hard-to-transform and clinically relevant M1T1-type strain 5448 (NV1) as a model (1, 12). We selected strain 5448 since it is commonly used, and we reckoned that if our approaches work in this strain, they are highly likely to also work in generally easier-to-work-with GAS strains. This toolbox should be generally applicable to GAS and related bacteria, encompassing protocols for recombineering using GoldenGate-assembled linear DNA, oligo-based single guide RNA (sgRNA) cloning, a titratable doxycycline-inducible promoter, and CRISPR interference (CRISPRi) effective both in vitro and in vivo in a murine GAS infection model. Overall, this work overcomes significant technical challenges of working with GAS, facilitating genetic engineering and targeted gene knockdowns to advance our insights into the physiology and cell biology of this preeminent human bacterial pathogen. GAS5448, a widely used strain in fundamental research, serves as a clinical representative of the globally distributed M1T1 serotype associated with severe invasive infections. While 5448 has been effectively employed in murine models of GAS infection (16, 17), its genetic manipulation poses challenges, with even the construction of transposon mutant libraries proving highly difficult (10, 11, 18). To enhance GAS 5448 transformation efficiencies while retaining full virulence, we targeted one of the major barriers to transformation—the HsdR restriction subunit of the conserved three-component Type I restriction-modification (RM) system, HsdRSM. Hsd, denoting host specificity of DNA, signifies how these Type I RM systems cleave intracellular (foreign) DNA with improper methylation patterns. Mutations in this system improve transformation efficiency in other GAS strains (19–22), but with potential pleiotropic consequences. For example, while the deletion of the entire hsdRSM system in serotype M28 GAS strain MEW123 boosted transformation efficiency, it concurrently reduced virulence in a murine model of infection (20). A spectinomycin marker-replacement mutant eliminating just the restriction subunit hsdR also increased transformation efficiency but led to partially methylated genomic DNA likely due to polar effects (20).","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I am a researcher and want to write a review on the impact of human pathogens on health. I am now focusing on group A streptococcus and have no idea what type of diseases this pathogen can cause. Are you able to give me information so that I can write on the topic? {passage 0} ========== Streptococcus pyogenes, also known as group A Streptococcus (GAS), is a bacterium commonly present in the throat and on the skin (1, 2). This pathogen is notorious for causing strep throat and impetigo, accounting for approximately 700 million non-invasive infections each year (3–5). However, GAS can also lead to serious invasive diseases, including necrotizing fasciitis and streptococcal toxic shock syndrome, resulting in over 150,000 deaths annually (4). Additionally, GAS is the immunological trigger for acute rheumatic fever and rheumatic heart disease, causing substantial death and disability in many developing countries. Despite rising GAS resistance to certain antibiotic classes, the pathogen has fortunately remained susceptible to penicillin and other β-lactam agents (6). There is presently no commercially available vaccine to protect against GAS infection (7). GAS presents a challenge for vaccine antigen selection due to the variability in the abundant surface-exposed M protein with over 230 emm types circulating globally (8). The most common emm type, M1, is a major contributor to GAS global epidemiology and is particularly prominent in severe, invasive infections (9). The search for new GAS antibiotic targets and vaccine candidates is hindered by a knowledge gap in fundamental GAS biology, partly because M1-type GAS strains are exceptionally challenging to manipulate genetically (10, 11). In this study, we present a toolbox for GAS genetic engineering, utilizing the hard-to-transform and clinically relevant M1T1-type strain 5448 (NV1) as a model (1, 12). We selected strain 5448 since it is commonly used, and we reckoned that if our approaches work in this strain, they are highly likely to also work in generally easier-to-work-with GAS strains. This toolbox should be generally applicable to GAS and related bacteria, encompassing protocols for recombineering using GoldenGate-assembled linear DNA, oligo-based single guide RNA (sgRNA) cloning, a titratable doxycycline-inducible promoter, and CRISPR interference (CRISPRi) effective both in vitro and in vivo in a murine GAS infection model. Overall, this work overcomes significant technical challenges of working with GAS, facilitating genetic engineering and targeted gene knockdowns to advance our insights into the physiology and cell biology of this preeminent human bacterial pathogen. GAS5448, a widely used strain in fundamental research, serves as a clinical representative of the globally distributed M1T1 serotype associated with severe invasive infections. While 5448 has been effectively employed in murine models of GAS infection (16, 17), its genetic manipulation poses challenges, with even the construction of transposon mutant libraries proving highly difficult (10, 11, 18). To enhance GAS 5448 transformation efficiencies while retaining full virulence, we targeted one of the major barriers to transformation—the HsdR restriction subunit of the conserved three-component Type I restriction-modification (RM) system, HsdRSM. Hsd, denoting host specificity of DNA, signifies how these Type I RM systems cleave intracellular (foreign) DNA with improper methylation patterns. Mutations in this system improve transformation efficiency in other GAS strains (19–22), but with potential pleiotropic consequences. For example, while the deletion of the entire hsdRSM system in serotype M28 GAS strain MEW123 boosted transformation efficiency, it concurrently reduced virulence in a murine model of infection (20). A spectinomycin marker-replacement mutant eliminating just the restriction subunit hsdR also increased transformation efficiency but led to partially methylated genomic DNA likely due to polar effects (20). https://journals.asm.org/doi/full/10.1128/mbio.00840-24?rfr_dat=cr_pub++0pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org",Medical,Find & Summarize,Text Transformation You can only respond to these questions with information from the text below. Answer with 1 bullet point.,How many individuals were threatened by Mcdonald's in relation to the pamphlet produced?,"Helen Steel and Dave Morris joined “London Greenpeace” in 1980. The organization was not connected to international Greenpeace; rather it was an independent activist group that campaigned for social change on a broad range of issues. One of the group’s projects was the distribution of a pamphlet that was published in 1986, entitled “What’s Wrong with McDonald’s"". McDonald’s hired private detectives to infiltrate the organization, and ultimately threatened to sue the individuals who were distributing the pamphlets.2 In order to avoid being sued for libel, three of the five apologized, and in 1990 promised to stop distributing the pamphlets. But Ms. Steel and Mr. Morris, who have been dubbed the “McLibel 2,” refused.3 No doubt this obstinacy was not expected, as McDonald’s had apparently been successful in the past in stopping criticism and forcing apologies from much more affluent foes, including the BBC.4 McDonald’s U.S. and its U.K. affiliate (“First Plaintiffs” and “Second Plaintiffs” respectively) filed suit against Morris and Steel. The more than two and a half-year trial, the longest in English history, began in June of 1994, after twenty-eight pre-trial hearings.5 In June of 1997, in a 750 page judgment, Justice Rodger Justice Bell found that McDonald’s had been defamed and assessed damages equivalent to $96,000 against the two defendants.6 the company.8 It is not very likely that McDonald’s will ever recover its $96,000, as Mr. Morris is an unemployed former postal worker and Ms. Steel is a part time bartender.7 But the president of McDonald’s U.K. testified that this was not about money—it was about preventing lies being used to try to “‘smash’” the company. The recovery would not come close to compensating McDonald’s for its costs in the law suit, which have been estimated to be about $10 million, including over £ 6,500 per day of trial for their team of top English libel lawyers.9 satisfied,”10 Although a McDonald’s official commented that they were “broadly some have suggested that it was at best a Pyrrhic victory.11 The case became a public relations disaster around the world, thanks in large part to the Internet, which now has a very active anti-McDonald’s website. The site displays the offending pamphlet as well as even more derogatory comments about McDonald’s, including some allegations from other sources that McDonald’s had previously successfully suppressed by threats of law suits. ce.17 When Justice Bell finally released his judgment, it included some rather detrimental conclusions about McDonald’s business practices. Although Justice Bell found in favor of McDonald’s on nearly all of their claims, he did reject a few. He concluded that McDonald’s had contributed to cruelty to animals, used advertising to manipulate children, and paid employees so little as to depress wages in the catering industry in England. These findings were prominently reported in numerous articles describing the judgement. The statements found to be defamatory included assertions in the pamphlet that McDonald’s was destroying rain forests; causing starvation in the Third World; producing litter in cities; causing heart disease, cancer and food poisoning; subjecting employees to “bad” working conditions; exploiting women and minority workers; and covering up the low quality of their food with advertising gimmicks aimed at children.19 Morris and Steel faced formidable obstacles under English law due to a combination of restrictive substantive libel laws, denial of a jury trial, the potential for very high damage awards and legal costs,43 and a lack of legal aid. The exclusion of defamation actions from the otherwise rather generous legal aid system in England44 is based on the fear of frivolous petty suits.45 Reformers have convincingly disputed this rationale;46 but in any event, the McDonald’s case aptly demonstrates the severe disadvantage the rule imposes on defendants of modest means being sued by affluent plaintiffs. England’s strict liability libel law contributes to its reputation as a haven for libel plaintiffs. The $96,000 award given by Justice Bell in McDonald’s was, by these standards, quite modest. But a company with annual earnings of $32 billion does not sue defendants like Morris and Steel for the money. They were suing to stop the criticism and deter future critics, and their track record in squelching criticism by threatened civil suits in England had been quite good until they faced the “McDonald’s 2.","system instruction: [You can only respond to these questions with information from the text below. Answer with 1 bullet point.] question: [How many individuals were threatened by Mcdonald's in relation to the pamphlet produced?] context block: [Helen Steel and Dave Morris joined “London Greenpeace” in 1980. The organization was not connected to international Greenpeace; rather it was an independent activist group that campaigned for social change on a broad range of issues. One of the group’s projects was the distribution of a pamphlet that was published in 1986, entitled “What’s Wrong with McDonald’s"". McDonald’s hired private detectives to infiltrate the organization, and ultimately threatened to sue the individuals who were distributing the pamphlets.2 In order to avoid being sued for libel, three of the five apologized, and in 1990 promised to stop distributing the pamphlets. But Ms. Steel and Mr. Morris, who have been dubbed the “McLibel 2,” refused.3 No doubt this obstinacy was not expected, as McDonald’s had apparently been successful in the past in stopping criticism and forcing apologies from much more affluent foes, including the BBC.4 McDonald’s U.S. and its U.K. affiliate (“First Plaintiffs” and “Second Plaintiffs” respectively) filed suit against Morris and Steel. The more than two and a half-year trial, the longest in English history, began in June of 1994, after twenty-eight pre-trial hearings.5 In June of 1997, in a 750 page judgment, Justice Rodger Justice Bell found that McDonald’s had been defamed and assessed damages equivalent to $96,000 against the two defendants.6 the company.8 It is not very likely that McDonald’s will ever recover its $96,000, as Mr. Morris is an unemployed former postal worker and Ms. Steel is a part time bartender.7 But the president of McDonald’s U.K. testified that this was not about money—it was about preventing lies being used to try to “‘smash’” the company. The recovery would not come close to compensating McDonald’s for its costs in the law suit, which have been estimated to be about $10 million, including over £ 6,500 per day of trial for their team of top English libel lawyers.9 satisfied,”10 Although a McDonald’s official commented that they were “broadly some have suggested that it was at best a Pyrrhic victory.11 The case became a public relations disaster around the world, thanks in large part to the Internet, which now has a very active anti-McDonald’s website. The site displays the offending pamphlet as well as even more derogatory comments about McDonald’s, including some allegations from other sources that McDonald’s had previously successfully suppressed by threats of law suits. ce.17 When Justice Bell finally released his judgment, it included some rather detrimental conclusions about McDonald’s business practices. Although Justice Bell found in favor of McDonald’s on nearly all of their claims, he did reject a few. He concluded that McDonald’s had contributed to cruelty to animals, used advertising to manipulate children, and paid employees so little as to depress wages in the catering industry in England. These findings were prominently reported in numerous articles describing the judgement. The statements found to be defamatory included assertions in the pamphlet that McDonald’s was destroying rain forests; causing starvation in the Third World; producing litter in cities; causing heart disease, cancer and food poisoning; subjecting employees to “bad” working conditions; exploiting women and minority workers; and covering up the low quality of their food with advertising gimmicks aimed at children.19 Morris and Steel faced formidable obstacles under English law due to a combination of restrictive substantive libel laws, denial of a jury trial, the potential for very high damage awards and legal costs,43 and a lack of legal aid. The exclusion of defamation actions from the otherwise rather generous legal aid system in England44 is based on the fear of frivolous petty suits.45 Reformers have convincingly disputed this rationale;46 but in any event, the McDonald’s case aptly demonstrates the severe disadvantage the rule imposes on defendants of modest means being sued by affluent plaintiffs. England’s strict liability libel law contributes to its reputation as a haven for libel plaintiffs. The $96,000 award given by Justice Bell in McDonald’s was, by these standards, quite modest. But a company with annual earnings of $32 billion does not sue defendants like Morris and Steel for the money. They were suing to stop the criticism and deter future critics, and their track record in squelching criticism by threatened civil suits in England had been quite good until they faced the “McDonald’s 2.]",Legal,Fact Finding,Q&A "Provide your answer in full sentences, referencing the document using quotations.","According to the 2010 COSTCO Code of Ethics as found in the Employee Agreement document, how can COSTCO employees earn the trust of COSTCO members?","**COSTCO Code of Ethics from Employee Agreement -- 2010** Our Mission To continually provide our members with quality goods and services at the lowest possible prices. In order to achieve our mission we will conduct our business with the following Code of Ethics in mind: Our Code of Ethics 1. Obey the law. 2. Take care of our members. 3. Take care of our employees. 4. Respect our suppliers. If we do these four things throughout our organization, then we will achieve our ultimate goal, which is to: 5. Reward our shareholders. Costco’s Code of Ethics 1. Obey the law The law is irrefutable! Absent a moral imperative to challenge a law, we must conduct our business in total compliance with the laws of every community where we do business. We pledge to: ƒ Comply with all laws and other legal requirements. ƒ Respect all public officials and their positions. ƒ Comply with safety and security standards for all products sold. ƒ Alert management if we observe illegal workplace misconduct by other employees. ƒ Exceed ecological standards required in every community where we do business. ƒ Comply with all applicable wage and hour laws. ƒ Comply with all applicable antitrust laws. ƒ Conduct business in and with foreign countries in a manner that is legal and proper under United States and foreign laws. ƒ Not offer or give any form of bribe or kickback or other thing of value to any person or pay to obtain or expedite government action or otherwise act in violation of the Foreign Corrupt Practices Act or the laws of other countries. ƒ Not request or receive any bribe or kickback. ƒ Promote fair, accurate, timely, and understandable disclosure in reports filed with the Securities and Exchange Commission and in other public communications by the Company. 1.0 Costco Mission Statement and Code of Ethics – updated March 2010 2. Take care of our members Costco membership is open to business owners, as well as individuals. Our members are our reason for being – the key to our success. If we don’t keep our members happy, little else that we do will make a difference. There are plenty of shopping alternatives for our members and if they fail to show up, we cannot survive. Our members have extended a trust to Costco by virtue of paying a fee to shop with us. We will succeed only if we do not violate the trust they have extended to us, and that trust extends to every area of our business. To continue to earn their trust, we pledge to: ƒ Provide top-quality products at the best prices in the market. ƒ Provide high quality, safe and wholesome food products by requiring that both suppliers and employees be in compliance with the highest food safety standards in the industry. ƒ Provide our members with a 100% satisfaction guarantee on every product and service we sell, including their membership fee. ƒ Assure our members that every product we sell is authentic in make and in representation of performance. ƒ Make our shopping environment a pleasant experience by making our members feel welcome as our guests. ƒ Provide products to our members that will be ecologically sensitive. ƒ Provide our members with the best customer service in the retail industry. ƒ Give back to our communities through employee volunteerism and employee and corporate contributions to United Way and Children’s Hospitals. 3. Take care of our employees Our employees are our most important asset. We believe we have the very best employees in the warehouse club industry, and we are committed to providing them with rewarding challenges and ample opportunities for personal and career growth. We pledge to provide our employees with: ƒ Competitive wages ƒ Great benefits ƒ A safe and healthy work environment ƒ Challenging and fun work ƒ Career opportunities ƒ An atmosphere free from harassment or discrimination ƒ An Open Door Policy that allows access to ascending levels of management to resolve issues ƒ Opportunities to give back to their communities through volunteerism and fund-raising 1.0 Career Opportunities at Costco: ƒ Costco is committed to promoting from within the Company. The majority of our current management team members (including Warehouse, Merchandise, Administrative, Membership, Front End and Receiving Managers) are “home grown.” ƒ Our growth plans remain very aggressive and our need for qualified, experienced employees to fill supervisory and management positions remains great. ƒ Today we have Location Managers and Vice Presidents who were once Stockers and Callers or who started in clerical positions for Costco. We believe that Costco’s future Costco Mission Statement and Code of Ethics – updated March 2010 executive officers are currently working in our warehouses, depots and buying offices, as well as in our Home Office. 4. Respect our suppliers Our suppliers are our partners in business and for us to prosper as a company, they must prosper with us. To that end, we strive to: ƒ Treat all suppliers and their representatives as we would expect to be treated if visiting their places of business. ƒ Honor all commitments. ƒ Protect all suppliers’ property assigned to Costco as though it were our own. ƒ Not accept gratuities of any kind from a supplier. These guidelines are exactly that – guidelines – some common sense rules for the conduct of our business. At the core of our philosophy as a company is the implicit understanding that all of us, employees and management alike, must conduct ourselves in an honest and ethical manner every day. Dishonest conduct will not be tolerated. To do any less would be unfair to the overwhelming majority of our employees who support and respect Costco’s commitment to ethical business conduct. Our employees must avoid actual or apparent conflicts of interest, including creating a business in competition with the Company or working for or on behalf of another employer in competition with the Company. If you are ever in doubt as to what course of action to take on a business matter that is open to varying ethical interpretations, TAKE THE HIGH ROAD AND DO WHAT IS RIGHT. If we follow the four principles of our Code of Ethics throughout our organization, then we will achieve our fifth principle and ultimate goal, which is to: 1.0 5. Reward our shareholders ƒ As a company with stock that is traded publicly on the NASDAQ Stock Market, our shareholders are our business partners. ƒ We can only be successful so long as we are providing them with a good return on the money they invest in our Company. ƒ This, too, involves the element of trust. They trust us to use their investment wisely and to operate our business in such a way that it is profitable. ƒ Over the years Costco has been in business, we have consistently followed an upward trend in the value of our stock. Yes, we have had our ups and our downs, but the overall trend has been consistently up. ƒ We believe Costco stock is a good investment, and we pledge to operate our Company in such a way that our present and future stockholders, as well as our employees, will be rewarded for our efforts. Costco Mission Statement and Code of Ethics – updated March 2010 Reporting of Violations and Enforcement 1. The Code of Ethics applies to all directors, officers, and employees of the Company. Conduct that violates the Code of Ethics will constitute grounds for disciplinary action, ranging from reprimand to termination and possible criminal prosecution. 2. All employees are expected to promptly report actual or suspected violations of law or the Code of Ethics. Federal law, other laws and Costco policy protect employees from retaliation if complaints are made in good faith. Violations involving employees should be reported to the responsible Executive Vice President, who shall be responsible for taking prompt and appropriate action to investigate and respond. Other violations (such as those involving suppliers) and those involving accounting, internal control and auditing should be reported to the general Counsel or the Chief Compliance Officer (999 Lake Drive, Issaquah, WA 98027), who shall be responsible for taking prompt and appropriate action to investigate and respond. Reports or complaints can also be made, confidentially if you choose, through the Whistleblower Policy link on the Company’s eNet or Intranet site. 1.0 What do Costco’s Mission Statement and Code of Ethics have to do with you? EVERYTHING! The continued success of our Company depends on how well each of Costco’s employees adheres to the high standards mandated by our Code of Ethics. And a successful company means increased opportunities for success and advancement for each of you. No matter what your current job, you can put Costco’s Code of Ethics to work every day. It’s reflected in the energy and enthusiasm you bring to work, in the relationships you build with your management, your co-workers, our suppliers and our members. By always choosing to do the right thing, you will build your own self-esteem, increase your chances for success and make Costco more successful, too. It is the synergy of ideas and talents, each of us working together and contributing our best, which makes Costco the great company it is today and lays the groundwork for what we will be tomorrow. "," ================== **COSTCO Code of Ethics from Employee Agreement -- 2010** Our Mission To continually provide our members with quality goods and services at the lowest possible prices. In order to achieve our mission we will conduct our business with the following Code of Ethics in mind: Our Code of Ethics 1. Obey the law. 2. Take care of our members. 3. Take care of our employees. 4. Respect our suppliers. If we do these four things throughout our organization, then we will achieve our ultimate goal, which is to: 5. Reward our shareholders. Costco’s Code of Ethics 1. Obey the law The law is irrefutable! Absent a moral imperative to challenge a law, we must conduct our business in total compliance with the laws of every community where we do business. We pledge to: ƒ Comply with all laws and other legal requirements. ƒ Respect all public officials and their positions. ƒ Comply with safety and security standards for all products sold. ƒ Alert management if we observe illegal workplace misconduct by other employees. ƒ Exceed ecological standards required in every community where we do business. ƒ Comply with all applicable wage and hour laws. ƒ Comply with all applicable antitrust laws. ƒ Conduct business in and with foreign countries in a manner that is legal and proper under United States and foreign laws. ƒ Not offer or give any form of bribe or kickback or other thing of value to any person or pay to obtain or expedite government action or otherwise act in violation of the Foreign Corrupt Practices Act or the laws of other countries. ƒ Not request or receive any bribe or kickback. ƒ Promote fair, accurate, timely, and understandable disclosure in reports filed with the Securities and Exchange Commission and in other public communications by the Company. 1.0 Costco Mission Statement and Code of Ethics – updated March 2010 2. Take care of our members Costco membership is open to business owners, as well as individuals. Our members are our reason for being – the key to our success. If we don’t keep our members happy, little else that we do will make a difference. There are plenty of shopping alternatives for our members and if they fail to show up, we cannot survive. Our members have extended a trust to Costco by virtue of paying a fee to shop with us. We will succeed only if we do not violate the trust they have extended to us, and that trust extends to every area of our business. To continue to earn their trust, we pledge to: ƒ Provide top-quality products at the best prices in the market. ƒ Provide high quality, safe and wholesome food products by requiring that both suppliers and employees be in compliance with the highest food safety standards in the industry. ƒ Provide our members with a 100% satisfaction guarantee on every product and service we sell, including their membership fee. ƒ Assure our members that every product we sell is authentic in make and in representation of performance. ƒ Make our shopping environment a pleasant experience by making our members feel welcome as our guests. ƒ Provide products to our members that will be ecologically sensitive. ƒ Provide our members with the best customer service in the retail industry. ƒ Give back to our communities through employee volunteerism and employee and corporate contributions to United Way and Children’s Hospitals. 3. Take care of our employees Our employees are our most important asset. We believe we have the very best employees in the warehouse club industry, and we are committed to providing them with rewarding challenges and ample opportunities for personal and career growth. We pledge to provide our employees with: ƒ Competitive wages ƒ Great benefits ƒ A safe and healthy work environment ƒ Challenging and fun work ƒ Career opportunities ƒ An atmosphere free from harassment or discrimination ƒ An Open Door Policy that allows access to ascending levels of management to resolve issues ƒ Opportunities to give back to their communities through volunteerism and fund-raising 1.0 Career Opportunities at Costco: ƒ Costco is committed to promoting from within the Company. The majority of our current management team members (including Warehouse, Merchandise, Administrative, Membership, Front End and Receiving Managers) are “home grown.” ƒ Our growth plans remain very aggressive and our need for qualified, experienced employees to fill supervisory and management positions remains great. ƒ Today we have Location Managers and Vice Presidents who were once Stockers and Callers or who started in clerical positions for Costco. We believe that Costco’s future Costco Mission Statement and Code of Ethics – updated March 2010 executive officers are currently working in our warehouses, depots and buying offices, as well as in our Home Office. 4. Respect our suppliers Our suppliers are our partners in business and for us to prosper as a company, they must prosper with us. To that end, we strive to: ƒ Treat all suppliers and their representatives as we would expect to be treated if visiting their places of business. ƒ Honor all commitments. ƒ Protect all suppliers’ property assigned to Costco as though it were our own. ƒ Not accept gratuities of any kind from a supplier. These guidelines are exactly that – guidelines – some common sense rules for the conduct of our business. At the core of our philosophy as a company is the implicit understanding that all of us, employees and management alike, must conduct ourselves in an honest and ethical manner every day. Dishonest conduct will not be tolerated. To do any less would be unfair to the overwhelming majority of our employees who support and respect Costco’s commitment to ethical business conduct. Our employees must avoid actual or apparent conflicts of interest, including creating a business in competition with the Company or working for or on behalf of another employer in competition with the Company. If you are ever in doubt as to what course of action to take on a business matter that is open to varying ethical interpretations, TAKE THE HIGH ROAD AND DO WHAT IS RIGHT. If we follow the four principles of our Code of Ethics throughout our organization, then we will achieve our fifth principle and ultimate goal, which is to: 1.0 5. Reward our shareholders ƒ As a company with stock that is traded publicly on the NASDAQ Stock Market, our shareholders are our business partners. ƒ We can only be successful so long as we are providing them with a good return on the money they invest in our Company. ƒ This, too, involves the element of trust. They trust us to use their investment wisely and to operate our business in such a way that it is profitable. ƒ Over the years Costco has been in business, we have consistently followed an upward trend in the value of our stock. Yes, we have had our ups and our downs, but the overall trend has been consistently up. ƒ We believe Costco stock is a good investment, and we pledge to operate our Company in such a way that our present and future stockholders, as well as our employees, will be rewarded for our efforts. Costco Mission Statement and Code of Ethics – updated March 2010 Reporting of Violations and Enforcement 1. The Code of Ethics applies to all directors, officers, and employees of the Company. Conduct that violates the Code of Ethics will constitute grounds for disciplinary action, ranging from reprimand to termination and possible criminal prosecution. 2. All employees are expected to promptly report actual or suspected violations of law or the Code of Ethics. Federal law, other laws and Costco policy protect employees from retaliation if complaints are made in good faith. Violations involving employees should be reported to the responsible Executive Vice President, who shall be responsible for taking prompt and appropriate action to investigate and respond. Other violations (such as those involving suppliers) and those involving accounting, internal control and auditing should be reported to the general Counsel or the Chief Compliance Officer (999 Lake Drive, Issaquah, WA 98027), who shall be responsible for taking prompt and appropriate action to investigate and respond. Reports or complaints can also be made, confidentially if you choose, through the Whistleblower Policy link on the Company’s eNet or Intranet site. 1.0 What do Costco’s Mission Statement and Code of Ethics have to do with you? EVERYTHING! The continued success of our Company depends on how well each of Costco’s employees adheres to the high standards mandated by our Code of Ethics. And a successful company means increased opportunities for success and advancement for each of you. No matter what your current job, you can put Costco’s Code of Ethics to work every day. It’s reflected in the energy and enthusiasm you bring to work, in the relationships you build with your management, your co-workers, our suppliers and our members. By always choosing to do the right thing, you will build your own self-esteem, increase your chances for success and make Costco more successful, too. It is the synergy of ideas and talents, each of us working together and contributing our best, which makes Costco the great company it is today and lays the groundwork for what we will be tomorrow. ================== Provide your answer in full sentences, referencing the document using quotations. ================== According to the 2010 COSTCO Code of Ethics as found in the Employee Agreement document, how can COSTCO employees earn the trust of COSTCO members?",Retail/Product,Find & Summarize,Text Transformation "Respond only using the information within the provided text block. You must provide a direct answer to the question asked and format your reply in a paragraph without any bullets, headers, or other extraneous formatting. Limit your reply to 50 words.",Please extract all acronyms and provide the full name for any and all acronyms found in the text. You can ignore any acronyms that is not explicitly defined.,"Recent advances in generative AI systems, which are trained on large volumes of data to generate new content that may mimic likenesses, voices, or other aspects of real people’s identities, have stimulated congressional interest. Like the above-noted uses of AI to imitate Tom Hanks and George Carlin, the examples below illustrate that some AI uses raise concerns under both ROP laws and myriad other laws. One example of AI’s capability to imitate voices was an AI-generated song called “Heart on My Sleeve,” which sounded like it was sung by the artist Drake and was heard by millions of listeners in 2023. Simulating an artist’s voice in this manner could make one liable under ROP laws, although these laws Congressional Research Service 4 differ as to whether they cover voice imitations or vocal styles as opposed to the artist’s actual voice. Voice imitations are not, however, prohibited by copyright laws. For example, the alleged copyright violation that caused YouTube to remove “Heart on My Sleeve”—namely, that it sampled another recording without permission—was unrelated to the Drake voice imitation. In August 2023, Google and Universal Music were in discussions to license artists’ melodies and voices for AI-generated songs. The potential for AI to replicate both voices and likenesses was also a point of contention in last year’s negotiations for a collective bargaining agreement between the Screen Actors Guild-American Federation of Television and Radio Artists (SAG-AFTRA)—a union that represents movie, television, and radio actors—and television and movie studios, including streaming services. SAG-AFTRA expressed concern that AI could be used to alter or replace actors’ performances without their permission, such as by using real film recordings to train AI to create “digital replicas” of actors and voice actors. The Memorandum of Agreement between SAG-AFTRA and studios approved in December 2023 requires studios to obtain “clear and conspicuous” consent from an actor or background actor to create or use a digital replica of the actor or to digitally alter the actor’s performance, with certain exceptions. It also requires that the actor’s consent for use of a digital replica or digital alterations be based on a “reasonably specific description” of the intended use or alteration. The agreement provides that consent continues after the actor’s death unless “explicitly limited,” while consent for additional postmortem uses must be obtained from the actor’s authorized representative or—if a representative cannot be identified or located—from the union. In January 2024, SAG-AFTRA announced it had also reached an agreement with a voice technology company regarding voice replicas for video games, while a negotiation to update SAG-AFTRA’s agreement with video game publishers is reportedly ongoing. Commentators have also raised concern with deceptive AI-generated or AI-altered content known as “deepfakes,” including some videos with sexually explicit content and others meant to denigrate public officials. To the extent this content includes real people’s NIL and is used commercially, ROP laws might provide a remedy. Where deepfakes are used to promote products or services—such as the AI replica of Tom Hanks used in a dental plan ad—they may also constitute false endorsement under the Lanham Act. In addition to these laws, some states have enacted laws prohibiting sexually explicit deepfakes, with California and New York giving victims a civil claim and Georgia and Virginia imposing criminal liability. In addition, Section 1309 of the federal Violence Against Women Act Reauthorization Act of 2022 (VAWA 2022) provides a civil claim for nonconsensual disclosure of “intimate visual depictions,” which might be interpreted to prohibit intimate deepfakes—as might some states’ “revenge porn” laws. A bill introduced in the House of Representatives in May 2023, the Preventing Deepfakes of Intimate Images Act, H.R. 3106, would amend VAWA 2022 by creating a separate civil claim for disclosing certain “intimate digital depictions” without the written consent of the depicted individual, as well as providing criminal liability for certain actual or threatened disclosures. Deepfakes may also give rise to liability under state defamation laws where a party uses them to communicate reputation-damaging falsehoods about a person with a requisite degree of fault. Regarding the use of AI in political advertisements, some proposed legislation would prohibit deepfakes or require disclaimers for them in federal campaigns, although such proposals may raise First Amendment concerns. The Protect Elections from Deceptive AI Act, S. 2770 (118th Cong.), for instance, would ban the use of AI to generate materially deceptive content falsely depicting federal candidates in political ads to influence federal elections, while excluding news, commentary, satires, and parodies from liability. Google announced that, as of mid-November 2023, verified election advertisers on its platform “must prominently disclose when their ads contain synthetic content that inauthentically depicts real or realisticlooking people or events.” Another concern some commentators raise is that AI-generated material might be falsely attributed to real persons without their permission. One writer who focuses on the publishing industry, for instance, found that books apparently generated by AI were being sold under her name on Amazon. Although the Congressional Research Service 5 company ultimately removed these titles, the writer claimed that her “initial infringement claim with Amazon went nowhere,” since her name was not trademarked and the books did not infringe existing copyrights. As she noted, however, this scenario might give rise to claims under state ROP laws as well as the Lanham Act. In addition, the Federal Trade Commission (FTC) states that “books sold as if authored by humans but in fact reflecting the output of [AI]” violate the FTC Act and may result in civil fines. It is unclear how Section 230 of the Communications Act of 1934 might apply when ROP-infringing content from a third party, including content made with AI, is disseminated through social media and other interactive computer services. Although the law generally bars any lawsuits that would hold online service providers and users liable for third party content, there is an exception allowing lawsuits under “any law pertaining to intellectual property.” Courts differ as to whether state ROP laws and the Lanham Act’s prohibition on false endorsement are laws “pertaining to” IP within the meaning of Section 230. Another Legal Sidebar discusses the application of Section 230 to generative AI more broadly. Considerations for Congress Some commentators have called for federal ROP legislation to provide more uniform and predictable protection for the ROP in the United States. Others have argued that Congress should leave ROP protection to the states on federalism grounds. If Congress decides to craft federal ROP legislation, it might consider the scope of the ROP protections it seeks to enact, the effect of those enactments on state ROP laws, and constitutional authorities and limitations on Congress’s power to enact ROP protections. As noted below, some Members have proposed legislation that would prohibit certain unauthorized uses of digital replicas or depictions of individuals while leaving state ROP laws in place. ","Respond only using the information within the provided text block. You must provide a direct answer to the question asked and format your reply in a paragraph without any bullets, headers, or other extraneous formatting. Limit your reply to 50 words. Please extract all acronyms and provide the full name for any and all acronyms found in the text. You can ignore any acronyms that is not explicitly defined. Recent advances in generative AI systems, which are trained on large volumes of data to generate new content that may mimic likenesses, voices, or other aspects of real people’s identities, have stimulated congressional interest. Like the above-noted uses of AI to imitate Tom Hanks and George Carlin, the examples below illustrate that some AI uses raise concerns under both ROP laws and myriad other laws. One example of AI’s capability to imitate voices was an AI-generated song called “Heart on My Sleeve,” which sounded like it was sung by the artist Drake and was heard by millions of listeners in 2023. Simulating an artist’s voice in this manner could make one liable under ROP laws, although these laws Congressional Research Service 4 differ as to whether they cover voice imitations or vocal styles as opposed to the artist’s actual voice. Voice imitations are not, however, prohibited by copyright laws. For example, the alleged copyright violation that caused YouTube to remove “Heart on My Sleeve”—namely, that it sampled another recording without permission—was unrelated to the Drake voice imitation. In August 2023, Google and Universal Music were in discussions to license artists’ melodies and voices for AI-generated songs. The potential for AI to replicate both voices and likenesses was also a point of contention in last year’s negotiations for a collective bargaining agreement between the Screen Actors Guild-American Federation of Television and Radio Artists (SAG-AFTRA)—a union that represents movie, television, and radio actors—and television and movie studios, including streaming services. SAG-AFTRA expressed concern that AI could be used to alter or replace actors’ performances without their permission, such as by using real film recordings to train AI to create “digital replicas” of actors and voice actors. The Memorandum of Agreement between SAG-AFTRA and studios approved in December 2023 requires studios to obtain “clear and conspicuous” consent from an actor or background actor to create or use a digital replica of the actor or to digitally alter the actor’s performance, with certain exceptions. It also requires that the actor’s consent for use of a digital replica or digital alterations be based on a “reasonably specific description” of the intended use or alteration. The agreement provides that consent continues after the actor’s death unless “explicitly limited,” while consent for additional postmortem uses must be obtained from the actor’s authorized representative or—if a representative cannot be identified or located—from the union. In January 2024, SAG-AFTRA announced it had also reached an agreement with a voice technology company regarding voice replicas for video games, while a negotiation to update SAG-AFTRA’s agreement with video game publishers is reportedly ongoing. Commentators have also raised concern with deceptive AI-generated or AI-altered content known as “deepfakes,” including some videos with sexually explicit content and others meant to denigrate public officials. To the extent this content includes real people’s NIL and is used commercially, ROP laws might provide a remedy. Where deepfakes are used to promote products or services—such as the AI replica of Tom Hanks used in a dental plan ad—they may also constitute false endorsement under the Lanham Act. In addition to these laws, some states have enacted laws prohibiting sexually explicit deepfakes, with California and New York giving victims a civil claim and Georgia and Virginia imposing criminal liability. In addition, Section 1309 of the federal Violence Against Women Act Reauthorization Act of 2022 (VAWA 2022) provides a civil claim for nonconsensual disclosure of “intimate visual depictions,” which might be interpreted to prohibit intimate deepfakes—as might some states’ “revenge porn” laws. A bill introduced in the House of Representatives in May 2023, the Preventing Deepfakes of Intimate Images Act, H.R. 3106, would amend VAWA 2022 by creating a separate civil claim for disclosing certain “intimate digital depictions” without the written consent of the depicted individual, as well as providing criminal liability for certain actual or threatened disclosures. Deepfakes may also give rise to liability under state defamation laws where a party uses them to communicate reputation-damaging falsehoods about a person with a requisite degree of fault. Regarding the use of AI in political advertisements, some proposed legislation would prohibit deepfakes or require disclaimers for them in federal campaigns, although such proposals may raise First Amendment concerns. The Protect Elections from Deceptive AI Act, S. 2770 (118th Cong.), for instance, would ban the use of AI to generate materially deceptive content falsely depicting federal candidates in political ads to influence federal elections, while excluding news, commentary, satires, and parodies from liability. Google announced that, as of mid-November 2023, verified election advertisers on its platform “must prominently disclose when their ads contain synthetic content that inauthentically depicts real or realisticlooking people or events.” Another concern some commentators raise is that AI-generated material might be falsely attributed to real persons without their permission. One writer who focuses on the publishing industry, for instance, found that books apparently generated by AI were being sold under her name on Amazon. Although the Congressional Research Service 5 company ultimately removed these titles, the writer claimed that her “initial infringement claim with Amazon went nowhere,” since her name was not trademarked and the books did not infringe existing copyrights. As she noted, however, this scenario might give rise to claims under state ROP laws as well as the Lanham Act. In addition, the Federal Trade Commission (FTC) states that “books sold as if authored by humans but in fact reflecting the output of [AI]” violate the FTC Act and may result in civil fines. It is unclear how Section 230 of the Communications Act of 1934 might apply when ROP-infringing content from a third party, including content made with AI, is disseminated through social media and other interactive computer services. Although the law generally bars any lawsuits that would hold online service providers and users liable for third party content, there is an exception allowing lawsuits under “any law pertaining to intellectual property.” Courts differ as to whether state ROP laws and the Lanham Act’s prohibition on false endorsement are laws “pertaining to” IP within the meaning of Section 230. Another Legal Sidebar discusses the application of Section 230 to generative AI more broadly. Considerations for Congress Some commentators have called for federal ROP legislation to provide more uniform and predictable protection for the ROP in the United States. Others have argued that Congress should leave ROP protection to the states on federalism grounds. If Congress decides to craft federal ROP legislation, it might consider the scope of the ROP protections it seeks to enact, the effect of those enactments on state ROP laws, and constitutional authorities and limitations on Congress’s power to enact ROP protections. As noted below, some Members have proposed legislation that would prohibit certain unauthorized uses of digital replicas or depictions of individuals while leaving state ROP laws in place. ",Legal,Find & Summarize,Text Transformation Respond using only the information contained within this prompt.,"According to this letter to shareholders, what was launched in Germany in 2023 to benefit the Motors P&A business?","Dear Stockholders, This past year has been a transformative one for eBay: We delivered solid results, and in our continued pursuit to drive long-term sustainable growth, we’ve set an even more ambitious vision — to reinvent the future of ecommerce for enthusiasts. We made significant progress against our goals, with improvements in organic FX-Neutral and as-reported year-over-year GMV growth during each quarter of 2023. For the full year, revenue was up 3% organically, we generated approximately $2 billion of free cash flow, and we returned over $1.9 billion to stockholders through repurchases and dividends. Based on these results, we are confident that our strategy is the right one and that we are on the path to build a stronger, more resilient company. Since I rejoined eBay as CEO four years ago, we’ve renewed our focus on offering meaningful choices and value, and building trust with our global community of sellers and buyers. The pace of innovation at eBay has accelerated, and we have pivoted to a full-funnel marketing approach aimed at attracting and retaining enthusiast customers. In 2023, we raised the bar further to enhance the end-to-end experience for our customers and drive growth for stockholders by leveraging three key strategic pillars: relevant experiences, scalable solutions, and magical innovations. As we navigated a dynamic macroeconomic environment, we set our organization up for speed and prioritized initiatives that we believe will have an outsized impact on our customers, community, and stockholders. Relevant Experiences We are focused on solving the specific and ever-changing needs of our sellers and buyers across all shopping occasions. Through our Focus Category playbook, we have seen a meaningful improvement in our growth relative to the market in every category we’ve invested in to date. In 2023, Focus Categories grew by 4% year-over-year on an FX-neutral basis, outpacing the remainder of our business by roughly seven points. We exited the year with Focus Categories making up nearly 30% of our business, and we will continue to expand to new categories in 2024. Our investments in Focus Categories led to numerous improvements in the overall customer experience on eBay last year, including: CEO Letter to Stockholders 2023 2 • We launched eBay Guaranteed Fit in the U.S. and similar programs in the UK and Germany to benefit our Motors Parts & Accessories (P&A) business, assuring buyers that eBay will stand behind them if a part doesn’t fit their vehicle. These programs are underpinned by multiple years of investment in P&A technology, have delivered a game-changing level of trust for buyers, and have yielded measurable uplift in conversion for sellers. • We launched the Certified by Brand program with over 30 brands offering new and certified preowned inventory, bringing an enhanced level of trust to the watch, jewelry, and handbag categories. • Our eBay Refurbished program continues to outperform as consumers turn to eBay for sustainability and value in the current economic environment. eBay Refurbished was one of our fastest growing Focus Categories in 2023, posting healthy double-digit, FX-Neutral GMV growth for the full year. Last year, we added dozens of new categories to the program, signed up more brands and OEMs to sell refurbished inventory directly on eBay, and made onboarding for small business sellers faster and more scalable to increase the amount of great refurbished inventory available to buyers. In addition to Focus Categories, we’re investing in country-specific experiences so that our marketplace is more attuned to the needs of local sellers and buyers. Last year, we made a significant investment in Germany, our third largest market as measured by demand, adopting a similar approach to our vertical playbook: • We removed some of the biggest hurdles for sellers and introduced a number of features to address the unique needs of German consumers, including search and SEO enhancements, shipping and return label improvements, and a complete overhaul of the local pickup experience. Additionally, we eliminated final value fees for German C2C sellers on domestic transactions to stimulate our sell-to-buy flywheel in the country. • Over the past year, C2C seller NPS and customer satisfaction have increased by 20 points or more, buyers who sell returned to positive growth, unpaid items have been cut in half for local pickups, and C2C volume in Germany has returned to positive growth. • Notably, these investments have made our business significantly more resilient to the challenging macroenvironment in Germany and have resulted in hundreds of millions of dollars of incremental GMV relative to our prior trajectory. CEO Letter to Stockholders 2023 3 Finally, we continued to improve the selling and buying experiences with horizontal enhancements in 2023: • We invested further in new capabilities for Search, such as deep learning and visual similarity to improve ranking and retrieval, reducing queries with low or null results to surface more of our amazing inventory for customers. • We began our work in modernizing the buying experience on eBay by rolling out an enhanced View Item page, which features a streamlined appearance, larger and higher-resolution images, and an optimized information hierarchy. This update has contributed to a measurable uplift in GMV versus our previous design, and our work to modernize the overall shopping experience will continue in 2024. Scalable Solutions eBay’s scale is one of our most powerful assets, with over 28 years of data, 132 million buyers, and nearly 2 billion live listings in 190 markets around the world at the end of 2023. With the foundational capabilities we developed using AI last year, we will continue to invest in unlocking the power of our data assets to fuel next-gen ecommerce experiences that we are confident will exceed our customers’ expectations and set a new standard for the industry. Our advertising business continued to show strong double-digit growth rates in 2023, driving our ability to invest meaningfully into the rest of the business. Our advertising platform, which surpassed 900 million live Promoted Listings in 2023, helps sellers achieve greater velocity and price realization for their inventory. • We generated over $1.4 billion of total advertising revenue, up roughly 25% on an FX-Neutral basis for the year and more than double our advertising revenue in 2019. • Promoted Listings Standard, our cost-per-acquisition product, remains our largest contributor to advertising revenue due to its simplicity and proven return on ad spend. • And Promoted Listings Advanced, our cost-per-click format, was among the fastest-growing products in our advertising portfolio on a year-over-year basis. Over the course of the year, we significantly enhanced this product with customized keywords and bidding structures, and by using AI to optimize campaigns. Also, the payments platform processed approximately $70 billion of volume in 2023 while enabling transactions between millions of eBay sellers and buyers globally. We continued to scale our financial services offerings like FX conversion and alternative methods to pay and get paid. We also meaningfully improved our identity and risk management capabilities that enhance customer value CEO Letter to Stockholders 2023 4 and marketplace trust. For instance, investments in the eBay checkout experience and in-house risk modeling enhancements aimed at reducing transaction friction have measurably improved conversion on our marketplace and contributed nearly $1 billion in incremental GMV in 2023. Lastly, our global scale and cross-border capabilities enabled us to launch the eBay International Shipping (eIS) program, which makes trade more seamless and cost effective for sellers and buyers worldwide by simplifying the complexities of taxes, duties, and returns. • We introduced combined shipping for eIS, allowing buyers to order multiple items from an international seller and pay one consolidated shipping fee. • We ended 2023 with over 400 million live listings from U.S. sellers shippable to international buyers, and sellers have had an overwhelmingly positive response to the program, with customer satisfaction ratings over 40 points higher than the previous global shipping program eIS replaced.","System instruction: Respond using only the information contained within this prompt. question: According to this letter to shareholders, what was launched in Germany in 2023 to benefit the Motors P&A business? context: Dear Stockholders, This past year has been a transformative one for eBay: We delivered solid results, and in our continued pursuit to drive long-term sustainable growth, we’ve set an even more ambitious vision — to reinvent the future of ecommerce for enthusiasts. We made significant progress against our goals, with improvements in organic FX-Neutral and as-reported year-over-year GMV growth during each quarter of 2023. For the full year, revenue was up 3% organically, we generated approximately $2 billion of free cash flow, and we returned over $1.9 billion to stockholders through repurchases and dividends. Based on these results, we are confident that our strategy is the right one and that we are on the path to build a stronger, more resilient company. Since I rejoined eBay as CEO four years ago, we’ve renewed our focus on offering meaningful choices and value, and building trust with our global community of sellers and buyers. The pace of innovation at eBay has accelerated, and we have pivoted to a full-funnel marketing approach aimed at attracting and retaining enthusiast customers. In 2023, we raised the bar further to enhance the end-to-end experience for our customers and drive growth for stockholders by leveraging three key strategic pillars: relevant experiences, scalable solutions, and magical innovations. As we navigated a dynamic macroeconomic environment, we set our organization up for speed and prioritized initiatives that we believe will have an outsized impact on our customers, community, and stockholders. Relevant Experiences We are focused on solving the specific and ever-changing needs of our sellers and buyers across all shopping occasions. Through our Focus Category playbook, we have seen a meaningful improvement in our growth relative to the market in every category we’ve invested in to date. In 2023, Focus Categories grew by 4% year-over-year on an FX-neutral basis, outpacing the remainder of our business by roughly seven points. We exited the year with Focus Categories making up nearly 30% of our business, and we will continue to expand to new categories in 2024. Our investments in Focus Categories led to numerous improvements in the overall customer experience on eBay last year, including: CEO Letter to Stockholders 2023 2 • We launched eBay Guaranteed Fit in the U.S. and similar programs in the UK and Germany to benefit our Motors Parts & Accessories (P&A) business, assuring buyers that eBay will stand behind them if a part doesn’t fit their vehicle. These programs are underpinned by multiple years of investment in P&A technology, have delivered a game-changing level of trust for buyers, and have yielded measurable uplift in conversion for sellers. • We launched the Certified by Brand program with over 30 brands offering new and certified preowned inventory, bringing an enhanced level of trust to the watch, jewelry, and handbag categories. • Our eBay Refurbished program continues to outperform as consumers turn to eBay for sustainability and value in the current economic environment. eBay Refurbished was one of our fastest growing Focus Categories in 2023, posting healthy double-digit, FX-Neutral GMV growth for the full year. Last year, we added dozens of new categories to the program, signed up more brands and OEMs to sell refurbished inventory directly on eBay, and made onboarding for small business sellers faster and more scalable to increase the amount of great refurbished inventory available to buyers. In addition to Focus Categories, we’re investing in country-specific experiences so that our marketplace is more attuned to the needs of local sellers and buyers. Last year, we made a significant investment in Germany, our third largest market as measured by demand, adopting a similar approach to our vertical playbook: • We removed some of the biggest hurdles for sellers and introduced a number of features to address the unique needs of German consumers, including search and SEO enhancements, shipping and return label improvements, and a complete overhaul of the local pickup experience. Additionally, we eliminated final value fees for German C2C sellers on domestic transactions to stimulate our sell-to-buy flywheel in the country. • Over the past year, C2C seller NPS and customer satisfaction have increased by 20 points or more, buyers who sell returned to positive growth, unpaid items have been cut in half for local pickups, and C2C volume in Germany has returned to positive growth. • Notably, these investments have made our business significantly more resilient to the challenging macroenvironment in Germany and have resulted in hundreds of millions of dollars of incremental GMV relative to our prior trajectory. CEO Letter to Stockholders 2023 3 Finally, we continued to improve the selling and buying experiences with horizontal enhancements in 2023: • We invested further in new capabilities for Search, such as deep learning and visual similarity to improve ranking and retrieval, reducing queries with low or null results to surface more of our amazing inventory for customers. • We began our work in modernizing the buying experience on eBay by rolling out an enhanced View Item page, which features a streamlined appearance, larger and higher-resolution images, and an optimized information hierarchy. This update has contributed to a measurable uplift in GMV versus our previous design, and our work to modernize the overall shopping experience will continue in 2024. Scalable Solutions eBay’s scale is one of our most powerful assets, with over 28 years of data, 132 million buyers, and nearly 2 billion live listings in 190 markets around the world at the end of 2023. With the foundational capabilities we developed using AI last year, we will continue to invest in unlocking the power of our data assets to fuel next-gen ecommerce experiences that we are confident will exceed our customers’ expectations and set a new standard for the industry. Our advertising business continued to show strong double-digit growth rates in 2023, driving our ability to invest meaningfully into the rest of the business. Our advertising platform, which surpassed 900 million live Promoted Listings in 2023, helps sellers achieve greater velocity and price realization for their inventory. • We generated over $1.4 billion of total advertising revenue, up roughly 25% on an FX-Neutral basis for the year and more than double our advertising revenue in 2019. • Promoted Listings Standard, our cost-per-acquisition product, remains our largest contributor to advertising revenue due to its simplicity and proven return on ad spend. • And Promoted Listings Advanced, our cost-per-click format, was among the fastest-growing products in our advertising portfolio on a year-over-year basis. Over the course of the year, we significantly enhanced this product with customized keywords and bidding structures, and by using AI to optimize campaigns. Also, the payments platform processed approximately $70 billion of volume in 2023 while enabling transactions between millions of eBay sellers and buyers globally. We continued to scale our financial services offerings like FX conversion and alternative methods to pay and get paid. We also meaningfully improved our identity and risk management capabilities that enhance customer value CEO Letter to Stockholders 2023 4 and marketplace trust. For instance, investments in the eBay checkout experience and in-house risk modeling enhancements aimed at reducing transaction friction have measurably improved conversion on our marketplace and contributed nearly $1 billion in incremental GMV in 2023. Lastly, our global scale and cross-border capabilities enabled us to launch the eBay International Shipping (eIS) program, which makes trade more seamless and cost effective for sellers and buyers worldwide by simplifying the complexities of taxes, duties, and returns. • We introduced combined shipping for eIS, allowing buyers to order multiple items from an international seller and pay one consolidated shipping fee. • We ended 2023 with over 400 million live listings from U.S. sellers shippable to international buyers, and sellers have had an overwhelmingly positive response to the program, with customer satisfaction ratings over 40 points higher than the previous global shipping program eIS replaced.",Financial,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","As you know AI is advancing in every field, I'm bit interested in healthcare as it is my domain. How is generative AI being used in healthcare system?","Revolutionizing Healthcare: The Transformative Power of AI May 17, 2024 By Kevin Riddleberger, Co-founder, DispatchHealth Kevin Riddleberger, PA-C, MBA, co-founder and chief strategy officer at DispatchHealth. As the co-founder of a pioneering digital health company and a seasoned physician associate, I have navigated the forefront of healthcare innovation over the last decade. Our journey has witnessed both incremental advancements and radical shifts, but none as transformative as the current wave led by Artificial Intelligence (AI). This technological revolution promises to redefine healthcare delivery and management, bringing profound changes that were once the realm of science fiction into today’s clinical practices. The impact on the healthcare society will be bigger than electricity, the computer or the internet by many multiples. Research published in the New England Journal of Medicine last year indicates that generative AI has improved patient outcomes by up to 45% in clinical trials, particularly in the treatment of chronic diseases such as diabetes and heart disease, through personalized medicine and management plans. While a report by McKinsey & Company predicts that generative AI could help reduce healthcare costs in the United States by up to $150 billion annually by 2026 through automation of administrative tasks and optimization of clinical workflows. Just last year, I highlighted in a thought leadership piece a typical day in the life of a clinician leveraging generative AI models embedded in their daily workflow. Since then we have witnessed an explosion of venture capital in companies to the tune of billions of dollars due to immense impact on healthcare operations and drug discoveries. Generative AI models are crucial for achieving the Quintuple Aim of healthcare, enhancing care quality, provider satisfaction, and patient engagement while reducing costs and improving health populations. The volume of medical literature published annually is overwhelming, with estimates suggesting it would take decades for a clinician to process a year’s worth of research. We have long surpassed the power of the human brain and need augmentation quickly. The Expanding Role of AI in Healthcare AI’s integration into healthcare is set to usher in transformative changes, including the development of personalized treatment plans tailored to individual genetic profiles and lifestyles, and virtual health assistants available 24/7, providing real-time, accurate medical advice. The expectation is that AI will manage over 85% of customer interactions in healthcare by 2025, reducing the need for human intervention and allowing healthcare professionals to focus more on patient care. This shift towards technology-dependent care teams emphasizes AI’s role as a partner in healthcare, enhancing our capabilities to serve and care. While technology won’t replace humans, it will become a more integral member of the care team. The future of care delivery will lie in a technology-dependent care team approach, where healthcare workers focus on their greatest comparative advantages over technology. In the quest for top-of-license care, clinician roles, decision making processes, and workflows will evolve by embedding this transformative technology. Companies Leading the AI Healthcare Revolution Eko Health: Known for its AI-powered cardiac monitoring tools, Eko has developed algorithms that significantly improve the detection of heart conditions in routine screenings, potentially reducing the rates of undiagnosed cardiac issues by up to 30%. Eko recently was awarded by the FDA the first AI to aid heart failure detection during routine check-ups using their stethoscopes. Butterfly Network: Their portable ultrasound device, powered by AI, has democratized medical imaging, making it more accessible and affordable. Introducing AI-powered POCUS is proving to increase diagnostic speed and accuracy in point of care settings thus minimizing more expensive imaging studies required. Abridge and Nuance These companies are at the forefront of conversational AI, significantly reducing the clerical burden on clinicians, with both platforms now seamlessly integrated into Epic systems. The technologies use AI to transcribe and structure medical conversations during patient visits, which helps in ensuring that crucial information is captured accurately and can be easily referenced later, reducing the 70+ hours of documentation per clinician every month. Hippocratic AI: The product is a novel staffing marketplace where companies can “hire” auto-pilot generative AI-powered agents to conduct low-risk, non-diagnostic, patient-facing services to help solve the massive healthcare staffing crisis. The company’s vision is centered around how generative AI can provide super staffing and healthcare abundance and equity in our industry. Glass Health: An emerging player, Glass Health uses AI to integrate various data sources to provide a holistic view of patient health, aiding in more comprehensive care planning and clinical decision support at the point of care. Looking Forward: Embracing the Future of Medicine AI is a strategy enabler, not a strategy in itself. Effective AI adopters in healthcare will prioritize integrated governance over isolated initiatives, using AI as a tool to support strategic endeavors and to incorporate data as a key competitive asset. While AI presents unprecedented opportunities for advancement, it also brings challenges such as data privacy concerns, the need for robust ethical frameworks to prevent bias, and the importance of maintaining the human touch in medicine. Addressing these issues is crucial as we integrate more AI tools into clinical settings. The American Academy of PAs (AAPA) has recently developed an AI task force to guide future legislation and ensure that the PA profession is safeguarded in future regulatory frameworks, and I am proud to be part of this esteemed group moving forward. As we prepare for the upcoming annual AAPA conference in Houston, I look forward to engaging with healthcare professionals and leaders to discuss the future of medicine and AI’s role. The opportunity to hear from pioneers like Daniel Kraft, MD and leading a panel discussion on healthcare innovation will further our understanding and implementation of AI technologies.These events at the AAPA conference underscore the vibrant, dynamic nature of our profession and the central role that innovation plays in driving us forward. I am eager to share ideas with fellow thought leaders and continue pushing the boundaries of what is possible in healthcare. As we stand on the brink of a technological revolution in healthcare, driven by artificial intelligence, our responsibilities are manifold. We must not only embrace AI and its capabilities but also guide its integration thoughtfully and ethically to enhance patient care and improve health outcomes. The promise of AI in healthcare is vast and exciting, and I am optimistic about the transformative changes we are about to witness. Let us step boldly into this future, equipped with knowledge, inspired by innovation, and committed to the betterment of patient care worldwide. Let’s not be afraid but rather be bold and embrace the evolution of technology to advance our industry and our profession.","""================ ======= Revolutionizing Healthcare: The Transformative Power of AI May 17, 2024 By Kevin Riddleberger, Co-founder, DispatchHealth Kevin Riddleberger, PA-C, MBA, co-founder and chief strategy officer at DispatchHealth. As the co-founder of a pioneering digital health company and a seasoned physician associate, I have navigated the forefront of healthcare innovation over the last decade. Our journey has witnessed both incremental advancements and radical shifts, but none as transformative as the current wave led by Artificial Intelligence (AI). This technological revolution promises to redefine healthcare delivery and management, bringing profound changes that were once the realm of science fiction into today’s clinical practices. The impact on the healthcare society will be bigger than electricity, the computer or the internet by many multiples. Research published in the New England Journal of Medicine last year indicates that generative AI has improved patient outcomes by up to 45% in clinical trials, particularly in the treatment of chronic diseases such as diabetes and heart disease, through personalized medicine and management plans. While a report by McKinsey & Company predicts that generative AI could help reduce healthcare costs in the United States by up to $150 billion annually by 2026 through automation of administrative tasks and optimization of clinical workflows. Just last year, I highlighted in a thought leadership piece a typical day in the life of a clinician leveraging generative AI models embedded in their daily workflow. Since then we have witnessed an explosion of venture capital in companies to the tune of billions of dollars due to immense impact on healthcare operations and drug discoveries. Generative AI models are crucial for achieving the Quintuple Aim of healthcare, enhancing care quality, provider satisfaction, and patient engagement while reducing costs and improving health populations. The volume of medical literature published annually is overwhelming, with estimates suggesting it would take decades for a clinician to process a year’s worth of research. We have long surpassed the power of the human brain and need augmentation quickly. The Expanding Role of AI in Healthcare AI’s integration into healthcare is set to usher in transformative changes, including the development of personalized treatment plans tailored to individual genetic profiles and lifestyles, and virtual health assistants available 24/7, providing real-time, accurate medical advice. The expectation is that AI will manage over 85% of customer interactions in healthcare by 2025, reducing the need for human intervention and allowing healthcare professionals to focus more on patient care. This shift towards technology-dependent care teams emphasizes AI’s role as a partner in healthcare, enhancing our capabilities to serve and care. While technology won’t replace humans, it will become a more integral member of the care team. The future of care delivery will lie in a technology-dependent care team approach, where healthcare workers focus on their greatest comparative advantages over technology. In the quest for top-of-license care, clinician roles, decision making processes, and workflows will evolve by embedding this transformative technology. Companies Leading the AI Healthcare Revolution Eko Health: Known for its AI-powered cardiac monitoring tools, Eko has developed algorithms that significantly improve the detection of heart conditions in routine screenings, potentially reducing the rates of undiagnosed cardiac issues by up to 30%. Eko recently was awarded by the FDA the first AI to aid heart failure detection during routine check-ups using their stethoscopes. Butterfly Network: Their portable ultrasound device, powered by AI, has democratized medical imaging, making it more accessible and affordable. Introducing AI-powered POCUS is proving to increase diagnostic speed and accuracy in point of care settings thus minimizing more expensive imaging studies required. Abridge and Nuance These companies are at the forefront of conversational AI, significantly reducing the clerical burden on clinicians, with both platforms now seamlessly integrated into Epic systems. The technologies use AI to transcribe and structure medical conversations during patient visits, which helps in ensuring that crucial information is captured accurately and can be easily referenced later, reducing the 70+ hours of documentation per clinician every month. Hippocratic AI: The product is a novel staffing marketplace where companies can “hire” auto-pilot generative AI-powered agents to conduct low-risk, non-diagnostic, patient-facing services to help solve the massive healthcare staffing crisis. The company’s vision is centered around how generative AI can provide super staffing and healthcare abundance and equity in our industry. Glass Health: An emerging player, Glass Health uses AI to integrate various data sources to provide a holistic view of patient health, aiding in more comprehensive care planning and clinical decision support at the point of care. Looking Forward: Embracing the Future of Medicine AI is a strategy enabler, not a strategy in itself. Effective AI adopters in healthcare will prioritize integrated governance over isolated initiatives, using AI as a tool to support strategic endeavors and to incorporate data as a key competitive asset. While AI presents unprecedented opportunities for advancement, it also brings challenges such as data privacy concerns, the need for robust ethical frameworks to prevent bias, and the importance of maintaining the human touch in medicine. Addressing these issues is crucial as we integrate more AI tools into clinical settings. The American Academy of PAs (AAPA) has recently developed an AI task force to guide future legislation and ensure that the PA profession is safeguarded in future regulatory frameworks, and I am proud to be part of this esteemed group moving forward. As we prepare for the upcoming annual AAPA conference in Houston, I look forward to engaging with healthcare professionals and leaders to discuss the future of medicine and AI’s role. The opportunity to hear from pioneers like Daniel Kraft, MD and leading a panel discussion on healthcare innovation will further our understanding and implementation of AI technologies.These events at the AAPA conference underscore the vibrant, dynamic nature of our profession and the central role that innovation plays in driving us forward. I am eager to share ideas with fellow thought leaders and continue pushing the boundaries of what is possible in healthcare. As we stand on the brink of a technological revolution in healthcare, driven by artificial intelligence, our responsibilities are manifold. We must not only embrace AI and its capabilities but also guide its integration thoughtfully and ethically to enhance patient care and improve health outcomes. The promise of AI in healthcare is vast and exciting, and I am optimistic about the transformative changes we are about to witness. Let us step boldly into this future, equipped with knowledge, inspired by innovation, and committed to the betterment of patient care worldwide. Let’s not be afraid but rather be bold and embrace the evolution of technology to advance our industry and our profession. https://www.aapa.org/news-central/2024/05/revolutionizing-healthcare-the-transformative-power-of-ai/ ================ ======= As you know AI is advancing in every field, I'm bit interested in healthcare as it is my domain. How is generative AI being used in healthcare system? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Internet/Technology,Fact Finding,Q&A "To answer the following question, use only information contained in the context block/prompt. Do not use any previous knowledge or outside sources. ","Whether currently available or unavailable, what is an example of a smokeless cannabis delivery method that clinical trials hope to help develop?"," Three focal concerns in evaluating the medical use of marijuana are: 1. Evaluation of the effects of isolated cannabinoids; 2. Evaluation of the risks associated with the medical use of marijuana; and 3. Evaluation of the use of smoked marijuana. EFFECTS OF ISOLATED CANNABINOIDS Cannabinoid Biology Much has been learned since the 1982 IOM report Marijuana and Health. Although it was clear then that most of the effects of marijuana were due to its actions on the brain, there was little information about how THC acted on brain cells (neurons), which cells were affected by THC, or even what general areas of the brain were most affected by THC. In addition, too little was known about cannabinoid physiology to offer any scientific insights into the harmful or therapeutic effects of marijuana. That all changed with the identification and characterization of cannabinoid receptors in the 1980s and 1990s. During the past 16 years, science has advanced greatly and can tell us much more about the potential medical benefits of cannabinoids. Conclusion: At this point, our knowledge about the biology of marijuana and cannabinoids allows us to make some general conclusions: o Cannabinoids likely have a natural role in pain modulation, control of movement, and memory. o The natural role of cannabinoids in immune systems is likely multi-faceted and remains unclear. o The brain develops tolerance to cannabinoids. o Animal research demonstrates the potential for dependence, but this potential is observed under a narrower range of conditions than with benzodiazepines, opiates, cocaine, or nicotine. o Withdrawal symptoms can be observed in animals but appear to be mild compared to opiates or benzodiazepines, such as diazepam (Valium). Conclusion: The different cannabinoid receptor types found in the body appear to play different roles in normal human physiology. In addition, some effects of cannabinoids appear to be independent of those receptors. The variety of mechanisms through which cannabinoids can influence human physiology underlies the variety of potential therapeutic uses for drugs that might act selectively on different cannabinoid systems. Recommendation 1: Research should continue into the physiological effects of synthetic and plant-derived cannabinoids and the natural function of cannabinoids found in the body. Because different cannabinoids appear to have different effects, cannabinoid research should include, but not be restricted to, effects attributable to THC alone. Efficacy of Cannabinoid Drugs The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation. The therapeutic effects of cannabinoids are best established for THC, which is generally one of the two most abundant of the cannabinoids in marijuana. (Cannabidiol is generally the other most abundant cannabinoid.) The effects of cannabinoids on the symptoms studied are generally modest, and in most cases there are more effective medications. However, people vary in their responses to medications, and there will likely always be a subpopulation of patients who do not respond well to other medications. The combination of cannabinoid drug effects (anxiety reduction, appetite stimulation, nausea reduction, and pain relief) suggests that cannabinoids would be moderately well suited for particular conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting. Defined substances, such as purified cannabinoid compounds, are preferable to plant products, which are of variable and uncertain composition. Use of defined cannabinoids permits a more precise evaluation of their effects, whether in combination or alone. Medications that can maximize the desired effects of cannabinoids and minimize the undesired effects can very likely be identified. Although most scientists who study cannabinoids agree that the pathways to cannabinoid drug development are clearly marked, there is no guarantee that the fruits of scientific research will be made available to the public for medical use. Cannabinoid- based drugs will only become available if public investment in cannabinoid drug research is sustained and if there is enough incentive for private enterprise to develop and market such drugs. Conclusion: Scientific data indicate the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances. Recommendation 2: Clinical trials of cannabinoid drugs for symptom management should be conducted with the goal of developing rapid-onset, reliable, and safe delivery systems. Influence of Psychological Effects on Therapeutic Effects The psychological effects of THC and similar cannabinoids pose three issues for the therapeutic use of cannabinoid drugs. First, for some patients--particularly older patients with no previous marijuana experience--the psychological effects are disturbing. Those patients report experiencing unpleasant feelings and disorientation after being treated with THC, generally more severe for oral THC than for smoked marijuana. Second, for conditions such as movement disorders or nausea, in which anxiety exacerbates the symptoms, the antianxiety effects of cannabinoid drugs can influence symptoms indirectly. This can be beneficial or can create false impressions of the drug effect. Third, for cases in which symptoms are multifaceted, the combination of THC effects might provide a form of adjunctive therapy; for example, AIDS wasting patients would likely benefit from a medication that simultaneously reduces anxiety, pain, and nausea while stimulating appetite. Conclusion: The psychological effects of cannabinoids, such as anxiety reduction, sedation, and euphoria can influence their potential therapeutic value. Those effects are potentially undesirable for certain patients and situations and beneficial for others. In addition, psychological effects can complicate the interpretation of other aspects of the drug's effect. Recommendation 3: Psychological effects of cannabinoids such as anxiety reduction and sedation, which can influence medical benefits, should be evaluated in clinical trials. RISKS ASSOCIATED WITH MEDICAL USE OF MARIJUANA Physiological Risks Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications. The harmful effects to individuals from the perspective of possible medical use of marijuana are not necessarily the same as the harmful physical effects of drug abuse. When interpreting studies purporting to show the harmful effects of marijuana, it is important to keep in mind that the majority of those studies are based on smoked marijuana, and cannabinoid effects cannot be separated from the effects of inhaling smoke from burning plant material and contaminants. For most people the primary adverse effect of acute marijuana use is diminished psychomotor performance. It is, therefore, inadvisable to operate any vehicle or potentially dangerous equipment while under the influence of marijuana, THC, or any cannabinoid drug with comparable effects. In addition, a minority of marijuana users experience dysphoria, or unpleasant feelings. Finally, the short-term immunosuppressive effects are not well established but, if they exist, are not likely great enough to preclude a legitimate medical use. The chronic effects of marijuana are of greater concern for medical use and fall into two categories: the effects of chronic smoking and the effects of THC. Marijuana smoking is associated with abnormalities of cells lining the human respiratory tract. Marijuana smoke, like tobacco smoke, is associated with increased risk of cancer, lung damage, and poor pregnancy outcomes. Although cellular, genetic, and human studies all suggest that marijuana smoke is an important risk factor for the development of respiratory cancer, proof that habitual marijuana smoking does or does not cause cancer awaits the results of well-designed studies. Conclusion: Numerous studies suggest that marijuana smoke is an important risk factor in the development of respiratory disease. Recommendation 4: Studies to define the individual health risks of smoking marijuana should be conducted, particularly among populations in which marijuana use is prevalent. Marijuana Dependence and Withdrawal A second concern associated with chronic marijuana use is dependence on the psychoactive effects of THC. Although few marijuana users develop dependence, some do. Risk factors for marijuana dependence are similar to those for other forms of substance abuse. In particular, anti-social personality and conduct disorders are closely associated with substance abuse. Conclusion: A distinctive marijuana withdrawal syndrome has been identified, but it is mild and short lived. The syndrome includes restlessness, irritability, mild agitation, insomnia, sleep disturbance, nausea, and cramping. Marijuana as a ""Gateway"" Drug Patterns in progression of drug use from adolescence to adulthood are strikingly regular. Because it is the most widely used illicit drug, marijuana is predictably the first illicit drug most people encounter. Not surprisingly, most users of other illicit drugs have used marijuana first. In fact, most drug users begin with alcohol and nicotine before marijuana--usually before they are of legal age. In the sense that marijuana use typically precedes rather than follows initiation of other illicit drug use, it is indeed a ""gateway"" drug. But because underage smoking and alcohol use typically precede marijuana use, marijuana is not the most common, and is rarely the first, ""gateway"" to illicit drug use. There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs. An important caution is that data on drug use progression cannot be assumed to apply to the use of drugs for medical purposes. It does not follow from those data that if marijuana were available by prescription for medical use, the pattern of drug use would remain the same as seen in illicit use. Finally, there is a broad social concern that sanctioning the medical use of marijuana might increase its use among the general population. At this point there are no convincing data to support this concern. The existing data are consistent with the idea that this would not be a problem if the medical use of marijuana were as closely regulated as other medications with abuse potential. Conclusion: Present data on drug use progression neither support nor refute the suggestion that medical availability would increase drug abuse. However, this question is beyond the issues normally considered for medical uses of drugs and should not be a factor in evaluating the therapeutic potential of marijuana or cannabinoids. USE OF SMOKED MARIJUANA Because of the health risks associated with smoking, smoked marijuana should generally not be recommended for long-term medical use. Nonetheless, for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern. Further, despite the legal, social, and health problems associated with smoking marijuana, it is widely used by certain patient groups. Recommendation 5: Clinical trials of marijuana use for medical purposes should be conducted under the following limited circumstances: trials should involve only short-term marijuana use (less than six months), should be conducted in patients with conditions for which there is reasonable expectation of efficacy, should be approved by institutional review boards, and should collect data about efficacy. The goal of clinical trials of smoked marijuana would not be to develop marijuana as a licensed drug but rather to serve as a first step toward the possible development of nonsmoked rapid-onset cannabinoid delivery systems. However, it will likely be many years before a safe and effective cannabinoid delivery system, such as an inhaler, is available for patients. In the meantime there are patients with debilitating symptoms for whom smoked marijuana might provide relief. The use of smoked marijuana for those patients should weigh both the expected efficacy of marijuana and ethical issues in patient care, including providing information about the known and suspected risks of smoked marijuana use. Recommendation 6: Short-term use of smoked marijuana (less than six months) for patients with debilitating symptoms (such as intractable pain or vomiting) must meet the following conditions: o failure of all approved medications to provide relief has been documented, o the symptoms can reasonably be expected to be relieved by rapid- onset cannabinoid drugs, o such treatment is administered under medical supervision in a manner that allows for assessment of treatment effectiveness, and o involves an oversight strategy comparable to an institutional review board process that could provide guidance within 24 hours of a submission by a physician to provide marijuana to a patient for a specified use. Until a nonsmoked rapid-onset cannabinoid drug delivery system becomes available, we acknowledge that there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting. One possible approach is to treat patients as n-of-1 clinical trials (single-patient trials), in which patients are fully informed of their status as experimental subjects using a harmful drug delivery system and in which their condition is closely monitored and documented under medical supervision, thereby increasing the knowledge base of the risks and benefits of marijuana use under such conditions.data, it is important to understand that decisions about drug regulation are based on a variety of moral and social considerations, as well as on medical and scientific ones. Even when a drug is used only for medical purposes, value judgments affect policy decisions concerning its medical use. For example, the magnitude of a drug's expected medical benefit affects regulatory judgments about the acceptability of risks associated with its use. Also, although a drug is normally approved for medical use only on proof of its ""safety and efficacy,"" patients with life-threatening conditions are sometimes (under protocols for ""compassionate use"") allowed access to unapproved drugs whose benefits and risks are uncertain. Value judgments play an even more substantial role in regulatory decisions concerning drugs, such as marijuana, that are sought and used for nonmedical purposes. Then policymakers must take into account not only the risks and benefits associated with medical use but also possible interactions between the regulatory arrangements governing medical use and the integrity of the legal controls set up to restrict nonmedical use. It should be clear that many elements of drug control policy lie outside the realm of biology and medicine. Ultimately, the complex moral and social judgments that underlie drug control policy must be made by the American people and their elected officials. A goal of this report is to evaluate the biological and medical factors that should be taken into account in making those judgments. HOW THIS STUDY WAS CONDUCTED Information was gathered through scientific workshops, site visits, analysis of the relevant scientific literature, and extensive consultation with biomedical and social scientists. The three 2-day workshops--in Irvine, California; New Orleans, Louisiana; and Washington, D.C.--were open to the public and included scientific presentations and reports, mostly from patients and their families, about their experiences with and perspectives on the medical use of marijuana. Scientific experts in various fields were selected to talk about the latest research on marijuana, cannabinoids, and related topics (listed in Appendix B). Selection of the experts was based on recommendations by their peers, who ranked them among the most accomplished scientists and the most knowledgeable about marijuana and cannabinoids in their own fields. In addition, advocates for (John Morgan) and against (Eric A. Voth) the medical use of marijuana were invited to present scientific evidence in support of their positions. Information presented at the scientific workshops was supplemented by analysis of the scientific literature and evaluating the methods used in various studies and the validity of the authors' conclusions. Different kinds of clinical studies are useful in different ways: results of a controlled double-blind study with adequate sample sizes can be expected to apply to the general population from which study subjects were drawn; an isolated case report can suggest further studies but cannot be presumed to be broadly applicable; and survey data can be highly informative but are generally limited by the need to rely on self-reports of drug use and on unconfirmed medical diagnoses. This report relies mainly on the most relevant and methodologically rigorous studies available and treats the results of more limited studies cautiously. In addition, study results are presented in such a way as to allow thoughtful readers to judge the results themselves. The Institute of Medicine (IOM) appointed a panel of nine experts to advise the study team on technical issues. These included neurology and the treatment of pain (Howard Fields); regulation of prescription drugs (J. Richard Crout); AIDS wasting and clinical trials (Judith Feinberg); treatment and pathology of multiple sclerosis (Timothy Vollmer); drug dependence among adolescents (Thomas Crowley); varieties of drug dependence (Dorothy Hatsukami); internal medicine, health care delivery, and clinical epidemiology (Eric B. Larson); cannabinoids and marijuana pharmacology (Billy R. Martin); and cannabinoid neuroscience (Steven R. Childers). Public outreach included setting up a Web site that provided information about the study and asked for input from the public. The Web site was open for comment from November 1997 until November 1998. Some 130 organizations were invited to participate in the public workshops. Many people in the organizations--particularly those opposed to the medical use of marijuana--felt that a public forum was not conducive to expressing their views; they were invited to communicate their opinions (and reasons for holding them) by mail or telephone. As a result, roughly equal numbers of persons and organizations opposed to and in favor of the medical use of marijuana were heard from. The study team visited four cannabis buyers' clubs in California (the Oakland Cannabis Buyers' Cooperative, the San Francisco Cannabis Cultivators Club, the Los Angeles Cannabis Resource Center, and Californians Helping Alleviate Medical Problems, or CHAMPS) and two HIV/AIDS clinics (AIDS Health Care Foundation in Los Angeles and Louisiana State University Medical Center in New Orleans). We listened to many individual stories from the buyers' clubs about using marijuana to treat a variety of symptoms and heard clinical observations on the use of Marinol to treat AIDS 9 patients. Marinol is the brand name for dronabinol, which is (THC) in pill form and is available by prescription for the treatment of nausea associated with chemotherapy and AIDS wasting. MARIJUANA TODAY The Changing Legal Landscape In the 20th century, marijuana has been used more for its euphoric effects than as a medicine. Its psychological and behavioral effects have concerned public officials since the drug first appeared in the southwestern and southern states during the first two decades of the century. By 1931, at least 29 states had prohibited use of the drug for 3 nonmedicalpurposes. MarijuanawasfirstregulatedatthefederallevelbytheMarijuana Tax Act of 1937, which required anyone producing, distributing, or using marijuana for medical purposes to register and pay a tax and which effectively prohibited nonmedical use of the drug. Although the act did not make medical use of marijuana illegal, it did make it expensive and inconvenient. In 1942, marijuana was removed from the U.S. -tetrahydrocannabinol Pharmacopoeia because it was believed to be a harmful and addictive drug that caused psychoses, mental deterioration, and violent behavior. In the late 1960s and early 1970s, there was a sharp increase in marijuana use among adolescents and young adults. The current legal status of marijuana was established in 1970 with the passage of the Controlled Substances Act, which divided drugs into five schedules and placed marijuana in Schedule I, the category for drugs with high potential for abuse and no accepted medical use (see Appendix C, Scheduling Definitions). In 1972, the National Organization for the Reform of Marijuana Legislation (NORML), an organization that supports decriminalization of marijuana, unsuccessfully petitioned the Bureau of Narcotics and Dangerous Drugs to move marijuana from Schedule I to Schedule II. NORML argued that marijuana is therapeutic in numerous serious ailments, 13 less toxic, and in many cases more effective than conventional medicines. years the medical marijuana movement has been closely linked with the marijuana decriminalization movement, which has colored the debate. Many people criticized that association in their letters to IOM and during the public workshops of this study. The argument against the medical use of marijuana presented most often to the IOM study team was that ""the medical marijuana movement is a Trojan horse""; that is, it is a deceptive tactic used by advocates of marijuana decriminalization who would exploit the public's sympathy for seriously ill patients. Since NORML's petition in 1972, there have been a variety of legal decisions concerning marijuana. From 1973 to 1978, 11 states adopted statutes that decriminalized use of marijuana, although some of them recriminalized marijuana use in the 1980s and 1990s. During the 1970s, reports of the medical value of marijuana began to appear, particularly claims that marijuana relieved the nausea associated with chemotherapy. Health departments in six states conducted small studies to investigate the reports. When the AIDS epidemic spread in the 1980s, patients found that marijuana sometimes relieved their symptoms, most dramatically those associated with AIDS wasting. Over this period a number of defendants charged with unlawful possession of marijuana claimed that they were using the drug to treat medical conditions and that violation of the law was therefore justified (the so-called medical necessity defense). Although most courts rejected these 8 Against that backdrop, voters in California and Arizona in 1996 passed two referenda that attempted to legalize the medical use of marijuana under particular conditions. Public support for patient access to marijuana for medical use appears substantial; public opinion polls taken during 1997 and 1998 generally reported 60—70 percent of 15 However, those referenda are at odds with federal laws regulating marijuana, and their implementation raises complex legal questions. Despite the current level of interest, referenda and public discussions have not been well informed by carefully reasoned scientific debate. Although previous reports have all called for more research, the nature of the research that will be most helpful depends greatly on the specific health conditions to be addressed. And while there have been claims, some accepted them. respondents in favor of allowing medical uses of marijuana. Thus, for 25 important recent advances in our understanding of the physiological effects of marijuana, few of the recent investigators have had the time or resources to permit detailed analysis. The results of those advances, only now beginning to be explored, have significant implications for the medical marijuana debate. Several months after the passage of the California and Arizona medical marijuana referendums, the Office of National Drug Control Policy (ONDCP) asked whether IOM would conduct a scientific review of the medical value of marijuana and its constituent compounds. In August 1997, IOM formally began the study and appointed John A. Benson Jr. and Stanley J. Watson Jr. to serve as principal investigators for the study. The charge to IOM was to review the medical use of marijuana and the harms and benefits attributed to it (details are given in Appendix D). Marijuana plants have been used since antiquity for both herbal medication and intoxication. The current debate over the medical use of marijuana is essentially a debate over the value of its medicinal properties relative to the risk posed by its use. 1,10,11 Marijuana's use as an herbal remedy before the 20th century is well documented. However, modern medicine adheres to different standards from those used in the past. The question is not whether marijuana can be used as an herbal remedy but rather how well this remedy meets today's standards of efficacy and safety. We understand much more than previous generations about medical risks. Our society generally expects its licensed medications to be safe, reliable, and of proven efficacy; contaminants and inconsistent ingredients in our health treatments are not tolerated. That refers not only to prescription and over-the-counter drugs but also to vitamin supplements and herbal remedies purchased at the grocery store. For example, the essential amino acid l- tryptophan was widely sold in health food stores as a natural remedy for insomnia until early 1990 when it became linked to an epidemic of a new and potentially fatal illness 9,12 When it was removed from the market shortly thereafter, there was little protest, despite the fact that it was safe for the vast majority of the population. The 1,536 cases and 27 deaths were later traced to contaminants in a batch produced by a single Japanese manufacturer. Although few herbal medicines meet today's standards, they have provided the foundation for modern Western pharmaceuticals. Most current prescriptions have their 7 rootseitherdirectlyorindirectlyinplantremedies. Atthesametime,mostcurrent prescriptions are synthetic compounds that are only distantly related to the natural compounds that led to their development. Digitalis was discovered in foxglove, morphine in poppies, and taxol in the yew tree. Even aspirin (acetylsalicylic acid) has its counterpart in herbal medicine: for many generations, American Indians relieved headaches by chewing the bark of the willow tree, which is rich in a related form of salicylic acid. Although plants continue to be valuable resources for medical advances, drug development is likely to be less and less reliant on plants and more reliant on the tools of (eosinophilia-myalgia syndrome). modern science. Molecular biology, bioinformatics software, and DNA array-based analyses of genes and chemistry are all beginning to yield great advances in drug discovery and development. Until recently, drugs could only be discovered; now they can be designed. Even the discovery process has been accelerated through the use of modern drug-screening techniques. It is increasingly possible to identify or isolate the chemical compounds in a plant, determine which compounds are responsible for the plant's effects, and select the most effective and safe compounds--either for use as purified substances or as tools to develop even more effective, safer, or less expensive compounds. Yet even as the modern pharmacological toolbox becomes more sophisticated and biotechnology yields an ever greater abundance of therapeutic drugs, people increasingly 4,5 In 1997, 46 percent of Americans sought nontraditional medicines and spent over 27 billion unreimbursed dollars; the total number of visits to alternative medicine practitioners appears to have exceeded the number of 5,6 Recent interest in the medical use of marijuana coincides with this trend toward self-help and a search for ""natural"" therapies. Indeed, several people who spoke at the IOM public hearings in support of the medical use of marijuana said that they generally preferred herbal medicines to standard pharmaceuticals. However, few alternative therapies have been carefully and systematically tested for safety and efficacy, as is required for medications approved by 2 WHO USES MEDICAL MARIJUANA? There have been no comprehensive surveys of the demographics and medical conditions of medical marijuana users, but a few reports provide some indication. In each case, survey results should be understood to reflect the situation in which they were conducted and are not necessarily characteristic of medical marijuana users as a whole. Respondents to surveys reported to the IOM study team were all members of ""buyers' clubs,"" organizations that provide their members with marijuana, although not necessarily through direct cash transactions. The atmosphere of the marijuana buyers' clubs ranges from that of the comparatively formal and closely regulated Oakland Cannabis Buyers' Cooperative to that of a ""country club for the indigent,"" as Denis Peron described the San Francisco Cannabis Cultivators Club (SFCCC), which he directed. John Mendelson, an internist and pharmacologist at the University of California, San Francisco (UCSF) Pain Management Center, surveyed 100 members of the SFCCC who were using marijuana at least weekly. Most of the respondents were unemployed men in their forties. Subjects were paid $50 to participate in the survey; this might have encouraged a greater representation of unemployed subjects. All subjects were tested for drug use. About half tested positive for marijuana only; the other half tested positive for drugs in addition to marijuana (23% for cocaine and 13% for amphetamines). The predominant disorder was AIDS, followed by roughly equal numbers of members who reported chronic pain, mood disorders, and musculoskeletal disorders (Table 1.1). seek alternative, low-technology therapies. visits to primary care physicians. the FDA (Food and Drug Administration). The membership profile of the San Francisco club was similar to that of the Los Angeles Cannabis Resource Center (LACRC), where 83% of the 739 patients were men, 45% were 36—45 years old, and 71% were HIV positive. Table 1.2 shows a distribution of conditions somewhat different from that in SFCCC respondents, probably because of a different membership profile. For example, cancer is generally a disease that occurs late in life; 34 (4.7%) of LACRC members were over 55 years old; only 2% of survey respondents in the SFCCC study were over 55 years old. Jeffrey Jones, executive director of the Oakland Cannabis Buyers' Cooperative, reported that its largest group of patients is HIV-positive men in their forties. The second- largest group is patients with chronic pain. Among the 42 people who spoke at the public workshops or wrote to the study team, only six identified themselves as members of marijuana buyers' clubs. Nonetheless, they presented a similar profile: HIV/AIDS was the predominant disorder, followed by chronic pain (Tables 1.3 and 1.4). All HIV/AIDS patients reported that marijuana relieved nausea and vomiting and improved their appetite. About half the patients who reported using marijuana for chronic pain also reported that it reduced nausea and vomiting. Note that the medical conditions referred to are only those reported to the study team or to interviewers; they cannot be assumed to represent complete or accurate diagnoses. Michael Rowbotham, a neurologist at the UCSF Pain Management Center, noted that many pain patients referred to that center arrive with incorrect diagnoses or with pain of unknown origin. At that center the patients who report medical benefit from marijuana say that it does not reduce their pain but enables them to cope with it. Most--not all--people who use marijuana to relieve medical conditions have previously used it recreationally. An estimated 95% of the LACRC members had used marijuana before joining the club. It is important to emphasize the absence of comprehensive information on marijuana use before its use for medical conditions. Frequency of prior use almost certainly depends on many factors, including membership in a buyers' club, membership in a population sector that uses marijuana more often than others (for example, men 20—30 years old), and the medical condition being treated with marijuana (for example, there are probably relatively fewer recreational marijuana users among cancer patients than among AIDS patients). Patients who reported their experience with marijuana at the public workshops said that marijuana provided them with great relief from symptoms associated with disparate diseases and ailments, including AIDS wasting, spasticity from multiple sclerosis, depression, chronic pain, and nausea associated with chemotherapy. Their circumstances and symptoms were varied, and the IOM study team was not in a position to make medical evaluations or confirm diagnoses. Three representative cases presented to the IOM study team are presented in Box 1.1; the stories have been edited for brevity, but each case is presented in the patient's words and with the patient's permission. The variety of stories presented left the study team with a clear view of people's beliefs about how marijuana had helped them. But this collection of anecdotal data, although useful, is limited. We heard many positive stories but no stories from people who had tried marijuana but found it ineffective. This is a fraction with an unknown denominator. For the numerator we have a sample of positive responses; for the denominator we have no idea of the total number of people who have tried marijuana for medical purposes. Hence, it is impossible to estimate the clinical value of marijuana or cannabinoids in the general population based on anecdotal reports. Marijuana clearly seems to relieve some symptoms for some people--even if only as a placebo effect. But what is the balance of harmful and beneficial effects? That is the essential medical question that can be answered only by careful analysis of data collected under controlled conditions. CANNABIS AND THE CANNABINOIDS Marijuana is the common name for Cannabis sativa, a hemp plant that grows throughout temperate and tropical climates. The most recent review of the constituents of 16 marijuana lists 66 cannabinoids (Table 1.5). different cannabinoid effects or interactions. Most of the cannabinoids are closely related; they fall into only 10 groups of closely related cannabinoids, many of which differ by only a single chemical moiety and might be midpoints along biochemical pathways--that -tetrahydrocannabinol ( THC) is the primary psychoactive ingredient; depending on the particular plant, either THC or cannabidiol is the most abundant cannabinoid in marijuana (Figure 1.1). 9 is, degradation products, precursors, or byproducts. - But that does not mean there are 66 16,18 9 9 Throughout this report, THC is used to indicate of THC are discussed, the full names are used. All the cannabinoids are lipophilic--they are highly soluble in fatty fluids and tissues but not in water. Indeed, THC is so lipophilic that it is aptly described as ""greasy."" Throughout this report, marijuana refers to unpurified plant extracts, including leaves and flower tops, regardless of how they are consumed--whether by ingestion or by smoking. References to the effects of marijuana should be understood to include the composite effects of its various components; that is, the effects of THC are included among the effects of marijuana, but not all the effects of marijuana are necessarily due to THC. Discussions concerning cannabinoids refer only to those particular compounds and not to the plant extract. This distinction is important; it is often blurred or exaggerated. Cannabinoids are produced in epidermal glands on the leaves (especially the upper ones), stems, and the bracts that support the flowers of the marijuana plant. Although the flower itself has no epidermal glands, it has the highest cannabinoid content anywhere on the plant, probably because of the accumulation of resin secreted by the supporting bracteole (the small leaf-like part below the flower). The amounts of cannabinoids and their relative abundance in a marijuana plant vary with growing conditions, including 14 ). The chemical stability of cannabinoids in harvested plant material is also affected by moisture, temperature, sunlight, and storage. They degrade under any storage condition. humidity, temperature, and soil nutrients (reviewed in Pate, 1994 -THC. In the few cases where variants ORGANIZATION OF THE REPORT Throughout the report, steps that might be taken to fill the gaps in understanding both the potential harms and benefits of marijuana and cannabinoid use are identified. Those steps include identifying knowledge gaps, promising research directions, and potential therapies based on scientific advances in cannabinoid biology. Chapter 2 reviews basic cannabinoid biology and provides a foundation to understand the medical value of marijuana or its constituent cannabinoids. In consideration of the physician's first rule, ""first, do no harm,"" the potential harms attributed to the medical use of marijuana are reviewed before the potential medical benefits. Chapter 3 reviews the risks posed by marijuana use, with emphasis on medical use. Chapter 4 analyzes the most credible clinical data relevant to the medical use of marijuana. It reviews what is known about the physiological mechanisms underlying particular conditions (for example, chronic pain, vomiting, anorexia, and muscle spasticity), what is known about the cellular actions of cannabinoids, and the levels of proof needed to show that marijuana is an effective treatment for specific symptoms. It does not analyze the historical literature; history is informative in enumerating uses of marijuana, but it does not provide the sort of information needed for a scientifically sound evaluation of the efficacy and safety of marijuana for clinical use. Because marijuana is advocated primarily as affording relief from the symptoms of disease rather than as a cure, this chapter is organized largely by symptoms as opposed to disease categories. Finally, chapter 4 compares the conclusions of this report with those of other recent reports on the medical use of marijuana. Chapter 5 describes the process of and analyzes the prospects for cannabinoid drug development. Three focal concerns in evaluating the medical use of marijuana are: 1. Evaluation of the effects of isolated cannabinoids; 2. Evaluation of the risks associated with the medical use of marijuana; and 3. Evaluation of the use of smoked marijuana. EFFECTS OF ISOLATED CANNABINOIDS Cannabinoid Biology Much has been learned since the 1982 IOM report Marijuana and Health. Although it was clear then that most of the effects of marijuana were due to its actions on the brain, there was little information about how THC acted on brain cells (neurons), which cells were affected by THC, or even what general areas of the brain were most affected by THC. In addition, too little was known about cannabinoid physiology to offer any scientific insights into the harmful or therapeutic effects of marijuana. That all changed with the identification and characterization of cannabinoid receptors in the 1980s and 1990s. During the past 16 years, science has advanced greatly and can tell us much more about the potential medical benefits of cannabinoids. Conclusion: At this point, our knowledge about the biology of marijuana and cannabinoids allows us to make some general conclusions: o Cannabinoids likely have a natural role in pain modulation, control of movement, and memory. o The natural role of cannabinoids in immune systems is likely multi-faceted and remains unclear. o The brain develops tolerance to cannabinoids. o Animal research demonstrates the potential for dependence, but this potential is observed under a narrower range of conditions than with benzodiazepines, opiates, cocaine, or nicotine. o Withdrawal symptoms can be observed in animals but appear to be mild compared to opiates or benzodiazepines, such as diazepam (Valium). Conclusion: The different cannabinoid receptor types found in the body appear to play different roles in normal human physiology. In addition, some effects of cannabinoids appear to be independent of those receptors. The variety of mechanisms through which cannabinoids can influence human physiology underlies the variety of potential therapeutic uses for drugs that might act selectively on different cannabinoid systems. Recommendation 1: Research should continue into the physiological effects of synthetic and plant-derived cannabinoids and the natural function of cannabinoids found in the body. Because different cannabinoids appear to have different effects, cannabinoid research should include, but not be restricted to, effects attributable to THC alone. Efficacy of Cannabinoid Drugs The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation. The therapeutic effects of cannabinoids are best established for THC, which is generally one of the two most abundant of the cannabinoids in marijuana. (Cannabidiol is generally the other most abundant cannabinoid.) The effects of cannabinoids on the symptoms studied are generally modest, and in most cases there are more effective medications. However, people vary in their responses to medications, and there will likely always be a subpopulation of patients who do not respond well to other medications. The combination of cannabinoid drug effects (anxiety reduction, appetite stimulation, nausea reduction, and pain relief) suggests that cannabinoids would be moderately well suited for particular conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting. Defined substances, such as purified cannabinoid compounds, are preferable to plant products, which are of variable and uncertain composition. Use of defined cannabinoids permits a more precise evaluation of their effects, whether in combination or alone. Medications that can maximize the desired effects of cannabinoids and minimize the undesired effects can very likely be identified. Although most scientists who study cannabinoids agree that the pathways to cannabinoid drug development are clearly marked, there is no guarantee that the fruits of scientific research will be made available to the public for medical use. Cannabinoid- based drugs will only become available if public investment in cannabinoid drug research is sustained and if there is enough incentive for private enterprise to develop and market such drugs. Conclusion: Scientific data indicate the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances. Recommendation 2: Clinical trials of cannabinoid drugs for symptom management should be conducted with the goal of developing rapid-onset, reliable, and safe delivery systems. Influence of Psychological Effects on Therapeutic Effects The psychological effects of THC and similar cannabinoids pose three issues for the therapeutic use of cannabinoid drugs. First, for some patients--particularly older patients with no previous marijuana experience--the psychological effects are disturbing. Those patients report experiencing unpleasant feelings and disorientation after being treated with THC, generally more severe for oral THC than for smoked marijuana. Second, for conditions such as movement disorders or nausea, in which anxiety exacerbates the symptoms, the antianxiety effects of cannabinoid drugs can influence symptoms indirectly. This can be beneficial or can create false impressions of the drug effect. Third, for cases in which symptoms are multifaceted, the combination of THC effects might provide a form of adjunctive therapy; for example, AIDS wasting patients would likely benefit from a medication that simultaneously reduces anxiety, pain, and nausea while stimulating appetite. Conclusion: The psychological effects of cannabinoids, such as anxiety reduction, sedation, and euphoria can influence their potential therapeutic value. Those effects are potentially undesirable for certain patients and situations and beneficial for others. In addition, psychological effects can complicate the interpretation of other aspects of the drug's effect. Recommendation 3: Psychological effects of cannabinoids such as anxiety reduction and sedation, which can influence medical benefits, should be evaluated in clinical trials. RISKS ASSOCIATED WITH MEDICAL USE OF MARIJUANA Physiological Risks Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications. The harmful effects to individuals from the perspective of possible medical use of marijuana are not necessarily the same as the harmful physical effects of drug abuse. When interpreting studies purporting to show the harmful effects of marijuana, it is important to keep in mind that the majority of those studies are based on smoked marijuana, and cannabinoid effects cannot be separated from the effects of inhaling smoke from burning plant material and contaminants. For most people the primary adverse effect of acute marijuana use is diminished psychomotor performance. It is, therefore, inadvisable to operate any vehicle or potentially dangerous equipment while under the influence of marijuana, THC, or any cannabinoid drug with comparable effects. In addition, a minority of marijuana users experience dysphoria, or unpleasant feelings. Finally, the short-term immunosuppressive effects are not well established but, if they exist, are not likely great enough to preclude a legitimate medical use. The chronic effects of marijuana are of greater concern for medical use and fall into two categories: the effects of chronic smoking and the effects of THC. Marijuana smoking is associated with abnormalities of cells lining the human respiratory tract. Marijuana smoke, like tobacco smoke, is associated with increased risk of cancer, lung damage, and poor pregnancy outcomes. Although cellular, genetic, and human studies all suggest that marijuana smoke is an important risk factor for the development of respiratory cancer, proof that habitual marijuana smoking does or does not cause cancer awaits the results of well-designed studies. Conclusion: Numerous studies suggest that marijuana smoke is an important risk factor in the development of respiratory disease. Recommendation 4: Studies to define the individual health risks of smoking marijuana should be conducted, particularly among populations in which marijuana use is prevalent. Marijuana Dependence and Withdrawal A second concern associated with chronic marijuana use is dependence on the psychoactive effects of THC. Although few marijuana users develop dependence, some do. Risk factors for marijuana dependence are similar to those for other forms of substance abuse. In particular, anti-social personality and conduct disorders are closely associated with substance abuse. Conclusion: A distinctive marijuana withdrawal syndrome has been identified, but it is mild and short lived. The syndrome includes restlessness, irritability, mild agitation, insomnia, sleep disturbance, nausea, and cramping. Marijuana as a ""Gateway"" Drug Patterns in progression of drug use from adolescence to adulthood are strikingly regular. Because it is the most widely used illicit drug, marijuana is predictably the first illicit drug most people encounter. Not surprisingly, most users of other illicit drugs have used marijuana first. In fact, most drug users begin with alcohol and nicotine before marijuana--usually before they are of legal age. In the sense that marijuana use typically precedes rather than follows initiation of other illicit drug use, it is indeed a ""gateway"" drug. But because underage smoking and alcohol use typically precede marijuana use, marijuana is not the most common, and is rarely the first, ""gateway"" to illicit drug use. There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs. An important caution is that data on drug use progression cannot be assumed to apply to the use of drugs for medical purposes. It does not follow from those data that if marijuana were available by prescription for medical use, the pattern of drug use would remain the same as seen in illicit use. Finally, there is a broad social concern that sanctioning the medical use of marijuana might increase its use among the general population. At this point there are no convincing data to support this concern. The existing data are consistent with the idea that this would not be a problem if the medical use of marijuana were as closely regulated as other medications with abuse potential. Conclusion: Present data on drug use progression neither support nor refute the suggestion that medical availability would increase drug abuse. However, this question is beyond the issues normally considered for medical uses of drugs and should not be a factor in evaluating the therapeutic potential of marijuana or cannabinoids. USE OF SMOKED MARIJUANA Because of the health risks associated with smoking, smoked marijuana should generally not be recommended for long-term medical use. Nonetheless, for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern. Further, despite the legal, social, and health problems associated with smoking marijuana, it is widely used by certain patient groups. Recommendation 5: Clinical trials of marijuana use for medical purposes should be conducted under the following limited circumstances: trials should involve only short-term marijuana use (less than six months), should be conducted in patients with conditions for which there is reasonable expectation of efficacy, should be approved by institutional review boards, and should collect data about efficacy. The goal of clinical trials of smoked marijuana would not be to develop marijuana as a licensed drug but rather to serve as a first step toward the possible development of nonsmoked rapid-onset cannabinoid delivery systems. However, it will likely be many years before a safe and effective cannabinoid delivery system, such as an inhaler, is available for patients. In the meantime there are patients with debilitating symptoms for whom smoked marijuana might provide relief. The use of smoked marijuana for those patients should weigh both the expected efficacy of marijuana and ethical issues in patient care, including providing information about the known and suspected risks of smoked marijuana use. Recommendation 6: Short-term use of smoked marijuana (less than six months) for patients with debilitating symptoms (such as intractable pain or vomiting) must meet the following conditions: o failure of all approved medications to provide relief has been documented, o the symptoms can reasonably be expected to be relieved by rapid- onset cannabinoid drugs, o such treatment is administered under medical supervision in a manner that allows for assessment of treatment effectiveness, and o involves an oversight strategy comparable to an institutional review board process that could provide guidance within 24 hours of a submission by a physician to provide marijuana to a patient for a specified use. Until a nonsmoked rapid-onset cannabinoid drug delivery system becomes available, we acknowledge that there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting. One possible approach is to treat patients as n-of-1 clinical trials (single-patient trials), in which patients are fully informed of their status as experimental subjects using a harmful drug delivery system and in which their condition is closely monitored and documented under medical supervision, thereby increasing the knowledge base of the risks and benefits of marijuana use under such conditions.data, it is important to understand that decisions about drug regulation are based on a variety of moral and social considerations, as well as on medical and scientific ones. Even when a drug is used only for medical purposes, value judgments affect policy decisions concerning its medical use. For example, the magnitude of a drug's expected medical benefit affects regulatory judgments about the acceptability of risks associated with its use. Also, although a drug is normally approved for medical use only on proof of its ""safety and efficacy,"" patients with life-threatening conditions are sometimes (under protocols for ""compassionate use"") allowed access to unapproved drugs whose benefits and risks are uncertain. Value judgments play an even more substantial role in regulatory decisions concerning drugs, such as marijuana, that are sought and used for nonmedical purposes. Then policymakers must take into account not only the risks and benefits associated with medical use but also possible interactions between the regulatory arrangements governing medical use and the integrity of the legal controls set up to restrict nonmedical use. It should be clear that many elements of drug control policy lie outside the realm of biology and medicine. Ultimately, the complex moral and social judgments that underlie drug control policy must be made by the American people and their elected officials. A goal of this report is to evaluate the biological and medical factors that should be taken into account in making those judgments. HOW THIS STUDY WAS CONDUCTED Information was gathered through scientific workshops, site visits, analysis of the relevant scientific literature, and extensive consultation with biomedical and social scientists. The three 2-day workshops--in Irvine, California; New Orleans, Louisiana; and Washington, D.C.--were open to the public and included scientific presentations and reports, mostly from patients and their families, about their experiences with and perspectives on the medical use of marijuana. Scientific experts in various fields were selected to talk about the latest research on marijuana, cannabinoids, and related topics (listed in Appendix B). Selection of the experts was based on recommendations by their peers, who ranked them among the most accomplished scientists and the most knowledgeable about marijuana and cannabinoids in their own fields. In addition, advocates for (John Morgan) and against (Eric A. Voth) the medical use of marijuana were invited to present scientific evidence in support of their positions. Information presented at the scientific workshops was supplemented by analysis of the scientific literature and evaluating the methods used in various studies and the validity of the authors' conclusions. Different kinds of clinical studies are useful in different ways: results of a controlled double-blind study with adequate sample sizes can be expected to apply to the general population from which study subjects were drawn; an isolated case report can suggest further studies but cannot be presumed to be broadly applicable; and survey data can be highly informative but are generally limited by the need to rely on self-reports of drug use and on unconfirmed medical diagnoses. This report relies mainly on the most relevant and methodologically rigorous studies available and treats the results of more limited studies cautiously. In addition, study results are presented in such a way as to allow thoughtful readers to judge the results themselves. The Institute of Medicine (IOM) appointed a panel of nine experts to advise the study team on technical issues. These included neurology and the treatment of pain (Howard Fields); regulation of prescription drugs (J. Richard Crout); AIDS wasting and clinical trials (Judith Feinberg); treatment and pathology of multiple sclerosis (Timothy Vollmer); drug dependence among adolescents (Thomas Crowley); varieties of drug dependence (Dorothy Hatsukami); internal medicine, health care delivery, and clinical epidemiology (Eric B. Larson); cannabinoids and marijuana pharmacology (Billy R. Martin); and cannabinoid neuroscience (Steven R. Childers). Public outreach included setting up a Web site that provided information about the study and asked for input from the public. The Web site was open for comment from November 1997 until November 1998. Some 130 organizations were invited to participate in the public workshops. Many people in the organizations--particularly those opposed to the medical use of marijuana--felt that a public forum was not conducive to expressing their views; they were invited to communicate their opinions (and reasons for holding them) by mail or telephone. As a result, roughly equal numbers of persons and organizations opposed to and in favor of the medical use of marijuana were heard from. The study team visited four cannabis buyers' clubs in California (the Oakland Cannabis Buyers' Cooperative, the San Francisco Cannabis Cultivators Club, the Los Angeles Cannabis Resource Center, and Californians Helping Alleviate Medical Problems, or CHAMPS) and two HIV/AIDS clinics (AIDS Health Care Foundation in Los Angeles and Louisiana State University Medical Center in New Orleans). We listened to many individual stories from the buyers' clubs about using marijuana to treat a variety of symptoms and heard clinical observations on the use of Marinol to treat AIDS 9 patients. Marinol is the brand name for dronabinol, which is (THC) in pill form and is available by prescription for the treatment of nausea associated with chemotherapy and AIDS wasting. MARIJUANA TODAY The Changing Legal Landscape In the 20th century, marijuana has been used more for its euphoric effects than as a medicine. Its psychological and behavioral effects have concerned public officials since the drug first appeared in the southwestern and southern states during the first two decades of the century. By 1931, at least 29 states had prohibited use of the drug for 3 nonmedicalpurposes. MarijuanawasfirstregulatedatthefederallevelbytheMarijuana Tax Act of 1937, which required anyone producing, distributing, or using marijuana for medical purposes to register and pay a tax and which effectively prohibited nonmedical use of the drug. Although the act did not make medical use of marijuana illegal, it did make it expensive and inconvenient. In 1942, marijuana was removed from the U.S. -tetrahydrocannabinol Pharmacopoeia because it was believed to be a harmful and addictive drug that caused psychoses, mental deterioration, and violent behavior. In the late 1960s and early 1970s, there was a sharp increase in marijuana use among adolescents and young adults. The current legal status of marijuana was established in 1970 with the passage of the Controlled Substances Act, which divided drugs into five schedules and placed marijuana in Schedule I, the category for drugs with high potential for abuse and no accepted medical use (see Appendix C, Scheduling Definitions). In 1972, the National Organization for the Reform of Marijuana Legislation (NORML), an organization that supports decriminalization of marijuana, unsuccessfully petitioned the Bureau of Narcotics and Dangerous Drugs to move marijuana from Schedule I to Schedule II. NORML argued that marijuana is therapeutic in numerous serious ailments, 13 less toxic, and in many cases more effective than conventional medicines. years the medical marijuana movement has been closely linked with the marijuana decriminalization movement, which has colored the debate. Many people criticized that association in their letters to IOM and during the public workshops of this study. The argument against the medical use of marijuana presented most often to the IOM study team was that ""the medical marijuana movement is a Trojan horse""; that is, it is a deceptive tactic used by advocates of marijuana decriminalization who would exploit the public's sympathy for seriously ill patients. Since NORML's petition in 1972, there have been a variety of legal decisions concerning marijuana. From 1973 to 1978, 11 states adopted statutes that decriminalized use of marijuana, although some of them recriminalized marijuana use in the 1980s and 1990s. During the 1970s, reports of the medical value of marijuana began to appear, particularly claims that marijuana relieved the nausea associated with chemotherapy. Health departments in six states conducted small studies to investigate the reports. When the AIDS epidemic spread in the 1980s, patients found that marijuana sometimes relieved their symptoms, most dramatically those associated with AIDS wasting. Over this period a number of defendants charged with unlawful possession of marijuana claimed that they were using the drug to treat medical conditions and that violation of the law was therefore justified (the so-called medical necessity defense). Although most courts rejected these 8 Against that backdrop, voters in California and Arizona in 1996 passed two referenda that attempted to legalize the medical use of marijuana under particular conditions. Public support for patient access to marijuana for medical use appears substantial; public opinion polls taken during 1997 and 1998 generally reported 60—70 percent of 15 However, those referenda are at odds with federal laws regulating marijuana, and their implementation raises complex legal questions. Despite the current level of interest, referenda and public discussions have not been well informed by carefully reasoned scientific debate. Although previous reports have all called for more research, the nature of the research that will be most helpful depends greatly on the specific health conditions to be addressed. And while there have been claims, some accepted them. respondents in favor of allowing medical uses of marijuana. Thus, for 25 important recent advances in our understanding of the physiological effects of marijuana, few of the recent investigators have had the time or resources to permit detailed analysis. The results of those advances, only now beginning to be explored, have significant implications for the medical marijuana debate. Several months after the passage of the California and Arizona medical marijuana referendums, the Office of National Drug Control Policy (ONDCP) asked whether IOM would conduct a scientific review of the medical value of marijuana and its constituent compounds. In August 1997, IOM formally began the study and appointed John A. Benson Jr. and Stanley J. Watson Jr. to serve as principal investigators for the study. The charge to IOM was to review the medical use of marijuana and the harms and benefits attributed to it (details are given in Appendix D). Marijuana plants have been used since antiquity for both herbal medication and intoxication. The current debate over the medical use of marijuana is essentially a debate over the value of its medicinal properties relative to the risk posed by its use. 1,10,11 Marijuana's use as an herbal remedy before the 20th century is well documented. However, modern medicine adheres to different standards from those used in the past. The question is not whether marijuana can be used as an herbal remedy but rather how well this remedy meets today's standards of efficacy and safety. We understand much more than previous generations about medical risks. Our society generally expects its licensed medications to be safe, reliable, and of proven efficacy; contaminants and inconsistent ingredients in our health treatments are not tolerated. That refers not only to prescription and over-the-counter drugs but also to vitamin supplements and herbal remedies purchased at the grocery store. For example, the essential amino acid l- tryptophan was widely sold in health food stores as a natural remedy for insomnia until early 1990 when it became linked to an epidemic of a new and potentially fatal illness 9,12 When it was removed from the market shortly thereafter, there was little protest, despite the fact that it was safe for the vast majority of the population. The 1,536 cases and 27 deaths were later traced to contaminants in a batch produced by a single Japanese manufacturer. Although few herbal medicines meet today's standards, they have provided the foundation for modern Western pharmaceuticals. Most current prescriptions have their 7 rootseitherdirectlyorindirectlyinplantremedies. Atthesametime,mostcurrent prescriptions are synthetic compounds that are only distantly related to the natural compounds that led to their development. Digitalis was discovered in foxglove, morphine in poppies, and taxol in the yew tree. Even aspirin (acetylsalicylic acid) has its counterpart in herbal medicine: for many generations, American Indians relieved headaches by chewing the bark of the willow tree, which is rich in a related form of salicylic acid. Although plants continue to be valuable resources for medical advances, drug development is likely to be less and less reliant on plants and more reliant on the tools of (eosinophilia-myalgia syndrome). modern science. Molecular biology, bioinformatics software, and DNA array-based analyses of genes and chemistry are all beginning to yield great advances in drug discovery and development. Until recently, drugs could only be discovered; now they can be designed. Even the discovery process has been accelerated through the use of modern drug-screening techniques. It is increasingly possible to identify or isolate the chemical compounds in a plant, determine which compounds are responsible for the plant's effects, and select the most effective and safe compounds--either for use as purified substances or as tools to develop even more effective, safer, or less expensive compounds. Yet even as the modern pharmacological toolbox becomes more sophisticated and biotechnology yields an ever greater abundance of therapeutic drugs, people increasingly 4,5 In 1997, 46 percent of Americans sought nontraditional medicines and spent over 27 billion unreimbursed dollars; the total number of visits to alternative medicine practitioners appears to have exceeded the number of 5,6 Recent interest in the medical use of marijuana coincides with this trend toward self-help and a search for ""natural"" therapies. Indeed, several people who spoke at the IOM public hearings in support of the medical use of marijuana said that they generally preferred herbal medicines to standard pharmaceuticals. However, few alternative therapies have been carefully and systematically tested for safety and efficacy, as is required for medications approved by 2 WHO USES MEDICAL MARIJUANA? There have been no comprehensive surveys of the demographics and medical conditions of medical marijuana users, but a few reports provide some indication. In each case, survey results should be understood to reflect the situation in which they were conducted and are not necessarily characteristic of medical marijuana users as a whole. Respondents to surveys reported to the IOM study team were all members of ""buyers' clubs,"" organizations that provide their members with marijuana, although not necessarily through direct cash transactions. The atmosphere of the marijuana buyers' clubs ranges from that of the comparatively formal and closely regulated Oakland Cannabis Buyers' Cooperative to that of a ""country club for the indigent,"" as Denis Peron described the San Francisco Cannabis Cultivators Club (SFCCC), which he directed. John Mendelson, an internist and pharmacologist at the University of California, San Francisco (UCSF) Pain Management Center, surveyed 100 members of the SFCCC who were using marijuana at least weekly. Most of the respondents were unemployed men in their forties. Subjects were paid $50 to participate in the survey; this might have encouraged a greater representation of unemployed subjects. All subjects were tested for drug use. About half tested positive for marijuana only; the other half tested positive for drugs in addition to marijuana (23% for cocaine and 13% for amphetamines). The predominant disorder was AIDS, followed by roughly equal numbers of members who reported chronic pain, mood disorders, and musculoskeletal disorders (Table 1.1). seek alternative, low-technology therapies. visits to primary care physicians. the FDA (Food and Drug Administration). The membership profile of the San Francisco club was similar to that of the Los Angeles Cannabis Resource Center (LACRC), where 83% of the 739 patients were men, 45% were 36—45 years old, and 71% were HIV positive. Table 1.2 shows a distribution of conditions somewhat different from that in SFCCC respondents, probably because of a different membership profile. For example, cancer is generally a disease that occurs late in life; 34 (4.7%) of LACRC members were over 55 years old; only 2% of survey respondents in the SFCCC study were over 55 years old. Jeffrey Jones, executive director of the Oakland Cannabis Buyers' Cooperative, reported that its largest group of patients is HIV-positive men in their forties. The second- largest group is patients with chronic pain. Among the 42 people who spoke at the public workshops or wrote to the study team, only six identified themselves as members of marijuana buyers' clubs. Nonetheless, they presented a similar profile: HIV/AIDS was the predominant disorder, followed by chronic pain (Tables 1.3 and 1.4). All HIV/AIDS patients reported that marijuana relieved nausea and vomiting and improved their appetite. About half the patients who reported using marijuana for chronic pain also reported that it reduced nausea and vomiting. Note that the medical conditions referred to are only those reported to the study team or to interviewers; they cannot be assumed to represent complete or accurate diagnoses. Michael Rowbotham, a neurologist at the UCSF Pain Management Center, noted that many pain patients referred to that center arrive with incorrect diagnoses or with pain of unknown origin. At that center the patients who report medical benefit from marijuana say that it does not reduce their pain but enables them to cope with it. Most--not all--people who use marijuana to relieve medical conditions have previously used it recreationally. An estimated 95% of the LACRC members had used marijuana before joining the club. It is important to emphasize the absence of comprehensive information on marijuana use before its use for medical conditions. Frequency of prior use almost certainly depends on many factors, including membership in a buyers' club, membership in a population sector that uses marijuana more often than others (for example, men 20—30 years old), and the medical condition being treated with marijuana (for example, there are probably relatively fewer recreational marijuana users among cancer patients than among AIDS patients). Patients who reported their experience with marijuana at the public workshops said that marijuana provided them with great relief from symptoms associated with disparate diseases and ailments, including AIDS wasting, spasticity from multiple sclerosis, depression, chronic pain, and nausea associated with chemotherapy. Their circumstances and symptoms were varied, and the IOM study team was not in a position to make medical evaluations or confirm diagnoses. Three representative cases presented to the IOM study team are presented in Box 1.1; the stories have been edited for brevity, but each case is presented in the patient's words and with the patient's permission. The variety of stories presented left the study team with a clear view of people's beliefs about how marijuana had helped them. But this collection of anecdotal data, although useful, is limited. We heard many positive stories but no stories from people who had tried marijuana but found it ineffective. This is a fraction with an unknown denominator. For the numerator we have a sample of positive responses; for the denominator we have no idea of the total number of people who have tried marijuana for medical purposes. Hence, it is impossible to estimate the clinical value of marijuana or cannabinoids in the general population based on anecdotal reports. Marijuana clearly seems to relieve some symptoms for some people--even if only as a placebo effect. But what is the balance of harmful and beneficial effects? That is the essential medical question that can be answered only by careful analysis of data collected under controlled conditions. CANNABIS AND THE CANNABINOIDS Marijuana is the common name for Cannabis sativa, a hemp plant that grows throughout temperate and tropical climates. The most recent review of the constituents of 16 marijuana lists 66 cannabinoids (Table 1.5). different cannabinoid effects or interactions. Most of the cannabinoids are closely related; they fall into only 10 groups of closely related cannabinoids, many of which differ by only a single chemical moiety and might be midpoints along biochemical pathways--that -tetrahydrocannabinol ( THC) is the primary psychoactive ingredient; depending on the particular plant, either THC or cannabidiol is the most abundant cannabinoid in marijuana (Figure 1.1). 9 is, degradation products, precursors, or byproducts. - But that does not mean there are 66 16,18 9 9 Throughout this report, THC is used to indicate of THC are discussed, the full names are used. All the cannabinoids are lipophilic--they are highly soluble in fatty fluids and tissues but not in water. Indeed, THC is so lipophilic that it is aptly described as ""greasy."" Throughout this report, marijuana refers to unpurified plant extracts, including leaves and flower tops, regardless of how they are consumed--whether by ingestion or by smoking. References to the effects of marijuana should be understood to include the composite effects of its various components; that is, the effects of THC are included among the effects of marijuana, but not all the effects of marijuana are necessarily due to THC. Discussions concerning cannabinoids refer only to those particular compounds and not to the plant extract. This distinction is important; it is often blurred or exaggerated. Cannabinoids are produced in epidermal glands on the leaves (especially the upper ones), stems, and the bracts that support the flowers of the marijuana plant. Although the flower itself has no epidermal glands, it has the highest cannabinoid content anywhere on the plant, probably because of the accumulation of resin secreted by the supporting bracteole (the small leaf-like part below the flower). The amounts of cannabinoids and their relative abundance in a marijuana plant vary with growing conditions, including 14 ). The chemical stability of cannabinoids in harvested plant material is also affected by moisture, temperature, sunlight, and storage. They degrade under any storage condition. humidity, temperature, and soil nutrients (reviewed in Pate, 1994 -THC. In the few cases where variants ORGANIZATION OF THE REPORT Throughout the report, steps that might be taken to fill the gaps in understanding both the potential harms and benefits of marijuana and cannabinoid use are identified. Those steps include identifying knowledge gaps, promising research directions, and potential therapies based on scientific advances in cannabinoid biology. Chapter 2 reviews basic cannabinoid biology and provides a foundation to understand the medical value of marijuana or its constituent cannabinoids. In consideration of the physician's first rule, ""first, do no harm,"" the potential harms attributed to the medical use of marijuana are reviewed before the potential medical benefits. Chapter 3 reviews the risks posed by marijuana use, with emphasis on medical use. Chapter 4 analyzes the most credible clinical data relevant to the medical use of marijuana. It reviews what is known about the physiological mechanisms underlying particular conditions (for example, chronic pain, vomiting, anorexia, and muscle spasticity), what is known about the cellular actions of cannabinoids, and the levels of proof needed to show that marijuana is an effective treatment for specific symptoms. It does not analyze the historical literature; history is informative in enumerating uses of marijuana, but it does not provide the sort of information needed for a scientifically sound evaluation of the efficacy and safety of marijuana for clinical use. Because marijuana is advocated primarily as affording relief from the symptoms of disease rather than as a cure, this chapter is organized largely by symptoms as opposed to disease categories. Finally, chapter 4 compares the conclusions of this report with those of other recent reports on the medical use of marijuana. Chapter 5 describes the process of and analyzes the prospects for cannabinoid drug development. Primum non nocere. This is the physician's first rule: whatever treatment a physician prescribes to a patient--first, that treatment must not harm the patient. The most contentious aspect of the medical marijuana debate is not whether marijuana can alleviate particular symptoms but rather the degree of harm associated with its use. This chapter explores the negative health consequences of marijuana use, first with respect to drug abuse, then from a psychological perspective, and finally from a physiological perspective. THE MARIJUANA ""HIGH"" The most commonly reported effects of smoked marijuana are a sense of well-being or euphoria and increased talkativeness and laughter alternating with periods of introspective dreaminess followed by lethargy and sleepiness (see reviews by Adams and 1 59 60 Martin, 1996, Hall and Solowij, and Hall et al. ). A characteristic feature of a marijuana ""high"" is a distortion in the sense of time associated with deficits in short-term memory and learning. A marijuana smoker typically has a sense of enhanced physical and emotional sensitivity, including a feeling of greater interpersonal closeness. The most obvious behavioral abnormality displayed by someone under the influence of marijuana is difficulty in carrying on an intelligible conversation, perhaps because of an inability to remember what was just said even a few words earlier. The high associated with marijuana is not generally claimed to be integral to its therapeutic value. But mood enhancement, anxiety reduction, and mild sedation can be desirable qualities in medications--particularly for patients suffering pain and anxiety. Thus, although the psychological effects of marijuana are merely side effects in the treatment of some symptoms, they might contribute directly to relief of other symptoms. They also must be monitored in controlled clinical trials to discern which effect of cannabinoids is beneficial. These possibilities are discussed later under the discussions of specific symptoms in chapter 4. The effects of various doses and routes of delivery of THC are shown in Table 3.1. Adverse Mood Reactions Although euphoria is the more common reaction to smoking marijuana, adverse mood reactions can occur. Such reactions occur most frequently in inexperienced users after large doses of smoked or oral marijuana. They usually disappear within hours and respond well to reassurance and a supportive environment. Anxiety and paranoia are the 59 most common acute adverse reactions; others include panic, depression, dysphoria, 1,40,66,69 depersonalization, delusions, illusions, and hallucinations. Of regular marijuana smokers, 17% report that they have experienced at least one of the symptoms, usually 145 early in their use of marijuana. of medical marijuana in people who have not previously used marijuana. DRUG DYNAMICS There are many misunderstandings about drug abuse and dependence (see reviews by 114 54 Those observations are particularly relevant for the use O'Brien themostrecentDiagnosticandStatisticalManualofMentalDisorders(DSM-IV), the most influential system in the United States for diagnoses of mental disorders, including substance abuse (see Box 3.1). Tolerance, dependence, and withdrawal are often presumed to imply abuse or addiction, but this is not the case. Tolerance and dependence are normal physiological adaptations to repeated use of any drug. The correct use of prescribed medications for pain, anxiety, and even hypertension commonly produces tolerance and some measure of physiological dependence. Even a patient who takes a medicine for appropriate medical indications and at the correct dosage can develop tolerance, physical dependence, and withdrawal symptoms if the drug is stopped abruptly rather than gradually. For example, a hypertensive patient receiving a beta-adrenergic receptor blocker, such as propranolol, might have a good therapeutic response; but if the drug is stopped abruptly, there can be a withdrawal syndrome that consists of tachycardia and a rebound increase in blood pressure to a point that is temporarily higher than before administration of the medication began. Because it is an illegal substance, some people consider any use of marijuana as substance abuse. However, this report uses the medical definition; that is, substance abuse is a maladaptive pattern of repeated substance use manifested by recurrent and 3 significantadverseconsequences. Substanceabuseanddependencearebothdiagnoses of pathological substance use. Dependence is the more serious diagnosis and implies compulsive drug use that is difficult to stop despite significant substance-related problems (see Box 3.2). Reinforcement Drugs vary in their ability to produce good feelings in users, and the more strongly reinforcing a drug is, the more likely it will be abused (G. Koob, Institute of Medicine (IOM) workshop). Marijuana is indisputably reinforcing for many people. The reinforcing properties of even so mild a stimulant as caffeine are typical of reinforcement 54 in 1994). Caffeine is reinforcing for many people at low doses (100—200 mg, the average amount of caffeine in one to two cups of and Goldstein ). The terms and concepts used in this report are as defined in 3 by addicting drugs (reviewed by Goldstein coffee) and is aversive at high doses (600 mg, the average amount of caffeine in six cups of coffee). The reinforcing effects of many drugs are different for different people. For example, caffeine was most reinforcing for test subjects who scored lowest on tests of anxiety but tended not to be reinforcing for the most anxious subjects. As an argument to dispute the abuse potential of marijuana, some have cited the observation that animals do not willingly self-administer THC, as they will cocaine. Even if that were true, it would not be relevant to human use of marijuana. The value in animal models of drug self-administration is not that they are necessary to show that a drug is reinforcing but rather that they provide a model in which the effects of a drug can be studied. Furthermore, THC is indeed rewarding to animals at some doses but, like many 93 reinforcing drugs, is aversive at high doses (4.0 mg/kg). in experiments conducted in animals outfitted with intravenous catheters that allow them 100 A specific set of neural pathways has been proposed to be a ""reward system"" that 51 to self-administer WIN 55,212, a drug that mimics the effects of THC. underlies the reinforcement of drugs of abuse and other pleasurable stimuli. properties of drugs are associated with their ability to increase concentrations of particular neurotransmitters in areas that are part of the proposed brain reward system. The median forebrain bundle and the nucleus accumbens are associated with brain reward 88 144 Cocaine, amphetamine, alcohol, opioids, nicotine, and THC extracellular fluid dopamine in the nucleus accumbens region (reviewed by Koob and Le pathways. all increase 88 110 Moal brain reward systems are not strictly ""drug reinforcement centers."" Rather, their biological role is to respond to a range of positive stimuli, including sweet foods and sexual attraction. Tolerance The rate at which tolerance to the various effects of any drug develops is an important consideration for its safety and efficacy. For medical use, tolerance to some effects of cannabinoids might be desirable. Differences in the rates at which tolerance to the multiple effects of a drug develops can be dangerous. For example, tolerance to the euphoric effects of heroin develops faster than tolerance to its respiratory depressant effects, so heroin users tend to increase their daily doses to reach their desired level of euphoria, thereby putting themselves at risk for respiratory arrest. Because tolerance to the various effects of cannabinoids might develop at different rates, it is important to evaluate independently their effects on mood, motor performance, memory, and attention, as well as any therapeutic use under investigation. Tolerance to most of the effects of marijuana can develop rapidly after only a few doses, and it also disappears rapidly. Tolerance to large doses has been found to persist in experimental animals for long periods after cessation of drug use. Performance impairment is less among people who use marijuana heavily than it is among those who 29,104,124 and Nestler and Aghajanian in 1997). However, it is important to note that possibly because of tolerance. Heavy users tend to reach higher plasma concentrations of THC than light users after similar doses of use marijuana only occasionally, Similar effects have been found Reinforcing THC, arguing against the possibility that heavy users show less performance impairment because they somehow absorb less THC (perhaps due to differences in smoking 95 There appear to be variations in the development of tolerance to the different effects of marijuana and oral THC. For example, daily marijuana smokers participated in a residential laboratory study to compare the development of tolerance to THC pills and to 61,62 behavior). smoked marijuana. day for four consecutive days; another group was given THC pills on the same schedule. During the four-day period, both groups became tolerant to feeling ""high"" and what they reported as a ""good drug effect."" In contrast, neither group became tolerant to the stimulatory effects of marijuana or THC on appetite. ""Tolerance"" does not mean that the drug no longer produced the effects but simply that the effects were less at the end than at the beginning of the four-day period. The marijuana smoking group reported feeling ""mellow"" after smoking and did not show tolerance to this effect; the group that took THC pills did not report feeling ""mellow."" The difference was also reported by many people who described their experiences to the IOM study team. The oral and smoked doses were designed to deliver roughly equivalent amounts of THC to a subject. Each smoked marijuana dose consisted of five 10-second puffs of a marijuana cigarette containing 3.1% THC; the pills contained 30 mg of THC. Both groups also received placebo drugs during other four-day periods. Although the dosing of the two groups was comparable, different routes of administration resulted in different patterns of drug effect. The peak effect of smoked marijuana is usually felt within 68,95 One group was given marijuana cigarettes to smoke four times per minutes and declines sharply after 30 minutes not felt until about an hour and lasts for several hours. Withdrawal A distinctive marijuana and THC withdrawal syndrome has been identified, but it is mild and subtle compared with the profound physical syndrome of alcohol or heroin withdrawal. The symptoms of marijuana withdrawal include restlessness, irritability, 31,74 mild agitation, insomnia, sleep EEG disturbance, nausea, and cramping (Table 3.2). In addition to those symptoms, two recent studies noted several more. A group of adolescents under treatment for conduct disorders also reported fatigue and illusions or hallucinations after marijuana abstinence (this study is discussed further in the section on 31 In a residential study of daily marijuana users, withdrawal symptoms included sweating and 62 A marijuana withdrawal syndrome, however, has been reported only in a group of adolescents in treatment for substance 31 ; the peak effect of oral THC is usually 118 ""Prevalence and Predictors of Dependence on Marijuana and Other Drugs""). runny nose, in addition to those listed above. abuse problems 62,74 daily. and in a research setting where subjects were given marijuana or THC Withdrawal symptoms have been observed in carefully controlled laboratory studies 61,62 of people after use of both oral THC and smoked marijuana. were given very high doses of oral THC: 180—210 mg per day for 10—20 days, roughly In one study, subjects equivalent to smoking 9—10 2% THC cigarettes per day. During the abstinence period at the end of the study, the study subjects were irritable and showed insomnia, runny nose, sweating, and decreased appetite. The withdrawal symptoms, however, were short lived. In four days they had abated. The time course contrasts with that in another study in which lower doses of oral THC were used (80—120 mg/day for four days) and 61,62 withdrawal symptoms were still near maximal after four days. In animals, simply discontinuing chronic heavy dosing of THC does not reveal withdrawal symptoms, but the ""removal"" of THC from the brain can be made abrupt by another drug that blocks THC at its receptor if administered when the chronic THC is withdrawn. The withdrawal syndrome is pronounced, and the behavior of the animals 153 becomes hyperactive and disorganized. 16,24 The half-life of THC in brain is about an Although traces of THC can remain in the brain for much longer periods, the hour. amounts are not physiologically significant. Thus, the lack of a withdrawal syndrome when THC is abruptly withdrawn without administration of a receptor-blocking drug is probably not due to a prolonged decline in brain concentrations. Craving Craving, the intense desire for a drug, is the most difficult aspect of addiction to overcome. Research on craving has focused on nicotine, alcohol, cocaine, and opiates but 115 has not specifically addressed marijuana. is known about drug craving, its relevance to marijuana use has not been established. Most people who suffer from addiction relapse within a year of abstinence, and they 58 As addiction develops, craving increases even as maladaptive consequences accumulate. Animal studies indicate that the tendency to relapse is based on changes in brain function that continue for months or years after the 115 last use of the drug. manifestation of an abstinence syndrome remains an unanswered question in drug abuse 88 The ""liking"" of sweet foods, for example, is mediated by opioid forebrain systems and by brain stem systems, whereas ""wanting"" seems to be mediated by 109 Anticraving medications have been developed for nicotine and alcohol. The antidepressant, bupropion, blocks nicotine craving, while naltrexone blocks alcohol 115 often attribute their relapse to craving. research. ascending dopamine neurons that project to the nucleus accumbens. Another category of addiction medication includes drugs that block other drugs' effects. Some of those drugs also block craving. For example, methadone blocks the euphoric effects of heroin and also reduces craving. MARIJUANA USE AND DEPENDENCE Prevalence of Use Millions of Americans have tried marijuana, but most are not regular users. In 1996, 68.6 million people--32% of the U.S. population over 12 years old--had tried marijuana craving. 74 Thus, while this section briefly reviews what Whether neurobiological conditions change during the 132 or hashish at least once in their lifetime, but only 5% were current users. is most prevalent among 18- to 25-year-olds and declines sharply after the age of 34 77,132 (Figure 3.1). although the difference decreases by adulthood. Whites are more likely than blacks to use marijuana in adolescence, 132 Marijuana use Most people who have used marijuana did so first during adolescence. Social influences, such as peer pressure and prevalence of use by peers, are highly predictive of 9 initiationintomarijuanause. Initiationisnot,ofcourse,synonymouswithcontinuedor regular use. A cohort of 456 students who experimented with marijuana during their high school years were surveyed about their reasons for initiating, continuing, and stopping 9 theirmarijuanause. Studentswhobeganasheavyuserswereexcludedfromthe analysis. Those who did not become regular marijuana users cited two types of reasons for discontinuing. The first was related to health and well-being; that is, they felt that marijuana was bad for their health or for their family and work relationships. The second type was based on age-related changes in circumstances, including increased responsibility and decreased regular contact with other marijuana users. Among high school students who quit, parental disapproval was a stronger influence than peer disapproval in discontinuing marijuana use. In the initiation of marijuana use, the reverse was true. The reasons cited by those who continued to use marijuana were to ""get in a better mood or feel better."" Social factors were not a significant predictor of continued use. Data on young adults show similar trends. Those who use drugs in response to social influences are more likely to stop using them than those who also use them for 80 The age distribution of marijuana users among the general population contrasts with that of medical marijuana users. Marijuana use generally declines sharply after the age of 34 years, whereas medical marijuana users tend to be over 35. That raises the question of what, if any, relationship exists between abuse and medical use of marijuana; however, no studies reported in the scientific literature have addressed this question. Prevalence and Predictors of Dependence on Marijuana and Other Drugs Many factors influence the likelihood that a particular person will become a drug abuser or an addict; the user, the environment, and the drug are all important factors 114 (Table 3.3). people who are vulnerable to drug abuse for individual reasons and who find themselves in an environment that encourages drug abuse are initially likely to abuse the most readily available drug--regardless of its unique set of effects on the brain. The third category includes drug-specific effects that influence the abuse liability of a particular drug. As discussed earlier in this chapter, the more strongly reinforcing a drug is, the more likely that it will be abused. The abuse liability of a drug is enhanced by how quickly its effects are felt, and this is determined by how the drug is delivered. In general, the effects of drugs that are inhaled or injected are felt within minutes, and the effects of drugs that are ingested take a half hour or more. psychological reasons. The first two categories apply to potential abuse of any substance; that is, The proportion of people who become addicted varies among drugs. Table 3.4 shows estimates for the proportion of people among the general population who used or became dependent on different types of drugs. The proportion of users that ever became dependent includes anyone who was ever dependent--whether it was for a period of weeks or years--and thus includes more than those who are currently dependent. Compared to most other drugs listed in this table, dependence among marijuana users is relatively rare. This might be due to differences in specific drug effects, the availability of or penalties associated with the use of the different drugs, or some combination. Daily use of most illicit drugs is extremely rare in the general population. In 1989, daily use of marijuana among high school seniors was less than that of alcohol (2.9% and 76 Drug dependence is more prevalent in some sectors of the population than in others. 8 Age,gender,andraceorethnicgroupareallimportant. Excludingtobaccoandalcohol, 8 thefollowingtrendsofdrugdependencearestatisticallysignificant: Menare1.6times as likely than women to become drug dependent, non-Hispanic whites are about twice as likely as blacks to become drug dependent (the difference between non-Hispanic and Hispanic whites was not significant), and people 25—44 years old are more than three times as likely as those over 45 years old to become drug dependent. More often than not, drug dependence co-occurs with other psychiatric disorders. Most people with a diagnosis of drug dependence disorder also have a diagnosis of a 76 The most frequent co- occurring disorder is alcohol abuse; 60% of men and 30% of women with a diagnosis of drug dependence also abuse alcohol. In women who are drug dependent, phobic disorders and major depression are almost equally common (29% and 28%, respectively). Note that this study distinguished only between alcohol, nicotine and ""other drugs""; marijuana was grouped among ""other drugs."" The frequency with which drug dependence and other psychiatric disorders co-occur might not be the same for marijuana and other drugs that were included in that category. A strong association between drug dependence and antisocial personality or its precursor, conduct disorder, is also widely reported in children and adults (reviewed in 126 ). Although the causes of the association are uncertain, Robins recently concluded that it is more likely that conduct disorders generally lead to substance abuse 126 Such a trend might, however, depend on the age at which the conduct disorder is manifested. A longitudinal study by Brooks and co-workers noted a significant relationship between adolescent drug use and disruptive disorders in young adulthood; except for earlier psychopathology, such as childhood conduct disorder, the drug use preceded the 18 In contrast with use of other illicit drugs and tobacco, moderate (less than once a week and more than once a month) to heavy marijuana use did not predict anxiety or depressive disorders; but it was similar to those other drugs in predicting antisocial personality disorder. The rates of disruptive disorders increased with 4.2%, respectively). another psychiatric disorder (76% of men and 65% of women). 1998 by Robins than the reverse. psychiatric disorders. increased drug use. Thus, heavy drug use among adolescents can be a warning sign for later psychiatric disorders; whether it is an early manifestation of or a cause of those disorders remains to be determined. Psychiatric disorders are more prevalent among adolescents who use drugs--including 79 alcohol and nicotine--than among those who do not. Table 3.5 indicates that adolescent boys who smoke cigarettes daily are about 10 times as likely to have a psychiatric disorder diagnosis as those who do not smoke. However, the table does not compare intensity of use among the different drug classes. Thus, although daily cigarette smoking among adolescent boys is more strongly associated with psychiatric disorders than is any use of illicit substances, it does not follow that this comparison is true for every amount 79 Few marijuana users become dependent on it (Table 3.4), but those who do encounter 19,143 of cigarette smoking. problems similar to those associated with dependence on other drugs. appears to be less severe among people who use only marijuana than among those who 19,143 abuse cocaine or those who abuse marijuana with other drugs (including alcohol). Data gathered in 1990—1992 from the National Comorbidity Study of over 8,000 persons 15—54 years old indicate that 4.2% of the general population were dependent on 8 marijuanaatsometime. Similarresultsforthefrequencyofsubstanceabuseamongthe general population were obtained from the Epidemiological Catchment Area Program, a survey of over 19,000 people. According to data collected in the early 1980s for that study, 4.4% of adults have, at one time, met the criteria for marijuana dependence. In comparison, 13.8% of adults met the criteria for alcohol dependence and 36.0% for tobacco dependence. After alcohol and nicotine, marijuana was the substance most frequently associated with a diagnosis of substance dependence. In a 15-year study begun in 1979, 7.3% of 1,201 adolescents and young adults in suburban New Jersey at some time met the criteria for marijuana dependence; this indicates that the rate of marijuana dependence might be even higher in some groups of 71 Adolescents meet the criteria for drug dependence at lower rates of marijuana use than do adults, and this 25 adolescents and young adults than in the general population. suggests that they are more vulnerable to dependence than adults (see Box 3.2). Dependence Youths who are already dependent on other substances are particularly vulnerable to 31 marijuana dependence. For example, Crowley and co-workers 229 adolescent patients in a residential treatment program for delinquent, substance- involved youth and found that those patients were dependent on an average of 3.2 substances. The adolescents had previously been diagnosed as dependent on at least one substance (including nicotine and alcohol) and had three or more conduct disorder symptoms during their life. About 83% of those who had used marijuana at least six times went on to develop marijuana dependence. About equal numbers of youths in the study had a diagnosis of marijuana dependence and a diagnosis of alcohol dependence; fewer were nicotine dependent. Comparisons of dependence potential between different drugs should be made cautiously. The probability that a particular drug will be abused is interviewed a group of influenced by many factors, including the specific drug effects and availability of the drug. Although parents often state that marijuana caused their children to be rebellious, the troubled adolescents in the study by Crowley and co-workers developed conduct disorders before marijuana abuse. That is consistent with reports that the more symptoms 127 of conduct disorders children have, the younger they begin drug abuse, earlier they begin drug use, the more likely it is to be followed by abuse or 125 Genetic factors are known to play a role in the likelihood of abuse for drugs other than 7,129 dependence. marijuana, and it is not unexpected that genetic factors play a role in the marijuana experience, including the likelihood of abuse. A study of over 8,000 male twins listed in the Vietnam Era Twin Registry indicated that genes have a statistically significant 97 influence on whether a person finds the effects of marijuana pleasant. Not surprisingly, people who found marijuana to be pleasurable used it more often than those who found it unpleasant. The study suggested that, although social influences play an important role in the initiation of use, individual differences--perhaps associated with the brain's reward system--influence whether a person will continue using marijuana. Similar results were 86 Family and social environment strongly influenced the likelihood of ever using marijuana but had little effect on the likelihood of heavy use or abuse. The latter were more influenced by genetic factors. Those results are consistent with the finding that the degree to which rats find THC rewarding is genetically based. In summary, although few marijuana users develop dependence, some do. But they appear to be less likely to do so than users of other drugs (including alcohol and nicotine), and marijuana dependence appears to be less severe than dependence on other drugs. Drug dependence is more prevalent in some sectors of the population than others, but no group has been identified as particularly vulnerable to the drug-specific effects of marijuana. Adolescents, especially troubled ones, and people with psychiatric disorders (including substance abuse) appear to be more likely than the general population to become dependent on marijuana. If marijuana or cannabinoid drugs were approved for therapeutic uses, it would be important to consider the possibility of dependence, particularly for patients at high risk for substance dependence. Some controlled substances that are approved medications produce dependence after long-term use; this, however, is a normal part of patient management and does not generally present undue risk to the patient. Progression from Marijuana to Other Drugs The fear that marijuana use might cause, as opposed to merely precede, the use of drugs that are more harmful is of great concern. To judge from comments submitted to the IOM study team, it appears to be of greater concern than the harms directly related to marijuana itself. The discussion that marijuana is a ""gateway"" drug implicitly recognizes that other illicit drugs might inflict greater damage to health or social relations than found in a study of female twins. and that the 92 marijuana. Although the scientific literature generally discusses drug use progression between a variety of drug classes, including alcohol and tobacco, the public discussion has focused on marijuana as a ""gateway"" drug that leads to abuse of more harmful illicit drugs, such as cocaine and heroin. There are strikingly regular patterns in the progression of drug use from adolescence to adulthood. Because it is the most widely used illicit drug, marijuana is predictably the first illicit drug that most people encounter. Not surprisingly, most users of other illicit 81,82 drugs used marijuana first. marijuana--they begin with alcohol and nicotine, usually when they are too young to do 82,90 so legally. The gateway analogy evokes two ideas that are often confused. The first, more often referred to as the ""stepping stone"" hypothesis, is the idea that progression from marijuana 82 In fact, most drug users do not begin their drug use with to other drugs arises from pharmacological properties of marijuana itself. that marijuana serves as a gateway to the world of illegal drugs in which youths have greater opportunity and are under greater social pressure to try other illegal drugs. The latter interpretation is most often used in the scientific literature, and it is supported, although not proven, by the available data. The stepping stone hypothesis applies to marijuana only in the broadest sense. People who enjoy the effects of marijuana are, logically, more likely to be willing to try other mood-altering drugs than are people who are not willing to try marijuana or who dislike its effects. In other words, many of the factors associated with a willingness to use marijuana are, presumably, the same as those associated with a willingness to use other illicit drugs. Those factors include physiological reactions to the drug effect, which are consistent with the stepping stone hypothesis, but also psychosocial factors, which are independent of drug-specific effects. There is no evidence that marijuana serves as a stepping stone on the basis of its particular physiological effect. One might argue that marijuana is generally used before other illicit mood-altering drugs, in part, because its effects are milder; in that case, marijuana is a stepping stone only in the same sense as taking a small dose of a particular drug and then increasing that dose over time is a stepping stone to increased drug use. Whereas the stepping stone hypothesis presumes a predominantly physiological component of drug progression, the gateway theory is a social theory. The latter does not suggest that the pharmacological qualities of marijuana make it a risk factor for progression to other drug use. Instead, the legal status of marijuana makes it a gateway 82 Psychiatric disorders are associated with substance dependence and are probably risk factors for progression in drug use. For example, the troubled adolescents studied by 31 were dependent on an average of 3.2 substances, and this suggests that their conduct disorders were associated with increased risk of progressing from one drug to another. Abuse of a single substance is probably also a risk factor for later multiple drug use. For example, in a longitudinal study that examined drug use and drug. Crowley and co-workers The second is dependence, about 26% of problem drinkers reported that they first used marijuana after the onset of alcohol-related problems (R. Pandina, IOM workshop). The study also found that 11% of marijuana users developed chronic marijuana problems; most also had alcohol problems. Intensity of drug use is an important risk factor in progression. Daily marijuana users are more likely than their peers to be extensive users of other substances (for review, see 78 Kandel and Davies by the age 24—25, 75% never used any other illicit drug; 53% of those who had used it 78 The factors that best predict use of illicit drugs other than marijuana are probably the following: age of first alcohol or nicotine use, heavy marijuana use, and psychiatric disorders. However, progression to illicit drug use is not synonymous with heavy or persistent drug use. Indeed, although the age of onset of use of licit drugs (alcohol and nicotine) predicts later illicit drug use, it does not appear to predict persistent or heavy 90 use of illicit drugs. Data on the gateway phenomenon are often overinterpreted. For example, one study 55 ). Of 34- to 35-year- old men who had used marijuana 10—99 times more than 100 times did progress to using other illicit drugs 10 or more times. Comparable proportions for women are 64% and 50%. reports that ""marijuana's role as a gateway drug appears to have increased."" It was a retrospective study based on interviews of drug abusers who reported smoking crack or injecting heroin daily. The data from the study provide no indication of what proportion of marijuana users become serious drug abusers; rather, they indicate that serious drug abusers usually use marijuana before they smoke crack or inject heroin. Only a small percentage of the adult population uses crack or heroin daily; during the five-year period from 1993 to 1997, an average of three people per 1,000 used crack and about two per 132 Many of the data on which the gateway theory is based do not measure dependence; instead, they measure use--even once-only use. Thus, they show only that marijuana users are more likely to use other illicit drugs (even if only once) than are people who never use marijuana, not that they become dependent or even frequent users. The authors of these studies are careful to point out that their data should not be used as evidence of an inexorable causal progression; rather they note that identifying stage-based user groups makes it possible to identify the specific risk factors that predict movement from 25 In the sense that marijuana use typically precedes rather than follows initiation into the use of other illicit drugs, it is indeed a gateway drug. However, it does not appear to be a gateway drug to the extent that it is the cause or even that it is the most significant predictor of serious drug abuse; that is, care must be taken not to attribute cause to association. The most consistent predictors of serious drug use appear to be the intensity of marijuana use and co-occurring psychiatric disorders or a family history of 78,83 psychopathology (including alcoholism). 1,000 used heroin in the preceding month. one stage of drug use to the next--the real issue in the gateway discussion. An important caution is that data on drug use progression pertain to nonmedical drug use. It does not follow from those data that if marijuana were available by prescription for medical use, the pattern of drug use would be the same. Kandel and co-workers also included nonmedical use of prescription psychoactive drugs in their study of drug use 82 progression. a clear and consistent sequence of drug use involving the abuse of prescription psychoactive drugs. The current data on drug use progression neither support nor refute the suggestion that medical availability would increase drug abuse among medical marijuana users. Whether the medical use of marijuana might encourage drug abuse among the general community--not among medical marijuana users themselves but among others simply because of the fact that marijuana would be used for medical purposes--is another question. LINK BETWEEN MEDICAL USE AND DRUG ABUSE Almost everyone who spoke or wrote to the IOM study team about the potential harms posed by the medical use of marijuana felt that it would send the wrong message to children and teenagers. They stated that information about the harms caused by marijuana is undermined by claims that marijuana might have medical value. Yet many of our powerful medicines are also dangerous medicines. These two facets of medicine-- effectiveness and risk--are inextricably linked. The question here is not whether marijuana can be both harmful and helpful but whether the perception of its benefits will increase its abuse. For now any answer to the question remains conjecture. Because marijuana is not an approved medicine, there is little information about the consequences of its medical use in modern society. Reasonable inferences might be drawn from some examples. Opiates, such as morphine and codeine, are an example of a class of drugs that is both abused to great harm and used to great medical benefit, and it would be useful to examine the relationship between their medical use and their abuse. In a ""natural experiment"" during 1973—1978 some states decriminalized marijuana, and others did not. Finally, one can examine the short-term consequences of the publicity surrounding the 1996 medical marijuana campaign in California and ask whether it had any measurable impact on marijuana consumption among youth in California; the consequences of ""message"" that marijuana might have medical use are examined below. Medical Use and Abuse of Opiates Two highly influential papers published in the 1920s and 1950s led to widespread concern among physicians and medical licensing boards that liberal use of opiates would 106 in 1996). Such fears have proven unfounded; it is now recognized that fear of producing addicts through medical treatment resulted in needless suffering among patients with pain as physicians 27,44 In contrast with the use of alcohol, nicotine, and illicit drugs, there was not result in many addicts (reviewed by Moulin and co-workers needlessly limited appropriate doses of medications. addiction problems with misuse of drugs that have been prescribed for medical use. Few people begin their drug 114 Opiates are carefully regulated in the medical setting, and diversion of medically prescribed opiates to the black market is not generally considered to be a major problem. No evidence suggests that the use of opiates or cocaine for medical purposes has increased the perception that their illicit use is safe or acceptable. Clearly, there are risks that patients will abuse marijuana for its psychoactive effects and some likelihood of diversion of marijuana from legitimate medical channels into the illicit market. But those risks do not differentiate marijuana from many accepted medications that are abused by some patients or diverted from medical channels for nonmedical use. Medications with abuse potential are placed in Schedule II of the Controlled Substances Act, which brings them under stricter control, including quotas on the amount that can be legally manufactured (see chapter 5 for discussion of the Controlled Substances Act). That scheduling also signals to physicians that a drug has abuse potential and that they should monitor its use by patients who could be at risk for drug abuse. Marijuana Decriminalization Monitoring the Future, the annual survey of values and lifestyles of high school seniors, revealed that high school seniors in decriminalized states reported using no more 72 marijuana than did their counterparts in states where marijuana was not decriminalized. Another study reported somewhat conflicting evidence indicating that decriminalization 105 had increased marijuana use. Network (DAWN), which has collected data on drug-related emergency room (ER) cases since 1975. There was a greater increase from 1975 to 1978 in the proportion of ER patients who had used marijuana in states that had decriminalized marijuana in 1975— 1976 than in states that had not decriminalized it (Table 3.6). Despite the greater increase among decriminalized states, the proportion of marijuana users among ER patients by 1978 was about equal in states that had and states that had not decriminalized marijuana. That is because the non-decriminalized states had higher rates of marijuana use before decriminalization. In contrast with marijuana use, rates of other illicit drug use among ER patients were substantially higher in states that did not decriminalize marijuana use. Thus, there are different possible reasons for the greater increase in marijuana use in the decriminalized states. On the one hand, decriminalization might have led to an increased use of marijuana (at least among people who sought health care in hospital ERs). On the other hand, the lack of decriminalization might have encouraged greater use of drugs that are even more dangerous than marijuana. The differences between the results for high school seniors from the Monitoring the Future study and the DAWN data are unclear, although the author of the latter study suggests that the reasons might lie in limitations inherent in how the DAWN data are 105 In 1976, the Netherlands adopted a policy of toleration for possession of up to 30 g of marijuana. There was little change in marijuana use during the seven years after the policy change, which suggests that the change itself had little effect; however, in 1984, when Dutch ""coffee shops"" that sold marijuana commercially spread throughout That study used data from the Drug Awareness Warning collected. Amsterdam, marijuana use began to increase. continued to increase in the Netherlands at the same rate as in the United States and Norway--two countries that strictly forbid marijuana sale and possession. Furthermore, during this period, approximately equal percentages of American and Dutch 18 year olds used marijuana; Norwegian 18 year olds were about half as likely to have used marijuana. The authors of this study conclude that there is little evidence that the Dutch marijuana depenalization policy led to increased marijuana use, although they note that commercialization of marijuana might have contributed to its increased use. Thus, there is little evidence that decriminalization of marijuana use necessarily leads to a substantial increase in marijuana use. The Medical Marijuana Debate The most recent National Household Survey on Drug Abuse showed that among people 12—17 years old the perceived risk associated with smoking marijuana once or 132 (Perceived risk is measured as the percentage of survey respondents who report that they ""perceive great risk of harm"" in using a drug at a specified frequency.) At first glance, that might seem to validate the fear that the medical marijuana debate of 1996--before passage of the California medical marijuana referendum in November 1997--had sent a message that marijuana use is safe. But a closer analysis of the data shows that Californian youth were an exception to the national trend. In contrast to the national trend, the perceived risk of 1321 In summary, there is no evidence that the medical marijuana debate has altered adolescents' 132 PSYCHOLOGICAL HARMS In assessing the relative risks and benefits related to the medical use of marijuana, the psychological effects of marijuana can be viewed both as unwanted side effects and as potentially desirable end points in medical treatment. However, the vast majority of research on the psychological effects of marijuana has been in the context of assessing the drug's intoxicating effects when it is used for nonmedical purposes. Thus, the literature does not directly address the effects of marijuana taken for medical purposes. There are some important caveats to consider in attempting to extrapolate from the research mentioned above to the medical use of marijuana. The circumstances under which psychoactive drugs are taken are an important influence on their psychological effects. Furthermore, research protocols to study marijuana's psychological effects in most instances were required to use participants who already had experience with marijuana. People who might have had adverse reactions to marijuana either would choose not to participate in this type of study or would be screened out by the investigator. Therefore, the incidence of adverse reactions to marijuana that might occur in people with no marijuana experience cannot be estimated from such studies. A further complicating factor concerns the dose regimen used for laboratory studies. In most instances, laboratory research studies have looked at the effects of single doses of twice a week had decreased significantly between 1996 and 1997. marijuana use did not change among California youth between 1996 and 1997. perceptions of the risks associated with marijuana use. 98 During the 1990s, marijuana use has marijuana, which might be different from those observed when the drug is taken repeatedly for a chronic medical condition. Nonetheless, laboratory studies are useful in suggesting what psychological functions might be studied when marijuana is evaluated for medical purposes. Results of laboratory studies indicate that acute and chronic marijuana use has pronounced effects on mood, psychomotor, and cognitive functions. These psychological domains should therefore be considered in assessing the relative risks and therapeutic benefits related to marijuana or cannabinoids for any medical condition. Psychiatric Disorders A major question remains as to whether marijuana can produce lasting mood disorders 52 or psychotic disorders, such as schizophrenia. Georgotas and Zeidenberg reported that smoking 10—22 marijuana cigarettes per day was associated with a gradual waning of the positive mood and social facilitating effects of marijuana and an increase in irritability, social isolation, and paranoid thinking. Inasmuch as smoking one cigarette is 68,95,118 enough to make a person feel ""high"" for about 1—3 hours, the subjects in that study were taking very high doses of marijuana. Reports have described the development of apathy, lowered motivation, and impaired educational performance in heavy marijuana 121,122 There are clinical reports of marijuana-induced psychosis-like states (schizophrenia-like, 112 depression, and/or mania) lasting for a week or more. of the varied nature of the psychotic states induced by marijuana, there is no specific ""marijuana psychosis."" Rather, the marijuana experience might trigger latent users who do not appear to be behaviorally impaired in other ways. psychopathology of many types. concluded that disorder. As noted earlier, drug abuse is common among people with psychiatric 66 60 More recently, Hall and colleagues ""there is reasonable evidence that heavy cannabis use, and perhaps acute use in sensitive individuals, can produce an acute psychosis in which confusion, amnesia, delusions, hallucinations, anxiety, agitation and hypomanic symptoms predominate."" Regardless of which of those interpretations is correct, the two reports agree that there is little evidence that marijuana alone produces a psychosis that persists after the period of intoxication. Schizophrenia The association between marijuana and schizophrenia is not well understood. The scientific literature indicates general agreement that heavy marijuana use can precipitate schizophrenic episodes but not that marijuana use can cause the underlying psychotic 59,96,151 disorders. Estimates of the prevalence of marijuana use among schizophrenics vary considerably but are in general agreement that it is at least as great as that among the general population. 35 Schizophrenics prefer the effects of marijuana to those of alcohol 134 134 and cocaine, reasons for this are unknown, but it raises the possibility that schizophrenics might obtain some symptomatic relief from moderate marijuana use. But overall, compared with the general population, people with schizophrenia or with a family history of schizophrenia which they seem to use less often than does the general population. The Hollister suggests that, because are likely to be at greater risk for adverse psychiatric effects from the use of cannabinoids. Cognition As discussed earlier, acutely administered marijuana impairs cognition. 60,66,112 Positron emission tomography (PET) imaging allows investigators to measure the acute effects of marijuana smoking on active brain function. Human volunteers who perform auditory attention tasks before and after smoking a marijuana cigarette show impaired performance while under the influence of marijuana; this is associated with substantial reduction in blood flow to the temporal lobe of the brain, an area that is sensitive to such 116,117 tasks. Marijuana smoking increases blood flow in other brain regions, such as the 101,155 frontal lobes and lateral cerebellum. Earlier studies purporting to show structural 22 changes in the brains of heavy marijuana users have not been replicated with more sophisticated techniques. 28,89 14,122 Nevertheless, recent studies marijuana users after a brief period (19—24 hours) of marijuana abstinence. Longer term 140 Although these studies have attempted to match heavy marijuana users with subjects of similar cognitive abilities before exposure to marijuana use, the adequacy of this matching has been 133 cognitive deficits in heavy marijuana users have also been reported. have found subtle defects in cognitive tasks in heavy questioned. reviewed in an article by Pope and colleagues. are designed to differentiate between changes in brain function caused the effects of marijuana and by the illness for which marijuana is being given. AIDS dementia is an obvious example of this possible confusion. It is also important to determine whether repeated use of marijuana at therapeutic dosages produces any irreversible cognitive effects. Psychomotor Performance Marijuana administration has been reported to affect psychomotor performance on a 23 not only details the studies that have been done but also points out the inconsistencies among studies, the methodological shortcomings of many studies, and the large individual differences among the studies attributable to subject, situational, and methodological factors. Those factors must be considered in studies of psychomotor performance when participants are involved in a clinical trial of the efficacy of marijuana. The types of psychomotor functions that have been shown to be disrupted by the acute administration of marijuana include body sway, hand steadiness, rotary pursuit, driving and flying simulation, divided attention, sustained attention, and the digit-symbol substitution test. A study of experienced airplane pilots showed that even 24 hours after a single marijuana cigarette their performance on flight 163 Before the tests, however, they told the study investigators that they were sure their performance would be unaffected. The complex methodological issues facing research in this area are well number of tasks. The review by Chait and Pierri simulator tests was impaired. 121 Care must be exercised so that studies Cognitive impairments associated with acutely administered marijuana limit the activities that people would be able to do safely or productively. For example, no one under the influence of marijuana or THC should drive a vehicle or operate potentially dangerous equipment. Amotivational Syndrome One of the more controversial effects claimed for marijuana is the production of an ""amotivational syndrome."" This syndrome is not a medical diagnosis, but it has been used to describe young people who drop out of social activities and show little interest in school, work, or other goal-directed activity. When heavy marijuana use accompanies these symptoms, the drug is often cited as the cause, but no convincing data demonstrate 23 a causal relationship between marijuana smoking and these behavioral characteristics. is not enough to observe that a chronic marijuana user lacks motivation. Instead, relevant personality traits and behavior of subjects must be assessed before and after the subject becomes a heavy marijuana user. Because such research can only be done on subjects who become heavy marijuana users on their own, a large population study--such as the Epidemiological Catchment Area study described earlier in this chapter--would be needed to shed light on the relationship between motivation and marijuana use. Even then, although a causal relationship between the two could, in theory, be dismissed by an epidemiological study, causality could not be proven.","Whether currently available or unavailable, what is an example of a smokeless cannabis delivery method that clinical trials hope to help develop? To answer the following question, use only information contained in the context block/prompt. Do not use any previous knowledge or outside sources. Three focal concerns in evaluating the medical use of marijuana are: 1. Evaluation of the effects of isolated cannabinoids; 2. Evaluation of the risks associated with the medical use of marijuana; and 3. Evaluation of the use of smoked marijuana. EFFECTS OF ISOLATED CANNABINOIDS Cannabinoid Biology Much has been learned since the 1982 IOM report Marijuana and Health. Although it was clear then that most of the effects of marijuana were due to its actions on the brain, there was little information about how THC acted on brain cells (neurons), which cells were affected by THC, or even what general areas of the brain were most affected by THC. In addition, too little was known about cannabinoid physiology to offer any scientific insights into the harmful or therapeutic effects of marijuana. That all changed with the identification and characterization of cannabinoid receptors in the 1980s and 1990s. During the past 16 years, science has advanced greatly and can tell us much more about the potential medical benefits of cannabinoids. Conclusion: At this point, our knowledge about the biology of marijuana and cannabinoids allows us to make some general conclusions: o Cannabinoids likely have a natural role in pain modulation, control of movement, and memory. o The natural role of cannabinoids in immune systems is likely multi-faceted and remains unclear. o The brain develops tolerance to cannabinoids. o Animal research demonstrates the potential for dependence, but this potential is observed under a narrower range of conditions than with benzodiazepines, opiates, cocaine, or nicotine. o Withdrawal symptoms can be observed in animals but appear to be mild compared to opiates or benzodiazepines, such as diazepam (Valium). Conclusion: The different cannabinoid receptor types found in the body appear to play different roles in normal human physiology. In addition, some effects of cannabinoids appear to be independent of those receptors. The variety of mechanisms through which cannabinoids can influence human physiology underlies the variety of potential therapeutic uses for drugs that might act selectively on different cannabinoid systems. Recommendation 1: Research should continue into the physiological effects of synthetic and plant-derived cannabinoids and the natural function of cannabinoids found in the body. Because different cannabinoids appear to have different effects, cannabinoid research should include, but not be restricted to, effects attributable to THC alone. Efficacy of Cannabinoid Drugs The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation. The therapeutic effects of cannabinoids are best established for THC, which is generally one of the two most abundant of the cannabinoids in marijuana. (Cannabidiol is generally the other most abundant cannabinoid.) The effects of cannabinoids on the symptoms studied are generally modest, and in most cases there are more effective medications. However, people vary in their responses to medications, and there will likely always be a subpopulation of patients who do not respond well to other medications. The combination of cannabinoid drug effects (anxiety reduction, appetite stimulation, nausea reduction, and pain relief) suggests that cannabinoids would be moderately well suited for particular conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting. Defined substances, such as purified cannabinoid compounds, are preferable to plant products, which are of variable and uncertain composition. Use of defined cannabinoids permits a more precise evaluation of their effects, whether in combination or alone. Medications that can maximize the desired effects of cannabinoids and minimize the undesired effects can very likely be identified. Although most scientists who study cannabinoids agree that the pathways to cannabinoid drug development are clearly marked, there is no guarantee that the fruits of scientific research will be made available to the public for medical use. Cannabinoid- based drugs will only become available if public investment in cannabinoid drug research is sustained and if there is enough incentive for private enterprise to develop and market such drugs. Conclusion: Scientific data indicate the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances. Recommendation 2: Clinical trials of cannabinoid drugs for symptom management should be conducted with the goal of developing rapid-onset, reliable, and safe delivery systems. Influence of Psychological Effects on Therapeutic Effects The psychological effects of THC and similar cannabinoids pose three issues for the therapeutic use of cannabinoid drugs. First, for some patients--particularly older patients with no previous marijuana experience--the psychological effects are disturbing. Those patients report experiencing unpleasant feelings and disorientation after being treated with THC, generally more severe for oral THC than for smoked marijuana. Second, for conditions such as movement disorders or nausea, in which anxiety exacerbates the symptoms, the antianxiety effects of cannabinoid drugs can influence symptoms indirectly. This can be beneficial or can create false impressions of the drug effect. Third, for cases in which symptoms are multifaceted, the combination of THC effects might provide a form of adjunctive therapy; for example, AIDS wasting patients would likely benefit from a medication that simultaneously reduces anxiety, pain, and nausea while stimulating appetite. Conclusion: The psychological effects of cannabinoids, such as anxiety reduction, sedation, and euphoria can influence their potential therapeutic value. Those effects are potentially undesirable for certain patients and situations and beneficial for others. In addition, psychological effects can complicate the interpretation of other aspects of the drug's effect. Recommendation 3: Psychological effects of cannabinoids such as anxiety reduction and sedation, which can influence medical benefits, should be evaluated in clinical trials. RISKS ASSOCIATED WITH MEDICAL USE OF MARIJUANA Physiological Risks Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications. The harmful effects to individuals from the perspective of possible medical use of marijuana are not necessarily the same as the harmful physical effects of drug abuse. When interpreting studies purporting to show the harmful effects of marijuana, it is important to keep in mind that the majority of those studies are based on smoked marijuana, and cannabinoid effects cannot be separated from the effects of inhaling smoke from burning plant material and contaminants. For most people the primary adverse effect of acute marijuana use is diminished psychomotor performance. It is, therefore, inadvisable to operate any vehicle or potentially dangerous equipment while under the influence of marijuana, THC, or any cannabinoid drug with comparable effects. In addition, a minority of marijuana users experience dysphoria, or unpleasant feelings. Finally, the short-term immunosuppressive effects are not well established but, if they exist, are not likely great enough to preclude a legitimate medical use. The chronic effects of marijuana are of greater concern for medical use and fall into two categories: the effects of chronic smoking and the effects of THC. Marijuana smoking is associated with abnormalities of cells lining the human respiratory tract. Marijuana smoke, like tobacco smoke, is associated with increased risk of cancer, lung damage, and poor pregnancy outcomes. Although cellular, genetic, and human studies all suggest that marijuana smoke is an important risk factor for the development of respiratory cancer, proof that habitual marijuana smoking does or does not cause cancer awaits the results of well-designed studies. Conclusion: Numerous studies suggest that marijuana smoke is an important risk factor in the development of respiratory disease. Recommendation 4: Studies to define the individual health risks of smoking marijuana should be conducted, particularly among populations in which marijuana use is prevalent. Marijuana Dependence and Withdrawal A second concern associated with chronic marijuana use is dependence on the psychoactive effects of THC. Although few marijuana users develop dependence, some do. Risk factors for marijuana dependence are similar to those for other forms of substance abuse. In particular, anti-social personality and conduct disorders are closely associated with substance abuse. Conclusion: A distinctive marijuana withdrawal syndrome has been identified, but it is mild and short lived. The syndrome includes restlessness, irritability, mild agitation, insomnia, sleep disturbance, nausea, and cramping. Marijuana as a ""Gateway"" Drug Patterns in progression of drug use from adolescence to adulthood are strikingly regular. Because it is the most widely used illicit drug, marijuana is predictably the first illicit drug most people encounter. Not surprisingly, most users of other illicit drugs have used marijuana first. In fact, most drug users begin with alcohol and nicotine before marijuana--usually before they are of legal age. In the sense that marijuana use typically precedes rather than follows initiation of other illicit drug use, it is indeed a ""gateway"" drug. But because underage smoking and alcohol use typically precede marijuana use, marijuana is not the most common, and is rarely the first, ""gateway"" to illicit drug use. There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs. An important caution is that data on drug use progression cannot be assumed to apply to the use of drugs for medical purposes. It does not follow from those data that if marijuana were available by prescription for medical use, the pattern of drug use would remain the same as seen in illicit use. Finally, there is a broad social concern that sanctioning the medical use of marijuana might increase its use among the general population. At this point there are no convincing data to support this concern. The existing data are consistent with the idea that this would not be a problem if the medical use of marijuana were as closely regulated as other medications with abuse potential. Conclusion: Present data on drug use progression neither support nor refute the suggestion that medical availability would increase drug abuse. However, this question is beyond the issues normally considered for medical uses of drugs and should not be a factor in evaluating the therapeutic potential of marijuana or cannabinoids. USE OF SMOKED MARIJUANA Because of the health risks associated with smoking, smoked marijuana should generally not be recommended for long-term medical use. Nonetheless, for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern. Further, despite the legal, social, and health problems associated with smoking marijuana, it is widely used by certain patient groups. Recommendation 5: Clinical trials of marijuana use for medical purposes should be conducted under the following limited circumstances: trials should involve only short-term marijuana use (less than six months), should be conducted in patients with conditions for which there is reasonable expectation of efficacy, should be approved by institutional review boards, and should collect data about efficacy. The goal of clinical trials of smoked marijuana would not be to develop marijuana as a licensed drug but rather to serve as a first step toward the possible development of nonsmoked rapid-onset cannabinoid delivery systems. However, it will likely be many years before a safe and effective cannabinoid delivery system, such as an inhaler, is available for patients. In the meantime there are patients with debilitating symptoms for whom smoked marijuana might provide relief. The use of smoked marijuana for those patients should weigh both the expected efficacy of marijuana and ethical issues in patient care, including providing information about the known and suspected risks of smoked marijuana use. Recommendation 6: Short-term use of smoked marijuana (less than six months) for patients with debilitating symptoms (such as intractable pain or vomiting) must meet the following conditions: o failure of all approved medications to provide relief has been documented, o the symptoms can reasonably be expected to be relieved by rapid- onset cannabinoid drugs, o such treatment is administered under medical supervision in a manner that allows for assessment of treatment effectiveness, and o involves an oversight strategy comparable to an institutional review board process that could provide guidance within 24 hours of a submission by a physician to provide marijuana to a patient for a specified use. Until a nonsmoked rapid-onset cannabinoid drug delivery system becomes available, we acknowledge that there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting. One possible approach is to treat patients as n-of-1 clinical trials (single-patient trials), in which patients are fully informed of their status as experimental subjects using a harmful drug delivery system and in which their condition is closely monitored and documented under medical supervision, thereby increasing the knowledge base of the risks and benefits of marijuana use under such conditions.data, it is important to understand that decisions about drug regulation are based on a variety of moral and social considerations, as well as on medical and scientific ones. Even when a drug is used only for medical purposes, value judgments affect policy decisions concerning its medical use. For example, the magnitude of a drug's expected medical benefit affects regulatory judgments about the acceptability of risks associated with its use. Also, although a drug is normally approved for medical use only on proof of its ""safety and efficacy,"" patients with life-threatening conditions are sometimes (under protocols for ""compassionate use"") allowed access to unapproved drugs whose benefits and risks are uncertain. Value judgments play an even more substantial role in regulatory decisions concerning drugs, such as marijuana, that are sought and used for nonmedical purposes. Then policymakers must take into account not only the risks and benefits associated with medical use but also possible interactions between the regulatory arrangements governing medical use and the integrity of the legal controls set up to restrict nonmedical use. It should be clear that many elements of drug control policy lie outside the realm of biology and medicine. Ultimately, the complex moral and social judgments that underlie drug control policy must be made by the American people and their elected officials. A goal of this report is to evaluate the biological and medical factors that should be taken into account in making those judgments. HOW THIS STUDY WAS CONDUCTED Information was gathered through scientific workshops, site visits, analysis of the relevant scientific literature, and extensive consultation with biomedical and social scientists. The three 2-day workshops--in Irvine, California; New Orleans, Louisiana; and Washington, D.C.--were open to the public and included scientific presentations and reports, mostly from patients and their families, about their experiences with and perspectives on the medical use of marijuana. Scientific experts in various fields were selected to talk about the latest research on marijuana, cannabinoids, and related topics (listed in Appendix B). Selection of the experts was based on recommendations by their peers, who ranked them among the most accomplished scientists and the most knowledgeable about marijuana and cannabinoids in their own fields. In addition, advocates for (John Morgan) and against (Eric A. Voth) the medical use of marijuana were invited to present scientific evidence in support of their positions. Information presented at the scientific workshops was supplemented by analysis of the scientific literature and evaluating the methods used in various studies and the validity of the authors' conclusions. Different kinds of clinical studies are useful in different ways: results of a controlled double-blind study with adequate sample sizes can be expected to apply to the general population from which study subjects were drawn; an isolated case report can suggest further studies but cannot be presumed to be broadly applicable; and survey data can be highly informative but are generally limited by the need to rely on self-reports of drug use and on unconfirmed medical diagnoses. This report relies mainly on the most relevant and methodologically rigorous studies available and treats the results of more limited studies cautiously. In addition, study results are presented in such a way as to allow thoughtful readers to judge the results themselves. The Institute of Medicine (IOM) appointed a panel of nine experts to advise the study team on technical issues. These included neurology and the treatment of pain (Howard Fields); regulation of prescription drugs (J. Richard Crout); AIDS wasting and clinical trials (Judith Feinberg); treatment and pathology of multiple sclerosis (Timothy Vollmer); drug dependence among adolescents (Thomas Crowley); varieties of drug dependence (Dorothy Hatsukami); internal medicine, health care delivery, and clinical epidemiology (Eric B. Larson); cannabinoids and marijuana pharmacology (Billy R. Martin); and cannabinoid neuroscience (Steven R. Childers). Public outreach included setting up a Web site that provided information about the study and asked for input from the public. The Web site was open for comment from November 1997 until November 1998. Some 130 organizations were invited to participate in the public workshops. Many people in the organizations--particularly those opposed to the medical use of marijuana--felt that a public forum was not conducive to expressing their views; they were invited to communicate their opinions (and reasons for holding them) by mail or telephone. As a result, roughly equal numbers of persons and organizations opposed to and in favor of the medical use of marijuana were heard from. The study team visited four cannabis buyers' clubs in California (the Oakland Cannabis Buyers' Cooperative, the San Francisco Cannabis Cultivators Club, the Los Angeles Cannabis Resource Center, and Californians Helping Alleviate Medical Problems, or CHAMPS) and two HIV/AIDS clinics (AIDS Health Care Foundation in Los Angeles and Louisiana State University Medical Center in New Orleans). We listened to many individual stories from the buyers' clubs about using marijuana to treat a variety of symptoms and heard clinical observations on the use of Marinol to treat AIDS 9 patients. Marinol is the brand name for dronabinol, which is (THC) in pill form and is available by prescription for the treatment of nausea associated with chemotherapy and AIDS wasting. MARIJUANA TODAY The Changing Legal Landscape In the 20th century, marijuana has been used more for its euphoric effects than as a medicine. Its psychological and behavioral effects have concerned public officials since the drug first appeared in the southwestern and southern states during the first two decades of the century. By 1931, at least 29 states had prohibited use of the drug for 3 nonmedicalpurposes. MarijuanawasfirstregulatedatthefederallevelbytheMarijuana Tax Act of 1937, which required anyone producing, distributing, or using marijuana for medical purposes to register and pay a tax and which effectively prohibited nonmedical use of the drug. Although the act did not make medical use of marijuana illegal, it did make it expensive and inconvenient. In 1942, marijuana was removed from the U.S. -tetrahydrocannabinol Pharmacopoeia because it was believed to be a harmful and addictive drug that caused psychoses, mental deterioration, and violent behavior. In the late 1960s and early 1970s, there was a sharp increase in marijuana use among adolescents and young adults. The current legal status of marijuana was established in 1970 with the passage of the Controlled Substances Act, which divided drugs into five schedules and placed marijuana in Schedule I, the category for drugs with high potential for abuse and no accepted medical use (see Appendix C, Scheduling Definitions). In 1972, the National Organization for the Reform of Marijuana Legislation (NORML), an organization that supports decriminalization of marijuana, unsuccessfully petitioned the Bureau of Narcotics and Dangerous Drugs to move marijuana from Schedule I to Schedule II. NORML argued that marijuana is therapeutic in numerous serious ailments, 13 less toxic, and in many cases more effective than conventional medicines. years the medical marijuana movement has been closely linked with the marijuana decriminalization movement, which has colored the debate. Many people criticized that association in their letters to IOM and during the public workshops of this study. The argument against the medical use of marijuana presented most often to the IOM study team was that ""the medical marijuana movement is a Trojan horse""; that is, it is a deceptive tactic used by advocates of marijuana decriminalization who would exploit the public's sympathy for seriously ill patients. Since NORML's petition in 1972, there have been a variety of legal decisions concerning marijuana. From 1973 to 1978, 11 states adopted statutes that decriminalized use of marijuana, although some of them recriminalized marijuana use in the 1980s and 1990s. During the 1970s, reports of the medical value of marijuana began to appear, particularly claims that marijuana relieved the nausea associated with chemotherapy. Health departments in six states conducted small studies to investigate the reports. When the AIDS epidemic spread in the 1980s, patients found that marijuana sometimes relieved their symptoms, most dramatically those associated with AIDS wasting. Over this period a number of defendants charged with unlawful possession of marijuana claimed that they were using the drug to treat medical conditions and that violation of the law was therefore justified (the so-called medical necessity defense). Although most courts rejected these 8 Against that backdrop, voters in California and Arizona in 1996 passed two referenda that attempted to legalize the medical use of marijuana under particular conditions. Public support for patient access to marijuana for medical use appears substantial; public opinion polls taken during 1997 and 1998 generally reported 60—70 percent of 15 However, those referenda are at odds with federal laws regulating marijuana, and their implementation raises complex legal questions. Despite the current level of interest, referenda and public discussions have not been well informed by carefully reasoned scientific debate. Although previous reports have all called for more research, the nature of the research that will be most helpful depends greatly on the specific health conditions to be addressed. And while there have been claims, some accepted them. respondents in favor of allowing medical uses of marijuana. Thus, for 25 important recent advances in our understanding of the physiological effects of marijuana, few of the recent investigators have had the time or resources to permit detailed analysis. The results of those advances, only now beginning to be explored, have significant implications for the medical marijuana debate. Several months after the passage of the California and Arizona medical marijuana referendums, the Office of National Drug Control Policy (ONDCP) asked whether IOM would conduct a scientific review of the medical value of marijuana and its constituent compounds. In August 1997, IOM formally began the study and appointed John A. Benson Jr. and Stanley J. Watson Jr. to serve as principal investigators for the study. The charge to IOM was to review the medical use of marijuana and the harms and benefits attributed to it (details are given in Appendix D). Marijuana plants have been used since antiquity for both herbal medication and intoxication. The current debate over the medical use of marijuana is essentially a debate over the value of its medicinal properties relative to the risk posed by its use. 1,10,11 Marijuana's use as an herbal remedy before the 20th century is well documented. However, modern medicine adheres to different standards from those used in the past. The question is not whether marijuana can be used as an herbal remedy but rather how well this remedy meets today's standards of efficacy and safety. We understand much more than previous generations about medical risks. Our society generally expects its licensed medications to be safe, reliable, and of proven efficacy; contaminants and inconsistent ingredients in our health treatments are not tolerated. That refers not only to prescription and over-the-counter drugs but also to vitamin supplements and herbal remedies purchased at the grocery store. For example, the essential amino acid l- tryptophan was widely sold in health food stores as a natural remedy for insomnia until early 1990 when it became linked to an epidemic of a new and potentially fatal illness 9,12 When it was removed from the market shortly thereafter, there was little protest, despite the fact that it was safe for the vast majority of the population. The 1,536 cases and 27 deaths were later traced to contaminants in a batch produced by a single Japanese manufacturer. Although few herbal medicines meet today's standards, they have provided the foundation for modern Western pharmaceuticals. Most current prescriptions have their 7 rootseitherdirectlyorindirectlyinplantremedies. Atthesametime,mostcurrent prescriptions are synthetic compounds that are only distantly related to the natural compounds that led to their development. Digitalis was discovered in foxglove, morphine in poppies, and taxol in the yew tree. Even aspirin (acetylsalicylic acid) has its counterpart in herbal medicine: for many generations, American Indians relieved headaches by chewing the bark of the willow tree, which is rich in a related form of salicylic acid. Although plants continue to be valuable resources for medical advances, drug development is likely to be less and less reliant on plants and more reliant on the tools of (eosinophilia-myalgia syndrome). modern science. Molecular biology, bioinformatics software, and DNA array-based analyses of genes and chemistry are all beginning to yield great advances in drug discovery and development. Until recently, drugs could only be discovered; now they can be designed. Even the discovery process has been accelerated through the use of modern drug-screening techniques. It is increasingly possible to identify or isolate the chemical compounds in a plant, determine which compounds are responsible for the plant's effects, and select the most effective and safe compounds--either for use as purified substances or as tools to develop even more effective, safer, or less expensive compounds. Yet even as the modern pharmacological toolbox becomes more sophisticated and biotechnology yields an ever greater abundance of therapeutic drugs, people increasingly 4,5 In 1997, 46 percent of Americans sought nontraditional medicines and spent over 27 billion unreimbursed dollars; the total number of visits to alternative medicine practitioners appears to have exceeded the number of 5,6 Recent interest in the medical use of marijuana coincides with this trend toward self-help and a search for ""natural"" therapies. Indeed, several people who spoke at the IOM public hearings in support of the medical use of marijuana said that they generally preferred herbal medicines to standard pharmaceuticals. However, few alternative therapies have been carefully and systematically tested for safety and efficacy, as is required for medications approved by 2 WHO USES MEDICAL MARIJUANA? There have been no comprehensive surveys of the demographics and medical conditions of medical marijuana users, but a few reports provide some indication. In each case, survey results should be understood to reflect the situation in which they were conducted and are not necessarily characteristic of medical marijuana users as a whole. Respondents to surveys reported to the IOM study team were all members of ""buyers' clubs,"" organizations that provide their members with marijuana, although not necessarily through direct cash transactions. The atmosphere of the marijuana buyers' clubs ranges from that of the comparatively formal and closely regulated Oakland Cannabis Buyers' Cooperative to that of a ""country club for the indigent,"" as Denis Peron described the San Francisco Cannabis Cultivators Club (SFCCC), which he directed. John Mendelson, an internist and pharmacologist at the University of California, San Francisco (UCSF) Pain Management Center, surveyed 100 members of the SFCCC who were using marijuana at least weekly. Most of the respondents were unemployed men in their forties. Subjects were paid $50 to participate in the survey; this might have encouraged a greater representation of unemployed subjects. All subjects were tested for drug use. About half tested positive for marijuana only; the other half tested positive for drugs in addition to marijuana (23% for cocaine and 13% for amphetamines). The predominant disorder was AIDS, followed by roughly equal numbers of members who reported chronic pain, mood disorders, and musculoskeletal disorders (Table 1.1). seek alternative, low-technology therapies. visits to primary care physicians. the FDA (Food and Drug Administration). The membership profile of the San Francisco club was similar to that of the Los Angeles Cannabis Resource Center (LACRC), where 83% of the 739 patients were men, 45% were 36—45 years old, and 71% were HIV positive. Table 1.2 shows a distribution of conditions somewhat different from that in SFCCC respondents, probably because of a different membership profile. For example, cancer is generally a disease that occurs late in life; 34 (4.7%) of LACRC members were over 55 years old; only 2% of survey respondents in the SFCCC study were over 55 years old. Jeffrey Jones, executive director of the Oakland Cannabis Buyers' Cooperative, reported that its largest group of patients is HIV-positive men in their forties. The second- largest group is patients with chronic pain. Among the 42 people who spoke at the public workshops or wrote to the study team, only six identified themselves as members of marijuana buyers' clubs. Nonetheless, they presented a similar profile: HIV/AIDS was the predominant disorder, followed by chronic pain (Tables 1.3 and 1.4). All HIV/AIDS patients reported that marijuana relieved nausea and vomiting and improved their appetite. About half the patients who reported using marijuana for chronic pain also reported that it reduced nausea and vomiting. Note that the medical conditions referred to are only those reported to the study team or to interviewers; they cannot be assumed to represent complete or accurate diagnoses. Michael Rowbotham, a neurologist at the UCSF Pain Management Center, noted that many pain patients referred to that center arrive with incorrect diagnoses or with pain of unknown origin. At that center the patients who report medical benefit from marijuana say that it does not reduce their pain but enables them to cope with it. Most--not all--people who use marijuana to relieve medical conditions have previously used it recreationally. An estimated 95% of the LACRC members had used marijuana before joining the club. It is important to emphasize the absence of comprehensive information on marijuana use before its use for medical conditions. Frequency of prior use almost certainly depends on many factors, including membership in a buyers' club, membership in a population sector that uses marijuana more often than others (for example, men 20—30 years old), and the medical condition being treated with marijuana (for example, there are probably relatively fewer recreational marijuana users among cancer patients than among AIDS patients). Patients who reported their experience with marijuana at the public workshops said that marijuana provided them with great relief from symptoms associated with disparate diseases and ailments, including AIDS wasting, spasticity from multiple sclerosis, depression, chronic pain, and nausea associated with chemotherapy. Their circumstances and symptoms were varied, and the IOM study team was not in a position to make medical evaluations or confirm diagnoses. Three representative cases presented to the IOM study team are presented in Box 1.1; the stories have been edited for brevity, but each case is presented in the patient's words and with the patient's permission. The variety of stories presented left the study team with a clear view of people's beliefs about how marijuana had helped them. But this collection of anecdotal data, although useful, is limited. We heard many positive stories but no stories from people who had tried marijuana but found it ineffective. This is a fraction with an unknown denominator. For the numerator we have a sample of positive responses; for the denominator we have no idea of the total number of people who have tried marijuana for medical purposes. Hence, it is impossible to estimate the clinical value of marijuana or cannabinoids in the general population based on anecdotal reports. Marijuana clearly seems to relieve some symptoms for some people--even if only as a placebo effect. But what is the balance of harmful and beneficial effects? That is the essential medical question that can be answered only by careful analysis of data collected under controlled conditions. CANNABIS AND THE CANNABINOIDS Marijuana is the common name for Cannabis sativa, a hemp plant that grows throughout temperate and tropical climates. The most recent review of the constituents of 16 marijuana lists 66 cannabinoids (Table 1.5). different cannabinoid effects or interactions. Most of the cannabinoids are closely related; they fall into only 10 groups of closely related cannabinoids, many of which differ by only a single chemical moiety and might be midpoints along biochemical pathways--that -tetrahydrocannabinol ( THC) is the primary psychoactive ingredient; depending on the particular plant, either THC or cannabidiol is the most abundant cannabinoid in marijuana (Figure 1.1). 9 is, degradation products, precursors, or byproducts. - But that does not mean there are 66 16,18 9 9 Throughout this report, THC is used to indicate of THC are discussed, the full names are used. All the cannabinoids are lipophilic--they are highly soluble in fatty fluids and tissues but not in water. Indeed, THC is so lipophilic that it is aptly described as ""greasy."" Throughout this report, marijuana refers to unpurified plant extracts, including leaves and flower tops, regardless of how they are consumed--whether by ingestion or by smoking. References to the effects of marijuana should be understood to include the composite effects of its various components; that is, the effects of THC are included among the effects of marijuana, but not all the effects of marijuana are necessarily due to THC. Discussions concerning cannabinoids refer only to those particular compounds and not to the plant extract. This distinction is important; it is often blurred or exaggerated. Cannabinoids are produced in epidermal glands on the leaves (especially the upper ones), stems, and the bracts that support the flowers of the marijuana plant. Although the flower itself has no epidermal glands, it has the highest cannabinoid content anywhere on the plant, probably because of the accumulation of resin secreted by the supporting bracteole (the small leaf-like part below the flower). The amounts of cannabinoids and their relative abundance in a marijuana plant vary with growing conditions, including 14 ). The chemical stability of cannabinoids in harvested plant material is also affected by moisture, temperature, sunlight, and storage. They degrade under any storage condition. humidity, temperature, and soil nutrients (reviewed in Pate, 1994 -THC. In the few cases where variants ORGANIZATION OF THE REPORT Throughout the report, steps that might be taken to fill the gaps in understanding both the potential harms and benefits of marijuana and cannabinoid use are identified. Those steps include identifying knowledge gaps, promising research directions, and potential therapies based on scientific advances in cannabinoid biology. Chapter 2 reviews basic cannabinoid biology and provides a foundation to understand the medical value of marijuana or its constituent cannabinoids. In consideration of the physician's first rule, ""first, do no harm,"" the potential harms attributed to the medical use of marijuana are reviewed before the potential medical benefits. Chapter 3 reviews the risks posed by marijuana use, with emphasis on medical use. Chapter 4 analyzes the most credible clinical data relevant to the medical use of marijuana. It reviews what is known about the physiological mechanisms underlying particular conditions (for example, chronic pain, vomiting, anorexia, and muscle spasticity), what is known about the cellular actions of cannabinoids, and the levels of proof needed to show that marijuana is an effective treatment for specific symptoms. It does not analyze the historical literature; history is informative in enumerating uses of marijuana, but it does not provide the sort of information needed for a scientifically sound evaluation of the efficacy and safety of marijuana for clinical use. Because marijuana is advocated primarily as affording relief from the symptoms of disease rather than as a cure, this chapter is organized largely by symptoms as opposed to disease categories. Finally, chapter 4 compares the conclusions of this report with those of other recent reports on the medical use of marijuana. Chapter 5 describes the process of and analyzes the prospects for cannabinoid drug development. Three focal concerns in evaluating the medical use of marijuana are: 1. Evaluation of the effects of isolated cannabinoids; 2. Evaluation of the risks associated with the medical use of marijuana; and 3. Evaluation of the use of smoked marijuana. EFFECTS OF ISOLATED CANNABINOIDS Cannabinoid Biology Much has been learned since the 1982 IOM report Marijuana and Health. Although it was clear then that most of the effects of marijuana were due to its actions on the brain, there was little information about how THC acted on brain cells (neurons), which cells were affected by THC, or even what general areas of the brain were most affected by THC. In addition, too little was known about cannabinoid physiology to offer any scientific insights into the harmful or therapeutic effects of marijuana. That all changed with the identification and characterization of cannabinoid receptors in the 1980s and 1990s. During the past 16 years, science has advanced greatly and can tell us much more about the potential medical benefits of cannabinoids. Conclusion: At this point, our knowledge about the biology of marijuana and cannabinoids allows us to make some general conclusions: o Cannabinoids likely have a natural role in pain modulation, control of movement, and memory. o The natural role of cannabinoids in immune systems is likely multi-faceted and remains unclear. o The brain develops tolerance to cannabinoids. o Animal research demonstrates the potential for dependence, but this potential is observed under a narrower range of conditions than with benzodiazepines, opiates, cocaine, or nicotine. o Withdrawal symptoms can be observed in animals but appear to be mild compared to opiates or benzodiazepines, such as diazepam (Valium). Conclusion: The different cannabinoid receptor types found in the body appear to play different roles in normal human physiology. In addition, some effects of cannabinoids appear to be independent of those receptors. The variety of mechanisms through which cannabinoids can influence human physiology underlies the variety of potential therapeutic uses for drugs that might act selectively on different cannabinoid systems. Recommendation 1: Research should continue into the physiological effects of synthetic and plant-derived cannabinoids and the natural function of cannabinoids found in the body. Because different cannabinoids appear to have different effects, cannabinoid research should include, but not be restricted to, effects attributable to THC alone. Efficacy of Cannabinoid Drugs The accumulated data indicate a potential therapeutic value for cannabinoid drugs, particularly for symptoms such as pain relief, control of nausea and vomiting, and appetite stimulation. The therapeutic effects of cannabinoids are best established for THC, which is generally one of the two most abundant of the cannabinoids in marijuana. (Cannabidiol is generally the other most abundant cannabinoid.) The effects of cannabinoids on the symptoms studied are generally modest, and in most cases there are more effective medications. However, people vary in their responses to medications, and there will likely always be a subpopulation of patients who do not respond well to other medications. The combination of cannabinoid drug effects (anxiety reduction, appetite stimulation, nausea reduction, and pain relief) suggests that cannabinoids would be moderately well suited for particular conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting. Defined substances, such as purified cannabinoid compounds, are preferable to plant products, which are of variable and uncertain composition. Use of defined cannabinoids permits a more precise evaluation of their effects, whether in combination or alone. Medications that can maximize the desired effects of cannabinoids and minimize the undesired effects can very likely be identified. Although most scientists who study cannabinoids agree that the pathways to cannabinoid drug development are clearly marked, there is no guarantee that the fruits of scientific research will be made available to the public for medical use. Cannabinoid- based drugs will only become available if public investment in cannabinoid drug research is sustained and if there is enough incentive for private enterprise to develop and market such drugs. Conclusion: Scientific data indicate the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances. Recommendation 2: Clinical trials of cannabinoid drugs for symptom management should be conducted with the goal of developing rapid-onset, reliable, and safe delivery systems. Influence of Psychological Effects on Therapeutic Effects The psychological effects of THC and similar cannabinoids pose three issues for the therapeutic use of cannabinoid drugs. First, for some patients--particularly older patients with no previous marijuana experience--the psychological effects are disturbing. Those patients report experiencing unpleasant feelings and disorientation after being treated with THC, generally more severe for oral THC than for smoked marijuana. Second, for conditions such as movement disorders or nausea, in which anxiety exacerbates the symptoms, the antianxiety effects of cannabinoid drugs can influence symptoms indirectly. This can be beneficial or can create false impressions of the drug effect. Third, for cases in which symptoms are multifaceted, the combination of THC effects might provide a form of adjunctive therapy; for example, AIDS wasting patients would likely benefit from a medication that simultaneously reduces anxiety, pain, and nausea while stimulating appetite. Conclusion: The psychological effects of cannabinoids, such as anxiety reduction, sedation, and euphoria can influence their potential therapeutic value. Those effects are potentially undesirable for certain patients and situations and beneficial for others. In addition, psychological effects can complicate the interpretation of other aspects of the drug's effect. Recommendation 3: Psychological effects of cannabinoids such as anxiety reduction and sedation, which can influence medical benefits, should be evaluated in clinical trials. RISKS ASSOCIATED WITH MEDICAL USE OF MARIJUANA Physiological Risks Marijuana is not a completely benign substance. It is a powerful drug with a variety of effects. However, except for the harms associated with smoking, the adverse effects of marijuana use are within the range of effects tolerated for other medications. The harmful effects to individuals from the perspective of possible medical use of marijuana are not necessarily the same as the harmful physical effects of drug abuse. When interpreting studies purporting to show the harmful effects of marijuana, it is important to keep in mind that the majority of those studies are based on smoked marijuana, and cannabinoid effects cannot be separated from the effects of inhaling smoke from burning plant material and contaminants. For most people the primary adverse effect of acute marijuana use is diminished psychomotor performance. It is, therefore, inadvisable to operate any vehicle or potentially dangerous equipment while under the influence of marijuana, THC, or any cannabinoid drug with comparable effects. In addition, a minority of marijuana users experience dysphoria, or unpleasant feelings. Finally, the short-term immunosuppressive effects are not well established but, if they exist, are not likely great enough to preclude a legitimate medical use. The chronic effects of marijuana are of greater concern for medical use and fall into two categories: the effects of chronic smoking and the effects of THC. Marijuana smoking is associated with abnormalities of cells lining the human respiratory tract. Marijuana smoke, like tobacco smoke, is associated with increased risk of cancer, lung damage, and poor pregnancy outcomes. Although cellular, genetic, and human studies all suggest that marijuana smoke is an important risk factor for the development of respiratory cancer, proof that habitual marijuana smoking does or does not cause cancer awaits the results of well-designed studies. Conclusion: Numerous studies suggest that marijuana smoke is an important risk factor in the development of respiratory disease. Recommendation 4: Studies to define the individual health risks of smoking marijuana should be conducted, particularly among populations in which marijuana use is prevalent. Marijuana Dependence and Withdrawal A second concern associated with chronic marijuana use is dependence on the psychoactive effects of THC. Although few marijuana users develop dependence, some do. Risk factors for marijuana dependence are similar to those for other forms of substance abuse. In particular, anti-social personality and conduct disorders are closely associated with substance abuse. Conclusion: A distinctive marijuana withdrawal syndrome has been identified, but it is mild and short lived. The syndrome includes restlessness, irritability, mild agitation, insomnia, sleep disturbance, nausea, and cramping. Marijuana as a ""Gateway"" Drug Patterns in progression of drug use from adolescence to adulthood are strikingly regular. Because it is the most widely used illicit drug, marijuana is predictably the first illicit drug most people encounter. Not surprisingly, most users of other illicit drugs have used marijuana first. In fact, most drug users begin with alcohol and nicotine before marijuana--usually before they are of legal age. In the sense that marijuana use typically precedes rather than follows initiation of other illicit drug use, it is indeed a ""gateway"" drug. But because underage smoking and alcohol use typically precede marijuana use, marijuana is not the most common, and is rarely the first, ""gateway"" to illicit drug use. There is no conclusive evidence that the drug effects of marijuana are causally linked to the subsequent abuse of other illicit drugs. An important caution is that data on drug use progression cannot be assumed to apply to the use of drugs for medical purposes. It does not follow from those data that if marijuana were available by prescription for medical use, the pattern of drug use would remain the same as seen in illicit use. Finally, there is a broad social concern that sanctioning the medical use of marijuana might increase its use among the general population. At this point there are no convincing data to support this concern. The existing data are consistent with the idea that this would not be a problem if the medical use of marijuana were as closely regulated as other medications with abuse potential. Conclusion: Present data on drug use progression neither support nor refute the suggestion that medical availability would increase drug abuse. However, this question is beyond the issues normally considered for medical uses of drugs and should not be a factor in evaluating the therapeutic potential of marijuana or cannabinoids. USE OF SMOKED MARIJUANA Because of the health risks associated with smoking, smoked marijuana should generally not be recommended for long-term medical use. Nonetheless, for certain patients, such as the terminally ill or those with debilitating symptoms, the long-term risks are not of great concern. Further, despite the legal, social, and health problems associated with smoking marijuana, it is widely used by certain patient groups. Recommendation 5: Clinical trials of marijuana use for medical purposes should be conducted under the following limited circumstances: trials should involve only short-term marijuana use (less than six months), should be conducted in patients with conditions for which there is reasonable expectation of efficacy, should be approved by institutional review boards, and should collect data about efficacy. The goal of clinical trials of smoked marijuana would not be to develop marijuana as a licensed drug but rather to serve as a first step toward the possible development of nonsmoked rapid-onset cannabinoid delivery systems. However, it will likely be many years before a safe and effective cannabinoid delivery system, such as an inhaler, is available for patients. In the meantime there are patients with debilitating symptoms for whom smoked marijuana might provide relief. The use of smoked marijuana for those patients should weigh both the expected efficacy of marijuana and ethical issues in patient care, including providing information about the known and suspected risks of smoked marijuana use. Recommendation 6: Short-term use of smoked marijuana (less than six months) for patients with debilitating symptoms (such as intractable pain or vomiting) must meet the following conditions: o failure of all approved medications to provide relief has been documented, o the symptoms can reasonably be expected to be relieved by rapid- onset cannabinoid drugs, o such treatment is administered under medical supervision in a manner that allows for assessment of treatment effectiveness, and o involves an oversight strategy comparable to an institutional review board process that could provide guidance within 24 hours of a submission by a physician to provide marijuana to a patient for a specified use. Until a nonsmoked rapid-onset cannabinoid drug delivery system becomes available, we acknowledge that there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting. One possible approach is to treat patients as n-of-1 clinical trials (single-patient trials), in which patients are fully informed of their status as experimental subjects using a harmful drug delivery system and in which their condition is closely monitored and documented under medical supervision, thereby increasing the knowledge base of the risks and benefits of marijuana use under such conditions.data, it is important to understand that decisions about drug regulation are based on a variety of moral and social considerations, as well as on medical and scientific ones. Even when a drug is used only for medical purposes, value judgments affect policy decisions concerning its medical use. For example, the magnitude of a drug's expected medical benefit affects regulatory judgments about the acceptability of risks associated with its use. Also, although a drug is normally approved for medical use only on proof of its ""safety and efficacy,"" patients with life-threatening conditions are sometimes (under protocols for ""compassionate use"") allowed access to unapproved drugs whose benefits and risks are uncertain. Value judgments play an even more substantial role in regulatory decisions concerning drugs, such as marijuana, that are sought and used for nonmedical purposes. Then policymakers must take into account not only the risks and benefits associated with medical use but also possible interactions between the regulatory arrangements governing medical use and the integrity of the legal controls set up to restrict nonmedical use. It should be clear that many elements of drug control policy lie outside the realm of biology and medicine. Ultimately, the complex moral and social judgments that underlie drug control policy must be made by the American people and their elected officials. A goal of this report is to evaluate the biological and medical factors that should be taken into account in making those judgments. HOW THIS STUDY WAS CONDUCTED Information was gathered through scientific workshops, site visits, analysis of the relevant scientific literature, and extensive consultation with biomedical and social scientists. The three 2-day workshops--in Irvine, California; New Orleans, Louisiana; and Washington, D.C.--were open to the public and included scientific presentations and reports, mostly from patients and their families, about their experiences with and perspectives on the medical use of marijuana. Scientific experts in various fields were selected to talk about the latest research on marijuana, cannabinoids, and related topics (listed in Appendix B). Selection of the experts was based on recommendations by their peers, who ranked them among the most accomplished scientists and the most knowledgeable about marijuana and cannabinoids in their own fields. In addition, advocates for (John Morgan) and against (Eric A. Voth) the medical use of marijuana were invited to present scientific evidence in support of their positions. Information presented at the scientific workshops was supplemented by analysis of the scientific literature and evaluating the methods used in various studies and the validity of the authors' conclusions. Different kinds of clinical studies are useful in different ways: results of a controlled double-blind study with adequate sample sizes can be expected to apply to the general population from which study subjects were drawn; an isolated case report can suggest further studies but cannot be presumed to be broadly applicable; and survey data can be highly informative but are generally limited by the need to rely on self-reports of drug use and on unconfirmed medical diagnoses. This report relies mainly on the most relevant and methodologically rigorous studies available and treats the results of more limited studies cautiously. In addition, study results are presented in such a way as to allow thoughtful readers to judge the results themselves. The Institute of Medicine (IOM) appointed a panel of nine experts to advise the study team on technical issues. These included neurology and the treatment of pain (Howard Fields); regulation of prescription drugs (J. Richard Crout); AIDS wasting and clinical trials (Judith Feinberg); treatment and pathology of multiple sclerosis (Timothy Vollmer); drug dependence among adolescents (Thomas Crowley); varieties of drug dependence (Dorothy Hatsukami); internal medicine, health care delivery, and clinical epidemiology (Eric B. Larson); cannabinoids and marijuana pharmacology (Billy R. Martin); and cannabinoid neuroscience (Steven R. Childers). Public outreach included setting up a Web site that provided information about the study and asked for input from the public. The Web site was open for comment from November 1997 until November 1998. Some 130 organizations were invited to participate in the public workshops. Many people in the organizations--particularly those opposed to the medical use of marijuana--felt that a public forum was not conducive to expressing their views; they were invited to communicate their opinions (and reasons for holding them) by mail or telephone. As a result, roughly equal numbers of persons and organizations opposed to and in favor of the medical use of marijuana were heard from. The study team visited four cannabis buyers' clubs in California (the Oakland Cannabis Buyers' Cooperative, the San Francisco Cannabis Cultivators Club, the Los Angeles Cannabis Resource Center, and Californians Helping Alleviate Medical Problems, or CHAMPS) and two HIV/AIDS clinics (AIDS Health Care Foundation in Los Angeles and Louisiana State University Medical Center in New Orleans). We listened to many individual stories from the buyers' clubs about using marijuana to treat a variety of symptoms and heard clinical observations on the use of Marinol to treat AIDS 9 patients. Marinol is the brand name for dronabinol, which is (THC) in pill form and is available by prescription for the treatment of nausea associated with chemotherapy and AIDS wasting. MARIJUANA TODAY The Changing Legal Landscape In the 20th century, marijuana has been used more for its euphoric effects than as a medicine. Its psychological and behavioral effects have concerned public officials since the drug first appeared in the southwestern and southern states during the first two decades of the century. By 1931, at least 29 states had prohibited use of the drug for 3 nonmedicalpurposes. MarijuanawasfirstregulatedatthefederallevelbytheMarijuana Tax Act of 1937, which required anyone producing, distributing, or using marijuana for medical purposes to register and pay a tax and which effectively prohibited nonmedical use of the drug. Although the act did not make medical use of marijuana illegal, it did make it expensive and inconvenient. In 1942, marijuana was removed from the U.S. -tetrahydrocannabinol Pharmacopoeia because it was believed to be a harmful and addictive drug that caused psychoses, mental deterioration, and violent behavior. In the late 1960s and early 1970s, there was a sharp increase in marijuana use among adolescents and young adults. The current legal status of marijuana was established in 1970 with the passage of the Controlled Substances Act, which divided drugs into five schedules and placed marijuana in Schedule I, the category for drugs with high potential for abuse and no accepted medical use (see Appendix C, Scheduling Definitions). In 1972, the National Organization for the Reform of Marijuana Legislation (NORML), an organization that supports decriminalization of marijuana, unsuccessfully petitioned the Bureau of Narcotics and Dangerous Drugs to move marijuana from Schedule I to Schedule II. NORML argued that marijuana is therapeutic in numerous serious ailments, 13 less toxic, and in many cases more effective than conventional medicines. years the medical marijuana movement has been closely linked with the marijuana decriminalization movement, which has colored the debate. Many people criticized that association in their letters to IOM and during the public workshops of this study. The argument against the medical use of marijuana presented most often to the IOM study team was that ""the medical marijuana movement is a Trojan horse""; that is, it is a deceptive tactic used by advocates of marijuana decriminalization who would exploit the public's sympathy for seriously ill patients. Since NORML's petition in 1972, there have been a variety of legal decisions concerning marijuana. From 1973 to 1978, 11 states adopted statutes that decriminalized use of marijuana, although some of them recriminalized marijuana use in the 1980s and 1990s. During the 1970s, reports of the medical value of marijuana began to appear, particularly claims that marijuana relieved the nausea associated with chemotherapy. Health departments in six states conducted small studies to investigate the reports. When the AIDS epidemic spread in the 1980s, patients found that marijuana sometimes relieved their symptoms, most dramatically those associated with AIDS wasting. Over this period a number of defendants charged with unlawful possession of marijuana claimed that they were using the drug to treat medical conditions and that violation of the law was therefore justified (the so-called medical necessity defense). Although most courts rejected these 8 Against that backdrop, voters in California and Arizona in 1996 passed two referenda that attempted to legalize the medical use of marijuana under particular conditions. Public support for patient access to marijuana for medical use appears substantial; public opinion polls taken during 1997 and 1998 generally reported 60—70 percent of 15 However, those referenda are at odds with federal laws regulating marijuana, and their implementation raises complex legal questions. Despite the current level of interest, referenda and public discussions have not been well informed by carefully reasoned scientific debate. Although previous reports have all called for more research, the nature of the research that will be most helpful depends greatly on the specific health conditions to be addressed. And while there have been claims, some accepted them. respondents in favor of allowing medical uses of marijuana. Thus, for 25 important recent advances in our understanding of the physiological effects of marijuana, few of the recent investigators have had the time or resources to permit detailed analysis. The results of those advances, only now beginning to be explored, have significant implications for the medical marijuana debate. Several months after the passage of the California and Arizona medical marijuana referendums, the Office of National Drug Control Policy (ONDCP) asked whether IOM would conduct a scientific review of the medical value of marijuana and its constituent compounds. In August 1997, IOM formally began the study and appointed John A. Benson Jr. and Stanley J. Watson Jr. to serve as principal investigators for the study. The charge to IOM was to review the medical use of marijuana and the harms and benefits attributed to it (details are given in Appendix D). Marijuana plants have been used since antiquity for both herbal medication and intoxication. The current debate over the medical use of marijuana is essentially a debate over the value of its medicinal properties relative to the risk posed by its use. 1,10,11 Marijuana's use as an herbal remedy before the 20th century is well documented. However, modern medicine adheres to different standards from those used in the past. The question is not whether marijuana can be used as an herbal remedy but rather how well this remedy meets today's standards of efficacy and safety. We understand much more than previous generations about medical risks. Our society generally expects its licensed medications to be safe, reliable, and of proven efficacy; contaminants and inconsistent ingredients in our health treatments are not tolerated. That refers not only to prescription and over-the-counter drugs but also to vitamin supplements and herbal remedies purchased at the grocery store. For example, the essential amino acid l- tryptophan was widely sold in health food stores as a natural remedy for insomnia until early 1990 when it became linked to an epidemic of a new and potentially fatal illness 9,12 When it was removed from the market shortly thereafter, there was little protest, despite the fact that it was safe for the vast majority of the population. The 1,536 cases and 27 deaths were later traced to contaminants in a batch produced by a single Japanese manufacturer. Although few herbal medicines meet today's standards, they have provided the foundation for modern Western pharmaceuticals. Most current prescriptions have their 7 rootseitherdirectlyorindirectlyinplantremedies. Atthesametime,mostcurrent prescriptions are synthetic compounds that are only distantly related to the natural compounds that led to their development. Digitalis was discovered in foxglove, morphine in poppies, and taxol in the yew tree. Even aspirin (acetylsalicylic acid) has its counterpart in herbal medicine: for many generations, American Indians relieved headaches by chewing the bark of the willow tree, which is rich in a related form of salicylic acid. Although plants continue to be valuable resources for medical advances, drug development is likely to be less and less reliant on plants and more reliant on the tools of (eosinophilia-myalgia syndrome). modern science. Molecular biology, bioinformatics software, and DNA array-based analyses of genes and chemistry are all beginning to yield great advances in drug discovery and development. Until recently, drugs could only be discovered; now they can be designed. Even the discovery process has been accelerated through the use of modern drug-screening techniques. It is increasingly possible to identify or isolate the chemical compounds in a plant, determine which compounds are responsible for the plant's effects, and select the most effective and safe compounds--either for use as purified substances or as tools to develop even more effective, safer, or less expensive compounds. Yet even as the modern pharmacological toolbox becomes more sophisticated and biotechnology yields an ever greater abundance of therapeutic drugs, people increasingly 4,5 In 1997, 46 percent of Americans sought nontraditional medicines and spent over 27 billion unreimbursed dollars; the total number of visits to alternative medicine practitioners appears to have exceeded the number of 5,6 Recent interest in the medical use of marijuana coincides with this trend toward self-help and a search for ""natural"" therapies. Indeed, several people who spoke at the IOM public hearings in support of the medical use of marijuana said that they generally preferred herbal medicines to standard pharmaceuticals. However, few alternative therapies have been carefully and systematically tested for safety and efficacy, as is required for medications approved by 2 WHO USES MEDICAL MARIJUANA? There have been no comprehensive surveys of the demographics and medical conditions of medical marijuana users, but a few reports provide some indication. In each case, survey results should be understood to reflect the situation in which they were conducted and are not necessarily characteristic of medical marijuana users as a whole. Respondents to surveys reported to the IOM study team were all members of ""buyers' clubs,"" organizations that provide their members with marijuana, although not necessarily through direct cash transactions. The atmosphere of the marijuana buyers' clubs ranges from that of the comparatively formal and closely regulated Oakland Cannabis Buyers' Cooperative to that of a ""country club for the indigent,"" as Denis Peron described the San Francisco Cannabis Cultivators Club (SFCCC), which he directed. John Mendelson, an internist and pharmacologist at the University of California, San Francisco (UCSF) Pain Management Center, surveyed 100 members of the SFCCC who were using marijuana at least weekly. Most of the respondents were unemployed men in their forties. Subjects were paid $50 to participate in the survey; this might have encouraged a greater representation of unemployed subjects. All subjects were tested for drug use. About half tested positive for marijuana only; the other half tested positive for drugs in addition to marijuana (23% for cocaine and 13% for amphetamines). The predominant disorder was AIDS, followed by roughly equal numbers of members who reported chronic pain, mood disorders, and musculoskeletal disorders (Table 1.1). seek alternative, low-technology therapies. visits to primary care physicians. the FDA (Food and Drug Administration). The membership profile of the San Francisco club was similar to that of the Los Angeles Cannabis Resource Center (LACRC), where 83% of the 739 patients were men, 45% were 36—45 years old, and 71% were HIV positive. Table 1.2 shows a distribution of conditions somewhat different from that in SFCCC respondents, probably because of a different membership profile. For example, cancer is generally a disease that occurs late in life; 34 (4.7%) of LACRC members were over 55 years old; only 2% of survey respondents in the SFCCC study were over 55 years old. Jeffrey Jones, executive director of the Oakland Cannabis Buyers' Cooperative, reported that its largest group of patients is HIV-positive men in their forties. The second- largest group is patients with chronic pain. Among the 42 people who spoke at the public workshops or wrote to the study team, only six identified themselves as members of marijuana buyers' clubs. Nonetheless, they presented a similar profile: HIV/AIDS was the predominant disorder, followed by chronic pain (Tables 1.3 and 1.4). All HIV/AIDS patients reported that marijuana relieved nausea and vomiting and improved their appetite. About half the patients who reported using marijuana for chronic pain also reported that it reduced nausea and vomiting. Note that the medical conditions referred to are only those reported to the study team or to interviewers; they cannot be assumed to represent complete or accurate diagnoses. Michael Rowbotham, a neurologist at the UCSF Pain Management Center, noted that many pain patients referred to that center arrive with incorrect diagnoses or with pain of unknown origin. At that center the patients who report medical benefit from marijuana say that it does not reduce their pain but enables them to cope with it. Most--not all--people who use marijuana to relieve medical conditions have previously used it recreationally. An estimated 95% of the LACRC members had used marijuana before joining the club. It is important to emphasize the absence of comprehensive information on marijuana use before its use for medical conditions. Frequency of prior use almost certainly depends on many factors, including membership in a buyers' club, membership in a population sector that uses marijuana more often than others (for example, men 20—30 years old), and the medical condition being treated with marijuana (for example, there are probably relatively fewer recreational marijuana users among cancer patients than among AIDS patients). Patients who reported their experience with marijuana at the public workshops said that marijuana provided them with great relief from symptoms associated with disparate diseases and ailments, including AIDS wasting, spasticity from multiple sclerosis, depression, chronic pain, and nausea associated with chemotherapy. Their circumstances and symptoms were varied, and the IOM study team was not in a position to make medical evaluations or confirm diagnoses. Three representative cases presented to the IOM study team are presented in Box 1.1; the stories have been edited for brevity, but each case is presented in the patient's words and with the patient's permission. The variety of stories presented left the study team with a clear view of people's beliefs about how marijuana had helped them. But this collection of anecdotal data, although useful, is limited. We heard many positive stories but no stories from people who had tried marijuana but found it ineffective. This is a fraction with an unknown denominator. For the numerator we have a sample of positive responses; for the denominator we have no idea of the total number of people who have tried marijuana for medical purposes. Hence, it is impossible to estimate the clinical value of marijuana or cannabinoids in the general population based on anecdotal reports. Marijuana clearly seems to relieve some symptoms for some people--even if only as a placebo effect. But what is the balance of harmful and beneficial effects? That is the essential medical question that can be answered only by careful analysis of data collected under controlled conditions. CANNABIS AND THE CANNABINOIDS Marijuana is the common name for Cannabis sativa, a hemp plant that grows throughout temperate and tropical climates. The most recent review of the constituents of 16 marijuana lists 66 cannabinoids (Table 1.5). different cannabinoid effects or interactions. Most of the cannabinoids are closely related; they fall into only 10 groups of closely related cannabinoids, many of which differ by only a single chemical moiety and might be midpoints along biochemical pathways--that -tetrahydrocannabinol ( THC) is the primary psychoactive ingredient; depending on the particular plant, either THC or cannabidiol is the most abundant cannabinoid in marijuana (Figure 1.1). 9 is, degradation products, precursors, or byproducts. - But that does not mean there are 66 16,18 9 9 Throughout this report, THC is used to indicate of THC are discussed, the full names are used. All the cannabinoids are lipophilic--they are highly soluble in fatty fluids and tissues but not in water. Indeed, THC is so lipophilic that it is aptly described as ""greasy."" Throughout this report, marijuana refers to unpurified plant extracts, including leaves and flower tops, regardless of how they are consumed--whether by ingestion or by smoking. References to the effects of marijuana should be understood to include the composite effects of its various components; that is, the effects of THC are included among the effects of marijuana, but not all the effects of marijuana are necessarily due to THC. Discussions concerning cannabinoids refer only to those particular compounds and not to the plant extract. This distinction is important; it is often blurred or exaggerated. Cannabinoids are produced in epidermal glands on the leaves (especially the upper ones), stems, and the bracts that support the flowers of the marijuana plant. Although the flower itself has no epidermal glands, it has the highest cannabinoid content anywhere on the plant, probably because of the accumulation of resin secreted by the supporting bracteole (the small leaf-like part below the flower). The amounts of cannabinoids and their relative abundance in a marijuana plant vary with growing conditions, including 14 ). The chemical stability of cannabinoids in harvested plant material is also affected by moisture, temperature, sunlight, and storage. They degrade under any storage condition. humidity, temperature, and soil nutrients (reviewed in Pate, 1994 -THC. In the few cases where variants ORGANIZATION OF THE REPORT Throughout the report, steps that might be taken to fill the gaps in understanding both the potential harms and benefits of marijuana and cannabinoid use are identified. Those steps include identifying knowledge gaps, promising research directions, and potential therapies based on scientific advances in cannabinoid biology. Chapter 2 reviews basic cannabinoid biology and provides a foundation to understand the medical value of marijuana or its constituent cannabinoids. In consideration of the physician's first rule, ""first, do no harm,"" the potential harms attributed to the medical use of marijuana are reviewed before the potential medical benefits. Chapter 3 reviews the risks posed by marijuana use, with emphasis on medical use. Chapter 4 analyzes the most credible clinical data relevant to the medical use of marijuana. It reviews what is known about the physiological mechanisms underlying particular conditions (for example, chronic pain, vomiting, anorexia, and muscle spasticity), what is known about the cellular actions of cannabinoids, and the levels of proof needed to show that marijuana is an effective treatment for specific symptoms. It does not analyze the historical literature; history is informative in enumerating uses of marijuana, but it does not provide the sort of information needed for a scientifically sound evaluation of the efficacy and safety of marijuana for clinical use. Because marijuana is advocated primarily as affording relief from the symptoms of disease rather than as a cure, this chapter is organized largely by symptoms as opposed to disease categories. Finally, chapter 4 compares the conclusions of this report with those of other recent reports on the medical use of marijuana. Chapter 5 describes the process of and analyzes the prospects for cannabinoid drug development. Primum non nocere. This is the physician's first rule: whatever treatment a physician prescribes to a patient--first, that treatment must not harm the patient. The most contentious aspect of the medical marijuana debate is not whether marijuana can alleviate particular symptoms but rather the degree of harm associated with its use. This chapter explores the negative health consequences of marijuana use, first with respect to drug abuse, then from a psychological perspective, and finally from a physiological perspective. THE MARIJUANA ""HIGH"" The most commonly reported effects of smoked marijuana are a sense of well-being or euphoria and increased talkativeness and laughter alternating with periods of introspective dreaminess followed by lethargy and sleepiness (see reviews by Adams and 1 59 60 Martin, 1996, Hall and Solowij, and Hall et al. ). A characteristic feature of a marijuana ""high"" is a distortion in the sense of time associated with deficits in short-term memory and learning. A marijuana smoker typically has a sense of enhanced physical and emotional sensitivity, including a feeling of greater interpersonal closeness. The most obvious behavioral abnormality displayed by someone under the influence of marijuana is difficulty in carrying on an intelligible conversation, perhaps because of an inability to remember what was just said even a few words earlier. The high associated with marijuana is not generally claimed to be integral to its therapeutic value. But mood enhancement, anxiety reduction, and mild sedation can be desirable qualities in medications--particularly for patients suffering pain and anxiety. Thus, although the psychological effects of marijuana are merely side effects in the treatment of some symptoms, they might contribute directly to relief of other symptoms. They also must be monitored in controlled clinical trials to discern which effect of cannabinoids is beneficial. These possibilities are discussed later under the discussions of specific symptoms in chapter 4. The effects of various doses and routes of delivery of THC are shown in Table 3.1. Adverse Mood Reactions Although euphoria is the more common reaction to smoking marijuana, adverse mood reactions can occur. Such reactions occur most frequently in inexperienced users after large doses of smoked or oral marijuana. They usually disappear within hours and respond well to reassurance and a supportive environment. Anxiety and paranoia are the 59 most common acute adverse reactions; others include panic, depression, dysphoria, 1,40,66,69 depersonalization, delusions, illusions, and hallucinations. Of regular marijuana smokers, 17% report that they have experienced at least one of the symptoms, usually 145 early in their use of marijuana. of medical marijuana in people who have not previously used marijuana. DRUG DYNAMICS There are many misunderstandings about drug abuse and dependence (see reviews by 114 54 Those observations are particularly relevant for the use O'Brien themostrecentDiagnosticandStatisticalManualofMentalDisorders(DSM-IV), the most influential system in the United States for diagnoses of mental disorders, including substance abuse (see Box 3.1). Tolerance, dependence, and withdrawal are often presumed to imply abuse or addiction, but this is not the case. Tolerance and dependence are normal physiological adaptations to repeated use of any drug. The correct use of prescribed medications for pain, anxiety, and even hypertension commonly produces tolerance and some measure of physiological dependence. Even a patient who takes a medicine for appropriate medical indications and at the correct dosage can develop tolerance, physical dependence, and withdrawal symptoms if the drug is stopped abruptly rather than gradually. For example, a hypertensive patient receiving a beta-adrenergic receptor blocker, such as propranolol, might have a good therapeutic response; but if the drug is stopped abruptly, there can be a withdrawal syndrome that consists of tachycardia and a rebound increase in blood pressure to a point that is temporarily higher than before administration of the medication began. Because it is an illegal substance, some people consider any use of marijuana as substance abuse. However, this report uses the medical definition; that is, substance abuse is a maladaptive pattern of repeated substance use manifested by recurrent and 3 significantadverseconsequences. Substanceabuseanddependencearebothdiagnoses of pathological substance use. Dependence is the more serious diagnosis and implies compulsive drug use that is difficult to stop despite significant substance-related problems (see Box 3.2). Reinforcement Drugs vary in their ability to produce good feelings in users, and the more strongly reinforcing a drug is, the more likely it will be abused (G. Koob, Institute of Medicine (IOM) workshop). Marijuana is indisputably reinforcing for many people. The reinforcing properties of even so mild a stimulant as caffeine are typical of reinforcement 54 in 1994). Caffeine is reinforcing for many people at low doses (100—200 mg, the average amount of caffeine in one to two cups of and Goldstein ). The terms and concepts used in this report are as defined in 3 by addicting drugs (reviewed by Goldstein coffee) and is aversive at high doses (600 mg, the average amount of caffeine in six cups of coffee). The reinforcing effects of many drugs are different for different people. For example, caffeine was most reinforcing for test subjects who scored lowest on tests of anxiety but tended not to be reinforcing for the most anxious subjects. As an argument to dispute the abuse potential of marijuana, some have cited the observation that animals do not willingly self-administer THC, as they will cocaine. Even if that were true, it would not be relevant to human use of marijuana. The value in animal models of drug self-administration is not that they are necessary to show that a drug is reinforcing but rather that they provide a model in which the effects of a drug can be studied. Furthermore, THC is indeed rewarding to animals at some doses but, like many 93 reinforcing drugs, is aversive at high doses (4.0 mg/kg). in experiments conducted in animals outfitted with intravenous catheters that allow them 100 A specific set of neural pathways has been proposed to be a ""reward system"" that 51 to self-administer WIN 55,212, a drug that mimics the effects of THC. underlies the reinforcement of drugs of abuse and other pleasurable stimuli. properties of drugs are associated with their ability to increase concentrations of particular neurotransmitters in areas that are part of the proposed brain reward system. The median forebrain bundle and the nucleus accumbens are associated with brain reward 88 144 Cocaine, amphetamine, alcohol, opioids, nicotine, and THC extracellular fluid dopamine in the nucleus accumbens region (reviewed by Koob and Le pathways. all increase 88 110 Moal brain reward systems are not strictly ""drug reinforcement centers."" Rather, their biological role is to respond to a range of positive stimuli, including sweet foods and sexual attraction. Tolerance The rate at which tolerance to the various effects of any drug develops is an important consideration for its safety and efficacy. For medical use, tolerance to some effects of cannabinoids might be desirable. Differences in the rates at which tolerance to the multiple effects of a drug develops can be dangerous. For example, tolerance to the euphoric effects of heroin develops faster than tolerance to its respiratory depressant effects, so heroin users tend to increase their daily doses to reach their desired level of euphoria, thereby putting themselves at risk for respiratory arrest. Because tolerance to the various effects of cannabinoids might develop at different rates, it is important to evaluate independently their effects on mood, motor performance, memory, and attention, as well as any therapeutic use under investigation. Tolerance to most of the effects of marijuana can develop rapidly after only a few doses, and it also disappears rapidly. Tolerance to large doses has been found to persist in experimental animals for long periods after cessation of drug use. Performance impairment is less among people who use marijuana heavily than it is among those who 29,104,124 and Nestler and Aghajanian in 1997). However, it is important to note that possibly because of tolerance. Heavy users tend to reach higher plasma concentrations of THC than light users after similar doses of use marijuana only occasionally, Similar effects have been found Reinforcing THC, arguing against the possibility that heavy users show less performance impairment because they somehow absorb less THC (perhaps due to differences in smoking 95 There appear to be variations in the development of tolerance to the different effects of marijuana and oral THC. For example, daily marijuana smokers participated in a residential laboratory study to compare the development of tolerance to THC pills and to 61,62 behavior). smoked marijuana. day for four consecutive days; another group was given THC pills on the same schedule. During the four-day period, both groups became tolerant to feeling ""high"" and what they reported as a ""good drug effect."" In contrast, neither group became tolerant to the stimulatory effects of marijuana or THC on appetite. ""Tolerance"" does not mean that the drug no longer produced the effects but simply that the effects were less at the end than at the beginning of the four-day period. The marijuana smoking group reported feeling ""mellow"" after smoking and did not show tolerance to this effect; the group that took THC pills did not report feeling ""mellow."" The difference was also reported by many people who described their experiences to the IOM study team. The oral and smoked doses were designed to deliver roughly equivalent amounts of THC to a subject. Each smoked marijuana dose consisted of five 10-second puffs of a marijuana cigarette containing 3.1% THC; the pills contained 30 mg of THC. Both groups also received placebo drugs during other four-day periods. Although the dosing of the two groups was comparable, different routes of administration resulted in different patterns of drug effect. The peak effect of smoked marijuana is usually felt within 68,95 One group was given marijuana cigarettes to smoke four times per minutes and declines sharply after 30 minutes not felt until about an hour and lasts for several hours. Withdrawal A distinctive marijuana and THC withdrawal syndrome has been identified, but it is mild and subtle compared with the profound physical syndrome of alcohol or heroin withdrawal. The symptoms of marijuana withdrawal include restlessness, irritability, 31,74 mild agitation, insomnia, sleep EEG disturbance, nausea, and cramping (Table 3.2). In addition to those symptoms, two recent studies noted several more. A group of adolescents under treatment for conduct disorders also reported fatigue and illusions or hallucinations after marijuana abstinence (this study is discussed further in the section on 31 In a residential study of daily marijuana users, withdrawal symptoms included sweating and 62 A marijuana withdrawal syndrome, however, has been reported only in a group of adolescents in treatment for substance 31 ; the peak effect of oral THC is usually 118 ""Prevalence and Predictors of Dependence on Marijuana and Other Drugs""). runny nose, in addition to those listed above. abuse problems 62,74 daily. and in a research setting where subjects were given marijuana or THC Withdrawal symptoms have been observed in carefully controlled laboratory studies 61,62 of people after use of both oral THC and smoked marijuana. were given very high doses of oral THC: 180—210 mg per day for 10—20 days, roughly In one study, subjects equivalent to smoking 9—10 2% THC cigarettes per day. During the abstinence period at the end of the study, the study subjects were irritable and showed insomnia, runny nose, sweating, and decreased appetite. The withdrawal symptoms, however, were short lived. In four days they had abated. The time course contrasts with that in another study in which lower doses of oral THC were used (80—120 mg/day for four days) and 61,62 withdrawal symptoms were still near maximal after four days. In animals, simply discontinuing chronic heavy dosing of THC does not reveal withdrawal symptoms, but the ""removal"" of THC from the brain can be made abrupt by another drug that blocks THC at its receptor if administered when the chronic THC is withdrawn. The withdrawal syndrome is pronounced, and the behavior of the animals 153 becomes hyperactive and disorganized. 16,24 The half-life of THC in brain is about an Although traces of THC can remain in the brain for much longer periods, the hour. amounts are not physiologically significant. Thus, the lack of a withdrawal syndrome when THC is abruptly withdrawn without administration of a receptor-blocking drug is probably not due to a prolonged decline in brain concentrations. Craving Craving, the intense desire for a drug, is the most difficult aspect of addiction to overcome. Research on craving has focused on nicotine, alcohol, cocaine, and opiates but 115 has not specifically addressed marijuana. is known about drug craving, its relevance to marijuana use has not been established. Most people who suffer from addiction relapse within a year of abstinence, and they 58 As addiction develops, craving increases even as maladaptive consequences accumulate. Animal studies indicate that the tendency to relapse is based on changes in brain function that continue for months or years after the 115 last use of the drug. manifestation of an abstinence syndrome remains an unanswered question in drug abuse 88 The ""liking"" of sweet foods, for example, is mediated by opioid forebrain systems and by brain stem systems, whereas ""wanting"" seems to be mediated by 109 Anticraving medications have been developed for nicotine and alcohol. The antidepressant, bupropion, blocks nicotine craving, while naltrexone blocks alcohol 115 often attribute their relapse to craving. research. ascending dopamine neurons that project to the nucleus accumbens. Another category of addiction medication includes drugs that block other drugs' effects. Some of those drugs also block craving. For example, methadone blocks the euphoric effects of heroin and also reduces craving. MARIJUANA USE AND DEPENDENCE Prevalence of Use Millions of Americans have tried marijuana, but most are not regular users. In 1996, 68.6 million people--32% of the U.S. population over 12 years old--had tried marijuana craving. 74 Thus, while this section briefly reviews what Whether neurobiological conditions change during the 132 or hashish at least once in their lifetime, but only 5% were current users. is most prevalent among 18- to 25-year-olds and declines sharply after the age of 34 77,132 (Figure 3.1). although the difference decreases by adulthood. Whites are more likely than blacks to use marijuana in adolescence, 132 Marijuana use Most people who have used marijuana did so first during adolescence. Social influences, such as peer pressure and prevalence of use by peers, are highly predictive of 9 initiationintomarijuanause. Initiationisnot,ofcourse,synonymouswithcontinuedor regular use. A cohort of 456 students who experimented with marijuana during their high school years were surveyed about their reasons for initiating, continuing, and stopping 9 theirmarijuanause. Studentswhobeganasheavyuserswereexcludedfromthe analysis. Those who did not become regular marijuana users cited two types of reasons for discontinuing. The first was related to health and well-being; that is, they felt that marijuana was bad for their health or for their family and work relationships. The second type was based on age-related changes in circumstances, including increased responsibility and decreased regular contact with other marijuana users. Among high school students who quit, parental disapproval was a stronger influence than peer disapproval in discontinuing marijuana use. In the initiation of marijuana use, the reverse was true. The reasons cited by those who continued to use marijuana were to ""get in a better mood or feel better."" Social factors were not a significant predictor of continued use. Data on young adults show similar trends. Those who use drugs in response to social influences are more likely to stop using them than those who also use them for 80 The age distribution of marijuana users among the general population contrasts with that of medical marijuana users. Marijuana use generally declines sharply after the age of 34 years, whereas medical marijuana users tend to be over 35. That raises the question of what, if any, relationship exists between abuse and medical use of marijuana; however, no studies reported in the scientific literature have addressed this question. Prevalence and Predictors of Dependence on Marijuana and Other Drugs Many factors influence the likelihood that a particular person will become a drug abuser or an addict; the user, the environment, and the drug are all important factors 114 (Table 3.3). people who are vulnerable to drug abuse for individual reasons and who find themselves in an environment that encourages drug abuse are initially likely to abuse the most readily available drug--regardless of its unique set of effects on the brain. The third category includes drug-specific effects that influence the abuse liability of a particular drug. As discussed earlier in this chapter, the more strongly reinforcing a drug is, the more likely that it will be abused. The abuse liability of a drug is enhanced by how quickly its effects are felt, and this is determined by how the drug is delivered. In general, the effects of drugs that are inhaled or injected are felt within minutes, and the effects of drugs that are ingested take a half hour or more. psychological reasons. The first two categories apply to potential abuse of any substance; that is, The proportion of people who become addicted varies among drugs. Table 3.4 shows estimates for the proportion of people among the general population who used or became dependent on different types of drugs. The proportion of users that ever became dependent includes anyone who was ever dependent--whether it was for a period of weeks or years--and thus includes more than those who are currently dependent. Compared to most other drugs listed in this table, dependence among marijuana users is relatively rare. This might be due to differences in specific drug effects, the availability of or penalties associated with the use of the different drugs, or some combination. Daily use of most illicit drugs is extremely rare in the general population. In 1989, daily use of marijuana among high school seniors was less than that of alcohol (2.9% and 76 Drug dependence is more prevalent in some sectors of the population than in others. 8 Age,gender,andraceorethnicgroupareallimportant. Excludingtobaccoandalcohol, 8 thefollowingtrendsofdrugdependencearestatisticallysignificant: Menare1.6times as likely than women to become drug dependent, non-Hispanic whites are about twice as likely as blacks to become drug dependent (the difference between non-Hispanic and Hispanic whites was not significant), and people 25—44 years old are more than three times as likely as those over 45 years old to become drug dependent. More often than not, drug dependence co-occurs with other psychiatric disorders. Most people with a diagnosis of drug dependence disorder also have a diagnosis of a 76 The most frequent co- occurring disorder is alcohol abuse; 60% of men and 30% of women with a diagnosis of drug dependence also abuse alcohol. In women who are drug dependent, phobic disorders and major depression are almost equally common (29% and 28%, respectively). Note that this study distinguished only between alcohol, nicotine and ""other drugs""; marijuana was grouped among ""other drugs."" The frequency with which drug dependence and other psychiatric disorders co-occur might not be the same for marijuana and other drugs that were included in that category. A strong association between drug dependence and antisocial personality or its precursor, conduct disorder, is also widely reported in children and adults (reviewed in 126 ). Although the causes of the association are uncertain, Robins recently concluded that it is more likely that conduct disorders generally lead to substance abuse 126 Such a trend might, however, depend on the age at which the conduct disorder is manifested. A longitudinal study by Brooks and co-workers noted a significant relationship between adolescent drug use and disruptive disorders in young adulthood; except for earlier psychopathology, such as childhood conduct disorder, the drug use preceded the 18 In contrast with use of other illicit drugs and tobacco, moderate (less than once a week and more than once a month) to heavy marijuana use did not predict anxiety or depressive disorders; but it was similar to those other drugs in predicting antisocial personality disorder. The rates of disruptive disorders increased with 4.2%, respectively). another psychiatric disorder (76% of men and 65% of women). 1998 by Robins than the reverse. psychiatric disorders. increased drug use. Thus, heavy drug use among adolescents can be a warning sign for later psychiatric disorders; whether it is an early manifestation of or a cause of those disorders remains to be determined. Psychiatric disorders are more prevalent among adolescents who use drugs--including 79 alcohol and nicotine--than among those who do not. Table 3.5 indicates that adolescent boys who smoke cigarettes daily are about 10 times as likely to have a psychiatric disorder diagnosis as those who do not smoke. However, the table does not compare intensity of use among the different drug classes. Thus, although daily cigarette smoking among adolescent boys is more strongly associated with psychiatric disorders than is any use of illicit substances, it does not follow that this comparison is true for every amount 79 Few marijuana users become dependent on it (Table 3.4), but those who do encounter 19,143 of cigarette smoking. problems similar to those associated with dependence on other drugs. appears to be less severe among people who use only marijuana than among those who 19,143 abuse cocaine or those who abuse marijuana with other drugs (including alcohol). Data gathered in 1990—1992 from the National Comorbidity Study of over 8,000 persons 15—54 years old indicate that 4.2% of the general population were dependent on 8 marijuanaatsometime. Similarresultsforthefrequencyofsubstanceabuseamongthe general population were obtained from the Epidemiological Catchment Area Program, a survey of over 19,000 people. According to data collected in the early 1980s for that study, 4.4% of adults have, at one time, met the criteria for marijuana dependence. In comparison, 13.8% of adults met the criteria for alcohol dependence and 36.0% for tobacco dependence. After alcohol and nicotine, marijuana was the substance most frequently associated with a diagnosis of substance dependence. In a 15-year study begun in 1979, 7.3% of 1,201 adolescents and young adults in suburban New Jersey at some time met the criteria for marijuana dependence; this indicates that the rate of marijuana dependence might be even higher in some groups of 71 Adolescents meet the criteria for drug dependence at lower rates of marijuana use than do adults, and this 25 adolescents and young adults than in the general population. suggests that they are more vulnerable to dependence than adults (see Box 3.2). Dependence Youths who are already dependent on other substances are particularly vulnerable to 31 marijuana dependence. For example, Crowley and co-workers 229 adolescent patients in a residential treatment program for delinquent, substance- involved youth and found that those patients were dependent on an average of 3.2 substances. The adolescents had previously been diagnosed as dependent on at least one substance (including nicotine and alcohol) and had three or more conduct disorder symptoms during their life. About 83% of those who had used marijuana at least six times went on to develop marijuana dependence. About equal numbers of youths in the study had a diagnosis of marijuana dependence and a diagnosis of alcohol dependence; fewer were nicotine dependent. Comparisons of dependence potential between different drugs should be made cautiously. The probability that a particular drug will be abused is interviewed a group of influenced by many factors, including the specific drug effects and availability of the drug. Although parents often state that marijuana caused their children to be rebellious, the troubled adolescents in the study by Crowley and co-workers developed conduct disorders before marijuana abuse. That is consistent with reports that the more symptoms 127 of conduct disorders children have, the younger they begin drug abuse, earlier they begin drug use, the more likely it is to be followed by abuse or 125 Genetic factors are known to play a role in the likelihood of abuse for drugs other than 7,129 dependence. marijuana, and it is not unexpected that genetic factors play a role in the marijuana experience, including the likelihood of abuse. A study of over 8,000 male twins listed in the Vietnam Era Twin Registry indicated that genes have a statistically significant 97 influence on whether a person finds the effects of marijuana pleasant. Not surprisingly, people who found marijuana to be pleasurable used it more often than those who found it unpleasant. The study suggested that, although social influences play an important role in the initiation of use, individual differences--perhaps associated with the brain's reward system--influence whether a person will continue using marijuana. Similar results were 86 Family and social environment strongly influenced the likelihood of ever using marijuana but had little effect on the likelihood of heavy use or abuse. The latter were more influenced by genetic factors. Those results are consistent with the finding that the degree to which rats find THC rewarding is genetically based. In summary, although few marijuana users develop dependence, some do. But they appear to be less likely to do so than users of other drugs (including alcohol and nicotine), and marijuana dependence appears to be less severe than dependence on other drugs. Drug dependence is more prevalent in some sectors of the population than others, but no group has been identified as particularly vulnerable to the drug-specific effects of marijuana. Adolescents, especially troubled ones, and people with psychiatric disorders (including substance abuse) appear to be more likely than the general population to become dependent on marijuana. If marijuana or cannabinoid drugs were approved for therapeutic uses, it would be important to consider the possibility of dependence, particularly for patients at high risk for substance dependence. Some controlled substances that are approved medications produce dependence after long-term use; this, however, is a normal part of patient management and does not generally present undue risk to the patient. Progression from Marijuana to Other Drugs The fear that marijuana use might cause, as opposed to merely precede, the use of drugs that are more harmful is of great concern. To judge from comments submitted to the IOM study team, it appears to be of greater concern than the harms directly related to marijuana itself. The discussion that marijuana is a ""gateway"" drug implicitly recognizes that other illicit drugs might inflict greater damage to health or social relations than found in a study of female twins. and that the 92 marijuana. Although the scientific literature generally discusses drug use progression between a variety of drug classes, including alcohol and tobacco, the public discussion has focused on marijuana as a ""gateway"" drug that leads to abuse of more harmful illicit drugs, such as cocaine and heroin. There are strikingly regular patterns in the progression of drug use from adolescence to adulthood. Because it is the most widely used illicit drug, marijuana is predictably the first illicit drug that most people encounter. Not surprisingly, most users of other illicit 81,82 drugs used marijuana first. marijuana--they begin with alcohol and nicotine, usually when they are too young to do 82,90 so legally. The gateway analogy evokes two ideas that are often confused. The first, more often referred to as the ""stepping stone"" hypothesis, is the idea that progression from marijuana 82 In fact, most drug users do not begin their drug use with to other drugs arises from pharmacological properties of marijuana itself. that marijuana serves as a gateway to the world of illegal drugs in which youths have greater opportunity and are under greater social pressure to try other illegal drugs. The latter interpretation is most often used in the scientific literature, and it is supported, although not proven, by the available data. The stepping stone hypothesis applies to marijuana only in the broadest sense. People who enjoy the effects of marijuana are, logically, more likely to be willing to try other mood-altering drugs than are people who are not willing to try marijuana or who dislike its effects. In other words, many of the factors associated with a willingness to use marijuana are, presumably, the same as those associated with a willingness to use other illicit drugs. Those factors include physiological reactions to the drug effect, which are consistent with the stepping stone hypothesis, but also psychosocial factors, which are independent of drug-specific effects. There is no evidence that marijuana serves as a stepping stone on the basis of its particular physiological effect. One might argue that marijuana is generally used before other illicit mood-altering drugs, in part, because its effects are milder; in that case, marijuana is a stepping stone only in the same sense as taking a small dose of a particular drug and then increasing that dose over time is a stepping stone to increased drug use. Whereas the stepping stone hypothesis presumes a predominantly physiological component of drug progression, the gateway theory is a social theory. The latter does not suggest that the pharmacological qualities of marijuana make it a risk factor for progression to other drug use. Instead, the legal status of marijuana makes it a gateway 82 Psychiatric disorders are associated with substance dependence and are probably risk factors for progression in drug use. For example, the troubled adolescents studied by 31 were dependent on an average of 3.2 substances, and this suggests that their conduct disorders were associated with increased risk of progressing from one drug to another. Abuse of a single substance is probably also a risk factor for later multiple drug use. For example, in a longitudinal study that examined drug use and drug. Crowley and co-workers The second is dependence, about 26% of problem drinkers reported that they first used marijuana after the onset of alcohol-related problems (R. Pandina, IOM workshop). The study also found that 11% of marijuana users developed chronic marijuana problems; most also had alcohol problems. Intensity of drug use is an important risk factor in progression. Daily marijuana users are more likely than their peers to be extensive users of other substances (for review, see 78 Kandel and Davies by the age 24—25, 75% never used any other illicit drug; 53% of those who had used it 78 The factors that best predict use of illicit drugs other than marijuana are probably the following: age of first alcohol or nicotine use, heavy marijuana use, and psychiatric disorders. However, progression to illicit drug use is not synonymous with heavy or persistent drug use. Indeed, although the age of onset of use of licit drugs (alcohol and nicotine) predicts later illicit drug use, it does not appear to predict persistent or heavy 90 use of illicit drugs. Data on the gateway phenomenon are often overinterpreted. For example, one study 55 ). Of 34- to 35-year- old men who had used marijuana 10—99 times more than 100 times did progress to using other illicit drugs 10 or more times. Comparable proportions for women are 64% and 50%. reports that ""marijuana's role as a gateway drug appears to have increased."" It was a retrospective study based on interviews of drug abusers who reported smoking crack or injecting heroin daily. The data from the study provide no indication of what proportion of marijuana users become serious drug abusers; rather, they indicate that serious drug abusers usually use marijuana before they smoke crack or inject heroin. Only a small percentage of the adult population uses crack or heroin daily; during the five-year period from 1993 to 1997, an average of three people per 1,000 used crack and about two per 132 Many of the data on which the gateway theory is based do not measure dependence; instead, they measure use--even once-only use. Thus, they show only that marijuana users are more likely to use other illicit drugs (even if only once) than are people who never use marijuana, not that they become dependent or even frequent users. The authors of these studies are careful to point out that their data should not be used as evidence of an inexorable causal progression; rather they note that identifying stage-based user groups makes it possible to identify the specific risk factors that predict movement from 25 In the sense that marijuana use typically precedes rather than follows initiation into the use of other illicit drugs, it is indeed a gateway drug. However, it does not appear to be a gateway drug to the extent that it is the cause or even that it is the most significant predictor of serious drug abuse; that is, care must be taken not to attribute cause to association. The most consistent predictors of serious drug use appear to be the intensity of marijuana use and co-occurring psychiatric disorders or a family history of 78,83 psychopathology (including alcoholism). 1,000 used heroin in the preceding month. one stage of drug use to the next--the real issue in the gateway discussion. An important caution is that data on drug use progression pertain to nonmedical drug use. It does not follow from those data that if marijuana were available by prescription for medical use, the pattern of drug use would be the same. Kandel and co-workers also included nonmedical use of prescription psychoactive drugs in their study of drug use 82 progression. a clear and consistent sequence of drug use involving the abuse of prescription psychoactive drugs. The current data on drug use progression neither support nor refute the suggestion that medical availability would increase drug abuse among medical marijuana users. Whether the medical use of marijuana might encourage drug abuse among the general community--not among medical marijuana users themselves but among others simply because of the fact that marijuana would be used for medical purposes--is another question. LINK BETWEEN MEDICAL USE AND DRUG ABUSE Almost everyone who spoke or wrote to the IOM study team about the potential harms posed by the medical use of marijuana felt that it would send the wrong message to children and teenagers. They stated that information about the harms caused by marijuana is undermined by claims that marijuana might have medical value. Yet many of our powerful medicines are also dangerous medicines. These two facets of medicine-- effectiveness and risk--are inextricably linked. The question here is not whether marijuana can be both harmful and helpful but whether the perception of its benefits will increase its abuse. For now any answer to the question remains conjecture. Because marijuana is not an approved medicine, there is little information about the consequences of its medical use in modern society. Reasonable inferences might be drawn from some examples. Opiates, such as morphine and codeine, are an example of a class of drugs that is both abused to great harm and used to great medical benefit, and it would be useful to examine the relationship between their medical use and their abuse. In a ""natural experiment"" during 1973—1978 some states decriminalized marijuana, and others did not. Finally, one can examine the short-term consequences of the publicity surrounding the 1996 medical marijuana campaign in California and ask whether it had any measurable impact on marijuana consumption among youth in California; the consequences of ""message"" that marijuana might have medical use are examined below. Medical Use and Abuse of Opiates Two highly influential papers published in the 1920s and 1950s led to widespread concern among physicians and medical licensing boards that liberal use of opiates would 106 in 1996). Such fears have proven unfounded; it is now recognized that fear of producing addicts through medical treatment resulted in needless suffering among patients with pain as physicians 27,44 In contrast with the use of alcohol, nicotine, and illicit drugs, there was not result in many addicts (reviewed by Moulin and co-workers needlessly limited appropriate doses of medications. addiction problems with misuse of drugs that have been prescribed for medical use. Few people begin their drug 114 Opiates are carefully regulated in the medical setting, and diversion of medically prescribed opiates to the black market is not generally considered to be a major problem. No evidence suggests that the use of opiates or cocaine for medical purposes has increased the perception that their illicit use is safe or acceptable. Clearly, there are risks that patients will abuse marijuana for its psychoactive effects and some likelihood of diversion of marijuana from legitimate medical channels into the illicit market. But those risks do not differentiate marijuana from many accepted medications that are abused by some patients or diverted from medical channels for nonmedical use. Medications with abuse potential are placed in Schedule II of the Controlled Substances Act, which brings them under stricter control, including quotas on the amount that can be legally manufactured (see chapter 5 for discussion of the Controlled Substances Act). That scheduling also signals to physicians that a drug has abuse potential and that they should monitor its use by patients who could be at risk for drug abuse. Marijuana Decriminalization Monitoring the Future, the annual survey of values and lifestyles of high school seniors, revealed that high school seniors in decriminalized states reported using no more 72 marijuana than did their counterparts in states where marijuana was not decriminalized. Another study reported somewhat conflicting evidence indicating that decriminalization 105 had increased marijuana use. Network (DAWN), which has collected data on drug-related emergency room (ER) cases since 1975. There was a greater increase from 1975 to 1978 in the proportion of ER patients who had used marijuana in states that had decriminalized marijuana in 1975— 1976 than in states that had not decriminalized it (Table 3.6). Despite the greater increase among decriminalized states, the proportion of marijuana users among ER patients by 1978 was about equal in states that had and states that had not decriminalized marijuana. That is because the non-decriminalized states had higher rates of marijuana use before decriminalization. In contrast with marijuana use, rates of other illicit drug use among ER patients were substantially higher in states that did not decriminalize marijuana use. Thus, there are different possible reasons for the greater increase in marijuana use in the decriminalized states. On the one hand, decriminalization might have led to an increased use of marijuana (at least among people who sought health care in hospital ERs). On the other hand, the lack of decriminalization might have encouraged greater use of drugs that are even more dangerous than marijuana. The differences between the results for high school seniors from the Monitoring the Future study and the DAWN data are unclear, although the author of the latter study suggests that the reasons might lie in limitations inherent in how the DAWN data are 105 In 1976, the Netherlands adopted a policy of toleration for possession of up to 30 g of marijuana. There was little change in marijuana use during the seven years after the policy change, which suggests that the change itself had little effect; however, in 1984, when Dutch ""coffee shops"" that sold marijuana commercially spread throughout That study used data from the Drug Awareness Warning collected. Amsterdam, marijuana use began to increase. continued to increase in the Netherlands at the same rate as in the United States and Norway--two countries that strictly forbid marijuana sale and possession. Furthermore, during this period, approximately equal percentages of American and Dutch 18 year olds used marijuana; Norwegian 18 year olds were about half as likely to have used marijuana. The authors of this study conclude that there is little evidence that the Dutch marijuana depenalization policy led to increased marijuana use, although they note that commercialization of marijuana might have contributed to its increased use. Thus, there is little evidence that decriminalization of marijuana use necessarily leads to a substantial increase in marijuana use. The Medical Marijuana Debate The most recent National Household Survey on Drug Abuse showed that among people 12—17 years old the perceived risk associated with smoking marijuana once or 132 (Perceived risk is measured as the percentage of survey respondents who report that they ""perceive great risk of harm"" in using a drug at a specified frequency.) At first glance, that might seem to validate the fear that the medical marijuana debate of 1996--before passage of the California medical marijuana referendum in November 1997--had sent a message that marijuana use is safe. But a closer analysis of the data shows that Californian youth were an exception to the national trend. In contrast to the national trend, the perceived risk of 1321 In summary, there is no evidence that the medical marijuana debate has altered adolescents' 132 PSYCHOLOGICAL HARMS In assessing the relative risks and benefits related to the medical use of marijuana, the psychological effects of marijuana can be viewed both as unwanted side effects and as potentially desirable end points in medical treatment. However, the vast majority of research on the psychological effects of marijuana has been in the context of assessing the drug's intoxicating effects when it is used for nonmedical purposes. Thus, the literature does not directly address the effects of marijuana taken for medical purposes. There are some important caveats to consider in attempting to extrapolate from the research mentioned above to the medical use of marijuana. The circumstances under which psychoactive drugs are taken are an important influence on their psychological effects. Furthermore, research protocols to study marijuana's psychological effects in most instances were required to use participants who already had experience with marijuana. People who might have had adverse reactions to marijuana either would choose not to participate in this type of study or would be screened out by the investigator. Therefore, the incidence of adverse reactions to marijuana that might occur in people with no marijuana experience cannot be estimated from such studies. A further complicating factor concerns the dose regimen used for laboratory studies. In most instances, laboratory research studies have looked at the effects of single doses of twice a week had decreased significantly between 1996 and 1997. marijuana use did not change among California youth between 1996 and 1997. perceptions of the risks associated with marijuana use. 98 During the 1990s, marijuana use has marijuana, which might be different from those observed when the drug is taken repeatedly for a chronic medical condition. Nonetheless, laboratory studies are useful in suggesting what psychological functions might be studied when marijuana is evaluated for medical purposes. Results of laboratory studies indicate that acute and chronic marijuana use has pronounced effects on mood, psychomotor, and cognitive functions. These psychological domains should therefore be considered in assessing the relative risks and therapeutic benefits related to marijuana or cannabinoids for any medical condition. Psychiatric Disorders A major question remains as to whether marijuana can produce lasting mood disorders 52 or psychotic disorders, such as schizophrenia. Georgotas and Zeidenberg reported that smoking 10—22 marijuana cigarettes per day was associated with a gradual waning of the positive mood and social facilitating effects of marijuana and an increase in irritability, social isolation, and paranoid thinking. Inasmuch as smoking one cigarette is 68,95,118 enough to make a person feel ""high"" for about 1—3 hours, the subjects in that study were taking very high doses of marijuana. Reports have described the development of apathy, lowered motivation, and impaired educational performance in heavy marijuana 121,122 There are clinical reports of marijuana-induced psychosis-like states (schizophrenia-like, 112 depression, and/or mania) lasting for a week or more. of the varied nature of the psychotic states induced by marijuana, there is no specific ""marijuana psychosis."" Rather, the marijuana experience might trigger latent users who do not appear to be behaviorally impaired in other ways. psychopathology of many types. concluded that disorder. As noted earlier, drug abuse is common among people with psychiatric 66 60 More recently, Hall and colleagues ""there is reasonable evidence that heavy cannabis use, and perhaps acute use in sensitive individuals, can produce an acute psychosis in which confusion, amnesia, delusions, hallucinations, anxiety, agitation and hypomanic symptoms predominate."" Regardless of which of those interpretations is correct, the two reports agree that there is little evidence that marijuana alone produces a psychosis that persists after the period of intoxication. Schizophrenia The association between marijuana and schizophrenia is not well understood. The scientific literature indicates general agreement that heavy marijuana use can precipitate schizophrenic episodes but not that marijuana use can cause the underlying psychotic 59,96,151 disorders. Estimates of the prevalence of marijuana use among schizophrenics vary considerably but are in general agreement that it is at least as great as that among the general population. 35 Schizophrenics prefer the effects of marijuana to those of alcohol 134 134 and cocaine, reasons for this are unknown, but it raises the possibility that schizophrenics might obtain some symptomatic relief from moderate marijuana use. But overall, compared with the general population, people with schizophrenia or with a family history of schizophrenia which they seem to use less often than does the general population. The Hollister suggests that, because are likely to be at greater risk for adverse psychiatric effects from the use of cannabinoids. Cognition As discussed earlier, acutely administered marijuana impairs cognition. 60,66,112 Positron emission tomography (PET) imaging allows investigators to measure the acute effects of marijuana smoking on active brain function. Human volunteers who perform auditory attention tasks before and after smoking a marijuana cigarette show impaired performance while under the influence of marijuana; this is associated with substantial reduction in blood flow to the temporal lobe of the brain, an area that is sensitive to such 116,117 tasks. Marijuana smoking increases blood flow in other brain regions, such as the 101,155 frontal lobes and lateral cerebellum. Earlier studies purporting to show structural 22 changes in the brains of heavy marijuana users have not been replicated with more sophisticated techniques. 28,89 14,122 Nevertheless, recent studies marijuana users after a brief period (19—24 hours) of marijuana abstinence. Longer term 140 Although these studies have attempted to match heavy marijuana users with subjects of similar cognitive abilities before exposure to marijuana use, the adequacy of this matching has been 133 cognitive deficits in heavy marijuana users have also been reported. have found subtle defects in cognitive tasks in heavy questioned. reviewed in an article by Pope and colleagues. are designed to differentiate between changes in brain function caused the effects of marijuana and by the illness for which marijuana is being given. AIDS dementia is an obvious example of this possible confusion. It is also important to determine whether repeated use of marijuana at therapeutic dosages produces any irreversible cognitive effects. Psychomotor Performance Marijuana administration has been reported to affect psychomotor performance on a 23 not only details the studies that have been done but also points out the inconsistencies among studies, the methodological shortcomings of many studies, and the large individual differences among the studies attributable to subject, situational, and methodological factors. Those factors must be considered in studies of psychomotor performance when participants are involved in a clinical trial of the efficacy of marijuana. The types of psychomotor functions that have been shown to be disrupted by the acute administration of marijuana include body sway, hand steadiness, rotary pursuit, driving and flying simulation, divided attention, sustained attention, and the digit-symbol substitution test. A study of experienced airplane pilots showed that even 24 hours after a single marijuana cigarette their performance on flight 163 Before the tests, however, they told the study investigators that they were sure their performance would be unaffected. The complex methodological issues facing research in this area are well number of tasks. The review by Chait and Pierri simulator tests was impaired. 121 Care must be exercised so that studies Cognitive impairments associated with acutely administered marijuana limit the activities that people would be able to do safely or productively. For example, no one under the influence of marijuana or THC should drive a vehicle or operate potentially dangerous equipment. Amotivational Syndrome One of the more controversial effects claimed for marijuana is the production of an ""amotivational syndrome."" This syndrome is not a medical diagnosis, but it has been used to describe young people who drop out of social activities and show little interest in school, work, or other goal-directed activity. When heavy marijuana use accompanies these symptoms, the drug is often cited as the cause, but no convincing data demonstrate 23 a causal relationship between marijuana smoking and these behavioral characteristics. is not enough to observe that a chronic marijuana user lacks motivation. Instead, relevant personality traits and behavior of subjects must be assessed before and after the subject becomes a heavy marijuana user. Because such research can only be done on subjects who become heavy marijuana users on their own, a large population study--such as the Epidemiological Catchment Area study described earlier in this chapter--would be needed to shed light on the relationship between motivation and marijuana use. Even then, although a causal relationship between the two could, in theory, be dismissed by an epidemiological study, causality could not be proven.",Medical,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","In the reference text, three trends are stated. I would like you to summarize the central idea of each trend. Their respective implication should be included in the summary. Finally, in trend one, consumers in the US are expressing a desire to have other kinds of at-home kits, could you retrieve the test with the lowest percentage?","Five trends shaping the consumer health and wellness space in 2024 Fifty-eight percent of US respondents to our survey said they are prioritizing wellness more now than they did a year ago. The following five trends encompass their newly emerging priorities, as well as those that are consistent with our earlier research. Trend one: Health at home The COVID-19 pandemic made at-home testing kits a household item. As the pandemic has moved into its endemic phase, consumers are expressing greater interest in other kinds of at-home kits: 26 percent of US consumers are interested in testing for vitamin and mineral deficiencies at home, 24 percent for cold and flu symptoms, and 23 percent for cholesterol levels. At-home diagnostic tests are appealing to consumers because they offer greater convenience than going to a doctor’s office, quick results, and the ability to test frequently. In China, 35 percent of consumers reported that they had even replaced some in-person healthcare appointments with at-home diagnostic tests—a higher share than in the United States or the United Kingdom. Although there is growing interest in the space, some consumers express hesitancy. In the United States and the United Kingdom, top barriers to adoption include the preference to see a doctor in person, a perceived lack of need, and price; in China, test accuracy is a concern for approximately 30 percent of consumers. Implications for companies: Companies can address three critical considerations to help ensure success in this category. First, companies will want to determine the right price value equation for at-home diagnostic kits since cost still presents a major barrier for many consumers today. Second, companies should consider creating consumer feedback loops, encouraging users to take action based on their test results and then test again to assess the impact of those interventions. Third, companies that help consumers understand their test results—either through the use of generative AI to help analyze and deliver personalized results, or through integration with telehealth services—could develop a competitive advantage. Trend two: A new era for biomonitoring and wearables Roughly half of all consumers we surveyed have purchased a fitness wearable at some point in time. While wearable devices such as watches have been popular for years, new modalities powered by breakthrough technologies have ushered in a new era for biomonitoring and wearable devices. Wearable biometric rings, for example, are now equipped with sensors that provide consumers with insights about their sleep quality through paired mobile apps. Continuous glucose monitors, which can be applied to the back of the user’s arm, provide insights about the user’s blood sugar levels, which may then be interpreted by a nutritionist who can offer personalized health guidance. Roughly one-third of surveyed wearable users said they use their devices more often than they did last year, and more than 75 percent of all surveyed consumers indicated an openness to using a wearable in the future. We expect the use of wearable devices to continue to grow, particularly as companies track a wider range of health indicators. Implications for companies: While there is a range of effective wearable solutions on the market today for fitness and sleep, there are fewer for nutrition, weight management, and mindfulness, presenting an opportunity for companies to fill these gaps. Wearables makers and health product and services providers in areas such as nutrition, fitness, and sleep can explore partnerships that try to make the data collected through wearable devices actionable, which could drive greater behavioral change among consumers. One example: a consumer interested in managing stress levels might wear a device that tracks spikes in cortisol. Companies could then use this data to make personalized recommendations for products related to wellness, fitness, and mindfulness exercises. Businesses must keep data privacy and clarity of insights top of mind. Roughly 30 percent of China, UK, and US consumers are open to using a wearable device only if the data is shared exclusively with them. Additionally, requiring too much manual data input or sharing overly complicated insights could diminish the user experience. Ensuring that data collection is transparent and that insights are simple to understand and targeted to consumers’ specific health goals or risk factors will be crucial to attracting potential consumers. Trend three: Personalization’s gen AI boost Nearly one in five US consumers and one in three US millennials prefer personalized products and services. While the preference for personalized wellness products was lower than in years prior, we believe this is likely due to consumers becoming more selective about which personalized products and services they use. Technological advancements and the rise of first-party data are giving personalization a new edge. Approximately 20 percent of consumers in the United Kingdom and the United States and 30 percent in China look for personalized products and services that use biometric data to provide recommendations. There is an opportunity to pair these tools with gen AI to unlock greater precision and customization. In fact, gen AI has already made its way to the wearables and app space: some wearables use gen AI to design customized workouts for users based on their fitness data. Implications for companies: Companies that offer software-based health and wellness services to consumers are uniquely positioned to incorporate gen AI into their personalization offerings. Other businesses could explore partnerships with companies that use gen AI to create personalized wellness recommendations.","""================ ======= Five trends shaping the consumer health and wellness space in 2024 Fifty-eight percent of US respondents to our survey said they are prioritizing wellness more now than they did a year ago. The following five trends encompass their newly emerging priorities, as well as those that are consistent with our earlier research. Trend one: Health at home The COVID-19 pandemic made at-home testing kits a household item. As the pandemic has moved into its endemic phase, consumers are expressing greater interest in other kinds of at-home kits: 26 percent of US consumers are interested in testing for vitamin and mineral deficiencies at home, 24 percent for cold and flu symptoms, and 23 percent for cholesterol levels. At-home diagnostic tests are appealing to consumers because they offer greater convenience than going to a doctor’s office, quick results, and the ability to test frequently. In China, 35 percent of consumers reported that they had even replaced some in-person healthcare appointments with at-home diagnostic tests—a higher share than in the United States or the United Kingdom. Although there is growing interest in the space, some consumers express hesitancy. In the United States and the United Kingdom, top barriers to adoption include the preference to see a doctor in person, a perceived lack of need, and price; in China, test accuracy is a concern for approximately 30 percent of consumers. Implications for companies: Companies can address three critical considerations to help ensure success in this category. First, companies will want to determine the right price value equation for at-home diagnostic kits since cost still presents a major barrier for many consumers today. Second, companies should consider creating consumer feedback loops, encouraging users to take action based on their test results and then test again to assess the impact of those interventions. Third, companies that help consumers understand their test results—either through the use of generative AI to help analyze and deliver personalized results, or through integration with telehealth services—could develop a competitive advantage. Trend two: A new era for biomonitoring and wearables Roughly half of all consumers we surveyed have purchased a fitness wearable at some point in time. While wearable devices such as watches have been popular for years, new modalities powered by breakthrough technologies have ushered in a new era for biomonitoring and wearable devices. Wearable biometric rings, for example, are now equipped with sensors that provide consumers with insights about their sleep quality through paired mobile apps. Continuous glucose monitors, which can be applied to the back of the user’s arm, provide insights about the user’s blood sugar levels, which may then be interpreted by a nutritionist who can offer personalized health guidance. Roughly one-third of surveyed wearable users said they use their devices more often than they did last year, and more than 75 percent of all surveyed consumers indicated an openness to using a wearable in the future. We expect the use of wearable devices to continue to grow, particularly as companies track a wider range of health indicators. Implications for companies: While there is a range of effective wearable solutions on the market today for fitness and sleep, there are fewer for nutrition, weight management, and mindfulness, presenting an opportunity for companies to fill these gaps. Wearables makers and health product and services providers in areas such as nutrition, fitness, and sleep can explore partnerships that try to make the data collected through wearable devices actionable, which could drive greater behavioral change among consumers. One example: a consumer interested in managing stress levels might wear a device that tracks spikes in cortisol. Companies could then use this data to make personalized recommendations for products related to wellness, fitness, and mindfulness exercises. Businesses must keep data privacy and clarity of insights top of mind. Roughly 30 percent of China, UK, and US consumers are open to using a wearable device only if the data is shared exclusively with them. Additionally, requiring too much manual data input or sharing overly complicated insights could diminish the user experience. Ensuring that data collection is transparent and that insights are simple to understand and targeted to consumers’ specific health goals or risk factors will be crucial to attracting potential consumers. Trend three: Personalization’s gen AI boost Nearly one in five US consumers and one in three US millennials prefer personalized products and services. While the preference for personalized wellness products was lower than in years prior, we believe this is likely due to consumers becoming more selective about which personalized products and services they use. Technological advancements and the rise of first-party data are giving personalization a new edge. Approximately 20 percent of consumers in the United Kingdom and the United States and 30 percent in China look for personalized products and services that use biometric data to provide recommendations. There is an opportunity to pair these tools with gen AI to unlock greater precision and customization. In fact, gen AI has already made its way to the wearables and app space: some wearables use gen AI to design customized workouts for users based on their fitness data. Implications for companies: Companies that offer software-based health and wellness services to consumers are uniquely positioned to incorporate gen AI into their personalization offerings. Other businesses could explore partnerships with companies that use gen AI to create personalized wellness recommendations. https://www.mckinsey.com/industries/consumer-packaged-goods/our-insights/the-trends-defining-the-1-point-8-trillion-dollar-global-wellness-market-in-2024?stcr=E8E9B8D1DADC4FF7928252A2E8D12F2B&cid=other-eml-alt-mip-mck&hlkid=3ac2023292574ef9a3db1c1785acc32d&hctky=12113536&hdpid=0df4d40d-7d9b-4711-914d-82aea6c69268 ================ ======= In the reference text, three trends are stated. I would like you to summarize the central idea of each trend. Their respective implication should be included in the summary. Finally, in trend one, consumers in the US are expressing a desire to have other kinds of at-home kits, could you retrieve the test with the lowest percentage? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Find & Summarize,Text Transformation "Answer the question using only information from the provided context block. ",What are some of the benefits of online education?,"INTRODUCTION Historically, postsecondary education in the United States was founded on the principles of the European system, requiring the physical presence of professors and students in the same location (Knowles, 1994). From 1626, with the founding of Harvard University (The Harvard Guide, 2004), to the development of junior colleges and vocational schools in the early 1900s (Cohen & Brawer, 1996; Jacobs & Grubb, 2003), the higher education system developed to prepare post-high school students for one of three separate tiers. The college and university system in the United States developed its own set of structures designed to prepare students for baccalaureate and graduate degrees. Junior colleges were limited to associate degrees, while vocational education institutions offered occupational certificates. In many cases, there was inadequate recognition of the postsecondary education offered at junior colleges and vocational education institutions, resulting in the inability of students to transfer to 4-year institutions (National Center for Education Statistics, 2006). In the mid-20th century, some junior colleges began to provide academic, vocational, and personal development educational offerings for members of the local communities. During this same period, junior or community colleges developed a role as transfer institutions for students who, because of time, preparedness, economics, or distance, could not begin their postsecondary education at a 4-year institution (Cohen & Brawer, 1996). Until the mid-1990s, the majority of transfer programs involved Associate of Arts (AA) and Associate of Science (AS) degrees. Associate of Applied Science (AAS) degrees were developed during the 1990s. The AAS degree was granted to those 2 who successfully completed the majority of their college program in vocational education. The creation of a variety of applied baccalaureate degrees allowed students who had previously thought of the AAS degree as a terminal program to complete a baccalaureate degree (Kansas Board of Regents, 2002-2003). Online education also became a strategy for students to access higher education in the 1990s (Allen & Seaman, 2007b). The proliferation of online courses alleviated some of the location-bound barriers to higher education, but online education was criticized as less rigorous than traditional classroom-based course work by traditional academicians. Russell attempted to address this argument with his 1999 meta-analysis of studies dating from the 1920s and covering multiple delivery models, including online education. Russell concluded there was no statistically significant difference in student achievement between courses offered online and those offered in the traditional classroom setting. Since the development of correspondence courses in the 1920s, researchers have attempted to ascertain if students participating in distance education are being shortchanged in their educational goals. No significant difference in grades has been found in the majority of studies designed to address this issue. Studies analyzing online student retention have shown significantly lower retention for online students. In the last 10 years, research studies have expanded to include variations of online education. These include strictly online, hybrid courses, Web-assisted classroom settings, and the traditional higher education course offered only as face-to-face instruction (Carmel & Gold, 2007). Online education continues to proliferate at the same time the number of secondary students in the United States overall is projected to increase (National Center 3 for Education Statistics [NCES], 2006). The projected increase of potential postsecondary students and online postsecondary options provides opportunities for increases in online education programs and courses. In 2000, NCES reported that over 65% of students in higher education were participating in online courses. In a 2007 study, Allen and Seaman estimated only 16% of those enrolled in online education courses are undergraduate students seeking their first degree, counter to the projected increase in traditional-age students. The majority of enrollees in online education are adults updating or advancing their credentials, creating an additional educational market for colleges and universities seeking to expand enrollment without adding physical space (Allen & Seaman, 2007a). For states and localities faced with a contradictory traditional-age enrollment decrease, these figures present an untapped market for higher education courses and programs. Background Researchers attempted to analyze the efficacy of distance education as far back as the 1920s when correspondence courses were created to meet the need of students not willing to attend a traditional classroom-based higher education setting. A meta-analysis of these studies resulted in “The No Significant Difference Phenomenon,” reported by Russell (2001). The results of over 355 studies were compiled, comparing various modes of delivery including correspondence, audio, television courses, and the newest wave of computer-facilitated instruction. Following analyses of studies completed prior to 2001, Russell concluded there was no difference in learning between students enrolled in distance education and those completing courses in the traditional setting. Studies completed since then have provided mixed results. Summers, Waigand, and Whittaker (2005) found there was no difference in GPA and retention between the 4 online and traditional classroom. Arle (2002) found higher achievement by online students, and Brown and Liedholm (2002) found GPA and student retention better in a traditional classroom setting. Student retention is an integral part of the student achievement conversation and is an issue for all forms of higher education. Degree-seeking students’ overall retention has been reported as less than 56% by NCES (2001). Long considered a problem in higher education, attention to the distance education model has shown even lower retention rates in online students than in students attending at the traditional college setting (Phipps & Meristosis, 1999). Research on different modalities, such as fully online and hybrid online courses, has produced mixed results (Carmel & Gold, 2007). No significant trend toward increased retention of students in any of the online modalities has been documented. Retention studies of transfer students have primarily included traditionally defined students transfering from a community college. Statistics have consistantly shown a lower retention rate for students transfering from a community college to a 4-year university than for students who began their post-high school education at a 4-year institution (NCES, 2006). Townsend’s studies of transfer students at the University of Missouri-Columbia also showed a lower baccalaureate retention rate for students who had completed an AAS degree than for students beginning their education at a 4-year institution (Townsend, 2002). Occupationally oriented bachelor’s degree completion programs are relatively new to higher education. Transfer programs in the liberal arts from community colleges to 4-year institutions were common by the 1990s. Townsend (2001), in her study 5 conducted at the University of Missouri–Columbia, observed the blurring of the lines between non-transferrable occupationally oriented undergraduate degrees and undergraduate degrees and certificates that were easily transferred. The study conducted by Townsend was among the first to recognize that many students who began their education at community and technical colleges had bachelor’s degree aspirations that grew after their completion of an occupationally-oriented degree. Laanan proposed that the increase in institutions offering AAS degrees necessitated new ways to transfer undergraduate credits (2003). The setting of this study is a medium-sized Midwestern campus located in Topeka, Kansas. Washburn University enrolls approximately 6000 students a year in undergraduate and graduate programs, including liberal arts, professional schools, and a law school (Washburn University, 2008). The Technology Administration (TA) program selected for the present study began in the 1990s as a baccalaureate degree completion program for students who had received an occupationally oriented associate degree at a Kansas community college or through Washburn’s articulation agreement with Kansas vocational-technical schools. This program provided students who previously had obtained an Associate of Applied Science degree in an occupational area an opportunity to earn a bachelor’s degree. Peterson, Dean of Continuing Education, Washburn University, stated that in early 1999, Washburn University began online courses and programs at the behest of a neighboring community college (personal communication, April 18, 2008). Washburn was asked to develop an online bachelor’s degree completion program for students graduating from community colleges and technical colleges with an Associate of Applied 6 Science degree. The TA program was among the first programs to offer the online bachelor’s degree completion option. The TA program offered its first online courses in Spring 2000. Online education at Washburn expanded to other programs and courses, to include over 200 courses (Washburn University, 2008). The original online partnership with two community colleges expanded to include 16 additional community colleges and four technical colleges in Kansas, as well as colleges in Missouri, California, Wisconsin, South Carolina, and Nebraska (Washburn University, 2008). An initial study in 2002 of student’s course grades and retention in online courses offered at Washburn showed no significant difference between students enrolled in online courses and students enrolled in traditional face-to-face course work (Peterson, personal communication, April 18, 2008). No studies of program retention have been completed. In 2008, Atkins reported overall enrollment at Washburn University decreased 6.7% from Fall 2004 to Fall 2008, from 7400 to 6901 students. During the same period, online course enrollment patterns increased 65%, from 3550 students to 5874 in 2007- 2008 (Washburn University, 2008). Atkins also reported that between 1998 and 2008, the ratio of traditional post-high school age students to nontraditional students enrolling at Washburn University reversed from 40:60 to 60:40. The shift in enrollment patterns produced an increase in enrollment in the early part of the 21st century; however, Washburn University anticipated a decrease in high school graduates in Kansas through 2016, based on demographic patterns of the state. The state figures are opposite the anticipated increase of traditional-age students nationally (NCES, 2008). The increase in 7 distance education students in relation to the anticipated decline in traditional-age students provided the focus for the study. Purpose of the Study Online education has become an important strategy for the higher education institution that was the setting of this study. First, the purpose of the study was to determine if there was a significant difference between the course grades of students participating in TA online courses and their traditional classroom-based counterparts. The second purpose of the study was to determine if there was a significant difference between course retention of students participating in TA online courses and their traditional classroom-based counterparts. The second part of the study was a replication of studies comparing modes of online course delivery to traditional classroom-based instruction (Carmel & Gold, 2007; Russell, 1999). A third purpose of the study was to determine if there was a significant difference between program retention of students who began the TA program in online courses and those who began the program enrolled in traditional face-to-face courses. The study’s purpose was to expand the knowledge base concerning online education to include its efficacy in providing baccalaureate degree completion opportunities. Research Questions Roberts (2004) stated research questions guide the study and usually provide the structure for presenting the results of the research. The research questions guiding this study were: 8 1. Is there is a statistically significant difference between students’ grades in online classes and traditional face-to-face classes? 2. Is there a statistically significant difference between course retention rates in online classes and traditional face-to-face classes? 3. Is there a statistically significant difference between program retention for students entering the program enrolled in online classes and students entering the program enrolled in traditional face-to-face classes? Overview of the Methodology A quantitative study was utilized to compare grades by course, course retention, and program retention of students enrolled in the online and traditional face-to-face TA program at Washburn University. Archival data from the student system at Washburn University were utilized from comparative online and traditional face-to-face classes in two separate courses. In order to answer Research Question 1, a sample of 885 students enrolled in online and traditional face-to-face courses was identified. The sample included students entering the program in the Fall semesters of 2002, 2003, 2004, 2005, and 2006 in both the online and traditional face-to-face classes. Two instructors were responsible for concurrent instruction of both the online and face-to-face classes for the period analyzed. A two-factor analysis of variance was used to analyze for the potential difference in the dependent variables, course grades due to delivery method (online and face-to-face), instructor (instructors A and B), and the potential interaction between the two independent variables (Research Question 1). A chi-square test for differences among proportions was used to analyze course and program retention (Research Questions 2 and 3). 9 Delimitations Roberts (2004) defined delimitations as the boundaries of the study that are controlled principally by the researcher. The delimitations for this study were 1. Only data from 2002 through 2008 from Technology Administration online and face-to-face courses were utilized. 2. The study was confined to students enrolled at Washburn University in the Technology Administration program. 3. Only grades and retention were analyzed. Assumptions Assumptions are defined as those things presupposed in a study (Roberts, 2004). The study was based on the following assumptions: 1. Delivery of content was consistent between online and face-to-face courses and instructors, 2. Course objectives were the same for paired online and traditional face-toface courses, 3. All students enrolled in the TA program met the same criteria for admission to the University, 4. All data entered in the Excel spreadsheets were correct, 5. All students enrolled in the TA program met the same criteria for grade point average and program prerequisites. 10 Definitions The following terms are defined for the purpose of this study: Distance education. Education or training courses delivered to remote locations via postal delivery, or broadcast by audio, video, or computer technologies (Allen, 2007). Dropout. A dropout is defined as a student who has left school and discontinued studies (Merriam-Webster's Collegiate Dictionary, 1998). Face-to-face delivery. This is a course that uses no online technology; content is delivered in person, either in written or oral form (Allen, 2007). Hybrid course. This course is a blend of the online and face-to-face course. A substantial proportion of the content is delivered online, typically using some online discussions and some face-to-face meetings (Allen, 2007). Online course. This defines a course where most or all of the content is delivered online via computer technologies. Typically, there are no face-to-face meetings (Allen, 2007). 2+2 PLAN. The Partnership for Learning and Networking is a collaborative set of online 2+2 baccalaureate degree programs developed by Washburn University. The programs require completion of an associate degree from one of the partner community or technical colleges (Washburn University, 2008). Retention. This term refers to the completion of a course by receiving a letter grade in a course, or a certificate of completion or degree for program completion (Washburn University, 2008). Web-assisted. A course that uses Web-based technology to facilitate what is essentially a face-to-face course (Allen, 2007). 11 Organization of the Study This study consists of five chapters. Chapter One introduced the role of distance education in higher education. Chapter One included the background of the study, the research questions, overview of the methodology, the delimitations of the study, and the definition of terms. Chapter Two presents a literature review, which includes the history of occupational postsecondary education, distance education, and studies relating to grades and retention of students involved in distance education. Chapter Three describes the methodology used for the research study. It includes the selection of participants, design, data collection, and statistical procedures of the study. Chapter Four presents the findings of the research study. Finally, Chapter Five provides a discussion of the results, conclusions, and implications for further research and practice. 12 CHAPTER TWO LITERATURE REVIEW This chapter presents the background for research into the efficacy of distance education in the delivery of higher education. Research studies have focused primarily on grades as a measure of the quality of distance education courses as compared to traditional face-to-face instruction. Utilizing grades has produced a dividing line among education researchers concerning the use of distance education as a delivery model. Retention in distance education has focused primarily on single courses, with little program retention data available. Data from retention studies in higher education have focused primarily on the traditional 4-year university student. Retention studies of community college students have produced quantitative results; however, these studies have been directed at community college students who identify themselves as transfer students early in their community college careers. Retention studies of students enrolled in occupationally oriented programs are limited. Statistical data of higher education shows an increased use of distance education for traditional academic courses as well as occupationally oriented courses. The increase in distance education courses and programs has provided a new dimension to studies of both grades and retention. The recognition of this increase, as well as questions concerning its impact on student learning and retention, produced the impetus for this study. The following review of the literature represents the literature related to this research study. Through examination of previous research, the direction of the present study was formulated. Specifically, the chapter is organized into four sections: (a) the 13 history of occupational transfer programs; (b) the history and research of distance education, including occupational transfer programs utilizing distance education; (c) research utilizing grades as an indicator of student learning in online education; and (d) research focusing on student retention in higher education, including student retention issues in transfer education and online transfer courses and programs. History of Occupational Transfer Programs The measure of success in higher education has been characterized as the attainment of a bachelor’s degree at a 4-year university. Occupationally oriented education was considered primarily a function of job preparation, and until the 1990s was not considered transferrable to other higher education institutions. Occupational transfer programs are a recent occurrence within the postsecondary system that provides an additional pathway to bachelor’s degree completion. Historically, the postsecondary experience in the United States developed as a three-track system. Colleges were established in the United States in 1636 with the founding of Harvard College (The Harvard Guide, 2004). Junior colleges were first founded in 1901 as experimental post-high school graduate programs (Joliet Junior College History, 2008). Their role was initially as a transfer institution to the university. When the Smith-Hughes Act was passed in 1917, a system of vocational education was born in the United States (Jacobs & Grubb, 2003), and was designed to provide further education to those students not viewed as capable of success in a university setting. Vocational education, currently referred to as occupational or technical education, was not originally designed to be a path to higher education. The first programs were designed to help agricultural workers complete their education and increase their skills. 14 More vocational programs were developed during the early 20th century as industrialization developed and as increasing numbers of skills were needed by workers in blue-collar occupations (Jacobs & Grubb, 2003). In the mid-20th century, some junior colleges expanded their programs beyond academic selections to provide occupational development and continuing education. Because of the geographic area from which they attracted students, junior colleges developed a role as “community” colleges. They also solidified their role as transfer institutions for students who, because of time, preparedness, economics, or distance, could not begin their postsecondary education at a 4-year institution (Cohen & Brawer, 1996). Until the mid-1990s, the majority of transfer programs to 4-year universities involved traditional academic degrees, including the Associate of Arts (AA) and Associate of Science (AS) degrees. Occupational programs and continuing education were viewed as terminal and non-transferrable. In 1984, Congress authorized the Carl Perkins Vocational and Technical Education Act (P.L. 98-524). In the legislation, Congress responded to employers’ concerns about the lack of basic skills in employees by adding academic requirements to vocational education legislation. Vocational program curriculum was expanded to include language arts, mathematics, and science principles, and the curriculum reflected the context of the program. The Secretary’s Commission on Achieving Necessary Skills (SCANS) was created in 1990 to determine the skills young people need to succeed in the world of work (U.S. Department of Labor, 2000). In the second Carl Perkins reauthorization in 1990 (P.L. 105-332), Congress responded to the report, which targeted academic and job skills, by outlining a seamless system of vocational and academic 15 education to prepare vocational students to progress into and through higher education. This emphasis led to the development of Associate of Applied Science (AAS) degrees during the 1990s. Granted to those who have successfully completed programs in the applied arts and sciences for careers, AAS degrees were seen as terminal (Kansas Board of Regents, 2002-2003). But as one goal was attained, conversation turned to creating a pathway from occupational associate degrees to bachelor’s degree completion. The desire of students to continue from technical degrees to a baccalaureate was not a new idea. In a paper presented in 1989 to the American Technical Association national conference, TrouttErvin and Morgan’s overview of 2+2 programs showed acceptance of AAS degrees at traditional universities was generally non-existent. Their suggestion for an academic bridge from early technical education to baccalaureate programs highlighted programs accepting AAS degrees toward baccalaureate completion were an exception rather than a rule (Troutt-Ervin & Morgan, 1989). It was not until the late 1990s that applied baccalaureate degrees recognized credits from technical degree students who had previously thought of themselves in a terminal program to complete their baccalaureate degree (Wellman, 2002). Despite the advance of recognition of AAS degrees, standard definitions of transfer students continued to exclude students who completed technical programs. The U.S. Department of Education did not include students receiving an Associate of Applied Science degree in the definition of students preparing for transfer to 4-year colleges (Bradburn, Hurst, & Peng, 2001; Carnevale, 2006). Most states had comparable policies in place concerning core academic curriculum, articulation agreements, transfer of credit, 16 and statewide transfer guides. There was no general recognition of occupational credit transfer. Only a few states, including Kansas, Missouri, and Washington, allowed credits earned in occupationally oriented degrees to transfer to 4-year institutions (Townsend, 2001). No state had set clear goals for the transference of occupational credits between institutions or for the state as a whole (Wellman, 2002). Despite the lack of recognition of occupational transfer credit at the federal level, a new definition of transfer education had emerged. Initially defined as the general education component of the first 2 years of a baccalaureate, the definition of transfer education now included any courses that transferred to a 4-year college, regardless of the nature of the courses (Townsend, 2001). The line between vocational schools, community colleges, and 4-year institutions blurred in the United States as employers and students increasingly made business decisions regarding education and workforce development. Employers increasingly asked for employees with academic and technical skills, as well as critical thinking skills and personal responsibility (U.S. Department of Labor, 2000). Returning students themselves were more attuned to the demands of the 21st century workforce. Their desire to return to higher education, coupled with the economy and the variety of options available to them, required a more adaptive higher education system (Carnevale, 2006). There was growing demand among new and returning students for higher education opportunities responsive to their needs. The expanding needs of the returning student provided opportunities for higher education to respond by utilizing different delivery models. 17 Distance Education Online education became a strategy for postsecondary institutions when the first correspondence courses were initiated with the mail service in the early 20th century (Russell, 1999). As various technologies emerged, distance education utilized television and video models, in addition to paper-based correspondence courses. The expansion of distance education utilizing computer technologies renewed academic debate over the efficacy of the delivery model. Online education utilizing the Internet became a significant factor in the 1990s, prompting renewed evaluation of the use of distance learning opportunities (Russell, 1999, Phipps & Meristosis, 1999). In 1999–2000, the number of students who took any distance education courses was 8.4% of total undergraduates enrolled in postsecondary education (NCES, 2000). In 2000, the report of the Web-Based Education Commission to the President and Congress concluded that the Internet was no longer in question as a tool to transform the way teaching and learning was offered. The Commission recommended that the nation embrace E-learning as a strategy to provide on-demand, high-quality teaching and professional development to keep the United States competitive in the global workforce. They also recommended continued funding of research into teaching and learning utilizing web-based resources (Web-Based Education Commission, 2000). The acceptance of the importance of the Internet for delivery of higher education opened new opportunities for research and continued the academic debate of the quality of instruction delivered in online education courses and programs. In a longitudinal study from 2002-2007, The Sloan Consortium, a group of higher education institutions actively involved in online education, began studies of online 18 education in the United States over a period of 5 years. In the first study, researchers Allen and Seaman (2003) conducted polls of postsecondary institutions involved with online education and found that students overwhelming responded to the availability of online education, with over 1.6 million students taking at least one online course during the Fall semester of 2002. Over one third of these students took all of their courses online. The survey also found that in 2002, 81% of all institutions of higher education offered at least one fully online or blended course (Allen & Seaman, 2003). In their intermediate report in 2005, Allen and Seaman postulated that online education had continued to make inroads in postsecondary education, with 65% of schools offering graduate courses and programs face-to-face also offering graduate courses online. Sixty-three percent of undergraduate institutions offering face-to-face courses also offered courses online. From 2003 to 2005, the survey results showed that online education, as a long-term strategy for institutions, had increased from 49% to 56%. In addition, core education online course offerings had increased (Allen & Seaman, 2005). In Allen and Seaman’s final report (2007b) for the Sloan Consortium, the researchers reported that almost 3.5 million students participated in at least one online course during the Fall 2006 term, a nearly 10% increase over the number reported in the previous year. Allen and Seaman also reported a 9.7% increase in online enrollment, compared to the 1.5% growth in overall higher education. They found by 2007, 2-year institutions had the highest growth rates and accounted for over the half the online enrollments in the previous 5 years. The researchers concluded, based on a survey 19 conducted as part of the research, institutions believed that improved student access was the top reason for offering online courses and programs (Allen & Seaman, 2007b). Community colleges began embracing distance education in the 1920s as part of their mission to provide low-cost, time-effective education. Community colleges initially provided correspondence courses by mail, but later switched to television and video courses as technology improved (Cohen & Brawer, 1996). In 2001, over 90% of public 2- year colleges in the United States provided distance education courses over the Internet (NCES, 2001). Vocational education, by the nature of its instructional format, was among the last of the educational institutions to participate in distance education. Because of the kinesthetic nature of instruction, vocational education leaders began investigating distance education opportunities in the 1990s, relying on the method to provide only the lecture portion of instruction. By 2004, only 31% of students enrolled in vocational schools had participated in some form of distance education during their program of study (NCES, 2005). In 2008, hands-on instruction in programs such as automobile mechanics and welding, and the clinical portion of health occupations programs, continued to be taught in the traditional classroom setting (NCES, 2008). Analysis of data reported by the NCES indicated that distance education had become a staple for higher education institutions. At both the 4-year and 2-year university level, over 65% of institutions offered more than 12 million courses in 2006-2007 by distance education. While vocational education had traditionally been more hands-on, distance education had become more prevalent in providing opportunities for students to participate in components of the system over the Internet (NCES, 2008). 20 Distance education became the prevalent strategy for higher education institutions to expand their services to new and returning students, without the financial implications of capital expansion. Higher education utilized the strategy to market to students outside their traditional geographic reach by utilizing the power of the Internet. The increasing demand from students of all ages for online opportunities provided new ground for the expansion of higher education opportunities. Grades as an Indicator of Quality of Student Learning The grading system in the United States educational system has served as an indicator of knowledge for over 100 years. Educators have utilized high school grades as a sorting mechanism in American schools to determine postsecondary opportunities. Modern society has accepted honors attainment, graduation honors, and course grades as an indicator of knowledge acquisition in postsecondary education. Stray (2001) reported that the use of grading in schools can be traced to the industrial revolution and the development of factories. William Farish of Cambridge University developed the first grading system in higher education in 1792 (Stray, 2001). Farish mimicked the system established by factories of the time: grade A being the best. The thought was that Farish employed the grading system in order to teach more students, an aberration at that time when instructors rarely had more than a few. The demand for more higher education opportunities prompted Farish to open his class to more students, and as such, led to his use of a sorting system. This was the first known record of grading utilized in classrooms to measure student achievement (Stray, 2001). 21 Smallwood (1935) reported the first grading in higher education at Yale University in 1792. Stiles, President of Yale University, directed the use of the scale in the late 18th century. However, Smallwood noted it was not until 1813 that any record of grades or marking appeared. Using a scale of 100, philosophy and mathematic professors instituted the first use of a marking instrument in the 1800s at Harvard. Smallwood noted early systems were experimental, utilizing different numerical scales, with no standardized system in place between higher education institutions. It was not until the late 1800s that faculty began using descriptors, such as A and B, to rank students according to a predetermined numerical scale (Smallwood, 1935). Experimentation with evaluation of achievement continued into the early 20th century, when educational psychologists, including Dewey and Thorndike, attempted to compare grading scales with intelligence testing. Thorndike’s philosophy of standardized testing and grading survived the 20th century, and his quote, “Whatever exists at all exists in some amount” (Thorndike, 1916, as cited in Ebel & Frisbie, p. 26) has been utilized in educational measurement textbooks as a validation of the use of standards of measurement to measure achievement (Ebel & Frisbie, 1991). The use of grades expanded to community colleges, high schools, and elementary schools in the early 1900s (Pressey, 1920). The use of grades throughout the educational system is fairly standardized today with the 4.0 scale. It is this standardization that allows comparison of grades as achievement between educational levels and institutions (Ebel & Frisbie, 1991) and allows grades to be utilized as a measure for comparison of educational achievement. 22 Researchers analyzing the success of community college transfer students have traditionally studied the grades of the traditional transfer student with an AA or AS degree. Keeley and House’s 1993 study of sophomore and junior transfer students at Northern Illinois University analyzed “transfer shock” (p. 2) for students matriculating from community colleges. The researchers found students who transferred from a community college obtained a grade point average significantly lower in their first semester than did students who began their college career at a 4-year institution. However, the results of the longitudinal studies showed that transfer students who persisted to graduation showed an equivalent GPA at baccalaureate completion (Keeley & House, 1993). Students who transferred from occupationally oriented degree programs typically were not included in traditional studies of transfer students. While the research in general does not include AAS students in traditional transfer data, limited conclusions were available comparing AAS students to traditional 4-year college attendees. Townsend’s study at the University of Missouri-Columbia (2002) showed no difference in grades at baccalaureate graduation between students with an AA/AS degree and students with an AAS degree. The use of grades as an indicator of the level of student achievement has been relied upon by studies comparing traditional classroom instruction and distance instruction. Research analyzing the effectiveness of student learning in distance education began with the first correspondence courses offered utilizing the mail service (Russell, 1999). The study of effectiveness of correspondence courses expanded to include new technologies, such as television and video courses, and increased with the proliferation of 23 online educational offerings. Researchers continued to challenge the effectiveness of learning methods not delivered in traditional higher education settings. In 1991, Russell reviewed over 355 studies, dating from the 1930s and continuing through the late 1980s, and found no significant difference in student learning using any form of distance education, as compared with students in classroom-based instruction (Russell, 1999). Russell’s conclusion formed the basis for a series of works collectively known as “No Significant Difference.” Russell’s conclusion from his studies follows: The fact is the findings of comparative studies are absolutely conclusive; one can bank on them. No matter how it is produced, how it is delivered, whether or not it is interactive, low tech or high tech, students learn equally well with each technology and learn as well as their on-campus, face-to-face counterparts even though students would rather be on campus with the instructor if that were a real choice. (p. xviii) Overwhelmingly, studies have supported Russell’s conclusions, including Neuhauser’s (2002) study of traditional face-to-face education and online education in a business communications class at a large urban university in North Carolina. Neuhauser concluded there was no significant difference in pre- and post-test scores of students enrolled in online and traditional communications classes. In addition, Neuhauser found no significant difference in final grades, homework grades, and grades on research papers, even though learners in the online course were significantly older than were learners in the traditional face-to-face section. The Summers et al. (2005) research included a comparison of student achievement and satisfaction in an online versus a traditional face-to-face statistics class. 24 The study, conducted at the University of Missouri-Columbia, included undergraduate nursing students who were tested on both their pre- and post-course knowledge of statistics. Their results indicated that utilizing grades as an indicator of knowledge showed no significant difference between the online and traditional classroom students. In their meta-analysis, Machtmes and Asher (2002) reviewed 30 studies and concluded there did not appear to be a difference in achievement, as measured by grades, between distance and traditional learners. As technology use continued to evolve in online education, various studies were conducted to determine whether different delivery methods created a difference in the grades of online students compared to their face-to-face counterparts. A study conducted by Carmel and Gold (2007) supported Russell’s original conclusion by analyzing specific types of online platforms and delivery models. Carmel and Gold’s study included hybrid and traditional classroom-based instruction. They analyzed results from 164 students in 110 courses and found no significant difference in student achievement based on grades between students enrolled in either delivery method. Additional studies supporting Russell’s theory have crossed multiple content areas and delivery models. Brown and Liedholm’s (2002) study at Michigan State University included microeconomics students in virtual, hybrid, and traditional classroom-based instruction. The study included 389 students in the traditional setting, 258 in the hybrid delivery section and 89 students enrolled in online education. No significant difference in student learning as measured by end of course grades was found. Research also showed type of course discipline is not affected by the online delivery model. Schulman and Simms (1999) compared pretest and posttest scores of 25 students enrolled in an online course and a traditional course at Nova Southeastern University. The researchers compared 40 undergraduate students enrolled in online courses and 59 undergraduate students enrolled in the classroom setting of the same course. Results indicated that the students who select online courses scored higher than traditional students scored on the pretest results. However, posttest results showed no significant difference for the online students versus the in-class students. Schulman and Simms concluded that online students were learning equally as well as their classroombased counterparts. Reigle’s (2007) analysis across disciplines at the University of San Francisco and the University of California found no significant difference between online and face-to-face student grade attainment. Shachar and Neumann (2003) conducted a meta-analysis that estimated and compared the differences between the academic performance of students enrolled in distance education compared to those enrolled in traditional settings over the period from 1990-2002. Eighty-six studies containing data from over 15,000 participating students were included in their analysis. The results of the meta-analysis showed that in two-thirds of the cases, students taking courses by distance education outperformed their student counterparts enrolled in traditionally instructed courses. Lynch, during the use of the “Tegrity” system, a brand-specific online platform at Louisiana State University, found that students’ grades were slightly better after utilizing the technology than when the traditional approach was used (Lynch, 2002). Initial results of a University of Wisconsin-Milwaukee study of 5000 students over 2 years indicated that the U-Pace online students performed 12% better than their traditional Psychology 101 counterparts on the same cumulative test (Perez, 2009). Arle’s (2002) study found 26 students enrolled in online human anatomy courses at Rio Salado College scored an average of 6.3% higher on assessments than the national achievement average. Students were assessed using a national standardized test generated by the Human Anatomy and Physiology Society, whose norming sample is based entirely on traditional classroom delivery (Arle, 2002). In a study conducted by Stephenson, Brown, and Griffin (2008), comparing three different delivery styles (traditional, asynchronous electronic courseware, and synchronous e-lectures), results indicated no increased effectiveness of any delivery style when all question types were taken into account. However, when results were analyzed, students receiving traditional lectures showed the lowest levels on questions designed to assess comprehension. Research found supporters in higher education academic leaders. In a 2006 survey of Midwestern postsecondary institutions concerning their online offerings, 56 % of academic leaders in the 11 states rated the learning outcomes in online education as the same or superior to those in face-to-face instructional settings. The proportion of higher education institutions believing that online learning outcomes were superior to those for face-to-face outcomes was still relatively small, but had grown by 34% since 2003, from 10.2 to 13.7 % (Allen & Seaman, 2007b). This belief added merit to the conclusions supported by Russell and others. Russell’s (1999) “no significant difference” conclusion had its detractors. The most commonly cited is Phipps and Merisotis (1999), who reviewed Russell’s original meta-analysis (1999) and reported a much different conclusion. They concluded that the overall quality of the original research was questionable, that much of the research did 27 not control for extraneous variables, and therefore it could not show cause and effect. They included in their findings evidence that the studies utilized by Russell (2000) in the meta-analysis did not use randomly selected subjects, did not take into effect the differences among students, and did not include tests of validity and reliability. The Phipps and Merisotis (1999) analysis included the conclusion that research has focused too much on individual courses rather than on academic programs, and has not taken into account differences among students. They postulated that based on these conclusions, there is a significant difference in the learning results, as evidenced by grades, of students participating in distance education as compared to their classroombased peers. Their analysis of Russell’s original work questioned both the quality and effectiveness of research comparing distance and traditional education delivery. While there has been ongoing conjecture that online education students are not receiving an equivalent learning experience compared to their traditional classroom counterparts, studies utilizing grades as an indicator of student learning have produced little evidence of the disparity. The incidence of studies showing significant negative differences in grades of online learners is small. Higher education institutions have indicated their support for online education, and its continued growth has allowed studies such as the present research to contribute to ongoing dialogue. Student Retention in Postsecondary Education Persistence and retention in higher education is an issue that has intrigued researchers for over 50 years. Quantitative studies conducted in the mid-20th century produced data that caused researchers to look at low retention rates in higher education 28 and search for answers. This question has continued to consume researchers and higher education institutions. In 1987, Tinto attempted to summarize studies of individual student retention in higher education by proposing a theory to allow higher education administrators to predict success and support students (Tinto, 1987). Tinto’s model of student engagement has been in use for over 20 years as higher education administrators and faculty attempt to explain student retention issues at universities and colleges. Tinto’s model primarily focused on factors of student engagement: How students respond to instructors, the higher education community itself, and students’ own engagement in learning are the primary factors Tinto theorized as determining the student’s retention. In the concluding remarks to his 1987 treatise on retention, Tinto acknowledged that persistence in higher education is but one facet of human growth and development, and one that cannot necessarily be attributed to a single factor or strategy. Tinto’s (1987) original study of student retention included the observation that student retention is a complicated web of events that shape student leaving and persistence. He observed that the view of student retention had changed since the 1950s, when students were thought to leave due to lack of motivation, persistence, and skills, hence the name dropout. In the 1970s, research began to focus on the role of the environment in student decisions to stay or leave. In the 1990s, Tinto proposed that the actions of the faculty were the key to institutional efforts to enhance student retention (Tinto, 2007). This was a significant addition to his theory, placing the cause on the instructor instead of the student, and it has done much to influence retention strategies 29 utilized in higher education institutions (Tinto, 2007). Tinto’s studies have driven research in both traditional retention studies and those involving distance education. Studies of the persistence of the postsecondary student routinely focus on 4-year postsecondary education. It is only within the last 20 years that persistence studies have included community college students and occupational students, acknowledging that their reasons for entering the postsecondary community are different from the traditional 4- year higher education participant (Cohen & Brawer, 1996). With different avenues to a baccalaureate degree more prevalent, the research into college persistence has expanded to include other types of programs and students. Postsecondary student retention rates routinely utilize data from longitudinal studies of students entering in a Fall semester and completing a bachelor’s program no more than 6 years later (NCES, 2003). The National Center for Education Statistics reported that 55% of those seeking a baccalaureate degree would complete in 6 years (NCES, 2003). The report acknowledged institutions are unable to follow students who transfer to other institutions; they are able to report only the absence of enrollment in their own institution. Research has also found a large gap between community college entrants and 4- year college entrants in rates of attaining a bachelor’s degree. Dougherty (1992) reported that students entering community college receive 11 to 19% fewer bachelor’s degrees than students beginning at a 4-year university. Dougherty postulated that the lower baccalaureate attainment rate of community college entrants was attributable to both their individual traits and the institution they entered (Dougherty, 1992). 30 Studies of student retention of community college also vary based on the types of students. Community college retention rates are routinely reported as lower than traditional 4-year institutions (NCES, 2007). Cohen and Brawer (1996) attributed the differences in retention to the difference in the mission. In many instances, students did not enroll in a community college in order to attain a degree (Cohen & Brawer, 1996). The most recent longitudinal study in 1993 showed a retention rate of 55.4% of students after 3 years (NCES, 2001). Of community college students, only 60.9% indicated a desire to transfer later to a baccalaureate degree completion program (NCES, 2003). While retention data collected by the federal government (NCES, 2003) did not include students with an AAS degree, Townsend’s studies of the transfer rates and baccalaureate attainment rates of students in Missouri who had completed an Associate of Arts and students who had completed an Associate of Applied Science degree was 61% compared to 54% (Townsend, 2001). Vocational or occupational programs have reported retention rates as “program completion,” a definition involving completion of specific tasks and competencies instead of grades and tied to a limited program length. This state and federal requirement indicates program quality and ensures continued federal funding. In 2001, the U.S. Department of Education reported a 60.1% completion rate of postsecondary students enrolled in occupational education (NCES, 2007). Until 1995, the reasons for students leaving was neither delineated nor reported; it was not until federal reporting requirements under the Carl Perkins Act of 1994 that institutions were required to explore why students were not retained in vocational programs (P.L. 105-332). 31 Distance education provided a new arena for the study of student persistence. Theorists and researchers have attempted to utilize Tinto’s model of student persistence to explain retention issues involved with distance education. However, Rovai (2003) analyzed the differing student characteristics of distance learners as compared to the traditional students targeted by Tinto’s original models and concluded that student retention theories proposed from that population were no longer applicable to distance education learners. Rovai proposed that distance educators could address retention in ways that traditional higher education has not. He suggested that distance educators utilize strategies such as capitalizing on students’ expectations of technology, addressing economic benefits and specific educational needs to increase student retention in courses (Rovai, 2003). The expanded use of technology created a distinct subset of research into student retention issues. In 2004, Berge and Huang developed an overview of models of student retention, with special emphasis on models developed to explain the retention rates in distance education. Their studies primarily focused on the variables in student demographics and external factors, such as age and gender, which influence persistence and retention in online learning. Berge and Huang found that traditional models of student retention such as Tinto’s did not acknowledge the differences in student expectations and goals that are ingrained in the student’s selection of the online learning option. Other researchers have attempted to study retention issues specifically for online education. In a meta-analysis, Nora and Snyder (2009) found the majority of studies of online education focused on students’ individual characteristics and individual 32 perceptions of technology. Nora and Snyder concluded that researchers attempt to utilize traditional models of student engagement to explain student retention issues in distance or online learning courses, with little or no success. This supported Berge and Huard’s conclusions. Nora and Snyder (2009) also noted a dearth of quantitative research. Few quantitative studies exist that support higher or equal retention in online students compared to their classroom-based counterparts. One example is the Carmel and Gold (2007) study. They found no significant difference in student retention rates between students in distance education courses and their traditional classroom-based counterparts. The study utilized data from 164 students, 95 enrolled in classroom-based courses and 69 enrolled in a hybrid online format. Participants randomly self-selected and were not all enrolled in the same course, introducing variables not attributed in the study. The majority of quantitative studies instead concluded there is a higher retention rate in traditional classrooms than in distance education. In the Phipps and Merisotis (1999) review of Russell’s original research, which included online education, results indicated that research has shown even lower retention rates in online students than in students attending classes in the traditional college setting. The high dropout rate among distance education students was not addressed in Russell’s meta-analysis, and Phipps and Merisotis found no suitable explanation in the research. They postulated that the decreased retention rate documented within distance education studies skews achievement data by excluding the dropouts. Diaz (2002) found a high drop rate for online students compared to traditional classroom-based students in an online health education course at Nova Southeastern. Other studies have supported the theory that retention of online students is far below that 33 of the traditional campus students. In 2002, Carr, reporting for The Chronicle of Higher Education, noted that online courses routinely lose 50 % of students who originally enrolled, as compared to a retention rate of 70-75% of traditional face-to-face students. Carr reported dropout rates of up to 75% in online courses as a likely indicator of the difficultly faced in retaining distance education students who do not routinely meet with faculty. The data have not been refuted. As community colleges began utilizing distance education, retention rates were reported as higher than traditional students (Nash, 1984). However, the California Community College System report for Fall 2008 courses showed inconsistent retention results for distance education learners, varying by the type of course. Results indicated equivalent retention rates for online instruction compared to traditional coursework in the majority of courses. Lower retention rates were indicated in online engineering, social sciences, and mathematics courses as compared to traditional classroom instructional models (California Community Colleges Chancellor's Office, 2009). Due to the limited number of vocational/technical or occupational courses taught in the online mode, there was little data on student retention. In 1997, Hogan studied technical course and program completion of students in distance and traditional vocational education and found that course completion rates were higher for distance education students. However, program completion rates were higher for traditional students than for students enrolled in distance education (Hogan, 1997). In summary, studies of retention have focused primarily on student characteristics while acknowledging that postsecondary retention rates vary according to a variety of factors. Research showed mixed results concerning the retention rate of online students, 34 though quantitative data leans heavily toward a lower course retention rate in online students. Data from 4-year universities have shown lower retention rates for online students than for traditional face-to-face students, while community colleges have shown inconsistent results. Data from vocational-technical education has been limited, but course retention rates are higher for online students, while program retention rates are lower. No significant research factor affecting retention has been isolated between students in online baccalaureate completion programs and students participating in traditional classroom-based settings. Summary Research studies have been conducted analyzing student retention in higher education, transfer and retention of students from community colleges to universities, the impact of distance education, and student achievement and retention factors related to distance education. However, no comparative research was identified that compared the achievement and retention of students participating in an occupationally oriented transfer program utilizing both online education and traditional classroom-based instruction. Chapter Three addresses the topics of research design, hypotheses, and research questions. Additionally, population and sample, data collection, and data analysis are discussed. 35 CHAPTER THREE METHODOLOGY The purpose of this study was to determine if there is a significant difference between course grades of students enrolled in online Technology Administration courses and their traditional classroom-based counterparts. The study also examined if there is a significant difference between course retention and program retention of students enrolled in online Technology Administration courses and their traditional classroombased counterparts. The methodology employed to test the research hypotheses is presented in this chapter. The chapter is organized into the following sections: research design, hypotheses and research questions, population and sample, data collection, data analysis, and summary. Research Design A quantitative, quasi-experimental research design was selected to study grades, course retention, and program retention in students enrolled in the Technology Administration program. The design was chosen as a means to determine if significant differences occur between online and face-to-face students by examining numerical scores from all participants enrolled, and retention rates in both courses and programs in the Technology Administration program. Hypotheses and Research Questions This study focused on three research questions with accompanying hypotheses. The research questions and hypotheses guiding the study follow. 36 Research Question 1: Is there is a statistically significant difference between students’ grades in online classes and traditional face-to-face classes? H1: There is a statistically significant difference in course grades of students participating in online courses and students enrolled in a traditional classroom setting at the 0.05 level of significance. Research Question 2: Is there a statistically significant difference between course retention rate of students in online classes and traditional face-to-face classes? H2: There is a statistically significant difference in student course retention between students participating in online courses and students enrolled in face-to-face courses at the 0.05 level of significance. Research Question 3: Is there a statistically significant difference in program retention between students who entered the program in online classes and students who entered the program in traditional face-to-face classes? H3: There is a statistically significant difference in program retention between students who begin the Technology Administration program in online courses and students who begin in face-to-face courses at the 0.05 level of significance. Population and Sample The two populations selected were students enrolled in online and face-to-face courses. The sample included students enrolled in Technology Administration courses. Student enrollment was analyzed for all Technology Administration courses in the program sequence to determine the number of samples available in online and face-toface classes. The course enrollment data for the sample are outlined in Table E1. The subsample of the data utilized for the study is presented in Table 1. 37 Table 1 Technology Administration Enrollment Data Year Instructor TA 300 TA310 FTF OL FTF OL Spring 02 A 14 25 Fall 02 A 11 20 9 26 Spring 03 A 29 38 Fall 03 A 20 29 13 34 Spring 04 B 32 25 Fall 04 B 18 32 10 28 Spring 05 B 23 31 Fall 05 B 15 28 11 28 Spring 06 B 13 30 Fall 06 B 14 24 24 32 Spring 07 B 15 33 Fall 07 B 16 23 27 30 Spring 08 B 22 3529 TOTAL 94 156 242 395 Note: TA 300 Evolution and Development of Technology, TA 310 Technology and Society The subsample for hypothesis 1 and hypothesis 2 included all students enrolled in two entry-level courses required for completion of the Technology Administration program: TA 300 Evolution and Development of Technology, and TA 310 Society and 38 Technology. The university offered the courses in online and face-to-face formats during the period of the study. Two instructors, identified as A and B, were involved with teaching the online and face-to-face courses. Two courses were selected that met the following criteria: (a) the same faculty member taught both courses, (b) the courses were offered over the period of the study consistently in online and face-to-face instruction, and (c) the syllabi for simultaneous online and face-to-face sections were identical. For hypothesis 3, data included records of all students enrolled in TA 300 Evolution and Development of Technology for the Fall semesters of 2002, 2003, 2004, 2005, and 2006. The course was selected for inclusion in the study based on the following criteria: (a) student enrollment in the course was the result of declaration of the Technology Administration program major and (b) parameters of the study allowed students 2 or more years to complete the program requirements. For the purpose of the study, all student names were removed. Data Collection An Institutional Review Board (IRB) form was prepared for Washburn University approval prior to data collection. The study was designated as an exempt study. The Washburn University IRB form is provided in Appendix A. Approval of the IRB was transmitted by e-mail. A copy is located in Appendix B. In addition, an IRB was submitted to Baker University. The form is located in Appendix C. The Baker IRB approval letter is located in Appendix D. Washburn University had two types of data collection systems in place during the period identified for the study, Spring 2002 through Spring 2008. The AS 400 data collection system generated paper reports for 2002 and 2003. The researcher was allowed 39 access to paper records for 2002 and 2003. Enrollment results for all technology administration sections for 2002-2003 were entered manually into an Excel spreadsheet. In 2004, the University transferred to the Banner electronic student data management system. All records since 2004 were archived electronically and were retrieved utilizing the following filters for data specific to students enrolled in the identified Technology Administration courses: TA course designation and specific coding for year and semester to be analyzed (01 = Spring semester, 03 = Fall semester, 200X for specified year). Results retrieved under the Banner system were saved as an Excel spreadsheet by the researcher. The course enrollment data for the sample are presented in Tables E1 and E2. Student transcripts and records were analyzed to determine program completion or continued enrollment in the program for program retention analysis. Documents examined included paper student advising files located within the Technology Administration department and specific student records housed within the Banner reporting system. Technology Administration course TA 300 was selected based on the following: (a) It is a required entry course only for Technology Administration majors, and (b) TA 310 is a dual enrollment course for business department majors. Data Analysis Data analysis for all hypothesis testing was conducted utilizing SPSS software version 16.0. The software system provided automated analysis of the statistical measures. To address Research Question 1, a two-factor analysis of variance was used to analyze for a potential difference in delivery method (online and face-to-face), potential 40 difference in instructor (instructors A and B), and potential interaction between the two factors. When the analysis of variance reveals a difference between the levels of any factor, Salkind (2008) referred to this as the main effect. This analysis produces three F statistics: to determine if a difference in grades of online students as compared to their classroom based counterparts was affected by a main effect for delivery, a main effect for instructor, and for interaction between instructor and delivery. Chi-square testing was selected to address research questions 2 and 3. The rationale for selecting chi-square testing was to observe whether a specific distribution of frequencies is the same as if it were to occur by chance (Salkind, 2008). If the obtained chi-square value is greater than the critical value, it indicates there is sufficient evidence to believe the research hypothesis is true. For research question 2, a chi-square test for differences between proportions analyzed course retention of online and face-to-face students at the end of semester. For Research Question 3, a chi-square test for differences between proportions analyzed program retention comparing students who began the program in the online section of TA 300 to the students who began in the face-to-face section. Limitations of the Study Roberts (2004) defined the limitations of the study as those features of the study that may affect the results of the study or the ability to generalize the results. The limitations of this study included (a) potential for data entry error, (b) curriculum modifications not reflected in the syllabi made by instructors over the period of the study, (c) behavior of the instructors during delivery in the two different formats, and (d) 41 rationale of students for selecting one course delivery method over another. These may affect the generalizability of this study to other populations. Summary This chapter described the research design, population and sample, hypotheses, data collection, and analysis used in this research study. Statistical analysis using twoway analysis of variance and chi-square were used to determine if there are significant statistical differences in the course grades, course retention, and program retention of students enrolled in online classes as compared to their face-to face counterparts. The results of this study are presented in Chapter Four. 42 CHAPTER FOUR RESULTS The study had three main purposes. The first purpose was to determine if there was a difference in grades between students in online classes and students in traditional face-to-face classes in the Technology Administration program. In addition, the study was designed to examine the difference in course retention rates of students in the online classes as compared to the face-to-face classes. The third part of the study was designed to examine program retention rates of students who began the program in online classes and students who began the program in traditional face-to-face classes. This chapter begins with the descriptive statistics for the sample: gender, age, grades by gender, and course selection of students in online or face-to-face courses by gender. From the three research questions, research hypotheses were developed, and the results of statistical analyses used to test each hypothesis are presented. Descriptive Statistics Demographic data for the sample was collected from the student data system for 2002 through 2009. The descriptive statistics presented below include gender (n = 884), age (n = 880), grades by gender (n = 884) and course selection online or face-to-face by gender (n = 884). Table 2 describes the cross-tabulation of the frequencies for gender and of the sample selected for the study. The mean age for the sample tested was 31.06 years, with a standard deviation of 9.46 years. The age range of the sample was from 18 to 66 years. One participant did not report gender. Age was not available for three participants. 43 Table 2 Participant Age Group by Gender (n=880) Age Range By Years < 20 20-29 30-39 40-49 50-59 60-69 Female 0 198 121 62 29 3 Male 5 281 104 53 19 5 Note: Gender not reported for one participant; Age not reported for four participants Females = 413 Males = 467 Table 3 presents the frequency of course grades by gender and total number of students receiving each grade. Grades were distributed across the continuum, with slightly more females than males receiving A’s, more males than females receiving B’s, C’s and F’s, and an equal distribution of students receiving D’s. More males withdrew from classes than did females. 44 Table 3 Average Grades by Gender (n=884) Grades Female Male Total A 245 208 453 B 53 79 132 C 32 70 102 D 17 16 33 F 37 55 92 No Credit 1 0 1 Passing 0 1 1 Withdraw 25 42 67 Withdraw Failing 3 0 3 Total 413 471 884 Note: Gender not reported for one participant Table 4 presents the course selection patterns of male and female students. Overall, more students selected online courses than face-to-face courses. Females and males enrolled in online courses in equal numbers; however, proportionally more females (68.7%) chose the online instructional format instead of face-to-face compared with males (60.1%). 45 Table 4 Course Selection by Gender (n=884) Course Type Female Male Total Face-to-face 129 184 313 Online 284 287 571 Total 413 471 884 Note: Gender not reported for one participant Hypothesis Testing H1: There is a statistically significant difference in the course grades of students enrolled in online classes and students enrolled in a traditional classroom setting at the 0.05 level of significance. The sample consisted of 815 students enrolled in online and face-to-face Technology Administration courses at Washburn University. A two-factor analysis of variance was used to analyze for the potential difference in course grades due to delivery method (online and face-to-face), the potential difference due to instructor (instructors A and B), and the potential interaction between the two independent variables. Mean and standard deviation for grades were calculated by delivery type and instructor. Table 5 presents the descriptive statistics. The mean of grades by delivery showed no significant difference between online and face-to-face instruction. Additionally, no significant difference in mean grade was evident when analyzed by instructor. 46 Table 5 Means and Standard Deviations by Course Type and Instructor Course type Instructor Mean Standard Deviation n Face-to-face A 3.0690` 1.41247 29 B 2.9586 1.39073 266 Total 2.9695 1.39084 295 Online A 2.9024 1.52979 41 B 3.0271 1.35579 479 Total 3.0271 1.36911 520 Total A 2.9714 1.47414 70 B 3.0027 1.36783 745 Total 3.000 1.37635 815 The results of the two-factor ANOVA, presented in Table 6, indicated there was no statistically significant difference in grades due to delivery method (F = 0.078, p = 0.780, df = 1, 811). This test was specific for hypothesis 1. In addition, there was no statistically significant difference in grades due to instructor (F = 0.002, p = .967, df = 1, 811), and no significant interaction between the two factors (F = 0.449, p = 0.503, df = 1, 811). The research hypothesis was not supported. 47 Table 6 Two-Factor Analysis of Variance (ANOVA) of Delivery by Instructor df F p Delivery 1 0.148 0.780 Instructor 1 0.003 0.967 Delivery*Instructor 1 0.449 0.503 Error 811 Total 815 H2: There is a statistically significant difference in student course retention between students enrolled in online courses and students enrolled in face-to-face courses at the 0.05 level of significance. The sample consisted of 885 students enrolled in TA 300 and TA 320 online and face-to-face courses. The hypothesis testing began with the analysis of the contingency data presented in Table 7. The data are organized with course selection (online or face-to-face) as the row variable and retention in the course as the column variable. Data were included in the retained column if a final grade was reported for participant. Participants who were coded as withdraw or withdraw failing were labeled as not retained. Chi-square analysis was selected to observe whether a specific distribution of frequencies is the same as if it were to occur by chance (Roberts, 2004). The result of the chi square testing (X2 = 2.524, p = .112, df = 1, 884) indicated there was no statistically significant difference between retention of students enrolled in online courses compared to students enrolled in face-to-face courses in the TA program. Additional results indicated that 93.92% (294/313) of the online students were retained, 48 compared to 90.89% (519/571) of the face-to-face students. The research hypothesis was not supported. Table 7 Course retention of online and face-to-face TA students Retained Not retained Total Face-to-face students 294 19 313 Online students 519 52 571 Total 813 71 884 H3: There is a statistically significant difference in program retention between students who begin the Technology Administration program in online courses and students who begin in face-to-face courses at the 0.05 level of significance. The sample consisted of 249 students enrolled in TA 300 in the online and face-to-face courses from Fall 2002 through Fall 2008. The hypothesis testing began with the analysis of the contingency data located in Table 8. The table is organized with course selection (online or face-to-face) as the row variable and program retention as the column variable. Data were included in the retention column if students had successfully met requirements for a Bachelors of Applied Science in Technology Administration or if they were enrolled in the program in Spring 2009. Data were included in the non-retained column if students had not fulfilled degree requirements and they were not enrolled in Spring 2009. Chisquare analysis was selected to observe whether a specific distribution of frequencies is the same as if it were to occur by chance (Roberts, 2004). 49 The result of the chi-square testing (X2 = .132, p = .717, df = 1, 249) indicated there was no statistically significant difference between the program retention rate of students who began the TA program in the online courses compared to the students who began the program in the face-to-face courses. Additional results showed that 91.57% (163/178) of students who began in online courses were retained compared to 92.96% (66/71) of students who began the TA program in face-to-face courses. The research hypothesis was not supported. Table 8 Program retention of online and face-to-face TA students Retained Not retained Total Face-to-face 66 5 71 Online 163 15 178 Total 229 20 249 Summary In this chapter, an introduction provided a summary of the analysis and statistical testing and in the order in which it was presented. This was followed by descriptive statistics of the sample, including age range of participants, grades by gender, and course selection by gender. Results from testing of H1 revealed no significant difference between course grades of online students and students enrolled in traditional face-to-face classes. Chisquare testing was utilized for testing of H2. Results indicated there was no significant 50 difference in course retention of students enrolled in online courses and students enrolled in traditional face-to-face courses. H3 was also tested utilizing chi-square testing. The results indicated no significant difference in program retention of students who began the TA program in online courses and students who began in traditional face-to-face courses. Chapter Five provides a summary of the study, discussion of the findings in relationship to the literature, implications for practice, recommendations for further research, and conclusions. 51 CHAPTER FIVE INTERPRETATION AND RECOMMENDATIONS Introduction In the preceding chapter, the results of the analysis were reported. Chapter Five consists of the summary of the study, an overview of the problem, purpose statement and research questions, review of the methodology, major findings, and findings related to the literature. Chapter Five also contains implications for further action and recommendations for further research. The purpose of the latter sections is to expand on the research into distance education, including implications for expansion of course and program delivery and future research. Finally, a summary is offered to capture the scope and substance of what has been offered in the research. Study Summary The online delivery of course content in higher education has increased dramatically in the past decade. Allen and Seaman (2007a) reported that almost 3.5 million students participated in at least one online course during the Fall 2006 term, a nearly 10% increase over the number reported in the previous year. They also reported a 9.7% increase in online enrollment compared to the 1.5% growth in overall higher education. As online delivery has grown, so has criticism of its efficacy. Online delivery of education has become an important strategy for the institution that is the setting of this study. The purpose of this study was three-fold. The first purpose of the study was to determine if there was a significant difference between the course grades of students participating in TA online courses and their traditional classroombased counterparts. The second purpose of the study was to determine if there was a 52 significant difference between course retention of students participating in TA online courses and their traditional classroom-based counterparts. A third purpose of the study was to determine if there was a significant difference between program retention of students who began the TA program in online courses and those who began the program enrolled in traditional face-to-face courses. The study was designed to expand the knowledge base concerning online education and its efficacy in providing baccalaureate degree completion opportunities. The research design was a quantitative study to compare course grades, course retention, and program retention of students enrolled in the online and traditional face-toface TA program at Washburn University. Archival data from the student system at Washburn University was utilized to compare online and traditional face-to-face students. In order to answer Research Question 1, a sample of students enrolled in TA 300 and TA 310 online and traditional face-to-face courses was analyzed. The sample included students entering the program in the Fall semesters of 2002, 2003, 2004, 2005, and 2006. Two instructors were responsible for concurrent instruction of both the online and faceto-face classes for the period analyzed. A two-factor analysis of variance was used to analyze for a potential difference in the dependent variable, course grades, due to delivery method (online and face-to-face), the instructor (instructors A and B), and the potential interaction between the two independent variables (Research Question 1). A chi-square test for differences among proportions was used to analyze both course and program retention (Research Questions 2 and 3). For Research Question 2, archived data from the Washburn University student system was analyzed for students enrolled in TA 300 and TA 310. Additional variables identified for this sample included 53 course selection and instructor (A or B). For Research Question 3, archived data from the Washburn University system was used, which identified students with declared Technology Administration majors who began the TA program enrolled in online and face-to-face courses. A single gatekeeper course (TA 300) was identified for testing. Two instructors (A and B) were responsible for instruction during the testing period. A two-factor ANOVA was utilized to test H1: There is a statistically significant difference in course grades of students participating in online courses and students enrolled in a traditional classroom setting at the 0.05 level of significance. ANOVA testing was utilized to account for the two delivery methods and two instructors involved for the period of the study. The results of the test indicated there was no statistically significant difference in grades due to delivery method. The results of the testing also indicated no statistically significant difference in grades due to instructor and no interaction between the two independent variables. The research hypothesis was not supported. To test the next hypothesis, chi-square testing was utilized. H2: There is a statistically significant difference in student course retention between students participating in online courses and students enrolled in face-to-face courses at the 0.05 level of significance. The result of the chi-square testing indicated there was no statistically significant difference in course retention of students enrolled in online courses and students enrolled in face-to-face courses in the TA program. The research hypothesis was not supported. To test the final hypothesis, chi-square testing was also used. H3: There is a statistically significant difference in program retention between students who begin the 54 Technology Administration program in online courses and students who begin in face-toface courses at the 0.05 level of significance. The result of the chi-square testing indicated there was no statistically significant difference in the program retention rate of students who began the TA program in the online courses and students who began the program in the face-to-face courses. The research hypothesis was not supported. Testing found that course retention was high in both formats, leading to interpretation that higher results may be due to the age of participants or prior degree completion. The results found no significant difference in grades, course, or program retention for students in online TA courses and students enrolled in traditional face-to-face instruction. The implication of these results compared to current literature is discussed in the next section. Findings Related to the Literature Online education has become a strategy for higher education to provide instruction to students limited by distance or time, or who, for other reasons, do not wish to attend traditional classroom-based university classes. Additionally, online education allows higher education institutions to expand their geographic base. Institutions have utilized distance education for over a century to provide instruction, but it was only within the last two decades that instruction over the Internet had replaced correspondence, television, and video courses as the method of choice for delivery (Russell, 1999). Utilizing grades as a measure of achievement, meta-analyses conducted by Russell (1999), Shachar and Neumann (2003), and Machtmes and Asher (2002) found no significant difference in grades of online students and traditional classroom-based 55 students. These analyses utilized multiple studies of course information, comparing grades of online students and traditional face-to-face students, primarily utilizing t tests as the preferred methodology. The results of previous research were supported by the present study. Additionally, this study went further, analyzing data over more than one semester, controlling for the effect of different instructors. These results were contrary to the conclusion reached by Phipps and Merisotis (1999). The second purpose of the study was to determine if a significant difference existed between the course retention of students enrolled in online TA courses and students enrolled in face-to-face courses. Meta-analyses conducted by Phipps and Merisotis (1999) and Nora and Snyder (2009) concluded a much lower course retention rate in online students as compared to their face-to-face counterparts. The previous metaanalyses examined retention of online students and traditional face-to-face students in distinct courses, utilizing t tests as the primary methodology. The chosen method of t tests was used instead of the chi square testing due to the limitations of the studies to one course taught by one instructor, limited to one semester or cycle. Carr (2002) reported in The Chronicle of Higher Education that retention of online students was 50% less than that of traditional face-to-face students. Carr’s results were based on the examination of longitudinal retention data from universities as reported to the United States Department of Education. The results of the present study found no significant difference in the course retention rates. These results are supported by the findings of Carmel and Gold (2007) in which they reported no significant difference in course retention rates of online students compared to traditional face-to-face students in their analysis of students in multiple 56 courses in disciplines across a 4-year university. The present study expanded those results, examining course data in the same discipline over a 6-year period and controlling for delivery by two separate instructors. Research into program completion rates of AAS students has been conducted primarily in traditional university settings, including Townsend’s (2002) studies at the University of Missouri-Columbia. Townsend’s results showed a lower baccalaureate completion rate for students entering with an AAS than students who transferred to 4- year universities with an AA degree. Studies by Hogan (1997) of vocational-education programs also found a lower program completion rate for online students compared to students in traditional delivery vocational education programs. Analysis of the data in the current study showed no significant difference in program completion rate of students who began in online TA courses as compared to students who began the program in faceto-face courses. Conclusions The use of distance education for postsecondary instruction, primarily in the form of the Internet, has both changed and challenged the views of traditional university-based instruction. Multiple studies have been designed in an effort to examine whether online students have the same level of academic achievement as their traditional higher education peers. The present study agrees with the research indicating there is no statistically significant difference in the grades of online students and their face-to-face counterparts. In addition, with student retention an issue for all postsecondary institutions, the data from previous studies indicated a lower retention rate for online students than for their traditional face-to-face classmates. The current study contradicted 57 those arguments. In the following sections, implications for action, recommendations for research, and concluding remarks are addressed. Implications for Action As postsecondary institutions move into the 21st century, many have examined issues of student recruitment and retention in an effort to meet the demands of both their students and their communities. The majority of postsecondary institutions have initiated online education as a strategy to recruit students from beyond their traditional geographic areas. This study supported existing research utilizing grades as a measure of achievement and should alleviate doubt that online students are shortchanged in their education. The transition of existing face-to-face to courses to an online delivery model can be accomplished without sacrificing achievement of course and program goals. The study also examined course and program retention data, finding no significant differences between online and traditional students in the TA program. The findings of this study support the expansion of additional online courses and programs within the School of Applied Studies. Finally, this study can provide the basis for further action, including analyzing other programs and courses offered in the online format by the University. The analysis of other programs offered in an online delivery model would enhance further development of online courses and programs. Recommendations for Future Research Distance education delivery has expanded dramatically with the use of the Internet for online instruction. The present study could be continued in future years to measure the effects of specific curriculum delivery models and changes made to online 58 delivery platforms. In addition, the study could be expanded to include specific characteristics of student retention named in the literature, such as examining whether the age and entering GPA of students provides any insight into course and program retention. The study could also be expanded to include other universities with similar baccalaureate-degree completion programs and other disciplines. Because the body of research is limited concerning the baccalaureate-degree completion of students who begin their postsecondary education in career-oriented instruction, there is value in continuing to study baccalaureate completion rates, both in an online format and in more traditionally based settings. Concluding Remarks The current study examined a Technology Administration program that has been offered in both online and face-to-face format, utilizing data from Fall 2002 through Spring 2008. The TA program was developed to allow students who had completed an occupationally oriented AAS degree to complete a bachelor’s degree program. Three hypotheses were tested in this study, examining course grades, course retention, and program retention of students enrolled in online and face-to-face courses in Technology Administration. No significant difference was found for the three hypotheses. These results form a strong foundation for expanding online courses and programs at Washburn University. By addressing two of the major concerns of educators, achievement and retention, the study results allow expansion of online courses and programs to benefit from data-driven decision-making. Other institutions can and should utilize data to examine existing online course and program data. 59 REFERENCES Allen, I. E., & Seaman, J. (2003). Seizing the opportunity: The quality and extent of online education in the United States, 2002 and 2003. Needham, MA: The Sloan Consortium. Allen, I. E., & Seaman, J. (2005). Growing by degrees: Online education in the United States, 2005. Needham, MA: The Sloan Consortium. Allen, I. E., & Seaman, J. (2007a). Making the grade: Online education in the United States. Needham, MA: The Sloan Consortium Allen, I. E., & Seaman, J. (2007b). Online nation: Five years of growth in online learning. Needham, MA: The Sloan Consortium. Arle, J. (2002). Rio Salado College online human anatomy. In C. Twigg, Innovations in online learning: Moving beyond no significant difference (p. 18). Troy, NY: Center for Academic Transformation. Atkins, T. (2008, May 13). Changing times bring recruiting challenges at WU. Retrieved May 15, 2008, from CJOnline Web site at http://cjonline.com/stories/ 051308/loc_278440905.shtml Berge, Z., & Huang, L. P. (2004, May). A model for sustainable student retention: A holistic perspective on the student dropout problem with special attention to elearning. American Center for the Study of Distance Education. Retrieved April 17, 2009, from DEOSNEWS Web site at http://www.ed.psu.edu/acsde/deos/deosnews/deosarchives.asp 60 Bradburn, E., Hurst, D., & Peng, S. (2001). Community college transfer rates to 4-year institutions using alternative definitions of transfer. Washington, DC: National Center for Education Statistics. Brown, B. W., & Liedholm, C. (2002, May). Can Web courses replace the classroom in principles of microeconomics? The American Economic Review, 92, 444-448. California Community Colleges Chancellor's Office. (2009, April 20). Retention rates for community colleges. Retrieved April 20, 2009, from https://misweb.cccco.edu/mis/onlinestat/ret_suc_rpt.cfm?timeout=800 Carmel, A. & Gold, S. S.. (2007). The effects of course delivery modality on student satisfaction and retention and GPA in on-site vs. hybrid courses. Retrieved September 15, 2008, from ERIC database. (Doc. No. ED496527) Carnevale, D. (2006, November 17). Company's survey suggests strong growth potential for online education. The Chronicle of Higher Education , p. 35. Carr, S. (2000, February 11). As distance education comes of age, the challenge is keeping the students. The Chronicle of Higher Education , pp. 1-5. Cohen, A., & Brawer, F. (1996). The American community college. San Francisco: Jossey-Bass. Diaz, D. (2002, May-June). Online drop rates revisited. Retrieved April 8, 2008, from The Technology Source Archives Web site at http://www.technologysource.org/article/online_drop_rates-revisited/ Dougherty, K. J. (1992). Community colleges and baccalaureate attainment. The Journal of Higher Education, 63, 188-214. 61 Ebel, R., & Frisbie, D. (1991). Essentials of educational measurement. Prentice Hall: Englewood Cliffs, NJ. The Harvard guide. (2004). Retrieved May 20, 2008, from http://www.news.harvard.edu/guide Hogan, R. (1997, July). Analysis of student success in distance learning courses compared to traditional courses. Paper presented at Sixth Annual Conference on Multimedia in Education and Industry, Chattanoga, TN. Jacobs, J., & Grubb, W. N. (2003). The federal role in vocational education. New York: Community College Research Center. Joliet Junior College history. (2008). Retrieved May 20, 2008, from Joliet Junior College Web site at http://www.jjc.edu/campus_info/history/ Kansas Board of Regents. (2002-2003). Degree and program inventory. Retrieved May 14, 2008, from http://www.kansasregents.org Keeley, E. J., & House, J. D. (1993). Transfer shock revisited: A longitudinal study of transfer academic performance. Paper presented at the 33rd Annual Forum of the Association for Institutional Research, Chicago, IL. Knowles, M. S. (1994). A history of the adult education movement in the United States. Melbourne, FL: Krieger. Laanan, F. (2003). Degree aspirations of two-year students. Community College Journal of Research and Practice, 27, 495-518. Lynch, T. (2002). LSU expands distance learning program through online learning solution. T H E Journal (Technological Horizons in Education), 29(6), 47. 62 Machtmes, K., & Asher, J. W. (2000). A meta-analysis of the effectiveness of telecourses in distance education. The American Journal of Distance Education, 14(1), 27-41. Gilman, E. W., Lowe, J., McHenry, R., & Pease, R. (Eds.). (1998). Merriam-Webster’s collegiate dictionary. Springfield, MA: Merriam. Nash, R. (1984, Winter). Course completion rates among distance learners: Identifying possible methods to improve retention. Retrieved April 19, 2009, from Online Journal of Distance Education Web site at http://www.westga.edu/~distance/ojdla/winter84/nash84.htm National Center for Education Statistics. (2000). Distance education statistics 1999-2000. Retrieved March 13, 2008, from at http://nces.ed.gov/das/library/tables_listing National Center for Education Statistics. (2001). Percentage of undergraduates who took any distance education courses in 1999-2000","INTRODUCTION Historically, postsecondary education in the United States was founded on the principles of the European system, requiring the physical presence of professors and students in the same location (Knowles, 1994). From 1626, with the founding of Harvard University (The Harvard Guide, 2004), to the development of junior colleges and vocational schools in the early 1900s (Cohen & Brawer, 1996; Jacobs & Grubb, 2003), the higher education system developed to prepare post-high school students for one of three separate tiers. The college and university system in the United States developed its own set of structures designed to prepare students for baccalaureate and graduate degrees. Junior colleges were limited to associate degrees, while vocational education institutions offered occupational certificates. In many cases, there was inadequate recognition of the postsecondary education offered at junior colleges and vocational education institutions, resulting in the inability of students to transfer to 4-year institutions (National Center for Education Statistics, 2006). In the mid-20th century, some junior colleges began to provide academic, vocational, and personal development educational offerings for members of the local communities. During this same period, junior or community colleges developed a role as transfer institutions for students who, because of time, preparedness, economics, or distance, could not begin their postsecondary education at a 4-year institution (Cohen & Brawer, 1996). Until the mid-1990s, the majority of transfer programs involved Associate of Arts (AA) and Associate of Science (AS) degrees. Associate of Applied Science (AAS) degrees were developed during the 1990s. The AAS degree was granted to those 2 who successfully completed the majority of their college program in vocational education. The creation of a variety of applied baccalaureate degrees allowed students who had previously thought of the AAS degree as a terminal program to complete a baccalaureate degree (Kansas Board of Regents, 2002-2003). Online education also became a strategy for students to access higher education in the 1990s (Allen & Seaman, 2007b). The proliferation of online courses alleviated some of the location-bound barriers to higher education, but online education was criticized as less rigorous than traditional classroom-based course work by traditional academicians. Russell attempted to address this argument with his 1999 meta-analysis of studies dating from the 1920s and covering multiple delivery models, including online education. Russell concluded there was no statistically significant difference in student achievement between courses offered online and those offered in the traditional classroom setting. Since the development of correspondence courses in the 1920s, researchers have attempted to ascertain if students participating in distance education are being shortchanged in their educational goals. No significant difference in grades has been found in the majority of studies designed to address this issue. Studies analyzing online student retention have shown significantly lower retention for online students. In the last 10 years, research studies have expanded to include variations of online education. These include strictly online, hybrid courses, Web-assisted classroom settings, and the traditional higher education course offered only as face-to-face instruction (Carmel & Gold, 2007). Online education continues to proliferate at the same time the number of secondary students in the United States overall is projected to increase (National Center 3 for Education Statistics [NCES], 2006). The projected increase of potential postsecondary students and online postsecondary options provides opportunities for increases in online education programs and courses. In 2000, NCES reported that over 65% of students in higher education were participating in online courses. In a 2007 study, Allen and Seaman estimated only 16% of those enrolled in online education courses are undergraduate students seeking their first degree, counter to the projected increase in traditional-age students. The majority of enrollees in online education are adults updating or advancing their credentials, creating an additional educational market for colleges and universities seeking to expand enrollment without adding physical space (Allen & Seaman, 2007a). For states and localities faced with a contradictory traditional-age enrollment decrease, these figures present an untapped market for higher education courses and programs. Background Researchers attempted to analyze the efficacy of distance education as far back as the 1920s when correspondence courses were created to meet the need of students not willing to attend a traditional classroom-based higher education setting. A meta-analysis of these studies resulted in “The No Significant Difference Phenomenon,” reported by Russell (2001). The results of over 355 studies were compiled, comparing various modes of delivery including correspondence, audio, television courses, and the newest wave of computer-facilitated instruction. Following analyses of studies completed prior to 2001, Russell concluded there was no difference in learning between students enrolled in distance education and those completing courses in the traditional setting. Studies completed since then have provided mixed results. Summers, Waigand, and Whittaker (2005) found there was no difference in GPA and retention between the 4 online and traditional classroom. Arle (2002) found higher achievement by online students, and Brown and Liedholm (2002) found GPA and student retention better in a traditional classroom setting. Student retention is an integral part of the student achievement conversation and is an issue for all forms of higher education. Degree-seeking students’ overall retention has been reported as less than 56% by NCES (2001). Long considered a problem in higher education, attention to the distance education model has shown even lower retention rates in online students than in students attending at the traditional college setting (Phipps & Meristosis, 1999). Research on different modalities, such as fully online and hybrid online courses, has produced mixed results (Carmel & Gold, 2007). No significant trend toward increased retention of students in any of the online modalities has been documented. Retention studies of transfer students have primarily included traditionally defined students transfering from a community college. Statistics have consistantly shown a lower retention rate for students transfering from a community college to a 4-year university than for students who began their post-high school education at a 4-year institution (NCES, 2006). Townsend’s studies of transfer students at the University of Missouri-Columbia also showed a lower baccalaureate retention rate for students who had completed an AAS degree than for students beginning their education at a 4-year institution (Townsend, 2002). Occupationally oriented bachelor’s degree completion programs are relatively new to higher education. Transfer programs in the liberal arts from community colleges to 4-year institutions were common by the 1990s. Townsend (2001), in her study 5 conducted at the University of Missouri–Columbia, observed the blurring of the lines between non-transferrable occupationally oriented undergraduate degrees and undergraduate degrees and certificates that were easily transferred. The study conducted by Townsend was among the first to recognize that many students who began their education at community and technical colleges had bachelor’s degree aspirations that grew after their completion of an occupationally-oriented degree. Laanan proposed that the increase in institutions offering AAS degrees necessitated new ways to transfer undergraduate credits (2003). The setting of this study is a medium-sized Midwestern campus located in Topeka, Kansas. Washburn University enrolls approximately 6000 students a year in undergraduate and graduate programs, including liberal arts, professional schools, and a law school (Washburn University, 2008). The Technology Administration (TA) program selected for the present study began in the 1990s as a baccalaureate degree completion program for students who had received an occupationally oriented associate degree at a Kansas community college or through Washburn’s articulation agreement with Kansas vocational-technical schools. This program provided students who previously had obtained an Associate of Applied Science degree in an occupational area an opportunity to earn a bachelor’s degree. Peterson, Dean of Continuing Education, Washburn University, stated that in early 1999, Washburn University began online courses and programs at the behest of a neighboring community college (personal communication, April 18, 2008). Washburn was asked to develop an online bachelor’s degree completion program for students graduating from community colleges and technical colleges with an Associate of Applied 6 Science degree. The TA program was among the first programs to offer the online bachelor’s degree completion option. The TA program offered its first online courses in Spring 2000. Online education at Washburn expanded to other programs and courses, to include over 200 courses (Washburn University, 2008). The original online partnership with two community colleges expanded to include 16 additional community colleges and four technical colleges in Kansas, as well as colleges in Missouri, California, Wisconsin, South Carolina, and Nebraska (Washburn University, 2008). An initial study in 2002 of student’s course grades and retention in online courses offered at Washburn showed no significant difference between students enrolled in online courses and students enrolled in traditional face-to-face course work (Peterson, personal communication, April 18, 2008). No studies of program retention have been completed. In 2008, Atkins reported overall enrollment at Washburn University decreased 6.7% from Fall 2004 to Fall 2008, from 7400 to 6901 students. During the same period, online course enrollment patterns increased 65%, from 3550 students to 5874 in 2007- 2008 (Washburn University, 2008). Atkins also reported that between 1998 and 2008, the ratio of traditional post-high school age students to nontraditional students enrolling at Washburn University reversed from 40:60 to 60:40. The shift in enrollment patterns produced an increase in enrollment in the early part of the 21st century; however, Washburn University anticipated a decrease in high school graduates in Kansas through 2016, based on demographic patterns of the state. The state figures are opposite the anticipated increase of traditional-age students nationally (NCES, 2008). The increase in 7 distance education students in relation to the anticipated decline in traditional-age students provided the focus for the study. Purpose of the Study Online education has become an important strategy for the higher education institution that was the setting of this study. First, the purpose of the study was to determine if there was a significant difference between the course grades of students participating in TA online courses and their traditional classroom-based counterparts. The second purpose of the study was to determine if there was a significant difference between course retention of students participating in TA online courses and their traditional classroom-based counterparts. The second part of the study was a replication of studies comparing modes of online course delivery to traditional classroom-based instruction (Carmel & Gold, 2007; Russell, 1999). A third purpose of the study was to determine if there was a significant difference between program retention of students who began the TA program in online courses and those who began the program enrolled in traditional face-to-face courses. The study’s purpose was to expand the knowledge base concerning online education to include its efficacy in providing baccalaureate degree completion opportunities. Research Questions Roberts (2004) stated research questions guide the study and usually provide the structure for presenting the results of the research. The research questions guiding this study were: 8 1. Is there is a statistically significant difference between students’ grades in online classes and traditional face-to-face classes? 2. Is there a statistically significant difference between course retention rates in online classes and traditional face-to-face classes? 3. Is there a statistically significant difference between program retention for students entering the program enrolled in online classes and students entering the program enrolled in traditional face-to-face classes? Overview of the Methodology A quantitative study was utilized to compare grades by course, course retention, and program retention of students enrolled in the online and traditional face-to-face TA program at Washburn University. Archival data from the student system at Washburn University were utilized from comparative online and traditional face-to-face classes in two separate courses. In order to answer Research Question 1, a sample of 885 students enrolled in online and traditional face-to-face courses was identified. The sample included students entering the program in the Fall semesters of 2002, 2003, 2004, 2005, and 2006 in both the online and traditional face-to-face classes. Two instructors were responsible for concurrent instruction of both the online and face-to-face classes for the period analyzed. A two-factor analysis of variance was used to analyze for the potential difference in the dependent variables, course grades due to delivery method (online and face-to-face), instructor (instructors A and B), and the potential interaction between the two independent variables (Research Question 1). A chi-square test for differences among proportions was used to analyze course and program retention (Research Questions 2 and 3). 9 Delimitations Roberts (2004) defined delimitations as the boundaries of the study that are controlled principally by the researcher. The delimitations for this study were 1. Only data from 2002 through 2008 from Technology Administration online and face-to-face courses were utilized. 2. The study was confined to students enrolled at Washburn University in the Technology Administration program. 3. Only grades and retention were analyzed. Assumptions Assumptions are defined as those things presupposed in a study (Roberts, 2004). The study was based on the following assumptions: 1. Delivery of content was consistent between online and face-to-face courses and instructors, 2. Course objectives were the same for paired online and traditional face-toface courses, 3. All students enrolled in the TA program met the same criteria for admission to the University, 4. All data entered in the Excel spreadsheets were correct, 5. All students enrolled in the TA program met the same criteria for grade point average and program prerequisites. 10 Definitions The following terms are defined for the purpose of this study: Distance education. Education or training courses delivered to remote locations via postal delivery, or broadcast by audio, video, or computer technologies (Allen, 2007). Dropout. A dropout is defined as a student who has left school and discontinued studies (Merriam-Webster's Collegiate Dictionary, 1998). Face-to-face delivery. This is a course that uses no online technology; content is delivered in person, either in written or oral form (Allen, 2007). Hybrid course. This course is a blend of the online and face-to-face course. A substantial proportion of the content is delivered online, typically using some online discussions and some face-to-face meetings (Allen, 2007). Online course. This defines a course where most or all of the content is delivered online via computer technologies. Typically, there are no face-to-face meetings (Allen, 2007). 2+2 PLAN. The Partnership for Learning and Networking is a collaborative set of online 2+2 baccalaureate degree programs developed by Washburn University. The programs require completion of an associate degree from one of the partner community or technical colleges (Washburn University, 2008). Retention. This term refers to the completion of a course by receiving a letter grade in a course, or a certificate of completion or degree for program completion (Washburn University, 2008). Web-assisted. A course that uses Web-based technology to facilitate what is essentially a face-to-face course (Allen, 2007). 11 Organization of the Study This study consists of five chapters. Chapter One introduced the role of distance education in higher education. Chapter One included the background of the study, the research questions, overview of the methodology, the delimitations of the study, and the definition of terms. Chapter Two presents a literature review, which includes the history of occupational postsecondary education, distance education, and studies relating to grades and retention of students involved in distance education. Chapter Three describes the methodology used for the research study. It includes the selection of participants, design, data collection, and statistical procedures of the study. Chapter Four presents the findings of the research study. Finally, Chapter Five provides a discussion of the results, conclusions, and implications for further research and practice. 12 CHAPTER TWO LITERATURE REVIEW This chapter presents the background for research into the efficacy of distance education in the delivery of higher education. Research studies have focused primarily on grades as a measure of the quality of distance education courses as compared to traditional face-to-face instruction. Utilizing grades has produced a dividing line among education researchers concerning the use of distance education as a delivery model. Retention in distance education has focused primarily on single courses, with little program retention data available. Data from retention studies in higher education have focused primarily on the traditional 4-year university student. Retention studies of community college students have produced quantitative results; however, these studies have been directed at community college students who identify themselves as transfer students early in their community college careers. Retention studies of students enrolled in occupationally oriented programs are limited. Statistical data of higher education shows an increased use of distance education for traditional academic courses as well as occupationally oriented courses. The increase in distance education courses and programs has provided a new dimension to studies of both grades and retention. The recognition of this increase, as well as questions concerning its impact on student learning and retention, produced the impetus for this study. The following review of the literature represents the literature related to this research study. Through examination of previous research, the direction of the present study was formulated. Specifically, the chapter is organized into four sections: (a) the 13 history of occupational transfer programs; (b) the history and research of distance education, including occupational transfer programs utilizing distance education; (c) research utilizing grades as an indicator of student learning in online education; and (d) research focusing on student retention in higher education, including student retention issues in transfer education and online transfer courses and programs. History of Occupational Transfer Programs The measure of success in higher education has been characterized as the attainment of a bachelor’s degree at a 4-year university. Occupationally oriented education was considered primarily a function of job preparation, and until the 1990s was not considered transferrable to other higher education institutions. Occupational transfer programs are a recent occurrence within the postsecondary system that provides an additional pathway to bachelor’s degree completion. Historically, the postsecondary experience in the United States developed as a three-track system. Colleges were established in the United States in 1636 with the founding of Harvard College (The Harvard Guide, 2004). Junior colleges were first founded in 1901 as experimental post-high school graduate programs (Joliet Junior College History, 2008). Their role was initially as a transfer institution to the university. When the Smith-Hughes Act was passed in 1917, a system of vocational education was born in the United States (Jacobs & Grubb, 2003), and was designed to provide further education to those students not viewed as capable of success in a university setting. Vocational education, currently referred to as occupational or technical education, was not originally designed to be a path to higher education. The first programs were designed to help agricultural workers complete their education and increase their skills. 14 More vocational programs were developed during the early 20th century as industrialization developed and as increasing numbers of skills were needed by workers in blue-collar occupations (Jacobs & Grubb, 2003). In the mid-20th century, some junior colleges expanded their programs beyond academic selections to provide occupational development and continuing education. Because of the geographic area from which they attracted students, junior colleges developed a role as “community” colleges. They also solidified their role as transfer institutions for students who, because of time, preparedness, economics, or distance, could not begin their postsecondary education at a 4-year institution (Cohen & Brawer, 1996). Until the mid-1990s, the majority of transfer programs to 4-year universities involved traditional academic degrees, including the Associate of Arts (AA) and Associate of Science (AS) degrees. Occupational programs and continuing education were viewed as terminal and non-transferrable. In 1984, Congress authorized the Carl Perkins Vocational and Technical Education Act (P.L. 98-524). In the legislation, Congress responded to employers’ concerns about the lack of basic skills in employees by adding academic requirements to vocational education legislation. Vocational program curriculum was expanded to include language arts, mathematics, and science principles, and the curriculum reflected the context of the program. The Secretary’s Commission on Achieving Necessary Skills (SCANS) was created in 1990 to determine the skills young people need to succeed in the world of work (U.S. Department of Labor, 2000). In the second Carl Perkins reauthorization in 1990 (P.L. 105-332), Congress responded to the report, which targeted academic and job skills, by outlining a seamless system of vocational and academic 15 education to prepare vocational students to progress into and through higher education. This emphasis led to the development of Associate of Applied Science (AAS) degrees during the 1990s. Granted to those who have successfully completed programs in the applied arts and sciences for careers, AAS degrees were seen as terminal (Kansas Board of Regents, 2002-2003). But as one goal was attained, conversation turned to creating a pathway from occupational associate degrees to bachelor’s degree completion. The desire of students to continue from technical degrees to a baccalaureate was not a new idea. In a paper presented in 1989 to the American Technical Association national conference, TrouttErvin and Morgan’s overview of 2+2 programs showed acceptance of AAS degrees at traditional universities was generally non-existent. Their suggestion for an academic bridge from early technical education to baccalaureate programs highlighted programs accepting AAS degrees toward baccalaureate completion were an exception rather than a rule (Troutt-Ervin & Morgan, 1989). It was not until the late 1990s that applied baccalaureate degrees recognized credits from technical degree students who had previously thought of themselves in a terminal program to complete their baccalaureate degree (Wellman, 2002). Despite the advance of recognition of AAS degrees, standard definitions of transfer students continued to exclude students who completed technical programs. The U.S. Department of Education did not include students receiving an Associate of Applied Science degree in the definition of students preparing for transfer to 4-year colleges (Bradburn, Hurst, & Peng, 2001; Carnevale, 2006). Most states had comparable policies in place concerning core academic curriculum, articulation agreements, transfer of credit, 16 and statewide transfer guides. There was no general recognition of occupational credit transfer. Only a few states, including Kansas, Missouri, and Washington, allowed credits earned in occupationally oriented degrees to transfer to 4-year institutions (Townsend, 2001). No state had set clear goals for the transference of occupational credits between institutions or for the state as a whole (Wellman, 2002). Despite the lack of recognition of occupational transfer credit at the federal level, a new definition of transfer education had emerged. Initially defined as the general education component of the first 2 years of a baccalaureate, the definition of transfer education now included any courses that transferred to a 4-year college, regardless of the nature of the courses (Townsend, 2001). The line between vocational schools, community colleges, and 4-year institutions blurred in the United States as employers and students increasingly made business decisions regarding education and workforce development. Employers increasingly asked for employees with academic and technical skills, as well as critical thinking skills and personal responsibility (U.S. Department of Labor, 2000). Returning students themselves were more attuned to the demands of the 21st century workforce. Their desire to return to higher education, coupled with the economy and the variety of options available to them, required a more adaptive higher education system (Carnevale, 2006). There was growing demand among new and returning students for higher education opportunities responsive to their needs. The expanding needs of the returning student provided opportunities for higher education to respond by utilizing different delivery models. 17 Distance Education Online education became a strategy for postsecondary institutions when the first correspondence courses were initiated with the mail service in the early 20th century (Russell, 1999). As various technologies emerged, distance education utilized television and video models, in addition to paper-based correspondence courses. The expansion of distance education utilizing computer technologies renewed academic debate over the efficacy of the delivery model. Online education utilizing the Internet became a significant factor in the 1990s, prompting renewed evaluation of the use of distance learning opportunities (Russell, 1999, Phipps & Meristosis, 1999). In 1999–2000, the number of students who took any distance education courses was 8.4% of total undergraduates enrolled in postsecondary education (NCES, 2000). In 2000, the report of the Web-Based Education Commission to the President and Congress concluded that the Internet was no longer in question as a tool to transform the way teaching and learning was offered. The Commission recommended that the nation embrace E-learning as a strategy to provide on-demand, high-quality teaching and professional development to keep the United States competitive in the global workforce. They also recommended continued funding of research into teaching and learning utilizing web-based resources (Web-Based Education Commission, 2000). The acceptance of the importance of the Internet for delivery of higher education opened new opportunities for research and continued the academic debate of the quality of instruction delivered in online education courses and programs. In a longitudinal study from 2002-2007, The Sloan Consortium, a group of higher education institutions actively involved in online education, began studies of online 18 education in the United States over a period of 5 years. In the first study, researchers Allen and Seaman (2003) conducted polls of postsecondary institutions involved with online education and found that students overwhelming responded to the availability of online education, with over 1.6 million students taking at least one online course during the Fall semester of 2002. Over one third of these students took all of their courses online. The survey also found that in 2002, 81% of all institutions of higher education offered at least one fully online or blended course (Allen & Seaman, 2003). In their intermediate report in 2005, Allen and Seaman postulated that online education had continued to make inroads in postsecondary education, with 65% of schools offering graduate courses and programs face-to-face also offering graduate courses online. Sixty-three percent of undergraduate institutions offering face-to-face courses also offered courses online. From 2003 to 2005, the survey results showed that online education, as a long-term strategy for institutions, had increased from 49% to 56%. In addition, core education online course offerings had increased (Allen & Seaman, 2005). In Allen and Seaman’s final report (2007b) for the Sloan Consortium, the researchers reported that almost 3.5 million students participated in at least one online course during the Fall 2006 term, a nearly 10% increase over the number reported in the previous year. Allen and Seaman also reported a 9.7% increase in online enrollment, compared to the 1.5% growth in overall higher education. They found by 2007, 2-year institutions had the highest growth rates and accounted for over the half the online enrollments in the previous 5 years. The researchers concluded, based on a survey 19 conducted as part of the research, institutions believed that improved student access was the top reason for offering online courses and programs (Allen & Seaman, 2007b). Community colleges began embracing distance education in the 1920s as part of their mission to provide low-cost, time-effective education. Community colleges initially provided correspondence courses by mail, but later switched to television and video courses as technology improved (Cohen & Brawer, 1996). In 2001, over 90% of public 2- year colleges in the United States provided distance education courses over the Internet (NCES, 2001). Vocational education, by the nature of its instructional format, was among the last of the educational institutions to participate in distance education. Because of the kinesthetic nature of instruction, vocational education leaders began investigating distance education opportunities in the 1990s, relying on the method to provide only the lecture portion of instruction. By 2004, only 31% of students enrolled in vocational schools had participated in some form of distance education during their program of study (NCES, 2005). In 2008, hands-on instruction in programs such as automobile mechanics and welding, and the clinical portion of health occupations programs, continued to be taught in the traditional classroom setting (NCES, 2008). Analysis of data reported by the NCES indicated that distance education had become a staple for higher education institutions. At both the 4-year and 2-year university level, over 65% of institutions offered more than 12 million courses in 2006-2007 by distance education. While vocational education had traditionally been more hands-on, distance education had become more prevalent in providing opportunities for students to participate in components of the system over the Internet (NCES, 2008). 20 Distance education became the prevalent strategy for higher education institutions to expand their services to new and returning students, without the financial implications of capital expansion. Higher education utilized the strategy to market to students outside their traditional geographic reach by utilizing the power of the Internet. The increasing demand from students of all ages for online opportunities provided new ground for the expansion of higher education opportunities. Grades as an Indicator of Quality of Student Learning The grading system in the United States educational system has served as an indicator of knowledge for over 100 years. Educators have utilized high school grades as a sorting mechanism in American schools to determine postsecondary opportunities. Modern society has accepted honors attainment, graduation honors, and course grades as an indicator of knowledge acquisition in postsecondary education. Stray (2001) reported that the use of grading in schools can be traced to the industrial revolution and the development of factories. William Farish of Cambridge University developed the first grading system in higher education in 1792 (Stray, 2001). Farish mimicked the system established by factories of the time: grade A being the best. The thought was that Farish employed the grading system in order to teach more students, an aberration at that time when instructors rarely had more than a few. The demand for more higher education opportunities prompted Farish to open his class to more students, and as such, led to his use of a sorting system. This was the first known record of grading utilized in classrooms to measure student achievement (Stray, 2001). 21 Smallwood (1935) reported the first grading in higher education at Yale University in 1792. Stiles, President of Yale University, directed the use of the scale in the late 18th century. However, Smallwood noted it was not until 1813 that any record of grades or marking appeared. Using a scale of 100, philosophy and mathematic professors instituted the first use of a marking instrument in the 1800s at Harvard. Smallwood noted early systems were experimental, utilizing different numerical scales, with no standardized system in place between higher education institutions. It was not until the late 1800s that faculty began using descriptors, such as A and B, to rank students according to a predetermined numerical scale (Smallwood, 1935). Experimentation with evaluation of achievement continued into the early 20th century, when educational psychologists, including Dewey and Thorndike, attempted to compare grading scales with intelligence testing. Thorndike’s philosophy of standardized testing and grading survived the 20th century, and his quote, “Whatever exists at all exists in some amount” (Thorndike, 1916, as cited in Ebel & Frisbie, p. 26) has been utilized in educational measurement textbooks as a validation of the use of standards of measurement to measure achievement (Ebel & Frisbie, 1991). The use of grades expanded to community colleges, high schools, and elementary schools in the early 1900s (Pressey, 1920). The use of grades throughout the educational system is fairly standardized today with the 4.0 scale. It is this standardization that allows comparison of grades as achievement between educational levels and institutions (Ebel & Frisbie, 1991) and allows grades to be utilized as a measure for comparison of educational achievement. 22 Researchers analyzing the success of community college transfer students have traditionally studied the grades of the traditional transfer student with an AA or AS degree. Keeley and House’s 1993 study of sophomore and junior transfer students at Northern Illinois University analyzed “transfer shock” (p. 2) for students matriculating from community colleges. The researchers found students who transferred from a community college obtained a grade point average significantly lower in their first semester than did students who began their college career at a 4-year institution. However, the results of the longitudinal studies showed that transfer students who persisted to graduation showed an equivalent GPA at baccalaureate completion (Keeley & House, 1993). Students who transferred from occupationally oriented degree programs typically were not included in traditional studies of transfer students. While the research in general does not include AAS students in traditional transfer data, limited conclusions were available comparing AAS students to traditional 4-year college attendees. Townsend’s study at the University of Missouri-Columbia (2002) showed no difference in grades at baccalaureate graduation between students with an AA/AS degree and students with an AAS degree. The use of grades as an indicator of the level of student achievement has been relied upon by studies comparing traditional classroom instruction and distance instruction. Research analyzing the effectiveness of student learning in distance education began with the first correspondence courses offered utilizing the mail service (Russell, 1999). The study of effectiveness of correspondence courses expanded to include new technologies, such as television and video courses, and increased with the proliferation of 23 online educational offerings. Researchers continued to challenge the effectiveness of learning methods not delivered in traditional higher education settings. In 1991, Russell reviewed over 355 studies, dating from the 1930s and continuing through the late 1980s, and found no significant difference in student learning using any form of distance education, as compared with students in classroom-based instruction (Russell, 1999). Russell’s conclusion formed the basis for a series of works collectively known as “No Significant Difference.” Russell’s conclusion from his studies follows: The fact is the findings of comparative studies are absolutely conclusive; one can bank on them. No matter how it is produced, how it is delivered, whether or not it is interactive, low tech or high tech, students learn equally well with each technology and learn as well as their on-campus, face-to-face counterparts even though students would rather be on campus with the instructor if that were a real choice. (p. xviii) Overwhelmingly, studies have supported Russell’s conclusions, including Neuhauser’s (2002) study of traditional face-to-face education and online education in a business communications class at a large urban university in North Carolina. Neuhauser concluded there was no significant difference in pre- and post-test scores of students enrolled in online and traditional communications classes. In addition, Neuhauser found no significant difference in final grades, homework grades, and grades on research papers, even though learners in the online course were significantly older than were learners in the traditional face-to-face section. The Summers et al. (2005) research included a comparison of student achievement and satisfaction in an online versus a traditional face-to-face statistics class. 24 The study, conducted at the University of Missouri-Columbia, included undergraduate nursing students who were tested on both their pre- and post-course knowledge of statistics. Their results indicated that utilizing grades as an indicator of knowledge showed no significant difference between the online and traditional classroom students. In their meta-analysis, Machtmes and Asher (2002) reviewed 30 studies and concluded there did not appear to be a difference in achievement, as measured by grades, between distance and traditional learners. As technology use continued to evolve in online education, various studies were conducted to determine whether different delivery methods created a difference in the grades of online students compared to their face-to-face counterparts. A study conducted by Carmel and Gold (2007) supported Russell’s original conclusion by analyzing specific types of online platforms and delivery models. Carmel and Gold’s study included hybrid and traditional classroom-based instruction. They analyzed results from 164 students in 110 courses and found no significant difference in student achievement based on grades between students enrolled in either delivery method. Additional studies supporting Russell’s theory have crossed multiple content areas and delivery models. Brown and Liedholm’s (2002) study at Michigan State University included microeconomics students in virtual, hybrid, and traditional classroom-based instruction. The study included 389 students in the traditional setting, 258 in the hybrid delivery section and 89 students enrolled in online education. No significant difference in student learning as measured by end of course grades was found. Research also showed type of course discipline is not affected by the online delivery model. Schulman and Simms (1999) compared pretest and posttest scores of 25 students enrolled in an online course and a traditional course at Nova Southeastern University. The researchers compared 40 undergraduate students enrolled in online courses and 59 undergraduate students enrolled in the classroom setting of the same course. Results indicated that the students who select online courses scored higher than traditional students scored on the pretest results. However, posttest results showed no significant difference for the online students versus the in-class students. Schulman and Simms concluded that online students were learning equally as well as their classroombased counterparts. Reigle’s (2007) analysis across disciplines at the University of San Francisco and the University of California found no significant difference between online and face-to-face student grade attainment. Shachar and Neumann (2003) conducted a meta-analysis that estimated and compared the differences between the academic performance of students enrolled in distance education compared to those enrolled in traditional settings over the period from 1990-2002. Eighty-six studies containing data from over 15,000 participating students were included in their analysis. The results of the meta-analysis showed that in two-thirds of the cases, students taking courses by distance education outperformed their student counterparts enrolled in traditionally instructed courses. Lynch, during the use of the “Tegrity” system, a brand-specific online platform at Louisiana State University, found that students’ grades were slightly better after utilizing the technology than when the traditional approach was used (Lynch, 2002). Initial results of a University of Wisconsin-Milwaukee study of 5000 students over 2 years indicated that the U-Pace online students performed 12% better than their traditional Psychology 101 counterparts on the same cumulative test (Perez, 2009). Arle’s (2002) study found 26 students enrolled in online human anatomy courses at Rio Salado College scored an average of 6.3% higher on assessments than the national achievement average. Students were assessed using a national standardized test generated by the Human Anatomy and Physiology Society, whose norming sample is based entirely on traditional classroom delivery (Arle, 2002). In a study conducted by Stephenson, Brown, and Griffin (2008), comparing three different delivery styles (traditional, asynchronous electronic courseware, and synchronous e-lectures), results indicated no increased effectiveness of any delivery style when all question types were taken into account. However, when results were analyzed, students receiving traditional lectures showed the lowest levels on questions designed to assess comprehension. Research found supporters in higher education academic leaders. In a 2006 survey of Midwestern postsecondary institutions concerning their online offerings, 56 % of academic leaders in the 11 states rated the learning outcomes in online education as the same or superior to those in face-to-face instructional settings. The proportion of higher education institutions believing that online learning outcomes were superior to those for face-to-face outcomes was still relatively small, but had grown by 34% since 2003, from 10.2 to 13.7 % (Allen & Seaman, 2007b). This belief added merit to the conclusions supported by Russell and others. Russell’s (1999) “no significant difference” conclusion had its detractors. The most commonly cited is Phipps and Merisotis (1999), who reviewed Russell’s original meta-analysis (1999) and reported a much different conclusion. They concluded that the overall quality of the original research was questionable, that much of the research did 27 not control for extraneous variables, and therefore it could not show cause and effect. They included in their findings evidence that the studies utilized by Russell (2000) in the meta-analysis did not use randomly selected subjects, did not take into effect the differences among students, and did not include tests of validity and reliability. The Phipps and Merisotis (1999) analysis included the conclusion that research has focused too much on individual courses rather than on academic programs, and has not taken into account differences among students. They postulated that based on these conclusions, there is a significant difference in the learning results, as evidenced by grades, of students participating in distance education as compared to their classroombased peers. Their analysis of Russell’s original work questioned both the quality and effectiveness of research comparing distance and traditional education delivery. While there has been ongoing conjecture that online education students are not receiving an equivalent learning experience compared to their traditional classroom counterparts, studies utilizing grades as an indicator of student learning have produced little evidence of the disparity. The incidence of studies showing significant negative differences in grades of online learners is small. Higher education institutions have indicated their support for online education, and its continued growth has allowed studies such as the present research to contribute to ongoing dialogue. Student Retention in Postsecondary Education Persistence and retention in higher education is an issue that has intrigued researchers for over 50 years. Quantitative studies conducted in the mid-20th century produced data that caused researchers to look at low retention rates in higher education 28 and search for answers. This question has continued to consume researchers and higher education institutions. In 1987, Tinto attempted to summarize studies of individual student retention in higher education by proposing a theory to allow higher education administrators to predict success and support students (Tinto, 1987). Tinto’s model of student engagement has been in use for over 20 years as higher education administrators and faculty attempt to explain student retention issues at universities and colleges. Tinto’s model primarily focused on factors of student engagement: How students respond to instructors, the higher education community itself, and students’ own engagement in learning are the primary factors Tinto theorized as determining the student’s retention. In the concluding remarks to his 1987 treatise on retention, Tinto acknowledged that persistence in higher education is but one facet of human growth and development, and one that cannot necessarily be attributed to a single factor or strategy. Tinto’s (1987) original study of student retention included the observation that student retention is a complicated web of events that shape student leaving and persistence. He observed that the view of student retention had changed since the 1950s, when students were thought to leave due to lack of motivation, persistence, and skills, hence the name dropout. In the 1970s, research began to focus on the role of the environment in student decisions to stay or leave. In the 1990s, Tinto proposed that the actions of the faculty were the key to institutional efforts to enhance student retention (Tinto, 2007). This was a significant addition to his theory, placing the cause on the instructor instead of the student, and it has done much to influence retention strategies 29 utilized in higher education institutions (Tinto, 2007). Tinto’s studies have driven research in both traditional retention studies and those involving distance education. Studies of the persistence of the postsecondary student routinely focus on 4-year postsecondary education. It is only within the last 20 years that persistence studies have included community college students and occupational students, acknowledging that their reasons for entering the postsecondary community are different from the traditional 4- year higher education participant (Cohen & Brawer, 1996). With different avenues to a baccalaureate degree more prevalent, the research into college persistence has expanded to include other types of programs and students. Postsecondary student retention rates routinely utilize data from longitudinal studies of students entering in a Fall semester and completing a bachelor’s program no more than 6 years later (NCES, 2003). The National Center for Education Statistics reported that 55% of those seeking a baccalaureate degree would complete in 6 years (NCES, 2003). The report acknowledged institutions are unable to follow students who transfer to other institutions; they are able to report only the absence of enrollment in their own institution. Research has also found a large gap between community college entrants and 4- year college entrants in rates of attaining a bachelor’s degree. Dougherty (1992) reported that students entering community college receive 11 to 19% fewer bachelor’s degrees than students beginning at a 4-year university. Dougherty postulated that the lower baccalaureate attainment rate of community college entrants was attributable to both their individual traits and the institution they entered (Dougherty, 1992). 30 Studies of student retention of community college also vary based on the types of students. Community college retention rates are routinely reported as lower than traditional 4-year institutions (NCES, 2007). Cohen and Brawer (1996) attributed the differences in retention to the difference in the mission. In many instances, students did not enroll in a community college in order to attain a degree (Cohen & Brawer, 1996). The most recent longitudinal study in 1993 showed a retention rate of 55.4% of students after 3 years (NCES, 2001). Of community college students, only 60.9% indicated a desire to transfer later to a baccalaureate degree completion program (NCES, 2003). While retention data collected by the federal government (NCES, 2003) did not include students with an AAS degree, Townsend’s studies of the transfer rates and baccalaureate attainment rates of students in Missouri who had completed an Associate of Arts and students who had completed an Associate of Applied Science degree was 61% compared to 54% (Townsend, 2001). Vocational or occupational programs have reported retention rates as “program completion,” a definition involving completion of specific tasks and competencies instead of grades and tied to a limited program length. This state and federal requirement indicates program quality and ensures continued federal funding. In 2001, the U.S. Department of Education reported a 60.1% completion rate of postsecondary students enrolled in occupational education (NCES, 2007). Until 1995, the reasons for students leaving was neither delineated nor reported; it was not until federal reporting requirements under the Carl Perkins Act of 1994 that institutions were required to explore why students were not retained in vocational programs (P.L. 105-332). 31 Distance education provided a new arena for the study of student persistence. Theorists and researchers have attempted to utilize Tinto’s model of student persistence to explain retention issues involved with distance education. However, Rovai (2003) analyzed the differing student characteristics of distance learners as compared to the traditional students targeted by Tinto’s original models and concluded that student retention theories proposed from that population were no longer applicable to distance education learners. Rovai proposed that distance educators could address retention in ways that traditional higher education has not. He suggested that distance educators utilize strategies such as capitalizing on students’ expectations of technology, addressing economic benefits and specific educational needs to increase student retention in courses (Rovai, 2003). The expanded use of technology created a distinct subset of research into student retention issues. In 2004, Berge and Huang developed an overview of models of student retention, with special emphasis on models developed to explain the retention rates in distance education. Their studies primarily focused on the variables in student demographics and external factors, such as age and gender, which influence persistence and retention in online learning. Berge and Huang found that traditional models of student retention such as Tinto’s did not acknowledge the differences in student expectations and goals that are ingrained in the student’s selection of the online learning option. Other researchers have attempted to study retention issues specifically for online education. In a meta-analysis, Nora and Snyder (2009) found the majority of studies of online education focused on students’ individual characteristics and individual 32 perceptions of technology. Nora and Snyder concluded that researchers attempt to utilize traditional models of student engagement to explain student retention issues in distance or online learning courses, with little or no success. This supported Berge and Huard’s conclusions. Nora and Snyder (2009) also noted a dearth of quantitative research. Few quantitative studies exist that support higher or equal retention in online students compared to their classroom-based counterparts. One example is the Carmel and Gold (2007) study. They found no significant difference in student retention rates between students in distance education courses and their traditional classroom-based counterparts. The study utilized data from 164 students, 95 enrolled in classroom-based courses and 69 enrolled in a hybrid online format. Participants randomly self-selected and were not all enrolled in the same course, introducing variables not attributed in the study. The majority of quantitative studies instead concluded there is a higher retention rate in traditional classrooms than in distance education. In the Phipps and Merisotis (1999) review of Russell’s original research, which included online education, results indicated that research has shown even lower retention rates in online students than in students attending classes in the traditional college setting. The high dropout rate among distance education students was not addressed in Russell’s meta-analysis, and Phipps and Merisotis found no suitable explanation in the research. They postulated that the decreased retention rate documented within distance education studies skews achievement data by excluding the dropouts. Diaz (2002) found a high drop rate for online students compared to traditional classroom-based students in an online health education course at Nova Southeastern. Other studies have supported the theory that retention of online students is far below that 33 of the traditional campus students. In 2002, Carr, reporting for The Chronicle of Higher Education, noted that online courses routinely lose 50 % of students who originally enrolled, as compared to a retention rate of 70-75% of traditional face-to-face students. Carr reported dropout rates of up to 75% in online courses as a likely indicator of the difficultly faced in retaining distance education students who do not routinely meet with faculty. The data have not been refuted. As community colleges began utilizing distance education, retention rates were reported as higher than traditional students (Nash, 1984). However, the California Community College System report for Fall 2008 courses showed inconsistent retention results for distance education learners, varying by the type of course. Results indicated equivalent retention rates for online instruction compared to traditional coursework in the majority of courses. Lower retention rates were indicated in online engineering, social sciences, and mathematics courses as compared to traditional classroom instructional models (California Community Colleges Chancellor's Office, 2009). Due to the limited number of vocational/technical or occupational courses taught in the online mode, there was little data on student retention. In 1997, Hogan studied technical course and program completion of students in distance and traditional vocational education and found that course completion rates were higher for distance education students. However, program completion rates were higher for traditional students than for students enrolled in distance education (Hogan, 1997). In summary, studies of retention have focused primarily on student characteristics while acknowledging that postsecondary retention rates vary according to a variety of factors. Research showed mixed results concerning the retention rate of online students, 34 though quantitative data leans heavily toward a lower course retention rate in online students. Data from 4-year universities have shown lower retention rates for online students than for traditional face-to-face students, while community colleges have shown inconsistent results. Data from vocational-technical education has been limited, but course retention rates are higher for online students, while program retention rates are lower. No significant research factor affecting retention has been isolated between students in online baccalaureate completion programs and students participating in traditional classroom-based settings. Summary Research studies have been conducted analyzing student retention in higher education, transfer and retention of students from community colleges to universities, the impact of distance education, and student achievement and retention factors related to distance education. However, no comparative research was identified that compared the achievement and retention of students participating in an occupationally oriented transfer program utilizing both online education and traditional classroom-based instruction. Chapter Three addresses the topics of research design, hypotheses, and research questions. Additionally, population and sample, data collection, and data analysis are discussed. 35 CHAPTER THREE METHODOLOGY The purpose of this study was to determine if there is a significant difference between course grades of students enrolled in online Technology Administration courses and their traditional classroom-based counterparts. The study also examined if there is a significant difference between course retention and program retention of students enrolled in online Technology Administration courses and their traditional classroombased counterparts. The methodology employed to test the research hypotheses is presented in this chapter. The chapter is organized into the following sections: research design, hypotheses and research questions, population and sample, data collection, data analysis, and summary. Research Design A quantitative, quasi-experimental research design was selected to study grades, course retention, and program retention in students enrolled in the Technology Administration program. The design was chosen as a means to determine if significant differences occur between online and face-to-face students by examining numerical scores from all participants enrolled, and retention rates in both courses and programs in the Technology Administration program. Hypotheses and Research Questions This study focused on three research questions with accompanying hypotheses. The research questions and hypotheses guiding the study follow. 36 Research Question 1: Is there is a statistically significant difference between students’ grades in online classes and traditional face-to-face classes? H1: There is a statistically significant difference in course grades of students participating in online courses and students enrolled in a traditional classroom setting at the 0.05 level of significance. Research Question 2: Is there a statistically significant difference between course retention rate of students in online classes and traditional face-to-face classes? H2: There is a statistically significant difference in student course retention between students participating in online courses and students enrolled in face-to-face courses at the 0.05 level of significance. Research Question 3: Is there a statistically significant difference in program retention between students who entered the program in online classes and students who entered the program in traditional face-to-face classes? H3: There is a statistically significant difference in program retention between students who begin the Technology Administration program in online courses and students who begin in face-to-face courses at the 0.05 level of significance. Population and Sample The two populations selected were students enrolled in online and face-to-face courses. The sample included students enrolled in Technology Administration courses. Student enrollment was analyzed for all Technology Administration courses in the program sequence to determine the number of samples available in online and face-toface classes. The course enrollment data for the sample are outlined in Table E1. The subsample of the data utilized for the study is presented in Table 1. 37 Table 1 Technology Administration Enrollment Data Year Instructor TA 300 TA310 FTF OL FTF OL Spring 02 A 14 25 Fall 02 A 11 20 9 26 Spring 03 A 29 38 Fall 03 A 20 29 13 34 Spring 04 B 32 25 Fall 04 B 18 32 10 28 Spring 05 B 23 31 Fall 05 B 15 28 11 28 Spring 06 B 13 30 Fall 06 B 14 24 24 32 Spring 07 B 15 33 Fall 07 B 16 23 27 30 Spring 08 B 22 3529 TOTAL 94 156 242 395 Note: TA 300 Evolution and Development of Technology, TA 310 Technology and Society The subsample for hypothesis 1 and hypothesis 2 included all students enrolled in two entry-level courses required for completion of the Technology Administration program: TA 300 Evolution and Development of Technology, and TA 310 Society and 38 Technology. The university offered the courses in online and face-to-face formats during the period of the study. Two instructors, identified as A and B, were involved with teaching the online and face-to-face courses. Two courses were selected that met the following criteria: (a) the same faculty member taught both courses, (b) the courses were offered over the period of the study consistently in online and face-to-face instruction, and (c) the syllabi for simultaneous online and face-to-face sections were identical. For hypothesis 3, data included records of all students enrolled in TA 300 Evolution and Development of Technology for the Fall semesters of 2002, 2003, 2004, 2005, and 2006. The course was selected for inclusion in the study based on the following criteria: (a) student enrollment in the course was the result of declaration of the Technology Administration program major and (b) parameters of the study allowed students 2 or more years to complete the program requirements. For the purpose of the study, all student names were removed. Data Collection An Institutional Review Board (IRB) form was prepared for Washburn University approval prior to data collection. The study was designated as an exempt study. The Washburn University IRB form is provided in Appendix A. Approval of the IRB was transmitted by e-mail. A copy is located in Appendix B. In addition, an IRB was submitted to Baker University. The form is located in Appendix C. The Baker IRB approval letter is located in Appendix D. Washburn University had two types of data collection systems in place during the period identified for the study, Spring 2002 through Spring 2008. The AS 400 data collection system generated paper reports for 2002 and 2003. The researcher was allowed 39 access to paper records for 2002 and 2003. Enrollment results for all technology administration sections for 2002-2003 were entered manually into an Excel spreadsheet. In 2004, the University transferred to the Banner electronic student data management system. All records since 2004 were archived electronically and were retrieved utilizing the following filters for data specific to students enrolled in the identified Technology Administration courses: TA course designation and specific coding for year and semester to be analyzed (01 = Spring semester, 03 = Fall semester, 200X for specified year). Results retrieved under the Banner system were saved as an Excel spreadsheet by the researcher. The course enrollment data for the sample are presented in Tables E1 and E2. Student transcripts and records were analyzed to determine program completion or continued enrollment in the program for program retention analysis. Documents examined included paper student advising files located within the Technology Administration department and specific student records housed within the Banner reporting system. Technology Administration course TA 300 was selected based on the following: (a) It is a required entry course only for Technology Administration majors, and (b) TA 310 is a dual enrollment course for business department majors. Data Analysis Data analysis for all hypothesis testing was conducted utilizing SPSS software version 16.0. The software system provided automated analysis of the statistical measures. To address Research Question 1, a two-factor analysis of variance was used to analyze for a potential difference in delivery method (online and face-to-face), potential 40 difference in instructor (instructors A and B), and potential interaction between the two factors. When the analysis of variance reveals a difference between the levels of any factor, Salkind (2008) referred to this as the main effect. This analysis produces three F statistics: to determine if a difference in grades of online students as compared to their classroom based counterparts was affected by a main effect for delivery, a main effect for instructor, and for interaction between instructor and delivery. Chi-square testing was selected to address research questions 2 and 3. The rationale for selecting chi-square testing was to observe whether a specific distribution of frequencies is the same as if it were to occur by chance (Salkind, 2008). If the obtained chi-square value is greater than the critical value, it indicates there is sufficient evidence to believe the research hypothesis is true. For research question 2, a chi-square test for differences between proportions analyzed course retention of online and face-to-face students at the end of semester. For Research Question 3, a chi-square test for differences between proportions analyzed program retention comparing students who began the program in the online section of TA 300 to the students who began in the face-to-face section. Limitations of the Study Roberts (2004) defined the limitations of the study as those features of the study that may affect the results of the study or the ability to generalize the results. The limitations of this study included (a) potential for data entry error, (b) curriculum modifications not reflected in the syllabi made by instructors over the period of the study, (c) behavior of the instructors during delivery in the two different formats, and (d) 41 rationale of students for selecting one course delivery method over another. These may affect the generalizability of this study to other populations. Summary This chapter described the research design, population and sample, hypotheses, data collection, and analysis used in this research study. Statistical analysis using twoway analysis of variance and chi-square were used to determine if there are significant statistical differences in the course grades, course retention, and program retention of students enrolled in online classes as compared to their face-to face counterparts. The results of this study are presented in Chapter Four. 42 CHAPTER FOUR RESULTS The study had three main purposes. The first purpose was to determine if there was a difference in grades between students in online classes and students in traditional face-to-face classes in the Technology Administration program. In addition, the study was designed to examine the difference in course retention rates of students in the online classes as compared to the face-to-face classes. The third part of the study was designed to examine program retention rates of students who began the program in online classes and students who began the program in traditional face-to-face classes. This chapter begins with the descriptive statistics for the sample: gender, age, grades by gender, and course selection of students in online or face-to-face courses by gender. From the three research questions, research hypotheses were developed, and the results of statistical analyses used to test each hypothesis are presented. Descriptive Statistics Demographic data for the sample was collected from the student data system for 2002 through 2009. The descriptive statistics presented below include gender (n = 884), age (n = 880), grades by gender (n = 884) and course selection online or face-to-face by gender (n = 884). Table 2 describes the cross-tabulation of the frequencies for gender and of the sample selected for the study. The mean age for the sample tested was 31.06 years, with a standard deviation of 9.46 years. The age range of the sample was from 18 to 66 years. One participant did not report gender. Age was not available for three participants. 43 Table 2 Participant Age Group by Gender (n=880) Age Range By Years < 20 20-29 30-39 40-49 50-59 60-69 Female 0 198 121 62 29 3 Male 5 281 104 53 19 5 Note: Gender not reported for one participant; Age not reported for four participants Females = 413 Males = 467 Table 3 presents the frequency of course grades by gender and total number of students receiving each grade. Grades were distributed across the continuum, with slightly more females than males receiving A’s, more males than females receiving B’s, C’s and F’s, and an equal distribution of students receiving D’s. More males withdrew from classes than did females. 44 Table 3 Average Grades by Gender (n=884) Grades Female Male Total A 245 208 453 B 53 79 132 C 32 70 102 D 17 16 33 F 37 55 92 No Credit 1 0 1 Passing 0 1 1 Withdraw 25 42 67 Withdraw Failing 3 0 3 Total 413 471 884 Note: Gender not reported for one participant Table 4 presents the course selection patterns of male and female students. Overall, more students selected online courses than face-to-face courses. Females and males enrolled in online courses in equal numbers; however, proportionally more females (68.7%) chose the online instructional format instead of face-to-face compared with males (60.1%). 45 Table 4 Course Selection by Gender (n=884) Course Type Female Male Total Face-to-face 129 184 313 Online 284 287 571 Total 413 471 884 Note: Gender not reported for one participant Hypothesis Testing H1: There is a statistically significant difference in the course grades of students enrolled in online classes and students enrolled in a traditional classroom setting at the 0.05 level of significance. The sample consisted of 815 students enrolled in online and face-to-face Technology Administration courses at Washburn University. A two-factor analysis of variance was used to analyze for the potential difference in course grades due to delivery method (online and face-to-face), the potential difference due to instructor (instructors A and B), and the potential interaction between the two independent variables. Mean and standard deviation for grades were calculated by delivery type and instructor. Table 5 presents the descriptive statistics. The mean of grades by delivery showed no significant difference between online and face-to-face instruction. Additionally, no significant difference in mean grade was evident when analyzed by instructor. 46 Table 5 Means and Standard Deviations by Course Type and Instructor Course type Instructor Mean Standard Deviation n Face-to-face A 3.0690` 1.41247 29 B 2.9586 1.39073 266 Total 2.9695 1.39084 295 Online A 2.9024 1.52979 41 B 3.0271 1.35579 479 Total 3.0271 1.36911 520 Total A 2.9714 1.47414 70 B 3.0027 1.36783 745 Total 3.000 1.37635 815 The results of the two-factor ANOVA, presented in Table 6, indicated there was no statistically significant difference in grades due to delivery method (F = 0.078, p = 0.780, df = 1, 811). This test was specific for hypothesis 1. In addition, there was no statistically significant difference in grades due to instructor (F = 0.002, p = .967, df = 1, 811), and no significant interaction between the two factors (F = 0.449, p = 0.503, df = 1, 811). The research hypothesis was not supported. 47 Table 6 Two-Factor Analysis of Variance (ANOVA) of Delivery by Instructor df F p Delivery 1 0.148 0.780 Instructor 1 0.003 0.967 Delivery*Instructor 1 0.449 0.503 Error 811 Total 815 H2: There is a statistically significant difference in student course retention between students enrolled in online courses and students enrolled in face-to-face courses at the 0.05 level of significance. The sample consisted of 885 students enrolled in TA 300 and TA 320 online and face-to-face courses. The hypothesis testing began with the analysis of the contingency data presented in Table 7. The data are organized with course selection (online or face-to-face) as the row variable and retention in the course as the column variable. Data were included in the retained column if a final grade was reported for participant. Participants who were coded as withdraw or withdraw failing were labeled as not retained. Chi-square analysis was selected to observe whether a specific distribution of frequencies is the same as if it were to occur by chance (Roberts, 2004). The result of the chi square testing (X2 = 2.524, p = .112, df = 1, 884) indicated there was no statistically significant difference between retention of students enrolled in online courses compared to students enrolled in face-to-face courses in the TA program. Additional results indicated that 93.92% (294/313) of the online students were retained, 48 compared to 90.89% (519/571) of the face-to-face students. The research hypothesis was not supported. Table 7 Course retention of online and face-to-face TA students Retained Not retained Total Face-to-face students 294 19 313 Online students 519 52 571 Total 813 71 884 H3: There is a statistically significant difference in program retention between students who begin the Technology Administration program in online courses and students who begin in face-to-face courses at the 0.05 level of significance. The sample consisted of 249 students enrolled in TA 300 in the online and face-to-face courses from Fall 2002 through Fall 2008. The hypothesis testing began with the analysis of the contingency data located in Table 8. The table is organized with course selection (online or face-to-face) as the row variable and program retention as the column variable. Data were included in the retention column if students had successfully met requirements for a Bachelors of Applied Science in Technology Administration or if they were enrolled in the program in Spring 2009. Data were included in the non-retained column if students had not fulfilled degree requirements and they were not enrolled in Spring 2009. Chisquare analysis was selected to observe whether a specific distribution of frequencies is the same as if it were to occur by chance (Roberts, 2004). 49 The result of the chi-square testing (X2 = .132, p = .717, df = 1, 249) indicated there was no statistically significant difference between the program retention rate of students who began the TA program in the online courses compared to the students who began the program in the face-to-face courses. Additional results showed that 91.57% (163/178) of students who began in online courses were retained compared to 92.96% (66/71) of students who began the TA program in face-to-face courses. The research hypothesis was not supported. Table 8 Program retention of online and face-to-face TA students Retained Not retained Total Face-to-face 66 5 71 Online 163 15 178 Total 229 20 249 Summary In this chapter, an introduction provided a summary of the analysis and statistical testing and in the order in which it was presented. This was followed by descriptive statistics of the sample, including age range of participants, grades by gender, and course selection by gender. Results from testing of H1 revealed no significant difference between course grades of online students and students enrolled in traditional face-to-face classes. Chisquare testing was utilized for testing of H2. Results indicated there was no significant 50 difference in course retention of students enrolled in online courses and students enrolled in traditional face-to-face courses. H3 was also tested utilizing chi-square testing. The results indicated no significant difference in program retention of students who began the TA program in online courses and students who began in traditional face-to-face courses. Chapter Five provides a summary of the study, discussion of the findings in relationship to the literature, implications for practice, recommendations for further research, and conclusions. 51 CHAPTER FIVE INTERPRETATION AND RECOMMENDATIONS Introduction In the preceding chapter, the results of the analysis were reported. Chapter Five consists of the summary of the study, an overview of the problem, purpose statement and research questions, review of the methodology, major findings, and findings related to the literature. Chapter Five also contains implications for further action and recommendations for further research. The purpose of the latter sections is to expand on the research into distance education, including implications for expansion of course and program delivery and future research. Finally, a summary is offered to capture the scope and substance of what has been offered in the research. Study Summary The online delivery of course content in higher education has increased dramatically in the past decade. Allen and Seaman (2007a) reported that almost 3.5 million students participated in at least one online course during the Fall 2006 term, a nearly 10% increase over the number reported in the previous year. They also reported a 9.7% increase in online enrollment compared to the 1.5% growth in overall higher education. As online delivery has grown, so has criticism of its efficacy. Online delivery of education has become an important strategy for the institution that is the setting of this study. The purpose of this study was three-fold. The first purpose of the study was to determine if there was a significant difference between the course grades of students participating in TA online courses and their traditional classroombased counterparts. The second purpose of the study was to determine if there was a 52 significant difference between course retention of students participating in TA online courses and their traditional classroom-based counterparts. A third purpose of the study was to determine if there was a significant difference between program retention of students who began the TA program in online courses and those who began the program enrolled in traditional face-to-face courses. The study was designed to expand the knowledge base concerning online education and its efficacy in providing baccalaureate degree completion opportunities. The research design was a quantitative study to compare course grades, course retention, and program retention of students enrolled in the online and traditional face-toface TA program at Washburn University. Archival data from the student system at Washburn University was utilized to compare online and traditional face-to-face students. In order to answer Research Question 1, a sample of students enrolled in TA 300 and TA 310 online and traditional face-to-face courses was analyzed. The sample included students entering the program in the Fall semesters of 2002, 2003, 2004, 2005, and 2006. Two instructors were responsible for concurrent instruction of both the online and faceto-face classes for the period analyzed. A two-factor analysis of variance was used to analyze for a potential difference in the dependent variable, course grades, due to delivery method (online and face-to-face), the instructor (instructors A and B), and the potential interaction between the two independent variables (Research Question 1). A chi-square test for differences among proportions was used to analyze both course and program retention (Research Questions 2 and 3). For Research Question 2, archived data from the Washburn University student system was analyzed for students enrolled in TA 300 and TA 310. Additional variables identified for this sample included 53 course selection and instructor (A or B). For Research Question 3, archived data from the Washburn University system was used, which identified students with declared Technology Administration majors who began the TA program enrolled in online and face-to-face courses. A single gatekeeper course (TA 300) was identified for testing. Two instructors (A and B) were responsible for instruction during the testing period. A two-factor ANOVA was utilized to test H1: There is a statistically significant difference in course grades of students participating in online courses and students enrolled in a traditional classroom setting at the 0.05 level of significance. ANOVA testing was utilized to account for the two delivery methods and two instructors involved for the period of the study. The results of the test indicated there was no statistically significant difference in grades due to delivery method. The results of the testing also indicated no statistically significant difference in grades due to instructor and no interaction between the two independent variables. The research hypothesis was not supported. To test the next hypothesis, chi-square testing was utilized. H2: There is a statistically significant difference in student course retention between students participating in online courses and students enrolled in face-to-face courses at the 0.05 level of significance. The result of the chi-square testing indicated there was no statistically significant difference in course retention of students enrolled in online courses and students enrolled in face-to-face courses in the TA program. The research hypothesis was not supported. To test the final hypothesis, chi-square testing was also used. H3: There is a statistically significant difference in program retention between students who begin the 54 Technology Administration program in online courses and students who begin in face-toface courses at the 0.05 level of significance. The result of the chi-square testing indicated there was no statistically significant difference in the program retention rate of students who began the TA program in the online courses and students who began the program in the face-to-face courses. The research hypothesis was not supported. Testing found that course retention was high in both formats, leading to interpretation that higher results may be due to the age of participants or prior degree completion. The results found no significant difference in grades, course, or program retention for students in online TA courses and students enrolled in traditional face-to-face instruction. The implication of these results compared to current literature is discussed in the next section. Findings Related to the Literature Online education has become a strategy for higher education to provide instruction to students limited by distance or time, or who, for other reasons, do not wish to attend traditional classroom-based university classes. Additionally, online education allows higher education institutions to expand their geographic base. Institutions have utilized distance education for over a century to provide instruction, but it was only within the last two decades that instruction over the Internet had replaced correspondence, television, and video courses as the method of choice for delivery (Russell, 1999). Utilizing grades as a measure of achievement, meta-analyses conducted by Russell (1999), Shachar and Neumann (2003), and Machtmes and Asher (2002) found no significant difference in grades of online students and traditional classroom-based 55 students. These analyses utilized multiple studies of course information, comparing grades of online students and traditional face-to-face students, primarily utilizing t tests as the preferred methodology. The results of previous research were supported by the present study. Additionally, this study went further, analyzing data over more than one semester, controlling for the effect of different instructors. These results were contrary to the conclusion reached by Phipps and Merisotis (1999). The second purpose of the study was to determine if a significant difference existed between the course retention of students enrolled in online TA courses and students enrolled in face-to-face courses. Meta-analyses conducted by Phipps and Merisotis (1999) and Nora and Snyder (2009) concluded a much lower course retention rate in online students as compared to their face-to-face counterparts. The previous metaanalyses examined retention of online students and traditional face-to-face students in distinct courses, utilizing t tests as the primary methodology. The chosen method of t tests was used instead of the chi square testing due to the limitations of the studies to one course taught by one instructor, limited to one semester or cycle. Carr (2002) reported in The Chronicle of Higher Education that retention of online students was 50% less than that of traditional face-to-face students. Carr’s results were based on the examination of longitudinal retention data from universities as reported to the United States Department of Education. The results of the present study found no significant difference in the course retention rates. These results are supported by the findings of Carmel and Gold (2007) in which they reported no significant difference in course retention rates of online students compared to traditional face-to-face students in their analysis of students in multiple 56 courses in disciplines across a 4-year university. The present study expanded those results, examining course data in the same discipline over a 6-year period and controlling for delivery by two separate instructors. Research into program completion rates of AAS students has been conducted primarily in traditional university settings, including Townsend’s (2002) studies at the University of Missouri-Columbia. Townsend’s results showed a lower baccalaureate completion rate for students entering with an AAS than students who transferred to 4- year universities with an AA degree. Studies by Hogan (1997) of vocational-education programs also found a lower program completion rate for online students compared to students in traditional delivery vocational education programs. Analysis of the data in the current study showed no significant difference in program completion rate of students who began in online TA courses as compared to students who began the program in faceto-face courses. Conclusions The use of distance education for postsecondary instruction, primarily in the form of the Internet, has both changed and challenged the views of traditional university-based instruction. Multiple studies have been designed in an effort to examine whether online students have the same level of academic achievement as their traditional higher education peers. The present study agrees with the research indicating there is no statistically significant difference in the grades of online students and their face-to-face counterparts. In addition, with student retention an issue for all postsecondary institutions, the data from previous studies indicated a lower retention rate for online students than for their traditional face-to-face classmates. The current study contradicted 57 those arguments. In the following sections, implications for action, recommendations for research, and concluding remarks are addressed. Implications for Action As postsecondary institutions move into the 21st century, many have examined issues of student recruitment and retention in an effort to meet the demands of both their students and their communities. The majority of postsecondary institutions have initiated online education as a strategy to recruit students from beyond their traditional geographic areas. This study supported existing research utilizing grades as a measure of achievement and should alleviate doubt that online students are shortchanged in their education. The transition of existing face-to-face to courses to an online delivery model can be accomplished without sacrificing achievement of course and program goals. The study also examined course and program retention data, finding no significant differences between online and traditional students in the TA program. The findings of this study support the expansion of additional online courses and programs within the School of Applied Studies. Finally, this study can provide the basis for further action, including analyzing other programs and courses offered in the online format by the University. The analysis of other programs offered in an online delivery model would enhance further development of online courses and programs. Recommendations for Future Research Distance education delivery has expanded dramatically with the use of the Internet for online instruction. The present study could be continued in future years to measure the effects of specific curriculum delivery models and changes made to online 58 delivery platforms. In addition, the study could be expanded to include specific characteristics of student retention named in the literature, such as examining whether the age and entering GPA of students provides any insight into course and program retention. The study could also be expanded to include other universities with similar baccalaureate-degree completion programs and other disciplines. Because the body of research is limited concerning the baccalaureate-degree completion of students who begin their postsecondary education in career-oriented instruction, there is value in continuing to study baccalaureate completion rates, both in an online format and in more traditionally based settings. Concluding Remarks The current study examined a Technology Administration program that has been offered in both online and face-to-face format, utilizing data from Fall 2002 through Spring 2008. The TA program was developed to allow students who had completed an occupationally oriented AAS degree to complete a bachelor’s degree program. Three hypotheses were tested in this study, examining course grades, course retention, and program retention of students enrolled in online and face-to-face courses in Technology Administration. No significant difference was found for the three hypotheses. These results form a strong foundation for expanding online courses and programs at Washburn University. By addressing two of the major concerns of educators, achievement and retention, the study results allow expansion of online courses and programs to benefit from data-driven decision-making. Other institutions can and should utilize data to examine existing online course and program data. 59 REFERENCES Allen, I. E., & Seaman, J. (2003). Seizing the opportunity: The quality and extent of online education in the United States, 2002 and 2003. Needham, MA: The Sloan Consortium. Allen, I. E., & Seaman, J. (2005). Growing by degrees: Online education in the United States, 2005. Needham, MA: The Sloan Consortium. Allen, I. E., & Seaman, J. (2007a). Making the grade: Online education in the United States. Needham, MA: The Sloan Consortium Allen, I. E., & Seaman, J. (2007b). Online nation: Five years of growth in online learning. Needham, MA: The Sloan Consortium. Arle, J. (2002). Rio Salado College online human anatomy. In C. Twigg, Innovations in online learning: Moving beyond no significant difference (p. 18). Troy, NY: Center for Academic Transformation. Atkins, T. (2008, May 13). Changing times bring recruiting challenges at WU. Retrieved May 15, 2008, from CJOnline Web site at http://cjonline.com/stories/ 051308/loc_278440905.shtml Berge, Z., & Huang, L. P. (2004, May). A model for sustainable student retention: A holistic perspective on the student dropout problem with special attention to elearning. American Center for the Study of Distance Education. Retrieved April 17, 2009, from DEOSNEWS Web site at http://www.ed.psu.edu/acsde/deos/deosnews/deosarchives.asp 60 Bradburn, E., Hurst, D., & Peng, S. (2001). Community college transfer rates to 4-year institutions using alternative definitions of transfer. Washington, DC: National Center for Education Statistics. Brown, B. W., & Liedholm, C. (2002, May). Can Web courses replace the classroom in principles of microeconomics? The American Economic Review, 92, 444-448. California Community Colleges Chancellor's Office. (2009, April 20). Retention rates for community colleges. Retrieved April 20, 2009, from https://misweb.cccco.edu/mis/onlinestat/ret_suc_rpt.cfm?timeout=800 Carmel, A. & Gold, S. S.. (2007). The effects of course delivery modality on student satisfaction and retention and GPA in on-site vs. hybrid courses. Retrieved September 15, 2008, from ERIC database. (Doc. No. ED496527) Carnevale, D. (2006, November 17). Company's survey suggests strong growth potential for online education. The Chronicle of Higher Education , p. 35. Carr, S. (2000, February 11). As distance education comes of age, the challenge is keeping the students. The Chronicle of Higher Education , pp. 1-5. Cohen, A., & Brawer, F. (1996). The American community college. San Francisco: Jossey-Bass. Diaz, D. (2002, May-June). Online drop rates revisited. Retrieved April 8, 2008, from The Technology Source Archives Web site at http://www.technologysource.org/article/online_drop_rates-revisited/ Dougherty, K. J. (1992). Community colleges and baccalaureate attainment. The Journal of Higher Education, 63, 188-214. 61 Ebel, R., & Frisbie, D. (1991). Essentials of educational measurement. Prentice Hall: Englewood Cliffs, NJ. The Harvard guide. (2004). Retrieved May 20, 2008, from http://www.news.harvard.edu/guide Hogan, R. (1997, July). Analysis of student success in distance learning courses compared to traditional courses. Paper presented at Sixth Annual Conference on Multimedia in Education and Industry, Chattanoga, TN. Jacobs, J., & Grubb, W. N. (2003). The federal role in vocational education. New York: Community College Research Center. Joliet Junior College history. (2008). Retrieved May 20, 2008, from Joliet Junior College Web site at http://www.jjc.edu/campus_info/history/ Kansas Board of Regents. (2002-2003). Degree and program inventory. Retrieved May 14, 2008, from http://www.kansasregents.org Keeley, E. J., & House, J. D. (1993). Transfer shock revisited: A longitudinal study of transfer academic performance. Paper presented at the 33rd Annual Forum of the Association for Institutional Research, Chicago, IL. Knowles, M. S. (1994). A history of the adult education movement in the United States. Melbourne, FL: Krieger. Laanan, F. (2003). Degree aspirations of two-year students. Community College Journal of Research and Practice, 27, 495-518. Lynch, T. (2002). LSU expands distance learning program through online learning solution. T H E Journal (Technological Horizons in Education), 29(6), 47. 62 Machtmes, K., & Asher, J. W. (2000). A meta-analysis of the effectiveness of telecourses in distance education. The American Journal of Distance Education, 14(1), 27-41. Gilman, E. W., Lowe, J., McHenry, R., & Pease, R. (Eds.). (1998). Merriam-Webster’s collegiate dictionary. Springfield, MA: Merriam. Nash, R. (1984, Winter). Course completion rates among distance learners: Identifying possible methods to improve retention. Retrieved April 19, 2009, from Online Journal of Distance Education Web site at http://www.westga.edu/~distance/ojdla/winter84/nash84.htm National Center for Education Statistics. (2000). Distance education statistics 1999-2000. Retrieved March 13, 2008, from at http://nces.ed.gov/das/library/tables_listing National Center for Education Statistics. (2001). Percentage of undergraduates who took any distance education courses in 1999-2000 Answer the question using only information from the provided context block. What are some of the benefits of online education?",Unknown,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","Analyzing the impact of new technologies and shifting legislation, how did compliance of the new financial technologies, for instance, blockchain and cryptocurrency, evolve? Also, what are the consequences for retail and product industries in the aspects of cybersecurity and consumers’ protection? Kindly write the paper outlining the following and including specific regulations/technological advancement, and effects on operational financial compliance and safety of retail products.","In recent years, blockchain and cryptocurrency technologies have disrupted traditional financial systems, bringing about significant changes in compliance and regulatory frameworks. This article explores how these technologies influence financial regulations and their broader implications for various industries, including retail and cybersecurity. Blockchain and Cryptocurrency: A Brief Overview Blockchain technology, which underpins cryptocurrencies like Bitcoin and Ethereum, is a decentralized ledger that records transactions across a network of computers. Its features—transparency, security, and immutability—pose both opportunities and challenges for financial regulators. Cryptocurrencies, digital assets using cryptography for security, have gained prominence as alternative investment vehicles and payment methods. Impact on Financial Regulation The rise of cryptocurrencies has led to a reevaluation of financial regulations. Traditional financial systems are governed by a range of regulations designed to prevent fraud, money laundering, and other illicit activities. As cryptocurrencies operate outside conventional banking systems, regulators have had to adapt their approaches to address these new challenges. Anti-Money Laundering (AML) and Know Your Customer (KYC) Regulations: Cryptocurrencies have attracted regulatory attention due to their potential for facilitating money laundering and other illegal activities. In response, jurisdictions like the European Union have enacted measures such as the Fifth Anti-Money Laundering Directive (5AMLD), which requires cryptocurrency exchanges and wallet providers to comply with AML and KYC regulations. This includes verifying customer identities and monitoring transactions to prevent illicit activities. Financial Action Task Force (FATF) Guidelines: The FATF, an international body that sets standards for combating money laundering and terrorist financing, has issued guidelines for the cryptocurrency industry. These guidelines mandate that virtual asset service providers (VASPs) adhere to similar regulatory standards as traditional financial institutions, including transaction monitoring and reporting requirements. Regulatory Responses in Different Regions: Different countries have taken varied approaches to cryptocurrency regulation. For instance, the United States has implemented a patchwork of federal and state regulations, with agencies like the Securities and Exchange Commission (SEC) and the Commodity Futures Trading Commission (CFTC) overseeing different aspects of the market. In contrast, countries like China have imposed strict bans on cryptocurrency trading and mining, reflecting a more cautious stance. Implications for Retail and Product Industries The adoption of cryptocurrencies in retail and product industries introduces both opportunities and risks. As more retailers accept digital currencies as payment, they must navigate new regulatory and cybersecurity challenges. Cybersecurity Concerns: Retailers accepting cryptocurrencies must enhance their cybersecurity measures to protect against potential breaches. Blockchain technology, while secure, is not immune to attacks. Hacks targeting cryptocurrency exchanges and digital wallets have highlighted the need for robust security protocols. Retailers must invest in secure payment systems and educate staff on best practices for managing digital assets. Consumer Protection: The use of cryptocurrencies in retail transactions raises questions about consumer protection. Regulatory bodies are working to establish standards for ensuring fair practices and protecting consumer rights. For example, regulations may require retailers to provide clear information about the risks associated with cryptocurrency transactions and to implement mechanisms for resolving disputes. Impact on Product Safety: In the product sector, the integration of blockchain technology offers potential benefits such as improved traceability and transparency in supply chains. Blockchain can be used to track the provenance of goods, verify authenticity, and ensure compliance with safety standards. However, the technology also necessitates updates to existing regulatory frameworks to address issues related to data privacy and accuracy. Conclusion Blockchain and cryptocurrency technologies are reshaping the financial landscape, prompting significant changes in regulatory frameworks. As these technologies continue to evolve, regulators and industries must adapt to new challenges and opportunities. By staying informed and proactive, stakeholders can navigate the complexities of the digital economy while ensuring compliance and protecting consumer interests.","""================ ======= In recent years, blockchain and cryptocurrency technologies have disrupted traditional financial systems, bringing about significant changes in compliance and regulatory frameworks. This article explores how these technologies influence financial regulations and their broader implications for various industries, including retail and cybersecurity. Blockchain and Cryptocurrency: A Brief Overview Blockchain technology, which underpins cryptocurrencies like Bitcoin and Ethereum, is a decentralized ledger that records transactions across a network of computers. Its features—transparency, security, and immutability—pose both opportunities and challenges for financial regulators. Cryptocurrencies, digital assets using cryptography for security, have gained prominence as alternative investment vehicles and payment methods. Impact on Financial Regulation The rise of cryptocurrencies has led to a reevaluation of financial regulations. Traditional financial systems are governed by a range of regulations designed to prevent fraud, money laundering, and other illicit activities. As cryptocurrencies operate outside conventional banking systems, regulators have had to adapt their approaches to address these new challenges. Anti-Money Laundering (AML) and Know Your Customer (KYC) Regulations: Cryptocurrencies have attracted regulatory attention due to their potential for facilitating money laundering and other illegal activities. In response, jurisdictions like the European Union have enacted measures such as the Fifth Anti-Money Laundering Directive (5AMLD), which requires cryptocurrency exchanges and wallet providers to comply with AML and KYC regulations. This includes verifying customer identities and monitoring transactions to prevent illicit activities. Financial Action Task Force (FATF) Guidelines: The FATF, an international body that sets standards for combating money laundering and terrorist financing, has issued guidelines for the cryptocurrency industry. These guidelines mandate that virtual asset service providers (VASPs) adhere to similar regulatory standards as traditional financial institutions, including transaction monitoring and reporting requirements. Regulatory Responses in Different Regions: Different countries have taken varied approaches to cryptocurrency regulation. For instance, the United States has implemented a patchwork of federal and state regulations, with agencies like the Securities and Exchange Commission (SEC) and the Commodity Futures Trading Commission (CFTC) overseeing different aspects of the market. In contrast, countries like China have imposed strict bans on cryptocurrency trading and mining, reflecting a more cautious stance. Implications for Retail and Product Industries The adoption of cryptocurrencies in retail and product industries introduces both opportunities and risks. As more retailers accept digital currencies as payment, they must navigate new regulatory and cybersecurity challenges. Cybersecurity Concerns: Retailers accepting cryptocurrencies must enhance their cybersecurity measures to protect against potential breaches. Blockchain technology, while secure, is not immune to attacks. Hacks targeting cryptocurrency exchanges and digital wallets have highlighted the need for robust security protocols. Retailers must invest in secure payment systems and educate staff on best practices for managing digital assets. Consumer Protection: The use of cryptocurrencies in retail transactions raises questions about consumer protection. Regulatory bodies are working to establish standards for ensuring fair practices and protecting consumer rights. For example, regulations may require retailers to provide clear information about the risks associated with cryptocurrency transactions and to implement mechanisms for resolving disputes. Impact on Product Safety: In the product sector, the integration of blockchain technology offers potential benefits such as improved traceability and transparency in supply chains. Blockchain can be used to track the provenance of goods, verify authenticity, and ensure compliance with safety standards. However, the technology also necessitates updates to existing regulatory frameworks to address issues related to data privacy and accuracy. Conclusion Blockchain and cryptocurrency technologies are reshaping the financial landscape, prompting significant changes in regulatory frameworks. As these technologies continue to evolve, regulators and industries must adapt to new challenges and opportunities. By staying informed and proactive, stakeholders can navigate the complexities of the digital economy while ensuring compliance and protecting consumer interests. https://www.fatf-gafi.org/en/publications/Fatfrecommendations/targeted-update-virtual-assets-vasps-2024.html ================ ======= Analyzing the impact of new technologies and shifting legislation, how did compliance of the new financial technologies, for instance, blockchain and cryptocurrency, evolve? Also, what are the consequences for retail and product industries in the aspects of cybersecurity and consumers’ protection? Kindly write the paper outlining the following and including specific regulations/technological advancement, and effects on operational financial compliance and safety of retail products. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Financial,Effect Analysis,Q&A Respond using only the information provided in the context. Do not use any other information or knowledge.,What are some potential consequences of the federal prohibition of marijuana regarding money?,"Notwithstanding the foregoing state laws, any activity involving marijuana that is not authorized under the CSA remains a federal crime anywhere in the United States, including in states that have purported to legalize medical or recreational marijuana. The Supreme Court has held that state laws authorizing medical marijuana use do not affect the CSA’s restrictions. Thus, when states “legalize” a federally controlled substance such as marijuana, the sole result is that the substance is no longer controlled under state law. As discussed in another Legal Sidebar, moving marijuana from Schedule I to Schedule III, without other legal changes, would have some impact on marijuana users and businesses but would not bring the state-legal medical or recreational marijuana industry into compliance with federal controlled substances law. Activities that violate the CSA may give rise to federal criminal prosecution. As a practical matter, however, DEA and DOJ lack the resources to prosecute all violations of the CSA. DOJ guidance memoranda from the Obama Administration broadly affirmed federal authority to prosecute such activities but also indicated that DOJ would generally not prioritize prosecution of activities involving medical marijuana that complied with state law. Under the Trump Administration, DOJ rescinded that guidance, instead reaffirming the authority of federal prosecutors to exercise prosecutorial discretion to target federal marijuana offenses “in accordance with all applicable laws, regulations, and appropriations.” DOJ has not issued formal guidance on marijuana policy during the Biden Administration, but Attorney General Merrick Garland has indicated that the agency will not prioritize prosecuting individuals for personal use of marijuana. Notwithstanding the changes in guidance, data from the U.S. Sentencing Commission indicate that the number of federal marijuana trafficking prosecutions decreased every year between FY2018 and FY2022.The reference to appropriations in the DOJ guidance is significant, because in each budget cycle since FY2015, Congress has passed an appropriations rider barring DOJ from using taxpayer funds to prevent states from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” The appropriations rider thus prohibits federal prosecution of state-legal activities involving medical marijuana. However, it poses no bar to prosecution of activities involving recreational marijuana. Moreover, the rider does not remove criminal liability; it merely prevents enforcement of the CSA in certain circumstances. As the U.S. Court of Appeals for the Ninth Circuit has explained, if Congress repealed the appropriations rider, DOJ would be able to prosecute violations of the CSA that occurred while the rider was in effect, subject to the applicable statute of limitations. Even absent criminal prosecution or conviction, individuals and organizations engaged in marijuanarelated activities in violation of the CSA—including participants in the state-legal cannabis industry— may face collateral consequences arising from the federal prohibition of marijuana. Other federal laws impose legal consequences based on criminal activity, including violations of the CSA. For example, a financial institution handling income from an illegal marijuana business may violate federal anti-money laundering laws. The presence of income from a marijuana-related business may also prevent a bankruptcy court from confirming a bankruptcy plan (though courts have split on the issue). Likewise, marijuana businesses may be ineligible for certain federal tax deductions. (This restriction applies only to activities involving substances in Schedule I or II, so moving marijuana to Schedule III would allow marijuana businesses to deduct business expenses on federal tax filings.)For individuals, participation in the state-legal marijuana industry may have adverse immigration consequences. Violations of the CSA may also affect individuals’ ability to receive certain federal government benefits. In addition, federal law prohibits gun ownership and possession by any person who is an “unlawful user of or addicted to any controlled substance,” with no exception for users of state-legal medical marijuana.","What are some potential consequences of the federal prohibition of marijuana regarding money? Respond using only the information provided in the context. Do not use any other information or knowledge. Notwithstanding the foregoing state laws, any activity involving marijuana that is not authorized under the CSA remains a federal crime anywhere in the United States, including in states that have purported to legalize medical or recreational marijuana. The Supreme Court has held that state laws authorizing medical marijuana use do not affect the CSA’s restrictions. Thus, when states “legalize” a federally controlled substance such as marijuana, the sole result is that the substance is no longer controlled under state law. As discussed in another Legal Sidebar, moving marijuana from Schedule I to Schedule III, without other legal changes, would have some impact on marijuana users and businesses but would not bring the state-legal medical or recreational marijuana industry into compliance with federal controlled substances law. Activities that violate the CSA may give rise to federal criminal prosecution. As a practical matter, however, DEA and DOJ lack the resources to prosecute all violations of the CSA. DOJ guidance memoranda from the Obama Administration broadly affirmed federal authority to prosecute such activities but also indicated that DOJ would generally not prioritize prosecution of activities involving medical marijuana that complied with state law. Under the Trump Administration, DOJ rescinded that guidance, instead reaffirming the authority of federal prosecutors to exercise prosecutorial discretion to target federal marijuana offenses “in accordance with all applicable laws, regulations, and appropriations.” DOJ has not issued formal guidance on marijuana policy during the Biden Administration, but Attorney General Merrick Garland has indicated that the agency will not prioritize prosecuting individuals for personal use of marijuana. Notwithstanding the changes in guidance, data from the U.S. Sentencing Commission indicate that the number of federal marijuana trafficking prosecutions decreased every year between FY2018 and FY2022.The reference to appropriations in the DOJ guidance is significant, because in each budget cycle since FY2015, Congress has passed an appropriations rider barring DOJ from using taxpayer funds to prevent states from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” The appropriations rider thus prohibits federal prosecution of state-legal activities involving medical marijuana. However, it poses no bar to prosecution of activities involving recreational marijuana. Moreover, the rider does not remove criminal liability; it merely prevents enforcement of the CSA in certain circumstances. As the U.S. Court of Appeals for the Ninth Circuit has explained, if Congress repealed the appropriations rider, DOJ would be able to prosecute violations of the CSA that occurred while the rider was in effect, subject to the applicable statute of limitations. Even absent criminal prosecution or conviction, individuals and organizations engaged in marijuanarelated activities in violation of the CSA—including participants in the state-legal cannabis industry— may face collateral consequences arising from the federal prohibition of marijuana. Other federal laws impose legal consequences based on criminal activity, including violations of the CSA. For example, a financial institution handling income from an illegal marijuana business may violate federal anti-money laundering laws. The presence of income from a marijuana-related business may also prevent a bankruptcy court from confirming a bankruptcy plan (though courts have split on the issue). Likewise, marijuana businesses may be ineligible for certain federal tax deductions. (This restriction applies only to activities involving substances in Schedule I or II, so moving marijuana to Schedule III would allow marijuana businesses to deduct business expenses on federal tax filings.)For individuals, participation in the state-legal marijuana industry may have adverse immigration consequences. Violations of the CSA may also affect individuals’ ability to receive certain federal government benefits. In addition, federal law prohibits gun ownership and possession by any person who is an “unlawful user of or addicted to any controlled substance,” with no exception for users of state-legal medical marijuana.",Legal,Fact Finding,Q&A This task requires you to answer questions based only on the information provided in the prompt. Give your answer in bullet points.,Briefly summarize the IRS's efforts to create a DF system. Include only the important facts.,"Individuals may satisfy their income tax obligations by filing a paper return or filing an electronic one (efiling). To e-file, a taxpayer must use software preapproved by the Internal Revenue Service (IRS). Most individual returns are e-filed. For the 2022 tax year (through December 29, 2023), the IRS received 162 million returns, 93% of which (150 million) had been e-filed. Professional preparers submitted 57% of the e-filed returns and self-preparing individuals the other 43%. Historically, the IRS has provided taxpayers with several options for free e-filing, but those options did not include e-filing directly with the IRS through a secure portal on its website, an option known as Direct File (DF). As a result of several recent developments, a DF option is now available as a pilot program during the 2024 filing season. This Insight describes how the pilot DF system came to be and how it is intended to work. Emergence of An IRS Direct-File Option The IRS’s efforts to create a DF system go back to the early 2000s. The initial attempt was a response to a 2001 directive from the Office of Management and Budget to expand e-filing as part of an effort to increase the range of online federal government services. In 2002, concerned about the cost of developing and maintaining a DF system and facing opposition in Congress to such an initiative, the IRS formed a partnership with a number of commercial tax preparation firms to provide free tax preparation and e-filing to lower-income taxpayers through a program known as Free File. Under the agreement establishing the program, member companies were to provide free e-filing to eligible taxpayers through their online platforms, and in return, the IRS would refrain from developing its own DF system. This restriction lasted from 2003 until 2019, when it was dropped from the memorandum of understanding governing the Free File program. There were several reasons for this decision. Historic usage rates for the program had ranged from 3% to 4% of eligible taxpayers. The IRS invested little in promoting and policing the program. Some media reports in 2019 revealed that some member companies had been diverting Free File-eligible taxpayers to the companies’ paid filing services. Interest in the IRS providing a DF service seems to have grown since 2019. The Inflation Reduction Act (IRA, P.L. 117-169) provided the IRS with $15 million to create a direct e-file task force and deliver two reports to Congress by May 16, 2023. The task force was to prepare one report, and an “independent third party” chosen by the IRS was to prepare a second report. ","This task requires you to answer questions based only on the information provided in the prompt. Give your answer in bullet points. Briefly summarize the IRS's efforts to create a DF system. Include only the important facts. Individuals may satisfy their income tax obligations by filing a paper return or filing an electronic one (efiling). To e-file, a taxpayer must use software preapproved by the Internal Revenue Service (IRS). Most individual returns are e-filed. For the 2022 tax year (through December 29, 2023), the IRS received 162 million returns, 93% of which (150 million) had been e-filed. Professional preparers submitted 57% of the e-filed returns and self-preparing individuals the other 43%. Historically, the IRS has provided taxpayers with several options for free e-filing, but those options did not include e-filing directly with the IRS through a secure portal on its website, an option known as Direct File (DF). As a result of several recent developments, a DF option is now available as a pilot program during the 2024 filing season. This Insight describes how the pilot DF system came to be and how it is intended to work. Emergence of An IRS Direct-File Option The IRS’s efforts to create a DF system go back to the early 2000s. The initial attempt was a response to a 2001 directive from the Office of Management and Budget to expand e-filing as part of an effort to increase the range of online federal government services. In 2002, concerned about the cost of developing and maintaining a DF system and facing opposition in Congress to such an initiative, the IRS formed a partnership with a number of commercial tax preparation firms to provide free tax preparation and e-filing to lower-income taxpayers through a program known as Free File. Under the agreement establishing the program, member companies were to provide free e-filing to eligible taxpayers through their online platforms, and in return, the IRS would refrain from developing its own DF system. This restriction lasted from 2003 until 2019, when it was dropped from the memorandum of understanding governing the Free File program. There were several reasons for this decision. Historic usage rates for the program had ranged from 3% to 4% of eligible taxpayers. The IRS invested little in promoting and policing the program. Some media reports in 2019 revealed that some member companies had been diverting Free File-eligible taxpayers to the companies’ paid filing services. Interest in the IRS providing a DF service seems to have grown since 2019. The Inflation Reduction Act (IRA, P.L. 117-169) provided the IRS with $15 million to create a direct e-file task force and deliver two reports to Congress by May 16, 2023. The task force was to prepare one report, and an “independent third party” chosen by the IRS was to prepare a second report. ",Financial,Summarize & Simplify,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Can you explain to me in layman's terms what the SAFE Bet Act is and what it is proposing into law? Answer in a minimum of 200 words.,"Rep. Paul Tonko and Sen. Richard Blumenthal announced details of their new Supporting Affordability and Fairness with Every Bet (SAFE) Bet Act during a press conference on Thursday. Bill would create federal oversight of state-run sports betting The overarching idea of the bill is to let states continue to regulate and oversee sports betting but to implement a set of federal minimum standards that state regulators and operators need to meet. States would be required to apply to the Department of Justice in order to get the greenlight to run a regulated market. Those federal standards cover a wide range of topics related to responsible and problem gambling. Unlike Tonko’s previous bill, the Betting on Our Future Act, which sought to ban all electronic advertising of sports betting, this version would allow it, but with several limitations. The bill would prohibit advertising during primetime hours as well as during live sporting events, implement language restrictions on words like “bonus”, “odds boost” and “no-sweat”, prohibit education about how to bet within the advertising and limit celebrity spokespeople from offering suggested bets to users. Bill would introduce affordability checks, limit ads, prohibit AI The legislation also takes a nod from other markets like the U.K. and includes what would be the first mandated affordability checks for sports bettors in the regulated U.S. market. Bettors would not be able to deposit via credit card, they would be limited to five deposits a day and operators would need to run affordability checks on bettors wagering at least $1,000 in a one-day period or $10,000 in a 30-day period. Bettors whose wagering exceeds more than 30% of their income would not be approved to bet. The bill would greenlight several reports, including from the Substance Abuse Mental Health Services Administration (SAMHSA), the Surgeon General’s office and the Center for Disease Control and would also introduce a national self-exclusion list. Finally, the bill would take proactive steps to limit the use of AI by sportsbook operators to track bettor behavior, create personalized betting offers or to generate gambling products like microbes. In-game betting was a major focus of the press conference, with lawmakers and representatives from the National Public Health Institute suggesting that the proliferation of in-game and microbetting was not what the government anticipated when the Supreme Court overturned the Professional and Amateur Sports Protection Act (PASPA). They did not call out DraftKings by name but specifically mentioned DraftKings’s acquisition of Simplebet as an indicator of what they feel is a problem. While Blumenthal also introduced the Gambling Addiction Recovery, Investment and Treatment (GRIT) Act at the start of the year, which would allocate the funds collected on the federal excise tax on sports betting and use them to fund problem gambling initiatives, the subject of funding did not come up during Thursday’s press event. Based on the limited information around the bill, it seems to only apply to sports betting and would not impact other forms of gambling such as casinos, online casinos or the lottery. Trade orgs quick to speak out against SAFE Bet Act Trade groups within the industry were quick to respond to the press conference expressing concerns about the proposed legislation. “Today’s regulated sports wagering operators are contributing billions in state taxes across the U.S., protecting consumers from dangerous neighborhood bookies and illegal offshore websites, and working diligently with over 5,000 state and tribal regulators and other stakeholders to ensure a commitment to responsibility and positive play. Six years into legal sports betting, introducing heavy-handed federal prohibitions is a slap in the face to state legislatures and gaming regulators who have dedicated countless time and resources to developing thoughtful frameworks unique to their jurisdictions, and have continued to iterate as their marketplaces evolve,” said American Gaming Associaton Senior Vice President of Government Relations Chris Cylke. iDEA Growth issued a statement on the measure as well, saying, in part: “iDEA remains committed to working with lawmakers, regulators, and stakeholders to enhance player protections in a way that empowers states and preserves the benefits of a well-regulated, competitive market. We urge Congress to reject this misguided federal mandate and instead support state-based solutions that are already working across the country. The SAFE Bet Act’s blanket, one-size-fits-all requirements on advertising, affordability checks, and artificial intelligence stifle the autonomy of states and tribal governments, many of which have implemented their own robust regulatory frameworks tailored to the needs of their constituents. These measures not only infringe on states’ rights but also risk undermining the operational flexibility that has allowed the legal sports betting industry to thrive, create jobs, and generate critical tax revenue that supports education, infrastructure, and other vital services.” Since the repeal of PASPA, several federal bills have been introduced regarding sports wagering, but none have made much progress or even advanced out of committee.","[question] Can you explain to me in layman's terms what the SAFE Bet Act is and what it is proposing into law? Answer in a minimum of 200 words. ===================== [text] Rep. Paul Tonko and Sen. Richard Blumenthal announced details of their new Supporting Affordability and Fairness with Every Bet (SAFE) Bet Act during a press conference on Thursday. Bill would create federal oversight of state-run sports betting The overarching idea of the bill is to let states continue to regulate and oversee sports betting but to implement a set of federal minimum standards that state regulators and operators need to meet. States would be required to apply to the Department of Justice in order to get the greenlight to run a regulated market. Those federal standards cover a wide range of topics related to responsible and problem gambling. Unlike Tonko’s previous bill, the Betting on Our Future Act, which sought to ban all electronic advertising of sports betting, this version would allow it, but with several limitations. The bill would prohibit advertising during primetime hours as well as during live sporting events, implement language restrictions on words like “bonus”, “odds boost” and “no-sweat”, prohibit education about how to bet within the advertising and limit celebrity spokespeople from offering suggested bets to users. Bill would introduce affordability checks, limit ads, prohibit AI The legislation also takes a nod from other markets like the U.K. and includes what would be the first mandated affordability checks for sports bettors in the regulated U.S. market. Bettors would not be able to deposit via credit card, they would be limited to five deposits a day and operators would need to run affordability checks on bettors wagering at least $1,000 in a one-day period or $10,000 in a 30-day period. Bettors whose wagering exceeds more than 30% of their income would not be approved to bet. The bill would greenlight several reports, including from the Substance Abuse Mental Health Services Administration (SAMHSA), the Surgeon General’s office and the Center for Disease Control and would also introduce a national self-exclusion list. Finally, the bill would take proactive steps to limit the use of AI by sportsbook operators to track bettor behavior, create personalized betting offers or to generate gambling products like microbes. In-game betting was a major focus of the press conference, with lawmakers and representatives from the National Public Health Institute suggesting that the proliferation of in-game and microbetting was not what the government anticipated when the Supreme Court overturned the Professional and Amateur Sports Protection Act (PASPA). They did not call out DraftKings by name but specifically mentioned DraftKings’s acquisition of Simplebet as an indicator of what they feel is a problem. While Blumenthal also introduced the Gambling Addiction Recovery, Investment and Treatment (GRIT) Act at the start of the year, which would allocate the funds collected on the federal excise tax on sports betting and use them to fund problem gambling initiatives, the subject of funding did not come up during Thursday’s press event. Based on the limited information around the bill, it seems to only apply to sports betting and would not impact other forms of gambling such as casinos, online casinos or the lottery. Trade orgs quick to speak out against SAFE Bet Act Trade groups within the industry were quick to respond to the press conference expressing concerns about the proposed legislation. “Today’s regulated sports wagering operators are contributing billions in state taxes across the U.S., protecting consumers from dangerous neighborhood bookies and illegal offshore websites, and working diligently with over 5,000 state and tribal regulators and other stakeholders to ensure a commitment to responsibility and positive play. Six years into legal sports betting, introducing heavy-handed federal prohibitions is a slap in the face to state legislatures and gaming regulators who have dedicated countless time and resources to developing thoughtful frameworks unique to their jurisdictions, and have continued to iterate as their marketplaces evolve,” said American Gaming Associaton Senior Vice President of Government Relations Chris Cylke. iDEA Growth issued a statement on the measure as well, saying, in part: “iDEA remains committed to working with lawmakers, regulators, and stakeholders to enhance player protections in a way that empowers states and preserves the benefits of a well-regulated, competitive market. We urge Congress to reject this misguided federal mandate and instead support state-based solutions that are already working across the country. The SAFE Bet Act’s blanket, one-size-fits-all requirements on advertising, affordability checks, and artificial intelligence stifle the autonomy of states and tribal governments, many of which have implemented their own robust regulatory frameworks tailored to the needs of their constituents. These measures not only infringe on states’ rights but also risk undermining the operational flexibility that has allowed the legal sports betting industry to thrive, create jobs, and generate critical tax revenue that supports education, infrastructure, and other vital services.” Since the repeal of PASPA, several federal bills have been introduced regarding sports wagering, but none have made much progress or even advanced out of committee. https://sbcamericas.com/2024/09/12/safe-bet-act-details/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Summarize & Simplify,Text Transformation "Respond using only the available context. Do not use dictionaries, internal knowledge, or any other resource. If the query is not answerable using the available context, respond with ""Sorry, I dunno :("".",I don't really understand this. What is AICOA and how is it different from monopoly and Sherman and stuff?,"Yelp’s Self-preferencing Claims AMERICANACTIONFORUM.ORG Yelp brought its lawsuit against Google largely alleging a violation of Section 2 of the Sherman Act, which prohibits the illegal monopolization of a market. To succeed on a Section 2 illegal monopolization claim, a plaintiff must show two elements: 1) that the defendant had monopoly power in a relevant market, and 2) that the firm illegally acquired or maintained that monopoly power using anticompetitive means. While Yelp alleges a few different theories in the case, this paper focuses on the claim that Google is using monopoly power in the general search market to self-preference local search offerings at the expense of rivals such as Yelp. Element 1: Monopoly Power First, Yelp must show that Google has monopoly power in a relevant market. For the type of conduct at issue in this case, Yelp would likely need to show that Google both has monopoly power in the general search market and uses that monopoly power to attempt to monopolize the more specific local search market. The timing of this lawsuit is not a coincidence. In July, the DOJ won its case arguing that Google had illegally monopolized the general search market through the use of default search engine agreements with browsers and smartphone manufacturers. While that specific conduct isn’t at issue here, Yelp will almost certainly point to the finding that Google does, in fact, have monopoly power in general search. This provides Yelp with a strong foundation for its case, and if a court accepts Yelp’s argument, Yelp would simply need to show either that Google has monopoly power in the local search market or that Google has sufficient market power to pose a dangerous probability of monopolizing that market. Yelp’s case isn’t clear cut, however. First, the decision in the DOJ case is not binding here because Yelp is suing in a different jurisdiction, though a district court opinion from another jurisdiction may be a persuasive authority. Even if the judge in the Yelp case defers to the D.C. decision, the D.C. decision largely dismissed arguments about generative AI being a viable alternative to the traditional search engine because, at the time of discovery, the technology didn’t exist commercially. Within the past two years, tools that offer similar search functionality such as ChatGPT have grown significantly, providing an alternative to Google’s general search product and restricting Google’s ability to act as a monopolist. Second, Google will undoubtedly argue that local search is not distinct from general search. Element 2: Anticompetitive Conduct In addition to monopoly power, Yelp will need to show that Google could acquire that monopoly power in the local search market through “willful acquisition…as distinguished from growth or development as a consequence of a superior product, business acumen, or historic accident.” At the core of the complaint, Yelp alleges that “Google has degraded quality, demoted rivals, and grown its monopoly power by (1) inserting Google’s own vertical search results at the top of its horizontal search results page to divert user attention away from organic search results and (2) excluding rivals and their vertical content from that prime placement in the vertical search sections that populate the top of the [search engine results page].” This argument relies on what is known as “self-preferencing,” a legal theory that has become popular in European competition law in recent years, but is largely dismissed by U.S. courts. Courts in the United States have found that even firms with monopoly power generally have no duty to deal with their rivals, as firms AMERICANACTIONFORUM.ORG should be able to choose how they offer their products and services to better compete on the merits. Some tying arrangements can violate the law, but tying arguments generally require a firm to tie the purchase of a product in a market in which the firm has monopoly power to the purchase of a product in another market in which the firm does not have monopoly power. Yet as antitrust scholar Herbert Hovenkamp has explained, these types of tying agreements do not usually reach mere preferential ordering of goods that falls short of prohibitions on dealing. The reason courts generally don’t recognize self-preferencing as a viable theory of harm under the law is because firms use these displays to compete on the merits. If a customer searches for “best local lunch spots near me,” for example, Yelp would still be the top general search result on the website, though Google Places appears at the top of the result with a direct list of restaurants, their reviews, and their locations. Google, by incorporating its own vertical products, provides the user with immediate suggestions to the question, a tool to see how individuals rate the restaurants, and a map to see how far away they are. And if users want a more detailed local search option, they can simply click on the Yelp link right below the vertical offerings. Courts tend to prefer to give firms freedom to design their products as they see fit, largely due to concerns that mandating specific designs could negatively affect competition and consumers. AICOA in an Alternate Universe The American Innovation and Choice Online Act specifically targets the kind of conduct at issue here. First, the bill would designate large technology platforms like Google as covered platforms. Second, the bill would make it illegal to “preference the products, services, or lines of business of the covered platform operator over those of another business user on the covered platform in a manner that would materially harm competition,” along with a variety of other restrictions on harming smaller competitors. Under AICOA, a case against Google would more likely succeed, though it would still present challenges. First, and most important, Yelp couldn’t bring the case directly under the law, as AICOA would require the Department of Justice, the Federal Trade Commission, or a state attorney general to bring a claim. Yelp could still bring private litigation, and perhaps having this law on the books may persuade courts to recognize a self- preferencing claim, but it would not be able to bring an AICOA claim. Second, under AICOA, a plaintiff could largely ignore any discussion of monopoly power. Monopoly power is difficult to demonstrate, and it is extremely costly to adjudicate at trial for all parties involved. It is, however, a critical part to the competition analysis: If a firm lacks the power to profitably raise prices or exclude rivals, it is unlikely that the firm’s behavior would harm competition regardless of how it acts, as alternatives exist and business would go elsewhere. Instead, under AICOA, Google would essentially already be found to have that power, forgoing any analysis of market structure and restrictions on behavior, and would hold instead that the firm is large enough for the courts to be concerned. AMERICANACTIONFORUM.ORG Third, AICOA specifically prohibits self-preferencing, a theory largely not recognized by courts in the United States as described above. Though the legislation includes language about materially harming competition, courts would have flexibility in interpreting that provision. It could simply be a rule of reason analysis in which the court weighs the procompetitive justifications against the anticompetitive harms, but it could also mean that there is some harm to the competitive process, regardless of whether there are procompetitive justifications or even on the net a benefit to competition. Similarly, the legislation would allow defendants to argue an affirmative defense that the conduct was “reasonably tailored and reasonably necessary…to maintain or substantially enhance the core functionality of the covered platform,” but affirmative defenses mean that the defendant has already been found in violation of the law and have the burden of proving by a preponderance of the evidence that the defense applies. In other words, it would be up to the defendant to prove that that the conduct was reasonably tailored and reasonably necessary. This is similar to the burden-shifting analysis under the current anticompetitive conduct element of Section 2 claims – but by requiring the defendant prove that the conduct would “substantially” enhance the core functionality of a product, a firm like Google would have a more difficult time arguing the procompetitive case for conduct that led to vertical integration.","[Respond using only the available context. Do not use dictionaries, internal knowledge, or any other resource. If the query is not answerable using the available context, respond with ""Sorry, I dunno :("".] Context: [Yelp’s Self-preferencing Claims AMERICANACTIONFORUM.ORG Yelp brought its lawsuit against Google largely alleging a violation of Section 2 of the Sherman Act, which prohibits the illegal monopolization of a market. To succeed on a Section 2 illegal monopolization claim, a plaintiff must show two elements: 1) that the defendant had monopoly power in a relevant market, and 2) that the firm illegally acquired or maintained that monopoly power using anticompetitive means. While Yelp alleges a few different theories in the case, this paper focuses on the claim that Google is using monopoly power in the general search market to self-preference local search offerings at the expense of rivals such as Yelp. Element 1: Monopoly Power First, Yelp must show that Google has monopoly power in a relevant market. For the type of conduct at issue in this case, Yelp would likely need to show that Google both has monopoly power in the general search market and uses that monopoly power to attempt to monopolize the more specific local search market. The timing of this lawsuit is not a coincidence. In July, the DOJ won its case arguing that Google had illegally monopolized the general search market through the use of default search engine agreements with browsers and smartphone manufacturers. While that specific conduct isn’t at issue here, Yelp will almost certainly point to the finding that Google does, in fact, have monopoly power in general search. This provides Yelp with a strong foundation for its case, and if a court accepts Yelp’s argument, Yelp would simply need to show either that Google has monopoly power in the local search market or that Google has sufficient market power to pose a dangerous probability of monopolizing that market. Yelp’s case isn’t clear cut, however. First, the decision in the DOJ case is not binding here because Yelp is suing in a different jurisdiction, though a district court opinion from another jurisdiction may be a persuasive authority. Even if the judge in the Yelp case defers to the D.C. decision, the D.C. decision largely dismissed arguments about generative AI being a viable alternative to the traditional search engine because, at the time of discovery, the technology didn’t exist commercially. Within the past two years, tools that offer similar search functionality such as ChatGPT have grown significantly, providing an alternative to Google’s general search product and restricting Google’s ability to act as a monopolist. Second, Google will undoubtedly argue that local search is not distinct from general search. Element 2: Anticompetitive Conduct In addition to monopoly power, Yelp will need to show that Google could acquire that monopoly power in the local search market through “willful acquisition…as distinguished from growth or development as a consequence of a superior product, business acumen, or historic accident.” At the core of the complaint, Yelp alleges that “Google has degraded quality, demoted rivals, and grown its monopoly power by (1) inserting Google’s own vertical search results at the top of its horizontal search results page to divert user attention away from organic search results and (2) excluding rivals and their vertical content from that prime placement in the vertical search sections that populate the top of the [search engine results page].” This argument relies on what is known as “self-preferencing,” a legal theory that has become popular in European competition law in recent years, but is largely dismissed by U.S. courts. Courts in the United States have found that even firms with monopoly power generally have no duty to deal with their rivals, as firms AMERICANACTIONFORUM.ORG should be able to choose how they offer their products and services to better compete on the merits. Some tying arrangements can violate the law, but tying arguments generally require a firm to tie the purchase of a product in a market in which the firm has monopoly power to the purchase of a product in another market in which the firm does not have monopoly power. Yet as antitrust scholar Herbert Hovenkamp has explained, these types of tying agreements do not usually reach mere preferential ordering of goods that falls short of prohibitions on dealing. The reason courts generally don’t recognize self-preferencing as a viable theory of harm under the law is because firms use these displays to compete on the merits. If a customer searches for “best local lunch spots near me,” for example, Yelp would still be the top general search result on the website, though Google Places appears at the top of the result with a direct list of restaurants, their reviews, and their locations. Google, by incorporating its own vertical products, provides the user with immediate suggestions to the question, a tool to see how individuals rate the restaurants, and a map to see how far away they are. And if users want a more detailed local search option, they can simply click on the Yelp link right below the vertical offerings. Courts tend to prefer to give firms freedom to design their products as they see fit, largely due to concerns that mandating specific designs could negatively affect competition and consumers. AICOA in an Alternate Universe The American Innovation and Choice Online Act specifically targets the kind of conduct at issue here. First, the bill would designate large technology platforms like Google as covered platforms. Second, the bill would make it illegal to “preference the products, services, or lines of business of the covered platform operator over those of another business user on the covered platform in a manner that would materially harm competition,” along with a variety of other restrictions on harming smaller competitors. Under AICOA, a case against Google would more likely succeed, though it would still present challenges. First, and most important, Yelp couldn’t bring the case directly under the law, as AICOA would require the Department of Justice, the Federal Trade Commission, or a state attorney general to bring a claim. Yelp could still bring private litigation, and perhaps having this law on the books may persuade courts to recognize a self- preferencing claim, but it would not be able to bring an AICOA claim. Second, under AICOA, a plaintiff could largely ignore any discussion of monopoly power. Monopoly power is difficult to demonstrate, and it is extremely costly to adjudicate at trial for all parties involved. It is, however, a critical part to the competition analysis: If a firm lacks the power to profitably raise prices or exclude rivals, it is unlikely that the firm’s behavior would harm competition regardless of how it acts, as alternatives exist and business would go elsewhere. Instead, under AICOA, Google would essentially already be found to have that power, forgoing any analysis of market structure and restrictions on behavior, and would hold instead that the firm is large enough for the courts to be concerned. AMERICANACTIONFORUM.ORG Third, AICOA specifically prohibits self-preferencing, a theory largely not recognized by courts in the United States as described above. Though the legislation includes language about materially harming competition, courts would have flexibility in interpreting that provision. It could simply be a rule of reason analysis in which the court weighs the procompetitive justifications against the anticompetitive harms, but it could also mean that there is some harm to the competitive process, regardless of whether there are procompetitive justifications or even on the net a benefit to competition. Similarly, the legislation would allow defendants to argue an affirmative defense that the conduct was “reasonably tailored and reasonably necessary…to maintain or substantially enhance the core functionality of the covered platform,” but affirmative defenses mean that the defendant has already been found in violation of the law and have the burden of proving by a preponderance of the evidence that the defense applies. In other words, it would be up to the defendant to prove that that the conduct was reasonably tailored and reasonably necessary. This is similar to the burden-shifting analysis under the current anticompetitive conduct element of Section 2 claims – but by requiring the defendant prove that the conduct would “substantially” enhance the core functionality of a product, a firm like Google would have a more difficult time arguing the procompetitive case for conduct that led to vertical integration.] User query: [I don't really understand this. What is AICOA and how is it different from monopoly and Sherman and stuff?]",Legal,Concept Comparison,Q&A "Only provide the opinions that were given in the context document. If you cannot answer a question using the provided context alone, then say ""I'm sorry, but I do not have the context to answer this question.""","Based on the document provided, how does the user make the shortcuts menu appear while playing music? ","User Manual Version 1.1 Table of Contents Get started 7 What's in the box 7 Charge your watch 8 Set up Versa 3 9 Connect to Wi-Fi 9 See your data in the Fitbit app 10 Unlock Fitbit Premium 11 Advanced health metrics 11 Premium health and wellness reminders 12 Wear Versa 3 13 Placement for all-day wear vs. exercise 13 Fasten the band 14 Handedness 15 Wear and care tips 16 Change the band 16 Remove a band 16 Attach a band 17 Basics 18 Navigate Versa 3 18 Basic navigation 18 Button shortcuts 19 Widgets 22 Adjust settings 23 Display 24 Vibration & audio 24 Goal reminders 24 Quiet modes 24 Shortcuts 25 Check battery level 25 Set up device lock 26 2 Adjust always-on display 26 Turn off the screen 28 Care for Versa 3 28 Apps and Clock Faces 29 Change the clock face 29 Open apps 30 Organize apps 30 Download additional apps 30 Remove apps 30 Update apps 31 Adjust app settings and permissions 31 Voice Assistant 32 Set up Amazon Alexa Built-in 32 Interact with Alexa 32 Check Alexa alarms, reminders, and timers 34 Lifestyle 35 Starbucks 35 Agenda 35 Weather 35 Check the weather 36 Add or remove a city 36 Find Phone 36 Notifications from your phone 38 Set up notifications 38 See incoming notifications 38 Manage notifications 39 Turn off notifications 39 Answer or reject phone calls 40 Respond to messages (Android phones) 41 Timekeeping 42 Use the Alarms app 42 Dismiss or snooze an alarm 42 3 Use the Timer app 43 Activity and Wellness 44 See your stats 44 Track a daily activity goal 45 Choose a goal 45 Track your hourly activity 45 Track your sleep 46 Set a sleep goal 46 Learn about your sleep habits 46 Practice guided breathing 47 Exercise and Heart Health 48 Track your exercise automatically 48 Track and analyze exercise with the Exercise app 49 Track an exercise 49 Customize your exercise settings 50 Check your workout summary 51 Check your heart rate 51 Custom heart-rate zones 53 Earn Active Zone Minutes 53 View your cardio fitness score 53 Work out with Fitbit Coach 54 Share your activity 54 Music 55 Connect Bluetooth headphones or speakers 55 Control music with Versa 3 55 Choose the music source 56 Control music 56 Control music with the Spotify - Connect & Control app 56 Listen to music with the Pandora app (United States only) 57 Listen to music with the Deezer app 57 Fitbit Pay 58 Use credit and debit cards 58 4 Set up Fitbit Pay 58 Make purchases 59 Change your default card 60 Pay for transit 60 Update, Restart, and Erase 62 Update Versa 3 62 Restart Versa 3 62 Shutdown Versa 3 63 Erase Versa 3 63 Troubleshooting 64 Heart-rate signal missing 64 GPS signal missing 64 Can't connect to Wi-Fi 65 Other issues 66 General Info and Specifications 67 Sensors and Components 67 Materials 67 Wireless technology 68 Haptic feedback 68 Battery 68 Memory 68 Display 68 Band size 68 Environmental conditions 69 Learn more 69 Return policy and warranty 69 Regulatory and Safety Notices 70 USA: Federal Communications Commission (FCC) statement 70 Canada: Industry Canada (IC) statement 71 European Union (EU) 72 IP Rating 73 Argentina 74 5 Australia and New Zealand 74 Belarus 74 Botswana 75 China 75 Customs Union 77 Indonesia 77 Israel 77 Japan 77 Kingdom of Saudi Arabia 78 Mexico 78 Moldova 78 Morocco 79 Nigeria 79 Oman 79 Pakistan 79 Philippines 80 Serbia 80 Singapore 80 South Korea 80 Taiwan 82 United Arab Emirates 84 Vietnam 85 Zambia 85 Safety Statement 85 6 Get started Meet Fitbit Versa 3, the health and fitness smartwatch with built-in GPS, Active Zone Minutes, 20+ exercise modes, and music experiences to keep you motivated to move. Take a moment to review our complete safety information at fitbit.com/safety. Versa 3 is not intended to provide medical or scientific data. What's in the box Your Versa 3 box includes: Watch with small band (color and material varies) Charging cable Additional large band The detachable bands on Versa 3 come in a variety of colors and materials, sold separately. 7 Charge your watch A fully-charged Versa 3 has a battery life of 6+ days. Battery life and charge cycles vary with use and other factors; actual results will vary. To charge Versa 3: 1. Plug the charging cable into the USB port on your computer, a UL-certified USB wall charger, or another low-energy charging device. 2. Hold the other end of the charging cable near the port on the back of the watch until it attaches magnetically. Make sure the pins on the charging cable align with the port on the back of your watch. Charge Versa 3 for 12 minutes for 24 hours of battery life. While the watch charges, tap the screen twice or press the button to turn the screen on. The battery level appears for several seconds, then disappears so you can use your watch while it charges. Charging fully takes about 1-2 hours. 8 Set up Versa 3 Set up Versa 3 with the Fitbit app for iPhones and iPads or Android phones. The Fitbit app is compatible with most popular phones and tablets. See fitbit.com/devices to check if your phone or tablet is compatible. To get started: 1. Download the Fitbit app: l Apple App Store for iPhones and iPads l Google Play Store for Android phones 2. Install the app, and open it. l If you already have a Fitbit account, log in to your account > tap the Today tab > your profile picture > Set Up a Device. l If you don't have a Fitbit account, tap Join Fitbit to be guided through a series of questions to create a Fitbit account. 3. Continue to follow the on-screen instructions to connect Versa 3 to your account. When you're done with setup, read through the guide to learn more about your new watch and then explore the Fitbit app. For more information, see help.fitbit.com. Connect to Wi-Fi During setup, you're prompted to connect Versa 3 to your Wi-Fi network. Versa 3 uses Wi-Fi to more quickly transfer music from Pandora or Deezer, download apps 9 from the Fitbit App Gallery, and for faster, more reliable OS updates. Versa 3 can connect to open, WEP, WPA personal, and WPA2 personal Wi-Fi networks. Your watch won't connect to 5GHz, WPA enterprise, or public Wi-Fi networks that require more than a password to connect—for example, logins, subscriptions, or profiles. If you see fields for a username or domain when connecting to the Wi-Fi network on a computer, the network isn't supported. For best results, connect Versa 3 to your home Wi-Fi network. Make sure you know the network password before connecting. For more information, see help.fitbit.com. See your data in the Fitbit app Open the Fitbit app on your phone or tablet to view your activity and sleep data, log food and water, participate in challenges, and more. 10 Unlock Fitbit Premium Fitbit Premium helps you build healthy habits by offering tailored workouts, insights into how your behavior impacts your health, and personalized plans to help you reach your goals. A Fitbit Premium subscription includes health insights and guidance, advanced health metrics, sleep details, customized programs, and 150+ workouts from fitness brands. New Fitbit Premium customers can redeem a free trial. For more information, see help.fitbit.com. Advanced health metrics Know your body better with health metrics in the Fitbit app. This feature helps you view key metrics tracked by your Fitbit device over time so that you can see trends and assess what’s changed. Metrics include: l Oxygen saturation (SpO2) l Skin temperature variation l Heart rate variability l Resting heart rate l Breathing rate Note: This feature is not intended to diagnose or treat any medical condition and should not be relied on for any medical purposes. It is intended to provide information that can help you manage your well-being. If you have any concerns about your health, please talk to a healthcare provider. If you believe you are experiencing a medical emergency, call emergency services. For more information, see help.fitbit.com. 11 Premium health and wellness reminders Set up Premium health and wellness reminders in the Fitbit app, and receive reminders on your watch that encourage you to form and maintain healthy behaviors. For more information, see help.fitbit.com. 12 Wear Versa 3 Wear Versa 3 around your wrist. If you need to attach a different size band, or if you purchased another band, see the instructions in ""Change the band"" on page 16. Placement for all-day wear vs. exercise When you're not exercising, wear Versa 3 a finger's width above your wrist bone. In general, it's always important to give your wrist a break on a regular basis by removing your watch for around an hour after extended wear. We recommend removing your watch while you shower. Although you can shower while wearing your watch, not doing so reduces the potential for exposure to soaps, shampoos, and conditioners, which can cause long-term damage to your watch and may cause skin irritation. For optimized heart-rate tracking while exercising: l During workouts, try moving the band higher on your wrist to get a better fit. If you experience any discomfort, loosen the band, and if it persists give your wrist a break by taking it off. 13 l Wear your watch on top of your wrist, and make sure the back of the device is in contact with your skin. Fasten the band 1. Place Versa 3 around your wrist. 2. Slide the bottom band through the first loop in the top band. 14 3. Tighten the band until it fits comfortably, and press the peg through one of the holes in the band. 4. Slide the loose end of the band through the second loop until it lies flat on your wrist. Make sure the band isn’t too tight. Wear the band loosely enough that it can move back and forth on your wrist. Handedness For greater accuracy, you must specify whether you wear Versa 3 on your dominant or non-dominant hand. Your dominant hand is the one you use for writing and eating. To start, the Wrist setting is set to non-dominant. If you wear Versa 3 on your dominant hand, change the Wrist setting in the Fitbit app: From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile > Wrist > Dominant. 15 Wear and care tips l Clean your band and wrist regularly with a soap-free cleanser. l If your watch gets wet, remove and dry it completely after your activity. l Take your watch off from time to time. l If you notice skin irritation, remove your watch and contact customer support. For more information, see fitbit.com/productcare. Change the band Versa 3 comes with a small band attached and an additional large, bottom band in the box. Both the top and bottom bands can be swapped with accessory bands, sold separately on fitbit.com. For band measurements, see ""Band size"" on page 68. Fitbit Sense bands are compatible with Versa 3. Remove a band 1. Turn over Versa 3 and find the band latches. 2. To release the latch, slide the flat button toward the band. 16 3. Gently pull the band away from the watch to release it. 4. Repeat on the other side. Attach a band To attach a band, press it into the end of the watch until you hear a click and it snaps into place. The band with the loops and peg attaches to the top of the watch. 17 Basics Learn how to manage settings, set a personal PIN code, navigate the screen, and care for your watch. Navigate Versa 3 Versa 3 has a color AMOLED touchscreen display and 1 button. Navigate Versa 3 by tapping the screen, swiping side to side and up and down, or pressing the button. To preserve battery, the watch’s screen turns off when not in use, unless you turn on the always-on display setting. For more information, see ""Adjust always-on display"" on page 26. Basic navigation The home screen is the clock. l Swipe down to see notifications. l Swipe up to see widgets, such as your daily stats, the weather, and a shortcut to start the Relax app. l Swipe left to see the apps on your watch. l Swipe right to open quick settings or return to the previous screen in an app. l Press the button to return to the clock face. 18 Button shortcuts Use the button to quickly access Fitbit Pay, voice assistant, quick settings, or your favorite apps. Press and hold the button Hold the button for 2 seconds to activate a feature of your choice. The first time you use the button shortcut, select which feature it activates. To change which feature activates when you hold the button, open the Settings app on your watch and tap Shortcuts. Tap Press & hold, and select the app you want. 19 Double-press the button Double-press the button to open shortcuts to 4 apps or features. To start, the 4 shortcuts are music controls , quick settings , your voice assistant, and Fitbit Pay . To change these shortcuts, open the Settings app on your watch and tap Shortcuts. Under Double Press, tap the shortcut you want to change. Quick settings Swipe right from the clock face on your watch to access quick settings. 20 Do Not Disturb When the do not disturb setting is on: l Notifications, goal celebrations, and reminders are muted. l The do not disturb icon illuminates in quick settings. You can't turn on do not disturb and sleep mode at the same time. Sleep Mode When the sleep mode setting is on: l Notifications, goal celebrations, and reminders are muted. l The screen's brightness is set to dim. l The Always-On Display clock face is turned off. l The screen stays dark when you turn your wrist. l The sleep mode icon illuminates in quick settings. Sleep mode turns off automatically when you set a sleep schedule. To set a schedule: 1. Open the Settings app and tap Quiet modes. 2. Under Sleep mode, tap Schedule mode > Off- hours. 3. Tap the start or stop time to adjust when the mode turns on and off. Swipe up or down to change the time, and tap the time to select it. Sleep mode automatically turns off at the time you schedule, even if you manually turned it on. You can't turn on do not disturb and sleep mode at the same time. Screen Wake When you set screen wake to automatic , the screen turns on each time you turn your wrist. 21 When you set screen wake to manual, press the button or tap the screen to turn on the display. Brightness Adjust the screen brightness. Always-On Display Turn always-on display on or off. For more information, see ""Adjust always-on display"" on page 26. Music Volume Adjust the volume of music playing through headphones or speakers paired to your watch. For more information, see ""Connect Bluetooth headphones or speakers"" on page 55. Widgets Add widgets to your watch to see your daily stats, log your water intake or weight, check the weather forecast, and start a session in the Relax app, and more. To see your widgets, swipe up from the clock face. To add a new widget: 22 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Under More Widgets, tap the icon next to the widget you want to add. 3. Swipe up to the bottom of the page, and tap Done. To turn off a widget: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Tap the > icon next to the widget you want to adjust. 3. Tap the switch icon next to Show Widget to turn it off. 4. Swipe up to the bottom of the page, and tap Done. To adjust the information you see on a widget: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Tap the > icon next to the widget you want to adjust. 3. Adjust any settings you want to change. 4. Swipe up to the bottom of the page, and tap Done. To change the order of widgets: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Press and hold the widget you want to move, and drag it up or down in the list of widgets. When it's in the correct new location, lift your finger. 3. Swipe up to the bottom of the page, and tap Done. Adjust settings Manage basic settings in the Settings app : 23 Display Brightness Change the screen's brightness. Screen wake Change whether the screen turns on when you turn your wrist. Screen timeout Adjust the amount of time before the screen turns off or switches to the always-on display clock face. Always-on display Turn always-on display on or off, and change the type of clock face shown. Vibration & audio Vibration Adjust your watch's vibration strength. Microphone Choose whether your watch can access the microphone. Bluetooth Manage connected Bluetooth devices. Goal reminders Active Zone Minutes goal Turn Active Zone Minutes weekly goal notifications on or off. Quiet modes Focus mode Turn off notifications while using the Exercise app . Do not disturb Turn off all notifications. Sleep mode Adjust sleep mode settings, including setting a schedule for the mode to automatically turn on and off. Alexa notifications Turn Amazon Alexa notifications off. 24 Shortcuts Press & hold Choose the app or feature you want to open when you press and hold the button. Double Press Choose 4 apps or features to appear as shortcuts when you double-press the button. Tap a setting to adjust it. Swipe up to see the full list of settings. Check battery level From the clock face, swipe right. The battery level icon is at the top of the screen. Wi-Fi won't work on Versa 3 when the battery is 25% or less, and you'll be unable to update your device. If your watch's battery is low (fewer than 24 hours remaining), a red battery indicator appears on the clock face. If your watch's battery is critically low (fewer than 4 hours remaining), the battery indicator flashes. When the battery is low: l The screen brightness is set to dim l The vibration strength is set to light l If you’re tracking an exercise with GPS, GPS tracking turns off l Always-on display is turned off l You can't use the voice assistant feature l You can't use quick replies 25 l You can't use music controls l You won't receive notifications from your phone Charge Versa 3 to use or adjust these features. Set up device lock To help keep your watch secure, turn on device lock in the Fitbit app, which prompts you to enter a personal 4-digit PIN code to unlock your watch. If you set up Fitbit Pay to make contactless payments from your watch, device lock is turned on automatically and you're required to set a code. If you don't use Fitbit Pay, device lock is optional. Turn on device lock or reset your PIN code in the Fitbit app: From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile > Device Lock. For more information, see help.fitbit.com. Adjust always-on display Turn on always-on display to show the time on your watch, even when you're not interacting with the screen. Many clock faces and certain apps have an always-on display mode. 26 To turn always-on display on or off, swipe right from the clock face to open quick settings. Tap the always-on display icon . Note that turning on this feature impacts your watch's battery life. When always-on display is turned on, Versa 3 requires more frequent charging. Clock faces without an always-on display mode use a default always-on display clock face. Choose between an analog or digital clock face. Open the Settings app > Display. In the Always-on display section, tap Analog or Digital. Always-on display automatically turns off when your watch's battery is critically low. For more information, see help.fitbit.com. 27 Turn off the screen To turn off your watch's screen when not in use, briefly cover the watch face with your opposite hand, press the buttons, or turn your wrist away from your body. Note that if you turn on the always-on display setting, the screen won't turn off. Care for Versa 3 It's important to clean and dry Versa 3 regularly. For more information, see fitbit.com/productcare. 28 Apps and Clock Faces The Fitbit Gallery offers apps and clock faces to personalize your watch and meet a variety of health, fitness, timekeeping, and everyday needs. Change the clock face The Fitbit Clock Gallery offers a variety of clock faces to personalize your watch. 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Clock Faces > All Clocks. 3. Browse the available clock faces. Tap a clock face to see a detailed view. 4. Tap Select to add the clock face to Versa 3. Save up to 5 clock faces to switch between them: l When you select a new clock face, it’s automatically saved unless you already have 5 saved clock faces. l To see your saved clock faces from your watch, open the Clocks app and swipe to find the clock face you want to use. Tap to select it. l To see your saved clock faces in the Fitbit app, tap the Today tab > your profile picture > your device image > Clock Faces. See your saved clock faces in My Clock Faces. 29 l To remove a clock face, tap the clock face > Remove clock face. l To switch to a saved clock face, tap the clock face > Select. Open apps From the clock face, swipe left to see the apps installed on your watch. To open an app, tap it. Organize apps To change the placement of an app on Versa 3, press and hold an app until it's selected, and drag it to a new location. The app is selected when the icon increases slightly in size and the watch vibrates. Download additional apps 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps > All Apps. 3. Browse the available apps. When you find one you want to install, tap it. 4. Tap Install to add the app to Versa 3. For more information, see help.fitbit.com. Remove apps You can remove most apps installed on Versa 3: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, tap the app you want to remove. You may have to swipe up to find it. 4. Tap Remove. 30 Update apps Apps update over Wi-Fi as needed. Versa 3 searches for updates when plugged into the charger and in range of your Wi-Fi network. You can also manually update apps: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, find the app you want to update. You may have to swipe up to find it. 4. Tap the pink Update button next to the app. Adjust app settings and permissions Many apps include options to adjust the notifications, allow certain permissions, and customize what it displays. Note that turning off any app permissions might cause the app to stop functioning. To access these settings: 1. With your watch nearby, in the Fitbit app, tap the Today tab > your profile picture > your device image. 2. Tap Apps or Clock Faces. 3. Tap the app or clock face whose settings you want to change. You may have to swipe up to see some apps. 4. Tap Settings or Permissions. 5. Tap Back or Details when you're done making changes. 31 Voice Assistant Check the weather, set timers and alarms, control your smart home devices, and more by speaking to your watch. Set up Amazon Alexa Built-in 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Amazon Alexa > Sign in with Amazon. 3. Tap Get Started. 4. Log in to your Amazon account or create one if necessary. 5. Follow the on-screen instructions and read about what Alexa can do, and tap Close to return to your device settings in the Fitbit app. To change the language Alexa recognizes or disconnect your Amazon account: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Amazon Alexa. 3. Tap the current language to change it, or tap Logout to stop using Alexa on your watch. Interact with Alexa 1. Open the Alexa app on your watch. Note that the Fitbit app must be running in the background on your phone. 2. Say your request. 32 You don't need to say ""Alexa"" before speaking your request. For example: l Set a timer for 10 minutes. l Set an alarm for 8:00 a.m. l What's the temperature outside? l Remind me to make dinner at 6:00 p.m. l How much protein is in an egg? l Ask Fitbit to start a run.* l Start a bike ride with Fitbit.* *To ask Alexa to open the Exercise app on your watch, you must first set up the Fitbit skill for Alexa. For more information, see help.fitbit.com. These commands are currently available in English, German, French, Italian, Spanish, and Japanese. Amazon Alexa not available in all countries. For more information, see fitbit.com/voice. Note that saying “Alexa” doesn’t activate Alexa on your watch—you must open the Alexa app on your watch before the microphone turns on. The microphone turns off when you close Alexa, or when your watch’s screen turns off. For added functionality, install the Amazon Alexa app on your phone. With the app, your watch can access additional Alexa skills. For more information, see help.fitbit.com. 33 Check Alexa alarms, reminders, and timers 1. Open the Alexa app on your watch. 2. Tap the alerts icon and swipe up to view your alarms, reminders, and timers. 3. Tap an alarm to turn it on or off. To adjust or cancel a reminder or timer, tap the Alexa icon and say your request. Note that Alexa's alarms and timers are separate from those you set in the Alarms app or Timer app . 34 Lifestyle Use apps to stay connected to what you care about most. See ""Apps and Clock Faces"" on page 29 for instructions on how to add and delete apps. For more information, see help.fitbit.com. Starbucks Add your Starbucks card or Starbucks Rewards program number in the Fitbit App Gallery in the Fitbit app, and then use the Starbucks app to pay from your wrist. For more information, see help.fitbit.com. Agenda Connect your phone's calendar in the Fitbit app to see upcoming calendar events for today and tomorrow in the Agenda app on your watch. For more information, see help.fitbit.com. Weather See the weather in your current location, as well as 2 additional locations you choose, in the Weather app on your watch. 35 Check the weather Open the Weather app to see conditions in your current location. Swipe up to view the weather in other locations you added. Tap a location to see a more detailed report. You can also add a weather widget to your watch. For more information, see ""Widgets"" on page 22. If the weather for your current location doesn't appear, check that you turned on location services for the Fitbit app. If you change locations or don't see updated data for your current location, sync your watch to see your new location and latest data in the Weather app or widget. Choose your unit of temperature in the Fitbit app. For more information, see help.fitbit.com. Add or remove a city 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, tap the gear icon next to Weather. You may need to swipe up to find the app. 4. Tap Add city to add up to 2 additional locations or tap Edit > the X icon to delete a location. Note that you can't delete your current location. Find Phone Use the Find Phone app to locate your phone. Requirements: 36 l Your watch must be connected (“paired”) to the phone you want to locate. l Your phone must have Bluetooth turned on and be within 30 feet (10m) of your Fitbit device. l The Fitbit app must be running in the background on your phone. l Your phone must be turned on. To find your phone: l Open the Find Phone app on your watch. l Tap Find Phone. Your phone rings loudly. l When you locate your phone, tap Cancel to end the ringtone. 37 Notifications from your phone Versa 3 can show call, text, calendar, and app notifications from your phone to keep you informed. Keep your watch within 30 feet of your phone to receive notifications. Set up notifications Check that Bluetooth on your phone is on and that your phone can receive notifications (often under Settings > Notifications). Then set up notifications: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Notifications. 3. Follow the on-screen instructions to pair your watch if you haven't already. Call, text, and calendar notifications are turned on automatically. 4. To turn on notifications from apps installed on your phone, including Fitbit and WhatsApp, tap App Notifications and turn on the notifications you want to see. Note that if you have an iPhone or iPad, Versa 3 shows notifications from all calendars synced to the Calendar app. If you have an Android phone, Versa 3 shows calendar notifications from the calendar app you chose during setup. For more information, see help.fitbit.com. See incoming notifications A notification causes your watch to vibrate. If you don't read the notification when it arrives, you can check it later by swiping down from the top of the screen. 38 If your watch's battery is critically low, notifications won't cause Versa 3 to vibrate or the screen to turn on. Manage notifications Versa 3 stores up to 30 notifications, after which the oldest are replaced as you receive new ones. To manage notifications: l Swipe down from the top of the screen to see your notifications and tap any notification to expand it. l To delete a notification, tap to expand it, then swipe to the bottom and tap Clear. l To delete all notifications at once, swipe to the top of your notifications and tap Clear All. Turn off notifications Turn off certain notifications in the Fitbit app, or turn off all notifications in quick settings on Versa 3. When you turn off all notifications, your watch won't vibrate and the screen won't turn on when your phone receives a notification. To turn off certain notifications: 1. From the Today tab in the Fitbit app on your phone, tap your profile picture > Versa 3 tile > Notifications. 39 2. Turn off the notifications you no longer want to receive on your watch. To turn off all notifications: 1. From the clock face, swipe right to access quick settings. 2. Tap the do not disturb icon . All notifications, including goal celebrations and reminders, are turned off. Note that if you use the do not disturb setting on your phone, you don't receive notifications on your watch until you turn off this setting. Answer or reject phone calls If paired to an iPhone or Android (8.0+) phone, Versa 3 lets you accept or reject incoming phone calls. If your phone is running an older version of the Android OS, you can reject, but not accept, calls on your watch. To accept a call, tap the green phone icon on your watch's screen. Note that you can't speak into the watch—accepting a phone call answers the call on your nearby phone. To reject a call, tap the red phone icon to send the caller to voicemail. The caller's name appears if that person is in your contacts list; otherwise you see a phone number. 40 Respond to messages (Android phones) Respond directly to text messages and notifications from certain apps on your watch with preset quick replies or by speaking your reply into Versa 3. Keep your phone nearby with the Fitbit app running in the background to respond to messages from your watch. To respond to a message: 1. Open the notification you want to respond to. 2. Choose how to reply to the message: l Tap the microphone icon to respond to the message using voice-to- text. To change the language recognized by the microphone, tap Language. After you speak your reply, tap Send, or tap Retry to try again. If you notice a mistake after you send the message, tap Undo within 3 seconds to cancel the message. l Tap the text icon to respond to a message from a list of quick replies. l Tap the emoji icon to respond to the message with an emoji. For more information, including how to customize quick replies, see help.fitbit.com. 41 Timekeeping Alarms vibrate to wake or alert you at a time you set. Set up to 8 alarms to occur once or on multiple days of the week. You can also time events with the stopwatch or set a countdown timer. Note that alarms and timers you set with a voice assistant are separate from the ones you set in the Alarms app and Timer app. For more information, see ""Voice Assistant"" on page 32. Use the Alarms app Set one-time or recurring alarms with the Alarms app . When an alarm goes off, your watch vibrates. When setting an alarm, turn on Smart Wake to allow your watch to find the best time to wake you starting 30 minutes before the alarm time you set. It avoids waking you during deep sleep so you're more likely to wake up feeling refreshed. If Smart Wake can’t find the best time to wake you, your alarm alerts you at the set time. For more information, see help.fitbit.com. Dismiss or snooze an alarm When an alarm goes off, your watch vibrates. To dismiss the alarm, tap the alarm icon . To snooze the alarm for 9 minutes, tap the snooze icon . Snooze the alarm as many times as you want. Versa 3 automatically goes into snooze mode if you ignore the alarm for more than 1 minute. 42 Use the Timer app Time events with the stopwatch or set a countdown timer with the Timer app on your watch. You can run the stopwatch and countdown timer at the same time. When the screen turns off, your watch continues to display the stopwatch or countdown timer until it ends or you exit the app. For more information, see help.fitbit.com. 43 Activity and Wellness Versa 3 continuously tracks a variety of stats whenever you wear it, including hourly activity, heart rate, and sleep. Data automatically syncs with the Fitbit app throughout the day. See your stats Open the Today app or swipe up from the clock face to see your daily stats, including: Steps Steps taken today and progress toward your daily goal Heart rate Current heart rate and either your heart-rate zone or resting heart rate (if not in a zone) Calories burned Calories burned today and progress toward your daily goal Floors Floors climbed today and progress toward your daily goal Distance Distance covered today and progress toward your daily goal Active Zone Minutes Active Zone Minutes earned today and the number of Active Zone Minutes you're currently earning per minute Exercise Number of days you met your exercise goal this week Sleep Sleep duration and sleep score Hourly activity The number of hours today you met your hourly activity goal Food Calories eaten and calories remaining today Menstrual health Information on the current stage of your menstrual cycle, if applicable Water Water intake logged today and progress toward your daily goal Weight Current weight and your progress toward your weight goal Core temp Your most recent logged temperature 44 Tap a tile to view more details or log an entry (for water, weight, and core temperature). Find your complete history and other information detected by your watch in the Fitbit app. Track a daily activity goal Versa 3 tracks your progress toward a daily activity goal of your choice. When you reach your goal, your watch vibrates and shows a celebration. Choose a goal Set a goal to help you get started on your health and fitness journey. To begin, your goal is to take 10,000 steps per day. Choose to change the number of steps, or pick a different activity goal depending on your device. For more information, see help.fitbit.com. Track progress toward your goal on Versa 3. For more information, see ""See your stats"" on the previous page. Track your hourly activity Versa 3 helps you stay active throughout the day by keeping track of when you're stationary and reminding you to move. Reminders nudge you to walk at least 250 steps each hour. You feel a vibration and see a reminder on your screen at 10 minutes before the hour if you haven't walked 250 steps. When you meet the 250-step goal after receiving the reminder, you feel a second vibration and see a congratulatory message. 45 For more information, see help.fitbit.com. Track your sleep Wear Versa 3 to bed to automatically track basic stats about your sleep, including your time asleep, sleep stages (time spent in REM, light sleep, and deep sleep), and sleep score (the quality of your sleep). Versa 3 also tracks your estimated oxygen variation throughout the night to help you uncover potential breathing disturbances. To see your sleep stats, sync your watch when you wake up and check the Fitbit app, or swipe up from the clock face on your watch to see your sleep stats. For more information, see help.fitbit.com. Set a sleep goal To start, you have a sleep goal of 8 hours of sleep per night. Customize this goal to meet your needs. For more information, see help.fitbit.com. Learn about your sleep habits With a Fitbit Premium subscription, see more details about your sleep score and how you compare to your peers, which can help you build a better sleep routine and wake up feeling refreshed. For more information, see help.fitbit.com. 46 Practice guided breathing The Relax app on Versa 3 provides personalized guided breathing sessions to help you find moments of calm throughout the day. All notifications are automatically disabled during the session. 1. On Versa 3, open the Relax app . 2. Tap Edit to change the duration of the session or turn off the optional vibration. 3. Tap Start to begin the session. Follow the on-screen instructions. 4. When the session ends, tap Log It to reflect on how you feel, or tap Skip to skip this step. 5. View your summary, and tap Done to close the app. For more information, see help.fitbit.com. 47 Exercise and Heart Health Track activity with the Exercise app and complete guided workouts with the Fitbit Coach app right on your wrist. Check the Fitbit app to share your activity with friends and family, see how your overall fitness level compares to your peers, and more. During a workout, you can play music through the Pandora app or Deezer app on your watch, control music playing in Spotify using the Spotify - Connect & Control app , or control music playing on your phone. 1. Start music playing in an app or on your phone. 2. Open the Exercise or Coach app and start a workout. To control music playing while you exercise, double-press the button. Your shortcuts appear. 3. Tap the music controls icon . 4. To return to your workout, press the button. Note that you need to pair a Bluetooth audio device, such as headphones or a speaker, to Versa 3 to hear music stored on your watch. For more information, see ""Music"" on page 55. Track your exercise automatically Versa 3 automatically recognizes and records many high-movement activities which are at least 15 minutes long. See basic stats about your activity in the Fitbit app on your phone. From the Today tab , tap the Exercise tile. For more information, see help.fitbit.com. 48 Track and analyze exercise with the Exercise app Track specific exercises with the Exercise app on Versa 3 to see real-time stats, including heart-rate data, calories burned, elapsed time, and a post-workout summary on your wrist. For complete workout stats, and a workout intensity map if you used GPS, tap the Exercise tile in the Fitbit app. Track an exercise 1. On Versa 3, open the Exercise app and swipe to find an exercise. 2. Tap the exercise to choose it. If the exercise uses GPS, you can wait for the signal to connect, or start the exercise and GPS will connect when a signal is available. Note that GPS can take a few minutes to connect. 3. Tap the play icon to begin the exercise, or swipe up to choose an exercise goal or adjust the settings. For more information on the settings, see ""Customize your exercise settings"" on the next page. 4. Tap the large stat to scroll through your real-time stats. To pause your workout, swipe up and tap the pause icon . 5. When you're done with your workout, swipe up and tap the end icon > End. Your workout summary appears. 6. Tap Done to close the summary screen. Notes: l If you set an exercise goal, your watch alerts you when you’re halfway to your goal and when you reach the goal. l If the exercise uses GPS, ""GPS connecting..."" appears at the top of the screen. When the screen says ""GPS connected"" and Versa 3 vibrates, GPS is connected. 49 Using built-in GPS impacts your watch's battery life. When GPS tracking is turned on, Versa 3 can track up to 12 hours of continuous exercise. Customize your exercise settings Customize settings for each exercise type on your watch. Settings include: Heart Zone Notifications Receive notifications when you hit target heart-rate zones during your workout. For more information, see help.fitbit.com Laps Receive notifications when you reach certain milestones during your workout Show Stats Choose what stats you want to see when tracking an exercise GPS Track your route using GPS Auto-Pause Automatically pause a run or bike ride when you stop moving Run Detect Track runs automatically without opening the Exercise app Always-on Display Keep the screen on during exercise Pool Length Set the length of your pool Interval Adjust the move and rest intervals used during interval training 1. On Versa 3, open the Exercise app . 2. Swipe to find an exercise. 50 3. Swipe up from the bottom of the screen, then swipe up through the list of settings. 4. Tap a setting to adjust it. 5. When you're done, swipe down until you see the play icon . Check your workout summary After you complete a workout, Versa 3 shows a summary of your stats. Check the Exercise tile in the Fitbit app to see additional stats and a workout intensity map if you used GPS. Check your heart rate Versa 3 personalizes your heart-rate zones using your heart rate reserve, which is the difference between your maximum heart rate and your resting heart rate. To help you target the training intensity of your choice, check your heart rate and heart-rate zone on your watch during exercise. Versa 3 notifies you when you enter a heart-rate zone. 51 Icon Zone Calculation Description Below Zone Below 40% of your heart rate reserve Below the fat burn zone, your heart beats at a slower pace. Fat Burn Zone Between 40% and 59% of your heart rate reserve In the fat burn zone, you’re likely in a moderate activity such as a brisk walk. Your heart rate and breathing might be elevated, but you can still carry on a conversation. Cardio Zone Between 60% and 84% of your heart rate reserve In the cardio zone, you’re likely doing a vigorous activity such as running or spinning. Peak Zone Greater than 85% of your heart rate reserve In the peak zone, you’re likely doing a short, intense activity that improves performance and speed, such as sprinting or high-intensity interval training. 52 Custom heart-rate zones Instead of using these heart-rate zones, you can create a custom zone in the Fitbit app to target a specific heart-rate range. For more information, see help.fitbit.com. Earn Active Zone Minutes Earn Active Zone Minutes for time spent in the fat burn, cardio, or peak heart-rate zones. To help you maximize your time, you earn 2 Active Zone Minutes for each minute you’re in the cardio or peak zones. 1 minute in the fat burn zone = 1 Active Zone Minute 1 minute in the cardio or peak zones = 2 Active Zone Minutes A few moments after you enter a different heart-rate zone during your exercise, your watch buzzes so that you know how hard you’re working. The number of times your watch vibrates indicates which zone you’re in: 1 buzz = below zone 2 buzzes = fat burn zone 3 buzzes = cardio zone 4 buzzes = peak zone To start, your weekly goal is set to 150 Active Zone Minutes. You’ll receive notifications as you reach your goal. For more information, see help.fitbit.com. View your cardio fitness score View your overall cardiovascular fitness in the Fitbit app. See your cardio fitness score and cardio fitness level, which shows how you compare to your peers. 53 In the Fitbit app, tap the Heart-rate tile and swipe left on your heart-rate graph to see your detailed cardio fitness stats. For more information, see help.fitbit.com. Work out with Fitbit Coach The Fitbit Coach app provides guided bodyweight workouts on your wrist to help you stay fit anywhere. 1. On Versa 3, open the Fitbit Coach app . 2. Swipe to find a workout. 3. Tap the workout you want. To preview the workout, tap the menu icon . Press the button to return to the workout. 4. Tap Start. For more information, see help.fitbit.com. Share your activity After you complete a workout, open the Fitbit app to share your stats with friends and family. For more information, see help.fitbit.com. 54 Music Use apps on your watch to listen to music with Bluetooth headphones or speakers. Connect Bluetooth headphones or speakers Connect up to 8 Bluetooth audio devices to listen to music from your watch. To pair a new Bluetooth audio device: 1. Activate pairing mode on your Bluetooth headphones or speaker. 2. On Versa 3, open the Settings app > Vibration & audio. 3. In the Bluetooth section, tap Manage devices. 4. Swipe up to see the Other devices section. Versa 3 searches for nearby devices. 5. When Versa 3 finds nearby Bluetooth audio devices, it shows a list on the screen. Tap the name of the device you want to pair. When pairing is complete, a check mark appears on the screen. To listen to music with a different Bluetooth device: 1. On Versa 3, open the Settings app > Vibration & audio. 2. In the Bluetooth section, tap the device you want to use, or pair a new device. Then wait for a moment for the device to connect. For more information, see help.fitbit.com. Control music with Versa 3 Control music playing in an app on Versa 3 or on your phone. 55 Choose the music source 1. Double-press the button on Versa 3. Your shortcuts appear. 2. Tap the music controls icon . 3. The icon in the top-left corner shows whether the music source is currently set to your phone or your watch . Tap it to change the music source, then press the button to return to your music controls. Control music 1. While music is playing, double-press the button. Your shortcuts appear. 2. Tap the music controls icon . 3. Play, pause, or tap the arrow icons to skip to the next track or previous track. Tap the volume icon to adjust the volume. Control music with the Spotify - Connect & Control app Use the Spotify - Connect & Control app on Versa 3 to control Spotify on your phone, computer, or other Spotify Connect device. Navigate between playlists, like songs, and switch between devices from your watch. Note that at this time, the Spotify - Connect & Control app only controls music playing on your paired device, so your device must remain nearby and connected to the internet. You need a 56 Spotify Premium subscription to use this app. For more information about Spotify Premium, see spotify.com. For instructions, see help.fitbit.com. Listen to music with the Pandora app (United States only) With the Pandora app on Versa 3, download up to 3 of your most-played Pandora stations or popular curated Workout stations directly to your watch. Note that you need a paid subscription to Pandora and a Wi-Fi connection to download stations. For more information about Pandora subscriptions, see help.pandora.com. For instructions, see help.fitbit.com. Listen to music with the Deezer app With the Deezer app on Versa 3, download your Deezer playlists and Flow directly to your watch. Note that you need a paid subscription to Deezer and a Wi- Fi connection to download music. For more information about Deezer subscriptions, see support.deezer.com. For instructions, see help.fitbit.com. 57 Fitbit Pay Versa 3 includes a built-in NFC chip, which lets you use your credit and debit cards on your watch. Use credit and debit cards Set up Fitbit Pay in the Wallet section of the Fitbit app, and use your watch to make purchases in stores that accept contactless payments. We’re always adding new locations and card issuers to our list of partners. To see if your payment card works with Fitbit Pay, see fitbit.com/fitbit-pay/banks. Set up Fitbit Pay To use Fitbit Pay, add at least 1 credit or debit card from a participating bank to the Wallet section of the Fitbit app. The Wallet is where you add and remove payment cards, set a default card for your watch, edit a payment method, and review recent purchases. 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap the Wallet tile. 3. Follow the on-screen instructions to add a payment card. In some cases, your bank might require additional verification. If you're adding a card for the first time, you might be prompted to set a 4-digit PIN code for your watch. Note that you also need passcode protection enabled for your phone. 4. After you add a card, follow the on-screen instructions to turn on notifications for your phone (if you haven't already done so) to complete the setup. You can add up to 6 payment cards to the Wallet and choose which card to set as the default payment option. 58 Make purchases Make purchases using Fitbit Pay at any store that accepts contactless payments. To determine if the store accepts Fitbit Pay, look for the symbol below on the payment terminal: 1. Open the Wallet app on your watch. 2. If prompted, enter your 4-digit watch PIN code. Your default card appears on the screen. 3. To pay with your default card, hold your wrist near the payment terminal. To pay with a different card, swipe to find the card you want to use, and hold your wrist near the payment terminal. 59 When the payment succeeds, your watch vibrates and you see a confirmation on the screen. If the payment terminal doesn't recognize Fitbit Pay, make sure the watch face is near the reader and that the cashier knows you're using a contactless payment. For added security, you must wear Versa 3 on your wrist to use Fitbit Pay. For more information, see help.fitbit.com. Change your default card 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap the Wallet tile. 3. Find the card you want to set as the default option. 4. Tap Set as Default on Versa 3. Pay for transit Use Fitbit Pay to tap on and off at transit readers that accept contactless credit or debit card payments. To pay with your watch, follow the steps listed in ""Use credit and debit cards"" on page 58. 60 Pay with the same card on your Fitbit watch when you tap the transit reader at the start and end of your trip. Make sure your device is charged before beginning your trip. 61 Update, Restart, and Erase Some troubleshooting steps may require you to restart your watch, while erasing it is useful if you want to give Versa 3 to another person. Update your watch to receive new Fitbit OS updates. Update Versa 3 Update your watch to get the latest feature enhancements and product updates. When an update is available, a notification appears in the Fitbit app. After you start the update, follow the progress bars on Versa 3 and in the Fitbit app until the update is complete. Keep your watch and phone close to each other during the update. Updating Versa 3 takes several minutes and may be demanding on the battery. We recommend plugging your watch into the charger before starting the update. For more information, see help.fitbit.com. Restart Versa 3 If you can’t sync Versa 3 or you have trouble with tracking your stats or receiving notifications, restart your watch from your wrist: To restart your watch, press and hold the button for 10 seconds until you see the Fitbit logo on the screen, and then release the button. Restarting your watch reboots the device but doesn't delete any data. Versa 3 has small holes on the device for the altimeter, speaker, and microphone. Don’t attempt to restart your device by inserting any items, such as paper clips, into these holes as you can damage Versa 3. 62 Shutdown Versa 3 To turn off your watch, open the Settings app > Shut down. To turn on your watch, press the button. For information about how to store Versa 3 long term, see help.fitbit.com. Erase Versa 3 If you want to give Versa 3 to another person or wish to return it, first clear your personal data: On Versa 3, open the Settings app > About Versa 3 > Factory reset. 63 Troubleshooting If Versa 3 isn't working properly, see our troubleshooting steps below. Visit help.fitbit.com for more information. Heart-rate signal missing Versa 3 continuously tracks your heart rate while you're exercising and throughout the day. If the heart-rate sensor on your watch has difficulty detecting a signal, dashed lines appear. If your watch doesn't detect a heart-rate signal, make sure you're wearing your watch correctly, either by moving it higher or lower on your wrist or by tightening or loosening the band. Versa 3 should be in contact with your skin. After holding your arm still and straight for a short time, you should see your heart rate again. For more information, see help.fitbit.com. GPS signal missing Environmental factors including tall buildings, dense forest, steep hills, and thick cloud cover can interfere with your watch's ability to connect to GPS satellites. If your watch is searching for a GPS signal during an exercise, you’ll see “ GPS connecting ” appear at the top of the screen. If Versa 3 can't connect to a 64 GPS satellite, the watch stops trying to connect until the next time you start a GPS exercise. For best results, wait for Versa 3 to find the signal before you start your workout. If Versa 3 loses the GPS signal during your workout, ""GPS lost signal"" appears at the top of the screen. Your watch will attempt to reconnect. For more information, see help.fitbit.com. Can't connect to Wi-Fi If Versa 3 can't connect to Wi-Fi, you might have entered an incorrect password, or the password might have changed: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Wi-Fi Settings > Next. 3. Tap the network you want to use > Remove. 65 4. Tap Add Network and follow the on-screen instructions to reconnect the Wi- Fi network. To check if your Wi-Fi network is working correctly, connect another device to your network; if it connects successfully, try again to connect your watch. If Versa 3 still won't connect to Wi-Fi, make sure that you're attempting to connect your watch to a compatible network. For best results, use your home Wi-Fi network. Versa 3 can't connect to 5GHz Wi-Fi, WPA enterprise, or public networks that require logins, subscriptions, or profiles. For a list of compatible network types, see ""Connect to Wi-Fi"" on page 9. After you verify the network is compatible, restart your watch and try connecting to Wi-Fi again. If you see other networks appear in the list of available networks, but not your preferred network, move your watch closer to your router. For more information, see help.fitbit.com. Other issues If you experience any of the following issues, restart your watch: l Won't sync l Won't respond to taps, swipes, or button press l Won't track steps or other data l Won't show notifications For instructions, see ""Restart Versa 3"" on page 62. For more information, see help.fitbit.com. 66 General Info and Specifications Sensors and Components Fitbit Versa 3 contains the following sensors and motors: l 3-axis accelerometer, which tracks motion patterns l Altimeter, which tracks altitude changes l Built-in GPS receiver + GLONASS, which tracks your location during a workout l Optical heart-rate tracker l Device temperature sensor (skin temperature variation available through Premium only) l Ambient light sensor l Microphone l Speaker l Vibration motor Materials The band that comes with Versa 3 is made of a flexible, durable elastomer material similar to that used in many sports watches. The housing and buckle on Versa 3 are made of anodized aluminum. While anodized aluminum can contain traces of nickel, which can cause an allergic reaction in someone with nickel sensitivity, the amount of nickel in all Fitbit products meets the European Union's stringent Nickel Directive. Our products may contain trace amounts of acrylates and methacrylates from adhesives used in those products but we work to ensure our products adhere to rigorous design specifications and meet extensive test requirements so as to minimum the potential for reaction to these adhesives. 67 Wireless technology Versa 3 contains a Bluetooth 5.0 radio transceiver, Wi-Fi chip, and NFC chip. Haptic feedback Versa 3 contains a vibration motor for alarms, goals, notifications, reminders, and apps. Battery Versa 3 contains a rechargeable lithium-polymer battery. Memory Versa 3 stores your data, including daily stats, sleep information, and exercise history, for 7 days. See your historical data in the Fitbit app. Display Versa 3 has a color AMOLED display. Band size Band sizes are shown below. Note that accessory bands sold separately may vary slightly. Small band Fits a wrist between 5.5 - 7.1 inches (140 mm - 180 mm) in circumference Large band Fits a wrist between 7.1 - 8.7 inches (180 mm - 220 mm) in circumference 68 Environmental conditions Operating temperature 14° to 113° F (-10° to 45° C) Non-operating temperature -4° to 14° F (-20° to -10° C) 113° to 140°F (45° to 60° C) Charging temperature 32° to 95° F (0° to 35° C) Water resistance Water resistant up to 50 meters Maximum operating altitude 28,000 feet (8,534 m) Learn more To learn more about your watch, how to track your progress in the Fitbit app, and how to build healthy habits with Fitbit Premium, visit help.fitbit.com. Return policy and warranty Find warranty information and the fitbit.com return policy on our website. 69 Regulatory and Safety Notices Notice to the User: Regulatory content for certain regions can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info USA: Federal Communications Commission (FCC) statement Model FB511 FCC ID: XRAFB511 Notice to the User: The FCC ID can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Supplier's Declaration of Conformity Unique Identifier: FB511 Responsible Party – U.S. Contact Information 199 Fremont Street, 14th Floor San Francisco, CA 94105 United States 877-623-4997 FCC Compliance Statement (for products subject to Part 15) This device complies with Part 15 of the FCC Rules. Operation is subject to the following two conditions: 70 1. This device may not cause harmful interference and 2. This device must accept any interference, including interference that may cause undesired operation of the device. FCC Warning Changes or modifications not expressly approved by the party responsible for compliance could void the user’s authority to operate the equipment. Note: This equipment has been tested and found to comply with the limits for a Class B digital device, pursuant to part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference in a residential installation. This equipment generates, uses and can radiate radio frequency energy and, if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However, there is no guarantee that interference will not occur in a particular installation. If this equipment does cause harmful interference to radio or television reception, which can be determined by turning the equipment off and on, the user is encouraged to try to correct the interference by one or more of the following measures: l Reorient or relocate the receiving antenna. l Increase the separation between the equipment and receiver. l Connect the equipment into an outlet on a circuit different from that to which the receiver is connected. l Consult the dealer or an experienced radio/TV technician for help. This device meets the FCC and IC requirements for RF exposure in public or uncontrolled environments. Canada: Industry Canada (IC) statement Model/Modèle FB511 IC: 8542A-FB511 Notice to the User: The IC ID can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 71 Avis à l'utilisateur: L'ID de l'IC peut également être consulté sur votre appareil. Pour voir le contenu: Paramètres > À propos de Versa 3 > Mentions légales This device meets the IC requirements for RF exposure in public or uncontrolled environments. Cet appareil est conforme aux conditions de la IC en matière de RF dans des environnements publics ou incontrôlée IC Notice to Users English/French in accordance with current issue of RSS GEN: This device complies with Industry Canada license exempt RSS standard(s). Operation is subject to the following two conditions: 1. this device may not cause interference, and 2. this device must accept any interference, including interference that may cause undesired operation of the device. Cet appareil est conforme avec Industrie Canada RSS standard exempts de licence (s). Son utilisation est soumise à Les deux conditions suivantes: 1. cet appareil ne peut pas provoquer d’interférences et 2. cet appareil doit accepter Toute interférence, y compris les interférences qui peuvent causer un mauvais fonctionnement du dispositif European Union (EU) Simplified EU Declaration of Conformity Hereby, Fitbit, Inc. declares that the radio equipment type Model FB511 is in compliance with Directive 2014/53/EU. The full text of the EU declaration of conformity is available at the following internet address: www.fitbit.com/safety Vereinfachte EU-Konformitätserklärung 72 Fitbit, Inc. erklärt hiermit, dass die Funkgerättypen Modell FB511 die Richtlinie 2014/53/EU erfüllen. Der vollständige Wortlaut der EU-Konformitätserklärungen kann unter folgender Internetadresse abgerufen werden: www.fitbit.com/safety Declaración UE de Conformidad simplificada Por la presente, Fitbit, Inc. declara que el tipo de dispositivo de radio Modelo FB511 cumple con la Directiva 2014/53/UE. El texto completo de la declaración de conformidad de la UE está disponible en la siguiente dirección de Internet: www.fitbit.com/safety Déclaration UE de conformité simplifiée Fitbit, Inc. déclare par la présente que les modèles d’appareils radio FB511 sont conformes à la Directive 2014/53/UE. Les déclarations UE de conformité sont disponibles dans leur intégralité sur le site suivant : www.fitbit.com/safety Dichiarazione di conformità UE semplificata Fitbit, Inc. dichiara che il tipo di apparecchiatura radio Modello FB511 è conforme alla Direttiva 2014/53/UE. Il testo completo della dichiarazione di conformità UE è disponibile al seguente indirizzo Internet: www.fitbit.com/safety IP Rating Model FB511 has a water resistance rating of IPX8 under IEC standard 60529, up to a depth of 50 meters. Model FB511 has a dust ingress rating of IP6X under IEC standard 60529 which indicates the device is dust-tight. Please refer to the beginning of this section for instructions on how to access your product’s IP rating. 73 Argentina C-25002 Australia and New Zealand Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Belarus Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 74 Botswana Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory Info China Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory Info 75 China RoHS 部件名称 Part Name 有毒和危险品 Toxic and Hazardous Substances or Elements Model FB511 铅 (Pb) 水银 (Hg) 镉 (Cd) 六价铬 (Cr(VI)) 多溴化苯 (PBB) 多溴化二苯 醚 (PBDE) 表带和表扣 (Strap and Buckle) O O O O O O 电子 (Electronics) -- O O O O O 电池 (Battery) O O O O O O 充电线 (Charging Cable) O O O O O O 本表格依据 SJ/T 11364 的规定编制 O = 表示该有害物质在该部件所有均质材料中的含量均在 GB/T 26572规定的限量要求以下 (indicates that the content of the toxic and hazardous substance in all the Homogeneous Materials of the part is below the concentration limit requirement as described in GB/T 26572). X = 表示该有害物质至少在该部件的某一均质材料中的含量超出 GB/T 26572规定的限量要 求 (indicates that the content of the toxic and hazardous substance in at least one Homogeneous Material of the part exceeds the concentration limit requirement as described in GB/T 26572). CMIIT ID 2020DJ7882 76 Frequency band: 2400-2483.5 MHz NFC: 13.56MHz Transmitted power: Max EIRP, 14.4dBm Occupied bandwidth: BLE: BLE: 2MHz, BT: 1MHz, NFC: 2.3 kHz, WiFi: 20MHz Modulation system: BLE: GFSK, BT: GFSK (BDR), n/4-DQPSK (EDR), 8PSK (EDR), NFC: ASK, WiFi: DSSS, OFDM CMIIT ID displayed: On packaging Customs Union Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Indonesia 69814/SDPPI/2020 3788 Israel מספראישוראלחוטישלמשרדהתקשורתהוא.74746-51 אסורלהחליףאתהאנטנההמקוריתשלהמכשירולאלעשותבוכלשינויטכניאחר Japan Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 77 201-200606 Kingdom of Saudi Arabia Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Mexico Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info La operación de este equipo está sujeta a las siguientes dos condiciones: 1. Es posible que este equipo o dispositivo no cause interferencia perjudicial y 2. Este equipo o dispositivo debe aceptar cualquier interferencia, incluyendo la que pueda causar su operación no deseada Moldova Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 78 Morocco AGREE PAR L’ANRT MAROC Numéro d’agrément: MR00025102ANRT2020 Date d’agrément: 02/08/2020 Nigeria Connection and use of this communications equipment is permitted by the Nigerian Communications Commission. Oman TRA/TA-R/9745/20 D090258 Pakistan PTA Approved Model No.: FB511 TAC No.: 9.687/2020 Device Type: Smart Watch 79 Philippines Type Accepted No: ESD-RCE-2023407 Serbia Singapore Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info South Korea Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 80 본 제품의 전자파흡수율은 과학기술정보통신부의「전자파 인체보호기준」을 만족합니 다. 본 제품은 국립전파연구원의「전자파흡수율 측정기준」에 따라 최대출력 조건에서 머리 에 근접하여 시험되었으며, 최대 전자파흡수율 측정값은 다음과같습니다. 모델명 (Model) 머리 전자파흡수율 (Head SAR) FB511 0.089 W/kg 클래스 B 장치 (가정 사용을위한 방송 통신 기기) : EMC 등록 주로 가정용 (B 급)으로하고, 모 든 지역에서 사용할 수 있습니다 얻을이 장치. Translation: Class B devices (broadcast communications equipment for home use): EMC registration is mainly for household use (B class) and can be used in all areas get this device. 81 Taiwan 用戶注意：某些地區的法規內容也可以在您的設備上查看。要查看內容： 設定 > 關於 Versa 3 > 法規資訊 Translation: Notice to the User: Regulatory content can also be viewed on your device. Instructions to view content from your menu: Settings > About Versa 3 > Regulatory info 低功率警語: l 取得審驗證明之低功率射頻器材，非經核准，公司、商號或使用者均不得擅自變更 頻率、加大功率或變更原設計之特性及功能。 l 低功率射頻器材之使用不得影響飛航安全及干擾合法通信；經發現有干擾現象時， 應立即停用，並改善至無干擾時方得繼續使用。前述合法通信，指依電信管理法規 定作業之無線電通信。低功率射頻器材須忍受合法通信或工業、科學及醫療用電波 輻射性電機設備之干擾。 Translation: Warning Statement for Low Power Radios: l Without permission granted by the NCC, no company, enterprise, or user is allowed to change the frequency of an approved low power radio-frequency device, enhance its transmitting power or alter original characteristics or performance. l The use of low power RF devices must not affect flight safety or interfere with legal communications: when interference is found, it should be immediately stopped and ameliorated not to interfere before continuing to use it. The legal communications mentioned here refer to radio communications operating in accordance with the provisions of the Telecommunication Law. Low power RF devices need to bear with interference from legal communications or industrial, scientific and medical radio wave radiating equipment 電池警語： 82 此裝置使用鋰電池。 若未遵照下列準則，則裝置內的鋰離子電池壽命可能會縮短或有損壞裝置、發生火災、化學 品灼傷、電解液洩漏及／或受傷的風險。 l 請勿拆解、鑿孔或損壞裝置或電池。 l 請勿取出或嘗試取出使用者不可自行更換的電池。 l 請勿將電池曝露於火焰、爆炸或其他危險中。 l 請勿使用尖銳物品取出電池。 Translation: Battery warning: This device uses a lithium-ion battery. If the following guidelines are not followed, the life of the lithium-ion battery in the device may be shortened or there is a risk of damage to the device, fire, chemical burn, electrolyte leakage and / or injury.. l Do not disassemble, puncture or damage the device or battery. l Do not remove or try to remove the battery that the user cannot replace. l Do not expose the battery to flames, explosions or other hazards. l Do not use sharp objects to remove the battery. Vision Warning 使用過度恐傷害視力 警語 • 使用過度恐傷害視力 注意事項 • 使用30分鐘請休息10分鐘。未滿2歲幼兒不看螢幕，2歲以上每天看螢幕不要超過1 小時 Translation: Excessive use may damage vision 83 Warning: l Excessive use may damage vision Attention: l Rest for 10 minutes after every 30 minutes. l Children under 2 years old should stay away from this product. Children 2 years old or more should not see the screen for more than 1 hour a day. Taiwan RoHS United Arab Emirates Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 84 TRA – United Arab Emirates Dealer ID: DA35294/14 TA RTTE: ER88790/ 20 Model: FB511 Type: Smartwatch Vietnam Zambia ZMB / ZICTA / TA / 2020 / 9 / 78 Safety Statement This equipment has been tested to comply with safety certification in accordance with the specifications of EN Standard: EN60950-1:2006 + A11:2009 + A1:2010 + A12:2011 + A2:2013 & EN62368-1:2014 + A11:2017. 85 ©2020 Fitbit, Inc. All rights reserved. Fitbit and the Fitbit logo are trademarks or registered trademarks of Fitbit in the US and other countries. A more complete list of Fitbit trademarks can be found at http://www.fitbit.com/legal/trademark-list. Third-party trademarks mentioned are the property of their respective owners.","Only provide the opinions that were given in the context document. If you cannot answer a question using the provided context alone, then say ""I'm sorry, but I do not have the context to answer this question."" Based on the document provided, how does the user make the shortcuts menu appear while playing music? User Manual Version 1.1 Table of Contents Get started 7 What's in the box 7 Charge your watch 8 Set up Versa 3 9 Connect to Wi-Fi 9 See your data in the Fitbit app 10 Unlock Fitbit Premium 11 Advanced health metrics 11 Premium health and wellness reminders 12 Wear Versa 3 13 Placement for all-day wear vs. exercise 13 Fasten the band 14 Handedness 15 Wear and care tips 16 Change the band 16 Remove a band 16 Attach a band 17 Basics 18 Navigate Versa 3 18 Basic navigation 18 Button shortcuts 19 Widgets 22 Adjust settings 23 Display 24 Vibration & audio 24 Goal reminders 24 Quiet modes 24 Shortcuts 25 Check battery level 25 Set up device lock 26 2 Adjust always-on display 26 Turn off the screen 28 Care for Versa 3 28 Apps and Clock Faces 29 Change the clock face 29 Open apps 30 Organize apps 30 Download additional apps 30 Remove apps 30 Update apps 31 Adjust app settings and permissions 31 Voice Assistant 32 Set up Amazon Alexa Built-in 32 Interact with Alexa 32 Check Alexa alarms, reminders, and timers 34 Lifestyle 35 Starbucks 35 Agenda 35 Weather 35 Check the weather 36 Add or remove a city 36 Find Phone 36 Notifications from your phone 38 Set up notifications 38 See incoming notifications 38 Manage notifications 39 Turn off notifications 39 Answer or reject phone calls 40 Respond to messages (Android phones) 41 Timekeeping 42 Use the Alarms app 42 Dismiss or snooze an alarm 42 3 Use the Timer app 43 Activity and Wellness 44 See your stats 44 Track a daily activity goal 45 Choose a goal 45 Track your hourly activity 45 Track your sleep 46 Set a sleep goal 46 Learn about your sleep habits 46 Practice guided breathing 47 Exercise and Heart Health 48 Track your exercise automatically 48 Track and analyze exercise with the Exercise app 49 Track an exercise 49 Customize your exercise settings 50 Check your workout summary 51 Check your heart rate 51 Custom heart-rate zones 53 Earn Active Zone Minutes 53 View your cardio fitness score 53 Work out with Fitbit Coach 54 Share your activity 54 Music 55 Connect Bluetooth headphones or speakers 55 Control music with Versa 3 55 Choose the music source 56 Control music 56 Control music with the Spotify - Connect & Control app 56 Listen to music with the Pandora app (United States only) 57 Listen to music with the Deezer app 57 Fitbit Pay 58 Use credit and debit cards 58 4 Set up Fitbit Pay 58 Make purchases 59 Change your default card 60 Pay for transit 60 Update, Restart, and Erase 62 Update Versa 3 62 Restart Versa 3 62 Shutdown Versa 3 63 Erase Versa 3 63 Troubleshooting 64 Heart-rate signal missing 64 GPS signal missing 64 Can't connect to Wi-Fi 65 Other issues 66 General Info and Specifications 67 Sensors and Components 67 Materials 67 Wireless technology 68 Haptic feedback 68 Battery 68 Memory 68 Display 68 Band size 68 Environmental conditions 69 Learn more 69 Return policy and warranty 69 Regulatory and Safety Notices 70 USA: Federal Communications Commission (FCC) statement 70 Canada: Industry Canada (IC) statement 71 European Union (EU) 72 IP Rating 73 Argentina 74 5 Australia and New Zealand 74 Belarus 74 Botswana 75 China 75 Customs Union 77 Indonesia 77 Israel 77 Japan 77 Kingdom of Saudi Arabia 78 Mexico 78 Moldova 78 Morocco 79 Nigeria 79 Oman 79 Pakistan 79 Philippines 80 Serbia 80 Singapore 80 South Korea 80 Taiwan 82 United Arab Emirates 84 Vietnam 85 Zambia 85 Safety Statement 85 6 Get started Meet Fitbit Versa 3, the health and fitness smartwatch with built-in GPS, Active Zone Minutes, 20+ exercise modes, and music experiences to keep you motivated to move. Take a moment to review our complete safety information at fitbit.com/safety. Versa 3 is not intended to provide medical or scientific data. What's in the box Your Versa 3 box includes: Watch with small band (color and material varies) Charging cable Additional large band The detachable bands on Versa 3 come in a variety of colors and materials, sold separately. 7 Charge your watch A fully-charged Versa 3 has a battery life of 6+ days. Battery life and charge cycles vary with use and other factors; actual results will vary. To charge Versa 3: 1. Plug the charging cable into the USB port on your computer, a UL-certified USB wall charger, or another low-energy charging device. 2. Hold the other end of the charging cable near the port on the back of the watch until it attaches magnetically. Make sure the pins on the charging cable align with the port on the back of your watch. Charge Versa 3 for 12 minutes for 24 hours of battery life. While the watch charges, tap the screen twice or press the button to turn the screen on. The battery level appears for several seconds, then disappears so you can use your watch while it charges. Charging fully takes about 1-2 hours. 8 Set up Versa 3 Set up Versa 3 with the Fitbit app for iPhones and iPads or Android phones. The Fitbit app is compatible with most popular phones and tablets. See fitbit.com/devices to check if your phone or tablet is compatible. To get started: 1. Download the Fitbit app: l Apple App Store for iPhones and iPads l Google Play Store for Android phones 2. Install the app, and open it. l If you already have a Fitbit account, log in to your account > tap the Today tab > your profile picture > Set Up a Device. l If you don't have a Fitbit account, tap Join Fitbit to be guided through a series of questions to create a Fitbit account. 3. Continue to follow the on-screen instructions to connect Versa 3 to your account. When you're done with setup, read through the guide to learn more about your new watch and then explore the Fitbit app. For more information, see help.fitbit.com. Connect to Wi-Fi During setup, you're prompted to connect Versa 3 to your Wi-Fi network. Versa 3 uses Wi-Fi to more quickly transfer music from Pandora or Deezer, download apps 9 from the Fitbit App Gallery, and for faster, more reliable OS updates. Versa 3 can connect to open, WEP, WPA personal, and WPA2 personal Wi-Fi networks. Your watch won't connect to 5GHz, WPA enterprise, or public Wi-Fi networks that require more than a password to connect—for example, logins, subscriptions, or profiles. If you see fields for a username or domain when connecting to the Wi-Fi network on a computer, the network isn't supported. For best results, connect Versa 3 to your home Wi-Fi network. Make sure you know the network password before connecting. For more information, see help.fitbit.com. See your data in the Fitbit app Open the Fitbit app on your phone or tablet to view your activity and sleep data, log food and water, participate in challenges, and more. 10 Unlock Fitbit Premium Fitbit Premium helps you build healthy habits by offering tailored workouts, insights into how your behavior impacts your health, and personalized plans to help you reach your goals. A Fitbit Premium subscription includes health insights and guidance, advanced health metrics, sleep details, customized programs, and 150+ workouts from fitness brands. New Fitbit Premium customers can redeem a free trial. For more information, see help.fitbit.com. Advanced health metrics Know your body better with health metrics in the Fitbit app. This feature helps you view key metrics tracked by your Fitbit device over time so that you can see trends and assess what’s changed. Metrics include: l Oxygen saturation (SpO2) l Skin temperature variation l Heart rate variability l Resting heart rate l Breathing rate Note: This feature is not intended to diagnose or treat any medical condition and should not be relied on for any medical purposes. It is intended to provide information that can help you manage your well-being. If you have any concerns about your health, please talk to a healthcare provider. If you believe you are experiencing a medical emergency, call emergency services. For more information, see help.fitbit.com. 11 Premium health and wellness reminders Set up Premium health and wellness reminders in the Fitbit app, and receive reminders on your watch that encourage you to form and maintain healthy behaviors. For more information, see help.fitbit.com. 12 Wear Versa 3 Wear Versa 3 around your wrist. If you need to attach a different size band, or if you purchased another band, see the instructions in ""Change the band"" on page 16. Placement for all-day wear vs. exercise When you're not exercising, wear Versa 3 a finger's width above your wrist bone. In general, it's always important to give your wrist a break on a regular basis by removing your watch for around an hour after extended wear. We recommend removing your watch while you shower. Although you can shower while wearing your watch, not doing so reduces the potential for exposure to soaps, shampoos, and conditioners, which can cause long-term damage to your watch and may cause skin irritation. For optimized heart-rate tracking while exercising: l During workouts, try moving the band higher on your wrist to get a better fit. If you experience any discomfort, loosen the band, and if it persists give your wrist a break by taking it off. 13 l Wear your watch on top of your wrist, and make sure the back of the device is in contact with your skin. Fasten the band 1. Place Versa 3 around your wrist. 2. Slide the bottom band through the first loop in the top band. 14 3. Tighten the band until it fits comfortably, and press the peg through one of the holes in the band. 4. Slide the loose end of the band through the second loop until it lies flat on your wrist. Make sure the band isn’t too tight. Wear the band loosely enough that it can move back and forth on your wrist. Handedness For greater accuracy, you must specify whether you wear Versa 3 on your dominant or non-dominant hand. Your dominant hand is the one you use for writing and eating. To start, the Wrist setting is set to non-dominant. If you wear Versa 3 on your dominant hand, change the Wrist setting in the Fitbit app: From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile > Wrist > Dominant. 15 Wear and care tips l Clean your band and wrist regularly with a soap-free cleanser. l If your watch gets wet, remove and dry it completely after your activity. l Take your watch off from time to time. l If you notice skin irritation, remove your watch and contact customer support. For more information, see fitbit.com/productcare. Change the band Versa 3 comes with a small band attached and an additional large, bottom band in the box. Both the top and bottom bands can be swapped with accessory bands, sold separately on fitbit.com. For band measurements, see ""Band size"" on page 68. Fitbit Sense bands are compatible with Versa 3. Remove a band 1. Turn over Versa 3 and find the band latches. 2. To release the latch, slide the flat button toward the band. 16 3. Gently pull the band away from the watch to release it. 4. Repeat on the other side. Attach a band To attach a band, press it into the end of the watch until you hear a click and it snaps into place. The band with the loops and peg attaches to the top of the watch. 17 Basics Learn how to manage settings, set a personal PIN code, navigate the screen, and care for your watch. Navigate Versa 3 Versa 3 has a color AMOLED touchscreen display and 1 button. Navigate Versa 3 by tapping the screen, swiping side to side and up and down, or pressing the button. To preserve battery, the watch’s screen turns off when not in use, unless you turn on the always-on display setting. For more information, see ""Adjust always-on display"" on page 26. Basic navigation The home screen is the clock. l Swipe down to see notifications. l Swipe up to see widgets, such as your daily stats, the weather, and a shortcut to start the Relax app. l Swipe left to see the apps on your watch. l Swipe right to open quick settings or return to the previous screen in an app. l Press the button to return to the clock face. 18 Button shortcuts Use the button to quickly access Fitbit Pay, voice assistant, quick settings, or your favorite apps. Press and hold the button Hold the button for 2 seconds to activate a feature of your choice. The first time you use the button shortcut, select which feature it activates. To change which feature activates when you hold the button, open the Settings app on your watch and tap Shortcuts. Tap Press & hold, and select the app you want. 19 Double-press the button Double-press the button to open shortcuts to 4 apps or features. To start, the 4 shortcuts are music controls , quick settings , your voice assistant, and Fitbit Pay . To change these shortcuts, open the Settings app on your watch and tap Shortcuts. Under Double Press, tap the shortcut you want to change. Quick settings Swipe right from the clock face on your watch to access quick settings. 20 Do Not Disturb When the do not disturb setting is on: l Notifications, goal celebrations, and reminders are muted. l The do not disturb icon illuminates in quick settings. You can't turn on do not disturb and sleep mode at the same time. Sleep Mode When the sleep mode setting is on: l Notifications, goal celebrations, and reminders are muted. l The screen's brightness is set to dim. l The Always-On Display clock face is turned off. l The screen stays dark when you turn your wrist. l The sleep mode icon illuminates in quick settings. Sleep mode turns off automatically when you set a sleep schedule. To set a schedule: 1. Open the Settings app and tap Quiet modes. 2. Under Sleep mode, tap Schedule mode > Off- hours. 3. Tap the start or stop time to adjust when the mode turns on and off. Swipe up or down to change the time, and tap the time to select it. Sleep mode automatically turns off at the time you schedule, even if you manually turned it on. You can't turn on do not disturb and sleep mode at the same time. Screen Wake When you set screen wake to automatic , the screen turns on each time you turn your wrist. 21 When you set screen wake to manual, press the button or tap the screen to turn on the display. Brightness Adjust the screen brightness. Always-On Display Turn always-on display on or off. For more information, see ""Adjust always-on display"" on page 26. Music Volume Adjust the volume of music playing through headphones or speakers paired to your watch. For more information, see ""Connect Bluetooth headphones or speakers"" on page 55. Widgets Add widgets to your watch to see your daily stats, log your water intake or weight, check the weather forecast, and start a session in the Relax app, and more. To see your widgets, swipe up from the clock face. To add a new widget: 22 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Under More Widgets, tap the icon next to the widget you want to add. 3. Swipe up to the bottom of the page, and tap Done. To turn off a widget: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Tap the > icon next to the widget you want to adjust. 3. Tap the switch icon next to Show Widget to turn it off. 4. Swipe up to the bottom of the page, and tap Done. To adjust the information you see on a widget: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Tap the > icon next to the widget you want to adjust. 3. Adjust any settings you want to change. 4. Swipe up to the bottom of the page, and tap Done. To change the order of widgets: 1. From the clock face, swipe up to the bottom of the widgets, and tap Manage. 2. Press and hold the widget you want to move, and drag it up or down in the list of widgets. When it's in the correct new location, lift your finger. 3. Swipe up to the bottom of the page, and tap Done. Adjust settings Manage basic settings in the Settings app : 23 Display Brightness Change the screen's brightness. Screen wake Change whether the screen turns on when you turn your wrist. Screen timeout Adjust the amount of time before the screen turns off or switches to the always-on display clock face. Always-on display Turn always-on display on or off, and change the type of clock face shown. Vibration & audio Vibration Adjust your watch's vibration strength. Microphone Choose whether your watch can access the microphone. Bluetooth Manage connected Bluetooth devices. Goal reminders Active Zone Minutes goal Turn Active Zone Minutes weekly goal notifications on or off. Quiet modes Focus mode Turn off notifications while using the Exercise app . Do not disturb Turn off all notifications. Sleep mode Adjust sleep mode settings, including setting a schedule for the mode to automatically turn on and off. Alexa notifications Turn Amazon Alexa notifications off. 24 Shortcuts Press & hold Choose the app or feature you want to open when you press and hold the button. Double Press Choose 4 apps or features to appear as shortcuts when you double-press the button. Tap a setting to adjust it. Swipe up to see the full list of settings. Check battery level From the clock face, swipe right. The battery level icon is at the top of the screen. Wi-Fi won't work on Versa 3 when the battery is 25% or less, and you'll be unable to update your device. If your watch's battery is low (fewer than 24 hours remaining), a red battery indicator appears on the clock face. If your watch's battery is critically low (fewer than 4 hours remaining), the battery indicator flashes. When the battery is low: l The screen brightness is set to dim l The vibration strength is set to light l If you’re tracking an exercise with GPS, GPS tracking turns off l Always-on display is turned off l You can't use the voice assistant feature l You can't use quick replies 25 l You can't use music controls l You won't receive notifications from your phone Charge Versa 3 to use or adjust these features. Set up device lock To help keep your watch secure, turn on device lock in the Fitbit app, which prompts you to enter a personal 4-digit PIN code to unlock your watch. If you set up Fitbit Pay to make contactless payments from your watch, device lock is turned on automatically and you're required to set a code. If you don't use Fitbit Pay, device lock is optional. Turn on device lock or reset your PIN code in the Fitbit app: From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile > Device Lock. For more information, see help.fitbit.com. Adjust always-on display Turn on always-on display to show the time on your watch, even when you're not interacting with the screen. Many clock faces and certain apps have an always-on display mode. 26 To turn always-on display on or off, swipe right from the clock face to open quick settings. Tap the always-on display icon . Note that turning on this feature impacts your watch's battery life. When always-on display is turned on, Versa 3 requires more frequent charging. Clock faces without an always-on display mode use a default always-on display clock face. Choose between an analog or digital clock face. Open the Settings app > Display. In the Always-on display section, tap Analog or Digital. Always-on display automatically turns off when your watch's battery is critically low. For more information, see help.fitbit.com. 27 Turn off the screen To turn off your watch's screen when not in use, briefly cover the watch face with your opposite hand, press the buttons, or turn your wrist away from your body. Note that if you turn on the always-on display setting, the screen won't turn off. Care for Versa 3 It's important to clean and dry Versa 3 regularly. For more information, see fitbit.com/productcare. 28 Apps and Clock Faces The Fitbit Gallery offers apps and clock faces to personalize your watch and meet a variety of health, fitness, timekeeping, and everyday needs. Change the clock face The Fitbit Clock Gallery offers a variety of clock faces to personalize your watch. 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Clock Faces > All Clocks. 3. Browse the available clock faces. Tap a clock face to see a detailed view. 4. Tap Select to add the clock face to Versa 3. Save up to 5 clock faces to switch between them: l When you select a new clock face, it’s automatically saved unless you already have 5 saved clock faces. l To see your saved clock faces from your watch, open the Clocks app and swipe to find the clock face you want to use. Tap to select it. l To see your saved clock faces in the Fitbit app, tap the Today tab > your profile picture > your device image > Clock Faces. See your saved clock faces in My Clock Faces. 29 l To remove a clock face, tap the clock face > Remove clock face. l To switch to a saved clock face, tap the clock face > Select. Open apps From the clock face, swipe left to see the apps installed on your watch. To open an app, tap it. Organize apps To change the placement of an app on Versa 3, press and hold an app until it's selected, and drag it to a new location. The app is selected when the icon increases slightly in size and the watch vibrates. Download additional apps 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps > All Apps. 3. Browse the available apps. When you find one you want to install, tap it. 4. Tap Install to add the app to Versa 3. For more information, see help.fitbit.com. Remove apps You can remove most apps installed on Versa 3: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, tap the app you want to remove. You may have to swipe up to find it. 4. Tap Remove. 30 Update apps Apps update over Wi-Fi as needed. Versa 3 searches for updates when plugged into the charger and in range of your Wi-Fi network. You can also manually update apps: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, find the app you want to update. You may have to swipe up to find it. 4. Tap the pink Update button next to the app. Adjust app settings and permissions Many apps include options to adjust the notifications, allow certain permissions, and customize what it displays. Note that turning off any app permissions might cause the app to stop functioning. To access these settings: 1. With your watch nearby, in the Fitbit app, tap the Today tab > your profile picture > your device image. 2. Tap Apps or Clock Faces. 3. Tap the app or clock face whose settings you want to change. You may have to swipe up to see some apps. 4. Tap Settings or Permissions. 5. Tap Back or Details when you're done making changes. 31 Voice Assistant Check the weather, set timers and alarms, control your smart home devices, and more by speaking to your watch. Set up Amazon Alexa Built-in 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Amazon Alexa > Sign in with Amazon. 3. Tap Get Started. 4. Log in to your Amazon account or create one if necessary. 5. Follow the on-screen instructions and read about what Alexa can do, and tap Close to return to your device settings in the Fitbit app. To change the language Alexa recognizes or disconnect your Amazon account: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Amazon Alexa. 3. Tap the current language to change it, or tap Logout to stop using Alexa on your watch. Interact with Alexa 1. Open the Alexa app on your watch. Note that the Fitbit app must be running in the background on your phone. 2. Say your request. 32 You don't need to say ""Alexa"" before speaking your request. For example: l Set a timer for 10 minutes. l Set an alarm for 8:00 a.m. l What's the temperature outside? l Remind me to make dinner at 6:00 p.m. l How much protein is in an egg? l Ask Fitbit to start a run.* l Start a bike ride with Fitbit.* *To ask Alexa to open the Exercise app on your watch, you must first set up the Fitbit skill for Alexa. For more information, see help.fitbit.com. These commands are currently available in English, German, French, Italian, Spanish, and Japanese. Amazon Alexa not available in all countries. For more information, see fitbit.com/voice. Note that saying “Alexa” doesn’t activate Alexa on your watch—you must open the Alexa app on your watch before the microphone turns on. The microphone turns off when you close Alexa, or when your watch’s screen turns off. For added functionality, install the Amazon Alexa app on your phone. With the app, your watch can access additional Alexa skills. For more information, see help.fitbit.com. 33 Check Alexa alarms, reminders, and timers 1. Open the Alexa app on your watch. 2. Tap the alerts icon and swipe up to view your alarms, reminders, and timers. 3. Tap an alarm to turn it on or off. To adjust or cancel a reminder or timer, tap the Alexa icon and say your request. Note that Alexa's alarms and timers are separate from those you set in the Alarms app or Timer app . 34 Lifestyle Use apps to stay connected to what you care about most. See ""Apps and Clock Faces"" on page 29 for instructions on how to add and delete apps. For more information, see help.fitbit.com. Starbucks Add your Starbucks card or Starbucks Rewards program number in the Fitbit App Gallery in the Fitbit app, and then use the Starbucks app to pay from your wrist. For more information, see help.fitbit.com. Agenda Connect your phone's calendar in the Fitbit app to see upcoming calendar events for today and tomorrow in the Agenda app on your watch. For more information, see help.fitbit.com. Weather See the weather in your current location, as well as 2 additional locations you choose, in the Weather app on your watch. 35 Check the weather Open the Weather app to see conditions in your current location. Swipe up to view the weather in other locations you added. Tap a location to see a more detailed report. You can also add a weather widget to your watch. For more information, see ""Widgets"" on page 22. If the weather for your current location doesn't appear, check that you turned on location services for the Fitbit app. If you change locations or don't see updated data for your current location, sync your watch to see your new location and latest data in the Weather app or widget. Choose your unit of temperature in the Fitbit app. For more information, see help.fitbit.com. Add or remove a city 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Apps. 3. In the My Apps tab, tap the gear icon next to Weather. You may need to swipe up to find the app. 4. Tap Add city to add up to 2 additional locations or tap Edit > the X icon to delete a location. Note that you can't delete your current location. Find Phone Use the Find Phone app to locate your phone. Requirements: 36 l Your watch must be connected (“paired”) to the phone you want to locate. l Your phone must have Bluetooth turned on and be within 30 feet (10m) of your Fitbit device. l The Fitbit app must be running in the background on your phone. l Your phone must be turned on. To find your phone: l Open the Find Phone app on your watch. l Tap Find Phone. Your phone rings loudly. l When you locate your phone, tap Cancel to end the ringtone. 37 Notifications from your phone Versa 3 can show call, text, calendar, and app notifications from your phone to keep you informed. Keep your watch within 30 feet of your phone to receive notifications. Set up notifications Check that Bluetooth on your phone is on and that your phone can receive notifications (often under Settings > Notifications). Then set up notifications: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Notifications. 3. Follow the on-screen instructions to pair your watch if you haven't already. Call, text, and calendar notifications are turned on automatically. 4. To turn on notifications from apps installed on your phone, including Fitbit and WhatsApp, tap App Notifications and turn on the notifications you want to see. Note that if you have an iPhone or iPad, Versa 3 shows notifications from all calendars synced to the Calendar app. If you have an Android phone, Versa 3 shows calendar notifications from the calendar app you chose during setup. For more information, see help.fitbit.com. See incoming notifications A notification causes your watch to vibrate. If you don't read the notification when it arrives, you can check it later by swiping down from the top of the screen. 38 If your watch's battery is critically low, notifications won't cause Versa 3 to vibrate or the screen to turn on. Manage notifications Versa 3 stores up to 30 notifications, after which the oldest are replaced as you receive new ones. To manage notifications: l Swipe down from the top of the screen to see your notifications and tap any notification to expand it. l To delete a notification, tap to expand it, then swipe to the bottom and tap Clear. l To delete all notifications at once, swipe to the top of your notifications and tap Clear All. Turn off notifications Turn off certain notifications in the Fitbit app, or turn off all notifications in quick settings on Versa 3. When you turn off all notifications, your watch won't vibrate and the screen won't turn on when your phone receives a notification. To turn off certain notifications: 1. From the Today tab in the Fitbit app on your phone, tap your profile picture > Versa 3 tile > Notifications. 39 2. Turn off the notifications you no longer want to receive on your watch. To turn off all notifications: 1. From the clock face, swipe right to access quick settings. 2. Tap the do not disturb icon . All notifications, including goal celebrations and reminders, are turned off. Note that if you use the do not disturb setting on your phone, you don't receive notifications on your watch until you turn off this setting. Answer or reject phone calls If paired to an iPhone or Android (8.0+) phone, Versa 3 lets you accept or reject incoming phone calls. If your phone is running an older version of the Android OS, you can reject, but not accept, calls on your watch. To accept a call, tap the green phone icon on your watch's screen. Note that you can't speak into the watch—accepting a phone call answers the call on your nearby phone. To reject a call, tap the red phone icon to send the caller to voicemail. The caller's name appears if that person is in your contacts list; otherwise you see a phone number. 40 Respond to messages (Android phones) Respond directly to text messages and notifications from certain apps on your watch with preset quick replies or by speaking your reply into Versa 3. Keep your phone nearby with the Fitbit app running in the background to respond to messages from your watch. To respond to a message: 1. Open the notification you want to respond to. 2. Choose how to reply to the message: l Tap the microphone icon to respond to the message using voice-to- text. To change the language recognized by the microphone, tap Language. After you speak your reply, tap Send, or tap Retry to try again. If you notice a mistake after you send the message, tap Undo within 3 seconds to cancel the message. l Tap the text icon to respond to a message from a list of quick replies. l Tap the emoji icon to respond to the message with an emoji. For more information, including how to customize quick replies, see help.fitbit.com. 41 Timekeeping Alarms vibrate to wake or alert you at a time you set. Set up to 8 alarms to occur once or on multiple days of the week. You can also time events with the stopwatch or set a countdown timer. Note that alarms and timers you set with a voice assistant are separate from the ones you set in the Alarms app and Timer app. For more information, see ""Voice Assistant"" on page 32. Use the Alarms app Set one-time or recurring alarms with the Alarms app . When an alarm goes off, your watch vibrates. When setting an alarm, turn on Smart Wake to allow your watch to find the best time to wake you starting 30 minutes before the alarm time you set. It avoids waking you during deep sleep so you're more likely to wake up feeling refreshed. If Smart Wake can’t find the best time to wake you, your alarm alerts you at the set time. For more information, see help.fitbit.com. Dismiss or snooze an alarm When an alarm goes off, your watch vibrates. To dismiss the alarm, tap the alarm icon . To snooze the alarm for 9 minutes, tap the snooze icon . Snooze the alarm as many times as you want. Versa 3 automatically goes into snooze mode if you ignore the alarm for more than 1 minute. 42 Use the Timer app Time events with the stopwatch or set a countdown timer with the Timer app on your watch. You can run the stopwatch and countdown timer at the same time. When the screen turns off, your watch continues to display the stopwatch or countdown timer until it ends or you exit the app. For more information, see help.fitbit.com. 43 Activity and Wellness Versa 3 continuously tracks a variety of stats whenever you wear it, including hourly activity, heart rate, and sleep. Data automatically syncs with the Fitbit app throughout the day. See your stats Open the Today app or swipe up from the clock face to see your daily stats, including: Steps Steps taken today and progress toward your daily goal Heart rate Current heart rate and either your heart-rate zone or resting heart rate (if not in a zone) Calories burned Calories burned today and progress toward your daily goal Floors Floors climbed today and progress toward your daily goal Distance Distance covered today and progress toward your daily goal Active Zone Minutes Active Zone Minutes earned today and the number of Active Zone Minutes you're currently earning per minute Exercise Number of days you met your exercise goal this week Sleep Sleep duration and sleep score Hourly activity The number of hours today you met your hourly activity goal Food Calories eaten and calories remaining today Menstrual health Information on the current stage of your menstrual cycle, if applicable Water Water intake logged today and progress toward your daily goal Weight Current weight and your progress toward your weight goal Core temp Your most recent logged temperature 44 Tap a tile to view more details or log an entry (for water, weight, and core temperature). Find your complete history and other information detected by your watch in the Fitbit app. Track a daily activity goal Versa 3 tracks your progress toward a daily activity goal of your choice. When you reach your goal, your watch vibrates and shows a celebration. Choose a goal Set a goal to help you get started on your health and fitness journey. To begin, your goal is to take 10,000 steps per day. Choose to change the number of steps, or pick a different activity goal depending on your device. For more information, see help.fitbit.com. Track progress toward your goal on Versa 3. For more information, see ""See your stats"" on the previous page. Track your hourly activity Versa 3 helps you stay active throughout the day by keeping track of when you're stationary and reminding you to move. Reminders nudge you to walk at least 250 steps each hour. You feel a vibration and see a reminder on your screen at 10 minutes before the hour if you haven't walked 250 steps. When you meet the 250-step goal after receiving the reminder, you feel a second vibration and see a congratulatory message. 45 For more information, see help.fitbit.com. Track your sleep Wear Versa 3 to bed to automatically track basic stats about your sleep, including your time asleep, sleep stages (time spent in REM, light sleep, and deep sleep), and sleep score (the quality of your sleep). Versa 3 also tracks your estimated oxygen variation throughout the night to help you uncover potential breathing disturbances. To see your sleep stats, sync your watch when you wake up and check the Fitbit app, or swipe up from the clock face on your watch to see your sleep stats. For more information, see help.fitbit.com. Set a sleep goal To start, you have a sleep goal of 8 hours of sleep per night. Customize this goal to meet your needs. For more information, see help.fitbit.com. Learn about your sleep habits With a Fitbit Premium subscription, see more details about your sleep score and how you compare to your peers, which can help you build a better sleep routine and wake up feeling refreshed. For more information, see help.fitbit.com. 46 Practice guided breathing The Relax app on Versa 3 provides personalized guided breathing sessions to help you find moments of calm throughout the day. All notifications are automatically disabled during the session. 1. On Versa 3, open the Relax app . 2. Tap Edit to change the duration of the session or turn off the optional vibration. 3. Tap Start to begin the session. Follow the on-screen instructions. 4. When the session ends, tap Log It to reflect on how you feel, or tap Skip to skip this step. 5. View your summary, and tap Done to close the app. For more information, see help.fitbit.com. 47 Exercise and Heart Health Track activity with the Exercise app and complete guided workouts with the Fitbit Coach app right on your wrist. Check the Fitbit app to share your activity with friends and family, see how your overall fitness level compares to your peers, and more. During a workout, you can play music through the Pandora app or Deezer app on your watch, control music playing in Spotify using the Spotify - Connect & Control app , or control music playing on your phone. 1. Start music playing in an app or on your phone. 2. Open the Exercise or Coach app and start a workout. To control music playing while you exercise, double-press the button. Your shortcuts appear. 3. Tap the music controls icon . 4. To return to your workout, press the button. Note that you need to pair a Bluetooth audio device, such as headphones or a speaker, to Versa 3 to hear music stored on your watch. For more information, see ""Music"" on page 55. Track your exercise automatically Versa 3 automatically recognizes and records many high-movement activities which are at least 15 minutes long. See basic stats about your activity in the Fitbit app on your phone. From the Today tab , tap the Exercise tile. For more information, see help.fitbit.com. 48 Track and analyze exercise with the Exercise app Track specific exercises with the Exercise app on Versa 3 to see real-time stats, including heart-rate data, calories burned, elapsed time, and a post-workout summary on your wrist. For complete workout stats, and a workout intensity map if you used GPS, tap the Exercise tile in the Fitbit app. Track an exercise 1. On Versa 3, open the Exercise app and swipe to find an exercise. 2. Tap the exercise to choose it. If the exercise uses GPS, you can wait for the signal to connect, or start the exercise and GPS will connect when a signal is available. Note that GPS can take a few minutes to connect. 3. Tap the play icon to begin the exercise, or swipe up to choose an exercise goal or adjust the settings. For more information on the settings, see ""Customize your exercise settings"" on the next page. 4. Tap the large stat to scroll through your real-time stats. To pause your workout, swipe up and tap the pause icon . 5. When you're done with your workout, swipe up and tap the end icon > End. Your workout summary appears. 6. Tap Done to close the summary screen. Notes: l If you set an exercise goal, your watch alerts you when you’re halfway to your goal and when you reach the goal. l If the exercise uses GPS, ""GPS connecting..."" appears at the top of the screen. When the screen says ""GPS connected"" and Versa 3 vibrates, GPS is connected. 49 Using built-in GPS impacts your watch's battery life. When GPS tracking is turned on, Versa 3 can track up to 12 hours of continuous exercise. Customize your exercise settings Customize settings for each exercise type on your watch. Settings include: Heart Zone Notifications Receive notifications when you hit target heart-rate zones during your workout. For more information, see help.fitbit.com Laps Receive notifications when you reach certain milestones during your workout Show Stats Choose what stats you want to see when tracking an exercise GPS Track your route using GPS Auto-Pause Automatically pause a run or bike ride when you stop moving Run Detect Track runs automatically without opening the Exercise app Always-on Display Keep the screen on during exercise Pool Length Set the length of your pool Interval Adjust the move and rest intervals used during interval training 1. On Versa 3, open the Exercise app . 2. Swipe to find an exercise. 50 3. Swipe up from the bottom of the screen, then swipe up through the list of settings. 4. Tap a setting to adjust it. 5. When you're done, swipe down until you see the play icon . Check your workout summary After you complete a workout, Versa 3 shows a summary of your stats. Check the Exercise tile in the Fitbit app to see additional stats and a workout intensity map if you used GPS. Check your heart rate Versa 3 personalizes your heart-rate zones using your heart rate reserve, which is the difference between your maximum heart rate and your resting heart rate. To help you target the training intensity of your choice, check your heart rate and heart-rate zone on your watch during exercise. Versa 3 notifies you when you enter a heart-rate zone. 51 Icon Zone Calculation Description Below Zone Below 40% of your heart rate reserve Below the fat burn zone, your heart beats at a slower pace. Fat Burn Zone Between 40% and 59% of your heart rate reserve In the fat burn zone, you’re likely in a moderate activity such as a brisk walk. Your heart rate and breathing might be elevated, but you can still carry on a conversation. Cardio Zone Between 60% and 84% of your heart rate reserve In the cardio zone, you’re likely doing a vigorous activity such as running or spinning. Peak Zone Greater than 85% of your heart rate reserve In the peak zone, you’re likely doing a short, intense activity that improves performance and speed, such as sprinting or high-intensity interval training. 52 Custom heart-rate zones Instead of using these heart-rate zones, you can create a custom zone in the Fitbit app to target a specific heart-rate range. For more information, see help.fitbit.com. Earn Active Zone Minutes Earn Active Zone Minutes for time spent in the fat burn, cardio, or peak heart-rate zones. To help you maximize your time, you earn 2 Active Zone Minutes for each minute you’re in the cardio or peak zones. 1 minute in the fat burn zone = 1 Active Zone Minute 1 minute in the cardio or peak zones = 2 Active Zone Minutes A few moments after you enter a different heart-rate zone during your exercise, your watch buzzes so that you know how hard you’re working. The number of times your watch vibrates indicates which zone you’re in: 1 buzz = below zone 2 buzzes = fat burn zone 3 buzzes = cardio zone 4 buzzes = peak zone To start, your weekly goal is set to 150 Active Zone Minutes. You’ll receive notifications as you reach your goal. For more information, see help.fitbit.com. View your cardio fitness score View your overall cardiovascular fitness in the Fitbit app. See your cardio fitness score and cardio fitness level, which shows how you compare to your peers. 53 In the Fitbit app, tap the Heart-rate tile and swipe left on your heart-rate graph to see your detailed cardio fitness stats. For more information, see help.fitbit.com. Work out with Fitbit Coach The Fitbit Coach app provides guided bodyweight workouts on your wrist to help you stay fit anywhere. 1. On Versa 3, open the Fitbit Coach app . 2. Swipe to find a workout. 3. Tap the workout you want. To preview the workout, tap the menu icon . Press the button to return to the workout. 4. Tap Start. For more information, see help.fitbit.com. Share your activity After you complete a workout, open the Fitbit app to share your stats with friends and family. For more information, see help.fitbit.com. 54 Music Use apps on your watch to listen to music with Bluetooth headphones or speakers. Connect Bluetooth headphones or speakers Connect up to 8 Bluetooth audio devices to listen to music from your watch. To pair a new Bluetooth audio device: 1. Activate pairing mode on your Bluetooth headphones or speaker. 2. On Versa 3, open the Settings app > Vibration & audio. 3. In the Bluetooth section, tap Manage devices. 4. Swipe up to see the Other devices section. Versa 3 searches for nearby devices. 5. When Versa 3 finds nearby Bluetooth audio devices, it shows a list on the screen. Tap the name of the device you want to pair. When pairing is complete, a check mark appears on the screen. To listen to music with a different Bluetooth device: 1. On Versa 3, open the Settings app > Vibration & audio. 2. In the Bluetooth section, tap the device you want to use, or pair a new device. Then wait for a moment for the device to connect. For more information, see help.fitbit.com. Control music with Versa 3 Control music playing in an app on Versa 3 or on your phone. 55 Choose the music source 1. Double-press the button on Versa 3. Your shortcuts appear. 2. Tap the music controls icon . 3. The icon in the top-left corner shows whether the music source is currently set to your phone or your watch . Tap it to change the music source, then press the button to return to your music controls. Control music 1. While music is playing, double-press the button. Your shortcuts appear. 2. Tap the music controls icon . 3. Play, pause, or tap the arrow icons to skip to the next track or previous track. Tap the volume icon to adjust the volume. Control music with the Spotify - Connect & Control app Use the Spotify - Connect & Control app on Versa 3 to control Spotify on your phone, computer, or other Spotify Connect device. Navigate between playlists, like songs, and switch between devices from your watch. Note that at this time, the Spotify - Connect & Control app only controls music playing on your paired device, so your device must remain nearby and connected to the internet. You need a 56 Spotify Premium subscription to use this app. For more information about Spotify Premium, see spotify.com. For instructions, see help.fitbit.com. Listen to music with the Pandora app (United States only) With the Pandora app on Versa 3, download up to 3 of your most-played Pandora stations or popular curated Workout stations directly to your watch. Note that you need a paid subscription to Pandora and a Wi-Fi connection to download stations. For more information about Pandora subscriptions, see help.pandora.com. For instructions, see help.fitbit.com. Listen to music with the Deezer app With the Deezer app on Versa 3, download your Deezer playlists and Flow directly to your watch. Note that you need a paid subscription to Deezer and a Wi- Fi connection to download music. For more information about Deezer subscriptions, see support.deezer.com. For instructions, see help.fitbit.com. 57 Fitbit Pay Versa 3 includes a built-in NFC chip, which lets you use your credit and debit cards on your watch. Use credit and debit cards Set up Fitbit Pay in the Wallet section of the Fitbit app, and use your watch to make purchases in stores that accept contactless payments. We’re always adding new locations and card issuers to our list of partners. To see if your payment card works with Fitbit Pay, see fitbit.com/fitbit-pay/banks. Set up Fitbit Pay To use Fitbit Pay, add at least 1 credit or debit card from a participating bank to the Wallet section of the Fitbit app. The Wallet is where you add and remove payment cards, set a default card for your watch, edit a payment method, and review recent purchases. 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap the Wallet tile. 3. Follow the on-screen instructions to add a payment card. In some cases, your bank might require additional verification. If you're adding a card for the first time, you might be prompted to set a 4-digit PIN code for your watch. Note that you also need passcode protection enabled for your phone. 4. After you add a card, follow the on-screen instructions to turn on notifications for your phone (if you haven't already done so) to complete the setup. You can add up to 6 payment cards to the Wallet and choose which card to set as the default payment option. 58 Make purchases Make purchases using Fitbit Pay at any store that accepts contactless payments. To determine if the store accepts Fitbit Pay, look for the symbol below on the payment terminal: 1. Open the Wallet app on your watch. 2. If prompted, enter your 4-digit watch PIN code. Your default card appears on the screen. 3. To pay with your default card, hold your wrist near the payment terminal. To pay with a different card, swipe to find the card you want to use, and hold your wrist near the payment terminal. 59 When the payment succeeds, your watch vibrates and you see a confirmation on the screen. If the payment terminal doesn't recognize Fitbit Pay, make sure the watch face is near the reader and that the cashier knows you're using a contactless payment. For added security, you must wear Versa 3 on your wrist to use Fitbit Pay. For more information, see help.fitbit.com. Change your default card 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap the Wallet tile. 3. Find the card you want to set as the default option. 4. Tap Set as Default on Versa 3. Pay for transit Use Fitbit Pay to tap on and off at transit readers that accept contactless credit or debit card payments. To pay with your watch, follow the steps listed in ""Use credit and debit cards"" on page 58. 60 Pay with the same card on your Fitbit watch when you tap the transit reader at the start and end of your trip. Make sure your device is charged before beginning your trip. 61 Update, Restart, and Erase Some troubleshooting steps may require you to restart your watch, while erasing it is useful if you want to give Versa 3 to another person. Update your watch to receive new Fitbit OS updates. Update Versa 3 Update your watch to get the latest feature enhancements and product updates. When an update is available, a notification appears in the Fitbit app. After you start the update, follow the progress bars on Versa 3 and in the Fitbit app until the update is complete. Keep your watch and phone close to each other during the update. Updating Versa 3 takes several minutes and may be demanding on the battery. We recommend plugging your watch into the charger before starting the update. For more information, see help.fitbit.com. Restart Versa 3 If you can’t sync Versa 3 or you have trouble with tracking your stats or receiving notifications, restart your watch from your wrist: To restart your watch, press and hold the button for 10 seconds until you see the Fitbit logo on the screen, and then release the button. Restarting your watch reboots the device but doesn't delete any data. Versa 3 has small holes on the device for the altimeter, speaker, and microphone. Don’t attempt to restart your device by inserting any items, such as paper clips, into these holes as you can damage Versa 3. 62 Shutdown Versa 3 To turn off your watch, open the Settings app > Shut down. To turn on your watch, press the button. For information about how to store Versa 3 long term, see help.fitbit.com. Erase Versa 3 If you want to give Versa 3 to another person or wish to return it, first clear your personal data: On Versa 3, open the Settings app > About Versa 3 > Factory reset. 63 Troubleshooting If Versa 3 isn't working properly, see our troubleshooting steps below. Visit help.fitbit.com for more information. Heart-rate signal missing Versa 3 continuously tracks your heart rate while you're exercising and throughout the day. If the heart-rate sensor on your watch has difficulty detecting a signal, dashed lines appear. If your watch doesn't detect a heart-rate signal, make sure you're wearing your watch correctly, either by moving it higher or lower on your wrist or by tightening or loosening the band. Versa 3 should be in contact with your skin. After holding your arm still and straight for a short time, you should see your heart rate again. For more information, see help.fitbit.com. GPS signal missing Environmental factors including tall buildings, dense forest, steep hills, and thick cloud cover can interfere with your watch's ability to connect to GPS satellites. If your watch is searching for a GPS signal during an exercise, you’ll see “ GPS connecting ” appear at the top of the screen. If Versa 3 can't connect to a 64 GPS satellite, the watch stops trying to connect until the next time you start a GPS exercise. For best results, wait for Versa 3 to find the signal before you start your workout. If Versa 3 loses the GPS signal during your workout, ""GPS lost signal"" appears at the top of the screen. Your watch will attempt to reconnect. For more information, see help.fitbit.com. Can't connect to Wi-Fi If Versa 3 can't connect to Wi-Fi, you might have entered an incorrect password, or the password might have changed: 1. From the Today tab in the Fitbit app, tap your profile picture > Versa 3 tile. 2. Tap Wi-Fi Settings > Next. 3. Tap the network you want to use > Remove. 65 4. Tap Add Network and follow the on-screen instructions to reconnect the Wi- Fi network. To check if your Wi-Fi network is working correctly, connect another device to your network; if it connects successfully, try again to connect your watch. If Versa 3 still won't connect to Wi-Fi, make sure that you're attempting to connect your watch to a compatible network. For best results, use your home Wi-Fi network. Versa 3 can't connect to 5GHz Wi-Fi, WPA enterprise, or public networks that require logins, subscriptions, or profiles. For a list of compatible network types, see ""Connect to Wi-Fi"" on page 9. After you verify the network is compatible, restart your watch and try connecting to Wi-Fi again. If you see other networks appear in the list of available networks, but not your preferred network, move your watch closer to your router. For more information, see help.fitbit.com. Other issues If you experience any of the following issues, restart your watch: l Won't sync l Won't respond to taps, swipes, or button press l Won't track steps or other data l Won't show notifications For instructions, see ""Restart Versa 3"" on page 62. For more information, see help.fitbit.com. 66 General Info and Specifications Sensors and Components Fitbit Versa 3 contains the following sensors and motors: l 3-axis accelerometer, which tracks motion patterns l Altimeter, which tracks altitude changes l Built-in GPS receiver + GLONASS, which tracks your location during a workout l Optical heart-rate tracker l Device temperature sensor (skin temperature variation available through Premium only) l Ambient light sensor l Microphone l Speaker l Vibration motor Materials The band that comes with Versa 3 is made of a flexible, durable elastomer material similar to that used in many sports watches. The housing and buckle on Versa 3 are made of anodized aluminum. While anodized aluminum can contain traces of nickel, which can cause an allergic reaction in someone with nickel sensitivity, the amount of nickel in all Fitbit products meets the European Union's stringent Nickel Directive. Our products may contain trace amounts of acrylates and methacrylates from adhesives used in those products but we work to ensure our products adhere to rigorous design specifications and meet extensive test requirements so as to minimum the potential for reaction to these adhesives. 67 Wireless technology Versa 3 contains a Bluetooth 5.0 radio transceiver, Wi-Fi chip, and NFC chip. Haptic feedback Versa 3 contains a vibration motor for alarms, goals, notifications, reminders, and apps. Battery Versa 3 contains a rechargeable lithium-polymer battery. Memory Versa 3 stores your data, including daily stats, sleep information, and exercise history, for 7 days. See your historical data in the Fitbit app. Display Versa 3 has a color AMOLED display. Band size Band sizes are shown below. Note that accessory bands sold separately may vary slightly. Small band Fits a wrist between 5.5 - 7.1 inches (140 mm - 180 mm) in circumference Large band Fits a wrist between 7.1 - 8.7 inches (180 mm - 220 mm) in circumference 68 Environmental conditions Operating temperature 14° to 113° F (-10° to 45° C) Non-operating temperature -4° to 14° F (-20° to -10° C) 113° to 140°F (45° to 60° C) Charging temperature 32° to 95° F (0° to 35° C) Water resistance Water resistant up to 50 meters Maximum operating altitude 28,000 feet (8,534 m) Learn more To learn more about your watch, how to track your progress in the Fitbit app, and how to build healthy habits with Fitbit Premium, visit help.fitbit.com. Return policy and warranty Find warranty information and the fitbit.com return policy on our website. 69 Regulatory and Safety Notices Notice to the User: Regulatory content for certain regions can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info USA: Federal Communications Commission (FCC) statement Model FB511 FCC ID: XRAFB511 Notice to the User: The FCC ID can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Supplier's Declaration of Conformity Unique Identifier: FB511 Responsible Party – U.S. Contact Information 199 Fremont Street, 14th Floor San Francisco, CA 94105 United States 877-623-4997 FCC Compliance Statement (for products subject to Part 15) This device complies with Part 15 of the FCC Rules. Operation is subject to the following two conditions: 70 1. This device may not cause harmful interference and 2. This device must accept any interference, including interference that may cause undesired operation of the device. FCC Warning Changes or modifications not expressly approved by the party responsible for compliance could void the user’s authority to operate the equipment. Note: This equipment has been tested and found to comply with the limits for a Class B digital device, pursuant to part 15 of the FCC Rules. These limits are designed to provide reasonable protection against harmful interference in a residential installation. This equipment generates, uses and can radiate radio frequency energy and, if not installed and used in accordance with the instructions, may cause harmful interference to radio communications. However, there is no guarantee that interference will not occur in a particular installation. If this equipment does cause harmful interference to radio or television reception, which can be determined by turning the equipment off and on, the user is encouraged to try to correct the interference by one or more of the following measures: l Reorient or relocate the receiving antenna. l Increase the separation between the equipment and receiver. l Connect the equipment into an outlet on a circuit different from that to which the receiver is connected. l Consult the dealer or an experienced radio/TV technician for help. This device meets the FCC and IC requirements for RF exposure in public or uncontrolled environments. Canada: Industry Canada (IC) statement Model/Modèle FB511 IC: 8542A-FB511 Notice to the User: The IC ID can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 71 Avis à l'utilisateur: L'ID de l'IC peut également être consulté sur votre appareil. Pour voir le contenu: Paramètres > À propos de Versa 3 > Mentions légales This device meets the IC requirements for RF exposure in public or uncontrolled environments. Cet appareil est conforme aux conditions de la IC en matière de RF dans des environnements publics ou incontrôlée IC Notice to Users English/French in accordance with current issue of RSS GEN: This device complies with Industry Canada license exempt RSS standard(s). Operation is subject to the following two conditions: 1. this device may not cause interference, and 2. this device must accept any interference, including interference that may cause undesired operation of the device. Cet appareil est conforme avec Industrie Canada RSS standard exempts de licence (s). Son utilisation est soumise à Les deux conditions suivantes: 1. cet appareil ne peut pas provoquer d’interférences et 2. cet appareil doit accepter Toute interférence, y compris les interférences qui peuvent causer un mauvais fonctionnement du dispositif European Union (EU) Simplified EU Declaration of Conformity Hereby, Fitbit, Inc. declares that the radio equipment type Model FB511 is in compliance with Directive 2014/53/EU. The full text of the EU declaration of conformity is available at the following internet address: www.fitbit.com/safety Vereinfachte EU-Konformitätserklärung 72 Fitbit, Inc. erklärt hiermit, dass die Funkgerättypen Modell FB511 die Richtlinie 2014/53/EU erfüllen. Der vollständige Wortlaut der EU-Konformitätserklärungen kann unter folgender Internetadresse abgerufen werden: www.fitbit.com/safety Declaración UE de Conformidad simplificada Por la presente, Fitbit, Inc. declara que el tipo de dispositivo de radio Modelo FB511 cumple con la Directiva 2014/53/UE. El texto completo de la declaración de conformidad de la UE está disponible en la siguiente dirección de Internet: www.fitbit.com/safety Déclaration UE de conformité simplifiée Fitbit, Inc. déclare par la présente que les modèles d’appareils radio FB511 sont conformes à la Directive 2014/53/UE. Les déclarations UE de conformité sont disponibles dans leur intégralité sur le site suivant : www.fitbit.com/safety Dichiarazione di conformità UE semplificata Fitbit, Inc. dichiara che il tipo di apparecchiatura radio Modello FB511 è conforme alla Direttiva 2014/53/UE. Il testo completo della dichiarazione di conformità UE è disponibile al seguente indirizzo Internet: www.fitbit.com/safety IP Rating Model FB511 has a water resistance rating of IPX8 under IEC standard 60529, up to a depth of 50 meters. Model FB511 has a dust ingress rating of IP6X under IEC standard 60529 which indicates the device is dust-tight. Please refer to the beginning of this section for instructions on how to access your product’s IP rating. 73 Argentina C-25002 Australia and New Zealand Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Belarus Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 74 Botswana Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory Info China Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory Info 75 China RoHS 部件名称 Part Name 有毒和危险品 Toxic and Hazardous Substances or Elements Model FB511 铅 (Pb) 水银 (Hg) 镉 (Cd) 六价铬 (Cr(VI)) 多溴化苯 (PBB) 多溴化二苯 醚 (PBDE) 表带和表扣 (Strap and Buckle) O O O O O O 电子 (Electronics) -- O O O O O 电池 (Battery) O O O O O O 充电线 (Charging Cable) O O O O O O 本表格依据 SJ/T 11364 的规定编制 O = 表示该有害物质在该部件所有均质材料中的含量均在 GB/T 26572规定的限量要求以下 (indicates that the content of the toxic and hazardous substance in all the Homogeneous Materials of the part is below the concentration limit requirement as described in GB/T 26572). X = 表示该有害物质至少在该部件的某一均质材料中的含量超出 GB/T 26572规定的限量要 求 (indicates that the content of the toxic and hazardous substance in at least one Homogeneous Material of the part exceeds the concentration limit requirement as described in GB/T 26572). CMIIT ID 2020DJ7882 76 Frequency band: 2400-2483.5 MHz NFC: 13.56MHz Transmitted power: Max EIRP, 14.4dBm Occupied bandwidth: BLE: BLE: 2MHz, BT: 1MHz, NFC: 2.3 kHz, WiFi: 20MHz Modulation system: BLE: GFSK, BT: GFSK (BDR), n/4-DQPSK (EDR), 8PSK (EDR), NFC: ASK, WiFi: DSSS, OFDM CMIIT ID displayed: On packaging Customs Union Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Indonesia 69814/SDPPI/2020 3788 Israel מספראישוראלחוטישלמשרדהתקשורתהוא.74746-51 אסורלהחליףאתהאנטנההמקוריתשלהמכשירולאלעשותבוכלשינויטכניאחר Japan Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 77 201-200606 Kingdom of Saudi Arabia Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info Mexico Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info La operación de este equipo está sujeta a las siguientes dos condiciones: 1. Es posible que este equipo o dispositivo no cause interferencia perjudicial y 2. Este equipo o dispositivo debe aceptar cualquier interferencia, incluyendo la que pueda causar su operación no deseada Moldova Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 78 Morocco AGREE PAR L’ANRT MAROC Numéro d’agrément: MR00025102ANRT2020 Date d’agrément: 02/08/2020 Nigeria Connection and use of this communications equipment is permitted by the Nigerian Communications Commission. Oman TRA/TA-R/9745/20 D090258 Pakistan PTA Approved Model No.: FB511 TAC No.: 9.687/2020 Device Type: Smart Watch 79 Philippines Type Accepted No: ESD-RCE-2023407 Serbia Singapore Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info South Korea Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 80 본 제품의 전자파흡수율은 과학기술정보통신부의「전자파 인체보호기준」을 만족합니 다. 본 제품은 국립전파연구원의「전자파흡수율 측정기준」에 따라 최대출력 조건에서 머리 에 근접하여 시험되었으며, 최대 전자파흡수율 측정값은 다음과같습니다. 모델명 (Model) 머리 전자파흡수율 (Head SAR) FB511 0.089 W/kg 클래스 B 장치 (가정 사용을위한 방송 통신 기기) : EMC 등록 주로 가정용 (B 급)으로하고, 모 든 지역에서 사용할 수 있습니다 얻을이 장치. Translation: Class B devices (broadcast communications equipment for home use): EMC registration is mainly for household use (B class) and can be used in all areas get this device. 81 Taiwan 用戶注意：某些地區的法規內容也可以在您的設備上查看。要查看內容： 設定 > 關於 Versa 3 > 法規資訊 Translation: Notice to the User: Regulatory content can also be viewed on your device. Instructions to view content from your menu: Settings > About Versa 3 > Regulatory info 低功率警語: l 取得審驗證明之低功率射頻器材，非經核准，公司、商號或使用者均不得擅自變更 頻率、加大功率或變更原設計之特性及功能。 l 低功率射頻器材之使用不得影響飛航安全及干擾合法通信；經發現有干擾現象時， 應立即停用，並改善至無干擾時方得繼續使用。前述合法通信，指依電信管理法規 定作業之無線電通信。低功率射頻器材須忍受合法通信或工業、科學及醫療用電波 輻射性電機設備之干擾。 Translation: Warning Statement for Low Power Radios: l Without permission granted by the NCC, no company, enterprise, or user is allowed to change the frequency of an approved low power radio-frequency device, enhance its transmitting power or alter original characteristics or performance. l The use of low power RF devices must not affect flight safety or interfere with legal communications: when interference is found, it should be immediately stopped and ameliorated not to interfere before continuing to use it. The legal communications mentioned here refer to radio communications operating in accordance with the provisions of the Telecommunication Law. Low power RF devices need to bear with interference from legal communications or industrial, scientific and medical radio wave radiating equipment 電池警語： 82 此裝置使用鋰電池。 若未遵照下列準則，則裝置內的鋰離子電池壽命可能會縮短或有損壞裝置、發生火災、化學 品灼傷、電解液洩漏及／或受傷的風險。 l 請勿拆解、鑿孔或損壞裝置或電池。 l 請勿取出或嘗試取出使用者不可自行更換的電池。 l 請勿將電池曝露於火焰、爆炸或其他危險中。 l 請勿使用尖銳物品取出電池。 Translation: Battery warning: This device uses a lithium-ion battery. If the following guidelines are not followed, the life of the lithium-ion battery in the device may be shortened or there is a risk of damage to the device, fire, chemical burn, electrolyte leakage and / or injury.. l Do not disassemble, puncture or damage the device or battery. l Do not remove or try to remove the battery that the user cannot replace. l Do not expose the battery to flames, explosions or other hazards. l Do not use sharp objects to remove the battery. Vision Warning 使用過度恐傷害視力 警語 • 使用過度恐傷害視力 注意事項 • 使用30分鐘請休息10分鐘。未滿2歲幼兒不看螢幕，2歲以上每天看螢幕不要超過1 小時 Translation: Excessive use may damage vision 83 Warning: l Excessive use may damage vision Attention: l Rest for 10 minutes after every 30 minutes. l Children under 2 years old should stay away from this product. Children 2 years old or more should not see the screen for more than 1 hour a day. Taiwan RoHS United Arab Emirates Notice to the User: Regulatory content for this region can also be viewed on your device. To view the content: Settings > About Versa 3 > Regulatory info 84 TRA – United Arab Emirates Dealer ID: DA35294/14 TA RTTE: ER88790/ 20 Model: FB511 Type: Smartwatch Vietnam Zambia ZMB / ZICTA / TA / 2020 / 9 / 78 Safety Statement This equipment has been tested to comply with safety certification in accordance with the specifications of EN Standard: EN60950-1:2006 + A11:2009 + A1:2010 + A12:2011 + A2:2013 & EN62368-1:2014 + A11:2017. 85 ©2020 Fitbit, Inc. All rights reserved. Fitbit and the Fitbit logo are trademarks or registered trademarks of Fitbit in the US and other countries. A more complete list of Fitbit trademarks can be found at http://www.fitbit.com/legal/trademark-list. Third-party trademarks mentioned are the property of their respective owners.",Unknown,Fact Finding,Q&A Answer the question only based on the below text.,"According to this document, summarize any financial figures stated for the 2023 fiscal year.","OVERVIEW The following overview is a high-level discussion of our operating results, as well as some of the trends and drivers that affect our business. Management believes that an understanding of these trends and drivers provides important context for our results for the fiscal year ended March 31, 2024, as well as our future prospects. This summary is not intended to be exhaustive, nor is it intended to be a substitute for the detailed discussion and analysis provided elsewhere in this Form 10-K, including in the “Business” section and the “Risk Factors” above, the remainder of “Management’s Discussion and Analysis of Financial Condition and Results of Operations (“MD&A”)” or the Consolidated Financial Statements and related Notes. About Electronic Arts Electronic Arts is a global leader in digital interactive entertainment. We develop, market, publish and deliver games, content and services that can be experienced on game consoles, PCs, mobile phones and tablets. At our core is a portfolio of intellectual property from which we create innovative games and experiences that deliver high-quality entertainment and drive engagement across our network of hundreds of millions of unique active accounts. Our portfolio includes brands that we either wholly own (such as Apex Legends, Battlefield, and The Sims) or license from others (such as the licenses within EA SPORTS FC and EA SPORTS Madden NFL). Through our live services offerings, we offer high-quality experiences designed to provide value to players, and extend and enhance gameplay. These live services include extra content, subscription offerings and other revenue generated in addition to the sale of our full games. We are focusing on building games and experiences that grow the global online communities around our key franchises; deepening engagement through connecting interactive storytelling to key intellectual property; and building re-occurring revenue from scaling our live services and growth in our annualized sports franchises, our console, PC and mobile catalog titles. Financial Results Our key financial results for our fiscal year ended March 31, 2024 were as follows: • Total net revenue was $7,562 million, up 2 percent year-over-year. • Live services and other net revenue was $5,547 million, up 1 percent year-over-year. • Gross margin was 77.4 percent, up 2 percentage points year-over-year. • Operating expenses were $4,334 million, up 1 percent year-over-year. • Operating income was $1,518 million, up 14 percent year-over-year. • Net income was $1,273 million with diluted earnings per share of $4.68. • Net cash provided by operating activities was $2,315 million, up 49 percent year-over-year. • Total cash, cash equivalents and short-term investments were $3,262 million. • We repurchased 10.0 million shares of our common stock for $1,300 million. • We paid cash dividends of $205 million during the fiscal year ended March 31, 2024. Trends in Our Business Live Services Business. We offer our players high-quality experiences designed to provide value to players and to extend and enhance gameplay. These live services include extra content, subscription offerings and other revenue generated in addition to the sale of our full games and free-to-play games. Our net revenue attributable to live services and other was $5,547 million, $5,489 million, and $4,998 million for fiscal years 2024, 2023, and 2022, respectively, and we expect that live services net revenue will continue to be material to our business. Within live services and other, net revenue attributable to extra content was $4,463 million, $4,277 million, and $3,910 million for fiscal years 2024, 2023, and 2022, respectively. Extra content net revenue has increased as more players engage with our games and services, and purchase additional content designed to provide value to players and extend and enhance gameplay. Our most popular live services are the extra content purchased for the Ultimate Team mode associated with our sports franchises, that allows players to collect current and former professional players in order to build and compete as a personalized team, and extra content purchased for our Apex Legends franchise. Live services net revenue generated from extra content purchased within the Ultimate Team mode associated with our sports franchises, a substantial portion of which is derived from Ultimate Team within our global football franchise and from our Apex Legends franchise, is material to our business. 20 Digital Delivery of Games. In our industry, players increasingly purchase games digitally as opposed to purchasing physical discs. While this trend, as applied to our business, may not be linear due to a mix of products during a fiscal year, consumer buying patterns and other factors, over time we expect players to purchase an increasingly higher proportion of our games digitally. As a result, we expect net revenue attributable to digital full game downloads to increase over time and net revenue attributable to sales of packaged goods to decrease. Our net revenue attributable to digital full game downloads was $1,343 million, $1,262 million, and $1,282 million during fiscal years 2024, 2023, and 2022, respectively; while our net revenue attributable to packaged goods sales was $672 million, $675 million, and $711 million in fiscal years 2024, 2023, and 2022, respectively. In addition, as measured based on total units sold on Microsoft’s Xbox One and Xbox Series X and Sony’s PlayStation 4 and 5 rather than by net revenue, we estimate that 73 percent, 68 percent, and 65 percent of our total units sold during fiscal years 2024, 2023, and 2022, were sold digitally. Digital full game units are based on sales information provided by Microsoft and Sony; packaged goods units sold through are estimated by obtaining data from significant retail and distribution partners in North America, Europe and Asia, and applying internal sales estimates with respect to retail partners from which we do not obtain data. We believe that these percentages are reasonable estimates of the proportion of our games that are digitally downloaded in relation to our total number of units sold for the applicable period of measurement. Increases in consumer adoption of digital purchase of games combined with increases in our live services revenue generally results in expansion of our gross margin, as costs associated with selling a game digitally is generally less than selling the same game through traditional retail and distribution channels. Increased Competition. Competition in our business is intense. Our competitors range from established interactive entertainment companies to emerging start-ups. In addition, the gaming, technology/internet, and entertainment industries are converging, and we compete with large, diversified technology companies in those industries. Their greater financial or other resources may provide larger budgets to develop and market tools, technologies, products and services that gain consumer success and shift player time and engagement away from our products and services. In addition, our leading position within the interactive entertainment industry makes us a prime target for recruiting our executives, as well as key creative and technical talent, resulting in retention challenges and increased cost to retain and incentivize our key people. Concentration of Sales Among the Most Popular Games. In our industry, we see a large portion of games sales concentrated on the most popular titles. Similarly, a significant portion of our revenue historically has been derived from games based on a few popular franchises, such as EA SPORTS FC, EA SPORTS Madden NFL, Apex Legends, Battlefield, and The Sims. In particular, we have historically derived a significant portion of our net revenue from our global football franchise, the annualized version of which is consistently one of the best-selling games in the marketplace. We transitioned our global football franchise to a new EA SPORTS FC brand in the second quarter of fiscal 2024. Our continued vision for the future of EA SPORTS FC is to create and innovate across platforms, geographies, and business models to expand our global football experiences and entertain even more fans around the world. Re-occurring Revenue Sources. Our business model includes revenue that we deem re-occurring in nature, such as revenue from our live services, annualized sports franchises (e.g., EA SPORTS FC, EA SPORTS Madden NFL), and our console, PC and mobile catalog titles (i.e., titles that did not launch in the current fiscal year). We have been able to forecast revenue from these areas of our business with greater relative confidence than for new games, services and business models. As we continue to incorporate new business models and modalities of play into our games, our goal is to continue to look for opportunities to expand the re-occurring portion of our business.","System instruction: Answer the question only based on the below text. question: According to this document, summarize any financial figures stated for the 2023 fiscal year. context: OVERVIEW The following overview is a high-level discussion of our operating results, as well as some of the trends and drivers that affect our business. Management believes that an understanding of these trends and drivers provides important context for our results for the fiscal year ended March 31, 2024, as well as our future prospects. This summary is not intended to be exhaustive, nor is it intended to be a substitute for the detailed discussion and analysis provided elsewhere in this Form 10-K, including in the “Business” section and the “Risk Factors” above, the remainder of “Management’s Discussion and Analysis of Financial Condition and Results of Operations (“MD&A”)” or the Consolidated Financial Statements and related Notes. About Electronic Arts Electronic Arts is a global leader in digital interactive entertainment. We develop, market, publish and deliver games, content and services that can be experienced on game consoles, PCs, mobile phones and tablets. At our core is a portfolio of intellectual property from which we create innovative games and experiences that deliver high-quality entertainment and drive engagement across our network of hundreds of millions of unique active accounts. Our portfolio includes brands that we either wholly own (such as Apex Legends, Battlefield, and The Sims) or license from others (such as the licenses within EA SPORTS FC and EA SPORTS Madden NFL). Through our live services offerings, we offer high-quality experiences designed to provide value to players, and extend and enhance gameplay. These live services include extra content, subscription offerings and other revenue generated in addition to the sale of our full games. We are focusing on building games and experiences that grow the global online communities around our key franchises; deepening engagement through connecting interactive storytelling to key intellectual property; and building re-occurring revenue from scaling our live services and growth in our annualized sports franchises, our console, PC and mobile catalog titles. Financial Results Our key financial results for our fiscal year ended March 31, 2024 were as follows: • Total net revenue was $7,562 million, up 2 percent year-over-year. • Live services and other net revenue was $5,547 million, up 1 percent year-over-year. • Gross margin was 77.4 percent, up 2 percentage points year-over-year. • Operating expenses were $4,334 million, up 1 percent year-over-year. • Operating income was $1,518 million, up 14 percent year-over-year. • Net income was $1,273 million with diluted earnings per share of $4.68. • Net cash provided by operating activities was $2,315 million, up 49 percent year-over-year. • Total cash, cash equivalents and short-term investments were $3,262 million. • We repurchased 10.0 million shares of our common stock for $1,300 million. • We paid cash dividends of $205 million during the fiscal year ended March 31, 2024. Trends in Our Business Live Services Business. We offer our players high-quality experiences designed to provide value to players and to extend and enhance gameplay. These live services include extra content, subscription offerings and other revenue generated in addition to the sale of our full games and free-to-play games. Our net revenue attributable to live services and other was $5,547 million, $5,489 million, and $4,998 million for fiscal years 2024, 2023, and 2022, respectively, and we expect that live services net revenue will continue to be material to our business. Within live services and other, net revenue attributable to extra content was $4,463 million, $4,277 million, and $3,910 million for fiscal years 2024, 2023, and 2022, respectively. Extra content net revenue has increased as more players engage with our games and services, and purchase additional content designed to provide value to players and extend and enhance gameplay. Our most popular live services are the extra content purchased for the Ultimate Team mode associated with our sports franchises, that allows players to collect current and former professional players in order to build and compete as a personalized team, and extra content purchased for our Apex Legends franchise. Live services net revenue generated from extra content purchased within the Ultimate Team mode associated with our sports franchises, a substantial portion of which is derived from Ultimate Team within our global football franchise and from our Apex Legends franchise, is material to our business. 20 Digital Delivery of Games. In our industry, players increasingly purchase games digitally as opposed to purchasing physical discs. While this trend, as applied to our business, may not be linear due to a mix of products during a fiscal year, consumer buying patterns and other factors, over time we expect players to purchase an increasingly higher proportion of our games digitally. As a result, we expect net revenue attributable to digital full game downloads to increase over time and net revenue attributable to sales of packaged goods to decrease. Our net revenue attributable to digital full game downloads was $1,343 million, $1,262 million, and $1,282 million during fiscal years 2024, 2023, and 2022, respectively; while our net revenue attributable to packaged goods sales was $672 million, $675 million, and $711 million in fiscal years 2024, 2023, and 2022, respectively. In addition, as measured based on total units sold on Microsoft’s Xbox One and Xbox Series X and Sony’s PlayStation 4 and 5 rather than by net revenue, we estimate that 73 percent, 68 percent, and 65 percent of our total units sold during fiscal years 2024, 2023, and 2022, were sold digitally. Digital full game units are based on sales information provided by Microsoft and Sony; packaged goods units sold through are estimated by obtaining data from significant retail and distribution partners in North America, Europe and Asia, and applying internal sales estimates with respect to retail partners from which we do not obtain data. We believe that these percentages are reasonable estimates of the proportion of our games that are digitally downloaded in relation to our total number of units sold for the applicable period of measurement. Increases in consumer adoption of digital purchase of games combined with increases in our live services revenue generally results in expansion of our gross margin, as costs associated with selling a game digitally is generally less than selling the same game through traditional retail and distribution channels. Increased Competition. Competition in our business is intense. Our competitors range from established interactive entertainment companies to emerging start-ups. In addition, the gaming, technology/internet, and entertainment industries are converging, and we compete with large, diversified technology companies in those industries. Their greater financial or other resources may provide larger budgets to develop and market tools, technologies, products and services that gain consumer success and shift player time and engagement away from our products and services. In addition, our leading position within the interactive entertainment industry makes us a prime target for recruiting our executives, as well as key creative and technical talent, resulting in retention challenges and increased cost to retain and incentivize our key people. Concentration of Sales Among the Most Popular Games. In our industry, we see a large portion of games sales concentrated on the most popular titles. Similarly, a significant portion of our revenue historically has been derived from games based on a few popular franchises, such as EA SPORTS FC, EA SPORTS Madden NFL, Apex Legends, Battlefield, and The Sims. In particular, we have historically derived a significant portion of our net revenue from our global football franchise, the annualized version of which is consistently one of the best-selling games in the marketplace. We transitioned our global football franchise to a new EA SPORTS FC brand in the second quarter of fiscal 2024. Our continued vision for the future of EA SPORTS FC is to create and innovate across platforms, geographies, and business models to expand our global football experiences and entertain even more fans around the world. Re-occurring Revenue Sources. Our business model includes revenue that we deem re-occurring in nature, such as revenue from our live services, annualized sports franchises (e.g., EA SPORTS FC, EA SPORTS Madden NFL), and our console, PC and mobile catalog titles (i.e., titles that did not launch in the current fiscal year). We have been able to forecast revenue from these areas of our business with greater relative confidence than for new games, services and business models. As we continue to incorporate new business models and modalities of play into our games, our goal is to continue to look for opportunities to expand the re-occurring portion of our business.",Financial,Find & Summarize,Text Transformation "You will only rely on information from the context block, and not on any external or prior knowledge. You will limit your response to 200 words.",Find and summarize key similarities between the IDEA and the NCLB acts.,"Introduction The skills, knowledge, and credentials obtained through education are widely believed to be connected to positive occupational and economic outcomes. In recent decades, considerable attention has been devoted to improving educational attainment levels of students with disabilities. Several federal policies have aimed to require educators to pay greater attention to the educational progress and attainment of students with disabilities, and many others provide for a variety of supports with the goal of improving levels of attainment. Data collection efforts have also been launched to allow for better tracking of relevant trends. This report discusses policies aiming to promote educational attainment and examines trends in high school graduation and college enrollment for students with disabilities. It begins with a discussion of the laws related to the education of students with disabilities at the secondary and postsecondary levels. Subsequent sections discuss the existing data on transition-aged students with disabilities, what is currently known about such students, and federal legislation and other factors that may have contributed to changes in students with disabilities’ high school graduation rates and postsecondary enrollment over time. The report offers a brief overview of what is currently known about the U.S. population of students with disabilities in secondary and postsecondary education. It focuses on data gathered in conjunction with federal programs and federally funded studies of nationally representative samples of students with disabilities. It does not attempt to provide an overview or review of existing research on transition-aged students with disabilities or to provide an in-depth examination of the differences between the rights of and services afforded to students with disabilities at the secondary and postsecondary levels. The next sections of the report provide an overview of the education and civil rights laws that aim to support students with disabilities as they work toward completing high school and potentially transition into further educational pursuits. Education Laws Individuals with Disabilities Education Act (IDEA) The IDEA was originally enacted in 1975 (P.L. 94-142) 1 and was most recently reauthorized in 2004. 2 It is the primary federal act providing for special education and related services for children with disabilities between birth and 21 years old.3 Approximately 13% of the K-12 student population received IDEA services in the 2013-2014 school year (SY).4 The IDEA provides states with grants that support the identification, evaluation, and provision of special education services to children with disabilities. States may receive grants under the 1 When P.L. 94-142, the Education for All Handicapped Children Act, was reauthorized in 1990 (P.L. 101-476), its name was changed to the Individuals with Disabilities Education Act (IDEA). 2 The Individuals with Disabilities Education Improvement Act of 2004, P.L. 108-446. 3 For more information, see CRS Report R41833, The Individuals with Disabilities Education Act (IDEA), Part B: Key Statutory and Regulatory Provisions, by Kyrie E. Dragoo and CRS Report R43631, The Individuals with Disabilities Education Act (IDEA), Part C: Early Intervention for Infants and Toddlers with Disabilities, by Kyrie E. Dragoo. 4 U.S. Department of Education, National Center for Education Statistics, Digest of Education Statistics, 2015, Table 204.30, “Children 3 to 21 years old served under Individuals with Disabilities Education Act (IDEA), Part B, by type of disability: Selected years, 1976-77 through 2013-14.” Students with Disabilities: High School to Postsecondary Transition Congressional Research Service R44887 · VERSION 2 · UPDATED 2 condition that, among other requirements, they provide each qualifying student with (1) an individualized education program (IEP) outlining the student’s goals, and the accommodations, special education, and related services that the school will provide to the student, and (2) a free appropriate public education (FAPE) in the least restrictive environment (LRE). This means specially designed instruction to meet students’ needs, provided to the greatest extent possible with their general education peers and at no cost to their families. Beginning with its 1990 reauthorization,5 the IDEA has required that the IEPs of students who are 16 years old or older contain a statement of transition goals and services. Transition services are defined as: A coordinated set of activities for a child with a disability that— (A) is designed to be within a results-oriented process, that is focused on improving the academic and functional achievement of the child with a disability to facilitate the child’s movement from school to post-school activities, including post-secondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation; (B) is based on the individual child’s needs, taking into account the child’s strengths, preferences, and interests; and (C) includes instruction, related services, community experiences, the development of employment and other post-school adult living objectives, and, when appropriate, acquisition of daily living skills and functional vocational evaluation. 6 The 1997 and 20047 amendments to the IDEA have supported students with disabilities graduating with regular diplomas and transitioning to postsecondary education by  increasing local education agencies’ (LEAs) accountability for improving the performance of students with IEPs,  emphasizing students’ progress toward meaningful educational and postsecondary goals in the IEP process, and  requiring states to develop IDEA performance goals and indicators, including dropout and graduation rates, and to report to the Secretary of Education (the Secretary) and the public on the progress of the state and of students with disabilities in the state toward these indicators at least every two years. 8 Elementary and Secondary Education Act of 1965 (ESEA) The ESEA was originally enacted in 1965 (20 U.S.C. 6301 et seq.). It was most recently reauthorized by the Every Student Succeeds Act (ESSA; P.L. 114-95) in 2015. The ESEA is the largest source of federal aid to K-12 education, supporting educational and related services for low-achieving and other students attending elementary and secondary schools with high concentrations of students from low-income families. The largest grant program in the ESEA is 5 P.L. 101-476. 6 20 U.S.C. §1401(a)(34). 7 In the 2004 reauthorization of the IDEA, Congress stated in their findings, “As the graduation rates for children with disabilities continue to climb, providing effective transition services to promote successful post-school employment or education is an important measure of accountability for children with disabilities.” (P.L. 108-446, §601 (c)(14)). 8 P.L. 105-17, §612 (a)(16). Students with Disabilities: High School to Postsecondary Transition Congressional Research Service R44887 · VERSION 2 · UPDATED 3 Title I-A. There are a number of educational accountability requirements that states, LEAs, and schools must meet to receive Title I-A funds. For example, amendments to the ESEA enacted under the No Child Left Behind Act of 2001(NCLB; P.L. 107-110) included several educational accountability provisions that aimed to promote the educational progress of all students in schools served. These provisions have subsequently been amended through the ESSA. Over half of public elementary and secondary schools receive Title I-A funds. While students with disabilities benefit from this funding, they are not specifically targeted by it. However, many of the ESEA’s educational accountability provisions do require that schools pay particular attention to students with disabilities and likely have an effect on them. For example, when the ESEA was amended through the NCLB in 2001, provisions were adopted requiring states to develop and implement a state accountability system to ensure that schools and LEAs made progress with respect to student achievement.9 Under the NCLB provisions, student progress was not only systematically measured and monitored for the broad population of K-12 students served under the ESEA but also for specific subgroups of students, of which “students with disabilities” was one. Under NCLB provisions, student proficiency in relation to academic performance standards was regularly tracked in selected subject areas, as were high school graduation rates. The NCLB contained high-stakes accountability provisions featuring varied consequences for schools in which a sufficient percentage of students or subgroups of students, such as students with disabilities, failed to make sufficient academic progress in relation to the academic achievement and high school graduation standards. The accountability provisions of the NCLB, and those in place after the ESEA was amended through the ESSA, emphasize holding all students and all subgroups of students (including students with disabilities) to the same standards and levels of academic achievement, and closing gaps between subgroups of students. To comply with these accountability provisions, schools and school districts are required to pay specific attention to the academic progress and graduation rates of students with disabilities. Higher Education Act of 1965 (HEA) The HEA was originally enacted in 1965 (P.L. 89-329). It was most recently reauthorized in 2008 by the Higher Education Opportunity Act (HEOA; P.L. 110-315) in 2008, which authorized appropriations for most HEA programs through FY2014. Funding is still being provided for HEA programs through appropriations acts. The HEA authorizes student financial aid programs that help students and their families meet the costs of attending postsecondary institutions, a series of targeted grant programs that assist students transitioning into postsecondary education, and grants that support program and institutional development at some colleges and universities. While students with disabilities benefit from many of the HEA’s student financial aid programs, the programs that specifically target support and assistance to students with disabilities are the TRIO Student Support Services (SSS) program10 and Comprehensive Transition and Postsecondary (CTP) programs for students with intellectual disabilities. 11 9 ESEA, §1111(b)(2). 10 Higher Education Act (HEA), P.L. 113-67, §402(D); 20 U.S.C. 1070a–14. 11 P.L. 113-67, §760; 20 U.S.C. 1140. Students with Disabilities: High School to Postsecondary Transition Congressional Research Service R44887 · VERSION 2 · UPDATED 4 The TRIO SSS program served over 200,000 students through grants to over 1,000 projects in SY2015-2016. 12 The program, originally enacted in 1992 through amendments to the HEA, 13 provides support services to primarily low-income first generation college students with the aim of improving their retention, graduation rates, financial and economic literacy, and transfers from two-year to four-year schools.14 TRIO SSS programs are also intended to foster an institutional climate supportive of potentially disconnected students. These include students with disabilities, students who are limited English proficient, students from groups that are traditionally underrepresented in postsecondary education, students who are homeless children and youths, and students who are in foster care or aging out of the foster care system. Under the TRIO SSS program, the U.S. Department of Education (ED) makes competitive grants to Institutions of Higher Education (IHEs) and combinations of IHEs. Grantees must provide statutorily defined services to an approved number of participants. At least two-thirds of participants must be either students with disabilities15 or low-income, first-generation college students. The remaining onethird of participants must be low-income students, students with disabilities, or first-generation college students. Also, at least one-third of the participating students with disabilities must be low-income. The CTP programs for students with intellectual disabilities served approximately 1,000 students through grants to 66 institutions in SY2015-2016. 16 The programs, enacted through the HEOA, provide transition support for students with intellectual disabilities. 17 Under provisions in the HEA, CTP programs for students with intellectual disabilities are not required to lead to a recognized credential (e.g., bachelor’s or associate’s degree, certificate) or adhere to the same durational requirements that regular postsecondary programs must meet (e.g., a certain number of credit-bearing clock hours). Instead, CTP programs require students with intellectual disabilities to receive curriculum advising, participate at least part-time in courses or training with students who do not have intellectual disabilities, and prepare for gainful employment. Civil Rights Laws In addition to the education laws that fund programs for students with disabilities, there are two civil rights laws that protect them in secondary and postsecondary education from discrimination based on their disabilities: Section 504 of the Rehabilitation Act (P.L. 93-112) and the Americans with Disabilities Act of 1990 (ADA; 42 U.S.C. §12101 et seq.). 12 U.S. Department of Education, Student Support Services Program Awards, FY2016, https://www2.ed.gov/programs/ triostudsupp/awards.html. 13 Higher Education Amendments of 1992, P.L. 102-325, §402(a)(2). 14 For more background information, see CRS Report R42724, The TRIO Programs: A Primer, by Cassandria Dortch. 15 “Disability” is defined in §12102 of the Americans with Disabilities Act (ADA; 42 U.S.C. 12101 et seq.). 16 The U.S. Department of Education (ED) tracks the estimated enrollment of the 43 (out of 66) CTP programs that receive TPSID grants (see footnote 17). An estimated 730 students participate in these TPSID programs (an average of approximately 17 students per program). There are an additional 23 CTP programs that do not report student enrollment rates. CRS estimates that if these 23 CTP programs serve an average of 12 or more students, and those students are added to the 730 students served in the TPSID programs, more than 1,000 students would be served by CTP programs in total. 17 A new CTP grant program, the Model Transition Programs for Students with Intellectual Disabilities into Higher Education (TPSID), which is intended to help IHEs create or expand high-quality, inclusive-model CTP programs for students with intellectual disabilities, was included in the Higher Education Opportunity Act of 2008 (HEOA; P.L. 110- 315). Students with Disabilities: High School to Postsecondary Transition Congressional Research Service R44887 · VERSION 2 · UPDATED 5 Section 504 of the Rehabilitation Act18 Section 504 prohibits discrimination on the basis of a disability by protecting the rights of people with disabilities to access programs receiving federal funding. Section 504 also provides for accommodations such as extended time on tests for students with learning disabilities, accessible classrooms for students with orthopedic impairments, and large print or braille materials for students who are visually impaired. These accommodations are available at all levels of schooling—preschool to postsecondary—in schools that receive any federal funding. All children with disabilities attending K-12 public schools who are served under Section 504 are entitled to a FAPE and an individualized accommodations plan, often called a “504 plan.” At the postsecondary level, Section 504 requires IHEs to provide students with disabilities with appropriate academic adjustments and equitable access to educational programs and facilities. ED’s Office for Civil Rights (OCR) reported that in SY2011-2012, more than 6 million K-12 students were served under the IDEA, and slightly less than three-quarters of a million K-12 students were served under Section 504. 19 This means approximately 89% of children with disabilities served by K-12 public schools are served under the IDEA and approximately 11% of students with disabilities served by K-12 public schools are served solely by Section 504.20 At the postsecondary level, however, the IDEA no longer applies to students with disabilities; instead, all students with disabilities attending IHEs that receive federal funding are protected by Section 504. Most IHEs have a 504 coordinator or a disabled student services (DSS) office on campus that coordinates accommodations such as extended time on tests, early course registration, and physical accommodations and access to campus facilities for students with disabilities. Americans with Disabilities Act of 1990 (ADA) The Americans with Disabilities Act of 1990, most recently amended by the ADA Amendments Act of 2008 (together, ADA), 21 includes a conforming amendment to the Rehabilitation Act that broadens the meaning of the term “disability” in both the ADA and Section 504 to protect people who have or are regarded as having a physical or mental disability that impacts one or more major life activities. The ADA provides broad nondiscrimination protection in employment, public services, public accommodations and services operated by private entities, transportation, and telecommunications for individuals with disabilities. The ADA states that its purpose is “to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities.” In 2008, in response to Supreme Court and lower court decisions that narrowly interpreted the term “disability,” Congress passed the ADA Amendments Act to, among other things, “carry out the ADA's objectives of providing 'a clear and comprehensive national mandate for the elimination of discrimination' and 'clear, strong, consistent, enforceable standards addressing discrimination' by reinstating a broad scope of protection to be available under the ADA.” Both Section 504 and the ADA require that educational institutions at all levels provide equal access for people with disabilities. The ADA extends the requirements of Section 504 from only institutions receiving federal financial assistance to all institutions, with some exceptions for 18 Section 504 of the Rehabilitation Act of 1973 is commonly referred to simply as “Section 504.” 19 U.S. Department of Education, Office for Civil Rights, Civil Rights Data Collection, 2011-12, http://ocrdata.ed.gov. 20 Because having an IEP and a 504 plan is considered duplicative, students with IEPs usually only have IEPs, and students who have disabilities that do not qualify for IDEA services (e.g., a disability that impacts a child medically or physically but not educationally) have 504 plans. 21 42 U.S.C. §12101 et seq. Students with Disabilities: High School to Postsecondary Transition Congressional Research Service R44887 · VERSION 2 · UPDATED 6 institutions controlled by religious organizations. The ADA impacts schools from pre-K to postsecondary because it extends the rights of people with disabilities to access facilities and receive accommodations, allowing them to participate in the activities of both public and private institutions. ","You will only rely on information from the context block, and not on any external or prior knowledge. You will limit your response to 200 words. Find and summarize key similarities between the IDEA and the NCLB acts. Context block: Introduction The skills, knowledge, and credentials obtained through education are widely believed to be connected to positive occupational and economic outcomes. In recent decades, considerable attention has been devoted to improving educational attainment levels of students with disabilities. Several federal policies have aimed to require educators to pay greater attention to the educational progress and attainment of students with disabilities, and many others provide for a variety of supports with the goal of improving levels of attainment. Data collection efforts have also been launched to allow for better tracking of relevant trends. This report discusses policies aiming to promote educational attainment and examines trends in high school graduation and college enrollment for students with disabilities. It begins with a discussion of the laws related to the education of students with disabilities at the secondary and postsecondary levels. Subsequent sections discuss the existing data on transition-aged students with disabilities, what is currently known about such students, and federal legislation and other factors that may have contributed to changes in students with disabilities’ high school graduation rates and postsecondary enrollment over time. The report offers a brief overview of what is currently known about the U.S. population of students with disabilities in secondary and postsecondary education. It focuses on data gathered in conjunction with federal programs and federally funded studies of nationally representative samples of students with disabilities. It does not attempt to provide an overview or review of existing research on transition-aged students with disabilities or to provide an in-depth examination of the differences between the rights of and services afforded to students with disabilities at the secondary and postsecondary levels. The next sections of the report provide an overview of the education and civil rights laws that aim to support students with disabilities as they work toward completing high school and potentially transition into further educational pursuits. Education Laws Individuals with Disabilities Education Act (IDEA) The IDEA was originally enacted in 1975 (P.L. 94-142) 1 and was most recently reauthorized in 2004. 2 It is the primary federal act providing for special education and related services for children with disabilities between birth and 21 years old.3 Approximately 13% of the K-12 student population received IDEA services in the 2013-2014 school year (SY).4 The IDEA provides states with grants that support the identification, evaluation, and provision of special education services to children with disabilities. States may receive grants under the 1 When P.L. 94-142, the Education for All Handicapped Children Act, was reauthorized in 1990 (P.L. 101-476), its name was changed to the Individuals with Disabilities Education Act (IDEA). 2 The Individuals with Disabilities Education Improvement Act of 2004, P.L. 108-446. 3 For more information, see CRS Report R41833, The Individuals with Disabilities Education Act (IDEA), Part B: Key Statutory and Regulatory Provisions, by Kyrie E. Dragoo and CRS Report R43631, The Individuals with Disabilities Education Act (IDEA), Part C: Early Intervention for Infants and Toddlers with Disabilities, by Kyrie E. Dragoo. 4 U.S. Department of Education, National Center for Education Statistics, Digest of Education Statistics, 2015, Table 204.30, “Children 3 to 21 years old served under Individuals with Disabilities Education Act (IDEA), Part B, by type of disability: Selected years, 1976-77 through 2013-14.” Students with Disabilities: High School to Postsecondary Transition Congressional Research Service R44887 · VERSION 2 · UPDATED 2 condition that, among other requirements, they provide each qualifying student with (1) an individualized education program (IEP) outlining the student’s goals, and the accommodations, special education, and related services that the school will provide to the student, and (2) a free appropriate public education (FAPE) in the least restrictive environment (LRE). This means specially designed instruction to meet students’ needs, provided to the greatest extent possible with their general education peers and at no cost to their families. Beginning with its 1990 reauthorization,5 the IDEA has required that the IEPs of students who are 16 years old or older contain a statement of transition goals and services. Transition services are defined as: A coordinated set of activities for a child with a disability that— (A) is designed to be within a results-oriented process, that is focused on improving the academic and functional achievement of the child with a disability to facilitate the child’s movement from school to post-school activities, including post-secondary education, vocational education, integrated employment (including supported employment), continuing and adult education, adult services, independent living, or community participation; (B) is based on the individual child’s needs, taking into account the child’s strengths, preferences, and interests; and (C) includes instruction, related services, community experiences, the development of employment and other post-school adult living objectives, and, when appropriate, acquisition of daily living skills and functional vocational evaluation. 6 The 1997 and 20047 amendments to the IDEA have supported students with disabilities graduating with regular diplomas and transitioning to postsecondary education by  increasing local education agencies’ (LEAs) accountability for improving the performance of students with IEPs,  emphasizing students’ progress toward meaningful educational and postsecondary goals in the IEP process, and  requiring states to develop IDEA performance goals and indicators, including dropout and graduation rates, and to report to the Secretary of Education (the Secretary) and the public on the progress of the state and of students with disabilities in the state toward these indicators at least every two years. 8 Elementary and Secondary Education Act of 1965 (ESEA) The ESEA was originally enacted in 1965 (20 U.S.C. 6301 et seq.). It was most recently reauthorized by the Every Student Succeeds Act (ESSA; P.L. 114-95) in 2015. The ESEA is the largest source of federal aid to K-12 education, supporting educational and related services for low-achieving and other students attending elementary and secondary schools with high concentrations of students from low-income families. The largest grant program in the ESEA is 5 P.L. 101-476. 6 20 U.S.C. §1401(a)(34). 7 In the 2004 reauthorization of the IDEA, Congress stated in their findings, “As the graduation rates for children with disabilities continue to climb, providing effective transition services to promote successful post-school employment or education is an important measure of accountability for children with disabilities.” (P.L. 108-446, §601 (c)(14)). 8 P.L. 105-17, §612 (a)(16). Students with Disabilities: High School to Postsecondary Transition Congressional Research Service R44887 · VERSION 2 · UPDATED 3 Title I-A. There are a number of educational accountability requirements that states, LEAs, and schools must meet to receive Title I-A funds. For example, amendments to the ESEA enacted under the No Child Left Behind Act of 2001(NCLB; P.L. 107-110) included several educational accountability provisions that aimed to promote the educational progress of all students in schools served. These provisions have subsequently been amended through the ESSA. Over half of public elementary and secondary schools receive Title I-A funds. While students with disabilities benefit from this funding, they are not specifically targeted by it. However, many of the ESEA’s educational accountability provisions do require that schools pay particular attention to students with disabilities and likely have an effect on them. For example, when the ESEA was amended through the NCLB in 2001, provisions were adopted requiring states to develop and implement a state accountability system to ensure that schools and LEAs made progress with respect to student achievement.9 Under the NCLB provisions, student progress was not only systematically measured and monitored for the broad population of K-12 students served under the ESEA but also for specific subgroups of students, of which “students with disabilities” was one. Under NCLB provisions, student proficiency in relation to academic performance standards was regularly tracked in selected subject areas, as were high school graduation rates. The NCLB contained high-stakes accountability provisions featuring varied consequences for schools in which a sufficient percentage of students or subgroups of students, such as students with disabilities, failed to make sufficient academic progress in relation to the academic achievement and high school graduation standards. The accountability provisions of the NCLB, and those in place after the ESEA was amended through the ESSA, emphasize holding all students and all subgroups of students (including students with disabilities) to the same standards and levels of academic achievement, and closing gaps between subgroups of students. To comply with these accountability provisions, schools and school districts are required to pay specific attention to the academic progress and graduation rates of students with disabilities. Higher Education Act of 1965 (HEA) The HEA was originally enacted in 1965 (P.L. 89-329). It was most recently reauthorized in 2008 by the Higher Education Opportunity Act (HEOA; P.L. 110-315) in 2008, which authorized appropriations for most HEA programs through FY2014. Funding is still being provided for HEA programs through appropriations acts. The HEA authorizes student financial aid programs that help students and their families meet the costs of attending postsecondary institutions, a series of targeted grant programs that assist students transitioning into postsecondary education, and grants that support program and institutional development at some colleges and universities. While students with disabilities benefit from many of the HEA’s student financial aid programs, the programs that specifically target support and assistance to students with disabilities are the TRIO Student Support Services (SSS) program10 and Comprehensive Transition and Postsecondary (CTP) programs for students with intellectual disabilities. 11 9 ESEA, §1111(b)(2). 10 Higher Education Act (HEA), P.L. 113-67, §402(D); 20 U.S.C. 1070a–14. 11 P.L. 113-67, §760; 20 U.S.C. 1140. Students with Disabilities: High School to Postsecondary Transition Congressional Research Service R44887 · VERSION 2 · UPDATED 4 The TRIO SSS program served over 200,000 students through grants to over 1,000 projects in SY2015-2016. 12 The program, originally enacted in 1992 through amendments to the HEA, 13 provides support services to primarily low-income first generation college students with the aim of improving their retention, graduation rates, financial and economic literacy, and transfers from two-year to four-year schools.14 TRIO SSS programs are also intended to foster an institutional climate supportive of potentially disconnected students. These include students with disabilities, students who are limited English proficient, students from groups that are traditionally underrepresented in postsecondary education, students who are homeless children and youths, and students who are in foster care or aging out of the foster care system. Under the TRIO SSS program, the U.S. Department of Education (ED) makes competitive grants to Institutions of Higher Education (IHEs) and combinations of IHEs. Grantees must provide statutorily defined services to an approved number of participants. At least two-thirds of participants must be either students with disabilities15 or low-income, first-generation college students. The remaining onethird of participants must be low-income students, students with disabilities, or first-generation college students. Also, at least one-third of the participating students with disabilities must be low-income. The CTP programs for students with intellectual disabilities served approximately 1,000 students through grants to 66 institutions in SY2015-2016. 16 The programs, enacted through the HEOA, provide transition support for students with intellectual disabilities. 17 Under provisions in the HEA, CTP programs for students with intellectual disabilities are not required to lead to a recognized credential (e.g., bachelor’s or associate’s degree, certificate) or adhere to the same durational requirements that regular postsecondary programs must meet (e.g., a certain number of credit-bearing clock hours). Instead, CTP programs require students with intellectual disabilities to receive curriculum advising, participate at least part-time in courses or training with students who do not have intellectual disabilities, and prepare for gainful employment. Civil Rights Laws In addition to the education laws that fund programs for students with disabilities, there are two civil rights laws that protect them in secondary and postsecondary education from discrimination based on their disabilities: Section 504 of the Rehabilitation Act (P.L. 93-112) and the Americans with Disabilities Act of 1990 (ADA; 42 U.S.C. §12101 et seq.). 12 U.S. Department of Education, Student Support Services Program Awards, FY2016, https://www2.ed.gov/programs/ triostudsupp/awards.html. 13 Higher Education Amendments of 1992, P.L. 102-325, §402(a)(2). 14 For more background information, see CRS Report R42724, The TRIO Programs: A Primer, by Cassandria Dortch. 15 “Disability” is defined in §12102 of the Americans with Disabilities Act (ADA; 42 U.S.C. 12101 et seq.). 16 The U.S. Department of Education (ED) tracks the estimated enrollment of the 43 (out of 66) CTP programs that receive TPSID grants (see footnote 17). An estimated 730 students participate in these TPSID programs (an average of approximately 17 students per program). There are an additional 23 CTP programs that do not report student enrollment rates. CRS estimates that if these 23 CTP programs serve an average of 12 or more students, and those students are added to the 730 students served in the TPSID programs, more than 1,000 students would be served by CTP programs in total. 17 A new CTP grant program, the Model Transition Programs for Students with Intellectual Disabilities into Higher Education (TPSID), which is intended to help IHEs create or expand high-quality, inclusive-model CTP programs for students with intellectual disabilities, was included in the Higher Education Opportunity Act of 2008 (HEOA; P.L. 110- 315). Students with Disabilities: High School to Postsecondary Transition Congressional Research Service R44887 · VERSION 2 · UPDATED 5 Section 504 of the Rehabilitation Act18 Section 504 prohibits discrimination on the basis of a disability by protecting the rights of people with disabilities to access programs receiving federal funding. Section 504 also provides for accommodations such as extended time on tests for students with learning disabilities, accessible classrooms for students with orthopedic impairments, and large print or braille materials for students who are visually impaired. These accommodations are available at all levels of schooling—preschool to postsecondary—in schools that receive any federal funding. All children with disabilities attending K-12 public schools who are served under Section 504 are entitled to a FAPE and an individualized accommodations plan, often called a “504 plan.” At the postsecondary level, Section 504 requires IHEs to provide students with disabilities with appropriate academic adjustments and equitable access to educational programs and facilities. ED’s Office for Civil Rights (OCR) reported that in SY2011-2012, more than 6 million K-12 students were served under the IDEA, and slightly less than three-quarters of a million K-12 students were served under Section 504. 19 This means approximately 89% of children with disabilities served by K-12 public schools are served under the IDEA and approximately 11% of students with disabilities served by K-12 public schools are served solely by Section 504.20 At the postsecondary level, however, the IDEA no longer applies to students with disabilities; instead, all students with disabilities attending IHEs that receive federal funding are protected by Section 504. Most IHEs have a 504 coordinator or a disabled student services (DSS) office on campus that coordinates accommodations such as extended time on tests, early course registration, and physical accommodations and access to campus facilities for students with disabilities. Americans with Disabilities Act of 1990 (ADA) The Americans with Disabilities Act of 1990, most recently amended by the ADA Amendments Act of 2008 (together, ADA), 21 includes a conforming amendment to the Rehabilitation Act that broadens the meaning of the term “disability” in both the ADA and Section 504 to protect people who have or are regarded as having a physical or mental disability that impacts one or more major life activities. The ADA provides broad nondiscrimination protection in employment, public services, public accommodations and services operated by private entities, transportation, and telecommunications for individuals with disabilities. The ADA states that its purpose is “to provide a clear and comprehensive national mandate for the elimination of discrimination against individuals with disabilities.” In 2008, in response to Supreme Court and lower court decisions that narrowly interpreted the term “disability,” Congress passed the ADA Amendments Act to, among other things, “carry out the ADA's objectives of providing 'a clear and comprehensive national mandate for the elimination of discrimination' and 'clear, strong, consistent, enforceable standards addressing discrimination' by reinstating a broad scope of protection to be available under the ADA.” Both Section 504 and the ADA require that educational institutions at all levels provide equal access for people with disabilities. The ADA extends the requirements of Section 504 from only institutions receiving federal financial assistance to all institutions, with some exceptions for 18 Section 504 of the Rehabilitation Act of 1973 is commonly referred to simply as “Section 504.” 19 U.S. Department of Education, Office for Civil Rights, Civil Rights Data Collection, 2011-12, http://ocrdata.ed.gov. 20 Because having an IEP and a 504 plan is considered duplicative, students with IEPs usually only have IEPs, and students who have disabilities that do not qualify for IDEA services (e.g., a disability that impacts a child medically or physically but not educationally) have 504 plans. 21 42 U.S.C. §12101 et seq. Students with Disabilities: High School to Postsecondary Transition Congressional Research Service R44887 · VERSION 2 · UPDATED 6 institutions controlled by religious organizations. The ADA impacts schools from pre-K to postsecondary because it extends the rights of people with disabilities to access facilities and receive accommodations, allowing them to participate in the activities of both public and private institutions. ",Legal,Fact Finding,Q&A Draw your answer from the above text only.,What are the two components of the Orphan Drug Act?,"The Orphan Drug Act and FDA Regulations: Setting the Stage for Ensuing Litigation The cost and availability of prescription drugs have been of congressional interest, and expenditures related to the research and development of new drugs are a significant driver of drug costs.1 A 2016 report by the Tufts Center for Drug Development estimated the pretax and preapproval cost of developing a Food and Drug Administration (FDA)-approved prescription drug was $2.6 billion, while a 2016 Department of Health and Human Services (HHS) report estimated a range from $1.2 billion to $2.6 billion.2 Given the extraordinary cost associated with development and marketing of a new drug, manufacturers aim to recover much of their research and development costs through drug sales. Historically, drugs designed to treat rare diseases and conditions received little attention from U.S. drug manufacturers, given the high cost of development and lack of widespread use.3 These drugs became known as “orphan drugs.”4 In the 1970s, there was growing concern about the need for drugs to treat rare diseases; at that time, FDA established two committees to study the “inadequate motivation, and resources, for the development and distribution of drugs for rare diseases.” 5 Congress began investigating and holding hearings on the development of drugs for rare diseases in June 1980.6 As part of this effort, the House Subcommittee on Health and the Environment surveyed a number of federal agencies, universities, and pharmaceutical companies to gather information about various drug products used to treat rare diseases in the United States.7 The results of the survey, published in 1982, showed that so-called orphan drugs were generally not profitable, many were not patentable, and it was difficult for drug sponsors to conduct clinical trials to demonstrate their safety and effectiveness—in part because of the small patient populations they were developed to treat.8 Given the high cost of drug development and approval in the United States, Congress found that “it is not financially feasible, except as a public service, for a pharmaceutical manufacturer to expend research and development funds” on orphan drugs, which are typically used only to treat small subsets of the population.9 So in 1983, Congress enacted the Orphan Drug Act (ODA) as a way to “facilitate the development of drugs for rare diseases or conditions,” 10 primarily by establishing financial incentives—including tax credits, grant funding, and market exclusivity— to encourage pharmaceutical companies to develop and market orphan drugs in the United States.11 The FDA, a division of HHS, administers the ODA. The statute does not explicitly define “orphan drug,” but FDA has issued regulations to define the term as a drug “intended for use in a rare disease or condition,” which is consistent with the statute’s phrasing.12 The ODA contains two main components: (1) orphan-drug designation, as described in Section 360bb, and (2) orphan-drug market exclusivity, as described in Section 360cc. 13 Drug manufacturers may apply to obtain an orphan-drug designation for drugs in development. If granted, orphan-drug designation enables a drug manufacturer to access financial assistance for drug research and development, including tax credits for clinical testing of the drug, grant funding to cover research costs, and a waiver of FDA’s Prescription Drug User Fee if it ultimately submits an application for FDA approval of the drug. 14 If a drug manufacturer receives FDA approval to market a drug designated as an orphan drug, the manufacturer is generally entitled to a seven-year exclusivity period. During the seven-year orphan-drug exclusivity period, the FDA cannot approve an application from a different drug manufacturer for approval15 to market the same drug for the same disease or condition.16 These statutory mechanisms of designation, approval, and exclusivity are intended to work together to promote the research and development of orphan drugs.17 Orphan-Drug Designation Orphan-drug designation allows drug manufacturers18 and sponsors19 to access financial benefits and incentives early in the drug development process, and it also assures orphan-drug exclusivity for a successfully marketed drug, which aids in the recoupment of the sizable upfront investment in drug development.20 A manufacturer or sponsor may apply for an orphan-drug designation at any time during the drug development process, so long as the request is submitted before submitting the application for FDA approval of the drug.21 FDA regulations spell out the specific requirements for the content and format of orphan-drug designation requests,22 discuss how the FDA verifies orphan-drug status23 and alerts drug sponsors of deficiencies, 24 and stipulate the conditions under which the FDA may refuse to grant25 or revoke a designation request. 26 Manufacturers and sponsors may seek an orphan-drug designation if the drug is currently being investigated or will be investigated for a rare disease or condition and the approval or licensing of the drug would be for the “use for such disease or condition.” 27 For purposes of orphan-drug designation, a “rare disease or condition” is one that either (1) affects fewer than 200,000 people in the United States; or (2) affects more than 200,000 people in the United States but for which a manufacturer does not have a “reasonable expectation” of recovering its development costs from sales.28 A manufacturer may seek orphan-drug designation for either a previously unapproved drug, or for a new use of a drug that is already FDA-approved.29 Additionally, if the FDA has already designated and approved an orphan drug for a particular rare disease or condition, a sponsor may receive a subsequent designation for the same drug for the same disease or condition if it can present a “plausible hypothesis” that the second drug is clinically superior to the original.30","The Orphan Drug Act and FDA Regulations: Setting the Stage for Ensuing Litigation The cost and availability of prescription drugs have been of congressional interest, and expenditures related to the research and development of new drugs are a significant driver of drug costs.1 A 2016 report by the Tufts Center for Drug Development estimated the pretax and preapproval cost of developing a Food and Drug Administration (FDA)-approved prescription drug was $2.6 billion, while a 2016 Department of Health and Human Services (HHS) report estimated a range from $1.2 billion to $2.6 billion.2 Given the extraordinary cost associated with development and marketing of a new drug, manufacturers aim to recover much of their research and development costs through drug sales. Historically, drugs designed to treat rare diseases and conditions received little attention from U.S. drug manufacturers, given the high cost of development and lack of widespread use.3 These drugs became known as “orphan drugs.”4 In the 1970s, there was growing concern about the need for drugs to treat rare diseases; at that time, FDA established two committees to study the “inadequate motivation, and resources, for the development and distribution of drugs for rare diseases.” 5 Congress began investigating and holding hearings on the development of drugs for rare diseases in June 1980.6 As part of this effort, the House Subcommittee on Health and the Environment surveyed a number of federal agencies, universities, and pharmaceutical companies to gather information about various drug products used to treat rare diseases in the United States.7 The results of the survey, published in 1982, showed that so-called orphan drugs were generally not profitable, many were not patentable, and it was difficult for drug sponsors to conduct clinical trials to demonstrate their safety and effectiveness—in part because of the small patient populations they were developed to treat.8 Given the high cost of drug development and approval in the United States, Congress found that “it is not financially feasible, except as a public service, for a pharmaceutical manufacturer to expend research and development funds” on orphan drugs, which are typically used only to treat small subsets of the population.9 So in 1983, Congress enacted the Orphan Drug Act (ODA) as a way to “facilitate the development of drugs for rare diseases or conditions,” 10 primarily by establishing financial incentives—including tax credits, grant funding, and market exclusivity— to encourage pharmaceutical companies to develop and market orphan drugs in the United States.11 The FDA, a division of HHS, administers the ODA. The statute does not explicitly define “orphan drug,” but FDA has issued regulations to define the term as a drug “intended for use in a rare disease or condition,” which is consistent with the statute’s phrasing.12 The ODA contains two main components: (1) orphan-drug designation, as described in Section 360bb, and (2) orphan-drug market exclusivity, as described in Section 360cc. 13 Drug manufacturers may apply to obtain an orphan-drug designation for drugs in development. If granted, orphan-drug designation enables a drug manufacturer to access financial assistance for drug research and development, including tax credits for clinical testing of the drug, grant funding to cover research costs, and a waiver of FDA’s Prescription Drug User Fee if it ultimately submits an application for FDA approval of the drug. 14 If a drug manufacturer receives FDA approval to market a drug designated as an orphan drug, the manufacturer is generally entitled to a seven-year exclusivity period. During the seven-year orphan-drug exclusivity period, the FDA cannot approve an application from a different drug manufacturer for approval15 to market the same drug for the same disease or condition.16 These statutory mechanisms of designation, approval, and exclusivity are intended to work together to promote the research and development of orphan drugs.17 Orphan-Drug Designation Orphan-drug designation allows drug manufacturers18 and sponsors19 to access financial benefits and incentives early in the drug development process, and it also assures orphan-drug exclusivity for a successfully marketed drug, which aids in the recoupment of the sizable upfront investment in drug development.20 A manufacturer or sponsor may apply for an orphan-drug designation at any time during the drug development process, so long as the request is submitted before submitting the application for FDA approval of the drug.21 FDA regulations spell out the specific requirements for the content and format of orphan-drug designation requests,22 discuss how the FDA verifies orphan-drug status23 and alerts drug sponsors of deficiencies, 24 and stipulate the conditions under which the FDA may refuse to grant25 or revoke a designation request. 26 Manufacturers and sponsors may seek an orphan-drug designation if the drug is currently being investigated or will be investigated for a rare disease or condition and the approval or licensing of the drug would be for the “use for such disease or condition.” 27 For purposes of orphan-drug designation, a “rare disease or condition” is one that either (1) affects fewer than 200,000 people in the United States; or (2) affects more than 200,000 people in the United States but for which a manufacturer does not have a “reasonable expectation” of recovering its development costs from sales.28 A manufacturer may seek orphan-drug designation for either a previously unapproved drug, or for a new use of a drug that is already FDA-approved.29 Additionally, if the FDA has already designated and approved an orphan drug for a particular rare disease or condition, a sponsor may receive a subsequent designation for the same drug for the same disease or condition if it can present a “plausible hypothesis” that the second drug is clinically superior to the original.30 What are the two components of the Orphan Drug Act? Draw your answer from the above text only.",Medical,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","Explain in layman's terms the events related to the settlement of the case. Specifically, I want to know why it took so long from the order to mediate in July to a settlement agreement being proposed.","RECITALS A. On January 31, 2012, a federal multidistrict litigation was established in the United States District Court for the Eastern District of Pennsylvania, In re: National Football League Players’ Concussion Injury Litigation, MDL No. 2323. Plaintiffs in MDL No. 2323 filed a Master Administrative Long-Form Complaint and a Master Administrative Class Action Complaint for Medical Monitoring on June 7, 2012. Plaintiffs filed an Amended Master Administrative Long-Form Complaint on July 17, 2012. Additional similar lawsuits are pending in various state and federal courts. B. The lawsuits arise from the alleged effects of mild traumatic brain injury allegedly caused by the concussive and sub-concussive impacts experienced by former NFL Football players. Plaintiffs seek to hold the NFL Parties responsible for their alleged injuries under various theories of liability, including that the NFL Parties allegedly breached a duty to NFL Football players to warn and protect them from the long-term health problems associated with concussions and that the NFL Parties allegedly concealed and misrepresented the connection between concussions and long term chronic brain injury. C. On August 30, 2012, the NFL Parties filed motions to dismiss the Master Administrative Class Action Complaint for Medical Monitoring and the Amended Master Administrative Long-Form Complaint on preemption grounds. Plaintiffs filed their oppositions to the motions on October 31, 2012, the NFL Parties filed reply memoranda of law on December 17, 2012, and plaintiffs filed sur reply memoranda of law on January 28, 2013. Oral argument on the NFL Parties’ motions to dismiss on preemption grounds was held on April 9, 2013. D. On July 8, 2013, prior to ruling on the motions to dismiss, the Court ordered the plaintiffs and NFL Parties to engage in mediation to determine if consensual resolution was possible and appointed retired United States District Court Judge Layn Phillips of Irell & Manella LLP as mediator. E. Over the course of the following two months, the Parties, by and through their respective counsel, engaged in settlement negotiations under the direction of Judge Phillips. On August 29, 2013, the Parties signed a settlement term sheet setting forth the material terms of a settlement agreement. On the same day, the Court issued an order deferring a ruling on the NFL Parties’ motions to dismiss and ordering the Parties to submit, as soon as possible, the full documentation relating to the settlement, along with a motion seeking preliminary approval of the settlement and notice plan. On December 16, 2013, the Court appointed a special master, Perry Golkin (“Special Master Golkin”), to assist the Court in evaluating the financial aspects of the proposed settlement. F. On January 6, 2014, Class Counsel moved the Court for an order, among other things, granting preliminary approval of the proposed settlement and conditionally certifying a settlement class and subclasses. On January 14, 2014, the Court denied that motion without prejudice. G. In conjunction with the January 2014 filing of the proposed settlement agreement, and this Settlement Agreement, the Class and Subclass Representatives filed Plaintiffs’ Class Action Complaint (“Class Action Complaint”) on January 6, 2014. In the Class Action Complaint, the Class and Subclass Representatives allege claims for equitable, injunctive and declaratory relief pursuant to Federal Rules of Civil Procedure 23(a)(1-4) & (b)(2), or, alternatively, for compensatory damages pursuant to Federal Rule of Civil Procedure 23(b)(3), for negligence, negligent hiring, negligent retention, negligent misrepresentation, fraud, fraudulent concealment, medical monitoring, wrongful death and survival, and loss of consortium, all under state law. H. The NFL Parties deny the Class and Subclass Representatives’ allegations, and the allegations in Related Lawsuits, and deny any liability to the Class and Subclass Representatives, the Settlement Class, or any Settlement Class Member for any claims, causes of action, costs, expenses, attorneys’ fees, or damages of any kind, and would assert a number of substantial legal and factual defenses against plaintiffs’ claims if they were litigated to conclusion. I. The Class and Subclass Representatives, through their counsel, have engaged in substantial fact gathering to evaluate the merits of their claims and the NFL Parties’ defenses. In addition, the Class and Subclass Representatives have analyzed the legal issues raised by their claims and the NFL Parties’ defenses, including, without limitation, the NFL Parties’ motions to dismiss the Amended Master Administrative Long-Form Complaint and Master Administrative Class Action Complaint on preemption grounds. J. After careful consideration, the Class and Subclass Representatives, and their respective Counsel, have concluded that it is in the best interests of the Class and Subclass Representatives and the Settlement Class and Subclasses to compromise and settle all Released Claims against the Released Parties for consideration reflected in the terms and benefits of this Settlement Agreement. After arm’s length negotiations with Counsel for the NFL Parties, including through the efforts of the court-appointed mediator and Special Master Golkin, the Class and Subclass Representatives have considered, among other things: (1) the complexity, expense, and likely duration of the litigation; (2) the stage of the litigation and amount of fact gathering completed; (3) the potential for the NFL Parties to prevail on threshold issues and on the merits; and (4) the range of possible recovery, and have determined that this Settlement Agreement is fair, reasonable, adequate, and in the best interests of the Class and Subclass Representatives and the Settlement Class and Subclasses. K. The NFL Parties have concluded, in light of the costs, risks, and burden of litigation, that this Settlement Agreement in this complex putative class action litigation is appropriate. The NFL Parties and Counsel for the NFL Parties agree with the Class and Subclass Representatives and their respective counsel that this Settlement Agreement is a fair, reasonable, and adequate resolution of the Released Claims. The NFL Parties reached this conclusion after considering the factual and legal issues relating to the litigation, the substantial benefits of this Settlement Agreement, the expense that would be necessary to defend claims by Settlement Class Members through trial and any appeals that might be taken, the benefits of disposing of protracted and complex litigation, and the desire of the NFL Parties to conduct their business unhampered by the costs, distraction and risks of continued litigation over Released Claims. L. The Parties desire to settle, compromise, and resolve fully all Released Claims. M. The Parties desire and intend to seek Court review and approval of the Settlement Agreement, and, upon preliminary approval by the Court, the Parties intend to seek a Final Order and Judgment from the Court dismissing with prejudice the Class Action Complaint and ordering the dismissal with prejudice of Related Lawsuits. N. This Settlement Agreement will not be construed as evidence of, or as an admission by, the NFL Parties of any liability or wrongdoing whatsoever or as an admission by the Class or Subclass Representatives, or Settlement Class Members, of any lack of merit in their claims.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Explain in layman's terms the events related to the settlement of the case. Specifically, I want to know why it took so long from the order to mediate in July to a settlement agreement being proposed. RECITALS A. On January 31, 2012, a federal multidistrict litigation was established in the United States District Court for the Eastern District of Pennsylvania, In re: National Football League Players’ Concussion Injury Litigation, MDL No. 2323. Plaintiffs in MDL No. 2323 filed a Master Administrative Long-Form Complaint and a Master Administrative Class Action Complaint for Medical Monitoring on June 7, 2012. Plaintiffs filed an Amended Master Administrative Long-Form Complaint on July 17, 2012. Additional similar lawsuits are pending in various state and federal courts. B. The lawsuits arise from the alleged effects of mild traumatic brain injury allegedly caused by the concussive and sub-concussive impacts experienced by former NFL Football players. Plaintiffs seek to hold the NFL Parties responsible for their alleged injuries under various theories of liability, including that the NFL Parties allegedly breached a duty to NFL Football players to warn and protect them from the long-term health problems associated with concussions and that the NFL Parties allegedly concealed and misrepresented the connection between concussions and long term chronic brain injury. C. On August 30, 2012, the NFL Parties filed motions to dismiss the Master Administrative Class Action Complaint for Medical Monitoring and the Amended Master Administrative Long-Form Complaint on preemption grounds. Plaintiffs filed their oppositions to the motions on October 31, 2012, the NFL Parties filed reply memoranda of law on December 17, 2012, and plaintiffs filed sur reply memoranda of law on January 28, 2013. Oral argument on the NFL Parties’ motions to dismiss on preemption grounds was held on April 9, 2013. D. On July 8, 2013, prior to ruling on the motions to dismiss, the Court ordered the plaintiffs and NFL Parties to engage in mediation to determine if consensual resolution was possible and appointed retired United States District Court Judge Layn Phillips of Irell & Manella LLP as mediator. E. Over the course of the following two months, the Parties, by and through their respective counsel, engaged in settlement negotiations under the direction of Judge Phillips. On August 29, 2013, the Parties signed a settlement term sheet setting forth the material terms of a settlement agreement. On the same day, the Court issued an order deferring a ruling on the NFL Parties’ motions to dismiss and ordering the Parties to submit, as soon as possible, the full documentation relating to the settlement, along with a motion seeking preliminary approval of the settlement and notice plan. On December 16, 2013, the Court appointed a special master, Perry Golkin (“Special Master Golkin”), to assist the Court in evaluating the financial aspects of the proposed settlement. F. On January 6, 2014, Class Counsel moved the Court for an order, among other things, granting preliminary approval of the proposed settlement and conditionally certifying a settlement class and subclasses. On January 14, 2014, the Court denied that motion without prejudice. G. In conjunction with the January 2014 filing of the proposed settlement agreement, and this Settlement Agreement, the Class and Subclass Representatives filed Plaintiffs’ Class Action Complaint (“Class Action Complaint”) on January 6, 2014. In the Class Action Complaint, the Class and Subclass Representatives allege claims for equitable, injunctive and declaratory relief pursuant to Federal Rules of Civil Procedure 23(a)(1-4) & (b)(2), or, alternatively, for compensatory damages pursuant to Federal Rule of Civil Procedure 23(b)(3), for negligence, negligent hiring, negligent retention, negligent misrepresentation, fraud, fraudulent concealment, medical monitoring, wrongful death and survival, and loss of consortium, all under state law. H. The NFL Parties deny the Class and Subclass Representatives’ allegations, and the allegations in Related Lawsuits, and deny any liability to the Class and Subclass Representatives, the Settlement Class, or any Settlement Class Member for any claims, causes of action, costs, expenses, attorneys’ fees, or damages of any kind, and would assert a number of substantial legal and factual defenses against plaintiffs’ claims if they were litigated to conclusion. I. The Class and Subclass Representatives, through their counsel, have engaged in substantial fact gathering to evaluate the merits of their claims and the NFL Parties’ defenses. In addition, the Class and Subclass Representatives have analyzed the legal issues raised by their claims and the NFL Parties’ defenses, including, without limitation, the NFL Parties’ motions to dismiss the Amended Master Administrative Long-Form Complaint and Master Administrative Class Action Complaint on preemption grounds. J. After careful consideration, the Class and Subclass Representatives, and their respective Counsel, have concluded that it is in the best interests of the Class and Subclass Representatives and the Settlement Class and Subclasses to compromise and settle all Released Claims against the Released Parties for consideration reflected in the terms and benefits of this Settlement Agreement. After arm’s length negotiations with Counsel for the NFL Parties, including through the efforts of the court-appointed mediator and Special Master Golkin, the Class and Subclass Representatives have considered, among other things: (1) the complexity, expense, and likely duration of the litigation; (2) the stage of the litigation and amount of fact gathering completed; (3) the potential for the NFL Parties to prevail on threshold issues and on the merits; and (4) the range of possible recovery, and have determined that this Settlement Agreement is fair, reasonable, adequate, and in the best interests of the Class and Subclass Representatives and the Settlement Class and Subclasses. K. The NFL Parties have concluded, in light of the costs, risks, and burden of litigation, that this Settlement Agreement in this complex putative class action litigation is appropriate. The NFL Parties and Counsel for the NFL Parties agree with the Class and Subclass Representatives and their respective counsel that this Settlement Agreement is a fair, reasonable, and adequate resolution of the Released Claims. The NFL Parties reached this conclusion after considering the factual and legal issues relating to the litigation, the substantial benefits of this Settlement Agreement, the expense that would be necessary to defend claims by Settlement Class Members through trial and any appeals that might be taken, the benefits of disposing of protracted and complex litigation, and the desire of the NFL Parties to conduct their business unhampered by the costs, distraction and risks of continued litigation over Released Claims. L. The Parties desire to settle, compromise, and resolve fully all Released Claims. M. The Parties desire and intend to seek Court review and approval of the Settlement Agreement, and, upon preliminary approval by the Court, the Parties intend to seek a Final Order and Judgment from the Court dismissing with prejudice the Class Action Complaint and ordering the dismissal with prejudice of Related Lawsuits. N. This Settlement Agreement will not be construed as evidence of, or as an admission by, the NFL Parties of any liability or wrongdoing whatsoever or as an admission by the Class or Subclass Representatives, or Settlement Class Members, of any lack of merit in their claims. https://www.nflconcussionsettlement.com/Documents/Class_Action_Settlement_Agreement_with_Exhibits.pdf",Legal,Summarize & Simplify,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",Clinical prediction models are being developed and used in the diagnosis of neonatal sepsis. Give me a summary of the predictors that are used in the models included in the study. Emphasize the numbers and percentages.,"Clinical prediction models to diagnose neonatal sepsis in low-income and middle-income countries: a scoping review Neonatal sepsis causes significant morbidity and mortality worldwide but is difficult to diagnose clinically. Clinical prediction models (CPMs) could improve diagnostic accuracy. Neonates in lowincome and middle-income countries are disproportionately affected by sepsis, yet no review has comprehensively synthesised CPMs validated in this setting. We performed a scoping review of CPMs for neonatal sepsis diagnosis validated in low-income and middle-income countries. From 4598 unique records, we included 82 studies validating 44 distinct models. Most studies were set in neonatal intensive or special care units in middle-income countries and included neonates already suspected of sepsis. Three quarters of models were only validated in one study. Our review highlights several literature gaps, particularly a paucity of studies validating models in low-income countries and the WHO African region, and models for the general neonatal population. Furthermore, heterogeneity in study populations, definitions of sepsis and reporting of models may hinder progress in this field. METHODS We conducted this review according to an a priori published protocol,15 developed with reference to the scoping review guidelines provided by the Joanna Briggs Institute.16 We report methods and results in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (see supplementary appendix).17 Search strategy Eligibility criteria are shown in Table 1. After reviewing the extent and breadth of the literature from our initial searches, we narrowed the scope of our original protocol to focus specifically on studies that validate a CPM to diagnose neonatal sepsis in a LMIC, as defined by the World Bank in 2020. 18 We searched six electronic databases from their inception: Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, Global Index Medicus, and the Cochrane Library. Searches were initially performed on 20 December 2019 and updated on 5 September 2022 and 16 June 2024. Search terms were chosen to capture the three domains of the research question (‘neonate’, ‘sepsis’, and ‘clinical prediction model’) through collaboration with a child health specialist librarian. The search strategy was developed for Ovid MEDLINE and adapted for each database (see supplementary appendix). Additional studies were identified by citation analysis and by hand searching the reference lists of included studies. Record screening We imported identified records into EndNote 21 for deduplication.19 Unique records were then uploaded to the Rayyan application for screening by two independent reviewers (DM, HG, MZ, SRN or SS). 20 Titles and abstracts were first examined against the eligibility criteria to determine if each record was potentially eligible for inclusion. Next, full texts of potentially eligible studies were obtained and reviewed to confirm eligibility. Authors were contacted to request full texts where these could not be found online. Conflicts were resolved by discussion amongst the review team. Data extraction and synthesis Data extraction was performed independently by two reviewers for the initial searches (SRN and SS) and by one reviewer for each updated search (SRN or SS). We extracted data on study, participant and model characteristics, and model performance using a pre-piloted data extraction form (see supplementary appendix). Data items were chosen based on the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement.21 We summarised results by narrative synthesis. Data for quantitative outcomes were not pooled in a meta-analysis as this is beyond the scoping review methodology. Where multiple variations of a model were presented in the same study (e.g. different combinations of predictors presented during model specification), or model performance was presented at multiple classification thresholds, we only included data for the ‘optimal’ or ‘final’ model at a single classification threshold. RESULTS Searches and included studies Searches identified 4598 unique records (Figure 1). From these, 82 studies published between 2003 and 2024 were included, 22-103 and are summarised in Tables 2 and 3. The number of published studies validating a CPM to diagnose neonatal sepsis in LMICs has increased rapidly in recent years (Figure 2). Studies were conducted in 22 individual countries (Figure 3 and Table 4), with the greatest number of studies conducted in the World Health Organization (WHO) South-East Asian Region (n=48, 59%), particularly in India (n=37, 45%). The fewest studies were conducted in the WHO African Region (n=4, 5%). Regarding economic status, 51 studies were conducted exclusively in lower middle-income countries (62%) and 30 exclusively in upper middle-income countries (37%). One study pooled data from both low-income and lower middle-income countries.98 Most studies were set in intensive care or special care admission units (n=64, 78%). The remainder included all live births at study sites (n=12, 15%), neonates presenting to emergency care services (n=3, 4%), all hospitalised neonates (n=1, 1%), or the setting was unclear (n=2, 2%). In total, 24252 neonates were included across all studies. The median number of participants per study was 151 (range 36 to 3303, interquartile range [IQR] 200). Few studies restricted the study population based on gestational age or birthweight, with only 4 studies (5%) specifically investigating preterm neonates and 5 studies (6%) specifically investigating low or very low birthweight neonates. Most studies included neonates clinically suspected of sepsis or with specific maternal risk factors including chorioamnionitis (n=58, 71%). Almost all studies included a positive blood and/or CSF culture in their outcome definition for sepsis (n=75, 91%). Of these, 18 (22% of all studies) also included clinical features or clinical suspicion of sepsis. One study used a consultant neonatologist’s clinical diagnosis of sepsis, 76 one study used the International Classification of Diseases 10th Revision criteria for sepsis,77 and in three studies the outcome was unclear. Model characteristics The 82 included studies performed 109 evaluations validating 44 distinct models (Table 3).22- 25,32,33,40,46,47,49-51,54,56,57,63,68,72,76-78,81,83,86,87,90,92,98-101,103-113 The most frequently validated model was the Hematological Scoring System by Rodwell et al. (n=32, 39% of studies; including studies that made minor modifications to the original model).112 Most models were only validated in one study (n=34, 77% of models). A total of 135 predictors of sepsis were included across all models, of which 82 were clinical parameters (signs, symptoms or risk factors) and 53 were laboratory parameters (see supplementary appendix). The median number of predictors per model was 6 (range 2 to 110, IQR 4). 14 models (32%) included only clinical parameters, 12 models (27%) included only laboratory parameters, and 18 models (41%) included both. The commonest laboratory parameters were white cell count (n=17 models, 39%), C-reactive protein (CRP) (n=16 models, 36%) and platelet count (n=15 models, 34%). The commonest clinical parameters were neonatal fever (n=13 models, 30%) and gestational age (n=11 models, 25%). Most models were developed using logistic regression (n=16 models, 36%) (often with stepwise selection to select predictors) or consisted of a scoring system based on univariable predictor performance or literature review and expert opinion (n=10 models, 23%)."," Only use the provided text to answer the question, no outside sources. Clinical prediction models are being developed and used in the diagnosis of neonatal sepsis. Give me a summary of the predictors that are used in the models included in the study. Emphasize the numbers and percentages. Clinical prediction models to diagnose neonatal sepsis in low-income and middle-income countries: a scoping review Neonatal sepsis causes significant morbidity and mortality worldwide but is difficult to diagnose clinically. Clinical prediction models (CPMs) could improve diagnostic accuracy. Neonates in lowincome and middle-income countries are disproportionately affected by sepsis, yet no review has comprehensively synthesised CPMs validated in this setting. We performed a scoping review of CPMs for neonatal sepsis diagnosis validated in low-income and middle-income countries. From 4598 unique records, we included 82 studies validating 44 distinct models. Most studies were set in neonatal intensive or special care units in middle-income countries and included neonates already suspected of sepsis. Three quarters of models were only validated in one study. Our review highlights several literature gaps, particularly a paucity of studies validating models in low-income countries and the WHO African region, and models for the general neonatal population. Furthermore, heterogeneity in study populations, definitions of sepsis and reporting of models may hinder progress in this field. METHODS We conducted this review according to an a priori published protocol,15 developed with reference to the scoping review guidelines provided by the Joanna Briggs Institute.16 We report methods and results in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (see supplementary appendix).17 Search strategy Eligibility criteria are shown in Table 1. After reviewing the extent and breadth of the literature from our initial searches, we narrowed the scope of our original protocol to focus specifically on studies that validate a CPM to diagnose neonatal sepsis in a LMIC, as defined by the World Bank in 2020. 18 We searched six electronic databases from their inception: Ovid MEDLINE, Ovid Embase, Scopus, Web of Science Core Collection, Global Index Medicus, and the Cochrane Library. Searches were initially performed on 20 December 2019 and updated on 5 September 2022 and 16 June 2024. Search terms were chosen to capture the three domains of the research question (‘neonate’, ‘sepsis’, and ‘clinical prediction model’) through collaboration with a child health specialist librarian. The search strategy was developed for Ovid MEDLINE and adapted for each database (see supplementary appendix). Additional studies were identified by citation analysis and by hand searching the reference lists of included studies. Record screening We imported identified records into EndNote 21 for deduplication.19 Unique records were then uploaded to the Rayyan application for screening by two independent reviewers (DM, HG, MZ, SRN or SS). 20 Titles and abstracts were first examined against the eligibility criteria to determine if each record was potentially eligible for inclusion. Next, full texts of potentially eligible studies were obtained and reviewed to confirm eligibility. Authors were contacted to request full texts where these could not be found online. Conflicts were resolved by discussion amongst the review team. Data extraction and synthesis Data extraction was performed independently by two reviewers for the initial searches (SRN and SS) and by one reviewer for each updated search (SRN or SS). We extracted data on study, participant and model characteristics, and model performance using a pre-piloted data extraction form (see supplementary appendix). Data items were chosen based on the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement.21 We summarised results by narrative synthesis. Data for quantitative outcomes were not pooled in a meta-analysis as this is beyond the scoping review methodology. Where multiple variations of a model were presented in the same study (e.g. different combinations of predictors presented during model specification), or model performance was presented at multiple classification thresholds, we only included data for the ‘optimal’ or ‘final’ model at a single classification threshold. RESULTS Searches and included studies Searches identified 4598 unique records (Figure 1). From these, 82 studies published between 2003 and 2024 were included, 22-103 and are summarised in Tables 2 and 3. The number of published studies validating a CPM to diagnose neonatal sepsis in LMICs has increased rapidly in recent years (Figure 2). Studies were conducted in 22 individual countries (Figure 3 and Table 4), with the greatest number of studies conducted in the World Health Organization (WHO) South-East Asian Region (n=48, 59%), particularly in India (n=37, 45%). The fewest studies were conducted in the WHO African Region (n=4, 5%). Regarding economic status, 51 studies were conducted exclusively in lower middle-income countries (62%) and 30 exclusively in upper middle-income countries (37%). One study pooled data from both low-income and lower middle-income countries.98 Most studies were set in intensive care or special care admission units (n=64, 78%). The remainder included all live births at study sites (n=12, 15%), neonates presenting to emergency care services (n=3, 4%), all hospitalised neonates (n=1, 1%), or the setting was unclear (n=2, 2%). In total, 24252 neonates were included across all studies. The median number of participants per study was 151 (range 36 to 3303, interquartile range [IQR] 200). Few studies restricted the study population based on gestational age or birthweight, with only 4 studies (5%) specifically investigating preterm neonates and 5 studies (6%) specifically investigating low or very low birthweight neonates. Most studies included neonates clinically suspected of sepsis or with specific maternal risk factors including chorioamnionitis (n=58, 71%). Almost all studies included a positive blood and/or CSF culture in their outcome definition for sepsis (n=75, 91%). Of these, 18 (22% of all studies) also included clinical features or clinical suspicion of sepsis. One study used a consultant neonatologist’s clinical diagnosis of sepsis, 76 one study used the International Classification of Diseases 10th Revision criteria for sepsis,77 and in three studies the outcome was unclear. Model characteristics The 82 included studies performed 109 evaluations validating 44 distinct models (Table 3).22- 25,32,33,40,46,47,49-51,54,56,57,63,68,72,76-78,81,83,86,87,90,92,98-101,103-113 The most frequently validated model was the Hematological Scoring System by Rodwell et al. (n=32, 39% of studies; including studies that made minor modifications to the original model).112 Most models were only validated in one study (n=34, 77% of models). A total of 135 predictors of sepsis were included across all models, of which 82 were clinical parameters (signs, symptoms or risk factors) and 53 were laboratory parameters (see supplementary appendix). The median number of predictors per model was 6 (range 2 to 110, IQR 4). 14 models (32%) included only clinical parameters, 12 models (27%) included only laboratory parameters, and 18 models (41%) included both. The commonest laboratory parameters were white cell count (n=17 models, 39%), C-reactive protein (CRP) (n=16 models, 36%) and platelet count (n=15 models, 34%). The commonest clinical parameters were neonatal fever (n=13 models, 30%) and gestational age (n=11 models, 25%). Most models were developed using logistic regression (n=16 models, 36%) (often with stepwise selection to select predictors) or consisted of a scoring system based on univariable predictor performance or literature review and expert opinion (n=10 models, 23%). https://www.medrxiv.org/content/10.1101/2024.09.05.24313133v2.full.pdf",Medical,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",What is the medication Atorvastatin used for and what potential side effects can result from it? Be thorough in your response and make it at least 150 words.,"Why is this medication prescribed? Atorvastatin is used together with diet, weight loss, and exercise to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Atorvastatin is also used to decrease the amount of fatty substances such as low-density lipoprotein (LDL) cholesterol ('bad cholesterol') and triglycerides in the blood and to increase the amount of high-density lipoprotein (HDL) cholesterol ('good cholesterol') in the blood. Atorvastatin may also be used to decrease the amount of cholesterol and other fatty substances in the blood in children and teenagers 10 to 17 years of age who have familial heterozygous hypercholesterolemia (an inherited condition in which cholesterol cannot be removed from the body normally). Atorvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body. Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats with atorvastatin has been shown to prevent heart disease, angina (chest pain), strokes, and heart attacks. How should this medicine be used? Atorvastatin comes as a tablet and suspension (liquid) to take by mouth. The tablet is usually taken once a day with or without food. The suspension is usually taken once a day on an empty stomach (at least 1 hour before or 2 hours after a meal).Take atorvastatin at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take atorvastatin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may start you on a low dose of atorvastatin and gradually increase your dose, not more than once every 2 to 4 weeks. If you are taking the suspension, do not use a household spoon to measure your dose. Use a properly marked measuring device such as a medicine spoon or oral syringe. Ask your doctor or pharmacist if you need help getting or using a measuring device. Continue to take atorvastatin even if you feel well. Do not stop taking atorvastatin without talking to your doctor. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking atorvastatin, tell your doctor and pharmacist if you are allergic to atorvastatin, any other medications, or any of the ingredients in atorvastatin tablets and suspension. Ask your pharmacist for a list of the ingredients. Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking atorvastatin. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. The following nonprescription products may interact with atorvastatin: cimetidine (Tagamet), and niacin. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking atorvastatin. Do not start any of these medications while taking atorvastatin without discussing with your healthcare provider. tell your doctor if you have or ever had liver disease. Your doctor will order laboratory tests to see how well your liver is working even if you do not think you have liver disease. Your doctor will probably tell you not to take atorvastatin if you have liver disease or if the tests show you may be developing liver disease. tell your doctor if you drink more than 2 alcoholic beverages daily, if you are 65 years of age or older, and if you have or have ever had muscle aches or weakness, diabetes, seizures, low blood pressure, or thyroid or kidney disease. tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while taking atorvastatin, stop taking atorvastatin and call your doctor immediately. Atorvastatin may harm the fetus. tell your doctor if you are breastfeeding or plan to breastfeed. You should not breastfeed while you are taking this medication. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking atorvastatin. If you are hospitalized due to serious injury or infection, tell the doctor who treats you that you are taking atorvastatin. ask your doctor about the safe use of alcoholic beverages while you are taking atorvastatin. Alcohol can increase the risk of serious side effects. What special dietary instructions should I follow? Eat a low-fat, low-cholesterol diet. Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. You can also visit the National Cholesterol Education Program (NCEP) website for additional dietary information at https://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf. Avoid drinking large amounts [more than 1.2 liter (approximately 1 quart) per day] of grapefruit juice while taking atorvastatin. What should I do if I forget a dose? If you miss a dose of the tablet, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. If you miss a dose of the suspension, take the missed dose as soon as you remember it. However, if it is less than 12 hours until your next scheduled dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? Atorvastatin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: diarrhea heartburn gas joint pain forgetfulness or memory loss confusion Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor or get emergency medical help immediately: muscle pain, tenderness, or weakness lack of energy fever chest pain nausea extreme tiredness weakness unusual bleeding or bruising loss of appetite pain in the upper right part of the stomach flu-like symptoms dark colored urine yellowing of the skin or eyes hoarseness"," Only use the provided text to answer the question, no outside sources. What is the medication Atorvastatin used for and what potential side effects can result from it? Be thorough in your response and make it at least 150 words. Why is this medication prescribed? Atorvastatin is used together with diet, weight loss, and exercise to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Atorvastatin is also used to decrease the amount of fatty substances such as low-density lipoprotein (LDL) cholesterol ('bad cholesterol') and triglycerides in the blood and to increase the amount of high-density lipoprotein (HDL) cholesterol ('good cholesterol') in the blood. Atorvastatin may also be used to decrease the amount of cholesterol and other fatty substances in the blood in children and teenagers 10 to 17 years of age who have familial heterozygous hypercholesterolemia (an inherited condition in which cholesterol cannot be removed from the body normally). Atorvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body. Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats with atorvastatin has been shown to prevent heart disease, angina (chest pain), strokes, and heart attacks. How should this medicine be used? Atorvastatin comes as a tablet and suspension (liquid) to take by mouth. The tablet is usually taken once a day with or without food. The suspension is usually taken once a day on an empty stomach (at least 1 hour before or 2 hours after a meal).Take atorvastatin at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take atorvastatin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor may start you on a low dose of atorvastatin and gradually increase your dose, not more than once every 2 to 4 weeks. If you are taking the suspension, do not use a household spoon to measure your dose. Use a properly marked measuring device such as a medicine spoon or oral syringe. Ask your doctor or pharmacist if you need help getting or using a measuring device. Continue to take atorvastatin even if you feel well. Do not stop taking atorvastatin without talking to your doctor. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking atorvastatin, tell your doctor and pharmacist if you are allergic to atorvastatin, any other medications, or any of the ingredients in atorvastatin tablets and suspension. Ask your pharmacist for a list of the ingredients. Tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking atorvastatin. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. The following nonprescription products may interact with atorvastatin: cimetidine (Tagamet), and niacin. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking atorvastatin. Do not start any of these medications while taking atorvastatin without discussing with your healthcare provider. tell your doctor if you have or ever had liver disease. Your doctor will order laboratory tests to see how well your liver is working even if you do not think you have liver disease. Your doctor will probably tell you not to take atorvastatin if you have liver disease or if the tests show you may be developing liver disease. tell your doctor if you drink more than 2 alcoholic beverages daily, if you are 65 years of age or older, and if you have or have ever had muscle aches or weakness, diabetes, seizures, low blood pressure, or thyroid or kidney disease. tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while taking atorvastatin, stop taking atorvastatin and call your doctor immediately. Atorvastatin may harm the fetus. tell your doctor if you are breastfeeding or plan to breastfeed. You should not breastfeed while you are taking this medication. if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking atorvastatin. If you are hospitalized due to serious injury or infection, tell the doctor who treats you that you are taking atorvastatin. ask your doctor about the safe use of alcoholic beverages while you are taking atorvastatin. Alcohol can increase the risk of serious side effects. What special dietary instructions should I follow? Eat a low-fat, low-cholesterol diet. Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. You can also visit the National Cholesterol Education Program (NCEP) website for additional dietary information at https://www.nhlbi.nih.gov/health/public/heart/chol/chol_tlc.pdf. Avoid drinking large amounts [more than 1.2 liter (approximately 1 quart) per day] of grapefruit juice while taking atorvastatin. What should I do if I forget a dose? If you miss a dose of the tablet, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. If you miss a dose of the suspension, take the missed dose as soon as you remember it. However, if it is less than 12 hours until your next scheduled dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? Atorvastatin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: diarrhea heartburn gas joint pain forgetfulness or memory loss confusion Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor or get emergency medical help immediately: muscle pain, tenderness, or weakness lack of energy fever chest pain nausea extreme tiredness weakness unusual bleeding or bruising loss of appetite pain in the upper right part of the stomach flu-like symptoms dark colored urine yellowing of the skin or eyes hoarseness https://medlineplus.gov/druginfo/meds/a600045.html",Medical,Fact Finding,Q&A "ONLY USE THE DATA I PROVIDE Limit your response to 500 words Organize the response in a FAQs document If you cannot answer using the contexts alone, say ""I cannot determine the answer to that due to lack of context""","According to this document, what are the minimum rights that must be guaranteed with regard to employee working hours and conditions?","**Responsible Supplier Policy Background** Virgin Atlantic is a purpose led company and we believe that everyone can take on the world. It underpins everything we do and drives us to do better for our planet, people, customers and communities. As an airline, we know we must lead from the front. Responsibly bringing the benefits of travel, connectivity and exploration to the communities and customers we serve. For us that means tackling our carbon footprint, championing inclusion and being an advocate for change. We work with suppliers who share our values and, like us, see business as a force for good. Ensuring that the products and services we buy are sourced as sustainably as possible, with partners that innovate to improve practices, drive positive impact and bring economic and societal benefits. • Sourcing goods and services in a way that treats the people we work with (directly and indirectly) with respect and dignity • Supporting practices that minimise damage to the environment and natural resources on which we all depend • Promote positive animal welfare standards. Choosing who we work with matters. This policy sets out the standards we adhere to at Virgin Atlantic and that we expect our suppliers to comply with too. Based on best-in-class and internationally agreed standards to reduce our environmental impact, ensure basic human rights and protect animal welfare. Our commitment At Virgin Atlantic, our people with responsibility for procurement and supplier management put sustainable procurement practices at the heart of everything they do. The sustainability criteria outlined in this policy are built into our procurement process, from sourcing and selection to contract award and ongoing contract management. Over time these will increasingly become a prerequisite for all our suppliers. We encourage all suppliers to proactively work to improve practices in relation to these principles, in order to secure new and ongoing contracts with us. We know it’s not always straightforward, but we do expect openness and transparency in our relationships with our suppliers. We support continuous improvement with suppliers who need help in any area of this policy. Ultimate responsibility for this policy is held by our Procurement Director with full endorsement by our Chief Executive Officer. Your commitment We ask our suppliers to commit to the following: • To embrace the policy and assign a senior member of the business to promote skills and compliance. • To set up a documented monitoring process to verify standards are met and continually reviewed to ensure compliance, with a process for corrective actions to be set up and followed through. • To look to impose a policy of similar or higher standards on their own supply chains, including any sub-contractors they work with. The expectation is that each supplier in the supply chain will monitor their own compliance with a view that Virgin Atlantic or Virgin Atlantic Holidays will be able to meaningfully audit any tier in the chain if this is required. • To make their workforce (including those not directly employed by the Supplier i.e. agency staff, contractors and subcontractors) aware of the policy or the supplier’s own policy, if this is to a higher standard, and provide them with the appropriate training and skills to continually improve the supply chain. Minimum requirements We expect all suppliers to meet all requirements in this section. For some suppliers, certain certifications or standards may be minimum requirements (see following sections) and these would be communicated by the contract owner. People • Suppliers should provide safe and fair working conditions for their employees. Standards should, at a minimum, meet national laws. • Suppliers must not use child labour defined as anyone under 15 years of age, or as stipulated in the International Labour Organisation (ILO) C138 Minimum Age Convention. • There is no forced, bonded or compulsory labour. • Workers are not required to lodge ’deposits’ or their identity papers with their employer and are free to leave their employer after reasonable notice. • The company shall respect the right of personnel to a living wage and ensure that wages paid for a normal work week shall always meet at least legal or industry minimum standards and shall be sufficient to meet the basic needs of personnel and to provide some discretionary income. • All workers shall be provided with written and understandable information about their employment conditions before they enter employment. • Employees should be allowed freedom of association and the right to collective bargaining. Where the law restricts freedom of association and collective bargaining, employers should facilitate alternative means of representation by staff. • Employees working hours should comply with national laws and industry standards at a minimum. They should have at least 1 day off in 7 on average, and overtime should be voluntary and comply with local working law legislation. Employees should also be given regular breaks. • Working conditions must be safe and hygienic (bearing in mind any hazards specific to that industry), with access to clean toilets and water for drinking and washing. There should also be access to medical care when needed. • Employees should receive regular health and safety training and guidance, with clear health and safety procedures for all staff in the workplace, including those specific to their role. A senior representative should hold responsibility for the health and safety of all staff, including emergency procedures, and all accidents should be logged. • Accommodation, where provided, shall be clean, safe, and meet the basic needs of the workers. • Employees should not be submitted to harsh or inhumane treatment and all disciplinary procedures should be held on record. • Employees should not suffer discrimination in employment on any grounds including but not limited to: gender, race, age, disability, religion, political affiliation, sexual orientation, medical condition or freedom of association. Environment • Suppliers should comply with local and national environmental legislation. • Suppliers should monitor and reduce the environmental impacts of their business including: o Reducing fossil energy and fuel use, electricity use, and associated greenhouse gas emissions. o Reducing and recycling waste. o Ensuring responsible water management, including water saving measures and protection of supply of clean water to communities where these are affected by supplier operations. o Minimising the use of environmentally damaging chemicals and ensuring responsible disposal to prevent pollution of land and water sources. o Preventing negative business impacts on forests, land use, biodiversity and wild life, and ensuring high-value native eco-systems are maintained. Animal Welfare Suppliers of tourist attractions or hotels featuring animals should avoid any form of animal neglect or cruelty and fully adhere to the minimum standards set out in the ABTA Global Guidelines for Animal Welfare. Business Ethics We have a strict anti-bribery policy and expect our suppliers to uphold high standards of integrity, transparency and governance. At a minimum we expect suppliers: • To comply with all relevant local laws and regulations. • Not to be associated with any group that supports acts of violence or terrorism. • Not to offer, promise, give or receive any bribe or kickback and/or other improper advantage to or from any person, customer or supplier. • Not to make nor offer, directly or indirectly, any payment, gift or other advantage to a Foreign Public Official with the intention of influencing them and obtaining or retaining an advantage in the conduct of business. • To adhere to our anti-facilitation of tax evasion policy and not engage in any activity, practice or conduct which would cause an offence to be committed relating to the prevention of tax evasion and/or the facilitation of tax evasion under the Criminal Finances Act 2017. Priority working practices As part of our relationship with our suppliers there are priority areas of improvement that we want our suppliers to incorporate in support of doing ongoing business together. People • Suppliers should take responsibility for the local community they operate in, maximising social and economic benefits to the local community and minimising negative impacts. • Where medical conditions such as HIV / AIDS, malaria, hepatitis B etc. are a significant issue, employers should raise awareness to their employees on the risks of these medical conditions and assist in providing access to education, treatment and medication where possible. Employers should not subject employees to mandatory testing or ask employees to disclose their medical status. • Employers should not subject employees to mandatory pregnancy or virginity testing or questioning. Environment • Suppliers should have an environmental management system in place, whereby relevant, material environmental impacts are monitored and steps are taken to significantly reduce these. • For all onboard products, suppliers should help us to minimise fuel use and carbon emissions by providing us with lightweight products and packaging (without detriment to the safety or security of that product). • Suppliers should consider the full life cycle of products during design and packaging by aiming to (in order): o Reduce material, to reduce both weight and waste o Source all materials from sustainable, renewable or recycled sources. o Provide durable products that allow for re-use wherever possible o Ensure material can be recycled (providing clear labelling to show the recycling route) • Suppliers should remove or reduce all single use items wherever possible (including, but not limited to plastics), and where alternative materials are used they should come from recycled or otherwise verified sustainable sources. • Suppliers are required to ensure products associated with high rainforest destruction risk (i.e., made from, or consisting of, beef, leather, paper, wood, soy, palm oil or biofuels) are responsibly sourced through transparent supply chains with the appropriate independent certification. • All goods and services should be as resource efficient as possible, e.g. energy efficient lighting and appliances, fuel efficient, hybrid or electriccars, renewable electricity or low water use appliances. • Suppliers should help us reduce the carbon footprint of our products through effective management and reduction of their own carbon footprint through: o Utilising efficient manufacturing processes, and by using materials which do not require excessive energy to extract or produce. o Using local suppliers and running efficient logistical systems that reduce transport of our customers, staff and products as far as possible, to reduce both carbon emissions and local air pollution. o Responsible waste reductions and recycling within their business.","{Query} ========== According to this document, what are the minimum rights that must be guaranteed with regard to employee working hours and conditions? {Task Instructions} ========== ONLY USE THE DATA I PROVIDE Limit your response to 500 words Organize the response in a FAQs document If you cannot answer using the contexts alone, say ""I cannot determine the answer to that due to lack of context"" {Text Passage} ========== **Responsible Supplier Policy Background** Virgin Atlantic is a purpose led company and we believe that everyone can take on the world. It underpins everything we do and drives us to do better for our planet, people, customers and communities. As an airline, we know we must lead from the front. Responsibly bringing the benefits of travel, connectivity and exploration to the communities and customers we serve. For us that means tackling our carbon footprint, championing inclusion and being an advocate for change. We work with suppliers who share our values and, like us, see business as a force for good. Ensuring that the products and services we buy are sourced as sustainably as possible, with partners that innovate to improve practices, drive positive impact and bring economic and societal benefits. • Sourcing goods and services in a way that treats the people we work with (directly and indirectly) with respect and dignity • Supporting practices that minimise damage to the environment and natural resources on which we all depend • Promote positive animal welfare standards. Choosing who we work with matters. This policy sets out the standards we adhere to at Virgin Atlantic and that we expect our suppliers to comply with too. Based on best-in-class and internationally agreed standards to reduce our environmental impact, ensure basic human rights and protect animal welfare. Our commitment At Virgin Atlantic, our people with responsibility for procurement and supplier management put sustainable procurement practices at the heart of everything they do. The sustainability criteria outlined in this policy are built into our procurement process, from sourcing and selection to contract award and ongoing contract management. Over time these will increasingly become a prerequisite for all our suppliers. We encourage all suppliers to proactively work to improve practices in relation to these principles, in order to secure new and ongoing contracts with us. We know it’s not always straightforward, but we do expect openness and transparency in our relationships with our suppliers. We support continuous improvement with suppliers who need help in any area of this policy. Ultimate responsibility for this policy is held by our Procurement Director with full endorsement by our Chief Executive Officer. Your commitment We ask our suppliers to commit to the following: • To embrace the policy and assign a senior member of the business to promote skills and compliance. • To set up a documented monitoring process to verify standards are met and continually reviewed to ensure compliance, with a process for corrective actions to be set up and followed through. • To look to impose a policy of similar or higher standards on their own supply chains, including any sub-contractors they work with. The expectation is that each supplier in the supply chain will monitor their own compliance with a view that Virgin Atlantic or Virgin Atlantic Holidays will be able to meaningfully audit any tier in the chain if this is required. • To make their workforce (including those not directly employed by the Supplier i.e. agency staff, contractors and subcontractors) aware of the policy or the supplier’s own policy, if this is to a higher standard, and provide them with the appropriate training and skills to continually improve the supply chain. Minimum requirements We expect all suppliers to meet all requirements in this section. For some suppliers, certain certifications or standards may be minimum requirements (see following sections) and these would be communicated by the contract owner. People • Suppliers should provide safe and fair working conditions for their employees. Standards should, at a minimum, meet national laws. • Suppliers must not use child labour defined as anyone under 15 years of age, or as stipulated in the International Labour Organisation (ILO) C138 Minimum Age Convention. • There is no forced, bonded or compulsory labour. • Workers are not required to lodge ’deposits’ or their identity papers with their employer and are free to leave their employer after reasonable notice. • The company shall respect the right of personnel to a living wage and ensure that wages paid for a normal work week shall always meet at least legal or industry minimum standards and shall be sufficient to meet the basic needs of personnel and to provide some discretionary income. • All workers shall be provided with written and understandable information about their employment conditions before they enter employment. • Employees should be allowed freedom of association and the right to collective bargaining. Where the law restricts freedom of association and collective bargaining, employers should facilitate alternative means of representation by staff. • Employees working hours should comply with national laws and industry standards at a minimum. They should have at least 1 day off in 7 on average, and overtime should be voluntary and comply with local working law legislation. Employees should also be given regular breaks. • Working conditions must be safe and hygienic (bearing in mind any hazards specific to that industry), with access to clean toilets and water for drinking and washing. There should also be access to medical care when needed. • Employees should receive regular health and safety training and guidance, with clear health and safety procedures for all staff in the workplace, including those specific to their role. A senior representative should hold responsibility for the health and safety of all staff, including emergency procedures, and all accidents should be logged. • Accommodation, where provided, shall be clean, safe, and meet the basic needs of the workers. • Employees should not be submitted to harsh or inhumane treatment and all disciplinary procedures should be held on record. • Employees should not suffer discrimination in employment on any grounds including but not limited to: gender, race, age, disability, religion, political affiliation, sexual orientation, medical condition or freedom of association. Environment • Suppliers should comply with local and national environmental legislation. • Suppliers should monitor and reduce the environmental impacts of their business including: o Reducing fossil energy and fuel use, electricity use, and associated greenhouse gas emissions. o Reducing and recycling waste. o Ensuring responsible water management, including water saving measures and protection of supply of clean water to communities where these are affected by supplier operations. o Minimising the use of environmentally damaging chemicals and ensuring responsible disposal to prevent pollution of land and water sources. o Preventing negative business impacts on forests, land use, biodiversity and wild life, and ensuring high-value native eco-systems are maintained. Animal Welfare Suppliers of tourist attractions or hotels featuring animals should avoid any form of animal neglect or cruelty and fully adhere to the minimum standards set out in the ABTA Global Guidelines for Animal Welfare. Business Ethics We have a strict anti-bribery policy and expect our suppliers to uphold high standards of integrity, transparency and governance. At a minimum we expect suppliers: • To comply with all relevant local laws and regulations. • Not to be associated with any group that supports acts of violence or terrorism. • Not to offer, promise, give or receive any bribe or kickback and/or other improper advantage to or from any person, customer or supplier. • Not to make nor offer, directly or indirectly, any payment, gift or other advantage to a Foreign Public Official with the intention of influencing them and obtaining or retaining an advantage in the conduct of business. • To adhere to our anti-facilitation of tax evasion policy and not engage in any activity, practice or conduct which would cause an offence to be committed relating to the prevention of tax evasion and/or the facilitation of tax evasion under the Criminal Finances Act 2017. Priority working practices As part of our relationship with our suppliers there are priority areas of improvement that we want our suppliers to incorporate in support of doing ongoing business together. People • Suppliers should take responsibility for the local community they operate in, maximising social and economic benefits to the local community and minimising negative impacts. • Where medical conditions such as HIV / AIDS, malaria, hepatitis B etc. are a significant issue, employers should raise awareness to their employees on the risks of these medical conditions and assist in providing access to education, treatment and medication where possible. Employers should not subject employees to mandatory testing or ask employees to disclose their medical status. • Employers should not subject employees to mandatory pregnancy or virginity testing or questioning. Environment • Suppliers should have an environmental management system in place, whereby relevant, material environmental impacts are monitored and steps are taken to significantly reduce these. • For all onboard products, suppliers should help us to minimise fuel use and carbon emissions by providing us with lightweight products and packaging (without detriment to the safety or security of that product). • Suppliers should consider the full life cycle of products during design and packaging by aiming to (in order): o Reduce material, to reduce both weight and waste o Source all materials from sustainable, renewable or recycled sources. o Provide durable products that allow for re-use wherever possible o Ensure material can be recycled (providing clear labelling to show the recycling route) • Suppliers should remove or reduce all single use items wherever possible (including, but not limited to plastics), and where alternative materials are used they should come from recycled or otherwise verified sustainable sources. • Suppliers are required to ensure products associated with high rainforest destruction risk (i.e., made from, or consisting of, beef, leather, paper, wood, soy, palm oil or biofuels) are responsibly sourced through transparent supply chains with the appropriate independent certification. • All goods and services should be as resource efficient as possible, e.g. energy efficient lighting and appliances, fuel efficient, hybrid or electriccars, renewable electricity or low water use appliances. • Suppliers should help us reduce the carbon footprint of our products through effective management and reduction of their own carbon footprint through: o Utilising efficient manufacturing processes, and by using materials which do not require excessive energy to extract or produce. o Using local suppliers and running efficient logistical systems that reduce transport of our customers, staff and products as far as possible, to reduce both carbon emissions and local air pollution. o Responsible waste reductions and recycling within their business.",Unknown,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","My weight has gotten out of control ever since I had my daughter. I'm considering gastric bypass surgery. I know that there are risks with every surgery. Summarize what the procedure entails, the risks, how it impacts nutrients and compares to other options.","Roux-en-Y gastric bypass involves creating a small gastric pouch, about the size of an egg, by stapling off the upper section of the stomach and then attaching it to a section of the intestines called the Roux limb. Simply put, this procedure both reshapes the stomach and reroutes the intestines by bypassing a large portion of the small intestine. This procedure promotes weight loss because it… Reduces the amount of food that your stomach can hold Limits the number of calories and nutrients that your body can absorb Changes your gut hormones affecting both appetite and intake Research also shows that the average weight loss associated with the Roux-en-Y gastric bypass is about 70% excess weight, which is about 10% higher than the average weight loss associated with the gastric sleeve. The total amount of weight you lose depends on your type of surgery and the changes you make in your lifestyle habits. Medical benefits of gastric bypass surgery [box] Gastric bypass can help you to reduce your risk of obesity-related health problems including… Gastroesophageal reflux disease Heart disease High blood pressure High cholesterol Hyperlipidemia Relief of musculoskeletal pain Obstructive sleep apnea Type 2 diabetes Stroke Cancer Infertility So, you might be thinking that these medical benefits sound similar to those related to other bariatric surgeries… and you would be right. However, one noted difference in Roux-en-Y gastric bypass is related to the amount of time it takes to see results. Research published in the Texas Heart Institute Journal reveals that it is possible for the blood sugar of a diabetic patient to return to normal following Roux-en-Y gastric bypass before substantial weight loss takes place. It is estimated that approximately 40% of obese patients with type 2 diabetes go into remission within days or weeks after Roux-en-Y Gastric Bypass. So, what about the financial benefits related to bariatric surgery? It’s possible that the high upfront cost of bariatric surgery can be intimidating, but research shows that it can be worth it in the long run (or actually a shorter run than you might think). One study published in the Obesity Reviews reveals that obesity alone, without any other related diseases or conditions, can cost an additional $1723 dollars a year. If you are thinking that isn’t a lot of money… Just wait until you factor in other conditions like diabetes. A study published by the Obesity Society estimated the yearly cost for managing diabetes is about $13,243 dollars. Now that’s a significant amount of money. Historically for bariatric surgery patients, the initial investment averaged about $29,000 for open surgeries in 2004-2007 and $19,000 for laparoscopic surgeries in 2004-2007. Results from a study published by Surgery for Obesity and Related Diseases found that 1 year after bariatric surgery the improvement in the quality of life was similar between the Sleeve Gastrectomy and Gastric Bypass. However, this study found a greater increase in physical functioning after Roux-en-Y Gastric Bypass. Short-term Complications of Gastric Bypass or abdominal surgery can include: Excessive bleeding Infection Adverse reactions to anesthesia Blood clots Perforation Stricture Lung or breathing problems Leaks in your gastrointestinal system Long-Term Complications of Gastric Bypass can include: Bowel obstruction Dumping syndrome Gallstones Hernias Low blood sugar Malnutrition/Nutrient Deficiencies Stomach perforation Ulcers Vomiting One study published by the NCBI found that anywhere from 3% to 20% of patients following Roux-en-Y Gastric Bypass had Long-term complications that could require reoperation. Due to the nature of the surgery and how it impacts absorption of nutrients it is important to be aware of Nutrient Deficiencies that can occur.","""================ ======= Roux-en-Y gastric bypass involves creating a small gastric pouch, about the size of an egg, by stapling off the upper section of the stomach and then attaching it to a section of the intestines called the Roux limb. Simply put, this procedure both reshapes the stomach and reroutes the intestines by bypassing a large portion of the small intestine. This procedure promotes weight loss because it… Reduces the amount of food that your stomach can hold Limits the number of calories and nutrients that your body can absorb Changes your gut hormones affecting both appetite and intake Research also shows that the average weight loss associated with the Roux-en-Y gastric bypass is about 70% excess weight, which is about 10% higher than the average weight loss associated with the gastric sleeve. The total amount of weight you lose depends on your type of surgery and the changes you make in your lifestyle habits. Medical benefits of gastric bypass surgery [box] Gastric bypass can help you to reduce your risk of obesity-related health problems including… Gastroesophageal reflux disease Heart disease High blood pressure High cholesterol Hyperlipidemia Relief of musculoskeletal pain Obstructive sleep apnea Type 2 diabetes Stroke Cancer Infertility So, you might be thinking that these medical benefits sound similar to those related to other bariatric surgeries… and you would be right. However, one noted difference in Roux-en-Y gastric bypass is related to the amount of time it takes to see results. Research published in the Texas Heart Institute Journal reveals that it is possible for the blood sugar of a diabetic patient to return to normal following Roux-en-Y gastric bypass before substantial weight loss takes place. It is estimated that approximately 40% of obese patients with type 2 diabetes go into remission within days or weeks after Roux-en-Y Gastric Bypass. So, what about the financial benefits related to bariatric surgery? It’s possible that the high upfront cost of bariatric surgery can be intimidating, but research shows that it can be worth it in the long run (or actually a shorter run than you might think). One study published in the Obesity Reviews reveals that obesity alone, without any other related diseases or conditions, can cost an additional $1723 dollars a year. If you are thinking that isn’t a lot of money… Just wait until you factor in other conditions like diabetes. A study published by the Obesity Society estimated the yearly cost for managing diabetes is about $13,243 dollars. Now that’s a significant amount of money. Historically for bariatric surgery patients, the initial investment averaged about $29,000 for open surgeries in 2004-2007 and $19,000 for laparoscopic surgeries in 2004-2007. Results from a study published by Surgery for Obesity and Related Diseases found that 1 year after bariatric surgery the improvement in the quality of life was similar between the Sleeve Gastrectomy and Gastric Bypass. However, this study found a greater increase in physical functioning after Roux-en-Y Gastric Bypass. Short-term Complications of Gastric Bypass or abdominal surgery can include: Excessive bleeding Infection Adverse reactions to anesthesia Blood clots Perforation Stricture Lung or breathing problems Leaks in your gastrointestinal system Long-Term Complications of Gastric Bypass can include: Bowel obstruction Dumping syndrome Gallstones Hernias Low blood sugar Malnutrition/Nutrient Deficiencies Stomach perforation Ulcers Vomiting One study published by the NCBI found that anywhere from 3% to 20% of patients following Roux-en-Y Gastric Bypass had Long-term complications that could require reoperation. Due to the nature of the surgery and how it impacts absorption of nutrients it is important to be aware of Nutrient Deficiencies that can occur. https://www.barilife.com/blog/pros-and-cons-of-gastric-bypass/ ================ ======= My weight has gotten out of control ever since I had my daughter. I'm considering gastric bypass surgery. I know that there are risks with every surgery. Summarize what the procedure entails, the risks, how it impacts nutrients and compares to other options. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Pros & Cons,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","I have an idea for a new product but I need a manufacturer to produce it for me. How do I know someone won't steal my idea, and what kinds of failsafe should I have in place in case they do try to steal my idea?","How does using an NDA with U.S. manufacturers protect your idea? The NDA or no disclosure agreement is a promise to keep your idea secret. They can’t file a patent application because it would publish as a patent or pre-grant publication. They can’t market your invention. These would all be considered a breach of the NDA. But, how do you get manufacturers to sign the NDA? Early on during the conversation, don’t ask the manufacturer to sign a nondisclosure agreement. That will put them on the defensive. They’ll just reject you. Most companies won’t want to sign a non-disclosure agreement immediately. NDAs are viewed as an invitation to a lawsuit since they require them to keep your information confidential. If there is even an appearance of a breach, they are afraid that you will sue them. Rather, a better approach is to see if, in general, they can make your product. Talk about generic matters first. You and the manufacturer can get a feel for each other first to see if you’re a good fit. After a while, you’ll come to a point where you need to share your idea with them. You’ve done your due diligence and you believe that this manufacturer might be a good fit for you. They’ll also want to hear your idea so that they can gain your business. It’s at this point that you should ask them to sign a non-disclosure agreement. How does using an NNN agreement with Chinese manufacturers protect your idea? The NNN agreement works in the same way as the NDA to protect your idea. The Chinese manufacturer is agreeing to protect your idea. But, how do you get a Chinese manufacturer to sign an NDA? First, don’t call it an NDA. Just ask them to sign an NNN agreement which stands for non-disclosure, non-compete, and non-use. It’s their version of the NDA. Because of that, you’ll get less pushback from manufacturers in China since they’re used to signing these agreements. Click here to download a sample NNN Agreement. How does using multiple manufacturers prevent your manufacturers from stealing your idea? You could split up the production of your product amongst 2 or more manufacturers. This only works if your product has multiple components. In this way, no one manufacturer would know what the product is and don’t have all of the information to steal the idea from you. How does documenting your idea prevents a manufacturer from stealing your idea? You should document your idea to protect yourself against the manufacturer. The document we are referring to is an inventor’s notebook. It’s typically a dated running log of your ideas in a bound book. By documenting your ideas in an inventor’s notebook, you can establish which ideas are yours. If the manufacturer claims an idea is theirs, you can prove that you already had that idea by showing them your inventor’s notebook. Let’s see how this plays out in a typical scenario. You’ve done your due diligence and selected a manufacturer. You’ve entered into a nondisclosure agreement then you tell the manufacturer about your idea. As you and the manufacturer brainstorm how to make the product, the manufacturer suggests a feature for the product. They claim that feature as their own. Does that feature belong to the manufacturer? Or do you own the intellectual property? That’s the dispute between the manufacturer and you. By showing them your inventor’s notebook, you can show the manufacturer that you already thought of that feature. You can establish that the feature already belongs to you. The manufacturer might argue that you fabricated the document after the fact. However, it’s harder to do with a running logbook that’s dated. How a patent application prevents your manufacturer from stealing your idea? The patent application provides further proof that you invented a particular idea. In the event the manufacturer suggests a feature for your product, the patent application establishes that feature as your own if it’s already in there. They can’t argue that you fabricated the document after the fact because the USPTO establishes the filing date of that document. How a patent prevents your manufacturer from stealing your idea? A design patent can prevent your manufacturer from using the molds that you paid for to make and sell products to others. If they use your molds, those products would be infringing on your design patent. You can sue them for patent infringement. Moreover, if you get a utility patent, the manufacturer can’t infringe on your utility patent. Otherwise, you would sue them for patent infringement. In order to more effectively protect yourself against manufacturers, the final agreement between you and the manufacturer should include an assignment of all inventions that they come up with while they are working on your project. For example, if they came up with a feature that you like, you should be able to get a patent for that. After all, you paid them money to make products for you. You can read more about this in: Nondisclosure Agreements and other basic agreements.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I have an idea for a new product but I need a manufacturer to produce it for me. How do I know someone won't steal my idea, and what kinds of failsafe should I have in place in case they do try to steal my idea? {passage 0} ========== How does using an NDA with U.S. manufacturers protect your idea? The NDA or no disclosure agreement is a promise to keep your idea secret. They can’t file a patent application because it would publish as a patent or pre-grant publication. They can’t market your invention. These would all be considered a breach of the NDA. But, how do you get manufacturers to sign the NDA? Early on during the conversation, don’t ask the manufacturer to sign a nondisclosure agreement. That will put them on the defensive. They’ll just reject you. Most companies won’t want to sign a non-disclosure agreement immediately. NDAs are viewed as an invitation to a lawsuit since they require them to keep your information confidential. If there is even an appearance of a breach, they are afraid that you will sue them. Rather, a better approach is to see if, in general, they can make your product. Talk about generic matters first. You and the manufacturer can get a feel for each other first to see if you’re a good fit. After a while, you’ll come to a point where you need to share your idea with them. You’ve done your due diligence and you believe that this manufacturer might be a good fit for you. They’ll also want to hear your idea so that they can gain your business. It’s at this point that you should ask them to sign a non-disclosure agreement. How does using an NNN agreement with Chinese manufacturers protect your idea? The NNN agreement works in the same way as the NDA to protect your idea. The Chinese manufacturer is agreeing to protect your idea. But, how do you get a Chinese manufacturer to sign an NDA? First, don’t call it an NDA. Just ask them to sign an NNN agreement which stands for non-disclosure, non-compete, and non-use. It’s their version of the NDA. Because of that, you’ll get less pushback from manufacturers in China since they’re used to signing these agreements. Click here to download a sample NNN Agreement. How does using multiple manufacturers prevent your manufacturers from stealing your idea? You could split up the production of your product amongst 2 or more manufacturers. This only works if your product has multiple components. In this way, no one manufacturer would know what the product is and don’t have all of the information to steal the idea from you. How does documenting your idea prevents a manufacturer from stealing your idea? You should document your idea to protect yourself against the manufacturer. The document we are referring to is an inventor’s notebook. It’s typically a dated running log of your ideas in a bound book. By documenting your ideas in an inventor’s notebook, you can establish which ideas are yours. If the manufacturer claims an idea is theirs, you can prove that you already had that idea by showing them your inventor’s notebook. Let’s see how this plays out in a typical scenario. You’ve done your due diligence and selected a manufacturer. You’ve entered into a nondisclosure agreement then you tell the manufacturer about your idea. As you and the manufacturer brainstorm how to make the product, the manufacturer suggests a feature for the product. They claim that feature as their own. Does that feature belong to the manufacturer? Or do you own the intellectual property? That’s the dispute between the manufacturer and you. By showing them your inventor’s notebook, you can show the manufacturer that you already thought of that feature. You can establish that the feature already belongs to you. The manufacturer might argue that you fabricated the document after the fact. However, it’s harder to do with a running logbook that’s dated. How a patent application prevents your manufacturer from stealing your idea? The patent application provides further proof that you invented a particular idea. In the event the manufacturer suggests a feature for your product, the patent application establishes that feature as your own if it’s already in there. They can’t argue that you fabricated the document after the fact because the USPTO establishes the filing date of that document. How a patent prevents your manufacturer from stealing your idea? A design patent can prevent your manufacturer from using the molds that you paid for to make and sell products to others. If they use your molds, those products would be infringing on your design patent. You can sue them for patent infringement. Moreover, if you get a utility patent, the manufacturer can’t infringe on your utility patent. Otherwise, you would sue them for patent infringement. In order to more effectively protect yourself against manufacturers, the final agreement between you and the manufacturer should include an assignment of all inventions that they come up with while they are working on your project. For example, if they came up with a feature that you like, you should be able to get a patent for that. After all, you paid them money to make products for you. You can read more about this in: Nondisclosure Agreements and other basic agreements. https://ocpatentlawyer.com/how-to-prevent-your-manufacturer-from-stealing-your-idea/",Legal,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Which one of these should I buy? Money is no object, but fuel efficiency and range are critical to me. Give me enough detail to make a really informed decision.","Here's Every New Electric Vehicle Model for Sale in the U.S. Electric vehicles make up a small percentage of the total automotive market today, but their appeal continues to grow as the automakers expand their range, performance, and style—and as recharging becomes quicker and easier. Shoppers looking for zero-emissions driving now have an expansive list of vehicles to choose from, with a wide variety of body styles and several different price points. Audi e-tron GT 2024 audi rs etron gtAudi Audi's take on the Porsche Taycan bears the name e-tron GT. Sharing its key mechanical bits with Porsche's electric sedan, the e-tron GT wears distinct bodywork and interior decor. Two flavors of Audi's low-slung EV are available: standard e-tron GT and rowdy RS e-tron GT. Both come exclusively with all-wheel drive, courtesy of an electric motor at each axle, and a 93.4-kWh battery pack. The two electric motors in the entry-level e-tron GT work together to produce a combined peak of 522 horsepower, while the RS e-tron GT ups the ante to 637 ponies. Regardless of trim, both variants of Audi's low-slung electric sedan net 249 miles of EPA-estimated range for 2024. Base price: $107,995 EPA fuel economy, combined/city/highway: 85/85/85 MPGe EPA combined range: 249 miles LEARN MORE ABOUT THE E-TRON GT Audi Q4 e-tron 2022 audi q4 50 etron quattro prestigeAudi Bearing the name Q4 e-tron, this Audi compact electric SUV shares components with the Volkswagen ID.4. Befitting its reputation, the four-ringed brand's battery-electric SUV is notably swankier than its more mainstream VW cousin. Rear-drive comes standard, however, all-wheel-drive is optionally available. A 77.0-kWh lithium-ion battery pack affords up to 265 miles of EPA-rated driving range. Those looking for a bit of extra style can opt for the Q4 e-tron Sportback is the fastback equivalent to the brand's squareback Q4 e-tron. Unlike its squarer stablemate, though, the Sportback comes exclusively with all-wheel drive. There's no cheaper and more efficient rear-driver option here. Though the dual-motor setup is more powerful than the single-motor of the entry-level Q4 e-tron squareback, it's also a good deal less efficient. As such, the Sportback's 95 MPGe combined rating is down 8 MPGe to the most efficient Q4 e-tron squareback. Base price: $50,995 EPA fuel economy, combined/city/highway: 103/112/94 MPGe EPA combined range: 265 miles LEARN MORE ABOUT THE Q4 E-TRON Advertisement - Continue Reading Below Audi Q8 e-tron 2024 audi q8 and sq8 etronaudi Last year's Audi e-tron SUV becomes the Q8 e-tron for 2024. A sizable 95.0-kWh lithium-ion battery pack and two electric motors (one at each axle) generate a peak of 402 horsepower and 490 pound-feet of torque. Unfortunately, the Audi's 226 miles of range isn't that impressive. That said, in our testing, the Q8 e-tron hit 60 mph in 5.2 seconds, so it's at least rather quick. An even more powerful 496-hp SQ8 e-tron is also available, however, it manages a mere 73 MPGe combined and offers less range than the standard Q8 e-tron. Audi also offers the Q8 (and SQ8) e-tron in fastback Sportback guise. Though going the Sportback route adds a few grand to the price tag, it also nets an EPA-rated range of up to 296 miles thanks to its additional efficiency. Base price: $75,595 EPA fuel economy, combined/city/highway: 81/80/83 MPGe EPA combined range: 285 miles LEARN MORE ABOUT THE Q8 E-TRON BMW i4 2022 bmw i4 electric sedan in silverBMW The BMW i4 is an electric four-door fastback available in four distinct flavors: the sensible eDrive35, the mid-level eDrive40, the dual-motor xDrive40, and the racy M50. The eDrive i4 variants pack a single rear-axle-mounted electric motor. An 80.7-kWh battery pack supplies enough electricity to take the mid-level eDrive40 more than 300 miles on a full charge, according to the EPA. Opting for the pricier all-wheel-drive i4 M50 allows this Bimmer to race to 60 mph in 3.3 seconds. Alas, the additional power of the M50 drops the i4's driving range down to an EPA-estimated 271 miles. Base price: $53,195 EPA fuel economy, combined/city/highway: 120/122/119 MPGe EPA combined range: 276 miles LEARN MORE ABOUT THE I4 Advertisement - Continue Reading Below BMW i5 2024 bmw i5BMW The i5 is the electric variant of BMW's popular 5-series sedan, and it offers a similar driving experience to its conventionally powered sibling. Two models of i5 are available: the range-optimized eDrive40 and the performance-minded M60 xDrive (a mid-level xDrive40 arrives for 2025). The cabin draws heavily from that of the larger i7, which is a good thing. If you like your electric sedans with a little extra oomph, get the M60 xDrive for its 510-horsepower dual-motor powertrain. Base price: $67,795 EPA fuel economy, combined/city/highway: 105/104/105 MPGe EPA combined range: 295 miles LEARN MORE ABOUT THE I5 BMW i7 2023 bmw i7 xdrive60BMW Flagship luxury and electric motoring converge for BMW with the introduction of the i7. Despite its size, the i7 is fairly efficient in eDrive50 guise, boasting an EPA combined rating of 90 MPGe and up to 321 miles per charge. To get to those maximums though, you’ll have to restrain yourself from ordering the optional 20- or 21-inch wheels, as either one of those reduces range and efficiency slightly. No matter which wheels you choose, you’ll find the i7 is both quick and quiet with an interior that is both plush and ultramodern. Base price: $106,695 EPA fuel economy, combined/city/highway: 90/87/95 MPGe EPA combined range: 321 miles LEARN MORE ABOUT THE I7 Advertisement - Continue Reading Below BMW iX 2022 bmw ix xdrive50 in redJessica Lynn Walker|Car and Driver The BMW iX's design may polarize, but its elegantly appointed interior is sure to impress. As is its all-wheel-drive battery-electric powertrain, which includes two electric motors (one at each axle) that produce a total of 516 horsepower in xDrive50 guise. Those in need of even more power can snag the 610 horsepower iX M60. No matter the trim, the iX packs serious dynamic performance. And yet, it's also surprisingly efficient. Its 83 MPGe combined figure helps this big SUV earn an EPA-rated range of 307 miles. Base price: $88,095 EPA fuel economy, combined/city/highway: 83/83/82 MPGe EPA combined range: 307 miles LEARN MORE ABOUT THE IX Cadillac Lyriq 2023 cadillac lyriqCadillac Cadillac’s first entry into the luxury electric SUV category is the slick-looking Lyriq. It shares its battery tech with other high-profile GM EVs, including the GMC Hummer EV pickup truck, but it wears a more upscale wardrobe. The rear-wheel-drive model offers the most range—up to 314 miles per charge. The all-wheel-drive model adds an additional electric motor to produce a combined 500 horsepower. Unlike Caddy’s sports sedans, the Lyriq’s driving demeanor takes on a more comfortable, cruising-focused feel and the quiet cabin is spacious for both people and cargo. Base price: $58,590 EPA fuel economy, combined/city/highway: 88/95/82 MPGe EPA combined range: 314 miles LEARN MORE ABOUT THE LYRIQ Chevrolet Blazer EV 2024 chevrolet blazer ev rsChevrolet Apart from being a midsize two-row Chevy SUV wearing aggressive styling, the Blazer EV shares little in common with its gas-powered relative. The Blazer EV comes in three trim levels: LT, RS, and SS. Many drivetrain combinations are available, ranging from a mild single-motor front-wheel-drive setup for the base LT to a wild 557-horsepower dual-motor all-wheel-drive fitment for the SS. Base price: $53,195 EPA fuel economy, combined/city/highway: 96/103/88 MPGe EPA combined range: 279 miles"," Only use the provided text to answer the question, no outside sources. Which one of these should I buy? Money is no object, but fuel efficiency and range are critical to me. Give me enough detail to make a really informed decision. Here's Every New Electric Vehicle Model for Sale in the U.S. Electric vehicles make up a small percentage of the total automotive market today, but their appeal continues to grow as the automakers expand their range, performance, and style—and as recharging becomes quicker and easier. Shoppers looking for zero-emissions driving now have an expansive list of vehicles to choose from, with a wide variety of body styles and several different price points. Audi e-tron GT 2024 audi rs etron gtAudi Audi's take on the Porsche Taycan bears the name e-tron GT. Sharing its key mechanical bits with Porsche's electric sedan, the e-tron GT wears distinct bodywork and interior decor. Two flavors of Audi's low-slung EV are available: standard e-tron GT and rowdy RS e-tron GT. Both come exclusively with all-wheel drive, courtesy of an electric motor at each axle, and a 93.4-kWh battery pack. The two electric motors in the entry-level e-tron GT work together to produce a combined peak of 522 horsepower, while the RS e-tron GT ups the ante to 637 ponies. Regardless of trim, both variants of Audi's low-slung electric sedan net 249 miles of EPA-estimated range for 2024. Base price: $107,995 EPA fuel economy, combined/city/highway: 85/85/85 MPGe EPA combined range: 249 miles LEARN MORE ABOUT THE E-TRON GT Audi Q4 e-tron 2022 audi q4 50 etron quattro prestigeAudi Bearing the name Q4 e-tron, this Audi compact electric SUV shares components with the Volkswagen ID.4. Befitting its reputation, the four-ringed brand's battery-electric SUV is notably swankier than its more mainstream VW cousin. Rear-drive comes standard, however, all-wheel-drive is optionally available. A 77.0-kWh lithium-ion battery pack affords up to 265 miles of EPA-rated driving range. Those looking for a bit of extra style can opt for the Q4 e-tron Sportback is the fastback equivalent to the brand's squareback Q4 e-tron. Unlike its squarer stablemate, though, the Sportback comes exclusively with all-wheel drive. There's no cheaper and more efficient rear-driver option here. Though the dual-motor setup is more powerful than the single-motor of the entry-level Q4 e-tron squareback, it's also a good deal less efficient. As such, the Sportback's 95 MPGe combined rating is down 8 MPGe to the most efficient Q4 e-tron squareback. Base price: $50,995 EPA fuel economy, combined/city/highway: 103/112/94 MPGe EPA combined range: 265 miles LEARN MORE ABOUT THE Q4 E-TRON Advertisement - Continue Reading Below Audi Q8 e-tron 2024 audi q8 and sq8 etronaudi Last year's Audi e-tron SUV becomes the Q8 e-tron for 2024. A sizable 95.0-kWh lithium-ion battery pack and two electric motors (one at each axle) generate a peak of 402 horsepower and 490 pound-feet of torque. Unfortunately, the Audi's 226 miles of range isn't that impressive. That said, in our testing, the Q8 e-tron hit 60 mph in 5.2 seconds, so it's at least rather quick. An even more powerful 496-hp SQ8 e-tron is also available, however, it manages a mere 73 MPGe combined and offers less range than the standard Q8 e-tron. Audi also offers the Q8 (and SQ8) e-tron in fastback Sportback guise. Though going the Sportback route adds a few grand to the price tag, it also nets an EPA-rated range of up to 296 miles thanks to its additional efficiency. Base price: $75,595 EPA fuel economy, combined/city/highway: 81/80/83 MPGe EPA combined range: 285 miles LEARN MORE ABOUT THE Q8 E-TRON BMW i4 2022 bmw i4 electric sedan in silverBMW The BMW i4 is an electric four-door fastback available in four distinct flavors: the sensible eDrive35, the mid-level eDrive40, the dual-motor xDrive40, and the racy M50. The eDrive i4 variants pack a single rear-axle-mounted electric motor. An 80.7-kWh battery pack supplies enough electricity to take the mid-level eDrive40 more than 300 miles on a full charge, according to the EPA. Opting for the pricier all-wheel-drive i4 M50 allows this Bimmer to race to 60 mph in 3.3 seconds. Alas, the additional power of the M50 drops the i4's driving range down to an EPA-estimated 271 miles. Base price: $53,195 EPA fuel economy, combined/city/highway: 120/122/119 MPGe EPA combined range: 276 miles LEARN MORE ABOUT THE I4 Advertisement - Continue Reading Below BMW i5 2024 bmw i5BMW The i5 is the electric variant of BMW's popular 5-series sedan, and it offers a similar driving experience to its conventionally powered sibling. Two models of i5 are available: the range-optimized eDrive40 and the performance-minded M60 xDrive (a mid-level xDrive40 arrives for 2025). The cabin draws heavily from that of the larger i7, which is a good thing. If you like your electric sedans with a little extra oomph, get the M60 xDrive for its 510-horsepower dual-motor powertrain. Base price: $67,795 EPA fuel economy, combined/city/highway: 105/104/105 MPGe EPA combined range: 295 miles LEARN MORE ABOUT THE I5 BMW i7 2023 bmw i7 xdrive60BMW Flagship luxury and electric motoring converge for BMW with the introduction of the i7. Despite its size, the i7 is fairly efficient in eDrive50 guise, boasting an EPA combined rating of 90 MPGe and up to 321 miles per charge. To get to those maximums though, you’ll have to restrain yourself from ordering the optional 20- or 21-inch wheels, as either one of those reduces range and efficiency slightly. No matter which wheels you choose, you’ll find the i7 is both quick and quiet with an interior that is both plush and ultramodern. Base price: $106,695 EPA fuel economy, combined/city/highway: 90/87/95 MPGe EPA combined range: 321 miles LEARN MORE ABOUT THE I7 Advertisement - Continue Reading Below BMW iX 2022 bmw ix xdrive50 in redJessica Lynn Walker|Car and Driver The BMW iX's design may polarize, but its elegantly appointed interior is sure to impress. As is its all-wheel-drive battery-electric powertrain, which includes two electric motors (one at each axle) that produce a total of 516 horsepower in xDrive50 guise. Those in need of even more power can snag the 610 horsepower iX M60. No matter the trim, the iX packs serious dynamic performance. And yet, it's also surprisingly efficient. Its 83 MPGe combined figure helps this big SUV earn an EPA-rated range of 307 miles. Base price: $88,095 EPA fuel economy, combined/city/highway: 83/83/82 MPGe EPA combined range: 307 miles LEARN MORE ABOUT THE IX Cadillac Lyriq 2023 cadillac lyriqCadillac Cadillac’s first entry into the luxury electric SUV category is the slick-looking Lyriq. It shares its battery tech with other high-profile GM EVs, including the GMC Hummer EV pickup truck, but it wears a more upscale wardrobe. The rear-wheel-drive model offers the most range—up to 314 miles per charge. The all-wheel-drive model adds an additional electric motor to produce a combined 500 horsepower. Unlike Caddy’s sports sedans, the Lyriq’s driving demeanor takes on a more comfortable, cruising-focused feel and the quiet cabin is spacious for both people and cargo. Base price: $58,590 EPA fuel economy, combined/city/highway: 88/95/82 MPGe EPA combined range: 314 miles LEARN MORE ABOUT THE LYRIQ Chevrolet Blazer EV 2024 chevrolet blazer ev rsChevrolet Apart from being a midsize two-row Chevy SUV wearing aggressive styling, the Blazer EV shares little in common with its gas-powered relative. The Blazer EV comes in three trim levels: LT, RS, and SS. Many drivetrain combinations are available, ranging from a mild single-motor front-wheel-drive setup for the base LT to a wild 557-horsepower dual-motor all-wheel-drive fitment for the SS. Base price: $53,195 EPA fuel economy, combined/city/highway: 96/103/88 MPGe EPA combined range: 279 miles https://www.caranddriver.com/features/g32463239/new-ev-models-us/?utm_source=google&utm_medium=cpc&utm_campaign=dda_ga_cd_ext_prog_org_us_g32463239&utm_source=google&utm_medium=cpc&utm_campaign=dda_ga_cd_md_bm_prog_org_us_20600399402&gad_source=1&gclid=CjwKCAjw_4S3BhAAEiwA_64Yhm8SAofgx5e15GZ4218GmxzQi1fBbihK5U_xLAG0ndpWd_rScc9HYRoCPJ0QAvD_BwE",Retail/Product,Concept Comparison,Q&A Any information used should come solely from the provided text. Use no outside information or prior knowledge in your response.,Provide one example of how the change in scheduling would impact low-income people.,"Legal Consequences of Rescheduling Marijuana Updated May 1, 2024 On April 30, 2024, news outlets reported that the Drug Enforcement Administration (DEA) planned to move marijuana from Schedule I to Schedule III under the Controlled Substances Act (CSA). The planned change followed an August 2023 recommendation from the Department of Health and Human Services (HHS) that DEA reschedule marijuana from Schedule I to Schedule III. Any change to the status of marijuana via the DEA rulemaking process would not take effect immediately. According to reports, the proposal will be reviewed by the White House Office of Management and Budget and will then be subject to public comment. A previous CRS Insight outlined policy considerations related to rescheduling marijuana. This Legal Sidebar provides additional information on the legal consequences of the possible move of marijuana from Schedule I to Schedule III. Current Legal Status of Cannabis Under the CSA Cannabis and its derivatives generally fall within one of two categories under federal law: marijuana or hemp. Unless an exception applies, the CSA classifies the cannabis plant and its derivatives as marijuana (some provisions of the statute use an alternative spelling, “marihuana”). The CSA definition of marijuana excludes (1) products that meet the legal definition of hemp and (2) the mature stalks of the cannabis plant; the sterilized seeds of the plant; and fibers, oils, and other products made from the stalks and seeds. Marijuana is a Schedule I controlled substance under the CSA. Federal law defines hemp as the cannabis plant or any part of that plant with a delta-9 tetrahydrocannabinol (THC) concentration of no more than 0.3%. The non-psychoactive compound cannabidiol (CBD) falls within the legal definition of hemp. Hemp is not a controlled substance under the CSA. Substances become subject to the CSA through placement in one of five lists, known as Schedules I through V. Congress placed marijuana in Schedule I in 1970 when it enacted the CSA. A lower schedule number carries greater restrictions under the CSA, with controlled substances in Schedule I subject to the most stringent controls. Schedule I controlled substances have no currently accepted medical use. It is illegal to produce, dispense, or possess such substances except in the context of federally approved Congressional Research Service https://crsreports.congress.gov LSB11105 Congressional Research Service 2 scientific studies, subject to CSA regulatory requirements designed to prevent abuse and diversion. Unauthorized activities involving Schedule I controlled substances are federal crimes that may give rise to large fines and significant jail time. DEA is required to set annual production quotas for Schedule I controlled substances manufactured for use in approved research. In addition to the general regulatory framework that applies due to marijuana’s Schedule I status, some provisions of the CSA apply specifically to marijuana. For instance, 21 U.S.C. § 841 imposes mandatory minimum prison sentences for persons convicted of criminal CSA violations involving set quantities of specific controlled substances, including marijuana. In addition, 21 U.S.C. § 823 creates special registration requirements for those who manufacture marijuana for research purposes. In sharp contrast to the stringent federal control of marijuana, in recent decades nearly all the states have changed their laws to permit the use of marijuana (or other cannabis products) for medical purposes. In addition, twenty-four states and the District of Columbia have passed laws removing certain state criminal prohibitions on recreational marijuana use by adults. As the Supreme Court has recognized, states cannot actually legalize marijuana because the states cannot change federal law, and the Constitution’s Supremacy Clause dictates that federal law takes precedence over conflicting state laws. So long as marijuana is a Schedule I controlled substance under the CSA, all unauthorized activities involving marijuana are federal crimes anywhere in the United States, including in states that have purported to legalize medical or recreational marijuana. Nonetheless, Congress has granted the states some leeway to allow the distribution and use of medical marijuana. In each budget cycle since FY2014, Congress has passed an appropriations rider barring the Department of Justice (DOJ) from using taxpayer funds to prevent states from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” Courts have interpreted the appropriations rider to prohibit federal prosecution of state-legal activities involving medical marijuana. However, it poses no bar to federal prosecution of activities involving recreational marijuana. Moreover, the rider does not remove criminal liability; it merely limits enforcement of the CSA in certain circumstances while the rider remains in effect. While official DOJ policy has varied somewhat across Administrations, recent presidential Administrations have not prioritized prosecution of state-legal activities involving marijuana. Even absent criminal prosecution or conviction, individuals and organizations engaged in marijuanarelated activities in violation of the CSA—including participants in the state-legal marijuana industry— may face collateral consequences arising from the federal prohibition of marijuana. Other federal laws impose legal consequences based on criminal activity, including violations of the CSA. For example, a financial institution handling income from a marijuana business may violate federal anti-money laundering laws. Likewise, Section 280E of the Internal Revenue Code renders marijuana businesses ineligible for certain federal tax deductions. The presence of income from a marijuana-related business may also prevent a bankruptcy court from confirming a bankruptcy plan (though courts have split on the issue). For individuals, participation in the state-legal marijuana industry may have adverse immigration consequences. Violations of the CSA may also affect individuals’ ability to receive certain federal government benefits. In addition, federal law prohibits gun ownership and possession by any person who is an “unlawful user of or addicted to any controlled substance,” with no exception for users of state-legal medical marijuana. Legal Consequences If Marijuana Moved to Schedule III Moving marijuana from Schedule I to Schedule III, without other legal changes, would not bring the state-legal medical or recreational marijuana industry into compliance with federal controlled substances law. With respect to medical marijuana, a key difference between placement in Schedule I and Schedule III is that substances in Schedule III have an accepted medical use and may lawfully be dispensed by Congressional Research Service 3 prescription, while substances in Schedule I cannot. However, prescription drugs must be approved by the Food and Drug Administration (FDA). Although FDA has approved some drugs derived from or related to cannabis, marijuana itself is not an FDA-approved drug. Moreover, if one or more marijuana products obtained FDA approval, manufacturers and distributors would need to register with DEA and comply with regulatory requirements that apply to Schedule III substances in order to handle those products. Users of medical marijuana would need to obtain valid prescriptions for the substance from medical providers, subject to federal legal requirements that differ from existing state regulatory requirements for medical marijuana. Rescheduling marijuana would not affect the medical marijuana appropriations rider. Thus, so long as the current rider remains in effect, participants in the state-legal medical marijuana industry who comply with state law would be shielded from federal prosecution. If the rider were to lapse or be repealed, these persons would again be subject to prosecution at the discretion of DOJ. With respect to the manufacture, distribution, and possession of recreational marijuana, if marijuana were moved to Schedule III, such activities would remain illegal under federal law and potentially subject to federal prosecution regardless of their status under state law. Some criminal penalties for CSA violations depend on the schedule in which a substance is classified. If marijuana were moved to Schedule III, applicable penalties for some offenses would be reduced. However, CSA penalties that apply to activities involving marijuana specifically, such as the quantitybased mandatory minimum sentences discussed above, would not change as a result of rescheduling. DEA is not required to set annual production quotas for Schedule III controlled substances. The prohibition on business deductions in Section 280E of the Internal Revenue Code applies to any trade or business that “consists of trafficking in controlled substances (within the meaning of schedule I and II of the Controlled Substances Act) which is prohibited by Federal law or the law of any State in which such trade or business is conducted.” Because the provision applies only to activities involving substances in Schedule I or II, moving marijuana from Schedule I to Schedule III would allow marijuana businesses to deduct business expenses on federal tax filings. Other collateral legal consequences would continue to attach to unauthorized marijuana-related activities. Considerations for Congress Either Congress or the executive branch has the authority to change the status of marijuana under the CSA. Congress can change the status of a controlled substance through legislation, while the CSA empowers DEA to make scheduling decisions through the notice-and-comment rulemaking process. When considering whether to schedule or reschedule a controlled substance, DEA is bound by HHS’s recommendations on scientific and medical matters. However, DEA has stated that it has “final authority to schedule, reschedule, or deschedule a drug under the Controlled Substances Act.” A proposal from the 118th Congress would provide for congressional review of DEA rescheduling decisions related to marijuana. If Congress wishes to change the legal status of marijuana, it has broad authority to do so before or after DEA makes any final scheduling decision. Several proposals from the 118th Congress would remove marijuana from control under the CSA or move the substance to a less restrictive schedule. If Congress moved marijuana to Schedule III by legislation, it could simultaneously consider whether to change some of the legal consequences of Schedule III status described above. Congress could also legislate to move marijuana to another CSA schedule, which would subject it to controls more or less stringent than those that apply to Schedule III controlled substances. Rescheduling or descheduling marijuana under the CSA could raise additional legal questions. For instance, FDA regulates certain cannabis products under the Federal Food, Drug, and Cosmetic Act, so Congressional Research Service 4 LSB11105 · VERSION 2 · UPDATED Congress might also consider whether to alter that regulatory regime or create some alternative regulatory framework. In addition, relaxing the CSA’s restrictions on marijuana could implicate the United States’ international treaty obligations. While most recent proposals would relax federal regulation of marijuana, Congress could also seek to impose more stringent controls. One proposal from the 118th Congress would withhold certain federal funds from states in which the purchase or public possession of marijuana for recreational purposes is lawful. A proposal from the 117th Congress would have prohibited the use of benefits under the Temporary Assistance for Needy Families block grant at any store that offers marijuana for sale. Other proposals from the 117th Congress sought to address the issues of workplace impairment or driving under the influence of marijuana and other substances. ","Any information used should come solely from the provided text. Use no outside information or prior knowledge in your response. Legal Consequences of Rescheduling Marijuana Updated May 1, 2024 On April 30, 2024, news outlets reported that the Drug Enforcement Administration (DEA) planned to move marijuana from Schedule I to Schedule III under the Controlled Substances Act (CSA). The planned change followed an August 2023 recommendation from the Department of Health and Human Services (HHS) that DEA reschedule marijuana from Schedule I to Schedule III. Any change to the status of marijuana via the DEA rulemaking process would not take effect immediately. According to reports, the proposal will be reviewed by the White House Office of Management and Budget and will then be subject to public comment. A previous CRS Insight outlined policy considerations related to rescheduling marijuana. This Legal Sidebar provides additional information on the legal consequences of the possible move of marijuana from Schedule I to Schedule III. Current Legal Status of Cannabis Under the CSA Cannabis and its derivatives generally fall within one of two categories under federal law: marijuana or hemp. Unless an exception applies, the CSA classifies the cannabis plant and its derivatives as marijuana (some provisions of the statute use an alternative spelling, “marihuana”). The CSA definition of marijuana excludes (1) products that meet the legal definition of hemp and (2) the mature stalks of the cannabis plant; the sterilized seeds of the plant; and fibers, oils, and other products made from the stalks and seeds. Marijuana is a Schedule I controlled substance under the CSA. Federal law defines hemp as the cannabis plant or any part of that plant with a delta-9 tetrahydrocannabinol (THC) concentration of no more than 0.3%. The non-psychoactive compound cannabidiol (CBD) falls within the legal definition of hemp. Hemp is not a controlled substance under the CSA. Substances become subject to the CSA through placement in one of five lists, known as Schedules I through V. Congress placed marijuana in Schedule I in 1970 when it enacted the CSA. A lower schedule number carries greater restrictions under the CSA, with controlled substances in Schedule I subject to the most stringent controls. Schedule I controlled substances have no currently accepted medical use. It is illegal to produce, dispense, or possess such substances except in the context of federally approved Congressional Research Service https://crsreports.congress.gov LSB11105 Congressional Research Service 2 scientific studies, subject to CSA regulatory requirements designed to prevent abuse and diversion. Unauthorized activities involving Schedule I controlled substances are federal crimes that may give rise to large fines and significant jail time. DEA is required to set annual production quotas for Schedule I controlled substances manufactured for use in approved research. In addition to the general regulatory framework that applies due to marijuana’s Schedule I status, some provisions of the CSA apply specifically to marijuana. For instance, 21 U.S.C. § 841 imposes mandatory minimum prison sentences for persons convicted of criminal CSA violations involving set quantities of specific controlled substances, including marijuana. In addition, 21 U.S.C. § 823 creates special registration requirements for those who manufacture marijuana for research purposes. In sharp contrast to the stringent federal control of marijuana, in recent decades nearly all the states have changed their laws to permit the use of marijuana (or other cannabis products) for medical purposes. In addition, twenty-four states and the District of Columbia have passed laws removing certain state criminal prohibitions on recreational marijuana use by adults. As the Supreme Court has recognized, states cannot actually legalize marijuana because the states cannot change federal law, and the Constitution’s Supremacy Clause dictates that federal law takes precedence over conflicting state laws. So long as marijuana is a Schedule I controlled substance under the CSA, all unauthorized activities involving marijuana are federal crimes anywhere in the United States, including in states that have purported to legalize medical or recreational marijuana. Nonetheless, Congress has granted the states some leeway to allow the distribution and use of medical marijuana. In each budget cycle since FY2014, Congress has passed an appropriations rider barring the Department of Justice (DOJ) from using taxpayer funds to prevent states from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” Courts have interpreted the appropriations rider to prohibit federal prosecution of state-legal activities involving medical marijuana. However, it poses no bar to federal prosecution of activities involving recreational marijuana. Moreover, the rider does not remove criminal liability; it merely limits enforcement of the CSA in certain circumstances while the rider remains in effect. While official DOJ policy has varied somewhat across Administrations, recent presidential Administrations have not prioritized prosecution of state-legal activities involving marijuana. Even absent criminal prosecution or conviction, individuals and organizations engaged in marijuanarelated activities in violation of the CSA—including participants in the state-legal marijuana industry— may face collateral consequences arising from the federal prohibition of marijuana. Other federal laws impose legal consequences based on criminal activity, including violations of the CSA. For example, a financial institution handling income from a marijuana business may violate federal anti-money laundering laws. Likewise, Section 280E of the Internal Revenue Code renders marijuana businesses ineligible for certain federal tax deductions. The presence of income from a marijuana-related business may also prevent a bankruptcy court from confirming a bankruptcy plan (though courts have split on the issue). For individuals, participation in the state-legal marijuana industry may have adverse immigration consequences. Violations of the CSA may also affect individuals’ ability to receive certain federal government benefits. In addition, federal law prohibits gun ownership and possession by any person who is an “unlawful user of or addicted to any controlled substance,” with no exception for users of state-legal medical marijuana. Legal Consequences If Marijuana Moved to Schedule III Moving marijuana from Schedule I to Schedule III, without other legal changes, would not bring the state-legal medical or recreational marijuana industry into compliance with federal controlled substances law. With respect to medical marijuana, a key difference between placement in Schedule I and Schedule III is that substances in Schedule III have an accepted medical use and may lawfully be dispensed by Congressional Research Service 3 prescription, while substances in Schedule I cannot. However, prescription drugs must be approved by the Food and Drug Administration (FDA). Although FDA has approved some drugs derived from or related to cannabis, marijuana itself is not an FDA-approved drug. Moreover, if one or more marijuana products obtained FDA approval, manufacturers and distributors would need to register with DEA and comply with regulatory requirements that apply to Schedule III substances in order to handle those products. Users of medical marijuana would need to obtain valid prescriptions for the substance from medical providers, subject to federal legal requirements that differ from existing state regulatory requirements for medical marijuana. Rescheduling marijuana would not affect the medical marijuana appropriations rider. Thus, so long as the current rider remains in effect, participants in the state-legal medical marijuana industry who comply with state law would be shielded from federal prosecution. If the rider were to lapse or be repealed, these persons would again be subject to prosecution at the discretion of DOJ. With respect to the manufacture, distribution, and possession of recreational marijuana, if marijuana were moved to Schedule III, such activities would remain illegal under federal law and potentially subject to federal prosecution regardless of their status under state law. Some criminal penalties for CSA violations depend on the schedule in which a substance is classified. If marijuana were moved to Schedule III, applicable penalties for some offenses would be reduced. However, CSA penalties that apply to activities involving marijuana specifically, such as the quantitybased mandatory minimum sentences discussed above, would not change as a result of rescheduling. DEA is not required to set annual production quotas for Schedule III controlled substances. The prohibition on business deductions in Section 280E of the Internal Revenue Code applies to any trade or business that “consists of trafficking in controlled substances (within the meaning of schedule I and II of the Controlled Substances Act) which is prohibited by Federal law or the law of any State in which such trade or business is conducted.” Because the provision applies only to activities involving substances in Schedule I or II, moving marijuana from Schedule I to Schedule III would allow marijuana businesses to deduct business expenses on federal tax filings. Other collateral legal consequences would continue to attach to unauthorized marijuana-related activities. Considerations for Congress Either Congress or the executive branch has the authority to change the status of marijuana under the CSA. Congress can change the status of a controlled substance through legislation, while the CSA empowers DEA to make scheduling decisions through the notice-and-comment rulemaking process. When considering whether to schedule or reschedule a controlled substance, DEA is bound by HHS’s recommendations on scientific and medical matters. However, DEA has stated that it has “final authority to schedule, reschedule, or deschedule a drug under the Controlled Substances Act.” A proposal from the 118th Congress would provide for congressional review of DEA rescheduling decisions related to marijuana. If Congress wishes to change the legal status of marijuana, it has broad authority to do so before or after DEA makes any final scheduling decision. Several proposals from the 118th Congress would remove marijuana from control under the CSA or move the substance to a less restrictive schedule. If Congress moved marijuana to Schedule III by legislation, it could simultaneously consider whether to change some of the legal consequences of Schedule III status described above. Congress could also legislate to move marijuana to another CSA schedule, which would subject it to controls more or less stringent than those that apply to Schedule III controlled substances. Rescheduling or descheduling marijuana under the CSA could raise additional legal questions. For instance, FDA regulates certain cannabis products under the Federal Food, Drug, and Cosmetic Act, so Congressional Research Service 4 LSB11105 · VERSION 2 · UPDATED Congress might also consider whether to alter that regulatory regime or create some alternative regulatory framework. In addition, relaxing the CSA’s restrictions on marijuana could implicate the United States’ international treaty obligations. While most recent proposals would relax federal regulation of marijuana, Congress could also seek to impose more stringent controls. One proposal from the 118th Congress would withhold certain federal funds from states in which the purchase or public possession of marijuana for recreational purposes is lawful. A proposal from the 117th Congress would have prohibited the use of benefits under the Temporary Assistance for Needy Families block grant at any store that offers marijuana for sale. Other proposals from the 117th Congress sought to address the issues of workplace impairment or driving under the influence of marijuana and other substances. Provide one example of how the change in scheduling would impact low-income people.",Legal,Fact Finding,Q&A This task requires you to draw your answer from the given text only. Do not use any outside resources or prior knowledge. Your answer must be 100 words or less.,What arguments did the US Court of appeals reject?,"In April 2024, the Federal Trade Commission (FTC) issued a rule prohibiting most employers from entering into or enforcing non-compete agreements with workers, subject to exceptions for the sale of a business and preexisting non-competes with senior executives. The rule (the Non-Compete Rule) implicates unsettled issues regarding the FTC’s authority to issue substantive competition regulations. Lawsuits challenging the rule followed. In one of those cases, a federal district court has declared the Non-Compete Rule unlawful and barred the FTC from enforcing it nationwide. Shortly before that decision, another court held that a separate challenge to the rule was likely to succeed and preliminarily enjoined the rule’s enforcement against the named plaintiff in that case. A third court has taken a more favorable view of the Non-Compete Rule, denying a motion for a preliminary injunction and concluding that the plaintiff had not established a reasonable probability that the rule exceeds the FTC’s legal authority. This Legal Sidebar provides background on the Non-Compete Rule and associated legal issues, along with an overview of the litigation challenging it. Background The Non-Compete Rule The Non-Compete Rule makes it unlawful to enter into or enforce a non-compete clause with any worker who is not a senior executive. The rule prohibits employers from entering into non-competes with senior executives after the rule’s effective date, but allows employers to enforce preexisting non-competes with senior executives. The rule defines the term “senior executive” to mean a worker who occupied a “policy-making position” and received total compensation of at least $151,164 in the preceding year. The rule’s prohibitions are subject to an exception for non-compete clauses entered into pursuant to a bona fide sale of a business entity, a person’s ownership interest in a business entity, or all or substantially all of a business entity’s operating assets. Congressional Research Service https://crsreports.congress.gov LSB11228 Congressional Research Service 2 The rule defines the term “non-compete clause” to mean a term or condition of employment that “prohibits,” “penalizes,” or “functions to prevent” a worker from seeking or accepting work with a different person after the conclusion of the employment that includes the term or condition. The rule explains that this definition encompasses “de facto” or “functional” non-competes—for example, “forfeiture-for-competition” clauses that extinguish an employer’s obligation to pay promised compensation or benefits if a worker accepts another job. The rule does not, however, categorically prohibit non-disclosure agreements (NDAs) or non-solicitation agreements. The Non-Compete Rule defines the term “worker” to include employees and independent contractors. That term does not include franchisees in the context of a franchisor-franchisee relationship, but does include employees of a franchisor or franchisee. Employers that fall outside of the FTC’s jurisdiction under the FTC Act are not subject to the rule. These employers include certain banks, savings and loan institutions, federal credit unions, common carriers, air carriers, and “persons, partnerships, or corporations insofar as they are subject to the Packers and Stockyards Act.” Corporations that are not “organized to carry on business for [their] own profit or that of [their] members” are also excluded from the FTC Act’s coverage. The rule explains that simply claiming non-profit status under the tax code is not sufficient to qualify for this exclusion. Instead, the FTC evaluates the economic realities of an entity’s activities to determine whether the exclusion applies. The Non-Compete Rule requires employers to provide “clear and conspicuous notice” to workers subject to prohibited non-compete clauses that the clauses “will not be, and cannot legally be” enforced. Legal Authority The FTC relied on Sections 5 and 6(g) of the Federal Trade Commission Act (FTC Act) in promulgating the Non-Compete Rule. Section 5 prohibits “unfair methods of competition” (UMC) and empowers the FTC to enforce that prohibition through adjudication. Section 6 is titled “Additional powers of Commission.” It confers a range of authorities, most of which involve investigations and the publication of reports. The provision also includes Section 6(g), which empowers the FTC to “from time to time classify corporations and . . . to make rules and regulations for the purpose of carrying out” the FTC Act. Sections 5 and 6(g) were both part of the original FTC Act, which Congress enacted in 1914. Since the statute’s enactment, Congress has adopted several laws granting the FTC rulemaking authority over discrete subjects, including the Wool Products Labeling Act, the Textile Fiber Products Identification Act, the Fur Products Labeling Act, the Flammable Fabrics Act, and the Fair Packaging and Labeling Act. The FTC first asserted that Section 6(g) endows it with general substantive rulemaking power in 1962, and the agency adopted a number of trade regulation rules in the years that followed. Some of those rules defined certain conduct as both a UMC and an “unfair or deceptive act or practice” (UDAP)—a separate category of conduct prohibited by Section 5. Other rules relied only on the FTC’s UDAP power. One rule relied solely on the FTC’s competition authority, but was never enforced and has been repealed. In the 1970s, a trade association challenged the FTC’s authority to issue substantive rules under Section 6(g) in National Petroleum Refiners Association v. FTC. The trade association argued that Section 6(g) authorized only procedural rules, emphasizing that the FTC had not asserted substantive rulemaking authority under Section 6(g) until 1962 and that FTC officials had occasionally denied the existence of such authority. The trade association also contended that Congress’s enactment of several statutes granting the FTC specific rulemaking authorities implied that the FTC lacked general rulemaking authority. The U.S. Court of Appeals for the D.C. Circuit rejected those arguments. In affirming the FTC’s power to issue legislative rules under Section 6(g), the court relied on appellate decisions construing similar statutes as authorizing substantive rulemaking, the advantages of rulemaking in effectuating the FTC Congressional Research Service 3 Act’s purposes, and the absence of any limiting language in the statutory text. The D.C. Circuit downplayed the fact that the FTC had not claimed general rulemaking authority until 1962, reasoning that the agency’s earlier interpretation of its legal authority did not warrant judicial deference. The court also concluded that Congress may have provided the FTC with more specific rulemaking authorities based on “uncertainty, understandable caution, and a desire to avoid litigation,” rather than a firm conviction that the FTC lacked general rulemaking authority. Two years after the National Petroleum Refiners decision, Congress enacted the Magnuson-Moss Act, which imposed special procedural requirements for the FTC’s UDAP rules and eliminated the FTC’s authority to issue such rules under Section 6(g). Magnuson-Moss did not by its terms affect the FTC’s authority to issue UMC rules: the statute included a provision disclaiming an intent to affect “any authority of the Commission to prescribe rules (including interpretive rules), and general statements of policy, with respect to unfair methods of competition.” Despite this language in Magnuson-Moss, the FTC’s putative authority to issue UMC rules has been dormant since the enactment of that statute. The Non-Compete Rule marks the first rule promulgated under Section 6(g) since the 1970s and the second rule ever that relies solely upon the FTC’s competition authority.","This task requires you to draw your answer from the given text only. Do not use any outside resources or prior knowledge. Your answer must be 100 words or less. In April 2024, the Federal Trade Commission (FTC) issued a rule prohibiting most employers from entering into or enforcing non-compete agreements with workers, subject to exceptions for the sale of a business and preexisting non-competes with senior executives. The rule (the Non-Compete Rule) implicates unsettled issues regarding the FTC’s authority to issue substantive competition regulations. Lawsuits challenging the rule followed. In one of those cases, a federal district court has declared the Non-Compete Rule unlawful and barred the FTC from enforcing it nationwide. Shortly before that decision, another court held that a separate challenge to the rule was likely to succeed and preliminarily enjoined the rule’s enforcement against the named plaintiff in that case. A third court has taken a more favorable view of the Non-Compete Rule, denying a motion for a preliminary injunction and concluding that the plaintiff had not established a reasonable probability that the rule exceeds the FTC’s legal authority. This Legal Sidebar provides background on the Non-Compete Rule and associated legal issues, along with an overview of the litigation challenging it. Background The Non-Compete Rule The Non-Compete Rule makes it unlawful to enter into or enforce a non-compete clause with any worker who is not a senior executive. The rule prohibits employers from entering into non-competes with senior executives after the rule’s effective date, but allows employers to enforce preexisting non-competes with senior executives. The rule defines the term “senior executive” to mean a worker who occupied a “policy-making position” and received total compensation of at least $151,164 in the preceding year. The rule’s prohibitions are subject to an exception for non-compete clauses entered into pursuant to a bona fide sale of a business entity, a person’s ownership interest in a business entity, or all or substantially all of a business entity’s operating assets. Congressional Research Service https://crsreports.congress.gov LSB11228 Congressional Research Service 2 The rule defines the term “non-compete clause” to mean a term or condition of employment that “prohibits,” “penalizes,” or “functions to prevent” a worker from seeking or accepting work with a different person after the conclusion of the employment that includes the term or condition. The rule explains that this definition encompasses “de facto” or “functional” non-competes—for example, “forfeiture-for-competition” clauses that extinguish an employer’s obligation to pay promised compensation or benefits if a worker accepts another job. The rule does not, however, categorically prohibit non-disclosure agreements (NDAs) or non-solicitation agreements. The Non-Compete Rule defines the term “worker” to include employees and independent contractors. That term does not include franchisees in the context of a franchisor-franchisee relationship, but does include employees of a franchisor or franchisee. Employers that fall outside of the FTC’s jurisdiction under the FTC Act are not subject to the rule. These employers include certain banks, savings and loan institutions, federal credit unions, common carriers, air carriers, and “persons, partnerships, or corporations insofar as they are subject to the Packers and Stockyards Act.” Corporations that are not “organized to carry on business for [their] own profit or that of [their] members” are also excluded from the FTC Act’s coverage. The rule explains that simply claiming non-profit status under the tax code is not sufficient to qualify for this exclusion. Instead, the FTC evaluates the economic realities of an entity’s activities to determine whether the exclusion applies. The Non-Compete Rule requires employers to provide “clear and conspicuous notice” to workers subject to prohibited non-compete clauses that the clauses “will not be, and cannot legally be” enforced. Legal Authority The FTC relied on Sections 5 and 6(g) of the Federal Trade Commission Act (FTC Act) in promulgating the Non-Compete Rule. Section 5 prohibits “unfair methods of competition” (UMC) and empowers the FTC to enforce that prohibition through adjudication. Section 6 is titled “Additional powers of Commission.” It confers a range of authorities, most of which involve investigations and the publication of reports. The provision also includes Section 6(g), which empowers the FTC to “from time to time classify corporations and . . . to make rules and regulations for the purpose of carrying out” the FTC Act. Sections 5 and 6(g) were both part of the original FTC Act, which Congress enacted in 1914. Since the statute’s enactment, Congress has adopted several laws granting the FTC rulemaking authority over discrete subjects, including the Wool Products Labeling Act, the Textile Fiber Products Identification Act, the Fur Products Labeling Act, the Flammable Fabrics Act, and the Fair Packaging and Labeling Act. The FTC first asserted that Section 6(g) endows it with general substantive rulemaking power in 1962, and the agency adopted a number of trade regulation rules in the years that followed. Some of those rules defined certain conduct as both a UMC and an “unfair or deceptive act or practice” (UDAP)—a separate category of conduct prohibited by Section 5. Other rules relied only on the FTC’s UDAP power. One rule relied solely on the FTC’s competition authority, but was never enforced and has been repealed. In the 1970s, a trade association challenged the FTC’s authority to issue substantive rules under Section 6(g) in National Petroleum Refiners Association v. FTC. The trade association argued that Section 6(g) authorized only procedural rules, emphasizing that the FTC had not asserted substantive rulemaking authority under Section 6(g) until 1962 and that FTC officials had occasionally denied the existence of such authority. The trade association also contended that Congress’s enactment of several statutes granting the FTC specific rulemaking authorities implied that the FTC lacked general rulemaking authority. The U.S. Court of Appeals for the D.C. Circuit rejected those arguments. In affirming the FTC’s power to issue legislative rules under Section 6(g), the court relied on appellate decisions construing similar statutes as authorizing substantive rulemaking, the advantages of rulemaking in effectuating the FTC Congressional Research Service 3 Act’s purposes, and the absence of any limiting language in the statutory text. The D.C. Circuit downplayed the fact that the FTC had not claimed general rulemaking authority until 1962, reasoning that the agency’s earlier interpretation of its legal authority did not warrant judicial deference. The court also concluded that Congress may have provided the FTC with more specific rulemaking authorities based on “uncertainty, understandable caution, and a desire to avoid litigation,” rather than a firm conviction that the FTC lacked general rulemaking authority. Two years after the National Petroleum Refiners decision, Congress enacted the Magnuson-Moss Act, which imposed special procedural requirements for the FTC’s UDAP rules and eliminated the FTC’s authority to issue such rules under Section 6(g). Magnuson-Moss did not by its terms affect the FTC’s authority to issue UMC rules: the statute included a provision disclaiming an intent to affect “any authority of the Commission to prescribe rules (including interpretive rules), and general statements of policy, with respect to unfair methods of competition.” Despite this language in Magnuson-Moss, the FTC’s putative authority to issue UMC rules has been dormant since the enactment of that statute. The Non-Compete Rule marks the first rule promulgated under Section 6(g) since the 1970s and the second rule ever that relies solely upon the FTC’s competition authority. What arguments did the US Court of appeals reject?",Legal,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Give a summary, limited in 150 words, about the results of this paper, focusing on the comparisons between the stub design and the quarter wave transformer design.","Design and Analysis of a 170 GHz Antenna for Millimeter-wave Applications ABSTRACT: Microstrip patch antennas are low-profile and robust when mounted on rigid surfaces of the devices making them suitable for communication and millimeter-wave applications. In this paper, an antenna is designed for the resonant frequency of 170 GHz using microstrip technology concerning its miniaturization and cost-effectiveness. The designed antenna is a part of a stray radiation detection system for ECE diagnostic to be installed on fusion research machine ITER. It offers low-directivity to receive radiation from all directions, high bandwidth, low side-lobe-level and return loss of -50 dB, leading to its remarkable utilization in the detection system being designed to protect millimeter wave components of ITER ECE Diagnostic. Power-handling and power-capturing capability of the designed antenna have also been discussed in the paper. Far-field simulations have been performed using CST Microwave Studio software to study the radiation characteristics of the designed antenna. V. RESULTS Impedance matching always ensures the maximum power transfer between the source and the load. Hence, a noble matching circuit is required for a specific design ensuring its better performance. The corporate feed network can use either a quarter-wave transformer or a stub to match patch element impedance to standard 50-ohm input impedance. The preferences mentioned above for our design are configured in Fig. 3. The important properties of the designed system with both configurations are simulated using CST Microwave Studio software and examined below to check their reliability. A. S-Parameter and VSWR The amount of power reflected from the antenna is parametrized by 𝑆11 parameter and Voltage Standing Wave Ratio (VSWR) related to each other by the following relation 𝑆11 = 𝑅𝑒𝑡𝑢𝑟𝑛 𝐿𝑜𝑠𝑠(𝑑𝐵) = -20 log10 ( 𝑉𝑆𝑊𝑅 - 1 𝑉𝑆𝑊𝑅 + 1 ) The antenna bandwidth can also be measured from the VSWR plot over a range of frequencies where its value is ≤ 2. The variation of 𝑆11 over the range of frequencies for quarter-wave transformer and stub configuration is plotted in Fig. 4. At the resonant frequency, i.e., 170 GHz , the minimum value of 𝑆11 is -50 𝑑𝐵 for quarter-wave and -35 𝑑𝐵 for stub configuration. It articulates the impedance matching along the propagation path of the signal and effective power delivery for quarter-wave transformer configuration. B. Side Lobe Level and Beamwidth The performance of an antenna is usually measured in terms of gain and its relative 3D radiation pattern. The radiation pattern is represented by polar plots as shown in Fig. 5(a) and (b), measured in the far-field antenna range as mentioned earlier. It suggests that the main lobe direction is different for both the quarter-wave transformer and the stub configuration for the resonant frequency 170 GHz, which is 260 and 7 0 , respectively. However, they possess approximately the same magnitude of gain depicted in Fig. 5(c) and (d). Gain IEEE measured in both configurations does not include the losses associated with the polarization and impedance mismatching. Far-field characteristics also enable us to investigate two important parameters associated with antenna performance. One is Half-Power beamwidth (also known as angular width), defined as the angular separation of 3dB in the radiation pattern. It deals with the resolution capabilities of the system. And another is the Side-lobe level (SLL), measured by the ratio of the amplitude of the main lobe to that of the side lobe. Low SLL minimizes the false target indication through the side lobes. There is a trade-off between both parameters and one needs to be compromised over the other [21]. We designed a system with a wider reception angle in lieu of high SLL to meet our requirements. The major difference in both the configuration, i.e., stub and quarter-wave transformer, can be noted in Fig. 5. In the case of stub configuration, the value of angular width and SLL parameter are 31.5 0 and -3.6𝑑𝐵, respectively. However, for quarter-wave transformer these are 70.5 0 and -15.5𝑑𝐵. It is evident from here that the parameters such as bandwidth, gain, S-parameter and side-lobe level attain desirable values for antenna array with quarter-wave transformer as a matching circuit. In other words, the quarter-wave transformer dominates over the stub in terms of better impedance matching, which makes it suitable for our desired application. C. Efficiency The power supplied to the system generally dispenses into surface-wave excitation, radiation emission and conductor and dielectric dissipation. Radiation efficiency is defined as the ratio of power radiated to the power inserted into the antenna system which is plotted in Fig. 6 for the 2 × 2 antenna array. It also encompasses the total efficiency of the system that takes into account all 𝐼 2𝑅 losses and the reflections arise due to mismatching between the antenna and the transmission line. For better understanding, we summarized the above-discussed properties of the individual patch antenna and the antenna array (with two different matching circuit configurations) in tabular form in Table 2. Here, we conclude the superiority of the 2×2 antenna array with a quarter-wave 14 transformer over other systems in terms of return loss, bandwidth, efficiency, angular width and SLL. VI. CONCLUSION A 2 × 2 microstrip antenna array has been designed and simulated successfully for the resonant frequency of 170 GHz using CST Microwave Studio software. The dominance of the antenna array over the individual patch has been proved while investigating their properties and power handling capabilities. However, continuous increment in the number of patches of an antenna array enhances its directivity further and decreases its angular width. Hence, the 2 × 2 antenna geometry reasonably satisfies our desired requirements. Significant properties of the designed system such as S-parameter, VSWR, gain, beamwidth, side-lobe level, efficiency have been estimated and discussed. A comparative study of the two matching circuits, i.e., stub and quarterwave transformer, have also been performed. The designed system's power-handling capability is also evaluated to check its reliability. At resonant frequency 170 GHz, the return loss is -50 dB, angular width is 70.5 0 and the gain is 8.6dBi for the designed antenna. The simulation results show that the designed system fulfills required characteristics and is recommended for high-frequency detector applications. The future work is to design a detector system for application in ECE diagnostic components protection, utilizing this designed antenna."," Only use the provided text to answer the question, no outside sources. Give a summary, limited in 150 words, about the results of this paper, focusing on the comparisons between the stub design and the quarter wave transformer design. Design and Analysis of a 170 GHz Antenna for Millimeter-wave Applications ABSTRACT: Microstrip patch antennas are low-profile and robust when mounted on rigid surfaces of the devices making them suitable for communication and millimeter-wave applications. In this paper, an antenna is designed for the resonant frequency of 170 GHz using microstrip technology concerning its miniaturization and cost-effectiveness. The designed antenna is a part of a stray radiation detection system for ECE diagnostic to be installed on fusion research machine ITER. It offers low-directivity to receive radiation from all directions, high bandwidth, low side-lobe-level and return loss of -50 dB, leading to its remarkable utilization in the detection system being designed to protect millimeter wave components of ITER ECE Diagnostic. Power-handling and power-capturing capability of the designed antenna have also been discussed in the paper. Far-field simulations have been performed using CST Microwave Studio software to study the radiation characteristics of the designed antenna. V. RESULTS Impedance matching always ensures the maximum power transfer between the source and the load. Hence, a noble matching circuit is required for a specific design ensuring its better performance. The corporate feed network can use either a quarter-wave transformer or a stub to match patch element impedance to standard 50-ohm input impedance. The preferences mentioned above for our design are configured in Fig. 3. The important properties of the designed system with both configurations are simulated using CST Microwave Studio software and examined below to check their reliability. A. S-Parameter and VSWR The amount of power reflected from the antenna is parametrized by 𝑆11 parameter and Voltage Standing Wave Ratio (VSWR) related to each other by the following relation 𝑆11 = 𝑅𝑒𝑡𝑢𝑟𝑛 𝐿𝑜𝑠𝑠(𝑑𝐵) = -20 log10 ( 𝑉𝑆𝑊𝑅 - 1 𝑉𝑆𝑊𝑅 + 1 ) The antenna bandwidth can also be measured from the VSWR plot over a range of frequencies where its value is ≤ 2. The variation of 𝑆11 over the range of frequencies for quarter-wave transformer and stub configuration is plotted in Fig. 4. At the resonant frequency, i.e., 170 GHz , the minimum value of 𝑆11 is -50 𝑑𝐵 for quarter-wave and -35 𝑑𝐵 for stub configuration. It articulates the impedance matching along the propagation path of the signal and effective power delivery for quarter-wave transformer configuration. B. Side Lobe Level and Beamwidth The performance of an antenna is usually measured in terms of gain and its relative 3D radiation pattern. The radiation pattern is represented by polar plots as shown in Fig. 5(a) and (b), measured in the far-field antenna range as mentioned earlier. It suggests that the main lobe direction is different for both the quarter-wave transformer and the stub configuration for the resonant frequency 170 GHz, which is 260 and 7 0 , respectively. However, they possess approximately the same magnitude of gain depicted in Fig. 5(c) and (d). Gain IEEE measured in both configurations does not include the losses associated with the polarization and impedance mismatching. Far-field characteristics also enable us to investigate two important parameters associated with antenna performance. One is Half-Power beamwidth (also known as angular width), defined as the angular separation of 3dB in the radiation pattern. It deals with the resolution capabilities of the system. And another is the Side-lobe level (SLL), measured by the ratio of the amplitude of the main lobe to that of the side lobe. Low SLL minimizes the false target indication through the side lobes. There is a trade-off between both parameters and one needs to be compromised over the other [21]. We designed a system with a wider reception angle in lieu of high SLL to meet our requirements. The major difference in both the configuration, i.e., stub and quarter-wave transformer, can be noted in Fig. 5. In the case of stub configuration, the value of angular width and SLL parameter are 31.5 0 and -3.6𝑑𝐵, respectively. However, for quarter-wave transformer these are 70.5 0 and -15.5𝑑𝐵. It is evident from here that the parameters such as bandwidth, gain, S-parameter and side-lobe level attain desirable values for antenna array with quarter-wave transformer as a matching circuit. In other words, the quarter-wave transformer dominates over the stub in terms of better impedance matching, which makes it suitable for our desired application. C. Efficiency The power supplied to the system generally dispenses into surface-wave excitation, radiation emission and conductor and dielectric dissipation. Radiation efficiency is defined as the ratio of power radiated to the power inserted into the antenna system which is plotted in Fig. 6 for the 2 × 2 antenna array. It also encompasses the total efficiency of the system that takes into account all 𝐼 2𝑅 losses and the reflections arise due to mismatching between the antenna and the transmission line. For better understanding, we summarized the above-discussed properties of the individual patch antenna and the antenna array (with two different matching circuit configurations) in tabular form in Table 2. Here, we conclude the superiority of the 2×2 antenna array with a quarter-wave 14 transformer over other systems in terms of return loss, bandwidth, efficiency, angular width and SLL. VI. CONCLUSION A 2 × 2 microstrip antenna array has been designed and simulated successfully for the resonant frequency of 170 GHz using CST Microwave Studio software. The dominance of the antenna array over the individual patch has been proved while investigating their properties and power handling capabilities. However, continuous increment in the number of patches of an antenna array enhances its directivity further and decreases its angular width. Hence, the 2 × 2 antenna geometry reasonably satisfies our desired requirements. Significant properties of the designed system such as S-parameter, VSWR, gain, beamwidth, side-lobe level, efficiency have been estimated and discussed. A comparative study of the two matching circuits, i.e., stub and quarterwave transformer, have also been performed. The designed system's power-handling capability is also evaluated to check its reliability. At resonant frequency 170 GHz, the return loss is -50 dB, angular width is 70.5 0 and the gain is 8.6dBi for the designed antenna. The simulation results show that the designed system fulfills required characteristics and is recommended for high-frequency detector applications. The future work is to design a detector system for application in ECE diagnostic components protection, utilizing this designed antenna. https://arxiv.org/pdf/2208.10075",Internet/Technology,Concept Comparison,Q&A "Use only the information provided in the text to form your response, do not use any external sources or prior knowledge. Give your answers in a numbered list with an explanation or context following each one.",What are the challenges to Hokkaido's economy that can be found in the article?,"After the Second World War, Hokkaido drew up 6 Development Plans. These Plans showed the basic development concept and direction. Based on that, important large scale infrastructure projects such as roads, harbors, rail ways, air ports and large scale industrial parks were projected. Then necessary investment amount and their economic and social effects on Hokkaido region were calculated. The Plans were finally decided by the Cabinet after the discussions in Hokkaido Development Council which is operated by Hokkaido Development Agency (now Ministry of Infrastructure, Land and Transport). Targets and contents of the Plans were changed according to the changes of global and Japanese economic situation and Hokkaido’s development stage. The basic development strategy of Hokkaido was to utilize and develop the remaining rich natural resources and support settlement of the people safely and happily. At the first stage just after the war, Hokkaido was expected to become a base of supplying foodstuffs and to accept growing and returning population from former overseas territories. Then later, various large infrastructure projects were planed and implemented for developing her economy and now-a-days development of Hokkaido’s identities has come to be emphasized, such as remaining natural beauty, her northern location and cultural heritages. Today, through the 6 Development Plans, Hokkaido, which has 22% of total Japanese territory but only 4.5% population is enjoying well developed infrastructure compared with other regions. But from the view point of industrial structure, it is still biased to natural resources supply industry. Manufacturing industry has not been developed enough yet. For instance, share of manufacturing industries in the total Hokkaido GDP is less than 10%, compared with more than 20% of Japanese average. More over if we see her manufacturing sector’s structure, in 2005 food processing industry dominated, and share of assembly industry is only 12%, compared with 48% in Japanese average. So far, the basic development strategy for Hokkaido has been characterized by heavy infrastructure investment. It has developed excessive construction industry and they have come to require continuous infrastructure investment. And this situation could not give a good condition for diversifying its industrial structure. Now Hokkaido has faced with the problems decreasing natural forestry and fishery resources. And there are many impoverishing areas which used to depend on coal mine industry. This change of the basic economic and social condition has to be considered in the future program of Hokkaido development. As for fishery industry, 200 mile economic zone system was introduced internationally in 1976. After that, Japanese northern sea fishery, which was used to be main profit sources for Hokkaido fishery industry, was damaged greatly. In the case of coal industry, since around 1960’s, energy revolution progressed rapidly and the shift from coal to oil as energy source happened. Then the important industrial sector, coal industry in Hokkaido started to decline. Hokkaido used to produce 20 million tons of coal annually but in 2002 the last coal mine was closed and the history of coal producing industry in Hokkaido was finished. Some areas, where depended on coal industry were greatly affected by closing mines and still have struggled with their economic decline and collapsing communities. As for the agricultural products, Hokkaido is ranked as No.1 producing place for many products in Japan. Even such situation, global competition has been getting severe and has required the efforts to differentiate them from foreign and other regions’ products. Now Hokkaido’s main development strategy seems to promote the change of her industrial structure to more advanced and high value added ones by not only inviting outside capitals but also fostering indigenous companies. Also, new type tourism industry becomes one of the important target to be promoted. However under the long lasted economic recession, Hokkaido’s regional economy has been weakened and financial condition of many local self-governments is facing with very critical conditions.","System instruction: Use only the information provided in the text to form your response, do not use any external sources or prior knowledge. Give your answers in a numbered list with an explanation or context following each one. Question: What are the challenges to Hokkaido's economy that can be found in the article? Context block: After the Second World War, Hokkaido drew up 6 Development Plans. These Plans showed the basic development concept and direction. Based on that, important large scale infrastructure projects such as roads, harbors, rail ways, air ports and large scale industrial parks were projected. Then necessary investment amount and their economic and social effects on Hokkaido region were calculated. The Plans were finally decided by the Cabinet after the discussions in Hokkaido Development Council which is operated by Hokkaido Development Agency (now Ministry of Infrastructure, Land and Transport). Targets and contents of the Plans were changed according to the changes of global and Japanese economic situation and Hokkaido’s development stage. The basic development strategy of Hokkaido was to utilize and develop the remaining rich natural resources and support settlement of the people safely and happily. At the first stage just after the war, Hokkaido was expected to become a base of supplying foodstuffs and to accept growing and returning population from former overseas territories. Then later, various large infrastructure projects were planed and implemented for developing her economy and now-a-days development of Hokkaido’s identities has come to be emphasized, such as remaining natural beauty, her northern location and cultural heritages. Today, through the 6 Development Plans, Hokkaido, which has 22% of total Japanese territory but only 4.5% population is enjoying well developed infrastructure compared with other regions. But from the view point of industrial structure, it is still biased to natural resources supply industry. Manufacturing industry has not been developed enough yet. For instance, share of manufacturing industries in the total Hokkaido GDP is less than 10%, compared with more than 20% of Japanese average. More over if we see her manufacturing sector’s structure, in 2005 food processing industry dominated, and share of assembly industry is only 12%, compared with 48% in Japanese average. So far, the basic development strategy for Hokkaido has been characterized by heavy infrastructure investment. It has developed excessive construction industry and they have come to require continuous infrastructure investment. And this situation could not give a good condition for diversifying its industrial structure. Now Hokkaido has faced with the problems decreasing natural forestry and fishery resources. And there are many impoverishing areas which used to depend on coal mine industry. This change of the basic economic and social condition has to be considered in the future program of Hokkaido development. As for fishery industry, 200 mile economic zone system was introduced internationally in 1976. After that, Japanese northern sea fishery, which was used to be main profit sources for Hokkaido fishery industry, was damaged greatly. In the case of coal industry, since around 1960’s, energy revolution progressed rapidly and the shift from coal to oil as energy source happened. Then the important industrial sector, coal industry in Hokkaido started to decline. Hokkaido used to produce 20 million tons of coal annually but in 2002 the last coal mine was closed and the history of coal producing industry in Hokkaido was finished. Some areas, where depended on coal industry were greatly affected by closing mines and still have struggled with their economic decline and collapsing communities. As for the agricultural products, Hokkaido is ranked as No.1 producing place for many products in Japan. Even such situation, global competition has been getting severe and has required the efforts to differentiate them from foreign and other regions’ products. Now Hokkaido’s main development strategy seems to promote the change of her industrial structure to more advanced and high value added ones by not only inviting outside capitals but also fostering indigenous companies. Also, new type tourism industry becomes one of the important target to be promoted. However under the long lasted economic recession, Hokkaido’s regional economy has been weakened and financial condition of many local self-governments is facing with very critical conditions.",Financial,Fact Finding,Q&A Please answer the question using only the provided context. ,Please summarize the major differences between cash- and tax-basis account as explained in the context provided.,"Practice Aid Accounting and Financial Reporting Guidelines for Cash- and Tax-Basis Financial Statements © 2018 Association of International Certified Professional Accountants. All rights reserved. For other uses of this work, please email copyright@aicpa.org with your request or write to us at 220 Leigh Farm Road, Durham, NC 27707-8110 USA. This document was created by the Association of International Certified Professional Accountants as a free member benefit which may be freely used and shared by members for personal use. All copyright statements should be maintained. © 2018 Association of International Certified Professional Accountants. All rights reserved. 1 Preface Because of the complexities of accounting principles generally accepted in the United States of America (GAAP), many smaller entities have determined that financial statements prepared by applying the cash‐ or tax‐basis of accounting more appropriately suit their needs. Unlike GAAP, little authoritative guidance is available with re‐ spect to the preparation of financial statements when applying the cash‐ or tax‐basis of accounting. Financial statements prepared when applying the cash‐ or tax‐basis of accounting need to have a level of consistency so that they are useful and not misleading to users of the financial statements. Additionally, because financial statements prepared when applying the cash‐ or tax‐basis of accounting are not considered appropriate in form unless the financial statements include informative disclosures similar to those required by GAAP if the financial statements contain items that are the same as, or similar to, those in financial statements prepared in accord‐ ance with GAAP, preparers of full disclosure financial statements prepared when applying the cash‐ or tax‐basis of accounting are often faced with difficult questions. This practice aid is intended to provide preparers of cash‐ and tax‐basis financial statements with guidelines and best practices to promote consistency and for resolving the often difficult questions regarding the preparation of such financial statements. Although this practice aid is the best source for such guidance, it is nonauthorita‐ tive and should not be used as a substitute for the preparer’s professional judgment. This practice aid has not been approved, disapproved, or otherwise acted upon by any senior committee of the AICPA. This practice aid does not contain guidance with respect to performing an audit, review, or compilation of finan‐ cial statements prepared when applying the cash‐ or tax‐basis of accounting. Practitioners engaged to audit such financial statements should refer to Statements on Auditing Standards, including AU‐C section 800, Special Con‐ siderations—Audits of Financial Statements Prepared in Accordance With Special Purpose Frameworks (AICPA, Professional Standards). Practitioners engaged to perform a review or compilation should refer to Statements on Standards for Accounting and Review Services (SSARSs). Likewise, CPAs in public practice who prepare finan‐ cial statements for clients but are not engaged to perform an audit, review, or compilation of such financial statements should refer to SSARSs. Prepared by Michael P. Glynn Senior Technical Manager Audit and Attest Standards Team Edited by Kelly G. McAuliffe Technical Manager Member Learning and Competency 2 © 2018 Association of International Certified Professional Accountants. All rights reserved. Acknowledgments In 1998, the AICPA published the Practice Aid Preparing and Reporting on Cash‐ and Tax‐Basis Financial State‐ ments. That publication was written by Michael J. Ramos, CPA, and edited by the AICPA Accounting and Publica‐ tions Team. That publication served as a basis for the preparation of the original edition of this practice aid. In addition to this practice aid, the AICPA has also published a separate practice aid, Applying OCBOA in State and Local Government Financial Statements, authored by Michael A. (Mike) Crawford, CPA. Mike served as an invaluable resource in the preparation of the original edition of this practice aid. The AICPA also greatly appreciates the invaluable input provided by the late Dr. Thomas A. Ratcliffe in the de‐ velopment of the previous edition of this practice aid. Finally, the AICPA would like to thank the 2011/12 members of the Accounting and Review Services Committee and the 2011/12 members of the AICPA PCPS Technical Issues Committee, who provided invaluable input re‐ garding the content of the original edition of this practice aid. © 2018 Association of International Certified Professional Accountants. All rights reserved. 3 4 © 2018 Association of International Certified Professional Accountants. All rights reserved. Chapter 1 Overview of Cash‐ and Tax‐Basis Financial Statements Introduction Financial statements, including related notes, are a structured representation of historical financial information intended to communicate an entity’s economic resources and obligations at a point in time or the changes therein for a period of time in accordance with a financial reporting framework. fn 1 All financial statements are prepared in accordance with a financial reporting framework. The term financial reporting framework is defined as “a set of criteria used to determine measurement, recognition, presentation, and disclosure of all material items appearing in the financial statements.” fn 2 Examples of financial reporting frameworks are accounting principles generally accepted in the United States of America (GAAP), International Financial Reporting Stand‐ ards promulgated by the International Accounting Standards Board, and special purpose frameworks such as the cash‐, tax, regulatory‐, contractual‐, and other bases that use a definitive set of logical, reasonable criteria that is applied to all material items appearing in the financial statements. The cash‐, tax‐, regulatory‐, and other‐basis of accounting are commonly referred to as other comprehensive bases of accounting. As GAAP becomes increasingly complex and less cost beneficial for private companies, such companies consider issuing cash‐ and tax‐basis financial statements as cost‐effective and useful alternatives. Many of these private companies are small and medium‐sized entities that report to a narrow range of financial statement users. Those users, unlike users of public company financial statements, typically have access to company management and additional financial information beyond that provided in the financial statements. Cash‐ or tax‐basis financial statements may be appropriate whenever the entity is not contractually or otherwise required to issue GAAP financial statements. The following conditions may indicate that financial statements prepared when applying the cash‐ or tax‐basis of accounting is appropriate: • The users of the financial statements—both internal and external to the entity—understand a cash‐ or tax‐basis presentation and find it relevant for their needs. • It is cost‐effective to prepare cash‐ or tax‐basis financial statements. • The operations of the entity are conducive to a cash‐ or tax‐basis presentation. Preparing cash‐ or tax‐basis financial statements has many benefits. A significant benefit is due to the fact that many smaller entities maintain their accounting records on a cash‐ or tax‐basis. Often, accounting and finance personnel responsible for maintaining the books and records can more easily understand the concepts of cash in fn 1 Paragraph .05 of AR‐C section 90, Review of Financial Statements (AICPA, Professional Standards), and paragraph .13 of AU‐C section 200, Overall Objectives of the Independent Auditor and Conduct of an Audit in Accordance With Generally Accepted Auditing Standards (AICPA, Professional Standards). fn 2 See footnote 1. © 2018 Association of International Certified Professional Accountants. All rights reserved. 5 and out as well as tax reporting compared to GAAP. Because the internal records are often maintained on the cash‐ or tax‐basis of accounting, it is easier to prepare the financial statements when applying that same basis. If the financial statements are prepared in accordance with GAAP, the accounting and finance personnel would “true‐up” the financial information through a series of journal entries. Additionally, many users of smaller entity financial statements find cash‐ or tax‐basis financial statements to be more understandable than financial statements prepared in accordance with GAAP because those users are often accustomed to preparing and con‐ sidering budgets on a cash‐basis and understand tax issues. Because many smaller entities are appropriately concerned with minimizing costs and maximizing the resources that are available to fund the operations of the business, resources allocated to accounting and financial report‐ ing are often not sufficient to maintain GAAP basis accounting records and to prepare financial statements in ac‐ cordance with GAAP. Preparing financial statements when applying the cash‐ or tax‐basis of accounting general‐ ly is less costly than preparing GAAP financial statements because of the following: • Less complex measurement requirements. Financial statements prepared when applying the cash‐basis of accounting reflect transactions resulting from cash receipt and disbursement transactions or events. Financial statements prepared when applying the tax‐basis of accounting reflect transactions in the same manner as those transactions are reflected in the entity’s tax return. • Less extensive disclosure requirements. Financial statements prepared when applying the cash‐ or tax‐ basis of accounting do not require all of the extensive disclosures required of GAAP statements because the statements do not include some of the items, events, and transactions that are typically included in GAAP basis financial statements. Observations and Suggestions Often, preparers of cash‐ and tax‐basis financial statements elect to omit substantially all disclosures required by the cash‐ or tax‐basis of accounting. The omission of disclosures is a departure from the cash‐ or tax‐basis of ac‐ counting and, if such disclosures were included in the financial statements, they might influence the user’s con‐ clusions about the entity’s financial position, results of operations, and cash flows. However, the omission may not necessarily result in misleading financial statements provided that the intended users are informed about such matters. • Ability to prepare tax returns and financial statements from the same information. When tax‐basis finan‐ cial statements are issued, a significant portion of the cost can be absorbed by the preparation of the tax return. Additionally, the entity is not required to maintain two sets of accounting records to account for items such as depreciation, bad debts, and consolidation matters. However, in addition to the benefits of financial statements prepared when applying a cash‐ or tax‐basis of ac‐ counting, financial statement preparers should also be aware of the limitations of such financial statements. For example, financial statements prepared when applying the cash‐ or tax‐basis of accounting may not meet the needs of certain users such as regulators and certain lenders. In addition, the cash‐basis of accounting can be easily manipulated by accelerating or delaying the timing of the receipt or disbursement of cash and therefore may not be a comprehensive measure of the entity’s complete economic condition. In practice, the most typical industries in which cash‐ or tax‐basis financial statements are issued include the fol‐ lowing: • Professional services 6 © 2018 Association of International Certified Professional Accountants. All rights reserved. • Medical • Retail • Real estate • Farming/agricultural • Construction • Not‐for‐profit Cash‐Basis of Accounting The cash‐basis of accounting is a basis of accounting that the entity uses to record cash receipts and disburse‐ ments. When applying the cash‐basis of accounting, transactions are recognized based on the timing of cash re‐ ceipts and disbursements. As a result, • revenues are recognized only when cash is received rather than when earned, and • expenses are recognized only when cash is paid rather than when the obligation is incurred. When applying the cash‐basis, cash outflows to purchase an “asset” are not capitalized but instead are recorded as a disbursement as of the date of purchase, so there is no depreciation or amortization. Accruals are not made and prepaid assets are not recorded. The cash‐basis of accounting in its purest form is rarely used but may be appropriate whenever the entity • is interested primarily in sources and uses of cash. • has a limited number of financial statement users. • has relatively simple operations engaged in one primary activity. • does not have significant amounts of debt, capital assets, or other items that would be recognized in ac‐ cordance with the accrual basis. Examples of some entities that may use the cash‐basis of accounting include the following: • Estates • Trusts • Civic ventures • Student activity funds • Political campaigns and committees © 2018 Association of International Certified Professional Accountants. All rights reserved. 7 When applying the cash‐basis of accounting, because the only assets of the entity would be cash and cash equivalents and there would be no liabilities, a balance sheet equivalent is often not presented. The income statement equivalent would report cash receipts and disbursements and other changes in cash and cash equiva‐ lents and disclose any restrictions on ending cash and cash equivalents. Any departure from the presentation of cash and cash equivalent balances and changes in such balances, such as the reporting of long‐term debt arising from cash transactions, the capitalization and depreciation of capital assets acquired with cash, or the reporting of investments or receivables and payables resulting from cash transactions, should be considered a modification to the cash‐basis of accounting. Such deviations require eval‐ uation regarding whether they are appropriate modifications of the cash‐basis of accounting. Appropriate modi‐ fications of the cash‐basis of accounting are discussed in the subsequent section. In‐Substance Two‐Step Transactions or Events in the Cash‐Basis of Accounting The preparer of cash‐basis financial statements may encounter single‐step transactions or events that may not directly involve a cash inflow or outflow but may nevertheless be recorded as an in‐substance two‐step cash transaction or event when applying the cash‐basis of accounting. For example, management of an entity may sign a note from a bank in order to purchase equipment. The bank may then directly pay the vendor for the pur‐ chase of the equipment. Because there was no cash transaction, the entity may not record the single‐step trans‐ action in the financial statements. However, so as not to be misleading to users of the financial statements, the preparer may choose to record the transaction as an in‐substance two‐step transaction. In accordance with that treatment, the journal entries may look as follows: Cash XX,XXX Note Proceeds (Revenue) XX,XXX (To record note proceeds that were paid directly to the vendor) Capital expenditure XX,XXX Cash XX,XXX (To record purchase of equipment) Then, subsequent payments on the note would be recorded as follows: Debt service expenditure XXX Cash XXX (To record principal and interest payment on note payable) Modified Cash‐Basis of Accounting The modified cash‐basis of accounting involves logical and consistent modifications to transactions or events that are derived from cash receipts or cash disbursements. For example, a modification to the cash‐basis of ac‐ counting to report capital assets should involve recording and depreciating only those capital assets that result from cash transactions or events. The modification should not involve the recording and depreciating of donated capital assets because these transactions or events do not involve an inflow or outflow of cash. Once deprecia‐ ble capital assets arising from cash transactions or events are recorded when applying a modified cash‐basis of accounting, such assets should also be depreciated over their estimated useful lives. Depreciating capital assets that were acquired with cash is a logical allocation of the cash‐basis assets’ costs over the assets’ useful lives. 8 © 2018 Association of International Certified Professional Accountants. All rights reserved. An easy way to look at whether a modification is appropriate is to consider whether the transaction or event would have been recorded if the entity was preparing the cash‐basis financial statements. For example, if an en‐ tity purchased a capital asset and was preparing cash‐basis financial statements, the journal entry would look like this: Capital expenditure XXXX Cash XXXX (To record purchase of capital asset) Because cash is part of the journal entry, it would be an appropriate modification to capitalize the asset and de‐ preciate the cost over the estimated useful life of the asset. On the other hand, the recording of trade accounts receivable arising from services provided or goods sold would not be an appropriate modification of the cash‐basis of accounting assuming cash was not received at the time the services were provided or goods were sold. Modifications to the cash‐basis of accounting generally result when cash receipts or cash disbursements provide a benefit or an obligation that covers multiple reporting periods. For example, a preparer may conclude that fi‐ nancial statement users would be misled if cash purchases of capital assets are recorded as disbursements or expenditures in the period in which the assets are purchased. Instead, the preparer may elect to modify the cash‐basis of accounting to record the asset on the balance sheet equivalent and depreciate it over the estimat‐ ed useful life of the asset, thereby, in effect, spreading the benefit of the cash outflow over multiple reporting periods in a manner that has substantial support and is logical and consistent. Questions often arise in the application of a modified cash‐basis of accounting regarding whether reported as‐ sets and liabilities derived from cash transactions or events should ever be written down or written off once they are recorded at their original cash value. Temporary changes in the fair value of an asset or liability should not be recognized in applying a modified cash‐basis of accounting and all recognized assets and liabilities should be measured and reported at their original cash value (net of any accumulated depreciation or amortization, if applicable). If an asset or liability has been permanently impaired and has no future cash value or represents no future obligation against cash, it would be appropriate to write‐down or write‐off such amounts in modified cash‐basis financial statements. A significant challenge to preparing financial statements when applying a modified cash‐basis of accounting is developing the appropriate accounting policy that results in financial statements that meet the needs of the primary users of the statements and consistently applying that policy to cash transactions and events in order to keep the financial statements from being misleading for the purposes for which they are intended. The preparer may find benefit in spelling out the logic behind the cash‐basis modifications and documenting the accounting policy prior to preparation of the basic financial statements. Although there is no single accepted method of applying a modified cash‐basis of accounting, modified cash‐ basis financial statements can be more meaningful if they are comparable with similar financial statements. Some preparers have inappropriately considered the modified cash‐basis of accounting as a “free‐for‐all” propo‐ sition in which they can unilaterally and arbitrarily choose the modifications that they will apply. For example, a preparer may inappropriately decide to prepare financial statements applying a modified cash‐basis of account‐ ing that records assets arising from cash transactions or events, including investments, inventories, and capital assets but does not record short‐term and long‐term liabilities and other obligations arising from cash transac‐ tions. Inconsistent uses of a modified cash‐basis framework should be avoided in general use financial state‐ ments because such inconsistencies will normally result in financial statements that are misleading for general © 2018 Association of International Certified Professional Accountants. All rights reserved. 9 use. Financial statements that are prepared using inconsistent modifications may be appropriate for special pur‐ poses involving limited users but should be labeled as such with clear disclosure and use of descriptive headings. With the needs of the primary financial statement users in mind, when preparing financial statements applying a modified cash‐basis of accounting, the preparer should consider modifying the following cash transactions or events, among others, by the recording of the following: • Receivables resulting from an outflow of cash, such as a cash advance to an employee • Investments in marketable securities acquired with cash • Inventories acquired with cash • Capital assets arising from cash transactions and depreciating the assets where appropriate • Deferred revenue resulting from cash receipts • Liabilities resulting from short‐term cash borrowings • Long‐term notes and other debt arising from cash transactions or events • Any other material assets, liabilities, revenues, and expenses resulting from cash transactions or events If the financial statements are prepared when applying a modified cash‐basis accounting policy in which one or more of the preceding—but not all—are recorded, the preparer should be prepared to defend how the decision to modify or not modify is a logical and consistent application of the accounting policy and does not result in misleading financial statements for the purposes for which they are intended. A number of transactions or events are not appropriate modifications to the cash‐basis of accounting. Generally, these transactions or events should not be recorded when applying a modified cash‐basis of accounting because they do not involve cash inflows or outflows, are illogical, or are not substantially supported in the accounting literature. Common transactions or events that should not be reported in financial statements prepared when applying a modified cash‐basis of accounting include the recording or adjusting of the following: • Capital assets arising from cash transactions or events, but not recording depreciation where appropri‐ ate • Donated capital assets where cash outflows were not involved • Accounts receivable from services provided or goods sold and other accrued receivables • Pledges receivable or other receivables where cash outflows were not involved • Investments for which cash outflows were not involved • Accounts payable for goods or services received where no cash outflow was involved • Accrued income taxes, accrued interest expense, other accrued liabilities where no cash outflow was in‐ volved 10 © 2018 Association of International Certified Professional Accountants. All rights reserved. • Subsequent write ups or write downs to fair value to recognize unrealized gains and losses on marketa‐ ble investments • Derivative instruments where cash inflows or outflows were not involved as well as the mark to market for fair value changes Because modified cash‐basis frameworks do not involve financial statement elements resulting from accruals and noncash transactions or events, it is unlikely that an acceptable modified cash‐basis framework would ever be materially equivalent to GAAP. However, it is important for financial statement preparers to avoid attempting to make certain modifications to GAAP financial statements and then referring to those financial statements as modified cash‐basis financial statements. For example, financial statements that are presented in conformity with GAAP, except that material leases are not capitalized, are not considered modified cash‐basis financial statements. Such financial statements are considered GAAP financial statements with a material departure due to the failure to capitalize material leases. The preparer will need to use judgment in determining if modified “cash‐basis” statements are tantamount to financial statements purported to be prepared in accordance with GAAP with material departures therefrom. Tax‐Basis of Accounting The tax‐basis is a basis of accounting that the entity uses to file its federal income tax or federal information re‐ turn for the period covered by the financial statements. The tax‐basis of accounting is based on the principles and rules for accounting for transactions under the federal income tax laws and regulations. Few new measurement guidelines need to be established because the method is based on tax laws. The tax‐basis of accounting covers a range of alternative bases, from cash to full accrual, depending on the nature of the taxpayer, and in some circumstances, the taxpayer’s elections. An entity need not be a taxable entity to prepare tax‐basis financial statements. Any entity that files a return with the IRS, either an income tax return or an information return, may prepare tax‐basis financial statements. Therefore, not‐for‐profit organizations, C corporations, S corporations, partnerships, limited liability partner‐ ships, limited liability companies, and sole proprietors may all use the tax‐basis of accounting. The tax‐basis of accounting is most useful for small, nonpublic entities whose financial statement users are in‐ terested primarily in the tax aspects of their relationship with the entity. For example, investors in tax‐driven partnerships, such as those commonly employed in the real estate industry, may be primarily interested in the tax consequences of transactions. However, they may want more information than would be provided by a tax return. Determining Whether to Prepare and Issue Cash‐ or Tax‐Basis Financial Statements As long as the entity is not contractually or otherwise required to issue financial statements prepared in accord‐ ance with GAAP or a regulatory or contractual basis of accounting, the entity may prepare and issue cash‐ or tax‐ basis financial statements. Understanding the needs of the financial statement users is an important step in de‐ termining whether to prepare and issue cash‐ or tax‐basis financial statements. If the users of the financial statements understand the presentation, and if the information presented when applying that basis of account‐ ing is relevant to their needs, then the preparer may determine that it is useful and appropriate to prepare and issue cash‐ or tax‐basis financial statements. The following are characteristics of entities that generally are good candidates to prepare cash‐ or tax‐basis financial statements: © 2018 Association of International Certified Professional Accountants. All rights reserved. 11 a. The entity’s creditors do not need or require financial statements prepared in accordance with GAAP. b. The cost of complying with GAAP would exceed the benefits (for example, a small construction contrac‐ tor who would be required to account for long term contracts using the percentage of completion method and would be required to compute deferred taxes). c. The owners are closely involved in the day‐to‐day operations of the business and have a fairly accurate picture of the entity’s financial position. d. The owners are primarily interested in cash flows (for example, a professional corporation of physicians that distributes its cash‐basis earnings through salaries, bonuses, and retirement plan contributions). e. The owners are primarily interested in the tax implications of transactions (for example, partners in a partnership who are concerned about the effects of transactions on their personal tax returns). f. It may not be appropriate to prepare and issue cash‐ or tax‐basis financial statements if the entity is or soon will be required to issue GAAP‐basis financial statements. For example, management of a company that is anticipating selling its business may be required to issue financial statements prepared in accord‐ ance with GAAP. Additionally, financial statements prepared when applying the cash‐ or tax‐basis of accounting should not be is‐ sued if the results are misleading. Cash‐ and tax‐basis financial statements are intended to be a cost‐effective al‐ ternative to GAAP, not a way to deliberately mislead financial statement users. Example Situation In Which it May Not Be Prudent to Issue Tax‐Basis Financial Statements • Long Street Partners has typically issued tax‐basis financial statements because the partners are more interested in the tax treatment of partnership transactions. Outside creditors have also accepted the tax‐basis financial statements as suitable for their needs. During the current year, two events occur that significantly affect the partnership: Several large customers experience financial difficulty and the part‐ nership’s receivables from the customers are in danger of not being collected. If the financial statements were prepared in accordance with GAAP, the partnership would be required to record a valuation al‐ lowance and recognize a bad debt expense. Under the tax rules, the partnership uses the direct write‐off method, so a tax deduction may not be allowed in the current year. • The partnership has acknowledged that it is obligated to perform an environmental remediation at one of its sites. If the financial statements were prepared in accordance with GAAP, the partnership would be required to recognize the liability and a loss. Although the entity may disclose the information in a risks and uncertainties note, under the tax rules, the deduction is not allowed until the amount is paid and therefore would not be included in the income statement equivalent. • Prior to preparing and issuing tax‐basis financial statements, in determining whether the proposed fi‐ nancial reporting framework is appropriate, the preparer may consider the following: — Whether the tax‐basis financial statements continue to be suitable for the users’ needs. In the example, the entity had a long history of issuing tax‐basis financial statements, which were suit‐ 12 © 2018 Association of International Certified Professional Accountants. All rights reserved. able for the needs of the users. The events in the current year merely illustrate the limitations of tax‐basis financial statements. — Appropriateness of disclosure. The preparer may determine to expand on the information in‐ cluded in the notes to the financial statements about these two events. For example, the part‐ nership might disclose the nature of the environmental remediation liability and the amounts involved. — Recognition may be appropriate. Depending on the nature and magnitude of the item, it may be appropriate to recognize it in the financial statements. In this example, the partnership might decide to account for bad debts using the allowance method and to recognize a contingent lia‐ bility for the remediation obligation. This would be a departure from the tax‐basis of accounting and the management of the entity may determine that, in the circumstances, it may be more appropriate to prepare its financial statements in accordance with GAAP. — Consider GAAP financials. As a result of the changed circumstances, financial statements pre‐ pared when applying the cash‐ or tax‐basis of accounting may no longer be appropriate, and the management of the entity may decide to prepare its financial statements in accordance with GAAP. Deciding Between Modified Cash‐ or Accrual Tax‐Basis Financial Statements In some situations it may be difficult to determine whether to issue modified cash‐ or accrual tax‐basis financial statements. Each basis has its own distinct advantages and disadvantages. Modified Cash‐ or Accrual Tax‐Basis Advantages and Disadvantages of Each Advantages Disadvantages Modified Cash‐Basis • Can be simpler to prepare than tax‐ basis • Not affected by changes in tax laws • Interim financial statements are easy to prepare • Recognition and measurement prin‐ ciples are not well‐defined • Not well‐suited for entities that have inventory or complex operations Accrual Tax‐Basis • Better‐suited for entities with inven‐ tory or complex operations • Well‐defined recognition and meas‐ urement criteria • Decisions made for tax reporting purposes may have unintended fi‐ nancial reporting effects • Accounting treatments are affected © 2018 Association of International Certified Professional Accountants. All rights reserved. 13 Advantages Disadvantages by changes in tax laws 14 © 2018 Association of International Certified Professional Accountants. All rights reserved. Chapter 2 Recognition and Measurement Issues in Financial Statements Prepared When Applying the Cash‐ or Tax‐Basis of Accounting The determination of what information should be reported in the financial statements and when to recognize transactions or events (recognition), and how to record transactions or events and at what amounts (measure‐ ment) varies depending on the type of framework used to prepare the financial statements. This chapter in‐ cludes a discussion of recognition and measurement issues for cash‐, modified cash‐, and tax‐basis financial statements. Cash‐Basis and Modified Cash‐Basis Observations and Suggestions In accordance with the master glossary included in the FASB Accounting Standards Codification® , cash equiva‐ lents are short‐term, highly liquid investments that have both of the following characteristics: a. Readily convertible to known amounts of cash b. So near their maturity that they present insignificant risks of changes in value because of changes in in‐ terest rates Generally, only investments with original maturities of three months or less qualify under that definition. Origi‐ nal maturity means original maturity to the entity holding the investment. For example, both a three‐month U.S. Treasury bill and a three‐year U.S. Treasury note purchased three months from maturity qualify as cash equiva‐ lents. However, a Treasury note purchased three years ago does not become a cash equivalent when its remain‐ ing maturity is three months. Examples of items commonly considered to be cash equivalents are Treasury bills, commercial paper, money market funds, and federal funds sold (for an entity with banking operations). The following represents certain significant measurement and recognition issues with respect to the cash‐ and modified‐cash bases of accounting. Investments In accordance with the cash‐basis of accounting, entities would reflect purchases of investments as cash dis‐ bursements and sales of investments as cash receipts in the period that the cash is disbursed or received. In‐ vestments acquired via noncash transactions should not be recorded and unrealized gains and losses should not be recognized. A common modification to the cash‐basis of accounting is to record investments in marketable securities as as‐ sets. If the entity prepared its financial statements in accordance with accounting principles generally accepted in the United States of America (GAAP), the investments would be reflected in the balance sheet. As such, the investments would be initially recorded at cost and subsequent unrealized changes in value would be recorded to reflect the fair value of the investments. Because unrealized gains and losses are not the result of a cash © 2018 Association of International Certified Professional Accountants. All rights reserved. 15 transaction or event, such unrealized gains and losses should not be recorded in financial statements when ap‐ plying a modified cash‐basis of accounting. Instead, the investments would remain on the balance sheet equiva‐ lent at cost unless and until they become worthless or are sold. Receivables Receivables should not be recognized in financial statements prepared when applying the cash basis of account‐ ing unless the receivables result from an outflow of cash. Other receivables such as those arising from sales transactions made on credit should not be recorded. Property and Equipment Under the cash‐basis of accounting, purchases of property and equipment would be reflected in the financial statements as cash disbursements in the period the transaction occurred. The assets would not be capitalized and depreciation would not be recorded. A common modification to the cash‐basis of accounting is to record property and equipment arising from cash transactions as assets. Once the modification is made, the entity should adopt and consistently apply an alloca‐ tion policy (depreciation or amortization) that has substantial support in the accounting literature and is logical. Such policy should also include recording any financing arrangements that are part of a cash transaction. As part of this policy, management of the entity should consider how it would address single‐step transactions or events that may not directly involve a cash inflow or outflow but may nevertheless be recorded as an in‐substance two‐ step cash transaction or event. See chapter 1, “Overview of Cash‐ and Tax‐Basis Financial Statements,” for dis‐ cussion of in‐substance two‐step transactions. Donated assets should not be recognized as “assets” because they are not derived from the use of cash or cash equivalents. It would be appropriate to write off any remaining carrying value of property and equipment once the assets are no longer in use or have been permanently impaired. Bank Overdrafts Bank overdrafts may be netted with other cash balances from the same bank. Bank overdrafts should not be netted against funds held at another financial institution. If the entity has an overall negative cash balance from a financial institution, when applying the cash‐basis of accounting, the negative cash balance would be shown as a liability on the balance sheet equivalent, if one is presented. For example, if the net balance in Bank A is $(1,000) and the net balance in Bank B is $5,000, the balance sheet equivalent would show a cash asset of $5,000 and the $(1,000) overdraft as a liability. If the entity has an overall global negative cash balance, the neg‐ ative cash balance would be shown as negative cash on hand at the end of the period on the statement of cash receipts and disbursements. Borrowings When applying the cash‐basis of accounting, the entity should record all proceeds from borrowings as cash re‐ ceipts when received and then reflect the principal repaid and associated interest as cash disbursements when paid. If a loan provides direct financing of an asset, neither the loan nor the asset should be recorded. However, 16 © 2018 Association of International Certified Professional Accountants. All rights reserved. the principal and interest payments would be reflected as cash disbursements when paid. See chapter 1 for dis‐ cussion of in‐substance two‐step transactions. Tax‐Basis In tax‐basis financial statements, transactions are recognized and measured in the same manner as they are in the entity’s federal tax return. Therefore, the preparer of financial statements when applying the tax‐basis of ac‐ counting is required to understand the federal tax laws applicable to the particular entity. Although this chapter highlights certain common measurement and recognition issues with respect to the tax‐basis of accounting, it is not a substitute for understanding the federal tax laws applicable to the particular entity. Additionally, although the IRS permits all entities to use the accrual method of accounting for tax purposes, many smaller entities can instead elect to use the cash method of accounting for tax purposes. Entities with in‐ ventories are required to use the accrual method for sales and purchases of inventory. Nontaxable Revenues and Nondeductible Expenses Under federal income tax laws, certain revenue is not taxable and certain expenses are not deductible. For ex‐ ample, receipts such as interest on obligations of state and local governments and proceeds from life insurance policies are not taxable. Costs such as premiums paid on officers’ life insurance policies are not deductible. When presenting tax‐basis financial statements, in order to be transparent, preparers of tax‐basis financial statements may recognize nontaxable revenues and nondeductible expenses outside of taxable income. Nontaxable revenues should be recognized when received (cash‐basis) or when earned (accrual basis). Nonde‐ ductible expenses should be reported and charged to expense in the period paid (cash‐basis) or when incurred (accrual basis). Additional Income Taxes for Prior Years An IRS exam may result in additional income taxes being assessed for prior years. Two alternative methods may be used to account for additional taxes for prior years. • The amount may be charged to expense in the current period if there are no corresponding adjustments to the balance sheet equivalent for expenses capitalized or revenue recognized. • The amount may be treated as a prior period adjustment and charged to retained earnings in a manner that is logical and consistent with the equivalent of a presentation in accordance with GAAP. The IRS may disallow amounts charged to expense in prior years and require those amounts to be capitalized and amortized or may require recognition of previously unreported revenue. Such amounts, net of income tax adjustments, should be treated as prior period adjustments. Otherwise, either of the preceding methods is con‐ sidered acceptable. The method used and the amount of additional taxes should be disclosed in the notes to the financial statements. Accounting Changes for Tax Purposes For tax purposes, the effects of an accounting change may be recognized prospectively over a specified number of years. Accounting changes should be treated in the same manner as they are treated in the tax return. © 2018 Association of International Certified Professional Accountants. All rights reserved. 17 S Corporations Income of an S corporation is taxable to its shareholders. Consequently, such a corporation may be required to maintain information on distinct classes of retained earnings. However, in tax‐basis financial statements, S cor‐ porations usually report retained earnings as a single amount and should report distributions to stockholders. Significant Differences Between GAAP and Tax‐Basis There are many differences between the way items are accounted for in accordance with GAAP and the way they are treated under the tax rules. Some of the more common include the following: • Bad debt losses on uncollectible receivables • Inventory capitalization and valuation • Unrealized gains on investment securities • Depreciation and impairment of capital assets • Fair value measurements • Consolidation 18 © 2018 Association of International Certified Professional Accountants. All rights reserved. Chapter 3 Presentation and Disclosure Issues in Financial Statements Prepared When Ap‐ plying the Cash‐ or Tax‐Basis of Accounting The determination of the form and content of the financial statements or which financial statements to present and what to include (presentation and disclosure) varies depending on the financial reporting framework ap‐ plied. Financial statements prepared when applying the cash‐ or tax‐basis of accounting may provide less complex and more understandable alternatives to financial statements prepared in accordance with accounting principles generally accepted in the United States of America (GAAP). However, preparers must be knowledgeable of GAAP disclosure requirements because cash‐ and tax‐basis financial statements should include informative disclosures similar to those required by GAAP if the financial statements contain items that are the same as, or similar to, those in financial statements prepared in accordance with GAAP. Observations and Suggestions Often, preparers of cash‐ and tax‐basis financial statements elect to omit substantially all disclosures required by the cash‐ or tax‐basis of accounting. The omission of disclosures is a departure from the cash‐ or tax‐basis of ac‐ counting and, if such disclosures were included in the financial statements, they might influence the user’s con‐ clusions about the entity’s financial position, results of operations, and cash flows. However, the omission may not necessarily result in misleading financial statements provided that the intended users are informed about such matters. If cash‐ or tax‐basis financial statements contain items for which GAAP would require disclosure, the financial statements may either provide the relevant disclosure that would be required for those items in a GAAP presen‐ tation or provide information that communicates the substance of that disclosure. This may result in substitut‐ ing qualitative information for some of the quantitative information required for GAAP presentations. For exam‐ ple, • disclosure of the repayment terms of significant long‐term borrowings may sufficiently communicate in‐ formation about future principal reduction without providing the summary of principal reduction during each of the next five years. • information about the effects of accounting changes, discontinued operations, and extraordinary items could be disclosed in a note to the financial statements without following the GAAP presentation re‐ quirements in the income statement equivalent or disclosing net‐of‐tax effects. • instead of showing expenses by their functional classifications with respect to the financial statements of a not‐for‐profit organization, a statement of activities could present expenses according to their natu‐ ral classifications, and a note to the financial statements could use estimated percentages to communi‐ cate information about expenses incurred by the major program and supporting services. • instead of showing the amounts of, and changes in, the unrestricted and temporarily and permanently restricted classes of net assets with respect to the financial statements of a not‐for‐profit organization, a © 2018 Association of International Certified Professional Accountants. All rights reserved. 19 statement of assets, liabilities, and net assets could report total net assets or fund balances, a related statement of activities could report changes in those totals, and a note to the financial statements could provide information, using estimated or actual amounts or percentages, about the restrictions on those amounts and on any deferred restricted amounts, describe the major restrictions, and provide infor‐ mation about significant changes in restricted amounts. For financial statements prepared when applying the cash‐ or tax‐basis of accounting, GAAP disclosure require‐ ments that are not relevant to the measurement of the item need not be considered. To illustrate, • fair value disclosures for investments in debt and equity securities would not be relevant when the basis of presentation does not adjust the cost of such securities to their fair value. • disclosures related to actuarial calculations for contributions to defined benefit plans would not be rele‐ vant in financial statements prepared when applying the cash‐ or tax‐basis of accounting. • disclosures related to the use of estimates would not be relevant in a presentation that has no esti‐ mates, such as the cash‐ or modified cash‐basis of accounting. Financial statements prepared when applying the cash‐basis of accounting generally do not include a statement of cash flows. However, depending on the user’s requirements, financial statements prepared when applying a modified cash‐ or the tax‐basis of accounting may include a statement of cash flows. For example, it may be challenging for users to obtain accurate information on operating, investing, and financing activities in single‐ year financial statements prepared when applying the tax‐basis of accounting unless a statement of cash flows is presented. Similar to financial statements prepared in accordance with GAAP, in order to achieve fair presentation, financial statements prepared when applying the cash‐ or tax‐basis of accounting should include all informative disclo‐ sures that are appropriate for the applicable financial reporting framework, including all significant matters that materially affect the financial statements’ use, understanding, and interpretation. Additionally, because financial statements prepared when applying the cash‐ or tax‐basis of accounting have certain inherent presentation and disclosure limitations, in order to enhance the value and usefulness of such fi‐ nancial statements, the preparer may disclose additional information in the notes to the financial statements. For example, donated capital assets would not be included in the balance sheet equivalent in financial state‐ ments prepared when applying a modified cash‐basis of accounting—even if the modification to the cash‐basis of accounting is to record capital expenditures as assets and depreciate them over their estimated useful lives. The preparer may elect to disclose the value of such donated capital assets in the notes to the financial state‐ ments. Presentation—Cash‐Basis Financial Statements Because a balance sheet equivalent would simply show the cash balance and a corresponding equity account, and a statement of cash flows would be repetitive of the statement of cash receipts and disbursements, finan‐ cial statements prepared when applying the cash‐basis of accounting may consist only of a statement of cash re‐ ceipts and disbursements. Although a single statement may be presented, informative disclosures are still nec‐ essary. Additionally, restrictions on cash balances should either be presented on the face of the statement of cash receipts and disbursements or should be disclosed in the notes to the financial statements. 20 © 2018 Association of International Certified Professional Accountants. All rights reserved. Basis of Accounting A required disclosure for all cash‐ and tax‐basis financial statements is the description of the basis of accounting (financial reporting framework), including how that basis of accounting differs from GAAP. Although these dif‐ ferences from GAAP should be qualitatively described, they need not be quantified. This description is important in financial statements prepared when applying a modified cash‐basis of accounting because such financial statements may vary depending on the modifications to the cash‐basis that were made. The description there‐ fore becomes essential to the user’s understanding of the financial statements. The description of the basis of accounting is usually presented in the summary of significant accounting policies section of the notes to the financial statements with a heading such as “Basis of Accounting.” The following ex‐ amples represent how the basis of accounting may be disclosed in the notes to financial statements prepared when applying the cash‐, a modified cash‐, and the tax‐basis of accounting. Example: Basis of Accounting Note—Cash‐Basis of Accounting Basis of Accounting The financial statements of Company X have been prepared on the cash‐basis of accounting, which is a compre‐ hensive basis of accounting other than accounting principles generally accepted in the United States of America (GAAP). The cash‐basis of accounting differs from GAAP primarily because revenues are recognized when re‐ ceived rather than when earned and expenses are recorded when paid rather than when incurred. The financial statements therefore present only cash and cash equivalents and changes therein in the form of cash receipts and disbursements. Example: Basis of Accounting Note—Modified Cash‐Basis of Accounting Basis of Accounting The financial statements of Company X have been prepared on the cash‐basis of accounting, modified to record assets or liabilities with respect to cash transactions and events that provide a benefit or result in an obligation that covers a period greater than the period in which the cash transaction or event occurred. The modifications result in the recording of investments, inventories, capital assets, and related short‐term and long‐term obliga‐ tions on the statement of financial position. This method of accounting represents a comprehensive basis of ac‐ counting other than accounting principles generally accepted in the United States of America (GAAP). This basis of accounting differs from GAAP primarily because certain revenue and related assets (such as accounts receiva‐ ble and revenue for billed or provided services not yet collected, and other accrued revenue and receivables) have been recognized when received rather than when earned and certain expenses and related liabilities (such as accounts payable and expenses for goods or services received but not yet paid, and other accrued liabilities and expenses) have been recognized when paid rather than when the obligations were incurred. Example: Basis of Accounting Note—Tax‐Basis of Accounting Basis of Accounting The financial statements of Company X have been prepared on the accrual basis of accounting that the Company uses for filing its federal income tax return, which is a comprehensive basis of accounting other than accounting principles generally accepted in the United States of America (GAAP). This basis differs from GAAP primarily be‐ © 2018 Association of International Certified Professional Accountants. All rights reserved. 21 cause the Company expenses the cost of certain types of assets in accordance with IRC Section 179. GAAP re‐ quires that such assets be capitalized and expensed over their estimated useful lives. Summary of Significant Accounting Policies FASB Accounting Standards Codification (ASC) 235, Notes to Financial Statements, requires that financial state‐ ments prepared in accordance with GAAP include a summary of significant accounting policies in the notes to the financial statements. Accordingly, cash‐ and tax‐basis financial statements should include a summary of sig‐ nificant accounting policies in the notes to the financial statements. In addition to the basis of accounting discussed previously, the note should include disclosure of the significant accounting policies used to prepare the financial statements, including policies that involve the following: • A selection from existing acceptable alternatives • Industry specific applications • Unusual or innovative applications of accounting principles Because the cash‐basis of accounting does not include the recognition of noncash assets, liabilities, and noncash transactions, elaborate accounting policy disclosures are usually unnecessary. In financial statements prepared when applying a modified cash‐basis of accounting, such disclosures may include information about the follow‐ ing: • Investments • Inventory • Property and equipment • Income taxes • Consolidation • Related parties and related party transactions • Commitments and contingencies • Uncertainties • Subsequent events • Asset impairments The significant accounting policies note for tax‐basis financial statements should include disclosure of the follow‐ ing: • Whether the basic method of accounting is cash or accrual 22 © 2018 Association of International Certified Professional Accountants. All rights reserved. • The tax filing status of the entity, if other than a taxable corporation (that is, a C corporation) • That revenues and related assets and expenses and related obligations are recognized only when they are reported or deducted for federal income tax purposes • That nontaxable income and nondeductible expenses are included in the determination of the equiva‐ lent of operating results or “net income” • The nature of any optional tax methods of accounting followed • The nature of any important judgments or policies necessary for an understanding of the methods of recognizing revenue and allocating costs to current and future periods • Tax uncertainties including open tax years Also, tax uncertainties should be addressed in financial statements prepared when applying the cash‐ or tax‐ basis of accounting. FASB ASC 740‐10‐50‐15 requires that open tax years be disclosed—even if the reporting en‐ tity is a pass‐through entity or a not‐for‐profit organization. In addition, in financial statements prepared when applying the tax‐basis of accounting, disclosures regarding significant accounting policies may include information about receivables. The following represents guidance on certain other common presentation and disclosure issues with respect to cash‐ and tax‐basis financial statements. Subsequent Events FASB ASC 855, Subsequent Events, sets forth general standards of accounting for and disclosure of events that occur after the balance sheet date but before the financial statements are issued or are available to be issued. The preparer should disclose the date through which subsequent events have been evaluated, which is the date the financial statements are available to be issued. When financial statements prepared when applying the cash‐ or tax‐basis of accounting contain items that are the same as, or similar to, those in financial statements pre‐ pared in accordance with GAAP, such financial statements should contain the disclosures required by FASB ASC 855. Related Party Transactions The existence of related party transactions that are material individually or in the aggregate and the nature and amounts of the transactions and balances should be disclosed. Note that the tax rules may define “related par‐ ty” differently than how it is defined in accordance with GAAP. To avoid confusion on the part of users of the tax‐basis financial statements, the GAAP definition of related party should be considered for all financial report‐ ing purposes. Commitments and Contingencies The existence and nature of material commitments and contingencies should be disclosed in the notes to finan‐ cial statements prepared when applying the cash‐ or tax‐basis of accounting. © 2018 Association of International Certified Professional Accountants. All rights reserved. 23 Pension Plans The existence and nature of a pension plan should be disclosed in the notes to financial statements when apply‐ ing the cash‐ or tax‐basis of accounting. Assets and Liabilities Information disclosed for assets and liabilities commonly includes the following items: • Restricted cash, segregated from cash available for current operations, with a description of the nature of the restriction • The aggregate fair value of investments in marketable securities • Accounts and notes receivable from officers, employees, and affiliates, presented separately with disclo‐ sure of the effective interest rate on notes receivable, and interest income for the period • The major classes of property, plant, and equipment; depreciation expense for the period; the meth‐ od(s) used in computing depreciation; and the aggregate, accumulated depreciation • The method of determining inventory cost (for example, last in, first out and first in, first out) Owners’ Equity The financial statements often include disclosures regarding information on owners’ equity as follows: • For each class of stock, the number of shares authorized, issued, and outstanding; the par or stated val‐ ue; and, in summary form, the pertinent rights and privileges of each outstanding class (if more than one class is outstanding) • The existence of stock option and stock purchase plans • Restrictions on the payment of dividends • Changes for the period in the separate components of owners’ equity A note to the financial statements of a voluntary health and welfare organization that prepares tax‐basis finan‐ cial statements could provide information, using estimated or actual amounts or percentages, about the re‐ strictions on total net assets or fund balances and on any deferred restricted amounts, describe the major re‐ strictions, and provide information about significant changes in restricted amounts. Risks and Uncertainties Financial statements prepared in accordance with GAAP are required to include a number of disclosures with re‐ spect to risks and uncertainties. The following table summarizes these disclosures and how GAAP requirements for disclosing risks and uncer‐ tainties should be addressed in cash‐ and tax‐basis financial statements. The table is not meant to be all‐ inclusive. 24 © 2018 Association of International Certified Professional Accountants. All rights reserved. Observations and Suggestions Often, preparers of cash‐ and tax‐basis financial statements elect to omit substantially all disclosures required by the cash‐ or tax‐basis of accounting. The omission of disclosures is a departure from the cash‐ or tax‐basis of ac‐ counting and, if such disclosures were included in the financial statements, they might influence the user’s con‐ clusions about the entity’s financial position, results of operations, and cash flows. However, the omission may not necessarily result in misleading financial statements provided that the intended users are informed about such matters. GAAP Requirement Summary of Required Disclosures Applicability to Cash‐ or Tax‐ Basis of Accounting Nature of Operations Entities should disclose a de‐ scription of the major products or services the reporting entity sells or provides and its principal markets. This information is use‐ ful because it helps financial statement users understand the nature of the entity’s business and the risks common to that business. This disclosure is relevant to all financial statements prepared in accordance with the cash‐ or tax‐ basis of accounting and should be made. Use of Estimates Financial statements should in‐ clude an explanation that the preparation of financial state‐ ments in accordance with GAAP requires the use of manage‐ ment’s estimates. This disclosure may not be rele‐ vant to some financial state‐ ments prepared in accordance with the cash‐ or tax‐basis of accounting; for example, finan‐ cial statements prepared on the cash‐basis that do not include estimated amounts. Certain Significant Estimates If certain criteria are met, the entity is required to disclose the nature of an uncertainty if it is at least reasonably possible that a change in an estimate will occur in the near term. The purpose of the disclosure is to communicate to financial statement users that there is a reasonable possibility that certain estimated amounts in the current year financial statements will change signifi‐ cantly and affect the subsequent years’ financial statements. If the GAAP disclosure criteria are met, the financial statements should include disclosure of the information required by GAAP. Vulnerability Due to Concentra‐ If certain criteria are met, the If the GAAP disclosure criteria © 2018 Association of International Certified Professional Accountants. All rights reserved. 25 GAAP Requirement Summary of Required Disclosures Applicability to Cash‐ or Tax‐ Basis of Accounting tions financial statements are re‐ quired to include disclosure in‐ formation about its vulnerability due to concentrations; for ex‐ ample, significant volume of business conducted with one customer. are met, the preparer should disclose the information re‐ quired by GAAP. Going Concern A basic premise underlying fi‐ nancial reporting is that a user of the financial statements can as‐ sume that the entity will contin‐ ue as a going concern for a rea‐ sonable period of time. If the preparer concludes that material uncertainties exist such that the entity may not continue as a go‐ ing concern for a reasonable pe‐ riod of time, the financial state‐ ments should include disclosure of such uncertainty. If the preparer concludes that there is substantial doubt about the entity’s ability to continue as a going concern for a reasonable period of time (generally one year from the date of the bal‐ ance sheet equivalent), the pre‐ parer should disclose the going concern considerations in a note to the financial statements. Terminology for Cash‐ and Tax‐Basis Financial Statements There is no requirement to modify financial statement titles in cash‐ or tax‐basis financial statements. However, users of such financial statements should be able to readily identify the basis of accounting used to prepare the financial statements. A common and convenient way of identifying the basis of accounting is through the finan‐ cial statement titles by adding “cash‐basis,” “modified cash‐basis,” or “tax‐basis” after the financial statement ti‐ tle. Cash‐basis financial statements might be titled, for example, • Statement of Assets and Liabilities Arising from Cash Transactions; • Statement of Revenue Collected and Expenses Paid; • Statement of Revenue and Expenses—Cash‐Basis; or • Statement of Cash Receipts and Disbursements. Modified cash‐basis financial statements might be titled, for example, • Statement of Assets and Net Assets—Modified Cash‐Basis; or • Statement of Revenue, Expenses and Changes in Net Assets—Modified Cash‐Basis. Tax‐basis financial statements might be titled, for example, 26 © 2018 Association of International Certified Professional Accountants. All rights reserved. • Statement of Assets, Liabilities, and Capital—Tax‐Basis; • Statement of Operations—Tax‐Basis; or • Statement of Revenue and Expenses—Tax‐Basis. The preceding examples are not meant to be all‐inclusive and are not the only acceptable titles. With respect to the captions to be used with the cash‐, modified cash‐, or tax‐basis financial statements, there is no requirement to modify the standard GAAP financial statement captions. Therefore, captions such as “net in‐ come,” “net loss,” and “retained earnings” are acceptable. However, if modifications are desired (which many preparers prefer as a means of additional emphasis that the financial statements are not prepared in accordance with GAAP), common examples for cash‐basis financial statements are excess of revenue collected over expenses paid and excess of expenses paid over revenue collected. For financial statements prepared when applying a modified cash‐basis of accounting, common modifications are excess of revenue over expenses and excess of ex‐ penses over revenue. With respect to tax‐basis financial statements, modifications with respect to financial statement captions are rarely made. However, modifications, if made, may include retained earnings—tax‐basis and net income—tax‐basis. Consolidation Accounting Professional judgment should be applied to determine which presentation—consolidated, unconsolidated, or combined—provides the most meaningful and relevant information. A preparer should not consolidate entities unless all entities to be consolidated use the same basis of accounting. For example, it would not be appropriate to consolidate an entity that prepares its financial statements using a modified cash‐basis of accounting with its parent who maintains its books and records in accordance with the tax‐basis of accounting. If the modified cash‐ basis of accounting is used, then all consolidated entities should utilize the same modifications to the cash‐basis of accounting. With respect to financial statements prepared when applying the tax‐basis of accounting, consolidation is based on the IRC. Therefore, the consolidation requirements of FASB ASC 810, Consolidation, do not apply. However, if the entity files a consolidated tax return, it should report consolidated results on its tax‐basis financial state‐ ments. In the case of brother‐sister corporations in which each entity maintains its books and records on the tax‐basis of accounting, but a consolidated tax return is not filed, the preparer may prepare combined financial statements because such financial statements may be more useful to users than individual uncombined financial statements. Although the tax consolidation rules are followed, additional disclosures may be necessary to lessen the chance that the financial statements are not misleading. Consider, for example, a 60 percent owned subsidiary that would be consolidated in financial statements prepared in accordance with GAAP but is not consolidated in fi‐ nancial statements prepared when applying the tax‐basis of accounting because the threshold for consolidation under the IRC is 80 percent ownership. Even though the subsidiary is not consolidated, the preparer should con‐ sider which disclosures are appropriate relative to the 60 percent owned subsidiary. Examples of matters that might require disclosure are the ownership and relationship with the subsidiary, related party transactions, guarantees, and commitments. © 2018 Association of International Certified Professional Accountants. All rights reserved. 27 Change From GAAP to Cash‐ or Tax‐Basis A change from GAAP to cash‐ or tax‐basis statements (or vice versa) does not represent a change in accounting principles as described in FASB ASC 250, Accounting Changes and Error Corrections. Therefore, no justification for the change is required, and a cumulative effect adjustment is unnecessary. When only the current year’s cash‐ or tax‐basis statements are presented, there are three ways of presenting opening equity: • Show opening equity as previously reported in accordance with GAAP, with an adjustment to convert to the cash‐ or tax‐basis. • Show opening equity on the as‐adjusted cash‐ or tax‐basis. • Show the effects of the adjustment to convert as a cumulative‐effect adjustment in the income state‐ ment equivalent. If comparative financial statements are presented, the prior periods should be restated and presented on the basis to which the company has changed. Restatement is necessary to ensure comparability between all periods presented. In all cases, the change in accounting basis should be disclosed in the notes to the financial statements. The fol‐ lowing is an example of how such a change in accounting basis could be disclosed in the notes to the financial statements: In 20X1, management adopted a policy of preparing its financial statements on the basis of accounting that it uses to file its federal income tax return. Prior to 20X1, the Company’s financial statements were prepared in accordance with accounting principles generally accepted in the United States of America. Management believes that this change results in more relevant financial reporting that is easier and less costly to understand, apply, and use in the Company’s circumstances and considering the needs of the users of the financial statements. The 20X1 financial statements have been restated to be on the tax‐ basis of accounting. 28 © 2018 Association of International Certified Professional Accountants. All rights reserved. Appendix Illustrative Cash‐ and Tax‐Basis Financial Statements This appendix contains illustrative examples of financial statements prepared when applying the cash‐, modified cash‐, or tax‐basis of accounting for different types of entities. These financial statements are intended to illus‐ trate the significant discussion points in chapters 1–3 of this practice aid. Each financial statement has been an‐ notated to highlight these key points. Name of Entity Type of Entity Basis of Preparation Ceolainn Club Not‐for‐profit Cash Mickey’s Center Not‐for‐profit Modified Cash Donnelly & Oates Limited Liability Partnership Tax (Accrual Basis) Charlton Contractors, Inc. Construction Contractor Tax (Accrual Basis) Margaret Rose 1964 Irrevocable Trust Trust Tax (Accrual Basis) CEOLAINN CLUB FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 20X2 AND 20X1 Circumstances include the following: • The financial statements are for a not‐for‐profit membership club. • The financial statements are prepared on the cash‐basis of accounting. • The financial statements are comparative for the years ended June 30, 20X2, and 20X1. The financial statements illustrate the following: • The financial statements include a statement of functional expenses, which is required by accounting principles generally accepted in the United States of America (GAAP). Financial statements prepared when applying the cash‐basis of accounting are not required to include such a statement, but may in‐ stead communicate the substance of that requirement. • GAAP requires not‐for‐profit organizations to report the amount of unrestricted, temporarily restricted, and permanently restricted net assets on the face of the statement of financial position. Because a statement of financial position equivalent is not presented, the illustrative financial statements com‐ municate the substance of the GAAP requirement in the notes to the financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 29 Ceoliann Club Statements of Cash Receipts and Disbursements For the Years Ended June 30, 20X2 and 20X1 June 30, 20X2 June 30, 20X1 Cash received from support activities: Membership dues $ 49,899 $ 46,759 Donations 996 1,125 Programs 7,495 10,645 Total cash received from support activities 58,390 58,529 Cash received from other sources: Interest income 19 30 Other 300 3,720 Total cash received from other sources 319 3,750 TOTAL CASH RECEIVED $ 58,709 $ 62,279 Cash disbursed: Program services $ 29,110 $ 29,484 Supporting services 19,783 19,113 Fundraising 6,288 8,803 TOTAL CASH DISBURSED $ 55,181 $ 57,400 Excess of revenue collected over expenses paid 3,528 4,879 Cash and cash equivalents, beginning of year 39,046 34,167 Cash and cash equivalents, end of year $ 42,574 $ 39,046 See accompanying notes to financial statements. 30 © 2018 Association of International Certified Professional Accountants. All rights reserved. The Ceoliann Club Statements of Functional Expenses Cash‐Basis For the Years Ended June 30, 20X2 and 20X1 Program Services Supporting Services Fundraising Total June 30, 20X2 Program Services Supporting Services Fundraising Total June 30, 20X1 Salaries and benefits $ 23,333 $ 16,440 $ 4,241 $ 44,014 $ 23,633 $15,876 $ 5,937 $ 45,446 Events—special 1,795 1,795 2,513 2,513 Legal and ac‐ counting 2,320 2,320 2,500 2,500 Insurance 313 51 45 409 317 49 63 429 Postage/printing 3,477 3,477 3,398 3,398 Licenses/fees 114 114 464 464 Office expense 612 232 207 1.051 620 224 290 1,134 Miscellaneous 1,375 626 2,001 1,516 1,516 $ 29,110 $19,783 $6,288 $55,181 $29,484 $19,113 $8,803 $57,400 53% 36% 11% 52% 33% 15% See accompanying notes to financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 31 Ceolainn Club Notes to Financial Statements Cash‐Basis For the Years Ended June 30, 20X2 and 20X1 Note 1—Summary of Significant Accounting Policies Nature of Activities The Ceolainn Club (the Club) is a New York not‐for‐profit organization. The Club’s mission is to promote safe so‐ cial programs for young adults. Basis of Accounting The Club’s financial statements have been prepared on the cash‐basis of accounting, which is a comprehensive basis of accounting other than accounting principles generally accepted in the United States of America (GAAP). The cash‐basis of accounting differs from GAAP primarily because revenues are recognized when received rather than when earned and expenses are recorded when paid rather than when incurred. The financial statements therefore present only cash and cash equivalents and changes therein in the form of cash receipts and dis‐ bursements. Cash and Cash Equivalents The Club considers all highly liquid investments available for current use with an initial maturity of three months or less to be cash equivalents. As of June 30, 20X2, and 20X1, cash and cash equivalents consisted entirely of the adjusted book balance in the Club’s checking account. Net Assets As of June 30, 20X2, and 20X1, all of the Club’s net assets were unrestricted. Income Taxes The Club is exempt from federal and state income taxes under Internal Revenue Code Section 501(c)(7). Accord‐ ingly, no provision for income taxes has been made in the financial statements. Uncertain Tax Positions Federal and state income tax returns for the years 20X0 to date are subject to examination by taxing authorities. Subsequent Events Management has evaluated subsequent events through August 28, 20X2, which is the date the financial state‐ ments were available to be issued. 32 © 2018 Association of International Certified Professional Accountants. All rights reserved. MICKEY’S CENTER FINANCIAL STATEMENTS AS OF AND FOR THE YEAR ENDED AUGUST 31, 20X2 Circumstances include the following: • The financial statements are for a not‐for‐profit charity. • The financial statements are prepared on a modified cash‐basis of accounting. The cash‐basis of ac‐ counting was modified to accrue cash transactions and events that provide a benefit or result in an obli‐ gation that covers a period greater than the period in which the cash transactions or events occurred. Such accruals resulted in the recording of property and equipment as assets on the statement of assets and net assets and subsequent depreciation of those assets over their estimated useful lives. • The financial statements are as of August 31, 20X2, and for the year then ended. The financial statements illustrate the following: • The financial statements include a statement of functional expenses, which is required by accounting principles generally accepted in the United States of America (GAAP). Financial statements prepared when applying a modified cash‐basis of accounting are not required to include such a statement, but may instead communicate the substance of that requirement. • GAAP requires not‐for‐profit organizations to report the amount of unrestricted, temporarily restricted, and permanently restricted net assets on the face of the balance sheet (in the case of the illustrative fi‐ nancial statements prepared on a modified cash‐basis of accounting, such point in time statement is re‐ ferred to as the statement of assets and net assets). The illustrative financial statements do not follow those presentation requirements but instead, communicate their substance by providing relevant in‐ formation in the notes to the financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 33 Mickey’s Center Statement of Assets and Net Assets Modified Cash‐Basis August 31, 20X2 Assets Cash and cash equivalents $ 316,258 Restricted cash (Note 2) 108,084 Property and equipment (net of accumulated de‐ preciation of $35,565) 9,018 $ 433,360 Net Assets Unrestricted net assets (Note 5) 433,360 Net assets $ 433,360 See accompanying notes to financial statements. 34 © 2018 Association of International Certified Professional Accountants. All rights reserved. Mickey’s Center Statement of Revenue, Expenses and Changes in Net Assets Modified Cash‐Basis For the Year Ended August 31, 20X2 Revenue Corporate and foundation contributions $ 536,134 Other contributions 235,920 Exchange club projects 105,302 Unsolicited and other donations 69,754 Total revenue 947,110 Expenses Program services 769,426 Management and general 100,718 Fundraising 55,264 155,982 Total expenses 925,408 Increase in net assets 21,702 Net assets, beginning of year 411,658 Net assets, end of year $ 433,360 See accompanying notes to financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 35 Mickey’s Center Statement of Functional Expenses Modified Cash‐Basis For the Year Ended August 31, 20X2 Program Services Management and General Fundraising Total Salaries and bene‐ fits $ 451,675 $ 76,781 $ 38,041 $ 566,497 Grant expense 41,291 41,291 Special events 77,790 13,233 91,023 Training 16,029 16,029 Professional ser‐ vices 16,810 16,810 Telephone 14,782 720 428 15,930 Postage/printing 6,176 301 178 6,655 Office supplies 16,597 809 481 17,887 Program materials 16,279 16,279 Depreciation 8,917 435 259 9,611 Rent 58,084 2,831 1,683 62,598 Miscellaneous 61,806 2,031 961 64,798 $ 769,426 $ 100,718 $ 55,264 $ 925,408 83% 11% 6% See accompanying notes to financial statements. 36 © 2018 Association of International Certified Professional Accountants. All rights reserved. Mickey’s Center Notes to Financial Statements Modified Cash‐Basis August 31, 20X2 Note 1—Summary of Significant Accounting Policies Nature of Activities Mickey’s Center (the Center) is a nonprofit corporation incorporated under the Texas Non‐Profit Corporation Act. The purpose of the Center is to use its funds exclusively for charitable, scientific, and educational purposes, especially the prevention of child abuse. Basis of Accounting The financial statements of the Center have been prepared on the cash‐basis of accounting, modified to record assets or liabilities with respect to cash transactions and events that provide a benefit or result in an obligation that covers a period greater than the period in which the cash transactions or events occurred. The modifica‐ tions result in the recording of capital assets on the statement of assets and net assets. Except for depreciation, all transactions are recognized as either revenue or expenses when received or paid in cash. Except for deprecia‐ tion, noncash transactions are not recognized. This basis of accounting represents a comprehensive basis of ac‐ counting other than accounting principles generally accepted in the United States of America (GAAP). This basis of accounting differs from GAAP primarily because certain revenue and related assets have been recognized when received rather than when earned and certain expenses and related liabilities have been recognized when paid rather than when the obligations were incurred. Property and Equipment Property and equipment are recorded at cost and consist of the office building and equipment. Depreciation is computed on the straight‐line method based on estimated useful lives of 30 years and 5 years for the office building and equipment, respectively. Cash Equivalents The Center considers all highly liquid debt instruments with an original maturity of three months or less to be cash equivalents. Contributions The Center records contributions when received in cash. Contributed Services Many individuals volunteer their time to help the Center with its educational activities. During the year ended August 31, 20X2, the Center received approximately 200 volunteer hours that have not been recorded in the statement of revenue, expenses, and changes in net assets. Functional Expenses © 2018 Association of International Certified Professional Accountants. All rights reserved. 37 The costs of providing the various programs, fundraising, and other activities have been summarized on a func‐ tional basis in the statement of functional expenses. Accordingly, certain costs have been allocated among the programs and fundraising activities benefited. Functional expenses are allocated to programs and supporting services based on specific identification. Expenses that relate to more than one program or support activity are allocated based on salary expenditure. Income Taxes The Center is exempt from federal and state income taxes under Internal Revenue Code Section 501(c)(3), ex‐ cept to the extent that it has taxable income from businesses that are not related to its tax exempt purpose. Un‐ related business income, if there was any, would be taxed at the applicable corporate income tax rate. The Cen‐ ter did not have any unrelated business income during the year ended August 31, 20X2, and accordingly, no pro‐ vision for income taxes has been made in the financial statements. The Center is not currently under examination by any taxing jurisdiction. Federal and state taxing authorities no longer have the right to examine tax years prior to 20Y9. For the year ended August 31, 20X2, there were no in‐ terest or penalties associated with tax positions recorded in the accompanying financial statements. Use of Estimates The preparation of financial statements on a modified cash‐basis of accounting requires management to make estimates and assumptions that affect financial statement amounts and disclosures. Actual results could differ from those estimates and assumptions. Subsequent Events In preparing these financial statements, management of the Center has evaluated events and transactions for potential recognition or disclosure through January 20, 20X3, the date the financial statements were available to be issued. Note 2—Restricted Cash The balance represents funds restricted by the board of directors in an amount equal to the balance in the School Initiatives Fund. Note 3—Commitments and Contingencies The land on which the Center’s office is located is being leased on an annual basis at a rate of $1,400 per annum. See Note 4. Note 4—Subsequent Events In September 20X2, the Center entered into a “purchase and sale agreement,” which provided for the purchase of a building in the amount of $230,000 and the assumption of a lease of the land on which the building is locat‐ ed. The building purchase was executed on September 28, 20X2, and was financed in part by a $220,000 note payable to a bank. The terms of the note provide for quarterly interest payments at the bank’s prime rate through the note maturity date. A $100,000 principal payment was due and made in December 20X2, and the remaining balance is due September 20X8. The note is secured by a leasehold deed of trust and security agree‐ ment and an assignment of rents and leases. 38 © 2018 Association of International Certified Professional Accountants. All rights reserved. The assumed lease previously referred to is an operating lease that requires annual payments of $19,600 through September 20X6. The Center has the option to terminate the lease in March 20X9. If the lease is not terminated, the annual payment will be revised to reflect 6 percent of the value of the land, which will be de‐ termined as set forth in the lease agreement. In December 20X2, the Center entered into a construction contract for $138,000 to design and construct certain building and leasehold improvements. Note 5—Internally Restricted Net Assets Net assets internally restricted for the School Initiatives Fund consist of amounts allocated from unrestricted net assets as approved by the board of directors. The internally restricted amounts are to be used for purchasing equipment and establishing programs for educational programs in schools and are not available for other pur‐ poses without approval by the board of directors. Note 6—Allocation of Joint Costs During the year ended August 31, 20X2, the Center conducted activities that included appeals for contributions and incurred joint costs of approximately $46,000. These activities included direct mail campaigns and special events. Approximately 65 percent of these joint costs were allocated to fundraising activities and 35 percent to program services. © 2018 Association of International Certified Professional Accountants. All rights reserved. 39 DONNELLY & OATES LIMITED LIABILITY PARTNERSHIP FINANCIAL STATEMENTS AS OF AND FOR THE YEAR ENDED DECEMBER 31, 20X2 Circumstances include the following: • The financial statements are for a limited liability partnership (LLP) that owns and operates a racquet and swim club. • The financial statements are prepared on basis of accounting that the LLP uses for federal income tax purposes. • The financial statements are as of and for the year ended December 31, 20X2. The financial statements illustrate the following: • The Statement of Revenues and Expenses uses the caption “Revenues in excess of expenses” to portray what a financial statement prepared in accordance with accounting principles generally accepted in the United States of America (GAAP) would describe as “Net income.” There is no prohibition on the use of “Net income” or other GAAP captions within the financial statements. In this situation, the entity has chosen the term because management believes it to be more descriptive. • The financial statements include a Statement of Cash Flows, which is not required for financial state‐ ments prepared when applying the tax‐basis of accounting. However, in this case, the financial state‐ ments include a single year only, thus it would be difficult for financial statement users to obtain accu‐ rately the information on operating, investing and financing activities presented in a statement of cash flows. 40 © 2018 Association of International Certified Professional Accountants. All rights reserved. Donnelly & Oates Limited Liability Partnership Statements of Assets, Liabilities and Partners’ Capital Tax‐Basis December 31, 20X2 Assets Cash 450,944 Accounts receivable 451,194 Inventory 311,214 Prepaid expenses and other assets 24,046 Financing fees, less accumulated amortization of $57,096 259,124 Syndication costs 312,166 Property and equipment, net of accumulated depreci‐ ation of $2,810,112 9,054,554 $ 10,863,242 Liabilities and Partners’ Capital Accounts payable $ 276,502 Accrued payroll and related costs 117,792 Other accrued expenses 23,998 Unearned dues 369,586 Mortgage payable $ 7,566,966 Total liabilities 8,354,844 Partners’ capital 2,508,398 $ 10,863,242 See accompanying notes. © 2018 Association of International Certified Professional Accountants. All rights reserved. 41 Donnelly & Oates Limited Liability Partnership Statement of Revenues and Expenses Tax‐Basis For the Year Ended December 31, 20X2 Revenues Membership dues $ 3,970,334 Initiation fees 389,638 Tennis court fees and lessons 1,103,224 Other income 726,936 Sports shop and café 1,219,740 Total revenues 7,409,872 Expenses Management fee 50,700 Maintenance and operating 504,448 Utilities 391,460 Advertising and promotions 191,088 Payroll and related costs 2,774,706 Insurance 136,984 Administrative 246,906 Real estate taxes 351,246 Cost of sales—sports shop and café 701,800 Total expenses 5,349,338 Net operating income 2,060,534 Partnership expenses (9,572) Interest expense (765,476) Depreciation and amortization (610,094) Loss on sale of equipment (4,240) Revenues in excess of expenses $ 671,152 See accompanying notes. 42 © 2018 Association of International Certified Professional Accountants. All rights reserved. Donnelly & Oates Limited Liability Partnership Statement of Partners’ Capital Tax‐Basis For the Year Ended December 31, 20X2 Limited Part‐ ners Special Limited Partner General Part‐ ner Partners’ Capi‐ tal Balance, December 31, 20X1 $ 1,017,392 $ 1,256,710 $ (69,276) $ 2,204,826 Cash distributions (238,924) (55,138) (73,518) (367,580) Revenues in excess of ex‐ penses 436,254 100,674 134,224 671,152 Balance, December 31, 20X2 $ 1,214,722 $ 1,302,246 $ (8,570) $ 2,508,398 See accompanying notes. © 2018 Association of International Certified Professional Accountants. All rights reserved. 43 Donnelly & Oates Limited Liability Partnership Statement of Cash Flows Tax‐Basis For the Year Ended December 31, 20X2 Cash flows from operating activities Revenues in excess of expenses $ 671,152 Adjustments to reconcile revenues in excess of ex‐ penses to cash flows from operating activities Depreciation and amortization 610,094 Loss on sale of equipment 4,240 (Increase) decrease in: Accounts receivable (23,494) Inventory (102,916) Prepaid expenses 1,472 Accounts payable and accrued expenses 74,992 Unearned dues 32,874 Net cash flows provided by operating activities 1,268,414 Cash flows from investing activities Acquisition of equipment (277,138) Proceeds from sale of equipment 620 Net cash flows used by investing activities (276,518) Cash flows from financing activities Repayment of debt (473,574) Cash distributions to partners (367,580) Net cash flows used by financing activities (841,154) Increase in cash 150,742 Cash at beginning of year 300,202 Cash at end of year $ 450,944 Supplemental disclosures of cash flow information: Cash paid during the year for interest $ 774,170 See accompanying notes. 44 © 2018 Association of International Certified Professional Accountants. All rights reserved. Donnelly & Oates Limited Liability Partnership Notes to Financial Statements Tax‐Basis For the Year Ended December 31, 20X2 Note 1—Summary of Significant Accounting Policies Nature of Operations The Partnership owns and operates a racquet and swim club (the Club) located in Minnesota. The Club has approximately 3,000 members at December 31, 20X2. The Club extends credit to members for the payment of dues and other charges. The Partnership, formed in 19W5, is a limited liability partnership in accordance with the provisions of the Uni‐ form Partnership Act as in effect in the State of Minnesota. The general partner of the Partnership is Tony Donnelly. Basis of Accounting The Partnership’s financial statements are prepared on the accounting basis the Partnership used for federal in‐ come tax purposes, which is a comprehensive basis of accounting other than accounting principles generally ac‐ cepted in the United States of America (GAAP). The Partnership uses the Accelerated Cost Recovery System (ACRS) and Modified Accelerated Cost Recovery System (MACRS) in depreciating its property. Under ACRS and MACRS, depreciation is determined over periods of time that are shorter than those used in accordance with GAAP. Additionally, the income tax methods used to capitalize and amortize amortizable assets differ from those used under GAAP. Syndication costs are carried as an asset of the Partnership and are not amortized. Under GAAP these costs would be deducted from partners’ capital. Cash Equivalents The Partnership considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Concentration of Credit Risk The Partnership places its cash with one banking institution. At times the amount on deposit exceeds the in‐ sured limit of the institution and exposes the Partnership to a collection risk. Inventories Inventories, which consist of merchandise for sale in the sports shop, food, and beverages, are stated at the lower of cost (first in, first out method) or market. Membership Dues and Initiation Fees © 2018 Association of International Certified Professional Accountants. All rights reserved. 45 Membership dues are billed in advance and recorded in accounts receivable and unearned dues. The dues are recognized as revenue in the month earned. Initiation fees are recorded as revenue in the period when the fee is collected. Property and Equipment Property and equipment are carried at depreciated cost. Depreciation is computed using income tax methods. The cost of maintenance and repairs is charged to income as incurred; significant renewals or betterments are capitalized. Financing Fees Financing fees are amortized over the term of the related debt using the straight‐line method. During 20XX, fi‐ nancing fees related to retired debt were written off. The financing fees related to new debt were capitalized. Amortization expense was $12,149 during 20X2. Start‐Up Costs Start‐up costs are amortized over 60 months using the straight‐line method. Income Taxes Income taxes on Partnership income are levied on the partners at the partner level. Accordingly, all profits and losses of the Partnership are recognized by each partner on his respective tax return. Management believes that the Partnership has adequately addressed all relevant tax positions and that there are no unrecorded tax liabilities. Tax returns filed for the tax years ending from December 31, 20Y9, through cur‐ rent are still subject to examination by federal and state tax authorities. Any interest or penalties assessed to the Partnership are recorded in operating expenses. No interest or penalties from federal or state tax authorities were recorded in the accompanying financial statements. Advertising and Promotions Advertising costs are expensed as incurred. For the year ended December 31, 20X2, the Partnership incurred $191,088 in advertising costs. Estimates The preparation of financial statements on the tax‐basis of accounting requires management to make estimates and assumptions that affect the amounts reported on the financial statements and accompanying notes. Actual results could differ from those estimates. Subsequent Events Subsequent events have been evaluated through February 24, 20X3, which is the date the financial statements were available to be issued, and there are no subsequent events requiring disclosure. Note 2—Partnership Organization Profit and Loss Allocations 46 © 2018 Association of International Certified Professional Accountants. All rights reserved. Prior to December 1, 20XX, profits and losses from annual operations were allocated 99 percent to the limited partners and 1 percent to the general partner. Subsequent to November 30, 20XX, and until the Class A limited partners have received distributions of net cash flow equal to their preferred return, profits and losses from annual operations are allocated 65 percent to the Class A limited partners; 15 percent to the special limited partner; and 20 percent to the general partner. After the Class A limited partners have received cumulative distributions of net cash flow equal to their pre‐ ferred return, profits and losses from annual operations will be allocated 45 percent to the Class A limited part‐ ners; 15 percent to the special limited partner; and 40 percent to the general partner. Net Cash Flow Allocation From Operations Subsequent to November 30, 20XX, net cash flow is allocated 65 percent to the Class A limited partners; 15 per‐ cent to the special limited partner; and 20 percent to the general partner until such time as the Class A limited partners have received cumulative distributions equal to their preferred return. The balance of any net cash flow will be distributed 45 percent to the Class A limited partners; 15 percent to the special limited partner; and 40 percent to the general partner. Preferred Return The preferred return means a 9 percent per annum cumulative noncompounded return on the adjusted capital contribution of the Class A limited partners. The adjusted capital contribution means the original capital contri‐ butions are reduced only by distribution from the net proceeds of sale or refinancing. Note 3—Property and Equipment Property and equipment at December 31, 20X2, consisted of the following: Recovery Peri‐ od—Years Land $ 975,720 — Building 9,320,050 7–40 Tenant improvements 1,568,896 5–7 Total cost of property and equip‐ ment being depreciated $ 11,864,666 Less: Accumulated depreciation 2,810,112 Total property and equipment, net $ 9,054,554 Depreciation expense was $597,945 during 20X2. © 2018 Association of International Certified Professional Accountants. All rights reserved. 47 Note 4—Mortgage Payable At December 31, 20X2, debt consisted of the following: Mortgage loan payable in monthly payments of $73,124, including interest at 9.375%, through January 20XY when the interest rate changes to 3.5% above the 3‐ year Treasury base rate. Beginning February 1, 20XY, monthly payments will be ad‐ justed to reflect the new interest rate; the payments will be based upon a 15‐year term. The remaining principal is due January 1, 20XZ. The mortgage is secured by property, equipment, and a personal guaranty. $ 6,778,186 10% unsecured note payable to the special limited partners due in monthly install‐ ments of $16,546, including principal and interest, through February 1, 20XZ, when the unpaid balance is due. 788,780 $ 7,566,966 Scheduled principal payments under these loans are approximately $380,000 per year until February 1, 20XY, when payment terms will be adjusted as described previously. Note 5—Amendment of the Partnership Agreement The Partnership agreement was amended effective November 30, 20XX. The primary purpose of the amend‐ ment was to create a new class of limited partner (the special limited partner) and to change the allocations of profits, losses, and cash distributions. Effective November 30, 20XX, Michael Oates surrendered his 67 limited partnership units in exchange for $1,450,000 and a 15 percent special limited partnership interest. Additionally, as part of this exchange, $200,000 was paid down on the note payable to the special limited partner, the interest rate on this note was reduced to 10 percent from 12 percent, and the term of the note was shortened. Note 6—Transactions With Affiliates At December 31, 20X2, the Partnership owed partners or affiliated entities $788,780. During 20X2 a management fee of $50,700 was paid to a partner. 48 © 2018 Association of International Certified Professional Accountants. All rights reserved. CHARLTON CONTRACTORS, INC. FINANCIAL STATEMENTS AS OF AND FOR THE YEARS ENDED DECEMBER 31, 20X2, AND 20X1 Circumstances include the following: • The financial statements are for a general contractor. The general contractor has elected to be treated as a small business corporation (S corporation) under Internal Revenue Code Section 1362. • The financial statements are prepared on the accrual method of accounting used for federal income tax purposes. • The financial statements are comparative statements as of and for the years ended December 31, 20X2, and 20X1. The financial statements illustrate the following: • The financial statements include a statement of cash flows, which is not required for financial state‐ ments prepared when applying the tax‐basis of accounting. • Information about contract receivables (Note 2), billings in excess of costs on uncompleted contracts (Note 5), and backlog (Note 7) are disclosures typically made in the financial statements of construction contractors. However, the aging summary of contract receivables is not usually disclosed. In this situa‐ tion, the preparer concluded that the information is relevant to the financial statement users. • The information on accounts payable and accruals is not required but has been included because the preparer concluded that users of the financial statements find it meaningful. • Accounting principles generally accepted in the United States of America (GAAP) requires a summary of future minimum lease payments, which usually is presented in a schedule. Because the entity’s lease commitments are not complex, this information has been summarized in narrative form, which is ac‐ ceptable for financial statements prepared on the tax‐basis of accounting. © 2018 Association of International Certified Professional Accountants. All rights reserved. 49 Charlton Contractors, Inc. Statements of Assets, Liabilities and Equity Tax‐Basis December 31, 20X2 and 20X1 20X2 20X1 Assets Current Assets Cash and cash equivalents $ 3,078,966 $ 3,608,930 Accounts receivable—contract (Note 2) 2,409,554 1,422,268 Advances to officers 7,812 — Inventory 287,714 196,200 Total current assets 5,784,046 5,227,398 Property and Equipment Machinery and equipment 1,694,980 1,710,828 Transportation equipment 384,790 395,042 Office furniture and equipment 162,454 163,034 Leasehold improvements 363,798 363,798 Total cost 2,606,022 2,632,702 Accumulated depreciation and amortization (Note 3) (2,362,850) (2,343,812) Net property and equipment 243,172 288,890 Other Assets Cash surrender value of officers’ life insurance 24,454 23,610 Miscellaneous 1,460 20,766 Total other assets 25,914 44,376 Total assets $ 6,053,132 $ 5,560,664 See accompanying notes to financial statements. 50 © 2018 Association of International Certified Professional Accountants. All rights reserved. Charlton Contractors, Inc. Statements of Assets, Liabilities and Equity Tax‐Basis Years Ended December 31, 20X2 and 20X1 20X2 20X1 Liabilities and Stockholders’ Equity Current Liabilities Accounts payable and accruals (Note 4) $ 548,646 $ 288,904 Billings in excess of costs on uncompleted con‐ tracts (Note 5) 976,754 445,108 Total current liabilities 1,525,400 734,012 Contributed Capital Common stock, $1,000 par value; 100 shares authorized; 60 shares issued and outstanding 60,000 60,000 Retained Earnings 4,467,732 4,766,652 Total stockholders’ equity 4,527,732 4,826,652 Total liabilities and stockholders’ equity $ 6,053,132 $ 5,560,664 See accompanying notes to financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 51 Charlton Contractors, Inc. Statements of Operations and Retained Earnings Tax‐Basis Years Ended December 31, 20X2 and 20X1 20X2 20X1 Contract revenue $ 7,009,498 $ 8,116,380 Cost of contract revenue Direct costs Materials and supplies 1,710,330 1,729,310 Salaries and wages 1,184,132 1,264,664 Subcontracts 1,670,596 1,838,942 Other 99,486 92,560 4,664,544 4,925,476 Indirect costs 813,520 967,278 5,478,064 5,892,754 Gross profit 1,531,434 2,223,626 General and administrative expenses Salaries and wages 1,298,552 2,139,444 Profit‐sharing plan contribution — 6,138 Other 596,938 539,786 1,895,490 2,685,368 Operating loss (364,056) (461,742) Financing income 88,148 132,590 Net loss (275,908) (329,152) Retained earnings, beginning of year 4,766,652 5,255,804 Distributions to stockholders (23,012) (160,000) Retained earnings, end of year $ 4,467,732 $ 4,766,652 See accompanying notes to financial statements. 52 © 2018 Association of International Certified Professional Accountants. All rights reserved. Charlton Contractors, Inc. Statements of Cash Flows Tax‐Basis Years Ended December 31, 20X2 and 20X1 20X2 20X1 Cash flows from operating activities Net loss $ (275,908) $ (329,152) Noncash items included in net loss: Depreciation 45,718 60,204 (Increase) decrease in: Contract receivables (987,286) 2,103,570 Inventory (91,514) (3,260) Cash surrender of officers’ life insurance (844) (1,200) Other assets — (408) Increase (decrease) in: Accounts payable and accruals 259,742 (100,832) Billings in excess of costs on uncompleted contracts 531,646 (895,508) Net cash (used) provided by operat‐ ing activities (518,446) 833,414 Cash flows from investing activities Property and equipment purchases — (60,000) Advances to officers (7,812) — Redemption of certificates of deposit — 2,132,038 Decrease in miscellaneous assets 19,306 — Net cash provided by investing ac‐ tivities 11,494 2,072,038 Cash flows from financing activities Distributions to stockholders (23,012) (160,000) Net (decrease) increase in cash and cash equiva‐ lents (529,964) 2,745,452 Cash and cash equivalents, beginning of year 3,608,930 863,478 Cash and cash equivalents, end of year $ 3,078,966 $ 3,608,930 See accompanying notes to financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 53 Charlton Contractors, Inc. Notes to Financial Statements Tax‐Basis December 31, 20X2 and 20X1 Note 1—Summary of Significant Accounting Policies Nature of Operations Charlton Contractors is a general contractor primarily engaged in the construction of commercial and multifami‐ ly residential projects in the San Diego metropolitan area. Basis of Accounting The accompanying financial statements have been prepared on the accrual method of accounting used for fed‐ eral income tax purposes, which is a comprehensive basis of accounting other than accounting principles gener‐ ally accepted in the United States of America (GAAP). If the accompanying financial statements were prepared in conformity with GAAP, contract revenue and costs would be recognized under the percentage‐of‐completion method of accounting, an allowance for uncollectible accounts receivable would be established, property and equipment would be depreciated over their estimated useful lives, and the related party lease would be capitalized as an asset and liability. The Corporation has elected to be treated as a small business corporation (S corporation) under Internal Reve‐ nue Code Section 1362. This election provides that, in lieu of corporate income taxes, the taxable items and credits pass directly to the stockholders. Therefore, these financial statements do not include federal or state in‐ come taxes that would otherwise be applicable. The Corporation uses the accrual completed contract method to recognize construction revenue. That method of accounting recognizes contract revenue and costs when a contract is completed or substantially completed. A contract is considered substantially completed when all costs except insignificant items have been incurred and the installation has been accepted by the customer. Contract costs include all direct material and labor costs and those indirect costs related to contract perfor‐ mance, such as rent, depreciation, maintenance, and insurance. Indirect costs are allocated based on contract revenue. General and administrative costs are charged to expenses as incurred. Amounts billed in excess of costs are classified as current liabilities under billings in excess of cost on uncom‐ pleted contracts. Contract retentions are included in contract receivables. The preparation of financial statements requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from these estimates. Cash and Cash Equivalents Cash and cash equivalents consist of highly liquid investments with a maturity of three months or less when pur‐ chased. 54 © 2018 Association of International Certified Professional Accountants. All rights reserved. At December 31, 20X2, and 20X1, the Corporation had on deposit with several banks amounts in excess of Fed‐ eral Deposit Insurance Corporation insurance limits. The Corporation has not experienced any losses in such ac‐ counts. The Corporation believes it is not exposed to any significant credit risk on cash and cash equivalents. Contract Receivables Contract receivables, including retentions, are recorded as progress billings and rendered in accordance with the provisions of the contracts. The Corporation uses the direct write‐off method to record uncollectible accounts in compliance with the Internal Revenue Code. Inventory Inventory is valued at the lower of cost, based on the first in, first out method, or market. Property and Equipment Property and equipment are recorded at cost and depreciated using principally accelerated methods. Leasehold improvements are amortized over the life of the related leases or their estimated useful lives, whichever is shorter. Property and equipment are depreciated over the following recovery periods: Machinery and equipment 5 years Transportation equipment 5 years Office furniture and equipment 5–7 years Leasehold improvements 10–31.5 years Expenditures for maintenance and repairs that do not materially extend the lives of the assets are charged to earnings. When property or equipment is sold or otherwise disposed of, the cost and related accumulated de‐ preciation are removed from the respective accounts, and the resulting gain or loss is reflected in earnings. Profit‐Sharing Plan The Corporation adopted a profit‐sharing plan effective November 22, 19V4. Substantially all full‐time employ‐ ees are eligible to participate. The Corporation’s contributions on behalf of its employees are determined annu‐ ally by the board of directors. The Corporation did not make a contribution for 20X2. Profit‐sharing contributions were $6,138 for the year ended December 31, 20X1. Statement of Cash Flows For purposes of the statement of cash flows, cash and cash equivalents include money market accounts and op‐ erating bank accounts. The Corporation did not pay any interest expense for 20X2 and 20X1. Income Taxes © 2018 Association of International Certified Professional Accountants. All rights reserved. 55 The Corporation, with the consent of its shareholders, has elected, in accordance with the Internal Revenue Code, to be treated as an S corporation. In lieu of federal income taxes, the shareholders of an S corporation are taxed on their proportionate share of the corporation’s taxable income. Therefore, no provision for federal in‐ come taxes has been included in these financial statements. California law generally conforms to federal law ex‐ cept for a 1.5 percent tax imposed on S corporation’s earnings. The Corporation is subject to tax in other states. Deferred income taxes have not been recognized in these financial statements because the amount of deferred taxes is not considered material. The Corporation does not recognize a liability for uncertain tax positions until agreement and settlement is reached with the taxing authority. Tax returns filed for the tax years ending from December 31, 20Y9, through current are still subject to examination by federal and state tax authorities. Subsequent Events The Corporation has evaluated subsequent events from the date of the statement of assets, liabilities, and equi‐ ty—tax‐basis through March 12, 20X3, the date on which the financial statements were available to be issued, and determined that there are no items to disclose. Note 2—Contract Receivables An aging summary of contract receivables at December 31, is as follows: 20X2 20X1 Billed Current $ 1,131,718 $ 364,284 30 days 486,854 306,318 60 days 189,138 79,914 90 days and over 129,326 133,272 1,937,036 883,788 Unbilled retentions 456,512 444,252 Unbilled amounts on complet‐ ed contracts 16,006 94,228 Totals $ 2,409,554 $ 1,422,268 56 © 2018 Association of International Certified Professional Accountants. All rights reserved. Completed and uncompleted contract receivables at December 31, are as follows: 20X2 20X1 Completed contracts Billed, including retentions $ 906,052 $ 581,760 Unbilled retentions 116,772 125,206 Unbilled amounts on completed con‐ tracts 16,006 94,228 Uncompleted contracts Uncompleted contracts billed 1,030,984 302,028 Unbilled retentions 339,740 319,046 Totals $ 2,409,554 $ 1,422,268 Receivables written off as uncollectible totaled $30,158 for the year ended December 31, 20X2, and $2,000 for the year ended December 31, 20X1. Recoveries of receivables written off an uncollectible totaled $17,000 for the year ended December 31, 20X1. Note 3—Depreciation and Amortization The accumulated depreciation and amortization balances at December 31, are as follows: 20X2 20X1 Machinery and equipment $ 1,689,162 $ 1,701,064 Transportation equipment 308,130 296,002 Office furniture and equipment 161,612 160,440 Leasehold improvements 203,946 186,306 Totals $ 2,362,850 $ 2,343,812 © 2018 Association of International Certified Professional Accountants. All rights reserved. 57 Note 4—Accounts Payable and Accruals Accounts payable and accruals consist of the following at December 31: 20X2 20X1 Trade accounts payable $ 343,222 $ 157,726 Subcontract payables 156,130 86,104 Accrued payroll 40,626 39,814 Accrued and withheld payroll taxes 3,124 860 Sales tax payable 5,544 4,400 Totals $ 548,646 $ 288,904 Note 5—Billings in Excess of Costs on Uncompleted Contracts Billings in excess of costs on uncompleted contracts at December 31 are as follows: 20X2 20X1 Billings on uncompleted contracts $ 4,320,008 $ 2,258,286 Costs incurred on uncompleted contracts (3,343,254) (1,813,178) Billings in excess of costs on un‐ completed contracts $ 976,754 $ 445,108 Note 6—Commitment Under Lease Agreement On December 15, 20V6, the Corporation signed a lease with its stockholders for an office and production facility located in Mira Mesa, California. The facility lease is for 25 years, terminating December 15, 20YY. The base an‐ nual rent was $343,000 for 20X2 and 20X1. Increases in the base annual rent are to be based on the consumer price index, not to exceed 6 percent. The stockholders pay the real estate taxes and the Corporation pays all maintenance charges and operating costs for the facility. The rental payments include an escalation for increas‐ es in real estate taxes. At December 31, 20X2, the aggregate minimum lease payments under this lease were approximately $2,800,000. Future minimum lease payments are scheduled to be approximately $350,000 for each of the next 5 years. Rent expense for each of the years ended December 31, 20X2, and 20X1 was $353,000. Note 7—Backlog The estimated gross revenue on work to be performed on signed contracts was $3,467,894 at December 31, 20X2, and $4,183,624 at December 31, 20X1. In addition to the backlog of work to be performed, there was gross revenue to be reported in future periods under the accrual completed contract method used by the com‐ pany of $1,548,173 at December 31, 20X2, and $1,668,961 at December 31, 20X1. 58 © 2018 Association of International Certified Professional Accountants. All rights reserved. MARGARET ROSE 1964 IRREVOCABLE TRUST FINANCIAL STATEMENTS AS OF AND FOR THE YEARS ENDED DECEMBER 31, 20X2 AND 20X1 Circumstances include the following: • The financial statements are for an irrevocable trust. • The financial statements are prepared on the cash method of accounting used for federal income tax purposes. • The financial statements are comparative as of and for the years ended December 31, 20X2, and 20X1. The financial statements illustrate the following: • The financial statements do not include a statement of cash flows, which is acceptable for a presenta‐ tion when applying the tax‐basis of accounting. The preparer concluded that a statement of cash flows is not necessary because (1) the users of the financial statements are more interested in asset balances ra‐ ther than cash flows, and (2) if cash flow information is needed, it could easily be derived from the in‐ formation presented. © 2018 Association of International Certified Professional Accountants. All rights reserved. 59 Margaret Rose 1964 Irrevocable Trust Statements of Assets, Liabilities and Corpus Tax‐Basis December 31, 20X2 and 20X1 20X2 20X1 Assets Marketable securities—at cost $ 1,830,087 $ 1,560,681 (market value $2,746,922 and $2,353,519 in 20X2 and 20X1, respectively) Purchased interest 340 — Total assets $ 1,830,427 $ 1,560,681 Liabilities and Corpus Due to beneficiary 157,946 75,302 Total liabilities 157,946 75,302 Corpus 1,672,481 1,485,379 Total liabilities and corpus $ 1,830,427 $ 1,560,681 See accompanying notes. 60 © 2018 Association of International Certified Professional Accountants. All rights reserved. Margaret Rose 1964 Irrevocable Trust Statements of Revenues, Expenses and Corpus Tax‐Basis Years Ended December 31, 20X2 and 20X1 20X2 20X1 Revenues Dividends $ 76,139 $ 69,044 Interest 4,729 4,457 Gain (loss) on sale of securities, net 201,370 46,094 Total revenues 282,238 119,595 Expenses Accounting fee 7,500 7,000 Bank custodian fee 3,018 2,588 Investment counsel fee 9,474 7,588 Total expenses 19,992 17,176 Income before provision for income taxes 262,246 102,419 Provision for income taxes 75,144 22,207 Net income 187,102 80,212 Corpus, beginning of year 1,485,379 1,405,167 Corpus, end of year $ 1,672,481 $ 1,485,379 See notes to financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 61 Margaret Rose 1964 Irrevocable Trust Notes to Financial Statements Tax‐Basis For the Years Ended December 31, 20X2 and 20X1 Note 1—Nature of Trust and Significant Accounting Policies Nature of Trust The Margaret Rose 1964 Irrevocable Trust (the Trust) was created on May 5, 1964, by Michael Thomas. Distribu‐ tion of 25 percent of principal is to be made at age 30, and 33 1/3 percent at age 35. After January 1, 19X2, the beneficiary may request annually a noncumulative distribution of the larger of $5,000 or 5 percent of the princi‐ pal as of the end of the year. Upon death of the beneficiary, the Trust is to be distributed according to the terms of her will. The trustee has discretionary power to distribute principal or income, or both. Basis of Accounting The accompanying financial statements have been prepared on the cash method of accounting used for federal income tax purposes, which is a comprehensive basis of accounting other than accounting principles generally accepted in the United States of America (GAAP). Consequently, certain revenues and expenses are recognized in the determination of income in different reporting periods than they would be if the financial statements were prepared in conformity with GAAP. Although income tax rules are used to determine the timing of the re‐ porting of revenues and expenses, nontaxable revenues and nondeductible expenses are included in the deter‐ mination of net income. Use of Estimates The preparation of financial statements in conformity with the cash method of accounting used for federal in‐ come tax purposes requires management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. Actual results could differ from those estimates. Marketable Securities Marketable securities are carried at cost. The cost of marketable securities sold is based on cost as determined under the specific identification method. Income Taxes The Trust does not recognize a liability for uncertain tax positions. Tax returns filed for the tax years ending from December 31, 20Y9, through current are still subject to examination by federal and state tax authorities. Subsequent Events In preparing these financial statements, the Trust has evaluated events and transactions for potential recogni‐ tion or disclosure through April 1, 20X3, the date the financial statements were available to be issued, and de‐ termined that there are no items to disclose. 62 © 2018 Association of International Certified Professional Accountants. All rights reserved. Note 2—Marketable Securities At December 31, 20X2, and 20X1, gross unrealized gains and losses pertaining to marketable securities in the portfolio were as follows: Cost Market Value Unrealized Gains Losses 20X2 Equities $ 948,766 $ 1,790,955 $ 854,565 $ 12,376 Fixed income and money market 881,321 955,967 119,362 44,716 Total $ 1,830,087 $ 2,746,922 $ 973,927 $ 57,092 Market Unrealized Cost Value Gains Losses 20X1 Equities $ 891,685 $ 1,611,732 $ 757,910 $ 37,863 Fixed income and money market 668,996 741,787 72,791 — Total $ 1,560,681 $ 2,353,519 $ 830,701 $ 37,863 Note 3—Income Taxes The income tax expense shown in the accompanying financial statements differs from the expense that would result from applying statutory tax rates to income before income taxes primarily because of capital gains. Distributions to beneficiaries are allowed as a deduction from taxable income for the trust in the year in which such distributions are made. The provision for income taxes for the years ended December 31 consists of: 20X2 20X1 Federal $ 63,200 $ 17,874 State 11,944 4,333 Provision for income taxes $ 75,144 $ 22,207","Please answer the question using only the provided context. Please summarize the major differences between cash- and tax-basis account as explained in the context provided. Practice Aid Accounting and Financial Reporting Guidelines for Cash- and Tax-Basis Financial Statements © 2018 Association of International Certified Professional Accountants. All rights reserved. For other uses of this work, please email copyright@aicpa.org with your request or write to us at 220 Leigh Farm Road, Durham, NC 27707-8110 USA. This document was created by the Association of International Certified Professional Accountants as a free member benefit which may be freely used and shared by members for personal use. All copyright statements should be maintained. © 2018 Association of International Certified Professional Accountants. All rights reserved. 1 Preface Because of the complexities of accounting principles generally accepted in the United States of America (GAAP), many smaller entities have determined that financial statements prepared by applying the cash‐ or tax‐basis of accounting more appropriately suit their needs. Unlike GAAP, little authoritative guidance is available with re‐ spect to the preparation of financial statements when applying the cash‐ or tax‐basis of accounting. Financial statements prepared when applying the cash‐ or tax‐basis of accounting need to have a level of consistency so that they are useful and not misleading to users of the financial statements. Additionally, because financial statements prepared when applying the cash‐ or tax‐basis of accounting are not considered appropriate in form unless the financial statements include informative disclosures similar to those required by GAAP if the financial statements contain items that are the same as, or similar to, those in financial statements prepared in accord‐ ance with GAAP, preparers of full disclosure financial statements prepared when applying the cash‐ or tax‐basis of accounting are often faced with difficult questions. This practice aid is intended to provide preparers of cash‐ and tax‐basis financial statements with guidelines and best practices to promote consistency and for resolving the often difficult questions regarding the preparation of such financial statements. Although this practice aid is the best source for such guidance, it is nonauthorita‐ tive and should not be used as a substitute for the preparer’s professional judgment. This practice aid has not been approved, disapproved, or otherwise acted upon by any senior committee of the AICPA. This practice aid does not contain guidance with respect to performing an audit, review, or compilation of finan‐ cial statements prepared when applying the cash‐ or tax‐basis of accounting. Practitioners engaged to audit such financial statements should refer to Statements on Auditing Standards, including AU‐C section 800, Special Con‐ siderations—Audits of Financial Statements Prepared in Accordance With Special Purpose Frameworks (AICPA, Professional Standards). Practitioners engaged to perform a review or compilation should refer to Statements on Standards for Accounting and Review Services (SSARSs). Likewise, CPAs in public practice who prepare finan‐ cial statements for clients but are not engaged to perform an audit, review, or compilation of such financial statements should refer to SSARSs. Prepared by Michael P. Glynn Senior Technical Manager Audit and Attest Standards Team Edited by Kelly G. McAuliffe Technical Manager Member Learning and Competency 2 © 2018 Association of International Certified Professional Accountants. All rights reserved. Acknowledgments In 1998, the AICPA published the Practice Aid Preparing and Reporting on Cash‐ and Tax‐Basis Financial State‐ ments. That publication was written by Michael J. Ramos, CPA, and edited by the AICPA Accounting and Publica‐ tions Team. That publication served as a basis for the preparation of the original edition of this practice aid. In addition to this practice aid, the AICPA has also published a separate practice aid, Applying OCBOA in State and Local Government Financial Statements, authored by Michael A. (Mike) Crawford, CPA. Mike served as an invaluable resource in the preparation of the original edition of this practice aid. The AICPA also greatly appreciates the invaluable input provided by the late Dr. Thomas A. Ratcliffe in the de‐ velopment of the previous edition of this practice aid. Finally, the AICPA would like to thank the 2011/12 members of the Accounting and Review Services Committee and the 2011/12 members of the AICPA PCPS Technical Issues Committee, who provided invaluable input re‐ garding the content of the original edition of this practice aid. © 2018 Association of International Certified Professional Accountants. All rights reserved. 3 4 © 2018 Association of International Certified Professional Accountants. All rights reserved. Chapter 1 Overview of Cash‐ and Tax‐Basis Financial Statements Introduction Financial statements, including related notes, are a structured representation of historical financial information intended to communicate an entity’s economic resources and obligations at a point in time or the changes therein for a period of time in accordance with a financial reporting framework. fn 1 All financial statements are prepared in accordance with a financial reporting framework. The term financial reporting framework is defined as “a set of criteria used to determine measurement, recognition, presentation, and disclosure of all material items appearing in the financial statements.” fn 2 Examples of financial reporting frameworks are accounting principles generally accepted in the United States of America (GAAP), International Financial Reporting Stand‐ ards promulgated by the International Accounting Standards Board, and special purpose frameworks such as the cash‐, tax, regulatory‐, contractual‐, and other bases that use a definitive set of logical, reasonable criteria that is applied to all material items appearing in the financial statements. The cash‐, tax‐, regulatory‐, and other‐basis of accounting are commonly referred to as other comprehensive bases of accounting. As GAAP becomes increasingly complex and less cost beneficial for private companies, such companies consider issuing cash‐ and tax‐basis financial statements as cost‐effective and useful alternatives. Many of these private companies are small and medium‐sized entities that report to a narrow range of financial statement users. Those users, unlike users of public company financial statements, typically have access to company management and additional financial information beyond that provided in the financial statements. Cash‐ or tax‐basis financial statements may be appropriate whenever the entity is not contractually or otherwise required to issue GAAP financial statements. The following conditions may indicate that financial statements prepared when applying the cash‐ or tax‐basis of accounting is appropriate: • The users of the financial statements—both internal and external to the entity—understand a cash‐ or tax‐basis presentation and find it relevant for their needs. • It is cost‐effective to prepare cash‐ or tax‐basis financial statements. • The operations of the entity are conducive to a cash‐ or tax‐basis presentation. Preparing cash‐ or tax‐basis financial statements has many benefits. A significant benefit is due to the fact that many smaller entities maintain their accounting records on a cash‐ or tax‐basis. Often, accounting and finance personnel responsible for maintaining the books and records can more easily understand the concepts of cash in fn 1 Paragraph .05 of AR‐C section 90, Review of Financial Statements (AICPA, Professional Standards), and paragraph .13 of AU‐C section 200, Overall Objectives of the Independent Auditor and Conduct of an Audit in Accordance With Generally Accepted Auditing Standards (AICPA, Professional Standards). fn 2 See footnote 1. © 2018 Association of International Certified Professional Accountants. All rights reserved. 5 and out as well as tax reporting compared to GAAP. Because the internal records are often maintained on the cash‐ or tax‐basis of accounting, it is easier to prepare the financial statements when applying that same basis. If the financial statements are prepared in accordance with GAAP, the accounting and finance personnel would “true‐up” the financial information through a series of journal entries. Additionally, many users of smaller entity financial statements find cash‐ or tax‐basis financial statements to be more understandable than financial statements prepared in accordance with GAAP because those users are often accustomed to preparing and con‐ sidering budgets on a cash‐basis and understand tax issues. Because many smaller entities are appropriately concerned with minimizing costs and maximizing the resources that are available to fund the operations of the business, resources allocated to accounting and financial report‐ ing are often not sufficient to maintain GAAP basis accounting records and to prepare financial statements in ac‐ cordance with GAAP. Preparing financial statements when applying the cash‐ or tax‐basis of accounting general‐ ly is less costly than preparing GAAP financial statements because of the following: • Less complex measurement requirements. Financial statements prepared when applying the cash‐basis of accounting reflect transactions resulting from cash receipt and disbursement transactions or events. Financial statements prepared when applying the tax‐basis of accounting reflect transactions in the same manner as those transactions are reflected in the entity’s tax return. • Less extensive disclosure requirements. Financial statements prepared when applying the cash‐ or tax‐ basis of accounting do not require all of the extensive disclosures required of GAAP statements because the statements do not include some of the items, events, and transactions that are typically included in GAAP basis financial statements. Observations and Suggestions Often, preparers of cash‐ and tax‐basis financial statements elect to omit substantially all disclosures required by the cash‐ or tax‐basis of accounting. The omission of disclosures is a departure from the cash‐ or tax‐basis of ac‐ counting and, if such disclosures were included in the financial statements, they might influence the user’s con‐ clusions about the entity’s financial position, results of operations, and cash flows. However, the omission may not necessarily result in misleading financial statements provided that the intended users are informed about such matters. • Ability to prepare tax returns and financial statements from the same information. When tax‐basis finan‐ cial statements are issued, a significant portion of the cost can be absorbed by the preparation of the tax return. Additionally, the entity is not required to maintain two sets of accounting records to account for items such as depreciation, bad debts, and consolidation matters. However, in addition to the benefits of financial statements prepared when applying a cash‐ or tax‐basis of ac‐ counting, financial statement preparers should also be aware of the limitations of such financial statements. For example, financial statements prepared when applying the cash‐ or tax‐basis of accounting may not meet the needs of certain users such as regulators and certain lenders. In addition, the cash‐basis of accounting can be easily manipulated by accelerating or delaying the timing of the receipt or disbursement of cash and therefore may not be a comprehensive measure of the entity’s complete economic condition. In practice, the most typical industries in which cash‐ or tax‐basis financial statements are issued include the fol‐ lowing: • Professional services 6 © 2018 Association of International Certified Professional Accountants. All rights reserved. • Medical • Retail • Real estate • Farming/agricultural • Construction • Not‐for‐profit Cash‐Basis of Accounting The cash‐basis of accounting is a basis of accounting that the entity uses to record cash receipts and disburse‐ ments. When applying the cash‐basis of accounting, transactions are recognized based on the timing of cash re‐ ceipts and disbursements. As a result, • revenues are recognized only when cash is received rather than when earned, and • expenses are recognized only when cash is paid rather than when the obligation is incurred. When applying the cash‐basis, cash outflows to purchase an “asset” are not capitalized but instead are recorded as a disbursement as of the date of purchase, so there is no depreciation or amortization. Accruals are not made and prepaid assets are not recorded. The cash‐basis of accounting in its purest form is rarely used but may be appropriate whenever the entity • is interested primarily in sources and uses of cash. • has a limited number of financial statement users. • has relatively simple operations engaged in one primary activity. • does not have significant amounts of debt, capital assets, or other items that would be recognized in ac‐ cordance with the accrual basis. Examples of some entities that may use the cash‐basis of accounting include the following: • Estates • Trusts • Civic ventures • Student activity funds • Political campaigns and committees © 2018 Association of International Certified Professional Accountants. All rights reserved. 7 When applying the cash‐basis of accounting, because the only assets of the entity would be cash and cash equivalents and there would be no liabilities, a balance sheet equivalent is often not presented. The income statement equivalent would report cash receipts and disbursements and other changes in cash and cash equiva‐ lents and disclose any restrictions on ending cash and cash equivalents. Any departure from the presentation of cash and cash equivalent balances and changes in such balances, such as the reporting of long‐term debt arising from cash transactions, the capitalization and depreciation of capital assets acquired with cash, or the reporting of investments or receivables and payables resulting from cash transactions, should be considered a modification to the cash‐basis of accounting. Such deviations require eval‐ uation regarding whether they are appropriate modifications of the cash‐basis of accounting. Appropriate modi‐ fications of the cash‐basis of accounting are discussed in the subsequent section. In‐Substance Two‐Step Transactions or Events in the Cash‐Basis of Accounting The preparer of cash‐basis financial statements may encounter single‐step transactions or events that may not directly involve a cash inflow or outflow but may nevertheless be recorded as an in‐substance two‐step cash transaction or event when applying the cash‐basis of accounting. For example, management of an entity may sign a note from a bank in order to purchase equipment. The bank may then directly pay the vendor for the pur‐ chase of the equipment. Because there was no cash transaction, the entity may not record the single‐step trans‐ action in the financial statements. However, so as not to be misleading to users of the financial statements, the preparer may choose to record the transaction as an in‐substance two‐step transaction. In accordance with that treatment, the journal entries may look as follows: Cash XX,XXX Note Proceeds (Revenue) XX,XXX (To record note proceeds that were paid directly to the vendor) Capital expenditure XX,XXX Cash XX,XXX (To record purchase of equipment) Then, subsequent payments on the note would be recorded as follows: Debt service expenditure XXX Cash XXX (To record principal and interest payment on note payable) Modified Cash‐Basis of Accounting The modified cash‐basis of accounting involves logical and consistent modifications to transactions or events that are derived from cash receipts or cash disbursements. For example, a modification to the cash‐basis of ac‐ counting to report capital assets should involve recording and depreciating only those capital assets that result from cash transactions or events. The modification should not involve the recording and depreciating of donated capital assets because these transactions or events do not involve an inflow or outflow of cash. Once deprecia‐ ble capital assets arising from cash transactions or events are recorded when applying a modified cash‐basis of accounting, such assets should also be depreciated over their estimated useful lives. Depreciating capital assets that were acquired with cash is a logical allocation of the cash‐basis assets’ costs over the assets’ useful lives. 8 © 2018 Association of International Certified Professional Accountants. All rights reserved. An easy way to look at whether a modification is appropriate is to consider whether the transaction or event would have been recorded if the entity was preparing the cash‐basis financial statements. For example, if an en‐ tity purchased a capital asset and was preparing cash‐basis financial statements, the journal entry would look like this: Capital expenditure XXXX Cash XXXX (To record purchase of capital asset) Because cash is part of the journal entry, it would be an appropriate modification to capitalize the asset and de‐ preciate the cost over the estimated useful life of the asset. On the other hand, the recording of trade accounts receivable arising from services provided or goods sold would not be an appropriate modification of the cash‐basis of accounting assuming cash was not received at the time the services were provided or goods were sold. Modifications to the cash‐basis of accounting generally result when cash receipts or cash disbursements provide a benefit or an obligation that covers multiple reporting periods. For example, a preparer may conclude that fi‐ nancial statement users would be misled if cash purchases of capital assets are recorded as disbursements or expenditures in the period in which the assets are purchased. Instead, the preparer may elect to modify the cash‐basis of accounting to record the asset on the balance sheet equivalent and depreciate it over the estimat‐ ed useful life of the asset, thereby, in effect, spreading the benefit of the cash outflow over multiple reporting periods in a manner that has substantial support and is logical and consistent. Questions often arise in the application of a modified cash‐basis of accounting regarding whether reported as‐ sets and liabilities derived from cash transactions or events should ever be written down or written off once they are recorded at their original cash value. Temporary changes in the fair value of an asset or liability should not be recognized in applying a modified cash‐basis of accounting and all recognized assets and liabilities should be measured and reported at their original cash value (net of any accumulated depreciation or amortization, if applicable). If an asset or liability has been permanently impaired and has no future cash value or represents no future obligation against cash, it would be appropriate to write‐down or write‐off such amounts in modified cash‐basis financial statements. A significant challenge to preparing financial statements when applying a modified cash‐basis of accounting is developing the appropriate accounting policy that results in financial statements that meet the needs of the primary users of the statements and consistently applying that policy to cash transactions and events in order to keep the financial statements from being misleading for the purposes for which they are intended. The preparer may find benefit in spelling out the logic behind the cash‐basis modifications and documenting the accounting policy prior to preparation of the basic financial statements. Although there is no single accepted method of applying a modified cash‐basis of accounting, modified cash‐ basis financial statements can be more meaningful if they are comparable with similar financial statements. Some preparers have inappropriately considered the modified cash‐basis of accounting as a “free‐for‐all” propo‐ sition in which they can unilaterally and arbitrarily choose the modifications that they will apply. For example, a preparer may inappropriately decide to prepare financial statements applying a modified cash‐basis of account‐ ing that records assets arising from cash transactions or events, including investments, inventories, and capital assets but does not record short‐term and long‐term liabilities and other obligations arising from cash transac‐ tions. Inconsistent uses of a modified cash‐basis framework should be avoided in general use financial state‐ ments because such inconsistencies will normally result in financial statements that are misleading for general © 2018 Association of International Certified Professional Accountants. All rights reserved. 9 use. Financial statements that are prepared using inconsistent modifications may be appropriate for special pur‐ poses involving limited users but should be labeled as such with clear disclosure and use of descriptive headings. With the needs of the primary financial statement users in mind, when preparing financial statements applying a modified cash‐basis of accounting, the preparer should consider modifying the following cash transactions or events, among others, by the recording of the following: • Receivables resulting from an outflow of cash, such as a cash advance to an employee • Investments in marketable securities acquired with cash • Inventories acquired with cash • Capital assets arising from cash transactions and depreciating the assets where appropriate • Deferred revenue resulting from cash receipts • Liabilities resulting from short‐term cash borrowings • Long‐term notes and other debt arising from cash transactions or events • Any other material assets, liabilities, revenues, and expenses resulting from cash transactions or events If the financial statements are prepared when applying a modified cash‐basis accounting policy in which one or more of the preceding—but not all—are recorded, the preparer should be prepared to defend how the decision to modify or not modify is a logical and consistent application of the accounting policy and does not result in misleading financial statements for the purposes for which they are intended. A number of transactions or events are not appropriate modifications to the cash‐basis of accounting. Generally, these transactions or events should not be recorded when applying a modified cash‐basis of accounting because they do not involve cash inflows or outflows, are illogical, or are not substantially supported in the accounting literature. Common transactions or events that should not be reported in financial statements prepared when applying a modified cash‐basis of accounting include the recording or adjusting of the following: • Capital assets arising from cash transactions or events, but not recording depreciation where appropri‐ ate • Donated capital assets where cash outflows were not involved • Accounts receivable from services provided or goods sold and other accrued receivables • Pledges receivable or other receivables where cash outflows were not involved • Investments for which cash outflows were not involved • Accounts payable for goods or services received where no cash outflow was involved • Accrued income taxes, accrued interest expense, other accrued liabilities where no cash outflow was in‐ volved 10 © 2018 Association of International Certified Professional Accountants. All rights reserved. • Subsequent write ups or write downs to fair value to recognize unrealized gains and losses on marketa‐ ble investments • Derivative instruments where cash inflows or outflows were not involved as well as the mark to market for fair value changes Because modified cash‐basis frameworks do not involve financial statement elements resulting from accruals and noncash transactions or events, it is unlikely that an acceptable modified cash‐basis framework would ever be materially equivalent to GAAP. However, it is important for financial statement preparers to avoid attempting to make certain modifications to GAAP financial statements and then referring to those financial statements as modified cash‐basis financial statements. For example, financial statements that are presented in conformity with GAAP, except that material leases are not capitalized, are not considered modified cash‐basis financial statements. Such financial statements are considered GAAP financial statements with a material departure due to the failure to capitalize material leases. The preparer will need to use judgment in determining if modified “cash‐basis” statements are tantamount to financial statements purported to be prepared in accordance with GAAP with material departures therefrom. Tax‐Basis of Accounting The tax‐basis is a basis of accounting that the entity uses to file its federal income tax or federal information re‐ turn for the period covered by the financial statements. The tax‐basis of accounting is based on the principles and rules for accounting for transactions under the federal income tax laws and regulations. Few new measurement guidelines need to be established because the method is based on tax laws. The tax‐basis of accounting covers a range of alternative bases, from cash to full accrual, depending on the nature of the taxpayer, and in some circumstances, the taxpayer’s elections. An entity need not be a taxable entity to prepare tax‐basis financial statements. Any entity that files a return with the IRS, either an income tax return or an information return, may prepare tax‐basis financial statements. Therefore, not‐for‐profit organizations, C corporations, S corporations, partnerships, limited liability partner‐ ships, limited liability companies, and sole proprietors may all use the tax‐basis of accounting. The tax‐basis of accounting is most useful for small, nonpublic entities whose financial statement users are in‐ terested primarily in the tax aspects of their relationship with the entity. For example, investors in tax‐driven partnerships, such as those commonly employed in the real estate industry, may be primarily interested in the tax consequences of transactions. However, they may want more information than would be provided by a tax return. Determining Whether to Prepare and Issue Cash‐ or Tax‐Basis Financial Statements As long as the entity is not contractually or otherwise required to issue financial statements prepared in accord‐ ance with GAAP or a regulatory or contractual basis of accounting, the entity may prepare and issue cash‐ or tax‐ basis financial statements. Understanding the needs of the financial statement users is an important step in de‐ termining whether to prepare and issue cash‐ or tax‐basis financial statements. If the users of the financial statements understand the presentation, and if the information presented when applying that basis of account‐ ing is relevant to their needs, then the preparer may determine that it is useful and appropriate to prepare and issue cash‐ or tax‐basis financial statements. The following are characteristics of entities that generally are good candidates to prepare cash‐ or tax‐basis financial statements: © 2018 Association of International Certified Professional Accountants. All rights reserved. 11 a. The entity’s creditors do not need or require financial statements prepared in accordance with GAAP. b. The cost of complying with GAAP would exceed the benefits (for example, a small construction contrac‐ tor who would be required to account for long term contracts using the percentage of completion method and would be required to compute deferred taxes). c. The owners are closely involved in the day‐to‐day operations of the business and have a fairly accurate picture of the entity’s financial position. d. The owners are primarily interested in cash flows (for example, a professional corporation of physicians that distributes its cash‐basis earnings through salaries, bonuses, and retirement plan contributions). e. The owners are primarily interested in the tax implications of transactions (for example, partners in a partnership who are concerned about the effects of transactions on their personal tax returns). f. It may not be appropriate to prepare and issue cash‐ or tax‐basis financial statements if the entity is or soon will be required to issue GAAP‐basis financial statements. For example, management of a company that is anticipating selling its business may be required to issue financial statements prepared in accord‐ ance with GAAP. Additionally, financial statements prepared when applying the cash‐ or tax‐basis of accounting should not be is‐ sued if the results are misleading. Cash‐ and tax‐basis financial statements are intended to be a cost‐effective al‐ ternative to GAAP, not a way to deliberately mislead financial statement users. Example Situation In Which it May Not Be Prudent to Issue Tax‐Basis Financial Statements • Long Street Partners has typically issued tax‐basis financial statements because the partners are more interested in the tax treatment of partnership transactions. Outside creditors have also accepted the tax‐basis financial statements as suitable for their needs. During the current year, two events occur that significantly affect the partnership: Several large customers experience financial difficulty and the part‐ nership’s receivables from the customers are in danger of not being collected. If the financial statements were prepared in accordance with GAAP, the partnership would be required to record a valuation al‐ lowance and recognize a bad debt expense. Under the tax rules, the partnership uses the direct write‐off method, so a tax deduction may not be allowed in the current year. • The partnership has acknowledged that it is obligated to perform an environmental remediation at one of its sites. If the financial statements were prepared in accordance with GAAP, the partnership would be required to recognize the liability and a loss. Although the entity may disclose the information in a risks and uncertainties note, under the tax rules, the deduction is not allowed until the amount is paid and therefore would not be included in the income statement equivalent. • Prior to preparing and issuing tax‐basis financial statements, in determining whether the proposed fi‐ nancial reporting framework is appropriate, the preparer may consider the following: — Whether the tax‐basis financial statements continue to be suitable for the users’ needs. In the example, the entity had a long history of issuing tax‐basis financial statements, which were suit‐ 12 © 2018 Association of International Certified Professional Accountants. All rights reserved. able for the needs of the users. The events in the current year merely illustrate the limitations of tax‐basis financial statements. — Appropriateness of disclosure. The preparer may determine to expand on the information in‐ cluded in the notes to the financial statements about these two events. For example, the part‐ nership might disclose the nature of the environmental remediation liability and the amounts involved. — Recognition may be appropriate. Depending on the nature and magnitude of the item, it may be appropriate to recognize it in the financial statements. In this example, the partnership might decide to account for bad debts using the allowance method and to recognize a contingent lia‐ bility for the remediation obligation. This would be a departure from the tax‐basis of accounting and the management of the entity may determine that, in the circumstances, it may be more appropriate to prepare its financial statements in accordance with GAAP. — Consider GAAP financials. As a result of the changed circumstances, financial statements pre‐ pared when applying the cash‐ or tax‐basis of accounting may no longer be appropriate, and the management of the entity may decide to prepare its financial statements in accordance with GAAP. Deciding Between Modified Cash‐ or Accrual Tax‐Basis Financial Statements In some situations it may be difficult to determine whether to issue modified cash‐ or accrual tax‐basis financial statements. Each basis has its own distinct advantages and disadvantages. Modified Cash‐ or Accrual Tax‐Basis Advantages and Disadvantages of Each Advantages Disadvantages Modified Cash‐Basis • Can be simpler to prepare than tax‐ basis • Not affected by changes in tax laws • Interim financial statements are easy to prepare • Recognition and measurement prin‐ ciples are not well‐defined • Not well‐suited for entities that have inventory or complex operations Accrual Tax‐Basis • Better‐suited for entities with inven‐ tory or complex operations • Well‐defined recognition and meas‐ urement criteria • Decisions made for tax reporting purposes may have unintended fi‐ nancial reporting effects • Accounting treatments are affected © 2018 Association of International Certified Professional Accountants. All rights reserved. 13 Advantages Disadvantages by changes in tax laws 14 © 2018 Association of International Certified Professional Accountants. All rights reserved. Chapter 2 Recognition and Measurement Issues in Financial Statements Prepared When Applying the Cash‐ or Tax‐Basis of Accounting The determination of what information should be reported in the financial statements and when to recognize transactions or events (recognition), and how to record transactions or events and at what amounts (measure‐ ment) varies depending on the type of framework used to prepare the financial statements. This chapter in‐ cludes a discussion of recognition and measurement issues for cash‐, modified cash‐, and tax‐basis financial statements. Cash‐Basis and Modified Cash‐Basis Observations and Suggestions In accordance with the master glossary included in the FASB Accounting Standards Codification® , cash equiva‐ lents are short‐term, highly liquid investments that have both of the following characteristics: a. Readily convertible to known amounts of cash b. So near their maturity that they present insignificant risks of changes in value because of changes in in‐ terest rates Generally, only investments with original maturities of three months or less qualify under that definition. Origi‐ nal maturity means original maturity to the entity holding the investment. For example, both a three‐month U.S. Treasury bill and a three‐year U.S. Treasury note purchased three months from maturity qualify as cash equiva‐ lents. However, a Treasury note purchased three years ago does not become a cash equivalent when its remain‐ ing maturity is three months. Examples of items commonly considered to be cash equivalents are Treasury bills, commercial paper, money market funds, and federal funds sold (for an entity with banking operations). The following represents certain significant measurement and recognition issues with respect to the cash‐ and modified‐cash bases of accounting. Investments In accordance with the cash‐basis of accounting, entities would reflect purchases of investments as cash dis‐ bursements and sales of investments as cash receipts in the period that the cash is disbursed or received. In‐ vestments acquired via noncash transactions should not be recorded and unrealized gains and losses should not be recognized. A common modification to the cash‐basis of accounting is to record investments in marketable securities as as‐ sets. If the entity prepared its financial statements in accordance with accounting principles generally accepted in the United States of America (GAAP), the investments would be reflected in the balance sheet. As such, the investments would be initially recorded at cost and subsequent unrealized changes in value would be recorded to reflect the fair value of the investments. Because unrealized gains and losses are not the result of a cash © 2018 Association of International Certified Professional Accountants. All rights reserved. 15 transaction or event, such unrealized gains and losses should not be recorded in financial statements when ap‐ plying a modified cash‐basis of accounting. Instead, the investments would remain on the balance sheet equiva‐ lent at cost unless and until they become worthless or are sold. Receivables Receivables should not be recognized in financial statements prepared when applying the cash basis of account‐ ing unless the receivables result from an outflow of cash. Other receivables such as those arising from sales transactions made on credit should not be recorded. Property and Equipment Under the cash‐basis of accounting, purchases of property and equipment would be reflected in the financial statements as cash disbursements in the period the transaction occurred. The assets would not be capitalized and depreciation would not be recorded. A common modification to the cash‐basis of accounting is to record property and equipment arising from cash transactions as assets. Once the modification is made, the entity should adopt and consistently apply an alloca‐ tion policy (depreciation or amortization) that has substantial support in the accounting literature and is logical. Such policy should also include recording any financing arrangements that are part of a cash transaction. As part of this policy, management of the entity should consider how it would address single‐step transactions or events that may not directly involve a cash inflow or outflow but may nevertheless be recorded as an in‐substance two‐ step cash transaction or event. See chapter 1, “Overview of Cash‐ and Tax‐Basis Financial Statements,” for dis‐ cussion of in‐substance two‐step transactions. Donated assets should not be recognized as “assets” because they are not derived from the use of cash or cash equivalents. It would be appropriate to write off any remaining carrying value of property and equipment once the assets are no longer in use or have been permanently impaired. Bank Overdrafts Bank overdrafts may be netted with other cash balances from the same bank. Bank overdrafts should not be netted against funds held at another financial institution. If the entity has an overall negative cash balance from a financial institution, when applying the cash‐basis of accounting, the negative cash balance would be shown as a liability on the balance sheet equivalent, if one is presented. For example, if the net balance in Bank A is $(1,000) and the net balance in Bank B is $5,000, the balance sheet equivalent would show a cash asset of $5,000 and the $(1,000) overdraft as a liability. If the entity has an overall global negative cash balance, the neg‐ ative cash balance would be shown as negative cash on hand at the end of the period on the statement of cash receipts and disbursements. Borrowings When applying the cash‐basis of accounting, the entity should record all proceeds from borrowings as cash re‐ ceipts when received and then reflect the principal repaid and associated interest as cash disbursements when paid. If a loan provides direct financing of an asset, neither the loan nor the asset should be recorded. However, 16 © 2018 Association of International Certified Professional Accountants. All rights reserved. the principal and interest payments would be reflected as cash disbursements when paid. See chapter 1 for dis‐ cussion of in‐substance two‐step transactions. Tax‐Basis In tax‐basis financial statements, transactions are recognized and measured in the same manner as they are in the entity’s federal tax return. Therefore, the preparer of financial statements when applying the tax‐basis of ac‐ counting is required to understand the federal tax laws applicable to the particular entity. Although this chapter highlights certain common measurement and recognition issues with respect to the tax‐basis of accounting, it is not a substitute for understanding the federal tax laws applicable to the particular entity. Additionally, although the IRS permits all entities to use the accrual method of accounting for tax purposes, many smaller entities can instead elect to use the cash method of accounting for tax purposes. Entities with in‐ ventories are required to use the accrual method for sales and purchases of inventory. Nontaxable Revenues and Nondeductible Expenses Under federal income tax laws, certain revenue is not taxable and certain expenses are not deductible. For ex‐ ample, receipts such as interest on obligations of state and local governments and proceeds from life insurance policies are not taxable. Costs such as premiums paid on officers’ life insurance policies are not deductible. When presenting tax‐basis financial statements, in order to be transparent, preparers of tax‐basis financial statements may recognize nontaxable revenues and nondeductible expenses outside of taxable income. Nontaxable revenues should be recognized when received (cash‐basis) or when earned (accrual basis). Nonde‐ ductible expenses should be reported and charged to expense in the period paid (cash‐basis) or when incurred (accrual basis). Additional Income Taxes for Prior Years An IRS exam may result in additional income taxes being assessed for prior years. Two alternative methods may be used to account for additional taxes for prior years. • The amount may be charged to expense in the current period if there are no corresponding adjustments to the balance sheet equivalent for expenses capitalized or revenue recognized. • The amount may be treated as a prior period adjustment and charged to retained earnings in a manner that is logical and consistent with the equivalent of a presentation in accordance with GAAP. The IRS may disallow amounts charged to expense in prior years and require those amounts to be capitalized and amortized or may require recognition of previously unreported revenue. Such amounts, net of income tax adjustments, should be treated as prior period adjustments. Otherwise, either of the preceding methods is con‐ sidered acceptable. The method used and the amount of additional taxes should be disclosed in the notes to the financial statements. Accounting Changes for Tax Purposes For tax purposes, the effects of an accounting change may be recognized prospectively over a specified number of years. Accounting changes should be treated in the same manner as they are treated in the tax return. © 2018 Association of International Certified Professional Accountants. All rights reserved. 17 S Corporations Income of an S corporation is taxable to its shareholders. Consequently, such a corporation may be required to maintain information on distinct classes of retained earnings. However, in tax‐basis financial statements, S cor‐ porations usually report retained earnings as a single amount and should report distributions to stockholders. Significant Differences Between GAAP and Tax‐Basis There are many differences between the way items are accounted for in accordance with GAAP and the way they are treated under the tax rules. Some of the more common include the following: • Bad debt losses on uncollectible receivables • Inventory capitalization and valuation • Unrealized gains on investment securities • Depreciation and impairment of capital assets • Fair value measurements • Consolidation 18 © 2018 Association of International Certified Professional Accountants. All rights reserved. Chapter 3 Presentation and Disclosure Issues in Financial Statements Prepared When Ap‐ plying the Cash‐ or Tax‐Basis of Accounting The determination of the form and content of the financial statements or which financial statements to present and what to include (presentation and disclosure) varies depending on the financial reporting framework ap‐ plied. Financial statements prepared when applying the cash‐ or tax‐basis of accounting may provide less complex and more understandable alternatives to financial statements prepared in accordance with accounting principles generally accepted in the United States of America (GAAP). However, preparers must be knowledgeable of GAAP disclosure requirements because cash‐ and tax‐basis financial statements should include informative disclosures similar to those required by GAAP if the financial statements contain items that are the same as, or similar to, those in financial statements prepared in accordance with GAAP. Observations and Suggestions Often, preparers of cash‐ and tax‐basis financial statements elect to omit substantially all disclosures required by the cash‐ or tax‐basis of accounting. The omission of disclosures is a departure from the cash‐ or tax‐basis of ac‐ counting and, if such disclosures were included in the financial statements, they might influence the user’s con‐ clusions about the entity’s financial position, results of operations, and cash flows. However, the omission may not necessarily result in misleading financial statements provided that the intended users are informed about such matters. If cash‐ or tax‐basis financial statements contain items for which GAAP would require disclosure, the financial statements may either provide the relevant disclosure that would be required for those items in a GAAP presen‐ tation or provide information that communicates the substance of that disclosure. This may result in substitut‐ ing qualitative information for some of the quantitative information required for GAAP presentations. For exam‐ ple, • disclosure of the repayment terms of significant long‐term borrowings may sufficiently communicate in‐ formation about future principal reduction without providing the summary of principal reduction during each of the next five years. • information about the effects of accounting changes, discontinued operations, and extraordinary items could be disclosed in a note to the financial statements without following the GAAP presentation re‐ quirements in the income statement equivalent or disclosing net‐of‐tax effects. • instead of showing expenses by their functional classifications with respect to the financial statements of a not‐for‐profit organization, a statement of activities could present expenses according to their natu‐ ral classifications, and a note to the financial statements could use estimated percentages to communi‐ cate information about expenses incurred by the major program and supporting services. • instead of showing the amounts of, and changes in, the unrestricted and temporarily and permanently restricted classes of net assets with respect to the financial statements of a not‐for‐profit organization, a © 2018 Association of International Certified Professional Accountants. All rights reserved. 19 statement of assets, liabilities, and net assets could report total net assets or fund balances, a related statement of activities could report changes in those totals, and a note to the financial statements could provide information, using estimated or actual amounts or percentages, about the restrictions on those amounts and on any deferred restricted amounts, describe the major restrictions, and provide infor‐ mation about significant changes in restricted amounts. For financial statements prepared when applying the cash‐ or tax‐basis of accounting, GAAP disclosure require‐ ments that are not relevant to the measurement of the item need not be considered. To illustrate, • fair value disclosures for investments in debt and equity securities would not be relevant when the basis of presentation does not adjust the cost of such securities to their fair value. • disclosures related to actuarial calculations for contributions to defined benefit plans would not be rele‐ vant in financial statements prepared when applying the cash‐ or tax‐basis of accounting. • disclosures related to the use of estimates would not be relevant in a presentation that has no esti‐ mates, such as the cash‐ or modified cash‐basis of accounting. Financial statements prepared when applying the cash‐basis of accounting generally do not include a statement of cash flows. However, depending on the user’s requirements, financial statements prepared when applying a modified cash‐ or the tax‐basis of accounting may include a statement of cash flows. For example, it may be challenging for users to obtain accurate information on operating, investing, and financing activities in single‐ year financial statements prepared when applying the tax‐basis of accounting unless a statement of cash flows is presented. Similar to financial statements prepared in accordance with GAAP, in order to achieve fair presentation, financial statements prepared when applying the cash‐ or tax‐basis of accounting should include all informative disclo‐ sures that are appropriate for the applicable financial reporting framework, including all significant matters that materially affect the financial statements’ use, understanding, and interpretation. Additionally, because financial statements prepared when applying the cash‐ or tax‐basis of accounting have certain inherent presentation and disclosure limitations, in order to enhance the value and usefulness of such fi‐ nancial statements, the preparer may disclose additional information in the notes to the financial statements. For example, donated capital assets would not be included in the balance sheet equivalent in financial state‐ ments prepared when applying a modified cash‐basis of accounting—even if the modification to the cash‐basis of accounting is to record capital expenditures as assets and depreciate them over their estimated useful lives. The preparer may elect to disclose the value of such donated capital assets in the notes to the financial state‐ ments. Presentation—Cash‐Basis Financial Statements Because a balance sheet equivalent would simply show the cash balance and a corresponding equity account, and a statement of cash flows would be repetitive of the statement of cash receipts and disbursements, finan‐ cial statements prepared when applying the cash‐basis of accounting may consist only of a statement of cash re‐ ceipts and disbursements. Although a single statement may be presented, informative disclosures are still nec‐ essary. Additionally, restrictions on cash balances should either be presented on the face of the statement of cash receipts and disbursements or should be disclosed in the notes to the financial statements. 20 © 2018 Association of International Certified Professional Accountants. All rights reserved. Basis of Accounting A required disclosure for all cash‐ and tax‐basis financial statements is the description of the basis of accounting (financial reporting framework), including how that basis of accounting differs from GAAP. Although these dif‐ ferences from GAAP should be qualitatively described, they need not be quantified. This description is important in financial statements prepared when applying a modified cash‐basis of accounting because such financial statements may vary depending on the modifications to the cash‐basis that were made. The description there‐ fore becomes essential to the user’s understanding of the financial statements. The description of the basis of accounting is usually presented in the summary of significant accounting policies section of the notes to the financial statements with a heading such as “Basis of Accounting.” The following ex‐ amples represent how the basis of accounting may be disclosed in the notes to financial statements prepared when applying the cash‐, a modified cash‐, and the tax‐basis of accounting. Example: Basis of Accounting Note—Cash‐Basis of Accounting Basis of Accounting The financial statements of Company X have been prepared on the cash‐basis of accounting, which is a compre‐ hensive basis of accounting other than accounting principles generally accepted in the United States of America (GAAP). The cash‐basis of accounting differs from GAAP primarily because revenues are recognized when re‐ ceived rather than when earned and expenses are recorded when paid rather than when incurred. The financial statements therefore present only cash and cash equivalents and changes therein in the form of cash receipts and disbursements. Example: Basis of Accounting Note—Modified Cash‐Basis of Accounting Basis of Accounting The financial statements of Company X have been prepared on the cash‐basis of accounting, modified to record assets or liabilities with respect to cash transactions and events that provide a benefit or result in an obligation that covers a period greater than the period in which the cash transaction or event occurred. The modifications result in the recording of investments, inventories, capital assets, and related short‐term and long‐term obliga‐ tions on the statement of financial position. This method of accounting represents a comprehensive basis of ac‐ counting other than accounting principles generally accepted in the United States of America (GAAP). This basis of accounting differs from GAAP primarily because certain revenue and related assets (such as accounts receiva‐ ble and revenue for billed or provided services not yet collected, and other accrued revenue and receivables) have been recognized when received rather than when earned and certain expenses and related liabilities (such as accounts payable and expenses for goods or services received but not yet paid, and other accrued liabilities and expenses) have been recognized when paid rather than when the obligations were incurred. Example: Basis of Accounting Note—Tax‐Basis of Accounting Basis of Accounting The financial statements of Company X have been prepared on the accrual basis of accounting that the Company uses for filing its federal income tax return, which is a comprehensive basis of accounting other than accounting principles generally accepted in the United States of America (GAAP). This basis differs from GAAP primarily be‐ © 2018 Association of International Certified Professional Accountants. All rights reserved. 21 cause the Company expenses the cost of certain types of assets in accordance with IRC Section 179. GAAP re‐ quires that such assets be capitalized and expensed over their estimated useful lives. Summary of Significant Accounting Policies FASB Accounting Standards Codification (ASC) 235, Notes to Financial Statements, requires that financial state‐ ments prepared in accordance with GAAP include a summary of significant accounting policies in the notes to the financial statements. Accordingly, cash‐ and tax‐basis financial statements should include a summary of sig‐ nificant accounting policies in the notes to the financial statements. In addition to the basis of accounting discussed previously, the note should include disclosure of the significant accounting policies used to prepare the financial statements, including policies that involve the following: • A selection from existing acceptable alternatives • Industry specific applications • Unusual or innovative applications of accounting principles Because the cash‐basis of accounting does not include the recognition of noncash assets, liabilities, and noncash transactions, elaborate accounting policy disclosures are usually unnecessary. In financial statements prepared when applying a modified cash‐basis of accounting, such disclosures may include information about the follow‐ ing: • Investments • Inventory • Property and equipment • Income taxes • Consolidation • Related parties and related party transactions • Commitments and contingencies • Uncertainties • Subsequent events • Asset impairments The significant accounting policies note for tax‐basis financial statements should include disclosure of the follow‐ ing: • Whether the basic method of accounting is cash or accrual 22 © 2018 Association of International Certified Professional Accountants. All rights reserved. • The tax filing status of the entity, if other than a taxable corporation (that is, a C corporation) • That revenues and related assets and expenses and related obligations are recognized only when they are reported or deducted for federal income tax purposes • That nontaxable income and nondeductible expenses are included in the determination of the equiva‐ lent of operating results or “net income” • The nature of any optional tax methods of accounting followed • The nature of any important judgments or policies necessary for an understanding of the methods of recognizing revenue and allocating costs to current and future periods • Tax uncertainties including open tax years Also, tax uncertainties should be addressed in financial statements prepared when applying the cash‐ or tax‐ basis of accounting. FASB ASC 740‐10‐50‐15 requires that open tax years be disclosed—even if the reporting en‐ tity is a pass‐through entity or a not‐for‐profit organization. In addition, in financial statements prepared when applying the tax‐basis of accounting, disclosures regarding significant accounting policies may include information about receivables. The following represents guidance on certain other common presentation and disclosure issues with respect to cash‐ and tax‐basis financial statements. Subsequent Events FASB ASC 855, Subsequent Events, sets forth general standards of accounting for and disclosure of events that occur after the balance sheet date but before the financial statements are issued or are available to be issued. The preparer should disclose the date through which subsequent events have been evaluated, which is the date the financial statements are available to be issued. When financial statements prepared when applying the cash‐ or tax‐basis of accounting contain items that are the same as, or similar to, those in financial statements pre‐ pared in accordance with GAAP, such financial statements should contain the disclosures required by FASB ASC 855. Related Party Transactions The existence of related party transactions that are material individually or in the aggregate and the nature and amounts of the transactions and balances should be disclosed. Note that the tax rules may define “related par‐ ty” differently than how it is defined in accordance with GAAP. To avoid confusion on the part of users of the tax‐basis financial statements, the GAAP definition of related party should be considered for all financial report‐ ing purposes. Commitments and Contingencies The existence and nature of material commitments and contingencies should be disclosed in the notes to finan‐ cial statements prepared when applying the cash‐ or tax‐basis of accounting. © 2018 Association of International Certified Professional Accountants. All rights reserved. 23 Pension Plans The existence and nature of a pension plan should be disclosed in the notes to financial statements when apply‐ ing the cash‐ or tax‐basis of accounting. Assets and Liabilities Information disclosed for assets and liabilities commonly includes the following items: • Restricted cash, segregated from cash available for current operations, with a description of the nature of the restriction • The aggregate fair value of investments in marketable securities • Accounts and notes receivable from officers, employees, and affiliates, presented separately with disclo‐ sure of the effective interest rate on notes receivable, and interest income for the period • The major classes of property, plant, and equipment; depreciation expense for the period; the meth‐ od(s) used in computing depreciation; and the aggregate, accumulated depreciation • The method of determining inventory cost (for example, last in, first out and first in, first out) Owners’ Equity The financial statements often include disclosures regarding information on owners’ equity as follows: • For each class of stock, the number of shares authorized, issued, and outstanding; the par or stated val‐ ue; and, in summary form, the pertinent rights and privileges of each outstanding class (if more than one class is outstanding) • The existence of stock option and stock purchase plans • Restrictions on the payment of dividends • Changes for the period in the separate components of owners’ equity A note to the financial statements of a voluntary health and welfare organization that prepares tax‐basis finan‐ cial statements could provide information, using estimated or actual amounts or percentages, about the re‐ strictions on total net assets or fund balances and on any deferred restricted amounts, describe the major re‐ strictions, and provide information about significant changes in restricted amounts. Risks and Uncertainties Financial statements prepared in accordance with GAAP are required to include a number of disclosures with re‐ spect to risks and uncertainties. The following table summarizes these disclosures and how GAAP requirements for disclosing risks and uncer‐ tainties should be addressed in cash‐ and tax‐basis financial statements. The table is not meant to be all‐ inclusive. 24 © 2018 Association of International Certified Professional Accountants. All rights reserved. Observations and Suggestions Often, preparers of cash‐ and tax‐basis financial statements elect to omit substantially all disclosures required by the cash‐ or tax‐basis of accounting. The omission of disclosures is a departure from the cash‐ or tax‐basis of ac‐ counting and, if such disclosures were included in the financial statements, they might influence the user’s con‐ clusions about the entity’s financial position, results of operations, and cash flows. However, the omission may not necessarily result in misleading financial statements provided that the intended users are informed about such matters. GAAP Requirement Summary of Required Disclosures Applicability to Cash‐ or Tax‐ Basis of Accounting Nature of Operations Entities should disclose a de‐ scription of the major products or services the reporting entity sells or provides and its principal markets. This information is use‐ ful because it helps financial statement users understand the nature of the entity’s business and the risks common to that business. This disclosure is relevant to all financial statements prepared in accordance with the cash‐ or tax‐ basis of accounting and should be made. Use of Estimates Financial statements should in‐ clude an explanation that the preparation of financial state‐ ments in accordance with GAAP requires the use of manage‐ ment’s estimates. This disclosure may not be rele‐ vant to some financial state‐ ments prepared in accordance with the cash‐ or tax‐basis of accounting; for example, finan‐ cial statements prepared on the cash‐basis that do not include estimated amounts. Certain Significant Estimates If certain criteria are met, the entity is required to disclose the nature of an uncertainty if it is at least reasonably possible that a change in an estimate will occur in the near term. The purpose of the disclosure is to communicate to financial statement users that there is a reasonable possibility that certain estimated amounts in the current year financial statements will change signifi‐ cantly and affect the subsequent years’ financial statements. If the GAAP disclosure criteria are met, the financial statements should include disclosure of the information required by GAAP. Vulnerability Due to Concentra‐ If certain criteria are met, the If the GAAP disclosure criteria © 2018 Association of International Certified Professional Accountants. All rights reserved. 25 GAAP Requirement Summary of Required Disclosures Applicability to Cash‐ or Tax‐ Basis of Accounting tions financial statements are re‐ quired to include disclosure in‐ formation about its vulnerability due to concentrations; for ex‐ ample, significant volume of business conducted with one customer. are met, the preparer should disclose the information re‐ quired by GAAP. Going Concern A basic premise underlying fi‐ nancial reporting is that a user of the financial statements can as‐ sume that the entity will contin‐ ue as a going concern for a rea‐ sonable period of time. If the preparer concludes that material uncertainties exist such that the entity may not continue as a go‐ ing concern for a reasonable pe‐ riod of time, the financial state‐ ments should include disclosure of such uncertainty. If the preparer concludes that there is substantial doubt about the entity’s ability to continue as a going concern for a reasonable period of time (generally one year from the date of the bal‐ ance sheet equivalent), the pre‐ parer should disclose the going concern considerations in a note to the financial statements. Terminology for Cash‐ and Tax‐Basis Financial Statements There is no requirement to modify financial statement titles in cash‐ or tax‐basis financial statements. However, users of such financial statements should be able to readily identify the basis of accounting used to prepare the financial statements. A common and convenient way of identifying the basis of accounting is through the finan‐ cial statement titles by adding “cash‐basis,” “modified cash‐basis,” or “tax‐basis” after the financial statement ti‐ tle. Cash‐basis financial statements might be titled, for example, • Statement of Assets and Liabilities Arising from Cash Transactions; • Statement of Revenue Collected and Expenses Paid; • Statement of Revenue and Expenses—Cash‐Basis; or • Statement of Cash Receipts and Disbursements. Modified cash‐basis financial statements might be titled, for example, • Statement of Assets and Net Assets—Modified Cash‐Basis; or • Statement of Revenue, Expenses and Changes in Net Assets—Modified Cash‐Basis. Tax‐basis financial statements might be titled, for example, 26 © 2018 Association of International Certified Professional Accountants. All rights reserved. • Statement of Assets, Liabilities, and Capital—Tax‐Basis; • Statement of Operations—Tax‐Basis; or • Statement of Revenue and Expenses—Tax‐Basis. The preceding examples are not meant to be all‐inclusive and are not the only acceptable titles. With respect to the captions to be used with the cash‐, modified cash‐, or tax‐basis financial statements, there is no requirement to modify the standard GAAP financial statement captions. Therefore, captions such as “net in‐ come,” “net loss,” and “retained earnings” are acceptable. However, if modifications are desired (which many preparers prefer as a means of additional emphasis that the financial statements are not prepared in accordance with GAAP), common examples for cash‐basis financial statements are excess of revenue collected over expenses paid and excess of expenses paid over revenue collected. For financial statements prepared when applying a modified cash‐basis of accounting, common modifications are excess of revenue over expenses and excess of ex‐ penses over revenue. With respect to tax‐basis financial statements, modifications with respect to financial statement captions are rarely made. However, modifications, if made, may include retained earnings—tax‐basis and net income—tax‐basis. Consolidation Accounting Professional judgment should be applied to determine which presentation—consolidated, unconsolidated, or combined—provides the most meaningful and relevant information. A preparer should not consolidate entities unless all entities to be consolidated use the same basis of accounting. For example, it would not be appropriate to consolidate an entity that prepares its financial statements using a modified cash‐basis of accounting with its parent who maintains its books and records in accordance with the tax‐basis of accounting. If the modified cash‐ basis of accounting is used, then all consolidated entities should utilize the same modifications to the cash‐basis of accounting. With respect to financial statements prepared when applying the tax‐basis of accounting, consolidation is based on the IRC. Therefore, the consolidation requirements of FASB ASC 810, Consolidation, do not apply. However, if the entity files a consolidated tax return, it should report consolidated results on its tax‐basis financial state‐ ments. In the case of brother‐sister corporations in which each entity maintains its books and records on the tax‐basis of accounting, but a consolidated tax return is not filed, the preparer may prepare combined financial statements because such financial statements may be more useful to users than individual uncombined financial statements. Although the tax consolidation rules are followed, additional disclosures may be necessary to lessen the chance that the financial statements are not misleading. Consider, for example, a 60 percent owned subsidiary that would be consolidated in financial statements prepared in accordance with GAAP but is not consolidated in fi‐ nancial statements prepared when applying the tax‐basis of accounting because the threshold for consolidation under the IRC is 80 percent ownership. Even though the subsidiary is not consolidated, the preparer should con‐ sider which disclosures are appropriate relative to the 60 percent owned subsidiary. Examples of matters that might require disclosure are the ownership and relationship with the subsidiary, related party transactions, guarantees, and commitments. © 2018 Association of International Certified Professional Accountants. All rights reserved. 27 Change From GAAP to Cash‐ or Tax‐Basis A change from GAAP to cash‐ or tax‐basis statements (or vice versa) does not represent a change in accounting principles as described in FASB ASC 250, Accounting Changes and Error Corrections. Therefore, no justification for the change is required, and a cumulative effect adjustment is unnecessary. When only the current year’s cash‐ or tax‐basis statements are presented, there are three ways of presenting opening equity: • Show opening equity as previously reported in accordance with GAAP, with an adjustment to convert to the cash‐ or tax‐basis. • Show opening equity on the as‐adjusted cash‐ or tax‐basis. • Show the effects of the adjustment to convert as a cumulative‐effect adjustment in the income state‐ ment equivalent. If comparative financial statements are presented, the prior periods should be restated and presented on the basis to which the company has changed. Restatement is necessary to ensure comparability between all periods presented. In all cases, the change in accounting basis should be disclosed in the notes to the financial statements. The fol‐ lowing is an example of how such a change in accounting basis could be disclosed in the notes to the financial statements: In 20X1, management adopted a policy of preparing its financial statements on the basis of accounting that it uses to file its federal income tax return. Prior to 20X1, the Company’s financial statements were prepared in accordance with accounting principles generally accepted in the United States of America. Management believes that this change results in more relevant financial reporting that is easier and less costly to understand, apply, and use in the Company’s circumstances and considering the needs of the users of the financial statements. The 20X1 financial statements have been restated to be on the tax‐ basis of accounting. 28 © 2018 Association of International Certified Professional Accountants. All rights reserved. Appendix Illustrative Cash‐ and Tax‐Basis Financial Statements This appendix contains illustrative examples of financial statements prepared when applying the cash‐, modified cash‐, or tax‐basis of accounting for different types of entities. These financial statements are intended to illus‐ trate the significant discussion points in chapters 1–3 of this practice aid. Each financial statement has been an‐ notated to highlight these key points. Name of Entity Type of Entity Basis of Preparation Ceolainn Club Not‐for‐profit Cash Mickey’s Center Not‐for‐profit Modified Cash Donnelly & Oates Limited Liability Partnership Tax (Accrual Basis) Charlton Contractors, Inc. Construction Contractor Tax (Accrual Basis) Margaret Rose 1964 Irrevocable Trust Trust Tax (Accrual Basis) CEOLAINN CLUB FINANCIAL STATEMENTS FOR THE YEARS ENDED JUNE 30, 20X2 AND 20X1 Circumstances include the following: • The financial statements are for a not‐for‐profit membership club. • The financial statements are prepared on the cash‐basis of accounting. • The financial statements are comparative for the years ended June 30, 20X2, and 20X1. The financial statements illustrate the following: • The financial statements include a statement of functional expenses, which is required by accounting principles generally accepted in the United States of America (GAAP). Financial statements prepared when applying the cash‐basis of accounting are not required to include such a statement, but may in‐ stead communicate the substance of that requirement. • GAAP requires not‐for‐profit organizations to report the amount of unrestricted, temporarily restricted, and permanently restricted net assets on the face of the statement of financial position. Because a statement of financial position equivalent is not presented, the illustrative financial statements com‐ municate the substance of the GAAP requirement in the notes to the financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 29 Ceoliann Club Statements of Cash Receipts and Disbursements For the Years Ended June 30, 20X2 and 20X1 June 30, 20X2 June 30, 20X1 Cash received from support activities: Membership dues $ 49,899 $ 46,759 Donations 996 1,125 Programs 7,495 10,645 Total cash received from support activities 58,390 58,529 Cash received from other sources: Interest income 19 30 Other 300 3,720 Total cash received from other sources 319 3,750 TOTAL CASH RECEIVED $ 58,709 $ 62,279 Cash disbursed: Program services $ 29,110 $ 29,484 Supporting services 19,783 19,113 Fundraising 6,288 8,803 TOTAL CASH DISBURSED $ 55,181 $ 57,400 Excess of revenue collected over expenses paid 3,528 4,879 Cash and cash equivalents, beginning of year 39,046 34,167 Cash and cash equivalents, end of year $ 42,574 $ 39,046 See accompanying notes to financial statements. 30 © 2018 Association of International Certified Professional Accountants. All rights reserved. The Ceoliann Club Statements of Functional Expenses Cash‐Basis For the Years Ended June 30, 20X2 and 20X1 Program Services Supporting Services Fundraising Total June 30, 20X2 Program Services Supporting Services Fundraising Total June 30, 20X1 Salaries and benefits $ 23,333 $ 16,440 $ 4,241 $ 44,014 $ 23,633 $15,876 $ 5,937 $ 45,446 Events—special 1,795 1,795 2,513 2,513 Legal and ac‐ counting 2,320 2,320 2,500 2,500 Insurance 313 51 45 409 317 49 63 429 Postage/printing 3,477 3,477 3,398 3,398 Licenses/fees 114 114 464 464 Office expense 612 232 207 1.051 620 224 290 1,134 Miscellaneous 1,375 626 2,001 1,516 1,516 $ 29,110 $19,783 $6,288 $55,181 $29,484 $19,113 $8,803 $57,400 53% 36% 11% 52% 33% 15% See accompanying notes to financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 31 Ceolainn Club Notes to Financial Statements Cash‐Basis For the Years Ended June 30, 20X2 and 20X1 Note 1—Summary of Significant Accounting Policies Nature of Activities The Ceolainn Club (the Club) is a New York not‐for‐profit organization. The Club’s mission is to promote safe so‐ cial programs for young adults. Basis of Accounting The Club’s financial statements have been prepared on the cash‐basis of accounting, which is a comprehensive basis of accounting other than accounting principles generally accepted in the United States of America (GAAP). The cash‐basis of accounting differs from GAAP primarily because revenues are recognized when received rather than when earned and expenses are recorded when paid rather than when incurred. The financial statements therefore present only cash and cash equivalents and changes therein in the form of cash receipts and dis‐ bursements. Cash and Cash Equivalents The Club considers all highly liquid investments available for current use with an initial maturity of three months or less to be cash equivalents. As of June 30, 20X2, and 20X1, cash and cash equivalents consisted entirely of the adjusted book balance in the Club’s checking account. Net Assets As of June 30, 20X2, and 20X1, all of the Club’s net assets were unrestricted. Income Taxes The Club is exempt from federal and state income taxes under Internal Revenue Code Section 501(c)(7). Accord‐ ingly, no provision for income taxes has been made in the financial statements. Uncertain Tax Positions Federal and state income tax returns for the years 20X0 to date are subject to examination by taxing authorities. Subsequent Events Management has evaluated subsequent events through August 28, 20X2, which is the date the financial state‐ ments were available to be issued. 32 © 2018 Association of International Certified Professional Accountants. All rights reserved. MICKEY’S CENTER FINANCIAL STATEMENTS AS OF AND FOR THE YEAR ENDED AUGUST 31, 20X2 Circumstances include the following: • The financial statements are for a not‐for‐profit charity. • The financial statements are prepared on a modified cash‐basis of accounting. The cash‐basis of ac‐ counting was modified to accrue cash transactions and events that provide a benefit or result in an obli‐ gation that covers a period greater than the period in which the cash transactions or events occurred. Such accruals resulted in the recording of property and equipment as assets on the statement of assets and net assets and subsequent depreciation of those assets over their estimated useful lives. • The financial statements are as of August 31, 20X2, and for the year then ended. The financial statements illustrate the following: • The financial statements include a statement of functional expenses, which is required by accounting principles generally accepted in the United States of America (GAAP). Financial statements prepared when applying a modified cash‐basis of accounting are not required to include such a statement, but may instead communicate the substance of that requirement. • GAAP requires not‐for‐profit organizations to report the amount of unrestricted, temporarily restricted, and permanently restricted net assets on the face of the balance sheet (in the case of the illustrative fi‐ nancial statements prepared on a modified cash‐basis of accounting, such point in time statement is re‐ ferred to as the statement of assets and net assets). The illustrative financial statements do not follow those presentation requirements but instead, communicate their substance by providing relevant in‐ formation in the notes to the financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 33 Mickey’s Center Statement of Assets and Net Assets Modified Cash‐Basis August 31, 20X2 Assets Cash and cash equivalents $ 316,258 Restricted cash (Note 2) 108,084 Property and equipment (net of accumulated de‐ preciation of $35,565) 9,018 $ 433,360 Net Assets Unrestricted net assets (Note 5) 433,360 Net assets $ 433,360 See accompanying notes to financial statements. 34 © 2018 Association of International Certified Professional Accountants. All rights reserved. Mickey’s Center Statement of Revenue, Expenses and Changes in Net Assets Modified Cash‐Basis For the Year Ended August 31, 20X2 Revenue Corporate and foundation contributions $ 536,134 Other contributions 235,920 Exchange club projects 105,302 Unsolicited and other donations 69,754 Total revenue 947,110 Expenses Program services 769,426 Management and general 100,718 Fundraising 55,264 155,982 Total expenses 925,408 Increase in net assets 21,702 Net assets, beginning of year 411,658 Net assets, end of year $ 433,360 See accompanying notes to financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 35 Mickey’s Center Statement of Functional Expenses Modified Cash‐Basis For the Year Ended August 31, 20X2 Program Services Management and General Fundraising Total Salaries and bene‐ fits $ 451,675 $ 76,781 $ 38,041 $ 566,497 Grant expense 41,291 41,291 Special events 77,790 13,233 91,023 Training 16,029 16,029 Professional ser‐ vices 16,810 16,810 Telephone 14,782 720 428 15,930 Postage/printing 6,176 301 178 6,655 Office supplies 16,597 809 481 17,887 Program materials 16,279 16,279 Depreciation 8,917 435 259 9,611 Rent 58,084 2,831 1,683 62,598 Miscellaneous 61,806 2,031 961 64,798 $ 769,426 $ 100,718 $ 55,264 $ 925,408 83% 11% 6% See accompanying notes to financial statements. 36 © 2018 Association of International Certified Professional Accountants. All rights reserved. Mickey’s Center Notes to Financial Statements Modified Cash‐Basis August 31, 20X2 Note 1—Summary of Significant Accounting Policies Nature of Activities Mickey’s Center (the Center) is a nonprofit corporation incorporated under the Texas Non‐Profit Corporation Act. The purpose of the Center is to use its funds exclusively for charitable, scientific, and educational purposes, especially the prevention of child abuse. Basis of Accounting The financial statements of the Center have been prepared on the cash‐basis of accounting, modified to record assets or liabilities with respect to cash transactions and events that provide a benefit or result in an obligation that covers a period greater than the period in which the cash transactions or events occurred. The modifica‐ tions result in the recording of capital assets on the statement of assets and net assets. Except for depreciation, all transactions are recognized as either revenue or expenses when received or paid in cash. Except for deprecia‐ tion, noncash transactions are not recognized. This basis of accounting represents a comprehensive basis of ac‐ counting other than accounting principles generally accepted in the United States of America (GAAP). This basis of accounting differs from GAAP primarily because certain revenue and related assets have been recognized when received rather than when earned and certain expenses and related liabilities have been recognized when paid rather than when the obligations were incurred. Property and Equipment Property and equipment are recorded at cost and consist of the office building and equipment. Depreciation is computed on the straight‐line method based on estimated useful lives of 30 years and 5 years for the office building and equipment, respectively. Cash Equivalents The Center considers all highly liquid debt instruments with an original maturity of three months or less to be cash equivalents. Contributions The Center records contributions when received in cash. Contributed Services Many individuals volunteer their time to help the Center with its educational activities. During the year ended August 31, 20X2, the Center received approximately 200 volunteer hours that have not been recorded in the statement of revenue, expenses, and changes in net assets. Functional Expenses © 2018 Association of International Certified Professional Accountants. All rights reserved. 37 The costs of providing the various programs, fundraising, and other activities have been summarized on a func‐ tional basis in the statement of functional expenses. Accordingly, certain costs have been allocated among the programs and fundraising activities benefited. Functional expenses are allocated to programs and supporting services based on specific identification. Expenses that relate to more than one program or support activity are allocated based on salary expenditure. Income Taxes The Center is exempt from federal and state income taxes under Internal Revenue Code Section 501(c)(3), ex‐ cept to the extent that it has taxable income from businesses that are not related to its tax exempt purpose. Un‐ related business income, if there was any, would be taxed at the applicable corporate income tax rate. The Cen‐ ter did not have any unrelated business income during the year ended August 31, 20X2, and accordingly, no pro‐ vision for income taxes has been made in the financial statements. The Center is not currently under examination by any taxing jurisdiction. Federal and state taxing authorities no longer have the right to examine tax years prior to 20Y9. For the year ended August 31, 20X2, there were no in‐ terest or penalties associated with tax positions recorded in the accompanying financial statements. Use of Estimates The preparation of financial statements on a modified cash‐basis of accounting requires management to make estimates and assumptions that affect financial statement amounts and disclosures. Actual results could differ from those estimates and assumptions. Subsequent Events In preparing these financial statements, management of the Center has evaluated events and transactions for potential recognition or disclosure through January 20, 20X3, the date the financial statements were available to be issued. Note 2—Restricted Cash The balance represents funds restricted by the board of directors in an amount equal to the balance in the School Initiatives Fund. Note 3—Commitments and Contingencies The land on which the Center’s office is located is being leased on an annual basis at a rate of $1,400 per annum. See Note 4. Note 4—Subsequent Events In September 20X2, the Center entered into a “purchase and sale agreement,” which provided for the purchase of a building in the amount of $230,000 and the assumption of a lease of the land on which the building is locat‐ ed. The building purchase was executed on September 28, 20X2, and was financed in part by a $220,000 note payable to a bank. The terms of the note provide for quarterly interest payments at the bank’s prime rate through the note maturity date. A $100,000 principal payment was due and made in December 20X2, and the remaining balance is due September 20X8. The note is secured by a leasehold deed of trust and security agree‐ ment and an assignment of rents and leases. 38 © 2018 Association of International Certified Professional Accountants. All rights reserved. The assumed lease previously referred to is an operating lease that requires annual payments of $19,600 through September 20X6. The Center has the option to terminate the lease in March 20X9. If the lease is not terminated, the annual payment will be revised to reflect 6 percent of the value of the land, which will be de‐ termined as set forth in the lease agreement. In December 20X2, the Center entered into a construction contract for $138,000 to design and construct certain building and leasehold improvements. Note 5—Internally Restricted Net Assets Net assets internally restricted for the School Initiatives Fund consist of amounts allocated from unrestricted net assets as approved by the board of directors. The internally restricted amounts are to be used for purchasing equipment and establishing programs for educational programs in schools and are not available for other pur‐ poses without approval by the board of directors. Note 6—Allocation of Joint Costs During the year ended August 31, 20X2, the Center conducted activities that included appeals for contributions and incurred joint costs of approximately $46,000. These activities included direct mail campaigns and special events. Approximately 65 percent of these joint costs were allocated to fundraising activities and 35 percent to program services. © 2018 Association of International Certified Professional Accountants. All rights reserved. 39 DONNELLY & OATES LIMITED LIABILITY PARTNERSHIP FINANCIAL STATEMENTS AS OF AND FOR THE YEAR ENDED DECEMBER 31, 20X2 Circumstances include the following: • The financial statements are for a limited liability partnership (LLP) that owns and operates a racquet and swim club. • The financial statements are prepared on basis of accounting that the LLP uses for federal income tax purposes. • The financial statements are as of and for the year ended December 31, 20X2. The financial statements illustrate the following: • The Statement of Revenues and Expenses uses the caption “Revenues in excess of expenses” to portray what a financial statement prepared in accordance with accounting principles generally accepted in the United States of America (GAAP) would describe as “Net income.” There is no prohibition on the use of “Net income” or other GAAP captions within the financial statements. In this situation, the entity has chosen the term because management believes it to be more descriptive. • The financial statements include a Statement of Cash Flows, which is not required for financial state‐ ments prepared when applying the tax‐basis of accounting. However, in this case, the financial state‐ ments include a single year only, thus it would be difficult for financial statement users to obtain accu‐ rately the information on operating, investing and financing activities presented in a statement of cash flows. 40 © 2018 Association of International Certified Professional Accountants. All rights reserved. Donnelly & Oates Limited Liability Partnership Statements of Assets, Liabilities and Partners’ Capital Tax‐Basis December 31, 20X2 Assets Cash 450,944 Accounts receivable 451,194 Inventory 311,214 Prepaid expenses and other assets 24,046 Financing fees, less accumulated amortization of $57,096 259,124 Syndication costs 312,166 Property and equipment, net of accumulated depreci‐ ation of $2,810,112 9,054,554 $ 10,863,242 Liabilities and Partners’ Capital Accounts payable $ 276,502 Accrued payroll and related costs 117,792 Other accrued expenses 23,998 Unearned dues 369,586 Mortgage payable $ 7,566,966 Total liabilities 8,354,844 Partners’ capital 2,508,398 $ 10,863,242 See accompanying notes. © 2018 Association of International Certified Professional Accountants. All rights reserved. 41 Donnelly & Oates Limited Liability Partnership Statement of Revenues and Expenses Tax‐Basis For the Year Ended December 31, 20X2 Revenues Membership dues $ 3,970,334 Initiation fees 389,638 Tennis court fees and lessons 1,103,224 Other income 726,936 Sports shop and café 1,219,740 Total revenues 7,409,872 Expenses Management fee 50,700 Maintenance and operating 504,448 Utilities 391,460 Advertising and promotions 191,088 Payroll and related costs 2,774,706 Insurance 136,984 Administrative 246,906 Real estate taxes 351,246 Cost of sales—sports shop and café 701,800 Total expenses 5,349,338 Net operating income 2,060,534 Partnership expenses (9,572) Interest expense (765,476) Depreciation and amortization (610,094) Loss on sale of equipment (4,240) Revenues in excess of expenses $ 671,152 See accompanying notes. 42 © 2018 Association of International Certified Professional Accountants. All rights reserved. Donnelly & Oates Limited Liability Partnership Statement of Partners’ Capital Tax‐Basis For the Year Ended December 31, 20X2 Limited Part‐ ners Special Limited Partner General Part‐ ner Partners’ Capi‐ tal Balance, December 31, 20X1 $ 1,017,392 $ 1,256,710 $ (69,276) $ 2,204,826 Cash distributions (238,924) (55,138) (73,518) (367,580) Revenues in excess of ex‐ penses 436,254 100,674 134,224 671,152 Balance, December 31, 20X2 $ 1,214,722 $ 1,302,246 $ (8,570) $ 2,508,398 See accompanying notes. © 2018 Association of International Certified Professional Accountants. All rights reserved. 43 Donnelly & Oates Limited Liability Partnership Statement of Cash Flows Tax‐Basis For the Year Ended December 31, 20X2 Cash flows from operating activities Revenues in excess of expenses $ 671,152 Adjustments to reconcile revenues in excess of ex‐ penses to cash flows from operating activities Depreciation and amortization 610,094 Loss on sale of equipment 4,240 (Increase) decrease in: Accounts receivable (23,494) Inventory (102,916) Prepaid expenses 1,472 Accounts payable and accrued expenses 74,992 Unearned dues 32,874 Net cash flows provided by operating activities 1,268,414 Cash flows from investing activities Acquisition of equipment (277,138) Proceeds from sale of equipment 620 Net cash flows used by investing activities (276,518) Cash flows from financing activities Repayment of debt (473,574) Cash distributions to partners (367,580) Net cash flows used by financing activities (841,154) Increase in cash 150,742 Cash at beginning of year 300,202 Cash at end of year $ 450,944 Supplemental disclosures of cash flow information: Cash paid during the year for interest $ 774,170 See accompanying notes. 44 © 2018 Association of International Certified Professional Accountants. All rights reserved. Donnelly & Oates Limited Liability Partnership Notes to Financial Statements Tax‐Basis For the Year Ended December 31, 20X2 Note 1—Summary of Significant Accounting Policies Nature of Operations The Partnership owns and operates a racquet and swim club (the Club) located in Minnesota. The Club has approximately 3,000 members at December 31, 20X2. The Club extends credit to members for the payment of dues and other charges. The Partnership, formed in 19W5, is a limited liability partnership in accordance with the provisions of the Uni‐ form Partnership Act as in effect in the State of Minnesota. The general partner of the Partnership is Tony Donnelly. Basis of Accounting The Partnership’s financial statements are prepared on the accounting basis the Partnership used for federal in‐ come tax purposes, which is a comprehensive basis of accounting other than accounting principles generally ac‐ cepted in the United States of America (GAAP). The Partnership uses the Accelerated Cost Recovery System (ACRS) and Modified Accelerated Cost Recovery System (MACRS) in depreciating its property. Under ACRS and MACRS, depreciation is determined over periods of time that are shorter than those used in accordance with GAAP. Additionally, the income tax methods used to capitalize and amortize amortizable assets differ from those used under GAAP. Syndication costs are carried as an asset of the Partnership and are not amortized. Under GAAP these costs would be deducted from partners’ capital. Cash Equivalents The Partnership considers all highly liquid investments with an original maturity of three months or less to be cash equivalents. Concentration of Credit Risk The Partnership places its cash with one banking institution. At times the amount on deposit exceeds the in‐ sured limit of the institution and exposes the Partnership to a collection risk. Inventories Inventories, which consist of merchandise for sale in the sports shop, food, and beverages, are stated at the lower of cost (first in, first out method) or market. Membership Dues and Initiation Fees © 2018 Association of International Certified Professional Accountants. All rights reserved. 45 Membership dues are billed in advance and recorded in accounts receivable and unearned dues. The dues are recognized as revenue in the month earned. Initiation fees are recorded as revenue in the period when the fee is collected. Property and Equipment Property and equipment are carried at depreciated cost. Depreciation is computed using income tax methods. The cost of maintenance and repairs is charged to income as incurred; significant renewals or betterments are capitalized. Financing Fees Financing fees are amortized over the term of the related debt using the straight‐line method. During 20XX, fi‐ nancing fees related to retired debt were written off. The financing fees related to new debt were capitalized. Amortization expense was $12,149 during 20X2. Start‐Up Costs Start‐up costs are amortized over 60 months using the straight‐line method. Income Taxes Income taxes on Partnership income are levied on the partners at the partner level. Accordingly, all profits and losses of the Partnership are recognized by each partner on his respective tax return. Management believes that the Partnership has adequately addressed all relevant tax positions and that there are no unrecorded tax liabilities. Tax returns filed for the tax years ending from December 31, 20Y9, through cur‐ rent are still subject to examination by federal and state tax authorities. Any interest or penalties assessed to the Partnership are recorded in operating expenses. No interest or penalties from federal or state tax authorities were recorded in the accompanying financial statements. Advertising and Promotions Advertising costs are expensed as incurred. For the year ended December 31, 20X2, the Partnership incurred $191,088 in advertising costs. Estimates The preparation of financial statements on the tax‐basis of accounting requires management to make estimates and assumptions that affect the amounts reported on the financial statements and accompanying notes. Actual results could differ from those estimates. Subsequent Events Subsequent events have been evaluated through February 24, 20X3, which is the date the financial statements were available to be issued, and there are no subsequent events requiring disclosure. Note 2—Partnership Organization Profit and Loss Allocations 46 © 2018 Association of International Certified Professional Accountants. All rights reserved. Prior to December 1, 20XX, profits and losses from annual operations were allocated 99 percent to the limited partners and 1 percent to the general partner. Subsequent to November 30, 20XX, and until the Class A limited partners have received distributions of net cash flow equal to their preferred return, profits and losses from annual operations are allocated 65 percent to the Class A limited partners; 15 percent to the special limited partner; and 20 percent to the general partner. After the Class A limited partners have received cumulative distributions of net cash flow equal to their pre‐ ferred return, profits and losses from annual operations will be allocated 45 percent to the Class A limited part‐ ners; 15 percent to the special limited partner; and 40 percent to the general partner. Net Cash Flow Allocation From Operations Subsequent to November 30, 20XX, net cash flow is allocated 65 percent to the Class A limited partners; 15 per‐ cent to the special limited partner; and 20 percent to the general partner until such time as the Class A limited partners have received cumulative distributions equal to their preferred return. The balance of any net cash flow will be distributed 45 percent to the Class A limited partners; 15 percent to the special limited partner; and 40 percent to the general partner. Preferred Return The preferred return means a 9 percent per annum cumulative noncompounded return on the adjusted capital contribution of the Class A limited partners. The adjusted capital contribution means the original capital contri‐ butions are reduced only by distribution from the net proceeds of sale or refinancing. Note 3—Property and Equipment Property and equipment at December 31, 20X2, consisted of the following: Recovery Peri‐ od—Years Land $ 975,720 — Building 9,320,050 7–40 Tenant improvements 1,568,896 5–7 Total cost of property and equip‐ ment being depreciated $ 11,864,666 Less: Accumulated depreciation 2,810,112 Total property and equipment, net $ 9,054,554 Depreciation expense was $597,945 during 20X2. © 2018 Association of International Certified Professional Accountants. All rights reserved. 47 Note 4—Mortgage Payable At December 31, 20X2, debt consisted of the following: Mortgage loan payable in monthly payments of $73,124, including interest at 9.375%, through January 20XY when the interest rate changes to 3.5% above the 3‐ year Treasury base rate. Beginning February 1, 20XY, monthly payments will be ad‐ justed to reflect the new interest rate; the payments will be based upon a 15‐year term. The remaining principal is due January 1, 20XZ. The mortgage is secured by property, equipment, and a personal guaranty. $ 6,778,186 10% unsecured note payable to the special limited partners due in monthly install‐ ments of $16,546, including principal and interest, through February 1, 20XZ, when the unpaid balance is due. 788,780 $ 7,566,966 Scheduled principal payments under these loans are approximately $380,000 per year until February 1, 20XY, when payment terms will be adjusted as described previously. Note 5—Amendment of the Partnership Agreement The Partnership agreement was amended effective November 30, 20XX. The primary purpose of the amend‐ ment was to create a new class of limited partner (the special limited partner) and to change the allocations of profits, losses, and cash distributions. Effective November 30, 20XX, Michael Oates surrendered his 67 limited partnership units in exchange for $1,450,000 and a 15 percent special limited partnership interest. Additionally, as part of this exchange, $200,000 was paid down on the note payable to the special limited partner, the interest rate on this note was reduced to 10 percent from 12 percent, and the term of the note was shortened. Note 6—Transactions With Affiliates At December 31, 20X2, the Partnership owed partners or affiliated entities $788,780. During 20X2 a management fee of $50,700 was paid to a partner. 48 © 2018 Association of International Certified Professional Accountants. All rights reserved. CHARLTON CONTRACTORS, INC. FINANCIAL STATEMENTS AS OF AND FOR THE YEARS ENDED DECEMBER 31, 20X2, AND 20X1 Circumstances include the following: • The financial statements are for a general contractor. The general contractor has elected to be treated as a small business corporation (S corporation) under Internal Revenue Code Section 1362. • The financial statements are prepared on the accrual method of accounting used for federal income tax purposes. • The financial statements are comparative statements as of and for the years ended December 31, 20X2, and 20X1. The financial statements illustrate the following: • The financial statements include a statement of cash flows, which is not required for financial state‐ ments prepared when applying the tax‐basis of accounting. • Information about contract receivables (Note 2), billings in excess of costs on uncompleted contracts (Note 5), and backlog (Note 7) are disclosures typically made in the financial statements of construction contractors. However, the aging summary of contract receivables is not usually disclosed. In this situa‐ tion, the preparer concluded that the information is relevant to the financial statement users. • The information on accounts payable and accruals is not required but has been included because the preparer concluded that users of the financial statements find it meaningful. • Accounting principles generally accepted in the United States of America (GAAP) requires a summary of future minimum lease payments, which usually is presented in a schedule. Because the entity’s lease commitments are not complex, this information has been summarized in narrative form, which is ac‐ ceptable for financial statements prepared on the tax‐basis of accounting. © 2018 Association of International Certified Professional Accountants. All rights reserved. 49 Charlton Contractors, Inc. Statements of Assets, Liabilities and Equity Tax‐Basis December 31, 20X2 and 20X1 20X2 20X1 Assets Current Assets Cash and cash equivalents $ 3,078,966 $ 3,608,930 Accounts receivable—contract (Note 2) 2,409,554 1,422,268 Advances to officers 7,812 — Inventory 287,714 196,200 Total current assets 5,784,046 5,227,398 Property and Equipment Machinery and equipment 1,694,980 1,710,828 Transportation equipment 384,790 395,042 Office furniture and equipment 162,454 163,034 Leasehold improvements 363,798 363,798 Total cost 2,606,022 2,632,702 Accumulated depreciation and amortization (Note 3) (2,362,850) (2,343,812) Net property and equipment 243,172 288,890 Other Assets Cash surrender value of officers’ life insurance 24,454 23,610 Miscellaneous 1,460 20,766 Total other assets 25,914 44,376 Total assets $ 6,053,132 $ 5,560,664 See accompanying notes to financial statements. 50 © 2018 Association of International Certified Professional Accountants. All rights reserved. Charlton Contractors, Inc. Statements of Assets, Liabilities and Equity Tax‐Basis Years Ended December 31, 20X2 and 20X1 20X2 20X1 Liabilities and Stockholders’ Equity Current Liabilities Accounts payable and accruals (Note 4) $ 548,646 $ 288,904 Billings in excess of costs on uncompleted con‐ tracts (Note 5) 976,754 445,108 Total current liabilities 1,525,400 734,012 Contributed Capital Common stock, $1,000 par value; 100 shares authorized; 60 shares issued and outstanding 60,000 60,000 Retained Earnings 4,467,732 4,766,652 Total stockholders’ equity 4,527,732 4,826,652 Total liabilities and stockholders’ equity $ 6,053,132 $ 5,560,664 See accompanying notes to financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 51 Charlton Contractors, Inc. Statements of Operations and Retained Earnings Tax‐Basis Years Ended December 31, 20X2 and 20X1 20X2 20X1 Contract revenue $ 7,009,498 $ 8,116,380 Cost of contract revenue Direct costs Materials and supplies 1,710,330 1,729,310 Salaries and wages 1,184,132 1,264,664 Subcontracts 1,670,596 1,838,942 Other 99,486 92,560 4,664,544 4,925,476 Indirect costs 813,520 967,278 5,478,064 5,892,754 Gross profit 1,531,434 2,223,626 General and administrative expenses Salaries and wages 1,298,552 2,139,444 Profit‐sharing plan contribution — 6,138 Other 596,938 539,786 1,895,490 2,685,368 Operating loss (364,056) (461,742) Financing income 88,148 132,590 Net loss (275,908) (329,152) Retained earnings, beginning of year 4,766,652 5,255,804 Distributions to stockholders (23,012) (160,000) Retained earnings, end of year $ 4,467,732 $ 4,766,652 See accompanying notes to financial statements. 52 © 2018 Association of International Certified Professional Accountants. All rights reserved. Charlton Contractors, Inc. Statements of Cash Flows Tax‐Basis Years Ended December 31, 20X2 and 20X1 20X2 20X1 Cash flows from operating activities Net loss $ (275,908) $ (329,152) Noncash items included in net loss: Depreciation 45,718 60,204 (Increase) decrease in: Contract receivables (987,286) 2,103,570 Inventory (91,514) (3,260) Cash surrender of officers’ life insurance (844) (1,200) Other assets — (408) Increase (decrease) in: Accounts payable and accruals 259,742 (100,832) Billings in excess of costs on uncompleted contracts 531,646 (895,508) Net cash (used) provided by operat‐ ing activities (518,446) 833,414 Cash flows from investing activities Property and equipment purchases — (60,000) Advances to officers (7,812) — Redemption of certificates of deposit — 2,132,038 Decrease in miscellaneous assets 19,306 — Net cash provided by investing ac‐ tivities 11,494 2,072,038 Cash flows from financing activities Distributions to stockholders (23,012) (160,000) Net (decrease) increase in cash and cash equiva‐ lents (529,964) 2,745,452 Cash and cash equivalents, beginning of year 3,608,930 863,478 Cash and cash equivalents, end of year $ 3,078,966 $ 3,608,930 See accompanying notes to financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 53 Charlton Contractors, Inc. Notes to Financial Statements Tax‐Basis December 31, 20X2 and 20X1 Note 1—Summary of Significant Accounting Policies Nature of Operations Charlton Contractors is a general contractor primarily engaged in the construction of commercial and multifami‐ ly residential projects in the San Diego metropolitan area. Basis of Accounting The accompanying financial statements have been prepared on the accrual method of accounting used for fed‐ eral income tax purposes, which is a comprehensive basis of accounting other than accounting principles gener‐ ally accepted in the United States of America (GAAP). If the accompanying financial statements were prepared in conformity with GAAP, contract revenue and costs would be recognized under the percentage‐of‐completion method of accounting, an allowance for uncollectible accounts receivable would be established, property and equipment would be depreciated over their estimated useful lives, and the related party lease would be capitalized as an asset and liability. The Corporation has elected to be treated as a small business corporation (S corporation) under Internal Reve‐ nue Code Section 1362. This election provides that, in lieu of corporate income taxes, the taxable items and credits pass directly to the stockholders. Therefore, these financial statements do not include federal or state in‐ come taxes that would otherwise be applicable. The Corporation uses the accrual completed contract method to recognize construction revenue. That method of accounting recognizes contract revenue and costs when a contract is completed or substantially completed. A contract is considered substantially completed when all costs except insignificant items have been incurred and the installation has been accepted by the customer. Contract costs include all direct material and labor costs and those indirect costs related to contract perfor‐ mance, such as rent, depreciation, maintenance, and insurance. Indirect costs are allocated based on contract revenue. General and administrative costs are charged to expenses as incurred. Amounts billed in excess of costs are classified as current liabilities under billings in excess of cost on uncom‐ pleted contracts. Contract retentions are included in contract receivables. The preparation of financial statements requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from these estimates. Cash and Cash Equivalents Cash and cash equivalents consist of highly liquid investments with a maturity of three months or less when pur‐ chased. 54 © 2018 Association of International Certified Professional Accountants. All rights reserved. At December 31, 20X2, and 20X1, the Corporation had on deposit with several banks amounts in excess of Fed‐ eral Deposit Insurance Corporation insurance limits. The Corporation has not experienced any losses in such ac‐ counts. The Corporation believes it is not exposed to any significant credit risk on cash and cash equivalents. Contract Receivables Contract receivables, including retentions, are recorded as progress billings and rendered in accordance with the provisions of the contracts. The Corporation uses the direct write‐off method to record uncollectible accounts in compliance with the Internal Revenue Code. Inventory Inventory is valued at the lower of cost, based on the first in, first out method, or market. Property and Equipment Property and equipment are recorded at cost and depreciated using principally accelerated methods. Leasehold improvements are amortized over the life of the related leases or their estimated useful lives, whichever is shorter. Property and equipment are depreciated over the following recovery periods: Machinery and equipment 5 years Transportation equipment 5 years Office furniture and equipment 5–7 years Leasehold improvements 10–31.5 years Expenditures for maintenance and repairs that do not materially extend the lives of the assets are charged to earnings. When property or equipment is sold or otherwise disposed of, the cost and related accumulated de‐ preciation are removed from the respective accounts, and the resulting gain or loss is reflected in earnings. Profit‐Sharing Plan The Corporation adopted a profit‐sharing plan effective November 22, 19V4. Substantially all full‐time employ‐ ees are eligible to participate. The Corporation’s contributions on behalf of its employees are determined annu‐ ally by the board of directors. The Corporation did not make a contribution for 20X2. Profit‐sharing contributions were $6,138 for the year ended December 31, 20X1. Statement of Cash Flows For purposes of the statement of cash flows, cash and cash equivalents include money market accounts and op‐ erating bank accounts. The Corporation did not pay any interest expense for 20X2 and 20X1. Income Taxes © 2018 Association of International Certified Professional Accountants. All rights reserved. 55 The Corporation, with the consent of its shareholders, has elected, in accordance with the Internal Revenue Code, to be treated as an S corporation. In lieu of federal income taxes, the shareholders of an S corporation are taxed on their proportionate share of the corporation’s taxable income. Therefore, no provision for federal in‐ come taxes has been included in these financial statements. California law generally conforms to federal law ex‐ cept for a 1.5 percent tax imposed on S corporation’s earnings. The Corporation is subject to tax in other states. Deferred income taxes have not been recognized in these financial statements because the amount of deferred taxes is not considered material. The Corporation does not recognize a liability for uncertain tax positions until agreement and settlement is reached with the taxing authority. Tax returns filed for the tax years ending from December 31, 20Y9, through current are still subject to examination by federal and state tax authorities. Subsequent Events The Corporation has evaluated subsequent events from the date of the statement of assets, liabilities, and equi‐ ty—tax‐basis through March 12, 20X3, the date on which the financial statements were available to be issued, and determined that there are no items to disclose. Note 2—Contract Receivables An aging summary of contract receivables at December 31, is as follows: 20X2 20X1 Billed Current $ 1,131,718 $ 364,284 30 days 486,854 306,318 60 days 189,138 79,914 90 days and over 129,326 133,272 1,937,036 883,788 Unbilled retentions 456,512 444,252 Unbilled amounts on complet‐ ed contracts 16,006 94,228 Totals $ 2,409,554 $ 1,422,268 56 © 2018 Association of International Certified Professional Accountants. All rights reserved. Completed and uncompleted contract receivables at December 31, are as follows: 20X2 20X1 Completed contracts Billed, including retentions $ 906,052 $ 581,760 Unbilled retentions 116,772 125,206 Unbilled amounts on completed con‐ tracts 16,006 94,228 Uncompleted contracts Uncompleted contracts billed 1,030,984 302,028 Unbilled retentions 339,740 319,046 Totals $ 2,409,554 $ 1,422,268 Receivables written off as uncollectible totaled $30,158 for the year ended December 31, 20X2, and $2,000 for the year ended December 31, 20X1. Recoveries of receivables written off an uncollectible totaled $17,000 for the year ended December 31, 20X1. Note 3—Depreciation and Amortization The accumulated depreciation and amortization balances at December 31, are as follows: 20X2 20X1 Machinery and equipment $ 1,689,162 $ 1,701,064 Transportation equipment 308,130 296,002 Office furniture and equipment 161,612 160,440 Leasehold improvements 203,946 186,306 Totals $ 2,362,850 $ 2,343,812 © 2018 Association of International Certified Professional Accountants. All rights reserved. 57 Note 4—Accounts Payable and Accruals Accounts payable and accruals consist of the following at December 31: 20X2 20X1 Trade accounts payable $ 343,222 $ 157,726 Subcontract payables 156,130 86,104 Accrued payroll 40,626 39,814 Accrued and withheld payroll taxes 3,124 860 Sales tax payable 5,544 4,400 Totals $ 548,646 $ 288,904 Note 5—Billings in Excess of Costs on Uncompleted Contracts Billings in excess of costs on uncompleted contracts at December 31 are as follows: 20X2 20X1 Billings on uncompleted contracts $ 4,320,008 $ 2,258,286 Costs incurred on uncompleted contracts (3,343,254) (1,813,178) Billings in excess of costs on un‐ completed contracts $ 976,754 $ 445,108 Note 6—Commitment Under Lease Agreement On December 15, 20V6, the Corporation signed a lease with its stockholders for an office and production facility located in Mira Mesa, California. The facility lease is for 25 years, terminating December 15, 20YY. The base an‐ nual rent was $343,000 for 20X2 and 20X1. Increases in the base annual rent are to be based on the consumer price index, not to exceed 6 percent. The stockholders pay the real estate taxes and the Corporation pays all maintenance charges and operating costs for the facility. The rental payments include an escalation for increas‐ es in real estate taxes. At December 31, 20X2, the aggregate minimum lease payments under this lease were approximately $2,800,000. Future minimum lease payments are scheduled to be approximately $350,000 for each of the next 5 years. Rent expense for each of the years ended December 31, 20X2, and 20X1 was $353,000. Note 7—Backlog The estimated gross revenue on work to be performed on signed contracts was $3,467,894 at December 31, 20X2, and $4,183,624 at December 31, 20X1. In addition to the backlog of work to be performed, there was gross revenue to be reported in future periods under the accrual completed contract method used by the com‐ pany of $1,548,173 at December 31, 20X2, and $1,668,961 at December 31, 20X1. 58 © 2018 Association of International Certified Professional Accountants. All rights reserved. MARGARET ROSE 1964 IRREVOCABLE TRUST FINANCIAL STATEMENTS AS OF AND FOR THE YEARS ENDED DECEMBER 31, 20X2 AND 20X1 Circumstances include the following: • The financial statements are for an irrevocable trust. • The financial statements are prepared on the cash method of accounting used for federal income tax purposes. • The financial statements are comparative as of and for the years ended December 31, 20X2, and 20X1. The financial statements illustrate the following: • The financial statements do not include a statement of cash flows, which is acceptable for a presenta‐ tion when applying the tax‐basis of accounting. The preparer concluded that a statement of cash flows is not necessary because (1) the users of the financial statements are more interested in asset balances ra‐ ther than cash flows, and (2) if cash flow information is needed, it could easily be derived from the in‐ formation presented. © 2018 Association of International Certified Professional Accountants. All rights reserved. 59 Margaret Rose 1964 Irrevocable Trust Statements of Assets, Liabilities and Corpus Tax‐Basis December 31, 20X2 and 20X1 20X2 20X1 Assets Marketable securities—at cost $ 1,830,087 $ 1,560,681 (market value $2,746,922 and $2,353,519 in 20X2 and 20X1, respectively) Purchased interest 340 — Total assets $ 1,830,427 $ 1,560,681 Liabilities and Corpus Due to beneficiary 157,946 75,302 Total liabilities 157,946 75,302 Corpus 1,672,481 1,485,379 Total liabilities and corpus $ 1,830,427 $ 1,560,681 See accompanying notes. 60 © 2018 Association of International Certified Professional Accountants. All rights reserved. Margaret Rose 1964 Irrevocable Trust Statements of Revenues, Expenses and Corpus Tax‐Basis Years Ended December 31, 20X2 and 20X1 20X2 20X1 Revenues Dividends $ 76,139 $ 69,044 Interest 4,729 4,457 Gain (loss) on sale of securities, net 201,370 46,094 Total revenues 282,238 119,595 Expenses Accounting fee 7,500 7,000 Bank custodian fee 3,018 2,588 Investment counsel fee 9,474 7,588 Total expenses 19,992 17,176 Income before provision for income taxes 262,246 102,419 Provision for income taxes 75,144 22,207 Net income 187,102 80,212 Corpus, beginning of year 1,485,379 1,405,167 Corpus, end of year $ 1,672,481 $ 1,485,379 See notes to financial statements. © 2018 Association of International Certified Professional Accountants. All rights reserved. 61 Margaret Rose 1964 Irrevocable Trust Notes to Financial Statements Tax‐Basis For the Years Ended December 31, 20X2 and 20X1 Note 1—Nature of Trust and Significant Accounting Policies Nature of Trust The Margaret Rose 1964 Irrevocable Trust (the Trust) was created on May 5, 1964, by Michael Thomas. Distribu‐ tion of 25 percent of principal is to be made at age 30, and 33 1/3 percent at age 35. After January 1, 19X2, the beneficiary may request annually a noncumulative distribution of the larger of $5,000 or 5 percent of the princi‐ pal as of the end of the year. Upon death of the beneficiary, the Trust is to be distributed according to the terms of her will. The trustee has discretionary power to distribute principal or income, or both. Basis of Accounting The accompanying financial statements have been prepared on the cash method of accounting used for federal income tax purposes, which is a comprehensive basis of accounting other than accounting principles generally accepted in the United States of America (GAAP). Consequently, certain revenues and expenses are recognized in the determination of income in different reporting periods than they would be if the financial statements were prepared in conformity with GAAP. Although income tax rules are used to determine the timing of the re‐ porting of revenues and expenses, nontaxable revenues and nondeductible expenses are included in the deter‐ mination of net income. Use of Estimates The preparation of financial statements in conformity with the cash method of accounting used for federal in‐ come tax purposes requires management to make estimates and assumptions that affect the amounts reported in the financial statements and accompanying notes. Actual results could differ from those estimates. Marketable Securities Marketable securities are carried at cost. The cost of marketable securities sold is based on cost as determined under the specific identification method. Income Taxes The Trust does not recognize a liability for uncertain tax positions. Tax returns filed for the tax years ending from December 31, 20Y9, through current are still subject to examination by federal and state tax authorities. Subsequent Events In preparing these financial statements, the Trust has evaluated events and transactions for potential recogni‐ tion or disclosure through April 1, 20X3, the date the financial statements were available to be issued, and de‐ termined that there are no items to disclose. 62 © 2018 Association of International Certified Professional Accountants. All rights reserved. Note 2—Marketable Securities At December 31, 20X2, and 20X1, gross unrealized gains and losses pertaining to marketable securities in the portfolio were as follows: Cost Market Value Unrealized Gains Losses 20X2 Equities $ 948,766 $ 1,790,955 $ 854,565 $ 12,376 Fixed income and money market 881,321 955,967 119,362 44,716 Total $ 1,830,087 $ 2,746,922 $ 973,927 $ 57,092 Market Unrealized Cost Value Gains Losses 20X1 Equities $ 891,685 $ 1,611,732 $ 757,910 $ 37,863 Fixed income and money market 668,996 741,787 72,791 — Total $ 1,560,681 $ 2,353,519 $ 830,701 $ 37,863 Note 3—Income Taxes The income tax expense shown in the accompanying financial statements differs from the expense that would result from applying statutory tax rates to income before income taxes primarily because of capital gains. Distributions to beneficiaries are allowed as a deduction from taxable income for the trust in the year in which such distributions are made. The provision for income taxes for the years ended December 31 consists of: 20X2 20X1 Federal $ 63,200 $ 17,874 State 11,944 4,333 Provision for income taxes $ 75,144 $ 22,207",Financial,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","i've been cooking more and more for my husband since he was hospitalized after a heart attack last july, but it's getting to be too complicated. i'm looking for a cookbook that will have recipes with affordable ingredients that i can use, as well as a meal plan guide for like 4 weeks that will help me plan recipes for him in a smart way. do you have a recommendation?","Book Cover of Bobby Parrish, Dessi Parrish - FlavCity's 5 Ingredient Meals: 50 Easy & Tasty Recipes Using the Best Ingredients from the Grocery Store (Heart Healthy Budget Cooking) FlavCity's 5 Ingredient Meals 50 Easy & Tasty Recipes Using the Best Ingredients from the Grocery Store By Bobby Parrish - Passionate home cook & Food Network champion + 1 more 4.72 |2020|208 Pages StraightforwardInformativeEducational FlavCity Five Ingredient Meals For Easy Weeknight Dinners and More! #1 Bestseller in Slow Cooker Recipes, Heart Healthy Cooking, Diets & Weight Loss, Gluten-Free Diets, Budget Cooking, Green Housekeeping, and Allergies, Special Conditions, Cooking Methods, Regional & International, Soul Food, and Quick & Easy. You don’t have to be a chef to create delicious food. In fact, it only takes a handful of ingredients to make mouthwatering and easy weeknight dinners. This cookbook by Bobby and Dessi Parrish is packed full of simple, healthy dinner ideas that even newbie cooks find easy to make. An introduction to easy meals and cooking. ...more Recommended for: Home cooks seeking simple, healthy dinner ideas with minimal ingredients. Beginner to Intermediate readers. You will: Create delicious food with a handful of ingredients Cooking doesn’t have to be complicated Tips for smarter grocery shopping Cooking with a combination of store-bought and fresh items Insight into healthier food choices and product selection Reviews: Simple Recipes Healthy Ingredients Quick Tips Family Passion Grocery Shopping Tips Small Text Missing App #16 Best Seller in Budget Cooking on Amazon Added to Reading List by Nepluz Nepluz Read Amazon reviews | Rate or write a review 2 Book Cover of Ingrid Lamarr - The 15-Minute Air Fryer Cookbook for Beginners: 1800+ Days of Super Easy, Tasty and Budget-Friendly, Low-fat, Air Fryer Recipes for Weight Loss & Eating Healthier. Tips for Perfect Frying and Baking The 15-Minute Air Fryer Cookbook for Beginners 1800+ Days of Super Easy, Tasty and Budget-Friendly, Low-fat, Air Fryer Recipes for Weight Loss & Eating Healthier. Tips for Perfect Frying and Baking By Ingrid Lamarr - Renowned best-selling author and culinary enthusiast 4.66 |2024|111 Pages 🎁 Discover now the 4 EXCLUSIVE BONUSES included: a complete meal prep guide, a conversion chart, Air Fryer maintenance, and a guide to avoiding common mistakes! 🎁. ⭐ ""Transform your kitchen and diet in just 15 minutes with the Air Fryer!"" ⭐. Are you ready to say goodbye to excess oil and effortlessly prepare healthy and delicious meals? Do you want to discover the secret to crispy, flavorful dishes while keeping calorie intake and costs under control? Revolutionize your kitchen with ""The 15-Minute Air Fryer Cookbook for Beginners"" by Ingrid Lamarr, now enriched with an innovative visual experience through QR codes! ...more Recommended for: Culinary enthusiasts seeking healthy, simple, and economical cooking solutions. Beginner to Intermediate readers. Reviews: Tasty Recipes Healthy Meals Budget-Friendly Meal Prep Guide Conversion Chart Light Print Hard to Discern Photos #50 Best Seller in Fryer Recipes on Amazon Read Amazon reviews | Rate or write a review 3 Book Cover of Rosy Luke - Budget-Friendly Diabetic Cookbook for Beginners: Low-Carb, Quick & Tasty Recipes to Master Pre-Diabetes, Type 1 & 2 Diabetes with Ease. Includes 4-Week Smart Meal Plan with Affordable Ingredients Budget-Friendly Diabetic Cookbook for Beginners Low-Carb, Quick & Tasty Recipes to Master Pre-Diabetes, Type 1 & 2 Diabetes with Ease. Includes 4-Week Smart Meal Plan with Affordable Ingredients By Rosy Luke - Passionate advocate for healthy living and delicious food 4.61 |2024|65 Pages EducationalInformativePractical 🎁 Unlock Exclusive EXTRA CONTENTS! 🎁📘 1# Medication Log Books: Stay organized and on track with your diabetes medications effortlessly. 📝 2# Food Journal Log Book: Track your daily meals and snacks to stay mindful of your dietary choices. 📈 3# Blood Sugar Log Book: Monitor and manage your blood sugar levels effectively with my handy log book. 🍽️ 4# Recipe Remix: Transform your favorite dishes into diabetic-friendly delights with my expert tips. 🌟 5# Dine Out Smart Guide: Master the art of dining out while keeping your blood sugar levels in check with my essential tips. Check within your book how to get them! ...more Recommended for: Healthy living enthusiasts seeking delicious and budget-friendly diabetic recipes. Beginner to Intermediate readers. You will: Empower yourself with basic diabetes education and nutritional insights. Save time in the kitchen with quick and easy recipes tailored to busy lifestyles. Use common, affordable ingredients easily found in regular supermarkets. Explore a diverse range of mouthwatering recipes designed to satisfy your taste buds. Prepare recipes suitable for the entire family, reducing the need to cook separate meals. Reviews: Educational Value No-Stress Recipes Cost-Effective Solutions Variety and Taste Family-Friendly Options Too much education High-carb recipes Read Amazon reviews | Rate or write a review Rate or write a review LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS A Complete guide to Heart Healthy Budget-Friendly recipes with a 30 days meal plan By ALLISON WINSTON 4.16 |2024|90 Pages Have you ever wondered if you could go on a gastronomic journey that satisfied your palate and filled your heart at the same time? Welcome to ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS,"" a cookbook that aims to refute the stereotype that eating a healthy diet is monotonous or constrictive. We want you to challenge the conventional wisdom about what it means to enjoy food that loves you back as we turn the pages of this culinary adventure. Uncover Delicious Health: Indulge in a selection of 30 delectable days, each chock-full of meals that skillfully combine taste and nutrient-denseness. Every meal on the heart-healthy menu, from the refreshing crispness of Cucumber Mint Infused Water to the cozy embrace of Lentil and Vegetable Soup, is a tribute to the variety of flavors that are accessible. Advantages That Go Beyond Taste:. Enhanced Vitality: Fuel your days with meals high in nutrients that promote your general health. Cost-Effective Genius: Acquire the skill of astute supermarket shopping and cost-effective food preparation without sacrificing flavor. Empowered Eating: Take control of your health and rediscover the pleasure of cooking, one delicious meal at a time. Embrace Your Passion for Cooking:. This cookbook is more than simply a collection of recipes; it's an appeal to change your perspective on food and a call to action. Accept the power of choice; every component and cooking technique is a deliberate choice that will lead to a more vibrant, healthier version of yourself. Bring Your Inner Chef Out:. ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" gives both novice and experienced cooks the tools they need to create meals that uplift the spirit and the heart. It's an investigation of the remarkable tastes that arise from the union of pleasure and wellness. Get a copy of ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" by clicking on "" add to cart"" and on a taste-tempting, nourishing, and transformational culinary adventure. The ingredients are ready, the table is set; challenge the commonplace, welcome the exceptional, and practice the art of generous living. Makeover your kitchen. Fill your spirit with nourishment. Explore ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" right now. (show less)","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== i've been cooking more and more for my husband since he was hospitalized after a heart attack last july, but it's getting to be too complicated. i'm looking for a cookbook that will have recipes with affordable ingredients that i can use, as well as a meal plan guide for like 4 weeks that will help me plan recipes for him in a smart way. do you have a recommendation? {passage 0} ========== Book Cover of Bobby Parrish, Dessi Parrish - FlavCity's 5 Ingredient Meals: 50 Easy & Tasty Recipes Using the Best Ingredients from the Grocery Store (Heart Healthy Budget Cooking) FlavCity's 5 Ingredient Meals 50 Easy & Tasty Recipes Using the Best Ingredients from the Grocery Store By Bobby Parrish - Passionate home cook & Food Network champion + 1 more 4.72 |2020|208 Pages StraightforwardInformativeEducational FlavCity Five Ingredient Meals For Easy Weeknight Dinners and More! #1 Bestseller in Slow Cooker Recipes, Heart Healthy Cooking, Diets & Weight Loss, Gluten-Free Diets, Budget Cooking, Green Housekeeping, and Allergies, Special Conditions, Cooking Methods, Regional & International, Soul Food, and Quick & Easy. You don’t have to be a chef to create delicious food. In fact, it only takes a handful of ingredients to make mouthwatering and easy weeknight dinners. This cookbook by Bobby and Dessi Parrish is packed full of simple, healthy dinner ideas that even newbie cooks find easy to make. An introduction to easy meals and cooking. ...more Recommended for: Home cooks seeking simple, healthy dinner ideas with minimal ingredients. Beginner to Intermediate readers. You will: Create delicious food with a handful of ingredients Cooking doesn’t have to be complicated Tips for smarter grocery shopping Cooking with a combination of store-bought and fresh items Insight into healthier food choices and product selection Reviews: Simple Recipes Healthy Ingredients Quick Tips Family Passion Grocery Shopping Tips Small Text Missing App #16 Best Seller in Budget Cooking on Amazon Added to Reading List by Nepluz Nepluz Read Amazon reviews | Rate or write a review 2 Book Cover of Ingrid Lamarr - The 15-Minute Air Fryer Cookbook for Beginners: 1800+ Days of Super Easy, Tasty and Budget-Friendly, Low-fat, Air Fryer Recipes for Weight Loss & Eating Healthier. Tips for Perfect Frying and Baking The 15-Minute Air Fryer Cookbook for Beginners 1800+ Days of Super Easy, Tasty and Budget-Friendly, Low-fat, Air Fryer Recipes for Weight Loss & Eating Healthier. Tips for Perfect Frying and Baking By Ingrid Lamarr - Renowned best-selling author and culinary enthusiast 4.66 |2024|111 Pages 🎁 Discover now the 4 EXCLUSIVE BONUSES included: a complete meal prep guide, a conversion chart, Air Fryer maintenance, and a guide to avoiding common mistakes! 🎁. ⭐ ""Transform your kitchen and diet in just 15 minutes with the Air Fryer!"" ⭐. Are you ready to say goodbye to excess oil and effortlessly prepare healthy and delicious meals? Do you want to discover the secret to crispy, flavorful dishes while keeping calorie intake and costs under control? Revolutionize your kitchen with ""The 15-Minute Air Fryer Cookbook for Beginners"" by Ingrid Lamarr, now enriched with an innovative visual experience through QR codes! ...more Recommended for: Culinary enthusiasts seeking healthy, simple, and economical cooking solutions. Beginner to Intermediate readers. Reviews: Tasty Recipes Healthy Meals Budget-Friendly Meal Prep Guide Conversion Chart Light Print Hard to Discern Photos #50 Best Seller in Fryer Recipes on Amazon Read Amazon reviews | Rate or write a review 3 Book Cover of Rosy Luke - Budget-Friendly Diabetic Cookbook for Beginners: Low-Carb, Quick & Tasty Recipes to Master Pre-Diabetes, Type 1 & 2 Diabetes with Ease. Includes 4-Week Smart Meal Plan with Affordable Ingredients Budget-Friendly Diabetic Cookbook for Beginners Low-Carb, Quick & Tasty Recipes to Master Pre-Diabetes, Type 1 & 2 Diabetes with Ease. Includes 4-Week Smart Meal Plan with Affordable Ingredients By Rosy Luke - Passionate advocate for healthy living and delicious food 4.61 |2024|65 Pages EducationalInformativePractical 🎁 Unlock Exclusive EXTRA CONTENTS! 🎁📘 1# Medication Log Books: Stay organized and on track with your diabetes medications effortlessly. 📝 2# Food Journal Log Book: Track your daily meals and snacks to stay mindful of your dietary choices. 📈 3# Blood Sugar Log Book: Monitor and manage your blood sugar levels effectively with my handy log book. 🍽️ 4# Recipe Remix: Transform your favorite dishes into diabetic-friendly delights with my expert tips. 🌟 5# Dine Out Smart Guide: Master the art of dining out while keeping your blood sugar levels in check with my essential tips. Check within your book how to get them! ...more Recommended for: Healthy living enthusiasts seeking delicious and budget-friendly diabetic recipes. Beginner to Intermediate readers. You will: Empower yourself with basic diabetes education and nutritional insights. Save time in the kitchen with quick and easy recipes tailored to busy lifestyles. Use common, affordable ingredients easily found in regular supermarkets. Explore a diverse range of mouthwatering recipes designed to satisfy your taste buds. Prepare recipes suitable for the entire family, reducing the need to cook separate meals. Reviews: Educational Value No-Stress Recipes Cost-Effective Solutions Variety and Taste Family-Friendly Options Too much education High-carb recipes Read Amazon reviews | Rate or write a review Rate or write a review LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS A Complete guide to Heart Healthy Budget-Friendly recipes with a 30 days meal plan By ALLISON WINSTON 4.16 |2024|90 Pages Have you ever wondered if you could go on a gastronomic journey that satisfied your palate and filled your heart at the same time? Welcome to ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS,"" a cookbook that aims to refute the stereotype that eating a healthy diet is monotonous or constrictive. We want you to challenge the conventional wisdom about what it means to enjoy food that loves you back as we turn the pages of this culinary adventure. Uncover Delicious Health: Indulge in a selection of 30 delectable days, each chock-full of meals that skillfully combine taste and nutrient-denseness. Every meal on the heart-healthy menu, from the refreshing crispness of Cucumber Mint Infused Water to the cozy embrace of Lentil and Vegetable Soup, is a tribute to the variety of flavors that are accessible. Advantages That Go Beyond Taste:. Enhanced Vitality: Fuel your days with meals high in nutrients that promote your general health. Cost-Effective Genius: Acquire the skill of astute supermarket shopping and cost-effective food preparation without sacrificing flavor. Empowered Eating: Take control of your health and rediscover the pleasure of cooking, one delicious meal at a time. Embrace Your Passion for Cooking:. This cookbook is more than simply a collection of recipes; it's an appeal to change your perspective on food and a call to action. Accept the power of choice; every component and cooking technique is a deliberate choice that will lead to a more vibrant, healthier version of yourself. Bring Your Inner Chef Out:. ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" gives both novice and experienced cooks the tools they need to create meals that uplift the spirit and the heart. It's an investigation of the remarkable tastes that arise from the union of pleasure and wellness. Get a copy of ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" by clicking on "" add to cart"" and on a taste-tempting, nourishing, and transformational culinary adventure. The ingredients are ready, the table is set; challenge the commonplace, welcome the exceptional, and practice the art of generous living. Makeover your kitchen. Fill your spirit with nourishment. Explore ""LOW CHOLESTEROL DIET COOKBOOK ON A BUDGET FOR BEGINNERS"" right now. (show less) https://bookauthority.org/books/beginner-budget-cooking-books",Retail/Product,Find & Summarize,Text Transformation You must respond only using information provided in the prompt. Explain your reasoning using at least three supporting points.,Does Malawi support big families?,"CHAPTER THREE: POLICY PRIORITY AREAS The Policy has the following six priority areas: a. Managing population growth; b. Inclusion of vulnerable and marginalized populations; c. Climate change adaptation and resilience; d. Information Management; e. Financing; and f. Capacity strengthening, linkages, and coordination. Priority Area 1: Managing Population Growth Managing population growth is about applying a rights-based approach to making the environment conducive for women and men to decide on the number of children they would like to have. The goal is to reduce population growth rate to levels that are sustainable. This is crucial in ensuring that Malawi achieves its long-term aspiration of being an inclusively wealthy and self-reliant nation, as it will contribute to accelerating the attainment of the country's lowermiddle-income economy status by 2030. The population of Malawi has been growing rapidly due to high fertility. This priority area addresses drivers of rapid population growth, use of modern contraceptive methods especially among the youth, child survival, and early childbearing. Policy Statements a) The Policy will ensure that the fertility decline is accelerated. Strategies: i. Intensify population education campaigns including adopting modern family planning practices of having few children and use of contraception; ii. Identify and implement optimum models for providing quality reproductive health services including modern family planning to both in and out of school youth to reduce unmet need for family planning information and services and teenage pregnancies; and iii. Strengthen implementation of Malawi’s Costed Implementation Plan for Family Planning, FP2030, and ICPD25 commitments. b) The Policy will ensure that child and maternal mortality is reduced. Strategies: i. Support child immunization campaigns; 14 ii. Promote skilled care attendance before, during, and after birth in population messages; and iii. Promote child and maternal nutrition for the special 1,000 days. c) The Policy will ensure that on-set of childbearing is delayed (No children by children). Strategies: i. Eliminate child marriages; ii. Scaling up efforts to reduce teenage pregnancies: iii. Intensify comprehensive sexuality education for in and out of school youth; iv. Keep girls in school for at least twelve years; v. Strengthen implementation of the school re-admission policy; and vi. Identify and implement optimum models for providing quality RH services including modern family planning to both in and out of school youth to reduce unmet need for family planning information and services and teenage pregnancies.","You must respond only using information provided in the prompt. Explain your reasoning using at least three supporting points. CHAPTER THREE: POLICY PRIORITY AREAS The Policy has the following six priority areas: a. Managing population growth; b. Inclusion of vulnerable and marginalized populations; c. Climate change adaptation and resilience; d. Information Management; e. Financing; and f. Capacity strengthening, linkages, and coordination. Priority Area 1: Managing Population Growth Managing population growth is about applying a rights-based approach to making the environment conducive for women and men to decide on the number of children they would like to have. The goal is to reduce population growth rate to levels that are sustainable. This is crucial in ensuring that Malawi achieves its long-term aspiration of being an inclusively wealthy and self-reliant nation, as it will contribute to accelerating the attainment of the country's lowermiddle-income economy status by 2030. The population of Malawi has been growing rapidly due to high fertility. This priority area addresses drivers of rapid population growth, use of modern contraceptive methods especially among the youth, child survival, and early childbearing. Policy Statements a) The Policy will ensure that the fertility decline is accelerated. Strategies: i. Intensify population education campaigns including adopting modern family planning practices of having few children and use of contraception; ii. Identify and implement optimum models for providing quality reproductive health services including modern family planning to both in and out of school youth to reduce unmet need for family planning information and services and teenage pregnancies; and iii. Strengthen implementation of Malawi’s Costed Implementation Plan for Family Planning, FP2030, and ICPD25 commitments. b) The Policy will ensure that child and maternal mortality is reduced. Strategies: i. Support child immunization campaigns; 14 ii. Promote skilled care attendance before, during, and after birth in population messages; and iii. Promote child and maternal nutrition for the special 1,000 days. c) The Policy will ensure that on-set of childbearing is delayed (No children by children). Strategies: i. Eliminate child marriages; ii. Scaling up efforts to reduce teenage pregnancies: iii. Intensify comprehensive sexuality education for in and out of school youth; iv. Keep girls in school for at least twelve years; v. Strengthen implementation of the school re-admission policy; and vi. Identify and implement optimum models for providing quality RH services including modern family planning to both in and out of school youth to reduce unmet need for family planning information and services and teenage pregnancies. Does Malawi support big families?",Legal,Fact Finding,Q&A "You will respond using only the text provided. The response will include only small paragraphs of less than 5 sentences.","What are the capacities of the board mentioned that have the potential for abuse, that the text does not include a condition to account for?","ACTS OF 1949 AN ACT concerning public health, providing for State and local health officials and personnel, prescribing their powers and duties, estab- lishing a public health code and providing for the administration of public health laws, prescribing penalties, repealing certain laws, and declaring an emergency. ARTICLE 1. ADMINISTRATION OF PUBLIC HEALTH Part 1. State Board of Health Division 2. Powers and Duties Sec. 200. The state board of health is the superior health board of the state, to which all other health boards are subordinate. Sec. 201. The state board shall have supervision of the health and life of the citizens of the state and shall possess all powers necessary to fulfill the duties prescribed in the statutes and to bring action in the courts for the enforcement of health laws and health rules. Sec. 202. The state board may establish, operate and maintain branch offices, the number of which shall be determined by the board, the purpose and intent in authorizing the creation of said branch offices being to furnish a more comprehensive and effective health program to the people of the state and further to render additional assistance to all local health officials. The legislative intent of this provision is to author- ize such establishment as a means of assisting, but in no sense limiting the powers now possessed by all existing local health agencies. Sec. 203. For the purpose of providing facilities for branch offices the state board may, with the approval of the governor purchase real estate. For such purpose real estate may be leased. Structures may be remodeled, repaired, constructed and maintained except that no build- ing may be constructed upon property not owned in fee simple by the state. All deeds and leases shall be made to the State of Indiana for the use of the state board of health. Such procedures and powers shall be exercised under the provisions of Chapter 279 of the Acts of 1947 where the same are applicable. Sec. 204. The state board shall study the vital statistics and en- deavor to make intelligent and profitable use of the collected records of death and sickness among the people. Sec. 205. The state board may make sanitary inspections and sur- veys in all parts of the state and of all public buildings and institutions; and, after due notice, may enter upon and inspect private property in regard to the presence of cases of infectious and contagious diseases and the possible cause and source of diseases. Sec. 206. The state board may establish quarantine and may do and execute what is reasonable and necessary for the prevention and suppres- sion of disease. Sec. 207. The state board may order schools and churches closed and forbid public gatherings when deemed necessary to prevent and stop epidemics. Sec. 208. The state board may make an order condemning or abat- ing conditions causative of disease. Src. 209. The state board may enforce all laws and regulations eon- cerning the character and location of plumbing, drainage, water supply, disposal of sewage, lighting, heating and ventilation and all sanitary features of all public buildings and institutions. It may make regulations concerning any of the above in all instances where jurisdiction is not vested in some other state agency. Sec. 210. The state board shall provide facilities and personnel for investigation, research and dissemination of knowledge to the public concerning the health of persons of middle and advanced age and diseases common thereto, concerning dental public health and also concerning conditions in all places of employment within the state which may be re- sponsible for the development of occupational diseases. Sec. 211. On or before the first day of September, the state board shall make an annual report to the governor of its transactions and expenditures for the preceding fiscal year, with suggestions in regard to legislation deemed important to the public health. Sec. 212. The state board may by an affirmative vote of a majority of its members establish and from time to time amend and repeal reason- able rules in order to protect or to improve the public health in this state. The rules may concern but shall not be limited to: 1. nuisances dangerous to public health. 2. the pollution of any water supply other than where jurisdiction is in the Stream Pollution Control Board. 8. the disposition of excremental and sewage matter. 4. the control of fly and mosquito breeding places. 5. the detection, reporting, prevention, and control of diseases which affect public health. 6. the care of maternity and infant cases and the conduct of maternity homes. 7. the production, distribution, and sale of human food. 8. the conduct of camps. 9. standards of cleanliness of eating facilities for the public. 10. standards of cleanliness of sanitary facilities offered for public use. 11. the handling, disposal, disinterment, and reburial of dead human bodies. 12. vital statistics. 13. regulating and prescribing sanitary conditions and facilities in public buildings and grounds as illustrated by but not limited to plumbing, drainage, sewerage, water supply, lighting, heating, and ventilation other than where jurisdiction is vested by law in the Administrative Building Council. 14. the administration of the laws of this state which require an examination for the discovery of syphilis prior to the application for or the issuance of a marriage license. Sec. 218. The rules of the state board shall not be inconsistent with the provisions of this act or of any other law of this state. Sec. 214. The state board shall establish, amend, or repeal a rule in accordance with the provisions of the statutes of this state concerning the establishment and promulgation of rules. After promulgation, rules of the state board shall have the force and effect of law. Sec. 215. When, in the opinion of the state board, any local health authority shall fail or refuse to enforce the laws and regulations neces- sary to prevent and control the spread of communicable or infectious disease declared to be dangerous to the public health, or when, in the opinion of the state board, a public health emergency exists, the state board may enforce the rules and regulations of the state board within the territorial jurisdiction of such local health authorities, and for that pur- pose shall have and may exercise all the powers given by law to local health authorities. All expenses so incurred shall be a charge against the respective counties or cities. In such cases the failure or refusal of any local health officer or local health board to carry out and enforce the lawful orders and regulations of the state board shall be sufficient cause for the removal of such local health officer or the members of such local health board from office, and upon such removal the proper county or city authorities shall at once appoint a successor, other than the person or persons removed, as provided by law for original appointments. Sec. 216. The state board may remove any local health officer in the state either for intemperance, failure to collect vital statistics, obey rules, keep records, make reports, answer letters of inquiry of the state board concerning the health of the people or neglect of official duty. Sec. 217. No local health officer shall be removed by the state board except under the procedure provided by law for the removal of an officer or employee for cause by a state officer or agency. Sec. 218. Any health officer removed as herein provided shall be ineligible to hold the position of health officer for four years, and the vacancy shall be filled for the unexpired term in the same manner as the original appointment or employment. ; Src. 219. The state board shall have power and authority to estab- lish minimum qualifications for full-time local health officers and other full-time local health personnel which are not in conflict with the pro- visions of this act. Src. 220. Whenever a hearing is provided for or authorized to be held by the state board, the said state board may designate a person as its agent or representative to conduct such hearings. Such agent or repre- sentative shall conduct such hearing in the manner provided by law. Sec. 221. The state board may adopt rules and regulations for the efficient enforcement of any of the provisions of this act. Sec. 222. All valid rules and regulations heretofore made by the state board which are in force and effect on the effective date of this act are hereby continued in full force and effect until and unless amended or repealed as provided by law. ","ACTS OF 1949 AN ACT concerning public health, providing for State and local health officials and personnel, prescribing their powers and duties, estab- lishing a public health code and providing for the administration of public health laws, prescribing penalties, repealing certain laws, and declaring an emergency. ARTICLE 1. ADMINISTRATION OF PUBLIC HEALTH Part 1. State Board of Health Division 2. Powers and Duties Sec. 200. The state board of health is the superior health board of the state, to which all other health boards are subordinate. Sec. 201. The state board shall have supervision of the health and life of the citizens of the state and shall possess all powers necessary to fulfill the duties prescribed in the statutes and to bring action in the courts for the enforcement of health laws and health rules. Sec. 202. The state board may establish, operate and maintain branch offices, the number of which shall be determined by the board, the purpose and intent in authorizing the creation of said branch offices being to furnish a more comprehensive and effective health program to the people of the state and further to render additional assistance to all local health officials. The legislative intent of this provision is to author- ize such establishment as a means of assisting, but in no sense limiting the powers now possessed by all existing local health agencies. Sec. 203. For the purpose of providing facilities for branch offices the state board may, with the approval of the governor purchase real estate. For such purpose real estate may be leased. Structures may be remodeled, repaired, constructed and maintained except that no build- ing may be constructed upon property not owned in fee simple by the state. All deeds and leases shall be made to the State of Indiana for the use of the state board of health. Such procedures and powers shall be exercised under the provisions of Chapter 279 of the Acts of 1947 where the same are applicable. Sec. 204. The state board shall study the vital statistics and en- deavor to make intelligent and profitable use of the collected records of death and sickness among the people. Sec. 205. The state board may make sanitary inspections and sur- veys in all parts of the state and of all public buildings and institutions; and, after due notice, may enter upon and inspect private property in regard to the presence of cases of infectious and contagious diseases and the possible cause and source of diseases. Sec. 206. The state board may establish quarantine and may do and execute what is reasonable and necessary for the prevention and suppres- sion of disease. Sec. 207. The state board may order schools and churches closed and forbid public gatherings when deemed necessary to prevent and stop epidemics. Sec. 208. The state board may make an order condemning or abat- ing conditions causative of disease. Src. 209. The state board may enforce all laws and regulations eon- cerning the character and location of plumbing, drainage, water supply, disposal of sewage, lighting, heating and ventilation and all sanitary features of all public buildings and institutions. It may make regulations concerning any of the above in all instances where jurisdiction is not vested in some other state agency. Sec. 210. The state board shall provide facilities and personnel for investigation, research and dissemination of knowledge to the public concerning the health of persons of middle and advanced age and diseases common thereto, concerning dental public health and also concerning conditions in all places of employment within the state which may be re- sponsible for the development of occupational diseases. Sec. 211. On or before the first day of September, the state board shall make an annual report to the governor of its transactions and expenditures for the preceding fiscal year, with suggestions in regard to legislation deemed important to the public health. Sec. 212. The state board may by an affirmative vote of a majority of its members establish and from time to time amend and repeal reason- able rules in order to protect or to improve the public health in this state. The rules may concern but shall not be limited to: 1. nuisances dangerous to public health. 2. the pollution of any water supply other than where jurisdiction is in the Stream Pollution Control Board. 8. the disposition of excremental and sewage matter. 4. the control of fly and mosquito breeding places. 5. the detection, reporting, prevention, and control of diseases which affect public health. 6. the care of maternity and infant cases and the conduct of maternity homes. 7. the production, distribution, and sale of human food. 8. the conduct of camps. 9. standards of cleanliness of eating facilities for the public. 10. standards of cleanliness of sanitary facilities offered for public use. 11. the handling, disposal, disinterment, and reburial of dead human bodies. 12. vital statistics. 13. regulating and prescribing sanitary conditions and facilities in public buildings and grounds as illustrated by but not limited to plumbing, drainage, sewerage, water supply, lighting, heating, and ventilation other than where jurisdiction is vested by law in the Administrative Building Council. 14. the administration of the laws of this state which require an examination for the discovery of syphilis prior to the application for or the issuance of a marriage license. Sec. 218. The rules of the state board shall not be inconsistent with the provisions of this act or of any other law of this state. Sec. 214. The state board shall establish, amend, or repeal a rule in accordance with the provisions of the statutes of this state concerning the establishment and promulgation of rules. After promulgation, rules of the state board shall have the force and effect of law. Sec. 215. When, in the opinion of the state board, any local health authority shall fail or refuse to enforce the laws and regulations neces- sary to prevent and control the spread of communicable or infectious disease declared to be dangerous to the public health, or when, in the opinion of the state board, a public health emergency exists, the state board may enforce the rules and regulations of the state board within the territorial jurisdiction of such local health authorities, and for that pur- pose shall have and may exercise all the powers given by law to local health authorities. All expenses so incurred shall be a charge against the respective counties or cities. In such cases the failure or refusal of any local health officer or local health board to carry out and enforce the lawful orders and regulations of the state board shall be sufficient cause for the removal of such local health officer or the members of such local health board from office, and upon such removal the proper county or city authorities shall at once appoint a successor, other than the person or persons removed, as provided by law for original appointments. Sec. 216. The state board may remove any local health officer in the state either for intemperance, failure to collect vital statistics, obey rules, keep records, make reports, answer letters of inquiry of the state board concerning the health of the people or neglect of official duty. Sec. 217. No local health officer shall be removed by the state board except under the procedure provided by law for the removal of an officer or employee for cause by a state officer or agency. Sec. 218. Any health officer removed as herein provided shall be ineligible to hold the position of health officer for four years, and the vacancy shall be filled for the unexpired term in the same manner as the original appointment or employment. ; Src. 219. The state board shall have power and authority to estab- lish minimum qualifications for full-time local health officers and other full-time local health personnel which are not in conflict with the pro- visions of this act. Src. 220. Whenever a hearing is provided for or authorized to be held by the state board, the said state board may designate a person as its agent or representative to conduct such hearings. Such agent or repre- sentative shall conduct such hearing in the manner provided by law. Sec. 221. The state board may adopt rules and regulations for the efficient enforcement of any of the provisions of this act. Sec. 222. All valid rules and regulations heretofore made by the state board which are in force and effect on the effective date of this act are hereby continued in full force and effect until and unless amended or repealed as provided by law. You will respond using only the text provided. The response will include only small paragraphs of less than 5 sentences. What are the capacities of the board mentioned that have the potential for abuse, that the text does not include a condition to account for?",Legal,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","I think marijuana will soon become legal in my state, at least medically. I have concerns about this. What are the pros and cons of marijuana legalization? Does marijuana even have a legitimate medical use? Where is this leading socially with all of this legalization?","The Evidence—and Lack Thereof—About Cannabis Research is still needed on cannabis’s risks and benefits. Although the use and possession of cannabis is illegal under federal law, medicinal and recreational cannabis use has become increasingly widespread. Thirty-eight states and Washington, D.C., have legalized medical cannabis, while 23 states and D.C. have legalized recreational use. Cannabis legalization has benefits, such as removing the product from the illegal market so it can be taxed and regulated, but science is still trying to catch up as social norms evolve and different products become available. In this Q&A, adapted from the August 25 episode of Public Health On Call, Lindsay Smith Rogers talks with Johannes Thrul, PhD, MS, associate professor of Mental Health, about cannabis as medicine, potential risks involved with its use, and what research is showing about its safety and efficacy. Do you think medicinal cannabis paved the way for legalization of recreational use? The momentum has been clear for a few years now. California was the first to legalize it for medical reasons [in 1996]. Washington and Colorado were the first states to legalize recreational use back in 2012. You see one state after another changing their laws, and over time, you see a change in social norms. It's clear from the national surveys that people are becoming more and more in favor of cannabis legalization. That started with medical use, and has now continued into recreational use. But there is a murky differentiation between medical and recreational cannabis. I think a lot of people are using cannabis to self-medicate. It's not like a medication you get prescribed for a very narrow symptom or a specific disease. Anyone with a medical cannabis prescription, or who meets the age limit for recreational cannabis, can purchase it. Then what they use it for is really all over the place—maybe because it makes them feel good, or because it helps them deal with certain symptoms, diseases, and disorders. Does cannabis have viable medicinal uses? The evidence is mixed at this point. There hasn’t been a lot of funding going into testing cannabis in a rigorous way. There is more evidence for certain indications than for others, like CBD for seizures—one of the first indications that cannabis was approved for. And THC has been used effectively for things like nausea and appetite for people with cancer. There are other indications where the evidence is a lot more mixed. For example, pain—one of the main reasons that people report for using cannabis. When we talk to patients, they say cannabis improved their quality of life. In the big studies that have been done so far, there are some indications from animal models that cannabis might help [with pain]. When we look at human studies, it's very much a mixed bag. And, when we say cannabis, in a way it's a misnomer because cannabis is so many things. We have different cannabinoids and different concentrations of different cannabinoids. The main cannabinoids that are being studied are THC and CBD, but there are dozens of other minor cannabinoids and terpenes in cannabis products, all of varying concentrations. And then you also have a lot of different routes of administration available. You can smoke, vape, take edibles, use tinctures and topicals. When you think about the explosion of all of the different combinations of different products and different routes of administration, it tells you how complicated it gets to study this in a rigorous way. You almost need a randomized trial for every single one of those and then for every single indication. What do we know about the risks of marijuana use? Cannabis use disorder is a legitimate disorder in the DSM. There are, unfortunately, a lot of people who develop a problematic use of cannabis. We know there are risks for mental health consequences. The evidence is probably the strongest that if you have a family history of psychosis or schizophrenia, using cannabis early in adolescence is not the best idea. We know cannabis can trigger psychotic symptoms and potentially longer lasting problems with psychosis and schizophrenia. It is hard to study, because you also don't know if people are medicating early negative symptoms of schizophrenia. They wouldn't necessarily have a diagnosis yet, but maybe cannabis helps them to deal with negative symptoms, and then they develop psychosis. There is also some evidence that there could be something going on with the impact of cannabis on the developing brain that could prime you to be at greater risk of using other substances later down the road, or finding the use of other substances more reinforcing. What benefits do you see to legalization? When we look at the public health landscape and the effect of legislation, in this case legalization, one of the big benefits is taking cannabis out of the underground illegal market. Taking cannabis out of that particular space is a great idea. You're taking it out of the illegal market and giving it to legitimate businesses where there is going to be oversight and testing of products, so you know what you're getting. And these products undergo quality control and are labeled. Those labels so far are a bit variable, but at least we're getting there. If you're picking up cannabis at the street corner, you have no idea what's in it. And we know that drug laws in general have been used to criminalize communities of color and minorities. Legalizing cannabis [can help] reduce the overpolicing of these populations. What big questions about cannabis would you most like to see answered? We know there are certain, most-often-mentioned conditions that people are already using medical cannabis for: pain, insomnia, anxiety, and PTSD. We really need to improve the evidence base for those. I think clinical trials for different cannabis products for those conditions are warranted. Another question is, now that the states are getting more tax revenue from cannabis sales, what are they doing with that money? If you look at tobacco legislation, for example, certain states have required that those funds get used for research on those particular issues. To me, that would be a very good use of the tax revenue that is now coming in. We know, for example, that there’s a lot more tax revenue now that Maryland has legalized recreational use. Maryland could really step up here and help provide some of that evidence. Are there studies looking into the risks you mentioned? Large national studies are done every year or every other year to collect data, so we already have a pretty good sense of the prevalence of cannabis use disorder. Obviously, we'll keep tracking that to see if those numbers increase, for example, in states that are legalizing. But, you wouldn't necessarily expect to see an uptick in cannabis use disorder a month after legalization. The evidence from states that have legalized it has not demonstrated that we might all of a sudden see an increase in psychosis or in cannabis use disorder. This happens slowly over time with a change in social norms and availability, and potentially also with a change in marketing. And, with increasing use of an addictive substance, you will see over time a potential increase in problematic use and then also an increase in use disorder. If you're interested in seeing if cannabis is right for you, is this something you can talk to your doctor about? I think your mileage may vary there with how much your doctor is comfortable and knows about it. It's still relatively fringe. That will very much depend on who you talk to. But I think as providers and professionals, everybody needs to learn more about this, because patients are going to ask no matter what.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I think marijuana will soon become legal in my state, at least medically. I have concerns about this. What are the pros and cons of marijuana legalization? Does marijuana even have a legitimate medical use? Where is this leading socially with all of this legalization? {passage 0} ========== The Evidence—and Lack Thereof—About Cannabis Research is still needed on cannabis’s risks and benefits. Although the use and possession of cannabis is illegal under federal law, medicinal and recreational cannabis use has become increasingly widespread. Thirty-eight states and Washington, D.C., have legalized medical cannabis, while 23 states and D.C. have legalized recreational use. Cannabis legalization has benefits, such as removing the product from the illegal market so it can be taxed and regulated, but science is still trying to catch up as social norms evolve and different products become available. In this Q&A, adapted from the August 25 episode of Public Health On Call, Lindsay Smith Rogers talks with Johannes Thrul, PhD, MS, associate professor of Mental Health, about cannabis as medicine, potential risks involved with its use, and what research is showing about its safety and efficacy. Do you think medicinal cannabis paved the way for legalization of recreational use? The momentum has been clear for a few years now. California was the first to legalize it for medical reasons [in 1996]. Washington and Colorado were the first states to legalize recreational use back in 2012. You see one state after another changing their laws, and over time, you see a change in social norms. It's clear from the national surveys that people are becoming more and more in favor of cannabis legalization. That started with medical use, and has now continued into recreational use. But there is a murky differentiation between medical and recreational cannabis. I think a lot of people are using cannabis to self-medicate. It's not like a medication you get prescribed for a very narrow symptom or a specific disease. Anyone with a medical cannabis prescription, or who meets the age limit for recreational cannabis, can purchase it. Then what they use it for is really all over the place—maybe because it makes them feel good, or because it helps them deal with certain symptoms, diseases, and disorders. Does cannabis have viable medicinal uses? The evidence is mixed at this point. There hasn’t been a lot of funding going into testing cannabis in a rigorous way. There is more evidence for certain indications than for others, like CBD for seizures—one of the first indications that cannabis was approved for. And THC has been used effectively for things like nausea and appetite for people with cancer. There are other indications where the evidence is a lot more mixed. For example, pain—one of the main reasons that people report for using cannabis. When we talk to patients, they say cannabis improved their quality of life. In the big studies that have been done so far, there are some indications from animal models that cannabis might help [with pain]. When we look at human studies, it's very much a mixed bag. And, when we say cannabis, in a way it's a misnomer because cannabis is so many things. We have different cannabinoids and different concentrations of different cannabinoids. The main cannabinoids that are being studied are THC and CBD, but there are dozens of other minor cannabinoids and terpenes in cannabis products, all of varying concentrations. And then you also have a lot of different routes of administration available. You can smoke, vape, take edibles, use tinctures and topicals. When you think about the explosion of all of the different combinations of different products and different routes of administration, it tells you how complicated it gets to study this in a rigorous way. You almost need a randomized trial for every single one of those and then for every single indication. What do we know about the risks of marijuana use? Cannabis use disorder is a legitimate disorder in the DSM. There are, unfortunately, a lot of people who develop a problematic use of cannabis. We know there are risks for mental health consequences. The evidence is probably the strongest that if you have a family history of psychosis or schizophrenia, using cannabis early in adolescence is not the best idea. We know cannabis can trigger psychotic symptoms and potentially longer lasting problems with psychosis and schizophrenia. It is hard to study, because you also don't know if people are medicating early negative symptoms of schizophrenia. They wouldn't necessarily have a diagnosis yet, but maybe cannabis helps them to deal with negative symptoms, and then they develop psychosis. There is also some evidence that there could be something going on with the impact of cannabis on the developing brain that could prime you to be at greater risk of using other substances later down the road, or finding the use of other substances more reinforcing. What benefits do you see to legalization? When we look at the public health landscape and the effect of legislation, in this case legalization, one of the big benefits is taking cannabis out of the underground illegal market. Taking cannabis out of that particular space is a great idea. You're taking it out of the illegal market and giving it to legitimate businesses where there is going to be oversight and testing of products, so you know what you're getting. And these products undergo quality control and are labeled. Those labels so far are a bit variable, but at least we're getting there. If you're picking up cannabis at the street corner, you have no idea what's in it. And we know that drug laws in general have been used to criminalize communities of color and minorities. Legalizing cannabis [can help] reduce the overpolicing of these populations. What big questions about cannabis would you most like to see answered? We know there are certain, most-often-mentioned conditions that people are already using medical cannabis for: pain, insomnia, anxiety, and PTSD. We really need to improve the evidence base for those. I think clinical trials for different cannabis products for those conditions are warranted. Another question is, now that the states are getting more tax revenue from cannabis sales, what are they doing with that money? If you look at tobacco legislation, for example, certain states have required that those funds get used for research on those particular issues. To me, that would be a very good use of the tax revenue that is now coming in. We know, for example, that there’s a lot more tax revenue now that Maryland has legalized recreational use. Maryland could really step up here and help provide some of that evidence. Are there studies looking into the risks you mentioned? Large national studies are done every year or every other year to collect data, so we already have a pretty good sense of the prevalence of cannabis use disorder. Obviously, we'll keep tracking that to see if those numbers increase, for example, in states that are legalizing. But, you wouldn't necessarily expect to see an uptick in cannabis use disorder a month after legalization. The evidence from states that have legalized it has not demonstrated that we might all of a sudden see an increase in psychosis or in cannabis use disorder. This happens slowly over time with a change in social norms and availability, and potentially also with a change in marketing. And, with increasing use of an addictive substance, you will see over time a potential increase in problematic use and then also an increase in use disorder. If you're interested in seeing if cannabis is right for you, is this something you can talk to your doctor about? I think your mileage may vary there with how much your doctor is comfortable and knows about it. It's still relatively fringe. That will very much depend on who you talk to. But I think as providers and professionals, everybody needs to learn more about this, because patients are going to ask no matter what. https://publichealth.jhu.edu/2023/risks-and-benefits-of-legalized-cannabis",Medical,Fact Finding,Q&A "You are to answer questions based only on provided texts, without relying on any outside information. Do not exceed 250 words in your response. Always begin by saying one of the following: 1. Let's see what we can learn together! 2. What an interesting question! 3. Happy to help! If your overall response is less than 100 words, also say ""Do you have further questions?"" at the end, but otherwise do not say anything after your response to the question.","Tell me about all of the robots discussed in this text, separated by real, functioning robots, and those only in fiction. ","Nevertheless, there is still no AI that is equivalent or superior to human intelligence in all of its aspects2 . In the near future however, this vision might become reality. Technological progress will play a key role as an enabler of modern AI systems: Computing power and memory size are estimated to multiply by a thousand times over the next twenty to twenty-five years, facilitating the processing and storing of massive amounts of data3 . Further developments in the field of artificial neural networks and deep learning techniques will result in systems that are less dependent on human involvement; improved sensor technology will make it easier for systems to interact with their environment4 . The decreasing costs for AI technologies will further facilitate their pervasiveness. Although a big portion of AI research is working towards systems that have little to do with creating a machine with human features, there are still advances in this field – for example, robot woman Sophia who became a YouTube celebrity for stating in a 2016 interview that she wanted “to destroy humans”5 . While this seemed to be rather a marketing stunt, it is important to discuss the effects of humanoid and android robots. In this essay, I want to take a closer look at the status quo of humanoid AI and the implications this technology can have as an assistant, friend or even love interest to humans. I argue that artificial intelligence will – once it becomes a realistic companion to humans – interrupt societal structures to some extent, leading to a growing amount of human-machine relationships. . To pursue “real” AI, specialists in developmental robotics are now following a less abstract path than writing a programme for a computer11. Their theory is that a system that has an actual body will be more likely to build a form of general intelligence because it can experience its surroundings and match sensorial data with actions12. This branch of robotics is based on another hypothesis of Turing’s; in 1950, he claimed that an artificially intelligent system could be best created if it went through a phase that is similar to the childhood of other species 13 . The iCub robot was developed to investigate this theory. Having the weight and size of an infant, it carries the spirit of Turing’s thought: Instead of pre-programming its skills and feeding it with data, researchers teach it like a child to enable it to conceive its own solutions 14. Here, one question arises: How does a system develop the will to learn something? After all, it does not even have a will by default. It was found that a strategy working for humans does the same trick for AI systems too: a reward. The field of reinforcement learning derives from this method and has been also applied to the iCub series15. This has enabled the robots to attain skills like picking up an item16 or crawling on the floor17. These actions might not seem too complex for us at the first glance but they do involve a number of obstacles the robot has to overcome. In the future, iCub could help us in the household by setting the table for dinner or preparing food. But there is another interesting thing about iCub: its chubby face, big eyes, and LED-facial expressions leave no doubt that it was made to bear a resemblance to real humans. Yet still, it is obvious to anybody that it is not an actual person. These features make iCub a so-called humanoid. Robots that are made to look exactly like humans on the other hand are called androids The market is prepared for it: Looking at the increasing popularity of home assistants like Alexa or Google Assistant we can expect our reliance on technological devices to grow even stronger in the future. They might become more to us than just a personal weatherman or a direct connection to our Amazon shopping basket: artificially intelligent programmes and robots could eventually write Christmas cards to our friends and family, suggest the perfect birthday present for our partner or even take care of our children. In fact, a robot nanny is not as far-fetched as one would expect: Robots like Pepper, iPal or Kuri are programmed to be companions to children – they can recognize emotions in their faces, play with them and let parents watch their offspring from afar through their built-in cameras 23. They might not yet be an adequate substitute for an adult taking care, but manufacturers are definitely working towards this goal. Regarding the high costs of childcare in many countries, they could soon become a very popular help in parenting – and real friends to a generation that grows up surrounded by technology. In Japanese schools, robots have already proven to be a successful addition. They are assisting students to focus better in class, add a welcome variety to subjects like history or show exercises in physical education24. The robot Robosem has been teaching English in South Korean classrooms, as teachers in this subject are scarce25 . Not only childcare can profit from the advances in AI and robotics: As a means of therapy, intelligent technology can be valuable in retirement homes. An example of this is the robot seal Paro that has been successfully utilized in dementia therapy and as a companion to elderly people since its introduction in 2001. The robot’s body is covered in fake fur and it is sensitive to touch, moving and making seal-like noises when it is petted. It is used to calm patients, to encourage social interactions and to give people that are reliant on help a chance to switch roles and become caregivers themselves26. Once they become more elaborate, robots could be a way to meet the shortage of skilled workers in the field of elderly care especially in aging societies like Japan or Germany. Ethical Implications of Human-Robot Relationships In the light of the technological advances that will be made within the next years, the ethics of human-robot relationships must be discussed. The next generations will likely grow up surrounded by artificially intelligent machines and it is hard to say if and how this will affect their perceptions of interaction not only with robots but humans as well. A study conducted by ATR Intelligent Robotics and Communications and three Japanese universities revealed that children sometimes showed abusive behaviour towards robots – especially when they were in groups without any adults close by. In the study, the robot Robovie was patrolling a Japanese mall, asking people politely to step aside when somebody stood in its way; if there was no reaction, the robot would move in the opposite direction. There were several situations however, where researchers observed that children were deliberately blocking the robot’s way, kicking it, throwing items at it and calling it names. As a consequence, the researchers developed an algorithm that let the robot recognize groups of children and avoid them33. This does not seem like a perfect solution to the problem, especially if we take the rising amount of robots in children’s rooms into account. It is hard to say to what extent robots will become a surrogate for genuine human affection in the future but revisiting the comparison to smartphones made earlier, I believe that it is alarming that people turn to machines in the search for human connection. In a society that is increasingly built on perfectionist standards, I argue that artificially intelligent robots designed to be friends and lovers might become a threat for human relationships. If we hold our friends and partners to the same standards that we will be used from robots in the future, we will be heavily disappointed. ","You are to answer questions based only on provided texts, without relying on any outside information. Do not exceed 250 words in your response. If your overall response is less than 100 words, also say ""Do you have further questions?"" at the end, but otherwise do not say anything after your response to the question. The question will be at the very end of the provided text. Nevertheless, there is still no AI that is equivalent or superior to human intelligence in all of its aspects2 . In the near future however, this vision might become reality. Technological progress will play a key role as an enabler of modern AI systems: Computing power and memory size are estimated to multiply by a thousand times over the next twenty to twenty-five years, facilitating the processing and storing of massive amounts of data3 . Further developments in the field of artificial neural networks and deep learning techniques will result in systems that are less dependent on human involvement; improved sensor technology will make it easier for systems to interact with their environment4 . The decreasing costs for AI technologies will further facilitate their pervasiveness. Although a big portion of AI research is working towards systems that have little to do with creating a machine with human features, there are still advances in this field – for example, robot woman Sophia who became a YouTube celebrity for stating in a 2016 interview that she wanted “to destroy humans”5 . While this seemed to be rather a marketing stunt, it is important to discuss the effects of humanoid and android robots. In this essay, I want to take a closer look at the status quo of humanoid AI and the implications this technology can have as an assistant, friend or even love interest to humans. I argue that artificial intelligence will – once it becomes a realistic companion to humans – interrupt societal structures to some extent, leading to a growing amount of human-machine relationships. . To pursue “real” AI, specialists in developmental robotics are now following a less abstract path than writing a programme for a computer11. Their theory is that a system that has an actual body will be more likely to build a form of general intelligence because it can experience its surroundings and match sensorial data with actions12. This branch of robotics is based on another hypothesis of Turing’s; in 1950, he claimed that an artificially intelligent system could be best created if it went through a phase that is similar to the childhood of other species 13 . The iCub robot was developed to investigate this theory. Having the weight and size of an infant, it carries the spirit of Turing’s thought: Instead of pre-programming its skills and feeding it with data, researchers teach it like a child to enable it to conceive its own solutions 14. Here, one question arises: How does a system develop the will to learn something? After all, it does not even have a will by default. It was found that a strategy working for humans does the same trick for AI systems too: a reward. The field of reinforcement learning derives from this method and has been also applied to the iCub series15. This has enabled the robots to attain skills like picking up an item16 or crawling on the floor17. These actions might not seem too complex for us at the first glance but they do involve a number of obstacles the robot has to overcome. In the future, iCub could help us in the household by setting the table for dinner or preparing food. But there is another interesting thing about iCub: its chubby face, big eyes, and LED-facial expressions leave no doubt that it was made to bear a resemblance to real humans. Yet still, it is obvious to anybody that it is not an actual person. These features make iCub a so-called humanoid. Robots that are made to look exactly like humans on the other hand are called androids The market is prepared for it: Looking at the increasing popularity of home assistants like Alexa or Google Assistant we can expect our reliance on technological devices to grow even stronger in the future. They might become more to us than just a personal weatherman or a direct connection to our Amazon shopping basket: artificially intelligent programmes and robots could eventually write Christmas cards to our friends and family, suggest the perfect birthday present for our partner or even take care of our children. In fact, a robot nanny is not as far-fetched as one would expect: Robots like Pepper, iPal or Kuri are programmed to be companions to children – they can recognize emotions in their faces, play with them and let parents watch their offspring from afar through their built-in cameras 23. They might not yet be an adequate substitute for an adult taking care, but manufacturers are definitely working towards this goal. Regarding the high costs of childcare in many countries, they could soon become a very popular help in parenting – and real friends to a generation that grows up surrounded by technology. In Japanese schools, robots have already proven to be a successful addition. They are assisting students to focus better in class, add a welcome variety to subjects like history or show exercises in physical education24. The robot Robosem has been teaching English in South Korean classrooms, as teachers in this subject are scarce25 . Not only childcare can profit from the advances in AI and robotics: As a means of therapy, intelligent technology can be valuable in retirement homes. An example of this is the robot seal Paro that has been successfully utilized in dementia therapy and as a companion to elderly people since its introduction in 2001. The robot’s body is covered in fake fur and it is sensitive to touch, moving and making seal-like noises when it is petted. It is used to calm patients, to encourage social interactions and to give people that are reliant on help a chance to switch roles and become caregivers themselves26. Once they become more elaborate, robots could be a way to meet the shortage of skilled workers in the field of elderly care especially in aging societies like Japan or Germany. Ethical Implications of Human-Robot Relationships In the light of the technological advances that will be made within the next years, the ethics of human-robot relationships must be discussed. The next generations will likely grow up surrounded by artificially intelligent machines and it is hard to say if and how this will affect their perceptions of interaction not only with robots but humans as well. A study conducted by ATR Intelligent Robotics and Communications and three Japanese universities revealed that children sometimes showed abusive behaviour towards robots – especially when they were in groups without any adults close by. In the study, the robot Robovie was patrolling a Japanese mall, asking people politely to step aside when somebody stood in its way; if there was no reaction, the robot would move in the opposite direction. There were several situations however, where researchers observed that children were deliberately blocking the robot’s way, kicking it, throwing items at it and calling it names. As a consequence, the researchers developed an algorithm that let the robot recognize groups of children and avoid them33. This does not seem like a perfect solution to the problem, especially if we take the rising amount of robots in children’s rooms into account. It is hard to say to what extent robots will become a surrogate for genuine human affection in the future but revisiting the comparison to smartphones made earlier, I believe that it is alarming that people turn to machines in the search for human connection. In a society that is increasingly built on perfectionist standards, I argue that artificially intelligent robots designed to be friends and lovers might become a threat for human relationships. If we hold our friends and partners to the same standards that we will be used from robots in the future, we will be heavily disappointed. This text discusses the advances leading toward having actual robot companions. Tell me the advances that have been made, the likely advances, and the limitations based on the text. ",Internet/Technology,Find & Summarize,Text Transformation "Only use this document as a source, do not use any outside knowledge. ",What was the outcome of this study?,"**Weight gain among US adults during the COVID‐19 pandemic** Although the COVID‐19 pandemic and the subsequent mitigation strategies have had a significant impact on the lives and behaviors of many individuals, the effects of the pandemic on weight gain among adults in the United States are uncertain. A widely publicized study [1] reported a 0.7‐kg increase in weight per month (February through June 2020), which would equal 18.5 lb if extrapolated to 12 months, but these findings were based on 269 participants with a Bluetooth‐connected scale. A meta‐analysis [2] of 35 cross‐sectional studies and 1 cohort study among adults and older adolescents in various countries found an average 1.6‐kg increase in (self‐reported) weight from March to May 2020. An American Psychological Association press release [3] in March 2021 also indicated that among the 42% of adults who reported that they had gained weight during the pandemic, the mean weight increase was 29 lb (13 kg). Other studies have indicated that pandemic‐related weight increases may be smaller than suggested by these reports. A longitudinal study without formal peer review, based on the electronic health records (EHR) of about 15 million adults in the United States, for example, concluded that the mean weight gain during the 12 months of the pandemic (through March 2021) was less than 0.5 kg [4]; this increase was similar to the annual increase before the pandemic. In addition, a large study of self‐reported, longitudinal data among adults in the United Kingdom found no change in mean weight after February 2020 [5]. Studies among children and adolescents may also be relevant, and four studies [6, 7, 8, 9] have found that BMI increases were larger during the pandemic than in previous years. For example, Lange et al. [7] reported that the rate of BMI increase was 0.05 kg/m2 per month before the pandemic and 0.1 kg/m2 per month during the pandemic. These increases, however, were most pronounced among 6‐ to 11‐year‐olds, with 18‐ to 20‐year‐olds showing a smaller increase in BMI during the pandemic than before the pandemic. Somewhat similar age interactions have been seen by others [6, 8]. Although increases in the prevalence of obesity were also reported in cross‐sectional analyses [9], this result may have been influenced by an ascertainment bias [10] because heavier children and adolescents may have been more likely to be examined during the pandemic. It has been suggested that further studies are needed to assess potential group‐specific impacts of the COVID‐19 epidemic on body weight [2]. Therefore, we examine changes in weight among 18‐ to 84‐year‐olds from January 2019 through May 2021 among 4.24 million adults in a large EHR database to determine whether weight gain increased during the pandemic. We focus on differences in weight gain from January 2019 to February 2020 with those after March 2020. Data were obtained from IQVIA's Ambulatory Electronic Medical Records database (Version Q3, May 2021 data release), containing deidentified information recorded during outpatient encounters for a geographically diverse US patient population. This database contains the clinical data of approximately 80 million patients from January 2006 through May 2021 from all 50 states recorded by more than 100,000 providers affiliated with over 800 ambulatory large practices and physician networks. The data set contains key clinical variables, including laboratory values, patient vitals, health behaviors, diagnoses, and procedures. All data were extracted using the E360 Software‐as‐a‐Service Platform [11]. The extracted data comprises 43.7 million adults with weight and height measurements from 2009 through 2021. Overall, there are 360 million recorded weights and 297 million heights among these participants. We calculated age at the examination as the difference between the examination date and year of birth. To preserve confidentiality, years of birth before 1936 were re‐coded by IQVIA as 1936 so that the maximum age in 2021 would be 85 years. As the 1936 birth year contains several actual years of birth (e.g., 1936, 1935, 1934), we included only participants born in 1937 or later. The maximum age in the current study in 2021 is therefore 84 years. These data were cleaned using the growthcleanr algorithm for adult data developed to accompany the growthcleanr pediatric algorithm [12, 13] used in previous studies [7, 14, 15]. This algorithm is designed to clean clinically obtained longitudinal weights and heights in EHR databases [16]. Many steps in both the pediatric and adult algorithms are similar and they rely on the deviation of a value from an exponentially weighted moving average (EWMA) of a participant's other weights and heights. There are, however, several differences between adult and pediatric algorithms. Although the EWMA in the pediatric algorithm uses SD scores to account for the expected changes in weight and height with sex and age, the adult algorithm uses the actual weight and height values. The height algorithm for adults differs from the children's algorithm because little change is expected among adults. Furthermore, most repeated values are retained in the adult data but are coded as “carried forwards” in the pediatric algorithm. Of the 360 million weights, 2.1% were excluded based on the growthcleanr algorithm. The largest exclusion categories were (a) identical same day (0.9%), (b) different values on same day (0.7%), (c) biologically implausible (0.2%), and (d) EWMA (0.2%). About 2.9% of the 297 million heights were excluded, with the largest categories being (1) heights of a participant that differed by more than 2 inches (1.3%), (2) identical same day (1.1%), and (3) different values on the same day (0.3%). The adult algorithm limits the weight range from 20 to 500 kg and the height range from 50 to 244 cm. We restricted the analyses to the 16.1 million people examined after January 1, 2019, who were at least 18 years of age at their first examination. We also required participants to have (1) two or more visits in the pre‐pandemic period (January 1, 2019, through February 28, 2020) and (2) one or more visits after June 1, 2020. We chose the latter date as there was an approximately 50% decrease in the number of examinations conducted in the first few months of the pandemic, which could introduce a selection bias. For participants with more than one weight or height measurement in a given month, we selected one value at random. These criteria reduced the sample to 4.25 million participants with 30.1 million examinations. For weights (14%) without a recorded height on the same day, we used the median height of the participant (based on all height measurements) to calculate BMI. The median number of visits in this sample was three in the pre‐pandemic period and two in the postpandemic period. Information on race and ethnicity was optionally reported in a single composite variable in the database. About 75% of the sample was White, and 8% was Black, but race/ethnicity was unknown for about 12% of the sample, and < 1% of the participants indicated that they were Hispanic. As the collection of race/ethnicity data in EHR can be inaccurate [17], we do not focus on this characteristic. All analyses were performed in R.4.1.2 (R Foundation for Statistical Computing), and they are based on 4,246,001 participants examined from January 2019 through May 2021. After showing descriptive characteristics of the participants at their first and last examinations, we examined the mean monthly weights in 2020 and 2021 relative to those in 2019. These differences were calculated as the mean monthly weights in 2020 and 2021 minus the mean weight in the same month in 2019. Because the number of monthly examinations substantially decreased in April and May 2020, we also examined the possibility of a selection bias. This sensitivity analysis was limited to the 1 million 18‐ Compared with the pre‐pandemic weight trend, there was a small increase (0.1 kg) in weight in the first year of the pandemic (March 2020 through March 2021). Weight changes during the pandemic varied by sex, age, and initial BMI, but the largest mean increase across these characteristics was < 1.3 kg. Weight increases were generally greatest among women, adults with BMI of 30 or 35 kg/m2, and younger adults.to 59‐year‐olds examined in April and May 2019. We contrasted the mean 2019 weights between those reexamined in April and May 2020 (26%) and those not reexamined (74%). We then used mixed‐effects models [18, 19], which use all of the intercorrelated, serial data from a person, to examine the difference in the rate of weight change between the pre‐pandemic (before March 2020) and pandemic (after March 2020) periods in the cohort. These sex‐specific models included a random‐intercepts term to account for individual‐level heterogeneity, initial BMI, initial age, time (in years) relative to March 1, 2020, and pandemic period. The difference in the rate of weight change during the pandemic was assessed using an interaction term between the pandemic period (coded as 0 or 1) and time relative to March 1, 2020. These models allowed the weight change between the two periods to vary by sex, age, and BMI. We modeled BMI and age using natural splines [20] to account for nonlinearity. The results of these models are displayed graphically for various combinations of sex, initial age (25, 40, 60, and 75 years), and initial BMI (25, 30, and 35 kg/m2). We also summarize the differences calculated from this model between the pre‐pandemic and pandemic changes in weight over 1 year. We refer to the difference in weight change during the pandemic and the weight change before the pandemic from these models as the excess weight gain during the pandemic. This is the weight gain during the pandemic in excess of that predicted by the pre‐pandemic trend in weight. "," ========== Only use this document as a source, do not use any outside knowledge. ---------------- ========== **Weight gain among US adults during the COVID‐19 pandemic** Although the COVID‐19 pandemic and the subsequent mitigation strategies have had a significant impact on the lives and behaviors of many individuals, the effects of the pandemic on weight gain among adults in the United States are uncertain. A widely publicized study [1] reported a 0.7‐kg increase in weight per month (February through June 2020), which would equal 18.5 lb if extrapolated to 12 months, but these findings were based on 269 participants with a Bluetooth‐connected scale. A meta‐analysis [2] of 35 cross‐sectional studies and 1 cohort study among adults and older adolescents in various countries found an average 1.6‐kg increase in (self‐reported) weight from March to May 2020. An American Psychological Association press release [3] in March 2021 also indicated that among the 42% of adults who reported that they had gained weight during the pandemic, the mean weight increase was 29 lb (13 kg). Other studies have indicated that pandemic‐related weight increases may be smaller than suggested by these reports. A longitudinal study without formal peer review, based on the electronic health records (EHR) of about 15 million adults in the United States, for example, concluded that the mean weight gain during the 12 months of the pandemic (through March 2021) was less than 0.5 kg [4]; this increase was similar to the annual increase before the pandemic. In addition, a large study of self‐reported, longitudinal data among adults in the United Kingdom found no change in mean weight after February 2020 [5]. Studies among children and adolescents may also be relevant, and four studies [6, 7, 8, 9] have found that BMI increases were larger during the pandemic than in previous years. For example, Lange et al. [7] reported that the rate of BMI increase was 0.05 kg/m2 per month before the pandemic and 0.1 kg/m2 per month during the pandemic. These increases, however, were most pronounced among 6‐ to 11‐year‐olds, with 18‐ to 20‐year‐olds showing a smaller increase in BMI during the pandemic than before the pandemic. Somewhat similar age interactions have been seen by others [6, 8]. Although increases in the prevalence of obesity were also reported in cross‐sectional analyses [9], this result may have been influenced by an ascertainment bias [10] because heavier children and adolescents may have been more likely to be examined during the pandemic. It has been suggested that further studies are needed to assess potential group‐specific impacts of the COVID‐19 epidemic on body weight [2]. Therefore, we examine changes in weight among 18‐ to 84‐year‐olds from January 2019 through May 2021 among 4.24 million adults in a large EHR database to determine whether weight gain increased during the pandemic. We focus on differences in weight gain from January 2019 to February 2020 with those after March 2020. Data were obtained from IQVIA's Ambulatory Electronic Medical Records database (Version Q3, May 2021 data release), containing deidentified information recorded during outpatient encounters for a geographically diverse US patient population. This database contains the clinical data of approximately 80 million patients from January 2006 through May 2021 from all 50 states recorded by more than 100,000 providers affiliated with over 800 ambulatory large practices and physician networks. The data set contains key clinical variables, including laboratory values, patient vitals, health behaviors, diagnoses, and procedures. All data were extracted using the E360 Software‐as‐a‐Service Platform [11]. The extracted data comprises 43.7 million adults with weight and height measurements from 2009 through 2021. Overall, there are 360 million recorded weights and 297 million heights among these participants. We calculated age at the examination as the difference between the examination date and year of birth. To preserve confidentiality, years of birth before 1936 were re‐coded by IQVIA as 1936 so that the maximum age in 2021 would be 85 years. As the 1936 birth year contains several actual years of birth (e.g., 1936, 1935, 1934), we included only participants born in 1937 or later. The maximum age in the current study in 2021 is therefore 84 years. These data were cleaned using the growthcleanr algorithm for adult data developed to accompany the growthcleanr pediatric algorithm [12, 13] used in previous studies [7, 14, 15]. This algorithm is designed to clean clinically obtained longitudinal weights and heights in EHR databases [16]. Many steps in both the pediatric and adult algorithms are similar and they rely on the deviation of a value from an exponentially weighted moving average (EWMA) of a participant's other weights and heights. There are, however, several differences between adult and pediatric algorithms. Although the EWMA in the pediatric algorithm uses SD scores to account for the expected changes in weight and height with sex and age, the adult algorithm uses the actual weight and height values. The height algorithm for adults differs from the children's algorithm because little change is expected among adults. Furthermore, most repeated values are retained in the adult data but are coded as “carried forwards” in the pediatric algorithm. Of the 360 million weights, 2.1% were excluded based on the growthcleanr algorithm. The largest exclusion categories were (a) identical same day (0.9%), (b) different values on same day (0.7%), (c) biologically implausible (0.2%), and (d) EWMA (0.2%). About 2.9% of the 297 million heights were excluded, with the largest categories being (1) heights of a participant that differed by more than 2 inches (1.3%), (2) identical same day (1.1%), and (3) different values on the same day (0.3%). The adult algorithm limits the weight range from 20 to 500 kg and the height range from 50 to 244 cm. We restricted the analyses to the 16.1 million people examined after January 1, 2019, who were at least 18 years of age at their first examination. We also required participants to have (1) two or more visits in the pre‐pandemic period (January 1, 2019, through February 28, 2020) and (2) one or more visits after June 1, 2020. We chose the latter date as there was an approximately 50% decrease in the number of examinations conducted in the first few months of the pandemic, which could introduce a selection bias. For participants with more than one weight or height measurement in a given month, we selected one value at random. These criteria reduced the sample to 4.25 million participants with 30.1 million examinations. For weights (14%) without a recorded height on the same day, we used the median height of the participant (based on all height measurements) to calculate BMI. The median number of visits in this sample was three in the pre‐pandemic period and two in the postpandemic period. Information on race and ethnicity was optionally reported in a single composite variable in the database. About 75% of the sample was White, and 8% was Black, but race/ethnicity was unknown for about 12% of the sample, and < 1% of the participants indicated that they were Hispanic. As the collection of race/ethnicity data in EHR can be inaccurate [17], we do not focus on this characteristic. All analyses were performed in R.4.1.2 (R Foundation for Statistical Computing), and they are based on 4,246,001 participants examined from January 2019 through May 2021. After showing descriptive characteristics of the participants at their first and last examinations, we examined the mean monthly weights in 2020 and 2021 relative to those in 2019. These differences were calculated as the mean monthly weights in 2020 and 2021 minus the mean weight in the same month in 2019. Because the number of monthly examinations substantially decreased in April and May 2020, we also examined the possibility of a selection bias. This sensitivity analysis was limited to the 1 million 18‐ Compared with the pre‐pandemic weight trend, there was a small increase (0.1 kg) in weight in the first year of the pandemic (March 2020 through March 2021). Weight changes during the pandemic varied by sex, age, and initial BMI, but the largest mean increase across these characteristics was < 1.3 kg. Weight increases were generally greatest among women, adults with BMI of 30 or 35 kg/m2, and younger adults.to 59‐year‐olds examined in April and May 2019. We contrasted the mean 2019 weights between those reexamined in April and May 2020 (26%) and those not reexamined (74%). We then used mixed‐effects models [18, 19], which use all of the intercorrelated, serial data from a person, to examine the difference in the rate of weight change between the pre‐pandemic (before March 2020) and pandemic (after March 2020) periods in the cohort. These sex‐specific models included a random‐intercepts term to account for individual‐level heterogeneity, initial BMI, initial age, time (in years) relative to March 1, 2020, and pandemic period. The difference in the rate of weight change during the pandemic was assessed using an interaction term between the pandemic period (coded as 0 or 1) and time relative to March 1, 2020. These models allowed the weight change between the two periods to vary by sex, age, and BMI. We modeled BMI and age using natural splines [20] to account for nonlinearity. The results of these models are displayed graphically for various combinations of sex, initial age (25, 40, 60, and 75 years), and initial BMI (25, 30, and 35 kg/m2). We also summarize the differences calculated from this model between the pre‐pandemic and pandemic changes in weight over 1 year. We refer to the difference in weight change during the pandemic and the weight change before the pandemic from these models as the excess weight gain during the pandemic. This is the weight gain during the pandemic in excess of that predicted by the pre‐pandemic trend in weight. ---------------- ========== What was the outcome of this study?",Medical,Find & Summarize,Text Transformation Respond with only information from the provided context. ,What should be included in my new businesses organization agreement?," Preface A cooperative is a business. As such, it must operate in a manner compatible with all the laws that apply to a business, with cooperative principles, and with the needs and desires of its member-patrons in mind. To comply with each of these limitations on its operations, a cooperative must have a set of organizational documents that is uniquely crafted to its particular situation. Drafting new, and updating old, legal documents of cooperatives takes both time and expertise. This report is intended to assist persons organizing new cooperatives, managers and directors of existing cooperatives, and their professional advisers to develop and update the important legal documents of cooperatives. It explains issues to be considered and options that are available. It provides sample language to be used as a starting point; the wording is not to be copied without review and thought. To help distinguish sample document language from explanatory text, a straight black line has been drawn along the left-hand margin of the sample document language. Contents ORGANIZATION AGREEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Statement of Purposes ...................................................... 2 Organization Committee ................................................... 3 Patronage Commitment ..................................................... 3 Financial Commitment ...................................................... 4 Calling of Membership Meeting ....................................... 6 Accounting .......................................................................... 7 SELECTING THE PROPER STATE INCORPORATION STATUTE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ARTICLES OF INCORPORATION ..*...................,..*.*.............t. 11 Heading ............................................................................ 1 1 Name ................................................................................. 1 2 Principal Place of Business ............................................. 12 Purposes ............................................................................ 1 2 Powers ............................................................................... 13 Duration ............................................................................ 15 Directors ........................................................................... 15 Capital Structure ............................................................... 16 Amendment ..................................................................... 20 Signatures ......................................................................... 20 BYLAWS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Membership ...................................................................... 21 Meetings of Members ...................................................... 24 Directors and Officers ....................................................... 26 Duties of Directors ........................................................... 32 ii Duties of Officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Operation at Cost and Members’ Capital . . . . . . . . . . . . . . . . . . . . . . . . . 36 Equity Redemption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..I....... 39 Consent . . . . . . . . . ..f................................................................ 4 0 Nonmember Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Nonpatronage Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 Handling of Losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Dissolution . . . . . . . . ..f............................................................ 4 5 Indemnification . . . . . . . . . ..I....................................I.............. 45 Amendment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 MARKETING AGREEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..*................. 4 7 Introduction . . . . . . . . . . . . . . . . . . . . . . . . ..I...........................................4 6 Sales Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..I...........................4 9 Enforcement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Termination and Renewal ..****...*.**.*.........................*...... 55 Miscellaneous Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 MEMBERSHIP APPLICATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 DIRECTOR HANDBOOK . . . . . . ..a.. a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 APPENDIX A. ELECTION OF DIRECTORS BY DISTRICTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 APPENDIX B. ALTERNATIVE EQUITY REDEMPTION BYLAWS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 APPENDIX C. BASE CAPITAL PLAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 . . . 111 Sample Legal Documents for Cooperatives Donald A. Frederick, Attorney-Adviser One of the axioms of business planning is that a strong foundation is essential if an organization is to have a strong structure. An important component of a strong cooperative foundation is a set of basic legal documents that conforms to Federal, State, and local law and facilitates conducting the business affairs of the association to enhance the mutual well-being of the members. This report explains the role each document plays in building the organization and the various issues treated in each document. It discusses options available to members in handling many of the issues. It also presents sample language as an aid in preparing initial documents, or in revising existing ones, to make sure they promote the objectives of the cooperative venture. Most of the sample language in this report is suitable for virtually any type of cooperative. Where the language must be tailored to reflect specific functions of the association, wording appropriate for an agricultural marketing cooperative is used. Counsel can help make the necessary modifications to cover supply and related service organizations and nonagricultural activities. One point cannot be stressed too much! Cooperative organizers, advisers, and leaders should not just sit down and copy these, or any other set, of legal documents and declare them as their own. These foundation documents should only be adopted after review by a competent attorney, one who understands the unique characteristics of cooperatives and the industry in which the association does business. This will maximize the likelihood that the documents will conform to applicable law and meet the specific needs of the association and its members. One problem in drafting organizational papers is they can be thorough or simple, but not both. This report contains many “compromises” between these two objectives. This only reinforces the need for cooperative founders and leaders, and their professional advisers, to avoid adopting any sample set of documents verbatim and to review existing documents on a regular basis. 1 The idea of forming a cooperative is usually conceived and nurtured by a few individuals who foresee coordinated group action as a solution to a problem confronting themselves and similarly situated persons. This organizing group often has to formulate a development plan, arrange for or provide seed money, and contribute sweat equity to get the association up and running. The organization period involves considerable discussion and data collection. While these efforts provide a good forecast for the level of support the cooperative is likely to attract, before launching the venture it is a good idea to have those persons who say they want the services of the cooperative formally commit to use those services. The organization agreement secures both a patronage and a financial commitment from prospective members. It is also a vehicle for educating prospective members about the cooperative form of business and the objectives of the proposed association. Statement of Purposes This first provision in a typical organization agreement sets out the services the proposed organization will perform. The services can be described in broad terms, such as to “process” and “market” certain farm commodities and “furnish” certain farm supplies. The language should refer only to services the cooperative will provide from its inception. This minimizes member pressure to expand the scope of operations too rapidly. For example, it is usually best not to mention furnishing supplies in the organizational agreement if the new organization will limit its initial activity to marketing fresh vegetables. 1. The undersigned, a producer of agricultural products, hereinafter referred to as “Producer,” together with other signers of agreements similar hereto, propose to organize a cooperative association 2 under the laws of the State of for the purpose of . Organization Committee Although the association has not yet been incorporated, a decision making process should be formalized. The organizers will usually appoint some or all of their group to an official organization committee that will serve as the initial policy body for the association. This provision lists the committee members and sets out the committee’s authority. 2. (a) The association shall be organized with suitable articles of incorporation and bylaws as determined by an organizational committee consisting of the following persons: Name Address 2. (b) This committee may, by vote of a majority of its members, increase its membership, fill any vacancy therein, and appoint any subcommittees deemed necessary to conduct its affairs. The committee, or any subcommittee designated by it, may prescribe an organization fee to be paid by each person signing an organization agreement and may incur necessary obligations, make necessary expenditures, and take any such action as may, in its discretion, be deemed advisable to further the organization of the association. 3 Patronage Commitment Most cooperatives, especially those involved in marketing agricultural commodities, need a minimum level of product to be successful and the best possible projections of anticipated volumes to plan effectively. Their organization agreements should spell out the extent of the prospective members’ commitment: usually all production, a defined volume of product,. or production from a set number of acres. If either all production or production from a set number of acres is used, a projection of likely volume delivered should also be secured. Sample language is provided for each type of commitment: Full Production. 3. Producer agrees to sign a marketing agreement committing all (product) produced by Producer, on land owned or leased by Producer, to the cooperative for direct marketing, processing, or other disposition as the cooperative sees fit. Producer estimates such production will total (units) in (year). *********** Defined Volume. 3. Producer agrees to sign a marketing agreement to commit (units) of (product), produced by Producer, to the cooperative for direct marketing, processing, or other disposition as the cooperative sees fit. *********** Set Acreage. 3. Producer agrees to sign a marketing agreement to commit all (product) produced by Producer on acres of land, owned or leased by Producer, to the cooperative for direct marketing, processing, or other disposition as the cooperative sees fit. Producer estimates such production will total -(units) in _ (year). 4 If the cooperative is likely to have a minimum quality standard that must be met before product will be accepted, that standard should also be explained and the person or entity judging quality should be named. Financial Commitment Every new business must have equity capital. In a cooperative, the members supply that capital. In this provision the prospective member agrees to provide initial financial support for the cooperative. Each prospective member should commit to purchase one share of common voting stock (or, in a nonstock cooperative, pay a membership fee) for a fixed dollar amount, perhaps $1,000. This investment gives the member the right to vote on issues submitted to the membership. Often the initial investment tied to membership status does not raise enough equity to fund the association. Additional capital is needed. Usually the organizers have substantial leeway in collecting and recognizing this investment. Each prospective member may be asked to make an equal contribution, or the level can vary with anticipated patronage. While this investment is classified as preferred stock in this report, it can also be structured as equity credits, revolving fund credits, or any similar term satisfactory to the organizers. Organizers should avoid using any term usually associated with debt capital, such as “note” or “bond,” and should also avoid creating a second class of common stock, which is sure to be confused with regular voting common stock. The agreement should expressly state that this financial commitment is irrevocable unless the organization effort is terminated. Initial development of the cooperative is totally dependent on promised financial support being forthcoming. Leaders must have the tools to force compliance with this commitment, by legal action if necessary. I 4. Producer agrees to purchase one share of voting common stock of the association, par value $ payable on demand following a favorable vozihe signees of agreements similar hereto to 5 incorporate the association. Producer further agrees to purchase shares of nonvoting preferred stock of the association, par value $ each, and agrees to pay for same as follows: S- cash on demand following incorporation of the association, g-on or before . 19 -9 and, $--- on or before ,19_. Producer expressly understands that this stock subscription agreement is an irrevocable legally binding obligation which will be relied upon by the association, other producers who subscribe to its stock, and lending institutions from which the association will seek financing to implement its cooperative purposes. If a cooperative is organized as a nonstock corporation, the sample language might be altered to call for payment of a membership fee, rather than purchase of a share of common stock, and payment of an additional sum into an equity account, rather than purchase of nonvoting preferred stock. Calling of Membership Meeting One of the principal responsibilities of the organization committee is to determine if enough firm interest exists to justify forming the cooperative. It is advisable to put a time limit on member solicitation. An open-ended solicitation period may exceed the patience of early signees to get started or abort the effort. If the committee decides there is enough interest, the agreement usually calls for a meeting of the signees to make the final decision to complete formation and begin operation of the cooperative. While the typical agreement provides that the affirmative vote of a simple majority of signees approves formation, the committee should move cautiously if substantial resistance 6 develops. Few associations overcome internal strife during the formation period to become useful and viable cooperative enterprises. 5. If, on or before 9 19-t the organization committee is of the opinion that sufficient signup has been obtained to enable the association to operate efficiently, the committee shall set a time and place for a meeting of those persons who have signed this agreement to determine, by majority vote, whether to proceed with the formation and operation of the association, and to consider such other business as may be deemed appropriate. Not less than ten days before the meeting, notice of the time and place of the meeting shall be sent to all signees by first-class mail, and an appropriate notice shall be published in one or more newspapers of general circulation in the area in which those who signed agreements like this one reside. , Sometimes the agreement will set minimum levels of support that must be committed before the prospective members will vote to begin the venture, If the organizers decide to adopt that option, the first paragraph of this provision might begin: 5. If, on or before 9 19-t bona fide producers of agricultural products otherwise eligible to become members in the association agree to execute marketing agreements covering (units) of (product) and subscribe to provide equity to the association equal to the sum of at least I dollars, ($ ), the organization committee shall set a time and place for a meeting . . . (continue as above). Accounting There should be a clearly stated obligation placed on the organization committee to keep good records and make the 7 appropriate disposition of any funds remaining after the vote on formation of the cooperative is conducted. 6. The organization committee shall keep detailed, accurate accounts of all receipts and of all expenditures of every kind. It shall have such accounts audited and render a written report thereof to the board of directors of the association when organized. And it shall thereupon turn over to the association any balance remaining in its hands free of obligation. If the association is not organized, such unexpended balance shall be prorated among, and returned to, those who contributed to the organization fund. The agreement should conclude with spaces for the prospective member to sign the agreement, and provide his or her address, and for the chairperson of the organizing committee to sign the agreement as an acceptance. SELECTING THE PROPER STATE INCORPORATION STATUTE While no drafting is involved, and thus no sample language is provided in this section, an important step in the development of a successful cooperative is selection of the proper statutory foundation for the association. To operate effectively in today’s business world, a cooperative must be a unique legal entity, separate from its members. The best way to create this unique entity is to form a cooperative corporation. A cooperative becomes a corporation when its organizers follow the steps set out in a law authorizing the formation of corporations. There is no Federal incorporation statute. Cooperatives incorporate under an appropriate State law. Incorporation offers several advantages over alternative structures, such as partnerships and unincorporated associations: l Incorporation facilitates the orderly succession of ownership. The entity has a perpetual life. As some members resign and new people join, redemption and issuance of a share of common stock or a membership certificate is a relatively simple means of clarifying each person’s status and rights in the association. l A corporation conveys to members and outsiders the image of a solid, longlasting venture. l If a cooperative is incorporated, the personal liability of each individual member, for losses suffered by the cooperative, is limited to the member’s equity in the cooperative. The organization of a cooperative as a business corporation has some important implications for how it conducts its affairs: l A corporation derives all of its legal authority from the State. It is a “person” in the eyes of the law, just like a natural person. It can do many things natural persons can, such as sign contracts, borrow money, own property, and sue and be sued. l While its powers are broad, those powers are limited to the ones granted by the State. For example, when the State agricultural cooperative law says only agricultural producers can vote in farmer cooperative affairs, no one else has the right to participate in policy decisions made by the membership. l The cooperative must obey business laws. Since managers and directors make the decisions for the corporation, they have an obligation to know and make sure the association follows all applicable laws. Persons who organize a cooperative have several incorporation statutes to choose from: l All States have special cooperative incorporation statutes. Some are broad, permitting the incorporation of virtually any business as a cooperative. Other are limited in scope. Many States have an Agricultural Cooperative Associations Act specially written to authorize incorporation of associations of producers of agricultural products. 9 l Every State has a general business corporation statute. A cooperative can be incorporated under this law and have its cooperative character established through proper drafting of the articles of incorporation and bylaws. l While most cooperatives are incorporated under a law of the State where the principle office is located, a few are organized under the laws of a different State. .It is usually best to organize under a cooperative incorporation statute of the State where the association’s headquarters is located. But it’s very important that the statute authorizing the cooperative permits a structure that meets the needs and desires of the members. The General Business Corporation Act and outof-State incorporation laws should be considered if the applicable cooperative law doesn’t permit the necessary organizational structure. A few so-called cooperatives are organized under a general not-for-profit corporation statute. Usually this is done to make it easier to obtain grant money. There are some potential adverse legal consequences of this type of incorporation that should be reviewed before following this path: l Most not-for-profit corporation laws expressly forbid the distribution of any earnings to members, trustees, officers, or other private persons. This means an association organized under such a statute can’t pay patronage refunds, one of the main reasons for operating a business as a cooperative. 0 In many States, if a nonprofit corporation goes out of business, members are prohibited from sharing in any assets left after the debts are paid. l Nonprofit corporations sometimes have had more trouble than cooperative corporations enforcing marketing agreements with their members. Cooperative statutes frequently provide specific authority for enforcement of marketing agreements. Not-for-profit acts have no such provision. If the leadership determines a cooperative is not organized 10 under the appropriate State statute, it is usually possible to reincorporate without seriously disrupting the ongoing business of the association. This will ordinarily involve redrafting the organization papers to conform to the new law and paying a modest fee to the appropriate State agency. ARTICLES OF INCORPORATION Once the leadership has determined the statute to use as the legal authority for a cooperative, the first document prepared is the articles of incorporation (articles). It is the acceptance of the articles by the State that establishes the cooperative as a unique “person” under the law. Most incorporation laws require a fairly common set of provisions to be included in the articles. These are discussed below. The statute will also require that before the articles are official they must be recorded in the office of a designated State officer. Failure to properly file the articles makes any business activity vulnerable to legal challenge. It is usually permissible to include information in the articles beyond that required by the incorporation statute. However, this is ordinarily not done because it is frequently more difficult to amend the articles than it is with other documents that may contain the same information. The articles are not a piece of paper to be prepared and then forgotten. The articles are routinely given the same respect by the courts as a statute. Therefore, the articles are binding on the directors, officers, and manager of a cooperative. Conduct beyond that authorized in the articles can subject the cooperative and its leaders to potential legal liability. The following are the elements common to most cooperative articles of incorporation. Heading The heading sets out the title of the document, the name of the cooperative, and the title of the authorization statute. 1 1 ARTICLES OF INCORPORATION (Name of Cooperative) We, the undersigned, all of whom are engaged in the production of agricultural products, do hereby voluntarily associate ourselves together for the purpose of forming a cooperative association, with (or without) capital stock, under the provisions of the Act of the State of Name The official name of the cooperative must be stated in the body of the articles and is usually the first provision: ARTICLE I. NAME The name of the association shall be Principal Place of Business This is a simple statement of the general location of the cooperative’s office: ARTICLE II. PRINCIPAL PLACE OF BUSINESS The association shall have its principal place of business in the city of County of , Stateof ’ . Purposes The purposes for which the cooperative is being organized are specifically set out. While the purposes clause of the organizational agreement is limited to immediate objectives, the pur12 poses are usually stated as broadly as possible in the articles of incorporation. Any service the cooperative may someday provide is frequently authorized, at least in a general way. This reduces the likelihood the articles will have to be amended whenever the association is asked by the members to provide additional services. Powers ARTICLE III. PURPOSES The association is formed for the following purposes: To market for its members and other producers any and all agricultural products or any products derived therefrom: to engage in any activity in connection with the picking, gathering, harvesting, receiving, assembling, handling, grading, cleaning, shelling, standardizing, packing, preserving, drying, processing, transporting, storing, financing, advertising, selling, marketing, or distribution of any such agricultural products or any products derived therefrom: to purchase for its members and others farm supplies and equipment: to manufacture, process, sell, store, handle, ship, distribute, furnish, supply, and procure any and all such farm supplies and equipment; and to exercise all such powers in any capacity and on any cooperative basis that may be agreed upon. The State statute authorizing formation of a cooperative will set out in detail the activities the cooperative may engage in. As a general rule, the statutory language is copied virtually verbatim into the articles. The following is an example of a typical statutory provision restated as an article of incorporation: ARTICLE IV. POWERS I This association shall have the following powers: 13 (a) To borrow money without limitation as to amount of corporate indebtedness or liability: to give a lien on any of its property as security therefore in any manner permitted by law: and to make advance payments and advances to members and other producers. (b) To act as the agent or representative of any member or members in any of the activities mentioned in Article III hereof. (cl To buy, lease, hold, and exercise all privileges of ownership over such real or personal property as may be necessary or convenient for the conduct and operation of the business of the association, or incidental thereto. (d) To draw, make, accept, endorse, guarantee, execute, and issue promissory notes, bills of exchange, drafts, warrants, certificates, and all kinds of obligations and negotiable or transferable instruments for any purpose that is deemed to further the objects for which this association is formed, and to give a lien on any of its property as security therefor. (e) To acquire, own, and develop any interest in patents, trademarks, and copyrights connected with, or incidental to, the business of the association. (fl To cooperate with other similar associations in creating central, regional, or national cooperative agencies, for any of the purposes for which this association is formed, and to become a member or stockholder of such agencies as now are or hereinafter may be in existence. (g) To have and exercise, in addition to the foregoing, all powers, privileges, and rights conferred on ordinary corporations and cooperative 14 marketing associations by the laws of this State and all powers and rights incidental or conducive to carrying out the purpose for which this association is formed, except such as are inconsistent with the express provisions of the act under which this association is incorporated, and to do any such thing anywhere; and the enumeration of the foregoing powers shall not be held to limit or restrict in any manner the general powers which may by law be possessed by this association, all of which are hereby expressly claimed. Duration The articles will say how long the cooperative is authorized to exist. Virtually all modern laws permit perpetual existence. Some laws in effect at the time longstanding cooperatives were organized limited the permissible life of a cooperative to a set period of time, such as 50 years. Associations that have been active for several decades should check to make sure their duration clause provides for perpetual operation. I ARTICLE V. PERIOD OF DURATION This association shall have perpetual existence. Directors Most statutes require the articles to name the initial policymakers of the cooperative. A majority of the incorporation statutes ask for the number of directors and names and addresses of the initial board. The articles often require “at least” the minimum number of directors required by statute: the precise number is set in the bylaws. Some statutes ask for the names and addresses of incorporators, in which case the appropriate title and references to incorporators would be substituted for “directors” in the example. If the law asks for both. then this draft provision is essentially inserted a second time and appro15 priately worded in each instance. ARTICLE VI. DIRECTORS This association shall have at least_ directors. The names and addresses of those who are to serve as the initial directors are: NAME ADDRESS Capital Structure The articles usually contain a description of the capital structure of the cooperative. If stock is issued, the number of shares authorized and the par value of each share of each class of stock (common, preferred) are set forth. The rights granted owners of each class of stock, the restrictions on owners of each class, and the dividends to which each class is entitled are also explained. If stock is not issued, a description must be included of how the rights and interests of the members will be determined. Sample language for both a stock and a nonstock association is provided below. The capital stock example provides for both voting common and nonvoting preferred stock. Nonvoting preferred stock is a useful way to account for additional nonpatronage investments by members. It has also been used as a way of raising equity from nonmembers, such as other members of the community interested in supporting the cooperative. If any interest in the cooperative is being sold to nonmembers, counsel must be retained to advise the association on applicable securities law requirements. The sample language also assumes that the organization 16 limits each member to one vote. If proportional voting based on patronage is utilized, counsel will have to prepare a description of how votes will be accumulated and any limit on the number of votes any one member can amass. All of the information in the example below is important and should be included somewhere in the organizational documents. However, not all incorporation laws require that all of it be in the articles. It may be possible to place some of these provisions in the bylaws. ARTICLE VII. CAPITAL STOCK (stock cooperative) Section 1. Classes and Authorized Amounts. The capital stock of the association shall consist of shares of common stock with a par value of $ per share, and shares of preferred stock with a par value of $ per share. Section 2. Common Stock. The common stock of this association may be purchased, owned, or held only by agricultural producers who (1) patronize the association in accordance with uniform terms and conditions prescribed by it, and (2) have been approved by the board of directors. ‘Producer’ shall mean and include persons (natural or corporate) engaged in the production of (product), or other agricultural products, including tenants of land used for the production of any such product, and lessors of such land who receive as rent therefore part of any such product of such land, and cooperative associations (corporate or otherwise) of such producers. Each member shall hold only one share of common stock and each eligible holder of common stock shall be entitled to only one vote in any meeting of the stockholders upon each matter submitted to vote at a meeting of the stockholders. In the event the board of directors of the association shall find, following a hearing, that any of 17 the common stock of this association has come into the hands of any person who is not eligible for membership, or that the holder thereof has ceased to be an eligible member, such holder shall have no rights or privileges on account of such stock, or vote or voice in the management or affairs of the association other than the right to participate in accordance with law in case of dissolution, The association shall repurchase such stock for par value. If such holder fails to deliver any certificate evidencing the stock, the association may cancel such certificate on its books and records, and the certificate is thereby null and void. The common stock of this association may be transferred only with the consent of the board of directors of the association and on the books of the association, and then only to persons eligible to hold it. No purported assignment or transfer of common stock shall pass to any person not eligible to hold it, nor the rights or privileges on account of such stock, nor a vote or voice in the management of the affairs of the association. This association shall have a lien .on all of its issued common stock for all indebtedness of the holders thereof to the association. No dividends shall be paid on the common stock. Section 3. Preferred Stock. The preferred stock of this association may be issued to any person, association, partnership, or corporation. Preferred stock shall carry no voting rights. Noncumulative dividends not to exceed percent (_%) per year may be paid on preferred stock at the absolute discretion of the board of directors. Preferred stock may be transferred only on the books of the association. It may be redeemed in whole or in part on a pro rata basis at par, plus any dividends declared and unpaid, at any time on thirty 18 (30) days’ notice by the association, provided said stock is redeemed in the same order as originally issued by years. If the owner fails to deliver any certificate evidencing such stock, the association may cancel the stock on its books. This association shall have a lien on all of its issued preferred stock for all indebtedness of the holders thereof to the association. Upon dissolution or distribution of the assets of the association, the holders of all preferred stock shall be entitled to receive the par value of their stock, plus any dividend declared and unpaid, before any distribution is made on the common stock. *ii********* ARTICLE VII. MENBERSHIP (nonstock cooperative) The association shall not have capital stock but shall admit applicants to membership in the association upon such uniform conditions as may be prescribed in its bylaws. This association shall be operated on a cooperative basis for the mutual benefit of its members as producers. Membership in the association shall be restricted to producers and associations of producers who shall patronize the association, The voting rights of the members of the association shall be equal, and no member shall have more than one vote upon each matter submitted to a vote at a meeting of the members. The property rights and interests of each member in the association shall be unequal and shall be determined and fixed on a patronage basis, and the net proceeds from the business of the association shall be allocated to member-patrons in the proportion that the patronage of each member bears to the total patronage of all the members of the association. 19 Amendment The articles may be changed whenever the appropriate percentage of the membership (and, if required by statute, the directors), as set out in the incorporation statute, votes to amend them. While the percentage is established by law, it is a good idea to include that requirement in the articles to remind people that the articles can be changed and to eliminate doubt as to the supp,ort required when the issue of possible amendment arises. While a majority of the statutes set the requirement at a simple or two-thirds majority of the members voting, several statutes require approval of a majority of the total membership. If turnout for member meetings is light, this poses a serious obstacle to changing the articles. ARTICLE VIII. Amendment These articles may be amended upon the affirmative vote of two-thirds of the members actually voting on the proposed amendment. Signatures Those persons who ask the State to authorize the cooperative, often called incorporators, complete the document by signing it. Signed this day of ,19__, by the undersigned incorporators, all of whom are engaged in agriculture as bona fide producers of agricultural products. I 20 BYLAWS Shortly after the cooperative is incorporated, the members adopt a set of bylaws. Bylaws provide a detailed description of the structure and method of operation of the cooperative. Bylaws are a working plan for how the association should function. Most incorporation laws give members flexibility to structure their cooperative as they see fit. Most references to bylaws are permissive, giving members the authority to write their own rules on how to handle a particular issue. Bylaws normally are not filed with the State. But like the articles, they are treated in a manner similar to statutes by the courts. Failure of the leadership to follow the bylaws can also lead to legal liability. Numerous provisions are usually found in cooperative bylaws. Some are similar to those included in bylaws of forprofit corporations, others are unique to cooperation. The most common provisions are discussed in this report. But a cooperative is free to place virtually any rule on the conduct of its affairs in the bylaws, provided the provision doesn’t conflict with an applicable law or the articles of incorporation. While almost any activity can be covered by a bylaw, only broad issues of long-term significance to members should be the subject of a bylaw. Operating decisions should not be covered in the bylaws, but rather in board policy resolutions. Board policies are directives to the management, issued by the board in its role as policymaker for the cooperative, that can be changed to reflect changing conditions at any time by the board. For example, whether the cooperative will do business with nonmembers is a general, long-term decision that should be covered in the bylaws. How nonmembers will be charged to insure that they pay their fair share of cooperative expenses is a short-term decision requiring the flexibility possible under a policy statement. Membership The first bylaw usually states the qualifications to be a member of the cooperative. Membership should be limited to 21 persons who will patronize the cooperative. For an agricultural cooperative, this means membership should be limited to producers of agricultural products and other farmer cooperative associations. Limiting the membership to producers and producer cooperatives is essential if the association wants to qualify for the limited antitrust protection of the Capper-Volstead Act, or for tax treatment under section 521 of the Internal Revenue Code, or if the cooperative is incorporated under a State law that requires that members be agricultural producers. This bylaw may also include other reasonable prerequisites to membership, such as agreeing to purchase a share of stock, sign a marketing agreement, and patronize the association on a regular basis. This bylaw should also provide for the orderly termination of a membership. This can be particularly important for an agricultural cooperative. The significant legal privileges listed above are only available to associations of producers. This requirement is only met if the membership of anyone who stops farming is revoked. When a membership is terminated, it is a good practice to return the purchase price of the voting share of common stock, or the membership fee in a nonstock cooperative (but not necessarily the retained patronage investments). This makes it clear to the former member that the termination was more than a symbolic gesture and that he or she no longer has the right to participate in the policymaking of the association. This sample language is written for a stock cooperative. In a nonstock cooperative, appropriate references to membership certificates and fees would be substituted for the terms common stock and purchase price. I ARTICLE I. MEMBERSHIP Section 1. Qualifications. Any person, firm, partnership, corporation or association, including both landlord and tenant in share tenancies, who is a bona fide producer of agricultural products in the territory in which the association is engaged in business, and who agrees to be a patron of the associa22 tion, signs a marketing agreement with the association, purchases one share of common stock, and meets such other conditions as may be prescribed by the board of directors, may become a member of the association. All applications for membership must be approved by the board of directors. Member status is effective as of the time the board approves the application for membership. Section 2. Suspension or Termination. In the event the board of directors of the association shall find, following a hearing, that any of the common stock of this association has come into the hands of any person who is not eligible for membership, or that the holder thereof has ceased to be an eligible member, or that such holder has not marketed through the association the products covered by a marketing agreement with the association, or not otherwise patronized the association for a period of (_) year(s), or otherwise violated the articles of incorporation, bylaws, or other agreements made with the association, the association may suspend such holder’s rights as a member and terminate the membership. When a membership is terminated, the association shall repurchase the member’s share of common stock for par value. The holder shall return to the association the certificate evidencing the holder’s share of stock. If such holder fails to deliver the certificate, the association may cancel such certificate on its books and records, and the certificate is then null and void. A suspended or terminated member shall have no rights or privileges on account of any stock held, nor vote or voice in the management or affairs of the association other than the right to participate in accordance with law in case of dissolution. 23 Meetings of Members A cooperative is owned and controlled by its members. A bylaw sets out the ground rules for convening the members to exercise their control function. An annual meeting is held each year to elect directors, review past performance and future plans, and conduct other business as needed. It is often a good idea to set the time of the annual meeting as promptly as possible after the end of the fiscal year. This encourages management to close the books for the year in a timely fashion and the auditor to review financial results and issue the audit report without delay. Also, the members are still focusing on last year’s performance. If the annual meeting is delayed too long, the members are often into another production cycle and not able to properly exercise their control over the cooperative. This bylaw should also authorize special member meetings to handle any business that can’t wait until the next annual meeting. Members should receive sufficient advance notice so they can plan to attend meetings. Many incorporation statutes have specific minimum notice requirements, both in terms of lead time (often 10 days or 2 weeks) and method (direct mail, publication in local newspaper). Associations incorporated under such a law must make sure the bylaw provides at least as much notice as the statute requires, and that appropriate notice is actually given. Otherwise any action taken at the meeting may be open to legal challenge. A statement on how voting will be conducted is also appropriate in this bylaw. How many votes each member will have is only one aspect of this issue. The draft language limits each member to one vote. If proportional voting is used, a description of how members will qualify for multiple votes, and a limit, if any, on the number of votes any one member can accumulate, should be substituted in the applicable place. Language on voting on behalf of members organized as partnerships and corporations can avoid an embarrassing dispute right before or even during a membership meeting over how such a member will vote on an issue. Many cooperatives 24 have members organized as partnerships or corporations designate, in writing, who will cast the member’s vote, and that person alone can vote for the member until the member provides a valid written notice of a change in the designee. Other topics that should be addressed include proxy voting, voting by mail, and cumulative voting. There is no “right” way to handle these matters, although cumulative voting is usually prohibited. Sometimes the incorporation statute discusses proxy voting and voting by mail. Many cooperatives that permit proxy voting limit the number of proxies a member can vote, often to only one. If voting by mail is allowed, it is often limited to issues discussed in the meeting notice. Finally, the minimum number of members that need be present to conduct business, called a quorum, should be specified. If the statute permits, quorum requirements are frequently set low (e.g., 10 members or 10 percent of the membership, whichever is greater) so meetings will not have to be adjourned for lack of a quorum. While this exposes the association to control by an active minority, it is sometimes necessary in order to make sure that any business is conducted at all. ARTICLE II. MEETINGS OF MEMBERS Section 1. Annual Meeting. The annual meeting of the members of this association shall be held in the State of , during the month of -9at such time and in such place as the board of directors shall designate. Section 2. Special Meetings. Special meetings of the members of the association may be called at any time by order of the board of directors and shall be called upon written request of at least members, or at least _ percent (__%) of the membership, whichever is a greater number. Section 3. Notice of Meetings. Written notice of every regular and special meeting of members shall be prepared and mailed to the last known post office 25 address of each member not less than -0 days before such meeting. Such notice shall state the nature of the business expected to be conducted and the time and place of the meeting. No business shall be transacted at any special meeting other than that referred to in the notice. Section 4. Voting. Unless otherwise stated in the articles of incorporation, or these bylaws, or required by applicable law, all questions shall be decided by a vote of a majority of the members voting thereon. Each member shall be entitled to only one vote, Voting by mail shall not be permitted. Proxy voting shall be allowed. Each proxy shall be in writing, and no member shall vote more than one proxy. Cumulative voting is not permitted. If a membership is held by a partnership, corporation, or other legal entity, the member shall designate in writing the person who shall vote on behalf of the member. That designation shall remain in effect until written notice of a properly authorized change in the designated voter shall be received by the association. Section 5. Quorum.( members or percent I%) of the membership, whichever is a larger number, shall constitute a quorum at any properly called annual or special membership meeting. Directors and Officers While the members own and control the cooperative, the responsibility for continuous supervision of the association is usually delegated to a small group of democratically elected leaders referred to as the board of directors, who in turn select officers to carry out specific leadership duties. Many cooperative experts consider the selection of directors as the most important governance decision made by the membership. 26 This bylaw covers the administrative rules for the selection of directors and officers and for the conduct of their meetings. Many important issues are discussed in this provision. Number and Qualification of Directors. The specific number and qualifications of directors must be established. The incorporation law will usually prescribe a minimum number of directors. There is no legal maximum on the size of a board, but experience suggests that if more than about nine people are on a local cooperative board, efficiency is reduced substantially. Many State statutes require that all directors be members of the cooperative. Some permit, or even require, one or more outside directors. The sample bylaw requires directors to be association members. If outside directors are to be authorized, the number and manner of selection should be included in the bylaw. Directors have access to pricing and other marketing plans that could be used by a competitor to take business from the cooperative. Thus, many cooperatives bar persons affiliated with competitors of the association from being directors. Cooperatives usually do not, however, bar such persons from membership. For example, a farmer who sells produce directly to a grocery chain may belong to and market some produce through a cooperative that also sells wholesale, but that farmer is frequently denied access to a seat on the cooperative board. A few cooperatives guarantee board turnover by limiting the number of consecutive terms a director can serve. Director and Officer Selection. The rules for election of directors by the members, and officers by the directors, are set out in the bylaws. In many cooperatives the directors are elected for three-year terms on a staggered basis. While directors are usually elected from the membership at large, some cooperatives elect directors on the basis of geographic regions, usually called districts. Sample language authorizing the election of directors by districts is set out in Appendix A. Officers are usually elected for one-year terms. Even many statutes that require all directors to be association members permit some officers, notably the secretary and treasurer, to be nonmembers of the association. This allows staff employees who normally keep association records and books to have both the appropriate title and attendant responsibilities. 27 Sometimes directors and officers are not able to serve their full term. The bylaws should provide for a method to fill vacant director and officer positions, Usually the remaining directors select an interim director to fill a board vacancy until the next membership meeting. Directors can usually select a replacement officer at any properly called board meeting. Meetings. The bylaws frequently provide much of the same information for director meetings as for member meetings - regular and special meetings are authorized, notice and quorum requirements are set out. Compensation . Another issue that should be addressed is director compensation. Many directors spend innumerable hours each year overseeing and promoting the cooperative. It seems reasonable for the association to at least cover out-ofpocket expenses incurred on behalf of the association. Some cooperatives also pay a modest fee for each meeting directors attend, or time they spend on cooperative affairs. While reimbursement of reasonable expenses is usually covered with a blanket authorization, fees should be handled more delicately. Directors should not have the right to set their own compensation. Both the decision to pay any fee, and the level of any fee authorized, should be made by the members. Nepotism. Many cooperatives also have a bylaw provision preventing directors and members of their immediate families from holding salaried positions with the cooperative. This antinepotism language eliminates the chance some members might view the awarding of the position as the result of undue influence of the director, rather than selection on the basis of merit. Removal of Directors. Finally, it may be necessary at some time to remove a director from that position. Sometimes termination is automatic, e.g., failure to maintain member status or missing too many board meetings. The ultimate authority in a cooperative is vested in the members, and they should be able to remove a director at will. As this is often a severe and divisive undertaking, it is best to provide a procedure in the bylaws that affords due process for the director under attack and conforms closely to any procedural requirements set out in the incorporation statute. 28 ARTICLE III. DIRECTORS AND OFFICERS Section 1. Number and Qualification of Directors. The association shall have a board of directors of _(_) members. Each director elected shall be a member of this association in good standing. No person shall be eligible to be a director if that person is in competition with, or is affiliated with any enterprise that is in competition with, the association. If a majority of the board of directors of the association finds at any time following a hearing that any director is so engaged or affiliated that person shall thereupon cease to be a director. No director after having served for I ) consecutive full term(s) shall be eligible to succeed himself or herself, but after a lapse of _ I_) yed4 d-d again be eligible. Section 2. Election of Directors. At the first annual meeting of the members of this association, directors shall be elected to succeed the incorporating directors. _ director(s) shall be elected for one (1) year: _ directors for two (2) years and _directors for three (3) years. At each annual meeting thereafter, new directors shall be elected, for a term of three (3) years each, to succeed those directors whose terms are expiring. All directors shall be elected by secret ballot, and the nominee(s) receiving the greatest number of votes shall be elected. Section 3. Election of Officers. The board of directors shall meet within seven (7) days after the first election and within seven (7) days after each annual election and shall elect by ballot a president, vice president, secretary, and treasurer, each of whom shall hold office until the election and qualifi29 cation of a successor, unless earlier removed., by death, resignation, or for cause. The president and vice president shall be members of the board of directors. The secretary and treasurer need not be directors or members of the association. Section 4. Vacancies. Whenever a vacancy occurs in the board of directors, other than from the expiration of a term of office, the remaining directors shall appoint a member to fill the vacancy until the next regular meeting of the members. If the term of the vacating director does not expire at that regular member meeting, a special election shall be held to select a director to fill the year or years remaining in that term. If one or more officer positions become vacant, such offices shall be filled by the board of directors, through election by ballot, at either a regular or special meeting of the board. Section 5. Regular Board Meetings. In addition to the meetings mentioned above, regular meetings of the board of directors shall be held monthly, or at such other times and at such places as the board may determine. Section 6. Special Board Meetings. A special meeting of the board of directors shall be held whenever called by the president or by a majority of the directors. Only the business specified in the written notice shall be transacted at a special meeting. Each call for a special meeting shall be in writing, shall be I signed by the person or persons calling the meeting, shall be addressed and delivered to the secretary, and shall state the time and place of such meeting. Section 7. Notice of Board Meetings. Oral or written notice of each meeting of the board of directors shall be given each director by, or under the 30 supervision of, the secretary of the association not less than _ hours prior to the time of meeting. But such notice may be waived by all the directors, and their appearance at a meeting shall constitute a waiver of notice. Section 8. Quorum. A majority of the board of directors shall constitute a quorum at any meeting of the board. Section 9 . Reimbursement and Compensation. The association shall reimburse directors for all reasonable expenses incurred in carrying out their duties and responsibilities. The compensation, if any, of the members of the board of directors shall be determined by the members of the association at any annual or special meeting of the association. No member of the board of directors, or member of the immediate family of any board member, shall occupy any position in the association on regular salary. Section 10. Removal of Directors. Whenever any director shall fail to meet the qualifications as described in Section I of this Article, or fails to attend three (3) consecutive board meetings, either regular or special, without just cause and provided that notice of such meetings has been given in accordance with these bylaws, then it shall be the duty of the board to remove said director and to fill the vacancy in accordance with Section 4 of this Article. Members, through petition noting the charges and signed by at least _(J members or _ percent (_%) of the membership, whichever is a greater number, may request the removal of any member of the board. Such director shall be notified in writing of the charges and given an opportunity to be heard at a membership meeting of the association. Removal of a director shall require a vote of of 31 I members voting. Any vacancy resulting from such action shall be filled by nomination and vote of members at such meeting. Duties of Directors The directors are responsible for the ongoing operations of the cooperative. They set policy and oversee the staff operations that implement that policy. Cooperative bylaws often contain language placing a legally binding obligation on the directors to carry out their most important duties. This bylaw often establishes the general relationship between the directors and the manager. An important responsibility of the board is to hire and supervise the manager. The board sets manager compensation and benefits. The manager, not the board, runs the day-to-day business operations of the cooperative. This includes hiring and firing other employees. If the board is dissatisfied with the way the cooperative is conducting its affairs, it should exercise its authority to replace the manager, but it should not take on the manager’s responsibilities. The bylaw should also recognize another important board responsibility-protecting member assets-by providing for appropriate bonds and insurance, an accounting and auditing system, and board control of association funds. Finally, the board should have the authority to appoint committees so its work load can be handled efficiently. Sometimes specific reference is made to an executive committee. An executive committee with broad powers can be useful, especially when the membership is spread over a large geographic area and some directors have to travel some distance to attend meetings. But the other directors must be careful not to abdicate all board responsibility to the executive committee. ARTI&E IV. DUTIES OF DIRECTORS Section 1. Management of Business. The board of directors shall have general supervision and control of the business and the affairs of the associa32 tion and shall make all rules and regulations not inconsistent with law, the articles of incorporation, or bylaws for the management of the business and the guidance of the members, officers, employees, I and agents of the association. Section 2. Employment of Manager. The board of directors shall have power to employ, define duties, fix compensation, and dismiss a manager with or without cause at any time. The board shall authorize the employment of such other employees, agents, and counsel as it from time to time deems necessary or advisable in the interest of the association. The manager shall have charge of the business of the association under the direction of the board of directors. Section 3. Bonds and Insurance. The board of directors shall require the manager and all other officers, agents, and employees charged by the association with responsibility for the custody of any of its funds or negotiable instruments to give adequate bonds. Such bonds, unless cash security is given, shall be furnished by a responsible bonding company and approved by the board of directors, and the cost thereof shall be paid by the association. The board of directors shall provide for the adequate insurance of the property of the association, or property which may be in the possession of the association, or stored by it, and not otherwise adequately insured, and, in addition, adequate insurance covering liability for accidents to all employees and the public. Section 4. Accounting System and Audits. The board of directors shall have installed an accounting system which shall be adequate to meet the requirements of the business and shall require proper records to be kept of all business transactions. 33 Duti 34 At least once in each year the board of directors shall secure the services of a competent and disinterested public auditor or accountant, who shall make a careful audit of the books and accounts of the association and render a report in writing thereon, which report shall be submitted to the directors and the manager of the association and made available to the members of the association. This report shall include at least a balance sheet showing the true assets and liabilities of the association, and an operating statement for the fiscal period under review. Section 5. Depository. The board of directors shall select one or more banks to act as depositories of the funds of the association and determine the manner of receiving, depositing, and disbursing the funds of the association and the form of checks and the person or persons by whom they shall be signed, with the power to change such banks and the person or persons signing such checks and the form thereof at will. Section 6. Committees. The board may, at its discretion, appoint from its own membership an executive committee of _members, and determine their tenure of office and their powers and duties. The board may delegate to the executive committee all or any stated portion of the functions and powers of the board, subject to the general direction, approval, and control of the board. Copies of the minutes of any meeting of the executive committee shall be mailed to all directors within seven (7) days following such meeting. The board of directors may, at its discretion, appoint such other committees as it deems appropriate. 5 of Officers Nhile the tasks that go with each major office of a corpora- tion are generally well understood, it is still important to have those duties spelled out in the bylaws. This will minimize any uncertainty over the roles each plays in leading the association. ARTICLE V. DUTIES OF OFFICERS Section 1. Duties of President. The president shall (1) preside over all meetings of the association and of the board of directors: (2) call special meetings of the board of directors; (3) appoint such committees as the board of directors may deem advisable for the proper conduct of the cooperative: and (4) perform all acts and duties usually performed by a presiding officer. Section 2. Duties of Vice President. In the absence or disability of the president, the vice president shall perform the duties of the president, provided, however, that in case of death, resignation, or disability of the president, the board of directors may declare the office vacant and elect any eligible person president. Section 3. Duties of Secretary. The secretary shall keep a complete record of all meetings of the association and of the board of directors and shall have general charge and supervision of the books and records of the association. The secretary shall sign papers pertaining to the association as authorized or directed by the board of directors. The secretary shall serve all notices required by law and by these bylaws and shall make a full report of all matters and business pertaining to the office to the members at the annual meeting. The secretary shall keep the corporate seal and all books of blank certificates, complete and countersign all certificates issued, and affix the corporate seal to all papers requiring a seal: shall keep complete stock ownership records: shall make all reports required by law: and shall perform 35 such other duties as may be required by the association or the board of directors. Upon the election of a successor, the secretary shall turn over all books and other property belonging to the association. Section 4. Duties of Treasurer. The treasurer shah be responsible for the keeping and disbursing of all monies of the association, and shall keep accurate books of accounts of all transactions of the association. The treasurer shall perform such duties with respect to the finances of the association as may be prescribed by the board of directors. At the expiration of his term of office, the treasurer shall promptly turn over to his successor all monies, property, books, records, and documents pertaining to his office or belonging to the association. Operation at Cost and Members’ Capital Many of the unique aspects of the bylaws of a cooperative pertain to the association’s financial affairs. Tax law plays an important part in structuring these provisions. This report does not attempt to explain cooperative taxation but only makes passing references to tax terms when explaining the importance of certain bylaw provisions. Since the overall objective of a cooperative is to maximize the income of its members, leaders must have flexibility to acquire capital and minimize taxes. The next several provisions, up to and including dissolution, authorize business and tax planning options compatible with doing business on a cooperative basis. This section often starts with a straightforward statement that the association will operate on a service-at-cost basis for the mutual benefit of the members as patrons and then covers specific issues to implement that statement. Language is usually included to allocate margins on a patronage basis. Allocation can be based on the volume or the value of business conducted on a patronage basis. Cooperatives dealing in one commodity, or in similar commodities, usually use the volume method. Those that handle several products 3s with divergent values often use the dollar-value-of-business method. The sample language assumes that the association is a marketing cooperative using the volume method. Appropriate wording for supply cooperatives and those using the value method is provided in parentheses. Marketing cooperatives have an alternative method of raising equity capital, the collection of per-unit retains. Language authorizing this option should be included in their bylaws. The term “capital credits” is used in the sample language to distinguish the retained margins and per-unit retains from direct member investments in stock. This distinction simplifies establishing an equity redemption program for patronage-based investments apart from any redemption of direct investments. The bylaw should specify whether dividends will be paid on this patronage capital. Since the completeness and accuracy of each patron’s account is vital to assigning financial obligations and benefits in the appropriate manner, a provision obligating the association to keep the required records is an important protection for the members. A statement requiring the timely distribution of written notices of allocation and per-unit retain certificate is both good business practice and a requirement for favorable tax treatment under the Internal Revenue Code. That statement should authorize the board to issue those notices and certificates, in either qualified or nonqualified form, so as to maximize the tax planning alternatives available. ARTICLE VI. OPERATION AT COST AND MEMBERS’ CAPITAL Section 1. Operation at Cost. The association shall at all times be operated on a cooperative service-at-cost basis for the mutual benefit of its member patrons. Section 2. Margin Allocation. In order to induce patronage and to assure that this association 37 will operate on a service-at-cost basis in all its transactions with its members, the association is obligated to account on a patronage basis to all member patrons on an annual basis for all amounts received from business conducted with members on a patronage basis, over and above the cost of providing such services and making reasonable additions to reserves. Such allocation shall be on the basis on the volume (dollar value) of product marketed through (purchased from) the association. The association is hereby obligated to pay all such amounts to the patrons in cash or by credits to a capital account of each member patron. Section 3. Per-Unit Retains. Each member also agrees to provide capital in such amounts as determined by the board of directors based on physical units of product marketed through the association. Such per-unit retains shall be allocated to the member’s capital credit account, Section 4. Dividends. No dividends shall be paid on any capital credits. Section 5. Records and Documentation. The books and records of the association shall be set up and kept in such a manner that at the end of each fiscal year, the amount of capital, if any, so furnished by each member is clearly reflected and credited in an appropriate record to the capital account of each member. The association shall, within 8-l/2 months after the close of each fiscal year, notify each member of the capital so credited to the member’s account. The notice shall be in the form of a written notice of allocation or per-unit retain certificate (as those terms are used in Subchapter T of the Internal Revenue Code) or other appropriate written document. The board shall have discretion to issue such 38 notices and certificates in either “qualified” or “nonqualified” form as permitted by the Internal Revenue Code and other applicable law. Section 6. Fiscal Year. The fiscal year of this association shall commence on the first day of (month) and end on the last day of (preceding month). Equity redemption A bylaw authorizing redemption of patronage capital and explaining the method to be used helps insure that, to the extent possible, current patrons finance the cooperative. There are three types of equity redemption plans. Most cooperatives that have an equity redemption program use a revolving fund plan whereby equities are redeemed in the order in which they were allocated. The first paragraph of the sample bylaw presents this approach. A limited number of cooperatives redeem a percentage of all outstanding equities each year. Sample language to implement this plan is found in section 1 of the Alternative Equity Redemption Bylaw (Appendix B). A few cooperatives have adopted a base capital plan. Under a base capital plan each member is assigned responsibility for providing a pro rata share of needed capital based on proportional use of the cooperative during a base period. A sample bylaw authorizing a Base Capital Plan is presented in Appendix C. Associations interested in such a plan should contact a professional adviser who can draft a scheme tailored to the association’s unique needs. Some cooperatives grant the board discretion to retire outstanding member equity “out of order” as it deems in the best interests of the association. Sample language for implementation of the discretionary approach appears in the second paragraph of the sample bylaw below. Other cooperatives provide a specific redemption preference for equity of the estates of deceased members and/or retired members who have reached a certain age. An event-specific preferences clause can be complex, particularly if it attempts to 39 deal with the special problems created by members organized as legal entities and thus do not regularly retire or die. Sample language covering this situation is provided in section 2 of the sample bylaw in Appendix B. New associations are not going to be in a position to redeem equity for several years. But an early commitment to develop a regular equity redemption program and agreement on the rules for its implementation will strengthen an association’s cooperative character and give early supporters some assurance that they will get their investment back at some time in the future. Consent ARTICLE VII. EQUITY REDEMPTION Section I. Regular Redemption, Revolving Fund. If at any time the board of directors determines that the financial condition of the association will not be impaired thereby, capital credited to members’ accounts may be redeemed in full or in part. Any such redemption of capital shall be made in order of priority according to the year in which the capital was furnished and credited, the capital first received by the association being the first redeemed. Section 2. Discretionary Special Redemptions. Notwithstanding any other provision of these bylaws, the board, at its absolute discretion, shall have the power to retire any capital credited to members’ accounts on such terms and conditions as may be agreed upon by the parties in any instance in which the interests of the association and its members are deemed to be furthered thereby and funds are determined by the board to be available for such purposes. If the cooperative is to deduct the face value of written notices of allocation and per-unit retain certificates from taxable income in the year issued, the Internal Revenue Code requires patrons to consent to include those amounts in taxable income 40 in the year they receive a notice or certificate, even though the cooperative retains the funds. The simplest way to obtain consent from members is to include a bylaw making consent a condition for membership. The Internal Revenue Service has published a model consent bylaw which should be adopted. Another paragraph is inserted making it clear that the cooperative must explain the meaning of consent to members and prospective members: this reminds leaders that such an explanation is also a tax law requirement. ARTICLE VIII. CONSENT Each person who hereafter applies for and is accepted to membership in this association, and each member of this association on the effective date of this bylaw who continues as a member after such date, shall, by such act alone, consent that the amount of any distributions with respect to his patronage occurring after the effective date of this bylaw, which are made in qualified written notices of allocation or qualified per-unit retain certificates (as defined in 26 U.S.C. 1388), and which are received by him from the cooperative, will be taken into account by him at their stated dollar amounts in the manner provided in 26 U.S.C. 1385(a) in the taxable year in which such written notices of allocation and per-unit retain certificates are received by him. Written notification of the adoption of this Article, a statement of its significance, and a copy of the provision shall be given separately to each member and prospective member before membership in the association. Nonmember Business The bylaws should make it clear whether the association may or may not do business with nonmembers. The sample bylaw assumes that the association will want the option to conduct nonmember business. 41 If the association does nonmember business, the CapperVolstead Act and many State incorporation laws require that a majority of the association business be done with or for members. The first three sentences of the sample bylaw are thus found in most cooperative bylaws. If an association wishes to qualify for tax treatment under section 521 of the Internal Revenue Code, it may not do more than 15 percent of its farm supply business with persons who are neither members nor producers (business with the Federal government can be disregarded in making this computation). The last two sentences in the example cover this situation. ARTICLE IX. NONMEMBER BUSINESS This association may conduct business with nonmembers on either a patronage or nonpatronage basis. However, this association shall not market the products of nonmembers in an amount the value of which exceeds the value of the products marketed for members. Itshall not purchase supplies and equipment for nonmembers in an amount the value of which exceeds the value of the supplies and equipment purchased for members. It shall not purchase supplies and equipment for persons who are neither members nor producers of agricultural products in an amount the value of which exceeds fifteen percent (15%) of all its purchases. Business done for the United States or any of its agencies shall be disregarded in determining the limitations imposed by this section. Nonpatronage Income Several factors are combining to increase the proportion of cooperatives that have taxable earnings from nonpatronage sourced. These factors include a growing reliance on nonmember business to sustain the cooperative, more forceful positions by IRS auditors to classify investment income as nonpatronage sources, and less use of section 521. The bylaws should recog42 nize this as special income and provide the board discretion to add it to a capital reserve, distribute it to members, or put it to any other lawful use. I ARTICLE X. NONPAlXONAGE INCOME The nonpatronage income of the association shall be its gross receipts derived from all sources which under law do not qualify as patronage income, less all expenses properly attributable to the production of such nonpatronage sources income and all income taxes payable on such receipts by the association, Nonpatronage income shall be used in behalf of the association and its members in accordance with such lawful purposes, including assignment to an unallocated reserve account and allocation in whole or in part to members, as may be determined by the board of directors. Handling of Losses While cooperatives operate at cost over the long term, the financial world operates for accounting and tax purposes in single-year segments. Sometimes cooperatives have a loss in that relatively short framework. The bylaws should anticipate the possibility of a loss year. They should explain how decisions will be made to allocate the loss on an equitable basis. The proper treatment of losses by cooperatives for tax purposes has long been a contentious issue between cooperatives and the Internal Revenue Service. The sample bylaw reflects a moderate position that financial results on patronage and nonpatronage business should be separated: gains and losses within each category can be combined, or “netted,” for tax purposes; and losses under either category can be carried back or forward to offset earnings in other years under the applicable provisions of the tax code for businesses in general. As the rules for handling losses are subject to change from time to time, counsel should be asked to keep informed on this issue and advise the association when this bylaw may need revision. 43 It may also be prudent to include a prohibition on directors voting a direct assessment on the members. This will prevent outside interests from pressuring the directors into an action likely to have a negative impact on member relations. ARTICLE XI. LOSSES Section z . Patronage Losses. In the event the association suffers a loss during any year on business conducted with or for patrons, such loss may be apportioned among the patrons during the year of loss so that such loss will, to the extent practicable, be borne by the patrons of the loss year on an equitable basis. The board shall have full authority to prescribe the basis on which capital furnished by patrons may be reduced or such loss otherwise equitably apportioned among the patrons. In the event of a patronage loss in one or more departments or divisions of the operation of this association, but not so much as to cause an overall loss for the fiscal year, such loss or losses may be prorated against each of the remaining profitable departments on the basis of their respective percentage of the net margins during such fiscal year. Section 2. Nonpatronage Losses. If in any fiscal year the association shall incur a loss other than on patronage operations, such loss may be charged against any reserve accumulated from nonpatronage earnings in prior years. Section 3. General Provisions. The board shall have no authority to make assessments against members. This section shall not be construed to deprive the association of the right to carry backward or forward losses from any source whatsoever in accordance with the Internal Revenue Code or state taxing statutes. 44 Dissolution Many of the rules to dissolve a cooperative are contained in various statutes and are too complex to reproduce in the bylaws. One issue that should be addressed is how any assets that might remain after all liabilities are met should be distributed. In a noncooperative corporation this is usually done on the basis of stock ownership and, if the bylaws are silent on this issue, this may be the rule imposed on cooperative members by a court. It is a good idea to consider language in the bylaws of a cooperative making clear that such a distribution will be on the basis on patronage. I ARTICLE XII. DISSOLUTION AND PROPERTY INTEREST OF MEMBERS Upon dissolution, after all debts and liabilities of the association shall have been paid, all shares of preferred stock and common stock redeemed, and all capital furnished through patronage shall have been retired without priority on a pro rata basis, the remaining property and assets of the association shall be distributed among the members and former members in the proportion which the aggregate patronage of each member bears to the total patronage of all such members insofar as practicable, unless otherwise provided by law. Indemnification As the trend toward litigating to test the validity of various decisions by corporate leaders has grown, so has the possibility that directors, officers and employees may be found personally liable for the adverse consequences of their decisions. This has made some people understandably reluctant to assume leadership positions, particularly as unpaid or minimally compensated directors and officers. State governments, recognizing the valuable role directors and officers play in corporate affairs, have adopted a variety of 45 laws limiting liability of corporate leaders and permitting corporations to shield leaders from direct personal loss for decisions they make on behalf of the corporation. In many States this is a developing area of the law, and the extent of permissible indemnification changes frequently. To encourage members to serve as directors, and to make sure leaders don’t shy away from innovative ideas, cooperatives should consider a bylaw accepting the maximum amount of responsibility for indemnification permitted by State law. Prudent risk management usually includes the purchase of liability insurance to protect against an indemnification claim that might otherwise lead to significant exposure for the association. This coverage can seem quite expensive, so the sample language uses the permissive term “may” rather than the mandatory term “shall.” But whenever possible, this insurance should be obtained to avoid exposing member assets to unacceptable risk. I ARTICLE XIII. INDl3MNIFICATION The association shall indemnify its officers, directors, employees, and agents to the fullest extent possible under the provisions of the (applicable State law), as it may be amended from time to time. The association may purchase liability insurance coverage for any person serving as an officer, director, employee or agent to the extent permitted by applicable State law. Amendment It is important for cooperative leaders to remember that bylaws are not set in stone. They can, and should, be changed whenever they stand as a barrier to cooperative activity desired by the member-owners and permissible under the law. While the incorporation statute will include language permitting amendment of the bylaws and setting out how this can be accomplished, a bylaw on amendment is usually included to 46 remind leaders that change is possible and to call attention to any unusual legal requirement, such as a higher than normal positive voting requirement, that may be applicable. ARTICLE XIV. AMEXWMENTS If notice of the character of the amendment proposed has been given in the notice of meeting, these bylaws may be altered or amended at any regular or special meeting of the members by the affirmative vote of (_) of the members present or voting by proxy. Again, these are only examples of the provisions common to most cooperative bylaws. Virtually any other rule can be included that is permissible under law. It is up to the leaders and members of a cooperative to craft a set of bylaws that guides the association to serving members’ needs. MARKETING AGREEMENT Cooperatives that market farm products and other goods of their members will usually want a separate contract with each member establishing the terms upon which they will conduct their business transactions. This contract is commonly called a marketing agreement. If the members only want the cooperative to serve as a home-of-last-resort for product that can’t be sold elsewhere, then a marketing agreement is not necessary. But if the members want an organization that will enhance the return they earn on all of their production, then a marketing agreement is an important marketing tool. The marketing agreement is a unique contract in that, because the members own ,and control the cooperative, the members are entering into a contract with themselves. But it is more accurate to picture the agreement as a contract between each individual member and the membership as a whole. An important key to making the system work is for everyone to remember that the cooperative is democratically con47 trolled by the members. No individual member has a right to unilaterally cancel or change the marketing agreement, and the leadership should not insist on arrangements that are contrary to the wishes of a majority of the membership. The marketing agreement builds on the patronage commitment section of the organizational agreement. Each individual member’s obligation to the organization committee is transferred to the new cooperative entity. While the basic content of the articles and bylaws is standardized throughout the cooperative community, the substantive provisions of the marketing agreement are influenced by the custom and trade of the market for the commodity covered by the agreement. Thus the sample language may need substantial modification to meet member needs. As with the articles and bylaws, the terms of the marketing agreement are binding until changed, but they are not etched in stone. The association-represented by its officers and directors-and the members are free to adopt an approach to any issue different than the approach set out in the organization agreement or in previously adopted marketing agreements. Introduction These initial provisions identify the parties to the contract, the cooperative and the producer, and usually establish any other requirements that the producer must meet, including any initial equity investment obligation, to be a member of the cooperative. I MARKEUINGAGREEMENT THIS AGREEMENT, made as of this _ day of x9_, by and between , herein referred to as “Producer,” and t an agricultural cooperative having an office at , herein referred to as “Association”. RECITALS A. Association is an agricultural cooperative organized under the laws of the State of . B. Producer is a member of the Association who produces . C. Producer has purchased one share of common voting stock and paid to Association the sum of dollars ($), calculated at the rate of $ per -(unit) of (product) as specified in Producer’s membership application, receipt of which is acknowledged as an equity investment in the Association. This entitles Producer to all the benefits of membership in the Association as long as Producer complies with the articles of incorporation and bylaws of the Association and the provisions of this agreement. In consideration of the mutual covenants and obligations contained herein, the parties agree as follows: sales Terms This provision outlines how the association will sell the products and pay the member-patrons. The first paragraph normally defines the obligation of the producer to deliver product to the association. The same three options outlined in the patronage commitment examples for the organization agreement-full production, defined volume, and set acreage-are available for use in setting the delivery commitment once operation begins, The defined volume option is utilized in this example, so if another type of obligation is adopted, appropriate modification of the first paragraph should be made. The second paragraph explains how the association will distribute the proceeds of resale to the member. Two ways of accounting for these proceeds are common. One is sometimes referred to as a gross margin operation. The association agrees 49 to pay the member the going market price for the product, less deductions for operating expenses. After the end of the fiscal year, any margin is returned to the producers as a patronage refund. The other is called the pooling method. In this arrangement all proceeds above expenses are returned to the producers on the basis of patronage. Such associations do not generate margins, as such, and thus lack access to retained patronage refunds to obtain equity. Pooling cooperatives must rely on per-unit retains and other means of raising capital. An example of draft language for each option is set forth below. Other terms of sale should also be included in the agreement. Sample language on several areas commonly covered are provided: responsibilities for delivery and for inspection and grading of the product; authorization for the association to pledge the product and sales proceeds as collateral for loans and otherwise exercise the rights of ownership: authorization for the association to withhold fees to cover operating expenses and capital retains from checks to growers; and an explanation of how the parties to the contract will deal with liens against the product. Section 1. Sale of (product). Association agrees to buy and Producer agrees to sell to Association (number) (units) of (product) as defined by USDA standards and grown by Producer. This agreement is intended by the parties to pass an absolute title to (number) _ (units) of (product) grown by Producer as soon as they have a potential existence but such (product) shall be at the risk of Producer until delivery. * * * * * * OPTION - Gross Margin Operation * * * * l l Section 2. Payment to Producer. Association shall market Producer’s (product) and Producer shall accept as payment for Producer’s (product) a price based on the current market price in the area for (product) of like grade and 50 quality. Association shall pay the amount due Producer, less deductions authorized in Section 6 of this agreement, not more than _ days after delivery of [product) to Association or Association’s prescribed buying location. l * * l l * OPTION - Pooling Operation l l * * * * Section 2. Payment to Producer. The Association may at any time pool any or all (product) of Producer with any other (product) of a similar kind and grade. Producer shall receive, for (product) pooled, a unit price equal to the average net unit price obtained for the pooled (product), less deductions authorized in Section 6 of this agreement. Association shall make an advance payment to Producer of percent of the current market price in the area for (product) of like grade and quality not more than _ days after delivery of (product) to Association or Association’s prescribed buying location. Section 3. Delivery. All (product) shall be delivered by Producer at Producer’s expense at the earliest reasonable time after harvesting, or at such time as called for by Association, to Association’s principal place of business or to one of Association’s authorized buying locations as prescribed by Association. The Association will use its best efforts to locate buying locations within a reasonable distance from Producer’s farm. Section 4. Inspection and Grading. Prior to acceptance by Association, all (product) shall be inspected and graded by the USDA in accordance with USDA standard rules and regulations. All purchases and/or marketings of (product) received by Association from Producer 51 shall be based upon USDA grade, and Producer agrees to accept the grading established by USDA. Section 5. Loans and Security. Association shall have the power to borrow money for any purpose on the security of the (product) delivered to Association, the products derived thereupon, and evidence of such products or by-products, or cash or accounts arising from the sale thereof, and to give a lien, either legal or equitable, thereon as the absolute owner and/or marketing agent thereof. Association may commingle such products and byproducts with other products and by-products of like grade and variety and shall exercise all other rights of ownership without limitation. Section 6. Deductions. Association agrees to purchase from and/or market for Producer the (product) set forth in Section 1 and to pay to Producer for said (product) the price set forth in Section 2, less the following deductions authorized by Producer: a. An amount to be determined annually by the board of directors, in the sole discretion of the board, to meet the general contingencies of the business of the Association including operating expenses. b.A$ . per___ (unit) capital retain deduction by the Association on the purchase price of each _(unit) of (product) received from Producer. Section 7. Liens. Producer shall notify the Association of any lien on any (product) covered by this agreement. Producer shall obtain permission from the lien holder for Association to market such (product) and to retain any deductions from the payments to Producer autho52 rized hereunder and under the articles of incorporation and bylaws of the Association. After any such deductions, Producer authorizes the Association to apply the balance of the sale proceeds, or so much thereof as necessary, for payment of the lien. Enforcement As a member owned and controlled entity, one of the most sensitive areas of management and leadership in a cooperative is the disciplining of members who violate their agreements with the association. But unless each member honors his or her obligations to the association, the collective strength of the venture is weakened and the entity’s chance of success is diminished. This is especially true where a marketing agreement is in effect. Management has to be able to anticipate the amount of product that will be delivered so it can plan for its processing and resale. Disruptions in anticipated delivery by natural causes, such as drought, are usually excused under a so-called “Act of God” clause in the cooperative’s contracts with buyers. But if members simply do not deliver product to the association as promised, management may be forced to buy product on the open market to meet association commitments or even default on its own contractual obligations. Usually a member knowingly violates the marketing agreement because the member thinks he or she can get a better price somewhere else. In the short term, this may indeed be the case. No firm always has the best price in a competitive market. But a cooperative must view itself as a long-term undertaking. If some members are allowed to forsake the cooperative for personal shortterm gain, they do so at the expense of those members who honor their agreement. Because the marketing agreement is a contract between each individual member and the membership as a whole, the leadership has the responsibility to protect the interest of the group as a whole. That means taking steps, including legal action if necessary, to enforce the marketing agreement. Most State cooperative incorporation statutes permit contractual provisions to facilitate enforcement of marketing agree53 ments. One is the inclusion of language providing for liquidated damages. In general corporate law, an injured party must prove the extent of the loss with great specificity to be eligible for compensation. This can be very difficult to do when agricultural commodities are involved. Their value changes by the day, or even by the minute. So in this instance, the parties can agree through contract on a specific level of damages, called liquidated damages, that will be the penalty for violating the contract. The level must be high enough to truly discourage breaches of the contract and to compensate the other members for their loss. A frequently used rule-of-thumb is 25 percent of the estimated market value of the commodity if it had been delivered under the contract. Marketing agreements also usually authorize the association to go to court and seek a restraining order against either actual or anticipated breach of the contract. The agreement may also make the offending party liable for legal fees incurred by the association in defending the agreement. Section 8. Liquidated Damages. The remedy at law would be inadequate and it would be impracticable and difficult to determine the actual damages to the Association should Producer fail to deliver the (product] covered by this agreement. Therefore, regardless of the cause of such failure, Producer agrees to pay to the Association for all such (product) delivered or disposed of by Producer, other than in accordance with the terms of this agreement, a sum equal to _ % of the fair market value of the product at the close of business on the day the product should have been delivered to the Association, as liquidated damages for the breach of this agreement. All parties agree that this agreement is one of a series dependent for its true value on the adherence of all the contracting parties to all of the agreements, but the cancellation of any other similar agreement or the failure of any of the parties thereto to comply therewith shall not affect the validity of this agreement. Failure to deliver the (product) commit54 ted herein due to ACTS OF GOD shall not constitute a breach of this agreement. Section 9. Specific Performance. Producer agrees that in the event of a breach or threatened breach by Producer of any provisions of this marketing agreement regarding delivery of (pmduct), the Association shall be entitled to a preliminary restraining order and an injunction to prevent breach or further breach hereof and to a decree of specific performance hereof. The parties agree that this is a contract for the purchase and sale of personal property under special circumstances and conditions and that the Association may, but shall not be obligated to, go into the open markets and buy -(product) to replace any that Producer may fail to deliver. Section 20. Legal Costs and Expenses. If the Association brings any action whatsoever by reason of a breach or threatened breach of this agreement, Producer shall pay to the Association all court costs, costs for bonds, travel expenses and all other expenses arising out of or caused by the litigation, including reasonable attorney’s fees expended or incurred by Association in such proceedings, and all such costs and expenses shall be included in the judgment. Termination and Renewal Management doesn’t want to have to get every member to sign a new agreement each year, and the producers aren’t going to want to be obligated to continue to patronize the cooperative if it isn’t meeting their needs. A provision providing that the contract automatically renews itself for another year unless either the cooperative or the member provides notice during a specific period of time-usually about a month during a slow period in production and cooperative activity-that it wants to terminate the agreement gives adequate flexibility and stability to the relationship. 55 Section 2 1. Termination and Renewal. After this agreement has been in effect one year from the date of execution, either party may terminate it in any year by notifying the other party in writing between (date) and (date). It is mutually agreed that failure to so terminate in any year shall constitute conclusive evidence that the parties have renewed this agreement for another year. Miscellaneous Provisions Individual cooperatives have adopted numerous additional provisions to tailor their marketing agreements to their individual needs. Examples of some of the more common, but by no means all, of these types of provisions are provided. Nonconforming agreements. From time to time, the association may want to alter the terms of its marketing agreement. This may occur when numerous agreements are in effect, and it is a good cooperative practice to treat all member equitably. Therefore, a provision permitting nonconforming contracts, but offering persons with ongoing agreements the option to change to the new agreement, often called a “most favored nation clause,” can be useful. If the association wants to bring all agreements back to uniformity, it can do so during the next time period for terminating existing agreements. Section 12. Nonconforming Agreements. Association may enter into agreements with other growers differing in terms from those contained herein, consistent with the bylaws of the Association, without invalidating this agreement, provided that Producer at Producer’s request may sign a similar agreement as a substitute for this agreement. No contrary agreements. One of the most difficult legal situations to untangle involves the member who signs more than one contract for the sale of the same commodity. A clause forbidding such activity helps place the responsibility for injuries suffered by the cooperative on the member. Section 13. No Contrary Agreements. Producer warrants that Producer has not contracted to sell, market, consign, or deliver and will not contract to sell, market, consign, or deliver any (product) during the term of this agreement to any person, firm or corporation, contrary to this agreement. Forfeiture of membership. If a member is going to disregard the terms of the marketing agreement, the cooperative is usually better off without that person as a member. A provision giving the board authority to revoke the membership of a member who violates the agreement gives appropriate discretion to the directors in dealing with a breach of the contract. Section 14. Forfeiture of Membership. Violation of this agreement in any material respect by Producer shall be grounds for the board of directors to terminate Producer’s membership in the Association. Abide by articles and bylaws. A similar provision requiring members to abide by the articles and bylaws, as written at the time the agreement is signed or subsequently a&nded, makes it clear that a member can’t abrogate the agreement if the membership approves a change in the cooperative organizational documents the individual member doesn’t like. That member must honor the agreement until the annual period for orderly termination arrives. I Section 15. Articles and Bylaws. Producer agrees to conform to and observe the articles of incorporation and bylaws of the Association now in force and as they may be amended hereafter. Assignment. Sometimes reorganizations occur during the year at either the association or the member level. The right of a new entity replacing one of the parties to enforce the contract can be clarified in the agreement itself. Because the association is the members as a whole, it can usually assign its rights at will. However, to protect against one member assigning rights to an 5 7 unqualified person, usually a member must have board approval to assign contract rights. Section 26. Assignment. This agreement may be assigned by the Association in its sole discretion. Producer may assign this agreement, but only upon written authorization granted by the board of directors of the Association. Entire agreement. A major cause of disputes over business contracts is the unwritten exception. One party to the contract will say, “I know the contract says that, but you told me you would do this.” Marketing agreements will frequently include language stating that the organizational documents and the agreement itself are the only contracts between the parties and no oral or other types of agreements will be honored. The manager, in particular, needs to be reminded of this rule. Special unauthorized promises or “deals” for selected members can do serious harm to the cohesiveness of the association. ~ Section 17. Entire Agreement. It is agreed that the articles of incorporation and the bylaws of the Association, now or hereafter in effect, and this marketing agreement constitute the entire agreement between the Association and Producer, and that there are no oral or other conditions, promises, covenants, representations, or inducements in addition to, or at variance with, any terms of this agreement. Governing law. Even if an association intends to limit its activity to a single State, disputes that involve the marketing agreement can arise from transactions that cross State lines in any number of ways. To avoid arguments over which State’s law shall be applied, the contract might have a clause naming the State. This can be particularly important if the association is incorporated under a statute of a State different from the one where its headquarters are located. I Section 18. Governing Law. This agreement shall be governed by the laws of the State of , Signatures. To make the contracts official, they must be signed by both parties. If the producer is a business and not a real person, the association should check to make sure the signee for the business is authorized to enter into such agreements for the business. IN WITNESS WHEREOF, these parties have executed this agreement as of the day, month and year first above written: Producer (Cooperative name) BY President ATTEST I Secretary MEMBERSHIP APPLICATION When a person applies for membership in a cooperative, it is a good idea to have a simple document that ties the loose ends together and, when approved, serves as official notice that the applicant is a bona fide member of the association. If the articles, bylaws, and marketing agreement are well drafted, this need be little more than a summary of the commitments made. Applicant certifies that the requirements of membership have been met, and the appropriate cooperative officers, usually the president and secretary, acknowledge board approval of the applicant. 5 9 MEMBERSHIP APPLICATION Applicant’s Statement. I hereby apply for membership in and agree to abide by the articles of incorporation and bylaws of the association, now and hereafter in effect, copies of which have been presented to me for inspection. I certify that I am a producer of , have tendered the purchase price of one share of common voting stock, have signed a marketing agreement, and met such other qualifications for membership as have been explained to me. After my membership shall have been in effect for one year from the date of its acceptance by the association, either party may terminate it by notifying the other party in writing of this intention between (date) and (date) of any year. If neither of the parties to this agreement so notifies the other, it is mutually agreed that this shall constitute conclusive evidence that the parties have renewed this agreement for another year. Date ,199_. Applicant’s: name address telephone number social security number Applicant’s signature Acceptance. This certifies that is a member of and is entitled to all of the rights, benefits, and privileges of membership in the association. Date , 199_. President: Secretary: As mentioned earlier, familiarity with the documents reviewed in this report is an ongoing responsibility of each cooperative leader, particularly members of the board of directors. The same is true for other important cooperative papers: e.g., audit reports and current financial statements, board policies, loan agreements, the manager’s job description, and minutes of board and membership meetings. As the manager’s job is to run the day-to-day operations of the cooperative, the manager acquires the necessary familiarity with these items as part of his or her ongoing duties. Directors usually don’t have the continuous contact with the business that the manager does. They need to have the documents available so they can look up information and ask informed questions when necessary. A good director handbook meets this need. The director handbook can be nothing more than a solid three-ring binder that contains up-to-date copies of all documents the directors need to set cooperative policy. Every new director should get a current handbook as soon as he or she is elected to the board. At each board meeting the manager or the president should distribute minutes of the previous meeting and new versions of any documents that have been modified or adopted since the last meeting. Time should be taken to make sure the directors place the new pages in the proper place in the book and to let the directors review and ask questions about the additions and replacements. The director handbook will get the important cooperative papers out of the file cabinet and into the mainstream of the decision-making process. It will minimize the likelihood leaders will innocently violate a provision of the articles and bylaws, contracts, or other written guidelines. It will provide ready answers to questions about the limitations on managerial discretion imposed by these documents. And it will facilitate the conduct of business meetings in a professional and efficient manner. In summary, it will soon become a valuable tool for cooperative management and planning. 61 Appendix A. Election of Directors by Districts (bylaw provision) ARTICLE III. DIRECTORS AND OFFICERS Section 2. Election of Directors by Districts. (Two paragraphs as in sample language on page 29, main text. Next, add the following:) The territory in which the association has members shall be divided into _ (same number as number of directors) districts. The respective districts and their boundaries shall be established by resolution of the board of directors. The board of directors may from time to time change the boundaries of one or more districts by adding territory not included within any district, by adding to one district territory previously included in another district, or by excluding from a district a part of its territory. There shall be as many directors as there are districts, one director to be elected by the members of each district. However, when the number of districts is an even number, there shall be one additional director to be known as a director-at-large and to be elected by all members of the association. A district director must be a resident of, or be a producer of agricultural products in, the district for which such director is elected or appointed. Any questions as to the effect of any changes made in district boundaries, or the number or identity or districts, shall be conclusively determined by the board of directors. Nominations for directors, either for a district or at large, shall be made by petition addressed to the secretary of the association requesting placement on the ballot of the name of the person so nominated. Such a petition nominating a district director shall be signed by not less than _ members of that district. Such a petition nominating a director-atlarge shall be signed by not less than _ members of the association. 62 Appendix B. Equity Redemption (alternative bylaw) ARTICLE VII. EQUITY REDEMPTION Section I. Regular Redemption, Percent of All Equities. It shall be the policy of the association, when other redemption priorities set forth herein have been met, and when funds are available, to redeem in cash a percentage of each member patron’s capital credits, rather than ratably by year. The time and method of any such redemption shall be determined by the board of directors. Section 2. Specified Special Redemptions. The association shall give priority to redemption of members’ capital credits held by deceased persons for the settlement of their estate. The association shall thereafter grant priority redemption to capital credits of former members who have attained their 65th birthday and are no longer actively engaged in agricultural production as actual producers or landlords in share tenancy. The time and method of such redemption shall be determined solely by the board of directors, dependent upon the financial condition of the association. In the case of redemption of the equities of those persons who have attained age 65 and retired from farming, preference may be given to the oldest retirees in establishing the order of priority among those eligible. In the case of a corporation or partnership holder of members’ capital credits, such corporation or partnership shall be considered eligible for priority treatment to the same extent as the individual stockholders of such corporation or partners of the partnership would have qualified, if each individual stockholder or partner were an individual memberpatron of this association. Any redemption shall be made to the corporation or partnership, and not to the individual stockholder or partner thereof. Each corporation or partnership shall report to the association the percentage of ownership interest 63 in the corporation or partnership of each of its stockholders or partners. Failure to report accurately the percentage of individual ownership interest shall disqualify any allocations made to the corporation or partnership by this association from redemption priority. If a corporation or partnership should dissolve, its capital credits in this association shall be prorated among, and transferred to, the individual stockholders or partners and considered for redemp tion on an individual ownership basis. The amount of any redemption or prorate related to a corporate or partnership member shall be determined by the percentage of ownership interest as reported by the corporation or partnership. When two or more persons are holders of capital credits as tenants in common, without a designation of rights of survivorship, they shall be deemed by this association to be acting as partners and shall be subject to the same requirements as a partnership. Capital credits held in joint tenancy with rights of survivorship shall be considered for priority of redemption according to the qualifying status of the youngest member of the joint tenancy or, in the event of death of one of the joint tenants, of the survivor. Appendix C. Base Capital Plan (bylaw provision) ARTICLE VII. EQUITY REDEMPTION Section 1. Members’ Equity Requirements. Each year the board of directors shall determine the amount of equity capital necessary for successful operation of the cooperative. The total amount of member volume and the volume each member has marketed through the association during the past _( ) years shall be calculated. Each member’s equity requirement is equal to the amount of equity, determined necessary by the board of directors, multiplied by the member’s proportion of the association’s total member volume during the base _ year period. Section 2. Member Investment. Members can invest equity to meet their requirements by direct cash investment, allocated patronage refunds, and per-unit capital retains. Section 3. Member Account Adjustments. At the end of each fiscal year the association shall recalculate each member’s capital credits account to include all per-unit retains for the year and each member’s share of patronage refunds for the year. (a) If a member’s total capital credits are less than the member’s equity requirement for that year, cash returns on business done with the association will be limited to those required by the Internal Revenue Code or other applicable law. (b) If the member’s capital credits, less any cash that must be refunded to comply with the Internal Revenue Code or other applicable law, are greater than the member’s equity requirement for that year, the excess shall be redeemed in cash within g-112 months after the close of the association’s fiscal year. 65 ","Respond with only information from the provided context. What should be included in my new businesses organization agreement? Preface A cooperative is a business. As such, it must operate in a manner compatible with all the laws that apply to a business, with cooperative principles, and with the needs and desires of its member-patrons in mind. To comply with each of these limitations on its operations, a cooperative must have a set of organizational documents that is uniquely crafted to its particular situation. Drafting new, and updating old, legal documents of cooperatives takes both time and expertise. This report is intended to assist persons organizing new cooperatives, managers and directors of existing cooperatives, and their professional advisers to develop and update the important legal documents of cooperatives. It explains issues to be considered and options that are available. It provides sample language to be used as a starting point; the wording is not to be copied without review and thought. To help distinguish sample document language from explanatory text, a straight black line has been drawn along the left-hand margin of the sample document language. Contents ORGANIZATION AGREEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Statement of Purposes ...................................................... 2 Organization Committee ................................................... 3 Patronage Commitment ..................................................... 3 Financial Commitment ...................................................... 4 Calling of Membership Meeting ....................................... 6 Accounting .......................................................................... 7 SELECTING THE PROPER STATE INCORPORATION STATUTE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 ARTICLES OF INCORPORATION ..*...................,..*.*.............t. 11 Heading ............................................................................ 1 1 Name ................................................................................. 1 2 Principal Place of Business ............................................. 12 Purposes ............................................................................ 1 2 Powers ............................................................................... 13 Duration ............................................................................ 15 Directors ........................................................................... 15 Capital Structure ............................................................... 16 Amendment ..................................................................... 20 Signatures ......................................................................... 20 BYLAWS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Membership ...................................................................... 21 Meetings of Members ...................................................... 24 Directors and Officers ....................................................... 26 Duties of Directors ........................................................... 32 ii Duties of Officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Operation at Cost and Members’ Capital . . . . . . . . . . . . . . . . . . . . . . . . . 36 Equity Redemption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..I....... 39 Consent . . . . . . . . . ..f................................................................ 4 0 Nonmember Business . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Nonpatronage Income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 Handling of Losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Dissolution . . . . . . . . ..f............................................................ 4 5 Indemnification . . . . . . . . . ..I....................................I.............. 45 Amendment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 MARKETING AGREEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..*................. 4 7 Introduction . . . . . . . . . . . . . . . . . . . . . . . . ..I...........................................4 6 Sales Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..I...........................4 9 Enforcement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Termination and Renewal ..****...*.**.*.........................*...... 55 Miscellaneous Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 MEMBERSHIP APPLICATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .59 DIRECTOR HANDBOOK . . . . . . ..a.. a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 APPENDIX A. ELECTION OF DIRECTORS BY DISTRICTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 APPENDIX B. ALTERNATIVE EQUITY REDEMPTION BYLAWS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 APPENDIX C. BASE CAPITAL PLAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 . . . 111 Sample Legal Documents for Cooperatives Donald A. Frederick, Attorney-Adviser One of the axioms of business planning is that a strong foundation is essential if an organization is to have a strong structure. An important component of a strong cooperative foundation is a set of basic legal documents that conforms to Federal, State, and local law and facilitates conducting the business affairs of the association to enhance the mutual well-being of the members. This report explains the role each document plays in building the organization and the various issues treated in each document. It discusses options available to members in handling many of the issues. It also presents sample language as an aid in preparing initial documents, or in revising existing ones, to make sure they promote the objectives of the cooperative venture. Most of the sample language in this report is suitable for virtually any type of cooperative. Where the language must be tailored to reflect specific functions of the association, wording appropriate for an agricultural marketing cooperative is used. Counsel can help make the necessary modifications to cover supply and related service organizations and nonagricultural activities. One point cannot be stressed too much! Cooperative organizers, advisers, and leaders should not just sit down and copy these, or any other set, of legal documents and declare them as their own. These foundation documents should only be adopted after review by a competent attorney, one who understands the unique characteristics of cooperatives and the industry in which the association does business. This will maximize the likelihood that the documents will conform to applicable law and meet the specific needs of the association and its members. One problem in drafting organizational papers is they can be thorough or simple, but not both. This report contains many “compromises” between these two objectives. This only reinforces the need for cooperative founders and leaders, and their professional advisers, to avoid adopting any sample set of documents verbatim and to review existing documents on a regular basis. 1 The idea of forming a cooperative is usually conceived and nurtured by a few individuals who foresee coordinated group action as a solution to a problem confronting themselves and similarly situated persons. This organizing group often has to formulate a development plan, arrange for or provide seed money, and contribute sweat equity to get the association up and running. The organization period involves considerable discussion and data collection. While these efforts provide a good forecast for the level of support the cooperative is likely to attract, before launching the venture it is a good idea to have those persons who say they want the services of the cooperative formally commit to use those services. The organization agreement secures both a patronage and a financial commitment from prospective members. It is also a vehicle for educating prospective members about the cooperative form of business and the objectives of the proposed association. Statement of Purposes This first provision in a typical organization agreement sets out the services the proposed organization will perform. The services can be described in broad terms, such as to “process” and “market” certain farm commodities and “furnish” certain farm supplies. The language should refer only to services the cooperative will provide from its inception. This minimizes member pressure to expand the scope of operations too rapidly. For example, it is usually best not to mention furnishing supplies in the organizational agreement if the new organization will limit its initial activity to marketing fresh vegetables. 1. The undersigned, a producer of agricultural products, hereinafter referred to as “Producer,” together with other signers of agreements similar hereto, propose to organize a cooperative association 2 under the laws of the State of for the purpose of . Organization Committee Although the association has not yet been incorporated, a decision making process should be formalized. The organizers will usually appoint some or all of their group to an official organization committee that will serve as the initial policy body for the association. This provision lists the committee members and sets out the committee’s authority. 2. (a) The association shall be organized with suitable articles of incorporation and bylaws as determined by an organizational committee consisting of the following persons: Name Address 2. (b) This committee may, by vote of a majority of its members, increase its membership, fill any vacancy therein, and appoint any subcommittees deemed necessary to conduct its affairs. The committee, or any subcommittee designated by it, may prescribe an organization fee to be paid by each person signing an organization agreement and may incur necessary obligations, make necessary expenditures, and take any such action as may, in its discretion, be deemed advisable to further the organization of the association. 3 Patronage Commitment Most cooperatives, especially those involved in marketing agricultural commodities, need a minimum level of product to be successful and the best possible projections of anticipated volumes to plan effectively. Their organization agreements should spell out the extent of the prospective members’ commitment: usually all production, a defined volume of product,. or production from a set number of acres. If either all production or production from a set number of acres is used, a projection of likely volume delivered should also be secured. Sample language is provided for each type of commitment: Full Production. 3. Producer agrees to sign a marketing agreement committing all (product) produced by Producer, on land owned or leased by Producer, to the cooperative for direct marketing, processing, or other disposition as the cooperative sees fit. Producer estimates such production will total (units) in (year). *********** Defined Volume. 3. Producer agrees to sign a marketing agreement to commit (units) of (product), produced by Producer, to the cooperative for direct marketing, processing, or other disposition as the cooperative sees fit. *********** Set Acreage. 3. Producer agrees to sign a marketing agreement to commit all (product) produced by Producer on acres of land, owned or leased by Producer, to the cooperative for direct marketing, processing, or other disposition as the cooperative sees fit. Producer estimates such production will total -(units) in _ (year). 4 If the cooperative is likely to have a minimum quality standard that must be met before product will be accepted, that standard should also be explained and the person or entity judging quality should be named. Financial Commitment Every new business must have equity capital. In a cooperative, the members supply that capital. In this provision the prospective member agrees to provide initial financial support for the cooperative. Each prospective member should commit to purchase one share of common voting stock (or, in a nonstock cooperative, pay a membership fee) for a fixed dollar amount, perhaps $1,000. This investment gives the member the right to vote on issues submitted to the membership. Often the initial investment tied to membership status does not raise enough equity to fund the association. Additional capital is needed. Usually the organizers have substantial leeway in collecting and recognizing this investment. Each prospective member may be asked to make an equal contribution, or the level can vary with anticipated patronage. While this investment is classified as preferred stock in this report, it can also be structured as equity credits, revolving fund credits, or any similar term satisfactory to the organizers. Organizers should avoid using any term usually associated with debt capital, such as “note” or “bond,” and should also avoid creating a second class of common stock, which is sure to be confused with regular voting common stock. The agreement should expressly state that this financial commitment is irrevocable unless the organization effort is terminated. Initial development of the cooperative is totally dependent on promised financial support being forthcoming. Leaders must have the tools to force compliance with this commitment, by legal action if necessary. I 4. Producer agrees to purchase one share of voting common stock of the association, par value $ payable on demand following a favorable vozihe signees of agreements similar hereto to 5 incorporate the association. Producer further agrees to purchase shares of nonvoting preferred stock of the association, par value $ each, and agrees to pay for same as follows: S- cash on demand following incorporation of the association, g-on or before . 19 -9 and, $--- on or before ,19_. Producer expressly understands that this stock subscription agreement is an irrevocable legally binding obligation which will be relied upon by the association, other producers who subscribe to its stock, and lending institutions from which the association will seek financing to implement its cooperative purposes. If a cooperative is organized as a nonstock corporation, the sample language might be altered to call for payment of a membership fee, rather than purchase of a share of common stock, and payment of an additional sum into an equity account, rather than purchase of nonvoting preferred stock. Calling of Membership Meeting One of the principal responsibilities of the organization committee is to determine if enough firm interest exists to justify forming the cooperative. It is advisable to put a time limit on member solicitation. An open-ended solicitation period may exceed the patience of early signees to get started or abort the effort. If the committee decides there is enough interest, the agreement usually calls for a meeting of the signees to make the final decision to complete formation and begin operation of the cooperative. While the typical agreement provides that the affirmative vote of a simple majority of signees approves formation, the committee should move cautiously if substantial resistance 6 develops. Few associations overcome internal strife during the formation period to become useful and viable cooperative enterprises. 5. If, on or before 9 19-t the organization committee is of the opinion that sufficient signup has been obtained to enable the association to operate efficiently, the committee shall set a time and place for a meeting of those persons who have signed this agreement to determine, by majority vote, whether to proceed with the formation and operation of the association, and to consider such other business as may be deemed appropriate. Not less than ten days before the meeting, notice of the time and place of the meeting shall be sent to all signees by first-class mail, and an appropriate notice shall be published in one or more newspapers of general circulation in the area in which those who signed agreements like this one reside. , Sometimes the agreement will set minimum levels of support that must be committed before the prospective members will vote to begin the venture, If the organizers decide to adopt that option, the first paragraph of this provision might begin: 5. If, on or before 9 19-t bona fide producers of agricultural products otherwise eligible to become members in the association agree to execute marketing agreements covering (units) of (product) and subscribe to provide equity to the association equal to the sum of at least I dollars, ($ ), the organization committee shall set a time and place for a meeting . . . (continue as above). Accounting There should be a clearly stated obligation placed on the organization committee to keep good records and make the 7 appropriate disposition of any funds remaining after the vote on formation of the cooperative is conducted. 6. The organization committee shall keep detailed, accurate accounts of all receipts and of all expenditures of every kind. It shall have such accounts audited and render a written report thereof to the board of directors of the association when organized. And it shall thereupon turn over to the association any balance remaining in its hands free of obligation. If the association is not organized, such unexpended balance shall be prorated among, and returned to, those who contributed to the organization fund. The agreement should conclude with spaces for the prospective member to sign the agreement, and provide his or her address, and for the chairperson of the organizing committee to sign the agreement as an acceptance. SELECTING THE PROPER STATE INCORPORATION STATUTE While no drafting is involved, and thus no sample language is provided in this section, an important step in the development of a successful cooperative is selection of the proper statutory foundation for the association. To operate effectively in today’s business world, a cooperative must be a unique legal entity, separate from its members. The best way to create this unique entity is to form a cooperative corporation. A cooperative becomes a corporation when its organizers follow the steps set out in a law authorizing the formation of corporations. There is no Federal incorporation statute. Cooperatives incorporate under an appropriate State law. Incorporation offers several advantages over alternative structures, such as partnerships and unincorporated associations: l Incorporation facilitates the orderly succession of ownership. The entity has a perpetual life. As some members resign and new people join, redemption and issuance of a share of common stock or a membership certificate is a relatively simple means of clarifying each person’s status and rights in the association. l A corporation conveys to members and outsiders the image of a solid, longlasting venture. l If a cooperative is incorporated, the personal liability of each individual member, for losses suffered by the cooperative, is limited to the member’s equity in the cooperative. The organization of a cooperative as a business corporation has some important implications for how it conducts its affairs: l A corporation derives all of its legal authority from the State. It is a “person” in the eyes of the law, just like a natural person. It can do many things natural persons can, such as sign contracts, borrow money, own property, and sue and be sued. l While its powers are broad, those powers are limited to the ones granted by the State. For example, when the State agricultural cooperative law says only agricultural producers can vote in farmer cooperative affairs, no one else has the right to participate in policy decisions made by the membership. l The cooperative must obey business laws. Since managers and directors make the decisions for the corporation, they have an obligation to know and make sure the association follows all applicable laws. Persons who organize a cooperative have several incorporation statutes to choose from: l All States have special cooperative incorporation statutes. Some are broad, permitting the incorporation of virtually any business as a cooperative. Other are limited in scope. Many States have an Agricultural Cooperative Associations Act specially written to authorize incorporation of associations of producers of agricultural products. 9 l Every State has a general business corporation statute. A cooperative can be incorporated under this law and have its cooperative character established through proper drafting of the articles of incorporation and bylaws. l While most cooperatives are incorporated under a law of the State where the principle office is located, a few are organized under the laws of a different State. .It is usually best to organize under a cooperative incorporation statute of the State where the association’s headquarters is located. But it’s very important that the statute authorizing the cooperative permits a structure that meets the needs and desires of the members. The General Business Corporation Act and outof-State incorporation laws should be considered if the applicable cooperative law doesn’t permit the necessary organizational structure. A few so-called cooperatives are organized under a general not-for-profit corporation statute. Usually this is done to make it easier to obtain grant money. There are some potential adverse legal consequences of this type of incorporation that should be reviewed before following this path: l Most not-for-profit corporation laws expressly forbid the distribution of any earnings to members, trustees, officers, or other private persons. This means an association organized under such a statute can’t pay patronage refunds, one of the main reasons for operating a business as a cooperative. 0 In many States, if a nonprofit corporation goes out of business, members are prohibited from sharing in any assets left after the debts are paid. l Nonprofit corporations sometimes have had more trouble than cooperative corporations enforcing marketing agreements with their members. Cooperative statutes frequently provide specific authority for enforcement of marketing agreements. Not-for-profit acts have no such provision. If the leadership determines a cooperative is not organized 10 under the appropriate State statute, it is usually possible to reincorporate without seriously disrupting the ongoing business of the association. This will ordinarily involve redrafting the organization papers to conform to the new law and paying a modest fee to the appropriate State agency. ARTICLES OF INCORPORATION Once the leadership has determined the statute to use as the legal authority for a cooperative, the first document prepared is the articles of incorporation (articles). It is the acceptance of the articles by the State that establishes the cooperative as a unique “person” under the law. Most incorporation laws require a fairly common set of provisions to be included in the articles. These are discussed below. The statute will also require that before the articles are official they must be recorded in the office of a designated State officer. Failure to properly file the articles makes any business activity vulnerable to legal challenge. It is usually permissible to include information in the articles beyond that required by the incorporation statute. However, this is ordinarily not done because it is frequently more difficult to amend the articles than it is with other documents that may contain the same information. The articles are not a piece of paper to be prepared and then forgotten. The articles are routinely given the same respect by the courts as a statute. Therefore, the articles are binding on the directors, officers, and manager of a cooperative. Conduct beyond that authorized in the articles can subject the cooperative and its leaders to potential legal liability. The following are the elements common to most cooperative articles of incorporation. Heading The heading sets out the title of the document, the name of the cooperative, and the title of the authorization statute. 1 1 ARTICLES OF INCORPORATION (Name of Cooperative) We, the undersigned, all of whom are engaged in the production of agricultural products, do hereby voluntarily associate ourselves together for the purpose of forming a cooperative association, with (or without) capital stock, under the provisions of the Act of the State of Name The official name of the cooperative must be stated in the body of the articles and is usually the first provision: ARTICLE I. NAME The name of the association shall be Principal Place of Business This is a simple statement of the general location of the cooperative’s office: ARTICLE II. PRINCIPAL PLACE OF BUSINESS The association shall have its principal place of business in the city of County of , Stateof ’ . Purposes The purposes for which the cooperative is being organized are specifically set out. While the purposes clause of the organizational agreement is limited to immediate objectives, the pur12 poses are usually stated as broadly as possible in the articles of incorporation. Any service the cooperative may someday provide is frequently authorized, at least in a general way. This reduces the likelihood the articles will have to be amended whenever the association is asked by the members to provide additional services. Powers ARTICLE III. PURPOSES The association is formed for the following purposes: To market for its members and other producers any and all agricultural products or any products derived therefrom: to engage in any activity in connection with the picking, gathering, harvesting, receiving, assembling, handling, grading, cleaning, shelling, standardizing, packing, preserving, drying, processing, transporting, storing, financing, advertising, selling, marketing, or distribution of any such agricultural products or any products derived therefrom: to purchase for its members and others farm supplies and equipment: to manufacture, process, sell, store, handle, ship, distribute, furnish, supply, and procure any and all such farm supplies and equipment; and to exercise all such powers in any capacity and on any cooperative basis that may be agreed upon. The State statute authorizing formation of a cooperative will set out in detail the activities the cooperative may engage in. As a general rule, the statutory language is copied virtually verbatim into the articles. The following is an example of a typical statutory provision restated as an article of incorporation: ARTICLE IV. POWERS I This association shall have the following powers: 13 (a) To borrow money without limitation as to amount of corporate indebtedness or liability: to give a lien on any of its property as security therefore in any manner permitted by law: and to make advance payments and advances to members and other producers. (b) To act as the agent or representative of any member or members in any of the activities mentioned in Article III hereof. (cl To buy, lease, hold, and exercise all privileges of ownership over such real or personal property as may be necessary or convenient for the conduct and operation of the business of the association, or incidental thereto. (d) To draw, make, accept, endorse, guarantee, execute, and issue promissory notes, bills of exchange, drafts, warrants, certificates, and all kinds of obligations and negotiable or transferable instruments for any purpose that is deemed to further the objects for which this association is formed, and to give a lien on any of its property as security therefor. (e) To acquire, own, and develop any interest in patents, trademarks, and copyrights connected with, or incidental to, the business of the association. (fl To cooperate with other similar associations in creating central, regional, or national cooperative agencies, for any of the purposes for which this association is formed, and to become a member or stockholder of such agencies as now are or hereinafter may be in existence. (g) To have and exercise, in addition to the foregoing, all powers, privileges, and rights conferred on ordinary corporations and cooperative 14 marketing associations by the laws of this State and all powers and rights incidental or conducive to carrying out the purpose for which this association is formed, except such as are inconsistent with the express provisions of the act under which this association is incorporated, and to do any such thing anywhere; and the enumeration of the foregoing powers shall not be held to limit or restrict in any manner the general powers which may by law be possessed by this association, all of which are hereby expressly claimed. Duration The articles will say how long the cooperative is authorized to exist. Virtually all modern laws permit perpetual existence. Some laws in effect at the time longstanding cooperatives were organized limited the permissible life of a cooperative to a set period of time, such as 50 years. Associations that have been active for several decades should check to make sure their duration clause provides for perpetual operation. I ARTICLE V. PERIOD OF DURATION This association shall have perpetual existence. Directors Most statutes require the articles to name the initial policymakers of the cooperative. A majority of the incorporation statutes ask for the number of directors and names and addresses of the initial board. The articles often require “at least” the minimum number of directors required by statute: the precise number is set in the bylaws. Some statutes ask for the names and addresses of incorporators, in which case the appropriate title and references to incorporators would be substituted for “directors” in the example. If the law asks for both. then this draft provision is essentially inserted a second time and appro15 priately worded in each instance. ARTICLE VI. DIRECTORS This association shall have at least_ directors. The names and addresses of those who are to serve as the initial directors are: NAME ADDRESS Capital Structure The articles usually contain a description of the capital structure of the cooperative. If stock is issued, the number of shares authorized and the par value of each share of each class of stock (common, preferred) are set forth. The rights granted owners of each class of stock, the restrictions on owners of each class, and the dividends to which each class is entitled are also explained. If stock is not issued, a description must be included of how the rights and interests of the members will be determined. Sample language for both a stock and a nonstock association is provided below. The capital stock example provides for both voting common and nonvoting preferred stock. Nonvoting preferred stock is a useful way to account for additional nonpatronage investments by members. It has also been used as a way of raising equity from nonmembers, such as other members of the community interested in supporting the cooperative. If any interest in the cooperative is being sold to nonmembers, counsel must be retained to advise the association on applicable securities law requirements. The sample language also assumes that the organization 16 limits each member to one vote. If proportional voting based on patronage is utilized, counsel will have to prepare a description of how votes will be accumulated and any limit on the number of votes any one member can amass. All of the information in the example below is important and should be included somewhere in the organizational documents. However, not all incorporation laws require that all of it be in the articles. It may be possible to place some of these provisions in the bylaws. ARTICLE VII. CAPITAL STOCK (stock cooperative) Section 1. Classes and Authorized Amounts. The capital stock of the association shall consist of shares of common stock with a par value of $ per share, and shares of preferred stock with a par value of $ per share. Section 2. Common Stock. The common stock of this association may be purchased, owned, or held only by agricultural producers who (1) patronize the association in accordance with uniform terms and conditions prescribed by it, and (2) have been approved by the board of directors. ‘Producer’ shall mean and include persons (natural or corporate) engaged in the production of (product), or other agricultural products, including tenants of land used for the production of any such product, and lessors of such land who receive as rent therefore part of any such product of such land, and cooperative associations (corporate or otherwise) of such producers. Each member shall hold only one share of common stock and each eligible holder of common stock shall be entitled to only one vote in any meeting of the stockholders upon each matter submitted to vote at a meeting of the stockholders. In the event the board of directors of the association shall find, following a hearing, that any of 17 the common stock of this association has come into the hands of any person who is not eligible for membership, or that the holder thereof has ceased to be an eligible member, such holder shall have no rights or privileges on account of such stock, or vote or voice in the management or affairs of the association other than the right to participate in accordance with law in case of dissolution, The association shall repurchase such stock for par value. If such holder fails to deliver any certificate evidencing the stock, the association may cancel such certificate on its books and records, and the certificate is thereby null and void. The common stock of this association may be transferred only with the consent of the board of directors of the association and on the books of the association, and then only to persons eligible to hold it. No purported assignment or transfer of common stock shall pass to any person not eligible to hold it, nor the rights or privileges on account of such stock, nor a vote or voice in the management of the affairs of the association. This association shall have a lien .on all of its issued common stock for all indebtedness of the holders thereof to the association. No dividends shall be paid on the common stock. Section 3. Preferred Stock. The preferred stock of this association may be issued to any person, association, partnership, or corporation. Preferred stock shall carry no voting rights. Noncumulative dividends not to exceed percent (_%) per year may be paid on preferred stock at the absolute discretion of the board of directors. Preferred stock may be transferred only on the books of the association. It may be redeemed in whole or in part on a pro rata basis at par, plus any dividends declared and unpaid, at any time on thirty 18 (30) days’ notice by the association, provided said stock is redeemed in the same order as originally issued by years. If the owner fails to deliver any certificate evidencing such stock, the association may cancel the stock on its books. This association shall have a lien on all of its issued preferred stock for all indebtedness of the holders thereof to the association. Upon dissolution or distribution of the assets of the association, the holders of all preferred stock shall be entitled to receive the par value of their stock, plus any dividend declared and unpaid, before any distribution is made on the common stock. *ii********* ARTICLE VII. MENBERSHIP (nonstock cooperative) The association shall not have capital stock but shall admit applicants to membership in the association upon such uniform conditions as may be prescribed in its bylaws. This association shall be operated on a cooperative basis for the mutual benefit of its members as producers. Membership in the association shall be restricted to producers and associations of producers who shall patronize the association, The voting rights of the members of the association shall be equal, and no member shall have more than one vote upon each matter submitted to a vote at a meeting of the members. The property rights and interests of each member in the association shall be unequal and shall be determined and fixed on a patronage basis, and the net proceeds from the business of the association shall be allocated to member-patrons in the proportion that the patronage of each member bears to the total patronage of all the members of the association. 19 Amendment The articles may be changed whenever the appropriate percentage of the membership (and, if required by statute, the directors), as set out in the incorporation statute, votes to amend them. While the percentage is established by law, it is a good idea to include that requirement in the articles to remind people that the articles can be changed and to eliminate doubt as to the supp,ort required when the issue of possible amendment arises. While a majority of the statutes set the requirement at a simple or two-thirds majority of the members voting, several statutes require approval of a majority of the total membership. If turnout for member meetings is light, this poses a serious obstacle to changing the articles. ARTICLE VIII. Amendment These articles may be amended upon the affirmative vote of two-thirds of the members actually voting on the proposed amendment. Signatures Those persons who ask the State to authorize the cooperative, often called incorporators, complete the document by signing it. Signed this day of ,19__, by the undersigned incorporators, all of whom are engaged in agriculture as bona fide producers of agricultural products. I 20 BYLAWS Shortly after the cooperative is incorporated, the members adopt a set of bylaws. Bylaws provide a detailed description of the structure and method of operation of the cooperative. Bylaws are a working plan for how the association should function. Most incorporation laws give members flexibility to structure their cooperative as they see fit. Most references to bylaws are permissive, giving members the authority to write their own rules on how to handle a particular issue. Bylaws normally are not filed with the State. But like the articles, they are treated in a manner similar to statutes by the courts. Failure of the leadership to follow the bylaws can also lead to legal liability. Numerous provisions are usually found in cooperative bylaws. Some are similar to those included in bylaws of forprofit corporations, others are unique to cooperation. The most common provisions are discussed in this report. But a cooperative is free to place virtually any rule on the conduct of its affairs in the bylaws, provided the provision doesn’t conflict with an applicable law or the articles of incorporation. While almost any activity can be covered by a bylaw, only broad issues of long-term significance to members should be the subject of a bylaw. Operating decisions should not be covered in the bylaws, but rather in board policy resolutions. Board policies are directives to the management, issued by the board in its role as policymaker for the cooperative, that can be changed to reflect changing conditions at any time by the board. For example, whether the cooperative will do business with nonmembers is a general, long-term decision that should be covered in the bylaws. How nonmembers will be charged to insure that they pay their fair share of cooperative expenses is a short-term decision requiring the flexibility possible under a policy statement. Membership The first bylaw usually states the qualifications to be a member of the cooperative. Membership should be limited to 21 persons who will patronize the cooperative. For an agricultural cooperative, this means membership should be limited to producers of agricultural products and other farmer cooperative associations. Limiting the membership to producers and producer cooperatives is essential if the association wants to qualify for the limited antitrust protection of the Capper-Volstead Act, or for tax treatment under section 521 of the Internal Revenue Code, or if the cooperative is incorporated under a State law that requires that members be agricultural producers. This bylaw may also include other reasonable prerequisites to membership, such as agreeing to purchase a share of stock, sign a marketing agreement, and patronize the association on a regular basis. This bylaw should also provide for the orderly termination of a membership. This can be particularly important for an agricultural cooperative. The significant legal privileges listed above are only available to associations of producers. This requirement is only met if the membership of anyone who stops farming is revoked. When a membership is terminated, it is a good practice to return the purchase price of the voting share of common stock, or the membership fee in a nonstock cooperative (but not necessarily the retained patronage investments). This makes it clear to the former member that the termination was more than a symbolic gesture and that he or she no longer has the right to participate in the policymaking of the association. This sample language is written for a stock cooperative. In a nonstock cooperative, appropriate references to membership certificates and fees would be substituted for the terms common stock and purchase price. I ARTICLE I. MEMBERSHIP Section 1. Qualifications. Any person, firm, partnership, corporation or association, including both landlord and tenant in share tenancies, who is a bona fide producer of agricultural products in the territory in which the association is engaged in business, and who agrees to be a patron of the associa22 tion, signs a marketing agreement with the association, purchases one share of common stock, and meets such other conditions as may be prescribed by the board of directors, may become a member of the association. All applications for membership must be approved by the board of directors. Member status is effective as of the time the board approves the application for membership. Section 2. Suspension or Termination. In the event the board of directors of the association shall find, following a hearing, that any of the common stock of this association has come into the hands of any person who is not eligible for membership, or that the holder thereof has ceased to be an eligible member, or that such holder has not marketed through the association the products covered by a marketing agreement with the association, or not otherwise patronized the association for a period of (_) year(s), or otherwise violated the articles of incorporation, bylaws, or other agreements made with the association, the association may suspend such holder’s rights as a member and terminate the membership. When a membership is terminated, the association shall repurchase the member’s share of common stock for par value. The holder shall return to the association the certificate evidencing the holder’s share of stock. If such holder fails to deliver the certificate, the association may cancel such certificate on its books and records, and the certificate is then null and void. A suspended or terminated member shall have no rights or privileges on account of any stock held, nor vote or voice in the management or affairs of the association other than the right to participate in accordance with law in case of dissolution. 23 Meetings of Members A cooperative is owned and controlled by its members. A bylaw sets out the ground rules for convening the members to exercise their control function. An annual meeting is held each year to elect directors, review past performance and future plans, and conduct other business as needed. It is often a good idea to set the time of the annual meeting as promptly as possible after the end of the fiscal year. This encourages management to close the books for the year in a timely fashion and the auditor to review financial results and issue the audit report without delay. Also, the members are still focusing on last year’s performance. If the annual meeting is delayed too long, the members are often into another production cycle and not able to properly exercise their control over the cooperative. This bylaw should also authorize special member meetings to handle any business that can’t wait until the next annual meeting. Members should receive sufficient advance notice so they can plan to attend meetings. Many incorporation statutes have specific minimum notice requirements, both in terms of lead time (often 10 days or 2 weeks) and method (direct mail, publication in local newspaper). Associations incorporated under such a law must make sure the bylaw provides at least as much notice as the statute requires, and that appropriate notice is actually given. Otherwise any action taken at the meeting may be open to legal challenge. A statement on how voting will be conducted is also appropriate in this bylaw. How many votes each member will have is only one aspect of this issue. The draft language limits each member to one vote. If proportional voting is used, a description of how members will qualify for multiple votes, and a limit, if any, on the number of votes any one member can accumulate, should be substituted in the applicable place. Language on voting on behalf of members organized as partnerships and corporations can avoid an embarrassing dispute right before or even during a membership meeting over how such a member will vote on an issue. Many cooperatives 24 have members organized as partnerships or corporations designate, in writing, who will cast the member’s vote, and that person alone can vote for the member until the member provides a valid written notice of a change in the designee. Other topics that should be addressed include proxy voting, voting by mail, and cumulative voting. There is no “right” way to handle these matters, although cumulative voting is usually prohibited. Sometimes the incorporation statute discusses proxy voting and voting by mail. Many cooperatives that permit proxy voting limit the number of proxies a member can vote, often to only one. If voting by mail is allowed, it is often limited to issues discussed in the meeting notice. Finally, the minimum number of members that need be present to conduct business, called a quorum, should be specified. If the statute permits, quorum requirements are frequently set low (e.g., 10 members or 10 percent of the membership, whichever is greater) so meetings will not have to be adjourned for lack of a quorum. While this exposes the association to control by an active minority, it is sometimes necessary in order to make sure that any business is conducted at all. ARTICLE II. MEETINGS OF MEMBERS Section 1. Annual Meeting. The annual meeting of the members of this association shall be held in the State of , during the month of -9at such time and in such place as the board of directors shall designate. Section 2. Special Meetings. Special meetings of the members of the association may be called at any time by order of the board of directors and shall be called upon written request of at least members, or at least _ percent (__%) of the membership, whichever is a greater number. Section 3. Notice of Meetings. Written notice of every regular and special meeting of members shall be prepared and mailed to the last known post office 25 address of each member not less than -0 days before such meeting. Such notice shall state the nature of the business expected to be conducted and the time and place of the meeting. No business shall be transacted at any special meeting other than that referred to in the notice. Section 4. Voting. Unless otherwise stated in the articles of incorporation, or these bylaws, or required by applicable law, all questions shall be decided by a vote of a majority of the members voting thereon. Each member shall be entitled to only one vote, Voting by mail shall not be permitted. Proxy voting shall be allowed. Each proxy shall be in writing, and no member shall vote more than one proxy. Cumulative voting is not permitted. If a membership is held by a partnership, corporation, or other legal entity, the member shall designate in writing the person who shall vote on behalf of the member. That designation shall remain in effect until written notice of a properly authorized change in the designated voter shall be received by the association. Section 5. Quorum.( members or percent I%) of the membership, whichever is a larger number, shall constitute a quorum at any properly called annual or special membership meeting. Directors and Officers While the members own and control the cooperative, the responsibility for continuous supervision of the association is usually delegated to a small group of democratically elected leaders referred to as the board of directors, who in turn select officers to carry out specific leadership duties. Many cooperative experts consider the selection of directors as the most important governance decision made by the membership. 26 This bylaw covers the administrative rules for the selection of directors and officers and for the conduct of their meetings. Many important issues are discussed in this provision. Number and Qualification of Directors. The specific number and qualifications of directors must be established. The incorporation law will usually prescribe a minimum number of directors. There is no legal maximum on the size of a board, but experience suggests that if more than about nine people are on a local cooperative board, efficiency is reduced substantially. Many State statutes require that all directors be members of the cooperative. Some permit, or even require, one or more outside directors. The sample bylaw requires directors to be association members. If outside directors are to be authorized, the number and manner of selection should be included in the bylaw. Directors have access to pricing and other marketing plans that could be used by a competitor to take business from the cooperative. Thus, many cooperatives bar persons affiliated with competitors of the association from being directors. Cooperatives usually do not, however, bar such persons from membership. For example, a farmer who sells produce directly to a grocery chain may belong to and market some produce through a cooperative that also sells wholesale, but that farmer is frequently denied access to a seat on the cooperative board. A few cooperatives guarantee board turnover by limiting the number of consecutive terms a director can serve. Director and Officer Selection. The rules for election of directors by the members, and officers by the directors, are set out in the bylaws. In many cooperatives the directors are elected for three-year terms on a staggered basis. While directors are usually elected from the membership at large, some cooperatives elect directors on the basis of geographic regions, usually called districts. Sample language authorizing the election of directors by districts is set out in Appendix A. Officers are usually elected for one-year terms. Even many statutes that require all directors to be association members permit some officers, notably the secretary and treasurer, to be nonmembers of the association. This allows staff employees who normally keep association records and books to have both the appropriate title and attendant responsibilities. 27 Sometimes directors and officers are not able to serve their full term. The bylaws should provide for a method to fill vacant director and officer positions, Usually the remaining directors select an interim director to fill a board vacancy until the next membership meeting. Directors can usually select a replacement officer at any properly called board meeting. Meetings. The bylaws frequently provide much of the same information for director meetings as for member meetings - regular and special meetings are authorized, notice and quorum requirements are set out. Compensation . Another issue that should be addressed is director compensation. Many directors spend innumerable hours each year overseeing and promoting the cooperative. It seems reasonable for the association to at least cover out-ofpocket expenses incurred on behalf of the association. Some cooperatives also pay a modest fee for each meeting directors attend, or time they spend on cooperative affairs. While reimbursement of reasonable expenses is usually covered with a blanket authorization, fees should be handled more delicately. Directors should not have the right to set their own compensation. Both the decision to pay any fee, and the level of any fee authorized, should be made by the members. Nepotism. Many cooperatives also have a bylaw provision preventing directors and members of their immediate families from holding salaried positions with the cooperative. This antinepotism language eliminates the chance some members might view the awarding of the position as the result of undue influence of the director, rather than selection on the basis of merit. Removal of Directors. Finally, it may be necessary at some time to remove a director from that position. Sometimes termination is automatic, e.g., failure to maintain member status or missing too many board meetings. The ultimate authority in a cooperative is vested in the members, and they should be able to remove a director at will. As this is often a severe and divisive undertaking, it is best to provide a procedure in the bylaws that affords due process for the director under attack and conforms closely to any procedural requirements set out in the incorporation statute. 28 ARTICLE III. DIRECTORS AND OFFICERS Section 1. Number and Qualification of Directors. The association shall have a board of directors of _(_) members. Each director elected shall be a member of this association in good standing. No person shall be eligible to be a director if that person is in competition with, or is affiliated with any enterprise that is in competition with, the association. If a majority of the board of directors of the association finds at any time following a hearing that any director is so engaged or affiliated that person shall thereupon cease to be a director. No director after having served for I ) consecutive full term(s) shall be eligible to succeed himself or herself, but after a lapse of _ I_) yed4 d-d again be eligible. Section 2. Election of Directors. At the first annual meeting of the members of this association, directors shall be elected to succeed the incorporating directors. _ director(s) shall be elected for one (1) year: _ directors for two (2) years and _directors for three (3) years. At each annual meeting thereafter, new directors shall be elected, for a term of three (3) years each, to succeed those directors whose terms are expiring. All directors shall be elected by secret ballot, and the nominee(s) receiving the greatest number of votes shall be elected. Section 3. Election of Officers. The board of directors shall meet within seven (7) days after the first election and within seven (7) days after each annual election and shall elect by ballot a president, vice president, secretary, and treasurer, each of whom shall hold office until the election and qualifi29 cation of a successor, unless earlier removed., by death, resignation, or for cause. The president and vice president shall be members of the board of directors. The secretary and treasurer need not be directors or members of the association. Section 4. Vacancies. Whenever a vacancy occurs in the board of directors, other than from the expiration of a term of office, the remaining directors shall appoint a member to fill the vacancy until the next regular meeting of the members. If the term of the vacating director does not expire at that regular member meeting, a special election shall be held to select a director to fill the year or years remaining in that term. If one or more officer positions become vacant, such offices shall be filled by the board of directors, through election by ballot, at either a regular or special meeting of the board. Section 5. Regular Board Meetings. In addition to the meetings mentioned above, regular meetings of the board of directors shall be held monthly, or at such other times and at such places as the board may determine. Section 6. Special Board Meetings. A special meeting of the board of directors shall be held whenever called by the president or by a majority of the directors. Only the business specified in the written notice shall be transacted at a special meeting. Each call for a special meeting shall be in writing, shall be I signed by the person or persons calling the meeting, shall be addressed and delivered to the secretary, and shall state the time and place of such meeting. Section 7. Notice of Board Meetings. Oral or written notice of each meeting of the board of directors shall be given each director by, or under the 30 supervision of, the secretary of the association not less than _ hours prior to the time of meeting. But such notice may be waived by all the directors, and their appearance at a meeting shall constitute a waiver of notice. Section 8. Quorum. A majority of the board of directors shall constitute a quorum at any meeting of the board. Section 9 . Reimbursement and Compensation. The association shall reimburse directors for all reasonable expenses incurred in carrying out their duties and responsibilities. The compensation, if any, of the members of the board of directors shall be determined by the members of the association at any annual or special meeting of the association. No member of the board of directors, or member of the immediate family of any board member, shall occupy any position in the association on regular salary. Section 10. Removal of Directors. Whenever any director shall fail to meet the qualifications as described in Section I of this Article, or fails to attend three (3) consecutive board meetings, either regular or special, without just cause and provided that notice of such meetings has been given in accordance with these bylaws, then it shall be the duty of the board to remove said director and to fill the vacancy in accordance with Section 4 of this Article. Members, through petition noting the charges and signed by at least _(J members or _ percent (_%) of the membership, whichever is a greater number, may request the removal of any member of the board. Such director shall be notified in writing of the charges and given an opportunity to be heard at a membership meeting of the association. Removal of a director shall require a vote of of 31 I members voting. Any vacancy resulting from such action shall be filled by nomination and vote of members at such meeting. Duties of Directors The directors are responsible for the ongoing operations of the cooperative. They set policy and oversee the staff operations that implement that policy. Cooperative bylaws often contain language placing a legally binding obligation on the directors to carry out their most important duties. This bylaw often establishes the general relationship between the directors and the manager. An important responsibility of the board is to hire and supervise the manager. The board sets manager compensation and benefits. The manager, not the board, runs the day-to-day business operations of the cooperative. This includes hiring and firing other employees. If the board is dissatisfied with the way the cooperative is conducting its affairs, it should exercise its authority to replace the manager, but it should not take on the manager’s responsibilities. The bylaw should also recognize another important board responsibility-protecting member assets-by providing for appropriate bonds and insurance, an accounting and auditing system, and board control of association funds. Finally, the board should have the authority to appoint committees so its work load can be handled efficiently. Sometimes specific reference is made to an executive committee. An executive committee with broad powers can be useful, especially when the membership is spread over a large geographic area and some directors have to travel some distance to attend meetings. But the other directors must be careful not to abdicate all board responsibility to the executive committee. ARTI&E IV. DUTIES OF DIRECTORS Section 1. Management of Business. The board of directors shall have general supervision and control of the business and the affairs of the associa32 tion and shall make all rules and regulations not inconsistent with law, the articles of incorporation, or bylaws for the management of the business and the guidance of the members, officers, employees, I and agents of the association. Section 2. Employment of Manager. The board of directors shall have power to employ, define duties, fix compensation, and dismiss a manager with or without cause at any time. The board shall authorize the employment of such other employees, agents, and counsel as it from time to time deems necessary or advisable in the interest of the association. The manager shall have charge of the business of the association under the direction of the board of directors. Section 3. Bonds and Insurance. The board of directors shall require the manager and all other officers, agents, and employees charged by the association with responsibility for the custody of any of its funds or negotiable instruments to give adequate bonds. Such bonds, unless cash security is given, shall be furnished by a responsible bonding company and approved by the board of directors, and the cost thereof shall be paid by the association. The board of directors shall provide for the adequate insurance of the property of the association, or property which may be in the possession of the association, or stored by it, and not otherwise adequately insured, and, in addition, adequate insurance covering liability for accidents to all employees and the public. Section 4. Accounting System and Audits. The board of directors shall have installed an accounting system which shall be adequate to meet the requirements of the business and shall require proper records to be kept of all business transactions. 33 Duti 34 At least once in each year the board of directors shall secure the services of a competent and disinterested public auditor or accountant, who shall make a careful audit of the books and accounts of the association and render a report in writing thereon, which report shall be submitted to the directors and the manager of the association and made available to the members of the association. This report shall include at least a balance sheet showing the true assets and liabilities of the association, and an operating statement for the fiscal period under review. Section 5. Depository. The board of directors shall select one or more banks to act as depositories of the funds of the association and determine the manner of receiving, depositing, and disbursing the funds of the association and the form of checks and the person or persons by whom they shall be signed, with the power to change such banks and the person or persons signing such checks and the form thereof at will. Section 6. Committees. The board may, at its discretion, appoint from its own membership an executive committee of _members, and determine their tenure of office and their powers and duties. The board may delegate to the executive committee all or any stated portion of the functions and powers of the board, subject to the general direction, approval, and control of the board. Copies of the minutes of any meeting of the executive committee shall be mailed to all directors within seven (7) days following such meeting. The board of directors may, at its discretion, appoint such other committees as it deems appropriate. 5 of Officers Nhile the tasks that go with each major office of a corpora- tion are generally well understood, it is still important to have those duties spelled out in the bylaws. This will minimize any uncertainty over the roles each plays in leading the association. ARTICLE V. DUTIES OF OFFICERS Section 1. Duties of President. The president shall (1) preside over all meetings of the association and of the board of directors: (2) call special meetings of the board of directors; (3) appoint such committees as the board of directors may deem advisable for the proper conduct of the cooperative: and (4) perform all acts and duties usually performed by a presiding officer. Section 2. Duties of Vice President. In the absence or disability of the president, the vice president shall perform the duties of the president, provided, however, that in case of death, resignation, or disability of the president, the board of directors may declare the office vacant and elect any eligible person president. Section 3. Duties of Secretary. The secretary shall keep a complete record of all meetings of the association and of the board of directors and shall have general charge and supervision of the books and records of the association. The secretary shall sign papers pertaining to the association as authorized or directed by the board of directors. The secretary shall serve all notices required by law and by these bylaws and shall make a full report of all matters and business pertaining to the office to the members at the annual meeting. The secretary shall keep the corporate seal and all books of blank certificates, complete and countersign all certificates issued, and affix the corporate seal to all papers requiring a seal: shall keep complete stock ownership records: shall make all reports required by law: and shall perform 35 such other duties as may be required by the association or the board of directors. Upon the election of a successor, the secretary shall turn over all books and other property belonging to the association. Section 4. Duties of Treasurer. The treasurer shah be responsible for the keeping and disbursing of all monies of the association, and shall keep accurate books of accounts of all transactions of the association. The treasurer shall perform such duties with respect to the finances of the association as may be prescribed by the board of directors. At the expiration of his term of office, the treasurer shall promptly turn over to his successor all monies, property, books, records, and documents pertaining to his office or belonging to the association. Operation at Cost and Members’ Capital Many of the unique aspects of the bylaws of a cooperative pertain to the association’s financial affairs. Tax law plays an important part in structuring these provisions. This report does not attempt to explain cooperative taxation but only makes passing references to tax terms when explaining the importance of certain bylaw provisions. Since the overall objective of a cooperative is to maximize the income of its members, leaders must have flexibility to acquire capital and minimize taxes. The next several provisions, up to and including dissolution, authorize business and tax planning options compatible with doing business on a cooperative basis. This section often starts with a straightforward statement that the association will operate on a service-at-cost basis for the mutual benefit of the members as patrons and then covers specific issues to implement that statement. Language is usually included to allocate margins on a patronage basis. Allocation can be based on the volume or the value of business conducted on a patronage basis. Cooperatives dealing in one commodity, or in similar commodities, usually use the volume method. Those that handle several products 3s with divergent values often use the dollar-value-of-business method. The sample language assumes that the association is a marketing cooperative using the volume method. Appropriate wording for supply cooperatives and those using the value method is provided in parentheses. Marketing cooperatives have an alternative method of raising equity capital, the collection of per-unit retains. Language authorizing this option should be included in their bylaws. The term “capital credits” is used in the sample language to distinguish the retained margins and per-unit retains from direct member investments in stock. This distinction simplifies establishing an equity redemption program for patronage-based investments apart from any redemption of direct investments. The bylaw should specify whether dividends will be paid on this patronage capital. Since the completeness and accuracy of each patron’s account is vital to assigning financial obligations and benefits in the appropriate manner, a provision obligating the association to keep the required records is an important protection for the members. A statement requiring the timely distribution of written notices of allocation and per-unit retain certificate is both good business practice and a requirement for favorable tax treatment under the Internal Revenue Code. That statement should authorize the board to issue those notices and certificates, in either qualified or nonqualified form, so as to maximize the tax planning alternatives available. ARTICLE VI. OPERATION AT COST AND MEMBERS’ CAPITAL Section 1. Operation at Cost. The association shall at all times be operated on a cooperative service-at-cost basis for the mutual benefit of its member patrons. Section 2. Margin Allocation. In order to induce patronage and to assure that this association 37 will operate on a service-at-cost basis in all its transactions with its members, the association is obligated to account on a patronage basis to all member patrons on an annual basis for all amounts received from business conducted with members on a patronage basis, over and above the cost of providing such services and making reasonable additions to reserves. Such allocation shall be on the basis on the volume (dollar value) of product marketed through (purchased from) the association. The association is hereby obligated to pay all such amounts to the patrons in cash or by credits to a capital account of each member patron. Section 3. Per-Unit Retains. Each member also agrees to provide capital in such amounts as determined by the board of directors based on physical units of product marketed through the association. Such per-unit retains shall be allocated to the member’s capital credit account, Section 4. Dividends. No dividends shall be paid on any capital credits. Section 5. Records and Documentation. The books and records of the association shall be set up and kept in such a manner that at the end of each fiscal year, the amount of capital, if any, so furnished by each member is clearly reflected and credited in an appropriate record to the capital account of each member. The association shall, within 8-l/2 months after the close of each fiscal year, notify each member of the capital so credited to the member’s account. The notice shall be in the form of a written notice of allocation or per-unit retain certificate (as those terms are used in Subchapter T of the Internal Revenue Code) or other appropriate written document. The board shall have discretion to issue such 38 notices and certificates in either “qualified” or “nonqualified” form as permitted by the Internal Revenue Code and other applicable law. Section 6. Fiscal Year. The fiscal year of this association shall commence on the first day of (month) and end on the last day of (preceding month). Equity redemption A bylaw authorizing redemption of patronage capital and explaining the method to be used helps insure that, to the extent possible, current patrons finance the cooperative. There are three types of equity redemption plans. Most cooperatives that have an equity redemption program use a revolving fund plan whereby equities are redeemed in the order in which they were allocated. The first paragraph of the sample bylaw presents this approach. A limited number of cooperatives redeem a percentage of all outstanding equities each year. Sample language to implement this plan is found in section 1 of the Alternative Equity Redemption Bylaw (Appendix B). A few cooperatives have adopted a base capital plan. Under a base capital plan each member is assigned responsibility for providing a pro rata share of needed capital based on proportional use of the cooperative during a base period. A sample bylaw authorizing a Base Capital Plan is presented in Appendix C. Associations interested in such a plan should contact a professional adviser who can draft a scheme tailored to the association’s unique needs. Some cooperatives grant the board discretion to retire outstanding member equity “out of order” as it deems in the best interests of the association. Sample language for implementation of the discretionary approach appears in the second paragraph of the sample bylaw below. Other cooperatives provide a specific redemption preference for equity of the estates of deceased members and/or retired members who have reached a certain age. An event-specific preferences clause can be complex, particularly if it attempts to 39 deal with the special problems created by members organized as legal entities and thus do not regularly retire or die. Sample language covering this situation is provided in section 2 of the sample bylaw in Appendix B. New associations are not going to be in a position to redeem equity for several years. But an early commitment to develop a regular equity redemption program and agreement on the rules for its implementation will strengthen an association’s cooperative character and give early supporters some assurance that they will get their investment back at some time in the future. Consent ARTICLE VII. EQUITY REDEMPTION Section I. Regular Redemption, Revolving Fund. If at any time the board of directors determines that the financial condition of the association will not be impaired thereby, capital credited to members’ accounts may be redeemed in full or in part. Any such redemption of capital shall be made in order of priority according to the year in which the capital was furnished and credited, the capital first received by the association being the first redeemed. Section 2. Discretionary Special Redemptions. Notwithstanding any other provision of these bylaws, the board, at its absolute discretion, shall have the power to retire any capital credited to members’ accounts on such terms and conditions as may be agreed upon by the parties in any instance in which the interests of the association and its members are deemed to be furthered thereby and funds are determined by the board to be available for such purposes. If the cooperative is to deduct the face value of written notices of allocation and per-unit retain certificates from taxable income in the year issued, the Internal Revenue Code requires patrons to consent to include those amounts in taxable income 40 in the year they receive a notice or certificate, even though the cooperative retains the funds. The simplest way to obtain consent from members is to include a bylaw making consent a condition for membership. The Internal Revenue Service has published a model consent bylaw which should be adopted. Another paragraph is inserted making it clear that the cooperative must explain the meaning of consent to members and prospective members: this reminds leaders that such an explanation is also a tax law requirement. ARTICLE VIII. CONSENT Each person who hereafter applies for and is accepted to membership in this association, and each member of this association on the effective date of this bylaw who continues as a member after such date, shall, by such act alone, consent that the amount of any distributions with respect to his patronage occurring after the effective date of this bylaw, which are made in qualified written notices of allocation or qualified per-unit retain certificates (as defined in 26 U.S.C. 1388), and which are received by him from the cooperative, will be taken into account by him at their stated dollar amounts in the manner provided in 26 U.S.C. 1385(a) in the taxable year in which such written notices of allocation and per-unit retain certificates are received by him. Written notification of the adoption of this Article, a statement of its significance, and a copy of the provision shall be given separately to each member and prospective member before membership in the association. Nonmember Business The bylaws should make it clear whether the association may or may not do business with nonmembers. The sample bylaw assumes that the association will want the option to conduct nonmember business. 41 If the association does nonmember business, the CapperVolstead Act and many State incorporation laws require that a majority of the association business be done with or for members. The first three sentences of the sample bylaw are thus found in most cooperative bylaws. If an association wishes to qualify for tax treatment under section 521 of the Internal Revenue Code, it may not do more than 15 percent of its farm supply business with persons who are neither members nor producers (business with the Federal government can be disregarded in making this computation). The last two sentences in the example cover this situation. ARTICLE IX. NONMEMBER BUSINESS This association may conduct business with nonmembers on either a patronage or nonpatronage basis. However, this association shall not market the products of nonmembers in an amount the value of which exceeds the value of the products marketed for members. Itshall not purchase supplies and equipment for nonmembers in an amount the value of which exceeds the value of the supplies and equipment purchased for members. It shall not purchase supplies and equipment for persons who are neither members nor producers of agricultural products in an amount the value of which exceeds fifteen percent (15%) of all its purchases. Business done for the United States or any of its agencies shall be disregarded in determining the limitations imposed by this section. Nonpatronage Income Several factors are combining to increase the proportion of cooperatives that have taxable earnings from nonpatronage sourced. These factors include a growing reliance on nonmember business to sustain the cooperative, more forceful positions by IRS auditors to classify investment income as nonpatronage sources, and less use of section 521. The bylaws should recog42 nize this as special income and provide the board discretion to add it to a capital reserve, distribute it to members, or put it to any other lawful use. I ARTICLE X. NONPAlXONAGE INCOME The nonpatronage income of the association shall be its gross receipts derived from all sources which under law do not qualify as patronage income, less all expenses properly attributable to the production of such nonpatronage sources income and all income taxes payable on such receipts by the association, Nonpatronage income shall be used in behalf of the association and its members in accordance with such lawful purposes, including assignment to an unallocated reserve account and allocation in whole or in part to members, as may be determined by the board of directors. Handling of Losses While cooperatives operate at cost over the long term, the financial world operates for accounting and tax purposes in single-year segments. Sometimes cooperatives have a loss in that relatively short framework. The bylaws should anticipate the possibility of a loss year. They should explain how decisions will be made to allocate the loss on an equitable basis. The proper treatment of losses by cooperatives for tax purposes has long been a contentious issue between cooperatives and the Internal Revenue Service. The sample bylaw reflects a moderate position that financial results on patronage and nonpatronage business should be separated: gains and losses within each category can be combined, or “netted,” for tax purposes; and losses under either category can be carried back or forward to offset earnings in other years under the applicable provisions of the tax code for businesses in general. As the rules for handling losses are subject to change from time to time, counsel should be asked to keep informed on this issue and advise the association when this bylaw may need revision. 43 It may also be prudent to include a prohibition on directors voting a direct assessment on the members. This will prevent outside interests from pressuring the directors into an action likely to have a negative impact on member relations. ARTICLE XI. LOSSES Section z . Patronage Losses. In the event the association suffers a loss during any year on business conducted with or for patrons, such loss may be apportioned among the patrons during the year of loss so that such loss will, to the extent practicable, be borne by the patrons of the loss year on an equitable basis. The board shall have full authority to prescribe the basis on which capital furnished by patrons may be reduced or such loss otherwise equitably apportioned among the patrons. In the event of a patronage loss in one or more departments or divisions of the operation of this association, but not so much as to cause an overall loss for the fiscal year, such loss or losses may be prorated against each of the remaining profitable departments on the basis of their respective percentage of the net margins during such fiscal year. Section 2. Nonpatronage Losses. If in any fiscal year the association shall incur a loss other than on patronage operations, such loss may be charged against any reserve accumulated from nonpatronage earnings in prior years. Section 3. General Provisions. The board shall have no authority to make assessments against members. This section shall not be construed to deprive the association of the right to carry backward or forward losses from any source whatsoever in accordance with the Internal Revenue Code or state taxing statutes. 44 Dissolution Many of the rules to dissolve a cooperative are contained in various statutes and are too complex to reproduce in the bylaws. One issue that should be addressed is how any assets that might remain after all liabilities are met should be distributed. In a noncooperative corporation this is usually done on the basis of stock ownership and, if the bylaws are silent on this issue, this may be the rule imposed on cooperative members by a court. It is a good idea to consider language in the bylaws of a cooperative making clear that such a distribution will be on the basis on patronage. I ARTICLE XII. DISSOLUTION AND PROPERTY INTEREST OF MEMBERS Upon dissolution, after all debts and liabilities of the association shall have been paid, all shares of preferred stock and common stock redeemed, and all capital furnished through patronage shall have been retired without priority on a pro rata basis, the remaining property and assets of the association shall be distributed among the members and former members in the proportion which the aggregate patronage of each member bears to the total patronage of all such members insofar as practicable, unless otherwise provided by law. Indemnification As the trend toward litigating to test the validity of various decisions by corporate leaders has grown, so has the possibility that directors, officers and employees may be found personally liable for the adverse consequences of their decisions. This has made some people understandably reluctant to assume leadership positions, particularly as unpaid or minimally compensated directors and officers. State governments, recognizing the valuable role directors and officers play in corporate affairs, have adopted a variety of 45 laws limiting liability of corporate leaders and permitting corporations to shield leaders from direct personal loss for decisions they make on behalf of the corporation. In many States this is a developing area of the law, and the extent of permissible indemnification changes frequently. To encourage members to serve as directors, and to make sure leaders don’t shy away from innovative ideas, cooperatives should consider a bylaw accepting the maximum amount of responsibility for indemnification permitted by State law. Prudent risk management usually includes the purchase of liability insurance to protect against an indemnification claim that might otherwise lead to significant exposure for the association. This coverage can seem quite expensive, so the sample language uses the permissive term “may” rather than the mandatory term “shall.” But whenever possible, this insurance should be obtained to avoid exposing member assets to unacceptable risk. I ARTICLE XIII. INDl3MNIFICATION The association shall indemnify its officers, directors, employees, and agents to the fullest extent possible under the provisions of the (applicable State law), as it may be amended from time to time. The association may purchase liability insurance coverage for any person serving as an officer, director, employee or agent to the extent permitted by applicable State law. Amendment It is important for cooperative leaders to remember that bylaws are not set in stone. They can, and should, be changed whenever they stand as a barrier to cooperative activity desired by the member-owners and permissible under the law. While the incorporation statute will include language permitting amendment of the bylaws and setting out how this can be accomplished, a bylaw on amendment is usually included to 46 remind leaders that change is possible and to call attention to any unusual legal requirement, such as a higher than normal positive voting requirement, that may be applicable. ARTICLE XIV. AMEXWMENTS If notice of the character of the amendment proposed has been given in the notice of meeting, these bylaws may be altered or amended at any regular or special meeting of the members by the affirmative vote of (_) of the members present or voting by proxy. Again, these are only examples of the provisions common to most cooperative bylaws. Virtually any other rule can be included that is permissible under law. It is up to the leaders and members of a cooperative to craft a set of bylaws that guides the association to serving members’ needs. MARKETING AGREEMENT Cooperatives that market farm products and other goods of their members will usually want a separate contract with each member establishing the terms upon which they will conduct their business transactions. This contract is commonly called a marketing agreement. If the members only want the cooperative to serve as a home-of-last-resort for product that can’t be sold elsewhere, then a marketing agreement is not necessary. But if the members want an organization that will enhance the return they earn on all of their production, then a marketing agreement is an important marketing tool. The marketing agreement is a unique contract in that, because the members own ,and control the cooperative, the members are entering into a contract with themselves. But it is more accurate to picture the agreement as a contract between each individual member and the membership as a whole. An important key to making the system work is for everyone to remember that the cooperative is democratically con47 trolled by the members. No individual member has a right to unilaterally cancel or change the marketing agreement, and the leadership should not insist on arrangements that are contrary to the wishes of a majority of the membership. The marketing agreement builds on the patronage commitment section of the organizational agreement. Each individual member’s obligation to the organization committee is transferred to the new cooperative entity. While the basic content of the articles and bylaws is standardized throughout the cooperative community, the substantive provisions of the marketing agreement are influenced by the custom and trade of the market for the commodity covered by the agreement. Thus the sample language may need substantial modification to meet member needs. As with the articles and bylaws, the terms of the marketing agreement are binding until changed, but they are not etched in stone. The association-represented by its officers and directors-and the members are free to adopt an approach to any issue different than the approach set out in the organization agreement or in previously adopted marketing agreements. Introduction These initial provisions identify the parties to the contract, the cooperative and the producer, and usually establish any other requirements that the producer must meet, including any initial equity investment obligation, to be a member of the cooperative. I MARKEUINGAGREEMENT THIS AGREEMENT, made as of this _ day of x9_, by and between , herein referred to as “Producer,” and t an agricultural cooperative having an office at , herein referred to as “Association”. RECITALS A. Association is an agricultural cooperative organized under the laws of the State of . B. Producer is a member of the Association who produces . C. Producer has purchased one share of common voting stock and paid to Association the sum of dollars ($), calculated at the rate of $ per -(unit) of (product) as specified in Producer’s membership application, receipt of which is acknowledged as an equity investment in the Association. This entitles Producer to all the benefits of membership in the Association as long as Producer complies with the articles of incorporation and bylaws of the Association and the provisions of this agreement. In consideration of the mutual covenants and obligations contained herein, the parties agree as follows: sales Terms This provision outlines how the association will sell the products and pay the member-patrons. The first paragraph normally defines the obligation of the producer to deliver product to the association. The same three options outlined in the patronage commitment examples for the organization agreement-full production, defined volume, and set acreage-are available for use in setting the delivery commitment once operation begins, The defined volume option is utilized in this example, so if another type of obligation is adopted, appropriate modification of the first paragraph should be made. The second paragraph explains how the association will distribute the proceeds of resale to the member. Two ways of accounting for these proceeds are common. One is sometimes referred to as a gross margin operation. The association agrees 49 to pay the member the going market price for the product, less deductions for operating expenses. After the end of the fiscal year, any margin is returned to the producers as a patronage refund. The other is called the pooling method. In this arrangement all proceeds above expenses are returned to the producers on the basis of patronage. Such associations do not generate margins, as such, and thus lack access to retained patronage refunds to obtain equity. Pooling cooperatives must rely on per-unit retains and other means of raising capital. An example of draft language for each option is set forth below. Other terms of sale should also be included in the agreement. Sample language on several areas commonly covered are provided: responsibilities for delivery and for inspection and grading of the product; authorization for the association to pledge the product and sales proceeds as collateral for loans and otherwise exercise the rights of ownership: authorization for the association to withhold fees to cover operating expenses and capital retains from checks to growers; and an explanation of how the parties to the contract will deal with liens against the product. Section 1. Sale of (product). Association agrees to buy and Producer agrees to sell to Association (number) (units) of (product) as defined by USDA standards and grown by Producer. This agreement is intended by the parties to pass an absolute title to (number) _ (units) of (product) grown by Producer as soon as they have a potential existence but such (product) shall be at the risk of Producer until delivery. * * * * * * OPTION - Gross Margin Operation * * * * l l Section 2. Payment to Producer. Association shall market Producer’s (product) and Producer shall accept as payment for Producer’s (product) a price based on the current market price in the area for (product) of like grade and 50 quality. Association shall pay the amount due Producer, less deductions authorized in Section 6 of this agreement, not more than _ days after delivery of [product) to Association or Association’s prescribed buying location. l * * l l * OPTION - Pooling Operation l l * * * * Section 2. Payment to Producer. The Association may at any time pool any or all (product) of Producer with any other (product) of a similar kind and grade. Producer shall receive, for (product) pooled, a unit price equal to the average net unit price obtained for the pooled (product), less deductions authorized in Section 6 of this agreement. Association shall make an advance payment to Producer of percent of the current market price in the area for (product) of like grade and quality not more than _ days after delivery of (product) to Association or Association’s prescribed buying location. Section 3. Delivery. All (product) shall be delivered by Producer at Producer’s expense at the earliest reasonable time after harvesting, or at such time as called for by Association, to Association’s principal place of business or to one of Association’s authorized buying locations as prescribed by Association. The Association will use its best efforts to locate buying locations within a reasonable distance from Producer’s farm. Section 4. Inspection and Grading. Prior to acceptance by Association, all (product) shall be inspected and graded by the USDA in accordance with USDA standard rules and regulations. All purchases and/or marketings of (product) received by Association from Producer 51 shall be based upon USDA grade, and Producer agrees to accept the grading established by USDA. Section 5. Loans and Security. Association shall have the power to borrow money for any purpose on the security of the (product) delivered to Association, the products derived thereupon, and evidence of such products or by-products, or cash or accounts arising from the sale thereof, and to give a lien, either legal or equitable, thereon as the absolute owner and/or marketing agent thereof. Association may commingle such products and byproducts with other products and by-products of like grade and variety and shall exercise all other rights of ownership without limitation. Section 6. Deductions. Association agrees to purchase from and/or market for Producer the (product) set forth in Section 1 and to pay to Producer for said (product) the price set forth in Section 2, less the following deductions authorized by Producer: a. An amount to be determined annually by the board of directors, in the sole discretion of the board, to meet the general contingencies of the business of the Association including operating expenses. b.A$ . per___ (unit) capital retain deduction by the Association on the purchase price of each _(unit) of (product) received from Producer. Section 7. Liens. Producer shall notify the Association of any lien on any (product) covered by this agreement. Producer shall obtain permission from the lien holder for Association to market such (product) and to retain any deductions from the payments to Producer autho52 rized hereunder and under the articles of incorporation and bylaws of the Association. After any such deductions, Producer authorizes the Association to apply the balance of the sale proceeds, or so much thereof as necessary, for payment of the lien. Enforcement As a member owned and controlled entity, one of the most sensitive areas of management and leadership in a cooperative is the disciplining of members who violate their agreements with the association. But unless each member honors his or her obligations to the association, the collective strength of the venture is weakened and the entity’s chance of success is diminished. This is especially true where a marketing agreement is in effect. Management has to be able to anticipate the amount of product that will be delivered so it can plan for its processing and resale. Disruptions in anticipated delivery by natural causes, such as drought, are usually excused under a so-called “Act of God” clause in the cooperative’s contracts with buyers. But if members simply do not deliver product to the association as promised, management may be forced to buy product on the open market to meet association commitments or even default on its own contractual obligations. Usually a member knowingly violates the marketing agreement because the member thinks he or she can get a better price somewhere else. In the short term, this may indeed be the case. No firm always has the best price in a competitive market. But a cooperative must view itself as a long-term undertaking. If some members are allowed to forsake the cooperative for personal shortterm gain, they do so at the expense of those members who honor their agreement. Because the marketing agreement is a contract between each individual member and the membership as a whole, the leadership has the responsibility to protect the interest of the group as a whole. That means taking steps, including legal action if necessary, to enforce the marketing agreement. Most State cooperative incorporation statutes permit contractual provisions to facilitate enforcement of marketing agree53 ments. One is the inclusion of language providing for liquidated damages. In general corporate law, an injured party must prove the extent of the loss with great specificity to be eligible for compensation. This can be very difficult to do when agricultural commodities are involved. Their value changes by the day, or even by the minute. So in this instance, the parties can agree through contract on a specific level of damages, called liquidated damages, that will be the penalty for violating the contract. The level must be high enough to truly discourage breaches of the contract and to compensate the other members for their loss. A frequently used rule-of-thumb is 25 percent of the estimated market value of the commodity if it had been delivered under the contract. Marketing agreements also usually authorize the association to go to court and seek a restraining order against either actual or anticipated breach of the contract. The agreement may also make the offending party liable for legal fees incurred by the association in defending the agreement. Section 8. Liquidated Damages. The remedy at law would be inadequate and it would be impracticable and difficult to determine the actual damages to the Association should Producer fail to deliver the (product] covered by this agreement. Therefore, regardless of the cause of such failure, Producer agrees to pay to the Association for all such (product) delivered or disposed of by Producer, other than in accordance with the terms of this agreement, a sum equal to _ % of the fair market value of the product at the close of business on the day the product should have been delivered to the Association, as liquidated damages for the breach of this agreement. All parties agree that this agreement is one of a series dependent for its true value on the adherence of all the contracting parties to all of the agreements, but the cancellation of any other similar agreement or the failure of any of the parties thereto to comply therewith shall not affect the validity of this agreement. Failure to deliver the (product) commit54 ted herein due to ACTS OF GOD shall not constitute a breach of this agreement. Section 9. Specific Performance. Producer agrees that in the event of a breach or threatened breach by Producer of any provisions of this marketing agreement regarding delivery of (pmduct), the Association shall be entitled to a preliminary restraining order and an injunction to prevent breach or further breach hereof and to a decree of specific performance hereof. The parties agree that this is a contract for the purchase and sale of personal property under special circumstances and conditions and that the Association may, but shall not be obligated to, go into the open markets and buy -(product) to replace any that Producer may fail to deliver. Section 20. Legal Costs and Expenses. If the Association brings any action whatsoever by reason of a breach or threatened breach of this agreement, Producer shall pay to the Association all court costs, costs for bonds, travel expenses and all other expenses arising out of or caused by the litigation, including reasonable attorney’s fees expended or incurred by Association in such proceedings, and all such costs and expenses shall be included in the judgment. Termination and Renewal Management doesn’t want to have to get every member to sign a new agreement each year, and the producers aren’t going to want to be obligated to continue to patronize the cooperative if it isn’t meeting their needs. A provision providing that the contract automatically renews itself for another year unless either the cooperative or the member provides notice during a specific period of time-usually about a month during a slow period in production and cooperative activity-that it wants to terminate the agreement gives adequate flexibility and stability to the relationship. 55 Section 2 1. Termination and Renewal. After this agreement has been in effect one year from the date of execution, either party may terminate it in any year by notifying the other party in writing between (date) and (date). It is mutually agreed that failure to so terminate in any year shall constitute conclusive evidence that the parties have renewed this agreement for another year. Miscellaneous Provisions Individual cooperatives have adopted numerous additional provisions to tailor their marketing agreements to their individual needs. Examples of some of the more common, but by no means all, of these types of provisions are provided. Nonconforming agreements. From time to time, the association may want to alter the terms of its marketing agreement. This may occur when numerous agreements are in effect, and it is a good cooperative practice to treat all member equitably. Therefore, a provision permitting nonconforming contracts, but offering persons with ongoing agreements the option to change to the new agreement, often called a “most favored nation clause,” can be useful. If the association wants to bring all agreements back to uniformity, it can do so during the next time period for terminating existing agreements. Section 12. Nonconforming Agreements. Association may enter into agreements with other growers differing in terms from those contained herein, consistent with the bylaws of the Association, without invalidating this agreement, provided that Producer at Producer’s request may sign a similar agreement as a substitute for this agreement. No contrary agreements. One of the most difficult legal situations to untangle involves the member who signs more than one contract for the sale of the same commodity. A clause forbidding such activity helps place the responsibility for injuries suffered by the cooperative on the member. Section 13. No Contrary Agreements. Producer warrants that Producer has not contracted to sell, market, consign, or deliver and will not contract to sell, market, consign, or deliver any (product) during the term of this agreement to any person, firm or corporation, contrary to this agreement. Forfeiture of membership. If a member is going to disregard the terms of the marketing agreement, the cooperative is usually better off without that person as a member. A provision giving the board authority to revoke the membership of a member who violates the agreement gives appropriate discretion to the directors in dealing with a breach of the contract. Section 14. Forfeiture of Membership. Violation of this agreement in any material respect by Producer shall be grounds for the board of directors to terminate Producer’s membership in the Association. Abide by articles and bylaws. A similar provision requiring members to abide by the articles and bylaws, as written at the time the agreement is signed or subsequently a&nded, makes it clear that a member can’t abrogate the agreement if the membership approves a change in the cooperative organizational documents the individual member doesn’t like. That member must honor the agreement until the annual period for orderly termination arrives. I Section 15. Articles and Bylaws. Producer agrees to conform to and observe the articles of incorporation and bylaws of the Association now in force and as they may be amended hereafter. Assignment. Sometimes reorganizations occur during the year at either the association or the member level. The right of a new entity replacing one of the parties to enforce the contract can be clarified in the agreement itself. Because the association is the members as a whole, it can usually assign its rights at will. However, to protect against one member assigning rights to an 5 7 unqualified person, usually a member must have board approval to assign contract rights. Section 26. Assignment. This agreement may be assigned by the Association in its sole discretion. Producer may assign this agreement, but only upon written authorization granted by the board of directors of the Association. Entire agreement. A major cause of disputes over business contracts is the unwritten exception. One party to the contract will say, “I know the contract says that, but you told me you would do this.” Marketing agreements will frequently include language stating that the organizational documents and the agreement itself are the only contracts between the parties and no oral or other types of agreements will be honored. The manager, in particular, needs to be reminded of this rule. Special unauthorized promises or “deals” for selected members can do serious harm to the cohesiveness of the association. ~ Section 17. Entire Agreement. It is agreed that the articles of incorporation and the bylaws of the Association, now or hereafter in effect, and this marketing agreement constitute the entire agreement between the Association and Producer, and that there are no oral or other conditions, promises, covenants, representations, or inducements in addition to, or at variance with, any terms of this agreement. Governing law. Even if an association intends to limit its activity to a single State, disputes that involve the marketing agreement can arise from transactions that cross State lines in any number of ways. To avoid arguments over which State’s law shall be applied, the contract might have a clause naming the State. This can be particularly important if the association is incorporated under a statute of a State different from the one where its headquarters are located. I Section 18. Governing Law. This agreement shall be governed by the laws of the State of , Signatures. To make the contracts official, they must be signed by both parties. If the producer is a business and not a real person, the association should check to make sure the signee for the business is authorized to enter into such agreements for the business. IN WITNESS WHEREOF, these parties have executed this agreement as of the day, month and year first above written: Producer (Cooperative name) BY President ATTEST I Secretary MEMBERSHIP APPLICATION When a person applies for membership in a cooperative, it is a good idea to have a simple document that ties the loose ends together and, when approved, serves as official notice that the applicant is a bona fide member of the association. If the articles, bylaws, and marketing agreement are well drafted, this need be little more than a summary of the commitments made. Applicant certifies that the requirements of membership have been met, and the appropriate cooperative officers, usually the president and secretary, acknowledge board approval of the applicant. 5 9 MEMBERSHIP APPLICATION Applicant’s Statement. I hereby apply for membership in and agree to abide by the articles of incorporation and bylaws of the association, now and hereafter in effect, copies of which have been presented to me for inspection. I certify that I am a producer of , have tendered the purchase price of one share of common voting stock, have signed a marketing agreement, and met such other qualifications for membership as have been explained to me. After my membership shall have been in effect for one year from the date of its acceptance by the association, either party may terminate it by notifying the other party in writing of this intention between (date) and (date) of any year. If neither of the parties to this agreement so notifies the other, it is mutually agreed that this shall constitute conclusive evidence that the parties have renewed this agreement for another year. Date ,199_. Applicant’s: name address telephone number social security number Applicant’s signature Acceptance. This certifies that is a member of and is entitled to all of the rights, benefits, and privileges of membership in the association. Date , 199_. President: Secretary: As mentioned earlier, familiarity with the documents reviewed in this report is an ongoing responsibility of each cooperative leader, particularly members of the board of directors. The same is true for other important cooperative papers: e.g., audit reports and current financial statements, board policies, loan agreements, the manager’s job description, and minutes of board and membership meetings. As the manager’s job is to run the day-to-day operations of the cooperative, the manager acquires the necessary familiarity with these items as part of his or her ongoing duties. Directors usually don’t have the continuous contact with the business that the manager does. They need to have the documents available so they can look up information and ask informed questions when necessary. A good director handbook meets this need. The director handbook can be nothing more than a solid three-ring binder that contains up-to-date copies of all documents the directors need to set cooperative policy. Every new director should get a current handbook as soon as he or she is elected to the board. At each board meeting the manager or the president should distribute minutes of the previous meeting and new versions of any documents that have been modified or adopted since the last meeting. Time should be taken to make sure the directors place the new pages in the proper place in the book and to let the directors review and ask questions about the additions and replacements. The director handbook will get the important cooperative papers out of the file cabinet and into the mainstream of the decision-making process. It will minimize the likelihood leaders will innocently violate a provision of the articles and bylaws, contracts, or other written guidelines. It will provide ready answers to questions about the limitations on managerial discretion imposed by these documents. And it will facilitate the conduct of business meetings in a professional and efficient manner. In summary, it will soon become a valuable tool for cooperative management and planning. 61 Appendix A. Election of Directors by Districts (bylaw provision) ARTICLE III. DIRECTORS AND OFFICERS Section 2. Election of Directors by Districts. (Two paragraphs as in sample language on page 29, main text. Next, add the following:) The territory in which the association has members shall be divided into _ (same number as number of directors) districts. The respective districts and their boundaries shall be established by resolution of the board of directors. The board of directors may from time to time change the boundaries of one or more districts by adding territory not included within any district, by adding to one district territory previously included in another district, or by excluding from a district a part of its territory. There shall be as many directors as there are districts, one director to be elected by the members of each district. However, when the number of districts is an even number, there shall be one additional director to be known as a director-at-large and to be elected by all members of the association. A district director must be a resident of, or be a producer of agricultural products in, the district for which such director is elected or appointed. Any questions as to the effect of any changes made in district boundaries, or the number or identity or districts, shall be conclusively determined by the board of directors. Nominations for directors, either for a district or at large, shall be made by petition addressed to the secretary of the association requesting placement on the ballot of the name of the person so nominated. Such a petition nominating a district director shall be signed by not less than _ members of that district. Such a petition nominating a director-atlarge shall be signed by not less than _ members of the association. 62 Appendix B. Equity Redemption (alternative bylaw) ARTICLE VII. EQUITY REDEMPTION Section I. Regular Redemption, Percent of All Equities. It shall be the policy of the association, when other redemption priorities set forth herein have been met, and when funds are available, to redeem in cash a percentage of each member patron’s capital credits, rather than ratably by year. The time and method of any such redemption shall be determined by the board of directors. Section 2. Specified Special Redemptions. The association shall give priority to redemption of members’ capital credits held by deceased persons for the settlement of their estate. The association shall thereafter grant priority redemption to capital credits of former members who have attained their 65th birthday and are no longer actively engaged in agricultural production as actual producers or landlords in share tenancy. The time and method of such redemption shall be determined solely by the board of directors, dependent upon the financial condition of the association. In the case of redemption of the equities of those persons who have attained age 65 and retired from farming, preference may be given to the oldest retirees in establishing the order of priority among those eligible. In the case of a corporation or partnership holder of members’ capital credits, such corporation or partnership shall be considered eligible for priority treatment to the same extent as the individual stockholders of such corporation or partners of the partnership would have qualified, if each individual stockholder or partner were an individual memberpatron of this association. Any redemption shall be made to the corporation or partnership, and not to the individual stockholder or partner thereof. Each corporation or partnership shall report to the association the percentage of ownership interest 63 in the corporation or partnership of each of its stockholders or partners. Failure to report accurately the percentage of individual ownership interest shall disqualify any allocations made to the corporation or partnership by this association from redemption priority. If a corporation or partnership should dissolve, its capital credits in this association shall be prorated among, and transferred to, the individual stockholders or partners and considered for redemp tion on an individual ownership basis. The amount of any redemption or prorate related to a corporate or partnership member shall be determined by the percentage of ownership interest as reported by the corporation or partnership. When two or more persons are holders of capital credits as tenants in common, without a designation of rights of survivorship, they shall be deemed by this association to be acting as partners and shall be subject to the same requirements as a partnership. Capital credits held in joint tenancy with rights of survivorship shall be considered for priority of redemption according to the qualifying status of the youngest member of the joint tenancy or, in the event of death of one of the joint tenants, of the survivor. Appendix C. Base Capital Plan (bylaw provision) ARTICLE VII. EQUITY REDEMPTION Section 1. Members’ Equity Requirements. Each year the board of directors shall determine the amount of equity capital necessary for successful operation of the cooperative. The total amount of member volume and the volume each member has marketed through the association during the past _( ) years shall be calculated. Each member’s equity requirement is equal to the amount of equity, determined necessary by the board of directors, multiplied by the member’s proportion of the association’s total member volume during the base _ year period. Section 2. Member Investment. Members can invest equity to meet their requirements by direct cash investment, allocated patronage refunds, and per-unit capital retains. Section 3. Member Account Adjustments. At the end of each fiscal year the association shall recalculate each member’s capital credits account to include all per-unit retains for the year and each member’s share of patronage refunds for the year. (a) If a member’s total capital credits are less than the member’s equity requirement for that year, cash returns on business done with the association will be limited to those required by the Internal Revenue Code or other applicable law. (b) If the member’s capital credits, less any cash that must be refunded to comply with the Internal Revenue Code or other applicable law, are greater than the member’s equity requirement for that year, the excess shall be redeemed in cash within g-112 months after the close of the association’s fiscal year. 65 ",Legal,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Explain the difference between the Somogyi phenomenon and the dawn phenomenon, how each can be avoided, and why each happens at night. Use a maximum of 500 words.","Definition/Introduction The Somogyi effect, also known as the ""chronic Somogyi rebound"" or ""posthypoglycemic hyperglycemia,"" was a theory proposed in the 1930s by Dr. Michael Somogyi, a Hungarian-born professor at Washington University, St. Louis, MO, United States.[1] He described the paradoxical tendency of the body to react to hypoglycemia by producing hyperglycemia. Somogyi proposed that when blood glucose levels drop too low during the late evening, activation of counterregulatory hormones such as adrenaline, corticosteroids, growth hormone, and glucagon may be observed, leading to activation of gluconeogenesis and resultant hyperglycemia in the early morning.[2] However, more recent studies involving continuous glucose monitoring (CGM) have disputed this theory. Also, clinicians have observed that patients with early morning hyperglycemia tend to have high blood glucose measurements at night rather than low.[1] As a result, the debate continues in the scientific community regarding Somogyi's theory. Moreover, recently proposed mechanisms of morning hyperglycemia include nocturnal growth hormone secretion, hypoinsulinemia, and insulin resistance associated with metabolic syndrome.[3] A phenomenon known as the dawn phenomenon was introduced by Dr. Schimdt in the 1980s, stating that morning hyperglycemia is due to the decreased levels of endogenous insulin secreted at night.[1] The dawn phenomenon also contributes to morning hyperglycemia to increased concentrations of insulin-antagonist hormones. The dawn phenomenon is comparable to the Somogyi phenomenon, which attributes morning hyperglycemia to counterregulatory hormones from low glucose. The dawn phenomenon has been noted to occur more commonly than the Somogyi phenomenon.[1] While the two theories are not seen in all cases of insulin-dependent diabetics, it is important to note that the best way to prevent either is optimal diabetes control with the proper insulin therapy.[1] The Somogyi phenomenon states that early morning hyperglycemia occurs due to a rebound effect from late-night hypoglycemia. However, the dawn phenomenon does not include hypoglycemic episodes to be a factor. Insulin Release and Insulin Resistance With recent studies attributing early morning hyperglycemia to hypoinsulinemia, there is an observable pattern in which the body secretes insulin. The theory is insulin gets secreted in a circadian pattern, with the lowest concentrations between midnight and 6 AM and the highest concentrations between noon and 6 PM.[4] This pattern of insulin secretion is the opposite of melatonin from the pineal gland. The circadian pattern of insulin secretion provides evidence for the dawn phenomenon. The Somogyi phenomenon has been a proposed phenomenon in insulin-dependent diabetic patients. The thinking is that these patients should monitor their blood glucose levels and adjust insulin dosages as necessary to prevent hypo- or hyperglycemic episodes. In an individual that does not have diabetes, the blood glucose and insulin concentrations stay flat and constant throughout the night, with a transient increase in insulin just before dawn to prevent hepatic glucose production through gluconeogenesis and prevent hyperglycemia.[5] This explains why non-diabetic patients do not exhibit the dawn phenomenon, as their insulin levels follow the circadian pattern necessary for optimal glucose control. Insulin resistance, seen in diabetes or metabolic syndrome, has been associated with constant exposure to high insulin levels.[6] As patients get diagnosed with diabetes or metabolic syndrome at an earlier age, there is more exogenous insulin exposure that leads to this resistance. Because of this, the normal regulation and pattern of insulin levels make it difficult for insulin-dependent diabetics to control their blood glucose levels during their sleep. Not only is insulin necessary to regulate glucose levels, but it is also the primary hormone that inhibits gluconeogenesis.[7] Gluconeogenesis in the morning gets inhibited in a non-diabetic due to the transient increase in insulin right before dawn. As a patient becomes more and more resistant to insulin, the key inhibitor of gluconeogenesis is no longer working; this allows the body to produce more glucose, leading to a hyperglycemic state. Clinical Significance The Somogyi phenomenon had been considered in the past; an essential consideration for the proper diagnosis and management of blood glucose levels is vital for the body’s metabolic demands. The post-hypoglycemic hyperglycemia raises the question of whether a patient’s insulin levels should be adjusted in the evening to prevent hyperglycemia in the morning. As this is something ideally avoided, the Somogyi phenomenon occurs too infrequently to make this standardized practice.","[question] Explain the difference between the Somogyi phenomenon and the dawn phenomenon, how each can be avoided, and why each happens at night. Use a maximum of 500 words. ===================== [text] Definition/Introduction The Somogyi effect, also known as the ""chronic Somogyi rebound"" or ""posthypoglycemic hyperglycemia,"" was a theory proposed in the 1930s by Dr. Michael Somogyi, a Hungarian-born professor at Washington University, St. Louis, MO, United States.[1] He described the paradoxical tendency of the body to react to hypoglycemia by producing hyperglycemia. Somogyi proposed that when blood glucose levels drop too low during the late evening, activation of counterregulatory hormones such as adrenaline, corticosteroids, growth hormone, and glucagon may be observed, leading to activation of gluconeogenesis and resultant hyperglycemia in the early morning.[2] However, more recent studies involving continuous glucose monitoring (CGM) have disputed this theory. Also, clinicians have observed that patients with early morning hyperglycemia tend to have high blood glucose measurements at night rather than low.[1] As a result, the debate continues in the scientific community regarding Somogyi's theory. Moreover, recently proposed mechanisms of morning hyperglycemia include nocturnal growth hormone secretion, hypoinsulinemia, and insulin resistance associated with metabolic syndrome.[3] A phenomenon known as the dawn phenomenon was introduced by Dr. Schimdt in the 1980s, stating that morning hyperglycemia is due to the decreased levels of endogenous insulin secreted at night.[1] The dawn phenomenon also contributes to morning hyperglycemia to increased concentrations of insulin-antagonist hormones. The dawn phenomenon is comparable to the Somogyi phenomenon, which attributes morning hyperglycemia to counterregulatory hormones from low glucose. The dawn phenomenon has been noted to occur more commonly than the Somogyi phenomenon.[1] While the two theories are not seen in all cases of insulin-dependent diabetics, it is important to note that the best way to prevent either is optimal diabetes control with the proper insulin therapy.[1] The Somogyi phenomenon states that early morning hyperglycemia occurs due to a rebound effect from late-night hypoglycemia. However, the dawn phenomenon does not include hypoglycemic episodes to be a factor. Insulin Release and Insulin Resistance With recent studies attributing early morning hyperglycemia to hypoinsulinemia, there is an observable pattern in which the body secretes insulin. The theory is insulin gets secreted in a circadian pattern, with the lowest concentrations between midnight and 6 AM and the highest concentrations between noon and 6 PM.[4] This pattern of insulin secretion is the opposite of melatonin from the pineal gland. The circadian pattern of insulin secretion provides evidence for the dawn phenomenon. The Somogyi phenomenon has been a proposed phenomenon in insulin-dependent diabetic patients. The thinking is that these patients should monitor their blood glucose levels and adjust insulin dosages as necessary to prevent hypo- or hyperglycemic episodes. In an individual that does not have diabetes, the blood glucose and insulin concentrations stay flat and constant throughout the night, with a transient increase in insulin just before dawn to prevent hepatic glucose production through gluconeogenesis and prevent hyperglycemia.[5] This explains why non-diabetic patients do not exhibit the dawn phenomenon, as their insulin levels follow the circadian pattern necessary for optimal glucose control. Insulin resistance, seen in diabetes or metabolic syndrome, has been associated with constant exposure to high insulin levels.[6] As patients get diagnosed with diabetes or metabolic syndrome at an earlier age, there is more exogenous insulin exposure that leads to this resistance. Because of this, the normal regulation and pattern of insulin levels make it difficult for insulin-dependent diabetics to control their blood glucose levels during their sleep. Not only is insulin necessary to regulate glucose levels, but it is also the primary hormone that inhibits gluconeogenesis.[7] Gluconeogenesis in the morning gets inhibited in a non-diabetic due to the transient increase in insulin right before dawn. As a patient becomes more and more resistant to insulin, the key inhibitor of gluconeogenesis is no longer working; this allows the body to produce more glucose, leading to a hyperglycemic state. Clinical Significance The Somogyi phenomenon had been considered in the past; an essential consideration for the proper diagnosis and management of blood glucose levels is vital for the body’s metabolic demands. The post-hypoglycemic hyperglycemia raises the question of whether a patient’s insulin levels should be adjusted in the evening to prevent hyperglycemia in the morning. As this is something ideally avoided, the Somogyi phenomenon occurs too infrequently to make this standardized practice. https://www.ncbi.nlm.nih.gov/books/NBK551525/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Concept Comparison,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","How is the Reconfigurable Intelligent Surface (RIS) technology being utilized and developed in this experiment to improve antenna systems? Write a 100-word summary, describing the interplay between the RIS element, the base station, and the user.","The Interference Broadcast Channel with Reconfigurable Intelligent Surfaces: A Cooperative Sum-Rate Maximization Approach Abstract—This paper studies the interference broadcast channel comprising multiple multi-antenna Base Stations (BSs), each controlling a beyond diagonal Reconfigurable Intelligent Surface (RIS) and serving multiple single-antenna users. Wideband transmissions are considered with the objective to jointly design the BS linear precoding vectors and the phase configurations at the RISs in a distributed manner. We take into account the frequency selectivity behavior of each RIS’s tunable metaelement, and focusing on the sum rate as the system’s performance criterion, we present a distributed optimization approach that enables cooperation between the RIS control units and their respective BSs. According to the proposed scheme, each design variable can be efficiently obtained in an iterative parallel way with guaranteed convergence properties. Our simulation results demonstrate the validity of the presented distributed algorithm and showcase its superiority over a non-cooperative scheme as well as over the special case where the RISs have a conventional diagonal structure. IV. NUMERICAL RESULTS In our simulations, all nodes were considered positioned on a 3D Cartesian coordinate system. In particular, we have set Q = 4 and located the BSs in a square of width w = 60 m placing BS1 at the origin and the others at the remaining corners, letting zBSq = 5 m ∀q= 1, 2, . . . , Q. For simplicity, we considered Lq = 1 ∀q = 1, 2, . . . , Q, and the UEs were located at the corners of a square, with origin at (30, 60) and width equal to 2.5 m, letting also zUE = 1.5 m. Each RIS was placed close to the corresponding BS with zRIS = 3 m: RIS1 was fixed at (-2.5, 8.5), RIS2 at (62.5, 8.5), RIS3 at (-2.5, 111.5), and RIS4 at (62.5, 111.5). All wireless wideband channels were modeled as described in [13] with 16 delay taps. For the fading component, we have considered distance-dependent pathloss between any two nodes i, j with distance di,j (where i, j ∈ {BS, UE, RIS}): PLi,j = PL0(di,j/d0) -αi,j with PL0 = ( λc 4π ) 2 denoting the signal attenuation at the reference distance d0 = 1 m and λc represents the carrier wavelength, with fc = 3.5 GHz. For the pathloss exponents, we have set αBS,UE = 3.7, αBS,RIS = 2.2, and αRIS,UE = 2.6. Equal transmit powers and noise variances was considered for all users: Pq = P and σ 2 ℓq,k = -90 dBm (∀k, ℓ, q), as well as bandwidth BW = 0.1 GHz and the number K of SCs was set to 64. For the algorithmic parameters, we have set τ = 0.80 and a time-varying step size (as detailed in [10]). The RIS circuit elements were set as in [9]. For comparison purposes, we have also included the achievable rates for the following schemes: i) “w/o RISs” with no RISs deployed; and ii) “RISs” for Sq =IM. We have also simulated the equivalent non-cooperative schemes for which “Π = 0”. We have used 100 independent Monte Carlo realizations for all performance evaluation results that follow. In Fig. 1, we examine the performance of the proposed design as a function of each BS’s transmit power P for the various simulated cases. Evidently, all curves follow a nondecreasing trend as P gets larger. It is also demonstrated that the achievable sum rate for the “BD-RISs” case outperforms the cases with diagonal RISs and that of “w/o RISs,” especially when P ≥ 25 dBm. This implies that the distributed schemes outperform the corresponding non-cooperative ones, indicating that adequately optimized cooperative transmit/reflective beamforming yields improved gains. V. CONCLUSION In this paper, we studied the RIS-empowered interference broadcast channel and presented a cooperative approach for the achievable sum-rate maximization with wideband transmissions. Our numerical investigation showcased the additional degrees of freedom offered by the proposed optimized BD RISs in the high transmit power regime, as well as the gains offered by the cooperation among the multiple BSs. II. SYSTEM MODEL AND PROBLEM FORMULATION A. System Model We consider a multi-RIS-empowered interference broadcast channel comprising Q multi-antenna BSs, each wishing to communicate in the downlink direction with multiple singleantenna User Equipments (UEs). We assume that each Nantenna BS sends information to its exclusively associated UEs using OFDM in a common set of physical resources, e.g., time and bandwidth. Thus, each BS-UE communicating pair is modeled as the superposition of a direct BS-UE link and a BS-RIS-UE link realized via the RIS-enabled tunable reflection. Each RIS, comprising M passive reflecting elements, is assumed to be controlled by its solely owned BS and is placed either closely to it or near to the corresponding set of UEs [3]. According to the deployed OFDM scheme, the total bandwidth is equally split into K orthogonal Sub-Carriers (SCs). Let wℓq,k ∈ C N×1 , with k = 1, 2, . . . , K represent the linear precoding vector at each q-th BS that models the digital spatial processing of its unit-power signal sℓq,k (i.e., E{|sℓq,k| 2} = 1) before transmission. We assume that the total transmit power available at each q-th BS is given by Pq. Letting Lq denote the number of assigned UEs to the q-th BS, the corresponding transmit signal xq,k can be compactly expressed as: xq,k = PLq ℓ=1 wℓq,ksℓq,k. Thus, the condition PLq ℓ=1 PK k=1∥wℓq,k∥ 2 ≤ Pq must be satisfied. We also consider a quasi-static block fading channel model for all channels involved and focus on each particular fading block where the channels remain approximately constant with perfect Channel State Information (CSI) knowledge. B. BD RIS Structure and Element Response We consider a BD RIS structure [8], according to which an M × M array of ON/OFF-state switches is deployed to interconnect all RIS elements. Specifically, an ON-state at the switch in the position (i, j) (i, j = 1, 2, . . . , M) of the switch array indicates that the signal impinging on the i-th metamaterial element will be guided to and tunably reflected by the j-th element. This behavior can be mathematically expressed by a selection matrix Sq ∈ {0, 1}M×M (q = 1, 2, . . . , Q), whose role is to indicate the switch array selection process at each q-th RIS. In particular, each Sq is a binary-valued selection matrix (i.e., [Sq]i,j ∈ {0, 1}) which by definition needs to satisfy the property of having only one non-zero value per row and column simultaneously and, thus, constitutes an extra design parameter. Clearly, a typical diagonal RIS, which does not require switches [2], is obtained by setting Sq = IM."," Only use the provided text to answer the question, no outside sources. How is the Reconfigurable Intelligent Surface (RIS) technology being utilized and developed in this experiment to improve antenna systems? Write a 100-word summary, describing the interplay between the RIS element, the base station, and the user. The Interference Broadcast Channel with Reconfigurable Intelligent Surfaces: A Cooperative Sum-Rate Maximization Approach Abstract—This paper studies the interference broadcast channel comprising multiple multi-antenna Base Stations (BSs), each controlling a beyond diagonal Reconfigurable Intelligent Surface (RIS) and serving multiple single-antenna users. Wideband transmissions are considered with the objective to jointly design the BS linear precoding vectors and the phase configurations at the RISs in a distributed manner. We take into account the frequency selectivity behavior of each RIS’s tunable metaelement, and focusing on the sum rate as the system’s performance criterion, we present a distributed optimization approach that enables cooperation between the RIS control units and their respective BSs. According to the proposed scheme, each design variable can be efficiently obtained in an iterative parallel way with guaranteed convergence properties. Our simulation results demonstrate the validity of the presented distributed algorithm and showcase its superiority over a non-cooperative scheme as well as over the special case where the RISs have a conventional diagonal structure. IV. NUMERICAL RESULTS In our simulations, all nodes were considered positioned on a 3D Cartesian coordinate system. In particular, we have set Q = 4 and located the BSs in a square of width w = 60 m placing BS1 at the origin and the others at the remaining corners, letting zBSq = 5 m ∀q= 1, 2, . . . , Q. For simplicity, we considered Lq = 1 ∀q = 1, 2, . . . , Q, and the UEs were located at the corners of a square, with origin at (30, 60) and width equal to 2.5 m, letting also zUE = 1.5 m. Each RIS was placed close to the corresponding BS with zRIS = 3 m: RIS1 was fixed at (-2.5, 8.5), RIS2 at (62.5, 8.5), RIS3 at (-2.5, 111.5), and RIS4 at (62.5, 111.5). All wireless wideband channels were modeled as described in [13] with 16 delay taps. For the fading component, we have considered distance-dependent pathloss between any two nodes i, j with distance di,j (where i, j ∈ {BS, UE, RIS}): PLi,j = PL0(di,j/d0) -αi,j with PL0 = ( λc 4π ) 2 denoting the signal attenuation at the reference distance d0 = 1 m and λc represents the carrier wavelength, with fc = 3.5 GHz. For the pathloss exponents, we have set αBS,UE = 3.7, αBS,RIS = 2.2, and αRIS,UE = 2.6. Equal transmit powers and noise variances was considered for all users: Pq = P and σ 2 ℓq,k = -90 dBm (∀k, ℓ, q), as well as bandwidth BW = 0.1 GHz and the number K of SCs was set to 64. For the algorithmic parameters, we have set τ = 0.80 and a time-varying step size (as detailed in [10]). The RIS circuit elements were set as in [9]. For comparison purposes, we have also included the achievable rates for the following schemes: i) “w/o RISs” with no RISs deployed; and ii) “RISs” for Sq =IM. We have also simulated the equivalent non-cooperative schemes for which “Π = 0”. We have used 100 independent Monte Carlo realizations for all performance evaluation results that follow. In Fig. 1, we examine the performance of the proposed design as a function of each BS’s transmit power P for the various simulated cases. Evidently, all curves follow a nondecreasing trend as P gets larger. It is also demonstrated that the achievable sum rate for the “BD-RISs” case outperforms the cases with diagonal RISs and that of “w/o RISs,” especially when P ≥ 25 dBm. This implies that the distributed schemes outperform the corresponding non-cooperative ones, indicating that adequately optimized cooperative transmit/reflective beamforming yields improved gains. V. CONCLUSION In this paper, we studied the RIS-empowered interference broadcast channel and presented a cooperative approach for the achievable sum-rate maximization with wideband transmissions. Our numerical investigation showcased the additional degrees of freedom offered by the proposed optimized BD RISs in the high transmit power regime, as well as the gains offered by the cooperation among the multiple BSs. II. SYSTEM MODEL AND PROBLEM FORMULATION A. System Model We consider a multi-RIS-empowered interference broadcast channel comprising Q multi-antenna BSs, each wishing to communicate in the downlink direction with multiple singleantenna User Equipments (UEs). We assume that each Nantenna BS sends information to its exclusively associated UEs using OFDM in a common set of physical resources, e.g., time and bandwidth. Thus, each BS-UE communicating pair is modeled as the superposition of a direct BS-UE link and a BS-RIS-UE link realized via the RIS-enabled tunable reflection. Each RIS, comprising M passive reflecting elements, is assumed to be controlled by its solely owned BS and is placed either closely to it or near to the corresponding set of UEs [3]. According to the deployed OFDM scheme, the total bandwidth is equally split into K orthogonal Sub-Carriers (SCs). Let wℓq,k ∈ C N×1 , with k = 1, 2, . . . , K represent the linear precoding vector at each q-th BS that models the digital spatial processing of its unit-power signal sℓq,k (i.e., E{|sℓq,k| 2} = 1) before transmission. We assume that the total transmit power available at each q-th BS is given by Pq. Letting Lq denote the number of assigned UEs to the q-th BS, the corresponding transmit signal xq,k can be compactly expressed as: xq,k = PLq ℓ=1 wℓq,ksℓq,k. Thus, the condition PLq ℓ=1 PK k=1∥wℓq,k∥ 2 ≤ Pq must be satisfied. We also consider a quasi-static block fading channel model for all channels involved and focus on each particular fading block where the channels remain approximately constant with perfect Channel State Information (CSI) knowledge. B. BD RIS Structure and Element Response We consider a BD RIS structure [8], according to which an M × M array of ON/OFF-state switches is deployed to interconnect all RIS elements. Specifically, an ON-state at the switch in the position (i, j) (i, j = 1, 2, . . . , M) of the switch array indicates that the signal impinging on the i-th metamaterial element will be guided to and tunably reflected by the j-th element. This behavior can be mathematically expressed by a selection matrix Sq ∈ {0, 1}M×M (q = 1, 2, . . . , Q), whose role is to indicate the switch array selection process at each q-th RIS. In particular, each Sq is a binary-valued selection matrix (i.e., [Sq]i,j ∈ {0, 1}) which by definition needs to satisfy the property of having only one non-zero value per row and column simultaneously and, thus, constitutes an extra design parameter. Clearly, a typical diagonal RIS, which does not require switches [2], is obtained by setting Sq = IM. https://www.arxiv.org/pdf/2409.03841",Internet/Technology,Find & Summarize,Text Transformation Respond using only the information contained in the provided text.,"Find and summarize the following three things, using three sentences for each one: The reason for this appeal The judgment The reasons for the judgment","Background to the Appeal This appeal forms part of long-running litigation about discharges of foul water contaminated with untreated sewage into the Manchester Ship Canal. The Supreme Court is asked to decide whether the owner of the beds and banks of the canal, the Manchester Ship Canal Company Ltd (“the Canal Company”), can bring a claim in nuisance or trespass when the canal is polluted by discharges of foul water from outfalls maintained by the statutory sewerage undertaker, United Utilities Water Ltd (“United Utilities”). United Utilities is the statutory sewerage undertaker for the North West of England. Its sewerage network includes around 100 outfalls from which material emanating from sewers, sewage treatment works and pumping stations is discharged into the canal. When it is operating within its hydraulic capacity, the discharges are of surface water or treated effluent, but when the system’s hydraulic capacity is exceeded at least some of the outfalls discharge foul water into the canal. There is no suggestion that these polluting discharges are caused by negligence or deliberate wrongdoing on the part of United Utilities. However, they could be avoided if United Utilities invested in improved infrastructure and treatment processes. The Canal Company threatened to bring a claim against United Utilities for trespass and nuisance. In response, United Utilities asked the court to make a declaration that the Canal Company had no right of action. The court was not asked to decide whether the Canal Company’s claim would be successful on the relevant facts. Rather, the question was whether the claim would be inconsistent with and therefore barred by the statutory scheme for regulating sewerage established by the Water Industry Act 1991 (“the 1991 Act”). The High Court judge agreed to make the declaration requested by United Utilities. His decision was upheld by the Court of Appeal. The implication of these judgments is that no owner of a canal (or other watercourse or body of water) can bring a claim based on nuisance or trespass against a sewerage undertaker in respect of polluting discharges into the water, unless the sewerage undertaker is guilty of negligence or deliberate wrongdoing. A claim of this kind would be prevented even if the polluting discharges were frequent and had significant and damaging effects on the owner’s commercial or other interests, or on its ability to enjoy its property. The Canal Company appeals to the Supreme Court. Judgment The Supreme Court unanimously allows the Canal Company’s appeal. It holds that the 1991 Act does not prevent the Canal Company from bringing a claim in nuisance or trespass when the canal is polluted by discharges of foul water from United Utilities’ outfalls, even if there has been no negligence or deliberate misconduct. Lord Reed and Lord Hodge give a joint judgment with which the other members of the Court agree. Reasons for the Judgment The starting point is that the owner of a canal or other watercourse has a property right in the watercourse, including a right to preserve the quality of the water. That right is protected by the common law. The discharge of polluting effluent into a privately-owned watercourse is an actionable nuisance at common law if the pollution interferes with the owner’s use or enjoyment of its property. The Supreme Court is, therefore, asked to decide whether the 1991 Act excludes common law rights of action in nuisance and trespass. This is a question of statutory interpretation [108]-[110]. A body which exercises statutory powers, such as a sewerage undertaker, is liable in the same way as any other person if it is responsible for a nuisance, trespass or other tort, unless either it: (i) is acting within its statutory powers, or (ii) has been granted some statutory immunity from suit. If a sewerage undertaker interferes with a person’s rights, it is therefore necessary to distinguish between interferences which Parliament has authorised, which are lawful, and interferences which Parliament has not authorised, which are unlawful. When drawing this distinction, two principles are relevant. First, a person’s rights to the peaceful enjoyment of its property and to access the courts are protected by both the common law and the Human Rights Act 1998. The principle of legality holds that fundamental rights cannot be overridden by general or ambiguous words. A statute will, therefore, only authorise what would otherwise be an unlawful interference with property rights, or deprive a person of the right to bring a legal claim, if this is clear from or a necessary implication of the express language used by Parliament. Secondly, Parliament will not be taken to have intended that statutory powers should be exercised, or duties performed, in a way which interferes with private rights, unless the interference is inevitable [15]-[21]. The 1991 Act does not expressly authorise United Utilities to cause a nuisance or to trespass by discharging foul water through the outfalls into the canal. United Utilities’ entitlement to use the outfalls derives from section 116 of the 1991 Act. However, this entitlement is subject to a number of statutory protections for watercourses. Section 117(5) provides that nothing in section 116 (or the other relevant sewerage provisions of the 1991 Act) authorises a sewerage undertaker to use a sewer, drain or outfall to convey foul water into a watercourse. Sewerage undertakers therefore do not have statutory authority to discharge untreated sewage into watercourses. Section 117(6) prevents a sewerage undertaker from carrying out its functions under the relevant sewerage provisions so as to create a nuisance. Section 94(4) makes it clear that the common law remedies for nuisance – such as an injunction or damages – are available in addition to any remedy available by virtue of section 94. Section 186(3) further protects the owners of watercourses, and other rights-holders, by stating that nothing in the relevant sewerage provisions authorises a sewerage undertaker to damage a watercourse, or the quality of the water in it, without consent [60]-[62], [65], [111]-[112], [116]. The polluting discharges similarly cannot be regarded as having been impliedly authorised by Parliament, since they are not an inevitable consequence of a sewerage undertaker’s performance of its statutory powers and duties. In the present case, the discharges could be avoided if United Utilities invested in improved infrastructure and treatment processes [113]. If Parliament has not authorised an interference with private law rights, it would normally follow that a claimant can enforce those rights at common law. Furthermore, since sections 117(5) and 186(3) limit the authority conferred on sewerage undertakers by the 1991 Act, there must be a common law remedy where those limits are exceeded: otherwise, the sections would have no purpose [114]-[115]. However, United Utilities argues that the Canal Company has no cause of action because the only way to avoid the discharges of foul water into the canal would be to construct new sewerage infrastructure. It relies on the House of Lords’ decision in Marcic v Thames Water Utilities Ltd [2003] UKHL 66 (“Marcic”), which it says established that Parliament’s intention was that the construction of new sewerage infrastructure should be a matter for the Secretary of State or the regulator, the Water Services Regulation Authority (known as “Ofwat”), not the courts [106]. The Supreme Court rejects this argument. There are a number of indications that Parliament did not intend the 1991 Act to exclude a claimant’s right to enforce its private property right in a watercourse. First, section 186(7) provides for arbitration where water quality has been damaged without consent, at the option of the party complaining. This strongly suggests that the complainant could alternatively choose to pursue a common law claim [66], [117]. Secondly, section 180 of the 1991 Act gives effect to Schedule 12, which makes provision for statutory compensation. Compensation is available for damage caused by the authorised acts of sewerage undertakers, but not for damage caused by acts which are unauthorised, such as the discharges of foul water into the canal. This indicates that the victims of unauthorised damage retain their common law rights of action. Otherwise, they would be left without any remedy for the damage they have suffered, which would be anomalous. They would also be treated less favourably than the victims of authorised damage, which would be perverse [64], [118]-[121]. Thirdly, depriving the victims of a nuisance or trespass of their common law rights of action would be a substantial change to the law as it stood before the 1991 Act was enacted. It is unlikely that a change of this kind would have been made in a consolidation statute. Consolidation acts are not designed to make substantive changes to the law, but rather to reorganise and restate the existing law so that it is clearer and easier to understand. ","Respond using only the information contained in the provided text. Find and summarize the following three things, using three sentences for each one: The reason for this appeal The judgment The reasons for the judgment Background to the Appeal This appeal forms part of long-running litigation about discharges of foul water contaminated with untreated sewage into the Manchester Ship Canal. The Supreme Court is asked to decide whether the owner of the beds and banks of the canal, the Manchester Ship Canal Company Ltd (“the Canal Company”), can bring a claim in nuisance or trespass when the canal is polluted by discharges of foul water from outfalls maintained by the statutory sewerage undertaker, United Utilities Water Ltd (“United Utilities”). United Utilities is the statutory sewerage undertaker for the North West of England. Its sewerage network includes around 100 outfalls from which material emanating from sewers, sewage treatment works and pumping stations is discharged into the canal. When it is operating within its hydraulic capacity, the discharges are of surface water or treated effluent, but when the system’s hydraulic capacity is exceeded at least some of the outfalls discharge foul water into the canal. There is no suggestion that these polluting discharges are caused by negligence or deliberate wrongdoing on the part of United Utilities. However, they could be avoided if United Utilities invested in improved infrastructure and treatment processes. The Canal Company threatened to bring a claim against United Utilities for trespass and nuisance. In response, United Utilities asked the court to make a declaration that the Canal Company had no right of action. The court was not asked to decide whether the Canal Company’s claim would be successful on the relevant facts. Rather, the question was whether the claim would be inconsistent with and therefore barred by the statutory scheme for regulating sewerage established by the Water Industry Act 1991 (“the 1991 Act”). The High Court judge agreed to make the declaration requested by United Utilities. His decision was upheld by the Court of Appeal. The implication of these judgments is that no owner of a canal (or other watercourse or body of water) can bring a claim based on nuisance or trespass against a sewerage undertaker in respect of polluting discharges into the water, unless the sewerage undertaker is guilty of negligence or deliberate wrongdoing. A claim of this kind would be prevented even if the polluting discharges were frequent and had significant and damaging effects on the owner’s commercial or other interests, or on its ability to enjoy its property. The Canal Company appeals to the Supreme Court. Judgment The Supreme Court unanimously allows the Canal Company’s appeal. It holds that the 1991 Act does not prevent the Canal Company from bringing a claim in nuisance or trespass when the canal is polluted by discharges of foul water from United Utilities’ outfalls, even if there has been no negligence or deliberate misconduct. Lord Reed and Lord Hodge give a joint judgment with which the other members of the Court agree. Reasons for the Judgment The starting point is that the owner of a canal or other watercourse has a property right in the watercourse, including a right to preserve the quality of the water. That right is protected by the common law. The discharge of polluting effluent into a privately-owned watercourse is an actionable nuisance at common law if the pollution interferes with the owner’s use or enjoyment of its property. The Supreme Court is, therefore, asked to decide whether the 1991 Act excludes common law rights of action in nuisance and trespass. This is a question of statutory interpretation [108]-[110]. A body which exercises statutory powers, such as a sewerage undertaker, is liable in the same way as any other person if it is responsible for a nuisance, trespass or other tort, unless either it: (i) is acting within its statutory powers, or (ii) has been granted some statutory immunity from suit. If a sewerage undertaker interferes with a person’s rights, it is therefore necessary to distinguish between interferences which Parliament has authorised, which are lawful, and interferences which Parliament has not authorised, which are unlawful. When drawing this distinction, two principles are relevant. First, a person’s rights to the peaceful enjoyment of its property and to access the courts are protected by both the common law and the Human Rights Act 1998. The principle of legality holds that fundamental rights cannot be overridden by general or ambiguous words. A statute will, therefore, only authorise what would otherwise be an unlawful interference with property rights, or deprive a person of the right to bring a legal claim, if this is clear from or a necessary implication of the express language used by Parliament. Secondly, Parliament will not be taken to have intended that statutory powers should be exercised, or duties performed, in a way which interferes with private rights, unless the interference is inevitable [15]-[21]. The 1991 Act does not expressly authorise United Utilities to cause a nuisance or to trespass by discharging foul water through the outfalls into the canal. United Utilities’ entitlement to use the outfalls derives from section 116 of the 1991 Act. However, this entitlement is subject to a number of statutory protections for watercourses. Section 117(5) provides that nothing in section 116 (or the other relevant sewerage provisions of the 1991 Act) authorises a sewerage undertaker to use a sewer, drain or outfall to convey foul water into a watercourse. Sewerage undertakers therefore do not have statutory authority to discharge untreated sewage into watercourses. Section 117(6) prevents a sewerage undertaker from carrying out its functions under the relevant sewerage provisions so as to create a nuisance. Section 94(4) makes it clear that the common law remedies for nuisance – such as an injunction or damages – are available in addition to any remedy available by virtue of section 94. Section 186(3) further protects the owners of watercourses, and other rights-holders, by stating that nothing in the relevant sewerage provisions authorises a sewerage undertaker to damage a watercourse, or the quality of the water in it, without consent [60]-[62], [65], [111]-[112], [116]. The polluting discharges similarly cannot be regarded as having been impliedly authorised by Parliament, since they are not an inevitable consequence of a sewerage undertaker’s performance of its statutory powers and duties. In the present case, the discharges could be avoided if United Utilities invested in improved infrastructure and treatment processes [113]. If Parliament has not authorised an interference with private law rights, it would normally follow that a claimant can enforce those rights at common law. Furthermore, since sections 117(5) and 186(3) limit the authority conferred on sewerage undertakers by the 1991 Act, there must be a common law remedy where those limits are exceeded: otherwise, the sections would have no purpose [114]-[115]. However, United Utilities argues that the Canal Company has no cause of action because the only way to avoid the discharges of foul water into the canal would be to construct new sewerage infrastructure. It relies on the House of Lords’ decision in Marcic v Thames Water Utilities Ltd [2003] UKHL 66 (“Marcic”), which it says established that Parliament’s intention was that the construction of new sewerage infrastructure should be a matter for the Secretary of State or the regulator, the Water Services Regulation Authority (known as “Ofwat”), not the courts [106]. The Supreme Court rejects this argument. There are a number of indications that Parliament did not intend the 1991 Act to exclude a claimant’s right to enforce its private property right in a watercourse. First, section 186(7) provides for arbitration where water quality has been damaged without consent, at the option of the party complaining. This strongly suggests that the complainant could alternatively choose to pursue a common law claim [66], [117]. Secondly, section 180 of the 1991 Act gives effect to Schedule 12, which makes provision for statutory compensation. Compensation is available for damage caused by the authorised acts of sewerage undertakers, but not for damage caused by acts which are unauthorised, such as the discharges of foul water into the canal. This indicates that the victims of unauthorised damage retain their common law rights of action. Otherwise, they would be left without any remedy for the damage they have suffered, which would be anomalous. They would also be treated less favourably than the victims of authorised damage, which would be perverse [64], [118]-[121]. Thirdly, depriving the victims of a nuisance or trespass of their common law rights of action would be a substantial change to the law as it stood before the 1991 Act was enacted. It is unlikely that a change of this kind would have been made in a consolidation statute. Consolidation acts are not designed to make substantive changes to the law, but rather to reorganise and restate the existing law so that it is clearer and easier to understand. ",Legal,Find & Summarize,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",How can china achieve technological parity with the US military? What lessons from history can it learn in trying to achieve this aim? Under 300 words please.,"Can adversaries of the United States easily imitate its most advanced weapon systems and thus erode its military-technological superiority? Do reverse engineering, industrial espi- onage, and, in particular, cyber espionage facilitate and accelerate this process? China’s decades-long economic boom, military modernization program, mas- sive reliance on cyber espionage, and assertive foreign policy have made these questions increasingly salient. Yet, almost everything known about this topic draws from the past. As we explain in this article, the conclusions that the ex- isting literature has reached by studying prior eras have no applicability to the current day. Scholarship in international relations theory generally assumes that ris- ing states beneªt from the “advantage of backwardness,” as described by Alexander Gerschenkron.1 By free riding on the research and technology of the most advanced countries, less developed states can allegedly close the military-technological gap with their rivals relatively easily and quickly.2 More recent works maintain that globalization, the emergence of dual-use compo- nents, and advances in communications (including the opportunity for cyber espionage) have facilitated this process.3 This literature is built on shaky theo- retical foundations, and its claims lack empirical support. The international relations literature largely ignores one of the most impor- tant changes to have occurred in the realm of weapons development since the second industrial revolution (1870–1914): the exponential increase in the com- plexity of military technology. We argue that this increase in complexity has promoted a change in the system of production that has made the imita- tion and replication of the performance of state-of-the-art weapon systems harder—so much so as to offset the diffusing effects of globalization and ad- vances in communications. On the one hand, the increase in complexity has signiªcantly raised the entry barriers for the production of advanced wea- pon systems: countries must now possess an extremely advanced industrial, scientiªc, and technological base in weapons production before they can copy foreign military technology. On the other hand, the knowledge to design, de- velop, and produce advanced weapon systems is less likely to diffuse, given its increasingly tacit and organizational nature. As a result, the advantage of backwardness has shrunk signiªcantly, and know-how and experience in the production of advanced weapon systems have become an important source of power for those who master them. We employ two case studies to test this ar- gument: Imperial Germany’s rapid success in closing the technological gap with the British Dreadnought battleship, despite signiªcant inhibiting factors; and China’s struggle to imitate the U.S. F-22/A Raptor jet ªghter, despite sev- eral facilitating conditions. Our research contributes to key theoretical and policy debates. First, the ability to imitate state-of-the-art military hardware plays a central role in theo- ries that seek to explain patterns of internal balancing and the rise and fall of great powers. Yet, the mainstream international relations literature has not in- vestigated this process.4 Because imitating military technology was relatively easy in the past, scholars and policymakers assume that it also is today, as fre- quent analogies between Wilhelmine Germany and contemporary China epit- omize.5 In this article, we investigate the conditions under which the imitation of state-of-the-art weapon systems such as attack submarines and combat air- craft is more or less likely to succeed. Second, we develop the ªrst systematic theoretical explanation of why U.S. superiority in military technology remains largely unrivaled almost thirty years after the end of the Cold War, despite globalization and the information and communication technology revolution. Some scholars have argued that developing modern weapon systems has become dramatically more demand- ing, which in turn has made internal balancing against the United States more difªcult.6 This literature, however, cannot explain why in the age of globaliza- tion and instant communications—with cyber espionage permitting the theft of massive amount of digital data—U.S. know-how in advanced weapon sys- tems has not already diffused to other states. Other contributors to the debate on unipolarity have either pointed to the relative inferiority of Chinese mili- tary technology without providing a theoretical explanation, or they have ar- gued that developing the military capabilities to challenge the status quo is, in the long run, a function of political will—an argument that cannot account for the failure of the Soviet Union to cope with U.S. military technology from the late 1970s onward.7 We argue that in the transition from the second industrial revolution to the information age, the imitation of state-of-the-art mili- tary technology has become more difªcult, so much so that today rising powers or even peer competitors cannot easily copy foreign weapon systems.8 Our ªndings address existing concerns that China’s use of cyber espionage and the increasing globalization of arms production will allow Beijing to rap- idly close the military-technological gap with the United States.9 Third, the international relations literature accepts the claim that globali- zation and advances in communications have made the imitation of military technology easier; yet no one has empirically tested this proposition.10 This failing is particularly concerning in light of the opportunities opened by cyber espionage—a practice that, according to many observers, could erode the U.S. advantage in military technology. Richard Clark, a former U.S. senior govern- ment ofªcial, believes that Chinese cyber espionage could result in the United States “hav[ing] all of [its] research and development stolen”; Gen. Keith Alexander, a former director of the National Security Agency, worries that cyber espionage could lead to “the greatest transfer of wealth in history.”11 With a few notable exceptions, however, international relations scholars have paid little attention to the advantages and limits of cyber espionage for copy- ing foreign military technology.12 Our research ªlls this gap and tests the con- ventional wisdom using the case of China, one of the states that has beneªted the most from globalization and that has employed cyber espionage more ex- tensively than any other country.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. How can china achieve technological parity with the US military? What lessons from history can it learn in trying to achieve this aim? Under 300 words please. Can adversaries of the United States easily imitate its most advanced weapon systems and thus erode its military-technological superiority? Do reverse engineering, industrial espi- onage, and, in particular, cyber espionage facilitate and accelerate this process? China’s decades-long economic boom, military modernization program, mas- sive reliance on cyber espionage, and assertive foreign policy have made these questions increasingly salient. Yet, almost everything known about this topic draws from the past. As we explain in this article, the conclusions that the ex- isting literature has reached by studying prior eras have no applicability to the current day. Scholarship in international relations theory generally assumes that ris- ing states beneªt from the “advantage of backwardness,” as described by Alexander Gerschenkron.1 By free riding on the research and technology of the most advanced countries, less developed states can allegedly close the military-technological gap with their rivals relatively easily and quickly.2 More recent works maintain that globalization, the emergence of dual-use compo- nents, and advances in communications (including the opportunity for cyber espionage) have facilitated this process.3 This literature is built on shaky theo- retical foundations, and its claims lack empirical support. The international relations literature largely ignores one of the most impor- tant changes to have occurred in the realm of weapons development since the second industrial revolution (1870–1914): the exponential increase in the com- plexity of military technology. We argue that this increase in complexity has promoted a change in the system of production that has made the imita- tion and replication of the performance of state-of-the-art weapon systems harder—so much so as to offset the diffusing effects of globalization and ad- vances in communications. On the one hand, the increase in complexity has signiªcantly raised the entry barriers for the production of advanced wea- pon systems: countries must now possess an extremely advanced industrial, scientiªc, and technological base in weapons production before they can copy foreign military technology. On the other hand, the knowledge to design, de- velop, and produce advanced weapon systems is less likely to diffuse, given its increasingly tacit and organizational nature. As a result, the advantage of backwardness has shrunk signiªcantly, and know-how and experience in the production of advanced weapon systems have become an important source of power for those who master them. We employ two case studies to test this ar- gument: Imperial Germany’s rapid success in closing the technological gap with the British Dreadnought battleship, despite signiªcant inhibiting factors; and China’s struggle to imitate the U.S. F-22/A Raptor jet ªghter, despite sev- eral facilitating conditions. Our research contributes to key theoretical and policy debates. First, the ability to imitate state-of-the-art military hardware plays a central role in theo- ries that seek to explain patterns of internal balancing and the rise and fall of great powers. Yet, the mainstream international relations literature has not in- vestigated this process.4 Because imitating military technology was relatively easy in the past, scholars and policymakers assume that it also is today, as fre- quent analogies between Wilhelmine Germany and contemporary China epit- omize.5 In this article, we investigate the conditions under which the imitation of state-of-the-art weapon systems such as attack submarines and combat air- craft is more or less likely to succeed. Second, we develop the ªrst systematic theoretical explanation of why U.S. superiority in military technology remains largely unrivaled almost thirty years after the end of the Cold War, despite globalization and the information and communication technology revolution. Some scholars have argued that developing modern weapon systems has become dramatically more demand- ing, which in turn has made internal balancing against the United States more difªcult.6 This literature, however, cannot explain why in the age of globaliza- tion and instant communications—with cyber espionage permitting the theft of massive amount of digital data—U.S. know-how in advanced weapon sys- tems has not already diffused to other states. Other contributors to the debate on unipolarity have either pointed to the relative inferiority of Chinese mili- tary technology without providing a theoretical explanation, or they have ar- gued that developing the military capabilities to challenge the status quo is, in the long run, a function of political will—an argument that cannot account for the failure of the Soviet Union to cope with U.S. military technology from the late 1970s onward.7 We argue that in the transition from the second industrial revolution to the information age, the imitation of state-of-the-art mili- tary technology has become more difªcult, so much so that today rising powers or even peer competitors cannot easily copy foreign weapon systems.8 Our ªndings address existing concerns that China’s use of cyber espionage and the increasing globalization of arms production will allow Beijing to rap- idly close the military-technological gap with the United States.9 Third, the international relations literature accepts the claim that globali- zation and advances in communications have made the imitation of military technology easier; yet no one has empirically tested this proposition.10 This failing is particularly concerning in light of the opportunities opened by cyber espionage—a practice that, according to many observers, could erode the U.S. advantage in military technology. Richard Clark, a former U.S. senior govern- ment ofªcial, believes that Chinese cyber espionage could result in the United States “hav[ing] all of [its] research and development stolen”; Gen. Keith Alexander, a former director of the National Security Agency, worries that cyber espionage could lead to “the greatest transfer of wealth in history.”11 With a few notable exceptions, however, international relations scholars have paid little attention to the advantages and limits of cyber espionage for copy- ing foreign military technology.12 Our research ªlls this gap and tests the con- ventional wisdom using the case of China, one of the states that has beneªted the most from globalization and that has employed cyber espionage more ex- tensively than any other country. https://direct.mit.edu/isec/article/43/3/141/12218/Why-China-Has-Not-Caught-Up-Yet-Military",Internet/Technology,Effect Analysis,Q&A Give me your answer as a full sentence. Answer the question only using the context provided in the document.,"According to this transcript, what was ipad revenue in the December quarter?","**Tim Cook** Thank you. Suhasini. Good afternoon, everyone, and thanks for joining the call. Today, Apple is reporting revenue of $119.6 billion for the December quarter, up 2% from a year ago despite having one less week in the quarter. EPS was $2.18, up 16% from a year ago and an all-time record. We achieved revenue records across more than two dozen countries and regions including all-time records in Europe and rest of Asia-Pacific. We also continue to see strong double-digit growth in many emerging markets with all-time records in Malaysia, Mexico, The Philippines, Poland, and Turkey, as well as December quarter records in India, Indonesia, Saudi Arabia, and Chile. In Services, we set an all-time revenue record with paid subscriptions growing double-digits year-over-year. And I'm pleased to announce today that we have set a new record for our installed base, which has now surpassed 2.2 billion active devices. We are announcing these results on the eve of what is sure to be a historic day as we enter the era of spatial computing. Starting tomorrow, Apple Vision Pro, the most advanced personal electronics device ever, will be available in Apple stores for customers in the U.S. with expansion to other countries later this year. Apple Vision Pro is a revolutionary device built on decades of Apple innovation and it's years ahead of anything else. Apple Vision Pro has a groundbreaking new input system and thousands of innovations, and it will unlock incredible experiences for users and developers that are simply not possible on any other device. There is already so much excitement behind this product from reviewers, customers, and developers. They are praising everything from the incredible experience of watching a movie on a 100-foot screen to remarkable new machine learning capabilities like hand tracking and room mapping. We can't wait for people to experience the magic for themselves. Moments like these are what we live for at Apple. They're why we do what we do. They're why we're so unflinchingly dedicated to groundbreaking innovation and why we're so focused on pushing technology to its limits as we work to enrich the lives of our users. As we look ahead, we will continue to invest in these and other technologies that will shape the future. That includes artificial intelligence where we continue to spend a tremendous amount of time and effort, and we're excited to share the details of our ongoing work in that space later this year. Now, let's turn to the results for the December quarter, beginning with iPhone. We are proud to report that revenue came in at $69.7 billion, 6% higher than a year ago. The iPhone 15 lineup has earned glowing reviews and been embraced by customers. The iPhone 15 and iPhone 15 Plus feature a gorgeous new design with color-infused back glass and contoured edges, Dynamic Island, A16 Bionic, and a new 48 megapixel camera system. And the iPhone 15 Pro and iPhone 15 Pro Max set the gold standard for smartphones with a beautiful and lighter titanium design, industry-leading performance with A17 Pro and our most advanced camera system with the equivalent of seven pro lenses and the ability to record spatial video. Features like Emergency SoS and roadside assistance via satellite bring peace of mind to users when they travel, and I'm grateful for every note I've received about their lifesaving impact. Turning to Mac. Revenue came in at $7.8 billion, up 1% year-over-year, driven by the strength of our latest M3-powered MacBook Pro models in spite of having one less week of sales. Just last week, we got to wish Mac a happy 40th birthday. When it was introduced 40 years ago, Mac changed everything, and through the years, it has done so again and again. Recently, we have been on a tremendous pace of innovation. Since the introduction of Apple silicon in 2020, we've been proud to offer our users unmatched performance and power along with a remarkable Neural Engine for artificial intelligence and machine learning. This past fall, we had an amazing launch of the latest generation of Apple silicon for Mac, M3, M3 Pro, and M3 Max. These chips break new ground in power and performance empowering users to do more than they ever could before, whether they're making a musical masterpiece using the latest features in Logic Pro, or beating their high score in a graphics intensive game. A favorite amongst students, business owners, artists, and video editors, our MacBook Pro lineup is the world's best pro notebook family. And iMac, the world's most capable and best-selling all-in one, is now faster than ever, thanks to M3. In iPad, revenue for the December quarter was $7 billion, down 25% year-over-year due to a difficult compare with the launch of the M2 iPad Pro and the 10th generation iPad during the December quarter last year and one less week of sales. iPad remains the most versatile, capable, and elegant tablet on the market today. It continues to be the go-to-device for students, creators, and more with customers loving iPad's incredible combination of portability and performance. Powerful apps like Final Cut Pro and Logic Pro for iPad allow video and music creators to unleash their creativity in new ways that are only possible on iPad. iPad continues to push the boundaries of what's possible on a tablet. In Wearables, Home and Accessories, revenue came in at $12 billion, down 11% from a year ago due to a difficult compare with the launch timing of several products in this category and the impact of the 14th week last year. Across our latest Apple Watch lineup, we're enabling and encouraging our users to live a healthier day, while making Apple Watch even more intuitive to use. The new double tap gesture on Apple Watch Series 9 and Apple Watch Ultra 2 make it easier to answer calls, play and pause music or take a photo with iPhone. I've been deeply moved by the many touching stories about how features like a regular rhythm notification and fall detection helped Apple Watch users when they needed it most. And for the first time ever, users can choose a carbon-neutral option of any new Apple Watch. Meanwhile, our AirPods lineup continue to be a holiday favorite. In Services, we set an all-time revenue record of $23.1 billion and an 11% year-over-year increase. Because we had one less week this quarter, this growth represents an acceleration from the September quarter, and we achieved all-time revenue records across advertising, cloud services, payment services and video, as well as December quarter records in App Store and AppleCare. Across our services, we're constantly growing our offerings to give users even more to love. With the redesigned Apple TV app, we've made it easier for subscribers to enjoy all their favorite shows, movies and sports, including Apple TV+ hits like Masters of the Air, Monarch, and Slow Horses. We're proud to be a part of Martin Scorsese's Killers of the Flower Moon, a film that has moved audiences and earned more than 200 accolades including Best Film of the Year from the New York Film Critics Circle, nine BAFTA nominations, a Golden Globe win, and 10 Oscar nominations, including Best Picture. Across all Apple TV+ productions, we've now earned 2050 award nominations and 450 wins since we've introduced the service. We're also excited to have a new season of Major League Soccer kicking off this month. We're looking forward to seeing Lionel Messi return to the field and to following all of our favorite teams in what is sure to be an incredible season. And we're counting down to the Apple Music Super Bowl halftime show, featuring Usher. Turning to Retail. In recent months, we opened three stores, including our 100th store in Asia-Pacific. Throughout the holidays, our team members pulled out all the stops to help customers find the perfect gift. And I know our U.S. team members are especially excited to begin demoing Apple Vision Pro for our customers tomorrow. At Apple, we live and breathe innovation. We are driven to pioneer new technology that can enrich our customers' lives, and we're just as intentional about showing up with our values and being a force for good in the world. February is Black History Month, and to honor it, we've launched our new Black Unity Collection, which includes the Black Unity Sport Loop band. This year's designs reflect a lasting commitment to working toward a more equitable world. We also continue to do a central work through our Racial Equity and Justice Initiative, and we're proud to continue providing grants to organizations that are making a real impact in the world. In recent months, we've also taken significant strides in our environmental work. We're partnering with suppliers to bring more clean energy online for Apple production. We're using more recycled materials than ever before and more energy-efficient transportation than ever before. And each day, we are taking more and more steps toward becoming 100% carbon-neutral across all of our products by 2030. Apple is a company that has never shied away from big challenges. That's because we are grounded by a deep sense of purpose and guided by core belief in the transformative power of innovation. And so, we are optimistic about the future, confident in the long-term, and as excited as we've ever been to deliver for our users like only Apple can. With that, I'll turn it over to Luca.","{Query} ======= According to this transcript, what was ipad revenue in the December quarter? ---------- {Task} ======= Give me your answer as a full sentence. Answer the question only using the context provided in the document. ---------- {Text} ======= **Tim Cook** Thank you. Suhasini. Good afternoon, everyone, and thanks for joining the call. Today, Apple is reporting revenue of $119.6 billion for the December quarter, up 2% from a year ago despite having one less week in the quarter. EPS was $2.18, up 16% from a year ago and an all-time record. We achieved revenue records across more than two dozen countries and regions including all-time records in Europe and rest of Asia-Pacific. We also continue to see strong double-digit growth in many emerging markets with all-time records in Malaysia, Mexico, The Philippines, Poland, and Turkey, as well as December quarter records in India, Indonesia, Saudi Arabia, and Chile. In Services, we set an all-time revenue record with paid subscriptions growing double-digits year-over-year. And I'm pleased to announce today that we have set a new record for our installed base, which has now surpassed 2.2 billion active devices. We are announcing these results on the eve of what is sure to be a historic day as we enter the era of spatial computing. Starting tomorrow, Apple Vision Pro, the most advanced personal electronics device ever, will be available in Apple stores for customers in the U.S. with expansion to other countries later this year. Apple Vision Pro is a revolutionary device built on decades of Apple innovation and it's years ahead of anything else. Apple Vision Pro has a groundbreaking new input system and thousands of innovations, and it will unlock incredible experiences for users and developers that are simply not possible on any other device. There is already so much excitement behind this product from reviewers, customers, and developers. They are praising everything from the incredible experience of watching a movie on a 100-foot screen to remarkable new machine learning capabilities like hand tracking and room mapping. We can't wait for people to experience the magic for themselves. Moments like these are what we live for at Apple. They're why we do what we do. They're why we're so unflinchingly dedicated to groundbreaking innovation and why we're so focused on pushing technology to its limits as we work to enrich the lives of our users. As we look ahead, we will continue to invest in these and other technologies that will shape the future. That includes artificial intelligence where we continue to spend a tremendous amount of time and effort, and we're excited to share the details of our ongoing work in that space later this year. Now, let's turn to the results for the December quarter, beginning with iPhone. We are proud to report that revenue came in at $69.7 billion, 6% higher than a year ago. The iPhone 15 lineup has earned glowing reviews and been embraced by customers. The iPhone 15 and iPhone 15 Plus feature a gorgeous new design with color-infused back glass and contoured edges, Dynamic Island, A16 Bionic, and a new 48 megapixel camera system. And the iPhone 15 Pro and iPhone 15 Pro Max set the gold standard for smartphones with a beautiful and lighter titanium design, industry-leading performance with A17 Pro and our most advanced camera system with the equivalent of seven pro lenses and the ability to record spatial video. Features like Emergency SoS and roadside assistance via satellite bring peace of mind to users when they travel, and I'm grateful for every note I've received about their lifesaving impact. Turning to Mac. Revenue came in at $7.8 billion, up 1% year-over-year, driven by the strength of our latest M3-powered MacBook Pro models in spite of having one less week of sales. Just last week, we got to wish Mac a happy 40th birthday. When it was introduced 40 years ago, Mac changed everything, and through the years, it has done so again and again. Recently, we have been on a tremendous pace of innovation. Since the introduction of Apple silicon in 2020, we've been proud to offer our users unmatched performance and power along with a remarkable Neural Engine for artificial intelligence and machine learning. This past fall, we had an amazing launch of the latest generation of Apple silicon for Mac, M3, M3 Pro, and M3 Max. These chips break new ground in power and performance empowering users to do more than they ever could before, whether they're making a musical masterpiece using the latest features in Logic Pro, or beating their high score in a graphics intensive game. A favorite amongst students, business owners, artists, and video editors, our MacBook Pro lineup is the world's best pro notebook family. And iMac, the world's most capable and best-selling all-in one, is now faster than ever, thanks to M3. In iPad, revenue for the December quarter was $7 billion, down 25% year-over-year due to a difficult compare with the launch of the M2 iPad Pro and the 10th generation iPad during the December quarter last year and one less week of sales. iPad remains the most versatile, capable, and elegant tablet on the market today. It continues to be the go-to-device for students, creators, and more with customers loving iPad's incredible combination of portability and performance. Powerful apps like Final Cut Pro and Logic Pro for iPad allow video and music creators to unleash their creativity in new ways that are only possible on iPad. iPad continues to push the boundaries of what's possible on a tablet. In Wearables, Home and Accessories, revenue came in at $12 billion, down 11% from a year ago due to a difficult compare with the launch timing of several products in this category and the impact of the 14th week last year. Across our latest Apple Watch lineup, we're enabling and encouraging our users to live a healthier day, while making Apple Watch even more intuitive to use. The new double tap gesture on Apple Watch Series 9 and Apple Watch Ultra 2 make it easier to answer calls, play and pause music or take a photo with iPhone. I've been deeply moved by the many touching stories about how features like a regular rhythm notification and fall detection helped Apple Watch users when they needed it most. And for the first time ever, users can choose a carbon-neutral option of any new Apple Watch. Meanwhile, our AirPods lineup continue to be a holiday favorite. In Services, we set an all-time revenue record of $23.1 billion and an 11% year-over-year increase. Because we had one less week this quarter, this growth represents an acceleration from the September quarter, and we achieved all-time revenue records across advertising, cloud services, payment services and video, as well as December quarter records in App Store and AppleCare. Across our services, we're constantly growing our offerings to give users even more to love. With the redesigned Apple TV app, we've made it easier for subscribers to enjoy all their favorite shows, movies and sports, including Apple TV+ hits like Masters of the Air, Monarch, and Slow Horses. We're proud to be a part of Martin Scorsese's Killers of the Flower Moon, a film that has moved audiences and earned more than 200 accolades including Best Film of the Year from the New York Film Critics Circle, nine BAFTA nominations, a Golden Globe win, and 10 Oscar nominations, including Best Picture. Across all Apple TV+ productions, we've now earned 2050 award nominations and 450 wins since we've introduced the service. We're also excited to have a new season of Major League Soccer kicking off this month. We're looking forward to seeing Lionel Messi return to the field and to following all of our favorite teams in what is sure to be an incredible season. And we're counting down to the Apple Music Super Bowl halftime show, featuring Usher. Turning to Retail. In recent months, we opened three stores, including our 100th store in Asia-Pacific. Throughout the holidays, our team members pulled out all the stops to help customers find the perfect gift. And I know our U.S. team members are especially excited to begin demoing Apple Vision Pro for our customers tomorrow. At Apple, we live and breathe innovation. We are driven to pioneer new technology that can enrich our customers' lives, and we're just as intentional about showing up with our values and being a force for good in the world. February is Black History Month, and to honor it, we've launched our new Black Unity Collection, which includes the Black Unity Sport Loop band. This year's designs reflect a lasting commitment to working toward a more equitable world. We also continue to do a central work through our Racial Equity and Justice Initiative, and we're proud to continue providing grants to organizations that are making a real impact in the world. In recent months, we've also taken significant strides in our environmental work. We're partnering with suppliers to bring more clean energy online for Apple production. We're using more recycled materials than ever before and more energy-efficient transportation than ever before. And each day, we are taking more and more steps toward becoming 100% carbon-neutral across all of our products by 2030. Apple is a company that has never shied away from big challenges. That's because we are grounded by a deep sense of purpose and guided by core belief in the transformative power of innovation. And so, we are optimistic about the future, confident in the long-term, and as excited as we've ever been to deliver for our users like only Apple can. With that, I'll turn it over to Luca.",Financial,Fact Finding,Q&A "When responding, restrict yourself to only information found within the given article - no other information is valid or necessary.","What are the steps to returning Bundle, bonus, and defective items?","Marketplace seller's return policy, and how to return a Marketplace product, visit our Returning a Marketplace Product page. On this page: • General return and exchange policy • Cellular and wireless devices • Bundle, bonus, and defective items • Non-returnable items • Product condition requirements • Shipping charges and Environmental Handling Fees General return and exchange policy Most products sold by Best Buy can be returned or exchanged within 30 days from the date of your in-store purchase, or 30 days from the date your online order is delivered. The exceptions to this policy are cellular and wireless devices (details below) and non-returnable items (details below). All products must be returned in their original packaging. The product must be in like-new condition (i.e., no signs of use), and some products can only be returned or exchanged if the packaging is unopened. Read the complete policy details below for full details. To process a return or exchange, you will need to provide the following: • The original receipt (invoice) from your purchase. • The original method of payment. Payment card purchases will be refunded to the original payment card. Store credit will be given for returns with gift receipts. • Original packaging and all items originally included by the manufacturer or by Best Buy (including manuals, accessories, gifts with purchase, bonus items, and any other included items) • Your name, address, phone number, and signature. Valid government-issued photo ID may be requested to confirm this information. Cellular and wireless devices Best Buy adheres to the CRTC Wireless Code of Conduct and the rights of the consumer. Subject to usage restrictions set by the carriers, cellular and wireless devices can be returned up to15 days from the date of your in-store purchase, or 15 days from the date your online order is delivered. The return period is up to 30 days for any person who has self-identified as a person with a disability. For more information about the CRTC Wireless Code of Conduct, you can visit the Wireless Code of Canada webpage. Cellular and wireless devices include cell phones and smartphones, and carrier-activated tablets, mobile hotspots, and wearables. Before returning a cellular or wireless device, make sure to disable the security settings. See more details in the “Disabling security settings on certain devices” section below. Bundle, bonus, and defective items Returning a bonus item Bonus items, or free gifts, are items that were included free with certain purchases. If you wish to return a bonus item, you will need to return both the item that you paid for and the bonus item to be eligible for a refund. Bonus items can be exchanged only if they are defective. All other terms and conditions of the Best Buy Return and Exchange Policies apply. Returning a bundle item Bundle items are items that came as part of a combo or package promotion with another item. Bundling items together allows us to offer them to you at a (combined) lower price than if you were to purchase them each separately. If you decide to return one or more of the items included in a bundle, you will be charged the stand-alone price for each item you wish to keep, which may be higher than the bundled price, then refunded for the items you wish to return. All other terms and conditions of the Best Buy Return and Exchange Policies apply. Returning a defective item A defective item can be returned or exchanged within 30 days, and must be in its original packaging with all items originally included by the manufacturer or by Best Buy. Non-returnable items The following products cannot be returned: • Major appliances that are Open Box, floor models, and/or of the Miele brand • Service, delivery, and installation fees • Gift cards and pre-paid cards • Digital downloads (such as digital software and video games) • Books, magazines, and copyright materials • Food, vitamins, and supplements • Earrings • Intimate products • Oura Ring Sizing Kits • Personal protective equipment (PPE) • Seasonal holiday goods • Shopping bags Product condition requirements Most items can be returned or exchanged even if the box or packaging has been opened, with the exception of non-returnable items and certain items that must be unopened. If the box or packaging is opened, the product must be in like-new condition, with no signs of use. Additional conditions apply to the following items: e All furniture must be unassembled. This includes indoor and outdoor furniture, nursery and baby furniture, and all other types of furniture. e Fashion apparel, linens, bedding, maternity products, and baby clothes, shoes, and accessories must be unused, unworn (if applicable), unlaundered, and still have the original tags attached. e Cell phones, smartphones, wireless devices, computers (laptop and desktop), tablets, iPads, and eReaders must have all security settings disabled. See more details in the ""Disabling security settings on certain devices"" section below. e Electric bikes and scooters must be returned in their original packaging. Restocking fees on certain opened items There are no restocking fees when returning unopened items, or when returning most items that have been opened. However, a restocking fee of 15% of the purchase price will apply to the following items only if the original packaging is opened: • Action cameras and camcorders • DSLR and mirrorless cameras • Camera drones • Camera lenses and flashes Electric bikes and scooters must be returned with their original packaging. A restocking fee of 15% of the purchase price will only be applied if the original packaging is not included with the return. items eligible for return or exchange only if unopened The following products can only be returned or exchanged if the original packaging is unopened: • Major appliances • except Open Box, floor models, and Miele major appliances, which are all non-returnable. • Baby, nursery, and maternity products • except baby monitors, gates, and highchairs, which can be returned if opened. • Beauty, grooming, and personal care products • except hair dryers, hair straighteners, and curling irons, which can be returned if opened. • Fitness equipment • Computer components and upgrades • Physical software, blank media (e.g., blank CDs), and entertainment media (including video games, music, and movies) • Office supply consumables (ink, toner, etc.) • Paper supplies (paper, writing instruments, etc.) • Headphones, PC headsets, gaming headsets, and virtual reality headsets • Microphones • DJ and karaoke equipment, musical instrument consumables (e.g., guitar strings, etc.), and wind instruments (e.g., harmonicas) • Beverage dispensers or soda machines with compressed gas • Photo film • Batteries • Cleaning supplies and chemicals ","When responding, restrict yourself to only information found within the given article - no other information is valid or necessary. What are the steps to returning Bundle, bonus, and defective items? Marketplace seller's return policy, and how to return a Marketplace product, visit our Returning a Marketplace Product page. On this page: • General return and exchange policy • Cellular and wireless devices • Bundle, bonus, and defective items • Non-returnable items • Product condition requirements • Shipping charges and Environmental Handling Fees General return and exchange policy Most products sold by Best Buy can be returned or exchanged within 30 days from the date of your in-store purchase, or 30 days from the date your online order is delivered. The exceptions to this policy are cellular and wireless devices (details below) and non-returnable items (details below). All products must be returned in their original packaging. The product must be in like-new condition (i.e., no signs of use), and some products can only be returned or exchanged if the packaging is unopened. Read the complete policy details below for full details. To process a return or exchange, you will need to provide the following: • The original receipt (invoice) from your purchase. • The original method of payment. Payment card purchases will be refunded to the original payment card. Store credit will be given for returns with gift receipts. • Original packaging and all items originally included by the manufacturer or by Best Buy (including manuals, accessories, gifts with purchase, bonus items, and any other included items) • Your name, address, phone number, and signature. Valid government-issued photo ID may be requested to confirm this information. Cellular and wireless devices Best Buy adheres to the CRTC Wireless Code of Conduct and the rights of the consumer. Subject to usage restrictions set by the carriers, cellular and wireless devices can be returned up to15 days from the date of your in-store purchase, or 15 days from the date your online order is delivered. The return period is up to 30 days for any person who has self-identified as a person with a disability. For more information about the CRTC Wireless Code of Conduct, you can visit the Wireless Code of Canada webpage. Cellular and wireless devices include cell phones and smartphones, and carrier-activated tablets, mobile hotspots, and wearables. Before returning a cellular or wireless device, make sure to disable the security settings. See more details in the “Disabling security settings on certain devices” section below. Bundle, bonus, and defective items Returning a bonus item Bonus items, or free gifts, are items that were included free with certain purchases. If you wish to return a bonus item, you will need to return both the item that you paid for and the bonus item to be eligible for a refund. Bonus items can be exchanged only if they are defective. All other terms and conditions of the Best Buy Return and Exchange Policies apply. Returning a bundle item Bundle items are items that came as part of a combo or package promotion with another item. Bundling items together allows us to offer them to you at a (combined) lower price than if you were to purchase them each separately. If you decide to return one or more of the items included in a bundle, you will be charged the stand-alone price for each item you wish to keep, which may be higher than the bundled price, then refunded for the items you wish to return. All other terms and conditions of the Best Buy Return and Exchange Policies apply. Returning a defective item A defective item can be returned or exchanged within 30 days, and must be in its original packaging with all items originally included by the manufacturer or by Best Buy. Non-returnable items The following products cannot be returned: • Major appliances that are Open Box, floor models, and/or of the Miele brand • Service, delivery, and installation fees • Gift cards and pre-paid cards • Digital downloads (such as digital software and video games) • Books, magazines, and copyright materials • Food, vitamins, and supplements • Earrings • Intimate products • Oura Ring Sizing Kits • Personal protective equipment (PPE) • Seasonal holiday goods • Shopping bags Product condition requirements Most items can be returned or exchanged even if the box or packaging has been opened, with the exception of non-returnable items and certain items that must be unopened. If the box or packaging is opened, the product must be in like-new condition, with no signs of use. Additional conditions apply to the following items: e All furniture must be unassembled. This includes indoor and outdoor furniture, nursery and baby furniture, and all other types of furniture. e Fashion apparel, linens, bedding, maternity products, and baby clothes, shoes, and accessories must be unused, unworn (if applicable), unlaundered, and still have the original tags attached. e Cell phones, smartphones, wireless devices, computers (laptop and desktop), tablets, iPads, and eReaders must have all security settings disabled. See more details in the ""Disabling security settings on certain devices"" section below. e Electric bikes and scooters must be returned in their original packaging. Restocking fees on certain opened items There are no restocking fees when returning unopened items, or when returning most items that have been opened. However, a restocking fee of 15% of the purchase price will apply to the following items only if the original packaging is opened: • Action cameras and camcorders • DSLR and mirrorless cameras • Camera drones • Camera lenses and flashes Electric bikes and scooters must be returned with their original packaging. A restocking fee of 15% of the purchase price will only be applied if the original packaging is not included with the return. items eligible for return or exchange only if unopened The following products can only be returned or exchanged if the original packaging is unopened: • Major appliances • except Open Box, floor models, and Miele major appliances, which are all non-returnable. • Baby, nursery, and maternity products • except baby monitors, gates, and highchairs, which can be returned if opened. • Beauty, grooming, and personal care products • except hair dryers, hair straighteners, and curling irons, which can be returned if opened. • Fitness equipment • Computer components and upgrades • Physical software, blank media (e.g., blank CDs), and entertainment media (including video games, music, and movies) • Office supply consumables (ink, toner, etc.) • Paper supplies (paper, writing instruments, etc.) • Headphones, PC headsets, gaming headsets, and virtual reality headsets • Microphones • DJ and karaoke equipment, musical instrument consumables (e.g., guitar strings, etc.), and wind instruments (e.g., harmonicas) • Beverage dispensers or soda machines with compressed gas • Photo film • Batteries • Cleaning supplies and chemicals ",Retail/Product,Explanation/Definition,Q&A This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Please limit your response to 200 words and avoid using bullet points.,"How much jail time could I, as a Virginia resdent face for my 60 Marijuana plants?","Code of Virginia Title 4.1. Alcoholic Beverage and Cannabis Control Subtitle II. Cannabis Control Act Chapter 11. Possession of Retail Marijuana and Retail Marijuana Products; Prohibited Practices Generally § 4.1-1101. Home cultivation of marijuana for personal use; penalties A. Notwithstanding the provisions of subdivision (c) of § 18.2-248.1, a person 21 years of age or older may cultivate up to four marijuana plants for personal use at their place of residence; however, at no point shall a household contain more than four marijuana plants. For purposes of this section, a ""household"" means those individuals, whether related or not, who live in the same house or other place of residence. A person may only cultivate marijuana plants pursuant to this section at such person's main place of residence. A violation of this subsection shall be punishable as follows: 1. For possession of more than four marijuana plants but no more than 10 marijuana plants, (i) a civil penalty of $250 for a first offense, (ii) a Class 3 misdemeanor for a second offense, and (iii) a Class 2 misdemeanor for a third and any subsequent offense; 2. For possession of more than 10 but no more than 49 marijuana plants, a Class 1 misdemeanor; 3. For possession of more than 49 but no more than 100 marijuana plants, a Class 6 felony; and 4. For possession of more than 100 marijuana plants, a felony punishable by a term of imprisonment of not less than one year nor more than 10 years or a fine of not more than $250,000, or both. B. A person who cultivates marijuana for personal use pursuant to this section shall: 1. Ensure that no marijuana plant is visible from a public way without the use of aircraft, binoculars, or other optical aids; 2. Take precautions to prevent unauthorized access by persons younger than 21 years of age; and 3. Attach to each marijuana plant a legible tag that includes the person's name, driver's license or identification number, and a notation that the marijuana plant is being grown for personal use as authorized under this section. Any person who violates this subsection is subject to a civil penalty of no more than $25. The penalty for any violations of this section by an adult shall be prepayable according to the procedures in § 16.1-69.40:2. C. A person shall not manufacture marijuana concentrate from home-cultivated marijuana. The owner of a property or parcel or tract of land may not intentionally or knowingly allow another person to manufacture marijuana concentrate from home-cultivated marijuana within or on that property or land. 2021, Sp. Sess. I, cc. 550, 551;2022, Sp. Sess. I, c. 2;2023, Sp. Sess. I, c. 1. 1 9/11/2024 12:00:00 The chapters of the acts of assembly referenced in the historical citation at the end of this section(s) may not constitute a comprehensive list of such chapters and may exclude chapters whose provisions have expired.","system instruction: This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Please limit your response to 200 words and avoid using bullet points. question: How much jail time could I, as a Virginia resdent face for my 60 Marijuana plants? context block: Code of Virginia Title 4.1. Alcoholic Beverage and Cannabis Control Subtitle II. Cannabis Control Act Chapter 11. Possession of Retail Marijuana and Retail Marijuana Products; Prohibited Practices Generally § 4.1-1101. Home cultivation of marijuana for personal use; penalties A. Notwithstanding the provisions of subdivision (c) of § 18.2-248.1, a person 21 years of age or older may cultivate up to four marijuana plants for personal use at their place of residence; however, at no point shall a household contain more than four marijuana plants. For purposes of this section, a ""household"" means those individuals, whether related or not, who live in the same house or other place of residence. A person may only cultivate marijuana plants pursuant to this section at such person's main place of residence. A violation of this subsection shall be punishable as follows: 1. For possession of more than four marijuana plants but no more than 10 marijuana plants, (i) a civil penalty of $250 for a first offense, (ii) a Class 3 misdemeanor for a second offense, and (iii) a Class 2 misdemeanor for a third and any subsequent offense; 2. For possession of more than 10 but no more than 49 marijuana plants, a Class 1 misdemeanor; 3. For possession of more than 49 but no more than 100 marijuana plants, a Class 6 felony; and 4. For possession of more than 100 marijuana plants, a felony punishable by a term of imprisonment of not less than one year nor more than 10 years or a fine of not more than $250,000, or both. B. A person who cultivates marijuana for personal use pursuant to this section shall: 1. Ensure that no marijuana plant is visible from a public way without the use of aircraft, binoculars, or other optical aids; 2. Take precautions to prevent unauthorized access by persons younger than 21 years of age; and 3. Attach to each marijuana plant a legible tag that includes the person's name, driver's license or identification number, and a notation that the marijuana plant is being grown for personal use as authorized under this section. Any person who violates this subsection is subject to a civil penalty of no more than $25. The penalty for any violations of this section by an adult shall be prepayable according to the procedures in § 16.1-69.40:2. C. A person shall not manufacture marijuana concentrate from home-cultivated marijuana. The owner of a property or parcel or tract of land may not intentionally or knowingly allow another person to manufacture marijuana concentrate from home-cultivated marijuana within or on that property or land. 2021, Sp. Sess. I, cc. 550, 551;2022, Sp. Sess. I, c. 2;2023, Sp. Sess. I, c. 1. 1 9/11/2024 12:00:00 The chapters of the acts of assembly referenced in the historical citation at the end of this section(s) may not constitute a comprehensive list of such chapters and may exclude chapters whose provisions have expired.",Legal,Fact Finding,Q&A "Only use the information above to answer the question. Do not use any outside sources. If you cannot answer the question with the information provided say ""I cannot answer without further research."" The response should be written in paragraph form unless the answer would be more beneficial in markdown format. Please answer in a simple manner that is easy for the average person to understand. ","According to the information provided, Rule 1004.2 in Chapter 15 Cases, who can file a motion for a determination that the debtor’s center of main interests is other than as stated in the petition for recognition commencing the Chapter 15 case, and when should this motion be filed?","FEDERAL RULES OF BANKRUPTCY PROCEDURE Effective August 1, 1983, as amended to December 1, 2017 Rule 1001. Scope of Rules and Forms; Short Title The Bankruptcy Rules and Forms govern procedure in cases under title 11 of the United States Code. The rules shall be cited as the Federal Rules of Bankruptcy Procedure and the forms as the Official Bankruptcy Forms. These rules shall be construed, administered, and employed by the court and the parties to secure the just, speedy, and inexpensive determination of every case and proceeding. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 27, 2017, eff. Dec. 1, 2017.) PART I—COMMENCEMENT OF CASE; PROCEEDINGS RELATING TO PETITION AND ORDER FOR RELIEF Rule 1002. Commencement of Case (a) PETITION. A petition commencing a case under the Code shall be filed with the clerk. (b) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall forthwith transmit to the United States trustee a copy of the petition filed pursuant to subdivision (a) of this rule. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1003. Involuntary Petition (a) TRANSFEROR OR TRANSFEREE OF CLAIM. A transferor or transferee of a claim shall annex to the original and each copy of the petition a copy of all documents evidencing the transfer, whether transferred unconditionally, for security, or otherwise, and a signed statement that the claim was not transferred for the purpose of commencing the case and setting forth the consideration for and terms of the transfer. An entity that has transferred or acquired a claim for the purpose of commencing a case for liquidation under chapter 7 or for reorganization under chapter 11 shall not be a qualified petitioner. (b) JOINDER OF PETITIONERS AFTER FILING. If the answer to an involuntary petition filed by fewer than three creditors avers the existence of 12 or more creditors, the debtor shall file with the answer a list of all creditors with their addresses, a brief statement of the nature of their claims, and the amounts thereof. If it appears that there are 12 or more creditors as provided in § 303(b) of the Code, the court shall afford a reasonable opportunity for other creditors to join in the petition before a hearing is held thereon. (As amended Mar. 30, 1987, eff. Aug. 1, 1987.) Rule 1004. Involuntary Petition Against a Partnership After filing of an involuntary petition under § 303(b)(3) of the Code, (1) the petitioning partners or other petitioners shall promptly send to or serve on each general partner who is not a petitioner a copy of the petition; and (2) the clerk shall promptly issue a summons for service on each general partner who is not a petitioner. Rule 1010 applies to the form and service of the summons. (As amended Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 1004.1. Petition for an Infant or Incompetent Person If an infant or incompetent person has a representative, including a general guardian, committee, conservator, or similar fiduciary, the representative may file a voluntary petition on behalf of the infant or incompetent person. An infant or incompetent person who does not have a duly appointed representative may file a voluntary petition by next friend or guardian ad litem. The court shall appoint a guardian ad litem for an infant or incompetent person who is a debtor and is not otherwise represented or shall make any other order to protect the infant or incompetent debtor. (Added Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 1004.2. Petition in Chapter 15 Cases (a) DESIGNATING CENTER OF MAIN INTERESTS. A petition for recognition of a foreign proceeding under chapter 15 of the Code shall state the country where the debtor has its center of main interests. The petition shall also identify each country in which a foreign proceeding by, regarding, or against the debtor is pending. (b) CHALLENGING DESIGNATION. The United States trustee or a party in interest may file a motion for a determination that the debtor’s center of main interests is other than as stated in the petition for recognition commencing the chapter 15 case. Unless the court orders otherwise, the motion shall be filed no later than seven days before the date set for the hearing on the petition. The motion shall be transmitted to the United States trustee and served on the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor was a party as of the time the petition was filed, and such other entities as the court may direct. (Added Apr. 26, 2011, eff. Dec. 1, 2011.) Rule 1005. Caption of Petition The caption of a petition commencing a case under the Code shall contain the name of the court, the title of the case, and the docket number. The title of the case shall include the following information about the debtor: name, employer identification number, last four digits of the social-security number or individual debtor’s taxpayer-identification number, any other federal taxpayer-identification number, and all other names used within eight years before filing the petition. If the petition is not filed by 3 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 the debtor, it shall include all names used by the debtor which are known to the petitioners. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1006. Filing Fee (a) GENERAL REQUIREMENT. Every petition shall be accompanied by the filing fee except as provided in subdivisions (b) and (c) of this rule. For the purpose of this rule, ‘‘filing fee’’ means the filing fee prescribed by 28 U.S.C. § 1930(a)(1)–(a)(5) and any other fee prescribed by the Judicial Conference of the United States under 28 U.S.C. § 1930(b) that is payable to the clerk upon the commencement of a case under the Code. (b) PAYMENT OF FILING FEE IN INSTALLMENTS. (1) Application to Pay Filing Fee in Installments. A voluntary petition by an individual shall be accepted for filing, regardless of whether any portion of the filing fee is paid, if accompanied by the debtor’s signed application, prepared as prescribed by the appropriate Official Form, stating that the debtor is unable to pay the filing fee except in installments. (2) Action on Application. Prior to the meeting of creditors, the court may order the filing fee paid to the clerk or grant leave to pay in installments and fix the number, amount and dates of payment. The number of installments shall not exceed four, and the final installment shall be payable not later than 120 days after filing the petition. For cause shown, the court may extend the time of any installment, provided the last installment is paid not later than 180 days after filing the petition. (3) Postponement of Attorney’s Fees. All installments of the filing fee must be paid in full before the debtor or chapter 13 trustee may make further payments to an attorney or any other person who renders services to the debtor in connection with the case. (c) WAIVER OF FILING FEE. A voluntary chapter 7 petition filed by an individual shall be accepted for filing if accompanied by the debtor’s application requesting a waiver under 28 U.S.C. § 1930(f), prepared as prescribed by the appropriate Official Form. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 27, 2017, eff. Dec. 1, 2017.) Rule 1007. Lists, Schedules, Statements, and Other Documents; Time Limits (a) CORPORATE OWNERSHIP STATEMENT, LIST OF CREDITORS AND EQUITY SECURITY HOLDERS, AND OTHER LISTS. (1) Voluntary Case. In a voluntary case, the debtor shall file with the petition a list containing the name and address of each entity included or to be included on Schedules D, E/F, G, and H as prescribed by the Official Forms. If the debtor is a corporation, other than a governmental unit, the debtor shall file with the petition a corporate ownership statement containing the information described in Rule 7007.1. The debtor shall file a supplemental statement promptly upon any change in circumstances that renders the corporate ownership statement inaccurate. Rule 1007 FEDERAL RULES OF BANKRUPTCY PROCEDURE 4 (2) Involuntary Case. In an involuntary case, the debtor shall file, within seven days after entry of the order for relief, a list containing the name and address of each entity included or to be included on Schedules D, E/F, G, and H as prescribed by the Official Forms. (3) Equity Security Holders. In a chapter 11 reorganization case, unless the court orders otherwise, the debtor shall file within 14 days after entry of the order for relief a list of the debtor’s equity security holders of each class showing the number and kind of interests registered in the name of each holder, and the last known address or place of business of each holder. (4) Chapter 15 Case. In addition to the documents required under § 1515 of the Code, a foreign representative filing a petition for recognition under chapter 15 shall file with the petition: (A) a corporate ownership statement containing the information described in Rule 7007.1; and (B) unless the court orders otherwise, a list containing the names and addresses of all persons or bodies authorized to administer foreign proceedings of the debtor, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and all entities against whom provisional relief is being sought under § 1519 of the Code. (5) Extension of Time. Any extension of time for the filing of the lists required by this subdivision may be granted only on motion for cause shown and on notice to the United States trustee and to any trustee, committee elected under § 705 or appointed under § 1102 of the Code, or other party as the court may direct. (b) SCHEDULES, STATEMENTS, AND OTHER DOCUMENTS REQUIRED. (1) Except in a chapter 9 municipality case, the debtor, unless the court orders otherwise, shall file the following schedules, statements, and other documents, prepared as prescribed by the appropriate Official Forms, if any: (A) schedules of assets and liabilities; (B) a schedule of current income and expenditures; (C) a schedule of executory contracts and unexpired leases; (D) a statement of financial affairs; (E) copies of all payment advices or other evidence of payment, if any, received by the debtor from an employer within 60 days before the filing of the petition, with redaction of all but the last four digits of the debtor’s social-security number or individual taxpayer-identification number; and (F) a record of any interest that the debtor has in an account or program of the type specified in § 521(c) of the Code. (2) An individual debtor in a chapter 7 case shall file a statement of intention as required by § 521(a) of the Code, prepared as prescribed by the appropriate Official Form. A copy of the statement of intention shall be served on the trustee and the creditors named in the statement on or before the filing of the statement. 5 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 (3) Unless the United States trustee has determined that the credit counseling requirement of § 109(h) does not apply in the district, an individual debtor must file a statement of compliance with the credit counseling requirement, prepared as prescribed by the appropriate Official Form which must include one of the following: (A) an attached certificate and debt repayment plan, if any, required by § 521(b); (B) a statement that the debtor has received the credit counseling briefing required by § 109(h)(1) but does not have the certificate required by § 521(b); (C) a certification under § 109(h)(3); or (D) a request for a determination by the court under § 109(h)(4). (4) Unless § 707(b)(2)(D) applies, an individual debtor in a chapter 7 case shall file a statement of current monthly income prepared as prescribed by the appropriate Official Form, and, if the current monthly income exceeds the median family income for the applicable state and household size, the information, including calculations, required by § 707(b), prepared as prescribed by the appropriate Official Form. (5) An individual debtor in a chapter 11 case shall file a statement of current monthly income, prepared as prescribed by the appropriate Official Form. (6) A debtor in a chapter 13 case shall file a statement of current monthly income, prepared as prescribed by the appropriate Official Form, and, if the current monthly income exceeds the median family income for the applicable state and household size, a calculation of disposable income made in accordance with § 1325(b)(3), prepared as prescribed by the appropriate Official Form. (7) Unless an approved provider of an instructional course concerning personal financial management has notified the court that a debtor has completed the course after filing the petition: (A) An individual debtor in a chapter 7 or chapter 13 case shall file a statement of completion of the course, prepared as prescribed by the appropriate Official Form; and (B) An individual debtor in a chapter 11 case shall file the statement if § 1141(d)(3) applies. (8) If an individual debtor in a chapter 11, 12, or 13 case has claimed an exemption under § 522(b)(3)(A) in property of the kind described in § 522(p)(1) with a value in excess of the amount set out in § 522(q)(1), the debtor shall file a statement as to whether there is any proceeding pending in which the debtor may be found guilty of a felony of a kind described in § 522(q)(1)(A) or found liable for a debt of the kind described in § 522(q)(1)(B). (c) TIME LIMITS. In a voluntary case, the schedules, statements, and other documents required by subdivision (b)(1), (4), (5), and (6) shall be filed with the petition or within 14 days thereafter, except as otherwise provided in subdivisions (d), (e), (f), and (h) of this rule. In an involuntary case, the schedules, statements, and other Rule 1007 FEDERAL RULES OF BANKRUPTCY PROCEDURE 6 1So in original. Probably should be only one section symbol. documents required by subdivision (b)(1) shall be filed by the debtor within 14 days after the entry of the order for relief. In a voluntary case, the documents required by paragraphs (A), (C), and (D) of subdivision (b)(3) shall be filed with the petition. Unless the court orders otherwise, a debtor who has filed a statement under subdivision (b)(3)(B), shall file the documents required by subdivision (b)(3)(A) within 14 days of the order for relief. In a chapter 7 case, the debtor shall file the statement required by subdivision (b)(7) within 60 days after the first date set for the meeting of creditors under § 341 of the Code, and in a chapter 11 or 13 case no later than the date when the last payment was made by the debtor as required by the plan or the filing of a motion for a discharge under § 1141(d)(5)(B) or § 1328(b) of the Code. The court may, at any time and in its discretion, enlarge the time to file the statement required by subdivision (b)(7). The debtor shall file the statement required by subdivision (b)(8) no earlier than the date of the last payment made under the plan or the date of the filing of a motion for a discharge under §§ 1141(d)(5)(B),1 1228(b), or 1328(b) of the Code. Lists, schedules, statements, and other documents filed prior to the conversion of a case to another chapter shall be deemed filed in the converted case unless the court directs otherwise. Except as provided in § 1116(3), any extension of time to file schedules, statements, and other documents required under this rule may be granted only on motion for cause shown and on notice to the United States trustee, any committee elected under § 705 or appointed under § 1102 of the Code, trustee, examiner, or other party as the court may direct. Notice of an extension shall be given to the United States trustee and to any committee, trustee, or other party as the court may direct. (d) LIST OF 20 LARGEST CREDITORS IN CHAPTER 9 MUNICIPALITY CASE OR CHAPTER 11 REORGANIZATION CASE. In addition to the list required by subdivision (a) of this rule, a debtor in a chapter 9 municipality case or a debtor in a voluntary chapter 11 reorganization case shall file with the petition a list containing the name, address and claim of the creditors that hold the 20 largest unsecured claims, excluding insiders, as prescribed by the appropriate Official Form. In an involuntary chapter 11 reorganization case, such list shall be filed by the debtor within 2 days after entry of the order for relief under § 303(h) of the Code. (e) LIST IN CHAPTER 9 MUNICIPALITY CASES. The list required by subdivision (a) of this rule shall be filed by the debtor in a chapter 9 municipality case within such time as the court shall fix. If a proposed plan requires a revision of assessments so that the proportion of special assessments or special taxes to be assessed against some real property will be different from the proportion in effect at the date the petition is filed, the debtor shall also file a list showing the name and address of each known holder of title, legal or equitable, to real property adversely affected. On motion for cause shown, the court may modify the requirements of this subdivision and subdivision (a) of this rule. 7 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 (f) STATEMENT OF SOCIAL SECURITY NUMBER. An individual debtor shall submit a verified statement that sets out the debtor’s social security number, or states that the debtor does not have a social security number. In a voluntary case, the debtor shall submit the statement with the petition. In an involuntary case, the debtor shall submit the statement within 14 days after the entry of the order for relief. (g) PARTNERSHIP AND PARTNERS. The general partners of a debtor partnership shall prepare and file the list required under subdivision (a), schedules of the assets and liabilities, schedule of current income and expenditures, schedule of executory contracts and unexpired leases, and statement of financial affairs of the partnership. The court may order any general partner to file a statement of personal assets and liabilities within such time as the court may fix. (h) INTERESTS ACQUIRED OR ARISING AFTER PETITION. If, as provided by § 541(a)(5) of the Code, the debtor acquires or becomes entitled to acquire any interest in property, the debtor shall within 14 days after the information comes to the debtor’s knowledge or within such further time the court may allow, file a supplemental schedule in the chapter 7 liquidation case, chapter 11 reorganization case, chapter 12 family farmer’s debt adjustment case, or chapter 13 individual debt adjustment case. If any of the property required to be reported under this subdivision is claimed by the debtor as exempt, the debtor shall claim the exemptions in the supplemental schedule. The duty to file a supplemental schedule in accordance with this subdivision continues notwithstanding the closing of the case, except that the schedule need not be filed in a chapter 11, chapter 12, or chapter 13 case with respect to property acquired after entry of the order confirming a chapter 11 plan or discharging the debtor in a chapter 12 or chapter 13 case. (i) DISCLOSURE OF LIST OF SECURITY HOLDERS. After notice and hearing and for cause shown, the court may direct an entity other than the debtor or trustee to disclose any list of security holders of the debtor in its possession or under its control, indicating the name, address and security held by any of them. The entity possessing this list may be required either to produce the list or a true copy thereof, or permit inspection or copying, or otherwise disclose the information contained on the list. (j) IMPOUNDING OF LISTS. On motion of a party in interest and for cause shown the court may direct the impounding of the lists filed under this rule, and may refuse to permit inspection by any entity. The court may permit inspection or use of the lists, however, by any party in interest on terms prescribed by the court. (k) PREPARATION OF LIST, SCHEDULES, OR STATEMENTS ON DEFAULT OF DEBTOR. If a list, schedule, or statement, other than a statement of intention, is not prepared and filed as required by this rule, the court may order the trustee, a petitioning creditor, committee, or other party to prepare and file any of these papers within a time fixed by the court. The court may approve reimbursement of the cost incurred in complying with such an order as an administrative expense. (l) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall forthwith transmit to the United States trustee a copy of every list, schedule, and statement filed pursuant to subdivision (a)(1), (a)(2), (b), (d), or (h) of this rule. (m) INFANTS AND INCOMPETENT PERSONS. If the debtor knows that a person on the list of creditors or schedules is an infant or incompetent person, the debtor also shall include the name, address, and legal relationship of any person upon whom process would be served in an adversary proceeding against the infant or incompetent person in accordance with Rule 7004(b)(2). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 23, 2001, eff. Dec. 1, 2001; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 25, 2005, eff. Dec. 1, 2005; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 23, 2012, eff. Dec. 1, 2012: Apr. 16, 2013, eff. Dec. 1, 2013; Apr. 29, 2015, eff. Dec. 1, 2015.) Rule 1008. Verification of Petitions and Accompanying Papers All petitions, lists, schedules, statements and amendments thereto shall be verified or contain an unsworn declaration as provided in 28 U.S.C. § 1746. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1009. Amendments of Voluntary Petitions, Lists, Schedules and Statements (a) GENERAL RIGHT TO AMEND. A voluntary petition, list, schedule, or statement may be amended by the debtor as a matter of course at any time before the case is closed. The debtor shall give notice of the amendment to the trustee and to any entity affected thereby. On motion of a party in interest, after notice and a hearing, the court may order any voluntary petition, list, schedule, or statement to be amended and the clerk shall give notice of the amendment to entities designated by the court. (b) STATEMENT OF INTENTION. The statement of intention may be amended by the debtor at any time before the expiration of the period provided in § 521(a) of the Code. The debtor shall give notice of the amendment to the trustee and to any entity affected thereby. (c) STATEMENT OF SOCIAL SECURITY NUMBER. If a debtor becomes aware that the statement of social security number submitted under Rule 1007(f) is incorrect, the debtor shall promptly submit an amended verified statement setting forth the correct social security number. The debtor shall give notice of the amendment to all of the entities required to be included on the list filed under Rule 1007(a)(1) or (a)(2). (d) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall promptly transmit to the United States trustee a copy of every amendment filed or submitted under subdivision (a), (b), or (c) of this rule. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 12, 2006, eff. Dec. 1, 2006; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1010. Service of Involuntary Petition and Summons (a) SERVICE OF INVOLUNTARY PETITION AND SUMMONS. On the filing of an involuntary petition, the clerk shall forthwith issue a summons for service. When an involuntary petition is filed, service shall be made on the debtor. The summons shall be served with a copy of the petition in the manner provided for service of a summons and complaint by Rule 7004(a) or (b). If service cannot be so made, the court may order that the summons and petition be served by mailing copies to the party’s last known address, and by at least one publication in a manner and form directed by the court. The summons and petition may be served on the party anywhere. Rule 7004(e) and Rule 4(l) F.R.Civ.P. apply when service is made or attempted under this rule. (b) CORPORATE OWNERSHIP STATEMENT. Each petitioner that is a corporation shall file with the involuntary petition a corporate ownership statement containing the information described in Rule 7007.1. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1011. Responsive Pleading or Motion in Involuntary Cases (a) WHO MAY CONTEST PETITION. The debtor named in an involuntary petition may contest the petition. In the case of a petition against a partnership under Rule 1004, a nonpetitioning general partner, or a person who is alleged to be a general partner but denies the allegation, may contest the petition. (b) DEFENSES AND OBJECTIONS; WHEN PRESENTED. Defenses and objections to the petition shall be presented in the manner prescribed by Rule 12 F.R.Civ.P. and shall be filed and served within 21 days after service of the summons, except that if service is made by publication on a party or partner not residing or found within the state in which the court sits, the court shall prescribe the time for filing and serving the response. (c) EFFECT OF MOTION. Service of a motion under Rule 12(b) F.R.Civ.P. shall extend the time for filing and serving a responsive pleading as permitted by Rule 12(a) F.R.Civ.P. (d) CLAIMS AGAINST PETITIONERS. A claim against a petitioning creditor may not be asserted in the answer except for the purpose of defeating the petition. (e) OTHER PLEADINGS. No other pleadings shall be permitted, except that the court may order a reply to an answer and prescribe the time for filing and service. (f) CORPORATE OWNERSHIP STATEMENT. If the entity responding to the involuntary petition is a corporation, the entity shall file with its first appearance, pleading, motion, response, or other request addressed to the court a corporate ownership statement containing the information described in Rule 7007.1. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 26, 2004, eff. Dec. 1, 2004; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1012. Responsive Pleading in Cross-Border Cases (a) WHO MAY CONTEST PETITION. The debtor or any party in interest may contest a petition for recognition of a foreign proceeding. (b) OBJECTIONS AND RESPONSES; WHEN PRESENTED. Objections and other responses to the petition shall be presented no later Rule 1013 FEDERAL RULES OF BANKRUPTCY PROCEDURE 10 than seven days before the date set for the hearing on the petition, unless the court prescribes some other time or manner for responses. (c) CORPORATE OWNERSHIP STATEMENT. If the entity responding to the petition is a corporation, then the entity shall file a corporate ownership statement containing the information described in Rule 7007.1 with its first appearance, pleading, motion, response, or other request addressed to the court. (Added Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1013. Hearing and Disposition of a Petition in an Involuntary Case (a) CONTESTED PETITION. The court shall determine the issues of a contested petition at the earliest practicable time and forthwith enter an order for relief, dismiss the petition, or enter any other appropriate order. (b) DEFAULT. If no pleading or other defense to a petition is filed within the time provided by Rule 1011, the court, on the next day, or as soon thereafter as practicable, shall enter an order for the relief requested in the petition. [(c) ORDER FOR RELIEF] (Abrogated Apr. 22, 1993, eff. Aug. 1, 1993) (As amended Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993.) Rule 1014. Dismissal and Change of Venue (a) DISMISSAL AND TRANSFER OF CASES. (1) Cases Filed in Proper District. If a petition is filed in the proper district, the court, on the timely motion of a party in interest or on its own motion, and after hearing on notice to the petitioners, the United States trustee, and other entities as directed by the court, may transfer the case to any other district if the court determines that the transfer is in the interest of justice or for the convenience of the parties. (2) Cases Filed in Improper District. If a petition is filed in an improper district, the court, on the timely motion of a party in interest or on its own motion, and after hearing on notice to the petitioners, the United States trustee, and other entities as directed by the court, may dismiss the case or transfer it to any other district if the court determines that transfer is in the interest of justice or for the convenience of the parties. (b) PROCEDURE WHEN PETITIONS INVOLVING THE SAME DEBTOR OR RELATED DEBTORS ARE FILED IN DIFFERENT COURTS. If petitions commencing cases under the Code or seeking recognition under chapter 15 are filed in different districts by, regarding, or against (1) the same debtor, (2) a partnership and one or more of its general partners, (3) two or more general partners, or (4) a debtor and an affiliate, the court in the district in which the first-filed petition is pending may determine, in the interest of justice or for the convenience of the parties, the district or districts in which any of the cases should proceed. The court may so determine on motion and after a hearing, with notice to the following entities in the affected cases: the United States trustee, entities entitled to notice under Rule 2002(a), and other entities as the court directs. 11 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1017 The court may order the parties to the later-filed cases not to proceed further until it makes the determination. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 30, 2007, eff. Dec. 1, 2007; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 25, 2014, eff. Dec. 1, 2014.) Rule 1015. Consolidation or Joint Administration of Cases Pending in Same Court (a) CASES INVOLVING SAME DEBTOR. If two or more petitions by, regarding, or against the same debtor are pending in the same court, the court may order consolidation of the cases. (b) CASES INVOLVING TWO OR MORE RELATED DEBTORS. If a joint petition or two or more petitions are pending in the same court by or against (1) spouses, or (2) a partnership and one or more of its general partners, or (3) two or more general partners, or (4) a debtor and an affiliate, the court may order a joint administration of the estates. Prior to entering an order the court shall give consideration to protecting creditors of different estates against potential conflicts of interest. An order directing joint administration of individual cases of spouses shall, if one spouse has elected the exemptions under § 522(b)(2) of the Code and the other has elected the exemptions under § 522(b)(3), fix a reasonable time within which either may amend the election so that both shall have elected the same exemptions. The order shall notify the debtors that unless they elect the same exemptions within the time fixed by the court, they will be deemed to have elected the exemptions provided by § 522(b)(2). (c) EXPEDITING AND PROTECTIVE ORDERS. When an order for consolidation or joint administration of a joint case or two or more cases is entered pursuant to this rule, while protecting the rights of the parties under the Code, the court may enter orders as may tend to avoid unnecessary costs and delay. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 27, 2017, eff. Dec. 1, 2017.) Rule 1016. Death or Incompetency of Debtor Death or incompetency of the debtor shall not abate a liquidation case under chapter 7 of the Code. In such event the estate shall be administered and the case concluded in the same manner, so far as possible, as though the death or incompetency had not occurred. If a reorganization, family farmer’s debt adjustment, or individual’s debt adjustment case is pending under chapter 11, chapter 12, or chapter 13, the case may be dismissed; or if further administration is possible and in the best interest of the parties, the case may proceed and be concluded in the same manner, so far as possible, as though the death or incompetency had not occurred. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1017. Dismissal or Conversion of Case; Suspension (a) VOLUNTARY DISMISSAL; DISMISSAL FOR WANT OF PROSECUTION OR OTHER CAUSE. Except as provided in §§ 707(a)(3), 707(b), 1208(b), and 1307(b) of the Code, and in Rule 1017(b), (c), and (e), a case Rule 1017 FEDERAL RULES OF BANKRUPTCY PROCEDURE 12 shall not be dismissed on motion of the petitioner, for want of prosecution or other cause, or by consent of the parties, before a hearing on notice as provided in Rule 2002. For the purpose of the notice, the debtor shall file a list of creditors with their addresses within the time fixed by the court unless the list was previously filed. If the debtor fails to file the list, the court may order the debtor or another entity to prepare and file it. (b) DISMISSAL FOR FAILURE TO PAY FILING FEE. (1) If any installment of the filing fee has not been paid, the court may, after a hearing on notice to the debtor and the trustee, dismiss the case. (2) If the case is dismissed or closed without full payment of the filing fee, the installments collected shall be distributed in the same manner and proportions as if the filing fee had been paid in full. (c) DISMISSAL OF VOLUNTARY CHAPTER 7 OR CHAPTER 13 CASE FOR FAILURE TO TIMELY FILE LIST OF CREDITORS, SCHEDULES, AND STATEMENT OF FINANCIAL AFFAIRS. The court may dismiss a voluntary chapter 7 or chapter 13 case under § 707(a)(3) or § 1307(c)(9) after a hearing on notice served by the United States trustee on the debtor, the trustee, and any other entities as the court directs. (d) SUSPENSION. The court shall not dismiss a case or suspend proceedings under § 305 before a hearing on notice as provided in Rule 2002(a). (e) DISMISSAL OF AN INDIVIDUAL DEBTOR’S CHAPTER 7 CASE, OR CONVERSION TO A CASE UNDER CHAPTER 11 OR 13, FOR ABUSE. The court may dismiss or, with the debtor’s consent, convert an individual debtor’s case for abuse under § 707(b) only on motion and after a hearing on notice to the debtor, the trustee, the United States trustee, and any other entity as the court directs. (1) Except as otherwise provided in § 704(b)(2), a motion to dismiss a case for abuse under § 707(b) or (c) may be filed only within 60 days after the first date set for the meeting of creditors under § 341(a), unless, on request filed before the time has expired, the court for cause extends the time for filing the motion to dismiss. The party filing the motion shall set forth in the motion all matters to be considered at the hearing. In addition, a motion to dismiss under § 707(b)(1) and (3) shall state with particularity the circumstances alleged to constitute abuse. (2) If the hearing is set on the court’s own motion, notice of the hearing shall be served on the debtor no later than 60 days after the first date set for the meeting of creditors under § 341(a). The notice shall set forth all matters to be considered by the court at the hearing. (f) PROCEDURE FOR DISMISSAL, CONVERSION, OR SUSPENSION. (1) Rule 9014 governs a proceeding to dismiss or suspend a case, or to convert a case to another chapter, except under §§ 706(a), 1112(a), 1208(a) or (b), or 1307(a) or (b). (2) Conversion or dismissal under §§ 706(a), 1112(a), 1208(b), or 1307(b) shall be on motion filed and served as required by Rule 9013. (3) A chapter 12 or chapter 13 case shall be converted without court order when the debtor files a notice of conversion under 13 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1019 §§ 1208(a) or 1307(a). The filing date of the notice becomes the date of the conversion order for the purposes of applying § 348(c) and Rule 1019. The clerk shall promptly transmit a copy of the notice to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 17, 2000, eff. Dec. 1, 2000; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1018. Contested Involuntary Petitions; Contested Petitions Commencing Chapter 15 Cases; Proceedings to Vacate Order for Relief; Applicability of Rules in Part VII Governing Adversary Proceedings Unless the court otherwise directs and except as otherwise prescribed in Part I of these rules, the following rules in Part VII apply to all proceedings contesting an involuntary petition or a chapter 15 petition for recognition, and to all proceedings to vacate an order for relief: Rules 7005, 7008–7010, 7015, 7016, 7024–7026, 7028–7037, 7052, 7054, 7056, and 7062. The court may direct that other rules in Part VII shall also apply. For the purposes of this rule a reference in the Part VII rules to adversary proceedings shall be read as a reference to proceedings contesting an involuntary petition or a chapter 15 petition for recognition, or proceedings to vacate an order for relief. Reference in the Federal Rules of Civil Procedure to the complaint shall be read as a reference to the petition. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 28, 2010, eff. Dec. 1, 2010.) Rule 1019. Conversion of a Chapter 11 Reorganization Case, Chapter 12 Family Farmer’s Debt Adjustment Case, or Chapter 13 Individual’s Debt Adjustment Case to a Chapter 7 Liquidation Case When a chapter 11, chapter 12, or chapter 13 case has been converted or reconverted to a chapter 7 case: (1) Filing of Lists, Inventories, Schedules, Statements. (A) Lists, inventories, schedules, and statements of financial affairs theretofore filed shall be deemed to be filed in the chapter 7 case, unless the court directs otherwise. If they have not been previously filed, the debtor shall comply with Rule 1007 as if an order for relief had been entered on an involuntary petition on the date of the entry of the order directing that the case continue under chapter 7. (B) If a statement of intention is required, it shall be filed within 30 days after entry of the order of conversion or before the first date set for the meeting of creditors, whichever is earlier. The court may grant an extension of time for cause only on written motion filed, or oral request made during a hearing, before the time has expired. Notice of an extension shall be given to the United States trustee and to any committee, trustee, or other party as the court may direct. (2) New Filing Periods. (A) A new time period for filing a motion under § 707(b) or (c), a claim, a complaint objecting to discharge, or a Rule 1019 FEDERAL RULES OF BANKRUPTCY PROCEDURE 14 1So in original. Probably should be ‘‘Rule’’. complaint to obtain a determination of dischargeability of any debt shall commence under Rules 1 1017, 3002, 4004, or 4007, but a new time period shall not commence if a chapter 7 case had been converted to a chapter 11, 12, or 13 case and thereafter reconverted to a chapter 7 case and the time for filing a motion under § 707(b) or (c), a claim, a complaint objecting to discharge, or a complaint to obtain a determination of the dischargeability of any debt, or any extension thereof, expired in the original chapter 7 case. (B) A new time period for filing an objection to a claim of exemptions shall commence under Rule 4003(b) after conversion of a case to chapter 7 unless: (i) the case was converted to chapter 7 more than one year after the entry of the first order confirming a plan under chapter 11, 12, or 13; or (ii) the case was previously pending in chapter 7 and the time to object to a claimed exemption had expired in the original chapter 7 case. (3) Claims Filed Before Conversion. All claims actually filed by a creditor before conversion of the case are deemed filed in the chapter 7 case. (4) Turnover of Records and Property. After qualification of, or assumption of duties by the chapter 7 trustee, any debtor in possession or trustee previously acting in the chapter 11, 12, or 13 case shall, forthwith, unless otherwise ordered, turn over to the chapter 7 trustee all records and property of the estate in the possession or control of the debtor in possession or trustee. (5) Filing Final Report and Schedule of Postpetition Debts. (A) Conversion of Chapter 11 or Chapter 12 Case. Unless the court directs otherwise, if a chapter 11 or chapter 12 case is converted to chapter 7, the debtor in possession or, if the debtor is not a debtor in possession, the trustee serving at the time of conversion, shall: (i) not later than 14 days after conversion of the case, file a schedule of unpaid debts incurred after the filing of the petition and before conversion of the case, including the name and address of each holder of a claim; and (ii) not later than 30 days after conversion of the case, file and transmit to the United States trustee a final report and account; (B) Conversion of Chapter 13 Case. Unless the court directs otherwise, if a chapter 13 case is converted to chapter 7, (i) the debtor, not later than 14 days after conversion of the case, shall file a schedule of unpaid debts incurred after the filing of the petition and before conversion of the case, including the name and address of each holder of a claim; and (ii) the trustee, not later than 30 days after conversion of the case, shall file and transmit to the United States trustee a final report and account; 15 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1020 (C) Conversion After Confirmation of a Plan. Unless the court orders otherwise, if a chapter 11, chapter 12, or chapter 13 case is converted to chapter 7 after confirmation of a plan, the debtor shall file: (i) a schedule of property not listed in the final report and account acquired after the filing of the petition but before conversion, except if the case is converted from chapter 13 to chapter 7 and § 348(f)(2) does not apply; (ii) a schedule of unpaid debts not listed in the final report and account incurred after confirmation but before the conversion; and (iii) a schedule of executory contracts and unexpired leases entered into or assumed after the filing of the petition but before conversion. (D) Transmission to United States Trustee. The clerk shall forthwith transmit to the United States trustee a copy of every schedule filed pursuant to Rule 1019(5). (6) Postpetition Claims; Preconversion Administrative Expenses; Notice. A request for payment of an administrative expense incurred before conversion of the case is timely filed under § 503(a) of the Code if it is filed before conversion or a time fixed by the court. If the request is filed by a governmental unit, it is timely if it is filed before conversion or within the later of a time fixed by the court or 180 days after the date of the conversion. A claim of a kind specified in § 348(d) may be filed in accordance with Rules 3001(a)–(d) and 3002. Upon the filing of the schedule of unpaid debts incurred after commencement of the case and before conversion, the clerk, or some other person as the court may direct, shall give notice to those entities listed on the schedule of the time for filing a request for payment of an administrative expense and, unless a notice of insufficient assets to pay a dividend is mailed in accordance with Rule 2002(e), the time for filing a claim of a kind specified in § 348(d). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2010, eff. Dec. 1, 2010.) Rule 1020. Small Business Chapter 11 Reorganization Case (a) SMALL BUSINESS DEBTOR DESIGNATION. In a voluntary chapter 11 case, the debtor shall state in the petition whether the debtor is a small business debtor. In an involuntary chapter 11 case, the debtor shall file within 14 days after entry of the order for relief a statement as to whether the debtor is a small business debtor. Except as provided in subdivision (c), the status of the case as a small business case shall be in accordance with the debtor’s statement under this subdivision, unless and until the court enters an order finding that the debtor’s statement is incorrect. (b) OBJECTING TO DESIGNATION. Except as provided in subdivision (c), the United States trustee or a party in interest may file an objection to the debtor’s statement under subdivision (a) no later than 30 days after the conclusion of the meeting of creditors held Rule 1021 FEDERAL RULES OF BANKRUPTCY PROCEDURE 16 under § 341(a) of the Code, or within 30 days after any amendment to the statement, whichever is later. (c) APPOINTMENT OF COMMITTEE OF UNSECURED CREDITORS. If a committee of unsecured creditors has been appointed under § 1102(a)(1), the case shall proceed as a small business case only if, and from the time when, the court enters an order determining that the committee has not been sufficiently active and representative to provide effective oversight of the debtor and that the debtor satisfies all the other requirements for being a small business. A request for a determination under this subdivision may be filed by the United States trustee or a party in interest only within a reasonable time after the failure of the committee to be sufficiently active and representative. The debtor may file a request for a determination at any time as to whether the committee has been sufficiently active and representative. (d) PROCEDURE FOR OBJECTION OR DETERMINATION. Any objection or request for a determination under this rule shall be governed by Rule 9014 and served on: the debtor; the debtor’s attorney; the United States trustee; the trustee; any committee appointed under § 1102 or its authorized agent, or, if no committee of unsecured creditors has been appointed under § 1102, the creditors included on the list filed under Rule 1007(d); and any other entity as the court directs. (Added Apr. 11, 1997, eff. Dec. 1, 1997; amended Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 1021. Health Care Business Case (a) HEALTH CARE BUSINESS DESIGNATION. Unless the court orders otherwise, if a petition in a case under chapter 7, chapter 9, or chapter 11 states that the debtor is a health care business, the case shall proceed as a case in which the debtor is a health care business. (b) MOTION. The United States trustee or a party in interest may file a motion to determine whether the debtor is a health care business. The motion shall be transmitted to the United States trustee and served on: the debtor; the trustee; any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, the creditors included on the list filed under Rule 1007(d); and any other entity as the court directs. The motion shall be governed by Rule 9014. (Added Apr. 23, 2008, eff. Dec. 1, 2008.) PART II—OFFICERS AND ADMINISTRATION; NOTICES; MEETINGS; EXAMINATIONS; ELECTIONS; ATTORNEYS AND ACCOUNTANTS Rule 2001. Appointment of Interim Trustee Before Order for Relief in a Chapter 7 Liquidation Case (a) APPOINTMENT. At any time following the commencement of an involuntary liquidation case and before an order for relief, the court on written motion of a party in interest may order the appointment of an interim trustee under § 303(g) of the Code. The 17 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 motion shall set forth the necessity for the appointment and may be granted only after hearing on notice to the debtor, the petitioning creditors, the United States trustee, and other parties in interest as the court may designate. (b) BOND OF MOVANT. An interim trustee may not be appointed under this rule unless the movant furnishes a bond in an amount approved by the court, conditioned to indemnify the debtor for costs, attorney’s fee, expenses, and damages allowable under § 303(i) of the Code. (c) ORDER OF APPOINTMENT. The order directing the appointment of an interim trustee shall state the reason the appointment is necessary and shall specify the trustee’s duties. (d) TURNOVER AND REPORT. Following qualification of the trustee selected under § 702 of the Code, the interim trustee, unless otherwise ordered, shall (1) forthwith deliver to the trustee all the records and property of the estate in possession or subject to control of the interim trustee and, (2) within 30 days thereafter file a final report and account. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2002. Notices to Creditors, Equity Security Holders, Administrators in Foreign Proceedings, Persons Against Whom Provisional Relief is Sought in Ancillary and Other Cross-Border Cases, United States, and United States Trustee (a) TWENTY-ONE-DAY NOTICES TO PARTIES IN INTEREST. Except as provided in subdivisions (h), (i), (l), (p), and (q) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, the trustee, all creditors and indenture trustees at least 21 days’ notice by mail of: (1) the meeting of creditors under § 341 or § 1104(b) of the Code, which notice, unless the court orders otherwise, shall include the debtor’s employer identification number, social security number, and any other federal taxpayer identification number; (2) a proposed use, sale, or lease of property of the estate other than in the ordinary course of business, unless the court for cause shown shortens the time or directs another method of giving notice; (3) the hearing on approval of a compromise or settlement of a controversy other than approval of an agreement pursuant to Rule 4001(d), unless the court for cause shown directs that notice not be sent; (4) in a chapter 7 liquidation, a chapter 11 reorganization case, or a chapter 12 family farmer debt adjustment case, the hearing on the dismissal of the case or the conversion of the case to another chapter, unless the hearing is under § 707(a)(3) or § 707(b) or is on dismissal of the case for failure to pay the filing fee; (5) the time fixed to accept or reject a proposed modification of a plan; (6) a hearing on any entity’s request for compensation or reimbursement of expenses if the request exceeds $1,000; (7) the time fixed for filing proofs of claims pursuant to Rule 3003(c); Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 18 (8) the time fixed for filing objections and the hearing to consider confirmation of a chapter 12 plan; and (9) the time fixed for filing objections to confirmation of a chapter 13 plan. (b) TWENTY-EIGHT-DAY NOTICES TO PARTIES IN INTEREST. Except as provided in subdivision (l) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, the trustee, all creditors and indenture trustees not less than 28 days’ notice by mail of the time fixed (1) for filing objections and the hearing to consider approval of a disclosure statement or, under § 1125(f), to make a final determination whether the plan provides adequate information so that a separate disclosure statement is not necessary; (2) for filing objections and the hearing to consider confirmation of a chapter 9 or chapter 11 plan; and (3) for the hearing to consider confirmation of a chapter 13 plan. (c) CONTENT OF NOTICE. (1) Proposed Use, Sale, or Lease of Property. Subject to Rule 6004, the notice of a proposed use, sale, or lease of property required by subdivision (a)(2) of this rule shall include the time and place of any public sale, the terms and conditions of any private sale and the time fixed for filing objections. The notice of a proposed use, sale, or lease of property, including real estate, is sufficient if it generally describes the property. The notice of a proposed sale or lease of personally identifiable information under § 363(b)(1) of the Code shall state whether the sale is consistent with any policy prohibiting the transfer of the information. (2) Notice of Hearing on Compensation. The notice of a hearing on an application for compensation or reimbursement of expenses required by subdivision (a)(6) of this rule shall identify the applicant and the amounts requested. (3) Notice of Hearing on Confirmation When Plan Provides for an Injunction. If a plan provides for an injunction against conduct not otherwise enjoined under the Code, the notice required under Rule 2002(b)(2) shall: (A) include in conspicuous language (bold, italic, or underlined text) a statement that the plan proposes an injunction; (B) describe briefly the nature of the injunction; and (C) identify the entities that would be subject to the injunction. (d) NOTICE TO EQUITY SECURITY HOLDERS. In a chapter 11 reorganization case, unless otherwise ordered by the court, the clerk, or some other person as the court may direct, shall in the manner and form directed by the court give notice to all equity security holders of (1) the order for relief; (2) any meeting of equity security holders held pursuant to § 341 of the Code; (3) the hearing on the proposed sale of all or substantially all of the debtor’s assets; (4) the hearing on the dismissal or conversion of a case to another chapter; (5) the time fixed for filing objections to and the hearing to consider approval of a disclosure statement; (6) the time fixed for filing objections to and the hearing to consider confirmation of a plan; and (7) the time fixed to accept or reject a proposed modification of a plan. 19 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 (e) NOTICE OF NO DIVIDEND. In a chapter 7 liquidation case, if it appears from the schedules that there are no assets from which a dividend can be paid, the notice of the meeting of creditors may include a statement to that effect; that it is unnecessary to file claims; and that if sufficient assets become available for the payment of a dividend, further notice will be given for the filing of claims. (f) OTHER NOTICES. Except as provided in subdivision (l) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, all creditors, and indenture trustees notice by mail of: (1) the order for relief; (2) the dismissal or the conversion of the case to another chapter, or the suspension of proceedings under § 305; (3) the time allowed for filing claims pursuant to Rule 3002; (4) the time fixed for filing a complaint objecting to the debtor’s discharge pursuant to § 727 of the Code as provided in Rule 4004; (5) the time fixed for filing a complaint to determine the dischargeability of a debt pursuant to § 523 of the Code as provided in Rule 4007; (6) the waiver, denial, or revocation of a discharge as provided in Rule 4006; (7) entry of an order confirming a chapter 9, 11, or 12 plan; (8) a summary of the trustee’s final report in a chapter 7 case if the net proceeds realized exceed $1,500; (9) a notice under Rule 5008 regarding the presumption of abuse; (10) a statement under § 704(b)(1) as to whether the debtor’s case would be presumed to be an abuse under § 707(b); and (11) the time to request a delay in the entry of the discharge under §§ 1141(d)(5)(C), 1228(f), and 1328(h). Notice of the time fixed for accepting or rejecting a plan pursuant to Rule 3017(c) shall be given in accordance with Rule 3017(d). (g) ADDRESSING NOTICES. (1) Notices required to be mailed under Rule 2002 to a creditor, indenture trustee, or equity security holder shall be addressed as such entity or an authorized agent has directed in its last request filed in the particular case. For the purposes of this subdivision— (A) a proof of claim filed by a creditor or indenture trustee that designates a mailing address constitutes a filed request to mail notices to that address, unless a notice of no dividend has been given under Rule 2002(e) and a later notice of possible dividend under Rule 3002(c)(5) has not been given; and (B) a proof of interest filed by an equity security holder that designates a mailing address constitutes a filed request to mail notices to that address. (2) Except as provided in § 342(f) of the Code, if a creditor or indenture trustee has not filed a request designating a mailing address under Rule 2002(g)(1) or Rule 5003(e), the notices shall be mailed to the address shown on the list of creditors or schedule of liabilities, whichever is filed later. If an equity security holder has not filed a request designating a mailing address under Rule 2002(g)(1) or Rule 5003(e), the notices shall be Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 20 mailed to the address shown on the list of equity security holders. (3) If a list or schedule filed under Rule 1007 includes the name and address of a legal representative of an infant or incompetent person, and a person other than that representative files a request or proof of claim designating a name and mailing address that differs from the name and address of the representative included in the list or schedule, unless the court orders otherwise, notices under Rule 2002 shall be mailed to the representative included in the list or schedules and to the name and address designated in the request or proof of claim. (4) Notwithstanding Rule 2002(g)(1)–(3), an entity and a notice provider may agree that when the notice provider is directed by the court to give a notice, the notice provider shall give the notice to the entity in the manner agreed to and at the address or addresses the entity supplies to the notice provider. That address is conclusively presumed to be a proper address for the notice. The notice provider’s failure to use the supplied address does not invalidate any notice that is otherwise effective under applicable law. (5) A creditor may treat a notice as not having been brought to the creditor’s attention under § 342(g)(1) only if, prior to issuance of the notice, the creditor has filed a statement that designates the name and address of the person or organizational subdivision of the creditor responsible for receiving notices under the Code, and that describes the procedures established by the creditor to cause such notices to be delivered to the designated person or subdivision. (h) NOTICES TO CREDITORS WHOSE CLAIMS ARE FILED. In a chapter 7 case, after 90 days following the first date set for the meeting of creditors under § 341 of the Code, the court may direct that all notices required by subdivision (a) of this rule be mailed only to the debtor, the trustee, all indenture trustees, creditors that hold claims for which proofs of claim have been filed, and creditors, if any, that are still permitted to file claims by reason of an extension granted pursuant to Rule 3002(c)(1) or (c)(2). In a case where notice of insufficient assets to pay a dividend has been given to creditors pursuant to subdivision (e) of this rule, after 90 days following the mailing of a notice of the time for filing claims pursuant to Rule 3002(c)(5), the court may direct that notices be mailed only to the entities specified in the preceding sentence. (i) NOTICES TO COMMITTEES. Copies of all notices required to be mailed pursuant to this rule shall be mailed to the committees elected under § 705 or appointed under § 1102 of the Code or to their authorized agents. Notwithstanding the foregoing subdivisions, the court may order that notices required by subdivision (a)(2), (3) and (6) of this rule be transmitted to the United States trustee and be mailed only to the committees elected under § 705 or appointed under § 1102 of the Code or to their authorized agents and to the creditors and equity security holders who serve on the trustee or debtor in possession and file a request that all notices be mailed to them. A committee appointed under § 1114 shall receive copies of all notices required by subdivisions (a)(1), (a)(5), (b), (f)(2), and (f)(7), and such other notices as the court may direct. 21 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 1So in original. Period probably should not appear. (j) NOTICES TO THE UNITED STATES. Copies of notices required to be mailed to all creditors under this rule shall be mailed (1) in a chapter 11 reorganization case, to the Securities and Exchange Commission at any place the Commission designates, if the Commission has filed either a notice of appearance in the case or a written request to receive notices; (2) in a commodity broker case, to the Commodity Futures Trading Commission at Washington, D.C.; (3) in a chapter 11 case, to the Internal Revenue Service at its address set out in the register maintained under Rule 5003(e) for the district in which the case is pending; (4) if the papers in the case disclose a debt to the United States other than for taxes, to the United States attorney for the district in which the case is pending and to the department, agency, or instrumentality of the United States through which the debtor became indebted; or (5) if the filed papers disclose a stock interest of the United States, to the Secretary of the Treasury at Washington, D.C. (k) NOTICES TO UNITED STATES TRUSTEE. Unless the case is a chapter 9 municipality case or unless the United States trustee requests otherwise, the clerk, or some other person as the court may direct, shall transmit to the United States trustee notice of the matters described in subdivisions (a)(2), (a)(3), (a)(4), (a)(8), (b), (f)(1), (f)(2), (f)(4), (f)(6), (f)(7), (f)(8), and (q) of this rule and notice of hearings on all applications for compensation or reimbursement of expenses. Notices to the United States trustee shall be transmitted within the time prescribed in subdivision (a) or (b) of this rule. The United States trustee shall also receive notice of any other matter if such notice is requested by the United States trustee or ordered by the court. Nothing in these rules requires the clerk or any other person to transmit to the United States trustee any notice, schedule, report, application or other document in a case under the Securities Investor Protection Act, 15 U.S.C. § 78aaa et. 1 seq. (l) NOTICE BY PUBLICATION. The court may order notice by publication if it finds that notice by mail is impracticable or that it is desirable to supplement the notice. (m) ORDERS DESIGNATING MATTER OF NOTICES. The court may from time to time enter orders designating the matters in respect to which, the entity to whom, and the form and manner in which notices shall be sent except as otherwise provided by these rules. (n) CAPTION. The caption of every notice given under this rule shall comply with Rule 1005. The caption of every notice required to be given by the debtor to a creditor shall include the information required to be in the notice by § 342(c) of the Code. (o) NOTICE OF ORDER FOR RELIEF IN CONSUMER CASE. In a voluntary case commenced by an individual debtor whose debts are primarily consumer debts, the clerk or some other person as the court may direct shall give the trustee and all creditors notice by mail of the order for relief within 21 days from the date thereof. (p) NOTICE TO A CREDITOR WITH A FOREIGN ADDRESS. (1) If, at the request of the United States trustee or a party in interest, or on its own initiative, the court finds that a notice mailed within the time prescribed by these rules would Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 22 not be sufficient to give a creditor with a foreign address to which notices under these rules are mailed reasonable notice under the circumstances, the court may order that the notice be supplemented with notice by other means or that the time prescribed for the notice by mail be enlarged. (2) Unless the court for cause orders otherwise, a creditor with a foreign address to which notices under this rule are mailed shall be given at least 30 days’ notice of the time fixed for filing a proof of claim under Rule 3002(c) or Rule 3003(c). (3) Unless the court for cause orders otherwise, the mailing address of a creditor with a foreign address shall be determined under Rule 2002(g). (q) NOTICE OF PETITION FOR RECOGNITION OF FOREIGN PROCEEDING AND OF COURT’S INTENTION TO COMMUNICATE WITH FOREIGN COURTS AND FOREIGN REPRESENTATIVES. (1) Notice of Petition for Recognition. After the filing of a petition for recognition of a foreign proceeding, the court shall promptly schedule and hold a hearing on the petition. The clerk, or some other person as the court may direct, shall forthwith give the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and such other entities as the court may direct, at least 21 days’ notice by mail of the hearing. The notice shall state whether the petition seeks recognition as a foreign main proceeding or foreign nonmain proceeding and shall include the petition and any other document the court may require. If the court consolidates the hearing on the petition with the hearing on a request for provisional relief, the court may set a shorter notice period, with notice to the entities listed in this subdivision. (2) Notice of Court’s Intention to Communicate with Foreign Courts and Foreign Representatives. The clerk, or some other person as the court may direct, shall give the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and such other entities as the court may direct, notice by mail of the court’s intention to communicate with a foreign court or foreign representative. (As amended Pub. L. 98–91, § 2(a), Aug. 30, 1983, 97 Stat. 607; Pub. L. 98–353, title III, § 321, July 10, 1984, 98 Stat. 357; Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 17, 2000, eff. Dec. 1, 2000; Apr. 23, 2001, eff. Dec. 1, 2001; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 26, 2004, eff. Dec. 1, 2004; Apr. 25, 2005, eff. Dec. 1, 2005; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2016, eff. Dec. 1, 2016; Apr. 27, 2017, eff. Dec. 1, 2017.) 23 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2003 Rule 2003. Meeting of Creditors or Equity Security Holders (a) DATE AND PLACE. Except as otherwise provided in § 341(e) of the Code, in a chapter 7 liquidation or a chapter 11 reorganization case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 40 days after the order for relief. In a chapter 12 family farmer debt adjustment case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 35 days after the order for relief. In a chapter 13 individual’s debt adjustment case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 50 days after the order for relief. If there is an appeal from or a motion to vacate the order for relief, or if there is a motion to dismiss the case, the United States trustee may set a later date for the meeting. The meeting may be held at a regular place for holding court or at any other place designated by the United States trustee within the district convenient for the parties in interest. If the United States trustee designates a place for the meeting which is not regularly staffed by the United States trustee or an assistant who may preside at the meeting, the meeting may be held not more than 60 days after the order for relief. (b) ORDER OF MEETING. (1) Meeting of Creditors. The United States trustee shall preside at the meeting of creditors. The business of the meeting shall include the examination of the debtor under oath and, in a chapter 7 liquidation case, may include the election of a creditors’ committee and, if the case is not under subchapter V of chapter 7, the election of a trustee. The presiding officer shall have the authority to administer oaths. (2) Meeting of Equity Security Holders. If the United States trustee convenes a meeting of equity security holders pursuant to § 341(b) of the Code, the United States trustee shall fix a date for the meeting and shall preside. (3) Right To Vote. In a chapter 7 liquidation case, a creditor is entitled to vote at a meeting if, at or before the meeting, the creditor has filed a proof of claim or a writing setting forth facts evidencing a right to vote pursuant to § 702(a) of the Code unless objection is made to the claim or the proof of claim is insufficient on its face. A creditor of a partnership may file a proof of claim or writing evidencing a right to vote for the trustee for the estate of the general partner notwithstanding that a trustee for the estate of the partnership has previously qualified. In the event of an objection to the amount or allowability of a claim for the purpose of voting, unless the court orders otherwise, the United States trustee shall tabulate the votes for each alternative presented by the dispute and, if resolution of such dispute is necessary to determine the result of the election, the tabulations for each alternative shall be reported to the court. (c) RECORD OF MEETING. Any examination under oath at the meeting of creditors held pursuant to § 341(a) of the Code shall be recorded verbatim by the United States trustee using electronic sound recording equipment or other means of recording, and such record shall be preserved by the United States trustee and available for public access until two years after the conclusion of the Rule 2004 FEDERAL RULES OF BANKRUPTCY PROCEDURE 24 meeting of creditors. Upon request of any entity, the United States trustee shall certify and provide a copy or transcript of such recording at the entity’s expense. (d) REPORT OF ELECTION AND RESOLUTION OF DISPUTES IN A CHAPTER 7 CASE. (1) Report of Undisputed Election. In a chapter 7 case, if the election of a trustee or a member of a creditors’ committee is not disputed, the United States trustee shall promptly file a report of the election, including the name and address of the person or entity elected and a statement that the election is undisputed. (2) Disputed Election. If the election is disputed, the United States trustee shall promptly file a report stating that the election is disputed, informing the court of the nature of the dispute, and listing the name and address of any candidate elected under any alternative presented by the dispute. No later than the date on which the report is filed, the United States trustee shall mail a copy of the report to any party in interest that has made a request to receive a copy of the report. Pending disposition by the court of a disputed election for trustee, the interim trustee shall continue in office. Unless a motion for the resolution of the dispute is filed no later than 14 days after the United States trustee files a report of a disputed election for trustee, the interim trustee shall serve as trustee in the case. (e) ADJOURNMENT. The meeting may be adjourned from time to time by announcement at the meeting of the adjourned date and time. The presiding official shall promptly file a statement specifying the date and time to which the meeting is adjourned. (f) SPECIAL MEETINGS. The United States trustee may call a special meeting of creditors on request of a party in interest or on the United States trustee’s own initiative. (g) FINAL MEETING. If the United States trustee calls a final meeting of creditors in a case in which the net proceeds realized exceed $1,500, the clerk shall mail a summary of the trustee’s final account to the creditors with a notice of the meeting, together with a statement of the amount of the claims allowed. The trustee shall attend the final meeting and shall, if requested, report on the administration of the estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 26, 1999, eff. Dec. 1, 1999; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 26, 2011, eff. Dec. 1, 2011.) Rule 2004. Examination (a) EXAMINATION ON MOTION. On motion of any party in interest, the court may order the examination of any entity. (b) SCOPE OF EXAMINATION. The examination of an entity under this rule or of the debtor under § 343 of the Code may relate only to the acts, conduct, or property or to the liabilities and financial condition of the debtor, or to any matter which may affect the administration of the debtor’s estate, or to the debtor’s right to a discharge. In a family farmer’s debt adjustment case under chapter 12, an individual’s debt adjustment case under chapter 13, or 25 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2005 a reorganization case under chapter 11 of the Code, other than for the reorganization of a railroad, the examination may also relate to the operation of any business and the desirability of its continuance, the source of any money or property acquired or to be acquired by the debtor for purposes of consummating a plan and the consideration given or offered therefor, and any other matter relevant to the case or to the formulation of a plan. (c) COMPELLING ATTENDANCE AND PRODUCTION OF DOCUMENTS. The attendance of an entity for examination and for the production of documents, whether the examination is to be conducted within or without the district in which the case is pending, may be compelled as provided in Rule 9016 for the attendance of a witness at a hearing or trial. As an officer of the court, an attorney may issue and sign a subpoena on behalf of the court for the district in which the examination is to be held if the attorney is admitted to practice in that court or in the court in which the case is pending. (d) TIME AND PLACE OF EXAMINATION OF DEBTOR. The court may for cause shown and on terms as it may impose order the debtor to be examined under this rule at any time or place it designates, whether within or without the district wherein the case is pending. (e) MILEAGE. An entity other than a debtor shall not be required to attend as a witness unless lawful mileage and witness fee for one day’s attendance shall be first tendered. If the debtor resides more than 100 miles from the place of examination when required to appear for an examination under this rule, the mileage allowed by law to a witness shall be tendered for any distance more than 100 miles from the debtor’s residence at the date of the filing of the first petition commencing a case under the Code or the residence at the time the debtor is required to appear for the examination, whichever is the lesser. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 2005. Apprehension and Removal of Debtor to Compel Attendance for Examination (a) ORDER TO COMPEL ATTENDANCE FOR EXAMINATION. On motion of any party in interest supported by an affidavit alleging (1) that the examination of the debtor is necessary for the proper administration of the estate and that there is reasonable cause to believe that the debtor is about to leave or has left the debtor’s residence or principal place of business to avoid examination, or (2) that the debtor has evaded service of a subpoena or of an order to attend for examination, or (3) that the debtor has willfully disobeyed a subpoena or order to attend for examination, duly served, the court may issue to the marshal, or some other officer authorized by law, an order directing the officer to bring the debtor before the court without unnecessary delay. If, after hearing, the court finds the allegations to be true, the court shall thereupon cause the debtor to be examined forthwith. If necessary, the court shall fix conditions for further examination and for the debtor’s obedience to all orders made in reference thereto. (b) REMOVAL. Whenever any order to bring the debtor before the court is issued under this rule and the debtor is found in a district Rule 2006 FEDERAL RULES OF BANKRUPTCY PROCEDURE 26 other than that of the court issuing the order, the debtor may be taken into custody under the order and removed in accordance with the following rules: (1) If the debtor is taken into custody under the order at a place less than 100 miles from the place of issue of the order, the debtor shall be brought forthwith before the court that issued the order. (2) If the debtor is taken into custody under the order at a place 100 miles or more from the place of issue of the order, the debtor shall be brought without unnecessary delay before the nearest available United States magistrate judge, bankruptcy judge, or district judge. If, after hearing, the magistrate judge, bankruptcy judge, or district judge finds that an order has issued under this rule and that the person in custody is the debtor, or if the person in custody waives a hearing, the magistrate judge, bankruptcy judge, or district judge shall order removal, and the person in custody shall be released on conditions ensuring prompt appearance before the court that issued the order to compel the attendance. (c) CONDITIONS OF RELEASE. In determining what conditions will reasonably assure attendance or obedience under subdivision (a) of this rule or appearance under subdivision (b) of this rule, the court shall be governed by the provisions and policies of title 18, U.S.C., § 3146(a) and (b). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 22, 1993, eff. Aug. 1, 1993.) Rule 2006. Solicitation and Voting of Proxies in Chapter 7 Liquidation Cases (a) APPLICABILITY. This rule applies only in a liquidation case pending under chapter 7 of the Code. (b) DEFINITIONS. (1) Proxy. A proxy is a written power of attorney authorizing any entity to vote the claim or otherwise act as the owner’s attorney in fact in connection with the administration of the estate. (2) Solicitation of Proxy. The solicitation of a proxy is any communication, other than one from an attorney to a regular client who owns a claim or from an attorney to the owner of a claim who has requested the attorney to represent the owner, by which a creditor is asked, directly or indirectly, to give a proxy after or in contemplation of the filing of a petition by or against the debtor. (c) AUTHORIZED SOLICITATION. (1) A proxy may be solicited only by (A) a creditor owning an allowable unsecured claim against the estate on the date of the filing of the petition; (B) a committee elected pursuant to § 705 of the Code; (C) a committee of creditors selected by a majority in number and amount of claims of creditors (i) whose claims are not contingent or unliquidated, (ii) who are not disqualified from voting under § 702(a) of the Code and (iii) who were present or represented at a meeting of which all creditors having claims of over $500 or the 100 creditors having the largest claims had at least seven days’ notice in writing 27 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2006 and of which meeting written minutes were kept and are available reporting the names of the creditors present or represented and voting and the amounts of their claims; or (D) a bona fide trade or credit association, but such association may solicit only creditors who were its members or subscribers in good standing and had allowable unsecured claims on the date of the filing of the petition. (2) A proxy may be solicited only in writing. (d) SOLICITATION NOT AUTHORIZED. This rule does not permit solicitation (1) in any interest other than that of general creditors; (2) by or on behalf of any custodian; (3) by the interim trustee or by or on behalf of any entity not qualified to vote under § 702(a) of the Code; (4) by or on behalf of an attorney at law; or (5) by or on behalf of a transferee of a claim for collection only. (e) DATA REQUIRED FROM HOLDERS OF MULTIPLE PROXIES. At any time before the voting commences at any meeting of creditors pursuant to § 341(a) of the Code, or at any other time as the court may direct, a holder of two or more proxies shall file and transmit to the United States trustee a verified list of the proxies to be voted and a verified statement of the pertinent facts and circumstances in connection with the execution and delivery of each proxy, including: (1) a copy of the solicitation; (2) identification of the solicitor, the forwarder, if the forwarder is neither the solicitor nor the owner of the claim, and the proxyholder, including their connections with the debtor and with each other. If the solicitor, forwarder, or proxyholder is an association, there shall also be included a statement that the creditors whose claims have been solicited and the creditors whose claims are to be voted were members or subscribers in good standing and had allowable unsecured claims on the date of the filing of the petition. If the solicitor, forwarder, or proxyholder is a committee of creditors, the statement shall also set forth the date and place the committee was organized, that the committee was organized in accordance with clause (B) or (C) of paragraph (c)(1) of this rule, the members of the committee, the amounts of their claims, when the claims were acquired, the amounts paid therefor, and the extent to which the claims of the committee members are secured or entitled to priority; (3) a statement that no consideration has been paid or promised by the proxyholder for the proxy; (4) a statement as to whether there is any agreement and, if so, the particulars thereof, between the proxyholder and any other entity for the payment of any consideration in connection with voting the proxy, or for the sharing of compensation with any entity, other than a member or regular associate of the proxyholder’s law firm, which may be allowed the trustee or any entity for services rendered in the case, or for the employment of any person as attorney, accountant, appraiser, auctioneer, or other employee for the estate; (5) if the proxy was solicited by an entity other than the proxyholder, or forwarded to the holder by an entity who is neither a solicitor of the proxy nor the owner of the claim, a statement signed and verified by the solicitor or forwarder that no consideration has been paid or promised for the proxy, and whether there is any agreement, and, if so, the particulars thereof, between the solicitor or forwarder and any other entity for the payment of any consideration in connection with voting the proxy, or for sharing compensation with any entity other than a member or regular associate of the solicitor’s or forwarder’s law firm which may be allowed the trustee or any entity for services rendered in the case, or for the employment of any person as attorney, accountant, appraiser, auctioneer, or other employee for the estate; (6) if the solicitor, forwarder, or proxyholder is a committee, a statement signed and verified by each member as to the amount and source of any consideration paid or to be paid to such member in connection with the case other than by way of dividend on the member’s claim. (f) ENFORCEMENT OF RESTRICTIONS ON SOLICITATION. On motion of any party in interest or on its own initiative, the court may determine whether there has been a failure to comply with the provisions of this rule or any other impropriety in connection with the solicitation or voting of a proxy. After notice and a hearing the court may reject any proxy for cause, vacate any order entered in consequence of the voting of any proxy which should have been rejected, or take any other appropriate action. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2007. Review of Appointment of Creditors’ Committee Organized Before Commencement of the Case (a) MOTION TO REVIEW APPOINTMENT. If a committee appointed by the United States trustee pursuant to § 1102(a) of the Code consists of the members of a committee organized by creditors before the commencement of a chapter 9 or chapter 11 case, on motion of a party in interest and after a hearing on notice to the United States trustee and other entities as the court may direct, the court may determine whether the appointment of the committee satisfies the requirements of § 1102(b)(1) of the Code. (b) SELECTION OF MEMBERS OF COMMITTEE. The court may find that a committee organized by unsecured creditors before the commencement of a chapter 9 or chapter 11 case was fairly chosen if: (1) it was selected by a majority in number and amount of claims of unsecured creditors who may vote under § 702(a) of the Code and were present in person or represented at a meeting of which all creditors having unsecured claims of over $1,000 or the 100 unsecured creditors having the largest claims had at least seven days’ notice in writing, and of which meeting written minutes reporting the names of the creditors present or represented and voting and the amounts of their claims were kept and are available for inspection; (2) all proxies voted at the meeting for the elected committee were solicited pursuant to Rule 2006 and the lists and statements required by subdivision (e) thereof have been transmitted to the United States trustee; and (3) the organization of the committee was in all other respects fair and proper. 29 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2007.1 (c) FAILURE TO COMPLY WITH REQUIREMENTS FOR APPOINTMENT. After a hearing on notice pursuant to subdivision (a) of this rule, the court shall direct the United States trustee to vacate the appointment of the committee and may order other appropriate action if the court finds that such appointment failed to satisfy the requirements of § 1102(b)(1) of the Code. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2007.1. Appointment of Trustee or Examiner in a Chapter 11 Reorganization Case (a) ORDER TO APPOINT TRUSTEE OR EXAMINER. In a chapter 11 reorganization case, a motion for an order to appoint a trustee or an examiner under § 1104(a) or § 1104(c) of the Code shall be made in accordance with Rule 9014. (b) ELECTION OF TRUSTEE. (1) Request for an Election. A request to convene a meeting of creditors for the purpose of electing a trustee in a chapter 11 reorganization case shall be filed and transmitted to the United States trustee in accordance with Rule 5005 within the time prescribed by § 1104(b) of the Code. Pending court approval of the person elected, any person appointed by the United States trustee under § 1104(d) and approved in accordance with subdivision (c) of this rule shall serve as trustee. (2) Manner of Election and Notice. An election of a trustee under § 1104(b) of the Code shall be conducted in the manner provided in Rules 2003(b)(3) and 2006. Notice of the meeting of creditors convened under § 1104(b) shall be given as provided in Rule 2002. The United States trustee shall preside at the meeting. A proxy for the purpose of voting in the election may be solicited only by a committee of creditors appointed under § 1102 of the Code or by any other party entitled to solicit a proxy pursuant to Rule 2006. (3) Report of Election and Resolution of Disputes. (A) Report of Undisputed Election. If no dispute arises out of the election, the United States trustee shall promptly file a report certifying the election, including the name and address of the person elected and a statement that the election is undisputed. The report shall be accompanied by a verified statement of the person elected setting forth that person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (B) Dispute Arising Out of an Election. If a dispute arises out of an election, the United States trustee shall promptly file a report stating that the election is disputed, informing the court of the nature of the dispute, and listing the name and address of any candidate elected under any alternative presented by the dispute. The report shall be accompanied by a verified statement by each candidate elected under each alternative presented by the dispute, setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any Rule 2007.2 FEDERAL RULES OF BANKRUPTCY PROCEDURE 30 person employed in the office of the United States trustee. Not later than the date on which the report of the disputed election is filed, the United States trustee shall mail a copy of the report and each verified statement to any party in interest that has made a request to convene a meeting under § 1104(b) or to receive a copy of the report, and to any committee appointed under § 1102 of the Code. (c) APPROVAL OF APPOINTMENT. An order approving the appointment of a trustee or an examiner under § 1104(d) of the Code shall be made on application of the United States trustee. The application shall state the name of the person appointed and, to the best of the applicant’s knowledge, all the person’s connections with the debtor, creditors, any other parties in interest, their respective attorneys and accountants, the United States trustee, or persons employed in the office of the United States trustee. The application shall state the names of the parties in interest with whom the United States trustee consulted regarding the appointment. The application shall be accompanied by a verified statement of the person appointed setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (Added Apr. 30, 1991, eff. Aug. 1, 1991; amended Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 2007.2. Appointment of Patient Care Ombudsman in a Health Care Business Case (a) ORDER TO APPOINT PATIENT CARE OMBUDSMAN. In a chapter 7, chapter 9, or chapter 11 case in which the debtor is a health care business, the court shall order the appointment of a patient care ombudsman under § 333 of the Code, unless the court, on motion of the United States trustee or a party in interest filed no later than 21 days after the commencement of the case or within another time fixed by the court, finds that the appointment of a patient care ombudsman is not necessary under the specific circumstances of the case for the protection of patients. (b) MOTION FOR ORDER TO APPOINT OMBUDSMAN. If the court has found that the appointment of an ombudsman is not necessary, or has terminated the appointment, the court, on motion of the United States trustee or a party in interest, may order the appointment at a later time if it finds that the appointment has become necessary to protect patients. (c) NOTICE OF APPOINTMENT. If a patient care ombudsman is appointed under § 333, the United States trustee shall promptly file a notice of the appointment, including the name and address of the person appointed. Unless the person appointed is a State Long-Term Care Ombudsman, the notice shall be accompanied by a verified statement of the person appointed setting forth the person’s connections with the debtor, creditors, patients, any other party in interest, their respective attorneys and accountants, the United States trustee, and any person employed in the office of the United States trustee. (d) TERMINATION OF APPOINTMENT. On motion of the United States trustee or a party in interest, the court may terminate the 31 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2009 appointment of a patient care ombudsman if the court finds that the appointment is not necessary to protect patients. (e) MOTION. A motion under this rule shall be governed by Rule 9014. The motion shall be transmitted to the United States trustee and served on: the debtor; the trustee; any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, on the creditors included on the list filed under Rule 1007(d); and such other entities as the court may direct. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2008. Notice to Trustee of Selection The United States trustee shall immediately notify the person selected as trustee how to qualify and, if applicable, the amount of the trustee’s bond. A trustee that has filed a blanket bond pursuant to Rule 2010 and has been selected as trustee in a chapter 7, chapter 12, or chapter 13 case that does not notify the court and the United States trustee in writing of rejection of the office within seven days after receipt of notice of selection shall be deemed to have accepted the office. Any other person selected as trustee shall notify the court and the United States trustee in writing of acceptance of the office within seven days after receipt of notice of selection or shall be deemed to have rejected the office. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2009. Trustees for Estates When Joint Administration Ordered (a) ELECTION OF SINGLE TRUSTEE FOR ESTATES BEING JOINTLY ADMINISTERED. If the court orders a joint administration of two or more estates under Rule 1015(b), creditors may elect a single trustee for the estates being jointly administered, unless the case is under subchapter V of chapter 7 of the Code. (b) RIGHT OF CREDITORS TO ELECT SEPARATE TRUSTEE. Notwithstanding entry of an order for joint administration under Rule 1015(b), the creditors of any debtor may elect a separate trustee for the estate of the debtor as provided in § 702 of the Code, unless the case is under subchapter V of chapter 7. (c) APPOINTMENT OF TRUSTEES FOR ESTATES BEING JOINTLY ADMINISTERED. (1) Chapter 7 Liquidation Cases. Except in a case governed by subchapter V of chapter 7, the United States trustee may appoint one or more interim trustees for estates being jointly administered in chapter 7 cases. (2) Chapter 11 Reorganization Cases. If the appointment of a trustee is ordered, the United States trustee may appoint one or more trustees for estates being jointly administered in chapter 11 cases. (3) Chapter 12 Family Farmer’s Debt Adjustment Cases. The United States trustee may appoint one or more trustees for estates being jointly administered in chapter 12 cases. Rule 2010 FEDERAL RULES OF BANKRUPTCY PROCEDURE 32 (4) Chapter 13 Individual’s Debt Adjustment Cases. The United States trustee may appoint one or more trustees for estates being jointly administered in chapter 13 cases. (d) POTENTIAL CONFLICTS OF INTEREST. On a showing that creditors or equity security holders of the different estates will be prejudiced by conflicts of interest of a common trustee who has been elected or appointed, the court shall order the selection of separate trustees for estates being jointly administered. (e) SEPARATE ACCOUNTS. The trustee or trustees of estates being jointly administered shall keep separate accounts of the property and distribution of each estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 27, 2003, eff. Dec. 1, 2003.) Rule 2010. Qualification by Trustee; Proceeding on Bond (a) BLANKET BOND. The United States trustee may authorize a blanket bond in favor of the United States conditioned on the faithful performance of official duties by the trustee or trustees to cover (1) a person who qualifies as trustee in a number of cases, and (2) a number of trustees each of whom qualifies in a different case. (b) PROCEEDING ON BOND. A proceeding on the trustee’s bond may be brought by any party in interest in the name of the United States for the use of the entity injured by the breach of the condition. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2011. Evidence of Debtor in Possession or Qualification of Trustee (a) Whenever evidence is required that a debtor is a debtor in possession or that a trustee has qualified, the clerk may so certify and the certificate shall constitute conclusive evidence of that fact. (b) If a person elected or appointed as trustee does not qualify within the time prescribed by § 322(a) of the Code, the clerk shall so notify the court and the United States trustee. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2012. Substitution of Trustee or Successor Trustee; Accounting (a) TRUSTEE. If a trustee is appointed in a chapter 11 case or the debtor is removed as debtor in possession in a chapter 12 case, the trustee is substituted automatically for the debtor in possession as a party in any pending action, proceeding, or matter. (b) SUCCESSOR TRUSTEE. When a trustee dies, resigns, is removed, or otherwise ceases to hold office during the pendency of a case under the Code (1) the successor is automatically substituted as a party in any pending action, proceeding, or matter; and (2) the successor trustee shall prepare, file, and transmit to the United States trustee an accounting of the prior administration of the estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) 33 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2014 Rule 2013. Public Record of Compensation Awarded to Trustees, Examiners, and Professionals (a) RECORD TO BE KEPT. The clerk shall maintain a public record listing fees awarded by the court (1) to trustees and attorneys, accountants, appraisers, auctioneers and other professionals employed by trustees, and (2) to examiners. The record shall include the name and docket number of the case, the name of the individual or firm receiving the fee and the amount of the fee awarded. The record shall be maintained chronologically and shall be kept current and open to examination by the public without charge. ‘‘Trustees,’’ as used in this rule, does not include debtors in possession. (b) SUMMARY OF RECORD. At the close of each annual period, the clerk shall prepare a summary of the public record by individual or firm name, to reflect total fees awarded during the preceding year. The summary shall be open to examination by the public without charge. The clerk shall transmit a copy of the summary to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2014. Employment of Professional Persons (a) APPLICATION FOR AND ORDER OF EMPLOYMENT. An order approving the employment of attorneys, accountants, appraisers, auctioneers, agents, or other professionals pursuant to § 327, § 1103, or § 1114 of the Code shall be made only on application of the trustee or committee. The application shall be filed and, unless the case is a chapter 9 municipality case, a copy of the application shall be transmitted by the applicant to the United States trustee. The application shall state the specific facts showing the necessity for the employment, the name of the person to be employed, the reasons for the selection, the professional services to be rendered, any proposed arrangement for compensation, and, to the best of the applicant’s knowledge, all of the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. The application shall be accompanied by a verified statement of the person to be employed setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (b) SERVICES RENDERED BY MEMBER OR ASSOCIATE OF FIRM OF ATTORNEYS OR ACCOUNTANTS. If, under the Code and this rule, a law partnership or corporation is employed as an attorney, or an accounting partnership or corporation is employed as an accountant, or if a named attorney or accountant is employed, any partner, member, or regular associate of the partnership, corporation, or individual may act as attorney or accountant so employed, without further order of the court. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2015 FEDERAL RULES OF BANKRUPTCY PROCEDURE 34 Rule 2015. Duty to Keep Records, Make Reports, and Give Notice of Case or Change of Status (a) TRUSTEE OR DEBTOR IN POSSESSION. A trustee or debtor in possession shall: (1) in a chapter 7 liquidation case and, if the court directs, in a chapter 11 reorganization case file and transmit to the United States trustee a complete inventory of the property of the debtor within 30 days after qualifying as a trustee or debtor in possession, unless such an inventory has already been filed; (2) keep a record of receipts and the disposition of money and property received; (3) file the reports and summaries required by § 704(a)(8) of the Code, which shall include a statement, if payments are made to employees, of the amounts of deductions for all taxes required to be withheld or paid for and in behalf of employees and the place where these amounts are deposited; (4) as soon as possible after the commencement of the case, give notice of the case to every entity known to be holding money or property subject to withdrawal or order of the debtor, including every bank, savings or building and loan association, public utility company, and landlord with whom the debtor has a deposit, and to every insurance company which has issued a policy having a cash surrender value payable to the debtor, except that notice need not be given to any entity who has knowledge or has previously been notified of the case; (5) in a chapter 11 reorganization case, on or before the last day of the month after each calendar quarter during which there is a duty to pay fees under 28 U.S.C. § 1930(a)(6), file and transmit to the United States trustee a statement of any disbursements made during that quarter and of any fees payable under 28 U.S.C. § 1930(a)(6) for that quarter; and (6) in a chapter 11 small business case, unless the court, for cause, sets another reporting interval, file and transmit to the United States trustee for each calendar month after the order for relief, on the appropriate Official Form, the report required by § 308. If the order for relief is within the first 15 days of a calendar month, a report shall be filed for the portion of the month that follows the order for relief. If the order for relief is after the 15th day of a calendar month, the period for the remainder of the month shall be included in the report for the next calendar month. Each report shall be filed no later than 21 days after the last day of the calendar month following the month covered by the report. The obligation to file reports under this subparagraph terminates on the effective date of the plan, or conversion or dismissal of the case. (b) CHAPTER 12 TRUSTEE AND DEBTOR IN POSSESSION. In a chapter 12 family farmer’s debt adjustment case, the debtor in possession shall perform the duties prescribed in clauses (2)–(4) of subdivision (a) of this rule and, if the court directs, shall file and transmit to the United States trustee a complete inventory of the property of the debtor within the time fixed by the court. If the debtor is removed as debtor in possession, the trustee shall perform the duties of the debtor in possession prescribed in this paragraph. 35 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2015.1 (c) CHAPTER 13 TRUSTEE AND DEBTOR. (1) Business Cases. In a chapter 13 individual’s debt adjustment case, when the debtor is engaged in business, the debtor shall perform the duties prescribed by clauses (2)–(4) of subdivision (a) of this rule and, if the court directs, shall file and transmit to the United States trustee a complete inventory of the property of the debtor within the time fixed by the court. (2) Nonbusiness Cases. In a chapter 13 individual’s debt adjustment case, when the debtor is not engaged in business, the trustee shall perform the duties prescribed by clause (2) of subdivision (a) of this rule. (d) FOREIGN REPRESENTATIVE. In a case in which the court has granted recognition of a foreign proceeding under chapter 15, the foreign representative shall file any notice required under § 1518 of the Code within 14 days after the date when the representative becomes aware of the subsequent information. (e) TRANSMISSION OF REPORTS. In a chapter 11 case the court may direct that copies or summaries of annual reports and copies or summaries of other reports shall be mailed to the creditors, equity security holders, and indenture trustees. The court may also direct the publication of summaries of any such reports. A copy of every report or summary mailed or published pursuant to this subdivision shall be transmitted to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 29, 2002, eff. Dec. 1, 2002; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 23, 2012, eff. Dec. 1, 2012.) Rule 2015.1. Patient Care Ombudsman (a) REPORTS. A patient care ombudsman, at least 14 days before making a report under § 333(b)(2) of the Code, shall give notice that the report will be made to the court, unless the court orders otherwise. The notice shall be transmitted to the United States trustee, posted conspicuously at the health care facility that is the subject of the report, and served on: the debtor; the trustee; all patients; and any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, on the creditors included on the list filed under Rule 1007(d); and such other entities as the court may direct. The notice shall state the date and time when the report will be made, the manner in which the report will be made, and, if the report is in writing, the name, address, telephone number, email address, and website, if any, of the person from whom a copy of the report may be obtained at the debtor’s expense. (b) AUTHORIZATION TO REVIEW CONFIDENTIAL PATIENT RECORDS. A motion by a patient care ombudsman under § 333(c) to review confidential patient records shall be governed by Rule 9014, served on the patient and any family member or other contact person whose name and address have been given to the trustee or the debtor for the purpose of providing information regarding the patient’s health care, and transmitted to the United States trustee subject Rule 2015.2 FEDERAL RULES OF BANKRUPTCY PROCEDURE 36 to applicable nonbankruptcy law relating to patient privacy. Unless the court orders otherwise, a hearing on the motion may not be commenced earlier than 14 days after service of the motion. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2015.2. Transfer of Patient in Health Care Business Case Unless the court orders otherwise, if the debtor is a health care business, the trustee may not transfer a patient to another health care business under § 704(a)(12) of the Code unless the trustee gives at least 14 days’ notice of the transfer to the patient care ombudsman, if any, the patient, and any family member or other contact person whose name and address has been given to the trustee or the debtor for the purpose of providing information regarding the patient’s health care. The notice is subject to applicable nonbankruptcy law relating to patient privacy. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2015.3. Reports of Financial Information on Entities in Which a Chapter 11 Estate Holds a Controlling or Substantial Interest (a) REPORTING REQUIREMENT. In a chapter 11 case, the trustee or debtor in possession shall file periodic financial reports of the value, operations, and profitability of each entity that is not a publicly traded corporation or a debtor in a case under title 11, and in which the estate holds a substantial or controlling interest. The reports shall be prepared as prescribed by the appropriate Official Form, and shall be based upon the most recent information reasonably available to the trustee or debtor in possession. (b) TIME FOR FILING; SERVICE. The first report required by this rule shall be filed no later than seven days before the first date set for the meeting of creditors under § 341 of the Code. Subsequent reports shall be filed no less frequently than every six months thereafter, until the effective date of a plan or the case is dismissed or converted. Copies of the report shall be served on the United States trustee, any committee appointed under § 1102 of the Code, and any other party in interest that has filed a request therefor. (c) PRESUMPTION OF SUBSTANTIAL OR CONTROLLING INTEREST; JUDICIAL DETERMINATION. For purposes of this rule, an entity of which the estate controls or owns at least a 20 percent interest, shall be presumed to be an entity in which the estate has a substantial or controlling interest. An entity in which the estate controls or owns less than a 20 percent interest shall be presumed not to be an entity in which the estate has a substantial or controlling interest. Upon motion, the entity, any holder of an interest therein, the United States trustee, or any other party in interest may seek to rebut either presumption, and the court shall, after notice and a hearing, determine whether the estate’s interest in the entity is substantial or controlling. (d) MODIFICATION OF REPORTING REQUIREMENT. The court may, after notice and a hearing, vary the reporting requirement established by subdivision (a) of this rule for cause, including that the 37 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2016 trustee or debtor in possession is not able, after a good faith effort, to comply with those reporting requirements, or that the information required by subdivision (a) is publicly available. (e) NOTICE AND PROTECTIVE ORDERS. No later than 14 days before filing the first report required by this rule, the trustee or debtor in possession shall send notice to the entity in which the estate has a substantial or controlling interest, and to all holders— known to the trustee or debtor in possession—of an interest in that entity, that the trustee or debtor in possession expects to file and serve financial information relating to the entity in accordance with this rule. The entity in which the estate has a substantial or controlling interest, or a person holding an interest in that entity, may request protection of the information under § 107 of the Code. (f) EFFECT OF REQUEST. Unless the court orders otherwise, the pendency of a request under subdivisions (c), (d), or (e) of this rule shall not alter or stay the requirements of subdivision (a). (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2016. Compensation for Services Rendered and Reimbursement of Expenses (a) APPLICATION FOR COMPENSATION OR REIMBURSEMENT. An entity seeking interim or final compensation for services, or reimbursement of necessary expenses, from the estate shall file an application setting forth a detailed statement of (1) the services rendered, time expended and expenses incurred, and (2) the amounts requested. An application for compensation shall include a statement as to what payments have theretofore been made or promised to the applicant for services rendered or to be rendered in any capacity whatsoever in connection with the case, the source of the compensation so paid or promised, whether any compensation previously received has been shared and whether an agreement or understanding exists between the applicant and any other entity for the sharing of compensation received or to be received for services rendered in or in connection with the case, and the particulars of any sharing of compensation or agreement or understanding therefor, except that details of any agreement by the applicant for the sharing of compensation as a member or regular associate of a firm of lawyers or accountants shall not be required. The requirements of this subdivision shall apply to an application for compensation for services rendered by an attorney or accountant even though the application is filed by a creditor or other entity. Unless the case is a chapter 9 municipality case, the applicant shall transmit to the United States trustee a copy of the application. (b) DISCLOSURE OF COMPENSATION PAID OR PROMISED TO ATTORNEY FOR DEBTOR. Every attorney for a debtor, whether or not the attorney applies for compensation, shall file and transmit to the United States trustee within 14 days after the order for relief, or at another time as the court may direct, the statement required by § 329 of the Code including whether the attorney has shared or agreed to share the compensation with any other entity. The statement shall include the particulars of any such sharing or Rule 2017 FEDERAL RULES OF BANKRUPTCY PROCEDURE 38 agreement to share by the attorney, but the details of any agreement for the sharing of the compensation with a member or regular associate of the attorney’s law firm shall not be required. A supplemental statement shall be filed and transmitted to the United States trustee within 14 days after any payment or agreement not previously disclosed. (c) DISCLOSURE OF COMPENSATION PAID OR PROMISED TO BANKRUPTCY PETITION PREPARER. Before a petition is filed, every bankruptcy petition preparer for a debtor shall deliver to the debtor, the declaration under penalty of perjury required by § 110(h)(2). The declaration shall disclose any fee, and the source of any fee, received from or on behalf of the debtor within 12 months of the filing of the case and all unpaid fees charged to the debtor. The declaration shall also describe the services performed and documents prepared or caused to be prepared by the bankruptcy petition preparer. The declaration shall be filed with the petition. The petition preparer shall file a supplemental statement within 14 days after any payment or agreement not previously disclosed. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 27, 2003, eff. Dec. 1, 2003; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2017. Examination of Debtor’s Transactions with Debtor’s Attorney ","Only use the information above to answer the question. Do not use any outside sources. If you cannot answer the question with the information provided say ""I cannot answer without further research."" The response should be written in paragraph form unless the answer would be more beneficial in markdown format. Please answer in a simple manner that is easy for the average person to understand. FEDERAL RULES OF BANKRUPTCY PROCEDURE Effective August 1, 1983, as amended to December 1, 2017 Rule 1001. Scope of Rules and Forms; Short Title The Bankruptcy Rules and Forms govern procedure in cases under title 11 of the United States Code. The rules shall be cited as the Federal Rules of Bankruptcy Procedure and the forms as the Official Bankruptcy Forms. These rules shall be construed, administered, and employed by the court and the parties to secure the just, speedy, and inexpensive determination of every case and proceeding. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 27, 2017, eff. Dec. 1, 2017.) PART I—COMMENCEMENT OF CASE; PROCEEDINGS RELATING TO PETITION AND ORDER FOR RELIEF Rule 1002. Commencement of Case (a) PETITION. A petition commencing a case under the Code shall be filed with the clerk. (b) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall forthwith transmit to the United States trustee a copy of the petition filed pursuant to subdivision (a) of this rule. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1003. Involuntary Petition (a) TRANSFEROR OR TRANSFEREE OF CLAIM. A transferor or transferee of a claim shall annex to the original and each copy of the petition a copy of all documents evidencing the transfer, whether transferred unconditionally, for security, or otherwise, and a signed statement that the claim was not transferred for the purpose of commencing the case and setting forth the consideration for and terms of the transfer. An entity that has transferred or acquired a claim for the purpose of commencing a case for liquidation under chapter 7 or for reorganization under chapter 11 shall not be a qualified petitioner. (b) JOINDER OF PETITIONERS AFTER FILING. If the answer to an involuntary petition filed by fewer than three creditors avers the existence of 12 or more creditors, the debtor shall file with the answer a list of all creditors with their addresses, a brief statement of the nature of their claims, and the amounts thereof. If it appears that there are 12 or more creditors as provided in § 303(b) of the Code, the court shall afford a reasonable opportunity for other creditors to join in the petition before a hearing is held thereon. (As amended Mar. 30, 1987, eff. Aug. 1, 1987.) Rule 1004. Involuntary Petition Against a Partnership After filing of an involuntary petition under § 303(b)(3) of the Code, (1) the petitioning partners or other petitioners shall promptly send to or serve on each general partner who is not a petitioner a copy of the petition; and (2) the clerk shall promptly issue a summons for service on each general partner who is not a petitioner. Rule 1010 applies to the form and service of the summons. (As amended Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 1004.1. Petition for an Infant or Incompetent Person If an infant or incompetent person has a representative, including a general guardian, committee, conservator, or similar fiduciary, the representative may file a voluntary petition on behalf of the infant or incompetent person. An infant or incompetent person who does not have a duly appointed representative may file a voluntary petition by next friend or guardian ad litem. The court shall appoint a guardian ad litem for an infant or incompetent person who is a debtor and is not otherwise represented or shall make any other order to protect the infant or incompetent debtor. (Added Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 1004.2. Petition in Chapter 15 Cases (a) DESIGNATING CENTER OF MAIN INTERESTS. A petition for recognition of a foreign proceeding under chapter 15 of the Code shall state the country where the debtor has its center of main interests. The petition shall also identify each country in which a foreign proceeding by, regarding, or against the debtor is pending. (b) CHALLENGING DESIGNATION. The United States trustee or a party in interest may file a motion for a determination that the debtor’s center of main interests is other than as stated in the petition for recognition commencing the chapter 15 case. Unless the court orders otherwise, the motion shall be filed no later than seven days before the date set for the hearing on the petition. The motion shall be transmitted to the United States trustee and served on the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor was a party as of the time the petition was filed, and such other entities as the court may direct. (Added Apr. 26, 2011, eff. Dec. 1, 2011.) Rule 1005. Caption of Petition The caption of a petition commencing a case under the Code shall contain the name of the court, the title of the case, and the docket number. The title of the case shall include the following information about the debtor: name, employer identification number, last four digits of the social-security number or individual debtor’s taxpayer-identification number, any other federal taxpayer-identification number, and all other names used within eight years before filing the petition. If the petition is not filed by 3 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 the debtor, it shall include all names used by the debtor which are known to the petitioners. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1006. Filing Fee (a) GENERAL REQUIREMENT. Every petition shall be accompanied by the filing fee except as provided in subdivisions (b) and (c) of this rule. For the purpose of this rule, ‘‘filing fee’’ means the filing fee prescribed by 28 U.S.C. § 1930(a)(1)–(a)(5) and any other fee prescribed by the Judicial Conference of the United States under 28 U.S.C. § 1930(b) that is payable to the clerk upon the commencement of a case under the Code. (b) PAYMENT OF FILING FEE IN INSTALLMENTS. (1) Application to Pay Filing Fee in Installments. A voluntary petition by an individual shall be accepted for filing, regardless of whether any portion of the filing fee is paid, if accompanied by the debtor’s signed application, prepared as prescribed by the appropriate Official Form, stating that the debtor is unable to pay the filing fee except in installments. (2) Action on Application. Prior to the meeting of creditors, the court may order the filing fee paid to the clerk or grant leave to pay in installments and fix the number, amount and dates of payment. The number of installments shall not exceed four, and the final installment shall be payable not later than 120 days after filing the petition. For cause shown, the court may extend the time of any installment, provided the last installment is paid not later than 180 days after filing the petition. (3) Postponement of Attorney’s Fees. All installments of the filing fee must be paid in full before the debtor or chapter 13 trustee may make further payments to an attorney or any other person who renders services to the debtor in connection with the case. (c) WAIVER OF FILING FEE. A voluntary chapter 7 petition filed by an individual shall be accepted for filing if accompanied by the debtor’s application requesting a waiver under 28 U.S.C. § 1930(f), prepared as prescribed by the appropriate Official Form. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 27, 2017, eff. Dec. 1, 2017.) Rule 1007. Lists, Schedules, Statements, and Other Documents; Time Limits (a) CORPORATE OWNERSHIP STATEMENT, LIST OF CREDITORS AND EQUITY SECURITY HOLDERS, AND OTHER LISTS. (1) Voluntary Case. In a voluntary case, the debtor shall file with the petition a list containing the name and address of each entity included or to be included on Schedules D, E/F, G, and H as prescribed by the Official Forms. If the debtor is a corporation, other than a governmental unit, the debtor shall file with the petition a corporate ownership statement containing the information described in Rule 7007.1. The debtor shall file a supplemental statement promptly upon any change in circumstances that renders the corporate ownership statement inaccurate. Rule 1007 FEDERAL RULES OF BANKRUPTCY PROCEDURE 4 (2) Involuntary Case. In an involuntary case, the debtor shall file, within seven days after entry of the order for relief, a list containing the name and address of each entity included or to be included on Schedules D, E/F, G, and H as prescribed by the Official Forms. (3) Equity Security Holders. In a chapter 11 reorganization case, unless the court orders otherwise, the debtor shall file within 14 days after entry of the order for relief a list of the debtor’s equity security holders of each class showing the number and kind of interests registered in the name of each holder, and the last known address or place of business of each holder. (4) Chapter 15 Case. In addition to the documents required under § 1515 of the Code, a foreign representative filing a petition for recognition under chapter 15 shall file with the petition: (A) a corporate ownership statement containing the information described in Rule 7007.1; and (B) unless the court orders otherwise, a list containing the names and addresses of all persons or bodies authorized to administer foreign proceedings of the debtor, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and all entities against whom provisional relief is being sought under § 1519 of the Code. (5) Extension of Time. Any extension of time for the filing of the lists required by this subdivision may be granted only on motion for cause shown and on notice to the United States trustee and to any trustee, committee elected under § 705 or appointed under § 1102 of the Code, or other party as the court may direct. (b) SCHEDULES, STATEMENTS, AND OTHER DOCUMENTS REQUIRED. (1) Except in a chapter 9 municipality case, the debtor, unless the court orders otherwise, shall file the following schedules, statements, and other documents, prepared as prescribed by the appropriate Official Forms, if any: (A) schedules of assets and liabilities; (B) a schedule of current income and expenditures; (C) a schedule of executory contracts and unexpired leases; (D) a statement of financial affairs; (E) copies of all payment advices or other evidence of payment, if any, received by the debtor from an employer within 60 days before the filing of the petition, with redaction of all but the last four digits of the debtor’s social-security number or individual taxpayer-identification number; and (F) a record of any interest that the debtor has in an account or program of the type specified in § 521(c) of the Code. (2) An individual debtor in a chapter 7 case shall file a statement of intention as required by § 521(a) of the Code, prepared as prescribed by the appropriate Official Form. A copy of the statement of intention shall be served on the trustee and the creditors named in the statement on or before the filing of the statement. 5 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 (3) Unless the United States trustee has determined that the credit counseling requirement of § 109(h) does not apply in the district, an individual debtor must file a statement of compliance with the credit counseling requirement, prepared as prescribed by the appropriate Official Form which must include one of the following: (A) an attached certificate and debt repayment plan, if any, required by § 521(b); (B) a statement that the debtor has received the credit counseling briefing required by § 109(h)(1) but does not have the certificate required by § 521(b); (C) a certification under § 109(h)(3); or (D) a request for a determination by the court under § 109(h)(4). (4) Unless § 707(b)(2)(D) applies, an individual debtor in a chapter 7 case shall file a statement of current monthly income prepared as prescribed by the appropriate Official Form, and, if the current monthly income exceeds the median family income for the applicable state and household size, the information, including calculations, required by § 707(b), prepared as prescribed by the appropriate Official Form. (5) An individual debtor in a chapter 11 case shall file a statement of current monthly income, prepared as prescribed by the appropriate Official Form. (6) A debtor in a chapter 13 case shall file a statement of current monthly income, prepared as prescribed by the appropriate Official Form, and, if the current monthly income exceeds the median family income for the applicable state and household size, a calculation of disposable income made in accordance with § 1325(b)(3), prepared as prescribed by the appropriate Official Form. (7) Unless an approved provider of an instructional course concerning personal financial management has notified the court that a debtor has completed the course after filing the petition: (A) An individual debtor in a chapter 7 or chapter 13 case shall file a statement of completion of the course, prepared as prescribed by the appropriate Official Form; and (B) An individual debtor in a chapter 11 case shall file the statement if § 1141(d)(3) applies. (8) If an individual debtor in a chapter 11, 12, or 13 case has claimed an exemption under § 522(b)(3)(A) in property of the kind described in § 522(p)(1) with a value in excess of the amount set out in § 522(q)(1), the debtor shall file a statement as to whether there is any proceeding pending in which the debtor may be found guilty of a felony of a kind described in § 522(q)(1)(A) or found liable for a debt of the kind described in § 522(q)(1)(B). (c) TIME LIMITS. In a voluntary case, the schedules, statements, and other documents required by subdivision (b)(1), (4), (5), and (6) shall be filed with the petition or within 14 days thereafter, except as otherwise provided in subdivisions (d), (e), (f), and (h) of this rule. In an involuntary case, the schedules, statements, and other Rule 1007 FEDERAL RULES OF BANKRUPTCY PROCEDURE 6 1So in original. Probably should be only one section symbol. documents required by subdivision (b)(1) shall be filed by the debtor within 14 days after the entry of the order for relief. In a voluntary case, the documents required by paragraphs (A), (C), and (D) of subdivision (b)(3) shall be filed with the petition. Unless the court orders otherwise, a debtor who has filed a statement under subdivision (b)(3)(B), shall file the documents required by subdivision (b)(3)(A) within 14 days of the order for relief. In a chapter 7 case, the debtor shall file the statement required by subdivision (b)(7) within 60 days after the first date set for the meeting of creditors under § 341 of the Code, and in a chapter 11 or 13 case no later than the date when the last payment was made by the debtor as required by the plan or the filing of a motion for a discharge under § 1141(d)(5)(B) or § 1328(b) of the Code. The court may, at any time and in its discretion, enlarge the time to file the statement required by subdivision (b)(7). The debtor shall file the statement required by subdivision (b)(8) no earlier than the date of the last payment made under the plan or the date of the filing of a motion for a discharge under §§ 1141(d)(5)(B),1 1228(b), or 1328(b) of the Code. Lists, schedules, statements, and other documents filed prior to the conversion of a case to another chapter shall be deemed filed in the converted case unless the court directs otherwise. Except as provided in § 1116(3), any extension of time to file schedules, statements, and other documents required under this rule may be granted only on motion for cause shown and on notice to the United States trustee, any committee elected under § 705 or appointed under § 1102 of the Code, trustee, examiner, or other party as the court may direct. Notice of an extension shall be given to the United States trustee and to any committee, trustee, or other party as the court may direct. (d) LIST OF 20 LARGEST CREDITORS IN CHAPTER 9 MUNICIPALITY CASE OR CHAPTER 11 REORGANIZATION CASE. In addition to the list required by subdivision (a) of this rule, a debtor in a chapter 9 municipality case or a debtor in a voluntary chapter 11 reorganization case shall file with the petition a list containing the name, address and claim of the creditors that hold the 20 largest unsecured claims, excluding insiders, as prescribed by the appropriate Official Form. In an involuntary chapter 11 reorganization case, such list shall be filed by the debtor within 2 days after entry of the order for relief under § 303(h) of the Code. (e) LIST IN CHAPTER 9 MUNICIPALITY CASES. The list required by subdivision (a) of this rule shall be filed by the debtor in a chapter 9 municipality case within such time as the court shall fix. If a proposed plan requires a revision of assessments so that the proportion of special assessments or special taxes to be assessed against some real property will be different from the proportion in effect at the date the petition is filed, the debtor shall also file a list showing the name and address of each known holder of title, legal or equitable, to real property adversely affected. On motion for cause shown, the court may modify the requirements of this subdivision and subdivision (a) of this rule. 7 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1007 (f) STATEMENT OF SOCIAL SECURITY NUMBER. An individual debtor shall submit a verified statement that sets out the debtor’s social security number, or states that the debtor does not have a social security number. In a voluntary case, the debtor shall submit the statement with the petition. In an involuntary case, the debtor shall submit the statement within 14 days after the entry of the order for relief. (g) PARTNERSHIP AND PARTNERS. The general partners of a debtor partnership shall prepare and file the list required under subdivision (a), schedules of the assets and liabilities, schedule of current income and expenditures, schedule of executory contracts and unexpired leases, and statement of financial affairs of the partnership. The court may order any general partner to file a statement of personal assets and liabilities within such time as the court may fix. (h) INTERESTS ACQUIRED OR ARISING AFTER PETITION. If, as provided by § 541(a)(5) of the Code, the debtor acquires or becomes entitled to acquire any interest in property, the debtor shall within 14 days after the information comes to the debtor’s knowledge or within such further time the court may allow, file a supplemental schedule in the chapter 7 liquidation case, chapter 11 reorganization case, chapter 12 family farmer’s debt adjustment case, or chapter 13 individual debt adjustment case. If any of the property required to be reported under this subdivision is claimed by the debtor as exempt, the debtor shall claim the exemptions in the supplemental schedule. The duty to file a supplemental schedule in accordance with this subdivision continues notwithstanding the closing of the case, except that the schedule need not be filed in a chapter 11, chapter 12, or chapter 13 case with respect to property acquired after entry of the order confirming a chapter 11 plan or discharging the debtor in a chapter 12 or chapter 13 case. (i) DISCLOSURE OF LIST OF SECURITY HOLDERS. After notice and hearing and for cause shown, the court may direct an entity other than the debtor or trustee to disclose any list of security holders of the debtor in its possession or under its control, indicating the name, address and security held by any of them. The entity possessing this list may be required either to produce the list or a true copy thereof, or permit inspection or copying, or otherwise disclose the information contained on the list. (j) IMPOUNDING OF LISTS. On motion of a party in interest and for cause shown the court may direct the impounding of the lists filed under this rule, and may refuse to permit inspection by any entity. The court may permit inspection or use of the lists, however, by any party in interest on terms prescribed by the court. (k) PREPARATION OF LIST, SCHEDULES, OR STATEMENTS ON DEFAULT OF DEBTOR. If a list, schedule, or statement, other than a statement of intention, is not prepared and filed as required by this rule, the court may order the trustee, a petitioning creditor, committee, or other party to prepare and file any of these papers within a time fixed by the court. The court may approve reimbursement of the cost incurred in complying with such an order as an administrative expense. (l) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall forthwith transmit to the United States trustee a copy of every list, schedule, and statement filed pursuant to subdivision (a)(1), (a)(2), (b), (d), or (h) of this rule. (m) INFANTS AND INCOMPETENT PERSONS. If the debtor knows that a person on the list of creditors or schedules is an infant or incompetent person, the debtor also shall include the name, address, and legal relationship of any person upon whom process would be served in an adversary proceeding against the infant or incompetent person in accordance with Rule 7004(b)(2). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 23, 2001, eff. Dec. 1, 2001; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 25, 2005, eff. Dec. 1, 2005; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 23, 2012, eff. Dec. 1, 2012: Apr. 16, 2013, eff. Dec. 1, 2013; Apr. 29, 2015, eff. Dec. 1, 2015.) Rule 1008. Verification of Petitions and Accompanying Papers All petitions, lists, schedules, statements and amendments thereto shall be verified or contain an unsworn declaration as provided in 28 U.S.C. § 1746. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1009. Amendments of Voluntary Petitions, Lists, Schedules and Statements (a) GENERAL RIGHT TO AMEND. A voluntary petition, list, schedule, or statement may be amended by the debtor as a matter of course at any time before the case is closed. The debtor shall give notice of the amendment to the trustee and to any entity affected thereby. On motion of a party in interest, after notice and a hearing, the court may order any voluntary petition, list, schedule, or statement to be amended and the clerk shall give notice of the amendment to entities designated by the court. (b) STATEMENT OF INTENTION. The statement of intention may be amended by the debtor at any time before the expiration of the period provided in § 521(a) of the Code. The debtor shall give notice of the amendment to the trustee and to any entity affected thereby. (c) STATEMENT OF SOCIAL SECURITY NUMBER. If a debtor becomes aware that the statement of social security number submitted under Rule 1007(f) is incorrect, the debtor shall promptly submit an amended verified statement setting forth the correct social security number. The debtor shall give notice of the amendment to all of the entities required to be included on the list filed under Rule 1007(a)(1) or (a)(2). (d) TRANSMISSION TO UNITED STATES TRUSTEE. The clerk shall promptly transmit to the United States trustee a copy of every amendment filed or submitted under subdivision (a), (b), or (c) of this rule. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 12, 2006, eff. Dec. 1, 2006; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1010. Service of Involuntary Petition and Summons (a) SERVICE OF INVOLUNTARY PETITION AND SUMMONS. On the filing of an involuntary petition, the clerk shall forthwith issue a summons for service. When an involuntary petition is filed, service shall be made on the debtor. The summons shall be served with a copy of the petition in the manner provided for service of a summons and complaint by Rule 7004(a) or (b). If service cannot be so made, the court may order that the summons and petition be served by mailing copies to the party’s last known address, and by at least one publication in a manner and form directed by the court. The summons and petition may be served on the party anywhere. Rule 7004(e) and Rule 4(l) F.R.Civ.P. apply when service is made or attempted under this rule. (b) CORPORATE OWNERSHIP STATEMENT. Each petitioner that is a corporation shall file with the involuntary petition a corporate ownership statement containing the information described in Rule 7007.1. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1011. Responsive Pleading or Motion in Involuntary Cases (a) WHO MAY CONTEST PETITION. The debtor named in an involuntary petition may contest the petition. In the case of a petition against a partnership under Rule 1004, a nonpetitioning general partner, or a person who is alleged to be a general partner but denies the allegation, may contest the petition. (b) DEFENSES AND OBJECTIONS; WHEN PRESENTED. Defenses and objections to the petition shall be presented in the manner prescribed by Rule 12 F.R.Civ.P. and shall be filed and served within 21 days after service of the summons, except that if service is made by publication on a party or partner not residing or found within the state in which the court sits, the court shall prescribe the time for filing and serving the response. (c) EFFECT OF MOTION. Service of a motion under Rule 12(b) F.R.Civ.P. shall extend the time for filing and serving a responsive pleading as permitted by Rule 12(a) F.R.Civ.P. (d) CLAIMS AGAINST PETITIONERS. A claim against a petitioning creditor may not be asserted in the answer except for the purpose of defeating the petition. (e) OTHER PLEADINGS. No other pleadings shall be permitted, except that the court may order a reply to an answer and prescribe the time for filing and service. (f) CORPORATE OWNERSHIP STATEMENT. If the entity responding to the involuntary petition is a corporation, the entity shall file with its first appearance, pleading, motion, response, or other request addressed to the court a corporate ownership statement containing the information described in Rule 7007.1. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 26, 2004, eff. Dec. 1, 2004; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1012. Responsive Pleading in Cross-Border Cases (a) WHO MAY CONTEST PETITION. The debtor or any party in interest may contest a petition for recognition of a foreign proceeding. (b) OBJECTIONS AND RESPONSES; WHEN PRESENTED. Objections and other responses to the petition shall be presented no later Rule 1013 FEDERAL RULES OF BANKRUPTCY PROCEDURE 10 than seven days before the date set for the hearing on the petition, unless the court prescribes some other time or manner for responses. (c) CORPORATE OWNERSHIP STATEMENT. If the entity responding to the petition is a corporation, then the entity shall file a corporate ownership statement containing the information described in Rule 7007.1 with its first appearance, pleading, motion, response, or other request addressed to the court. (Added Apr. 28, 2016, eff. Dec. 1, 2016.) Rule 1013. Hearing and Disposition of a Petition in an Involuntary Case (a) CONTESTED PETITION. The court shall determine the issues of a contested petition at the earliest practicable time and forthwith enter an order for relief, dismiss the petition, or enter any other appropriate order. (b) DEFAULT. If no pleading or other defense to a petition is filed within the time provided by Rule 1011, the court, on the next day, or as soon thereafter as practicable, shall enter an order for the relief requested in the petition. [(c) ORDER FOR RELIEF] (Abrogated Apr. 22, 1993, eff. Aug. 1, 1993) (As amended Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993.) Rule 1014. Dismissal and Change of Venue (a) DISMISSAL AND TRANSFER OF CASES. (1) Cases Filed in Proper District. If a petition is filed in the proper district, the court, on the timely motion of a party in interest or on its own motion, and after hearing on notice to the petitioners, the United States trustee, and other entities as directed by the court, may transfer the case to any other district if the court determines that the transfer is in the interest of justice or for the convenience of the parties. (2) Cases Filed in Improper District. If a petition is filed in an improper district, the court, on the timely motion of a party in interest or on its own motion, and after hearing on notice to the petitioners, the United States trustee, and other entities as directed by the court, may dismiss the case or transfer it to any other district if the court determines that transfer is in the interest of justice or for the convenience of the parties. (b) PROCEDURE WHEN PETITIONS INVOLVING THE SAME DEBTOR OR RELATED DEBTORS ARE FILED IN DIFFERENT COURTS. If petitions commencing cases under the Code or seeking recognition under chapter 15 are filed in different districts by, regarding, or against (1) the same debtor, (2) a partnership and one or more of its general partners, (3) two or more general partners, or (4) a debtor and an affiliate, the court in the district in which the first-filed petition is pending may determine, in the interest of justice or for the convenience of the parties, the district or districts in which any of the cases should proceed. The court may so determine on motion and after a hearing, with notice to the following entities in the affected cases: the United States trustee, entities entitled to notice under Rule 2002(a), and other entities as the court directs. 11 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1017 The court may order the parties to the later-filed cases not to proceed further until it makes the determination. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 30, 2007, eff. Dec. 1, 2007; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 25, 2014, eff. Dec. 1, 2014.) Rule 1015. Consolidation or Joint Administration of Cases Pending in Same Court (a) CASES INVOLVING SAME DEBTOR. If two or more petitions by, regarding, or against the same debtor are pending in the same court, the court may order consolidation of the cases. (b) CASES INVOLVING TWO OR MORE RELATED DEBTORS. If a joint petition or two or more petitions are pending in the same court by or against (1) spouses, or (2) a partnership and one or more of its general partners, or (3) two or more general partners, or (4) a debtor and an affiliate, the court may order a joint administration of the estates. Prior to entering an order the court shall give consideration to protecting creditors of different estates against potential conflicts of interest. An order directing joint administration of individual cases of spouses shall, if one spouse has elected the exemptions under § 522(b)(2) of the Code and the other has elected the exemptions under § 522(b)(3), fix a reasonable time within which either may amend the election so that both shall have elected the same exemptions. The order shall notify the debtors that unless they elect the same exemptions within the time fixed by the court, they will be deemed to have elected the exemptions provided by § 522(b)(2). (c) EXPEDITING AND PROTECTIVE ORDERS. When an order for consolidation or joint administration of a joint case or two or more cases is entered pursuant to this rule, while protecting the rights of the parties under the Code, the court may enter orders as may tend to avoid unnecessary costs and delay. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 23, 2008, eff. Dec. 1, 2008; Apr. 28, 2010, eff. Dec. 1, 2010; Apr. 27, 2017, eff. Dec. 1, 2017.) Rule 1016. Death or Incompetency of Debtor Death or incompetency of the debtor shall not abate a liquidation case under chapter 7 of the Code. In such event the estate shall be administered and the case concluded in the same manner, so far as possible, as though the death or incompetency had not occurred. If a reorganization, family farmer’s debt adjustment, or individual’s debt adjustment case is pending under chapter 11, chapter 12, or chapter 13, the case may be dismissed; or if further administration is possible and in the best interest of the parties, the case may proceed and be concluded in the same manner, so far as possible, as though the death or incompetency had not occurred. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 1017. Dismissal or Conversion of Case; Suspension (a) VOLUNTARY DISMISSAL; DISMISSAL FOR WANT OF PROSECUTION OR OTHER CAUSE. Except as provided in §§ 707(a)(3), 707(b), 1208(b), and 1307(b) of the Code, and in Rule 1017(b), (c), and (e), a case Rule 1017 FEDERAL RULES OF BANKRUPTCY PROCEDURE 12 shall not be dismissed on motion of the petitioner, for want of prosecution or other cause, or by consent of the parties, before a hearing on notice as provided in Rule 2002. For the purpose of the notice, the debtor shall file a list of creditors with their addresses within the time fixed by the court unless the list was previously filed. If the debtor fails to file the list, the court may order the debtor or another entity to prepare and file it. (b) DISMISSAL FOR FAILURE TO PAY FILING FEE. (1) If any installment of the filing fee has not been paid, the court may, after a hearing on notice to the debtor and the trustee, dismiss the case. (2) If the case is dismissed or closed without full payment of the filing fee, the installments collected shall be distributed in the same manner and proportions as if the filing fee had been paid in full. (c) DISMISSAL OF VOLUNTARY CHAPTER 7 OR CHAPTER 13 CASE FOR FAILURE TO TIMELY FILE LIST OF CREDITORS, SCHEDULES, AND STATEMENT OF FINANCIAL AFFAIRS. The court may dismiss a voluntary chapter 7 or chapter 13 case under § 707(a)(3) or § 1307(c)(9) after a hearing on notice served by the United States trustee on the debtor, the trustee, and any other entities as the court directs. (d) SUSPENSION. The court shall not dismiss a case or suspend proceedings under § 305 before a hearing on notice as provided in Rule 2002(a). (e) DISMISSAL OF AN INDIVIDUAL DEBTOR’S CHAPTER 7 CASE, OR CONVERSION TO A CASE UNDER CHAPTER 11 OR 13, FOR ABUSE. The court may dismiss or, with the debtor’s consent, convert an individual debtor’s case for abuse under § 707(b) only on motion and after a hearing on notice to the debtor, the trustee, the United States trustee, and any other entity as the court directs. (1) Except as otherwise provided in § 704(b)(2), a motion to dismiss a case for abuse under § 707(b) or (c) may be filed only within 60 days after the first date set for the meeting of creditors under § 341(a), unless, on request filed before the time has expired, the court for cause extends the time for filing the motion to dismiss. The party filing the motion shall set forth in the motion all matters to be considered at the hearing. In addition, a motion to dismiss under § 707(b)(1) and (3) shall state with particularity the circumstances alleged to constitute abuse. (2) If the hearing is set on the court’s own motion, notice of the hearing shall be served on the debtor no later than 60 days after the first date set for the meeting of creditors under § 341(a). The notice shall set forth all matters to be considered by the court at the hearing. (f) PROCEDURE FOR DISMISSAL, CONVERSION, OR SUSPENSION. (1) Rule 9014 governs a proceeding to dismiss or suspend a case, or to convert a case to another chapter, except under §§ 706(a), 1112(a), 1208(a) or (b), or 1307(a) or (b). (2) Conversion or dismissal under §§ 706(a), 1112(a), 1208(b), or 1307(b) shall be on motion filed and served as required by Rule 9013. (3) A chapter 12 or chapter 13 case shall be converted without court order when the debtor files a notice of conversion under 13 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1019 §§ 1208(a) or 1307(a). The filing date of the notice becomes the date of the conversion order for the purposes of applying § 348(c) and Rule 1019. The clerk shall promptly transmit a copy of the notice to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 17, 2000, eff. Dec. 1, 2000; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 1018. Contested Involuntary Petitions; Contested Petitions Commencing Chapter 15 Cases; Proceedings to Vacate Order for Relief; Applicability of Rules in Part VII Governing Adversary Proceedings Unless the court otherwise directs and except as otherwise prescribed in Part I of these rules, the following rules in Part VII apply to all proceedings contesting an involuntary petition or a chapter 15 petition for recognition, and to all proceedings to vacate an order for relief: Rules 7005, 7008–7010, 7015, 7016, 7024–7026, 7028–7037, 7052, 7054, 7056, and 7062. The court may direct that other rules in Part VII shall also apply. For the purposes of this rule a reference in the Part VII rules to adversary proceedings shall be read as a reference to proceedings contesting an involuntary petition or a chapter 15 petition for recognition, or proceedings to vacate an order for relief. Reference in the Federal Rules of Civil Procedure to the complaint shall be read as a reference to the petition. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 28, 2010, eff. Dec. 1, 2010.) Rule 1019. Conversion of a Chapter 11 Reorganization Case, Chapter 12 Family Farmer’s Debt Adjustment Case, or Chapter 13 Individual’s Debt Adjustment Case to a Chapter 7 Liquidation Case When a chapter 11, chapter 12, or chapter 13 case has been converted or reconverted to a chapter 7 case: (1) Filing of Lists, Inventories, Schedules, Statements. (A) Lists, inventories, schedules, and statements of financial affairs theretofore filed shall be deemed to be filed in the chapter 7 case, unless the court directs otherwise. If they have not been previously filed, the debtor shall comply with Rule 1007 as if an order for relief had been entered on an involuntary petition on the date of the entry of the order directing that the case continue under chapter 7. (B) If a statement of intention is required, it shall be filed within 30 days after entry of the order of conversion or before the first date set for the meeting of creditors, whichever is earlier. The court may grant an extension of time for cause only on written motion filed, or oral request made during a hearing, before the time has expired. Notice of an extension shall be given to the United States trustee and to any committee, trustee, or other party as the court may direct. (2) New Filing Periods. (A) A new time period for filing a motion under § 707(b) or (c), a claim, a complaint objecting to discharge, or a Rule 1019 FEDERAL RULES OF BANKRUPTCY PROCEDURE 14 1So in original. Probably should be ‘‘Rule’’. complaint to obtain a determination of dischargeability of any debt shall commence under Rules 1 1017, 3002, 4004, or 4007, but a new time period shall not commence if a chapter 7 case had been converted to a chapter 11, 12, or 13 case and thereafter reconverted to a chapter 7 case and the time for filing a motion under § 707(b) or (c), a claim, a complaint objecting to discharge, or a complaint to obtain a determination of the dischargeability of any debt, or any extension thereof, expired in the original chapter 7 case. (B) A new time period for filing an objection to a claim of exemptions shall commence under Rule 4003(b) after conversion of a case to chapter 7 unless: (i) the case was converted to chapter 7 more than one year after the entry of the first order confirming a plan under chapter 11, 12, or 13; or (ii) the case was previously pending in chapter 7 and the time to object to a claimed exemption had expired in the original chapter 7 case. (3) Claims Filed Before Conversion. All claims actually filed by a creditor before conversion of the case are deemed filed in the chapter 7 case. (4) Turnover of Records and Property. After qualification of, or assumption of duties by the chapter 7 trustee, any debtor in possession or trustee previously acting in the chapter 11, 12, or 13 case shall, forthwith, unless otherwise ordered, turn over to the chapter 7 trustee all records and property of the estate in the possession or control of the debtor in possession or trustee. (5) Filing Final Report and Schedule of Postpetition Debts. (A) Conversion of Chapter 11 or Chapter 12 Case. Unless the court directs otherwise, if a chapter 11 or chapter 12 case is converted to chapter 7, the debtor in possession or, if the debtor is not a debtor in possession, the trustee serving at the time of conversion, shall: (i) not later than 14 days after conversion of the case, file a schedule of unpaid debts incurred after the filing of the petition and before conversion of the case, including the name and address of each holder of a claim; and (ii) not later than 30 days after conversion of the case, file and transmit to the United States trustee a final report and account; (B) Conversion of Chapter 13 Case. Unless the court directs otherwise, if a chapter 13 case is converted to chapter 7, (i) the debtor, not later than 14 days after conversion of the case, shall file a schedule of unpaid debts incurred after the filing of the petition and before conversion of the case, including the name and address of each holder of a claim; and (ii) the trustee, not later than 30 days after conversion of the case, shall file and transmit to the United States trustee a final report and account; 15 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 1020 (C) Conversion After Confirmation of a Plan. Unless the court orders otherwise, if a chapter 11, chapter 12, or chapter 13 case is converted to chapter 7 after confirmation of a plan, the debtor shall file: (i) a schedule of property not listed in the final report and account acquired after the filing of the petition but before conversion, except if the case is converted from chapter 13 to chapter 7 and § 348(f)(2) does not apply; (ii) a schedule of unpaid debts not listed in the final report and account incurred after confirmation but before the conversion; and (iii) a schedule of executory contracts and unexpired leases entered into or assumed after the filing of the petition but before conversion. (D) Transmission to United States Trustee. The clerk shall forthwith transmit to the United States trustee a copy of every schedule filed pursuant to Rule 1019(5). (6) Postpetition Claims; Preconversion Administrative Expenses; Notice. A request for payment of an administrative expense incurred before conversion of the case is timely filed under § 503(a) of the Code if it is filed before conversion or a time fixed by the court. If the request is filed by a governmental unit, it is timely if it is filed before conversion or within the later of a time fixed by the court or 180 days after the date of the conversion. A claim of a kind specified in § 348(d) may be filed in accordance with Rules 3001(a)–(d) and 3002. Upon the filing of the schedule of unpaid debts incurred after commencement of the case and before conversion, the clerk, or some other person as the court may direct, shall give notice to those entities listed on the schedule of the time for filing a request for payment of an administrative expense and, unless a notice of insufficient assets to pay a dividend is mailed in accordance with Rule 2002(e), the time for filing a claim of a kind specified in § 348(d). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2010, eff. Dec. 1, 2010.) Rule 1020. Small Business Chapter 11 Reorganization Case (a) SMALL BUSINESS DEBTOR DESIGNATION. In a voluntary chapter 11 case, the debtor shall state in the petition whether the debtor is a small business debtor. In an involuntary chapter 11 case, the debtor shall file within 14 days after entry of the order for relief a statement as to whether the debtor is a small business debtor. Except as provided in subdivision (c), the status of the case as a small business case shall be in accordance with the debtor’s statement under this subdivision, unless and until the court enters an order finding that the debtor’s statement is incorrect. (b) OBJECTING TO DESIGNATION. Except as provided in subdivision (c), the United States trustee or a party in interest may file an objection to the debtor’s statement under subdivision (a) no later than 30 days after the conclusion of the meeting of creditors held Rule 1021 FEDERAL RULES OF BANKRUPTCY PROCEDURE 16 under § 341(a) of the Code, or within 30 days after any amendment to the statement, whichever is later. (c) APPOINTMENT OF COMMITTEE OF UNSECURED CREDITORS. If a committee of unsecured creditors has been appointed under § 1102(a)(1), the case shall proceed as a small business case only if, and from the time when, the court enters an order determining that the committee has not been sufficiently active and representative to provide effective oversight of the debtor and that the debtor satisfies all the other requirements for being a small business. A request for a determination under this subdivision may be filed by the United States trustee or a party in interest only within a reasonable time after the failure of the committee to be sufficiently active and representative. The debtor may file a request for a determination at any time as to whether the committee has been sufficiently active and representative. (d) PROCEDURE FOR OBJECTION OR DETERMINATION. Any objection or request for a determination under this rule shall be governed by Rule 9014 and served on: the debtor; the debtor’s attorney; the United States trustee; the trustee; any committee appointed under § 1102 or its authorized agent, or, if no committee of unsecured creditors has been appointed under § 1102, the creditors included on the list filed under Rule 1007(d); and any other entity as the court directs. (Added Apr. 11, 1997, eff. Dec. 1, 1997; amended Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 1021. Health Care Business Case (a) HEALTH CARE BUSINESS DESIGNATION. Unless the court orders otherwise, if a petition in a case under chapter 7, chapter 9, or chapter 11 states that the debtor is a health care business, the case shall proceed as a case in which the debtor is a health care business. (b) MOTION. The United States trustee or a party in interest may file a motion to determine whether the debtor is a health care business. The motion shall be transmitted to the United States trustee and served on: the debtor; the trustee; any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, the creditors included on the list filed under Rule 1007(d); and any other entity as the court directs. The motion shall be governed by Rule 9014. (Added Apr. 23, 2008, eff. Dec. 1, 2008.) PART II—OFFICERS AND ADMINISTRATION; NOTICES; MEETINGS; EXAMINATIONS; ELECTIONS; ATTORNEYS AND ACCOUNTANTS Rule 2001. Appointment of Interim Trustee Before Order for Relief in a Chapter 7 Liquidation Case (a) APPOINTMENT. At any time following the commencement of an involuntary liquidation case and before an order for relief, the court on written motion of a party in interest may order the appointment of an interim trustee under § 303(g) of the Code. The 17 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 motion shall set forth the necessity for the appointment and may be granted only after hearing on notice to the debtor, the petitioning creditors, the United States trustee, and other parties in interest as the court may designate. (b) BOND OF MOVANT. An interim trustee may not be appointed under this rule unless the movant furnishes a bond in an amount approved by the court, conditioned to indemnify the debtor for costs, attorney’s fee, expenses, and damages allowable under § 303(i) of the Code. (c) ORDER OF APPOINTMENT. The order directing the appointment of an interim trustee shall state the reason the appointment is necessary and shall specify the trustee’s duties. (d) TURNOVER AND REPORT. Following qualification of the trustee selected under § 702 of the Code, the interim trustee, unless otherwise ordered, shall (1) forthwith deliver to the trustee all the records and property of the estate in possession or subject to control of the interim trustee and, (2) within 30 days thereafter file a final report and account. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2002. Notices to Creditors, Equity Security Holders, Administrators in Foreign Proceedings, Persons Against Whom Provisional Relief is Sought in Ancillary and Other Cross-Border Cases, United States, and United States Trustee (a) TWENTY-ONE-DAY NOTICES TO PARTIES IN INTEREST. Except as provided in subdivisions (h), (i), (l), (p), and (q) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, the trustee, all creditors and indenture trustees at least 21 days’ notice by mail of: (1) the meeting of creditors under § 341 or § 1104(b) of the Code, which notice, unless the court orders otherwise, shall include the debtor’s employer identification number, social security number, and any other federal taxpayer identification number; (2) a proposed use, sale, or lease of property of the estate other than in the ordinary course of business, unless the court for cause shown shortens the time or directs another method of giving notice; (3) the hearing on approval of a compromise or settlement of a controversy other than approval of an agreement pursuant to Rule 4001(d), unless the court for cause shown directs that notice not be sent; (4) in a chapter 7 liquidation, a chapter 11 reorganization case, or a chapter 12 family farmer debt adjustment case, the hearing on the dismissal of the case or the conversion of the case to another chapter, unless the hearing is under § 707(a)(3) or § 707(b) or is on dismissal of the case for failure to pay the filing fee; (5) the time fixed to accept or reject a proposed modification of a plan; (6) a hearing on any entity’s request for compensation or reimbursement of expenses if the request exceeds $1,000; (7) the time fixed for filing proofs of claims pursuant to Rule 3003(c); Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 18 (8) the time fixed for filing objections and the hearing to consider confirmation of a chapter 12 plan; and (9) the time fixed for filing objections to confirmation of a chapter 13 plan. (b) TWENTY-EIGHT-DAY NOTICES TO PARTIES IN INTEREST. Except as provided in subdivision (l) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, the trustee, all creditors and indenture trustees not less than 28 days’ notice by mail of the time fixed (1) for filing objections and the hearing to consider approval of a disclosure statement or, under § 1125(f), to make a final determination whether the plan provides adequate information so that a separate disclosure statement is not necessary; (2) for filing objections and the hearing to consider confirmation of a chapter 9 or chapter 11 plan; and (3) for the hearing to consider confirmation of a chapter 13 plan. (c) CONTENT OF NOTICE. (1) Proposed Use, Sale, or Lease of Property. Subject to Rule 6004, the notice of a proposed use, sale, or lease of property required by subdivision (a)(2) of this rule shall include the time and place of any public sale, the terms and conditions of any private sale and the time fixed for filing objections. The notice of a proposed use, sale, or lease of property, including real estate, is sufficient if it generally describes the property. The notice of a proposed sale or lease of personally identifiable information under § 363(b)(1) of the Code shall state whether the sale is consistent with any policy prohibiting the transfer of the information. (2) Notice of Hearing on Compensation. The notice of a hearing on an application for compensation or reimbursement of expenses required by subdivision (a)(6) of this rule shall identify the applicant and the amounts requested. (3) Notice of Hearing on Confirmation When Plan Provides for an Injunction. If a plan provides for an injunction against conduct not otherwise enjoined under the Code, the notice required under Rule 2002(b)(2) shall: (A) include in conspicuous language (bold, italic, or underlined text) a statement that the plan proposes an injunction; (B) describe briefly the nature of the injunction; and (C) identify the entities that would be subject to the injunction. (d) NOTICE TO EQUITY SECURITY HOLDERS. In a chapter 11 reorganization case, unless otherwise ordered by the court, the clerk, or some other person as the court may direct, shall in the manner and form directed by the court give notice to all equity security holders of (1) the order for relief; (2) any meeting of equity security holders held pursuant to § 341 of the Code; (3) the hearing on the proposed sale of all or substantially all of the debtor’s assets; (4) the hearing on the dismissal or conversion of a case to another chapter; (5) the time fixed for filing objections to and the hearing to consider approval of a disclosure statement; (6) the time fixed for filing objections to and the hearing to consider confirmation of a plan; and (7) the time fixed to accept or reject a proposed modification of a plan. 19 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 (e) NOTICE OF NO DIVIDEND. In a chapter 7 liquidation case, if it appears from the schedules that there are no assets from which a dividend can be paid, the notice of the meeting of creditors may include a statement to that effect; that it is unnecessary to file claims; and that if sufficient assets become available for the payment of a dividend, further notice will be given for the filing of claims. (f) OTHER NOTICES. Except as provided in subdivision (l) of this rule, the clerk, or some other person as the court may direct, shall give the debtor, all creditors, and indenture trustees notice by mail of: (1) the order for relief; (2) the dismissal or the conversion of the case to another chapter, or the suspension of proceedings under § 305; (3) the time allowed for filing claims pursuant to Rule 3002; (4) the time fixed for filing a complaint objecting to the debtor’s discharge pursuant to § 727 of the Code as provided in Rule 4004; (5) the time fixed for filing a complaint to determine the dischargeability of a debt pursuant to § 523 of the Code as provided in Rule 4007; (6) the waiver, denial, or revocation of a discharge as provided in Rule 4006; (7) entry of an order confirming a chapter 9, 11, or 12 plan; (8) a summary of the trustee’s final report in a chapter 7 case if the net proceeds realized exceed $1,500; (9) a notice under Rule 5008 regarding the presumption of abuse; (10) a statement under § 704(b)(1) as to whether the debtor’s case would be presumed to be an abuse under § 707(b); and (11) the time to request a delay in the entry of the discharge under §§ 1141(d)(5)(C), 1228(f), and 1328(h). Notice of the time fixed for accepting or rejecting a plan pursuant to Rule 3017(c) shall be given in accordance with Rule 3017(d). (g) ADDRESSING NOTICES. (1) Notices required to be mailed under Rule 2002 to a creditor, indenture trustee, or equity security holder shall be addressed as such entity or an authorized agent has directed in its last request filed in the particular case. For the purposes of this subdivision— (A) a proof of claim filed by a creditor or indenture trustee that designates a mailing address constitutes a filed request to mail notices to that address, unless a notice of no dividend has been given under Rule 2002(e) and a later notice of possible dividend under Rule 3002(c)(5) has not been given; and (B) a proof of interest filed by an equity security holder that designates a mailing address constitutes a filed request to mail notices to that address. (2) Except as provided in § 342(f) of the Code, if a creditor or indenture trustee has not filed a request designating a mailing address under Rule 2002(g)(1) or Rule 5003(e), the notices shall be mailed to the address shown on the list of creditors or schedule of liabilities, whichever is filed later. If an equity security holder has not filed a request designating a mailing address under Rule 2002(g)(1) or Rule 5003(e), the notices shall be Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 20 mailed to the address shown on the list of equity security holders. (3) If a list or schedule filed under Rule 1007 includes the name and address of a legal representative of an infant or incompetent person, and a person other than that representative files a request or proof of claim designating a name and mailing address that differs from the name and address of the representative included in the list or schedule, unless the court orders otherwise, notices under Rule 2002 shall be mailed to the representative included in the list or schedules and to the name and address designated in the request or proof of claim. (4) Notwithstanding Rule 2002(g)(1)–(3), an entity and a notice provider may agree that when the notice provider is directed by the court to give a notice, the notice provider shall give the notice to the entity in the manner agreed to and at the address or addresses the entity supplies to the notice provider. That address is conclusively presumed to be a proper address for the notice. The notice provider’s failure to use the supplied address does not invalidate any notice that is otherwise effective under applicable law. (5) A creditor may treat a notice as not having been brought to the creditor’s attention under § 342(g)(1) only if, prior to issuance of the notice, the creditor has filed a statement that designates the name and address of the person or organizational subdivision of the creditor responsible for receiving notices under the Code, and that describes the procedures established by the creditor to cause such notices to be delivered to the designated person or subdivision. (h) NOTICES TO CREDITORS WHOSE CLAIMS ARE FILED. In a chapter 7 case, after 90 days following the first date set for the meeting of creditors under § 341 of the Code, the court may direct that all notices required by subdivision (a) of this rule be mailed only to the debtor, the trustee, all indenture trustees, creditors that hold claims for which proofs of claim have been filed, and creditors, if any, that are still permitted to file claims by reason of an extension granted pursuant to Rule 3002(c)(1) or (c)(2). In a case where notice of insufficient assets to pay a dividend has been given to creditors pursuant to subdivision (e) of this rule, after 90 days following the mailing of a notice of the time for filing claims pursuant to Rule 3002(c)(5), the court may direct that notices be mailed only to the entities specified in the preceding sentence. (i) NOTICES TO COMMITTEES. Copies of all notices required to be mailed pursuant to this rule shall be mailed to the committees elected under § 705 or appointed under § 1102 of the Code or to their authorized agents. Notwithstanding the foregoing subdivisions, the court may order that notices required by subdivision (a)(2), (3) and (6) of this rule be transmitted to the United States trustee and be mailed only to the committees elected under § 705 or appointed under § 1102 of the Code or to their authorized agents and to the creditors and equity security holders who serve on the trustee or debtor in possession and file a request that all notices be mailed to them. A committee appointed under § 1114 shall receive copies of all notices required by subdivisions (a)(1), (a)(5), (b), (f)(2), and (f)(7), and such other notices as the court may direct. 21 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2002 1So in original. Period probably should not appear. (j) NOTICES TO THE UNITED STATES. Copies of notices required to be mailed to all creditors under this rule shall be mailed (1) in a chapter 11 reorganization case, to the Securities and Exchange Commission at any place the Commission designates, if the Commission has filed either a notice of appearance in the case or a written request to receive notices; (2) in a commodity broker case, to the Commodity Futures Trading Commission at Washington, D.C.; (3) in a chapter 11 case, to the Internal Revenue Service at its address set out in the register maintained under Rule 5003(e) for the district in which the case is pending; (4) if the papers in the case disclose a debt to the United States other than for taxes, to the United States attorney for the district in which the case is pending and to the department, agency, or instrumentality of the United States through which the debtor became indebted; or (5) if the filed papers disclose a stock interest of the United States, to the Secretary of the Treasury at Washington, D.C. (k) NOTICES TO UNITED STATES TRUSTEE. Unless the case is a chapter 9 municipality case or unless the United States trustee requests otherwise, the clerk, or some other person as the court may direct, shall transmit to the United States trustee notice of the matters described in subdivisions (a)(2), (a)(3), (a)(4), (a)(8), (b), (f)(1), (f)(2), (f)(4), (f)(6), (f)(7), (f)(8), and (q) of this rule and notice of hearings on all applications for compensation or reimbursement of expenses. Notices to the United States trustee shall be transmitted within the time prescribed in subdivision (a) or (b) of this rule. The United States trustee shall also receive notice of any other matter if such notice is requested by the United States trustee or ordered by the court. Nothing in these rules requires the clerk or any other person to transmit to the United States trustee any notice, schedule, report, application or other document in a case under the Securities Investor Protection Act, 15 U.S.C. § 78aaa et. 1 seq. (l) NOTICE BY PUBLICATION. The court may order notice by publication if it finds that notice by mail is impracticable or that it is desirable to supplement the notice. (m) ORDERS DESIGNATING MATTER OF NOTICES. The court may from time to time enter orders designating the matters in respect to which, the entity to whom, and the form and manner in which notices shall be sent except as otherwise provided by these rules. (n) CAPTION. The caption of every notice given under this rule shall comply with Rule 1005. The caption of every notice required to be given by the debtor to a creditor shall include the information required to be in the notice by § 342(c) of the Code. (o) NOTICE OF ORDER FOR RELIEF IN CONSUMER CASE. In a voluntary case commenced by an individual debtor whose debts are primarily consumer debts, the clerk or some other person as the court may direct shall give the trustee and all creditors notice by mail of the order for relief within 21 days from the date thereof. (p) NOTICE TO A CREDITOR WITH A FOREIGN ADDRESS. (1) If, at the request of the United States trustee or a party in interest, or on its own initiative, the court finds that a notice mailed within the time prescribed by these rules would Rule 2002 FEDERAL RULES OF BANKRUPTCY PROCEDURE 22 not be sufficient to give a creditor with a foreign address to which notices under these rules are mailed reasonable notice under the circumstances, the court may order that the notice be supplemented with notice by other means or that the time prescribed for the notice by mail be enlarged. (2) Unless the court for cause orders otherwise, a creditor with a foreign address to which notices under this rule are mailed shall be given at least 30 days’ notice of the time fixed for filing a proof of claim under Rule 3002(c) or Rule 3003(c). (3) Unless the court for cause orders otherwise, the mailing address of a creditor with a foreign address shall be determined under Rule 2002(g). (q) NOTICE OF PETITION FOR RECOGNITION OF FOREIGN PROCEEDING AND OF COURT’S INTENTION TO COMMUNICATE WITH FOREIGN COURTS AND FOREIGN REPRESENTATIVES. (1) Notice of Petition for Recognition. After the filing of a petition for recognition of a foreign proceeding, the court shall promptly schedule and hold a hearing on the petition. The clerk, or some other person as the court may direct, shall forthwith give the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and such other entities as the court may direct, at least 21 days’ notice by mail of the hearing. The notice shall state whether the petition seeks recognition as a foreign main proceeding or foreign nonmain proceeding and shall include the petition and any other document the court may require. If the court consolidates the hearing on the petition with the hearing on a request for provisional relief, the court may set a shorter notice period, with notice to the entities listed in this subdivision. (2) Notice of Court’s Intention to Communicate with Foreign Courts and Foreign Representatives. The clerk, or some other person as the court may direct, shall give the debtor, all persons or bodies authorized to administer foreign proceedings of the debtor, all entities against whom provisional relief is being sought under § 1519 of the Code, all parties to litigation pending in the United States in which the debtor is a party at the time of the filing of the petition, and such other entities as the court may direct, notice by mail of the court’s intention to communicate with a foreign court or foreign representative. (As amended Pub. L. 98–91, § 2(a), Aug. 30, 1983, 97 Stat. 607; Pub. L. 98–353, title III, § 321, July 10, 1984, 98 Stat. 357; Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 26, 1999, eff. Dec. 1, 1999; Apr. 17, 2000, eff. Dec. 1, 2000; Apr. 23, 2001, eff. Dec. 1, 2001; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 26, 2004, eff. Dec. 1, 2004; Apr. 25, 2005, eff. Dec. 1, 2005; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 28, 2016, eff. Dec. 1, 2016; Apr. 27, 2017, eff. Dec. 1, 2017.) 23 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2003 Rule 2003. Meeting of Creditors or Equity Security Holders (a) DATE AND PLACE. Except as otherwise provided in § 341(e) of the Code, in a chapter 7 liquidation or a chapter 11 reorganization case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 40 days after the order for relief. In a chapter 12 family farmer debt adjustment case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 35 days after the order for relief. In a chapter 13 individual’s debt adjustment case, the United States trustee shall call a meeting of creditors to be held no fewer than 21 and no more than 50 days after the order for relief. If there is an appeal from or a motion to vacate the order for relief, or if there is a motion to dismiss the case, the United States trustee may set a later date for the meeting. The meeting may be held at a regular place for holding court or at any other place designated by the United States trustee within the district convenient for the parties in interest. If the United States trustee designates a place for the meeting which is not regularly staffed by the United States trustee or an assistant who may preside at the meeting, the meeting may be held not more than 60 days after the order for relief. (b) ORDER OF MEETING. (1) Meeting of Creditors. The United States trustee shall preside at the meeting of creditors. The business of the meeting shall include the examination of the debtor under oath and, in a chapter 7 liquidation case, may include the election of a creditors’ committee and, if the case is not under subchapter V of chapter 7, the election of a trustee. The presiding officer shall have the authority to administer oaths. (2) Meeting of Equity Security Holders. If the United States trustee convenes a meeting of equity security holders pursuant to § 341(b) of the Code, the United States trustee shall fix a date for the meeting and shall preside. (3) Right To Vote. In a chapter 7 liquidation case, a creditor is entitled to vote at a meeting if, at or before the meeting, the creditor has filed a proof of claim or a writing setting forth facts evidencing a right to vote pursuant to § 702(a) of the Code unless objection is made to the claim or the proof of claim is insufficient on its face. A creditor of a partnership may file a proof of claim or writing evidencing a right to vote for the trustee for the estate of the general partner notwithstanding that a trustee for the estate of the partnership has previously qualified. In the event of an objection to the amount or allowability of a claim for the purpose of voting, unless the court orders otherwise, the United States trustee shall tabulate the votes for each alternative presented by the dispute and, if resolution of such dispute is necessary to determine the result of the election, the tabulations for each alternative shall be reported to the court. (c) RECORD OF MEETING. Any examination under oath at the meeting of creditors held pursuant to § 341(a) of the Code shall be recorded verbatim by the United States trustee using electronic sound recording equipment or other means of recording, and such record shall be preserved by the United States trustee and available for public access until two years after the conclusion of the Rule 2004 FEDERAL RULES OF BANKRUPTCY PROCEDURE 24 meeting of creditors. Upon request of any entity, the United States trustee shall certify and provide a copy or transcript of such recording at the entity’s expense. (d) REPORT OF ELECTION AND RESOLUTION OF DISPUTES IN A CHAPTER 7 CASE. (1) Report of Undisputed Election. In a chapter 7 case, if the election of a trustee or a member of a creditors’ committee is not disputed, the United States trustee shall promptly file a report of the election, including the name and address of the person or entity elected and a statement that the election is undisputed. (2) Disputed Election. If the election is disputed, the United States trustee shall promptly file a report stating that the election is disputed, informing the court of the nature of the dispute, and listing the name and address of any candidate elected under any alternative presented by the dispute. No later than the date on which the report is filed, the United States trustee shall mail a copy of the report to any party in interest that has made a request to receive a copy of the report. Pending disposition by the court of a disputed election for trustee, the interim trustee shall continue in office. Unless a motion for the resolution of the dispute is filed no later than 14 days after the United States trustee files a report of a disputed election for trustee, the interim trustee shall serve as trustee in the case. (e) ADJOURNMENT. The meeting may be adjourned from time to time by announcement at the meeting of the adjourned date and time. The presiding official shall promptly file a statement specifying the date and time to which the meeting is adjourned. (f) SPECIAL MEETINGS. The United States trustee may call a special meeting of creditors on request of a party in interest or on the United States trustee’s own initiative. (g) FINAL MEETING. If the United States trustee calls a final meeting of creditors in a case in which the net proceeds realized exceed $1,500, the clerk shall mail a summary of the trustee’s final account to the creditors with a notice of the meeting, together with a statement of the amount of the claims allowed. The trustee shall attend the final meeting and shall, if requested, report on the administration of the estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 22, 1993, eff. Aug. 1, 1993; Apr. 26, 1999, eff. Dec. 1, 1999; Mar. 27, 2003, eff. Dec. 1, 2003; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 26, 2011, eff. Dec. 1, 2011.) Rule 2004. Examination (a) EXAMINATION ON MOTION. On motion of any party in interest, the court may order the examination of any entity. (b) SCOPE OF EXAMINATION. The examination of an entity under this rule or of the debtor under § 343 of the Code may relate only to the acts, conduct, or property or to the liabilities and financial condition of the debtor, or to any matter which may affect the administration of the debtor’s estate, or to the debtor’s right to a discharge. In a family farmer’s debt adjustment case under chapter 12, an individual’s debt adjustment case under chapter 13, or 25 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2005 a reorganization case under chapter 11 of the Code, other than for the reorganization of a railroad, the examination may also relate to the operation of any business and the desirability of its continuance, the source of any money or property acquired or to be acquired by the debtor for purposes of consummating a plan and the consideration given or offered therefor, and any other matter relevant to the case or to the formulation of a plan. (c) COMPELLING ATTENDANCE AND PRODUCTION OF DOCUMENTS. The attendance of an entity for examination and for the production of documents, whether the examination is to be conducted within or without the district in which the case is pending, may be compelled as provided in Rule 9016 for the attendance of a witness at a hearing or trial. As an officer of the court, an attorney may issue and sign a subpoena on behalf of the court for the district in which the examination is to be held if the attorney is admitted to practice in that court or in the court in which the case is pending. (d) TIME AND PLACE OF EXAMINATION OF DEBTOR. The court may for cause shown and on terms as it may impose order the debtor to be examined under this rule at any time or place it designates, whether within or without the district wherein the case is pending. (e) MILEAGE. An entity other than a debtor shall not be required to attend as a witness unless lawful mileage and witness fee for one day’s attendance shall be first tendered. If the debtor resides more than 100 miles from the place of examination when required to appear for an examination under this rule, the mileage allowed by law to a witness shall be tendered for any distance more than 100 miles from the debtor’s residence at the date of the filing of the first petition commencing a case under the Code or the residence at the time the debtor is required to appear for the examination, whichever is the lesser. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 29, 2002, eff. Dec. 1, 2002.) Rule 2005. Apprehension and Removal of Debtor to Compel Attendance for Examination (a) ORDER TO COMPEL ATTENDANCE FOR EXAMINATION. On motion of any party in interest supported by an affidavit alleging (1) that the examination of the debtor is necessary for the proper administration of the estate and that there is reasonable cause to believe that the debtor is about to leave or has left the debtor’s residence or principal place of business to avoid examination, or (2) that the debtor has evaded service of a subpoena or of an order to attend for examination, or (3) that the debtor has willfully disobeyed a subpoena or order to attend for examination, duly served, the court may issue to the marshal, or some other officer authorized by law, an order directing the officer to bring the debtor before the court without unnecessary delay. If, after hearing, the court finds the allegations to be true, the court shall thereupon cause the debtor to be examined forthwith. If necessary, the court shall fix conditions for further examination and for the debtor’s obedience to all orders made in reference thereto. (b) REMOVAL. Whenever any order to bring the debtor before the court is issued under this rule and the debtor is found in a district Rule 2006 FEDERAL RULES OF BANKRUPTCY PROCEDURE 26 other than that of the court issuing the order, the debtor may be taken into custody under the order and removed in accordance with the following rules: (1) If the debtor is taken into custody under the order at a place less than 100 miles from the place of issue of the order, the debtor shall be brought forthwith before the court that issued the order. (2) If the debtor is taken into custody under the order at a place 100 miles or more from the place of issue of the order, the debtor shall be brought without unnecessary delay before the nearest available United States magistrate judge, bankruptcy judge, or district judge. If, after hearing, the magistrate judge, bankruptcy judge, or district judge finds that an order has issued under this rule and that the person in custody is the debtor, or if the person in custody waives a hearing, the magistrate judge, bankruptcy judge, or district judge shall order removal, and the person in custody shall be released on conditions ensuring prompt appearance before the court that issued the order to compel the attendance. (c) CONDITIONS OF RELEASE. In determining what conditions will reasonably assure attendance or obedience under subdivision (a) of this rule or appearance under subdivision (b) of this rule, the court shall be governed by the provisions and policies of title 18, U.S.C., § 3146(a) and (b). (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 22, 1993, eff. Aug. 1, 1993.) Rule 2006. Solicitation and Voting of Proxies in Chapter 7 Liquidation Cases (a) APPLICABILITY. This rule applies only in a liquidation case pending under chapter 7 of the Code. (b) DEFINITIONS. (1) Proxy. A proxy is a written power of attorney authorizing any entity to vote the claim or otherwise act as the owner’s attorney in fact in connection with the administration of the estate. (2) Solicitation of Proxy. The solicitation of a proxy is any communication, other than one from an attorney to a regular client who owns a claim or from an attorney to the owner of a claim who has requested the attorney to represent the owner, by which a creditor is asked, directly or indirectly, to give a proxy after or in contemplation of the filing of a petition by or against the debtor. (c) AUTHORIZED SOLICITATION. (1) A proxy may be solicited only by (A) a creditor owning an allowable unsecured claim against the estate on the date of the filing of the petition; (B) a committee elected pursuant to § 705 of the Code; (C) a committee of creditors selected by a majority in number and amount of claims of creditors (i) whose claims are not contingent or unliquidated, (ii) who are not disqualified from voting under § 702(a) of the Code and (iii) who were present or represented at a meeting of which all creditors having claims of over $500 or the 100 creditors having the largest claims had at least seven days’ notice in writing 27 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2006 and of which meeting written minutes were kept and are available reporting the names of the creditors present or represented and voting and the amounts of their claims; or (D) a bona fide trade or credit association, but such association may solicit only creditors who were its members or subscribers in good standing and had allowable unsecured claims on the date of the filing of the petition. (2) A proxy may be solicited only in writing. (d) SOLICITATION NOT AUTHORIZED. This rule does not permit solicitation (1) in any interest other than that of general creditors; (2) by or on behalf of any custodian; (3) by the interim trustee or by or on behalf of any entity not qualified to vote under § 702(a) of the Code; (4) by or on behalf of an attorney at law; or (5) by or on behalf of a transferee of a claim for collection only. (e) DATA REQUIRED FROM HOLDERS OF MULTIPLE PROXIES. At any time before the voting commences at any meeting of creditors pursuant to § 341(a) of the Code, or at any other time as the court may direct, a holder of two or more proxies shall file and transmit to the United States trustee a verified list of the proxies to be voted and a verified statement of the pertinent facts and circumstances in connection with the execution and delivery of each proxy, including: (1) a copy of the solicitation; (2) identification of the solicitor, the forwarder, if the forwarder is neither the solicitor nor the owner of the claim, and the proxyholder, including their connections with the debtor and with each other. If the solicitor, forwarder, or proxyholder is an association, there shall also be included a statement that the creditors whose claims have been solicited and the creditors whose claims are to be voted were members or subscribers in good standing and had allowable unsecured claims on the date of the filing of the petition. If the solicitor, forwarder, or proxyholder is a committee of creditors, the statement shall also set forth the date and place the committee was organized, that the committee was organized in accordance with clause (B) or (C) of paragraph (c)(1) of this rule, the members of the committee, the amounts of their claims, when the claims were acquired, the amounts paid therefor, and the extent to which the claims of the committee members are secured or entitled to priority; (3) a statement that no consideration has been paid or promised by the proxyholder for the proxy; (4) a statement as to whether there is any agreement and, if so, the particulars thereof, between the proxyholder and any other entity for the payment of any consideration in connection with voting the proxy, or for the sharing of compensation with any entity, other than a member or regular associate of the proxyholder’s law firm, which may be allowed the trustee or any entity for services rendered in the case, or for the employment of any person as attorney, accountant, appraiser, auctioneer, or other employee for the estate; (5) if the proxy was solicited by an entity other than the proxyholder, or forwarded to the holder by an entity who is neither a solicitor of the proxy nor the owner of the claim, a statement signed and verified by the solicitor or forwarder that no consideration has been paid or promised for the proxy, and whether there is any agreement, and, if so, the particulars thereof, between the solicitor or forwarder and any other entity for the payment of any consideration in connection with voting the proxy, or for sharing compensation with any entity other than a member or regular associate of the solicitor’s or forwarder’s law firm which may be allowed the trustee or any entity for services rendered in the case, or for the employment of any person as attorney, accountant, appraiser, auctioneer, or other employee for the estate; (6) if the solicitor, forwarder, or proxyholder is a committee, a statement signed and verified by each member as to the amount and source of any consideration paid or to be paid to such member in connection with the case other than by way of dividend on the member’s claim. (f) ENFORCEMENT OF RESTRICTIONS ON SOLICITATION. On motion of any party in interest or on its own initiative, the court may determine whether there has been a failure to comply with the provisions of this rule or any other impropriety in connection with the solicitation or voting of a proxy. After notice and a hearing the court may reject any proxy for cause, vacate any order entered in consequence of the voting of any proxy which should have been rejected, or take any other appropriate action. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2007. Review of Appointment of Creditors’ Committee Organized Before Commencement of the Case (a) MOTION TO REVIEW APPOINTMENT. If a committee appointed by the United States trustee pursuant to § 1102(a) of the Code consists of the members of a committee organized by creditors before the commencement of a chapter 9 or chapter 11 case, on motion of a party in interest and after a hearing on notice to the United States trustee and other entities as the court may direct, the court may determine whether the appointment of the committee satisfies the requirements of § 1102(b)(1) of the Code. (b) SELECTION OF MEMBERS OF COMMITTEE. The court may find that a committee organized by unsecured creditors before the commencement of a chapter 9 or chapter 11 case was fairly chosen if: (1) it was selected by a majority in number and amount of claims of unsecured creditors who may vote under § 702(a) of the Code and were present in person or represented at a meeting of which all creditors having unsecured claims of over $1,000 or the 100 unsecured creditors having the largest claims had at least seven days’ notice in writing, and of which meeting written minutes reporting the names of the creditors present or represented and voting and the amounts of their claims were kept and are available for inspection; (2) all proxies voted at the meeting for the elected committee were solicited pursuant to Rule 2006 and the lists and statements required by subdivision (e) thereof have been transmitted to the United States trustee; and (3) the organization of the committee was in all other respects fair and proper. 29 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2007.1 (c) FAILURE TO COMPLY WITH REQUIREMENTS FOR APPOINTMENT. After a hearing on notice pursuant to subdivision (a) of this rule, the court shall direct the United States trustee to vacate the appointment of the committee and may order other appropriate action if the court finds that such appointment failed to satisfy the requirements of § 1102(b)(1) of the Code. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2007.1. Appointment of Trustee or Examiner in a Chapter 11 Reorganization Case (a) ORDER TO APPOINT TRUSTEE OR EXAMINER. In a chapter 11 reorganization case, a motion for an order to appoint a trustee or an examiner under § 1104(a) or § 1104(c) of the Code shall be made in accordance with Rule 9014. (b) ELECTION OF TRUSTEE. (1) Request for an Election. A request to convene a meeting of creditors for the purpose of electing a trustee in a chapter 11 reorganization case shall be filed and transmitted to the United States trustee in accordance with Rule 5005 within the time prescribed by § 1104(b) of the Code. Pending court approval of the person elected, any person appointed by the United States trustee under § 1104(d) and approved in accordance with subdivision (c) of this rule shall serve as trustee. (2) Manner of Election and Notice. An election of a trustee under § 1104(b) of the Code shall be conducted in the manner provided in Rules 2003(b)(3) and 2006. Notice of the meeting of creditors convened under § 1104(b) shall be given as provided in Rule 2002. The United States trustee shall preside at the meeting. A proxy for the purpose of voting in the election may be solicited only by a committee of creditors appointed under § 1102 of the Code or by any other party entitled to solicit a proxy pursuant to Rule 2006. (3) Report of Election and Resolution of Disputes. (A) Report of Undisputed Election. If no dispute arises out of the election, the United States trustee shall promptly file a report certifying the election, including the name and address of the person elected and a statement that the election is undisputed. The report shall be accompanied by a verified statement of the person elected setting forth that person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (B) Dispute Arising Out of an Election. If a dispute arises out of an election, the United States trustee shall promptly file a report stating that the election is disputed, informing the court of the nature of the dispute, and listing the name and address of any candidate elected under any alternative presented by the dispute. The report shall be accompanied by a verified statement by each candidate elected under each alternative presented by the dispute, setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any Rule 2007.2 FEDERAL RULES OF BANKRUPTCY PROCEDURE 30 person employed in the office of the United States trustee. Not later than the date on which the report of the disputed election is filed, the United States trustee shall mail a copy of the report and each verified statement to any party in interest that has made a request to convene a meeting under § 1104(b) or to receive a copy of the report, and to any committee appointed under § 1102 of the Code. (c) APPROVAL OF APPOINTMENT. An order approving the appointment of a trustee or an examiner under § 1104(d) of the Code shall be made on application of the United States trustee. The application shall state the name of the person appointed and, to the best of the applicant’s knowledge, all the person’s connections with the debtor, creditors, any other parties in interest, their respective attorneys and accountants, the United States trustee, or persons employed in the office of the United States trustee. The application shall state the names of the parties in interest with whom the United States trustee consulted regarding the appointment. The application shall be accompanied by a verified statement of the person appointed setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (Added Apr. 30, 1991, eff. Aug. 1, 1991; amended Apr. 11, 1997, eff. Dec. 1, 1997; Apr. 23, 2008, eff. Dec. 1, 2008.) Rule 2007.2. Appointment of Patient Care Ombudsman in a Health Care Business Case (a) ORDER TO APPOINT PATIENT CARE OMBUDSMAN. In a chapter 7, chapter 9, or chapter 11 case in which the debtor is a health care business, the court shall order the appointment of a patient care ombudsman under § 333 of the Code, unless the court, on motion of the United States trustee or a party in interest filed no later than 21 days after the commencement of the case or within another time fixed by the court, finds that the appointment of a patient care ombudsman is not necessary under the specific circumstances of the case for the protection of patients. (b) MOTION FOR ORDER TO APPOINT OMBUDSMAN. If the court has found that the appointment of an ombudsman is not necessary, or has terminated the appointment, the court, on motion of the United States trustee or a party in interest, may order the appointment at a later time if it finds that the appointment has become necessary to protect patients. (c) NOTICE OF APPOINTMENT. If a patient care ombudsman is appointed under § 333, the United States trustee shall promptly file a notice of the appointment, including the name and address of the person appointed. Unless the person appointed is a State Long-Term Care Ombudsman, the notice shall be accompanied by a verified statement of the person appointed setting forth the person’s connections with the debtor, creditors, patients, any other party in interest, their respective attorneys and accountants, the United States trustee, and any person employed in the office of the United States trustee. (d) TERMINATION OF APPOINTMENT. On motion of the United States trustee or a party in interest, the court may terminate the 31 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2009 appointment of a patient care ombudsman if the court finds that the appointment is not necessary to protect patients. (e) MOTION. A motion under this rule shall be governed by Rule 9014. The motion shall be transmitted to the United States trustee and served on: the debtor; the trustee; any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, on the creditors included on the list filed under Rule 1007(d); and such other entities as the court may direct. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2008. Notice to Trustee of Selection The United States trustee shall immediately notify the person selected as trustee how to qualify and, if applicable, the amount of the trustee’s bond. A trustee that has filed a blanket bond pursuant to Rule 2010 and has been selected as trustee in a chapter 7, chapter 12, or chapter 13 case that does not notify the court and the United States trustee in writing of rejection of the office within seven days after receipt of notice of selection shall be deemed to have accepted the office. Any other person selected as trustee shall notify the court and the United States trustee in writing of acceptance of the office within seven days after receipt of notice of selection or shall be deemed to have rejected the office. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2009. Trustees for Estates When Joint Administration Ordered (a) ELECTION OF SINGLE TRUSTEE FOR ESTATES BEING JOINTLY ADMINISTERED. If the court orders a joint administration of two or more estates under Rule 1015(b), creditors may elect a single trustee for the estates being jointly administered, unless the case is under subchapter V of chapter 7 of the Code. (b) RIGHT OF CREDITORS TO ELECT SEPARATE TRUSTEE. Notwithstanding entry of an order for joint administration under Rule 1015(b), the creditors of any debtor may elect a separate trustee for the estate of the debtor as provided in § 702 of the Code, unless the case is under subchapter V of chapter 7. (c) APPOINTMENT OF TRUSTEES FOR ESTATES BEING JOINTLY ADMINISTERED. (1) Chapter 7 Liquidation Cases. Except in a case governed by subchapter V of chapter 7, the United States trustee may appoint one or more interim trustees for estates being jointly administered in chapter 7 cases. (2) Chapter 11 Reorganization Cases. If the appointment of a trustee is ordered, the United States trustee may appoint one or more trustees for estates being jointly administered in chapter 11 cases. (3) Chapter 12 Family Farmer’s Debt Adjustment Cases. The United States trustee may appoint one or more trustees for estates being jointly administered in chapter 12 cases. Rule 2010 FEDERAL RULES OF BANKRUPTCY PROCEDURE 32 (4) Chapter 13 Individual’s Debt Adjustment Cases. The United States trustee may appoint one or more trustees for estates being jointly administered in chapter 13 cases. (d) POTENTIAL CONFLICTS OF INTEREST. On a showing that creditors or equity security holders of the different estates will be prejudiced by conflicts of interest of a common trustee who has been elected or appointed, the court shall order the selection of separate trustees for estates being jointly administered. (e) SEPARATE ACCOUNTS. The trustee or trustees of estates being jointly administered shall keep separate accounts of the property and distribution of each estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 27, 2003, eff. Dec. 1, 2003.) Rule 2010. Qualification by Trustee; Proceeding on Bond (a) BLANKET BOND. The United States trustee may authorize a blanket bond in favor of the United States conditioned on the faithful performance of official duties by the trustee or trustees to cover (1) a person who qualifies as trustee in a number of cases, and (2) a number of trustees each of whom qualifies in a different case. (b) PROCEEDING ON BOND. A proceeding on the trustee’s bond may be brought by any party in interest in the name of the United States for the use of the entity injured by the breach of the condition. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2011. Evidence of Debtor in Possession or Qualification of Trustee (a) Whenever evidence is required that a debtor is a debtor in possession or that a trustee has qualified, the clerk may so certify and the certificate shall constitute conclusive evidence of that fact. (b) If a person elected or appointed as trustee does not qualify within the time prescribed by § 322(a) of the Code, the clerk shall so notify the court and the United States trustee. (As amended Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2012. Substitution of Trustee or Successor Trustee; Accounting (a) TRUSTEE. If a trustee is appointed in a chapter 11 case or the debtor is removed as debtor in possession in a chapter 12 case, the trustee is substituted automatically for the debtor in possession as a party in any pending action, proceeding, or matter. (b) SUCCESSOR TRUSTEE. When a trustee dies, resigns, is removed, or otherwise ceases to hold office during the pendency of a case under the Code (1) the successor is automatically substituted as a party in any pending action, proceeding, or matter; and (2) the successor trustee shall prepare, file, and transmit to the United States trustee an accounting of the prior administration of the estate. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) 33 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2014 Rule 2013. Public Record of Compensation Awarded to Trustees, Examiners, and Professionals (a) RECORD TO BE KEPT. The clerk shall maintain a public record listing fees awarded by the court (1) to trustees and attorneys, accountants, appraisers, auctioneers and other professionals employed by trustees, and (2) to examiners. The record shall include the name and docket number of the case, the name of the individual or firm receiving the fee and the amount of the fee awarded. The record shall be maintained chronologically and shall be kept current and open to examination by the public without charge. ‘‘Trustees,’’ as used in this rule, does not include debtors in possession. (b) SUMMARY OF RECORD. At the close of each annual period, the clerk shall prepare a summary of the public record by individual or firm name, to reflect total fees awarded during the preceding year. The summary shall be open to examination by the public without charge. The clerk shall transmit a copy of the summary to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2014. Employment of Professional Persons (a) APPLICATION FOR AND ORDER OF EMPLOYMENT. An order approving the employment of attorneys, accountants, appraisers, auctioneers, agents, or other professionals pursuant to § 327, § 1103, or § 1114 of the Code shall be made only on application of the trustee or committee. The application shall be filed and, unless the case is a chapter 9 municipality case, a copy of the application shall be transmitted by the applicant to the United States trustee. The application shall state the specific facts showing the necessity for the employment, the name of the person to be employed, the reasons for the selection, the professional services to be rendered, any proposed arrangement for compensation, and, to the best of the applicant’s knowledge, all of the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. The application shall be accompanied by a verified statement of the person to be employed setting forth the person’s connections with the debtor, creditors, any other party in interest, their respective attorneys and accountants, the United States trustee, or any person employed in the office of the United States trustee. (b) SERVICES RENDERED BY MEMBER OR ASSOCIATE OF FIRM OF ATTORNEYS OR ACCOUNTANTS. If, under the Code and this rule, a law partnership or corporation is employed as an attorney, or an accounting partnership or corporation is employed as an accountant, or if a named attorney or accountant is employed, any partner, member, or regular associate of the partnership, corporation, or individual may act as attorney or accountant so employed, without further order of the court. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991.) Rule 2015 FEDERAL RULES OF BANKRUPTCY PROCEDURE 34 Rule 2015. Duty to Keep Records, Make Reports, and Give Notice of Case or Change of Status (a) TRUSTEE OR DEBTOR IN POSSESSION. A trustee or debtor in possession shall: (1) in a chapter 7 liquidation case and, if the court directs, in a chapter 11 reorganization case file and transmit to the United States trustee a complete inventory of the property of the debtor within 30 days after qualifying as a trustee or debtor in possession, unless such an inventory has already been filed; (2) keep a record of receipts and the disposition of money and property received; (3) file the reports and summaries required by § 704(a)(8) of the Code, which shall include a statement, if payments are made to employees, of the amounts of deductions for all taxes required to be withheld or paid for and in behalf of employees and the place where these amounts are deposited; (4) as soon as possible after the commencement of the case, give notice of the case to every entity known to be holding money or property subject to withdrawal or order of the debtor, including every bank, savings or building and loan association, public utility company, and landlord with whom the debtor has a deposit, and to every insurance company which has issued a policy having a cash surrender value payable to the debtor, except that notice need not be given to any entity who has knowledge or has previously been notified of the case; (5) in a chapter 11 reorganization case, on or before the last day of the month after each calendar quarter during which there is a duty to pay fees under 28 U.S.C. § 1930(a)(6), file and transmit to the United States trustee a statement of any disbursements made during that quarter and of any fees payable under 28 U.S.C. § 1930(a)(6) for that quarter; and (6) in a chapter 11 small business case, unless the court, for cause, sets another reporting interval, file and transmit to the United States trustee for each calendar month after the order for relief, on the appropriate Official Form, the report required by § 308. If the order for relief is within the first 15 days of a calendar month, a report shall be filed for the portion of the month that follows the order for relief. If the order for relief is after the 15th day of a calendar month, the period for the remainder of the month shall be included in the report for the next calendar month. Each report shall be filed no later than 21 days after the last day of the calendar month following the month covered by the report. The obligation to file reports under this subparagraph terminates on the effective date of the plan, or conversion or dismissal of the case. (b) CHAPTER 12 TRUSTEE AND DEBTOR IN POSSESSION. In a chapter 12 family farmer’s debt adjustment case, the debtor in possession shall perform the duties prescribed in clauses (2)–(4) of subdivision (a) of this rule and, if the court directs, shall file and transmit to the United States trustee a complete inventory of the property of the debtor within the time fixed by the court. If the debtor is removed as debtor in possession, the trustee shall perform the duties of the debtor in possession prescribed in this paragraph. 35 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2015.1 (c) CHAPTER 13 TRUSTEE AND DEBTOR. (1) Business Cases. In a chapter 13 individual’s debt adjustment case, when the debtor is engaged in business, the debtor shall perform the duties prescribed by clauses (2)–(4) of subdivision (a) of this rule and, if the court directs, shall file and transmit to the United States trustee a complete inventory of the property of the debtor within the time fixed by the court. (2) Nonbusiness Cases. In a chapter 13 individual’s debt adjustment case, when the debtor is not engaged in business, the trustee shall perform the duties prescribed by clause (2) of subdivision (a) of this rule. (d) FOREIGN REPRESENTATIVE. In a case in which the court has granted recognition of a foreign proceeding under chapter 15, the foreign representative shall file any notice required under § 1518 of the Code within 14 days after the date when the representative becomes aware of the subsequent information. (e) TRANSMISSION OF REPORTS. In a chapter 11 case the court may direct that copies or summaries of annual reports and copies or summaries of other reports shall be mailed to the creditors, equity security holders, and indenture trustees. The court may also direct the publication of summaries of any such reports. A copy of every report or summary mailed or published pursuant to this subdivision shall be transmitted to the United States trustee. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Apr. 23, 1996, eff. Dec. 1, 1996; Apr. 29, 2002, eff. Dec. 1, 2002; Apr. 23, 2008, eff. Dec. 1, 2008; Mar. 26, 2009, eff. Dec. 1, 2009; Apr. 23, 2012, eff. Dec. 1, 2012.) Rule 2015.1. Patient Care Ombudsman (a) REPORTS. A patient care ombudsman, at least 14 days before making a report under § 333(b)(2) of the Code, shall give notice that the report will be made to the court, unless the court orders otherwise. The notice shall be transmitted to the United States trustee, posted conspicuously at the health care facility that is the subject of the report, and served on: the debtor; the trustee; all patients; and any committee elected under § 705 or appointed under § 1102 of the Code or its authorized agent, or, if the case is a chapter 9 municipality case or a chapter 11 reorganization case and no committee of unsecured creditors has been appointed under § 1102, on the creditors included on the list filed under Rule 1007(d); and such other entities as the court may direct. The notice shall state the date and time when the report will be made, the manner in which the report will be made, and, if the report is in writing, the name, address, telephone number, email address, and website, if any, of the person from whom a copy of the report may be obtained at the debtor’s expense. (b) AUTHORIZATION TO REVIEW CONFIDENTIAL PATIENT RECORDS. A motion by a patient care ombudsman under § 333(c) to review confidential patient records shall be governed by Rule 9014, served on the patient and any family member or other contact person whose name and address have been given to the trustee or the debtor for the purpose of providing information regarding the patient’s health care, and transmitted to the United States trustee subject Rule 2015.2 FEDERAL RULES OF BANKRUPTCY PROCEDURE 36 to applicable nonbankruptcy law relating to patient privacy. Unless the court orders otherwise, a hearing on the motion may not be commenced earlier than 14 days after service of the motion. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2015.2. Transfer of Patient in Health Care Business Case Unless the court orders otherwise, if the debtor is a health care business, the trustee may not transfer a patient to another health care business under § 704(a)(12) of the Code unless the trustee gives at least 14 days’ notice of the transfer to the patient care ombudsman, if any, the patient, and any family member or other contact person whose name and address has been given to the trustee or the debtor for the purpose of providing information regarding the patient’s health care. The notice is subject to applicable nonbankruptcy law relating to patient privacy. (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2015.3. Reports of Financial Information on Entities in Which a Chapter 11 Estate Holds a Controlling or Substantial Interest (a) REPORTING REQUIREMENT. In a chapter 11 case, the trustee or debtor in possession shall file periodic financial reports of the value, operations, and profitability of each entity that is not a publicly traded corporation or a debtor in a case under title 11, and in which the estate holds a substantial or controlling interest. The reports shall be prepared as prescribed by the appropriate Official Form, and shall be based upon the most recent information reasonably available to the trustee or debtor in possession. (b) TIME FOR FILING; SERVICE. The first report required by this rule shall be filed no later than seven days before the first date set for the meeting of creditors under § 341 of the Code. Subsequent reports shall be filed no less frequently than every six months thereafter, until the effective date of a plan or the case is dismissed or converted. Copies of the report shall be served on the United States trustee, any committee appointed under § 1102 of the Code, and any other party in interest that has filed a request therefor. (c) PRESUMPTION OF SUBSTANTIAL OR CONTROLLING INTEREST; JUDICIAL DETERMINATION. For purposes of this rule, an entity of which the estate controls or owns at least a 20 percent interest, shall be presumed to be an entity in which the estate has a substantial or controlling interest. An entity in which the estate controls or owns less than a 20 percent interest shall be presumed not to be an entity in which the estate has a substantial or controlling interest. Upon motion, the entity, any holder of an interest therein, the United States trustee, or any other party in interest may seek to rebut either presumption, and the court shall, after notice and a hearing, determine whether the estate’s interest in the entity is substantial or controlling. (d) MODIFICATION OF REPORTING REQUIREMENT. The court may, after notice and a hearing, vary the reporting requirement established by subdivision (a) of this rule for cause, including that the 37 FEDERAL RULES OF BANKRUPTCY PROCEDURE Rule 2016 trustee or debtor in possession is not able, after a good faith effort, to comply with those reporting requirements, or that the information required by subdivision (a) is publicly available. (e) NOTICE AND PROTECTIVE ORDERS. No later than 14 days before filing the first report required by this rule, the trustee or debtor in possession shall send notice to the entity in which the estate has a substantial or controlling interest, and to all holders— known to the trustee or debtor in possession—of an interest in that entity, that the trustee or debtor in possession expects to file and serve financial information relating to the entity in accordance with this rule. The entity in which the estate has a substantial or controlling interest, or a person holding an interest in that entity, may request protection of the information under § 107 of the Code. (f) EFFECT OF REQUEST. Unless the court orders otherwise, the pendency of a request under subdivisions (c), (d), or (e) of this rule shall not alter or stay the requirements of subdivision (a). (Added Apr. 23, 2008, eff. Dec. 1, 2008; amended Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2016. Compensation for Services Rendered and Reimbursement of Expenses (a) APPLICATION FOR COMPENSATION OR REIMBURSEMENT. An entity seeking interim or final compensation for services, or reimbursement of necessary expenses, from the estate shall file an application setting forth a detailed statement of (1) the services rendered, time expended and expenses incurred, and (2) the amounts requested. An application for compensation shall include a statement as to what payments have theretofore been made or promised to the applicant for services rendered or to be rendered in any capacity whatsoever in connection with the case, the source of the compensation so paid or promised, whether any compensation previously received has been shared and whether an agreement or understanding exists between the applicant and any other entity for the sharing of compensation received or to be received for services rendered in or in connection with the case, and the particulars of any sharing of compensation or agreement or understanding therefor, except that details of any agreement by the applicant for the sharing of compensation as a member or regular associate of a firm of lawyers or accountants shall not be required. The requirements of this subdivision shall apply to an application for compensation for services rendered by an attorney or accountant even though the application is filed by a creditor or other entity. Unless the case is a chapter 9 municipality case, the applicant shall transmit to the United States trustee a copy of the application. (b) DISCLOSURE OF COMPENSATION PAID OR PROMISED TO ATTORNEY FOR DEBTOR. Every attorney for a debtor, whether or not the attorney applies for compensation, shall file and transmit to the United States trustee within 14 days after the order for relief, or at another time as the court may direct, the statement required by § 329 of the Code including whether the attorney has shared or agreed to share the compensation with any other entity. The statement shall include the particulars of any such sharing or Rule 2017 FEDERAL RULES OF BANKRUPTCY PROCEDURE 38 agreement to share by the attorney, but the details of any agreement for the sharing of the compensation with a member or regular associate of the attorney’s law firm shall not be required. A supplemental statement shall be filed and transmitted to the United States trustee within 14 days after any payment or agreement not previously disclosed. (c) DISCLOSURE OF COMPENSATION PAID OR PROMISED TO BANKRUPTCY PETITION PREPARER. Before a petition is filed, every bankruptcy petition preparer for a debtor shall deliver to the debtor, the declaration under penalty of perjury required by § 110(h)(2). The declaration shall disclose any fee, and the source of any fee, received from or on behalf of the debtor within 12 months of the filing of the case and all unpaid fees charged to the debtor. The declaration shall also describe the services performed and documents prepared or caused to be prepared by the bankruptcy petition preparer. The declaration shall be filed with the petition. The petition preparer shall file a supplemental statement within 14 days after any payment or agreement not previously disclosed. (As amended Mar. 30, 1987, eff. Aug. 1, 1987; Apr. 30, 1991, eff. Aug. 1, 1991; Mar. 27, 2003, eff. Dec. 1, 2003; Mar. 26, 2009, eff. Dec. 1, 2009.) Rule 2017. Examination of Debtor’s Transactions with Debtor’s Attorney According to the information provided, Rule 1004.2 in Chapter 15 Cases, who can file a motion for a determination that the debtor’s center of main interests is other than as stated in the petition for recognition commencing the Chapter 15 case, and when should this motion be filed?",Legal,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]","What did the Supreme Court hold in the case Miranda v. Arizona, 384 U.S. 436(1966), and did any justices dissent from the majority opinion?","Facts The Supreme Court’s decision in Miranda v. Arizona addressed four different cases involving custodial interrogations. In each of these cases, the defendant was questioned by police officers, detectives, or a prosecuting attorney in a room in which he was cut off from the outside world. In none of these cases was the defendant given a full and effective warning of his rights at the outset of the interrogation process. In all the cases, the questioning elicited oral admissions and, in three of them, signed statements that were admitted at trial. Miranda v. Arizona: Miranda was arrested at his home and taken in custody to a police station where he was identified by the complaining witness. He was then interrogated by two police officers for two hours, which resulted in a signed, written confession. At trial, the oral and written confessions were presented to the jury. Miranda was found guilty of kidnapping and rape and was sentenced to 20-30 years imprisonment on each count. On appeal, the Supreme Court of Arizona held that Miranda’s constitutional rights were not violated in obtaining the confession. Vignera v. New York: Vignera was picked up by New York police in connection with the robbery of a dress shop that had occurred three days prior. He was first taken to the 17th Detective Squad headquarters. He was then taken to the 66th Detective Squad, where he orally admitted the robbery and was placed under formal arrest. He was then taken to the 70th Precinct for detention, where he was questioned by an assistant district attorney in the presence of a hearing reporter who transcribed the questions and answers. At trial, the oral confession and the transcript were presented to the jury. Vignera was found guilty of first degree robbery and sentenced to 30-60 years imprisonment. The conviction was affirmed without opinion by the Appellate Division and the Court of Appeals. Westover v. United States: Westover was arrested by local police in Kansas City as a suspect in two Kansas City robberies and taken to a local police station. A report was also received from the FBI that Westover was wanted on a felony charge in California. Westover was interrogated the night of the arrest and the next morning by local police. Then, FBI agents continued the interrogation at the station. After two-and-a-half hours of interrogation by the FBI, Westover signed separate confessions, which had been prepared by one of the agents during the interrogation, to each of the two robberies in California. These statements were introduced at trial. Westover was convicted of the California robberies and sentenced to 15 years’ imprisonment on each count. The conviction was affirmed by the Court of Appeals for the Ninth Circuit. California v. Stewart: In the course of investigating a series of purse-snatch robberies in which one of the victims died of injuries inflicted by her assailant, Stewart was identified as the endorser of checks stolen in one of the robberies. Steward was arrested at his home. Police also arrested Stewart’s wife and three other people who were visiting him. Stewart was placed in a cell, and, over the next five days, was interrogated on nine different occasions. During the ninth interrogation session, Stewart stated that he had robbed the deceased, but had not meant to hurt her. At that time, police released the four other people arrested with Stewart because there was no evidence to connect any of them with the crime. At trial, Stewart’s statements were introduced. Stewart was convicted of robbery and first-degree murder and sentenced to death. The Supreme Court of California reversed, holding that Stewart should have been advised of his right to remain silent and his right to counsel. Issues Whether “statements obtained from an individual who is subjected to custodial police interrogation” are admissible against him in a criminal trial and whether “procedures which assure that the individual is accorded his privilege under the Fifth Amendment to the Constitution not to be compelled to incriminate himself” are necessary. Supreme Court holding The Court held that “there can be no doubt that the Fifth Amendment privilege is available outside of criminal court proceedings and serves to protect persons in all settings in which their freedom of action is curtailed in any significant way from being compelled to incriminate themselves.” As such, “the prosecution may not use statements, whether exculpatory or inculpatory, stemming from custodial interrogation of the defendant unless it demonstrates the use of procedural safeguards effective to secure the privilege against self-incrimination. By custodial interrogation, we mean questioning initiated by law enforcement officers after a person has been taken into custody or otherwise deprived of his freedom of action in any significant way.” The Court further held that “without proper safeguards the process of in-custody interrogation of persons suspected or accused of crime contains inherently compelling pressures which work to undermine the individual’s will to resist and to compel him to speak where he would otherwise do so freely.” Therefore, a defendant “must be warned prior to any questioning that he has the right to remain silent, that anything he says can be used against him in a court of law, that he has the right to the presence of an attorney, and that if he cannot afford an attorney one will be appointed for him prior to any questioning if he so desires.” The Supreme Court reversed the judgment of the Supreme Court of Arizona in Miranda, reversed the judgment of the New York Court of Appeals in Vignera, reversed the judgment of the Court of Appeals for the Ninth Circuit in Westover, and affirmed the judgment of the Supreme Court of California in Stewart. Argued: Feb. 28, March 1 and 2, 1966 Decided: June 13, 1966 Vote: 5-4 Majority opinion written by Chief Justice Warren and joined by Justices Black, Douglas, Brennan, and Fortas. Dissenting opinion written by Justice Harlan and joined by Justices Stewart and White. Dissenting in part opinion written by Justice Clark."," Only use the provided text to answer the question, no outside sources. What did the Supreme Court hold in the case Miranda v. Arizona, 384 U.S. 436(1966), and did any justices dissent from the majority opinion? Facts The Supreme Court’s decision in Miranda v. Arizona addressed four different cases involving custodial interrogations. In each of these cases, the defendant was questioned by police officers, detectives, or a prosecuting attorney in a room in which he was cut off from the outside world. In none of these cases was the defendant given a full and effective warning of his rights at the outset of the interrogation process. In all the cases, the questioning elicited oral admissions and, in three of them, signed statements that were admitted at trial. Miranda v. Arizona: Miranda was arrested at his home and taken in custody to a police station where he was identified by the complaining witness. He was then interrogated by two police officers for two hours, which resulted in a signed, written confession. At trial, the oral and written confessions were presented to the jury. Miranda was found guilty of kidnapping and rape and was sentenced to 20-30 years imprisonment on each count. On appeal, the Supreme Court of Arizona held that Miranda’s constitutional rights were not violated in obtaining the confession. Vignera v. New York: Vignera was picked up by New York police in connection with the robbery of a dress shop that had occurred three days prior. He was first taken to the 17th Detective Squad headquarters. He was then taken to the 66th Detective Squad, where he orally admitted the robbery and was placed under formal arrest. He was then taken to the 70th Precinct for detention, where he was questioned by an assistant district attorney in the presence of a hearing reporter who transcribed the questions and answers. At trial, the oral confession and the transcript were presented to the jury. Vignera was found guilty of first degree robbery and sentenced to 30-60 years imprisonment. The conviction was affirmed without opinion by the Appellate Division and the Court of Appeals. Westover v. United States: Westover was arrested by local police in Kansas City as a suspect in two Kansas City robberies and taken to a local police station. A report was also received from the FBI that Westover was wanted on a felony charge in California. Westover was interrogated the night of the arrest and the next morning by local police. Then, FBI agents continued the interrogation at the station. After two-and-a-half hours of interrogation by the FBI, Westover signed separate confessions, which had been prepared by one of the agents during the interrogation, to each of the two robberies in California. These statements were introduced at trial. Westover was convicted of the California robberies and sentenced to 15 years’ imprisonment on each count. The conviction was affirmed by the Court of Appeals for the Ninth Circuit. California v. Stewart: In the course of investigating a series of purse-snatch robberies in which one of the victims died of injuries inflicted by her assailant, Stewart was identified as the endorser of checks stolen in one of the robberies. Steward was arrested at his home. Police also arrested Stewart’s wife and three other people who were visiting him. Stewart was placed in a cell, and, over the next five days, was interrogated on nine different occasions. During the ninth interrogation session, Stewart stated that he had robbed the deceased, but had not meant to hurt her. At that time, police released the four other people arrested with Stewart because there was no evidence to connect any of them with the crime. At trial, Stewart’s statements were introduced. Stewart was convicted of robbery and first-degree murder and sentenced to death. The Supreme Court of California reversed, holding that Stewart should have been advised of his right to remain silent and his right to counsel. Issues Whether “statements obtained from an individual who is subjected to custodial police interrogation” are admissible against him in a criminal trial and whether “procedures which assure that the individual is accorded his privilege under the Fifth Amendment to the Constitution not to be compelled to incriminate himself” are necessary. Supreme Court holding The Court held that “there can be no doubt that the Fifth Amendment privilege is available outside of criminal court proceedings and serves to protect persons in all settings in which their freedom of action is curtailed in any significant way from being compelled to incriminate themselves.” As such, “the prosecution may not use statements, whether exculpatory or inculpatory, stemming from custodial interrogation of the defendant unless it demonstrates the use of procedural safeguards effective to secure the privilege against self-incrimination. By custodial interrogation, we mean questioning initiated by law enforcement officers after a person has been taken into custody or otherwise deprived of his freedom of action in any significant way.” The Court further held that “without proper safeguards the process of in-custody interrogation of persons suspected or accused of crime contains inherently compelling pressures which work to undermine the individual’s will to resist and to compel him to speak where he would otherwise do so freely.” Therefore, a defendant “must be warned prior to any questioning that he has the right to remain silent, that anything he says can be used against him in a court of law, that he has the right to the presence of an attorney, and that if he cannot afford an attorney one will be appointed for him prior to any questioning if he so desires.” The Supreme Court reversed the judgment of the Supreme Court of Arizona in Miranda, reversed the judgment of the New York Court of Appeals in Vignera, reversed the judgment of the Court of Appeals for the Ninth Circuit in Westover, and affirmed the judgment of the Supreme Court of California in Stewart. Argued: Feb. 28, March 1 and 2, 1966 Decided: June 13, 1966 Vote: 5-4 Majority opinion written by Chief Justice Warren and joined by Justices Black, Douglas, Brennan, and Fortas. Dissenting opinion written by Justice Harlan and joined by Justices Stewart and White. Dissenting in part opinion written by Justice Clark. https://www.uscourts.gov/educational-resources/educational-activities/facts-and-case-summary-miranda-v-arizona",Legal,Find & Summarize,Text Transformation You must only respond to the prompt solely using the information provided in the context block and no other sources. Your role is to explain complicated medical information using clear and understandable language.,Explain the methods used for the treatment of asthma as outlined in the context document.,"4.5. Treatment of asthma is aimed at prevention of troublesome symptoms, enabling levels of activity and lifestyle that are as normal as possible, maintaining the best possible level of lung function and preventing recurring attacks, in particular those that are severe or life threatening. 4.6. Treatment strategy is complex and includes procedures for avoidance of allergens or environmental provocation of attacks, and drug treatment with a variety of therapeutic agents. 4.7. Drug treatment. This involves the use of several types of drugs by varying methods of delivery. Evolving research has regularly produced new preparations over recent years. 4.7.1. The mainstay of treatment that is responsible for more than 90% of prescriptions for asthma is the use of inhaled β2-adrenoreceptor agonists, which mimic the bronchodilator action of adrenaline, and inhaled corticosteroids, which reduce the inflammatory response in the bronchial mucosa. These are used either separately or in combined preparations. The inhaled β2-agonists generally are used intermittently as “relievers” to abort an acute attack whereas inhaled corticosteroids are used regularly in the longer term for prevention. Inhalation therapy is given by a variety of methods using aerosol, dry powder or nebulisation. The use of “spacer” devices can facilitate delivery of aerosol preparations. Longer acting β2-agonists such as salmeterol and formaterol are now available to enhance control but these drugs should be used separately. 4.7.2. Oral β2-agonists may be used in more difficult cases and oral corticosteroids may be used to resolve a more severe attack. Long-term use of oral corticosteroids is avoided in most cases because of the potentially serious systemic side effects. 4.7.3. Other bronchodilator drugs such as the methylxanthines (e.g. theophylline and its derivatives) may be used. Several other substances such as sodium cromoglycate, nedocromil sodium, ipratropium, and more recently leukotriene receptor antagonists have been added to the armamentarium for managing difficult asthma. 4.7.4. The British Thoracic Society has produced a set of guidelines for the management of asthma which describe five steps of drug treatment depending on severity and individual response to treatment. Severity is based on a generally accepted scale which is broadly similar to that quoted at section 2.8.17 The five steps are: • Step 1 - mild intermittent asthma. Short acting β2-agonist inhalers needed less than once a day • Step 2 - mild persistent asthma. Regular anti-inflammatory treatment such as inhaled corticosteroids, sodium cromoglycate or nedocromil • Step 3 - moderate persistent asthma that has failed to be controlled at step 2. The addition of long-acting β2-agonist combined with inhaled low dose corticosteroid • Step 4 - severe persistent asthma. The combination of treatment at step 3 with high dose inhaled steroid and the addition of theophylline or leukotriene receptor antagonist • Step 5 - severe persistent asthma not controlled at step 4. The addition of oral corticosteroids 4.8. Most patients treated in the community are at step 1-2 while those needing steps 3-5 represent less than 5% of patients. Approximately 1.2 million people in the UK suffer regular restriction of activity.5 The step of treatment needed for control in an individual can be a useful guide to the severity of asthma, although some who are well controlled at a higher step may be less disabled than others who need a lower step but who comply poorly with treatment. 4.9. Airways remodelling. Chronic long-term asthma, particularly where treatment has been inadequate or compliance poor can result in permanent change in the structure of the air passages, which may lead to permanent loss of lung function with loss of the normal feature of reversibility. Airways remodelling may also contribute to the bronchial hyperresponsiveness seen in more severe asthma despite treatment with corticosteroids. 4.10. Management of asthma must involve active support of the patient with advice and information as well as surveillance of the clinical state and adjustment of treatment. An understanding of the aims of the treatment regime is essential to maintain compliance, particularly at times when symptomatically improved. ","system instruction: You must only respond to the prompt solely using the information provided in the context block and no other sources. Your role is to explain complicated medical information using clear and understandable language. question: Explain the methods used for the treatment of asthma as outlined in the context document. Context block: 4.5. Treatment of asthma is aimed at prevention of troublesome symptoms, enabling levels of activity and lifestyle that are as normal as possible, maintaining the best possible level of lung function and preventing recurring attacks, in particular those that are severe or life threatening. 4.6. Treatment strategy is complex and includes procedures for avoidance of allergens or environmental provocation of attacks, and drug treatment with a variety of therapeutic agents. 4.7. Drug treatment. This involves the use of several types of drugs by varying methods of delivery. Evolving research has regularly produced new preparations over recent years. 4.7.1. The mainstay of treatment that is responsible for more than 90% of prescriptions for asthma is the use of inhaled β2-adrenoreceptor agonists, which mimic the bronchodilator action of adrenaline, and inhaled corticosteroids, which reduce the inflammatory response in the bronchial mucosa. These are used either separately or in combined preparations. The inhaled β2-agonists generally are used intermittently as “relievers” to abort an acute attack whereas inhaled corticosteroids are used regularly in the longer term for prevention. Inhalation therapy is given by a variety of methods using aerosol, dry powder or nebulisation. The use of “spacer” devices can facilitate delivery of aerosol preparations. Longer acting β2-agonists such as salmeterol and formaterol are now available to enhance control but these drugs should be used separately. 4.7.2. Oral β2-agonists may be used in more difficult cases and oral corticosteroids may be used to resolve a more severe attack. Long-term use of oral corticosteroids is avoided in most cases because of the potentially serious systemic side effects. 4.7.3. Other bronchodilator drugs such as the methylxanthines (e.g. theophylline and its derivatives) may be used. Several other substances such as sodium cromoglycate, nedocromil sodium, ipratropium, and more recently leukotriene receptor antagonists have been added to the armamentarium for managing difficult asthma. 4.7.4. The British Thoracic Society has produced a set of guidelines for the management of asthma which describe five steps of drug treatment depending on severity and individual response to treatment. Severity is based on a generally accepted scale which is broadly similar to that quoted at section 2.8.17 The five steps are: • Step 1 - mild intermittent asthma. Short acting β2-agonist inhalers needed less than once a day • Step 2 - mild persistent asthma. Regular anti-inflammatory treatment such as inhaled corticosteroids, sodium cromoglycate or nedocromil • Step 3 - moderate persistent asthma that has failed to be controlled at step 2. The addition of long-acting β2-agonist combined with inhaled low dose corticosteroid • Step 4 - severe persistent asthma. The combination of treatment at step 3 with high dose inhaled steroid and the addition of theophylline or leukotriene receptor antagonist • Step 5 - severe persistent asthma not controlled at step 4. The addition of oral corticosteroids 4.8. Most patients treated in the community are at step 1-2 while those needing steps 3-5 represent less than 5% of patients. Approximately 1.2 million people in the UK suffer regular restriction of activity.5 The step of treatment needed for control in an individual can be a useful guide to the severity of asthma, although some who are well controlled at a higher step may be less disabled than others who need a lower step but who comply poorly with treatment. 4.9. Airways remodelling. Chronic long-term asthma, particularly where treatment has been inadequate or compliance poor can result in permanent change in the structure of the air passages, which may lead to permanent loss of lung function with loss of the normal feature of reversibility. Airways remodelling may also contribute to the bronchial hyperresponsiveness seen in more severe asthma despite treatment with corticosteroids. 4.10. Management of asthma must involve active support of the patient with advice and information as well as surveillance of the clinical state and adjustment of treatment. An understanding of the aims of the treatment regime is essential to maintain compliance, particularly at times when symptomatically improved.",Financial,Fact Finding,Q&A "When asked a question, you should only use the information within the provided context to form your answer. If you can't answer a question using the given context, reply with ""I don't have that information, did you have any other questions?"". Limit your answers to 200 words or less.","I know that violent video games can potentially have negative effects on children, but are there any positive psychological effects associated with video games?","Parents often ask about the effects of violent video games on their children and teenagers. In most cases, they note that their “common sense” instinct is that too much exposure to violent video games must have some sort of negative effect on their children, but that they have read in the media that “the jury is still out” on violent media effects or that there is no convincing evidence that violent video game playing is harmful. Confusion around this conflict will often prompt them then to ask: “what does the scientific evidence really say?” In this chapter we show that the common sense view is backed up by a substantial body of recent scientific findings. Helpful and pro-social video game content has great potential for enhancing the lives of children and adolescents, but exposure to anti-social and violent video game content increases the likelihood of a range of negative outcomes, with greater exposure increasing the risk. Video games have been around for nearly 50 years. Kirsch (2010) notes the first as being Spacewar (released in 1962), a game in which two spaceships battle to the death in space. Although the graphics were very simple compared to modern games, the theme of battling to the death is one that has endured through the ensuing five decades. According to the most recent comprehensive poll by the Kaiser Foundation, American children aged 8–18 play an average of eight hours of video games per week, an increase of over 400 per cent from 1999 (Rideout, Foehr & Roberts, 2010). Playing is heaviest in the 11–14 age group, with boys outplaying girls more than 2.5 hours to 1. A recent study suggests that around 99 per cent of American boys play video games, along with 94 per cent of girls (Lenhart et al, 2008). It is common for US children and adolescents to play more than 20 hours per week 56Chapter in W. Warburton & D. Braunstein (Eds.) Growing Up Fast and Furious: Reviewing the Impacts of Violent and Sexualised Media on Children, (pp. 56-84). Annandale, NSW, Australia: The Federation Press. and it is not uncommon for males to play 40 hours or more per week (Bailey, West & Anderson, 2010). On average, Australian 7–18-year-olds played somewhat less than their US counterparts in 2007 (4.7 hours per week: see ACMA, 2007), but this figure could have risen substantially in recent years if Australian children have followed the steep upward trend found in the latest US studies. The types of games vary, but content analyses by Dill and colleagues (2005) show that the majority of top selling video games and children’s favourite games contain violence, and often strong violence. More recently, Call of Duty: Modern Warfare 2 grossed ~$USD 550 million in the first five days of its 2009 release, at that time more than any other entertainment product in history (movies included). Next on the list in 2009 was Grant Theft Auto IV (GTA), with ~$USD 500 million in five days. Even more recently (a year is a long time in the video game world) Call of Duty: Black Ops grossed $USD 360 million in a single day, breaking all records (Ortutay, 2010). According to Wikipedia, the massive multiplayer online game (MMOG) World of Warcraft has more than 12 million online subscribers and thus currently grosses more than $USD 180 million per month (at $15 per month per player). GTA, which is rated M17+ in the United States and involves such activities as going on murderous rampages, having sex with prostitutes and then murdering them to retrieve the money paid, has been played by 56 per cent of United States children aged 8–18 (Rideout et al, 2010). Clearly, a large number of children and adolescents are exposed regularly to video games with high levels of violence and anti-social themes. This makes it important for parents, educators and professionals who work with children to have some knowledge of their effects. Before turning to the negative effects of violent video games however, it is important to stress that video games can have many helpful benefits. Here are just a few. Helpful effects of video games Pain management Kirsch (2010) notes that various media, including video games, can be used to distract and relax children during painful medical procedures. 57 The impACT of violenT video gAmes: An overview Coordination and spatial cognition A number of studies reveal that video games which require the place- ment of objects within a screen (such as Tetris) can enhance the spatial cognition abilities of players (that is, the ability to mentally arrange and rotate objects in three dimensions). Indeed, video game playing has been linked with a wide array of visual and spatial skills, primarily through practice effects (see Green & Bavelier, 2006; Okagaki & Frensch, 1994; see also Bailey et al, 2010, for a review). In one study by Gopher, Weil and Bareket (1994), the flight performance of Israeli Air Force cadets who had been trained on the Space Fortress II video game was compared with the performance of an untrained group. The trained cadets performed better in almost all aspects of flight performance and as a result the game was incorporated into the Israeli Air Force training program. Pro-social behaviour Although this area of study is still in its infancy, there is mounting evidence that video games which model and involve participants in pro- social, helping behaviours can lead to increases in pro-social behaviour in the short and long term. Most notably, Gentile et al (2009) found that elementary school students exposed to pro-social video games were more helpful than those exposed to violent or non-social video games. In a second longitudinal study of Japanese children in grades 5, 8 and 11, exposure to pro-social video games at the start of the study was linked with increased pro-social behaviour some months later, even when the baseline pro-social tendencies of children were statistically removed. In a final study of Singaporean secondary school students, the amount of pro-social video game play experienced was correlated with helping behaviour, cooperation, sharing and empathy. A study by Greitemeyer and Osswald (2009) found that pro-social video game playing led to a short-term reduction in the tendency to see the world as hostile and an immediate reduction in anti-social thoughts. Education A considerable literature reveals video games to be a powerful teaching tool (eg, Barlett et al, 2009; Murphy et al, 2002; Swing & Anderson, 58 growing up fAsT And furious 2008). They have been used to teach algebra (Corbett et al, 2001), biol- ogy (Ybarrondo, 1984), photography (Abrams, 1986), and computer programming (Kahn, 1999), to teach children how to manage diabetes (Lieberman, 2001; 2006) and to teach specific skills using simulators (for example, by Qantas pilots, NASA and the Air Force). Gentile and Gentile (2008) describe the educational advantages of using video games as teaching tools. These include the power of video games to engage children and to “encourage children to persevere in acquiring and mastering a number of skills, to navigate through complex problems and changing environments, and to experiment with different identities until success is achieved” (p 127). Exercise There has been a recent explosion in the popularity of video games that promote physical activity and exercise (that is, “Exergames”). Games such as Wii Sports Heart Rate; Wii Fit; Wii Play; Wii FitPlus; Dance, Dance Revolution and Just Dance seem to be part of a recent trend that has seen an increase in the availability and popularity of non-violent, helpful games. Clearly, video games have considerable potential to enhance the lives of children and adolescents. Unfortunately, excessive video game playing, especially of violent video games, has the potential to impact children in a number of negative ways. Harmful effects of video games Video game addiction In his moving biography, Unplugged: My Journey into the Dark World of Video Game Addiction, Ryan Van Cleave describes the way that a violent online game, World of Warcraft, dominated his life to such an extent that he was unable to function normally and was driven to the verge of suicide. Video game addiction is now taken so seriously by psychologists and psychiatrists that it was recently considered for inclusion in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM) as a diagnosable psychiatric disorder and has been lodged in its appendix to encourage further research. It is clear that many children 59 The impACT of violenT video gAmes: An overview play video games at a “pathological” level that causes damage to family, social, school or psychological functioning (see Anderson et al, 2012). For example, it has been found that 8.5 per cent of 8–18-year-old US video game players do so at pathological levels (Gentile, 2009). Similar studies have found figures of 11.9 per cent in Europe (Grusser et al, 2007), 8.7 per cent in Singapore (Choo et al, 2010), 10.3 per cent in China (Peng & Li, 2009) and 4 per cent for 12–18-year-olds in Norway (Johansson & Götestam, 2004), with a further 15.5 per cent “at risk”. As will be seen in the ensuing sections, the amount that children play video games is very important. Those who play excessively are not only at risk of a number of negative outcomes, they are also much more likely to be playing violent games (see Krahé & Möller, 2004). Attention deficits There are some studies linking the amount of time children spend play- ing video games to attention deficits, impulsivity and hyperactivity (see Bailey et al, 2010; Swing et al, 2010). For example, Gentile (2009) found that adolescents who used video games at pathological levels were nearly three times more likely to be diagnosed with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder than adolescents who played at non-pathological levels. In a landmark paper, Swing and colleagues (2010) examined the effect of video game playing on atten- tion in elementary school children. They used a longitudinal study that statistically controlled for a range of other factors that could also lead to attention problems and found that amount of time spent playing video games predicted increases in teacher assessments of attention deficits in the children 13 months later. These results suggest that the children’s level of video game playing played a causal role in their subsequent loss of attentional capacity. Anderson et al (2012) believe that on theoretical grounds some video games should have less effect on attentional problems (for exam- ple, those that require controlled thought and planning) and that those which require constant reactive behaviours from players (a common feature of many violent first person shooting games for example) may be more problematic in terms of children developing attentional difficulties. 60 growing up fAsT And furious School performance It is well established that spending longer hours playing video games is linked with poorer school performance for both children and adoles- cents (Anderson et al, 2007; Chan & Rabinowitz, 2006; Chiu et al, 2004; Cordes & Miller, 2000; Gentile, 2009; Gentile et al, 2004; Sharif & Sargent, 2006). One explanation for this is a simple displacement of time – hours spent playing video games eats into time that would normally be spent studying and reading. For example, in a study of 1491 youth between 10 and 19, gamers spent 30 per cent less time reading and 34 per cent less time doing homework (Cummings & Vandewater, 2007). It is also possible, however, that children who perform more poorly at school are also more likely to “spend more time playing games, where they may feel a sense of mastery that eludes them at school” (Anderson et al, 2012). Of course, another possibility is the that excessive gaming creates attention deficits, which in turn can lead to poorer school performance. Increased aggression Should we be concerned about children and adolescents playing violent video games? Can this lead to aggressive behaviour? Over 98 per cent of paediatricians in the United States have considered these questions and believe that excessive violent media exposure has a negative effect on childhood aggression (Gentile et al, 2004). Similarly, there is a consen- sus amongst the vast majority of violent video game researchers that too much exposure to violent video games increases the likelihood of aggressive thoughts, feelings and behaviours, leads to desensitisation to violence and also leads to decreases in pro-social behaviours and empathy (Anderson et al, 2010; Huesmann, 2010). There are, however, a small number of researchers who dispute this evidence and it seems that the views of this small minority have had a large impact on public perceptions (Anderson & Gentile, 2008; Dill, 2009). In this section of the chapter we will broadly examine the arguments for this view and then review the scientific evidence that does find violent video game effects. In this way, we hope that readers can judge the evidence for themselves. 1. The first argument against violent video game effects is that there is little evidence linking the playing of violent video games to very violent behaviours (such as school shootings). To better understand 61 The impACT of violenT video gAmes: An overview this argument it is helpful to reflect on the difference between aggres- sion and violence. In essence, violence is aggressive behaviour that has extreme harm as its goal (Anderson & Bushman, 2002). Thus, all violence is aggression but not all aggression is violence. With this in mind we make four points. (a) Ethically it is not possible to use the most powerful methods – experi- mental manipulations – to test the causal link between violent video games and violence because we cannot rightfully incite people to cause extreme harm in a laboratory. There are, however, ways to test links with aggressive behaviour, which can be examined ethi- cally in a laboratory. It is disingenuous to suggest that because there are no experimental studies that randomly assign children to years of playing violent or nonviolent video games and then measure which group commits the most violent crimes, that therefore there are no established negative or anti-social effects. This is like saying that because there are no experimental studies on humans showing that cigarette smoking causes lung cancer, smoking is not a causal risk factor. The causal links between violent video game playing and physical aggression are, in our opinion, well established. (b) Cross-sectional (correlational) studies and longitudinal studies of violent video game effects have established significant links to violent behaviour. Several longitudinal studies in particular provide strong evidence that these are causal effects. (c) Aggressive behaviour, which can include bullying, hurting other people physically, hurting other people’s property or relationships and hurting people verbally, is a very important social phenomenon in its own right. Aggression does not have to escalate into violence to be harmful and destructive. (d) No aggression researchers claim that media violence is the sole or even the most important source of violent behaviour. The most common approach, and the one taken by the authors, is the “risk factor” approach. According to this approach, people can have vari- ous risk factors for aggression or violent behaviour (see Figure 1). These might include coming from a violent home, having a violent peer group, high levels of trait aggression, exposure to violent media and a number of other factors. The more risk factors that are present for a person, especially when they are present from a young age, the more likely that person is to be aggressive or violent. Strasburger (2009, p 203) notes that: The research on media violence and its relationship to real-life aggression is clear: young people learn their attitudes about violence at a very young age, and once learned, those attitudes are difficult to change (Anderson et al, 2003; Bushman & Huesmann, 2006). Conservative estimates are that media violence may be causing 10% of real-life violence – not the leading cause by any means, but an unhealthy chunk that we could do something about if we chose to (Strasburger et al, 2009; Comstock & Strasburger, 1990). We believe that Victor Strasburger is right. Many risk factors for aggression and violence are very hard to deal with as parents, as educators, as professionals and as policy-makers. Media violence, though, is one risk factor that can be controlled and about which action can be taken from the level of the individual home through to the level of State and federal governments. This makes the research on media violence effects particularly important. 2. Detractors of the view that playing violent video games increases the likelihood of aggressive behaviour also criticise the methodology of video game studies and of meta-analyses of these studies. It is to this important scientific evidence that we now turn. Figure 1: Some longitudinal factors for youth violence Adapted from US Department of Health and Human Services (2001), Bushman and Huesmann (2006) and Anderson et al (2010). 63 The impACT of violenT video gAmes: An overview What is a meta-analysis and what evidence do the meta-analyses provide? A meta-analysis is a statistical technique whereby scientific studies that test the same or a similar hypothesis (for example, that violent video game exposure compared to neutral video game exposure will result in increased aggression) and the same or a similar outcome (for example, aggressive behaviour) are combined to ascertain the strength (“effect size”) of the average finding. To date there have been a number of meta- analyses of the effect of violent video games on aggressive thoughts, feelings and behaviours. In particular, studies by Distinguished Professor Craig Anderson and Dr Chris Ferguson have received a lot of publicity in recent years and it is valuable to compare them. Dr Ferguson, a vocal critic of the research demonstrating a link between violent video game playing and aggression, along with video game industry representatives, claims that violent video game research is methodologically flawed and that mainstream media violence researchers selectively report biased findings. Dr Ferguson has also suggested that Professor Anderson’s meta-analyses have a “publication bias” that undermines their results. Dr Ferguson cites his own three meta-analyses that examine the question of whether violent video game playing increases subsequent aggression. These examined 24, 17 and 14 published papers, encompassing 25, 21 and 15 separate tests of the same hypothesis respectively (Ferguson 2007a, 2007b; Ferguson & Kilburn, 2009). In total, 4205 and 3602 participants were tested in the first two meta-analyses (the number cannot be determined for the most recent study but is assumed to be lower). Dr Ferguson found a positive relation- ship between violent video game exposure and aggressive behaviour, with effect sizes of .29, .14 and .15 respectively. He then inappropriately (according to some meta-analysis experts, see Bushman, Rothstein, & Anderson, 2010) “corrected” for publication bias using a controversial statistical procedure called “trim and fill” that reduced these effect sizes. Such a procedure guesses what unpublished studies might be out there and adds these guesses to the averaging procedure. Based on the “corrected” figures, Dr Ferguson concluded there was no effect of violent video games on aggressive behaviour. These three meta-analyses, which use highly overlapping subsets of the same small sample of studies, are 64 growing up fAsT And furious widely cited as the strongest evidence that violent video game playing does not increase the likelihood of aggressive behaviour. Evidence that playing violent video games does increase the likeli- hood of aggression comes from many researchers. Professor Anderson and his colleagues have themselves conducted a large number of such studies and have also summarised the available studies in three compre- hensive meta-analyses, the first in 2001 (Anderson & Bushman, 2001), the second in 2004 (Anderson et al, 2004) and the most recent in 2010 (Anderson et al, 2010). The latter paper was co-authored by Professor Hannah Rothstein, an expert in meta-analyses and publication bias. This paper detailed major shortcomings in the Ferguson meta-analyses (which failed to include numerous relevant studies) and included all relevant studies then known. Data from 136 articles, 381 separate tests of hypotheses, and across a massive sample of 130, 296 participants were analysed. In this large, all-inclusive meta-analysis, research methodology was also examined. Among the many findings was that studies with better research methods tended to find stronger effects of violent video game playing on aggressive behaviour. We present a summary of the findings in Figure 2 (over page). We understand that the concept of effect size is a hard one to grasp without a detailed knowledge of statistical procedures, so we will provide some comparison data afterwards to help readers make sense of the results. The middle bar shows the effect found, the bars on either side reflect how variable the findings were in the studies tested. Figure 2 shows several meta-analyses. Each tests a different hypoth- esis. All hypotheses are tested as outcomes of exposure to violent video games, and these outcomes include aggressive behaviour, aggressive thoughts (cognitions), aggressive feelings (affects), physiological arousal, desensitisation to violence/low empathy and pro-social behaviour. As can be seen, the average effect across these many studies was one whereby exposure to violent video games led to an increase in aggressive behaviours, aggressive thoughts, aggressive feelings and physiological arousal (which is linked to aggressive behaviour), to desensitisation to violence and decreased empathy, and to a reduction in pro-social behaviours. It is important to note that these findings come from a range of study types – experimental studies in which all participants have exactly the same experience other than the media type they experi- ence, correlational studies of the links between levels of violent video game playing and various types of aggressive behaviours in real life, and longitudinal studies that follow video game playing patterns and behavioural patterns in the same people over time. Each study type makes a unique contribution to what we know. Experiments can be used to infer that one thing causes another, but it is harder to generalise these findings to “real life”. Correlational studies involve “real life” behaviours and can test alternative hypotheses, but it is difficult to determine the causal direction of relationships found (that is, whether playing violent games causes aggression or whether aggressive people choose violent games). Longitudinal studies are real world studies and can be used to find whether one thing causes another over time in a person’s life. Some media violence studies have followed the same people for over 40 years (eg, Huesmann et al, 2003) and have very detailed data. Because links between violent video game playing and aggression are found consistently across all three study types, the evidence converges to suggest both a causal link and an effect that is found in the real world. The Anderson et al (2010) meta-analysis also found that when proper statistical methods are used, there was no evidence of systematic publication bias in the studies. The rather weak evidence of publication bias produced by Dr Ferguson was likely the result of several factors, including failure to use all of the relevant studies and the combining of cross-sectional and experimental studies in the publication bias analysis. To understand how strong the obtained violent video game effect on aggression is, it can be helpful to get a sense of what the “effect size” numbers actually mean. It is easy to understand that a higher number means a stronger effect, but it is much harder to know how a big a number needs to be before it is considered important. Figure 3 shows some effect sizes for well known phenomena that can be used as points for comparison. As can be seen from Figure 3, violent video game effects are larger than the effect of eating calcium on bone mass, of asbestos inhalation Figure 3: The comparative effect sizes of violent video game effects and other well known phenomena * From Best Practices studies, Anderson et al, Psychological Bulletin, 2010. 67 The impACT of violenT video gAmes: An overview on related cancers, of condom use on reducing HIV infection numbers, of taking aspirin on reducing heart attacks and a range of other very important phenomena. Clearly, the size of violent video game effects is large enough to be considered socially important. A final finding from the Anderson et al (2010) meta-analyses is that the violent video game effects occurred for both males and females, and across low-violence collectivistic Eastern countries (for example, Japan) and high-violence individualistic Western countries (for example, Australia and the United States). This is not a surprising finding, as other reviews have found that violent video games affect people regardless of age, gender, socio-economic status, game genre and game system (Barlett et al, 2009). In fact, to the knowledge of the authors, no group has yet been identified that are immune to the effects of exposure to violent media such as video games (see Anderson et al, 2003). Perhaps the best brief summary of the evidence presented here is articulated in a statement produced by 13 researchers into violent video game effects (including the authors of this chapter), prepared for an amicus curiae (friend of the court) brief for the Schwarzenegger and Brown v Video Software Dealers Association and Entertainment Software Association case in the Supreme Court of the United States (Docket # 08-1448). This statement was supported as being accurate by a further 102 well-respected researchers in this area. Statement on Video Game Violence Both the American Psychological Association (APA, 2005) and the American Academy of Pediatrics (AAP, 2009) have issued formal statements stating that scientific research on violent video games clearly shows that such games are causally related to later aggressive behavior in children and adolescents. Extensive research has been conducted over many years using all three major types of research designs (experimental, cross-sectional, and longitudinal). Numerous original empirical research studies have been conducted on children and adolescents. Overall, the research data conclude that exposure to violent video games causes an increase in the likelihood of aggres- sive behavior. The effects are both immediate and long term. Violent video games have measurable and statistically significant effects on both males and females. Theoretically important effects of violent video games have been confirmed by many empirical studies. The effects have been replicated by researchers in different settings and in numerous countries. The psychological processes underlying 68 growing up fAsT And furious such effects are well understood and include: imitation, observa- tional learning, priming of cognitive, emotional and behavioral scripts, physiological arousal, and emotional desensitization. These are general processes that underlie all types of social behavior, not just aggression and violence; they have been confirmed by count- less studies outside of the media violence domain. In addition to causing an increase in the likelihood of aggressive behavior, violent video games have also been found to increase aggressive thinking, aggressive feelings, physiological desensitization to violence, and to decrease pro-social behavior. Importantly, this statement alludes to the psychological processes that are known to underlie the effect of exposure to violent video games on children. These are worth examining in more detail because they also provide some insight as to why the effects of violent video games, compared to other violent media, may be stronger. The psychology of violent video game effects on children Most of the explanations related to violent video game effects involve different types of learning. Because of certain features of violent video game playing – interactivity, repetition and the actual playing of the role of aggressor – the effects may be stronger and patterns of behaviour better learned. Imitation Humans seem to be hard-wired from birth to imitate others. Recently discovered “mirror neurons” in humans and primates represent one mechanism in the brain that may facilitate this (Caggiano et al, 2009; Gallese et al, 1996; Rizzolati et al, 1996; Umilta et al, 2001). Imitation has benefits, including the fast learning of important behaviours, and plays a role in human bonding. However, imitation of unhelpful and anti-social behaviours can have clear negative effects for the individual and for society. We know that children will imitate aggressive behaviours, even if the behaviours are totally new to the child and are not seen to be rewarded in any way (Bandura, 1965; 1973; Bandura et al, 1961; 1963a, 1963b). We also know that children imitate characters from the media they see, with some characters more likely to be imitated than others – those that are attractive, heroic, rewarded for their behaviour or liked, or that have high social status. In violent video games the central characters 69 The impACT of violenT video gAmes: An overview often meet several of these criteria. Does this mean, though, that people will copy the behaviours of the characters in very violent games such as GTA and others? It is possible. For example, an 18-year-old youth in Thailand stabbed a taxi driver to death trying to “find out if it was as easy in real life to rob a taxi as it was in the game” (Reed, 2008). As a result, GTA IV was banned in Thailand. In 2003 William Buckner, 16, and his step-brother Joshua, 14, killed a man and seriously wounded a woman shooting at cars in Tennessee (Calvert, 2003). The boys claimed they were acting out the game Grand Theft Auto III. Also in 2003, Devin Moore, an 18-year-old from Alabama, killed three police officers follow- ing his arrest for a carjacking. On being re-arrested he is reported to have told police that “Life is like a video game. Everybody’s got to die sometime” (Leung, 2005). Again, the killer told police he was copy- ing behaviour he had learned playing GTA III. We are not suggesting that violent video game playing alone was causal in these crimes. As noted earlier, numerous risk factors influence the likelihood of aggressive and violent b ehaviour, and the most severe forms of violence virtually always require the convergence of many risk factors. Furthermore, it is difficult (perhaps impossible) to identify which risk factors were crucial to any particular aggressive or violent act. Nonetheless, imitation of media violence seems to have played some role in these cases. There are numerous other stories of aggressive behaviours that seemingly imitate violent video games. These are easily accessed on the internet with a simple search. Clearly, for some violent video game players, simple imitation may play a causal role in some acts of aggression. However there are a number of other factors, also linked with imitation and learned aggression, that may also be important. Identification Although media effects can occur without the person identifying with any of the characters they have seen, identifying with an aggressor has been shown to increase the likelihood of adopting aggressive behav- iours and attitudes (Cantor, 1994; Huesmann & Eron, 1986; Huesmann et al, 2003). People are more likely to identify with a character who is perceived as similar, heroic and attractive (Hearold, 1986; Heath et al, 1989), and are more likely to identify with and believe realistic portray- als because they are easier to relate to personal experiences (Berkowitz 70 growing up fAsT And furious & Alioto, 1973; Feshback, 1972; Geen, 1975). In violent video games, the player strongly identifies with (and usually takes the role of) the aggres- sor. The aggressive central character is usually glorified and portrayed as heroic and, in recent years, the portrayal of aggressive characters in video games has become increasingly realistic (Gentile et al, 2007). For these reasons, identification with violent/aggressive characters may be a key way that video games impact on children. Repetition It is well established that repetition of behaviours establishes them in memory, increases skill and automates them as learned responses (eg, Gentile & Gentile, 2008). Further, repeating an entire behavioural sequence commits it to memory better than repeating only part of a sequence (Gentile et al, 2007). Violent video games are much more repetitive than other forms of violent media and more often involve the repetition of complete behavioural sequences (Gentile et al, 2007). Players repeat the same behaviours and receive similar rewards throughout the game, experience similar thoughts and feelings during those actions and are exposed to the attitudes espoused in the game implicitly and explicitly (for example, sleeping with prostitutes and then murdering them to retrieve one’s money in GTA implies misogyny, the acceptance of violence to get what one wants and that human life has little value). Simply put, the repetitive nature of violent video games is ideal for learning aggressive attitudes and scripts for behaviour. Interactivity Active participation assists learning as it requires attention, and closely attending to a task assists people to memorise the relevant behaviours and knowledge (Gentile et al, 2007; Gentile & Gentile, 2008). Violent video games are highly interactive, and the recent development of home consoles that allow players to use realistic weapons such as replica guns and swords further increases the level of interactivity and decreases the gap between game playing behaviours and “real world” behaviours. The combination of interactivity and frequent rehearsal is a potent one for learning. In essence, this is a key reason that video games are such powerful tools for teaching pilots, astronauts and soldiers their core skills. These factors give video games tremendous potential for 71 The impACT of violenT video gAmes: An overview pro-social pursuits and as learning tools, but have less welcome implica- tions regarding the interactive rehearsal of anti-social and aggressive behaviours. Lack of negative consequences Another basic tenet of learning theory, demonstrated across thousands of studies, is that people are more likely to behave in ways that are rewarded and less likely to behave in ways that are punished. In terms of imitation, children imitate aggression they perceive as being rewarded more often than aggression they perceive as resulting in punishment. Interestingly, children will imitate unpunished aggression as often as rewarded aggression (eg, see Bandura, 1973). With these facts in mind, it is relevant that most acts of violence in video games: (a) go unpunished; (b) are rewarded (for example, by points, money, status and eleva- tion to higher game levels); (c) have unrealistic consequences for the victim. With relation to the final point, it is important for parents and profession- als to note that seeing victims suffer realistic and negative consequences as a result of media violence should reduce the likelihood of subsequent aggression because pain cues usually inhibit aggressive behaviour (Baron, 1971a, 1971b, 1979). Also note, however, that in some circum- stances pain and suffering cues can increase aggressive behaviour (see Berkowitz, 1993, p 174). Associative learning As noted in Chapter 1, the brain is a neural network in which concepts, ideas, feelings and memories are stored and interconnected. The way this network “wires up” depends on what people experience, with paired experiences (such as the smell of fresh coffee, pleasure and a craving for a hot beverage) becoming more strongly wired together the more they are experienced together. This means that people learn to associate one thing with another. In media generally, and in violent video games especially, many things are frequently paired and thus become “wired” together. For 72 growing up fAsT And furious example, guns are rarely used for any purpose other than violent action. This is why there is a well demonstrated “weapons effect”, whereby the simple sight of a weapon increases the likelihood of aggression if the person has mentally paired a weapon such as a gun with killing or hurting people rather than with a non-aggressive use such as sports shooting (Bartholow et al, 2005; Berkowitz & LePage, 1967; Carlson et al, 1990). This suggests that children who often play video games where there is frequent weapon use for the purpose of killing and hurting others are more likely to be aggressive immediately after playing the game and are more likely to be aggressive when exposed to a weapon of a similar type in real life. Associative learning also explains why whole sequences of behav- iour are learned during video game play and why the acquisition of aggression-related knowledge structures is so important. Acquisition of aggressive knowledge structures, attitudes and scripts for behaviour Clearly, violent video games are powerful teachers, but what is the outcome of such learning for the individual child? In essence, the child (and adult for that matter) internalises clusters of associated knowledge about aggressive behaviour (knowledge structures or “schemas”), as well as attitudes about aggressive behaviour and “scripts” for how to behave in certain circumstances. Schemas and scripts contain knowledge about an aspect of living, mental links to related attitudes, feelings and memories, and a repertoire of associated behaviours. Scripts additionally contain information about how commonly experienced situations “play out” (such as visiting a supermarket) and the typical sequence of behaviours in that situation (entrance at the left of the store, grab a trolley, milk at the back, bread in the second aisle, line up and pay). Schemas and scripts are activated by a trigger (for example, the supermarket logo) and, once active, help to direct our behaviour, often without our being aware of it. Children start to develop schemas about the world as toddlers (and perhaps earlier) and these can sometimes be aggressive in nature. In relation to the development of aggressive knowledge structures and attitudes, there is considerable evidence that exposure to violent media (including violent video games): 73 The impACT of violenT video gAmes: An overview (a) increases attitudes approving of aggressive behaviour as a “normal” social response (Huesmann, 1998); (b) increases mental access to scripts for resolving conflict that involve aggressive behaviour and reduces access to conflict- solving scripts that are non-aggressive (Bushman & Anderson, 2002; Huesmann, 1998); (c) underpins the attitude that aggression is (1) exciting and (2) increases one’s social status (Groebel, 1998); (d) increases the belief that the world is a frightening place (Cantor, 2003; Donnerstein et al, 1994); (e) increases a hostile attributional bias whereby ambiguous but innocent behaviours by others are interpreted as deliberately hurtful (Anderson et al, 2010; Möller & Krahé, 2009); and (f) increases the likelihood of aggressive behaviour (Anderson et al, 2010). Regrettably, children are exposed to a lot of violent media. As noted in Chapter 1, by the age of 18, most US children will have seen many tens of thousands of murders and acts of violence on television alone. Heavy playing of violent video games that involve frequently killing of other people or creatures would add greatly to those figures, especially for murders. This means that for a lot of children, violent media influences may result in higher levels of aggressive schemas, fear about the wider world, hostile and anti-social attitudes, and scripts for behaving aggres- sively, than might otherwise occur without those influences. Fictitious violence versus real violence Recent brain imaging studies, in which children’s brain activation patterns are “photographed” by fMRI machines whilst they are expe- riencing violent media, have shown that even when children know the violence they are watching is fictitious or fantasy violence, their brains respond to the violence as if there was a real threat (Murray et al, 2006; see also Weber et al, 2006). In addition, long-term memory systems were activated, suggesting that this effect could endure beyond the initial exposure. This research suggests that fantasy media violence seems to have a similar impact on children as exposure to realistic media violence. The General Aggression Model The General Aggression Model (GAM: Anderson & Bushman 2002; DeWall, Anderson & Bushman, in press) provides a theoretically sound and helpful way of understanding how exposure to violent media can increase a person’s likelihood of being aggressive in both the short and long term (see Figures 4 and 5). The GAM is a model of what is happening psychologically during an episode of aggression. In essence the person brings their own readiness to aggress, through their gender, beliefs and attitudes about aggres- sion, personality and other stable factors. Each situation has cues and triggers for aggression, such as the presence of a weapon or an insult. When a person encounters an aggression-triggering situation, various relevant cognitions (memories, beliefs, attitudes, scripts for behaviour) are activated, along with feelings (such as fear and anger) and a level of physiological arousal. Higher levels of arousal make a dominant tendency to act more likely. Figure 4: The General Aggression Model 75 The impACT of violenT video gAmes: An overview As a result of these activated cognitions and feelings, and of the level of arousal, the person has an immediate response. If they are very aroused or if the situation requires immediate action, this will probably be the ultimate response. If the person has the time and cognitive capac- ity for a more considered response they will evaluate their options and are more likely to make a thought-through response. Either way, the eventual response, which may be aggressive, is enacted, elicits a social response and the episode is encoded into memory. Once in memory, it becomes part of the “person” and can then affect their responses to future situations. Although “person” characteristics are very important in deter- mining how an individual reacts in a specific situation, the research presented in this chapter reveals that most people, regardless of personal characteristics, are influenced by violent video games. It also reveals that violent video games provide many cues for aggressive behaviour, activate aggressive cognitions and feelings, and can increase levels of arousal. These internal processes can explain why there is also a robust link between violent video game playing and aggressive behaviour. Over the long term, exposure to the attitudes, ideas and scripts for behaviour in violent video games leads to stable knowledge structures, attitudes, biases in thinking, scripts for conflict resolution and action tendencies that include aggressive behaviour (see Figure 5). In turn, these increase the base level of aggressiveness in that person’s personal- ity and bring the person to an aggression-triggering type of situation with a higher predisposition to aggress. Between the two models, it is easy to see how playing a video game can lead to aggression in the short term, and how repeated playing can lead to higher levels of aggression in the long term. Conclusions and advice for parents and professionals working with children In this chapter we have detailed the evidence that video games can be used for a wide array of helpful purposes, but that there can be many negative consequences for playing violent games, especially when played excessively. This raises an important question: “How do we help children to benefit from video games but escape their negative impacts?” In Chapter 1 it was noted that the “you are what you eat” principle applies to the way media exposure affects the way the human neural network “wires up” as well as to food consumption. Using the food metaphor can be helpful for parents and professionals when it comes to advising children on how to use media in a beneficial way. Through 77 The impACT of violenT video gAmes: An overview school education many children are interested in healthy eating and this can be extended to maintaining a healthy media diet. For example, children could be told that, as with food, there are media that are good to consume regularly (in moderation), media that are for infrequent consumption and media that children should avoid. Helping a child to self-regulate what they watch and hear in the media can be very important to a child’s development in this media saturated world. This may involve: • educating children about media effects generally and about video game effects specifically, so that children can learn to make informed choices; • helping children to limit their time playing video games; • encouraging children to play pro-social and educational video games in preference to violent games; • keeping video game consoles in public areas and out of children’s bedrooms; and • playing video games with your children so that you are aware of their content and can knowledgeably discuss the implications of playing certain types of games and screen out potentially harmful ones. It is desirable for children to be able use video games for a range of educational and developmental objectives, but to have less exposure to the more harmful impacts. We hope that this chapter has helped to dispel some popular myths about the impact of violent video games on children and adolescents and has clarified for readers how positive outcomes might be achieved. A Tragic Postscript I see MW2 more as a part of my training-simulation than anything else … You can more or less completely simulate actual operations These were the chilling words with which Anders Behring Breivik referred to the computer game Modern Warfare 2 in a 1500-page mani- festo disseminated just hours before he was responsible for the deaths of 76 of his fellow Norwegians (Moses, 2011; Shah, 2011; Townsend & Tisdall, 2011). The 32-year-old male behind the now infamous bombing 78 growing up fAsT And furious of government buildings in Oslo and subsequent shooting massacre on Utoya island on 22 July 2011 made no secret of the fact that playing the violent video games Modern Warfare 2 and World of Warcraft aided him in preparing and executing his attacks. Breivik identified Modern Warfare 2 as helping him with “target practice” (Shah, 2011) and involvement with World of Warcraft as providing sufficient cover for his preparatory activities (Moses, 2011). As a result of the attacks, one of Norway’s biggest retailers, Coop Norway, issued a ban of indefinite duration on these and other violent video games that, at the time of publication, has yet to be lifted (Narcisse, 2011; Navarro, 2011). When considering the impact of violent video games, particularly in light of the Norway atrocities, it should also be noted that video games in which acts of violence are executed in first-person, immersive environments have long been recognised and used by the US military forces as effec- tive in both the training and recruitment of their members (Holguin, 2009; Robson, 2008).","When asked a question, you should only use the information within the provided context to form your answer. If you can't answer a question using the given context, reply with ""I don't have that information, did you have any other questions?"". Limit your answers to 200 words or less. Parents often ask about the effects of violent video games on their children and teenagers. In most cases, they note that their “common sense” instinct is that too much exposure to violent video games must have some sort of negative effect on their children, but that they have read in the media that “the jury is still out” on violent media effects or that there is no convincing evidence that violent video game playing is harmful. Confusion around this conflict will often prompt them then to ask: “what does the scientific evidence really say?” In this chapter we show that the common sense view is backed up by a substantial body of recent scientific findings. Helpful and pro-social video game content has great potential for enhancing the lives of children and adolescents, but exposure to anti-social and violent video game content increases the likelihood of a range of negative outcomes, with greater exposure increasing the risk. Video games have been around for nearly 50 years. Kirsch (2010) notes the first as being Spacewar (released in 1962), a game in which two spaceships battle to the death in space. Although the graphics were very simple compared to modern games, the theme of battling to the death is one that has endured through the ensuing five decades. According to the most recent comprehensive poll by the Kaiser Foundation, American children aged 8–18 play an average of eight hours of video games per week, an increase of over 400 per cent from 1999 (Rideout, Foehr & Roberts, 2010). Playing is heaviest in the 11–14 age group, with boys outplaying girls more than 2.5 hours to 1. A recent study suggests that around 99 per cent of American boys play video games, along with 94 per cent of girls (Lenhart et al, 2008). It is common for US children and adolescents to play more than 20 hours per week 56Chapter in W. Warburton & D. Braunstein (Eds.) Growing Up Fast and Furious: Reviewing the Impacts of Violent and Sexualised Media on Children, (pp. 56-84). Annandale, NSW, Australia: The Federation Press. and it is not uncommon for males to play 40 hours or more per week (Bailey, West & Anderson, 2010). On average, Australian 7–18-year-olds played somewhat less than their US counterparts in 2007 (4.7 hours per week: see ACMA, 2007), but this figure could have risen substantially in recent years if Australian children have followed the steep upward trend found in the latest US studies. The types of games vary, but content analyses by Dill and colleagues (2005) show that the majority of top selling video games and children’s favourite games contain violence, and often strong violence. More recently, Call of Duty: Modern Warfare 2 grossed ~$USD 550 million in the first five days of its 2009 release, at that time more than any other entertainment product in history (movies included). Next on the list in 2009 was Grant Theft Auto IV (GTA), with ~$USD 500 million in five days. Even more recently (a year is a long time in the video game world) Call of Duty: Black Ops grossed $USD 360 million in a single day, breaking all records (Ortutay, 2010). According to Wikipedia, the massive multiplayer online game (MMOG) World of Warcraft has more than 12 million online subscribers and thus currently grosses more than $USD 180 million per month (at $15 per month per player). GTA, which is rated M17+ in the United States and involves such activities as going on murderous rampages, having sex with prostitutes and then murdering them to retrieve the money paid, has been played by 56 per cent of United States children aged 8–18 (Rideout et al, 2010). Clearly, a large number of children and adolescents are exposed regularly to video games with high levels of violence and anti-social themes. This makes it important for parents, educators and professionals who work with children to have some knowledge of their effects. Before turning to the negative effects of violent video games however, it is important to stress that video games can have many helpful benefits. Here are just a few. Helpful effects of video games Pain management Kirsch (2010) notes that various media, including video games, can be used to distract and relax children during painful medical procedures. 57 The impACT of violenT video gAmes: An overview Coordination and spatial cognition A number of studies reveal that video games which require the place- ment of objects within a screen (such as Tetris) can enhance the spatial cognition abilities of players (that is, the ability to mentally arrange and rotate objects in three dimensions). Indeed, video game playing has been linked with a wide array of visual and spatial skills, primarily through practice effects (see Green & Bavelier, 2006; Okagaki & Frensch, 1994; see also Bailey et al, 2010, for a review). In one study by Gopher, Weil and Bareket (1994), the flight performance of Israeli Air Force cadets who had been trained on the Space Fortress II video game was compared with the performance of an untrained group. The trained cadets performed better in almost all aspects of flight performance and as a result the game was incorporated into the Israeli Air Force training program. Pro-social behaviour Although this area of study is still in its infancy, there is mounting evidence that video games which model and involve participants in pro- social, helping behaviours can lead to increases in pro-social behaviour in the short and long term. Most notably, Gentile et al (2009) found that elementary school students exposed to pro-social video games were more helpful than those exposed to violent or non-social video games. In a second longitudinal study of Japanese children in grades 5, 8 and 11, exposure to pro-social video games at the start of the study was linked with increased pro-social behaviour some months later, even when the baseline pro-social tendencies of children were statistically removed. In a final study of Singaporean secondary school students, the amount of pro-social video game play experienced was correlated with helping behaviour, cooperation, sharing and empathy. A study by Greitemeyer and Osswald (2009) found that pro-social video game playing led to a short-term reduction in the tendency to see the world as hostile and an immediate reduction in anti-social thoughts. Education A considerable literature reveals video games to be a powerful teaching tool (eg, Barlett et al, 2009; Murphy et al, 2002; Swing & Anderson, 58 growing up fAsT And furious 2008). They have been used to teach algebra (Corbett et al, 2001), biol- ogy (Ybarrondo, 1984), photography (Abrams, 1986), and computer programming (Kahn, 1999), to teach children how to manage diabetes (Lieberman, 2001; 2006) and to teach specific skills using simulators (for example, by Qantas pilots, NASA and the Air Force). Gentile and Gentile (2008) describe the educational advantages of using video games as teaching tools. These include the power of video games to engage children and to “encourage children to persevere in acquiring and mastering a number of skills, to navigate through complex problems and changing environments, and to experiment with different identities until success is achieved” (p 127). Exercise There has been a recent explosion in the popularity of video games that promote physical activity and exercise (that is, “Exergames”). Games such as Wii Sports Heart Rate; Wii Fit; Wii Play; Wii FitPlus; Dance, Dance Revolution and Just Dance seem to be part of a recent trend that has seen an increase in the availability and popularity of non-violent, helpful games. Clearly, video games have considerable potential to enhance the lives of children and adolescents. Unfortunately, excessive video game playing, especially of violent video games, has the potential to impact children in a number of negative ways. Harmful effects of video games Video game addiction In his moving biography, Unplugged: My Journey into the Dark World of Video Game Addiction, Ryan Van Cleave describes the way that a violent online game, World of Warcraft, dominated his life to such an extent that he was unable to function normally and was driven to the verge of suicide. Video game addiction is now taken so seriously by psychologists and psychiatrists that it was recently considered for inclusion in the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM) as a diagnosable psychiatric disorder and has been lodged in its appendix to encourage further research. It is clear that many children 59 The impACT of violenT video gAmes: An overview play video games at a “pathological” level that causes damage to family, social, school or psychological functioning (see Anderson et al, 2012). For example, it has been found that 8.5 per cent of 8–18-year-old US video game players do so at pathological levels (Gentile, 2009). Similar studies have found figures of 11.9 per cent in Europe (Grusser et al, 2007), 8.7 per cent in Singapore (Choo et al, 2010), 10.3 per cent in China (Peng & Li, 2009) and 4 per cent for 12–18-year-olds in Norway (Johansson & Götestam, 2004), with a further 15.5 per cent “at risk”. As will be seen in the ensuing sections, the amount that children play video games is very important. Those who play excessively are not only at risk of a number of negative outcomes, they are also much more likely to be playing violent games (see Krahé & Möller, 2004). Attention deficits There are some studies linking the amount of time children spend play- ing video games to attention deficits, impulsivity and hyperactivity (see Bailey et al, 2010; Swing et al, 2010). For example, Gentile (2009) found that adolescents who used video games at pathological levels were nearly three times more likely to be diagnosed with Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder than adolescents who played at non-pathological levels. In a landmark paper, Swing and colleagues (2010) examined the effect of video game playing on atten- tion in elementary school children. They used a longitudinal study that statistically controlled for a range of other factors that could also lead to attention problems and found that amount of time spent playing video games predicted increases in teacher assessments of attention deficits in the children 13 months later. These results suggest that the children’s level of video game playing played a causal role in their subsequent loss of attentional capacity. Anderson et al (2012) believe that on theoretical grounds some video games should have less effect on attentional problems (for exam- ple, those that require controlled thought and planning) and that those which require constant reactive behaviours from players (a common feature of many violent first person shooting games for example) may be more problematic in terms of children developing attentional difficulties. 60 growing up fAsT And furious School performance It is well established that spending longer hours playing video games is linked with poorer school performance for both children and adoles- cents (Anderson et al, 2007; Chan & Rabinowitz, 2006; Chiu et al, 2004; Cordes & Miller, 2000; Gentile, 2009; Gentile et al, 2004; Sharif & Sargent, 2006). One explanation for this is a simple displacement of time – hours spent playing video games eats into time that would normally be spent studying and reading. For example, in a study of 1491 youth between 10 and 19, gamers spent 30 per cent less time reading and 34 per cent less time doing homework (Cummings & Vandewater, 2007). It is also possible, however, that children who perform more poorly at school are also more likely to “spend more time playing games, where they may feel a sense of mastery that eludes them at school” (Anderson et al, 2012). Of course, another possibility is the that excessive gaming creates attention deficits, which in turn can lead to poorer school performance. Increased aggression Should we be concerned about children and adolescents playing violent video games? Can this lead to aggressive behaviour? Over 98 per cent of paediatricians in the United States have considered these questions and believe that excessive violent media exposure has a negative effect on childhood aggression (Gentile et al, 2004). Similarly, there is a consen- sus amongst the vast majority of violent video game researchers that too much exposure to violent video games increases the likelihood of aggressive thoughts, feelings and behaviours, leads to desensitisation to violence and also leads to decreases in pro-social behaviours and empathy (Anderson et al, 2010; Huesmann, 2010). There are, however, a small number of researchers who dispute this evidence and it seems that the views of this small minority have had a large impact on public perceptions (Anderson & Gentile, 2008; Dill, 2009). In this section of the chapter we will broadly examine the arguments for this view and then review the scientific evidence that does find violent video game effects. In this way, we hope that readers can judge the evidence for themselves. 1. The first argument against violent video game effects is that there is little evidence linking the playing of violent video games to very violent behaviours (such as school shootings). To better understand 61 The impACT of violenT video gAmes: An overview this argument it is helpful to reflect on the difference between aggres- sion and violence. In essence, violence is aggressive behaviour that has extreme harm as its goal (Anderson & Bushman, 2002). Thus, all violence is aggression but not all aggression is violence. With this in mind we make four points. (a) Ethically it is not possible to use the most powerful methods – experi- mental manipulations – to test the causal link between violent video games and violence because we cannot rightfully incite people to cause extreme harm in a laboratory. There are, however, ways to test links with aggressive behaviour, which can be examined ethi- cally in a laboratory. It is disingenuous to suggest that because there are no experimental studies that randomly assign children to years of playing violent or nonviolent video games and then measure which group commits the most violent crimes, that therefore there are no established negative or anti-social effects. This is like saying that because there are no experimental studies on humans showing that cigarette smoking causes lung cancer, smoking is not a causal risk factor. The causal links between violent video game playing and physical aggression are, in our opinion, well established. (b) Cross-sectional (correlational) studies and longitudinal studies of violent video game effects have established significant links to violent behaviour. Several longitudinal studies in particular provide strong evidence that these are causal effects. (c) Aggressive behaviour, which can include bullying, hurting other people physically, hurting other people’s property or relationships and hurting people verbally, is a very important social phenomenon in its own right. Aggression does not have to escalate into violence to be harmful and destructive. (d) No aggression researchers claim that media violence is the sole or even the most important source of violent behaviour. The most common approach, and the one taken by the authors, is the “risk factor” approach. According to this approach, people can have vari- ous risk factors for aggression or violent behaviour (see Figure 1). These might include coming from a violent home, having a violent peer group, high levels of trait aggression, exposure to violent media and a number of other factors. The more risk factors that are present for a person, especially when they are present from a young age, the more likely that person is to be aggressive or violent. Strasburger (2009, p 203) notes that: The research on media violence and its relationship to real-life aggression is clear: young people learn their attitudes about violence at a very young age, and once learned, those attitudes are difficult to change (Anderson et al, 2003; Bushman & Huesmann, 2006). Conservative estimates are that media violence may be causing 10% of real-life violence – not the leading cause by any means, but an unhealthy chunk that we could do something about if we chose to (Strasburger et al, 2009; Comstock & Strasburger, 1990). We believe that Victor Strasburger is right. Many risk factors for aggression and violence are very hard to deal with as parents, as educators, as professionals and as policy-makers. Media violence, though, is one risk factor that can be controlled and about which action can be taken from the level of the individual home through to the level of State and federal governments. This makes the research on media violence effects particularly important. 2. Detractors of the view that playing violent video games increases the likelihood of aggressive behaviour also criticise the methodology of video game studies and of meta-analyses of these studies. It is to this important scientific evidence that we now turn. Figure 1: Some longitudinal factors for youth violence Adapted from US Department of Health and Human Services (2001), Bushman and Huesmann (2006) and Anderson et al (2010). 63 The impACT of violenT video gAmes: An overview What is a meta-analysis and what evidence do the meta-analyses provide? A meta-analysis is a statistical technique whereby scientific studies that test the same or a similar hypothesis (for example, that violent video game exposure compared to neutral video game exposure will result in increased aggression) and the same or a similar outcome (for example, aggressive behaviour) are combined to ascertain the strength (“effect size”) of the average finding. To date there have been a number of meta- analyses of the effect of violent video games on aggressive thoughts, feelings and behaviours. In particular, studies by Distinguished Professor Craig Anderson and Dr Chris Ferguson have received a lot of publicity in recent years and it is valuable to compare them. Dr Ferguson, a vocal critic of the research demonstrating a link between violent video game playing and aggression, along with video game industry representatives, claims that violent video game research is methodologically flawed and that mainstream media violence researchers selectively report biased findings. Dr Ferguson has also suggested that Professor Anderson’s meta-analyses have a “publication bias” that undermines their results. Dr Ferguson cites his own three meta-analyses that examine the question of whether violent video game playing increases subsequent aggression. These examined 24, 17 and 14 published papers, encompassing 25, 21 and 15 separate tests of the same hypothesis respectively (Ferguson 2007a, 2007b; Ferguson & Kilburn, 2009). In total, 4205 and 3602 participants were tested in the first two meta-analyses (the number cannot be determined for the most recent study but is assumed to be lower). Dr Ferguson found a positive relation- ship between violent video game exposure and aggressive behaviour, with effect sizes of .29, .14 and .15 respectively. He then inappropriately (according to some meta-analysis experts, see Bushman, Rothstein, & Anderson, 2010) “corrected” for publication bias using a controversial statistical procedure called “trim and fill” that reduced these effect sizes. Such a procedure guesses what unpublished studies might be out there and adds these guesses to the averaging procedure. Based on the “corrected” figures, Dr Ferguson concluded there was no effect of violent video games on aggressive behaviour. These three meta-analyses, which use highly overlapping subsets of the same small sample of studies, are 64 growing up fAsT And furious widely cited as the strongest evidence that violent video game playing does not increase the likelihood of aggressive behaviour. Evidence that playing violent video games does increase the likeli- hood of aggression comes from many researchers. Professor Anderson and his colleagues have themselves conducted a large number of such studies and have also summarised the available studies in three compre- hensive meta-analyses, the first in 2001 (Anderson & Bushman, 2001), the second in 2004 (Anderson et al, 2004) and the most recent in 2010 (Anderson et al, 2010). The latter paper was co-authored by Professor Hannah Rothstein, an expert in meta-analyses and publication bias. This paper detailed major shortcomings in the Ferguson meta-analyses (which failed to include numerous relevant studies) and included all relevant studies then known. Data from 136 articles, 381 separate tests of hypotheses, and across a massive sample of 130, 296 participants were analysed. In this large, all-inclusive meta-analysis, research methodology was also examined. Among the many findings was that studies with better research methods tended to find stronger effects of violent video game playing on aggressive behaviour. We present a summary of the findings in Figure 2 (over page). We understand that the concept of effect size is a hard one to grasp without a detailed knowledge of statistical procedures, so we will provide some comparison data afterwards to help readers make sense of the results. The middle bar shows the effect found, the bars on either side reflect how variable the findings were in the studies tested. Figure 2 shows several meta-analyses. Each tests a different hypoth- esis. All hypotheses are tested as outcomes of exposure to violent video games, and these outcomes include aggressive behaviour, aggressive thoughts (cognitions), aggressive feelings (affects), physiological arousal, desensitisation to violence/low empathy and pro-social behaviour. As can be seen, the average effect across these many studies was one whereby exposure to violent video games led to an increase in aggressive behaviours, aggressive thoughts, aggressive feelings and physiological arousal (which is linked to aggressive behaviour), to desensitisation to violence and decreased empathy, and to a reduction in pro-social behaviours. It is important to note that these findings come from a range of study types – experimental studies in which all participants have exactly the same experience other than the media type they experi- ence, correlational studies of the links between levels of violent video game playing and various types of aggressive behaviours in real life, and longitudinal studies that follow video game playing patterns and behavioural patterns in the same people over time. Each study type makes a unique contribution to what we know. Experiments can be used to infer that one thing causes another, but it is harder to generalise these findings to “real life”. Correlational studies involve “real life” behaviours and can test alternative hypotheses, but it is difficult to determine the causal direction of relationships found (that is, whether playing violent games causes aggression or whether aggressive people choose violent games). Longitudinal studies are real world studies and can be used to find whether one thing causes another over time in a person’s life. Some media violence studies have followed the same people for over 40 years (eg, Huesmann et al, 2003) and have very detailed data. Because links between violent video game playing and aggression are found consistently across all three study types, the evidence converges to suggest both a causal link and an effect that is found in the real world. The Anderson et al (2010) meta-analysis also found that when proper statistical methods are used, there was no evidence of systematic publication bias in the studies. The rather weak evidence of publication bias produced by Dr Ferguson was likely the result of several factors, including failure to use all of the relevant studies and the combining of cross-sectional and experimental studies in the publication bias analysis. To understand how strong the obtained violent video game effect on aggression is, it can be helpful to get a sense of what the “effect size” numbers actually mean. It is easy to understand that a higher number means a stronger effect, but it is much harder to know how a big a number needs to be before it is considered important. Figure 3 shows some effect sizes for well known phenomena that can be used as points for comparison. As can be seen from Figure 3, violent video game effects are larger than the effect of eating calcium on bone mass, of asbestos inhalation Figure 3: The comparative effect sizes of violent video game effects and other well known phenomena * From Best Practices studies, Anderson et al, Psychological Bulletin, 2010. 67 The impACT of violenT video gAmes: An overview on related cancers, of condom use on reducing HIV infection numbers, of taking aspirin on reducing heart attacks and a range of other very important phenomena. Clearly, the size of violent video game effects is large enough to be considered socially important. A final finding from the Anderson et al (2010) meta-analyses is that the violent video game effects occurred for both males and females, and across low-violence collectivistic Eastern countries (for example, Japan) and high-violence individualistic Western countries (for example, Australia and the United States). This is not a surprising finding, as other reviews have found that violent video games affect people regardless of age, gender, socio-economic status, game genre and game system (Barlett et al, 2009). In fact, to the knowledge of the authors, no group has yet been identified that are immune to the effects of exposure to violent media such as video games (see Anderson et al, 2003). Perhaps the best brief summary of the evidence presented here is articulated in a statement produced by 13 researchers into violent video game effects (including the authors of this chapter), prepared for an amicus curiae (friend of the court) brief for the Schwarzenegger and Brown v Video Software Dealers Association and Entertainment Software Association case in the Supreme Court of the United States (Docket # 08-1448). This statement was supported as being accurate by a further 102 well-respected researchers in this area. Statement on Video Game Violence Both the American Psychological Association (APA, 2005) and the American Academy of Pediatrics (AAP, 2009) have issued formal statements stating that scientific research on violent video games clearly shows that such games are causally related to later aggressive behavior in children and adolescents. Extensive research has been conducted over many years using all three major types of research designs (experimental, cross-sectional, and longitudinal). Numerous original empirical research studies have been conducted on children and adolescents. Overall, the research data conclude that exposure to violent video games causes an increase in the likelihood of aggres- sive behavior. The effects are both immediate and long term. Violent video games have measurable and statistically significant effects on both males and females. Theoretically important effects of violent video games have been confirmed by many empirical studies. The effects have been replicated by researchers in different settings and in numerous countries. The psychological processes underlying 68 growing up fAsT And furious such effects are well understood and include: imitation, observa- tional learning, priming of cognitive, emotional and behavioral scripts, physiological arousal, and emotional desensitization. These are general processes that underlie all types of social behavior, not just aggression and violence; they have been confirmed by count- less studies outside of the media violence domain. In addition to causing an increase in the likelihood of aggressive behavior, violent video games have also been found to increase aggressive thinking, aggressive feelings, physiological desensitization to violence, and to decrease pro-social behavior. Importantly, this statement alludes to the psychological processes that are known to underlie the effect of exposure to violent video games on children. These are worth examining in more detail because they also provide some insight as to why the effects of violent video games, compared to other violent media, may be stronger. The psychology of violent video game effects on children Most of the explanations related to violent video game effects involve different types of learning. Because of certain features of violent video game playing – interactivity, repetition and the actual playing of the role of aggressor – the effects may be stronger and patterns of behaviour better learned. Imitation Humans seem to be hard-wired from birth to imitate others. Recently discovered “mirror neurons” in humans and primates represent one mechanism in the brain that may facilitate this (Caggiano et al, 2009; Gallese et al, 1996; Rizzolati et al, 1996; Umilta et al, 2001). Imitation has benefits, including the fast learning of important behaviours, and plays a role in human bonding. However, imitation of unhelpful and anti-social behaviours can have clear negative effects for the individual and for society. We know that children will imitate aggressive behaviours, even if the behaviours are totally new to the child and are not seen to be rewarded in any way (Bandura, 1965; 1973; Bandura et al, 1961; 1963a, 1963b). We also know that children imitate characters from the media they see, with some characters more likely to be imitated than others – those that are attractive, heroic, rewarded for their behaviour or liked, or that have high social status. In violent video games the central characters 69 The impACT of violenT video gAmes: An overview often meet several of these criteria. Does this mean, though, that people will copy the behaviours of the characters in very violent games such as GTA and others? It is possible. For example, an 18-year-old youth in Thailand stabbed a taxi driver to death trying to “find out if it was as easy in real life to rob a taxi as it was in the game” (Reed, 2008). As a result, GTA IV was banned in Thailand. In 2003 William Buckner, 16, and his step-brother Joshua, 14, killed a man and seriously wounded a woman shooting at cars in Tennessee (Calvert, 2003). The boys claimed they were acting out the game Grand Theft Auto III. Also in 2003, Devin Moore, an 18-year-old from Alabama, killed three police officers follow- ing his arrest for a carjacking. On being re-arrested he is reported to have told police that “Life is like a video game. Everybody’s got to die sometime” (Leung, 2005). Again, the killer told police he was copy- ing behaviour he had learned playing GTA III. We are not suggesting that violent video game playing alone was causal in these crimes. As noted earlier, numerous risk factors influence the likelihood of aggressive and violent b ehaviour, and the most severe forms of violence virtually always require the convergence of many risk factors. Furthermore, it is difficult (perhaps impossible) to identify which risk factors were crucial to any particular aggressive or violent act. Nonetheless, imitation of media violence seems to have played some role in these cases. There are numerous other stories of aggressive behaviours that seemingly imitate violent video games. These are easily accessed on the internet with a simple search. Clearly, for some violent video game players, simple imitation may play a causal role in some acts of aggression. However there are a number of other factors, also linked with imitation and learned aggression, that may also be important. Identification Although media effects can occur without the person identifying with any of the characters they have seen, identifying with an aggressor has been shown to increase the likelihood of adopting aggressive behav- iours and attitudes (Cantor, 1994; Huesmann & Eron, 1986; Huesmann et al, 2003). People are more likely to identify with a character who is perceived as similar, heroic and attractive (Hearold, 1986; Heath et al, 1989), and are more likely to identify with and believe realistic portray- als because they are easier to relate to personal experiences (Berkowitz 70 growing up fAsT And furious & Alioto, 1973; Feshback, 1972; Geen, 1975). In violent video games, the player strongly identifies with (and usually takes the role of) the aggres- sor. The aggressive central character is usually glorified and portrayed as heroic and, in recent years, the portrayal of aggressive characters in video games has become increasingly realistic (Gentile et al, 2007). For these reasons, identification with violent/aggressive characters may be a key way that video games impact on children. Repetition It is well established that repetition of behaviours establishes them in memory, increases skill and automates them as learned responses (eg, Gentile & Gentile, 2008). Further, repeating an entire behavioural sequence commits it to memory better than repeating only part of a sequence (Gentile et al, 2007). Violent video games are much more repetitive than other forms of violent media and more often involve the repetition of complete behavioural sequences (Gentile et al, 2007). Players repeat the same behaviours and receive similar rewards throughout the game, experience similar thoughts and feelings during those actions and are exposed to the attitudes espoused in the game implicitly and explicitly (for example, sleeping with prostitutes and then murdering them to retrieve one’s money in GTA implies misogyny, the acceptance of violence to get what one wants and that human life has little value). Simply put, the repetitive nature of violent video games is ideal for learning aggressive attitudes and scripts for behaviour. Interactivity Active participation assists learning as it requires attention, and closely attending to a task assists people to memorise the relevant behaviours and knowledge (Gentile et al, 2007; Gentile & Gentile, 2008). Violent video games are highly interactive, and the recent development of home consoles that allow players to use realistic weapons such as replica guns and swords further increases the level of interactivity and decreases the gap between game playing behaviours and “real world” behaviours. The combination of interactivity and frequent rehearsal is a potent one for learning. In essence, this is a key reason that video games are such powerful tools for teaching pilots, astronauts and soldiers their core skills. These factors give video games tremendous potential for 71 The impACT of violenT video gAmes: An overview pro-social pursuits and as learning tools, but have less welcome implica- tions regarding the interactive rehearsal of anti-social and aggressive behaviours. Lack of negative consequences Another basic tenet of learning theory, demonstrated across thousands of studies, is that people are more likely to behave in ways that are rewarded and less likely to behave in ways that are punished. In terms of imitation, children imitate aggression they perceive as being rewarded more often than aggression they perceive as resulting in punishment. Interestingly, children will imitate unpunished aggression as often as rewarded aggression (eg, see Bandura, 1973). With these facts in mind, it is relevant that most acts of violence in video games: (a) go unpunished; (b) are rewarded (for example, by points, money, status and eleva- tion to higher game levels); (c) have unrealistic consequences for the victim. With relation to the final point, it is important for parents and profession- als to note that seeing victims suffer realistic and negative consequences as a result of media violence should reduce the likelihood of subsequent aggression because pain cues usually inhibit aggressive behaviour (Baron, 1971a, 1971b, 1979). Also note, however, that in some circum- stances pain and suffering cues can increase aggressive behaviour (see Berkowitz, 1993, p 174). Associative learning As noted in Chapter 1, the brain is a neural network in which concepts, ideas, feelings and memories are stored and interconnected. The way this network “wires up” depends on what people experience, with paired experiences (such as the smell of fresh coffee, pleasure and a craving for a hot beverage) becoming more strongly wired together the more they are experienced together. This means that people learn to associate one thing with another. In media generally, and in violent video games especially, many things are frequently paired and thus become “wired” together. For 72 growing up fAsT And furious example, guns are rarely used for any purpose other than violent action. This is why there is a well demonstrated “weapons effect”, whereby the simple sight of a weapon increases the likelihood of aggression if the person has mentally paired a weapon such as a gun with killing or hurting people rather than with a non-aggressive use such as sports shooting (Bartholow et al, 2005; Berkowitz & LePage, 1967; Carlson et al, 1990). This suggests that children who often play video games where there is frequent weapon use for the purpose of killing and hurting others are more likely to be aggressive immediately after playing the game and are more likely to be aggressive when exposed to a weapon of a similar type in real life. Associative learning also explains why whole sequences of behav- iour are learned during video game play and why the acquisition of aggression-related knowledge structures is so important. Acquisition of aggressive knowledge structures, attitudes and scripts for behaviour Clearly, violent video games are powerful teachers, but what is the outcome of such learning for the individual child? In essence, the child (and adult for that matter) internalises clusters of associated knowledge about aggressive behaviour (knowledge structures or “schemas”), as well as attitudes about aggressive behaviour and “scripts” for how to behave in certain circumstances. Schemas and scripts contain knowledge about an aspect of living, mental links to related attitudes, feelings and memories, and a repertoire of associated behaviours. Scripts additionally contain information about how commonly experienced situations “play out” (such as visiting a supermarket) and the typical sequence of behaviours in that situation (entrance at the left of the store, grab a trolley, milk at the back, bread in the second aisle, line up and pay). Schemas and scripts are activated by a trigger (for example, the supermarket logo) and, once active, help to direct our behaviour, often without our being aware of it. Children start to develop schemas about the world as toddlers (and perhaps earlier) and these can sometimes be aggressive in nature. In relation to the development of aggressive knowledge structures and attitudes, there is considerable evidence that exposure to violent media (including violent video games): 73 The impACT of violenT video gAmes: An overview (a) increases attitudes approving of aggressive behaviour as a “normal” social response (Huesmann, 1998); (b) increases mental access to scripts for resolving conflict that involve aggressive behaviour and reduces access to conflict- solving scripts that are non-aggressive (Bushman & Anderson, 2002; Huesmann, 1998); (c) underpins the attitude that aggression is (1) exciting and (2) increases one’s social status (Groebel, 1998); (d) increases the belief that the world is a frightening place (Cantor, 2003; Donnerstein et al, 1994); (e) increases a hostile attributional bias whereby ambiguous but innocent behaviours by others are interpreted as deliberately hurtful (Anderson et al, 2010; Möller & Krahé, 2009); and (f) increases the likelihood of aggressive behaviour (Anderson et al, 2010). Regrettably, children are exposed to a lot of violent media. As noted in Chapter 1, by the age of 18, most US children will have seen many tens of thousands of murders and acts of violence on television alone. Heavy playing of violent video games that involve frequently killing of other people or creatures would add greatly to those figures, especially for murders. This means that for a lot of children, violent media influences may result in higher levels of aggressive schemas, fear about the wider world, hostile and anti-social attitudes, and scripts for behaving aggres- sively, than might otherwise occur without those influences. Fictitious violence versus real violence Recent brain imaging studies, in which children’s brain activation patterns are “photographed” by fMRI machines whilst they are expe- riencing violent media, have shown that even when children know the violence they are watching is fictitious or fantasy violence, their brains respond to the violence as if there was a real threat (Murray et al, 2006; see also Weber et al, 2006). In addition, long-term memory systems were activated, suggesting that this effect could endure beyond the initial exposure. This research suggests that fantasy media violence seems to have a similar impact on children as exposure to realistic media violence. The General Aggression Model The General Aggression Model (GAM: Anderson & Bushman 2002; DeWall, Anderson & Bushman, in press) provides a theoretically sound and helpful way of understanding how exposure to violent media can increase a person’s likelihood of being aggressive in both the short and long term (see Figures 4 and 5). The GAM is a model of what is happening psychologically during an episode of aggression. In essence the person brings their own readiness to aggress, through their gender, beliefs and attitudes about aggres- sion, personality and other stable factors. Each situation has cues and triggers for aggression, such as the presence of a weapon or an insult. When a person encounters an aggression-triggering situation, various relevant cognitions (memories, beliefs, attitudes, scripts for behaviour) are activated, along with feelings (such as fear and anger) and a level of physiological arousal. Higher levels of arousal make a dominant tendency to act more likely. Figure 4: The General Aggression Model 75 The impACT of violenT video gAmes: An overview As a result of these activated cognitions and feelings, and of the level of arousal, the person has an immediate response. If they are very aroused or if the situation requires immediate action, this will probably be the ultimate response. If the person has the time and cognitive capac- ity for a more considered response they will evaluate their options and are more likely to make a thought-through response. Either way, the eventual response, which may be aggressive, is enacted, elicits a social response and the episode is encoded into memory. Once in memory, it becomes part of the “person” and can then affect their responses to future situations. Although “person” characteristics are very important in deter- mining how an individual reacts in a specific situation, the research presented in this chapter reveals that most people, regardless of personal characteristics, are influenced by violent video games. It also reveals that violent video games provide many cues for aggressive behaviour, activate aggressive cognitions and feelings, and can increase levels of arousal. These internal processes can explain why there is also a robust link between violent video game playing and aggressive behaviour. Over the long term, exposure to the attitudes, ideas and scripts for behaviour in violent video games leads to stable knowledge structures, attitudes, biases in thinking, scripts for conflict resolution and action tendencies that include aggressive behaviour (see Figure 5). In turn, these increase the base level of aggressiveness in that person’s personal- ity and bring the person to an aggression-triggering type of situation with a higher predisposition to aggress. Between the two models, it is easy to see how playing a video game can lead to aggression in the short term, and how repeated playing can lead to higher levels of aggression in the long term. Conclusions and advice for parents and professionals working with children In this chapter we have detailed the evidence that video games can be used for a wide array of helpful purposes, but that there can be many negative consequences for playing violent games, especially when played excessively. This raises an important question: “How do we help children to benefit from video games but escape their negative impacts?” In Chapter 1 it was noted that the “you are what you eat” principle applies to the way media exposure affects the way the human neural network “wires up” as well as to food consumption. Using the food metaphor can be helpful for parents and professionals when it comes to advising children on how to use media in a beneficial way. Through 77 The impACT of violenT video gAmes: An overview school education many children are interested in healthy eating and this can be extended to maintaining a healthy media diet. For example, children could be told that, as with food, there are media that are good to consume regularly (in moderation), media that are for infrequent consumption and media that children should avoid. Helping a child to self-regulate what they watch and hear in the media can be very important to a child’s development in this media saturated world. This may involve: • educating children about media effects generally and about video game effects specifically, so that children can learn to make informed choices; • helping children to limit their time playing video games; • encouraging children to play pro-social and educational video games in preference to violent games; • keeping video game consoles in public areas and out of children’s bedrooms; and • playing video games with your children so that you are aware of their content and can knowledgeably discuss the implications of playing certain types of games and screen out potentially harmful ones. It is desirable for children to be able use video games for a range of educational and developmental objectives, but to have less exposure to the more harmful impacts. We hope that this chapter has helped to dispel some popular myths about the impact of violent video games on children and adolescents and has clarified for readers how positive outcomes might be achieved. A Tragic Postscript I see MW2 more as a part of my training-simulation than anything else … You can more or less completely simulate actual operations These were the chilling words with which Anders Behring Breivik referred to the computer game Modern Warfare 2 in a 1500-page mani- festo disseminated just hours before he was responsible for the deaths of 76 of his fellow Norwegians (Moses, 2011; Shah, 2011; Townsend & Tisdall, 2011). The 32-year-old male behind the now infamous bombing 78 growing up fAsT And furious of government buildings in Oslo and subsequent shooting massacre on Utoya island on 22 July 2011 made no secret of the fact that playing the violent video games Modern Warfare 2 and World of Warcraft aided him in preparing and executing his attacks. Breivik identified Modern Warfare 2 as helping him with “target practice” (Shah, 2011) and involvement with World of Warcraft as providing sufficient cover for his preparatory activities (Moses, 2011). As a result of the attacks, one of Norway’s biggest retailers, Coop Norway, issued a ban of indefinite duration on these and other violent video games that, at the time of publication, has yet to be lifted (Narcisse, 2011; Navarro, 2011). When considering the impact of violent video games, particularly in light of the Norway atrocities, it should also be noted that video games in which acts of violence are executed in first-person, immersive environments have long been recognised and used by the US military forces as effec- tive in both the training and recruitment of their members (Holguin, 2009; Robson, 2008). I know that violent video games can potentially have negative effects on children, but are there any positive psychological effects associated with video games?",Medical,Effect Analysis,Q&A You use only the information contained in this prompt to respond to the prompt. Do not use any external sources of information or other knowledge in your response.,What sort of regulatory model might use a risk-based approach that categorizes specific applications of AI?,"5.2 Regulatory models Bradford (2023) identifies three primary regulatory models, adopted in the US, China and the EU. The “market-driven” regulatory model in the US is characterised by a market-based approach that emphasises innovation, self-regulation and scepticism of government intervention. The “state-driven” regulatory model in China utilises technology for political objectives, and aims to grow the industry while exporting technology infrastructure. The “rights-driven” regulatory model of the EU is focused on protecting individual and societal rights and the equitable distribution of digital transformation gains. These regulatory models, while distinct, are not mutually exclusive and show a tendency to converge towards the principles highlighted above, as well as towards rather similar operationalisations. In the United States, the regulation of AI has evolved from voluntary guidance to executive actions. Initially, the Blueprint for an AI Bill of Rights in October 2022 laid foundational ethical considerations. This was followed by voluntary commitments from leading AI firms in July 2023, signalling industry readiness to address AI’s societal impacts. The shift towards regulatory oversight was marked by the Executive Order on Safe, Secure, and Trustworthy AI in November 2023, which mandated over 25 agencies to address AI-related harms, including security, privacy, and discrimination. These agencies are now tasked with establishing rules, funding research, assessing risks, and enforcing transparency through safety tests and reporting by AI developers. However, there has not been significant legislative action on AI regulation. China’s AI regulation has evolved from a state-driven approach to more sectorspecific guidance. The 2018 Guiding Opinions for financial institutions mandated algorithm filing, risk disclosure, and manual intervention to mitigate pro-cyclicality risk in financial markets, highlighting a cautious approach to AI’s systemic impacts. The 2022 Deep Synthesis Provisions and the 2023 Generative AI Provisions set the stage for regulatory oversight, emphasising the adherence to socialist values, content reliability, and discrimination prevention. An AI Law is underway, proposing a framework for public-facing generative AI systems, including content standards, privacy respect, and a mandatory filing to the algorithm registry. The European Union’s AI Act, approved in February 2024, aims to ensure that AI technologies are safe and respect fundamental rights while fostering innovation and economic growth. This regulatory framework introduces a risk-based approach that categorises AI systems according to the risk they pose to users. For example, the act identifies specific applications of AI that pose unacceptable risks and are therefore prohibited. These include social scoring, manipulation or exploitation of vulnerabilities and certain uses of biometric identification. The EU AI Act also introduces governance rules for AI applications that might pose risks to health, safety, fundamental rights, the environment, democracy and the rule of law. For these high-risk categories, stringent regulatory requirements are set.","You use only the information contained in this prompt to respond to the prompt. Do not use any external sources of information or other knowledge in your response. 5.2 Regulatory models Bradford (2023) identifies three primary regulatory models, adopted in the US, China and the EU. The “market-driven” regulatory model in the US is characterised by a market-based approach that emphasises innovation, self-regulation and scepticism of government intervention. The “state-driven” regulatory model in China utilises technology for political objectives, and aims to grow the industry while exporting technology infrastructure. The “rights-driven” regulatory model of the EU is focused on protecting individual and societal rights and the equitable distribution of digital transformation gains. These regulatory models, while distinct, are not mutually exclusive and show a tendency to converge towards the principles highlighted above, as well as towards rather similar operationalisations. In the United States, the regulation of AI has evolved from voluntary guidance to executive actions. Initially, the Blueprint for an AI Bill of Rights in October 2022 laid foundational ethical considerations. This was followed by voluntary commitments from leading AI firms in July 2023, signalling industry readiness to address AI’s societal impacts. The shift towards regulatory oversight was marked by the Executive Order on Safe, Secure, and Trustworthy AI in November 2023, which mandated over 25 agencies to address AI-related harms, including security, privacy, and discrimination. These agencies are now tasked with establishing rules, funding research, assessing risks, and enforcing transparency through safety tests and reporting by AI developers. However, there has not been significant legislative action on AI regulation. China’s AI regulation has evolved from a state-driven approach to more sectorspecific guidance. The 2018 Guiding Opinions for financial institutions mandated algorithm filing, risk disclosure, and manual intervention to mitigate pro-cyclicality risk in financial markets, highlighting a cautious approach to AI’s systemic impacts. The 2022 Deep Synthesis Provisions and the 2023 Generative AI Provisions set the stage for regulatory oversight, emphasising the adherence to socialist values, content reliability, and discrimination prevention. An AI Law is underway, proposing a framework for public-facing generative AI systems, including content standards, privacy respect, and a mandatory filing to the algorithm registry. The European Union’s AI Act, approved in February 2024, aims to ensure that AI technologies are safe and respect fundamental rights while fostering innovation and economic growth. This regulatory framework introduces a risk-based approach that categorises AI systems according to the risk they pose to users. For example, the act identifies specific applications of AI that pose unacceptable risks and are therefore prohibited. These include social scoring, manipulation or exploitation of vulnerabilities and certain uses of biometric identification. The EU AI Act also introduces governance rules for AI applications that might pose risks to health, safety, fundamental rights, the environment, democracy and the rule of law. For these high-risk categories, stringent regulatory requirements are set. What sort of regulatory model might use a risk-based approach that categorizes specific applications of AI?",Legal,Find & Summarize,Text Transformation "Create a short paragraph response to the question using clear, precise vocabulary. This should only rely on information contained in the text.",What are the primary positive aspects reviewers refer to?,"Talking 2-XL Robot by Tiger Electronics User Reviews 1. Reviewer: Leslie Cain Rating: 5.0 stars Date: June 7, 2016 Verified Purchase Review: Great toy. Still a hit with the next generation of kids as well. Arrived on time and in perfect working condition. One person found this helpful. 2. Reviewer: Artfan1166 Rating: 5.0 stars Date: May 11, 2015 Verified Purchase Review: It was perfect, exactly what I had hoped it would be! 3. Reviewer: Richard K. Rating: 5.0 stars Date: January 5, 2015 Verified Purchase Review: Just what I expected.","Create a short paragraph response to the question using clear, precise vocabulary. This should only rely on information contained in the text. What are the primary positive aspects reviewers refer to? Talking 2-XL Robot by Tiger Electronics User Reviews 1. Reviewer: Leslie Cain Rating: 5.0 stars Date: June 7, 2016 Verified Purchase Review: Great toy. Still a hit with the next generation of kids as well. Arrived on time and in perfect working condition. One person found this helpful. 2. Reviewer: Artfan1166 Rating: 5.0 stars Date: May 11, 2015 Verified Purchase Review: It was perfect, exactly what I had hoped it would be! 3. Reviewer: Richard K. Rating: 5.0 stars Date: January 5, 2015 Verified Purchase Review: Just what I expected.",Retail/Product,Effect Analysis,Q&A Only use the text that is provided to answer the question. Answer using complete sentences. The answer must be a minimum of 3 sentences.,Based on the given text would Wayne recommend Freedom Mobile?,"Freedom Mobile Reviews from Users Freedom mobile reviews from users seem generally positive and assuring. They praise the provider’s ability to provide great offers and excellent service. The operator is also appreciated for offering unique services and promotions to users, every now and then. If you’ve used their services and would like to share a review with others, feel free to share your experience right here! Last 365 days average - 2.2 18 reviews All-time average - 2.6 35 reviews Sasha Mississauga, Ontario 2024-01-03 Horrible customer service You people have no idea what customer service is! Horrible service! I will be complaining! Wayne Toronto, Ontario 2024-02-23 Freedom allowed a sim swap. Freedom has terrible privacy protection. They are incompetent. I was a victim of a sim swap from Freedom. I had my banking and other financial accounts stolen. Freedom will not take any responsibility for my financial losses. They gave a SIM card replacement to a frauster and never requested my consent. Siro J Toronto, Ontario 2024-02-10 A fake mobile network Zero reception in downtown building toronto Sy Toronto, Ontario 2024-01-30 It’s alright Freedom offers cheap plans, but with that you get cheap service. While they offer canada-usa plans their network is a bit wonky. Sometimes you’ll be right beside a tower with full bars and only get around 30 mbps down. Some dropped calls and their reliability indoors isn’t as good as other carriers, although wifi calling is an option. Overall, you get what you pay for.","[Instruction] ======= Only use the text that is provided to answer the question. Answer using complete sentences. The answer must be a minimum of 3 sentences. ---------------- [Passage] ======= Freedom Mobile Reviews from Users Freedom mobile reviews from users seem generally positive and assuring. They praise the provider’s ability to provide great offers and excellent service. The operator is also appreciated for offering unique services and promotions to users, every now and then. If you’ve used their services and would like to share a review with others, feel free to share your experience right here! Last 365 days average - 2.2 18 reviews All-time average - 2.6 35 reviews Sasha Mississauga, Ontario 2024-01-03 Horrible customer service You people have no idea what customer service is! Horrible service! I will be complaining! Wayne Toronto, Ontario 2024-02-23 Freedom allowed a sim swap. Freedom has terrible privacy protection. They are incompetent. I was a victim of a sim swap from Freedom. I had my banking and other financial accounts stolen. Freedom will not take any responsibility for my financial losses. They gave a SIM card replacement to a frauster and never requested my consent. Siro J Toronto, Ontario 2024-02-10 A fake mobile network Zero reception in downtown building toronto Sy Toronto, Ontario 2024-01-30 It’s alright Freedom offers cheap plans, but with that you get cheap service. While they offer canada-usa plans their network is a bit wonky. Sometimes you’ll be right beside a tower with full bars and only get around 30 mbps down. Some dropped calls and their reliability indoors isn’t as good as other carriers, although wifi calling is an option. Overall, you get what you pay for. ---------------- [Query] ======= Based on the given text would Wayne recommend Freedom Mobile?",Retail/Product,Find & Summarize,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","Explain how smoking affects different organs and bodily systems in both smokers and nonsmokers. Include specific details on how recent changes in cigarette design have influenced health outcomes. Additionally, describe how smoking during pregnancy impacts both the mother and the infant, including potential genetic changes to the baby. Please provide a response within 3-5 sentences.","Smoking is the leading cause of premature, preventable death in this country. Cigarette smoking and exposure to tobacco smoke cause about 480,000 premature deaths each year in the United States (1). Of those premature deaths, about 36% are from cancer, 39% are from heart disease and stroke, and 24% are from lung disease (1). Mortality rates among smokers are about three times higher than among people who have never smoked (6, 7). Smoking harms nearly every bodily organ and organ system in the body and diminishes a person’s overall health. Smoking causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia (1–3). Smoking also causes heart disease, stroke, aortic aneurysm (a balloon-like bulge in an artery in the chest), chronic obstructive pulmonary disease (COPD) (chronic bronchitis and emphysema), diabetes, osteoporosis, rheumatoid arthritis, age-related macular degeneration, and cataracts, and worsens asthma symptoms in adults. Smokers are at higher risk of developing pneumonia, tuberculosis, and other airway infections (1–3). In addition, smoking causes inflammation and impairs immune function (1). Since the 1960s, a smoker’s risk of developing lung cancer or COPD has actually increased compared with nonsmokers, even though the number of cigarettes consumed per smoker has decreased (1). There have also been changes over time in the type of lung cancer smokers develop – a decline in squamous cell carcinomas but a dramatic increase in adenocarcinomas. Both of these shifts may be due to changes in cigarette design and composition, in how tobacco leaves are cured, and in how deeply smokers inhale cigarette smoke and the toxicants it contains (1, 8). Smoking makes it harder for a woman to get pregnant. A pregnant smoker is at higher risk of miscarriage, having an ectopic pregnancy, having her baby born too early and with an abnormally low birth weight, and having her baby born with a cleft lip and/or cleft palate (1). A woman who smokes during or after pregnancy increases her infant’s risk of death from Sudden Infant Death Syndrome (SIDS) (2, 3). Men who smoke are at greater risk of erectile dysfunction (1, 9). The longer a smoker’s duration of smoking, the greater their likelihood of experiencing harm from smoking, including earlier death (7). But regardless of their age, smokers can substantially reduce their risk of disease, including cancer, by quitting. What are the risks of tobacco smoke to nonsmokers? Secondhand smoke (also called environmental tobacco smoke, involuntary smoking, and passive smoking) is the combination of “sidestream” smoke (the smoke given off by a burning tobacco product) and “mainstream” smoke (the smoke exhaled by a smoker) (4, 5, 10, 11). The U.S. Environmental Protection Agency, the U.S. National Toxicology Program, the U.S. Surgeon General, and the International Agency for Research on Cancer have classified secondhand smoke as a known human carcinogen (cancer-causing agent) (5, 11, 12). Inhaling secondhand smoke causes lung cancer in nonsmoking adults (1, 2, 4). Approximately 7,300 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke (1). The U.S. Surgeon General estimates that living with a smoker increases a nonsmoker’s chances of developing lung cancer by 20 to 30% (4). Secondhand smoke causes disease and premature death in nonsmoking adults and children (2, 4). Exposure to secondhand smoke irritates the airways and has immediate harmful effects on a person’s heart and blood vessels. It increases the risk of heart disease by an estimated 25 to 30% (4). In the United States, exposure to secondhand smoke is estimated to cause about 34,000 deaths from heart disease each year (1). Exposure to secondhand smoke also increases the risk of stroke by 20 to 30% (1). Pregnant women exposed to secondhand smoke are at increased risk of having a baby with a small reduction in birth weight (1). Children exposed to secondhand smoke are at an increased risk of SIDS, ear infections, colds, pneumonia, and bronchitis. Secondhand smoke exposure can also increase the frequency and severity of asthma symptoms among children who have asthma. Being exposed to secondhand smoke slows the growth of children’s lungs and can cause them to cough, wheeze, and feel breathless (2, 4). Is smoking addictive? Smoking is highly addictive. Nicotine is the drug primarily responsible for a person’s addiction to tobacco products, including cigarettes. The addiction to cigarettes and other tobacco products that nicotine causes is similar to the addiction produced by using drugs such as heroin and cocaine (13). Nicotine is present naturally in the tobacco plant. But tobacco companies intentionally design cigarettes to have enough nicotine to create and sustain addiction. The amount of nicotine that gets into the body is determined by the way a person smokes a tobacco product and by the nicotine content and design of the product. Nicotine is absorbed into the bloodstream through the lining of the mouth and the lungs and travels to the brain in a matter of seconds. Taking more frequent and deeper puffs of tobacco smoke increases the amount of nicotine absorbed by the body. Are other tobacco products, such as smokeless tobacco or pipe tobacco, harmful and addictive? Yes. All forms of tobacco are harmful and addictive (4, 11). There is no safe tobacco product. In addition to cigarettes, other forms of tobacco include smokeless tobacco, cigars, pipes, hookahs (waterpipes), bidis, and kreteks. There is no safe level of smoking. Smoking even just one cigarette per day over a lifetime can cause smoking-related cancers (lung, bladder, and pancreas) and premature death (24, 25). What are the immediate health benefits of quitting smoking? The immediate health benefits of quitting smoking are substantial: Heart rate and blood pressure, which are abnormally high while smoking, begin to return to normal. Within a few hours, the level of carbon monoxide in the blood begins to decline. (Carbon monoxide reduces the blood’s ability to carry oxygen.) Within a few weeks, people who quit smoking have improved circulation, produce less phlegm, and don’t cough or wheeze as often. Within several months of quitting, people can expect substantial improvements in lung function (26). Within a few years of quitting, people will have lower risks of cancer, heart disease, and other chronic diseases than if they had continued to smoke.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Explain how smoking affects different organs and bodily systems in both smokers and nonsmokers. Include specific details on how recent changes in cigarette design have influenced health outcomes. Additionally, describe how smoking during pregnancy impacts both the mother and the infant, including potential genetic changes to the baby. Please provide a response within 3-5 sentences. Smoking is the leading cause of premature, preventable death in this country. Cigarette smoking and exposure to tobacco smoke cause about 480,000 premature deaths each year in the United States (1). Of those premature deaths, about 36% are from cancer, 39% are from heart disease and stroke, and 24% are from lung disease (1). Mortality rates among smokers are about three times higher than among people who have never smoked (6, 7). Smoking harms nearly every bodily organ and organ system in the body and diminishes a person’s overall health. Smoking causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, liver, pancreas, stomach, cervix, colon, and rectum, as well as acute myeloid leukemia (1–3). Smoking also causes heart disease, stroke, aortic aneurysm (a balloon-like bulge in an artery in the chest), chronic obstructive pulmonary disease (COPD) (chronic bronchitis and emphysema), diabetes, osteoporosis, rheumatoid arthritis, age-related macular degeneration, and cataracts, and worsens asthma symptoms in adults. Smokers are at higher risk of developing pneumonia, tuberculosis, and other airway infections (1–3). In addition, smoking causes inflammation and impairs immune function (1). Since the 1960s, a smoker’s risk of developing lung cancer or COPD has actually increased compared with nonsmokers, even though the number of cigarettes consumed per smoker has decreased (1). There have also been changes over time in the type of lung cancer smokers develop – a decline in squamous cell carcinomas but a dramatic increase in adenocarcinomas. Both of these shifts may be due to changes in cigarette design and composition, in how tobacco leaves are cured, and in how deeply smokers inhale cigarette smoke and the toxicants it contains (1, 8). Smoking makes it harder for a woman to get pregnant. A pregnant smoker is at higher risk of miscarriage, having an ectopic pregnancy, having her baby born too early and with an abnormally low birth weight, and having her baby born with a cleft lip and/or cleft palate (1). A woman who smokes during or after pregnancy increases her infant’s risk of death from Sudden Infant Death Syndrome (SIDS) (2, 3). Men who smoke are at greater risk of erectile dysfunction (1, 9). The longer a smoker’s duration of smoking, the greater their likelihood of experiencing harm from smoking, including earlier death (7). But regardless of their age, smokers can substantially reduce their risk of disease, including cancer, by quitting. What are the risks of tobacco smoke to nonsmokers? Secondhand smoke (also called environmental tobacco smoke, involuntary smoking, and passive smoking) is the combination of “sidestream” smoke (the smoke given off by a burning tobacco product) and “mainstream” smoke (the smoke exhaled by a smoker) (4, 5, 10, 11). The U.S. Environmental Protection Agency, the U.S. National Toxicology Program, the U.S. Surgeon General, and the International Agency for Research on Cancer have classified secondhand smoke as a known human carcinogen (cancer-causing agent) (5, 11, 12). Inhaling secondhand smoke causes lung cancer in nonsmoking adults (1, 2, 4). Approximately 7,300 lung cancer deaths occur each year among adult nonsmokers in the United States as a result of exposure to secondhand smoke (1). The U.S. Surgeon General estimates that living with a smoker increases a nonsmoker’s chances of developing lung cancer by 20 to 30% (4). Secondhand smoke causes disease and premature death in nonsmoking adults and children (2, 4). Exposure to secondhand smoke irritates the airways and has immediate harmful effects on a person’s heart and blood vessels. It increases the risk of heart disease by an estimated 25 to 30% (4). In the United States, exposure to secondhand smoke is estimated to cause about 34,000 deaths from heart disease each year (1). Exposure to secondhand smoke also increases the risk of stroke by 20 to 30% (1). Pregnant women exposed to secondhand smoke are at increased risk of having a baby with a small reduction in birth weight (1). Children exposed to secondhand smoke are at an increased risk of SIDS, ear infections, colds, pneumonia, and bronchitis. Secondhand smoke exposure can also increase the frequency and severity of asthma symptoms among children who have asthma. Being exposed to secondhand smoke slows the growth of children’s lungs and can cause them to cough, wheeze, and feel breathless (2, 4). Is smoking addictive? Smoking is highly addictive. Nicotine is the drug primarily responsible for a person’s addiction to tobacco products, including cigarettes. The addiction to cigarettes and other tobacco products that nicotine causes is similar to the addiction produced by using drugs such as heroin and cocaine (13). Nicotine is present naturally in the tobacco plant. But tobacco companies intentionally design cigarettes to have enough nicotine to create and sustain addiction. The amount of nicotine that gets into the body is determined by the way a person smokes a tobacco product and by the nicotine content and design of the product. Nicotine is absorbed into the bloodstream through the lining of the mouth and the lungs and travels to the brain in a matter of seconds. Taking more frequent and deeper puffs of tobacco smoke increases the amount of nicotine absorbed by the body. Are other tobacco products, such as smokeless tobacco or pipe tobacco, harmful and addictive? Yes. All forms of tobacco are harmful and addictive (4, 11). There is no safe tobacco product. In addition to cigarettes, other forms of tobacco include smokeless tobacco, cigars, pipes, hookahs (waterpipes), bidis, and kreteks. There is no safe level of smoking. Smoking even just one cigarette per day over a lifetime can cause smoking-related cancers (lung, bladder, and pancreas) and premature death (24, 25). What are the immediate health benefits of quitting smoking? The immediate health benefits of quitting smoking are substantial: Heart rate and blood pressure, which are abnormally high while smoking, begin to return to normal. Within a few hours, the level of carbon monoxide in the blood begins to decline. (Carbon monoxide reduces the blood’s ability to carry oxygen.) Within a few weeks, people who quit smoking have improved circulation, produce less phlegm, and don’t cough or wheeze as often. Within several months of quitting, people can expect substantial improvements in lung function (26). Within a few years of quitting, people will have lower risks of cancer, heart disease, and other chronic diseases than if they had continued to smoke. https://www.cancer.gov/about-cancer/causes-prevention/risk/tobacco/cessation-fact-sheet#:~:text=Since%20the%201960s%2C%20a%20smoker's,dysfunction%20(1%2C%209).",Medical,Effect Analysis,Q&A "For this task, you are required to answer questions using the information--and ONLY the information--provided as part of the prompt. Do NOT use any resources outside of this information to answer the questions,","Give examples of how data analytics has changed the way baseball, basketball, and soccer are played.","A core factor in fueling the widespread adoption of analytics in sports is the integration of technology. Although it is fairly straightforward to track all the action in a computer game, as they are ultimately mediated by lines of code and actions within the video game can be dumped into spreadsheets and databases for analysis, sports happen within a framework where the data must be collected before it can be assessed. In line with James’s early concerns about the poor state of play-by-play data in baseball, major sports leagues have invested greatly in the integration of technology to assess players and how they interact in games. Baseball pitches are tracked and the results compared with the strike zone to rate umpires. A company called Second Spectrum uses technology originally designed to track missiles to map how players move on basketball courts and soccer pitches, enabling comparative analysis about how players defend, run, and generally play the game. Catapult developed a wearable system that tracks how players stress their bodies during practice and games, aiding the ability to determine when players need a rest and when they are likely at the peak of their ability to perform. Technology has also become a means by which players, teams, and analysts can “directly engage in an active exploration to understand why and how such information may have emerged.”2 The combination of technologies to track sports makes them a bit more like a video game, where every data point is ready to be pulled into analysis. Increasing the data available to analysts creates a feedback loop, where the data can increase understanding to lead to new questions and new technological development in order to continue to refine the meta. Although there is likely to be a point of diminishing returns for both the technology and the analysis, that point will probably come when a sport is solved, which will make it far less interesting to watch and play. Baseball offers up an example of a sport that stands as a largely solved game, as analytics are widely accepted and their lessons frame strategy and play. Along the road toward solving a sport, data analysis leads to insights that change how certain teams play the game. When those teams overperform, their tactics are copied, frequently changing how the game is played and often upending decades of tradition in establishing a new “best” way to play. In baseball this shows up in defensive shifts where instead of dividing the field equally, defenders align themselves in a manner matched to where the hitter typically strikes the ball. In basketball, the three-point revolution took over as teams recognized that shots worth three points are expected to generate more points than long two-pointers and basically every shot other than those very close to the basket.3 In soccer, pressing dominates as elite teams noted that being able to win the ball high up the field makes them more likely to score and renders the opposition less likely to get a shot off. Football analytics found what Madden players had known for years, which is that going for it more often on fourth down increases offensive production (and is generally more fun). Throughout these changes, there is a back and forth as analytics debuts some new insight and established norms within the game resist. A strategy that is proven to be more effective in the long run does not take hold unless a coach or manager makes it to the long run in the first place by not getting fired. Short-run struggles, especially for those with novel approaches, can quickly leads to questions from the media and fans, potentially ending a career. For a new meta to really get established, it not only has to work, but it has to do so fairly quickly, and then as it spreads, it can become the new set of norms the next insight will have to overcome.","system instruction: For this task, you are required to answer questions using the information--and ONLY the information--provided as part of the prompt. Do NOT use any resources outside of this information to answer the questions, question: Give examples of how data analytics has changed the way baseball, basketball, and soccer are played. context block: A core factor in fueling the widespread adoption of analytics in sports is the integration of technology. Although it is fairly straightforward to track all the action in a computer game, as they are ultimately mediated by lines of code and actions within the video game can be dumped into spreadsheets and databases for analysis, sports happen within a framework where the data must be collected before it can be assessed. In line with James’s early concerns about the poor state of play-by-play data in baseball, major sports leagues have invested greatly in the integration of technology to assess players and how they interact in games. Baseball pitches are tracked and the results compared with the strike zone to rate umpires. A company called Second Spectrum uses technology originally designed to track missiles to map how players move on basketball courts and soccer pitches, enabling comparative analysis about how players defend, run, and generally play the game. Catapult developed a wearable system that tracks how players stress their bodies during practice and games, aiding the ability to determine when players need a rest and when they are likely at the peak of their ability to perform. Technology has also become a means by which players, teams, and analysts can “directly engage in an active exploration to understand why and how such information may have emerged.”2 The combination of technologies to track sports makes them a bit more like a video game, where every data point is ready to be pulled into analysis. Increasing the data available to analysts creates a feedback loop, where the data can increase understanding to lead to new questions and new technological development in order to continue to refine the meta. Although there is likely to be a point of diminishing returns for both the technology and the analysis, that point will probably come when a sport is solved, which will make it far less interesting to watch and play. Baseball offers up an example of a sport that stands as a largely solved game, as analytics are widely accepted and their lessons frame strategy and play. Along the road toward solving a sport, data analysis leads to insights that change how certain teams play the game. When those teams overperform, their tactics are copied, frequently changing how the game is played and often upending decades of tradition in establishing a new “best” way to play. In baseball this shows up in defensive shifts where instead of dividing the field equally, defenders align themselves in a manner matched to where the hitter typically strikes the ball. In basketball, the three-point revolution took over as teams recognized that shots worth three points are expected to generate more points than long two-pointers and basically every shot other than those very close to the basket.3 In soccer, pressing dominates as elite teams noted that being able to win the ball high up the field makes them more likely to score and renders the opposition less likely to get a shot off. Football analytics found what Madden players had known for years, which is that going for it more often on fourth down increases offensive production (and is generally more fun). Throughout these changes, there is a back and forth as analytics debuts some new insight and established norms within the game resist. A strategy that is proven to be more effective in the long run does not take hold unless a coach or manager makes it to the long run in the first place by not getting fired. Short-run struggles, especially for those with novel approaches, can quickly leads to questions from the media and fans, potentially ending a career. For a new meta to really get established, it not only has to work, but it has to do so fairly quickly, and then as it spreads, it can become the new set of norms the next insight will have to overcome.",Internet/Technology,Fact Finding,Q&A "The answer you present must be derived solely from the information within the prompt. No past knowledge or external sources can be used. If the context alone isn't enough to answer the prompt, please say so.",What does H.R. 4611 entail?,"Artificial Intelligence (AI) and Campaign Finance Policy: Recent Developments Updated August 27, 2024 No federal statute or regulation specifically addresses artificial intelligence (AI) in political campaigns. The Federal Election Campaign Act (FECA) and Federal Election Commission (FEC) regulations govern conduct that calls for election or defeat of federal candidates or solicits funds. They also regulate some advertisements (electioneering communications) that refer to clearly identified federal candidates during preelection periods that do not call for election or defeat. Disclaimer requirements that mandate attribution for communications regulated by campaign finance law appear to apply to ads created with AI. Those requirements do not mandate that such advertising alert the audience, or regulators, to the presence of AI-generated content. Campaign management decisions, such as which technology to use, are generally not subject to regulation. This updated CRS Insight discusses recent developments that could be relevant as Congress monitors or considers legislation related to AI and campaign finance policy. It does not address legal issues. Other CRS products provide information on generative AI and other AI policy areas. AI in Political Campaigns, and Recent Legislative Developments Recent policy attention to AI in campaigns focuses on “deepfakes,” referring to artificially manipulated audio or video content in political advertising. Such advertising appears to present new challenges for campaigns and voters about how to determine whether communications are authentic. Recent legislation proposes disclaimers, reporting requirements, or prohibitions on deepfakes in federal campaigns or elections. Bills introduced in the 118th Congress include H.R. 3044; H.R. 3106; H.R. 3831; H.R. 4611; H.R. 5586; H.R. 8384; H.R. 8668; S. 686; S. 1596; S. 2770; and S. 3875. The Senate Committee on Rules and Administration reported an amended version of S. 3875 on May 15, 2024. The bill would amend FECA to require disclaimers on certain political advertisements that are generated using AI. Legislation (H.R. 1; H.R. 5314) addressing various elections topics, including some provisions concerning deepfakes, passed the House in the 117th Congress but was not enacted. In May 2023, the American Association of Political Consultants (AAPC) issued a statement explaining that its board of directors unanimously “condemn[ed] use of deceptive generative AI content in political campaigns” as inconsistent with the organization’s code of ethics. The AAPC position represents a Congressional Research Service https://crsreports.congress.gov IN12222 Congressional Research Service 2 voluntary professional standard, not a regulatory requirement. The AAPC also stated its support for a February 2024 Federal Communications Commission (FCC) declaratory ruling that calls made with AI-generated voices are “artificial” under the Automated Telephone Consumer Protection Act of 1991 (47 U.S.C. §227), and that using AI-generated voice for robocalls absent prior consumer consent is “illegal.” FCC activity on robocalls is otherwise beyond the scope of this Insight. Despite the focus on AI’s role in political advertising, AI also can serve campaign-management functions. For example, political professionals or volunteers could use AI to automate, or supplement human labor to complete, various internal campaign tasks. According to media reports, campaigns have used AI to perform data analysis, compile opposition research, or draft fundraising appeals. Federal Election Commission Rulemaking Activity On June 22, 2023, members of the FEC deadlocked on whether to issue a notice of availability (NOA) to receive comments on an AI rulemaking petition from the interest group Public Citizen. The request asked the FEC to issue rules specifying that the FEC fraudulent misrepresentation of campaign authority prohibition (52 U.S.C. §30124) applied to AI-generated ads. At the June 22 meeting, some commissioners expressed skepticism about the agency’s statutory authority to regulate AI ads; others expressed support for a rulemaking. On July 13, 2023, several Members of Congress wrote to the commission expressing “disappoint[ment]” with the FEC’s action and requested additional information. Also on July 13, 2023, Public Citizen submitted a new rulemaking petition. The commission considered the new petition on August 10, 2023. In this case, it approved an NOA. Discussion at the August 10 meeting suggested that at least some commissioners continued to have reservations about the commission’s authority concerning regulating AI ads in particular; about the appropriateness of the FECA fraudulent misrepresentation provision as an avenue to do so; or both. Fifty-two Members of Congress submitted joint comments encouraging the FEC to adopt rules specifying that the fraudulent-misrepresentation provisions apply to ads created using generative AI, and to require disclaimers on ads created with the technology. In August 2024, three commissioners proposed a notice of disposition (NOD) for the second Public Citizen rulemaking request, following the NOA noted above. The draft proposes to explain that the commission declines to issue rules in this instance for, among other reasons, lack of statutory authority. The commission is scheduled to consider the draft NOD on August 29. FEC Responses to Federal Communications Commission Activity Some House and Senate activity has examined a proposed FCC rulemaking that does not directly implicate campaign finance policy and which is largely beyond the scope of this Insight. On July 25, 2024, the FCC approved a notice of proposed rulemaking (NPRM), published in the Federal Register on August 5. If approved, the rules would require certain licensees (e.g., broadcasters) to (1) announce on air that a political ad contains “AI-generated content”; and (2) include the information in their “political files” of advertising contracts. Another CRS product discusses identification requirements on political advertising in telecommunications law and regulation. On June 3, 2024, FEC Chair Sean Cooksey wrote to FCC Chair Jessica Rosenworcel, stating that the reportedly forthcoming FCC proposed rules would infringe on FEC jurisdiction and could cause confusion before the general election. Three days later, FEC Vice Chair Ellen Weintraub wrote to Rosenworcel stating that the FCC could add telecommunications expertise to AI regulation. It is unclear how or whether the FEC might respond if the FCC adopted the proposed rules. Congressional Research Service 3 IN12222 · VERSION 5 · UPDATED Potential Policy Considerations for Congress If pursuing legislation, Congress might need to determine whether to do so narrowly, such as by addressing specific AI issues, or to also address other campaign finance or elections topics. Congress has pursued both approaches to campaign finance regulation recently. If Congress chose to task the FEC with pursuing rulemaking without also providing additional statutory guidance, it is possible that the commission would be unable to agree, with the four of six minimum required votes, about how to proceed. Maintaining the status quo likely would reinforce the emerging debate about whether additional regulation is needed, including about what role industry should play. Congress could also require agency (or committee or task force) study of AI issues before, or in addition to, other policymaking. Amending FECA would be a typical approach to further regulate ads that are made by political committees; or that solicit funds, engage in express advocacy, or refer to federal candidates through electioneering communications. Although Congress could also amend FECA or another statute to require disclaimers on ads that do not meet those requirements (e.g., issue advocacy), federal campaign finance law currently generally does not regulate issue advocacy. As noted above, amending telecommunications law or regulation could affect broadcasters or other entities that transmit ads, and could affect issue advocacy in ways that campaign finance law and regulation do not. Prohibiting AI-generated ads might raise First Amendment concerns, such as those discussed in another CRS campaign finance product. Author Information R. Sam Garrett Specialist in American National Government","System instruction: [The answer you present must be derived solely from the information within the prompt. No past knowledge or external sources can be used. If the context alone isn't enough to answer the prompt, please say so.] context: [Artificial Intelligence (AI) and Campaign Finance Policy: Recent Developments Updated August 27, 2024 No federal statute or regulation specifically addresses artificial intelligence (AI) in political campaigns. The Federal Election Campaign Act (FECA) and Federal Election Commission (FEC) regulations govern conduct that calls for election or defeat of federal candidates or solicits funds. They also regulate some advertisements (electioneering communications) that refer to clearly identified federal candidates during preelection periods that do not call for election or defeat. Disclaimer requirements that mandate attribution for communications regulated by campaign finance law appear to apply to ads created with AI. Those requirements do not mandate that such advertising alert the audience, or regulators, to the presence of AI-generated content. Campaign management decisions, such as which technology to use, are generally not subject to regulation. This updated CRS Insight discusses recent developments that could be relevant as Congress monitors or considers legislation related to AI and campaign finance policy. It does not address legal issues. Other CRS products provide information on generative AI and other AI policy areas. AI in Political Campaigns, and Recent Legislative Developments Recent policy attention to AI in campaigns focuses on “deepfakes,” referring to artificially manipulated audio or video content in political advertising. Such advertising appears to present new challenges for campaigns and voters about how to determine whether communications are authentic. Recent legislation proposes disclaimers, reporting requirements, or prohibitions on deepfakes in federal campaigns or elections. Bills introduced in the 118th Congress include H.R. 3044; H.R. 3106; H.R. 3831; H.R. 4611; H.R. 5586; H.R. 8384; H.R. 8668; S. 686; S. 1596; S. 2770; and S. 3875. The Senate Committee on Rules and Administration reported an amended version of S. 3875 on May 15, 2024. The bill would amend FECA to require disclaimers on certain political advertisements that are generated using AI. Legislation (H.R. 1; H.R. 5314) addressing various elections topics, including some provisions concerning deepfakes, passed the House in the 117th Congress but was not enacted. In May 2023, the American Association of Political Consultants (AAPC) issued a statement explaining that its board of directors unanimously “condemn[ed] use of deceptive generative AI content in political campaigns” as inconsistent with the organization’s code of ethics. The AAPC position represents a Congressional Research Service https://crsreports.congress.gov IN12222 Congressional Research Service 2 voluntary professional standard, not a regulatory requirement. The AAPC also stated its support for a February 2024 Federal Communications Commission (FCC) declaratory ruling that calls made with AI-generated voices are “artificial” under the Automated Telephone Consumer Protection Act of 1991 (47 U.S.C. §227), and that using AI-generated voice for robocalls absent prior consumer consent is “illegal.” FCC activity on robocalls is otherwise beyond the scope of this Insight. Despite the focus on AI’s role in political advertising, AI also can serve campaign-management functions. For example, political professionals or volunteers could use AI to automate, or supplement human labor to complete, various internal campaign tasks. According to media reports, campaigns have used AI to perform data analysis, compile opposition research, or draft fundraising appeals. Federal Election Commission Rulemaking Activity On June 22, 2023, members of the FEC deadlocked on whether to issue a notice of availability (NOA) to receive comments on an AI rulemaking petition from the interest group Public Citizen. The request asked the FEC to issue rules specifying that the FEC fraudulent misrepresentation of campaign authority prohibition (52 U.S.C. §30124) applied to AI-generated ads. At the June 22 meeting, some commissioners expressed skepticism about the agency’s statutory authority to regulate AI ads; others expressed support for a rulemaking. On July 13, 2023, several Members of Congress wrote to the commission expressing “disappoint[ment]” with the FEC’s action and requested additional information. Also on July 13, 2023, Public Citizen submitted a new rulemaking petition. The commission considered the new petition on August 10, 2023. In this case, it approved an NOA. Discussion at the August 10 meeting suggested that at least some commissioners continued to have reservations about the commission’s authority concerning regulating AI ads in particular; about the appropriateness of the FECA fraudulent misrepresentation provision as an avenue to do so; or both. Fifty-two Members of Congress submitted joint comments encouraging the FEC to adopt rules specifying that the fraudulent-misrepresentation provisions apply to ads created using generative AI, and to require disclaimers on ads created with the technology. In August 2024, three commissioners proposed a notice of disposition (NOD) for the second Public Citizen rulemaking request, following the NOA noted above. The draft proposes to explain that the commission declines to issue rules in this instance for, among other reasons, lack of statutory authority. The commission is scheduled to consider the draft NOD on August 29. FEC Responses to Federal Communications Commission Activity Some House and Senate activity has examined a proposed FCC rulemaking that does not directly implicate campaign finance policy and which is largely beyond the scope of this Insight. On July 25, 2024, the FCC approved a notice of proposed rulemaking (NPRM), published in the Federal Register on August 5. If approved, the rules would require certain licensees (e.g., broadcasters) to (1) announce on air that a political ad contains “AI-generated content”; and (2) include the information in their “political files” of advertising contracts. Another CRS product discusses identification requirements on political advertising in telecommunications law and regulation. On June 3, 2024, FEC Chair Sean Cooksey wrote to FCC Chair Jessica Rosenworcel, stating that the reportedly forthcoming FCC proposed rules would infringe on FEC jurisdiction and could cause confusion before the general election. Three days later, FEC Vice Chair Ellen Weintraub wrote to Rosenworcel stating that the FCC could add telecommunications expertise to AI regulation. It is unclear how or whether the FEC might respond if the FCC adopted the proposed rules. Congressional Research Service 3 IN12222 · VERSION 5 · UPDATED Potential Policy Considerations for Congress If pursuing legislation, Congress might need to determine whether to do so narrowly, such as by addressing specific AI issues, or to also address other campaign finance or elections topics. Congress has pursued both approaches to campaign finance regulation recently. If Congress chose to task the FEC with pursuing rulemaking without also providing additional statutory guidance, it is possible that the commission would be unable to agree, with the four of six minimum required votes, about how to proceed. Maintaining the status quo likely would reinforce the emerging debate about whether additional regulation is needed, including about what role industry should play. Congress could also require agency (or committee or task force) study of AI issues before, or in addition to, other policymaking. Amending FECA would be a typical approach to further regulate ads that are made by political committees; or that solicit funds, engage in express advocacy, or refer to federal candidates through electioneering communications. Although Congress could also amend FECA or another statute to require disclaimers on ads that do not meet those requirements (e.g., issue advocacy), federal campaign finance law currently generally does not regulate issue advocacy. As noted above, amending telecommunications law or regulation could affect broadcasters or other entities that transmit ads, and could affect issue advocacy in ways that campaign finance law and regulation do not. Prohibiting AI-generated ads might raise First Amendment concerns, such as those discussed in another CRS campaign finance product. Author Information R. Sam Garrett Specialist in American National Government] question: [What does H.R. 4611 entail?]",Internet/Technology,Fact Finding,Q&A You only have access to the provided information to answer questions.,What could happen if someone has an emergency related to HT? Explain in bullet points then summarize in 1 paragraph.,"Key issues for the Providers: 1. Most people with hypertension in India are unaware of their condition. To improve rates of detection of hypertension, all adults over the age of 18 should undergo opportunistic screening for hypertension during visits to non-physician health staff as well as health facilities. In addition, community based health workers should also do targeted screening of high risk groups under their care – elderly > 60 years, diabetic, obese, those with any cardiovascular disease, family history of premature cardiovascular disease. 2. Screening for hypertension should involve measurement of blood pressure using a validated device ( mercury or digital) with an appropriate sized cuff, following a standardised procedure on a relaxed patient, seated with arm supported at the heart level with the legs uncrossed. Diagnosis of hypertension should be based on a minimum of 2 sets of readings on 2 different occasions, which are at least 1-4 weeks apart, except in the case of hypertensive emergencies and urgencies. Hypertension in persons <80 years of age is diagnosed on documentation of persistent elevation of systolic BP of > 140 mm and/or 90 mm diastolic. 3. Patients should be educated about the nature of the disease and its therapy, about lifestyle modifications that can reduce BP and cardiovascular risk. Patients should undergo assessment for cardiovascular risk factors, target organ damage related to hypertension, associated clinical conditions like diabetes, chronic kidney disease, and cardiovascular disease ( e.g. coronary artery disease, stroke). Most of these assessments which involve history, clinical examination, and examination for proteinuria, diabetes, serum creatinine, lipids and ECG will be possible to complete at the PHC and CHC levels with the advent of the free diagnostics initiative. 4. Hypertension is a primary care issue and best managed at the primary care level with a team approach involving physicians, and allied staff. .Hypertension should be managed using a combination of lifestyle modifications and use of drug therapy with ACE inhibitors, Calcium channel blockers and thiazide diuretics, either alone or in combination. The benefit of treatment is related to reduction of BP rather than the use of a particular drug. All drug classes have equivalent effects but some are preferred in the presence of compelling indiccation. Both Calcium channel blockers and ACE inhibitors are effective, have few side effects, and have no adverse metabolic consequences or high requirements for monitoring. 5. The target BP should be less than < 140 mm systolic in persons < 80 year old and < 150 mm systolic in those over 80 years old, while the target diastolic BP is < 90 mm Hg. To achieve the target BP especially in those with Grade 2 and Grade 3 Hypertension may require the use of 2 or even drugs. Grade 1 HT which is uncomplicated, may be given a trial of lifestyle modifications alone for 3 months, 6. Efforts should be made to promote follow up and adherence to long term therapy to antihypertensive. In selected patients especially those with associated cardiovascular disease, both statin and aspirin may be given along with antihypertensive to reduce risk of CV event. In patients with diabetes, statins may be indicated. Key issues for the programme: 8Screening, Diagnosis, Assessment, and Management of Primary Hypertension- Full Document The screening of hypertension should be done by a physician or trained non physician staff, using an automated BP instrument or any other validated device, and following a standardised BP measurement procedure. 1.4.Blood pressure should be measured a few (5) minutes after the patient is in a relaxed state, is seated with the arm at the level of the heart, with legs uncrossed. The cuff should have a bladder whose length is about 80% and whose breadth is about 40% of the arm circumference. If the auscultation based method is being used, the then the cuff should initially be inflated to at least 30 mm Hg beyond the point of disappearance of the radial pulse. It should then be deflated at a rate of 2- 3 mm per second. The first and the last audible Korotkoff sounds should be taken at the systolic BP and diastolic BP respectively. The column should be read to the nearest 2 mm Hg. 1.5.At least 2 readings should be taken at each visit with an interval of at least 1 minute between the measurements. If the two readings are substantially different a third reading should be taken. The lower of the two readings should be taken as the representative SBP and DBP. Hypertensive emergencies are potentially life-threatening situations where hypertension (usually severe and > 180 mm systolic and >120 mm diastolic associated with the presence of recent onset and progressive target organ damage resulting in cardiovascular, neurologic, renal and visual dysfunction. These situations may include severe hypertension associated with acute coronary syndrome (chest pain), acute left ventricular dysfunction (shortness of breath), and hypertensive encephalopathy (altered sensorium), stroke (focal weakness), and renal failure. It is most often associated with severe hypertension, except in children and pregnant women where hypertensive emergencies can occur with lower elevations of BP. The induction and orientation session was held on 21st July 2015 in which the facilitator (Chair) welcomed all the members of the subgroup, and set up the rules of operation based on the STG development manual, on the consistent use of terminology and definitions, using the structured power-point presentation provided by NHSRC/NICE. None of the members report any conflict of interest in the development of this guideline and have all signed their declarations 2. Search and selection of evidence based guidelines: In view of the paucity of time available to develop this guideline, a decision was taken by the Task Force for the Development of STGs for the National Health Mission that these STGs would be adopted and/or adapted from existing evidence based guidelines to make them relevant to our context, resource settings and priorities. A search was conducted for evidence based guidelines on primary hypertension, which had been published within the past 5 years and which had been framed using evidence based methodology and using international guideline development criteria. The National Guidelines Clearinghouse (NGC) website was used since the guidelines have already gone through a rigorous ‘quality’ sifts based on international standards (http://www.guideline.gov/). The criteria for Inclusion of Clinical Practice Guidelines in NGC are based on the Institute of Medicine (IOM) Clinical Guidelines Standards 2011 and IOM systematic review standards 2014. The guidelines available on the database have been developed, reviewed, or revised within the past five years. The NGC entry criteria are similar to the AGREE II Instrument criteria5 ","You only have access to the provided information to answer questions. What could happen if someone has an emergency related to HT? Explain in bullet points then summarize in 1 paragraph. Key issues for the Providers: 1. Most people with hypertension in India are unaware of their condition. To improve rates of detection of hypertension, all adults over the age of 18 should undergo opportunistic screening for hypertension during visits to non-physician health staff as well as health facilities. In addition, community based health workers should also do targeted screening of high risk groups under their care – elderly > 60 years, diabetic, obese, those with any cardiovascular disease, family history of premature cardiovascular disease. 2. Screening for hypertension should involve measurement of blood pressure using a validated device ( mercury or digital) with an appropriate sized cuff, following a standardised procedure on a relaxed patient, seated with arm supported at the heart level with the legs uncrossed. Diagnosis of hypertension should be based on a minimum of 2 sets of readings on 2 different occasions, which are at least 1-4 weeks apart, except in the case of hypertensive emergencies and urgencies. Hypertension in persons <80 years of age is diagnosed on documentation of persistent elevation of systolic BP of > 140 mm and/or 90 mm diastolic. 3. Patients should be educated about the nature of the disease and its therapy, about lifestyle modifications that can reduce BP and cardiovascular risk. Patients should undergo assessment for cardiovascular risk factors, target organ damage related to hypertension, associated clinical conditions like diabetes, chronic kidney disease, and cardiovascular disease ( e.g. coronary artery disease, stroke). Most of these assessments which involve history, clinical examination, and examination for proteinuria, diabetes, serum creatinine, lipids and ECG will be possible to complete at the PHC and CHC levels with the advent of the free diagnostics initiative. 4. Hypertension is a primary care issue and best managed at the primary care level with a team approach involving physicians, and allied staff. .Hypertension should be managed using a combination of lifestyle modifications and use of drug therapy with ACE inhibitors, Calcium channel blockers and thiazide diuretics, either alone or in combination. The benefit of treatment is related to reduction of BP rather than the use of a particular drug. All drug classes have equivalent effects but some are preferred in the presence of compelling indiccation. Both Calcium channel blockers and ACE inhibitors are effective, have few side effects, and have no adverse metabolic consequences or high requirements for monitoring. 5. The target BP should be less than < 140 mm systolic in persons < 80 year old and < 150 mm systolic in those over 80 years old, while the target diastolic BP is < 90 mm Hg. To achieve the target BP especially in those with Grade 2 and Grade 3 Hypertension may require the use of 2 or even drugs. Grade 1 HT which is uncomplicated, may be given a trial of lifestyle modifications alone for 3 months, 6. Efforts should be made to promote follow up and adherence to long term therapy to antihypertensive. In selected patients especially those with associated cardiovascular disease, both statin and aspirin may be given along with antihypertensive to reduce risk of CV event. In patients with diabetes, statins may be indicated. Key issues for the programme: 8Screening, Diagnosis, Assessment, and Management of Primary Hypertension- Full Document The screening of hypertension should be done by a physician or trained non physician staff, using an automated BP instrument or any other validated device, and following a standardised BP measurement procedure. 1.4.Blood pressure should be measured a few (5) minutes after the patient is in a relaxed state, is seated with the arm at the level of the heart, with legs uncrossed. The cuff should have a bladder whose length is about 80% and whose breadth is about 40% of the arm circumference. If the auscultation based method is being used, the then the cuff should initially be inflated to at least 30 mm Hg beyond the point of disappearance of the radial pulse. It should then be deflated at a rate of 2- 3 mm per second. The first and the last audible Korotkoff sounds should be taken at the systolic BP and diastolic BP respectively. The column should be read to the nearest 2 mm Hg. 1.5.At least 2 readings should be taken at each visit with an interval of at least 1 minute between the measurements. If the two readings are substantially different a third reading should be taken. The lower of the two readings should be taken as the representative SBP and DBP. Hypertensive emergencies are potentially life-threatening situations where hypertension (usually severe and > 180 mm systolic and >120 mm diastolic associated with the presence of recent onset and progressive target organ damage resulting in cardiovascular, neurologic, renal and visual dysfunction. These situations may include severe hypertension associated with acute coronary syndrome (chest pain), acute left ventricular dysfunction (shortness of breath), and hypertensive encephalopathy (altered sensorium), stroke (focal weakness), and renal failure. It is most often associated with severe hypertension, except in children and pregnant women where hypertensive emergencies can occur with lower elevations of BP. The induction and orientation session was held on 21st July 2015 in which the facilitator (Chair) welcomed all the members of the subgroup, and set up the rules of operation based on the STG development manual, on the consistent use of terminology and definitions, using the structured power-point presentation provided by NHSRC/NICE. None of the members report any conflict of interest in the development of this guideline and have all signed their declarations 2. Search and selection of evidence based guidelines: In view of the paucity of time available to develop this guideline, a decision was taken by the Task Force for the Development of STGs for the National Health Mission that these STGs would be adopted and/or adapted from existing evidence based guidelines to make them relevant to our context, resource settings and priorities. A search was conducted for evidence based guidelines on primary hypertension, which had been published within the past 5 years and which had been framed using evidence based methodology and using international guideline development criteria. The National Guidelines Clearinghouse (NGC) website was used since the guidelines have already gone through a rigorous ‘quality’ sifts based on international standards (http://www.guideline.gov/). The criteria for Inclusion of Clinical Practice Guidelines in NGC are based on the Institute of Medicine (IOM) Clinical Guidelines Standards 2011 and IOM systematic review standards 2014. The guidelines available on the database have been developed, reviewed, or revised within the past five years. The NGC entry criteria are similar to the AGREE II Instrument criteria5",Medical,Find & Summarize,Text Transformation Respond with only information from the given context. Respond in list form with descriptions for each item. ,What are the organizational factors of productivity in knowledge work?,"Organisational input factors Already the terms knowledge-intensive organisation and knowledge workers highlight the fact that human capital of employees is the most important input. Their ability to convert previous knowledge and experiences into new solutions forms the base for organisations’ operation. It is, in fact, what pure knowledge-intensive organisations are selling. Essential are not only the knowledge reserves of the workers, but also what they are able to do with them. (Drucker 1999, p. 84) Characteristic to knowledge work is also the element of learning. For example a person working in product development has to be able to observe his research subject and to learn from it, as well as to be able to apply the things he learns into new products. To a certain point, also a knowledge worker’s productivity can be increased by education, but above all, as Polanyi (1966) states it, most of the exploitable human capital is tacit in nature and is formed through experience rather than learned from books (according to Nonaka and Takeuchi 1995, pp. 59-61). Because human memory is limited, it is relevant that workers can share their information and knowledge with each other – learn themselves but also teach others (Drucker 1999, pp. 84). Learning and the ability to create new things are also highlighted when the organisation’s objective is to innovate. Organisation’s innovativeness can be defined as an ability to maintain existing success factors at the same time, when new solutions are made in order to ensure competitive advantage also in future (Pöyhönen 2004, Ståhle et al. 2004, p. 13). The innovative potential is basically in the employees, but it can be brought about by different managerial actions. It requires at least an implication from the management that innovative behaviour is what is expected from the employee. Innovativeness appears as worker’s ability to create new solutions and not just relying on existing practises and models. On the other hand, sharing of information is important when we think about information used in work process. This includes not only information that is gathered from the customer but 6 also information, which already exists in the organisation but is not specifically “owned” by certain employee. Just as in manual work, waiting and searching for resources hinders productivity of a knowledge worker – their resources are only immaterial in nature and it might be more difficult to pay attention to the time used in looking for information. It often is a part of the work to look for adequate new information. However, it is not productive that employees should spend time looking for information that already exists but is too difficult to find. Although information systems are nowadays used by virtually all companies, and are therefore seen more as a tool instead of a resource, their importance in information sharing is undeniable. Especially important is the worker’s ability to exploit them in their work and that information systems support the way an organisation answers to its customer’s needs. (Ståhle et al. 2004, p. 78) Information systems are, however, quite useless if the quality of information they include is low – information is, for example, wrong or incomplete. Knowledge workers make decisions based on the information available, and if it is unsatisfactory, outcome of the process can be poor in quality or even totally unusable for the customer. Information should not be shared only between the workers within organisation, but also with all interest groups. Organisational networks are a part of intellectual capital. An organisation can enforce some networks (customers, subcontractors, distributors, research partners etc.; Edvinsson and Malone 1997, p. 11) and provide its employees with sufficient means to attain information needed in their work. Insufficient networks can result in a deficit of information, which will evidently lead to inability to answer to customers’ needs and loss of competitive advantage. Although knowledge work is distinctively described as something, where the workers themselves decide, how they manage their tasks (Pepitone 2002 refers to the amount of discretion required), in every organization there are certain standards, routines and practices that have come about in the course of time. They are based on mental models that the members share, and often reflect the values, norms, beliefs and myths of the organisation (Juuti 2003 and Schein 1987 according to Ståhle et al. 2004. p. 82). These standards can either support working or hinder it. Anyhow, they do exist and should not be neglected when examining productivity. Castells (2000) has argued, that standardisation of work processes intensifies also knowledge work especially when there is interaction between different actors of the process (see also McKenzie and van Winkelen 2004, p. 40). On the other hand both Jackson (1999) and Blom et al. (2001) have emphasised the ability of a knowledge-intensive organisation to utilise new practices to concentrate on allowing employees to determine their own approaches. Time used in production is a rather complex input factor. Traditionally, productivity is seen increased if the output has been produced in shorter time period. This often happens also in knowledge work: when the workers learn how to do things and have more experience to which they can relate new problems they can perform similar tasks faster than before. However, there is a limit for how much time used can be decreased before the quality of work is eroded. In knowledge work, “quality is the essence of the output” (Drucker 1999, p. 84). Also, if a worker has too much time or too little work to do, his productivity can suffer. The key issue is to find the right balance. Working environment and its effect on productivity has been researched rather extensively. It is also the area, where subjective productivity measurement has been mostly used. Lighting, air conditioning, cleaning, heating, noise controlling as well as office layouts are known to affect productivity (see for example Seppänen 2004 or Oseland and Bartlett 1999). Working environment at its worst prevents employees from doing their job and its best can contribute to innovative atmosphere (Davenport et al. 2002; Ståhle et al. 2004, pp. 78-82) Working environment includes not only physical facilities but also the psychological atmosphere and the organisational culture. They can actually be even more important in knowledge work, as 7 for example acceptance of new ideas (Kanter 1987, p. 181), common language (DeSimone and Hatsopoulos 1995: Von Krogh 1998), values and goals (West 1990) as well as approval of different people and taking failures as part of innovative work are known to support innovative atmosphere in organisations (in Ståhle et al. 2004, pp. 82-95). But above all, even if the workers of knowledge-intensive organisation have all the other inputs described – human capital, knowledge and experiences, information systems, perfect working environment etc. – not much can be done with it, if they do not know what they are pursuing for. The clear aim of working is the essential for succeeding. As Drucker (1999, p. 84) puts it, the productivity assessment in knowledge work should always be based on the questions “What is the worker’s actual task?” instead of “How should the work be done?”. Therefore, in order to be able to fulfil their task, knowledge workers should be clearly aware what it is that the organisation wants them to do, and this should always be the first input to any process.","Respond with only information from the given context. Respond in list form with descriptions for each item. What are the organizational factors of productivity in knowledge work? Organisational input factors Already the terms knowledge-intensive organisation and knowledge workers highlight the fact that human capital of employees is the most important input. Their ability to convert previous knowledge and experiences into new solutions forms the base for organisations’ operation. It is, in fact, what pure knowledge-intensive organisations are selling. Essential are not only the knowledge reserves of the workers, but also what they are able to do with them. (Drucker 1999, p. 84) Characteristic to knowledge work is also the element of learning. For example a person working in product development has to be able to observe his research subject and to learn from it, as well as to be able to apply the things he learns into new products. To a certain point, also a knowledge worker’s productivity can be increased by education, but above all, as Polanyi (1966) states it, most of the exploitable human capital is tacit in nature and is formed through experience rather than learned from books (according to Nonaka and Takeuchi 1995, pp. 59-61). Because human memory is limited, it is relevant that workers can share their information and knowledge with each other – learn themselves but also teach others (Drucker 1999, pp. 84). Learning and the ability to create new things are also highlighted when the organisation’s objective is to innovate. Organisation’s innovativeness can be defined as an ability to maintain existing success factors at the same time, when new solutions are made in order to ensure competitive advantage also in future (Pöyhönen 2004, Ståhle et al. 2004, p. 13). The innovative potential is basically in the employees, but it can be brought about by different managerial actions. It requires at least an implication from the management that innovative behaviour is what is expected from the employee. Innovativeness appears as worker’s ability to create new solutions and not just relying on existing practises and models. On the other hand, sharing of information is important when we think about information used in work process. This includes not only information that is gathered from the customer but 6 also information, which already exists in the organisation but is not specifically “owned” by certain employee. Just as in manual work, waiting and searching for resources hinders productivity of a knowledge worker – their resources are only immaterial in nature and it might be more difficult to pay attention to the time used in looking for information. It often is a part of the work to look for adequate new information. However, it is not productive that employees should spend time looking for information that already exists but is too difficult to find. Although information systems are nowadays used by virtually all companies, and are therefore seen more as a tool instead of a resource, their importance in information sharing is undeniable. Especially important is the worker’s ability to exploit them in their work and that information systems support the way an organisation answers to its customer’s needs. (Ståhle et al. 2004, p. 78) Information systems are, however, quite useless if the quality of information they include is low – information is, for example, wrong or incomplete. Knowledge workers make decisions based on the information available, and if it is unsatisfactory, outcome of the process can be poor in quality or even totally unusable for the customer. Information should not be shared only between the workers within organisation, but also with all interest groups. Organisational networks are a part of intellectual capital. An organisation can enforce some networks (customers, subcontractors, distributors, research partners etc.; Edvinsson and Malone 1997, p. 11) and provide its employees with sufficient means to attain information needed in their work. Insufficient networks can result in a deficit of information, which will evidently lead to inability to answer to customers’ needs and loss of competitive advantage. Although knowledge work is distinctively described as something, where the workers themselves decide, how they manage their tasks (Pepitone 2002 refers to the amount of discretion required), in every organization there are certain standards, routines and practices that have come about in the course of time. They are based on mental models that the members share, and often reflect the values, norms, beliefs and myths of the organisation (Juuti 2003 and Schein 1987 according to Ståhle et al. 2004. p. 82). These standards can either support working or hinder it. Anyhow, they do exist and should not be neglected when examining productivity. Castells (2000) has argued, that standardisation of work processes intensifies also knowledge work especially when there is interaction between different actors of the process (see also McKenzie and van Winkelen 2004, p. 40). On the other hand both Jackson (1999) and Blom et al. (2001) have emphasised the ability of a knowledge-intensive organisation to utilise new practices to concentrate on allowing employees to determine their own approaches. Time used in production is a rather complex input factor. Traditionally, productivity is seen increased if the output has been produced in shorter time period. This often happens also in knowledge work: when the workers learn how to do things and have more experience to which they can relate new problems they can perform similar tasks faster than before. However, there is a limit for how much time used can be decreased before the quality of work is eroded. In knowledge work, “quality is the essence of the output” (Drucker 1999, p. 84). Also, if a worker has too much time or too little work to do, his productivity can suffer. The key issue is to find the right balance. Working environment and its effect on productivity has been researched rather extensively. It is also the area, where subjective productivity measurement has been mostly used. Lighting, air conditioning, cleaning, heating, noise controlling as well as office layouts are known to affect productivity (see for example Seppänen 2004 or Oseland and Bartlett 1999). Working environment at its worst prevents employees from doing their job and its best can contribute to innovative atmosphere (Davenport et al. 2002; Ståhle et al. 2004, pp. 78-82) Working environment includes not only physical facilities but also the psychological atmosphere and the organisational culture. They can actually be even more important in knowledge work, as 7 for example acceptance of new ideas (Kanter 1987, p. 181), common language (DeSimone and Hatsopoulos 1995: Von Krogh 1998), values and goals (West 1990) as well as approval of different people and taking failures as part of innovative work are known to support innovative atmosphere in organisations (in Ståhle et al. 2004, pp. 82-95). But above all, even if the workers of knowledge-intensive organisation have all the other inputs described – human capital, knowledge and experiences, information systems, perfect working environment etc. – not much can be done with it, if they do not know what they are pursuing for. The clear aim of working is the essential for succeeding. As Drucker (1999, p. 84) puts it, the productivity assessment in knowledge work should always be based on the questions “What is the worker’s actual task?” instead of “How should the work be done?”. Therefore, in order to be able to fulfil their task, knowledge workers should be clearly aware what it is that the organisation wants them to do, and this should always be the first input to any process.",Unknown,Find & Summarize,Text Transformation Create your answer using only information found in the context provided.,What are the circumstances in which someone should not take BuSpar?,"Renal Impairment After multiple-dose administration of buspirone to renally impaired (Clcr = 10– 70 mL/min/1.73 m2) patients, steady-state AUC of buspirone increased 4-fold compared with healthy (Clcr ≥80 mL/min/1.73 m2) subjects (see PRECAUTIONS). Race Effects The effects of race on the pharmacokinetics of buspirone have not been studied. INDICATIONS AND USAGE BuSpar is indicated for the management of anxiety disorders or the short-term relief of the symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. The efficacy of BuSpar has been demonstrated in controlled clinical trials of outpatients whose diagnosis roughly corresponds to Generalized Anxiety Disorder (GAD). Many of the patients enrolled in these studies also had coexisting depressive symptoms and BuSpar relieved anxiety in the presence of these coexisting depressive symptoms. The patients evaluated in these studies had experienced symptoms for periods of 1 month to over 1 year prior to the study, with an average symptom duration of 6 months. Generalized Anxiety Disorder (300.02) is described in the American Psychiatric Association's Diagnostic and Statistical Manual, III1 as follows: Generalized, persistent anxiety (of at least 1 month continual duration), manifested by symptoms from three of the four following categories: 1. Motor tension: shakiness, jitteriness, jumpiness, trembling, tension, muscle aches, fatigability, inability to relax, eyelid twitch, furrowed brow, strained face, fidgeting, restlessness, easy startle. 2. Autonomic hyperactivity: sweating, heart pounding or racing, cold, clammy hands, dry mouth, dizziness, lightheadedness, paresthesias (tingling in hands or feet), upset stomach, hot or cold spells, frequent urination, diarrhea, discomfort in the pit of the stomach, lump in the throat, flushing, pallor, high resting pulse and respiration rate. 4 Reference ID: 2867200 3. Apprehensive expectation: anxiety, worry, fear, rumination, and anticipation of misfortune to self or others. 4. Vigilance and scanning: hyperattentiveness resulting in distractibility, difficulty in concentrating, insomnia, feeling ""on edge,"" irritability, impatience. The above symptoms would not be due to another mental disorder, such as a depressive disorder or schizophrenia. However, mild depressive symptoms are common in GAD. The effectiveness of BuSpar in long-term use, that is, for more than 3 to 4 weeks, has not been demonstrated in controlled trials. There is no body of evidence available that systematically addresses the appropriate duration of treatment for GAD. However, in a study of long-term use, 264 patients were treated with BuSpar for 1 year without ill effect. Therefore, the physician who elects to use BuSpar for extended periods should periodically reassess the usefulness of the drug for the individual patient. CONTRAINDICATIONS BuSpar is contraindicated in patients hypersensitive to buspirone hydrochloride. WARNINGS The administration of BuSpar to a patient taking a monoamine oxidase inhibitor (MAOI) may pose a hazard. There have been reports of the occurrence of elevated blood pressure when BuSpar (buspirone hydrochloride) has been added to a regimen including an MAOI. Therefore, it is recommended that BuSpar not be used concomitantly with an MAOI. Because BuSpar has no established antipsychotic activity, it should not be employed in lieu of appropriate antipsychotic treatment. PRECAUTIONS General Interference with Cognitive and Motor Performance Studies indicate that BuSpar is less sedating than other anxiolytics and that it does not produce significant functional impairment. However, its CNS effects in any individual patient may not be predictable. Therefore, patients should be cautioned about operating an 5 Reference ID: 2867200 automobile or using complex machinery until they are reasonably certain that buspirone treatment does not affect them adversely. While formal studies of the interaction of BuSpar (buspirone hydrochloride) with alcohol indicate that buspirone does not increase alcohol-induced impairment in motor and mental performance, it is prudent to avoid concomitant use of alcohol and buspirone. Potential for Withdrawal Reactions in Sedative/Hypnotic/Anxiolytic Drug- Dependent Patients Because BuSpar does not exhibit cross-tolerance with benzodiazepines and other common sedative/hypnotic drugs, it will not block the withdrawal syndrome often seen with cessation of therapy with these drugs. Therefore, before starting therapy with BuSpar, it is advisable to withdraw patients gradually, especially patients who have been using a CNS-depressant drug chronically, from their prior treatment. Rebound or withdrawal symptoms may occur over varying time periods, depending in part on the type of drug, and its effective half-life of elimination. The syndrome of withdrawal from sedative/hypnotic/anxiolytic drugs can appear as any combination of irritability, anxiety, agitation, insomnia, tremor, abdominal cramps, muscle cramps, vomiting, sweating, flu-like symptoms without fever, and occasionally, even as seizures. Possible Concerns Related to Buspirone's Binding to Dopamine Receptors Because buspirone can bind to central dopamine receptors, a question has been raised about its potential to cause acute and chronic changes in dopamine-mediated neurological function (eg, dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia). Clinical experience in controlled trials has failed to identify any significant neuroleptic-like activity; however, a syndrome of restlessness, appearing shortly after initiation of treatment, has been reported in some small fraction of buspirone-treated patients. The syndrome may be explained in several ways. For example, buspirone may increase central noradrenergic activity; alternatively, the effect may be attributable to dopaminergic effects (ie, represent akathisia). See ADVERSE REACTIONS: Postmarketing Experience.","Create your answer using only information found in the context provided. What are the circumstances in which someone should not take BuSpar? Renal Impairment After multiple-dose administration of buspirone to renally impaired (Clcr = 10– 70 mL/min/1.73 m2) patients, steady-state AUC of buspirone increased 4-fold compared with healthy (Clcr ≥80 mL/min/1.73 m2) subjects (see PRECAUTIONS). Race Effects The effects of race on the pharmacokinetics of buspirone have not been studied. INDICATIONS AND USAGE BuSpar is indicated for the management of anxiety disorders or the short-term relief of the symptoms of anxiety. Anxiety or tension associated with the stress of everyday life usually does not require treatment with an anxiolytic. The efficacy of BuSpar has been demonstrated in controlled clinical trials of outpatients whose diagnosis roughly corresponds to Generalized Anxiety Disorder (GAD). Many of the patients enrolled in these studies also had coexisting depressive symptoms and BuSpar relieved anxiety in the presence of these coexisting depressive symptoms. The patients evaluated in these studies had experienced symptoms for periods of 1 month to over 1 year prior to the study, with an average symptom duration of 6 months. Generalized Anxiety Disorder (300.02) is described in the American Psychiatric Association's Diagnostic and Statistical Manual, III1 as follows: Generalized, persistent anxiety (of at least 1 month continual duration), manifested by symptoms from three of the four following categories: 1. Motor tension: shakiness, jitteriness, jumpiness, trembling, tension, muscle aches, fatigability, inability to relax, eyelid twitch, furrowed brow, strained face, fidgeting, restlessness, easy startle. 2. Autonomic hyperactivity: sweating, heart pounding or racing, cold, clammy hands, dry mouth, dizziness, lightheadedness, paresthesias (tingling in hands or feet), upset stomach, hot or cold spells, frequent urination, diarrhea, discomfort in the pit of the stomach, lump in the throat, flushing, pallor, high resting pulse and respiration rate. 4 Reference ID: 2867200 3. Apprehensive expectation: anxiety, worry, fear, rumination, and anticipation of misfortune to self or others. 4. Vigilance and scanning: hyperattentiveness resulting in distractibility, difficulty in concentrating, insomnia, feeling ""on edge,"" irritability, impatience. The above symptoms would not be due to another mental disorder, such as a depressive disorder or schizophrenia. However, mild depressive symptoms are common in GAD. The effectiveness of BuSpar in long-term use, that is, for more than 3 to 4 weeks, has not been demonstrated in controlled trials. There is no body of evidence available that systematically addresses the appropriate duration of treatment for GAD. However, in a study of long-term use, 264 patients were treated with BuSpar for 1 year without ill effect. Therefore, the physician who elects to use BuSpar for extended periods should periodically reassess the usefulness of the drug for the individual patient. CONTRAINDICATIONS BuSpar is contraindicated in patients hypersensitive to buspirone hydrochloride. WARNINGS The administration of BuSpar to a patient taking a monoamine oxidase inhibitor (MAOI) may pose a hazard. There have been reports of the occurrence of elevated blood pressure when BuSpar (buspirone hydrochloride) has been added to a regimen including an MAOI. Therefore, it is recommended that BuSpar not be used concomitantly with an MAOI. Because BuSpar has no established antipsychotic activity, it should not be employed in lieu of appropriate antipsychotic treatment. PRECAUTIONS General Interference with Cognitive and Motor Performance Studies indicate that BuSpar is less sedating than other anxiolytics and that it does not produce significant functional impairment. However, its CNS effects in any individual patient may not be predictable. Therefore, patients should be cautioned about operating an 5 Reference ID: 2867200 automobile or using complex machinery until they are reasonably certain that buspirone treatment does not affect them adversely. While formal studies of the interaction of BuSpar (buspirone hydrochloride) with alcohol indicate that buspirone does not increase alcohol-induced impairment in motor and mental performance, it is prudent to avoid concomitant use of alcohol and buspirone. Potential for Withdrawal Reactions in Sedative/Hypnotic/Anxiolytic Drug- Dependent Patients Because BuSpar does not exhibit cross-tolerance with benzodiazepines and other common sedative/hypnotic drugs, it will not block the withdrawal syndrome often seen with cessation of therapy with these drugs. Therefore, before starting therapy with BuSpar, it is advisable to withdraw patients gradually, especially patients who have been using a CNS-depressant drug chronically, from their prior treatment. Rebound or withdrawal symptoms may occur over varying time periods, depending in part on the type of drug, and its effective half-life of elimination. The syndrome of withdrawal from sedative/hypnotic/anxiolytic drugs can appear as any combination of irritability, anxiety, agitation, insomnia, tremor, abdominal cramps, muscle cramps, vomiting, sweating, flu-like symptoms without fever, and occasionally, even as seizures. Possible Concerns Related to Buspirone's Binding to Dopamine Receptors Because buspirone can bind to central dopamine receptors, a question has been raised about its potential to cause acute and chronic changes in dopamine-mediated neurological function (eg, dystonia, pseudo-parkinsonism, akathisia, and tardive dyskinesia). Clinical experience in controlled trials has failed to identify any significant neuroleptic-like activity; however, a syndrome of restlessness, appearing shortly after initiation of treatment, has been reported in some small fraction of buspirone-treated patients. The syndrome may be explained in several ways. For example, buspirone may increase central noradrenergic activity; alternatively, the effect may be attributable to dopaminergic effects (ie, represent akathisia). See ADVERSE REACTIONS: Postmarketing Experience.",Medical,Fact Finding,Q&A You may only respond with information from the text that I give you. Do not use outside information or your knowledge base.,How are mental health services handled with power of attorney?,"Except to the extent you state otherwise, this document gives the person you name as your agent the authority to make any and all health care decisions for you in accordance with your wishes, including your religious and moral beliefs, when you are unable to make the decisions for yourself. Because ""health care"" means any treatment, service, or procedure to maintain, diagnose, or treat your physical or mental condition, your agent has the power to make a broad range of health care decisions for you. Your agent may consent, refuse to consent, or withdraw consent to medical treatment and may make decisions about withdrawing or withholding life- sustaining treatment. Your agent may not consent to voluntary inpatient mental health services, convulsive treatment, psychosurgery, or abortion. A physician must comply with your agent's instructions or allow you to be transferred to another physician. Your agent's authority is effective when your doctor certifies that you lack the competence to make health care decisions. Your agent is obligated to follow your instructions when making decisions on your behalf. Unless you state otherwise, your agent has the same authority to make decisions about your health care as you would have if you were able to make health care decisions for yourself. It is important that you discuss this document with your physician or other health care provider before you sign the document to ensure that you understand the nature and range of decisions that may be made on your behalf. If you do not have a physician, you should talk with someone else who is knowledgeable about these issues and can answer your questions. You do not need a lawyer's assistance to complete this document, but if there is anything in this document that you do not understand, you should ask a lawyer to explain it to you. The person you appoint as agent should be someone you know and trust. The person must be 18 years of age or older or a person under 18 years of age who has had the disabilities of minority removed. If you appoint your health or residential care provider (e.g., your physician or an employee of a home health agency, hospital, nursing facility, or residential care facility, other than a relative), that person has to choose between acting as your agent or as your health or residential care provider; the law does not allow a person to serve as both at the same time. You should inform the person you appoint that you want the person to be your health care agent. You should discuss this document with your agent and your physician and give each a signed copy. You should indicate on the document itself the people and institutions that you intend to have signed copies. Your agent is not liable for health care decisions made in good faith on your behalf. Once you have signed this document, you have the right to make health care decisions for yourself as long as you are able to make those decisions, and treatment cannot be given to you or stopped over your objection. You have the right to revoke the authority granted to your agent by informing your agent or your health or residential care provider orally or in writing or by your execution of a subsequent medical power of attorney. Unless you state otherwise in this document, your appointment of a spouse is revoked if your marriage is dissolved, annulled, or declared void. This document may not be changed or modified. If you want to make changes in this document, you must execute a new medical power of attorney. You may wish to designate an alternate agent in the event that your agent is unwilling, unable, or ineligible to act as your agent. If you designate an alternate agent, the alternate agent has the same authority as the agent to make health care decisions for you. This Power Of Attorney Is Not Valid Unless: (1) You Sign It And Have Your Signature Acknowledged Before A Notary Public; Or (2) You Sign It In The Presence Of Two Competent Adult Witnesses. The Following Persons May Not Act As One Of The Witnesses: (1) the person you have designated as your agent; (2) a person related to you by blood or marriage; (3) a person entitled to any part of your estate after your death under a will or codicil executed by you or by operation of law; (4) your attending physician; (5) an employee of your attending physician; (6) an employee of a health care facility in which you are a patient if the employee is providing direct patient care to you or is an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility; or (7) a person who, at the time this medical power of attorney is executed, has a claim against any part of your estate after your death. ","How are mental health services handled with power of attorney? You may only respond with information from the text that I give you. Do not use outside information or your knowledge base. Except to the extent you state otherwise, this document gives the person you name as your agent the authority to make any and all health care decisions for you in accordance with your wishes, including your religious and moral beliefs, when you are unable to make the decisions for yourself. Because ""health care"" means any treatment, service, or procedure to maintain, diagnose, or treat your physical or mental condition, your agent has the power to make a broad range of health care decisions for you. Your agent may consent, refuse to consent, or withdraw consent to medical treatment and may make decisions about withdrawing or withholding life- sustaining treatment. Your agent may not consent to voluntary inpatient mental health services, convulsive treatment, psychosurgery, or abortion. A physician must comply with your agent's instructions or allow you to be transferred to another physician. Your agent's authority is effective when your doctor certifies that you lack the competence to make health care decisions. Your agent is obligated to follow your instructions when making decisions on your behalf. Unless you state otherwise, your agent has the same authority to make decisions about your health care as you would have if you were able to make health care decisions for yourself. It is important that you discuss this document with your physician or other health care provider before you sign the document to ensure that you understand the nature and range of decisions that may be made on your behalf. If you do not have a physician, you should talk with someone else who is knowledgeable about these issues and can answer your questions. You do not need a lawyer's assistance to complete this document, but if there is anything in this document that you do not understand, you should ask a lawyer to explain it to you. The person you appoint as agent should be someone you know and trust. The person must be 18 years of age or older or a person under 18 years of age who has had the disabilities of minority removed. If you appoint your health or residential care provider (e.g., your physician or an employee of a home health agency, hospital, nursing facility, or residential care facility, other than a relative), that person has to choose between acting as your agent or as your health or residential care provider; the law does not allow a person to serve as both at the same time. You should inform the person you appoint that you want the person to be your health care agent. You should discuss this document with your agent and your physician and give each a signed copy. You should indicate on the document itself the people and institutions that you intend to have signed copies. Your agent is not liable for health care decisions made in good faith on your behalf. Once you have signed this document, you have the right to make health care decisions for yourself as long as you are able to make those decisions, and treatment cannot be given to you or stopped over your objection. You have the right to revoke the authority granted to your agent by informing your agent or your health or residential care provider orally or in writing or by your execution of a subsequent medical power of attorney. Unless you state otherwise in this document, your appointment of a spouse is revoked if your marriage is dissolved, annulled, or declared void. This document may not be changed or modified. If you want to make changes in this document, you must execute a new medical power of attorney. You may wish to designate an alternate agent in the event that your agent is unwilling, unable, or ineligible to act as your agent. If you designate an alternate agent, the alternate agent has the same authority as the agent to make health care decisions for you. This Power Of Attorney Is Not Valid Unless: (1) You Sign It And Have Your Signature Acknowledged Before A Notary Public; Or (2) You Sign It In The Presence Of Two Competent Adult Witnesses. The Following Persons May Not Act As One Of The Witnesses: (1) the person you have designated as your agent; (2) a person related to you by blood or marriage; (3) a person entitled to any part of your estate after your death under a will or codicil executed by you or by operation of law; (4) your attending physician; (5) an employee of your attending physician; (6) an employee of a health care facility in which you are a patient if the employee is providing direct patient care to you or is an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility; or (7) a person who, at the time this medical power of attorney is executed, has a claim against any part of your estate after your death. ",Medical,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",Uncle Joe has a mental condition and he thinks he served during World War 2 in 1945 three years. In 1965 we found out that he was only active duty for training in the Guard and Reserves for those three years. Does Uncle Joe's service in the military make him eligible for VA financing?,"SERVICE ELIGIBILITY You are eligible for VA financing if your service falls within any of the following categories: Wartime Service. If you served any time during:  World War II (September 16, 1940 to July 25, 1947),  Korean Conflict (June 27, 1950 to January 31, 1955),  Vietnam Era (August 5, 1964 to May 7, 1975), the Vietnam Era begins February 28, 1961 for individuals who served in the Republic of Vietnam.  Persian Gulf War (August 2, 1990 to present (requires service for 2 years or the full period for which called to active duty, except that exceptions applying to service between September 7, 1980 and August 1, 1990 also apply to Persian Gulf War).) See below. You must have served at least 90 days on active duty and been discharged or released under other than dishonorable conditions. If you served less than 90 days, you may be eligible if discharged because of a service-connected disability. Peacetime Service. If your service fell entirely within any one of the following periods:  July 26, 1947 to June 26, 1950,  February 1, 1955 to August 4, 1964, or  May 8, 1975 to September 7, 1980 (if enlisted) or to October 16, 1981 (if officer, you must have served at least 181 days of continuous active duty and been discharged or released under conditions other than dishonorable). If you served less than 181 days, you may be eligible if discharged because of a service-connected disability. Service between September 7, 1980 (enlisted) or October 16, 1981 (officer) and August 1, 1990. If your entire period of service was between September 7, 1980 (October 16, 1981) and August 1, 1990, you must have:  Completed 24 months of continuous active duty or the full period (at least 181 days) for which you were called or ordered to active duty, and been discharged or released under conditions other than dishonorable. You may also be determined eligible if you were discharged for a service-connected disability, or you were discharged for the convenience of the Government after completing at least 20 months of a 2-year enlistment, or you completed 181 days of active duty and: were discharged because of a hardship, or were determined to have a service-connected compensable disability, or were discharged or released from active duty for a medical condition which preexisted service and has not been determined to be service-connected, or If the certificate cannot be issued by ACE, you can request it from VA, by completing VA Form 26-1880, “Request for A Certificate of Eligibility.” The form should be submitted along with either • received an involuntary discharge or release from active duty for the convenience of the Government as a result of a reduction in force, or were discharged or released from active duty for a physical or mental condition not characterized as a disability and not the result of misconduct, but which did interfere with your performance of duty. NOTE: During the Persian Gulf War, the foregoing exceptions to the 2-year requirement apply, except that 90 days of active duty is sufficient in lieu of 181 days. Active Duty Service Personnel. If you are now on active duty, eligibility can be established after having served on continuous active duty for at least 90 days. Upon discharge or release from active duty, eligibility must be reestablished. Members of the Selected Reserve. Individuals who are not otherwise eligible and who have completed at least 6 years in the Reserves or National Guard, or been discharged because of a service-connected disability, and  have been discharged with an honorable discharge, or  have been placed on the retired list, or  have been transferred to an element of the Ready reserve other than the Selected Reserve, or  continue to serve in the Selected Reserve are eligible for a GI loan. Other Types of Service Certain United States citizens who served in the armed forces of a government allied with the United States in World War II. Unmarried surviving spouses of the above-described eligible persons who died as the result of service or service-connected injuries (Children of deceased veterans are not eligible). NOTE: Also, a surviving spouse who remarried on or after attaining age 57, and on or after December 16, 2003, may be eligible for the home loan benefit. The spouse of any member of the Armed Forces serving on active duty who is listed as missing in action, or is a prisoner of war and has been so listed for a total of more than 90 days.  Individuals with service as members in certain other organizations, services, programs and schools may also be eligible. Questions about whether this service qualifies for home loan benefits should be referred to your VA Regional Loan Center. Obtaining a Certificate of Eligibility VA determines your eligibility and, if you are qualified, a Certificate of Eligibility will be issued. ACE (automated certificate of eligibility): In some cases veterans can obtain the Certificate of Eligibility from a lender. Most lenders have access to the ACE system. This Internet based application can establish eligibility and issue an online Certificate of Eligibility in a matter of seconds. Not all cases can be processed through ACE - only those for which VA has sufficient data in our records. However, veterans are encouraged to ask their lenders about this method of obtaining a certificate. the originals or legible copies of your most recent discharge or separation papers covering active military duty since September 16, 1940, which show active duty dates and type of discharge. This form may be obtained from VA or at http://www.va.gov/vaforms/. If you were separated after January 1, 1950, you must submit DD Form 214, Certificate of Release or Discharge From Active Duty. In addition, if you are now on active duty and have not been previously discharged from active duty service, you must submit a statement of service which includes the name of the issuing authority (base or command), and is signed by or at the direction of an appropriate official. The statement must include date of entry on active duty and the duration of any time lost. Since there is no uniform document similar to the DD214 for proof of service in the Selected Reserve, a number of different forms may be accepted as documentation of service in the Selected Reserve. For those who served in the Army or Air National Guard and were discharged after at least 6 years of such service, NGB Form 22 may be sufficient. Those who served in the Army, Navy, Air Force, Marine Corps or Coast Guard Reserves may need to rely on any of a variety of forms that document at least 6 years of honorable service. Often, it will be necessary to submit a combination of documents such as an Honorable Discharge certificate together with a retirement point’s statement. It is the reservist's responsibility to obtain and submit documentation of 6 years of honorable service. The Request for Certificate of Eligibility, VA Form 26-1880, should be mailed to the Atlanta Regional Loan Center, ATTN: COE (262), P.O. Box 100034, Decature, GA 30031. The Eligibility Center also maintains a toll free number (888-768-2132) for persons seeking information on eligibility.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Uncle Joe has a mental condition and he thinks he served during World War 2 in 1945 three years. In 1965 we found out that he was only active duty for training in the Guard and Reserves for those three years. Does Uncle Joe's service in the military make him eligible for VA financing? {passage 0} ========== SERVICE ELIGIBILITY You are eligible for VA financing if your service falls within any of the following categories: Wartime Service. If you served any time during:  World War II (September 16, 1940 to July 25, 1947),  Korean Conflict (June 27, 1950 to January 31, 1955),  Vietnam Era (August 5, 1964 to May 7, 1975), the Vietnam Era begins February 28, 1961 for individuals who served in the Republic of Vietnam.  Persian Gulf War (August 2, 1990 to present (requires service for 2 years or the full period for which called to active duty, except that exceptions applying to service between September 7, 1980 and August 1, 1990 also apply to Persian Gulf War).) See below. You must have served at least 90 days on active duty and been discharged or released under other than dishonorable conditions. If you served less than 90 days, you may be eligible if discharged because of a service-connected disability. Peacetime Service. If your service fell entirely within any one of the following periods:  July 26, 1947 to June 26, 1950,  February 1, 1955 to August 4, 1964, or  May 8, 1975 to September 7, 1980 (if enlisted) or to October 16, 1981 (if officer, you must have served at least 181 days of continuous active duty and been discharged or released under conditions other than dishonorable). If you served less than 181 days, you may be eligible if discharged because of a service-connected disability. Service between September 7, 1980 (enlisted) or October 16, 1981 (officer) and August 1, 1990. If your entire period of service was between September 7, 1980 (October 16, 1981) and August 1, 1990, you must have:  Completed 24 months of continuous active duty or the full period (at least 181 days) for which you were called or ordered to active duty, and been discharged or released under conditions other than dishonorable. You may also be determined eligible if you were discharged for a service-connected disability, or you were discharged for the convenience of the Government after completing at least 20 months of a 2-year enlistment, or you completed 181 days of active duty and: were discharged because of a hardship, or were determined to have a service-connected compensable disability, or were discharged or released from active duty for a medical condition which preexisted service and has not been determined to be service-connected, or If the certificate cannot be issued by ACE, you can request it from VA, by completing VA Form 26-1880, “Request for A Certificate of Eligibility.” The form should be submitted along with either • received an involuntary discharge or release from active duty for the convenience of the Government as a result of a reduction in force, or were discharged or released from active duty for a physical or mental condition not characterized as a disability and not the result of misconduct, but which did interfere with your performance of duty. NOTE: During the Persian Gulf War, the foregoing exceptions to the 2-year requirement apply, except that 90 days of active duty is sufficient in lieu of 181 days. Active Duty Service Personnel. If you are now on active duty, eligibility can be established after having served on continuous active duty for at least 90 days. Upon discharge or release from active duty, eligibility must be reestablished. Members of the Selected Reserve. Individuals who are not otherwise eligible and who have completed at least 6 years in the Reserves or National Guard, or been discharged because of a service-connected disability, and  have been discharged with an honorable discharge, or  have been placed on the retired list, or  have been transferred to an element of the Ready reserve other than the Selected Reserve, or  continue to serve in the Selected Reserve are eligible for a GI loan. Other Types of Service Certain United States citizens who served in the armed forces of a government allied with the United States in World War II. Unmarried surviving spouses of the above-described eligible persons who died as the result of service or service-connected injuries (Children of deceased veterans are not eligible). NOTE: Also, a surviving spouse who remarried on or after attaining age 57, and on or after December 16, 2003, may be eligible for the home loan benefit. The spouse of any member of the Armed Forces serving on active duty who is listed as missing in action, or is a prisoner of war and has been so listed for a total of more than 90 days.  Individuals with service as members in certain other organizations, services, programs and schools may also be eligible. Questions about whether this service qualifies for home loan benefits should be referred to your VA Regional Loan Center. Obtaining a Certificate of Eligibility VA determines your eligibility and, if you are qualified, a Certificate of Eligibility will be issued. ACE (automated certificate of eligibility): In some cases veterans can obtain the Certificate of Eligibility from a lender. Most lenders have access to the ACE system. This Internet based application can establish eligibility and issue an online Certificate of Eligibility in a matter of seconds. Not all cases can be processed through ACE - only those for which VA has sufficient data in our records. However, veterans are encouraged to ask their lenders about this method of obtaining a certificate. the originals or legible copies of your most recent discharge or separation papers covering active military duty since September 16, 1940, which show active duty dates and type of discharge. This form may be obtained from VA or at http://www.va.gov/vaforms/. If you were separated after January 1, 1950, you must submit DD Form 214, Certificate of Release or Discharge From Active Duty. In addition, if you are now on active duty and have not been previously discharged from active duty service, you must submit a statement of service which includes the name of the issuing authority (base or command), and is signed by or at the direction of an appropriate official. The statement must include date of entry on active duty and the duration of any time lost. Since there is no uniform document similar to the DD214 for proof of service in the Selected Reserve, a number of different forms may be accepted as documentation of service in the Selected Reserve. For those who served in the Army or Air National Guard and were discharged after at least 6 years of such service, NGB Form 22 may be sufficient. Those who served in the Army, Navy, Air Force, Marine Corps or Coast Guard Reserves may need to rely on any of a variety of forms that document at least 6 years of honorable service. Often, it will be necessary to submit a combination of documents such as an Honorable Discharge certificate together with a retirement point’s statement. It is the reservist's responsibility to obtain and submit documentation of 6 years of honorable service. The Request for Certificate of Eligibility, VA Form 26-1880, should be mailed to the Atlanta Regional Loan Center, ATTN: COE (262), P.O. Box 100034, Decature, GA 30031. The Eligibility Center also maintains a toll free number (888-768-2132) for persons seeking information on eligibility. https://benefits.va.gov/homeloans/documents/docs/vap_26-4_online_version.pdf",Financial,Fact Finding,Q&A Use information from the article only to explain your answer. Do not rely on outside knowledge.,What happened in the Obergefell v. Hodges case?,"Obergefell v. Hodges: Same-Sex Marriage Legalized Rodney M. Perry Legislative Attorney August 7, 2015 Congressional Research Service 7-5700 www.crs.gov R44143 Obergefell v. Hodges: Same-Sex Marriage Legalized Summary On June 26, 2015, the Supreme Court issued its decision in Obergefell v. Hodges requiring states to issue marriage licenses to same-sex couples and to recognize same-sex marriages that were legally formed in other states. In doing so, the Court resolved a circuit split regarding the constitutionality of state same-sex marriage bans and legalized same-sex marriage throughout the country. The Court’s decision relied on the Fourteenth Amendment’s equal protection and due process guarantees. Under the Fourteenth Amendment’s Equal Protection Clause, state action that classifies groups of individuals may be subject to heightened levels of judicial scrutiny, depending on the type of classification involved or whether the classification interferes with a fundamental right. Additionally, under the Fourteenth Amendment’s substantive due process guarantees, state action that infringes upon a fundamental right—such as the right to marry—is subject to a high level of judicial scrutiny. In striking down state same-sex marriage bans as unconstitutional in Obergefell, the Court rested its decision upon the fundamental right to marry. The Court acknowledged that its precedents have described the fundamental right to marry in terms of opposite-sex relationships. Even so, the Court determined that the reasons why the right to marry is considered fundamental apply equally to same-sex marriages. The Court thus held that the fundamental right to marry extends to samesex couples, and that state same-sex marriage bans unconstitutionally interfere with this right. Though the Supreme Court’s decision in Obergefell resolved the question of whether or not state same-sex marriage bans are unconstitutional, it raised a number of other questions. These include questions regarding, among other things, Obergefell’s broader impact on the rights of gay individuals; the proper level of judicial scrutiny applicable to classifications based on sexual orientation; what the decision might mean for laws prohibiting plural marriages; the Court’s approach to recognizing fundamental rights moving forward; and the proper level of judicial scrutiny applicable to governmental action interfering with fundamental rights. This report explores these questions. Congressional Research Service Obergefell v. Hodges: Same-Sex Marriage Legalized Contents General Constitutional Principles .................................................................................................... 1 Equal Protection ........................................................................................................................ 1 Substantive Due Process............................................................................................................ 3 The Supreme Court Invalidates State Same-Sex Marriage Bans in Obergefell ............................... 4 Implications of the Supreme Court’s Decision in Obergefell .......................................................... 6 Contacts Author Contact Information............................................................................................................. 8 Congressional Research Service Obergefell v. Hodges: Same-Sex Marriage Legalized O n June 26, 2015, the Supreme Court issued its decision in Obergefell v. Hodges legalizing same-sex marriage throughout the country by requiring states to issue marriage licenses to same-sex couples and to recognize same-sex marriages that were legally formed in other states. In doing so, the Court resolved a circuit split1 regarding the constitutionality of state same-sex marriage bans. This report provides background on, and analysis of, significant legal issues raised by the Supreme Court’s decision in Obergefell. It first offers background on the constitutional principles on which the Court relied in Obergefell to invalidate state same-sex marriage bans as unconstitutional. Then, it walks through the Court’s opinion and rationale. Finally, it discusses potential implications of the Court’s decision. General Constitutional Principles Equal Protection Under the Fourteenth Amendment’s Equal Protection Clause, “[n]o State shall … deny to any person within its jurisdiction the equal protection of the laws.”2 Though there is no parallel constitutional provision expressly prohibiting the federal government from denying equal protection of the law, the Supreme Court has held that equal protection principles similarly apply to the federal government.3 Under the Constitution’s equal protection guarantees, when courts review governmental action that distinguishes between classes of people, they apply different levels of scrutiny depending on the classification involved. The more suspect the government’s classification, or the more likely that the government’s classification was motivated by discrimination, the higher the level of scrutiny that courts will utilize in evaluating the government’s action.4 Increased scrutiny raises the likelihood that a court will find the action unconstitutional. Generally speaking, there are three such levels of scrutiny: (1) strict scrutiny; (2) intermediate scrutiny; and (3) rational basis review. Strict scrutiny is the most demanding form of judicial review. The Supreme Court has observed that strict scrutiny applies to governmental classifications that are constitutionally “suspect,” or that interfere with fundamental rights.5 In determining whether a classification is suspect, courts consider whether the classified group (1) has historically been subject to discrimination; (2) is a 11 Previously, the Fourth, Seventh, Ninth, and Tenth Circuits had struck down state same-sex marriage bans under equal protection or due process grounds after generally, though not uniformly, subjecting them to heightened levels of judicial scrutiny. Bostic v. Schaeffer, 760 F.3d 352 (4th Cir. 2014); Baskin v. Bogan, 766 F.3d 648 (7th Cir. 2014); Latta v. Otter, 771 F.3d 456 (9th Cir. 2014); Bishop v. Smith, 760 F.3d 1070 (10th Cir. 2014); Kitchen v. Herbert, 755 F.3d 1193 (10th Cir. 2014). Conversely, the Sixth Circuit had upheld state same-sex marriage bans and observed that such bans warrant the lowest level of judicial review. DeBoer v. Snyder, 772 F.3d 388 (6th Cir. 2014). 2 U.S. Const. amend. XIV, §1. 3 See Bolling v. Sharpe, 347 U.S. 497 (1954). More specifically, the Court has held that the Fifth Amendment’s guarantee of “due process of the law,” applicable to the federal government, incorporates equal protection guarantees. See id. at 500. 4 Compare City of Cleburne v. Cleburne Living Center, 473 U.S. 432 (1985) (holding that mental disability is not a “quasi-suspect” classification, and thus is entitled to rational basis review), with Graham v. Richardson, 403 U.S. 365 (1971) (holding that classifications based on alienage are “inherently suspect,” and are subject to strict scrutiny). 5 See Mass. Bd. of Retirement v. Murgia, 427 U.S. 307, 312 (1976); see also Heller v. Doe, 509 U.S. 312, 319 (1993). Congressional Research Service 1 Obergefell v. Hodges: Same-Sex Marriage Legalized minority group exhibiting an unchangeable characteristic that establishes the group as distinct; or (3) is inadequately protected by the political process.6 There are generally three governmental classifications that are suspect—those based on race, national origin, and alienage.7 When applying strict scrutiny to governmental action, reviewing courts consider whether the governmental action is narrowly tailored to a compelling government interest.8 The government bears the burden of proving the constitutional validity of its action under strict scrutiny, and, in doing so, must generally show that it cannot meet its goals via less discriminatory means.9 Intermediate scrutiny is less searching than strict scrutiny, though it subjects governmental action to more stringent inspection than rational basis review. Intermediate scrutiny applies to “quasisuspect” classifications such as classifications based on gender10 or illegitimacy.11 When reviewing courts apply intermediate scrutiny to governmental action, they determine whether the action is substantially related to achieving an important government interest.12 As with strict scrutiny, the government bears the burden of establishing the constitutional validity of its actions under intermediate scrutiny.13 Rational basis review is the least searching form of judicial scrutiny, and generally applies to all classifications that are not subject to heightened levels of scrutiny.14 For governmental action to survive rational basis review, it must be rationally related to a legitimate government interest.15 When evaluating governmental action under rational basis review, courts consider the legitimacy of any possible governmental purpose behind the action.16 That is, courts are not limited to considering the actual purposes behind the government’s action.17 Additionally, the governmental action needs only be a reasonable way of achieving a legitimate government purpose to survive rational basis review; it does not need to be the most reasonable way of doing so, or even more reasonable than alternatives.18 Accordingly, rational basis review is deferential to the government, and courts generally presume that governmental action that is subject to such review is 6 See Lyng v. Castillo, 477 U.S. 635, 638 (1986); see also United States v. Carolene Prods. Co., 304 U.S. 144, 152 n. 4 (1938). 7 Graham, 403 U.S. at 371-72 (“… the Court’s decisions have established that classifications based on alienage, like those based on nationality or race, are inherently suspect and subject to close judicial scrutiny.”). 8 Parents Involved in Cmty. Schs. v. Seattle Sch. Dist. No. 1, 551 U.S. 701, 720 (2007). 9 See Fisher v. University of Tex. at Austin, 133 S. Ct. 2411, 2420 (2014). 10 United States v. Virginia, 518 U.S. 515, 533 (1996); see Miss. Univ. for Women v. Hogan, 458 U.S. 718, 724 (1982). 11 Clark v. Jeter, 486 U.S. 456, 461 (1988) (“Between these extremes of rational basis review and strict scrutiny lies a level of intermediate scrutiny, which generally has been applied to discriminatory classifications based on sex or illegitimacy.”). 12 See Craig v. Boren, 429 U.S. 190, 198 (1976); see also Clark, 486 U.S. at 461. 13 Virginia, 518 U.S. at 533; see Miss. Univ. for Women, 458 U.S. at 724. 14 See Cleburne Living Center, 473 U.S at 440-42; see also Schweiker v. Wilson, 450 U.S. 221, 230 (1981). 15 See City of Cleburne, 473 U.S. at 440. 16 See Nordlinger v. Hahn, 505 U.S. 1, 15 (1992); see also Heller, 509 U.S. at 320. 17 See Nordlinger, 505 U.S. at 15; see also Heller, 509 U.S. at 320. 18 See Schweiker, 450 U.S. 221, 235 (1981) (observing that, under rational basis review, “[a]s long as the classificatory scheme chosen by Congress rationally advances a reasonable and identifiable governmental objective, we must disregard the existence of other methods of allocation that we, as individuals, perhaps would have preferred.”); see also Heller, 509 U.S. at 320 (observing that under rational basis review, “a classification ‘must be upheld against equal protection challenge if there is any reasonably conceivable state of facts that could provide a rational basis for the classification.’”) (quoting F.C.C. v. Beach Commc’ns, Inc., 508 U.S. 307, 312 (1993)). Congressional Research Service 2 Obergefell v. Hodges: Same-Sex Marriage Legalized constitutionally valid.19 Parties challenging governmental actions bear the burden of establishing their invalidity under rational basis review.20 Substantive Due Process The U.S. Constitution’s due process guarantees are contained within two separate clauses; one can be found in the Fifth Amendment, and the other resides in the Fourteenth Amendment. Each clause provides that the government shall not deprive a person of “life, liberty, or property, without due process of law.”21 However, the Fifth Amendment applies to action by the federal government, whereas the Fourteenth Amendment applies to state action.22 The Constitution’s due process language makes clear that the government cannot deprive individuals of life, liberty, or property without observing certain procedural requirements. The Supreme Court has interpreted this language to also include substantive guarantees that prohibit the government from taking action that unduly burdens certain liberty interests.23 More specifically, substantive due process protects against undue governmental infringement upon fundamental rights.24 In determining whether a right is fundamental, Supreme Court precedent looks to whether the right was historically and traditionally recognized, and whether failing to recognize the right would contravene liberty and justice.25 The Supreme Court has held that governmental action infringing upon fundamental rights is subject to strict scrutiny,26 and thus must be narrowly tailored to a compelling government interest.27 Under strict scrutiny, the government must generally show that it has a “substantial” and “legitimate” need for its action to be in furtherance of a compelling government interest.28 If the government successfully establishes a compelling interest, its action cannot encumber fundamental rights any more than is necessary to achieve the government’s need.29 Additionally, the government could not have possibly taken alternative action that would similarly further its interest while being less burdensome on fundamental rights.30 Otherwise, the government’s action is not narrowly tailored to the government’s interest.31 The Supreme Court has recognized a 19 See Beach Commc’ns, Inc., 508 U.S. at 315; see also Murgia, 427 U.S. at 315. Heller, 509 U.S. at 320 (noting that, when reviewing a governmental classification under rational basis review, a governmental action is “presumed constitutional,” and the burden lies on the party attacking the governmental action to establish the action’s unconstitutionality.). 21 U.S. Const. amend. XIV, §1; U.S. Const. amend. V. 22 See U.S. Const. amend. XIV, §1; U.S. Const. amend. V. 23 See Washington v. Glucksberg, 521 U.S. 702, 719-720 (1997). 24 See id. 25 See id. at 720. 26 See Reno v. Flores, 507 U.S. 292, 301-02 (1993). 27 Id. (observing that a line of Supreme Court cases interprets the Fifth Amendment’s and Fourteenth Amendment’s due process principles to “forbid[] the government to infringe certain ‘fundamental’ liberty interests at all … unless the infringement is narrowly tailored to serve a compelling state interest.”). 28 San Antonio Indep. School Dist. v. Rodriguez, 411 U.S. 1, 98 (1973). 29 See Dunn v. Blumstein, 405 U.S. 330, 343 (1972). 30 Id. (“if there are other, reasonable ways to achieve [government interests] with a lesser burden on constitutionally protected activity, a State may not choose the way of greater interference. If it acts at all, it must choose ‘less drastic means.’”) (quoting Shelton v. Tucker, 364 U.S. 479, 488 (1960)). 31 See id. 20 Congressional Research Service 3 Obergefell v. Hodges: Same-Sex Marriage Legalized number of rights as fundamental, including the right to have children,32 use contraception,33 and marry.34 In Obergefell, the Court considered whether the Fourteenth Amendment’s substantive due process guarantees require states to issue marriage licenses to same-sex couples and require states to recognize same-sex marriages that were legally formed in other states. The Supreme Court Invalidates State Same-Sex Marriage Bans in Obergefell The Supreme Court resolved a circuit split on the constitutionality of state same-sex marriage bans, finding them unconstitutional in Obergefell v. Hodges. In doing so, the Court relied on the Constitution’s due process and equal protection principles to hold that states must issue marriage licenses to same-sex couples and recognize same-sex marriages that were legally formed in other states. The majority in Obergefell rested its decision upon the fundamental right to marry. The Court observed that it has long found the right to marry to be constitutionally protected, though it acknowledged that its precedent describing the right presumed an opposite-sex relationship.35 Even so, according to the Court, these cases have identified reasons why the right to marry is fundamental,36 which apply equally to same-sex couples. 37 These reasons included (1) personal choice in whom to marry is inherent in the concept of individual autonomy; (2) marriage’s unique support and recognition of a two-person, committed union; (3) the safeguarding of children within a marriage, as both same-sex couples and opposite-sex couples have children; and (4) marriage as a keystone of the nation’s social order, with no distinction between same-sex couples and opposite-sex couples in states conferring benefits and responsibilities upon marriages.38 Accordingly, the Court extended the fundamental right to marry to same-sex couples. In holding that the fundamental right to marry includes same-sex couples’ right to marry, the Court appeared to acknowledge its departure from precedent for determining whether a right is fundamental—mentioned earlier in this report—which considers whether it is “deeply rooted in this Nation’s history and tradition and implicit in the concept of ordered liberty.”39 The Court observed that if rights were defined by who could historically use them, old practices could continuously prevent new groups from exercising fundamental rights.40 As such, the Court found that “rights come not from ancient sources alone. They rise, too, from a better informed 32 Skinner v. Okla., 316 U.S. 535 (1942). Griswold v. Connecticut, 381 U.S. 479 (1965). 34 Loving v. Virginia, 388 U.S. 1 (1967). 35 Obergefell, 135 S.Ct. at 2598. 36 Id. 37 Id. at 2599. 38 Id. at 2599-2601. 39 Glucksberg, 512 U.S. at 720. 40 Obergefell, 135 S. Ct. at 2602 (“If rights were defined by who exercised them in the past, then received practices could serve as their own continued justification and new groups could not invoke rights once denied.”). 33 Congressional Research Service 4 Obergefell v. Hodges: Same-Sex Marriage Legalized understanding of how constitutional imperatives define a liberty that remains urgent in our own era.”41 After determining that the fundamental right to marry includes the right of same-sex couples to marry, the Court also seemed to depart from precedent—and the approaches of courts of appeals that relied on the fundamental right to marry to strike down state same-sex marriage bans—by not applying strict scrutiny to such bans. As previously noted, courts generally subject governmental action that infringes upon a fundamental right to strict scrutiny, requiring that the action be narrowly tailored to a compelling government interest to be constitutional.42 The states had argued two primary interests for their bans on same-marriage: (1) the desire to wait and see how the same-sex marriage debate progresses before changing long-existing marriage norms; and (2) incentivizing procreating couples to stay together during child rearing. However, the Court made no mention of whether the state same-sex marriage bans at issue were narrowly tailored to these justifications. Rather, the Court noted why these justifications were invalid without appearing to apply any of the typical levels of judicial review (i.e., rational basis review, intermediate scrutiny, or strict scrutiny).43 The Court held that both equal protection and due process guarantees protect the fundamental right to marry, and that states can no longer deny this right to same-sex couples.44 Importantly, in doing so, the Court did not hold that classifications based on sexual orientation warrant any form of heightened scrutiny. In fact, the Court made no mention of the proper level of scrutiny applicable to such classifications. Some of the dissenting Justices in Obergefell thought that the majority exceeded the Court’s proper role by removing the question of whether same-sex couples have the right to marry from the democratic process, where, they stated, it is properly resolved.45 According to these Justices, the five-person majority should not have resolved the hotly contested issue of same-sex marriage for the entire country; such resolution should have come from the people.46 The dissenting Justices also voiced concern with the majority looking beyond history and tradition to establish a fundamental right contrary to Supreme Court precedent.47 According to the dissenting Justices, the requirement that fundamental rights be rooted in tradition and history exists to prevent the Court from imparting its policy decisions regarding which rights have constitutional protection.48 41 Id. See Flores, 507 U.S. at 301-02. 43 See Obergefell, 135 S. Ct. at 2605-07. 44 Id. at 2604. 45 Id. at 2612, 2615 (Roberts, J., dissenting). 46 See id. 47 See id. at 2617. 48 See id. 42 Congressional Research Service 5 Obergefell v. Hodges: Same-Sex Marriage Legalized Implications of the Supreme Court’s Decision in Obergefell Although the Supreme Court answered questions surrounding the constitutionality of state samesex marriage bans in Obergefell, its decision raised a number of other questions. These include questions regarding, among other things, Obergefell’s broader impact on the rights of gay individuals; the proper level of judicial scrutiny applicable to classifications based on sexual orientation; what the decision might mean for laws prohibiting plural marriages; the Court’s approach to recognizing fundamental rights moving forward; and the proper level of judicial scrutiny applicable to governmental action interfering with fundamental rights. This section briefly explores these questions. Obergefell raised questions about the decision’s broader impact on the rights of gay individuals— that is, whether its rationale extends rights to gay individuals outside of the marriage context. However, the decision appears limited to the marriage context. Although the majority opinion did make reference to same-sex marriage bans implicating equal protection guarantees, its holding rested entirely on such bans infringing upon the fundamental right to marry in violation of both equal protection and due process guarantees. The Court did not mention whether classifications based on sexual orientation are suspect or quasi-suspect, and thus warrant any form of heightened scrutiny. If the Court had rendered such a holding, its decision would have arguably had broader implications for the rights of gay individuals, as it would have potentially subjected all governmental action that classifies based on sexual orientation to a heightened form of judicial scrutiny. Prior to Obergefell, federal appeals courts were split regarding the proper level of judicial scrutiny applicable to governmental action that classifies based on sexual orientation. The U.S. Court of Appeals for the Ninth Circuit (Ninth Circuit) has held that classifications based on sexual orientation warrant heightened scrutiny, though it did not clarify whether this heightened scrutiny was intermediate or strict scrutiny.49 The U.S. Court of Appeals for the Second Circuit (Second Circuit) has similarly found that classifications based on sexual orientation are quasisuspect, and thus any governmental action that classifies based on sexual orientation is subject to intermediate scrutiny.50 Conversely, however, the U.S. Court of Appeals for the Sixth Circuit (Sixth Circuit) has held that governmental action that classifies based on sexual orientation is neither suspect nor quasi-suspect, and thus subject only to rational basis review.51 Because the Court’s decision in Obergefell rested on the fundamental right to marry—and therefore seems limited to the marriage context—nothing in the opinion appears to resolve the circuit split between the Second, Sixth, and Ninth Circuits regarding the correct level of scrutiny applicable to classifications based on sexual orientation. Other lower courts will be left to grapple with this issue in the future. This ambiguity leaves open the possibility that, moving forward, circuit courts could either, like the Second and Ninth Circuits, apply heightened scrutiny to laws that classify based on sexual orientation (e.g., laws that provide exemptions from antidiscrimination legislation for religious entities based on their objections to certain sexual 49 See Latta, 771 F.3d at 468. Windsor v. United States, 699 F.3d 169, 185 (2nd Cir. 2012). 51 Davis v. Prison Health Servs., 679 F.3d 433, 438 (6th Cir. 2012). 50 Congressional Research Service 6 Obergefell v. Hodges: Same-Sex Marriage Legalized orientations), or could apply rational basis review to such laws like the Sixth Circuit. The fact that some lower courts may apply heightened scrutiny to government action that classifies based on sexual orientation where other courts may not is significant because, as discussed earlier in this report, laws subject to higher levels of scrutiny are more likely to be found unconstitutional. As such, this could create a situation wherein similar laws that classify based on sexual orientation receive dissimilar outcomes when facing constitutional challenge, depending on the evaluating court. The Supreme Court’s decision in Obergefell also raised questions regarding whether the Court’s rationale could potentially extend the fundamental right to marry to polygamy. In fact, Chief Justice John Roberts, in his dissent in Obergefell, seems to suggest that the majority’s opinion could lead to the legalization of plural marriages.52 However, the majority’s opinion seems crafted so as to try to limit its reach to the same-sex marriage context, in a possible attempt to prevent its rationale from extending the fundamental right to marry to plural marriages. As previously discussed, the majority in Obergefell found that the four reasons why the right to marry is fundamental apply equally to same-sex couples, and thus extended the fundamental right to marry to same-sex couples. Some commentators have observed that there are distinctions between plural marriages and same-sex marriages sufficient to prevent Obergefell’s rationale from being extended to legalize plural marriage.53 Conversely, other commentators have observed that parts of the Court’s opinion discussing why the fundamental right to marry includes same-sex marriage (e.g., the majority’s consideration of individual autonomy and family) could potentially provide basis for extending constitutional protections to plural marriages.54 Additionally, the majority in Obergefell seemingly departed from precedent for determining whether a right is fundamental by looking beyond historical and traditional recognition. This deviation from prior cases raises the possibility that, when determining whether a right is fundamental in the future, the Court will consider how the right is viewed at the time, in addition to its historical and traditional recognition. This could have the effect of expanding the number of rights that are deemed fundamental for purposes of substantive due process protections. Finally, the Court did not clarify which, if any, of the typical levels of judicial review (i.e., rational basis review, intermediate scrutiny, or strict scrutiny) it applied to state same-sex marriage bans after finding that such bans interfere with same-sex couples’ fundamental right to marry. Moving forward, this raises questions regarding the proper level of judicial scrutiny 52 See Obergefell, 135 S. Ct. at 2621 (“It is striking how much of the majority’s reasoning would apply with equal force to the claim of a fundamental right to plural marriage.”). 53 See, e.g., Joanna L. Grossman and Lawrence M. Friedman, Is Three Still a Crowd? Polygamy and the Law After Obergefell v. Hodges, JUSTIA, July 7, 2015, https://verdict.justia.com/2015/07/07/is-three-still-a-crowd-polygamy-andthe-law-after-obergefell-v-hodges (observing that, to win in court, polygamists must “convince a court that the justification for allowing same-sex couples to marry applies with equal force to a person who wants multiple spouses,” and questioning whether the four “main reasons for recognizing the right of same-sex couples to marry” apply to polygamists); see also Richard A. Posner, The Chief Justice’s Dissent is Heartless, Slate, June 27, 2015, http://www.slate.com/articles/news_and_politics/the_breakfast_table/features/2015/scotus_roundup/ supreme_court_gay_marriage_john_roberts_dissent_in_obergefell_is_heartless.html. 54 See, e.g., William Baude, Is Polygamy Next?, N. Y. TIMES, July 21, 2015, http://www.nytimes.com/2015/07/21/ opinion/is-polygamy-next.html?mabReward=CTM&action=click&pgtype=Homepage®ion=CColumn&module= Recommendation&src=rechp&WT.nav=RecEngine; see also Jonathan Turley, The Trouble with the ‘Dignity’ of SameSex Marriage, Wash. Post, July 2, 2015, https://www.washingtonpost.com/opinions/the-trouble-with-the-dignity-ofsame-sex-marriage/2015/07/02/43bd8f70-1f4e-11e5-aeb9-a411a84c9d55_story.html. Congressional Research Service 7 Obergefell v. Hodges: Same-Sex Marriage Legalized applicable to governmental action that infringes upon fundamental rights. Given that increased scrutiny decreases the likelihood that a court will find government action constitutional, this could create ambiguity regarding the degree to which the government can permissibly take action that interferes with fundamental rights. Author Contact Information Rodney M. Perry Legislative Attorney rperry@crs.loc.gov, 7-5203 Congressional Research Service 8 ","Use information from the article only to explain your answer. Do not rely on outside knowledge. What happened in the Obergefell v. Hodges case? Obergefell v. Hodges: Same-Sex Marriage Legalized Rodney M. Perry Legislative Attorney August 7, 2015 Congressional Research Service 7-5700 www.crs.gov R44143 Obergefell v. Hodges: Same-Sex Marriage Legalized Summary On June 26, 2015, the Supreme Court issued its decision in Obergefell v. Hodges requiring states to issue marriage licenses to same-sex couples and to recognize same-sex marriages that were legally formed in other states. In doing so, the Court resolved a circuit split regarding the constitutionality of state same-sex marriage bans and legalized same-sex marriage throughout the country. The Court’s decision relied on the Fourteenth Amendment’s equal protection and due process guarantees. Under the Fourteenth Amendment’s Equal Protection Clause, state action that classifies groups of individuals may be subject to heightened levels of judicial scrutiny, depending on the type of classification involved or whether the classification interferes with a fundamental right. Additionally, under the Fourteenth Amendment’s substantive due process guarantees, state action that infringes upon a fundamental right—such as the right to marry—is subject to a high level of judicial scrutiny. In striking down state same-sex marriage bans as unconstitutional in Obergefell, the Court rested its decision upon the fundamental right to marry. The Court acknowledged that its precedents have described the fundamental right to marry in terms of opposite-sex relationships. Even so, the Court determined that the reasons why the right to marry is considered fundamental apply equally to same-sex marriages. The Court thus held that the fundamental right to marry extends to samesex couples, and that state same-sex marriage bans unconstitutionally interfere with this right. Though the Supreme Court’s decision in Obergefell resolved the question of whether or not state same-sex marriage bans are unconstitutional, it raised a number of other questions. These include questions regarding, among other things, Obergefell’s broader impact on the rights of gay individuals; the proper level of judicial scrutiny applicable to classifications based on sexual orientation; what the decision might mean for laws prohibiting plural marriages; the Court’s approach to recognizing fundamental rights moving forward; and the proper level of judicial scrutiny applicable to governmental action interfering with fundamental rights. This report explores these questions. Congressional Research Service Obergefell v. Hodges: Same-Sex Marriage Legalized Contents General Constitutional Principles .................................................................................................... 1 Equal Protection ........................................................................................................................ 1 Substantive Due Process............................................................................................................ 3 The Supreme Court Invalidates State Same-Sex Marriage Bans in Obergefell ............................... 4 Implications of the Supreme Court’s Decision in Obergefell .......................................................... 6 Contacts Author Contact Information............................................................................................................. 8 Congressional Research Service Obergefell v. Hodges: Same-Sex Marriage Legalized O n June 26, 2015, the Supreme Court issued its decision in Obergefell v. Hodges legalizing same-sex marriage throughout the country by requiring states to issue marriage licenses to same-sex couples and to recognize same-sex marriages that were legally formed in other states. In doing so, the Court resolved a circuit split1 regarding the constitutionality of state same-sex marriage bans. This report provides background on, and analysis of, significant legal issues raised by the Supreme Court’s decision in Obergefell. It first offers background on the constitutional principles on which the Court relied in Obergefell to invalidate state same-sex marriage bans as unconstitutional. Then, it walks through the Court’s opinion and rationale. Finally, it discusses potential implications of the Court’s decision. General Constitutional Principles Equal Protection Under the Fourteenth Amendment’s Equal Protection Clause, “[n]o State shall … deny to any person within its jurisdiction the equal protection of the laws.”2 Though there is no parallel constitutional provision expressly prohibiting the federal government from denying equal protection of the law, the Supreme Court has held that equal protection principles similarly apply to the federal government.3 Under the Constitution’s equal protection guarantees, when courts review governmental action that distinguishes between classes of people, they apply different levels of scrutiny depending on the classification involved. The more suspect the government’s classification, or the more likely that the government’s classification was motivated by discrimination, the higher the level of scrutiny that courts will utilize in evaluating the government’s action.4 Increased scrutiny raises the likelihood that a court will find the action unconstitutional. Generally speaking, there are three such levels of scrutiny: (1) strict scrutiny; (2) intermediate scrutiny; and (3) rational basis review. Strict scrutiny is the most demanding form of judicial review. The Supreme Court has observed that strict scrutiny applies to governmental classifications that are constitutionally “suspect,” or that interfere with fundamental rights.5 In determining whether a classification is suspect, courts consider whether the classified group (1) has historically been subject to discrimination; (2) is a 11 Previously, the Fourth, Seventh, Ninth, and Tenth Circuits had struck down state same-sex marriage bans under equal protection or due process grounds after generally, though not uniformly, subjecting them to heightened levels of judicial scrutiny. Bostic v. Schaeffer, 760 F.3d 352 (4th Cir. 2014); Baskin v. Bogan, 766 F.3d 648 (7th Cir. 2014); Latta v. Otter, 771 F.3d 456 (9th Cir. 2014); Bishop v. Smith, 760 F.3d 1070 (10th Cir. 2014); Kitchen v. Herbert, 755 F.3d 1193 (10th Cir. 2014). Conversely, the Sixth Circuit had upheld state same-sex marriage bans and observed that such bans warrant the lowest level of judicial review. DeBoer v. Snyder, 772 F.3d 388 (6th Cir. 2014). 2 U.S. Const. amend. XIV, §1. 3 See Bolling v. Sharpe, 347 U.S. 497 (1954). More specifically, the Court has held that the Fifth Amendment’s guarantee of “due process of the law,” applicable to the federal government, incorporates equal protection guarantees. See id. at 500. 4 Compare City of Cleburne v. Cleburne Living Center, 473 U.S. 432 (1985) (holding that mental disability is not a “quasi-suspect” classification, and thus is entitled to rational basis review), with Graham v. Richardson, 403 U.S. 365 (1971) (holding that classifications based on alienage are “inherently suspect,” and are subject to strict scrutiny). 5 See Mass. Bd. of Retirement v. Murgia, 427 U.S. 307, 312 (1976); see also Heller v. Doe, 509 U.S. 312, 319 (1993). Congressional Research Service 1 Obergefell v. Hodges: Same-Sex Marriage Legalized minority group exhibiting an unchangeable characteristic that establishes the group as distinct; or (3) is inadequately protected by the political process.6 There are generally three governmental classifications that are suspect—those based on race, national origin, and alienage.7 When applying strict scrutiny to governmental action, reviewing courts consider whether the governmental action is narrowly tailored to a compelling government interest.8 The government bears the burden of proving the constitutional validity of its action under strict scrutiny, and, in doing so, must generally show that it cannot meet its goals via less discriminatory means.9 Intermediate scrutiny is less searching than strict scrutiny, though it subjects governmental action to more stringent inspection than rational basis review. Intermediate scrutiny applies to “quasisuspect” classifications such as classifications based on gender10 or illegitimacy.11 When reviewing courts apply intermediate scrutiny to governmental action, they determine whether the action is substantially related to achieving an important government interest.12 As with strict scrutiny, the government bears the burden of establishing the constitutional validity of its actions under intermediate scrutiny.13 Rational basis review is the least searching form of judicial scrutiny, and generally applies to all classifications that are not subject to heightened levels of scrutiny.14 For governmental action to survive rational basis review, it must be rationally related to a legitimate government interest.15 When evaluating governmental action under rational basis review, courts consider the legitimacy of any possible governmental purpose behind the action.16 That is, courts are not limited to considering the actual purposes behind the government’s action.17 Additionally, the governmental action needs only be a reasonable way of achieving a legitimate government purpose to survive rational basis review; it does not need to be the most reasonable way of doing so, or even more reasonable than alternatives.18 Accordingly, rational basis review is deferential to the government, and courts generally presume that governmental action that is subject to such review is 6 See Lyng v. Castillo, 477 U.S. 635, 638 (1986); see also United States v. Carolene Prods. Co., 304 U.S. 144, 152 n. 4 (1938). 7 Graham, 403 U.S. at 371-72 (“… the Court’s decisions have established that classifications based on alienage, like those based on nationality or race, are inherently suspect and subject to close judicial scrutiny.”). 8 Parents Involved in Cmty. Schs. v. Seattle Sch. Dist. No. 1, 551 U.S. 701, 720 (2007). 9 See Fisher v. University of Tex. at Austin, 133 S. Ct. 2411, 2420 (2014). 10 United States v. Virginia, 518 U.S. 515, 533 (1996); see Miss. Univ. for Women v. Hogan, 458 U.S. 718, 724 (1982). 11 Clark v. Jeter, 486 U.S. 456, 461 (1988) (“Between these extremes of rational basis review and strict scrutiny lies a level of intermediate scrutiny, which generally has been applied to discriminatory classifications based on sex or illegitimacy.”). 12 See Craig v. Boren, 429 U.S. 190, 198 (1976); see also Clark, 486 U.S. at 461. 13 Virginia, 518 U.S. at 533; see Miss. Univ. for Women, 458 U.S. at 724. 14 See Cleburne Living Center, 473 U.S at 440-42; see also Schweiker v. Wilson, 450 U.S. 221, 230 (1981). 15 See City of Cleburne, 473 U.S. at 440. 16 See Nordlinger v. Hahn, 505 U.S. 1, 15 (1992); see also Heller, 509 U.S. at 320. 17 See Nordlinger, 505 U.S. at 15; see also Heller, 509 U.S. at 320. 18 See Schweiker, 450 U.S. 221, 235 (1981) (observing that, under rational basis review, “[a]s long as the classificatory scheme chosen by Congress rationally advances a reasonable and identifiable governmental objective, we must disregard the existence of other methods of allocation that we, as individuals, perhaps would have preferred.”); see also Heller, 509 U.S. at 320 (observing that under rational basis review, “a classification ‘must be upheld against equal protection challenge if there is any reasonably conceivable state of facts that could provide a rational basis for the classification.’”) (quoting F.C.C. v. Beach Commc’ns, Inc., 508 U.S. 307, 312 (1993)). Congressional Research Service 2 Obergefell v. Hodges: Same-Sex Marriage Legalized constitutionally valid.19 Parties challenging governmental actions bear the burden of establishing their invalidity under rational basis review.20 Substantive Due Process The U.S. Constitution’s due process guarantees are contained within two separate clauses; one can be found in the Fifth Amendment, and the other resides in the Fourteenth Amendment. Each clause provides that the government shall not deprive a person of “life, liberty, or property, without due process of law.”21 However, the Fifth Amendment applies to action by the federal government, whereas the Fourteenth Amendment applies to state action.22 The Constitution’s due process language makes clear that the government cannot deprive individuals of life, liberty, or property without observing certain procedural requirements. The Supreme Court has interpreted this language to also include substantive guarantees that prohibit the government from taking action that unduly burdens certain liberty interests.23 More specifically, substantive due process protects against undue governmental infringement upon fundamental rights.24 In determining whether a right is fundamental, Supreme Court precedent looks to whether the right was historically and traditionally recognized, and whether failing to recognize the right would contravene liberty and justice.25 The Supreme Court has held that governmental action infringing upon fundamental rights is subject to strict scrutiny,26 and thus must be narrowly tailored to a compelling government interest.27 Under strict scrutiny, the government must generally show that it has a “substantial” and “legitimate” need for its action to be in furtherance of a compelling government interest.28 If the government successfully establishes a compelling interest, its action cannot encumber fundamental rights any more than is necessary to achieve the government’s need.29 Additionally, the government could not have possibly taken alternative action that would similarly further its interest while being less burdensome on fundamental rights.30 Otherwise, the government’s action is not narrowly tailored to the government’s interest.31 The Supreme Court has recognized a 19 See Beach Commc’ns, Inc., 508 U.S. at 315; see also Murgia, 427 U.S. at 315. Heller, 509 U.S. at 320 (noting that, when reviewing a governmental classification under rational basis review, a governmental action is “presumed constitutional,” and the burden lies on the party attacking the governmental action to establish the action’s unconstitutionality.). 21 U.S. Const. amend. XIV, §1; U.S. Const. amend. V. 22 See U.S. Const. amend. XIV, §1; U.S. Const. amend. V. 23 See Washington v. Glucksberg, 521 U.S. 702, 719-720 (1997). 24 See id. 25 See id. at 720. 26 See Reno v. Flores, 507 U.S. 292, 301-02 (1993). 27 Id. (observing that a line of Supreme Court cases interprets the Fifth Amendment’s and Fourteenth Amendment’s due process principles to “forbid[] the government to infringe certain ‘fundamental’ liberty interests at all … unless the infringement is narrowly tailored to serve a compelling state interest.”). 28 San Antonio Indep. School Dist. v. Rodriguez, 411 U.S. 1, 98 (1973). 29 See Dunn v. Blumstein, 405 U.S. 330, 343 (1972). 30 Id. (“if there are other, reasonable ways to achieve [government interests] with a lesser burden on constitutionally protected activity, a State may not choose the way of greater interference. If it acts at all, it must choose ‘less drastic means.’”) (quoting Shelton v. Tucker, 364 U.S. 479, 488 (1960)). 31 See id. 20 Congressional Research Service 3 Obergefell v. Hodges: Same-Sex Marriage Legalized number of rights as fundamental, including the right to have children,32 use contraception,33 and marry.34 In Obergefell, the Court considered whether the Fourteenth Amendment’s substantive due process guarantees require states to issue marriage licenses to same-sex couples and require states to recognize same-sex marriages that were legally formed in other states. The Supreme Court Invalidates State Same-Sex Marriage Bans in Obergefell The Supreme Court resolved a circuit split on the constitutionality of state same-sex marriage bans, finding them unconstitutional in Obergefell v. Hodges. In doing so, the Court relied on the Constitution’s due process and equal protection principles to hold that states must issue marriage licenses to same-sex couples and recognize same-sex marriages that were legally formed in other states. The majority in Obergefell rested its decision upon the fundamental right to marry. The Court observed that it has long found the right to marry to be constitutionally protected, though it acknowledged that its precedent describing the right presumed an opposite-sex relationship.35 Even so, according to the Court, these cases have identified reasons why the right to marry is fundamental,36 which apply equally to same-sex couples. 37 These reasons included (1) personal choice in whom to marry is inherent in the concept of individual autonomy; (2) marriage’s unique support and recognition of a two-person, committed union; (3) the safeguarding of children within a marriage, as both same-sex couples and opposite-sex couples have children; and (4) marriage as a keystone of the nation’s social order, with no distinction between same-sex couples and opposite-sex couples in states conferring benefits and responsibilities upon marriages.38 Accordingly, the Court extended the fundamental right to marry to same-sex couples. In holding that the fundamental right to marry includes same-sex couples’ right to marry, the Court appeared to acknowledge its departure from precedent for determining whether a right is fundamental—mentioned earlier in this report—which considers whether it is “deeply rooted in this Nation’s history and tradition and implicit in the concept of ordered liberty.”39 The Court observed that if rights were defined by who could historically use them, old practices could continuously prevent new groups from exercising fundamental rights.40 As such, the Court found that “rights come not from ancient sources alone. They rise, too, from a better informed 32 Skinner v. Okla., 316 U.S. 535 (1942). Griswold v. Connecticut, 381 U.S. 479 (1965). 34 Loving v. Virginia, 388 U.S. 1 (1967). 35 Obergefell, 135 S.Ct. at 2598. 36 Id. 37 Id. at 2599. 38 Id. at 2599-2601. 39 Glucksberg, 512 U.S. at 720. 40 Obergefell, 135 S. Ct. at 2602 (“If rights were defined by who exercised them in the past, then received practices could serve as their own continued justification and new groups could not invoke rights once denied.”). 33 Congressional Research Service 4 Obergefell v. Hodges: Same-Sex Marriage Legalized understanding of how constitutional imperatives define a liberty that remains urgent in our own era.”41 After determining that the fundamental right to marry includes the right of same-sex couples to marry, the Court also seemed to depart from precedent—and the approaches of courts of appeals that relied on the fundamental right to marry to strike down state same-sex marriage bans—by not applying strict scrutiny to such bans. As previously noted, courts generally subject governmental action that infringes upon a fundamental right to strict scrutiny, requiring that the action be narrowly tailored to a compelling government interest to be constitutional.42 The states had argued two primary interests for their bans on same-marriage: (1) the desire to wait and see how the same-sex marriage debate progresses before changing long-existing marriage norms; and (2) incentivizing procreating couples to stay together during child rearing. However, the Court made no mention of whether the state same-sex marriage bans at issue were narrowly tailored to these justifications. Rather, the Court noted why these justifications were invalid without appearing to apply any of the typical levels of judicial review (i.e., rational basis review, intermediate scrutiny, or strict scrutiny).43 The Court held that both equal protection and due process guarantees protect the fundamental right to marry, and that states can no longer deny this right to same-sex couples.44 Importantly, in doing so, the Court did not hold that classifications based on sexual orientation warrant any form of heightened scrutiny. In fact, the Court made no mention of the proper level of scrutiny applicable to such classifications. Some of the dissenting Justices in Obergefell thought that the majority exceeded the Court’s proper role by removing the question of whether same-sex couples have the right to marry from the democratic process, where, they stated, it is properly resolved.45 According to these Justices, the five-person majority should not have resolved the hotly contested issue of same-sex marriage for the entire country; such resolution should have come from the people.46 The dissenting Justices also voiced concern with the majority looking beyond history and tradition to establish a fundamental right contrary to Supreme Court precedent.47 According to the dissenting Justices, the requirement that fundamental rights be rooted in tradition and history exists to prevent the Court from imparting its policy decisions regarding which rights have constitutional protection.48 41 Id. See Flores, 507 U.S. at 301-02. 43 See Obergefell, 135 S. Ct. at 2605-07. 44 Id. at 2604. 45 Id. at 2612, 2615 (Roberts, J., dissenting). 46 See id. 47 See id. at 2617. 48 See id. 42 Congressional Research Service 5 Obergefell v. Hodges: Same-Sex Marriage Legalized Implications of the Supreme Court’s Decision in Obergefell Although the Supreme Court answered questions surrounding the constitutionality of state samesex marriage bans in Obergefell, its decision raised a number of other questions. These include questions regarding, among other things, Obergefell’s broader impact on the rights of gay individuals; the proper level of judicial scrutiny applicable to classifications based on sexual orientation; what the decision might mean for laws prohibiting plural marriages; the Court’s approach to recognizing fundamental rights moving forward; and the proper level of judicial scrutiny applicable to governmental action interfering with fundamental rights. This section briefly explores these questions. Obergefell raised questions about the decision’s broader impact on the rights of gay individuals— that is, whether its rationale extends rights to gay individuals outside of the marriage context. However, the decision appears limited to the marriage context. Although the majority opinion did make reference to same-sex marriage bans implicating equal protection guarantees, its holding rested entirely on such bans infringing upon the fundamental right to marry in violation of both equal protection and due process guarantees. The Court did not mention whether classifications based on sexual orientation are suspect or quasi-suspect, and thus warrant any form of heightened scrutiny. If the Court had rendered such a holding, its decision would have arguably had broader implications for the rights of gay individuals, as it would have potentially subjected all governmental action that classifies based on sexual orientation to a heightened form of judicial scrutiny. Prior to Obergefell, federal appeals courts were split regarding the proper level of judicial scrutiny applicable to governmental action that classifies based on sexual orientation. The U.S. Court of Appeals for the Ninth Circuit (Ninth Circuit) has held that classifications based on sexual orientation warrant heightened scrutiny, though it did not clarify whether this heightened scrutiny was intermediate or strict scrutiny.49 The U.S. Court of Appeals for the Second Circuit (Second Circuit) has similarly found that classifications based on sexual orientation are quasisuspect, and thus any governmental action that classifies based on sexual orientation is subject to intermediate scrutiny.50 Conversely, however, the U.S. Court of Appeals for the Sixth Circuit (Sixth Circuit) has held that governmental action that classifies based on sexual orientation is neither suspect nor quasi-suspect, and thus subject only to rational basis review.51 Because the Court’s decision in Obergefell rested on the fundamental right to marry—and therefore seems limited to the marriage context—nothing in the opinion appears to resolve the circuit split between the Second, Sixth, and Ninth Circuits regarding the correct level of scrutiny applicable to classifications based on sexual orientation. Other lower courts will be left to grapple with this issue in the future. This ambiguity leaves open the possibility that, moving forward, circuit courts could either, like the Second and Ninth Circuits, apply heightened scrutiny to laws that classify based on sexual orientation (e.g., laws that provide exemptions from antidiscrimination legislation for religious entities based on their objections to certain sexual 49 See Latta, 771 F.3d at 468. Windsor v. United States, 699 F.3d 169, 185 (2nd Cir. 2012). 51 Davis v. Prison Health Servs., 679 F.3d 433, 438 (6th Cir. 2012). 50 Congressional Research Service 6 Obergefell v. Hodges: Same-Sex Marriage Legalized orientations), or could apply rational basis review to such laws like the Sixth Circuit. The fact that some lower courts may apply heightened scrutiny to government action that classifies based on sexual orientation where other courts may not is significant because, as discussed earlier in this report, laws subject to higher levels of scrutiny are more likely to be found unconstitutional. As such, this could create a situation wherein similar laws that classify based on sexual orientation receive dissimilar outcomes when facing constitutional challenge, depending on the evaluating court. The Supreme Court’s decision in Obergefell also raised questions regarding whether the Court’s rationale could potentially extend the fundamental right to marry to polygamy. In fact, Chief Justice John Roberts, in his dissent in Obergefell, seems to suggest that the majority’s opinion could lead to the legalization of plural marriages.52 However, the majority’s opinion seems crafted so as to try to limit its reach to the same-sex marriage context, in a possible attempt to prevent its rationale from extending the fundamental right to marry to plural marriages. As previously discussed, the majority in Obergefell found that the four reasons why the right to marry is fundamental apply equally to same-sex couples, and thus extended the fundamental right to marry to same-sex couples. Some commentators have observed that there are distinctions between plural marriages and same-sex marriages sufficient to prevent Obergefell’s rationale from being extended to legalize plural marriage.53 Conversely, other commentators have observed that parts of the Court’s opinion discussing why the fundamental right to marry includes same-sex marriage (e.g., the majority’s consideration of individual autonomy and family) could potentially provide basis for extending constitutional protections to plural marriages.54 Additionally, the majority in Obergefell seemingly departed from precedent for determining whether a right is fundamental by looking beyond historical and traditional recognition. This deviation from prior cases raises the possibility that, when determining whether a right is fundamental in the future, the Court will consider how the right is viewed at the time, in addition to its historical and traditional recognition. This could have the effect of expanding the number of rights that are deemed fundamental for purposes of substantive due process protections. Finally, the Court did not clarify which, if any, of the typical levels of judicial review (i.e., rational basis review, intermediate scrutiny, or strict scrutiny) it applied to state same-sex marriage bans after finding that such bans interfere with same-sex couples’ fundamental right to marry. Moving forward, this raises questions regarding the proper level of judicial scrutiny 52 See Obergefell, 135 S. Ct. at 2621 (“It is striking how much of the majority’s reasoning would apply with equal force to the claim of a fundamental right to plural marriage.”). 53 See, e.g., Joanna L. Grossman and Lawrence M. Friedman, Is Three Still a Crowd? Polygamy and the Law After Obergefell v. Hodges, JUSTIA, July 7, 2015, https://verdict.justia.com/2015/07/07/is-three-still-a-crowd-polygamy-andthe-law-after-obergefell-v-hodges (observing that, to win in court, polygamists must “convince a court that the justification for allowing same-sex couples to marry applies with equal force to a person who wants multiple spouses,” and questioning whether the four “main reasons for recognizing the right of same-sex couples to marry” apply to polygamists); see also Richard A. Posner, The Chief Justice’s Dissent is Heartless, Slate, June 27, 2015, http://www.slate.com/articles/news_and_politics/the_breakfast_table/features/2015/scotus_roundup/ supreme_court_gay_marriage_john_roberts_dissent_in_obergefell_is_heartless.html. 54 See, e.g., William Baude, Is Polygamy Next?, N. Y. TIMES, July 21, 2015, http://www.nytimes.com/2015/07/21/ opinion/is-polygamy-next.html?mabReward=CTM&action=click&pgtype=Homepage®ion=CColumn&module= Recommendation&src=rechp&WT.nav=RecEngine; see also Jonathan Turley, The Trouble with the ‘Dignity’ of SameSex Marriage, Wash. Post, July 2, 2015, https://www.washingtonpost.com/opinions/the-trouble-with-the-dignity-ofsame-sex-marriage/2015/07/02/43bd8f70-1f4e-11e5-aeb9-a411a84c9d55_story.html. Congressional Research Service 7 Obergefell v. Hodges: Same-Sex Marriage Legalized applicable to governmental action that infringes upon fundamental rights. Given that increased scrutiny decreases the likelihood that a court will find government action constitutional, this could create ambiguity regarding the degree to which the government can permissibly take action that interferes with fundamental rights. Author Contact Information Rodney M. Perry Legislative Attorney rperry@crs.loc.gov, 7-5203 Congressional Research Service 8 ",Legal,Explanation/Definition,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Explain the potential effects of the Federal Reserve's upcoming interest rate cuts on personal finance, particularly focusing on credit card debt, mortgages, and auto loans. How should individuals prepare for these changes?","Reference Text: Inflation has slowed and the labor market has softened enough to satisfy the Federal Reserve. That means the central bank is about to cut interest rates. On Aug. 23, Fed Chair Jerome Powell said, “The time has come for policy to adjust. The direction of travel is clear, and the timing and pace of rate cuts will depend on incoming data, the evolving outlook, and the balance of risks.” In other words, Americans should prepare to finally catch a break when it comes to borrowing to pay for a home, buy a car or open a new credit card. There are also other implications for the health of the broader economy. Back in March 2022, the Federal Open Markets Committee (FOMC) began to increase the federal funds rate in response to growing inflation. It hiked rates 11 times before finally pausing. The rates, set at 5.25% to 5.50%, haven’t budged since July 2023. The first cut will almost certainly happen at the Fed’s upcoming meeting scheduled for Sept. 17-18. The futures market’s CME FedWatch Tool now predicts a 87% likelihood that the FOMC will cut the current target rate by 25 basis points; it predicts a 13% likelihood of a larger cut of 50 basis points. But even if the Fed trims rates next week as expected, the target will still be a long way from the near-zero rate of early 2020 and immediate effects will be muted. Mortgage rates have already been easing in anticipation of a cut, for example, and most consumer credit and lending products are more dependent on your credit score than on the Fed rate. Still, this is viewed as a significant event and could build expectations for more cuts down the road. So what happens next? NerdWallet writers teamed up to explain how upcoming Fed rate cuts could impact your personal finances and what you can do to prepare. Credit card interest rates are variable, meaning they adjust up or down shortly after the Fed changes the federal funds rate. So if the Fed lowers interest rates, credit card debt will cost slightly less. The operative word here is “slightly.” Credit card debt is expensive no matter what the federal funds rate happens to be. Let’s say you have an average balance of $5,000 on a card charging 25% APR. You’ll spend around $1,250 in interest over the course of a year. If your interest rate was 24% instead, that’s just $50 less in interest for the year. Point being, a rate reduction doesn’t translate to a massive savings in interest when it comes to credit cards. Still, you can use the upcoming Fed news as a reminder to check in on your debt and make a plan to pay it down as aggressively as you can. If you qualify, a balance transfer credit card could give you a year or more without interest. Lower interest rates might make a personal loan a compelling debt consolidation option. Mortgage interest rates have already headed lower ahead of any action by the Fed. In April, the average interest rate on a 30-year, fixed-rate loan was 7.04%. August's average was nearly three-quarters of a percentage point lower, at 6.31%. That 73-basis-point drop is larger than any anticipated rate cut, but rates may push even lower once the central bankers start chopping. Homeowners with adjustable-rate mortgages or home equity lines of credit (HELOCs) should see savings right away as their interest rates ratchet downward. But lower mortgage interest rates might also be a boon to homeowners with fixed-rate mortgages. Those who bought when rates were higher could finally see a significant benefit from refinancing, while owners who feel tethered by their current low mortgage rates may feel more confident about making a move. Reducing that rate ""lock in"" effect could put more homes on the market, particularly at the starter-home level. Prospective home buyers likely feel heartened by the prospect of rate cuts, but a quarter or even half of a percentage point cut from the Federal Reserve shouldn't cause a sudden drop in mortgage rates, especially with a downward trend already in progress. So, don't wait on the Fed: Buy when you're ready, not when interest rates are. While you're preparing to buy — and during your home search — work on your finances. Continue to pay down high-interest debt, try to build your credit score, don't take out new loans and keep making on-time payments. That way, when you're applying for a mortgage, you'll be in a strong position to get a lender's best possible interest rate regardless of where prevailing rates are. Auto loan interest rates typically follow the path of the Fed rate, but it can take time to see. When car loan rates do begin to fall, will it be a good time to buy or refinance? Here are some considerations to help you decide. Your APR on a car loan is determined by many factors, such as your credit history, credit score, loan term and vehicle age. Taking time to improve your credit, or to find a slightly used car rather than a new one, is likely to affect your loan rate more than a slight drop in the Fed rate. From the car-buying perspective, your interest rate is just one part of your monthly payment, which also includes the amount you borrow to pay for the car. In July, the average transaction price for new cars was $48,401, with an average monthly payment of $753. The average listing price for used cars was $25,415. Car prices have improved compared to a year ago, but they still remain higher than pre-pandemic levels. Even when interest rates drop, you will want to focus on a vehicle’s out-the-door price and whether the resulting monthly payment fits your budget. If you financed a car at a high interest rate, refinancing could be a way to lower the rate and your monthly payment. In general, lenders recommend reducing your rate by 1% or more, without extending the loan term, to get the most out of refinancing. And you’ll want to make sure your savings outweigh any lender or title transfer fees. Since the Fed’s rate decrease is expected to be 50 basis points or less, waiting to refinance after additional rate cuts could be more beneficial.","[question] Explain the potential effects of the Federal Reserve's upcoming interest rate cuts on personal finance, particularly focusing on credit card debt, mortgages, and auto loans. How should individuals prepare for these changes? ===================== [text] Reference Text: Inflation has slowed and the labor market has softened enough to satisfy the Federal Reserve. That means the central bank is about to cut interest rates. On Aug. 23, Fed Chair Jerome Powell said, “The time has come for policy to adjust. The direction of travel is clear, and the timing and pace of rate cuts will depend on incoming data, the evolving outlook, and the balance of risks.” In other words, Americans should prepare to finally catch a break when it comes to borrowing to pay for a home, buy a car or open a new credit card. There are also other implications for the health of the broader economy. Back in March 2022, the Federal Open Markets Committee (FOMC) began to increase the federal funds rate in response to growing inflation. It hiked rates 11 times before finally pausing. The rates, set at 5.25% to 5.50%, haven’t budged since July 2023. The first cut will almost certainly happen at the Fed’s upcoming meeting scheduled for Sept. 17-18. The futures market’s CME FedWatch Tool now predicts a 87% likelihood that the FOMC will cut the current target rate by 25 basis points; it predicts a 13% likelihood of a larger cut of 50 basis points. But even if the Fed trims rates next week as expected, the target will still be a long way from the near-zero rate of early 2020 and immediate effects will be muted. Mortgage rates have already been easing in anticipation of a cut, for example, and most consumer credit and lending products are more dependent on your credit score than on the Fed rate. Still, this is viewed as a significant event and could build expectations for more cuts down the road. So what happens next? NerdWallet writers teamed up to explain how upcoming Fed rate cuts could impact your personal finances and what you can do to prepare. Credit card interest rates are variable, meaning they adjust up or down shortly after the Fed changes the federal funds rate. So if the Fed lowers interest rates, credit card debt will cost slightly less. The operative word here is “slightly.” Credit card debt is expensive no matter what the federal funds rate happens to be. Let’s say you have an average balance of $5,000 on a card charging 25% APR. You’ll spend around $1,250 in interest over the course of a year. If your interest rate was 24% instead, that’s just $50 less in interest for the year. Point being, a rate reduction doesn’t translate to a massive savings in interest when it comes to credit cards. Still, you can use the upcoming Fed news as a reminder to check in on your debt and make a plan to pay it down as aggressively as you can. If you qualify, a balance transfer credit card could give you a year or more without interest. Lower interest rates might make a personal loan a compelling debt consolidation option. Mortgage interest rates have already headed lower ahead of any action by the Fed. In April, the average interest rate on a 30-year, fixed-rate loan was 7.04%. August's average was nearly three-quarters of a percentage point lower, at 6.31%. That 73-basis-point drop is larger than any anticipated rate cut, but rates may push even lower once the central bankers start chopping. Homeowners with adjustable-rate mortgages or home equity lines of credit (HELOCs) should see savings right away as their interest rates ratchet downward. But lower mortgage interest rates might also be a boon to homeowners with fixed-rate mortgages. Those who bought when rates were higher could finally see a significant benefit from refinancing, while owners who feel tethered by their current low mortgage rates may feel more confident about making a move. Reducing that rate ""lock in"" effect could put more homes on the market, particularly at the starter-home level. Prospective home buyers likely feel heartened by the prospect of rate cuts, but a quarter or even half of a percentage point cut from the Federal Reserve shouldn't cause a sudden drop in mortgage rates, especially with a downward trend already in progress. So, don't wait on the Fed: Buy when you're ready, not when interest rates are. While you're preparing to buy — and during your home search — work on your finances. Continue to pay down high-interest debt, try to build your credit score, don't take out new loans and keep making on-time payments. That way, when you're applying for a mortgage, you'll be in a strong position to get a lender's best possible interest rate regardless of where prevailing rates are. Auto loan interest rates typically follow the path of the Fed rate, but it can take time to see. When car loan rates do begin to fall, will it be a good time to buy or refinance? Here are some considerations to help you decide. Your APR on a car loan is determined by many factors, such as your credit history, credit score, loan term and vehicle age. Taking time to improve your credit, or to find a slightly used car rather than a new one, is likely to affect your loan rate more than a slight drop in the Fed rate. From the car-buying perspective, your interest rate is just one part of your monthly payment, which also includes the amount you borrow to pay for the car. In July, the average transaction price for new cars was $48,401, with an average monthly payment of $753. The average listing price for used cars was $25,415. Car prices have improved compared to a year ago, but they still remain higher than pre-pandemic levels. Even when interest rates drop, you will want to focus on a vehicle’s out-the-door price and whether the resulting monthly payment fits your budget. If you financed a car at a high interest rate, refinancing could be a way to lower the rate and your monthly payment. In general, lenders recommend reducing your rate by 1% or more, without extending the loan term, to get the most out of refinancing. And you’ll want to make sure your savings outweigh any lender or title transfer fees. Since the Fed’s rate decrease is expected to be 50 basis points or less, waiting to refinance after additional rate cuts could be more beneficial. https://www.nasdaq.com/articles/what-happens-when-fed-finally-cuts-rates ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Financial,Effect Analysis,Q&A Only use the information provided in the context document. Present the answer in a markdown formatted table.,"Give me an example daily nutrition plan with food recommendations for a 42-year-old female in the week before a race. ","4 NUTRITION Nutrition is extremely important for individuals who are doing a sport in competitive level and for recreational individuals as well. Proper nutrition makes exercising more efficient and improves recovery from the exercises. A versatile diet that considers limitations ensures that the most important areas e.g. vitamins, mineralsand macro- nutrients are covered. The recommended total energy intake varies between individuals, sports and training period. The emphasis of macronutrients varies between sports. Endurance sports require more energy from carbohydrates than sports related to speed and power. (Mero 2016, 177.) The specific training period, as mentioned before affects energy requirement level. During the general preparation periods, energy intake varies from 3000 kcal to 6000 kcal depending on the exercise duration and intensity. One rule of thumb is to calculate daily need with 45-70 kcal/kg of body weight. Total energy intake should vary depending on the need, however, the amount of carbohydrates should remain high to be able to maintain proper recovery. Total energy intake should be 100-300 kcal over the daily consumption to recover and improve optimally. (Mero 2016, 204 –205.) 4.1 Carbohydrates Carbohydrates form the base of nutrition for endurance athletes. Carbohydrates are needed as an energy source during long lasting exercises and in recovery. The amount of carbohydrates consumed should be 6-10 g/kg or 60-75% of total energy intake. Carbohydrates that are consumed before training ensure that the blood glucose level stays high and the intensity can be as high as planned. This can be achieved by consuming a meal that includes carbohydrates and protein 1- 4 hours before the exercise. (Mero 2016, 204 – 205.) Good sources of carbohydrates include e.g. rice, pasta, potatoes, bread and fruits. It is recommended that recreational runners should prefer fiber rich carbohydrate sources because they fit for wellbeing purposes also. However, for athletes with high-energy expenditure, sugars can be used to reach high enough carbohydrate intake level. Sugar rich energy sources are e.g. juices, jams and honey. (Ilander, 2014a, 136—137.) 4.2 Fat Fats are needed to maintain hormonal functions in the body, and to enhance the absorption of vitamins. Fat intake level should be 1,0-1,5 g/kg or 20-30% of total energy intake (Mero 2016, 204). Due to high amount of energy that fats contain, the amount should be limited. The high requirement of carbohydrates and protein also affect to the intake level of fat. Fats that are consumed should mainly be unsaturated fat. Athletes should favor products that include low levels of fat. (Arjanne, Laaksonen & Ojala 2016, 164 – 168.) Good sources of fat include high amount of un-saturated fats and are low on saturated fats. Un-saturated fats can be found from e.g. nuts, fish and vegetable oils. Saturated fat can be found from e.g. red meat, and thus too extensive use should be avoided. (Ilander, 2014b, 229—238.) 4.3 Protein Proteins are used to build muscle mass, and serve as an energy source during long lasting performances. Protein intake level should be 2-3 g/kg or 15-20% of total energy intake (Mero 2016, 204). A high amount of proteins in the diet ensures, that there is no loss in muscle mass, and that the recovery from the training is optimal. Proteins also help in weight control by giving a feeling of satiety. (Arjanne, Laaksonen & Ojala, 2016, 164 – 168.) In versatile diet, the amount of protein is covered, but in case additional protein is needed, it can be consumed from supplements or from other sources. For people with special diets e.g. vegetarians and vegans, it is extremely important to make sure that the protein intake level is sufficient. Good sources of protein are e.g. milk, eggs, fish, seeds and nuts. (Ilander & Lindblad, 2014, 222—225.) 4.4 Carbohydrate and hydration loading for competitions Carbohydrate loading is beneficial before long lasting events, because the body’s glycogen stores can become a limiting factor for performance. Filling up the glycogen stores will allow one to perform longer with high intensity. There are several strategies for carbohydrate loading, some being riskier than others. In the guide, we introduced a fast and low risk way to do it. A fast and low risk method for carbohydrate loading starts with a short, but maximal intensity exercise, which is done 48 hours before the competition. After the exercise, a very high carbohydrate intake is maintained for 24 hours. The amount of carbohydrates consumed correspond to 12 g/kg of fat free body mass. During this 24 hours, no training should be done to avoid depletion of the glycogen stores. After the 24 hour period, a normal, high carbohydrate diet (6-10 g/kg) is maintained until the competition. (Fairchild et al 2002.) Good carbohydrate sources for loading purposes are pasta, white bread, rice and sports drinks. During the carbohydrate loading, protein and fat rich food should be avoided as well as low energy foods e.g. vegetables (Collier & O’dea 1983; Fairchild et al 2002). Dehydration is a risk factor that can ruin a well-planned competition. It can be avoided by consuming additional two liters of liquid for every day for 3-4 days before the competition and by consuming liquids during the competition as well. The competition day should have normal liquid consumption. A sufficient amount of liquids during the competition is 0,5-1 liter per hour. (Juoksijalehti n.d.) However, consuming too much liquid can predispose one to hyponatremia (Mayoclinic 2014).","Give me an example daily nutrition plan with food recommendations for a 42 year old female in the week before a race. System Instructions: Only use the information provided in the context document. Present the answer in a markdown formatted table. 4 NUTRITION Nutrition is extremely important for individuals who are doing a sport in competitive level and for recreational individuals as well. Proper nutrition makes exercising more efficient and improves recovery from the exercises. A versatile diet that considers limitations ensures that the most important areas e.g. vitamins, mineralsand macro- nutrients are covered. The recommended total energy intake varies between individuals, sports and training period. The emphasis of macronutrients varies between sports. Endurance sports require more energy from carbohydrates than sports related to speed and power. (Mero 2016, 177.) The specific training period, as mentioned before affects energy requirement level. During the general preparation periods, energy intake varies from 3000 kcal to 6000 kcal depending on the exercise duration and intensity. One rule of thumb is to calculate daily need with 45-70 kcal/kg of body weight. Total energy intake should vary depending on the need, however, the amount of carbohydrates should remain high to be able to maintain proper recovery. Total energy intake should be 100-300 kcal over the daily consumption to recover and improve optimally. (Mero 2016, 204 –205.) 4.1 Carbohydrates Carbohydrates form the base of nutrition for endurance athletes. Carbohydrates are needed as an energy source during long lasting exercises and in recovery. The amount of carbohydrates consumed should be 6-10 g/kg or 60-75% of total energy intake. Carbohydrates that are consumed before training ensure that the blood glucose level stays high and the intensity can be as high as planned. This can be achieved by consuming a meal that includes carbohydrates and protein 1- 4 hours before the exercise. (Mero 2016, 204 – 205.) Good sources of carbohydrates include e.g. rice, pasta, potatoes, bread and fruits. It is recommended that recreational runners should prefer fiber rich carbohydrate sources because they fit for wellbeing purposes also. However, for athletes with high-energy expenditure, sugars can be used to reach high enough carbohydrate intake level. Sugar rich energy sources are e.g. juices, jams and honey. (Ilander, 2014a, 136—137.) 4.2 Fat Fats are needed to maintain hormonal functions in the body, and to enhance the absorption of vitamins. Fat intake level should be 1,0-1,5 g/kg or 20-30% of total energy intake (Mero 2016, 204). Due to high amount of energy that fats contain, the amount should be limited. The high requirement of carbohydrates and protein also affect to the intake level of fat. Fats that are consumed should mainly be unsaturated fat. Athletes should favor products that include low levels of fat. (Arjanne, Laaksonen & Ojala 2016, 164 – 168.) Good sources of fat include high amount of un-saturated fats and are low on saturated fats. Un-saturated fats can be found from e.g. nuts, fish and vegetable oils. Saturated fat can be found from e.g. red meat, and thus too extensive use should be avoided. (Ilander, 2014b, 229—238.) 4.3 Protein Proteins are used to build muscle mass, and serve as an energy source during long lasting performances. Protein intake level should be 2-3 g/kg or 15-20% of total energy intake (Mero 2016, 204). A high amount of proteins in the diet ensures, that there is no loss in muscle mass, and that the recovery from the training is optimal. Proteins also help in weight control by giving a feeling of satiety. (Arjanne, Laaksonen & Ojala, 2016, 164 – 168.) In versatile diet, the amount of protein is covered, but in case additional protein is needed, it can be consumed from supplements or from other sources. For people with special diets e.g. vegetarians and vegans, it is extremely important to make sure that the protein intake level is sufficient. Good sources of protein are e.g. milk, eggs, fish, seeds and nuts. (Ilander & Lindblad, 2014, 222—225.) 4.4 Carbohydrate and hydration loading for competitions Carbohydrate loading is beneficial before long lasting events, because the body’s glycogen stores can become a limiting factor for performance. Filling up the glycogen stores will allow one to perform longer with high intensity. There are several strategies for carbohydrate loading, some being riskier than others. In the guide, we introduced a fast and low risk way to do it. A fast and low risk method for carbohydrate loading starts with a short, but maximal intensity exercise, which is done 48 hours before the competition. After the exercise, a very high carbohydrate intake is maintained for 24 hours. The amount of carbohydrates consumed correspond to 12 g/kg of fat free body mass. During this 24 hours, no training should be done to avoid depletion of the glycogen stores. After the 24 hour period, a normal, high carbohydrate diet (6-10 g/kg) is maintained until the competition. (Fairchild et al 2002.) Good carbohydrate sources for loading purposes are pasta, white bread, rice and sports drinks. During the carbohydrate loading, protein and fat rich food should be avoided as well as low energy foods e.g. vegetables (Collier & O’dea 1983; Fairchild et al 2002). Dehydration is a risk factor that can ruin a well-planned competition. It can be avoided by consuming additional two liters of liquid for every day for 3-4 days before the competition and by consuming liquids during the competition as well. The competition day should have normal liquid consumption. A sufficient amount of liquids during the competition is 0,5-1 liter per hour. (Juoksijalehti n.d.) However, consuming too much liquid can predispose one to hyponatremia (Mayoclinic 2014). ",Retail/Product,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","With Accenture and HCL, and other major ICT firms beginning to aim for sustainability, what is the position of carbon-counting tools like GreenFrame in the mitigation of emission from front-end web applications? Further, how do these companies apply 3R model(Reduce, Reuse, Recycle) in their sustainability initiatives, and what issues may ensue during the implementing strategy of these services into the ICT services?","Studies show that carbon emissions generated by the internet, devices, and systems that support it account for 3.7% of global greenhouse gas emissions. That’s more than all aviation emissions (2.5%). It doesn’t end there. Research conducted by “Green the Web.” found that a single web page consumes on average 1.76 g CO2 per page view. As businesses, the question we need to ask ourselves is how much every click on our website/data storage/use of tech devices costs the planet. There are no specific points or steps to follow while designing a green or sustainable IT system. In truth, it’s a collection of ideas, facts, and best practices that should be followed while prioritizing sustainability principles. Climate change is an indisputable reality every organization under the sun is grappling with. Increased global warming due to rising carbon emissions is compelling both companies and customers to think about sustainability for their own future. A few statistics to understand the gravity of the current scenario: Forests being cut down: Since 2016, an average of 28 million hectares have been cut down every year. Half of the world’s rainforest has been destroyed in just one century. Nearly 2.7 billion tons of coal mined globally to date: Strip mining accounts for 40% of the world’s coal mines and the practice destroys landscapes, forests, and wildlife habitation. The global Information Communication Technology (ICT) industry contributes 2%-3% of greenhouse gas (GHG) emissions: User devices, networks, and data centers hold the largest share of carbon emissions compared to other contributors within the ICT industry. Related reading: The growth of green consumerism: Shaping sustainable futures “Sustainability” – the real buzz around the entire ICT industry Environmental, Social, and Governance (ESG) investors are using non-financial aspects more often as part of their analytical process to assess opportunities and identify material risks. ESG investors have become a growing force in capital markets and poured around $649 Bn into ESG funds in 2021. The US has experienced the highest growth in recent years and may come to dominate the category starting in 2022. ECG-mandated & non-mandated assets Shifts in design globally and the role of IT companies Green or sustainable IT is bringing about a transformative change in the users’ mindset. Right from the efficient utilization of resources, reduction in waste, innovative and sustainable design approach, low power devices, and more, ICT companies can immensely contribute towards this objective of global environmental sustainability. Global IT industry leaders like Accenture, Microsoft, IBM, HCL, Oracle, etc., are working towards IT sustainability and incorporating a sustainable approach in their products and services. There are tools available to measure CO2 emissions in front-end web applications (E.g. Wholegrain Digital and GreenFrame). However, for native/mobile applications currently, a few startups are working to measure CO2 emissions. Some of the names include Pangolin, CoGo, and ImpactVision. Increasing use of 3D arts, electronics wearables, mobile apps, NFTs, gamification, IoT devices, and data centers have raised serious concerns for designers and developers about incurring sustainability issues and reducing carbon footprints. Savvy startups eager to prove their concern are already working towards providing sustainability in their product/services. Current innovation in and sustainability R&D concept in the IT industry are being developed and applied to future paradigm parameters like the generation of extremely consistent recycling management approaches for hardware and batteries. Importance of 3 Rs in sustainable IT: reusing, recycling, reducing The entire environmental sustainability revolves around 3 Rs (reusing, recycling, reducing). IT enterprises (more likely hardware companies) can create advanced IT systems keeping these 3 Rs in mind. Recycling is using old components or parts in a new way or using waste as resources. Reusing refers to the repeated use of items or parts of items which still have usable aspects including network interfaces and communication devices. Reducing means optimizing the amount of waste or energy consumed with means of choosing things with care to reduce the amount of waste generated. Optimized customer experiences are turning into game-changers and IT technology trends are focused on this digital-savvy generation. The necessity to get on the sustainable IT trends wave Before discussing sustainable IT trends, let’s start with why it is imperative to catch up with these trends: Competitive edge: Staying informed on the latest trends of sustainability and monitoring how your competitors are treating their customers helps you drive competitive uniqueness. New customer acquisition: Consumers have begun to change their buying patterns due to the shift to digital platforms, products, and services. Considering sustainability (low power, fast charging, and compact designs) as the primary go-to-market strategy allows enterprises to tap into new ways to acquire customers. Customer retention: Customer loyalty is an irreplaceable asset. By offering your customers the experience they deserve, enterprises can build a connection that goes beyond a single interaction or purchase. Sustainability will remain a top priority for ICT brands to survive and thrive. A few key trends we think will help your customers and the market at large take note of your sustainable approach now and into the future: ICT initiative that lifts sustainability Ensuring these ideas are embedded into hardware and software designs will not only lead to improved performance and usability. It will also ensure quality of product or services that company offers. As leading ICT brands like Microsoft, Intel, Google, AT&T, AWS, etc. need to implement a sustainability approach to build a green future, accessible to all. Creating a simpler, smoother online experience can also help reduce visitor screen time and webpage bandwidth usage. As a part of sustainable product/service design, savvy companies are already working to support the environment by compact designs, use of advanced technologies like AI and ML, and incorporate energy efficient systems. Going green is a core part of doing business today for any enterprise. Sustainable/green approach results in a win-win-win situation for the economy, society, and environment. Enterprises operating in ICT sector must consider sustainability as their responsibility while developing new technologies, products, and services.","""================ ======= Studies show that carbon emissions generated by the internet, devices, and systems that support it account for 3.7% of global greenhouse gas emissions. That’s more than all aviation emissions (2.5%). It doesn’t end there. Research conducted by “Green the Web.” found that a single web page consumes on average 1.76 g CO2 per page view. As businesses, the question we need to ask ourselves is how much every click on our website/data storage/use of tech devices costs the planet. There are no specific points or steps to follow while designing a green or sustainable IT system. In truth, it’s a collection of ideas, facts, and best practices that should be followed while prioritizing sustainability principles. Climate change is an indisputable reality every organization under the sun is grappling with. Increased global warming due to rising carbon emissions is compelling both companies and customers to think about sustainability for their own future. A few statistics to understand the gravity of the current scenario: Forests being cut down: Since 2016, an average of 28 million hectares have been cut down every year. Half of the world’s rainforest has been destroyed in just one century. Nearly 2.7 billion tons of coal mined globally to date: Strip mining accounts for 40% of the world’s coal mines and the practice destroys landscapes, forests, and wildlife habitation. The global Information Communication Technology (ICT) industry contributes 2%-3% of greenhouse gas (GHG) emissions: User devices, networks, and data centers hold the largest share of carbon emissions compared to other contributors within the ICT industry. Related reading: The growth of green consumerism: Shaping sustainable futures “Sustainability” – the real buzz around the entire ICT industry Environmental, Social, and Governance (ESG) investors are using non-financial aspects more often as part of their analytical process to assess opportunities and identify material risks. ESG investors have become a growing force in capital markets and poured around $649 Bn into ESG funds in 2021. The US has experienced the highest growth in recent years and may come to dominate the category starting in 2022. ECG-mandated & non-mandated assets Shifts in design globally and the role of IT companies Green or sustainable IT is bringing about a transformative change in the users’ mindset. Right from the efficient utilization of resources, reduction in waste, innovative and sustainable design approach, low power devices, and more, ICT companies can immensely contribute towards this objective of global environmental sustainability. Global IT industry leaders like Accenture, Microsoft, IBM, HCL, Oracle, etc., are working towards IT sustainability and incorporating a sustainable approach in their products and services. There are tools available to measure CO2 emissions in front-end web applications (E.g. Wholegrain Digital and GreenFrame). However, for native/mobile applications currently, a few startups are working to measure CO2 emissions. Some of the names include Pangolin, CoGo, and ImpactVision. Increasing use of 3D arts, electronics wearables, mobile apps, NFTs, gamification, IoT devices, and data centers have raised serious concerns for designers and developers about incurring sustainability issues and reducing carbon footprints. Savvy startups eager to prove their concern are already working towards providing sustainability in their product/services. Current innovation in and sustainability R&D concept in the IT industry are being developed and applied to future paradigm parameters like the generation of extremely consistent recycling management approaches for hardware and batteries. Importance of 3 Rs in sustainable IT: reusing, recycling, reducing The entire environmental sustainability revolves around 3 Rs (reusing, recycling, reducing). IT enterprises (more likely hardware companies) can create advanced IT systems keeping these 3 Rs in mind. Recycling is using old components or parts in a new way or using waste as resources. Reusing refers to the repeated use of items or parts of items which still have usable aspects including network interfaces and communication devices. Reducing means optimizing the amount of waste or energy consumed with means of choosing things with care to reduce the amount of waste generated. Optimized customer experiences are turning into game-changers and IT technology trends are focused on this digital-savvy generation. The necessity to get on the sustainable IT trends wave Before discussing sustainable IT trends, let’s start with why it is imperative to catch up with these trends: Competitive edge: Staying informed on the latest trends of sustainability and monitoring how your competitors are treating their customers helps you drive competitive uniqueness. New customer acquisition: Consumers have begun to change their buying patterns due to the shift to digital platforms, products, and services. Considering sustainability (low power, fast charging, and compact designs) as the primary go-to-market strategy allows enterprises to tap into new ways to acquire customers. Customer retention: Customer loyalty is an irreplaceable asset. By offering your customers the experience they deserve, enterprises can build a connection that goes beyond a single interaction or purchase. Sustainability will remain a top priority for ICT brands to survive and thrive. A few key trends we think will help your customers and the market at large take note of your sustainable approach now and into the future: ICT initiative that lifts sustainability Ensuring these ideas are embedded into hardware and software designs will not only lead to improved performance and usability. It will also ensure quality of product or services that company offers. As leading ICT brands like Microsoft, Intel, Google, AT&T, AWS, etc. need to implement a sustainability approach to build a green future, accessible to all. Creating a simpler, smoother online experience can also help reduce visitor screen time and webpage bandwidth usage. As a part of sustainable product/service design, savvy companies are already working to support the environment by compact designs, use of advanced technologies like AI and ML, and incorporate energy efficient systems. Going green is a core part of doing business today for any enterprise. Sustainable/green approach results in a win-win-win situation for the economy, society, and environment. Enterprises operating in ICT sector must consider sustainability as their responsibility while developing new technologies, products, and services. https://www.netscribes.com/sustainable-it-reducing-carbon-footprints-and-preserving-resources/ ================ ======= With Accenture and HCL, and other major ICT firms beginning to aim for sustainability, what is the position of carbon-counting tools like GreenFrame in the mitigation of emission from front-end web applications? Further, how do these companies apply 3R model(Reduce, Reuse, Recycle) in their sustainability initiatives, and what issues may ensue during the implementing strategy of these services into the ICT services? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Internet/Technology,Effect Analysis,Q&A "You can only respond using information in the context block, and no other sources. ",What are the implications of an acrylate allergy?,"The British Association of Dermatologists has issued warnings regarding the dangers of chemicals found in nail cosmetics. The retrospective analysis of patch testing results conducted on individuals diagnosed with contact dermatitis(CD) due to nail cosmetic ingredients revealed the most frequently occurring positive reactions to specific chemicals [3].4.2.1 Acrylates are chemicals found in gel nail products, acrylic nails, and some nailadhesives. Hydroxyethyl Methacrylates (HEMA), Methyl Methacrylate and Ethyl Acrylateare commonly used in these products and resulted to be the most allergenic in the study(56.6%, 27.8% and 25.2%, respectively) [3] . Some individuals may develop contact dermatitis or allergic reactions to these chemicals, especially if they come into prolonged or repeated contact with the skin and are cross-reactive with one another [12].An EECDRG (European Environmental Contact Dermatitis Research Group) study revealed136 cases of allergic contact dermatitis (ACD) caused by nail acrylates, diagnosed through targeted testing [4] . This accounted for approximately 67% of all cases of (meth)acrylate allergy observed between the years 2013 and 2015. The study identified the main allergens responsible for these reactions, with 2-hydroxyethyl methacrylate (2-HEMA) showing a positivity rate of 91.9%, followed by hydroxypropyl methacrylate with 83.2% positivity, and ethylene glycol dimethacrylate at 69.2% positivity.The monomer commonly used in nail cosmetic procedures is typically a methacrylatemonomer. Initially, methyl methacrylate (MMA) was frequently employed in these products. 63However, due to the occurrence of severe cases of contact dermatitis associated with MMA exposure, its use has been restricted in the United States and Europe [13] . To address safety concerns, regulations were implemented in the United States, which led to the prohibition of products with 100% MMA monomer. Additionally, in Europe, many products containing over90% MMA monomer were recalled preventing potential adverse health effects [14].4.2.2 Formaldehyde is a preservative and hardening agent found in some nail hardeners and nail polishes [15] . It can cause skin irritation and allergic reactions, and long-term exposure may pose health risks. There has been a decline in sensitization to tosylamide/formaldehyde resin, a common ingredient found in ""classical"" nail polish, while the incidence of(meth)acrylate-related allergic contact dermatitis (ACD) has been on the rise [16].3.2.3 Parabens are preservatives used in some nail products to extend their shelf life [17] .They have been linked to skin irritation and may cause allergic reactions in sensitive individuals. They are very weak allergens with a sensitization prevalence of arounf 1% or less.4.3. Allergic Contact DermatitisThe most studied adverse effect of methacrylate monomers in the gel polish is allergic contact dermatitis (ACD) [18] . Recently, the incidence of allergic contact dermatitis associated with nail cosmetics has increased among beauticians and customers, particularly with the rising popularity of photo-bonded acrylic gel nails[19].ACD caused by (meth)acrylates is commonly observed in specific occupational groups, including beauticians such as nail technicians, dental personnel (dentists and technicians), and employees working in industries involved in fiberglass, printing, glue, or paint manufacturing[1] . These professionals are at an increased risk of developing allergic reactions to(meth)acrylates due to their frequent and direct exposure to products containing these compounds in their work environments. Gatica-Ortega et al. (2017) presented a picture of a typical patient with ACD caused by methacrylates in artificial nails as a young, non-atopic woman, who works as a nail technician and suffers from hand and face dermatisis [18] . They used MOAHFLA index, which is the acronym for male, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, face dermatitis, and age >40 years. Among the 1.82% patients with ACD of 2353 studied, the most frequently positive allergens were HPMA (positive reactions observed in almost all 64patients except one), HEMA, and THFMA. Only one patient had negative patch test results for both HPMA and HEMA. Patch testing with both HPMA and THFMA would have ensured that no patients with (meth)acrylate allergies were missed.Interestingly, these three allergens, HPMA, HEMA, and THFMA, were also the most identified (meth)acrylate compounds listed on the labels of the products used by the patients.This correlation between positive patch test results and the presence of these allergens in the products suggests the importance of identifying and labeling these compounds accurately to aid in diagnosing and managing allergic contact dermatitis caused by (meth)acrylates.The risk of developing allergic contact dermatitis to nail cosmetics is higher in individuals who have previously been sensitized to these allergens. Sensitization can occur through repeated or prolonged exposure to these chemicals, leading the body's immune system to recognize them as harmful substances and trigger an allergic reaction upon subsequent exposure [20]. The nail technicians are under the highest risk of allergies.The retrospective study conducted by the European Environmental Contact Dermatitis Research Group (EECDRG) revealed significant insights into acrylate-induced allergic contact dermatitis (ACD) [4].Authors showed that an overwhelming 67% of ACD cases attributed to acrylates were caused by materials used in nail stylization. Among the affected individuals, 43% were exposed as consumers using nail cosmetic products, while 56% were exposed occupationally, primarily referring to nail technicians who handle these products regularly.A notable finding from the study was that 65% of the cases of occupational ACD were identified within the first year of starting work. This indicates a high sensitizing potency of acrylate chemicals, as the allergic reactions were detected relatively early in the occupational exposure. It highlights the importance of recognizing the risks associated with acrylate exposure in the workplace and the need for preventative measures to protect the health of professionals working in nail stylization.Symptoms of allergic contact dermatitis may include redness, itching, swelling, and blistering around the nail area or on the skin exposed to the nail products [4,21] . In severe cases, the reaction may spread to other parts of the body that encountered the allergen, leading to widespread dermatitis. 654.5.1. Diagnosis Patch testing is considered the gold standard in confirming the diagnosis of allergy to acrylates [1] . During the procedure, small amounts of potential allergens, including acrylate compounds, are applied to patches that are then placed on the patient's back. The patches are left in place for a specific time, usually around 48 hours. After this period, the patches are removed, and the skin is carefully examined for any signs of allergic reactions.If a patient is allergic to acrylates, the patch test will reveal a positive reaction in the form of redness, swelling, or rash at the site of exposure to the acrylate allergen. This positive result confirms the diagnosis of acrylate allergy and helps the healthcare provider to identify the specific acrylate compounds to which the patient is sensitive.Acrylate allergies can sometimes be polyvalent, meaning patients may exhibit positive patch test reactions to multiple acrylate compounds even if they have not been directly exposed toall those substances individually [20]. This phenomenon is often attributed to cross-reactions between different acrylic monomers and concomitant allergies.4.4. Additional RiskAllergies to gel nail chemicals are more likely to occur if gel polish isn't accurately or sufficiently cured under a UV or LED lamp during the manicure, leading to skin sensitization[2]. The British Association of Dermatologists has urged caution with at-home gel nail kits, as improper curing and exposure to acrylates can cause allergic reactions [22–24].Acrylates are not only present in nail cosmetics but have a wide application in various medical purposes, such as dental ligatures, soft contact lenses, endoprostheses, hearing aids and medical devices for diabetes patients [25–28].As a result, individuals who have previously developed allergic contact dermatitis (ACD) to acrylates from artificial nails may experience allergic reactions upon re-exposure to acrylates in these other materials. Moreover, cross-reactions with other acrylic monomers may occur, leading to additional allergic responses [20].For individuals with ACD to acrylates in artificial nails, it is essential to exercise caution when using other products that contain acrylates. However, it has been reported that those 66 who are not allergic to ethyl cyanoacrylate, which is present in all nail glues, can safely use silk wrap nails as an alternative [5] . This option provides a potentially safer choice for nail enhancements without the risk of triggering allergic reactions caused by acrylates in artificial nails.","System instruction: You can only respond using information in the context block, and no other sources. question: What are the implications of an acrylate allergy? context: The British Association of Dermatologists has issued warnings regarding the dangers of chemicals found in nail cosmetics. The retrospective analysis of patch testing results conducted on individuals diagnosed with contact dermatitis(CD) due to nail cosmetic ingredients revealed the most frequently occurring positive reactions to specific chemicals [3].4.2.1 Acrylates are chemicals found in gel nail products, acrylic nails, and some nailadhesives. Hydroxyethyl Methacrylates (HEMA), Methyl Methacrylate and Ethyl Acrylateare commonly used in these products and resulted to be the most allergenic in the study(56.6%, 27.8% and 25.2%, respectively) [3] . Some individuals may develop contact dermatitis or allergic reactions to these chemicals, especially if they come into prolonged or repeated contact with the skin and are cross-reactive with one another [12].An EECDRG (European Environmental Contact Dermatitis Research Group) study revealed136 cases of allergic contact dermatitis (ACD) caused by nail acrylates, diagnosed through targeted testing [4] . This accounted for approximately 67% of all cases of (meth)acrylate allergy observed between the years 2013 and 2015. The study identified the main allergens responsible for these reactions, with 2-hydroxyethyl methacrylate (2-HEMA) showing a positivity rate of 91.9%, followed by hydroxypropyl methacrylate with 83.2% positivity, and ethylene glycol dimethacrylate at 69.2% positivity.The monomer commonly used in nail cosmetic procedures is typically a methacrylatemonomer. Initially, methyl methacrylate (MMA) was frequently employed in these products. 63However, due to the occurrence of severe cases of contact dermatitis associated with MMA exposure, its use has been restricted in the United States and Europe [13] . To address safety concerns, regulations were implemented in the United States, which led to the prohibition of products with 100% MMA monomer. Additionally, in Europe, many products containing over90% MMA monomer were recalled preventing potential adverse health effects [14].4.2.2 Formaldehyde is a preservative and hardening agent found in some nail hardeners and nail polishes [15] . It can cause skin irritation and allergic reactions, and long-term exposure may pose health risks. There has been a decline in sensitization to tosylamide/formaldehyde resin, a common ingredient found in ""classical"" nail polish, while the incidence of(meth)acrylate-related allergic contact dermatitis (ACD) has been on the rise [16].3.2.3 Parabens are preservatives used in some nail products to extend their shelf life [17] .They have been linked to skin irritation and may cause allergic reactions in sensitive individuals. They are very weak allergens with a sensitization prevalence of arounf 1% or less.4.3. Allergic Contact DermatitisThe most studied adverse effect of methacrylate monomers in the gel polish is allergic contact dermatitis (ACD) [18] . Recently, the incidence of allergic contact dermatitis associated with nail cosmetics has increased among beauticians and customers, particularly with the rising popularity of photo-bonded acrylic gel nails[19].ACD caused by (meth)acrylates is commonly observed in specific occupational groups, including beauticians such as nail technicians, dental personnel (dentists and technicians), and employees working in industries involved in fiberglass, printing, glue, or paint manufacturing[1] . These professionals are at an increased risk of developing allergic reactions to(meth)acrylates due to their frequent and direct exposure to products containing these compounds in their work environments. Gatica-Ortega et al. (2017) presented a picture of a typical patient with ACD caused by methacrylates in artificial nails as a young, non-atopic woman, who works as a nail technician and suffers from hand and face dermatisis [18] . They used MOAHFLA index, which is the acronym for male, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, face dermatitis, and age >40 years. Among the 1.82% patients with ACD of 2353 studied, the most frequently positive allergens were HPMA (positive reactions observed in almost all 64patients except one), HEMA, and THFMA. Only one patient had negative patch test results for both HPMA and HEMA. Patch testing with both HPMA and THFMA would have ensured that no patients with (meth)acrylate allergies were missed.Interestingly, these three allergens, HPMA, HEMA, and THFMA, were also the most identified (meth)acrylate compounds listed on the labels of the products used by the patients.This correlation between positive patch test results and the presence of these allergens in the products suggests the importance of identifying and labeling these compounds accurately to aid in diagnosing and managing allergic contact dermatitis caused by (meth)acrylates.The risk of developing allergic contact dermatitis to nail cosmetics is higher in individuals who have previously been sensitized to these allergens. Sensitization can occur through repeated or prolonged exposure to these chemicals, leading the body's immune system to recognize them as harmful substances and trigger an allergic reaction upon subsequent exposure [20]. The nail technicians are under the highest risk of allergies.The retrospective study conducted by the European Environmental Contact Dermatitis Research Group (EECDRG) revealed significant insights into acrylate-induced allergic contact dermatitis (ACD) [4].Authors showed that an overwhelming 67% of ACD cases attributed to acrylates were caused by materials used in nail stylization. Among the affected individuals, 43% were exposed as consumers using nail cosmetic products, while 56% were exposed occupationally, primarily referring to nail technicians who handle these products regularly.A notable finding from the study was that 65% of the cases of occupational ACD were identified within the first year of starting work. This indicates a high sensitizing potency of acrylate chemicals, as the allergic reactions were detected relatively early in the occupational exposure. It highlights the importance of recognizing the risks associated with acrylate exposure in the workplace and the need for preventative measures to protect the health of professionals working in nail stylization.Symptoms of allergic contact dermatitis may include redness, itching, swelling, and blistering around the nail area or on the skin exposed to the nail products [4,21] . In severe cases, the reaction may spread to other parts of the body that encountered the allergen, leading to widespread dermatitis. 654.5.1. Diagnosis Patch testing is considered the gold standard in confirming the diagnosis of allergy to acrylates [1] . During the procedure, small amounts of potential allergens, including acrylate compounds, are applied to patches that are then placed on the patient's back. The patches are left in place for a specific time, usually around 48 hours. After this period, the patches are removed, and the skin is carefully examined for any signs of allergic reactions.If a patient is allergic to acrylates, the patch test will reveal a positive reaction in the form of redness, swelling, or rash at the site of exposure to the acrylate allergen. This positive result confirms the diagnosis of acrylate allergy and helps the healthcare provider to identify the specific acrylate compounds to which the patient is sensitive.Acrylate allergies can sometimes be polyvalent, meaning patients may exhibit positive patch test reactions to multiple acrylate compounds even if they have not been directly exposed toall those substances individually [20]. This phenomenon is often attributed to cross-reactions between different acrylic monomers and concomitant allergies.4.4. Additional RiskAllergies to gel nail chemicals are more likely to occur if gel polish isn't accurately or sufficiently cured under a UV or LED lamp during the manicure, leading to skin sensitization[2]. The British Association of Dermatologists has urged caution with at-home gel nail kits, as improper curing and exposure to acrylates can cause allergic reactions [22–24].Acrylates are not only present in nail cosmetics but have a wide application in various medical purposes, such as dental ligatures, soft contact lenses, endoprostheses, hearing aids and medical devices for diabetes patients [25–28].As a result, individuals who have previously developed allergic contact dermatitis (ACD) to acrylates from artificial nails may experience allergic reactions upon re-exposure to acrylates in these other materials. Moreover, cross-reactions with other acrylic monomers may occur, leading to additional allergic responses [20].For individuals with ACD to acrylates in artificial nails, it is essential to exercise caution when using other products that contain acrylates. However, it has been reported that those 66 who are not allergic to ethyl cyanoacrylate, which is present in all nail glues, can safely use silk wrap nails as an alternative [5] . This option provides a potentially safer choice for nail enhancements without the risk of triggering allergic reactions caused by acrylates in artificial nails.",Medical,Fact Finding,Q&A Do not use any outside sources of prior knowledge when you answer. Only use the provided text to answer.,Explain the different time periods in a way that would be suitable for my 6 year-old daughter to understand.,"ARIZONA PUBLIC SERVICE COMPANY A.C.C. No. 6154 Phoenix, Arizona Cancelling A.C.C. No. 6122 Filed by: Jessica E. Hobbick Rate Schedule TOU-E Title: Director, Regulation and Pricing Revision No. 3 Original Effective Date: August 19, 2017 Effective: March 8, 2024 in Decision No. 79293 Page 1 of 4 RATE SCHEDULE TOU-E RESIDENTIAL TIME-OF-USE SERVICE TIME-OF-USE 4PM-7PM WEEKDAYS AVAILABILITY This rate schedule is available to all residential Customers, including Partial Requirements Customers with an on-site distributed generation system. DESCRIPTION This rate has two parts: a basic service charge and an energy charge. The energy charge will vary by season (summer or winter) and by the time of day that the energy is used (On-Peak, Off-Peak, or Super Off-Peak). This rate does not include a demand charge. TIME PERIODS The On-Peak time period for residential rate schedules is 4 p.m. to 7 p.m. Monday through Friday year-round. This rate also has a Super Off-Peak period, which is 10 a.m. to 3 p.m. Monday through Friday during the winter season, which is the billing cycles of November through April. All other hours are Off-Peak hours. The following holidays are also included in the Off-Peak hours: • New Year’s Day - January 1* • Martin Luther King Day - Third Monday in January • Presidents Day - Third Monday in February • Cesar Chavez Day - March 31* • Memorial Day - Last Monday in May • Juneteenth – June 19* • Independence Day - July 4* • Labor Day - First Monday in September • Indigenous Peoples’ Day / Columbus Day – Second Monday in October • Veterans Day - November 11* • Thanksgiving - Fourth Thursday in November • Christmas Eve - December 24** • Christmas Day - December 25* • New Year’s Eve - December 31** *If these holidays fall on a Saturday, the preceding Friday will be Off-Peak. If they fall on a Sunday, the following Monday will be Off-Peak. **The day on which these holidays fall will be Off-Peak days. The rate also varies by summer and winter seasons. The summer season is the May through October billing cycles, and the winter season is the November through April billing cycles. ARIZONA PUBLIC SERVICE COMPANY A.C.C. No. 6154 Phoenix, Arizona Cancelling A.C.C. No. 6122 Filed by: Jessica E. Hobbick Rate Schedule TOU-E Title: Director, Regulation and Pricing Revision No. 3 Original Effective Date: August 19, 2017 Effective: March 8, 2024 in Decision No. 79293 Page 2 of 4 RATE SCHEDULE TOU-E RESIDENTIAL TIME-OF-USE SERVICE TIME-OF-USE 4PM-7PM WEEKDAYS CHARGES The monthly bill will consist of the following charges, plus adjustments: Bundled Charges Basic Service Charge $ 0.458 per day Summer Winter On-Peak Energy Charge $ 0.34396 $ 0.32543 per kWh Off-Peak Energy Charge $ 0.12345 $ 0.12351 per kWh Super Off-Peak Energy Charge $ 0.03495 per kWh Unbundled Components of the Bundled Charges Bundled Charges consist of the components shown below. These are not additional charges. Basic Service Charge Components Customer Accounts Charge $ 0.078 per day Metering Charge $ 0.215 per day Meter Reading Charge $ 0.078 per day Billing Charge $ 0.087 per day Energy Charge Components System Benefits Charge $ 0.00361 per kWh Transmission Charge $ 0.01097 per kWh Summer Winter Delivery Charge On-Peak $ 0.03469 $ 0.03469 per kWh Delivery Charge Off-Peak $ 0.03469 $ 0.03469 per kWh Delivery Charge Super Off-Peak $ 0.01232 per kWh Generation On-Peak Charge $ 0.29469 $ 0.27616 per kWh Generation Off-Peak Charge $ 0.07418 $ 0.07424 per kWh Generation Super Off-Peak Charge $ 0.00805 per kWh ARIZONA PUBLIC SERVICE COMPANY A.C.C. No. 6154 Phoenix, Arizona Cancelling A.C.C. No. 6122 Filed by: Jessica E. Hobbick Rate Schedule TOU-E Title: Director, Regulation and Pricing Revision No. 3 Original Effective Date: August 19, 2017 Effective: March 8, 2024 in Decision No. 79293 Page 3 of 4 RATE SCHEDULE TOU-E RESIDENTIAL TIME-OF-USE SERVICE TIME-OF-USE 4PM-7PM WEEKDAYS CHARGE FOR ON-SITE DISTRIBUTED GENERATION CUSTOMERS The monthly bill for Customers on this rate schedule that have an on-site distributed generation system will also include a Grid Access Charge. This charge will apply to the nameplate kW-dc power rating of the Customer’s distributed generation facility: Grid Access Charge $ 0.242 per kW-dc of generation ADJUSTMENTS The bill will include the following adjustments: 1. The Renewable Energy Adjustment Charge, Adjustment Schedule REAC-1. 2. The Power Supply Adjustment charge, Adjustment Schedule PSA-1. 3. The Transmission Cost Adjustment charge, Adjustment Schedule TCA-1. 4. The Demand Side Management Adjustment Charge, Adjustment Schedule DSMAC-1. 5. The Lost Fixed Cost Recovery adjustment charge, Adjustment Schedule LFCR. 6. The Tax Expense Adjustor Mechanism charge, Adjustment Schedule TEAM. 7. The Court Resolution Surcharge, Adjustment Schedule CRS-1. 8. The System Reliability Benefit Adjustment Mechanism charge, Adjustment Schedule SRB-1. 9. Direct Access Customers returning to Standard Offer service may be subject to a Returning Customer Direct Access Charge, Adjustment Schedule RCDAC-1. 10. Any applicable taxes and governmental fees that are assessed on APS’s revenues, prices, sales volume, or generation volume. ARIZONA PUBLIC SERVICE COMPANY A.C.C. No. 6154 Phoenix, Arizona Cancelling A.C.C. No. 6122 Filed by: Jessica E. Hobbick Rate Schedule TOU-E Title: Director, Regulation and Pricing Revision No. 3 Original Effective Date: August 19, 2017 Effective: March 8, 2024 in Decision No. 79293 Page 4 of 4 RATE SCHEDULE TOU-E RESIDENTIAL TIME-OF-USE SERVICE TIME-OF-USE 4PM-7PM WEEKDAYS RATE RIDERS Eligible rate riders for this rate schedule are: CPP (RES) Critical Peak Pricing (Residential) EPR-2 Partial Requirements EPR-6 Partial Requirements – Net Metering (Residential Non-Solar) RCP Resource Comparison Proxy E-3 Limited income discount E-4 Limited income medical discount GPS-1, GPS-2, GPS-3 Green Power SERVICE DETAILS 1. Customers that self-provide some of their electrical requirements from on-site generation will be billed according to one of the Partial Requirements Service rate riders. 2. APS provides electric service under the Company’s Service Schedules. These schedules provide details about how the Company serves its Customers, and they have provisions and charges that may affect the Customer’s bill (for example, service connection charges). 3. Electric service provided will be single-phase, 60 Hertz at the Company’s standard voltages available at the Customer site. Three-phase service is required for motors of an individual rated capacity of 7½ HP or more. 4. Electric service is supplied at a single point of delivery and measured through a single meter. 5. Direct Access Customers who purchase available electric services from a supplier other than APS may take service under this schedule. The bill for these Customers will only include the Unbundled Component charges for Customer Accounts, Delivery, System Benefits, and any applicable Adjustments. If metering and billing services are not available from another supplier, those services will be provided by APS and billed to the Customer at the charges shown above.","Do not use any outside sources of prior knowledge when you answer. Only use the provided text to answer. Explain the different time periods in a way that would be suitable for my 6 year-old daughter to understand. ARIZONA PUBLIC SERVICE COMPANY A.C.C. No. 6154 Phoenix, Arizona Cancelling A.C.C. No. 6122 Filed by: Jessica E. Hobbick Rate Schedule TOU-E Title: Director, Regulation and Pricing Revision No. 3 Original Effective Date: August 19, 2017 Effective: March 8, 2024 in Decision No. 79293 Page 1 of 4 RATE SCHEDULE TOU-E RESIDENTIAL TIME-OF-USE SERVICE TIME-OF-USE 4PM-7PM WEEKDAYS AVAILABILITY This rate schedule is available to all residential Customers, including Partial Requirements Customers with an on-site distributed generation system. DESCRIPTION This rate has two parts: a basic service charge and an energy charge. The energy charge will vary by season (summer or winter) and by the time of day that the energy is used (On-Peak, Off-Peak, or Super Off-Peak). This rate does not include a demand charge. TIME PERIODS The On-Peak time period for residential rate schedules is 4 p.m. to 7 p.m. Monday through Friday year-round. This rate also has a Super Off-Peak period, which is 10 a.m. to 3 p.m. Monday through Friday during the winter season, which is the billing cycles of November through April. All other hours are Off-Peak hours. The following holidays are also included in the Off-Peak hours: • New Year’s Day - January 1* • Martin Luther King Day - Third Monday in January • Presidents Day - Third Monday in February • Cesar Chavez Day - March 31* • Memorial Day - Last Monday in May • Juneteenth – June 19* • Independence Day - July 4* • Labor Day - First Monday in September • Indigenous Peoples’ Day / Columbus Day – Second Monday in October • Veterans Day - November 11* • Thanksgiving - Fourth Thursday in November • Christmas Eve - December 24** • Christmas Day - December 25* • New Year’s Eve - December 31** *If these holidays fall on a Saturday, the preceding Friday will be Off-Peak. If they fall on a Sunday, the following Monday will be Off-Peak. **The day on which these holidays fall will be Off-Peak days. The rate also varies by summer and winter seasons. The summer season is the May through October billing cycles, and the winter season is the November through April billing cycles. ARIZONA PUBLIC SERVICE COMPANY A.C.C. No. 6154 Phoenix, Arizona Cancelling A.C.C. No. 6122 Filed by: Jessica E. Hobbick Rate Schedule TOU-E Title: Director, Regulation and Pricing Revision No. 3 Original Effective Date: August 19, 2017 Effective: March 8, 2024 in Decision No. 79293 Page 2 of 4 RATE SCHEDULE TOU-E RESIDENTIAL TIME-OF-USE SERVICE TIME-OF-USE 4PM-7PM WEEKDAYS CHARGES The monthly bill will consist of the following charges, plus adjustments: Bundled Charges Basic Service Charge $ 0.458 per day Summer Winter On-Peak Energy Charge $ 0.34396 $ 0.32543 per kWh Off-Peak Energy Charge $ 0.12345 $ 0.12351 per kWh Super Off-Peak Energy Charge $ 0.03495 per kWh Unbundled Components of the Bundled Charges Bundled Charges consist of the components shown below. These are not additional charges. Basic Service Charge Components Customer Accounts Charge $ 0.078 per day Metering Charge $ 0.215 per day Meter Reading Charge $ 0.078 per day Billing Charge $ 0.087 per day Energy Charge Components System Benefits Charge $ 0.00361 per kWh Transmission Charge $ 0.01097 per kWh Summer Winter Delivery Charge On-Peak $ 0.03469 $ 0.03469 per kWh Delivery Charge Off-Peak $ 0.03469 $ 0.03469 per kWh Delivery Charge Super Off-Peak $ 0.01232 per kWh Generation On-Peak Charge $ 0.29469 $ 0.27616 per kWh Generation Off-Peak Charge $ 0.07418 $ 0.07424 per kWh Generation Super Off-Peak Charge $ 0.00805 per kWh ARIZONA PUBLIC SERVICE COMPANY A.C.C. No. 6154 Phoenix, Arizona Cancelling A.C.C. No. 6122 Filed by: Jessica E. Hobbick Rate Schedule TOU-E Title: Director, Regulation and Pricing Revision No. 3 Original Effective Date: August 19, 2017 Effective: March 8, 2024 in Decision No. 79293 Page 3 of 4 RATE SCHEDULE TOU-E RESIDENTIAL TIME-OF-USE SERVICE TIME-OF-USE 4PM-7PM WEEKDAYS CHARGE FOR ON-SITE DISTRIBUTED GENERATION CUSTOMERS The monthly bill for Customers on this rate schedule that have an on-site distributed generation system will also include a Grid Access Charge. This charge will apply to the nameplate kW-dc power rating of the Customer’s distributed generation facility: Grid Access Charge $ 0.242 per kW-dc of generation ADJUSTMENTS The bill will include the following adjustments: 1. The Renewable Energy Adjustment Charge, Adjustment Schedule REAC-1. 2. The Power Supply Adjustment charge, Adjustment Schedule PSA-1. 3. The Transmission Cost Adjustment charge, Adjustment Schedule TCA-1. 4. The Demand Side Management Adjustment Charge, Adjustment Schedule DSMAC-1. 5. The Lost Fixed Cost Recovery adjustment charge, Adjustment Schedule LFCR. 6. The Tax Expense Adjustor Mechanism charge, Adjustment Schedule TEAM. 7. The Court Resolution Surcharge, Adjustment Schedule CRS-1. 8. The System Reliability Benefit Adjustment Mechanism charge, Adjustment Schedule SRB-1. 9. Direct Access Customers returning to Standard Offer service may be subject to a Returning Customer Direct Access Charge, Adjustment Schedule RCDAC-1. 10. Any applicable taxes and governmental fees that are assessed on APS’s revenues, prices, sales volume, or generation volume. ARIZONA PUBLIC SERVICE COMPANY A.C.C. No. 6154 Phoenix, Arizona Cancelling A.C.C. No. 6122 Filed by: Jessica E. Hobbick Rate Schedule TOU-E Title: Director, Regulation and Pricing Revision No. 3 Original Effective Date: August 19, 2017 Effective: March 8, 2024 in Decision No. 79293 Page 4 of 4 RATE SCHEDULE TOU-E RESIDENTIAL TIME-OF-USE SERVICE TIME-OF-USE 4PM-7PM WEEKDAYS RATE RIDERS Eligible rate riders for this rate schedule are: CPP (RES) Critical Peak Pricing (Residential) EPR-2 Partial Requirements EPR-6 Partial Requirements – Net Metering (Residential Non-Solar) RCP Resource Comparison Proxy E-3 Limited income discount E-4 Limited income medical discount GPS-1, GPS-2, GPS-3 Green Power SERVICE DETAILS 1. Customers that self-provide some of their electrical requirements from on-site generation will be billed according to one of the Partial Requirements Service rate riders. 2. APS provides electric service under the Company’s Service Schedules. These schedules provide details about how the Company serves its Customers, and they have provisions and charges that may affect the Customer’s bill (for example, service connection charges). 3. Electric service provided will be single-phase, 60 Hertz at the Company’s standard voltages available at the Customer site. Three-phase service is required for motors of an individual rated capacity of 7½ HP or more. 4. Electric service is supplied at a single point of delivery and measured through a single meter. 5. Direct Access Customers who purchase available electric services from a supplier other than APS may take service under this schedule. The bill for these Customers will only include the Unbundled Component charges for Customer Accounts, Delivery, System Benefits, and any applicable Adjustments. If metering and billing services are not available from another supplier, those services will be provided by APS and billed to the Customer at the charges shown above.",Retail/Product,Summarize & Simplify,Text Transformation "Only respond using the information in the context block. Do not in any way rely on your own knowledge or on outside information. You can use a mixture of paragraphs and lists in your response, if appropriate.","Why do people believe independent bookstores might make a comeback, despite chains like Amazon and Barnes and Noble?","Book Brawl Independent bookstores, the Internet, chain stores and discount houses duke it out. (Whole Earth Summer 99) One of the shocks to emerge in recent years from the book industry is the fact that blockbusters such as Angela’s Ashes and Cold Mountain almost didn’t make it into America’s consciousness. These books hit best-seller lists, publishing experts agree, because of thousands of privately owned, independent bookstores around the country that discovered them and spread the word. Everything else followed far behind in terms of stimulating the books’ early sales. One would think that these neighborhood bookstores-their numbers so diminished and their efforts so embattled in the ""bookstore wars"" of recent years-would be celebrated by publishers for saving such worthwhile books from obscurity. Instead, independent bookstores are increasingly abandoned by publishers as a kind of dying breed, as though they have already been Starbucked, Costcoed, and Amazoned right out of existence. One would think independent bookstores have played no historic part in preserving the best of American literature. And yet, noted modern writers who were once unknown-Toni Morrison, Amy Tan, Anne Lamott, Ethan Canin, Alice Walker, Dorothy Allison, Cormac McCarthy, Barbara Kingsolver, Charles Johnson, and many others-would never have been widely read if it were not for the support of this network of independent bookstores. As we reach the end of the twentieth century, perhaps the greatest shock is that these privately owned neighborhood bookstores, so key to the health of literature in the United States, are dying. Under-the-Table Deals? The problem began in the 1970s when the first wave of chain bookstores (B. Dalton, Waldenbooks) brought thousands of quick-profit mall stores into competition with traditional neighborhood bookstores. The result: 1,000 of the 7,000 independent bookstores in the United States closed down within the decade. With more chains, department stores, and price clubs in the 1980s (Crown, Walmart, Costco), and the most recent wave of chain superstores with CDs, videos, and cafes, in the 1990s (Barnes & Noble, Borders), a few thousand more independent bookstores have gone under, bringing the total number of independents (according to the American Booksellers Association) from 5,132 in 1991 to about 3,200 today, many of them teetering close to bankruptcy. What no independent can compete against are the alleged illegal discounts and under-the-table deals that independents believe publishers have been giving the chains from the start. The courts have agreed with independents in two separate lawsuits, but abuses continue, according to allegations in the American Booksellers Association’s own lawsuit, set for trial next year. As a consequence of the chains’ success, the percentage of books sold by independents has fallen disastrously. According to the Book Industry Study Group, in 1991 independent bookstores accounted for the largest share (32 percent) of the book market. Today that percentage has dropped to 17.2 percent, leaving independents in third place, below chain bookstores (26 percent) and price club/department stores (20 percent). Enter Amazon.com By 1998, Amazon.com (launched in 1995), the first of the snazzy, reader-friendly bookselling Web sites, had begun to pull ahead of chain book superstores in sales while at the same time its stock price soared at unprecedented rates. By mid-April 1999, although Borders and Barnes & Noble kept showing declines, the stock of Amazon, which has never shown a profit and loses millions each quarter, was up more than 75 percent for the year. The fun of browsing through Amazon’s cyberstore with its virtual shopping carts, irreverent ""customer comments,"" and alluring discounts (including the online moratorium on sales tax) has pulled many a loyal customer away from independent stores and onto the Web. Media adoration of ""e-commerce"" during the 1998 holiday season glorified Amazon and resulted in further hemorrhaging of independent bookstore sales. A few cracks have opened in Amazon’s armor, beginning with recent disclosures that this hip and ""customer-centric"" online marketplace has been taking money from publishers to place titles on its best-seller list and ""recommendations"" in such categories as ""Destined for Greatness,"" without telling customers. Amazon now tells readers about paid placements (on a hard-to-find page). Some customers seem to have lost their loyalty along the way and often go searching for cut-rate imitators like bestsellersforless.com. Enter Bertelsmann The bookseller wars are chaotic and damaging enough, but at least the separation between church and state (publishing and bookselling) remained sacrosanct-that is, until last year, when two events brought the industry into cataclysm. This occurred in the midst of the ""merger mania"" in New York that has reduced the publishing industry from thirty houses a few decades ago to about seven conglomerate firms today. Not only have foreign houses begun to dominate the scene, but Bertelsmann of Germany, the largest publisher in the world, has initiated a series of takeovers with horrifying repercussions. Last year, though it already owned Bantam Doubleday Dell, Bertelsmann acquired Random House with all its many imprints (Knopf, Pantheon, Crown, Times, Ballantine, Vintage, Villard, Fawcett, etc.), then proceeded to buy one-half of barnesandnoble.com, the online division (and competitor to Amazon) of Barnes & Noble. Wham! What had been feared before, that publishers were cozying up to booksellers in compromising ways (asking chains to approve jacket illustrations, flap copy, even the authors’ texts), seemed frighteningly real. Piling all the imprints together under the Random House imprint, Bertelsmann controlled more than a fifth of the publishing market; now its investment in Barnes & Noble meant Bertelsmann controlled a major player in the bookselling side as well. And then, wham! again. Barnes & Noble announced its intention to buy Ingram, the largest book distributor in the country, whose main clientele up to that point had been-ta da!-independent bookstores. This meant that Barnes & Noble would have access to the financial records of competitors it was mowing down right and left, and also have the power to direct sales of best-selling books to itself first. A nationwide protest of the Ingram purchase has brought thousands of letters and calls to the Federal Trade Commission, which has the authority to approve or disapprove the sale. (Industry observers think the FTC will approve it when it makes its decision later this year.) Wham! Wham! Wham! With the decline of independents, publishers are cutting back on the sales representatives who visit each store to present the publisher’s list of upcoming books to the store’s buyers. This means that books by unknown or highly literary authors will not be explained to store buyers in a way that would inspire the staff to read them, promote them, hand-sell to customers, and get word-of-mouth going. The Tide, She Changing In the last few years, independents have joined together to sue the pants off the chains; create their own Web sites to compete with Amazon ""brand"" consumers’ consciousness with ""Book Sense,"" a branding and marketing campaign for independents that will also offer a national gift-certificate program that operates like FTD; fight the Ingram sale; and, by god, make a stand. Do they have a chance? Here are some reasons even skeptics believe the ""day of the independent bookseller"" may yet see a comeback. Famous Authors such as Barbara Kingsolver, Larry McMurtry, and Adrienne Rich are speaking out in support of independents by writing letters to newspapers, making speeches, appearing on radio and television. 1. Who Loved Ya (First), Baby campaigns (my term but that’s what they are) have started up among independents to educate authors like Frank McCourt ( Angela’s Ashes ) and Stephen King to stop appearing in television ads promoting Barnes & Noble. 2. Friends of the Bookstore groups are sprouting to help independents bring in donations, host benefits, offer lectures, present authors, and conduct classes, book clubs, writers’ groups, etc. 3. Planning Commissions and City Councils are beginning to deny petitions by chain bookstores to locate 25,000-square-foot super-stores in areas where they would compete unfairly with independents. 4. Nonprofit and Profit-Making Combinations are being built into independent booksellers’ financial statements so that the many services these stores have provided for free can bring in new income. 5. Redevelopment Money is being directed toward independent bookstores to help revitalize seedy areas and give the independents a chance to compete. 6. Community Centers are forming with space for galleries, theaters, computers, cafes, conference rooms, and, at their core, independent bookstores. So let’s all slow down and remember this wonderful tradition of independent bookselling. Let’s just get out of the fast lane and recognize that the human element (conversation, selection, trust, opinion, love of reading, expertise, community involvement) has always been a staple of the neighborhood independent bookstore. You think independents are whining? ""This is a war,"" writes one bookseller, referring specifically to Barnes & Nobles’ purchase of Ingram, ""and every book sale by Barnes & Noble is a bullet at us, and every book sold by an independent is a bullet at Barnes & Noble."" As they say on TV (that old dinosaur): ""Are you ready?"" Because that’s just the opening salvo. So here’s how you can become a foot soldier in the war to preserve the heartful caretakers of American literature: 1. Pledge to buy nothing but books as gifts for every holiday; concentrate your shopping at one or two or a handful of independent bookstores and never set foot in a Barnes & Noble or Borders store again; 2. Seek out the best Web sites of independent bookstores and never order from Amazon.com again; 3. When in doubt, buy big gift certificates right now at your local independent-this helps finance the store (cash flow is the hardest problem for any retailer right now) and brings in more walk-in traffic. 4. Join a Friends of the Bookstore group if you can find one, and if not, start one. 5. Attend autographings and other in-store events. Do you love your neighborhood? Then love that neighborhood bookstore, because if you don’t, it’s not going to be there tomorrow.","Only respond using the information in the context block. Do not in any way rely on your own knowledge or on outside information. You can use a mixture of paragraphs and lists in your response, if appropriate. Why do people believe independent bookstores might make a comeback, despite chains like Amazon and Barnes and Noble? Book Brawl Independent bookstores, the Internet, chain stores and discount houses duke it out. (Whole Earth Summer 99) One of the shocks to emerge in recent years from the book industry is the fact that blockbusters such as Angela’s Ashes and Cold Mountain almost didn’t make it into America’s consciousness. These books hit best-seller lists, publishing experts agree, because of thousands of privately owned, independent bookstores around the country that discovered them and spread the word. Everything else followed far behind in terms of stimulating the books’ early sales. One would think that these neighborhood bookstores-their numbers so diminished and their efforts so embattled in the ""bookstore wars"" of recent years-would be celebrated by publishers for saving such worthwhile books from obscurity. Instead, independent bookstores are increasingly abandoned by publishers as a kind of dying breed, as though they have already been Starbucked, Costcoed, and Amazoned right out of existence. One would think independent bookstores have played no historic part in preserving the best of American literature. And yet, noted modern writers who were once unknown-Toni Morrison, Amy Tan, Anne Lamott, Ethan Canin, Alice Walker, Dorothy Allison, Cormac McCarthy, Barbara Kingsolver, Charles Johnson, and many others-would never have been widely read if it were not for the support of this network of independent bookstores. As we reach the end of the twentieth century, perhaps the greatest shock is that these privately owned neighborhood bookstores, so key to the health of literature in the United States, are dying. Under-the-Table Deals? The problem began in the 1970s when the first wave of chain bookstores (B. Dalton, Waldenbooks) brought thousands of quick-profit mall stores into competition with traditional neighborhood bookstores. The result: 1,000 of the 7,000 independent bookstores in the United States closed down within the decade. With more chains, department stores, and price clubs in the 1980s (Crown, Walmart, Costco), and the most recent wave of chain superstores with CDs, videos, and cafes, in the 1990s (Barnes & Noble, Borders), a few thousand more independent bookstores have gone under, bringing the total number of independents (according to the American Booksellers Association) from 5,132 in 1991 to about 3,200 today, many of them teetering close to bankruptcy. What no independent can compete against are the alleged illegal discounts and under-the-table deals that independents believe publishers have been giving the chains from the start. The courts have agreed with independents in two separate lawsuits, but abuses continue, according to allegations in the American Booksellers Association’s own lawsuit, set for trial next year. As a consequence of the chains’ success, the percentage of books sold by independents has fallen disastrously. According to the Book Industry Study Group, in 1991 independent bookstores accounted for the largest share (32 percent) of the book market. Today that percentage has dropped to 17.2 percent, leaving independents in third place, below chain bookstores (26 percent) and price club/department stores (20 percent). Enter Amazon.com By 1998, Amazon.com (launched in 1995), the first of the snazzy, reader-friendly bookselling Web sites, had begun to pull ahead of chain book superstores in sales while at the same time its stock price soared at unprecedented rates. By mid-April 1999, although Borders and Barnes & Noble kept showing declines, the stock of Amazon, which has never shown a profit and loses millions each quarter, was up more than 75 percent for the year. The fun of browsing through Amazon’s cyberstore with its virtual shopping carts, irreverent ""customer comments,"" and alluring discounts (including the online moratorium on sales tax) has pulled many a loyal customer away from independent stores and onto the Web. Media adoration of ""e-commerce"" during the 1998 holiday season glorified Amazon and resulted in further hemorrhaging of independent bookstore sales. A few cracks have opened in Amazon’s armor, beginning with recent disclosures that this hip and ""customer-centric"" online marketplace has been taking money from publishers to place titles on its best-seller list and ""recommendations"" in such categories as ""Destined for Greatness,"" without telling customers. Amazon now tells readers about paid placements (on a hard-to-find page). Some customers seem to have lost their loyalty along the way and often go searching for cut-rate imitators like bestsellersforless.com. Enter Bertelsmann The bookseller wars are chaotic and damaging enough, but at least the separation between church and state (publishing and bookselling) remained sacrosanct-that is, until last year, when two events brought the industry into cataclysm. This occurred in the midst of the ""merger mania"" in New York that has reduced the publishing industry from thirty houses a few decades ago to about seven conglomerate firms today. Not only have foreign houses begun to dominate the scene, but Bertelsmann of Germany, the largest publisher in the world, has initiated a series of takeovers with horrifying repercussions. Last year, though it already owned Bantam Doubleday Dell, Bertelsmann acquired Random House with all its many imprints (Knopf, Pantheon, Crown, Times, Ballantine, Vintage, Villard, Fawcett, etc.), then proceeded to buy one-half of barnesandnoble.com, the online division (and competitor to Amazon) of Barnes & Noble. Wham! What had been feared before, that publishers were cozying up to booksellers in compromising ways (asking chains to approve jacket illustrations, flap copy, even the authors’ texts), seemed frighteningly real. Piling all the imprints together under the Random House imprint, Bertelsmann controlled more than a fifth of the publishing market; now its investment in Barnes & Noble meant Bertelsmann controlled a major player in the bookselling side as well. And then, wham! again. Barnes & Noble announced its intention to buy Ingram, the largest book distributor in the country, whose main clientele up to that point had been-ta da!-independent bookstores. This meant that Barnes & Noble would have access to the financial records of competitors it was mowing down right and left, and also have the power to direct sales of best-selling books to itself first. A nationwide protest of the Ingram purchase has brought thousands of letters and calls to the Federal Trade Commission, which has the authority to approve or disapprove the sale. (Industry observers think the FTC will approve it when it makes its decision later this year.) Wham! Wham! Wham! With the decline of independents, publishers are cutting back on the sales representatives who visit each store to present the publisher’s list of upcoming books to the store’s buyers. This means that books by unknown or highly literary authors will not be explained to store buyers in a way that would inspire the staff to read them, promote them, hand-sell to customers, and get word-of-mouth going. The Tide, She Changing In the last few years, independents have joined together to sue the pants off the chains; create their own Web sites to compete with Amazon ""brand"" consumers’ consciousness with ""Book Sense,"" a branding and marketing campaign for independents that will also offer a national gift-certificate program that operates like FTD; fight the Ingram sale; and, by god, make a stand. Do they have a chance? Here are some reasons even skeptics believe the ""day of the independent bookseller"" may yet see a comeback. Famous Authors such as Barbara Kingsolver, Larry McMurtry, and Adrienne Rich are speaking out in support of independents by writing letters to newspapers, making speeches, appearing on radio and television. 1. Who Loved Ya (First), Baby campaigns (my term but that’s what they are) have started up among independents to educate authors like Frank McCourt ( Angela’s Ashes ) and Stephen King to stop appearing in television ads promoting Barnes & Noble. 2. Friends of the Bookstore groups are sprouting to help independents bring in donations, host benefits, offer lectures, present authors, and conduct classes, book clubs, writers’ groups, etc. 3. Planning Commissions and City Councils are beginning to deny petitions by chain bookstores to locate 25,000-square-foot super-stores in areas where they would compete unfairly with independents. 4. Nonprofit and Profit-Making Combinations are being built into independent booksellers’ financial statements so that the many services these stores have provided for free can bring in new income. 5. Redevelopment Money is being directed toward independent bookstores to help revitalize seedy areas and give the independents a chance to compete. 6. Community Centers are forming with space for galleries, theaters, computers, cafes, conference rooms, and, at their core, independent bookstores. So let’s all slow down and remember this wonderful tradition of independent bookselling. Let’s just get out of the fast lane and recognize that the human element (conversation, selection, trust, opinion, love of reading, expertise, community involvement) has always been a staple of the neighborhood independent bookstore. You think independents are whining? ""This is a war,"" writes one bookseller, referring specifically to Barnes & Nobles’ purchase of Ingram, ""and every book sale by Barnes & Noble is a bullet at us, and every book sold by an independent is a bullet at Barnes & Noble."" As they say on TV (that old dinosaur): ""Are you ready?"" Because that’s just the opening salvo. So here’s how you can become a foot soldier in the war to preserve the heartful caretakers of American literature: 1. Pledge to buy nothing but books as gifts for every holiday; concentrate your shopping at one or two or a handful of independent bookstores and never set foot in a Barnes & Noble or Borders store again; 2. Seek out the best Web sites of independent bookstores and never order from Amazon.com again; 3. When in doubt, buy big gift certificates right now at your local independent-this helps finance the store (cash flow is the hardest problem for any retailer right now) and brings in more walk-in traffic. 4. Join a Friends of the Bookstore group if you can find one, and if not, start one. 5. Attend autographings and other in-store events. Do you love your neighborhood? Then love that neighborhood bookstore, because if you don’t, it’s not going to be there tomorrow.",Financial,Effect Analysis,Q&A "Carefully review the text below, then answer the question that follows. You should ONLY use information found in the included text to respond. ",What impact did the Norman Conquest have on Old and Middle English dialects and their conditions?,"1. Chapter One 1.1. Historical Background English as a separate and distinct entity appeared in the great Germanic century, but it was until the beginning of the seventh that the language defiantly emerged from the confusion and turmoil of the conquest of Britain and began to take its place among the modern tongues of Europe. If we take a look to the history of the British Isles, we find that it has been visited by many people from the European mainland and the visitors must have liked what they have found, because often the visits turned into invasions or attempted invasions Before the dawn of recorded history, the British Isles had been visited, overrun, and conquered by two separate groups of Celtic invaders, speaking tongues which were the remote ancestors of present-day Gaelic and Welsh. (Pei,1953:12) During the earlier part of the eleventh century, Edward, the son of Ethelred the Unready and of the daughter of a Norman duke, was being brought up in Normandy, and when he at last came to the throne in 1042 the influence of his upbringing naturally remained, and his friends and supporters were both spiritual and temporal French. This certainly prepared the way for the Norman Conquest. (Jespersen, 1955:105) The Normans adopted a northern dialect of Old French known as Anglo-Norman(Carpenter,2004:79-80), which they spoke with certain characteristics and it was this dialect which was carried into English in the eleventh century and which was developed there into a specific variety known as Anglo- Norman. 1.2. English Language before the coming of the Normans Before the Norman Conquest, the people of England spoke Old English or what was called Anglo-Saxon. This language was Germanic in vocabulary, with few borrowings. It had many declensions of substantives. There was one declension which formed its genitive singular in –es and its nominative plural in –as; and there were other declensions in which –a, -an, -e appear as endings for the genitive singular m and –a, -an, -e,-u for the nominative plural. Out of all these the –es and –as declension is the online that remains in general use. If we take a look to the case-endings in Old English ; we find that –es was the only one that meant anything other than a genitive singular and –as which only meant a nominative or accusative plural. Thus hanan stands for the genitive, dative, and accusative singular and the nominative and accusative plural of hana, a cock. So it is a popular error to suppose that it was in the consequence of the Norman Conquest that the –es and –as declension came to sup ride all the rest. In fact, the change began in the Northern dialect.( Bradley, 1955:35) It is estimated that in the field of vocabulary about 450 Latin words came into Old English before the Norman Conquest. This is a surprisingly large total to those who think of the Anglo-Saxon era as the period of pure Germanium in the language. It is those words that would normally have entered English from 1066 on, and it is clear that even without the French cultural importation, present-day English would not be altogether a simon-pure Germanic tongue. Just before the coming of the Normans, Old English was a deft blend of west Germanic and Scandinavian, with the former still predominating and respectable amount of Latin- Greek borrowings, about half of them of a religious nature. 2. Chapter two ?ً 2.1. what is the Norman Conquest.. The Norman Conquest is the invasion and conquering of the Normans to England in 1066.It began when William of Normandy invaded England and seized its throne. .2. The Roots of the Norman Conquest. 2 When William the Bastard, Duke of Normandy, descend of Rollo (leader of Norsemen) and son of a tanner's daughter , conceived the ambitious plan of making himself master of the great island beyond the sea, he did not minimize the difficulty of invasion . He knew that Anglo-Saxons and Danes had been forged into a united, and hardy race by the wise policies of Alfred and Cnut, and that the armies of his opponent Harold were strong. Historians estimate that of the vast host gathered by William for the invasion of England only one third of them were of native Normans. These men were land hungry. It was their expectations that in case of victory the lands of England would be wrested from their Anglo-Saxon owners and given to them. They were not disappointed for William kept his promises. When the Norman host disembarked at Hastings, Anglo-Saxon England was already carved up in advance a fact which Harold's men did not know. Being fresh from a victory , they won against the king of Norway, supported by Harold's brother. They may have thought that in case of defeat, their lot would be no worse than had been their ancestor's in the Danelagh. The Normans would be absorbed, Anglicized as to language and customs, and all would go on as before. In the final analysis, they were perhaps right. However, centuries had to elapse before this would come to pass.(Encyclopaedia Britanica,v.5:881-882) The Norman victory was complete, so was the conquest. For five years after the fateful day the Saxons thugs and earls were forcibly deprived of their lands and privileges by the insolent invaders, continued to rebel and resist, while William and his mercenaries raged through the land. After that the resistance died away. The Saxon nobility robbed in everything in favor of William's followers; sank suddenly to the level of their own peasantry, while the ancient free men of England, now undistinguished from the churls, turned into villains of the new seigneurs. Saxon England was laid low .Norman England had replaced it.(Campbell,1982:240) Yet Saxon England was not quite dead. The new court, clergy and nobility knew and spoke only French and Latin. However the subject population lived on and so did its language; a language now scorned for literary purposes as the language of an inferior race. (Pei, 1953:33) From what has been mentioned above, it is noticed that the Normans were looked at as an alien race; their occupation of the country attracted much more notice and lasted longer than that of the Danes; they become the ruling class. They represented a higher culture than that of the native and had a literature of their own . The Normans became the masters of England and they remained masters for a sufficiently long time to leave impress on the language. The conquerors would have been far less if they had not continued for centuries in actual contact with the French of France. After the conquest, the immigrants formed the upper class of the English society. The following classes of words show this fact: Words relating to government Crown, state, government, reign, realm, sovereign, authority, country, minister, chancellor, authority, parliament, people, nation . Words related to feudalism: Fief, feudal, vassal, liege . Words relating to steps in the scale of rank: Prince, peer, duke, marquis, viscount, baron . Words related to military affairs: War, peace, battle, arms, armour, buckler, mail, lance, officer, dart, lieutenant, sergeant, solider, troops, vessel, navy, admiral, enemy, danger, prison, siege, guard. Words related to law: 124 Justice, just, judge, court, suit, sue, plaintiff, defendant, plea, plead, cause, assize, fee, accuse, crime, traitor, damage, heritage, properly, penalty, injury, privilege, tenure . Words related to church: Religion, service, trinity, savior, virgin, angle, saint, abbey, cloister, friar, clergy, parish, baptism, sacrifice, orison, alter, sermon, preach, pray, prayer, feast . Words related to the pleasure of life: Joy, pleasure, delight, ease, comfort Some of the favorite pastimes were Chase, Cards and Dice, so we find many French words related to them, such as: Brace, couple, lease, falcon, quarry, warren, scent, track, partner, suit, trump Words related to dress: apparel, dress, costume, garment Words related to art: art, beauty, colour, image, design, figure, ornament The long list of words which is mentioned above indicates the fact that French was the rich, powerful, and refined class in the English society. Therefore, it was natural that the lower classes should soon begin to adopt such of the expressions of the rich as they could catch the meaning . 3. Chapter Three 3. 1. The Linguistic Effects of the Norman Conquest on English language The Norman Conquest of Britain has a number of linguistic effects on the language spoken in England at that time. Some of the results of these influences were the following: 1. Change in the conditions of dialects .The conquest placed all four Old English dialects more or less on a level. As such, West Saxon lost its supremacy and the center of culture and learning gradually shifted from Winchester to London. The Old Northumbrian dialect became divided into Scottish and Northern, although little is known of either of these divisions before the end of the 13th century. The Old Mercian dialect was split into East and West Midland. West Saxon became slightly diminished in area and was more appropriately named the South Western dialect. The Kentish dialect was considerably extended and was called South Eastern. All five Middle English dialects (Northern, West Midland, East Midland, South Western, and South Eastern) went their own ways and developed their own characteristics. 2. Change in the writing of English from the clear and easily readable in solar hand of Irish origin to the dialect Carolingian script then in use on the continent. 3. Change in spelling for the sake of clarity. Old English y becomes u, Ý as yi, u as ou (ow when final), u was often written o before and after m, n, u, w; and i was sometimes written y before and after m and n, ew was changed to qu; hw to wh; qu or quh to ch or tch; se to sh; cg to gg and ht to ght. Thus, for example, mycel(much) appeared as muchel; fyr(fire) as fuir; hus (house) as hous; hu(how) as how; snnu (son) as sone; him(him) as hym; cwen as queen; hwelet as what; quat (quart)as quhrt ; dic as ditch; scip as ship, sccage (siege) as segge; and miht as might. The Northern infinitive was already one syllable, whereas the past participle – en inflection of Old English was strictly kept. Old English mutated –ended in the present participle had already become –inde in late Southern and it was this inflection that blended with the –ing suffix of nouns of action that had already become near-gerunds in such compound nouns as athswearing (oath swearing)and writing feather (writing feather pen) The Northern 2nd person singular singis was inherited unchanged from common Germanic. The final t sound in Midland –est. and Southern –st was excrescent comparable with the final t in modern (admist) and (amongst) from older amides and amonges. The Northern 3rd person singular singis had quite different origin. Like the singis of the plural, it resulted almost casually from an inadvertent retraction of the tongue in enunciation from an interdental –th sound to postendal –s. Today the form (singeth) services as a poetic archaism Shakespeare used both –eth and –s endings (It ""mercy""blesseth him that gives and him that takes) 3.1.1. The Changes in Sounds and stress which took place after the Norman Conquest French words which adopted in English suffered a great change in sounds; they have participated in all sound changes that have taken place in English since their adaptation. Thus, words with the long [i] sound have had it diphthongized into [ai], e.g. fine, price, lion. The long [u], written ou has become [au], e.g. Old French espouse pronounced /spuize/ now pronounce /spauze/ The English is unable to imitate the French accentuation, that's why there are a great many words now stressed on the final syllable. All English, it is said, had the stress on the final syllable, and this habit was unconsciously extended to foreign words on their first adoption into the language. In the plural, Old French had a nominative without any ending and an accusative in –s; and English popular instinct naturally associated the latter form with the native plural ending in –es. In course of time those words which had for a long time in English as in French formed their plural without any ending (e.g. case) were made to conform to the general rule (sg.case.cases) As to the verbs, the rule is that the stem of French present plural served as basis for the English form; thus (je survis), nouns survivor vous survives, ils survivent became survive ;( je resous), resolvous, etc.became resolve. After what is stated, and in order to prove the great impact the Norman Conquest had left on English, some of the French words with their synonyms in English should be mentioned and they are arranged chronically. A. The foreign words in the twelfth century can be classified as follows:ِa. . Words denoting person or rank:1 Abbat ""abbot"" canonic ""canon"" capelein ""chaplain"" cardinal ""cardinal"" cuntesse ""countess"" due ""duke"" emperice ""empress"" legat ""legate"" Ex: pehefde be Emperice in Alamanic & nu was cuntesse in Angou. ""Who had been Empress of Germany and now was Countess of Anjou"" Com an of Rome Henri was gehaten ""a legate called Henry came from Rome"" 2. words denoting finance: rent ""rent"" tresor ""treasure"" Ex: Wrothe on pe circe & sette parto landes& rentes (worked on the church and endowed it with lands and rents) 3. words denoting law and social relations: acorden ""reconcill"" justicse ""justice"" pais ""peace"" privilegie ""privileges"" 4. words denoting religion: carite ""charity"" miracle ""miracle"" nativite ""nativity"" procession""procession"" 5. words denoting military: werre ""war"" werrien ""to make war against"" 6. words denoting nature: 128 Best ""beast"" Contre ""country"" Flum ""river"" Marbre ""marble"" Leun ""lion"" Oil ""oil"" Rose ""rose"" 7. Words denoting Household and other things: Basi ""basin"" Coup ""cup"" Furneis ""furnace"" Lamp ""lamp"" 8. words denoting physical action and appearance: Cachen ""catch"" Changen ""change"" Chere ""face, appearance"" Savour ""savour"" 9. Words denoting moral and Intellectual Clergie ""science"" Craviant ""defeated"" Deol ""sorrow"" Dout ""doubt, fear"" Fausien ""fail"" Gin ""device"" Meistrie ""mastery"" Reisun ""reason"" B.some of the French words `during the period between 1200-1250: 1. words denoting person: Ame ""friend"" Baban ""baby"" Baptist ""Baptist"" Kunseiler ""councilor"" Messager ""messenger"" Nurice ""nurse"" Prison ""prisoner"" 2. words denoting finance: Cwile ""quit"" Spense ""expense"" 3. words denoting buildings: Celere ""cellar"" Cite ""city"" Knuent ""convent"" Genere ""granary"" Tur ""tower"" 4. words denoting law and social relations: 129 Baundun ""power "" Crune ""villiaains"" Juggen ""judge"" Noces ""marriage"" Trone ""throne"" 5. Words denoting religion Calize ""chalice"" Canoniicl ""canonical"" Creoisem ""to make the sign of the cross on"" Eresi ""heresy"" Feste ""festival"" Grace ""grace"" Parais ""Paradise"" 6. Words denoting military Baret ""strife"" Calenge ""challenge"" Gunfanenr ""standard bearer"" Skirmen ""fight"" Turnement ""tournament"" 7. words denoting nature: Bame ""balm"" Carbin ""raven"" Cou de gilofre ""clove"" Gingiuere ""ginger"" Flur ""flour"" Fluren ""to flower"" Licur ""liquor"" 8. words denoting clothes: Abit ""habbit"" Atiffen ""adorn"" Broche ""brooch"" 9. words denoting household: Beaabelet ""jewel"" Buste ""box"" Cage ""cage"" Chetel ""chattels"" Crèche ""crib"" Scorge ""scourge"" Trufle ""trifle"" 10. words denoting physical action: Aboutien ""lean out"" Aspien ""spy on"" Babelinde ""chattering"" Buffeten ""to buffet"" Disturben ""disturb"" Recoilen ""to drive back"" Rute ""road"" 11 . Words denoting moral and Intellectual: Anui ""worry"" Asprete ""bitterness"" Comfort ""comfort"" Kunscence ""consciousness"" Contumace ""contumacy"" Creaunt ""craven"" Debonere ""gentle"" Deinte ""dignity"" Delit ""delight"" Noblesce ""nobility"" Mesure ""moderation"" Largesse ""generosity"" Pacience ""pacience"" 12. words denoting mental action: Affaiten ""dispose"" Akointed ""acquainted"" Asaumple ""example"" Attente ""endeavour"" Bisamplen ""to moralize"" Counsail ""advice"" Defaut ""fault"" Paien ""please"" Preach ""preach"" Preisen ""to praise"" Scandle ""scandal"" C. the French words during the period between 1250-1300 1. words denoting person: Barun ""barun"" Caynard ""eascal"" Chanoun ""clerk"" dam ""sir"" Sergauuz ""sergents"" 2. words denoting law and social relations: Eir ""heir"" Eritage ""heritage"" Per ""peer"" Warrant ""surely"" 3. words denoting religion: Aungel ""angel"" Auter ""alter"" Beneisun ""benison"" 131 Malison ""malison"" Croize ""cross"" Preie ""pray"" 4. words denoting military: Baret ""strife"" Gisarm ""sword"" Skriming ""large shield"" 5. words denoting nature: Bise ""beast"" Runic ""horse"" Laumprei ""lamprey"" Flour ""flower"" 6. words denoting clothes: Charbuole ""carbuncle"" Ioupe ""losse jacket"" 7. Physical action: Aise ""ease"" Bout ""throw"" Croune ""crown"" Couere ""recover"" Fyn ""end"" Sane ""safe"" 8. words denoting food: Broys ""broth"" Clare ""claret"" Pastees ""sweet special wine"" Simenels ""bread of fine flour"" Super ""supper"" Ueneysun ""venison"" 9. Moral and Intellectual: Anuicu ""to worry"" Chiche ""mean"" Conseyl ""counsel"" Faith ""faith"" Fey ""felong"" Fol ""foolish"" Gent ""noble"" Atendre ""tender"" 3.2. Was the French influence restricted to one period? The French influence was not restricted to one particular period, and it is interesting to compare the forms of old loan-words with these of recent ones, in which we can recognize traces of the changes the French language has undergone since medieval times, where a ch in an originally French word is pronounced as in change, chaunt, etc;(with the sound /ts/) where it is sounded as in champagne (with simple /s/), we have a recent loan. The word chief is thus shown to belong to the first period, while its doublet chef (=chef de cuisine) is much more modern. It is curious that two pet-names should now be spelled in the same way, Charlie, although they are distinct in pronunciation: the masculine is derived from the old loan Charles and has, therefore, the, the sound [t ] .the feminine is from the recent loan Charlotte with [ ], but they have all of them the same initial sound. Other examples of the same French word appearing in more than one shape according to its age in English are Saloon and salon, suit and suit, liquor and liqueur, rout and route ;the diphthong in the former word is an English development of long[u], quart, pronounced [kw t], and quart, pronounced [kw t] pronounced [k t],""a sequence of four cards in pique,"" also quarte or carte in fencing. In early middle English, words were borrowed from French containing the sound-group ch [t ](as in English child),e.g. chief, chivalry, duchess, chase ,torch; and [d ](as in gem),e.g. judge (both constants) just, journey, large; these consonant-groups became respectively [ ]and[ ]in later French. Initially,however,[ ] is not found in English without a proposed [d]; thus gentle, genteel, and jaunty represent three larges of the borrowing from the same word. 3.3. How did common people manage to learn so many foreign words? And how far did they assimilate them? We expect to find many changes carried out in the French words after their adoption in order to be easy to learn. In few cases the process of assimilation was facilitate by the fact that a French word happened to resemble an old native one and this is exemplified by the following: The old native verb choose was supplemented with the noun choice, from French choix. Old English hergian and Old French herir run together in Middle English harry. Old English hege and French haie run together in hay ""hedge,fence"". The word nevew (now spelled nephew)recalled Old English nefa, menege recalled Old English meniegeo. It is important to understand that the French words which were brought into English represent two different dialects. The form of the French language which obtained currency in England as the immediate consequence of the Norman Conquest was the northern dialect-the speech of Normandy and Picardy. But with the accession of the Angevine dynasty in the middle of the twelfth century the dialect of Central France became the language of the court and of the fashionable society. The two dialects differed considerably in pronunciation: for instance, Northern French had [k ]where Central French had [ch] and [ch] where Central French had [s]. One consequence of the two –fold character of the French spoken in England was that very often the same French word was adopted into English twice over, in two different forms and with meanings more or less different. Thus we have in modern English the words catch, warden, launch, wage, which came from Norman French and alongside them there are chase ,guardian ,lance, gage, which represent the same words as pronounced in French The vocabulary of language after the conquest has been enriched by a multitude of new derivation formed with the prefixes and suffixes that already existed in Old English. The native machinery of derivation is no longer found sufficient for the necessities of the language and has been largely supplemented by additions obtained from other languages. The adoption of foreign formative machinery has been rendered possible by the fact that many Latin and French primitive words have been taken English along with their derivations, formed with French or Latin suffixes. Therefore, when such pairs of words as derive and derivation, esteem and estimation, laud and laudation have found their way into the English vocabulary, it is natural that the suffixation should be recognized by English speakers as an allowable means of making ""nouns of action"" out of verbs. This suffix supplied a real want because the only native means of forming nouns of action was the suffix –ing, which was not quite definite enough in meaning. Many French suffixes, such as –age, -al (as used in withdrawal, upheaval, betrothal);-ment, and -able which have no thing corresponding to them in English have been extensively used in the formation of English derivations.(Henry,1955:86). 3.4. Did the influence of the Norman Conquest continue with the same degree of effect as when it first began? The influence of the Normans did not continue to be as strong as when it first began. So it is naturally expected to find that the French as a second language faced some retreat. The dawn of the 13th century found a trilingual England in which French, Latin, and English live side by side ,each used for a different purpose and with a different function. The first was the literary and courtly tongue, the second was the church and legal documents tongue and the third was the common intercourse tongue. With the loss of Normandy by King John in 1204 (Pei, 1953:44), the English language received the mighty Philip. It is conceivable that up to that time many of England's new landed gentry thought of Normandy as ""home"" and of England as a colonial possession in which they held their major domains. Now there was no longer a ""home ""for them, except England. By the time of Edward I, all Englishmen, whether of Saxon or Norman descent, were united ,and in 1295 the king of England charged the French kings ,among other crimes, with wanting to wipe out the English tongue. So it is by the end of the 13th century that French had become almost a foreign tongue in England, though it was gaining influence and prestige on the continent to such an extent that German barons had it taught to their children. However, as far as England was concerned, French was beginning to be taught out of manuals as a cultural tongue and even the children of nobility learned it as a foreign language. It was the Hindered Year's War with its bitter animosity against the French., and the black Death of 1349-1350,which lead to rise in the importance of the laboring classes and their tongue, that gave the death blow to French in England. In 1349 English was reinstated in the schools; in 1362 Parliament forbade the use of French in law courts, on the ground that ""French is much unknown"". By 1385 English had penetrated the scared precincts of the universities, with John Cornwall and Richard Pencrich leading it at Oxford. By the time of Henry V (1413) English was the official language at the court.","Carefully review the text below, then answer the question that follows. You should ONLY use information found in the included text to respond. What impact did the Norman Conquest have on Old and Middle English dialects and their conditions? 1. Chapter One 1.1. Historical Background English as a separate and distinct entity appeared in the great Germanic century, but it was until the beginning of the seventh that the language defiantly emerged from the confusion and turmoil of the conquest of Britain and began to take its place among the modern tongues of Europe. If we take a look to the history of the British Isles, we find that it has been visited by many people from the European mainland and the visitors must have liked what they have found, because often the visits turned into invasions or attempted invasions Before the dawn of recorded history, the British Isles had been visited, overrun, and conquered by two separate groups of Celtic invaders, speaking tongues which were the remote ancestors of present-day Gaelic and Welsh. (Pei,1953:12) During the earlier part of the eleventh century, Edward, the son of Ethelred the Unready and of the daughter of a Norman duke, was being brought up in Normandy, and when he at last came to the throne in 1042 the influence of his upbringing naturally remained, and his friends and supporters were both spiritual and temporal French. This certainly prepared the way for the Norman Conquest. (Jespersen, 1955:105) The Normans adopted a northern dialect of Old French known as Anglo-Norman(Carpenter,2004:79-80), which they spoke with certain characteristics and it was this dialect which was carried into English in the eleventh century and which was developed there into a specific variety known as Anglo- Norman. 1.2. English Language before the coming of the Normans Before the Norman Conquest, the people of England spoke Old English or what was called Anglo-Saxon. This language was Germanic in vocabulary, with few borrowings. It had many declensions of substantives. There was one declension which formed its genitive singular in –es and its nominative plural in –as; and there were other declensions in which –a, -an, -e appear as endings for the genitive singular m and –a, -an, -e,-u for the nominative plural. Out of all these the –es and –as declension is the online that remains in general use. If we take a look to the case-endings in Old English ; we find that –es was the only one that meant anything other than a genitive singular and –as which only meant a nominative or accusative plural. Thus hanan stands for the genitive, dative, and accusative singular and the nominative and accusative plural of hana, a cock. So it is a popular error to suppose that it was in the consequence of the Norman Conquest that the –es and –as declension came to sup ride all the rest. In fact, the change began in the Northern dialect.( Bradley, 1955:35) It is estimated that in the field of vocabulary about 450 Latin words came into Old English before the Norman Conquest. This is a surprisingly large total to those who think of the Anglo-Saxon era as the period of pure Germanium in the language. It is those words that would normally have entered English from 1066 on, and it is clear that even without the French cultural importation, present-day English would not be altogether a simon-pure Germanic tongue. Just before the coming of the Normans, Old English was a deft blend of west Germanic and Scandinavian, with the former still predominating and respectable amount of Latin- Greek borrowings, about half of them of a religious nature. 2. Chapter two ?ً 2.1. what is the Norman Conquest.. The Norman Conquest is the invasion and conquering of the Normans to England in 1066.It began when William of Normandy invaded England and seized its throne. .2. The Roots of the Norman Conquest. 2 When William the Bastard, Duke of Normandy, descend of Rollo (leader of Norsemen) and son of a tanner's daughter , conceived the ambitious plan of making himself master of the great island beyond the sea, he did not minimize the difficulty of invasion . He knew that Anglo-Saxons and Danes had been forged into a united, and hardy race by the wise policies of Alfred and Cnut, and that the armies of his opponent Harold were strong. Historians estimate that of the vast host gathered by William for the invasion of England only one third of them were of native Normans. These men were land hungry. It was their expectations that in case of victory the lands of England would be wrested from their Anglo-Saxon owners and given to them. They were not disappointed for William kept his promises. When the Norman host disembarked at Hastings, Anglo-Saxon England was already carved up in advance a fact which Harold's men did not know. Being fresh from a victory , they won against the king of Norway, supported by Harold's brother. They may have thought that in case of defeat, their lot would be no worse than had been their ancestor's in the Danelagh. The Normans would be absorbed, Anglicized as to language and customs, and all would go on as before. In the final analysis, they were perhaps right. However, centuries had to elapse before this would come to pass.(Encyclopaedia Britanica,v.5:881-882) The Norman victory was complete, so was the conquest. For five years after the fateful day the Saxons thugs and earls were forcibly deprived of their lands and privileges by the insolent invaders, continued to rebel and resist, while William and his mercenaries raged through the land. After that the resistance died away. The Saxon nobility robbed in everything in favor of William's followers; sank suddenly to the level of their own peasantry, while the ancient free men of England, now undistinguished from the churls, turned into villains of the new seigneurs. Saxon England was laid low .Norman England had replaced it.(Campbell,1982:240) Yet Saxon England was not quite dead. The new court, clergy and nobility knew and spoke only French and Latin. However the subject population lived on and so did its language; a language now scorned for literary purposes as the language of an inferior race. (Pei, 1953:33) From what has been mentioned above, it is noticed that the Normans were looked at as an alien race; their occupation of the country attracted much more notice and lasted longer than that of the Danes; they become the ruling class. They represented a higher culture than that of the native and had a literature of their own . The Normans became the masters of England and they remained masters for a sufficiently long time to leave impress on the language. The conquerors would have been far less if they had not continued for centuries in actual contact with the French of France. After the conquest, the immigrants formed the upper class of the English society. The following classes of words show this fact: Words relating to government Crown, state, government, reign, realm, sovereign, authority, country, minister, chancellor, authority, parliament, people, nation . Words related to feudalism: Fief, feudal, vassal, liege . Words relating to steps in the scale of rank: Prince, peer, duke, marquis, viscount, baron . Words related to military affairs: War, peace, battle, arms, armour, buckler, mail, lance, officer, dart, lieutenant, sergeant, solider, troops, vessel, navy, admiral, enemy, danger, prison, siege, guard. Words related to law: 124 Justice, just, judge, court, suit, sue, plaintiff, defendant, plea, plead, cause, assize, fee, accuse, crime, traitor, damage, heritage, properly, penalty, injury, privilege, tenure . Words related to church: Religion, service, trinity, savior, virgin, angle, saint, abbey, cloister, friar, clergy, parish, baptism, sacrifice, orison, alter, sermon, preach, pray, prayer, feast . Words related to the pleasure of life: Joy, pleasure, delight, ease, comfort Some of the favorite pastimes were Chase, Cards and Dice, so we find many French words related to them, such as: Brace, couple, lease, falcon, quarry, warren, scent, track, partner, suit, trump Words related to dress: apparel, dress, costume, garment Words related to art: art, beauty, colour, image, design, figure, ornament The long list of words which is mentioned above indicates the fact that French was the rich, powerful, and refined class in the English society. Therefore, it was natural that the lower classes should soon begin to adopt such of the expressions of the rich as they could catch the meaning . 3. Chapter Three 3. 1. The Linguistic Effects of the Norman Conquest on English language The Norman Conquest of Britain has a number of linguistic effects on the language spoken in England at that time. Some of the results of these influences were the following: 1. Change in the conditions of dialects .The conquest placed all four Old English dialects more or less on a level. As such, West Saxon lost its supremacy and the center of culture and learning gradually shifted from Winchester to London. The Old Northumbrian dialect became divided into Scottish and Northern, although little is known of either of these divisions before the end of the 13th century. The Old Mercian dialect was split into East and West Midland. West Saxon became slightly diminished in area and was more appropriately named the South Western dialect. The Kentish dialect was considerably extended and was called South Eastern. All five Middle English dialects (Northern, West Midland, East Midland, South Western, and South Eastern) went their own ways and developed their own characteristics. 2. Change in the writing of English from the clear and easily readable in solar hand of Irish origin to the dialect Carolingian script then in use on the continent. 3. Change in spelling for the sake of clarity. Old English y becomes u, Ý as yi, u as ou (ow when final), u was often written o before and after m, n, u, w; and i was sometimes written y before and after m and n, ew was changed to qu; hw to wh; qu or quh to ch or tch; se to sh; cg to gg and ht to ght. Thus, for example, mycel(much) appeared as muchel; fyr(fire) as fuir; hus (house) as hous; hu(how) as how; snnu (son) as sone; him(him) as hym; cwen as queen; hwelet as what; quat (quart)as quhrt ; dic as ditch; scip as ship, sccage (siege) as segge; and miht as might. The Northern infinitive was already one syllable, whereas the past participle – en inflection of Old English was strictly kept. Old English mutated –ended in the present participle had already become –inde in late Southern and it was this inflection that blended with the –ing suffix of nouns of action that had already become near-gerunds in such compound nouns as athswearing (oath swearing)and writing feather (writing feather pen) The Northern 2nd person singular singis was inherited unchanged from common Germanic. The final t sound in Midland –est. and Southern –st was excrescent comparable with the final t in modern (admist) and (amongst) from older amides and amonges. The Northern 3rd person singular singis had quite different origin. Like the singis of the plural, it resulted almost casually from an inadvertent retraction of the tongue in enunciation from an interdental –th sound to postendal –s. Today the form (singeth) services as a poetic archaism Shakespeare used both –eth and –s endings (It ""mercy""blesseth him that gives and him that takes) 3.1.1. The Changes in Sounds and stress which took place after the Norman Conquest French words which adopted in English suffered a great change in sounds; they have participated in all sound changes that have taken place in English since their adaptation. Thus, words with the long [i] sound have had it diphthongized into [ai], e.g. fine, price, lion. The long [u], written ou has become [au], e.g. Old French espouse pronounced /spuize/ now pronounce /spauze/ The English is unable to imitate the French accentuation, that's why there are a great many words now stressed on the final syllable. All English, it is said, had the stress on the final syllable, and this habit was unconsciously extended to foreign words on their first adoption into the language. In the plural, Old French had a nominative without any ending and an accusative in –s; and English popular instinct naturally associated the latter form with the native plural ending in –es. In course of time those words which had for a long time in English as in French formed their plural without any ending (e.g. case) were made to conform to the general rule (sg.case.cases) As to the verbs, the rule is that the stem of French present plural served as basis for the English form; thus (je survis), nouns survivor vous survives, ils survivent became survive ;( je resous), resolvous, etc.became resolve. After what is stated, and in order to prove the great impact the Norman Conquest had left on English, some of the French words with their synonyms in English should be mentioned and they are arranged chronically. A. The foreign words in the twelfth century can be classified as follows:ِa. . Words denoting person or rank:1 Abbat ""abbot"" canonic ""canon"" capelein ""chaplain"" cardinal ""cardinal"" cuntesse ""countess"" due ""duke"" emperice ""empress"" legat ""legate"" Ex: pehefde be Emperice in Alamanic & nu was cuntesse in Angou. ""Who had been Empress of Germany and now was Countess of Anjou"" Com an of Rome Henri was gehaten ""a legate called Henry came from Rome"" 2. words denoting finance: rent ""rent"" tresor ""treasure"" Ex: Wrothe on pe circe & sette parto landes& rentes (worked on the church and endowed it with lands and rents) 3. words denoting law and social relations: acorden ""reconcill"" justicse ""justice"" pais ""peace"" privilegie ""privileges"" 4. words denoting religion: carite ""charity"" miracle ""miracle"" nativite ""nativity"" procession""procession"" 5. words denoting military: werre ""war"" werrien ""to make war against"" 6. words denoting nature: 128 Best ""beast"" Contre ""country"" Flum ""river"" Marbre ""marble"" Leun ""lion"" Oil ""oil"" Rose ""rose"" 7. Words denoting Household and other things: Basi ""basin"" Coup ""cup"" Furneis ""furnace"" Lamp ""lamp"" 8. words denoting physical action and appearance: Cachen ""catch"" Changen ""change"" Chere ""face, appearance"" Savour ""savour"" 9. Words denoting moral and Intellectual Clergie ""science"" Craviant ""defeated"" Deol ""sorrow"" Dout ""doubt, fear"" Fausien ""fail"" Gin ""device"" Meistrie ""mastery"" Reisun ""reason"" B.some of the French words `during the period between 1200-1250: 1. words denoting person: Ame ""friend"" Baban ""baby"" Baptist ""Baptist"" Kunseiler ""councilor"" Messager ""messenger"" Nurice ""nurse"" Prison ""prisoner"" 2. words denoting finance: Cwile ""quit"" Spense ""expense"" 3. words denoting buildings: Celere ""cellar"" Cite ""city"" Knuent ""convent"" Genere ""granary"" Tur ""tower"" 4. words denoting law and social relations: 129 Baundun ""power "" Crune ""villiaains"" Juggen ""judge"" Noces ""marriage"" Trone ""throne"" 5. Words denoting religion Calize ""chalice"" Canoniicl ""canonical"" Creoisem ""to make the sign of the cross on"" Eresi ""heresy"" Feste ""festival"" Grace ""grace"" Parais ""Paradise"" 6. Words denoting military Baret ""strife"" Calenge ""challenge"" Gunfanenr ""standard bearer"" Skirmen ""fight"" Turnement ""tournament"" 7. words denoting nature: Bame ""balm"" Carbin ""raven"" Cou de gilofre ""clove"" Gingiuere ""ginger"" Flur ""flour"" Fluren ""to flower"" Licur ""liquor"" 8. words denoting clothes: Abit ""habbit"" Atiffen ""adorn"" Broche ""brooch"" 9. words denoting household: Beaabelet ""jewel"" Buste ""box"" Cage ""cage"" Chetel ""chattels"" Crèche ""crib"" Scorge ""scourge"" Trufle ""trifle"" 10. words denoting physical action: Aboutien ""lean out"" Aspien ""spy on"" Babelinde ""chattering"" Buffeten ""to buffet"" Disturben ""disturb"" Recoilen ""to drive back"" Rute ""road"" 11 . Words denoting moral and Intellectual: Anui ""worry"" Asprete ""bitterness"" Comfort ""comfort"" Kunscence ""consciousness"" Contumace ""contumacy"" Creaunt ""craven"" Debonere ""gentle"" Deinte ""dignity"" Delit ""delight"" Noblesce ""nobility"" Mesure ""moderation"" Largesse ""generosity"" Pacience ""pacience"" 12. words denoting mental action: Affaiten ""dispose"" Akointed ""acquainted"" Asaumple ""example"" Attente ""endeavour"" Bisamplen ""to moralize"" Counsail ""advice"" Defaut ""fault"" Paien ""please"" Preach ""preach"" Preisen ""to praise"" Scandle ""scandal"" C. the French words during the period between 1250-1300 1. words denoting person: Barun ""barun"" Caynard ""eascal"" Chanoun ""clerk"" dam ""sir"" Sergauuz ""sergents"" 2. words denoting law and social relations: Eir ""heir"" Eritage ""heritage"" Per ""peer"" Warrant ""surely"" 3. words denoting religion: Aungel ""angel"" Auter ""alter"" Beneisun ""benison"" 131 Malison ""malison"" Croize ""cross"" Preie ""pray"" 4. words denoting military: Baret ""strife"" Gisarm ""sword"" Skriming ""large shield"" 5. words denoting nature: Bise ""beast"" Runic ""horse"" Laumprei ""lamprey"" Flour ""flower"" 6. words denoting clothes: Charbuole ""carbuncle"" Ioupe ""losse jacket"" 7. Physical action: Aise ""ease"" Bout ""throw"" Croune ""crown"" Couere ""recover"" Fyn ""end"" Sane ""safe"" 8. words denoting food: Broys ""broth"" Clare ""claret"" Pastees ""sweet special wine"" Simenels ""bread of fine flour"" Super ""supper"" Ueneysun ""venison"" 9. Moral and Intellectual: Anuicu ""to worry"" Chiche ""mean"" Conseyl ""counsel"" Faith ""faith"" Fey ""felong"" Fol ""foolish"" Gent ""noble"" Atendre ""tender"" 3.2. Was the French influence restricted to one period? The French influence was not restricted to one particular period, and it is interesting to compare the forms of old loan-words with these of recent ones, in which we can recognize traces of the changes the French language has undergone since medieval times, where a ch in an originally French word is pronounced as in change, chaunt, etc;(with the sound /ts/) where it is sounded as in champagne (with simple /s/), we have a recent loan. The word chief is thus shown to belong to the first period, while its doublet chef (=chef de cuisine) is much more modern. It is curious that two pet-names should now be spelled in the same way, Charlie, although they are distinct in pronunciation: the masculine is derived from the old loan Charles and has, therefore, the, the sound [t ] .the feminine is from the recent loan Charlotte with [ ], but they have all of them the same initial sound. Other examples of the same French word appearing in more than one shape according to its age in English are Saloon and salon, suit and suit, liquor and liqueur, rout and route ;the diphthong in the former word is an English development of long[u], quart, pronounced [kw t], and quart, pronounced [kw t] pronounced [k t],""a sequence of four cards in pique,"" also quarte or carte in fencing. In early middle English, words were borrowed from French containing the sound-group ch [t ](as in English child),e.g. chief, chivalry, duchess, chase ,torch; and [d ](as in gem),e.g. judge (both constants) just, journey, large; these consonant-groups became respectively [ ]and[ ]in later French. Initially,however,[ ] is not found in English without a proposed [d]; thus gentle, genteel, and jaunty represent three larges of the borrowing from the same word. 3.3. How did common people manage to learn so many foreign words? And how far did they assimilate them? We expect to find many changes carried out in the French words after their adoption in order to be easy to learn. In few cases the process of assimilation was facilitate by the fact that a French word happened to resemble an old native one and this is exemplified by the following: The old native verb choose was supplemented with the noun choice, from French choix. Old English hergian and Old French herir run together in Middle English harry. Old English hege and French haie run together in hay ""hedge,fence"". The word nevew (now spelled nephew)recalled Old English nefa, menege recalled Old English meniegeo. It is important to understand that the French words which were brought into English represent two different dialects. The form of the French language which obtained currency in England as the immediate consequence of the Norman Conquest was the northern dialect-the speech of Normandy and Picardy. But with the accession of the Angevine dynasty in the middle of the twelfth century the dialect of Central France became the language of the court and of the fashionable society. The two dialects differed considerably in pronunciation: for instance, Northern French had [k ]where Central French had [ch] and [ch] where Central French had [s]. One consequence of the two –fold character of the French spoken in England was that very often the same French word was adopted into English twice over, in two different forms and with meanings more or less different. Thus we have in modern English the words catch, warden, launch, wage, which came from Norman French and alongside them there are chase ,guardian ,lance, gage, which represent the same words as pronounced in French The vocabulary of language after the conquest has been enriched by a multitude of new derivation formed with the prefixes and suffixes that already existed in Old English. The native machinery of derivation is no longer found sufficient for the necessities of the language and has been largely supplemented by additions obtained from other languages. The adoption of foreign formative machinery has been rendered possible by the fact that many Latin and French primitive words have been taken English along with their derivations, formed with French or Latin suffixes. Therefore, when such pairs of words as derive and derivation, esteem and estimation, laud and laudation have found their way into the English vocabulary, it is natural that the suffixation should be recognized by English speakers as an allowable means of making ""nouns of action"" out of verbs. This suffix supplied a real want because the only native means of forming nouns of action was the suffix –ing, which was not quite definite enough in meaning. Many French suffixes, such as –age, -al (as used in withdrawal, upheaval, betrothal);-ment, and -able which have no thing corresponding to them in English have been extensively used in the formation of English derivations.(Henry,1955:86). 3.4. Did the influence of the Norman Conquest continue with the same degree of effect as when it first began? The influence of the Normans did not continue to be as strong as when it first began. So it is naturally expected to find that the French as a second language faced some retreat. The dawn of the 13th century found a trilingual England in which French, Latin, and English live side by side ,each used for a different purpose and with a different function. The first was the literary and courtly tongue, the second was the church and legal documents tongue and the third was the common intercourse tongue. With the loss of Normandy by King John in 1204 (Pei, 1953:44), the English language received the mighty Philip. It is conceivable that up to that time many of England's new landed gentry thought of Normandy as ""home"" and of England as a colonial possession in which they held their major domains. Now there was no longer a ""home ""for them, except England. By the time of Edward I, all Englishmen, whether of Saxon or Norman descent, were united ,and in 1295 the king of England charged the French kings ,among other crimes, with wanting to wipe out the English tongue. So it is by the end of the 13th century that French had become almost a foreign tongue in England, though it was gaining influence and prestige on the continent to such an extent that German barons had it taught to their children. However, as far as England was concerned, French was beginning to be taught out of manuals as a cultural tongue and even the children of nobility learned it as a foreign language. It was the Hindered Year's War with its bitter animosity against the French., and the black Death of 1349-1350,which lead to rise in the importance of the laboring classes and their tongue, that gave the death blow to French in England. In 1349 English was reinstated in the schools; in 1362 Parliament forbade the use of French in law courts, on the ground that ""French is much unknown"". By 1385 English had penetrated the scared precincts of the universities, with John Cornwall and Richard Pencrich leading it at Oxford. By the time of Henry V (1413) English was the official language at the court.",Unknown,Effect Analysis,Q&A "The response should only contain information from the provided text. The content should be understandable by someone not familiar with the context. Provide the answer as a bulleted list, each with their own simple explanation. There should be an even number of points. The explanations should have an odd number of words.",I just got this compass and tried setting it up using the instructions but it isnt working. Could you go through the text and highlight anything that I may have done wrong?,"Digital Vehicle Compass 63-1120 OWNER’S MANUAL — Please read before using this equipment. Thank you for purchasing a RadioShack Digital Vehicle Compass. Your compass conveniently provides accurate heading information inside your vehicle. It incorporates the same magnetic sensor technology that is used in factory-installed vehicle compasses. The compass electronically separates the Earth’s magnetic field from the magnetic fields generated by your vehicle, to provide accurate compass headings. Automatic Shut-Off — conserves power by turning off the compass about 10 minutes after you park the vehicle when there are no significant changes in the surrounding magnetic fields. Magnetic Distortion Detection — alerts you when outside magnetic interference is affecting compass accuracy. INSTALLING BATTERIES Your compass requires two AAA batteries (not supplied) for power. For the best performance and longest life, we recommend RadioShack batteries. Battery life is about 11 months (based on an average of 8 hours of compass use and 2 hours of backlight use per week). Cautions: • Use only fresh batteries of the required size and recommended type. • Do not mix old and new batteries, different types of batteries (standard, alkaline, or rechargeable), or rechargeable batteries of different capacities. @ RadioShack www.radioshack.com™ © 2001 RadioShack Corporation. All Rights Reserved. RadioShack and RadioShack.com are trademarks used by RadioShack Corporation. 1. Slide the battery compartment cover in the direction of the OPEN arrow to remove it. 2. Place two AAA batteries in the compartment as indicated by the polarity symbols (+ and -) marked inside. 3. Replace the cover. All the arrows flash. After you install or replace batteries, you must calibrate the compass (see “Calibrating the Compass” on Page 4). If all the arrows and digits flash, and the backlight turns on when you turn on the compass, replace the batteries or use vehicle battery power (see “Using Vehicle Battery Power”). Warning: Dispose of old batteries promptly and properly. Do not burn or bury them. Caution: If you do not plan to use the compass for a month or more, remove the batteries. Batteries can leak chemicals that can destroy electronic parts. USING VEHICLE BATTERY POWER This compass is designed to be used with RadioShack’s 12V DC adapter Cat. No. 270-031A (available at your local RadioShack store). Using any other adapter could void the warranty and damage the compass. You can power the compass from a vehicle’s 12V power source (such as cigarette-lighter socket) using a 12V, 3 amp DC adapter (not supplied, available at your local RadioShack store). Cautions: A You must use a power source that supplies 12V DC . and delivers at least 3 amps. Its center tip must be set 2 to positive and its plug must fit the compass' jack. Using an adapter that does not meet these specifications could damage the compass or the adapter. • Always connect the DC adapter to the compass before you connect it to the power source. When you finish, disconnect the adapter from the power source before you disconnect it from the compass. Note: Since not all vehicles have constant power supplied to the power outlet, two AAA batteries are required to retain the compass calibration settings in memory (although they do not power the compass when vehicle battery power is used). Insert the barrel plug of the 12V DC adapter (not supplied) into the DC12V jack on the back of the compass. Then insert the DC plug into your vehicle’s power outlet. MOUNTING THE COMPASS Choose a clean mounting location on the vehicle’s windshield where the compass is at least 5 inches away from any stereo speakers and will not obstruct the driver’s field of view. Your compass comes with three suction cups for secure mounting. 1. Insert the small ball head of each suction cup into the larger hole on the bottom of the bracket and slide it into the bracket’s smaller hole so it fits tightly. 2. Place the compass in the holder. Note: To remove the compass from the holder, simply slide it out. 3 3. Firmly press the bracket with the Vertical Plane 4. Adjust the angle of the windshield. against the vehicle’s compass 20' maximum down tilt 20 maximum up tilt Horizontal Plane bracket so > that the face of the compass points to the back of the vehicle. Then adjust the bracket to an angle no more than 20° above or below the horizontal plane. 5. Tighten the bracket’s screw to hold it at the desired angle. Caution: If you use a reflective sun shade, do not leave the compass between the sun shade and the windshield. The extreme heat might damage the compass. Note: Your compass will not calibrate correctly and will not be accurate unless it is mounted so the display faces the back of your vehicle and is titled no more than 20° above or below the horizontal plane. The selected angle must stay fixed after calibration for the compass to remain accurate. CALIBRATING THE COMPASS Calibration enables the compass to separate the earth’s magnetic field from the magnetic fields generated by external influences (such as your vehicle) so it can provide accurate heading information. 4 When calibrating the compass, you must drive your vehicle in one complete circle. Be sure your vehicle is on level ground in an open area, such as a parking lot. The size of the circle and the direction your vehicle points when beginning or ending the circle do not matter. The circle does not need to be perfect, but it must be completed within 2 minutes. Important: If you do not calibrate your compass properly, it will not work correctly or accurately. You must calibrate your compass when you use it the first time and recalibrate it anytime: • you move the compass to a different location • you adjust the bracket/display angle • you remove and replace the batteries • BIST appears steadily • all the arrows flash 1. Ensure the compass is securely mounted (see “Mounting the Compass” on Page 3). 2. Hold down LIGHT and POWER at the same time until all arrows flash at the same time. Note: If you have just installed/replaced the batteries, all the arrows and digits briefly appear, then all the arrows flash at the same time and the backlight turns on. Begin from Step 3 to calibrate your compass. 3. Press POWER. The arrows appear one at a time. 4. With the compass mounted, drive in one complete circle and then press POWER. The current compass heading appears. 5 Note: If you press LIGHT while calibrating your compass (except after installing/replacing batteries), the compass does not store the calibration setting and the original setting is unchanged. USING THE COMPASS The 8 displayed cardinal points for this compass are N, NE, E, SE, S, SW, W, and NW. Distortion Detection When DiST appears, the compass is detecting magnetic interference that compromises its accuracy. Distortion occurs when there has been a significant change in the surrounding magnetic fields, such as when you are driving under an overpass, or over a bridge. The steel in these structures causes inaccurate readings in any magnetic compass, but unlike other compasses, this compass detects interference and alerts you. If DIST appears continuously, recalibrate your compass (see “Calibrating the Compass” on Page 4). Turning the Compass On and Off Press POWER to turn the compass on and off. Or, you can press LIGHT to turn on the compass and the backlight. To turn off the compass and the backlight, press POWER. Important: The compass automatically turns off after about 10 minutes to conserve power if no significant changes occur in the surrounding magnetic fields. 6 Using the Backlight To turn on the backlight, press LIGHT. To turn off the backlight, press LIGHT again. The backlight automatically turns off after about 1 minute if it is powered by internal batteries. It automatically turns off after about 10 minutes if it is powered by vehicle battery power, unless significant changes occur in the surrounding magnetic fields. CARE Keep the compass dry; if it gets wet, wipe it dry immediately. Use and store the compass only in normal temperature environments. Handle the compass carefully; do not drop it. Keep the compass away from dust and dirt, and wipe it with a damp cloth occasionally to keep it looking new. Modifying or tampering with the compass’ internal components can cause a malfunction and might invalidate its warranty. If your compass is not performing as it should, take it to your local RadioShack store for assistance. ","I just got this compass and tried setting it up using the instructions but it isnt working. Could you go through the text and highlight anything that I may have done wrong? Digital Vehicle Compass 63-1120 OWNER’S MANUAL — Please read before using this equipment. Thank you for purchasing a RadioShack Digital Vehicle Compass. Your compass conveniently provides accurate heading information inside your vehicle. It incorporates the same magnetic sensor technology that is used in factory-installed vehicle compasses. The compass electronically separates the Earth’s magnetic field from the magnetic fields generated by your vehicle, to provide accurate compass headings. Automatic Shut-Off — conserves power by turning off the compass about 10 minutes after you park the vehicle when there are no significant changes in the surrounding magnetic fields. Magnetic Distortion Detection — alerts you when outside magnetic interference is affecting compass accuracy. INSTALLING BATTERIES Your compass requires two AAA batteries (not supplied) for power. For the best performance and longest life, we recommend RadioShack batteries. Battery life is about 11 months (based on an average of 8 hours of compass use and 2 hours of backlight use per week). Cautions: • Use only fresh batteries of the required size and recommended type. • Do not mix old and new batteries, different types of batteries (standard, alkaline, or rechargeable), or rechargeable batteries of different capacities. @ RadioShack www.radioshack.com™ © 2001 RadioShack Corporation. All Rights Reserved. RadioShack and RadioShack.com are trademarks used by RadioShack Corporation. 1. Slide the battery compartment cover in the direction of the OPEN arrow to remove it. 2. Place two AAA batteries in the compartment as indicated by the polarity symbols (+ and -) marked inside. 3. Replace the cover. All the arrows flash. After you install or replace batteries, you must calibrate the compass (see “Calibrating the Compass” on Page 4). If all the arrows and digits flash, and the backlight turns on when you turn on the compass, replace the batteries or use vehicle battery power (see “Using Vehicle Battery Power”). Warning: Dispose of old batteries promptly and properly. Do not burn or bury them. Caution: If you do not plan to use the compass for a month or more, remove the batteries. Batteries can leak chemicals that can destroy electronic parts. USING VEHICLE BATTERY POWER This compass is designed to be used with RadioShack’s 12V DC adapter Cat. No. 270-031A (available at your local RadioShack store). Using any other adapter could void the warranty and damage the compass. You can power the compass from a vehicle’s 12V power source (such as cigarette-lighter socket) using a 12V, 3 amp DC adapter (not supplied, available at your local RadioShack store). Cautions: A You must use a power source that supplies 12V DC . and delivers at least 3 amps. Its center tip must be set 2 to positive and its plug must fit the compass' jack. Using an adapter that does not meet these specifications could damage the compass or the adapter. • Always connect the DC adapter to the compass before you connect it to the power source. When you finish, disconnect the adapter from the power source before you disconnect it from the compass. Note: Since not all vehicles have constant power supplied to the power outlet, two AAA batteries are required to retain the compass calibration settings in memory (although they do not power the compass when vehicle battery power is used). Insert the barrel plug of the 12V DC adapter (not supplied) into the DC12V jack on the back of the compass. Then insert the DC plug into your vehicle’s power outlet. MOUNTING THE COMPASS Choose a clean mounting location on the vehicle’s windshield where the compass is at least 5 inches away from any stereo speakers and will not obstruct the driver’s field of view. Your compass comes with three suction cups for secure mounting. 1. Insert the small ball head of each suction cup into the larger hole on the bottom of the bracket and slide it into the bracket’s smaller hole so it fits tightly. 2. Place the compass in the holder. Note: To remove the compass from the holder, simply slide it out. 3 3. Firmly press the bracket with the Vertical Plane 4. Adjust the angle of the windshield. against the vehicle’s compass 20' maximum down tilt 20 maximum up tilt Horizontal Plane bracket so > that the face of the compass points to the back of the vehicle. Then adjust the bracket to an angle no more than 20° above or below the horizontal plane. 5. Tighten the bracket’s screw to hold it at the desired angle. Caution: If you use a reflective sun shade, do not leave the compass between the sun shade and the windshield. The extreme heat might damage the compass. Note: Your compass will not calibrate correctly and will not be accurate unless it is mounted so the display faces the back of your vehicle and is titled no more than 20° above or below the horizontal plane. The selected angle must stay fixed after calibration for the compass to remain accurate. CALIBRATING THE COMPASS Calibration enables the compass to separate the earth’s magnetic field from the magnetic fields generated by external influences (such as your vehicle) so it can provide accurate heading information. 4 When calibrating the compass, you must drive your vehicle in one complete circle. Be sure your vehicle is on level ground in an open area, such as a parking lot. The size of the circle and the direction your vehicle points when beginning or ending the circle do not matter. The circle does not need to be perfect, but it must be completed within 2 minutes. Important: If you do not calibrate your compass properly, it will not work correctly or accurately. You must calibrate your compass when you use it the first time and recalibrate it anytime: • you move the compass to a different location • you adjust the bracket/display angle • you remove and replace the batteries • BIST appears steadily • all the arrows flash 1. Ensure the compass is securely mounted (see “Mounting the Compass” on Page 3). 2. Hold down LIGHT and POWER at the same time until all arrows flash at the same time. Note: If you have just installed/replaced the batteries, all the arrows and digits briefly appear, then all the arrows flash at the same time and the backlight turns on. Begin from Step 3 to calibrate your compass. 3. Press POWER. The arrows appear one at a time. 4. With the compass mounted, drive in one complete circle and then press POWER. The current compass heading appears. 5 Note: If you press LIGHT while calibrating your compass (except after installing/replacing batteries), the compass does not store the calibration setting and the original setting is unchanged. USING THE COMPASS The 8 displayed cardinal points for this compass are N, NE, E, SE, S, SW, W, and NW. Distortion Detection When DiST appears, the compass is detecting magnetic interference that compromises its accuracy. Distortion occurs when there has been a significant change in the surrounding magnetic fields, such as when you are driving under an overpass, or over a bridge. The steel in these structures causes inaccurate readings in any magnetic compass, but unlike other compasses, this compass detects interference and alerts you. If DIST appears continuously, recalibrate your compass (see “Calibrating the Compass” on Page 4). Turning the Compass On and Off Press POWER to turn the compass on and off. Or, you can press LIGHT to turn on the compass and the backlight. To turn off the compass and the backlight, press POWER. Important: The compass automatically turns off after about 10 minutes to conserve power if no significant changes occur in the surrounding magnetic fields. 6 Using the Backlight To turn on the backlight, press LIGHT. To turn off the backlight, press LIGHT again. The backlight automatically turns off after about 1 minute if it is powered by internal batteries. It automatically turns off after about 10 minutes if it is powered by vehicle battery power, unless significant changes occur in the surrounding magnetic fields. CARE Keep the compass dry; if it gets wet, wipe it dry immediately. Use and store the compass only in normal temperature environments. Handle the compass carefully; do not drop it. Keep the compass away from dust and dirt, and wipe it with a damp cloth occasionally to keep it looking new. Modifying or tampering with the compass’ internal components can cause a malfunction and might invalidate its warranty. If your compass is not performing as it should, take it to your local RadioShack store for assistance. The response should only contain information from the provided text. The content should be understandable by someone not familiar with the context. Provide the answer as a bulleted list, each with their own simple explanation. There should be an even number of points. The explanations should have an odd number of words.",Retail/Product,Fact Finding,Q&A Only use the provided context block below for your answer. Do not use outside sources.,How do these three differ from each other?,"-Hybrid Electric Vehicles HEVs are powered by an internal combus- tion engine or other propulsion source that runs on conventional or alternative fuel and an electric motor that uses energy stored in a battery. The extra power provided by the electric motor allows for a smaller engine, resulting in better fuel economy without sacrificing performance. HEVs combine the benefits of high fuel economy and low emissions with the power and range of conventional vehicles. HEVs do not require a plug to charge the battery; instead, they charge using regenerative braking and the internal combustion engine. They capture energy normally lost during braking by using the electric motor as a generator, storing the captured energy in the battery. The energy from the battery provides extra power during acceleration and auxiliary power when idling. -Plug-In Hybrid Electric Vehicles PHEVs are powered by conventional fuels and by electrical energy stored in a battery. Using electricity from the grid to charge the battery some of the time costs less and reduces petroleum consumption compared with conventional vehicles. PHEVs can also reduce emissions, depending on the electricity source. PHEVs have an internal combustion engine or other propulsion source and an electric motor, which uses energy stored in a battery. PHEVs have larger battery packs than HEVs, making it possible to drive using only electric power (about 10 to 40 miles in current models). This is commonly referred to as the all-electric range of the vehicle. PHEV batteries can be charged several ways: by an outside electric power source, by the internal combustion engine, or through regenerative braking. If a PHEV is never plugged in to charge, its fuel economy will be about the same as that of a similarly sized HEV. If the vehicle is fully charged and then driven a shorter distance than its all-electric range, it is possible to use electric power only. -All-Electric Vehicles EVs use a battery to store the electrical energy that powers the motor. EV batter- ies are charged by plugging the vehicle into an electric power source. Although electricity production may contribute to air pollution, the U.S. Environmental Protection Agency (EPA) considers EVs to be zero-emission vehicles because their motors produce no exhaust or emissions. Since EVs use no other fuel, they help reduce petroleum consumption. Currently available EVs have a shorter range per charge than most conventional vehicles have per tank of gas. EV manu- facturers typically target a minimum range of 100 miles. According to the U.S. Department of Transportation’s Federal Highway Administration, 100 miles is sufficient for more than 90% of all house- hold vehicle trips in the United States. Light-duty HEV, PHEV, and EV models are currently available from a number of auto manufacturers, with additional models expected to be released in com- ing years. There are also a variety of medium- and heavy-duty options avail- able. For up-to-date information on available vehicle models, refer to the Alternative Fuels and Advanced Vehicles Data Center’s (AFDC) Electric Vehicle Availability page (www.afdc.energy.gov/ afdc/vehicles/electric_availability.html) and FuelEconomy.gov.","Only use the provided context block below for your answer. Do not use outside sources. How do these three differ from each other? [-Hybrid Electric Vehicles HEVs are powered by an internal combus- tion engine or other propulsion source that runs on conventional or alternative fuel and an electric motor that uses energy stored in a battery. The extra power provided by the electric motor allows for a smaller engine, resulting in better fuel economy without sacrificing performance. HEVs combine the benefits of high fuel economy and low emissions with the power and range of conventional vehicles. HEVs do not require a plug to charge the battery; instead, they charge using regenerative braking and the internal combustion engine. They capture energy normally lost during braking by using the electric motor as a generator, storing the captured energy in the battery. The energy from the battery provides extra power during acceleration and auxiliary power when idling. -Plug-In Hybrid Electric Vehicles PHEVs are powered by conventional fuels and by electrical energy stored in a battery. Using electricity from the grid to charge the battery some of the time costs less and reduces petroleum consumption compared with conventional vehicles. PHEVs can also reduce emissions, depending on the electricity source. PHEVs have an internal combustion engine or other propulsion source and an electric motor, which uses energy stored in a battery. PHEVs have larger battery packs than HEVs, making it possible to drive using only electric power (about 10 to 40 miles in current models). This is commonly referred to as the all-electric range of the vehicle. PHEV batteries can be charged several ways: by an outside electric power source, by the internal combustion engine, or through regenerative braking. If a PHEV is never plugged in to charge, its fuel economy will be about the same as that of a similarly sized HEV. If the vehicle is fully charged and then driven a shorter distance than its all-electric range, it is possible to use electric power only. -All-Electric Vehicles EVs use a battery to store the electrical energy that powers the motor. EV batter- ies are charged by plugging the vehicle into an electric power source. Although electricity production may contribute to air pollution, the U.S. Environmental Protection Agency (EPA) considers EVs to be zero-emission vehicles because their motors produce no exhaust or emissions. Since EVs use no other fuel, they help reduce petroleum consumption. Currently available EVs have a shorter range per charge than most conventional vehicles have per tank of gas. EV manu- facturers typically target a minimum range of 100 miles. According to the U.S. Department of Transportation’s Federal Highway Administration, 100 miles is sufficient for more than 90% of all house- hold vehicle trips in the United States. Light-duty HEV, PHEV, and EV models are currently available from a number of auto manufacturers, with additional models expected to be released in com- ing years. There are also a variety of medium- and heavy-duty options avail- able. For up-to-date information on available vehicle models, refer to the Alternative Fuels and Advanced Vehicles Data Center’s (AFDC) Electric Vehicle Availability page (www.afdc.energy.gov/ afdc/vehicles/electric_availability.html) and FuelEconomy.gov.]",Internet/Technology,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",Summarize this article in 400 words or list. Create bullet lists for what causes skin tags and how skin tags are created. Include a list of people most likely to get skin tags and why.,"Skin tags: Why they develop, and how to remove them Skin tags are harmless growths that can appear anywhere on your skin, but often develop on the neck, eyelids, or underarms. They may be the same color as your skin or darker. Some are pink. Others turn red when irritated. You may see one dangling from a stalk, while another is firmly fixed to the skin. With all this variation, there is one thing that acrochordons (medical name for skin tags) seem to have in common. Many people want to remove them. You only need to remove a skin tag if it becomes irritated, feels uncomfortable, or affects your eyesight. If one or more of your skin tags fits this description, contact a board-certified dermatologist because no one understands your skin better. Man placing his finger just below an irritated skin tag on his neck. The following explains how dermatologists remove skin tags. It also answers other questions that patients frequently ask their dermatologist. Why am I getting skin tags? These growths can appear anywhere on the skin, but they usually develop where skin has been rubbing against skin, jewelry, or clothing for some time. That’s why they usually occur in one or more of these areas: Breasts (beneath) Eyelids Groin Neck creases (or where clothing or jewelry rubs against the neck) Underarms Skin tags are also commonly found on the sides, abdomen, or back. Because they develop where skin rubs against skin, people who are overweight, pregnant, or have loose skin are more likely to get skin tags. You also have a higher risk of developing skin tags if you have diabetes, metabolic syndrome (high blood pressure, unhealthy blood sugar levels, extra fat around your waist, or unhealthy cholesterol levels), or a blood relative has skin tags. It’s important to keep in mind that these growths are harmless. Should I remove a skin tag? Because they’re harmless, a skin tag only needs to be removed if it: Becomes irritated or bleeds Develops on your eyelid and affects your eyesight Feels painful, especially when the pain comes on suddenly A skin tag can become irritated if it frequently rubs against jewelry, clothing, or a seat belt. Shaving can also irritate it, especially if you nick the skin tag. A dermatologist can remove these skin tags. Suddenly developing many skin tags while rare can be a sign that something is going on inside your body. If this happens, see a board-certified dermatologist, who can make sure you have skin tags and may recommend that you see your primary care doctor. Several skin tags on a person’s skin If you dislike the way a skin tag looks, your dermatologist can also remove it. However, you’ll likely pay the cost. Insurance providers consider removing a skin growth for looks alone a cosmetic treatment. Insurance rarely covers the cost of cosmetic treatments. How does a dermatologist remove skin tags? Your dermatologist can quickly and safely remove one or more skin tags during an office visit, and usually without the need for a follow-up appointment. The treatment that your dermatologist uses will depend on the size of the skin tag, where it appears on your body, and other considerations. Your dermatologist may use: Cryosurgery: During this treatment, your dermatologist applies an extremely cold substance like liquid nitrogen to freeze and destroy the skin tag. Sometimes, freezing causes a blister or scab. When the blister or scab falls off, so will the skin tag. When using cryosurgery, your dermatologist may freeze only the bottom of the skin tag and then snip it off with a sterile surgical blade or scissors. Electrodesiccation: Your dermatologistuses a tiny needle to zap the skin tag, which destroys it.You’ll develop a scab on the treated skin that will heal in one to three weeks. Snip: Your dermatologist will numb the area, use sterile surgical scissors or a blade to remove the skin tag, and then apply a solution to stop the bleeding. After treatment, your dermatologist may give you aftercare instructions to follow. This may include removing the bandage, washing the area carefully, and covering it with a new bandage. Follow your aftercare instructions carefully to prevent problems like an infection. Products that you can use at-home to remove skin tags are not recommended The U.S. Food and Drug Administration (FDA) has not approved any of these products. Because of the harm these products can cause, the FDA warns people NOT to use them. To find out more, go to 5 reasons to see a dermatologist for mole, skin tag removal. Does wart remover work on skin tags? Given that some skin tags look like warts, it’s easy to think wart remover would work well. It doesn’t. Warts are hard and need strong medication. Skin tags are soft, so using a wart remover on them can damage your skin. You may develop scarring or irritated skin where you apply wart remover. Seeing a dermatologist can give you peace of mind Skin tags come in many shapes and sizes, so you may mistake a wart or even a skin cancer for a skin tag. Board-certified dermatologists know the difference between something small and something major. By seeing a dermatologist, you’ll find out what’s going on and that can bring peace of mind. Related AAD resources 5 reasons to see a dermatologist for mole, skin tag removal Images Image 1: Getty Images Image 2: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol. 2019;81:1037-57.) References Belgam Syed SY, Lipoff JB, et al. “Acrochordon.” In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Farshchian M, Kimyai-Asadi A et al. “Cryosnip for skin tag removal.” J Am Acad Dermatol. 2021 May 30:S0190-9622(21)01032-X. doi: 10.1016/j.jaad.2021.05.039. Epub ahead of print. Hirt PA, Castillo DE, et al. “Skin changes in the obese patient.” J Am Acad Dermatol. 2019 Nov;81(5):1037-57. Kutzner HH, Kamino H, et al. “Fibrous and fibrohistiocytic proliferations of the skin and tendons.” In: Bolognia JL, et al. Dermatology. (fourth edition). Mosby Elsevier, China, 2018: 2068-9. Schwartz, RA. “Acrochordon.” In:Medscape(Elston DM., Ed.) Last updated 10/26/2022. Last accessed 3/28/2023. Tucker, R. “Advice on how to treat skin tags.” The Pharm Jour. Published March 1, 2011. Last accessed March 23, 2023. U.S. Food and Drug Administration. “Products marketed for removing moles and other skin lesions can cause injuries, scarring.” Last updated 8/10/22. Last visited 3/30/23."," Only use the provided text to answer the question, no outside sources. Summarize this article in 400 words or list. Create bullet lists for what causes skin tags and how skin tags are created. Include a list of people most likely to get skin tags and why. Skin tags: Why they develop, and how to remove them Skin tags are harmless growths that can appear anywhere on your skin, but often develop on the neck, eyelids, or underarms. They may be the same color as your skin or darker. Some are pink. Others turn red when irritated. You may see one dangling from a stalk, while another is firmly fixed to the skin. With all this variation, there is one thing that acrochordons (medical name for skin tags) seem to have in common. Many people want to remove them. You only need to remove a skin tag if it becomes irritated, feels uncomfortable, or affects your eyesight. If one or more of your skin tags fits this description, contact a board-certified dermatologist because no one understands your skin better. Man placing his finger just below an irritated skin tag on his neck. The following explains how dermatologists remove skin tags. It also answers other questions that patients frequently ask their dermatologist. Why am I getting skin tags? These growths can appear anywhere on the skin, but they usually develop where skin has been rubbing against skin, jewelry, or clothing for some time. That’s why they usually occur in one or more of these areas: Breasts (beneath) Eyelids Groin Neck creases (or where clothing or jewelry rubs against the neck) Underarms Skin tags are also commonly found on the sides, abdomen, or back. Because they develop where skin rubs against skin, people who are overweight, pregnant, or have loose skin are more likely to get skin tags. You also have a higher risk of developing skin tags if you have diabetes, metabolic syndrome (high blood pressure, unhealthy blood sugar levels, extra fat around your waist, or unhealthy cholesterol levels), or a blood relative has skin tags. It’s important to keep in mind that these growths are harmless. Should I remove a skin tag? Because they’re harmless, a skin tag only needs to be removed if it: Becomes irritated or bleeds Develops on your eyelid and affects your eyesight Feels painful, especially when the pain comes on suddenly A skin tag can become irritated if it frequently rubs against jewelry, clothing, or a seat belt. Shaving can also irritate it, especially if you nick the skin tag. A dermatologist can remove these skin tags. Suddenly developing many skin tags while rare can be a sign that something is going on inside your body. If this happens, see a board-certified dermatologist, who can make sure you have skin tags and may recommend that you see your primary care doctor. Several skin tags on a person’s skin If you dislike the way a skin tag looks, your dermatologist can also remove it. However, you’ll likely pay the cost. Insurance providers consider removing a skin growth for looks alone a cosmetic treatment. Insurance rarely covers the cost of cosmetic treatments. How does a dermatologist remove skin tags? Your dermatologist can quickly and safely remove one or more skin tags during an office visit, and usually without the need for a follow-up appointment. The treatment that your dermatologist uses will depend on the size of the skin tag, where it appears on your body, and other considerations. Your dermatologist may use: Cryosurgery: During this treatment, your dermatologist applies an extremely cold substance like liquid nitrogen to freeze and destroy the skin tag. Sometimes, freezing causes a blister or scab. When the blister or scab falls off, so will the skin tag. When using cryosurgery, your dermatologist may freeze only the bottom of the skin tag and then snip it off with a sterile surgical blade or scissors. Electrodesiccation: Your dermatologistuses a tiny needle to zap the skin tag, which destroys it.You’ll develop a scab on the treated skin that will heal in one to three weeks. Snip: Your dermatologist will numb the area, use sterile surgical scissors or a blade to remove the skin tag, and then apply a solution to stop the bleeding. After treatment, your dermatologist may give you aftercare instructions to follow. This may include removing the bandage, washing the area carefully, and covering it with a new bandage. Follow your aftercare instructions carefully to prevent problems like an infection. Products that you can use at-home to remove skin tags are not recommended The U.S. Food and Drug Administration (FDA) has not approved any of these products. Because of the harm these products can cause, the FDA warns people NOT to use them. To find out more, go to 5 reasons to see a dermatologist for mole, skin tag removal. Does wart remover work on skin tags? Given that some skin tags look like warts, it’s easy to think wart remover would work well. It doesn’t. Warts are hard and need strong medication. Skin tags are soft, so using a wart remover on them can damage your skin. You may develop scarring or irritated skin where you apply wart remover. Seeing a dermatologist can give you peace of mind Skin tags come in many shapes and sizes, so you may mistake a wart or even a skin cancer for a skin tag. Board-certified dermatologists know the difference between something small and something major. By seeing a dermatologist, you’ll find out what’s going on and that can bring peace of mind. Related AAD resources 5 reasons to see a dermatologist for mole, skin tag removal Images Image 1: Getty Images Image 2: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol. 2019;81:1037-57.) References Belgam Syed SY, Lipoff JB, et al. “Acrochordon.” In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Farshchian M, Kimyai-Asadi A et al. “Cryosnip for skin tag removal.” J Am Acad Dermatol. 2021 May 30:S0190-9622(21)01032-X. doi: 10.1016/j.jaad.2021.05.039. Epub ahead of print. Hirt PA, Castillo DE, et al. “Skin changes in the obese patient.” J Am Acad Dermatol. 2019 Nov;81(5):1037-57. Kutzner HH, Kamino H, et al. “Fibrous and fibrohistiocytic proliferations of the skin and tendons.” In: Bolognia JL, et al. Dermatology. (fourth edition). Mosby Elsevier, China, 2018: 2068-9. Schwartz, RA. “Acrochordon.” In:Medscape(Elston DM., Ed.) Last updated 10/26/2022. Last accessed 3/28/2023. Tucker, R. “Advice on how to treat skin tags.” The Pharm Jour. Published March 1, 2011. Last accessed March 23, 2023. U.S. Food and Drug Administration. “Products marketed for removing moles and other skin lesions can cause injuries, scarring.” Last updated 8/10/22. Last visited 3/30/23. https://www.aad.org/public/diseases/a-z/skin-tags",Medical,Summarize & Format,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Give me the differences between micronutrients and macronutrients in terms of their functions and the and the amount required in the body.For each give examples while explaining how they help the body. Respond with 500 words.,"What are the nutrients? The foods we eat contain nutrients. Nutrients are substances required by the body to perform its basic functions. Nutrients must be obtained from our diet since the human body can not make them. Nutrients have one or more of three basic functions: they provide energy, contribute to body structure, and/or regulate chemical processes in the body. These basic functions allow us to detect and respond to environmental surroundings, move, excrete wastes, breathe, grow, and reproduce. There are six classes of nutrients required for the body to function and maintain overall health. These are carbohydrates, lipids, proteins, water, vitamins, and minerals. Foods also contain non-nutrient that may be harmful such as natural toxins common in plant foods and additives like some dyes and preservatives or beneficial like antioxidants. Key Functions of the 6 Essential Nutrients Protein Necessary for tissue formation, cell reparation, and hormone and enzyme production. It is essential for building strong muscles and a healthy immune system. Carbohydrates Provide a ready source of energy for the body and provide structural constituents for the formation of cells. Fat Provides stored energy for the body, functions as structural components of cells, and signaling molecules for proper cellular communication. It provides insulation to vital organs and works to maintain body temperature. Vitamins Regulate body processes and promote normal body-system functions. Minerals Regulate body processes, are necessary for proper cellular function, and comprise body tissue. Water Transports essential nutrients to all body parts, transports waste products for disposal, and aids with body temperature maintenance. macronutrients Nutrients that are needed in large amounts are called macronutrients. There are three classes of macronutrients: carbohydrates, lipids, and proteins. These can be metabolically processed into cellular energy. The energy from macronutrients comes from their chemical bonds. This chemical energy is converted into cellular energy used to perform work, allowing our bodies to conduct their basic functions. A unit of measurement of food energy is the calorie. On nutrition food labels, the amount given for “calories” is actually equivalent to each calorie multiplied by one thousand. A kilocalorie (Calorie) is the amount of heat generated by a particular macronutrient that raises the temperature of 1 kilogram of water 1 degree Celsius. On the Nutrition Facts panel, the calories within a particular food are expressed as kilocalories, which is commonly denoted as “Calories” with a capital “C” (1 kcal = 1 Calorie = 1,000 calories). Water is also a macronutrient in the sense that you require a large amount of it, but unlike the other macronutrients, it does not provide calories. carbohydrates Carbohydrates are molecules composed of carbon, hydrogen, and oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy vegetables, like potatoes. Non-starchy vegetables also contain carbohydrates but in lesser quantities. Carbohydrates are broadly classified into two forms based on their chemical structure: simple carbohydrates, simple sugars, and complex carbohydrates. Simple carbohydrates consist of one or two basic units. Examples of simple sugars include sucrose, the type of sugar you would have in a bowl on the breakfast table, and glucose, the type of sugar that circulates in your blood. Complex carbohydrates are long chains of simple sugars that can be unbranched or branched. During digestion, the body breaks down digestible complex carbohydrates into simple sugars, mostly glucose. Glucose is then transported to all our cells, stored, used to make energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but digestive enzymes cannot break it down in the human intestine. As a result, it passes through the digestive tract undigested unless the bacteria that inhabit the colon or large intestine break it down. One gram of digestible carbohydrates yields four kilocalories of energy for the body’s cells to perform work. Besides providing energy and serving as building blocks for bigger macromolecules, carbohydrates are essential for the nervous system’s proper functioning, heart, and kidneys. As mentioned, glucose can be stored in the body for future use. In humans, the storage molecule of carbohydrates is called glycogen, and in plants, it is known as starch. Glycogen and starch are complex carbohydrates. protein Proteins are macromolecules composed of chains of subunits called amino acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and nitrogen. Food sources of proteins include meats, dairy products, seafood, and various plant-based foods, most notably soy. The word protein comes from a Greek word meaning “of primary importance,” which is an apt description of these macronutrients; they are also known colloquially as the “workhorses” of life. Proteins provide four kilocalories of energy per gram; however, providing energy is not protein’s most important function. Proteins provide structure to bones, muscles, and skin and play a role in conducting most of the chemical reactions that take place in the body. Scientists estimate that greater than one-hundred thousand different proteins exist within the human body. The genetic codes in DNA are basically protein recipes that determine the order in which 20 different amino acids are bound together to make thousands of specific proteins. lipids Lipids are also a family of molecules composed of carbon, hydrogen, and oxygen, but they are insoluble in water, unlike carbohydrates. Lipids are found predominantly in butter, oils, meats, dairy products, nuts, seeds, and processed foods. The three main types of lipids are triglycerides (triacylglycerols), phospholipids, and sterols. The main job of lipids is to provide or store energy. Lipids provide more energy per gram than carbohydrates (nine kilocalories per gram of lipids versus four kilocalories per gram of carbohydrates). In addition to energy storage, lipids serve as a major component of cell membranes, surround and protect organs (in fat-storing tissues), provide insulation to aid in temperature regulation, and regulate many other body functions. water There is one other nutrient that we must have in large quantities: water. Water does not contain carbon but is composed of two hydrogens and one oxygen per molecule of water. More than 60 percent of your total body weight is water. Without it, nothing could be transported in or out of the body, chemical reactions would not occur, organs would not be cushioned, and body temperature would fluctuate widely. On average, an adult consumes just over two liters of water per day from food and drink combined. Since water is so critical for life’s basic processes, the amount of water input and output is significant, a topic we will explore in detail micronutrients Micronutrients are nutrients required by the body in lesser amounts but are still essential for carrying out bodily functions. Micronutrients include all the essential minerals and vitamins. There are sixteen essential minerals and thirteen vitamins. In contrast to carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories), but they assist in the process as cofactors or components of enzymes (i.e., coenzymes). Enzymes are proteins that catalyze chemical reactions in the body and are involved in all aspects of body functions, from producing energy to digesting nutrients to building macromolecules. Micronutrients play many essential roles in the body. minerals Minerals are solid inorganic substances that form crystals and are classified depending on how much of them we need. Trace minerals, such as molybdenum, selenium, zinc, iron, and iodine, are only required in a few milligrams or less. Macrominerals, such as calcium, magnesium, potassium, sodium, and phosphorus, are required in hundreds of milligrams. Many minerals are critical for enzyme function. Others are used to maintain fluid balance, build bone tissue, synthesize hormones, transmit nerve impulses, contract and relax muscles, and protect against harmful free radicals in the body that can cause health problems such as cancer.","""================ ======= What are the nutrients? The foods we eat contain nutrients. Nutrients are substances required by the body to perform its basic functions. Nutrients must be obtained from our diet since the human body can not make them. Nutrients have one or more of three basic functions: they provide energy, contribute to body structure, and/or regulate chemical processes in the body. These basic functions allow us to detect and respond to environmental surroundings, move, excrete wastes, breathe, grow, and reproduce. There are six classes of nutrients required for the body to function and maintain overall health. These are carbohydrates, lipids, proteins, water, vitamins, and minerals. Foods also contain non-nutrient that may be harmful such as natural toxins common in plant foods and additives like some dyes and preservatives or beneficial like antioxidants. Key Functions of the 6 Essential Nutrients Protein Necessary for tissue formation, cell reparation, and hormone and enzyme production. It is essential for building strong muscles and a healthy immune system. Carbohydrates Provide a ready source of energy for the body and provide structural constituents for the formation of cells. Fat Provides stored energy for the body, functions as structural components of cells, and signaling molecules for proper cellular communication. It provides insulation to vital organs and works to maintain body temperature. Vitamins Regulate body processes and promote normal body-system functions. Minerals Regulate body processes, are necessary for proper cellular function, and comprise body tissue. Water Transports essential nutrients to all body parts, transports waste products for disposal, and aids with body temperature maintenance. macronutrients Nutrients that are needed in large amounts are called macronutrients. There are three classes of macronutrients: carbohydrates, lipids, and proteins. These can be metabolically processed into cellular energy. The energy from macronutrients comes from their chemical bonds. This chemical energy is converted into cellular energy used to perform work, allowing our bodies to conduct their basic functions. A unit of measurement of food energy is the calorie. On nutrition food labels, the amount given for “calories” is actually equivalent to each calorie multiplied by one thousand. A kilocalorie (Calorie) is the amount of heat generated by a particular macronutrient that raises the temperature of 1 kilogram of water 1 degree Celsius. On the Nutrition Facts panel, the calories within a particular food are expressed as kilocalories, which is commonly denoted as “Calories” with a capital “C” (1 kcal = 1 Calorie = 1,000 calories). Water is also a macronutrient in the sense that you require a large amount of it, but unlike the other macronutrients, it does not provide calories. carbohydrates Carbohydrates are molecules composed of carbon, hydrogen, and oxygen. The major food sources of carbohydrates are grains, milk, fruits, and starchy vegetables, like potatoes. Non-starchy vegetables also contain carbohydrates but in lesser quantities. Carbohydrates are broadly classified into two forms based on their chemical structure: simple carbohydrates, simple sugars, and complex carbohydrates. Simple carbohydrates consist of one or two basic units. Examples of simple sugars include sucrose, the type of sugar you would have in a bowl on the breakfast table, and glucose, the type of sugar that circulates in your blood. Complex carbohydrates are long chains of simple sugars that can be unbranched or branched. During digestion, the body breaks down digestible complex carbohydrates into simple sugars, mostly glucose. Glucose is then transported to all our cells, stored, used to make energy, or used to build macromolecules. Fiber is also a complex carbohydrate, but digestive enzymes cannot break it down in the human intestine. As a result, it passes through the digestive tract undigested unless the bacteria that inhabit the colon or large intestine break it down. One gram of digestible carbohydrates yields four kilocalories of energy for the body’s cells to perform work. Besides providing energy and serving as building blocks for bigger macromolecules, carbohydrates are essential for the nervous system’s proper functioning, heart, and kidneys. As mentioned, glucose can be stored in the body for future use. In humans, the storage molecule of carbohydrates is called glycogen, and in plants, it is known as starch. Glycogen and starch are complex carbohydrates. protein Proteins are macromolecules composed of chains of subunits called amino acids. Amino acids are simple subunits composed of carbon, oxygen, hydrogen, and nitrogen. Food sources of proteins include meats, dairy products, seafood, and various plant-based foods, most notably soy. The word protein comes from a Greek word meaning “of primary importance,” which is an apt description of these macronutrients; they are also known colloquially as the “workhorses” of life. Proteins provide four kilocalories of energy per gram; however, providing energy is not protein’s most important function. Proteins provide structure to bones, muscles, and skin and play a role in conducting most of the chemical reactions that take place in the body. Scientists estimate that greater than one-hundred thousand different proteins exist within the human body. The genetic codes in DNA are basically protein recipes that determine the order in which 20 different amino acids are bound together to make thousands of specific proteins. lipids Lipids are also a family of molecules composed of carbon, hydrogen, and oxygen, but they are insoluble in water, unlike carbohydrates. Lipids are found predominantly in butter, oils, meats, dairy products, nuts, seeds, and processed foods. The three main types of lipids are triglycerides (triacylglycerols), phospholipids, and sterols. The main job of lipids is to provide or store energy. Lipids provide more energy per gram than carbohydrates (nine kilocalories per gram of lipids versus four kilocalories per gram of carbohydrates). In addition to energy storage, lipids serve as a major component of cell membranes, surround and protect organs (in fat-storing tissues), provide insulation to aid in temperature regulation, and regulate many other body functions. water There is one other nutrient that we must have in large quantities: water. Water does not contain carbon but is composed of two hydrogens and one oxygen per molecule of water. More than 60 percent of your total body weight is water. Without it, nothing could be transported in or out of the body, chemical reactions would not occur, organs would not be cushioned, and body temperature would fluctuate widely. On average, an adult consumes just over two liters of water per day from food and drink combined. Since water is so critical for life’s basic processes, the amount of water input and output is significant, a topic we will explore in detail micronutrients Micronutrients are nutrients required by the body in lesser amounts but are still essential for carrying out bodily functions. Micronutrients include all the essential minerals and vitamins. There are sixteen essential minerals and thirteen vitamins. In contrast to carbohydrates, lipids, and proteins, micronutrients are not sources of energy (calories), but they assist in the process as cofactors or components of enzymes (i.e., coenzymes). Enzymes are proteins that catalyze chemical reactions in the body and are involved in all aspects of body functions, from producing energy to digesting nutrients to building macromolecules. Micronutrients play many essential roles in the body. minerals Minerals are solid inorganic substances that form crystals and are classified depending on how much of them we need. Trace minerals, such as molybdenum, selenium, zinc, iron, and iodine, are only required in a few milligrams or less. Macrominerals, such as calcium, magnesium, potassium, sodium, and phosphorus, are required in hundreds of milligrams. Many minerals are critical for enzyme function. Others are used to maintain fluid balance, build bone tissue, synthesize hormones, transmit nerve impulses, contract and relax muscles, and protect against harmful free radicals in the body that can cause health problems such as cancer. https://open.maricopa.edu/nutritionessentials/chapter/essential-nutrients/#:~:text=Nutrients%20have%20one%20or%20more,breathe%2C%20grow%2C%20and%20reproduce. ================ ======= Give me the differences between micronutrients and macronutrients in terms of their functions and the and the amount required in the body.For each give examples while explaining how they help the body. Respond with 500 words. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Fact Finding,Q&A Do not make use of any external information or prior knowledge when answering the question. Only use the following text to formulate an answer. Make your answer between 300 and 500 words.,How does the Study Panel recommend addressing societal implications of AI technology?,"AI POLICY, NOW AND IN THE FUTURE Throughout history, humans have both shaped and adapted to new technologies. This report anticipates that advances in AI technologies will be developed and fielded gradually—not in sudden, unexpected jumps in the techniques themselves—and will build on what exists today, making this adaptation easier. On the other hand, small improvements to techniques, computing power, or availability of data can occasionally lead to novel, game-changing applications. The measure of success for AI applications is the value they create for human lives. Going forward, the ease with which people use and adapt to AI applications will likewise largely determine their success. Conversely, since AI applications are susceptible to errors and failures, a mark of their success will be how users perceive and tolerate their shortcomings. As AI becomes increasingly embedded in daily lives and used for more critical tasks, system mistakes may lead to backlash from users and negatively affect their trust. Though accidents in a self-driving car may be less probable than those driven by humans, for example, they will attract more attention. Design strategies that enhance the ability of humans to understand AI systems and decisions (such as explicitly explaining those decisions), and to participate in their use, may help build trust and prevent drastic failures. Likewise, developers should help manage people’s expectations, which will affect their happiness and satisfaction with AI applications. Frustration in carrying out functions promised by a system diminishes people’s trust and reduces their willingness to use the system in the future. Another important consideration is how AI systems that take over certain tasks will affect people’s affordances and capabilities. As machines deliver super-human performances on some tasks, people’s ability to perform them may wither. Already, introducing calculators to classrooms has reduced children’s ability to do basic arithmetic operations. Still, humans and AI systems have complementary abilities. People are likely to focus on tasks that machines cannot do as well, including complex reasoning and creative expression. Already, children are increasingly exposed to AI applications, such as interacting with personal assistants on cell phones or with virtual agents in theme parks. Having early exposure will improve children’s interactions with AI applications, which will become a natural part of their daily lives. As a result, gaps will appear in how younger and older generations perceive AI’s influences on society. 43 Likewise, AI could widen existing inequalities of opportunity if access to AI technologies—along with the high-powered computation and large-scale data that fuel many of them—is unfairly distributed across society. These technologies will improve the abilities and efficiency of people who have access to them. A person with access to accurate Machine Translation technology will be better able to use learning resources available in different languages. Similarly, if speech translation technology is only available in English, people who do not speak English will be at a disadvantage. Further, AI applications and the data they rely upon may reflect the biases of their designers and users, who specify the data sources. This threatens to deepen existing social biases, and concentrate AI’s benefits unequally among different subgroups of society. For example, some speech recognition technologies do not work well for women and people with accents. As AI is increasingly used in critical applications, these biases may surface issues of fairness to diverse groups in society. On the other hand, compared to the well-documented biases in human decision-making, AI-based decision-making tools have the potential to significantly reduce the bias in critical decisions such as who is lent money or sent to jail. Privacy concerns about AI-enabled surveillance are also widespread, particularly in cities with pervasive instrumentation. Sousveillance, the recording of an activity by a participant, usually with portable personal devices, has increased as well. Since views about bias and privacy are based on personal and societal ethical and value judgments, the debates over how to address these concerns will likely grow and resist quick resolution. Similarly, since AI is generating significant wealth, debates will grow regarding how the economic fruits of AI technologies should be shared—especially as AI expertise and the underlying data sets that fuel applications are concentrated in a small number of large corporations. To help address these concerns about the individual and societal implications of rapidly evolving AI technologies, the Study Panel offers three general policy recommendations: 1. Define a path toward accruing technical expertise in AI at all levels of government. Effective governance requires more experts who understand and can analyze the interactions between AI technologies, programmatic objectives, and overall societal values. Absent sufficient technical expertise to assess safety or other metrics, national or local officials may refuse to permit a potentially promising application. Or insufficiently trained officials may simply take the word of industry technologists and green light a sensitive application that has not been adequately vetted. Without an understanding of how AI systems interact with human behavior and societal values, officials will be poorly positioned to evaluate the impact of AI on programmatic objectives. 2. Remove the perceived and actual impediments to research on the fairness, security, privacy, and social impacts of AI systems. Some interpretations of federal laws such as the Computer Fraud and Abuse Act and the anti-circumvention provision of the Digital Millennium Copyright Act are ambiguous regarding whether and how proprietary AI systems may be reverse engineered and evaluated by academics, journalists, and other researchers. Such research is critical if AI systems with physical and other material consequences are to be properly vetted and held accountable. 3. Increase public and private funding for interdisciplinary studies of the societal impacts of AI. As a society, we are underinvesting resources in research on the societal implications of AI technologies. Private and public dollars should be directed toward interdisciplinary 44 teams capable of analyzing AI from multiple angles. Research questions range from basic research into intelligence to methods to assess and affect the safety, privacy, fairness, and other impacts of AI. Questions include: Who is responsible when a self-driven car crashes or an intelligent medical device fails? How can AI applications be prevented from unlawful discrimination? Who should reap the gains of efficiencies enabled by AI technologies and what protections should be afforded to people whose skills are rendered obsolete? As AI becomes integrated more broadly and deeply into industrial and consumer products, it enters areas in which established regulatory regimes will need to be adapted to AI innovations or in some cases fundamentally reconfigured according to broadly accepted goals and principles. The approach in the United States to date has been sector-specific, with oversight by a variety of agencies. The use of AI in devices that deliver medical diagnostics and treatments is subject to aggressive regulation by the Food and Drug Administration (FDA), both in defining what the product is and specifying the methods by which it is produced, including standards of software engineering. The use of drones in regulated airspace falls under the authority of the Federal Aviation Administration (FAA).126 For consumer-facing AI systems, regulation by the Federal Trade Commission (FTC) comes into play. Financial markets using AI technologies, such as in high-frequency trading, come under regulation by the Security Exchange Commission (SEC). In addition to sector-specific approaches, the somewhat ambiguous and broad regulatory category of “critical infrastructure” may apply to AI applications.127 The Obama Administration’s Presidential Policy Directive (PPD) 21 broadly defines critical infrastructure as composed of “the assets, systems, and networks, whether physical or virtual, so vital to the United States that their incapacitation or destruction would have a debilitating effect on security, national economic security, national public health or safety, or any combination thereof.” Today, an enterprise does not come under federal regulation solely by falling under that broad definition. Instead, the general trend of federal policy is to seek regulation in sixteen sectors of the economy.128 As regards AI, critical infrastructure is notably defined by the end-user application, and not the technology or sector that actually produces AI software.","How does the Study Panel recommend addressing societal implications of AI technology? Do not make use of any external information or prior knowledge when answering the question. Only use the following text to formulate an answer. Make your answer between 300 and 500 words. AI POLICY, NOW AND IN THE FUTURE Throughout history, humans have both shaped and adapted to new technologies. This report anticipates that advances in AI technologies will be developed and fielded gradually—not in sudden, unexpected jumps in the techniques themselves—and will build on what exists today, making this adaptation easier. On the other hand, small improvements to techniques, computing power, or availability of data can occasionally lead to novel, game-changing applications. The measure of success for AI applications is the value they create for human lives. Going forward, the ease with which people use and adapt to AI applications will likewise largely determine their success. Conversely, since AI applications are susceptible to errors and failures, a mark of their success will be how users perceive and tolerate their shortcomings. As AI becomes increasingly embedded in daily lives and used for more critical tasks, system mistakes may lead to backlash from users and negatively affect their trust. Though accidents in a self-driving car may be less probable than those driven by humans, for example, they will attract more attention. Design strategies that enhance the ability of humans to understand AI systems and decisions (such as explicitly explaining those decisions), and to participate in their use, may help build trust and prevent drastic failures. Likewise, developers should help manage people’s expectations, which will affect their happiness and satisfaction with AI applications. Frustration in carrying out functions promised by a system diminishes people’s trust and reduces their willingness to use the system in the future. Another important consideration is how AI systems that take over certain tasks will affect people’s affordances and capabilities. As machines deliver super-human performances on some tasks, people’s ability to perform them may wither. Already, introducing calculators to classrooms has reduced children’s ability to do basic arithmetic operations. Still, humans and AI systems have complementary abilities. People are likely to focus on tasks that machines cannot do as well, including complex reasoning and creative expression. Already, children are increasingly exposed to AI applications, such as interacting with personal assistants on cell phones or with virtual agents in theme parks. Having early exposure will improve children’s interactions with AI applications, which will become a natural part of their daily lives. As a result, gaps will appear in how younger and older generations perceive AI’s influences on society. 43 Likewise, AI could widen existing inequalities of opportunity if access to AI technologies—along with the high-powered computation and large-scale data that fuel many of them—is unfairly distributed across society. These technologies will improve the abilities and efficiency of people who have access to them. A person with access to accurate Machine Translation technology will be better able to use learning resources available in different languages. Similarly, if speech translation technology is only available in English, people who do not speak English will be at a disadvantage. Further, AI applications and the data they rely upon may reflect the biases of their designers and users, who specify the data sources. This threatens to deepen existing social biases, and concentrate AI’s benefits unequally among different subgroups of society. For example, some speech recognition technologies do not work well for women and people with accents. As AI is increasingly used in critical applications, these biases may surface issues of fairness to diverse groups in society. On the other hand, compared to the well-documented biases in human decision-making, AI-based decision-making tools have the potential to significantly reduce the bias in critical decisions such as who is lent money or sent to jail. Privacy concerns about AI-enabled surveillance are also widespread, particularly in cities with pervasive instrumentation. Sousveillance, the recording of an activity by a participant, usually with portable personal devices, has increased as well. Since views about bias and privacy are based on personal and societal ethical and value judgments, the debates over how to address these concerns will likely grow and resist quick resolution. Similarly, since AI is generating significant wealth, debates will grow regarding how the economic fruits of AI technologies should be shared—especially as AI expertise and the underlying data sets that fuel applications are concentrated in a small number of large corporations. To help address these concerns about the individual and societal implications of rapidly evolving AI technologies, the Study Panel offers three general policy recommendations: 1. Define a path toward accruing technical expertise in AI at all levels of government. Effective governance requires more experts who understand and can analyze the interactions between AI technologies, programmatic objectives, and overall societal values. Absent sufficient technical expertise to assess safety or other metrics, national or local officials may refuse to permit a potentially promising application. Or insufficiently trained officials may simply take the word of industry technologists and green light a sensitive application that has not been adequately vetted. Without an understanding of how AI systems interact with human behavior and societal values, officials will be poorly positioned to evaluate the impact of AI on programmatic objectives. 2. Remove the perceived and actual impediments to research on the fairness, security, privacy, and social impacts of AI systems. Some interpretations of federal laws such as the Computer Fraud and Abuse Act and the anti-circumvention provision of the Digital Millennium Copyright Act are ambiguous regarding whether and how proprietary AI systems may be reverse engineered and evaluated by academics, journalists, and other researchers. Such research is critical if AI systems with physical and other material consequences are to be properly vetted and held accountable. 3. Increase public and private funding for interdisciplinary studies of the societal impacts of AI. As a society, we are underinvesting resources in research on the societal implications of AI technologies. Private and public dollars should be directed toward interdisciplinary 44 teams capable of analyzing AI from multiple angles. Research questions range from basic research into intelligence to methods to assess and affect the safety, privacy, fairness, and other impacts of AI. Questions include: Who is responsible when a self-driven car crashes or an intelligent medical device fails? How can AI applications be prevented from unlawful discrimination? Who should reap the gains of efficiencies enabled by AI technologies and what protections should be afforded to people whose skills are rendered obsolete? As AI becomes integrated more broadly and deeply into industrial and consumer products, it enters areas in which established regulatory regimes will need to be adapted to AI innovations or in some cases fundamentally reconfigured according to broadly accepted goals and principles. The approach in the United States to date has been sector-specific, with oversight by a variety of agencies. The use of AI in devices that deliver medical diagnostics and treatments is subject to aggressive regulation by the Food and Drug Administration (FDA), both in defining what the product is and specifying the methods by which it is produced, including standards of software engineering. The use of drones in regulated airspace falls under the authority of the Federal Aviation Administration (FAA).126 For consumer-facing AI systems, regulation by the Federal Trade Commission (FTC) comes into play. Financial markets using AI technologies, such as in high-frequency trading, come under regulation by the Security Exchange Commission (SEC). In addition to sector-specific approaches, the somewhat ambiguous and broad regulatory category of “critical infrastructure” may apply to AI applications.127 The Obama Administration’s Presidential Policy Directive (PPD) 21 broadly defines critical infrastructure as composed of “the assets, systems, and networks, whether physical or virtual, so vital to the United States that their incapacitation or destruction would have a debilitating effect on security, national economic security, national public health or safety, or any combination thereof.” Today, an enterprise does not come under federal regulation solely by falling under that broad definition. Instead, the general trend of federal policy is to seek regulation in sixteen sectors of the economy.128 As regards AI, critical infrastructure is notably defined by the end-user application, and not the technology or sector that actually produces AI software.",Internet/Technology,Find & Summarize,Text Transformation Only refer to the attached document in providing your response.,What are the health benefits of stretching?,"Stretching: 9 Benefits Is stretching good for you? There are many benefits to regular stretching. Not only can stretching help increase your flexibility, which is an important factor of fitness, but it can also improve your posture, reduce stress and body aches, and more. 9 Benefits of stretching 1. Increases your flexibility Regular stretching can help increase your flexibility, which is crucial for your overall health. Not only can improved flexibility help you to perform everyday activities with relative ease, but it can also help delay the reduced mobility that can come with aging. 2. Increases your range of motion Being able to move a joint through its full range of motion gives you more freedom of movement. Stretching on a regular basis can help increase your range of motion. 3. Improves your performance in physical activities Performing dynamic stretches (moving stretches) prior to physical activities has been shown to help. It may also help improve your performance in an athletic event or exercise. 4. Increases blood flow to your muscles Performing stretches on a regular basis may improve your circulation. Improved circulation increases blood flow to your muscles, which can shorten your recovery time and reduce muscle soreness (also known as delayed onset muscle soreness or DOMS). 5. Improves your posture Muscle imbalances are common and can lead to poor posture. One source found that a combination of strengthening and stretching specific muscle groups can reduce musculoskeletal pain and encourage proper alignment. That, in turn, may help improve your posture. 6. Helps to heal and prevent back pain Tight muscles can lead to a decrease in your range of motion. When this happens, you increase the likelihood of straining the muscles in your back. Stretching can help heal an existing back injury by stretching the muscles. A regular stretching routine can also help prevent future back pain by strengthening your back muscles and reducing your risk for muscle strain. 7. Is great for stress relief When you’re experiencing stress, there’s a good chance your muscles are tense. That’s because your muscles tend to tighten up in response to physical and emotional stress. Focus on areas of your body where you tend to hold your stress, such as your neck, shoulders, and upper back. 8. Can calm your mind Participating in a regular stretching program not only helps increase your flexibility, but it can also calm your mind. While you stretch, focus on mindfulness and meditation exercises, which give your mind a mental break. 9. Helps decrease tension headaches Tension and stress headaches can interfere with your daily life. In addition to a proper diet, adequate hydration, and plenty of rest, stretching may help reduce the tension you feel from headaches.","Only refer to the attached document in providing your response. What are the health benefits of stretching? Stretching: 9 Benefits Is stretching good for you? There are many benefits to regular stretching. Not only can stretching help increase your flexibility, which is an important factor of fitness, but it can also improve your posture, reduce stress and body aches, and more. 9 Benefits of stretching 1. Increases your flexibility Regular stretching can help increase your flexibility, which is crucial for your overall health. Not only can improved flexibility help you to perform everyday activities with relative ease, but it can also help delay the reduced mobility that can come with aging. 2. Increases your range of motion Being able to move a joint through its full range of motion gives you more freedom of movement. Stretching on a regular basis can help increase your range of motion. 3. Improves your performance in physical activities Performing dynamic stretches (moving stretches) prior to physical activities has been shown to help. It may also help improve your performance in an athletic event or exercise. 4. Increases blood flow to your muscles Performing stretches on a regular basis may improve your circulation. Improved circulation increases blood flow to your muscles, which can shorten your recovery time and reduce muscle soreness (also known as delayed onset muscle soreness or DOMS). 5. Improves your posture Muscle imbalances are common and can lead to poor posture. One source found that a combination of strengthening and stretching specific muscle groups can reduce musculoskeletal pain and encourage proper alignment. That, in turn, may help improve your posture. 6. Helps to heal and prevent back pain Tight muscles can lead to a decrease in your range of motion. When this happens, you increase the likelihood of straining the muscles in your back. Stretching can help heal an existing back injury by stretching the muscles. A regular stretching routine can also help prevent future back pain by strengthening your back muscles and reducing your risk for muscle strain. 7. Is great for stress relief When you’re experiencing stress, there’s a good chance your muscles are tense. That’s because your muscles tend to tighten up in response to physical and emotional stress. Focus on areas of your body where you tend to hold your stress, such as your neck, shoulders, and upper back. 8. Can calm your mind Participating in a regular stretching program not only helps increase your flexibility, but it can also calm your mind. While you stretch, focus on mindfulness and meditation exercises, which give your mind a mental break. 9. Helps decrease tension headaches Tension and stress headaches can interfere with your daily life. In addition to a proper diet, adequate hydration, and plenty of rest, stretching may help reduce the tension you feel from headaches.",Medical,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","Explain the benefits of using mobile technology to improve healthcare management in both hi-income and low-income countries. I especially want to know about how mobile interventions have impacted mortality rates and health behaviors. Also, include a comparison of the cost-effectiveness of these interventions.","Abstract Background Mobile technologies could be a powerful media for providing individual level support to health care consumers. We conducted a systematic review to assess the effectiveness of mobile technology interventions delivered to health care consumers. Methods and Findings We searched for all controlled trials of mobile technology-based health interventions delivered to health care consumers using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990–Sept 2010). Two authors extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and used random effects meta-analysis. We identified 75 trials. Fifty-nine trials investigated the use of mobile technologies to improve disease management and 26 trials investigated their use to change health behaviours. Nearly all trials were conducted in high-income countries. Four trials had a low risk of bias. Two trials of disease management had low risk of bias; in one, antiretroviral (ART) adherence, use of text messages reduced high viral load (>400 copies), with a relative risk (RR) of 0.85 (95% CI 0.72–0.99), but no statistically significant benefit on mortality (RR 0.79 [95% CI 0.47–1.32]). In a second, a PDA based intervention increased scores for perceived self care agency in lung transplant patients. Two trials of health behaviour management had low risk of bias. The pooled effect of text messaging smoking cessation support on biochemically verified smoking cessation was (RR 2.16 [95% CI 1.77–2.62]). Interventions for other conditions showed suggestive benefits in some cases, but the results were not consistent. No evidence of publication bias was demonstrated on visual or statistical examination of the funnel plots for either disease management or health behaviours. To address the limitation of the older search, we also reviewed more recent literature. Conclusions Text messaging interventions increased adherence to ART and smoking cessation and should be considered for inclusion in services. Although there is suggestive evidence of benefit in some other areas, high quality adequately powered trials of optimised interventions are required to evaluate effects on objective outcomes. Please see later in the article for the Editors' Summary Editors’ Summary Background Every year, millions of people die from cardiovascular diseases (diseases of the heart and circulation), chronic obstructive pulmonary disease (a long-term lung disease), lung cancer, HIV infection, and diabetes. These diseases are increasingly important causes of mortality (death) in low- and middle-income countries and are responsible for nearly 40% of deaths in high-income countries. For all these diseases, individuals can adopt healthy behaviors that help prevent disease onset. For example, people can lower their risk of diabetes and cardiovascular disease by maintaining a healthy body weight, and, if they are smokers, they can reduce their risk of lung cancer and cardiovascular disease by giving up cigarettes. In addition, optimal treatment of existing diseases can reduce mortality and morbidity (illness). Thus, in people who are infected with HIV, antiretroviral therapy delays the progression of HIV infection and the onset of AIDS, and in people who have diabetes, good blood sugar control can prevent retinopathy (a type of blindness) and other serious complications of diabetes. Why Was This Study Done? Health-care providers need effective ways to encourage ""health-care consumers"" to make healthy lifestyle choices and to self-manage chronic diseases. The amount of information, encouragement and support that can be conveyed to individuals during face-to-face consultations or through traditional media such as leaflets is limited, but mobile technologies such as mobile phones and portable computers have the potential to transform the delivery of health messages. These increasingly popular technologies—more than two-thirds of the world's population now owns a mobile phone—can be used to deliver health messages to people anywhere and at the most relevant times. For example, smokers trying to quit smoking can be sent regular text messages to sustain their motivation, but can also use text messaging to request extra support when it is needed. But is ""mHealth,"" the provision of health-related services using mobile communication technology, an effective way to deliver health messages to health-care consumers? In this systematic review (a study that uses predefined criteria to identify all the research on a given topic), the researchers assess the effectiveness of mobile technology-based health behavior change interventions and disease management interventions delivered to health-care consumers. What Did the Researchers Do and Find? The researchers identified 75 controlled trials (studies that compare the outcomes of people who do and do not receive an intervention) of mobile technology-based health interventions delivered to health-care consumers that met their predefined criteria. Twenty-six trials investigated the use of mobile technologies to change health behaviors, 59 investigated their use in disease management, most were of low quality, and nearly all were undertaken in high-income countries. In one high-quality trial that used text messages to improve adherence to antiretroviral therapy among HIV-positive patients in Kenya, the intervention significantly reduced the patients’ viral load but did not significantly reduce mortality (the observed reduction in deaths may have happened by chance). In two high-quality UK trials, a smoking intervention based on text messaging (txt2stop) more than doubled biochemically verified smoking cessation. Other lower-quality trials indicated that using text messages to encourage physical activity improved diabetes control but had no effect on body weight. Combined diet and physical activity text messaging interventions also had no effect on weight, whereas interventions for other conditions showed suggestive benefits in some but not all cases. What Do These Findings Mean? These findings provide mixed evidence for the effectiveness of health intervention delivery to health-care consumers using mobile technologies. Moreover, they highlight the need for additional high-quality controlled trials of this mHealth application, particularly in low- and middle-income countries. Specifically, the demonstration that text messaging interventions increased adherence to antiretroviral therapy in a low-income setting and increased smoking cessation in a high-income setting provides some support for the inclusion of these two interventions in health-care services in similar settings. However, the effects of these two interventions need to be established in other settings and their cost-effectiveness needs to be measured before they are widely implemented. Finally, for other mobile technology–based interventions designed to change health behaviors or to improve self-management of chronic diseases, the results of this systematic review suggest that the interventions need to be optimized before further trials are undertaken to establish their clinical benefits.","""================ ======= Abstract Background Mobile technologies could be a powerful media for providing individual level support to health care consumers. We conducted a systematic review to assess the effectiveness of mobile technology interventions delivered to health care consumers. Methods and Findings We searched for all controlled trials of mobile technology-based health interventions delivered to health care consumers using MEDLINE, EMBASE, PsycINFO, Global Health, Web of Science, Cochrane Library, UK NHS HTA (Jan 1990–Sept 2010). Two authors extracted data on allocation concealment, allocation sequence, blinding, completeness of follow-up, and measures of effect. We calculated effect estimates and used random effects meta-analysis. We identified 75 trials. Fifty-nine trials investigated the use of mobile technologies to improve disease management and 26 trials investigated their use to change health behaviours. Nearly all trials were conducted in high-income countries. Four trials had a low risk of bias. Two trials of disease management had low risk of bias; in one, antiretroviral (ART) adherence, use of text messages reduced high viral load (>400 copies), with a relative risk (RR) of 0.85 (95% CI 0.72–0.99), but no statistically significant benefit on mortality (RR 0.79 [95% CI 0.47–1.32]). In a second, a PDA based intervention increased scores for perceived self care agency in lung transplant patients. Two trials of health behaviour management had low risk of bias. The pooled effect of text messaging smoking cessation support on biochemically verified smoking cessation was (RR 2.16 [95% CI 1.77–2.62]). Interventions for other conditions showed suggestive benefits in some cases, but the results were not consistent. No evidence of publication bias was demonstrated on visual or statistical examination of the funnel plots for either disease management or health behaviours. To address the limitation of the older search, we also reviewed more recent literature. Conclusions Text messaging interventions increased adherence to ART and smoking cessation and should be considered for inclusion in services. Although there is suggestive evidence of benefit in some other areas, high quality adequately powered trials of optimised interventions are required to evaluate effects on objective outcomes. Please see later in the article for the Editors' Summary Editors’ Summary Background Every year, millions of people die from cardiovascular diseases (diseases of the heart and circulation), chronic obstructive pulmonary disease (a long-term lung disease), lung cancer, HIV infection, and diabetes. These diseases are increasingly important causes of mortality (death) in low- and middle-income countries and are responsible for nearly 40% of deaths in high-income countries. For all these diseases, individuals can adopt healthy behaviors that help prevent disease onset. For example, people can lower their risk of diabetes and cardiovascular disease by maintaining a healthy body weight, and, if they are smokers, they can reduce their risk of lung cancer and cardiovascular disease by giving up cigarettes. In addition, optimal treatment of existing diseases can reduce mortality and morbidity (illness). Thus, in people who are infected with HIV, antiretroviral therapy delays the progression of HIV infection and the onset of AIDS, and in people who have diabetes, good blood sugar control can prevent retinopathy (a type of blindness) and other serious complications of diabetes. Why Was This Study Done? Health-care providers need effective ways to encourage ""health-care consumers"" to make healthy lifestyle choices and to self-manage chronic diseases. The amount of information, encouragement and support that can be conveyed to individuals during face-to-face consultations or through traditional media such as leaflets is limited, but mobile technologies such as mobile phones and portable computers have the potential to transform the delivery of health messages. These increasingly popular technologies—more than two-thirds of the world's population now owns a mobile phone—can be used to deliver health messages to people anywhere and at the most relevant times. For example, smokers trying to quit smoking can be sent regular text messages to sustain their motivation, but can also use text messaging to request extra support when it is needed. But is ""mHealth,"" the provision of health-related services using mobile communication technology, an effective way to deliver health messages to health-care consumers? In this systematic review (a study that uses predefined criteria to identify all the research on a given topic), the researchers assess the effectiveness of mobile technology-based health behavior change interventions and disease management interventions delivered to health-care consumers. What Did the Researchers Do and Find? The researchers identified 75 controlled trials (studies that compare the outcomes of people who do and do not receive an intervention) of mobile technology-based health interventions delivered to health-care consumers that met their predefined criteria. Twenty-six trials investigated the use of mobile technologies to change health behaviors, 59 investigated their use in disease management, most were of low quality, and nearly all were undertaken in high-income countries. In one high-quality trial that used text messages to improve adherence to antiretroviral therapy among HIV-positive patients in Kenya, the intervention significantly reduced the patients’ viral load but did not significantly reduce mortality (the observed reduction in deaths may have happened by chance). In two high-quality UK trials, a smoking intervention based on text messaging (txt2stop) more than doubled biochemically verified smoking cessation. Other lower-quality trials indicated that using text messages to encourage physical activity improved diabetes control but had no effect on body weight. Combined diet and physical activity text messaging interventions also had no effect on weight, whereas interventions for other conditions showed suggestive benefits in some but not all cases. What Do These Findings Mean? These findings provide mixed evidence for the effectiveness of health intervention delivery to health-care consumers using mobile technologies. Moreover, they highlight the need for additional high-quality controlled trials of this mHealth application, particularly in low- and middle-income countries. Specifically, the demonstration that text messaging interventions increased adherence to antiretroviral therapy in a low-income setting and increased smoking cessation in a high-income setting provides some support for the inclusion of these two interventions in health-care services in similar settings. However, the effects of these two interventions need to be established in other settings and their cost-effectiveness needs to be measured before they are widely implemented. Finally, for other mobile technology–based interventions designed to change health behaviors or to improve self-management of chronic diseases, the results of this systematic review suggest that the interventions need to be optimized before further trials are undertaken to establish their clinical benefits. https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001362 ================ ======= Explain the benefits of using mobile technology to improve healthcare management in both hi-income and low-income countries. I especially want to know about how mobile interventions have impacted mortality rates and health behaviors. Also, include a comparison of the cost-effectiveness of these interventions. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Concept Comparison,Q&A "Your answer must exclusively be derived from the content block, no internal knowledge or external sources are permissible. Your answer should aim to be under 100 words, if it has to be more than 100 words, you must use at least 150.",What are the main features of Ether?,"Cryptocurrencies may be used to facilitate transactions and may be held as speculative investments. Since 2009, when Satoshi Nakamoto launched the first cryptocurrency blockchain, thousands of cryptocurrencies and different classes of other digital assets have emerged. This section provides a non-exhaustive survey of various cryptocurrencies and some representative features. Cryptocurrencies The term cryptocurrency generally refers to blockchain-based digital currencies maintained on decentralized networks. For the purposes of this report, cryptocurrencies refers to a type of digital asset. Stablecoins (see “Stablecoins” below) are a subset of cryptocurrency. Non-fungible tokens and digital (or metaverse) real estate are other types of digital assets. They use similar technology but are beyond the scope of this report. Other terms used synonymously with cryptocurrency are crypto asset and tokens, among others. The term cryptocurrencies and citation of broad market capitalization often include stablecoins (see “Stablecoins”), which have their own distinct set of properties—most notably that they try to maintain a peg to some underlying asset. The two most prevalent cryptocurrencies are Bitcoin and Ether, which combined represent around 61% of the entire crypto market.27 The cryptocurrency market, which consists of between 13,000 and 20,000 cryptocurrencies, according to industry tracking websites, has been characterized by near constant and rapid price increases and price decreases.28 Most recently, after experiencing exponential growth from 2020 to a record high of nearly $3 trillion in November 2021, the market capitalization fell to less than $800 billion in November 2022. Bitcoin fell from nearly $69,000 to a two-year low of below $16,000 during this time.29 This trend has been referred to as crypto winter. A host of cryptocurrency project and company failures in summer and fall 2022, including the collapse of FTX, perhaps the most notable to date, were caused—and exacerbated—by this broader market downturn.30 As of the time of this report, the total crypto market capitalization is around $1 trillion.31 Bitcoin Bitcoin was the first cryptocurrency to gain widespread adoption. Bitcoin runs on a public blockchain, secured by cryptography, and uses the proof of work consensus mechanism described above to validate transactions. It also exhibits unique characteristics. For example, the mining and hashing and use of Bitcoin block rewards creates a relationship intended to keep block mining (approval) times roughly stable.32 The hashing complexity is intended to ensure block approval rates of 10 minutes.33 If the number of miners or the computing capacity being used increases— perhaps because the Bitcoin block reward induces more miners to compete or deploy more advanced equipment—thus mining blocks faster than 10 minutes (on average), the proof difficulty increases. Alternatively, if the network and its participants mine blocks at a slower rate (perhaps because the number of miners falls), the proof of work difficulty falls, ensuring that the number of active miners is capable of meeting the 10-minute goal.34 The effort required of the proof of work favors miners with greater computational power requiring significant amounts of energy.35 Other notable and interrelated Bitcoin features include transactions fees, a hard cap on the number of Bitcoin, and block reward halving. The limit on block approval rates means that transactions are slow compared to traditional payment systems.36 Network participants can pay transaction fees to incentivize miners to process their transactions more quickly. Although the block reward (which is hard-coded into the design) is still the primary form of compensation, transaction fees are expected to grow as block rewards shrink.37 For approximately every 210,000 blocks, the system “halves” the block reward miners receive for validating transactions. Halving occurs roughly every four years.38 The original block reward was 50 Bitcoin. As of 2022, after three halvings, miners are rewarded 6.25 for each block mined.39 Finally, the number of Bitcoin created is capped at 21 million, when creation of new Bitcoin is to cease.40 Ethereum Ether is the cryptocurrency native to the Ethereum blockchain, which claims to “build on Bitcoin, with some big differences.”41 In an assessment of Bitcoin, Vitalik Buterin—Ethereum’s founder—described Bitcoin as having a “weak version of a concept of ‘smart’ contracts.”42 Smart contracts are programs or software that can self-execute when various participants meet some predetermined set of criteria. Ethereum thus set out to create an “alternative protocol for building decentralized applications … allowing anyone to write smart contracts and decentralized applications where they can create their own arbitrary rules for ownership, transaction formats and state transition functions.”43 In cryptocurrency and decentralized finance (see “Decentralized Finance (DeFi)” below), smart contracts are often used to facilitate trades between users without an intermediary. Ethereum shares some similarities with Bitcoin, including pseudonymity, immutability, decentralization, and broadly speaking its basic functions as a unit of account and medium of exchange, among others. However, there are some important differences. Because of the enhanced programmability offered, the Ethereum network has become a favorite foundation for cryptocurrency projects that require a certain level of flexibility afforded by smart contracts, including the creation of additional tokens and the implementation of broader decentralized finance, or DeFi, projects.44 Bitcoin has only ever been mineable—developed from nothing and with no initial allotment or pre-sale of coins to participants—and has a hard cap of 21 million Bitcoin. This is not the case with Ether. Ether pre-sold a majority of the initially created cryptocurrency (83.5% at the time) in a pre-mine in 2014 and set aside the remainder for accrued expenses and a post-sale reserve.45 As Ether became mineable and network mining activities created more Ether, the share of pre-mined crypto (those that were purchased prior to the network going live) fell as a percentage of the total outstanding. While there is no hard cap on the amount of Ether that may ever enter the system, the network recently implemented various upgrades that sought to both limit the creation of new Ether and reduce existing supply.46 The first of the two changes implemented in the “London upgrade” affected Ether supply. As a result of this upgrade, the network burns—or removes from circulation—a certain amount of Ether from the supply with each transaction.47 In addition, the recent and more momentous upgrade, called “the Merge,” drastically reduced the network block reward.48 Therefore, new Ether supply increases at a much slower pace than before the Merge.49 The Merge was arguably one of the biggest things to happen to the Ethereum network since its inception. The Merge shifted the network from proof of work to a proof of stake consensus protocol.50 Ethereum, like Bitcoin, was initiated using proof of work but with the ambition from its origins of shifting consensus protocols.51 Proof of stake is an alternative method for securing a blockchain that proponents believe is less energy intensive.52 Proof of work requires miners to compete with each other to solve computationally intensive, cryptographically secured puzzles, which prioritize network nodes with computation power. In proof of stake, by contrast, any validating node that “stakes,” or deposits, at least 32 Ether enters a pool of potential validators that may be randomly selected to submit the next block.53 The network can seize validator-staked Ether for malicious activity or other offenses. Ethereum’s founder claimed that the shift would reduce the Ethereum network’s power consumption and emissions by greater than 99% and reduce global energy consumption by 0.2%.54 Stablecoins55 Cryptocurrencies such as Bitcoin and Ether fluctuate in value based on market supply and demand. By contrast, stablecoins are digital assets “designed to maintain a stable value relative to a national currency or other reference assets.”56 For example, the Tether stablecoin is tied to the U.S. dollar and set equal in value to $1.57 Total market capitalization for stablecoins is more than $140 billion.58 One primary use of stablecoins is trading of other cryptocurrencies. According to an industry data source, nearly 75% of trading on all crypto platforms is between stablecoins and other tokens.59 Proponents often point to stablecoins’ relative stability as an advantage for their use in payments. However, despite their name, stablecoins do not always maintain their stable value. While stablecoins typically attempt to maintain a peg to a fiat currency, issuers may attempt to achieve this goal in different ways. Certain stablecoins attempt to achieve this peg by holding “reserve assets.”60 Others may use algorithms or smart contracts to manage the supply of tokens and guide their value to various reference assets.61","System Instructions: [Your answer must exclusively be derived from the content block, no internal knowledge or external sources are permissible. Your answer should aim to be under 100 words, if it has to be more than 100 words, you must use at least 150.] Question: [What are the main features of Ether?] Context Block: [Cryptocurrencies may be used to facilitate transactions and may be held as speculative investments. Since 2009, when Satoshi Nakamoto launched the first cryptocurrency blockchain, thousands of cryptocurrencies and different classes of other digital assets have emerged. This section provides a non-exhaustive survey of various cryptocurrencies and some representative features. Cryptocurrencies The term cryptocurrency generally refers to blockchain-based digital currencies maintained on decentralized networks. For the purposes of this report, cryptocurrencies refers to a type of digital asset. Stablecoins (see “Stablecoins” below) are a subset of cryptocurrency. Non-fungible tokens and digital (or metaverse) real estate are other types of digital assets. They use similar technology but are beyond the scope of this report. Other terms used synonymously with cryptocurrency are crypto asset and tokens, among others. The term cryptocurrencies and citation of broad market capitalization often include stablecoins (see “Stablecoins”), which have their own distinct set of properties—most notably that they try to maintain a peg to some underlying asset. The two most prevalent cryptocurrencies are Bitcoin and Ether, which combined represent around 61% of the entire crypto market.27 The cryptocurrency market, which consists of between 13,000 and 20,000 cryptocurrencies, according to industry tracking websites, has been characterized by near constant and rapid price increases and price decreases.28 Most recently, after experiencing exponential growth from 2020 to a record high of nearly $3 trillion in November 2021, the market capitalization fell to less than $800 billion in November 2022. Bitcoin fell from nearly $69,000 to a two-year low of below $16,000 during this time.29 This trend has been referred to as crypto winter. A host of cryptocurrency project and company failures in summer and fall 2022, including the collapse of FTX, perhaps the most notable to date, were caused—and exacerbated—by this broader market downturn.30 As of the time of this report, the total crypto market capitalization is around $1 trillion.31 Bitcoin Bitcoin was the first cryptocurrency to gain widespread adoption. Bitcoin runs on a public blockchain, secured by cryptography, and uses the proof of work consensus mechanism described above to validate transactions. It also exhibits unique characteristics. For example, the mining and hashing and use of Bitcoin block rewards creates a relationship intended to keep block mining (approval) times roughly stable.32 The hashing complexity is intended to ensure block approval rates of 10 minutes.33 If the number of miners or the computing capacity being used increases— perhaps because the Bitcoin block reward induces more miners to compete or deploy more advanced equipment—thus mining blocks faster than 10 minutes (on average), the proof difficulty increases. Alternatively, if the network and its participants mine blocks at a slower rate (perhaps because the number of miners falls), the proof of work difficulty falls, ensuring that the number of active miners is capable of meeting the 10-minute goal.34 The effort required of the proof of work favors miners with greater computational power requiring significant amounts of energy.35 Other notable and interrelated Bitcoin features include transactions fees, a hard cap on the number of Bitcoin, and block reward halving. The limit on block approval rates means that transactions are slow compared to traditional payment systems.36 Network participants can pay transaction fees to incentivize miners to process their transactions more quickly. Although the block reward (which is hard-coded into the design) is still the primary form of compensation, transaction fees are expected to grow as block rewards shrink.37 For approximately every 210,000 blocks, the system “halves” the block reward miners receive for validating transactions. Halving occurs roughly every four years.38 The original block reward was 50 Bitcoin. As of 2022, after three halvings, miners are rewarded 6.25 for each block mined.39 Finally, the number of Bitcoin created is capped at 21 million, when creation of new Bitcoin is to cease.40 Ethereum Ether is the cryptocurrency native to the Ethereum blockchain, which claims to “build on Bitcoin, with some big differences.”41 In an assessment of Bitcoin, Vitalik Buterin—Ethereum’s founder—described Bitcoin as having a “weak version of a concept of ‘smart’ contracts.”42 Smart contracts are programs or software that can self-execute when various participants meet some predetermined set of criteria. Ethereum thus set out to create an “alternative protocol for building decentralized applications … allowing anyone to write smart contracts and decentralized applications where they can create their own arbitrary rules for ownership, transaction formats and state transition functions.”43 In cryptocurrency and decentralized finance (see “Decentralized Finance (DeFi)” below), smart contracts are often used to facilitate trades between users without an intermediary. Ethereum shares some similarities with Bitcoin, including pseudonymity, immutability, decentralization, and broadly speaking its basic functions as a unit of account and medium of exchange, among others. However, there are some important differences. Because of the enhanced programmability offered, the Ethereum network has become a favorite foundation for cryptocurrency projects that require a certain level of flexibility afforded by smart contracts, including the creation of additional tokens and the implementation of broader decentralized finance, or DeFi, projects.44 Bitcoin has only ever been mineable—developed from nothing and with no initial allotment or pre-sale of coins to participants—and has a hard cap of 21 million Bitcoin. This is not the case with Ether. Ether pre-sold a majority of the initially created cryptocurrency (83.5% at the time) in a pre-mine in 2014 and set aside the remainder for accrued expenses and a post-sale reserve.45 As Ether became mineable and network mining activities created more Ether, the share of pre-mined crypto (those that were purchased prior to the network going live) fell as a percentage of the total outstanding. While there is no hard cap on the amount of Ether that may ever enter the system, the network recently implemented various upgrades that sought to both limit the creation of new Ether and reduce existing supply.46 The first of the two changes implemented in the “London upgrade” affected Ether supply. As a result of this upgrade, the network burns—or removes from circulation—a certain amount of Ether from the supply with each transaction.47 In addition, the recent and more momentous upgrade, called “the Merge,” drastically reduced the network block reward.48 Therefore, new Ether supply increases at a much slower pace than before the Merge.49 The Merge was arguably one of the biggest things to happen to the Ethereum network since its inception. The Merge shifted the network from proof of work to a proof of stake consensus protocol.50 Ethereum, like Bitcoin, was initiated using proof of work but with the ambition from its origins of shifting consensus protocols.51 Proof of stake is an alternative method for securing a blockchain that proponents believe is less energy intensive.52 Proof of work requires miners to compete with each other to solve computationally intensive, cryptographically secured puzzles, which prioritize network nodes with computation power. In proof of stake, by contrast, any validating node that “stakes,” or deposits, at least 32 Ether enters a pool of potential validators that may be randomly selected to submit the next block.53 The network can seize validator-staked Ether for malicious activity or other offenses. Ethereum’s founder claimed that the shift would reduce the Ethereum network’s power consumption and emissions by greater than 99% and reduce global energy consumption by 0.2%.54 Stablecoins55 Cryptocurrencies such as Bitcoin and Ether fluctuate in value based on market supply and demand. By contrast, stablecoins are digital assets “designed to maintain a stable value relative to a national currency or other reference assets.”56 For example, the Tether stablecoin is tied to the U.S. dollar and set equal in value to $1.57 Total market capitalization for stablecoins is more than $140 billion.58 One primary use of stablecoins is trading of other cryptocurrencies. According to an industry data source, nearly 75% of trading on all crypto platforms is between stablecoins and other tokens.59 Proponents often point to stablecoins’ relative stability as an advantage for their use in payments. However, despite their name, stablecoins do not always maintain their stable value. While stablecoins typically attempt to maintain a peg to a fiat currency, issuers may attempt to achieve this goal in different ways. Certain stablecoins attempt to achieve this peg by holding “reserve assets.”60 Others may use algorithms or smart contracts to manage the supply of tokens and guide their value to various reference assets.61]",Financial,Find & Summarize,Text Transformation "Use the provided context to answer the question. Do not rely on information external to the document. Do not hallucinate any information outside the document.","Explain the bills described in the following context in detail. Connect the information so that a layman can understand, but do not omit any aspect of the laws.","Bills in the 116th Congress Legislation Commissioning Agency Analyses In January 2019, the House passed three bills that would commission studies concerning the use of virtual currencies for illicit purposes. H.R. 56, the Financial Technology Protection Act, would establish an Independent Financial Technology Task Force to Combat Terrorism and Illicit Financing (Task Force) led by the Treasury Secretary.98 The bill would direct the Task Force to (1) “conduct independent research on terrorist and illicit use of new financial technologies, including digital currencies,” and (2) “develop legislative and regulatory proposals to improve counter-terrorist and counter-illicit financing efforts.” 99 H.R. 56 would further require the Task Force to annually report its findings to Congress.100 The bill would also establish two programs to incentivize members of the public to assist the federal government’s efforts to combat the illicit use of virtual currencies. First, the bill would direct the Treasury Secretary to establish a reward of up to $450,000 for persons who “provide[] information leading to the conviction of an individual involved with terrorist use of digital currencies.” 101 Second, the bill would direct the Treasury Secretary to create a grant program “for the development of tools and programs to detect terrorist and illicit use of digital currencies.”102 After passing the House in January 2019, H.R. 56 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. A second bill, H.R. 428, the Homeland Security Assessment of Terrorists’ Use of Virtual Currencies Act, would similarly commission an analysis of the use of virtual currencies by terrorists. 103 Specifically, H.R. 428 would direct the Under Secretary of Homeland Security for Intelligence and Analysis to conduct a “threat assessment” analyzing “the actual and potential threat posed by individuals using virtual currency to carry out activities in furtherance of an act of terrorism, including the provision of material support or resources to a foreign terrorist organization.” 104 After passing the House in January 2019, H.R. 428 was referred to the Senate Committee on Homeland Security and Governmental Affairs. Finally, H.R. 502, the Fight Illicit Networks and Detect Trafficking Act (the FIND Trafficking Act), would direct the Government Accountability Office (GAO) to conduct a study “on how virtual currencies and online marketplaces are used to facilitate sex and drug trafficking.” 105 The bill would require GAO to provide Congress with a report summarizing the results of the study, together with any recommendations for legislative or regulatory action that would assist the federal government in combatting the use of virtual currencies to facilitate sex and drug trafficking.106 After passing the House in January 2019, H.R. 56 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. H.R. 1414, FinCEN Improvement Act of 2019 In March 2019, the House passed H.R. 1414, the FinCEN Improvement Act of 2019.107 The bill would, among other things, clarify that FinCEN’s statutory power to coordinate with foreign financial intelligence units on antiterrorism and AML initiatives108 “includ[es] matters involving emerging technologies or value that substitutes for currency.” 109 After passing the House in March 2019, H.R. 1414 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. H.R. 528, Blockchain Regulatory Certainty Act In January 2019, H.R. 528, the Blockchain Regulatory Certainty Act, was introduced in the House of Representatives. 110 The bill would create a safe harbor from federal and state money transmitter licensing and registration requirements for certain blockchain developers. Specifically, the bill would provide that noncontrolling “blockchain developers” and providers of a “blockchain service” shall not be treated as “money transmitters,” MSBs, “or any other State or Federal legal designation[s] requiring licensing or registration as a condition to acting as a blockchain developer or provider of a blockchain service.” 111 A blockchain developer or provider of a blockchain service would qualify as a noncontrolling developer or provider as long as it does not have control over users’ digital currency in the regular course of business.112 Some commentators have argued that such a safe harbor is necessary to provide legal certainty to actors in the virtual currency space, including persons who contribute code to virtual currency platforms or develop blockchain-related software but do not take custody of others’ virtual currency. 113 However, another commentator has noted that it is “debat[able]” whether federal registration requirements apply to such persons. 114 H.R. 528 was referred to the House Committee on Financial Services and the House Committee on the Judiciary in January 2019.","SYSTEM INSTRUCTION: Use the provided context to answer the question. Do not rely on information external to the document. Do not hallucinate any information outside the document. CONTEXT: Bills in the 116th Congress Legislation Commissioning Agency Analyses In January 2019, the House passed three bills that would commission studies concerning the use of virtual currencies for illicit purposes. H.R. 56, the Financial Technology Protection Act, would establish an Independent Financial Technology Task Force to Combat Terrorism and Illicit Financing (Task Force) led by the Treasury Secretary.98 The bill would direct the Task Force to (1) “conduct independent research on terrorist and illicit use of new financial technologies, including digital currencies,” and (2) “develop legislative and regulatory proposals to improve counter-terrorist and counter-illicit financing efforts.” 99 H.R. 56 would further require the Task Force to annually report its findings to Congress.100 The bill would also establish two programs to incentivize members of the public to assist the federal government’s efforts to combat the illicit use of virtual currencies. First, the bill would direct the Treasury Secretary to establish a reward of up to $450,000 for persons who “provide[] information leading to the conviction of an individual involved with terrorist use of digital currencies.” 101 Second, the bill would direct the Treasury Secretary to create a grant program “for the development of tools and programs to detect terrorist and illicit use of digital currencies.”102 After passing the House in January 2019, H.R. 56 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. A second bill, H.R. 428, the Homeland Security Assessment of Terrorists’ Use of Virtual Currencies Act, would similarly commission an analysis of the use of virtual currencies by terrorists. 103 Specifically, H.R. 428 would direct the Under Secretary of Homeland Security for Intelligence and Analysis to conduct a “threat assessment” analyzing “the actual and potential threat posed by individuals using virtual currency to carry out activities in furtherance of an act of terrorism, including the provision of material support or resources to a foreign terrorist organization.” 104 After passing the House in January 2019, H.R. 428 was referred to the Senate Committee on Homeland Security and Governmental Affairs. Finally, H.R. 502, the Fight Illicit Networks and Detect Trafficking Act (the FIND Trafficking Act), would direct the Government Accountability Office (GAO) to conduct a study “on how virtual currencies and online marketplaces are used to facilitate sex and drug trafficking.” 105 The bill would require GAO to provide Congress with a report summarizing the results of the study, together with any recommendations for legislative or regulatory action that would assist the federal government in combatting the use of virtual currencies to facilitate sex and drug trafficking.106 After passing the House in January 2019, H.R. 56 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. H.R. 1414, FinCEN Improvement Act of 2019 In March 2019, the House passed H.R. 1414, the FinCEN Improvement Act of 2019.107 The bill would, among other things, clarify that FinCEN’s statutory power to coordinate with foreign financial intelligence units on antiterrorism and AML initiatives108 “includ[es] matters involving emerging technologies or value that substitutes for currency.” 109 After passing the House in March 2019, H.R. 1414 was referred to the Senate Committee on Banking, Housing, and Urban Affairs. H.R. 528, Blockchain Regulatory Certainty Act In January 2019, H.R. 528, the Blockchain Regulatory Certainty Act, was introduced in the House of Representatives. 110 The bill would create a safe harbor from federal and state money transmitter licensing and registration requirements for certain blockchain developers. Specifically, the bill would provide that noncontrolling “blockchain developers” and providers of a “blockchain service” shall not be treated as “money transmitters,” MSBs, “or any other State or Federal legal designation[s] requiring licensing or registration as a condition to acting as a blockchain developer or provider of a blockchain service.” 111 A blockchain developer or provider of a blockchain service would qualify as a noncontrolling developer or provider as long as it does not have control over users’ digital currency in the regular course of business.112 Some commentators have argued that such a safe harbor is necessary to provide legal certainty to actors in the virtual currency space, including persons who contribute code to virtual currency platforms or develop blockchain-related software but do not take custody of others’ virtual currency. 113 However, another commentator has noted that it is “debat[able]” whether federal registration requirements apply to such persons. 114 H.R. 528 was referred to the House Committee on Financial Services and the House Committee on the Judiciary in January 2019. Question: Explain the bills described in the following context in detail. Connect the information so that a layman can understand, but do not omit any aspect of the laws.",Legal,Summarize & Simplify,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","What are the two most prevalent bacteria that cause neonatal meningitis? What are features of NMEC that allow for the bacteria to cause disease? What sequence type is associated with neonatal meningitis? Finally, what does O18:K1:H7 mean? Can you answer these questions in 500 words or less?","Neonatal meningitis (NM) is a devastating disease with a mortality rate of 10–15% and severe neurological sequelae including hearing loss, reduced motor skills, and impaired development in 30–50% of cases (Doctor et al., 2001; Stevens et al., 2003; Harvey et al., 1999). The incidence of disease is highest in low-income countries and occurs at a rate of 0.1–6.1/1000 live births (Harvey et al., 1999). Escherichia coli is the second most common cause of NM in full-term infants (herein NMEC), after group B Streptococcus (GBS) (Ouchenir et al., 2017; Gaschignard et al., 2011), and the most common cause of meningitis in preterm neonates (Gaschignard et al., 2011; Basmaci et al., 2015). Together, these two pathogens cause ~60% of all cases, with on average one case of NMEC for every two cases of GBS (May et al., 2005; Holt et al., 2001). In several countries, NM incidence caused by GBS has declined due to maternal intrapartum antibiotic prophylaxis; however, NM incidence caused by E. coli remains the same (May et al., 2005; van der Flier, 2021). Moreover, NMEC is a significant cause of relapsed infections in neonates (Anderson and Gilbert, 1990). NMEC are categorised genetically based on multi-locus sequence type (ST) or by serotyping based on cell-surface O antigen (O), capsule (K), and flagella (H) antigens. Analysis of NMEC diversity in France revealed ~25% of isolates belong to the ST95 clonal complex (STc95) (Geslain et al., 2019), however, a global picture of NMEC epidemiology is lacking. NMEC possess a limited diversity of serotypes, dominated by O18:K1:H7, O1:K1, O7:K1, O16:K1, O83:K1, and O45:K1:H7, which together account for >70% of NMEC (Sarff et al., 1975; Plainvert et al., 2007; Bidet et al., 2007; Johnson et al., 2002). Notably, ~80% of NMEC express the K1 capsule, a polysaccharide comprising linear homopolymers of α2–8-linked N-acetyl neuraminic acid (Sarff et al., 1975; Robbins et al., 1974). Apart from the K1 capsule, specific NMEC virulence factors are less-well defined, though studies have demonstrated a role for S fimbriae (Prasadarao et al., 1993), the outer membrane protein OmpA (Prasadarao et al., 1996), the endothelial invasin IbeA (Huang et al., 2001), and the cytotoxin necrotising factor CNF1 (Wang and Kim, 2013) in translocation of NMEC across the blood–brain barrier and pathogenesis. A large plasmid encoding colicin V (ColV), colicin Ia bacteriocins, and several virulence genes including iron-chelating siderophore systems has also been strongly associated with NMEC virulence (Peigne et al., 2009). Despite being the second major NM aetiology, genomic studies on NMEC are lacking, with most reporting single NMEC complete genomes. Here, we present the genomic analyses of a collection of 58 NMEC isolates obtained from seven different geographic regions over 46 years to understand virulence gene content, antibiotic resistance, and genomic diversity. In addition, we provide a complete genome for 18 NMEC isolates representing different STs, serotypes, and virulence gene profiles, thus more than tripling the number of available NMEC genomes that can be used as references in future studies. Three infants in our study suffered recrudescent invasive NMEC infection, and we show this was caused by the same isolate. We further revealed that patients that suffered recrudescent invasive infection had severe gut dysbiosis, and detected the infecting isolate in the intestinal microflora, suggesting NMEC colonisation of the gut provides a reservoir that can seed repeat infection.","[question] What are the two most prevalent bacteria that cause neonatal meningitis? What are features of NMEC that allow for the bacteria to cause disease? What sequence type is associated with neonatal meningitis? Finally, what does O18:K1:H7 mean? Can you answer these questions in 500 words or less? ===================== [text] Neonatal meningitis (NM) is a devastating disease with a mortality rate of 10–15% and severe neurological sequelae including hearing loss, reduced motor skills, and impaired development in 30–50% of cases (Doctor et al., 2001; Stevens et al., 2003; Harvey et al., 1999). The incidence of disease is highest in low-income countries and occurs at a rate of 0.1–6.1/1000 live births (Harvey et al., 1999). Escherichia coli is the second most common cause of NM in full-term infants (herein NMEC), after group B Streptococcus (GBS) (Ouchenir et al., 2017; Gaschignard et al., 2011), and the most common cause of meningitis in preterm neonates (Gaschignard et al., 2011; Basmaci et al., 2015). Together, these two pathogens cause ~60% of all cases, with on average one case of NMEC for every two cases of GBS (May et al., 2005; Holt et al., 2001). In several countries, NM incidence caused by GBS has declined due to maternal intrapartum antibiotic prophylaxis; however, NM incidence caused by E. coli remains the same (May et al., 2005; van der Flier, 2021). Moreover, NMEC is a significant cause of relapsed infections in neonates (Anderson and Gilbert, 1990). NMEC are categorised genetically based on multi-locus sequence type (ST) or by serotyping based on cell-surface O antigen (O), capsule (K), and flagella (H) antigens. Analysis of NMEC diversity in France revealed ~25% of isolates belong to the ST95 clonal complex (STc95) (Geslain et al., 2019), however, a global picture of NMEC epidemiology is lacking. NMEC possess a limited diversity of serotypes, dominated by O18:K1:H7, O1:K1, O7:K1, O16:K1, O83:K1, and O45:K1:H7, which together account for >70% of NMEC (Sarff et al., 1975; Plainvert et al., 2007; Bidet et al., 2007; Johnson et al., 2002). Notably, ~80% of NMEC express the K1 capsule, a polysaccharide comprising linear homopolymers of α2–8-linked N-acetyl neuraminic acid (Sarff et al., 1975; Robbins et al., 1974). Apart from the K1 capsule, specific NMEC virulence factors are less-well defined, though studies have demonstrated a role for S fimbriae (Prasadarao et al., 1993), the outer membrane protein OmpA (Prasadarao et al., 1996), the endothelial invasin IbeA (Huang et al., 2001), and the cytotoxin necrotising factor CNF1 (Wang and Kim, 2013) in translocation of NMEC across the blood–brain barrier and pathogenesis. A large plasmid encoding colicin V (ColV), colicin Ia bacteriocins, and several virulence genes including iron-chelating siderophore systems has also been strongly associated with NMEC virulence (Peigne et al., 2009). Despite being the second major NM aetiology, genomic studies on NMEC are lacking, with most reporting single NMEC complete genomes. Here, we present the genomic analyses of a collection of 58 NMEC isolates obtained from seven different geographic regions over 46 years to understand virulence gene content, antibiotic resistance, and genomic diversity. In addition, we provide a complete genome for 18 NMEC isolates representing different STs, serotypes, and virulence gene profiles, thus more than tripling the number of available NMEC genomes that can be used as references in future studies. Three infants in our study suffered recrudescent invasive NMEC infection, and we show this was caused by the same isolate. We further revealed that patients that suffered recrudescent invasive infection had severe gut dysbiosis, and detected the infecting isolate in the intestinal microflora, suggesting NMEC colonisation of the gut provides a reservoir that can seed repeat infection. https://elifesciences.org/articles/91853 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","How are the current generation of consoles comparing to PCs in terms of raw graphical performance? I want to play games like Cyberpunk and stuff like that, and really value high-quality visuals like ray-tracing and high FPS. Also, how do PC and consoles differ in terms of game availability? And what kind of price point would I be looking at for a solid PC that could keep up with the consoles?","Gaming PC vs. Console: Which Should You Buy in 2024? Ease of Use Let’s get the most obvious point out of the way: a game console is much, much easier to use than a gaming PC. Modern game consoles are a bit more complex than their predecessors, and users do need to know a bit about HDR, resolution, and refresh rate for the best experience. But PC gamers need to know all that, and more. Drivers, BIOS updates, hardware compatibility, software conflicts, Windows Updates...the list goes on. A PC also requires more patience when installing and launching a game. Launching a game on Xbox, PlayStation 5, or Switch usually takes mere seconds. The Xbox Series X|S and PlayStation 5 even have “quick resume” features that let you pick up precisely where you left off without reloading the game (so long as you haven’t played another in the meantime). This is an easy win for consoles. They provide the quickest, simplest path to launching and playing a game. Though some handheld gaming PCs do a decent job as well. Winner: Console Affordability Affordability is another clear win for consoles. It’s possible to buy a gaming PC for the price of an Xbox Series X or PlayStation 5, but you’ll end up with an outdated graphics card that can’t handle games designed for modern game consoles. Gamers that can’t quite afford the Xbox Series X or Playstation 5 will find fine alternatives in the Xbox Series S and Nintendo Switch. PCs sold at prices comparable to entry-level consoles, on the other hand, usually lack a graphics card. They’ll struggle even in games that are five years old, or older. Affordable PC gaming is possible. Handheld gaming PCs like the Steam Deck and AMD Ryzen-based mini-PCs like the Beelink SER6 MAX are surprisingly capable for their size and price. Still, they’re best when playing indie games with 2D graphics or cross-platform titles from the Xbox One / PlayStation 4 era (or older)—and they’re certainly not comparable to a Xbox Series X|S or PlayStation 5. Winner: Console Overall Value Game consoles are less expensive than a gaming PC, but that doesn’t mean they’re a better value. A console is built to handle specific tasks—gaming and media streaming. A PC is as much a tool as an entertainment device and can be used for everything from web browsing to video editing and software development. That’s relevant. Many people who own a game console will also want a computer, so it’s not fair to compare the total cost of a gaming PC against the price of a game console. It’s more sensible to compare the extra cash you paid to purchase a gaming PC (instead of a more barebones computer) against the price of the game console. PC gamers looking for a good mid-range, off-the-shelf desktop or gaming laptop with performance comparable to an Xbox Series X or PlayStation 5 will need to spend $1,500 to $2,000 (depending on whether you’re fine with an basic desktop from Dell or HP, or want something from a boutique like Origin PC or Digital Storm). DIY gamers can build a console-slaying desktop for under $1,500 with an AMD Ryzen 5600X processor and a solid budget GPU, like a Radeon RX 7800 XT graphics card. That’s still a lot of money. But if you need a solid PC for other demanding tasks, you’ll need to budget around $1,000 to buy it, which makes the price difference between the PC and console less extreme. And while new gaming PCs are expensive, many popular PC games aren’t demanding and don’t require expensive hardware. Games like Counter-Strike 2, DOTA 2, Team Fortress 2, Grand Theft Auto V, War Thunder, and Tom Clancy’s Rainbow Six Siege regularly top Steam’s charts. All of these games are playable even on PCs with an ancient video card like the Nvidia GTX 1060 or AMD Radeon RX 570. Winner: Tie Game Library Differences The game library available to modern game consoles is remarkable. Most games are now cross-platform, so the PlayStation 5, Xbox Series X|S, and Nintendo Switch share many titles. The PlayStation 5 and Xbox Series X|S are backwards-compatible with many previous-gen titles, too, which boosts the game library of each console into the thousands. Compared to a gaming PC, however, those numbers look absolutely adorable. The game library available to a modern gaming PC is a mystery, because there’s too many to count. An estimate of over 100,000 titles is safe: over 12,000 games were released to Steam in 2022 alone. A PC can also emulate the game library of most older titles and, in some cases, even modern games—a PC is arguably the best way to enjoy The Legend of Zelda: Tears of the Kingdom, if you can get it working (and buy a copy of the game, as emulating the game without buying it is piracy). A PC is the way to go if you want access to the largest game library on the face of the planet. Winner: PC Performance and Visuals In June of 2019 I found a chair in Los Angeles' Peacock Theater and let Microsoft’s Xbox press conference wash over me. It was an exciting year, as hype was brewing for Sony and Microsoft’s respective next-gen consoles. And that hype included a now long-forgotten promise: 8K resolution at up to 120 frames per second. It wasn’t exactly a lie: the PlayStation 5 and Xbox Series X can technically output a 8K signal, and also output 120 frames per second. But it was marketing bullshit. The most graphically demanding games are lucky to upscale to 4K at a framerate of 60 FPS, with many titles including a 30 FPS “graphics” or “visuals” mode. PC gaming is a different world. 60 FPS is considered the bare minimum for an optimal experience, and a framerate of 120 FPS or greater is preferable. 8K gaming isn’t really a thing even on the PC (though technically possible, I suppose, if you have a rare 8K television), but a native resolution beyond at and beyond 4K is possible. The Samsung Neo G9 57-inch super-ultrawide, which supports a native resolution of 7,680 x 2,160, is arguably the most extreme gaming display available right now—and gaming at its native resolution is only possible on a PC. Console titles also tend to use a lower quality preset than what’s available on PC. The details vary from game to game, with some better optimized than others. Generally speaking, however, most games available on the PlayStation 5 or Xbox Series X|S have visuals similar to the “Medium” or “High” preset in the PC release. Ray-tracing is another win for the PC. The PlayStation 5 and Xbox Series X|S can handle ray-tracing (a feature heavily marketed in the run-up to their release), but game support is underwhelming. Even some big “next-gen” exclusives, like Starfield, fail to include it. Cross-platform titles that support ray-tracing, like Cyberpunk 2077, usually stick to a level of quality that’s a notch or two below the maximum available on PC. It’s not all good news for the PC. Nvidia’s habit of stiffing gamers on video memory is catching up to cards with less than 16GB of video memory—the amount supported by the PlayStation 5 and Xbox Series X. Optimization problems can also cause problems in some PC ports. And, of course, achieving the best possible PC gaming experience can prove extremely expensive. Still, the fact remains that PC gaming beats console gaming on both performance (as measured by framerate) and visual quality. This gap will only increase in the coming years as the current console generation ages relative to new PC graphics cards. Winner: PC","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== How are the current generation of consoles comparing to PCs in terms of raw graphical performance? I want to play games like Cyberpunk and stuff like that, and really value high-quality visuals like ray-tracing and high FPS. Also, how do PC and consoles differ in terms of game availability? And what kind of price point would I be looking at for a solid PC that could keep up with the consoles? {passage 0} ========== Gaming PC vs. Console: Which Should You Buy in 2024? Ease of Use Let’s get the most obvious point out of the way: a game console is much, much easier to use than a gaming PC. Modern game consoles are a bit more complex than their predecessors, and users do need to know a bit about HDR, resolution, and refresh rate for the best experience. But PC gamers need to know all that, and more. Drivers, BIOS updates, hardware compatibility, software conflicts, Windows Updates...the list goes on. A PC also requires more patience when installing and launching a game. Launching a game on Xbox, PlayStation 5, or Switch usually takes mere seconds. The Xbox Series X|S and PlayStation 5 even have “quick resume” features that let you pick up precisely where you left off without reloading the game (so long as you haven’t played another in the meantime). This is an easy win for consoles. They provide the quickest, simplest path to launching and playing a game. Though some handheld gaming PCs do a decent job as well. Winner: Console Affordability Affordability is another clear win for consoles. It’s possible to buy a gaming PC for the price of an Xbox Series X or PlayStation 5, but you’ll end up with an outdated graphics card that can’t handle games designed for modern game consoles. Gamers that can’t quite afford the Xbox Series X or Playstation 5 will find fine alternatives in the Xbox Series S and Nintendo Switch. PCs sold at prices comparable to entry-level consoles, on the other hand, usually lack a graphics card. They’ll struggle even in games that are five years old, or older. Affordable PC gaming is possible. Handheld gaming PCs like the Steam Deck and AMD Ryzen-based mini-PCs like the Beelink SER6 MAX are surprisingly capable for their size and price. Still, they’re best when playing indie games with 2D graphics or cross-platform titles from the Xbox One / PlayStation 4 era (or older)—and they’re certainly not comparable to a Xbox Series X|S or PlayStation 5. Winner: Console Overall Value Game consoles are less expensive than a gaming PC, but that doesn’t mean they’re a better value. A console is built to handle specific tasks—gaming and media streaming. A PC is as much a tool as an entertainment device and can be used for everything from web browsing to video editing and software development. That’s relevant. Many people who own a game console will also want a computer, so it’s not fair to compare the total cost of a gaming PC against the price of a game console. It’s more sensible to compare the extra cash you paid to purchase a gaming PC (instead of a more barebones computer) against the price of the game console. PC gamers looking for a good mid-range, off-the-shelf desktop or gaming laptop with performance comparable to an Xbox Series X or PlayStation 5 will need to spend $1,500 to $2,000 (depending on whether you’re fine with an basic desktop from Dell or HP, or want something from a boutique like Origin PC or Digital Storm). DIY gamers can build a console-slaying desktop for under $1,500 with an AMD Ryzen 5600X processor and a solid budget GPU, like a Radeon RX 7800 XT graphics card. That’s still a lot of money. But if you need a solid PC for other demanding tasks, you’ll need to budget around $1,000 to buy it, which makes the price difference between the PC and console less extreme. And while new gaming PCs are expensive, many popular PC games aren’t demanding and don’t require expensive hardware. Games like Counter-Strike 2, DOTA 2, Team Fortress 2, Grand Theft Auto V, War Thunder, and Tom Clancy’s Rainbow Six Siege regularly top Steam’s charts. All of these games are playable even on PCs with an ancient video card like the Nvidia GTX 1060 or AMD Radeon RX 570. Winner: Tie Game Library Differences The game library available to modern game consoles is remarkable. Most games are now cross-platform, so the PlayStation 5, Xbox Series X|S, and Nintendo Switch share many titles. The PlayStation 5 and Xbox Series X|S are backwards-compatible with many previous-gen titles, too, which boosts the game library of each console into the thousands. Compared to a gaming PC, however, those numbers look absolutely adorable. The game library available to a modern gaming PC is a mystery, because there’s too many to count. An estimate of over 100,000 titles is safe: over 12,000 games were released to Steam in 2022 alone. A PC can also emulate the game library of most older titles and, in some cases, even modern games—a PC is arguably the best way to enjoy The Legend of Zelda: Tears of the Kingdom, if you can get it working (and buy a copy of the game, as emulating the game without buying it is piracy). A PC is the way to go if you want access to the largest game library on the face of the planet. Winner: PC Performance and Visuals In June of 2019 I found a chair in Los Angeles' Peacock Theater and let Microsoft’s Xbox press conference wash over me. It was an exciting year, as hype was brewing for Sony and Microsoft’s respective next-gen consoles. And that hype included a now long-forgotten promise: 8K resolution at up to 120 frames per second. It wasn’t exactly a lie: the PlayStation 5 and Xbox Series X can technically output a 8K signal, and also output 120 frames per second. But it was marketing bullshit. The most graphically demanding games are lucky to upscale to 4K at a framerate of 60 FPS, with many titles including a 30 FPS “graphics” or “visuals” mode. PC gaming is a different world. 60 FPS is considered the bare minimum for an optimal experience, and a framerate of 120 FPS or greater is preferable. 8K gaming isn’t really a thing even on the PC (though technically possible, I suppose, if you have a rare 8K television), but a native resolution beyond at and beyond 4K is possible. The Samsung Neo G9 57-inch super-ultrawide, which supports a native resolution of 7,680 x 2,160, is arguably the most extreme gaming display available right now—and gaming at its native resolution is only possible on a PC. Console titles also tend to use a lower quality preset than what’s available on PC. The details vary from game to game, with some better optimized than others. Generally speaking, however, most games available on the PlayStation 5 or Xbox Series X|S have visuals similar to the “Medium” or “High” preset in the PC release. Ray-tracing is another win for the PC. The PlayStation 5 and Xbox Series X|S can handle ray-tracing (a feature heavily marketed in the run-up to their release), but game support is underwhelming. Even some big “next-gen” exclusives, like Starfield, fail to include it. Cross-platform titles that support ray-tracing, like Cyberpunk 2077, usually stick to a level of quality that’s a notch or two below the maximum available on PC. It’s not all good news for the PC. Nvidia’s habit of stiffing gamers on video memory is catching up to cards with less than 16GB of video memory—the amount supported by the PlayStation 5 and Xbox Series X. Optimization problems can also cause problems in some PC ports. And, of course, achieving the best possible PC gaming experience can prove extremely expensive. Still, the fact remains that PC gaming beats console gaming on both performance (as measured by framerate) and visual quality. This gap will only increase in the coming years as the current console generation ages relative to new PC graphics cards. Winner: PC https://www.ign.com/articles/gaming-pc-vs-console-differences",Retail/Product,Fact Finding,Q&A "Answer any questions using only information from the provided text. Do not use outside or prior knowledge. Additionally, ensure all responses are concise (50-100 words) and factual.",What's the main source of income for theme parks?,"Introduction Revenue management is a collection of techniques that focus on maximising revenues, and has been credited for income improvement in several segments of the hospitality industry (Cross, 1997). In many service industries, capacity of supply is often fixed while demand is volatile. Therefore, it is challenging for service companies to achieve a balance between supply and demand (Peng, Xiao & Li, 2012). Theme parks are characterised by high capital investment, high operational fixed costs and, to some extent, high operational variable cost. Additionally, demand for the theme park product varies according to time of the year, day of the week and time of the day. Thus, the industry has the potential of benefiting from the adoption of creative revenue management strategies. 144 Revenue Management for Hospitality and Tourism To achieve success with revenue management techniques, firms must be willing to constantly reconsider their product offering, their pricing structures, and their general business processes (Cross, 1997). In the U.S. hospitality and tourism industry, revenue management began in the airline industry following the 1978 deregulation, and then spread to lodging and other industry sectors. However, to date, many theme parks have not fully utilised the benefits of revenue management (Berman, 2005), even though there are opportunities to apply this strategy in the industry (Heo & Lee, 2009). „ The global theme park industry Theme parks are a relatively new concept of tourist attraction and often attempt to create a fantasy atmosphere of another place and time. Theming is reflected through architecture, landscaping, costumed personnel, rides, shows, food services, merchandising and other environmental attributes that impact the guest’s experience (Milman, 2010). Disneyland’s opening in 1955 in Anaheim, California is often referred to by both scholars and industry experts as the genesis of the theme park industry (Price, 1999). Walt Disney wanted his park to stress cleanliness, to have a single point of entry, and to contain numerous themed sections around which all attractions, entertainment and retail activities were coordinated. Much emphasis was placed on isolating the outside world from the fantasy world presented in the parks and to provide an environment where families could be entertained together (Price, 1999). Other theme park attributes referred to in the literature include: the pay-oneprice admission fee, annual attendance revenue in excess of US$ one million, corporate ownership, specific design traits such as elaborate landscaping, architecture that entertains, as well as a mix of activities that includes large-scale rides, retail opportunities and live entertainment (Kyriazi, 1976; Lyon, 1987; Carlson & Popelka, 1988; Adams, 1991; Gottdiener, 1997; Williams, 1998). While the contemporary theme park industry was originally introduced in North America, in recent decades, the theme park industry has expanded globally. In 2011, over 196 million people visited the top 25 worldwide parks, a 3.8 percent increase over the 2010 figure (TEA/ AECOM, 2012). While the economic, social and political impact of these entertainment complexes is sometimes overlooked, it is interesting to note that in 2011 the number of visitors to the world’s top 25 theme parks was slightly higher than the number of international tourists that visited Spain, China, Italy, and the United Kingdom combined (World Tourism Organisation, 2012). 145 10 Theme Parks Revenue Management „ Sources of income in the theme park industry Revenues for the theme park industry are generated from a variety of sources, but primarily from the admission price. Admission price represents between 49 to 60 percent of overall theme park revenues (Vogel, 2010; Mintel, 2011). The number of guest admissions also represents the volume from which other sources of revenue are derived like food and beverage, merchandise and games. Guest spending on food and beverage accounts for approximately 14 to 17 percent of theme park revenues; merchandise sales (souvenirs, sundries, etc.) accounts for 6 to 10 percent of revenues (Vogel, 2010; Mintel, 2011) and guest spending on games accounts for another 4 percent of the total revenues (Vogel, 2010). Parking fees, concession charges, and sponsorship funds from external advertisers make up the remainder of the revenue sources for a typical theme park (First Research, 2012) (Figure 10.1)","What's the main source of income for theme parks? Answer any questions using only information from the provided text. Do not use outside or prior knowledge. Additionally, ensure all responses are concise (50-100 words) and factual. Introduction Revenue management is a collection of techniques that focus on maximising revenues, and has been credited for income improvement in several segments of the hospitality industry (Cross, 1997). In many service industries, capacity of supply is often fixed while demand is volatile. Therefore, it is challenging for service companies to achieve a balance between supply and demand (Peng, Xiao & Li, 2012). Theme parks are characterised by high capital investment, high operational fixed costs and, to some extent, high operational variable cost. Additionally, demand for the theme park product varies according to time of the year, day of the week and time of the day. Thus, the industry has the potential of benefiting from the adoption of creative revenue management strategies. 144 Revenue Management for Hospitality and Tourism To achieve success with revenue management techniques, firms must be willing to constantly reconsider their product offering, their pricing structures, and their general business processes (Cross, 1997). In the U.S. hospitality and tourism industry, revenue management began in the airline industry following the 1978 deregulation, and then spread to lodging and other industry sectors. However, to date, many theme parks have not fully utilised the benefits of revenue management (Berman, 2005), even though there are opportunities to apply this strategy in the industry (Heo & Lee, 2009). „ The global theme park industry Theme parks are a relatively new concept of tourist attraction and often attempt to create a fantasy atmosphere of another place and time. Theming is reflected through architecture, landscaping, costumed personnel, rides, shows, food services, merchandising and other environmental attributes that impact the guest’s experience (Milman, 2010). Disneyland’s opening in 1955 in Anaheim, California is often referred to by both scholars and industry experts as the genesis of the theme park industry (Price, 1999). Walt Disney wanted his park to stress cleanliness, to have a single point of entry, and to contain numerous themed sections around which all attractions, entertainment and retail activities were coordinated. Much emphasis was placed on isolating the outside world from the fantasy world presented in the parks and to provide an environment where families could be entertained together (Price, 1999). Other theme park attributes referred to in the literature include: the pay-oneprice admission fee, annual attendance revenue in excess of US$ one million, corporate ownership, specific design traits such as elaborate landscaping, architecture that entertains, as well as a mix of activities that includes large-scale rides, retail opportunities and live entertainment (Kyriazi, 1976; Lyon, 1987; Carlson & Popelka, 1988; Adams, 1991; Gottdiener, 1997; Williams, 1998). While the contemporary theme park industry was originally introduced in North America, in recent decades, the theme park industry has expanded globally. In 2011, over 196 million people visited the top 25 worldwide parks, a 3.8 percent increase over the 2010 figure (TEA/ AECOM, 2012). While the economic, social and political impact of these entertainment complexes is sometimes overlooked, it is interesting to note that in 2011 the number of visitors to the world’s top 25 theme parks was slightly higher than the number of international tourists that visited Spain, China, Italy, and the United Kingdom combined (World Tourism Organisation, 2012). 145 10 Theme Parks Revenue Management „ Sources of income in the theme park industry Revenues for the theme park industry are generated from a variety of sources, but primarily from the admission price. Admission price represents between 49 to 60 percent of overall theme park revenues (Vogel, 2010; Mintel, 2011). The number of guest admissions also represents the volume from which other sources of revenue are derived like food and beverage, merchandise and games. Guest spending on food and beverage accounts for approximately 14 to 17 percent of theme park revenues; merchandise sales (souvenirs, sundries, etc.) accounts for 6 to 10 percent of revenues (Vogel, 2010; Mintel, 2011) and guest spending on games accounts for another 4 percent of the total revenues (Vogel, 2010). Parking fees, concession charges, and sponsorship funds from external advertisers make up the remainder of the revenue sources for a typical theme park (First Research, 2012) (Figure 10.1)",Financial,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","If someone quits their job or is fired, what steps must they take to apply for Employment Insurance (EI) benefits, and how does Service Canada assess whether they qualify? Discuss what constitutes 'just cause' for quitting, how Service Canada determines misconduct for fired employees, and any recourse individuals have if Service Canada disqualifies their El claim. Include specific details from the application process, such as the importance of the Record of Employment (ROE) and the timeline for applying. Provide your response in 5-7 sentences.","Do I need my Record of Employment? It is easier to apply for EI if you have your Record of Employment (ROE). You will need an ROE for every employer you worked for in the past 12 months. If your employer sends your ROE to the government online: ● they do not have to give you a copy, and ● you do not need a copy to apply for EI. But you can get a copy from Service Canada if you want one. You need a My Service Canada account to see your ROE online. Access your account or set one up at servicecanada.ca. It is easier to apply for EI with your ROE. But you should apply for EI right away, even if you do not have your ROE yet. You will need proof of your employment, such as pay stubs and T4 slips. Employment Insurance | 5 If you do not apply within 4 weeks after your employment ends, you will probably get fewer EI payments. If you are having problems getting your ROE, call the Employment Insurance Telephone Information Service at 1-800-206-7218. For TTY, call 1-800-529-3742. CLEO has a tool that creates a letter you can send to your employer asking for your ROE. Go to stepstojustice.ca/ asking-for-roe. ❚❚❚ Can I get EI if I quit my job? If you quit your job, you will not qualify for regular EI benefits unless you had “just cause”. This means that you had to quit because you had no other reasonable choice. If you do not return to work when you are called back after a layoff, Service Canada sees this as quitting your job. If you have a problem at work, it helps to show that you tried to fix it. If the problem is so serious that it cannot be fixed, you might qualify for EI if you quit. But you might want to start looking for another job before you quit. Keep a record of your job search. What if I had just cause for quitting? If you can prove that you had just cause for quitting your job, you can get EI. There are many situations that could be just cause for quitting. Here are some examples. 6 | cleo.on.ca You were discriminated against for one of the following reasons: ● your race, colour, national or ethnic origin, or religion ● your sexual orientation or your sex, which includes discrimination because of pregnancy or childbirth ● your marital status or family status ● your disability or age ● you were convicted of a crime but have a pardon or record suspension ● you belong to a union Your employer or supervisor: ● refused to pay you for overtime work, or forced you to work too much overtime ● was unfair or hostile to you for no good reason ● was doing something that was against the law ● pressured you to leave your job Or you quit your job because your employer: ● expected you to work in dangerous conditions ● cut your wages significantly or made major changes to your duties Even if one of the examples applies to you, that might not be enough to be just cause. And there could be other reasons for leaving that Service Canada will see as just cause. It is best to get legal advice before you quit your job for any reason. See page 27 to find out where to get legal help. Employment Insurance | 7 ❚❚❚ Can I get EI if I was fired? It depends on why you were fired. If Service Canada says you were fired because of “misconduct”, they will not give you benefits. Misconduct usually means doing something wrong on purpose. Misconduct is more than not being able to do the job well. Here are some examples that could be misconduct: ● threatening someone or being violent ● destroying company property on purpose ● being away from work without permission ● not obeying an order from your employer It is often unclear if what a worker does is misconduct. Service Canada decides if you were fired for misconduct, not your employer. So you should apply, even if you were fired. ❚❚❚ If I quit or was fired, what happens when I apply for EI? When you apply, you have to answer questions on a special form if you quit or were fired. If you quit, you have to say: ● why you quit ● if you tried to fix the problem at work before you left ● if you tried to get other work before you quit 8 | cleo.on.ca If you were fired, you have to say: ● why you were fired ● if your employer gave you any warnings ● if you tried to fix the problem Once you have filled in the form, Service Canada may interview you. They may also contact your employer. Then they decide if you quit without having just cause or were fired for misconduct. Being disqualified Service Canada could decide that you: ● quit without having just cause, or ● were fired for misconduct. If this happens, they will tell you in a letter that you cannot get regular EI benefits. This is called being “disqualified”. The letter will also tell you that you have the right to ask them to reconsider their decision. This means asking them to review and change their decision. You must ask for this in writing within 30 days of finding out about Service Canada’s decision. For more information, see page 25. Even if you cannot get regular EI benefits, you might still be able to get the special benefits that are listed","""================ ======= Do I need my Record of Employment? It is easier to apply for EI if you have your Record of Employment (ROE). You will need an ROE for every employer you worked for in the past 12 months. If your employer sends your ROE to the government online: ● they do not have to give you a copy, and ● you do not need a copy to apply for EI. But you can get a copy from Service Canada if you want one. You need a My Service Canada account to see your ROE online. Access your account or set one up at servicecanada.ca. It is easier to apply for EI with your ROE. But you should apply for EI right away, even if you do not have your ROE yet. You will need proof of your employment, such as pay stubs and T4 slips. Employment Insurance | 5 If you do not apply within 4 weeks after your employment ends, you will probably get fewer EI payments. If you are having problems getting your ROE, call the Employment Insurance Telephone Information Service at 1-800-206-7218. For TTY, call 1-800-529-3742. CLEO has a tool that creates a letter you can send to your employer asking for your ROE. Go to stepstojustice.ca/ asking-for-roe. ❚❚❚ Can I get EI if I quit my job? If you quit your job, you will not qualify for regular EI benefits unless you had “just cause”. This means that you had to quit because you had no other reasonable choice. If you do not return to work when you are called back after a layoff, Service Canada sees this as quitting your job. If you have a problem at work, it helps to show that you tried to fix it. If the problem is so serious that it cannot be fixed, you might qualify for EI if you quit. But you might want to start looking for another job before you quit. Keep a record of your job search. What if I had just cause for quitting? If you can prove that you had just cause for quitting your job, you can get EI. There are many situations that could be just cause for quitting. Here are some examples. 6 | cleo.on.ca You were discriminated against for one of the following reasons: ● your race, colour, national or ethnic origin, or religion ● your sexual orientation or your sex, which includes discrimination because of pregnancy or childbirth ● your marital status or family status ● your disability or age ● you were convicted of a crime but have a pardon or record suspension ● you belong to a union Your employer or supervisor: ● refused to pay you for overtime work, or forced you to work too much overtime ● was unfair or hostile to you for no good reason ● was doing something that was against the law ● pressured you to leave your job Or you quit your job because your employer: ● expected you to work in dangerous conditions ● cut your wages significantly or made major changes to your duties Even if one of the examples applies to you, that might not be enough to be just cause. And there could be other reasons for leaving that Service Canada will see as just cause. It is best to get legal advice before you quit your job for any reason. See page 27 to find out where to get legal help. Employment Insurance | 7 ❚❚❚ Can I get EI if I was fired? It depends on why you were fired. If Service Canada says you were fired because of “misconduct”, they will not give you benefits. Misconduct usually means doing something wrong on purpose. Misconduct is more than not being able to do the job well. Here are some examples that could be misconduct: ● threatening someone or being violent ● destroying company property on purpose ● being away from work without permission ● not obeying an order from your employer It is often unclear if what a worker does is misconduct. Service Canada decides if you were fired for misconduct, not your employer. So you should apply, even if you were fired. ❚❚❚ If I quit or was fired, what happens when I apply for EI? When you apply, you have to answer questions on a special form if you quit or were fired. If you quit, you have to say: ● why you quit ● if you tried to fix the problem at work before you left ● if you tried to get other work before you quit 8 | cleo.on.ca If you were fired, you have to say: ● why you were fired ● if your employer gave you any warnings ● if you tried to fix the problem Once you have filled in the form, Service Canada may interview you. They may also contact your employer. Then they decide if you quit without having just cause or were fired for misconduct. Being disqualified Service Canada could decide that you: ● quit without having just cause, or ● were fired for misconduct. If this happens, they will tell you in a letter that you cannot get regular EI benefits. This is called being “disqualified”. The letter will also tell you that you have the right to ask them to reconsider their decision. This means asking them to review and change their decision. You must ask for this in writing within 30 days of finding out about Service Canada’s decision. For more information, see page 25. Even if you cannot get regular EI benefits, you might still be able to get the special benefits that are listed https://www.cleo.on.ca/wp-content/uploads/empins.pdf ================ ======= If someone quits their job or is fired, what steps must they take to apply for Employment Insurance (EI) benefits, and how does Service Canada assess whether they qualify? Discuss what constitutes 'just cause' for quitting, how Service Canada determines misconduct for fired employees, and any recourse individuals have if Service Canada disqualifies their El claim. Include specific details from the application process, such as the importance of the Record of Employment (ROE) and the timeline for applying. Provide your response in 5-7 sentences. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Legal,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","My brother and sister in law are considering moving to the west coast and im worried about potential health issues due to wildfires. List health issues associated with wildfire smoke and two ways to prevent them, but don't mention anything about the air quality index","What is the Air Quality Index? The United States Environmental Protection Agency (EPA) established an Air Quality Index (AQI) to measure air pollutants. A higher AQI, with color codes and corresponding numbers (ranging from 0 to 500), means a greater health concern. (Local AQI information is available on various apps and websites, including www.airnow.gov.) Particle pollution, also known as particulate matter (or PM), is a type of air pollutant made up of tiny particles of solids or liquids suspended in the air. It’s one of the main components of wildfire smoke, which is a mix of gases and fine particles from burning vegetation, as well as building and other materials. Particulate matter includes PM10, inhalable particles that are 10 micrometers and smaller in diameter, and PM2.5, inhalable particles with diameters of 2.5 micrometers and smaller. PM2.5 poses a greater health risk than PM10 because the particles are so small (30 times smaller than the diameter of a human hair) and can get deep into the lungs and bloodstream. Although air pollution is not good for anyone, certain groups are more sensitive to it than others, including those with heart or lung disease , older adults, infants and children, and pregnant women. As the AQI levels increase, the risk of health effects increases, especially among these more sensitive groups. “The advice to limit strenuous activities is because when your respiratory rate is higher, you inhale more particulates,” says Dr. Redlich. When the AQI is 201 and higher, everyone should be concerned about health risks and limit physical activity outdoors as much as possible, she adds. For context, with the recent wildfires in Canada, the PM2.5 AQI climbed above 400 for a brief period in New York City in early June. Why is particulate matter dangerous? PM2.5 particles are so tiny that they get through the usual defense mechanisms of the upper airway and can penetrate deep into the lungs, where they can impair lung function, cause illnesses, such as bronchitis, and increase asthma attacks . The particles can also pass into the bloodstream and travel to other organs, where they can cause damage. In addition to respiratory problems, PM2.5 exposure has been linked to an increased risk of heart attack , stroke , lung cancer , and a decline in cognitive function. “The health effects extend beyond respiratory issues and include the cardiovascular system,” Dr. Redlich says. “There is more extensive literature on particulate air pollution, in general, than forest fires specifically, but the indication is that wildfires have similar health effects. And there has been an explosion in research and understanding that even relatively low levels of air pollution can impact your lungs and heart, especially if you have asthma, chronic obstructive pulmonary disease [COPD] , or cardiac disease.” The reason particle pollution has such systemic effects, Dr. Redlich explains, is that when you inhale these tiny particles, “they get everywhere through the bloodstream and trigger inflammatory pathways, which can exacerbate a number of underlying cardiac and respiratory conditions.” Does a mask protect against wildfire smoke? The best type of mask to wear for protection against wildfire smoke is a well-fitted N95 or P100 respirator with two straps that go around your head. The “95” and “100” refer to the percentage of particles filtered out by the mask. They are not specially made for children. “A surgical mask probably does some good, but the N95 or even a KN95 is better,” Dr. Redlich says. “KN95s may be easier to find and may come in sizes that fit children better.” The EPA provides a one-sheet with information on how to choose the right mask for wildfire smoke. Is staying inside always best when the outdoor air quality is poor? When the air quality is poor, the general advice is to go inside, shut the windows, and use an air conditioner (with a clean filter and the fresh-air intake closed). But, not every home has air conditioning or can be tightly sealed to keep the bad air out, Dr. Redlich explains. “It’s not as though you go inside and the level drops to zero. Yes, going inside is usually a good idea, but you can also store poor air quality levels—or even air pollutants—in your home,” she says. “Plus, you can generate air pollutants inside by cooking, smoking cigarettes, and burning candles.” These, Dr. Redlich says, are all things we have control over and can be avoided or mitigated with steps like using a vent over your kitchen stove. Another step people can take to improve particulate air quality or reduce particulate air pollution in their homes is to use a portable air purifier with a HEPA (high efficiency particulate air) filter. The air purifier should be sized appropriately for the size of the room.","""================ ======= What is the Air Quality Index? The United States Environmental Protection Agency (EPA) established an Air Quality Index (AQI) to measure air pollutants. A higher AQI, with color codes and corresponding numbers (ranging from 0 to 500), means a greater health concern. (Local AQI information is available on various apps and websites, including www.airnow.gov.) Particle pollution, also known as particulate matter (or PM), is a type of air pollutant made up of tiny particles of solids or liquids suspended in the air. It’s one of the main components of wildfire smoke, which is a mix of gases and fine particles from burning vegetation, as well as building and other materials. Particulate matter includes PM10, inhalable particles that are 10 micrometers and smaller in diameter, and PM2.5, inhalable particles with diameters of 2.5 micrometers and smaller. PM2.5 poses a greater health risk than PM10 because the particles are so small (30 times smaller than the diameter of a human hair) and can get deep into the lungs and bloodstream. Although air pollution is not good for anyone, certain groups are more sensitive to it than others, including those with heart or lung disease , older adults, infants and children, and pregnant women. As the AQI levels increase, the risk of health effects increases, especially among these more sensitive groups. “The advice to limit strenuous activities is because when your respiratory rate is higher, you inhale more particulates,” says Dr. Redlich. When the AQI is 201 and higher, everyone should be concerned about health risks and limit physical activity outdoors as much as possible, she adds. For context, with the recent wildfires in Canada, the PM2.5 AQI climbed above 400 for a brief period in New York City in early June. Why is particulate matter dangerous? PM2.5 particles are so tiny that they get through the usual defense mechanisms of the upper airway and can penetrate deep into the lungs, where they can impair lung function, cause illnesses, such as bronchitis, and increase asthma attacks . The particles can also pass into the bloodstream and travel to other organs, where they can cause damage. In addition to respiratory problems, PM2.5 exposure has been linked to an increased risk of heart attack , stroke , lung cancer , and a decline in cognitive function. “The health effects extend beyond respiratory issues and include the cardiovascular system,” Dr. Redlich says. “There is more extensive literature on particulate air pollution, in general, than forest fires specifically, but the indication is that wildfires have similar health effects. And there has been an explosion in research and understanding that even relatively low levels of air pollution can impact your lungs and heart, especially if you have asthma, chronic obstructive pulmonary disease [COPD] , or cardiac disease.” The reason particle pollution has such systemic effects, Dr. Redlich explains, is that when you inhale these tiny particles, “they get everywhere through the bloodstream and trigger inflammatory pathways, which can exacerbate a number of underlying cardiac and respiratory conditions.” Does a mask protect against wildfire smoke? The best type of mask to wear for protection against wildfire smoke is a well-fitted N95 or P100 respirator with two straps that go around your head. The “95” and “100” refer to the percentage of particles filtered out by the mask. They are not specially made for children. “A surgical mask probably does some good, but the N95 or even a KN95 is better,” Dr. Redlich says. “KN95s may be easier to find and may come in sizes that fit children better.” The EPA provides a one-sheet with information on how to choose the right mask for wildfire smoke. Is staying inside always best when the outdoor air quality is poor? When the air quality is poor, the general advice is to go inside, shut the windows, and use an air conditioner (with a clean filter and the fresh-air intake closed). But, not every home has air conditioning or can be tightly sealed to keep the bad air out, Dr. Redlich explains. “It’s not as though you go inside and the level drops to zero. Yes, going inside is usually a good idea, but you can also store poor air quality levels—or even air pollutants—in your home,” she says. “Plus, you can generate air pollutants inside by cooking, smoking cigarettes, and burning candles.” These, Dr. Redlich says, are all things we have control over and can be avoided or mitigated with steps like using a vent over your kitchen stove. Another step people can take to improve particulate air quality or reduce particulate air pollution in their homes is to use a portable air purifier with a HEPA (high efficiency particulate air) filter. The air purifier should be sized appropriately for the size of the room. https://www.yalemedicine.org/news/how-bad-is-wildfire-smoke-for-your-health ================ ======= My brother and sister in law are considering moving to the west coast and im worried about potential health issues due to wildfires. List health issues associated with wildfire smoke and two ways to prevent them, but don't mention anything about the air quality index ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",I am doing a medical research paper and found this article. Summarize me introduction and epidemiology part in the bulleted points format. Keep it under 200 words.,"Introduction Staphylococcus aureus is a major bacterial human pathogen that causes a wide variety of clinical manifestations.[1] Infections are common both in community-acquired as well as hospital-acquired settings and treatment remains challenging to manage due to the emergence of multi-drug resistant strains such as MRSA (Methicillin-Resistant Staphylococcus aureus).[2][3] S. aureus is found in the environment and is also found in normal human flora, located on the skin and mucous membranes (most often the nasal area) of most healthy individuals.[1] S. aureus does not normally cause infection on healthy skin; however, if it is allowed to enter the bloodstream or internal tissues, these bacteria may cause a variety of potentially serious infections.[1] Transmission is typically from direct contact. However, some infections involve other transmission methods.[4] Go to: Etiology Staphylococcus aureus is Gram-positive bacteria (stain purple by Gram stain) that are cocci-shaped and tend to be arranged in clusters that are described as “grape-like.” On media, these organisms can grow in up to 10% salt, and colonies are often golden or yellow (aureus means golden or yellow). These organisms can grow aerobically or anaerobically (facultative) and at temperatures between 18 C and 40 C. Typical biochemical identification tests include catalase positive (all pathogenic Staphylococcus species), coagulase positive (to distinguish Staphylococcus aureus from other Staphylococcus species), novobiocin sensitive (to distinguish from Staphylococcus saprophyticus), and mannitol fermentation positive (to distinguish from Staphylococcus epidermidis).[4][1] MRSA strains carry a mec gene on the bacterial chromosome, which is a component of the larger Staphylococcal chromosomal cassette mec (SCCmec) region, conferring resistance to multiple antibiotics depending on the SCCmec type.[2] The mec gene encodes the protein PBP-2a (penicillin-binding protein 2a). PBP-2a is a penicillin-binding protein (PBP), or essential bacterial cell wall enzyme that catalyzes the production of the peptidoglycan in the bacterial cell wall. PBP-2A has a lower affinity to bind to beta-lactams (and other penicillin-derived antibiotics) when compared to other PBPs, so PBP-2A continues to catalyze the synthesis of the bacterial cell wall even in the presence of many antibiotics. As a result, S. aureus strains that synthesize PBP-2A can grow in the presence of many antibiotics, and these MRSA strains are resistant to many antibiotics. MRSA strains tend to be resistant to methicillin, nafcillin, oxacillin, and cephalosporins.[2][4] Go to: Epidemiology Staphylococcus aureus (including drug-resistant strains such as MRSA) are found on the skin and mucous membranes, and humans are the major reservoir for these organisms.[3][5] It is estimated that up to half of all adults are colonized, and approximately 15% of the population persistently carry S. aureus in the anterior nares. Some populations tend to have higher rates of S. aureus colonization (up to 80%), such as health care workers, persons who use needles on a regular basis (i.e., diabetics and intravenous (IV) drug users), hospitalized patients, and immunocompromised individuals. S. aureus can be transmitted person-to-person by direct contact or by fomites.[6][4][1] Go to: Pathophysiology S. aureus are one the most common bacterial infections in humans and are the causative agents of multiple human infections, including bacteremia, infective endocarditis, skin and soft tissue infections (e.g., impetigo, folliculitis, furuncles, carbuncles, cellulitis, scalded skin syndrome, and others), osteomyelitis, septic arthritis, prosthetic device infections, pulmonary infections (e.g., pneumonia and empyema), gastroenteritis, meningitis, toxic shock syndrome, and urinary tract infections.[6] Depending on the strains involved and the site of infection, these bacteria can cause invasive infections and/or toxin-mediated diseases.[6][7] The pathophysiology varies greatly depending on the type of S. aureus infection.[6] Mechanisms for evasion of the host immune response include the production of an antiphagocytic capsule, sequestering of host antibodies or antigen masking by Protein A, biofilm formation, intracellular survival, and blocking chemotaxis of leukocytes.[8][7] Binding of the bacteria to extracellular matrix proteins and fibronectin in infectious endocarditis is mediated by bacterial cell wall-associated proteins such as fibrinogen-binding proteins, clumping factors, and teichoic acids.[7] Also, Staphylococcal superantigens (TSST-1 or toxic shock syndrome toxin 1) are important virulence factors in infectious endocarditis, sepsis, as well as toxic shock syndrome.[9][10] Pneumonia infections are associated with the bacterial production of PVL (Panton-Valentine leukocidin), Protein A, and alpha-hemolysin, and infections are more common following influenza virus infection as well as a diagnosis of Cystic Fibrosis. Prosthetic device infections are often mediated by the ability of S. aureus strains to form biofilms as well as communicate using quorum sensing in a bacterial cell density-dependent manner. [11]","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I am doing a medical research paper and found this article. Summarize me introduction and epidemiology part in the bulleted points format. Keep it under 200 words. {passage 0} ========== Introduction Staphylococcus aureus is a major bacterial human pathogen that causes a wide variety of clinical manifestations.[1] Infections are common both in community-acquired as well as hospital-acquired settings and treatment remains challenging to manage due to the emergence of multi-drug resistant strains such as MRSA (Methicillin-Resistant Staphylococcus aureus).[2][3] S. aureus is found in the environment and is also found in normal human flora, located on the skin and mucous membranes (most often the nasal area) of most healthy individuals.[1] S. aureus does not normally cause infection on healthy skin; however, if it is allowed to enter the bloodstream or internal tissues, these bacteria may cause a variety of potentially serious infections.[1] Transmission is typically from direct contact. However, some infections involve other transmission methods.[4] Go to: Etiology Staphylococcus aureus is Gram-positive bacteria (stain purple by Gram stain) that are cocci-shaped and tend to be arranged in clusters that are described as “grape-like.” On media, these organisms can grow in up to 10% salt, and colonies are often golden or yellow (aureus means golden or yellow). These organisms can grow aerobically or anaerobically (facultative) and at temperatures between 18 C and 40 C. Typical biochemical identification tests include catalase positive (all pathogenic Staphylococcus species), coagulase positive (to distinguish Staphylococcus aureus from other Staphylococcus species), novobiocin sensitive (to distinguish from Staphylococcus saprophyticus), and mannitol fermentation positive (to distinguish from Staphylococcus epidermidis).[4][1] MRSA strains carry a mec gene on the bacterial chromosome, which is a component of the larger Staphylococcal chromosomal cassette mec (SCCmec) region, conferring resistance to multiple antibiotics depending on the SCCmec type.[2] The mec gene encodes the protein PBP-2a (penicillin-binding protein 2a). PBP-2a is a penicillin-binding protein (PBP), or essential bacterial cell wall enzyme that catalyzes the production of the peptidoglycan in the bacterial cell wall. PBP-2A has a lower affinity to bind to beta-lactams (and other penicillin-derived antibiotics) when compared to other PBPs, so PBP-2A continues to catalyze the synthesis of the bacterial cell wall even in the presence of many antibiotics. As a result, S. aureus strains that synthesize PBP-2A can grow in the presence of many antibiotics, and these MRSA strains are resistant to many antibiotics. MRSA strains tend to be resistant to methicillin, nafcillin, oxacillin, and cephalosporins.[2][4] Go to: Epidemiology Staphylococcus aureus (including drug-resistant strains such as MRSA) are found on the skin and mucous membranes, and humans are the major reservoir for these organisms.[3][5] It is estimated that up to half of all adults are colonized, and approximately 15% of the population persistently carry S. aureus in the anterior nares. Some populations tend to have higher rates of S. aureus colonization (up to 80%), such as health care workers, persons who use needles on a regular basis (i.e., diabetics and intravenous (IV) drug users), hospitalized patients, and immunocompromised individuals. S. aureus can be transmitted person-to-person by direct contact or by fomites.[6][4][1] Go to: Pathophysiology S. aureus are one the most common bacterial infections in humans and are the causative agents of multiple human infections, including bacteremia, infective endocarditis, skin and soft tissue infections (e.g., impetigo, folliculitis, furuncles, carbuncles, cellulitis, scalded skin syndrome, and others), osteomyelitis, septic arthritis, prosthetic device infections, pulmonary infections (e.g., pneumonia and empyema), gastroenteritis, meningitis, toxic shock syndrome, and urinary tract infections.[6] Depending on the strains involved and the site of infection, these bacteria can cause invasive infections and/or toxin-mediated diseases.[6][7] The pathophysiology varies greatly depending on the type of S. aureus infection.[6] Mechanisms for evasion of the host immune response include the production of an antiphagocytic capsule, sequestering of host antibodies or antigen masking by Protein A, biofilm formation, intracellular survival, and blocking chemotaxis of leukocytes.[8][7] Binding of the bacteria to extracellular matrix proteins and fibronectin in infectious endocarditis is mediated by bacterial cell wall-associated proteins such as fibrinogen-binding proteins, clumping factors, and teichoic acids.[7] Also, Staphylococcal superantigens (TSST-1 or toxic shock syndrome toxin 1) are important virulence factors in infectious endocarditis, sepsis, as well as toxic shock syndrome.[9][10] Pneumonia infections are associated with the bacterial production of PVL (Panton-Valentine leukocidin), Protein A, and alpha-hemolysin, and infections are more common following influenza virus infection as well as a diagnosis of Cystic Fibrosis. Prosthetic device infections are often mediated by the ability of S. aureus strains to form biofilms as well as communicate using quorum sensing in a bacterial cell density-dependent manner. [11] https://www.ncbi.nlm.nih.gov/books/NBK441868/",Medical,Summarize & Format,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","I live in California and am trying to understand stand your ground laws. Can you explain it to me? Also, how does it work in my state?","The common law principle of “castle doctrine” says that individuals have the right to use reasonable force, including deadly force, to protect themselves against an intruder in their home. This principle has been codified and expanded by state legislatures. In the 1980s, a handful of state laws (nicknamed “make my day” laws) addressed immunity from prosecution in use of deadly force against another who unlawfully and forcibly enters a person’s residence. In 2005, Florida passed a law related to castle doctrine, expanding on that premise with “stand your ground” language related to self-defense and duty to retreat. Florida’s law states “a person who is not engaged in an unlawful activity and who is attacked in any other place where he or she has a right to be has no duty to retreat and has the right to stand his or her ground and meet force with force, including deadly force, if he or she reasonably believes it is necessary to do so to prevent death or great bodily harm to himself or herself or another or to prevent the commission of a forcible felony.” Laws in at least 28 states and Puerto Rico allow that there is no duty to retreat an attacker in any place in which one is lawfully present. (Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah and West Virginia Wyoming.) At least ten of those states include language stating one may “stand his or her ground.” (Alabama, Florida, Georgia, Idaho, Kansas, Kentucky, Louisiana, Oklahoma, Pennsylvania and South Carolina.) Eight states (California, Colorado, Illinois, New Mexico, Oregon, Virginia, Vermont and Washington) permit the use of deadly force in self-defense through judicial decisions or jury instructions. Pennsylvania's law, amended in 2011, distinguishes use of deadly force outside one’s home or vehicle. It provides that in such locations one cannot use deadly force unless he has reasonable belief of imminent death or injury, and either he or she cannot retreat in safety or the attacker displays or uses a lethal weapon. Idaho’s law, passed in 2018, expanded the definition of justifiable homicide to include not only defending one’s home against an intruder, but also defending one’s place of employment or an occupied vehicle. Self-defense laws in at least 23 states (Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maryland, Michigan, Montana, New Hampshire, North Carolina, North Dakota, Oklahoma, Ohio, Pennsylvania, South Carolina, Tennessee West Virginia and Wisconsin) provide civil immunity under certain self- defense circumstances. Statutes in at least six states (Hawaii, Missouri, Nebraska, New Jersey, North Dakota and Tennessee) assert that civil remedies are unaffected by criminal provisions of self-defense law. *In 2018, the Ohio House and Senate voted to override the Governor’s veto of House Bill 228. The bill places the burden of disproving a self-defense claim on the prosecution. Additionally, some states (including Arizona, Arkansas, California, Florida, Kansas, Kentucky, Louisiana, Mississippi, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Wisconsin, and Wyoming) have replaced the common law “reasonable person” standard, which placed the burden on the defendant to show that their defensive action were reasonable, with a “presumption of reasonableness,” or “presumption of fear,” which shifts the burden of proof to the prosecutor to prove a negative.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I live in California and am trying to understand stand your ground laws. Can you explain it to me? Also, how does it work in my state? {passage 0} ========== The common law principle of “castle doctrine” says that individuals have the right to use reasonable force, including deadly force, to protect themselves against an intruder in their home. This principle has been codified and expanded by state legislatures. In the 1980s, a handful of state laws (nicknamed “make my day” laws) addressed immunity from prosecution in use of deadly force against another who unlawfully and forcibly enters a person’s residence. In 2005, Florida passed a law related to castle doctrine, expanding on that premise with “stand your ground” language related to self-defense and duty to retreat. Florida’s law states “a person who is not engaged in an unlawful activity and who is attacked in any other place where he or she has a right to be has no duty to retreat and has the right to stand his or her ground and meet force with force, including deadly force, if he or she reasonably believes it is necessary to do so to prevent death or great bodily harm to himself or herself or another or to prevent the commission of a forcible felony.” Laws in at least 28 states and Puerto Rico allow that there is no duty to retreat an attacker in any place in which one is lawfully present. (Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Montana, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah and West Virginia Wyoming.) At least ten of those states include language stating one may “stand his or her ground.” (Alabama, Florida, Georgia, Idaho, Kansas, Kentucky, Louisiana, Oklahoma, Pennsylvania and South Carolina.) Eight states (California, Colorado, Illinois, New Mexico, Oregon, Virginia, Vermont and Washington) permit the use of deadly force in self-defense through judicial decisions or jury instructions. Pennsylvania's law, amended in 2011, distinguishes use of deadly force outside one’s home or vehicle. It provides that in such locations one cannot use deadly force unless he has reasonable belief of imminent death or injury, and either he or she cannot retreat in safety or the attacker displays or uses a lethal weapon. Idaho’s law, passed in 2018, expanded the definition of justifiable homicide to include not only defending one’s home against an intruder, but also defending one’s place of employment or an occupied vehicle. Self-defense laws in at least 23 states (Arizona, Arkansas, Colorado, Florida, Georgia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Maryland, Michigan, Montana, New Hampshire, North Carolina, North Dakota, Oklahoma, Ohio, Pennsylvania, South Carolina, Tennessee West Virginia and Wisconsin) provide civil immunity under certain self- defense circumstances. Statutes in at least six states (Hawaii, Missouri, Nebraska, New Jersey, North Dakota and Tennessee) assert that civil remedies are unaffected by criminal provisions of self-defense law. *In 2018, the Ohio House and Senate voted to override the Governor’s veto of House Bill 228. The bill places the burden of disproving a self-defense claim on the prosecution. Additionally, some states (including Arizona, Arkansas, California, Florida, Kansas, Kentucky, Louisiana, Mississippi, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Wisconsin, and Wyoming) have replaced the common law “reasonable person” standard, which placed the burden on the defendant to show that their defensive action were reasonable, with a “presumption of reasonableness,” or “presumption of fear,” which shifts the burden of proof to the prosecutor to prove a negative. https://www.ncsl.org/civil-and-criminal-justice/self-defense-and-stand-your-ground",Legal,Explanation/Definition,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Is the Government of the United States legally obligated to prosecute war crimes committed outside its borders, regardless if the victims are citizens of the United States? What changes to existing laws are mentioned in the text? What two examples are provided in the text to show the limitations of the War Crimes Act of 1996 and who signed it into effect? Who signed the 2023 war crimes bill into effect?","Passed following an address by Ukraine’s leader and signed into the law in January 2023, the Justice for Victims of War Crimes Act authorizes the U.S. Justice Department to prosecute foreign nationals in the United States who are suspected of war crimes, even if the victims were not Americans, or the crimes were committed abroad. This blog post covers the legislation’s changes from its predecessor before discussing its significance in expanding U.S. prosecutorial power over international war crimes. On January 5, 2023, U.S. President Joe Biden signed into law the Justice for Victims of War Crimes Act, after it was introduced three months into the Russian invasion of Ukraine. This law expands the scope of federal prosecution power for international war crimes by authorizing the U.S. Department of Justice to prosecute suspected war criminals who are in the United States, regardless of the nationality of the victim or the perpetrator, or where the crime was committed. The unanimous and speedy Congressional approval of the bill came one day after Ukrainian President Volodymyr Zelenskyy’s joint address to the Congress, where he condemned the atrocities committed by President Vladimir Putin’s Russia and appealed for bipartisan support for his country. History of U.S. Prosecution Over War Crimes This law marks an important expansion of the U.S. prosecutorial power over international war crimes. Its predecessor, the War Crimes Act (18 U.S.C. § 2441), was signed into law in 1996 by President Bill Clinton and allowed the prosecution of war crime offenses committed anywhere, whether inside or outside of the United States if the victim or offender was a U.S. national or service member. This meant that war crimes committed outside of the United States against non-U.S. citizens were not justiciable in the United States, even if the perpetrators were residing in the country. Under the former law, Russian troops in Ukraine, committing war crimes against Ukrainians, would have been able to evade prosecution for their crimes abroad, even if they were to enter the United States. This limited jurisdiction effectively rendered the 1996 law a “dead letter” law, as there was not a single prosecution based on the statute in the 26 years since its enactment. Instead, the United States has only been able to resort to its immigration and counterterrorism laws to bring forward charges against those suspected of war crimes. Notably, the man known as the “General Dragon Master,” accused of committing atrocities during the Second Liberian Civil War, was only charged with using a fraudulently-obtained immigration document instead of being held accountable for his war crimes. Similarly, a federal judge was only able to sentence a commander of the Dos Erres Massacre Squad under charges of naturalization fraud rather than the atrocities he committed. The loopholes embedded in the 1996 War Crimes Act have essentially allowed these individuals to treat the United States as a safe haven where they can live and travel without the threat of domestic prosecution. Changes and Developments Under the New War Crimes Act The new law closes the legal loophole under the former War Crimes Act by broadening federal jurisdiction over alleged war criminals regardless of their nationality or the location of the offenses, as long as they are located within U.S. territory. This would allow the United States to prosecute war crimes committed in Ukraine if the perpetrators were to enter the country and sufficient evidence is gathered to support an indictment. The expanded jurisdiction may be particularly poignant in the possible scenarios in modern warfare where non-Americans belonging to military groups or contractors may be based in the United States while orchestrating, directing or aiding in the commission of war crimes overseas.","[question] Is the Government of the United States legally obligated to prosecute war crimes committed outside its borders, regardless if the victims are citizens of the United States? What changes to existing laws are mentioned in the text? What two examples are provided in the text to show the limitations of the War Crimes Act of 1996 and who signed it into effect? Who signed the 2023 war crimes bill into effect? ===================== [text] Passed following an address by Ukraine’s leader and signed into the law in January 2023, the Justice for Victims of War Crimes Act authorizes the U.S. Justice Department to prosecute foreign nationals in the United States who are suspected of war crimes, even if the victims were not Americans, or the crimes were committed abroad. This blog post covers the legislation’s changes from its predecessor before discussing its significance in expanding U.S. prosecutorial power over international war crimes. On January 5, 2023, U.S. President Joe Biden signed into law the Justice for Victims of War Crimes Act, after it was introduced three months into the Russian invasion of Ukraine. This law expands the scope of federal prosecution power for international war crimes by authorizing the U.S. Department of Justice to prosecute suspected war criminals who are in the United States, regardless of the nationality of the victim or the perpetrator, or where the crime was committed. The unanimous and speedy Congressional approval of the bill came one day after Ukrainian President Volodymyr Zelenskyy’s joint address to the Congress, where he condemned the atrocities committed by President Vladimir Putin’s Russia and appealed for bipartisan support for his country. History of U.S. Prosecution Over War Crimes This law marks an important expansion of the U.S. prosecutorial power over international war crimes. Its predecessor, the War Crimes Act (18 U.S.C. § 2441), was signed into law in 1996 by President Bill Clinton and allowed the prosecution of war crime offenses committed anywhere, whether inside or outside of the United States if the victim or offender was a U.S. national or service member. This meant that war crimes committed outside of the United States against non-U.S. citizens were not justiciable in the United States, even if the perpetrators were residing in the country. Under the former law, Russian troops in Ukraine, committing war crimes against Ukrainians, would have been able to evade prosecution for their crimes abroad, even if they were to enter the United States. This limited jurisdiction effectively rendered the 1996 law a “dead letter” law, as there was not a single prosecution based on the statute in the 26 years since its enactment. Instead, the United States has only been able to resort to its immigration and counterterrorism laws to bring forward charges against those suspected of war crimes. Notably, the man known as the “General Dragon Master,” accused of committing atrocities during the Second Liberian Civil War, was only charged with using a fraudulently-obtained immigration document instead of being held accountable for his war crimes. Similarly, a federal judge was only able to sentence a commander of the Dos Erres Massacre Squad under charges of naturalization fraud rather than the atrocities he committed. The loopholes embedded in the 1996 War Crimes Act have essentially allowed these individuals to treat the United States as a safe haven where they can live and travel without the threat of domestic prosecution. Changes and Developments Under the New War Crimes Act The new law closes the legal loophole under the former War Crimes Act by broadening federal jurisdiction over alleged war criminals regardless of their nationality or the location of the offenses, as long as they are located within U.S. territory. This would allow the United States to prosecute war crimes committed in Ukraine if the perpetrators were to enter the country and sufficient evidence is gathered to support an indictment. The expanded jurisdiction may be particularly poignant in the possible scenarios in modern warfare where non-Americans belonging to military groups or contractors may be based in the United States while orchestrating, directing or aiding in the commission of war crimes overseas. https://www.jtl.columbia.edu/bulletin-blog/expanding-us-prosecutorial-power-over-international-war-crimes ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Fact Finding,Q&A Refer only to the provided context document when answering the question.,"According to the text above, can the client use GEM's training materials for their own employees?","GREEN ENERGY MONEY Training Services Agreement PLEASE READ THIS TRAINING SERVICES AGREEMENT BEFORE PURCHASING OR USING THE SERVICES. BY USING OR PURCHASING THE SERVICES, CUSTOMER SIGNIFIES ITS ASSENT TO THIS AGREEMENT. IF YOU ARE ACTING ON BEHALF OF AN ENTITY, THEN YOU REPRESENT THAT YOU HAVE THE AUTHORITY TO ENTER INTO THIS AGREEMENT ON BEHALF OF THAT ENTITY. IF CUSTOMER DOES NOT ACCEPT THE TERMS OF THIS AGREEMENT, THEN YOU MUST NOT ENGAGE WITH USE OF THE SERVICES. This Training Services Agreement is between Green Energy Money, Inc. a Texas corporation, located at 1110 Ranch Road 620 South, Suite D Austin, TX 78734(“GEM”), and Affiliates, and the user of GEM’s services that accepts the terms of this Agreement (“Customer”). The effective date of this Agreement ('Effective Date') is the date that Customer signs this agreement. Capitalized terms have the meaning set forth in Section 8. 1. Services. Customer may purchase training services (the ""Services"") under this Agreement from GEM by signing this agreement, prior to, or the day of the training. Services are only for Customer’s internal use and Customer may not use the Services to supply any consulting, support or training services to any third party. 2. Fees. Customer shall pay fees (""Fees"") set forth under section 9 below. 3. Nondisclosure. For purposes of this Agreement, the party disclosing Confidential Information is the “Discloser,” and the party receiving Confidential Information is the “Recipient.” Confidential Information means all information concerning the parties’ business including, but not limited to, all tangible, intangible, visual, electronic, present, or future information such as: (a) trade secrets; (b) financial information, including pricing; (c) technical information, including research, development, procedures, algorithms, data, designs, and know-how; (d) business information, including operations, planning, marketing interests, and products; and (e) the terms of any agreement between GEM and the Customer and the discussions, negotiations and proposals related to that agreement. Confidential Information disclosed to the other party must be clearly identified. Recipient will only have a duty to protect Confidential Information if it is disclosed in a manner in which the Discloser reasonably communicated, or the Recipient should reasonably have understood under the circumstances, that the disclosure should be treated as confidential, whether or not the specific designation ""confidential"" or any similar designation is used. The Recipient does not have an obligation to protect Confidential Information that is: (a) in the public domain through no fault of the Recipient; (b) within the legitimate possession of the Recipient, with no confidentiality obligations to a third party; (c) lawfully received from a third party having rights in the information without restriction, and without notice of any restriction against its further disclosure; (d) independently developed by the Recipient without breaching this Agreement or by parties who have not had, either directly or indirectly, access to or knowledge of the Confidential Information; or (e) disclosed with the prior written consent of the Discloser. A party may disclose Confidential Information when compelled to do so by law if it provides reasonable prior notice to the other party. Upon Discloser’s written request, Recipient will promptly return all Confidential Information and copies, or notify Discloser in writing that it has destroyed all such materials. The Recipient may use Residuals (as defined below) for any purpose, including use in the acquisition, development, manufacture, promotion, sale, or maintenance of products and services; provided that this right to Residuals do not represent a license under any intellectual property and/or proprietary rights of Discloser. “Residuals” means information that is retained in the unaided memories of Recipient’s employees, agents, or contractors as permitted herein, who have had access to the Discloser’s Confidential Information. Memory is unaided if the employee or contractor has not intentionally memorized the Confidential Information for the purpose of retaining and subsequently using or disclosing it. 4. Intellectual Property. 4.1 GEM training courses and training materials (“Materials”) and all worldwide intellectual property rights therein, as the same may be amended and/or extended, including the copyright, and patented proprietary methods, are wholly owned solely by GEM, who shall retain all right, title and interest in and to all Materials. Customer shall be entitled to keep and use all Materials provided by GEM to Customer, but without any other license to exercise any of the intellectual property rightstherein, all of which are hereby strictly reserved to GEM. In particular and without limitation, Materials may not be copied electronically or otherwise whether or not for archive purposes, modified including translated, re-distributed, disclosed to third parties, lent, hired out, made available to the public, sold, offered for sale, shared, or transferred in any other way. The use of any Materials will be limited to use by the specific personsto whom the Services are provided. All GEM trademarks, trade names, logos and notices present on the Materials shall be preserved and not defaced, modified or obliterated. Customer shall not use any GEM trademarks without GEM’s express written authorization. 4.2 Customer acknowledges that as part of performing the Services, GEM personnel may utilize proprietary software, methodologies, tools, specifications, drawings, sketches, models, samples, records, documentation, works of authorship or creative works, ideas, knowledge, data or other materials which have been originated or developed by the personnel of GEM or its affiliates or by third parties under contract to GEM to develop same, or which have been purchased by, or licensed to, GEM (collectively, “GEM Proprietary Intellectual Property”). GEM Proprietary Intellectual Property includes, but is not limited to, any new or improved methodologies or tools developed by GEM during the course of any project under this Agreement. Customer agrees that GEM Proprietary Intellectual Property is the sole property of GEM (or its licensor) and that GEM (or its licensor) will at all times retain sole and exclusive title to and ownership thereof. Except as expressly provided above, nothing contained in this Agreement or otherwise will be construed to grant to Customer any right, title, license or other interest in, to or under any GEM Proprietary Intellectual Property. 5. Warranty and Disclaimer. 2 Training Agreement www.greenenergy-money.com (877) GEM-3011 Financial Solutions to Value a Sustainable Future 5.1 GEM warrants that the Services shall be performed in a workmanlike manner consistent with industry standards reasonably applicable to the performance ofsuch Services. If Customer believesthere has been a breach of this warranty, Customer must notify GEM in writing promptly following delivery of the Services stating in reasonable detail the nature of the alleged breach. If there has been a breach of this warranty, then GEM’s sole obligation, and Customer’s exclusive remedy, shall be for GEM to correct or re-perform, at no additional charge, any affected Services to cause them to comply with this warranty. 5.2 EXCEPT AS PROVIDED IN SECTION 5.1 ABOVE, THE SERVICES AND ANY MATERIALS FURNISHED OR PROVIDED TO CUSTOMER UNDER THIS AGREEMENT, ARE PROVIDED TO CUSTOMER “AS-IS” WITHOUT ANY WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, INTEGRATION, NON-INFRINGEMENT, TITLE, PERFORMANCE, AND ACCURACY AND ANY IMPLIED WARRANTIES ARISING FROM STATUTE, COURSE OF DEALING, COURSE OF PERFORMANCE, OR USAGE OF TRADE. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING DISCLAIMER, NEITHER THE SERVICES NOR ANY MATERIALS FURNISHED TO CUSTOMER UNDER THIS AGREEMENT ARE SPECIFICALLY DESIGNED, MANUFACTURED OR INTENDED FOR USE IN THE PLANNING, CONSTRUCTION, MAINTENANCE, CONTROL, OR DIRECT OPERATION OF NUCLEAR FACILITIES, AIRCRAFT NAVIGATION, CONTROL OR COMMUNICATION SYSTEMS, WEAPONS SYSTEMS, OR DIRECT LIFE SUPPORT SYSTEMS. 6. Limitation of Liability. IN NO EVENT WILL GEM BE LIABLE UNDER THIS AGREEMENT FOR ANY INDIRECT, RELIANCE, PUNITIVE, CONSEQUENTIAL, SPECIAL, EXEMPLARY, OR INCIDENTAL DAMAGES OF ANY KIND AND HOWEVER CAUSED. IN NO EVENT WILL GEM’S CUMULATIVE LIABILITY FOR ANY CLAIM ARISING IN CONNECTION WITH THIS AGREEMENT EXCEED THE AMOUNT OF THE TOTAL FEES PAID TO GEM UNDER THIS AGREEMENT BY CUSTOMER DURING THE TWELVE (12) MONTHS PRECEDING ANY SUCH CLAIM. THE PROVISIONS OF SECTIONS 5 AND 6 ALLOCATE RISKS UNDER THIS AGREEMENT BETWEEN CUSTOMER AND GEM. GEM’S FEES FOR THE SERVICES REFLECT THIS ALLOCATION OF RISKS AND LIMITATION OF LIABILITY. 7. Term and Termination. 7.1 The term (the “Term”) of this Agreement shall commence on the Effective Date and shall continue until the Services have been delivered. 7.2 If Customer provides written notice of its intent to cancel the Servicesto GEM at least 72 hours prior to the scheduled date of the Services, Customer may elect to receive a full refund or to reschedule the Services If GEM cancels the Services, Customer may choose to receive a full refund or to reschedule the Services. 7.3 Sections 2, 3, 4, 5, 6, 7 and 8 shall survive the expiration or termination of this Agreement. 8. General. 8.1 This Agreement shall be governed by the laws of the State of Texas. For all disputes arising out of this Agreement, the parties consent to the jurisdiction of the courts serving Travis County, Texas. 8.3 Unless otherwise specified in this Agreement, all notices shall be in writing and shall be mailed (via registered or certified mail, return receipt requested), delivered by a nationally recognized express courier 3 Training Agreement www.greenenergy-money.com (877) GEM-3011 Financial Solutions to Value a Sustainable Future service with the ability to track shipments, or personally delivered to the other party at the address set forth above for GEM and at registration for Customer. All notices shall be effective upon receipt. 8.4 This Agreement is the parties’ entire agreement relating to its subject and supersedes any prior or contemporaneous agreements on that subject. All amendments to this Agreement must be in writing, executed by both parties and expressly state that they are amending this Agreement. 8.5 Failure to enforce any provision of this Agreement shall not constitute a waiver thereof. No waiver shall be effective unless it is in writing and signed by the waiving party. If a party waives any right, power, or remedy, the waiver shall not waive any successive or other right, power, or remedy the party may have under this Agreement. If any provision is found to be unenforceable, it and any related provisions shall be interpreted to best accomplish the unenforceable provision’s essential purpose. 8.6 Neither party shall be liable for failures or delays in performance due to causes beyond its reasonable control, including, but not limited to, any act of God, fire, earthquake, flood, storm, natural disaster, accident, pandemic, labor unrest, civil disobedience, act of terrorism or act of government; however, the inability to meet financial obligations is expressly excluded. Both parties hereto agree to use their best efforts to minimize the effects of such failures or delays. ","Query: According to the text above, can the client use GEM's training materials for their own employees? ---------- Task Instruction: Refer only to the provided context document when answering the question. ---------- Document: GREEN ENERGY MONEY Training Services Agreement PLEASE READ THIS TRAINING SERVICES AGREEMENT BEFORE PURCHASING OR USING THE SERVICES. BY USING OR PURCHASING THE SERVICES, CUSTOMER SIGNIFIES ITS ASSENT TO THIS AGREEMENT. IF YOU ARE ACTING ON BEHALF OF AN ENTITY, THEN YOU REPRESENT THAT YOU HAVE THE AUTHORITY TO ENTER INTO THIS AGREEMENT ON BEHALF OF THAT ENTITY. IF CUSTOMER DOES NOT ACCEPT THE TERMS OF THIS AGREEMENT, THEN YOU MUST NOT ENGAGE WITH USE OF THE SERVICES. This Training Services Agreement is between Green Energy Money, Inc. a Texas corporation, located at 1110 Ranch Road 620 South, Suite D Austin, TX 78734(“GEM”), and Affiliates, and the user of GEM’s services that accepts the terms of this Agreement (“Customer”). The effective date of this Agreement ('Effective Date') is the date that Customer signs this agreement. Capitalized terms have the meaning set forth in Section 8. 1. Services. Customer may purchase training services (the ""Services"") under this Agreement from GEM by signing this agreement, prior to, or the day of the training. Services are only for Customer’s internal use and Customer may not use the Services to supply any consulting, support or training services to any third party. 2. Fees. Customer shall pay fees (""Fees"") set forth under section 9 below. 3. Nondisclosure. For purposes of this Agreement, the party disclosing Confidential Information is the “Discloser,” and the party receiving Confidential Information is the “Recipient.” Confidential Information means all information concerning the parties’ business including, but not limited to, all tangible, intangible, visual, electronic, present, or future information such as: (a) trade secrets; (b) financial information, including pricing; (c) technical information, including research, development, procedures, algorithms, data, designs, and know-how; (d) business information, including operations, planning, marketing interests, and products; and (e) the terms of any agreement between GEM and the Customer and the discussions, negotiations and proposals related to that agreement. Confidential Information disclosed to the other party must be clearly identified. Recipient will only have a duty to protect Confidential Information if it is disclosed in a manner in which the Discloser reasonably communicated, or the Recipient should reasonably have understood under the circumstances, that the disclosure should be treated as confidential, whether or not the specific designation ""confidential"" or any similar designation is used. The Recipient does not have an obligation to protect Confidential Information that is: (a) in the public domain through no fault of the Recipient; (b) within the legitimate possession of the Recipient, with no confidentiality obligations to a third party; (c) lawfully received from a third party having rights in the information without restriction, and without notice of any restriction against its further disclosure; (d) independently developed by the Recipient without breaching this Agreement or by parties who have not had, either directly or indirectly, access to or knowledge of the Confidential Information; or (e) disclosed with the prior written consent of the Discloser. A party may disclose Confidential Information when compelled to do so by law if it provides reasonable prior notice to the other party. Upon Discloser’s written request, Recipient will promptly return all Confidential Information and copies, or notify Discloser in writing that it has destroyed all such materials. The Recipient may use Residuals (as defined below) for any purpose, including use in the acquisition, development, manufacture, promotion, sale, or maintenance of products and services; provided that this right to Residuals do not represent a license under any intellectual property and/or proprietary rights of Discloser. “Residuals” means information that is retained in the unaided memories of Recipient’s employees, agents, or contractors as permitted herein, who have had access to the Discloser’s Confidential Information. Memory is unaided if the employee or contractor has not intentionally memorized the Confidential Information for the purpose of retaining and subsequently using or disclosing it. 4. Intellectual Property. 4.1 GEM training courses and training materials (“Materials”) and all worldwide intellectual property rights therein, as the same may be amended and/or extended, including the copyright, and patented proprietary methods, are wholly owned solely by GEM, who shall retain all right, title and interest in and to all Materials. Customer shall be entitled to keep and use all Materials provided by GEM to Customer, but without any other license to exercise any of the intellectual property rightstherein, all of which are hereby strictly reserved to GEM. In particular and without limitation, Materials may not be copied electronically or otherwise whether or not for archive purposes, modified including translated, re-distributed, disclosed to third parties, lent, hired out, made available to the public, sold, offered for sale, shared, or transferred in any other way. The use of any Materials will be limited to use by the specific personsto whom the Services are provided. All GEM trademarks, trade names, logos and notices present on the Materials shall be preserved and not defaced, modified or obliterated. Customer shall not use any GEM trademarks without GEM’s express written authorization. 4.2 Customer acknowledges that as part of performing the Services, GEM personnel may utilize proprietary software, methodologies, tools, specifications, drawings, sketches, models, samples, records, documentation, works of authorship or creative works, ideas, knowledge, data or other materials which have been originated or developed by the personnel of GEM or its affiliates or by third parties under contract to GEM to develop same, or which have been purchased by, or licensed to, GEM (collectively, “GEM Proprietary Intellectual Property”). GEM Proprietary Intellectual Property includes, but is not limited to, any new or improved methodologies or tools developed by GEM during the course of any project under this Agreement. Customer agrees that GEM Proprietary Intellectual Property is the sole property of GEM (or its licensor) and that GEM (or its licensor) will at all times retain sole and exclusive title to and ownership thereof. Except as expressly provided above, nothing contained in this Agreement or otherwise will be construed to grant to Customer any right, title, license or other interest in, to or under any GEM Proprietary Intellectual Property. 5. Warranty and Disclaimer. 2 Training Agreement www.greenenergy-money.com (877) GEM-3011 Financial Solutions to Value a Sustainable Future 5.1 GEM warrants that the Services shall be performed in a workmanlike manner consistent with industry standards reasonably applicable to the performance ofsuch Services. If Customer believesthere has been a breach of this warranty, Customer must notify GEM in writing promptly following delivery of the Services stating in reasonable detail the nature of the alleged breach. If there has been a breach of this warranty, then GEM’s sole obligation, and Customer’s exclusive remedy, shall be for GEM to correct or re-perform, at no additional charge, any affected Services to cause them to comply with this warranty. 5.2 EXCEPT AS PROVIDED IN SECTION 5.1 ABOVE, THE SERVICES AND ANY MATERIALS FURNISHED OR PROVIDED TO CUSTOMER UNDER THIS AGREEMENT, ARE PROVIDED TO CUSTOMER “AS-IS” WITHOUT ANY WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO, ANY IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, INTEGRATION, NON-INFRINGEMENT, TITLE, PERFORMANCE, AND ACCURACY AND ANY IMPLIED WARRANTIES ARISING FROM STATUTE, COURSE OF DEALING, COURSE OF PERFORMANCE, OR USAGE OF TRADE. WITHOUT LIMITING THE GENERALITY OF THE FOREGOING DISCLAIMER, NEITHER THE SERVICES NOR ANY MATERIALS FURNISHED TO CUSTOMER UNDER THIS AGREEMENT ARE SPECIFICALLY DESIGNED, MANUFACTURED OR INTENDED FOR USE IN THE PLANNING, CONSTRUCTION, MAINTENANCE, CONTROL, OR DIRECT OPERATION OF NUCLEAR FACILITIES, AIRCRAFT NAVIGATION, CONTROL OR COMMUNICATION SYSTEMS, WEAPONS SYSTEMS, OR DIRECT LIFE SUPPORT SYSTEMS. 6. Limitation of Liability. IN NO EVENT WILL GEM BE LIABLE UNDER THIS AGREEMENT FOR ANY INDIRECT, RELIANCE, PUNITIVE, CONSEQUENTIAL, SPECIAL, EXEMPLARY, OR INCIDENTAL DAMAGES OF ANY KIND AND HOWEVER CAUSED. IN NO EVENT WILL GEM’S CUMULATIVE LIABILITY FOR ANY CLAIM ARISING IN CONNECTION WITH THIS AGREEMENT EXCEED THE AMOUNT OF THE TOTAL FEES PAID TO GEM UNDER THIS AGREEMENT BY CUSTOMER DURING THE TWELVE (12) MONTHS PRECEDING ANY SUCH CLAIM. THE PROVISIONS OF SECTIONS 5 AND 6 ALLOCATE RISKS UNDER THIS AGREEMENT BETWEEN CUSTOMER AND GEM. GEM’S FEES FOR THE SERVICES REFLECT THIS ALLOCATION OF RISKS AND LIMITATION OF LIABILITY. 7. Term and Termination. 7.1 The term (the “Term”) of this Agreement shall commence on the Effective Date and shall continue until the Services have been delivered. 7.2 If Customer provides written notice of its intent to cancel the Servicesto GEM at least 72 hours prior to the scheduled date of the Services, Customer may elect to receive a full refund or to reschedule the Services If GEM cancels the Services, Customer may choose to receive a full refund or to reschedule the Services. 7.3 Sections 2, 3, 4, 5, 6, 7 and 8 shall survive the expiration or termination of this Agreement. 8. General. 8.1 This Agreement shall be governed by the laws of the State of Texas. For all disputes arising out of this Agreement, the parties consent to the jurisdiction of the courts serving Travis County, Texas. 8.3 Unless otherwise specified in this Agreement, all notices shall be in writing and shall be mailed (via registered or certified mail, return receipt requested), delivered by a nationally recognized express courier 3 Training Agreement www.greenenergy-money.com (877) GEM-3011 Financial Solutions to Value a Sustainable Future service with the ability to track shipments, or personally delivered to the other party at the address set forth above for GEM and at registration for Customer. All notices shall be effective upon receipt. 8.4 This Agreement is the parties’ entire agreement relating to its subject and supersedes any prior or contemporaneous agreements on that subject. All amendments to this Agreement must be in writing, executed by both parties and expressly state that they are amending this Agreement. 8.5 Failure to enforce any provision of this Agreement shall not constitute a waiver thereof. No waiver shall be effective unless it is in writing and signed by the waiving party. If a party waives any right, power, or remedy, the waiver shall not waive any successive or other right, power, or remedy the party may have under this Agreement. If any provision is found to be unenforceable, it and any related provisions shall be interpreted to best accomplish the unenforceable provision’s essential purpose. 8.6 Neither party shall be liable for failures or delays in performance due to causes beyond its reasonable control, including, but not limited to, any act of God, fire, earthquake, flood, storm, natural disaster, accident, pandemic, labor unrest, civil disobedience, act of terrorism or act of government; however, the inability to meet financial obligations is expressly excluded. Both parties hereto agree to use their best efforts to minimize the effects of such failures or delays. ",Legal,Find & Summarize,Text Transformation "Only answer the question from the information provided in the prompt, and don't use any external information or prior knowledge. If you can't answer part or all of the question, say something like ""There is not enough information to answer this"".",What are five effects that high interest rates could have on the economy?,"Why Is the Federal Reserve Keeping Interest Rates “High for Longer”? July 3, 2024 The Federal Reserve (Fed) responded to the post-pandemic spike in inflation by rapidly raising short-term interest rates between 2022 and 2023. Since July 2023, the Fed has maintained a target range of 5.25%- 5.5%, the highest target since 2001. As inflation subsequently fell, futures markets expected the Fed to begin reducing rates this spring. Instead, rates have remained unchanged through the first half of the year—a stance that has been popularly referred to as keeping rates “high for longer.” This Insight examines why. Inflation and Monetary Policy The Fed has a statutory mandate to promote “maximum employment, stable prices, and moderate longterm interest rates.” The Fed has defined 2% inflation—as measured by the personal consumer expenditures price (PCE) index—as consistent with its price stability mandate. Economists view monetary policy as the primary policy tool for influencing inflation. External factors can lead to short-term changes in inflation, but the Fed has demonstrated in recent decades that monetary policy has the ability to guide inflation to the Fed’s desired target over the medium term. To carry out monetary policy, the Fed targets the federal funds rate (the overnight bank lending rate), as explained in CRS In Focus IF11751, Introduction to U.S. Economy: Monetary Policy. When the Fed raises the federal funds rate, it reduces interest-sensitive spending, causing overall demand (spending) to cool off and inflation to fall, all else equal. Recent Trends and Policy Inflation was mostly near the Fed’s 2% target for decades until supply and demand disruptions caused by COVID-19 and the invasion of Ukraine caused inflation to rise rapidly (see CRS Report R47273, Inflation in the U.S. Economy: Causes and Policy Options). As seen in Figure 1, inflation has exceeded 2% since March 2021 as measured both by total PCE and core PCE, which excludes volatile food and energy prices. Overall inflation peaked above 7% in June 2022—its highest level since 1981. (By Congressional Research Service https://crsreports.congress.gov IN12388 Congressional Research Service 2 contrast, unemployment has been below 5% since 2021, so the Fed has not had to focus on supporting its employment mandate.) Figure 1. Inflation and Interest Rates January 2020 to April 2024 Source: Bureau of Economic Analysis and Federal Reserve. Notes: The figure plots the 12-month change in prices and the effective federal funds rate. Inflation fell rapidly in the second half of 2022 and 2023, falling below 3% by the end of 2023 because most supply disruptions were resolved and energy prices declined rapidly for most of 2023. September 2023 was the first meeting where the Fed left rates unchanged. The Fed reasoned that lags between changes in monetary policy and their effects on the economy meant that earlier rate increases would continue to reduce inflation. In December 2023, most Fed officials anticipated that the Fed would reduce rates by a projected cumulative 0.5-1.25 percentage points in 2024. In January 2024, with new data that overall and core inflation were both below 3%, the Fed shifted its language from “additional policy firming” to “moving into better balance,” which market participants interpreted as the Fed planning to begin reducing rates in the first half of 2024. For example, after the Fed’s January meeting, futures markets predicted a 94% chance that rates would be cut by May 2024. The Fed would like to eventually reduce rates, because it believes, as articulated by the chair, that the current interest rate target is too high to be consistent with maintaining full employment and a robust expansion once inflation has returned to 2%. It would like to avoid a “hard landing,” where high interest rates trigger a recession. Therefore, the Fed’s goal is to reduce rates but not until it “has gained greater confidence that inflation is moving sustainably toward 2%.” According to this position, inflation does not have to fall to 2% before rates are cut—rather, the Fed must have confidence that inflation is heading toward 2%. It first used this language in January 2024. Since then, it has backed off near-term rate cuts because the deceleration in inflation has stalled out. Since December 2023, overall inflation has not changed, and core inflation has fallen by less than ¼ of a percentage point. Although it is close to 2%, those measures of inflation cover the past 12 months, which includes several months of very small changes to the price indices in 2023 that bring down the average. By contrast, the one-month changes in prices in most months in 2024 have been high enough—with the exception of May, which was very low—that, were they to continue in the coming months, the 12-month inflation rate would start rising again as the low inflation months from 2023 drop out of the data. In June, most Fed officials anticipated Congressional Research Service 3 IN12388 · VERSION 1 · NEW that the Fed would reduce rates by a cumulative 0.25-0.5 percentage points in 2024, but some did not anticipate that rates would be cut at all. Looking Ahead Because rates have been above 5% for over a year, the lagged effects of monetary policy are largely working through the economy at this point. It is increasingly unlikely that the current stance of monetary policy alone will cause a hard landing, and private forecasters have lowered their probability of the economy entering a recession in the near term. So far, the Fed believes that the current level of rates will eventually reduce inflation to 2% if left in place long enough. One reason that it might prove to be correct is because, as inflation has fallen and nominal (i.e., not adjusted for inflation) interest rates have stayed the same, real (i.e., inflation-adjusted) interest rates have risen. Because economic activity is primarily influenced by real rates, the same nominal rate is more contractionary today than it was in July 2023. But at some point, if the decline in inflation continues to stall out, the Fed may need to consider whether somewhat higher rates are needed to reduce inflation and how that would affect the odds of a recession. Author Information Marc Labonte Specialist in Macroeconomic Policy Disclaimer This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you wish to copy or otherwise use copyrighted material.","Only answer the question from the information provided in the prompt, and don't use any external information or prior knowledge. If you can't answer part or all of the question, say something like ""There is not enough information to answer this"". What are five effects that high interest rates could have on the economy? Why Is the Federal Reserve Keeping Interest Rates “High for Longer”? July 3, 2024 The Federal Reserve (Fed) responded to the post-pandemic spike in inflation by rapidly raising short-term interest rates between 2022 and 2023. Since July 2023, the Fed has maintained a target range of 5.25%- 5.5%, the highest target since 2001. As inflation subsequently fell, futures markets expected the Fed to begin reducing rates this spring. Instead, rates have remained unchanged through the first half of the year—a stance that has been popularly referred to as keeping rates “high for longer.” This Insight examines why. Inflation and Monetary Policy The Fed has a statutory mandate to promote “maximum employment, stable prices, and moderate longterm interest rates.” The Fed has defined 2% inflation—as measured by the personal consumer expenditures price (PCE) index—as consistent with its price stability mandate. Economists view monetary policy as the primary policy tool for influencing inflation. External factors can lead to short-term changes in inflation, but the Fed has demonstrated in recent decades that monetary policy has the ability to guide inflation to the Fed’s desired target over the medium term. To carry out monetary policy, the Fed targets the federal funds rate (the overnight bank lending rate), as explained in CRS In Focus IF11751, Introduction to U.S. Economy: Monetary Policy. When the Fed raises the federal funds rate, it reduces interest-sensitive spending, causing overall demand (spending) to cool off and inflation to fall, all else equal. Recent Trends and Policy Inflation was mostly near the Fed’s 2% target for decades until supply and demand disruptions caused by COVID-19 and the invasion of Ukraine caused inflation to rise rapidly (see CRS Report R47273, Inflation in the U.S. Economy: Causes and Policy Options). As seen in Figure 1, inflation has exceeded 2% since March 2021 as measured both by total PCE and core PCE, which excludes volatile food and energy prices. Overall inflation peaked above 7% in June 2022—its highest level since 1981. (By Congressional Research Service https://crsreports.congress.gov IN12388 Congressional Research Service 2 contrast, unemployment has been below 5% since 2021, so the Fed has not had to focus on supporting its employment mandate.) Figure 1. Inflation and Interest Rates January 2020 to April 2024 Source: Bureau of Economic Analysis and Federal Reserve. Notes: The figure plots the 12-month change in prices and the effective federal funds rate. Inflation fell rapidly in the second half of 2022 and 2023, falling below 3% by the end of 2023 because most supply disruptions were resolved and energy prices declined rapidly for most of 2023. September 2023 was the first meeting where the Fed left rates unchanged. The Fed reasoned that lags between changes in monetary policy and their effects on the economy meant that earlier rate increases would continue to reduce inflation. In December 2023, most Fed officials anticipated that the Fed would reduce rates by a projected cumulative 0.5-1.25 percentage points in 2024. In January 2024, with new data that overall and core inflation were both below 3%, the Fed shifted its language from “additional policy firming” to “moving into better balance,” which market participants interpreted as the Fed planning to begin reducing rates in the first half of 2024. For example, after the Fed’s January meeting, futures markets predicted a 94% chance that rates would be cut by May 2024. The Fed would like to eventually reduce rates, because it believes, as articulated by the chair, that the current interest rate target is too high to be consistent with maintaining full employment and a robust expansion once inflation has returned to 2%. It would like to avoid a “hard landing,” where high interest rates trigger a recession. Therefore, the Fed’s goal is to reduce rates but not until it “has gained greater confidence that inflation is moving sustainably toward 2%.” According to this position, inflation does not have to fall to 2% before rates are cut—rather, the Fed must have confidence that inflation is heading toward 2%. It first used this language in January 2024. Since then, it has backed off near-term rate cuts because the deceleration in inflation has stalled out. Since December 2023, overall inflation has not changed, and core inflation has fallen by less than ¼ of a percentage point. Although it is close to 2%, those measures of inflation cover the past 12 months, which includes several months of very small changes to the price indices in 2023 that bring down the average. By contrast, the one-month changes in prices in most months in 2024 have been high enough—with the exception of May, which was very low—that, were they to continue in the coming months, the 12-month inflation rate would start rising again as the low inflation months from 2023 drop out of the data. In June, most Fed officials anticipated Congressional Research Service 3 IN12388 · VERSION 1 · NEW that the Fed would reduce rates by a cumulative 0.25-0.5 percentage points in 2024, but some did not anticipate that rates would be cut at all. Looking Ahead Because rates have been above 5% for over a year, the lagged effects of monetary policy are largely working through the economy at this point. It is increasingly unlikely that the current stance of monetary policy alone will cause a hard landing, and private forecasters have lowered their probability of the economy entering a recession in the near term. So far, the Fed believes that the current level of rates will eventually reduce inflation to 2% if left in place long enough. One reason that it might prove to be correct is because, as inflation has fallen and nominal (i.e., not adjusted for inflation) interest rates have stayed the same, real (i.e., inflation-adjusted) interest rates have risen. Because economic activity is primarily influenced by real rates, the same nominal rate is more contractionary today than it was in July 2023. But at some point, if the decline in inflation continues to stall out, the Fed may need to consider whether somewhat higher rates are needed to reduce inflation and how that would affect the odds of a recession. Author Information Marc Labonte Specialist in Macroeconomic Policy Disclaimer This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you wish to copy or otherwise use copyrighted material.",Financial,Fact Finding,Q&A This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Draw your answer from the context block only.,Isn't the theater required to provide me with an initial set-up of tea bags in my housing if I am an actor working under the terms of this contract?,"(J) (1) In order to facilitate the Actor’s planning, the Theatre will provide the Actor, no later than one week prior to the Actor’s arrival, with a description of the housing, including furnishings and appliances that will be available. (2) The following shall be the minimum furnishings supplied in each Actor’s housing: bed and mattress in good condition, nightstand, reading lamp, armchair or sofa, table and chairs, lamp, dresser, mirror, hangers, linens/towels, pillows, blankets, wastebasket, radio alarm clock, and television and cable, where available and necessary for adequate reception. In multi-bedroom units or dormitories, the television and armchairs or sofa may be provided in the common area. Theatre shall make available irons and ironing boards. (3) The following shall be the minimum kitchen equipment supplied in each Actor’s housing: pots and pans with lids, cooking utensils, silverware for four, not fewer than four plates, cups and glasses, can opener, kitchen knives and colander. Where housekeeping is not provided, a broom and dustpan as well as a mop and pail shall be furnished. If the housing contains a microwave oven, microwave-safe accessories shall also be furnished. (4) Theatre shall provide an initial set-up of the following items in Actor’s housing prior to Actor’s arrival: toilet paper, paper towels, hand soap, dish soap, salt & pepper, sugar, coffee, tea, garbage bags, and sponge.","system instruction: [This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Draw your answer from the context block only.] question: [Isn't the theater required to provide me with an initial set-up of tea bags in my housing if I am an actor working under the terms of this contract?] context block: [(J) (1) In order to facilitate the Actor’s planning, the Theatre will provide the Actor, no later than one week prior to the Actor’s arrival, with a description of the housing, including furnishings and appliances that will be available. (2) The following shall be the minimum furnishings supplied in each Actor’s housing: bed and mattress in good condition, nightstand, reading lamp, armchair or sofa, table and chairs, lamp, dresser, mirror, hangers, linens/towels, pillows, blankets, wastebasket, radio alarm clock, and television and cable, where available and necessary for adequate reception. In multi-bedroom units or dormitories, the television and armchairs or sofa may be provided in the common area. Theatre shall make available irons and ironing boards. (3) The following shall be the minimum kitchen equipment supplied in each Actor’s housing: pots and pans with lids, cooking utensils, silverware for four, not fewer than four plates, cups and glasses, can opener, kitchen knives and colander. Where housekeeping is not provided, a broom and dustpan as well as a mop and pail shall be furnished. If the housing contains a microwave oven, microwave-safe accessories shall also be furnished. (4) Theatre shall provide an initial set-up of the following items in Actor’s housing prior to Actor’s arrival: toilet paper, paper towels, hand soap, dish soap, salt & pepper, sugar, coffee, tea, garbage bags, and sponge.]",Legal,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",My daughter might need to have her wisdom teeth out soon so I'm trying to get ahead on information. What are some reasons they might need to come out? What are some risks and concerns with this surgery? I'm also interested in some food options she could enjoy while healing.,"Wisdom tooth removal — or wisdom tooth extraction — is a common oral surgery procedure. Dentists may recommend this treatment to preserve your oral health and protect your other teeth from possible issues in the future. Your wisdom teeth — also called third molars — are in the very back of your mouth. Typically, they erupt (grow in) sometime between the ages of 17 and 25. Scientists believe wisdom teeth are vestigial structures (parts of the human body that are no longer necessary). Our ancestors needed these teeth to crush and chew raw leaves, nuts, roots and meat. Today, we eat more cooked food and use forks and knives to cut our food up into smaller pieces. As a result, we don’t really need wisdom teeth anymore. Some people have all four wisdom teeth (one in each quadrant — the upper left, lower left, upper right and lower right). Others may have one, two, three or none at all. No matter how many wisdom teeth you do (or don’t) have, it doesn’t mean there’s something wrong. It’s just a variation of normal and a sign of the ever-changing evolutionary process. You might need wisdom teeth removed if you: Have one or more impacted wisdom teeth. (“Impacted” means partially or fully trapped in your gums or jawbone.) Have wisdom teeth that grew in crooked or sideways. Develop pain near the back of your mouth. Trap food and debris around your wisdom teeth. Develop gum disease, particularly around your molars. Have tooth decay (cavities) in a partially erupted wisdom tooth. Develop a cyst (fluid-filled sac) around one or more wisdom teeth. Have damage to nearby teeth or surrounding bone. In many cases, dentists recommend wisdom teeth extraction as a preventive measure. As a result, your dentist may suggest removing your wisdom teeth even if you don’t have any symptoms. This can help reduce your risk for future problems, including infection and tooth decay. How should I prepare for wisdom teeth removal? During a consultation with an oral surgeon, they’ll check the health of your wisdom teeth and take dental X-rays to determine their exact location. This is a good time to tell your surgeon about any medications, vitamins or supplements you’re currently taking. The day of your procedure, your surgeon will: Give you anesthesia to numb your teeth and gums and keep you comfortable. (If you choose sedation, they’ll give you sedative medications, as well.) Make incisions (cuts) in your gums, if necessary, to expose teeth trapped in your gums or jawbone. Carefully loosen your wisdom tooth and lift it from its socket. (They may need to divide your tooth into sections for easier removal.) Clean the area to make sure there’s no infection. Place stitches to close the surgical site, if necessary. Place gauze over the sockets to slow bleeding. How long does this procedure take? Wisdom tooth extraction usually takes an hour or less. Complex cases may take longer. What happens after wisdom teeth removal? After wisdom teeth removal, you can expect mild discomfort, slight bleeding and swelling. Your oral surgeon will give you instructions for wisdom teeth management to ease these side effects. Once your sedation wears off enough, a trusted friend or family member will drive you home. Dos and don’ts after wisdom tooth extraction Your surgeon will give you postoperative guidelines specific for your situation. Following these instructions will help you manage bleeding, swelling and pain after your procedure. DO: Leave gauze in place for about 30 minutes after your surgery. Replace with clean gauze if necessary. Your surgeon can tell you when to stop using gauze after wisdom tooth extraction. But in general, you can take it out when the bleeding slows. It’s normal to have some oozing, but you shouldn’t have excessive bleeding. Rest as much as you can. You should stay at home and recover for at least three to five days. If you have a physically demanding job, you might need to wait longer before returning to work. Use an ice pack to help reduce swelling. Wrap the ice pack in a clean towel and place it on your face. Leave it on for 20 minutes, and then take it off for 20 minutes. Repeat several times a day. Keep extraction sites clean. Gently soak the surgical areas with alcohol-free antibacterial mouthwash. Don’t swish. Swishing can dislodge blood clots and cause dry sockets, a painful condition that exposes the bone at your extraction site. Instead, lean your head to each side and let the mouthwash soak the areas. Brush and floss the rest of your teeth every day. While you don’t want to brush over the extraction sites, you’ll still need to keep your other teeth clean during recovery. This reduces your risk for infection. Take all medications as prescribed. Your surgeon will give you medications to keep you comfortable and reduce your risk of infection. Don’t stop taking these medications until your surgeon says it’s OK. DON’T: Drink through a straw. This dislodges blood clots and causes dry sockets. Exercise until your surgeon says it’s OK. Getting your heart rate up increases your risk for pain, bleeding and swelling. Most people can resume their fitness routines in about 48 to 72 hours. Lift heavy things. Heavy lifting also increases your risk for postoperative complications like pain, bleeding and swelling. Eat hard, crunchy or chewy foods. These can damage your healing gums and cause pain. Drink carbonated beverages or beverages containing alcohol. These beverages can dislodge blood clots and cause dry sockets. Skip these drinks for at least five days. Wisdom tooth removal can reduce your risk for future oral health problems, like: Gum disease. Tooth decay. Damage to neighboring teeth. Bone loss. Jaw damage. If you’ve already developed pain because of your wisdom teeth, then extraction can often ease discomfort almost immediately and get you back on track to better oral health. Wisdom teeth removal usually doesn’t result in long-term complications. In rare instances, people may develop: Infection (pus coming out of your socket or incisions). Dry sockets (loss of blood clot resulting in exposed bone). Damage to other oral structures, including your jawbone, nerves, sinuses or nearby teeth. Recovery and Outlook How long does it take to recover after wisdom teeth removal? Wisdom teeth removal recovery time takes one to two weeks on average. But most people can resume school, work and other routines in about three to five days. Your surgeon will give you detailed postoperative instructions to help keep you comfortable while you heal. In general, eat a soft food diet for the first three to five days. Avoid hard, crunchy or chewy foods, as these can cause pain and interfere with healing. Your surgeon will give you a list of things you can eat after wisdom tooth extraction. Some of these foods include: Yogurt. Smoothies. Pudding. Soups. Macaroni and cheese. Scrambled eggs. Applesauce. Mashed potatoes. Cottage cheese. Pureed fruit. Cooked vegetables. When can I go back to work or school? You’ll need to rest at home for three to five days after wisdom tooth removal. Most people can resume work, school and other routines at this point. Call your dentist or oral surgeon if you develop: A fever higher than 102 degrees Fahrenheit (38.8 degrees Celsius). Excessive bleeding. Severe pain that doesn’t get better with medication. Difficulty breathing or swallowing. Swelling that gets worse after three days. An infection (pus) coming from your surgical site. Additional Details","""================ ======= Wisdom tooth removal — or wisdom tooth extraction — is a common oral surgery procedure. Dentists may recommend this treatment to preserve your oral health and protect your other teeth from possible issues in the future. Your wisdom teeth — also called third molars — are in the very back of your mouth. Typically, they erupt (grow in) sometime between the ages of 17 and 25. Scientists believe wisdom teeth are vestigial structures (parts of the human body that are no longer necessary). Our ancestors needed these teeth to crush and chew raw leaves, nuts, roots and meat. Today, we eat more cooked food and use forks and knives to cut our food up into smaller pieces. As a result, we don’t really need wisdom teeth anymore. Some people have all four wisdom teeth (one in each quadrant — the upper left, lower left, upper right and lower right). Others may have one, two, three or none at all. No matter how many wisdom teeth you do (or don’t) have, it doesn’t mean there’s something wrong. It’s just a variation of normal and a sign of the ever-changing evolutionary process. You might need wisdom teeth removed if you: Have one or more impacted wisdom teeth. (“Impacted” means partially or fully trapped in your gums or jawbone.) Have wisdom teeth that grew in crooked or sideways. Develop pain near the back of your mouth. Trap food and debris around your wisdom teeth. Develop gum disease, particularly around your molars. Have tooth decay (cavities) in a partially erupted wisdom tooth. Develop a cyst (fluid-filled sac) around one or more wisdom teeth. Have damage to nearby teeth or surrounding bone. In many cases, dentists recommend wisdom teeth extraction as a preventive measure. As a result, your dentist may suggest removing your wisdom teeth even if you don’t have any symptoms. This can help reduce your risk for future problems, including infection and tooth decay. How should I prepare for wisdom teeth removal? During a consultation with an oral surgeon, they’ll check the health of your wisdom teeth and take dental X-rays to determine their exact location. This is a good time to tell your surgeon about any medications, vitamins or supplements you’re currently taking. The day of your procedure, your surgeon will: Give you anesthesia to numb your teeth and gums and keep you comfortable. (If you choose sedation, they’ll give you sedative medications, as well.) Make incisions (cuts) in your gums, if necessary, to expose teeth trapped in your gums or jawbone. Carefully loosen your wisdom tooth and lift it from its socket. (They may need to divide your tooth into sections for easier removal.) Clean the area to make sure there’s no infection. Place stitches to close the surgical site, if necessary. Place gauze over the sockets to slow bleeding. How long does this procedure take? Wisdom tooth extraction usually takes an hour or less. Complex cases may take longer. What happens after wisdom teeth removal? After wisdom teeth removal, you can expect mild discomfort, slight bleeding and swelling. Your oral surgeon will give you instructions for wisdom teeth management to ease these side effects. Once your sedation wears off enough, a trusted friend or family member will drive you home. Dos and don’ts after wisdom tooth extraction Your surgeon will give you postoperative guidelines specific for your situation. Following these instructions will help you manage bleeding, swelling and pain after your procedure. DO: Leave gauze in place for about 30 minutes after your surgery. Replace with clean gauze if necessary. Your surgeon can tell you when to stop using gauze after wisdom tooth extraction. But in general, you can take it out when the bleeding slows. It’s normal to have some oozing, but you shouldn’t have excessive bleeding. Rest as much as you can. You should stay at home and recover for at least three to five days. If you have a physically demanding job, you might need to wait longer before returning to work. Use an ice pack to help reduce swelling. Wrap the ice pack in a clean towel and place it on your face. Leave it on for 20 minutes, and then take it off for 20 minutes. Repeat several times a day. Keep extraction sites clean. Gently soak the surgical areas with alcohol-free antibacterial mouthwash. Don’t swish. Swishing can dislodge blood clots and cause dry sockets, a painful condition that exposes the bone at your extraction site. Instead, lean your head to each side and let the mouthwash soak the areas. Brush and floss the rest of your teeth every day. While you don’t want to brush over the extraction sites, you’ll still need to keep your other teeth clean during recovery. This reduces your risk for infection. Take all medications as prescribed. Your surgeon will give you medications to keep you comfortable and reduce your risk of infection. Don’t stop taking these medications until your surgeon says it’s OK. DON’T: Drink through a straw. This dislodges blood clots and causes dry sockets. Exercise until your surgeon says it’s OK. Getting your heart rate up increases your risk for pain, bleeding and swelling. Most people can resume their fitness routines in about 48 to 72 hours. Lift heavy things. Heavy lifting also increases your risk for postoperative complications like pain, bleeding and swelling. Eat hard, crunchy or chewy foods. These can damage your healing gums and cause pain. Drink carbonated beverages or beverages containing alcohol. These beverages can dislodge blood clots and cause dry sockets. Skip these drinks for at least five days. Wisdom tooth removal can reduce your risk for future oral health problems, like: Gum disease. Tooth decay. Damage to neighboring teeth. Bone loss. Jaw damage. If you’ve already developed pain because of your wisdom teeth, then extraction can often ease discomfort almost immediately and get you back on track to better oral health. Wisdom teeth removal usually doesn’t result in long-term complications. In rare instances, people may develop: Infection (pus coming out of your socket or incisions). Dry sockets (loss of blood clot resulting in exposed bone). Damage to other oral structures, including your jawbone, nerves, sinuses or nearby teeth. Recovery and Outlook How long does it take to recover after wisdom teeth removal? Wisdom teeth removal recovery time takes one to two weeks on average. But most people can resume school, work and other routines in about three to five days. Your surgeon will give you detailed postoperative instructions to help keep you comfortable while you heal. In general, eat a soft food diet for the first three to five days. Avoid hard, crunchy or chewy foods, as these can cause pain and interfere with healing. Your surgeon will give you a list of things you can eat after wisdom tooth extraction. Some of these foods include: Yogurt. Smoothies. Pudding. Soups. Macaroni and cheese. Scrambled eggs. Applesauce. Mashed potatoes. Cottage cheese. Pureed fruit. Cooked vegetables. When can I go back to work or school? You’ll need to rest at home for three to five days after wisdom tooth removal. Most people can resume work, school and other routines at this point. Call your dentist or oral surgeon if you develop: A fever higher than 102 degrees Fahrenheit (38.8 degrees Celsius). Excessive bleeding. Severe pain that doesn’t get better with medication. Difficulty breathing or swallowing. Swelling that gets worse after three days. An infection (pus) coming from your surgical site. Additional Details https://my.clevelandclinic.org/health/treatments/22119-wisdom-teeth-removal ================ ======= My daughter might need to have her wisdom teeth out soon so I'm trying to get ahead on information. What are some reasons they might need to come out? What are some risks and concerns with this surgery? I'm also interested in some food options she could enjoy while healing. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Fact Finding,Q&A You can only respond to the prompt using the information in the context block and no other sources.,"Based on this text, what are the primary differences between customer surveys and customer feedback collected from other sources?","The most direct method for measuring retail shoppability is to talk with customers. This can be as simple as asking shoppers what they like and dislike about the store, or a more structured questionnaire where people evaluate the quality of the shopping experience on several dimensions. Focus group studies can be a useful first step to identify problems with the shopping environment, but surveys are a better tool for the ongoing measurement and evaluation of store performance. A survey might ask shoppers to rate the store on specific features, including the breadth and depth of product assortments, the perception of product quality and value, the attractiveness of displays and merchandising, the ease of navigation, the level of shopping convenience, the availability of product information, the frequency of out-of-stocks, the quality of service, and the speed of checkout; as well as collecting more general reactions, such as overall enjoyment of the shopping experience, satisfaction with the products purchased, likelihood of recommending the store, and intention to return in the future. One common technique for collecting this information is the exit interview, where customers are asked to share their reactions after completing the shopping trip. The survey can be conducted immediately following the store visit — shoppers are intercepted and questioned as they leave the store — or at a later time using the customer’s phone number or e-mail address captured at checkout. Alternatively, the retailer can print the telephone number or web address of an automated survey on the sales receipt, along with an incentive to complete the interview. Another popular data-collection method is the critical incident technique. Shoppers are contacted at home and asked to remember the last time they went shopping for a particular product. Consumers recall the positive and negative aspects of the shopping experience and offer suggestions for improvement. Customer feedback can be collected on an ongoing basis from several other sources. Customer comments, complaints and suggestions at an in-store service desk or remote call center may suggest difficulties with service quality and other aspects of the shopping experience. Superquinn actively solicits such feedback from customers by rewarding each shopper with 100 SuperClub loyalty program points each time they report a company goof. Product returns and exchanges highlight potential problems in product quality and customer education. Customer inquiries, both in the store and through a toll-free number, can signal demand for new products. Employees are also a valuable source of information on what customers want, how they shop, and the obstacles they encounter. Survey research offers several benefits. It provides quick and inexpensive consumer feedback. It generates diagnostic information that can help guide improvements in the shopping experience. It allows the researcher to evaluate the importance of shopping factors for specific consumer segments and product categories. Store ratings can be benchmarked against competitors and tracked over time to evaluate performance. Surveys also have limitations that should be kept in mind. Consumers may not notice or report poor performance because it is what they have come to expect. Consumer memory is limited, so shoppers may not recall shelf arrangements, merchandising, and promotions, even though these variables affect their behavior. Consumers are only knowledgeable about the specific stores and categories they shop, so some ratings may not be reliable. Finally, it can be difficult to relate survey results to more objective measures of store performance.","You can only respond to the prompt using the information in the context block and no other sources. Based on this text, what are the primary differences between customer surveys and customer feedback collected from other sources? The most direct method for measuring retail shoppability is to talk with customers. This can be as simple as asking shoppers what they like and dislike about the store, or a more structured questionnaire where people evaluate the quality of the shopping experience on several dimensions. Focus group studies can be a useful first step to identify problems with the shopping environment, but surveys are a better tool for the ongoing measurement and evaluation of store performance. A survey might ask shoppers to rate the store on specific features, including the breadth and depth of product assortments, the perception of product quality and value, the attractiveness of displays and merchandising, the ease of navigation, the level of shopping convenience, the availability of product information, the frequency of out-of-stocks, the quality of service, and the speed of checkout; as well as collecting more general reactions, such as overall enjoyment of the shopping experience, satisfaction with the products purchased, likelihood of recommending the store, and intention to return in the future. One common technique for collecting this information is the exit interview, where customers are asked to share their reactions after completing the shopping trip. The survey can be conducted immediately following the store visit — shoppers are intercepted and questioned as they leave the store — or at a later time using the customer’s phone number or e-mail address captured at checkout. Alternatively, the retailer can print the telephone number or web address of an automated survey on the sales receipt, along with an incentive to complete the interview. Another popular data-collection method is the critical incident technique. Shoppers are contacted at home and asked to remember the last time they went shopping for a particular product. Consumers recall the positive and negative aspects of the shopping experience and offer suggestions for improvement. Customer feedback can be collected on an ongoing basis from several other sources. Customer comments, complaints and suggestions at an in-store service desk or remote call center may suggest difficulties with service quality and other aspects of the shopping experience. Superquinn actively solicits such feedback from customers by rewarding each shopper with 100 SuperClub loyalty program points each time they report a company goof. Product returns and exchanges highlight potential problems in product quality and customer education. Customer inquiries, both in the store and through a toll-free number, can signal demand for new products. Employees are also a valuable source of information on what customers want, how they shop, and the obstacles they encounter. Survey research offers several benefits. It provides quick and inexpensive consumer feedback. It generates diagnostic information that can help guide improvements in the shopping experience. It allows the researcher to evaluate the importance of shopping factors for specific consumer segments and product categories. Store ratings can be benchmarked against competitors and tracked over time to evaluate performance. Surveys also have limitations that should be kept in mind. Consumers may not notice or report poor performance because it is what they have come to expect. Consumer memory is limited, so shoppers may not recall shelf arrangements, merchandising, and promotions, even though these variables affect their behavior. Consumers are only knowledgeable about the specific stores and categories they shop, so some ratings may not be reliable. Finally, it can be difficult to relate survey results to more objective measures of store performance.",Retail/Product,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","I own a small jewelry retail business with three employees and want to improve profitability by reducing theft. My store is located in a shopping mall, with one entry and exit. We just opened a few months ago and my new loss prevention manager needs four strategies we can implement focusing on customer awareness to help turn my business around. We have about three cameras using CCTV and a POS system on two registers. We are a high traffic store and I need these strategies quick, we open in a few hours.","Loss prevention is how you prevent inventory loss and preserve profits. It’s a critical concern for retailers, amounting to over $94.5 billion in U.S. retail losses in 2021. It’s no wonder some 45% of retailers increased their loss prevention budgets in 2022. They know that theft, fraud, and unexplained inventory shrinkage can quickly eat up profits. Loss prevention is any practice designed to reduce a business's losses from theft, fraud, and operational errors. The goal of loss prevention is to eliminate preventable loss and preserve profits. It’s primarily found in retail, but also exists in other business environments. Managing loss prevention can feel overwhelming, especially if you’re a small to mid-sized operation. By implementing a few key security measures, however, you can reduce your risk of loss and improve profitability. Retail loss prevention consists of identifying shrinkage causes and following up with solutions. Businesses often implement strategies like hiring a loss prevention manager or installing security cameras to improve loss prevention and increase profits. It occurs in various scenarios, such as misappropriation of funds, time theft, falsified expense reports, etc. Internal theft can be caused by both customers and employees and can cost organizations thousands of dollars annually. You can also keep your store safe by monitoring activity with CCTV (closed-circuit television). These cameras can watch entry points into the store, like the customer entrance and loading docks. They record what's going on so you can see if anyone's trying to get in who shouldn't. Using CCTV also acts as a deterrent for potential thieves. It gives the appearance of strong security and shows you take losses seriously. Over 93% of retailers have a security policy or “code of conduct” for preventing loss and keeping people safe. For customers, your policy may include: Guidelines for respecting other customers and employees. Directions for reporting potential theft to store staff. Rules against stealing or damaging items. Train your employees on the rules and expectations of your security policy. Meetings and trainings are good ways to remind employees about the policy. To remind customers about the rules, you can also post signs around the store. inventory control is a system that retailers use to manage and track their inventory levels. This includes tracking product flow in and out of the store and keeping accurate sales records. You can reduce inventory losses and boost profits by implementing an inventory control system. It's important for retailers to invest in effective employee training to prevent shoplifting and other types of fraud. Educating staff on recognizing and preventing crimes can further protect your business and customers. There are many types of awareness and education programs. The NRF’s National Security Survey asked which programs retailers used to train and educate team members about loss prevention and retail asset protection. Here are the top initiatives they found: Anonymous telephone “hotline” program (87.9%) Active shooter training programs (84.5%) Bulletin board notices/posters (82.8%) Internet/computer-based training videos (79.3%) Face-to-face training during new hire orientation (74.1%) Anonymous online/email notification program (60.3%) It's easy to get loss prevention training. You can take an online course from Loss Prevention Academy or Loss Prevention Foundation or hire a third-party security and loss prevention expert to train your employees. Put up anti-theft signs. Signage around your store can help keep losses at a minimum. These are small reminders for potential shoplifters that tell them not to steal from your store. It can help deter people who don’t want to pay for items, especially if they know they are on camera. Use a third-party accountant. Work with an external accountant to ensure your accounts are accurate and up-to-date. They can give you an unbiased look at your records, identify any discrepancies in your profits and losses, and help you track inventory more effectively. Use your POS to identify loss. Sales and inventory reports help identify trends in missing items. It can also highlight patterns in gift card sales, returns and exchanges, and provide insight into who was working during times when suspicious activity took place. Hire a loss prevention specialist. These professionals are trained to identify potential areas of vulnerability and implement measures to help combat theft or fraud. Although Sears Canada finished shutting all its doors in early 2018, we can still learn from its example on the loss prevention front. Sears Canada focused on combining old standbys and cutting-edge technology. It armed loss prevention personnel with the best tools, not just the newest. It relied on video surveillance in all Sears Canada stores—but not to catch shoplifters after the fact. The loss prevention team used data and video analysis of in-store surveillance cameras to identify patterns, like areas of the store where customers spent a lot of time. By analyzing these patterns and sharing them across all stores, the team was better able to train their focus on “hot spots,” or areas prone to theft activity, and to catch shoplifting behaviors before they became a problem. One of the bigger retail developments of the past decade has been the appearance of self-checkout lines at major chains. Eliminating the cashier (scanning each item, interacting with customers, observing behavior) presents an obvious barrier to loss prevention efforts. Target approached this problem by leaning hard into one of the anti-shoplifting tactics above: conspicuous surveillance. If you’ve gone through self-checkout at a Target store recently, you might have noticed—right at eye level—your own face staring back at you. “You’re being monitored,” it reminds you. Target also trains surveillance on the scanner, so loss prevention personnel can see which items the customer scanned and which they didn't.","""================ ======= Loss prevention is how you prevent inventory loss and preserve profits. It’s a critical concern for retailers, amounting to over $94.5 billion in U.S. retail losses in 2021. It’s no wonder some 45% of retailers increased their loss prevention budgets in 2022. They know that theft, fraud, and unexplained inventory shrinkage can quickly eat up profits. Loss prevention is any practice designed to reduce a business's losses from theft, fraud, and operational errors. The goal of loss prevention is to eliminate preventable loss and preserve profits. It’s primarily found in retail, but also exists in other business environments. Managing loss prevention can feel overwhelming, especially if you’re a small to mid-sized operation. By implementing a few key security measures, however, you can reduce your risk of loss and improve profitability. Retail loss prevention consists of identifying shrinkage causes and following up with solutions. Businesses often implement strategies like hiring a loss prevention manager or installing security cameras to improve loss prevention and increase profits. It occurs in various scenarios, such as misappropriation of funds, time theft, falsified expense reports, etc. Internal theft can be caused by both customers and employees and can cost organizations thousands of dollars annually. You can also keep your store safe by monitoring activity with CCTV (closed-circuit television). These cameras can watch entry points into the store, like the customer entrance and loading docks. They record what's going on so you can see if anyone's trying to get in who shouldn't. Using CCTV also acts as a deterrent for potential thieves. It gives the appearance of strong security and shows you take losses seriously. Over 93% of retailers have a security policy or “code of conduct” for preventing loss and keeping people safe. For customers, your policy may include: Guidelines for respecting other customers and employees. Directions for reporting potential theft to store staff. Rules against stealing or damaging items. Train your employees on the rules and expectations of your security policy. Meetings and trainings are good ways to remind employees about the policy. To remind customers about the rules, you can also post signs around the store. inventory control is a system that retailers use to manage and track their inventory levels. This includes tracking product flow in and out of the store and keeping accurate sales records. You can reduce inventory losses and boost profits by implementing an inventory control system. It's important for retailers to invest in effective employee training to prevent shoplifting and other types of fraud. Educating staff on recognizing and preventing crimes can further protect your business and customers. There are many types of awareness and education programs. The NRF’s National Security Survey asked which programs retailers used to train and educate team members about loss prevention and retail asset protection. Here are the top initiatives they found: Anonymous telephone “hotline” program (87.9%) Active shooter training programs (84.5%) Bulletin board notices/posters (82.8%) Internet/computer-based training videos (79.3%) Face-to-face training during new hire orientation (74.1%) Anonymous online/email notification program (60.3%) It's easy to get loss prevention training. You can take an online course from Loss Prevention Academy or Loss Prevention Foundation or hire a third-party security and loss prevention expert to train your employees. Put up anti-theft signs. Signage around your store can help keep losses at a minimum. These are small reminders for potential shoplifters that tell them not to steal from your store. It can help deter people who don’t want to pay for items, especially if they know they are on camera. Use a third-party accountant. Work with an external accountant to ensure your accounts are accurate and up-to-date. They can give you an unbiased look at your records, identify any discrepancies in your profits and losses, and help you track inventory more effectively. Use your POS to identify loss. Sales and inventory reports help identify trends in missing items. It can also highlight patterns in gift card sales, returns and exchanges, and provide insight into who was working during times when suspicious activity took place. Hire a loss prevention specialist. These professionals are trained to identify potential areas of vulnerability and implement measures to help combat theft or fraud. Although Sears Canada finished shutting all its doors in early 2018, we can still learn from its example on the loss prevention front. Sears Canada focused on combining old standbys and cutting-edge technology. It armed loss prevention personnel with the best tools, not just the newest. It relied on video surveillance in all Sears Canada stores—but not to catch shoplifters after the fact. The loss prevention team used data and video analysis of in-store surveillance cameras to identify patterns, like areas of the store where customers spent a lot of time. By analyzing these patterns and sharing them across all stores, the team was better able to train their focus on “hot spots,” or areas prone to theft activity, and to catch shoplifting behaviors before they became a problem. One of the bigger retail developments of the past decade has been the appearance of self-checkout lines at major chains. Eliminating the cashier (scanning each item, interacting with customers, observing behavior) presents an obvious barrier to loss prevention efforts. Target approached this problem by leaning hard into one of the anti-shoplifting tactics above: conspicuous surveillance. If you’ve gone through self-checkout at a Target store recently, you might have noticed—right at eye level—your own face staring back at you. “You’re being monitored,” it reminds you. Target also trains surveillance on the scanner, so loss prevention personnel can see which items the customer scanned and which they didn't. https://www.shopify.com/retail/loss-prevention#3 ================ ======= I own a small jewelry retail business with three employees and want to improve profitability by reducing theft. My store is located in a shopping mall, with one entry and exit. We just opened a few months ago and my new loss prevention manager needs four strategies we can implement focusing on customer awareness to help turn my business around. We have about three cameras using CCTV and a POS system on two registers. We are a high traffic store and I need these strategies quick, we open in a few hours. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Retail/Product,Find & Summarize,Text Transformation "Give a maximum of three bullet points for each, and use only the information provided in the given text below.",Provide some potential benefits and risks of the IoT.,"The IoT is not separate from the Internet, but rather, a potentially huge extension and expansion of it. The “things” that form the basis of the IoT are objects. They could be virtually anything— streetlights, thermostats, electric meters,11 fitness trackers, factory equipment, automobiles, unmanned aircraft systems (UASs or drones),12 or even cows or sheep in a field.13 What makes an object part of the IoT is embedded or attached computer chips or similar components that give the object both a unique identifier and Internet connectivity. Objects with such components are often called “smart”—such as smart meters and smart cars. Internet connectivity allows a smart object to communicate with computers and with other smart objects. Connections of smart objects to the Internet can be wired, such as through Ethernet cables, or wireless, such as via a Wi-Fi or cellular network. To enable precise communications, each IoT object must be uniquely identifiable. That is accomplished through an Internet Protocol (IP) address, a number assigned to each Internet connected device, whether a desktop computer, a mobile phone, a printer, or an IoT object.14 Those IP addresses ensure that the device or object sending or receiving information is correctly identified. What kinds of information do IoT objects communicate? The answer depends on the nature of the object, and it can be simple or complex. For example, a smart thermometer might have only one sensor, used to communicate ambient temperature to a remote weather-monitoring center. A wireless medical device might, in contrast, use various sensors to communicate a person’s body temperature, pulse, blood pressure, and other variables to a medical service provider via a computer or mobile phone. Smart objects can also be involved in command networks. For example, industrial control systems can adjust manufacturing processes based on input from both other IoT objects and human operators. Network connectivity can permit such operations to be performed in “real time”—that is, almost instantaneously. Smart objects can form systems that communicate information and commands among themselves, usually in concert with computers they connect to. This kind of communication enables the use of smart systems in homes, vehicles, factories, and even entire cities. Smart systems allow for automated and remote control of many processes. A smart home can permit remote control of lighting, security, HVAC (heating, ventilating, and air conditioning), and appliances. In a smart city, an intelligent transportation system (ITS) may permit vehicles to communicate with other vehicles and roadways to determine the fastest route to a destination, avoiding traffic jams, and traffic signals can be adjusted based on congestion information received from cameras and other sensors.15 Buildings might automatically adjust electric usage, based on information sent from remote thermometers and other sensors.16 An Industrial Internet application can permit companies to monitor production systems and adjust processes, remotely control and synchronize machinery operations, track inventory and supply chains, and perform other tasks.17 IoT connections and communications can be created across a broad range of objects and networks and can transform previously independent processes into integrated systems. These integrated systems can potentially have substantial effects on homes and communities, factories and cities, and every sector of the economy, both domestically and globally. What Impacts Will the IoT Have? The IoT may significantly affect many aspects of the economy and society, although the full extent and nature of its eventual impacts remains uncertain. Many observers predict that the growth of the IoT will bring positive benefits through enhanced integration, efficiency, and productivity across many sectors of the U.S. and global economies.18 Among those commonly mentioned are agriculture, energy, health care, manufacturing, and transportation. Significant impacts may also be felt more broadly on economic growth, infrastructure and cities, and individual consumers. However, both policy and technical challenges, including security and privacy issues, might inhibit the growth and impact of IoT innovations. Economic Growth Several economic analyses have predicted that the IoT will contribute significantly to economic growth over the next decade, but the predictions vary substantially in magnitude. The current global IoT market has been valued at about $2 trillion, with estimates of its predicted value over the next 5 to 10 years varying from $4 trillion to $11 trillion.19 Such variability demonstrates the difficulty of making economic forecasts in the face of various uncertainties, including a lack of consensus among researchers about exactly what the IoT is and how it will develop.20 Economic Sectors Agriculture The IoT can be leveraged by the agriculture industry through precision agriculture, with the goal of optimizing production and efficiency while reducing costs and environmental impacts. For farming operations, it involves analysis of detailed, often real-time data on weather, soil and air quality, water supply, pest populations, crop maturity, and other factors such as the cost and availability of equipment and labor.21 Field sensors test soil moisture and chemical balance, which can be coupled with location technologies to enable precise irrigation and fertilization.22 Drones and satellites can be used to take detailed images of fields, giving farmers information about crop yield, nutrient deficiencies, and weed locations.23 For ranching and animal operations, radio frequency identification (RFID) chips and electronic identification readers (EID) help monitor animal movements, feeding patterns, and breeding capabilities, while maintaining detailed records on individual animals.24 Energy Within the energy sector, the IoT may impact both production and delivery, for example through facilitating monitoring of oil wellheads and pipelines.25 When IoT components are embedded into parts of the electrical grid, the resulting infrastructure is commonly referred to as the “smart grid.”26 This use of IoT enables greater control by utilities over the flow of electricity and can enhance the efficiency of grid operations.27 It can also expedite the integration of microgenerators into the grid.28 Smart-grid technology can also provide consumers with greater knowledge and control of their energy usage through the use of smart meters in the home or office.29 Connection of smart meters to a building’s HVAC, lighting, and other systems can result in “smart buildings” that integrate the operation of those systems.30 Smart buildings use sensors and other data to automatically adjust room temperatures, lighting, and overall energy usage, resulting in greater efficiency and lower energy cost.31 Information from adjacent buildings may be further integrated to provide additional efficiencies in a neighborhood or larger division in a city.","Provide some potential benefits and risks of the IoT. Give a maximum of three bullet points for each, and use only the information provided in the given text below. The IoT is not separate from the Internet, but rather, a potentially huge extension and expansion of it. The “things” that form the basis of the IoT are objects. They could be virtually anything— streetlights, thermostats, electric meters,11 fitness trackers, factory equipment, automobiles, unmanned aircraft systems (UASs or drones),12 or even cows or sheep in a field.13 What makes an object part of the IoT is embedded or attached computer chips or similar components that give the object both a unique identifier and Internet connectivity. Objects with such components are often called “smart”—such as smart meters and smart cars. Internet connectivity allows a smart object to communicate with computers and with other smart objects. Connections of smart objects to the Internet can be wired, such as through Ethernet cables, or wireless, such as via a Wi-Fi or cellular network. To enable precise communications, each IoT object must be uniquely identifiable. That is accomplished through an Internet Protocol (IP) address, a number assigned to each Internet connected device, whether a desktop computer, a mobile phone, a printer, or an IoT object.14 Those IP addresses ensure that the device or object sending or receiving information is correctly identified. What kinds of information do IoT objects communicate? The answer depends on the nature of the object, and it can be simple or complex. For example, a smart thermometer might have only one sensor, used to communicate ambient temperature to a remote weather-monitoring center. A wireless medical device might, in contrast, use various sensors to communicate a person’s body temperature, pulse, blood pressure, and other variables to a medical service provider via a computer or mobile phone. Smart objects can also be involved in command networks. For example, industrial control systems can adjust manufacturing processes based on input from both other IoT objects and human operators. Network connectivity can permit such operations to be performed in “real time”—that is, almost instantaneously. Smart objects can form systems that communicate information and commands among themselves, usually in concert with computers they connect to. This kind of communication enables the use of smart systems in homes, vehicles, factories, and even entire cities. Smart systems allow for automated and remote control of many processes. A smart home can permit remote control of lighting, security, HVAC (heating, ventilating, and air conditioning), and appliances. In a smart city, an intelligent transportation system (ITS) may permit vehicles to communicate with other vehicles and roadways to determine the fastest route to a destination, avoiding traffic jams, and traffic signals can be adjusted based on congestion information received from cameras and other sensors.15 Buildings might automatically adjust electric usage, based on information sent from remote thermometers and other sensors.16 An Industrial Internet application can permit companies to monitor production systems and adjust processes, remotely control and synchronize machinery operations, track inventory and supply chains, and perform other tasks.17 IoT connections and communications can be created across a broad range of objects and networks and can transform previously independent processes into integrated systems. These integrated systems can potentially have substantial effects on homes and communities, factories and cities, and every sector of the economy, both domestically and globally. What Impacts Will the IoT Have? The IoT may significantly affect many aspects of the economy and society, although the full extent and nature of its eventual impacts remains uncertain. Many observers predict that the growth of the IoT will bring positive benefits through enhanced integration, efficiency, and productivity across many sectors of the U.S. and global economies.18 Among those commonly mentioned are agriculture, energy, health care, manufacturing, and transportation. Significant impacts may also be felt more broadly on economic growth, infrastructure and cities, and individual consumers. However, both policy and technical challenges, including security and privacy issues, might inhibit the growth and impact of IoT innovations. Economic Growth Several economic analyses have predicted that the IoT will contribute significantly to economic growth over the next decade, but the predictions vary substantially in magnitude. The current global IoT market has been valued at about $2 trillion, with estimates of its predicted value over the next 5 to 10 years varying from $4 trillion to $11 trillion.19 Such variability demonstrates the difficulty of making economic forecasts in the face of various uncertainties, including a lack of consensus among researchers about exactly what the IoT is and how it will develop.20 Economic Sectors Agriculture The IoT can be leveraged by the agriculture industry through precision agriculture, with the goal of optimizing production and efficiency while reducing costs and environmental impacts. For farming operations, it involves analysis of detailed, often real-time data on weather, soil and air quality, water supply, pest populations, crop maturity, and other factors such as the cost and availability of equipment and labor.21 Field sensors test soil moisture and chemical balance, which can be coupled with location technologies to enable precise irrigation and fertilization.22 Drones and satellites can be used to take detailed images of fields, giving farmers information about crop yield, nutrient deficiencies, and weed locations.23 For ranching and animal operations, radio frequency identification (RFID) chips and electronic identification readers (EID) help monitor animal movements, feeding patterns, and breeding capabilities, while maintaining detailed records on individual animals.24 Energy Within the energy sector, the IoT may impact both production and delivery, for example through facilitating monitoring of oil wellheads and pipelines.25 When IoT components are embedded into parts of the electrical grid, the resulting infrastructure is commonly referred to as the “smart grid.”26 This use of IoT enables greater control by utilities over the flow of electricity and can enhance the efficiency of grid operations.27 It can also expedite the integration of microgenerators into the grid.28 Smart-grid technology can also provide consumers with greater knowledge and control of their energy usage through the use of smart meters in the home or office.29 Connection of smart meters to a building’s HVAC, lighting, and other systems can result in “smart buildings” that integrate the operation of those systems.30 Smart buildings use sensors and other data to automatically adjust room temperatures, lighting, and overall energy usage, resulting in greater efficiency and lower energy cost.31 Information from adjacent buildings may be further integrated to provide additional efficiencies in a neighborhood or larger division in a city.",Internet/Technology,Find & Summarize,Text Transformation "Use only the information contained in the prompt to answer any questions the user may ask. Do not use any other sources or any information from your stored data from before this conversation. If you cannot answer the user's question using only the provided context, say ""I can't determine the answer as the information you are seeking is not provided in the reference document."" Format your answer in a bullet point list. ",What mechanisms have been proposed for post-Covid neurological complications?,"Introduction The predominant acute presentations of COVID-19 are respiratory, but neurological manifestations have been recognized as an important component of the disease, even in cases without respiratory symptoms (2-5). The neurological manifestations associated with COVID-19 range from mild to critical, affect adults and children and can present both during and after acute COVID-19 infection. Reported neurological signs, symptoms or syndromes in the acute phase include headache, dizziness, impaired taste or smell, delirium, agitation, stroke, seizures, coma, meningoencephalitis and Guillain-Barré syndrome (6, 7). Consequences in the post-acute phase are also emerging, as either persisting or newly developing signs and symptoms (post-COVID-19 condition); these include headache, problems with smell or taste, cognitive impairment, confusion, fatigue, difficulty concentrating, sleep disturbances and neuropsychiatric symptoms (8, 9). COVID-19 disproportionately affects people with pre-existing neurological disorders. Chronic neurological disorders were found to be independently associated with increased mortality in hospitalized COVID-19 patients (hazard ratio [HR]: 2.13; 95% confidence interval [CI]: 1.38–3.28) (10). Individuals with pre-existing neurological conditions have been affected by disruptions to routine care, delayed care because of concerns about infectious risks and disruptions to supply chains for medicines and resultant stock-outs (11). This scientific brief provides a comprehensive overview of the relationship between neurology and COVID-19 and covers what is currently known about: • the acute neurological manifestations of COVID-19 • the neurological sequelae associated with post-COVID-19 condition • the risk of infection, severe illness and mortality from COVID-19 for people with pre-existing neurological conditions • the extent of disruptions to neurological services caused by the pandemic and mitigation strategies to address these disruptions • emerging evidence for neurological complications following COVID-19 vaccination. The target audience for this document includes health care providers, researchers, policy-makers and other stakeholders interested in the evidence relating to neurology and COVID-19. The aim is to increase awareness and recognition of the associated neurological aspects of COVID-19 to improve care and mitigation responses, particularly in low-resource settings. Methods This scientific brief is based on the evidence that emerged from systematic or rapid reviews and meta-analyses commissioned by WHO (14);1 WHO pulse surveys (15); WHO’s rapid assessment on services for mental, neurological and substance use (MNS) disorders (16) and other relevant publications. A commissioned rapid review. (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3907265); and Misra S, Kolappa K, Prasad M, Radhakrishnan D, Thakur KT, Solomon T. et al. Frequency of neurological manifestations in COVID-19: a systematic review and meta-analysis of 350 studies (https://www.medrxiv.org/content/10.1101/2021.04.20.21255780v1) 1 Neurology and COVID-19: Scientific brief -2- Review of the evidence Acute neurological manifestations of COVID-19 To assess the types and frequencies of reported neurological manifestations associated with COVID-19, WHO assisted with a systematic review and meta-analysis involving data from 145 721 patients with acute COVID-19 infections derived from 350 case series (17). COVID-19 infection was confirmed by real-time reverse-transcription polymerase chain reaction (RT-PCR) detection, high-throughput sequencing, SARS-CoV-2 viral culture in throat swab specimens, SARS-CoV-2 antibody detection in blood samples or SARS-CoV-2 viral culture in throat swab specimens. Most patients (n=129 786, 89%) included in the review were hospitalized. A total of 23 acute neurological symptoms (Table 1) and 14 neurological diagnoses (Table 2) were reported in the literature. Up to one third (n=48 059) of COVID-19 patients experienced some type of neurological manifestation, and 1 in 50 developed a stroke. In COVID-19 patients aged over 60 years, the most frequent neurological manifestation was acute confusion/delirium (pooled prevalence: 34%; 95% CI: 23–46%). For all ages, the likelihood of experiencing acute confusion/delirium, stroke, seizure and movement disorders increased with increasing severity of COVID-19, but these associations were not statistically significant. Smell and taste impairments were significantly associated with non-severe COVID-19 (odds ratio [OR]: 0.44; 95% CI: 0.28–0.68 and OR: 0.62; 95% CI: 0.42–0.91, respectively). In COVID-19 patients aged over 60 years, the presence of any neurological manifestations was associated with significantly increased mortality (OR: 1.80; 95% CI: 1.11–2.91). Limitations The overall risk of bias was assessed as being low for most studies (n=296, 85%) but studies with higher risk of bias yielded higher prevalence estimates. Also, for most outcomes the meta-analyses yielded a high degree of heterogeneity, indicating substantial clinical or methodological diversity, which in some instances rendered the pooling of data inappropriate. There are gaps in the evidence for non-hospitalized patient cohorts because their data are rarely reported in the literature. The evidence gaps have implications for incidence, prevalence, duration and severity. Similarly, the timing of the onset of signs or symptoms is often not reported. Limitations in study design of included case series precluded the comparison between acute neurological manifestations caused by COVID-19 and the incidence of such manifestations in the general population. Finally, in the absence of well-designed cohort studies, there are insufficient data to definitively assert causality between these symptoms and COVID-19. Neurological sequelae associated with post-COVID-19 condition Complications following acute viral illnesses are well described (18, 19). Soon after the advent of the COVID-19 pandemic, longitudinal cohort studies started to assess long-term sequelae of COVID-19, including neurological manifestations. At the same time, patients began to connect with each other and report on prolonged symptoms of COVID-19. In response, WHO commissioned a rapid review of 28 published population-based, cohort or case-control studies2. The review established specific new-onset neurological symptoms, signs or diagnoses occurring after the acute phase of COVID-19 that can be interpreted as complications of COVID-19; assessed specific neurological symptoms, signs or diagnoses that persist after the acute phase of COVID-19; and determined factors associated with these post acute neurological manifestations. Of the 28 studies, only two followed patients for up to 6 months. Pooling of information was not possible for methodological reasons. In a retrospective cohort of 1733 COVID-19 patients discharged from hospital, 19.6% (n=340) reported neurological manifestations after a median follow-up of 186 days (9). The complaints most commonly reported were fatigue or muscle weakness (63%; 1038/1655) and sleep difficulties (26%; 437/1655). Anxiety and depression were reported by 23% (367/1617) of patients and difficulty walking by 24% (103/423). The second prospective study followed 61 hospitalized COVID-19 patients with and without history of admission to an intensive care unit (ICU) (20). 2 Beghi E, Giussani G, Westenberg E, Allegri R, Garcia-Azorin D, Guekht A, Acute and Post-Acute Neurological Manifestations of COVID-19: Present findings, critical appraisal, and future directions. Manuscript in preparation, 2021. Neurology and COVID-19: Scientific brief Common complaints at discharge included amnestic dysfunction (30%; 18/61), dysexecutive syndrome (33%; 20/61), ataxia (11%, 7/61), and tetraparesis (18%; 11/61) (20). Limitations The evidence for long-term or newly emerging neurological complications after COVID-19 is limited, particularly in asymptomatic or non-hospitalized patients. Similarly, little is known about neurological sequelae in paediatric patients with conditions related to COVID-19, including multisystem inflammatory syndrome (MIS-C). Data from low- and middle-income countries are scarce, particularly in the post-acute phase. This has led to underreporting of neurological findings in the context of COVID-19 with reference to geography, ethnicity and sociocultural environment. Methodological issues and study design flaws further reduce the strength of the current evidence because some studies have included in the control group asymptomatic patients who were not screened with molecular or serological tests to confirm or exclude SARS-CoV-2 infection. Screening methods and diagnostic protocols vary across studies, depending on the background of the local investigators, the diagnostic approach, the number and type of contacts during follow-up and, not least, attrition and patient compliance. In addition, studies were done under surge conditions, which led to incomplete diagnostic assessment. The current understanding of neurological sequelae associated with post-COVID-19 condition is based mainly on patient reports; clinically relevant manifestations; and greater attention towards symptoms, signs and diseases that have been illustrated in previous reports By contrast, information is limited on signs that can be documented only through testing, imaging or biochemical or pathological investigations. Pre-existing neurological conditions and COVID-19 A range of pre-existing noncommunicable diseases (NCDs) are associated with an increased risk of severe outcomes in COVID-19 (21). These include several neurological conditions such as stroke and dementia. People with certain pre existing neurological conditions are more vulnerable to SARS-CoV-2 infection, experience exacerbations of their pre existing disease (22) and have higher risks of severe outcomes and death (10, 23). To synthesize the growing evidence on this topic, WHO commissioned a rapid review of 26 articles from 12 countries across three continents, with a total of 379 947 COVID-19 patients, to establish the risk of infection, severe illness and mortality from COVID-19 for people with pre-existing neurological conditions.3 The rapid review found that certain pre-existing neurological diseases are associated with severity of COVID-19.4 The most prevalent were cerebrovascular disease and dementia/neurodegenerative diseases (pooled OR: 1.99; 95% CI: 1.81 2.18). Mortality was high among people with pre-existing neurological conditions (pooled OR: 1.74; 95% CI: 1.56 1.94). Limitations Risk of bias was deemed high for most articles, and the overall quality of studies using GRADE (Grading of Recommendations Assessment, Development and Evaluations) methodology was low; hence, the value of the current evidence is limited. Most studies on the relationship between SARS-CoV-2 and pre-existing neurological conditions are based on retrospective cohorts or case series, with few data from prospective studies. Future research will benefit greatly from the use of standardized definitions and reporting for comorbidities, neurological symptoms or diagnoses. Use of standardized case report forms – such as those published by WHO (25, 26) – can also contribute to the accuracy and reliability of data. Disruptions to essential neurological services caused by the COVID-19 pandemic and mitigation strategies Interruption of routine treatment and care, as well as supply chains for medications during the COVID-19 pandemic, present significant challenges for people with neurological conditions (11). According to the latest WHO Pulse survey on continuity of essential health services during the COVID-19 pandemic (27), 45% of 121 countries for which information was available still reported disruptions to services for MNS disorders in the first quarter of 2021. Likewise, 3Chomba M, Schiess N, Seeher K, Akpalu A, Baila J, Boruah AP et al. Pre-existing neurological conditions and COVID-19 risk. A commissioned rapid review. (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3907265) 4Ibid. -4- Neurology and COVID-19: Scientific brief disruptions to rehabilitation services, a crucial aspect of neurological care, continue to be reported by 53% (of 89 countries). With respect to neurology-specific services, WHO’s rapid assessment of services for MNS disorders during the COVID-19 pandemic in mid-2020 (16) revealed that one in three of 98 countries closed down neurology inpatient units at least partly during the pandemic. Regarding service provision, surgeries for neurological disorders were disrupted in two-thirds of 130 countries for which information was available, and the management of emergency conditions such as status epilepticus was at least partially disrupted in 35% of the same 130 countries. To better understand the extent of service disruption, its causes and mitigation strategies for neurological disorders in the context of COVID-19, WHO commissioned a rapid review of 369 articles, providing data on 210 419 patients from 105 countries (14). Studies that investigated the extent of service disruption (n=188) described it as mild (n=40, 21%), moderate (n=131, 70%) or severe (n=10, 5%). The most frequently described reasons for service disruption across 240 studies were travel restrictions related to lockdown (n=196, 82%), closure of services or consultations as per health authority directive (n=157, 65%) and reduced outpatient volume due to patients not presenting (n=135, 56%). A total of 224 studies reported on mitigation strategies, with the most frequently reported strategies being telemedicine and other teleconsultation formats (n=184, 82%), novel dispensing approaches for medicines (n=116, 52%) and redirection of patients (n=95, 42%). Limitations To date, most of the data on service disruption have been derived from high- and middle-income countries, with information from low-income countries lacking. Similarly, evidence of the effectiveness and acceptability of mitigation strategies to patients remains limited. In addition, the current published literature seems biased towards certain settings or types of services (e.g. outpatient, emergency or inpatient care). There are few reports on other areas that are crucial for treating people with chronic neurological conditions (e.g. neurorehabilitation). Going forward, more systematic evaluations and reporting of disruption of the whole spectrum of neurological services can provide a more comprehensive picture. Neurological complications following COVID-19 vaccination There is a low risk following COVID-19 vaccination of neurological complications including Bell’s palsy (28), cerebral venous sinus thrombosis (CVST) and possibly Guillain-Barré syndrome (29). However, the risk of such complications is substantially lower than the risks associated with infection with SARS-CoV-2 (30, 31). Since March 2021, cases of thromboses associated with thrombocytopenia have been reported in patients vaccinated with the Oxford-AstraZeneca ChAdOx1-S and Johnson & Johnson (J&J) Janssen Ad26.COV2.S COVID-19 vaccines. Evaluation of the cases by national and international bodies concluded that there was a plausible causal link between these two adenovirus-vectored vaccines and CVST (32-34), based on the temporal association with vaccination and an increased incidence when compared with expected baseline rates of CVST (35-42). WHO has provided guidance for clinical case management of thrombosis with thrombocytopenia syndrome (TTS) following vaccination against COVID-19 (43). Overall knowledge gaps Current evidence suggests that SARS-CoV-2 can affect the nervous system. Multiple and probably overlapping mechanisms have been proposed for the neurological manifestations; they include hypoxia, cytokine storm, post infectious autoimmune responses, hypercoagulability, neurologic complications of severe systemic illness and potential direct neurotropism. Questions remain regarding the characteristics, timing and severity of neurological manifestations of COVID-19, including the pathophysiological mechanisms through which SARS-CoV-2 affects the nervous system. As more data emerge, associations of specific neurological disorders with COVID-19 will be further clarified – as has been seen, for example, with Guillain-Barré syndrome (29). Prospective data, as well as biomarker and neuropathological studies, are needed on the short- and long-term neurological sequelae. Existing reports on the association between COVID-19 and most neurological manifestations are flawed by selection and information bias, and available data reflect the spectrum of neurological manifestations in patients with the more severe COVID-19 cases. Neurological signs or symptoms occurring during the acute phase of COVID-19 infection cannot easily be disentangled from those with onset in the post-acute phase, and follow-up data are scarce, particularly for subclinical findings such as cognitive impairment. -5- Neurology and COVID-19: Scientific brief Other gaps in the literature include a lack of clarity on the interplay between pre-existing neurological disease and other underlying comorbidities such as hypertension and diabetes. Studies in this area were hospital-based and biased to people with more severe symptoms, making the findings difficult to generalize to people based in the community or having only mild symptoms. Understanding the impact of neurological conditions requires the inclusion of diverse populations from a variety of social backgrounds. Guidance is also needed for studies evaluating the disruption or the efficacy of mitigation strategies for care. Efforts should be made to harmonize the methods in this area of research and to enhance the comparability between studies and over time. In addition, funding for and progress in neurological research and training have been affected by the pandemic, owing to the temporary suspension of research projects or postponement or cancellation of fellowships, which need to be re-established as soon as possible (44). Implications for further research Well-designed case–control and cohort studies are needed to understand which patients are most vulnerable to neurological manifestations in the acute and post COVID-19 condition and to understand causality related to COVID 19. Series of patients with neurological conditions need to be compared to patients without neurological conditions. Use of case report forms (CRFs) such as WHO’s post-COVID-19 condition CRF (45) is encouraged to standardize data collection. Future research directions should include more “bottom-up” evidence-gathering efforts; for example, international surveys of neurological associations such as one recently undertaken by the European Federation of Neurological Associations (EFNA) with support from members of the WHO Neurology and COVID-19 Global Forum (46). Conclusion A wide spectrum of acute and post-acute neurological manifestations associated with COVID-19 have been reported across the globe. Clinicians and health care workers should be aware of such presentations and complications even in the absence of respiratory symptoms. Disruptions in access to essential neurological services and availability of essential medications for people with pre-existing neurological conditions can be detrimental; hence, mitigation strategies such as remote technology and telemedicine alternatives should be judiciously employed. The COVID-19 pandemic continues to have an impact on neurological health, service delivery, research and training while widening existing disparities worldwide. Recognizing and addressing these factors will provide opportunities to improve neurological care worldwide. Plans for updating WHO continues to monitor the situation closely for any changes that may affect this scientific brief.","System instruction: Use only the information contained in the prompt to answer any questions the user may ask. Do not use any other sources or any information from your stored data from before this conversation. If you cannot answer the user's question using only the provided context, say ""I can't determine the answer as the information you are seeking is not provided in the reference document."" Format your answer in a bullet point list. Question: What mechanisms have been proposed for post-Covid neurological complications? Context: Introduction The predominant acute presentations of COVID-19 are respiratory, but neurological manifestations have been recognized as an important component of the disease, even in cases without respiratory symptoms (2-5). The neurological manifestations associated with COVID-19 range from mild to critical, affect adults and children and can present both during and after acute COVID-19 infection. Reported neurological signs, symptoms or syndromes in the acute phase include headache, dizziness, impaired taste or smell, delirium, agitation, stroke, seizures, coma, meningoencephalitis and Guillain-Barré syndrome (6, 7). Consequences in the post-acute phase are also emerging, as either persisting or newly developing signs and symptoms (post-COVID-19 condition); these include headache, problems with smell or taste, cognitive impairment, confusion, fatigue, difficulty concentrating, sleep disturbances and neuropsychiatric symptoms (8, 9). COVID-19 disproportionately affects people with pre-existing neurological disorders. Chronic neurological disorders were found to be independently associated with increased mortality in hospitalized COVID-19 patients (hazard ratio [HR]: 2.13; 95% confidence interval [CI]: 1.38–3.28) (10). Individuals with pre-existing neurological conditions have been affected by disruptions to routine care, delayed care because of concerns about infectious risks and disruptions to supply chains for medicines and resultant stock-outs (11). This scientific brief provides a comprehensive overview of the relationship between neurology and COVID-19 and covers what is currently known about: • the acute neurological manifestations of COVID-19 • the neurological sequelae associated with post-COVID-19 condition • the risk of infection, severe illness and mortality from COVID-19 for people with pre-existing neurological conditions • the extent of disruptions to neurological services caused by the pandemic and mitigation strategies to address these disruptions • emerging evidence for neurological complications following COVID-19 vaccination. The target audience for this document includes health care providers, researchers, policy-makers and other stakeholders interested in the evidence relating to neurology and COVID-19. The aim is to increase awareness and recognition of the associated neurological aspects of COVID-19 to improve care and mitigation responses, particularly in low-resource settings. Methods This scientific brief is based on the evidence that emerged from systematic or rapid reviews and meta-analyses commissioned by WHO (14);1 WHO pulse surveys (15); WHO’s rapid assessment on services for mental, neurological and substance use (MNS) disorders (16) and other relevant publications. A commissioned rapid review. (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3907265); and Misra S, Kolappa K, Prasad M, Radhakrishnan D, Thakur KT, Solomon T. et al. Frequency of neurological manifestations in COVID-19: a systematic review and meta-analysis of 350 studies (https://www.medrxiv.org/content/10.1101/2021.04.20.21255780v1) 1 Neurology and COVID-19: Scientific brief -2- Review of the evidence Acute neurological manifestations of COVID-19 To assess the types and frequencies of reported neurological manifestations associated with COVID-19, WHO assisted with a systematic review and meta-analysis involving data from 145 721 patients with acute COVID-19 infections derived from 350 case series (17). COVID-19 infection was confirmed by real-time reverse-transcription polymerase chain reaction (RT-PCR) detection, high-throughput sequencing, SARS-CoV-2 viral culture in throat swab specimens, SARS-CoV-2 antibody detection in blood samples or SARS-CoV-2 viral culture in throat swab specimens. Most patients (n=129 786, 89%) included in the review were hospitalized. A total of 23 acute neurological symptoms (Table 1) and 14 neurological diagnoses (Table 2) were reported in the literature. Up to one third (n=48 059) of COVID-19 patients experienced some type of neurological manifestation, and 1 in 50 developed a stroke. In COVID-19 patients aged over 60 years, the most frequent neurological manifestation was acute confusion/delirium (pooled prevalence: 34%; 95% CI: 23–46%). For all ages, the likelihood of experiencing acute confusion/delirium, stroke, seizure and movement disorders increased with increasing severity of COVID-19, but these associations were not statistically significant. Smell and taste impairments were significantly associated with non-severe COVID-19 (odds ratio [OR]: 0.44; 95% CI: 0.28–0.68 and OR: 0.62; 95% CI: 0.42–0.91, respectively). In COVID-19 patients aged over 60 years, the presence of any neurological manifestations was associated with significantly increased mortality (OR: 1.80; 95% CI: 1.11–2.91). Limitations The overall risk of bias was assessed as being low for most studies (n=296, 85%) but studies with higher risk of bias yielded higher prevalence estimates. Also, for most outcomes the meta-analyses yielded a high degree of heterogeneity, indicating substantial clinical or methodological diversity, which in some instances rendered the pooling of data inappropriate. There are gaps in the evidence for non-hospitalized patient cohorts because their data are rarely reported in the literature. The evidence gaps have implications for incidence, prevalence, duration and severity. Similarly, the timing of the onset of signs or symptoms is often not reported. Limitations in study design of included case series precluded the comparison between acute neurological manifestations caused by COVID-19 and the incidence of such manifestations in the general population. Finally, in the absence of well-designed cohort studies, there are insufficient data to definitively assert causality between these symptoms and COVID-19. Neurological sequelae associated with post-COVID-19 condition Complications following acute viral illnesses are well described (18, 19). Soon after the advent of the COVID-19 pandemic, longitudinal cohort studies started to assess long-term sequelae of COVID-19, including neurological manifestations. At the same time, patients began to connect with each other and report on prolonged symptoms of COVID-19. In response, WHO commissioned a rapid review of 28 published population-based, cohort or case-control studies2. The review established specific new-onset neurological symptoms, signs or diagnoses occurring after the acute phase of COVID-19 that can be interpreted as complications of COVID-19; assessed specific neurological symptoms, signs or diagnoses that persist after the acute phase of COVID-19; and determined factors associated with these post acute neurological manifestations. Of the 28 studies, only two followed patients for up to 6 months. Pooling of information was not possible for methodological reasons. In a retrospective cohort of 1733 COVID-19 patients discharged from hospital, 19.6% (n=340) reported neurological manifestations after a median follow-up of 186 days (9). The complaints most commonly reported were fatigue or muscle weakness (63%; 1038/1655) and sleep difficulties (26%; 437/1655). Anxiety and depression were reported by 23% (367/1617) of patients and difficulty walking by 24% (103/423). The second prospective study followed 61 hospitalized COVID-19 patients with and without history of admission to an intensive care unit (ICU) (20). 2 Beghi E, Giussani G, Westenberg E, Allegri R, Garcia-Azorin D, Guekht A, Acute and Post-Acute Neurological Manifestations of COVID-19: Present findings, critical appraisal, and future directions. Manuscript in preparation, 2021. Neurology and COVID-19: Scientific brief Common complaints at discharge included amnestic dysfunction (30%; 18/61), dysexecutive syndrome (33%; 20/61), ataxia (11%, 7/61), and tetraparesis (18%; 11/61) (20). Limitations The evidence for long-term or newly emerging neurological complications after COVID-19 is limited, particularly in asymptomatic or non-hospitalized patients. Similarly, little is known about neurological sequelae in paediatric patients with conditions related to COVID-19, including multisystem inflammatory syndrome (MIS-C). Data from low- and middle-income countries are scarce, particularly in the post-acute phase. This has led to underreporting of neurological findings in the context of COVID-19 with reference to geography, ethnicity and sociocultural environment. Methodological issues and study design flaws further reduce the strength of the current evidence because some studies have included in the control group asymptomatic patients who were not screened with molecular or serological tests to confirm or exclude SARS-CoV-2 infection. Screening methods and diagnostic protocols vary across studies, depending on the background of the local investigators, the diagnostic approach, the number and type of contacts during follow-up and, not least, attrition and patient compliance. In addition, studies were done under surge conditions, which led to incomplete diagnostic assessment. The current understanding of neurological sequelae associated with post-COVID-19 condition is based mainly on patient reports; clinically relevant manifestations; and greater attention towards symptoms, signs and diseases that have been illustrated in previous reports By contrast, information is limited on signs that can be documented only through testing, imaging or biochemical or pathological investigations. Pre-existing neurological conditions and COVID-19 A range of pre-existing noncommunicable diseases (NCDs) are associated with an increased risk of severe outcomes in COVID-19 (21). These include several neurological conditions such as stroke and dementia. People with certain pre existing neurological conditions are more vulnerable to SARS-CoV-2 infection, experience exacerbations of their pre existing disease (22) and have higher risks of severe outcomes and death (10, 23). To synthesize the growing evidence on this topic, WHO commissioned a rapid review of 26 articles from 12 countries across three continents, with a total of 379 947 COVID-19 patients, to establish the risk of infection, severe illness and mortality from COVID-19 for people with pre-existing neurological conditions.3 The rapid review found that certain pre-existing neurological diseases are associated with severity of COVID-19.4 The most prevalent were cerebrovascular disease and dementia/neurodegenerative diseases (pooled OR: 1.99; 95% CI: 1.81 2.18). Mortality was high among people with pre-existing neurological conditions (pooled OR: 1.74; 95% CI: 1.56 1.94). Limitations Risk of bias was deemed high for most articles, and the overall quality of studies using GRADE (Grading of Recommendations Assessment, Development and Evaluations) methodology was low; hence, the value of the current evidence is limited. Most studies on the relationship between SARS-CoV-2 and pre-existing neurological conditions are based on retrospective cohorts or case series, with few data from prospective studies. Future research will benefit greatly from the use of standardized definitions and reporting for comorbidities, neurological symptoms or diagnoses. Use of standardized case report forms – such as those published by WHO (25, 26) – can also contribute to the accuracy and reliability of data. Disruptions to essential neurological services caused by the COVID-19 pandemic and mitigation strategies Interruption of routine treatment and care, as well as supply chains for medications during the COVID-19 pandemic, present significant challenges for people with neurological conditions (11). According to the latest WHO Pulse survey on continuity of essential health services during the COVID-19 pandemic (27), 45% of 121 countries for which information was available still reported disruptions to services for MNS disorders in the first quarter of 2021. Likewise, 3Chomba M, Schiess N, Seeher K, Akpalu A, Baila J, Boruah AP et al. Pre-existing neurological conditions and COVID-19 risk. A commissioned rapid review. (https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3907265) 4Ibid. -4- Neurology and COVID-19: Scientific brief disruptions to rehabilitation services, a crucial aspect of neurological care, continue to be reported by 53% (of 89 countries). With respect to neurology-specific services, WHO’s rapid assessment of services for MNS disorders during the COVID-19 pandemic in mid-2020 (16) revealed that one in three of 98 countries closed down neurology inpatient units at least partly during the pandemic. Regarding service provision, surgeries for neurological disorders were disrupted in two-thirds of 130 countries for which information was available, and the management of emergency conditions such as status epilepticus was at least partially disrupted in 35% of the same 130 countries. To better understand the extent of service disruption, its causes and mitigation strategies for neurological disorders in the context of COVID-19, WHO commissioned a rapid review of 369 articles, providing data on 210 419 patients from 105 countries (14). Studies that investigated the extent of service disruption (n=188) described it as mild (n=40, 21%), moderate (n=131, 70%) or severe (n=10, 5%). The most frequently described reasons for service disruption across 240 studies were travel restrictions related to lockdown (n=196, 82%), closure of services or consultations as per health authority directive (n=157, 65%) and reduced outpatient volume due to patients not presenting (n=135, 56%). A total of 224 studies reported on mitigation strategies, with the most frequently reported strategies being telemedicine and other teleconsultation formats (n=184, 82%), novel dispensing approaches for medicines (n=116, 52%) and redirection of patients (n=95, 42%). Limitations To date, most of the data on service disruption have been derived from high- and middle-income countries, with information from low-income countries lacking. Similarly, evidence of the effectiveness and acceptability of mitigation strategies to patients remains limited. In addition, the current published literature seems biased towards certain settings or types of services (e.g. outpatient, emergency or inpatient care). There are few reports on other areas that are crucial for treating people with chronic neurological conditions (e.g. neurorehabilitation). Going forward, more systematic evaluations and reporting of disruption of the whole spectrum of neurological services can provide a more comprehensive picture. Neurological complications following COVID-19 vaccination There is a low risk following COVID-19 vaccination of neurological complications including Bell’s palsy (28), cerebral venous sinus thrombosis (CVST) and possibly Guillain-Barré syndrome (29). However, the risk of such complications is substantially lower than the risks associated with infection with SARS-CoV-2 (30, 31). Since March 2021, cases of thromboses associated with thrombocytopenia have been reported in patients vaccinated with the Oxford-AstraZeneca ChAdOx1-S and Johnson & Johnson (J&J) Janssen Ad26.COV2.S COVID-19 vaccines. Evaluation of the cases by national and international bodies concluded that there was a plausible causal link between these two adenovirus-vectored vaccines and CVST (32-34), based on the temporal association with vaccination and an increased incidence when compared with expected baseline rates of CVST (35-42). WHO has provided guidance for clinical case management of thrombosis with thrombocytopenia syndrome (TTS) following vaccination against COVID-19 (43). Overall knowledge gaps Current evidence suggests that SARS-CoV-2 can affect the nervous system. Multiple and probably overlapping mechanisms have been proposed for the neurological manifestations; they include hypoxia, cytokine storm, post infectious autoimmune responses, hypercoagulability, neurologic complications of severe systemic illness and potential direct neurotropism. Questions remain regarding the characteristics, timing and severity of neurological manifestations of COVID-19, including the pathophysiological mechanisms through which SARS-CoV-2 affects the nervous system. As more data emerge, associations of specific neurological disorders with COVID-19 will be further clarified – as has been seen, for example, with Guillain-Barré syndrome (29). Prospective data, as well as biomarker and neuropathological studies, are needed on the short- and long-term neurological sequelae. Existing reports on the association between COVID-19 and most neurological manifestations are flawed by selection and information bias, and available data reflect the spectrum of neurological manifestations in patients with the more severe COVID-19 cases. Neurological signs or symptoms occurring during the acute phase of COVID-19 infection cannot easily be disentangled from those with onset in the post-acute phase, and follow-up data are scarce, particularly for subclinical findings such as cognitive impairment. -5- Neurology and COVID-19: Scientific brief Other gaps in the literature include a lack of clarity on the interplay between pre-existing neurological disease and other underlying comorbidities such as hypertension and diabetes. Studies in this area were hospital-based and biased to people with more severe symptoms, making the findings difficult to generalize to people based in the community or having only mild symptoms. Understanding the impact of neurological conditions requires the inclusion of diverse populations from a variety of social backgrounds. Guidance is also needed for studies evaluating the disruption or the efficacy of mitigation strategies for care. Efforts should be made to harmonize the methods in this area of research and to enhance the comparability between studies and over time. In addition, funding for and progress in neurological research and training have been affected by the pandemic, owing to the temporary suspension of research projects or postponement or cancellation of fellowships, which need to be re-established as soon as possible (44). Implications for further research Well-designed case–control and cohort studies are needed to understand which patients are most vulnerable to neurological manifestations in the acute and post COVID-19 condition and to understand causality related to COVID 19. Series of patients with neurological conditions need to be compared to patients without neurological conditions. Use of case report forms (CRFs) such as WHO’s post-COVID-19 condition CRF (45) is encouraged to standardize data collection. Future research directions should include more “bottom-up” evidence-gathering efforts; for example, international surveys of neurological associations such as one recently undertaken by the European Federation of Neurological Associations (EFNA) with support from members of the WHO Neurology and COVID-19 Global Forum (46). Conclusion A wide spectrum of acute and post-acute neurological manifestations associated with COVID-19 have been reported across the globe. Clinicians and health care workers should be aware of such presentations and complications even in the absence of respiratory symptoms. Disruptions in access to essential neurological services and availability of essential medications for people with pre-existing neurological conditions can be detrimental; hence, mitigation strategies such as remote technology and telemedicine alternatives should be judiciously employed. The COVID-19 pandemic continues to have an impact on neurological health, service delivery, research and training while widening existing disparities worldwide. Recognizing and addressing these factors will provide opportunities to improve neurological care worldwide. Plans for updating WHO continues to monitor the situation closely for any changes that may affect this scientific brief.",Medical,Fact Finding,Q&A "You will answer using only the provided text. The response will be in the form of a short paragraph and bulleted list for each topic.",I need a break down of this text in an organised format to study with. Include reasonable detail.,"Although the OSI model is useful, the TCP/IP protocols don’t match its structure exactly. Therefore, in our discussions of TCP/IP, we use the layers of the OSI model in the following way: Application Layer The Application Layer is the level of the protocol hierarchy where user-accessed network processes reside. In this text, a TCP/IP application is any network pro- cess that occurs above the Transport Layer. This includes all of the processes that users directly interact with as well as other processes at this level that users are not necessarily aware of. Presentation Layer For cooperating applications to exchange data, they must agree about how data is represented. In OSI, the Presentation Layer provides standard data presenta- tion routines. This function is frequently handled within the applications in TCP/IP, though TCP/IP protocols such as XDR and MIME also perform this function. Session Layer As with the Presentation Layer, the Session Layer is not identifiable as a separate layer in the TCP/IP protocol hierarchy. The OSI Session Layer manages the 8 | Chapter 1: Overview of TCP/IP sessions (connections) between cooperating applications. In TCP/IP, this func- tion largely occurs in the Transport Layer, and the term “session” is not used; instead, the terms “socket” and “port” are used to describe the path over which cooperating applications communicate. Transport Layer Much of our discussion of TCP/IP is directed to the protocols that occur in the Transport Layer. The Transport Layer in the OSI reference model guarantees that the receiver gets the data exactly as it was sent. In TCP/IP, this function is performed by the Transmission Control Protocol (TCP). However, TCP/IP offers a second Transport Layer service, User Datagram Protocol (UDP), that does not perform the end-to-end reliability checks. Network Layer The Network Layer manages connections across the network and isolates the upper layer protocols from the details of the underlying network. The Internet Protocol (IP), which isolates the upper layers from the underlying network and handles the addressing and delivery of data, is usually described as TCP/IP’s Network Layer. Data Link Layer The reliable delivery of data across the underlying physical network is handled by the Data Link Layer. TCP/IP rarely creates protocols in the Data Link Layer. Most RFCs that relate to the Data Link Layer discuss how IP can make use of existing data link protocols. Physical Layer The Physical Layer defines the characteristics of the hardware needed to carry the data transmission signal. Features such as voltage levels and the number and location of interface pins are defined in this layer. Examples of standards at the Physical Layer are interface connectors such as RS232C and V.35, and stan- dards for local area network wiring such as IEEE 802.3. TCP/IP does not define physical standards—it makes use of existing standards. The terminology of the OSI reference model helps us describe TCP/IP, but to fully understand it, we must use an architectural model that more closely matches the structure of TCP/IP. The next section introduces the protocol model we’ll use to describe TCP/IP. Transmission Control Protocol Applications that require the transport protocol to provide reliable data delivery use TCP because it verifies that data is delivered across the network accurately and in the proper sequence. TCP is a reliable, connection-oriented, byte-stream protocol. Let’s look at each of these characteristics in more detail. TCP provides reliability with a mechanism called Positive Acknowledgment with Retransmission (PAR). Simply stated, a system using PAR sends the data again unless it hears from the remote system that the data arrived OK. The unit of data exchanged between cooperating TCP modules is called a segment (see Figure 1-9). Each segment contains a checksum that the recipient uses to verify that the data is undamaged. If the data segment is received undamaged, the receiver sends a positive acknowledgment back to the sender. If the data segment is damaged, the receiver discards it. After an appropriate timeout period, the sending TCP module re-transmits any segment for which no positive acknowledgment has been received. TCP is connection-oriented. It establishes a logical end-to-end connection between the two communicating hosts. Control information, called a handshake, is exchanged between the two endpoints to establish a dialogue before data is transmitted. TCP indicates the control function of a segment by setting the appropriate bit in the Flags field in word 4 of the segment header. The type of handshake used by TCP is called a three-way handshake because three segments are exchanged. Figure 1-10 shows the simplest form of the three-way hand- shake. Host A begins the connection by sending host B a segment with the “Synchro- nize sequence numbers” (SYN) bit set. This segment tells host B that A wishes to set Transport Layer This is the Title of the Book, eMatter Edition Copyright © 2010 O’Reilly & Associates, Inc. All rights reserved. | 19 up a connection, and it tells B what sequence number host A will use as a starting number for its segments. (Sequence numbers are used to keep data in the proper order.) Host B responds to A with a segment that has the “Acknowledgment” (ACK) and SYN bits set. B’s segment acknowledges the receipt of A’s segment, and informs A which sequence number host B will start with. Finally, host A sends a segment that acknowledges receipt of B’s segment, and transfers the first actual data. After this exchange, host A’s TCP has positive evidence that the remote TCP is alive and ready to receive data. As soon as the connection is established, data can be trans- ferred. When the cooperating modules have concluded the data transfers, they will exchange a three-way handshake with segments containing the “No more data from sender” bit (called the FIN bit) to close the connection. It is the end-to-end exchange of data that provides the logical connection between the two systems. TCP views the data it sends as a continuous stream of bytes, not as independent packets. Therefore, TCP takes care to maintain the sequence in which bytes are sent and received. The Sequence Number and Acknowledgment Number fields in the TCP segment header keep track of the bytes. The TCP standard does not require that each system start numbering bytes with any specific number; each system chooses the number it will use as a starting point. To keep track of the data stream correctly, each end of the connection must know the other end’s initial number. The two ends of the connection synchronize byte-num- bering systems by exchanging SYN segments during the handshake. The Sequence Number field in the SYN segment contains the Initial Sequence Number (ISN), which is the starting point for the byte-numbering system. For security reasons the ISN should be a random number. Each byte of data is numbered sequentially from the ISN, so the first real byte of data sent has a Sequence Number of ISN+1. The Sequence Number in the header of a data segment identifies the sequential position in the data stream of the first data byte in 20 |Chapter 1: Overview of TCP/IP the segment. For example, if the first byte in the data stream was sequence number 1 (ISN=0) and 4000 bytes of data have already been transferred, then the first byte of data in the current segment is byte 4001, and the Sequence Number would be 4001. The Acknowledgment Segment (ACK) performs two functions: positive acknowledg- ment and flow control. The acknowledgment tells the sender how much data has been received and how much more the receiver can accept. The Acknowledgment Number is the sequence number of the next byte the receiver expects to receive. The standard does not require an individual acknowledgment for every packet. The acknowledgment number is a positive acknowledgment of all bytes up to that num- ber. For example, if the first byte sent was numbered 1 and 2000 bytes have been successfully received, the Acknowledgment Number would be 2001. The Window field contains the window, or the number of bytes the remote end is able to accept. If the receiver is capable of accepting 6000 more bytes, the window would be 6000. The window indicates to the sender that it can continue sending seg- ments as long as the total number of bytes that it sends is smaller than the window of bytes that the receiver can accept. The receiver controls the flow of bytes from the sender by changing the size of the window. A zero window tells the sender to cease transmission until it receives a non-zero window value. ","I need a break down of this text in an organised format to study with. Include reasonable detail. You will answer using only the provided text. The response will be in the form of a short paragraph and bulleted list for each topic. Although the OSI model is useful, the TCP/IP protocols don’t match its structure exactly. Therefore, in our discussions of TCP/IP, we use the layers of the OSI model in the following way: Application Layer The Application Layer is the level of the protocol hierarchy where user-accessed network processes reside. In this text, a TCP/IP application is any network pro- cess that occurs above the Transport Layer. This includes all of the processes that users directly interact with as well as other processes at this level that users are not necessarily aware of. Presentation Layer For cooperating applications to exchange data, they must agree about how data is represented. In OSI, the Presentation Layer provides standard data presenta- tion routines. This function is frequently handled within the applications in TCP/IP, though TCP/IP protocols such as XDR and MIME also perform this function. Session Layer As with the Presentation Layer, the Session Layer is not identifiable as a separate layer in the TCP/IP protocol hierarchy. The OSI Session Layer manages the 8 | Chapter 1: Overview of TCP/IP sessions (connections) between cooperating applications. In TCP/IP, this func- tion largely occurs in the Transport Layer, and the term “session” is not used; instead, the terms “socket” and “port” are used to describe the path over which cooperating applications communicate. Transport Layer Much of our discussion of TCP/IP is directed to the protocols that occur in the Transport Layer. The Transport Layer in the OSI reference model guarantees that the receiver gets the data exactly as it was sent. In TCP/IP, this function is performed by the Transmission Control Protocol (TCP). However, TCP/IP offers a second Transport Layer service, User Datagram Protocol (UDP), that does not perform the end-to-end reliability checks. Network Layer The Network Layer manages connections across the network and isolates the upper layer protocols from the details of the underlying network. The Internet Protocol (IP), which isolates the upper layers from the underlying network and handles the addressing and delivery of data, is usually described as TCP/IP’s Network Layer. Data Link Layer The reliable delivery of data across the underlying physical network is handled by the Data Link Layer. TCP/IP rarely creates protocols in the Data Link Layer. Most RFCs that relate to the Data Link Layer discuss how IP can make use of existing data link protocols. Physical Layer The Physical Layer defines the characteristics of the hardware needed to carry the data transmission signal. Features such as voltage levels and the number and location of interface pins are defined in this layer. Examples of standards at the Physical Layer are interface connectors such as RS232C and V.35, and stan- dards for local area network wiring such as IEEE 802.3. TCP/IP does not define physical standards—it makes use of existing standards. The terminology of the OSI reference model helps us describe TCP/IP, but to fully understand it, we must use an architectural model that more closely matches the structure of TCP/IP. The next section introduces the protocol model we’ll use to describe TCP/IP. Transmission Control Protocol Applications that require the transport protocol to provide reliable data delivery use TCP because it verifies that data is delivered across the network accurately and in the proper sequence. TCP is a reliable, connection-oriented, byte-stream protocol. Let’s look at each of these characteristics in more detail. TCP provides reliability with a mechanism called Positive Acknowledgment with Retransmission (PAR). Simply stated, a system using PAR sends the data again unless it hears from the remote system that the data arrived OK. The unit of data exchanged between cooperating TCP modules is called a segment (see Figure 1-9). Each segment contains a checksum that the recipient uses to verify that the data is undamaged. If the data segment is received undamaged, the receiver sends a positive acknowledgment back to the sender. If the data segment is damaged, the receiver discards it. After an appropriate timeout period, the sending TCP module re-transmits any segment for which no positive acknowledgment has been received. TCP is connection-oriented. It establishes a logical end-to-end connection between the two communicating hosts. Control information, called a handshake, is exchanged between the two endpoints to establish a dialogue before data is transmitted. TCP indicates the control function of a segment by setting the appropriate bit in the Flags field in word 4 of the segment header. The type of handshake used by TCP is called a three-way handshake because three segments are exchanged. Figure 1-10 shows the simplest form of the three-way hand- shake. Host A begins the connection by sending host B a segment with the “Synchro- nize sequence numbers” (SYN) bit set. This segment tells host B that A wishes to set Transport Layer This is the Title of the Book, eMatter Edition Copyright © 2010 O’Reilly & Associates, Inc. All rights reserved. | 19 up a connection, and it tells B what sequence number host A will use as a starting number for its segments. (Sequence numbers are used to keep data in the proper order.) Host B responds to A with a segment that has the “Acknowledgment” (ACK) and SYN bits set. B’s segment acknowledges the receipt of A’s segment, and informs A which sequence number host B will start with. Finally, host A sends a segment that acknowledges receipt of B’s segment, and transfers the first actual data. After this exchange, host A’s TCP has positive evidence that the remote TCP is alive and ready to receive data. As soon as the connection is established, data can be trans- ferred. When the cooperating modules have concluded the data transfers, they will exchange a three-way handshake with segments containing the “No more data from sender” bit (called the FIN bit) to close the connection. It is the end-to-end exchange of data that provides the logical connection between the two systems. TCP views the data it sends as a continuous stream of bytes, not as independent packets. Therefore, TCP takes care to maintain the sequence in which bytes are sent and received. The Sequence Number and Acknowledgment Number fields in the TCP segment header keep track of the bytes. The TCP standard does not require that each system start numbering bytes with any specific number; each system chooses the number it will use as a starting point. To keep track of the data stream correctly, each end of the connection must know the other end’s initial number. The two ends of the connection synchronize byte-num- bering systems by exchanging SYN segments during the handshake. The Sequence Number field in the SYN segment contains the Initial Sequence Number (ISN), which is the starting point for the byte-numbering system. For security reasons the ISN should be a random number. Each byte of data is numbered sequentially from the ISN, so the first real byte of data sent has a Sequence Number of ISN+1. The Sequence Number in the header of a data segment identifies the sequential position in the data stream of the first data byte in 20 |Chapter 1: Overview of TCP/IP the segment. For example, if the first byte in the data stream was sequence number 1 (ISN=0) and 4000 bytes of data have already been transferred, then the first byte of data in the current segment is byte 4001, and the Sequence Number would be 4001. The Acknowledgment Segment (ACK) performs two functions: positive acknowledg- ment and flow control. The acknowledgment tells the sender how much data has been received and how much more the receiver can accept. The Acknowledgment Number is the sequence number of the next byte the receiver expects to receive. The standard does not require an individual acknowledgment for every packet. The acknowledgment number is a positive acknowledgment of all bytes up to that num- ber. For example, if the first byte sent was numbered 1 and 2000 bytes have been successfully received, the Acknowledgment Number would be 2001. The Window field contains the window, or the number of bytes the remote end is able to accept. If the receiver is capable of accepting 6000 more bytes, the window would be 6000. The window indicates to the sender that it can continue sending seg- ments as long as the total number of bytes that it sends is smaller than the window of bytes that the receiver can accept. The receiver controls the flow of bytes from the sender by changing the size of the window. A zero window tells the sender to cease transmission until it receives a non-zero window value. ",Internet/Technology,Summarize & Format,Text Transformation Only refer to the attached document in providing your response.,According to the document what is the forecasted growth of the fashion industry in the year 2024 and what challenges does it face.,"Skip to main content Sign In | Subscribe The State of Fashion 2024: Finding pockets of growth as uncertainty reigns Share Print Download Save The State of Fashion 2024: Finding pockets of growth as uncertainty reigns November 29, 2023 | Report Share Print Download Save Fashion companies will face economic headwinds, technology shifts, and an evolving competitive landscape in 2024. However, shifting consumer priorities will continue to offer opportunities. DOWNLOADS The State of Fashion 2024 Full Report (128 pages) Storm clouds are gathering, but the experience of recent years shows how the fashion industry may ride out the challenges ahead. In 2022, the industry again showed its resilience, almost equaling the record economic profit of 2021, the McKinsey Global Fashion Index shows. Echoing the pattern of the previous year, the luxury sector outperformed, with a 36 percent rise in economic profit that offset weakness in other segments. Yet even the non-luxury sector was ahead of its long-term average. Strong margin performance meant the industry in 2022 achieved more than double the economic profit than in all years between 2011 and 2020, except for one. In 2023, the industry faced challenges that were both persistent and deepening. On a regional basis, Europe and the United States saw slow growth throughout the year, while China’s initially strong performance faded in the second half. Though the luxury segment initially fared well, it too began to feel the effects of weaker demand in the latter part of the year, leading to slowing sales and uneven performance. Sidebar About the authors Looking toward 2024, the most prominent sentiment among fashion industry leaders is uncertainty, reflecting the prospect of subdued economic growth, persistent inflation, and weak consumer confidence. Against this backdrop, businesses will be challenged to identify pockets of value and unlock new drivers of performance. According to McKinsey’s analysis of fashion forecasts, the global industry will post top-line growth of 2 to 4 percent in 2024 (exhibit), with regional and country-level variations. Once again, the luxury segment is expected to generate the biggest share of economic profit. However, even there, companies will be challenged by the tough economic environment. The segment is forecast to grow globally by 3 to 5 percent, compared with 5 to 7 percent in 2023, as consumers rein in spending after a postpandemic surge. European and Chinese growth is set to slow, while US growth is expected to pick up after a relatively weak 2023, reflecting the slightly more optimistic outlook there. Exhibit Slower but normalized growth is anticipated across regions in 2024. We strive to provide individuals with disabilities equal access to our website. If you would like information about this content we will be happy to work with you. Please email us at: McKinsey_Website_Accessibility@mckinsey.com MOST POPULAR INSIGHTS It’s cool to be kind: The value of empathy at work How to be a better chief of staff The economic potential of generative AI: The next productivity frontier What is diversity, equity, and inclusion? Adopting AI at speed and scale: The 4IR push to stay competitive Beyond luxury, growth of 2 to 4 percent is predicted for the year ahead, in line with the probable outcome in 2023. The European market will likely expand by just 1 to 3 percent, compared with 5 percent in the first half of 2023 and 1 to 3 percent in the second half. Slumping consumer confidence and declining household savings are expected to be the most probable causes of restrained spending. In the United States, nonluxury sector growth of 0 to 2 percent is forecast. And China is expected to be similarly challenged amid 4 to 6 percent growth, which is a slight uptick from the end of 2023 but slow when considered on a historical basis. These are just some of the findings from The State of Fashion 2024, published by the Business of Fashion (BoF) and McKinsey. The eighth report in the annual series discusses the major themes shaping the fashion economy and assesses the industry’s potential responses. Reflecting in-depth research and many conversations with industry leaders, it reveals the key trends that could shape the fashion landscape in the year ahead. Uncertainty in the face of headwinds With conflicts in Europe and the Middle East and strained international relations elsewhere, geopolitics is the number-one concern for fashion industry executives going into 2024, followed by economic volatility and inflation. Some 62 percent of executives in this year’s survey, conducted in September, cite geopolitical instability as the top risk to growth. Economic volatility is cited by 55 percent and inflation is mentioned by 51 percent (compared with 78 percent last year). The global average headline rate of inflation is predicted to moderate to 5.8 percent—still high on a historical basis—from 6.9 percent in 2023.1 Against a challenging economic backdrop, executive views of the industry’s prospects are more divided than in any year since the launch of the BoF–McKinsey Executive Survey in 2017. While 26 percent of survey respondents say they expect conditions to improve year on year, 37 percent see them remaining the same and 38 percent think they will worsen. Uncertainty within the industry reflects the broader economic situation, albeit with regional divergence. Going into 2024, pressure on household incomes is expected to dampen demand for apparel and prompt trading down across categories. Still, there are geographic outliers that may offer comfort. One is India, where consumer confidence hit a four-year high in September 2023.2 India-based executives are more optimistic than those in Western countries, with 85 percent of respondents to McKinsey’s Global Economics Intelligence survey saying that conditions have improved in the past six months.3 China’s economy is facing challenges, but the country’s consumers show a higher intent to shop for fashion in 2024 than consumers in both the United States and Europe. Ten themes for 2024 To prepare for challenges and be alert to opportunities, leading fashion companies will likely prioritize contingency planning for the coming year. A key theme will be companies keeping a firm grip on costs and inventories while driving growth by precisely managing prices. Brands and suppliers can expect an increasingly competitive environment. But they will also have opportunities, with consumers discovering new styles, tastes, and priorities—all presenting routes to value creation. As previously done, this year’s report highlights ten emerging themes that will be high on leadership agendas. Global economy: Fragmented future. In 2024, the global economic outlook will continue to be unsettled, as financial, geopolitical, and other challenges weigh on consumer confidence. Fashion markets in China, Europe, and the United States will likely face headwinds, some of which reflect individual regional dynamics. Suppliers, brands, and retailers may need to bolster contingency planning and manage for uncertainty. Climate urgency. The frequency and intensity of extreme weather-related events in 2023 mean the climate crisis is an even more urgent priority than in previous years. With physical and transition risks rising across continents, the industry must not delay in tackling emissions and building resilience into supply chains. Consumer shifts: Vacation mode. Consumers are gearing up for the biggest year of travel since before the pandemic. But a shift in values means expectations are evolving, even as shopping remains a priority. Brands and retailers should refresh distribution and category strategies to reflect the new reality. The new face of influence. It’s time for brand marketers to update their influencer playbooks, as a new guard of creative personalities wins fans. Working with opinion leaders in 2024 will require a different type of partnership, an emphasis on video, and a willingness to loosen the reins on creative control. Outdoors reinvented. Technical outdoor clothing and “gorpcore” are in demand as consumers embrace healthier lifestyles. In 2024, more outdoor brands are expected to launch lifestyle collections. At the same time, lifestyle brands will likely embed technical elements into collections, blurring the lines between functionality and style. Fashion system: Generative AI’s creative crossroads. After generative AI’s (gen AI) breakout year in 2023, more use cases are emerging across the industry. Capturing value will require fashion players to look beyond automation and explore gen AI’s potential to enhance the work of human creatives. Fast fashion’s power play. Fast-fashion competition is set to be fiercer than ever. Challengers, led by Shein and Temu, are bringing new tactics on price, customer experience, and speed. Success for disruptors and incumbents could hinge on adapting to new consumer preferences while navigating the regulatory agenda. All eyes on brand. Brand marketing is expected to be back in the spotlight as the fashion industry manages a switch away from performance marketing. Brands may benefit from forging emotional connections with consumers as marketers rewrite playbooks to emphasise long-term brand building. Sustainability rules. The era of fashion industry self-regulation is drawing to a close. Across jurisdictions, new rules will have significant effects on both consumers and fashion players. Brands and manufacturers may consider revamping business models to align with the changes ahead. Bullwhip snaps back. Shifts in consumer demand have created a “bullwhip effect,” by which order volatility reverberates unpredictably through supply chains. Suppliers will likely face pressure as brands and retailers focus on transparency and strategic partnerships. Looking ahead As the industry continues to be challenged by geopolitical and economic headwinds, fashion leaders in 2024 will look to strike a careful balance between managing uncertainty and seizing opportunities. With cost-saving tactics mostly exhausted, companies may focus on growing sales, underpinned by new pricing and promotion strategies. Across the industry, net intent to raise prices is more than 50 percent, according to the BoF–McKinsey Executive Survey. At the same time, reduced cost pressures could provide a potential boost to performance. As climate change brings increasingly extreme weather events and global temperatures rise, the coming year is likely to mark a heightened industry focus on environmental, social, and governance issues. Our survey shows that the topic is seen as both the number-one priority and number-one challenge for industry executives. The most successful companies will find a balance between sustainability initiatives, risk management, and commercial imperatives. In an uncertain world, consumer discretionary spend will be weighted toward trusted categories and brands. Hard luxury goods—jewelry, watches, and leather—will likely be in demand, reflecting their potential investment value in tough economic times. Consumers are expected to travel more and continue spending more time outdoors. And they prefer emotional connections and authenticity over celebrity endorsements. All told, executives are bracing for a strategically complex year ahead. To counter uncertainty, leading companies will prepare for a range of outcomes. The most successful will become more resilient, better equipped to manage the challenges, and ready to accelerate when the storm clouds begin to clear. ABOUT THE AUTHOR(S) Anita Balchandani is a senior partner in McKinsey’s London office, where Ewa Starzynska is a consultant; David Barrelet is an associate partner in the Munich office; Achim Berg is a senior partner in the Frankfurt office; Gemma D’Auria is a senior partner in the Milan office; and Felix Rölkens is a partner in the Berlin office. Imran Amed is the founder, editor-in-chief, and CEO of the Business of Fashion and is an alumnus of McKinsey’s London office. The authors wish to thank Asina De Branche and Joëlle Grunberg for their contributions to this article. Talk to us EXPLORE A CAREER WITH US Search Openings RELATED ARTICLES Female friends shopping together in clothing boutique. Report State of Fashion report archive (2017-2023) Sign up for emails on new Consumer & Retail articles Never miss an insight. We'll email you when new articles are published on this topic. Email address Subscribe Sign up for emails on new Consumer & Retail articles ","Only refer to the attached document in providing your response. According to the document what is the forecasted growth of the fashion industry in the year 2024 and what challenges does it face. Skip to main content Sign In | Subscribe The State of Fashion 2024: Finding pockets of growth as uncertainty reigns Share Print Download Save The State of Fashion 2024: Finding pockets of growth as uncertainty reigns November 29, 2023 | Report Share Print Download Save Fashion companies will face economic headwinds, technology shifts, and an evolving competitive landscape in 2024. However, shifting consumer priorities will continue to offer opportunities. DOWNLOADS The State of Fashion 2024 Full Report (128 pages) Storm clouds are gathering, but the experience of recent years shows how the fashion industry may ride out the challenges ahead. In 2022, the industry again showed its resilience, almost equaling the record economic profit of 2021, the McKinsey Global Fashion Index shows. Echoing the pattern of the previous year, the luxury sector outperformed, with a 36 percent rise in economic profit that offset weakness in other segments. Yet even the non-luxury sector was ahead of its long-term average. Strong margin performance meant the industry in 2022 achieved more than double the economic profit than in all years between 2011 and 2020, except for one. In 2023, the industry faced challenges that were both persistent and deepening. On a regional basis, Europe and the United States saw slow growth throughout the year, while China’s initially strong performance faded in the second half. Though the luxury segment initially fared well, it too began to feel the effects of weaker demand in the latter part of the year, leading to slowing sales and uneven performance. Sidebar About the authors Looking toward 2024, the most prominent sentiment among fashion industry leaders is uncertainty, reflecting the prospect of subdued economic growth, persistent inflation, and weak consumer confidence. Against this backdrop, businesses will be challenged to identify pockets of value and unlock new drivers of performance. According to McKinsey’s analysis of fashion forecasts, the global industry will post top-line growth of 2 to 4 percent in 2024 (exhibit), with regional and country-level variations. Once again, the luxury segment is expected to generate the biggest share of economic profit. However, even there, companies will be challenged by the tough economic environment. The segment is forecast to grow globally by 3 to 5 percent, compared with 5 to 7 percent in 2023, as consumers rein in spending after a postpandemic surge. European and Chinese growth is set to slow, while US growth is expected to pick up after a relatively weak 2023, reflecting the slightly more optimistic outlook there. Exhibit Slower but normalized growth is anticipated across regions in 2024. We strive to provide individuals with disabilities equal access to our website. If you would like information about this content we will be happy to work with you. Please email us at: McKinsey_Website_Accessibility@mckinsey.com MOST POPULAR INSIGHTS It’s cool to be kind: The value of empathy at work How to be a better chief of staff The economic potential of generative AI: The next productivity frontier What is diversity, equity, and inclusion? Adopting AI at speed and scale: The 4IR push to stay competitive Beyond luxury, growth of 2 to 4 percent is predicted for the year ahead, in line with the probable outcome in 2023. The European market will likely expand by just 1 to 3 percent, compared with 5 percent in the first half of 2023 and 1 to 3 percent in the second half. Slumping consumer confidence and declining household savings are expected to be the most probable causes of restrained spending. In the United States, nonluxury sector growth of 0 to 2 percent is forecast. And China is expected to be similarly challenged amid 4 to 6 percent growth, which is a slight uptick from the end of 2023 but slow when considered on a historical basis. These are just some of the findings from The State of Fashion 2024, published by the Business of Fashion (BoF) and McKinsey. The eighth report in the annual series discusses the major themes shaping the fashion economy and assesses the industry’s potential responses. Reflecting in-depth research and many conversations with industry leaders, it reveals the key trends that could shape the fashion landscape in the year ahead. Uncertainty in the face of headwinds With conflicts in Europe and the Middle East and strained international relations elsewhere, geopolitics is the number-one concern for fashion industry executives going into 2024, followed by economic volatility and inflation. Some 62 percent of executives in this year’s survey, conducted in September, cite geopolitical instability as the top risk to growth. Economic volatility is cited by 55 percent and inflation is mentioned by 51 percent (compared with 78 percent last year). The global average headline rate of inflation is predicted to moderate to 5.8 percent—still high on a historical basis—from 6.9 percent in 2023.1 Against a challenging economic backdrop, executive views of the industry’s prospects are more divided than in any year since the launch of the BoF–McKinsey Executive Survey in 2017. While 26 percent of survey respondents say they expect conditions to improve year on year, 37 percent see them remaining the same and 38 percent think they will worsen. Uncertainty within the industry reflects the broader economic situation, albeit with regional divergence. Going into 2024, pressure on household incomes is expected to dampen demand for apparel and prompt trading down across categories. Still, there are geographic outliers that may offer comfort. One is India, where consumer confidence hit a four-year high in September 2023.2 India-based executives are more optimistic than those in Western countries, with 85 percent of respondents to McKinsey’s Global Economics Intelligence survey saying that conditions have improved in the past six months.3 China’s economy is facing challenges, but the country’s consumers show a higher intent to shop for fashion in 2024 than consumers in both the United States and Europe. Ten themes for 2024 To prepare for challenges and be alert to opportunities, leading fashion companies will likely prioritize contingency planning for the coming year. A key theme will be companies keeping a firm grip on costs and inventories while driving growth by precisely managing prices. Brands and suppliers can expect an increasingly competitive environment. But they will also have opportunities, with consumers discovering new styles, tastes, and priorities—all presenting routes to value creation. As previously done, this year’s report highlights ten emerging themes that will be high on leadership agendas. Global economy: Fragmented future. In 2024, the global economic outlook will continue to be unsettled, as financial, geopolitical, and other challenges weigh on consumer confidence. Fashion markets in China, Europe, and the United States will likely face headwinds, some of which reflect individual regional dynamics. Suppliers, brands, and retailers may need to bolster contingency planning and manage for uncertainty. Climate urgency. The frequency and intensity of extreme weather-related events in 2023 mean the climate crisis is an even more urgent priority than in previous years. With physical and transition risks rising across continents, the industry must not delay in tackling emissions and building resilience into supply chains. Consumer shifts: Vacation mode. Consumers are gearing up for the biggest year of travel since before the pandemic. But a shift in values means expectations are evolving, even as shopping remains a priority. Brands and retailers should refresh distribution and category strategies to reflect the new reality. The new face of influence. It’s time for brand marketers to update their influencer playbooks, as a new guard of creative personalities wins fans. Working with opinion leaders in 2024 will require a different type of partnership, an emphasis on video, and a willingness to loosen the reins on creative control. Outdoors reinvented. Technical outdoor clothing and “gorpcore” are in demand as consumers embrace healthier lifestyles. In 2024, more outdoor brands are expected to launch lifestyle collections. At the same time, lifestyle brands will likely embed technical elements into collections, blurring the lines between functionality and style. Fashion system: Generative AI’s creative crossroads. After generative AI’s (gen AI) breakout year in 2023, more use cases are emerging across the industry. Capturing value will require fashion players to look beyond automation and explore gen AI’s potential to enhance the work of human creatives. Fast fashion’s power play. Fast-fashion competition is set to be fiercer than ever. Challengers, led by Shein and Temu, are bringing new tactics on price, customer experience, and speed. Success for disruptors and incumbents could hinge on adapting to new consumer preferences while navigating the regulatory agenda. All eyes on brand. Brand marketing is expected to be back in the spotlight as the fashion industry manages a switch away from performance marketing. Brands may benefit from forging emotional connections with consumers as marketers rewrite playbooks to emphasise long-term brand building. Sustainability rules. The era of fashion industry self-regulation is drawing to a close. Across jurisdictions, new rules will have significant effects on both consumers and fashion players. Brands and manufacturers may consider revamping business models to align with the changes ahead. Bullwhip snaps back. Shifts in consumer demand have created a “bullwhip effect,” by which order volatility reverberates unpredictably through supply chains. Suppliers will likely face pressure as brands and retailers focus on transparency and strategic partnerships. Looking ahead As the industry continues to be challenged by geopolitical and economic headwinds, fashion leaders in 2024 will look to strike a careful balance between managing uncertainty and seizing opportunities. With cost-saving tactics mostly exhausted, companies may focus on growing sales, underpinned by new pricing and promotion strategies. Across the industry, net intent to raise prices is more than 50 percent, according to the BoF–McKinsey Executive Survey. At the same time, reduced cost pressures could provide a potential boost to performance. As climate change brings increasingly extreme weather events and global temperatures rise, the coming year is likely to mark a heightened industry focus on environmental, social, and governance issues. Our survey shows that the topic is seen as both the number-one priority and number-one challenge for industry executives. The most successful companies will find a balance between sustainability initiatives, risk management, and commercial imperatives. In an uncertain world, consumer discretionary spend will be weighted toward trusted categories and brands. Hard luxury goods—jewelry, watches, and leather—will likely be in demand, reflecting their potential investment value in tough economic times. Consumers are expected to travel more and continue spending more time outdoors. And they prefer emotional connections and authenticity over celebrity endorsements. All told, executives are bracing for a strategically complex year ahead. To counter uncertainty, leading companies will prepare for a range of outcomes. The most successful will become more resilient, better equipped to manage the challenges, and ready to accelerate when the storm clouds begin to clear. ABOUT THE AUTHOR(S) Anita Balchandani is a senior partner in McKinsey’s London office, where Ewa Starzynska is a consultant; David Barrelet is an associate partner in the Munich office; Achim Berg is a senior partner in the Frankfurt office; Gemma D’Auria is a senior partner in the Milan office; and Felix Rölkens is a partner in the Berlin office. Imran Amed is the founder, editor-in-chief, and CEO of the Business of Fashion and is an alumnus of McKinsey’s London office. The authors wish to thank Asina De Branche and Joëlle Grunberg for their contributions to this article. Talk to us EXPLORE A CAREER WITH US Search Openings RELATED ARTICLES Female friends shopping together in clothing boutique. Report State of Fashion report archive (2017-2023) Sign up for emails on new Consumer & Retail articles Never miss an insight. We'll email you when new articles are published on this topic. Email address Subscribe Sign up for emails on new Consumer & Retail articles ",Retail/Product,Find & Summarize,Text Transformation Do not exceed 300 words. Do not provide response in table form or JSON. Please provide response based on the information that has been provided.,How much has ValueAct collected in fees from Disney since 2014?,"**Disney paid shareholder ValueAct millions in fees as part of a prior relationship** ValueAct managed more than $355 million in Disney pension funds prior to backing the company in a proxy fight with Nelson Peltz's Trian Partners, a rival activist said. Blackwells raised questions about Disney's relationship with Mason Morfit's ValueAct, suggesting that the company has heralded Morfit's support but not been fully transparent about ValueAct's financial benefit from the company. ValueAct has collected a cumulative $95 million in fees from Disney since 2014, Blackwells said. Activist investor Blackwells said Monday that Disney's board had not disclosed that shareholder ValueAct Capital had a financial relationship with the entertainment company, raising questions about the board's information sharing amid a multi-party proxy fight. Mason Morfit and his $12 billion investment firm ValueAct were heralded as ""constructive"" shareholders by Disney CEO Bob Iger in January, when the company secured ValueAct's backing ahead of an expected proxy fight with Nelson Peltz's Trian Partners. Blackwells Capital, which previously voiced support for Iger and Disney management, said ValueAct had been managing more than $350 million in Disney pension funds in a relationship dating from 2013 to at least 2022. ValueAct was not managing Disney pension assets by the time it built a stake in the company in 2023, a person familiar with the matter told CNBC. Disney had fully withdrawn its investment in the $12 billion investment firm by that time, and ValueAct was not managing money for Disney when the investment firm signed an information sharing agreement with the company in January, the person said. Still, the prior relationship is likely to muddy the waters given Disney has held up Morfit's support in its proxy filings. Blackwells, which has nominated its own slate of directors in a long-shot bid, said that Disney allowed its shareholders to believe that Morfit's fund ""provided its independent and unqualified support of the Board independently."" Blackwells highlighted 2022 filings from the Department of Labor that showed ValueAct was managing some $355 million in Disney pension funds. It said filings for 2023 and 2024 were not available. Blackwells has estimated that Disney paid a cumulative $95 million in fees to ValueAct from 2014 to 2022. Disney and Trian have been in the throes of a proxy fight since October, with the fight intensifying as Disney's annual shareholder meeting nears. Trian says Disney's board has been too connected to Iger, who ousted his hand-picked replacement Bob Chapek to return as CEO with the board's blessing. When Peltz began to re-amass a stake, Disney's share price had fallen dramatically from 2021 highs to trade at levels not seen since 2014. Disney has repeatedly voiced its support for Iger and has highlighted that its directors have experience overseeing successful succession planning. Disney has suggested that Trian bears ill will towards the company after the investment firm was fired as a pension fund manager. In proxy filings, Disney has also said that the company is executing on a plan to invest in its experiences and streaming businesses. It has also touted ValueAct and Morfit's support in presentations and securities filings. ""Can this Board believe that shareholders are able to evaluate the significance of ValueAct's endorsement without a full understanding of the relationship?"" Blackwells asked. Representatives for Disney and Blackwells did not respond to requests for comment. A spokesperson for Trian declined to comment."," ======= **Disney paid shareholder ValueAct millions in fees as part of a prior relationship** ValueAct managed more than $355 million in Disney pension funds prior to backing the company in a proxy fight with Nelson Peltz's Trian Partners, a rival activist said. Blackwells raised questions about Disney's relationship with Mason Morfit's ValueAct, suggesting that the company has heralded Morfit's support but not been fully transparent about ValueAct's financial benefit from the company. ValueAct has collected a cumulative $95 million in fees from Disney since 2014, Blackwells said. Activist investor Blackwells said Monday that Disney's board had not disclosed that shareholder ValueAct Capital had a financial relationship with the entertainment company, raising questions about the board's information sharing amid a multi-party proxy fight. Mason Morfit and his $12 billion investment firm ValueAct were heralded as ""constructive"" shareholders by Disney CEO Bob Iger in January, when the company secured ValueAct's backing ahead of an expected proxy fight with Nelson Peltz's Trian Partners. Blackwells Capital, which previously voiced support for Iger and Disney management, said ValueAct had been managing more than $350 million in Disney pension funds in a relationship dating from 2013 to at least 2022. ValueAct was not managing Disney pension assets by the time it built a stake in the company in 2023, a person familiar with the matter told CNBC. Disney had fully withdrawn its investment in the $12 billion investment firm by that time, and ValueAct was not managing money for Disney when the investment firm signed an information sharing agreement with the company in January, the person said. Still, the prior relationship is likely to muddy the waters given Disney has held up Morfit's support in its proxy filings. Blackwells, which has nominated its own slate of directors in a long-shot bid, said that Disney allowed its shareholders to believe that Morfit's fund ""provided its independent and unqualified support of the Board independently."" Blackwells highlighted 2022 filings from the Department of Labor that showed ValueAct was managing some $355 million in Disney pension funds. It said filings for 2023 and 2024 were not available. Blackwells has estimated that Disney paid a cumulative $95 million in fees to ValueAct from 2014 to 2022. Disney and Trian have been in the throes of a proxy fight since October, with the fight intensifying as Disney's annual shareholder meeting nears. Trian says Disney's board has been too connected to Iger, who ousted his hand-picked replacement Bob Chapek to return as CEO with the board's blessing. When Peltz began to re-amass a stake, Disney's share price had fallen dramatically from 2021 highs to trade at levels not seen since 2014. Disney has repeatedly voiced its support for Iger and has highlighted that its directors have experience overseeing successful succession planning. Disney has suggested that Trian bears ill will towards the company after the investment firm was fired as a pension fund manager. In proxy filings, Disney has also said that the company is executing on a plan to invest in its experiences and streaming businesses. It has also touted ValueAct and Morfit's support in presentations and securities filings. ""Can this Board believe that shareholders are able to evaluate the significance of ValueAct's endorsement without a full understanding of the relationship?"" Blackwells asked. Representatives for Disney and Blackwells did not respond to requests for comment. A spokesperson for Trian declined to comment. ---------------- ======= How much has ValueAct collected in fees from Disney since 2014? ---------------- ======= Do not exceed 300 words. Do not provide response in table form or JSON. Please provide response based on the information that has been provided.",Financial,Fact Finding,Q&A "You must only use information from the prompt when answering. If you discuss excessive use of force that specifically resulted in a serious injury, make bold the whole sentence.",Compare the specific cases of taser and pepper spray use.,"Tasers can be deployed in two modes. One of the most popular tasers used in the field—the X26, made by Taser International, Inc.—can fire two probes up to 35 feet and “discharges pulsed energy to deliver a 50,000 volt shock designed to override the subject’s central nervous system, causing uncontrollable contraction of the muscle tissue and instant collapse.” 74 Alternatively, the X26 and other similar devices can be used in “stun mode,” in which the device is physically pressed against a human body to deliver a more localized shock.75 Like all other use of force cases, those assessing the use of tasers tend to be heavily fact-specific from which it is difficult to derive universal principles. That said, a few general trends can be noted. First, the courts have held that the use of a taser is least justified against “nonviolent misdemeanants who do not flee or actively resist arrest and pose little or no threat to the security of the officer.” 76 For instance, in Brown v. City of Golden Valley, a woman and her husband were allegedly pulled over for speeding.77 When the officers reportedly engaged in aggressive behavior, the woman called 911, and refused to hang up when commanded by the officers.78 One of the officers tased her arm and threw the phone on the ground. The Eighth Circuit rejected the officer’s defense of qualified immunity, noting that the woman was only suspected of committing a minor offense and did not pose a threat to the safety of the officers. 79 In another case, the Sixth Circuit held that an officer was not entitled to qualified immunity when she “gratuitously” shocked a man after he had been restrained by police.80 Second, the courts have generally held that the use of a taser against persons who are belligerent or violent is permitted under the Fourth Amendment.81 In one case, a 9th grade student was tased by a police officer after he attempted to punch a police officer after refusing to hand over his portable video game console.82 The court rejected the student’s Section 1983 claim, observing that it was “simply impossible” to say that the amount of force used was unreasonable under the Fourth Amendment. Somewhere in the grey area between active resistance and no resistance are cases where law enforcement used a taser against someone who was passively resisting the officer’s commands. The majority of cases seem to permit the use of a taser for individuals against such passive resisters. In Buckley v. Haddock, for example, the Eleventh Circuit upheld the use of a taser on a man who fell to the ground after being handcuffed and refused to get up after several requests from the officer. 83 After giving the man several warnings, the officer tased him several times. In rejecting his claim, the court put significant weight on the government’s interest, noting that “[t]he government has an interest in arrests being completed efficiently and without waste of limited resources: police time and energy that may be needed elsewhere at any moment.” 84 In another case, the U.S. District Court for the Southern District of Ohio held that a police officer was justified in using a taser on an elderly suspect suffering from Alzheimer’s disease who had “refused to comply” with the officer’s orders. Once the officer decided to engage the suspect, the court posited, “he had to continue, and it seems the only way he was able to do this was with a taser.” 85 In doing so, the court denied the fact that the age or potential mental illness of a suspect should require a heightened use of force standard.86 Similarly, the Western District of Washington upheld the use of a taser against a mentally ill woman who attempted to drive away from two police officers who were sent to check on the suspect after her mother reported that she might attempt suicide.87 The district court upheld this use of force for two reasons. First, it found credible the officer’s belief that Lowe posed a risk to the safety of the officers and others when she got into her truck, which he believed could have been used as a weapon. Second, the court construed Lowe’s actions as “attempting to avoid legitimate contact by law enforcement.... ” 88 Beyond the level of threat posed by the individual, the courts have taken other factors into consideration including the degree of harm caused by the Taser and how many times it was used in a specific situation.89 For instance, the Eleventh Circuit observed that “[a]lthough being struck by a taser gun is an unpleasant experience, the amount of force [the officer] used—a single use of a taser gun causing a one-time shocking—was reasonably proportionate to the need for force and did not inflict any serious injury.” 90 To the contrary, the fact that an individual had suffered “serious injury requiring emergency medical care” and its multiple applications contributed to a court finding that the use of a taser multiple times was unreasonable.91 Because in the large majority of cases the target of the tasing is not going to suffer permanent injuries, the courts may be inclined to find that such use of force is reasonable in most cases. However, these opinions did not take into account the potential injury—including death—that might be caused by these devices. Other factors taken into consideration have included the vulnerability of the victim, 92 and whether the officers provided a warning to the target before employing the taser. 93 Pepper Spray Like tasers, the use of pepper spray by local police as a law enforcement tool has engendered considerable public attention, including well-known incidents during the Occupy Wall Street protests, 94 and more recently during the protests in Ferguson, Missouri. 95 Pepper spray, or oleoresin capsicum, is a chemical agent used by law enforcement to subdue violent or combative suspects without resorting to higher levels of force.96 The effects of pepper spray include “(1) dilation of the capillaries and instant closing of the eyes through swelling of the eyelids, (2) immediate respiratory inflammation, including uncontrollable coughing, retching, shortness of breath and gasping for air with a gagging sensation in the throat, and (3) immediate burning sensations to the mucous membranes, skin and inside the nose and mouth.” 97 The federal courts have generally been less deferential to law enforcement when using pepper spray on passive resisters than they have been with tasers. In cases in which the individual is only passively resisting—say, simply failing to listen to an officer’s order—the courts have generally held that the use of pepper spray is a violation of the Fourth Amendment.98 Take, for instance, Young v. County of Los Angeles, in which the Ninth Circuit held that the use of pepper spray against a nonviolent traffic offender was unreasonable under the Fourth Amendment.99 Similarly, in Headwaters Forest Defense v. County of Humboldt, the Ninth Circuit held that the use of pepper spray against nonviolent protestors constituted an unreasonable seizure under the Fourth Amendment.100 While these cases disapproved of the use of pepper spray against persons who were passive resisters, there have been rulings upholding such use of force in the course of traffic stops. In Mecham v. Frazier, the Tenth Circuit rejected the plaintiff’s Fourth Amendment claim that a police officer used excessive force when he sprayed her with pepper spray after she refused to leave her vehicle after a traffic stop.101 The court found that the officer’s actions were justified based on Mecham’s “disregard for the officer’s instructions, the length of the encounter, and the implausibility of Mecham’s rationale for not cooperating.” Like the use of tasers, the courts have generally held that an officer’s use of pepper spray is not unreasonable when a suspect is actively resisting arrest or fails to heed an officer’s direct command. In Singleton v. Darby, the Fifth Circuit upheld the use of pepper spray against a group of individuals, including the plaintiff Jeanette Singleton, who were protesting the Keystone XL Pipeline.102 In rejecting Singleton’s Section 1983 claim premised on excessive force, the court held that the use of the pepper spray was not unreasonable because (1) the state had a significant interest in keeping public roads clear; (2) the officer faced an “explosive situation” in which he was greatly outnumbered by the protesters; (3) he provided a warning before using the spray; and (4) pepper spray was likely the least intrusive force available to the officer.103 Finally, like with tasers, federal courts have generally held that it is unreasonable to use pepper spray against individuals who are not resisting and pose no danger to the officer or others.104 ","System Instructions: You must only use information from the prompt when answering. If you discuss excessive use of force that specifically resulted in a serious injury, make bold the whole sentence. Question: Compare the specific cases of taser and pepper spray use. Context: Tasers can be deployed in two modes. One of the most popular tasers used in the field—the X26, made by Taser International, Inc.—can fire two probes up to 35 feet and “discharges pulsed energy to deliver a 50,000 volt shock designed to override the subject’s central nervous system, causing uncontrollable contraction of the muscle tissue and instant collapse.” 74 Alternatively, the X26 and other similar devices can be used in “stun mode,” in which the device is physically pressed against a human body to deliver a more localized shock.75 Like all other use of force cases, those assessing the use of tasers tend to be heavily fact-specific from which it is difficult to derive universal principles. That said, a few general trends can be noted. First, the courts have held that the use of a taser is least justified against “nonviolent misdemeanants who do not flee or actively resist arrest and pose little or no threat to the security of the officer.” 76 For instance, in Brown v. City of Golden Valley, a woman and her husband were allegedly pulled over for speeding.77 When the officers reportedly engaged in aggressive behavior, the woman called 911, and refused to hang up when commanded by the officers.78 One of the officers tased her arm and threw the phone on the ground. The Eighth Circuit rejected the officer’s defense of qualified immunity, noting that the woman was only suspected of committing a minor offense and did not pose a threat to the safety of the officers. 79 In another case, the Sixth Circuit held that an officer was not entitled to qualified immunity when she “gratuitously” shocked a man after he had been restrained by police.80 Second, the courts have generally held that the use of a taser against persons who are belligerent or violent is permitted under the Fourth Amendment.81 In one case, a 9th grade student was tased by a police officer after he attempted to punch a police officer after refusing to hand over his portable video game console.82 The court rejected the student’s Section 1983 claim, observing that it was “simply impossible” to say that the amount of force used was unreasonable under the Fourth Amendment. Somewhere in the grey area between active resistance and no resistance are cases where law enforcement used a taser against someone who was passively resisting the officer’s commands. The majority of cases seem to permit the use of a taser for individuals against such passive resisters. In Buckley v. Haddock, for example, the Eleventh Circuit upheld the use of a taser on a man who fell to the ground after being handcuffed and refused to get up after several requests from the officer. 83 After giving the man several warnings, the officer tased him several times. In rejecting his claim, the court put significant weight on the government’s interest, noting that “[t]he government has an interest in arrests being completed efficiently and without waste of limited resources: police time and energy that may be needed elsewhere at any moment.” 84 In another case, the U.S. District Court for the Southern District of Ohio held that a police officer was justified in using a taser on an elderly suspect suffering from Alzheimer’s disease who had “refused to comply” with the officer’s orders. Once the officer decided to engage the suspect, the court posited, “he had to continue, and it seems the only way he was able to do this was with a taser.” 85 In doing so, the court denied the fact that the age or potential mental illness of a suspect should require a heightened use of force standard.86 Similarly, the Western District of Washington upheld the use of a taser against a mentally ill woman who attempted to drive away from two police officers who were sent to check on the suspect after her mother reported that she might attempt suicide.87 The district court upheld this use of force for two reasons. First, it found credible the officer’s belief that Lowe posed a risk to the safety of the officers and others when she got into her truck, which he believed could have been used as a weapon. Second, the court construed Lowe’s actions as “attempting to avoid legitimate contact by law enforcement.... ” 88 Beyond the level of threat posed by the individual, the courts have taken other factors into consideration including the degree of harm caused by the Taser and how many times it was used in a specific situation.89 For instance, the Eleventh Circuit observed that “[a]lthough being struck by a taser gun is an unpleasant experience, the amount of force [the officer] used—a single use of a taser gun causing a one-time shocking—was reasonably proportionate to the need for force and did not inflict any serious injury.” 90 To the contrary, the fact that an individual had suffered “serious injury requiring emergency medical care” and its multiple applications contributed to a court finding that the use of a taser multiple times was unreasonable.91 Because in the large majority of cases the target of the tasing is not going to suffer permanent injuries, the courts may be inclined to find that such use of force is reasonable in most cases. However, these opinions did not take into account the potential injury—including death—that might be caused by these devices. Other factors taken into consideration have included the vulnerability of the victim, 92 and whether the officers provided a warning to the target before employing the taser. 93 Pepper Spray Like tasers, the use of pepper spray by local police as a law enforcement tool has engendered considerable public attention, including well-known incidents during the Occupy Wall Street protests, 94 and more recently during the protests in Ferguson, Missouri. 95 Pepper spray, or oleoresin capsicum, is a chemical agent used by law enforcement to subdue violent or combative suspects without resorting to higher levels of force.96 The effects of pepper spray include “(1) dilation of the capillaries and instant closing of the eyes through swelling of the eyelids, (2) immediate respiratory inflammation, including uncontrollable coughing, retching, shortness of breath and gasping for air with a gagging sensation in the throat, and (3) immediate burning sensations to the mucous membranes, skin and inside the nose and mouth.” 97 The federal courts have generally been less deferential to law enforcement when using pepper spray on passive resisters than they have been with tasers. In cases in which the individual is only passively resisting—say, simply failing to listen to an officer’s order—the courts have generally held that the use of pepper spray is a violation of the Fourth Amendment.98 Take, for instance, Young v. County of Los Angeles, in which the Ninth Circuit held that the use of pepper spray against a nonviolent traffic offender was unreasonable under the Fourth Amendment.99 Similarly, in Headwaters Forest Defense v. County of Humboldt, the Ninth Circuit held that the use of pepper spray against nonviolent protestors constituted an unreasonable seizure under the Fourth Amendment.100 While these cases disapproved of the use of pepper spray against persons who were passive resisters, there have been rulings upholding such use of force in the course of traffic stops. In Mecham v. Frazier, the Tenth Circuit rejected the plaintiff’s Fourth Amendment claim that a police officer used excessive force when he sprayed her with pepper spray after she refused to leave her vehicle after a traffic stop.101 The court found that the officer’s actions were justified based on Mecham’s “disregard for the officer’s instructions, the length of the encounter, and the implausibility of Mecham’s rationale for not cooperating.” Like the use of tasers, the courts have generally held that an officer’s use of pepper spray is not unreasonable when a suspect is actively resisting arrest or fails to heed an officer’s direct command. In Singleton v. Darby, the Fifth Circuit upheld the use of pepper spray against a group of individuals, including the plaintiff Jeanette Singleton, who were protesting the Keystone XL Pipeline.102 In rejecting Singleton’s Section 1983 claim premised on excessive force, the court held that the use of the pepper spray was not unreasonable because (1) the state had a significant interest in keeping public roads clear; (2) the officer faced an “explosive situation” in which he was greatly outnumbered by the protesters; (3) he provided a warning before using the spray; and (4) pepper spray was likely the least intrusive force available to the officer.103 Finally, like with tasers, federal courts have generally held that it is unreasonable to use pepper spray against individuals who are not resisting and pose no danger to the officer or others.104 ",Legal,Concept Comparison,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Blockchain technology is best characterized by its non-erasable and distributed framework, which brings new levels of protection in the financial industry and healthcare. However, some critics opine that by virtue of being public ledgers, blockchain poses privacy issues when used to manage data. Analyze the impact of blockchain's transparency for highly sensitive information, and consider, how blockchain's decentralized structure may bring new challenges to the protection of data in a variety of sectors like supply chain and telecommunication.","Blockchain technology has been a buzzword in recent years, often associated with cryptocurrency and financial transactions. However, its potential extends far beyond these applications. It’s becoming an essential technology, with its global market size expected to hit $1.43 US trillion by 2030. Among many other applications, this technology has the power to revolutionize the way we manage and secure data across various industries, including healthcare, finance, and supply chain management. This article will discuss the untapped potential of blockchain technology in enhancing cybersecurity beyond its association with cryptocurrency. What is Blockchain? Blockchain is a digital ledger technology that records and stores data in a decentralized manner across a network of computers. It is often referred to as a ""chain"" because each block of data is linked to the previous block through a unique alphanumeric code called a hash. This creates a chronological sequence of data that is tamper-proof and immutable. Imagine a spreadsheet shared among multiple people, each with a copy. Whenever a new transaction is added, it is verified by all the people in the network before being added to the spreadsheet. This ensures that everyone has the same version of the spreadsheet, and no single person can alter the data without the others noticing. This makes it a great way to deal with online threats such as ransomware. The benefits of Blockchain in cybersecurity While blockchain technology is not a panacea for all cybersecurity challenges, its unique features and benefits make it a valuable tool for enhancing data security, preventing tampering, and increasing system resilience against cyber threats. One of the primary benefits of blockchain in cybersecurity is its ability to ensure data integrity and prevent tampering. Each block in the blockchain contains a cryptographic hash that links it to the previous block, forming an unbroken chain. Any attempt to modify data within a block would result in a different hash, immediately revealing the tampering. This immutability ensures that data stored on the blockchain remains accurate and unaltered, protecting against data breaches and unauthorized modifications. Decentralization and transparency Another significant advantage of blockchain is its decentralized architecture, which eliminates the need for a central authority or single point of failure. Traditional centralized systems are vulnerable to cyber attacks, as compromising a single server or database can lead to a complete breach. In contrast, blockchain networks are distributed across multiple nodes, making them highly resilient against attacks. Even if some nodes are compromised, the rest of the network can continue operating and validating transactions, minimizing the impact of a cyber-attack. Transparency is another crucial benefit of blockchain in cybersecurity. Every transaction or data entry on the blockchain is visible to all network participants, creating a transparent and auditable record. This transparency promotes accountability, as any attempt to manipulate data can be easily detected and traced back to the responsible party. Furthermore, blockchain's transparency facilitates automated auditing and compliance, reducing the risk of human error or intentional fraud. Additionally, since blockchain provides immutable evidence of all network events, you won’t need someone with a psychology degree to train your team members about security risks related to malware, phishing, and other threats. Blockchain applications in cybersecurity Blockchain technology has a wide range of applications beyond cryptocurrency, such as secure data storage, smart contracts, and supply chain management. It is particularly useful for industries where transparency, security, and trust are crucial, such as finance, healthcare, and even government. Healthcare Blockchain's decentralized nature ensures that patient data is kept secure and immutable, making it nearly impossible for unauthorized users to alter or tamper with medical records. This is crucial for maintaining the integrity and confidentiality of sensitive health information. Additionally, blockchain supports the use of smart contracts, which automate various healthcare processes including claims management and billing. These contracts execute conditions automatically, minimizing the risk of fraud and errors while ensuring transactions are handled efficiently. Blockchain also facilitates secure data exchange between different healthcare systems and providers by improving interoperability. This enhances coordinated care and improves overall health outcomes​ Finance Blockchain technology’s inherent properties such as decentralization, immutability, and transparency, are particularly suited to addressing some of the most pressing cybersecurity challenges faced by financial institutions. One key application is in banking systems, where blockchain can facilitate secure and auditable money transfers while eliminating the need for intermediaries and reducing the risk of tampering or unauthorized access. The technology creates a distributed ledger of transactions, ensuring financial records remain accurate, consistent, and resistant to manipulation. Each transaction undergoes cryptographic security measures before being added as a new immutable block, establishing a permanent and verifiable trail for easy auditing. This transparency and traceability aid in detecting and preventing fraudulent activities like money laundering, identity theft, and unauthorized fund transfers. Then again, blockchain's unalterable ledger also works well with traditional solutions such as PCI-compliant hosting, which adds another layer of security reporting. In addition to having the website as a whole protected, the same server could also store copies of transactions reported on the ledger, as well as pentesting reports and all essential data. It could also be used to make same-day ACH transfers, loan issuance, and other financial activities more efficient. Blockchain's decentralized architecture also eliminates single points of failure, making financial systems more resilient against cyber-attacks and data breaches. Several major banks and financial institutions actively explore and implement blockchain solutions to streamline operations, reduce costs, and enhance security for sensitive financial data and transactions. Supply chain management Blockchain technology significantly enhances cybersecurity within supply chain management by creating a decentralized and transparent environment that makes data tampering and fraud much more difficult. Immutable ledgers allow stakeholders to audit the supply chain in real-time and verify all activities without relying on a single point of trust​. Smart contracts streamline many supply chain processes, such as procurement and payments, reducing the potential for disputes and enhancing overall efficiency. These contracts trigger automatically when predefined conditions are met, thus ensuring compliance and speeding up operations. Furthermore, blockchain's ability to provide a comprehensive record of transactions helps significantly reduce the risk of counterfeit products entering the supply chain, as each product can be traced back to its origin​. The potential for Blockchain to become a universal cybersecurity solution Blockchain technology has the potential to become a universal cybersecurity solution across various industries and applications. Its decentralized, transparent, and immutable nature makes it a robust framework for securing data, systems, and transactions. The widespread adoption of blockchain as a universal cybersecurity solution is still in its early stages. However, there are ongoing research and development efforts to address challenges such as scalability and regulatory compliance and speed up its application. As the technology continues to evolve and mature, it has the potential to become an integral part of cybersecurity frameworks across multiple sectors. It has proven its ability to provide a secure and transparent foundation for data integrity as well as to protect your overall digital footprint. Scaling up isn't an issue with blockchain either—even an options-trading platform can rely on more efficient chains to process large amounts of data on a per-second basis, which can also be applied to other niches, such as music streaming, eSports, communication platforms, etc. Not to mention, the robust authentication mechanisms that blockchain provides us with, ensuring that only authorized parties can access and interact with sensitive information. Conclusion Blockchain technology is not just good for enhancing current security systems; it's also paving the way for new, decentralized security measures that could fundamentally change how we protect digital information. As cyber threats become more complex, blockchain's role in building secure, resilient digital systems becomes increasingly crucial. It represents a future where digital security is integrated seamlessly into the fabric of our digital interactions.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Blockchain technology is best characterized by its non-erasable and distributed framework, which brings new levels of protection in the financial industry and healthcare. However, some critics opine that by virtue of being public ledgers, blockchain poses privacy issues when used to manage data. Analyze the impact of blockchain's transparency for highly sensitive information, and consider, how blockchain's decentralized structure may bring new challenges to the protection of data in a variety of sectors like supply chain and telecommunication. {passage 0} ========== Blockchain technology has been a buzzword in recent years, often associated with cryptocurrency and financial transactions. However, its potential extends far beyond these applications. It’s becoming an essential technology, with its global market size expected to hit $1.43 US trillion by 2030. Among many other applications, this technology has the power to revolutionize the way we manage and secure data across various industries, including healthcare, finance, and supply chain management. This article will discuss the untapped potential of blockchain technology in enhancing cybersecurity beyond its association with cryptocurrency. What is Blockchain? Blockchain is a digital ledger technology that records and stores data in a decentralized manner across a network of computers. It is often referred to as a ""chain"" because each block of data is linked to the previous block through a unique alphanumeric code called a hash. This creates a chronological sequence of data that is tamper-proof and immutable. Imagine a spreadsheet shared among multiple people, each with a copy. Whenever a new transaction is added, it is verified by all the people in the network before being added to the spreadsheet. This ensures that everyone has the same version of the spreadsheet, and no single person can alter the data without the others noticing. This makes it a great way to deal with online threats such as ransomware. The benefits of Blockchain in cybersecurity While blockchain technology is not a panacea for all cybersecurity challenges, its unique features and benefits make it a valuable tool for enhancing data security, preventing tampering, and increasing system resilience against cyber threats. One of the primary benefits of blockchain in cybersecurity is its ability to ensure data integrity and prevent tampering. Each block in the blockchain contains a cryptographic hash that links it to the previous block, forming an unbroken chain. Any attempt to modify data within a block would result in a different hash, immediately revealing the tampering. This immutability ensures that data stored on the blockchain remains accurate and unaltered, protecting against data breaches and unauthorized modifications. Decentralization and transparency Another significant advantage of blockchain is its decentralized architecture, which eliminates the need for a central authority or single point of failure. Traditional centralized systems are vulnerable to cyber attacks, as compromising a single server or database can lead to a complete breach. In contrast, blockchain networks are distributed across multiple nodes, making them highly resilient against attacks. Even if some nodes are compromised, the rest of the network can continue operating and validating transactions, minimizing the impact of a cyber-attack. Transparency is another crucial benefit of blockchain in cybersecurity. Every transaction or data entry on the blockchain is visible to all network participants, creating a transparent and auditable record. This transparency promotes accountability, as any attempt to manipulate data can be easily detected and traced back to the responsible party. Furthermore, blockchain's transparency facilitates automated auditing and compliance, reducing the risk of human error or intentional fraud. Additionally, since blockchain provides immutable evidence of all network events, you won’t need someone with a psychology degree to train your team members about security risks related to malware, phishing, and other threats. Blockchain applications in cybersecurity Blockchain technology has a wide range of applications beyond cryptocurrency, such as secure data storage, smart contracts, and supply chain management. It is particularly useful for industries where transparency, security, and trust are crucial, such as finance, healthcare, and even government. Healthcare Blockchain's decentralized nature ensures that patient data is kept secure and immutable, making it nearly impossible for unauthorized users to alter or tamper with medical records. This is crucial for maintaining the integrity and confidentiality of sensitive health information. Additionally, blockchain supports the use of smart contracts, which automate various healthcare processes including claims management and billing. These contracts execute conditions automatically, minimizing the risk of fraud and errors while ensuring transactions are handled efficiently. Blockchain also facilitates secure data exchange between different healthcare systems and providers by improving interoperability. This enhances coordinated care and improves overall health outcomes​ Finance Blockchain technology’s inherent properties such as decentralization, immutability, and transparency, are particularly suited to addressing some of the most pressing cybersecurity challenges faced by financial institutions. One key application is in banking systems, where blockchain can facilitate secure and auditable money transfers while eliminating the need for intermediaries and reducing the risk of tampering or unauthorized access. The technology creates a distributed ledger of transactions, ensuring financial records remain accurate, consistent, and resistant to manipulation. Each transaction undergoes cryptographic security measures before being added as a new immutable block, establishing a permanent and verifiable trail for easy auditing. This transparency and traceability aid in detecting and preventing fraudulent activities like money laundering, identity theft, and unauthorized fund transfers. Then again, blockchain's unalterable ledger also works well with traditional solutions such as PCI-compliant hosting, which adds another layer of security reporting. In addition to having the website as a whole protected, the same server could also store copies of transactions reported on the ledger, as well as pentesting reports and all essential data. It could also be used to make same-day ACH transfers, loan issuance, and other financial activities more efficient. Blockchain's decentralized architecture also eliminates single points of failure, making financial systems more resilient against cyber-attacks and data breaches. Several major banks and financial institutions actively explore and implement blockchain solutions to streamline operations, reduce costs, and enhance security for sensitive financial data and transactions. Supply chain management Blockchain technology significantly enhances cybersecurity within supply chain management by creating a decentralized and transparent environment that makes data tampering and fraud much more difficult. Immutable ledgers allow stakeholders to audit the supply chain in real-time and verify all activities without relying on a single point of trust​. Smart contracts streamline many supply chain processes, such as procurement and payments, reducing the potential for disputes and enhancing overall efficiency. These contracts trigger automatically when predefined conditions are met, thus ensuring compliance and speeding up operations. Furthermore, blockchain's ability to provide a comprehensive record of transactions helps significantly reduce the risk of counterfeit products entering the supply chain, as each product can be traced back to its origin​. The potential for Blockchain to become a universal cybersecurity solution Blockchain technology has the potential to become a universal cybersecurity solution across various industries and applications. Its decentralized, transparent, and immutable nature makes it a robust framework for securing data, systems, and transactions. The widespread adoption of blockchain as a universal cybersecurity solution is still in its early stages. However, there are ongoing research and development efforts to address challenges such as scalability and regulatory compliance and speed up its application. As the technology continues to evolve and mature, it has the potential to become an integral part of cybersecurity frameworks across multiple sectors. It has proven its ability to provide a secure and transparent foundation for data integrity as well as to protect your overall digital footprint. Scaling up isn't an issue with blockchain either—even an options-trading platform can rely on more efficient chains to process large amounts of data on a per-second basis, which can also be applied to other niches, such as music streaming, eSports, communication platforms, etc. Not to mention, the robust authentication mechanisms that blockchain provides us with, ensuring that only authorized parties can access and interact with sensitive information. Conclusion Blockchain technology is not just good for enhancing current security systems; it's also paving the way for new, decentralized security measures that could fundamentally change how we protect digital information. As cyber threats become more complex, blockchain's role in building secure, resilient digital systems becomes increasingly crucial. It represents a future where digital security is integrated seamlessly into the fabric of our digital interactions. https://www.secureworld.io/industry-news/blockchain-beyond-crypto-cybersecurity",Internet/Technology,Effect Analysis,Q&A You must base your answer only on the provided text. You must not use any external sources or prior knowledge. Limit your response to 40 words.,"If a customer's meter seal was broken and lost service, but now wants it reconnected, what must they do?","DISCONTINUANCE AND RECONNECTION 4.11 General: Failure of SRP at any time to suspend the delivery of service, to terminate an Agreement for Electric Service, or to seek any other legal remedy upon default or breach by the Customer will not affect SRP’s right to seek any such remedies for the same or any future default or breach by the Customer. If a Customer fails to perform as required by these Rules and Regulations, the Price Plans, the Electric Service Specifications, or the Customer’s Agreement for Electric Service, SRP may disconnect service. No personal visit to a Customer’s premises is required prior to disconnection of service. SRP also may disconnect service to the Customer when necessary to comply with any law or regulation applicable to SRP or the Customer, or if a Governmental Entity revokes its clearance for the provision of electrical service. 4.12 Reconnect After Disconnect for Non-Payment: 4.12.1 Seven calendar days prior to disconnecting service for a delinquent SRP billing, SRP will mail, e-mail, or personally deliver to the Customer’s premises a written notice stating the delinquent amount and that SRP intends to disconnect service unless the delinquent amount is promptly paid. This notification requirement does not apply to delinquent extensions for payment of prior billings when a seven-day notice was previously given, to delinquent extensions for payment of deposits or other up-front charges that were billed as a courtesy to the Customer, to a pre-pay account when the Customer controls timing of the disconnection based on self-management of the pre-pay balance, or to insufficient funds regarding the Customer’s payment. 4.12.2 Once SRP disconnects service, SRP will not reconnect service until the Customer (a) applies for service; (b) pays all amounts the Customer owes SRP, including past-due bills and any charges for the cost of disconnecting and reconnecting service; and (c) corrects the condition that resulted in the SALT RIVER PROJECT AGRICULTURAL IMPROVEMENT AND POWER DISTRICT RULES AND REGULATIONS 29 disconnection. SRP may require an additional security deposit based on its evaluation of the Customer’s creditworthiness. 4.13 Disconnect and Reconnect Pursuant to a Request of a Governmental Entity: 4.13.1 If SRP receives a request to discontinue service from a Governmental Entity stating that it hasrevoked its clearance for the provision of electricalservice, SRP may immediately disconnect service to the Customer without notice. 4.13.2 Once SRP disconnects service due to a request by a Governmental Entity, SRP will not reconnect service until it receives notice that the clearance for the provision of electrical service has been restored by the Governmental Entity. 4.14 Fraud: 4.14.1 No Person shall connect a wire or contrivance to any apparatus used by SRP to supply electricity to a Customer, nor shall any Person provide Power to any device by induction from SRP’s Lines, in such manner that the Person takes electricity that is not properly metered or accounted for. No meter or other instrument installed for measuring the quantity of electricity consumed may be wrongfully obstructed, altered, injured, or prevented from functioning. When a meter seal has been broken by someone other than SRP’s personnel, SRP may assess a reconnection fee to the Customer’s billing. Bills for unmetered electricity may include the full cost or expense incurred by SRP to investigate and confirm diversion of electricity. SRP also reserves the right to impose additional charges, as it deems appropriate, when a provision of this Section 4.14.1 has been violated. Bills for all such charges are due and payable immediately upon presentation unless otherwise agreed by SRP. In addition to the remedies herein, SRP reserves all legal rights available to it including pursuing criminal prosecutions against, and criminal and civil damages from, any Party that violates this Section 4.14.1 or applicable law. 4.14.2 If SRP has evidence that any Customer has caused or allowed any of the conditions of Section 4.14.1 to exist, SRP may, at any time, without notice, discontinue the supply of electricity to the Customer and remove the meter or meters, apparatus, wires, and Service Lateral, as well as any evidence of the condition. 4.14.3 SRP will charge the Customer for periods of unmetered service, estimated using data from available records and information. In the event of damage to meters or Service Equipment, the current Customer of record shall pay SRP based on estimated Energy usage not previously billed as well as any SRP costs associated with restoring proper metering or service. SALT RIVER PROJECT AGRICULTURAL IMPROVEMENT AND POWER DISTRICT RULES AND REGULATIONS 30 4.14.4 If SRP disconnects service to the Customer because of a violation of these Rules and Regulations, SRP will not restore service to the Customer until all amounts due SRP have been paid. SRP will include the full cost or expense incurred by SRP for the removal and reinstallation of the meter or meters, apparatus, wires, and Service Lateral. The Customer’s service entrance must comply with SRP’s then-current Electric Service Specifications before it can be re-energized. 4.15 Other Reasons for Discontinuance: 4.15.1 SRP may terminate an Agreement for Electric Service with a Customer or suspend the delivery of service for any other default or breach of the Agreement by the Customer, but, except as expressly provided otherwise in these Rules and Regulations, SRP will not terminate or suspend service without first giving written notice to the Customer, stating in what particular way the Agreement has been violated. 4.15.2 SRP may terminate or suspend delivery of service in the event of a short circuit or other electrical system failure on the Customer’s side of the Point of Delivery or, if the utilization of the service by the Customer, in SRP’s sole discretion, is a safety hazard or may cause damage to Persons or property (“Emergency Disconnect”). Notwithstanding any other provision of these Rules and Regulations, the Price Plans, the Electric Service Specifications, a Customer’s Agreement for Electric Service, or the Distributed Generation Interconnection Handbook, no advance notice need be given to the Customer in the event of an Emergency Disconnect. 4.15.3 Upon prior written notice, SRP may terminate or suspend the delivery of service if: (a) the Customer refuses to grant or is unable to procure easements necessary for or incidental to SRP’s facilities or its provision of service to the Customer according to Section 5.1.5 or any written agreement between SRP and the Customer, or (b) SRP is not provided proper access to SRP Lines, Service Laterals, meters, or other equipment located on property owned or controlled by the Customer to perform maintenance or repair of SRP facilities, to provide service to the Customer, or to read meters on the Customer’s premises. 4.15.4 Notwithstanding any other provision of these Rules and Regulations, the Price Plans, the Electric Service Specifications, or the Customer’s Agreement for Electric Service or the Distributed Generation Interconnection Handbook, SRP may disconnect a Customer at any time, without notice, and remove the meter or meters if the Customer has misrepresented his or her identity in any manner. SALT RIVER PROJECT AGRICULTURAL IMPROVEMENT AND POWER DISTRICT RULES AND REGULATIONS 31 4.15.5 Upon prior written notice to Customer, SRP may terminate or suspend the delivery of electric service to any Customer who: (a) without obtaining SRP’s prior written approval, connects or allows the connection of a Distributed Energy Device to any portion of such Customer’s electric system; (b) is required to sign SRP’s Interconnection Agreement but refuses to do so; (c) fails to procure the signature of a third-party owner or operator on SRP’s Interconnection Agreement; or (d) fails to comply with the SRP’s Distributed Generation Interconnection Handbook. 4.15.6 SRP may terminate or suspend delivery of electric service at any time, without notice, if a Customer’s identity cannot be established to SRP’s satisfaction","system instruction: You must base your answer only on the provided text. You must not use any external sources or prior knowledge. Limit your response to 40 words. question: If a customer's meter seal was broken and lost service, but now wants it reconnected, what must they do? context block: DISCONTINUANCE AND RECONNECTION 4.11 General: Failure of SRP at any time to suspend the delivery of service, to terminate an Agreement for Electric Service, or to seek any other legal remedy upon default or breach by the Customer will not affect SRP’s right to seek any such remedies for the same or any future default or breach by the Customer. If a Customer fails to perform as required by these Rules and Regulations, the Price Plans, the Electric Service Specifications, or the Customer’s Agreement for Electric Service, SRP may disconnect service. No personal visit to a Customer’s premises is required prior to disconnection of service. SRP also may disconnect service to the Customer when necessary to comply with any law or regulation applicable to SRP or the Customer, or if a Governmental Entity revokes its clearance for the provision of electrical service. 4.12 Reconnect After Disconnect for Non-Payment: 4.12.1 Seven calendar days prior to disconnecting service for a delinquent SRP billing, SRP will mail, e-mail, or personally deliver to the Customer’s premises a written notice stating the delinquent amount and that SRP intends to disconnect service unless the delinquent amount is promptly paid. This notification requirement does not apply to delinquent extensions for payment of prior billings when a seven-day notice was previously given, to delinquent extensions for payment of deposits or other up-front charges that were billed as a courtesy to the Customer, to a pre-pay account when the Customer controls timing of the disconnection based on self-management of the pre-pay balance, or to insufficient funds regarding the Customer’s payment. 4.12.2 Once SRP disconnects service, SRP will not reconnect service until the Customer (a) applies for service; (b) pays all amounts the Customer owes SRP, including past-due bills and any charges for the cost of disconnecting and reconnecting service; and (c) corrects the condition that resulted in the SALT RIVER PROJECT AGRICULTURAL IMPROVEMENT AND POWER DISTRICT RULES AND REGULATIONS 29 disconnection. SRP may require an additional security deposit based on its evaluation of the Customer’s creditworthiness. 4.13 Disconnect and Reconnect Pursuant to a Request of a Governmental Entity: 4.13.1 If SRP receives a request to discontinue service from a Governmental Entity stating that it hasrevoked its clearance for the provision of electricalservice, SRP may immediately disconnect service to the Customer without notice. 4.13.2 Once SRP disconnects service due to a request by a Governmental Entity, SRP will not reconnect service until it receives notice that the clearance for the provision of electrical service has been restored by the Governmental Entity. 4.14 Fraud: 4.14.1 No Person shall connect a wire or contrivance to any apparatus used by SRP to supply electricity to a Customer, nor shall any Person provide Power to any device by induction from SRP’s Lines, in such manner that the Person takes electricity that is not properly metered or accounted for. No meter or other instrument installed for measuring the quantity of electricity consumed may be wrongfully obstructed, altered, injured, or prevented from functioning. When a meter seal has been broken by someone other than SRP’s personnel, SRP may assess a reconnection fee to the Customer’s billing. Bills for unmetered electricity may include the full cost or expense incurred by SRP to investigate and confirm diversion of electricity. SRP also reserves the right to impose additional charges, as it deems appropriate, when a provision of this Section 4.14.1 has been violated. Bills for all such charges are due and payable immediately upon presentation unless otherwise agreed by SRP. In addition to the remedies herein, SRP reserves all legal rights available to it including pursuing criminal prosecutions against, and criminal and civil damages from, any Party that violates this Section 4.14.1 or applicable law. 4.14.2 If SRP has evidence that any Customer has caused or allowed any of the conditions of Section 4.14.1 to exist, SRP may, at any time, without notice, discontinue the supply of electricity to the Customer and remove the meter or meters, apparatus, wires, and Service Lateral, as well as any evidence of the condition. 4.14.3 SRP will charge the Customer for periods of unmetered service, estimated using data from available records and information. In the event of damage to meters or Service Equipment, the current Customer of record shall pay SRP based on estimated Energy usage not previously billed as well as any SRP costs associated with restoring proper metering or service. SALT RIVER PROJECT AGRICULTURAL IMPROVEMENT AND POWER DISTRICT RULES AND REGULATIONS 30 4.14.4 If SRP disconnects service to the Customer because of a violation of these Rules and Regulations, SRP will not restore service to the Customer until all amounts due SRP have been paid. SRP will include the full cost or expense incurred by SRP for the removal and reinstallation of the meter or meters, apparatus, wires, and Service Lateral. The Customer’s service entrance must comply with SRP’s then-current Electric Service Specifications before it can be re-energized. 4.15 Other Reasons for Discontinuance: 4.15.1 SRP may terminate an Agreement for Electric Service with a Customer or suspend the delivery of service for any other default or breach of the Agreement by the Customer, but, except as expressly provided otherwise in these Rules and Regulations, SRP will not terminate or suspend service without first giving written notice to the Customer, stating in what particular way the Agreement has been violated. 4.15.2 SRP may terminate or suspend delivery of service in the event of a short circuit or other electrical system failure on the Customer’s side of the Point of Delivery or, if the utilization of the service by the Customer, in SRP’s sole discretion, is a safety hazard or may cause damage to Persons or property (“Emergency Disconnect”). Notwithstanding any other provision of these Rules and Regulations, the Price Plans, the Electric Service Specifications, a Customer’s Agreement for Electric Service, or the Distributed Generation Interconnection Handbook, no advance notice need be given to the Customer in the event of an Emergency Disconnect. 4.15.3 Upon prior written notice, SRP may terminate or suspend the delivery of service if: (a) the Customer refuses to grant or is unable to procure easements necessary for or incidental to SRP’s facilities or its provision of service to the Customer according to Section 5.1.5 or any written agreement between SRP and the Customer, or (b) SRP is not provided proper access to SRP Lines, Service Laterals, meters, or other equipment located on property owned or controlled by the Customer to perform maintenance or repair of SRP facilities, to provide service to the Customer, or to read meters on the Customer’s premises. 4.15.4 Notwithstanding any other provision of these Rules and Regulations, the Price Plans, the Electric Service Specifications, or the Customer’s Agreement for Electric Service or the Distributed Generation Interconnection Handbook, SRP may disconnect a Customer at any time, without notice, and remove the meter or meters if the Customer has misrepresented his or her identity in any manner. SALT RIVER PROJECT AGRICULTURAL IMPROVEMENT AND POWER DISTRICT RULES AND REGULATIONS 31 4.15.5 Upon prior written notice to Customer, SRP may terminate or suspend the delivery of electric service to any Customer who: (a) without obtaining SRP’s prior written approval, connects or allows the connection of a Distributed Energy Device to any portion of such Customer’s electric system; (b) is required to sign SRP’s Interconnection Agreement but refuses to do so; (c) fails to procure the signature of a third-party owner or operator on SRP’s Interconnection Agreement; or (d) fails to comply with the SRP’s Distributed Generation Interconnection Handbook. 4.15.6 SRP may terminate or suspend delivery of electric service at any time, without notice, if a Customer’s identity cannot be established to SRP’s satisfaction",Legal,Fact Finding,Q&A "Draw your answer from the context block solely, do not use external information. If you cannot answer using the provided context alone, output: ""Sorry, I cannot answer your question due to a lack of context."". Answer only in a paragraph format, without any markdown. Use statistics often, when relevant.","What do the main findings from the industry survey say about journalism, media, and technology companies?","These are the main findings from our industry survey, drawn from a strategic sample of more than 300 digital leaders from more than 50 countries and territories. • Just half (47%) of our sample of editors, CEOs, and digital executives say they are confident about the prospects for journalism in the year ahead, with around one-tenth (12%) expressing low confidence. Stated concerns relate to rising costs, declining advertising revenue, and a slowing in subscription growth – as well as increasing legal and physical harassment. Reasons to be cheerful include the hope that closely fought elections in the US and elsewhere could boost consumption and interest, albeit temporarily and with the potential for further damage to trust. • Almost two-thirds (63%) of our survey respondents say they are worried about a sharp decline in referral traffic from social media sites. Data sourced for this report from analytics provider Chartbeat shows that traffic to news sites from Facebook fell 48% in 2023, with traffic from X/Twitter declining by 27%. In response to these developments, around three-quarters (77%) say they will focus more on their own direct channels in the next year, with a fifth (22%) resorting to cutting costs and a similar proportion (20%) experimenting with alternative third-party platforms. • More specifically, publishers say they’ll be putting more effort into WhatsApp (+61 net score)2 and Instagram (+39) following Meta’s decision to open up broadcast channels for publishers. Interest in video networks such as TikTok (+55) and YouTube (+44) remain strong while Google Discover is becoming a more important but volatile referral source. By contrast, publisher sentiment towards Facebook has worsened further this year (-38 net score) along with X/Twitter (-39 net score). • Related to the above, the majority of our publisher respondents say they plan to create more video (+64 net score), more newsletters (+52), and more podcasts (+47), but broadly the same number of news articles – as they lean into some of the few remaining areas of audience and advertiser growth. Around half (54%) of respondents admit their companies are mostly focused on maximising attention rather than being more respectful of their audience’s time (37%). • The twin dangers of selective news avoidance and news fatigue remain a major source of concern for media companies looking to sustain interest in news from Gaza and Ukraine, amongst other difficult stories. Strategies that publishers consider very important to counter these trends include better explanation of complex stories (67%), more solutionsoriented or constructive approaches to storytelling (44%), and more inspirational human stories (43%). There was less support for commissioning more positive (21%) or entertaining (18%) news. • On the business side, publishers continue to invest in subscription and membership, with a large majority of those surveyed (80%) saying this will be an important revenue stream, ahead of both display and native advertising. Most of those operating a paid model report either a slight increase, or stable subscription numbers in the last year, despite the difficult economic outlook. • As a number of publishers aim to do lucrative licensing deals with AI platforms this year, there is little optimism that any benefits will be equally shared. In our survey a third (35%) of respondents believed that most of the money would go to big publishers. Around half (48%) felt that, at the end of the day, there would be very little money for any publisher. • Using AI for back-end news automation (56%) is considered the most important use of the technology by publisher respondents, followed by offering better recommendations (37%) and commercial uses (28%). Publishers are ambivalent about using AI for content creation, which is considered the biggest reputational risk by over half of respondents. • Experimental interfaces to the internet such as AR and VR glasses, lapel pins, and other wearable devices will be a feature of the year ahead. But existing voice activated devices such as headphones and smart speakers, as they get upgraded with AI technologies, are considered by respondents to be the most likely option (41%) to displace – or at least supplement – the smartphone in the medium term.","System Instructions: Draw your answer from the context block solely, do not use external information. If you cannot answer using the provided context alone, output: ""Sorry, I cannot answer your question due to a lack of context."". Answer only in a paragraph format, without any markdown. Use statistics often, when relevant. Question: What do the main findings from the industry survey say about journalism, media, and technology companies? Context Block: These are the main findings from our industry survey, drawn from a strategic sample of more than 300 digital leaders from more than 50 countries and territories. • Just half (47%) of our sample of editors, CEOs, and digital executives say they are confident about the prospects for journalism in the year ahead, with around one-tenth (12%) expressing low confidence. Stated concerns relate to rising costs, declining advertising revenue, and a slowing in subscription growth – as well as increasing legal and physical harassment. Reasons to be cheerful include the hope that closely fought elections in the US and elsewhere could boost consumption and interest, albeit temporarily and with the potential for further damage to trust. • Almost two-thirds (63%) of our survey respondents say they are worried about a sharp decline in referral traffic from social media sites. Data sourced for this report from analytics provider Chartbeat shows that traffic to news sites from Facebook fell 48% in 2023, with traffic from X/Twitter declining by 27%. In response to these developments, around three-quarters (77%) say they will focus more on their own direct channels in the next year, with a fifth (22%) resorting to cutting costs and a similar proportion (20%) experimenting with alternative third-party platforms. • More specifically, publishers say they’ll be putting more effort into WhatsApp (+61 net score)2 and Instagram (+39) following Meta’s decision to open up broadcast channels for publishers. Interest in video networks such as TikTok (+55) and YouTube (+44) remain strong while Google Discover is becoming a more important but volatile referral source. By contrast, publisher sentiment towards Facebook has worsened further this year (-38 net score) along with X/Twitter (-39 net score). • Related to the above, the majority of our publisher respondents say they plan to create more video (+64 net score), more newsletters (+52), and more podcasts (+47), but broadly the same number of news articles – as they lean into some of the few remaining areas of audience and advertiser growth. Around half (54%) of respondents admit their companies are mostly focused on maximising attention rather than being more respectful of their audience’s time (37%). • The twin dangers of selective news avoidance and news fatigue remain a major source of concern for media companies looking to sustain interest in news from Gaza and Ukraine, amongst other difficult stories. Strategies that publishers consider very important to counter these trends include better explanation of complex stories (67%), more solutionsoriented or constructive approaches to storytelling (44%), and more inspirational human stories (43%). There was less support for commissioning more positive (21%) or entertaining (18%) news. • On the business side, publishers continue to invest in subscription and membership, with a large majority of those surveyed (80%) saying this will be an important revenue stream, ahead of both display and native advertising. Most of those operating a paid model report either a slight increase, or stable subscription numbers in the last year, despite the difficult economic outlook. • As a number of publishers aim to do lucrative licensing deals with AI platforms this year, there is little optimism that any benefits will be equally shared. In our survey a third (35%) of respondents believed that most of the money would go to big publishers. Around half (48%) felt that, at the end of the day, there would be very little money for any publisher. • Using AI for back-end news automation (56%) is considered the most important use of the technology by publisher respondents, followed by offering better recommendations (37%) and commercial uses (28%). Publishers are ambivalent about using AI for content creation, which is considered the biggest reputational risk by over half of respondents. • Experimental interfaces to the internet such as AR and VR glasses, lapel pins, and other wearable devices will be a feature of the year ahead. But existing voice activated devices such as headphones and smart speakers, as they get upgraded with AI technologies, are considered by respondents to be the most likely option (41%) to displace – or at least supplement – the smartphone in the medium term.",Internet/Technology,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","My kid is an elite athlete fielding several college scholarships. I want to know the legalities of what he can do with his name, image, and likeness deals. Several companies have approached my kid with brand deals and I want to know how it will work and what it will mean for his future financially and within the realm of his sport. What's up? We are based in California.","Rules The current NIL rules related to college athletes apply via state law and/or NCAA rules. Due to the potential of having a patchwork of so many NIL rules, the NCAA is now asking for federal legislation addressing this patchwork of NIL rules. The NCAA allows member institutions to recruit and sign high school athletes who have participated in NIL activities while the student was in high school. The current NIL rules related to high school athletes are established state to state. There is a possibility of 51 different sets of rules relating to NIL (50 states and the District of Columbia), and 51 different sets of rules relating to transfer (undue influence, bona fide moves, traditional academic transfer rules, and subsequent eligibility determinations) leads to many questions. As of October 4, 2023, the following 30 states and the District of Columbia allow interscholastic athletes to receive NIL payments: Alaska, California, Colorado, Connecticut, District of Columbia, Georgia, Idaho, Illinois, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Virginia and Washington. This developing area requires measured and contemplative rule-making. What the landscape in both the near- and far-future will look like for both collegiate and high school NIL is anyone’s guess. But one thing is for sure, NIL at both the collegiate and interscholastic levels is here to stay. New and Different Options The financial opportunities for high school athletes are not just for product endorsement, gear sales or the more traditional NIL models – interscholastic opportunities can be much more sophisticated. Now, there must be consideration of rules that apply to 1) the developing individual athlete “brands” which the individual athlete has personally created on social media, and 2) the number of new and developing avenues of revenue streams for these athletes that don’t necessarily include U.S. currency. An example of such an option for high school athletes is what former USC quarterback and Heisman Trophy winner Matt Leinart and current USC quarterback and Heisman Trophy winner Caleb Williams provide with their Hall of Goats organization. Hall of Goats has a platform designed to provide athletes the opportunity to drop exclusive NFT collections and take advantage of their NIL rights, while providing personal brand, content and digital resources. NFT collections are “non-functional tokens.” These tokens and the platform are designed to allow athletes to use the platform to help build their brands, tell their stories and set them up for long-term success. As a result, the traditional notions of what constitutes remunerative value for a high school athlete no longer is only about “cash” but is about other things of value that if properly “negotiated” can lead to additional, and non-traditional monetizing of the athlete, at a time the athlete chooses. The significance of athletes having their own brand is that it allows them access to NIL separate from their high school team and school district. The most common limitations on high school NIL are that the athlete cannot use the school’s name, uniform, mascot, etc., as part of what they market for NIL. At the high school level, the brand’s value is not linked to the school the athlete attends but is linked to the individual. The “athlete brand” can be quantified by the number of social media followers the athlete has, and the number of views on videos that the athlete has. This is where the value to the athlete is, which is different from the collegiate model where an athlete may get a percentage of profits from the sale of their school jersey with the number and name they wear, cashing in on the school’s brand and name.","[question] My kid is an elite athlete fielding several college scholarships. I want to know the legalities of what he can do with his name, image, and likeness deals. Several companies have approached my kid with brand deals and I want to know how it will work and what it will mean for his future financially and within the realm of his sport. What's up? We are based in California. ===================== [text] Rules The current NIL rules related to college athletes apply via state law and/or NCAA rules. Due to the potential of having a patchwork of so many NIL rules, the NCAA is now asking for federal legislation addressing this patchwork of NIL rules. The NCAA allows member institutions to recruit and sign high school athletes who have participated in NIL activities while the student was in high school. The current NIL rules related to high school athletes are established state to state. There is a possibility of 51 different sets of rules relating to NIL (50 states and the District of Columbia), and 51 different sets of rules relating to transfer (undue influence, bona fide moves, traditional academic transfer rules, and subsequent eligibility determinations) leads to many questions. As of October 4, 2023, the following 30 states and the District of Columbia allow interscholastic athletes to receive NIL payments: Alaska, California, Colorado, Connecticut, District of Columbia, Georgia, Idaho, Illinois, Iowa, Kansas, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Nebraska, Nevada, New Jersey, New Mexico, New York, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, Tennessee, Utah, Virginia and Washington. This developing area requires measured and contemplative rule-making. What the landscape in both the near- and far-future will look like for both collegiate and high school NIL is anyone’s guess. But one thing is for sure, NIL at both the collegiate and interscholastic levels is here to stay. New and Different Options The financial opportunities for high school athletes are not just for product endorsement, gear sales or the more traditional NIL models – interscholastic opportunities can be much more sophisticated. Now, there must be consideration of rules that apply to 1) the developing individual athlete “brands” which the individual athlete has personally created on social media, and 2) the number of new and developing avenues of revenue streams for these athletes that don’t necessarily include U.S. currency. An example of such an option for high school athletes is what former USC quarterback and Heisman Trophy winner Matt Leinart and current USC quarterback and Heisman Trophy winner Caleb Williams provide with their Hall of Goats organization. Hall of Goats has a platform designed to provide athletes the opportunity to drop exclusive NFT collections and take advantage of their NIL rights, while providing personal brand, content and digital resources. NFT collections are “non-functional tokens.” These tokens and the platform are designed to allow athletes to use the platform to help build their brands, tell their stories and set them up for long-term success. As a result, the traditional notions of what constitutes remunerative value for a high school athlete no longer is only about “cash” but is about other things of value that if properly “negotiated” can lead to additional, and non-traditional monetizing of the athlete, at a time the athlete chooses. The significance of athletes having their own brand is that it allows them access to NIL separate from their high school team and school district. The most common limitations on high school NIL are that the athlete cannot use the school’s name, uniform, mascot, etc., as part of what they market for NIL. At the high school level, the brand’s value is not linked to the school the athlete attends but is linked to the individual. The “athlete brand” can be quantified by the number of social media followers the athlete has, and the number of views on videos that the athlete has. This is where the value to the athlete is, which is different from the collegiate model where an athlete may get a percentage of profits from the sale of their school jersey with the number and name they wear, cashing in on the school’s brand and name. https://www.nfhs.org/articles/name-image-and-likeness-for-interscholastic-athletes-what-does-it-look-like/#:~:text=NIL%20allows%20high%20school%20athletes,their%20high%20school%20athletic%20eligibility. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Find & Summarize,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","How are Senators and Representatives being compensated? Who is excluded from the compensation and why? Can a senator or representative be arrested during their attendance at any house session? What other authority or place can question a representative or a senator? When the passage was written, how many Senators would be required to be in attendance to establish a quorum?","Section. 5. Each House shall be the judge of the elections, returns and qualifications of its own members, and a majority of each shall constitute a quorum to do business; but a smaller number may adjourn from day to day, and may be authorized to compel the attendance of absent members, in such manner, and under such penalties as each House may provide. Each House may determine the rules of its proceedings, punish its members for disorderly behavior, and, with the concurrence of two thirds, expel a member. Each House shall keep a Journal of its proceedings, and from time to time publish the same, excepting such parts as may in their judgment require secrecy; and the yeas and nays of the members of either house on any question shall, at the desire of one fifth of those present, be entered on the journal. Neither House, during the session of Congress, shall, without the consent of the other, adjourn for more than three days, nor to any other place than that in which the two Houses shall be sitting. Section. 6. The Senators and Representatives shall receive a Compensation for their Services, to be ascertained by law, and paid out of the Treasury of the United States. They shall in all cases, except treason, felony and breach of the peace, be privileged from arrest during their attendance at the session of their respective Houses, and in going to and returning from the same; and for any speech or debate in either, they shall not be questioned in any other place. No Senator or Representative shall, during the time for which he was elected, be appointed to any civil office under the authority of the United States, which shall have been created, or the emoluments whereof shall have been increased during such time; and no person holding any office under the United States, shall be a member of either House during his continuance in office. Section. 7. All Bills for raising revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other Bills. Every bill which shall have passed the House of Representatives and the Senate, shall, before it become a law, be presented to the President of the United States; If he approve he shall sign it, but if not he shall return it, with his objections to that House in which it shall have originated, who shall enter the objections at large on their journal, and proceed to reconsider it. If after such reconsideration two thirds of that House shall agree to pass the bill, it shall be sent, together with the objections, to the other House, by which it shall likewise be reconsidered, and if approved by two thirds of that House, it shall become a law. But in all such cases the votes of both houses shall be determined by yeas and nays, and the names of the persons voting for and against the bill shall be entered on the journal of each house respectively. If any bill shall not be returned by the President within ten days (Sundays excepted) after it shall have been presented to him, the same shall be a law, in like manner as if he had signed it, unless the Congress by their adjournment prevent its return, in which case it shall not be a law.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. How are Senators and Representatives being compensated? Who is excluded from the compensation and why? Can a senator or representative be arrested during their attendance at any house session? What other authority or place can question a representative or a senator? When the passage was written, how many Senators would be required to be in attendance to establish a quorum? Section. 5. Each House shall be the judge of the elections, returns and qualifications of its own members, and a majority of each shall constitute a quorum to do business; but a smaller number may adjourn from day to day, and may be authorized to compel the attendance of absent members, in such manner, and under such penalties as each House may provide. Each House may determine the rules of its proceedings, punish its members for disorderly behavior, and, with the concurrence of two thirds, expel a member. Each House shall keep a Journal of its proceedings, and from time to time publish the same, excepting such parts as may in their judgment require secrecy; and the yeas and nays of the members of either house on any question shall, at the desire of one fifth of those present, be entered on the journal. Neither House, during the session of Congress, shall, without the consent of the other, adjourn for more than three days, nor to any other place than that in which the two Houses shall be sitting. Section. 6. The Senators and Representatives shall receive a Compensation for their Services, to be ascertained by law, and paid out of the Treasury of the United States. They shall in all cases, except treason, felony and breach of the peace, be privileged from arrest during their attendance at the session of their respective Houses, and in going to and returning from the same; and for any speech or debate in either, they shall not be questioned in any other place. No Senator or Representative shall, during the time for which he was elected, be appointed to any civil office under the authority of the United States, which shall have been created, or the emoluments whereof shall have been increased during such time; and no person holding any office under the United States, shall be a member of either House during his continuance in office. Section. 7. All Bills for raising revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other Bills. Every bill which shall have passed the House of Representatives and the Senate, shall, before it become a law, be presented to the President of the United States; If he approve he shall sign it, but if not he shall return it, with his objections to that House in which it shall have originated, who shall enter the objections at large on their journal, and proceed to reconsider it. If after such reconsideration two thirds of that House shall agree to pass the bill, it shall be sent, together with the objections, to the other House, by which it shall likewise be reconsidered, and if approved by two thirds of that House, it shall become a law. But in all such cases the votes of both houses shall be determined by yeas and nays, and the names of the persons voting for and against the bill shall be entered on the journal of each house respectively. If any bill shall not be returned by the President within ten days (Sundays excepted) after it shall have been presented to him, the same shall be a law, in like manner as if he had signed it, unless the Congress by their adjournment prevent its return, in which case it shall not be a law. https://billofrightsinstitute.org/primary-sources/constitution?url=https%3A%2F%2Fbillofrightsinstitute.org%2Fprimary-sources%2Fconstitution%3Fhttps%3A%2F%2Fbillofrightsinstitute.org%2Fprimary-sources%2Fconstitution%2F%26gad_source%3D1&gclid=Cj0KCQjwi5q3BhCiARIsAJCfuZlS51M2jNwFgSQNypBoPmVf9pkBSp-fWw3ZKSCQFfIfKAEGErDBk-QaAgvxEALw_wcB",Legal,Fact Finding,Q&A "Answer the question using only information found in the context block. Do no rely on any external information, Do not rely on any previous knowledge you may have.",what are the pros and cons of the DMCA as it pertains to online service providers? answer in bullet points,"As highlighted by commentators, the DMCA was adopted to both encourage copyright holders to disseminate or allow digital access to their works through online service providers while also protecting intermediaries from liability under specific conditions that would protect the interests of copyright holders.141 Specifically, the DMCA adopted section 512, which excludes the liability of online service providers, which engage in one or more of the following activities: (a) [s]erving as a conduit for the automatic online transmission of material as directed by third parties; (b) catching (i.e., temporarily storing) material that is being transmitted automatically over the internet from one third party to another; (c) storing (i.e., hosting) material at the direction of a user on a service provider’s system or network; or (d) referring or linking users to online sites using information location tools (e.g., a search engine).142 According to section 512, online providers are protected so long as they “(1) adopt and reasonably implement a policy of terminating in appropriate circumstances the accounts of subscribers who are repeat infringers; and (2) accommodate and not interfere with ‘standard technical measures’. . . which are measures copyright owners use to identify or protect copyrighted works.”143 In other words, intermediaries are not liable if they are not aware of the infringing content and the content is promptly removed after being informed of the infringement by the copyright holders—a system known as notice and take down procedure. Nevertheless, also under this system, service providers may be subject to limited injunctive relief for infringing activities conducted on or through their systems or networks.144 Despite the pressure of copyright holders, however, the DMCA does not impose a general monitoring obligation, or content filtering, for service providers.145 Instead, the DMCA leaves it to copyright holders to monitor the infringement of their works and notify service providers of instances of presumed infringement. As noted by commentators, “[i]mposing a general monitoring obligation would be excessive, unpractical and unfeasible to discern illegal contents in the internet universe.”146 Besides the costs of a mandatory filtering system, multiple concerns were expressed in this respect about the consequences of such system on freedom of expression and Internet access. Still, service providers are required to monitor and filter the content shared on their platform when they are aware or know about instances of infringement.147 The absence of a specific mandate does not prevent, however, service providers and copyright holder agreeing that service providers use filtering systems on a voluntary basis.148 Several platforms do adopt voluntary filtering systems and increasingly more often implement automation to monitor the content shared on their sites. With today’s advancement in technology, automatic systems are both less costly and faster than reviews done by humans. For example, beside responding to copyright holders’ independent takedown notices, YouTube uses an internal identification service to filter possible infringements.149 Should any content be flagged through these filters, YouTube takes down the content and later notifies the users, who can appeal the decision.150 For YouTube, this approach is more cost effective, as the number of appeals is lower and thus the platform must review a lower number of cases. Moreover, even in case of successful appeals due to erroneous takedowns, the damages to the user and potential revenue loss for YouTube are lower than the risk of a DMCA f ine for copyright infringement.151 As mentioned, the DMCA safe harbor provisions also do not exclude possible injunctive relief against service providers that do not promptly remove potentially infringing content. In this respect, courts should consider whether the injunction would significantly burden the provider’s system or network, the extension of the harm to the copyright owner, the technical feasibility, effectiveness, and proportionality of the injunction.152 In particular, the DMCA provides for three specific types of injunctions to use against service providers: identification of infringers, website blocking, and internet access suspension. Courts may also consider non-specified injunctions if they consider these necessary to prevent or restrain a copyright infringement.153 With respect to the identification of infringers, the DMCA provides that copyright holders can obtain from any U.S. district court a subpoena to an intermediary to expeditiously identify an alleged infringer to bring a civil lawsuit against him.154 On the other hand, courts need to follow the following steps to grant website blocking injunctions: (i) compare the impact of the injunction on the platform’s business and the harm to the copyright holders;155 (ii) consider the technical feasibility and effectiveness in preventing infringement; (iii) ensure that the injunction will not prevent access to non-infringing material to avoid a claim for violation of the First Amendment.156 In practice, however, courts rarely grant these injunctions.157 Finally, Internet access suspension is regulated by a Memorandum of Understanding (MOU), which entered into force in 2013 and provides for a graduated response based on “six-strikes.”158 Notably, following a copyright holder’s allegation of infringement, the service provider needs to identify the infringer to whom it will send five notices that inform her of the allegation, notify her of the legal alternatives to seek a copyright license, and warn her that a continued infringement may result into sanctions. Following these five strikes, the sixth and last strike is a mitigation measure that can include slower upload and download speeds, account downgrading, or a “temporary restriction” from Internet access.159 The accused infringer can also request an independent review of the case via the American Arbitration Association or the courts.160 Perhaps not surprisingly, the DMCA notice-and-take down procedure has been widely criticized.161 Service providers have often underscored that the system is bias toward copyright holders and allows a considerable number of abuses. For example, sending high volumes of often inaccurate notices is a common occurrence, which is magnified by the fact that copyright owners often automate these notices without effectively vetting their merit.162 Moreover, even though copyright holders are supposed to issue takedown notices in good faith, good faith remains a subjective standard, which is easy to evade and can lead to abuses of the system.163 An additional negative result of this procedure is that risk aversion and fear of a DMCA fines almost systematically lead service providers to ignore the possibility that the uploaded content may constitute fair use of unlicensed content. As a result, fair use is assessed only in case of appeals, which again represent a fraction of the take down cases.164 On the other hand, copyright holders have defined the DMCA as a “very reactive type of protocol” because it requires copyright holders to monitor the Internet for possible infringements and send takedown notices to service providers.165 They also found it to be ineffective against repeated infringers and advocated for a DMCA’s amendment, which would also include a “stay down system” in which copyright holders would notify of a specific infringement once and then the service providers would become responsible for monitoring their sites for repeated incidence of the same infringement.166 In the past years, several initiatives have been undertaken to amend and improve the current notice and takedown system, and overall, the DMCA. In 2020, the Copyright Office released a study on the possible revision of section 512 of the DMCA which found that, overall, “the operation of the section 512 safe harbor system today is unbalanced” in particular with respect to “eligibility qualifications for the service provider safe harbors, repeat infringer policies, knowledge requirement standards, specificity within takedown notices, non-standard notice requirements, subpoenas, and injunctions.”167 Legislators have also considered “modernizing” the current law. In late 2020, Senator Tillis of the Senate Judiciary Committee Subcommittee on Intellectual Property released a draft of the DMCA Modernization Act for stakeholders’ comments,168 which includes a system based on “notice-and-stay-down” procedure as advocated by part of the industry and copyright holders.169 However, the draft was immediately criticized as being against the First Amendment.170 At this time, the bill has not been further discussed and, even if it is clear that the DMCA and section 512 need to be reformed and modernized, these reforms may be lengthy and will certainly lead to heated debates. ","Answer the question using only information found in the context block. Do no rely on any external information, Do not rely on any previous knowledge you may have. what are the pros and cons of the DMCA as it pertains to online service providers? answer in bullet points. As highlighted by commentators, the DMCA was adopted to both encourage copyright holders to disseminate or allow digital access to their works through online service providers while also protecting intermediaries from liability under specific conditions that would protect the interests of copyright holders.141 Specifically, the DMCA adopted section 512, which excludes the liability of online service providers, which engage in one or more of the following activities: (a) [s]erving as a conduit for the automatic online transmission of material as directed by third parties; (b) catching (i.e., temporarily storing) material that is being transmitted automatically over the internet from one third party to another; (c) storing (i.e., hosting) material at the direction of a user on a service provider’s system or network; or (d) referring or linking users to online sites using information location tools (e.g., a search engine).142 According to section 512, online providers are protected so long as they “(1) adopt and reasonably implement a policy of terminating in appropriate circumstances the accounts of subscribers who are repeat infringers; and (2) accommodate and not interfere with ‘standard technical measures’. . . which are measures copyright owners use to identify or protect copyrighted works.”143 In other words, intermediaries are not liable if they are not aware of the infringing content and the content is promptly removed after being informed of the infringement by the copyright holders—a system known as notice and take down procedure. Nevertheless, also under this system, service providers may be subject to limited injunctive relief for infringing activities conducted on or through their systems or networks.144 Despite the pressure of copyright holders, however, the DMCA does not impose a general monitoring obligation, or content filtering, for service providers.145 Instead, the DMCA leaves it to copyright holders to monitor the infringement of their works and notify service providers of instances of presumed infringement. As noted by commentators, “[i]mposing a general monitoring obligation would be excessive, unpractical and unfeasible to discern illegal contents in the internet universe.”146 Besides the costs of a mandatory filtering system, multiple concerns were expressed in this respect about the consequences of such system on freedom of expression and Internet access. Still, service providers are required to monitor and filter the content shared on their platform when they are aware or know about instances of infringement.147 The absence of a specific mandate does not prevent, however, service providers and copyright holder agreeing that service providers use filtering systems on a voluntary basis.148 Several platforms do adopt voluntary filtering systems and increasingly more often implement automation to monitor the content shared on their sites. With today’s advancement in technology, automatic systems are both less costly and faster than reviews done by humans. For example, beside responding to copyright holders’ independent takedown notices, YouTube uses an internal identification service to filter possible infringements.149 Should any content be flagged through these filters, YouTube takes down the content and later notifies the users, who can appeal the decision.150 For YouTube, this approach is more cost effective, as the number of appeals is lower and thus the platform must review a lower number of cases. Moreover, even in case of successful appeals due to erroneous takedowns, the damages to the user and potential revenue loss for YouTube are lower than the risk of a DMCA f ine for copyright infringement.151 As mentioned, the DMCA safe harbor provisions also do not exclude possible injunctive relief against service providers that do not promptly remove potentially infringing content. In this respect, courts should consider whether the injunction would significantly burden the provider’s system or network, the extension of the harm to the copyright owner, the technical feasibility, effectiveness, and proportionality of the injunction.152 In particular, the DMCA provides for three specific types of injunctions to use against service providers: identification of infringers, website blocking, and internet access suspension. Courts may also consider non-specified injunctions if they consider these necessary to prevent or restrain a copyright infringement.153 With respect to the identification of infringers, the DMCA provides that copyright holders can obtain from any U.S. district court a subpoena to an intermediary to expeditiously identify an alleged infringer to bring a civil lawsuit against him.154 On the other hand, courts need to follow the following steps to grant website blocking injunctions: (i) compare the impact of the injunction on the platform’s business and the harm to the copyright holders;155 (ii) consider the technical feasibility and effectiveness in preventing infringement; (iii) ensure that the injunction will not prevent access to non-infringing material to avoid a claim for violation of the First Amendment.156 In practice, however, courts rarely grant these injunctions.157 Finally, Internet access suspension is regulated by a Memorandum of Understanding (MOU), which entered into force in 2013 and provides for a graduated response based on “six-strikes.”158 Notably, following a copyright holder’s allegation of infringement, the service provider needs to identify the infringer to whom it will send five notices that inform her of the allegation, notify her of the legal alternatives to seek a copyright license, and warn her that a continued infringement may result into sanctions. Following these five strikes, the sixth and last strike is a mitigation measure that can include slower upload and download speeds, account downgrading, or a “temporary restriction” from Internet access.159 The accused infringer can also request an independent review of the case via the American Arbitration Association or the courts.160 Perhaps not surprisingly, the DMCA notice-and-take down procedure has been widely criticized.161 Service providers have often underscored that the system is bias toward copyright holders and allows a considerable number of abuses. For example, sending high volumes of often inaccurate notices is a common occurrence, which is magnified by the fact that copyright owners often automate these notices without effectively vetting their merit.162 Moreover, even though copyright holders are supposed to issue takedown notices in good faith, good faith remains a subjective standard, which is easy to evade and can lead to abuses of the system.163 An additional negative result of this procedure is that risk aversion and fear of a DMCA fines almost systematically lead service providers to ignore the possibility that the uploaded content may constitute fair use of unlicensed content. As a result, fair use is assessed only in case of appeals, which again represent a fraction of the take down cases.164 On the other hand, copyright holders have defined the DMCA as a “very reactive type of protocol” because it requires copyright holders to monitor the Internet for possible infringements and send takedown notices to service providers.165 They also found it to be ineffective against repeated infringers and advocated for a DMCA’s amendment, which would also include a “stay down system” in which copyright holders would notify of a specific infringement once and then the service providers would become responsible for monitoring their sites for repeated incidence of the same infringement.166 In the past years, several initiatives have been undertaken to amend and improve the current notice and takedown system, and overall, the DMCA. In 2020, the Copyright Office released a study on the possible revision of section 512 of the DMCA which found that, overall, “the operation of the section 512 safe harbor system today is unbalanced” in particular with respect to “eligibility qualifications for the service provider safe harbors, repeat infringer policies, knowledge requirement standards, specificity within takedown notices, non-standard notice requirements, subpoenas, and injunctions.”167 Legislators have also considered “modernizing” the current law. In late 2020, Senator Tillis of the Senate Judiciary Committee Subcommittee on Intellectual Property released a draft of the DMCA Modernization Act for stakeholders’ comments,168 which includes a system based on “notice-and-stay-down” procedure as advocated by part of the industry and copyright holders.169 However, the draft was immediately criticized as being against the First Amendment.170 At this time, the bill has not been further discussed and, even if it is clear that the DMCA and section 512 need to be reformed and modernized, these reforms may be lengthy and will certainly lead to heated debates. ",Internet/Technology,Pros & Cons,Q&A For this task you are not allowed to use any external knowledge or information to respond. Only use the information provided in the prompt.,What are the listed audio and video products that health care providers are and are not allowed to use for telehealth?,"Application of HIPAA Requirements to Health Care Providers During the COVID-19 Emergency Although health care providers must typically comply with HIPAA’s requirements, HHS has said it will use its enforcement discretion to provide temporary relief in response to the COVID-19 pandemic. As detailed in this Report, federal agencies enjoy discretion in deciding whether to bring enforcement actions, and courts generally decline to review such decisions. Given this discretion, the HHS OCR has announced that during the COVID-19 public health emergency it is “exercising its enforcement discretion” not to enforce the HIPAA rules against health care providers providing telehealth services in good faith. In its notice of enforcement discretion, OCR explained that health care providers may use “non-public facing audio or video communications products” such as “Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype” without the risk that OCR will seek a penalty for HIPAA Congressional Research Service 4 LSB10490· VERSION 1 · NEW non-compliance. OCR encourages providers to notify patients of the potential privacy risks of these platforms, and also to enable all privacy modes and encryption where available. OCR noted, however, that health care providers who seek “additional privacy protections” should provide such services through technology vendors that are HIPAA compliant and will enter into business associate contracts. It identified several vendors—such as Skype for Business, Zoom for Healthcare, and Google G Suite Hangouts Meet—who have represented that they are HIPAA compliant and willing to enter into business associate contracts, although OCR disclaimed that it was validating any of the vendors’ HIPAA compliance. OCR said, however, that health care providers should not use public-facing services such as “Facebook Live, Twitch, TikTok,” and similar “public-facing” applications, and it further explained in a separate publication that use of these services could be evidence of “bad faith” subject to enforcement. OCR’s notice of enforcement discretion does not have an expiration date, and OCR has said that it will notify the public when it no longer applies. DOJ, unlike OCR, has not declared that it will refrain from exercising its criminal enforcement authority during the COVID-19 emergency. Consequently, individuals may still be liable for “knowingly” obtaining or disclosing PHI in violation of HIPAA’s requirements. However, while OCR did not address criminal liability in its notice of enforcement discretion, it might choose not to refer cases to DOJ for criminal prosecution that involve a health care provider relying in good faith on OCR’s notice of enforcement discretion.","For this task you are not allowed to use any external knowledge or information to respond. Only use the information provided in the prompt. What are the listed audio and video products that health care providers are and are not allowed to use for telehealth? Application of HIPAA Requirements to Health Care Providers During the COVID-19 Emergency Although health care providers must typically comply with HIPAA’s requirements, HHS has said it will use its enforcement discretion to provide temporary relief in response to the COVID-19 pandemic. As detailed in this Report, federal agencies enjoy discretion in deciding whether to bring enforcement actions, and courts generally decline to review such decisions. Given this discretion, the HHS OCR has announced that during the COVID-19 public health emergency it is “exercising its enforcement discretion” not to enforce the HIPAA rules against health care providers providing telehealth services in good faith. In its notice of enforcement discretion, OCR explained that health care providers may use “non-public facing audio or video communications products” such as “Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype” without the risk that OCR will seek a penalty for HIPAA Congressional Research Service 4 LSB10490· VERSION 1 · NEW non-compliance. OCR encourages providers to notify patients of the potential privacy risks of these platforms, and also to enable all privacy modes and encryption where available. OCR noted, however, that health care providers who seek “additional privacy protections” should provide such services through technology vendors that are HIPAA compliant and will enter into business associate contracts. It identified several vendors—such as Skype for Business, Zoom for Healthcare, and Google G Suite Hangouts Meet—who have represented that they are HIPAA compliant and willing to enter into business associate contracts, although OCR disclaimed that it was validating any of the vendors’ HIPAA compliance. OCR said, however, that health care providers should not use public-facing services such as “Facebook Live, Twitch, TikTok,” and similar “public-facing” applications, and it further explained in a separate publication that use of these services could be evidence of “bad faith” subject to enforcement. OCR’s notice of enforcement discretion does not have an expiration date, and OCR has said that it will notify the public when it no longer applies. DOJ, unlike OCR, has not declared that it will refrain from exercising its criminal enforcement authority during the COVID-19 emergency. Consequently, individuals may still be liable for “knowingly” obtaining or disclosing PHI in violation of HIPAA’s requirements. However, while OCR did not address criminal liability in its notice of enforcement discretion, it might choose not to refer cases to DOJ for criminal prosecution that involve a health care provider relying in good faith on OCR’s notice of enforcement discretion.",Legal,Fact Finding,Q&A Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document.,What are the health benefits of high-quality sleep?,"Y O U R G U I D E T O Healthy Sleep Y o u r G u i d e t o Healthy Sleep NIH Publication No. 11-5271 Originally printed November 2005 Revised August 2011 Contents Introduction 1 What Is Sleep? 4 What Makes You Sleep? 7 What Does Sleep Do for You? 12 Your Learning, Memory, and Mood 12 Your Heart 13 Your Hormones 14 How Much Sleep Is Enough? 19 What Disrupts Sleep? 25 Is Snoring a Problem? 30 Common Sleep Disorders 33 Insomnia 35 Sleep Apnea 38 Restless Legs Syndrome 47 Narcolepsy 48 Parasomnias (Abnormal Arousals) 51 Do You Think You Have a Sleep Disorder? 53 How To Find a Sleep Center and Sleep Specialist 56 Research 57 For More Sleep Information 60 Contents 1 Introduction Think of your daily activities. Which activity is so important you should devote one-third of your time to doing it? Probably the first things that come to mind are working, spending time with your family, or doing leisure activities. But there’s something else you should be doing about one-third of your time—sleeping. Many people view sleep as merely a “down time” when their brains shut off and their bodies rest. People may cut back on sleep, think ing it won’t be a problem, because other responsibilities seem much more important. But research shows that a number of vital tasks carried out during sleep help people stay healthy and function at their best. While you sleep, your brain is hard at work forming the pathways necessary for learning and creating memories and new insights. Without enough sleep, you can’t focus and pay attention or respond quickly. A lack of sleep may even cause mood problems. Also, growing evidence shows that a chronic lack of sleep increases your risk of obesity, diabetes, cardiovas cular disease, and infections. Introduction 2Your Guide to Healthy Sleep Despite growing support for the idea that adequate sleep, like adequate nutrition and physical activity, is vital to our well-being, people are sleeping less. The nonstop “24/7” nature of the world today encourages longer or nighttime work hours and offers continual access to entertainment and other activities. To keep up, people cut back on sleep. A common myth is that people can learn to get by on little sleep (such as less than 6 hours a night) with no adverse effects. Research suggests, however, that adults need at least 7–8 hours of sleep each night to be well rested. Indeed, in 1910, most people slept 9 hours a night. But recent surveys show the average adult now sleeps fewer than 7 hours a night. More than one-third of adults report daytime sleepiness so severe that it interferes with work, driving, and social functioning at least a few days each month. Evidence also shows that children’s and adolescents’ sleep is shorter than recommended. These trends have been linked to increased exposure to electronic media. Lack of sleep may have a direct effect on children’s health, behavior, and development. Chronic sleep loss or sleep disorders may affect as many as 70 million Americans. This may result in an annual cost of $16 billion in health care expenses and $50 billion in lost productivity. 3 What happens when you don’t get enough sleep? Can you make up for lost sleep during the week by sleeping more on the weekends? How does sleep change as you become older? Is snoring a problem? How can you tell if you have a sleep disorder? Read on to find the answers to these questions and to better understand what sleep is and why it is so necessary. Learn about common sleep myths and practical tips for getting enough sleep, coping with jet lag and nighttime shift work, and avoiding dangerous drowsy driving. Many common sleep disorders go unrecognized and thus are not Introduction treated. This booklet also gives the latest information on sleep disorders such as insomnia (trouble falling or staying asleep), sleep apnea (pauses in breathing during sleep), restless legs syndrome, narcolepsy (extreme daytime sleepiness), and parasomnias (abnormal sleep behaviors).It’s important to tell your doctor what you are experiencing, so you can help your doctor diagnose your condition. S Z E - P I N G “ ” 4Your Guide to Healthy Sleep What Is Sleep? Sleep was long considered just a block of time when your brain and body shut down. Thanks to sleep research studies done over the past several decades, it is now known that sleep has distinct stages that cycle throughout the night in predictable patterns. How well rested you are and how well you function depend not just on your total sleep time but on how much sleep you get each night and the timing of your sleep stages. Your brain and body functions stay active through out sleep, and each stage of sleep is linked to a specific type of brain waves (distinctive patterns of electrical activity in the brain). Sleep is divided into two basic types: rapid eye movement (REM) sleep and non-REM sleep (with three different stages). (For more information, see “Types of Sleep” on page 5.) Typically, sleep begins with non-REM sleep. In stage 1 non-REM sleep, you sleep lightly and can be awakened easily by noises or other disturbances. During this first stage of sleep, your eyes move slowly, your muscles relax, and your heart and breath ing rates begin to slow. You then enter stage 2 non-REM sleep, which is defined by slower brain waves with occasional bursts of rapid waves. You spend about half the night in this stage. When you progress into stage 3 non- REM sleep, your brain waves become even slower, and the brain produces extremely slow waves almost exclusively (called Delta waves). 5 l l l l l Stage 3 is a very deep stage of sleep, during which it is very difficult to be awakened. Children who wet the bed or sleep walk tend to do so during stage 3 of non-REM sleep. Deep sleep is considered the “restorative” stage of sleep that is necessary for feeling well rested and energetic during the day. Types of Sleep Non-REM Sleep REM Sleep Stage 1: Light sleep; easily awakened; muscles relax with occasional twitches; eye movements are slow. Stage 2: Eye movements stop; slower brain waves, with occasional bursts of rapid brain waves. Stage 3: Occurs soon after you fall asleep and mostly in the first half of the night. Deep sleep; difficult to awaken; large slow brain waves, heart and respiratory rates are slow and muscles are relaxed. Usually first occurs about 90 minutes after you fall asleep, and longer, deeper periods occur during the second half of the night; cycles along with the non-REM stages throughout the night. Eyes move rapidly behind closed eyelids. Breathing, heart rate, and blood pressure are irregular. Dreaming occurs. Arm and leg muscles are temporarily paralyzed. Types of Sleep During REM sleep, your eyes move rapidly in different directions, even though your eyelids stay closed. Your breathing also becomes more rapid, irregular, and shallow, and your heart rate and blood pressure increase. Dreaming typically occurs during REM sleep. During this type of sleep, your arm and leg muscles are temporarily paralyzed so that you cannot “act out” any dreams that you may be having. What Is Sleep? 6Your Guide to Healthy Sleep You typically first enter REM sleep about an hour to an hour and a half after falling asleep. After that, the sleep stages repeat them selves continuously while you sleep. As you sleep, REM sleep time becomes longer, while time spent in stage 3 non-REM sleep becomes shorter. By the time you wake up, nearly all your sleep time has been spent in stages 1 and 2 of non-REM sleep and in REM sleep. If REM sleep is severely disrupted during one night, REM sleep time is typically longer than normal in subsequent nights until you catch up. Overall, almost one-half of your total sleep time is spent in stage 2 non-REM sleep and about one-fifth each in deep sleep (stage 3 of non-REM sleep) and REM sleep. In contrast, infants spend half or more of their total sleep time in REM sleep. Gradually, as they grow, the percentage of total sleep time they spend in REM contin ues to decrease, until it reaches the one-fifth level typical of later childhood and adulthood. Why people dream and why REM sleep is so important are not well understood. It is known that REM sleep stimulates the brain regions you use to learn and make memories. Animal studies suggest that dreams may reflect the brain’s sorting and selectively storing new information acquired during wake time. While this information is processed, the brain might revisit scenes from the day and mix them randomly. Dreams are generally recalled when we wake briefly or are awakened by an alarm clock or some other noise in the environment. Studies show, however, that other stages of sleep besides REM also are needed to form the pathways in the brain that enable us to learn and remember. 7 What Makes You Sleep? Although you may put off going to sleep in order to squeeze more activities into your day, eventually your need for sleep becomes overwhelming. This need appears to be due, in part, to two sub stances your body produces. One substance, called adenosine, builds up in your blood while you’re awake. Then, while you sleep, your body breaks down the adenosine. Levels of this substance in your body may help trigger sleep when needed. A buildup of adenosine and many other complex factors might explain why, after several nights of less than optimal amounts of sleep, you build up a sleep debt. This may cause you to sleep longer than normal or at unplanned times during the day. Because of your body’s internal processes, you can’t adapt to getting less sleep than your body needs. Eventually, a lack of sleep catches up with you. The other substance that helps make you sleep is a hormone called melatonin. This hormone makes you naturally feel sleepy at night. It is part of your internal “biological clock,” which controls when you feel sleepy and your sleep patterns. Your biological clock is a small bundle of cells in your brain that works throughout the day and night. Internal and external environmental cues, such as light signals received through your eyes, control these cells. Your biologi cal clock triggers your body to produce melatonin, which helps prepare your brain and body for sleep. As melatonin is released, you’ll feel increasingly drowsy. Because of your biological clock, you naturally feel the most tired between midnight and 7 a.m. You also may feel mildly sleepy in the afternoon between 1 p.m. and 4 p.m. when another increase in melatonin occurs in your body. Your biological clock makes you the most alert during daylight hours and the least alert during the early morning hours. Conse quently, most people do their best work during the day. Our 24/7 society, however, demands that some people work at night. Nearly one-quarter of all workers work shifts that are not during the daytime, and more than two-thirds of these workers have problem sleepiness and/or difficulty sleeping. Because their work schedules What Makes You Sleep? 8Your Guide to Healthy Sleep are at odds with powerful sleep-regulating cues like sunlight, night shift workers often find themselves drowsy at work, and they have difficulty falling or staying asleep during the daylight hours when their work schedules require them to sleep. The fatigue experienced by night shift workers can be dangerous. Major industrial accidents—such as the Three Mile Island and Chernobyl nuclear power plant accidents and the Exxon Valdez oil spill—have been caused, in part, by mistakes made by overly tired workers on the night shift or an extended shift. Night shift workers also are at greater risk of being in car crashes when they drive home from work during the early morning hours, because the biological clock is not sending out an alerting signal. One study found that one-fifth of night shift workers had a car crash or a near miss in the preceding year because of sleepiness on the drive home from work. Night shift workers are also more likely to have physical problems, such as heart disease, digestive troubles, and infertility, as well as emotional problems. All of these problems may be related, at least in part, to the workers’ chronic sleepiness, possi bly because their biological clocks are not in tune with their work schedules. See “Working the Night Shift” on page 9 for some helpful tips if you work a night shift. Other factors also can influence your need for sleep, including your immune system’s production of hormones called cytokines. Cyto kines are made to help the immune system fight certain infections or chronic inflammation and may prompt you to sleep more than usual. The extra sleep may help you conserve the resources needed to fight the infection. Recent studies confirm that being well rested improves the body’s responses to infection. People are creatures of habit, and one of the hardest habits to break is the natural wake and sleep cycle. Together, a number of physiological factors help you sleep and wake up at the same times each day. 9 Consequently, you may have a hard time adjusting when you travel across time zones. The light cues outside and the clocks in your new location may tell you it is 8 a.m. and you should be active, but your body is telling you it is more like 4 a.m. and you should sleep. The end result is jet lag—sleepiness during the day, difficulty falling or staying asleep at night, poor concentration, confusion, nausea, and generally feeling unwell and irritable. See “Dealing With Jet Lag” on page 10. Working the Night Shift Try to limit night shift work, if that is possible. If you must work the night shift, the following tips may help you: l l l l l Increase your total amount of sleep by adding naps and lengthening the amount of time you allot for sleep. Use bright lights in your workplace. Minimize the number of shift changes so that your body’s biological clock has a longer time to adjust to a nighttime work schedule. Get rid of sound and light distractions in your bedroom during your daytime sleep. Use caffeine only during the first part of your shift to promote alertness at night. If you are unable to fall asleep during the day, and all else fails, talk with your doctor to see whether it would be wise for you to use prescribed, short-acting sleeping pills to help you sleep during the day. Night Shift What Makes You Sleep? 10Your Guide to Healthy Sleep Dealing With Jet Lag Be aware that adjusting to a new time zone may take several days. If you are going to be away for just a few days, it may be better to stick to your original sleep and wake times as much as possible, rather than adjusting your biological clock too many times in rapid succession. Eastward travel generally causes more severe jet lag than westward travel because traveling east requires you to shorten the day, and your biological clock is better able to adjust to a longer day than a shorter day. Fortunately for globetrotters, a few preventive measures and adjustments seem to help some people relieve jet lag, particularly when they are going to spend more than a few days at their destination: l l Adjust your biological clock. During the 2–3 days prior to a long trip, get adequate sleep. You can make minor changes to your sleep schedule. For example, if you are traveling west, delay your bed time and wake time progressively by 20- to 30-minute intervals. If you are traveling east, advance your wake time by 10 to 15 minutes a day for a few days and try to advance your bed time. Decreasing light exposure at bedtime and increasing light exposure at wake time can help you make these adjustments. When you arrive at your destination, spend a lot of time outdoors so your body gets the light cues it needs to adjust to the new time zone. Take a couple of short 10–15 minute catnaps if you feel tired, but do not take long naps during the day. Avoid alcohol and caffeine. Although it may be tempting to drink alcohol to relieve the stress of travel and make it easier to fall asleep, you’re more likely to sleep lighter and wake up in the middle of the night when the effects of the alcohol wear off. Caffeine can help keep you awake longer, but caffeine also can make it harder for you to fall asleep if its effects haven’t worn off by the time you are ready to go to bed. Therefore, it’s best to use caffeine only during the morning and not during the afternoon. 11 l What about melatonin? Your body produces this hormone that may cause some drowsiness and cues the brain and body that it is time to fall asleep. Melatonin builds up in your body during the early evening and into the first 2 hours of your sleep period, and then its release stops in the middle of the night. Melatonin is available as an over-the-counter supplement. Because melatonin is considered safe when used over a period of days or weeks and seems to help people feel sleepy, it has been suggested as a treatment for jet lag. But melatonin’s effectiveness is controversial, and its safety when used over a prolonged period is unclear. Some studies find that taking melatonin supplements before bedtime for several days after arrival in a new time zone can make it easier to fall asleep at the proper time. Other studies find that melatonin does not help relieve jet lag. What Makes You Sleep? Jet Lag 12Your Guide to Healthy Sleep What Does Sleep Do for You? A number of aspects of your health and quality of life are linked to sleep, and these aspects are impaired when you are sleep deprived. Your Learning, Memory, and Mood Students who have trouble grasping new information or learning new skills are often advised to “sleep on it,” and that advice seems well founded. Recent studies reveal that people can learn a task better if they are well rested. They also can better remember what they learned if they get a good night’s sleep after learning the task than if they are sleep deprived. Study volunteers had to sleep at least 6 hours to show improvement in learning. Additionally, the amount of improvement was directly related to how much time they slept—for example, volunteers who slept 8 hours outperformed those who slept only 6 or 7 hours. Other studies suggest that it’s important to get enough rest the night before a mentally challenging task, rather than only sleeping for a short period or waiting to sleep until after the task is complete. Many well-known artists and scientists claim to have had creative insights while they slept. Mary Shelley, for example, said the idea for her novel Frankenstein came to her in a dream. Although it has not been shown that dreaming is the driving force behind innova tion, one study suggests that sleep is needed for creative problem- solving. In that study, volunteers were asked to perform a memory task and then were tested on it 8 hours later. Those who were allowed to sleep for 8 hours immediately after trying the task and before being tested were much more likely to find a creative way of simplifying the task and improving their performance, compared with those who were awake the entire 8 hours before being tested. Exactly what happens during sleep to improve our learning, memo ry, and insight isn’t known. Experts suspect, however, that while 13 people sleep, they form or strengthen the pathways of brain cells needed to perform these tasks. This process may explain why sleep is needed for proper brain development in infants. Not only is a good night’s sleep required to form new learning and memory pathways in the brain, but also sleep is necessary for those pathways to work well. Several studies show that lack of sleep causes thinking processes to slow down. Lack of sleep also makes it harder to focus and pay attention. Lack of sleep can make you more easily confused. Studies also find that a lack of sleep leads to faulty decisionmaking and more risk taking. A lack of sleep slows down your reaction time, which is particularly important to driving and other tasks that require quick response. When people who lack sleep are tested on a driving simulator, they perform just as poorly as people who are drunk. (See “Crash in Bed, Not on the Road” on page 16.) The bottom line is: Not getting a good night’s sleep can be dangerous! Even if you don’t have a mentally or physically challenging day ahead of you, you should still get enough sleep to put yourself in a good mood. Most people report being irritable, if not downright unhappy, when they lack sleep. People who chronically suffer from a lack of sleep, either because they do not spend enough time in bed or because they have an untreated sleep disorder, are at greater risk of developing depression. One group of people who usually don’t get enough sleep is mothers of newborns. Some experts think depression after childbirth (postpar tum blues) is caused, in part, by a lack of sleep. Your Heart Sleep gives your heart and vascular system a much-needed rest. During non-REM sleep, your heart rate and blood pressure progressively slow as you enter deeper sleep. During REM sleep, in response to dreams, your heart What Does Sleep Do for You? 14Your Guide to Healthy Sleep and breathing rates can rise and fall and your blood pressure can be variable. These changes throughout the night in blood pressure and heart and breathing rates seem to promote cardiovascular health. If you don’t get enough sleep, the nightly dip in blood pressure that appears to be important for good cardiovascular health may not occur. Failure to experience the normal dip in blood pressure during sleep can be related to insufficient sleep time, an untreated sleep disorder (for example, sleep apnea), or other factors. Some sleep- related abnormalities may be markers of heart disease and increased risk of stroke. A lack of sleep also puts your body under stress and may trigger the release of more adrenaline, cortisol, and other stress hormones during the day. These hormones keep your blood pressure from dipping during sleep, which increases your risk for heart disease. Lack of sleep also may trigger your body to produce more of certain proteins thought to play a role in heart disease. For example, some studies find that people who repeatedly don’t get enough sleep have higher than normal blood levels of C-reactive protein, a sign of inflammation. High levels of this protein may indicate an increased risk for a condition called atherosclerosis, or hardening of the arteries. Your Hormones When you were young, your mother may have told you that you need to get enough sleep to grow strong and tall. She may have been right! Deep sleep (stage 3 non-REM sleep) triggers more release of growth hormone, which contributes to growth in children and boosts muscle mass and the repair of cells and tissues in children and adults. Sleep’s effect on the release of sex hormones also contributes to puberty and fertility. Consequently, women who work at night and tend to lack sleep may be at increased risk of miscarriage. Your mother also probably was right if she told you that getting a good night’s sleep on a regular basis would help keep you from getting sick and help you get better if you do get sick. During sleep, your body creates more cytokines—cellular hormones that help the immune system fight various infections. Lack of sleep can reduce your body’s ability to fight off common infections. Research also reveals that a lack of sleep can reduce the body’s response to the flu 15 vaccine. For example, sleep-deprived volunteers given the flu vaccine produced less than half as many flu antibodies as those who were well rested and given the same vaccine. Although lack of exercise and other factors also contribute, the current epidemic of diabetes and obesity seems to be related, at least in part, to chronically short or disrupted sleep or not sleeping during the night. Evidence is growing that sleep is a powerful regulator of appetite, energy use, and weight control. During sleep, the body’s production of the appetite suppressor leptin increases, and the appetite stimulant grehlin decreases. Studies find that the less people sleep, the more likely they are to be overweight or obese and prefer eating foods that are higher in calories and carbohydrates. People who report an average total sleep time of 5 hours a night, for example, are much more likely to become obese, compared with people who sleep 7–8 hours a night. A number of hormones released during sleep also control the body’s use of energy. A distinct rise and fall of blood sugar levels during sleep appears to be linked to sleep stages. Not sleeping at the right time, not getting enough sleep overall, or not enough of each stage of sleep disrupts this pattern. One study found that, when healthy young men slept only 4 hours a night for 6 nights in a row, their insulin and blood sugar levels matched those seen in people who were developing diabetes. Another study found that women who slept less than 7 hours a night were more likely to develop diabetes over time than those who slept between 7 and 8 hours a night. What Does Sleep Do for You? 16Your Guide to Healthy Sleep Crash in Bed Not on the Road Most people are aware of the hazards of drunk driving. But driving while sleepy can be just as dangerous. Indeed, crashes due to sleepy drivers are as deadly as those due to drivers impaired by alcohol. And you don’t have to be asleep at the wheel to put yourself and others in danger. Both alcohol and a lack of sleep limit your ability to react quickly to a suddenly braking car, a sharp curve in the road, or other situations that require rapid responses. Just a few seconds’ delay in reaction time can be a life-or-death matter when driving. When people who lack sleep are tested on a driving simulator, they perform as badly as or worse than those who are drunk. The combination of alcohol and lack of sleep can be especially dangerous. There is increasing evidence that sleep deprivation and inexperience behind the wheel, both particularly common in adolescents, is a lethal combination. Of course, driving is also hazardous if you fall asleep at the wheel, which happens surprisingly often. One-quarter of the drivers surveyed in New York State reported they had fallen asleep at the wheel at some time. Often, people briefly nod off at the wheel without being aware of it—they just can’t recall what happened over the previous few seconds or longer. And people who lack sleep are more apt to take risks and make poor judgments, which also can boost their chances of getting in a car crash. Opening a window or turning up the radio won’t help you stay awake while driving. The bottom line is that there is no substitute for sleep. Be aware of these warning signs that you are too sleepy to drive safely: trouble keeping your eyes open or focused, continual yawning, or being unable to recall driving the past few miles. Remember, if you are short on sleep, stay out of the driver’s seat! 17 Here are some potentially life-saving tips for avoiding drowsy driving: l l l l l l Be well rested before hitting the road. If you have several nights in a row of fewer than 7–8 hours of sleep, your reaction time slows. Restoring that reaction time to normal can take more than one night of good sleep, because a sleep debt accumulates after each night you lose sleep. It may take several nights of being well rested to repay that sleep debt and make you ready for driving on a long road trip. Avoid driving between midnight and 7 a.m. Unless you are accustomed to being awake then, this period of time is when we are naturally the least alert and most tired. Don’t drive alone. A companion who can keep you engaged in conversation might help you stay awake while driving. Schedule frequent breaks on long road trips. If you feel sleepy while driving, pull off the road and take a nap for 15–20 minutes. Don’t drink alcohol. Just one beer when you are sleep deprived will affect you as much as two or three beers when you are well rested. Don’t count on caffeine or other tricks. Although drinking a cola or a cup of coffee might help keep you awake for a short time, it won’t overcome extreme sleepiness or relieve a sleep debt. What Does Sleep Do for You? 18Your Guide to Healthy SleepI wake up early to get ready for school. I am tired in the morning, and by the end of the school day, I am very tired again. An afterschool nap seems to refresh me and help me focus on homework. Without it, I am grumpy and stressed, can’t focus, and sometimes get headaches. D A P H N E “ ” 19 How Much Sleep Is Enough? Animal studies suggest that sleep is as vital as food for survival. Rats, for example, normally live 2–3 years, but they live only 5 weeks if they are deprived of REM sleep and only 2–3 weeks if they are deprived of all sleep stages—a timeframe similar to death due to starvation. But how much sleep do humans need? To help answer that question, scientists look at how much people sleep when unrestricted, the average amount of sleep among various age groups, and the amount of sleep that studies reveal is necessary to function at your best. When healthy adults are given unlimited opportunity to sleep, they sleep on average between 8 and 8.5 hours a night. But sleep needs vary from person to person. Some people appear to need only about 7 hours to avoid problem sleepiness, whereas others need 9 or more hours of sleep. Sleep needs also change throughout the life cycle. Newborns sleep between 16 and 18 hours a day, and children in preschool sleep between 11 and 12 hours a day. School-aged children and adolescents need at least 10 hours of sleep each night. The hormonal influences of puberty tend to shift adolescents’ biologi cal clocks. As a result, teenagers (who need between 9 and 10 hours of sleep a night) are more likely to go to bed later than younger children and adults, and they tend to want to sleep later in the morning. This delayed sleep–wake rhythm conflicts with the early- morning start times of many high schools and helps explain why most teenagers get an average of only 7–7.5 hours of sleep a night. As people get older, the pattern of sleep also changes—especially the amount of time spent in deep sleep. This explains why children can sleep through loud noises and why they might not wake up when moved. Across the lifespan, the sleep period tends to advance, namely relative to teenagers; older adults tend to go to bed earlier and wake earlier. The quality—but not necessarily the quantity—of How Much Sleep Is Enough? 20Your Guide to Healthy Sleep deep, non-REM sleep also changes, with a trend toward lighter sleep. The relative percentages of stages of sleep appear to stay mostly constant after infancy. From midlife through late life, people awaken more throughout the night. These sleep disruptions cause older people to lose more and more of stages 1 and 2 non-REM sleep as well as REM sleep. Some older people complain of difficulty falling asleep, early morning awakenings, frequent and long awakenings during the night, daytime sleepiness, and a lack of refreshing sleep. Many sleep problems, however, are not a natural part of sleep in the elderly. Their sleep complaints may be due, in part, to medical conditions, illnesses, or medications they are taking— all of which can disrupt sleep. In fact, one study found that the prevalence of sleep problems is very low in healthy older adults. Other causes of some of older adults’ sleep complaints are sleep apnea, restless legs syndrome, and other sleep disorders that become more common with age. Also, older people are more likely to have their sleep disrupted by the need to urinate during the night. Some evidence shows that the biological clock shifts in older people, so they are more apt to go to sleep earlier at night and wake up earlier in the morning. No evidence indicates that older people can get by with less sleep than younger people. (See “Top 10 Sleep Myths” on page 22.) Poor sleep in older people may result in excessive daytime sleepiness, attention and memory problems, depressed mood, and overuse of sleeping pills. Despite variations in sleep quantity and quality, both related to age and 21 between individuals, studies suggest that the optimal amount of sleep needed to perform adequately, avoid a sleep debt, and not have problem sleepiness during the day is about 7–8 hours for adults and at least 10 hours for school-aged children and adolescents. Similar amounts seem to be necessary to avoid an increased risk of develop ing obesity, diabetes, or cardiovascular diseases. Quality of sleep and the timing of sleep are as important as quantity. People whose sleep is frequently interrupted or cut short may not get enough of both non-REM sleep and REM sleep. Both types of sleep appear to be crucial for learning and memory—and perhaps for the restorative benefits of healthy sleep, including the growth and repair of cells. Many people try to make up for lost sleep during the week by sleeping more on the weekends. But if you have lost too much sleep, sleeping in on a weekend does not completely erase your sleep debt. Certainly, sleeping more at the end of a week won’t make up for any poor performance you had earlier in that week. Just one night of inadequate sleep can negatively affect your functioning and mood during at least the next day. Daytime naps are another strategy some people use to make up for lost sleep during the night. Some evidence shows that short naps (up to an hour) can make up, at least partially, for the sleep missed on the previous night and improve alertness, mood, and work performance. But naps don’t substitute for a good night’s sleep. One study found that a daytime nap after a lack of sleep at night did not fully restore levels of blood sugar to the pattern seen with adequate nighttime sleep. If a nap lasts longer than 20 minutes, you may have a hard time waking up fully. In addition, late afternoon naps can make falling asleep at night more difficult. How Much Sleep Is Enough? 22Your Guide to Healthy Sleep Top 10 Sleep Myths Myth 1: Sleep is a time when your body and brain shut down for rest and relaxation. No evidence shows that any major organ (including the brain) or regulatory system in the body shuts down during sleep. Some physiological processes actually become more active while you sleep. For example, secretion of certain hormones is boosted, and activity of the pathways in the brain linked to learning and memory increases. Myth 2: Getting just 1 hour less sleep per night than needed will not have any effect on your daytime functioning. This lack of sleep may not make you noticeably sleepy during the day. But even slightly less sleep can affect your ability to think properly and respond quickly, and it can impair your cardiovascular health and energy balance as well as your body’s ability to fight infections, particularly if lack of sleep continues. If you consistently do not get enough sleep, a sleep debt builds up that you can never repay. This sleep debt affects your health and quality of life and makes you feel tired during the day. Myth 3: Your body adjusts quickly to different sleep schedules. Your biological clock makes you most alert during the daytime and least alert at night. Thus, even if you work the night shift, you will naturally feel sleepy when nighttime comes. Most people can reset their biological clock, but only by appropriately timed cues—and even then, by 1–2 hours per day at best. Consequently, it can take more than a week to adjust to a substantial change in your sleep–wake cycle—for example, when traveling across several time zones or switching from working the day shift to the night shift. Myth 4: People need less sleep as they get older. Older people don’t need less sleep, but they may get less sleep or find their sleep less refreshing. That’s because as people age, the quality of their sleep changes. Older people are also more likely to have insomnia or other medical conditions that disrupt their sleep. 23 Myth 5: Extra sleep for one night can cure you of problems with excessive daytime fatigue. Not only is the quantity of sleep important, but also the quality of sleep. Some people sleep 8 or 9 hours a night but don’t feel well rested when they wake up because the quality of their sleep is poor. A number of sleep disorders and other medical conditions affect the quality of sleep. Sleeping more won’t lessen the daytime sleepiness these disorders or conditions cause. However, many of these disorders or conditions can be treated effectively with changes in behavior or with medical therapies. Additionally, one night of increased sleep may not correct multiple nights of inadequate sleep. Myth 6: You can make up for lost sleep during the week by sleeping more on the weekends. Although this sleeping pattern will help you feel more rested, it will not completely make up for the lack of sleep or correct your sleep debt. This pattern also will not necessarily make up for impaired performance during the week or the physical problems that can result from not sleeping enough. Furthermore, sleeping later on the weekends can affect your biological clock, making it much harder to go to sleep at the right time on Sunday nights and get up early on Monday mornings. Myth 7: Naps are a waste of time. Although naps are no substitute for a good night’s sleep, they can be restorative and help counter some of the effects of not getting enough sleep at night. Naps can actually help you learn how to do certain tasks quicker. But avoid taking naps later than 3 p.m., particularly if you have trouble falling asleep at night, as late naps can make it harder for you to fall asleep when you go to bed. Also, limit your naps to no longer than 20 minutes, because longer naps will make it harder to wake up and How Much Sleep Is Enough? 24Your Guide to Healthy Sleep Top 10 Sleep Myths (continued) get back in the swing of things. If you take more than one or two planned or unplanned naps during the day, you may have a sleep disorder that should be treated. Myth 8: Snoring is a normal part of sleep. Snoring during sleep is common, particularly as a person gets older. Evidence is growing that snoring on a regular basis can make you sleepy during the day and increase your risk for diabetes and heart disease. In addition, some studies link frequent snoring to problem behavior and poorer school achievement in children. Loud, frequent snoring also can be a sign of sleep apnea, a serious sleep disorder that should be evaluated and treated. (See “Is Snoring a Problem?” on page 30.) Myth 9: Children who don’t get enough sleep at night will show signs of sleepiness during the day. Unlike adults, children who don’t get enough sleep at night typically become hyperactive, irritable, and inattentive during the day. They also have increased risk of injury and more behavior problems, and their growth rate may be impaired. Sleep debt appears to be quite common during childhood and may be misdiagnosed as attention-deficit hyperactivity disorder. Myth 10: The main cause of insomnia is worry. Although worry or stress can cause a short bout of insomnia, a persistent inability to fall asleep or stay asleep at night can be caused by a number of other factors. Certain medications and sleep disorders can keep you up at night. Other common causes of insomnia are depression, anxiety disorders, and asthma, arthritis, or other medical conditions with symptoms that tend to be troublesome at night. Some people who have chronic insomnia also appear to be more “revved up” than normal, so it is harder for them to fall asleep. Sleep Myths 25When medicines didn’t work for me, I started making big lifestyle changes. Now I try to eat a balanced diet and walk for at least an hour each day. Without doubt, my weight loss and more active lifestyle help me sleep better. What Disrupts Sleep? Many factors can prevent a good night’s sleep. These factors range from well-known stimulants, such as coffee, to certain pain relievers, decongestants, and other culprits. Many people depend on the caffeine in coffee, cola, or tea to wake them up in the morning or to keep them awake. Caffeine is thought to block the cell receptors that adenosine (a substance in the brain) uses to trigger its sleep- inducing signals. In this way, caffeine fools the body into thinking it isn’t tired. It can take as long as 6–8 hours for the effects of caffeine to wear off completely. Thus, drinking a cup of coffee in the late afternoon may prevent your falling asleep at night. Nicotine is another stimulant that can keep you awake. Nicotine also leads to lighter than normal sleep, and heavy smokers tend to wake up too early because of nicotine withdrawal. Although alcohol is a sedative that makes it easier to fall asleep, it prevents deep sleep and REM sleep, allowing only the lighter stages of sleep. People who drink alcohol also tend to wake up in the middle of the night when the effects of an alcoholic “nightcap” wear off. Certain commonly used prescrip tion and over-the-counter medi cines contain ingredients that can keep you awake. These ingredients include decongestants and steroids. Many medicines taken to relieve headaches contain caffeine. Heart and blood pressure medications known as beta blockers can make it difficult to fall asleep and cause more awakenings during the night. People who have chronic asthma or bronchitis also have more problems falling asleep and staying asleep than healthy people, either because of their breathing difficul ties or because of the medicines What Disrupts Sleep? S Z E - P I N G “ ” 26Your Guide to Healthy Sleep they take. Other chronic painful or uncomfortable conditions— such as arthritis, congestive heart failure, and sickle cell anemia— can disrupt sleep, too. A number of psychological disorders—including schizophrenia, bipolar disorder, and anxiety disorders—are well known for disrupt ing sleep. Depression often leads to insomnia, and insomnia can cause depression. Some of these psychological disorders are more likely to disrupt REM sleep. Psychological stress also takes its toll on sleep, making it more difficult to fall asleep or stay asleep. People who feel stressed also tend to spend less time in deep sleep and REM sleep. Many people report having difficulties sleeping if, for example, they have recently lost a loved one, are going through a divorce, or are under stress at work. Menstrual cycle hormones can affect how well women sleep. Pro gesterone is known to induce sleep and circulates in greater concen trations in the second half of the menstrual cycle. For this reason, women may sleep better during this phase of their menstrual cycle. On the other hand, many women report trouble sleeping the night before their menstrual flow starts. This sleep disruption may be related to the abrupt drop in progesterone levels that occurs just before menstruation. Women in their late forties and early fifties, however, report more difficulties sleeping (insomnia) than younger women. These difficulties may be linked to menopause, when they have lower concentrations of progesterone. Hot flashes in women of this age also may cause sleep disruption and difficulties. Certain lifestyle factors also may deprive a person of needed sleep. Large meals or vigorous exercise just before bedtime can make it harder to fall asleep. While vigorous exercise in the evening may delay sleep onset for various reasons, exercise in the daytime is associated with improved nighttime sleep. If you aren’t getting enough sleep or aren’t falling asleep early enough, you may be overscheduling activi ties that can pre vent you from getting the 27 quiet relaxation time you need to prepare for sleep. Most people report that it’s easier to fall asleep if they have time to wind down into a less active state before sleeping. Relaxing in a hot bath or having a hot, caffeine-free beverage before bedtime may help. In addition, your body temperature drops after a hot bath in a way that mimics, in part, what happens as you fall asleep. Probably for both these reasons, many people report that they fall asleep more easily after a hot bath. Your sleeping environment also can affect your sleep. Clear your bedroom of any potential sleep distractions, such as noises, bright lights, a TV, a cell phone, or computer. Having a comfortable mattress and pillow can help promote a good night’s sleep. You also sleep better if the temperature in your bedroom is kept on the cool side. For more ideas on improving your sleep, check out the tips for getting a good night’s sleep below. Tips for Getting a Good Night’s Sleep l l l Stick to a sleep schedule. Go to bed and wake up at the same time each day. As creatures of habit, people have a hard time adjusting to changes in sleep patterns. Sleeping later on weekends won’t fully make up for a lack of sleep during the week and will make it harder to wake up early on Monday morning. Exercise is great, but not too late in the day. Try to exercise at least 30 minutes on most days but not later than 2–3 hours before your bedtime. Avoid caffeine and nicotine. Coffee, colas, certain teas, and chocolate contain the stimulant caffeine, and its effects can take as long as 8 hours to wear off fully. Therefore, a cup of coffee in the late afternoon can make it hard for you to fall asleep at night. Nicotine is also a stimulant, often causing smokers to sleep only very lightly. In addition, smokers often wake up too early in the morning because of nicotine withdrawal. What Disrupts Sleep? 28Your Guide to Healthy Sleep Tips for Getting a Good Night’s Sleep (continued) l l l l l l l Avoid alcoholic drinks before bed. Having a “nightcap” or alcoholic beverage before sleep may help you relax, but heavy use robs you of deep sleep and REM sleep, keeping you in the lighter stages of sleep. Heavy alcohol ingestion also may contribute to impairment in breathing at night. You also tend to wake up in the middle of the night when the effects of the alcohol have worn off. Avoid large meals and beverages late at night. A light snack is okay, but a large meal can cause indigestion that interferes with sleep. Drinking too many fluids at night can cause frequent awakenings to urinate. If possible, avoid medicines that delay or disrupt your sleep. Some commonly prescribed heart, blood pressure, or asthma medications, as well as some over-the-counter and herbal remedies for coughs, colds, or allergies, can disrupt sleep patterns. If you have trouble sleeping, talk to your doctor or pharmacist to see whether any drugs you’re taking might be contributing to your insomnia and ask whether they can be taken at other times during the day or early in the evening. Don’t take naps after 3 p.m. Naps can help make up for lost sleep, but late afternoon naps can make it harder to fall asleep at night. Relax before bed. Don’t overschedule your day so that no time is left for unwinding. A relaxing activity, such as reading or listening to music, should be part of your bedtime ritual. Take a hot bath before bed. The drop in body temperature after getting out of the bath may help you feel sleepy, and the bath can help you relax and slow down so you’re more ready to sleep. Have a good sleeping environment. Get rid of anything in your bedroom that might distract you from sleep, such as noises, bright lights, an uncomfortable bed, or warm temperatures. You sleep better if the temperature in the room 29 is kept on the cool side. A TV, cell phone, or computer in the bedroom can be a distraction and deprive you of needed sleep. Having a comfortable mattress and pillow can help promote a good night’s sleep. Individuals who have insomnia often watch the clock. Turn the clock’s face out of view so you don’t worry about the time while trying to fall asleep. l l l Have the right sunlight exposure. Daylight is key to regulating daily sleep patterns. Try to get outside in natural sunlight for at least 30 minutes each day. If possible, wake up with the sun or use very bright lights in the morning. Sleep experts recommend that, if you have problems falling asleep, you should get an hour of exposure to morning sunlight and turn down the lights before bedtime. Don’t lie in bed awake. If you find yourself still awake after staying in bed for more than 20 minutes or if you are starting to feel anxious or worried, get up and do some relaxing activity until you feel sleepy. The anxiety of not being able to sleep can make it harder to fall asleep. See a doctor if you continue to have trouble sleeping. If you consistently find it difficult to fall or stay asleep and/ or feel tired or not well rested during the day despite spending enough time in bed at night, you may have a sleep disorder. Your family doctor or a sleep specialist should be able to help you, and it is important to rule out other health or psychiatric problems that may be disturbing your sleep. What Disrupts Sleep? 30My wife noticed that I snored loudly and sometimes stopped breathing in the middle of the night. She was the one who finally pushed me to see a doctor. Is Snoring a Problem? Long the material for jokes, snoring is generally accepted as com mon and annoying in adults but as nothing to worry about. How ever, snoring is no laughing matter. Frequent, loud snoring is often a sign of sleep apnea and may increase your risk of developing cardio vascular disease and diabetes. Snoring also may lead to daytime sleepiness and impaired performance. Snoring is caused by a narrowing or partial blockage of the airways at the back of your mouth, throat, or nose. This obstruction results in increased air turbulence when breathing in, causing the soft tissues in your upper airways to vibrate. The end result is a noisy snore that can disrupt the sleep of your bed partner. This narrowing of the airways is typically caused by the soft palate, tongue, and throat relaxing while you sleep, but allergies or sinus problems also can contribute to a narrowing of the airways, as can being over weight and having extra soft tissue around your upper airways. The larger the tissues in your soft palate (the roof of your mouth in the back of your throat), the more likely you are to snore while sleeping. Alcohol or sedatives taken shortly before sleep also promote snoring. These drugs cause greater relaxation of the tissues Your Guide to Healthy Sleep in your throat and mouth. Surveys reveal that about one-half of all adults snore, and 50 percent of these adults do so loudly and frequently. African Americans, Asians, and Hispanics are more likely to snore loudly and frequent ly compared with Caucasians, and snoring problems increase with age. Not everyone who snores has sleep apnea, but people who have sleep apnea typically do snore loudly and frequently. Sleep apnea is a J I M “ ” 31 serious sleep disorder, and its hallmark is loud, frequent snoring with pauses in breathing or shallow breaths while sleeping. (See “Sleep Apnea” on page 38.) Even if you don’t experience these breathing pauses, snoring can still be a problem for you as well as for your bed partner. Snoring adds extra effort to your breathing, which can reduce the quality of your sleep and lead to many of the same health consequences as sleep apnea. One study found that older adults who did not have sleep apnea, but who snored 6–7 nights a week, were more than twice as likely to report being extremely sleepy during the day than those who never snored. The more people snored, the more daytime fatigue they reported. That sleepiness may help explain why snorers are more likely to be in car crashes than people who don’t snore. Loud snoring also can disrupt the sleep of bed partners and strain marital relations, especially if snoring causes the spouses to sleep in separate bedrooms. In addition, snoring increases the risk of developing diabetes and heart disease. One study found that women who snored regularly were twice as likely as those who did not snore to develop diabetes, even if they were not overweight (another risk factor for diabetes). Other studies suggest that regular snoring may raise the lifetime risk of developing high blood pressure, heart failure, and stroke. About one-third of all pregnant women begin snoring for the first time during their second trimester. If you are snoring while preg nant, let your doctor know. Snoring in pregnancy can be associated with high blood pressure and can have a negative effect on your baby’s growth and development. Your doctor will keep a close eye on your blood pressure throughout your pregnancy and can let you know if any additional evaluations for the snoring might be useful. In most cases, the snoring and any related high blood pressure will go away shortly after delivery. Snoring also can be a problem in children. As many as 10–15 per cent of young children, who typically have enlarged adenoids and tonsils (both tissues in the throat), snore on a regular basis. Several studies show that children who snore (with or without sleep apnea) are more likely than those who do not snore to score lower on tests that measure intelligence, memory, and attention span. These children also have more problematic behavior, including hyperactiv ity. The end result is that children who snore don’t perform in Is Snoring a Problem? 32Your Guide to Healthy Sleep school as well as those who do not snore. Strikingly, snoring was linked to a greater drop in IQ than that seen in children who had elevated levels of lead in their blood. Although the behavior of children improves after they stop snoring, studies suggest they may continue to get poorer grades in school, perhaps because of lasting effects on the brain linked to the snoring. You should have your child evaluated by your doctor if the child snores loudly and frequently—three to four times a week—especially if you note brief pauses in breathing while asleep and if there are signs of hyperactiv ity or daytime sleepiness, inadequate school achievement, or slower than expected development. Surgery to remove the adenoids and tonsils of children often can cure their snoring and any associated sleep apnea. Such surgery has been linked to a reduction in hyperactivity and improved ability to pay attention, even in children who showed no signs of sleep apnea before surgery. Snoring in older children and adults may be relieved by less invasive measures, however. These measures include losing weight, refraining from use of tobacco, sleeping on the side rather than on the back, or elevating the head while sleeping. Treating chronic congestion and refraining from alcohol or sedatives before sleeping also may de crease snoring. In some adults, snoring can be relieved by dental appliances that reposition the soft tissues in the mouth. Although numerous over-the-counter nasal strips and sprays claim to relieve snoring, no scientific evidence supports those claims. 33 Common Sleep Disorders A number of sleep disorders can disrupt your sleep quality and make you overly sleepy during the day, even if you spent enough time in bed to be well rested. (See “Common Signs of a Sleep Disorder” on page 34.) Common Sleep Disorders More than 70 sleep disorders affect at least 40 million Americans and account for an estimated $16 billion in medical costs each year, not counting costs due to lost work time, car accidents, and other factors. The four most common sleep disorders are insomnia, sleep apnea, restless legs syndrome, and narcolepsy. Additional sleep problems include chronic insufficient sleep, circadian rhythm abnormalities, and “parasomnias” such as sleep walking, sleep paralysis, and night terrors. L A U R E N “My restless legs syndrome made me lose sleep and affected my quality of life. But I’m in a good place right now. I’m taking the right medicine for me, and I’ve adopted a healthy, active lifestyle. I am very passionate about taking control of my health. ” 34Your Guide to Healthy Sleep l l l l l l l l l l l l Common Signs of a Sleep disorder Look over this list of common signs of a sleep disorder, and talk to your doctor if you have any of them on three or more nights a week: It takes you more than 30 minutes to fall asleep at night. You awaken frequently in the night and then have trouble falling back to sleep again. You awaken too early in the morning. You often don’t feel well rested despite spending 7–8 hours or more asleep at night. You feel sleepy during the day and fall asleep within 5 minutes if you have an opportunity to nap, or you fall asleep unexpectedly or at inappropriate times during the day. Your bed partner claims you snore loudly, snort, gasp, or make choking sounds while you sleep, or your partner notices that your breathing stops for short periods. You have creeping, tingling, or crawling feelings in your legs that are relieved by moving or massaging them, especially in the evening and when you try to fall asleep. You have vivid, dreamlike experiences while falling asleep or dozing. You have episodes of sudden muscle weakness when you are angry or fearful, or when you laugh. You feel as though you cannot move when you first wake up. Your bed partner notes that your legs or arms jerk often during sleep. You regularly need to use stimulants to stay awake during the day. Also keep in mind that, although children can show some of these signs of a sleep disorder, they often do not show signs of excessive daytime sleepiness. Instead, they may seem overactive and have difficulty focusing and concentrating. They also may not do their best in school. 35 n n Insomnia Insomnia is defined as having trouble falling asleep or staying asleep, or as having unrefreshing sleep despite having ample opportunity to sleep. Life is filled with events that occasionally cause insomnia for a short time. Such temporary insomnia is common and is often brought on by situations such as stress at work, family pressures, or a traumatic event. A National Sleep Foundation poll of adults in the United States found that close to half of the respondents reported temporary insomnia in the nights immediately after the terrorist attacks on September 11, 2001. Chronic insomnia is defined as having symptoms at least 3 nights per week for more than 1 month. Most cases of chronic insomnia are secondary, which means they are due to another disorder or medications. Primary chronic insomnia is a distinct sleep disorder; its cause is not yet well understood. About 30–40 percent of adults say they have some symptoms of insomnia within any given year, and about 10–15 percent of adults say they have chronic insomnia. Chronic insomnia becomes more common with age, and women are more likely than men to report having insomnia. Insomnia often causes problems during the day, such as extreme sleepiness, fatigue, a lack of energy, difficulty concentrating, depressed mood, and irritability. Thus, untreated insomnia can impair quality of life as much as, or more than, other chronic medical problems. Chronic insomnia is often caused by one or more of the following: A disease or mood disorder. The most common causes of insomnia are depression and/or anxiety disorders. Neuro logical disorders, such as Alzheimer’s or Parkinson’s disease, also can have insomnia as a symptom. Chronic insomnia can result from thyroid dysfunction, arthritis, asthma, or other medical conditions in which symptoms become more trouble some at night, making it difficult to fall asleep or stay asleep. Various prescribed and over-the-counter medications that can disrupt sleep, such as decongestants, certain pain relievers, and steroids. Common Sleep Disorders 36Your Guide to Healthy Sleep n n Sleep-disrupting behavior such as drinking alcohol, exercising shortly before bedtime, ingesting caffeine late in the day, watching TV or reading while in bed, or irregular sleep schedules due to shift work or other causes. Another sleep disorder, such as sleep apnea or restless legs syndrome. Some people, however, have primary chronic insomnia. This condi tion is linked to a tendency to be more “revved up” than normal (hyperarousal). People who have primary chronic insomnia may have heightened levels of certain hormones, higher body tempera tures, faster heart rates, and a different pattern of brain waves while they sleep. Doctors diagnose insomnia based mainly on sleep history, often by reviewing a sleep diary. An overnight sleep recording may be required if another sleep disorder is suspected. Doctors also will try to diagnose and treat any other underlying medical or psychological problems as well as identify behaviors that might be causing the insomnia. Often, people who have insomnia enter into a vicious cycle—because they’ve had trouble sleeping on previous nights, they become anxious at the slightest sign that they may not be falling asleep right away. That anxiety can make it more difficult for them to fall asleep. The more time they spend in bed not sleeping, and watching the clock, the more their anxiety—and sleeplessness—increases. To break that cycle of anxiety and negative conditioning, experts recommend going to bed only when you’re sleepy. If you can’t fall asleep (or fall back to sleep) within 20 minutes, get out of bed, go into another room, and do a relaxing activity (such as reading) until you feel sleepy again. Then return to bed. Studies have shown that this reconditioning therapy is an effective way to treat insomnia. Relaxation therapy is another strategy that works for some people who have insomnia. Relaxation therapy may include meditation and other mental relaxation techniques. It also may include physical relaxation techniques, such as progressively tensing and then relax ing each of the muscle groups in your body before sleep. Another method is to focus on breathing deeply. Relaxation therapy can help your body and mind slow down so that you can fall asleep more easily at bedtime. 37 Sleep restriction therapy also works for some people who have insomnia. Calculate your average sleep time over the course of a week, and then limit your nightly sleep time to that average. Gradu ally add more sleep time each night until you achieve a more normal night’s sleep. You should avoid daytime naps longer than 15–20 min utes during sleep restriction therapy. Napping can make it harder to fall asleep at night, which may prolong insomnia. In addition, during sleep restriction therapy, avoid driving a car or operating dangerous machinery until you are getting enough sleep at night. All of these behavioral changes are part of a treatment called cognitive behavioral therapy. Cognitive behavioral therapy also can be used to replace negative thoughts about sleep, such as “I’ll never fall asleep without sleeping pills,” with more realistic positive thinking. Cognitive behavioral therapy is effective in most people who have chronic insomnia. Some people who have chronic insomnia that is not corrected by behavioral therapy or treatment of an underlying condition may need a prescription medication. You should talk to a doctor before trying to treat insomnia with alcohol, over-the-counter or prescribed short-acting sedatives, or sedating antihistamines that induce drowsiness. The benefits of these treatments are limited, and they have risks. Some may help you fall asleep but leave you feeling unrefreshed in the morning. Others have longer lasting effects and leave you feeling still tired and groggy in the morning. Some also may lose their effectiveness over time. Doctors may prescribe sedating antidepressants for insomnia, but the effectiveness of these medicines in people who do not have depression is not known, and there are significant side effects. Common Sleep Disorders 38Your Guide to Healthy Sleep To treat their insomnia, some people pursue “natural” remedies, such as melatonin supplements or valerian teas or extracts. These remedies are available over the counter. Little evidence exists that melatonin can help relieve insomnia. Studies with valerian also have been inconclusive, and the actual dose and purity of various supplements, extracts, or teas that contain valerian may vary from product to product. In addition, because melatonin, valerian, and other natural remedies are not regulated by the Food and Drug Administration, their safety is not monitored. Sleep Apnea In people who have sleep apnea (also referred to as sleep-disordered breathing), breathing briefly stops or becomes very shallow during sleep. This change is caused by intermittent blocking of the upper airway, usually when the soft tissue in the rear of the throat collapses and partially or completely closes the airway. Each pause in breathing typically lasts 10–120 seconds and may occur 20–30 times or more each sleeping hour. If you have sleep apnea, not enough air can flow into your lungs through your mouth and nose during sleep, even though breathing efforts continue. When this happens, the amount of oxygen in your blood decreases. Your brain responds by awakening you enough to tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound. Although people who have sleep apnea typically snore loudly and frequently, not everyone who snores has sleep apnea. (See “Is Snoring a Problem?” on page 30.) Because people who have sleep apnea frequently go from deeper sleep to lighter sleep during the night, they rarely spend enough time in deep, restorative stages of sleep. They are therefore often exces sively sleepy during the day. Such sleepiness is thought to lead to mood and behavior problems, including depression, and it more than triples the risk of being in a traffic or work-related accident. The many brief drops in blood-oxygen levels that occur during the night can result in morning headaches and trouble concentrating, thinking clearly, learning, and remembering. Additionally, the intermittent oxygen drops and reduced sleep quality together trigger the release of stress hormones. These hormones raise your blood pressure and heart rate and boost the risk of heart attack, stroke, irregular heartbeats, and congestive heart failure. In addition, 39 Common Sleep DisordersI realize now that my sleep apnea affected my quality of life. I felt tired all the time—so tired that I couldn’t exercise or spend time with my kids. I had other sleep apnea symptoms that affected my work—headaches, confusion, making errors, etc. “Looking back, I know that I should have taken it more seriously and told my doctor about my symptoms many years before I did. “One thing that helps me is physical activity. Now that I am feeling better, I come home from work with enough energy to have an exercise routine. J I M “ ” 40Your Guide to Healthy Sleep untreated sleep apnea can lead to changes in energy metabolism (the way your body changes food and oxygen into energy) that increase the risk for developing obesity and diabetes. Anyone can have sleep apnea. It is estimated that at least 12–18 million American adults have sleep apnea, making it as common as asthma. More than one-half of the people who have sleep apnea are overweight. Sleep apnea is more common in men. More than 1 in 25 middle-aged men and 1 in 50 middle-aged women have sleep apnea along with extreme daytime sleepiness. About 3 percent of children and 10 percent or more of people over age 65 have sleep apnea. This condition occurs more frequently in African Americans, Asians, Native Americans, and Hispanics than in Caucasians. More than one-half of all people who have sleep apnea are not diagnosed. People who have sleep apnea generally are not aware that their breathing stops in the night. They just notice that they don’t feel well rested when they wake up and are sleepy throughout the day. Their bed partners are likely to notice, however, that they snore loudly and frequently and that they often stop breathing briefly while sleeping. Doctors suspect sleep apnea if these symptoms are present, but the diagnosis must be confirmed with overnight sleep monitoring. (See “How Are Sleep Disorders Diagnosed?” on page 44.) This monitoring will reveal pauses in breathing, frequent sleep arousals (changes from sleep to wakefulness), and intermittent drops in levels of oxygen in the blood. 41 n n n n Like adults who have sleep apnea, children who have this disorder usually snore loudly, snort or gasp, and have brief pauses in breath ing while sleeping. Small children often have enlarged tonsils and adenoids that increase their risk for sleep apnea. But doctors may not suspect sleep apnea in children because, instead of showing the typical signs of sleepiness during the day, these children often become agitated and may be considered hyperactive. The effects of sleep apnea in children may include poor school performance and difficult, aggressive behavior. A number of factors can make a person susceptible to sleep apnea. These factors include: n n n n n n Throat muscles and tongue that relax more than normal while asleep Enlarged tonsils and adenoids Being overweight—the excess fat tissue around your neck makes it harder to keep the throat area open Head and neck shape that creates a somewhat smaller airway size in the mouth and throat area Congestion, due to allergies, that also can narrow the airway Family history of sleep apnea If your doctor suspects that you have sleep apnea, you may be referred to a sleep specialist. Some of the ways to help diagnose sleep apnea include: A medical history that includes asking you and your family questions about how you sleep and how you function during the day. Checking your mouth, nose, and throat for extra or large tissues—for example, checking the tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (the roof of your mouth in the back of your throat). An overnight recording of what happens with your breathing during sleep (polysomnogram, or PSG). A multiple sleep latency test (MSLT), usually done in a sleep center, to see how quickly you fall asleep at times when you would normally be awake. (Falling asleep in only a few minutes usually means that you are very sleepy during the day. Being very sleepy during the day can be a sign of sleep apnea.) Common Sleep Disorders 42Your Guide to Healthy Sleep n n n Once all the tests are completed, the sleep specialist will review the results and work with you and your family to develop a treatment plan. Changes in daily activities or habits may help reduce your symptoms: Sleep on your side instead of on your back. Sleeping on your side will help reduce the amount of upper airway collapse during sleep. Avoid alcohol, smoking, sleeping pills, herbal supplements, and any other medications that make you sleepy. They make it harder for your airways to stay open while you sleep, and sedatives can make the breathing pauses longer and more severe. Tobacco smoke irritates the airways and can help trigger the intermittent collapse of the upper airway. Lose weight if you are overweight. Even a little weight loss can sometimes improve symptoms. These changes may be all that are needed to treat mild sleep apnea. However, if you have moderate or severe sleep apnea, you will need additional, more direct treatment approaches. Continuous positive airway pressure (CPAP) is the most effective treatment for sleep apnea in adults. A CPAP machine uses mild air pressure to keep your airways open while you sleep. The machine delivers air to your airways through a specially designed nasal mask. The mask does not breathe for you; the flow of air creates increased pressure to keep the airways in your nose and mouth more open while you sleep. The air pressure is adjusted so that it is just enough to stop your airways from briefly becoming too small during sleep. The pressure is constant and continuous. Sleep apnea will return if CPAP is stopped or if it is used incorrectly. People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. CPAP treatment can cause side effects in some people. Possible side effects include dry or stuffy nose, irritation of the skin on the face, bloating of the stom ach, sore eyes, or headaches. If you have trouble with CPAP side effects, work with your sleep specialist and support staff. Together, you can do things to reduce or eliminate these problems. Currently, no medications cure sleep apnea. However, some prescription medications may help relieve the excessive sleepiness that sometimes persists even with CPAP treatment of sleep apnea. 43My doctor prescribed CPAP (continuous positive airway pressure) for me, but it was not easy to use at first. Sleeping with a CPAP machine was uncomfortable for me, so I didn’t use it like I should have—rarely, if at all. One day at work, I started feeling really bad, so I went to the hospital. The doctors told me that since I had not been using CPAP regularly, not enough oxygen was going to my brain, which caused symptoms like those for a stroke. So, I went back to my doctor and got a different CPAP machine that was more comfortable for me. “It’s important to talk with your health care provider to make sure that your treatment is comfortable and works for you. J I M “ ” Another treatment approach that may help some people is the use of a mouthpiece (oral or dental appliance). If you have mild sleep apnea or do not have sleep apnea but snore very loudly, your doctor or dentist also may recommend this. A custom-fitted plastic mouth piece will be made by a dentist or an orthodontist (a specialist in correcting teeth or jaw problems). The mouthpiece will adjust your lower jaw and tongue to help keep the airway in your throat more open while you are sleeping. Air can then flow more easily into your lungs because there is less resistance to breathing. Following up with the dentist or orthodontist is important to correct any side effects and to be sure that your mouthpiece continues to fit properly. It is also important to have a followup sleep study to see whether your sleep apnea has improved. Some people who have sleep apnea may benefit from surgery; this depends on the findings of the evaluation by the sleep specialist. Removing tonsils and adenoids that are blocking the airway is done frequently, especially in children. Uvulopalatopharyngoplasty (UPPP) is a surgery for adults that removes the tonsils, uvula, and part of the soft palate. Tracheostomy is a surgery used rarely and only in severe sleep apnea when no other treatments have been successful. A small hole is made in the windpipe, and a tube is inserted. Air will flow through the tube and into the lungs, bypass ing the obstruction in the upper airway. Common Sleep Disorders 44Your Guide to Healthy Sleep l l l How Are Sleep disorders diagnosed? Depending on your symptoms, your doctor will gather informa tion and consider several possible tests when trying to diagnose a sleep disorder: Sleep history and sleep log. Your doctor will ask you how many hours you sleep each night, how often you awaken during the night and for how long, how long it takes you to fall asleep, how well rested you feel upon awakening, and how sleepy you feel during the day. Your doctor may ask you to keep a sleep diary for a few weeks. (See “Sample Sleep Diary” on page 54.) Your doctor also may ask you whether you have any symptoms of sleep apnea or restless legs syndrome, such as loud snoring, snorting or gasping, morning headaches, tingling or unpleasant sensations in the limbs that are relieved by moving them, and jerking of the limbs during sleep. Your sleeping partner may be asked whether you have some of these symptoms, as you may not be aware of them yourself. Sleep recording in a sleep laboratory (polysomnogram). A sleep recording or polysomnogram (PSG) is usually done while you stay overnight at a sleep center or sleep laboratory. Electrodes and other monitors are placed on your scalp, face, chest, limbs, and finger. While you sleep, these devices measure your brain activity, eye movements, muscle activity, heart rate and rhythm, blood pressure, and how much air moves in and out of your lungs. This test also checks the amount of oxygen in your blood. A PSG test is painless. In certain circumstances, the PSG can be done at home. A home monitor can be used to record heart rate, how air moves in and out of your lungs, the amount of oxygen in your blood, and your breathing effort. Multiple sleep latency test (MSLT). This daytime sleep study measures how sleepy you are and is particularly useful for diagnosing narcolepsy. The MSLT is conducted in a sleep 45 laboratory and typically done after an overnight sleep recording (PSG). In this test, monitoring devices for sleep stage are placed on your scalp and face. You are asked to nap four or five times for 20 minutes every 2 hours during the day. Technicians note how quickly you fall asleep and how long it takes you to reach various stages of sleep, especially REM sleep, during your naps. Normal individuals either do not fall asleep during these short designated naptimes or take a long time to fall asleep. People who fall asleep in less than 5 minutes are likely to require treatment for a sleep disorder, as are those who quickly reach REM sleep during their naps. It is important to have a sleep specialist interpret the results of your PSG or MSLT. See “How To Find a Sleep Center and Sleep Specialist” on page 56. Common Sleep Disorders 46Your Guide to Healthy SleepI started to get weird feelings in my legs at night while I slept. To feel better, I would get up and move around and stretch. Then the weird feelings began to happen more often and made me lose sleep. I started to think that something was wrong. I decided to go to the doctor and was diagnosed with restless legs syndrome (RLS). “Because RLS symptoms can change, I’m always trying to find the right mix of diet, medication, and exercise. Exercise and massage help me manage my RLS. Yoga helps a lot too, because of all the stretching involved. L A U R E N “ ” 47 Restless Legs Syndrome Restless legs syndrome (RLS) causes an unpleasant prickling or tingling in the legs, especially in the calves, that is relieved by mov ing or massaging them. People who have RLS feel a need to stretch or move their legs to get rid of the uncomfortable or painful feelings. As a result, it may be difficult to fall asleep and stay asleep. One or both legs may be affected. Some people also feel the sensations in their arms. These sensations also can occur when lying down or sitting for long periods of time, such as while at a desk, riding in a car, or watching a movie. Many people who have RLS also have brief limb movements during sleep, often with abrupt onset, occurring every 5–90 seconds. This condition, known as periodic limb movements in sleep (PLMS), can repeatedly awaken people who have RLS, reducing their total sleep time and interrupting their sleep. Some people have PLMS but have no abnormal sensations in their legs while awake. RLS affects 5–15 percent of Americans, and its prevalence increases with age. RLS occurs more often in women than men. One study found that RLS accounted for one-third of the insomnia seen in patients older than age 60. Children also can have RLS. In children, the condition may be associated with symptoms of attention-deficit hyperactivity disorder. However, it’s not fully known how the disorders are related. Sometimes “growing pains” can be mistaken for RLS. RLS is often inherited. Pregnancy, kidney failure, and anemia related to iron or vitamin deficiency can trigger or worsen RLS symptoms. Researchers suspect that these conditions cause an iron deficiency that results in a lack of dopamine, which is used by the brain to control physical sensation and limb movements. Doctors usually can diagnose RLS by patients’ symptoms and a telltale worsening of symptoms at night or while at rest. Some doctors may order a blood test to check ferretin levels (ferretin is a form of iron). Doctors also may ask people who have RLS to spend a night in a sleep laboratory, where they are monitored to rule out other sleep disorders and to document the excessive limb movements. RLS is treatable but not always curable. Dramatic improvements are seen quickly when patients are given dopamine-like drugs or iron supplements. Alternatively, people who have milder cases may be treated successfully with sedatives or behavioral strategies. These Common Sleep Disorders 48Your Guide to Healthy Sleep n strategies include stretching, taking a hot bath, or massaging the legs before bedtime. Avoiding caffeinated beverages also can help reduce symptoms, and certain medications (e.g., some antidepressants, particularly selective serotonin reuptake inhibitors) may cause RLS. If iron or vitamin deficiency underlies RLS, symptoms may improve with prescribed iron, vitamin B12, or folate supplements. Some people may require anticonvulsant medications to control the creeping and crawling sensations in their limbs. Others who have severe symptoms that are associated with another medical disorder or that do not respond to normal treatments may need to be treated with pain relievers. Narcolepsy Narcolepsy’s main symptom is extreme and overwhelming daytime sleepiness, even after adequate nighttime sleep. In addition, nighttime sleep may be fragmented by frequent awakenings. People who have narcolepsy often fall asleep at inappropriate times and places. Although TV sitcoms occasionally feature these individuals to generate a few laughs, narcolepsy is no laughing matter. People who have narcolepsy experience daytime “sleep attacks” that last from seconds to more than one-half hour, can occur without warning, and may cause injury. These embarrassing sleep spells also can make it difficult to work and to maintain normal personal or social relationships. With narcolepsy, the usually sharp distinctions between being asleep and awake are blurred. Also, people who have narcolepsy tend to fall directly into dream-filled REM sleep, rather than enter REM sleep gradually after passing through the non-REM sleep stages first. In addition to overwhelming daytime sleepiness, narcolepsy has three other commonly associated symptoms, but these may not occur in all people: Sudden muscle weakness (cataplexy). This weakness is similar to the paralysis that normally occurs during REM sleep, but it lasts a few seconds to minutes while an individual is awake. Cataplexy tends to be triggered by sudden emotional reac tions, such as anger, surprise, fear, or laughter. The weakness may show up as limpness at the neck, buckling of the knees, or sagging facial muscles affecting speech, or it may cause a complete body collapse. 49 Common Sleep DisordersAt first, I was misdiagnosed with chronic fatigue syndrome, because I was in my forties and narcolepsy symptoms usually start during the teen years. Because I didn’t have any of the symptoms of chronic fatigue syndrome other than sleepiness, I went to a neurologist for help. He noticed the cataplexy (muscle weakness) right away, and then I was officially diagnosed with narcolepsy and then later on with borderline sleep apnea. “Even though there is no cure for narcolepsy, you can feel like you have control if you manage it well. “When you have narcolepsy, you live your life differently. But with a good plan and supportive friends and family, it all turns out OK. S Z E - P I N G “ ” 50Your Guide to Healthy Sleep n n Sleep paralysis. People who have narcolepsy may experience a temporary inability to talk or move when falling asleep or waking up, as if they were glued to their beds. Vivid dreams. These dreams can occur when people who have narcolepsy first fall asleep or wake up. The dreams are so lifelike that they can be confused with reality. Experts estimate that as many as 350,000 Americans have narco lepsy, but fewer than 50,000 are diagnosed. The disorder may be as widespread as Parkinson’s disease or multiple sclerosis, and more prevalent than cystic fibrosis, but it is less well known. Narcolepsy is often mistaken for depression, epilepsy, or the side effects of medicines. Narcolepsy can be difficult to diagnose in people who have only the symptom of excessive daytime sleepiness. It is usually diagnosed during an overnight sleep recording (PSG) that is followed by an MSLT. (See “How Are Sleep Disorders Diagnosed?” on page 44.) Both tests reveal symptoms of narcolepsy—the tendency to fall asleep rapidly and enter REM sleep early, even during brief naps. Narcolepsy can develop at any age, but the symptoms tend to appear first during adolescence or early adulthood. About 1 of every 10 people who have narcolepsy has a close family member who has the disorder, suggesting that one can inherit a tendency to develop narcolepsy. Studies suggest that a substance in the brain called hypocretin plays a key role in narcolepsy. Most people who have narcolepsy lack hypocretin, which promotes wakefulness. Scientists believe that an autoimmune reaction—perhaps triggered by disease, viral illness, or brain injury— specifically destroys the hypocretin-generating cells in the brains of people who have narcolepsy. 51 Eventually, researchers may develop a treatment for narcolepsy that restores hypocretin to normal levels. In the meantime, most people who have narcolepsy find some to all of their symptoms relieved by various drug treatments. For example, central nervous system stimulants can reduce daytime sleepiness. Antidepressants and other drugs that suppress REM sleep can prevent muscle weakness, sleep paralysis, and vivid dreaming. Doctors also usually recommend that people who have narcolepsy take short naps (10–15 minutes) two or three times a day, if possible, to help control excessive daytime sleepiness. Parasomnias (Abnormal Arousals) In some people, the walking, talking, and other body functions normally suppressed during sleep occur during certain sleep stages. Alternatively, the paralysis or vivid images usually experienced during dreaming may persist after awakening. These occurrences are collectively known as parasomnias and include confusional arousals (a mixed state of being both asleep and awake), sleep talking, sleep walking, night terrors, sleep paralysis, and REM sleep behavior disorder (acting out dreams). Most of these disorders— such as confusional arousals, sleep walking, and night terrors—are more common in children, who tend to outgrow them once they become adults. People who are sleep-deprived also may experience some of these disorders, including sleep walking and sleep paralysis. Sleep paralysis also commonly occurs in people who have narco lepsy. Certain medications or neurological disorders appear to lead to other parasomnias, such as REM sleep behavior disorder, and these parasomnias tend to occur more in elderly people. If you or a family member has persistent episodes of sleep paralysis, sleep walking, or acting out of dreams, talk with your doctor. Taking measures to assure the safety of children and other family members who have partial arousals from sleep is very important. Common Sleep Disorders 52Your Guide to Healthy SleepIt’s a scary experience, lying in bed, wanting to get up, but unable to—scary enough to almost make you not want to go to sleep anymore. I can remember, as a child, feeling as though there was a weight on me when I was trying to wake up, and I couldn’t move. When I would try to wake up, I would kick my legs and flail my arms, sometimes bumping my wife. I really didn’t have control over my limbs. “When the symptoms got really bad, I went to a sleep specialist, who told me I had sleep paralysis. My doctor prescribed a medicine that has worked great for me. Now, I rarely have sleep paralysis—maybe 3 times per year. L A W R E N C E “ ” 53 n n n n Do You Think You Have a Sleep Disorder? At various points in our lives, all of us suffer from a lack of sleep that can be corrected by making sure we have the opportunity to get enough sleep. But, if you are spending enough time in bed and still wake up tired or feel very sleepy during the day, you may have a sleep disorder. See “Common Signs of a Sleep Disorder” on page 34. One of the best ways you can tell whether you are getting enough good-quality sleep, and whether you have signs of a sleep disorder, is by keeping a sleep diary. (See “Sample Sleep Diary” on page 54.) Use this diary to record the quality and quantity of your sleep; your use of medications, alcohol, and caffeinated beverages; your exercise patterns; and how sleepy you feel during the day. After a week or so, look over this information to see how many hours of sleep or nighttime awakenings one night are linked to your being tired the next day. This information will give you a sense of how much uninterrupted sleep you need to avoid daytime sleepiness. You also can use the diary to see some of the patterns or practices that may keep you from getting a good night’s sleep. You may have a sleep disorder and should see your doctor if your sleep diary reveals any of the following: You consistently take more than 30 minutes each night to fall asleep. You consistently awaken more than a few times or for long periods of time each night. You take frequent naps. You often feel sleepy during the day—or you fall asleep at inappropriate times during the day. Do You Think You Have a Sleep Disorder? 54 Sample Sleep Diary Name: Complete in the Morning Today’s date (include month/day/year): Monday* Time I went to bed last night: Time I woke up this morning: No. of hours slept last night: 11 p.m. 7 a.m. 8 Number of awakenings and total time awake last night: 5 times 2 hours How long I took to fall asleep last night: 30 mins. Medications taken last night: None How awake did I feel when I got up this morning? 1—Wide awake 2—Awake but a little tired 3—Sleepy 2 Complete in the Evening Number of caffeinated drinks (coffee, tea, cola) and time when I had them today: 1 drink at 8 p.m. Number of alcoholic drinks (beer, wine, liquor) and time when I had them today: 2 drinks 9 p.m. Naptimes and lengths today: 3:30 p.m. 45 mins. Exercise times and lengths today: None How sleepy did I feel during the day today? 1—So sleepy had to struggle 1 to stay awake during much of the day 2—Somewhat tired 3—Fairly alert 4—Wide awake Your Guide to Healthy Sleep * This column shows example diary entries—use as a model for your own diary notes. 55 Do You Think You Have a Sleep Disorder? 56Your Guide to Healthy Sleep How To Find a Sleep Center and Sleep Specialist If your doctor refers you to a sleep center or sleep specialist, make sure that center or specialist is qualified to diagnose and treat your sleep problem. To find sleep centers accredited by the American Academy of Sleep Medicine, go to www.aasmnet.org and click on “Find a Sleep Center” (under the Patients & Public menu), or call 708–492–0930. To find sleep specialists certified by the American Board of Sleep Medicine, go to www.absm.org and click on “Verification of Diplomates of the ABSM.” 57 n n n n Research Researchers have learned a lot about sleep and sleep disorders in recent years. That knowledge has led to a better understanding of the importance of sleep to our lives and our health. Research supported by the National Heart, Lung, and Blood Institute (NHLBI) has helped identify some of the causes of sleep disorders and their effects on the heart, brain, lungs, and other body systems. The NHLBI also supports ongoing research on the most effective ways to diagnose and treat sleep disorders. Many questions remain about sleep and sleep disorders. The NHLBI continues to support a range of research that focuses on: Better understanding of how a lack of sleep increases the risk for obesity, diabetes, heart disease, and stroke New ways to diagnose sleep disorders Genetic, environmental, and social factors that lead to sleep disorders The adverse effects from a lack of sleep on body and brain Much of this research depends on the willingness of volunteers to participate in clinical research. If you would like to help researchers advance science on sleep or about a sleep disorder you have and possible treatments, talk to your doctor about participating in clinical research. (For more information, see “Clinical Research” on page 58.) Research 58Your Guide to Healthy Sleep Clinical research Researchers can learn quite a bit about sleep and sleep disorders by studying animals. However, to fully understand sleep and its affect on health and functioning, as well as how best to diagnose and treat sleep disorders, researchers need to do clinical research on people. This type of research is called clinical research because it is often conducted in clinical settings, such as hospitals or doctors’ offices. The two types of clinical research are clinical trials and clinical studies. l Clinical trials test new ways to diagnose, prevent, or treat various disorders. For example, treatments (such as medicines, medical devices, surgery, or other procedures) for a disorder need to be tested in people who have the disorder. A trial helps determine whether a treatment is safe and effective in humans before it is made available for public use. In a clinical trial, participants are randomly assigned to groups. One group receives the new treatment being tested. Other groups may receive a different treatment or a placebo (an inactive substance resembling a drug being tested). Comparing results from the groups gives researchers confidence that changes in the test group are due to the new treatment and not to other factors. 59 l l l l Other types of clinical studies are done to discover the factors, including environmental, behavioral, or genetic factors, that cause or worsen various disorders. Researchers may follow a group of people over time to learn what factors contribute to becoming sick. Clinical studies and trials may be relatively brief, or may last for years and require many visits to the study sites. These sites usually are university hospitals or research centers, but they can include private doctors’ offices and community hospitals. If you participate in clinical research, the research will be explained to you in detail, you will be given a chance to ask questions, and you will be asked to provide written permission. You may not directly benefit from the results of the clinical research you participate in, but the information gathered will help others and will add to scientific knowledge. Taking part in clinical research has other benefits, as well. You’ll learn more about your disorder, you’ll have the support of a team of health care providers, and your health will likely be monitored closely. However, participation also can have risks, which you should discuss with your doctor. No matter what you decide, your regular medical care will not be affected. If you’re thinking about participating in a clinical study, you may have questions about the purpose of the study, the types of tests and treatment involved, how participation will affect your daily life, and whether any costs are involved. Your doctor may be able to answer some of your questions and help you find clinical studies in which you can participate. You also can visit the following Web sites to learn about being in a study and to search for clinical trials being done on your disorder: www.clinicaltrials.gov http://clinicalresearch.nih.gov www.nhlbi.nih.gov/studies/index.htm Clinical Research Research 60Your Guide to Healthy Sleep For More Sleep Information Resources From the National Heart, Lung, and Blood Institute (NHLBI) National Center on Sleep Disorders Research Division of Lung Diseases, NHLBI Two Rockledge Centre, Suite 10170 6701 Rockledge Drive Bethesda, MD 20895–7952 Phone: 301–435–0199 Fax: 301–480–3451 Web site: www.nhlbi.nih.gov/sleep NHLBI Diseases and Conditions Index (DCI) The DCI includes articles on sleep disorders, tests, and procedures, along with videos, podcasts, and Spanish-language articles. Web site: www.nhlbi.nih.gov/health/dci/index.html NHLBI Health Information Center P.O. Box 30105 Bethesda, MD 20824–0105 Telephone: 301–592–8573 TTY: 240–629–3255 Fax: 301–592–8563 E-mail: nhlbiinfo@nhlbi.nih.gov Web site: www.nhlbi.nih.gov NIH Office of Science Education Web site (for high school supplemental curriculum: Sleep, Sleep Disorders, and Biological Rhythms) http://science.education.nih.gov 61 Resources From Other Sleep Organizations American Academy of Sleep Medicine (AASM) 2510 North Frontage Road Darien, IL 60561 Telephone: 630–737–9700 Fax: 630–737–9790 Web site: www.aasmnet.org American Sleep Apnea Association 6856 Eastern Avenue, NW., Suite 203 Washington, DC 20012 Telephone: 202–203–3650 Fax: 202–293–3656 Web site: www.sleepapnea.org Narcolepsy Network P.O. Box 294 Pleasantville, NY 10570 Telephone: 401–667–2523 Fax: 401–633–6567 E-mail: narnet@narcolepsynetwork.org Web site: www.narcolepsynetwork.org National Sleep Foundation 1010 North Glebe Road, Suite 310 Arlington, VA 22201 Telephone: 703–243–1697 E-mail: nsf@sleepfoundation.org Web site: www.sleepfoundation.org Restless Legs Syndrome Foundation 1610 14th Street, NW., Suite 300 Rochester, MN 55901 Telephone: 507–287–6465 Fax: 507–287–6312 E-mail: rlsfoundation@rls.org Web site: www.rls.org For More Sleep Information 62Your Guide to Healthy Sleep ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Notes 63 ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Notes Notes Discrimination Prohibited: Under provisions of applicable public laws enacted by Congress since 1964, no person in the United States shall, on the grounds of race, color, national origin, handicap, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity (or, on the basis of sex, with respect to any educa- tion program or activity) receiving Federal finan- cial assistance. In addition, Executive Order 11141 prohibits discrimination on the basis of age by contractors and subcontractors in the performance of Federal contracts, and Executive Order 11246 states that no federally funded con- tractor may discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. Therefore, the National Heart, Lung, and Blood Institute must be operated in compliance with these laws and Executive Orders. NIH Publication No. 11-5271 Originally printed November 2005 Revised August 2011","Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document. What are the health benefits of high-quality sleep? Y O U R G U I D E T O Healthy Sleep Y o u r G u i d e t o Healthy Sleep NIH Publication No. 11-5271 Originally printed November 2005 Revised August 2011 Contents Introduction 1 What Is Sleep? 4 What Makes You Sleep? 7 What Does Sleep Do for You? 12 Your Learning, Memory, and Mood 12 Your Heart 13 Your Hormones 14 How Much Sleep Is Enough? 19 What Disrupts Sleep? 25 Is Snoring a Problem? 30 Common Sleep Disorders 33 Insomnia 35 Sleep Apnea 38 Restless Legs Syndrome 47 Narcolepsy 48 Parasomnias (Abnormal Arousals) 51 Do You Think You Have a Sleep Disorder? 53 How To Find a Sleep Center and Sleep Specialist 56 Research 57 For More Sleep Information 60 Contents 1 Introduction Think of your daily activities. Which activity is so important you should devote one-third of your time to doing it? Probably the first things that come to mind are working, spending time with your family, or doing leisure activities. But there’s something else you should be doing about one-third of your time—sleeping. Many people view sleep as merely a “down time” when their brains shut off and their bodies rest. People may cut back on sleep, think ing it won’t be a problem, because other responsibilities seem much more important. But research shows that a number of vital tasks carried out during sleep help people stay healthy and function at their best. While you sleep, your brain is hard at work forming the pathways necessary for learning and creating memories and new insights. Without enough sleep, you can’t focus and pay attention or respond quickly. A lack of sleep may even cause mood problems. Also, growing evidence shows that a chronic lack of sleep increases your risk of obesity, diabetes, cardiovas cular disease, and infections. Introduction 2Your Guide to Healthy Sleep Despite growing support for the idea that adequate sleep, like adequate nutrition and physical activity, is vital to our well-being, people are sleeping less. The nonstop “24/7” nature of the world today encourages longer or nighttime work hours and offers continual access to entertainment and other activities. To keep up, people cut back on sleep. A common myth is that people can learn to get by on little sleep (such as less than 6 hours a night) with no adverse effects. Research suggests, however, that adults need at least 7–8 hours of sleep each night to be well rested. Indeed, in 1910, most people slept 9 hours a night. But recent surveys show the average adult now sleeps fewer than 7 hours a night. More than one-third of adults report daytime sleepiness so severe that it interferes with work, driving, and social functioning at least a few days each month. Evidence also shows that children’s and adolescents’ sleep is shorter than recommended. These trends have been linked to increased exposure to electronic media. Lack of sleep may have a direct effect on children’s health, behavior, and development. Chronic sleep loss or sleep disorders may affect as many as 70 million Americans. This may result in an annual cost of $16 billion in health care expenses and $50 billion in lost productivity. 3 What happens when you don’t get enough sleep? Can you make up for lost sleep during the week by sleeping more on the weekends? How does sleep change as you become older? Is snoring a problem? How can you tell if you have a sleep disorder? Read on to find the answers to these questions and to better understand what sleep is and why it is so necessary. Learn about common sleep myths and practical tips for getting enough sleep, coping with jet lag and nighttime shift work, and avoiding dangerous drowsy driving. Many common sleep disorders go unrecognized and thus are not Introduction treated. This booklet also gives the latest information on sleep disorders such as insomnia (trouble falling or staying asleep), sleep apnea (pauses in breathing during sleep), restless legs syndrome, narcolepsy (extreme daytime sleepiness), and parasomnias (abnormal sleep behaviors).It’s important to tell your doctor what you are experiencing, so you can help your doctor diagnose your condition. S Z E - P I N G “ ” 4Your Guide to Healthy Sleep What Is Sleep? Sleep was long considered just a block of time when your brain and body shut down. Thanks to sleep research studies done over the past several decades, it is now known that sleep has distinct stages that cycle throughout the night in predictable patterns. How well rested you are and how well you function depend not just on your total sleep time but on how much sleep you get each night and the timing of your sleep stages. Your brain and body functions stay active through out sleep, and each stage of sleep is linked to a specific type of brain waves (distinctive patterns of electrical activity in the brain). Sleep is divided into two basic types: rapid eye movement (REM) sleep and non-REM sleep (with three different stages). (For more information, see “Types of Sleep” on page 5.) Typically, sleep begins with non-REM sleep. In stage 1 non-REM sleep, you sleep lightly and can be awakened easily by noises or other disturbances. During this first stage of sleep, your eyes move slowly, your muscles relax, and your heart and breath ing rates begin to slow. You then enter stage 2 non-REM sleep, which is defined by slower brain waves with occasional bursts of rapid waves. You spend about half the night in this stage. When you progress into stage 3 non- REM sleep, your brain waves become even slower, and the brain produces extremely slow waves almost exclusively (called Delta waves). 5 l l l l l Stage 3 is a very deep stage of sleep, during which it is very difficult to be awakened. Children who wet the bed or sleep walk tend to do so during stage 3 of non-REM sleep. Deep sleep is considered the “restorative” stage of sleep that is necessary for feeling well rested and energetic during the day. Types of Sleep Non-REM Sleep REM Sleep Stage 1: Light sleep; easily awakened; muscles relax with occasional twitches; eye movements are slow. Stage 2: Eye movements stop; slower brain waves, with occasional bursts of rapid brain waves. Stage 3: Occurs soon after you fall asleep and mostly in the first half of the night. Deep sleep; difficult to awaken; large slow brain waves, heart and respiratory rates are slow and muscles are relaxed. Usually first occurs about 90 minutes after you fall asleep, and longer, deeper periods occur during the second half of the night; cycles along with the non-REM stages throughout the night. Eyes move rapidly behind closed eyelids. Breathing, heart rate, and blood pressure are irregular. Dreaming occurs. Arm and leg muscles are temporarily paralyzed. Types of Sleep During REM sleep, your eyes move rapidly in different directions, even though your eyelids stay closed. Your breathing also becomes more rapid, irregular, and shallow, and your heart rate and blood pressure increase. Dreaming typically occurs during REM sleep. During this type of sleep, your arm and leg muscles are temporarily paralyzed so that you cannot “act out” any dreams that you may be having. What Is Sleep? 6Your Guide to Healthy Sleep You typically first enter REM sleep about an hour to an hour and a half after falling asleep. After that, the sleep stages repeat them selves continuously while you sleep. As you sleep, REM sleep time becomes longer, while time spent in stage 3 non-REM sleep becomes shorter. By the time you wake up, nearly all your sleep time has been spent in stages 1 and 2 of non-REM sleep and in REM sleep. If REM sleep is severely disrupted during one night, REM sleep time is typically longer than normal in subsequent nights until you catch up. Overall, almost one-half of your total sleep time is spent in stage 2 non-REM sleep and about one-fifth each in deep sleep (stage 3 of non-REM sleep) and REM sleep. In contrast, infants spend half or more of their total sleep time in REM sleep. Gradually, as they grow, the percentage of total sleep time they spend in REM contin ues to decrease, until it reaches the one-fifth level typical of later childhood and adulthood. Why people dream and why REM sleep is so important are not well understood. It is known that REM sleep stimulates the brain regions you use to learn and make memories. Animal studies suggest that dreams may reflect the brain’s sorting and selectively storing new information acquired during wake time. While this information is processed, the brain might revisit scenes from the day and mix them randomly. Dreams are generally recalled when we wake briefly or are awakened by an alarm clock or some other noise in the environment. Studies show, however, that other stages of sleep besides REM also are needed to form the pathways in the brain that enable us to learn and remember. 7 What Makes You Sleep? Although you may put off going to sleep in order to squeeze more activities into your day, eventually your need for sleep becomes overwhelming. This need appears to be due, in part, to two sub stances your body produces. One substance, called adenosine, builds up in your blood while you’re awake. Then, while you sleep, your body breaks down the adenosine. Levels of this substance in your body may help trigger sleep when needed. A buildup of adenosine and many other complex factors might explain why, after several nights of less than optimal amounts of sleep, you build up a sleep debt. This may cause you to sleep longer than normal or at unplanned times during the day. Because of your body’s internal processes, you can’t adapt to getting less sleep than your body needs. Eventually, a lack of sleep catches up with you. The other substance that helps make you sleep is a hormone called melatonin. This hormone makes you naturally feel sleepy at night. It is part of your internal “biological clock,” which controls when you feel sleepy and your sleep patterns. Your biological clock is a small bundle of cells in your brain that works throughout the day and night. Internal and external environmental cues, such as light signals received through your eyes, control these cells. Your biologi cal clock triggers your body to produce melatonin, which helps prepare your brain and body for sleep. As melatonin is released, you’ll feel increasingly drowsy. Because of your biological clock, you naturally feel the most tired between midnight and 7 a.m. You also may feel mildly sleepy in the afternoon between 1 p.m. and 4 p.m. when another increase in melatonin occurs in your body. Your biological clock makes you the most alert during daylight hours and the least alert during the early morning hours. Conse quently, most people do their best work during the day. Our 24/7 society, however, demands that some people work at night. Nearly one-quarter of all workers work shifts that are not during the daytime, and more than two-thirds of these workers have problem sleepiness and/or difficulty sleeping. Because their work schedules What Makes You Sleep? 8Your Guide to Healthy Sleep are at odds with powerful sleep-regulating cues like sunlight, night shift workers often find themselves drowsy at work, and they have difficulty falling or staying asleep during the daylight hours when their work schedules require them to sleep. The fatigue experienced by night shift workers can be dangerous. Major industrial accidents—such as the Three Mile Island and Chernobyl nuclear power plant accidents and the Exxon Valdez oil spill—have been caused, in part, by mistakes made by overly tired workers on the night shift or an extended shift. Night shift workers also are at greater risk of being in car crashes when they drive home from work during the early morning hours, because the biological clock is not sending out an alerting signal. One study found that one-fifth of night shift workers had a car crash or a near miss in the preceding year because of sleepiness on the drive home from work. Night shift workers are also more likely to have physical problems, such as heart disease, digestive troubles, and infertility, as well as emotional problems. All of these problems may be related, at least in part, to the workers’ chronic sleepiness, possi bly because their biological clocks are not in tune with their work schedules. See “Working the Night Shift” on page 9 for some helpful tips if you work a night shift. Other factors also can influence your need for sleep, including your immune system’s production of hormones called cytokines. Cyto kines are made to help the immune system fight certain infections or chronic inflammation and may prompt you to sleep more than usual. The extra sleep may help you conserve the resources needed to fight the infection. Recent studies confirm that being well rested improves the body’s responses to infection. People are creatures of habit, and one of the hardest habits to break is the natural wake and sleep cycle. Together, a number of physiological factors help you sleep and wake up at the same times each day. 9 Consequently, you may have a hard time adjusting when you travel across time zones. The light cues outside and the clocks in your new location may tell you it is 8 a.m. and you should be active, but your body is telling you it is more like 4 a.m. and you should sleep. The end result is jet lag—sleepiness during the day, difficulty falling or staying asleep at night, poor concentration, confusion, nausea, and generally feeling unwell and irritable. See “Dealing With Jet Lag” on page 10. Working the Night Shift Try to limit night shift work, if that is possible. If you must work the night shift, the following tips may help you: l l l l l Increase your total amount of sleep by adding naps and lengthening the amount of time you allot for sleep. Use bright lights in your workplace. Minimize the number of shift changes so that your body’s biological clock has a longer time to adjust to a nighttime work schedule. Get rid of sound and light distractions in your bedroom during your daytime sleep. Use caffeine only during the first part of your shift to promote alertness at night. If you are unable to fall asleep during the day, and all else fails, talk with your doctor to see whether it would be wise for you to use prescribed, short-acting sleeping pills to help you sleep during the day. Night Shift What Makes You Sleep? 10Your Guide to Healthy Sleep Dealing With Jet Lag Be aware that adjusting to a new time zone may take several days. If you are going to be away for just a few days, it may be better to stick to your original sleep and wake times as much as possible, rather than adjusting your biological clock too many times in rapid succession. Eastward travel generally causes more severe jet lag than westward travel because traveling east requires you to shorten the day, and your biological clock is better able to adjust to a longer day than a shorter day. Fortunately for globetrotters, a few preventive measures and adjustments seem to help some people relieve jet lag, particularly when they are going to spend more than a few days at their destination: l l Adjust your biological clock. During the 2–3 days prior to a long trip, get adequate sleep. You can make minor changes to your sleep schedule. For example, if you are traveling west, delay your bed time and wake time progressively by 20- to 30-minute intervals. If you are traveling east, advance your wake time by 10 to 15 minutes a day for a few days and try to advance your bed time. Decreasing light exposure at bedtime and increasing light exposure at wake time can help you make these adjustments. When you arrive at your destination, spend a lot of time outdoors so your body gets the light cues it needs to adjust to the new time zone. Take a couple of short 10–15 minute catnaps if you feel tired, but do not take long naps during the day. Avoid alcohol and caffeine. Although it may be tempting to drink alcohol to relieve the stress of travel and make it easier to fall asleep, you’re more likely to sleep lighter and wake up in the middle of the night when the effects of the alcohol wear off. Caffeine can help keep you awake longer, but caffeine also can make it harder for you to fall asleep if its effects haven’t worn off by the time you are ready to go to bed. Therefore, it’s best to use caffeine only during the morning and not during the afternoon. 11 l What about melatonin? Your body produces this hormone that may cause some drowsiness and cues the brain and body that it is time to fall asleep. Melatonin builds up in your body during the early evening and into the first 2 hours of your sleep period, and then its release stops in the middle of the night. Melatonin is available as an over-the-counter supplement. Because melatonin is considered safe when used over a period of days or weeks and seems to help people feel sleepy, it has been suggested as a treatment for jet lag. But melatonin’s effectiveness is controversial, and its safety when used over a prolonged period is unclear. Some studies find that taking melatonin supplements before bedtime for several days after arrival in a new time zone can make it easier to fall asleep at the proper time. Other studies find that melatonin does not help relieve jet lag. What Makes You Sleep? Jet Lag 12Your Guide to Healthy Sleep What Does Sleep Do for You? A number of aspects of your health and quality of life are linked to sleep, and these aspects are impaired when you are sleep deprived. Your Learning, Memory, and Mood Students who have trouble grasping new information or learning new skills are often advised to “sleep on it,” and that advice seems well founded. Recent studies reveal that people can learn a task better if they are well rested. They also can better remember what they learned if they get a good night’s sleep after learning the task than if they are sleep deprived. Study volunteers had to sleep at least 6 hours to show improvement in learning. Additionally, the amount of improvement was directly related to how much time they slept—for example, volunteers who slept 8 hours outperformed those who slept only 6 or 7 hours. Other studies suggest that it’s important to get enough rest the night before a mentally challenging task, rather than only sleeping for a short period or waiting to sleep until after the task is complete. Many well-known artists and scientists claim to have had creative insights while they slept. Mary Shelley, for example, said the idea for her novel Frankenstein came to her in a dream. Although it has not been shown that dreaming is the driving force behind innova tion, one study suggests that sleep is needed for creative problem- solving. In that study, volunteers were asked to perform a memory task and then were tested on it 8 hours later. Those who were allowed to sleep for 8 hours immediately after trying the task and before being tested were much more likely to find a creative way of simplifying the task and improving their performance, compared with those who were awake the entire 8 hours before being tested. Exactly what happens during sleep to improve our learning, memo ry, and insight isn’t known. Experts suspect, however, that while 13 people sleep, they form or strengthen the pathways of brain cells needed to perform these tasks. This process may explain why sleep is needed for proper brain development in infants. Not only is a good night’s sleep required to form new learning and memory pathways in the brain, but also sleep is necessary for those pathways to work well. Several studies show that lack of sleep causes thinking processes to slow down. Lack of sleep also makes it harder to focus and pay attention. Lack of sleep can make you more easily confused. Studies also find that a lack of sleep leads to faulty decisionmaking and more risk taking. A lack of sleep slows down your reaction time, which is particularly important to driving and other tasks that require quick response. When people who lack sleep are tested on a driving simulator, they perform just as poorly as people who are drunk. (See “Crash in Bed, Not on the Road” on page 16.) The bottom line is: Not getting a good night’s sleep can be dangerous! Even if you don’t have a mentally or physically challenging day ahead of you, you should still get enough sleep to put yourself in a good mood. Most people report being irritable, if not downright unhappy, when they lack sleep. People who chronically suffer from a lack of sleep, either because they do not spend enough time in bed or because they have an untreated sleep disorder, are at greater risk of developing depression. One group of people who usually don’t get enough sleep is mothers of newborns. Some experts think depression after childbirth (postpar tum blues) is caused, in part, by a lack of sleep. Your Heart Sleep gives your heart and vascular system a much-needed rest. During non-REM sleep, your heart rate and blood pressure progressively slow as you enter deeper sleep. During REM sleep, in response to dreams, your heart What Does Sleep Do for You? 14Your Guide to Healthy Sleep and breathing rates can rise and fall and your blood pressure can be variable. These changes throughout the night in blood pressure and heart and breathing rates seem to promote cardiovascular health. If you don’t get enough sleep, the nightly dip in blood pressure that appears to be important for good cardiovascular health may not occur. Failure to experience the normal dip in blood pressure during sleep can be related to insufficient sleep time, an untreated sleep disorder (for example, sleep apnea), or other factors. Some sleep- related abnormalities may be markers of heart disease and increased risk of stroke. A lack of sleep also puts your body under stress and may trigger the release of more adrenaline, cortisol, and other stress hormones during the day. These hormones keep your blood pressure from dipping during sleep, which increases your risk for heart disease. Lack of sleep also may trigger your body to produce more of certain proteins thought to play a role in heart disease. For example, some studies find that people who repeatedly don’t get enough sleep have higher than normal blood levels of C-reactive protein, a sign of inflammation. High levels of this protein may indicate an increased risk for a condition called atherosclerosis, or hardening of the arteries. Your Hormones When you were young, your mother may have told you that you need to get enough sleep to grow strong and tall. She may have been right! Deep sleep (stage 3 non-REM sleep) triggers more release of growth hormone, which contributes to growth in children and boosts muscle mass and the repair of cells and tissues in children and adults. Sleep’s effect on the release of sex hormones also contributes to puberty and fertility. Consequently, women who work at night and tend to lack sleep may be at increased risk of miscarriage. Your mother also probably was right if she told you that getting a good night’s sleep on a regular basis would help keep you from getting sick and help you get better if you do get sick. During sleep, your body creates more cytokines—cellular hormones that help the immune system fight various infections. Lack of sleep can reduce your body’s ability to fight off common infections. Research also reveals that a lack of sleep can reduce the body’s response to the flu 15 vaccine. For example, sleep-deprived volunteers given the flu vaccine produced less than half as many flu antibodies as those who were well rested and given the same vaccine. Although lack of exercise and other factors also contribute, the current epidemic of diabetes and obesity seems to be related, at least in part, to chronically short or disrupted sleep or not sleeping during the night. Evidence is growing that sleep is a powerful regulator of appetite, energy use, and weight control. During sleep, the body’s production of the appetite suppressor leptin increases, and the appetite stimulant grehlin decreases. Studies find that the less people sleep, the more likely they are to be overweight or obese and prefer eating foods that are higher in calories and carbohydrates. People who report an average total sleep time of 5 hours a night, for example, are much more likely to become obese, compared with people who sleep 7–8 hours a night. A number of hormones released during sleep also control the body’s use of energy. A distinct rise and fall of blood sugar levels during sleep appears to be linked to sleep stages. Not sleeping at the right time, not getting enough sleep overall, or not enough of each stage of sleep disrupts this pattern. One study found that, when healthy young men slept only 4 hours a night for 6 nights in a row, their insulin and blood sugar levels matched those seen in people who were developing diabetes. Another study found that women who slept less than 7 hours a night were more likely to develop diabetes over time than those who slept between 7 and 8 hours a night. What Does Sleep Do for You? 16Your Guide to Healthy Sleep Crash in Bed Not on the Road Most people are aware of the hazards of drunk driving. But driving while sleepy can be just as dangerous. Indeed, crashes due to sleepy drivers are as deadly as those due to drivers impaired by alcohol. And you don’t have to be asleep at the wheel to put yourself and others in danger. Both alcohol and a lack of sleep limit your ability to react quickly to a suddenly braking car, a sharp curve in the road, or other situations that require rapid responses. Just a few seconds’ delay in reaction time can be a life-or-death matter when driving. When people who lack sleep are tested on a driving simulator, they perform as badly as or worse than those who are drunk. The combination of alcohol and lack of sleep can be especially dangerous. There is increasing evidence that sleep deprivation and inexperience behind the wheel, both particularly common in adolescents, is a lethal combination. Of course, driving is also hazardous if you fall asleep at the wheel, which happens surprisingly often. One-quarter of the drivers surveyed in New York State reported they had fallen asleep at the wheel at some time. Often, people briefly nod off at the wheel without being aware of it—they just can’t recall what happened over the previous few seconds or longer. And people who lack sleep are more apt to take risks and make poor judgments, which also can boost their chances of getting in a car crash. Opening a window or turning up the radio won’t help you stay awake while driving. The bottom line is that there is no substitute for sleep. Be aware of these warning signs that you are too sleepy to drive safely: trouble keeping your eyes open or focused, continual yawning, or being unable to recall driving the past few miles. Remember, if you are short on sleep, stay out of the driver’s seat! 17 Here are some potentially life-saving tips for avoiding drowsy driving: l l l l l l Be well rested before hitting the road. If you have several nights in a row of fewer than 7–8 hours of sleep, your reaction time slows. Restoring that reaction time to normal can take more than one night of good sleep, because a sleep debt accumulates after each night you lose sleep. It may take several nights of being well rested to repay that sleep debt and make you ready for driving on a long road trip. Avoid driving between midnight and 7 a.m. Unless you are accustomed to being awake then, this period of time is when we are naturally the least alert and most tired. Don’t drive alone. A companion who can keep you engaged in conversation might help you stay awake while driving. Schedule frequent breaks on long road trips. If you feel sleepy while driving, pull off the road and take a nap for 15–20 minutes. Don’t drink alcohol. Just one beer when you are sleep deprived will affect you as much as two or three beers when you are well rested. Don’t count on caffeine or other tricks. Although drinking a cola or a cup of coffee might help keep you awake for a short time, it won’t overcome extreme sleepiness or relieve a sleep debt. What Does Sleep Do for You? 18Your Guide to Healthy SleepI wake up early to get ready for school. I am tired in the morning, and by the end of the school day, I am very tired again. An afterschool nap seems to refresh me and help me focus on homework. Without it, I am grumpy and stressed, can’t focus, and sometimes get headaches. D A P H N E “ ” 19 How Much Sleep Is Enough? Animal studies suggest that sleep is as vital as food for survival. Rats, for example, normally live 2–3 years, but they live only 5 weeks if they are deprived of REM sleep and only 2–3 weeks if they are deprived of all sleep stages—a timeframe similar to death due to starvation. But how much sleep do humans need? To help answer that question, scientists look at how much people sleep when unrestricted, the average amount of sleep among various age groups, and the amount of sleep that studies reveal is necessary to function at your best. When healthy adults are given unlimited opportunity to sleep, they sleep on average between 8 and 8.5 hours a night. But sleep needs vary from person to person. Some people appear to need only about 7 hours to avoid problem sleepiness, whereas others need 9 or more hours of sleep. Sleep needs also change throughout the life cycle. Newborns sleep between 16 and 18 hours a day, and children in preschool sleep between 11 and 12 hours a day. School-aged children and adolescents need at least 10 hours of sleep each night. The hormonal influences of puberty tend to shift adolescents’ biologi cal clocks. As a result, teenagers (who need between 9 and 10 hours of sleep a night) are more likely to go to bed later than younger children and adults, and they tend to want to sleep later in the morning. This delayed sleep–wake rhythm conflicts with the early- morning start times of many high schools and helps explain why most teenagers get an average of only 7–7.5 hours of sleep a night. As people get older, the pattern of sleep also changes—especially the amount of time spent in deep sleep. This explains why children can sleep through loud noises and why they might not wake up when moved. Across the lifespan, the sleep period tends to advance, namely relative to teenagers; older adults tend to go to bed earlier and wake earlier. The quality—but not necessarily the quantity—of How Much Sleep Is Enough? 20Your Guide to Healthy Sleep deep, non-REM sleep also changes, with a trend toward lighter sleep. The relative percentages of stages of sleep appear to stay mostly constant after infancy. From midlife through late life, people awaken more throughout the night. These sleep disruptions cause older people to lose more and more of stages 1 and 2 non-REM sleep as well as REM sleep. Some older people complain of difficulty falling asleep, early morning awakenings, frequent and long awakenings during the night, daytime sleepiness, and a lack of refreshing sleep. Many sleep problems, however, are not a natural part of sleep in the elderly. Their sleep complaints may be due, in part, to medical conditions, illnesses, or medications they are taking— all of which can disrupt sleep. In fact, one study found that the prevalence of sleep problems is very low in healthy older adults. Other causes of some of older adults’ sleep complaints are sleep apnea, restless legs syndrome, and other sleep disorders that become more common with age. Also, older people are more likely to have their sleep disrupted by the need to urinate during the night. Some evidence shows that the biological clock shifts in older people, so they are more apt to go to sleep earlier at night and wake up earlier in the morning. No evidence indicates that older people can get by with less sleep than younger people. (See “Top 10 Sleep Myths” on page 22.) Poor sleep in older people may result in excessive daytime sleepiness, attention and memory problems, depressed mood, and overuse of sleeping pills. Despite variations in sleep quantity and quality, both related to age and 21 between individuals, studies suggest that the optimal amount of sleep needed to perform adequately, avoid a sleep debt, and not have problem sleepiness during the day is about 7–8 hours for adults and at least 10 hours for school-aged children and adolescents. Similar amounts seem to be necessary to avoid an increased risk of develop ing obesity, diabetes, or cardiovascular diseases. Quality of sleep and the timing of sleep are as important as quantity. People whose sleep is frequently interrupted or cut short may not get enough of both non-REM sleep and REM sleep. Both types of sleep appear to be crucial for learning and memory—and perhaps for the restorative benefits of healthy sleep, including the growth and repair of cells. Many people try to make up for lost sleep during the week by sleeping more on the weekends. But if you have lost too much sleep, sleeping in on a weekend does not completely erase your sleep debt. Certainly, sleeping more at the end of a week won’t make up for any poor performance you had earlier in that week. Just one night of inadequate sleep can negatively affect your functioning and mood during at least the next day. Daytime naps are another strategy some people use to make up for lost sleep during the night. Some evidence shows that short naps (up to an hour) can make up, at least partially, for the sleep missed on the previous night and improve alertness, mood, and work performance. But naps don’t substitute for a good night’s sleep. One study found that a daytime nap after a lack of sleep at night did not fully restore levels of blood sugar to the pattern seen with adequate nighttime sleep. If a nap lasts longer than 20 minutes, you may have a hard time waking up fully. In addition, late afternoon naps can make falling asleep at night more difficult. How Much Sleep Is Enough? 22Your Guide to Healthy Sleep Top 10 Sleep Myths Myth 1: Sleep is a time when your body and brain shut down for rest and relaxation. No evidence shows that any major organ (including the brain) or regulatory system in the body shuts down during sleep. Some physiological processes actually become more active while you sleep. For example, secretion of certain hormones is boosted, and activity of the pathways in the brain linked to learning and memory increases. Myth 2: Getting just 1 hour less sleep per night than needed will not have any effect on your daytime functioning. This lack of sleep may not make you noticeably sleepy during the day. But even slightly less sleep can affect your ability to think properly and respond quickly, and it can impair your cardiovascular health and energy balance as well as your body’s ability to fight infections, particularly if lack of sleep continues. If you consistently do not get enough sleep, a sleep debt builds up that you can never repay. This sleep debt affects your health and quality of life and makes you feel tired during the day. Myth 3: Your body adjusts quickly to different sleep schedules. Your biological clock makes you most alert during the daytime and least alert at night. Thus, even if you work the night shift, you will naturally feel sleepy when nighttime comes. Most people can reset their biological clock, but only by appropriately timed cues—and even then, by 1–2 hours per day at best. Consequently, it can take more than a week to adjust to a substantial change in your sleep–wake cycle—for example, when traveling across several time zones or switching from working the day shift to the night shift. Myth 4: People need less sleep as they get older. Older people don’t need less sleep, but they may get less sleep or find their sleep less refreshing. That’s because as people age, the quality of their sleep changes. Older people are also more likely to have insomnia or other medical conditions that disrupt their sleep. 23 Myth 5: Extra sleep for one night can cure you of problems with excessive daytime fatigue. Not only is the quantity of sleep important, but also the quality of sleep. Some people sleep 8 or 9 hours a night but don’t feel well rested when they wake up because the quality of their sleep is poor. A number of sleep disorders and other medical conditions affect the quality of sleep. Sleeping more won’t lessen the daytime sleepiness these disorders or conditions cause. However, many of these disorders or conditions can be treated effectively with changes in behavior or with medical therapies. Additionally, one night of increased sleep may not correct multiple nights of inadequate sleep. Myth 6: You can make up for lost sleep during the week by sleeping more on the weekends. Although this sleeping pattern will help you feel more rested, it will not completely make up for the lack of sleep or correct your sleep debt. This pattern also will not necessarily make up for impaired performance during the week or the physical problems that can result from not sleeping enough. Furthermore, sleeping later on the weekends can affect your biological clock, making it much harder to go to sleep at the right time on Sunday nights and get up early on Monday mornings. Myth 7: Naps are a waste of time. Although naps are no substitute for a good night’s sleep, they can be restorative and help counter some of the effects of not getting enough sleep at night. Naps can actually help you learn how to do certain tasks quicker. But avoid taking naps later than 3 p.m., particularly if you have trouble falling asleep at night, as late naps can make it harder for you to fall asleep when you go to bed. Also, limit your naps to no longer than 20 minutes, because longer naps will make it harder to wake up and How Much Sleep Is Enough? 24Your Guide to Healthy Sleep Top 10 Sleep Myths (continued) get back in the swing of things. If you take more than one or two planned or unplanned naps during the day, you may have a sleep disorder that should be treated. Myth 8: Snoring is a normal part of sleep. Snoring during sleep is common, particularly as a person gets older. Evidence is growing that snoring on a regular basis can make you sleepy during the day and increase your risk for diabetes and heart disease. In addition, some studies link frequent snoring to problem behavior and poorer school achievement in children. Loud, frequent snoring also can be a sign of sleep apnea, a serious sleep disorder that should be evaluated and treated. (See “Is Snoring a Problem?” on page 30.) Myth 9: Children who don’t get enough sleep at night will show signs of sleepiness during the day. Unlike adults, children who don’t get enough sleep at night typically become hyperactive, irritable, and inattentive during the day. They also have increased risk of injury and more behavior problems, and their growth rate may be impaired. Sleep debt appears to be quite common during childhood and may be misdiagnosed as attention-deficit hyperactivity disorder. Myth 10: The main cause of insomnia is worry. Although worry or stress can cause a short bout of insomnia, a persistent inability to fall asleep or stay asleep at night can be caused by a number of other factors. Certain medications and sleep disorders can keep you up at night. Other common causes of insomnia are depression, anxiety disorders, and asthma, arthritis, or other medical conditions with symptoms that tend to be troublesome at night. Some people who have chronic insomnia also appear to be more “revved up” than normal, so it is harder for them to fall asleep. Sleep Myths 25When medicines didn’t work for me, I started making big lifestyle changes. Now I try to eat a balanced diet and walk for at least an hour each day. Without doubt, my weight loss and more active lifestyle help me sleep better. What Disrupts Sleep? Many factors can prevent a good night’s sleep. These factors range from well-known stimulants, such as coffee, to certain pain relievers, decongestants, and other culprits. Many people depend on the caffeine in coffee, cola, or tea to wake them up in the morning or to keep them awake. Caffeine is thought to block the cell receptors that adenosine (a substance in the brain) uses to trigger its sleep- inducing signals. In this way, caffeine fools the body into thinking it isn’t tired. It can take as long as 6–8 hours for the effects of caffeine to wear off completely. Thus, drinking a cup of coffee in the late afternoon may prevent your falling asleep at night. Nicotine is another stimulant that can keep you awake. Nicotine also leads to lighter than normal sleep, and heavy smokers tend to wake up too early because of nicotine withdrawal. Although alcohol is a sedative that makes it easier to fall asleep, it prevents deep sleep and REM sleep, allowing only the lighter stages of sleep. People who drink alcohol also tend to wake up in the middle of the night when the effects of an alcoholic “nightcap” wear off. Certain commonly used prescrip tion and over-the-counter medi cines contain ingredients that can keep you awake. These ingredients include decongestants and steroids. Many medicines taken to relieve headaches contain caffeine. Heart and blood pressure medications known as beta blockers can make it difficult to fall asleep and cause more awakenings during the night. People who have chronic asthma or bronchitis also have more problems falling asleep and staying asleep than healthy people, either because of their breathing difficul ties or because of the medicines What Disrupts Sleep? S Z E - P I N G “ ” 26Your Guide to Healthy Sleep they take. Other chronic painful or uncomfortable conditions— such as arthritis, congestive heart failure, and sickle cell anemia— can disrupt sleep, too. A number of psychological disorders—including schizophrenia, bipolar disorder, and anxiety disorders—are well known for disrupt ing sleep. Depression often leads to insomnia, and insomnia can cause depression. Some of these psychological disorders are more likely to disrupt REM sleep. Psychological stress also takes its toll on sleep, making it more difficult to fall asleep or stay asleep. People who feel stressed also tend to spend less time in deep sleep and REM sleep. Many people report having difficulties sleeping if, for example, they have recently lost a loved one, are going through a divorce, or are under stress at work. Menstrual cycle hormones can affect how well women sleep. Pro gesterone is known to induce sleep and circulates in greater concen trations in the second half of the menstrual cycle. For this reason, women may sleep better during this phase of their menstrual cycle. On the other hand, many women report trouble sleeping the night before their menstrual flow starts. This sleep disruption may be related to the abrupt drop in progesterone levels that occurs just before menstruation. Women in their late forties and early fifties, however, report more difficulties sleeping (insomnia) than younger women. These difficulties may be linked to menopause, when they have lower concentrations of progesterone. Hot flashes in women of this age also may cause sleep disruption and difficulties. Certain lifestyle factors also may deprive a person of needed sleep. Large meals or vigorous exercise just before bedtime can make it harder to fall asleep. While vigorous exercise in the evening may delay sleep onset for various reasons, exercise in the daytime is associated with improved nighttime sleep. If you aren’t getting enough sleep or aren’t falling asleep early enough, you may be overscheduling activi ties that can pre vent you from getting the 27 quiet relaxation time you need to prepare for sleep. Most people report that it’s easier to fall asleep if they have time to wind down into a less active state before sleeping. Relaxing in a hot bath or having a hot, caffeine-free beverage before bedtime may help. In addition, your body temperature drops after a hot bath in a way that mimics, in part, what happens as you fall asleep. Probably for both these reasons, many people report that they fall asleep more easily after a hot bath. Your sleeping environment also can affect your sleep. Clear your bedroom of any potential sleep distractions, such as noises, bright lights, a TV, a cell phone, or computer. Having a comfortable mattress and pillow can help promote a good night’s sleep. You also sleep better if the temperature in your bedroom is kept on the cool side. For more ideas on improving your sleep, check out the tips for getting a good night’s sleep below. Tips for Getting a Good Night’s Sleep l l l Stick to a sleep schedule. Go to bed and wake up at the same time each day. As creatures of habit, people have a hard time adjusting to changes in sleep patterns. Sleeping later on weekends won’t fully make up for a lack of sleep during the week and will make it harder to wake up early on Monday morning. Exercise is great, but not too late in the day. Try to exercise at least 30 minutes on most days but not later than 2–3 hours before your bedtime. Avoid caffeine and nicotine. Coffee, colas, certain teas, and chocolate contain the stimulant caffeine, and its effects can take as long as 8 hours to wear off fully. Therefore, a cup of coffee in the late afternoon can make it hard for you to fall asleep at night. Nicotine is also a stimulant, often causing smokers to sleep only very lightly. In addition, smokers often wake up too early in the morning because of nicotine withdrawal. What Disrupts Sleep? 28Your Guide to Healthy Sleep Tips for Getting a Good Night’s Sleep (continued) l l l l l l l Avoid alcoholic drinks before bed. Having a “nightcap” or alcoholic beverage before sleep may help you relax, but heavy use robs you of deep sleep and REM sleep, keeping you in the lighter stages of sleep. Heavy alcohol ingestion also may contribute to impairment in breathing at night. You also tend to wake up in the middle of the night when the effects of the alcohol have worn off. Avoid large meals and beverages late at night. A light snack is okay, but a large meal can cause indigestion that interferes with sleep. Drinking too many fluids at night can cause frequent awakenings to urinate. If possible, avoid medicines that delay or disrupt your sleep. Some commonly prescribed heart, blood pressure, or asthma medications, as well as some over-the-counter and herbal remedies for coughs, colds, or allergies, can disrupt sleep patterns. If you have trouble sleeping, talk to your doctor or pharmacist to see whether any drugs you’re taking might be contributing to your insomnia and ask whether they can be taken at other times during the day or early in the evening. Don’t take naps after 3 p.m. Naps can help make up for lost sleep, but late afternoon naps can make it harder to fall asleep at night. Relax before bed. Don’t overschedule your day so that no time is left for unwinding. A relaxing activity, such as reading or listening to music, should be part of your bedtime ritual. Take a hot bath before bed. The drop in body temperature after getting out of the bath may help you feel sleepy, and the bath can help you relax and slow down so you’re more ready to sleep. Have a good sleeping environment. Get rid of anything in your bedroom that might distract you from sleep, such as noises, bright lights, an uncomfortable bed, or warm temperatures. You sleep better if the temperature in the room 29 is kept on the cool side. A TV, cell phone, or computer in the bedroom can be a distraction and deprive you of needed sleep. Having a comfortable mattress and pillow can help promote a good night’s sleep. Individuals who have insomnia often watch the clock. Turn the clock’s face out of view so you don’t worry about the time while trying to fall asleep. l l l Have the right sunlight exposure. Daylight is key to regulating daily sleep patterns. Try to get outside in natural sunlight for at least 30 minutes each day. If possible, wake up with the sun or use very bright lights in the morning. Sleep experts recommend that, if you have problems falling asleep, you should get an hour of exposure to morning sunlight and turn down the lights before bedtime. Don’t lie in bed awake. If you find yourself still awake after staying in bed for more than 20 minutes or if you are starting to feel anxious or worried, get up and do some relaxing activity until you feel sleepy. The anxiety of not being able to sleep can make it harder to fall asleep. See a doctor if you continue to have trouble sleeping. If you consistently find it difficult to fall or stay asleep and/ or feel tired or not well rested during the day despite spending enough time in bed at night, you may have a sleep disorder. Your family doctor or a sleep specialist should be able to help you, and it is important to rule out other health or psychiatric problems that may be disturbing your sleep. What Disrupts Sleep? 30My wife noticed that I snored loudly and sometimes stopped breathing in the middle of the night. She was the one who finally pushed me to see a doctor. Is Snoring a Problem? Long the material for jokes, snoring is generally accepted as com mon and annoying in adults but as nothing to worry about. How ever, snoring is no laughing matter. Frequent, loud snoring is often a sign of sleep apnea and may increase your risk of developing cardio vascular disease and diabetes. Snoring also may lead to daytime sleepiness and impaired performance. Snoring is caused by a narrowing or partial blockage of the airways at the back of your mouth, throat, or nose. This obstruction results in increased air turbulence when breathing in, causing the soft tissues in your upper airways to vibrate. The end result is a noisy snore that can disrupt the sleep of your bed partner. This narrowing of the airways is typically caused by the soft palate, tongue, and throat relaxing while you sleep, but allergies or sinus problems also can contribute to a narrowing of the airways, as can being over weight and having extra soft tissue around your upper airways. The larger the tissues in your soft palate (the roof of your mouth in the back of your throat), the more likely you are to snore while sleeping. Alcohol or sedatives taken shortly before sleep also promote snoring. These drugs cause greater relaxation of the tissues Your Guide to Healthy Sleep in your throat and mouth. Surveys reveal that about one-half of all adults snore, and 50 percent of these adults do so loudly and frequently. African Americans, Asians, and Hispanics are more likely to snore loudly and frequent ly compared with Caucasians, and snoring problems increase with age. Not everyone who snores has sleep apnea, but people who have sleep apnea typically do snore loudly and frequently. Sleep apnea is a J I M “ ” 31 serious sleep disorder, and its hallmark is loud, frequent snoring with pauses in breathing or shallow breaths while sleeping. (See “Sleep Apnea” on page 38.) Even if you don’t experience these breathing pauses, snoring can still be a problem for you as well as for your bed partner. Snoring adds extra effort to your breathing, which can reduce the quality of your sleep and lead to many of the same health consequences as sleep apnea. One study found that older adults who did not have sleep apnea, but who snored 6–7 nights a week, were more than twice as likely to report being extremely sleepy during the day than those who never snored. The more people snored, the more daytime fatigue they reported. That sleepiness may help explain why snorers are more likely to be in car crashes than people who don’t snore. Loud snoring also can disrupt the sleep of bed partners and strain marital relations, especially if snoring causes the spouses to sleep in separate bedrooms. In addition, snoring increases the risk of developing diabetes and heart disease. One study found that women who snored regularly were twice as likely as those who did not snore to develop diabetes, even if they were not overweight (another risk factor for diabetes). Other studies suggest that regular snoring may raise the lifetime risk of developing high blood pressure, heart failure, and stroke. About one-third of all pregnant women begin snoring for the first time during their second trimester. If you are snoring while preg nant, let your doctor know. Snoring in pregnancy can be associated with high blood pressure and can have a negative effect on your baby’s growth and development. Your doctor will keep a close eye on your blood pressure throughout your pregnancy and can let you know if any additional evaluations for the snoring might be useful. In most cases, the snoring and any related high blood pressure will go away shortly after delivery. Snoring also can be a problem in children. As many as 10–15 per cent of young children, who typically have enlarged adenoids and tonsils (both tissues in the throat), snore on a regular basis. Several studies show that children who snore (with or without sleep apnea) are more likely than those who do not snore to score lower on tests that measure intelligence, memory, and attention span. These children also have more problematic behavior, including hyperactiv ity. The end result is that children who snore don’t perform in Is Snoring a Problem? 32Your Guide to Healthy Sleep school as well as those who do not snore. Strikingly, snoring was linked to a greater drop in IQ than that seen in children who had elevated levels of lead in their blood. Although the behavior of children improves after they stop snoring, studies suggest they may continue to get poorer grades in school, perhaps because of lasting effects on the brain linked to the snoring. You should have your child evaluated by your doctor if the child snores loudly and frequently—three to four times a week—especially if you note brief pauses in breathing while asleep and if there are signs of hyperactiv ity or daytime sleepiness, inadequate school achievement, or slower than expected development. Surgery to remove the adenoids and tonsils of children often can cure their snoring and any associated sleep apnea. Such surgery has been linked to a reduction in hyperactivity and improved ability to pay attention, even in children who showed no signs of sleep apnea before surgery. Snoring in older children and adults may be relieved by less invasive measures, however. These measures include losing weight, refraining from use of tobacco, sleeping on the side rather than on the back, or elevating the head while sleeping. Treating chronic congestion and refraining from alcohol or sedatives before sleeping also may de crease snoring. In some adults, snoring can be relieved by dental appliances that reposition the soft tissues in the mouth. Although numerous over-the-counter nasal strips and sprays claim to relieve snoring, no scientific evidence supports those claims. 33 Common Sleep Disorders A number of sleep disorders can disrupt your sleep quality and make you overly sleepy during the day, even if you spent enough time in bed to be well rested. (See “Common Signs of a Sleep Disorder” on page 34.) Common Sleep Disorders More than 70 sleep disorders affect at least 40 million Americans and account for an estimated $16 billion in medical costs each year, not counting costs due to lost work time, car accidents, and other factors. The four most common sleep disorders are insomnia, sleep apnea, restless legs syndrome, and narcolepsy. Additional sleep problems include chronic insufficient sleep, circadian rhythm abnormalities, and “parasomnias” such as sleep walking, sleep paralysis, and night terrors. L A U R E N “My restless legs syndrome made me lose sleep and affected my quality of life. But I’m in a good place right now. I’m taking the right medicine for me, and I’ve adopted a healthy, active lifestyle. I am very passionate about taking control of my health. ” 34Your Guide to Healthy Sleep l l l l l l l l l l l l Common Signs of a Sleep disorder Look over this list of common signs of a sleep disorder, and talk to your doctor if you have any of them on three or more nights a week: It takes you more than 30 minutes to fall asleep at night. You awaken frequently in the night and then have trouble falling back to sleep again. You awaken too early in the morning. You often don’t feel well rested despite spending 7–8 hours or more asleep at night. You feel sleepy during the day and fall asleep within 5 minutes if you have an opportunity to nap, or you fall asleep unexpectedly or at inappropriate times during the day. Your bed partner claims you snore loudly, snort, gasp, or make choking sounds while you sleep, or your partner notices that your breathing stops for short periods. You have creeping, tingling, or crawling feelings in your legs that are relieved by moving or massaging them, especially in the evening and when you try to fall asleep. You have vivid, dreamlike experiences while falling asleep or dozing. You have episodes of sudden muscle weakness when you are angry or fearful, or when you laugh. You feel as though you cannot move when you first wake up. Your bed partner notes that your legs or arms jerk often during sleep. You regularly need to use stimulants to stay awake during the day. Also keep in mind that, although children can show some of these signs of a sleep disorder, they often do not show signs of excessive daytime sleepiness. Instead, they may seem overactive and have difficulty focusing and concentrating. They also may not do their best in school. 35 n n Insomnia Insomnia is defined as having trouble falling asleep or staying asleep, or as having unrefreshing sleep despite having ample opportunity to sleep. Life is filled with events that occasionally cause insomnia for a short time. Such temporary insomnia is common and is often brought on by situations such as stress at work, family pressures, or a traumatic event. A National Sleep Foundation poll of adults in the United States found that close to half of the respondents reported temporary insomnia in the nights immediately after the terrorist attacks on September 11, 2001. Chronic insomnia is defined as having symptoms at least 3 nights per week for more than 1 month. Most cases of chronic insomnia are secondary, which means they are due to another disorder or medications. Primary chronic insomnia is a distinct sleep disorder; its cause is not yet well understood. About 30–40 percent of adults say they have some symptoms of insomnia within any given year, and about 10–15 percent of adults say they have chronic insomnia. Chronic insomnia becomes more common with age, and women are more likely than men to report having insomnia. Insomnia often causes problems during the day, such as extreme sleepiness, fatigue, a lack of energy, difficulty concentrating, depressed mood, and irritability. Thus, untreated insomnia can impair quality of life as much as, or more than, other chronic medical problems. Chronic insomnia is often caused by one or more of the following: A disease or mood disorder. The most common causes of insomnia are depression and/or anxiety disorders. Neuro logical disorders, such as Alzheimer’s or Parkinson’s disease, also can have insomnia as a symptom. Chronic insomnia can result from thyroid dysfunction, arthritis, asthma, or other medical conditions in which symptoms become more trouble some at night, making it difficult to fall asleep or stay asleep. Various prescribed and over-the-counter medications that can disrupt sleep, such as decongestants, certain pain relievers, and steroids. Common Sleep Disorders 36Your Guide to Healthy Sleep n n Sleep-disrupting behavior such as drinking alcohol, exercising shortly before bedtime, ingesting caffeine late in the day, watching TV or reading while in bed, or irregular sleep schedules due to shift work or other causes. Another sleep disorder, such as sleep apnea or restless legs syndrome. Some people, however, have primary chronic insomnia. This condi tion is linked to a tendency to be more “revved up” than normal (hyperarousal). People who have primary chronic insomnia may have heightened levels of certain hormones, higher body tempera tures, faster heart rates, and a different pattern of brain waves while they sleep. Doctors diagnose insomnia based mainly on sleep history, often by reviewing a sleep diary. An overnight sleep recording may be required if another sleep disorder is suspected. Doctors also will try to diagnose and treat any other underlying medical or psychological problems as well as identify behaviors that might be causing the insomnia. Often, people who have insomnia enter into a vicious cycle—because they’ve had trouble sleeping on previous nights, they become anxious at the slightest sign that they may not be falling asleep right away. That anxiety can make it more difficult for them to fall asleep. The more time they spend in bed not sleeping, and watching the clock, the more their anxiety—and sleeplessness—increases. To break that cycle of anxiety and negative conditioning, experts recommend going to bed only when you’re sleepy. If you can’t fall asleep (or fall back to sleep) within 20 minutes, get out of bed, go into another room, and do a relaxing activity (such as reading) until you feel sleepy again. Then return to bed. Studies have shown that this reconditioning therapy is an effective way to treat insomnia. Relaxation therapy is another strategy that works for some people who have insomnia. Relaxation therapy may include meditation and other mental relaxation techniques. It also may include physical relaxation techniques, such as progressively tensing and then relax ing each of the muscle groups in your body before sleep. Another method is to focus on breathing deeply. Relaxation therapy can help your body and mind slow down so that you can fall asleep more easily at bedtime. 37 Sleep restriction therapy also works for some people who have insomnia. Calculate your average sleep time over the course of a week, and then limit your nightly sleep time to that average. Gradu ally add more sleep time each night until you achieve a more normal night’s sleep. You should avoid daytime naps longer than 15–20 min utes during sleep restriction therapy. Napping can make it harder to fall asleep at night, which may prolong insomnia. In addition, during sleep restriction therapy, avoid driving a car or operating dangerous machinery until you are getting enough sleep at night. All of these behavioral changes are part of a treatment called cognitive behavioral therapy. Cognitive behavioral therapy also can be used to replace negative thoughts about sleep, such as “I’ll never fall asleep without sleeping pills,” with more realistic positive thinking. Cognitive behavioral therapy is effective in most people who have chronic insomnia. Some people who have chronic insomnia that is not corrected by behavioral therapy or treatment of an underlying condition may need a prescription medication. You should talk to a doctor before trying to treat insomnia with alcohol, over-the-counter or prescribed short-acting sedatives, or sedating antihistamines that induce drowsiness. The benefits of these treatments are limited, and they have risks. Some may help you fall asleep but leave you feeling unrefreshed in the morning. Others have longer lasting effects and leave you feeling still tired and groggy in the morning. Some also may lose their effectiveness over time. Doctors may prescribe sedating antidepressants for insomnia, but the effectiveness of these medicines in people who do not have depression is not known, and there are significant side effects. Common Sleep Disorders 38Your Guide to Healthy Sleep To treat their insomnia, some people pursue “natural” remedies, such as melatonin supplements or valerian teas or extracts. These remedies are available over the counter. Little evidence exists that melatonin can help relieve insomnia. Studies with valerian also have been inconclusive, and the actual dose and purity of various supplements, extracts, or teas that contain valerian may vary from product to product. In addition, because melatonin, valerian, and other natural remedies are not regulated by the Food and Drug Administration, their safety is not monitored. Sleep Apnea In people who have sleep apnea (also referred to as sleep-disordered breathing), breathing briefly stops or becomes very shallow during sleep. This change is caused by intermittent blocking of the upper airway, usually when the soft tissue in the rear of the throat collapses and partially or completely closes the airway. Each pause in breathing typically lasts 10–120 seconds and may occur 20–30 times or more each sleeping hour. If you have sleep apnea, not enough air can flow into your lungs through your mouth and nose during sleep, even though breathing efforts continue. When this happens, the amount of oxygen in your blood decreases. Your brain responds by awakening you enough to tighten the upper airway muscles and open your windpipe. Normal breaths then start again, often with a loud snort or choking sound. Although people who have sleep apnea typically snore loudly and frequently, not everyone who snores has sleep apnea. (See “Is Snoring a Problem?” on page 30.) Because people who have sleep apnea frequently go from deeper sleep to lighter sleep during the night, they rarely spend enough time in deep, restorative stages of sleep. They are therefore often exces sively sleepy during the day. Such sleepiness is thought to lead to mood and behavior problems, including depression, and it more than triples the risk of being in a traffic or work-related accident. The many brief drops in blood-oxygen levels that occur during the night can result in morning headaches and trouble concentrating, thinking clearly, learning, and remembering. Additionally, the intermittent oxygen drops and reduced sleep quality together trigger the release of stress hormones. These hormones raise your blood pressure and heart rate and boost the risk of heart attack, stroke, irregular heartbeats, and congestive heart failure. In addition, 39 Common Sleep DisordersI realize now that my sleep apnea affected my quality of life. I felt tired all the time—so tired that I couldn’t exercise or spend time with my kids. I had other sleep apnea symptoms that affected my work—headaches, confusion, making errors, etc. “Looking back, I know that I should have taken it more seriously and told my doctor about my symptoms many years before I did. “One thing that helps me is physical activity. Now that I am feeling better, I come home from work with enough energy to have an exercise routine. J I M “ ” 40Your Guide to Healthy Sleep untreated sleep apnea can lead to changes in energy metabolism (the way your body changes food and oxygen into energy) that increase the risk for developing obesity and diabetes. Anyone can have sleep apnea. It is estimated that at least 12–18 million American adults have sleep apnea, making it as common as asthma. More than one-half of the people who have sleep apnea are overweight. Sleep apnea is more common in men. More than 1 in 25 middle-aged men and 1 in 50 middle-aged women have sleep apnea along with extreme daytime sleepiness. About 3 percent of children and 10 percent or more of people over age 65 have sleep apnea. This condition occurs more frequently in African Americans, Asians, Native Americans, and Hispanics than in Caucasians. More than one-half of all people who have sleep apnea are not diagnosed. People who have sleep apnea generally are not aware that their breathing stops in the night. They just notice that they don’t feel well rested when they wake up and are sleepy throughout the day. Their bed partners are likely to notice, however, that they snore loudly and frequently and that they often stop breathing briefly while sleeping. Doctors suspect sleep apnea if these symptoms are present, but the diagnosis must be confirmed with overnight sleep monitoring. (See “How Are Sleep Disorders Diagnosed?” on page 44.) This monitoring will reveal pauses in breathing, frequent sleep arousals (changes from sleep to wakefulness), and intermittent drops in levels of oxygen in the blood. 41 n n n n Like adults who have sleep apnea, children who have this disorder usually snore loudly, snort or gasp, and have brief pauses in breath ing while sleeping. Small children often have enlarged tonsils and adenoids that increase their risk for sleep apnea. But doctors may not suspect sleep apnea in children because, instead of showing the typical signs of sleepiness during the day, these children often become agitated and may be considered hyperactive. The effects of sleep apnea in children may include poor school performance and difficult, aggressive behavior. A number of factors can make a person susceptible to sleep apnea. These factors include: n n n n n n Throat muscles and tongue that relax more than normal while asleep Enlarged tonsils and adenoids Being overweight—the excess fat tissue around your neck makes it harder to keep the throat area open Head and neck shape that creates a somewhat smaller airway size in the mouth and throat area Congestion, due to allergies, that also can narrow the airway Family history of sleep apnea If your doctor suspects that you have sleep apnea, you may be referred to a sleep specialist. Some of the ways to help diagnose sleep apnea include: A medical history that includes asking you and your family questions about how you sleep and how you function during the day. Checking your mouth, nose, and throat for extra or large tissues—for example, checking the tonsils, uvula (the tissue that hangs from the middle of the back of the mouth), and soft palate (the roof of your mouth in the back of your throat). An overnight recording of what happens with your breathing during sleep (polysomnogram, or PSG). A multiple sleep latency test (MSLT), usually done in a sleep center, to see how quickly you fall asleep at times when you would normally be awake. (Falling asleep in only a few minutes usually means that you are very sleepy during the day. Being very sleepy during the day can be a sign of sleep apnea.) Common Sleep Disorders 42Your Guide to Healthy Sleep n n n Once all the tests are completed, the sleep specialist will review the results and work with you and your family to develop a treatment plan. Changes in daily activities or habits may help reduce your symptoms: Sleep on your side instead of on your back. Sleeping on your side will help reduce the amount of upper airway collapse during sleep. Avoid alcohol, smoking, sleeping pills, herbal supplements, and any other medications that make you sleepy. They make it harder for your airways to stay open while you sleep, and sedatives can make the breathing pauses longer and more severe. Tobacco smoke irritates the airways and can help trigger the intermittent collapse of the upper airway. Lose weight if you are overweight. Even a little weight loss can sometimes improve symptoms. These changes may be all that are needed to treat mild sleep apnea. However, if you have moderate or severe sleep apnea, you will need additional, more direct treatment approaches. Continuous positive airway pressure (CPAP) is the most effective treatment for sleep apnea in adults. A CPAP machine uses mild air pressure to keep your airways open while you sleep. The machine delivers air to your airways through a specially designed nasal mask. The mask does not breathe for you; the flow of air creates increased pressure to keep the airways in your nose and mouth more open while you sleep. The air pressure is adjusted so that it is just enough to stop your airways from briefly becoming too small during sleep. The pressure is constant and continuous. Sleep apnea will return if CPAP is stopped or if it is used incorrectly. People who have severe sleep apnea symptoms generally feel much better once they begin treatment with CPAP. CPAP treatment can cause side effects in some people. Possible side effects include dry or stuffy nose, irritation of the skin on the face, bloating of the stom ach, sore eyes, or headaches. If you have trouble with CPAP side effects, work with your sleep specialist and support staff. Together, you can do things to reduce or eliminate these problems. Currently, no medications cure sleep apnea. However, some prescription medications may help relieve the excessive sleepiness that sometimes persists even with CPAP treatment of sleep apnea. 43My doctor prescribed CPAP (continuous positive airway pressure) for me, but it was not easy to use at first. Sleeping with a CPAP machine was uncomfortable for me, so I didn’t use it like I should have—rarely, if at all. One day at work, I started feeling really bad, so I went to the hospital. The doctors told me that since I had not been using CPAP regularly, not enough oxygen was going to my brain, which caused symptoms like those for a stroke. So, I went back to my doctor and got a different CPAP machine that was more comfortable for me. “It’s important to talk with your health care provider to make sure that your treatment is comfortable and works for you. J I M “ ” Another treatment approach that may help some people is the use of a mouthpiece (oral or dental appliance). If you have mild sleep apnea or do not have sleep apnea but snore very loudly, your doctor or dentist also may recommend this. A custom-fitted plastic mouth piece will be made by a dentist or an orthodontist (a specialist in correcting teeth or jaw problems). The mouthpiece will adjust your lower jaw and tongue to help keep the airway in your throat more open while you are sleeping. Air can then flow more easily into your lungs because there is less resistance to breathing. Following up with the dentist or orthodontist is important to correct any side effects and to be sure that your mouthpiece continues to fit properly. It is also important to have a followup sleep study to see whether your sleep apnea has improved. Some people who have sleep apnea may benefit from surgery; this depends on the findings of the evaluation by the sleep specialist. Removing tonsils and adenoids that are blocking the airway is done frequently, especially in children. Uvulopalatopharyngoplasty (UPPP) is a surgery for adults that removes the tonsils, uvula, and part of the soft palate. Tracheostomy is a surgery used rarely and only in severe sleep apnea when no other treatments have been successful. A small hole is made in the windpipe, and a tube is inserted. Air will flow through the tube and into the lungs, bypass ing the obstruction in the upper airway. Common Sleep Disorders 44Your Guide to Healthy Sleep l l l How Are Sleep disorders diagnosed? Depending on your symptoms, your doctor will gather informa tion and consider several possible tests when trying to diagnose a sleep disorder: Sleep history and sleep log. Your doctor will ask you how many hours you sleep each night, how often you awaken during the night and for how long, how long it takes you to fall asleep, how well rested you feel upon awakening, and how sleepy you feel during the day. Your doctor may ask you to keep a sleep diary for a few weeks. (See “Sample Sleep Diary” on page 54.) Your doctor also may ask you whether you have any symptoms of sleep apnea or restless legs syndrome, such as loud snoring, snorting or gasping, morning headaches, tingling or unpleasant sensations in the limbs that are relieved by moving them, and jerking of the limbs during sleep. Your sleeping partner may be asked whether you have some of these symptoms, as you may not be aware of them yourself. Sleep recording in a sleep laboratory (polysomnogram). A sleep recording or polysomnogram (PSG) is usually done while you stay overnight at a sleep center or sleep laboratory. Electrodes and other monitors are placed on your scalp, face, chest, limbs, and finger. While you sleep, these devices measure your brain activity, eye movements, muscle activity, heart rate and rhythm, blood pressure, and how much air moves in and out of your lungs. This test also checks the amount of oxygen in your blood. A PSG test is painless. In certain circumstances, the PSG can be done at home. A home monitor can be used to record heart rate, how air moves in and out of your lungs, the amount of oxygen in your blood, and your breathing effort. Multiple sleep latency test (MSLT). This daytime sleep study measures how sleepy you are and is particularly useful for diagnosing narcolepsy. The MSLT is conducted in a sleep 45 laboratory and typically done after an overnight sleep recording (PSG). In this test, monitoring devices for sleep stage are placed on your scalp and face. You are asked to nap four or five times for 20 minutes every 2 hours during the day. Technicians note how quickly you fall asleep and how long it takes you to reach various stages of sleep, especially REM sleep, during your naps. Normal individuals either do not fall asleep during these short designated naptimes or take a long time to fall asleep. People who fall asleep in less than 5 minutes are likely to require treatment for a sleep disorder, as are those who quickly reach REM sleep during their naps. It is important to have a sleep specialist interpret the results of your PSG or MSLT. See “How To Find a Sleep Center and Sleep Specialist” on page 56. Common Sleep Disorders 46Your Guide to Healthy SleepI started to get weird feelings in my legs at night while I slept. To feel better, I would get up and move around and stretch. Then the weird feelings began to happen more often and made me lose sleep. I started to think that something was wrong. I decided to go to the doctor and was diagnosed with restless legs syndrome (RLS). “Because RLS symptoms can change, I’m always trying to find the right mix of diet, medication, and exercise. Exercise and massage help me manage my RLS. Yoga helps a lot too, because of all the stretching involved. L A U R E N “ ” 47 Restless Legs Syndrome Restless legs syndrome (RLS) causes an unpleasant prickling or tingling in the legs, especially in the calves, that is relieved by mov ing or massaging them. People who have RLS feel a need to stretch or move their legs to get rid of the uncomfortable or painful feelings. As a result, it may be difficult to fall asleep and stay asleep. One or both legs may be affected. Some people also feel the sensations in their arms. These sensations also can occur when lying down or sitting for long periods of time, such as while at a desk, riding in a car, or watching a movie. Many people who have RLS also have brief limb movements during sleep, often with abrupt onset, occurring every 5–90 seconds. This condition, known as periodic limb movements in sleep (PLMS), can repeatedly awaken people who have RLS, reducing their total sleep time and interrupting their sleep. Some people have PLMS but have no abnormal sensations in their legs while awake. RLS affects 5–15 percent of Americans, and its prevalence increases with age. RLS occurs more often in women than men. One study found that RLS accounted for one-third of the insomnia seen in patients older than age 60. Children also can have RLS. In children, the condition may be associated with symptoms of attention-deficit hyperactivity disorder. However, it’s not fully known how the disorders are related. Sometimes “growing pains” can be mistaken for RLS. RLS is often inherited. Pregnancy, kidney failure, and anemia related to iron or vitamin deficiency can trigger or worsen RLS symptoms. Researchers suspect that these conditions cause an iron deficiency that results in a lack of dopamine, which is used by the brain to control physical sensation and limb movements. Doctors usually can diagnose RLS by patients’ symptoms and a telltale worsening of symptoms at night or while at rest. Some doctors may order a blood test to check ferretin levels (ferretin is a form of iron). Doctors also may ask people who have RLS to spend a night in a sleep laboratory, where they are monitored to rule out other sleep disorders and to document the excessive limb movements. RLS is treatable but not always curable. Dramatic improvements are seen quickly when patients are given dopamine-like drugs or iron supplements. Alternatively, people who have milder cases may be treated successfully with sedatives or behavioral strategies. These Common Sleep Disorders 48Your Guide to Healthy Sleep n strategies include stretching, taking a hot bath, or massaging the legs before bedtime. Avoiding caffeinated beverages also can help reduce symptoms, and certain medications (e.g., some antidepressants, particularly selective serotonin reuptake inhibitors) may cause RLS. If iron or vitamin deficiency underlies RLS, symptoms may improve with prescribed iron, vitamin B12, or folate supplements. Some people may require anticonvulsant medications to control the creeping and crawling sensations in their limbs. Others who have severe symptoms that are associated with another medical disorder or that do not respond to normal treatments may need to be treated with pain relievers. Narcolepsy Narcolepsy’s main symptom is extreme and overwhelming daytime sleepiness, even after adequate nighttime sleep. In addition, nighttime sleep may be fragmented by frequent awakenings. People who have narcolepsy often fall asleep at inappropriate times and places. Although TV sitcoms occasionally feature these individuals to generate a few laughs, narcolepsy is no laughing matter. People who have narcolepsy experience daytime “sleep attacks” that last from seconds to more than one-half hour, can occur without warning, and may cause injury. These embarrassing sleep spells also can make it difficult to work and to maintain normal personal or social relationships. With narcolepsy, the usually sharp distinctions between being asleep and awake are blurred. Also, people who have narcolepsy tend to fall directly into dream-filled REM sleep, rather than enter REM sleep gradually after passing through the non-REM sleep stages first. In addition to overwhelming daytime sleepiness, narcolepsy has three other commonly associated symptoms, but these may not occur in all people: Sudden muscle weakness (cataplexy). This weakness is similar to the paralysis that normally occurs during REM sleep, but it lasts a few seconds to minutes while an individual is awake. Cataplexy tends to be triggered by sudden emotional reac tions, such as anger, surprise, fear, or laughter. The weakness may show up as limpness at the neck, buckling of the knees, or sagging facial muscles affecting speech, or it may cause a complete body collapse. 49 Common Sleep DisordersAt first, I was misdiagnosed with chronic fatigue syndrome, because I was in my forties and narcolepsy symptoms usually start during the teen years. Because I didn’t have any of the symptoms of chronic fatigue syndrome other than sleepiness, I went to a neurologist for help. He noticed the cataplexy (muscle weakness) right away, and then I was officially diagnosed with narcolepsy and then later on with borderline sleep apnea. “Even though there is no cure for narcolepsy, you can feel like you have control if you manage it well. “When you have narcolepsy, you live your life differently. But with a good plan and supportive friends and family, it all turns out OK. S Z E - P I N G “ ” 50Your Guide to Healthy Sleep n n Sleep paralysis. People who have narcolepsy may experience a temporary inability to talk or move when falling asleep or waking up, as if they were glued to their beds. Vivid dreams. These dreams can occur when people who have narcolepsy first fall asleep or wake up. The dreams are so lifelike that they can be confused with reality. Experts estimate that as many as 350,000 Americans have narco lepsy, but fewer than 50,000 are diagnosed. The disorder may be as widespread as Parkinson’s disease or multiple sclerosis, and more prevalent than cystic fibrosis, but it is less well known. Narcolepsy is often mistaken for depression, epilepsy, or the side effects of medicines. Narcolepsy can be difficult to diagnose in people who have only the symptom of excessive daytime sleepiness. It is usually diagnosed during an overnight sleep recording (PSG) that is followed by an MSLT. (See “How Are Sleep Disorders Diagnosed?” on page 44.) Both tests reveal symptoms of narcolepsy—the tendency to fall asleep rapidly and enter REM sleep early, even during brief naps. Narcolepsy can develop at any age, but the symptoms tend to appear first during adolescence or early adulthood. About 1 of every 10 people who have narcolepsy has a close family member who has the disorder, suggesting that one can inherit a tendency to develop narcolepsy. Studies suggest that a substance in the brain called hypocretin plays a key role in narcolepsy. Most people who have narcolepsy lack hypocretin, which promotes wakefulness. Scientists believe that an autoimmune reaction—perhaps triggered by disease, viral illness, or brain injury— specifically destroys the hypocretin-generating cells in the brains of people who have narcolepsy. 51 Eventually, researchers may develop a treatment for narcolepsy that restores hypocretin to normal levels. In the meantime, most people who have narcolepsy find some to all of their symptoms relieved by various drug treatments. For example, central nervous system stimulants can reduce daytime sleepiness. Antidepressants and other drugs that suppress REM sleep can prevent muscle weakness, sleep paralysis, and vivid dreaming. Doctors also usually recommend that people who have narcolepsy take short naps (10–15 minutes) two or three times a day, if possible, to help control excessive daytime sleepiness. Parasomnias (Abnormal Arousals) In some people, the walking, talking, and other body functions normally suppressed during sleep occur during certain sleep stages. Alternatively, the paralysis or vivid images usually experienced during dreaming may persist after awakening. These occurrences are collectively known as parasomnias and include confusional arousals (a mixed state of being both asleep and awake), sleep talking, sleep walking, night terrors, sleep paralysis, and REM sleep behavior disorder (acting out dreams). Most of these disorders— such as confusional arousals, sleep walking, and night terrors—are more common in children, who tend to outgrow them once they become adults. People who are sleep-deprived also may experience some of these disorders, including sleep walking and sleep paralysis. Sleep paralysis also commonly occurs in people who have narco lepsy. Certain medications or neurological disorders appear to lead to other parasomnias, such as REM sleep behavior disorder, and these parasomnias tend to occur more in elderly people. If you or a family member has persistent episodes of sleep paralysis, sleep walking, or acting out of dreams, talk with your doctor. Taking measures to assure the safety of children and other family members who have partial arousals from sleep is very important. Common Sleep Disorders 52Your Guide to Healthy SleepIt’s a scary experience, lying in bed, wanting to get up, but unable to—scary enough to almost make you not want to go to sleep anymore. I can remember, as a child, feeling as though there was a weight on me when I was trying to wake up, and I couldn’t move. When I would try to wake up, I would kick my legs and flail my arms, sometimes bumping my wife. I really didn’t have control over my limbs. “When the symptoms got really bad, I went to a sleep specialist, who told me I had sleep paralysis. My doctor prescribed a medicine that has worked great for me. Now, I rarely have sleep paralysis—maybe 3 times per year. L A W R E N C E “ ” 53 n n n n Do You Think You Have a Sleep Disorder? At various points in our lives, all of us suffer from a lack of sleep that can be corrected by making sure we have the opportunity to get enough sleep. But, if you are spending enough time in bed and still wake up tired or feel very sleepy during the day, you may have a sleep disorder. See “Common Signs of a Sleep Disorder” on page 34. One of the best ways you can tell whether you are getting enough good-quality sleep, and whether you have signs of a sleep disorder, is by keeping a sleep diary. (See “Sample Sleep Diary” on page 54.) Use this diary to record the quality and quantity of your sleep; your use of medications, alcohol, and caffeinated beverages; your exercise patterns; and how sleepy you feel during the day. After a week or so, look over this information to see how many hours of sleep or nighttime awakenings one night are linked to your being tired the next day. This information will give you a sense of how much uninterrupted sleep you need to avoid daytime sleepiness. You also can use the diary to see some of the patterns or practices that may keep you from getting a good night’s sleep. You may have a sleep disorder and should see your doctor if your sleep diary reveals any of the following: You consistently take more than 30 minutes each night to fall asleep. You consistently awaken more than a few times or for long periods of time each night. You take frequent naps. You often feel sleepy during the day—or you fall asleep at inappropriate times during the day. Do You Think You Have a Sleep Disorder? 54 Sample Sleep Diary Name: Complete in the Morning Today’s date (include month/day/year): Monday* Time I went to bed last night: Time I woke up this morning: No. of hours slept last night: 11 p.m. 7 a.m. 8 Number of awakenings and total time awake last night: 5 times 2 hours How long I took to fall asleep last night: 30 mins. Medications taken last night: None How awake did I feel when I got up this morning? 1—Wide awake 2—Awake but a little tired 3—Sleepy 2 Complete in the Evening Number of caffeinated drinks (coffee, tea, cola) and time when I had them today: 1 drink at 8 p.m. Number of alcoholic drinks (beer, wine, liquor) and time when I had them today: 2 drinks 9 p.m. Naptimes and lengths today: 3:30 p.m. 45 mins. Exercise times and lengths today: None How sleepy did I feel during the day today? 1—So sleepy had to struggle 1 to stay awake during much of the day 2—Somewhat tired 3—Fairly alert 4—Wide awake Your Guide to Healthy Sleep * This column shows example diary entries—use as a model for your own diary notes. 55 Do You Think You Have a Sleep Disorder? 56Your Guide to Healthy Sleep How To Find a Sleep Center and Sleep Specialist If your doctor refers you to a sleep center or sleep specialist, make sure that center or specialist is qualified to diagnose and treat your sleep problem. To find sleep centers accredited by the American Academy of Sleep Medicine, go to www.aasmnet.org and click on “Find a Sleep Center” (under the Patients & Public menu), or call 708–492–0930. To find sleep specialists certified by the American Board of Sleep Medicine, go to www.absm.org and click on “Verification of Diplomates of the ABSM.” 57 n n n n Research Researchers have learned a lot about sleep and sleep disorders in recent years. That knowledge has led to a better understanding of the importance of sleep to our lives and our health. Research supported by the National Heart, Lung, and Blood Institute (NHLBI) has helped identify some of the causes of sleep disorders and their effects on the heart, brain, lungs, and other body systems. The NHLBI also supports ongoing research on the most effective ways to diagnose and treat sleep disorders. Many questions remain about sleep and sleep disorders. The NHLBI continues to support a range of research that focuses on: Better understanding of how a lack of sleep increases the risk for obesity, diabetes, heart disease, and stroke New ways to diagnose sleep disorders Genetic, environmental, and social factors that lead to sleep disorders The adverse effects from a lack of sleep on body and brain Much of this research depends on the willingness of volunteers to participate in clinical research. If you would like to help researchers advance science on sleep or about a sleep disorder you have and possible treatments, talk to your doctor about participating in clinical research. (For more information, see “Clinical Research” on page 58.) Research 58Your Guide to Healthy Sleep Clinical research Researchers can learn quite a bit about sleep and sleep disorders by studying animals. However, to fully understand sleep and its affect on health and functioning, as well as how best to diagnose and treat sleep disorders, researchers need to do clinical research on people. This type of research is called clinical research because it is often conducted in clinical settings, such as hospitals or doctors’ offices. The two types of clinical research are clinical trials and clinical studies. l Clinical trials test new ways to diagnose, prevent, or treat various disorders. For example, treatments (such as medicines, medical devices, surgery, or other procedures) for a disorder need to be tested in people who have the disorder. A trial helps determine whether a treatment is safe and effective in humans before it is made available for public use. In a clinical trial, participants are randomly assigned to groups. One group receives the new treatment being tested. Other groups may receive a different treatment or a placebo (an inactive substance resembling a drug being tested). Comparing results from the groups gives researchers confidence that changes in the test group are due to the new treatment and not to other factors. 59 l l l l Other types of clinical studies are done to discover the factors, including environmental, behavioral, or genetic factors, that cause or worsen various disorders. Researchers may follow a group of people over time to learn what factors contribute to becoming sick. Clinical studies and trials may be relatively brief, or may last for years and require many visits to the study sites. These sites usually are university hospitals or research centers, but they can include private doctors’ offices and community hospitals. If you participate in clinical research, the research will be explained to you in detail, you will be given a chance to ask questions, and you will be asked to provide written permission. You may not directly benefit from the results of the clinical research you participate in, but the information gathered will help others and will add to scientific knowledge. Taking part in clinical research has other benefits, as well. You’ll learn more about your disorder, you’ll have the support of a team of health care providers, and your health will likely be monitored closely. However, participation also can have risks, which you should discuss with your doctor. No matter what you decide, your regular medical care will not be affected. If you’re thinking about participating in a clinical study, you may have questions about the purpose of the study, the types of tests and treatment involved, how participation will affect your daily life, and whether any costs are involved. Your doctor may be able to answer some of your questions and help you find clinical studies in which you can participate. You also can visit the following Web sites to learn about being in a study and to search for clinical trials being done on your disorder: www.clinicaltrials.gov http://clinicalresearch.nih.gov www.nhlbi.nih.gov/studies/index.htm Clinical Research Research 60Your Guide to Healthy Sleep For More Sleep Information Resources From the National Heart, Lung, and Blood Institute (NHLBI) National Center on Sleep Disorders Research Division of Lung Diseases, NHLBI Two Rockledge Centre, Suite 10170 6701 Rockledge Drive Bethesda, MD 20895–7952 Phone: 301–435–0199 Fax: 301–480–3451 Web site: www.nhlbi.nih.gov/sleep NHLBI Diseases and Conditions Index (DCI) The DCI includes articles on sleep disorders, tests, and procedures, along with videos, podcasts, and Spanish-language articles. Web site: www.nhlbi.nih.gov/health/dci/index.html NHLBI Health Information Center P.O. Box 30105 Bethesda, MD 20824–0105 Telephone: 301–592–8573 TTY: 240–629–3255 Fax: 301–592–8563 E-mail: nhlbiinfo@nhlbi.nih.gov Web site: www.nhlbi.nih.gov NIH Office of Science Education Web site (for high school supplemental curriculum: Sleep, Sleep Disorders, and Biological Rhythms) http://science.education.nih.gov 61 Resources From Other Sleep Organizations American Academy of Sleep Medicine (AASM) 2510 North Frontage Road Darien, IL 60561 Telephone: 630–737–9700 Fax: 630–737–9790 Web site: www.aasmnet.org American Sleep Apnea Association 6856 Eastern Avenue, NW., Suite 203 Washington, DC 20012 Telephone: 202–203–3650 Fax: 202–293–3656 Web site: www.sleepapnea.org Narcolepsy Network P.O. Box 294 Pleasantville, NY 10570 Telephone: 401–667–2523 Fax: 401–633–6567 E-mail: narnet@narcolepsynetwork.org Web site: www.narcolepsynetwork.org National Sleep Foundation 1010 North Glebe Road, Suite 310 Arlington, VA 22201 Telephone: 703–243–1697 E-mail: nsf@sleepfoundation.org Web site: www.sleepfoundation.org Restless Legs Syndrome Foundation 1610 14th Street, NW., Suite 300 Rochester, MN 55901 Telephone: 507–287–6465 Fax: 507–287–6312 E-mail: rlsfoundation@rls.org Web site: www.rls.org For More Sleep Information 62Your Guide to Healthy Sleep ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Notes 63 ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ Notes Notes Discrimination Prohibited: Under provisions of applicable public laws enacted by Congress since 1964, no person in the United States shall, on the grounds of race, color, national origin, handicap, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity (or, on the basis of sex, with respect to any educa- tion program or activity) receiving Federal finan- cial assistance. In addition, Executive Order 11141 prohibits discrimination on the basis of age by contractors and subcontractors in the performance of Federal contracts, and Executive Order 11246 states that no federally funded con- tractor may discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. Therefore, the National Heart, Lung, and Blood Institute must be operated in compliance with these laws and Executive Orders. NIH Publication No. 11-5271 Originally printed November 2005 Revised August 2011",Medical,Find & Summarize,Text Transformation "This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Draw your answer from the below text only. Respond in 3 sentences. ",Summarize PHSA Section 514,"Section 1411. Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances Background PHSA Title V, Part E (Sections 561-565), authorizes SAMHSA’s Children’s Mental Health Services. PHSA Title V, Part E, requires the Secretary to award grants to support “comprehensive community mental health services for children with a serious emotional disturbance.” 157 Reauthorized by the Cures Act, 158 the authorization specifies reporting requirements, technical assistance requirements, and the ages of children to be served, among other things. PHSA Section 565 (“General Provisions”) provides definitions for terms used in the Title V, Part E, authorizations and includes the authorization of appropriations, among other things. PHSA Section 565 previously authorized $119 million (rounded) to be appropriated for each of FY2018-FY2022. Provision Section 1411 amends PHSA Section by adding “kinship caregivers” to the definition of “family” and reauthorizing SAMHSA’s Children’s Mental Health Services. PHSA Section 565 now authorizes $125 million to be appropriated for each of FY2023-FY2027. Section. 1412. Substance Use Disorder Treatment and Early Intervention Services for Children and Adolescents Background PHSA Section 514 (“Substance Use Disorder Treatment and Early Intervention Services for Children, Adolescents, and Young Adults”) authorizes SAMHSA’s Children and Families program. PHSA Section 514 requires the Secretary to award grants, contracts, or cooperative agreements to support substance use disorder services for children and adolescents. Eligible entities include public and private nonprofit entities, including Native Alaskan entities and Indian Tribes and Tribal organizations. PHSA Section 514 requires the Secretary to give priority to applicants meeting specified criteria (e.g., providing gender-specific and culturally appropriate treatment). The Cures Act reauthorized the activities in this provision in 2016, further specifying definitions for Indian Tribes or Tribal Organizations and Indian Health Service facilities, among other things. 159 157 42 U.S.C. §290ff. 158 Cures Act §10001. 159 Cures Act §10003. The Restoring Hope for Mental Health and Well-Being Act of 2022 Congressional Research Service 48 PHSA Section 514 previously authorized $29.6 million (rounded) to be appropriated for each of FY2018-FY2022. Provision Section 1412 amends PHSA Section 514 by making technical edits to Tribal terms and reauthorizing $29.6 million (rounded) for each of FY2023-2027 for SAMHSA’s Children and Families program. Chapter 3—Garrett Lee Smith Memorial Reauthorization Sections 1421-1424 Background SAMHSA supports several suicide prevention initiatives, including the National Strategy for Suicide Prevention, a suicide prevention technical assistance center, and the Garrett Lee Smith (GLS) State and Campus suicide grant programs, among others. In 2004, the Garrett Lee Smith Memorial Act (P.L. 108-355 ) explicitly authorized three of these suicide prevention programs in PHSA Title V. PHSA Section 520C (“Suicide Prevention Technical Assistance Center”) authorizes the Garrett Lee Smith (GLS) Suicide Prevention Resource Center. Amended by the Cures Act, 160 PHSA Section 520C requires the Secretary, acting through the SAMHSA Assistant Secretary, to operate a technical assistance center focused on suicide prevention. The provision specifies the program’s focus on suicide prevention across the lifespan and requires the Secretary to submit to Congress a report on the activities carried out by the center. PHSA Section 520C previously authorized $6 million (rounded) to be appropriated annually for each of FY2018-FY2022 for the center. PHSA Sections 520E (“Youth Suicide Early Intervention and Prevention Strategies”) and 520E-2 (“Mental Health and Substance Use Disorder Services on Campus”) authorize the Garrett Lee Smith (GLS) State and Campus suicide grant programs. The GLS State grant program—entitled the GLS State/Tribal Youth Suicide Prevention and Early Intervention grant program—awards grants to states to support comprehensive statewide youth suicide prevention and early intervention strategies. The GLS Campus Suicide Prevention grant program provides institutions of higher education with grants to implement an array of suicide prevention initiatives on campus. 161 Both authorizing provisions were previously amended by the Cures Act in 2016.162 PHSA Section 520E previously authorized $30 million for each of FY2018-FY2022. PHSA Section 520E-2 previously authorized $7 million for each of FY2018-FY2022.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Draw your answer from the below text only. Respond in 3 sentences. Section 1411. Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances Background PHSA Title V, Part E (Sections 561-565), authorizes SAMHSA’s Children’s Mental Health Services. PHSA Title V, Part E, requires the Secretary to award grants to support “comprehensive community mental health services for children with a serious emotional disturbance.” 157 Reauthorized by the Cures Act, 158 the authorization specifies reporting requirements, technical assistance requirements, and the ages of children to be served, among other things. PHSA Section 565 (“General Provisions”) provides definitions for terms used in the Title V, Part E, authorizations and includes the authorization of appropriations, among other things. PHSA Section 565 previously authorized $119 million (rounded) to be appropriated for each of FY2018-FY2022. Provision Section 1411 amends PHSA Section by adding “kinship caregivers” to the definition of “family” and reauthorizing SAMHSA’s Children’s Mental Health Services. PHSA Section 565 now authorizes $125 million to be appropriated for each of FY2023-FY2027. Section. 1412. Substance Use Disorder Treatment and Early Intervention Services for Children and Adolescents Background PHSA Section 514 (“Substance Use Disorder Treatment and Early Intervention Services for Children, Adolescents, and Young Adults”) authorizes SAMHSA’s Children and Families program. PHSA Section 514 requires the Secretary to award grants, contracts, or cooperative agreements to support substance use disorder services for children and adolescents. Eligible entities include public and private nonprofit entities, including Native Alaskan entities and Indian Tribes and Tribal organizations. PHSA Section 514 requires the Secretary to give priority to applicants meeting specified criteria (e.g., providing gender-specific and culturally appropriate treatment). The Cures Act reauthorized the activities in this provision in 2016, further specifying definitions for Indian Tribes or Tribal Organizations and Indian Health Service facilities, among other things. 159 157 42 U.S.C. §290ff. 158 Cures Act §10001. 159 Cures Act §10003. The Restoring Hope for Mental Health and Well-Being Act of 2022 Congressional Research Service 48 PHSA Section 514 previously authorized $29.6 million (rounded) to be appropriated for each of FY2018-FY2022. Provision Section 1412 amends PHSA Section 514 by making technical edits to Tribal terms and reauthorizing $29.6 million (rounded) for each of FY2023-2027 for SAMHSA’s Children and Families program. Chapter 3—Garrett Lee Smith Memorial Reauthorization Sections 1421-1424 Background SAMHSA supports several suicide prevention initiatives, including the National Strategy for Suicide Prevention, a suicide prevention technical assistance center, and the Garrett Lee Smith (GLS) State and Campus suicide grant programs, among others. In 2004, the Garrett Lee Smith Memorial Act (P.L. 108-355 ) explicitly authorized three of these suicide prevention programs in PHSA Title V. PHSA Section 520C (“Suicide Prevention Technical Assistance Center”) authorizes the Garrett Lee Smith (GLS) Suicide Prevention Resource Center. Amended by the Cures Act, 160 PHSA Section 520C requires the Secretary, acting through the SAMHSA Assistant Secretary, to operate a technical assistance center focused on suicide prevention. The provision specifies the program’s focus on suicide prevention across the lifespan and requires the Secretary to submit to Congress a report on the activities carried out by the center. PHSA Section 520C previously authorized $6 million (rounded) to be appropriated annually for each of FY2018-FY2022 for the center. PHSA Sections 520E (“Youth Suicide Early Intervention and Prevention Strategies”) and 520E-2 (“Mental Health and Substance Use Disorder Services on Campus”) authorize the Garrett Lee Smith (GLS) State and Campus suicide grant programs. The GLS State grant program—entitled the GLS State/Tribal Youth Suicide Prevention and Early Intervention grant program—awards grants to states to support comprehensive statewide youth suicide prevention and early intervention strategies. The GLS Campus Suicide Prevention grant program provides institutions of higher education with grants to implement an array of suicide prevention initiatives on campus. 161 Both authorizing provisions were previously amended by the Cures Act in 2016.162 PHSA Section 520E previously authorized $30 million for each of FY2018-FY2022. PHSA Section 520E-2 previously authorized $7 million for each of FY2018-FY2022. Summarize PHSA Section 514",Medical,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","I'm a 27-year-old looking to start implementing Vitamin C in my diet. In under 150 words, why is vitamin C necessary for collagen, and how much would be needed for maximum absorption?","Vitamin C, also known as L-ascorbic acid, is a water-soluble vitamin that is naturally present in some foods, added to others, and available as a dietary supplement. Humans, unlike most animals, are unable to synthesize vitamin C endogenously, so it is an essential dietary component [1]. Vitamin C is required for the biosynthesis of collagen, L-carnitine, and certain neurotransmitters; vitamin C is also involved in protein metabolism [1,2]. Collagen is an essential component of connective tissue, which plays a vital role in wound healing. Vitamin C is also an important physiological antioxidant [3] and has been shown to regenerate other antioxidants within the body, including alpha-tocopherol (vitamin E) [4]. Ongoing research is examining whether vitamin C, by limiting the damaging effects of free radicals through its antioxidant activity, might help prevent or delay the development of certain cancers, cardiovascular disease, and other diseases in which oxidative stress plays a causal role. In addition to its biosynthetic and antioxidant functions, vitamin C plays an important role in immune function [4] and improves the absorption of nonheme iron [5], the form of iron present in plant-based foods. Insufficient vitamin C intake causes scurvy, which is characterized by fatigue or lassitude, widespread connective tissue weakness, and capillary fragility [1,2,4,6-9]. The intestinal absorption of vitamin C is regulated by at least one specific dose-dependent, active transporter [4]. Cells accumulate vitamin C via a second specific transport protein. In vitro studies have found that oxidized vitamin C, or dehydroascorbic acid, enters cells via some facilitated glucose transporters and is then reduced internally to ascorbic acid. The physiologic importance of dehydroascorbic acid uptake and its contribution to overall vitamin C economy are unknown. Oral vitamin C produces tissue and plasma concentrations that the body tightly controls. Approximately 70%–90% of vitamin C is absorbed at moderate intakes of 30–180 mg/day. However, at doses above 1 g/day, absorption falls to less than 50% and absorbed, unmetabolized ascorbic acid is excreted in the urine [4]. Results from pharmacokinetic studies indicate that oral doses of 1.25 g/day ascorbic acid produce mean peak plasma vitamin C concentrations of 135 micromol/L, which are about two times higher than those produced by consuming 200–300 mg/day ascorbic acid from vitamin C-rich foods [10]. Pharmacokinetic modeling predicts that even doses as high as 3 g ascorbic acid taken every 4 hours would produce peak plasma concentrations of only 220 micromol/L [10]. The total body content of vitamin C ranges from 300 mg (at near scurvy) to about 2 g [4]. High levels of vitamin C (millimolar concentrations) are maintained in cells and tissues and are highest in leukocytes (white blood cells), eyes, adrenal glands, pituitary gland, and brain. Relatively low levels of vitamin C (micromolar concentrations) are found in extracellular fluids, such as plasma, red blood cells, and saliva [4]. Recommended Intakes Intake recommendations for vitamin C and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine (IOM) of the National Academies (formerly National Academy of Sciences) [8]. DRI is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. These values, which vary by age and gender [8], include the following: Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals Adequate Intake (AI): Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals Tolerable Upper Intake Level (UL): Maximum daily intake unlikely to cause adverse health effects Table 1 lists the current RDAs for vitamin C [8]. The RDAs for vitamin C are based on its known physiological and antioxidant functions in white blood cells and are much higher than the amount required for protection from deficiency [4,8,11]. For infants from birth to 12 months, the FNB established an AI for vitamin C that is equivalent to the mean intake of vitamin C in healthy, breastfed infants.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I'm a 27-year-old looking to start implementing Vitamin C in my diet. In under 150 words, why is vitamin C necessary for collagen, and how much would be needed for maximum absorption? {passage 0} ========== Vitamin C, also known as L-ascorbic acid, is a water-soluble vitamin that is naturally present in some foods, added to others, and available as a dietary supplement. Humans, unlike most animals, are unable to synthesize vitamin C endogenously, so it is an essential dietary component [1]. Vitamin C is required for the biosynthesis of collagen, L-carnitine, and certain neurotransmitters; vitamin C is also involved in protein metabolism [1,2]. Collagen is an essential component of connective tissue, which plays a vital role in wound healing. Vitamin C is also an important physiological antioxidant [3] and has been shown to regenerate other antioxidants within the body, including alpha-tocopherol (vitamin E) [4]. Ongoing research is examining whether vitamin C, by limiting the damaging effects of free radicals through its antioxidant activity, might help prevent or delay the development of certain cancers, cardiovascular disease, and other diseases in which oxidative stress plays a causal role. In addition to its biosynthetic and antioxidant functions, vitamin C plays an important role in immune function [4] and improves the absorption of nonheme iron [5], the form of iron present in plant-based foods. Insufficient vitamin C intake causes scurvy, which is characterized by fatigue or lassitude, widespread connective tissue weakness, and capillary fragility [1,2,4,6-9]. The intestinal absorption of vitamin C is regulated by at least one specific dose-dependent, active transporter [4]. Cells accumulate vitamin C via a second specific transport protein. In vitro studies have found that oxidized vitamin C, or dehydroascorbic acid, enters cells via some facilitated glucose transporters and is then reduced internally to ascorbic acid. The physiologic importance of dehydroascorbic acid uptake and its contribution to overall vitamin C economy are unknown. Oral vitamin C produces tissue and plasma concentrations that the body tightly controls. Approximately 70%–90% of vitamin C is absorbed at moderate intakes of 30–180 mg/day. However, at doses above 1 g/day, absorption falls to less than 50% and absorbed, unmetabolized ascorbic acid is excreted in the urine [4]. Results from pharmacokinetic studies indicate that oral doses of 1.25 g/day ascorbic acid produce mean peak plasma vitamin C concentrations of 135 micromol/L, which are about two times higher than those produced by consuming 200–300 mg/day ascorbic acid from vitamin C-rich foods [10]. Pharmacokinetic modeling predicts that even doses as high as 3 g ascorbic acid taken every 4 hours would produce peak plasma concentrations of only 220 micromol/L [10]. The total body content of vitamin C ranges from 300 mg (at near scurvy) to about 2 g [4]. High levels of vitamin C (millimolar concentrations) are maintained in cells and tissues and are highest in leukocytes (white blood cells), eyes, adrenal glands, pituitary gland, and brain. Relatively low levels of vitamin C (micromolar concentrations) are found in extracellular fluids, such as plasma, red blood cells, and saliva [4]. Recommended Intakes Intake recommendations for vitamin C and other nutrients are provided in the Dietary Reference Intakes (DRIs) developed by the Food and Nutrition Board (FNB) at the Institute of Medicine (IOM) of the National Academies (formerly National Academy of Sciences) [8]. DRI is the general term for a set of reference values used for planning and assessing nutrient intakes of healthy people. These values, which vary by age and gender [8], include the following: Recommended Dietary Allowance (RDA): Average daily level of intake sufficient to meet the nutrient requirements of nearly all (97%–98%) healthy individuals; often used to plan nutritionally adequate diets for individuals Adequate Intake (AI): Intake at this level is assumed to ensure nutritional adequacy; established when evidence is insufficient to develop an RDA Estimated Average Requirement (EAR): Average daily level of intake estimated to meet the requirements of 50% of healthy individuals; usually used to assess the nutrient intakes of groups of people and to plan nutritionally adequate diets for them; can also be used to assess the nutrient intakes of individuals Tolerable Upper Intake Level (UL): Maximum daily intake unlikely to cause adverse health effects Table 1 lists the current RDAs for vitamin C [8]. The RDAs for vitamin C are based on its known physiological and antioxidant functions in white blood cells and are much higher than the amount required for protection from deficiency [4,8,11]. For infants from birth to 12 months, the FNB established an AI for vitamin C that is equivalent to the mean intake of vitamin C in healthy, breastfed infants. https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/",Medical,Find & Summarize,Text Transformation Answer only based on the provided document in one full sentence. Do not exceed more than two sentences in your response.,"According to this document, what qualities does a successful CFO need to have?","Becoming a CFO How can up and coming finance executives develop the necessary skills and leadership qualities to position themselves as credible candidates for CFO roles? Here are 10 tips that can help fuel their professional ascent For anyone pursuing a career in finance, the position of chief financial officer (CFO) is likely to be a prized objective, a role that can unlock untold professional satisfaction. But the path to such vocational riches rarely runs smooth. Numerous barriers — personal, structural, organisational — loom large. Even the most talented individuals enjoy no guarantee that their route to the top will be free of the pitfalls that can colour anyone’s career journey. At Spencer Stuart, we recently explored the gap between the skills of today’s CFOs and what will be needed in the years to come. Our report, CFO of the Future, looked at the capabilities and domains that next generation CFOs would need to master in order to be effective in their roles. In this new paper, we examine how aspiring CFOs can go about making themselves into credible candidates for these senior positions. What skills and leadership qualities do they require? What type of experiences will they need to accumulate as they advance their career? To help answer these questions, we sat down with a number of financial leaders from a variety of industries and geographies to discuss their collective experiences. 10 tips for aspiring CFOs So what do ambitious finance professionals need to do? How can they best channel their motivation and transformational zeal into a career path that will expose them to the right blend of experiences and life-lessons necessary for any CFO position? From our conversations with financial leaders and our own day-to-day experiences in the market, we have identified 10 key ideas for how aspiring finance professionals can become credible candidates for CFO roles. Here’s what we suggest: 1. Learn how to partner The CFO role sits at the very heart of the organisation and affords a 360-degree view of not only the finance function, but other teams, projects and programmes. This means that it is essential that finance executives who have their eye on the top job learn how to partner and collaborate with their colleagues — both internal and external. That’s because CFOs also play a critical role in building relationships with external stakeholders, such as bankers, lawyers and communications advisors. According to Prashanth Mahendra-Rajah, CFO of Analog Devices, this shift is rooted in the sheer complexity of running large organisations. “Today, CFOs must be able to step back and have the enterprise view, but also dive deep when needed,” he said. “At the same time, you need to acknowledge that you can’t be an expert in everything. Therefore, you must be skilled at asking the right questions, probing, looking for the patterns, but really rely on a much broader set of counsel for certain areas of expertise.” Niclas Rosenlew, CFO of Swedish manufacturing company SKF, also believes that collaboration is vital. “An important part of the role is now building internal bridges and executing on agreed strategies,” he said. “And this is not only in finance and control — it goes for all parts of strategy implementation. The CFO increasingly is the guardian ensuring that strategy is implemented and is seen in the overall company performance.” MD Ranganath agrees. The chairman of Catamaran Ventures and former CFO of IT company Infosys, believes that the CFO’s role now looks beyond numbers and into the bigger enterprise view. “The board now looks at finance as a strategic advisor and not just an accountant,” he said. “This means that CFOs must have the ability to play a key role in shaping strategy, to navigate risks and leverage technology in operations. They must also have a problem solving mindset, not a problem stating mindset.” 2. be ready to lead alongside the Ceo When thinking about the CFO-CEO relationship, it might be helpful to picture the collaboration between a captain and first officer in the cockpit of an aeroplane. Sitting in their designated seats, side by side, theirs is a relationship shaped by mutual trust as they are both accountable for the safety of their plane and passengers. Yet it is the captain — the CEO in this analogy — who has the primary responsibility and is the final decision maker. Nonetheless, such is the crossover and similarities between the two roles, CFOs are now increasingly expected to be a key counsel and sparring partner to the CEO, working alongside on critical strategic, commercial and transformation projects, including areas such as ESG-related compliance and reporting. CFOs are now increasingly expected to be a key counsel and sparring partner to the CEO Chris Figee, CFO of Dutch telecoms company KPN, is keen to stress the importance of the CEO and CFO working in tandem. “This is most important,” he said. “They are the only two executive committee members that oversee everything in a company. They are active in all processes and focused on strategy, and they are the only ones who can guard all the plans and their cohesion.” 3. Develop your knowledge of data and advanced analytics No CFO contender is going to get very far without advanced knowledge of data, analytics and the latest developments such as generative AI. As organisations jostle for digital advantage, it’s a pre-requisite, and one that extends across an increasing number of roles. For CFOs, data, analytics and technologies can be used in any number of ways, such as identifying cost savings and customer insights, helping make more informed decision-making at pace, uncovering new market trends — the list goes on. CFOs’ and finance teams’ role in data governance and stewardship is also especially pronounced because it provides embedded continuity to organisations on the topic of data. Simply put, pretty much every company has a CFO and established f inance function, but not all companies have chief data officers. This helps put the pressure on CFOs to not only be able to identify accurate data, but also take a holistic view and understand what the data is telling you. Maria Grigorova, global head of finance at The Adecco Group, says that having sufficient knowledge of data science and data governance will be quite important. “Data science will have a major role in the future of finance, both in providing advancedlevel analytics, and in automation and elimination of repetitive tasks” she said. “While accounting and reporting will be subject to automation and streamlining, the need and value of business insights will remain a major focus. The CFO will transform more and more into a chief insights officer and will need to be wellversed in the benefits of data science and the importance of data governance. Finance is uniquely placed to take care of this.” It’s also about using data to shine a revelatory light on trends both inside and outside of the business — both of which can lead to more effective decisions. Kasper Fangel, CFO of facilities management company, ISS A/S, believes that data and finance can combine to catalyse change. “Data is gold,” he said. “Customers use data to make decisions and if one does not have it to support decisions and customer insight on an almost live basis, it can be threatening in a business like ours. This means that transparency and metrics are absolutely crucial.” It’s not all good news, however. Glen Instone, CFO of Swedish manufacturing group, Husqvarna, points out there are challenges to be aware of too. “Most things can be automated and there is a need to be quicker today,” he said. “Cyber security has become very important. There is massive upside potential, but it’s also coupled with huge risks to be aware of.” This latter point is particularly important because cyber security often falls under the CFO’s remit. This is because one of the core elements of the CFO role is system upgrades and delivering automation across all processes. Digital transformation is not just about data and analysis, but also about pace, efficiencies and cost savings. 4. build your commercial experience Such is the breadth of responsibilities that now accompanies any CFO role, it is incumbent on potential applicants to have a broad professional hinterland — and this includes commercial experience. According to our data, this is already happening. In Europe, the number of CFOs with experience outside of finance rose to 60 percent between 2019–2021, compared to 47 percent between 2017–2019. Developing a commercially savvy profile will enable new CFOs to identify opportunities for the organisation (as well as issues of concern) from the very start, and it provides yet another tool for f inance leaders to drive results against performance objectives. Commercial experience will also add depth to the relationship with the CEO by helping the CFO to be more strategic, while also strengthening relationships with non-finance areas of the business, such as communications and marketing. Dónal Rooney, who has operated as group CFO in private equity (Amaris Hospitality / Lone Star), plc (Datalex) and public sector (NAMA) environments, cites his time outside of finance as pivotal in accelerating his career progress. “I spent two years in a front-line business role, leaving finance behind, and this was instrumental in helping me become a CFO and then, as a CFO, enabling me to contribute in a meaningful way to support the business,” he said. “I don’t believe I would have had the same impact as a CFO without that time spent outside finance. So, my advice to future CFOs is go out and get a front-line business role where you are making key commercial decisions. When you become CFO, you need that credibility and experience to influence change across the organisation.” 5. Make sure you’re always learning In any role, and in any walk of life, it is good to be on the lookout for new skills, perspectives and ideas. As Gandhi said, “Learn as if you were to live forever.” An ongoing curiosity drives new innovations and a constant hunger for new information — both of which help leaders such as CFOs excel at problem solving. It also strengthens collaboration and networking — again, crucial traits for CFOs — and underpins a hunger for knowledge which can only help them understand the strengths (and weaknesses) of their companies. This willingness to explore new ideas and strategies can make all the difference. It’s not just about theoretical knowledge, though. Prashanth Mahendra-Rajah says it’s also about taking any opportunity to learn from your colleagues and their practical, real-life experiences. ","[Task Instructions] ========== Answer only based on the provided document in one full sentence. Do not exceed more than two sentences in your response. ================ [Passage] ========== Becoming a CFO How can up and coming finance executives develop the necessary skills and leadership qualities to position themselves as credible candidates for CFO roles? Here are 10 tips that can help fuel their professional ascent For anyone pursuing a career in finance, the position of chief financial officer (CFO) is likely to be a prized objective, a role that can unlock untold professional satisfaction. But the path to such vocational riches rarely runs smooth. Numerous barriers — personal, structural, organisational — loom large. Even the most talented individuals enjoy no guarantee that their route to the top will be free of the pitfalls that can colour anyone’s career journey. At Spencer Stuart, we recently explored the gap between the skills of today’s CFOs and what will be needed in the years to come. Our report, CFO of the Future, looked at the capabilities and domains that next generation CFOs would need to master in order to be effective in their roles. In this new paper, we examine how aspiring CFOs can go about making themselves into credible candidates for these senior positions. What skills and leadership qualities do they require? What type of experiences will they need to accumulate as they advance their career? To help answer these questions, we sat down with a number of financial leaders from a variety of industries and geographies to discuss their collective experiences. 10 tips for aspiring CFOs So what do ambitious finance professionals need to do? How can they best channel their motivation and transformational zeal into a career path that will expose them to the right blend of experiences and life-lessons necessary for any CFO position? From our conversations with financial leaders and our own day-to-day experiences in the market, we have identified 10 key ideas for how aspiring finance professionals can become credible candidates for CFO roles. Here’s what we suggest: 1. Learn how to partner The CFO role sits at the very heart of the organisation and affords a 360-degree view of not only the finance function, but other teams, projects and programmes. This means that it is essential that finance executives who have their eye on the top job learn how to partner and collaborate with their colleagues — both internal and external. That’s because CFOs also play a critical role in building relationships with external stakeholders, such as bankers, lawyers and communications advisors. According to Prashanth Mahendra-Rajah, CFO of Analog Devices, this shift is rooted in the sheer complexity of running large organisations. “Today, CFOs must be able to step back and have the enterprise view, but also dive deep when needed,” he said. “At the same time, you need to acknowledge that you can’t be an expert in everything. Therefore, you must be skilled at asking the right questions, probing, looking for the patterns, but really rely on a much broader set of counsel for certain areas of expertise.” Niclas Rosenlew, CFO of Swedish manufacturing company SKF, also believes that collaboration is vital. “An important part of the role is now building internal bridges and executing on agreed strategies,” he said. “And this is not only in finance and control — it goes for all parts of strategy implementation. The CFO increasingly is the guardian ensuring that strategy is implemented and is seen in the overall company performance.” MD Ranganath agrees. The chairman of Catamaran Ventures and former CFO of IT company Infosys, believes that the CFO’s role now looks beyond numbers and into the bigger enterprise view. “The board now looks at finance as a strategic advisor and not just an accountant,” he said. “This means that CFOs must have the ability to play a key role in shaping strategy, to navigate risks and leverage technology in operations. They must also have a problem solving mindset, not a problem stating mindset.” 2. be ready to lead alongside the Ceo When thinking about the CFO-CEO relationship, it might be helpful to picture the collaboration between a captain and first officer in the cockpit of an aeroplane. Sitting in their designated seats, side by side, theirs is a relationship shaped by mutual trust as they are both accountable for the safety of their plane and passengers. Yet it is the captain — the CEO in this analogy — who has the primary responsibility and is the final decision maker. Nonetheless, such is the crossover and similarities between the two roles, CFOs are now increasingly expected to be a key counsel and sparring partner to the CEO, working alongside on critical strategic, commercial and transformation projects, including areas such as ESG-related compliance and reporting. CFOs are now increasingly expected to be a key counsel and sparring partner to the CEO Chris Figee, CFO of Dutch telecoms company KPN, is keen to stress the importance of the CEO and CFO working in tandem. “This is most important,” he said. “They are the only two executive committee members that oversee everything in a company. They are active in all processes and focused on strategy, and they are the only ones who can guard all the plans and their cohesion.” 3. Develop your knowledge of data and advanced analytics No CFO contender is going to get very far without advanced knowledge of data, analytics and the latest developments such as generative AI. As organisations jostle for digital advantage, it’s a pre-requisite, and one that extends across an increasing number of roles. For CFOs, data, analytics and technologies can be used in any number of ways, such as identifying cost savings and customer insights, helping make more informed decision-making at pace, uncovering new market trends — the list goes on. CFOs’ and finance teams’ role in data governance and stewardship is also especially pronounced because it provides embedded continuity to organisations on the topic of data. Simply put, pretty much every company has a CFO and established f inance function, but not all companies have chief data officers. This helps put the pressure on CFOs to not only be able to identify accurate data, but also take a holistic view and understand what the data is telling you. Maria Grigorova, global head of finance at The Adecco Group, says that having sufficient knowledge of data science and data governance will be quite important. “Data science will have a major role in the future of finance, both in providing advancedlevel analytics, and in automation and elimination of repetitive tasks” she said. “While accounting and reporting will be subject to automation and streamlining, the need and value of business insights will remain a major focus. The CFO will transform more and more into a chief insights officer and will need to be wellversed in the benefits of data science and the importance of data governance. Finance is uniquely placed to take care of this.” It’s also about using data to shine a revelatory light on trends both inside and outside of the business — both of which can lead to more effective decisions. Kasper Fangel, CFO of facilities management company, ISS A/S, believes that data and finance can combine to catalyse change. “Data is gold,” he said. “Customers use data to make decisions and if one does not have it to support decisions and customer insight on an almost live basis, it can be threatening in a business like ours. This means that transparency and metrics are absolutely crucial.” It’s not all good news, however. Glen Instone, CFO of Swedish manufacturing group, Husqvarna, points out there are challenges to be aware of too. “Most things can be automated and there is a need to be quicker today,” he said. “Cyber security has become very important. There is massive upside potential, but it’s also coupled with huge risks to be aware of.” This latter point is particularly important because cyber security often falls under the CFO’s remit. This is because one of the core elements of the CFO role is system upgrades and delivering automation across all processes. Digital transformation is not just about data and analysis, but also about pace, efficiencies and cost savings. 4. build your commercial experience Such is the breadth of responsibilities that now accompanies any CFO role, it is incumbent on potential applicants to have a broad professional hinterland — and this includes commercial experience. According to our data, this is already happening. In Europe, the number of CFOs with experience outside of finance rose to 60 percent between 2019–2021, compared to 47 percent between 2017–2019. Developing a commercially savvy profile will enable new CFOs to identify opportunities for the organisation (as well as issues of concern) from the very start, and it provides yet another tool for f inance leaders to drive results against performance objectives. Commercial experience will also add depth to the relationship with the CEO by helping the CFO to be more strategic, while also strengthening relationships with non-finance areas of the business, such as communications and marketing. Dónal Rooney, who has operated as group CFO in private equity (Amaris Hospitality / Lone Star), plc (Datalex) and public sector (NAMA) environments, cites his time outside of finance as pivotal in accelerating his career progress. “I spent two years in a front-line business role, leaving finance behind, and this was instrumental in helping me become a CFO and then, as a CFO, enabling me to contribute in a meaningful way to support the business,” he said. “I don’t believe I would have had the same impact as a CFO without that time spent outside finance. So, my advice to future CFOs is go out and get a front-line business role where you are making key commercial decisions. When you become CFO, you need that credibility and experience to influence change across the organisation.” 5. Make sure you’re always learning In any role, and in any walk of life, it is good to be on the lookout for new skills, perspectives and ideas. As Gandhi said, “Learn as if you were to live forever.” An ongoing curiosity drives new innovations and a constant hunger for new information — both of which help leaders such as CFOs excel at problem solving. It also strengthens collaboration and networking — again, crucial traits for CFOs — and underpins a hunger for knowledge which can only help them understand the strengths (and weaknesses) of their companies. This willingness to explore new ideas and strategies can make all the difference. It’s not just about theoretical knowledge, though. Prashanth Mahendra-Rajah says it’s also about taking any opportunity to learn from your colleagues and their practical, real-life experiences. ================ [Query] ========== According to this document, what qualities does a successful CFO need to have?",Financial,Find & Summarize,Text Transformation I'm providing you with your source material. You will not be using any outside material. Your job is to answer questions about the material.,What factor is contributing most to the increased rate of colorectal cancer in young adults?,"Original article Global patterns and trends in colorectal cancer incidence in young adults Rebecca L Siegel,‍ ‍ 1 Lindsey A Torre,1 Isabelle Soerjomataram,2 Richard B Hayes,3 Freddie Bray,2 Thomas K Weber,4,5 Ahmedin Jemal1 ►► Additional material is published online only. To view please visit the journal online (http://​dx.​doi.o​ rg/​10.​1136/​ gutjnl-2​ 019-​319511). 1 Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA 2 Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France 3 Department of Population Health, New York University School of Medicine, New York, New York, USA 4 Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA 5 Department of Surgical Oncology, Northwell Health Cancer Institute, Great Neck, New York, USA Correspondence to Ms Rebecca L Siegel, American Cancer Society, Atlanta, GA 30303, USA; ​rebecca.​siegel@​cancer.​org Received 22 July 2019 Revised 16 August 2019 Accepted 21 August 2019 Abstract Objective Early-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking. Design We extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20–49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand, Norway, Sweden, USA). Results During 2008–2012, age-standardised CRC incidence rates in adults <50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults <50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with longterm data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)). Conclusion CRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis. Introduction © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. To cite: Siegel RL, Torre LA, Soerjomataram I, et al. Gut Epub ahead of print: [please include Day Month Year]. doi:10.1136/ gutjnl-2019-319511 Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide, with an estimated 1.8 million new cases in 2018.1 Global patterns vary widely and are strongly linked to human development index level, reflecting the adoption of western lifestyles that accompany economic transition and elevate risk. In general, CRC incidence is rising in low-income and middle-income countries but beginning to stabilise or decline in high-income countries, especially those that have implemented screening.2 However, accumulating evidence from studies Significance of this study What is already known on this subject? ►► Colorectal cancer (CRC) incidence rates in young adults (aged <50 years) are increasing in several countries, despite declining rates in older adults. The extent to which this pattern is occurring on a global scale is unknown. What are the new findings? ►► CRC incidence rates are uniquely increasing in young adults in nine high-income countries (Germany, USA, Australia, Canada, New Zealand, UK, Denmark, Slovenia and Sweden) across North America, Europe and Oceania where rates in older adults are stable or declining. Conversely, CRC declined in young adults in only three countries (Italy, Austria and Lithuania) compared with 11 countries in adults 50 and older. How might it impact on clinical practice in the foreseeable future? ►► Improving awareness of the marked increases in young-onset CRC incidence could facilitate more diligent assessment of cancer family history by primary care clinicians, as well as follow-up of symptoms in young individuals, many of whom are diagnosed at a late stage. These findings also highlight the need for research on early-life exposures in relation to colorectal carcinogenesis. of cancer registry data indicates that favourable overall trends are masking an increase in young-onset CRC in the USA,3–6 Australia7 8 and Canada.9 Although the absolute risk of CRC in adults younger than 50 years is low relative to older adults, disease trends in young age groups are a key indicator of recent changes in risk factor exposures and often foreshadow the future cancer burden.10 In addition to country-specific analyses, there are recent reports on early-onset CRC occurrence in seven high-income countries,11 in Europe12 and in 11 ‘industrialised’ countries (data through 2007).13 However, a comprehensive examination of contemporary trends on a global scale is lacking. We analysed high-quality longterm population-based data on CRC occurrence by age at diagnosis for 43 countries covering six continents. Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511    1 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 1 Age-standardised incidence rate during 2008–2012 for colorectal cancer among adults ages 20–49 years. Bar shading indicates trend in incidence rates based on 10-year average annual per cent change; red: statistically significant increase; blue: statistically significant decrease; grey: stable or insufficient number of cases for trend analysis (‡). Rate for Finland unavailable.*Rate based on data during 2008-2010.†Excludes Nunavut, Quebec, and Yukon.‡Excluded from trend analysis due to insufficient number of annual cases.¶Rate based on data during 2008-2011. Methods We obtained high-quality population-based annual incidence data for colon and rectal cancer diagnosed through 2012 from the Cancer Incidence in Five Continents (CI5plus) database of the International Association of Cancer Registries and the International Agency for Research on Cancer (IARC).14 The CI5plus database is compiled from cancer registry data worldwide using a process that ensures comparable information that meets high quality standards established by IARC. Specifically, on submission the data coding is verified, the format is standardised, and an editorial board conducts an evaluation based on three dimensions of quality: comparability, completeness and validity. (For more information about the database, see c​ i5.​iarc.​ fr/​CI5-​XI/​Default.​aspx.) The population coverage of registries included in CI5 may be national or subnational. If a country is represented by one or more registries but without national coverage, the registries are specified. National or subnational registries with cancer incidence data going back to at least 1998 were included and multiple datasets from subnational registries within a single country were combined, resulting in a total of 43 countries examined. To take advantage of the availability of 2 more contemporary incidence, we obtained additional data by contacting individual registries or accessing publicly available data online. We acquired data through 2015 from Australia (​ www.​ aihw.​ gov.​ au/); through 2016 from Finland (personal communication), New Zealand (personal communication) and the USA (​seer.​cancer.​gov/​data/); and through 2017 from Norway (personal communication) and Sweden (​sdb.​socialstyrelsen.​se/​ if_​can/​val.​aspx). Seven countries had fewer than 10 CRC cases among ages 20–49 years in any single diagnosis year and were excluded from trend analysis. Incidence was stratified by age at diagnosis, categorised as 20–49 years (‘early-onset’) or 50 years or older (‘older adults’). Cancer subsite was categorised according to the International Classification of Diseases, 10th revision as colon (code C18) or rectum (code C19-C20). Given that trends in CRC incidence are quite similar in men and women overall2 and for earlyonset disease,6 15 16 the two sexes were combined to improve stability. Primary outcome measures were average annual incidence rates during diagnosis years 2008–2012 (42 countries; data unavailable for Finland) and time-weighted average annual per cent change (AAPC) in incidence rates during the last 10 years of available data (36 countries) based on joinpoint regression analysis. This method fits joined straight lines (joinpoints) to observed annual age-standardised rates on a logarithmic scale.17 The maximum number of joinpoints is determined by the number of years available for each country/registry and was limited to four for countries with ≥24 data years. Trends are described as ‘increasing’ or ‘decreasing’ if the AAPC is statistically significantly different from zero (p<0.05) and ‘stable’ otherwise. All rates are expressed per 100 000 population and age-standardised to the 1960 Segi world standard population (as modified by Doll and Cook).18 In a sensitivity analysis, we assessed the extent to which the inclusion of appendiceal cancer (C18.1) in the CI5plus grouping for colon cancer influenced our results by calculating rates and trends exclusive of appendix for three countries for which these data were available (USA, New Zealand and Canada). Results CRC incidence during 2008–2012 Among 42 countries with high-quality population-based cancer registry data, cross-sectional age-standardised CRC incidence rates in ages 20–49 years during 2008–2012 were lowest in India (Chennai; 3.5 per 100 000 (95% CI 3.2 to 3.9)); Uganda (3.8, 95% CI 3.0 to 4.6); and Chile (3.8, 95% CI 2.5 to 5.1) and highest in Korea (12.9, 95% CI 12.6 to 13.3); Australia (11.2, 95% CI 10.9 to 11.5); the USA (10.0, 95% CI 9.8 to 10.3); and Slovakia (10.0, 95% CI 9.3 to 10.7; figure 1; online supplementary table 1). The pattern in older adults was quite similar, with rates ranging from 27.5 (95% CI 25.9 to 29.1) in India to 192.5 (95% CI 188.6 to 196.3) in Slovakia (online supplementary table 2). Among young adults, incidence was generally higher for tumours developing in the colon than in the rectum, with a more than twofold difference in rates in Iceland, Italy and Cyprus (online supplementary tables 3 and 4). Exceptions were in Slovenia, where rates were similar, and Korea, India and China, where rates were slightly higher for rectal cancer. In contrast, incidence rates in older adults were a minimum of 7% higher for colon cancer than for rectal cancer (India, 14.2 per 100 000 vs 13.3) and commonly twofold higher, particularly in high incidence countries (online supplementary tables 5 and 6). Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 2 Average annual per cent change (AAPC) in colorectal cancer incidence by age during the most recent 10 years of available data (A) countries with stable or declining trend among adults age 50 and older (B) countries with increasing trend among adults age 50 and older. AAPC reflects incidence during 2003–2012 except for Australia (2006–2015); Costa Rica (2002–2011); Finland (2007–2016); New Zealand (2007–2016); Norway (2008–2017); Slovakia (2001–2010); Sweden (2008–2017); USA (2007–2016). *AAPC is statistically significantly different from zero (p<0.05) using a two-sided test based on the permutation method. CRC incidence trends Among 36 countries with a sufficient number of annual cases, CRC incidence in adults <50 during the past 10 years was stable in 14 countries and decreased in three—Austria, Italy and Lithuania—all by about 1% annually (online supplementary table 1). Incidence in adults 50 and older likewise declined in Austria and Italy, as well as in nine additional countries (online supplementary table 2). The increasing CRC trend in adults <50 in the remaining 19 countries was unique to that age group in nine countries (figure 2A). Among these nine countries, rates in older adults declined by 1%–2.4% per year in Germany, Canada, New Zealand, Australia, and USA, and were stable in UK, Sweden, Denmark, and Slovenia. Where data were available prior to 1990, the uptick in early-onset CRC began during 1992–1996 and was preceded by declining rates except in Slovenia, where there was a continuous increase of 0.8% per year from 1983 to 2012 (figure 3; online supplementary table 1). Early-onset CRC incidence increased most rapidly in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)), where rates rose at a similar pace among adults 50 and older (figure 2B). Incidence increased in both younger and older age groups in about one-quarter of countries examined; among these, the magnitude of the AAPC for young adults was notably larger than that for older adults in Cyprus, Netherlands and Norway. In Norway, for example, the Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 AAPC was 1.9 (95% CI 1.4 to 2.5) among ages 20–49 versus 0.5 (95% CI 0.3 to 0.7) among ages 50 and older (figure 2B; online supplementary tables 1 and 2). In the Netherlands, the respective AAPCs were 2.0 (95% CI 1.6 to 2.4) versus 1.1 (95% CI 0.7 to 1.6), and the most recent linear (joinpoint) segment (2007–2012) was stable in older adults. Incidence in young adults began to increase in 1998 in Netherlands and 1996 in Norway according to joinpoint analysis, consistent with the timing of the trend in other high-income countries. Subsite-specific incidence trends Subsite-specific incidence trends varied with no clear pattern. For example, declines in early-onset CRC were confined to colon cancer in Italy and Lithuania, but to rectal cancer in Austria (online supplementary tables 3–4). In countries with increasing rates exclusively for early-onset disease, AAPCs were comparable for colon and rectal tumours in the USA, Sweden and Denmark; larger for, or confined to, colon tumours in Australia, New Zealand, Germany and UK; and larger for rectal tumours in Canada and Slovenia. Notably, rectal cancer incidence in the Netherlands increased among adults <50 years (AAPC, 1.9 (95% CI 1.4 to 2.5)) but not among older adults (AAPC, −0.1 (95% CI −0.8 to 0.7)). Importantly, the interpretation of 3 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 3 Colorectal cancer incidence trends by age, including the average annual per cent change (AAPC) during the most recent 10 years of available data, among countries with a unique increase in early-onset disease, by continent: (A) North America and Oceania (B) Europe. AAPC reflects incidence during 2003–2012 except for Australia (2006–2015); New Zealand (2007–2016); Sweden (2008–2017); USA (2007–2016). *AAPC is statistically significantly different from zero (p<0.05) using a two-sided test based on the permutation method. these subsite-specific differences is limited by the inclusion of appendiceal malignancies (C18.1) within the grouping for colon cancer (C18) in CI5 data. The AAPC for appendiceal cancer incidence in the USA during 2007–2016 was 15.5 (95% CI 11.5 to 19.7) in ages 20–49 years.19 We evaluated the extent to which the inclusion of appendiceal malignancies influenced our results 4 by calculating AAPCs for CRC and colon cancer in the absence of appendiceal cancer for three countries (USA, New Zealand and Canada) for which these data were available. In the USA, the AAPC during 2007–2016 in ages 20–49 years excluding appendix was 1.7 (95% CI 1.5 to 2.0) for CRC (vs 2.2 (95% CI 1.9 to 2.5) including appendix) and 1.3 (95% CI 1.0 to 1.7) for Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer colon cancer (vs 2.1 (95% CI 1.7 to 2.6) including appendix) (online supplementary table 7). Thus, the AAPC for colon cancer (excluding appendix) is substantially smaller than that for rectal cancer (2.1, 95% CI 1.7 to 2.5) whereas it previously appeared identical. Results were similar for New Zealand and Canada. Discussion We found that the geographic variation in CRC incidence among adults ages 20–49 mirrors that in older adults, with a threefold difference between the highest (12.9 per 100 000 in Korea) and lowest (3.5 per 100 000 in India) rates. In contrast, age-specific temporal trends were variable, with a decline limited to three countries (Austria, Italy and Lithuania) for young-onset CRC versus 11 for older adults. Conversely, increasing incidence was unique to young adults in nine high-income countries (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA) spanning three continents, often against a backdrop of rapidly declining rates in older adults. Similarly, increasing trends in Cyprus, Netherlands and Norway were twice as steep in young adults as in older adults. Our findings are consistent with previous, mostly country-level studies of age-related differences in temporal trends of CRC.5 7–9 11 The most rapid increases in early-onset CRC occurred in countries where rates are already highest, such as Korea, which had the same pattern for older adults. Reasons for the high and escalating burden in Korea are unclear, but may be related to the rapid dietary transition that took place in the wake of remarkable economic growth following the Korean war.20 Changes in the food supply were also initiated by the importation of wheat from the USA in response to food shortages in the late 1960s, which prompted the production of many wheat-derived processed foods during the 1970s. Shortly thereafter was the introduction of fast-food restaurants especially popular among youth. The obesity epidemic may also be a factor, given that East Asia has experienced among the largest relative increases in body mass index (BMI) worldwide among both adults and children.21 Asians have disproportionately high levels of visceral adiposity compared with Caucasians,22 23 which may more strongly influence CRC risk than BMI or waist circumference.24 25 Another potential contributor is the high prevalence of early-life antibiotic use, which has been associated with increased risk of colorectal adenoma, especially in the rectum.26 A recent study found that among six high-income countries, South Korea had the highest rate of paediatric antibiotic consumption, sevenfold higher than that in Norway, which had the lowest rate.27 The adenoma detection rate among Korean individuals in their 40s has been reported at almost 30%,28 three times higher than that in Australians.29 Early-onset CRC also increased rapidly in countries where risk in older adults is declining at a similar pace, such as New Zealand, Australia, Canada and the USA. Reductions in CRC incidence among older adults in some countries are partly attributed to changing patterns in risk factors, such as reductions in smoking and widespread use of anti-inflammatory drugs.2 30 Likewise, rising incidence confined to young age groups signals changes in early life exposures that adversely influence CRC risk, particularly given the strong birth cohort effect apparent in the trend.5 9 11 Notably, eight of the nine countries with a unique rise in early-onset CRC had declining rates prior to the uptick beginning in the mid-1990s. Reductions in the prevalence of protective factors, such as physical activity (for colon cancer) and sufficient intake of dietary fibre, dairy, and fruits and vegetables, may play a role, as well as increased prevalence of obesity, smoking, Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 red and/or process meat consumption, and/or excess alcohol consumption.31 Obesity was recently found to be associated with a 20% excess risk of early-onset CRC,32 and prevalence has risen most rapidly in young adults33 and in English-speaking high-income countries,34 consistent with early-onset CRC patterns. However, increases in BMI are quite similar across Europe, despite varying CRC trends. For example, BMI increased from 24 kg/m2 in 1975 to 27 in 2014 in men in Germany, where early-onset CRC increased, as well as in Austria, Croatia, Israel and Italy, where it did not.34 BMI increases in women were smaller but also comparable. In addition, there are puzzling variations in the CRC trend by subsite,5 11 as well as by race/ethnicity and state within the USA,35 36 that suggest a role for risk factors beyond obesity. For example, obesity and a sedentary lifestyle are more strongly associated with colon tumours,37–40 yet rectal tumours appear to be driving the increase based on our findings herein and those of other studies.5 9 11 35 If this is true, the rectal epithelium may be more exposed and/or susceptible to the carcinogenic mechanisms causing the increase in disease. CRC risk is intrinsically linked to diet and its influence on gut immune response and inflammation.41 The global food supply has changed substantially in recent decades42 and evolving research is exploring the carcinogenic potential of relatively new food components. For example, associations have been uncovered between CRC and moderate consumption of sugar-sweetened beverages,43 as well as high fructose corn syrup specifically in animal studies,44 both in the absence of obesity and metabolic syndrome. An inflammatory diet, characterised by high consumption of processed foods and high-glycaemic load carbohydrates, creates an environment conducive to colonic proliferation45 and appears to increase CRC risk.46 What remains uncertain is how these dietary elements might influence early-life gut health. Importantly, the association between CRC and currently established risk factors is based almost entirely on disease occurrence in older aged cohorts.47 CRC screening programmes have mostly emerged over the past two decades and likely contributed to the declines in incidence among older adults in 11 countries. Of the 36 countries in our trend analysis, only four (Costa Rica, Cyprus, India and Philippines) lack a screening programme according to a recent global overview.48 In most countries, screening for CRC (generally with a stool test) is recommended to begin between the ages of 50 and 60 years. Exceptions are Italy, where screening begins at age 44 years, and China, Japan and Austria, where it begins at age 40. Notably, two (Austria and Italy) of the three countries where early-onset CRC declined have screened individuals beginning in their fourth decade since the early 1980s.48 Moreover, the decreasing trend among young adults in both Austria and Italy was confined to ages 40–49 years, with rates in ages 20–39 years increasing by 3% per year in Austria (data not shown). Although some of the rapid increases in early-onset CRC are reminiscent of the Korean thyroid cancer ‘epidemic’ that resulted from widespread ultrasound screening,49 overdetection of early-onset CRC is unlikely because screening before age 50 is rare in most countries, and mortality rates have also begun to rise.12 50 After an extensive evidence review, the American Cancer Society recently lowered the recommended age to begin screening from 50 to 45 because disease risk in individuals under 50 has shifted substantially51 and Cancer Intervention and Surveillance Modeling Network modelling studies found a greater benefit to burden ratio for initiation at age 45 compared with 50.52–54 The US Preventive Services Task Force, the other US entity that issues cancer screening guidelines, is currently in 5 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer the process of conducting an evidence review and expected to issue an updated recommendation by 2020–2021. Our study is the first to provide a comprehensive global assessment of contemporary trends in early-onset CRC based on high-quality population-based cancer incidence information. However, the interpretation of subsite-specific differences in CI5 data is limited by the inclusion of appendiceal malignancies within the grouping for colon cancer. Accumulating evidence suggests that these tumours differ from those that develop in the colon in their biology and other characteristics.55 Inclusion of appendix attenuates comparisons of the burden for colon versus rectal cancer. Additionally, although appendiceal cancer accounts for only about 10% of cases in ages <50 years (data for USA, New Zealand and Canada), incidence rates are rising rapidly in high-income countries56 57 due to changes in classification and improved detection. This likely hindered our ability to detect the steeper rise for rectal than for colon cancer that has been reported by numerous studies of early-onset CRC trends excluding appendix,5 9 11 but less often by those including appendix.12 Similarly, results from our sensitivity analyses that excluded appendix found larger increases for rectal than for colon tumours in each of the three countries with these data available. Incidence trends may also be influenced by temporal improvements in the quality of data, case capture, and specificity of coding. Other study limitations include incomplete population coverage for long-term incidence data in many countries; lack of more contemporary data (eg, since 2012) for most countries; and the absence of high-quality cancer registry data for the majority of low-income and middle-income countries. In summary, CRC incidence rates uniquely increased in young adults over the past two decades in nine high-income countries spanning three continents, often in sharp contrast to rapid declines in older adults. These patterns potentially signal changes in early-age exposures conducive to large bowel carcinogenesis and highlight an urgent need for research to explore the potentially unique aetiology of young-onset CRC. Beyond awaiting scientific discovery, clinicians have an opportunity to help mitigate premature morbidity and mortality from CRC with active documentation of familial cancer history; timely follow-up of symptoms, regardless of patient age; and screening when appropriate. Acknowledgements The authors gratefully acknowledge all cancer registries and their staff for their hard work and diligence in collecting cancer information, without which this research could not have been done. Contributors Study concept and design: RS, AJ. Analysis and interpretation of the data: RS, LT, AJ, IS. Drafting the manuscript: RS, LAT. Critical revision of the manuscript for important intellectual content: all authors. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. References 1 Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394–424. 2 Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut 2016. 3 Austin H, Henley SJ, King J, et al. Changes in colorectal cancer incidence rates in young and older adults in the United States: what does it tell us about screening. Cancer Causes Control 2014;25:191–201. 6 4 Bailey CE, Hu C-Y, You YN, et al. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA Surg 2015;150:17–22. 5 Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974–2013. J Natl Cancer Inst 2017;109:djw322. 6 Siegel RL, Jemal A, Ward EM. Increase in incidence of colorectal cancer among young men and women in the United States. Cancer Epidemiol Biomark Prev 2009;18:1695–8. 7 Young JP, Win AK, Rosty C, et al. Rising incidence of early-onset colorectal cancer in Australia over two decades: report and review. J Gastroenterol Hepatol 2015;30:6–13. 8 Feletto E, Yu XQ, Lew J-B, et al. Trends in colon and rectal cancer incidence in Australia from 1982 to 2014: analysis of data on over 375,000 cases. Cancer Epidemiol Biomarkers Prev 2019;28:83–90. 9 Brenner DR, Ruan Y, Shaw E, et al. Increasing colorectal cancer incidence trends among younger adults in Canada. Prev Med 2017;105:345–9. 10 Doll R. Progress against cancer: an epidemiologic assessment. The 1991 John C. Cassel memorial lecture. Am J Epidemiol 1991;134:675–88. 11 Araghi M, Soerjomataram I, Bardot A, et al. Changes in colorectal cancer incidence in seven high-income countries: a population-based study. Lancet Gastroenterol Hepatol 2019;4:511–8. 12 Vuik FER, Nieuwenburg SAV, Bardou M, et al. Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut 2019:gutjnl-2018-317592. 13 Lui RN, Tsoi KKF, Ho JMW, et al. Global increasing incidence of young-onset colorectal cancer across 5 continents: a joinpoint regression analysis of 1,922,167 cases. Cancer Epidemiol Biomarkers Prev 2019;28:1275–82. 14 Ferlay J, Colombet M, Bray F. Cancer Incidence in Five Continents, CI5plus: IARC CancerBase No. 9. Lyon, France: International Agency for Research on Cancer, 2018. 15 Patel P, De P. Trends in colorectal cancer incidence and related lifestyle risk factors in 15-49-year-olds in Canada, 1969-2010. Cancer Epidemiol 2016;42:90–100. 16 Troeung L, Sodhi-Berry N, Martini A, et al. Increasing incidence of colorectal cancer in adolescents and young adults aged 15–39 years in Western Australia 1982–2007: examination of colonoscopy history. Front Public Health 2017;5. 17 Kim H-J, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000;19:335–51. 18 Doll R, Cook P. Summarizing indices for comparison of cancer incidence data. Int J Cancer 1967;2:269–79. 19 Surveillance, Epidemiology and End Results Program. SEER*Stat Database: Incidence - SEER 9 Regs Research Data with Delay-Adjustment, Malignant Only, (1975-2016)National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2019, based on the November 2018 submission 2019. 20 Kim S, Moon S, Popkin BM. The nutrition transition in South Korea. Am J Clin Nutr 2000;71:44–53. 21 Sung H, Siegel RL, Torre LA, et al. Global patterns in excess body weight and the associated cancer burden. CA Cancer J Clin 2019;69:88–112. 22 Kadowaki T, Sekikawa A, Murata K, et al. Japanese men have larger areas of visceral adipose tissue than Caucasian men in the same levels of waist circumference in a population-based study. Int J Obes 2006;30:1163–5. 23 Park Y-W, Allison DB, Heymsfield SB, et al. Larger amounts of visceral adipose tissue in Asian Americans. Obes Res 2001;9:381–7. 24 Keum N, Lee DH, Kim R, et al. Visceral adiposity and colorectal adenomas: doseresponse meta-analysis of observational studies. Ann Oncol 2015;26:1101–9. 25 Nam SY, Kim BC, Han KS, et al. Abdominal visceral adipose tissue predicts risk of colorectal adenoma in both sexes. Clin Gastroenterol Hepatol 2010;8:443–50. 26 Cao Y, Wu K, Mehta R, et al. Long-Term use of antibiotics and risk of colorectal adenoma. Gut 2018;67:672–8. 27 Youngster I, Avorn J, Belleudi V, et al. Antibiotic use in children – a cross-national analysis of 6 countries. J Pediatr 2017;182:239–44. 28 Bae T, Ha Y, Kim C, et al. Distribution of the colonoscopic adenoma detection rate according to age: is recommending colonoscopy screening for Koreans over the age of 50 safe? Ann Coloproctol 2015;31:46–51. 29 Wong S, Lidums I, Rosty C, et al. Findings in young adults at colonoscopy from a hospital service database audit. BMC Gastroenterol 2017;17:56. 30 Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 2010;116:544–73. 31 Gunter MJ, Alhomoud S, Arnold M, et al. Meeting report from the joint IARC–NCI International cancer seminar series: a focus on colorectal cancer. Ann Oncol 2019;30:510–9. 32 Liu P-H, Wu K, Ng K, et al. Association of obesity with risk of early-onset colorectal cancer among women. JAMA Oncol 2019;5:37–44. 33 Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017;377:13–27. 34 Collaboration NCDRF. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. The Lancet 2016;387:1377–96. Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer 35 Siegel RL, Medhanie GA, Fedewa SA, et al. State variation in early-onset colorectal cancer in the United States, 1995–2015. J Natl Cancer Inst 2019;25. 36 Araghi M, Fidler MM, Arnold M, et al. The future burden of colorectal cancer among US blacks and whites. J Natl Cancer Inst 2018;110:791–3. 37 Boyle T, Keegel T, Bull F, et al. Physical activity and risks of proximal and distal colon cancers: a systematic review and meta-analysis. J Natl Cancer Inst 2012;104:1548–61. 38 Ma Y, Yang Y, Wang F, et al. Obesity and risk of colorectal cancer: a systematic review of prospective studies. PLoS One 2013;8:e53916. 39 Moghaddam AA, Woodward M, Huxley R. Obesity and risk of colorectal cancer: a meta-analysis of 31 studies with 70,000 events. Cancer Epidemiol Biomark Prev 2007;16:2533–47. 40 Robsahm TE, Aagnes B, Hjartaker A, et al. Body mass index, physical activity, and colorectal cancer by anatomical subsites: a systematic review and meta-analysis of cohort studies. Eur J Cancer Prev 2013;22:492–505. 41 O’Keefe SJD, Diet O’Keefe SJ.. Diet, microorganisms and their metabolites, and colon cancer. Nat Rev Gastroenterol Hepatol 2016;13:691–706. 42 Schmidhuber J, Sur P, Fay K, et al. The global nutrient database: availability of macronutrients and micronutrients in 195 countries from 1980 to 2013. The Lancet Planetary Health 2018;2:e353–68. 43 Fuchs MA, Sato K, Niedzwiecki D, et al. Sugar-Sweetened beverage intake and cancer recurrence and survival in CALGB 89803 (Alliance). PLoS One 2014;9:e99816. 44 Goncalves MD, Lu C, Tutnauer J, et al. High-Fructose corn syrup enhances intestinal tumor growth in mice. Science 2019;363:1345–9. 45 O’Keefe SJD, Li JV, Lahti L, et al. Fat, fibre and cancer risk in African Americans and rural Africans. Nat Commun 2015;6:6342. 46 Tabung FK, Liu L, Wang W, et al. Association of dietary inflammatory potential with colorectal cancer risk in men and women. JAMA Oncol 2018;4:366–73. Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 47 Nimptsch K, Wu K. Is timing important? the role of diet and lifestyle during early life on colorectal neoplasia. Curr Colorectal Cancer Rep 2018;14:1–11. 48 Schreuders EH, Ruco A, Rabeneck L, et al. Colorectal cancer screening: a global overview of existing programmes. Gut 2015;64:1637–49. 49 Park S, Oh C-M, Cho H, et al. Association between screening and the thyroid cancer “epidemic” in South Korea: evidence from a nationwide study. BMJ 2016;355. 50 Siegel RL, Miller KD, Jemal A. Colorectal cancer mortality rates in adults aged 20 to 54 years in the United States, 1970-2014. JAMA 2017;318:572–4. 51 Anderson JC, Samadder JN. To screen or not to screen adults 45-49 years of age: that is the question. Am J Gastroenterol 2018;113:1750–3. 52 Knudsen AB, Zauber AG, Rutter CM, et al. Estimation of benefits, burden, and harms of colorectal cancer screening strategies: modeling study for the US preventive services Task force. JAMA 2016;315. 53 Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for averagerisk adults: 2018 guideline update from the American cancer Society. CA Cancer J Clin 2018;68:250–81. 54 Peterse EFP, Meester RGS, Siegel RL, et al. The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American cancer Society colorectal cancer screening guideline. Cancer 2018;124:2964–73. 55 CS-P A, Shen JP, Hardy-Abeloos CJ, et al. Genomic landscape of appendiceal neoplasms. JCO Precision Oncology 2018:1–18. 56 Marmor S, Portschy PR, Tuttle TM, et al. The rise in appendiceal cancer incidence: 2000-2009. J Gastrointest Surg 2015;19:743–50. 57 van den Heuvel MGW, Lemmens VEPP, Verhoeven RHA, et al. The incidence of mucinous appendiceal malignancies: a population-based study. Int J Colorectal Dis 2013;28:1307–10. 7 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer ","I'm providing you with your source material. You will not be using any outside material. Your job is to answer questions about the material. What factor is contributing most to the increased rate of colorectal cancer in young adults? Original article Global patterns and trends in colorectal cancer incidence in young adults Rebecca L Siegel,‍ ‍ 1 Lindsey A Torre,1 Isabelle Soerjomataram,2 Richard B Hayes,3 Freddie Bray,2 Thomas K Weber,4,5 Ahmedin Jemal1 ►► Additional material is published online only. To view please visit the journal online (http://​dx.​doi.o​ rg/​10.​1136/​ gutjnl-2​ 019-​319511). 1 Intramural Research Department, American Cancer Society, Atlanta, Georgia, USA 2 Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France 3 Department of Population Health, New York University School of Medicine, New York, New York, USA 4 Department of Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA 5 Department of Surgical Oncology, Northwell Health Cancer Institute, Great Neck, New York, USA Correspondence to Ms Rebecca L Siegel, American Cancer Society, Atlanta, GA 30303, USA; ​rebecca.​siegel@​cancer.​org Received 22 July 2019 Revised 16 August 2019 Accepted 21 August 2019 Abstract Objective Early-onset colorectal cancer (CRC) is increasing in the USA despite rapid declines in older ages. Similar patterns are reported in Australia and Canada, but a comprehensive global analysis of contemporary data is lacking. Design We extracted long-term data from Cancer Incidence in Five Continents and supplemental sources to report on worldwide CRC incidence rates and trends by age (20–49 years and ≥50 years) through diagnosis year 2012 or beyond (Australia, Finland, New Zealand, Norway, Sweden, USA). Results During 2008–2012, age-standardised CRC incidence rates in adults <50 ranged from 3.5 per 100 000 (95% CI 3.2 to 3.9) in India (Chennai) to 12.9 (95% CI 12.6 to 13.3) in Korea. During the most recent decade of available data, incidence in adults <50 was stable in 14 of 36 countries; declined in Austria, Italy and Lithuania; and increased in 19 countries, nine of which had stable or declining trends in older adults (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA). In Cyprus, Netherlands and Norway, inclines in incidence in young adults were twice as rapid as those in older adults (eg, Norway average annual per cent change (AAPC), 1.9 (95% CI 1.4 to 2.5) vs 0.5 (95% CI 0.3 to 0.7)). Among most high-income countries with longterm data, the uptick in early-onset disease began in the mid-1990s. The steepest increases in young adults were in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)) and New Zealand (AAPC, 4.0 (95% CI 2.1 to 6.0)). Conclusion CRC incidence increased exclusively in young adults in nine high-income countries spanning three continents, potentially signalling changes in early-life exposures that influence large bowel carcinogenesis. Introduction © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ. To cite: Siegel RL, Torre LA, Soerjomataram I, et al. Gut Epub ahead of print: [please include Day Month Year]. doi:10.1136/ gutjnl-2019-319511 Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide, with an estimated 1.8 million new cases in 2018.1 Global patterns vary widely and are strongly linked to human development index level, reflecting the adoption of western lifestyles that accompany economic transition and elevate risk. In general, CRC incidence is rising in low-income and middle-income countries but beginning to stabilise or decline in high-income countries, especially those that have implemented screening.2 However, accumulating evidence from studies Significance of this study What is already known on this subject? ►► Colorectal cancer (CRC) incidence rates in young adults (aged <50 years) are increasing in several countries, despite declining rates in older adults. The extent to which this pattern is occurring on a global scale is unknown. What are the new findings? ►► CRC incidence rates are uniquely increasing in young adults in nine high-income countries (Germany, USA, Australia, Canada, New Zealand, UK, Denmark, Slovenia and Sweden) across North America, Europe and Oceania where rates in older adults are stable or declining. Conversely, CRC declined in young adults in only three countries (Italy, Austria and Lithuania) compared with 11 countries in adults 50 and older. How might it impact on clinical practice in the foreseeable future? ►► Improving awareness of the marked increases in young-onset CRC incidence could facilitate more diligent assessment of cancer family history by primary care clinicians, as well as follow-up of symptoms in young individuals, many of whom are diagnosed at a late stage. These findings also highlight the need for research on early-life exposures in relation to colorectal carcinogenesis. of cancer registry data indicates that favourable overall trends are masking an increase in young-onset CRC in the USA,3–6 Australia7 8 and Canada.9 Although the absolute risk of CRC in adults younger than 50 years is low relative to older adults, disease trends in young age groups are a key indicator of recent changes in risk factor exposures and often foreshadow the future cancer burden.10 In addition to country-specific analyses, there are recent reports on early-onset CRC occurrence in seven high-income countries,11 in Europe12 and in 11 ‘industrialised’ countries (data through 2007).13 However, a comprehensive examination of contemporary trends on a global scale is lacking. We analysed high-quality longterm population-based data on CRC occurrence by age at diagnosis for 43 countries covering six continents. Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511    1 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 1 Age-standardised incidence rate during 2008–2012 for colorectal cancer among adults ages 20–49 years. Bar shading indicates trend in incidence rates based on 10-year average annual per cent change; red: statistically significant increase; blue: statistically significant decrease; grey: stable or insufficient number of cases for trend analysis (‡). Rate for Finland unavailable.*Rate based on data during 2008-2010.†Excludes Nunavut, Quebec, and Yukon.‡Excluded from trend analysis due to insufficient number of annual cases.¶Rate based on data during 2008-2011. Methods We obtained high-quality population-based annual incidence data for colon and rectal cancer diagnosed through 2012 from the Cancer Incidence in Five Continents (CI5plus) database of the International Association of Cancer Registries and the International Agency for Research on Cancer (IARC).14 The CI5plus database is compiled from cancer registry data worldwide using a process that ensures comparable information that meets high quality standards established by IARC. Specifically, on submission the data coding is verified, the format is standardised, and an editorial board conducts an evaluation based on three dimensions of quality: comparability, completeness and validity. (For more information about the database, see c​ i5.​iarc.​ fr/​CI5-​XI/​Default.​aspx.) The population coverage of registries included in CI5 may be national or subnational. If a country is represented by one or more registries but without national coverage, the registries are specified. National or subnational registries with cancer incidence data going back to at least 1998 were included and multiple datasets from subnational registries within a single country were combined, resulting in a total of 43 countries examined. To take advantage of the availability of 2 more contemporary incidence, we obtained additional data by contacting individual registries or accessing publicly available data online. We acquired data through 2015 from Australia (​ www.​ aihw.​ gov.​ au/); through 2016 from Finland (personal communication), New Zealand (personal communication) and the USA (​seer.​cancer.​gov/​data/); and through 2017 from Norway (personal communication) and Sweden (​sdb.​socialstyrelsen.​se/​ if_​can/​val.​aspx). Seven countries had fewer than 10 CRC cases among ages 20–49 years in any single diagnosis year and were excluded from trend analysis. Incidence was stratified by age at diagnosis, categorised as 20–49 years (‘early-onset’) or 50 years or older (‘older adults’). Cancer subsite was categorised according to the International Classification of Diseases, 10th revision as colon (code C18) or rectum (code C19-C20). Given that trends in CRC incidence are quite similar in men and women overall2 and for earlyonset disease,6 15 16 the two sexes were combined to improve stability. Primary outcome measures were average annual incidence rates during diagnosis years 2008–2012 (42 countries; data unavailable for Finland) and time-weighted average annual per cent change (AAPC) in incidence rates during the last 10 years of available data (36 countries) based on joinpoint regression analysis. This method fits joined straight lines (joinpoints) to observed annual age-standardised rates on a logarithmic scale.17 The maximum number of joinpoints is determined by the number of years available for each country/registry and was limited to four for countries with ≥24 data years. Trends are described as ‘increasing’ or ‘decreasing’ if the AAPC is statistically significantly different from zero (p<0.05) and ‘stable’ otherwise. All rates are expressed per 100 000 population and age-standardised to the 1960 Segi world standard population (as modified by Doll and Cook).18 In a sensitivity analysis, we assessed the extent to which the inclusion of appendiceal cancer (C18.1) in the CI5plus grouping for colon cancer influenced our results by calculating rates and trends exclusive of appendix for three countries for which these data were available (USA, New Zealand and Canada). Results CRC incidence during 2008–2012 Among 42 countries with high-quality population-based cancer registry data, cross-sectional age-standardised CRC incidence rates in ages 20–49 years during 2008–2012 were lowest in India (Chennai; 3.5 per 100 000 (95% CI 3.2 to 3.9)); Uganda (3.8, 95% CI 3.0 to 4.6); and Chile (3.8, 95% CI 2.5 to 5.1) and highest in Korea (12.9, 95% CI 12.6 to 13.3); Australia (11.2, 95% CI 10.9 to 11.5); the USA (10.0, 95% CI 9.8 to 10.3); and Slovakia (10.0, 95% CI 9.3 to 10.7; figure 1; online supplementary table 1). The pattern in older adults was quite similar, with rates ranging from 27.5 (95% CI 25.9 to 29.1) in India to 192.5 (95% CI 188.6 to 196.3) in Slovakia (online supplementary table 2). Among young adults, incidence was generally higher for tumours developing in the colon than in the rectum, with a more than twofold difference in rates in Iceland, Italy and Cyprus (online supplementary tables 3 and 4). Exceptions were in Slovenia, where rates were similar, and Korea, India and China, where rates were slightly higher for rectal cancer. In contrast, incidence rates in older adults were a minimum of 7% higher for colon cancer than for rectal cancer (India, 14.2 per 100 000 vs 13.3) and commonly twofold higher, particularly in high incidence countries (online supplementary tables 5 and 6). Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 2 Average annual per cent change (AAPC) in colorectal cancer incidence by age during the most recent 10 years of available data (A) countries with stable or declining trend among adults age 50 and older (B) countries with increasing trend among adults age 50 and older. AAPC reflects incidence during 2003–2012 except for Australia (2006–2015); Costa Rica (2002–2011); Finland (2007–2016); New Zealand (2007–2016); Norway (2008–2017); Slovakia (2001–2010); Sweden (2008–2017); USA (2007–2016). *AAPC is statistically significantly different from zero (p<0.05) using a two-sided test based on the permutation method. CRC incidence trends Among 36 countries with a sufficient number of annual cases, CRC incidence in adults <50 during the past 10 years was stable in 14 countries and decreased in three—Austria, Italy and Lithuania—all by about 1% annually (online supplementary table 1). Incidence in adults 50 and older likewise declined in Austria and Italy, as well as in nine additional countries (online supplementary table 2). The increasing CRC trend in adults <50 in the remaining 19 countries was unique to that age group in nine countries (figure 2A). Among these nine countries, rates in older adults declined by 1%–2.4% per year in Germany, Canada, New Zealand, Australia, and USA, and were stable in UK, Sweden, Denmark, and Slovenia. Where data were available prior to 1990, the uptick in early-onset CRC began during 1992–1996 and was preceded by declining rates except in Slovenia, where there was a continuous increase of 0.8% per year from 1983 to 2012 (figure 3; online supplementary table 1). Early-onset CRC incidence increased most rapidly in Korea (AAPC, 4.2 (95% CI 3.4 to 5.0)), where rates rose at a similar pace among adults 50 and older (figure 2B). Incidence increased in both younger and older age groups in about one-quarter of countries examined; among these, the magnitude of the AAPC for young adults was notably larger than that for older adults in Cyprus, Netherlands and Norway. In Norway, for example, the Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 AAPC was 1.9 (95% CI 1.4 to 2.5) among ages 20–49 versus 0.5 (95% CI 0.3 to 0.7) among ages 50 and older (figure 2B; online supplementary tables 1 and 2). In the Netherlands, the respective AAPCs were 2.0 (95% CI 1.6 to 2.4) versus 1.1 (95% CI 0.7 to 1.6), and the most recent linear (joinpoint) segment (2007–2012) was stable in older adults. Incidence in young adults began to increase in 1998 in Netherlands and 1996 in Norway according to joinpoint analysis, consistent with the timing of the trend in other high-income countries. Subsite-specific incidence trends Subsite-specific incidence trends varied with no clear pattern. For example, declines in early-onset CRC were confined to colon cancer in Italy and Lithuania, but to rectal cancer in Austria (online supplementary tables 3–4). In countries with increasing rates exclusively for early-onset disease, AAPCs were comparable for colon and rectal tumours in the USA, Sweden and Denmark; larger for, or confined to, colon tumours in Australia, New Zealand, Germany and UK; and larger for rectal tumours in Canada and Slovenia. Notably, rectal cancer incidence in the Netherlands increased among adults <50 years (AAPC, 1.9 (95% CI 1.4 to 2.5)) but not among older adults (AAPC, −0.1 (95% CI −0.8 to 0.7)). Importantly, the interpretation of 3 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer Figure 3 Colorectal cancer incidence trends by age, including the average annual per cent change (AAPC) during the most recent 10 years of available data, among countries with a unique increase in early-onset disease, by continent: (A) North America and Oceania (B) Europe. AAPC reflects incidence during 2003–2012 except for Australia (2006–2015); New Zealand (2007–2016); Sweden (2008–2017); USA (2007–2016). *AAPC is statistically significantly different from zero (p<0.05) using a two-sided test based on the permutation method. these subsite-specific differences is limited by the inclusion of appendiceal malignancies (C18.1) within the grouping for colon cancer (C18) in CI5 data. The AAPC for appendiceal cancer incidence in the USA during 2007–2016 was 15.5 (95% CI 11.5 to 19.7) in ages 20–49 years.19 We evaluated the extent to which the inclusion of appendiceal malignancies influenced our results 4 by calculating AAPCs for CRC and colon cancer in the absence of appendiceal cancer for three countries (USA, New Zealand and Canada) for which these data were available. In the USA, the AAPC during 2007–2016 in ages 20–49 years excluding appendix was 1.7 (95% CI 1.5 to 2.0) for CRC (vs 2.2 (95% CI 1.9 to 2.5) including appendix) and 1.3 (95% CI 1.0 to 1.7) for Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer colon cancer (vs 2.1 (95% CI 1.7 to 2.6) including appendix) (online supplementary table 7). Thus, the AAPC for colon cancer (excluding appendix) is substantially smaller than that for rectal cancer (2.1, 95% CI 1.7 to 2.5) whereas it previously appeared identical. Results were similar for New Zealand and Canada. Discussion We found that the geographic variation in CRC incidence among adults ages 20–49 mirrors that in older adults, with a threefold difference between the highest (12.9 per 100 000 in Korea) and lowest (3.5 per 100 000 in India) rates. In contrast, age-specific temporal trends were variable, with a decline limited to three countries (Austria, Italy and Lithuania) for young-onset CRC versus 11 for older adults. Conversely, increasing incidence was unique to young adults in nine high-income countries (Australia, Canada, Denmark, Germany, New Zealand, Slovenia, Sweden, UK and USA) spanning three continents, often against a backdrop of rapidly declining rates in older adults. Similarly, increasing trends in Cyprus, Netherlands and Norway were twice as steep in young adults as in older adults. Our findings are consistent with previous, mostly country-level studies of age-related differences in temporal trends of CRC.5 7–9 11 The most rapid increases in early-onset CRC occurred in countries where rates are already highest, such as Korea, which had the same pattern for older adults. Reasons for the high and escalating burden in Korea are unclear, but may be related to the rapid dietary transition that took place in the wake of remarkable economic growth following the Korean war.20 Changes in the food supply were also initiated by the importation of wheat from the USA in response to food shortages in the late 1960s, which prompted the production of many wheat-derived processed foods during the 1970s. Shortly thereafter was the introduction of fast-food restaurants especially popular among youth. The obesity epidemic may also be a factor, given that East Asia has experienced among the largest relative increases in body mass index (BMI) worldwide among both adults and children.21 Asians have disproportionately high levels of visceral adiposity compared with Caucasians,22 23 which may more strongly influence CRC risk than BMI or waist circumference.24 25 Another potential contributor is the high prevalence of early-life antibiotic use, which has been associated with increased risk of colorectal adenoma, especially in the rectum.26 A recent study found that among six high-income countries, South Korea had the highest rate of paediatric antibiotic consumption, sevenfold higher than that in Norway, which had the lowest rate.27 The adenoma detection rate among Korean individuals in their 40s has been reported at almost 30%,28 three times higher than that in Australians.29 Early-onset CRC also increased rapidly in countries where risk in older adults is declining at a similar pace, such as New Zealand, Australia, Canada and the USA. Reductions in CRC incidence among older adults in some countries are partly attributed to changing patterns in risk factors, such as reductions in smoking and widespread use of anti-inflammatory drugs.2 30 Likewise, rising incidence confined to young age groups signals changes in early life exposures that adversely influence CRC risk, particularly given the strong birth cohort effect apparent in the trend.5 9 11 Notably, eight of the nine countries with a unique rise in early-onset CRC had declining rates prior to the uptick beginning in the mid-1990s. Reductions in the prevalence of protective factors, such as physical activity (for colon cancer) and sufficient intake of dietary fibre, dairy, and fruits and vegetables, may play a role, as well as increased prevalence of obesity, smoking, Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 red and/or process meat consumption, and/or excess alcohol consumption.31 Obesity was recently found to be associated with a 20% excess risk of early-onset CRC,32 and prevalence has risen most rapidly in young adults33 and in English-speaking high-income countries,34 consistent with early-onset CRC patterns. However, increases in BMI are quite similar across Europe, despite varying CRC trends. For example, BMI increased from 24 kg/m2 in 1975 to 27 in 2014 in men in Germany, where early-onset CRC increased, as well as in Austria, Croatia, Israel and Italy, where it did not.34 BMI increases in women were smaller but also comparable. In addition, there are puzzling variations in the CRC trend by subsite,5 11 as well as by race/ethnicity and state within the USA,35 36 that suggest a role for risk factors beyond obesity. For example, obesity and a sedentary lifestyle are more strongly associated with colon tumours,37–40 yet rectal tumours appear to be driving the increase based on our findings herein and those of other studies.5 9 11 35 If this is true, the rectal epithelium may be more exposed and/or susceptible to the carcinogenic mechanisms causing the increase in disease. CRC risk is intrinsically linked to diet and its influence on gut immune response and inflammation.41 The global food supply has changed substantially in recent decades42 and evolving research is exploring the carcinogenic potential of relatively new food components. For example, associations have been uncovered between CRC and moderate consumption of sugar-sweetened beverages,43 as well as high fructose corn syrup specifically in animal studies,44 both in the absence of obesity and metabolic syndrome. An inflammatory diet, characterised by high consumption of processed foods and high-glycaemic load carbohydrates, creates an environment conducive to colonic proliferation45 and appears to increase CRC risk.46 What remains uncertain is how these dietary elements might influence early-life gut health. Importantly, the association between CRC and currently established risk factors is based almost entirely on disease occurrence in older aged cohorts.47 CRC screening programmes have mostly emerged over the past two decades and likely contributed to the declines in incidence among older adults in 11 countries. Of the 36 countries in our trend analysis, only four (Costa Rica, Cyprus, India and Philippines) lack a screening programme according to a recent global overview.48 In most countries, screening for CRC (generally with a stool test) is recommended to begin between the ages of 50 and 60 years. Exceptions are Italy, where screening begins at age 44 years, and China, Japan and Austria, where it begins at age 40. Notably, two (Austria and Italy) of the three countries where early-onset CRC declined have screened individuals beginning in their fourth decade since the early 1980s.48 Moreover, the decreasing trend among young adults in both Austria and Italy was confined to ages 40–49 years, with rates in ages 20–39 years increasing by 3% per year in Austria (data not shown). Although some of the rapid increases in early-onset CRC are reminiscent of the Korean thyroid cancer ‘epidemic’ that resulted from widespread ultrasound screening,49 overdetection of early-onset CRC is unlikely because screening before age 50 is rare in most countries, and mortality rates have also begun to rise.12 50 After an extensive evidence review, the American Cancer Society recently lowered the recommended age to begin screening from 50 to 45 because disease risk in individuals under 50 has shifted substantially51 and Cancer Intervention and Surveillance Modeling Network modelling studies found a greater benefit to burden ratio for initiation at age 45 compared with 50.52–54 The US Preventive Services Task Force, the other US entity that issues cancer screening guidelines, is currently in 5 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer the process of conducting an evidence review and expected to issue an updated recommendation by 2020–2021. Our study is the first to provide a comprehensive global assessment of contemporary trends in early-onset CRC based on high-quality population-based cancer incidence information. However, the interpretation of subsite-specific differences in CI5 data is limited by the inclusion of appendiceal malignancies within the grouping for colon cancer. Accumulating evidence suggests that these tumours differ from those that develop in the colon in their biology and other characteristics.55 Inclusion of appendix attenuates comparisons of the burden for colon versus rectal cancer. Additionally, although appendiceal cancer accounts for only about 10% of cases in ages <50 years (data for USA, New Zealand and Canada), incidence rates are rising rapidly in high-income countries56 57 due to changes in classification and improved detection. This likely hindered our ability to detect the steeper rise for rectal than for colon cancer that has been reported by numerous studies of early-onset CRC trends excluding appendix,5 9 11 but less often by those including appendix.12 Similarly, results from our sensitivity analyses that excluded appendix found larger increases for rectal than for colon tumours in each of the three countries with these data available. Incidence trends may also be influenced by temporal improvements in the quality of data, case capture, and specificity of coding. Other study limitations include incomplete population coverage for long-term incidence data in many countries; lack of more contemporary data (eg, since 2012) for most countries; and the absence of high-quality cancer registry data for the majority of low-income and middle-income countries. In summary, CRC incidence rates uniquely increased in young adults over the past two decades in nine high-income countries spanning three continents, often in sharp contrast to rapid declines in older adults. These patterns potentially signal changes in early-age exposures conducive to large bowel carcinogenesis and highlight an urgent need for research to explore the potentially unique aetiology of young-onset CRC. Beyond awaiting scientific discovery, clinicians have an opportunity to help mitigate premature morbidity and mortality from CRC with active documentation of familial cancer history; timely follow-up of symptoms, regardless of patient age; and screening when appropriate. Acknowledgements The authors gratefully acknowledge all cancer registries and their staff for their hard work and diligence in collecting cancer information, without which this research could not have been done. Contributors Study concept and design: RS, AJ. Analysis and interpretation of the data: RS, LT, AJ, IS. Drafting the manuscript: RS, LAT. Critical revision of the manuscript for important intellectual content: all authors. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests None declared. Patient consent for publication Not required. Provenance and peer review Not commissioned; externally peer reviewed. Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. References 1 Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394–424. 2 Arnold M, Sierra MS, Laversanne M, et al. Global patterns and trends in colorectal cancer incidence and mortality. Gut 2016. 3 Austin H, Henley SJ, King J, et al. Changes in colorectal cancer incidence rates in young and older adults in the United States: what does it tell us about screening. Cancer Causes Control 2014;25:191–201. 6 4 Bailey CE, Hu C-Y, You YN, et al. Increasing disparities in the age-related incidences of colon and rectal cancers in the United States, 1975-2010. JAMA Surg 2015;150:17–22. 5 Siegel RL, Fedewa SA, Anderson WF, et al. Colorectal cancer incidence patterns in the United States, 1974–2013. J Natl Cancer Inst 2017;109:djw322. 6 Siegel RL, Jemal A, Ward EM. Increase in incidence of colorectal cancer among young men and women in the United States. Cancer Epidemiol Biomark Prev 2009;18:1695–8. 7 Young JP, Win AK, Rosty C, et al. Rising incidence of early-onset colorectal cancer in Australia over two decades: report and review. J Gastroenterol Hepatol 2015;30:6–13. 8 Feletto E, Yu XQ, Lew J-B, et al. Trends in colon and rectal cancer incidence in Australia from 1982 to 2014: analysis of data on over 375,000 cases. Cancer Epidemiol Biomarkers Prev 2019;28:83–90. 9 Brenner DR, Ruan Y, Shaw E, et al. Increasing colorectal cancer incidence trends among younger adults in Canada. Prev Med 2017;105:345–9. 10 Doll R. Progress against cancer: an epidemiologic assessment. The 1991 John C. Cassel memorial lecture. Am J Epidemiol 1991;134:675–88. 11 Araghi M, Soerjomataram I, Bardot A, et al. Changes in colorectal cancer incidence in seven high-income countries: a population-based study. Lancet Gastroenterol Hepatol 2019;4:511–8. 12 Vuik FER, Nieuwenburg SAV, Bardou M, et al. Increasing incidence of colorectal cancer in young adults in Europe over the last 25 years. Gut 2019:gutjnl-2018-317592. 13 Lui RN, Tsoi KKF, Ho JMW, et al. Global increasing incidence of young-onset colorectal cancer across 5 continents: a joinpoint regression analysis of 1,922,167 cases. Cancer Epidemiol Biomarkers Prev 2019;28:1275–82. 14 Ferlay J, Colombet M, Bray F. Cancer Incidence in Five Continents, CI5plus: IARC CancerBase No. 9. Lyon, France: International Agency for Research on Cancer, 2018. 15 Patel P, De P. Trends in colorectal cancer incidence and related lifestyle risk factors in 15-49-year-olds in Canada, 1969-2010. Cancer Epidemiol 2016;42:90–100. 16 Troeung L, Sodhi-Berry N, Martini A, et al. Increasing incidence of colorectal cancer in adolescents and young adults aged 15–39 years in Western Australia 1982–2007: examination of colonoscopy history. Front Public Health 2017;5. 17 Kim H-J, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med 2000;19:335–51. 18 Doll R, Cook P. Summarizing indices for comparison of cancer incidence data. Int J Cancer 1967;2:269–79. 19 Surveillance, Epidemiology and End Results Program. SEER*Stat Database: Incidence - SEER 9 Regs Research Data with Delay-Adjustment, Malignant Only, (1975-2016)National Cancer Institute, DCCPS, Surveillance Research Program, Surveillance Systems Branch, released April 2019, based on the November 2018 submission 2019. 20 Kim S, Moon S, Popkin BM. The nutrition transition in South Korea. Am J Clin Nutr 2000;71:44–53. 21 Sung H, Siegel RL, Torre LA, et al. Global patterns in excess body weight and the associated cancer burden. CA Cancer J Clin 2019;69:88–112. 22 Kadowaki T, Sekikawa A, Murata K, et al. Japanese men have larger areas of visceral adipose tissue than Caucasian men in the same levels of waist circumference in a population-based study. Int J Obes 2006;30:1163–5. 23 Park Y-W, Allison DB, Heymsfield SB, et al. Larger amounts of visceral adipose tissue in Asian Americans. Obes Res 2001;9:381–7. 24 Keum N, Lee DH, Kim R, et al. Visceral adiposity and colorectal adenomas: doseresponse meta-analysis of observational studies. Ann Oncol 2015;26:1101–9. 25 Nam SY, Kim BC, Han KS, et al. Abdominal visceral adipose tissue predicts risk of colorectal adenoma in both sexes. Clin Gastroenterol Hepatol 2010;8:443–50. 26 Cao Y, Wu K, Mehta R, et al. Long-Term use of antibiotics and risk of colorectal adenoma. Gut 2018;67:672–8. 27 Youngster I, Avorn J, Belleudi V, et al. Antibiotic use in children – a cross-national analysis of 6 countries. J Pediatr 2017;182:239–44. 28 Bae T, Ha Y, Kim C, et al. Distribution of the colonoscopic adenoma detection rate according to age: is recommending colonoscopy screening for Koreans over the age of 50 safe? Ann Coloproctol 2015;31:46–51. 29 Wong S, Lidums I, Rosty C, et al. Findings in young adults at colonoscopy from a hospital service database audit. BMC Gastroenterol 2017;17:56. 30 Edwards BK, Ward E, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975-2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates. Cancer 2010;116:544–73. 31 Gunter MJ, Alhomoud S, Arnold M, et al. Meeting report from the joint IARC–NCI International cancer seminar series: a focus on colorectal cancer. Ann Oncol 2019;30:510–9. 32 Liu P-H, Wu K, Ng K, et al. Association of obesity with risk of early-onset colorectal cancer among women. JAMA Oncol 2019;5:37–44. 33 Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med 2017;377:13–27. 34 Collaboration NCDRF. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. The Lancet 2016;387:1377–96. Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer 35 Siegel RL, Medhanie GA, Fedewa SA, et al. State variation in early-onset colorectal cancer in the United States, 1995–2015. J Natl Cancer Inst 2019;25. 36 Araghi M, Fidler MM, Arnold M, et al. The future burden of colorectal cancer among US blacks and whites. J Natl Cancer Inst 2018;110:791–3. 37 Boyle T, Keegel T, Bull F, et al. Physical activity and risks of proximal and distal colon cancers: a systematic review and meta-analysis. J Natl Cancer Inst 2012;104:1548–61. 38 Ma Y, Yang Y, Wang F, et al. Obesity and risk of colorectal cancer: a systematic review of prospective studies. PLoS One 2013;8:e53916. 39 Moghaddam AA, Woodward M, Huxley R. Obesity and risk of colorectal cancer: a meta-analysis of 31 studies with 70,000 events. Cancer Epidemiol Biomark Prev 2007;16:2533–47. 40 Robsahm TE, Aagnes B, Hjartaker A, et al. Body mass index, physical activity, and colorectal cancer by anatomical subsites: a systematic review and meta-analysis of cohort studies. Eur J Cancer Prev 2013;22:492–505. 41 O’Keefe SJD, Diet O’Keefe SJ.. Diet, microorganisms and their metabolites, and colon cancer. Nat Rev Gastroenterol Hepatol 2016;13:691–706. 42 Schmidhuber J, Sur P, Fay K, et al. The global nutrient database: availability of macronutrients and micronutrients in 195 countries from 1980 to 2013. The Lancet Planetary Health 2018;2:e353–68. 43 Fuchs MA, Sato K, Niedzwiecki D, et al. Sugar-Sweetened beverage intake and cancer recurrence and survival in CALGB 89803 (Alliance). PLoS One 2014;9:e99816. 44 Goncalves MD, Lu C, Tutnauer J, et al. High-Fructose corn syrup enhances intestinal tumor growth in mice. Science 2019;363:1345–9. 45 O’Keefe SJD, Li JV, Lahti L, et al. Fat, fibre and cancer risk in African Americans and rural Africans. Nat Commun 2015;6:6342. 46 Tabung FK, Liu L, Wang W, et al. Association of dietary inflammatory potential with colorectal cancer risk in men and women. JAMA Oncol 2018;4:366–73. Siegel RL, et al. Gut 2019;0:1–7. doi:10.1136/gutjnl-2019-319511 47 Nimptsch K, Wu K. Is timing important? the role of diet and lifestyle during early life on colorectal neoplasia. Curr Colorectal Cancer Rep 2018;14:1–11. 48 Schreuders EH, Ruco A, Rabeneck L, et al. Colorectal cancer screening: a global overview of existing programmes. Gut 2015;64:1637–49. 49 Park S, Oh C-M, Cho H, et al. Association between screening and the thyroid cancer “epidemic” in South Korea: evidence from a nationwide study. BMJ 2016;355. 50 Siegel RL, Miller KD, Jemal A. Colorectal cancer mortality rates in adults aged 20 to 54 years in the United States, 1970-2014. JAMA 2017;318:572–4. 51 Anderson JC, Samadder JN. To screen or not to screen adults 45-49 years of age: that is the question. Am J Gastroenterol 2018;113:1750–3. 52 Knudsen AB, Zauber AG, Rutter CM, et al. Estimation of benefits, burden, and harms of colorectal cancer screening strategies: modeling study for the US preventive services Task force. JAMA 2016;315. 53 Wolf AMD, Fontham ETH, Church TR, et al. Colorectal cancer screening for averagerisk adults: 2018 guideline update from the American cancer Society. CA Cancer J Clin 2018;68:250–81. 54 Peterse EFP, Meester RGS, Siegel RL, et al. The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American cancer Society colorectal cancer screening guideline. Cancer 2018;124:2964–73. 55 CS-P A, Shen JP, Hardy-Abeloos CJ, et al. Genomic landscape of appendiceal neoplasms. JCO Precision Oncology 2018:1–18. 56 Marmor S, Portschy PR, Tuttle TM, et al. The rise in appendiceal cancer incidence: 2000-2009. J Gastrointest Surg 2015;19:743–50. 57 van den Heuvel MGW, Lemmens VEPP, Verhoeven RHA, et al. The incidence of mucinous appendiceal malignancies: a population-based study. Int J Colorectal Dis 2013;28:1307–10. 7 Gut: first published as 10.1136/gutjnl-2019-319511 on 5 September 2019. Downloaded from http://gut.bmj.com/ on September 10, 2019 at Emory Univ Health Science Library. Protected by copyright. GI cancer ",Medical,Fact Finding,Q&A "You are instructed to use the text below to answer my question. You are not allowed to use any external resource, prior knowledge, or previous training.",Summarize this document into easily executable bullet points.,"Week 1, Day 1 What you will see first is the Adventure Screen. This is where you will spend a great deal of time while playing Heroes III. The main window provides you with a close view around your heroes and cities, while the world map (located in the upper-right corner of the screen) shows you a small view of the entire world. Notice that most of the world map is black – that is because until you send a hero to explore an area you won’t know what is there. Don’t worry about any of the other buttons below the World Map, these will be described in greater detail later. Your first hero, Lord Haart, should already be selected (he’s sitting on his horse, waiting for instructions). The first thing we’ll want him to do is visit the town, so place your mouse cursor over the entrance to the town (between the two flag poles). Notice how the horse icon rears up on its hind legs – this means that by traveling to that location, your hero will interact with whatever is there. Also, the name and a short description of the location appears in the Rollover Bar at the bottom of the screen (the rollover bar appears on nearly every screen in Heroes III and gives useful, context sensitive information). When you click on a location, a set of green arrows show the path your hero will take to reach the large green X. It is this X that marks your hero’s destination. Click again on the same location and your hero will move to the castle (a fast way to move is to simply double click on an intended destination – the first click selects the path, the second click sends the hero). When the hero arrives at the entrance to the town, the view will change to the Town Screen. Town Screen This is the Town Screen for the Castle town type (there are eight different town types in Heroes III, each with its own unique creatures and buildings). Most of this screen is taken up by the town view. Any structures or upgrades you build in this town will appear here. As you can see, several structures have already been constructed. Specific information about the town is displayed in the bottom-left corner of the screen, including town income (per day) and troop production (per week). To the right of the town info are two rows of boxes. The top row is for any troops that are currently in the town’s garrison, the bottom row is for any troops currently visiting a town with a hero. The first thing you will want to do is build a Fort. To do so, click on the larger of the two buildings on the left side of the town view – the Town Hall – to enter the Hall Screen. The Hall Screen is where you make all your construction decisions. Any building you can currently build is shown with its name in a green bar. Any building that you can not build, but can be built later is shown with its name in a red bar. If a building has been disabled or can never be built, its name will appear in a gray bar. Once you have completely built or upgraded a structure as high as it will go, its name will be displayed in gold. Click on the picture of the Fort. You will be shown a description of what the Fort does, as well as what resources are required to build it. Click on the Build button (in the lower left hand corner of the popup window) and the Fort will be constructed. Now that you have a Fort, click on it to view the Castle Window. This window shows you information about all seven units that can be produced by this town. Any troop-producing structures (usually referred to as Creature Generators) that are already constructed will show a number of Available units (currently the Guardhouse, Archers’ Tower, and Barracks show units available – the other structures have not been built yet). Click the Exit button (lower right) to return to the Town Screen. The round tower on the right side of the screen is your Mage Guild. It is here that heroes go to learn the spells that they will cast while adventuring. Click on the Mage Guild, then choose to buy a spell book. Since Lord Haart is a Knight, he does not begin with a spell book. All heroes must have a spell book before they can learn or cast spells. Once you agree to purchase a spell book, you are shown the Mage Guild Screen. Each of the spells the Mage Guild offers is listed on scrolls on the various shelves in the guild. Left or right clicking on any spell scroll will show you a description of that spell. When you are ready to leave, click on the Exit button (lower right). Your hero starts with troops, but it’s really just a token force, so you should buy any available troops and add them to his army. Along the hill at the back of your town are three towers. Click on the large central tower. The Recruit Pikemen window is displayed. Using the scroll bar you can select how many troops you wish to purchase, and the total cost is calculated to the right. However, the fastest way to buy troops is to use the Maximum button (the four up arrows at the bottom of the popup window) which will automatically calculate the maximum number of troops available that you can currently afford. Click the Maximum button, then click the Recruit button (bottom center). Notice how there are now Pikemen in the garrison row of your town.","System instructions: You are instructed to use the text below to answer my question. You are not allowed to use any external resource, prior knowledge, or previous training. Question: Summarize this document into easily executable bullet points. Context: Week 1, Day 1 What you will see first is the Adventure Screen. This is where you will spend a great deal of time while playing Heroes III. The main window provides you with a close view around your heroes and cities, while the world map (located in the upper-right corner of the screen) shows you a small view of the entire world. Notice that most of the world map is black – that is because until you send a hero to explore an area you won’t know what is there. Don’t worry about any of the other buttons below the World Map, these will be described in greater detail later. Your first hero, Lord Haart, should already be selected (he’s sitting on his horse, waiting for instructions). The first thing we’ll want him to do is visit the town, so place your mouse cursor over the entrance to the town (between the two flag poles). Notice how the horse icon rears up on its hind legs – this means that by traveling to that location, your hero will interact with whatever is there. Also, the name and a short description of the location appears in the Rollover Bar at the bottom of the screen (the rollover bar appears on nearly every screen in Heroes III and gives useful, context sensitive information). When you click on a location, a set of green arrows show the path your hero will take to reach the large green X. It is this X that marks your hero’s destination. Click again on the same location and your hero will move to the castle (a fast way to move is to simply double click on an intended destination – the first click selects the path, the second click sends the hero). When the hero arrives at the entrance to the town, the view will change to the Town Screen. Town Screen This is the Town Screen for the Castle town type (there are eight different town types in Heroes III, each with its own unique creatures and buildings). Most of this screen is taken up by the town view. Any structures or upgrades you build in this town will appear here. As you can see, several structures have already been constructed. Specific information about the town is displayed in the bottom-left corner of the screen, including town income (per day) and troop production (per week). To the right of the town info are two rows of boxes. The top row is for any troops that are currently in the town’s garrison, the bottom row is for any troops currently visiting a town with a hero. The first thing you will want to do is build a Fort. To do so, click on the larger of the two buildings on the left side of the town view – the Town Hall – to enter the Hall Screen. The Hall Screen is where you make all your construction decisions. Any building you can currently build is shown with its name in a green bar. Any building that you can not build, but can be built later is shown with its name in a red bar. If a building has been disabled or can never be built, its name will appear in a gray bar. Once you have completely built or upgraded a structure as high as it will go, its name will be displayed in gold. Click on the picture of the Fort. You will be shown a description of what the Fort does, as well as what resources are required to build it. Click on the Build button (in the lower left hand corner of the popup window) and the Fort will be constructed. Now that you have a Fort, click on it to view the Castle Window. This window shows you information about all seven units that can be produced by this town. Any troop-producing structures (usually referred to as Creature Generators) that are already constructed will show a number of Available units (currently the Guardhouse, Archers’ Tower, and Barracks show units available – the other structures have not been built yet). Click the Exit button (lower right) to return to the Town Screen. The round tower on the right side of the screen is your Mage Guild. It is here that heroes go to learn the spells that they will cast while adventuring. Click on the Mage Guild, then choose to buy a spell book. Since Lord Haart is a Knight, he does not begin with a spell book. All heroes must have a spell book before they can learn or cast spells. Once you agree to purchase a spell book, you are shown the Mage Guild Screen. Each of the spells the Mage Guild offers is listed on scrolls on the various shelves in the guild. Left or right clicking on any spell scroll will show you a description of that spell. When you are ready to leave, click on the Exit button (lower right). Your hero starts with troops, but it’s really just a token force, so you should buy any available troops and add them to his army. Along the hill at the back of your town are three towers. Click on the large central tower. The Recruit Pikemen window is displayed. Using the scroll bar you can select how many troops you wish to purchase, and the total cost is calculated to the right. However, the fastest way to buy troops is to use the Maximum button (the four up arrows at the bottom of the popup window) which will automatically calculate the maximum number of troops available that you can currently afford. Click the Maximum button, then click the Recruit button (bottom center). Notice how there are now Pikemen in the garrison row of your town.",Retail/Product,Summarize & Format,Text Transformation "Only use information presented in the prompt itself. Do not use any external sources or prior knowledge. Please say ""I don't have enough information to answer this question"" if the necessary information isn't available.",Why was China's economy so important during the pandemic?,"Other Sources of Data and Information Sizing up the U.S. government’s reliance on foreign goods faces similar challenges in data limitations.113 The U.S. General Services Administration (GSA) maintains a database, the Federal Procurement Data System-Next Generation (FPDS-NG, or FPDS), where federal agencies are required to report procurement contracts whose estimated value is $10,000 or more.114 The procurement data in FPDS-NG are not fully reliable. There are documented quality issues documented relating to accuracy, completeness, and timeliness of its data.115 These limitations have prompted many analysts to rely on FPDS-NG data primarily to identify broad trends and produce rough estimates, or to gather information about specific contracts. With these limitations in mind, FPDS-NG data may provide general information regarding the value, quantity, and types of domestic and foreign-made goods hat U.S. government agencies procure. Other information on domestic capacity, as well as changes resulting from increased production in the aftermath of the COVID-19 outbreak, generally comes from private research firms, news outlets, and trade associations. Many of the figures cited are often based on surveys, firms’ press releases, or firms/industries’ forecasts, which may differ significantly from actual production. China’s Economic Recovery: Prospects and Implications China’s leaders have focused on resuming manufacturing production to jumpstart economic growth.116 At an executive session of China’s cabinet, the State Council, on March 17, 2020, Chinese officials emphasized the importance of stabilizing employment and announced that the government would streamline business approvals and fast-track approvals for large infrastructure projects. They also offered government support to alleviate shortages of labor, raw materials, funds, and protective gear.117 To facilitate economic activity, the Chinese government also appears Congressional Research Service 38 to have liberalized company health requirements and lifted intra-provincial and intra-city travel and transportation restrictions. NDRC spokesperson Meng Wei said on March 17, 2020 that transportation was operating normally. Zhejiang, Jiangsu, and Shanghai were operating at close to 100% of normal capacity; and over 90% of large-scale industrial companies outside of Hubei had resumed production.118 Company reports of opening and resumption of operations did not necessarily mean that these facilities were fully online or operating at pre-crisis levels, however. Several economic analysts and news outlets, including the Financial Times, published alternative measures of business resumption rates using proxies for economic activity—such as data on traffic congestion, air pollution levels, and container freight movement. Overall, many of these measures suggested that businesses across China did not return to full capacity at the rates reported by local and provincial governments.119 In Wuhan, the center of the original outbreak, the Hubei provincial government issued a notice in March—that applies to Wuhan as Hubei’s capital—allowing certain companies to resume work ahead of other production. This included companies in the medical and health industry, as well as companies producing protective gear, disinfectant, daily necessities, agriculture, and products critical to national and global supply chains.120 China emerged in June 2020 as the first major country to announce a return to economic growth since the outbreak of COVID-19, but consumption lagged production recovery and the economic recovery has relied on government spending and exports to boost growth. The government reported 3.2% gross domestic product (GDP) growth in the second quarter and 4.9% GDP growth in the third quarter of 2020.121 The International Monetary Fund (IMF) projects China’s economy to grow by 1.9% in 2020. China since February 2020 has provided an estimated $506 billion in stimulus and increased the government’s budget deficit target to a record high of 3.6% of GDP, up from 2.8% in 2019. Shifting from efforts to reduce debt, the government announced the issuance of $142.9 billion of special treasury bonds for the first time since 2007; increased the quota for local government special bonds (a source of infrastructure funding); and fast-tracked issuance of corporate bonds to cover pandemic costs, but with potential broader uses. The IMF estimates that the fiscal measures and financing plans announced amounted to 4.1% of the China’s GDP, as of July 2020.122 China’s National Bureau of Statistics in November 2020 recorded a 5% year-on-year increase in retail sales, a 2.6% year-on-year increase in fixed asset investment, and a 7% year-on-year increase in value-added industrial output. COVID-19: China Medical Supply Chains and Broader Trade Issues Congressional Research Service 39 in investment in industrial output growth, however, was recorded in non-ferrous metals and real estate investment, not broader areas of domestic consumption.123 China Positioning to Export China’s economy depends on exports and the foreign exchange it earns through exports, as well as on the large productive role that foreign firms play in the domestic market and as exporters. Seeking to stabilize drops in foreign investment and trade, on March 12, Commerce Vice Minister Wang Shouwen held a call with 400 members of the American Chamber of Commerce in China, and on March 13, he held a similar webinar with the European Chamber of Commerce in China’s Advisory Council. Vice Minister Wang pressed companies to reopen operations and increase investments in China. Other Chinese agencies represented included NDRC, MIIT, the National Health Commission, the General Administration of Drug Supervision, the State Administration for Market Regulation, the General Administration of Customers, the Civil Aviation Administration of China, the Ministry of Transportation, and the State Taxation Administration.124 During past crises, such as the global financial crisis of 2008-09, China has pressed firms to idle facilities and keep them production-ready (instead of shuttering them) and retain workers (instead of laying them off) to maintain social stability and facilitate efforts to quickly ramp up production and exports later.125 These stimulus efforts are sometimes less visible than fiscal policies in other countries. Several market watchers have noted that, while a 17% drop in Chinese exports in January-February 2020 was significant, it was not as dramatic when considering China’s economy was shuttered for much of February. This indicates that Chinese industry may have had sufficient stock already at ports for export when the crisis hit. This also signals how China was able to resume an export push in the third quarter of 2020.126 China’s economic recovery has been important to the United States and the global economy, as it is an important center of demand and supply. At the same time, during this period of global economic downturn, the United States and other countries are now potentially vulnerable to a concerted PRC export push that has been expanding since summer 2020 and any effort China makes to take additional market share in strategic sectors. Congressional Research Service 40 Steel Overcapacity Chinese overcapacity in steel has been highly contentious for its global impacts, and China could potentially see exports as a quick way to reduce inventories and secure needed cash. Similar to what happened during the global financial crisis in 2008-09, China is poised to take additional global market share in 2020 because it did not dial back production during the COVID-19 outbreak. Chinese blast furnaces continued to run during the COVID-19 crisis, and China’s steel production for January-February 2020 was up 3% over the same period in 2019. Meanwhile, due to collapsing domestic demand and logistics constraints, China’s finished steel inventories rose by 45% in January-February 2020 over the same period in 2019.127 China’s steel production at the end of 2019 was already at an all-time high of almost 1 billion tons, with China producing over 50% of global supply, according to the World Steel Association and China’s State Statistical Bureau (Figure 8).128 China’s crude steel production recovered in July 2020, rising 9.1% year-on-year. China’s crude steel production during the January-September 2020 period is up 4.5% over the same period in 2019. In contrast, crude steel production over the same period is down 17.9% in the EU; down 18.2% in North America; down 16.5% in India; down 19.1% in Japan; and down 7.5% in South Korea.","[Other Sources of Data and Information Sizing up the U.S. government’s reliance on foreign goods faces similar challenges in data limitations.113 The U.S. General Services Administration (GSA) maintains a database, the Federal Procurement Data System-Next Generation (FPDS-NG, or FPDS), where federal agencies are required to report procurement contracts whose estimated value is $10,000 or more.114 The procurement data in FPDS-NG are not fully reliable. There are documented quality issues documented relating to accuracy, completeness, and timeliness of its data.115 These limitations have prompted many analysts to rely on FPDS-NG data primarily to identify broad trends and produce rough estimates, or to gather information about specific contracts. With these limitations in mind, FPDS-NG data may provide general information regarding the value, quantity, and types of domestic and foreign-made goods hat U.S. government agencies procure. Other information on domestic capacity, as well as changes resulting from increased production in the aftermath of the COVID-19 outbreak, generally comes from private research firms, news outlets, and trade associations. Many of the figures cited are often based on surveys, firms’ press releases, or firms/industries’ forecasts, which may differ significantly from actual production. China’s Economic Recovery: Prospects and Implications China’s leaders have focused on resuming manufacturing production to jumpstart economic growth.116 At an executive session of China’s cabinet, the State Council, on March 17, 2020, Chinese officials emphasized the importance of stabilizing employment and announced that the government would streamline business approvals and fast-track approvals for large infrastructure projects. They also offered government support to alleviate shortages of labor, raw materials, funds, and protective gear.117 To facilitate economic activity, the Chinese government also appears Congressional Research Service 38 to have liberalized company health requirements and lifted intra-provincial and intra-city travel and transportation restrictions. NDRC spokesperson Meng Wei said on March 17, 2020 that transportation was operating normally. Zhejiang, Jiangsu, and Shanghai were operating at close to 100% of normal capacity; and over 90% of large-scale industrial companies outside of Hubei had resumed production.118 Company reports of opening and resumption of operations did not necessarily mean that these facilities were fully online or operating at pre-crisis levels, however. Several economic analysts and news outlets, including the Financial Times, published alternative measures of business resumption rates using proxies for economic activity—such as data on traffic congestion, air pollution levels, and container freight movement. Overall, many of these measures suggested that businesses across China did not return to full capacity at the rates reported by local and provincial governments.119 In Wuhan, the center of the original outbreak, the Hubei provincial government issued a notice in March—that applies to Wuhan as Hubei’s capital—allowing certain companies to resume work ahead of other production. This included companies in the medical and health industry, as well as companies producing protective gear, disinfectant, daily necessities, agriculture, and products critical to national and global supply chains.120 China emerged in June 2020 as the first major country to announce a return to economic growth since the outbreak of COVID-19, but consumption lagged production recovery and the economic recovery has relied on government spending and exports to boost growth. The government reported 3.2% gross domestic product (GDP) growth in the second quarter and 4.9% GDP growth in the third quarter of 2020.121 The International Monetary Fund (IMF) projects China’s economy to grow by 1.9% in 2020. China since February 2020 has provided an estimated $506 billion in stimulus and increased the government’s budget deficit target to a record high of 3.6% of GDP, up from 2.8% in 2019. Shifting from efforts to reduce debt, the government announced the issuance of $142.9 billion of special treasury bonds for the first time since 2007; increased the quota for local government special bonds (a source of infrastructure funding); and fast-tracked issuance of corporate bonds to cover pandemic costs, but with potential broader uses. The IMF estimates that the fiscal measures and financing plans announced amounted to 4.1% of the China’s GDP, as of July 2020.122 China’s National Bureau of Statistics in November 2020 recorded a 5% year-on-year increase in retail sales, a 2.6% year-on-year increase in fixed asset investment, and a 7% year-on-year increase in value-added industrial output. COVID-19: China Medical Supply Chains and Broader Trade Issues Congressional Research Service 39 in investment in industrial output growth, however, was recorded in non-ferrous metals and real estate investment, not broader areas of domestic consumption.123 China Positioning to Export China’s economy depends on exports and the foreign exchange it earns through exports, as well as on the large productive role that foreign firms play in the domestic market and as exporters. Seeking to stabilize drops in foreign investment and trade, on March 12, Commerce Vice Minister Wang Shouwen held a call with 400 members of the American Chamber of Commerce in China, and on March 13, he held a similar webinar with the European Chamber of Commerce in China’s Advisory Council. Vice Minister Wang pressed companies to reopen operations and increase investments in China. Other Chinese agencies represented included NDRC, MIIT, the National Health Commission, the General Administration of Drug Supervision, the State Administration for Market Regulation, the General Administration of Customers, the Civil Aviation Administration of China, the Ministry of Transportation, and the State Taxation Administration.124 During past crises, such as the global financial crisis of 2008-09, China has pressed firms to idle facilities and keep them production-ready (instead of shuttering them) and retain workers (instead of laying them off) to maintain social stability and facilitate efforts to quickly ramp up production and exports later.125 These stimulus efforts are sometimes less visible than fiscal policies in other countries. Several market watchers have noted that, while a 17% drop in Chinese exports in January-February 2020 was significant, it was not as dramatic when considering China’s economy was shuttered for much of February. This indicates that Chinese industry may have had sufficient stock already at ports for export when the crisis hit. This also signals how China was able to resume an export push in the third quarter of 2020.126 China’s economic recovery has been important to the United States and the global economy, as it is an important center of demand and supply. At the same time, during this period of global economic downturn, the United States and other countries are now potentially vulnerable to a concerted PRC export push that has been expanding since summer 2020 and any effort China makes to take additional market share in strategic sectors. Congressional Research Service 40 Steel Overcapacity Chinese overcapacity in steel has been highly contentious for its global impacts, and China could potentially see exports as a quick way to reduce inventories and secure needed cash. Similar to what happened during the global financial crisis in 2008-09, China is poised to take additional global market share in 2020 because it did not dial back production during the COVID-19 outbreak. Chinese blast furnaces continued to run during the COVID-19 crisis, and China’s steel production for January-February 2020 was up 3% over the same period in 2019. Meanwhile, due to collapsing domestic demand and logistics constraints, China’s finished steel inventories rose by 45% in January-February 2020 over the same period in 2019.127 China’s steel production at the end of 2019 was already at an all-time high of almost 1 billion tons, with China producing over 50% of global supply, according to the World Steel Association and China’s State Statistical Bureau (Figure 8).128 China’s crude steel production recovered in July 2020, rising 9.1% year-on-year. China’s crude steel production during the January-September 2020 period is up 4.5% over the same period in 2019. In contrast, crude steel production over the same period is down 17.9% in the EU; down 18.2% in North America; down 16.5% in India; down 19.1% in Japan; and down 7.5% in South Korea.] [Why was China's economy so important during the pandemic?] [Only use information presented in the prompt itself. Do not use any external sources or prior knowledge. Please say ""I don't have enough information to answer this question"" if the necessary information isn't available.]",Financial,Effect Analysis,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",How does the role of mitochondria influence bone growth and osteoblasts. Please keep this between 200-300 words. Highlight specific cases/pathways of how this works and talk about the mechanism.,"Bioenergetics and mitochondrial biogenesis: OXPHOS vs glycolysis The initial metabolic study performed on bone tissues of mice in the 1960s suggested that bones predominantly utilized glycolysis rather than oxidative phosphorylation (OXPHOS) for their metabolism.4 The study reported that compared to other tissues such as the liver, bones exhibited lower oxygen consumption and significantly higher glucose consumption, leading to the abundant production of lactate. Similar findings were observed in rat calvaria,5 emphasizing the importance of glycolysis in bone metabolism. The significance of glycolysis in the regulation of bone mass was further supported by recent data suggesting defective glucose metabolism as the major cause of diabetes-induced bone loss, which showed that elevating glycolysis through administration of metformin or osteoblast-specific overexpression of Hif1a (hypoxia inducible factor 1 subunit alpha) or Pfkfb3 (6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3) in mice improved bone mass in diabetic mice.6,7 In vivo tracing with a stable isotope also demonstrated that glucose was largely metabolized to lactate and minimally contributed to the tricarboxylic acid (TCA) cycle in mouse cortical bones.8 Although glycolysis is evidently critical in the maintenance and growth of bone, evaluation of metabolic activity in isolated osteoblasts has revealed more complex and time-dependent results. Specifically, Komarova et al. closely examined changes in metabolism in differentiating primary calvarial osteoblasts in vitro and showed that OXPHOS was the primary energetic pathway utilized during the early stages (before day 10) of differentiation, but a shift to glycolysis occurred during the later stages (after day 10) when mineralized nodules formed.9 Similarly, Guntur et al. utilized a Seahorse real-time metabolic analyzer to measure oxygen consumption rate (OCR), indicative of OXPHOS, and extracellular acidification rates, indicative of glycolysis in mouse calvarial osteoblast cell line MC3T3-E1 and demonstrated that both OXPHPOS and glycolysis were initially upregulated in differentiating osteoblasts, but glycolysis was favored during the later stages of differentiation.10,11 Using the same method, Lee et al. showed that the contribution of glycolysis in total adenosine triphosphate (ATP) generation increased from approximately 40% at day 0 to 80% at day 7 of differentiation in primary calvarial osteoblasts.8 Our group also recently reported that both OCR and glycolytic proton efflux rate were elevated during the early maturation steps, but only glycolysis remained upregulated, while mitochondrial respiration decreased during the later mineralizing periods in primary calvarial osteoblasts.2 Noteworthily, mitochondrial ATP production may be critical during the early osteoblast maturation period since treatment with oligomycin A (ATP synthase inhibitor), antimycin A (mitochondrial complex III inhibitor), or siRNA targeting Atp5a1 gene, which encodes the alpha subunit of the mitochondrial ATP synthase F1 complex, at the initiation of osteogenic induction significantly impaired osteoblast differentiation.2 A recent review of metabolic activities in osteoblasts has underscored that OXPHOS increases as osteoblast maturation advances, although there are ongoing debates regarding the extent of glycolysis levels during osteoblast differentiation.12 Although further investigation is needed, particularly considering the distinct origins of osteoblasts (calvaria vs long bones), current evidence suggests that differentiating osteoblasts actively utilize both OXPHOS and glycolysis during the initial phases but tend to favor glycolysis as maturation progresses. Because OXPHOS far more efficiently produces ATP than aerobic glycolysis, why mature osteoblasts preferentially utilize glycolysis has remained unclear. It has been suggested that aerobic glycolysis is upregulated to offset the increase in ROS generation by OXPHOS.13 Additionally, Guntur et al. demonstrated that the increase in glycolytic ATP production in mature osteoblasts was the result of a decrease in mitochondrial membrane potential and OXPHOS activity.10 Similarly, using calvarial osteoblasts in which mitochondria were endogenously labelled with GFP, our group showed that mitophagy dramatically increased after differentiation day 14. This was confirmed by the increase in GFP-positive mitochondria co-localized with autophagic-lysosomal markers, LAMP1 (lysosomal-associated membrane protein 1) or LC3 (microtubule-associated protein light chain 3), suggesting that the decreased number of mitochondria after massive mitophagy may be the direct cause of reduced OXPHOS during the late differentiation stages.2 Consistent with the early increase in OXPHOS, mitochondrial biogenesis was found to increase during the initial phases of osteoblast maturation. Protein expression levels of mitochondrial biogenesis markers peroxisome proliferator-activated γ receptor coactivator-1α (PGC-1α) and mitochondrial transcription factor A (mtTFA or TFAM) were upregulated and peaked at day 7 of differentiation in MC3T3-E1 osteoblasts.14 Our group also reported that the expression of Ppargc1a, encoding PGC-1α, peaked at day 3, while the expressions of Tfam, Cox4i1 (cytochrome c oxidase subunit 4I1), and mt-Cytb (cytochrome B) peaked at day 7 in primary calvarial osteoblasts.2 Mitochondrial DNA copy number and expressions of mitochondrial proteins, COX4, and translocase of outer mitochondrial membrane 20, also peaked at day 7, after which the levels gradually declined possibly due to the progressive increase in mitophagy.2 Furthermore, enhancing mitochondrial biogenesis appears to accelerate osteogenic differentiation. For instance, An et al. demonstrated that activation of Wnt signaling pathway in C3H10T1/2 mouse mesenchymal cells promoted their osteoblastic differentiation through stimulating mitochondrial biogenesis.15 Increasing mitochondrial biogenesis through overexpression of Tfam enhanced Wnt-induced osteogenesis, while suppressing mitochondrial biogenesis through treatment with Zidovudine significantly impaired the osteogenic activity of C3H10T1/2 cells.15 In addition, nicotinamide (NAM), a form of vitamin B3, was recently shown to promote the differentiation of MC3T3-E1 osteoblasts partly through increasing the expression of Ppargc1a and mitochondrial biogenesis.16 These results suggest that potential bone therapeutics may target mitochondrial biogenesis in osteoblasts. Controversies persist regarding the metabolic activities during osteogenic differentiation of BMSCs. Shum et al. reported that OXPHOS was significantly enhanced during osteogenic differentiation of human MSCs, while glycolysis was unchanged and more critical during the proliferation of undifferentiated MSCs.17 They described that calvarial osteoblasts and MSCs exhibit distinct metabolic characteristics due to their different embryonic origin.17 Contrastingly, Ma et al. demonstrated that activating glycolysis through treatment with rotenone (complex I inhibitor) significantly promoted the osteogenic differentiation of BMSCs in mice, while inhibiting glycolysis through treatment with dichloroacetate, sodium oxamate, or 2-deoxy-D-glucose significantly impaired their osteogenic differentiation, highlighting the significance of glycolysis in MSC-mediated osteogenesis.18 They also showed that extracellular vesicles delivered lactate dehydrogenase A into BMSCs and stimulated glycolysis, enhancing bone formation in vivo.18 Further investigations are needed to clarify whether metabolic characteristics in osteogenic cells are embryonic origin-specific (neural crest vs mesoderm-derived) and differ between intramembranous and endochondral bone formation. A deeper understanding of osteogenic metabolism will not only advance insights into the mechanisms of metabolic bone diseases but also accelerate the development of strategies that modulate mitochondrial metabolism to promote osteogenesis. Oxidative stress Mitochondria produce most of the cellular ROS through OXPHOS, during which oxygen is reduced to superoxide anions that are subsequently converted to additional ROS such as hydrogen peroxide (H2O2). Accumulation of ROS is normally counterbalanced by the endogenous antioxidant defense system involving both non-enzymatic antioxidants, including ascorbic acid, vitamin E, and glutathione, and enzymatic antioxidants, including superoxide dismutases (SODs), catalase, glutathione peroxidases, and peroxiredoxins. Endogenous ROS, when the levels are controlled, may behave as second messengers to activate signaling pathways related to proliferation, differentiation, and survival, but excessively high levels of ROS can cause multiple pathological conditions, including osteoporosis.19","[question] How does the role of mitochondria influence bone growth and osteoblasts. Please keep this between 200-300 words. Highlight specific cases/pathways of how this works and talk about the mechanism. ===================== [text] Bioenergetics and mitochondrial biogenesis: OXPHOS vs glycolysis The initial metabolic study performed on bone tissues of mice in the 1960s suggested that bones predominantly utilized glycolysis rather than oxidative phosphorylation (OXPHOS) for their metabolism.4 The study reported that compared to other tissues such as the liver, bones exhibited lower oxygen consumption and significantly higher glucose consumption, leading to the abundant production of lactate. Similar findings were observed in rat calvaria,5 emphasizing the importance of glycolysis in bone metabolism. The significance of glycolysis in the regulation of bone mass was further supported by recent data suggesting defective glucose metabolism as the major cause of diabetes-induced bone loss, which showed that elevating glycolysis through administration of metformin or osteoblast-specific overexpression of Hif1a (hypoxia inducible factor 1 subunit alpha) or Pfkfb3 (6-phosphofructo-2-kinase/fructose-2,6-biphosphatase 3) in mice improved bone mass in diabetic mice.6,7 In vivo tracing with a stable isotope also demonstrated that glucose was largely metabolized to lactate and minimally contributed to the tricarboxylic acid (TCA) cycle in mouse cortical bones.8 Although glycolysis is evidently critical in the maintenance and growth of bone, evaluation of metabolic activity in isolated osteoblasts has revealed more complex and time-dependent results. Specifically, Komarova et al. closely examined changes in metabolism in differentiating primary calvarial osteoblasts in vitro and showed that OXPHOS was the primary energetic pathway utilized during the early stages (before day 10) of differentiation, but a shift to glycolysis occurred during the later stages (after day 10) when mineralized nodules formed.9 Similarly, Guntur et al. utilized a Seahorse real-time metabolic analyzer to measure oxygen consumption rate (OCR), indicative of OXPHOS, and extracellular acidification rates, indicative of glycolysis in mouse calvarial osteoblast cell line MC3T3-E1 and demonstrated that both OXPHPOS and glycolysis were initially upregulated in differentiating osteoblasts, but glycolysis was favored during the later stages of differentiation.10,11 Using the same method, Lee et al. showed that the contribution of glycolysis in total adenosine triphosphate (ATP) generation increased from approximately 40% at day 0 to 80% at day 7 of differentiation in primary calvarial osteoblasts.8 Our group also recently reported that both OCR and glycolytic proton efflux rate were elevated during the early maturation steps, but only glycolysis remained upregulated, while mitochondrial respiration decreased during the later mineralizing periods in primary calvarial osteoblasts.2 Noteworthily, mitochondrial ATP production may be critical during the early osteoblast maturation period since treatment with oligomycin A (ATP synthase inhibitor), antimycin A (mitochondrial complex III inhibitor), or siRNA targeting Atp5a1 gene, which encodes the alpha subunit of the mitochondrial ATP synthase F1 complex, at the initiation of osteogenic induction significantly impaired osteoblast differentiation.2 A recent review of metabolic activities in osteoblasts has underscored that OXPHOS increases as osteoblast maturation advances, although there are ongoing debates regarding the extent of glycolysis levels during osteoblast differentiation.12 Although further investigation is needed, particularly considering the distinct origins of osteoblasts (calvaria vs long bones), current evidence suggests that differentiating osteoblasts actively utilize both OXPHOS and glycolysis during the initial phases but tend to favor glycolysis as maturation progresses. Because OXPHOS far more efficiently produces ATP than aerobic glycolysis, why mature osteoblasts preferentially utilize glycolysis has remained unclear. It has been suggested that aerobic glycolysis is upregulated to offset the increase in ROS generation by OXPHOS.13 Additionally, Guntur et al. demonstrated that the increase in glycolytic ATP production in mature osteoblasts was the result of a decrease in mitochondrial membrane potential and OXPHOS activity.10 Similarly, using calvarial osteoblasts in which mitochondria were endogenously labelled with GFP, our group showed that mitophagy dramatically increased after differentiation day 14. This was confirmed by the increase in GFP-positive mitochondria co-localized with autophagic-lysosomal markers, LAMP1 (lysosomal-associated membrane protein 1) or LC3 (microtubule-associated protein light chain 3), suggesting that the decreased number of mitochondria after massive mitophagy may be the direct cause of reduced OXPHOS during the late differentiation stages.2 Consistent with the early increase in OXPHOS, mitochondrial biogenesis was found to increase during the initial phases of osteoblast maturation. Protein expression levels of mitochondrial biogenesis markers peroxisome proliferator-activated γ receptor coactivator-1α (PGC-1α) and mitochondrial transcription factor A (mtTFA or TFAM) were upregulated and peaked at day 7 of differentiation in MC3T3-E1 osteoblasts.14 Our group also reported that the expression of Ppargc1a, encoding PGC-1α, peaked at day 3, while the expressions of Tfam, Cox4i1 (cytochrome c oxidase subunit 4I1), and mt-Cytb (cytochrome B) peaked at day 7 in primary calvarial osteoblasts.2 Mitochondrial DNA copy number and expressions of mitochondrial proteins, COX4, and translocase of outer mitochondrial membrane 20, also peaked at day 7, after which the levels gradually declined possibly due to the progressive increase in mitophagy.2 Furthermore, enhancing mitochondrial biogenesis appears to accelerate osteogenic differentiation. For instance, An et al. demonstrated that activation of Wnt signaling pathway in C3H10T1/2 mouse mesenchymal cells promoted their osteoblastic differentiation through stimulating mitochondrial biogenesis.15 Increasing mitochondrial biogenesis through overexpression of Tfam enhanced Wnt-induced osteogenesis, while suppressing mitochondrial biogenesis through treatment with Zidovudine significantly impaired the osteogenic activity of C3H10T1/2 cells.15 In addition, nicotinamide (NAM), a form of vitamin B3, was recently shown to promote the differentiation of MC3T3-E1 osteoblasts partly through increasing the expression of Ppargc1a and mitochondrial biogenesis.16 These results suggest that potential bone therapeutics may target mitochondrial biogenesis in osteoblasts. Controversies persist regarding the metabolic activities during osteogenic differentiation of BMSCs. Shum et al. reported that OXPHOS was significantly enhanced during osteogenic differentiation of human MSCs, while glycolysis was unchanged and more critical during the proliferation of undifferentiated MSCs.17 They described that calvarial osteoblasts and MSCs exhibit distinct metabolic characteristics due to their different embryonic origin.17 Contrastingly, Ma et al. demonstrated that activating glycolysis through treatment with rotenone (complex I inhibitor) significantly promoted the osteogenic differentiation of BMSCs in mice, while inhibiting glycolysis through treatment with dichloroacetate, sodium oxamate, or 2-deoxy-D-glucose significantly impaired their osteogenic differentiation, highlighting the significance of glycolysis in MSC-mediated osteogenesis.18 They also showed that extracellular vesicles delivered lactate dehydrogenase A into BMSCs and stimulated glycolysis, enhancing bone formation in vivo.18 Further investigations are needed to clarify whether metabolic characteristics in osteogenic cells are embryonic origin-specific (neural crest vs mesoderm-derived) and differ between intramembranous and endochondral bone formation. A deeper understanding of osteogenic metabolism will not only advance insights into the mechanisms of metabolic bone diseases but also accelerate the development of strategies that modulate mitochondrial metabolism to promote osteogenesis. Oxidative stress Mitochondria produce most of the cellular ROS through OXPHOS, during which oxygen is reduced to superoxide anions that are subsequently converted to additional ROS such as hydrogen peroxide (H2O2). Accumulation of ROS is normally counterbalanced by the endogenous antioxidant defense system involving both non-enzymatic antioxidants, including ascorbic acid, vitamin E, and glutathione, and enzymatic antioxidants, including superoxide dismutases (SODs), catalase, glutathione peroxidases, and peroxiredoxins. Endogenous ROS, when the levels are controlled, may behave as second messengers to activate signaling pathways related to proliferation, differentiation, and survival, but excessively high levels of ROS can cause multiple pathological conditions, including osteoporosis.19 https://academic.oup.com/jbmr/article/39/9/1205/7697194 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Summarize,Text Transformation "- Refer only to the context document in your answer. Do not employ any outside knowledge. - Summarise this into one paragraph - Use less than 200 words.","According to the above document only, How does puppy socialization classes correlate with adult dog behavior?","**The Importance of Puppy Socialization** The current literature and common consensus among dog behavior experts is that lack of appropriate socialization during the sensitive period, along with lack of appropriate ongoing socialization during the dog’s life, plays a large role in whether or not the dog develops behavioral problems. Lack of appropriate early socialization to a range of people and other animals, as well as different environments, can result in adult dogs that exhibit problematic behaviors, such as undesirable aggression and fearfulness. Lack of exposure to animals that will be forming part of the puppy’s social group as an adult, which may include other dogs, different animal species, and people and children, can result in an individual that is unable to form strong social bonds with these groups. In one study, social and environmental exposure administered to puppies was found to be positively correlated with measures of sociability, and negatively correlated with measures of fear and aggression. Socialization with other animal species was negatively associated with inappropriate predatory behavior, and dogs that attended puppy preschool were found to be less fearful, less aggressive, and more social. Another study, however, highlights the importance of appropriate types of socialization: adult dogs with a fear of noises, such as thunder and fireworks, were more likely to have experienced thunder when they were younger than 4 months of age. This evidence indicates that early experiences play an important part in shaping behavior. If done in an appropriate manner, these experiences will help to reduce the likelihood of problematic behavior occurring in future. However, if this process is not well controlled, it could result in an increased likelihood of undesirable adult behavior. A 1999 study examined the effects of socialization on the ability to play search games with humans, an important element of search and rescue dog training. Dogs that had not been exposed to humans before they were 1 year of age could never learn how to play a searching game, while pet dogs with human exposure were able to learn how to play. However, one of the human-deprived dogs had lived with humans until it was 4 months old before being removed from the human environment, and it performed better than the other human-deprived dogs in this study. While the performance of a single dog should not lead to generalizations, this study demonstrates the positive long-term effects of early socialization to humans, possibly even if a dog is later removed from human environments for an extended period of time. A study conducted by Appleby et al investigated whether there was a relationship between the display of aggressive and avoidance behavior and dogs’ experiences during the first 6 months of their life. Their results indicated significant differences in aggression toward unfamiliar people and avoidance behavior between dogs who were raised in kennels, a barn, or a shed, compared with a domestic setting (ie, in the breeder’s home). This result points to the importance of environment in the socialization process. Breeders who raise a litter of puppies in a kennel, barn, or shed should be able to provide adequate socialization to the puppies; however, they may have to make a special effort to ensure that these experiences occur. The relationship between socialization practice and the prevalence of undesirable behaviors in adult dogs is important not just because these behaviors are annoying to owners. Undesirable behaviors may also signal the presence of other underlying issues that may impact negatively on the welfare of the dog. They may result from an underlying physical health problem, for example, or confusion about what behaviors are expected by the owner, and/or poor mental health in the dog. This can become a vicious cycle; a poorly socialized dog does not understand what its owner expects and may receive conflicting or confusing messages from the owner, which causes it to become stressed, resulting in more undesirable behavior. If the owner does not then make his/her expectations for the dog known in a very clear way or lower these expectations in accordance with the dog’s ability to meet them, then this stress continues, causing even further undesirable behavior. It is important that owners and veterinarians take behavioral problems seriously; regardless of whether or not they escalate to the point where the owner considers relinquishing the dog to a shelter, the dog’s welfare may be compromised if it is displaying problematic behaviors. There are breed differences in the development of stimulus response, according to Scott and Fuller’s seminal work in the 1960s. For example, a larger percentage of Fox terriers and Beagles had developed a startle response at 3 weeks of age than Cocker spaniels and Shetland Sheepdogs. However, by 4 weeks, all dogs of all breeds studied had developed the startle response. Furthermore, Coppinger and Coppinger state that different socialization experiences will have varying effects on certain dog breeds. They exposed a Labrador retriever puppy to livestock, in order to determine whether it would be possible to turn her into a livestock guarding dog. Unlike a dog that is bred specifically for that purpose, the Labrador never showed intense protective behaviors toward the livestock. Therefore, it is likely that breeding specifically for certain traits does influence ideal socialization practices and amounts. Perhaps there are sex differences in socialization practice needs, based on adult behavioral outcomes. Male dogs are more likely to be rated by authorities as expressing dominant and aggressive behaviors, and female dogs are more likely to be perceived as more obedient, easier to housetrain, and more demanding of affection. However, to our knowledge, sex differences in socialization have not been examined, even though Scott and Fuller did explain that, at any given moment in a dog’s development, males are likely to be physically larger than females, and size does affect behavior. They also state, however, that growth curve differences between the sexes do not necessarily correlate with differences in the rate of learning, so it is possible that there is no discernible sex difference in socialization needs. The results of available studies provide strong evidence of a link between inadequate socialization during puppy-hood and undesirable adult dog behaviors. What they do not explain, however, is how much socialization is optimal. Having no socialization has very clear negative impacts, so there must be a minimum amount required, but how much this actually consists of is not known. Also unknown is whether there is a maximum amount of socialization required, beyond which any extra socialization is unnecessary or even detrimental. These studies also do not explain why there is a link between puppy socialization and adult behavior. One possible reason is that the socialization periods during puppyhood are like biological windows that open and close at certain times, and an animal that does not have necessary experiences during those windows misses the opportunity forever. More likely is that there are periods where a puppy is developmentally more sensitive/receptive to certain experiences, and that learning plays a critical role in this process. Animals can only learn about things to which they are introduced, and they may do so more readily during a sensitive period. Therefore, a lack of exposure to a particular object or type of animal at the correct developmental time necessarily means that dogs do not have the chance to learn, or take longer to learn, whether that object or animal is harmless or dangerous. In addition, since mild stress seems to be an integral part of the socialization and exposure process, a lack of mild desensitization-related stress early in life may have negative neurological effects on the dog and make it incapable of handling any amount of stress later in life. Most likely, a combination of learning via desensitization and stress inoculation acts to prevent the behavioral problems noted in adult dogs without adequate socialization experiences. Despite the general agreement that puppy socialization practices are crucial in the development of normal social relationships and psychological health in adult dogs, the evidence is less clear on the benefit of puppy classes specifically. Many studies about the effects of puppy classes on adult dog behavior have been epidemiological in nature, meaning that they correlate the behavior of adult dogs with various demographic, owner, and environmental factors. This method is useful in establishing which factors have a stronger predictive value on the outcome, but there is some debate as to whether they can truly determine causal relationships. This can limit their utility in evaluating whether a single factor, such as attendance at a puppy class, has a clear effect on adult dog behavior. Nonetheless, because controlled experimental studies on specific populations of puppies are rare, epidemiological studies are probably the best available alternative in understanding whether there is any relationship between puppy classes and adult dog behavior. Another study showed that attendance at puppy classes reduced the risk of aggression toward unfamiliar people. As with the study by Duxbury et al, there were many other factors predicting less aggressive behavior, including being a desexed female, having a female owner, attending ring-craft classes, and positive reinforcement training methods. A further study showed a similar result: attendance at puppy socialization classes was associated with improved positive social behaviors, and fewer behavioral problems, as adults. Other factors that predicted these outcomes were being a male dog, a higher level of environmental and social interactions overall, and remaining in the litter longer. Taken together, the results of these studies suggest that socialization classes are one piece of the puzzle in developing adult dog behavior. Since these studies sometimes show contradictory results (eg, male dogs showed fewer behavioral problems in one study and desexed females showed less aggression in another), it is possible that the samples, or unaccounted for variables, have affected the results of these epidemiological studies. Another reason why puppy socialization classes do not always appear to singularly affect adult dog behavior could relate to the ways in which some classes are run. In most countries, there are no accreditation procedures in place and puppy classes may be run by people who lack the skills or experience necessary for this purpose. Perhaps many puppies simply find the experience too stressful to receive a noticeable benefit. Although mild stress is a component of socialization, it is important not to stress puppies too much, or else the benefits will not be conferred. ","{QUERY} According to the above document only, How does puppy socialization classes correlate with adult dog behavior? {TASK DESCRIPTION} - Refer only to the context document in your answer. Do not employ any outside knowledge. - Summarise this into one paragraph - Use less than 200 words. {TEXT PASSAGE} **The Importance of Puppy Socialization** The current literature and common consensus among dog behavior experts is that lack of appropriate socialization during the sensitive period, along with lack of appropriate ongoing socialization during the dog’s life, plays a large role in whether or not the dog develops behavioral problems. Lack of appropriate early socialization to a range of people and other animals, as well as different environments, can result in adult dogs that exhibit problematic behaviors, such as undesirable aggression and fearfulness. Lack of exposure to animals that will be forming part of the puppy’s social group as an adult, which may include other dogs, different animal species, and people and children, can result in an individual that is unable to form strong social bonds with these groups. In one study, social and environmental exposure administered to puppies was found to be positively correlated with measures of sociability, and negatively correlated with measures of fear and aggression. Socialization with other animal species was negatively associated with inappropriate predatory behavior, and dogs that attended puppy preschool were found to be less fearful, less aggressive, and more social. Another study, however, highlights the importance of appropriate types of socialization: adult dogs with a fear of noises, such as thunder and fireworks, were more likely to have experienced thunder when they were younger than 4 months of age. This evidence indicates that early experiences play an important part in shaping behavior. If done in an appropriate manner, these experiences will help to reduce the likelihood of problematic behavior occurring in future. However, if this process is not well controlled, it could result in an increased likelihood of undesirable adult behavior. A 1999 study examined the effects of socialization on the ability to play search games with humans, an important element of search and rescue dog training. Dogs that had not been exposed to humans before they were 1 year of age could never learn how to play a searching game, while pet dogs with human exposure were able to learn how to play. However, one of the human-deprived dogs had lived with humans until it was 4 months old before being removed from the human environment, and it performed better than the other human-deprived dogs in this study. While the performance of a single dog should not lead to generalizations, this study demonstrates the positive long-term effects of early socialization to humans, possibly even if a dog is later removed from human environments for an extended period of time. A study conducted by Appleby et al investigated whether there was a relationship between the display of aggressive and avoidance behavior and dogs’ experiences during the first 6 months of their life. Their results indicated significant differences in aggression toward unfamiliar people and avoidance behavior between dogs who were raised in kennels, a barn, or a shed, compared with a domestic setting (ie, in the breeder’s home). This result points to the importance of environment in the socialization process. Breeders who raise a litter of puppies in a kennel, barn, or shed should be able to provide adequate socialization to the puppies; however, they may have to make a special effort to ensure that these experiences occur. The relationship between socialization practice and the prevalence of undesirable behaviors in adult dogs is important not just because these behaviors are annoying to owners. Undesirable behaviors may also signal the presence of other underlying issues that may impact negatively on the welfare of the dog. They may result from an underlying physical health problem, for example, or confusion about what behaviors are expected by the owner, and/or poor mental health in the dog. This can become a vicious cycle; a poorly socialized dog does not understand what its owner expects and may receive conflicting or confusing messages from the owner, which causes it to become stressed, resulting in more undesirable behavior. If the owner does not then make his/her expectations for the dog known in a very clear way or lower these expectations in accordance with the dog’s ability to meet them, then this stress continues, causing even further undesirable behavior. It is important that owners and veterinarians take behavioral problems seriously; regardless of whether or not they escalate to the point where the owner considers relinquishing the dog to a shelter, the dog’s welfare may be compromised if it is displaying problematic behaviors. There are breed differences in the development of stimulus response, according to Scott and Fuller’s seminal work in the 1960s. For example, a larger percentage of Fox terriers and Beagles had developed a startle response at 3 weeks of age than Cocker spaniels and Shetland Sheepdogs. However, by 4 weeks, all dogs of all breeds studied had developed the startle response. Furthermore, Coppinger and Coppinger state that different socialization experiences will have varying effects on certain dog breeds. They exposed a Labrador retriever puppy to livestock, in order to determine whether it would be possible to turn her into a livestock guarding dog. Unlike a dog that is bred specifically for that purpose, the Labrador never showed intense protective behaviors toward the livestock. Therefore, it is likely that breeding specifically for certain traits does influence ideal socialization practices and amounts. Perhaps there are sex differences in socialization practice needs, based on adult behavioral outcomes. Male dogs are more likely to be rated by authorities as expressing dominant and aggressive behaviors, and female dogs are more likely to be perceived as more obedient, easier to housetrain, and more demanding of affection. However, to our knowledge, sex differences in socialization have not been examined, even though Scott and Fuller did explain that, at any given moment in a dog’s development, males are likely to be physically larger than females, and size does affect behavior. They also state, however, that growth curve differences between the sexes do not necessarily correlate with differences in the rate of learning, so it is possible that there is no discernible sex difference in socialization needs. The results of available studies provide strong evidence of a link between inadequate socialization during puppy-hood and undesirable adult dog behaviors. What they do not explain, however, is how much socialization is optimal. Having no socialization has very clear negative impacts, so there must be a minimum amount required, but how much this actually consists of is not known. Also unknown is whether there is a maximum amount of socialization required, beyond which any extra socialization is unnecessary or even detrimental. These studies also do not explain why there is a link between puppy socialization and adult behavior. One possible reason is that the socialization periods during puppyhood are like biological windows that open and close at certain times, and an animal that does not have necessary experiences during those windows misses the opportunity forever. More likely is that there are periods where a puppy is developmentally more sensitive/receptive to certain experiences, and that learning plays a critical role in this process. Animals can only learn about things to which they are introduced, and they may do so more readily during a sensitive period. Therefore, a lack of exposure to a particular object or type of animal at the correct developmental time necessarily means that dogs do not have the chance to learn, or take longer to learn, whether that object or animal is harmless or dangerous. In addition, since mild stress seems to be an integral part of the socialization and exposure process, a lack of mild desensitization-related stress early in life may have negative neurological effects on the dog and make it incapable of handling any amount of stress later in life. Most likely, a combination of learning via desensitization and stress inoculation acts to prevent the behavioral problems noted in adult dogs without adequate socialization experiences. Despite the general agreement that puppy socialization practices are crucial in the development of normal social relationships and psychological health in adult dogs, the evidence is less clear on the benefit of puppy classes specifically. Many studies about the effects of puppy classes on adult dog behavior have been epidemiological in nature, meaning that they correlate the behavior of adult dogs with various demographic, owner, and environmental factors. This method is useful in establishing which factors have a stronger predictive value on the outcome, but there is some debate as to whether they can truly determine causal relationships. This can limit their utility in evaluating whether a single factor, such as attendance at a puppy class, has a clear effect on adult dog behavior. Nonetheless, because controlled experimental studies on specific populations of puppies are rare, epidemiological studies are probably the best available alternative in understanding whether there is any relationship between puppy classes and adult dog behavior. Another study showed that attendance at puppy classes reduced the risk of aggression toward unfamiliar people. As with the study by Duxbury et al, there were many other factors predicting less aggressive behavior, including being a desexed female, having a female owner, attending ring-craft classes, and positive reinforcement training methods. A further study showed a similar result: attendance at puppy socialization classes was associated with improved positive social behaviors, and fewer behavioral problems, as adults. Other factors that predicted these outcomes were being a male dog, a higher level of environmental and social interactions overall, and remaining in the litter longer. Taken together, the results of these studies suggest that socialization classes are one piece of the puzzle in developing adult dog behavior. Since these studies sometimes show contradictory results (eg, male dogs showed fewer behavioral problems in one study and desexed females showed less aggression in another), it is possible that the samples, or unaccounted for variables, have affected the results of these epidemiological studies. Another reason why puppy socialization classes do not always appear to singularly affect adult dog behavior could relate to the ways in which some classes are run. In most countries, there are no accreditation procedures in place and puppy classes may be run by people who lack the skills or experience necessary for this purpose. Perhaps many puppies simply find the experience too stressful to receive a noticeable benefit. Although mild stress is a component of socialization, it is important not to stress puppies too much, or else the benefits will not be conferred. ",Unknown,Effect Analysis,Q&A " If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context"".",How many earned media impressions did Billie get with their product marketing campaign?,"**Product Marketing Strategy** An effective product marketing strategy can be the key to growing your brand, boosting revenue, and unlocking new opportunities. Focused on demonstrating the specific values and benefits of a product to your customer, a product marketing campaign can be extremely valuable in both B2B and B2C environments, particularly as customer-centric advertising grows more popular. Unfortunately, there are still countless people who don’t understand what product marketing actually means. Only around 5% of product marketers are convinced their role is fully understood, even among business leaders. Today, we’re going to be defining product marketing, exploring what it can do for your business, and providing top tips on how to use product marketing more effectively. Product marketing is the art and science of bringing a product to market. It involves various strategic marketing and sales tactics, as well as long-term lead nurturing, up-selling, and cross-selling techniques. A product marketing strategy is the exact plan a company uses to bring their product to their audience. Your strategy will usually include things like figuring out the positioning and messaging you want to link to your product, launching the product, and ensuring customers and salespeople understand what it can do. Strategies can also cover insights into how various teams (production, marketing, sales, and customer support) will work together to drive demand and usage of a product. While this might sound the same as conventional marketing, product marketing is slightly more focused. Part of the “7 P’s of marketing”, product marketing focuses specifically on product, while your other marketing campaigns might focus on people, prices, promotion, place, packaging, and positioning. Product Marketing Strategy Example Product marketing is focused on the steps people take to purchase your products, and how you can support people in adopting and using that product. Let’s take a look at a classic example. Apple is a household name in a highly competitive technology market. To stand out from the crowd, Apple ensures its products are beautifully well-designed, easy to use, and convenient. Apple’s product marketing strategy focuses specifically on the benefits it can deliver to users, rather than just listing the features you can get from each item. Apple’s language in virtually every product page and marketing campaign concentrates on telling consumers what they can do, and what they’ll be able to accomplish. Apple tells a narrative with its marketing content which helps the customer imagine the challenges they can overcome. For another example, look at Billie, a woman’s razor brand well known for the #ProjectBodyHair campaign. This started with a TV campaign that actually showed body hair in women’s razor ads – something which hadn’t been done before. The idea for this campaign came from the product team, who researched the market to find out customers didn’t like seeing ads where customers didn’t have body hair. Combine this with the rising demand from women to be portrayed realistically in the media, and Billie had an excellent product marketing campaign. In fact, it generated 3.3 billion earned media impressions across 23 countries. Why You Need a Product Marketing Strategy Product marketing strategies are all about understanding your audience’s needs, and positioning your product in a way that grabs attention. Developing the right product for your market and ensuring you present it in a way that captures audience attention is essential for growth. With a product marketing strategy, you can: Improve your understanding of your customer: Implementing a product marketing strategy requires companies to conduct in-depth research into their target audience. You learn what your customers need to see in your product to determine whether it’s valuable to them, and their lives. Understanding why customers gravitate toward your products will help you to create better buyer personas and more relevant campaigns. In other words, you’ll speak your customer’s language. Understand your competitors While you’re building your product marketing strategy, you’ll need to look at your wider market and determine how your product or service is different from other existing options. You can compare your strategy to those of your competitors, and get a better insight into what you’re going up against. With in-depth competitor research, you’ll be able to differentiate yourself more clearly in your target market and ensure you’re positioned appropriately in your chosen industry. After you’ve assessed your competition, ask yourself: How is my product suitable for today’s market? How is this product different from competing products? Can we differentiate our product even further (with extra features, pricing changes, etc)? Ensure your teams are on the same page When you know exactly what makes your product stand out and why customers want it, it’s much easier to give your teams a consistent view of their purpose, and your brand’s mission. With a strong product marketing strategy, you can align your product, sales, marketing, and service teams around a shared understanding of your company’s purpose. When everyone in your team has a better understanding of the purpose of the product you’re selling and why it’s so beneficial, they’ll be more likely to communicate this information correctly. Boost revenue and sales Ultimately, customers have endless options when it comes to where they can spend their money these days. The only way to ensure they come to you instead of the competition, is to position your product as the best possible option for their needs. Building a product marketing strategy that gives you an in-depth understanding of your customers will help you to generate more sales, through more personalized marketing. Remember, around 72% of customers say they expect businesses they buy from to understand them as individuals. How to Develop Your Own Product Marketing Strategy A good product marketing strategy should guide the positioning, promotion, and pricing of your product. With this plan, you should be able to take your product from the “development” stage, all the way through to launch with a clear vision. Here’s how you can get started. Step 1: Get to Know Your Product’s Target Audience A strong product marketing strategy begins with a deep knowledge of your target audience. You’ll need to define a specific target audience and create a buyer persona to help you understand the pain points, expectations, and requirements of that client. The more information you can include in your personas, the better. You’ll need to know where your target customer comes from, what kind of issues they’re facing, why they might want your product, and even how much they earn on a regular basis. The more data you have, the more you’ll be able to ensure all the aspects of your product marketing strategy are targeted to the right person. Step 2: Conduct market research After you’re done with your customer research, the next step is figuring out where your product is positioned in the context of the wider market. Look at the other products similar to yours that exist in the current market. What exactly can these products offer? Perform a full analysis of each item, thinking about: What your product can do better What your competitor’s product does well Whether people are happy with the product, or what their overall response is Answering these questions will help you to choose a position for yourself in your chosen market. Step 3: Determine your positioning and messaging With this knowledge of your target audience and your competition, you’ll be able to start investing in positioning and messaging strategies. Positioning involves thinking about where your product exists in the market in the context of other brands and solutions. For instance, is your product one of the cheapest on the market, or one of the most expensive? Do you offer the widest selection of features, or a specific focus on customer service your customers love? The positioning you discover will help you to determine what you need to emphasize in your messaging (such as excellent service, or low prices). Some of the questions you’ll need to answer when developing your positioning and messaging include: What makes this product unique? Why is this product better than our competitors? Why is our product ideal for our target audience? What will our audience get out of this product they can’t get elsewhere? Why should customers trust and invest in our product? Once you’ve answered these questions, you should be able to create an elevator pitch that describes everything someone would need to know about your product in an exciting, compact way. Step 4: Create your go-to-market strategy Now it’s time to think about how you’re going to bring your product to customers. dentify which personas you’re going to be targeting with your product, and how you’re going to be capturing their attention with your messaging strategy. Think about how you’re going to price your product, and what kind of methods you’re going to be using for selling. For instance, do you want to sell through distributors or direct to customers? You can also use this stage to consider the kind of marketing methods you’re going to use, like social media marketing, or content campaigns. At this stage, you can utilize a graphic design maker for compelling visual content across your marketing campaigns. As you choose marketing automation and sales strategies, also select KPIs you’ll want to measure as you progress to see whether your product marketing strategy is successful. Brief your sales and marketing leaders on your go-to-market strategy and ensure they have all the resources they need to do their job, such as advertising tools, product samples, brand guidelines, and go-to market strategy templates. Step 5: Launch, monitor, and optimize Finally, you’ll be ready to launch your product. There are two aspects to the “launch” for most companies. Internal launches involve introducing everyone in your team to your product’s main benefits and features, which you’ll need to do before anything else."," **Product Marketing Strategy** An effective product marketing strategy can be the key to growing your brand, boosting revenue, and unlocking new opportunities. Focused on demonstrating the specific values and benefits of a product to your customer, a product marketing campaign can be extremely valuable in both B2B and B2C environments, particularly as customer-centric advertising grows more popular. Unfortunately, there are still countless people who don’t understand what product marketing actually means. Only around 5% of product marketers are convinced their role is fully understood, even among business leaders. Today, we’re going to be defining product marketing, exploring what it can do for your business, and providing top tips on how to use product marketing more effectively. Product marketing is the art and science of bringing a product to market. It involves various strategic marketing and sales tactics, as well as long-term lead nurturing, up-selling, and cross-selling techniques. A product marketing strategy is the exact plan a company uses to bring their product to their audience. Your strategy will usually include things like figuring out the positioning and messaging you want to link to your product, launching the product, and ensuring customers and salespeople understand what it can do. Strategies can also cover insights into how various teams (production, marketing, sales, and customer support) will work together to drive demand and usage of a product. While this might sound the same as conventional marketing, product marketing is slightly more focused. Part of the “7 P’s of marketing”, product marketing focuses specifically on product, while your other marketing campaigns might focus on people, prices, promotion, place, packaging, and positioning. Product Marketing Strategy Example Product marketing is focused on the steps people take to purchase your products, and how you can support people in adopting and using that product. Let’s take a look at a classic example. Apple is a household name in a highly competitive technology market. To stand out from the crowd, Apple ensures its products are beautifully well-designed, easy to use, and convenient. Apple’s product marketing strategy focuses specifically on the benefits it can deliver to users, rather than just listing the features you can get from each item. Apple’s language in virtually every product page and marketing campaign concentrates on telling consumers what they can do, and what they’ll be able to accomplish. Apple tells a narrative with its marketing content which helps the customer imagine the challenges they can overcome. For another example, look at Billie, a woman’s razor brand well known for the #ProjectBodyHair campaign. This started with a TV campaign that actually showed body hair in women’s razor ads – something which hadn’t been done before. The idea for this campaign came from the product team, who researched the market to find out customers didn’t like seeing ads where customers didn’t have body hair. Combine this with the rising demand from women to be portrayed realistically in the media, and Billie had an excellent product marketing campaign. In fact, it generated 3.3 billion earned media impressions across 23 countries. Why You Need a Product Marketing Strategy Product marketing strategies are all about understanding your audience’s needs, and positioning your product in a way that grabs attention. Developing the right product for your market and ensuring you present it in a way that captures audience attention is essential for growth. With a product marketing strategy, you can: Improve your understanding of your customer: Implementing a product marketing strategy requires companies to conduct in-depth research into their target audience. You learn what your customers need to see in your product to determine whether it’s valuable to them, and their lives. Understanding why customers gravitate toward your products will help you to create better buyer personas and more relevant campaigns. In other words, you’ll speak your customer’s language. Understand your competitors While you’re building your product marketing strategy, you’ll need to look at your wider market and determine how your product or service is different from other existing options. You can compare your strategy to those of your competitors, and get a better insight into what you’re going up against. With in-depth competitor research, you’ll be able to differentiate yourself more clearly in your target market and ensure you’re positioned appropriately in your chosen industry. After you’ve assessed your competition, ask yourself: How is my product suitable for today’s market? How is this product different from competing products? Can we differentiate our product even further (with extra features, pricing changes, etc)? Ensure your teams are on the same page When you know exactly what makes your product stand out and why customers want it, it’s much easier to give your teams a consistent view of their purpose, and your brand’s mission. With a strong product marketing strategy, you can align your product, sales, marketing, and service teams around a shared understanding of your company’s purpose. When everyone in your team has a better understanding of the purpose of the product you’re selling and why it’s so beneficial, they’ll be more likely to communicate this information correctly. Boost revenue and sales Ultimately, customers have endless options when it comes to where they can spend their money these days. The only way to ensure they come to you instead of the competition, is to position your product as the best possible option for their needs. Building a product marketing strategy that gives you an in-depth understanding of your customers will help you to generate more sales, through more personalized marketing. Remember, around 72% of customers say they expect businesses they buy from to understand them as individuals. How to Develop Your Own Product Marketing Strategy A good product marketing strategy should guide the positioning, promotion, and pricing of your product. With this plan, you should be able to take your product from the “development” stage, all the way through to launch with a clear vision. Here’s how you can get started. Step 1: Get to Know Your Product’s Target Audience A strong product marketing strategy begins with a deep knowledge of your target audience. You’ll need to define a specific target audience and create a buyer persona to help you understand the pain points, expectations, and requirements of that client. The more information you can include in your personas, the better. You’ll need to know where your target customer comes from, what kind of issues they’re facing, why they might want your product, and even how much they earn on a regular basis. The more data you have, the more you’ll be able to ensure all the aspects of your product marketing strategy are targeted to the right person. Step 2: Conduct market research After you’re done with your customer research, the next step is figuring out where your product is positioned in the context of the wider market. Look at the other products similar to yours that exist in the current market. What exactly can these products offer? Perform a full analysis of each item, thinking about: What your product can do better What your competitor’s product does well Whether people are happy with the product, or what their overall response is Answering these questions will help you to choose a position for yourself in your chosen market. Step 3: Determine your positioning and messaging With this knowledge of your target audience and your competition, you’ll be able to start investing in positioning and messaging strategies. Positioning involves thinking about where your product exists in the market in the context of other brands and solutions. For instance, is your product one of the cheapest on the market, or one of the most expensive? Do you offer the widest selection of features, or a specific focus on customer service your customers love? The positioning you discover will help you to determine what you need to emphasize in your messaging (such as excellent service, or low prices). Some of the questions you’ll need to answer when developing your positioning and messaging include: What makes this product unique? Why is this product better than our competitors? Why is our product ideal for our target audience? What will our audience get out of this product they can’t get elsewhere? Why should customers trust and invest in our product? Once you’ve answered these questions, you should be able to create an elevator pitch that describes everything someone would need to know about your product in an exciting, compact way. Step 4: Create your go-to-market strategy Now it’s time to think about how you’re going to bring your product to customers. dentify which personas you’re going to be targeting with your product, and how you’re going to be capturing their attention with your messaging strategy. Think about how you’re going to price your product, and what kind of methods you’re going to be using for selling. For instance, do you want to sell through distributors or direct to customers? You can also use this stage to consider the kind of marketing methods you’re going to use, like social media marketing, or content campaigns. At this stage, you can utilize a graphic design maker for compelling visual content across your marketing campaigns. As you choose marketing automation and sales strategies, also select KPIs you’ll want to measure as you progress to see whether your product marketing strategy is successful. Brief your sales and marketing leaders on your go-to-market strategy and ensure they have all the resources they need to do their job, such as advertising tools, product samples, brand guidelines, and go-to market strategy templates. Step 5: Launch, monitor, and optimize Finally, you’ll be ready to launch your product. There are two aspects to the “launch” for most companies. Internal launches involve introducing everyone in your team to your product’s main benefits and features, which you’ll need to do before anything else. ================ If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context"". ================ How many earned media impressions did Billie get with their product marketing campaign?",Retail/Product,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","My grandmother is buried in Occala, but she bought a burial plot in Orlando's city cemetery's Block B12. I am her sole heir, and I want to be buried in Orlando. Will I be entitled to it? I also want my daughter to be buried with me. Will it be possible? My daughter says that she will only accept it if her father is buried there as well. Is this feasible? If I change my mind, can I sell the plot to my friend? I have a vague memory that grandpa's ashes are interred there. Does it change the picture?","Sec. 16.02. - Greenwood Cemetery Declared Public Cemetery of City; Description; Map; Use. The tract of land, being the southwest quarter of the northwest quarter of Section 31, Township 22 South, Range 30 East, according to a plat recorded at the office of the Clerk of the Circuit Court of the County in Deed Book 87, page 227, is declared to be the public cemetery of the City, to be known as Greenwood Cemetery. An official map of the Greenwood Cemetery shall at all times be on file at the office of the supervisor of Greenwood Cemetery. The cemetery is set apart only for the burial, entombment or inurnment of human remains and shall only be used as such in perpetuity. (Ord. of 6-27-1977, § 1; Ord. of 3-30-1981, § 1) Sec. 16.03. - Greenwood Cemetery Not Perpetual Care Cemetery. Greenwood Cemetery is not one of perpetual care and the City shall be under no obligation to maintain any set standard for its care and upkeep. The City shall endeavor to provide general maintenance and care to the cemetery in keeping with the reminder that it is sacredly devoted to the interment, entombment or inurnment of the dead. (Ord. of 6-27-1977, § 1) Sec. 16.04. - Burials in City Restricted to Greenwood Cemetery and Washington Park Cemetery. No human body shall be buried within the City limits of the City of Orlando, except in Greenwood Cemetery or in Washington Park Cemetery if a privately owned cemetery, or in such other cemetery facilities and/or property as the City Council may from time to time designate, acquire or control. ... Sec. 16.10. - Spaces; Sale to Permanent Residents; Exceptions. The City shall only sell spaces in Greenwood Cemetery for prices fixed by the City Council to residents of the City of Orlando who have resided within the corporate limits of the City for a period of more than one year prior to the date of sale, and to persons who are not permanent residents of the City provided that such sales shall be only for the immediate burial of a permanent resident of the City who met the residency requirements hereunder at the time of the resident's death. The Sexton of the Greenwood Cemetery shall require satisfactory evidence of such prior residence within the City. In addition, the City may sell spaces in Blocks 12, 16, 17, 18, 19 and 20 of Greenwood Cemetery to non-City, as well as City residents. Provided, however, that a person who has not met the residency requirements set forth herein may be permitted to purchase spaces in Greenwood Cemetery at the price established by City Council for qualified non-residents if such person is related by blood or marriage to a deceased person buried in said cemetery, unless such deceased person is interred in a section of the cemetery reserved for members of the American Legion, Spanish-American War Veterans, Grand Army of the Republic, Independent Order of Odd Fellows, or United Confederate Veterans, and such deceased person, at the time of his or her death, did not meet City residency requirements. ... Sec. 16.13. - Sales to Non-Family Members; City's Right of First Refusal. A space owner may sell or transfer his or her space only to a relative by blood or marriage, provided however, a space owner may sell or transfer his or her space to a person not related by blood or marriage if the owner receives approval of said sale from City Council. In the event a space owner wishes to sell or transfer his or her space to a person other than a relative by blood or marriage in a sale or transfer not approved by City Council, the owner shall first offer in writing the space for sale to the City of Orlando. The City may repurchase the space for the original purchase price or one-half of the current sales price, whichever is greater, less a recording fee if the deed from the City to the owner is not recorded. If the City wishes to purchase the space, the City shall notify the owner thereof within five (5) days of receipt of notice, and the sale shall be closed within five (5) days after receipt by the City of evidence of title to the space satisfactory to the Office of Legal Affairs. ... Sec. 16.14. - Declaration; Rights If No Declaration. The owner of a space may present his or her deed to the Cemetery Supervisor designating in writing persons entitled to be buried in the space or spaces owned. This designation may be amended at any time by the owner(s) in the same manner as the original designation. Only relatives by blood or marriage may be designated under this section; provided however, persons other than relatives by blood or marriage may be designated if the owner receives approval of said designation from City Council. In the event the owner fails to designate burial rights for the space or spaces owned, and in the event the property is not transferred or conveyed as provided herein, the right of interment in the space or spaces shall be in the following order: (1)One space, niche or crypt shall be forever reserved for the owner and one for the owner's surviving spouse, if any.(2)The remaining spaces shall pass to the heirs or devisees of the owner in the same manner as real property passes under Florida Law: provided, however, that no person shall be interred in a space passing under this section unless such person would have been eligible under the provisions of this Chapter to be designated for burial in such space at the date of such person's death or the interment of said person is approved by City Council. Sec. 16.15. - Rights Upon Interment. Whenever an interment of the remains of any person is made in a space, the space thereby becomes inalienable and shall be held as the space of the interred person except in the case of cremated remains as set forth in Section 16.17. ... Sec. 16.17. - Interments in General. All earth interments shall be in a liner or vault of concrete or steel of a type approved by the cemetery Supervisor. No more than the remains of one body shall be interred in any one space, vault or crypt, except in the case of a mother and stillborn child(ren). However, if written permission is given by the owner of a space or, if the owner is deceased, by the owner's heirs, permitting more than the remains of one person to occupy a space, vault or crypt, an exception will be made to permit no more than one regular interment and one cremain or two cremains in any one space, vault or crypt. Installation of cremorial headstones may be permitted under the same number, size and material restrictions as set forth in Section 16.26; provided, however, that in cases where the use of a cremorial headstone causes the total number of allowable interments or inurnments in any one space to be exceeded, each additional inurnment shall be charged a fee as set forth by City Council for right of additional interment. ... Sec. 16.29. - Children; Pets. No child under fifteen (15) years of age shall be permitted in the cemetery unless accompanied by an adult. Pets shall be prohibited in the cemetery. ... Sec. 16.35. - Double Interment Permitted. Notwithstanding the provisions of Section 16.17 hereof, no more than the remains of two (2) bodies shall be interred in any one space in Block 12 of Greenwood Cemetery, provided that a mother and a stillborn child shall be considered one body. All interments in Block 12 shall be in a vault installed by the City of Orlando.","""================ ======= Sec. 16.02. - Greenwood Cemetery Declared Public Cemetery of City; Description; Map; Use. The tract of land, being the southwest quarter of the northwest quarter of Section 31, Township 22 South, Range 30 East, according to a plat recorded at the office of the Clerk of the Circuit Court of the County in Deed Book 87, page 227, is declared to be the public cemetery of the City, to be known as Greenwood Cemetery. An official map of the Greenwood Cemetery shall at all times be on file at the office of the supervisor of Greenwood Cemetery. The cemetery is set apart only for the burial, entombment or inurnment of human remains and shall only be used as such in perpetuity. (Ord. of 6-27-1977, § 1; Ord. of 3-30-1981, § 1) Sec. 16.03. - Greenwood Cemetery Not Perpetual Care Cemetery. Greenwood Cemetery is not one of perpetual care and the City shall be under no obligation to maintain any set standard for its care and upkeep. The City shall endeavor to provide general maintenance and care to the cemetery in keeping with the reminder that it is sacredly devoted to the interment, entombment or inurnment of the dead. (Ord. of 6-27-1977, § 1) Sec. 16.04. - Burials in City Restricted to Greenwood Cemetery and Washington Park Cemetery. No human body shall be buried within the City limits of the City of Orlando, except in Greenwood Cemetery or in Washington Park Cemetery if a privately owned cemetery, or in such other cemetery facilities and/or property as the City Council may from time to time designate, acquire or control. ... Sec. 16.10. - Spaces; Sale to Permanent Residents; Exceptions. The City shall only sell spaces in Greenwood Cemetery for prices fixed by the City Council to residents of the City of Orlando who have resided within the corporate limits of the City for a period of more than one year prior to the date of sale, and to persons who are not permanent residents of the City provided that such sales shall be only for the immediate burial of a permanent resident of the City who met the residency requirements hereunder at the time of the resident's death. The Sexton of the Greenwood Cemetery shall require satisfactory evidence of such prior residence within the City. In addition, the City may sell spaces in Blocks 12, 16, 17, 18, 19 and 20 of Greenwood Cemetery to non-City, as well as City residents. Provided, however, that a person who has not met the residency requirements set forth herein may be permitted to purchase spaces in Greenwood Cemetery at the price established by City Council for qualified non-residents if such person is related by blood or marriage to a deceased person buried in said cemetery, unless such deceased person is interred in a section of the cemetery reserved for members of the American Legion, Spanish-American War Veterans, Grand Army of the Republic, Independent Order of Odd Fellows, or United Confederate Veterans, and such deceased person, at the time of his or her death, did not meet City residency requirements. ... Sec. 16.13. - Sales to Non-Family Members; City's Right of First Refusal. A space owner may sell or transfer his or her space only to a relative by blood or marriage, provided however, a space owner may sell or transfer his or her space to a person not related by blood or marriage if the owner receives approval of said sale from City Council. In the event a space owner wishes to sell or transfer his or her space to a person other than a relative by blood or marriage in a sale or transfer not approved by City Council, the owner shall first offer in writing the space for sale to the City of Orlando. The City may repurchase the space for the original purchase price or one-half of the current sales price, whichever is greater, less a recording fee if the deed from the City to the owner is not recorded. If the City wishes to purchase the space, the City shall notify the owner thereof within five (5) days of receipt of notice, and the sale shall be closed within five (5) days after receipt by the City of evidence of title to the space satisfactory to the Office of Legal Affairs. ... Sec. 16.14. - Declaration; Rights If No Declaration. The owner of a space may present his or her deed to the Cemetery Supervisor designating in writing persons entitled to be buried in the space or spaces owned. This designation may be amended at any time by the owner(s) in the same manner as the original designation. Only relatives by blood or marriage may be designated under this section; provided however, persons other than relatives by blood or marriage may be designated if the owner receives approval of said designation from City Council. In the event the owner fails to designate burial rights for the space or spaces owned, and in the event the property is not transferred or conveyed as provided herein, the right of interment in the space or spaces shall be in the following order: (1)One space, niche or crypt shall be forever reserved for the owner and one for the owner's surviving spouse, if any.(2)The remaining spaces shall pass to the heirs or devisees of the owner in the same manner as real property passes under Florida Law: provided, however, that no person shall be interred in a space passing under this section unless such person would have been eligible under the provisions of this Chapter to be designated for burial in such space at the date of such person's death or the interment of said person is approved by City Council. Sec. 16.15. - Rights Upon Interment. Whenever an interment of the remains of any person is made in a space, the space thereby becomes inalienable and shall be held as the space of the interred person except in the case of cremated remains as set forth in Section 16.17. ... Sec. 16.17. - Interments in General. All earth interments shall be in a liner or vault of concrete or steel of a type approved by the cemetery Supervisor. No more than the remains of one body shall be interred in any one space, vault or crypt, except in the case of a mother and stillborn child(ren). However, if written permission is given by the owner of a space or, if the owner is deceased, by the owner's heirs, permitting more than the remains of one person to occupy a space, vault or crypt, an exception will be made to permit no more than one regular interment and one cremain or two cremains in any one space, vault or crypt. Installation of cremorial headstones may be permitted under the same number, size and material restrictions as set forth in Section 16.26; provided, however, that in cases where the use of a cremorial headstone causes the total number of allowable interments or inurnments in any one space to be exceeded, each additional inurnment shall be charged a fee as set forth by City Council for right of additional interment. ... Sec. 16.29. - Children; Pets. No child under fifteen (15) years of age shall be permitted in the cemetery unless accompanied by an adult. Pets shall be prohibited in the cemetery. ... Sec. 16.35. - Double Interment Permitted. Notwithstanding the provisions of Section 16.17 hereof, no more than the remains of two (2) bodies shall be interred in any one space in Block 12 of Greenwood Cemetery, provided that a mother and a stillborn child shall be considered one body. All interments in Block 12 shall be in a vault installed by the City of Orlando. https://library.municode.com/fl/orlando/codes/code_of_ordinances?nodeId=TITIICICO_CH16CEBU_ARTIGEPR_S16.04BUREGRCEWAPACE ================ ======= My grandmother is buried in Occala, but she bought a burial plot in Orlando's city cemetery's Block B12. I am her sole heir, and I want to be buried in Orlando. Will I be entitled to it? I also want my daughter to be buried with me. Will it be possible? My daughter says that she will only accept it if her father is buried there as well. Is this feasible? If I change my mind, can I sell the plot to my friend? I have a vague memory that grandpa's ashes are interred there. Does it change the picture? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Legal,Fact Finding,Q&A "Please respond using only information provided in the context block. If the information needed to answer the question is not within the context block, state that you cannot answer. ",I am interested in what context one would use the glGenFrameBuffers() function. What does this function do exactly? Please include any extra information to help understand the function.,"Up to this point, all of our discussion regarding buffers has focused on the buffers provided by the windowing system, as you requested when you called glutCreateWindow() (and configured by your call to glutInitDisplayMode()). Although you can quite successfully use any technique with just those buffers, quite often various operations require moving data between buffers superfluously. This is where framebuffer objects enter the picture (as part of OpenGL Version 3.0). Using framebuffer objects, you can create our own framebuffers and use their attached renderbuffers to minimize data copies and optimize performance. Framebuffer objects are quite useful for performing off-screen-rendering, updating texture maps, and engaging in buffer ping-ponging (a data-transfer techniques used in GPGPU). The framebuffer that is provided by the windowing system is the only framebuffer that is available to the display system of your graphics server— that is, it is the only one you can see on your screen. It also places restrictions on the use of the buffers that were created when your window opened. By comparison, the framebuffers that your application creates cannot be displayed on your monitor; they support only off-screen rendering. Another difference between window-system-provided framebuffers and framebuffers you create is that those managed by the window system allocate their buffers—color, depth, stencil, and accumulation—when your window is created. When you create an application-managed framebuffer object, you need to create additional renderbuffers that you associate with the framebuffer objects you created. The buffers with the window-systemprovided buffers can never be associated with an application-created framebuffer object, and vice versa. To allocate an application-generated framebuffer object name, you need to call glGenFramebuffers() which will allocate an unused identifier for the framebuffer object. As compared to some other objects within OpenGL (e.g., texture objects and display lists), you always need to use an name returned from glGenFramebuffers(). Allocating a framebuffer object name doesn’t actually create the framebuffer object or allocate any storage for it. Those tasks are handled through a call to glBindFramebuffer(). glBindFramebuffer() operates in a similar manner to many of the other glBind*() routines you’ve seen in OpenGL. The first time it is called for a particular framebuffer, it causes void glGenFramebuffers(GLsize n, GLuint *ids); Allocate n unused framebuffer object names, and return those names in ids. storage for the object to be allocated and initialized. Any subsequent calls will bind the provided framebuffer object name as the active one. As with all of the other objects you have encountered in OpenGL, you can release an application-allocated framebuffer by calling glDeleteFramebuffers(). That function will mark the framebuffer object’s name as unallocated and release any resources associated with the framebuffer object. For completeness, you can determine whether a particular unsigned integer is an application-allocated framebuffer object by calling glIsFramebuffer():. void glBindFramebuffer(GLenum target, GLuint framebuffer); Specifies either a framebuffer for either reading or writing. When target is GL_DRAW_FRAMEBUFFER, framebuffer specifies the destination framebuffer for rendering. Similarly, when target is set to GL_READ_ FRAMEBUFFER, framebuffer specifies the source of read operations. Passing GL_FRAMEBUFFER for target sets both the read and write framebuffer bindings to framebuffer. framebuffer must either be zero, which binds target to the default; a window-system provided framebuffer; or a framebuffer object generated by a call to glGenFramebuffers(). A GL_INVALID_OPERATION error is generated if framebuffer is neither zero nor a valid framebuffer object previously generated by calling glGenFramebuffers(), but not deleted by calling glDeleteFramebuffers(). void glDeleteFramebuffers(GLsize n, const GLuint *ids); Deallocates the n framebuffer objects associated with the names provided in ids. If a framebuffer object is currently bound (i.e., its name was passed to the most recent call to glBindFramebuffer()), and is deleted, the framebuffer target is immediately bound to id zero (the window-system provided framebuffer), and the framebuffer object is released. No errors are generated by glDeleteFramebuffers(). Unused names or zero are simply ignored. GLboolean glIsFramebuffer(GLuint framebuffer); Framebuffer Objects 529 Once a framebuffer object is created, you still can’t do much with it. You need to provide a place for drawing to go and reading to come from; those places are called framebuffer attachments. We’ll discuss those in more detail after we examine renderbuffers, which are one type of buffer you can attach to a framebuffer object. Renderbuffers Renderbuffers are effectively memory managed by OpenGL that contains formatted image data. The data that a renderbuffer holds takes meaning once it is attached to a framebuffer object, assuming that the format of the image buffer matches what OpenGL is expecting to render into (e.g., you can’t render colors into the depth buffer). As with many other buffers in OpenGL, the process of allocating and deleting buffers is similar to what you’ve seen before. To create a new renderbuffer, you would call glGenRenderbuffers(). Likewise, a call to glDeleteRenderbuffers() will release the storage associated with a renderbuffer. Returns GL_TRUE if framebuffer is the name of a framebuffer returned from glGenFramebuffers(). Returns GL_FALSE if framebuffer is zero (the window-system default framebuffer) or a value that’s either unallocated or been deleted by a call to glDeleteFramebuffers(). void glGenRenderbuffers(GLsizei n, GLuint *ids); Allocate n unused renderbuffer object names, and return those names in ids. Names are unused until bound with a call to glBindRenderbuffer(). void glDeleteRenderbuffers(GLsizei n, const GLuint *ids); Deallocates the n renderbuffer objects associated with the names provided in ids. If one of the renderbuffers is currently bound and passed to glDeleteRenderbuffers(), a binding of zero replaces the binding at the current framebuffer attachment point, in addition to the renderbuffer being released. No errors are generated by glDeleteRenderbuffers(). Unused names or zero are simply ignored. Likewise, you can determine whether a name represents a valid renderbuffer by calling glIsRenderbuffer(). Similar to the process of binding a framebuffer object so that you can modify its state, you call glBindRenderbuffer() to affect a renderbuffer’s creation and to modify the state associated with it, which includes the format of the image data that it contains. Creating Renderbuffer Storage When you first call glBindRenderbuffer() with an unused renderbuffer name, the OpenGL server creates a renderbuffer with all its state information set to the default values. In this configuration, no storage has been allocated to store image data. Before you can attach a renderbuffer to a framebuffer and render into it, you need to allocate storage and specify its image format. This is done by calling either glRenderbufferStorage() or glRenderbufferStorageMultisample(). void glIsRenderbuffer(GLuint renderbuffer); Returns GL_TRUE if renderbuffer is the name of a renderbuffer returned from glGenRenderbuffers(). Returns GL_FALSE if renderbuffer is zero (the window-system default framebuffer) or a value that’s either unallocated or been deleted by a call to glDeleteRenderbuffers(). void glBindRenderbuffer(GLenum target, GLuint renderbuffer); Creates a renderbuffer and associates it with the name renderbuffer. target must be GL_RENDERBUFFER. renderbuffer must either be zero, which removes any renderbuffer binding, or a name that was generated by a call to glGenRenderbuffers(); otherwise, a GL_INVALID_OPERATION error will be generated. void glRenderbufferStorage(GLenum target, GLenum internalformat, GLsizei width, GLsizei height); void glRenderbufferStorageMultisample(GLenum target, GLsizei samples, GLenum internalformat, GLsizei width, GLsizei height); Framebuffer Objects 531 Allocates storage for image data for the bound renderbuffer. target must be GL_RENDERBUFFER. For a color-renderable buffer, internalformat must be one of: GL_RED, GL_R8, GL_R16, GL_RG, GL_RG8, GL_RG16, GL_RGB, GL_R3_G3_B2, GL_RGB4, GL_RGB5, GL_RGB8, GL_RGB10, GL_RGB12, GL_RGB16, GL_RGBA, GL_RGBA2, GL_RGBA4, GL_RGB5_A1, GL_RGBA8, GL_RGB10_A2, GL_RGBA12, GL_RGBA16, GL_SRGB, GL_SRGB8, GL_SRGB_ALPHA, GL_SRGB8_ALPHA8,GL_R16F, GL_R32F, GL_RG16F, GL_RG32F, GL_RGB16F, GL_RGB32F, GL_RGBA16F, GL_RGBA32F, GL_R11F_G11F_B10F, GL_RGB9_E5, GL_R8I, GL_R8UI, GL_R16I, GL_R16UI, GL_R32I, GL_R32UI, GL_RG8I, GL_RG8UI, GL_RG16I, GL_RG16UI, GL_RG32I, GL_RG32UI, GL_RGB8I, GL_RGB8UI, GL_RGB16I, GL_RGB16UI, GL_RGB32I, GL_RGB32UI, GL_RGBA8I, GL_RGBA8UI, GL_RGBA16I, GL_RGBA16UI, GL_RGBA32I. OpenGL version 3.1 adds the additional following formats: GL_R8_SNORM, GL_R16_SNORM, GL_RG8_SNORM, GL_RG16_SNORM, GL_RGB8_ SNORM, GL_RGB16_SNORM, GL_RGBA8_SNORM, GL_RGBA16_SNORM. To use a renderbuffer as a depth buffer, it must be depth-renderable, which is specified by setting internalformat to either GL_DEPTH_COMPONENT, GL_DEPTH_COMPONENT16, GL_DEPTH_COMPONENT32, GL_DEPTH_ COMPONENT32, or GL_DEPTH_COMPONENT32F. For use exclusively as a stencil buffer, internalformat should be specified as either GL_STENCIL_INDEX, GL_STENCIL_INDEX1, GL_STENCIL_ INDEX4, GL_STENCIL_INDEX8, or GL_STENCIL_INDEX16. For packed depth-stencil storage, internalformat must be GL_DEPTH_ STENCIL, which allows the renderbuffer to be attached as the depth buffer, stencil buffer, or at the combined depth-stencil attachment point. width and height specify the size of the renderbuffer in pixels, and samples specifies the number of multisample samples per pixel. Setting samples to zero in a call to glRenderbufferStorageMultisample() is identical to calling glRenderbufferStorage(). A GL_INVALID_VALUE is generated if width or height is greater than the value returned when querying GL_MAX_RENDERBUFFER_SIZE, or if samples is greater than the value returned when querying GL_MAX_ SAMPLES. A GL_INVALID_OPERATION is generated if internalformat is a signed- or unsigned-integer format (e.g., a format containing a “I”, or “UI” in its token), and samples is not zero, and the implementation doesn’t support multisampled integer buffers. Finally, if the renderbuffer size and format combined exceed the available memory able to be allocated, then a GL_OUT_OF_MEMORY error is generated. Example 10-6 Creating an RGBA Color Renderbuffer: fbo.c glGenRenderbuffers( 1, &color ); glBindRenderbuffer( GL_RENDERBUFFER, color ); glRenderbufferStorage( GL_RENDERBUFFER, GL_RGBA, 256, 256 ); Once you have created storage for your renderbuffer, you need to attach it to a framebuffer object before you can render into it. Framebuffer Attachments When you render, you can send the results of that rendering to a number of places: • The color buffer to create an image, or even multiple color buffers if you’re using multiple render targets (see “Special Output Values” in Chapter 15) • The depth buffer to store occlusion information • The stencil buffer for storing per-pixel masks to control rendering Each of those buffers represents a framebuffer attachment, to which you can attach suitable image buffers that you later render into, or read from. Currently, there are two types of rendering surfaces you can associate with one of those attachments: renderbuffers and a level of a texture image. Attachment Name Description GL_COLOR_ATTACHMENTi The ith color buffer. i can range from zero (the default color buffer) to GL_MAX_COLOR_ATTACHMENTS–1 GL_DEPTH_ATTACHMENT The depth buffer GL_STENCIL_ATTACHMENT The stencil buffer GL_DEPTH_STENCIL_ATTACHMENT A special attachment for packed depthstencil buffers (which require the renderbuffer to have been allocated as a GL_DEPTH_STENCIL pixel format) We’ll first discuss attaching a renderbuffer to a framebuffer object, which is done by calling glFramebufferRenderbuffer(). In Example 10-7, we create and attach two renderbuffers: one for color, and the other for depth. We then proceed to render, and finally copy the results back to the window-system-provided framebuffer to display the results. You might use this technique to generate frames for a movie rendering offscreen, where you don’t have to worry about the visible framebuffer being corrupted by overlapping windows or someone resizing the window and interrupting rendering. One important point to remember is that you might need to reset the viewport for each framebuffer before rendering, particularly if the size of your application-defined framebuffers differs from the window-system provided framebuffer. Another very common use for framebuffer objects is to update textures dynamically. You might do this to indicate changes in a surface’s appearance (such as bullet holes in a wall in a game) or to update values in a lookup table if you’re doing GPGPU-like computations. In these cases, you bind a level of a texture map as the framebuffer attachment, as compared to a renderbuffer. After rendering, the texture map can be detached from the framebuffer so that it can be used in subsequent rendering. Note: Nothing prevents you from reading from a texture that is simultaneously bound as a framebuffer attachment for writing. In this scenario, called a framebuffer rendering loop, the results are undefined for both operations. That is, the values returned from sampling the bound texture map, as well as the values written into the texture level while bound, will likely be incorrect. void glFramebufferTexture1D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level); void glFramebufferTexture2D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level); void glFramebufferTexture3D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level, GLint layer); Attaches a level of a texture objects as a rendering attachment to a framebuffer object. target must be either GL_READ_FRAMEBUFFER, GL_DRAW_FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_FRAMEBUFFER). attachment must be one of the framebuffer attachment points: GL_COLOR_ATTACHMENTi, GL_DEPTH_ ATTACHMENT, GL_STENCIL_ATTACHMENT, or GL_DEPTH_STENCIL_ ATTACHMENT (in which case, the internal format of the texture must be GL_DEPTH_STENCIL). For glFramebufferTexture1D(), texturetarget must be GL_TEXTURE_1D, if texture is not zero. For glFramebufferTexture2D(), texturetarget must be GL_TEXTURE_2D, GL_TEXTURE_RECTANGLE, GL_TEXTURE_CUBE_ MAP_POSITIVE_X, GL_TEXTURE_CUBE_MAP_POSITIVE_Y, GL_ TEXTURE_CUBE_MAP_POSITIVE_Z, GL_TEXTURE_CUBE_MAP_ NEGATIVE_X, GL_TEXTURE_CUBE_MAP_NEGATIVE_Y, GL_TEXTURE_ CUBE_MAP_NEGATIVE_Z, and for glFramebufferTexture3D() texturetarget must be GL_TEXTURE_3D. Similar to the previous example, Example 10-8 demonstrates the process of dynamically updating a texture, using the texture after its update is completed, and then rendering with it later. Framebuffer Completeness Given the myriad of combinations between texture and buffer formats, and between framebuffer attachments, various situations can arise that prevent the completion of rendering when you are using applicationdefined framebuffer objects. After modifying the attachments to a framebuffer object, it’s best to check the framebuffer’s status by calling glCheckFramebufferStatus(). The errors representing the various violations of framebuffer configurations are listed in Table 10-7. Of the listed errors, GL_FRAMEBUFFER_UNSUPPORTED is very implementation dependent, and may be the most complicated to debug. void glFramebufferTextureLayer(GLenum target, GLenum attachment, GLuint texture, GLint level, GLint layer); Attaches a layer of a three-dimensional texture, or a one- or twodimensional array texture as a framebuffer attachment, in a similar manner to glFramebufferTexture3D(). target must be one of GL_READ_FRAMEBUFFER, GL_DRAW_ FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_ FRAMEBUFFER). attachment must be one of GL_COLOR_ATTACHMENTi, GL_DEPTH_ATTACHMENT, GL_STENCIL_ATTACHMENT, or GL_DEPTH_ STENCIL_ATTACHMENT. texture must be either zero, indicating that the current binding for the attachment should be released, or a texture object name (as returned from glGenTextures()). level indicates the mipmap level of the texture object, and layer represents which layer of the texture (or array element) should be bound as an attachment. GLenum glCheckFramebufferStatus(GLenum target); Returns one of the framebuffer completeness status enums listed in Table 10-7. target must be one of GL_READ_FRAMEBUFFER, GL_DRAW_ FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_ FRAMEBUFFER). If glCheckFramebufferStatus() generates an error, zero is returned. Framebuffer Objects 539 Copying Pixel Rectangles While glCopyPixels() has been the default routine for replicating blocks of pixels since OpenGL Version 1.0, as OpenGL expanded its rendering facilities, a more substantial pixel-copying routine was required. glBlitFramebuffer(), described below, subsumes the operations of glCopyPixels() and glPixelZoom() in a single, enhanced call. glBlitFramebuffer() allows greater pixel filtering during the copy operation, much in the same manner as texture mapping (in fact, the same filtering operations, GL_NEAREST and GL_LINEAR are used during the copy). Additionally, this routine is aware of multisampled buffers, and supports copying between different framebuffers (as controlled by framebuffer objects). Framebuffer Completeness Status Enum Description GL_FRAMEBUFFER_COMPLETE The framebuffer and its attachments match the rendering or reading state required. GL_FRAMEBUFFER_UNDEFINED The bound framebuffer is specified to be the default framebuffer (i.e., glBindFramebuffer() with zero specified as the framebuffer), and the default framebuffer doesn’t exist. GL_FRAMEBUFFER_ INCOMPLETE_ATTACHMENT A necessary attachment to the bound framebuffer is uninitialized GL_FRAMEBUFFER_ INCOMPLETE_MISSING_ ATTACHMENT There are no images (e.g., texture layers or renderbuffers) attached to the framebuffer. GL_FRAMEBUFFER_ INCOMPLETE_DRAW_BUFFER Every drawing buffer (e.g., GL_DRAW_BUFFERi as specified by glDrawBuffers()) has an attachment. GL_FRAMEBUFFER_ INCOMPLETE_READ_BUFFER An attachment exists for the buffer specified for the buffer specified by glReadBuffer(). GL_FRAMEBUFFER_ UNSUPPORTED The combination of images attached to the framebuffer object is incompatible with the requirements of the OpenGL implementation. GL_FRAMEBUFFER_ INCOMPLETE_MULTISAMPLE The number of samples for all images across the framebuffer’s attachments do not match. void glBlitFramebuffer(GLint srcX0, GLint srcY0, GLint srcX1, GLint srcY1, GLint dstX0, GLint dstY0, GLint dstX1, GLint dstY1, GLbitfield buffers, GLenum filter); Copies a rectangle of pixel values from one region of the read framebuffer to another region of the draw framebuffer, potentially resizing, reversing, converting, and filtering the pixels in the process. srcX0, srcY0, srcX1, srcY1 represent the source region where pixels are sourced from, and written to the rectangular region specified by dstX0, dstY0, dstX1, dstY1. buffers is the bitwise-or of GL_COLOR_BUFFER_BIT, GL_DEPTH_BUFFER_ BIT, and GL_STENCIL_BUFFER_BIT, which represent the buffers in which the copy should occur. Finally, filter specifies the method of interpolation done if the two rectangular regions are different sizes, and must be one of GL_NEAREST or GL_LINEAR; no filtering is applied if the regions are the same size. If there are multiple color draw buffers (See “Rendering to Multiple Output Buffers” on page 729), each buffer receives a copy of the source region. If srcX1 < srcX0, or dstX1 < dstX0, the image is reversed in the horizontal direction. Likewise, if srcY1 < srcY0 or dstY1 < dstY0, the image is reverse in the vertical direction. However, If both the source and destination sizes are negative in the same direction, no reversal is done. If the source and destination buffers are of different formats, conversion of the pixel values is done in most situations. However, if the read color buffer is a floating-point format, and any of the write color buffers are not, or vice verse; and if the read color buffer is a signed (unsigned) integer format and not all of the draw buffers are signed (unsigned) integer values, the call will generate a GL_INVALID_OPERATION, and no pixels will be copied. Multisampled buffers also have an effect on the copying of pixels. If the source buffer is multisampled, and the destination is not, the samples are resolved to a single pixel value for the destination buffer. Conversely, if the source buffer is not multisampled, and the destination is, the source pixel’s data is replicated for each sample. Finally, if both buffers are multisampled and the number of samples for each buffer is the same, the samples are copied without modification. However, if the buffers have a different number of samples, no pixels are copied, and a GL_INVALID_ OPERATION error is generated. A GL_INVALID_VALUE error is generated if buffers has other bits set than those permitted, or if filter is other than GL_LINEAR or GL_NEAREST Chapter Objectives After reading this chapter, you’ll be able to do the following: • Render concave filled polygons by first tessellating them into convex polygons, which can be rendered using standard OpenGL routines • Use the OpenGL Utility Library to create quadrics objects to render and model the surfaces of spheres and cylinders, and to tessellate disks (circles) and partial disks (arcs) Note: In OpenGL Version 3.1, some of the techniques and functions described in this chapter—particularly those relating to quadric objects—were likely affected by deprecation. While many of these features can be found in the GLU library, they rely on OpenGL functions that were removed. The OpenGL Library (GL) is designed for low-level operations, both streamlined and accessible to hardware acceleration. The OpenGL Utility Library (GLU) complements the OpenGL library, supporting higher-level operations. Some of the GLU operations are covered in other chapters. Mipmapping (gluBuild*DMipmaps()) and image scaling (gluScaleImage()) are discussed along with other facets of texture mapping in Chapter 9. Several matrix transformation GLU routines (gluOrtho2D(), gluPerspective(), gluLookAt(), gluProject(), gluUnProject(), and gluUnProject4()) are described in Chapter 3. The use of gluPickMatrix() is explained in Chapter 13. The GLU NURBS facilities, which are built atop OpenGL evaluators, are covered in Chapter 12. Only two GLU topics remain: polygon tessellators and quadric surfaces; these topics are discussed in this chapter. To optimize performance, the basic OpenGL renders only convex polygons, but the GLU contains routines for tessellating concave polygons into convex ones, which the basic OpenGL can handle. Where the basic OpenGL operates on simple primitives, such as points, lines, and filled polygons, the GLU can create higher-level objects, such as the surfaces of spheres, cylinders, and cones. This chapter has the following major sections. • “Polygon Tessellation” explains how to tessellate concave polygons into easier-to-render convex polygons. • “Quadrics: Rendering Spheres, Cylinders, and Disks” describes how to generate spheres, cylinders, circles and arcs, including data such as surface normals and texture coordinates. Polygon Tessellation As discussed in “Describing Points, Lines, and Polygons” in Chapter 2, OpenGL can directly display only simple convex polygons. A polygon is simple if the edges intersect only at vertices, there are no duplicate vertices, and exactly two edges meet at any vertex. If your application requires the display of concave polygons, polygons containing holes, or polygons with intersecting edges, these polygons must first be subdivided into simple convex polygons before they can be displayed. Such subdivision is called tessellation, and the GLU provides a collection of routines that perform tessellation. These routines take as input arbitrary contours, which describe hard-to-render polygons, and they return some combination of triangles, triangle meshes, triangle fans, and lines. If you think a polygon may need tessellation, follow these typical steps: 1. Create a new tessellation object with gluNewTess(). 2. Use gluTessCallback() several times to register callback functions to perform operations during the tessellation. The trickiest case for a callback function is when the tessellation algorithm detects an intersection and must call the function registered for the GLU_TESS_ COMBINE callback. 3. Specify tessellation properties by calling gluTessProperty(). The most important property is the winding rule, which determines the regions that should be filled and those that should remain unshaded. 4. Create and render tessellated polygons by specifying the contours of one or more closed polygons. If the data for the object is static, encapsulate the tessellated polygons in a display list. (If you don’t have to recalculate the tessellation repeatedly, using display lists is more efficient.) 5. If you need to tessellate something else, you may reuse your tessellation object. If you are forever finished with your tessellation object, you may delete it with gluDeleteTess(). Note: The tessellator described here was introduced in Version 1.2 of the GLU. If you are using an older version of the GLU, you must use routines described in “Describing GLU Errors” on page 557. To query which version of GLU you have, use gluGetString(GLU_VERSION), which returns a string with your GLU version number. If you don’t seem to have gluGetString() in your GLU, then you have GLU 1.0, which did not yet have the gluGetString() routine. Creating a Tessellation Object As a complex polygon is being described and tessellated, it has associated data, such as the vertices, edges, and callback functions. All this data is tied to a single tessellation object. To perform tessellation, your program first has to create a tessellation object using the routine gluNewTess(). A single tessellation object can be reused for all your tessellations. This object is required only because library routines might need to do their own tessellations, and they should be able to do so without interfering with any tessellation that your program is doing. It might also be useful to have multiple tessellation objects if you want to use different sets of callbacks for different tessellations. A typical program, however, allocates a single tessellation object and uses it for all its tessellations. There’s no real need to free it, because it uses a small amount of memory. On the other hand, it never hurts to be tidy. Tessellation Callback Routines After you create a tessellation object, you must provide a series of callback routines to be called at appropriate times during the tessellation. After specifying the callbacks, you describe the contours of one or more polygons using GLU routines. When the description of the contours is complete, the tessellation facility invokes your callback routines as necessary. Any functions that are omitted are simply not called during the tessellation, and any information they might have returned to your program is lost. All are specified by the single routine gluTessCallback(). GLUtesselator* gluNewTess(void); Creates a new tessellation object and returns a pointer to it. A null pointer is returned if the creation fails. Polygon Tessellation 545 void gluTessCallback(GLUtesselator *tessobj, GLenum type, void (*fn)()); Associates the callback function fn with the tessellation object tessobj. The type of the callback is determined by the parameter type, which can be GLU_TESS_BEGIN, GLU_TESS_BEGIN_DATA, GLU_TESS_EDGE_FLAG, GLU_TESS_EDGE_FLAG_DATA, GLU_TESS_VERTEX, GLU_TESS_VERTEX_ DATA, GLU_TESS_END, GLU_TESS_END_DATA, GLU_TESS_COMBINE, GLU_TESS_COMBINE_DATA, GLU_TESS_ERROR, or GLU_TESS_ERROR_ DATA. The 12 possible callback functions have the following prototypes: GLU_TESS_BEGIN void begin(GLenum type); GLU_TESS_BEGIN_DATA void begin(GLenum type, void *user_data); GLU_TESS_EDGE_FLAG void edgeFlag(GLboolean flag); GLU_TESS_EDGE_FLAG_DATA void edgeFlag(GLboolean flag, void *user_data); GLU_TESS_VERTEX void vertex(void *vertex_data); GLU_TESS_VERTEX_DATA void vertex(void *vertex_data, void *user_data); GLU_TESS_END void end(void); GLU_TESS_END_DATA void end(void *user_data); GLU_TESS_COMBINE void combine( GLdouble coords[3], void*vertex_data[4], GLfloat weight[4], void **outData); GLU_TESS_COMBINE_DATA void combine( GLdouble coords[3], void*vertex_data[4], GLfloat weight[4], void **outData, void *user_data); GLU_TESS_ERROR void error(GLenum errno); GLU_TESS_ERROR_DATA void error(GLenum errno, void *user_data); To change a callback routine, simply call gluTessCallback() with the new routine. To eliminate a callback routine without replacing it with a new one, pass gluTessCallback() a null pointer for the appropriate function. As tessellation proceeds, the callback routines are called in a manner similar to how you use the OpenGL commands glBegin(), glEdgeFlag*(), glVertex*(), and glEnd(). (See “Marking Polygon Boundary Edges” in Chapter 2 for more information about glEdgeFlag*().) The combine callback is used to create new vertices where edges intersect. The error callback is invoked during the tessellation only if something goes wrong. For every tessellator object created, a GLU_TESS_BEGIN callback is invoked with one of four possible parameters: GL_TRIANGLE_FAN, GL_TRIANGLE_ STRIP, GL_TRIANGLES, or GL_LINE_LOOP. When the tessellator decomposes the polygons, the tessellation algorithm decides which type of triangle primitive is most efficient to use. (If the GLU_TESS_BOUNDARY_ONLY property is enabled, then GL_LINE_LOOP is used for rendering.) Since edge flags make no sense in a triangle fan or triangle strip, if there is a callback associated with GLU_TESS_EDGE_FLAG that enables edge flags, the GLU_TESS_BEGIN callback is called only with GL_TRIANGLES. The GLU_TESS_EDGE_FLAG callback works exactly analogously to the OpenGL glEdgeFlag*() call. After the GLU_TESS_BEGIN callback routine is called and before the callback associated with GLU_TESS_END is called, some combination of the GLU_TESS_EDGE_FLAG and GLU_TESS_VERTEX callbacks is invoked (usually by calls to gluTessVertex(), which is described on page 555). The associated edge flags and vertices are interpreted exactly as they are in OpenGL between glBegin() and the matching glEnd(). If something goes wrong, the error callback is passed a GLU error number. A character string describing the error is obtained using the routine gluErrorString(). (See “Describing GLU Errors” on page 557 for more information about this routine.) Example 11-1 shows a portion of tess.c, in which a tessellation object is created and several callbacks are registered. Example 11-1 Registering Tessellation Callbacks: tess.c #ifndef CALLBACK #define CALLBACK #endif Polygon Tessellation 547 /* a portion of init() */ tobj = gluNewTess(); gluTessCallback(tobj, GLU_TESS_VERTEX, glVertex3dv); gluTessCallback(tobj, GLU_TESS_BEGIN, beginCallback); gluTessCallback(tobj, GLU_TESS_END, endCallback); gluTessCallback(tobj, GLU_TESS_ERROR, errorCallback); /* the callback routines registered by gluTessCallback() */ void CALLBACK beginCallback(GLenum which) { glBegin(which); } void CALLBACK endCallback(void) { glEnd(); } void CALLBACK errorCallback(GLenum errorCode) { const GLubyte *estring; estring = gluErrorString(errorCode); fprintf(stderr, ""Tessellation Error: %s\n"", estring); exit(0); } Note: Type casting of callback functions is tricky, especially if you wish to make code that runs equally well on Microsoft Windows and UNIX. To run on Microsoft Windows, programs that declare callback functions, such as tess.c, need the symbol CALLBACK in the declarations of functions. The trick of using an empty definition for CALLBACK (as demonstrated below) allows the code to run well on both Microsoft Windows and UNIX: #ifndef CALLBACK #define CALLBACK #endif void CALLBACK callbackFunction(...) { .... } In Example 11-1, the registered GLU_TESS_VERTEX callback is simply glVertex3dv(), and only the coordinates at each vertex are passed along. However, if you want to specify more information at every vertex, such as a color value, a surface normal vector, or a texture coordinate, you’ll have to make a more complex callback routine. Example 11-2 shows the start of another tessellated object, further along in program tess.c. The registered function vertexCallback() expects to receive a parameter that is a pointer to six double-length floating-point values: the x-, y-, and z-coordinates and the red, green, and blue color values for that vertex. Example 11-2 Vertex and Combine Callbacks: tess.c /* a different portion of init() */ gluTessCallback(tobj, GLU_TESS_VERTEX, vertexCallback); gluTessCallback(tobj, GLU_TESS_BEGIN, beginCallback); gluTessCallback(tobj, GLU_TESS_END, endCallback); gluTessCallback(tobj, GLU_TESS_ERROR, errorCallback); gluTessCallback(tobj, GLU_TESS_COMBINE, combineCallback); /* new callback routines registered by these calls */ void CALLBACK vertexCallback(GLvoid *vertex) { const GLdouble *pointer; pointer = (GLdouble *) vertex; glColor3dv(pointer+3); glVertex3dv(vertex); } void CALLBACK combineCallback(GLdouble coords[3], GLdouble *vertex_data[4], GLfloat weight[4], GLdouble **dataOut ) { GLdouble *vertex; int i; vertex = (GLdouble *) malloc(6 * sizeof(GLdouble)); vertex[0] = coords[0]; vertex[1] = coords[1]; vertex[2] = coords[2]; for (i = 3; i < 6; i++) vertex[i] = weight[0] * vertex_data[0][i] + weight[1] * vertex_data[1][i] + weight[2] * vertex_data[2][i] + weight[3] * vertex_data[3][i]; *dataOut = vertex; } Polygon Tessellation 549 Example 11-2 also shows the use of the GLU_TESS_COMBINE callback. Whenever the tessellation algorithm examines the input contours, detects an intersection, and decides it must create a new vertex, the GLU_TESS_ COMBINE callback is invoked. The callback is also called when the tessellator decides to merge features of two vertices that are very close to one another. The newly created vertex is a linear combination of up to four existing vertices, referenced by vertex_data[0..3] in Example 11-2. The coefficients of the linear combination are given by weight[0..3]; these weights sum to 1.0. coords gives the location of the new vertex. The registered callback routine must allocate memory for another vertex, perform a weighted interpolation of data using vertex_data and weight, and return the new vertex pointer as dataOut. combineCallback() in Example 11-2 interpolates the RGB color value. The function allocates a six-element array, puts the x-, y-, and z-coordinates in the first three elements, and then puts the weighted average of the RGB color values in the last three elements. User-Specified Data Six kinds of callbacks can be registered. Since there are two versions of each kind of callback, there are 12 callbacks in all. For each kind of callback, there is one with user-specified data and one without. The user-specified data is given by the application to gluTessBeginPolygon() and is then passed, unaltered, to each *DATA callback routine. With GLU_TESS_BEGIN_DATA, the user-specified data may be used for “per-polygon” data. If you specify both versions of a particular callback, the callback with user_data is used, and the other is ignored. Therefore, although there are 12 callbacks, you can have a maximum of six callback functions active at any one time. For instance, Example 11-2 uses smooth shading, so vertexCallback() specifies an RGB color for every vertex. If you want to do lighting and smooth shading, the callback would specify a surface normal for every vertex. However, if you want lighting and flat shading, you might specify only one surface normal for every polygon, not for every vertex. In that case, you might choose to use the GLU_TESS_BEGIN_DATA callback and pass the vertex coordinates and surface normal in the user_data pointer. Tessellation Properties Prior to tessellation and rendering, you may use gluTessProperty() to set several properties to affect the tessellation algorithm. The most important and complicated of these properties is the winding rule, which determines what is considered “interior” and “exterior.” Winding Numbers and Winding Rules For a single contour, the winding number of a point is the signed number of revolutions we make around that point while traveling once around the contour (where a counterclockwise revolution is positive and a clockwise revolution is negative). When there are several contours, the individual winding numbers are summed. This procedure associates a signed integer value with each point in the plane. Note that the winding number is the same for all points in a single region. void gluTessProperty(GLUtesselator *tessobj, GLenum property, GLdouble value); For the tessellation object tessobj, the current value of property is set to value. property is GLU_TESS_BOUNDARY_ONLY, GLU_TESS_TOLERANCE, or GLU_TESS_WINDING_RULE. If property is GLU_TESS_BOUNDARY_ONLY, value is either GL_TRUE or GL_FALSE. When it is set to GL_TRUE, polygons are no longer tessellated into filled polygons; line loops are drawn to outline the contours that separate the polygon interior and exterior. The default value is GL_FALSE. (See gluTessNormal() to see how to control the winding direction of the contours.) If property is GLU_TESS_TOLERANCE, value is a distance used to calculate whether two vertices are close enough together to be merged by the GLU_TESS_COMBINE callback. The tolerance value is multiplied by the largest coordinate magnitude of an input vertex to determine the maximum distance any feature can move as a result of a single merge operation. Feature merging may not be supported by your implementation, and the tolerance value is only a hint. The default tolerance value is zero. The GLU_TESS_WINDING_RULE property determines which parts of the polygon are on the interior and which are on the exterior and should not be filled. value can be GLU_TESS_WINDING_ODD (the default), GLU_ TESS_WINDING_NONZERO, GLU_TESS_WINDING_POSITIVE, GLU_ TESS_WINDING_NEGATIVE, or GLU_TESS_WINDING_ABS_GEQ_TWO. In the set at the left, all three contours are counterclockwise, so each nested interior region adds 1 to the winding number. In the middle set, the two interior contours are drawn clockwise, so the winding number decreases and actually becomes negative. The winding rule classifies a region as inside if its winding number belongs to the chosen category (odd, nonzero, positive, negative, or “absolute value greater than or equal to 2”). The odd and nonzero rules are common ways to define the interior. The positive, negative, and “absolute value t 2” winding rules have some limited use for polygon CSG (computational solid geometry) operations. The program tesswind.c demonstrates the effects of winding rules. The four sets of contours shown in Figure 11-3 are rendered. The user can then cycle through the different winding rule properties to see their effects. For each winding rule, the dark areas represent interiors. Note the effects of clockwise and counterclockwise winding. CSG Uses for Winding Rules GLU_TESS_WINDING_ODD and GLU_TESS_WINDING_NONZERO are the most commonly used winding rules. They work for the most typical cases of shading. The winding rules are also designed for CSG operations, making it easy to find the union, difference, or intersection (Boolean operations) of several contours. 1 2 3 1 0 -1 1 1 1 1 1 2 First, assume that each contour is defined so that the winding number is 0 for each exterior region and 1 for each interior region. (Each contour must not intersect itself.) Under this model, counterclockwise contours define the outer boundary of the polygon, and clockwise contours define holes. Contours may be nested, but a nested contour must be oriented oppositely from the contour that contains it. 1 2 3 1 0 -1 1 2 321 4321 Contours and Winding Numbers Winding Rules Odd Nonzero Positive Negative ABS_GEQ_TWO Unfilled Unfilled Unfilled Unfilled If the original polygons do not satisfy this description, they can be converted to this form by first running the tessellator with the GLU_TESS_ BOUNDARY_ONLY property turned on. This returns a list of contours satisfying the restriction just described. By creating two tessellator objects, the callbacks from one tessellator can be fed directly as input to the other. Given two or more polygons of the preceding form, CSG operations can be implemented as follows: • UNION—To calculate the union of several contours, draw all input contours as a single polygon. The winding number of each resulting region is the number of original polygons that cover it. The union can be extracted by using the GLU_TESS_WINDING_NONZERO or GLU_TESS_WINDING_POSITIVE winding rule. Note that with the nonzero winding rule, we would get the same result if all contour orientations were reversed. • INTERSECTION—This works only for two contours at a time. Draw a single polygon using two contours. Extract the result using GLU_TESS_ WINDING_ABS_GEQ_TWO. • DIFFERENCE—Suppose you want to compute A diff (B union C union D). Draw a single polygon consisting of the unmodified contours from A, followed by the contours of B, C, and D, with their vertex order reversed. To extract the result, use the GLU_TESS_WINDING_POSITIVE winding rule. (If B, C, and D are the result of a GLU_TESS_BOUNDARY_ ONLY operation, an alternative to reversing the vertex order is to use gluTessNormal() to reverse the sign of the supplied normal.) Other Tessellation Property Routines There are also complementary routines, which work alongside gluTessProperty(). gluGetTessProperty() retrieves the current values of tessellator properties. If the tessellator is being used to generate wireframe outlines instead of filled polygons, gluTessNormal() can be used to determine the winding direction of the tessellated polygons. void gluGetTessProperty(GLUtesselator *tessobj, GLenum property, GLdouble *value); For the tessellation object tessobj, the current value of property is returned to value. Values for property and value are the same as for gluTessProperty(). If you have some knowledge about the location and orientation of the input data, then using gluTessNormal() can increase the speed of the tessellation. For example, if you know that all polygons lie on the xy-plane, call gluTessNormal(tessobj, 0, 0, 1). As stated above, the default normal is (0, 0, 0), and its effect is not immediately obvious. In this case, it is expected that the input data lies approximately in a plane, and a plane is fitted to the vertices, no matter how they are truly connected. The sign of the normal is chosen so that the sum of the signed areas of all input contours is non-negative (where a counterclockwise contour has a positive area). Note that if the input data does not lie approximately in a plane, then projection perpendicular to the computed normal may substantially change the geometry. After all the tessellation properties have been set and the callback actions have been registered, it is finally time to describe the vertices that comprise input contours and tessellate the polygons. Calls to gluTessBeginPolygon() and gluTessEndPolygon() surround the definition of one or more contours. When gluTessEndPolygon() is called, the tessellation algorithm is implemented, and the tessellated polygons are void gluTessNormal(GLUtesselator *tessobj, GLdouble x, GLdouble y, GLdouble z); For the tessellation object tessobj, gluTessNormal() defines a normal vector, which controls the winding direction of generated polygons. Before tessellation, all input data is projected into a plane perpendicular to the normal. Then, all output triangles are oriented counterclockwise, with respect to the normal. (Clockwise orientation can be obtained by reversing the sign of the supplied normal.) The default normal is (0, 0, 0). void gluTessBeginPolygon(GLUtesselator *tessobj, void *user_data); void gluTessEndPolygon(GLUtesselator *tessobj); Begins and ends the specification of a polygon to be tessellated and associates a tessellation object, tessobj, with it. user_data points to a userdefined data structure, which is passed along all the GLU_TESS_*_DATA callback functions that have been bound. generated and rendered. The callback functions and tessellation properties that were bound and set to the tessellation object using gluTessCallback() and gluTessProperty() are used. In practice, a minimum of three vertices is needed for a meaningful contour. In the program tess.c, a portion of which is shown in Example 11-3, two polygons are defined. One polygon is a rectangular contour with a triangular hole inside, and the other is a smooth-shaded, self-intersecting, five-pointed star. For efficiency, both polygons are stored in display lists. The first polygon consists of two contours; the outer one is wound counterclockwise, and the “hole” is wound clockwise. For the second polygon, the star array contains both the coordinate and color data, and its tessellation callback, vertexCallback(), uses both. It is important that each vertex is in a different memory location because the vertex data is not copied by gluTessVertex(); only the pointer (vertex_ data) is saved. A program that reuses the same memory for several vertices may not get the desired result. Note: In gluTessVertex(), it may seem redundant to specify the vertex coordinate data twice, for both the coords and vertex_data parameters; however, both are necessary. coords refers only to the vertex coordinates. vertex_data uses the coordinate data, but may also use other information for each vertex. void gluTessBeginContour(GLUtesselator *tessobj); void gluTessEndContour(GLUtesselator *tessobj); Begins and ends the specification of a closed contour, which is a portion of a polygon. A closed contour consists of zero or more calls to gluTessVertex(), which defines the vertices. The last vertex of each contour is automatically linked to the first. void gluTessVertex(GLUtesselator *tessobj, GLdouble coords[3], void *vertex_data); Specifies a vertex in the current contour for the tessellation object. coords contains the three-dimensional vertex coordinates, and vertex_data is a pointer that’s sent to the callback associated with GLU_TESS_VERTEX or GLU_TESS_VERTEX_DATA. Typically, vertex_data contains vertex coordinates, surface normals, texture coordinates, color information, or whatever else the application may find useful. Deleting a Tessellation Object If you no longer need a tessellation object, you can delete it and free all associated memory with gluDeleteTess(). Tessellation Performance Tips For best performance, remember these rules: • Cache the output of the tessellator in a display list or other user structure. To obtain the post-tessellation vertex coordinates, tessellate the polygons while in feedback mode. (See “Feedback” in Chapter 13.) • Use gluTessNormal() to supply the polygon normal. • Use the same tessellator object to render many polygons, rather than allocate a new tessellator for each one. (In a multithreaded, multiprocessor environment, you may get better performance using several tessellators.) Describing GLU Errors The GLU provides a routine for obtaining a descriptive string for an error code. This routine is not limited to tessellation but is also used for NURBS and quadrics errors, as well as for errors in the base GL. (See “Error void gluDeleteTess(GLUtesselator *tessobj); Deletes the specified tessellation object, tessobj, and frees all associated memory. Handling” in Chapter 14 for information about OpenGL’s error-handling facility.) Backward Compatibility If you are using the 1.0 or 1.1 version of GLU, you have a much less powerful tessellator. The 1.0/1.1 tessellator handles only simple nonconvex polygons or simple polygons containing holes. It does not properly tessellate intersecting contours (no COMBINE callback) or process per-polygon data. The 1.0/1.1 tessellator still works in either GLU 1.2 or 1.3, but its use is no longer recommended. The 1.0/1.1 tessellator has some similarities to the current tessellator. gluNewTess() and gluDeleteTess() are used for both tessellators. The main vertex specification routine remains gluTessVertex(). The callback mechanism is controlled by gluTessCallback(), although only five callback functions can be registered, a subset of the current 12. Here are the prototypes for the 1.0/1.1 tessellator: void gluBeginPolygon(GLUtriangulatorObj *tessobj); void gluNextContour(GLUtriangulatorObj *tessobj, GLenum type); void gluEndPolygon(GLUtriangulatorObj *tessobj); The outermost contour must be specified first, and it does not require an initial call to gluNextContour(). For polygons without holes, only one contour is defined, and gluNextContour() is not used. If a polygon has multiple contours (that is, holes or holes within holes), the contours are specified one after the other, each preceded by gluNextContour(). gluTessVertex() is called for each vertex of a contour. For gluNextContour(), type can be GLU_EXTERIOR, GLU_INTERIOR, GLU_CCW, GLU_CW, or GLU_UNKNOWN. These serve only as hints to the tessellation. If you get them right, the tessellation might go faster. If you get them wrong, they’re ignored, and the tessellation still works. For polygons with holes, one contour is the exterior contour and the other is the interior. The first contour is assumed to be of type GLU_EXTERIOR. Choosing clockwise or counterclockwise orientation is arbitrary in three dimensions; however, there are two different orientations in any plane, and the GLU_CCW and GLU_CW types should be used consistently. Use GLU_UNKNOWN if you don’t have a clue. Quadrics: Rendering Spheres, Cylinders, and Disks 559 It is highly recommended that you convert GLU 1.0/1.1 code to the new tessellation interface for GLU 1.2 by following these steps: 1. Change references to the major data structure type from GLUtriangulatorObj to GLUtesselator. In GLU 1.2, GLUtriangulatorObj and GLUtesselator are defined to be the same type. 2. Convert gluBeginPolygon() to two commands: gluTessBeginPolygon() and gluTessBeginContour(). All contours must be explicitly started, including the first one. 3. Convert gluNextContour() to both gluTessEndContour() and gluTessBeginContour(). You have to end the previous contour before starting the next one. 4. Convert gluEndPolygon() to both gluTessEndContour() and gluTessEndPolygon(). The final contour must be closed. 5. Change references to constants to gluTessCallback(). In GLU 1.2, GLU_BEGIN, GLU_VERTEX, GLU_END, GLU_ERROR, and GLU_EDGE_FLAG are defined as synonyms for GLU_TESS_BEGIN, GLU_TESS_VERTEX, GLU_TESS_END, GLU_TESS_ERROR, and GLU_TESS_EDGE_FLAG.","Up to this point, all of our discussion regarding buffers has focused on the buffers provided by the windowing system, as you requested when you called glutCreateWindow() (and configured by your call to glutInitDisplayMode()). Although you can quite successfully use any technique with just those buffers, quite often various operations require moving data between buffers superfluously. This is where framebuffer objects enter the picture (as part of OpenGL Version 3.0). Using framebuffer objects, you can create our own framebuffers and use their attached renderbuffers to minimize data copies and optimize performance. Framebuffer objects are quite useful for performing off-screen-rendering, updating texture maps, and engaging in buffer ping-ponging (a data-transfer techniques used in GPGPU). The framebuffer that is provided by the windowing system is the only framebuffer that is available to the display system of your graphics server— that is, it is the only one you can see on your screen. It also places restrictions on the use of the buffers that were created when your window opened. By comparison, the framebuffers that your application creates cannot be displayed on your monitor; they support only off-screen rendering. Another difference between window-system-provided framebuffers and framebuffers you create is that those managed by the window system allocate their buffers—color, depth, stencil, and accumulation—when your window is created. When you create an application-managed framebuffer object, you need to create additional renderbuffers that you associate with the framebuffer objects you created. The buffers with the window-systemprovided buffers can never be associated with an application-created framebuffer object, and vice versa. To allocate an application-generated framebuffer object name, you need to call glGenFramebuffers() which will allocate an unused identifier for the framebuffer object. As compared to some other objects within OpenGL (e.g., texture objects and display lists), you always need to use an name returned from glGenFramebuffers(). Allocating a framebuffer object name doesn’t actually create the framebuffer object or allocate any storage for it. Those tasks are handled through a call to glBindFramebuffer(). glBindFramebuffer() operates in a similar manner to many of the other glBind*() routines you’ve seen in OpenGL. The first time it is called for a particular framebuffer, it causes void glGenFramebuffers(GLsize n, GLuint *ids); Allocate n unused framebuffer object names, and return those names in ids. storage for the object to be allocated and initialized. Any subsequent calls will bind the provided framebuffer object name as the active one. As with all of the other objects you have encountered in OpenGL, you can release an application-allocated framebuffer by calling glDeleteFramebuffers(). That function will mark the framebuffer object’s name as unallocated and release any resources associated with the framebuffer object. For completeness, you can determine whether a particular unsigned integer is an application-allocated framebuffer object by calling glIsFramebuffer():. void glBindFramebuffer(GLenum target, GLuint framebuffer); Specifies either a framebuffer for either reading or writing. When target is GL_DRAW_FRAMEBUFFER, framebuffer specifies the destination framebuffer for rendering. Similarly, when target is set to GL_READ_ FRAMEBUFFER, framebuffer specifies the source of read operations. Passing GL_FRAMEBUFFER for target sets both the read and write framebuffer bindings to framebuffer. framebuffer must either be zero, which binds target to the default; a window-system provided framebuffer; or a framebuffer object generated by a call to glGenFramebuffers(). A GL_INVALID_OPERATION error is generated if framebuffer is neither zero nor a valid framebuffer object previously generated by calling glGenFramebuffers(), but not deleted by calling glDeleteFramebuffers(). void glDeleteFramebuffers(GLsize n, const GLuint *ids); Deallocates the n framebuffer objects associated with the names provided in ids. If a framebuffer object is currently bound (i.e., its name was passed to the most recent call to glBindFramebuffer()), and is deleted, the framebuffer target is immediately bound to id zero (the window-system provided framebuffer), and the framebuffer object is released. No errors are generated by glDeleteFramebuffers(). Unused names or zero are simply ignored. GLboolean glIsFramebuffer(GLuint framebuffer); Framebuffer Objects 529 Once a framebuffer object is created, you still can’t do much with it. You need to provide a place for drawing to go and reading to come from; those places are called framebuffer attachments. We’ll discuss those in more detail after we examine renderbuffers, which are one type of buffer you can attach to a framebuffer object. Renderbuffers Renderbuffers are effectively memory managed by OpenGL that contains formatted image data. The data that a renderbuffer holds takes meaning once it is attached to a framebuffer object, assuming that the format of the image buffer matches what OpenGL is expecting to render into (e.g., you can’t render colors into the depth buffer). As with many other buffers in OpenGL, the process of allocating and deleting buffers is similar to what you’ve seen before. To create a new renderbuffer, you would call glGenRenderbuffers(). Likewise, a call to glDeleteRenderbuffers() will release the storage associated with a renderbuffer. Returns GL_TRUE if framebuffer is the name of a framebuffer returned from glGenFramebuffers(). Returns GL_FALSE if framebuffer is zero (the window-system default framebuffer) or a value that’s either unallocated or been deleted by a call to glDeleteFramebuffers(). void glGenRenderbuffers(GLsizei n, GLuint *ids); Allocate n unused renderbuffer object names, and return those names in ids. Names are unused until bound with a call to glBindRenderbuffer(). void glDeleteRenderbuffers(GLsizei n, const GLuint *ids); Deallocates the n renderbuffer objects associated with the names provided in ids. If one of the renderbuffers is currently bound and passed to glDeleteRenderbuffers(), a binding of zero replaces the binding at the current framebuffer attachment point, in addition to the renderbuffer being released. No errors are generated by glDeleteRenderbuffers(). Unused names or zero are simply ignored. Likewise, you can determine whether a name represents a valid renderbuffer by calling glIsRenderbuffer(). Similar to the process of binding a framebuffer object so that you can modify its state, you call glBindRenderbuffer() to affect a renderbuffer’s creation and to modify the state associated with it, which includes the format of the image data that it contains. Creating Renderbuffer Storage When you first call glBindRenderbuffer() with an unused renderbuffer name, the OpenGL server creates a renderbuffer with all its state information set to the default values. In this configuration, no storage has been allocated to store image data. Before you can attach a renderbuffer to a framebuffer and render into it, you need to allocate storage and specify its image format. This is done by calling either glRenderbufferStorage() or glRenderbufferStorageMultisample(). void glIsRenderbuffer(GLuint renderbuffer); Returns GL_TRUE if renderbuffer is the name of a renderbuffer returned from glGenRenderbuffers(). Returns GL_FALSE if renderbuffer is zero (the window-system default framebuffer) or a value that’s either unallocated or been deleted by a call to glDeleteRenderbuffers(). void glBindRenderbuffer(GLenum target, GLuint renderbuffer); Creates a renderbuffer and associates it with the name renderbuffer. target must be GL_RENDERBUFFER. renderbuffer must either be zero, which removes any renderbuffer binding, or a name that was generated by a call to glGenRenderbuffers(); otherwise, a GL_INVALID_OPERATION error will be generated. void glRenderbufferStorage(GLenum target, GLenum internalformat, GLsizei width, GLsizei height); void glRenderbufferStorageMultisample(GLenum target, GLsizei samples, GLenum internalformat, GLsizei width, GLsizei height); Framebuffer Objects 531 Allocates storage for image data for the bound renderbuffer. target must be GL_RENDERBUFFER. For a color-renderable buffer, internalformat must be one of: GL_RED, GL_R8, GL_R16, GL_RG, GL_RG8, GL_RG16, GL_RGB, GL_R3_G3_B2, GL_RGB4, GL_RGB5, GL_RGB8, GL_RGB10, GL_RGB12, GL_RGB16, GL_RGBA, GL_RGBA2, GL_RGBA4, GL_RGB5_A1, GL_RGBA8, GL_RGB10_A2, GL_RGBA12, GL_RGBA16, GL_SRGB, GL_SRGB8, GL_SRGB_ALPHA, GL_SRGB8_ALPHA8,GL_R16F, GL_R32F, GL_RG16F, GL_RG32F, GL_RGB16F, GL_RGB32F, GL_RGBA16F, GL_RGBA32F, GL_R11F_G11F_B10F, GL_RGB9_E5, GL_R8I, GL_R8UI, GL_R16I, GL_R16UI, GL_R32I, GL_R32UI, GL_RG8I, GL_RG8UI, GL_RG16I, GL_RG16UI, GL_RG32I, GL_RG32UI, GL_RGB8I, GL_RGB8UI, GL_RGB16I, GL_RGB16UI, GL_RGB32I, GL_RGB32UI, GL_RGBA8I, GL_RGBA8UI, GL_RGBA16I, GL_RGBA16UI, GL_RGBA32I. OpenGL version 3.1 adds the additional following formats: GL_R8_SNORM, GL_R16_SNORM, GL_RG8_SNORM, GL_RG16_SNORM, GL_RGB8_ SNORM, GL_RGB16_SNORM, GL_RGBA8_SNORM, GL_RGBA16_SNORM. To use a renderbuffer as a depth buffer, it must be depth-renderable, which is specified by setting internalformat to either GL_DEPTH_COMPONENT, GL_DEPTH_COMPONENT16, GL_DEPTH_COMPONENT32, GL_DEPTH_ COMPONENT32, or GL_DEPTH_COMPONENT32F. For use exclusively as a stencil buffer, internalformat should be specified as either GL_STENCIL_INDEX, GL_STENCIL_INDEX1, GL_STENCIL_ INDEX4, GL_STENCIL_INDEX8, or GL_STENCIL_INDEX16. For packed depth-stencil storage, internalformat must be GL_DEPTH_ STENCIL, which allows the renderbuffer to be attached as the depth buffer, stencil buffer, or at the combined depth-stencil attachment point. width and height specify the size of the renderbuffer in pixels, and samples specifies the number of multisample samples per pixel. Setting samples to zero in a call to glRenderbufferStorageMultisample() is identical to calling glRenderbufferStorage(). A GL_INVALID_VALUE is generated if width or height is greater than the value returned when querying GL_MAX_RENDERBUFFER_SIZE, or if samples is greater than the value returned when querying GL_MAX_ SAMPLES. A GL_INVALID_OPERATION is generated if internalformat is a signed- or unsigned-integer format (e.g., a format containing a “I”, or “UI” in its token), and samples is not zero, and the implementation doesn’t support multisampled integer buffers. Finally, if the renderbuffer size and format combined exceed the available memory able to be allocated, then a GL_OUT_OF_MEMORY error is generated. Example 10-6 Creating an RGBA Color Renderbuffer: fbo.c glGenRenderbuffers( 1, &color ); glBindRenderbuffer( GL_RENDERBUFFER, color ); glRenderbufferStorage( GL_RENDERBUFFER, GL_RGBA, 256, 256 ); Once you have created storage for your renderbuffer, you need to attach it to a framebuffer object before you can render into it. Framebuffer Attachments When you render, you can send the results of that rendering to a number of places: • The color buffer to create an image, or even multiple color buffers if you’re using multiple render targets (see “Special Output Values” in Chapter 15) • The depth buffer to store occlusion information • The stencil buffer for storing per-pixel masks to control rendering Each of those buffers represents a framebuffer attachment, to which you can attach suitable image buffers that you later render into, or read from. Currently, there are two types of rendering surfaces you can associate with one of those attachments: renderbuffers and a level of a texture image. Attachment Name Description GL_COLOR_ATTACHMENTi The ith color buffer. i can range from zero (the default color buffer) to GL_MAX_COLOR_ATTACHMENTS–1 GL_DEPTH_ATTACHMENT The depth buffer GL_STENCIL_ATTACHMENT The stencil buffer GL_DEPTH_STENCIL_ATTACHMENT A special attachment for packed depthstencil buffers (which require the renderbuffer to have been allocated as a GL_DEPTH_STENCIL pixel format) We’ll first discuss attaching a renderbuffer to a framebuffer object, which is done by calling glFramebufferRenderbuffer(). In Example 10-7, we create and attach two renderbuffers: one for color, and the other for depth. We then proceed to render, and finally copy the results back to the window-system-provided framebuffer to display the results. You might use this technique to generate frames for a movie rendering offscreen, where you don’t have to worry about the visible framebuffer being corrupted by overlapping windows or someone resizing the window and interrupting rendering. One important point to remember is that you might need to reset the viewport for each framebuffer before rendering, particularly if the size of your application-defined framebuffers differs from the window-system provided framebuffer. Another very common use for framebuffer objects is to update textures dynamically. You might do this to indicate changes in a surface’s appearance (such as bullet holes in a wall in a game) or to update values in a lookup table if you’re doing GPGPU-like computations. In these cases, you bind a level of a texture map as the framebuffer attachment, as compared to a renderbuffer. After rendering, the texture map can be detached from the framebuffer so that it can be used in subsequent rendering. Note: Nothing prevents you from reading from a texture that is simultaneously bound as a framebuffer attachment for writing. In this scenario, called a framebuffer rendering loop, the results are undefined for both operations. That is, the values returned from sampling the bound texture map, as well as the values written into the texture level while bound, will likely be incorrect. void glFramebufferTexture1D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level); void glFramebufferTexture2D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level); void glFramebufferTexture3D(GLenum target, GLenum attachment, GLenum texturetarget, GLuint texture, GLint level, GLint layer); Attaches a level of a texture objects as a rendering attachment to a framebuffer object. target must be either GL_READ_FRAMEBUFFER, GL_DRAW_FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_FRAMEBUFFER). attachment must be one of the framebuffer attachment points: GL_COLOR_ATTACHMENTi, GL_DEPTH_ ATTACHMENT, GL_STENCIL_ATTACHMENT, or GL_DEPTH_STENCIL_ ATTACHMENT (in which case, the internal format of the texture must be GL_DEPTH_STENCIL). For glFramebufferTexture1D(), texturetarget must be GL_TEXTURE_1D, if texture is not zero. For glFramebufferTexture2D(), texturetarget must be GL_TEXTURE_2D, GL_TEXTURE_RECTANGLE, GL_TEXTURE_CUBE_ MAP_POSITIVE_X, GL_TEXTURE_CUBE_MAP_POSITIVE_Y, GL_ TEXTURE_CUBE_MAP_POSITIVE_Z, GL_TEXTURE_CUBE_MAP_ NEGATIVE_X, GL_TEXTURE_CUBE_MAP_NEGATIVE_Y, GL_TEXTURE_ CUBE_MAP_NEGATIVE_Z, and for glFramebufferTexture3D() texturetarget must be GL_TEXTURE_3D. Similar to the previous example, Example 10-8 demonstrates the process of dynamically updating a texture, using the texture after its update is completed, and then rendering with it later. Framebuffer Completeness Given the myriad of combinations between texture and buffer formats, and between framebuffer attachments, various situations can arise that prevent the completion of rendering when you are using applicationdefined framebuffer objects. After modifying the attachments to a framebuffer object, it’s best to check the framebuffer’s status by calling glCheckFramebufferStatus(). The errors representing the various violations of framebuffer configurations are listed in Table 10-7. Of the listed errors, GL_FRAMEBUFFER_UNSUPPORTED is very implementation dependent, and may be the most complicated to debug. void glFramebufferTextureLayer(GLenum target, GLenum attachment, GLuint texture, GLint level, GLint layer); Attaches a layer of a three-dimensional texture, or a one- or twodimensional array texture as a framebuffer attachment, in a similar manner to glFramebufferTexture3D(). target must be one of GL_READ_FRAMEBUFFER, GL_DRAW_ FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_ FRAMEBUFFER). attachment must be one of GL_COLOR_ATTACHMENTi, GL_DEPTH_ATTACHMENT, GL_STENCIL_ATTACHMENT, or GL_DEPTH_ STENCIL_ATTACHMENT. texture must be either zero, indicating that the current binding for the attachment should be released, or a texture object name (as returned from glGenTextures()). level indicates the mipmap level of the texture object, and layer represents which layer of the texture (or array element) should be bound as an attachment. GLenum glCheckFramebufferStatus(GLenum target); Returns one of the framebuffer completeness status enums listed in Table 10-7. target must be one of GL_READ_FRAMEBUFFER, GL_DRAW_ FRAMEBUFFER, or GL_FRAMEBUFFER (which is equivalent to GL_DRAW_ FRAMEBUFFER). If glCheckFramebufferStatus() generates an error, zero is returned. Framebuffer Objects 539 Copying Pixel Rectangles While glCopyPixels() has been the default routine for replicating blocks of pixels since OpenGL Version 1.0, as OpenGL expanded its rendering facilities, a more substantial pixel-copying routine was required. glBlitFramebuffer(), described below, subsumes the operations of glCopyPixels() and glPixelZoom() in a single, enhanced call. glBlitFramebuffer() allows greater pixel filtering during the copy operation, much in the same manner as texture mapping (in fact, the same filtering operations, GL_NEAREST and GL_LINEAR are used during the copy). Additionally, this routine is aware of multisampled buffers, and supports copying between different framebuffers (as controlled by framebuffer objects). Framebuffer Completeness Status Enum Description GL_FRAMEBUFFER_COMPLETE The framebuffer and its attachments match the rendering or reading state required. GL_FRAMEBUFFER_UNDEFINED The bound framebuffer is specified to be the default framebuffer (i.e., glBindFramebuffer() with zero specified as the framebuffer), and the default framebuffer doesn’t exist. GL_FRAMEBUFFER_ INCOMPLETE_ATTACHMENT A necessary attachment to the bound framebuffer is uninitialized GL_FRAMEBUFFER_ INCOMPLETE_MISSING_ ATTACHMENT There are no images (e.g., texture layers or renderbuffers) attached to the framebuffer. GL_FRAMEBUFFER_ INCOMPLETE_DRAW_BUFFER Every drawing buffer (e.g., GL_DRAW_BUFFERi as specified by glDrawBuffers()) has an attachment. GL_FRAMEBUFFER_ INCOMPLETE_READ_BUFFER An attachment exists for the buffer specified for the buffer specified by glReadBuffer(). GL_FRAMEBUFFER_ UNSUPPORTED The combination of images attached to the framebuffer object is incompatible with the requirements of the OpenGL implementation. GL_FRAMEBUFFER_ INCOMPLETE_MULTISAMPLE The number of samples for all images across the framebuffer’s attachments do not match. void glBlitFramebuffer(GLint srcX0, GLint srcY0, GLint srcX1, GLint srcY1, GLint dstX0, GLint dstY0, GLint dstX1, GLint dstY1, GLbitfield buffers, GLenum filter); Copies a rectangle of pixel values from one region of the read framebuffer to another region of the draw framebuffer, potentially resizing, reversing, converting, and filtering the pixels in the process. srcX0, srcY0, srcX1, srcY1 represent the source region where pixels are sourced from, and written to the rectangular region specified by dstX0, dstY0, dstX1, dstY1. buffers is the bitwise-or of GL_COLOR_BUFFER_BIT, GL_DEPTH_BUFFER_ BIT, and GL_STENCIL_BUFFER_BIT, which represent the buffers in which the copy should occur. Finally, filter specifies the method of interpolation done if the two rectangular regions are different sizes, and must be one of GL_NEAREST or GL_LINEAR; no filtering is applied if the regions are the same size. If there are multiple color draw buffers (See “Rendering to Multiple Output Buffers” on page 729), each buffer receives a copy of the source region. If srcX1 < srcX0, or dstX1 < dstX0, the image is reversed in the horizontal direction. Likewise, if srcY1 < srcY0 or dstY1 < dstY0, the image is reverse in the vertical direction. However, If both the source and destination sizes are negative in the same direction, no reversal is done. If the source and destination buffers are of different formats, conversion of the pixel values is done in most situations. However, if the read color buffer is a floating-point format, and any of the write color buffers are not, or vice verse; and if the read color buffer is a signed (unsigned) integer format and not all of the draw buffers are signed (unsigned) integer values, the call will generate a GL_INVALID_OPERATION, and no pixels will be copied. Multisampled buffers also have an effect on the copying of pixels. If the source buffer is multisampled, and the destination is not, the samples are resolved to a single pixel value for the destination buffer. Conversely, if the source buffer is not multisampled, and the destination is, the source pixel’s data is replicated for each sample. Finally, if both buffers are multisampled and the number of samples for each buffer is the same, the samples are copied without modification. However, if the buffers have a different number of samples, no pixels are copied, and a GL_INVALID_ OPERATION error is generated. A GL_INVALID_VALUE error is generated if buffers has other bits set than those permitted, or if filter is other than GL_LINEAR or GL_NEAREST Chapter Objectives After reading this chapter, you’ll be able to do the following: • Render concave filled polygons by first tessellating them into convex polygons, which can be rendered using standard OpenGL routines • Use the OpenGL Utility Library to create quadrics objects to render and model the surfaces of spheres and cylinders, and to tessellate disks (circles) and partial disks (arcs) Note: In OpenGL Version 3.1, some of the techniques and functions described in this chapter—particularly those relating to quadric objects—were likely affected by deprecation. While many of these features can be found in the GLU library, they rely on OpenGL functions that were removed. The OpenGL Library (GL) is designed for low-level operations, both streamlined and accessible to hardware acceleration. The OpenGL Utility Library (GLU) complements the OpenGL library, supporting higher-level operations. Some of the GLU operations are covered in other chapters. Mipmapping (gluBuild*DMipmaps()) and image scaling (gluScaleImage()) are discussed along with other facets of texture mapping in Chapter 9. Several matrix transformation GLU routines (gluOrtho2D(), gluPerspective(), gluLookAt(), gluProject(), gluUnProject(), and gluUnProject4()) are described in Chapter 3. The use of gluPickMatrix() is explained in Chapter 13. The GLU NURBS facilities, which are built atop OpenGL evaluators, are covered in Chapter 12. Only two GLU topics remain: polygon tessellators and quadric surfaces; these topics are discussed in this chapter. To optimize performance, the basic OpenGL renders only convex polygons, but the GLU contains routines for tessellating concave polygons into convex ones, which the basic OpenGL can handle. Where the basic OpenGL operates on simple primitives, such as points, lines, and filled polygons, the GLU can create higher-level objects, such as the surfaces of spheres, cylinders, and cones. This chapter has the following major sections. • “Polygon Tessellation” explains how to tessellate concave polygons into easier-to-render convex polygons. • “Quadrics: Rendering Spheres, Cylinders, and Disks” describes how to generate spheres, cylinders, circles and arcs, including data such as surface normals and texture coordinates. Polygon Tessellation As discussed in “Describing Points, Lines, and Polygons” in Chapter 2, OpenGL can directly display only simple convex polygons. A polygon is simple if the edges intersect only at vertices, there are no duplicate vertices, and exactly two edges meet at any vertex. If your application requires the display of concave polygons, polygons containing holes, or polygons with intersecting edges, these polygons must first be subdivided into simple convex polygons before they can be displayed. Such subdivision is called tessellation, and the GLU provides a collection of routines that perform tessellation. These routines take as input arbitrary contours, which describe hard-to-render polygons, and they return some combination of triangles, triangle meshes, triangle fans, and lines. If you think a polygon may need tessellation, follow these typical steps: 1. Create a new tessellation object with gluNewTess(). 2. Use gluTessCallback() several times to register callback functions to perform operations during the tessellation. The trickiest case for a callback function is when the tessellation algorithm detects an intersection and must call the function registered for the GLU_TESS_ COMBINE callback. 3. Specify tessellation properties by calling gluTessProperty(). The most important property is the winding rule, which determines the regions that should be filled and those that should remain unshaded. 4. Create and render tessellated polygons by specifying the contours of one or more closed polygons. If the data for the object is static, encapsulate the tessellated polygons in a display list. (If you don’t have to recalculate the tessellation repeatedly, using display lists is more efficient.) 5. If you need to tessellate something else, you may reuse your tessellation object. If you are forever finished with your tessellation object, you may delete it with gluDeleteTess(). Note: The tessellator described here was introduced in Version 1.2 of the GLU. If you are using an older version of the GLU, you must use routines described in “Describing GLU Errors” on page 557. To query which version of GLU you have, use gluGetString(GLU_VERSION), which returns a string with your GLU version number. If you don’t seem to have gluGetString() in your GLU, then you have GLU 1.0, which did not yet have the gluGetString() routine. Creating a Tessellation Object As a complex polygon is being described and tessellated, it has associated data, such as the vertices, edges, and callback functions. All this data is tied to a single tessellation object. To perform tessellation, your program first has to create a tessellation object using the routine gluNewTess(). A single tessellation object can be reused for all your tessellations. This object is required only because library routines might need to do their own tessellations, and they should be able to do so without interfering with any tessellation that your program is doing. It might also be useful to have multiple tessellation objects if you want to use different sets of callbacks for different tessellations. A typical program, however, allocates a single tessellation object and uses it for all its tessellations. There’s no real need to free it, because it uses a small amount of memory. On the other hand, it never hurts to be tidy. Tessellation Callback Routines After you create a tessellation object, you must provide a series of callback routines to be called at appropriate times during the tessellation. After specifying the callbacks, you describe the contours of one or more polygons using GLU routines. When the description of the contours is complete, the tessellation facility invokes your callback routines as necessary. Any functions that are omitted are simply not called during the tessellation, and any information they might have returned to your program is lost. All are specified by the single routine gluTessCallback(). GLUtesselator* gluNewTess(void); Creates a new tessellation object and returns a pointer to it. A null pointer is returned if the creation fails. Polygon Tessellation 545 void gluTessCallback(GLUtesselator *tessobj, GLenum type, void (*fn)()); Associates the callback function fn with the tessellation object tessobj. The type of the callback is determined by the parameter type, which can be GLU_TESS_BEGIN, GLU_TESS_BEGIN_DATA, GLU_TESS_EDGE_FLAG, GLU_TESS_EDGE_FLAG_DATA, GLU_TESS_VERTEX, GLU_TESS_VERTEX_ DATA, GLU_TESS_END, GLU_TESS_END_DATA, GLU_TESS_COMBINE, GLU_TESS_COMBINE_DATA, GLU_TESS_ERROR, or GLU_TESS_ERROR_ DATA. The 12 possible callback functions have the following prototypes: GLU_TESS_BEGIN void begin(GLenum type); GLU_TESS_BEGIN_DATA void begin(GLenum type, void *user_data); GLU_TESS_EDGE_FLAG void edgeFlag(GLboolean flag); GLU_TESS_EDGE_FLAG_DATA void edgeFlag(GLboolean flag, void *user_data); GLU_TESS_VERTEX void vertex(void *vertex_data); GLU_TESS_VERTEX_DATA void vertex(void *vertex_data, void *user_data); GLU_TESS_END void end(void); GLU_TESS_END_DATA void end(void *user_data); GLU_TESS_COMBINE void combine( GLdouble coords[3], void*vertex_data[4], GLfloat weight[4], void **outData); GLU_TESS_COMBINE_DATA void combine( GLdouble coords[3], void*vertex_data[4], GLfloat weight[4], void **outData, void *user_data); GLU_TESS_ERROR void error(GLenum errno); GLU_TESS_ERROR_DATA void error(GLenum errno, void *user_data); To change a callback routine, simply call gluTessCallback() with the new routine. To eliminate a callback routine without replacing it with a new one, pass gluTessCallback() a null pointer for the appropriate function. As tessellation proceeds, the callback routines are called in a manner similar to how you use the OpenGL commands glBegin(), glEdgeFlag*(), glVertex*(), and glEnd(). (See “Marking Polygon Boundary Edges” in Chapter 2 for more information about glEdgeFlag*().) The combine callback is used to create new vertices where edges intersect. The error callback is invoked during the tessellation only if something goes wrong. For every tessellator object created, a GLU_TESS_BEGIN callback is invoked with one of four possible parameters: GL_TRIANGLE_FAN, GL_TRIANGLE_ STRIP, GL_TRIANGLES, or GL_LINE_LOOP. When the tessellator decomposes the polygons, the tessellation algorithm decides which type of triangle primitive is most efficient to use. (If the GLU_TESS_BOUNDARY_ONLY property is enabled, then GL_LINE_LOOP is used for rendering.) Since edge flags make no sense in a triangle fan or triangle strip, if there is a callback associated with GLU_TESS_EDGE_FLAG that enables edge flags, the GLU_TESS_BEGIN callback is called only with GL_TRIANGLES. The GLU_TESS_EDGE_FLAG callback works exactly analogously to the OpenGL glEdgeFlag*() call. After the GLU_TESS_BEGIN callback routine is called and before the callback associated with GLU_TESS_END is called, some combination of the GLU_TESS_EDGE_FLAG and GLU_TESS_VERTEX callbacks is invoked (usually by calls to gluTessVertex(), which is described on page 555). The associated edge flags and vertices are interpreted exactly as they are in OpenGL between glBegin() and the matching glEnd(). If something goes wrong, the error callback is passed a GLU error number. A character string describing the error is obtained using the routine gluErrorString(). (See “Describing GLU Errors” on page 557 for more information about this routine.) Example 11-1 shows a portion of tess.c, in which a tessellation object is created and several callbacks are registered. Example 11-1 Registering Tessellation Callbacks: tess.c #ifndef CALLBACK #define CALLBACK #endif Polygon Tessellation 547 /* a portion of init() */ tobj = gluNewTess(); gluTessCallback(tobj, GLU_TESS_VERTEX, glVertex3dv); gluTessCallback(tobj, GLU_TESS_BEGIN, beginCallback); gluTessCallback(tobj, GLU_TESS_END, endCallback); gluTessCallback(tobj, GLU_TESS_ERROR, errorCallback); /* the callback routines registered by gluTessCallback() */ void CALLBACK beginCallback(GLenum which) { glBegin(which); } void CALLBACK endCallback(void) { glEnd(); } void CALLBACK errorCallback(GLenum errorCode) { const GLubyte *estring; estring = gluErrorString(errorCode); fprintf(stderr, ""Tessellation Error: %s\n"", estring); exit(0); } Note: Type casting of callback functions is tricky, especially if you wish to make code that runs equally well on Microsoft Windows and UNIX. To run on Microsoft Windows, programs that declare callback functions, such as tess.c, need the symbol CALLBACK in the declarations of functions. The trick of using an empty definition for CALLBACK (as demonstrated below) allows the code to run well on both Microsoft Windows and UNIX: #ifndef CALLBACK #define CALLBACK #endif void CALLBACK callbackFunction(...) { .... } In Example 11-1, the registered GLU_TESS_VERTEX callback is simply glVertex3dv(), and only the coordinates at each vertex are passed along. However, if you want to specify more information at every vertex, such as a color value, a surface normal vector, or a texture coordinate, you’ll have to make a more complex callback routine. Example 11-2 shows the start of another tessellated object, further along in program tess.c. The registered function vertexCallback() expects to receive a parameter that is a pointer to six double-length floating-point values: the x-, y-, and z-coordinates and the red, green, and blue color values for that vertex. Example 11-2 Vertex and Combine Callbacks: tess.c /* a different portion of init() */ gluTessCallback(tobj, GLU_TESS_VERTEX, vertexCallback); gluTessCallback(tobj, GLU_TESS_BEGIN, beginCallback); gluTessCallback(tobj, GLU_TESS_END, endCallback); gluTessCallback(tobj, GLU_TESS_ERROR, errorCallback); gluTessCallback(tobj, GLU_TESS_COMBINE, combineCallback); /* new callback routines registered by these calls */ void CALLBACK vertexCallback(GLvoid *vertex) { const GLdouble *pointer; pointer = (GLdouble *) vertex; glColor3dv(pointer+3); glVertex3dv(vertex); } void CALLBACK combineCallback(GLdouble coords[3], GLdouble *vertex_data[4], GLfloat weight[4], GLdouble **dataOut ) { GLdouble *vertex; int i; vertex = (GLdouble *) malloc(6 * sizeof(GLdouble)); vertex[0] = coords[0]; vertex[1] = coords[1]; vertex[2] = coords[2]; for (i = 3; i < 6; i++) vertex[i] = weight[0] * vertex_data[0][i] + weight[1] * vertex_data[1][i] + weight[2] * vertex_data[2][i] + weight[3] * vertex_data[3][i]; *dataOut = vertex; } Polygon Tessellation 549 Example 11-2 also shows the use of the GLU_TESS_COMBINE callback. Whenever the tessellation algorithm examines the input contours, detects an intersection, and decides it must create a new vertex, the GLU_TESS_ COMBINE callback is invoked. The callback is also called when the tessellator decides to merge features of two vertices that are very close to one another. The newly created vertex is a linear combination of up to four existing vertices, referenced by vertex_data[0..3] in Example 11-2. The coefficients of the linear combination are given by weight[0..3]; these weights sum to 1.0. coords gives the location of the new vertex. The registered callback routine must allocate memory for another vertex, perform a weighted interpolation of data using vertex_data and weight, and return the new vertex pointer as dataOut. combineCallback() in Example 11-2 interpolates the RGB color value. The function allocates a six-element array, puts the x-, y-, and z-coordinates in the first three elements, and then puts the weighted average of the RGB color values in the last three elements. User-Specified Data Six kinds of callbacks can be registered. Since there are two versions of each kind of callback, there are 12 callbacks in all. For each kind of callback, there is one with user-specified data and one without. The user-specified data is given by the application to gluTessBeginPolygon() and is then passed, unaltered, to each *DATA callback routine. With GLU_TESS_BEGIN_DATA, the user-specified data may be used for “per-polygon” data. If you specify both versions of a particular callback, the callback with user_data is used, and the other is ignored. Therefore, although there are 12 callbacks, you can have a maximum of six callback functions active at any one time. For instance, Example 11-2 uses smooth shading, so vertexCallback() specifies an RGB color for every vertex. If you want to do lighting and smooth shading, the callback would specify a surface normal for every vertex. However, if you want lighting and flat shading, you might specify only one surface normal for every polygon, not for every vertex. In that case, you might choose to use the GLU_TESS_BEGIN_DATA callback and pass the vertex coordinates and surface normal in the user_data pointer. Tessellation Properties Prior to tessellation and rendering, you may use gluTessProperty() to set several properties to affect the tessellation algorithm. The most important and complicated of these properties is the winding rule, which determines what is considered “interior” and “exterior.” Winding Numbers and Winding Rules For a single contour, the winding number of a point is the signed number of revolutions we make around that point while traveling once around the contour (where a counterclockwise revolution is positive and a clockwise revolution is negative). When there are several contours, the individual winding numbers are summed. This procedure associates a signed integer value with each point in the plane. Note that the winding number is the same for all points in a single region. void gluTessProperty(GLUtesselator *tessobj, GLenum property, GLdouble value); For the tessellation object tessobj, the current value of property is set to value. property is GLU_TESS_BOUNDARY_ONLY, GLU_TESS_TOLERANCE, or GLU_TESS_WINDING_RULE. If property is GLU_TESS_BOUNDARY_ONLY, value is either GL_TRUE or GL_FALSE. When it is set to GL_TRUE, polygons are no longer tessellated into filled polygons; line loops are drawn to outline the contours that separate the polygon interior and exterior. The default value is GL_FALSE. (See gluTessNormal() to see how to control the winding direction of the contours.) If property is GLU_TESS_TOLERANCE, value is a distance used to calculate whether two vertices are close enough together to be merged by the GLU_TESS_COMBINE callback. The tolerance value is multiplied by the largest coordinate magnitude of an input vertex to determine the maximum distance any feature can move as a result of a single merge operation. Feature merging may not be supported by your implementation, and the tolerance value is only a hint. The default tolerance value is zero. The GLU_TESS_WINDING_RULE property determines which parts of the polygon are on the interior and which are on the exterior and should not be filled. value can be GLU_TESS_WINDING_ODD (the default), GLU_ TESS_WINDING_NONZERO, GLU_TESS_WINDING_POSITIVE, GLU_ TESS_WINDING_NEGATIVE, or GLU_TESS_WINDING_ABS_GEQ_TWO. In the set at the left, all three contours are counterclockwise, so each nested interior region adds 1 to the winding number. In the middle set, the two interior contours are drawn clockwise, so the winding number decreases and actually becomes negative. The winding rule classifies a region as inside if its winding number belongs to the chosen category (odd, nonzero, positive, negative, or “absolute value greater than or equal to 2”). The odd and nonzero rules are common ways to define the interior. The positive, negative, and “absolute value t 2” winding rules have some limited use for polygon CSG (computational solid geometry) operations. The program tesswind.c demonstrates the effects of winding rules. The four sets of contours shown in Figure 11-3 are rendered. The user can then cycle through the different winding rule properties to see their effects. For each winding rule, the dark areas represent interiors. Note the effects of clockwise and counterclockwise winding. CSG Uses for Winding Rules GLU_TESS_WINDING_ODD and GLU_TESS_WINDING_NONZERO are the most commonly used winding rules. They work for the most typical cases of shading. The winding rules are also designed for CSG operations, making it easy to find the union, difference, or intersection (Boolean operations) of several contours. 1 2 3 1 0 -1 1 1 1 1 1 2 First, assume that each contour is defined so that the winding number is 0 for each exterior region and 1 for each interior region. (Each contour must not intersect itself.) Under this model, counterclockwise contours define the outer boundary of the polygon, and clockwise contours define holes. Contours may be nested, but a nested contour must be oriented oppositely from the contour that contains it. 1 2 3 1 0 -1 1 2 321 4321 Contours and Winding Numbers Winding Rules Odd Nonzero Positive Negative ABS_GEQ_TWO Unfilled Unfilled Unfilled Unfilled If the original polygons do not satisfy this description, they can be converted to this form by first running the tessellator with the GLU_TESS_ BOUNDARY_ONLY property turned on. This returns a list of contours satisfying the restriction just described. By creating two tessellator objects, the callbacks from one tessellator can be fed directly as input to the other. Given two or more polygons of the preceding form, CSG operations can be implemented as follows: • UNION—To calculate the union of several contours, draw all input contours as a single polygon. The winding number of each resulting region is the number of original polygons that cover it. The union can be extracted by using the GLU_TESS_WINDING_NONZERO or GLU_TESS_WINDING_POSITIVE winding rule. Note that with the nonzero winding rule, we would get the same result if all contour orientations were reversed. • INTERSECTION—This works only for two contours at a time. Draw a single polygon using two contours. Extract the result using GLU_TESS_ WINDING_ABS_GEQ_TWO. • DIFFERENCE—Suppose you want to compute A diff (B union C union D). Draw a single polygon consisting of the unmodified contours from A, followed by the contours of B, C, and D, with their vertex order reversed. To extract the result, use the GLU_TESS_WINDING_POSITIVE winding rule. (If B, C, and D are the result of a GLU_TESS_BOUNDARY_ ONLY operation, an alternative to reversing the vertex order is to use gluTessNormal() to reverse the sign of the supplied normal.) Other Tessellation Property Routines There are also complementary routines, which work alongside gluTessProperty(). gluGetTessProperty() retrieves the current values of tessellator properties. If the tessellator is being used to generate wireframe outlines instead of filled polygons, gluTessNormal() can be used to determine the winding direction of the tessellated polygons. void gluGetTessProperty(GLUtesselator *tessobj, GLenum property, GLdouble *value); For the tessellation object tessobj, the current value of property is returned to value. Values for property and value are the same as for gluTessProperty(). If you have some knowledge about the location and orientation of the input data, then using gluTessNormal() can increase the speed of the tessellation. For example, if you know that all polygons lie on the xy-plane, call gluTessNormal(tessobj, 0, 0, 1). As stated above, the default normal is (0, 0, 0), and its effect is not immediately obvious. In this case, it is expected that the input data lies approximately in a plane, and a plane is fitted to the vertices, no matter how they are truly connected. The sign of the normal is chosen so that the sum of the signed areas of all input contours is non-negative (where a counterclockwise contour has a positive area). Note that if the input data does not lie approximately in a plane, then projection perpendicular to the computed normal may substantially change the geometry. After all the tessellation properties have been set and the callback actions have been registered, it is finally time to describe the vertices that comprise input contours and tessellate the polygons. Calls to gluTessBeginPolygon() and gluTessEndPolygon() surround the definition of one or more contours. When gluTessEndPolygon() is called, the tessellation algorithm is implemented, and the tessellated polygons are void gluTessNormal(GLUtesselator *tessobj, GLdouble x, GLdouble y, GLdouble z); For the tessellation object tessobj, gluTessNormal() defines a normal vector, which controls the winding direction of generated polygons. Before tessellation, all input data is projected into a plane perpendicular to the normal. Then, all output triangles are oriented counterclockwise, with respect to the normal. (Clockwise orientation can be obtained by reversing the sign of the supplied normal.) The default normal is (0, 0, 0). void gluTessBeginPolygon(GLUtesselator *tessobj, void *user_data); void gluTessEndPolygon(GLUtesselator *tessobj); Begins and ends the specification of a polygon to be tessellated and associates a tessellation object, tessobj, with it. user_data points to a userdefined data structure, which is passed along all the GLU_TESS_*_DATA callback functions that have been bound. generated and rendered. The callback functions and tessellation properties that were bound and set to the tessellation object using gluTessCallback() and gluTessProperty() are used. In practice, a minimum of three vertices is needed for a meaningful contour. In the program tess.c, a portion of which is shown in Example 11-3, two polygons are defined. One polygon is a rectangular contour with a triangular hole inside, and the other is a smooth-shaded, self-intersecting, five-pointed star. For efficiency, both polygons are stored in display lists. The first polygon consists of two contours; the outer one is wound counterclockwise, and the “hole” is wound clockwise. For the second polygon, the star array contains both the coordinate and color data, and its tessellation callback, vertexCallback(), uses both. It is important that each vertex is in a different memory location because the vertex data is not copied by gluTessVertex(); only the pointer (vertex_ data) is saved. A program that reuses the same memory for several vertices may not get the desired result. Note: In gluTessVertex(), it may seem redundant to specify the vertex coordinate data twice, for both the coords and vertex_data parameters; however, both are necessary. coords refers only to the vertex coordinates. vertex_data uses the coordinate data, but may also use other information for each vertex. void gluTessBeginContour(GLUtesselator *tessobj); void gluTessEndContour(GLUtesselator *tessobj); Begins and ends the specification of a closed contour, which is a portion of a polygon. A closed contour consists of zero or more calls to gluTessVertex(), which defines the vertices. The last vertex of each contour is automatically linked to the first. void gluTessVertex(GLUtesselator *tessobj, GLdouble coords[3], void *vertex_data); Specifies a vertex in the current contour for the tessellation object. coords contains the three-dimensional vertex coordinates, and vertex_data is a pointer that’s sent to the callback associated with GLU_TESS_VERTEX or GLU_TESS_VERTEX_DATA. Typically, vertex_data contains vertex coordinates, surface normals, texture coordinates, color information, or whatever else the application may find useful. Deleting a Tessellation Object If you no longer need a tessellation object, you can delete it and free all associated memory with gluDeleteTess(). Tessellation Performance Tips For best performance, remember these rules: • Cache the output of the tessellator in a display list or other user structure. To obtain the post-tessellation vertex coordinates, tessellate the polygons while in feedback mode. (See “Feedback” in Chapter 13.) • Use gluTessNormal() to supply the polygon normal. • Use the same tessellator object to render many polygons, rather than allocate a new tessellator for each one. (In a multithreaded, multiprocessor environment, you may get better performance using several tessellators.) Describing GLU Errors The GLU provides a routine for obtaining a descriptive string for an error code. This routine is not limited to tessellation but is also used for NURBS and quadrics errors, as well as for errors in the base GL. (See “Error void gluDeleteTess(GLUtesselator *tessobj); Deletes the specified tessellation object, tessobj, and frees all associated memory. Handling” in Chapter 14 for information about OpenGL’s error-handling facility.) Backward Compatibility If you are using the 1.0 or 1.1 version of GLU, you have a much less powerful tessellator. The 1.0/1.1 tessellator handles only simple nonconvex polygons or simple polygons containing holes. It does not properly tessellate intersecting contours (no COMBINE callback) or process per-polygon data. The 1.0/1.1 tessellator still works in either GLU 1.2 or 1.3, but its use is no longer recommended. The 1.0/1.1 tessellator has some similarities to the current tessellator. gluNewTess() and gluDeleteTess() are used for both tessellators. The main vertex specification routine remains gluTessVertex(). The callback mechanism is controlled by gluTessCallback(), although only five callback functions can be registered, a subset of the current 12. Here are the prototypes for the 1.0/1.1 tessellator: void gluBeginPolygon(GLUtriangulatorObj *tessobj); void gluNextContour(GLUtriangulatorObj *tessobj, GLenum type); void gluEndPolygon(GLUtriangulatorObj *tessobj); The outermost contour must be specified first, and it does not require an initial call to gluNextContour(). For polygons without holes, only one contour is defined, and gluNextContour() is not used. If a polygon has multiple contours (that is, holes or holes within holes), the contours are specified one after the other, each preceded by gluNextContour(). gluTessVertex() is called for each vertex of a contour. For gluNextContour(), type can be GLU_EXTERIOR, GLU_INTERIOR, GLU_CCW, GLU_CW, or GLU_UNKNOWN. These serve only as hints to the tessellation. If you get them right, the tessellation might go faster. If you get them wrong, they’re ignored, and the tessellation still works. For polygons with holes, one contour is the exterior contour and the other is the interior. The first contour is assumed to be of type GLU_EXTERIOR. Choosing clockwise or counterclockwise orientation is arbitrary in three dimensions; however, there are two different orientations in any plane, and the GLU_CCW and GLU_CW types should be used consistently. Use GLU_UNKNOWN if you don’t have a clue. Quadrics: Rendering Spheres, Cylinders, and Disks 559 It is highly recommended that you convert GLU 1.0/1.1 code to the new tessellation interface for GLU 1.2 by following these steps: 1. Change references to the major data structure type from GLUtriangulatorObj to GLUtesselator. In GLU 1.2, GLUtriangulatorObj and GLUtesselator are defined to be the same type. 2. Convert gluBeginPolygon() to two commands: gluTessBeginPolygon() and gluTessBeginContour(). All contours must be explicitly started, including the first one. 3. Convert gluNextContour() to both gluTessEndContour() and gluTessBeginContour(). You have to end the previous contour before starting the next one. 4. Convert gluEndPolygon() to both gluTessEndContour() and gluTessEndPolygon(). The final contour must be closed. 5. Change references to constants to gluTessCallback(). In GLU 1.2, GLU_BEGIN, GLU_VERTEX, GLU_END, GLU_ERROR, and GLU_EDGE_FLAG are defined as synonyms for GLU_TESS_BEGIN, GLU_TESS_VERTEX, GLU_TESS_END, GLU_TESS_ERROR, and GLU_TESS_EDGE_FLAG. Please respond using only information provided in the context block. If the information needed to answer the question is not within the context block, state that you cannot answer. I am interested in what context one would use the glGenFrameBuffers() function. What does this function do exactly? Please include any extra information to help understand the function.",Internet/Technology,Explanation/Definition,Q&A You can only respond to the prompt using the information in the context block and no other sources.,List the pros and cons for Nestle in regards to this deal.,"Nestlé and Starbucks close deal for the perpetual global license of Starbucks Consumer Packaged Goods and Foodservice products Vevey and Seattle, 28 August 2018 – Nestlé and Starbucks Corporation today announced the closing of the deal granting Nestlé the perpetual rights to market Starbucks Consumer Packaged Goods and Foodservice products globally, outside of the company’s coffee shops. Through the alliance, the two companies will work closely together on the existing Starbucks range of roast and ground coffee, whole beans as well as instant and portioned coffee. The alliance will also capitalize on the experience and capabilities of both companies to work on innovation with the goal of enhancing its product offerings for coffee lovers globally. “This partnership demonstrates our growth agenda in action, giving Nestlé an unparalleled position in the coffee business with a full suite of innovative brands. With Starbucks, Nescafé and Nespresso we bring together the world’s most iconic coffee brands,” said Mark Schneider, Nestlé CEO. “The outstanding collaboration between the two teams resulted in a swift completion of this agreement, which will pave the way to capture further growth opportunities,” he added. The agreement significantly strengthens Nestlé’s coffee portfolio in the North American premium roast and ground and portioned coffee business. It also unlocks global expansion in grocery and food service for the Starbucks brand, utilizing the global reach of Nestlé. “This global coffee alliance with Nestlé is a significant strategic milestone for the growth of Starbucks,” said Kevin Johnson, president and ceo of Starbucks. “Bringing together the world’s leading coffee retailer, the world’s largest food and beverage company, and the world’s largest and fast-growing installed base of at-home and single-serve coffee machines helps us amplify the Starbucks brand around the world while delivering long-term value creation for our shareholders.” Approximately 500 Starbucks employees in the United States and Europe will join the Nestlé family, with the majority based in Seattle and London. The international expansion of the business will be led from Nestlé’s global headquarters in Vevey, Switzerland. The agreement covers Starbucks packaged coffee and tea brands, such as Starbucks®, Seattle’s Best Coffee®, TeavanaTM/MC, Starbucks VIA® Instant, Torrefazione Italia® coffee and Starbucks-branded ","You can only respond to the prompt using the information in the context block and no other sources. Nestlé and Starbucks close deal for the perpetual global license of Starbucks Consumer Packaged Goods and Foodservice products Vevey and Seattle, 28 August 2018 – Nestlé and Starbucks Corporation today announced the closing of the deal granting Nestlé the perpetual rights to market Starbucks Consumer Packaged Goods and Foodservice products globally, outside of the company’s coffee shops. Through the alliance, the two companies will work closely together on the existing Starbucks range of roast and ground coffee, whole beans as well as instant and portioned coffee. The alliance will also capitalize on the experience and capabilities of both companies to work on innovation with the goal of enhancing its product offerings for coffee lovers globally. “This partnership demonstrates our growth agenda in action, giving Nestlé an unparalleled position in the coffee business with a full suite of innovative brands. With Starbucks, Nescafé and Nespresso we bring together the world’s most iconic coffee brands,” said Mark Schneider, Nestlé CEO. “The outstanding collaboration between the two teams resulted in a swift completion of this agreement, which will pave the way to capture further growth opportunities,” he added. The agreement significantly strengthens Nestlé’s coffee portfolio in the North American premium roast and ground and portioned coffee business. It also unlocks global expansion in grocery and food service for the Starbucks brand, utilizing the global reach of Nestlé. “This global coffee alliance with Nestlé is a significant strategic milestone for the growth of Starbucks,” said Kevin Johnson, president and ceo of Starbucks. “Bringing together the world’s leading coffee retailer, the world’s largest food and beverage company, and the world’s largest and fast-growing installed base of at-home and single-serve coffee machines helps us amplify the Starbucks brand around the world while delivering long-term value creation for our shareholders.” Approximately 500 Starbucks employees in the United States and Europe will join the Nestlé family, with the majority based in Seattle and London. The international expansion of the business will be led from Nestlé’s global headquarters in Vevey, Switzerland. The agreement covers Starbucks packaged coffee and tea brands, such as Starbucks®, Seattle’s Best Coffee®, TeavanaTM/MC, Starbucks VIA® Instant, Torrefazione Italia® coffee and Starbucks-branded List the pros and cons for Nestle in regards to this deal.",Retail/Product,Pros & Cons,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",Summarize this article so that a college-level student would be able to understand the important concepts using scientific language. You should write your summary in the format of a lecture on autonomic dysfunction. Do not mention orthostatic hypotension and focus more on the associated tachycardia. Emphasize the pathophysiology and the effect autonomic dysfunction has on various regions of the body.,"Acquired Autoimmune: Guillain-Barre, Autoimmune autonomic ganglionopathy, Lambert-Eaton myasthenic syndrome, rheumatoid arthritis, Sjogren, systemic lupus erythematosus Abnormal reflex responses in carotid sinus hypersensitivity, vasovagal syncope, and other neuro-meditated syncopes; and probably in postural tachycardia syndrome (PoTS) Abnormal sweating responses, as in generalized or focal hyperhidrosis, are related to excessive activation. Metabolic/ Nutritional: Diabetes mellitus, vitamin B12 deficiency Degenerative neurologic diseases: Parkinson disease, multiple system atrophy/Shy-Drager syndrome, pure autonomic failure presenting or suffering from orthostatic hypotension, fixed heart rate responses Infections: Botulism, Chagas disease, human immunodeficiency virus (HIV), leprosy, Lyme disease, tetanus Neoplasia: Brain tumors, paraneoplastic syndromes Pharmacologic effects of several drugs that interfere with normal autonomic function and provoke symptoms include alpha- and beta-blocker-triggered orthostatic hypotension Toxin/drug-induced: Alcohol, amiodarone, chemotherapy Traumatic or tumoral spinal cord injuries at different levels and presenting with the so-called autonomic dysreflexia Uremic neuropathy/chronic liver diseases Medications That Exacerbate Orthostatic Hypotension Diuretics: furosemide, torsemide, thiazide Nitric oxide-mediated vasodilators: nitroglycerine, hydralazine, sildenafil Adrenergic antagonists: Alpha-1-adrenergic blockers: alfuzosin, terazosin Beta-adrenergic blockers: propranolol Alpha -2-adrenergic agonists: tizanidine, clonidine Renin-angiotensin system inhibitors: lisinopril, valsartan Dopamine antagonists: Phenothiazines: chlorpromazine Atypical antipsychotics: olanzapine, risperidone, quetiapine Calcium channel blockers: verapamil, diltiazem Selective serotonin receptor reuptake inhibitors: paroxetine Antidepressants: trazodone, amitriptyline Go to: Epidemiology Autonomic dysfunction, taken as a whole, is not infrequent. The most common autonomic dysfunction occurs in the cardiovascular control sphere and consists of an abnormal vasovagal response that leads to syncope. Other common manifestations are related to postural tachycardia syndrome (POTS) or changes seen with Parkinson disease and other parkinsonisms. Compared to other areas of autonomic control, urinary incontinence, as observed in multiple sclerosis and other nervous system disorders, is unspecific but not rare. Some symptoms of autonomic disturbance, such as the facial vasomotor and ocular symptoms in trigeminal autonomic headaches, are of secondary significance but help in diagnosis.[14][15][16][17] Orthostatic hypotension occurs in patients with neurodegenerative disorders such as Parkinson disease, multiple system atrophy, pure autonomic failure, and in individuals with ganglionopathies that affect autonomic nerves and peripheral neuropathy. The prevalence of orthostatic hypotension is proportional to age, and it is more common in institutionalized than community-dwelling elderly[18]. POTS is more prevalent in women. Syncope is highly prevalent in the general population, and the majority of syncope is due to reflex syncope. The frequency of reflex syncope is higher during adolescence and in individuals over 55 years. Carotid sinus hypersensitivity, defecation, and cough syncope occur almost exclusively in the elderly population.[18] Go to: Pathophysiology Pathophysiology in ANS depends upon the affected area. Both anatomically related, as well as isolated regions, can be affected. In the cardiovascular system, three pathophysiological syndromes are typically associated with chronic dysfunction of the ANS. These are Postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension with supine hypertension, and reflex cardiovascular syndromes. Hyperhidrosis and hypohidrosis are the main features of temperature control. Fixed mydriasis and myosis, also known as Adie's pupil and Horner syndrome in the eye, are also seen. Autonomic dysfunction may result from any disease that affects the peripheral or central components of ANS. Primary autonomic dysfunction involves primary (idiopathic) degeneration of autonomic postganglionic fibers without other neurologic abnormalities. Orthostatic hypotension is associated with autonomic dysfunction and motor and cerebellar abnormalities in diseases involving a central degenerative process, as described in the Shy–Drager syndrome. A central degenerative disease process involving preganglionic neuronal degeneration, presenting with orthostatic hypotension and typical parkinsonian symptoms, has been described.[19] Orthostatic hypotension is defined as a sustained reduction of systolic blood pressure of at least 20 mmHg or diastolic blood pressure of 10 mmHg within three minutes of standing or head-up tilt to at least 60 degrees on the tilt table. The magnitude of fall in blood pressure depends on baseline blood pressure. In patients with supine hypertension, a reduction of 30 mmHg in systolic blood pressure may be an appropriate criterion for orthostatic hypotension. Immediately upon standing, gravitationally mediated redistribution of the blood volume and pooling of 300 to 800 ml of blood in lower limbs and splanchnic venous capacitance system occurs, which leads to a reduction of venous return and cardiac filling pressure. During standing, contraction of skeletal muscles of the lower body prevents excessive pooling and increases venous return to the heart. Orthostatic hypotension is caused by an excessive fall of cardiac output or by inadequate or defective vasoconstrictor mechanisms. Neurally mediated (reflex) syncope includes vasovagal, carotid sinus, situational (cough, swallowing, micturition) syncope. It refers to a diverse group of conditions in which there is a relatively sudden change in ANS activity leading to a drop in blood pressure, heart rate, and cerebral perfusion. Neurally mediated syncope is best understood as a reflex with afferent, central, and efferent pathways, and the use of 'neurocardiogenic syncope' should be abandoned because the origin of the reflex is rarely in the heart. Postural tachycardia syndrome (POTS) is defined as a sustained heart rate increment of 30 beats per minute within 10 minutes of standing or head-up tilt in the absence of orthostatic hypotension. For individuals of ages 12 to 19 years, the requirement is at least 40 beats per minute. POTS may be accompanied by symptoms of autonomic overactivity and cerebral hypoperfusion that are relieved by recumbency. The pathophysiology and etiology of POTS are unknown but are likely heterogeneous. POTS is associated with recent viral illness, chronic fatigue syndrome, deconditioning, and limited or restricted autonomic neuropathy.[18] Diabetic neuropathy is a kind of nerve pathology that may occur for those with diabetes mellitus. Hyperglycemia interferes with a nerve's ability to send signals and weakens the walls of the vasa nervorum blood vessels that supply nerves with nutrients and oxygen. Diabetic neuropathy can affect the nerves of the ANS, especially general visceral afferent (GVA) fibers, resulting in gastroparesis and decreased blood pressure regulation.[20] GVA fibers affected by diabetic neuropathy reduce the response of their corresponding general visceral efferent (GVE). Parkinson disease is a progressive neurodegenerative disease characterized by bradykinesia and hypokinesia combined with rest tremor and rigidity. Constipation, dysphagia, sialorrhea, rhinorrhea, urinary difficulties, and sexual dysfunction are the common nonmotor problems related to autonomic dysfunction in Parkinson disease.[21][22] These signs and symptoms are also present in multiple system atrophy (MSA), making it hard to distinguish between the two disorders. However, the autonomic symptoms in MSA are generally more severe than in Parkinson disease. As the disease progresses, MSA tends to be less responsive to levodopa and is often associated with pyramidal and cerebellar findings.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Summarize this article so that a college-level student would be able to understand the important concepts using scientific language. You should write your summary in the format of a lecture on autonomic dysfunction. Do not mention orthostatic hypotension and focus more on the associated tachycardia. Emphasize the pathophysiology and the effect autonomic dysfunction has on various regions of the body. Acquired Autoimmune: Guillain-Barre, Autoimmune autonomic ganglionopathy, Lambert-Eaton myasthenic syndrome, rheumatoid arthritis, Sjogren, systemic lupus erythematosus Abnormal reflex responses in carotid sinus hypersensitivity, vasovagal syncope, and other neuro-meditated syncopes; and probably in postural tachycardia syndrome (PoTS) Abnormal sweating responses, as in generalized or focal hyperhidrosis, are related to excessive activation. Metabolic/ Nutritional: Diabetes mellitus, vitamin B12 deficiency Degenerative neurologic diseases: Parkinson disease, multiple system atrophy/Shy-Drager syndrome, pure autonomic failure presenting or suffering from orthostatic hypotension, fixed heart rate responses Infections: Botulism, Chagas disease, human immunodeficiency virus (HIV), leprosy, Lyme disease, tetanus Neoplasia: Brain tumors, paraneoplastic syndromes Pharmacologic effects of several drugs that interfere with normal autonomic function and provoke symptoms include alpha- and beta-blocker-triggered orthostatic hypotension Toxin/drug-induced: Alcohol, amiodarone, chemotherapy Traumatic or tumoral spinal cord injuries at different levels and presenting with the so-called autonomic dysreflexia Uremic neuropathy/chronic liver diseases Medications That Exacerbate Orthostatic Hypotension Diuretics: furosemide, torsemide, thiazide Nitric oxide-mediated vasodilators: nitroglycerine, hydralazine, sildenafil Adrenergic antagonists: Alpha-1-adrenergic blockers: alfuzosin, terazosin Beta-adrenergic blockers: propranolol Alpha -2-adrenergic agonists: tizanidine, clonidine Renin-angiotensin system inhibitors: lisinopril, valsartan Dopamine antagonists: Phenothiazines: chlorpromazine Atypical antipsychotics: olanzapine, risperidone, quetiapine Calcium channel blockers: verapamil, diltiazem Selective serotonin receptor reuptake inhibitors: paroxetine Antidepressants: trazodone, amitriptyline Go to: Epidemiology Autonomic dysfunction, taken as a whole, is not infrequent. The most common autonomic dysfunction occurs in the cardiovascular control sphere and consists of an abnormal vasovagal response that leads to syncope. Other common manifestations are related to postural tachycardia syndrome (POTS) or changes seen with Parkinson disease and other parkinsonisms. Compared to other areas of autonomic control, urinary incontinence, as observed in multiple sclerosis and other nervous system disorders, is unspecific but not rare. Some symptoms of autonomic disturbance, such as the facial vasomotor and ocular symptoms in trigeminal autonomic headaches, are of secondary significance but help in diagnosis.[14][15][16][17] Orthostatic hypotension occurs in patients with neurodegenerative disorders such as Parkinson disease, multiple system atrophy, pure autonomic failure, and in individuals with ganglionopathies that affect autonomic nerves and peripheral neuropathy. The prevalence of orthostatic hypotension is proportional to age, and it is more common in institutionalized than community-dwelling elderly[18]. POTS is more prevalent in women. Syncope is highly prevalent in the general population, and the majority of syncope is due to reflex syncope. The frequency of reflex syncope is higher during adolescence and in individuals over 55 years. Carotid sinus hypersensitivity, defecation, and cough syncope occur almost exclusively in the elderly population.[18] Go to: Pathophysiology Pathophysiology in ANS depends upon the affected area. Both anatomically related, as well as isolated regions, can be affected. In the cardiovascular system, three pathophysiological syndromes are typically associated with chronic dysfunction of the ANS. These are Postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension with supine hypertension, and reflex cardiovascular syndromes. Hyperhidrosis and hypohidrosis are the main features of temperature control. Fixed mydriasis and myosis, also known as Adie's pupil and Horner syndrome in the eye, are also seen. Autonomic dysfunction may result from any disease that affects the peripheral or central components of ANS. Primary autonomic dysfunction involves primary (idiopathic) degeneration of autonomic postganglionic fibers without other neurologic abnormalities. Orthostatic hypotension is associated with autonomic dysfunction and motor and cerebellar abnormalities in diseases involving a central degenerative process, as described in the Shy–Drager syndrome. A central degenerative disease process involving preganglionic neuronal degeneration, presenting with orthostatic hypotension and typical parkinsonian symptoms, has been described.[19] Orthostatic hypotension is defined as a sustained reduction of systolic blood pressure of at least 20 mmHg or diastolic blood pressure of 10 mmHg within three minutes of standing or head-up tilt to at least 60 degrees on the tilt table. The magnitude of fall in blood pressure depends on baseline blood pressure. In patients with supine hypertension, a reduction of 30 mmHg in systolic blood pressure may be an appropriate criterion for orthostatic hypotension. Immediately upon standing, gravitationally mediated redistribution of the blood volume and pooling of 300 to 800 ml of blood in lower limbs and splanchnic venous capacitance system occurs, which leads to a reduction of venous return and cardiac filling pressure. During standing, contraction of skeletal muscles of the lower body prevents excessive pooling and increases venous return to the heart. Orthostatic hypotension is caused by an excessive fall of cardiac output or by inadequate or defective vasoconstrictor mechanisms. Neurally mediated (reflex) syncope includes vasovagal, carotid sinus, situational (cough, swallowing, micturition) syncope. It refers to a diverse group of conditions in which there is a relatively sudden change in ANS activity leading to a drop in blood pressure, heart rate, and cerebral perfusion. Neurally mediated syncope is best understood as a reflex with afferent, central, and efferent pathways, and the use of 'neurocardiogenic syncope' should be abandoned because the origin of the reflex is rarely in the heart. Postural tachycardia syndrome (POTS) is defined as a sustained heart rate increment of 30 beats per minute within 10 minutes of standing or head-up tilt in the absence of orthostatic hypotension. For individuals of ages 12 to 19 years, the requirement is at least 40 beats per minute. POTS may be accompanied by symptoms of autonomic overactivity and cerebral hypoperfusion that are relieved by recumbency. The pathophysiology and etiology of POTS are unknown but are likely heterogeneous. POTS is associated with recent viral illness, chronic fatigue syndrome, deconditioning, and limited or restricted autonomic neuropathy.[18] Diabetic neuropathy is a kind of nerve pathology that may occur for those with diabetes mellitus. Hyperglycemia interferes with a nerve's ability to send signals and weakens the walls of the vasa nervorum blood vessels that supply nerves with nutrients and oxygen. Diabetic neuropathy can affect the nerves of the ANS, especially general visceral afferent (GVA) fibers, resulting in gastroparesis and decreased blood pressure regulation.[20] GVA fibers affected by diabetic neuropathy reduce the response of their corresponding general visceral efferent (GVE). Parkinson disease is a progressive neurodegenerative disease characterized by bradykinesia and hypokinesia combined with rest tremor and rigidity. Constipation, dysphagia, sialorrhea, rhinorrhea, urinary difficulties, and sexual dysfunction are the common nonmotor problems related to autonomic dysfunction in Parkinson disease.[21][22] These signs and symptoms are also present in multiple system atrophy (MSA), making it hard to distinguish between the two disorders. However, the autonomic symptoms in MSA are generally more severe than in Parkinson disease. As the disease progresses, MSA tends to be less responsive to levodopa and is often associated with pyramidal and cerebellar findings. https://www.ncbi.nlm.nih.gov/books/NBK430888/",Medical,Summarize & Format,Text Transformation "System Instructions: * Use only information provided to you: do not rely on external sources or prior knowledge. * Respond with a bulleted list. * Do not include any filler or explanations. * If you are unable to find the information requested within the context provided, say so instead of trying to answer.","Question: Find and summarize the most common symptoms of narcolepsy, using two or three sentences each.","Context: Narcolepsy Symptoms Excessive Daytime Sleepiness Excessive daytime sleepiness, or EDS, is the inability to stay awake and alert during the day, resulting in unintended lapses into drowsiness or sleep. • Every patient with narcolepsy has EDS, and it is often the first symptom. • When describing this symptom, patients may say that they: – Have a hard time staying awake while doing everyday things – Are tired or fatigued – Have trouble concentrating or staying focused – Are forgetful or have poor memory – Have mood changes or get upset easily • EDS may be disabling because of the high risk of falling asleep—or having a “sleep attack”—while you are doing everyday things, such as: – Sitting and reading – Riding in a car – Stopped in traffic while driving a car – Talking to someone • You may take daytime naps, but these naps likely only help you feel refreshed for a short period of time. Cataplexy Cataplexy is a sudden, brief loss of muscle strength or control triggered by strong emotions. • Cataplexy may cause a sudden feeling of weakness. • Cataplectic attacks are not the same in everyone. – Usually, attacks affect only certain muscle groups, such as the arms, neck, or face. You may not even recognize these subtle attacks, but your friends or family may notice them. – Less commonly, you can have weakness in your whole body and fall to the ground. – The type of cataplexy attack experienced by one person is usually the same (eg, head dropping). • Attacks are often triggered by: – Sudden, strong emotions such as happiness, laughter, surprise, or anger – Hearing or telling a joke • These attacks usually last for only a short time—from a few seconds to several minutes. • All people with cataplexy do not have the same number of attacks. For some people, they are rare. Other people have many attacks each day. Sleep Paralysis Sleep paralysis is the brief inability to move or speak while falling asleep or waking up. This can be a distressing or terrifying experience. During sleep paralysis, you can experience: • Eye fluttering • Moaning • Limb numbness or tingling • Rapid or strong heartbeat • Sweating • Sensation of struggling to move • Chest pressure • Difficulty breathing Episodes usually last seconds to minutes and can end by themselves or from being touched, shaken, or spoken to, or after trying hard to move. Sleep paralysis sometimes accompanies hypnagogic or hypnopompic hallucinations, other symptoms of narcolepsy. Disrupted Nighttime Sleep It’s normal to wake up during the night once in a while. But when you have disrupted sleep associated with narcolepsy, it means you often fall asleep quickly but wake up frequently throughout the night. • With disrupted nighttime sleep, you may: – Fall asleep easily but have trouble staying asleep for long periods of time – Report poor-quality sleep Hypnagogic/Hypnopompic Hallucinations Hypnagogic hallucinations are vivid dreamlike experiences that occur while you are falling asleep. When they occur while waking up, they are called hypnopompic hallucinations. • These hallucinations may be mistaken for nightmares. • These hallucinations may also occur with “sleep paralysis.” • You may have experiences such as: – Hearing sounds or words when drifting off to sleep – Having a strong feeling that someone or something is in the room – Seeing people or creatures near you or even lying in your bed • These events are usually frightening or disturbing. • Anyone can have one of these hallucinations at some time in his or her life. However, if you have them regularly, it could be a sign of narcolepsy.","System Instructions: * Use only information provided to you: do not rely on external sources or prior knowledge. * Respond with a bulleted list. * Do not include any filler or explanations. * If you are unable to find the information requested within the context provided, say so instead of trying to answer. Context: Narcolepsy Symptoms Excessive Daytime Sleepiness Excessive daytime sleepiness, or EDS, is the inability to stay awake and alert during the day, resulting in unintended lapses into drowsiness or sleep. • Every patient with narcolepsy has EDS, and it is often the first symptom. • When describing this symptom, patients may say that they: – Have a hard time staying awake while doing everyday things – Are tired or fatigued – Have trouble concentrating or staying focused – Are forgetful or have poor memory – Have mood changes or get upset easily • EDS may be disabling because of the high risk of falling asleep—or having a “sleep attack”—while you are doing everyday things, such as: – Sitting and reading – Riding in a car – Stopped in traffic while driving a car – Talking to someone • You may take daytime naps, but these naps likely only help you feel refreshed for a short period of time. Cataplexy Cataplexy is a sudden, brief loss of muscle strength or control triggered by strong emotions. • Cataplexy may cause a sudden feeling of weakness. • Cataplectic attacks are not the same in everyone. – Usually, attacks affect only certain muscle groups, such as the arms, neck, or face. You may not even recognize these subtle attacks, but your friends or family may notice them. – Less commonly, you can have weakness in your whole body and fall to the ground. – The type of cataplexy attack experienced by one person is usually the same (eg, head dropping). • Attacks are often triggered by: – Sudden, strong emotions such as happiness, laughter, surprise, or anger – Hearing or telling a joke • These attacks usually last for only a short time—from a few seconds to several minutes. • All people with cataplexy do not have the same number of attacks. For some people, they are rare. Other people have many attacks each day. Sleep Paralysis Sleep paralysis is the brief inability to move or speak while falling asleep or waking up. This can be a distressing or terrifying experience. During sleep paralysis, you can experience: • Eye fluttering • Moaning • Limb numbness or tingling • Rapid or strong heartbeat • Sweating • Sensation of struggling to move • Chest pressure • Difficulty breathing Episodes usually last seconds to minutes and can end by themselves or from being touched, shaken, or spoken to, or after trying hard to move. Sleep paralysis sometimes accompanies hypnagogic or hypnopompic hallucinations, other symptoms of narcolepsy. Disrupted Nighttime Sleep It’s normal to wake up during the night once in a while. But when you have disrupted sleep associated with narcolepsy, it means you often fall asleep quickly but wake up frequently throughout the night. • With disrupted nighttime sleep, you may: – Fall asleep easily but have trouble staying asleep for long periods of time – Report poor-quality sleep Hypnagogic/Hypnopompic Hallucinations Hypnagogic hallucinations are vivid dreamlike experiences that occur while you are falling asleep. When they occur while waking up, they are called hypnopompic hallucinations. • These hallucinations may be mistaken for nightmares. • These hallucinations may also occur with “sleep paralysis.” • You may have experiences such as: – Hearing sounds or words when drifting off to sleep – Having a strong feeling that someone or something is in the room – Seeing people or creatures near you or even lying in your bed • These events are usually frightening or disturbing. • Anyone can have one of these hallucinations at some time in his or her life. However, if you have them regularly, it could be a sign of narcolepsy. Question: Find and summarize the most common symptoms of narcolepsy, using two or three sentences each.",Medical,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","What are the different minerals in seawater which affect performance, what is causing the decrease in performance and how can we prevent performance degradation from occurring.","INTRODUCTION Hydrogen (H2), with its high-energy density and zero-emission properties, holds great promise as a sustainable energy carrier (1–4). Seawater electrolysis, as a promising alternative for sustainable hydrogen production, faces challenges due to the expensive and scarce platinum catalyst, as well as the need for additional purification processes to address the complex nature of seawater, resulting in higher production costs (5–7). Compared to the widely adopted practice of hydrogen production through electrolysis of alkaline freshwater, the advancement of hydrogen production from seawater has been relatively sluggish (8). The pH of natural seawater is typically around 8.0 and reduced ionic mobility in seawater leads to a diminished pH dependence of the hydrogen evolution reaction (HER) (9, 10), necessitating higher applied voltages to attain the desired efficiency in hydrogen production (11). Furthermore, the complex composition of seawater and the insoluble deposits formed by alkaline earth metal ions such as Ca2+, Mg2+ during electrolysis make seawater HER challenging (1, 12). More fatally, Cl- has a high affinity for the metal active sites of the catalysts as they have strong depassivation and penetrating properties (13, 14), leading to severe degradation of the catalyst and hindering direct seawater electrolysis for hydrogen production (15–17). Although certain catalysts demonstrated activity at low current densities but offer low hydrogen production rates (18, 19), far below the high-current hydrogen production conditions required for industrial water electrolysis. To address this bottleneck issue, various strategies have been developed, including selective active site engineering (20, 21), three-dimensional structure design (22, 23), and carbon layer protection (24, 25). Recently, Guo et al. (26) proposed an innovative strategy, wherein they enhanced the kinetic processes by generating an in situ localized alkaline environment, achieving excellent seawater catalytic performance at 60°C. Metal nitrides (MNs) have inherent chemical stability, electrical conductivity, and excellent catalytic activity, and their surfaces undergo in situ transformation to form highly catalytic active hydroxides, while the nitride core remains stable (27, 28). For example, NiMoN@NiFeN prepared by Yu et al. (29) required an overpotential of 160 mV to reach a current density of 500 mA cm-2 and stable operation for 48 hours, which is attributed to the amorphous NiFeOOH layer formed on the nitride surface. Regrettably, the performance of current MN-based electrocatalysts is still suboptimal and it is urgent to manipulate them for efficient seawater splitting. In this work, we present a protective strategy by introducing a V2O3 layer by in situ reduction into a catalyst with low loading of Pt and Ni3N. The V2O3 layer acts as an “armor” during electrolysis, markedly reducing the adsorption of Cl- and alkaline earth cations (Ca2+ and Mg2+) from seawater and preventing corrosion of the active sites on the electrode. Benefiting from the powerful protection mechanism, the assembled Pt-Ni3N@V2O3 catalyst exhibits remarkable HER activity in alkalized natural seawater and maintains its performance for at least 500 hours at industrial-grade current density, surpassing the performance of other reported electrocatalysts. RESULTS Synthesis and characterization The hydrothermal method was used to prepare hydroxide precursors in nanoflower-shaped structures, as illustrated in figs. S1 and S2. Subsequently, calcination in NH3 gas was used to obtain a composite of Ni3N and V2O3, resulting in the formation of numerous rough porous structures on the catalyst surface. Pt-Ni3N@V2O3/NF (nickel foam noted as NF) was constructed by placing the Ni3N@V2O3/NF precursor in an aqueous solution of H2PtCl6 at room temperature. On the basis of previous reports, we speculate on the reduction mechanism and route (30–32). Specifically, V2O3, as a strong reducing agent, first forms (V2O3)x(OH-)y(s) with H2O molecules (chemical eq. S1), and then Pt4+ ions in solution adsorb onto the surface of the (V2O3)x(OH-)y(s). In situ reduction then occurs with the assistance of H2O molecules to form Pt nanoparticles (chemical eq. S2). Theoretical calculations also confirm that Pt nanoparticles preferentially form on the V2O3 surface rather than the Ni3N surface (fig. S2). The powder x-ray diffraction (XRD) patterns, as illustrated in Fig. 1A and fig. S3, confirm the presence of a composite phase comprising Ni3N, V2O3, and Pt. These results demonstrate the successful preparation of Pt-Ni3N@V2O3/NF. The hydroxide precursors prepared by the hydrothermal method exhibited nanoflower-like structures with low crystallinity, as shown in figs. S4 and S5. After ammonolysis, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) show that Ni3N@V2O3/NF exhibit interconnected porous structures (fig. S6) with lattice stripes of 0.203 and 0.183 nm corresponding well to the (111) and (024) facets of Ni3N and V2O3 (fig. S7), respectively. After the incorporation of Pt, SEM and TEM analyses reveal that Pt-Ni3N@V2O3/NF exhibits a granular morphology, together with a rough surface (Fig. 1, B and C). Pt nanoparticles, formed in situ, have an average particle size of 4.41 nm. The high-resolution TEM (HRTEM) shows that amorphous/low crystallinity V2O3 covers the outer surface of Pt-Ni3N@V2O3/NF (Fig. 1D), with lattice stripes of 0.203 and 0.226 nm corresponding to the (111) facets of Ni3N and the (111) facets of Pt (Fig. 1, E to G), respectively. As demonstrated in fig. S8, the particle size of Pt-Ni3N@V2O3/NF increases with longer impregnation time, and this observation is also supported by the electrochemical properties. In Fig. 1 (H and I), high-angle annular dark-field scanning TEM (HAADF-STEM) images, energy-dispersive spectroscopy (EDS) elemental mapping, and EDS line scan collectively suggest that the internal larger nanoparticles comprise Ni3N, while V2O3 is distributed in the surrounding region. In addition, uniformly anchored, small-sized Pt nanoparticles are found on the surface of the structure, forming a dual-active site. The content of Pt is determined by energy dispersive x-ray spectroscopy to be approximately 6.61% (fig. S9 and table S1), which is consistent with the results of inductively coupled plasma–optical emission spectrometry (ICP-OES) analysis (6.94%). It is worth noting that the reduction of Pt also occurs on the Ni3N surface in the absence of the V2O3 in situ reduction layer (fig. S3C), but with considerable agglomeration (figs. S10 and S11), which is undoubtedly detrimental to catalytic performance. The V2O3 serves as both a potent in situ reducing agent and stabilizer. Its rough surface offers numerous anchor sites and exerts steric hindrance effects, influencing the nucleation and growth kinetics of Pt nanoparticles while impeding their migration and aggregation (30).To address this bottleneck issue, various strategies have been developed, including selective active site engineering (20, 21), three-dimensional structure design (22, 23), and carbon layer protection (24, 25). Recently, Guo et al. (26) proposed an innovative strategy, wherein they enhanced the kinetic processes by generating an in situ localized alkaline environment, achieving excellent seawater catalytic performance at 60°C. Metal nitrides (MNs) have inherent chemical stability, electrical conductivity, and excellent catalytic activity, and their surfaces undergo in situ transformation to form highly catalytic active hydroxides, while the nitride core remains stable (27, 28). For example, NiMoN@NiFeN prepared by Yu et al. (29) required an overpotential of 160 mV to reach a current density of 500 mA cm-2 and stable operation for 48 hours, which is attributed to the amorphous NiFeOOH layer formed on the nitride surface. Regrettably, the performance of current MN-based electrocatalysts is still suboptimal and it is urgent to manipulate them for efficient seawater splitting. In this work, we present a protective strategy by introducing a V2O3 layer by in situ reduction into a catalyst with low loading of Pt and Ni3N. The V2O3 layer acts as an “armor” during electrolysis, markedly reducing the adsorption of Cl- and alkaline earth cations (Ca2+ and Mg2+) from seawater and preventing corrosion of the active sites on the electrode. Benefiting from the powerful protection mechanism, the assembled Pt-Ni3N@V2O3 catalyst exhibits remarkable HER activity in alkalized natural seawater and maintains its performance for at least 500 hours at industrial-grade current density, surpassing the performance of other reported electrocatalysts","""================ ======= INTRODUCTION Hydrogen (H2), with its high-energy density and zero-emission properties, holds great promise as a sustainable energy carrier (1–4). Seawater electrolysis, as a promising alternative for sustainable hydrogen production, faces challenges due to the expensive and scarce platinum catalyst, as well as the need for additional purification processes to address the complex nature of seawater, resulting in higher production costs (5–7). Compared to the widely adopted practice of hydrogen production through electrolysis of alkaline freshwater, the advancement of hydrogen production from seawater has been relatively sluggish (8). The pH of natural seawater is typically around 8.0 and reduced ionic mobility in seawater leads to a diminished pH dependence of the hydrogen evolution reaction (HER) (9, 10), necessitating higher applied voltages to attain the desired efficiency in hydrogen production (11). Furthermore, the complex composition of seawater and the insoluble deposits formed by alkaline earth metal ions such as Ca2+, Mg2+ during electrolysis make seawater HER challenging (1, 12). More fatally, Cl- has a high affinity for the metal active sites of the catalysts as they have strong depassivation and penetrating properties (13, 14), leading to severe degradation of the catalyst and hindering direct seawater electrolysis for hydrogen production (15–17). Although certain catalysts demonstrated activity at low current densities but offer low hydrogen production rates (18, 19), far below the high-current hydrogen production conditions required for industrial water electrolysis. To address this bottleneck issue, various strategies have been developed, including selective active site engineering (20, 21), three-dimensional structure design (22, 23), and carbon layer protection (24, 25). Recently, Guo et al. (26) proposed an innovative strategy, wherein they enhanced the kinetic processes by generating an in situ localized alkaline environment, achieving excellent seawater catalytic performance at 60°C. Metal nitrides (MNs) have inherent chemical stability, electrical conductivity, and excellent catalytic activity, and their surfaces undergo in situ transformation to form highly catalytic active hydroxides, while the nitride core remains stable (27, 28). For example, NiMoN@NiFeN prepared by Yu et al. (29) required an overpotential of 160 mV to reach a current density of 500 mA cm-2 and stable operation for 48 hours, which is attributed to the amorphous NiFeOOH layer formed on the nitride surface. Regrettably, the performance of current MN-based electrocatalysts is still suboptimal and it is urgent to manipulate them for efficient seawater splitting. In this work, we present a protective strategy by introducing a V2O3 layer by in situ reduction into a catalyst with low loading of Pt and Ni3N. The V2O3 layer acts as an “armor” during electrolysis, markedly reducing the adsorption of Cl- and alkaline earth cations (Ca2+ and Mg2+) from seawater and preventing corrosion of the active sites on the electrode. Benefiting from the powerful protection mechanism, the assembled Pt-Ni3N@V2O3 catalyst exhibits remarkable HER activity in alkalized natural seawater and maintains its performance for at least 500 hours at industrial-grade current density, surpassing the performance of other reported electrocatalysts. RESULTS Synthesis and characterization The hydrothermal method was used to prepare hydroxide precursors in nanoflower-shaped structures, as illustrated in figs. S1 and S2. Subsequently, calcination in NH3 gas was used to obtain a composite of Ni3N and V2O3, resulting in the formation of numerous rough porous structures on the catalyst surface. Pt-Ni3N@V2O3/NF (nickel foam noted as NF) was constructed by placing the Ni3N@V2O3/NF precursor in an aqueous solution of H2PtCl6 at room temperature. On the basis of previous reports, we speculate on the reduction mechanism and route (30–32). Specifically, V2O3, as a strong reducing agent, first forms (V2O3)x(OH-)y(s) with H2O molecules (chemical eq. S1), and then Pt4+ ions in solution adsorb onto the surface of the (V2O3)x(OH-)y(s). In situ reduction then occurs with the assistance of H2O molecules to form Pt nanoparticles (chemical eq. S2). Theoretical calculations also confirm that Pt nanoparticles preferentially form on the V2O3 surface rather than the Ni3N surface (fig. S2). The powder x-ray diffraction (XRD) patterns, as illustrated in Fig. 1A and fig. S3, confirm the presence of a composite phase comprising Ni3N, V2O3, and Pt. These results demonstrate the successful preparation of Pt-Ni3N@V2O3/NF. The hydroxide precursors prepared by the hydrothermal method exhibited nanoflower-like structures with low crystallinity, as shown in figs. S4 and S5. After ammonolysis, scanning electron microscopy (SEM) and transmission electron microscopy (TEM) show that Ni3N@V2O3/NF exhibit interconnected porous structures (fig. S6) with lattice stripes of 0.203 and 0.183 nm corresponding well to the (111) and (024) facets of Ni3N and V2O3 (fig. S7), respectively. After the incorporation of Pt, SEM and TEM analyses reveal that Pt-Ni3N@V2O3/NF exhibits a granular morphology, together with a rough surface (Fig. 1, B and C). Pt nanoparticles, formed in situ, have an average particle size of 4.41 nm. The high-resolution TEM (HRTEM) shows that amorphous/low crystallinity V2O3 covers the outer surface of Pt-Ni3N@V2O3/NF (Fig. 1D), with lattice stripes of 0.203 and 0.226 nm corresponding to the (111) facets of Ni3N and the (111) facets of Pt (Fig. 1, E to G), respectively. As demonstrated in fig. S8, the particle size of Pt-Ni3N@V2O3/NF increases with longer impregnation time, and this observation is also supported by the electrochemical properties. In Fig. 1 (H and I), high-angle annular dark-field scanning TEM (HAADF-STEM) images, energy-dispersive spectroscopy (EDS) elemental mapping, and EDS line scan collectively suggest that the internal larger nanoparticles comprise Ni3N, while V2O3 is distributed in the surrounding region. In addition, uniformly anchored, small-sized Pt nanoparticles are found on the surface of the structure, forming a dual-active site. The content of Pt is determined by energy dispersive x-ray spectroscopy to be approximately 6.61% (fig. S9 and table S1), which is consistent with the results of inductively coupled plasma–optical emission spectrometry (ICP-OES) analysis (6.94%). It is worth noting that the reduction of Pt also occurs on the Ni3N surface in the absence of the V2O3 in situ reduction layer (fig. S3C), but with considerable agglomeration (figs. S10 and S11), which is undoubtedly detrimental to catalytic performance. The V2O3 serves as both a potent in situ reducing agent and stabilizer. Its rough surface offers numerous anchor sites and exerts steric hindrance effects, influencing the nucleation and growth kinetics of Pt nanoparticles while impeding their migration and aggregation (30).To address this bottleneck issue, various strategies have been developed, including selective active site engineering (20, 21), three-dimensional structure design (22, 23), and carbon layer protection (24, 25). Recently, Guo et al. (26) proposed an innovative strategy, wherein they enhanced the kinetic processes by generating an in situ localized alkaline environment, achieving excellent seawater catalytic performance at 60°C. Metal nitrides (MNs) have inherent chemical stability, electrical conductivity, and excellent catalytic activity, and their surfaces undergo in situ transformation to form highly catalytic active hydroxides, while the nitride core remains stable (27, 28). For example, NiMoN@NiFeN prepared by Yu et al. (29) required an overpotential of 160 mV to reach a current density of 500 mA cm-2 and stable operation for 48 hours, which is attributed to the amorphous NiFeOOH layer formed on the nitride surface. Regrettably, the performance of current MN-based electrocatalysts is still suboptimal and it is urgent to manipulate them for efficient seawater splitting. In this work, we present a protective strategy by introducing a V2O3 layer by in situ reduction into a catalyst with low loading of Pt and Ni3N. The V2O3 layer acts as an “armor” during electrolysis, markedly reducing the adsorption of Cl- and alkaline earth cations (Ca2+ and Mg2+) from seawater and preventing corrosion of the active sites on the electrode. Benefiting from the powerful protection mechanism, the assembled Pt-Ni3N@V2O3 catalyst exhibits remarkable HER activity in alkalized natural seawater and maintains its performance for at least 500 hours at industrial-grade current density, surpassing the performance of other reported electrocatalysts https://www.science.org/doi/10.1126/sciadv.adn7012 ================ ======= What are the different minerals in seawater which affect performance, what is causing the decrease in performance and how can we prevent performance degradation from occurring. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Internet/Technology,Explanation/Definition,Q&A Do not use any information outside of the context.,"According to the context, what are the pros and cons of using Motrin?","CLINICAL PHARMACOLOGY MOTRIN tablets contain ibuprofen which possesses analgesic and antipyretic activities. Its mode of action, like that of other NSAIDs, is not completely understood, but may be related to prostaglandin synthetase inhibition. In clinical studies in patients with rheumatoid arthritis and osteoarthritis, MOTRIN tablets have been shown to be comparable to aspirin in controlling pain and inflammation and to be associated with a statistically significant reduction in the milder gastrointestinal side effects. MOTRIN tablets may be well tolerated in some patients who have had gastrointestinal side effects with aspirin, but these patients when treated with MOTRIN tablets should be carefully followed for signs and symptoms of gastrointestinal ulceration and bleeding. Although it is not definitely known whether MOTRIN tablets causes less peptic ulceration than aspirin, in one study involving 885 patients with rheumatoid arthritis treated for up to one year, there were no reports of gastric ulceration with MOTRIN tablets whereas frank ulceration was reported in 13 patients in the aspirin group (statistically significant p<.001). Gastroscopic studies at varying doses show an increased tendency toward gastric irritation at higher doses. However, at comparable doses, gastric irritation is approximately half that seen with aspirin. In clinical studies in patients with rheumatoid arthritis, MOTRIN tablets have been shown to be comparable to indomethacin in controlling the signs and symptoms of disease activity and to be associated with a statistically significant reduction of the milder gastrointestinal and CNS side effects. Controlled studies have demonstrated that MOTRIN tablets are a more effective analgesic than propoxyphene for the relief of episiotomy pain, pain following dental extraction procedures, and for the relief of the symptoms of primary dysmenorrhea. In patients with primary dysmenorrhea, MOTRIN tablets have been shown to reduce elevated levels of prostaglandin activity in the menstrual fluid and to reduce resting and active intrauterine pressure, as well as the frequency of uterine contractions. The probable mechanism of action is to inhibit prostaglandin synthesis rather than simply to provide analgesia. INDICATIONS AND USAGE MOTRIN tablets are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis. MOTRIN tablets are indicated for relief of mild to moderate pain. MOTRIN tablets are also indicated for the treatment of primary dysmenorrhea. Controlled clinical trials to establish the safety and effectiveness of MOTRIN tablets in children have not been conducted. CONTRAINDICATIONS MOTRIN tablets are contraindicated in patients with known hypersensitivity to Ibuprofen. MOTRIN tablets should not be given to patients who have experienced asthma, urticaria, or allergictype reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients. MOTRIN tablets are contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS). WARNINGS CARDIOVASCULAR EFFECTS Cardiovascular Thrombotic Events Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs, both COX-2 selective and nonselective, may have a similar risk. Patients with known CV disease or risk factors for CV disease may be at greater risk. To minimize the potential risk for an adverse CV event in patients treated with an NSAID, the lowest effective dose should be used for the shortest duration possible. Physicians and patients should remain alert for the development of such events, even in the absence of previous CV symptoms. Patients should be informed about the signs and/or symptoms of serious CV events and the steps to take if they occur. There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use. The concurrent use of aspirin and an NSAID does increase the risk of serious GI events (see GI WARNINGS). Two large, controlled clinical trials of a COX-2 selective NSAID for the treatment of pain in the first 10-14 days following CABG surgery found an increased incidence of myocardial infarction and stroke (see CONTRAINDICATIONS). Hypertension NSAIDs including MOTRIN tablets, can lead to onset of new hypertension or worsening of preexisting hypertension, either of which may contribute to the increased incidence of CV events. Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs. NSAIDs, including MOTRIN tablets, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy. Congestive Heart Failure and Edema Fluid retention and edema have been observed in some patients taking NSAIDs. MOTRIN tablets should be used with caution in patients with fluid retention or heart failure. Gastrointestinal Effects - Risk of Ulceration, Bleeding, and Perforation NSAIDs, including MOTRIN tablets, can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine,which can be fatal. These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. Only one in five patients, who develop a serious upper GI adverse event on NSAID therapy, is symptomatic. Upper GI ulcers, gross bleeding, or perforation caused by NSAIDs occur in approximately 1% of patients treated for 3-6 months, and in about 2-4% of patients treated for one year. These trends continue with longer duration of use, increasing the likelihood of developing a serious GI event at some time during the course of therapy. However, even short-term therapy is not without risk. NSAIDs should be prescribed with extreme caution in those with a prior history of ulcer disease or gastrointestinal bleeding. Patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients treated with neither of these risk factors. Other factors that increase the risk of GI bleeding in patients treated with NSAIDs include concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor general health status. Most spontaneous reports of fatal GI events are in elderly or debilitated patients and therefore, special care should be taken in treating this population. To minimize the potential risk for an adverse GI event in patients treated with an NSAID, the lowest effective dose should be used for the shortest possible duration. Patients and physicians should remain alert for signs and symptoms of GI ulcerations and bleeding during NSAID therapy and promptly initiate additional evaluation and treatment if a serious GI event is suspected. This should include discontinuation of the NSAID until a serious GI adverse event is ruled out. For high-risk patients, alternate therapies that do not involve NSAIDs should be considered. Renal Effects Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of a NSAID may cause a dosedependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors, and the elderly. Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state. Advanced Renal Disease No information is available from controlled clinical studies regarding the use of MOTRIN tablets in patients with advanced renal disease. Therefore, treatment with MOTRIN tablets is not recommended in these patients with advanced renal disease. If MOTRIN tablet therapy must be initiated, close monitoring of the patients renal function is advisable. Anaphylactoid Reactions As with other NSAIDs, anaphylactoid reactions may occur in patients without known prior exposure to MOTRIN tablets. MOTRIN tablets should not be given to patients with the aspirin triad. This symptom complex typically occurs in asthmatic patients who experience rhinitis with or without nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs (see CONTRAINDICATIONS and PRECAUTIONS, Preexisting Asthma). Emergency help should be sought in cases where an anaphylactoid reaction occurs. Skin Reactions NSAIDs, including MOTRIN tablets, can cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. These serious events may occur without warning. Patients should be informed about the signs and symptoms of serious skin manifestations and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. Pregnancy In late pregnancy, as with other NSAIDs, MOTRIN tablets should be avoided because it may cause premature closure of the ductus arteriosus. ","Question: According to the context, what are the pros and cons of using Motrin? System Instructions: Do not use any information outside of the context. Context: CLINICAL PHARMACOLOGY MOTRIN tablets contain ibuprofen which possesses analgesic and antipyretic activities. Its mode of action, like that of other NSAIDs, is not completely understood, but may be related to prostaglandin synthetase inhibition. In clinical studies in patients with rheumatoid arthritis and osteoarthritis, MOTRIN tablets have been shown to be comparable to aspirin in controlling pain and inflammation and to be associated with a statistically significant reduction in the milder gastrointestinal side effects. MOTRIN tablets may be well tolerated in some patients who have had gastrointestinal side effects with aspirin, but these patients when treated with MOTRIN tablets should be carefully followed for signs and symptoms of gastrointestinal ulceration and bleeding. Although it is not definitely known whether MOTRIN tablets causes less peptic ulceration than aspirin, in one study involving 885 patients with rheumatoid arthritis treated for up to one year, there were no reports of gastric ulceration with MOTRIN tablets whereas frank ulceration was reported in 13 patients in the aspirin group (statistically significant p<.001). Gastroscopic studies at varying doses show an increased tendency toward gastric irritation at higher doses. However, at comparable doses, gastric irritation is approximately half that seen with aspirin. In clinical studies in patients with rheumatoid arthritis, MOTRIN tablets have been shown to be comparable to indomethacin in controlling the signs and symptoms of disease activity and to be associated with a statistically significant reduction of the milder gastrointestinal and CNS side effects. Controlled studies have demonstrated that MOTRIN tablets are a more effective analgesic than propoxyphene for the relief of episiotomy pain, pain following dental extraction procedures, and for the relief of the symptoms of primary dysmenorrhea. In patients with primary dysmenorrhea, MOTRIN tablets have been shown to reduce elevated levels of prostaglandin activity in the menstrual fluid and to reduce resting and active intrauterine pressure, as well as the frequency of uterine contractions. The probable mechanism of action is to inhibit prostaglandin synthesis rather than simply to provide analgesia. INDICATIONS AND USAGE MOTRIN tablets are indicated for relief of the signs and symptoms of rheumatoid arthritis and osteoarthritis. MOTRIN tablets are indicated for relief of mild to moderate pain. MOTRIN tablets are also indicated for the treatment of primary dysmenorrhea. Controlled clinical trials to establish the safety and effectiveness of MOTRIN tablets in children have not been conducted. CONTRAINDICATIONS MOTRIN tablets are contraindicated in patients with known hypersensitivity to Ibuprofen. MOTRIN tablets should not be given to patients who have experienced asthma, urticaria, or allergictype reactions after taking aspirin or other NSAIDs. Severe, rarely fatal, anaphylactic-like reactions to NSAIDs have been reported in such patients. MOTRIN tablets are contraindicated for the treatment of peri-operative pain in the setting of coronary artery bypass graft (CABG) surgery (see WARNINGS). WARNINGS CARDIOVASCULAR EFFECTS Cardiovascular Thrombotic Events Clinical trials of several COX-2 selective and nonselective NSAIDs of up to three years duration have shown an increased risk of serious cardiovascular (CV) thrombotic events, myocardial infarction, and stroke, which can be fatal. All NSAIDs, both COX-2 selective and nonselective, may have a similar risk. Patients with known CV disease or risk factors for CV disease may be at greater risk. To minimize the potential risk for an adverse CV event in patients treated with an NSAID, the lowest effective dose should be used for the shortest duration possible. Physicians and patients should remain alert for the development of such events, even in the absence of previous CV symptoms. Patients should be informed about the signs and/or symptoms of serious CV events and the steps to take if they occur. There is no consistent evidence that concurrent use of aspirin mitigates the increased risk of serious CV thrombotic events associated with NSAID use. The concurrent use of aspirin and an NSAID does increase the risk of serious GI events (see GI WARNINGS). Two large, controlled clinical trials of a COX-2 selective NSAID for the treatment of pain in the first 10-14 days following CABG surgery found an increased incidence of myocardial infarction and stroke (see CONTRAINDICATIONS). Hypertension NSAIDs including MOTRIN tablets, can lead to onset of new hypertension or worsening of preexisting hypertension, either of which may contribute to the increased incidence of CV events. Patients taking thiazides or loop diuretics may have impaired response to these therapies when taking NSAIDs. NSAIDs, including MOTRIN tablets, should be used with caution in patients with hypertension. Blood pressure (BP) should be monitored closely during the initiation of NSAID treatment and throughout the course of therapy. Congestive Heart Failure and Edema Fluid retention and edema have been observed in some patients taking NSAIDs. MOTRIN tablets should be used with caution in patients with fluid retention or heart failure. Gastrointestinal Effects - Risk of Ulceration, Bleeding, and Perforation NSAIDs, including MOTRIN tablets, can cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the stomach, small intestine, or large intestine,which can be fatal. These serious adverse events can occur at any time, with or without warning symptoms, in patients treated with NSAIDs. Only one in five patients, who develop a serious upper GI adverse event on NSAID therapy, is symptomatic. Upper GI ulcers, gross bleeding, or perforation caused by NSAIDs occur in approximately 1% of patients treated for 3-6 months, and in about 2-4% of patients treated for one year. These trends continue with longer duration of use, increasing the likelihood of developing a serious GI event at some time during the course of therapy. However, even short-term therapy is not without risk. NSAIDs should be prescribed with extreme caution in those with a prior history of ulcer disease or gastrointestinal bleeding. Patients with a prior history of peptic ulcer disease and/or gastrointestinal bleeding who use NSAIDs have a greater than 10-fold increased risk for developing a GI bleed compared to patients treated with neither of these risk factors. Other factors that increase the risk of GI bleeding in patients treated with NSAIDs include concomitant use of oral corticosteroids or anticoagulants, longer duration of NSAID therapy, smoking, use of alcohol, older age, and poor general health status. Most spontaneous reports of fatal GI events are in elderly or debilitated patients and therefore, special care should be taken in treating this population. To minimize the potential risk for an adverse GI event in patients treated with an NSAID, the lowest effective dose should be used for the shortest possible duration. Patients and physicians should remain alert for signs and symptoms of GI ulcerations and bleeding during NSAID therapy and promptly initiate additional evaluation and treatment if a serious GI event is suspected. This should include discontinuation of the NSAID until a serious GI adverse event is ruled out. For high-risk patients, alternate therapies that do not involve NSAIDs should be considered. Renal Effects Long-term administration of NSAIDs has resulted in renal papillary necrosis and other renal injury. Renal toxicity has also been seen in patients in whom renal prostaglandins have a compensatory role in the maintenance of renal perfusion. In these patients, administration of a NSAID may cause a dosedependent reduction in prostaglandin formation and, secondarily, in renal blood flow, which may precipitate overt renal decompensation. Patients at greatest risk of this reaction are those with impaired renal function, heart failure, liver dysfunction, those taking diuretics and ACE inhibitors, and the elderly. Discontinuation of NSAID therapy is usually followed by recovery to the pretreatment state. Advanced Renal Disease No information is available from controlled clinical studies regarding the use of MOTRIN tablets in patients with advanced renal disease. Therefore, treatment with MOTRIN tablets is not recommended in these patients with advanced renal disease. If MOTRIN tablet therapy must be initiated, close monitoring of the patients renal function is advisable. Anaphylactoid Reactions As with other NSAIDs, anaphylactoid reactions may occur in patients without known prior exposure to MOTRIN tablets. MOTRIN tablets should not be given to patients with the aspirin triad. This symptom complex typically occurs in asthmatic patients who experience rhinitis with or without nasal polyps, or who exhibit severe, potentially fatal bronchospasm after taking aspirin or other NSAIDs (see CONTRAINDICATIONS and PRECAUTIONS, Preexisting Asthma). Emergency help should be sought in cases where an anaphylactoid reaction occurs. Skin Reactions NSAIDs, including MOTRIN tablets, can cause serious skin adverse events such as exfoliative dermatitis, Stevens-Johnson Syndrome (SJS), and toxic epidermal necrolysis (TEN), which can be fatal. These serious events may occur without warning. Patients should be informed about the signs and symptoms of serious skin manifestations and use of the drug should be discontinued at the first appearance of skin rash or any other sign of hypersensitivity. Pregnancy In late pregnancy, as with other NSAIDs, MOTRIN tablets should be avoided because it may cause premature closure of the ductus arteriosus. ",Medical,Pros & Cons,Q&A This task requires you to answer only using the information provided in the prompt. No other information or resources is allowed to be used to formulate your answer.,In what ways are smaller firms disadvantaged in the global market?,"[1]—“Leveraging” Resources The primary business advantage of granting a license is “leveraging” business resources. By adding its licensees’ resources for particular business operations to its own, a licensor can address markets that it otherwise could not hope to serve. For example, small firms and start-up companies often do not have enough salespeople or offices to serve nationwide, let alone worldwide, markets. By granting others the right to market and distribute their products, they can penetrate geographic or products markets otherwise completely beyond their reach. This occurred, for example, when International Business Machines Corporation chose Microsoft Corporation’s “MS-DOS” operating system software as the platform upon which to build the “PC-DOS” operating system for IBM’s personal computer. Overnight, Microsoft obtained the benefit of IBM’s massive marketing and sales in forces distributing its products. Although the effect is seldom so dramatic as in this example, “leveraging” of resources is one of the primary advantages of granting licenses. The ability to leverage resources is restricted by limits on the patent rights. The patent exhaustion doctrine, in particular, restricts the ability of the patentee to control sales beyond the first sale of a patented product, or a product embodying a patented process.11 Because of this rule, a patent holder cannot exercise unlimited rights over an invention once embodiments of the invention have been sold.12 Rather, if he sells devices embodying the invention, or permits others to sell such devices, he will have limited control over what the buyers do with those devices because they take the items purchased free of the patent claims.13 In the sphere of copyright, a similar question is whether a rights holder can rely on digital rights management systems to protect against not just copyright infringement, but also other, non-infringing access to copyrighted works.14 Circumvention to permit use beyond the scope of a license may violate the protections for access controls (because it permits unauthorized access), even if it does not cause infringement of copyright (because the users had a license, even though the circumvention allows them to use the software beyond the scope of the license).15 Even while sensitive military or intelligence technology is subjected to secrecy orders by the United States government,16 it is important to seek licensees while patent applications are sequestered.17 If the patent applicant does not do so, it may have no basis for an otherwise valid claim for compensation from the United States government for the adverse effects of a secrecy order.18 [2]—Broadening Geographic Markets As the world becomes a “global village,” product markets that used to be regional or national are rapidly becoming worldwide. Few except the largest firms, however, have the personnel or resources to address worldwide markets successfully. One reason is that most products require some “translation” for foreign markets. Labels and instructions may need translation into foreign languages, goods may require physical modification to comply with local laws and regulations, and advertising and marketing programs may have to be adjusted to satisfy local customs and tastes. If a firm wishes to enter foreign markets but does not have ready marketing and distribution channels in foreign countries, it has only four alternatives. First, it can set up foreign branches, which may subject it to direct taxation abroad. Second, it may set up separate subsidiaries or affiliates in foreign countries. This may avoid direct foreign taxation of the parent company, although the foreign subsidiary will be subject to foreign income tax. Yet whether a branch or subsidiary, establishing of a foreign office requires time, energy, and money in order to complete the necessary legal work, put management and physical plant in place, and hire and train appropriate personnel. The third alternative for firms wishing to expand into foreign markets is a joint venture. If a joint venture is taxed as a separate entity, as is often the case,19 the tax consequences of this alternative are similar to those of establishing a foreign subsidiary. However, formation of a joint venture also involves resolving difficult questions of control, management, and communication that often consume considerable time and resources. If the joint venture is more than a shell—if it will have separate physical plant, employees, and a separate existence—its formation may be as complex as the establishment of a new business enterprise in the foreign country. The fourth alternative for expansion into foreign markets is, of course, licensing. By licensing a foreign entity to help exploit its intellectual property, a firm can take advantage of a preexisting organization, with personnel in place and established channels, resources, and procedures for production, marketing, and distribution. The firm need not establish any new entity because the licensee normally uses existing personnel and resources, or at least an existing management and business structure, to perform the delegated operations. By licensing a foreign concern to exploit its intellectual property in foreign markets, a firm also can use the foreign concern’s familiarity with foreign markets, customs, and needs. Because licensing takes advantage of these preexisting resources and capabilities, it is often the fastest route to the foreign marketplace. This advantage of licensing, however, is not limited to the international sphere. A firm in one state or region of the United States that wishes to expand its markets into another state or region has the same four alternatives as a firm wishing to expand abroad. 20 Very often the firm can achieve the most rapid penetration into new geographic markets simply by granting licenses to a firm already there. [3]—Broadening Product Markets Just as licensing can broaden geographic markets, it can broaden product markets. A firm may have the resources to exploit its intellectual property through one product, but its intellectual property may be applicable to other products or services. The video industry is an excellent example. There is now a tremendous market for entertainment programs for home use. Yet independent producers of movies and television shows often do not have the resources for mass production and distribution. To take advantage of this market, they license their intellectual property—namely, the copyrights in their movies and television shows—to firms that manufacture and distribute the videos. In the biotechnology industry, research firms have developed a number of monoclonal antibodies to be used outside the body as testing and diagnostic tools. Because the process of regulatory review is relatively simple for products used outside the body, these firms can take those products to market quickly. To exploit their technology fully, however, they may wish to develop drugs and biologicals for internal use. The approval process for these products takes much longer and requires much greater expense, as well as clinical expertise and familiarity with the regulatory process. Lacking the requisite resources, smaller biotechnology firms often license their technology to large drug companies for that purpose. 21 Licensing for the purpose of expanding product markets, however, has disadvantages. By granting others the right to use its intellectual property to develop new products, a firm may lose control over those new products. 22 Where a party authorizes another to sell the invention, buyers will be protected by first sale, even if the seller fails to pay the agreed royalties to the patent owner. 22.1 Any other rule would make the buyer of goods or services subject to disputes over which the buyer has neither control nor knowledge. That uncertainty would in turn add transaction costs to such sales. So the rule aids both patentees and ultimate buyers, by facilitating transactions. Unless it has access to improvements made by its licensees, it may quickly find itself left in a backwater of technology, at least insofar as the new product market is concerned. 23 It also may incur some risk of liability for damage caused by defects in its licensee’s products, 24 or even for breach of contract 25 or miscellaneous torts. 26 Nevertheless, for many firms, this sort of licensing is an important source of additional revenue. With appropriate provision for cooperation in the licensing agreement, a firm may stay in touch with the exploitation of its intellectual property and at the same time exploit that property in market areas that it could never hope to penetrate using only its own resources. The patent exhaustion doctrine may prevent a patentee from controlling patent markets beyond the first market which a patented product enters.","This task requires you to answer only using the information provided in the prompt. No other information or resources is allowed to be used to formulate your answer. In what ways are smaller firms disadvantaged in the global market? [1]—“Leveraging” Resources The primary business advantage of granting a license is “leveraging” business resources. By adding its licensees’ resources for particular business operations to its own, a licensor can address markets that it otherwise could not hope to serve. For example, small firms and start-up companies often do not have enough salespeople or offices to serve nationwide, let alone worldwide, markets. By granting others the right to market and distribute their products, they can penetrate geographic or products markets otherwise completely beyond their reach. This occurred, for example, when International Business Machines Corporation chose Microsoft Corporation’s “MS-DOS” operating system software as the platform upon which to build the “PC-DOS” operating system for IBM’s personal computer. Overnight, Microsoft obtained the benefit of IBM’s massive marketing and sales in forces distributing its products. Although the effect is seldom so dramatic as in this example, “leveraging” of resources is one of the primary advantages of granting licenses. The ability to leverage resources is restricted by limits on the patent rights. The patent exhaustion doctrine, in particular, restricts the ability of the patentee to control sales beyond the first sale of a patented product, or a product embodying a patented process.11 Because of this rule, a patent holder cannot exercise unlimited rights over an invention once embodiments of the invention have been sold.12 Rather, if he sells devices embodying the invention, or permits others to sell such devices, he will have limited control over what the buyers do with those devices because they take the items purchased free of the patent claims.13 In the sphere of copyright, a similar question is whether a rights holder can rely on digital rights management systems to protect against not just copyright infringement, but also other, non-infringing access to copyrighted works.14 Circumvention to permit use beyond the scope of a license may violate the protections for access controls (because it permits unauthorized access), even if it does not cause infringement of copyright (because the users had a license, even though the circumvention allows them to use the software beyond the scope of the license).15 Even while sensitive military or intelligence technology is subjected to secrecy orders by the United States government,16 it is important to seek licensees while patent applications are sequestered.17 If the patent applicant does not do so, it may have no basis for an otherwise valid claim for compensation from the United States government for the adverse effects of a secrecy order.18 [2]—Broadening Geographic Markets As the world becomes a “global village,” product markets that used to be regional or national are rapidly becoming worldwide. Few except the largest firms, however, have the personnel or resources to address worldwide markets successfully. One reason is that most products require some “translation” for foreign markets. Labels and instructions may need translation into foreign languages, goods may require physical modification to comply with local laws and regulations, and advertising and marketing programs may have to be adjusted to satisfy local customs and tastes. If a firm wishes to enter foreign markets but does not have ready marketing and distribution channels in foreign countries, it has only four alternatives. First, it can set up foreign branches, which may subject it to direct taxation abroad. Second, it may set up separate subsidiaries or affiliates in foreign countries. This may avoid direct foreign taxation of the parent company, although the foreign subsidiary will be subject to foreign income tax. Yet whether a branch or subsidiary, establishing of a foreign office requires time, energy, and money in order to complete the necessary legal work, put management and physical plant in place, and hire and train appropriate personnel. The third alternative for firms wishing to expand into foreign markets is a joint venture. If a joint venture is taxed as a separate entity, as is often the case,19 the tax consequences of this alternative are similar to those of establishing a foreign subsidiary. However, formation of a joint venture also involves resolving difficult questions of control, management, and communication that often consume considerable time and resources. If the joint venture is more than a shell—if it will have separate physical plant, employees, and a separate existence—its formation may be as complex as the establishment of a new business enterprise in the foreign country. The fourth alternative for expansion into foreign markets is, of course, licensing. By licensing a foreign entity to help exploit its intellectual property, a firm can take advantage of a preexisting organization, with personnel in place and established channels, resources, and procedures for production, marketing, and distribution. The firm need not establish any new entity because the licensee normally uses existing personnel and resources, or at least an existing management and business structure, to perform the delegated operations. By licensing a foreign concern to exploit its intellectual property in foreign markets, a firm also can use the foreign concern’s familiarity with foreign markets, customs, and needs. Because licensing takes advantage of these preexisting resources and capabilities, it is often the fastest route to the foreign marketplace. This advantage of licensing, however, is not limited to the international sphere. A firm in one state or region of the United States that wishes to expand its markets into another state or region has the same four alternatives as a firm wishing to expand abroad. 20 Very often the firm can achieve the most rapid penetration into new geographic markets simply by granting licenses to a firm already there. [3]—Broadening Product Markets Just as licensing can broaden geographic markets, it can broaden product markets. A firm may have the resources to exploit its intellectual property through one product, but its intellectual property may be applicable to other products or services. The video industry is an excellent example. There is now a tremendous market for entertainment programs for home use. Yet independent producers of movies and television shows often do not have the resources for mass production and distribution. To take advantage of this market, they license their intellectual property—namely, the copyrights in their movies and television shows—to firms that manufacture and distribute the videos. In the biotechnology industry, research firms have developed a number of monoclonal antibodies to be used outside the body as testing and diagnostic tools. Because the process of regulatory review is relatively simple for products used outside the body, these firms can take those products to market quickly. To exploit their technology fully, however, they may wish to develop drugs and biologicals for internal use. The approval process for these products takes much longer and requires much greater expense, as well as clinical expertise and familiarity with the regulatory process. Lacking the requisite resources, smaller biotechnology firms often license their technology to large drug companies for that purpose. 21 Licensing for the purpose of expanding product markets, however, has disadvantages. By granting others the right to use its intellectual property to develop new products, a firm may lose control over those new products. 22 Where a party authorizes another to sell the invention, buyers will be protected by first sale, even if the seller fails to pay the agreed royalties to the patent owner. 22.1 Any other rule would make the buyer of goods or services subject to disputes over which the buyer has neither control nor knowledge. That uncertainty would in turn add transaction costs to such sales. So the rule aids both patentees and ultimate buyers, by facilitating transactions. Unless it has access to improvements made by its licensees, it may quickly find itself left in a backwater of technology, at least insofar as the new product market is concerned. 23 It also may incur some risk of liability for damage caused by defects in its licensee’s products, 24 or even for breach of contract 25 or miscellaneous torts. 26 Nevertheless, for many firms, this sort of licensing is an important source of additional revenue. With appropriate provision for cooperation in the licensing agreement, a firm may stay in touch with the exploitation of its intellectual property and at the same time exploit that property in market areas that it could never hope to penetrate using only its own resources. The patent exhaustion doctrine may prevent a patentee from controlling patent markets beyond the first market which a patented product enters.",Retail/Product,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","I found this alarming article about microplastics making their way into the human body. Using this article as a reference, please explain what the red flags are for humans in regards to microplastics. Use at least 400 words.","When Jaime Ross, PhD, a neuroscientist and assistant professor at the University of Rhode Island College of Pharmacy, decided to study how contaminating the drinking water of mice with tiny fragments of plastic might affect their cognitive function, she didn’t expect the experiment to yield much. But in just three weeks, Ross and her team found microplastics had made their way into the mice’s brains, passing the robust defenses of the blood-brain barrier. The researchers performed a variety of tests and found that the microplastic-exposed mice started exhibiting signs of cognitive decline similar to dementia. “I didn’t really think we were going to see anything,” Ross says. But when they examined the mice’s tissues, they were shocked. “Every one we looked at we found the microplastics. It was surprising, especially finding them in the brain. Things are not supposed to go there!” The research findings from Ross’ team, published in August 2023, add to a slew of recent studies pointing to an alarming trend: microplastics are everywhere. Minuscule plastic particles that come from degraded plastic products are found throughout the environment. Scientists estimate there are 8-10 million metric tons of plastics in the oceans, and some of that is consumed by fish and other wildlife. Microplastics have been detected in fruits and vegetables, plastic water bottles, the air, cosmetics, and household dust. Now, researchers are finding them in almost every part of the human body, including in breast milk, the placenta, testicles, hearts, livers, and kidneys. Despite these findings, experts say that little is known and understood about what impact these microplastics have on human health. A few studies have drawn associations between microplastics and poor health outcomes, including cardiovascular disease and low male fertility. And chemicals often found in plastics are known to cause a variety of health problems, including cancers, metabolic disorders, attention deficit/hyperactivity disorder, and fertility issues. But most of the studies raising alarm have been in labs or in animal models that don’t give a complete picture of the effect on humans, says Mary Margaret Johnson, MD, PhD, a principal research scientist of environmental health at Harvard T.H. Chan School of Public Health in Boston. “I do think there needs to be more funding devoted to researching how it really is impacting our organs and disease itself,” she says. What are microplastics? Though plastics have become ubiquitous in modern life, they weren’t invented until the mid-1800s and weren’t produced on a large scale until the 1950s. Over the past century, technology to create a huge variety of malleable polymers (chains of large, repeating molecules) has evolved into the umbrella term plastics, which are often derived from petroleum and other fossil fuels, according to the Science History Institute in Philadelphia. Plastics are used in most containers and packaging materials; in most of the fabrics that make clothing, bedding, carpeting, and towels; in the construction of buildings and motor vehicles; and in many of the materials used in health care settings to prevent the spread of infection, among many other uses. The production of plastics worldwide has doubled in the last two decades, according to Our World in Data. Plastic’s versatility, durability, and low weight-to-strength ratio have made it an efficient material for many of life’s modern conveniences. However, by their nature, plastics can break down and degrade into smaller pieces. At the same time, scientists have found that plastic materials can exist for decades, if not longer, without completely disintegrating. Scientists have studied the impact of plastic on the ecological environment for decades and have raised concerns about the health effects of some chemicals used in plastics. But it’s only within the last several years that researchers have discovered the extent to which microplastics (which range from 1 nanometer, 1/80,000 the width of a strand of hair, to 5 millimeters, the size of a pencil-top eraser) and nanoplastics (which are even smaller and invisible) have become embedded in the environment and in human bodies, explains Tracey Woodruff, PhD, MPH, a professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences and director of the Program on Reproductive Health and the Environment at the University of California San Francisco (UCSF) School of Medicine. Woodruff, who has studied the effect of some chemicals found in plastics on human health, reproduction, and development for two decades, first started looking into microplastics in 2021. She and a group of scientists from across the University of California system reviewed hundreds of existing studies on microplastics and health and compiled a report for state lawmakers to consider during policymaking. Though mostly based on animal studies, Woodruff and her colleagues concluded that there was evidence that microplastics could harm fertility and increase cancer risk in humans. “Governments have not really fully figured out what they’re going to do about this,” Woodruff says. There have been some efforts to ban the use of plastic microbeads in cosmetics, but not much beyond that, she adds. Red flags for human health While there haven’t yet been any definitive studies showing that microplastics cause health problems in humans, researchers have identified several red flags that call for further investigation. In Ross’ research in mice, for example, the scientists used plastic particles that were “clean,” meaning that they did not have any of the known toxic chemicals found in many plastics and they were also free of bacteria and viruses that microplastics can pick up from environmental exposure. And yet, with the mere presence of the microplastics, the mice began to experience negative effects. This could be because the immune system recognizes the presence of a foreign invader and triggers inflammation, which can have a negative effect on a range of organs. “We just wanted to see the effect of plastic itself, but that’s not what is really in the environment,” Ross says. “Plastics in the environment are not this way; they’re not pristine.” Ross’ work has raised even more questions about microplastics in the body. “We’re trying to understand: How are they getting into the brain? What do they do? Where do they go? Do they get out?” she says. Sheela Sathyanarayana, MD, MPH, a professor in the University of Washington Department of Pediatrics and the Department of Environmental and Occupational Health Sciences, worries that the harm from microplastics in the body could be compounded by what are known as endocrine disrupting chemicals that are found in many plastics. Bisphenol A (BPA), phthalates, and per- and polyfluoroalkyl substances (PFAS) are just a few of the chemicals known to imitate hormones and disrupt the body’s natural endocrine system, which is responsible for making the hormones that govern processes such as growth and development, metabolism, appetite, mood, and certain aspects of reproduction. Sathyanarayana has focused her research on studying the impact of exposure to endocrine disrupting chemicals on reproduction and has found that they can have a profound impact, especially during fetal development. “That’s when organ development is happening; that’s when programming for later life happens,” Sathyanarayana says. “Whatever happens during pregnancy will affect your later life and health for the whole continuum.” She gave the example of research that found some women who experience famine while pregnant later have babies who experience obesity, likely because of the effect their mothers’ starvation has on the development of the babies’ metabolism. Fetal exposure to endocrine disrupting chemicals has been associated with abnormal development of reproductive organs in male babies, with increased risk of metabolic disorders in childhood, and may be associated with the child developing attention deficit hyperactivity disorder (ADHD). Some of these chemicals have also been linked to lower sperm quality in men."," Only use the provided text to answer the question, no outside sources. I found this alarming article about microplastics making their way into the human body. Using this article as a reference, please explain what the red flags are for humans in regards to microplastics. Use at least 400 words. When Jaime Ross, PhD, a neuroscientist and assistant professor at the University of Rhode Island College of Pharmacy, decided to study how contaminating the drinking water of mice with tiny fragments of plastic might affect their cognitive function, she didn’t expect the experiment to yield much. But in just three weeks, Ross and her team found microplastics had made their way into the mice’s brains, passing the robust defenses of the blood-brain barrier. The researchers performed a variety of tests and found that the microplastic-exposed mice started exhibiting signs of cognitive decline similar to dementia. “I didn’t really think we were going to see anything,” Ross says. But when they examined the mice’s tissues, they were shocked. “Every one we looked at we found the microplastics. It was surprising, especially finding them in the brain. Things are not supposed to go there!” The research findings from Ross’ team, published in August 2023, add to a slew of recent studies pointing to an alarming trend: microplastics are everywhere. Minuscule plastic particles that come from degraded plastic products are found throughout the environment. Scientists estimate there are 8-10 million metric tons of plastics in the oceans, and some of that is consumed by fish and other wildlife. Microplastics have been detected in fruits and vegetables, plastic water bottles, the air, cosmetics, and household dust. Now, researchers are finding them in almost every part of the human body, including in breast milk, the placenta, testicles, hearts, livers, and kidneys. Despite these findings, experts say that little is known and understood about what impact these microplastics have on human health. A few studies have drawn associations between microplastics and poor health outcomes, including cardiovascular disease and low male fertility. And chemicals often found in plastics are known to cause a variety of health problems, including cancers, metabolic disorders, attention deficit/hyperactivity disorder, and fertility issues. But most of the studies raising alarm have been in labs or in animal models that don’t give a complete picture of the effect on humans, says Mary Margaret Johnson, MD, PhD, a principal research scientist of environmental health at Harvard T.H. Chan School of Public Health in Boston. “I do think there needs to be more funding devoted to researching how it really is impacting our organs and disease itself,” she says. What are microplastics? Though plastics have become ubiquitous in modern life, they weren’t invented until the mid-1800s and weren’t produced on a large scale until the 1950s. Over the past century, technology to create a huge variety of malleable polymers (chains of large, repeating molecules) has evolved into the umbrella term plastics, which are often derived from petroleum and other fossil fuels, according to the Science History Institute in Philadelphia. Plastics are used in most containers and packaging materials; in most of the fabrics that make clothing, bedding, carpeting, and towels; in the construction of buildings and motor vehicles; and in many of the materials used in health care settings to prevent the spread of infection, among many other uses. The production of plastics worldwide has doubled in the last two decades, according to Our World in Data. Plastic’s versatility, durability, and low weight-to-strength ratio have made it an efficient material for many of life’s modern conveniences. However, by their nature, plastics can break down and degrade into smaller pieces. At the same time, scientists have found that plastic materials can exist for decades, if not longer, without completely disintegrating. Scientists have studied the impact of plastic on the ecological environment for decades and have raised concerns about the health effects of some chemicals used in plastics. But it’s only within the last several years that researchers have discovered the extent to which microplastics (which range from 1 nanometer, 1/80,000 the width of a strand of hair, to 5 millimeters, the size of a pencil-top eraser) and nanoplastics (which are even smaller and invisible) have become embedded in the environment and in human bodies, explains Tracey Woodruff, PhD, MPH, a professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences and director of the Program on Reproductive Health and the Environment at the University of California San Francisco (UCSF) School of Medicine. Woodruff, who has studied the effect of some chemicals found in plastics on human health, reproduction, and development for two decades, first started looking into microplastics in 2021. She and a group of scientists from across the University of California system reviewed hundreds of existing studies on microplastics and health and compiled a report for state lawmakers to consider during policymaking. Though mostly based on animal studies, Woodruff and her colleagues concluded that there was evidence that microplastics could harm fertility and increase cancer risk in humans. “Governments have not really fully figured out what they’re going to do about this,” Woodruff says. There have been some efforts to ban the use of plastic microbeads in cosmetics, but not much beyond that, she adds. Red flags for human health While there haven’t yet been any definitive studies showing that microplastics cause health problems in humans, researchers have identified several red flags that call for further investigation. In Ross’ research in mice, for example, the scientists used plastic particles that were “clean,” meaning that they did not have any of the known toxic chemicals found in many plastics and they were also free of bacteria and viruses that microplastics can pick up from environmental exposure. And yet, with the mere presence of the microplastics, the mice began to experience negative effects. This could be because the immune system recognizes the presence of a foreign invader and triggers inflammation, which can have a negative effect on a range of organs. “We just wanted to see the effect of plastic itself, but that’s not what is really in the environment,” Ross says. “Plastics in the environment are not this way; they’re not pristine.” Ross’ work has raised even more questions about microplastics in the body. “We’re trying to understand: How are they getting into the brain? What do they do? Where do they go? Do they get out?” she says. Sheela Sathyanarayana, MD, MPH, a professor in the University of Washington Department of Pediatrics and the Department of Environmental and Occupational Health Sciences, worries that the harm from microplastics in the body could be compounded by what are known as endocrine disrupting chemicals that are found in many plastics. Bisphenol A (BPA), phthalates, and per- and polyfluoroalkyl substances (PFAS) are just a few of the chemicals known to imitate hormones and disrupt the body’s natural endocrine system, which is responsible for making the hormones that govern processes such as growth and development, metabolism, appetite, mood, and certain aspects of reproduction. Sathyanarayana has focused her research on studying the impact of exposure to endocrine disrupting chemicals on reproduction and has found that they can have a profound impact, especially during fetal development. “That’s when organ development is happening; that’s when programming for later life happens,” Sathyanarayana says. “Whatever happens during pregnancy will affect your later life and health for the whole continuum.” She gave the example of research that found some women who experience famine while pregnant later have babies who experience obesity, likely because of the effect their mothers’ starvation has on the development of the babies’ metabolism. Fetal exposure to endocrine disrupting chemicals has been associated with abnormal development of reproductive organs in male babies, with increased risk of metabolic disorders in childhood, and may be associated with the child developing attention deficit hyperactivity disorder (ADHD). Some of these chemicals have also been linked to lower sperm quality in men. https://www.aamc.org/news/microplastics-are-inside-us-all-what-does-mean-our-health",Medical,Effect Analysis,Q&A You must only use information from the context. Please provide the answer in bullet points. if you are providing information from a quote then reference the quote's organisation.,How do consumer's feel about sustainability issues?,"A couple of experts suggests that some sustainability issues such as health, nutrition and safety are more pertinent to mainstream consumers because they are more likely to affect them personally. These could potentially act as triggers to sensitise consumers to a wider range of sustainability issues: There’s a hierarchy and it starts with the personal. They expect [retailers] to pay close attention to those aspects of sustainability that might affect their health or the quality of the product. A bit further down there are the sort of broader citizenship areas that might more broadly affect them CR Expert/SRI Nevertheless, some see the need for further encouragement and support to take consumers down this path, and reject the view that consumers will take the lead in pressurising retailers to be more sustainable: I don’t think there will be a consumer-led revolution. I think consumers will need to be persuaded and brought along to give their permission to companies and governments to take the action that needs taking, not the other way round CR Expert/SRI There is also a sense that consumers need carrots not sticks and that successful retailers will be those that are better at persuading consumers of the benefits of making sustainable choices: Ultimately I think it’s not going to be very successful if consumers have to feel they’re giving things up, that there are things they can’t do. Where it seems to have been successful is if it’s presented as an opportunity to make a difference NGO/Interest Group","Context: A couple of experts suggests that some sustainability issues such as health, nutrition and safety are more pertinent to mainstream consumers because they are more likely to affect them personally. These could potentially act as triggers to sensitise consumers to a wider range of sustainability issues: There’s a hierarchy and it starts with the personal. They expect [retailers] to pay close attention to those aspects of sustainability that might affect their health or the quality of the product. A bit further down there are the sort of broader citizenship areas that might more broadly affect them CR Expert/SRI Nevertheless, some see the need for further encouragement and support to take consumers down this path, and reject the view that consumers will take the lead in pressurising retailers to be more sustainable: I don’t think there will be a consumer-led revolution. I think consumers will need to be persuaded and brought along to give their permission to companies and governments to take the action that needs taking, not the other way round CR Expert/SRI There is also a sense that consumers need carrots not sticks and that successful retailers will be those that are better at persuading consumers of the benefits of making sustainable choices: Ultimately I think it’s not going to be very successful if consumers have to feel they’re giving things up, that there are things they can’t do. Where it seems to have been successful is if it’s presented as an opportunity to make a difference NGO/Interest Group System instructions: You must only use information from the context. Please provide the answer in bullet points. if you are providing information from a quote then reference the quote's organisation. User question: How do consumer's feel about sustainability issues?",Retail/Product,Find & Summarize,Text Transformation "Please use only the information provided in the text. If you cannot provide an answer from the text, please say, ""I cannot assess due to lack of context.""","For a pregnant person suspected to have placenta accreta spectrum, what type of doctors/consultants are needed in the operating room?","**""Caesarean Birth""** Care for women with placenta accreta spectrum in specialist centres 1.2.9 Consider an MRI scan to complement ultrasound findings when planning ongoing surgical management of placenta accreta spectrum. Discuss the following with the woman or pregnant person: • what to expect during an MRI procedure • that MRI can help clarify the degree of invasion, particularly with a posterior placenta • that current experience suggests that MRI is safe, but that there is a lack of evidence about any long-term risks to the baby. [2024] 1.2.10 Discuss birth options (for example, timing of birth, operative interventions including possibility of hysterectomy, need for blood transfusion) with a woman or pregnant person suspected to have placenta accreta spectrum. This discussion should be carried out by a senior obstetrician. [2011, amended 2024] When planning a caesarean birth for women or pregnant people suspected to have placenta accreta spectrum, the multidisciplinary team should: • agree which other healthcare professionals need to be consulted or present (for example, specialists in gynaecological surgery, interventional radiology, colorectal surgery, urology or vascular surgery, depending on the nature of the placenta accreta spectrum) and • the responsibilities of each team member. [2011, amended 2024] 1.2.12 When performing a planned caesarean birth for a woman or pregnant person suspected to have placenta accreta spectrum, ensure that: • a consultant obstetrician, a consultant gynaecologist and a consultant anaesthetist are present in the operating theatre • a paediatric or neonatal registrar or consultant is present to provide immediate care for the baby as soon as it is born • a haematology registrar or consultant is available to contact for advice • a critical care bed is available for the woman or pregnant person, and a critical care neonatal cot is available for the baby (although emergency surgery should not be delayed while waiting for a bed) • sufficient cross-matched blood and blood products are readily available (if blood transfusions are acceptable to the woman or pregnant person). See the NICE guideline on blood transfusion. [2011, amended 2024] 1.2.13 Specialist placenta accreta spectrum centres and the local maternity units they support should develop protocols covering how placenta accreta spectrum should be diagnosed, assessed and managed across their network. The protocol should include the care and management of placenta accreta spectrum identified late in pregnancy or in labour, including how specialist units can support emergency care in local maternity units. [2024] Predicting caesarean birth for cephalopelvic disproportion in labour 1.2.14 Do not use pelvimetry for decision making about mode of birth. [2004, amended 2021] 1.2.15 Do not use the following for decision making about mode of birth, as they do not accurately predict cephalopelvic disproportion: • maternal shoe size • maternal height • estimations of fetal size (ultrasound or clinical examination). [2004, amended 2021] Mother-to-child transmission of maternal infections HIV 1.2.16 Provide women with HIV information about the benefits and risks for them and their baby of the HIV treatment options and mode of birth as early as possible in their pregnancy, so that they can make an informed decision. Obtain specialist advice about HIV in pregnancy from a sexual health specialist if necessary. [2011, amended 2021] Hepatitis B virus 1.2.17 Do not offer pregnant women with hepatitis B a planned caesarean birth for this reason alone, as mother-to-baby transmission of hepatitis B can be reduced if the baby receives immunoglobulin and vaccination. [2004, amended 2021] Hepatitis C virus 1.2.18 Do not offer women who are infected with hepatitis C a planned caesarean birth for this reason alone. [2004, amended 2021] 1.2.19 Offer pregnant women who are co-infected with hepatitis C virus and HIV a planned caesarean birth to reduce mother-to-baby transmission of hepatitis C virus and HIV. [2004, amended 2021] Herpes simplex virus 1.2.20 Offer women with primary genital herpes simplex virus (HSV) infection occurring in the third trimester of pregnancy a planned caesarean birth to decrease the risk of neonatal HSV infection. [2004] 1.2.21 Do not routinely offer pregnant women with recurrent HSV infection a planned caesarean birth outside of the context of research. [2004, amended 2021] Body mass index 1.2.22 Do not use a BMI of over 50 kg/m2 alone as an indication for planned caesarean birth. [2011] Shared decision making 1.2.23 Ask for consent for caesarean birth only after providing pregnant women with evidence-based information. Ensure the woman's dignity, privacy, views and culture are respected, while taking the woman's clinical situation into account. [2004, amended 2021] 1.2.24 Advise women that they are entitled to decline the offer of treatment such as caesarean birth, even when it would benefit their or their baby's health. [2004, amended 2021] 1.2.25 When a woman decides on or declines a caesarean birth, document the factors that that are important to the woman when making her decision. [2004, amended 2021] Maternal choice for caesarean birth 1.2.26 When a woman or pregnant person with no medical indication for a caesarean birth requests a caesarean birth: • offer to discuss and explore the reasons for the request • ensure they have balanced and accurate information • offer to discuss alternative birth options (for example, place of birth, continuity of midwifery care where available, pain relief options), which may help address concerns they have about the birth • offer discussions with a consultant midwife or senior midwife, ideally in a birth options clinic or at a birth options appointment • offer discussions with a consultant or senior obstetrician and other members of the team (for example, an anaesthetist) if necessary or requested by the woman or pregnant person • record the discussions and decisions. [2011, amended 2023] 1.2.27 If a woman or pregnant person requests a caesarean birth, discuss the overall benefits and risks of caesarean birth compared with vaginal birth (see the section on planning mode of birth) and record that this discussion has taken place. [2011] 1.2.28 If a woman or pregnant person requests a caesarean birth because they have tokophobia or other severe anxiety about childbirth (for example, following abuse or a previous traumatic event), offer referral to a healthcare professional with expertise in providing perinatal mental health support to help with their anxiety. See the NICE guideline on antenatal and postnatal mental health for more detailed advice on providing mental health services during pregnancy. [2011, amended 2021] 1.2.29 Ensure healthcare professionals providing perinatal mental health support for women or pregnant people with tokophobia or other severe anxiety about childbirth are able to access the planned place of birth with the woman or pregnant person during the antenatal period, as part of the support offered to help them overcome fears and concerns about the labour and birth. [2011, amended 2023] 1.2.30 If, after an informed discussion about the options for birth (including the offer of perinatal mental health support if appropriate; see recommendation 1.2.27), the woman or pregnant person requests a caesarean birth, support their choice. [2011, amended 2023] 1.2.31 If a woman or pregnant person requests a caesarean birth this should be offered within their obstetric unit. [2011, amended 2023] "," ========== Please use only the information provided in the text. If you cannot provide an answer from the text, please say, ""I cannot assess due to lack of context."" ========== For a pregnant person suspected to have placenta accreta spectrum, what type of doctors/consultants are needed in the operating room? ========== **""Caesarean Birth""** Care for women with placenta accreta spectrum in specialist centres 1.2.9 Consider an MRI scan to complement ultrasound findings when planning ongoing surgical management of placenta accreta spectrum. Discuss the following with the woman or pregnant person: • what to expect during an MRI procedure • that MRI can help clarify the degree of invasion, particularly with a posterior placenta • that current experience suggests that MRI is safe, but that there is a lack of evidence about any long-term risks to the baby. [2024] 1.2.10 Discuss birth options (for example, timing of birth, operative interventions including possibility of hysterectomy, need for blood transfusion) with a woman or pregnant person suspected to have placenta accreta spectrum. This discussion should be carried out by a senior obstetrician. [2011, amended 2024] When planning a caesarean birth for women or pregnant people suspected to have placenta accreta spectrum, the multidisciplinary team should: • agree which other healthcare professionals need to be consulted or present (for example, specialists in gynaecological surgery, interventional radiology, colorectal surgery, urology or vascular surgery, depending on the nature of the placenta accreta spectrum) and • the responsibilities of each team member. [2011, amended 2024] 1.2.12 When performing a planned caesarean birth for a woman or pregnant person suspected to have placenta accreta spectrum, ensure that: • a consultant obstetrician, a consultant gynaecologist and a consultant anaesthetist are present in the operating theatre • a paediatric or neonatal registrar or consultant is present to provide immediate care for the baby as soon as it is born • a haematology registrar or consultant is available to contact for advice • a critical care bed is available for the woman or pregnant person, and a critical care neonatal cot is available for the baby (although emergency surgery should not be delayed while waiting for a bed) • sufficient cross-matched blood and blood products are readily available (if blood transfusions are acceptable to the woman or pregnant person). See the NICE guideline on blood transfusion. [2011, amended 2024] 1.2.13 Specialist placenta accreta spectrum centres and the local maternity units they support should develop protocols covering how placenta accreta spectrum should be diagnosed, assessed and managed across their network. The protocol should include the care and management of placenta accreta spectrum identified late in pregnancy or in labour, including how specialist units can support emergency care in local maternity units. [2024] Predicting caesarean birth for cephalopelvic disproportion in labour 1.2.14 Do not use pelvimetry for decision making about mode of birth. [2004, amended 2021] 1.2.15 Do not use the following for decision making about mode of birth, as they do not accurately predict cephalopelvic disproportion: • maternal shoe size • maternal height • estimations of fetal size (ultrasound or clinical examination). [2004, amended 2021] Mother-to-child transmission of maternal infections HIV 1.2.16 Provide women with HIV information about the benefits and risks for them and their baby of the HIV treatment options and mode of birth as early as possible in their pregnancy, so that they can make an informed decision. Obtain specialist advice about HIV in pregnancy from a sexual health specialist if necessary. [2011, amended 2021] Hepatitis B virus 1.2.17 Do not offer pregnant women with hepatitis B a planned caesarean birth for this reason alone, as mother-to-baby transmission of hepatitis B can be reduced if the baby receives immunoglobulin and vaccination. [2004, amended 2021] Hepatitis C virus 1.2.18 Do not offer women who are infected with hepatitis C a planned caesarean birth for this reason alone. [2004, amended 2021] 1.2.19 Offer pregnant women who are co-infected with hepatitis C virus and HIV a planned caesarean birth to reduce mother-to-baby transmission of hepatitis C virus and HIV. [2004, amended 2021] Herpes simplex virus 1.2.20 Offer women with primary genital herpes simplex virus (HSV) infection occurring in the third trimester of pregnancy a planned caesarean birth to decrease the risk of neonatal HSV infection. [2004] 1.2.21 Do not routinely offer pregnant women with recurrent HSV infection a planned caesarean birth outside of the context of research. [2004, amended 2021] Body mass index 1.2.22 Do not use a BMI of over 50 kg/m2 alone as an indication for planned caesarean birth. [2011] Shared decision making 1.2.23 Ask for consent for caesarean birth only after providing pregnant women with evidence-based information. Ensure the woman's dignity, privacy, views and culture are respected, while taking the woman's clinical situation into account. [2004, amended 2021] 1.2.24 Advise women that they are entitled to decline the offer of treatment such as caesarean birth, even when it would benefit their or their baby's health. [2004, amended 2021] 1.2.25 When a woman decides on or declines a caesarean birth, document the factors that that are important to the woman when making her decision. [2004, amended 2021] Maternal choice for caesarean birth 1.2.26 When a woman or pregnant person with no medical indication for a caesarean birth requests a caesarean birth: • offer to discuss and explore the reasons for the request • ensure they have balanced and accurate information • offer to discuss alternative birth options (for example, place of birth, continuity of midwifery care where available, pain relief options), which may help address concerns they have about the birth • offer discussions with a consultant midwife or senior midwife, ideally in a birth options clinic or at a birth options appointment • offer discussions with a consultant or senior obstetrician and other members of the team (for example, an anaesthetist) if necessary or requested by the woman or pregnant person • record the discussions and decisions. [2011, amended 2023] 1.2.27 If a woman or pregnant person requests a caesarean birth, discuss the overall benefits and risks of caesarean birth compared with vaginal birth (see the section on planning mode of birth) and record that this discussion has taken place. [2011] 1.2.28 If a woman or pregnant person requests a caesarean birth because they have tokophobia or other severe anxiety about childbirth (for example, following abuse or a previous traumatic event), offer referral to a healthcare professional with expertise in providing perinatal mental health support to help with their anxiety. See the NICE guideline on antenatal and postnatal mental health for more detailed advice on providing mental health services during pregnancy. [2011, amended 2021] 1.2.29 Ensure healthcare professionals providing perinatal mental health support for women or pregnant people with tokophobia or other severe anxiety about childbirth are able to access the planned place of birth with the woman or pregnant person during the antenatal period, as part of the support offered to help them overcome fears and concerns about the labour and birth. [2011, amended 2023] 1.2.30 If, after an informed discussion about the options for birth (including the offer of perinatal mental health support if appropriate; see recommendation 1.2.27), the woman or pregnant person requests a caesarean birth, support their choice. [2011, amended 2023] 1.2.31 If a woman or pregnant person requests a caesarean birth this should be offered within their obstetric unit. [2011, amended 2023] ",Medical,Fact Finding,Q&A This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any alternative sources of information.,Summarize how venous eczema affects the human body.,"VENOUS ECZEMA What are the aims of this leaflet? This leaflet has been written to help you understand more about venous eczema. It tells you what it is, what causes it, what can be done about it, and where you can find out more about it. What is venous eczema? Venous eczema is also known as varicose or stasis eczema and is the name given to a type of eczema on the lower leg. The word eczema (or dermatitis) refers to a common inflammatory skin condition. Venous eczema is more common as people get older and occurs more often in women than in men. What causes it? Venous eczema occurs when valves in the leg veins do not work properly, reducing drainage of blood from the legs. This leads to an increase in the pressure inside the leg veins. This congestion then causes damage to the overlying skin. The exact reason why the resulting skin changes occur is unclear, but is likely to be due to the increase in pressure pushing blood and blood products from the veins into the surrounding tissue. This then triggers inflammation in the skin. Being overweight, immobility, leg swelling, varicose veins, previous clots in the leg (venous thrombosis) and previous cellulitis are possible contributory factors. Is it hereditary? No. What are the features? Venous eczema occurs on the lower legs. The features vary depending on the severity and range from changes in skin colouring and dryness of the skin to areas of inflamed eczema with red spots, scaling, weeping and/or crusting. The eczema is often very itchy and can sometimes be painful. Swelling of the legs and varicose veins may also be present. In severe cases, white patches of skin, thinning and scarring (atrophie blanche) may be seen. Sometimes thickening of large areas of skin on the lower leg (lipodermatosclerosis) can occur and may be painful. Leg ulcers can also develop. Sometimes, venous eczema can trigger the development of eczema elsewhere on the body; this is known as secondary eczema. How is venous eczema diagnosed? It is usually a clinical diagnosis, based on its typical appearance and associated features. There are some other causes of a rash on the lower leg, such as allergic contact dermatitis (when a person develops an allergy to substances or treatments used on the skin) and irritant contact dermatitis (when the skin becomes irritated by secretions, bacteria or certain treatments). Doctors and nurses who regularly look after patients with venous eczema are usually able to identify which of these rashes is the most likely. On some occasions it may be necessary to carry out further investigations when the diagnosis is not clear. Can it be cured? Unfortunately, the problem of the valves in the veins not working properly cannot be cured; this means that venous eczema does not clear up completely if left untreated. However, simple measures to improve the function of the valves and treatments for the active eczema can greatly improve the skin and associated symptoms, keep the eczema under control and help to prevent complications such as leg swelling, infection and lipodermatosclerosis. How is it treated? Simple measures are very important in helping to reduce pressure in the veins. These include ensuring your weight is within the normal range and keeping physically active. Due to the effect of gravity exerting additional pressure on the veins, venous eczema can be made worse by spending long periods of time standing still or sitting, for example by sleeping in a chair. For this reason, it is recommended that when possible you raise your legs for at least part of the day; ideally above the level of your heart by lying down. Elevating the foot of the bed overnight can also be helpful. Care also needs to be taken to avoid damaging the skin on the leg, for example it is important to avoid knocking or hitting the leg on hard objects (such as supermarket shelves, trolleys, doors of kitchen cupboards, etc.). Such relatively minor injuries often take months to heal and can significantly impair healing of the eczema. Bandaging and compression stockings are another simple measure that help to reduce the pressure in the leg veins. Bandaging may be used when leg swelling is severe; once this swelling is reduced and the eczema is improved, compression stockings are used to maintain this. Compression stockings are available on prescription and should be worn long-term at all times during the day in order to support the veins. Compression stockings should not be used in patients with arterial disease in the legs. Your dermatologist or doctor can advise you about this and a simple test measuring your leg circulation is often performed before using compression stockings. Topical emollients (moisturisers) should be used at least daily to all the skin on the lower leg, whether affected or not; these make the skin more supple and can help to prevent the skin breaking down. Emollients should also be used as a soap substitute. Steroid ointments are often recommended to treat itchy flares in venous eczema; these should be applied to the affected patches of skin only. CAUTION: This leaflet mentions ‘emollients’ (moisturisers). When paraffincontaining emollient products get in contact with dressings, clothing, bed linen or hair, there is a danger that a naked flame or cigarette smoking could cause these to catch fire. To reduce the fire risk, patients using paraffin-containing skincare or haircare products are advised to avoid naked flames completely, including smoking cigarettes and being near people who are smoking or using naked flames. It is also advisable to wash clothing and bed linen regularly, preferably daily. In some situations a varicose vein operation may be helpful. In general, the responses to the above measures are good if they are used every day on a long-term basis. If the response is poor despite doing these treatments every day, it may be necessary to seek advice from your GP or dermatologist in case there is another cause for the leg rash, for example, a fungal skin or toe nail infection, or the development of a contact allergy to different topical agents used. Where can I find out more about venous eczema? Web links to detailed leaflets: www.cks.nhs.uk/venous_eczema_and_lipodermatosclerosis www.patient.co.uk/doctor/Varicose-Eczema.htm www.dermnetnz.org/dermatitis/venous-eczema.html For details of source materials used please contact the Clinical Standards Unit (clinicalstandards@bad.org.uk). This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor. ","System Instructions: This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any alternative sources of information. Question: Summarize how venous eczema affects the human body. Context Block: VENOUS ECZEMA What are the aims of this leaflet? This leaflet has been written to help you understand more about venous eczema. It tells you what it is, what causes it, what can be done about it, and where you can find out more about it. What is venous eczema? Venous eczema is also known as varicose or stasis eczema and is the name given to a type of eczema on the lower leg. The word eczema (or dermatitis) refers to a common inflammatory skin condition. Venous eczema is more common as people get older and occurs more often in women than in men. What causes it? Venous eczema occurs when valves in the leg veins do not work properly, reducing drainage of blood from the legs. This leads to an increase in the pressure inside the leg veins. This congestion then causes damage to the overlying skin. The exact reason why the resulting skin changes occur is unclear, but is likely to be due to the increase in pressure pushing blood and blood products from the veins into the surrounding tissue. This then triggers inflammation in the skin. Being overweight, immobility, leg swelling, varicose veins, previous clots in the leg (venous thrombosis) and previous cellulitis are possible contributory factors. Is it hereditary? No. What are the features? Venous eczema occurs on the lower legs. The features vary depending on the severity and range from changes in skin colouring and dryness of the skin to areas of inflamed eczema with red spots, scaling, weeping and/or crusting. The eczema is often very itchy and can sometimes be painful. Swelling of the legs and varicose veins may also be present. In severe cases, white patches of skin, thinning and scarring (atrophie blanche) may be seen. Sometimes thickening of large areas of skin on the lower leg (lipodermatosclerosis) can occur and may be painful. Leg ulcers can also develop. Sometimes, venous eczema can trigger the development of eczema elsewhere on the body; this is known as secondary eczema. How is venous eczema diagnosed? It is usually a clinical diagnosis, based on its typical appearance and associated features. There are some other causes of a rash on the lower leg, such as allergic contact dermatitis (when a person develops an allergy to substances or treatments used on the skin) and irritant contact dermatitis (when the skin becomes irritated by secretions, bacteria or certain treatments). Doctors and nurses who regularly look after patients with venous eczema are usually able to identify which of these rashes is the most likely. On some occasions it may be necessary to carry out further investigations when the diagnosis is not clear. Can it be cured? Unfortunately, the problem of the valves in the veins not working properly cannot be cured; this means that venous eczema does not clear up completely if left untreated. However, simple measures to improve the function of the valves and treatments for the active eczema can greatly improve the skin and associated symptoms, keep the eczema under control and help to prevent complications such as leg swelling, infection and lipodermatosclerosis. How is it treated? Simple measures are very important in helping to reduce pressure in the veins. These include ensuring your weight is within the normal range and keeping physically active. Due to the effect of gravity exerting additional pressure on the veins, venous eczema can be made worse by spending long periods of time standing still or sitting, for example by sleeping in a chair. For this reason, it is recommended that when possible you raise your legs for at least part of the day; ideally above the level of your heart by lying down. Elevating the foot of the bed overnight can also be helpful. Care also needs to be taken to avoid damaging the skin on the leg, for example it is important to avoid knocking or hitting the leg on hard objects (such as supermarket shelves, trolleys, doors of kitchen cupboards, etc.). Such relatively minor injuries often take months to heal and can significantly impair healing of the eczema. Bandaging and compression stockings are another simple measure that help to reduce the pressure in the leg veins. Bandaging may be used when leg swelling is severe; once this swelling is reduced and the eczema is improved, compression stockings are used to maintain this. Compression stockings are available on prescription and should be worn long-term at all times during the day in order to support the veins. Compression stockings should not be used in patients with arterial disease in the legs. Your dermatologist or doctor can advise you about this and a simple test measuring your leg circulation is often performed before using compression stockings. Topical emollients (moisturisers) should be used at least daily to all the skin on the lower leg, whether affected or not; these make the skin more supple and can help to prevent the skin breaking down. Emollients should also be used as a soap substitute. Steroid ointments are often recommended to treat itchy flares in venous eczema; these should be applied to the affected patches of skin only. CAUTION: This leaflet mentions ‘emollients’ (moisturisers). When paraffincontaining emollient products get in contact with dressings, clothing, bed linen or hair, there is a danger that a naked flame or cigarette smoking could cause these to catch fire. To reduce the fire risk, patients using paraffin-containing skincare or haircare products are advised to avoid naked flames completely, including smoking cigarettes and being near people who are smoking or using naked flames. It is also advisable to wash clothing and bed linen regularly, preferably daily. In some situations a varicose vein operation may be helpful. In general, the responses to the above measures are good if they are used every day on a long-term basis. If the response is poor despite doing these treatments every day, it may be necessary to seek advice from your GP or dermatologist in case there is another cause for the leg rash, for example, a fungal skin or toe nail infection, or the development of a contact allergy to different topical agents used. Where can I find out more about venous eczema? Web links to detailed leaflets: www.cks.nhs.uk/venous_eczema_and_lipodermatosclerosis www.patient.co.uk/doctor/Varicose-Eczema.htm www.dermnetnz.org/dermatitis/venous-eczema.html For details of source materials used please contact the Clinical Standards Unit (clinicalstandards@bad.org.uk). This leaflet aims to provide accurate information about the subject and is a consensus of the views held by representatives of the British Association of Dermatologists: individual patient circumstances may differ, which might alter both the advice and course of therapy given to you by your doctor. ",Medical,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",My husband and I have three children and I have been a stay at home mom for 10 years. My oldest daughter is 11. My husband's 16 year old daughter from a previous marriage wants to babysit for us. If we pay her to babysit can be we qualify for the dependent care credit?,"You may be able to claim the child and dependent care credit if you paid expenses for the care of a qualifying individual to enable you (and your spouse, if filing a joint return) to work or actively look for work. Generally, you may not take this credit if your filing status is married filing separately. However, see What's Your Filing Status? in Publication 503, Child and Dependent Care Expenses, which describes an exception for certain taxpayers living apart from their spouse and meeting other requirements. The amount of the credit is a percentage of the amount of work-related expenses you paid to a care provider for the care of a qualifying individual. The percentage depends on your adjusted gross income. Dollar limit The total expenses that you may use to calculate the credit may not be more than $3,000 (for one qualifying individual) or $6,000 (for two or more qualifying individuals). Expenses paid for the care of a qualifying individual are eligible expenses if the primary reason for paying the expense is to assure the individual's well-being and protection. If you received dependent care benefits that you exclude or deduct from your income, you must subtract the amount of those benefits from the dollar limit that applies to you. Qualifying individual A qualifying individual for the child and dependent care credit is: Your dependent qualifying child who was under age 13 when the care was provided, Your spouse who was physically or mentally incapable of self-care and lived with you for more than half of the year, or An individual who was physically or mentally incapable of self-care, lived with you for more than half of the year, and either: (a) was your dependent; or (b) could have been your dependent except that he or she received gross income of $4,700 or more, or filed a joint return, or you (or your spouse, if filing jointly) could have been claimed as a dependent on another taxpayer's 2023 return. Physically or mentally not able to care for oneself - An individual is physically or mentally incapable of self-care if, as a result of a physical or mental defect, the individual is incapable of caring for his or her hygiene or nutritional needs or requires the full-time attention of another person for the individual's own safety or the safety of others. Children of divorced or separated parents or parents living apart - A noncustodial parent who is claiming a child as a dependent should review the rules under the topic Child of divorced or separated parents or parents living apart in Publication 503, because a child may be treated as the qualifying individual of the custodial parent for the child and dependent care credit, even if the noncustodial parent is entitled to claim the child as a dependent. Individual qualifying for part of year - If an individual is a qualifying individual for only a part of the tax year, only those expenses paid for care of the individual during that part of the year are included in calculating the credit. Taxpayer identification number (TIN) - You must provide the TIN (usually the Social Security number) of each qualifying individual. Care of a qualifying individual The care may be provided in the household or outside the household; however, don't include any amounts that aren't primarily for the well-being of the individual. You should divide the expenses between amounts that are primarily for the care of the individual and amounts that aren't primarily for the care of the individual. You must reduce the expenses primarily for the care of the individual by the amount of any dependent care benefits provided by your employer that you exclude from gross income. In general, you can exclude up to $5,000 for dependent care benefits received from your employer. Additionally, in general, the expenses claimed may not exceed the smaller of your earned income or your spouse's earned income. If you or your spouse is a full-time student or incapable of self-care, then you or your spouse is treated as having earned income for each month that you or your spouse is a full-time student or incapable of self-care. Your or your spouse's earned income for each month is $250 if there is one qualifying person ($500 if two or more qualifying individuals). See the topic Earned Income Limit in Publication 503 PDF for further information. Care providers You must identify all persons or organizations that provide care for your child or dependent. You must report the name, address, and TIN (either the Social Security number or the employer identification number) of the care provider on your return. If the care provider is a tax-exempt organization, you need only report the name and address of the organization on your return. You can use Form W-10, Dependent Care Provider's Identification and Certification to request this information from the care provider. If you can't provide information regarding the care provider, you may still be eligible for the credit if you can show that you exercised due diligence in attempting to provide the required information. If you pay a provider to care for your dependent or spouse in your home, you may be a household employer. If you're a household employer, you may have to withhold and pay Social Security and Medicare taxes and pay federal unemployment tax. For more information, refer to Do You Have Household Employees? in Publication 503, Publication 926, Household Employer's Tax Guide, or Topic no. 756. Payments to relatives or dependents - The care provider can't be your spouse, the parent of your qualifying individual if your qualifying individual is your child and under age 13, your child who is under the age of 19, or a dependent whom you or your spouse may claim on your return. Reporting on your tax return If you qualify for the credit, complete Form 2441, Child and Dependent Care Expenses and attach to Form 1040, U.S Individual Income Tax Return, Form 1040-SR, U.S. Tax Return for Seniors or Form 1040-NR, U.S. Nonresident Alien Income Tax Return. If you received dependent care benefits from your employer (an amount is shown on your Form W-2, Wage and Tax Statement), you must complete Part III of Form 2441. Additional information For more information, refer to Am I eligible to claim the child and dependent care credit?"," Only use the provided text to answer the question, no outside sources. My husband and I have three children and I have been a stay at home mom for 10 years. My oldest daughter is 11. My husband's 16 year old daughter from a previous marriage wants to babysit for us. If we pay her to babysit can be we qualify for the dependent care credit? You may be able to claim the child and dependent care credit if you paid expenses for the care of a qualifying individual to enable you (and your spouse, if filing a joint return) to work or actively look for work. Generally, you may not take this credit if your filing status is married filing separately. However, see What's Your Filing Status? in Publication 503, Child and Dependent Care Expenses, which describes an exception for certain taxpayers living apart from their spouse and meeting other requirements. The amount of the credit is a percentage of the amount of work-related expenses you paid to a care provider for the care of a qualifying individual. The percentage depends on your adjusted gross income. Dollar limit The total expenses that you may use to calculate the credit may not be more than $3,000 (for one qualifying individual) or $6,000 (for two or more qualifying individuals). Expenses paid for the care of a qualifying individual are eligible expenses if the primary reason for paying the expense is to assure the individual's well-being and protection. If you received dependent care benefits that you exclude or deduct from your income, you must subtract the amount of those benefits from the dollar limit that applies to you. Qualifying individual A qualifying individual for the child and dependent care credit is: Your dependent qualifying child who was under age 13 when the care was provided, Your spouse who was physically or mentally incapable of self-care and lived with you for more than half of the year, or An individual who was physically or mentally incapable of self-care, lived with you for more than half of the year, and either: (a) was your dependent; or (b) could have been your dependent except that he or she received gross income of $4,700 or more, or filed a joint return, or you (or your spouse, if filing jointly) could have been claimed as a dependent on another taxpayer's 2023 return. Physically or mentally not able to care for oneself - An individual is physically or mentally incapable of self-care if, as a result of a physical or mental defect, the individual is incapable of caring for his or her hygiene or nutritional needs or requires the full-time attention of another person for the individual's own safety or the safety of others. Children of divorced or separated parents or parents living apart - A noncustodial parent who is claiming a child as a dependent should review the rules under the topic Child of divorced or separated parents or parents living apart in Publication 503, because a child may be treated as the qualifying individual of the custodial parent for the child and dependent care credit, even if the noncustodial parent is entitled to claim the child as a dependent. Individual qualifying for part of year - If an individual is a qualifying individual for only a part of the tax year, only those expenses paid for care of the individual during that part of the year are included in calculating the credit. Taxpayer identification number (TIN) - You must provide the TIN (usually the Social Security number) of each qualifying individual. Care of a qualifying individual The care may be provided in the household or outside the household; however, don't include any amounts that aren't primarily for the well-being of the individual. You should divide the expenses between amounts that are primarily for the care of the individual and amounts that aren't primarily for the care of the individual. You must reduce the expenses primarily for the care of the individual by the amount of any dependent care benefits provided by your employer that you exclude from gross income. In general, you can exclude up to $5,000 for dependent care benefits received from your employer. Additionally, in general, the expenses claimed may not exceed the smaller of your earned income or your spouse's earned income. If you or your spouse is a full-time student or incapable of self-care, then you or your spouse is treated as having earned income for each month that you or your spouse is a full-time student or incapable of self-care. Your or your spouse's earned income for each month is $250 if there is one qualifying person ($500 if two or more qualifying individuals). See the topic Earned Income Limit in Publication 503 PDF for further information. Care providers You must identify all persons or organizations that provide care for your child or dependent. You must report the name, address, and TIN (either the Social Security number or the employer identification number) of the care provider on your return. If the care provider is a tax-exempt organization, you need only report the name and address of the organization on your return. You can use Form W-10, Dependent Care Provider's Identification and Certification to request this information from the care provider. If you can't provide information regarding the care provider, you may still be eligible for the credit if you can show that you exercised due diligence in attempting to provide the required information. If you pay a provider to care for your dependent or spouse in your home, you may be a household employer. If you're a household employer, you may have to withhold and pay Social Security and Medicare taxes and pay federal unemployment tax. For more information, refer to Do You Have Household Employees? in Publication 503, Publication 926, Household Employer's Tax Guide, or Topic no. 756. Payments to relatives or dependents - The care provider can't be your spouse, the parent of your qualifying individual if your qualifying individual is your child and under age 13, your child who is under the age of 19, or a dependent whom you or your spouse may claim on your return. Reporting on your tax return If you qualify for the credit, complete Form 2441, Child and Dependent Care Expenses and attach to Form 1040, U.S Individual Income Tax Return, Form 1040-SR, U.S. Tax Return for Seniors or Form 1040-NR, U.S. Nonresident Alien Income Tax Return. If you received dependent care benefits from your employer (an amount is shown on your Form W-2, Wage and Tax Statement), you must complete Part III of Form 2441. Additional information For more information, refer to Am I eligible to claim the child and dependent care credit? https://www.irs.gov/taxtopics/tc602",Legal,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",My teen wants headphones for her birthday. She likes to listen to loud music and I'm worried about her hearing if she uses headphones. How can she safely use headphones?,"Is anyone listening? Monitoring your teen's headphone volume can help avoid hearing loss As a parent, do you often find yourself asking your child to remove their headphones? You may want to consider doing it even more often. If you’re the parent of a teenager, you likely have concerns about the link between headphones and hearing loss. Today, 1 in 5 teens will experience some form of hearing loss—a rate about 30% higher than it was 20 years ago. Many experts believe the escalation is due, in part, to increased use of headphones. According to James E. Foy, DO, an osteopathic pediatrician from Vallejo, California, listening through headphones at a high volume for extended periods of time can result in lifelong hearing loss for children and teens. “Even a mild hearing loss due to excessive noise could lead to developmental delays in speech and language,” he cautions. Doctors of Osteopathic Medicine, or DOs, look beyond your symptoms to understand how lifestyle and environmental factors affect your wellbeing. They listen and partner with you to help prevent injury and encourage your body’s natural tendency toward self-healing. How loud is too loud? Most MP3 players today can produce sounds up to 120 decibels, equivalent to a sound level at a rock concert. At that level, hearing loss can occur after only about an hour and 15 minutes, warns Dr. Foy. “I stress to my patients and their parents that if you can’t hear anything going on around you when listening to headphones, the decibel level is too high,” he says. Dr. Foy advises that people should not exceed 60% of maximum volume when listening through headphones. How long is too long? Duration of exposure to noise is also a major factor when examining headphones and hearing loss. “As a rule of thumb, you should only use MP3 devices at levels up to 60% of maximum volume for a total of 60 minutes a day,” says Dr. Foy. “The louder the volume, the shorter your duration should be. At maximum volume, you should listen for only about five minutes a day.” What are the signs of hearing loss? “The type of hearing loss due to headphone use is typically gradual, cumulative and without obvious warning signs,” explains Dr. Foy. “A hearing test and a medical examination are the only way to truly diagnose hearing damage.” However, if you or your child experiences any of the following symptoms, Dr. Foy recommends a visit to a physician immediately: Ringing, roaring, hissing or buzzing in the ear. Difficulty understanding speech in noisy places or places with poor acoustics. Muffled sounds and a feeling that your ear is plugged. Listening to the TV or radio at a higher volume than in the past. What is the treatment for hearing loss? “Unfortunately, the type of hearing loss caused by over exposure to very loud noise is irreversible, making prevention paramount,” says Dr. Foy. “Hearing aids and implants can help in amplifying sounds and making it easier to hear, but they are merely compensating for the damaged or nonworking parts of the ear.” How can I prevent hearing loss? “First and foremost, follow the 60/60 rule in regards to percentage of maximum volume and duration of time,” says Dr. Foy. Additionally, he suggests using older style, larger headphones that rest over the ear opening instead of earphones that are placed directly in your ear. “Whether using headphones or earphones, moderation is key,” says Dr. Foy. “Avoiding excessive use of listening devices altogether will go a long way in preventing hearing loss.”","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== My teen wants headphones for her birthday. She likes to listen to loud music and I'm worried about her hearing if she uses headphones. How can she safely use headphones? {passage 0} ========== Is anyone listening? Monitoring your teen's headphone volume can help avoid hearing loss As a parent, do you often find yourself asking your child to remove their headphones? You may want to consider doing it even more often. If you’re the parent of a teenager, you likely have concerns about the link between headphones and hearing loss. Today, 1 in 5 teens will experience some form of hearing loss—a rate about 30% higher than it was 20 years ago. Many experts believe the escalation is due, in part, to increased use of headphones. According to James E. Foy, DO, an osteopathic pediatrician from Vallejo, California, listening through headphones at a high volume for extended periods of time can result in lifelong hearing loss for children and teens. “Even a mild hearing loss due to excessive noise could lead to developmental delays in speech and language,” he cautions. Doctors of Osteopathic Medicine, or DOs, look beyond your symptoms to understand how lifestyle and environmental factors affect your wellbeing. They listen and partner with you to help prevent injury and encourage your body’s natural tendency toward self-healing. How loud is too loud? Most MP3 players today can produce sounds up to 120 decibels, equivalent to a sound level at a rock concert. At that level, hearing loss can occur after only about an hour and 15 minutes, warns Dr. Foy. “I stress to my patients and their parents that if you can’t hear anything going on around you when listening to headphones, the decibel level is too high,” he says. Dr. Foy advises that people should not exceed 60% of maximum volume when listening through headphones. How long is too long? Duration of exposure to noise is also a major factor when examining headphones and hearing loss. “As a rule of thumb, you should only use MP3 devices at levels up to 60% of maximum volume for a total of 60 minutes a day,” says Dr. Foy. “The louder the volume, the shorter your duration should be. At maximum volume, you should listen for only about five minutes a day.” What are the signs of hearing loss? “The type of hearing loss due to headphone use is typically gradual, cumulative and without obvious warning signs,” explains Dr. Foy. “A hearing test and a medical examination are the only way to truly diagnose hearing damage.” However, if you or your child experiences any of the following symptoms, Dr. Foy recommends a visit to a physician immediately: Ringing, roaring, hissing or buzzing in the ear. Difficulty understanding speech in noisy places or places with poor acoustics. Muffled sounds and a feeling that your ear is plugged. Listening to the TV or radio at a higher volume than in the past. What is the treatment for hearing loss? “Unfortunately, the type of hearing loss caused by over exposure to very loud noise is irreversible, making prevention paramount,” says Dr. Foy. “Hearing aids and implants can help in amplifying sounds and making it easier to hear, but they are merely compensating for the damaged or nonworking parts of the ear.” How can I prevent hearing loss? “First and foremost, follow the 60/60 rule in regards to percentage of maximum volume and duration of time,” says Dr. Foy. Additionally, he suggests using older style, larger headphones that rest over the ear opening instead of earphones that are placed directly in your ear. “Whether using headphones or earphones, moderation is key,” says Dr. Foy. “Avoiding excessive use of listening devices altogether will go a long way in preventing hearing loss.” https://osteopathic.org/what-is-osteopathic-medicine/headphones-hearing-loss/",Medical,Find & Summarize,Text Transformation "Provide responses in clear, concise and simple manner. The target audience has no knowledge of the subject and are not experts. You response should only rely on the provided context.",What are some of the main topics addressed as having occurred in the last fiscal year based on the information shared in the letter?,"Annual Letter to Shareholders Dear Shareholders, the Global McFamily and our Customers, At McDonald’s, we are privileged to be active participants in the local communities where we live, work and serve. That means we refect the values and understand the needs of the customers and people we strive to put frst every day. This was especially prudent as we navigated the COVID-19 pandemic and societal challenges within this past year. Through it all, and with the strength of our McFamily and a values-led mindset, we did the right thing from the start. We prioritized the safety of restaurant crew and customers; we took important steps to preserve our fnancial fexibility; we leveraged the power of our supply chain; and we stood by and supported our local communities. I believe frmly that our Brand will be defned by how we respond to such challenges, both as the world’s largest restaurant company—and as good neighbors. At the onset of the pandemic, I laid out fve principles that McDonald’s used to guide our approach to this historic challenge: Supported by these principles and energized by the incredible courage and efort from people across our three-legged stool, McDonald’s delivered a resilient performance in what was the most difcult year in our history. “We’re all in this together” “Think and act with a long-term mindset” “ Be transparent with each other and our stakeholders” “Lead by example” “Stay true to our purpose” Annual Letter to Shareholders Emerging from 2020 in a position of strength While conditions were challenging in most markets, we still achieved nearly $20 billion in full year revenue and over $90 billion in full year Systemwide sales. We were well-positioned to efectively navigate such challenging circumstances because of our operating model, our focus on running great restaurants and our many competitive strengths, including our formidable Drive Thru presence. We also were wellpositioned due to the signifcant investments we’ve made in recent years to develop our digital and delivery capabilities, which proved to be a boon throughout the pandemic. The US delivered its sixth consecutive year of positive comparable sales, and average US franchisee restaurant operating cash fow reached an all-time high in 2020, after a previous all-time high in 2019. Elsewhere, Japan and Australia posted fve and seven consecutive years of positive comparable sales growth, respectively. Markets that had to signifcantly reduce operations or face closures due to government restrictions did so with remarkable agility and care. Their ability to respond quickly to the external environment was a further demonstration of our System’s unmatched execution prowess. While 2020 was a historically demanding year, it has helped McDonald’s to do everything better. We engaged Mayo Clinic to provide ongoing expertise on emerging science in COVID-19 infection prevention, and we devised new ways to safely and reliably serve our customers. This, in turn, allowed us to continue gaining market share in most major markets. We also improved on our already unrivaled Drive Thru capabilities and continued to see the enormous benefts of contactless delivery, take-away, and curbside pick-up. Meanwhile, more customers used our app than ever before, as digital sales reached nearly 20 percent of Systemwide sales across our top six markets. At the outset of the pandemic, we committed to helping every operator and partner survive the crisis. We took prudent, quick action designed to prevent not a single Owner/Operator from failing due to the pandemic. We ofered franchisees nearly $1 billion in short-term fnancial liquidity support through rent and royalty deferrals, along with timely, targeted, and temporary assistance to individual franchisees in the most precarious situations. Thanks to our quick decision-making and our robust balance sheet, the fnancial health of the McDonald’s System remains strong. Just as important, we addressed our shortterm challenges without sacrifcing our long-term priorities. We continued to invest in our Brand, including an incremental $200 million in marketing support to widen our market share gains and accelerate our recovery. We also opened nearly 1,000 new restaurants globally, modernized another 900 restaurants in the US, and together with our franchisees, we invested more than $1 billion in technology and digital initiatives. I said several times through the year that we were confdent McDonald’s would be just as strong coming out of the pandemic as we were going into it, and we are proving that in so many ways. A new, holistic growth strategy to refect the changing environment Motivated by our resilience in the face of unprecedented challenges, we began writing the next chapter for McDonald’s as we shared our new growth strategy, Accelerating the Arches. Alongside bold business objectives, the strategy articulates a clear vision of where and how we intend to make a diference in the world, refecting the changing expectations that today’s customers have of modern corporations like McDonald’s. Annual Letter to Shareholders It is especially encouraging to see the power of the three pillars coming together already. The launch of Famous Orders in the US, for example, brought together the strength of our marketing, the popularity of our core menu items and enormous digital engagement to drive signifcant sales in the third and fourth quarters of 2020. The success of this initiative was just a glimpse of what is possible and we are excited for what is to come. We already knew customer habits and expectations were changing going into 2020. The pandemic accelerated some of those changes and brought other powerful truths into focus. First, our customers’ needs are diferent than they were prior to the pandemic, so the experience we ofer must adapt. A world with less dine-in and more takeout plays to our signifcant advantage in Drive Thru and our growing capabilities in delivery and curbside pick-up. More lunch and dinner visits are well-suited to our core menu, with iconic favorites that people love. Greater dependence on technology bodes well for McDonald’s fast-growing digital experience and our inherent scale advantages. This understanding was essential as we identifed three new growth pillars to deliver our next phase of sustainable growth under Accelerating the Arches. They are easy to remember… just think M-C-D: Leading with our purpose and refreshing our values to guide our strategy The second truth is that people expect more from corporations today and are seeking brands that refect their own values. Customers want to see that the McDonald’s they visit locally matches how we act globally. They want and expect us to be a force for good everywhere. The strength of McDonald’s business entering 2020 and our resilience through the pandemic allowed us to broaden our perspective to make Accelerating the Arches a strategy focused on more than just business performance. It is rooted in our belief that our next chapter of growth depends not just on what we do, but how we do it in more than 39,000 local restaurants around the world. Meeting the needs of our customers and communities requires us to embrace a bigger, more holistic vision. Just as our timeless commitment to Quality, Service, Cleanliness, and Value has been refned over the years to make them relevant for each era, the language we use to express our purpose, mission, and values must be reinvigorated to ensure it is responsive to today’s McDonald’s is one of the world’s most recognized brands, and we invest about $4 billion per year in marketing. Working with our agency partners, we will raise our creative ambition and capitalize on evolving digital behaviors to deepen the connection with our customers to drive growth. M - Maximize our Marketing McDonald’s menu is known around the globe, and customers love favorites like the Big Mac®, Chicken McNuggets®, and of course, our World Famous Fries®. During the pandemic, we focused on these classics and were reminded not only of customers’ enduring passion for these products, but also the signifcant growth opportunities that still exist within our core menu. C - Commit to the Core Digital, Delivery and Drive Thru. Customers have always loved McDonald’s for its convenience, and new technologies ofer us the opportunity to make the McDonald’s experience even faster and easier. We will innovate in these service channels to unlock even more growth. D - Double Down on the Three Ds Annual Letter to Shareholders Serve We put our customers and people frst Integrity We do the right thing Family We get better together Community We are good neighbors Inclusion We open our doors to everyone environment. That’s especially true in an era when customers and communities expect more of us. That is why one of our priorities over the past year was to ensure our purpose, mission, and values refect the role we play in society today— while embracing the vital place these timeless ideals and principles occupy as an essential part of this special Brand we all love. In speaking to franchisees, customers and crew around the world, it became clear that McDonald’s purpose is to feed and foster communities. It also became clear in those conversations that our ability to deliver on our purpose is rooted in a refreshed set of core values: Ray Kroc used to talk constantly about our values. He knew that in a System where every restaurant is unique and locally owned, our values would be the light that guides us through every decision. These refreshed values are a foundational component of Accelerating the Arches and will guide us in achieving our business objectives while providing a common compass for how we serve our communities, and one another. With its holistic view of what McDonald’s seeks to accomplish as an organization, Accelerating the Arches will strengthen our advantages and deliver value—not only to our business, but to our communities, customers, franchisees, crew, employees, farmers and suppliers. Looking forward to another year of progress We are a stronger Brand for the challenges we faced together in 2020. Our business performance and the trust we fostered throughout our communities reinforced our confdence in McDonald’s long-term success. As a result, we were pleased to continue the company’s more than 40-year tradition of annual dividend increases. While 2020 was a year beset with obstacles, it was also a year of progress for McDonald’s, and it has emboldened us to build on the platform we created to write our next great chapter together. Supported by a bold new strategy and our enduring foundation of running great restaurants, McDonald’s will continue to strive to be a force for good in our communities while strengthening and widening the competitive advantages that help us make delicious feel-good moments easy for everyone. Thank you to our shareholders for your continued investment in McDonald’s, to our customers for giving us the opportunity to serve you and your communities, and to the people in the McDonald’s System who make this business what it is and give us the spirit to succeed. Be well. Chris Kempczinski President and CEO McDonald’s Corporation","Provide responses in clear, concise and simple manner. The target audience has no knowledge of the subject and are not experts. You response should only rely on the provided context. What are some of the main topics addressed as having occurred in the last fiscal year based on the information shared in the letter? Annual Letter to Shareholders Dear Shareholders, the Global McFamily and our Customers, At McDonald’s, we are privileged to be active participants in the local communities where we live, work and serve. That means we refect the values and understand the needs of the customers and people we strive to put frst every day. This was especially prudent as we navigated the COVID-19 pandemic and societal challenges within this past year. Through it all, and with the strength of our McFamily and a values-led mindset, we did the right thing from the start. We prioritized the safety of restaurant crew and customers; we took important steps to preserve our fnancial fexibility; we leveraged the power of our supply chain; and we stood by and supported our local communities. I believe frmly that our Brand will be defned by how we respond to such challenges, both as the world’s largest restaurant company—and as good neighbors. At the onset of the pandemic, I laid out fve principles that McDonald’s used to guide our approach to this historic challenge: Supported by these principles and energized by the incredible courage and efort from people across our three-legged stool, McDonald’s delivered a resilient performance in what was the most difcult year in our history. “We’re all in this together” “Think and act with a long-term mindset” “ Be transparent with each other and our stakeholders” “Lead by example” “Stay true to our purpose” Annual Letter to Shareholders Emerging from 2020 in a position of strength While conditions were challenging in most markets, we still achieved nearly $20 billion in full year revenue and over $90 billion in full year Systemwide sales. We were well-positioned to efectively navigate such challenging circumstances because of our operating model, our focus on running great restaurants and our many competitive strengths, including our formidable Drive Thru presence. We also were wellpositioned due to the signifcant investments we’ve made in recent years to develop our digital and delivery capabilities, which proved to be a boon throughout the pandemic. The US delivered its sixth consecutive year of positive comparable sales, and average US franchisee restaurant operating cash fow reached an all-time high in 2020, after a previous all-time high in 2019. Elsewhere, Japan and Australia posted fve and seven consecutive years of positive comparable sales growth, respectively. Markets that had to signifcantly reduce operations or face closures due to government restrictions did so with remarkable agility and care. Their ability to respond quickly to the external environment was a further demonstration of our System’s unmatched execution prowess. While 2020 was a historically demanding year, it has helped McDonald’s to do everything better. We engaged Mayo Clinic to provide ongoing expertise on emerging science in COVID-19 infection prevention, and we devised new ways to safely and reliably serve our customers. This, in turn, allowed us to continue gaining market share in most major markets. We also improved on our already unrivaled Drive Thru capabilities and continued to see the enormous benefts of contactless delivery, take-away, and curbside pick-up. Meanwhile, more customers used our app than ever before, as digital sales reached nearly 20 percent of Systemwide sales across our top six markets. At the outset of the pandemic, we committed to helping every operator and partner survive the crisis. We took prudent, quick action designed to prevent not a single Owner/Operator from failing due to the pandemic. We ofered franchisees nearly $1 billion in short-term fnancial liquidity support through rent and royalty deferrals, along with timely, targeted, and temporary assistance to individual franchisees in the most precarious situations. Thanks to our quick decision-making and our robust balance sheet, the fnancial health of the McDonald’s System remains strong. Just as important, we addressed our shortterm challenges without sacrifcing our long-term priorities. We continued to invest in our Brand, including an incremental $200 million in marketing support to widen our market share gains and accelerate our recovery. We also opened nearly 1,000 new restaurants globally, modernized another 900 restaurants in the US, and together with our franchisees, we invested more than $1 billion in technology and digital initiatives. I said several times through the year that we were confdent McDonald’s would be just as strong coming out of the pandemic as we were going into it, and we are proving that in so many ways. A new, holistic growth strategy to refect the changing environment Motivated by our resilience in the face of unprecedented challenges, we began writing the next chapter for McDonald’s as we shared our new growth strategy, Accelerating the Arches. Alongside bold business objectives, the strategy articulates a clear vision of where and how we intend to make a diference in the world, refecting the changing expectations that today’s customers have of modern corporations like McDonald’s. Annual Letter to Shareholders It is especially encouraging to see the power of the three pillars coming together already. The launch of Famous Orders in the US, for example, brought together the strength of our marketing, the popularity of our core menu items and enormous digital engagement to drive signifcant sales in the third and fourth quarters of 2020. The success of this initiative was just a glimpse of what is possible and we are excited for what is to come. We already knew customer habits and expectations were changing going into 2020. The pandemic accelerated some of those changes and brought other powerful truths into focus. First, our customers’ needs are diferent than they were prior to the pandemic, so the experience we ofer must adapt. A world with less dine-in and more takeout plays to our signifcant advantage in Drive Thru and our growing capabilities in delivery and curbside pick-up. More lunch and dinner visits are well-suited to our core menu, with iconic favorites that people love. Greater dependence on technology bodes well for McDonald’s fast-growing digital experience and our inherent scale advantages. This understanding was essential as we identifed three new growth pillars to deliver our next phase of sustainable growth under Accelerating the Arches. They are easy to remember… just think M-C-D: Leading with our purpose and refreshing our values to guide our strategy The second truth is that people expect more from corporations today and are seeking brands that refect their own values. Customers want to see that the McDonald’s they visit locally matches how we act globally. They want and expect us to be a force for good everywhere. The strength of McDonald’s business entering 2020 and our resilience through the pandemic allowed us to broaden our perspective to make Accelerating the Arches a strategy focused on more than just business performance. It is rooted in our belief that our next chapter of growth depends not just on what we do, but how we do it in more than 39,000 local restaurants around the world. Meeting the needs of our customers and communities requires us to embrace a bigger, more holistic vision. Just as our timeless commitment to Quality, Service, Cleanliness, and Value has been refned over the years to make them relevant for each era, the language we use to express our purpose, mission, and values must be reinvigorated to ensure it is responsive to today’s McDonald’s is one of the world’s most recognized brands, and we invest about $4 billion per year in marketing. Working with our agency partners, we will raise our creative ambition and capitalize on evolving digital behaviors to deepen the connection with our customers to drive growth. M - Maximize our Marketing McDonald’s menu is known around the globe, and customers love favorites like the Big Mac®, Chicken McNuggets®, and of course, our World Famous Fries®. During the pandemic, we focused on these classics and were reminded not only of customers’ enduring passion for these products, but also the signifcant growth opportunities that still exist within our core menu. C - Commit to the Core Digital, Delivery and Drive Thru. Customers have always loved McDonald’s for its convenience, and new technologies ofer us the opportunity to make the McDonald’s experience even faster and easier. We will innovate in these service channels to unlock even more growth. D - Double Down on the Three Ds Annual Letter to Shareholders Serve We put our customers and people frst Integrity We do the right thing Family We get better together Community We are good neighbors Inclusion We open our doors to everyone environment. That’s especially true in an era when customers and communities expect more of us. That is why one of our priorities over the past year was to ensure our purpose, mission, and values refect the role we play in society today— while embracing the vital place these timeless ideals and principles occupy as an essential part of this special Brand we all love. In speaking to franchisees, customers and crew around the world, it became clear that McDonald’s purpose is to feed and foster communities. It also became clear in those conversations that our ability to deliver on our purpose is rooted in a refreshed set of core values: Ray Kroc used to talk constantly about our values. He knew that in a System where every restaurant is unique and locally owned, our values would be the light that guides us through every decision. These refreshed values are a foundational component of Accelerating the Arches and will guide us in achieving our business objectives while providing a common compass for how we serve our communities, and one another. With its holistic view of what McDonald’s seeks to accomplish as an organization, Accelerating the Arches will strengthen our advantages and deliver value—not only to our business, but to our communities, customers, franchisees, crew, employees, farmers and suppliers. Looking forward to another year of progress We are a stronger Brand for the challenges we faced together in 2020. Our business performance and the trust we fostered throughout our communities reinforced our confdence in McDonald’s long-term success. As a result, we were pleased to continue the company’s more than 40-year tradition of annual dividend increases. While 2020 was a year beset with obstacles, it was also a year of progress for McDonald’s, and it has emboldened us to build on the platform we created to write our next great chapter together. Supported by a bold new strategy and our enduring foundation of running great restaurants, McDonald’s will continue to strive to be a force for good in our communities while strengthening and widening the competitive advantages that help us make delicious feel-good moments easy for everyone. Thank you to our shareholders for your continued investment in McDonald’s, to our customers for giving us the opportunity to serve you and your communities, and to the people in the McDonald’s System who make this business what it is and give us the spirit to succeed. Be well. Chris Kempczinski President and CEO McDonald’s Corporation",Financial,Find & Summarize,Text Transformation Do not use external resources for your answer. Only use the provided context block.,What does the book include to help answer important questions about Bitcoin?,"There’s a lot of excitement about Bitcoin and cryptocurrencies. Optimists claim that Bitcoin will fundamentally alter payments, economics, and even politics around the world. Pessimists claim Bitcoin is inherently broken and will suffer an inevitable and spectacular collapse. Underlying these differing views is significant confusion about what Bitcoin is and how it works. We wrote this book to help cut through the hype and get to the core of what makes Bitcoin unique. To really understand what is special about Bitcoin, we need to understand how it works at a technical level. Bitcoin truly is a new technology and we can only get so far by explaining it through simple analogies to past technologies. We’ll assume that you have a basic understanding of computer science — how computers work, data structures and algorithms, and some programming experience. If you’re an undergraduate or graduate student of computer science, a software developer, an entrepreneur, or a technology hobbyist, this textbook is for you. In this book we’ll address the important questions about Bitcoin. How does Bitcoin work? What makes it different? How secure are your bitcoins? How anonymous are Bitcoin users? What applications can we build using Bitcoin as a platform? Can cryptocurrencies be regulated? If we were designing a new cryptocurrency today, what would we change? What might the future hold? Each chapter has a series of homework questions to help you understand these questions at a deeper level. In addition, there is a series of programming assignments in which you’ll implement various components of Bitcoin in simplified models. If you’re an auditory learner, most of the material of this book is available as a series of video lectures. You can find all these on our ​Coursera course.​ You should also supplement your learning with information you can find online including the Bitcoin wiki, forums, and research papers, and by interacting with your peers and the Bitcoin community. After reading this book, you’ll know everything you need to be able to separate fact from fiction when reading claims about Bitcoin and other cryptocurrencies. You’ll have the conceptual foundations you need to engineer secure software that interacts with the Bitcoin network. And you’ll be able to integrate ideas from Bitcoin into your own projects.","Do not use external resources for your answer. Only use the provided context block. What does the book include to help answer important questions about Bitcoin? [There’s a lot of excitement about Bitcoin and cryptocurrencies. Optimists claim that Bitcoin will fundamentally alter payments, economics, and even politics around the world. Pessimists claim Bitcoin is inherently broken and will suffer an inevitable and spectacular collapse. Underlying these differing views is significant confusion about what Bitcoin is and how it works. We wrote this book to help cut through the hype and get to the core of what makes Bitcoin unique. To really understand what is special about Bitcoin, we need to understand how it works at a technical level. Bitcoin truly is a new technology and we can only get so far by explaining it through simple analogies to past technologies. We’ll assume that you have a basic understanding of computer science — how computers work, data structures and algorithms, and some programming experience. If you’re an undergraduate or graduate student of computer science, a software developer, an entrepreneur, or a technology hobbyist, this textbook is for you. In this book we’ll address the important questions about Bitcoin. How does Bitcoin work? What makes it different? How secure are your bitcoins? How anonymous are Bitcoin users? What applications can we build using Bitcoin as a platform? Can cryptocurrencies be regulated? If we were designing a new cryptocurrency today, what would we change? What might the future hold? Each chapter has a series of homework questions to help you understand these questions at a deeper level. In addition, there is a series of programming assignments in which you’ll implement various components of Bitcoin in simplified models. If you’re an auditory learner, most of the material of this book is available as a series of video lectures. You can find all these on our ​Coursera course.​ You should also supplement your learning with information you can find online including the Bitcoin wiki, forums, and research papers, and by interacting with your peers and the Bitcoin community. After reading this book, you’ll know everything you need to be able to separate fact from fiction when reading claims about Bitcoin and other cryptocurrencies. You’ll have the conceptual foundations you need to engineer secure software that interacts with the Bitcoin network. And you’ll be able to integrate ideas from Bitcoin into your own projects.]",Financial,Find & Summarize,Text Transformation Only rely on the provided text.,Which American made significant contributions to our understanding of the distribution of wealth?,"In the theory of distribution interest must be aasigned a quite different and much more important r61e than economists thus far have given to it. In classical economics the nature of interest and its place in distribution were not clearly understood. Distribution has been erroneously defined as the division of the income of society into “interest, rent, wages, and profits.” Rent and interest are merely two ways of measuring the same income ; rent, aa the yield per acre or other physical unit, and interest aa the same yield expressed aa a per cent of capital value. The value of the capital is derived from the income which it yields by capitalizing it at the prevailing rate of interest. To reverse this process by multiplying the capitd vdue by the rate of interest gives the original income, aa long aa the capital value remains stationary. It is not really a complex product of two factors, but, on the contrary, is the single original factor, namely, income, from which we started. As explained in previous chapters, it is this income which affords the basis for the determination of the &e of interest, and through the rate of interest, of capital value. The hal enjoyable income of society is the ultimate and basic fact from which all values are derived and c3311 THE THEORY OF INTEREST toward which all economic action is bent. All of this income is derived from capital wealth, if land and man are included in that term, or if not, from capital and man, or capital, land, and man, according to the terminology adopted. This income may all be capitalized, and hence all income (excluding capital gain) may be viewed as interest upon the capital value thus found. Viewed as above outlined interest is not a part, but the whole, of income (except for capital gain). It includes what is called rent and profits and even wages, for the income of the workman may be capitalized quite as truly as the income of land or machinery. Thus, instead of having interest, rent, wages, and profits as mutually exclusive portions of social income, interest may be regarded as including all four. If we prefer to exclude profits, the reason is because of the element of risk and not because profits are not discountable just as truly as rent and wages. The error of the classical economists and of their modern followers in regarding interest, rent, wages and profits as separate but coijrdinate incomes is partly due to the failure to perceive thzlt, whereas all income is produced from capital wealth, capital vdue can emerge only from man’s psychic evaluation and capitalization of that income in advance of its occurrence. Another oversight closely ltssociated with the last stated fallacy is that in which rent and wages are conceived aa determined independently of the rate of interest, whereas we have just seen that the rate of interest enters aa a vital element into the determination of both. The great defect in the theories propounded by the classical economists lay in their inability to conceive of a general equilibrium and the mutual dependence of sacrifice and enjoyment. C 332 3 THE PLACE OF INTEREST IN ECONOMICS In discueeing the theory of distribution, we shall, there fore, abandon the classical point of view entirely. The claasical concepts of distribution are quite inappropriate to explain the every day facts of life and the economic structure. The phrase distribution of wealth, as understood by the ordinary man, implies the problem of the relative wealth of individuals, the problem of the rich and the poor. But the separation of the aggregate income into four abstract magnitudes, even if correctly done, has littIe to do with the question of how much income the different individuals in society receive. Only on condition that society WM composed of four independent and mutually exclusive groups, laborers, landlords, enterprisers, and capitalists, would the fourfold division of the classical economists be even partially dequate to explain the actual distribution of income. In fact, the four classes all overlap. The enterpriser is almost invariably a genuine capitalist and usually also performs labor; the capitalist is frequently a landlord and laborer, and even the typical laborer is today often a amall capitalist and sometimes a landlord. It is true that a century ago in England the lines of social classification corresponded roughly to the abstract divisions proposed at that time by the classical economists. But this fact is of little significance except as explaining historically the origin of the classical theory of distrib~tion.~ $5. Interest and Personal Distribution The main problem of distribution, as I see it, is concerned with the determination and explanation of the amounts and values of capitala and incomes possemed don, P. 8. King dc Son, 1903. '&e Cannan, Edwin, Thoties of production and Dt&ibuticm. hCWI THE THEORY OF INTEREST by Merent individuah in society. It is astonishing how little economistg have contributed to resolving the problem of distribution EO conceived. A statistid beginning w&s made by Professor Pareto in his present&ion of interesting “curves of distribution of income.” For the United States, Professor W. I. King and the National Bureau of Economic Research ?, and for England, Sir Josiah Stamp have made and analyzed important statistical compilations on the amount and distribution of income and capital wealth by income groups and social classes. On the theory of distribution, especially the rcile of interest in distribution, John Rae seems to have contributed more than any other writer O. He showed in a vivid way that persons who had naturally what we have called in this book a low rate of impatience or preference for present over future income tended to accumulate savings, whereas those who had t,he opposite trait tended to spend their incomes and even their capitals. In previous chapters it is shown that the rates of preference among different individurtls are equalized by borrowing and lending or, what amounts to the same thing, ‘Pareto, Cam 82-k Politipue, Vol. 11, Book III. ‘King, W. I., The Wealth and Income of the People of the United State, New York, The Macmillan Co., 1915. ‘Mitchell, W. C., King, W. I., Mseaulay, F. R., Knauth, 0. W., Income in the United States. New York, National Bureau of Economic Reeearch, Inc., 1922. Knauth, 0. W., Dietribution of I~~come byi3tat-a in 1919. New York, Harcourt, Brace & Co., 1822. Leven, Maurice, and King, w. I., Income in the Vuriou8 &utes; Its sovceS and DietribzLtion, 1910, f9#, and 19tl. New York, National Bureau of Economic Resesrch, Inc., 1925. ‘Stamp, Sir Josiah, WeaUh and Tdle Capacily. London, P. 9. King & hn, La., 1922. Also, Btitieh Incomes and Prqperty. London, P. 8. King & Son, 1916. ’ Rae, The Socidogid Thew o? Capitd, Chapter XIII. 1WI. THE PLACE OF INTEREST IN ECONOMICS by buying and selling. An individual whose rate of preference for present enjoyment is unduly high wil contrive to modify his income stream by increasing it in the pment at the expense of the future. The effects upon incomes may be traced to capital by applying the principles explained in The Nature of Caplltal and Income, Chapter XIV.","Which American made significant contributions to our understanding of the distribution of wealth? Only rely on the provided text. In the theory of distribution interest must be aasigned a quite different and much more important r61e than economists thus far have given to it. In classical economics the nature of interest and its place in distribution were not clearly understood. Distribution has been erroneously defined as the division of the income of society into “interest, rent, wages, and profits.” Rent and interest are merely two ways of measuring the same income ; rent, aa the yield per acre or other physical unit, and interest aa the same yield expressed aa a per cent of capital value. The value of the capital is derived from the income which it yields by capitalizing it at the prevailing rate of interest. To reverse this process by multiplying the capitd vdue by the rate of interest gives the original income, aa long aa the capital value remains stationary. It is not really a complex product of two factors, but, on the contrary, is the single original factor, namely, income, from which we started. As explained in previous chapters, it is this income which affords the basis for the determination of the &e of interest, and through the rate of interest, of capital value. The hal enjoyable income of society is the ultimate and basic fact from which all values are derived and c3311 THE THEORY OF INTEREST toward which all economic action is bent. All of this income is derived from capital wealth, if land and man are included in that term, or if not, from capital and man, or capital, land, and man, according to the terminology adopted. This income may all be capitalized, and hence all income (excluding capital gain) may be viewed as interest upon the capital value thus found. Viewed as above outlined interest is not a part, but the whole, of income (except for capital gain). It includes what is called rent and profits and even wages, for the income of the workman may be capitalized quite as truly as the income of land or machinery. Thus, instead of having interest, rent, wages, and profits as mutually exclusive portions of social income, interest may be regarded as including all four. If we prefer to exclude profits, the reason is because of the element of risk and not because profits are not discountable just as truly as rent and wages. The error of the classical economists and of their modern followers in regarding interest, rent, wages and profits as separate but coijrdinate incomes is partly due to the failure to perceive thzlt, whereas all income is produced from capital wealth, capital vdue can emerge only from man’s psychic evaluation and capitalization of that income in advance of its occurrence. Another oversight closely ltssociated with the last stated fallacy is that in which rent and wages are conceived aa determined independently of the rate of interest, whereas we have just seen that the rate of interest enters aa a vital element into the determination of both. The great defect in the theories propounded by the classical economists lay in their inability to conceive of a general equilibrium and the mutual dependence of sacrifice and enjoyment. C 332 3 THE PLACE OF INTEREST IN ECONOMICS In discueeing the theory of distribution, we shall, there fore, abandon the classical point of view entirely. The claasical concepts of distribution are quite inappropriate to explain the every day facts of life and the economic structure. The phrase distribution of wealth, as understood by the ordinary man, implies the problem of the relative wealth of individuals, the problem of the rich and the poor. But the separation of the aggregate income into four abstract magnitudes, even if correctly done, has littIe to do with the question of how much income the different individuals in society receive. Only on condition that society WM composed of four independent and mutually exclusive groups, laborers, landlords, enterprisers, and capitalists, would the fourfold division of the classical economists be even partially dequate to explain the actual distribution of income. In fact, the four classes all overlap. The enterpriser is almost invariably a genuine capitalist and usually also performs labor; the capitalist is frequently a landlord and laborer, and even the typical laborer is today often a amall capitalist and sometimes a landlord. It is true that a century ago in England the lines of social classification corresponded roughly to the abstract divisions proposed at that time by the classical economists. But this fact is of little significance except as explaining historically the origin of the classical theory of distrib~tion.~ $5. Interest and Personal Distribution The main problem of distribution, as I see it, is concerned with the determination and explanation of the amounts and values of capitala and incomes possemed don, P. 8. King dc Son, 1903. '&e Cannan, Edwin, Thoties of production and Dt&ibuticm. hCWI THE THEORY OF INTEREST by Merent individuah in society. It is astonishing how little economistg have contributed to resolving the problem of distribution EO conceived. A statistid beginning w&s made by Professor Pareto in his present&ion of interesting “curves of distribution of income.” For the United States, Professor W. I. King and the National Bureau of Economic Research ?, and for England, Sir Josiah Stamp have made and analyzed important statistical compilations on the amount and distribution of income and capital wealth by income groups and social classes. On the theory of distribution, especially the rcile of interest in distribution, John Rae seems to have contributed more than any other writer O. He showed in a vivid way that persons who had naturally what we have called in this book a low rate of impatience or preference for present over future income tended to accumulate savings, whereas those who had t,he opposite trait tended to spend their incomes and even their capitals. In previous chapters it is shown that the rates of preference among different individurtls are equalized by borrowing and lending or, what amounts to the same thing, ‘Pareto, Cam 82-k Politipue, Vol. 11, Book III. ‘King, W. I., The Wealth and Income of the People of the United State, New York, The Macmillan Co., 1915. ‘Mitchell, W. C., King, W. I., Mseaulay, F. R., Knauth, 0. W., Income in the United States. New York, National Bureau of Economic Reeearch, Inc., 1922. Knauth, 0. W., Dietribution of I~~come byi3tat-a in 1919. New York, Harcourt, Brace & Co., 1822. Leven, Maurice, and King, w. I., Income in the Vuriou8 &utes; Its sovceS and DietribzLtion, 1910, f9#, and 19tl. New York, National Bureau of Economic Resesrch, Inc., 1925. ‘Stamp, Sir Josiah, WeaUh and Tdle Capacily. London, P. 9. King & hn, La., 1922. Also, Btitieh Incomes and Prqperty. London, P. 8. King & Son, 1916. ’ Rae, The Socidogid Thew o? Capitd, Chapter XIII. 1WI. THE PLACE OF INTEREST IN ECONOMICS by buying and selling. An individual whose rate of preference for present enjoyment is unduly high wil contrive to modify his income stream by increasing it in the pment at the expense of the future. The effects upon incomes may be traced to capital by applying the principles explained in The Nature of Caplltal and Income, Chapter XIV.",Financial,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","My friend is trying to get me to start Ozempic, since it has helped her lose weight. I want to know more about what it is. Using this article, tell me how Ozempic works and what the risks are. Use at least 400 words.","Does Ozempic Have an Immediate Effect? Ozempic is a medication in the class of GLP-1 agonists, which mimic the action of a hormone called GLP-1 that your stomach naturally releases when you eat food. When blood sugar levels naturally start rising after you eat, these drugs stimulate the body to produce more insulin, which helps direct blood sugar into the body's cells to be used for energy. If you’re taking Ozempic for diabetes, “it doesn’t have the immediate effect that injecting actual insulin does,” she adds. Per the Centers for Disease Control and Prevention (CDC), rapid-acting insulin can start working in as little as 30 minutes to accelerate the entry of glucose into cells for metabolism into glycogen—a main source of energy for the body. Ozempic doesn’t have an immediate effect on weight loss either. “Ozempic is started at the lowest dose and advanced every four weeks,” says Mir Ali, M.D., a bariatric surgeon and the medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. “Each patient responds differently. Some feel the effects immediately, while others may need to be on higher dose levels to feel the effects. When the patients are at the appropriate dose, they feel much less hungry and feel full for a longer period of time.” The effects of a dose of Ozempic last for about one week—this is why it’s injected once-weekly. “Some people may see a tapering of the effects towards the end of the one-week period, while others don’t,” says Dr. Ali. It should be noted that the same holds true for Wegovy. The main difference between Wegovy and Ozempic is the amount of semaglutide in each injectable dose: Wegovy’s maximum maintenance dose is 2.4 milligrams (mg), while Ozempic’s is 2 mg. Lowering Blood Sugar How Long Does It Take Ozempic to Lower Blood Sugar? Every patient is different, but you can expect to notice lower levels of blood sugar as quickly as within the first week of taking Ozempic, says Dr. Lofton. “The effect will be more dramatic as the doses increase over a period of months,” she says. For instance, if the patient’s dose is increased monthly, they should reach the maximum dose of 2 mg on the fourth month. Sticking to lower doses for the first four weeks helps lower side effects, but higher doses are required to lower blood sugar in the long term, per the official dosing guidelines. “How long it takes to achieve a healthy blood sugar level depends on how well the glucose was controlled prior to initiating Ozempic as well as the patient’s diet, exercise, and other medications,” Dr. Lofton says. Your doctor will carry out the hemoglobin A1C test—a simple blood test that measures your average blood sugar levels over the past three months. “It takes three months for hemoglobin A1C to change, so I would expect some improvement in hemoglobin A1C three months after starting Ozempic,” Dr. Lofton explains. For those individuals with type 2 diabetes who take metformin, which is the first-line medication used to treat the condition, some may find that adding—or switching to—a GPL-1 agonist drug like Ozempic may improve outcomes; this is something your doctor will evaluate if this applies to your situation. Some people with type 2 diabetes may take insulin and Ozempic. “Often, a patient’s insulin requirement decreases as Ozempic doses increase so it is likely that type 2 diabetes may no longer require insulin when on a GLP-1 agonist,” says Dr. Lofton. “This is ideal because insulin can cause weight gain.” Weight Loss How Long Does It Take Ozempic to Lead to Weight Loss? The effect of Ozempic on weight really depends on the individual, says Dr. Ali. “Some patients will experience a loss of appetite with the initial dose,” he says. “However, most patients will likely not see significant weight loss until they reach higher dose levels at eight-to-12 weeks.” In Dr. Lofton's experience, there is usually some weight loss in the first month. “If weight goals are not met, then the dose can be increased,” she notes. Ozempic’s results are impressive when compared to other types of weight management drugs. Eric Williamson, Ph.D., a dietitian who specializes in sports and weight management and the founder of Toronto, Canada-based Unlocked Fitness and Nutrition, points out that the older obesity meds like Saxenda (liraglutide) yielded modest results: an average of 5% to 8% weight loss over the course of 68 weeks. “In contrast, the recent GLP-1 agonists like semaglutide stand out as the most effective drugs to date, with individuals experiencing a substantial 15% to 20% body weight reduction over a 68-week period when coupled with lifestyle interventions including nutrition and exercise,” says Williamson. That sort of weight loss can improve your body’s insulin sensitivity and help reverse insulin resistance—your essential weapons for winning the battle when you have type 2 diabetes. Williamson believes that the success of semaglutide lies in its ability to address the most common barrier to weight loss: increased appetite. “While a calorie deficit remains essential for weight loss, semaglutide makes achieving this deficit more manageable by reducing appetite,” he explains. What to Expect What to Expect After Your First Ozempic Injection It’s normal to experience some side effects from a new medication. According to Dr. Ali, the most common side effects reported from Ozempic are gastrointestinal, such as nausea, diarrhea or constipation, stomach cramping, and vomiting. “There are receptors for GLP-1 in the GI tract, which affects how it functions and leads to side effects,” explains Dr. Ali. “However, these side effects tend to subside with continued use of the medication.” According to clinical trials, the majority of reports of nausea, vomiting, and/or diarrhea occurred during dose escalation. Dr. Lofton warns that if you’re taking Ozempic and can’t tolerate the side effects, you should speak to your prescriber. “Lifestyle intervention is still the first-line approach to obesity treatment,” Williamson says. “In most cases, physicians will recommend lifestyle support with professionals like dietitians first. Even when drugs like semaglutide are prescribed, it is meant to complement lifestyle changes by mitigating the challenge of heightened appetite.” Williamson adds that there are three main risks if certain lifestyle adjustments are not considered: Inadequate nutrient intake. “Because appetite can be lowered quite drastically with semaglutide, it’s important that people are choosing nutrient dense foods to get adequate amounts of vitamins and minerals,” he says. Muscle loss. A subset of participants taking Ozempic in a study published in the New England Journal of Medicine lost 39% of their weight as lean mass (the largest portion of which will be muscle mass). “Exercise and obtaining adequate protein is important to prevent this so that one metabolic health issue isn’t presented (i.e., low muscle mass) as another one is solved (i.e., high fat mass),” Williamson explains. Not losing weight. According to research published in Drug Design, Development and Therapy, there is still a small proportion of people (around 7%) who do not lose weight on semaglutide. Williamson points out that more studies are required, but in his practice (and coming across people on the drug on a near-daily basis), he does see some people who eat a high enough caloric density diet (i.e. a high amount of calories for small amount of food) that they do not enter a calorie deficit even on weight loss drugs. “A diet made up of mostly nutritious low-calorie density whole filling foods is still required for many to lose weight on these drugs,” he says. It’s also a habit that can help those who drop out of using drugs like Ozempic from gaining the weight back."," Only use the provided text to answer the question, no outside sources. My friend is trying to get me to start Ozempic, since it has helped her lose weight. I want to know more about what it is. Using this article, tell me how Ozempic works and what the risks are. Use at least 400 words. Does Ozempic Have an Immediate Effect? Ozempic is a medication in the class of GLP-1 agonists, which mimic the action of a hormone called GLP-1 that your stomach naturally releases when you eat food. When blood sugar levels naturally start rising after you eat, these drugs stimulate the body to produce more insulin, which helps direct blood sugar into the body's cells to be used for energy. If you’re taking Ozempic for diabetes, “it doesn’t have the immediate effect that injecting actual insulin does,” she adds. Per the Centers for Disease Control and Prevention (CDC), rapid-acting insulin can start working in as little as 30 minutes to accelerate the entry of glucose into cells for metabolism into glycogen—a main source of energy for the body. Ozempic doesn’t have an immediate effect on weight loss either. “Ozempic is started at the lowest dose and advanced every four weeks,” says Mir Ali, M.D., a bariatric surgeon and the medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, CA. “Each patient responds differently. Some feel the effects immediately, while others may need to be on higher dose levels to feel the effects. When the patients are at the appropriate dose, they feel much less hungry and feel full for a longer period of time.” The effects of a dose of Ozempic last for about one week—this is why it’s injected once-weekly. “Some people may see a tapering of the effects towards the end of the one-week period, while others don’t,” says Dr. Ali. It should be noted that the same holds true for Wegovy. The main difference between Wegovy and Ozempic is the amount of semaglutide in each injectable dose: Wegovy’s maximum maintenance dose is 2.4 milligrams (mg), while Ozempic’s is 2 mg. Lowering Blood Sugar How Long Does It Take Ozempic to Lower Blood Sugar? Every patient is different, but you can expect to notice lower levels of blood sugar as quickly as within the first week of taking Ozempic, says Dr. Lofton. “The effect will be more dramatic as the doses increase over a period of months,” she says. For instance, if the patient’s dose is increased monthly, they should reach the maximum dose of 2 mg on the fourth month. Sticking to lower doses for the first four weeks helps lower side effects, but higher doses are required to lower blood sugar in the long term, per the official dosing guidelines. “How long it takes to achieve a healthy blood sugar level depends on how well the glucose was controlled prior to initiating Ozempic as well as the patient’s diet, exercise, and other medications,” Dr. Lofton says. Your doctor will carry out the hemoglobin A1C test—a simple blood test that measures your average blood sugar levels over the past three months. “It takes three months for hemoglobin A1C to change, so I would expect some improvement in hemoglobin A1C three months after starting Ozempic,” Dr. Lofton explains. For those individuals with type 2 diabetes who take metformin, which is the first-line medication used to treat the condition, some may find that adding—or switching to—a GPL-1 agonist drug like Ozempic may improve outcomes; this is something your doctor will evaluate if this applies to your situation. Some people with type 2 diabetes may take insulin and Ozempic. “Often, a patient’s insulin requirement decreases as Ozempic doses increase so it is likely that type 2 diabetes may no longer require insulin when on a GLP-1 agonist,” says Dr. Lofton. “This is ideal because insulin can cause weight gain.” Weight Loss How Long Does It Take Ozempic to Lead to Weight Loss? The effect of Ozempic on weight really depends on the individual, says Dr. Ali. “Some patients will experience a loss of appetite with the initial dose,” he says. “However, most patients will likely not see significant weight loss until they reach higher dose levels at eight-to-12 weeks.” In Dr. Lofton's experience, there is usually some weight loss in the first month. “If weight goals are not met, then the dose can be increased,” she notes. Ozempic’s results are impressive when compared to other types of weight management drugs. Eric Williamson, Ph.D., a dietitian who specializes in sports and weight management and the founder of Toronto, Canada-based Unlocked Fitness and Nutrition, points out that the older obesity meds like Saxenda (liraglutide) yielded modest results: an average of 5% to 8% weight loss over the course of 68 weeks. “In contrast, the recent GLP-1 agonists like semaglutide stand out as the most effective drugs to date, with individuals experiencing a substantial 15% to 20% body weight reduction over a 68-week period when coupled with lifestyle interventions including nutrition and exercise,” says Williamson. That sort of weight loss can improve your body’s insulin sensitivity and help reverse insulin resistance—your essential weapons for winning the battle when you have type 2 diabetes. Williamson believes that the success of semaglutide lies in its ability to address the most common barrier to weight loss: increased appetite. “While a calorie deficit remains essential for weight loss, semaglutide makes achieving this deficit more manageable by reducing appetite,” he explains. What to Expect What to Expect After Your First Ozempic Injection It’s normal to experience some side effects from a new medication. According to Dr. Ali, the most common side effects reported from Ozempic are gastrointestinal, such as nausea, diarrhea or constipation, stomach cramping, and vomiting. “There are receptors for GLP-1 in the GI tract, which affects how it functions and leads to side effects,” explains Dr. Ali. “However, these side effects tend to subside with continued use of the medication.” According to clinical trials, the majority of reports of nausea, vomiting, and/or diarrhea occurred during dose escalation. Dr. Lofton warns that if you’re taking Ozempic and can’t tolerate the side effects, you should speak to your prescriber. “Lifestyle intervention is still the first-line approach to obesity treatment,” Williamson says. “In most cases, physicians will recommend lifestyle support with professionals like dietitians first. Even when drugs like semaglutide are prescribed, it is meant to complement lifestyle changes by mitigating the challenge of heightened appetite.” Williamson adds that there are three main risks if certain lifestyle adjustments are not considered: Inadequate nutrient intake. “Because appetite can be lowered quite drastically with semaglutide, it’s important that people are choosing nutrient dense foods to get adequate amounts of vitamins and minerals,” he says. Muscle loss. A subset of participants taking Ozempic in a study published in the New England Journal of Medicine lost 39% of their weight as lean mass (the largest portion of which will be muscle mass). “Exercise and obtaining adequate protein is important to prevent this so that one metabolic health issue isn’t presented (i.e., low muscle mass) as another one is solved (i.e., high fat mass),” Williamson explains. Not losing weight. According to research published in Drug Design, Development and Therapy, there is still a small proportion of people (around 7%) who do not lose weight on semaglutide. Williamson points out that more studies are required, but in his practice (and coming across people on the drug on a near-daily basis), he does see some people who eat a high enough caloric density diet (i.e. a high amount of calories for small amount of food) that they do not enter a calorie deficit even on weight loss drugs. “A diet made up of mostly nutritious low-calorie density whole filling foods is still required for many to lose weight on these drugs,” he says. It’s also a habit that can help those who drop out of using drugs like Ozempic from gaining the weight back. https://www.healthcentral.com/condition/type-2-diabetes/how-long-does-it-take-ozempic-to-work",Medical,Find & Summarize,Text Transformation Only use information from the context in your response. ,In what ways can technology affect my child?,"The Impact of Technology on Children Parenting children of today’s generation comes with a unique set of challenges due to the many recent advancements in technology. There is no denying the reach technology has in our lives, as well as the lives of our children. Technology is virtually in every home in one way or another: about 96% of Americans have a TV and 94% of children ages 3 to 18 have internet access either through a computer or smartphone. According to a national survey done by Common Sense Media in 2019, 53% of children have a smartphone by the time they turn 11. Therefore, it’s important for parents to be mindful of how their children use technology and the potential effects—both positive and negative. Negative Impacts Technology can negatively affect children’s developing social skills, relationships, health, and overall ability to focus. • Social skills: With the increased use of technology, children might not be adequately developing their social skills. This can lead to more children being socially awkward, withdrawn, shy, or intimidated by social situations. They might not know how to engage with other children or adults. Developing social skills takes practice, and if technology is often in the way, there are fewer opportunities for kids to develop these skills. • Relationships: Children might get used to being alone and lose the desire to engage with their parents or even friends, outside of the internet. Often the virtual reality of their devices is more appealing and entertaining than the physical reality. • Health problems: Technology can potentially influence the child’s developing brain and problem-solving skills. For instance, the child might be reliant on a device to solve problems for them rather than using brain connections to work through a problem and find a solution. There could also be a lack of exercise due to being inside, which can cause weight gain. If kids use their devices before bedtime, this could lead to reduced sleep quality, affecting their overall wellbeing and immune system. • Ability to focus: Children who spend a lot of time using devices might have a reduced attention span and ability to focus due to their reliance on technology to pay attention for them. This is evident in classrooms, where teachers are opting for shorter lesson plans to accommodate students becoming easily distracted. • Dangers of browsing: With so much information available on the internet, it’s difficult for parents to monitor what their children are exposed to, including inappropriate content or interactions with strangers. Positive Impacts There are also many ways in which technology can positively impact our lives and those of our children—it all depends on how the technology is being used. • Organization: Technology can be beneficial to organization and planning. For example, families can keep an online calendar to make it easier to stay updated on each other’s schedules. Group text messaging is also convenient for streamlining communication and keeping everyone in the loop. Lastly, technology also makes budgeting easier with different apps, which can help parents teach children about money management. • Research and critical thinking: The internet provides access to a great deal of information and resources to help children learn about different topics. This is helpful for school projects or for researching areas of interest. This can also be a teachable moment, by showing children how to sift through information to find reliable sources. • Bonding and community: Technology can foster connection by allowing kids to stay in touch with family members or friends who do not live close by. Also, kids can interact with others in their age group while playing games online and learn to play as a team. • Self-expression: Children can learn how to share their thoughts online, which is a powerful tool that can build confidence. They can learn how to connect with others and be exposed to other viewpoints or perspectives. • Creativity and exploring interests: In many ways, technology fosters creativity and learning new skills through various apps for all different ages. Children can explore different areas they have an interest in, such as learning to play an instrument, creative writing, or beginner programs related to various subjects.","Only use information from the context in your response. In what ways can technology affect my child? The Impact of Technology on Children Parenting children of today’s generation comes with a unique set of challenges due to the many recent advancements in technology. There is no denying the reach technology has in our lives, as well as the lives of our children. Technology is virtually in every home in one way or another: about 96% of Americans have a TV and 94% of children ages 3 to 18 have internet access either through a computer or smartphone. According to a national survey done by Common Sense Media in 2019, 53% of children have a smartphone by the time they turn 11. Therefore, it’s important for parents to be mindful of how their children use technology and the potential effects—both positive and negative. Negative Impacts Technology can negatively affect children’s developing social skills, relationships, health, and overall ability to focus. • Social skills: With the increased use of technology, children might not be adequately developing their social skills. This can lead to more children being socially awkward, withdrawn, shy, or intimidated by social situations. They might not know how to engage with other children or adults. Developing social skills takes practice, and if technology is often in the way, there are fewer opportunities for kids to develop these skills. • Relationships: Children might get used to being alone and lose the desire to engage with their parents or even friends, outside of the internet. Often the virtual reality of their devices is more appealing and entertaining than the physical reality. • Health problems: Technology can potentially influence the child’s developing brain and problem-solving skills. For instance, the child might be reliant on a device to solve problems for them rather than using brain connections to work through a problem and find a solution. There could also be a lack of exercise due to being inside, which can cause weight gain. If kids use their devices before bedtime, this could lead to reduced sleep quality, affecting their overall wellbeing and immune system. • Ability to focus: Children who spend a lot of time using devices might have a reduced attention span and ability to focus due to their reliance on technology to pay attention for them. This is evident in classrooms, where teachers are opting for shorter lesson plans to accommodate students becoming easily distracted. • Dangers of browsing: With so much information available on the internet, it’s difficult for parents to monitor what their children are exposed to, including inappropriate content or interactions with strangers. Positive Impacts There are also many ways in which technology can positively impact our lives and those of our children—it all depends on how the technology is being used. • Organization: Technology can be beneficial to organization and planning. For example, families can keep an online calendar to make it easier to stay updated on each other’s schedules. Group text messaging is also convenient for streamlining communication and keeping everyone in the loop. Lastly, technology also makes budgeting easier with different apps, which can help parents teach children about money management. • Research and critical thinking: The internet provides access to a great deal of information and resources to help children learn about different topics. This is helpful for school projects or for researching areas of interest. This can also be a teachable moment, by showing children how to sift through information to find reliable sources. • Bonding and community: Technology can foster connection by allowing kids to stay in touch with family members or friends who do not live close by. Also, kids can interact with others in their age group while playing games online and learn to play as a team. • Self-expression: Children can learn how to share their thoughts online, which is a powerful tool that can build confidence. They can learn how to connect with others and be exposed to other viewpoints or perspectives. • Creativity and exploring interests: In many ways, technology fosters creativity and learning new skills through various apps for all different ages. Children can explore different areas they have an interest in, such as learning to play an instrument, creative writing, or beginner programs related to various subjects.",Internet/Technology,Effect Analysis,Q&A Please limit your knowledge to the document. Avoid generalizations and ensure accuracy by directly referencing the document's arguments and examples.,How can graduate students receive financial support at the University of Cincinnati?," University of Cincinnati Graduate College Graduate Handbook Welcome from the Graduate College! We invite you to review the Graduate Handbook. This document is designed as a helpful guide to graduate education at UC. Here is where you will find policies, procedures, and important information for the graduate student lifecycle, from admissions to graduation. In addition, there may also be requirements that pertain to specific degree programs and colleges. Please visit program and college websites for these specific requirements. 1 The Graduate College Graduate College Leadership Rose Marie Ward Vice Provost and Dean of the Graduate College Omotayo (Tayo) Banjo Associate Dean of the Graduate College Tai Collins Associate Dean of the Graduate College Laura Dell Graduate College Thought Leader Emily Kregor Software Applications Developer Lead Sarah Matthews Sr Data Reporting Analyst Angel Prewitt Assistant Director of Business Affairs Megan Tischner Carroll Program Director Graduate College Staff Kaitlin Bauer Academic Evaluator Virginia Dennis Program Manager, Student Services Shaymaa Minkara Program Manager, Graduation Caitie Norrie Program Manager, Professional Development Stephen Patrick Program Manager, Marketing and Communications Amy Wheeler Program Manager, Student Success & Retention Brandilyn Worrell Program Manager, Community and Belonging 2 Brady Wright Executive Staff Assistant and Office Manager Graduate College IT Staff Chris Amann Computer & Info Analyst, Management Specialist IT Dushan Aththidiyavidanalage Don Software Applications Developer Eric Rasnake Computer & Info Analyst I Coco Zhang Software Applications Developer Contact the Graduate College Location University of Cincinnati 110 Van Wormer Hall 2614 University Circle Cincinnati, OH Mailing Address P.O. Box 210627 Cincinnati, OH 45221-0627 Email: ucgc@ucmail.uc.edu or grad.info@uc.edu Phone: (513) 556-4335 Fax: (513) 556-0128 3 Introduction This Graduate Handbook is intended to provide information about university policies that assist faculty, students, and program coordinators in supporting their individual programs of study. To which educational programs does this Handbook pertain? The Graduate College oversees all post-baccalaureate certificates and degrees (master’s and doctoral level) EXCEPT the Juris Doctor (in the College of Law), the Doctor of Medicine (in the College of Medicine), and the Doctor of Pharmacy (in the College of Pharmacy). The University of Cincinnati does not discriminate on the basis of disability, race, color, religion, national origin, ancestry, medical condition, genetic information, marital status, parental status (including status as a foster parent), sex, age, sexual orientation, veteran status, military status (past, present, or future), or gender identity and expression in its programs and activities. View UC’s complete Notice of Non-Discrimination. Published 11/28/2023. This version is an update to the 2022-23 AY handbook to reflect changes to the Graduate Scholarship structure and terminology. This version supersedes all previous versions. 4 TABLE OF CONTENTS ADMISSION TO GRADUATE PROGRAMS ....................................... 9 ADMISSIONS POLICY .............................................................................................. 9 Faculty and Administrators' Eligibility for Graduate Degrees .................................. 9 ADMISSIONS CATEGORIES .................................................................................... 9 APPLICATION PROCESS FOR 4+1 AND AIM PROGRAMS .................................. 10 Application to 4+1 Degree Programs .................................................................... 10 Application to Accelerated Integrated Master’s (AIM) Programs .......................... 11 DUAL DEGREE PROGRAMS .................................................................................. 11 CHANGING DEGREE PROGRAMS AT UC ............................................................ 11 GRADUATE CERTIFICATE PROGRAMS ............................................................... 12 INTERNATIONAL STUDENT ADMISSION.............................................................. 12 English Proficiency Requirement .......................................................................... 13 FINANCIAL SUPPORT .................................................................... 14 UNIVERSITY MERIT-BASED GRADUATE AWARDS ............................................. 14 GRADUATE SCHOLARSHIPS (GS)........................................................................ 14 UNIVERSITY FELLOWSHIPS ................................................................................. 15 GRADUATE ASSISTANTSHIP STIPEND AWARDS ............................................... 16 Teaching Assistant Requirements and OEPT ...................................................... 17 Graduate Assistant/Fellow Health Insurance Awards ........................................... 17 Multiple Appointments/Employment ..................................................................... 18 Summer Employment Without Full-time Enrollment ............................................. 18 Graduate Assistants on Jury Duty ........................................................................ 18 Strike Policy for Graduate Assistants ................................................................... 19 Sick Leave/Family Leave for Graduate Assistants ............................................... 19 Holidays/UC Closing Policy for Graduate Assistants ............................................ 19 Military Duty .......................................................................................................... 19 Termination........................................................................................................... 19 Workers’ Compensation ....................................................................................... 19 Unemployment ..................................................................................................... 19 Social Security, Medicare Tax and Ohio Public Employees Retirement System (OPERS)............................................................................................................... 20 174 GRADUATE CREDIT RULE .............................................................................. 20 TAXATION OF CINCINNATI GRADUATE AWARDS .............................................. 21 EXEMPTION FROM OPERS FOR STUDENT EMPLOYEES.................................. 21 EXTERNAL SOURCES OF FUNDING .................................................................... 21 5 FEDERAL FINANCIAL AID ...................................................................................... 22 GRADUATE CREDIT AND GRADES............................................... 23 ELIGIBLE CREDITS ................................................................................................ 23 CREDITS REQUIRED TO EARN A GRADUATE DEGREE .................................... 23 Advanced Standing for Graduate Courses Taken Outside of UC ......................... 23 Transfer Credit for Graduate Courses Taken at UC ............................................. 24 Course Exemption for Prior Knowledge, Without Credit ....................................... 24 Multiple Degree Exemptions ................................................................................. 25 Enrolling in Non-UC Classes through the Greater Cincinnati Collegiate Connection ............................................................................................................................. 25 Graduate Credit for Undergraduate Students ....................................................... 25 Graduate Credit Earned in 6000-Level Courses ................................................... 25 GRADING ................................................................................................................ 25 Final Exams .......................................................................................................... 25 Make-up Final Exams ........................................................................................... 26 Grade Reports ...................................................................................................... 26 Grades Assigned to Research Courses That Are Repeated ................................ 27 Pass/Fail Grades .................................................................................................. 27 Grade Changes .................................................................................................... 27 No Grade Replacements for Graduate Students .................................................. 27 MAINTAINING GRADUATE STUDENT STATUS ............................ 29 MINIMUM CREDITS/REGISTRATION REQUIREMENTS ....................................... 29 Dual Degree Programs ......................................................................................... 29 FULL-TIME COURSE LOAD.................................................................................... 29 PART-TIME COURSE LOAD ................................................................................... 29 REDUCED COURSE LOAD (INTERNATIONAL STUDENTS) ................................ 30 MEETING PROGRAM REQUIREMENTS................................................................ 30 MINIMUM ACADEMIC PERFORMANCE ................................................................ 30 INTERNATIONAL STUDENTS, MAINTAINING IMMIGRATION STATUS............... 30 TIME TO DEGREE .................................................................................................. 30 Time to Degree and Extensions ........................................................................... 30 Reinstatements..................................................................................................... 31 Readmission ......................................................................................................... 32 Leaves of Absence ............................................................................................... 32 Withdrawal from Program ..................................................................................... 33 Dismissal from Program ....................................................................................... 33 MASTER’S DEGREE POLICIES AND PROCEDURES ................... 34 COURSE OF STUDY ............................................................................................... 34 6 CREDIT HOUR REQUIREMENTS .......................................................................... 34 CANDIDACY ............................................................................................................ 34 CULMINATING EXPERIENCE: THESES and CAPSTONES .................................. 34 Thesis Preparation, Evaluation and Submission Process..................................... 34 Capstone Process ................................................................................................ 35 GRADUATION ......................................................................................................... 35 Application to Graduate ........................................................................................ 36 Graduation from Dual Degree Programs .............................................................. 36 Certification for Graduation (Certify Online) .......................................................... 36 CONTINUING TO A DOCTORAL PROGRAM ......................................................... 37 DOCTORAL DEGREE POLICIES AND PROCEDURES ................. 38 COURSE OF STUDY ............................................................................................... 38 CREDIT HOUR REQUIREMENTS .......................................................................... 38 RESIDENCY AS FULL-TIME STUDENT ................................................................. 38 CANDIDACY, QUALIFYING EXAM ......................................................................... 38 UNIVERSITY GRADUATE FACULTY ROLE ........................................................... 39 DISSERTATION....................................................................................................... 39 Dissertation Advisor and Committee..................................................................... 39 Final Defense of Dissertation................................................................................ 40 Use of a Moderator ............................................................................................... 40 Submission of Dissertation ................................................................................... 40 GRADUATION ......................................................................................................... 41 Application to Graduate ........................................................................................ 41 Dual Degree Programs Graduation ...................................................................... 41 Graduation Requirements for Doctoral Degrees................................................... 41 Certification for Graduation (Certify Online) .......................................................... 41 GRADUATE CERTIFICATE VERIFICATION FOR UC TRANSCRIPT ENDORSEMENT ..................................................................................................... 42 DOCTORAL HOODING AND MASTER’S RECOGNITION CEREMONY ................ 42 INSTITUTIONAL RULES, POLICIES, AND PROCEDURES ............ 44 PROGRAM STANDARDS........................................................................................ 44 RECORDS PRIVACY, FERPA, AND THE RIGHT TO REVIEW .............................. 44 NOTICE OF NON-DISCRIMINATION ...................................................................... 44 ACADEMIC DISHONESTY ...................................................................................... 45 STUDENT CODE OF CONDUCT ............................................................................ 45 RESPONSIBLE CONDUCT OF RESEARCH .......................................................... 46 RESTRICTED RESEARCH ..................................................................................... 46 7 GRADUATE STUDENT GRIEVANCE PROCEDURES ........................................... 46 8 ADMISSION TO GRADUATE PROGRAMS ADMISSIONS POLICY The University of Cincinnati welcomes graduate applications from students who: • hold a baccalaureate degree from a college or university regarded as standard by a regional accrediting agency and; • have at least a B average (3.000/4.0 system) in undergraduate course work or otherwise give evidence of promise that is judged satisfactory by the admitting program and the Graduate College. Programs that wish to admit applicants who lack this 3.000 minimum GPA requirement must provide supporting evidence and rationale of how such students will be able to complete a graduate program that requires achievement of a 3.000 GPA, and indicate any support offered by the program to ensure the applicant’s success given the GPA deficiency. Decisions concerning admission to graduate programs rest with the programs, and criteria used for determining admission beyond these minimal requirements are established by the programs. All programs have established written criteria for judging the admissibility of applicants, which are published in each program’s graduate handbook. The program’s handbook for graduate study must be available to the student. Upon the student’s acceptance of the admission offer, the program and the student are bound by the terms and conditions set forth in the letter of appointment. Faculty and Administrators' Eligibility for Graduate Degrees No holder of an academic administrative title at the University of Cincinnati (equivalent to assistant dean or above) may matriculate or be granted a graduate certificate or degree from the University of Cincinnati. No graduate degree or certificate from the University of Cincinnati will be granted to any faculty member at the University of Cincinnati (full-time or part-time above rank of instructor) who teaches in the same department, division or school in which the degree is to be granted. This rule also applies to adjunct appointments at any faculty rank and to interdisciplinary degrees when the same college is one of the interdisciplinary colleges. College deans may petition the Associate Dean of the Graduate College for a waiver of this policy on an individual faculty member’s behalf. The written request should describe the teaching responsibilities of the faculty member, indicating whether they are teaching graduate students and a plan for managing potential conflicts of interest. ADMISSIONS CATEGORIES Matriculated graduate status is granted to an applicant who has been accepted into a graduate certificate or degree program and has met all admissions criteria. Note that applicants first receive a provisional acceptance, and conversion to matriculated graduate status is dependent upon receipt of an official transcript that confirms that the student holds a baccalaureate or higher degree from a college or university regarded as standard by a regional accrediting agency. Please note that additional official documentation may be required (e.g. if the transcript does not contain information about degree conferral or if a foreign degree needs confirmation as baccalaureate equivalent). Instructions and deadlines for meeting this requirement are included on the Transcript Submission Policy web page. 9 Provisional graduate status is granted to applicants who have been accepted into a graduate certificate or degree program, but who have NOT yet met all admissions criteria. As described above, one routine requirement for all students is the submission of an official transcript. However, some students must in addition take undergraduate courses or improve English language proficiency to satisfy prerequisites, and these students may be accepted by the program on a provisional basis that is contingent on satisfying those additional prerequisites. Letters of admission should be read carefully to make sure all requirements tied to provisional status are identified. Visiting student status allows students to take courses for graduate credit when they have not been admitted into a graduate degree program. These students were previously called “non- matriculated students”. Should this visiting student subsequently matriculate into a certificate or degree program, a maximum of 12 semester hours may be applied to the certificate or degree program. Students are not eligible for tuition or stipend awards allocated by the Graduate College while in visiting graduate status. This policy and other funding policies are further explained in the Financial Support chapter. APPLICATION PROCESS FOR 4+1 AND AIM PROGRAMS Application to 4+1 Degree Programs If an undergraduate student plans to matriculate into a master’s degree program upon completion of the bachelor's degree, they can consult with advisors to begin (A) taking graduate-level coursework as an advanced undergraduate student, and (B) focusing on thesis-related, independent research at an earlier date. This advising plan to achieve an articulated path to a master’s degree is called a 4+1 program. Students who enter these programs must complete all of the requirements of each respective degree and must apply separately for both degree programs at the appropriate time. To be eligible for entry to a 4+1 program, students must have junior standing (64 semester credits). In addition, students must meet all College and graduate program admission requirements for the particular program. 4+1 students should note the following: • 4+1 students who enroll in graduate-level coursework prior to formally matriculating as a graduate student are allowed to apply up to 12 semester graduate-level credits toward the requirements of the master’s degree. These credits cannot be used for the bachelor’s degree. Students in the 4+1 program will complete the rest of their graduate coursework after formal completion and certification of the bachelor's degree. Students should refer to the section of this handbook containing the general requirements of the master’s degree and speak to the directors of the graduate program about specific requirements. • 4+1 students wishing to matriculate into a master’s program must complete a formal graduate admission application online in their junior or senior year to be admitted to the graduate program and begin the master’s degree. Students should speak to the directors of the graduate program about specific admission and application requirements. 10 Application to Accelerated Integrated Master’s (AIM) Programs The university has a limited set of programs that allow for a single application and admission to obtain a bachelor’s plus master’s degree in a single course of study. These programs are tightly structured around co-op experiences and allow undergraduate students to accumulate more than 12 graduate credits prior to transitioning to a matriculated graduate student. Applicants apply to an AIM program at the time of application to UC as an undergraduate but are still required to formally apply to transition to the graduate portion of their program at a time defined by their AIM program. There is a free and abbreviated application for UC undergraduate students transitioning to the associated master’s degree that is part of their AIM program. DUAL DEGREE PROGRAMS The university offers the opportunity for students to pursue two complementary graduate degrees simultaneously through structured, official dual degree programs (see below for a complete listing). The advantage of these programs is that they may require fewer credits than completing each degree program separately. Each program’s entrance requirements must be met in addition to university requirements, and the applicant must be accepted by both programs. Below is a listing of the Dual Degree programs: • Accounting MBA/MS • Business Analytics MBA/MS • Business Administration/Arts Administration MBA/MA • Business Administration/Nursing MBA/MSN • Community Planning/Landscape Architecture MCP/MLA • Community Planning/Law MCP/JD • Finance MBA/MS • Human Resources MBA/MA • Information Systems MBA/MS • Marketing MBA/MS • Law/Women’s Studies JD/MA • Law/Business JD/MBA • Law/Political Science JD/MA • Law/Political Science JD/PhD Please see the Multiple Degree Exemptions section for information on the maximum amount of transfer credit that can be applied to the dual degree programs. CHANGING DEGREE PROGRAMS AT UC In order to change from one degree program to another within the university, a student must submit a complete application to the new program. If the degrees are housed in the same unit, and the change is made over consecutive term enrollments, the application fee is waived. If the new degree program is in a different administrative program, the student is responsible for paying the application fee. Students are always responsible for fulfilling the requirements of the given degree program in which they are matriculated. Please see the Transfer Credit for Graduate Courses Taken at UC 11 section for information on the amount of graduate credits that can be transferred if a student is changing from one graduate program to another within the university, or if a student is changing from visiting graduate status at the university. GRADUATE CERTIFICATE PROGRAMS The University of Cincinnati offers graduate certificate programs. Certificates vary in both credit hours and in how they are configured: for instance, some can be earned only in conjunction with a degree; some require a master’s degree as a prerequisite, and some can be earned outside of a degree program. Applicants must apply for admission to a certificate program. Graduate College general guidelines are as follows: • Students must hold a baccalaureate degree. • Certificate programs may enroll degree seeking and non-degree seeking students. • For students matriculated into a degree program, credit hours earned under a certificate program may count toward a degree in any program if approved by the program director, and if requirements for the certificate and degree are completed the student will be awarded both. Credits earned while matriculated in a certificate program will count as credits matriculated in a degree. • Students can apply a single course to multiple certificates but only to ONE master’s or doctoral degree. • Students can obtain more than one certificate within the same program prior to attaining their master’s degree. • Students apply for a certificate program just like applying for a degree program, and must pay any relevant application fee. • Students enrolled only in a graduate certificate program are not eligible for tuition or stipend support with university funds (University Graduate Assistantship/Graduate Scholarship funds). If a student is interested, the student should contact the appropriate program office to obtain the specific criteria and prerequisites for the desired certificate. INTERNATIONAL STUDENT ADMISSION UC International Services supports the needs of international students at the University of Cincinnati. The office assists international students in understanding the rules, regulations, and procedures that must be followed during their stay in the United States and provides support services and cultural information to students. UC International Services is located in Suite 7148, One Edwards Center (1-513-556-4278). Information about admission to the University of Cincinnati for international students is available on their website. International students with F-1 visas can only be granted admission as matriculated graduate status in a degree-seeking program. (Most international students with J-1 visas can be granted admission with matriculated graduate status only, with some exceptions.) Students with J-1 visas should inquire with UC International Services to determine the regulations that apply to them. Students with green cards (U.S. resident aliens/permanent residents) are not defined as international students and, therefore, are not governed by the university’s international student policies. However, the English proficiency requirement does apply to green card holders (see The English Proficiency Requirement, below). 12 In instances where an international student holds a degree for which the U.S. equivalent is not known, or if it is determined by the program or the Graduate College that the applicant does not have the equivalent of a bachelor’s degree, the program must submit a petition for admission without the bachelor’s degree, with supporting documentation and rationale, to the Associate Dean of the Graduate College. All international students are required to carry University of Cincinnati student health insurance unless they qualify for a waiver. Semester insurance fees are automatically assessed each registration period. Please visit the Graduate College website for more information on the Graduate Assistant/Fellow Health Insurance Award. English Proficiency Requirement English proficiency is required of all applicants whose native language is not English. Students can demonstrate proficiency in a number of ways at the graduate level. PLEASE NOTE, many colleges and programs have higher requirements than those listed below. Applicants should contact the programs to which they are applying for details. For more information, please refer to the English Proficiency Requirement web page. 13 FINANCIAL SUPPORT Graduate students may obtain financial support from several sources. • The University of Cincinnati provides merit-based graduate awards in the form of tuition scholarships (known as the Graduate Scholarships, which may be provided with or without an assistantship), as well as stipend awards (graduate assistantships including teaching and research assistantships), and program-specific scholarships and fellowships. • Scholarship and fellowship support is also available from a diverse collection of external sponsors at the local, state, national, and international levels. Programs and colleges may have additional sources of support through grants and endowed funds • Need-based support may be obtained from federal and state sources. Financial support from each of these sources is described below. UNIVERSITY MERIT-BASED GRADUATE AWARDS The University of Cincinnati offers several types of merit-based graduate awards. The most common types – Graduate Scholarships, fellowships, and University Graduate Assistantships – are described below. Most university graduate awards are underwritten by university funds allocated by the Graduate College (“general funds”) to each college, which are then awarded to students by the individual programs. Some awards are competitive and granted by the Graduate College upon recommendation of an individual graduate program. Not all graduate students are eligible for graduate awards. Graduate awards allocated by the Graduate College are not available to students: (1) taking classes as visiting students, (2) enrolled only in a graduate certificate program, (3) who have not maintained the minimum GPA of 3.000 in their program, (4) who are on academic probation, or (5) who have exceeded the 174 graduate credit rule. Awards can only be guaranteed for a maximum period of one academic year, and renewal of a university graduate award is not automatic. Awards that are appointed by individual programs are awarded to eligible students at the sole discretion of the program. Programs are not obligated to renew awards, even if previously awarded students met all eligibility requirements. GRADUATE SCHOLARSHIPS (GS) The Graduate College funds scholarships that cover all or part of a student’s tuition and fees. In most colleges, the scholarship awards supported by the Graduate College are the Graduate Scholarships (GS), with and without assistantships. The GS with assistantship is used to support graduate assistants who are additionally awarded a stipend that requires service in return for stipend support. The GS without assistantship is for graduate students who do not receive university stipend support and therefore no service is required in return for the GS award. The appointing program sends written offers of scholarship awards to students, including information about the amount and duration of the award and the terms of the offer. Students must maintain all of the required eligibility requirements in their offer letter to maintain their tuition scholarship. 14 Students receiving a tuition scholarship must register for a specified minimum number of graduate credit hours in each semester for which they are receiving support. If an international student is supported by a GS without assistantship, they must register for a minimum load of 10 graduate credit hours per semester during the time they receive the GS scholarship. If a domestic student is supported by a GS without assistantship, they must register for a minimum load of 1 graduate credit hour per semester during the time they receive the GS scholarship. Students supported by a GS with assistantship must register for a minimum of 12 graduate credit hours per semester during the time they receive the GS scholarship. These minimum enrollments in graded courses must be met prior to using scholarship support for any audited courses. If a student withdraws from a class funded by a tuition scholarship, with the remaining enrolled credit hours totaling less than the minimum required for the award, the award is cancelled immediately and the student is responsible for the tuition balance, based on the date of withdrawal. Full tuition scholarships cover a maximum of 18 credits per semester. Students registered for more than 18 credits in a semester will be billed tuition and general fees on a per-credit-hour rate for each credit over the 18. All rules that govern recipients of tuition support pertain to all students, including international students. Other rules and policies that apply specifically to international students are independent of GS regulations. Both sets of regulations must be met. Neither set of regulations negates or takes the place of the other. (See 174 Graduate Credit Rule.) Note: Financial awards that require no service may reduce eligibility for educational loans. Students should notify the Student Financial Aid Office of their tuition support if they apply for aid from that office. UNIVERSITY FELLOWSHIPS University of Cincinnati fellowships are financial awards that include tuition scholarships and stipends with no associated service requirements. The purpose of a fellowship award is to allow the recipient to concentrate exclusively on their studies; therefore, multiple appointments and/or employment by the University of Cincinnati are not permitted for students receiving fellowships. The appointing program sends written offers of fellowship awards, including information about the amount and duration of the award; a general description of the academic obligations accepted by the student as part of the award; a reference to sources of information about academic requirements for degree completion; a description of the conditions under which either the student or unit may terminate the award prior to its end-date; and criteria for reappointment. Students receiving fellowships should check with Student Financial Aid to be informed about the potential impact on their eligibility for aid. Income received that is not for services rendered (whether it be in the form of a fellowship, grant, or award) will be calculated in whether a student meets the Cost of Attendance for the University of Cincinnati. Fellowship awardees have an enrollment obligation identical to GS with assistantship/UGA (university graduate assistantship) awardees, and they lose eligibility for the fellowship award if they accumulate more than 174 graduate credit hours. (See 174 Graduate Credit Rule). 15 For information on university-sponsored fellowships, please see the Graduate College website. GRADUATE ASSISTANTSHIP STIPEND AWARDS A student awarded a graduate assistantship receives a financial stipend for services rendered in addition to a full or partial tuition scholarship. These stipend funds are called UGA (university graduate assistantship) awards. Graduate assistants are also entitled to a discount at the University Bookstore and may be eligible for the Graduate Assistant/Fellow Health Insurance Award. UGA awardees devote effort to a combined program of formal study and assigned duties of teaching, research or administrative service that is designed to enhance their university education. The stipend received by the graduate assistant is in recognition of these services. Those with teaching duties are teaching assistants (TAs) and those with research duties are research assistants (RAs). During the appointment, the goal is to help a graduate student become a more learned, creative, and professional individual through formal instruction, interaction with faculty, research, and administrative experience. Any such service assignments should be consistent with the student’s academic pursuits. UGA funds are awarded for designated periods of time by the graduate programs. Graduate Assistants are considered exempt from minimum wage and overtime requirements, and they are paid on a salaried basis. Minimum stipends are set by the Dean of the Graduate College. The minimum stipend for a graduate assistant, as set in July 2023, must be the equivalent of a minimum of $16.98 per hour for all master’s and doctoral students except those in PhD programs. Graduate assistants enrolled in PhD programs have a minimum of $22.28 per hour. The appointing academic program, college, or area of responsibility determines service requirements of students who hold assistantships. If awarded an assistantship outside their program, graduate assistants’ duties are governed by the academic program, college, or the area of responsibility that made the award. In all cases, the award obligates awardees to no more than 20 hours per week of services, and those services must make a substantive contribution to the student’s academic and professional development. Students must be appointed to a position that is consistent with their field of academic study. If the student determines that they cannot meet the requirements of the award, it is imperative that they notify the program to initiate renegotiation or reassignment of the award with correspondingly less support. A student’s hours are prorated for weeks with a holiday or school closure and students are not required to be available during break periods unless given additional compensation. UGA awardees must be registered for 12 graduate credit hours or more, exclusive of audit credits, for each semester they receive the assistantship. University assistantships will be cancelled if the awardee does not meet their enrollment obligation. The exception to this rule is summer semester. See Summer Employment without Full-time Enrollment section. Students lose eligibility for the UGA stipend funding if they accumulate more than 174 graduate credit hours. (See 174 Graduate Credit Rule.) Assistantship awards are contingent upon student status, satisfactory degree progress, and performance of service as assigned, and can be terminated at any time. Each year the assistantship is in effect, the appointing program, college, or area must notify the awardee in 16 writing of any significant change to the services or conditions of the appointment. Such changes include, but are not limited to: • the amount and duration of the award • any tuition and/or fee not paid by the program • the average expected time per week or per semester of required duties • description of the duties assigned to the student • description of the conditions under which either the student or unit may terminate the award prior to its end-date • criteria for reappointment of the award • criteria for determining variations in stipend levels where such variations exist • information on current IRS guidelines, Medicare, and the Public Employee Retirement System (PERS) • graduate appointment procedures if any of the documents have been modified since the student’s initial appointment. Teaching Assistant Requirements and OEPT All teaching assistants must be supervised by a faculty member who has the academic credentials and authorization (as defined by the Higher Learning Commission, Ohio Dept. of Higher Education, and the University of Cincinnati) to offer instruction to the students in the class. Supervising faculty must be listed (as supervisor or instructor) in any course/section overseen by a graduate teaching assistant. Non-native speakers of English who are awarded teaching assistantships at the University of Cincinnati are required to score at least a 3.0 on the Oral English Proficiency Test (OEPT). The OEPT evaluates the spoken language skills of non-native speakers of English. Students who pass are certified for oral English proficiency and may assume the full range of duties associated with their teaching assistantship. Students whose oral English proficiency has not been officially certified may not assume instructional responsibilities. However, students who score 26 or above on the speaking section of the TOEFL IBT or students with a score of 50 or above on the Test of Spoken English are exempt from the OEPT. Students are required to take the test at the beginning of their first term of study. If a score is less than 3.0, students are recommended to take ESL courses before retaking the test. A student is permitted to take the OEPT twice without charge during an academic year. Graduate Assistant/Fellow Health Insurance Awards Academic programs are required to notify eligible students with information on the Graduate Student Health Insurance (GSHI) award, which can subsidize the cost of UC Student Health Insurance for qualified students. Programs must provide graduate assistants/fellows with the GSHI Award application deadline and relevant details on GSHI Award criteria, and must keep records that they have provided this information to their students. Such information can be found at the Graduate Student Health Insurance Award web page. 17 Multiple Appointments/Employment Graduate assistantship awardees who are domestic students are limited to 24 total hours of combined service and student hourly work while school is in session. The following policies regarding multiple appointments must be followed: • Units are responsible for monitoring of hours worked by student employees assigned to their unit; this is especially important for students who hold multiple student appointments. • The program must closely monitor academic progress. • The additional appointment must be terminated if a student does not maintain academic progress deemed to be acceptable by the program. This limit applies only while school is in session. During scheduled breaks only, if students work more than 20 hours or they work more than the prorated salary hours required, they must be compensated at an hourly rate for the extra work. Students can be employed for a maximum of 40 hrs/week during scheduled breaks. International students are limited to working 20 hours per week while school is in session and are limited to 40 hours per week during scheduled breaks. All International Students must have onboarding conducted by the International Services Office. An international student on F-1 or J-1 immigration status contemplating employment should contact the International Student Services Office at 1-513-556-4278. Summer Employment Without Full-time Enrollment For summer semester only, students who are not registered for graduate credit hours or are registered for less than 12 credits hours are eligible to be employed by their respective program, usually by performing the duties of their assistantship such as teaching or lab work. In this case, the student will receive a stipend for the work performed. Retirement funds and taxes will be withheld from the student’s check. Questions about options with retirement funds once separated from the university should be directed to Human Resources and/or OPERS. Graduate Assistants on Jury Duty All graduate students are encouraged to participate when they are subpoenaed for jury duty. The student must seek their advisor’s and program director’s permission with the expectation that every effort will be made to accommodate the jury service. If the student’s absence from UC will create a hardship to the unit, they should seek a deferral or make arrangements to cover their responsibilities during the absence. Such arrangements must be approved by their program director. Students serving on jury duty will be paid their normal university stipend during the period of service, with the understanding that any compensation received for jury service must be returned to the university if their assistantship responsibilities remain uncovered. If the student makes arrangements to cover their assistantship commitment for the period in which they serve on jury duty, and if those arrangements are approved by their program director, they may keep the jury duty compensation in total. The student may also keep any travel reimbursement fees. 18 Strike Policy for Graduate Assistants In the event of a strike, graduate assistants are expected to fulfill commitments associated with their assistantships. Graduate assistants assigned to teach a course as part of their assistantship agreement are expected to teach the course during a strike. Graduate assistants who choose not to teach can lose their assistantship. If the student’s responsibilities are associated with a course taught by a faculty member and the strike results in the course not being taught, which makes it impossible for the student to fulfill their responsibilities, the student would not be held responsible. Sick Leave/Family Leave for Graduate Assistants Graduate assistants do not accrue vacation, sick leave or other paid time-off. In the event of illness, a graduate assistant shall notify the GA supervisor as soon as possible on each day of such absence. Holidays/UC Closing Policy for Graduate Assistants Graduate assistants are not hired as essential personnel, and thus cannot be required to work during holidays or official UC closings (such as emergency closings due to severe weather, public emergency, etc.). Required weekly hours will be prorated based on the official holidays or closings during that week. Military Duty A graduate assistant who is a member of any reserve component of the United States Armed Forces, who is voluntarily or involuntarily ordered to extended U.S. military service, shall be granted time-off without pay. The graduate assistant should provide to the appropriate program official advance written notice of the call for impending training or active duty. Upon completion of military service or if discharged under honorable conditions, and upon prompt re-registration as a student, the graduate assistant shall be returned to the former assistantship in a timely manner, based upon availability. Due to the temporary nature of graduate assistantships, if the assistantship is eliminated during the student’s absence, then no obligation exists. Termination A graduate assistantship may be terminated at any time with or without cause, unless there is an explicit written contract between the student and the university that provides otherwise. Workers’ Compensation The Ohio Workers’ Compensation Law covers graduate assistants, who are paid by payroll and provides medical, income and survivor benefits in the event of accidental injury, occupational disease or death occurring in the course of, and arising from, employment. Unemployment Graduate assistants are not entitled to unemployment compensation. 19 Social Security, Medicare Tax and Ohio Public Employees Retirement System (OPERS) Please see Exemption from OPERS/Medicare for Student Employees. 174 GRADUATE CREDIT RULE Students receiving any university award (e.g. UGA stipend, GS tuition scholarship) and students who receive funds from the State of Ohio are governed by the requirements and limitations described in the following paragraphs. Any student who becomes ineligible to receive state subsidy is not eligible to receive general funds financial aid (i.e., a university stipend and/or tuition). Since this policy is due to regulations governing state support of the university, exceptions to the policy are not considered. Graduate students who have attempted 174 graduate credit hours at the University of Cincinnati are not eligible for a university award for enrollment at or beyond the 174 hours. Hours attempted include hours for which credit has been awarded, as well as withdrawn courses, audited courses, and hours in progress or incomplete (these graduate credit hours include all courses with grades F, I, UW, SP, IP, UP, W, etc.). All graduate hours attempted at the University of Cincinnati, regardless of program or student status, count toward the 174 total. A student is not eligible for funding beginning with the semester in which said student will reach the 174 attempted hours. For example, if a student has earned 167 graduate credit hours at the University of Cincinnati by the close of summer sessions and registers for (i.e., attempts) 12 credit hours for fall semester, they are ineligible for a university graduate scholarship or fellowship in the fall semester. If a student earned master’s credits at the University of Cincinnati (for either a partial or a full degree), the exact number of these credits are deducted from the 174 credit hour total for which they can receive funding. This is true if the credits are earned at an earlier time and the student returns to the University of Cincinnati to continue graduate education, and it is true regardless of the discipline in which those credits were earned. For example, if a student has earned a master’s degree in engineering and then chooses to pursue a master’s and a doctoral degree in math, the credits earned to get the engineering degree are deducted from the 174 credit hours for which the student can receive state financial support (e.g., fellowships, assistantships, and scholarships). Graduate students who have earned a master’s degree or other equivalent or higher advanced degree at another institution are not eligible for a university scholarship or fellowship once they have attempted 140 graduate credit hours at the University of Cincinnati. If a student enters the University of Cincinnati with a master’s degree from any institution other than the University of Cincinnati, they are credited with 34 graduate credit hours toward the 174 credit hour limit for state funding eligibility. Per Ohio Department of Higher Education policy, Ohio can subsidize up to the remaining 140 credit hours. The 34 credit hours are deducted from the 174, regardless of the discipline and regardless of the graduate level at which the student enters the University of Cincinnati. For example, if a student has earned a master’s degree in engineering at The Ohio State University and then chooses to pursue a master’s and a doctoral degree in math at UC, the credits they earned to get their engineering degree are deducted from the 174 credit hours for which they can receive state financial support in the math program. Note that professional 20 degrees, like a juris doctorate or medical doctorate, do not count as a master’s or higher equivalent for the purpose of comparative funding. Students who enter graduate education at the University of Cincinnati with a professional degree and no other advanced degrees are still eligible to receive up to the 174 credit hours of funding. If a student enters the University of Cincinnati with only partial credit toward a degree from another institution, those credits are not deducted from the 174 total—even if the program they enter at the University of Cincinnati agrees to accept transfer of those credits toward the student’s degree requirements at the University of Cincinnati. The student can still receive state subsidy for up to 174 credit hours earned at the University of Cincinnati beyond those transferred in. Note: For the purposes of this policy, a master’s degree is one awarded by an American institution or a degree of equivalent value from a foreign institution. Students holding a master’s degree from a foreign institution that is the equivalent of a bachelor’s degree in the U.S. will have the higher limit (174). The higher limit will not be affected by a student’s completion of course work short of a master’s degree at another institution. TAXATION OF CINCINNATI GRADUATE AWARDS The university maintains a position that all income, from whatever source, is taxable and may be subject to withholding. The IRS maintains final authority on the taxability of all stipends, and in all cases, the university cannot guarantee that any stipend is tax-exempt. The Graduate College will not review an individual award nor provide legal advice to individual students. In addition, students (not the university) are responsible for the withholding information that they submit on their W-4 forms at the time of appointment. Those students who receive a stipend during any academic semester and are not enrolled for at least half time will have Medicare tax and Ohio Public Employee Retirement System (OPERS) payments deducted from their checks. If a student is enrolled half time or more, they may apply for an exemption from these fees in their program office. No taxes are withheld from fellowships, but students may still have a tax liability and should consult a tax advisor. EXEMPTION FROM OPERS FOR STUDENT EMPLOYEES Employees (including student employees) of Ohio public institutions do not contribute to the federal Social Security system. Student employees’ retirement contributions will be directed to the state retirement plan, the Ohio Public Employees Retirement System (OPERS). Student employees (including graduate assistants and hourly student workers) may be eligible to opt out of OPERS participation when first hired by UC as long as certain requirements are met. See the Student Employees web page on UC’s Human Resources site for the OPERS exemption form and for additional information. EXTERNAL SOURCES OF FUNDING Tuition scholarship and fellowship funding is provided to graduate students by a wide variety of governmental and private sponsors. UC’s Financial Aid website, the ScholarshipUniverse scholarship search application, the Office of Nationally Competitive Awards and local and university libraries are potential sources of information about these funding opportunities. The Office of Nationally Competitive Awards provides workshops, application writing assistance and university endorsement (for applicable awards). Students may also visit the Office of Research 21 for more information on upcoming grant opportunities, grant writing workshops, and searchable research opportunity databases. FEDERAL FINANCIAL AID See the Student Financial Aid website for more information on federal financial aid (including summer aid). The Graduate College does not regulate or audit any outside fellowships or other outside funding a student may receive. However, it is advised that students with outside funding consult with the Financial Aid Office to see if and how the outside funding may or may not affect other Financial Aid eligibility. 22 GRADUATE CREDIT AND GRADES ELIGIBLE CREDITS Credit towards a graduate degree or certificate can only be earned for those courses in this university that are listed as graduate in the Schedule of Classes or which have been approved in writing by appropriate program authority for inclusion in the curriculum. Graduate credit towards a degree will only be granted when a course is included in the graduate career category of the student record in Catalyst. CREDITS REQUIRED TO EARN A GRADUATE DEGREE Graduate degrees at UC each have a stated number of credit hours that must be completed satisfactorily to earn the degree. As described below, there are multiple opportunities where coursework taken prior to matriculation into a degree program may count towards that credit hour total. In all cases, to earn a degree at UC, at least 67% of the relevant coursework credit must be earned while a matriculated student at the University of Cincinnati. Students entering in Fall 2019 or later should make application to their program for such (advanced standing or transfer) credit during their first semester at UC to assure their course of study is optimized. For all students matriculating in Fall 2019 and later, such credit will only be granted if a complete and program-approved application for such credit is submitted to the Graduate College by the end of their first year in the program, or prior to their final semester of study, whichever comes first. This new policy (introduced in AY19-20) is in effect for all students matriculated in Fall 2019 and later. In prior policies, master’s degrees were granted when 50% of graduate credits were completed while matriculated in the graduate program granting the degree, therefore allowing up to 50% of credits to be via advanced standing. Advanced Standing for Graduate Courses Taken Outside of UC a. Programs are permitted to award up to one third of the credits of a UC graduate program through advanced standing (e.g., 10 credits are eligible in a 30 credit hour program or 13 credits in a 40 credit hour program). The relevant number of credits is based on the minimum credits required to earn the advanced degree starting from the minimum degree qualification (usually a baccalaureate degree). Note that for doctoral students the advanced standing credit total will include any use of the ODHE allowance of up to 30 credits for a prior master's degree. b. Any graduate course credits, including those earned from previously earned graduate or undergraduate degrees, are eligible as advanced standing credits. c. Advanced standing can only be offered for courses (including electives) entered in e- curriculum for the UC program. d. Program faculty must evaluate courses for equivalence or comparability prior to granting students Advanced Standing credit for courses taken at another institution, meeting all the following criteria; 1. Courses taken at a recognized University or College 2. Courses taken at the graduate level 3. Requested advanced standing credits must be the lower of the following two choices 23 i. Credits originally earned for the course ii. Credits available in the UC course listed in e-curriculum 4. For 1:1 course equivalency, one or more of the following criteria must be met when compared to the University of Cincinnati course for which Advanced Standing credit is sought: i. Course was taken in the same field with the same title ii. Course had similar topics iii. Course had similar learning outcomes iv. Course assignment and assessment requirements were similar v. Course readings requirements are similar 5. This evaluation process should be documented for each case in which it is applied e. The one third rule doesn’t apply to dual degrees, sequential master's to doctorate programs, or others with shared content that have received approval from the Graduate College. f. Advanced standing credit recommended by program faculty must first be approved by the graduate program director and then submitted for final review by the Graduate College to assure the request complies with the criteria above. Transfer Credit for Graduate Courses Taken at UC a. When leaving one graduate program to join another at UC, all UC graduate credits taken as part of the incomplete program are eligible to use to fulfill requirements in the new program, based on faculty evaluation of the equivalence to courses in the new curriculum and program approval. b. When a student enters a graduate program at UC, non-matriculated UC graduate credits are eligible to be used for the program, if the coursework is listed in e-curriculum as part of the curricular requirements. Subject to program approval, students may transfer up to one third of the credits required to earn their UC graduate degree Programs are permitted to award transfer credit from a prior UC graduate degree if (1) the sum of unique credits to earn both degrees is equal to or greater than the State minimums for each degree type, and (2) the transfer credit courses are part of the curriculum of the new degree program as defined in e-curriculum. Using credit that meets both criteria, up to one third of the credits of the new UC graduate program may be awarded through transfer credit. The relevant number of credits is based on the minimum credits required to earn the advanced degree starting from the minimum degree qualification (usually a baccalaureate degree). Note that for doctoral students the transfer credit total will include any use of the ODHE allowance of up to 30 credits for a prior master’s degree. Course Exemption for Prior Knowledge, Without Credit Faculty in a program have the option to provide students with an examination to determine if accumulated knowledge is sufficient to be exempted from specific courses in a graduate curriculum (e.g., continuing education courses in some professional fields may provide a background that eliminates the need to take introductory courses). The form and content of that examination is at the discretion of the program. When such exemptions are granted, the student does not earn graduate credit for such knowledge. The credits required to complete their UC graduate degree remain unchanged, and the student will take alternative coursework (approved by the graduate program director) to advance their knowledge. 24 Multiple Degree Exemptions a. If the graduate faculty from a UC program has participated in designing and/or presenting the curriculum at another institution, shared degree programs between the institutions can deviate from these rules with prior approval of the Graduate College and their college leadership. In no case will a UC degree be awarded if more than 50% of the curriculum is offered by non-UC faculty. b. Dual degree programs can combine two UC graduate degrees into a single curriculum if approved by the University. Approved dual degree programs can share up to one-third of the combined credits of the two degrees, but the total count of unique credits to earn both degrees must always be equal to or greater than the State minimums for each degree type. Enrolling in Non-UC Classes through the Greater Cincinnati Collegiate Connection The University of Cincinnati is a member of the Greater Cincinnati Collegiate Connection. GC3 classes are those not generally available at the University of Cincinnati but which can be used to satisfy degree requirements. The student must have met all tuition commitments at the University of Cincinnati and must observe all regulations of the host institution. For additional information, participating institutions, and registration instructions, consult the Greater Cincinnati Collegiate Connection page of the Registrar’s Office website. Approval is at the discretion of the program. Graduate Credit for Undergraduate Students Any program may allow juniors or seniors to register for graduate courses for graduate credit before those students have completed the baccalaureate degree. It is recommended, if the program permits such registration, to limit the privilege to students with senior status and a grade point average of at least 3.000 (higher in some programs). This is evidenced by a written request from the student that is signed by an authorized member of the graduate program. Upon approval by the graduate program and the course instructor, graduate credit will be given for the courses. A maximum of 12 semester graduate credits can be earned in this manner. Credit will not be given toward both graduate and undergraduate degrees for the same course. Graduate Credit Earned in 6000-Level Courses In fall 2016, all 6000-level courses became graduate only. In the past, 6000-level courses were available for either undergraduate or graduate credit (to earn graduate credit, students selected the graduate level designation (G) in these courses, indicating that additional work was required beyond that required of undergraduates in the course). PLEASE NOTE: with the transition to the new use of course numbers, there will be no change to the graduate (or undergraduate) credits earned previously in the pre-fall-2016 version of these courses. GRADING Final Exams Exams are held during the last week of the semester after classes have ended. For each term’s full final examination schedule, consult the Calendars page of the Registrar’s Office website. 25 Make-up Final Exams Special policies may govern the taking of missed final exams. Students and faculty members should check the college office or program office for specific details. Every student is responsible for the material presented in their class. Arrangements for make-up work and tests are determined by the instructor. Absences incurred by students officially representing the university will be excused, provided that official notification of such absence has been given in advance to the instructor. Grade Reports End-of-term final grades may be viewed in the Catalyst student portal immediately following submission of final grades by the instructor. Grade reports include total graduate hours and hours for the current semester. The student’s grade report differentiates between “units taken” (course credits the student enrolled in but did not complete successfully or which are still pending a final grade) and “credits passed” (course credits successfully completed with a final grade other than F). These values are posted on the student’s transcript as attempted hours and earned hours. A graduate grade point average (GPA) is calculated each semester. Approved transfer credits from other institutions are included in the sum of credits earned, but grades for those credits are not included in the GPA. All graduate work, regardless of the University of Cincinnati college in which the work was done, is accumulated in these tallies. For this reason, if a student record includes UC graduate courses that do not count towards the degree, this GPA may differ from the calculation of GPA in program coursework (a minimum 3.000 program GPA is essential to earn a graduate degree). The I incomplete grade is awarded as a course grade (without grade point assignment) at the end of a term when a significant portion of course work has been satisfactorily completed, but not all of the required course work has been completed. The incomplete grade is appropriate when the completed course work is of passing quality and the student has had such hardship that completion of the remaining course work within the term timeline would present an additional hardship. The instructor who assigns the incomplete grade should set a specific date by which the student must complete the remaining course work, recognizing that time must be available for any final evaluation and grade change to be made, prior to the deadline when the grade converts to an F. The deadline is one year to the last day of exams. (Please check the Office of the Registrar’s website for the specific date.) The student must work with the instructor to develop an agreement that indicates the date by which the remaining course work is to be completed and submitted to the instructor. The instructor is not obligated to provide the student with a full year to complete the remaining course work. If the remaining course work is completed within the time period agreed upon by the instructor and the student, and that completion occurs within the one year, then the instructor will submit a change of grade online (in Catalyst) based on the quality of the remaining work. If no specific time for completion is set by the instructor, the student has one year (from the end of the term in which the incomplete was assigned) to complete the remaining course work and submit it to the instructor in time for evaluation of the work and a final grade to be approved by the Registrar. If the coursework is not completed within the one-year period (i.e., one year from the end of the term in which the I grade was assigned), the I grade automatically converts to an I/F grade which affects the student’s GPA the same as the grade of F. For the complete graduate grading scale and a definition of all grades, consult the Grading Scales and Definitions page of the Registrar’s Office website. 26 Grades Assigned to Research Courses That Are Repeated If students are working on dissertation or thesis research, they should be registered in the appropriate research course (e.g., Individual Dissertation or Individual Master’s Thesis), and the course work should be given a final grade each semester. The use of P/F for such courses is strongly recommended to avoid undue influence on GPA due to individual grading practices and the large amount of research credit awarded, but it is recognized that some programs will want to use letter grades. “Placeholder” grades such as SP and NG should not be used. Regardless of the grading scheme selected, it must be consistently applied across an entire program. If a program faculty cannot agree on a single grading scheme, the program must use the P/F choice. Students should be graded for each semester based on their progress and achievements in that semester. Note: The definition of a “research course” is a course outside of formal class work or instruction that allows a student to be registered as a graduate student while they are working independently on their thesis or dissertation under the guidance of their advisor or dissertation committee. This policy also applies to internships and other multiple semester or series courses. Pass/Fail Grades An instructor may request approval for pass/fail grading for an individual student in their class prior to the first day of class. A graduate student can take a course on a pass/fail basis (P or U grade) when approved by their advisor and instructor. An instructor is not required to accept a student on such a basis. Grade Changes A change of grade is only appropriate for an I, an NG, an SP/UP, or an error made by the instructor. SP/UP grades must be converted to a final grade by the end of the following semester. Instructors may change an I or NG grade online in Catalyst for approximately one year (the interval extends from the initial grading semester to the last working day of the same term the following year). To request a change of grade for a non-research course for graduate credit after this period, or an F grade any time, the instructor must do an official, paper change of grade form and forward to the Registrar’s Office. Previously recorded grades may not be changed to W or I after the close of the term. Both I and W grades must be awarded while the course and semester are still in progress and cannot be awarded retroactively. W reflects an official withdrawal that took place by the deadline outlined in the academic calendar, and I indicates work remains to be completed and the student did not earn a final grade. Students cannot withdraw from a class retroactively or be given additional opportunities to seek a different final grade retroactively. If an F is in a non- required course or the required course has since been retaken for a passing grade, the Program Director at certification may request a waiver of the F grade from the Associate University Dean of the Graduate College. No Grade Replacements for Graduate Students Please note, if a graduate student re-registers and re-takes a course, both grades will be included in the student’s overall GPA. There are no grade replacements at the graduate level. The process to make a grade change cannot be initiated by a student. The course instructor of record must send the form. At no time should a student be in possession of a change of grade 27 form. Note: that an I/F grade is governed by the same policies that govern the F grade and is weighted into the student’s GPA in the same fashion. 28 MAINTAINING GRADUATE STUDENT STATUS Maintaining graduate student status signifies that the student is actively engaged in making progress towards their degree and meeting program requirements. Graduate status determines which students may use facilities of the university, may participate in the university governance process and student organizations, and are covered by the Student Code of Conduct and the grievance process. A University of Cincinnati graduate student must hold the equivalent of a baccalaureate or higher degree and must have been accepted for admission into graduate study by the appropriate graduate program. MINIMUM CREDITS/REGISTRATION REQUIREMENTS To maintain graduate status at the University of Cincinnati, students must register at UC for at least one graduate credit that contributes to degree requirements (as determined by the graduate program) in an academic year. If the student is registered for at least one graduate credit in the academic year (fall through summer), they will maintain graduate student status for the entire academic year. Credits that are audited or in which a student receives a W, UW or F do not count toward the minimum credit requirement. Any student that does not register in the fall of an academic year and has not registered for the previous two academic years will automatically be exited from their program. A student whose status has thus automatically terminated will no longer be considered a graduate student but may seek reinstatement (see Reinstatements). Also note that students wishing to use many UC resources, such as university housing, campus laboratories, office space, equipment, campus recreation center, computer labs, etc. may need to be registered. Students should check with specific facilities for their particular requirements. Dual Degree Programs In dual degree programs, students must be registered for at least one graduate credit that contributes to degree requirements in one of the two programs (as determined by the program) during the academic year in which they graduate with their dual degrees. FULL-TIME COURSE LOAD Students must be registered for 10 or more graduate credits each semester to be considered full- time students, 12 if holding a university sponsored graduate assistantship or fellowship. Audit or undergraduate credits do not count toward full-time status and cannot be supported by a University Graduate Award. PART-TIME COURSE LOAD Students who can devote less than full time to graduate study may register for the number of graduate credits judged by their program advisors to represent the appropriate fraction of a full- time load. However, doctoral students must satisfy the Board of Trustees residency requirement, which requires that they have one year of full-time study, which is defined as being enrolled for at least 10 graduate credits in their program in each of two semesters (including summer semester) during a span of three consecutive semesters. Full-time UC employees using their tuition remission benefit to complete a part-time doctoral program may request a waiver of this requirement from the Associate Dean of the Graduate College. (See Doctoral Degrees Policies and Procedures, Course of Study.) 29 REDUCED COURSE LOAD (INTERNATIONAL STUDENTS) Once an international student has finished all required course work and will no longer be enrolling full time, she/he may choose to enroll with a reduced course load. Visit the F-1 Students page on the UC International Services website, referring to the “Enrolling part-time as a graduate student who has finished all course requirements” section for the link to the form and more information. MEETING PROGRAM REQUIREMENTS Students who continue on active status in their program without interruption are responsible for meeting all current requirements, including requirements that are revised since the student first entered the program. Students readmitted into their program are responsible for meeting the program requirements applicable at the time of readmission. MINIMUM ACADEMIC PERFORMANCE The Graduate College requires that a student must have an aggregate grade point average (GPA) of at least 3.000 to obtain a graduate certificate or degree at the University of Cincinnati. The GPA used for this purpose should aggregate graduate-level coursework completed since the student’s matriculation into the particular degree program from which the student seeks graduation, and only courses taken that are applicable to the degree/certificate count towards this GPA. Transfer graduate credits may also be accepted at the discretion of the degree program (and within Graduate College limits), and any transfer credit coming from courses taken at the University of Cincinnati will contribute to the GPA certified for graduation. Please note that programs establish minimum academic standards that may exceed the overall university standards provided above, so students need to be aware of their program requirements. Note that there is no grade replacement for graduate students, so any failed graduate courses remain in the student record. However, if a student retakes a failed course and obtains a passing grade, and if the GPA calculated without that original failing grade is above 3.000, then the program can petition the Graduate College for a waiver of the GPA requirement for graduation. Multiple failing grades, or multiple attempts to pass a course, are examples of why a petition may be denied. INTERNATIONAL STUDENTS, MAINTAINING IMMIGRATION STATUS The student has responsibility for maintaining their immigration status. Key information on maintaining immigration status on the F-1 Students page on the UC International Services website. TIME TO DEGREE Time to Degree and Extensions The Board of Trustees stipulates that all degree requirements must be completed within a defined span of years starting from the date of matriculation into the degree program, regardless of whether students are full time or part time. This span is 5 years for the master's degree and 9 years for the doctoral degree. Under extenuating circumstances, a program may petition, on 30 behalf of the student, for extension of the time limit for attaining the degree. Prior to the program petitioning the Graduate College for an extension, the student must communicate with the student’s program advisor and/or director to review the student’s degree completion to date and form a plan for degree completion. All this information should be included in a petition submitted to the Graduate College, which will review this petition and make a final decision. Students who have not completed degree requirements by their time-to-degree limit are on inactive status regardless of course registration in each academic year. Such students are required to apply for an extension of their time-to-degree. Reinstatements Students who have not been registered for at least one graduate credit hour at UC that contributes to degree requirements (as determined by the graduate program) in an academic year (fall-summer) are considered inactive. Reinstatements are available to students who have been inactive for less than three academic years. Students who have not been enrolled for any credits in their graduate program for three or more consecutive academic years are not eligible for reinstatement and must apply for readmission to the university. (See Readmission.) Readmission is processed via the reinstatement petition in Gradtracker. Applications submitted by the student via the admissions system will not be accepted. To request reinstatement, a program must petition the Graduate College on behalf of the student. Prior to the program petitioning the Graduate College for a reinstatement, the student must communicate with the student’s program advisor and/or director to review the student’s degree completion to date and form a plan for degree completion. The program coordinator, director or advisor will begin the reinstatement process in Gradtracker. The originator of the petition in Gradtracker will upload documents in one pdf to include degree completion information to date and a written plan for degree completion. The Graduate College will review the packet and if approved the student will also need to approve the petition and fee. If a student wishes to be reinstated so they can register and take classes, reinstatement petitions must be submitted in Gradtracker prior to the start of the first day of the term to be eligible for reinstatement in that term. Petitions received before the census date (the 15th calendar day of the term), the term may be considered for the current term. Petitions received after the census date will be considered for the following term. If a student wishes to be reinstated so they can graduate without taking any further classes, petitions for reinstatement (and extensions) must be submitted in Gradtracker no later than 3 weeks prior to graduation for the student to be certified for graduation in that semester. Petitions received after this time will not be approved in time for graduation that same semester. Late petitions will be held through the next processing period and a decision will be granted in time for the next graduation. A reinstatement fee equal to the current tuition for one graduate credit for each of the unregistered years up to a maximum of 3 years is assessed. The reinstatement fee will be added to the student’s bursar account and will become part of the student bill. Reinstatement fees are due 30 days after formal approval unless a payment plan is agreed to with the bursar’s office. If the fee is not paid by the due date, service charges may accrue, a block may be placed on future registrations and/or on the release of UC diplomas and official transcripts, and the account may be sent to collections. 31 Readmission Graduate students who have been inactive (not enrolled in their program) for three or more academic years are not eligible for reinstatement and must apply for readmission to the university. Readmission does not change the student’s original entry date. Time to degree will be calculated from the student’s first entry date. The program may petition the Graduate College on behalf of the student for readmission. Additionally, if the student has exceeded time to degree limits, the program should also petition for an extension with the readmission to specify the term in which the student will graduate. The readmission process is an opportunity for the program to carefully consider the former student’s progress and length of time between the student’s inception into the program and completion of remaining requirements. This may result in readmission, readmission with conditions, or denial of readmission. Prior to the program petitioning for a readmission, the student must communicate with the student’s program advisor and/or director to review the student’s degree completion to date and form a written plan for completing remaining degree requirements and removing any standing impediments to graduation, including any I/F, F, NG grades and courses required for graduation. This plan should include a timeline that describes the student's progress toward degree completion to date. The program coordinator, director or advisor will begin the readmission process in Gradtracker and will upload documents in one pdf to include degree completion information to date and a written plan for degree completion. The Graduate College will review the packet and if approved, the student will need to approve the petition and fee as well. Upon approval, the student must pay a readmission fee equivalent to in-state tuition in effect at the time of readmission for three graduate credits. The student will also be asked to complete, sign, and return the supplemental form for residency requirements to the Registrar’s office. Leaves of Absence Under special circumstances, graduate students may apply for leave of absence from formal study at the university for a specific period up to one year. Assuming appropriate documentation is provided, the circumstances justifying a leave include but are not limited to personal or family medical conditions, call to active military duty, parental leave, or death in immediate family. The rationale must be documented by the applicant. An approved leave of absence preserves the student’s status in the degree program, and the time off will not be counted against the time limits for awarding degrees. Consequently, registration is not required during the leave period. A leave may be renewed past the first year, for up to a maximum of five years, depending on the individual circumstances. Renewal of a leave is subject to the approval of the program, college, and the Graduate College. While the Graduate College leave of absence is only necessary for students who will be unable to register for a full academic year, programs may have more strict and specific registration policies and leave of absence policies. Students should also consult their program handbook if there is a legitimate need not to register for any amount of time. 32 To apply for a leave of absence, a student must complete the Request for Leave of Absence Form and upload the appropriate documentation (e.g., doctor’s letter or military orders) through Gradtracker. The program will approve through Gradtracker as well. Once the program has approved the request, the Graduate College will review the petition and if approved, the student and program will receive an email notification through their UC email. Note: A student on a leave of absence is placed on inactive status and their Catalyst record is discontinued, to be reactivated upon their return. While on inactive status, they will not be eligible for student health insurance and may be unable to use many UC resources. Students with financial aid or student loans should confer with the Financial Aid Office prior to requesting a leave of absence to ascertain the consequences of a leave on their loan status. Students should also be aware that any scholarships or assistantships are not guaranteed to be available when a student returns from a leave of absence. Withdrawal from Program Students must notify their program in writing and copy the Graduate Admissions Program Manager regarding their intent to withdraw from their programs. Dismissal from Program Students must consult with individual programs concerning dismissal policies. If a program dismisses a student, the program must copy the Graduate Admissions Program Manager on the notification to the student. 33 MASTER’S DEGREE POLICIES AND PROCEDURES COURSE OF STUDY The course of study for the master’s degree is planned with the advisor and is subject to approval by the program graduate committee or its equivalent. It must show a reasonable degree of concentration on interrelated subjects. Programs will recommend students for degrees only after students have developed and demonstrated the necessary knowledge and skills and have fulfilled all other university requirements. At least once an academic year, the graduate program director or the graduate student’s advisor shall inform the student in writing of their academic progress in the master’s degree program. An annual Academic Progress Report or some other form of formal evaluation of progress is required throughout each student’s program. Students must take a minimum of one graduate credit that contributes to degree requirements (as determined by the graduate program) per academic year (fall-summer) to maintain active status. If a student does not maintain active status, they may apply for reinstatement within three years or apply for readmission to their program thereafter. There are fees associated with these steps. (See Maintaining Graduate Student Status, Reinstatements and Readmission.) CREDIT HOUR REQUIREMENTS The University of Cincinnati is on a semester system. Although qualification for the master’s degree is not based exclusively upon the completion of a definite number of hours of course work, the satisfactorily completed graduate work must consist of the equivalent of a minimum of one academic year of full-time graduate study consisting of at least 30 graduate semester credit hours, including any thesis or capstone project. Credits earned in professional law or medicine programs are not applicable to the 30-credit minimum. CANDIDACY There is no formal candidacy status for the master’s degree. However, some programs do have defense requirements, so each student should confer with their advisor or program director to ascertain the requirements of their specific program. CULMINATING EXPERIENCE: THESES and CAPSTONES Every degree requires a culminating experience that is designed to integrate and apply the knowledge and learning gained from the curriculum, and demonstrate mastery of the subject matter in the degree. A master’s thesis is required by some programs, and a master’s capstone project/experience is required in others. Each master’s degree student undergoes an individual evaluation process at the end of their program. Thesis Preparation, Evaluation and Submission Process Preparation of a thesis demonstrates the student’s ability to communicate and to evaluate critically. Information about preparing an electronic thesis is available on the Graduate College 34 website. The student should consult with their program office for additional forms required other than what appears on the graduation checklist. A student must note any relevant deadlines defined by their program, and work with their program leadership to form a thesis committee composed of at least two UC faculty members, at least one of whom must be a member of the university graduate faculty. The thesis committee can guide the student in their exploration of the topic of the master’s thesis, and is responsible for final evaluation of the thesis. The student must submit the completed thesis to the thesis committee for critical evaluation, by the deadline required by the program or their thesis committee. Students who have written a thesis are expected by the Graduate College per their program requirements to make a public announcement of their thesis defense, including time, date, and title of the public presentation. The format for thesis evaluation is decided by the academic unit offering the graduate degree. Faculty with emerit status may remain on the committee if they were members when the proposal was accepted and were full-time tenured, university graduate faculty. A faculty member originally on a student’s committee who leaves UC to take an academic position elsewhere may also continue to serve on the student’s committee if both the faculty member and the student agree to continue the relationship. However, neither an emerit professor nor a faculty member from another institution may serve as chair of the committee, since they are no longer eligible to be university graduate faculty. Once a thesis has been approved by their committee, the candidate for the master’s degree must submit an electronic thesis by following the current instructions online at the Graduate Collge's Graduation page. Be careful to adhere to any deadlines for submission, or graduation will be delayed. Capstone Process Master’s students who are not required to complete a thesis should consult their academic programs about the requirements and procedures for the capstone experience in their programs. In some programs, the final capstone event may be in the form of a comprehensive exam or research project; in others, the final evaluation may appropriately be a recital, performance, or exhibition. The specific nature of the final evaluation is determined by the academic unit offering the master’s degree program, but it must include evaluation by full-time faculty at the University of Cincinnati. If questioned, the appropriateness of a final evaluation will be decided by the University Graduate Council. GRADUATION One semester prior to the semester in which a student anticipates graduating, the student should: • confer with their program office staff; • consult the Graduate College’s website for deadlines, instructions on submitting their electronic thesis; • visit the Graduate Collge’s website to determine if they are defined as a thesis or non- thesis student, or consult with their program; and • talk to advisor about whether an embargo is needed. 35 Application to Graduate Students must: (1) complete academic requirements and (2) complete the official online Application to Graduate by the deadline for the semester in which they expect to graduate. NOTE: for all graduate students, the application for graduation is started at the Graduation page, and not within Catalyst. Start an application for graduation early in the semester you plan to graduate. Deadlines posted on the Graduation Deadlines page are firm and failure to meet them will delay students’ graduation until the following semester, when they must then submit a new application for their revised graduation date. A student graduating from a dual degree program must make a formal application for graduation for each program (see details in next section). All students applying to graduate will be assessed a non-refundable graduation application fee. The fee will be assessed each semester a student applies for graduation. Students who have applied for graduation and learn later they will not be graduating must be removed from the graduation list before they can apply again for any future semesters (programs must notify the Graduation Program Manager to remove a student). When the application for graduation is complete, the student receives an email receipt for payment of the graduation application from the registrar’s office. If this receipt is not received, promptly notify your program, as your graduation application may not be completed. Some PhD programs incorporate a master’s degree. Students should contact their program for help in adding this additional degree. Graduation from Dual Degree Programs The online Application to Graduate will allow a student to apply for graduation from both degree programs in an official dual degree program. Each of the two programs must follow and complete the certification processes and procedures necessary to facilitate a student’s graduation from their own program. In dual degree programs, students must be registered for at least one graduate credit that contributes to degree requirements in one of the two programs (as determined by the program) during the academic year in which they graduate with their dual degrees. Certification for Graduation (Certify Online) The finalization and submission of a student’s Application to Graduate will activate the process by which the student will be certified for graduation, and the following requirements must be met. The student should confer with their program office one-two weeks after the application period has ended to assure that any problems related to these requirements (reinstatements/ extensions, or grade changes) are resolved in a timely manner and avoid delay of graduation until a subsequent semester. Specifically, the student’s records will be reviewed to verify satisfaction of the following requirements: • finalization and submission of their online Graduation Application by the deadline; 36 • instructor’s submission of passing grades for their final semester credits; • removal of all I grades from their transcript; • removal of all UP/SP grades from unapproved courses and/or the final semester in the approved courses were taken; • assignment of letter grades rather than UP/SP grades for courses in the final semester of the student’s program; • removal of previously awarded NG grades and blank grade awards; • confirmation of satisfactory repetition or waiver of required courses in which an F was originally received; • confirmation of completion of work and changes of I grades within the one-year limit; • confirmation that the student was registered for at least one credit in their graduate program in each academic year, including the year of expected graduation; • confirmation that the student completed degree requirements within the prescribed time- to-degree; • satisfactory completion of at least 30 graduate credits completed to the satisfaction of the student’s program; • completion of all program requirements for the degree; • 3.000 GPA has been earned while a matriculated graduate student in the program; • if a thesis is required, upload the electronic thesis (ETD) with chair approval by the deadline date, which is posted on the Graduation Deadlines website. Note: The requirements explained here are university requirements. Students must contact their program’s office for any additional program-level requirements or deadlines that must be completed prior to graduation. Please see the Doctoral Hooding and Master’s Recognition Ceremony section for details on the event. CONTINUING TO A DOCTORAL PROGRAM For a UC master’s student continuing to a doctoral program in the same program area, the student will fill out the application in the graduate admissions application system, and the graduate application fee is waived. 37 DOCTORAL DEGREE POLICIES AND PROCEDURES COURSE OF STUDY The course of study for the doctoral degree is arranged with each student by their advisor and reviewed by the program’s graduate committee or its equivalent. The program should provide a concentration and breadth of study for the student to develop competence in research, scholarship, teaching, and professional performance in general, with knowledge of their chosen specialty in relation to allied branches of learning. A written assessment of performance for each doctoral student is required at the end of their first year; an annual Academic Progress Report or some other form of formal evaluation of progress is required throughout each student’s program. CREDIT HOUR REQUIREMENTS The doctoral degree will be granted for no less than the equivalent of three years of full-time graduate study. Individual program requirements vary, but eligibility for graduation typically requires a minimum of 90 graduate credits beyond the bachelor’s degree. Doctoral students with a prior master’s degree may petition their program to allow up to 30 transfer credits from the master’s degree towards their doctoral degree. Degree credits must include at least 7 hours in dissertation research. Some program credit requirements may be higher. The last 30 credits must be completed under the direction of University of Cincinnati graduate faculty. The degree will not be granted solely on the basis of the accumulation of the required number of credits. A program will recommend students for degrees only after they have developed the necessary intellectual maturity and have fulfilled all other requirements of the program and the university. RESIDENCY AS FULL-TIME STUDENT Prior to admission to doctoral candidacy, all doctoral students shall complete a residency requirement by enrolling in 10 graduate credit hours (12 if funded by a Graduate Assistantship) per semester for two out of three consecutive semesters of study (including summer). Part-time students are not exempt from enrollment requirements to achieve residency. However, full-time UC employees using their tuition remission benefit to complete a part-time doctoral program may request a waiver of this requirement from the Associate Dean of the Graduate College. CANDIDACY, QUALIFYING EXAM The Graduate College does not currently track time to candidacy, but encourages programs to implement candidacy exams early in their programs to allow the students optimal feedback on their aspirations and research. Doctoral students are required to complete a program certification process according to the program’s established standards. The student must have at least a 3.000 grade point average in doctoral coursework and fulfill all other pre-candidacy requirements specified by the doctoral program in which the student is enrolled. Upon completion of these requirements, the student will receive a formal letter from the Graduate College informing the student of admission to candidacy. 38 UNIVERSITY GRADUATE FACULTY ROLE In accordance with the university’s Board of Trustees’ rule (50-77-11) (B) (2), only university graduate faculty are permitted to chair thesis or dissertation committees. The Graduate College appropriately identifies members of the university graduate faculty. Faculty members are nominated for graduate-faculty status by the program most closely aligned with the academic unit holding their primary academic appointment, and with the approval of their college dean or associate dean in charge of graduate education (from whom the nomination should arrive to the Graduate College). Faculty members holding any type of faculty appointment may be eligible for college-initiated nomination to the graduate faculty, the decision to be made based on an evaluation of the individual curriculum vitae and research and creative profile of the nominee. Criteria for nomination are formulated by individual programs and used by the Graduate College in adjudication. DISSERTATION Each PhD and EdD student must produce and defend a dissertation showing high scholarly achievement based on their original research. The student is required to submit an electronic document as evidence of this research. Students in all other doctoral programs should consult their academic programs regarding requirements and procedures for the capstone experience required in their programs. Dissertation Advisor and Committee When the student has been admitted into doctoral candidacy and has selected a dissertation subject and dissertation advisor, a dissertation committee should be appointed as soon as possible. The dissertation advisor must be qualified to serve as the chair of the dissertation committee, meaning this faculty member must be a member of the university graduate faculty and all members of the committee will be appointed by the Graduate College upon recommendation of the program director or director of graduate studies (in consultation with the committee chair and student). Students have the right to request a change in the committee but must do so in consultation with the graduate program director and their program must make the change in GradTracker. Preferably, the dissertation committee will include at least one person from outside the program, who might be faculty from the University of Cincinnati or another institution. A dissertation committee must be composed of a minimum of three UC faculty members. Members of the university graduate faculty are eligible to serve on all thesis and dissertation committees. In addition, all tenured and tenure-track faculty members may serve on all thesis and dissertation committees (even if they are not members of the university graduate faculty, meaning they may not serve in the chair role and cannot act as primary advisors). Other types of UC faculty members may serve on committees if the appointing unit demonstrates that their expertise is beneficial for the dissertation project. Programs should make such requests to the Graduate College in advance, to be ascertained on a case-by-case basis. Neither an emerit faculty member nor a faculty member from another institution may serve as the chair of the committee. Emerit faculty may remain on the committee if they were members when the proposal was accepted. A faculty member originally on a student’s committee who leaves UC to take an academic position elsewhere may also continue to serve on the student’s committee if both the faculty member and the student agree to continue the relationship. If a non-UC faculty member or appropriate professional practitioner has special expertise in a dissertation topic, 39 such a person may be added to the dissertation committee if they are nominated by the candidate and approved by both the chairperson of the dissertation committee, the director of graduate studies for the academic unit involved and the Graduate College. All such individuals serve as a full voting member of the dissertation committee without compensation from either the university or the candidate and would serve in addition to the minimum number of three qualified full-time UC faculty. A copy of the completed dissertation must be submitted to each committee member for critical evaluation, with sufficient time for review as determined by the dissertation committee. If it is considered satisfactory with respect to form and content by the committee, a final defense of the dissertation can be scheduled. Final Defense of Dissertation Students should check with their program office for the final deadline for their dissertation defense. The student’s final defense of the dissertation will be open to the public and all members of the academic community. Students are required to enter details of their dissertation defense, such as time, date, and location, online at the Graduate College website through the Graduation checklist steps. Begin at the Graduation webpage. One can also browse scheduled dissertation defenses by visiting the Upcoming Dissertation Defenses page. The candidate answers questions posed by members of the committee and other members of the audience following an oral presentation of their dissertation. At the conclusion of the defense, the committee will withdraw, make a decision with regard to the acceptability of the dissertation and its defense, and report its decision to the candidate. At least ¾ of the voting members of the dissertation committee (including at least one representative of each major area involved, in the case of interdisciplinary programs) must approve the dissertation. When the student’s dissertation committee chair has approved a defense, the student should assure that they have met all requirements for graduation including those in the graduation information obtained online. Use of a Moderator Although an outside moderator is not required, a moderator may be assigned by the Graduate College dean upon the request of the candidate, the chairperson of the dissertation committee, or the person empowered to approve the composition of a dissertation committee (the director of graduate studies for the academic unit involved). Moderators should be members of the university graduate faculty from outside the academic unit involved. The duties of the moderator are limited to observing the oral defense of the dissertation and reporting in writing to the Graduate College dean on the academic propriety of the proceedings. Submission of Dissertation After a dissertation has been approved, the candidate for the doctoral degree must submit their electronic dissertation by following the current instructions found at the Electronic Thesis and Dissertation Information webpage. Students in all other doctoral programs should consult their academic programs for the capstone experience required in their programs. Deadlines are posted at the Graduation Deadlines page. • All thesis/dissertations must be electronically submitted by the student and approved by the advisor. Students log in via the link available on the Graduation webpage. 40 • Advisors are sent an email when the student submits for their approval, and the advisor then logs in to review/approve. • Once approved by the chair, the student is notified by email. • A Graduate College approval email is sent to the student once reviewed. • The program is copied on all email correspondence during the Electronic Thesis/Dissertation (ETD) approval process. GRADUATION One semester prior to the semester in which a student anticipates graduating, the student should: 1. Confer with their program office staff. 2. Consult the Graduation page on the Graduate College’s website for deadlines, instructions on submitting their electronic dissertation, and doctoral hooding ceremony information. 3. Talk to advisor about whether an embargo is needed. Application to Graduate Students must: (1) complete academic requirements and (2) complete the official online Application to Graduate by the deadline for the semester in which they expect to graduate. Deadlines are firm and failure to meet them will delay students’ graduation until the following semester, when they must then submit a new application for their revised graduation date. All students applying to graduate will be assessed a non-refundable graduation application fee. The fee will be assessed each semester a student applies for graduation. Dual Degree Programs Graduation The online Application to Graduate will allow a student to apply for graduation from both degree programs in a dual degree program. Each of the two programs must follow the certification processes and procedures necessary to facilitate the student’s graduation from their own program. In dual degree programs, students must be registered for at least one graduate credit that contributes to degree requirements in one of the two programs (as determined by the program) during the academic year in which they graduate with dual degrees. Graduation Requirements for Doctoral Degrees Students must be registered for at least one graduate credit that contributes to degree requirements (as determined by the graduate program) during the academic year in which they graduate from that program. Doctoral students must also complete degree requirements within a nine-year period unless they have an approved extension (see Maintaining Graduate Student Status, Time to Degree). They should contact their program offices for any additional program requirements or deadlines to be completed prior to graduation. Certification for Graduation (Certify Online) Finalization and submission of a student’s Application to Graduate will activate the process by which the student will be certified for graduation, and the following requirements have been met. 41 The student should confer with their program office one-two weeks after the application period has ended to assure that any problems related to these requirements are resolved in a timely manner and avoid delay of graduation until a subsequent semester. Specifically, the student’s records will be reviewed to verify satisfaction of the following requirements: • finalization and submission of their online Application to Graduate by the deadline; • instructor’s submission of passing grades for final semester credits; • removal of all I grades from transcript; • Removal of previously earned NG grades and blank grade awards - removal of all UP/SP grades from unapproved courses and/or the final semester in which the courses were taken; • assignment of letter grades rather than UP/SP grades for courses in the final semester of the student’s program; • confirmation of satisfactory repetition or waiver of required courses in which an F was originally received; • confirmation of completion of work and changes of I grades within the one-year limit; • confirmation that the student was registered for at least one credit in the graduate program in each academic year, including the year of expected graduation; • confirmation that the student reached candidacy and has a valid dissertation committee; • degree requirements completed within prescribed time-to-degree; • satisfactory completion of sufficient graduate credits. In general, doctoral degrees require at least 7 research credits (many programs have higher requirements), within a total of at least 90 graduate credits for students who do not have a prior master’s degree, or require a total of at least 60 credits for students beyond the master’s degree. Please note that individual program credit requirements can vary widely. • completion of all program requirements for the degree; • 3.000 GPA has been earned while matriculated in the graduate program; • if a dissertation is required, upload the electronic dissertation (ETD), following the instructions on the Electronic Thesis and Dissertation Information page, for chair approval by the deadline. Note: The requirements explained here are university requirements. Students must contact their program office for any additional program-level requirements or deadlines that must be completed prior to graduation. GRADUATE CERTIFICATE VERIFICATION FOR UC TRANSCRIPT ENDORSEMENT In order for students to have their UC transcript endorsed with an earned certificate, students must apply for graduation and the program must approve the record through certify online just like the master's or doctoral students. DOCTORAL HOODING AND MASTER’S RECOGNITION CEREMONY Doctoral and master’s students who are graduating or who have graduated during the academic year will receive an invitation from the Dean of the Graduate College to participate in the university’s prestigious Doctoral Hooding and Master’s Recognition Ceremony held each semester. Please visit the commencement ceremony’s website for up-to-date details or 42 the Graduate College’s Graduation webpage. This is a joyous occasion in which students celebrate their accomplishment with family and friends as they are recognized by faculty and university leadership. Doctoral participants will be adorned with their hoods during the ceremony, by either their faculty mentor or the dean of their college. Graduates must confirm their intent to participate by reserving a seat online for the celebratory event and providing current home and email addresses for notification purposes. If you wish to be hooded by your faculty mentor, discuss the date with them to make sure they can attend. 43 INSTITUTIONAL RULES, POLICIES, AND PROCEDURES PROGRAM STANDARDS This Graduate Handbook clarifies minimum university-level requirements and policies that apply to all graduate students throughout the University of Cincinnati. Beyond these, each student is also expected to adhere to requirements, policies, and procedures specific to their own degree program and college. All graduate programs must publish in writing in accessible format the minimum academic standards for each graduate program offered, including the following: • minimum grade point average, including grades earned in required courses; • acceptable grade distribution, including grades earned in required courses; • nature and number of programmatic examinations, such as preliminary or qualifying, and the consequences of failing all or part of each examination; • specified research requirements; • a time-related definition of normal progress for all full- and part-time students; • standards and procedures for the mandatory annual review of academic performance; • standards and procedures for probation, suspension, and dismissal from the program. RECORDS PRIVACY, FERPA, AND THE RIGHT TO REVIEW The Family Educational Rights and Privacy Act of 1974 (FERPA), is the federal law that governs the release of and access to student education records. FERPA affords students certain rights with respect to their education records. For the complete FERPA information, consult the FERPA and Records Privacy page of the Registrar’s Office website. NOTICE OF NON-DISCRIMINATION The University of Cincinnati does not discriminate on the basis of disability, race, color, religion, national origin, ancestry, medical condition, genetic information, marital status, parental status (including status as a foster parent), sex, age, sexual orientation, veteran status, military status (past, present, or future), or gender identity and expression in its programs and activities. The university does not tolerate discrimination, harassment, or retaliation on these bases and takes steps to ensure that students, employees, and third parties are not subject to a hostile environment in university programs or activities. The university responds promptly and effectively to allegations of discrimination, harassment, and retaliation. It promptly conducts investigations and takes appropriate action, including disciplinary action, against individuals found to have violated its policies, as well as provides appropriate remedies to complainants and the campus community. The university takes immediate action to end a hostile environment if one has been created, prevent its recurrence, and remedy the effects of any hostile environment on affected members of the campus community. UC is committed to the ideal of universal Web accessibility and strives to provide an accessible Web presence that enables all university community members and visitors full access to 44 information provided on its websites. Every effort has been made to make these pages as accessible as possible in accordance with the applicable guidelines. The University of Cincinnati provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). The University of Cincinnati also provides free language services to people whose primary language is not English, such as qualified interpreters (call 513-556-5503) and information written in other languages. If you need these services, please tell any employee of a University of Cincinnati health program or activity. If you believe that the University of Cincinnati has failed to provide these services or discriminated in another way, you can file a grievance with the Office of Equal Opportunity and Access and/or Office of Gender Equity & Inclusion. You can file a grievance in person, by mail or by email. If you need help filing a grievance, the Office of Equal Opportunity & Access and Office of Gender Equity & Inclusion staff are available to help you. ACADEMIC DISHONESTY Academic dishonesty in any form is a serious offense that cannot be tolerated in an academic community. Dishonesty—including cheating, plagiarism, deception of effort, and/or unauthorized assistance—may result in a failing grade in a course and/or suspension or dismissal from the university. Allegations of academic dishonesty will be processed pursuant to the university’s Student Code of Conduct. After graduation, alumni remain responsible for the academic integrity of the work they performed while a student at the University of Cincinnati. If evidence of academic dishonesty or research misconduct is revealed after the graduation of a student, the Office of Research, the Graduate College, and the university can examine whether such concerns impact the academic integrity of the degree that was conferred on the student, with consequences including but not limited to degree revocation. STUDENT CODE OF CONDUCT The Student Code of Conduct defines behavior expected of all University of Cincinnati students. It is each student’s responsibility to know and comply with the university’s Student Code of Conduct, and sanctions or penalties are outlined. Academic behavior considered to be misconduct is defined in the Student Code of Conduct. The code also addresses nonacademic misconduct (such as disturbing the peace, destruction of property, and theft). Disciplinary procedures are explained in a step-by-step manner, and the procedures for appeal of decisions are stated. In addition to this code, students must adhere to their college’s professional code of conduct and honor codes where applicable. Students should contact the office of the dean for their college to inquire about any applicable conduct and honor codes to ensure compliance. Students can be suspended or dismissed from the university for unprofessional behavior. 45 RESPONSIBLE CONDUCT OF RESEARCH Furthering of research is a major institutional goal of the University of Cincinnati. Research includes not only intellectual activity and exploration designed to expand knowledge and understanding, but also activities in the creative and performing arts designed to interpret and create. Such activities require responsibilities for the ethical and safe conduct of research. Individuals charged with supervision of research, as well as all individuals directly engaged in it, and collaborators of investigators outside their own units are responsible for the quality of the data generated in their own laboratories as well as the laboratories of their collaborators. Everyone shares responsibility for the physical safety and intellectual property of individuals in the responsible conduct of creative scholarship and research. RESTRICTED RESEARCH The right to open exchange of information and opinion in faculty relations with students carries the obligation to avoid comments or violations of confidentiality that would reduce free expression or inquiry by students. Student involvement in industrial proprietary projects should be permitted only when these projects in no way restrict the student’s ability to fulfill their degree requirements, which includes the obligation to publish dissertation results. Faculty members have the right to publish their research findings and the right to protection against retaliation because of displeasure over their conclusions by the public, administration, government, or others. They have the concomitant responsibility to refrain from conducting secret, non-publishable research as part of their university duties. GRADUATE STUDENT GRIEVANCE PROCEDURES The University of Cincinnati provides an opportunity for the resolution of disputes involving graduate students in a fair and collegial manner. The Graduate Student Grievance Procedures establish a formal academic process for graduate students to request review and redress of certain complaints arising out of their academic relationships with their programs, their colleges, or the university. The grievance begins with a mediation process and may proceed, if necessary, through the more formal review and decision or appeal processes. In general, however, it is expected that grievances will be resolved by the parties within their programs. Students are encouraged to seek assistance from the university Ombuds Office for possible resolution before initiating the formal grievance process. Students, faculty and staff should note that Grievance Procedures are not legal protocols. They are, however, effective means by which to resolve conflicts. The Graduate College endorses these procedures and expects all programs and students involved to follow them according to the established guidelines. No outside parties, such as lawyers, ministers, and family members, are allowed to participate in or impose upon the procedures. The Graduate Student Grievance Procedures cannot supplant final sanctions stemming from the University of Cincinnati Student Code of Conduct process. There is a time limit to filing a grievance: it must be filed within 60-90 business days of the alleged improper mistreatment. The procedures are applicable to the following types of grievances: • grievances alleging improper dismissal or suspension from a graduate program, not as a result of the Student Code of Conduct process; • grievances alleging the improper withholding or termination of financial support of any kind; 46 • grievances alleging any other improper treatment, either substantive or procedural, of a graduate student by a university employee or university affiliate except: o allegations of improper evaluation of the quality and/or quantity of academic work, which a student cannot grieve; o allegations of unfair recommendation for employment or further graduate study, which a student cannot grieve; o allegations of discrimination or harassment that are subject to review by the Office of Equal Opportunity and Access or the Office of Gender, Equity and Inclusion. Published November 28, 2023. This version is an update to the 2022-23 AY handbook to reflect changes to the Graduate Scholarship structure and terminology. This version supersedes all previous versions. 47 ","Please limit your knowledge to the document. Avoid generalizations and ensure accuracy by directly referencing the document's arguments and examples. How can graduate students receive financial support at the University of Cincinnati? University of Cincinnati Graduate College Graduate Handbook Welcome from the Graduate College! We invite you to review the Graduate Handbook. This document is designed as a helpful guide to graduate education at UC. Here is where you will find policies, procedures, and important information for the graduate student lifecycle, from admissions to graduation. In addition, there may also be requirements that pertain to specific degree programs and colleges. Please visit program and college websites for these specific requirements. 1 The Graduate College Graduate College Leadership Rose Marie Ward Vice Provost and Dean of the Graduate College Omotayo (Tayo) Banjo Associate Dean of the Graduate College Tai Collins Associate Dean of the Graduate College Laura Dell Graduate College Thought Leader Emily Kregor Software Applications Developer Lead Sarah Matthews Sr Data Reporting Analyst Angel Prewitt Assistant Director of Business Affairs Megan Tischner Carroll Program Director Graduate College Staff Kaitlin Bauer Academic Evaluator Virginia Dennis Program Manager, Student Services Shaymaa Minkara Program Manager, Graduation Caitie Norrie Program Manager, Professional Development Stephen Patrick Program Manager, Marketing and Communications Amy Wheeler Program Manager, Student Success & Retention Brandilyn Worrell Program Manager, Community and Belonging 2 Brady Wright Executive Staff Assistant and Office Manager Graduate College IT Staff Chris Amann Computer & Info Analyst, Management Specialist IT Dushan Aththidiyavidanalage Don Software Applications Developer Eric Rasnake Computer & Info Analyst I Coco Zhang Software Applications Developer Contact the Graduate College Location University of Cincinnati 110 Van Wormer Hall 2614 University Circle Cincinnati, OH Mailing Address P.O. Box 210627 Cincinnati, OH 45221-0627 Email: ucgc@ucmail.uc.edu or grad.info@uc.edu Phone: (513) 556-4335 Fax: (513) 556-0128 3 Introduction This Graduate Handbook is intended to provide information about university policies that assist faculty, students, and program coordinators in supporting their individual programs of study. To which educational programs does this Handbook pertain? The Graduate College oversees all post-baccalaureate certificates and degrees (master’s and doctoral level) EXCEPT the Juris Doctor (in the College of Law), the Doctor of Medicine (in the College of Medicine), and the Doctor of Pharmacy (in the College of Pharmacy). The University of Cincinnati does not discriminate on the basis of disability, race, color, religion, national origin, ancestry, medical condition, genetic information, marital status, parental status (including status as a foster parent), sex, age, sexual orientation, veteran status, military status (past, present, or future), or gender identity and expression in its programs and activities. View UC’s complete Notice of Non-Discrimination. Published 11/28/2023. This version is an update to the 2022-23 AY handbook to reflect changes to the Graduate Scholarship structure and terminology. This version supersedes all previous versions. 4 TABLE OF CONTENTS ADMISSION TO GRADUATE PROGRAMS ....................................... 9 ADMISSIONS POLICY .............................................................................................. 9 Faculty and Administrators' Eligibility for Graduate Degrees .................................. 9 ADMISSIONS CATEGORIES .................................................................................... 9 APPLICATION PROCESS FOR 4+1 AND AIM PROGRAMS .................................. 10 Application to 4+1 Degree Programs .................................................................... 10 Application to Accelerated Integrated Master’s (AIM) Programs .......................... 11 DUAL DEGREE PROGRAMS .................................................................................. 11 CHANGING DEGREE PROGRAMS AT UC ............................................................ 11 GRADUATE CERTIFICATE PROGRAMS ............................................................... 12 INTERNATIONAL STUDENT ADMISSION.............................................................. 12 English Proficiency Requirement .......................................................................... 13 FINANCIAL SUPPORT .................................................................... 14 UNIVERSITY MERIT-BASED GRADUATE AWARDS ............................................. 14 GRADUATE SCHOLARSHIPS (GS)........................................................................ 14 UNIVERSITY FELLOWSHIPS ................................................................................. 15 GRADUATE ASSISTANTSHIP STIPEND AWARDS ............................................... 16 Teaching Assistant Requirements and OEPT ...................................................... 17 Graduate Assistant/Fellow Health Insurance Awards ........................................... 17 Multiple Appointments/Employment ..................................................................... 18 Summer Employment Without Full-time Enrollment ............................................. 18 Graduate Assistants on Jury Duty ........................................................................ 18 Strike Policy for Graduate Assistants ................................................................... 19 Sick Leave/Family Leave for Graduate Assistants ............................................... 19 Holidays/UC Closing Policy for Graduate Assistants ............................................ 19 Military Duty .......................................................................................................... 19 Termination........................................................................................................... 19 Workers’ Compensation ....................................................................................... 19 Unemployment ..................................................................................................... 19 Social Security, Medicare Tax and Ohio Public Employees Retirement System (OPERS)............................................................................................................... 20 174 GRADUATE CREDIT RULE .............................................................................. 20 TAXATION OF CINCINNATI GRADUATE AWARDS .............................................. 21 EXEMPTION FROM OPERS FOR STUDENT EMPLOYEES.................................. 21 EXTERNAL SOURCES OF FUNDING .................................................................... 21 5 FEDERAL FINANCIAL AID ...................................................................................... 22 GRADUATE CREDIT AND GRADES............................................... 23 ELIGIBLE CREDITS ................................................................................................ 23 CREDITS REQUIRED TO EARN A GRADUATE DEGREE .................................... 23 Advanced Standing for Graduate Courses Taken Outside of UC ......................... 23 Transfer Credit for Graduate Courses Taken at UC ............................................. 24 Course Exemption for Prior Knowledge, Without Credit ....................................... 24 Multiple Degree Exemptions ................................................................................. 25 Enrolling in Non-UC Classes through the Greater Cincinnati Collegiate Connection ............................................................................................................................. 25 Graduate Credit for Undergraduate Students ....................................................... 25 Graduate Credit Earned in 6000-Level Courses ................................................... 25 GRADING ................................................................................................................ 25 Final Exams .......................................................................................................... 25 Make-up Final Exams ........................................................................................... 26 Grade Reports ...................................................................................................... 26 Grades Assigned to Research Courses That Are Repeated ................................ 27 Pass/Fail Grades .................................................................................................. 27 Grade Changes .................................................................................................... 27 No Grade Replacements for Graduate Students .................................................. 27 MAINTAINING GRADUATE STUDENT STATUS ............................ 29 MINIMUM CREDITS/REGISTRATION REQUIREMENTS ....................................... 29 Dual Degree Programs ......................................................................................... 29 FULL-TIME COURSE LOAD.................................................................................... 29 PART-TIME COURSE LOAD ................................................................................... 29 REDUCED COURSE LOAD (INTERNATIONAL STUDENTS) ................................ 30 MEETING PROGRAM REQUIREMENTS................................................................ 30 MINIMUM ACADEMIC PERFORMANCE ................................................................ 30 INTERNATIONAL STUDENTS, MAINTAINING IMMIGRATION STATUS............... 30 TIME TO DEGREE .................................................................................................. 30 Time to Degree and Extensions ........................................................................... 30 Reinstatements..................................................................................................... 31 Readmission ......................................................................................................... 32 Leaves of Absence ............................................................................................... 32 Withdrawal from Program ..................................................................................... 33 Dismissal from Program ....................................................................................... 33 MASTER’S DEGREE POLICIES AND PROCEDURES ................... 34 COURSE OF STUDY ............................................................................................... 34 6 CREDIT HOUR REQUIREMENTS .......................................................................... 34 CANDIDACY ............................................................................................................ 34 CULMINATING EXPERIENCE: THESES and CAPSTONES .................................. 34 Thesis Preparation, Evaluation and Submission Process..................................... 34 Capstone Process ................................................................................................ 35 GRADUATION ......................................................................................................... 35 Application to Graduate ........................................................................................ 36 Graduation from Dual Degree Programs .............................................................. 36 Certification for Graduation (Certify Online) .......................................................... 36 CONTINUING TO A DOCTORAL PROGRAM ......................................................... 37 DOCTORAL DEGREE POLICIES AND PROCEDURES ................. 38 COURSE OF STUDY ............................................................................................... 38 CREDIT HOUR REQUIREMENTS .......................................................................... 38 RESIDENCY AS FULL-TIME STUDENT ................................................................. 38 CANDIDACY, QUALIFYING EXAM ......................................................................... 38 UNIVERSITY GRADUATE FACULTY ROLE ........................................................... 39 DISSERTATION....................................................................................................... 39 Dissertation Advisor and Committee..................................................................... 39 Final Defense of Dissertation................................................................................ 40 Use of a Moderator ............................................................................................... 40 Submission of Dissertation ................................................................................... 40 GRADUATION ......................................................................................................... 41 Application to Graduate ........................................................................................ 41 Dual Degree Programs Graduation ...................................................................... 41 Graduation Requirements for Doctoral Degrees................................................... 41 Certification for Graduation (Certify Online) .......................................................... 41 GRADUATE CERTIFICATE VERIFICATION FOR UC TRANSCRIPT ENDORSEMENT ..................................................................................................... 42 DOCTORAL HOODING AND MASTER’S RECOGNITION CEREMONY ................ 42 INSTITUTIONAL RULES, POLICIES, AND PROCEDURES ............ 44 PROGRAM STANDARDS........................................................................................ 44 RECORDS PRIVACY, FERPA, AND THE RIGHT TO REVIEW .............................. 44 NOTICE OF NON-DISCRIMINATION ...................................................................... 44 ACADEMIC DISHONESTY ...................................................................................... 45 STUDENT CODE OF CONDUCT ............................................................................ 45 RESPONSIBLE CONDUCT OF RESEARCH .......................................................... 46 RESTRICTED RESEARCH ..................................................................................... 46 7 GRADUATE STUDENT GRIEVANCE PROCEDURES ........................................... 46 8 ADMISSION TO GRADUATE PROGRAMS ADMISSIONS POLICY The University of Cincinnati welcomes graduate applications from students who: • hold a baccalaureate degree from a college or university regarded as standard by a regional accrediting agency and; • have at least a B average (3.000/4.0 system) in undergraduate course work or otherwise give evidence of promise that is judged satisfactory by the admitting program and the Graduate College. Programs that wish to admit applicants who lack this 3.000 minimum GPA requirement must provide supporting evidence and rationale of how such students will be able to complete a graduate program that requires achievement of a 3.000 GPA, and indicate any support offered by the program to ensure the applicant’s success given the GPA deficiency. Decisions concerning admission to graduate programs rest with the programs, and criteria used for determining admission beyond these minimal requirements are established by the programs. All programs have established written criteria for judging the admissibility of applicants, which are published in each program’s graduate handbook. The program’s handbook for graduate study must be available to the student. Upon the student’s acceptance of the admission offer, the program and the student are bound by the terms and conditions set forth in the letter of appointment. Faculty and Administrators' Eligibility for Graduate Degrees No holder of an academic administrative title at the University of Cincinnati (equivalent to assistant dean or above) may matriculate or be granted a graduate certificate or degree from the University of Cincinnati. No graduate degree or certificate from the University of Cincinnati will be granted to any faculty member at the University of Cincinnati (full-time or part-time above rank of instructor) who teaches in the same department, division or school in which the degree is to be granted. This rule also applies to adjunct appointments at any faculty rank and to interdisciplinary degrees when the same college is one of the interdisciplinary colleges. College deans may petition the Associate Dean of the Graduate College for a waiver of this policy on an individual faculty member’s behalf. The written request should describe the teaching responsibilities of the faculty member, indicating whether they are teaching graduate students and a plan for managing potential conflicts of interest. ADMISSIONS CATEGORIES Matriculated graduate status is granted to an applicant who has been accepted into a graduate certificate or degree program and has met all admissions criteria. Note that applicants first receive a provisional acceptance, and conversion to matriculated graduate status is dependent upon receipt of an official transcript that confirms that the student holds a baccalaureate or higher degree from a college or university regarded as standard by a regional accrediting agency. Please note that additional official documentation may be required (e.g. if the transcript does not contain information about degree conferral or if a foreign degree needs confirmation as baccalaureate equivalent). Instructions and deadlines for meeting this requirement are included on the Transcript Submission Policy web page. 9 Provisional graduate status is granted to applicants who have been accepted into a graduate certificate or degree program, but who have NOT yet met all admissions criteria. As described above, one routine requirement for all students is the submission of an official transcript. However, some students must in addition take undergraduate courses or improve English language proficiency to satisfy prerequisites, and these students may be accepted by the program on a provisional basis that is contingent on satisfying those additional prerequisites. Letters of admission should be read carefully to make sure all requirements tied to provisional status are identified. Visiting student status allows students to take courses for graduate credit when they have not been admitted into a graduate degree program. These students were previously called “non- matriculated students”. Should this visiting student subsequently matriculate into a certificate or degree program, a maximum of 12 semester hours may be applied to the certificate or degree program. Students are not eligible for tuition or stipend awards allocated by the Graduate College while in visiting graduate status. This policy and other funding policies are further explained in the Financial Support chapter. APPLICATION PROCESS FOR 4+1 AND AIM PROGRAMS Application to 4+1 Degree Programs If an undergraduate student plans to matriculate into a master’s degree program upon completion of the bachelor's degree, they can consult with advisors to begin (A) taking graduate-level coursework as an advanced undergraduate student, and (B) focusing on thesis-related, independent research at an earlier date. This advising plan to achieve an articulated path to a master’s degree is called a 4+1 program. Students who enter these programs must complete all of the requirements of each respective degree and must apply separately for both degree programs at the appropriate time. To be eligible for entry to a 4+1 program, students must have junior standing (64 semester credits). In addition, students must meet all College and graduate program admission requirements for the particular program. 4+1 students should note the following: • 4+1 students who enroll in graduate-level coursework prior to formally matriculating as a graduate student are allowed to apply up to 12 semester graduate-level credits toward the requirements of the master’s degree. These credits cannot be used for the bachelor’s degree. Students in the 4+1 program will complete the rest of their graduate coursework after formal completion and certification of the bachelor's degree. Students should refer to the section of this handbook containing the general requirements of the master’s degree and speak to the directors of the graduate program about specific requirements. • 4+1 students wishing to matriculate into a master’s program must complete a formal graduate admission application online in their junior or senior year to be admitted to the graduate program and begin the master’s degree. Students should speak to the directors of the graduate program about specific admission and application requirements. 10 Application to Accelerated Integrated Master’s (AIM) Programs The university has a limited set of programs that allow for a single application and admission to obtain a bachelor’s plus master’s degree in a single course of study. These programs are tightly structured around co-op experiences and allow undergraduate students to accumulate more than 12 graduate credits prior to transitioning to a matriculated graduate student. Applicants apply to an AIM program at the time of application to UC as an undergraduate but are still required to formally apply to transition to the graduate portion of their program at a time defined by their AIM program. There is a free and abbreviated application for UC undergraduate students transitioning to the associated master’s degree that is part of their AIM program. DUAL DEGREE PROGRAMS The university offers the opportunity for students to pursue two complementary graduate degrees simultaneously through structured, official dual degree programs (see below for a complete listing). The advantage of these programs is that they may require fewer credits than completing each degree program separately. Each program’s entrance requirements must be met in addition to university requirements, and the applicant must be accepted by both programs. Below is a listing of the Dual Degree programs: • Accounting MBA/MS • Business Analytics MBA/MS • Business Administration/Arts Administration MBA/MA • Business Administration/Nursing MBA/MSN • Community Planning/Landscape Architecture MCP/MLA • Community Planning/Law MCP/JD • Finance MBA/MS • Human Resources MBA/MA • Information Systems MBA/MS • Marketing MBA/MS • Law/Women’s Studies JD/MA • Law/Business JD/MBA • Law/Political Science JD/MA • Law/Political Science JD/PhD Please see the Multiple Degree Exemptions section for information on the maximum amount of transfer credit that can be applied to the dual degree programs. CHANGING DEGREE PROGRAMS AT UC In order to change from one degree program to another within the university, a student must submit a complete application to the new program. If the degrees are housed in the same unit, and the change is made over consecutive term enrollments, the application fee is waived. If the new degree program is in a different administrative program, the student is responsible for paying the application fee. Students are always responsible for fulfilling the requirements of the given degree program in which they are matriculated. Please see the Transfer Credit for Graduate Courses Taken at UC 11 section for information on the amount of graduate credits that can be transferred if a student is changing from one graduate program to another within the university, or if a student is changing from visiting graduate status at the university. GRADUATE CERTIFICATE PROGRAMS The University of Cincinnati offers graduate certificate programs. Certificates vary in both credit hours and in how they are configured: for instance, some can be earned only in conjunction with a degree; some require a master’s degree as a prerequisite, and some can be earned outside of a degree program. Applicants must apply for admission to a certificate program. Graduate College general guidelines are as follows: • Students must hold a baccalaureate degree. • Certificate programs may enroll degree seeking and non-degree seeking students. • For students matriculated into a degree program, credit hours earned under a certificate program may count toward a degree in any program if approved by the program director, and if requirements for the certificate and degree are completed the student will be awarded both. Credits earned while matriculated in a certificate program will count as credits matriculated in a degree. • Students can apply a single course to multiple certificates but only to ONE master’s or doctoral degree. • Students can obtain more than one certificate within the same program prior to attaining their master’s degree. • Students apply for a certificate program just like applying for a degree program, and must pay any relevant application fee. • Students enrolled only in a graduate certificate program are not eligible for tuition or stipend support with university funds (University Graduate Assistantship/Graduate Scholarship funds). If a student is interested, the student should contact the appropriate program office to obtain the specific criteria and prerequisites for the desired certificate. INTERNATIONAL STUDENT ADMISSION UC International Services supports the needs of international students at the University of Cincinnati. The office assists international students in understanding the rules, regulations, and procedures that must be followed during their stay in the United States and provides support services and cultural information to students. UC International Services is located in Suite 7148, One Edwards Center (1-513-556-4278). Information about admission to the University of Cincinnati for international students is available on their website. International students with F-1 visas can only be granted admission as matriculated graduate status in a degree-seeking program. (Most international students with J-1 visas can be granted admission with matriculated graduate status only, with some exceptions.) Students with J-1 visas should inquire with UC International Services to determine the regulations that apply to them. Students with green cards (U.S. resident aliens/permanent residents) are not defined as international students and, therefore, are not governed by the university’s international student policies. However, the English proficiency requirement does apply to green card holders (see The English Proficiency Requirement, below). 12 In instances where an international student holds a degree for which the U.S. equivalent is not known, or if it is determined by the program or the Graduate College that the applicant does not have the equivalent of a bachelor’s degree, the program must submit a petition for admission without the bachelor’s degree, with supporting documentation and rationale, to the Associate Dean of the Graduate College. All international students are required to carry University of Cincinnati student health insurance unless they qualify for a waiver. Semester insurance fees are automatically assessed each registration period. Please visit the Graduate College website for more information on the Graduate Assistant/Fellow Health Insurance Award. English Proficiency Requirement English proficiency is required of all applicants whose native language is not English. Students can demonstrate proficiency in a number of ways at the graduate level. PLEASE NOTE, many colleges and programs have higher requirements than those listed below. Applicants should contact the programs to which they are applying for details. For more information, please refer to the English Proficiency Requirement web page. 13 FINANCIAL SUPPORT Graduate students may obtain financial support from several sources. • The University of Cincinnati provides merit-based graduate awards in the form of tuition scholarships (known as the Graduate Scholarships, which may be provided with or without an assistantship), as well as stipend awards (graduate assistantships including teaching and research assistantships), and program-specific scholarships and fellowships. • Scholarship and fellowship support is also available from a diverse collection of external sponsors at the local, state, national, and international levels. Programs and colleges may have additional sources of support through grants and endowed funds • Need-based support may be obtained from federal and state sources. Financial support from each of these sources is described below. UNIVERSITY MERIT-BASED GRADUATE AWARDS The University of Cincinnati offers several types of merit-based graduate awards. The most common types – Graduate Scholarships, fellowships, and University Graduate Assistantships – are described below. Most university graduate awards are underwritten by university funds allocated by the Graduate College (“general funds”) to each college, which are then awarded to students by the individual programs. Some awards are competitive and granted by the Graduate College upon recommendation of an individual graduate program. Not all graduate students are eligible for graduate awards. Graduate awards allocated by the Graduate College are not available to students: (1) taking classes as visiting students, (2) enrolled only in a graduate certificate program, (3) who have not maintained the minimum GPA of 3.000 in their program, (4) who are on academic probation, or (5) who have exceeded the 174 graduate credit rule. Awards can only be guaranteed for a maximum period of one academic year, and renewal of a university graduate award is not automatic. Awards that are appointed by individual programs are awarded to eligible students at the sole discretion of the program. Programs are not obligated to renew awards, even if previously awarded students met all eligibility requirements. GRADUATE SCHOLARSHIPS (GS) The Graduate College funds scholarships that cover all or part of a student’s tuition and fees. In most colleges, the scholarship awards supported by the Graduate College are the Graduate Scholarships (GS), with and without assistantships. The GS with assistantship is used to support graduate assistants who are additionally awarded a stipend that requires service in return for stipend support. The GS without assistantship is for graduate students who do not receive university stipend support and therefore no service is required in return for the GS award. The appointing program sends written offers of scholarship awards to students, including information about the amount and duration of the award and the terms of the offer. Students must maintain all of the required eligibility requirements in their offer letter to maintain their tuition scholarship. 14 Students receiving a tuition scholarship must register for a specified minimum number of graduate credit hours in each semester for which they are receiving support. If an international student is supported by a GS without assistantship, they must register for a minimum load of 10 graduate credit hours per semester during the time they receive the GS scholarship. If a domestic student is supported by a GS without assistantship, they must register for a minimum load of 1 graduate credit hour per semester during the time they receive the GS scholarship. Students supported by a GS with assistantship must register for a minimum of 12 graduate credit hours per semester during the time they receive the GS scholarship. These minimum enrollments in graded courses must be met prior to using scholarship support for any audited courses. If a student withdraws from a class funded by a tuition scholarship, with the remaining enrolled credit hours totaling less than the minimum required for the award, the award is cancelled immediately and the student is responsible for the tuition balance, based on the date of withdrawal. Full tuition scholarships cover a maximum of 18 credits per semester. Students registered for more than 18 credits in a semester will be billed tuition and general fees on a per-credit-hour rate for each credit over the 18. All rules that govern recipients of tuition support pertain to all students, including international students. Other rules and policies that apply specifically to international students are independent of GS regulations. Both sets of regulations must be met. Neither set of regulations negates or takes the place of the other. (See 174 Graduate Credit Rule.) Note: Financial awards that require no service may reduce eligibility for educational loans. Students should notify the Student Financial Aid Office of their tuition support if they apply for aid from that office. UNIVERSITY FELLOWSHIPS University of Cincinnati fellowships are financial awards that include tuition scholarships and stipends with no associated service requirements. The purpose of a fellowship award is to allow the recipient to concentrate exclusively on their studies; therefore, multiple appointments and/or employment by the University of Cincinnati are not permitted for students receiving fellowships. The appointing program sends written offers of fellowship awards, including information about the amount and duration of the award; a general description of the academic obligations accepted by the student as part of the award; a reference to sources of information about academic requirements for degree completion; a description of the conditions under which either the student or unit may terminate the award prior to its end-date; and criteria for reappointment. Students receiving fellowships should check with Student Financial Aid to be informed about the potential impact on their eligibility for aid. Income received that is not for services rendered (whether it be in the form of a fellowship, grant, or award) will be calculated in whether a student meets the Cost of Attendance for the University of Cincinnati. Fellowship awardees have an enrollment obligation identical to GS with assistantship/UGA (university graduate assistantship) awardees, and they lose eligibility for the fellowship award if they accumulate more than 174 graduate credit hours. (See 174 Graduate Credit Rule). 15 For information on university-sponsored fellowships, please see the Graduate College website. GRADUATE ASSISTANTSHIP STIPEND AWARDS A student awarded a graduate assistantship receives a financial stipend for services rendered in addition to a full or partial tuition scholarship. These stipend funds are called UGA (university graduate assistantship) awards. Graduate assistants are also entitled to a discount at the University Bookstore and may be eligible for the Graduate Assistant/Fellow Health Insurance Award. UGA awardees devote effort to a combined program of formal study and assigned duties of teaching, research or administrative service that is designed to enhance their university education. The stipend received by the graduate assistant is in recognition of these services. Those with teaching duties are teaching assistants (TAs) and those with research duties are research assistants (RAs). During the appointment, the goal is to help a graduate student become a more learned, creative, and professional individual through formal instruction, interaction with faculty, research, and administrative experience. Any such service assignments should be consistent with the student’s academic pursuits. UGA funds are awarded for designated periods of time by the graduate programs. Graduate Assistants are considered exempt from minimum wage and overtime requirements, and they are paid on a salaried basis. Minimum stipends are set by the Dean of the Graduate College. The minimum stipend for a graduate assistant, as set in July 2023, must be the equivalent of a minimum of $16.98 per hour for all master’s and doctoral students except those in PhD programs. Graduate assistants enrolled in PhD programs have a minimum of $22.28 per hour. The appointing academic program, college, or area of responsibility determines service requirements of students who hold assistantships. If awarded an assistantship outside their program, graduate assistants’ duties are governed by the academic program, college, or the area of responsibility that made the award. In all cases, the award obligates awardees to no more than 20 hours per week of services, and those services must make a substantive contribution to the student’s academic and professional development. Students must be appointed to a position that is consistent with their field of academic study. If the student determines that they cannot meet the requirements of the award, it is imperative that they notify the program to initiate renegotiation or reassignment of the award with correspondingly less support. A student’s hours are prorated for weeks with a holiday or school closure and students are not required to be available during break periods unless given additional compensation. UGA awardees must be registered for 12 graduate credit hours or more, exclusive of audit credits, for each semester they receive the assistantship. University assistantships will be cancelled if the awardee does not meet their enrollment obligation. The exception to this rule is summer semester. See Summer Employment without Full-time Enrollment section. Students lose eligibility for the UGA stipend funding if they accumulate more than 174 graduate credit hours. (See 174 Graduate Credit Rule.) Assistantship awards are contingent upon student status, satisfactory degree progress, and performance of service as assigned, and can be terminated at any time. Each year the assistantship is in effect, the appointing program, college, or area must notify the awardee in 16 writing of any significant change to the services or conditions of the appointment. Such changes include, but are not limited to: • the amount and duration of the award • any tuition and/or fee not paid by the program • the average expected time per week or per semester of required duties • description of the duties assigned to the student • description of the conditions under which either the student or unit may terminate the award prior to its end-date • criteria for reappointment of the award • criteria for determining variations in stipend levels where such variations exist • information on current IRS guidelines, Medicare, and the Public Employee Retirement System (PERS) • graduate appointment procedures if any of the documents have been modified since the student’s initial appointment. Teaching Assistant Requirements and OEPT All teaching assistants must be supervised by a faculty member who has the academic credentials and authorization (as defined by the Higher Learning Commission, Ohio Dept. of Higher Education, and the University of Cincinnati) to offer instruction to the students in the class. Supervising faculty must be listed (as supervisor or instructor) in any course/section overseen by a graduate teaching assistant. Non-native speakers of English who are awarded teaching assistantships at the University of Cincinnati are required to score at least a 3.0 on the Oral English Proficiency Test (OEPT). The OEPT evaluates the spoken language skills of non-native speakers of English. Students who pass are certified for oral English proficiency and may assume the full range of duties associated with their teaching assistantship. Students whose oral English proficiency has not been officially certified may not assume instructional responsibilities. However, students who score 26 or above on the speaking section of the TOEFL IBT or students with a score of 50 or above on the Test of Spoken English are exempt from the OEPT. Students are required to take the test at the beginning of their first term of study. If a score is less than 3.0, students are recommended to take ESL courses before retaking the test. A student is permitted to take the OEPT twice without charge during an academic year. Graduate Assistant/Fellow Health Insurance Awards Academic programs are required to notify eligible students with information on the Graduate Student Health Insurance (GSHI) award, which can subsidize the cost of UC Student Health Insurance for qualified students. Programs must provide graduate assistants/fellows with the GSHI Award application deadline and relevant details on GSHI Award criteria, and must keep records that they have provided this information to their students. Such information can be found at the Graduate Student Health Insurance Award web page. 17 Multiple Appointments/Employment Graduate assistantship awardees who are domestic students are limited to 24 total hours of combined service and student hourly work while school is in session. The following policies regarding multiple appointments must be followed: • Units are responsible for monitoring of hours worked by student employees assigned to their unit; this is especially important for students who hold multiple student appointments. • The program must closely monitor academic progress. • The additional appointment must be terminated if a student does not maintain academic progress deemed to be acceptable by the program. This limit applies only while school is in session. During scheduled breaks only, if students work more than 20 hours or they work more than the prorated salary hours required, they must be compensated at an hourly rate for the extra work. Students can be employed for a maximum of 40 hrs/week during scheduled breaks. International students are limited to working 20 hours per week while school is in session and are limited to 40 hours per week during scheduled breaks. All International Students must have onboarding conducted by the International Services Office. An international student on F-1 or J-1 immigration status contemplating employment should contact the International Student Services Office at 1-513-556-4278. Summer Employment Without Full-time Enrollment For summer semester only, students who are not registered for graduate credit hours or are registered for less than 12 credits hours are eligible to be employed by their respective program, usually by performing the duties of their assistantship such as teaching or lab work. In this case, the student will receive a stipend for the work performed. Retirement funds and taxes will be withheld from the student’s check. Questions about options with retirement funds once separated from the university should be directed to Human Resources and/or OPERS. Graduate Assistants on Jury Duty All graduate students are encouraged to participate when they are subpoenaed for jury duty. The student must seek their advisor’s and program director’s permission with the expectation that every effort will be made to accommodate the jury service. If the student’s absence from UC will create a hardship to the unit, they should seek a deferral or make arrangements to cover their responsibilities during the absence. Such arrangements must be approved by their program director. Students serving on jury duty will be paid their normal university stipend during the period of service, with the understanding that any compensation received for jury service must be returned to the university if their assistantship responsibilities remain uncovered. If the student makes arrangements to cover their assistantship commitment for the period in which they serve on jury duty, and if those arrangements are approved by their program director, they may keep the jury duty compensation in total. The student may also keep any travel reimbursement fees. 18 Strike Policy for Graduate Assistants In the event of a strike, graduate assistants are expected to fulfill commitments associated with their assistantships. Graduate assistants assigned to teach a course as part of their assistantship agreement are expected to teach the course during a strike. Graduate assistants who choose not to teach can lose their assistantship. If the student’s responsibilities are associated with a course taught by a faculty member and the strike results in the course not being taught, which makes it impossible for the student to fulfill their responsibilities, the student would not be held responsible. Sick Leave/Family Leave for Graduate Assistants Graduate assistants do not accrue vacation, sick leave or other paid time-off. In the event of illness, a graduate assistant shall notify the GA supervisor as soon as possible on each day of such absence. Holidays/UC Closing Policy for Graduate Assistants Graduate assistants are not hired as essential personnel, and thus cannot be required to work during holidays or official UC closings (such as emergency closings due to severe weather, public emergency, etc.). Required weekly hours will be prorated based on the official holidays or closings during that week. Military Duty A graduate assistant who is a member of any reserve component of the United States Armed Forces, who is voluntarily or involuntarily ordered to extended U.S. military service, shall be granted time-off without pay. The graduate assistant should provide to the appropriate program official advance written notice of the call for impending training or active duty. Upon completion of military service or if discharged under honorable conditions, and upon prompt re-registration as a student, the graduate assistant shall be returned to the former assistantship in a timely manner, based upon availability. Due to the temporary nature of graduate assistantships, if the assistantship is eliminated during the student’s absence, then no obligation exists. Termination A graduate assistantship may be terminated at any time with or without cause, unless there is an explicit written contract between the student and the university that provides otherwise. Workers’ Compensation The Ohio Workers’ Compensation Law covers graduate assistants, who are paid by payroll and provides medical, income and survivor benefits in the event of accidental injury, occupational disease or death occurring in the course of, and arising from, employment. Unemployment Graduate assistants are not entitled to unemployment compensation. 19 Social Security, Medicare Tax and Ohio Public Employees Retirement System (OPERS) Please see Exemption from OPERS/Medicare for Student Employees. 174 GRADUATE CREDIT RULE Students receiving any university award (e.g. UGA stipend, GS tuition scholarship) and students who receive funds from the State of Ohio are governed by the requirements and limitations described in the following paragraphs. Any student who becomes ineligible to receive state subsidy is not eligible to receive general funds financial aid (i.e., a university stipend and/or tuition). Since this policy is due to regulations governing state support of the university, exceptions to the policy are not considered. Graduate students who have attempted 174 graduate credit hours at the University of Cincinnati are not eligible for a university award for enrollment at or beyond the 174 hours. Hours attempted include hours for which credit has been awarded, as well as withdrawn courses, audited courses, and hours in progress or incomplete (these graduate credit hours include all courses with grades F, I, UW, SP, IP, UP, W, etc.). All graduate hours attempted at the University of Cincinnati, regardless of program or student status, count toward the 174 total. A student is not eligible for funding beginning with the semester in which said student will reach the 174 attempted hours. For example, if a student has earned 167 graduate credit hours at the University of Cincinnati by the close of summer sessions and registers for (i.e., attempts) 12 credit hours for fall semester, they are ineligible for a university graduate scholarship or fellowship in the fall semester. If a student earned master’s credits at the University of Cincinnati (for either a partial or a full degree), the exact number of these credits are deducted from the 174 credit hour total for which they can receive funding. This is true if the credits are earned at an earlier time and the student returns to the University of Cincinnati to continue graduate education, and it is true regardless of the discipline in which those credits were earned. For example, if a student has earned a master’s degree in engineering and then chooses to pursue a master’s and a doctoral degree in math, the credits earned to get the engineering degree are deducted from the 174 credit hours for which the student can receive state financial support (e.g., fellowships, assistantships, and scholarships). Graduate students who have earned a master’s degree or other equivalent or higher advanced degree at another institution are not eligible for a university scholarship or fellowship once they have attempted 140 graduate credit hours at the University of Cincinnati. If a student enters the University of Cincinnati with a master’s degree from any institution other than the University of Cincinnati, they are credited with 34 graduate credit hours toward the 174 credit hour limit for state funding eligibility. Per Ohio Department of Higher Education policy, Ohio can subsidize up to the remaining 140 credit hours. The 34 credit hours are deducted from the 174, regardless of the discipline and regardless of the graduate level at which the student enters the University of Cincinnati. For example, if a student has earned a master’s degree in engineering at The Ohio State University and then chooses to pursue a master’s and a doctoral degree in math at UC, the credits they earned to get their engineering degree are deducted from the 174 credit hours for which they can receive state financial support in the math program. Note that professional 20 degrees, like a juris doctorate or medical doctorate, do not count as a master’s or higher equivalent for the purpose of comparative funding. Students who enter graduate education at the University of Cincinnati with a professional degree and no other advanced degrees are still eligible to receive up to the 174 credit hours of funding. If a student enters the University of Cincinnati with only partial credit toward a degree from another institution, those credits are not deducted from the 174 total—even if the program they enter at the University of Cincinnati agrees to accept transfer of those credits toward the student’s degree requirements at the University of Cincinnati. The student can still receive state subsidy for up to 174 credit hours earned at the University of Cincinnati beyond those transferred in. Note: For the purposes of this policy, a master’s degree is one awarded by an American institution or a degree of equivalent value from a foreign institution. Students holding a master’s degree from a foreign institution that is the equivalent of a bachelor’s degree in the U.S. will have the higher limit (174). The higher limit will not be affected by a student’s completion of course work short of a master’s degree at another institution. TAXATION OF CINCINNATI GRADUATE AWARDS The university maintains a position that all income, from whatever source, is taxable and may be subject to withholding. The IRS maintains final authority on the taxability of all stipends, and in all cases, the university cannot guarantee that any stipend is tax-exempt. The Graduate College will not review an individual award nor provide legal advice to individual students. In addition, students (not the university) are responsible for the withholding information that they submit on their W-4 forms at the time of appointment. Those students who receive a stipend during any academic semester and are not enrolled for at least half time will have Medicare tax and Ohio Public Employee Retirement System (OPERS) payments deducted from their checks. If a student is enrolled half time or more, they may apply for an exemption from these fees in their program office. No taxes are withheld from fellowships, but students may still have a tax liability and should consult a tax advisor. EXEMPTION FROM OPERS FOR STUDENT EMPLOYEES Employees (including student employees) of Ohio public institutions do not contribute to the federal Social Security system. Student employees’ retirement contributions will be directed to the state retirement plan, the Ohio Public Employees Retirement System (OPERS). Student employees (including graduate assistants and hourly student workers) may be eligible to opt out of OPERS participation when first hired by UC as long as certain requirements are met. See the Student Employees web page on UC’s Human Resources site for the OPERS exemption form and for additional information. EXTERNAL SOURCES OF FUNDING Tuition scholarship and fellowship funding is provided to graduate students by a wide variety of governmental and private sponsors. UC’s Financial Aid website, the ScholarshipUniverse scholarship search application, the Office of Nationally Competitive Awards and local and university libraries are potential sources of information about these funding opportunities. The Office of Nationally Competitive Awards provides workshops, application writing assistance and university endorsement (for applicable awards). Students may also visit the Office of Research 21 for more information on upcoming grant opportunities, grant writing workshops, and searchable research opportunity databases. FEDERAL FINANCIAL AID See the Student Financial Aid website for more information on federal financial aid (including summer aid). The Graduate College does not regulate or audit any outside fellowships or other outside funding a student may receive. However, it is advised that students with outside funding consult with the Financial Aid Office to see if and how the outside funding may or may not affect other Financial Aid eligibility. 22 GRADUATE CREDIT AND GRADES ELIGIBLE CREDITS Credit towards a graduate degree or certificate can only be earned for those courses in this university that are listed as graduate in the Schedule of Classes or which have been approved in writing by appropriate program authority for inclusion in the curriculum. Graduate credit towards a degree will only be granted when a course is included in the graduate career category of the student record in Catalyst. CREDITS REQUIRED TO EARN A GRADUATE DEGREE Graduate degrees at UC each have a stated number of credit hours that must be completed satisfactorily to earn the degree. As described below, there are multiple opportunities where coursework taken prior to matriculation into a degree program may count towards that credit hour total. In all cases, to earn a degree at UC, at least 67% of the relevant coursework credit must be earned while a matriculated student at the University of Cincinnati. Students entering in Fall 2019 or later should make application to their program for such (advanced standing or transfer) credit during their first semester at UC to assure their course of study is optimized. For all students matriculating in Fall 2019 and later, such credit will only be granted if a complete and program-approved application for such credit is submitted to the Graduate College by the end of their first year in the program, or prior to their final semester of study, whichever comes first. This new policy (introduced in AY19-20) is in effect for all students matriculated in Fall 2019 and later. In prior policies, master’s degrees were granted when 50% of graduate credits were completed while matriculated in the graduate program granting the degree, therefore allowing up to 50% of credits to be via advanced standing. Advanced Standing for Graduate Courses Taken Outside of UC a. Programs are permitted to award up to one third of the credits of a UC graduate program through advanced standing (e.g., 10 credits are eligible in a 30 credit hour program or 13 credits in a 40 credit hour program). The relevant number of credits is based on the minimum credits required to earn the advanced degree starting from the minimum degree qualification (usually a baccalaureate degree). Note that for doctoral students the advanced standing credit total will include any use of the ODHE allowance of up to 30 credits for a prior master's degree. b. Any graduate course credits, including those earned from previously earned graduate or undergraduate degrees, are eligible as advanced standing credits. c. Advanced standing can only be offered for courses (including electives) entered in e- curriculum for the UC program. d. Program faculty must evaluate courses for equivalence or comparability prior to granting students Advanced Standing credit for courses taken at another institution, meeting all the following criteria; 1. Courses taken at a recognized University or College 2. Courses taken at the graduate level 3. Requested advanced standing credits must be the lower of the following two choices 23 i. Credits originally earned for the course ii. Credits available in the UC course listed in e-curriculum 4. For 1:1 course equivalency, one or more of the following criteria must be met when compared to the University of Cincinnati course for which Advanced Standing credit is sought: i. Course was taken in the same field with the same title ii. Course had similar topics iii. Course had similar learning outcomes iv. Course assignment and assessment requirements were similar v. Course readings requirements are similar 5. This evaluation process should be documented for each case in which it is applied e. The one third rule doesn’t apply to dual degrees, sequential master's to doctorate programs, or others with shared content that have received approval from the Graduate College. f. Advanced standing credit recommended by program faculty must first be approved by the graduate program director and then submitted for final review by the Graduate College to assure the request complies with the criteria above. Transfer Credit for Graduate Courses Taken at UC a. When leaving one graduate program to join another at UC, all UC graduate credits taken as part of the incomplete program are eligible to use to fulfill requirements in the new program, based on faculty evaluation of the equivalence to courses in the new curriculum and program approval. b. When a student enters a graduate program at UC, non-matriculated UC graduate credits are eligible to be used for the program, if the coursework is listed in e-curriculum as part of the curricular requirements. Subject to program approval, students may transfer up to one third of the credits required to earn their UC graduate degree Programs are permitted to award transfer credit from a prior UC graduate degree if (1) the sum of unique credits to earn both degrees is equal to or greater than the State minimums for each degree type, and (2) the transfer credit courses are part of the curriculum of the new degree program as defined in e-curriculum. Using credit that meets both criteria, up to one third of the credits of the new UC graduate program may be awarded through transfer credit. The relevant number of credits is based on the minimum credits required to earn the advanced degree starting from the minimum degree qualification (usually a baccalaureate degree). Note that for doctoral students the transfer credit total will include any use of the ODHE allowance of up to 30 credits for a prior master’s degree. Course Exemption for Prior Knowledge, Without Credit Faculty in a program have the option to provide students with an examination to determine if accumulated knowledge is sufficient to be exempted from specific courses in a graduate curriculum (e.g., continuing education courses in some professional fields may provide a background that eliminates the need to take introductory courses). The form and content of that examination is at the discretion of the program. When such exemptions are granted, the student does not earn graduate credit for such knowledge. The credits required to complete their UC graduate degree remain unchanged, and the student will take alternative coursework (approved by the graduate program director) to advance their knowledge. 24 Multiple Degree Exemptions a. If the graduate faculty from a UC program has participated in designing and/or presenting the curriculum at another institution, shared degree programs between the institutions can deviate from these rules with prior approval of the Graduate College and their college leadership. In no case will a UC degree be awarded if more than 50% of the curriculum is offered by non-UC faculty. b. Dual degree programs can combine two UC graduate degrees into a single curriculum if approved by the University. Approved dual degree programs can share up to one-third of the combined credits of the two degrees, but the total count of unique credits to earn both degrees must always be equal to or greater than the State minimums for each degree type. Enrolling in Non-UC Classes through the Greater Cincinnati Collegiate Connection The University of Cincinnati is a member of the Greater Cincinnati Collegiate Connection. GC3 classes are those not generally available at the University of Cincinnati but which can be used to satisfy degree requirements. The student must have met all tuition commitments at the University of Cincinnati and must observe all regulations of the host institution. For additional information, participating institutions, and registration instructions, consult the Greater Cincinnati Collegiate Connection page of the Registrar’s Office website. Approval is at the discretion of the program. Graduate Credit for Undergraduate Students Any program may allow juniors or seniors to register for graduate courses for graduate credit before those students have completed the baccalaureate degree. It is recommended, if the program permits such registration, to limit the privilege to students with senior status and a grade point average of at least 3.000 (higher in some programs). This is evidenced by a written request from the student that is signed by an authorized member of the graduate program. Upon approval by the graduate program and the course instructor, graduate credit will be given for the courses. A maximum of 12 semester graduate credits can be earned in this manner. Credit will not be given toward both graduate and undergraduate degrees for the same course. Graduate Credit Earned in 6000-Level Courses In fall 2016, all 6000-level courses became graduate only. In the past, 6000-level courses were available for either undergraduate or graduate credit (to earn graduate credit, students selected the graduate level designation (G) in these courses, indicating that additional work was required beyond that required of undergraduates in the course). PLEASE NOTE: with the transition to the new use of course numbers, there will be no change to the graduate (or undergraduate) credits earned previously in the pre-fall-2016 version of these courses. GRADING Final Exams Exams are held during the last week of the semester after classes have ended. For each term’s full final examination schedule, consult the Calendars page of the Registrar’s Office website. 25 Make-up Final Exams Special policies may govern the taking of missed final exams. Students and faculty members should check the college office or program office for specific details. Every student is responsible for the material presented in their class. Arrangements for make-up work and tests are determined by the instructor. Absences incurred by students officially representing the university will be excused, provided that official notification of such absence has been given in advance to the instructor. Grade Reports End-of-term final grades may be viewed in the Catalyst student portal immediately following submission of final grades by the instructor. Grade reports include total graduate hours and hours for the current semester. The student’s grade report differentiates between “units taken” (course credits the student enrolled in but did not complete successfully or which are still pending a final grade) and “credits passed” (course credits successfully completed with a final grade other than F). These values are posted on the student’s transcript as attempted hours and earned hours. A graduate grade point average (GPA) is calculated each semester. Approved transfer credits from other institutions are included in the sum of credits earned, but grades for those credits are not included in the GPA. All graduate work, regardless of the University of Cincinnati college in which the work was done, is accumulated in these tallies. For this reason, if a student record includes UC graduate courses that do not count towards the degree, this GPA may differ from the calculation of GPA in program coursework (a minimum 3.000 program GPA is essential to earn a graduate degree). The I incomplete grade is awarded as a course grade (without grade point assignment) at the end of a term when a significant portion of course work has been satisfactorily completed, but not all of the required course work has been completed. The incomplete grade is appropriate when the completed course work is of passing quality and the student has had such hardship that completion of the remaining course work within the term timeline would present an additional hardship. The instructor who assigns the incomplete grade should set a specific date by which the student must complete the remaining course work, recognizing that time must be available for any final evaluation and grade change to be made, prior to the deadline when the grade converts to an F. The deadline is one year to the last day of exams. (Please check the Office of the Registrar’s website for the specific date.) The student must work with the instructor to develop an agreement that indicates the date by which the remaining course work is to be completed and submitted to the instructor. The instructor is not obligated to provide the student with a full year to complete the remaining course work. If the remaining course work is completed within the time period agreed upon by the instructor and the student, and that completion occurs within the one year, then the instructor will submit a change of grade online (in Catalyst) based on the quality of the remaining work. If no specific time for completion is set by the instructor, the student has one year (from the end of the term in which the incomplete was assigned) to complete the remaining course work and submit it to the instructor in time for evaluation of the work and a final grade to be approved by the Registrar. If the coursework is not completed within the one-year period (i.e., one year from the end of the term in which the I grade was assigned), the I grade automatically converts to an I/F grade which affects the student’s GPA the same as the grade of F. For the complete graduate grading scale and a definition of all grades, consult the Grading Scales and Definitions page of the Registrar’s Office website. 26 Grades Assigned to Research Courses That Are Repeated If students are working on dissertation or thesis research, they should be registered in the appropriate research course (e.g., Individual Dissertation or Individual Master’s Thesis), and the course work should be given a final grade each semester. The use of P/F for such courses is strongly recommended to avoid undue influence on GPA due to individual grading practices and the large amount of research credit awarded, but it is recognized that some programs will want to use letter grades. “Placeholder” grades such as SP and NG should not be used. Regardless of the grading scheme selected, it must be consistently applied across an entire program. If a program faculty cannot agree on a single grading scheme, the program must use the P/F choice. Students should be graded for each semester based on their progress and achievements in that semester. Note: The definition of a “research course” is a course outside of formal class work or instruction that allows a student to be registered as a graduate student while they are working independently on their thesis or dissertation under the guidance of their advisor or dissertation committee. This policy also applies to internships and other multiple semester or series courses. Pass/Fail Grades An instructor may request approval for pass/fail grading for an individual student in their class prior to the first day of class. A graduate student can take a course on a pass/fail basis (P or U grade) when approved by their advisor and instructor. An instructor is not required to accept a student on such a basis. Grade Changes A change of grade is only appropriate for an I, an NG, an SP/UP, or an error made by the instructor. SP/UP grades must be converted to a final grade by the end of the following semester. Instructors may change an I or NG grade online in Catalyst for approximately one year (the interval extends from the initial grading semester to the last working day of the same term the following year). To request a change of grade for a non-research course for graduate credit after this period, or an F grade any time, the instructor must do an official, paper change of grade form and forward to the Registrar’s Office. Previously recorded grades may not be changed to W or I after the close of the term. Both I and W grades must be awarded while the course and semester are still in progress and cannot be awarded retroactively. W reflects an official withdrawal that took place by the deadline outlined in the academic calendar, and I indicates work remains to be completed and the student did not earn a final grade. Students cannot withdraw from a class retroactively or be given additional opportunities to seek a different final grade retroactively. If an F is in a non- required course or the required course has since been retaken for a passing grade, the Program Director at certification may request a waiver of the F grade from the Associate University Dean of the Graduate College. No Grade Replacements for Graduate Students Please note, if a graduate student re-registers and re-takes a course, both grades will be included in the student’s overall GPA. There are no grade replacements at the graduate level. The process to make a grade change cannot be initiated by a student. The course instructor of record must send the form. At no time should a student be in possession of a change of grade 27 form. Note: that an I/F grade is governed by the same policies that govern the F grade and is weighted into the student’s GPA in the same fashion. 28 MAINTAINING GRADUATE STUDENT STATUS Maintaining graduate student status signifies that the student is actively engaged in making progress towards their degree and meeting program requirements. Graduate status determines which students may use facilities of the university, may participate in the university governance process and student organizations, and are covered by the Student Code of Conduct and the grievance process. A University of Cincinnati graduate student must hold the equivalent of a baccalaureate or higher degree and must have been accepted for admission into graduate study by the appropriate graduate program. MINIMUM CREDITS/REGISTRATION REQUIREMENTS To maintain graduate status at the University of Cincinnati, students must register at UC for at least one graduate credit that contributes to degree requirements (as determined by the graduate program) in an academic year. If the student is registered for at least one graduate credit in the academic year (fall through summer), they will maintain graduate student status for the entire academic year. Credits that are audited or in which a student receives a W, UW or F do not count toward the minimum credit requirement. Any student that does not register in the fall of an academic year and has not registered for the previous two academic years will automatically be exited from their program. A student whose status has thus automatically terminated will no longer be considered a graduate student but may seek reinstatement (see Reinstatements). Also note that students wishing to use many UC resources, such as university housing, campus laboratories, office space, equipment, campus recreation center, computer labs, etc. may need to be registered. Students should check with specific facilities for their particular requirements. Dual Degree Programs In dual degree programs, students must be registered for at least one graduate credit that contributes to degree requirements in one of the two programs (as determined by the program) during the academic year in which they graduate with their dual degrees. FULL-TIME COURSE LOAD Students must be registered for 10 or more graduate credits each semester to be considered full- time students, 12 if holding a university sponsored graduate assistantship or fellowship. Audit or undergraduate credits do not count toward full-time status and cannot be supported by a University Graduate Award. PART-TIME COURSE LOAD Students who can devote less than full time to graduate study may register for the number of graduate credits judged by their program advisors to represent the appropriate fraction of a full- time load. However, doctoral students must satisfy the Board of Trustees residency requirement, which requires that they have one year of full-time study, which is defined as being enrolled for at least 10 graduate credits in their program in each of two semesters (including summer semester) during a span of three consecutive semesters. Full-time UC employees using their tuition remission benefit to complete a part-time doctoral program may request a waiver of this requirement from the Associate Dean of the Graduate College. (See Doctoral Degrees Policies and Procedures, Course of Study.) 29 REDUCED COURSE LOAD (INTERNATIONAL STUDENTS) Once an international student has finished all required course work and will no longer be enrolling full time, she/he may choose to enroll with a reduced course load. Visit the F-1 Students page on the UC International Services website, referring to the “Enrolling part-time as a graduate student who has finished all course requirements” section for the link to the form and more information. MEETING PROGRAM REQUIREMENTS Students who continue on active status in their program without interruption are responsible for meeting all current requirements, including requirements that are revised since the student first entered the program. Students readmitted into their program are responsible for meeting the program requirements applicable at the time of readmission. MINIMUM ACADEMIC PERFORMANCE The Graduate College requires that a student must have an aggregate grade point average (GPA) of at least 3.000 to obtain a graduate certificate or degree at the University of Cincinnati. The GPA used for this purpose should aggregate graduate-level coursework completed since the student’s matriculation into the particular degree program from which the student seeks graduation, and only courses taken that are applicable to the degree/certificate count towards this GPA. Transfer graduate credits may also be accepted at the discretion of the degree program (and within Graduate College limits), and any transfer credit coming from courses taken at the University of Cincinnati will contribute to the GPA certified for graduation. Please note that programs establish minimum academic standards that may exceed the overall university standards provided above, so students need to be aware of their program requirements. Note that there is no grade replacement for graduate students, so any failed graduate courses remain in the student record. However, if a student retakes a failed course and obtains a passing grade, and if the GPA calculated without that original failing grade is above 3.000, then the program can petition the Graduate College for a waiver of the GPA requirement for graduation. Multiple failing grades, or multiple attempts to pass a course, are examples of why a petition may be denied. INTERNATIONAL STUDENTS, MAINTAINING IMMIGRATION STATUS The student has responsibility for maintaining their immigration status. Key information on maintaining immigration status on the F-1 Students page on the UC International Services website. TIME TO DEGREE Time to Degree and Extensions The Board of Trustees stipulates that all degree requirements must be completed within a defined span of years starting from the date of matriculation into the degree program, regardless of whether students are full time or part time. This span is 5 years for the master's degree and 9 years for the doctoral degree. Under extenuating circumstances, a program may petition, on 30 behalf of the student, for extension of the time limit for attaining the degree. Prior to the program petitioning the Graduate College for an extension, the student must communicate with the student’s program advisor and/or director to review the student’s degree completion to date and form a plan for degree completion. All this information should be included in a petition submitted to the Graduate College, which will review this petition and make a final decision. Students who have not completed degree requirements by their time-to-degree limit are on inactive status regardless of course registration in each academic year. Such students are required to apply for an extension of their time-to-degree. Reinstatements Students who have not been registered for at least one graduate credit hour at UC that contributes to degree requirements (as determined by the graduate program) in an academic year (fall-summer) are considered inactive. Reinstatements are available to students who have been inactive for less than three academic years. Students who have not been enrolled for any credits in their graduate program for three or more consecutive academic years are not eligible for reinstatement and must apply for readmission to the university. (See Readmission.) Readmission is processed via the reinstatement petition in Gradtracker. Applications submitted by the student via the admissions system will not be accepted. To request reinstatement, a program must petition the Graduate College on behalf of the student. Prior to the program petitioning the Graduate College for a reinstatement, the student must communicate with the student’s program advisor and/or director to review the student’s degree completion to date and form a plan for degree completion. The program coordinator, director or advisor will begin the reinstatement process in Gradtracker. The originator of the petition in Gradtracker will upload documents in one pdf to include degree completion information to date and a written plan for degree completion. The Graduate College will review the packet and if approved the student will also need to approve the petition and fee. If a student wishes to be reinstated so they can register and take classes, reinstatement petitions must be submitted in Gradtracker prior to the start of the first day of the term to be eligible for reinstatement in that term. Petitions received before the census date (the 15th calendar day of the term), the term may be considered for the current term. Petitions received after the census date will be considered for the following term. If a student wishes to be reinstated so they can graduate without taking any further classes, petitions for reinstatement (and extensions) must be submitted in Gradtracker no later than 3 weeks prior to graduation for the student to be certified for graduation in that semester. Petitions received after this time will not be approved in time for graduation that same semester. Late petitions will be held through the next processing period and a decision will be granted in time for the next graduation. A reinstatement fee equal to the current tuition for one graduate credit for each of the unregistered years up to a maximum of 3 years is assessed. The reinstatement fee will be added to the student’s bursar account and will become part of the student bill. Reinstatement fees are due 30 days after formal approval unless a payment plan is agreed to with the bursar’s office. If the fee is not paid by the due date, service charges may accrue, a block may be placed on future registrations and/or on the release of UC diplomas and official transcripts, and the account may be sent to collections. 31 Readmission Graduate students who have been inactive (not enrolled in their program) for three or more academic years are not eligible for reinstatement and must apply for readmission to the university. Readmission does not change the student’s original entry date. Time to degree will be calculated from the student’s first entry date. The program may petition the Graduate College on behalf of the student for readmission. Additionally, if the student has exceeded time to degree limits, the program should also petition for an extension with the readmission to specify the term in which the student will graduate. The readmission process is an opportunity for the program to carefully consider the former student’s progress and length of time between the student’s inception into the program and completion of remaining requirements. This may result in readmission, readmission with conditions, or denial of readmission. Prior to the program petitioning for a readmission, the student must communicate with the student’s program advisor and/or director to review the student’s degree completion to date and form a written plan for completing remaining degree requirements and removing any standing impediments to graduation, including any I/F, F, NG grades and courses required for graduation. This plan should include a timeline that describes the student's progress toward degree completion to date. The program coordinator, director or advisor will begin the readmission process in Gradtracker and will upload documents in one pdf to include degree completion information to date and a written plan for degree completion. The Graduate College will review the packet and if approved, the student will need to approve the petition and fee as well. Upon approval, the student must pay a readmission fee equivalent to in-state tuition in effect at the time of readmission for three graduate credits. The student will also be asked to complete, sign, and return the supplemental form for residency requirements to the Registrar’s office. Leaves of Absence Under special circumstances, graduate students may apply for leave of absence from formal study at the university for a specific period up to one year. Assuming appropriate documentation is provided, the circumstances justifying a leave include but are not limited to personal or family medical conditions, call to active military duty, parental leave, or death in immediate family. The rationale must be documented by the applicant. An approved leave of absence preserves the student’s status in the degree program, and the time off will not be counted against the time limits for awarding degrees. Consequently, registration is not required during the leave period. A leave may be renewed past the first year, for up to a maximum of five years, depending on the individual circumstances. Renewal of a leave is subject to the approval of the program, college, and the Graduate College. While the Graduate College leave of absence is only necessary for students who will be unable to register for a full academic year, programs may have more strict and specific registration policies and leave of absence policies. Students should also consult their program handbook if there is a legitimate need not to register for any amount of time. 32 To apply for a leave of absence, a student must complete the Request for Leave of Absence Form and upload the appropriate documentation (e.g., doctor’s letter or military orders) through Gradtracker. The program will approve through Gradtracker as well. Once the program has approved the request, the Graduate College will review the petition and if approved, the student and program will receive an email notification through their UC email. Note: A student on a leave of absence is placed on inactive status and their Catalyst record is discontinued, to be reactivated upon their return. While on inactive status, they will not be eligible for student health insurance and may be unable to use many UC resources. Students with financial aid or student loans should confer with the Financial Aid Office prior to requesting a leave of absence to ascertain the consequences of a leave on their loan status. Students should also be aware that any scholarships or assistantships are not guaranteed to be available when a student returns from a leave of absence. Withdrawal from Program Students must notify their program in writing and copy the Graduate Admissions Program Manager regarding their intent to withdraw from their programs. Dismissal from Program Students must consult with individual programs concerning dismissal policies. If a program dismisses a student, the program must copy the Graduate Admissions Program Manager on the notification to the student. 33 MASTER’S DEGREE POLICIES AND PROCEDURES COURSE OF STUDY The course of study for the master’s degree is planned with the advisor and is subject to approval by the program graduate committee or its equivalent. It must show a reasonable degree of concentration on interrelated subjects. Programs will recommend students for degrees only after students have developed and demonstrated the necessary knowledge and skills and have fulfilled all other university requirements. At least once an academic year, the graduate program director or the graduate student’s advisor shall inform the student in writing of their academic progress in the master’s degree program. An annual Academic Progress Report or some other form of formal evaluation of progress is required throughout each student’s program. Students must take a minimum of one graduate credit that contributes to degree requirements (as determined by the graduate program) per academic year (fall-summer) to maintain active status. If a student does not maintain active status, they may apply for reinstatement within three years or apply for readmission to their program thereafter. There are fees associated with these steps. (See Maintaining Graduate Student Status, Reinstatements and Readmission.) CREDIT HOUR REQUIREMENTS The University of Cincinnati is on a semester system. Although qualification for the master’s degree is not based exclusively upon the completion of a definite number of hours of course work, the satisfactorily completed graduate work must consist of the equivalent of a minimum of one academic year of full-time graduate study consisting of at least 30 graduate semester credit hours, including any thesis or capstone project. Credits earned in professional law or medicine programs are not applicable to the 30-credit minimum. CANDIDACY There is no formal candidacy status for the master’s degree. However, some programs do have defense requirements, so each student should confer with their advisor or program director to ascertain the requirements of their specific program. CULMINATING EXPERIENCE: THESES and CAPSTONES Every degree requires a culminating experience that is designed to integrate and apply the knowledge and learning gained from the curriculum, and demonstrate mastery of the subject matter in the degree. A master’s thesis is required by some programs, and a master’s capstone project/experience is required in others. Each master’s degree student undergoes an individual evaluation process at the end of their program. Thesis Preparation, Evaluation and Submission Process Preparation of a thesis demonstrates the student’s ability to communicate and to evaluate critically. Information about preparing an electronic thesis is available on the Graduate College 34 website. The student should consult with their program office for additional forms required other than what appears on the graduation checklist. A student must note any relevant deadlines defined by their program, and work with their program leadership to form a thesis committee composed of at least two UC faculty members, at least one of whom must be a member of the university graduate faculty. The thesis committee can guide the student in their exploration of the topic of the master’s thesis, and is responsible for final evaluation of the thesis. The student must submit the completed thesis to the thesis committee for critical evaluation, by the deadline required by the program or their thesis committee. Students who have written a thesis are expected by the Graduate College per their program requirements to make a public announcement of their thesis defense, including time, date, and title of the public presentation. The format for thesis evaluation is decided by the academic unit offering the graduate degree. Faculty with emerit status may remain on the committee if they were members when the proposal was accepted and were full-time tenured, university graduate faculty. A faculty member originally on a student’s committee who leaves UC to take an academic position elsewhere may also continue to serve on the student’s committee if both the faculty member and the student agree to continue the relationship. However, neither an emerit professor nor a faculty member from another institution may serve as chair of the committee, since they are no longer eligible to be university graduate faculty. Once a thesis has been approved by their committee, the candidate for the master’s degree must submit an electronic thesis by following the current instructions online at the Graduate Collge's Graduation page. Be careful to adhere to any deadlines for submission, or graduation will be delayed. Capstone Process Master’s students who are not required to complete a thesis should consult their academic programs about the requirements and procedures for the capstone experience in their programs. In some programs, the final capstone event may be in the form of a comprehensive exam or research project; in others, the final evaluation may appropriately be a recital, performance, or exhibition. The specific nature of the final evaluation is determined by the academic unit offering the master’s degree program, but it must include evaluation by full-time faculty at the University of Cincinnati. If questioned, the appropriateness of a final evaluation will be decided by the University Graduate Council. GRADUATION One semester prior to the semester in which a student anticipates graduating, the student should: • confer with their program office staff; • consult the Graduate College’s website for deadlines, instructions on submitting their electronic thesis; • visit the Graduate Collge’s website to determine if they are defined as a thesis or non- thesis student, or consult with their program; and • talk to advisor about whether an embargo is needed. 35 Application to Graduate Students must: (1) complete academic requirements and (2) complete the official online Application to Graduate by the deadline for the semester in which they expect to graduate. NOTE: for all graduate students, the application for graduation is started at the Graduation page, and not within Catalyst. Start an application for graduation early in the semester you plan to graduate. Deadlines posted on the Graduation Deadlines page are firm and failure to meet them will delay students’ graduation until the following semester, when they must then submit a new application for their revised graduation date. A student graduating from a dual degree program must make a formal application for graduation for each program (see details in next section). All students applying to graduate will be assessed a non-refundable graduation application fee. The fee will be assessed each semester a student applies for graduation. Students who have applied for graduation and learn later they will not be graduating must be removed from the graduation list before they can apply again for any future semesters (programs must notify the Graduation Program Manager to remove a student). When the application for graduation is complete, the student receives an email receipt for payment of the graduation application from the registrar’s office. If this receipt is not received, promptly notify your program, as your graduation application may not be completed. Some PhD programs incorporate a master’s degree. Students should contact their program for help in adding this additional degree. Graduation from Dual Degree Programs The online Application to Graduate will allow a student to apply for graduation from both degree programs in an official dual degree program. Each of the two programs must follow and complete the certification processes and procedures necessary to facilitate a student’s graduation from their own program. In dual degree programs, students must be registered for at least one graduate credit that contributes to degree requirements in one of the two programs (as determined by the program) during the academic year in which they graduate with their dual degrees. Certification for Graduation (Certify Online) The finalization and submission of a student’s Application to Graduate will activate the process by which the student will be certified for graduation, and the following requirements must be met. The student should confer with their program office one-two weeks after the application period has ended to assure that any problems related to these requirements (reinstatements/ extensions, or grade changes) are resolved in a timely manner and avoid delay of graduation until a subsequent semester. Specifically, the student’s records will be reviewed to verify satisfaction of the following requirements: • finalization and submission of their online Graduation Application by the deadline; 36 • instructor’s submission of passing grades for their final semester credits; • removal of all I grades from their transcript; • removal of all UP/SP grades from unapproved courses and/or the final semester in the approved courses were taken; • assignment of letter grades rather than UP/SP grades for courses in the final semester of the student’s program; • removal of previously awarded NG grades and blank grade awards; • confirmation of satisfactory repetition or waiver of required courses in which an F was originally received; • confirmation of completion of work and changes of I grades within the one-year limit; • confirmation that the student was registered for at least one credit in their graduate program in each academic year, including the year of expected graduation; • confirmation that the student completed degree requirements within the prescribed time- to-degree; • satisfactory completion of at least 30 graduate credits completed to the satisfaction of the student’s program; • completion of all program requirements for the degree; • 3.000 GPA has been earned while a matriculated graduate student in the program; • if a thesis is required, upload the electronic thesis (ETD) with chair approval by the deadline date, which is posted on the Graduation Deadlines website. Note: The requirements explained here are university requirements. Students must contact their program’s office for any additional program-level requirements or deadlines that must be completed prior to graduation. Please see the Doctoral Hooding and Master’s Recognition Ceremony section for details on the event. CONTINUING TO A DOCTORAL PROGRAM For a UC master’s student continuing to a doctoral program in the same program area, the student will fill out the application in the graduate admissions application system, and the graduate application fee is waived. 37 DOCTORAL DEGREE POLICIES AND PROCEDURES COURSE OF STUDY The course of study for the doctoral degree is arranged with each student by their advisor and reviewed by the program’s graduate committee or its equivalent. The program should provide a concentration and breadth of study for the student to develop competence in research, scholarship, teaching, and professional performance in general, with knowledge of their chosen specialty in relation to allied branches of learning. A written assessment of performance for each doctoral student is required at the end of their first year; an annual Academic Progress Report or some other form of formal evaluation of progress is required throughout each student’s program. CREDIT HOUR REQUIREMENTS The doctoral degree will be granted for no less than the equivalent of three years of full-time graduate study. Individual program requirements vary, but eligibility for graduation typically requires a minimum of 90 graduate credits beyond the bachelor’s degree. Doctoral students with a prior master’s degree may petition their program to allow up to 30 transfer credits from the master’s degree towards their doctoral degree. Degree credits must include at least 7 hours in dissertation research. Some program credit requirements may be higher. The last 30 credits must be completed under the direction of University of Cincinnati graduate faculty. The degree will not be granted solely on the basis of the accumulation of the required number of credits. A program will recommend students for degrees only after they have developed the necessary intellectual maturity and have fulfilled all other requirements of the program and the university. RESIDENCY AS FULL-TIME STUDENT Prior to admission to doctoral candidacy, all doctoral students shall complete a residency requirement by enrolling in 10 graduate credit hours (12 if funded by a Graduate Assistantship) per semester for two out of three consecutive semesters of study (including summer). Part-time students are not exempt from enrollment requirements to achieve residency. However, full-time UC employees using their tuition remission benefit to complete a part-time doctoral program may request a waiver of this requirement from the Associate Dean of the Graduate College. CANDIDACY, QUALIFYING EXAM The Graduate College does not currently track time to candidacy, but encourages programs to implement candidacy exams early in their programs to allow the students optimal feedback on their aspirations and research. Doctoral students are required to complete a program certification process according to the program’s established standards. The student must have at least a 3.000 grade point average in doctoral coursework and fulfill all other pre-candidacy requirements specified by the doctoral program in which the student is enrolled. Upon completion of these requirements, the student will receive a formal letter from the Graduate College informing the student of admission to candidacy. 38 UNIVERSITY GRADUATE FACULTY ROLE In accordance with the university’s Board of Trustees’ rule (50-77-11) (B) (2), only university graduate faculty are permitted to chair thesis or dissertation committees. The Graduate College appropriately identifies members of the university graduate faculty. Faculty members are nominated for graduate-faculty status by the program most closely aligned with the academic unit holding their primary academic appointment, and with the approval of their college dean or associate dean in charge of graduate education (from whom the nomination should arrive to the Graduate College). Faculty members holding any type of faculty appointment may be eligible for college-initiated nomination to the graduate faculty, the decision to be made based on an evaluation of the individual curriculum vitae and research and creative profile of the nominee. Criteria for nomination are formulated by individual programs and used by the Graduate College in adjudication. DISSERTATION Each PhD and EdD student must produce and defend a dissertation showing high scholarly achievement based on their original research. The student is required to submit an electronic document as evidence of this research. Students in all other doctoral programs should consult their academic programs regarding requirements and procedures for the capstone experience required in their programs. Dissertation Advisor and Committee When the student has been admitted into doctoral candidacy and has selected a dissertation subject and dissertation advisor, a dissertation committee should be appointed as soon as possible. The dissertation advisor must be qualified to serve as the chair of the dissertation committee, meaning this faculty member must be a member of the university graduate faculty and all members of the committee will be appointed by the Graduate College upon recommendation of the program director or director of graduate studies (in consultation with the committee chair and student). Students have the right to request a change in the committee but must do so in consultation with the graduate program director and their program must make the change in GradTracker. Preferably, the dissertation committee will include at least one person from outside the program, who might be faculty from the University of Cincinnati or another institution. A dissertation committee must be composed of a minimum of three UC faculty members. Members of the university graduate faculty are eligible to serve on all thesis and dissertation committees. In addition, all tenured and tenure-track faculty members may serve on all thesis and dissertation committees (even if they are not members of the university graduate faculty, meaning they may not serve in the chair role and cannot act as primary advisors). Other types of UC faculty members may serve on committees if the appointing unit demonstrates that their expertise is beneficial for the dissertation project. Programs should make such requests to the Graduate College in advance, to be ascertained on a case-by-case basis. Neither an emerit faculty member nor a faculty member from another institution may serve as the chair of the committee. Emerit faculty may remain on the committee if they were members when the proposal was accepted. A faculty member originally on a student’s committee who leaves UC to take an academic position elsewhere may also continue to serve on the student’s committee if both the faculty member and the student agree to continue the relationship. If a non-UC faculty member or appropriate professional practitioner has special expertise in a dissertation topic, 39 such a person may be added to the dissertation committee if they are nominated by the candidate and approved by both the chairperson of the dissertation committee, the director of graduate studies for the academic unit involved and the Graduate College. All such individuals serve as a full voting member of the dissertation committee without compensation from either the university or the candidate and would serve in addition to the minimum number of three qualified full-time UC faculty. A copy of the completed dissertation must be submitted to each committee member for critical evaluation, with sufficient time for review as determined by the dissertation committee. If it is considered satisfactory with respect to form and content by the committee, a final defense of the dissertation can be scheduled. Final Defense of Dissertation Students should check with their program office for the final deadline for their dissertation defense. The student’s final defense of the dissertation will be open to the public and all members of the academic community. Students are required to enter details of their dissertation defense, such as time, date, and location, online at the Graduate College website through the Graduation checklist steps. Begin at the Graduation webpage. One can also browse scheduled dissertation defenses by visiting the Upcoming Dissertation Defenses page. The candidate answers questions posed by members of the committee and other members of the audience following an oral presentation of their dissertation. At the conclusion of the defense, the committee will withdraw, make a decision with regard to the acceptability of the dissertation and its defense, and report its decision to the candidate. At least ¾ of the voting members of the dissertation committee (including at least one representative of each major area involved, in the case of interdisciplinary programs) must approve the dissertation. When the student’s dissertation committee chair has approved a defense, the student should assure that they have met all requirements for graduation including those in the graduation information obtained online. Use of a Moderator Although an outside moderator is not required, a moderator may be assigned by the Graduate College dean upon the request of the candidate, the chairperson of the dissertation committee, or the person empowered to approve the composition of a dissertation committee (the director of graduate studies for the academic unit involved). Moderators should be members of the university graduate faculty from outside the academic unit involved. The duties of the moderator are limited to observing the oral defense of the dissertation and reporting in writing to the Graduate College dean on the academic propriety of the proceedings. Submission of Dissertation After a dissertation has been approved, the candidate for the doctoral degree must submit their electronic dissertation by following the current instructions found at the Electronic Thesis and Dissertation Information webpage. Students in all other doctoral programs should consult their academic programs for the capstone experience required in their programs. Deadlines are posted at the Graduation Deadlines page. • All thesis/dissertations must be electronically submitted by the student and approved by the advisor. Students log in via the link available on the Graduation webpage. 40 • Advisors are sent an email when the student submits for their approval, and the advisor then logs in to review/approve. • Once approved by the chair, the student is notified by email. • A Graduate College approval email is sent to the student once reviewed. • The program is copied on all email correspondence during the Electronic Thesis/Dissertation (ETD) approval process. GRADUATION One semester prior to the semester in which a student anticipates graduating, the student should: 1. Confer with their program office staff. 2. Consult the Graduation page on the Graduate College’s website for deadlines, instructions on submitting their electronic dissertation, and doctoral hooding ceremony information. 3. Talk to advisor about whether an embargo is needed. Application to Graduate Students must: (1) complete academic requirements and (2) complete the official online Application to Graduate by the deadline for the semester in which they expect to graduate. Deadlines are firm and failure to meet them will delay students’ graduation until the following semester, when they must then submit a new application for their revised graduation date. All students applying to graduate will be assessed a non-refundable graduation application fee. The fee will be assessed each semester a student applies for graduation. Dual Degree Programs Graduation The online Application to Graduate will allow a student to apply for graduation from both degree programs in a dual degree program. Each of the two programs must follow the certification processes and procedures necessary to facilitate the student’s graduation from their own program. In dual degree programs, students must be registered for at least one graduate credit that contributes to degree requirements in one of the two programs (as determined by the program) during the academic year in which they graduate with dual degrees. Graduation Requirements for Doctoral Degrees Students must be registered for at least one graduate credit that contributes to degree requirements (as determined by the graduate program) during the academic year in which they graduate from that program. Doctoral students must also complete degree requirements within a nine-year period unless they have an approved extension (see Maintaining Graduate Student Status, Time to Degree). They should contact their program offices for any additional program requirements or deadlines to be completed prior to graduation. Certification for Graduation (Certify Online) Finalization and submission of a student’s Application to Graduate will activate the process by which the student will be certified for graduation, and the following requirements have been met. 41 The student should confer with their program office one-two weeks after the application period has ended to assure that any problems related to these requirements are resolved in a timely manner and avoid delay of graduation until a subsequent semester. Specifically, the student’s records will be reviewed to verify satisfaction of the following requirements: • finalization and submission of their online Application to Graduate by the deadline; • instructor’s submission of passing grades for final semester credits; • removal of all I grades from transcript; • Removal of previously earned NG grades and blank grade awards - removal of all UP/SP grades from unapproved courses and/or the final semester in which the courses were taken; • assignment of letter grades rather than UP/SP grades for courses in the final semester of the student’s program; • confirmation of satisfactory repetition or waiver of required courses in which an F was originally received; • confirmation of completion of work and changes of I grades within the one-year limit; • confirmation that the student was registered for at least one credit in the graduate program in each academic year, including the year of expected graduation; • confirmation that the student reached candidacy and has a valid dissertation committee; • degree requirements completed within prescribed time-to-degree; • satisfactory completion of sufficient graduate credits. In general, doctoral degrees require at least 7 research credits (many programs have higher requirements), within a total of at least 90 graduate credits for students who do not have a prior master’s degree, or require a total of at least 60 credits for students beyond the master’s degree. Please note that individual program credit requirements can vary widely. • completion of all program requirements for the degree; • 3.000 GPA has been earned while matriculated in the graduate program; • if a dissertation is required, upload the electronic dissertation (ETD), following the instructions on the Electronic Thesis and Dissertation Information page, for chair approval by the deadline. Note: The requirements explained here are university requirements. Students must contact their program office for any additional program-level requirements or deadlines that must be completed prior to graduation. GRADUATE CERTIFICATE VERIFICATION FOR UC TRANSCRIPT ENDORSEMENT In order for students to have their UC transcript endorsed with an earned certificate, students must apply for graduation and the program must approve the record through certify online just like the master's or doctoral students. DOCTORAL HOODING AND MASTER’S RECOGNITION CEREMONY Doctoral and master’s students who are graduating or who have graduated during the academic year will receive an invitation from the Dean of the Graduate College to participate in the university’s prestigious Doctoral Hooding and Master’s Recognition Ceremony held each semester. Please visit the commencement ceremony’s website for up-to-date details or 42 the Graduate College’s Graduation webpage. This is a joyous occasion in which students celebrate their accomplishment with family and friends as they are recognized by faculty and university leadership. Doctoral participants will be adorned with their hoods during the ceremony, by either their faculty mentor or the dean of their college. Graduates must confirm their intent to participate by reserving a seat online for the celebratory event and providing current home and email addresses for notification purposes. If you wish to be hooded by your faculty mentor, discuss the date with them to make sure they can attend. 43 INSTITUTIONAL RULES, POLICIES, AND PROCEDURES PROGRAM STANDARDS This Graduate Handbook clarifies minimum university-level requirements and policies that apply to all graduate students throughout the University of Cincinnati. Beyond these, each student is also expected to adhere to requirements, policies, and procedures specific to their own degree program and college. All graduate programs must publish in writing in accessible format the minimum academic standards for each graduate program offered, including the following: • minimum grade point average, including grades earned in required courses; • acceptable grade distribution, including grades earned in required courses; • nature and number of programmatic examinations, such as preliminary or qualifying, and the consequences of failing all or part of each examination; • specified research requirements; • a time-related definition of normal progress for all full- and part-time students; • standards and procedures for the mandatory annual review of academic performance; • standards and procedures for probation, suspension, and dismissal from the program. RECORDS PRIVACY, FERPA, AND THE RIGHT TO REVIEW The Family Educational Rights and Privacy Act of 1974 (FERPA), is the federal law that governs the release of and access to student education records. FERPA affords students certain rights with respect to their education records. For the complete FERPA information, consult the FERPA and Records Privacy page of the Registrar’s Office website. NOTICE OF NON-DISCRIMINATION The University of Cincinnati does not discriminate on the basis of disability, race, color, religion, national origin, ancestry, medical condition, genetic information, marital status, parental status (including status as a foster parent), sex, age, sexual orientation, veteran status, military status (past, present, or future), or gender identity and expression in its programs and activities. The university does not tolerate discrimination, harassment, or retaliation on these bases and takes steps to ensure that students, employees, and third parties are not subject to a hostile environment in university programs or activities. The university responds promptly and effectively to allegations of discrimination, harassment, and retaliation. It promptly conducts investigations and takes appropriate action, including disciplinary action, against individuals found to have violated its policies, as well as provides appropriate remedies to complainants and the campus community. The university takes immediate action to end a hostile environment if one has been created, prevent its recurrence, and remedy the effects of any hostile environment on affected members of the campus community. UC is committed to the ideal of universal Web accessibility and strives to provide an accessible Web presence that enables all university community members and visitors full access to 44 information provided on its websites. Every effort has been made to make these pages as accessible as possible in accordance with the applicable guidelines. The University of Cincinnati provides free aids and services to people with disabilities to communicate effectively with us, such as qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). The University of Cincinnati also provides free language services to people whose primary language is not English, such as qualified interpreters (call 513-556-5503) and information written in other languages. If you need these services, please tell any employee of a University of Cincinnati health program or activity. If you believe that the University of Cincinnati has failed to provide these services or discriminated in another way, you can file a grievance with the Office of Equal Opportunity and Access and/or Office of Gender Equity & Inclusion. You can file a grievance in person, by mail or by email. If you need help filing a grievance, the Office of Equal Opportunity & Access and Office of Gender Equity & Inclusion staff are available to help you. ACADEMIC DISHONESTY Academic dishonesty in any form is a serious offense that cannot be tolerated in an academic community. Dishonesty—including cheating, plagiarism, deception of effort, and/or unauthorized assistance—may result in a failing grade in a course and/or suspension or dismissal from the university. Allegations of academic dishonesty will be processed pursuant to the university’s Student Code of Conduct. After graduation, alumni remain responsible for the academic integrity of the work they performed while a student at the University of Cincinnati. If evidence of academic dishonesty or research misconduct is revealed after the graduation of a student, the Office of Research, the Graduate College, and the university can examine whether such concerns impact the academic integrity of the degree that was conferred on the student, with consequences including but not limited to degree revocation. STUDENT CODE OF CONDUCT The Student Code of Conduct defines behavior expected of all University of Cincinnati students. It is each student’s responsibility to know and comply with the university’s Student Code of Conduct, and sanctions or penalties are outlined. Academic behavior considered to be misconduct is defined in the Student Code of Conduct. The code also addresses nonacademic misconduct (such as disturbing the peace, destruction of property, and theft). Disciplinary procedures are explained in a step-by-step manner, and the procedures for appeal of decisions are stated. In addition to this code, students must adhere to their college’s professional code of conduct and honor codes where applicable. Students should contact the office of the dean for their college to inquire about any applicable conduct and honor codes to ensure compliance. Students can be suspended or dismissed from the university for unprofessional behavior. 45 RESPONSIBLE CONDUCT OF RESEARCH Furthering of research is a major institutional goal of the University of Cincinnati. Research includes not only intellectual activity and exploration designed to expand knowledge and understanding, but also activities in the creative and performing arts designed to interpret and create. Such activities require responsibilities for the ethical and safe conduct of research. Individuals charged with supervision of research, as well as all individuals directly engaged in it, and collaborators of investigators outside their own units are responsible for the quality of the data generated in their own laboratories as well as the laboratories of their collaborators. Everyone shares responsibility for the physical safety and intellectual property of individuals in the responsible conduct of creative scholarship and research. RESTRICTED RESEARCH The right to open exchange of information and opinion in faculty relations with students carries the obligation to avoid comments or violations of confidentiality that would reduce free expression or inquiry by students. Student involvement in industrial proprietary projects should be permitted only when these projects in no way restrict the student’s ability to fulfill their degree requirements, which includes the obligation to publish dissertation results. Faculty members have the right to publish their research findings and the right to protection against retaliation because of displeasure over their conclusions by the public, administration, government, or others. They have the concomitant responsibility to refrain from conducting secret, non-publishable research as part of their university duties. GRADUATE STUDENT GRIEVANCE PROCEDURES The University of Cincinnati provides an opportunity for the resolution of disputes involving graduate students in a fair and collegial manner. The Graduate Student Grievance Procedures establish a formal academic process for graduate students to request review and redress of certain complaints arising out of their academic relationships with their programs, their colleges, or the university. The grievance begins with a mediation process and may proceed, if necessary, through the more formal review and decision or appeal processes. In general, however, it is expected that grievances will be resolved by the parties within their programs. Students are encouraged to seek assistance from the university Ombuds Office for possible resolution before initiating the formal grievance process. Students, faculty and staff should note that Grievance Procedures are not legal protocols. They are, however, effective means by which to resolve conflicts. The Graduate College endorses these procedures and expects all programs and students involved to follow them according to the established guidelines. No outside parties, such as lawyers, ministers, and family members, are allowed to participate in or impose upon the procedures. The Graduate Student Grievance Procedures cannot supplant final sanctions stemming from the University of Cincinnati Student Code of Conduct process. There is a time limit to filing a grievance: it must be filed within 60-90 business days of the alleged improper mistreatment. The procedures are applicable to the following types of grievances: • grievances alleging improper dismissal or suspension from a graduate program, not as a result of the Student Code of Conduct process; • grievances alleging the improper withholding or termination of financial support of any kind; 46 • grievances alleging any other improper treatment, either substantive or procedural, of a graduate student by a university employee or university affiliate except: o allegations of improper evaluation of the quality and/or quantity of academic work, which a student cannot grieve; o allegations of unfair recommendation for employment or further graduate study, which a student cannot grieve; o allegations of discrimination or harassment that are subject to review by the Office of Equal Opportunity and Access or the Office of Gender, Equity and Inclusion. Published November 28, 2023. This version is an update to the 2022-23 AY handbook to reflect changes to the Graduate Scholarship structure and terminology. This version supersedes all previous versions. 47 ",Unknown,Find & Summarize,Text Transformation "Answer solely based on the provided text, do not give any additional information or analysis beyond that which is provided in the text. Give your answer in the form of two lists of bullet points. ",What are the arguments for and against the Bill?,"The new British Ambassador to the United States, prior to his departure for Washington, perhaps with the idea of propitiating Irish opinion in America, elected to speak on St. Patrick's Day. He wore a green Irish halo for the occasion. He said it had been a labor of love for him during last summer and autumn to assist in reducing to legislative form proposals for ending the Irish question. He said the new Bill for the government of Ireland was ""a sincere attempt to place definitely and finally in the hands of the elected representatives of the Irish people the duty and responsibility of working out their own salvation and the salvation of their country."" No doubt this statement has been cabled to America, and I propose to examine here how far this statement is justified and how Ireland is indebted to Sir Auckland Geddes for his interest in its welfare. I lay this down as a fundamental proposition, which I do not think will be denied, that whoever controls the taxation and trade policy of a country controls its destiny and the entire character of its civilization. The body with control over customs, excise, income tax, supertax, excess profits duty and external trade has it in its power to make that country predominantly industrial or agricultural or to make a balance between urban and rural interests. It can direct the external trade of the country, make it flow into this or that channel. These powers over Irish taxation and trade policy are expressly denied to Ireland. Ireland in fact has less power under this last Bill over its own economic development than it had under the Act of Union. Under that Act, Ireland had one hundred and two members in the Imperial Parliament who could at times hold the balance of power. It was not a very real power, because when the interests of Ireland and Great Britain conflicted, both parties in Great Britain united against Ireland, but still to the leaders of parties Irish votes were worth angling for, for British purposes, and had to be paid for by Land Acts or other measures. The new Bill provides that the Irish representation at Westminster shall be reduced to forty-two members, and so at Westminster Ireland is made practically powerless, while everything which really affects Irish economic interests is still legislated for by the British Parliament.","What are the arguments for and against the Bill? Answer solely based on the provided text, do not give any additional information or analysis beyond that which is provided in the text. Give your answer in the form of two lists of bullet points. ""The new British Ambassador to the United States, prior to his departure for Washington, perhaps with the idea of propitiating Irish opinion in America, elected to speak on St. Patrick's Day. He wore a green Irish halo for the occasion. He said it had been a labor of love for him during last summer and autumn to assist in reducing to legislative form proposals for ending the Irish question. He said the new Bill for the government of Ireland was ""a sincere attempt to place definitely and finally in the hands of the elected representatives of the Irish people the duty and responsibility of working out their own salvation and the salvation of their country."" No doubt this statement has been cabled to America, and I propose to examine here how far this statement is justified and how Ireland is indebted to Sir Auckland Geddes for his interest in its welfare. I lay this down as a fundamental proposition, which I do not think will be denied, that whoever controls the taxation and trade policy of a country controls its destiny and the entire character of its civilization. The body with control over customs, excise, income tax, supertax, excess profits duty and external trade has it in its power to make that country predominantly industrial or agricultural or to make a balance between urban and rural interests. It can direct the external trade of the country, make it flow into this or that channel. These powers over Irish taxation and trade policy are expressly denied to Ireland. Ireland in fact has less power under this last Bill over its own economic development than it had under the Act of Union. Under that Act, Ireland had one hundred and two members in the Imperial Parliament who could at times hold the balance of power. It was not a very real power, because when the interests of Ireland and Great Britain conflicted, both parties in Great Britain united against Ireland, but still to the leaders of parties Irish votes were worth angling for, for British purposes, and had to be paid for by Land Acts or other measures. The new Bill provides that the Irish representation at Westminster shall be reduced to forty-two members, and so at Westminster Ireland is made practically powerless, while everything which really affects Irish economic interests is still legislated for by the British Parliament."" ",Legal,Pros & Cons,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",Can you summarize in 6-8 sentences how this paper suggests how to properly price AI stocks and what is so different about it compared to current strategies? Do not use the word AI or any other phrase that refers to Artificial Intelligence.,"Artificial Intelligence (AI) is having a powerful impact in the domain of finance. Estimates of the 10-year revenue figure vary but could be as high as $3 trillion. Over a similar period, the market value of AI firms is expected to grow at a 37% rate. Although the opportunities seem boundless, valuations conducted in the financial markets are increasingly complex to carry out for AI/tech stocks. Artificial Intelligence in Finance: Valuations and Opportunities Yosef Bonaparte Finance Research Letters A version of this paper can be found here Want to read our summaries of academic finance papers? Check out our Academic Research Insight category. What are the research questions? While there is literature that describes the “domain” of artificial intelligence, there are very few, if any, that analyze the valuation and pricing of AI stocks. The authors attempt to fill the void with a two-part methodology. What are Academic Insights? The methodology combines behavioral and fundamental components. The fundamental model incorporates new AI innovation into the P/E ratio and R&D as a percentage of revenue. FUNDAMENTAL: The key is to estimate future revenue as a function of the exposure of the stock to AI technology. The author uses Nvidia as an example of an overpriced (yes, overpriced!) stock in June 2023 via fundamentals as follows: The results are hypothetical results and are NOT an indicator of future results and do NOT represent returns that any investor actually attained. Indexes are unmanaged and do not reflect management or trading fees, and one cannot invest directly in an index. 2. BEHAVIORAL: The behavioral component is based on a technology sentiment index, using the Google trend of key technological terms. The key issue is to determine how the stock relates to AI technology. In the Nvidia case, the correlation between the Google Trend Index and Nvidia’s price acts as an estimate of how embedded the stock is to AI tech. Terms include: artificial intelligence, neural network, large language model, machine learning, generative AI, and deep learning. See Tables 1 and 2 below for estimates of the correlation for Nvidia over 2 separate time -periods. The estimate of AI sensitivity is found in Table 3. For Nvidia, the sum of artificial intelligence searches is 17.5% (from Table 1: 683 divided by total searches at 3904) and 35.2% when weighted across search terms. Nvidia has substantial exposure to AI terms, however, the exposure is less than the exposure of MSFT and GOOG. The same methodology can be used on other stocks to determine sensitivity to the AI opportunity. Why does it matter? The authors identified three key areas of knowledge an investor or analyst should acquire to understand how AI is transforming the financial landscape. First, develop a thorough understanding of the AI concept in terms of innovation and relevance to finance. Second, develop the methodologies for assessing AI companies and tech investment funds. Third, focus on the industry leaders in AI to provide context and provoke an examination of the future of AI. How will it influence the capital markets, how and what will drive growth in sales, and ultimately, how will valuations be influenced? The most important chart from the paper The results are hypothetical results and are NOT an indicator of future results and do NOT represent returns that any investor actually attained. Indexes are unmanaged and do not reflect management or trading fees, and one cannot invest directly in an index.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Can you summarize in 6-8 sentences how this paper suggests how to properly price AI stocks and what is so different about it compared to current strategies? Do not use the word AI or any other phrase that refers to Artificial Intelligence. {passage 0} ========== Artificial Intelligence (AI) is having a powerful impact in the domain of finance. Estimates of the 10-year revenue figure vary but could be as high as $3 trillion. Over a similar period, the market value of AI firms is expected to grow at a 37% rate. Although the opportunities seem boundless, valuations conducted in the financial markets are increasingly complex to carry out for AI/tech stocks. Artificial Intelligence in Finance: Valuations and Opportunities Yosef Bonaparte Finance Research Letters A version of this paper can be found here Want to read our summaries of academic finance papers? Check out our Academic Research Insight category. What are the research questions? While there is literature that describes the “domain” of artificial intelligence, there are very few, if any, that analyze the valuation and pricing of AI stocks. The authors attempt to fill the void with a two-part methodology. What are Academic Insights? The methodology combines behavioral and fundamental components. The fundamental model incorporates new AI innovation into the P/E ratio and R&D as a percentage of revenue. FUNDAMENTAL: The key is to estimate future revenue as a function of the exposure of the stock to AI technology. The author uses Nvidia as an example of an overpriced (yes, overpriced!) stock in June 2023 via fundamentals as follows: The results are hypothetical results and are NOT an indicator of future results and do NOT represent returns that any investor actually attained. Indexes are unmanaged and do not reflect management or trading fees, and one cannot invest directly in an index. 2. BEHAVIORAL: The behavioral component is based on a technology sentiment index, using the Google trend of key technological terms. The key issue is to determine how the stock relates to AI technology. In the Nvidia case, the correlation between the Google Trend Index and Nvidia’s price acts as an estimate of how embedded the stock is to AI tech. Terms include: artificial intelligence, neural network, large language model, machine learning, generative AI, and deep learning. See Tables 1 and 2 below for estimates of the correlation for Nvidia over 2 separate time -periods. The estimate of AI sensitivity is found in Table 3. For Nvidia, the sum of artificial intelligence searches is 17.5% (from Table 1: 683 divided by total searches at 3904) and 35.2% when weighted across search terms. Nvidia has substantial exposure to AI terms, however, the exposure is less than the exposure of MSFT and GOOG. The same methodology can be used on other stocks to determine sensitivity to the AI opportunity. Why does it matter? The authors identified three key areas of knowledge an investor or analyst should acquire to understand how AI is transforming the financial landscape. First, develop a thorough understanding of the AI concept in terms of innovation and relevance to finance. Second, develop the methodologies for assessing AI companies and tech investment funds. Third, focus on the industry leaders in AI to provide context and provoke an examination of the future of AI. How will it influence the capital markets, how and what will drive growth in sales, and ultimately, how will valuations be influenced? The most important chart from the paper The results are hypothetical results and are NOT an indicator of future results and do NOT represent returns that any investor actually attained. Indexes are unmanaged and do not reflect management or trading fees, and one cannot invest directly in an index. https://alphaarchitect.com/2024/04/valuing-artificial-intelligence-ai-stocks/",Financial,Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",What are the most common ways to save money for the Halloween season? Make the response less than 500 words but more than 300 words.,"Americans love Halloween. What other night can you dress like a hot dog and eat all your favorite sweets? But the problem is, we may love it a little too much. This year, Americans plan to spend around $10.6 billion—that’s billion with a B—on Halloween.1 That’s about $100 per person! If you’re tight on cash, spending that much might sound scary. But the good news is: You don’t have to spend a zombie arm and a leg to have a good time. Try these seven tricks to stick to your Halloween budget. 1. Costumes One of my favorite parts of Halloween is the costumes, hands down—from seeing adorable babies dressed as koalas to entire families decked out as the Addams Family. But when you start buying costumes for your own family, you realize just how pricey they can get! So, instead of buying a $40 Ninja Turtles costume for each of your four boys or sewing some DIY versions from scratch, turn hunting for costumes into a family game. Here’s how it works: Head to the consignment shop or thrift store with your family and give each of your kids an envelope with $5 or $10 inside. Split up into teams to pick out a costume or find materials to make a custom creation. When time’s up and purchases are made, head home and have the kids dig into their closets for the rest of their costumes. There’s nothing like a happy homemade Halloween! Don’t forget, just like kids grow out of clothes, they also grow out of Halloween costumes. Check with your friends and neighbors to see if they’ll let you borrow a costume this year. You don’t need to drop big money for a brand-new Hulk outfit when little Timmy down the street has one your kid can borrow for the night. 2. Decorations Halloween is a really big deal for some people—and a single pumpkin on the front porch just won’t cut it (especially if you’re easily inspired by fall décor on Instagram and Pinterest). But if you’re not careful, buying Halloween décor year after year can really take a bite out of your budget. Pro tip: If you need to stretch a dollar, hit up your local dollar store for decorations. And if you love going all out for Halloween, start saving and reusing your decorations. Since Halloween is almost as big of a deal as Christmas at your house, prep for it the same way. Instead of throwing away decorations at the end of the season, save some to reuse each year. Store your ghouls and goblins in a reusable tub once the season is over, and pull them out next year. 3. Candy It’s no secret that candy is pricey stuff. But living in a neighborhood that gets carloads of kids every year doesn’t mean you have to buy barrels of candy. If you know you’ll be visited by 50 to 100 princesses and superheroes, skip the fancy chocolate bars and grab a bulk bag of assorted candy instead. Be on the lookout for coupons and any two-for-one deals, but don’t feel like you need to get the brand-name stuff either. Just buy what you can afford, even if that means store brand. Trick-or-treaters get a lot of sugar, so don’t think you’re holding out on them if you buy generic. And when the candy’s gone, it’s gone. Early birds get the gummy worms, and when you’ve run out, you can turn the lights off and relax. And one more tip when it comes to candy—keep track of how many trick-or-treaters visit your house so you can plan for next year. There’s no need to overbuy and get stuck eating all the leftovers (unless that’s what you were hoping for). 4. Pumpkins For something that turns into a pile of moldy mush a few weeks after you buy it, pumpkins sure cost a pretty penny. And they’re kind of like potato chips: You can’t have just one. It can be super tempting to stage 20 pumpkins across our porches, decks and tables. Money Start budgeting with EveryDollar today! Don’t get me wrong—pumpkins are fun. But it’s way too easy to overspend on them. So give yourself a pumpkin budget. Seriously. Let the kids each pick one or cap yourself at $15. That way, you can keep the spending in check. And when you’re ready to buy pumpkins, going to the pumpkin patch is a blast, but not the best place to buy them if you’re on a budget. Instead, buy pumpkins from the grocery store, and look for two-for-one deals that pop up. Because when it all boils down to it, a pumpkin is a pumpkin. 5. Greeting Cards Do people really send out Halloween greeting cards? When was the last time you got a “Have a Batty Halloween” card in your mailbox? Well, nearly 45% of those surveyed by the National Retail Federation in 2021 said they planned to buy Halloween greeting cards, so somebody’s doing it.2 But you can make a spooky greeting card without dropping $6 on a glitter-bomb skeleton card for your favorite niece. Use some cardstock and get creative by drawing all kinds of creepy characters. Don’t forget to tape on a little something sweet too! However, if your heart is set on a store-bought card, look for the two-for-a-dollar kind. And remember, you don’t have to send a card. 6. Fall Activities There are plenty of harvest and Halloween festivals this time of year—and they’re usually free! Plus, there are plenty of other budget-friendly activities for the family. Spend the day walking around a farm or enjoying a hayride. Take a drive out of town to look at the leaves changing colors. Go apple picking or enjoy a fall festival. Take advantage of what’s already going on in your church or community, and budget a little extra for any special food or rides. Festive fall food can really add up if you’re not careful, so save some cash by packing a picnic and a comfy quilt. 7. Family Traditions Pick out a weekend or two for some quality time together with friends or your family this fall. If you’re tired of carving pumpkins or dressing up, why not start some new budget-friendly traditions? How about a fall-themed cooking or baking day? Try caramel apples, pumpkin pie and jack-o’-lantern pizzas (use pepperoni and veggies to make the face). Or have everyone vote for their favorite fall movies, then hunker down on the couch to get cozy and eat all those tasty treats you cooked up while you watch. If you’d rather be outside enjoying the leaves, head over to the park for a scavenger hunt and enjoy the scenery while you search. It’s 100% possible to have a memorable Halloween on a bite-size budget! Trust me, you’ll have more fun knowing you’re not wrecking your money goals to celebrate. Don’t let Halloween haunt your budget—so make sure you know exactly where each dollar is going this season with EveryDollar, our free budget tool.","""================ ======= Americans love Halloween. What other night can you dress like a hot dog and eat all your favorite sweets? But the problem is, we may love it a little too much. This year, Americans plan to spend around $10.6 billion—that’s billion with a B—on Halloween.1 That’s about $100 per person! If you’re tight on cash, spending that much might sound scary. But the good news is: You don’t have to spend a zombie arm and a leg to have a good time. Try these seven tricks to stick to your Halloween budget. 1. Costumes One of my favorite parts of Halloween is the costumes, hands down—from seeing adorable babies dressed as koalas to entire families decked out as the Addams Family. But when you start buying costumes for your own family, you realize just how pricey they can get! So, instead of buying a $40 Ninja Turtles costume for each of your four boys or sewing some DIY versions from scratch, turn hunting for costumes into a family game. Here’s how it works: Head to the consignment shop or thrift store with your family and give each of your kids an envelope with $5 or $10 inside. Split up into teams to pick out a costume or find materials to make a custom creation. When time’s up and purchases are made, head home and have the kids dig into their closets for the rest of their costumes. There’s nothing like a happy homemade Halloween! Don’t forget, just like kids grow out of clothes, they also grow out of Halloween costumes. Check with your friends and neighbors to see if they’ll let you borrow a costume this year. You don’t need to drop big money for a brand-new Hulk outfit when little Timmy down the street has one your kid can borrow for the night. 2. Decorations Halloween is a really big deal for some people—and a single pumpkin on the front porch just won’t cut it (especially if you’re easily inspired by fall décor on Instagram and Pinterest). But if you’re not careful, buying Halloween décor year after year can really take a bite out of your budget. Pro tip: If you need to stretch a dollar, hit up your local dollar store for decorations. And if you love going all out for Halloween, start saving and reusing your decorations. Since Halloween is almost as big of a deal as Christmas at your house, prep for it the same way. Instead of throwing away decorations at the end of the season, save some to reuse each year. Store your ghouls and goblins in a reusable tub once the season is over, and pull them out next year. 3. Candy It’s no secret that candy is pricey stuff. But living in a neighborhood that gets carloads of kids every year doesn’t mean you have to buy barrels of candy. If you know you’ll be visited by 50 to 100 princesses and superheroes, skip the fancy chocolate bars and grab a bulk bag of assorted candy instead. Be on the lookout for coupons and any two-for-one deals, but don’t feel like you need to get the brand-name stuff either. Just buy what you can afford, even if that means store brand. Trick-or-treaters get a lot of sugar, so don’t think you’re holding out on them if you buy generic. And when the candy’s gone, it’s gone. Early birds get the gummy worms, and when you’ve run out, you can turn the lights off and relax. And one more tip when it comes to candy—keep track of how many trick-or-treaters visit your house so you can plan for next year. There’s no need to overbuy and get stuck eating all the leftovers (unless that’s what you were hoping for). 4. Pumpkins For something that turns into a pile of moldy mush a few weeks after you buy it, pumpkins sure cost a pretty penny. And they’re kind of like potato chips: You can’t have just one. It can be super tempting to stage 20 pumpkins across our porches, decks and tables. Money Start budgeting with EveryDollar today! Don’t get me wrong—pumpkins are fun. But it’s way too easy to overspend on them. So give yourself a pumpkin budget. Seriously. Let the kids each pick one or cap yourself at $15. That way, you can keep the spending in check. And when you’re ready to buy pumpkins, going to the pumpkin patch is a blast, but not the best place to buy them if you’re on a budget. Instead, buy pumpkins from the grocery store, and look for two-for-one deals that pop up. Because when it all boils down to it, a pumpkin is a pumpkin. 5. Greeting Cards Do people really send out Halloween greeting cards? When was the last time you got a “Have a Batty Halloween” card in your mailbox? Well, nearly 45% of those surveyed by the National Retail Federation in 2021 said they planned to buy Halloween greeting cards, so somebody’s doing it.2 But you can make a spooky greeting card without dropping $6 on a glitter-bomb skeleton card for your favorite niece. Use some cardstock and get creative by drawing all kinds of creepy characters. Don’t forget to tape on a little something sweet too! However, if your heart is set on a store-bought card, look for the two-for-a-dollar kind. And remember, you don’t have to send a card. 6. Fall Activities There are plenty of harvest and Halloween festivals this time of year—and they’re usually free! Plus, there are plenty of other budget-friendly activities for the family. Spend the day walking around a farm or enjoying a hayride. Take a drive out of town to look at the leaves changing colors. Go apple picking or enjoy a fall festival. Take advantage of what’s already going on in your church or community, and budget a little extra for any special food or rides. Festive fall food can really add up if you’re not careful, so save some cash by packing a picnic and a comfy quilt. 7. Family Traditions Pick out a weekend or two for some quality time together with friends or your family this fall. If you’re tired of carving pumpkins or dressing up, why not start some new budget-friendly traditions? How about a fall-themed cooking or baking day? Try caramel apples, pumpkin pie and jack-o’-lantern pizzas (use pepperoni and veggies to make the face). Or have everyone vote for their favorite fall movies, then hunker down on the couch to get cozy and eat all those tasty treats you cooked up while you watch. If you’d rather be outside enjoying the leaves, head over to the park for a scavenger hunt and enjoy the scenery while you search. It’s 100% possible to have a memorable Halloween on a bite-size budget! Trust me, you’ll have more fun knowing you’re not wrecking your money goals to celebrate. Don’t let Halloween haunt your budget—so make sure you know exactly where each dollar is going this season with EveryDollar, our free budget tool. https://www.ramseysolutions.com/budgeting/5-money-saving-tricks-for-happier-halloween?srsltid=AfmBOoozsyg8q63H1t5yGvb12_1N6lX5_tAKP336LoR7LBOcS-2WYyjc ================ ======= What are the most common ways to save money for the Halloween season? Make the response less than 500 words but more than 300 words. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Financial,Summarize & Format,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",What are the reasons for why I would choose a cash secured put over a covered call? Compare their advantages and disadvantages assuming I don't have a capital requirement.,"What Is a Cash Secured Put? A cash-secured put involves writing a put option on a particular stock and securing the position with enough cash reserves to cover the purchase of shares should the option be exercised. The amount of cash required is equal to 100 shares of the stock at the option’s strike price. If the stock’s price remains above the strike price, the option expires worthless, and the investor keeps the premium. If the stock price drops below the strike price, the investor buys the stock at the lower price. What Is a Covered Call? A covered call is a strategy where an investor owns the underlying stock and sells a call option on it. This involves buying 100 shares of a stock and selling a call option with a strike price at or above the purchase price. If the stock’s price remains flat or declines, the investor keeps the premium, and the option expires worthless. If the stock’s price rises above the strike price, the investor sells the shares at the strike price, securing the option premium plus any capital gains up to the strike price. Cash Secured Put vs Covered Call – The Differences You Should Know Primary Motives: An investor using a cash-secured put has a neutral outlook but is prepared to buy shares at a lower price. A covered call suits an investor who already owns the stock and seeks to earn extra income from the option premium. Market Outlook: Choosing a cash secured put vs covered call requires to consider your outlook on the market (or, at least, on a company). Both trades have definitely a bullish orientation. Possible Profits: Cash-secured put sellers profit only from the option premium. Covered call sellers can profit from both the option premiums and any stock dividends or appreciation if the stock price rises above the strike price. Dividends: When debating cash secured put vs covered call, dividends are an aspect you cannot ignore. Covered calls allow investors to collect dividends since they own the underlying stock. Cash-secured puts do not offer this benefit as the stock is not owned unless the option is exercised. Time Horizon: Usually, a covered call is better for longer term positions, while the cash secured put will work best for shorter term operations, especially considering what we said above about dividends. If you understand these dynamics, you can effectively use cash secured puts to enhance your portfolio, balancing risk and reward based on your market outlook and investment goals. We gave you a rather practical approach to open an options trade, just make sure you do your homework before by carefully researching the company. You can also use our “High probability naked puts (85% prob of worthless, good companies, good risk-return profile)” predefined scan (you’ll find a link to it at the end of the article) to speed up the process, but this does not mean you should skip doing your own analysis. Cash Secured Put vs Covered Call – Picking the Right Strategy in the Right Moment Having seen the two examples above, it is now easier to draw some conclusions on when to use a cash secured put vs covered call strategy. Market Conditions Choosing between covered calls vs cash secured puts often depends on the market conditions. Both strategies benefit from bullish conditions, but a cash-secured put will leave the door open for a potential share assignment at a lower price if the stock price moves below the strike price, while a covered call requires you to buy the shares at once and sell a call right away. By owning the underlying stock, you can capitalize on both the premium from selling the call option and any appreciation in the stock price. In low-volatility markets, both strategies (cash secured put vs covered call) can provide a steady income stream, but understanding the market’s direction can help you select the optimal strategy. Investor Goals Investor goals and risk tolerance are crucial in the decision-making process. If your goal is to invest for the longer term, maybe a covered call will be the wisest choice (think, for instance, about the fact that you can receive a dividend). However, if you’re thinking about a shorter term position, the cash secured put works best. When looking at choosing between covered calls vs cash secured puts, consider that, if you own shares and seek to generate extra income with a bullish outlook, covered calls are a suitable choice. This approach lets you benefit from premiums and potential stock gains. Understanding your investment goals, whether it is acquiring new stocks or maximizing returns on existing holdings, will guide you in choosing between covered calls and cash secured puts.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What are the reasons for why I would choose a cash secured put over a covered call? Compare their advantages and disadvantages assuming I don't have a capital requirement. {passage 0} ========== What Is a Cash Secured Put? A cash-secured put involves writing a put option on a particular stock and securing the position with enough cash reserves to cover the purchase of shares should the option be exercised. The amount of cash required is equal to 100 shares of the stock at the option’s strike price. If the stock’s price remains above the strike price, the option expires worthless, and the investor keeps the premium. If the stock price drops below the strike price, the investor buys the stock at the lower price. What Is a Covered Call? A covered call is a strategy where an investor owns the underlying stock and sells a call option on it. This involves buying 100 shares of a stock and selling a call option with a strike price at or above the purchase price. If the stock’s price remains flat or declines, the investor keeps the premium, and the option expires worthless. If the stock’s price rises above the strike price, the investor sells the shares at the strike price, securing the option premium plus any capital gains up to the strike price. Cash Secured Put vs Covered Call – The Differences You Should Know Primary Motives: An investor using a cash-secured put has a neutral outlook but is prepared to buy shares at a lower price. A covered call suits an investor who already owns the stock and seeks to earn extra income from the option premium. Market Outlook: Choosing a cash secured put vs covered call requires to consider your outlook on the market (or, at least, on a company). Both trades have definitely a bullish orientation. Possible Profits: Cash-secured put sellers profit only from the option premium. Covered call sellers can profit from both the option premiums and any stock dividends or appreciation if the stock price rises above the strike price. Dividends: When debating cash secured put vs covered call, dividends are an aspect you cannot ignore. Covered calls allow investors to collect dividends since they own the underlying stock. Cash-secured puts do not offer this benefit as the stock is not owned unless the option is exercised. Time Horizon: Usually, a covered call is better for longer term positions, while the cash secured put will work best for shorter term operations, especially considering what we said above about dividends. If you understand these dynamics, you can effectively use cash secured puts to enhance your portfolio, balancing risk and reward based on your market outlook and investment goals. We gave you a rather practical approach to open an options trade, just make sure you do your homework before by carefully researching the company. You can also use our “High probability naked puts (85% prob of worthless, good companies, good risk-return profile)” predefined scan (you’ll find a link to it at the end of the article) to speed up the process, but this does not mean you should skip doing your own analysis. Cash Secured Put vs Covered Call – Picking the Right Strategy in the Right Moment Having seen the two examples above, it is now easier to draw some conclusions on when to use a cash secured put vs covered call strategy. Market Conditions Choosing between covered calls vs cash secured puts often depends on the market conditions. Both strategies benefit from bullish conditions, but a cash-secured put will leave the door open for a potential share assignment at a lower price if the stock price moves below the strike price, while a covered call requires you to buy the shares at once and sell a call right away. By owning the underlying stock, you can capitalize on both the premium from selling the call option and any appreciation in the stock price. In low-volatility markets, both strategies (cash secured put vs covered call) can provide a steady income stream, but understanding the market’s direction can help you select the optimal strategy. Investor Goals Investor goals and risk tolerance are crucial in the decision-making process. If your goal is to invest for the longer term, maybe a covered call will be the wisest choice (think, for instance, about the fact that you can receive a dividend). However, if you’re thinking about a shorter term position, the cash secured put works best. When looking at choosing between covered calls vs cash secured puts, consider that, if you own shares and seek to generate extra income with a bullish outlook, covered calls are a suitable choice. This approach lets you benefit from premiums and potential stock gains. Understanding your investment goals, whether it is acquiring new stocks or maximizing returns on existing holdings, will guide you in choosing between covered calls and cash secured puts. https://blog.optionsamurai.com/cash-secured-put-vs-covered-call/#:~:text=Both%20strategies%20benefit%20from%20bullish,sell%20a%20call%20right%20away.",Financial,Pros & Cons,Q&A Only respond using information from the context. ,What factors are negatively affecting the housing market?,"U.S. Economic, Housing and Mortgage Market Outlook Recent developments U.S. economy: U.S. economic growth moderated to start the year. According to the U.S. Bureau of Economic Analysis (BEA) “advance” estimate of Real Gross Domestic Product (GDP), the seasonally adjusted annual rate (SAAR) of growth in GDP in Q1 2024 was 1.6%, slowing from a 3.4% rate in Q4 2023. The deceleration in GDP growth was led by slower growth in consumption expenditures, net exports, and government consumption expenditures. Consumer spending was weaker due to a decline in spending on durable goods, primarily autos, and flatlining nondurable goods, primarily due to less spending on gasoline. Spending on services accelerated in the first quarter, led by higher spending on health care, financial services and insurance. Trade weighed on GDP growth with more modest exports and an increase in imports. Compared to most advanced economies, the U.S. economy continues to perform relatively well. The positive tailwinds to overall growth from government spending are waning. The contribution to GDP growth from government consumption expenditures and gross investment remains positive but was less than a third of what it was in Q4 2023. The latest report paints a picture of an economy that continues to perform well, but that is moderating as it settles into a growth pattern more consistent with long-run trends. Consistent with economic growth trends, the labor market moderated in April 2024 with nonfarm payroll employment increasing by 175,000, down from an increase of 315,000 in March, according to the Bureau of Labor Statistics (BLS). The unemployment rate inched up from 3.8% in March to 3.9% in April. However, the unemployment rate has remained below 4% for the twenty-seventh consecutive month. Average hourly earnings for all employees on private nonfarm payrolls rose 0.2% month-over-month, and compared to a year ago, average hourly earnings increased 3.9%. Overall, the jobs report indicates a resilient but cooling labor market. The core Personal Consumption Expenditures (PCE) price index, the Federal Reserve’s preferred inflation gauge that strips out volatile food and energy prices, rose 0.3% month-over-month in March.1 While this increase in the core PCE was in line with expectations, the progress on inflation has slowed and has implications for future Federal Reserve monetary policy. The index increased 2.8% from a year ago and remains above the Federal Reserve target of 2.0%. The Consumer Price Index (CPI) increased by 0.4% in April, exceeding consensus expectations and triggering a negative market reaction. In another sign of persistent inflationary pressures, the employment cost index came in above expectations with a 1.2% quarter-over-quarter increase in Q1 2024 and a 4.2% increase in compensation costs over the year. The persistence of inflation has led market participants to conclude that the likelihood of multiple Federal Reserve rate cuts in 2024 is diminished and the next rate cut is also likely further away. In summary, U.S. economic growth moderated at the beginning of 2024, reflecting the impact of higher interest rates and declining consumer savings. The labor market also showed signs of cooling with softer-than expected job growth in April. U.S. housing and mortgage market: After benefitting from stable mortgage rates in the first couple of months of the year, the housing market witnessed a slowdown in March due to the rebound in rates. Total (existing + new) home sales for March fell by 2.7% from February and were down 2.1% from a year ago. This decline was led by existing home sales, which continued to reel under the impact of rising rates. Existing home sales were at an annual rate of 4.19 million in March, 4.3% below February sales and 3.7% lower than March 2023.2 However, new home sales for March grew 8.8% from February to an annualized rate of 693,000, accounting for about 14% of total home sales.3 As the supply of existing homes for sale remains low and home prices continue to rise, more buyers are choosing to purchase new homes than in previous years. According to the National Association of Homebuilders’ Housing Market Index, homebuilder confidence remained steady in March with the index coming in at 51. This is above the threshold of 50, indicating positive building conditions.4 However, the housing construction sector experienced some moderation. According to the U.S. Census Bureau, new residential construction fell in March with total starts decreasing 14.7%, the largest monthly decline since May 2022. The decline was led by multifamily starts which fell around 21% month-overmonth and single-family housing starts fell 12% month-over-month in March. The FHFA Purchase-Only Home Price Index for February increased by 1.2% month-over-month compared to a decrease of 0.1% in January. Year-over-year house price growth remained strong at 7.0% for February. The depleted inventory of homes available for sale, along with still high demand, continued to put upward pressure on house prices. Mortgage rates ticked up in April averaging 6.99% for the month, as measured by Freddie Mac’s Primary Mortgage Market Survey®, and ended the month at 7.17%. According to the Mortgage Bankers Association (MBA) Weekly Application Survey, mortgage activity declined over the month as rates exceeded 7% for the first time this year. Overall mortgage activity was down 1.8% month-over-month and 10.4% year-over-year at the end of April. Refinance activity for April was down 3.3% compared to March, and purchase applications were down 2.7% month-over-month.Tight inventory coupled with higher rates resulted in a stagnant start to the year in terms of homeownership. The homeownership rate in Q1 2024 ticked down to 65.6% from 65.7% in Q4 2023 and 66% in Q1 2023.5 The historical average homeownership rate over the period from Q1 1964 to Q1 2024 is 65.2%. Total housing stock was at 146.4 million units as of Q1 2024, an increase of around 1.6 million units compared to the same time last year. This reflected an increase of approximately 1.4 million in total occupied housing units and 0.2 million vacant units. A large share of the increase in occupied units came from renters compared to homeowners. Renter-occupied units increased approximately 1 million over the last year while owner-occupied units were up around 0.6 million. The homeowner vacancy rate in Q1 2024 was down to 0.8% from 0.9% in Q4 2023. The rental vacancy rate was unchanged over the quarter at 6.6%. Vacancy rates remain on balance very low. To bring the vacancy rate, both rental and homeowner, back in line with historical averages, the U.S. would need to add an additional 1.5 million vacant for-sale and for-rent homes (Exhibit 1).6 Without such units, the pressure on housing markets will persist. Additionally, the vacant housing undersupply metric is almost certainly a dramatic underestimate of the total housing shortage for the U.S. This is because this metric does not account for latent housing demand and vacant housing that is not for sale or for rent. Overall, tight inventory and “higher for longer” rates are still key barriers to home sale volumes. Mortgage rates above 7% continue to price out many prospective homebuyers and sellers have less incentive to sell. Outlook While the U.S. economy has shown resilience so far, we expect higher interest rates to weigh on future growth, with the economy settling into a lower rate of growth in 2024 and 2025. However, we do not expect a recession in our baseline scenario. In our baseline, slower growth and a weaker labor market help to rein in inflation while the economy throttles back but avoids stalling. Our baseline scenario has one Federal Reserve rate cut towards the end of the year. As a result, we expect mortgage rates to remain elevated through most of 2024. These high interest rates will prompt prospective buyers to readjust their housing expectations, but we anticipate housing demand to remain high due to favorable demographics, particularly in the starter home segment. Despite the strong housing demand, our housing market outlook is tempered by lack of inventory for sale. Under our baseline scenario, we anticipate improvement in home sales compared to 2023, albeit by a slim margin, as the rate lock-in effect will delay existing homes from entering the market. Our outlook on the mortgage origination market is also clouded by the expectation of low sale volumes. With our projection of mortgage interest rates remaining higher for longer, we anticipate modest growth in mortgage origination volumes, supported by high home prices. However, the combination of higher interest rates and limited inventory could limit purchase originations. Additionally, we expect refinance origination volumes to decline as homeowners have already secured low rates, posing potential challenge in the refinance market. While our outlook is positive, there are emerging risks, particularly from inflation. Over the last year, almost half of the overall gains in inflation came from housing inflation, and in an environment where home prices are growing, inflationary pressures might persist for longer. Under a high inflation scenario, interest rates will remain high, negatively impacting consumer spending behavior and credit performance, which can further slowdown economic growth.","Only respond using information from the context. What factors are negatively affecting the housing market? U.S. Economic, Housing and Mortgage Market Outlook Recent developments U.S. economy: U.S. economic growth moderated to start the year. According to the U.S. Bureau of Economic Analysis (BEA) “advance” estimate of Real Gross Domestic Product (GDP), the seasonally adjusted annual rate (SAAR) of growth in GDP in Q1 2024 was 1.6%, slowing from a 3.4% rate in Q4 2023. The deceleration in GDP growth was led by slower growth in consumption expenditures, net exports, and government consumption expenditures. Consumer spending was weaker due to a decline in spending on durable goods, primarily autos, and flatlining nondurable goods, primarily due to less spending on gasoline. Spending on services accelerated in the first quarter, led by higher spending on health care, financial services and insurance. Trade weighed on GDP growth with more modest exports and an increase in imports. Compared to most advanced economies, the U.S. economy continues to perform relatively well. The positive tailwinds to overall growth from government spending are waning. The contribution to GDP growth from government consumption expenditures and gross investment remains positive but was less than a third of what it was in Q4 2023. The latest report paints a picture of an economy that continues to perform well, but that is moderating as it settles into a growth pattern more consistent with long-run trends. Consistent with economic growth trends, the labor market moderated in April 2024 with nonfarm payroll employment increasing by 175,000, down from an increase of 315,000 in March, according to the Bureau of Labor Statistics (BLS). The unemployment rate inched up from 3.8% in March to 3.9% in April. However, the unemployment rate has remained below 4% for the twenty-seventh consecutive month. Average hourly earnings for all employees on private nonfarm payrolls rose 0.2% month-over-month, and compared to a year ago, average hourly earnings increased 3.9%. Overall, the jobs report indicates a resilient but cooling labor market. The core Personal Consumption Expenditures (PCE) price index, the Federal Reserve’s preferred inflation gauge that strips out volatile food and energy prices, rose 0.3% month-over-month in March.1 While this increase in the core PCE was in line with expectations, the progress on inflation has slowed and has implications for future Federal Reserve monetary policy. The index increased 2.8% from a year ago and remains above the Federal Reserve target of 2.0%. The Consumer Price Index (CPI) increased by 0.4% in April, exceeding consensus expectations and triggering a negative market reaction. In another sign of persistent inflationary pressures, the employment cost index came in above expectations with a 1.2% quarter-over-quarter increase in Q1 2024 and a 4.2% increase in compensation costs over the year. The persistence of inflation has led market participants to conclude that the likelihood of multiple Federal Reserve rate cuts in 2024 is diminished and the next rate cut is also likely further away. In summary, U.S. economic growth moderated at the beginning of 2024, reflecting the impact of higher interest rates and declining consumer savings. The labor market also showed signs of cooling with softer-than expected job growth in April. U.S. housing and mortgage market: After benefitting from stable mortgage rates in the first couple of months of the year, the housing market witnessed a slowdown in March due to the rebound in rates. Total (existing + new) home sales for March fell by 2.7% from February and were down 2.1% from a year ago. This decline was led by existing home sales, which continued to reel under the impact of rising rates. Existing home sales were at an annual rate of 4.19 million in March, 4.3% below February sales and 3.7% lower than March 2023.2 However, new home sales for March grew 8.8% from February to an annualized rate of 693,000, accounting for about 14% of total home sales.3 As the supply of existing homes for sale remains low and home prices continue to rise, more buyers are choosing to purchase new homes than in previous years. According to the National Association of Homebuilders’ Housing Market Index, homebuilder confidence remained steady in March with the index coming in at 51. This is above the threshold of 50, indicating positive building conditions.4 However, the housing construction sector experienced some moderation. According to the U.S. Census Bureau, new residential construction fell in March with total starts decreasing 14.7%, the largest monthly decline since May 2022. The decline was led by multifamily starts which fell around 21% month-overmonth and single-family housing starts fell 12% month-over-month in March. The FHFA Purchase-Only Home Price Index for February increased by 1.2% month-over-month compared to a decrease of 0.1% in January. Year-over-year house price growth remained strong at 7.0% for February. The depleted inventory of homes available for sale, along with still high demand, continued to put upward pressure on house prices. Mortgage rates ticked up in April averaging 6.99% for the month, as measured by Freddie Mac’s Primary Mortgage Market Survey®, and ended the month at 7.17%. According to the Mortgage Bankers Association (MBA) Weekly Application Survey, mortgage activity declined over the month as rates exceeded 7% for the first time this year. Overall mortgage activity was down 1.8% month-over-month and 10.4% year-over-year at the end of April. Refinance activity for April was down 3.3% compared to March, and purchase applications were down 2.7% month-over-month.Tight inventory coupled with higher rates resulted in a stagnant start to the year in terms of homeownership. The homeownership rate in Q1 2024 ticked down to 65.6% from 65.7% in Q4 2023 and 66% in Q1 2023.5 The historical average homeownership rate over the period from Q1 1964 to Q1 2024 is 65.2%. Total housing stock was at 146.4 million units as of Q1 2024, an increase of around 1.6 million units compared to the same time last year. This reflected an increase of approximately 1.4 million in total occupied housing units and 0.2 million vacant units. A large share of the increase in occupied units came from renters compared to homeowners. Renter-occupied units increased approximately 1 million over the last year while owner-occupied units were up around 0.6 million. The homeowner vacancy rate in Q1 2024 was down to 0.8% from 0.9% in Q4 2023. The rental vacancy rate was unchanged over the quarter at 6.6%. Vacancy rates remain on balance very low. To bring the vacancy rate, both rental and homeowner, back in line with historical averages, the U.S. would need to add an additional 1.5 million vacant for-sale and for-rent homes (Exhibit 1).6 Without such units, the pressure on housing markets will persist. Additionally, the vacant housing undersupply metric is almost certainly a dramatic underestimate of the total housing shortage for the U.S. This is because this metric does not account for latent housing demand and vacant housing that is not for sale or for rent. Overall, tight inventory and “higher for longer” rates are still key barriers to home sale volumes. Mortgage rates above 7% continue to price out many prospective homebuyers and sellers have less incentive to sell. Outlook While the U.S. economy has shown resilience so far, we expect higher interest rates to weigh on future growth, with the economy settling into a lower rate of growth in 2024 and 2025. However, we do not expect a recession in our baseline scenario. In our baseline, slower growth and a weaker labor market help to rein in inflation while the economy throttles back but avoids stalling. Our baseline scenario has one Federal Reserve rate cut towards the end of the year. As a result, we expect mortgage rates to remain elevated through most of 2024. These high interest rates will prompt prospective buyers to readjust their housing expectations, but we anticipate housing demand to remain high due to favorable demographics, particularly in the starter home segment. Despite the strong housing demand, our housing market outlook is tempered by lack of inventory for sale. Under our baseline scenario, we anticipate improvement in home sales compared to 2023, albeit by a slim margin, as the rate lock-in effect will delay existing homes from entering the market. Our outlook on the mortgage origination market is also clouded by the expectation of low sale volumes. With our projection of mortgage interest rates remaining higher for longer, we anticipate modest growth in mortgage origination volumes, supported by high home prices. However, the combination of higher interest rates and limited inventory could limit purchase originations. Additionally, we expect refinance origination volumes to decline as homeowners have already secured low rates, posing potential challenge in the refinance market. While our outlook is positive, there are emerging risks, particularly from inflation. Over the last year, almost half of the overall gains in inflation came from housing inflation, and in an environment where home prices are growing, inflationary pressures might persist for longer. Under a high inflation scenario, interest rates will remain high, negatively impacting consumer spending behavior and credit performance, which can further slowdown economic growth.",Financial,Find & Summarize,Text Transformation "Only use the information in the context document. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context"".","According to the context document only, how can APs profit from a Bitcoin ETF?","**Spot Bitcoin ETFs: What Are They, And How Do They Work?** Bitcoin has been one of the best-performing assets over the last decade, rising from a relatively obscure peer-to-peer payment network to a global phenomenon. As the original cryptocurrency, bitcoin has spurred an entirely new asset class that now has over $1 trillion in market capitalization. With the approval of 11 spot bitcoin ETFs in January 2024, traditional investors have an even easier way to invest in bitcoin. What Is a Spot Bitcoin ETF? On January 10, 2024, the SEC approved 11 new spot bitcoin ETFs. ETFs, or exchange-traded funds, are a type of security that tracks the underlying performance of a collection of assets or commodities. A spot bitcoin ETF is an exchange-traded fund that tracks the spot, or current price of bitcoin. By holding an equivalent amount of bitcoin to back every share of the ETF that is sold, the fund is actually backed by bitcoin itself. Considering the hoops you have to jump through to own bitcoin—exchange accounts, digital wallets, private keys, network transfers, etc.—a spot bitcoin ETF is one of the easiest ways to add bitcoin exposure to your portfolio. Spot ETFs, such as the new spot bitcoin ETFs, allow for shares of the fund to be created or redeemed based on market demand. In this way, a spot bitcoin ETF allows investors to gain exposure to the current price of bitcoin without having to hold the asset itself. This is in contrast to bitcoin futures ETFs, which were approved for trading by the U.S. Securities and Exchange Commission in October 2021 and can only trade bitcoin futures. Futures are complex derivatives instruments that track potential future prices of the underlying asset. How Do Spot Bitcoin ETFs Work? Spot bitcoin ETFs purchase a select amount of bitcoins that are held in a secure digital wallet by a custodian. These custodians offer bitcoin storage in a secure vault. Most of these vaults are—as crypto insiders call—air gapped in “cold storage,” which means the bitcoins’ keys are stored offline and cannot be accessed through the internet. The ETFs then issue shares that represent the bitcoins held by the fund. These shares are priced to reflect the current spot price of bitcoin and can be traded on traditional stock exchanges. Spot bitcoin ETFs make it easier for retail investors and traders to buy and sell an asset tied to the current value of bitcoin without needing to hold bitcoin itself. They also allow investors seeking exposure to bitcoin in retirement accounts to have a much simpler option than opening a self-directed IRA that could hold bitcoin directly. How Does a Spot ETF Maintain Its Price? The price of a spot ETF can depart from the actual value of the underlying asset. To bring the fund back in line with the asset’s actual value, authorized participants, otherwise known as APs, are allowed to create or redeem large blocks of shares. APs are typically large financial institutions that profit from the arbitrage opportunity presented when an ETF’s price is higher or lower than the underlying asset’s value. 11 Spot Bitcoin ETFs Here are the 11 SEC-approved Spot Bitcoin ETFs as of January 31, 2024: Spot Bitcoin ETF Expense Ratio Fee Waiver ARK 21Shares Bitcoin ETF (ARKB) 0.21% 0% fee for six months (or until $1 billion in assets) Bitwise Bitcoin ETF (BITB) 0.20% 0% fee for six months (or until $1 billion in assets) Fidelity Wise Origin Bitcoin Trust (FBTC) 0.25% Fees waived until July 31, 2024 Franklin Bitcoin ETF (EZBC) 0.19% 0% fee until August 2, 2024 (or until $10 billion in assets) Grayscale Bitcoin Trust (GBTC) 1.50% No fee waiver Hashdex Bitcoin ETF (DEFI)* 0.90% No fee waiver Invesco Galaxy Bitcoin ETF (BTCO) 0.25% 0% fee for six months (or until $5 billion in assets) iShares Bitcoin Trust (IBIT) 0.25% 0.12% fee for 12 months (or until $5 billion in assets) Valkyrie Bitcoin Fund (BRRR) 0.25% 0% fee for three months VanEck Bitcoin Trust (HODL) 0.25% No fee waiver See More * The Hashdex Bitcoin Futures ETF (DEFI) will convert to a spot bitcoin ETF at a later date. Now That They’re Here, What’s the Future of Spot Bitcoin ETFs? For years, the SEC had rejected all applications for a spot bitcoin ETF, with over 20 thumbs down between 2018 and 2023. The SEC’s approval of 11 spot bitcoin ETFs on January 10 marks a shift in how regulators treat cryptocurrencies. A flurry of new applications has been sent to the SEC for approval, suggesting even more spot bitcoin ETFs may be coming. It’s important to note that just because spot bitcoin ETFs have been approved, that does not mean the SEC is certain to approve additional crypto ETFs. Gary Gensler, chairman of the SEC, said in the SEC’s announcement of the approval of spot bitcoin ETFs, “Importantly, today’s Commission action is cabined to ETPs holding one non-security commodity, bitcoin. It should in no way signal the Commission’s willingness to approve listing standards for crypto asset securities.” Will Spot Bitcoin ETFs Affect the Price of Bitcoin? In the short term, more investors will find it easier to invest in bitcoin through these spot ETFs. This could mean more demand for bitcoin, as funds purchase from crypto exchanges to meet the demand of the spot ETFs. Bitcoin’s price was already rising in the weeks leading up to the spot bitcoin ETF announcement—and a “sell the news” moment happened in the wake of the approval. Many bitcoin holders became sellers, with the price of bitcoin dropping over 10% in just a few weeks. Over the long term, however, demand could increase for Bitcoin, as retirement plans, 401(k) plans and financial advisors start offering spot bitcoin ETFs as a way to diversify portfolios into “alternative assets.” “I personally believe that it will positively impact Bitcoin’s price because of increased adoption, easier access to ‘normies’ and increased liquidity in the marketplace,” says Marko Zlatic, founder of Whiteboard Finance. “Since the Bitcoin protocol dictates a finite supply of 21 million bitcoin ever, this should drive prices up over time, as long as there is adequate demand.” Risks of Investing in Spot Bitcoin ETFs Investors should understand the risk of investing in a spot bitcoin ETF before allocating any funds toward one. “Investors should approach cautiously and look at previous price movements of bitcoin to make sure they can stomach the volatility before they dive in,” says Christopher Johns, founder and wealth advisor at Spark Wealth Advisors, LLC. Gold had a similar trajectory when spot gold ETFs were introduced. The assets under management, or AUM, of spot gold ETFs quickly rose to about $1 billion. Since then, total holdings have grown to over $50 billion. This—along with other macroeconomic factors—has helped push the price of gold up to new highs. Spot Bitcoin ETFs: Pros And Cons Pros Bitcoin legitimacy. With the approval of spot bitcoin ETFs, the original cryptocurrency is now seen as a more legitimate asset class. Investors from all walks of life can gain exposure to bitcoin in almost any type of investment account they own, including individual retirement accounts, or IRAs, and 401(k)s. More liquidity. With ETFs buying and selling large blocks of bitcoin based on demand, this could increase liquidity and help stabilize prices over the long term. Increase prices. While a spot bitcoin ETF does not directly affect the price of bitcoin, the increased demand and purchasing of bitcoin by these ETFs could boost the price over time. Lower trading fees. With more adoption and ease of access through a spot ETF, investors may be able to access bitcoin with lower trading fees than some crypto exchanges. Cons More regulation. Spot bitcoin ETFs are highly-regulated securities that are now tied to the price of bitcoin. Any regulatory actions against bitcoin could affect the price of spot bitcoin ETFs—and bitcoin itself—as well. Investors don’t take custody of bitcoin. While investing in a spot bitcoin ETF gives you exposure to the price of bitcoin, you can’t take custody of the asset itself. “[You’re] trusting a third party custodian to ‘HODL’ your bitcoin. Not your keys, not your bitcoin,” Zlatic says. Annual fees. While trading spot bitcoin ETFs might cost less in the short term, the annual expense ratios may make it more expensive to own versus purchasing and storing bitcoin yourself. Volatility. While spot bitcoin ETFs will help increase bitcoin adoption, it is still a volatile asset that wildly fluctuates in price, which can hurt investors who aren’t prepared for the risk involved in owning bitcoin. Alternatives to Spot Bitcoin ETFs While investing in a spot bitcoin ETF can give you direct exposure to the price of bitcoin, it’s not the only way to invest in bitcoin. Here are a few alternatives to consider: Purchase bitcoin directly. If you want to own the actual asset yourself, you can purchase bitcoin from an online exchange. This gives you the ability to own bitcoin—or at least a portion of bitcoin—and take it into custody. There is a higher barrier to entry to owning bitcoin, as you’ll need to create a crypto exchange account, open a digital wallet and perhaps even transfer your bitcoin keys to a hardware wallet for safekeeping. Bitcoin futures ETF. Bitcoin futures ETFs have been around for a while, although they operate a bit differently than a spot ETF. These ETFs do not hold any bitcoin and only hold futures contracts based on the future price of bitcoin. This makes them potentially even more volatile than bitcoin itself. Bitcoin mining stocks. Bitcoin mining is a real business in which companies own and operate large data centers used for mining bitcoin. Some of these companies are publicly traded, allowing you to invest in the operation of mining bitcoin and the profit mining companies make in the process.","{Instruction} ========== Only use the information in the context document. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context"". ---------------- {Passage} ========== **Spot Bitcoin ETFs: What Are They, And How Do They Work?** Bitcoin has been one of the best-performing assets over the last decade, rising from a relatively obscure peer-to-peer payment network to a global phenomenon. As the original cryptocurrency, bitcoin has spurred an entirely new asset class that now has over $1 trillion in market capitalization. With the approval of 11 spot bitcoin ETFs in January 2024, traditional investors have an even easier way to invest in bitcoin. What Is a Spot Bitcoin ETF? On January 10, 2024, the SEC approved 11 new spot bitcoin ETFs. ETFs, or exchange-traded funds, are a type of security that tracks the underlying performance of a collection of assets or commodities. A spot bitcoin ETF is an exchange-traded fund that tracks the spot, or current price of bitcoin. By holding an equivalent amount of bitcoin to back every share of the ETF that is sold, the fund is actually backed by bitcoin itself. Considering the hoops you have to jump through to own bitcoin—exchange accounts, digital wallets, private keys, network transfers, etc.—a spot bitcoin ETF is one of the easiest ways to add bitcoin exposure to your portfolio. Spot ETFs, such as the new spot bitcoin ETFs, allow for shares of the fund to be created or redeemed based on market demand. In this way, a spot bitcoin ETF allows investors to gain exposure to the current price of bitcoin without having to hold the asset itself. This is in contrast to bitcoin futures ETFs, which were approved for trading by the U.S. Securities and Exchange Commission in October 2021 and can only trade bitcoin futures. Futures are complex derivatives instruments that track potential future prices of the underlying asset. How Do Spot Bitcoin ETFs Work? Spot bitcoin ETFs purchase a select amount of bitcoins that are held in a secure digital wallet by a custodian. These custodians offer bitcoin storage in a secure vault. Most of these vaults are—as crypto insiders call—air gapped in “cold storage,” which means the bitcoins’ keys are stored offline and cannot be accessed through the internet. The ETFs then issue shares that represent the bitcoins held by the fund. These shares are priced to reflect the current spot price of bitcoin and can be traded on traditional stock exchanges. Spot bitcoin ETFs make it easier for retail investors and traders to buy and sell an asset tied to the current value of bitcoin without needing to hold bitcoin itself. They also allow investors seeking exposure to bitcoin in retirement accounts to have a much simpler option than opening a self-directed IRA that could hold bitcoin directly. How Does a Spot ETF Maintain Its Price? The price of a spot ETF can depart from the actual value of the underlying asset. To bring the fund back in line with the asset’s actual value, authorized participants, otherwise known as APs, are allowed to create or redeem large blocks of shares. APs are typically large financial institutions that profit from the arbitrage opportunity presented when an ETF’s price is higher or lower than the underlying asset’s value. 11 Spot Bitcoin ETFs Here are the 11 SEC-approved Spot Bitcoin ETFs as of January 31, 2024: Spot Bitcoin ETF Expense Ratio Fee Waiver ARK 21Shares Bitcoin ETF (ARKB) 0.21% 0% fee for six months (or until $1 billion in assets) Bitwise Bitcoin ETF (BITB) 0.20% 0% fee for six months (or until $1 billion in assets) Fidelity Wise Origin Bitcoin Trust (FBTC) 0.25% Fees waived until July 31, 2024 Franklin Bitcoin ETF (EZBC) 0.19% 0% fee until August 2, 2024 (or until $10 billion in assets) Grayscale Bitcoin Trust (GBTC) 1.50% No fee waiver Hashdex Bitcoin ETF (DEFI)* 0.90% No fee waiver Invesco Galaxy Bitcoin ETF (BTCO) 0.25% 0% fee for six months (or until $5 billion in assets) iShares Bitcoin Trust (IBIT) 0.25% 0.12% fee for 12 months (or until $5 billion in assets) Valkyrie Bitcoin Fund (BRRR) 0.25% 0% fee for three months VanEck Bitcoin Trust (HODL) 0.25% No fee waiver See More * The Hashdex Bitcoin Futures ETF (DEFI) will convert to a spot bitcoin ETF at a later date. Now That They’re Here, What’s the Future of Spot Bitcoin ETFs? For years, the SEC had rejected all applications for a spot bitcoin ETF, with over 20 thumbs down between 2018 and 2023. The SEC’s approval of 11 spot bitcoin ETFs on January 10 marks a shift in how regulators treat cryptocurrencies. A flurry of new applications has been sent to the SEC for approval, suggesting even more spot bitcoin ETFs may be coming. It’s important to note that just because spot bitcoin ETFs have been approved, that does not mean the SEC is certain to approve additional crypto ETFs. Gary Gensler, chairman of the SEC, said in the SEC’s announcement of the approval of spot bitcoin ETFs, “Importantly, today’s Commission action is cabined to ETPs holding one non-security commodity, bitcoin. It should in no way signal the Commission’s willingness to approve listing standards for crypto asset securities.” Will Spot Bitcoin ETFs Affect the Price of Bitcoin? In the short term, more investors will find it easier to invest in bitcoin through these spot ETFs. This could mean more demand for bitcoin, as funds purchase from crypto exchanges to meet the demand of the spot ETFs. Bitcoin’s price was already rising in the weeks leading up to the spot bitcoin ETF announcement—and a “sell the news” moment happened in the wake of the approval. Many bitcoin holders became sellers, with the price of bitcoin dropping over 10% in just a few weeks. Over the long term, however, demand could increase for Bitcoin, as retirement plans, 401(k) plans and financial advisors start offering spot bitcoin ETFs as a way to diversify portfolios into “alternative assets.” “I personally believe that it will positively impact Bitcoin’s price because of increased adoption, easier access to ‘normies’ and increased liquidity in the marketplace,” says Marko Zlatic, founder of Whiteboard Finance. “Since the Bitcoin protocol dictates a finite supply of 21 million bitcoin ever, this should drive prices up over time, as long as there is adequate demand.” Risks of Investing in Spot Bitcoin ETFs Investors should understand the risk of investing in a spot bitcoin ETF before allocating any funds toward one. “Investors should approach cautiously and look at previous price movements of bitcoin to make sure they can stomach the volatility before they dive in,” says Christopher Johns, founder and wealth advisor at Spark Wealth Advisors, LLC. Gold had a similar trajectory when spot gold ETFs were introduced. The assets under management, or AUM, of spot gold ETFs quickly rose to about $1 billion. Since then, total holdings have grown to over $50 billion. This—along with other macroeconomic factors—has helped push the price of gold up to new highs. Spot Bitcoin ETFs: Pros And Cons Pros Bitcoin legitimacy. With the approval of spot bitcoin ETFs, the original cryptocurrency is now seen as a more legitimate asset class. Investors from all walks of life can gain exposure to bitcoin in almost any type of investment account they own, including individual retirement accounts, or IRAs, and 401(k)s. More liquidity. With ETFs buying and selling large blocks of bitcoin based on demand, this could increase liquidity and help stabilize prices over the long term. Increase prices. While a spot bitcoin ETF does not directly affect the price of bitcoin, the increased demand and purchasing of bitcoin by these ETFs could boost the price over time. Lower trading fees. With more adoption and ease of access through a spot ETF, investors may be able to access bitcoin with lower trading fees than some crypto exchanges. Cons More regulation. Spot bitcoin ETFs are highly-regulated securities that are now tied to the price of bitcoin. Any regulatory actions against bitcoin could affect the price of spot bitcoin ETFs—and bitcoin itself—as well. Investors don’t take custody of bitcoin. While investing in a spot bitcoin ETF gives you exposure to the price of bitcoin, you can’t take custody of the asset itself. “[You’re] trusting a third party custodian to ‘HODL’ your bitcoin. Not your keys, not your bitcoin,” Zlatic says. Annual fees. While trading spot bitcoin ETFs might cost less in the short term, the annual expense ratios may make it more expensive to own versus purchasing and storing bitcoin yourself. Volatility. While spot bitcoin ETFs will help increase bitcoin adoption, it is still a volatile asset that wildly fluctuates in price, which can hurt investors who aren’t prepared for the risk involved in owning bitcoin. Alternatives to Spot Bitcoin ETFs While investing in a spot bitcoin ETF can give you direct exposure to the price of bitcoin, it’s not the only way to invest in bitcoin. Here are a few alternatives to consider: Purchase bitcoin directly. If you want to own the actual asset yourself, you can purchase bitcoin from an online exchange. This gives you the ability to own bitcoin—or at least a portion of bitcoin—and take it into custody. There is a higher barrier to entry to owning bitcoin, as you’ll need to create a crypto exchange account, open a digital wallet and perhaps even transfer your bitcoin keys to a hardware wallet for safekeeping. Bitcoin futures ETF. Bitcoin futures ETFs have been around for a while, although they operate a bit differently than a spot ETF. These ETFs do not hold any bitcoin and only hold futures contracts based on the future price of bitcoin. This makes them potentially even more volatile than bitcoin itself. Bitcoin mining stocks. Bitcoin mining is a real business in which companies own and operate large data centers used for mining bitcoin. Some of these companies are publicly traded, allowing you to invest in the operation of mining bitcoin and the profit mining companies make in the process. ---------------- {Question} ========== According to the context document only, how can APs profit from a Bitcoin ETF?",Financial,Find & Summarize,Text Transformation You can only respond to the prompt using information in the context block and no other sources.,Explain how COLAs are considered in determining Medicaid eligibility.,"Recipients of Social Security COLAs After April 1977 (“Pickle Amendment”) Section 503 of P.L. 94-566 generally requires states to provide Medicaid coverage for individuals who would continue to be eligible for SSI/SSP if not for increases in their Social Security benefits due to COLAs.64 Individuals qualify under this pathway it they • are receiving Social Security benefits, • lost SSI/SSP but would still be eligible for those benefits if Social Security COLAs received since losing SSI/SSP were deducted from their income, and • were eligible for and receiving SSI/SSP concurrently with Social Security for at least one month after April 1, 1977. 209(b) states may exclude all, some, or none of the Social Security benefit increases that caused ineligibility for SSI/SSP. This pathway is often known as the “Pickle Amendment” after the late Representative J.J. Pickle. Disabled Widow(er)s Receiving Benefit Increases Under P.L. 98-21 (“ARF Widow[er]s”) (This pathway is closed to new enrollment and applies to relatively few people.) Social Security provides widow(er)’s benefits starting at age 60, or at age 50 if the individual is disabled and meets certain other criteria. The amount of the aged or disabled widow(er)’s benefit is based on the deceased insured worker’s past earnings from covered employment, subject to a permanent reduction for each month of entitlement before the widow(er)’s full retirement age (65- 67, depending on year of birth). Under P.L. 98-21, lawmakers eliminated the additional reduction factor (ARF) for disabled widow(er)s aged 50-59, meaning their reduction penalty for claiming benefits before their full retirement age was capped at the percentage applicable to aged widow(er)s who first claim at age 60. All states (including 209[b] states) are required to provide Medicaid coverage for individuals who would continue to be eligible for SSI/SSP if not for increases in their widow(er)’s benefits due to the elimination of the ARF (known as “ARF Widow[er]s”).65 Individuals qualify under this pathway if they • were entitled to Social Security benefits in December 1983 and received disabled widow(er)’s benefits and SSI/SSP in January 1984, • lost SSI/SSP eligibility because of the elimination of the ARF, • have been continuously entitled to widow(er)’s benefits since January 1984, • filed for Medicaid continuation before July 1, 1988 (or a slightly later date in some cases), and • would continue to be eligible for SSI/SSP if the value of the increase in disabled widow(er)’s benefits under P.L. 98-21 and any subsequent COLAs were deducted from their countable income. Disabled Adult Children Disabled adult children of retired, disabled, or deceased insured workers typically qualify for Social Security disabled adult child’s (DAC) benefits if they are at least age 18 and became disabled before they attained age 22. States are generally required to provide Medicaid coverage for individuals who lose eligibility for SSI/SSP due to entitlement to or an increase in DAC benefits. 66 Individuals qualify under this pathway if they • lose eligibility for SSI/SSP due to receipt of DAC benefits on or after July 1, 1987, and • would continue to be eligible for SSI/SSP if not for their entitlement to or an increase in DAC benefits. 209(b) states may exclude all, some, or none of the DAC benefit or increases in that benefit that caused ineligibility for SSI/SSP. Widow(er)s Not Entitled to Medicare Part A (“Early Widow[er]s”) States are generally required to provide Medicaid coverage for individuals aged 50 to 64 who lose eligibility for SSI/SSP due to entitlement to Social Security widow(er)’s benefits but who are not yet entitled to Medicare Part A (Hospital Insurance).67 Individuals qualify under this pathway if they • are at least age 50 but have not yet attained age 65, • received SSI/SSP in the month before their widow(er)’s benefits began, • are not entitled to Medicare Part A,68 and • would continue to be eligible for SSI/SSP if not for their entitlement widow(er)’s benefits.69 Eligibility for Medicaid under this pathway continues until the individual becomes entitled to Medicare Part A. 209(b) states may exclude all, some, or none of the widow(er)’s benefit that caused ineligibility for SSP/SSI. Recipients of a 1972 Social Security COLA (This pathway is closed to new enrollment and applies to relatively few people.) Section 249E of P.L. 92-603 requires states to provide Medicaid coverage for individuals who would be eligible for SSI/SSP in the absence of a Social Security COLA enacted in 1972 under P.L. 92-336.70 Individuals qualify under this provision if they • were entitled to Social Security benefits in August 1972, • were receiving cash assistance under the former adult assistance programs in August 1972 (or would have been eligible for such assistance in certain instances), and • would be eligible for SSI/SSP had the COLA under P.L. 92-336 not been applied to their Social Security benefits.","You can only respond to the prompt using information in the context block and no other sources. Explain how COLAs are considered in determining Medicaid eligibility. Recipients of Social Security COLAs After April 1977 (“Pickle Amendment”) Section 503 of P.L. 94-566 generally requires states to provide Medicaid coverage for individuals who would continue to be eligible for SSI/SSP if not for increases in their Social Security benefits due to COLAs.64 Individuals qualify under this pathway it they • are receiving Social Security benefits, • lost SSI/SSP but would still be eligible for those benefits if Social Security COLAs received since losing SSI/SSP were deducted from their income, and • were eligible for and receiving SSI/SSP concurrently with Social Security for at least one month after April 1, 1977. 209(b) states may exclude all, some, or none of the Social Security benefit increases that caused ineligibility for SSI/SSP. This pathway is often known as the “Pickle Amendment” after the late Representative J.J. Pickle. Disabled Widow(er)s Receiving Benefit Increases Under P.L. 98-21 (“ARF Widow[er]s”) (This pathway is closed to new enrollment and applies to relatively few people.) Social Security provides widow(er)’s benefits starting at age 60, or at age 50 if the individual is disabled and meets certain other criteria. The amount of the aged or disabled widow(er)’s benefit is based on the deceased insured worker’s past earnings from covered employment, subject to a permanent reduction for each month of entitlement before the widow(er)’s full retirement age (65- 67, depending on year of birth). Under P.L. 98-21, lawmakers eliminated the additional reduction factor (ARF) for disabled widow(er)s aged 50-59, meaning their reduction penalty for claiming benefits before their full retirement age was capped at the percentage applicable to aged widow(er)s who first claim at age 60. All states (including 209[b] states) are required to provide Medicaid coverage for individuals who would continue to be eligible for SSI/SSP if not for increases in their widow(er)’s benefits due to the elimination of the ARF (known as “ARF Widow[er]s”).65 Individuals qualify under this pathway if they • were entitled to Social Security benefits in December 1983 and received disabled widow(er)’s benefits and SSI/SSP in January 1984, • lost SSI/SSP eligibility because of the elimination of the ARF, • have been continuously entitled to widow(er)’s benefits since January 1984, • filed for Medicaid continuation before July 1, 1988 (or a slightly later date in some cases), and • would continue to be eligible for SSI/SSP if the value of the increase in disabled widow(er)’s benefits under P.L. 98-21 and any subsequent COLAs were deducted from their countable income. Disabled Adult Children Disabled adult children of retired, disabled, or deceased insured workers typically qualify for Social Security disabled adult child’s (DAC) benefits if they are at least age 18 and became disabled before they attained age 22. States are generally required to provide Medicaid coverage for individuals who lose eligibility for SSI/SSP due to entitlement to or an increase in DAC benefits. 66 Individuals qualify under this pathway if they • lose eligibility for SSI/SSP due to receipt of DAC benefits on or after July 1, 1987, and • would continue to be eligible for SSI/SSP if not for their entitlement to or an increase in DAC benefits. 209(b) states may exclude all, some, or none of the DAC benefit or increases in that benefit that caused ineligibility for SSI/SSP. Widow(er)s Not Entitled to Medicare Part A (“Early Widow[er]s”) States are generally required to provide Medicaid coverage for individuals aged 50 to 64 who lose eligibility for SSI/SSP due to entitlement to Social Security widow(er)’s benefits but who are not yet entitled to Medicare Part A (Hospital Insurance).67 Individuals qualify under this pathway if they • are at least age 50 but have not yet attained age 65, • received SSI/SSP in the month before their widow(er)’s benefits began, • are not entitled to Medicare Part A,68 and • would continue to be eligible for SSI/SSP if not for their entitlement widow(er)’s benefits.69 Eligibility for Medicaid under this pathway continues until the individual becomes entitled to Medicare Part A. 209(b) states may exclude all, some, or none of the widow(er)’s benefit that caused ineligibility for SSP/SSI. Recipients of a 1972 Social Security COLA (This pathway is closed to new enrollment and applies to relatively few people.) Section 249E of P.L. 92-603 requires states to provide Medicaid coverage for individuals who would be eligible for SSI/SSP in the absence of a Social Security COLA enacted in 1972 under P.L. 92-336.70 Individuals qualify under this provision if they • were entitled to Social Security benefits in August 1972, • were receiving cash assistance under the former adult assistance programs in August 1972 (or would have been eligible for such assistance in certain instances), and • would be eligible for SSI/SSP had the COLA under P.L. 92-336 not been applied to their Social Security benefits.",Legal,Explanation/Definition,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","Are there any benefits to using AI? Are there any dangers in using AI? If the answer is yes to either of these questions, create a list of answers for each question.","Potential threats posed by AI can entail malicious objectives, unintended circumstances, and circumvention of safety measures. There are currently AI tools where the objectives are not clear, making them usable in a vast array of contexts, but also susceptible to manipulation or use in detrimental ways. For example, while Large Language Models (LLMs) are optimized for the narrow task of text prediction, they do not have a single objective in their main end-to-end applications; thus, they can be utilized in content generation for marketing purposes, in translation, and to produce misinformation at scale. In other cases, the objective is known and the AI system is optimized for that objective but the outcome can result in unintended harm. For instance, while some AI systems might aim for higher clicks, they might inadvertently contribute to societal polarization. This is an example of unintended consequence of an AI tool optimized on a known objective. As AI has evolved, especially with the development of Foundation models, numerous strategies have been proposed to integrate safety precautions and protective guardrails during deployment. However, there is substantial evidence indicating that malicious entities can bypass these barriers, leading the Foundation models to breach the safety protocols that were put in place. As such, there is a continued need for research into these safety challenges. Malicious objectives: It is important to protect against the misuse of AI. This is true for both proprietary and open-source AI. Ensuring public access to technology through open-source supports efforts to democratize AI development. However, these open-source models can be utilized by bad actors for malicious objectives such as phishing and scamming. Similarly, close-source models also can pose similar risks if they are misused by bad actors. Circumvention of safety measures: As AI systems become increasingly sophisticated, there is a heightened risk that they may devise means to bypass the very protocols put in place to oversee or limit their actions. This is particularly worrisome because, while humans design these safety measures with specific intentions, an AI might interpret them differently or identify loopholes. As the wave of AI and automation continues its transformative journey across industries, it will have a disruptive impact on employment opportunities. This impact could make jobs better and more accessible to a broader proportion of the population, but also has the potential to increase inequality. On one hand, sectors reliant on routine tasks are confronted with potential impacts on jobs, while on the other hand, the rise of AI-driven enterprises might inadvertently magnify the chasm of economic inequality. However, it should be noted that these studies discuss exposure to AI. Exposure does not necessarily translate to loss of jobs as the market could expand. It is apparent that some jobs will be lost and others will be created, and in some instances lower-performing workers will be boosted by AI, supplementing their capabilities. The concern is that without proactively developing the ability to detect and address changes and disruptions, and without awareness of labor market trends, available educational upskilling programs, and policies such as wage insurance for workers preparing for new roles (especially in the rapidly changing environment), it is possible to witness stark increases in inequality even as productivity rises. But the challenges are not solely economic. Ethical and societal dilemmas are emerging at the forefront, with growing concerns about individual privacy, copyright infringement, and the increasing human dependence on these technologies. Content authenticity verification presents a significant challenge, heightening worries about deepfakes and misinformation, which could undermine democratic processes. As AI systems grow more powerful and potentially gain more sophisticated capabilities, concerns have been raised about the possibility that these technologies will cause significant disruptions. These can manifest in the form of threats to democracy, like meddling in the electoral process, national security threats such as bioweapons or cyberattacks, and societal disruptions via polarizing AI systems used in platforms like social media. It should be noted that there are differing opinions on the feasibility of superhuman capabilities of AI and whether the risks can be categorized as large-scale disruption and catastrophic. In addition, many of these risks are instances of AI used for malicious objectives, unintended consequences of AI systems, or economic and societal risks as mentioned in previous parts taken to their extreme. These risks include: Uncontrolled growth: As AI acquires more sophisticated capabilities, some have raised concerns that it could act unpredictably, making decisions or taking actions not fully understood by its developers. Destabilization of democracy: The improper and malevolent use of AI has the potential to critically destabilize democratic systems. For example, if AI is harnessed to meddle with electoral processes, this could undermine confidence in democratic processes. One of the most prominent concerns is the spread of misinformation and disinformation. Moreover, AI tools can also be employed for more direct manipulation of voter behavior. National security threats: Malicious inputs have the capacity to trick AI systems, leading to operational failures. Furthermore, when AI is integrated into realms like warfare, cyber-attacks, and bioweapons, it can both intensify conflicts and usher in unpredictable combat tactics. Manipulation and polarization: AI, such as those used in social media platforms, can manipulate information to increase user engagement, inadvertently leading to societal polarization and misinformation. As AI's potential grows, so do the complexities and concerns surrounding its assimilation into diverse societal sectors. Nonetheless, every hurdle also presents a chance to evolve and refine. This is especially true in the AI domain. Delving into potential resolutions and protective measures isn't merely scholarly; it's imperative to ensure AI is utilized ethically, responsibly, and safely for everyone's advantage in the future. It's essential to enforce transparency, ensuring users recognize when they are engaging with an AI rather than a human, especially in scenarios where trust and authenticity are paramount. Below are some of the mitigation strategies suggested by the experts. Adaptive regulation: There has been emphasis on the importance of regulating AI in a manner that's both agile and adaptive. Given that AI can evolve faster than legislative systems, regulations need to be flexible enough to address current and future risks. Regulations should also be designed based on input from multiple stakeholders: corporations, advocacy groups, academic leaders. It has been further suggested that risk should be associated with AI's uses, not the technology itself. Lastly, in light of the recent declaration about voluntary commitments, it has been suggested to make some of these commitments obligatory. Other possible suggestions include and possibly encompass third-party verification, registration, and licensing of certain AI systems. Research investment: It is paramount to invest in AI research. It has been suggested that the research should be segmented into public and classified. The public research involves conventional academic research that openly publishes findings on AI risk safety solutions. This research can further delve into the appropriate governance and regulation necessary to ensure public safety, providing valuable insights for policymakers aiming to regulate AI effectively. The classified research pertains to concentrating on counteractions against malevolent users of AI or inadvertent AI control losses with national security consequences. Furthermore, experts advocate for international research by fostering global collaborations among institutes. Research with humanity at its core: There's a dual need for both open academic research focusing on safety solutions and classified research that addresses potential threats from bad actors using AI or unintentional loss of control over AI. Multi-stakeholder approach: Experts highlight the significance of including various stakeholders like AI builders, users, and civil society in the process. Companies, in particular, should invest in AI governance and adopt internal ethics frameworks. International coordination: It's imperative to develop joint international collaboration, ensuring that potent AI tools are not misused. Collaborative efforts with various nations, including those beyond the traditional U.S. allies, will help ensure a cohesive global approach to AI usage and its associated risks.","""================ ======= Potential threats posed by AI can entail malicious objectives, unintended circumstances, and circumvention of safety measures. There are currently AI tools where the objectives are not clear, making them usable in a vast array of contexts, but also susceptible to manipulation or use in detrimental ways. For example, while Large Language Models (LLMs) are optimized for the narrow task of text prediction, they do not have a single objective in their main end-to-end applications; thus, they can be utilized in content generation for marketing purposes, in translation, and to produce misinformation at scale. In other cases, the objective is known and the AI system is optimized for that objective but the outcome can result in unintended harm. For instance, while some AI systems might aim for higher clicks, they might inadvertently contribute to societal polarization. This is an example of unintended consequence of an AI tool optimized on a known objective. As AI has evolved, especially with the development of Foundation models, numerous strategies have been proposed to integrate safety precautions and protective guardrails during deployment. However, there is substantial evidence indicating that malicious entities can bypass these barriers, leading the Foundation models to breach the safety protocols that were put in place. As such, there is a continued need for research into these safety challenges. Malicious objectives: It is important to protect against the misuse of AI. This is true for both proprietary and open-source AI. Ensuring public access to technology through open-source supports efforts to democratize AI development. However, these open-source models can be utilized by bad actors for malicious objectives such as phishing and scamming. Similarly, close-source models also can pose similar risks if they are misused by bad actors. Circumvention of safety measures: As AI systems become increasingly sophisticated, there is a heightened risk that they may devise means to bypass the very protocols put in place to oversee or limit their actions. This is particularly worrisome because, while humans design these safety measures with specific intentions, an AI might interpret them differently or identify loopholes. As the wave of AI and automation continues its transformative journey across industries, it will have a disruptive impact on employment opportunities. This impact could make jobs better and more accessible to a broader proportion of the population, but also has the potential to increase inequality. On one hand, sectors reliant on routine tasks are confronted with potential impacts on jobs, while on the other hand, the rise of AI-driven enterprises might inadvertently magnify the chasm of economic inequality. However, it should be noted that these studies discuss exposure to AI. Exposure does not necessarily translate to loss of jobs as the market could expand. It is apparent that some jobs will be lost and others will be created, and in some instances lower-performing workers will be boosted by AI, supplementing their capabilities. The concern is that without proactively developing the ability to detect and address changes and disruptions, and without awareness of labor market trends, available educational upskilling programs, and policies such as wage insurance for workers preparing for new roles (especially in the rapidly changing environment), it is possible to witness stark increases in inequality even as productivity rises. But the challenges are not solely economic. Ethical and societal dilemmas are emerging at the forefront, with growing concerns about individual privacy, copyright infringement, and the increasing human dependence on these technologies. Content authenticity verification presents a significant challenge, heightening worries about deepfakes and misinformation, which could undermine democratic processes. As AI systems grow more powerful and potentially gain more sophisticated capabilities, concerns have been raised about the possibility that these technologies will cause significant disruptions. These can manifest in the form of threats to democracy, like meddling in the electoral process, national security threats such as bioweapons or cyberattacks, and societal disruptions via polarizing AI systems used in platforms like social media. It should be noted that there are differing opinions on the feasibility of superhuman capabilities of AI and whether the risks can be categorized as large-scale disruption and catastrophic. In addition, many of these risks are instances of AI used for malicious objectives, unintended consequences of AI systems, or economic and societal risks as mentioned in previous parts taken to their extreme. These risks include: Uncontrolled growth: As AI acquires more sophisticated capabilities, some have raised concerns that it could act unpredictably, making decisions or taking actions not fully understood by its developers. Destabilization of democracy: The improper and malevolent use of AI has the potential to critically destabilize democratic systems. For example, if AI is harnessed to meddle with electoral processes, this could undermine confidence in democratic processes. One of the most prominent concerns is the spread of misinformation and disinformation. Moreover, AI tools can also be employed for more direct manipulation of voter behavior. National security threats: Malicious inputs have the capacity to trick AI systems, leading to operational failures. Furthermore, when AI is integrated into realms like warfare, cyber-attacks, and bioweapons, it can both intensify conflicts and usher in unpredictable combat tactics. Manipulation and polarization: AI, such as those used in social media platforms, can manipulate information to increase user engagement, inadvertently leading to societal polarization and misinformation. As AI's potential grows, so do the complexities and concerns surrounding its assimilation into diverse societal sectors. Nonetheless, every hurdle also presents a chance to evolve and refine. This is especially true in the AI domain. Delving into potential resolutions and protective measures isn't merely scholarly; it's imperative to ensure AI is utilized ethically, responsibly, and safely for everyone's advantage in the future. It's essential to enforce transparency, ensuring users recognize when they are engaging with an AI rather than a human, especially in scenarios where trust and authenticity are paramount. Below are some of the mitigation strategies suggested by the experts. Adaptive regulation: There has been emphasis on the importance of regulating AI in a manner that's both agile and adaptive. Given that AI can evolve faster than legislative systems, regulations need to be flexible enough to address current and future risks. Regulations should also be designed based on input from multiple stakeholders: corporations, advocacy groups, academic leaders. It has been further suggested that risk should be associated with AI's uses, not the technology itself. Lastly, in light of the recent declaration about voluntary commitments, it has been suggested to make some of these commitments obligatory. Other possible suggestions include and possibly encompass third-party verification, registration, and licensing of certain AI systems. Research investment: It is paramount to invest in AI research. It has been suggested that the research should be segmented into public and classified. The public research involves conventional academic research that openly publishes findings on AI risk safety solutions. This research can further delve into the appropriate governance and regulation necessary to ensure public safety, providing valuable insights for policymakers aiming to regulate AI effectively. The classified research pertains to concentrating on counteractions against malevolent users of AI or inadvertent AI control losses with national security consequences. Furthermore, experts advocate for international research by fostering global collaborations among institutes. Research with humanity at its core: There's a dual need for both open academic research focusing on safety solutions and classified research that addresses potential threats from bad actors using AI or unintentional loss of control over AI. Multi-stakeholder approach: Experts highlight the significance of including various stakeholders like AI builders, users, and civil society in the process. Companies, in particular, should invest in AI governance and adopt internal ethics frameworks. International coordination: It's imperative to develop joint international collaboration, ensuring that potent AI tools are not misused. Collaborative efforts with various nations, including those beyond the traditional U.S. allies, will help ensure a cohesive global approach to AI usage and its associated risks. https://ai.gov/wp-content/uploads/2023/11/Findings_The-Potential-Future-Risks-of-AI.pdf ================ ======= Are there any benefits to using AI? Are there any dangers in using AI? If the answer is yes to either of these questions, create a list of answers for each question. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Internet/Technology,Summarize & Format,Text Transformation Only use information from the supplied context. Do not use outside information. Do not use extraneous text. Use bullets in at least some capacity to answer the questions. Your response should be under 100 words.,What are the five broad categories of business?,"Defining a successful business EVERY ENTREPRENEUR ASPIRES to create a successful business, and investors certainly want management to run successful businesses. So what determines whether a business is being successful? Before answering this question, it is helpful to define what a business is and the various forms it can take. A business is a commercial operation that provides products or services with the aim of making a profit for the benefit of its owners. The significant point is “for the benefit of its owners”, which differentiates it from a government or not-for-profit organisation, such as a charity, where the activity is conducted for the benefit of the people it serves. A profit is an essential element of running a successful business. It is a trading surplus whereby the revenues earned exceed the costs. This surplus belongs to the owners of the business to use as they choose: to take for themselves, to reinvest back in the business, or a mixture of the two. For a government organisation or charity, any surplus is reinvested in the activities to further benefit the people it serves. Business structure A business can take many forms, ranging from a sole trader to a large multinational company. The principal aim of making a profit for its owners is still the same. A person starting out and setting up a business will take all the risk and reward as the venture gets under way. As the business grows it can be advantageous to share the risk with others and separate the business activities from those of the owner by establishing a company. A company is a legal entity in its own right that is separate from its 2017 Guide Financial Management.indd 1 22/01/2018 13:36 2 guide to financial management owners. An investor is risking only the money paid for buying some shares in the company. If the company ceases trading, the shareholders (owners) are not liable to make up any shortfall between the value of the company’s assets and its liabilities. There are five broad categories of business: ■ Sole trader. Someone who sets up a business alone and takes all the risk and reward of running it, and who may employ staff. ■ Partnership. Two or more people who set up a business together. The partners have joint ownership and share the risk and reward of running the business. Like a sole trader they may employ staff. ■ Limited liability partnership (LLP). A hybrid of a partnership and a company which provides the owners with the limited risk of a company and the shared ownership and tax status of a partnership. ■ Private company. Usually a small organisation raising its money from a few private investors. The shares may be difficult to trade as they are not listed on any stock market. Investors’ liability in private and public companies is limited to the amount of their investment. ■ Public company. Typically a large organisation that is usually listed on a stock exchange. Because of its size it may require significant investment, and hence it may need to draw investment from many investors. In this book the focus is mainly on companies, though the principles can be equally well applied to a sole trader, a partnership and indeed not-for-profit organisations. The role of the board The directors of a company are people hired (and at times fired) by the shareholders to be stewards of their investment. However, they need to balance this with their primary fiduciary duty as a director, which is to act in the best interests of the company. Collectively, a board of directors has overall responsibility for running a company successfully. This is achieved by setting and implementing its strategy. 2017 Guide Financial Management.indd 2 22/01/2018 13:36 Defining a successful business 3 In fulfilling the strategic aims of the company, the board will be responsible for making sure not only that the company has the necessary resources in terms of investment, assets and people, but also that there are appropriate operating controls and procedures for managing business risk and making sure that all monies that flow through the business are properly accounted for. What is a successful business? The media love to report on successful entrepreneurs and tell of how they beat the odds as they built their business and became household names. The media also enjoy revelling in the collapse of mighty organisations and unpicking the journey to their downfall. So what is it that defines business success or failure? Many descriptions are used to describe success, including “the business is profitable”, “revenue is growing” and “the share price is rising”. All these attributes are elements of success, though individually they do not embrace the totality. To be successful in business is to “create a sustainable superior return on investment”. The core element of this definition is “return on investment” (ROI). The business, having been built from money provided by investors, has a responsibility to reward those investors for risking their money in the venture. The ROI is a measure of the reward being generated. The concept is similar to a savings account, where an amount of money is placed on deposit with a bank and the investor earns interest on it. Despite the banking crisis of 2008 and its aftermath, the investment in a savings account is still seen as low risk and consequently the return that the investor will make is similarly low. Therefore, if a deposit of $1,000 is placed in a bank and the gross interest earned over a year is $30, the ROI can be expressed as being 3%. For a business to be successful it needs to reward investors by making them wealthier than they would have been by putting their money in a savings account. Why should they accept the greater risk of investing in a business, with all the uncertainty it faces, if they are 2017 Guide Financial Management.indd 3 22/01/2018 13:36 4 guide to financial management not going to be any better off? The return that investors would require might be double or more than a savings account, depending on the perceived risk, which will be related to factors such as the nature and maturity of the business. The return in a business is derived from the profit it generates compared with the money invested to achieve that profit. Therefore, if investors place $1,000 in a business and the operating profit over a year is $200, the ROI can be expressed as being 20%. Some examples of the returns achieved by companies in 2016 and stated in their annual reports are Walmart (a retailer) 15.5%, ExxonMobil (an oil company) 3.9% and Anglo American (an international mining company) 11.0%. Generating a “superior” return is to achieve a ROI that is greater than the rate achieved by businesses running similar activities in similar markets, and so to be successful is to generate a return that is at least as good as that achieved by your competitors, but ideally better than them. A “sustainable” superior return is perhaps the most difficult objective to achieve. It means generating a superior rate of return year in, year out. A business may be flying high when its products or services are in fashion. But the fall can be swift when its products or services are no longer in vogue and the business has gone from producing superior returns to producing inferior ones. To be sustainable is to continuously develop the business proposition in a way that keeps customers buying the company’s products or services in preference to those of its competitors. Innovation, technology and cost reduction are all activities that can help maintain a sustainable return. For example, the returns generated by the mobile phone company Nokia in 2006 were almost 46%. They resulted from a pre-eminence in a growing market coupled with an ability to continue to introduce new technology and ignite passion for the company’s latest products. Subsequently, Nokia failed to offer leading technology and was late in offering smartphones. As a result, it lost customers and the superior returns declined; in 2012 Nokia reported losses of €2.3 billion and was finally bought by Microsoft in April 2014. At the same time as Nokia was declining, Apple, its American rival, was rising. The two companies’ ROI between 2006 and 2012 is shown in Figure 1.1. On creating a superior ROI the directors of a company have two choices. They can either distribute the wealth to the investors or retain it in the business. The second option depends on whether the directors can identify further investment opportunities that will create even more wealth in the future. Profits can be retained in a company while investment opportunities are identified. However, this is only in the short term as investors (particularly in public companies) will demand the cash be “earning or returning”. Wealth is created for investors in a business in two ways: ■ annual income – a distribution of profit to the investor (by way of a dividend); ■ capital growth – a reinvestment back in the business to increase its value (share price). Shareholder value The term “shareholder value” is also used to describe success. Two definitions of shareholder value are: ■ a concept that focuses strategic and operational decision-making on steadily increasing a company’s value for shareholders; ■ maximising shareholder benefit by focusing on raising company earnings and the share price. These definitions focus more on increasing the value of a business in the long term rather than delivering a profit in the short term. An example would be Amazon, one of the best-known online retailers, where the initial strategy was to invest in building the distribution network and customer base as the foundation of the business. Once customer numbers grew the profits would emerge. Throughout its early years the company was creating long-term value while making large losses. During this period Amazon’s share price was volatile as it reflected changing views on the future benefits that would arise for investors. For a mature business, an example would be its investment in research and development to provide the products and revenue streams of the future. This investment can create shareholder value because of the potential it is judged to provide. However, the danger is that success is built on a future promise, and in a fast-changing world the future is always uncertain. For example, AstraZeneca, a pharmaceutical company, had taken years to develop a new lung cancer drug only to find in July 2017 that the trials had failed: its share price fell 16% in one day. For a company that is quoted on a stock market, there is the expectation to achieve a sufficient ROI every year while also investing to create future value. Once the business has started to make profits, any performance that is worse than the previous year is likely to meet with an adverse reaction from analysts and investors, which in many instances can lead to a forced change of management. In February 2017 Unilever, a food company, defended a hostile bid from Kraft Foods on the basis that it would complete a “comprehensive review of options available to accelerate delivery of value for the benefit of our shareholders”. Like all other global companies, it battles to produce the ever more superior results that stockmarket investors look for. The details of the measures used to monitor ROI and shareholder value creation are explained in Chapter 14.","Only use information from the supplied context. Do not use outside information. Do not use extraneous text. Use bullets in at least some capacity to answer the questions. Your response should be under 100 words. What are the five broad categories of business? Defining a successful business EVERY ENTREPRENEUR ASPIRES to create a successful business, and investors certainly want management to run successful businesses. So what determines whether a business is being successful? Before answering this question, it is helpful to define what a business is and the various forms it can take. A business is a commercial operation that provides products or services with the aim of making a profit for the benefit of its owners. The significant point is “for the benefit of its owners”, which differentiates it from a government or not-for-profit organisation, such as a charity, where the activity is conducted for the benefit of the people it serves. A profit is an essential element of running a successful business. It is a trading surplus whereby the revenues earned exceed the costs. This surplus belongs to the owners of the business to use as they choose: to take for themselves, to reinvest back in the business, or a mixture of the two. For a government organisation or charity, any surplus is reinvested in the activities to further benefit the people it serves. Business structure A business can take many forms, ranging from a sole trader to a large multinational company. The principal aim of making a profit for its owners is still the same. A person starting out and setting up a business will take all the risk and reward as the venture gets under way. As the business grows it can be advantageous to share the risk with others and separate the business activities from those of the owner by establishing a company. A company is a legal entity in its own right that is separate from its 2017 Guide Financial Management.indd 1 22/01/2018 13:36 2 guide to financial management owners. An investor is risking only the money paid for buying some shares in the company. If the company ceases trading, the shareholders (owners) are not liable to make up any shortfall between the value of the company’s assets and its liabilities. There are five broad categories of business: ■ Sole trader. Someone who sets up a business alone and takes all the risk and reward of running it, and who may employ staff. ■ Partnership. Two or more people who set up a business together. The partners have joint ownership and share the risk and reward of running the business. Like a sole trader they may employ staff. ■ Limited liability partnership (LLP). A hybrid of a partnership and a company which provides the owners with the limited risk of a company and the shared ownership and tax status of a partnership. ■ Private company. Usually a small organisation raising its money from a few private investors. The shares may be difficult to trade as they are not listed on any stock market. Investors’ liability in private and public companies is limited to the amount of their investment. ■ Public company. Typically a large organisation that is usually listed on a stock exchange. Because of its size it may require significant investment, and hence it may need to draw investment from many investors. In this book the focus is mainly on companies, though the principles can be equally well applied to a sole trader, a partnership and indeed not-for-profit organisations. The role of the board The directors of a company are people hired (and at times fired) by the shareholders to be stewards of their investment. However, they need to balance this with their primary fiduciary duty as a director, which is to act in the best interests of the company. Collectively, a board of directors has overall responsibility for running a company successfully. This is achieved by setting and implementing its strategy. 2017 Guide Financial Management.indd 2 22/01/2018 13:36 Defining a successful business 3 In fulfilling the strategic aims of the company, the board will be responsible for making sure not only that the company has the necessary resources in terms of investment, assets and people, but also that there are appropriate operating controls and procedures for managing business risk and making sure that all monies that flow through the business are properly accounted for. What is a successful business? The media love to report on successful entrepreneurs and tell of how they beat the odds as they built their business and became household names. The media also enjoy revelling in the collapse of mighty organisations and unpicking the journey to their downfall. So what is it that defines business success or failure? Many descriptions are used to describe success, including “the business is profitable”, “revenue is growing” and “the share price is rising”. All these attributes are elements of success, though individually they do not embrace the totality. To be successful in business is to “create a sustainable superior return on investment”. The core element of this definition is “return on investment” (ROI). The business, having been built from money provided by investors, has a responsibility to reward those investors for risking their money in the venture. The ROI is a measure of the reward being generated. The concept is similar to a savings account, where an amount of money is placed on deposit with a bank and the investor earns interest on it. Despite the banking crisis of 2008 and its aftermath, the investment in a savings account is still seen as low risk and consequently the return that the investor will make is similarly low. Therefore, if a deposit of $1,000 is placed in a bank and the gross interest earned over a year is $30, the ROI can be expressed as being 3%. For a business to be successful it needs to reward investors by making them wealthier than they would have been by putting their money in a savings account. Why should they accept the greater risk of investing in a business, with all the uncertainty it faces, if they are 2017 Guide Financial Management.indd 3 22/01/2018 13:36 4 guide to financial management not going to be any better off? The return that investors would require might be double or more than a savings account, depending on the perceived risk, which will be related to factors such as the nature and maturity of the business. The return in a business is derived from the profit it generates compared with the money invested to achieve that profit. Therefore, if investors place $1,000 in a business and the operating profit over a year is $200, the ROI can be expressed as being 20%. Some examples of the returns achieved by companies in 2016 and stated in their annual reports are Walmart (a retailer) 15.5%, ExxonMobil (an oil company) 3.9% and Anglo American (an international mining company) 11.0%. Generating a “superior” return is to achieve a ROI that is greater than the rate achieved by businesses running similar activities in similar markets, and so to be successful is to generate a return that is at least as good as that achieved by your competitors, but ideally better than them. A “sustainable” superior return is perhaps the most difficult objective to achieve. It means generating a superior rate of return year in, year out. A business may be flying high when its products or services are in fashion. But the fall can be swift when its products or services are no longer in vogue and the business has gone from producing superior returns to producing inferior ones. To be sustainable is to continuously develop the business proposition in a way that keeps customers buying the company’s products or services in preference to those of its competitors. Innovation, technology and cost reduction are all activities that can help maintain a sustainable return. For example, the returns generated by the mobile phone company Nokia in 2006 were almost 46%. They resulted from a pre-eminence in a growing market coupled with an ability to continue to introduce new technology and ignite passion for the company’s latest products. Subsequently, Nokia failed to offer leading technology and was late in offering smartphones. As a result, it lost customers and the superior returns declined; in 2012 Nokia reported losses of €2.3 billion and was finally bought by Microsoft in April 2014. At the same time as Nokia was declining, Apple, its American rival, was rising. The two companies’ ROI between 2006 and 2012 is shown in Figure 1.1. On creating a superior ROI the directors of a company have two choices. They can either distribute the wealth to the investors or retain it in the business. The second option depends on whether the directors can identify further investment opportunities that will create even more wealth in the future. Profits can be retained in a company while investment opportunities are identified. However, this is only in the short term as investors (particularly in public companies) will demand the cash be “earning or returning”. Wealth is created for investors in a business in two ways: ■ annual income – a distribution of profit to the investor (by way of a dividend); ■ capital growth – a reinvestment back in the business to increase its value (share price). Shareholder value The term “shareholder value” is also used to describe success. Two definitions of shareholder value are: ■ a concept that focuses strategic and operational decision-making on steadily increasing a company’s value for shareholders; ■ maximising shareholder benefit by focusing on raising company earnings and the share price. These definitions focus more on increasing the value of a business in the long term rather than delivering a profit in the short term. An example would be Amazon, one of the best-known online retailers, where the initial strategy was to invest in building the distribution network and customer base as the foundation of the business. Once customer numbers grew the profits would emerge. Throughout its early years the company was creating long-term value while making large losses. During this period Amazon’s share price was volatile as it reflected changing views on the future benefits that would arise for investors. For a mature business, an example would be its investment in research and development to provide the products and revenue streams of the future. This investment can create shareholder value because of the potential it is judged to provide. However, the danger is that success is built on a future promise, and in a fast-changing world the future is always uncertain. For example, AstraZeneca, a pharmaceutical company, had taken years to develop a new lung cancer drug only to find in July 2017 that the trials had failed: its share price fell 16% in one day. For a company that is quoted on a stock market, there is the expectation to achieve a sufficient ROI every year while also investing to create future value. Once the business has started to make profits, any performance that is worse than the previous year is likely to meet with an adverse reaction from analysts and investors, which in many instances can lead to a forced change of management. In February 2017 Unilever, a food company, defended a hostile bid from Kraft Foods on the basis that it would complete a “comprehensive review of options available to accelerate delivery of value for the benefit of our shareholders”. Like all other global companies, it battles to produce the ever more superior results that stockmarket investors look for. The details of the measures used to monitor ROI and shareholder value creation are explained in Chapter 14.",Financial,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",I want my case thrown out. The man that is representing me comes to court drunk and has mishandled evidence needed to acquit me. How can I get the judge to throw it out and expunge my record in Texas?,"Can the Judge Dismiss a Case in Texas? Written by The Law Office of David White PLLC: Austin Criminal Lawyer, reviewed by David D. White May 18, 2024 can the judge dismiss a case Yes, the decision to dismiss a criminal case can lie within the discretion of the judge overseeing the proceedings. So can the judge dismiss a case in Texas?, well a case dismissal occurs when the court ends legal proceedings prematurely, effectively terminating the case before reaching a verdict. This can happen at any stage of the legal process, from the initial filing of charges to the trial itself. A dismissal is the optimal outcome for the defendant, as it means the case is dropped and no further action is taken. However, it’s essential to note that a dismissal does not mean the charge or arrest or citation are expunged from your record. For the best chance of having charges dismissed in your criminal case or obtaining another favorable outcome, discuss your case with an Austin Criminal Defense Lawyer now. What is a Case Dismissal? A criminal case dismissal by a judge occurs when a judge determines that there is not enough evidence to proceed with the case or that the prosecution has failed to meet its burden of proof beyond a reasonable doubt. A dismissal does not necessarily mean that the defendant is innocent or that they did not commit the alleged offense. Instead, it reflects the judge’s determination that the evidence presented by the prosecution is not sufficient to proceed with the case. In some instances, a dismissal may also occur if there are procedural errors or violations of the defendant’s constitutional rights. If you are facing criminal charges, you need a skilled attorney who can aggressively advocate for your rights and work toward the best possible outcome for your case. An experienced criminal defense attorney can assess the strength of the evidence against you, identify potential weaknesses in the prosecution’s case, and present persuasive arguments to the judge in support of a dismissal. Remember, each case is different and will require its own strategic defense tailored to your specific circumstances. Part of your defense lawyer’s job is to determine whether there are grounds for dismissal and take appropriate action, so you want a skilled attorney working on your case as soon as possible. Seeking a Dismissal from the Judge in Criminal Court Judges have the authority to dismiss cases, but they only do so under certain circumstances. They consider the facts presented, evaluate legal arguments, and assess the overall fairness and integrity of the case. Ultimately, the judge’s primary responsibility is to administer justice and ensure the proper functioning of the legal system. However, a judge will not review a case for errors or deficiencies on their own. Instead, your criminal defense lawyer will need to petition the court to dismiss the case by filing a proper motion. This motion must set forth the facts and arguments supporting the dismissal. Motion practice in a criminal case involves complicated legal requirements and procedures. You need an experienced defense attorney on board in your case right away, so they can identify any grounds for a possible dismissal and file persuasive motions with the court. If My Case is Dismissed, Will it Still Be in my File? While a case dismissal can be a favorable outcome, it’s important to understand that it does not automatically erase the charges from your record. In Texas, dismissed cases are typically still part of your criminal record, but they may be eligible for expunction or nondisclosure in certain circumstances. Expunction completely removes the record of the case, as if it never happened, while nondisclosure limits access to the record by most employers and the public. To determine if your case is eligible for expunction or nondisclosure, it is advisable to consult with an experienced Austin criminal defense attorney who can guide you through the process. You Need a Tough, Skilled Criminal Defense Lawyer in Austin, Texas Navigating the legal system can be overwhelming, especially when you’re hoping for a case dismissal in Texas. That’s where The Law Office of David D. White: Austin Criminal Lawyer comes in. Our experienced Austin criminal defense attorneys are dedicated to helping individuals like you overcome legal challenges and achieve the best possible outcome. To get the answers you need and start building your defense, contact our offices today and schedule a free, no-pressure consultation. David D. White","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I want my case thrown out. The man that is representing me comes to court drunk and has mishandled evidence needed to acquit me. How can I get the judge to throw it out and expunge my record in Texas? Can the Judge Dismiss a Case in Texas? Written by The Law Office of David White PLLC: Austin Criminal Lawyer, reviewed by David D. White May 18, 2024 can the judge dismiss a case Yes, the decision to dismiss a criminal case can lie within the discretion of the judge overseeing the proceedings. So can the judge dismiss a case in Texas?, well a case dismissal occurs when the court ends legal proceedings prematurely, effectively terminating the case before reaching a verdict. This can happen at any stage of the legal process, from the initial filing of charges to the trial itself. A dismissal is the optimal outcome for the defendant, as it means the case is dropped and no further action is taken. However, it’s essential to note that a dismissal does not mean the charge or arrest or citation are expunged from your record. For the best chance of having charges dismissed in your criminal case or obtaining another favorable outcome, discuss your case with an Austin Criminal Defense Lawyer now. What is a Case Dismissal? A criminal case dismissal by a judge occurs when a judge determines that there is not enough evidence to proceed with the case or that the prosecution has failed to meet its burden of proof beyond a reasonable doubt. A dismissal does not necessarily mean that the defendant is innocent or that they did not commit the alleged offense. Instead, it reflects the judge’s determination that the evidence presented by the prosecution is not sufficient to proceed with the case. In some instances, a dismissal may also occur if there are procedural errors or violations of the defendant’s constitutional rights. If you are facing criminal charges, you need a skilled attorney who can aggressively advocate for your rights and work toward the best possible outcome for your case. An experienced criminal defense attorney can assess the strength of the evidence against you, identify potential weaknesses in the prosecution’s case, and present persuasive arguments to the judge in support of a dismissal. Remember, each case is different and will require its own strategic defense tailored to your specific circumstances. Part of your defense lawyer’s job is to determine whether there are grounds for dismissal and take appropriate action, so you want a skilled attorney working on your case as soon as possible. Seeking a Dismissal from the Judge in Criminal Court Judges have the authority to dismiss cases, but they only do so under certain circumstances. They consider the facts presented, evaluate legal arguments, and assess the overall fairness and integrity of the case. Ultimately, the judge’s primary responsibility is to administer justice and ensure the proper functioning of the legal system. However, a judge will not review a case for errors or deficiencies on their own. Instead, your criminal defense lawyer will need to petition the court to dismiss the case by filing a proper motion. This motion must set forth the facts and arguments supporting the dismissal. Motion practice in a criminal case involves complicated legal requirements and procedures. You need an experienced defense attorney on board in your case right away, so they can identify any grounds for a possible dismissal and file persuasive motions with the court. If My Case is Dismissed, Will it Still Be in my File? While a case dismissal can be a favorable outcome, it’s important to understand that it does not automatically erase the charges from your record. In Texas, dismissed cases are typically still part of your criminal record, but they may be eligible for expunction or nondisclosure in certain circumstances. Expunction completely removes the record of the case, as if it never happened, while nondisclosure limits access to the record by most employers and the public. To determine if your case is eligible for expunction or nondisclosure, it is advisable to consult with an experienced Austin criminal defense attorney who can guide you through the process. You Need a Tough, Skilled Criminal Defense Lawyer in Austin, Texas Navigating the legal system can be overwhelming, especially when you’re hoping for a case dismissal in Texas. That’s where The Law Office of David D. White: Austin Criminal Lawyer comes in. Our experienced Austin criminal defense attorneys are dedicated to helping individuals like you overcome legal challenges and achieve the best possible outcome. To get the answers you need and start building your defense, contact our offices today and schedule a free, no-pressure consultation. David D. White https://www.wm-attorneys.com/can-the-judge-dismiss-a-case/#:~:text=A%20criminal%20case%20dismissal%20by,proof%20beyond%20a%20reasonable%20doubt.",Legal,Fact Finding,Q&A Your response must solely be based on the prompt. External resources and prior knowledge must not be used.,Summarize this.,"On March 18, 2022, the Department of Justice (DOJ), the agency mainly charged with enforcing the ADA, issued nonbinding web accessibility guidance for public accommodations (covered under ADA’sTitle III) and local governments (under ADA’s Title II). The guidance addresses, among other things, how public accommodations can make accessible the goods and services they offer online, although it does not provide detailed standards. The guidance offers a one-page summary of how to make a website accessible, emphasizing website providers’ “flexibility in how they comply.” WCAG and the federal government's Section 508 rules for its own websites are cited as “helpful guidance.” The limited 2022 guidance contrasts with the DOJ’s efforts in years past. In 2010, DOJ published an Advance Notice of Proposed Rulemaking providing detailed standards for website accessibility. Then, in 2017, it withdrew its regulatory proposals for websites, stating that it was “evaluating whether promulgating regulations about the accessibility of Web information and services is necessary and appropriate.” Aside from referring to WCAG and Section 508 guidelines, the 2022 DOJ guidance lists specific accessibility features web providers must consider. These include color contrast in text; text alternatives(descriptions of visual features that a screen reader can announce); captions for visual access to audio content; labels and other formatting for online forms; keyboard navigation; and a way to report accessibility issues. The DOJ guidance emphasizes that its summary “is not a complete list of things to consider.” And especially when it comes to ","Your response must solely be based on the prompt. External resources and prior knowledge must not be used. Summarize this. On March 18, 2022, the Department of Justice (DOJ), the agency mainly charged with enforcing the ADA, issued nonbinding web accessibility guidance for public accommodations (covered under ADA’sTitle III) and local governments (under ADA’s Title II). The guidance addresses, among other things, how public accommodations can make accessible the goods and services they offer online, although it does not provide detailed standards. The guidance offers a one-page summary of how to make a website accessible, emphasizing website providers’ “flexibility in how they comply.” WCAG and the federal government's Section 508 rules for its own websites are cited as “helpful guidance.” The limited 2022 guidance contrasts with the DOJ’s efforts in years past. In 2010, DOJ published an Advance Notice of Proposed Rulemaking providing detailed standards for website accessibility. Then, in 2017, it withdrew its regulatory proposals for websites, stating that it was “evaluating whether promulgating regulations about the accessibility of Web information and services is necessary and appropriate.” Aside from referring to WCAG and Section 508 guidelines, the 2022 DOJ guidance lists specific accessibility features web providers must consider. These include color contrast in text; text alternatives(descriptions of visual features that a screen reader can announce); captions for visual access to audio content; labels and other formatting for online forms; keyboard navigation; and a way to report accessibility issues. The DOJ guidance emphasizes that its summary “is not a complete list of things to consider.” And especially when it comes to ",Legal,Concept Comparison,Q&A "In your answer, refer only to the context document. Do not employ any outside knowledge","Based on the provided context, what are some ways the City of Stronghold helps small businesses?","**Small Business Startup/Management Guide** The Strongsville Business Startup & Management Guide Section Page # Small Business Readiness Assessment Tool……1 Small Business Planning Resources………...….2 State & County Financing Programs..………….3 Opportunities Within the City of Strongsville….4 Northeast Ohio Technology Incubators………...5 Workforce Development & Export Assistance…6 Additional Resources…………………………...7 Contact Information…………………...………..8 Entrepreneurship and small business development are critical to the sustainability of any community and the City of Strongsville is committed to helping local business men and women succeed through the challenge of starting and maintaining a small business. This document is designed to be a start-up guide rich with resources to help you on your journey to business ownership. I hope you find the following information helpful and please do not hesitate to contact me if I can be of assistance. Brent Painter Director of Economic Development City of Strongsville (440) 580-3118 brent.painter@strongsville.org i. Table of Contents Small Business Readiness Assessment Tool (SBAT) Developed by the Small Business Administration (SBA), the Small Business Readiness Assessment Tool (SBAT) is an interactive questionnaire developed to assess an entrepreneur’s readiness to start a business. Questions within the SBAT are designed to evaluate the user’s skills, personal characteristics, and experience in relation to their preparedness to start a business. After the questionnaire is completed the results are tallied and an assessment profile is provided. The user is also supplied a statement of “Suggested Next Steps” and links to free online courses and counseling. To complete the Small Business Readiness Assessment Tool please select the web address below: https://eweb1.sba.gov/cams/training/business_primer/assessment.htm *The SBAT is an automated self-assessment tool. None of the information provided is collected, tabulated, or utilized by the SBA or any other organization. 1 Starting a small business is a risk. Studies reveal that the common causes of business failure, in particular small business, are:  Poor Location  Lack of Research Regarding Market Potential  Over Optimistic Business Plans  Poor evaluation of Competition  Lack of Unique Selling Proposition (USP)  Lack of Marketing Expertise  Conflict with Partners  Failure to Put Forth Required Time and Effort  Insufficient Capital to Grow the Business  Inefficient Employees Careful planning and the utilization of available expertise are essential to the success of any new business. The first step within the planning process is to assess the entrepreneur’s readiness to expend the necessary resources to create and grow a prosperous small business. Small Business Readiness State of Ohio’s 1st Stop Business Connection (614) 466-4232 At the 1st Stop Business Connection website an entrepreneur will be guided through a six step process that will help them create a free business information kit containing state-level instructions regarding starting a business in Ohio. The business information kit includes:  A checklist detailing State of Ohio requirements & regulations for the specified industry  Instructions for applying for an Employer Identification Number (EIN)  Business name registration instructions  Workers Compensation information  And more One-on-One Small Business Counseling The Cleveland Small Business Administration (SBA) Office (216) 522-4180 The Small Business Administration is a federal government agency that was created to aid, counsel, assist, and protect the interests of small businesses, preserve free competitive enterprise, and maintain and strengthen the overall U.S. economy. The Cleveland SBA Office assists entrepreneurs through training, counseling, and business development programs including loan guaranties. For further detail on the Cleveland SBA please select the link listed below: www.sba.gov/localresources/district/oh/cleveland/index.html The Small Business Development Center (SBDC) of Cleveland (216) 987-2969 The Small Business Development Center of Cleveland is a division of the Ohio Department of Development whose mission is to contribute to the economic growth in the Greater Cleveland market by providing a one-stop business information portal and hands-on education throughout the entire lifecycle of a small business. To learn more about the Cleveland SBDC and schedule an appointment for free counseling please visit the link listed below: www.entrepreneurohio.org/center.aspx?center=17087&subloc=1 2 Small Business Planning Resources 3 JobsOhio (614) 224-6446 JobsOhio offers a wide range of financing options for companies looking to start, relocate, and expand within Ohio. To learn more about JobsOhio and State Incentive Programs please select the link listed below: https://www.jobsohio.com/ State of Ohio: Treasurer’s Office (614) 466-2160 The Treasurer’s GrowNOW interest rate reduction program is designed to help small businesses grow by providing them with critical cash flow. When a business is approved for a loan from one of the hundreds of eligible banks in Ohio, GrowNOW provides an additional three percent discount on the loan’s already negotiated interest rate, when the loan is linked to creating or saving jobs in Ohio. Select the link listed below to learn more regarding the Ohio Treasurer’s GrowNOW Program: tos.ohio.gov/grownow Cuyahoga County: Department of Development (216) 443-7260 The Cuyahoga County Department of Development offers various financing opportunities designed to create local business growth and enhanced employment opportunities within Cuyahoga County. Select the link listed below to learn more regarding the Cuyahoga County’s assistance programs: http://development.cuyahogacounty.us/en-US/Economic-Development-Programs.aspx State & County Financing Programs 4 Available Property Database The City of Strongsville, Department of Economic Development, maintains an available properties database to assist in the site selection process. Users can research available industrial & commercial land as well as retail, office, and industrial space within existing buildings. To view available properties within Strongsville please select the link listed below: www.strongsville.org/departments/economic-development/available-properties Tax Incentives The City of Strongsville has various tax incentive programs designed to benefit businesses who are relocating to Strongsville and expanding within the region. To review available tax incentives and eligibility requirements please select the link listed below: www.strongsville.org/departments/economic-development/tax-incentives The Strongsville Corporate Relocation Guide & Community Profile The Strongsville Corporate Relocation Guide & Community Profile describes the pro-business environment within the city and provides site selectors with the information most often requested. To download the Strongsville Corporate Relocation Guide select the link listed below: www.strongsville.org/departments/economic-development Demographics & Site Selector Resources Located on www.strongsville.org, the Demographics & Site Selectors Resources webpage provides information regarding demographic data, business & workforce reports, and specifics regarding the City of Strongsville, including distance to major markets, largest employers, and city traffic counts. To learn more select the link below: www.strongsville.org/departments/economic-development/community-profile *To relocate your business to Strongsville contact Brent Painter, Director of Economic Development, at (440) 580-3118 or at brent.painter@strongsville.org www.strongsville.org The City of Strongsville 5 Manufacturing Advocacy & Growth Network (MAGNET) www.magnetwork.org 1768 East 25th Street Cleveland, Ohio 44114 (216) 432-4197 Great Lakes Incubator for Developing Enterprises (GLIDE) www.glideit.org 151 Innovation Drive, Suite 210 (Located at Lorain County Community College) Elyria, Ohio 44035 (440) 366-4310 Braintree Partners www.braintreepartners.org 201 East Fifth Street, Suite 100 Mansfield, Ohio 44901 (419) 525-1614 The Akron Global Business Accelerator www.akronaccelerator.com 526 South Main Street Akron, Ohio 44311 (330) 375-2173 Youngstown Business Incubator (YBI) www.ybi.org 241 Federal Plaza West Youngstown, Ohio 44503 (330) 746-5003 Jumpstart, Inc. www.jumpstartinc.org 737 Bolivar Road, Suite 3000 Cleveland, Ohio 44115 (216) 363-3400 The Northeast Ohio Edison Technology Incubator Program is designed to assist technology-oriented start-ups during their concept definition & development stages. A list of local incubators can be found below. Northeast Ohio’s Incubators 6 Export Assistance U.S. Export Assistance Cleveland Office The Cleveland U.S. Export Assistance Center (USEAC) is a division of the U.S. Depart of Commerce and provide comprehensive solutions to international trade challenges through expert counseling. To review the services and programs provided by the USEAC please visit the website listed below: www.export.gov/ohio/northernohio/ International Trade Assistance Center The International Trade Assistance Center (ITAC) provides export assistance services to small and medium sized businesses in order to promote growth through exports. To learn more about ITAC select the link listed below: www.csuohio.edu/business/global/international-trade-assistance-center Ohio Development Services Agency: Global Markets Division With 7 international offices, the Ohio Development Services Agency’s Global Markets Division’s goal is to develop new relationships in foreign countries that will benefit the export strategies of Ohio’s businesses. Select the link listed below to learn more about the Global Markets Division: http://development.ohio.gov/bs/bs_globalohio.htm Workforce Development OhioMeansJobs OhioMeansJobs is a collaborative workforce system within Cuyahoga County that helps local employers meet their human capital needs and assists job seekers in finding success. To learn more about OhioMeansJobs please select the link below: www.ohiomeansjobs.com Cuyahoga Community College Corporate College Cuyahoga Community College offers Northeast Ohio companies affordable, cutting-edge training programs that can be custom-designed to accommodate an employers workforce development needs through the Corporate College. To learn more about the Corporate College please select the link listed below: www.corporatecollege.com Polaris Career Center The Polaris Career Center Adult Education Department offers comprehensive education and training services. For more details please click the link listed below: www.polaris.edu/adult-education/ Workforce Development & Export Assistance ","{question} ========== Based on the provided context, what are some ways the City of Stronghold helps small businesses? ---------- {task instructions} ========== In your answer, refer only to the context document. Do not employ any outside knowledge ---------- {passage} ========== **Small Business Startup/Management Guide** The Strongsville Business Startup & Management Guide Section Page # Small Business Readiness Assessment Tool……1 Small Business Planning Resources………...….2 State & County Financing Programs..………….3 Opportunities Within the City of Strongsville….4 Northeast Ohio Technology Incubators………...5 Workforce Development & Export Assistance…6 Additional Resources…………………………...7 Contact Information…………………...………..8 Entrepreneurship and small business development are critical to the sustainability of any community and the City of Strongsville is committed to helping local business men and women succeed through the challenge of starting and maintaining a small business. This document is designed to be a start-up guide rich with resources to help you on your journey to business ownership. I hope you find the following information helpful and please do not hesitate to contact me if I can be of assistance. Brent Painter Director of Economic Development City of Strongsville (440) 580-3118 brent.painter@strongsville.org i. Table of Contents Small Business Readiness Assessment Tool (SBAT) Developed by the Small Business Administration (SBA), the Small Business Readiness Assessment Tool (SBAT) is an interactive questionnaire developed to assess an entrepreneur’s readiness to start a business. Questions within the SBAT are designed to evaluate the user’s skills, personal characteristics, and experience in relation to their preparedness to start a business. After the questionnaire is completed the results are tallied and an assessment profile is provided. The user is also supplied a statement of “Suggested Next Steps” and links to free online courses and counseling. To complete the Small Business Readiness Assessment Tool please select the web address below: https://eweb1.sba.gov/cams/training/business_primer/assessment.htm *The SBAT is an automated self-assessment tool. None of the information provided is collected, tabulated, or utilized by the SBA or any other organization. 1 Starting a small business is a risk. Studies reveal that the common causes of business failure, in particular small business, are:  Poor Location  Lack of Research Regarding Market Potential  Over Optimistic Business Plans  Poor evaluation of Competition  Lack of Unique Selling Proposition (USP)  Lack of Marketing Expertise  Conflict with Partners  Failure to Put Forth Required Time and Effort  Insufficient Capital to Grow the Business  Inefficient Employees Careful planning and the utilization of available expertise are essential to the success of any new business. The first step within the planning process is to assess the entrepreneur’s readiness to expend the necessary resources to create and grow a prosperous small business. Small Business Readiness State of Ohio’s 1st Stop Business Connection (614) 466-4232 At the 1st Stop Business Connection website an entrepreneur will be guided through a six step process that will help them create a free business information kit containing state-level instructions regarding starting a business in Ohio. The business information kit includes:  A checklist detailing State of Ohio requirements & regulations for the specified industry  Instructions for applying for an Employer Identification Number (EIN)  Business name registration instructions  Workers Compensation information  And more One-on-One Small Business Counseling The Cleveland Small Business Administration (SBA) Office (216) 522-4180 The Small Business Administration is a federal government agency that was created to aid, counsel, assist, and protect the interests of small businesses, preserve free competitive enterprise, and maintain and strengthen the overall U.S. economy. The Cleveland SBA Office assists entrepreneurs through training, counseling, and business development programs including loan guaranties. For further detail on the Cleveland SBA please select the link listed below: www.sba.gov/localresources/district/oh/cleveland/index.html The Small Business Development Center (SBDC) of Cleveland (216) 987-2969 The Small Business Development Center of Cleveland is a division of the Ohio Department of Development whose mission is to contribute to the economic growth in the Greater Cleveland market by providing a one-stop business information portal and hands-on education throughout the entire lifecycle of a small business. To learn more about the Cleveland SBDC and schedule an appointment for free counseling please visit the link listed below: www.entrepreneurohio.org/center.aspx?center=17087&subloc=1 2 Small Business Planning Resources 3 JobsOhio (614) 224-6446 JobsOhio offers a wide range of financing options for companies looking to start, relocate, and expand within Ohio. To learn more about JobsOhio and State Incentive Programs please select the link listed below: https://www.jobsohio.com/ State of Ohio: Treasurer’s Office (614) 466-2160 The Treasurer’s GrowNOW interest rate reduction program is designed to help small businesses grow by providing them with critical cash flow. When a business is approved for a loan from one of the hundreds of eligible banks in Ohio, GrowNOW provides an additional three percent discount on the loan’s already negotiated interest rate, when the loan is linked to creating or saving jobs in Ohio. Select the link listed below to learn more regarding the Ohio Treasurer’s GrowNOW Program: tos.ohio.gov/grownow Cuyahoga County: Department of Development (216) 443-7260 The Cuyahoga County Department of Development offers various financing opportunities designed to create local business growth and enhanced employment opportunities within Cuyahoga County. Select the link listed below to learn more regarding the Cuyahoga County’s assistance programs: http://development.cuyahogacounty.us/en-US/Economic-Development-Programs.aspx State & County Financing Programs 4 Available Property Database The City of Strongsville, Department of Economic Development, maintains an available properties database to assist in the site selection process. Users can research available industrial & commercial land as well as retail, office, and industrial space within existing buildings. To view available properties within Strongsville please select the link listed below: www.strongsville.org/departments/economic-development/available-properties Tax Incentives The City of Strongsville has various tax incentive programs designed to benefit businesses who are relocating to Strongsville and expanding within the region. To review available tax incentives and eligibility requirements please select the link listed below: www.strongsville.org/departments/economic-development/tax-incentives The Strongsville Corporate Relocation Guide & Community Profile The Strongsville Corporate Relocation Guide & Community Profile describes the pro-business environment within the city and provides site selectors with the information most often requested. To download the Strongsville Corporate Relocation Guide select the link listed below: www.strongsville.org/departments/economic-development Demographics & Site Selector Resources Located on www.strongsville.org, the Demographics & Site Selectors Resources webpage provides information regarding demographic data, business & workforce reports, and specifics regarding the City of Strongsville, including distance to major markets, largest employers, and city traffic counts. To learn more select the link below: www.strongsville.org/departments/economic-development/community-profile *To relocate your business to Strongsville contact Brent Painter, Director of Economic Development, at (440) 580-3118 or at brent.painter@strongsville.org www.strongsville.org The City of Strongsville 5 Manufacturing Advocacy & Growth Network (MAGNET) www.magnetwork.org 1768 East 25th Street Cleveland, Ohio 44114 (216) 432-4197 Great Lakes Incubator for Developing Enterprises (GLIDE) www.glideit.org 151 Innovation Drive, Suite 210 (Located at Lorain County Community College) Elyria, Ohio 44035 (440) 366-4310 Braintree Partners www.braintreepartners.org 201 East Fifth Street, Suite 100 Mansfield, Ohio 44901 (419) 525-1614 The Akron Global Business Accelerator www.akronaccelerator.com 526 South Main Street Akron, Ohio 44311 (330) 375-2173 Youngstown Business Incubator (YBI) www.ybi.org 241 Federal Plaza West Youngstown, Ohio 44503 (330) 746-5003 Jumpstart, Inc. www.jumpstartinc.org 737 Bolivar Road, Suite 3000 Cleveland, Ohio 44115 (216) 363-3400 The Northeast Ohio Edison Technology Incubator Program is designed to assist technology-oriented start-ups during their concept definition & development stages. A list of local incubators can be found below. Northeast Ohio’s Incubators 6 Export Assistance U.S. Export Assistance Cleveland Office The Cleveland U.S. Export Assistance Center (USEAC) is a division of the U.S. Depart of Commerce and provide comprehensive solutions to international trade challenges through expert counseling. To review the services and programs provided by the USEAC please visit the website listed below: www.export.gov/ohio/northernohio/ International Trade Assistance Center The International Trade Assistance Center (ITAC) provides export assistance services to small and medium sized businesses in order to promote growth through exports. To learn more about ITAC select the link listed below: www.csuohio.edu/business/global/international-trade-assistance-center Ohio Development Services Agency: Global Markets Division With 7 international offices, the Ohio Development Services Agency’s Global Markets Division’s goal is to develop new relationships in foreign countries that will benefit the export strategies of Ohio’s businesses. Select the link listed below to learn more about the Global Markets Division: http://development.ohio.gov/bs/bs_globalohio.htm Workforce Development OhioMeansJobs OhioMeansJobs is a collaborative workforce system within Cuyahoga County that helps local employers meet their human capital needs and assists job seekers in finding success. To learn more about OhioMeansJobs please select the link below: www.ohiomeansjobs.com Cuyahoga Community College Corporate College Cuyahoga Community College offers Northeast Ohio companies affordable, cutting-edge training programs that can be custom-designed to accommodate an employers workforce development needs through the Corporate College. To learn more about the Corporate College please select the link listed below: www.corporatecollege.com Polaris Career Center The Polaris Career Center Adult Education Department offers comprehensive education and training services. For more details please click the link listed below: www.polaris.edu/adult-education/ Workforce Development & Export Assistance ",Unknown,Find & Summarize,Text Transformation Use information from the article only to explain your answer. Do not rely on outside knowledge.,What are three advantages of Trusts when planning your estate?,"Raymond James & Associates, Inc. Tandy G. Lewis, CFP®, WMS Managing Director, Investments 333 Texas Street, Suite 175 Shreveport, LA 71101 318-677-5518 866-297-6576 tandy.lewis@raymondjames.com https://bowenlewis.com Estate Planning Basics April 26, 2016 Estate Planning--An Introduction By definition, estate planning is a process designed to help you manage and preserve your assets while you are alive, and to conserve and control their distribution after your death according to your goals and objectives. But what estate planning means to you specifically depends on who you are. Your age, health, wealth, lifestyle, life stage, goals, and many other factors determine your particular estate planning needs. For example, you may have a small estate and may be concerned only that certain people receive particular things. A simple will is probably all you'll need. Or, you may have a large estate, and minimizing any potential estate tax impact is your foremost goal. Here, you'll need to use more sophisticated techniques in your estate plan, such as a trust. To help you understand what estate planning means to you, the following sections address some estate planning needs that are common among some very broad groups of individuals. Think of these suggestions as simply a point in the right direction, and then seek professional advice to implement the right plan for you. Over 18 Since incapacity can strike anyone at anytime, all adults over 18 should consider having: • A durable power of attorney: This document lets you name someone to manage your property for you in case you become incapacitated and cannot do so. • An advanced medical directive: The three main types of advanced medical directives are (1) a living will, (2) a durable power of attorney for health care (also known as a health-care proxy), and (3) a Do Not Resuscitate order. Be aware that not all states allow each kind of medical directive, so make sure you execute one that will be effective for you. Young and single If you're young and single, you may not need much estate planning. But if you have some material possessions, you should at least write a will. If you don't, the wealth you leave behind if you die will likely go to your parents, and that might not be what you would want. A will lets you leave your possessions to anyone you choose (e.g., your significant other, siblings, other relatives, or favorite charity). Unmarried couples You've committed to a life partner but aren't legally married. For you, a will is essential if you want your property to pass to your partner at your death. Without a will, state law directs that only your closest relatives will inherit your property, and your partner may get nothing. If you share certain property, such as a house or car, you might consider owning the property as joint tenants with rights of survivorship. That way, when one of you dies, the jointly held property will pass to the surviving partner automatically. Married couples For many years, married couples had to do careful estate planning, such as the creation of a credit shelter trust, in order to take advantage of their combined federal estate tax exclusions. A new law passed in 2010 allows the executor of a deceased spouse's estate to transfer any unused estate tax exclusion amount to the surviving spouse without such planning. This provision is effective for estates of decedents dying in 2011 and later years. You may be inclined to rely on these portability rules for estate tax avoidance, using outright bequests to your spouse instead of traditional trust planning. However, portability should not be relied upon solely for utilization of the first to die's estate tax exemption, and a credit shelter trust created at the first spouse's death may still be advantageous for several reasons: • Portability may be lost if the surviving spouse remarries and is later widowed again • The trust can protect any appreciation of assets from estate tax at the second spouse's death • The trust can provide protection of assets from the reach of the surviving spouse's creditors • Portability does not apply to the generation-skipping transfer (GST) tax, so the trust may be needed to fully leverage the GST exemptions of both spouses Married couples where one spouse is not a U.S. citizen have special planning concerns. The marital deduction is not allowed if the recipient spouse is a non-citizen spouse, but a $148,000 (in 2016, $147,000 in 2015) annual exclusion is allowed. If certain requirements By definition, estate planning is a process designed to help you manage and preserve your assets while you are alive, and to conserve and control their distribution after your death according to your goals and objectives. Page 2 of 7, see disclaimer on final page are met, however, a transfer to a qualified domestic trust (QDOT) will qualify for the marital deduction. Married with children If you're married and have children, you and your spouse should each have your own will. For you, wills are vital because you can name a guardian for your minor children in case both of you die simultaneously. If you fail to name a guardian in your will, a court may appoint someone you might not have chosen. Furthermore, without a will, some states dictate that at your death some of your property goes to your children and not to your spouse. If minor children inherit directly, the surviving parent will need court permission to manage the money for them. You may also want to consult an attorney about establishing a trust to manage your children's assets. You may also need life insurance. Your surviving spouse may not be able to support the family on his or her own and may need to replace your earnings to maintain the family. Comfortable and looking forward to retirement You've accumulated some wealth and you're thinking about retirement. Here's where estate planning overlaps with retirement planning. It's just as important to plan to care for yourself during your retirement as it is to plan to provide for your beneficiaries after your death. You should keep in mind that even though Social Security may be around when you retire, those benefits alone may not provide enough income for your retirement years. Wealthy and worried Depending on the size of your estate, you may need to be concerned about estate taxes. Estates of $5,450,000 (in 2016, $5,430,000 in 2015) are effectively exempt from the federal gift and estate tax. Estates over that amount may be subject to the tax at a top rate of 40 percent. Similarly, there is another tax, called the generation-skipping transfer (GST) tax, that is imposed on transfers of wealth that are made to grandchildren (and lower generations). The GST tax exemption is $5,450,000 (in 2016, $5,430,000 in 2015) and the GST tax rate is 40 percent. Whether your estate will be subject to state death taxes depends on the size of your estate and the tax laws in effect in the state in which you are domiciled. Elderly or ill If you're elderly or ill, you'll want to write a will or update your existing one, consider a revocable living trust, and make sure you have a durable power of attorney and a health-care directive. Talk with your family about your wishes, and make sure they have copies of your important papers or know where to locate them. Consider saving some of your accumulated wealth using other retirement and deferred vehicles, such as an individual retirement account (IRA). Page 3 of 7, see disclaimer on final page Steps to Estate Planning Success Estate Planning Pyramid Page 4 of 7, see disclaimer on final page Advantages of Trusts Why you might consider discussing trusts with your attorney • Trusts may be used to minimize estate taxes for married individuals with substantial assets. • Trusts provide management assistance for your heirs.* • Contingent trusts for minors (which take effect in the event that both parents die) may be used to avoid the costs of having a court-appointed guardian to manage your children's assets. • Properly funded trusts avoid many of the administrative costs of probate (e.g., attorney fees, document filing fees). • Generally, revocable living trusts will keep the distribution of your estate private. • Trusts can be used to dispense income to • Trusts can ensure that assets go to your intended beneficiaries. For example, if you have children from a prior marriage you can make sure that they, as well as a current spouse, are provided for. • Trusts can minimize income taxes by allowing the shifting of income among beneficiaries. • Properly structured irrevocable life insurance trusts can provide liquidity for estate settlement needs while removing the policy proceeds from estate taxation at the death of the insured. *This is particularly important for minors and incapacitated adults who may need support, maintenance, and/or education over a long period of time, or for adults who have difficulty managing money. intermediate beneficiaries (e.g., children, elderly parents) before final property distribution. Conducting a Periodic Review of Your Estate Plan With your estate plan successfully implemented, one final but critical step remains: carrying out a periodic review and update. Imagine this: since you implemented your estate plan five years ago, you got divorced and remarried, sold your house and bought a boat to live on, sold your legal practice and invested the money that provides you with enough income so you no longer have to work, and reconciled with your estranged daughter. This scenario may look more like fantasy than reality, but imagine how these major changes over a five-year period may affect your estate. And that's without considering changes in tax laws, the stock market, the economic climate, or other external factors. After all, if the only constant is change, it isn't unreasonable to speculate that your wishes have changed, the advantages you sought have eroded or vanished, or even that new opportunities now exist that could offer a better value for your estate. A periodic review can give you peace of mind. When should you conduct a review of your estate plan? Every year for large estates Those of you with large estates (i.e., more than the federal or your state's exemption amount, whichever is smaller) should review your plan annually or at certain life events that are suggested in the following paragraphs. Not a year goes by without significant changes in the tax laws. You need to stay on top of these to get the best results. Every five years for small estates Those of you with smaller estates (under the applicable exclusion amount) need only review every five years or following changes in your life events. Your estate will not be as affected by economic factors and changes in the tax laws as a larger estate might be. However, your personal situation is bound to change, and reviewing every five years will bring your plan up to date with your current situation. Upon changes in estate valuation If the value of your estate has changed more than 20 percent over the last two years, you may need to update your estate plan. Upon economic changes You need to review your estate plan if there has been a change in the value of your assets or your income level or requirements, or if you are retiring. What is a trust? A trust is a legal entity that is created for the purpose of transferring property to a trustee for the benefit of a third person (beneficiary). The trustee manages the property for the beneficiary according to the terms specified in the trust With your estate plan successfully implemented, one final but critical step remains: carrying out a periodic review and update. Page 5 of 7, see disclaimer on final page Upon changes in occupation or employment If you or your spouse changed jobs, you may need to make revisions in your estate plan. Upon changes in family situations You need to update your plan if: (1) your (or your children's or grandchildren's) marital status has changed, (2) a child (or grandchild) has been born or adopted, (3) your spouse, child, or grandchild has died, (4) you or a close family member has become ill or incapacitated, or (5) other individuals (e.g., your parents) have become dependent on you. Upon changes in your closely held business interest A review is in order if you have: (1) formed, purchased, or sold a closely held business, (2) reorganized or liquidated a closely held business, (3) instituted a pension plan, (4) executed a buy-sell agreement, (5) deferred compensation, or (6) changed employee benefits. Upon changes in the estate plan Of course, if you make a change in part of your estate plan (e.g., create a trust, execute a codicil, etc.), you should review the estate plan as a whole to ensure that it remains cohesive and effective. Upon major transactions Be sure to check your plan if you have: (1) Upon changes in insurance coverage Making changes in your insurance coverage may change your estate planning needs or may make changes necessary. Therefore, inform your estate planning advisor if you make any change to life insurance, health insurance, disability insurance, medical insurance, liability insurance, or beneficiary designations. Upon death of trustee/executor/guardian If a designated trustee, executor, or guardian dies or changes his or her mind about serving, you need to revise the parts of your estate plan affected (e.g., the trust agreement and your will) to replace that individual. Upon other important changes None of us has a crystal ball. We can't think of all the conditions that should prompt us to review and revise our estate plans. Use your common sense. Have your feelings about charity changed? Has your son finally become financially responsible? Has your spouse's health been declining? Are your children through college now? All you need to do is give it a little thought from time to time, and take action when necessary. received a sizable inheritance, bequest, or similar disposition, (2) made or received substantial gifts, (3) borrowed or lent substantial amounts of money, (4) purchased, leased, or sold material assets or investments, (5) changed residences, (6) changed significant property ownership, or (7) become involved in a lawsuit. Page 6 of 7, see disclaimer on final page Raymond James & Associates, Inc. Tandy G. Lewis, CFP®, WMS Managing Director, Investments 333 Texas Street, Suite 175 Shreveport, LA 71101 318-677-5518 866-297-6576 tandy.lewis@raymondjames.com https://bowenlewis.com April 26, 2016 Prepared by Broadridge Investor Communication Solutions, Inc. Copyright 2016 This information was developed by Broadridge, an independent third party. It is general in nature, is not a complete statement of all information necessary for making an investment decision, and is not a recommendation or a solicitation to buy or sell any security. Investments and strategies mentioned may not be suitable for all investors. Past performance may not be indicative of future results. Raymond James & Associates, Inc. member New York Stock Exchange/SIPC does not provide advice on tax, legal or mortgage issues. These matters should be discussed with an appropriate professional. Page 7 of 7 ","Use information from the article only to explain your answer. Do not rely on outside knowledge. What are three advantages of Trusts when planning your estate? Raymond James & Associates, Inc. Tandy G. Lewis, CFP®, WMS Managing Director, Investments 333 Texas Street, Suite 175 Shreveport, LA 71101 318-677-5518 866-297-6576 tandy.lewis@raymondjames.com https://bowenlewis.com Estate Planning Basics April 26, 2016 Estate Planning--An Introduction By definition, estate planning is a process designed to help you manage and preserve your assets while you are alive, and to conserve and control their distribution after your death according to your goals and objectives. But what estate planning means to you specifically depends on who you are. Your age, health, wealth, lifestyle, life stage, goals, and many other factors determine your particular estate planning needs. For example, you may have a small estate and may be concerned only that certain people receive particular things. A simple will is probably all you'll need. Or, you may have a large estate, and minimizing any potential estate tax impact is your foremost goal. Here, you'll need to use more sophisticated techniques in your estate plan, such as a trust. To help you understand what estate planning means to you, the following sections address some estate planning needs that are common among some very broad groups of individuals. Think of these suggestions as simply a point in the right direction, and then seek professional advice to implement the right plan for you. Over 18 Since incapacity can strike anyone at anytime, all adults over 18 should consider having: • A durable power of attorney: This document lets you name someone to manage your property for you in case you become incapacitated and cannot do so. • An advanced medical directive: The three main types of advanced medical directives are (1) a living will, (2) a durable power of attorney for health care (also known as a health-care proxy), and (3) a Do Not Resuscitate order. Be aware that not all states allow each kind of medical directive, so make sure you execute one that will be effective for you. Young and single If you're young and single, you may not need much estate planning. But if you have some material possessions, you should at least write a will. If you don't, the wealth you leave behind if you die will likely go to your parents, and that might not be what you would want. A will lets you leave your possessions to anyone you choose (e.g., your significant other, siblings, other relatives, or favorite charity). Unmarried couples You've committed to a life partner but aren't legally married. For you, a will is essential if you want your property to pass to your partner at your death. Without a will, state law directs that only your closest relatives will inherit your property, and your partner may get nothing. If you share certain property, such as a house or car, you might consider owning the property as joint tenants with rights of survivorship. That way, when one of you dies, the jointly held property will pass to the surviving partner automatically. Married couples For many years, married couples had to do careful estate planning, such as the creation of a credit shelter trust, in order to take advantage of their combined federal estate tax exclusions. A new law passed in 2010 allows the executor of a deceased spouse's estate to transfer any unused estate tax exclusion amount to the surviving spouse without such planning. This provision is effective for estates of decedents dying in 2011 and later years. You may be inclined to rely on these portability rules for estate tax avoidance, using outright bequests to your spouse instead of traditional trust planning. However, portability should not be relied upon solely for utilization of the first to die's estate tax exemption, and a credit shelter trust created at the first spouse's death may still be advantageous for several reasons: • Portability may be lost if the surviving spouse remarries and is later widowed again • The trust can protect any appreciation of assets from estate tax at the second spouse's death • The trust can provide protection of assets from the reach of the surviving spouse's creditors • Portability does not apply to the generation-skipping transfer (GST) tax, so the trust may be needed to fully leverage the GST exemptions of both spouses Married couples where one spouse is not a U.S. citizen have special planning concerns. The marital deduction is not allowed if the recipient spouse is a non-citizen spouse, but a $148,000 (in 2016, $147,000 in 2015) annual exclusion is allowed. If certain requirements By definition, estate planning is a process designed to help you manage and preserve your assets while you are alive, and to conserve and control their distribution after your death according to your goals and objectives. Page 2 of 7, see disclaimer on final page are met, however, a transfer to a qualified domestic trust (QDOT) will qualify for the marital deduction. Married with children If you're married and have children, you and your spouse should each have your own will. For you, wills are vital because you can name a guardian for your minor children in case both of you die simultaneously. If you fail to name a guardian in your will, a court may appoint someone you might not have chosen. Furthermore, without a will, some states dictate that at your death some of your property goes to your children and not to your spouse. If minor children inherit directly, the surviving parent will need court permission to manage the money for them. You may also want to consult an attorney about establishing a trust to manage your children's assets. You may also need life insurance. Your surviving spouse may not be able to support the family on his or her own and may need to replace your earnings to maintain the family. Comfortable and looking forward to retirement You've accumulated some wealth and you're thinking about retirement. Here's where estate planning overlaps with retirement planning. It's just as important to plan to care for yourself during your retirement as it is to plan to provide for your beneficiaries after your death. You should keep in mind that even though Social Security may be around when you retire, those benefits alone may not provide enough income for your retirement years. Wealthy and worried Depending on the size of your estate, you may need to be concerned about estate taxes. Estates of $5,450,000 (in 2016, $5,430,000 in 2015) are effectively exempt from the federal gift and estate tax. Estates over that amount may be subject to the tax at a top rate of 40 percent. Similarly, there is another tax, called the generation-skipping transfer (GST) tax, that is imposed on transfers of wealth that are made to grandchildren (and lower generations). The GST tax exemption is $5,450,000 (in 2016, $5,430,000 in 2015) and the GST tax rate is 40 percent. Whether your estate will be subject to state death taxes depends on the size of your estate and the tax laws in effect in the state in which you are domiciled. Elderly or ill If you're elderly or ill, you'll want to write a will or update your existing one, consider a revocable living trust, and make sure you have a durable power of attorney and a health-care directive. Talk with your family about your wishes, and make sure they have copies of your important papers or know where to locate them. Consider saving some of your accumulated wealth using other retirement and deferred vehicles, such as an individual retirement account (IRA). Page 3 of 7, see disclaimer on final page Steps to Estate Planning Success Estate Planning Pyramid Page 4 of 7, see disclaimer on final page Advantages of Trusts Why you might consider discussing trusts with your attorney • Trusts may be used to minimize estate taxes for married individuals with substantial assets. • Trusts provide management assistance for your heirs.* • Contingent trusts for minors (which take effect in the event that both parents die) may be used to avoid the costs of having a court-appointed guardian to manage your children's assets. • Properly funded trusts avoid many of the administrative costs of probate (e.g., attorney fees, document filing fees). • Generally, revocable living trusts will keep the distribution of your estate private. • Trusts can be used to dispense income to • Trusts can ensure that assets go to your intended beneficiaries. For example, if you have children from a prior marriage you can make sure that they, as well as a current spouse, are provided for. • Trusts can minimize income taxes by allowing the shifting of income among beneficiaries. • Properly structured irrevocable life insurance trusts can provide liquidity for estate settlement needs while removing the policy proceeds from estate taxation at the death of the insured. *This is particularly important for minors and incapacitated adults who may need support, maintenance, and/or education over a long period of time, or for adults who have difficulty managing money. intermediate beneficiaries (e.g., children, elderly parents) before final property distribution. Conducting a Periodic Review of Your Estate Plan With your estate plan successfully implemented, one final but critical step remains: carrying out a periodic review and update. Imagine this: since you implemented your estate plan five years ago, you got divorced and remarried, sold your house and bought a boat to live on, sold your legal practice and invested the money that provides you with enough income so you no longer have to work, and reconciled with your estranged daughter. This scenario may look more like fantasy than reality, but imagine how these major changes over a five-year period may affect your estate. And that's without considering changes in tax laws, the stock market, the economic climate, or other external factors. After all, if the only constant is change, it isn't unreasonable to speculate that your wishes have changed, the advantages you sought have eroded or vanished, or even that new opportunities now exist that could offer a better value for your estate. A periodic review can give you peace of mind. When should you conduct a review of your estate plan? Every year for large estates Those of you with large estates (i.e., more than the federal or your state's exemption amount, whichever is smaller) should review your plan annually or at certain life events that are suggested in the following paragraphs. Not a year goes by without significant changes in the tax laws. You need to stay on top of these to get the best results. Every five years for small estates Those of you with smaller estates (under the applicable exclusion amount) need only review every five years or following changes in your life events. Your estate will not be as affected by economic factors and changes in the tax laws as a larger estate might be. However, your personal situation is bound to change, and reviewing every five years will bring your plan up to date with your current situation. Upon changes in estate valuation If the value of your estate has changed more than 20 percent over the last two years, you may need to update your estate plan. Upon economic changes You need to review your estate plan if there has been a change in the value of your assets or your income level or requirements, or if you are retiring. What is a trust? A trust is a legal entity that is created for the purpose of transferring property to a trustee for the benefit of a third person (beneficiary). The trustee manages the property for the beneficiary according to the terms specified in the trust With your estate plan successfully implemented, one final but critical step remains: carrying out a periodic review and update. Page 5 of 7, see disclaimer on final page Upon changes in occupation or employment If you or your spouse changed jobs, you may need to make revisions in your estate plan. Upon changes in family situations You need to update your plan if: (1) your (or your children's or grandchildren's) marital status has changed, (2) a child (or grandchild) has been born or adopted, (3) your spouse, child, or grandchild has died, (4) you or a close family member has become ill or incapacitated, or (5) other individuals (e.g., your parents) have become dependent on you. Upon changes in your closely held business interest A review is in order if you have: (1) formed, purchased, or sold a closely held business, (2) reorganized or liquidated a closely held business, (3) instituted a pension plan, (4) executed a buy-sell agreement, (5) deferred compensation, or (6) changed employee benefits. Upon changes in the estate plan Of course, if you make a change in part of your estate plan (e.g., create a trust, execute a codicil, etc.), you should review the estate plan as a whole to ensure that it remains cohesive and effective. Upon major transactions Be sure to check your plan if you have: (1) Upon changes in insurance coverage Making changes in your insurance coverage may change your estate planning needs or may make changes necessary. Therefore, inform your estate planning advisor if you make any change to life insurance, health insurance, disability insurance, medical insurance, liability insurance, or beneficiary designations. Upon death of trustee/executor/guardian If a designated trustee, executor, or guardian dies or changes his or her mind about serving, you need to revise the parts of your estate plan affected (e.g., the trust agreement and your will) to replace that individual. Upon other important changes None of us has a crystal ball. We can't think of all the conditions that should prompt us to review and revise our estate plans. Use your common sense. Have your feelings about charity changed? Has your son finally become financially responsible? Has your spouse's health been declining? Are your children through college now? All you need to do is give it a little thought from time to time, and take action when necessary. received a sizable inheritance, bequest, or similar disposition, (2) made or received substantial gifts, (3) borrowed or lent substantial amounts of money, (4) purchased, leased, or sold material assets or investments, (5) changed residences, (6) changed significant property ownership, or (7) become involved in a lawsuit. Page 6 of 7, see disclaimer on final page Raymond James & Associates, Inc. Tandy G. Lewis, CFP®, WMS Managing Director, Investments 333 Texas Street, Suite 175 Shreveport, LA 71101 318-677-5518 866-297-6576 tandy.lewis@raymondjames.com https://bowenlewis.com April 26, 2016 Prepared by Broadridge Investor Communication Solutions, Inc. Copyright 2016 This information was developed by Broadridge, an independent third party. It is general in nature, is not a complete statement of all information necessary for making an investment decision, and is not a recommendation or a solicitation to buy or sell any security. Investments and strategies mentioned may not be suitable for all investors. Past performance may not be indicative of future results. Raymond James & Associates, Inc. member New York Stock Exchange/SIPC does not provide advice on tax, legal or mortgage issues. These matters should be discussed with an appropriate professional. Page 7 of 7 ",Financial,Find & Summarize,Text Transformation Only use the provided text to respond. Do not use any outside sources.,What are the two options for license plate size?,"Be it enacted by the Legislature of the State of Arizona: 2 Section 1. Section 28-2351, Arizona Revised Statutes, is amended to 3 read: 4 28-2351. License plate provided; design 5 A. Notwithstanding any other law, the department shall provide to 6 every owner one license plate for each vehicle registered. At the request 7 of the owner and on payment of a fee in an amount prescribed by the 8 director by rule, the department shall provide one additional license 9 plate for a vehicle for which a special plate is requested pursuant to 10 this chapter. 11 B. The license plate shall display the number assigned to the 12 vehicle and to the owner of the vehicle and the name of this state, which 13 may be abbreviated. The director shall coat the license plate with a 14 reflective material that is consistent with the determination of the 15 department regarding the color and design of license plates and special 16 plates. The director shall design the license plate and the letters and 17 numerals on the license plate to be of sufficient size to be plainly 18 readable during daylight from a distance of one hundred feet. In addition 19 to the standard license plate issued for a trailer before August 12, 2005, 20 the director shall issue a license plate for trailers that has a design 21 that is similar to the standard size license plate for trailers but that 22 is the same size as the license plate for motorcycles. The trailer owner 23 shall notify the department which size license plate the owner wants for 24 the trailer. 25 C. In addition to the requirements PRESCRIBED in subsection B of 26 this section, for all license plates, including all special plates, that 27 are designed or redesigned on or after September 24, 2022: 28 1. The background color of the license plate shall contrast 29 significantly with the color of the letters and numerals on the license 30 plate and with the name of this state on the license plate. 31 2. The name of this state shall appear on the license plate in 32 capital letters in sans serif font and be three-fourths of an inch in 33 height. 34 D. Notwithstanding any other law, the department shall not contract 35 with a nongovernmental entity to purchase or secure reflective material 36 for the plates issued by the department unless the department has made a 37 reasonable effort to secure qualified bids or proposals from as many 38 individual responsible respondents as possible. ","Only use the provided text to respond. Do not use any outside sources. Be it enacted by the Legislature of the State of Arizona: 2 Section 1. Section 28-2351, Arizona Revised Statutes, is amended to 3 read: 4 28-2351. License plate provided; design 5 A. Notwithstanding any other law, the department shall provide to 6 every owner one license plate for each vehicle registered. At the request 7 of the owner and on payment of a fee in an amount prescribed by the 8 director by rule, the department shall provide one additional license 9 plate for a vehicle for which a special plate is requested pursuant to 10 this chapter. 11 B. The license plate shall display the number assigned to the 12 vehicle and to the owner of the vehicle and the name of this state, which 13 may be abbreviated. The director shall coat the license plate with a 14 reflective material that is consistent with the determination of the 15 department regarding the color and design of license plates and special 16 plates. The director shall design the license plate and the letters and 17 numerals on the license plate to be of sufficient size to be plainly 18 readable during daylight from a distance of one hundred feet. In addition 19 to the standard license plate issued for a trailer before August 12, 2005, 20 the director shall issue a license plate for trailers that has a design 21 that is similar to the standard size license plate for trailers but that 22 is the same size as the license plate for motorcycles. The trailer owner 23 shall notify the department which size license plate the owner wants for 24 the trailer. 25 C. In addition to the requirements PRESCRIBED in subsection B of 26 this section, for all license plates, including all special plates, that 27 are designed or redesigned on or after September 24, 2022: 28 1. The background color of the license plate shall contrast 29 significantly with the color of the letters and numerals on the license 30 plate and with the name of this state on the license plate. 31 2. The name of this state shall appear on the license plate in 32 capital letters in sans serif font and be three-fourths of an inch in 33 height. 34 D. Notwithstanding any other law, the department shall not contract 35 with a nongovernmental entity to purchase or secure reflective material 36 for the plates issued by the department unless the department has made a 37 reasonable effort to secure qualified bids or proposals from as many 38 individual responsible respondents as possible. What are the two options for license plate size?",Legal,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Give me a bullet-point timeline showing how Vuori has grown over the past ten years. Keep each bullet point under 20 words, and be sure to mention how their product line has changed over the years.","Vuori, The Athleisure Brand Valued At $4 Billion, Is Halfway To Opening 100 Stores By 2026 Say athleisurewear and one name comes immediately to mind: Lululemon. For athletic wear, one name dominates the conversation, NikeNKE -1%, with honorable mention to Adidas and Puma. Vuori is far behind the leaders in both realms, but then the market share leaders had a big head start. Joe Kudla founded Vuori only in 2014, while Lululemon got started in 1998 and Nike back in 1964. But Vuori aims to become a brand as big if not bigger than those market leaders: “Vuori wants to be a relevant household name 20 years from now. We have no interest in growing really, really fast just to hit some number and then falling out of favor with consumers or having a major quality issue,” Kudla shared with Retail Dive. Slow And Steady Wins The Race Kudla has followed a methodical path to growth by correcting mistakes and filling whitespace left by the big guys. That strategy propelled it forward fast to reach a valuation of $4 billion in late 2021 after receiving $400 million in venture funding by Softback Investment Advisors and Trinity West Venture, according to Pitchbook. Now, Bloomberg reports it is considering an IPO this year, though the company has not confirmed the rumors. Nonetheless, Kudla has accomplished much with Vuori in its ten short years. Before becoming an entrepreneur, he was working as an accountant and had little fashion experience, though he did a modeling stint for a few years, which gave him a passion for the business. It was as an athlete, particularly his mountain climbing experience, where he found the business opportunity: filling the performance gap in men’s athletic apparel. And the company’s name came from those roots: Vuori is the Finnish word for “mountain.” The brand’s first product was a simple pair of men’s shorts made from super-soft, high-quality fabrics that look good enough to wear around town, but also provide support and wick away moisture when running the track. And whether in town or on the track, the shorts were super-comfortable to wear. Vuori became an instant hit with athletes who valued its superior quality and didn’t want to be a walking – or running – billboard for another brand. By year two, it was generating $1 million in DTC revenues and even more remarkable for a startup, it was profitable, credited to Kudla’s accounting background that kept him fixated on the books. “We never acquired a customer at a loss,” Kudla shared with Fast Company. “We were hyper-focused on cash flow, and getting the unit economics of a transaction profitable.” Reaching Further Growing buzz about the brand put it on REI’s radar, which after testing it in a few stores, found such strong customer affinity that it put it into more than 150 locations. By 2018, Vuori was generating upwards of $30 million in sales, much of it coming from wholesale distribution, which generates less revenue than DTC but gives a brand credibility and added exposure by having a respected retailer choose to carry it. Currently, it’s retail partners include NordstromJWN -1.3%, Selfridges, Harrods, Equinox Gyms, Barry’s Bootcamp and numerous specialty independent retailers. It was also in 2018 that Vuori launched into women’s apparel, reaching the other half of the athletic apparel market, estimated at $158 billion in North America in 2023 and expected to grow 6% CAGR through 2027, according to McKinsey. That combined with opening its first store in hometown Encinitas, CA got the brand’s flywheel humming. Currently, it operates over 50 stores in 17 states and internationally in London, Shanghai and Seoul, up from just four in 2019 all located in California. Plans are to open 20 to 25 stores over the next two or so years to reach 100 by 2026. Tasked with that mission is vice president of retail Catherine Pike who joined the company in 2019. A lawyer by training, Pike came from fitness franchiser Fit4Mom where she led franchise operations and before that, she spent eight years with Lululemon, rising from local store to regional manager.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Give me a bullet-point timeline showing how Vuori has grown over the past ten years. Keep each bullet point under 20 words, and be sure to mention how their product line has changed over the years. {passage 0} ========== Vuori, The Athleisure Brand Valued At $4 Billion, Is Halfway To Opening 100 Stores By 2026 Say athleisurewear and one name comes immediately to mind: Lululemon. For athletic wear, one name dominates the conversation, NikeNKE -1%, with honorable mention to Adidas and Puma. Vuori is far behind the leaders in both realms, but then the market share leaders had a big head start. Joe Kudla founded Vuori only in 2014, while Lululemon got started in 1998 and Nike back in 1964. But Vuori aims to become a brand as big if not bigger than those market leaders: “Vuori wants to be a relevant household name 20 years from now. We have no interest in growing really, really fast just to hit some number and then falling out of favor with consumers or having a major quality issue,” Kudla shared with Retail Dive. Slow And Steady Wins The Race Kudla has followed a methodical path to growth by correcting mistakes and filling whitespace left by the big guys. That strategy propelled it forward fast to reach a valuation of $4 billion in late 2021 after receiving $400 million in venture funding by Softback Investment Advisors and Trinity West Venture, according to Pitchbook. Now, Bloomberg reports it is considering an IPO this year, though the company has not confirmed the rumors. Nonetheless, Kudla has accomplished much with Vuori in its ten short years. Before becoming an entrepreneur, he was working as an accountant and had little fashion experience, though he did a modeling stint for a few years, which gave him a passion for the business. It was as an athlete, particularly his mountain climbing experience, where he found the business opportunity: filling the performance gap in men’s athletic apparel. And the company’s name came from those roots: Vuori is the Finnish word for “mountain.” The brand’s first product was a simple pair of men’s shorts made from super-soft, high-quality fabrics that look good enough to wear around town, but also provide support and wick away moisture when running the track. And whether in town or on the track, the shorts were super-comfortable to wear. Vuori became an instant hit with athletes who valued its superior quality and didn’t want to be a walking – or running – billboard for another brand. By year two, it was generating $1 million in DTC revenues and even more remarkable for a startup, it was profitable, credited to Kudla’s accounting background that kept him fixated on the books. “We never acquired a customer at a loss,” Kudla shared with Fast Company. “We were hyper-focused on cash flow, and getting the unit economics of a transaction profitable.” Reaching Further Growing buzz about the brand put it on REI’s radar, which after testing it in a few stores, found such strong customer affinity that it put it into more than 150 locations. By 2018, Vuori was generating upwards of $30 million in sales, much of it coming from wholesale distribution, which generates less revenue than DTC but gives a brand credibility and added exposure by having a respected retailer choose to carry it. Currently, it’s retail partners include NordstromJWN -1.3%, Selfridges, Harrods, Equinox Gyms, Barry’s Bootcamp and numerous specialty independent retailers. It was also in 2018 that Vuori launched into women’s apparel, reaching the other half of the athletic apparel market, estimated at $158 billion in North America in 2023 and expected to grow 6% CAGR through 2027, according to McKinsey. That combined with opening its first store in hometown Encinitas, CA got the brand’s flywheel humming. Currently, it operates over 50 stores in 17 states and internationally in London, Shanghai and Seoul, up from just four in 2019 all located in California. Plans are to open 20 to 25 stores over the next two or so years to reach 100 by 2026. Tasked with that mission is vice president of retail Catherine Pike who joined the company in 2019. A lawyer by training, Pike came from fitness franchiser Fit4Mom where she led franchise operations and before that, she spent eight years with Lululemon, rising from local store to regional manager. https://www.forbes.com/sites/pamdanziger/2024/02/25/vuori-the-athleisure-brand-valued-at-4-billion-is-halfway-to-opening-100-stores-by-2026/",Financial,Summarize & Format,Text Transformation You may only answer questions based solely on the information in the context block. You may not use any external sources or knowledge.,What does a positive Stemmer sign indicate?,"CLINICAL MANIFESTATIONS OF LIPEDEMA It is defined as a chronic disease that predominantly affects women and it is normally first noticed at puberty, pregnancy or menopause1,15. In 97% of the cases lipedema is located in lower limbs and in 31% in upper extremities14 . Patients present a symmetrical and abnormal increase of adipose tissue from the hips, involving the buttocks as well as the regions of thigh and calf (Figure 1c). The enlargement of the lower limbs is disproportionate in relation to the upper part of the body16 . Patients complain that edema in lower limbs may worsen in the afternoon or evening and increased swelling is often related to the orthostasis and heat with an increased sensitivity to pain and appearance of spontaneous or minimal trauma-induced bruising. Other symptoms include plantar arch abnormalities, cold skin and spontaneous pain. As lipedema progresses a significant volume excess is associated, and the occurrence of hip and knee joint damage that lead to orthopedic disorders adds gait alterations thus complicating the patient’s life (Figure 4d). In severe stages, the lymphatic system becomes decompensated to various degrees and it can also associate uni- or rather bilateral lymphedema that can be suspected with the swelling of the dorsum of the foot, a positive Stemmer sign (the inability to pinch a fold of skin at the base of the second toe due to thickening of the skin and subcutaneous tissues) or deep skin folds. The combination of lymphatic insufficiency and lipedema is called lipolymphedema or lympholipedema depending on the terminology (Figure 2). Concomitance with severe venous insufficiency is rare; however, varicosity is often seen among lipedematous patients17. We must bear in mind that lipedema is often combined with obesity and the clinical diagnosis may be confused as lipedema sufferers are commonly heavily overweight. ","System instruction: [You may only answer questions based solely on the information in the context block. You may not use any external sources or knowledge.] question: [What does a positive Stemmer sign indicate?] context block: [CLINICAL MANIFESTATIONS OF LIPEDEMA It is defined as a chronic disease that predominantly affects women and it is normally first noticed at puberty, pregnancy or menopause1,15. In 97% of the cases lipedema is located in lower limbs and in 31% in upper extremities14 . Patients present a symmetrical and abnormal increase of adipose tissue from the hips, involving the buttocks as well as the regions of thigh and calf (Figure 1c). The enlargement of the lower limbs is disproportionate in relation to the upper part of the body16 . Patients complain that edema in lower limbs may worsen in the afternoon or evening and increased swelling is often related to the orthostasis and heat with an increased sensitivity to pain and appearance of spontaneous or minimal trauma-induced bruising. Other symptoms include plantar arch abnormalities, cold skin and spontaneous pain. As lipedema progresses a significant volume excess is associated, and the occurrence of hip and knee joint damage that lead to orthopedic disorders adds gait alterations thus complicating the patient’s life (Figure 4d). In severe stages, the lymphatic system becomes decompensated to various degrees and it can also associate uni- or rather bilateral lymphedema that can be suspected with the swelling of the dorsum of the foot, a positive Stemmer sign (the inability to pinch a fold of skin at the base of the second toe due to thickening of the skin and subcutaneous tissues) or deep skin folds. The combination of lymphatic insufficiency and lipedema is called lipolymphedema or lympholipedema depending on the terminology (Figure 2). Concomitance with severe venous insufficiency is rare; however, varicosity is often seen among lipedematous patients17. We must bear in mind that lipedema is often combined with obesity and the clinical diagnosis may be confused as lipedema sufferers are commonly heavily overweight. ]",Medical,Find & Summarize,Text Transformation This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge.,Give me a summary of the events that led to Bed Bath & Beyond's cash flow problems.,"The company has avoided a bankruptcy filing for now by completing a complex stock offering that will give it an immediate injection of $225 million in funds and a pledge for $800 million in the future to pay down its current debt load. Bed Bath & Beyond is also shrinking to save money. The company said it plans to close around 400 of its roughly 760 Bed Bath & Beyond stores. It will keep open its most profitable stores in key markets. The moves are a lifeline for Bed Bath & Beyond. They will give the company time to pursue a turnaround without a bankruptcy filing, which can be costly, out of its control and wind up in a liquidation. “They are essentially doing a reorganization outside of bankruptcy court,” said Daniel Gielchinsky, an attorney at DGIM Law specializing in bankruptcy. “Slow the cash burn is the name of the game for the next 6 to 12 months and allow the company to pivot into a profitable position.” It will be a complicated turnaround and the company’s future remains uncertain. If Bed Bath & Beyond comes up short in the current version of its turnaround plan, the likelihood of a liquidation increases. Here’s how Bed Bath & Beyond, once a retailer pioneer, veered to the edge of bankruptcy and where it turns next. Superstore era Bed Bath & Beyond had been a crown jewel of the era of so-called “category killers”: chains that dominated a category of retail, such as Toys “R” Us, Circuit City and Sports Authority. Those companies, too, ultimately filed for bankruptcy. Bed Bath & Beyond became known for pots and pans, towels and bedding stacked from the floor to the ceilings at its cavernous stores — and for its ubiquitous 20%-off coupons. The blue-and-white coupons became something of a pop culture symbol, and millions of Americans wound up stashing them away in their cars, closets and basements. The retailer attracted a broad range of customers by selling name brands at cut-rate prices. Brands coveted a spot on Bed Bath & Beyond’s shelves, knowing it would lead to big sales. Plus, the open-store layout encouraged impulse buying: Shoppers would come in to buy new dishes and walk out with pillows, towels and other items. Stores were a fixture for shoppers around the winter holidays and during the back-to-school and college seasons, and Bed Bath & Beyond also had a strong baby and wedding registry business. Founded in 1971 by two veterans of discount retail in Springfield, New Jersey, the chain of small linen and bath stores — then called Bed ‘n Bath — first grew around the northeast and in California selling designer bedding, a new trend at the time. Unlike department stores, it didn’t rely on sales events to draw customers. “We had witnessed the department store shakeout and knew that specialty stores were going to be the next wave of retailing,” co-founder Leonard Feinstein reportedly said in 1993. “It was the beginning of the designer approach to linens and housewares and we saw a real window of opportunity.” In 1987, the company changed its name to Bed Bath & Beyond to reflect its expanded merchandise and bigger “superstores.” The company went public in 1992 with 38 stores and around $200 million in sales. By 2000, those figures leaped to 241 stores and $1.1 billion in sales. The 1,000th Bed Bath & Beyond store opened in 2009, when the chain had reached $7.8 billion in sales. The company was something of an iconoclast. It spent little on advertising, relying instead on print coupons distributed in weekly newspapers to attract customers. “Why not just tell the customer that we’ll give you a discount on the item you want — and not the one that we want to put on sale? We’ll mail a coupon, and it will be a lot cheaper,” Bed Bath & Beyond co-founder Warren Eisenberg, now 92, said in a 2020 New York Times interview. The chain was known for giving autonomy to store managers to decide which products to stock, allowing them to customize their individual stores, and for shipping products directly to stores instead of a central warehouse. The rise of e-commerce But as brick-and-mortar began to give way to e-commerce, Bed Bath & Beyond was slow to make the transition — a misstep compounded by the fact that home decor is one of the most commonly bought categories online. “We missed the boat on the internet,” Eisenberg said in a recent Wall Street Journal interview. Online shopping weakened the allure of Bed Bath & Beyond’s fan-favorite coupons, too, because consumers could find plenty of cheaper alternatives on Amazon or browse a wider selection on sites like Wayfair (W). It wasn’t just Amazon and online shopping that sank Bed Bath & Beyond, however. Walmart (WMT), Target (TGT) and Costco (COST) have grown over the past decade, and they have been able to draw Bed Bath & Beyond customers with lower prices and a wider array of merchandise. Discount chains such as HomeGoods and TJ Maxx and have also undercut Bed Bath & Beyond’s prices. Without the differentiators of the lowest prices or widest selection, Bed Bath & Beyond’s sales stagnated from 2012 to 2019. The company was hit hard during the pandemic, closing stores temporarily during 2020 while rivals remained open. Sales sunk 17% in 2020 and 15% in 2021. What’s more, Bed Bath & Beyond has rotated through several different executives and turnaround strategies in recent years. Former Target executive Mark Tritton took the helm in 2019 with backing from investors and a bold new strategy. He scaled back coupons and inventory from national brands in favor of Bed Bath & Beyond’s own private-label brands. But this change alienated customers who were loyal to big brands. The company also fell behind on payments to vendors and stores did not have enough merchandise to stock shelves. Tritton left as CEO in 2022. As of late November the company had 949 stores, including 762 Bed Bath & Beyond stores and 137 buybuyBaby stores. It said Tuesday that it will ultimately have about half that number – 360 Bed Bath & Beyond stores and 120 buybuyBaby locations. What’s next? Bed Bath & Beyond will close stores that drain the most cash out of its business. But the closures will mean Bed Bath & Beyond will give up on stores that brought in $1.2 billion in annual sales, Michael Lasser, an analyst at UBS, said in a note to clients Tuesday. Bed Bath & Beyond will recapture a portion of those sales from its other stores and online, Lasser said, but the majority will go to other retailers. But, to survive, the company needs to grow sales at its remaining stores. Otherwise, too much of Bed Bath & Beyond’s revenue will go toward repaying debt that it won’t be able to turn a profit. Reversing sales declines won’t be easy given challenges with waning customer demand, online traffic and rising competition in Bed Bath & Beyond product categories, Lasser said. Bed Bath & Beyond will have to overcome its significant hurdles to become a healthy, profitable company. Bankruptcy lawyer Daniel Gielchinsky, however, said it was an encouraging sign that Bed Bath & Beyond was able to raise enough cash through a public offering to stay afloat. The offering was reportedly backed by investment firm Hudson Bay Capital. (Hudson Bay did not respond to a CNN Business request for comment.) Still, liquidators will be watching closely, he said, eager to pounce. “They are assuredly waiting on the sidelines to dismantle the company at the ready","Give me a summary of the events that led to Bed Bath & Beyond's cash flow problems. This task requires you to answer questions based solely on the information provided below. You are not allowed to use any external resources or prior knowledge. The company has avoided a bankruptcy filing for now by completing a complex stock offering that will give it an immediate injection of $225 million in funds and a pledge for $800 million in the future to pay down its current debt load. Bed Bath & Beyond is also shrinking to save money. The company said it plans to close around 400 of its roughly 760 Bed Bath & Beyond stores. It will keep open its most profitable stores in key markets. The moves are a lifeline for Bed Bath & Beyond. They will give the company time to pursue a turnaround without a bankruptcy filing, which can be costly, out of its control and wind up in a liquidation. “They are essentially doing a reorganization outside of bankruptcy court,” said Daniel Gielchinsky, an attorney at DGIM Law specializing in bankruptcy. “Slow the cash burn is the name of the game for the next 6 to 12 months and allow the company to pivot into a profitable position.” It will be a complicated turnaround and the company’s future remains uncertain. If Bed Bath & Beyond comes up short in the current version of its turnaround plan, the likelihood of a liquidation increases. Here’s how Bed Bath & Beyond, once a retailer pioneer, veered to the edge of bankruptcy and where it turns next. Superstore era Bed Bath & Beyond had been a crown jewel of the era of so-called “category killers”: chains that dominated a category of retail, such as Toys “R” Us, Circuit City and Sports Authority. Those companies, too, ultimately filed for bankruptcy. Bed Bath & Beyond became known for pots and pans, towels and bedding stacked from the floor to the ceilings at its cavernous stores — and for its ubiquitous 20%-off coupons. The blue-and-white coupons became something of a pop culture symbol, and millions of Americans wound up stashing them away in their cars, closets and basements. The retailer attracted a broad range of customers by selling name brands at cut-rate prices. Brands coveted a spot on Bed Bath & Beyond’s shelves, knowing it would lead to big sales. Plus, the open-store layout encouraged impulse buying: Shoppers would come in to buy new dishes and walk out with pillows, towels and other items. Stores were a fixture for shoppers around the winter holidays and during the back-to-school and college seasons, and Bed Bath & Beyond also had a strong baby and wedding registry business. Founded in 1971 by two veterans of discount retail in Springfield, New Jersey, the chain of small linen and bath stores — then called Bed ‘n Bath — first grew around the northeast and in California selling designer bedding, a new trend at the time. Unlike department stores, it didn’t rely on sales events to draw customers. “We had witnessed the department store shakeout and knew that specialty stores were going to be the next wave of retailing,” co-founder Leonard Feinstein reportedly said in 1993. “It was the beginning of the designer approach to linens and housewares and we saw a real window of opportunity.” In 1987, the company changed its name to Bed Bath & Beyond to reflect its expanded merchandise and bigger “superstores.” The company went public in 1992 with 38 stores and around $200 million in sales. By 2000, those figures leaped to 241 stores and $1.1 billion in sales. The 1,000th Bed Bath & Beyond store opened in 2009, when the chain had reached $7.8 billion in sales. The company was something of an iconoclast. It spent little on advertising, relying instead on print coupons distributed in weekly newspapers to attract customers. “Why not just tell the customer that we’ll give you a discount on the item you want — and not the one that we want to put on sale? We’ll mail a coupon, and it will be a lot cheaper,” Bed Bath & Beyond co-founder Warren Eisenberg, now 92, said in a 2020 New York Times interview. The chain was known for giving autonomy to store managers to decide which products to stock, allowing them to customize their individual stores, and for shipping products directly to stores instead of a central warehouse. The rise of e-commerce But as brick-and-mortar began to give way to e-commerce, Bed Bath & Beyond was slow to make the transition — a misstep compounded by the fact that home decor is one of the most commonly bought categories online. “We missed the boat on the internet,” Eisenberg said in a recent Wall Street Journal interview. Online shopping weakened the allure of Bed Bath & Beyond’s fan-favorite coupons, too, because consumers could find plenty of cheaper alternatives on Amazon or browse a wider selection on sites like Wayfair (W). It wasn’t just Amazon and online shopping that sank Bed Bath & Beyond, however. Walmart (WMT), Target (TGT) and Costco (COST) have grown over the past decade, and they have been able to draw Bed Bath & Beyond customers with lower prices and a wider array of merchandise. Discount chains such as HomeGoods and TJ Maxx and have also undercut Bed Bath & Beyond’s prices. Without the differentiators of the lowest prices or widest selection, Bed Bath & Beyond’s sales stagnated from 2012 to 2019. The company was hit hard during the pandemic, closing stores temporarily during 2020 while rivals remained open. Sales sunk 17% in 2020 and 15% in 2021. What’s more, Bed Bath & Beyond has rotated through several different executives and turnaround strategies in recent years. Former Target executive Mark Tritton took the helm in 2019 with backing from investors and a bold new strategy. He scaled back coupons and inventory from national brands in favor of Bed Bath & Beyond’s own private-label brands. But this change alienated customers who were loyal to big brands. The company also fell behind on payments to vendors and stores did not have enough merchandise to stock shelves. Tritton left as CEO in 2022. As of late November the company had 949 stores, including 762 Bed Bath & Beyond stores and 137 buybuyBaby stores. It said Tuesday that it will ultimately have about half that number – 360 Bed Bath & Beyond stores and 120 buybuyBaby locations. What’s next? Bed Bath & Beyond will close stores that drain the most cash out of its business. But the closures will mean Bed Bath & Beyond will give up on stores that brought in $1.2 billion in annual sales, Michael Lasser, an analyst at UBS, said in a note to clients Tuesday. Bed Bath & Beyond will recapture a portion of those sales from its other stores and online, Lasser said, but the majority will go to other retailers. But, to survive, the company needs to grow sales at its remaining stores. Otherwise, too much of Bed Bath & Beyond’s revenue will go toward repaying debt that it won’t be able to turn a profit. Reversing sales declines won’t be easy given challenges with waning customer demand, online traffic and rising competition in Bed Bath & Beyond product categories, Lasser said. Bed Bath & Beyond will have to overcome its significant hurdles to become a healthy, profitable company. Bankruptcy lawyer Daniel Gielchinsky, however, said it was an encouraging sign that Bed Bath & Beyond was able to raise enough cash through a public offering to stay afloat. The offering was reportedly backed by investment firm Hudson Bay Capital. (Hudson Bay did not respond to a CNN Business request for comment.) Still, liquidators will be watching closely, he said, eager to pounce. “They are assuredly waiting on the sidelines to dismantle the company at the ready.",Retail/Product,Summarize,Text Transformation Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here.,Summarize the Annual Report.,"section should be read in conjunction with the Consolidated Financial Statements and accompanying notes thereto included in Item 8 of this Annual Report on Form 10-K. Overview Timberland Bancorp, Inc., a Washington corporation, is the holding company for Timberland Bank. The Bank opened for business in 1915 and serves consumers and businesses across Grays Harbor, Thurston, Pierce, King, Kitsap and Lewis counties, Washington with a full range of lending and deposit services through its 23 branches (including its main office in Hoquiam). At September 30, 2022, the Company had total assets of $1.86 billion, net loans receivable of $1.13 billion, total deposits of $1.63 billion and total shareholders’ equity of $218.57 million. The Company’s business activities generally are limited to passive investment activities and oversight of its investment in the Bank. Accordingly, the information set forth in this report relates primarily to the Bank’s operations. The Bank is a community-oriented bank which has traditionally offered a variety of savings products to its retail and business customers while concentrating its lending activities on real estate secured loans. Lending activities have been focused primarily on the origination of loans secured by real estate, including residential construction loans, one- to four-family residential loans, multi-family loans and commercial real estate loans. The Bank originates adjustable-rate residential mortgage loans, some of which do not qualify for sale in the secondary market. The Bank also originates commercial business loans and other consumer loans. The profitability of the Company’s operations depends primarily on its net interest income after provision for (recapture of) loan losses. Net interest income is the difference between interest income, which is the income that the Company earns on interest-earning assets, which are primarily loans and investments, and interest expense, which is the amount that the Company pays on its interest-bearing liabilities, which are primarily deposits and borrowings (as needed). Net interest income is affected by changes in the volume and mix of interest-earning assets, the interest earned on those assets, the volume and mix of interest-bearing liabilities and the interest paid on those interest-bearing liabilities. Management attempts to maintain a net interest margin placing it within the top quartile of its Washington State peers. Changes in market interest rates, the slope of the yield curve, and interest we earn on interest earning assets or pay on interest bearing liabilities, as well as the volume and types of interest earning assets, interest bearing and non-interest bearing liabilities and shareholders’ equity, usually have the largest impact on changes in our net interest spread, net interest margin and net interest income during a reporting period. Since March 2022, in response to inflation, the FOMC of the Federal Reserve has increased the target range for the federal funds rate by 300 basis points, including 150 basis points during the third calendar calendar quarter of 2022, to a range of 3.00% to 3.25% as of September 30, 2022. In November 2022, the FOMC increased the target range for the federal funds rate another 75 basis points to a range of 3.75% to 4.00%. We believe our balance sheet is structured to enhance our average yield on interest-earning assets as the lagging benefit of variable rate interest-earnings assets beginning to reprice occurs as well as a higher net interest margin if the FOMC continues to raise the targeted federal funds rate in an effort to curb inflation, which appears likely based on recent Federal Reserve communications and interest rate forecasts. The provision for (recapture of) loan losses is dependent on changes in the loan portfolio and management’s assessment of the collectability of the loan portfolio as well as prevailing economic and market conditions. The allowance for loan losses reflects the amount that the Company believes is adequate to cover probable credit losses inherent in its loan portfolio. The Company recorded a provision for loan losses of $270,000 for the year ended September 30, 2022, primarily due to increased loan portfolio growth. The Company did not record a provision for loan losses for the year ended September 30, 2021, primarily reflecting the improving economy and the resulting decline in forecasted probable loan losses from COVID-19 during that fiscal year. Net income is also affected by non-interest income and non-interest expense. For the year ended September 30, 2022, non-interest income consisted primarily of service charges on deposit accounts, gain on sales of loans, ATM and debit card interchange transaction fees, an increase in the cash surrender value of BOLI, escrow fees and other operating income. Noninterest income is also increased by net recoveries on investment securities and reduced by net OTTI losses on investment securities, if any. Non-interest income is also decreased by valuation allowances on loan servicing rights and increased by recoveries of valuation allowances on loan servicing rights, if any. Non-interest expense consisted primarily of salaries and employee benefits, premises and equipment, advertising, ATM and debit card interchange transaction fees, postage and courier expenses, amortization of CDI, state and local taxes, professional fees, FDIC insurance premiums, loan administration and foreclosure expenses, data processing and telecommunications expenses, deposit operation expenses and other non-interest expenses. Non-interest expense in certain periods are reduced by gains on the sale of premises and equipment and by gains on the sale of OREO. Non-interest income and non-interest expense are affected by the growth of the Company's operations and growth in the number and balances of loan and deposit accounts. 51 Results of operations may be affected significantly by general and local economic and competitive conditions, changes in market interest rates, governmental policies and actions of regulatory authorities. Operating Strategy The Company is a bank holding company which operates primarily through its subsidiary, the Bank. The Company's primary objective is to operate the Bank as a well capitalized, profitable, independent, community-oriented financial institution, serving customers in its primary market area of Grays Harbor, Pierce, Thurston, Kitsap, King and Lewis counties. The Company's strategy is to provide products and superior service to small businesses and individuals located in its primary market area. The Company's goal is to deliver returns to shareholders by focusing on the origination of higher-yielding assets (in particular, commercial real estate, construction, and commercial business loans), increasing core deposit balances, managing problem assets, efficiently managing expenses, and seeking expansion opportunities. The Company seeks to achieve these results by focusing on the following objectives: Expand our presence within our existing market areas by capturing opportunities resulting from changes in the competitive environment. We currently conduct our business primarily in western Washington. We have a community bank strategy that emphasizes responsive and personalized service to our customers. As a result of the consolidation of banks in our market areas, we believe that there is an opportunity for a community and customer focused bank to expand its customer base. By offering timely decision making, delivering appropriate banking products and services, and providing customer access to our senior managers, we believe that community banks, such as Timberland Bank, can distinguish themselves from larger banks operating in our market areas. We believe that we have a significant opportunity to attract additional borrowers and depositors and expand our market presence and market share within our extensive branch footprint. Portfolio diversification. In recent years, we have limited the origination of speculative construction loans and land development loans in favor of loans that possess credit profiles representing less risk to the Bank. We continue originating owner/builder and custom construction loans, multi-family loans, commercial business loans and commercial real estate loans which offer higher risk adjusted returns, shorter maturities and more sensitivity to interest rate fluctuations than fixed-rate oneto four-family loans. We anticipate capturing more of each customer's banking relationship by cross selling our loan and deposit products and offering additional services to our customers. Increase core deposits and other retail deposit products. We focus on establishing a total banking relationship with our customers with the intent of internally funding our loan portfolio. We anticipate that the continued focus on customer relationships will increase our level of core deposits. In addition to our retail branches, we maintain technology based products such as business cash management and a business remote deposit product that enable us to compete effectively with banks of all sizes. Managing exposure to fluctuating interest rates. For many years, the majority of the loans the Bank has retained in its portfolio have generally possessed periodic interest rate adjustment features or have been relatively short-term in nature. Loans originated for portfolio retention have generally included ARM loans, short-term construction loans, and, to a lesser extent, commercial business loans with interest rates tied to a market index such as the Prime Rate. Longer term fixed-rate mortgage loans have generally been originated for sale into the secondary market, although from time to time, the Bank may retain a portion of its fixed-rate mortgage loan originations and extend the initial fixed-rate period of its hybrid ARM commercial real estate loans for asset/liability purposes. Continue generating revenues through mortgage banking operations. The majority of the fixed-rate residential mortgage loans we originate have historically been sold into the secondary market with servicing retained. This strategy produces gains on the sale of such loans and reduces the interest rate and credit risk associated with fixed-rate residential lending. We continue to originate custom construction and owner/builder construction loans for sale into the secondary market upon the completion of construction. Maintaining strong asset quality. We believe that strong asset quality is a key to our long-term financial success. The percentage of non-performing loans to loans receivable, net was 0.18% and 0.29% at September 30, 2022 and 2021, respectively. The Company's percentage of non-performing assets to total assets at September 30, 2022 was 0.12% compared to 0.18% at September 30, 2021. Non-performing assets have decreased to $2.17 million at September 30, 2022 from $3.17 million at September 30, 2021. We continue to seek to reduce the level of non-performing assets through collections, writedowns, modifications and sales of OREO. We also take proactive steps to resolve our non-performing loans, including negotiating payment plans, forbearances, loan modifications and loan extensions and accepting short payoffs on delinquent loans when such actions have been deemed appropriate. Although the Company plans to continue to place emphasis on certain 52","Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here. Summarize the Annual Report. section should be read in conjunction with the Consolidated Financial Statements and accompanying notes thereto included in Item 8 of this Annual Report on Form 10-K. Overview Timberland Bancorp, Inc., a Washington corporation, is the holding company for Timberland Bank. The Bank opened for business in 1915 and serves consumers and businesses across Grays Harbor, Thurston, Pierce, King, Kitsap and Lewis counties, Washington with a full range of lending and deposit services through its 23 branches (including its main office in Hoquiam). At September 30, 2022, the Company had total assets of $1.86 billion, net loans receivable of $1.13 billion, total deposits of $1.63 billion and total shareholders’ equity of $218.57 million. The Company’s business activities generally are limited to passive investment activities and oversight of its investment in the Bank. Accordingly, the information set forth in this report relates primarily to the Bank’s operations. The Bank is a community-oriented bank which has traditionally offered a variety of savings products to its retail and business customers while concentrating its lending activities on real estate secured loans. Lending activities have been focused primarily on the origination of loans secured by real estate, including residential construction loans, one- to four-family residential loans, multi-family loans and commercial real estate loans. The Bank originates adjustable-rate residential mortgage loans, some of which do not qualify for sale in the secondary market. The Bank also originates commercial business loans and other consumer loans. The profitability of the Company’s operations depends primarily on its net interest income after provision for (recapture of) loan losses. Net interest income is the difference between interest income, which is the income that the Company earns on interest-earning assets, which are primarily loans and investments, and interest expense, which is the amount that the Company pays on its interest-bearing liabilities, which are primarily deposits and borrowings (as needed). Net interest income is affected by changes in the volume and mix of interest-earning assets, the interest earned on those assets, the volume and mix of interest-bearing liabilities and the interest paid on those interest-bearing liabilities. Management attempts to maintain a net interest margin placing it within the top quartile of its Washington State peers. Changes in market interest rates, the slope of the yield curve, and interest we earn on interest earning assets or pay on interest bearing liabilities, as well as the volume and types of interest earning assets, interest bearing and non-interest bearing liabilities and shareholders’ equity, usually have the largest impact on changes in our net interest spread, net interest margin and net interest income during a reporting period. Since March 2022, in response to inflation, the FOMC of the Federal Reserve has increased the target range for the federal funds rate by 300 basis points, including 150 basis points during the third calendar calendar quarter of 2022, to a range of 3.00% to 3.25% as of September 30, 2022. In November 2022, the FOMC increased the target range for the federal funds rate another 75 basis points to a range of 3.75% to 4.00%. We believe our balance sheet is structured to enhance our average yield on interest-earning assets as the lagging benefit of variable rate interest-earnings assets beginning to reprice occurs as well as a higher net interest margin if the FOMC continues to raise the targeted federal funds rate in an effort to curb inflation, which appears likely based on recent Federal Reserve communications and interest rate forecasts. The provision for (recapture of) loan losses is dependent on changes in the loan portfolio and management’s assessment of the collectability of the loan portfolio as well as prevailing economic and market conditions. The allowance for loan losses reflects the amount that the Company believes is adequate to cover probable credit losses inherent in its loan portfolio. The Company recorded a provision for loan losses of $270,000 for the year ended September 30, 2022, primarily due to increased loan portfolio growth. The Company did not record a provision for loan losses for the year ended September 30, 2021, primarily reflecting the improving economy and the resulting decline in forecasted probable loan losses from COVID-19 during that fiscal year. Net income is also affected by non-interest income and non-interest expense. For the year ended September 30, 2022, non-interest income consisted primarily of service charges on deposit accounts, gain on sales of loans, ATM and debit card interchange transaction fees, an increase in the cash surrender value of BOLI, escrow fees and other operating income. Noninterest income is also increased by net recoveries on investment securities and reduced by net OTTI losses on investment securities, if any. Non-interest income is also decreased by valuation allowances on loan servicing rights and increased by recoveries of valuation allowances on loan servicing rights, if any. Non-interest expense consisted primarily of salaries and employee benefits, premises and equipment, advertising, ATM and debit card interchange transaction fees, postage and courier expenses, amortization of CDI, state and local taxes, professional fees, FDIC insurance premiums, loan administration and foreclosure expenses, data processing and telecommunications expenses, deposit operation expenses and other non-interest expenses. Non-interest expense in certain periods are reduced by gains on the sale of premises and equipment and by gains on the sale of OREO. Non-interest income and non-interest expense are affected by the growth of the Company's operations and growth in the number and balances of loan and deposit accounts. 51 Results of operations may be affected significantly by general and local economic and competitive conditions, changes in market interest rates, governmental policies and actions of regulatory authorities. Operating Strategy The Company is a bank holding company which operates primarily through its subsidiary, the Bank. The Company's primary objective is to operate the Bank as a well capitalized, profitable, independent, community-oriented financial institution, serving customers in its primary market area of Grays Harbor, Pierce, Thurston, Kitsap, King and Lewis counties. The Company's strategy is to provide products and superior service to small businesses and individuals located in its primary market area. The Company's goal is to deliver returns to shareholders by focusing on the origination of higher-yielding assets (in particular, commercial real estate, construction, and commercial business loans), increasing core deposit balances, managing problem assets, efficiently managing expenses, and seeking expansion opportunities. The Company seeks to achieve these results by focusing on the following objectives: Expand our presence within our existing market areas by capturing opportunities resulting from changes in the competitive environment. We currently conduct our business primarily in western Washington. We have a community bank strategy that emphasizes responsive and personalized service to our customers. As a result of the consolidation of banks in our market areas, we believe that there is an opportunity for a community and customer focused bank to expand its customer base. By offering timely decision making, delivering appropriate banking products and services, and providing customer access to our senior managers, we believe that community banks, such as Timberland Bank, can distinguish themselves from larger banks operating in our market areas. We believe that we have a significant opportunity to attract additional borrowers and depositors and expand our market presence and market share within our extensive branch footprint. Portfolio diversification. In recent years, we have limited the origination of speculative construction loans and land development loans in favor of loans that possess credit profiles representing less risk to the Bank. We continue originating owner/builder and custom construction loans, multi-family loans, commercial business loans and commercial real estate loans which offer higher risk adjusted returns, shorter maturities and more sensitivity to interest rate fluctuations than fixed-rate oneto four-family loans. We anticipate capturing more of each customer's banking relationship by cross selling our loan and deposit products and offering additional services to our customers. Increase core deposits and other retail deposit products. We focus on establishing a total banking relationship with our customers with the intent of internally funding our loan portfolio. We anticipate that the continued focus on customer relationships will increase our level of core deposits. In addition to our retail branches, we maintain technology based products such as business cash management and a business remote deposit product that enable us to compete effectively with banks of all sizes. Managing exposure to fluctuating interest rates. For many years, the majority of the loans the Bank has retained in its portfolio have generally possessed periodic interest rate adjustment features or have been relatively short-term in nature. Loans originated for portfolio retention have generally included ARM loans, short-term construction loans, and, to a lesser extent, commercial business loans with interest rates tied to a market index such as the Prime Rate. Longer term fixed-rate mortgage loans have generally been originated for sale into the secondary market, although from time to time, the Bank may retain a portion of its fixed-rate mortgage loan originations and extend the initial fixed-rate period of its hybrid ARM commercial real estate loans for asset/liability purposes. Continue generating revenues through mortgage banking operations. The majority of the fixed-rate residential mortgage loans we originate have historically been sold into the secondary market with servicing retained. This strategy produces gains on the sale of such loans and reduces the interest rate and credit risk associated with fixed-rate residential lending. We continue to originate custom construction and owner/builder construction loans for sale into the secondary market upon the completion of construction. Maintaining strong asset quality. We believe that strong asset quality is a key to our long-term financial success. The percentage of non-performing loans to loans receivable, net was 0.18% and 0.29% at September 30, 2022 and 2021, respectively. The Company's percentage of non-performing assets to total assets at September 30, 2022 was 0.12% compared to 0.18% at September 30, 2021. Non-performing assets have decreased to $2.17 million at September 30, 2022 from $3.17 million at September 30, 2021. We continue to seek to reduce the level of non-performing assets through collections, writedowns, modifications and sales of OREO. We also take proactive steps to resolve our non-performing loans, including negotiating payment plans, forbearances, loan modifications and loan extensions and accepting short payoffs on delinquent loans when such actions have been deemed appropriate. Although the Company plans to continue to place emphasis on certain 52",Financial,Summarize,Text Transformation You can only respond using information in the context block.,Provide a summary of changes to top tax rates and exemption amounts for estate taxes over time.,"Early History of U.S. Taxes on Transfers Taxes on the transfer of assets have existed throughout history, dating back to ancient Egypt. In the United States, they were used prior to the modern estate and gift tax in 1916 to finance wars and similar emergencies.8 The first was enacted in 1797 to expand the Navy, given strained relationships with France. At that time, a documentary stamp tax on the inventories of deceased persons, the receipt of inheritances from an estate (except those to a wife, children, or grandchildren), and the probates and letters of administration of estates was imposed. These taxes were fixed amounts, although they were larger for larger inheritances and small inheritances were exempt. These taxes were repealed in 1802. In 1862, during the Civil War, an inheritance tax was imposed. Unlike the current estate tax, the tax was imposed on the beneficiaries, but unlike the stamp tax, it was a percentage of the inheritance. The tax was also imposed on gifts during the lifetime. The rate depended on the family relationships of the beneficiaries, and spouses and small inheritances were exempt. This tax was repealed in 1870. The 1894 income tax was not a transfer tax, but it included inheritances and gifts in income. It was short-lived after being found unconstitutional by the Supreme Court in Pollock v. Farmers’ Loan and Trust Company. In 1898, an estate tax was enacted to finance the Spanish-American War. Rates were graduated depending on degree of kinship and size, bequests to spouses were exempt, and there was an overall exemption that excluded small estates. It was repealed in 1902. The Modern Estate and Gift Tax Lawmakers enacted the direct ancestor of the current estate tax in 1916. It contained exemptions that excluded small estates, and rates were graduated based on the size of the estate. Over time, rates were increased, but the basic form of the tax remained. The top rate was 10% in 1916 with a $50,000 exemption, and it was increased to 25% in 1917, with the first $50,000 taxed at 2%. At the end of World War I in 1918, rates were reduced on smaller estates and charitable deductions were allowed. The top rate was increased to 40% in 1924, and a credit for state taxes was allowed for up to 25% of estate tax liability. The top rate was reduced to 20% from 1926 to 1931, increased to 40% in 1932, and eventually rose as high as 77% from 1941 to 1976. A separate gift tax was enacted in 1924 with the same rates and exemptions, and an annual exclusion per donee of $500. The tax was repealed in 1926, then reenacted in 1932 with a $5,000 annual exclusion per donee. In 1942, changes addressed the difference in treatment in community property states, where each spouse owned half the assets and only the half owned by the decedent was subject to tax. In other states where couples could own assets jointly, exclusions were allowed only if the surviving spouse contributed to the assets. The 1942 act treated assets in community property states the same as in other states. In 1948, this rule was changed to allow a deduction for property transferred to a spouse whether by the will or by law. The 1942 act made other changes in rates and exemptions and instituted a $3,000 annual gift exclusion per donee. The Tax Reform Act of 1976 (P.L. 94-455) created the modern unified estate and gift tax with a unified credit and graduated rates applied to all transfers. The 1976 act also instituted carryover basis for inherited assets, but that provision resulted in considerable controversy and was repealed retroactively in 1980. The exemption was increased from $60,000 to $120,000, and the top rate was lowered to 70%. The Economic Growth and Tax Relief Act of 2001 (EGTRRA; P.L. 107-16) provided for a gradual reduction in the estate tax. The law applied a unified exemption for both lifetime gifts and the estate of $675,000 prior to these changes. Under EGTRRA, the estate tax exemption rose from $675,000 in 2001 to $3.5 million in 2009, and the top tax rate fell from 55% to 45%. Although combined estate and gift tax rates are graduated, the exemption is effectively in the form of a credit that eliminates tax due at lower rates, resulting in a flat rate on taxable assets under 2009 law. The gift tax exemption was, however, restricted to $1 million. For 2010, EGTRRA scheduled the elimination of the estate tax, although it retained the gift tax and its $1 million exemption. EGTRRA also provided for a carryover of basis for assets inherited at death in 2010, so that, in contrast with prior law, heirs who sold assets would have to pay tax on gains accrued during the decedent’s lifetime. This provision had a $1.3 million exemption for gain (plus $3 million for a spouse). As with other provisions of EGTRRA, the estate tax revisions were to expire in 2011, returning the tax provisions to their pre-EGTRRA levels. The exemption would have reverted to $1 million (a value that had already been scheduled for pre-EGTRRA law) and the rate to 55% (with some graduated rates). The carryover basis provision effective in 2010 would have been eliminated (so that heirs would not be taxed on gain accumulated during the decedent’s life when they inherited assets). During debate on the estate tax, most agreed that the 2010 provisions would not be continued and, indeed, could be repealed retroactively. President Obama proposed a permanent extension of the 2009 rules (a $3.5 million exemption and a 45% tax rate), and the House provided for that permanent extension on December 3, 2009 (H.R. 4154). The Senate Democratic leadership indicated a plan to retroactively reinstate the 2009 rules for 2010 and beyond. Senate Minority Leader McConnell proposed an alternative of a 35% tax rate and a $5 million exemption.9 A similar proposal for a $5 million exemption and a 35% rate, which also included the ability of the surviving spouse to inherit any unused exemption of the decedent, is often referred to as Lincoln-Kyl (named after two Senators who sponsored it). Other proposals began with the $3.5 million exemption and 45% rate and would have phased in the $5 million exemption and 55% rate. Some Members of Congress argued for permanent estate tax repeal.10 At the end of 2010, P.L. 111-312 enacted a temporary two-year extension of the estate and gift tax, with a $5 million unified exemption, a 35% rate, and inheritance of unused spousal exemptions. For 2010, estates could elect to be taxed under the estate tax or under the carryover rules. These provisions provided for estate tax rules through 2012, after which the provisions would have reverted to the pre-EGTRRA rules ($1 million exemption, 55% top rate) absent legislation. The American Taxpayer Relief Act of 2012 (P.L. 112-240) established the permanent exemption ($5.25 million, indexed for inflation?) and rate (40%) described above. The 2017 tax revision (P.L. 115-97) doubled the exemption for the years 2018 through 2025. The House had proposed doubling the exemption through 2024 and then repealing the estate tax and lowering the gift tax rates to 35%. One issue that arises with the expiration of the increased exemptions is the treatment of gifts that had been transferred with exemptions higher than the exemptions that the law would revert to. ","You can only respond using information in the context block. Provide a summary of changes to top tax rates and exemption amounts for estate taxes over time. Early History of U.S. Taxes on Transfers Taxes on the transfer of assets have existed throughout history, dating back to ancient Egypt. In the United States, they were used prior to the modern estate and gift tax in 1916 to finance wars and similar emergencies.8 The first was enacted in 1797 to expand the Navy, given strained relationships with France. At that time, a documentary stamp tax on the inventories of deceased persons, the receipt of inheritances from an estate (except those to a wife, children, or grandchildren), and the probates and letters of administration of estates was imposed. These taxes were fixed amounts, although they were larger for larger inheritances and small inheritances were exempt. These taxes were repealed in 1802. In 1862, during the Civil War, an inheritance tax was imposed. Unlike the current estate tax, the tax was imposed on the beneficiaries, but unlike the stamp tax, it was a percentage of the inheritance. The tax was also imposed on gifts during the lifetime. The rate depended on the family relationships of the beneficiaries, and spouses and small inheritances were exempt. This tax was repealed in 1870. The 1894 income tax was not a transfer tax, but it included inheritances and gifts in income. It was short-lived after being found unconstitutional by the Supreme Court in Pollock v. Farmers’ Loan and Trust Company. In 1898, an estate tax was enacted to finance the Spanish-American War. Rates were graduated depending on degree of kinship and size, bequests to spouses were exempt, and there was an overall exemption that excluded small estates. It was repealed in 1902. The Modern Estate and Gift Tax Lawmakers enacted the direct ancestor of the current estate tax in 1916. It contained exemptions that excluded small estates, and rates were graduated based on the size of the estate. Over time, rates were increased, but the basic form of the tax remained. The top rate was 10% in 1916 with a $50,000 exemption, and it was increased to 25% in 1917, with the first $50,000 taxed at 2%. At the end of World War I in 1918, rates were reduced on smaller estates and charitable deductions were allowed. The top rate was increased to 40% in 1924, and a credit for state taxes was allowed for up to 25% of estate tax liability. The top rate was reduced to 20% from 1926 to 1931, increased to 40% in 1932, and eventually rose as high as 77% from 1941 to 1976. A separate gift tax was enacted in 1924 with the same rates and exemptions, and an annual exclusion per donee of $500. The tax was repealed in 1926, then reenacted in 1932 with a $5,000 annual exclusion per donee. In 1942, changes addressed the difference in treatment in community property states, where each spouse owned half the assets and only the half owned by the decedent was subject to tax. In other states where couples could own assets jointly, exclusions were allowed only if the surviving spouse contributed to the assets. The 1942 act treated assets in community property states the same as in other states. In 1948, this rule was changed to allow a deduction for property transferred to a spouse whether by the will or by law. The 1942 act made other changes in rates and exemptions and instituted a $3,000 annual gift exclusion per donee. The Tax Reform Act of 1976 (P.L. 94-455) created the modern unified estate and gift tax with a unified credit and graduated rates applied to all transfers. The 1976 act also instituted carryover basis for inherited assets, but that provision resulted in considerable controversy and was repealed retroactively in 1980. The exemption was increased from $60,000 to $120,000, and the top rate was lowered to 70%. The Economic Growth and Tax Relief Act of 2001 (EGTRRA; P.L. 107-16) provided for a gradual reduction in the estate tax. The law applied a unified exemption for both lifetime gifts and the estate of $675,000 prior to these changes. Under EGTRRA, the estate tax exemption rose from $675,000 in 2001 to $3.5 million in 2009, and the top tax rate fell from 55% to 45%. Although combined estate and gift tax rates are graduated, the exemption is effectively in the form of a credit that eliminates tax due at lower rates, resulting in a flat rate on taxable assets under 2009 law. The gift tax exemption was, however, restricted to $1 million. For 2010, EGTRRA scheduled the elimination of the estate tax, although it retained the gift tax and its $1 million exemption. EGTRRA also provided for a carryover of basis for assets inherited at death in 2010, so that, in contrast with prior law, heirs who sold assets would have to pay tax on gains accrued during the decedent’s lifetime. This provision had a $1.3 million exemption for gain (plus $3 million for a spouse). As with other provisions of EGTRRA, the estate tax revisions were to expire in 2011, returning the tax provisions to their pre-EGTRRA levels. The exemption would have reverted to $1 million (a value that had already been scheduled for pre-EGTRRA law) and the rate to 55% (with some graduated rates). The carryover basis provision effective in 2010 would have been eliminated (so that heirs would not be taxed on gain accumulated during the decedent’s life when they inherited assets). During debate on the estate tax, most agreed that the 2010 provisions would not be continued and, indeed, could be repealed retroactively. President Obama proposed a permanent extension of the 2009 rules (a $3.5 million exemption and a 45% tax rate), and the House provided for that permanent extension on December 3, 2009 (H.R. 4154). The Senate Democratic leadership indicated a plan to retroactively reinstate the 2009 rules for 2010 and beyond. Senate Minority Leader McConnell proposed an alternative of a 35% tax rate and a $5 million exemption.9 A similar proposal for a $5 million exemption and a 35% rate, which also included the ability of the surviving spouse to inherit any unused exemption of the decedent, is often referred to as Lincoln-Kyl (named after two Senators who sponsored it). Other proposals began with the $3.5 million exemption and 45% rate and would have phased in the $5 million exemption and 55% rate. Some Members of Congress argued for permanent estate tax repeal.10 At the end of 2010, P.L. 111-312 enacted a temporary two-year extension of the estate and gift tax, with a $5 million unified exemption, a 35% rate, and inheritance of unused spousal exemptions. For 2010, estates could elect to be taxed under the estate tax or under the carryover rules. These provisions provided for estate tax rules through 2012, after which the provisions would have reverted to the pre-EGTRRA rules ($1 million exemption, 55% top rate) absent legislation. The American Taxpayer Relief Act of 2012 (P.L. 112-240) established the permanent exemption ($5.25 million, indexed for inflation?) and rate (40%) described above. The 2017 tax revision (P.L. 115-97) doubled the exemption for the years 2018 through 2025. The House had proposed doubling the exemption through 2024 and then repealing the estate tax and lowering the gift tax rates to 35%. One issue that arises with the expiration of the increased exemptions is the treatment of gifts that had been transferred with exemptions higher than the exemptions that the law would revert to. ",Financial,Summarize,Text Transformation You must only draw information for your response from the text provided. Do not use any external sources. Your answer is always less than 200 words. When mentioning Newcastle United you refer to the club as NUFC and always in bold. When mentioning Sports Direct you will refer to the company as SD and always in italics.,How many clubs do the allegations affect?,"In summary, the Claimant alleges that: 1. The Club has abused its dominant position in the market for the wholesale supply of Newcastle United replica kit in the UK, in breach of the prohibition in Chapter II of the Act, by refusing to supply Sports Direct with the Club’s replica kit for the 2024/25 season and granting JD Sports, another UK sports retailer, exclusive rights as a third-party retailer of the Club’s replica kit (alongside only the Club’s and Adidas’s own channels), thereby foreclosing Sports Direct from the downstream retail market and eliminating effective competition on that market; and 2. If and to the extent that the Club contends that the refusal to supply is the necessary result of exclusivity arrangements it has agreed with JD Sports and/or Adidas, any such agreement is itself in breach of the prohibition in Chapter I of the Act and therefore void, and insofar as the Club implements any such agreement, it is breaching the Chapter I prohibition. The Claimant seeks an injunction restraining the Defendants from engaging in, and/or implementing the above breaches, damages and other relief. According to the Claim, replica kit are authentic reproductions of the short- and long-sleeved shirt, shorts, training wear, and socks (home, away, third, goalkeeper and special edition) in adult, junior and infant sizes to which a football club’s trademark is applied and which are worn by the club’s players when competing in professional football matches.","System Instruction: You must only draw information for your response from the text provided. Do not use any external sources. Your answer is always less than 200 words. When mentioning Newcastle United you refer to the club as NUFC and always in bold. When mentioning Sports Direct you will refer to the company as SD and always in italics. Question: How many clubs do the allegations affect? Context: In summary, the Claimant alleges that: 1. The Club has abused its dominant position in the market for the wholesale supply of Newcastle United replica kit in the UK, in breach of the prohibition in Chapter II of the Act, by refusing to supply Sports Direct with the Club’s replica kit for the 2024/25 season and granting JD Sports, another UK sports retailer, exclusive rights as a third-party retailer of the Club’s replica kit (alongside only the Club’s and Adidas’s own channels), thereby foreclosing Sports Direct from the downstream retail market and eliminating effective competition on that market; and 2. If and to the extent that the Club contends that the refusal to supply is the necessary result of exclusivity arrangements it has agreed with JD Sports and/or Adidas, any such agreement is itself in breach of the prohibition in Chapter I of the Act and therefore void, and insofar as the Club implements any such agreement, it is breaching the Chapter I prohibition. The Claimant seeks an injunction restraining the Defendants from engaging in, and/or implementing the above breaches, damages and other relief. According to the Claim, replica kit are authentic reproductions of the short- and long-sleeved shirt, shorts, training wear, and socks (home, away, third, goalkeeper and special edition) in adult, junior and infant sizes to which a football club’s trademark is applied and which are worn by the club’s players when competing in professional football matches.",Legal,Fact Finding,Q&A Summarize the provided text. Only use information from the provided context. Do not rely on your own knowledge or outside sources of information.,Summarize the text.,"CHAPTER ONE INFECTIOUS DISEASES 1. Introduction to infectious diseases Generally infectious diseases result from bacteria, viruses, fungi, and parasites. Despite decades of dramatic progress in their treatment and prevention, infectious diseases remain a major cause of death and are responsible for worsening the living conditions of many millions of people around the world especially in the developing countries. Infections frequently challenge the clinician’s diagnostic skill and must be considered in the differential diagnosis of syndromes affecting a multitude of organ systems. Infectious diseases often do not occur in isolated cases; rather they spread through a group exposed from a point source (e.g. a water supply contaminated with cholera) or from individual to individual (e.g. via respiratory droplets spreading tuberculosis). Many factors affect the likelihood of acquiring infections which include, host, environmental microbial factors. Host and Environmental Factors For any infectious process to occur, the parasite and the host must first encounter each other. Factors such as geography (e.g. altitude and malaria), environment (e.g. mosquito breeding site and malaria), disease vectors and host behavior (e.g. sexual behavior and sexually transmitted diseases) thus influence the likelihood of infection. Many Host Factors such as age, immunization, prior illness, nutritional status, pregnancy, coexisting illnesses and emotional status all have some impact on the risk of infection after exposure to a particular pathogen. Medical care itself can increase the patient’s risk of acquiring an infection. This can occur in several ways: through contact with the pathogens during hospitalization, through injections, surgical incisions, via mucosal surfaces by end tracheal tubes and bladder catheters, through the introduction of foreign bodies, through alteration of the natural flora with antibiotics, and through treatment with suppressive drugs such as steroids. Microbial Factors Infection involves complicated interaction of parasites and host and inevitably affects both. In most cases a pathogenic process consisting of several steps is required for the development of infections. Internal Medicine 2 Since the competent host has a complex series of defense mechanisms in place to prevent infection, the successful parasite must utilize specific strategies at each of these steps. The specific strategies used by bacteria, viruses, and parasites have some similarities, but the details are unique not only for each class of organism but also for individual species within a class; Invasion; Microorganisms attached to mucosal surface use specific mechanisms to invade deeper structures. For example, meningococci and gonococci penetrate and traverse mucosal epithelial cells by transcytotic mechanism. Tropism; In order to infect a host successfully, many pathogens occupy highly specific place within the host and thus are tropic to a particular body site or cell type. For example, malaria sporozoites are rapidly cleared from the blood into the hepatocyts, where they undergo maturation and release into the circulation; trophozoites in turn can infect only the erythrocytes. Microbial virulence strategies; Microbes have developed a variety of strategies for escaping the immunity. For example, some pathogenic organisms elaborate toxins and enzymes that facilitate the invasion of the host and are often responsible for the disease state and many bacteria are encapsulated with polysaccharides that allow them to invade and deposit in the absence of specific antibodies. Immune response: Is a defense mechanism developed by the host for recognizing and responding to microorganisms. It is divided I to two major classes. Innate and Acquired Immunity. Innate immunity (Natural Immunity): Is first line of defense and serves to protect the host with out prior exposure to the infectious agent. This immune response is nonspecific and has no memory. Examples of Innate immunity include skin and mucous mebrane, phagocytoses by macrophages and nutrophils, complement system etc Acquired (Adaptive) Immunity: Is specific immune mechanism developed against a particular organism. It takes time to develop and it has long standing memory. It has two major arms: Internal Medicine 3 • Cellular immunity: comprising T- lymphocytes, NK cells • Humeral Immunity: comprises of B-Lymphocytes and antibodies produced by plasma cells. Laboratory diagnosis The lab diagnosis of infections requires the demonstration, either 1. Direct microscopic visualization of pathogens in clinical material (e.g. Plasmodium species in blood films) or the growth of microorganisms in the laboratory (e.g. culture) or 2. Indirect (e.g. antibody / serology test for HIV), of viral, bacterial, mycotic, or parasitic agents in tissues, fluids, or excreta of the host. Treatment; Optimal therapy for infectious diseases requires a broad knowledge of medicine and careful clinical judgment. Life threatening infections such as bacterial meningitis and sepsis require urgent initiation of therapy often before a specific infective organism is identified. Antimicrobial agents must be chosen empirically and must be against the range of potential infectious agents consistent with the clinical condition. In contrast, good clinical judgment sometimes dictates withholding of antimicrobials in a self limited process or until a specific diagnosis is made. Certain infections (e.g. peritonitis, necrotizing fascitis, and abscess) require surgery as a primary means of cure; in these conditions, antibiotics play only as an adjunctive role. References: 1. Kasper L., Braunwald E., Harrison’s principles of Internal medicine, 16th Edition, Intruducion to infectious diseases, pages 695-700. ","Summarize the provided text. Only use information from the provided context. Do not rely on your own knowledge or outside sources of information. CHAPTER ONE INFECTIOUS DISEASES 1. Introduction to infectious diseases Generally infectious diseases result from bacteria, viruses, fungi, and parasites. Despite decades of dramatic progress in their treatment and prevention, infectious diseases remain a major cause of death and are responsible for worsening the living conditions of many millions of people around the world especially in the developing countries. Infections frequently challenge the clinician’s diagnostic skill and must be considered in the differential diagnosis of syndromes affecting a multitude of organ systems. Infectious diseases often do not occur in isolated cases; rather they spread through a group exposed from a point source (e.g. a water supply contaminated with cholera) or from individual to individual (e.g. via respiratory droplets spreading tuberculosis). Many factors affect the likelihood of acquiring infections which include, host, environmental microbial factors. Host and Environmental Factors For any infectious process to occur, the parasite and the host must first encounter each other. Factors such as geography (e.g. altitude and malaria), environment (e.g. mosquito breeding site and malaria), disease vectors and host behavior (e.g. sexual behavior and sexually transmitted diseases) thus influence the likelihood of infection. Many Host Factors such as age, immunization, prior illness, nutritional status, pregnancy, coexisting illnesses and emotional status all have some impact on the risk of infection after exposure to a particular pathogen. Medical care itself can increase the patient’s risk of acquiring an infection. This can occur in several ways: through contact with the pathogens during hospitalization, through injections, surgical incisions, via mucosal surfaces by end tracheal tubes and bladder catheters, through the introduction of foreign bodies, through alteration of the natural flora with antibiotics, and through treatment with suppressive drugs such as steroids. Microbial Factors Infection involves complicated interaction of parasites and host and inevitably affects both. In most cases a pathogenic process consisting of several steps is required for the development of infections. Internal Medicine 2 Since the competent host has a complex series of defense mechanisms in place to prevent infection, the successful parasite must utilize specific strategies at each of these steps. The specific strategies used by bacteria, viruses, and parasites have some similarities, but the details are unique not only for each class of organism but also for individual species within a class; Invasion; Microorganisms attached to mucosal surface use specific mechanisms to invade deeper structures. For example, meningococci and gonococci penetrate and traverse mucosal epithelial cells by transcytotic mechanism. Tropism; In order to infect a host successfully, many pathogens occupy highly specific place within the host and thus are tropic to a particular body site or cell type. For example, malaria sporozoites are rapidly cleared from the blood into the hepatocyts, where they undergo maturation and release into the circulation; trophozoites in turn can infect only the erythrocytes. Microbial virulence strategies; Microbes have developed a variety of strategies for escaping the immunity. For example, some pathogenic organisms elaborate toxins and enzymes that facilitate the invasion of the host and are often responsible for the disease state and many bacteria are encapsulated with polysaccharides that allow them to invade and deposit in the absence of specific antibodies. Immune response: Is a defense mechanism developed by the host for recognizing and responding to microorganisms. It is divided I to two major classes. Innate and Acquired Immunity. Innate immunity (Natural Immunity): Is first line of defense and serves to protect the host with out prior exposure to the infectious agent. This immune response is nonspecific and has no memory. Examples of Innate immunity include skin and mucous mebrane, phagocytoses by macrophages and nutrophils, complement system etc Acquired (Adaptive) Immunity: Is specific immune mechanism developed against a particular organism. It takes time to develop and it has long standing memory. It has two major arms: Internal Medicine 3 • Cellular immunity: comprising T- lymphocytes, NK cells • Humeral Immunity: comprises of B-Lymphocytes and antibodies produced by plasma cells. Laboratory diagnosis The lab diagnosis of infections requires the demonstration, either 1. Direct microscopic visualization of pathogens in clinical material (e.g. Plasmodium species in blood films) or the growth of microorganisms in the laboratory (e.g. culture) or 2. Indirect (e.g. antibody / serology test for HIV), of viral, bacterial, mycotic, or parasitic agents in tissues, fluids, or excreta of the host. Treatment; Optimal therapy for infectious diseases requires a broad knowledge of medicine and careful clinical judgment. Life threatening infections such as bacterial meningitis and sepsis require urgent initiation of therapy often before a specific infective organism is identified. Antimicrobial agents must be chosen empirically and must be against the range of potential infectious agents consistent with the clinical condition. In contrast, good clinical judgment sometimes dictates withholding of antimicrobials in a self limited process or until a specific diagnosis is made. Certain infections (e.g. peritonitis, necrotizing fascitis, and abscess) require surgery as a primary means of cure; in these conditions, antibiotics play only as an adjunctive role. References: 1. Kasper L., Braunwald E., Harrison’s principles of Internal medicine, 16th Edition, Intruducion to infectious diseases, pages 695-700. Summarize the text.",Medical,Summarize,Text Transformation You must answer questions based exclusively on the information provided in the prompt. You can not use external resources or prior knowledge.,What are the key differences between each clinical trial phase?,"Clinical Trial Phases  Phase 1 Trials. Phase 1 trials are the first time the product is introduced in human subjects. These carefully controlled trials typically involve 20 to 80 patients or volunteer subjects, though the exact numbers may vary depending on the product. Phase 1 trials generally assess how the product acts in the body and evaluate initial safety (i.e., side effects). They may also be used to determine the dosing levels to use in phase 2 (e.g., the maximum safe dose or what dose is required to have an effect). Depending on the product, phase 1 trials may also provide some initial indication as to whether the product may be effective. In the case of vaccines specifically, phase 1 trials also assess their ability to provoke an immune response in the body (i.e., immunogenicity).  Phase 2 Trials. Phase 2 trials continue to assess safety but also evaluate the product’s effectiveness and common short-term side effects or other risks associated with the product. Phase 2 trials are also used to determine the optimal dose of the product. For vaccines, phase 2 assesses how much of the vaccine to administer and on what dosing schedule (e.g., whether a boost is needed to maximize its effectiveness or whether the vaccine must be administered on a regular schedule to maintain immunity). As with phase 1 studies, phase 2 studies are carefully controlled. However, phase 2 involves a larger (though still relatively limited) number of volunteer subjects—generally no more than a few hundred participants.  Phase 3 Trials. Phase 3 trials involve an expanded number of participants—from several hundred to thousands—and are used to assess the product’s safety and effectiveness across a wide range of patient categories through controlled and uncontrolled studies. These trials are intended to present a clearer picture of expected risks and benefits under real-world conditions. The information obtained from phase 3 trials also forms the basis for the product’s labeling. Sponsors must generally complete all three phases to obtain FDA approval unless they obtain accelerated approval, in which case FDA requires post-approval trials to confirm the expected clinical benefit. FDA may also require, at its discretion, additional clinical trials after approval (i.e., phase 4 trials) for any approved product to continue assessing the product’s safety and effectiveness once on the market. ","What are the key differences between each clinical trial phase? You must answer questions based exclusively on the information provided in the prompt. You can not use external resources or prior knowledge. Clinical Trial Phases  Phase 1 Trials. Phase 1 trials are the first time the product is introduced in human subjects. These carefully controlled trials typically involve 20 to 80 patients or volunteer subjects, though the exact numbers may vary depending on the product. Phase 1 trials generally assess how the product acts in the body and evaluate initial safety (i.e., side effects). They may also be used to determine the dosing levels to use in phase 2 (e.g., the maximum safe dose or what dose is required to have an effect). Depending on the product, phase 1 trials may also provide some initial indication as to whether the product may be effective. In the case of vaccines specifically, phase 1 trials also assess their ability to provoke an immune response in the body (i.e., immunogenicity).  Phase 2 Trials. Phase 2 trials continue to assess safety but also evaluate the product’s effectiveness and common short-term side effects or other risks associated with the product. Phase 2 trials are also used to determine the optimal dose of the product. For vaccines, phase 2 assesses how much of the vaccine to administer and on what dosing schedule (e.g., whether a boost is needed to maximize its effectiveness or whether the vaccine must be administered on a regular schedule to maintain immunity). As with phase 1 studies, phase 2 studies are carefully controlled. However, phase 2 involves a larger (though still relatively limited) number of volunteer subjects—generally no more than a few hundred participants.  Phase 3 Trials. Phase 3 trials involve an expanded number of participants—from several hundred to thousands—and are used to assess the product’s safety and effectiveness across a wide range of patient categories through controlled and uncontrolled studies. These trials are intended to present a clearer picture of expected risks and benefits under real-world conditions. The information obtained from phase 3 trials also forms the basis for the product’s labeling. Sponsors must generally complete all three phases to obtain FDA approval unless they obtain accelerated approval, in which case FDA requires post-approval trials to confirm the expected clinical benefit. FDA may also require, at its discretion, additional clinical trials after approval (i.e., phase 4 trials) for any approved product to continue assessing the product’s safety and effectiveness once on the market.",Medical,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",What is considered the president's core constitutional powers and what is the case law that the court relies on to reach this core? Please list the case law at the end of your response in bulleted form. Give me the full case citation so I can look them up myself later.,"The D. C. Circuit affirmed. 91 F. 4th 1173 (2024) (per curiam). Citing Marbury v. Madison, 1 Cranch 137 (1803), the court distinguished between two kinds of official acts: discretionary and ministerial. 91 F. 4th, at 1189–1190. It observed that “although discretionary acts are ‘only politically examinable,’ the judiciary has the power to hear cases” involving ministerial acts that an officer is directed to perform by the legislature. Ibid. (quoting Marbury, 1 Cranch, at 166). From this distinction, the D. C. Circuit concluded that the “separation of powers doctrine, as expounded in Marbury and its progeny, necessarily permits the Judiciary to oversee the federal criminal prosecution of a former President for his official acts because the fact of the prosecution means that the former President has allegedly acted in defiance of the Congress’s laws.” 91 F. 4th, at 1191. In the court’s view, the fact that Trump’s actions “allegedly violated generally applicable criminal laws” meant that those actions “were not properly within the scope of his lawful discretion.” Id., at 1192. The D. C. Circuit thus concluded that Trump had “no structural immunity from the charges in the Indictment.” Ibid. Like the District Court, the D. C. We granted certiorari to consider the following question: “Whether and if so to what extent does a former President enjoy presidential immunity from criminal prosecution for conduct alleged to involve official acts during his tenure in office.” 601 U. S. ___ (2024). II This case is the first criminal prosecution in our Nation’s history of a former President for actions taken during his Presidency. We are called upon to consider whether and under what circumstances such a prosecution may proceed. Doing so requires careful assessment of the scope of Presidential power under the Constitution. We undertake that responsibility conscious that we must not confuse “the issue of a power’s validity with the cause it is invoked to promote,” but must instead focus on the “enduring consequences upon the balanced power structure of our Republic.” Youngstown Sheet & Tube Co. v. Sawyer, 343 U. S. 579, 634 (1952) (Jackson, J., concurring). The parties before us do not dispute that a former President can be subject to criminal prosecution for unofficial acts committed while in office. See Tr. of Oral Arg. 28. They also agree that some of the conduct described in the indictment includes actions taken by Trump in his unofficial capacity. See id., at 28–30, 36–37, 124. They disagree, however, about whether a former President can be prosecuted for his official actions. Trump contends that just as a President is absolutely immune from civil damages liability for acts within the outer perimeter of his official responsibilities, Fitzgerald, 457 U. S., at 756, he must be absolutely immune from criminal prosecution for such acts. Brief for Petitioner 10. And Trump argues that the bulk of the indictment’s allegations involve conduct in 6 TRUMP v. UNITED STATES Opinion of the Court his official capacity as President. See Tr. of Oral Arg. 30– 32. Although the Government agrees that some official actions are included in the indictment’s allegations, see id., at 125, it maintains that a former President does not enjoy immunity from criminal prosecution for any actions, regardless of how they are characterized. See Brief for United States 9. We conclude that under our constitutional structure of separated powers, the nature of Presidential power requires that a former President have some immunity from criminal prosecution for official acts during his tenure in office. At least with respect to the President’s exercise of his core constitutional powers, this immunity must be absolute. As for his remaining official actions, he is also entitled to immunity. At the current stage of proceedings in this case, however, we need not and do not decide whether that immunity must be absolute, or instead whether a presumptive immunity is sufficient. A Article II of the Constitution provides that “[t]he executive Power shall be vested in a President of the United States of America.” §1, cl. 1. The President’s duties are of “unrivaled gravity and breadth.” Trump v. Vance, 591 U. S. 786, 800 (2020). They include, for instance, commanding the Armed Forces of the United States; granting reprieves and pardons for offenses against the United States; and appointing public ministers and consuls, the Justices of this Court, and Officers of the United States. See §2. He also has important foreign relations responsibilities: making treaties, appointing ambassadors, recognizing foreign governments, meeting foreign leaders, overseeing international diplomacy and intelligence gathering, and managing matters related to terrorism, trade, and immigration. See §§2, 3. Domestically, he must “take Care that the Laws be faithfully executed,” §3, and he bears responsibility for the Cite as: 603 U. S. ____ (2024) 7 Opinion of the Court actions of the many departments and agencies within the Executive Branch. He also plays a role in lawmaking by recommending to Congress the measures he thinks wise and signing or vetoing the bills Congress passes. See Art. I, §7, cl. 2; Art. II, §3. No matter the context, the President’s authority to act necessarily “stem[s] either from an act of Congress or from the Constitution itself.” Youngstown, 343 U. S., at 585. In the latter case, the President’s authority is sometimes “conclusive and preclusive.” Id., at 638 (Jackson, J., concurring). When the President exercises such authority, he may act even when the measures he takes are “incompatible with the expressed or implied will of Congress.” Id., at 637. The exclusive constitutional authority of the President “disabl[es] the Congress from acting upon the subject.” Id., at 637–638. And the courts have “no power to control [the President’s] discretion” when he acts pursuant to the powers invested exclusively in him by the Constitution. Marbury, 1 Cranch, at 166. 8 TRUMP v. UNITED STATES Opinion of the Court (1872). But in 1870, Congress enacted a provision that prohibited using the President’s pardon as evidence of restoration of property rights. Id., at 143–144. Chief Justice Chase held the provision unconstitutional because it “impair[ed] the effect of a pardon, and thus infring[ed] the constitutional power of the Executive.” Id., at 147. “To the executive alone is intrusted the power of pardon,” and the “legislature cannot change the effect of such a pardon any more than the executive can change a law.” Id., at 147–148. The President’s authority to pardon, in other words, is “conclusive and preclusive,” “disabling the Congress from acting upon the subject.” Youngstown, 343 U. S., at 637–638 (Jackson, J., concurring). Some of the President’s other constitutional powers also fit that description. “The President’s power to remove—and thus supervise—those who wield executive power on his behalf,” for instance, “follows from the text of Article II.” Seila Law LLC v. Consumer Financial Protection Bureau, 591 U. S. 197, 204 (2020). We have thus held that Congress lacks authority to control the President’s “unrestricted power of removal” with respect to “executive officers of the United States whom he has appointed.” Myers v. United States, 272 U. S. 52, 106, 176 (1926); see Youngstown, 343 U. S., at 638, n. 4 (Jackson, J., concurring) (citing the President’s “exclusive power of removal in executive agencies” as an example of “conclusive and preclusive” constitutional authority); cf. Seila Law, 591 U. S., at 215 (noting only “two exceptions to the President’s unrestricted removal power”). The power “to control recognition determinations” of foreign countries is likewise an “exclusive power of the President.” Zivotofsky v. Kerry, 576 U. S. 1, 32 (2015). Congressional commands contrary to the President’s recognition determinations are thus invalid. Ibid.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What is considered the president's core constitutional powers and what is the case law that the court relies on to reach this core? Please list the case law at the end of your response in bulleted form. Give me the full case citation so I can look them up myself later. {passage 0} ========== The D. C. Circuit affirmed. 91 F. 4th 1173 (2024) (per curiam). Citing Marbury v. Madison, 1 Cranch 137 (1803), the court distinguished between two kinds of official acts: discretionary and ministerial. 91 F. 4th, at 1189–1190. It observed that “although discretionary acts are ‘only politically examinable,’ the judiciary has the power to hear cases” involving ministerial acts that an officer is directed to perform by the legislature. Ibid. (quoting Marbury, 1 Cranch, at 166). From this distinction, the D. C. Circuit concluded that the “separation of powers doctrine, as expounded in Marbury and its progeny, necessarily permits the Judiciary to oversee the federal criminal prosecution of a former President for his official acts because the fact of the prosecution means that the former President has allegedly acted in defiance of the Congress’s laws.” 91 F. 4th, at 1191. In the court’s view, the fact that Trump’s actions “allegedly violated generally applicable criminal laws” meant that those actions “were not properly within the scope of his lawful discretion.” Id., at 1192. The D. C. Circuit thus concluded that Trump had “no structural immunity from the charges in the Indictment.” Ibid. Like the District Court, the D. C. We granted certiorari to consider the following question: “Whether and if so to what extent does a former President enjoy presidential immunity from criminal prosecution for conduct alleged to involve official acts during his tenure in office.” 601 U. S. ___ (2024). II This case is the first criminal prosecution in our Nation’s history of a former President for actions taken during his Presidency. We are called upon to consider whether and under what circumstances such a prosecution may proceed. Doing so requires careful assessment of the scope of Presidential power under the Constitution. We undertake that responsibility conscious that we must not confuse “the issue of a power’s validity with the cause it is invoked to promote,” but must instead focus on the “enduring consequences upon the balanced power structure of our Republic.” Youngstown Sheet & Tube Co. v. Sawyer, 343 U. S. 579, 634 (1952) (Jackson, J., concurring). The parties before us do not dispute that a former President can be subject to criminal prosecution for unofficial acts committed while in office. See Tr. of Oral Arg. 28. They also agree that some of the conduct described in the indictment includes actions taken by Trump in his unofficial capacity. See id., at 28–30, 36–37, 124. They disagree, however, about whether a former President can be prosecuted for his official actions. Trump contends that just as a President is absolutely immune from civil damages liability for acts within the outer perimeter of his official responsibilities, Fitzgerald, 457 U. S., at 756, he must be absolutely immune from criminal prosecution for such acts. Brief for Petitioner 10. And Trump argues that the bulk of the indictment’s allegations involve conduct in 6 TRUMP v. UNITED STATES Opinion of the Court his official capacity as President. See Tr. of Oral Arg. 30– 32. Although the Government agrees that some official actions are included in the indictment’s allegations, see id., at 125, it maintains that a former President does not enjoy immunity from criminal prosecution for any actions, regardless of how they are characterized. See Brief for United States 9. We conclude that under our constitutional structure of separated powers, the nature of Presidential power requires that a former President have some immunity from criminal prosecution for official acts during his tenure in office. At least with respect to the President’s exercise of his core constitutional powers, this immunity must be absolute. As for his remaining official actions, he is also entitled to immunity. At the current stage of proceedings in this case, however, we need not and do not decide whether that immunity must be absolute, or instead whether a presumptive immunity is sufficient. A Article II of the Constitution provides that “[t]he executive Power shall be vested in a President of the United States of America.” §1, cl. 1. The President’s duties are of “unrivaled gravity and breadth.” Trump v. Vance, 591 U. S. 786, 800 (2020). They include, for instance, commanding the Armed Forces of the United States; granting reprieves and pardons for offenses against the United States; and appointing public ministers and consuls, the Justices of this Court, and Officers of the United States. See §2. He also has important foreign relations responsibilities: making treaties, appointing ambassadors, recognizing foreign governments, meeting foreign leaders, overseeing international diplomacy and intelligence gathering, and managing matters related to terrorism, trade, and immigration. See §§2, 3. Domestically, he must “take Care that the Laws be faithfully executed,” §3, and he bears responsibility for the Cite as: 603 U. S. ____ (2024) 7 Opinion of the Court actions of the many departments and agencies within the Executive Branch. He also plays a role in lawmaking by recommending to Congress the measures he thinks wise and signing or vetoing the bills Congress passes. See Art. I, §7, cl. 2; Art. II, §3. No matter the context, the President’s authority to act necessarily “stem[s] either from an act of Congress or from the Constitution itself.” Youngstown, 343 U. S., at 585. In the latter case, the President’s authority is sometimes “conclusive and preclusive.” Id., at 638 (Jackson, J., concurring). When the President exercises such authority, he may act even when the measures he takes are “incompatible with the expressed or implied will of Congress.” Id., at 637. The exclusive constitutional authority of the President “disabl[es] the Congress from acting upon the subject.” Id., at 637–638. And the courts have “no power to control [the President’s] discretion” when he acts pursuant to the powers invested exclusively in him by the Constitution. Marbury, 1 Cranch, at 166. 8 TRUMP v. UNITED STATES Opinion of the Court (1872). But in 1870, Congress enacted a provision that prohibited using the President’s pardon as evidence of restoration of property rights. Id., at 143–144. Chief Justice Chase held the provision unconstitutional because it “impair[ed] the effect of a pardon, and thus infring[ed] the constitutional power of the Executive.” Id., at 147. “To the executive alone is intrusted the power of pardon,” and the “legislature cannot change the effect of such a pardon any more than the executive can change a law.” Id., at 147–148. The President’s authority to pardon, in other words, is “conclusive and preclusive,” “disabling the Congress from acting upon the subject.” Youngstown, 343 U. S., at 637–638 (Jackson, J., concurring). Some of the President’s other constitutional powers also fit that description. “The President’s power to remove—and thus supervise—those who wield executive power on his behalf,” for instance, “follows from the text of Article II.” Seila Law LLC v. Consumer Financial Protection Bureau, 591 U. S. 197, 204 (2020). We have thus held that Congress lacks authority to control the President’s “unrestricted power of removal” with respect to “executive officers of the United States whom he has appointed.” Myers v. United States, 272 U. S. 52, 106, 176 (1926); see Youngstown, 343 U. S., at 638, n. 4 (Jackson, J., concurring) (citing the President’s “exclusive power of removal in executive agencies” as an example of “conclusive and preclusive” constitutional authority); cf. Seila Law, 591 U. S., at 215 (noting only “two exceptions to the President’s unrestricted removal power”). The power “to control recognition determinations” of foreign countries is likewise an “exclusive power of the President.” Zivotofsky v. Kerry, 576 U. S. 1, 32 (2015). Congressional commands contrary to the President’s recognition determinations are thus invalid. Ibid. https://www.supremecourt.gov/opinions/23pdf/23-939_e2pg.pdf",Legal,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","Summarize the provided information about Shigella in less than 600 words. At the end of the summary, list the symptoms one may experience in bold print.","Clinical Manifestations Symptoms of shigellosis include abdominal pain, tenesmus, watery diarrhea, and/or dysentery (multiple scanty, bloody, mucoid stools). Other signs may include abdominal tenderness, fever, vomiting, dehydration, and convulsions. Structure, Classification, and Antigenic Types Shigellae are Gram-negative, nonmotile, facultatively anaerobic, non-spore-forming rods. Shigella are differentiated from the closely related Escherichia coli on the basis of pathogenicity, physiology (failure to ferment lactose or decarboxylate lysine) and serology. The genus is divided into four serogroups with multiple serotypes: A (S dysenteriae, 12 serotypes); B (S flexneri, 6 serotypes); C (S boydii, 18 serotypes); and D (S sonnei, 1 serotype). Pathogenesis Infection is initiated by ingestion of shigellae (usually via fecal-oral contamination). An early symptom, diarrhea (possibly elicited by enterotoxins and/or cytotoxin), may occur as the organisms pass through the small intestine. The hallmarks of shigellosis are bacterial invasion of the colonic epithelium and inflammatory colitis. These are interdependent processes amplified by local release of cytokines and by the infiltration of inflammatory elements. Colitis in the rectosigmoid mucosa, with concomitant malabsorption, results in the characteristic sign of bacillary dysentery: scanty,. unformed stools tinged with blood and mucus. Host Defenses Inflammation, copious mucus secretion, and regeneration of the damaged colonic epithelium limit the spread of colitis and promote spontaneous recovery. Serotype-specific immunity is induced by a primary infection, suggesting a protective role of antibody recognizing the lipopolysaccharide (LPS) somatic antigen. Other Shigella antigens include enterotoxins, cytotoxin, and plasmid-encoded proteins that induce bacterial invasion of the epithelium. The protective role of immune responses against these antigens is unclear. Epidemiology Shigellosis is endemic in developing countries were sanitation is poor. Typically 10 to 20 percent of enteric disease, and 50% of the bloody diarrhea or dysentery of young children, can be characterized as shigellosis, and the prevalence of these infections decreases significantly after five years of life. In developed countries, single-source, food or water-borne outbreaks occur sporadically, and pockets of endemic shigellosis can be found in institutions and in remote areas with substandard sanitary facilities. Diagnosis Shigellosis can be correctly diagnosed in most patients on the basis of fresh blood in the stool. Neutrophils in fecal smears is also a strongly suggestive sign. Nonetheless, watery, mucoid diarrhea may be the only symptom of many S sonnei infections, and any clinical diagnosis should be confirmed by cultivation of the etiologic agent from stools. Control Prevention of fecal-oral transmission is the most effective control strategy. Severe dysentery is treated with ampicillin, trimethoprim-sulfamethoxazole, or, in patients over 17 years old, a 4-fluorquinolone such as ciprofloxacin. Vaccines are not currently available, but some promising candidates are being developed. Gram-negative, facultative anaerobes of the genus Shigella are the principal agents of bacillary dysentery. This disease differs from profuse watery diarrhea, as is commonly seen in choleraic diarrhea or in enterotoxigenic Escherichia coli diarrhea, in that the dysenteric stool is scant and contains blood, mucus, and inflammatory cells. In some individuals suffering from shigellosis, however, moderate volume diarrhea is a prodrome or the sole manifestation of the infection. Bacillary dysentery constitutes a significant proportion of acute intestinal disease in the children of developing countries, and this infection is a major contributor to stunted growth of these children. Shigellosis also presents a significant risk to travelers from developed countries when visiting in endemic areas, and sporadic food or water-borne outbreaks occur in developed countries. The pathogenic mechanism of shigellosis is complex, involving a possible enterotoxic and/or cytotoxic diarrheal prodrome, cytokine-mediated inflammation of the colon, and necrosis of the colonic epithelium. The underlying physiological insult that initiates this inflammatory cascade is the invasion of Shigella into the colonic epithelium and the lamina propria. The resulting colitis and ulceration of the mucosa result in bloody, mucoid stools, and/or febrile diarrhea.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Summarize the provided information about Shigella in less than 600 words. At the end of the summary, list the symptoms one may experience in bold print. Clinical Manifestations Symptoms of shigellosis include abdominal pain, tenesmus, watery diarrhea, and/or dysentery (multiple scanty, bloody, mucoid stools). Other signs may include abdominal tenderness, fever, vomiting, dehydration, and convulsions. Structure, Classification, and Antigenic Types Shigellae are Gram-negative, nonmotile, facultatively anaerobic, non-spore-forming rods. Shigella are differentiated from the closely related Escherichia coli on the basis of pathogenicity, physiology (failure to ferment lactose or decarboxylate lysine) and serology. The genus is divided into four serogroups with multiple serotypes: A (S dysenteriae, 12 serotypes); B (S flexneri, 6 serotypes); C (S boydii, 18 serotypes); and D (S sonnei, 1 serotype). Pathogenesis Infection is initiated by ingestion of shigellae (usually via fecal-oral contamination). An early symptom, diarrhea (possibly elicited by enterotoxins and/or cytotoxin), may occur as the organisms pass through the small intestine. The hallmarks of shigellosis are bacterial invasion of the colonic epithelium and inflammatory colitis. These are interdependent processes amplified by local release of cytokines and by the infiltration of inflammatory elements. Colitis in the rectosigmoid mucosa, with concomitant malabsorption, results in the characteristic sign of bacillary dysentery: scanty,. unformed stools tinged with blood and mucus. Host Defenses Inflammation, copious mucus secretion, and regeneration of the damaged colonic epithelium limit the spread of colitis and promote spontaneous recovery. Serotype-specific immunity is induced by a primary infection, suggesting a protective role of antibody recognizing the lipopolysaccharide (LPS) somatic antigen. Other Shigella antigens include enterotoxins, cytotoxin, and plasmid-encoded proteins that induce bacterial invasion of the epithelium. The protective role of immune responses against these antigens is unclear. Epidemiology Shigellosis is endemic in developing countries were sanitation is poor. Typically 10 to 20 percent of enteric disease, and 50% of the bloody diarrhea or dysentery of young children, can be characterized as shigellosis, and the prevalence of these infections decreases significantly after five years of life. In developed countries, single-source, food or water-borne outbreaks occur sporadically, and pockets of endemic shigellosis can be found in institutions and in remote areas with substandard sanitary facilities. Diagnosis Shigellosis can be correctly diagnosed in most patients on the basis of fresh blood in the stool. Neutrophils in fecal smears is also a strongly suggestive sign. Nonetheless, watery, mucoid diarrhea may be the only symptom of many S sonnei infections, and any clinical diagnosis should be confirmed by cultivation of the etiologic agent from stools. Control Prevention of fecal-oral transmission is the most effective control strategy. Severe dysentery is treated with ampicillin, trimethoprim-sulfamethoxazole, or, in patients over 17 years old, a 4-fluorquinolone such as ciprofloxacin. Vaccines are not currently available, but some promising candidates are being developed. Gram-negative, facultative anaerobes of the genus Shigella are the principal agents of bacillary dysentery. This disease differs from profuse watery diarrhea, as is commonly seen in choleraic diarrhea or in enterotoxigenic Escherichia coli diarrhea, in that the dysenteric stool is scant and contains blood, mucus, and inflammatory cells. In some individuals suffering from shigellosis, however, moderate volume diarrhea is a prodrome or the sole manifestation of the infection. Bacillary dysentery constitutes a significant proportion of acute intestinal disease in the children of developing countries, and this infection is a major contributor to stunted growth of these children. Shigellosis also presents a significant risk to travelers from developed countries when visiting in endemic areas, and sporadic food or water-borne outbreaks occur in developed countries. The pathogenic mechanism of shigellosis is complex, involving a possible enterotoxic and/or cytotoxic diarrheal prodrome, cytokine-mediated inflammation of the colon, and necrosis of the colonic epithelium. The underlying physiological insult that initiates this inflammatory cascade is the invasion of Shigella into the colonic epithelium and the lamina propria. The resulting colitis and ulceration of the mucosa result in bloody, mucoid stools, and/or febrile diarrhea. https://www.ncbi.nlm.nih.gov/books/NBK8038/",Medical,Summarize,Text Transformation You may only respond to the prompt using information provided in the context block.,Can I reuse the OEM hardware for this?,"Before beginning the installation, thoroughly & completely read these instructions. Please refer to the Parts List to insure that all parts & hardware are received prior to the disassembly of the vehicle. If any parts are found to be missing, contact SKYJACKER® Customer Service at 318-388-0816 to obtain the needed items. If you have any questions or reservations about installing this product, contact SKYJACKER® Technical Assistance at 318-388-0816. Installation: 1. Park the vehicle on a flat, level surface & block the front & rear tires. 2. Place the transmission in neutral. 3. Loosen all of the engine mount bolts about ½ turn. 4. Support the transfer case cross member with a transmission or floor jack. Remove the bolts & nuts for each side of the cross member. 5. Slowly lower the cross member, approximately 2"", to allow enough room to install the new Skyjacker tubular spacers. 1994-2001 Jeep Cherokee XJ Install the new Skyjacker transfer case linkage pivot drop bracket to the stock pivot bracket using the OEM hardware. Using the two 1/4"" x 1"" bolts with a flat washer & self locking nut, bolt the ball swivel bracket (See Arrow in Photo # 3) to the new Skyjacker drop bracket. Note: The bracket has two sets of holes. The bottom holes are for a 4"" lift as shown & the upper holes are for a 2 1/2"" lift. 2. Placing the pivot bracket back in location, start the end of the rod through the ball swivel & bolt the bracket in location with the OEM hardware. (See Photo # 4) 3. Check to make sure that the transfer case will fully engage at each end of the shifter travel. If linkage adjustment is required, 4. Check the transfer case shifter to see if it will move to 4L. If not, the linkage will need adjusting as follows. Place the shifter in 4L, loosen the adjustment bolt & push the linkage (""B"" Arrow in Photo # 5) forward until it stops. Now retighten adjustment bolt. Check to be sure the 4WD works properly. 5. On 5 speed models, engage the clutch & check the transmission shifter to see if it will go into 2nd gear. If not, the shifter housing on the floor will need trimming. Remove the center console, pull back the carpet, remove the screws holding the shifter boot to the floor, & trim or grind the floor board until sufficient clearance is obtained. Shift through each gear to check clearance at this time. Now reinstall the shifter boot, carpet, & console. ","You may only respond to the prompt using information provided in the context block. Can I reuse the OEM hardware for this? Before beginning the installation, thoroughly & completely read these instructions. Please refer to the Parts List to insure that all parts & hardware are received prior to the disassembly of the vehicle. If any parts are found to be missing, contact SKYJACKER® Customer Service at 318-388-0816 to obtain the needed items. If you have any questions or reservations about installing this product, contact SKYJACKER® Technical Assistance at 318-388-0816. Installation: 1. Park the vehicle on a flat, level surface & block the front & rear tires. 2. Place the transmission in neutral. 3. Loosen all of the engine mount bolts about ½ turn. 4. Support the transfer case cross member with a transmission or floor jack. Remove the bolts & nuts for each side of the cross member. 5. Slowly lower the cross member, approximately 2"", to allow enough room to install the new 6. Install the new Skyjacker tubular spacers between the cross member & frame. Slowly raise the jack to firmly hold the tubular spacers in place. 7. Install the OEM nuts, removed in Step # 4, onto the studs that are protruding out of the frame on each side to hold the top half of the new spacers in place. Note: There is only one stud on each side protruding out of the frame. Next, install the 3/8"" x 1"" bolt on each side through the cross member & the bottom half of the new tubular spacers. Install the 3/8 nut, washer, & hand tighten. 8. Install the new 10mm x 60mm bolt up through the cross member & tubular spacer & tighten to 33 ft. lbs. (See Photo # 2) 9. Tighten the 3/8"" nut down onto the 3/8"" x 1"" bolt from Step # 7 to 33 ft-lbs. Remove the transmission jack & set aside. 10. Re-torque the engine mount bolts loosened in Step # 3. The engine mount to block bolts torque to 45 ft-lbs. The engine mount to frame bolts torque to 30 ft-lbs. The thru bolts torque to 48 ft-lbs. 11. Install the transfer case linkage bracket. (See Steps # 1 thru # 5 Below) Skyjacker tubular spacers. 1994-2001 Jeep Cherokee XJ Install the new Skyjacker transfer case linkage pivot drop bracket to the stock pivot bracket using the OEM hardware. Using the two 1/4"" x 1"" bolts with a flat washer & self locking nut, bolt the ball swivel bracket (See Arrow in Photo # 3) to the new Skyjacker drop bracket. Note: The bracket has two sets of holes. The bottom holes are for a 4"" lift as shown & the upper holes are for a 2 1/2"" lift. 2. Placing the pivot bracket back in location, start the end of the rod through the ball swivel & bolt the bracket in location with the OEM hardware. (See Photo # 4) 3. Check to make sure that the transfer case will fully engage at each end of the shifter travel. If linkage adjustment is required, 4. Check the transfer case shifter to see if it will move to 4L. If not, the linkage will need adjusting as follows. Place the shifter in 4L, loosen the adjustment bolt & push the linkage (""B"" Arrow in Photo # 5) forward until it stops. Now retighten adjustment bolt. Check to be sure the 4WD works properly. 5. On 5 speed models, engage the clutch & check the transmission shifter to see if it will go into 2nd gear. If not, the shifter housing on the floor will need trimming. Remove the center console, pull back the carpet, remove the screws holding the shifter boot to the floor, & trim or grind the floor board until sufficient clearance is obtained. Shift through each gear to check clearance at this time. Now reinstall the shifter boot, carpet, & console.",Internet/Technology,Fact Finding,Q&A Draw your answer from the prompt text only.,What examples does the text give of government interests that are important enough to justify regulating speech related to strict and intermediate scrutiny?,"Levels of Scrutiny and Key Concepts Most often, a court adjudicating a free speech challenge will analyze the constitutionality of a law or government action by applying a level of scrutiny derived from the Supreme Court’s First Amendment precedents. The two most common levels of scrutiny in free speech analysis are strict and intermediate scrutiny.35 Strict scrutiny generally applies to laws that regulate speech on the basis of its content or message. 36 It is a “demanding standard” that the government is rarely able to meet.37 Intermediate scrutiny has several different formulations but generally applies to content-neutral laws and commercial speech restrictions. 38 Intermediate scrutiny too presents a high bar for the government, but regulations of speech are more likely to survive intermediate than strict scrutiny. To varying degrees, each level of scrutiny requires the government to prove that it has a sufficiently important interest in regulating the speech at issue and that the law directly advances and is narrowly tailored to that interest. While laws that fail strict or intermediate scrutiny often do so on lack-of-tailoring grounds, the government sometimes fails to show that its interests are “real” and “not merely conjectural.”39 For example, it may be insufficient for the government to cite an interest that is significant in the abstract if the government lacks evidence of a concrete harm threatening that interest.40 For “prophylactic” speech restrictions in particular, the government must “demonstrate that it is regulating speech in order to address what is in fact a serious problem and that the preventative measure it proposes will contribute in a material way to solving that problem.”41 For more information on the levels of scrutiny and other key First Amendment concepts, readers of this report’s HTML and PDF formats can click on a term or phrase in the text box titled “Free Speech Terminology” to navigate to a discussion of that concept. Strict Scrutiny Strict scrutiny generally applies to content-based laws—laws that regulate speech on the basis of its subject matter, topic, or substantive message.42 A law can be content based on its face or in its design or purpose.43 The Supreme Court considers viewpoint discrimination—distinctions based on a “specific motivating ideology,” opinion, or perspective—to be “an egregious form of content discrimination.”44 For this reason, courts sometimes invalidate viewpoint-based laws summarily, without undertaking a strict scrutiny analysis.45 Under strict scrutiny, the government must prove that its law is narrowly tailored to advance a compelling governmental interest and that the law is the least restrictive means of serving that interest.46 While not an exhaustive list, the Supreme Court has identified the following interests as compelling, at least in certain contexts: • “national security”; 47 • “public confidence in judicial integrity”; 48 • “protecting the physical and psychological well-being of minors”; 49 • “ensur[ing] the basic human rights of members of groups that have historically been subjected to discrimination”; 50 • “eradicating discrimination against [a state’s] female citizens”; 51 and • “depriving criminals of the profits of their crimes, and in using these funds to compensate victims.” 52 Both strict and intermediate scrutiny require narrow tailoring, 53 meaning that the government must “pursue its legitimate interests through ‘means that are neither seriously underinclusive nor seriously overinclusive.’” 54 The precise degree of tailoring required under each standard differs. Under strict scrutiny, the challenged law or action must be the “least restrictive means” of satisfying the government’s compelling interest. In other words, “[i]f a less restrictive alternative would serve the Government’s purpose, the legislature must use that alternative.”55 Intermediate Scrutiny Intermediate scrutiny typically applies to content-neutral laws and commercial speech restrictions, albeit following different lines of Supreme Court precedent. 56 A law is content neutral if it “serves purposes unrelated to the content of expression”57 and does not, on its face, regulate speech on the basis of its subject matter, topic, or viewpoint.58 The Supreme Court has established an intermediate scrutiny standard for content-neutral time, place, or manner regulations.59 Specifically, the Court has held that “[e]xpression, whether oral or written or symbolized by conduct, is subject to reasonable time, place, or manner restrictions,” 60 such as a regulation to control the volume of music played at a bandshell in a public park.61 Time, place, or manner restrictions “are valid provided that they are justified without reference to the content of the regulated speech, that they are narrowly tailored to serve a significant governmental interest, and that they leave open ample alternative channels for communication of the information.” 62 A similar test set out in United States v. O’Brien is used to evaluate restrictions on certain types of expressive conduct, such as “when ‘speech’ and ‘nonspeech’ elements are combined in the same course of conduct.”63 Intermediate scrutiny is also the standard applied to commercial speech restrictions. Commercial speech is (1) speech that “does no more than propose a commercial transaction” (e.g., an advertisement for a product or service); 64 or (2) “expression related solely to the economic interests of the speaker and its audience.”65 To sustain a restriction on lawful, nonmisleading commercial speech, the government must meet the standard set out in Central Hudson Gas and Electric Corp. v. Public Service Commission. 66 Specifically, the government must show that its law “directly advances” a “substantial” governmental interest and is narrowly tailored—that is, “not more extensive than necessary”—to serve that interest. 67 Examples of substantial or important governmental interests include • protecting the public from deceptive and misleading trade practices;68 • “maintaining standards of ethical conduct in the licensed professions”; 69 • “energy conservation”; 70 • preventing “quid pro quo” corruption or its appearance in election campaigns;71 and “promoting fair competition in the market for television programming.” 72 The tailoring requirement for intermediate scrutiny is less rigorous than for strict scrutiny. Under intermediate scrutiny, a law “need not be the least restrictive or least intrusive means” of advancing the government’s interest.73 Nevertheless, the government “still ‘may not regulate expression in such a manner that a substantial portion of the burden on speech does not serve to advance its goals.’” 74 Narrow tailoring for commercial speech restrictions, for example, requires “a fit that is not necessarily perfect, but reasonable; that represents not necessarily the single best disposition but one whose scope is in proportion to the interest served.”","Draw your answer from the prompt text only. What examples does the text give of government interests that are important enough to justify regulating speech related to strict and intermediate scrutiny? Levels of Scrutiny and Key Concepts Most often, a court adjudicating a free speech challenge will analyze the constitutionality of a law or government action by applying a level of scrutiny derived from the Supreme Court’s First Amendment precedents. The two most common levels of scrutiny in free speech analysis are strict and intermediate scrutiny.35 Strict scrutiny generally applies to laws that regulate speech on the basis of its content or message. 36 It is a “demanding standard” that the government is rarely able to meet.37 Intermediate scrutiny has several different formulations but generally applies to content-neutral laws and commercial speech restrictions. 38 Intermediate scrutiny too presents a high bar for the government, but regulations of speech are more likely to survive intermediate than strict scrutiny. To varying degrees, each level of scrutiny requires the government to prove that it has a sufficiently important interest in regulating the speech at issue and that the law directly advances and is narrowly tailored to that interest. While laws that fail strict or intermediate scrutiny often do so on lack-of-tailoring grounds, the government sometimes fails to show that its interests are “real” and “not merely conjectural.”39 For example, it may be insufficient for the government to cite an interest that is significant in the abstract if the government lacks evidence of a concrete harm threatening that interest.40 For “prophylactic” speech restrictions in particular, the government must “demonstrate that it is regulating speech in order to address what is in fact a serious problem and that the preventative measure it proposes will contribute in a material way to solving that problem.”41 For more information on the levels of scrutiny and other key First Amendment concepts, readers of this report’s HTML and PDF formats can click on a term or phrase in the text box titled “Free Speech Terminology” to navigate to a discussion of that concept. Strict Scrutiny Strict scrutiny generally applies to content-based laws—laws that regulate speech on the basis of its subject matter, topic, or substantive message.42 A law can be content based on its face or in its design or purpose.43 The Supreme Court considers viewpoint discrimination—distinctions based on a “specific motivating ideology,” opinion, or perspective—to be “an egregious form of content discrimination.”44 For this reason, courts sometimes invalidate viewpoint-based laws summarily, without undertaking a strict scrutiny analysis.45 Under strict scrutiny, the government must prove that its law is narrowly tailored to advance a compelling governmental interest and that the law is the least restrictive means of serving that interest.46 While not an exhaustive list, the Supreme Court has identified the following interests as compelling, at least in certain contexts: • “national security”;47 • “public confidence in judicial integrity”;48 • “protecting the physical and psychological well-being of minors”; 49 • “ensur[ing] the basic human rights of members of groups that have historically been subjected to discrimination”; 50 • “eradicating discrimination against [a state’s] female citizens”; 51 and • “depriving criminals of the profits of their crimes, and in using these funds to compensate victims.” 52 Both strict and intermediate scrutiny require narrow tailoring, 53 meaning that the government must “pursue its legitimate interests through ‘means that are neither seriously underinclusive nor seriously overinclusive.’” 54 The precise degree of tailoring required under each standard differs. Under strict scrutiny, the challenged law or action must be the “least restrictive means” of satisfying the government’s compelling interest. In other words, “[i]f a less restrictive alternative would serve the Government’s purpose, the legislature must use that alternative.”55 Intermediate Scrutiny Intermediate scrutiny typically applies to content-neutral laws and commercial speech restrictions, albeit following different lines of Supreme Court precedent. 56 A law is content neutral if it “serves purposes unrelated to the content of expression”57 and does not, on its face, regulate speech on the basis of its subject matter, topic, or viewpoint.58 The Supreme Court has established an intermediate scrutiny standard for content-neutral time, place, or manner regulations.59 Specifically, the Court has held that “[e]xpression, whether oral or written or symbolized by conduct, is subject to reasonable time, place, or manner restrictions,”60 such as a regulation to control the volume of music played at a bandshell in a public park.61 Time, place, or manner restrictions “are valid provided that they are justified without reference to the content of the regulated speech, that they are narrowly tailored to serve a significant governmental interest, and that they leave open ample alternative channels for communication of the information.”62 A similar test set out in United States v. O’Brien is used to evaluate restrictions on certain types of expressive conduct, such as “when ‘speech’ and ‘nonspeech’ elements are combined in the same course of conduct.”63 Intermediate scrutiny is also the standard applied to commercial speech restrictions. Commercial speech is (1) speech that “does no more than propose a commercial transaction” (e.g., an advertisement for a product or service); 64 or (2) “expression related solely to the economic interests of the speaker and its audience.”65 To sustain a restriction on lawful, nonmisleading commercial speech, the government must meet the standard set out in Central Hudson Gas and Electric Corp. v. Public Service Commission. 66 Specifically, the government must show that its law “directly advances” a “substantial” governmental interest and is narrowly tailored—that is, “not more extensive than necessary”—to serve that interest.67 Examples of substantial or important governmental interests include • protecting the public from deceptive and misleading trade practices;68 • “maintaining standards of ethical conduct in the licensed professions”;69 • “energy conservation”;70 • preventing “quid pro quo” corruption or its appearance in election campaigns;71 and “promoting fair competition in the market for television programming.”72 The tailoring requirement for intermediate scrutiny is less rigorous than for strict scrutiny. Under intermediate scrutiny, a law “need not be the least restrictive or least intrusive means” of advancing the government’s interest.73 Nevertheless, the government “still ‘may not regulate expression in such a manner that a substantial portion of the burden on speech does not serve to advance its goals.’” 74 Narrow tailoring for commercial speech restrictions, for example, requires “a fit that is not necessarily perfect, but reasonable; that represents not necessarily the single best disposition but one whose scope is in proportion to the interest served.”",Legal,Fact Finding,Q&A You must answer my questions based solely on the information provided. Do not use any external resources or prior knowledge.,When can the school year visitation schedule be reset?,"II. PARENTING TIME/VISITATION SCHEDULES The following schedule should not be construed as precluding other visitation or alternative arrangements. The best visitation plan is one the parties have agreed to, rather than one imposed by the Court. However, the Court will only enforce the strict terms of this Parenting Plan in the event of any future disagreements concerning visitation. A. Parenting Time/Visitation-General This visitation schedule is broken up into several different sections or types of visitation. Regardless of the age of the child(ren) whose custody is being addressed herein, this visitation schedule is organized to include visitation during the school year, during holidays from school and during summer. For all purposes herein, the following terms shall be applicable: 1) Visitation during school year: If the child(ren) are not enrolled in school, the published schedule of the local public school where the primary custodian resides shall be utilized. If the child(ren) are enrolled in school, the schedule of the school system in which the child(ren) is/are actually enrolled shall be utilized. In the event there is more than one child and the children are enrolled in schools which observe different schedules, the parties shall utilize a hybrid schedule that reflects the holidays which are common to all applicable school systems (the applicable schedule shall be referred to as the “School Year”). This schedule may also be referred to as the “Regular Schedule” or “Day-To-Day Schedule” herein. 2) Visitation during Thanksgiving Break: This period of visitation includes the dates that the applicable school system recesses for at least two consecutive school days in November of every year (“Thanksgiving Break”). This schedule begins to be applicable at 6:00 p.m. on the date that the Thanksgiving Break begins and ends at 6:00 p.m. on the Sunday after Thanksgiving. 3) Visitation during Winter Break: This period of visitation includes the dates that the applicable school system recesses for winter break and which includes December 25 of every year (“Winter Break”). This schedule begins to be applicable at 6:00 p.m. on the date that the Winter Break begins and ends at 6:00 p.m. on the day before school resumes. 4) Visitation during Spring Break: This period of visitation includes the dates that the applicable school system recesses for a full week in the month of March or April of every year (“Spring Break”). This schedule begins to be applicable at 6:00 p.m. on the day that school recesses for Spring Break and ends at 6:00 p.m. on the day before school resumes. 5) Visitation during Summer: This period of visitation includes the dates that the applicable school system recesses for at least one full month in the summer and is the period between academic years (“Summer Break”). The Summer Break begins to be applicable on the day that school recesses for Summer Break and ends at 6:00 p.m. five (5) days before school resumes. 6) Weekend: For purposes of this parenting plan, a weekend begins at 6:00 p.m. on Friday and ends at 6:00 p.m. on Sunday. 7) Weekday visitation: Weekday visitation begins at 4:00 p.m. and ends at 7:30 p.m. The party with weekday visitation shall provide the child(ren)’s evening meal and complete any homework assigned for that evening. B. Visitation during School Year: (Choose one of the following) During the school year, the Non-Custodial Parent shall have at a minimum the following rights of parenting time/visitation (choose an item): ( ) The weekend of the first, third and fifth Friday (if any) of each month. ( ) Every other weekend starting the second weekend after the date of this plan. Additionally, the Non-Custodial Parent shall have weekday parenting time/visitation on (choose an item): ( ) None ( ) One afternoon each week to be agreed upon by the parties. If the parties cannot agree, weekday visitation shall be on Tuesday. C. Visitation during Thanksgiving Break: (Choose one of the following) ( ) Applicable ( ) Not applicable, the Day-to-Day schedule applies ( ) See Paragraph XI below _______ In even-numbered years, the Non-Custodial Parent will have the child(ren) with him/her for the entire Thanksgiving Break. In odd-numbered years, the Custodial Parent shall have the child(ren) with him/her for the entire Thanksgiving Break. OR _______ The ( ) Custodial Parent ( ) Non-Custodial Parent shall have the child(ren) for the first period of Thanksgiving Break, beginning at the time that school recesses for Thanksgiving Break until 3:00 p.m. on Thanksgiving Day in (X) odd-numbered years ( ) even-numbered years ( ) every year. The other parent will have the child(ren) for the second period of Thanksgiving Break, beginning at 3:00 p.m. on Thanksgiving Day until 6:00 p.m. on the evening before Thanksgiving Break ends. Unless otherwise indicated, the parties shall alternate the first and second periods of Thanksgiving Break each year. D. Visitation during Winter Break: (Choose one of the following) ( ) Applicable ( ) Not applicable, the Day-to-Day schedule applies ( ) See Paragraph XI below _______ The ( ) Custodial Parent ( ) Non-Custodial Parent shall have the child(ren) for the first period of Winter Break, beginning at the time that school recesses for Winter Break until December 26th at 10:00 a.m. in ( ) odd-numbered years ( ) even-numbered years ( ) every year. The other parent will have the child(ren) for the second period of Winter Break, beginning at 10:00 a.m. on December 26th until 6:00 p.m. on the evening before Winter Break ends. Unless otherwise indicated, the parties shall alternate the first and second periods of Winter Break each year. For the purpose of resuming visitation during the School Year, the parent who exercised visitation during the first half of Winter Break shall have the child(ren) with that parent on the first weekend following the end of Winter Break visitation. This is the only time that visitation during the School Year might be reset. E. Visitation during Summer: (Choose one of the following) ( ) Applicable ( ) Not applicable, the day-to-day schedule applies ( ) See Paragraph XI below Unless the parties agree otherwise, visitation with the child(ren) during the Summer Break shall be alternated on a week-to-week basis. The first week of visitation during Summer Break begins on the Sunday after school recesses for the Summer Break at 6:00 p.m. and ends on the following Sunday at 6:00 p.m. The Non-Custodial Parent shall have the first week of Summer Break visitation. The Custodial Parent shall have the next week and the parties shall continue to alternate weeks of visitation during Summer Break thereafter. In all cases, the child(ren) shall be with the Custodial Parent for the last five consecutive days before Summer Break ends and the next School Year begins. ( ) Other: ___ F. Visitation during Spring Break: (Choose one of the following) ( ) Applicable ( ) Not applicable, the day-to-day schedule applies ( ) See Paragraph XI below ____In odd-numbered years, the Non-Custodial Parent shall have the child(ren) for Spring Break. In even-numbered years, the Custodial Parent shall have the child(ren) for the entire Spring Break. OR _______ The parties shall divide visitation during every Spring Break. If the parties are unable to agree on visitation during the child(ren)’s spring break, the parent whose Regular Schedule of visitation would include the first weekend of Spring Break will have the child(ren) for that weekend through 12:00 noon on Wednesday. At that time, the child(ren) will be returned to the other parent who will have visitation with the child(ren) for the remainder of Spring Break. G. Other holiday schedule: The child(ren) shall be with Mother on every Mother’s Day from 6:00 pm on the Saturday which precedes Mother’s Day until 6:00 pm of Mother’s Day. The child(ren) shall be with Father on every Father’s Day from 6:00 pm on the Saturday which precedes Father’s Day until 6:00 pm on Father’s Day. This schedule will be maintained, regardless of which parent the children would have been with on that particular weekend under the Regular Schedule of visitation or under the schedule of visitation applicable to Summer Break. H. School holidays that precede or follow weekend visitation during the school year For the purposes of this parenting plan, if the Non-Custodial Parent exercises visitation during the School Year on a weekend in which there is a Friday and/or Monday school holiday which immediately precedes and/or follows his weekend visitation, Non-Custodial Parent’s visitation shall include that Friday and/or Monday school holiday (“Holiday Extension”). For the purposes of this paragraph, a “school holiday” includes a teacher work day or other day in which students are not required to attend school and which is announced by the applicable school system before the end of the Non-Custodial Parent’s normal weekend visitation. ","System Instruction: You must answer my questions based solely on the information provided. Do not use any external resources or prior knowledge. Question: When can the school year visitation schedule be reset? Context Block: II. PARENTING TIME/VISITATION SCHEDULES The following schedule should not be construed as precluding other visitation or alternative arrangements. The best visitation plan is one the parties have agreed to, rather than one imposed by the Court. However, the Court will only enforce the strict terms of this Parenting Plan in the event of any future disagreements concerning visitation. A. Parenting Time/Visitation-General This visitation schedule is broken up into several different sections or types of visitation. Regardless of the age of the child(ren) whose custody is being addressed herein, this visitation schedule is organized to include visitation during the school year, during holidays from school and during summer. For all purposes herein, the following terms shall be applicable: 1) Visitation during school year: If the child(ren) are not enrolled in school, the published schedule of the local public school where the primary custodian resides shall be utilized. If the child(ren) are enrolled in school, the schedule of the school system in which the child(ren) is/are actually enrolled shall be utilized. In the event there is more than one child and the children are enrolled in schools which observe different schedules, the parties shall utilize a hybrid schedule that reflects the holidays which are common to all applicable school systems (the applicable schedule shall be referred to as the “School Year”). This schedule may also be referred to as the “Regular Schedule” or “Day-To-Day Schedule” herein. 2) Visitation during Thanksgiving Break: This period of visitation includes the dates that the applicable school system recesses for at least two consecutive school days in November of every year (“Thanksgiving Break”). This schedule begins to be applicable at 6:00 p.m. on the date that the Thanksgiving Break begins and ends at 6:00 p.m. on the Sunday after Thanksgiving. 3) Visitation during Winter Break: This period of visitation includes the dates that the applicable school system recesses for winter break and which includes December 25 of every year (“Winter Break”). This schedule begins to be applicable at 6:00 p.m. on the date that the Winter Break begins and ends at 6:00 p.m. on the day before school resumes. 4) Visitation during Spring Break: This period of visitation includes the dates that the applicable school system recesses for a full week in the month of March or April of every year (“Spring Break”). This schedule begins to be applicable at 6:00 p.m. on the day that school recesses for Spring Break and ends at 6:00 p.m. on the day before school resumes. 5) Visitation during Summer: This period of visitation includes the dates that the applicable school system recesses for at least one full month in the summer and is the period between academic years (“Summer Break”). The Summer Break begins to be applicable on the day that school recesses for Summer Break and ends at 6:00 p.m. five (5) days before school resumes. 6) Weekend: For purposes of this parenting plan, a weekend begins at 6:00 p.m. on Friday and ends at 6:00 p.m. on Sunday. 7) Weekday visitation: Weekday visitation begins at 4:00 p.m. and ends at 7:30 p.m. The party with weekday visitation shall provide the child(ren)’s evening meal and complete any homework assigned for that evening. B. Visitation during School Year: (Choose one of the following) During the school year, the Non-Custodial Parent shall have at a minimum the following rights of parenting time/visitation (choose an item): ( ) The weekend of the first, third and fifth Friday (if any) of each month. ( ) Every other weekend starting the second weekend after the date of this plan. Additionally, the Non-Custodial Parent shall have weekday parenting time/visitation on (choose an item): ( ) None ( ) One afternoon each week to be agreed upon by the parties. If the parties cannot agree, weekday visitation shall be on Tuesday. C. Visitation during Thanksgiving Break: (Choose one of the following) ( ) Applicable ( ) Not applicable, the Day-to-Day schedule applies ( ) See Paragraph XI below _______ In even-numbered years, the Non-Custodial Parent will have the child(ren) with him/her for the entire Thanksgiving Break. In odd-numbered years, the Custodial Parent shall have the child(ren) with him/her for the entire Thanksgiving Break. OR _______ The ( ) Custodial Parent ( ) Non-Custodial Parent shall have the child(ren) for the first period of Thanksgiving Break, beginning at the time that school recesses for Thanksgiving Break until 3:00 p.m. on Thanksgiving Day in (X) odd-numbered years ( ) even-numbered years ( ) every year. The other parent will have the child(ren) for the second period of Thanksgiving Break, beginning at 3:00 p.m. on Thanksgiving Day until 6:00 p.m. on the evening before Thanksgiving Break ends. Unless otherwise indicated, the parties shall alternate the first and second periods of Thanksgiving Break each year. D. Visitation during Winter Break: (Choose one of the following) ( ) Applicable ( ) Not applicable, the Day-to-Day schedule applies ( ) See Paragraph XI below _______ The ( ) Custodial Parent ( ) Non-Custodial Parent shall have the child(ren) for the first period of Winter Break, beginning at the time that school recesses for Winter Break until December 26th at 10:00 a.m. in ( ) odd-numbered years ( ) even-numbered years ( ) every year. The other parent will have the child(ren) for the second period of Winter Break, beginning at 10:00 a.m. on December 26th until 6:00 p.m. on the evening before Winter Break ends. Unless otherwise indicated, the parties shall alternate the first and second periods of Winter Break each year. For the purpose of resuming visitation during the School Year, the parent who exercised visitation during the first half of Winter Break shall have the child(ren) with that parent on the first weekend following the end of Winter Break visitation. This is the only time that visitation during the School Year might be reset. E. Visitation during Summer: (Choose one of the following) ( ) Applicable ( ) Not applicable, the day-to-day schedule applies ( ) See Paragraph XI below Unless the parties agree otherwise, visitation with the child(ren) during the Summer Break shall be alternated on a week-to-week basis. The first week of visitation during Summer Break begins on the Sunday after school recesses for the Summer Break at 6:00 p.m. and ends on the following Sunday at 6:00 p.m. The Non-Custodial Parent shall have the first week of Summer Break visitation. The Custodial Parent shall have the next week and the parties shall continue to alternate weeks of visitation during Summer Break thereafter. In all cases, the child(ren) shall be with the Custodial Parent for the last five consecutive days before Summer Break ends and the next School Year begins. ( ) Other: ___ F. Visitation during Spring Break: (Choose one of the following) ( ) Applicable ( ) Not applicable, the day-to-day schedule applies ( ) See Paragraph XI below ____In odd-numbered years, the Non-Custodial Parent shall have the child(ren) for Spring Break. In even-numbered years, the Custodial Parent shall have the child(ren) for the entire Spring Break. OR _______ The parties shall divide visitation during every Spring Break. If the parties are unable to agree on visitation during the child(ren)’s spring break, the parent whose Regular Schedule of visitation would include the first weekend of Spring Break will have the child(ren) for that weekend through 12:00 noon on Wednesday. At that time, the child(ren) will be returned to the other parent who will have visitation with the child(ren) for the remainder of Spring Break. G. Other holiday schedule: The child(ren) shall be with Mother on every Mother’s Day from 6:00 pm on the Saturday which precedes Mother’s Day until 6:00 pm of Mother’s Day. The child(ren) shall be with Father on every Father’s Day from 6:00 pm on the Saturday which precedes Father’s Day until 6:00 pm on Father’s Day. This schedule will be maintained, regardless of which parent the children would have been with on that particular weekend under the Regular Schedule of visitation or under the schedule of visitation applicable to Summer Break. H. School holidays that precede or follow weekend visitation during the school year For the purposes of this parenting plan, if the Non-Custodial Parent exercises visitation during the School Year on a weekend in which there is a Friday and/or Monday school holiday which immediately precedes and/or follows his weekend visitation, Non-Custodial Parent’s visitation shall include that Friday and/or Monday school holiday (“Holiday Extension”). For the purposes of this paragraph, a “school holiday” includes a teacher work day or other day in which students are not required to attend school and which is announced by the applicable school system before the end of the Non-Custodial Parent’s normal weekend visitation. ",Legal,Find & Summarize,Text Transformation "If you cannot answer using the context alone, say ""I cannot answer that."" Draw your answer from the text only. Use full sentences in your response.",What works have been cited?,"2.1 IntroductionDefining terminology is a useful starting point when reading or writing on the subject of service to prevent any confusion or assumptions that we all understand the terms to mean the same thing. So, what do we mean by goods, products and services? This is a book about service, but what is a ‘service’ and how is it different to ‘goods’ or ‘products’? Whilst most people intuitively know the difference between a product and service, actually defining this difference with clarity and accuracy of text is not straight forward. The terms ‘goods’ and ‘products’ appear to be used interchangeably in much of the literature, but even here we can find debate about meaning (Araujo and Spring 2006; Callon 1991, 2002). However, for the sake of brevity we will here accept that they both refer to the same thing and focus on attempts to differentiate goods and services. This quest is far from straightfor-ward. Since the early eighteenth century academics and scholars from different domains have attempted to define these terms explicitly (Say 1803; Levitt 1981; Hill 1999; Gadrey 2000). In this chapter we will attempt to illustrate their findings in order to provide some background to the debate. 2.2 GoodsIn the eighteenth century Adam Smith (1776) stated that goods have exchange-able value and so a characteristic of a good is that its ownership rights can be established and exchanged. Goods can be considered as embodying specialised knowledge in a way that is highly advantageous for promoting the division of labour (Smith 1776; Demsetz 1993). Nassau Senior (1863) described goods as material things, meaning that goods are tangible and have physical dimensions. These concepts were still accepted over 100 years later when The System of National Accounts (SNA) (1993) defined goods as physical objects for which a demand exists, over which ownership rights can be established and whose owner-ship can be transferred from one institutional unit to another by engaging in transactions on markets. Hill (1999) summed up the major characteristics of goods as an entity that exists independently of its owner and preserves its identity through time; his definition supporting of that of the SNA. Following these defini-tions we can outline a set of attributes for goods:Physical objects for which a demand exists•Their physical attributes are preserved over time•Ownership rights can be established•They exist independently of their owner•They are exchangeable•Unit ownership rights can be exchanged between institutions•They can be traded on markets•They embody specialised knowledge in a way that is highly advantageous for •promoting the division of labourThese attributes are broadly accepted by academics and reflect 200 years of ongoing debate. 2.3 ServicesAlthough we have found a long standing agreement over the definition of products/goods and their characteristics, the definition of services has never reached consen-sus. Consequently it is hard to obtain full acceptance about the distinction between goods and services. Here we will present some of the different perspectives on service from the literature. 2.4 Intangible, Heterogeneous, Inseparable & Perishable (IHIP) CharacteristicsAs marketers began to recognise and emphasise the importance of services (Fisk et al. 1993) they consequently called for services to form a separate part of a com-panies’ marketing strategy (Lovelock 1983). A major contribution to the services debate was a classification consisting of four features: •Intangible •Heterogeneous","If you cannot answer using the context alone, say ""I cannot answer that."" Draw your answer from the text only. Use full sentences in your response. What works have been cited? 2.1 IntroductionDefining terminology is a useful starting point when reading or writing on the subject of service to prevent any confusion or assumptions that we all understand the terms to mean the same thing. So, what do we mean by goods, products and services? This is a book about service, but what is a ‘service’ and how is it different to ‘goods’ or ‘products’? Whilst most people intuitively know the difference between a product and service, actually defining this difference with clarity and accuracy of text is not straight forward. The terms ‘goods’ and ‘products’ appear to be used interchangeably in much of the literature, but even here we can find debate about meaning (Araujo and Spring 2006; Callon 1991, 2002). However, for the sake of brevity we will here accept that they both refer to the same thing and focus on attempts to differentiate goods and services. This quest is far from straightfor-ward. Since the early eighteenth century academics and scholars from different domains have attempted to define these terms explicitly (Say 1803; Levitt 1981; Hill 1999; Gadrey 2000). In this chapter we will attempt to illustrate their findings in order to provide some background to the debate. 2.2 GoodsIn the eighteenth century Adam Smith (1776) stated that goods have exchange-able value and so a characteristic of a good is that its ownership rights can be established and exchanged. Goods can be considered as embodying specialised knowledge in a way that is highly advantageous for promoting the division of labour (Smith 1776; Demsetz 1993). Nassau Senior (1863) described goods as material things, meaning that goods are tangible and have physical dimensions. These concepts were still accepted over 100 years later when The System of National Accounts (SNA) (1993) defined goods as physical objects for which a demand exists, over which ownership rights can be established and whose owner-ship can be transferred from one institutional unit to another by engaging in transactions on markets. Hill (1999) summed up the major characteristics of goods as an entity that exists independently of its owner and preserves its identity through time; his definition supporting of that of the SNA. Following these defini-tions we can outline a set of attributes for goods:Physical objects for which a demand exists•Their physical attributes are preserved over time•Ownership rights can be established•They exist independently of their owner•They are exchangeable•Unit ownership rights can be exchanged between institutions•They can be traded on markets•They embody specialised knowledge in a way that is highly advantageous for •promoting the division of labourThese attributes are broadly accepted by academics and reflect 200 years of ongoing debate. 2.3 ServicesAlthough we have found a long standing agreement over the definition of products/goods and their characteristics, the definition of services has never reached consen-sus. Consequently it is hard to obtain full acceptance about the distinction between goods and services. Here we will present some of the different perspectives on service from the literature. 2.4 Intangible, Heterogeneous, Inseparable & Perishable (IHIP) CharacteristicsAs marketers began to recognise and emphasise the importance of services (Fisk et al. 1993) they consequently called for services to form a separate part of a com-panies’ marketing strategy (Lovelock 1983). A major contribution to the services debate was a classification consisting of four features: •Intangible •Heterogeneous",Retail/Product,Fact Finding,Q&A Draw your answer only from the context block below and not from external sources.,What does Apple not receive from me when I use Siri?,"The Siri and Dictation features of the iOS Software may not be available in all languages or regions and features may vary by region. If your iOS Device supports Siri and Dictation, these features may allow you to make requests, give commands and dictate text to your device using your voice. When you use Siri or Dictation, the things you say will be recorded and sent to Apple in order to convert what you say into text and to process your requests. Your device will also send Apple other information, such as your name and nickname; the names, nicknames, and relationship with you (e.g., “my dad”) of your address book contacts; and song names in your collection (collectively, your “User Data”). All of this data is used to help Siri and Dictation understand you better and recognize what you say. It is not linked to other data that Apple may have from your use of other Apple services. By using Siri or Dictation, you agree and consent to Apple’s and its subsidiaries’ and agents’ transmission, collection, maintenance, processing, and use of this information, including your voice input and User Data, to provide and improve Siri, Dictation, and dictation functionality in other Apple products and services. If you have Location Services turned on, the location of your iOS Device at the time you make a request to Siri may also be sent to Apple to help Siri improve the accuracy of its response to your location-based requests. You may disable the location-based functionality of Siri by going to the Location Services setting on your iOS Device and turning off the individual location setting for Siri. Siri can allow you to interact with your iOS Device without needing to unlock it. If you have enabled a passcode on your iOS Device and would like to prevent Siri from being used from the lock screen, you can tap Settings, tap General, tap Passcode Lock and turn the Siri option to “off”. You can also turn off Siri and Dictation altogether at any time. To do so, open Settings, tap General, tap Siri, and slide the Siri switch to “off”. ","Draw your answer only from the context block below and not from external sources. What does Apple not receive from me when I use Siri? [The Siri and Dictation features of the iOS Software may not be available in all languages or regions and features may vary by region. If your iOS Device supports Siri and Dictation, these features may allow you to make requests, give commands and dictate text to your device using your voice. When you use Siri or Dictation, the things you say will be recorded and sent to Apple in order to convert what you say into text and to process your requests. Your device will also send Apple other information, such as your name and nickname; the names, nicknames, and relationship with you (e.g., “my dad”) of your address book contacts; and song names in your collection (collectively, your “User Data”). All of this data is used to help Siri and Dictation understand you better and recognize what you say. It is not linked to other data that Apple may have from your use of other Apple services. By using Siri or Dictation, you agree and consent to Apple’s and its subsidiaries’ and agents’ transmission, collection, maintenance, processing, and use of this information, including your voice input and User Data, to provide and improve Siri, Dictation, and dictation functionality in other Apple products and services. If you have Location Services turned on, the location of your iOS Device at the time you make a request to Siri may also be sent to Apple to help Siri improve the accuracy of its response to your location-based requests. You may disable the location-based functionality of Siri by going to the Location Services setting on your iOS Device and turning off the individual location setting for Siri. Siri can allow you to interact with your iOS Device without needing to unlock it. If you have enabled a passcode on your iOS Device and would like to prevent Siri from being used from the lock screen, you can tap Settings, tap General, tap Passcode Lock and turn the Siri option to “off”. You can also turn off Siri and Dictation altogether at any time. To do so, open Settings, tap General, tap Siri, and slide the Siri switch to “off”.]",Legal,Fact Finding,Q&A Answer the question using only the information provided in the context and do not use any outside sources. Limit your response to 300 words.,In what circumstances would each type of foreign aid be best?,"Types of Foreign Aid Foreign assistance takes various forms. It may include the direct provision of commodities and equipment (e.g., food and generators); capacity-building technical assistance to partner governments or local beneficiaries; funding for transportation, water, or energy infrastructure; support to the general budget of foreign governments and international organizations; and direct lending or loan guarantees to partner governments, among others. For reporting purposes, agencies categorize all of these activities under five aid “types”: Projects, Administrative Costs, Core Contributions, Budget Support, Technical Assistance, and Other. Most U.S. foreign aid in recent years has been classified as projects, funded and managed through aid agencies (see Figure 1). These categories may be misleading. Project-based aid includes certain types of assistance provided directly to partner governments for ongoing operations, or for purchasing commodities delivered directly to disaster-affected communities. U.S. foreign assistance agencies report aid type under a framework agreed and maintained by the Organisation for Economic Co-operation and Development’s (OECD’s) Development Assistance Committee (DAC), a forum of leading bilateral donor countries.8 This reporting paradigm applies to all donors, and it does not account for the U.S. approach to foreign assistance delivery, leading to some apparently anomalous classifications. For instance, aid appropriated as “direct financial support” to the Government of Ukraine in 2022 was structured as a reimbursement for verified government expenditures—such as teachers’ salaries and social assistance payments—and managed by the World Bank. That funding has been classified as a project, including in the above figure, though the funding is meant to support Ukraine’s central budget. The aid type classifications used in reporting are important background to understand agencies’ relationships with an implementing partner, though the partner type is highly consequential for how aid will be implemented (see “Implementing Partner Types ”). While data reported in foreignassistance.gov may lack nuances necessary to understand the nature of each partnership, it still provides useful topline information about relative aid flows. Projects Projects take many forms but generally involve a third-party implementing partner working under an agreement with the managing foreign aid agency (see “Managing, Funding, and Implementing Agencies” text box). Such projects generally have a high-level goal, several objectives to advance that goal, a series of quantitative targets for making progress toward that objective, and a welldefined “scope of work” for the implementing partner (see “Key Terms” text box). Usually, the project goal is aspirational and would require complementary developments outside the project itself to be achieved—such as effective leadership by the central government, receptivity to new practices by local populations, and a relatively stable implementing environment. In practice, projects are diverse. A project’s scope may involve delivery of medicine or food, building a highway, researching a new technology, or advising a government on customs procedures, among others. A nongovernmental organization (NGO) is the most common partner organization for USAID. Of the $181.5 billion in foreign assistance obligations for projects by USAID from FY2013 to 2022, 9 NGOs implemented $109.8 billion (60%). 10 Public international organizations (PIOs) are the second-largest category of project-based implementing partners. Project-based assistance is the predominant method of providing foreign assistance for several reasons. For one, this structure mitigates the risk of implementing partners diverting funding to objectives outside of U.S. priorities.12 Project-based aid expenditures are to be “allowable, allocable, and reasonable” under an agency-designed scope of work. 13 Detailed scopes of work allow audits of project costs and direct oversight of project activities, making reporting lines clearer. USAID typically initiates projects by developing a preliminary design and a research agenda to further scope the concept. 14 Agency staff develop these proposals and then submit them for approval.15 The resulting proposal (1) states a development problem (usually associated with objectives in a country strategy or a global initiative’s strategy), (2) hypothesizes how a project may solve it (a “theory of change”), and (3) proposes an approach to implementing that solution. If approved, USAID then issues a call for proposals from implementing partners, with the implementation approach as the “scope of work.” For instance, a USAID project may identify evidence that professionalizing a government’s revenue collection and budget development processes leads to improved government responsiveness to its constituents more generally, improving faith in government and stabilizing democratic institutions. USAID officials then may propose a fiscal management project intended to build capacity in a partner government’s tax and budget bureaus. 16 Such projects may comprise a single implementing partner award or several. A paradigmatic project contains a dedicated scope of work with established deliverables and performance targets, to be carried out by an implementing partner’s team over a defined time period (typically not to exceed five years). A project may include building infrastructure, technical assistance, supply of goods or services, or some combination of all three. Usually, projects are divided into several work streams, each called “components.” The fiscal management project, for example, may include (1) technical assistance to reform an agency’s administrative procedures, (2) training for bureau staff in modern accounting practices, (3) a quantitative analysis of current tax compliance rates, (4) a marketing campaign encouraging citizens to pay their taxes, and (5) sourcing of new accounting software for each bureau to track finances better. Projects often have “cross-cutting themes” as well, which may include addressing the needs of vulnerable populations and ensuring the views of local residents are taken into account, among others. Budget Support and Core Contributions In contrast to project-based assistance, a U.S. foreign assistance agency may fund the general budget of a recipient organization. The Foreignassistance.gov database uses the label “budget support” for funding provided to a recipient government to support general operating costs rather than a specific scope of work. The label “core contribution” is used when such funding is provided to public international organizations (such as United Nations entities). Since at least 1995, most such assistance has been provided to public international organizations, with a smaller share going to foreign governments. Since 2022, the substantial budget support to Ukraine has reversed this balance, although that aid has been classified as a project. 17 USAID generally has issued budget support to foreign governments in a funding tranche after the government has met a predefined milestone.18 In providing budget support, USAID generally has relinquished exclusive control over spending, and funds instead have been managed according to the recipient’s own budgetary procedures and authorities.19 While USAID has less direct control over the recipient’s use of budget support aid, the agency does control whether it issues a funding tranche. For instance, USAID generally has provided budget support to Jordan (a top recipient of U.S. budget support aid) after the USAID/Jordan mission certifies annually that certain policy reforms have been met. For core contributions, the United States generally has not structured its funding in tranches. Rather, U.S. representatives have a direct role in the organization’s decisionmaking—often as a shareholder, member of the Board of Directors, or in appointing the organization’s leadership. For instance, the United States influences the World Bank’s decisionmaking as a major shareholder and nominates its president. 20 Budget Support: Loans and Loan Guarantees Historically, U.S. budget support to governments included a substantial lending element. From 1962 to 1988, loans represented 28% of total U.S. economic foreign assistance.21 Since 1988, Congress and the executive branch have shifted away from lending toward primarily grant-based assistance, viewing loans as contributing to already-burdensome debt levels among aid recipients.22 There has been some recent renewed interest in converting grant-based budget support to loans, with an FY2024 aid package to Ukraine requiring budget support through a loan rather than a grant.23 More frequently since the end of the Cold War, USAID has provided financing to governments through loan guarantees rather than direct loans. Loan guarantees are a commitment to repay all or part of a loan in the event a borrower stops payments. From 1993 to 2017, USAID issued 20 guarantees of sovereign bond issuances to Middle Eastern states and Ukraine, but only three remain active.24 The most recent such guarantees were issued in support of countries facing fiscal constraints due to political crises (the Arab Spring and the Russian incursion into Crimea and Eastern Ukraine). USAID has not issued any guarantees since 2017.25 Development financing to private entities, including loans and loan guarantees, remains an active area of U.S. support for international development. The U.S. International Development Finance Corporation administers most of those activities, typically by financing private sector projects rather than sovereign debt. 26 This financing generally has been based on market rates and, as a result, has not been accounted as foreign assistance. Administrative Costs Administrative costs are funds used to deliver or implement aid that do not fit the definitions of project aid or budget support/core contributions.27 From FY2013 to FY2022, U.S. assistance agencies directed 7.7% of nonmilitary foreign assistance obligations toward administrative costs. The parameters of administrative costs are highly nuanced and differ from agency to agency: some agencies, for instance, classify monitoring and evaluation as an administrative cost, while others do not. Congressional directives from the 1970s have shaped what USAID classifies as administrative costs. Congress directed that the following two categories be funded by the “Operating Expenses” account: • All salaries and benefits of USAID direct hires, including Foreign Service and Civil Service, including when those employees are working to oversee a project activity. • All costs not directly related to a specific project. 28 USAID classifies all Operating Expenses as an administrative cost. Activities are considered operating expenses if they are inherently governmental or part of the cost of doing business. Examples include developing USAID policies and notices to Congress, drafting contract agreements for projects, and managing USAID accounting.29 Because all USAID salaries are considered administrative costs, work such as supporting project implementation and designing development interventions are considered administrative expenditures. By contrast, administrative work by USAID implementing partners is considered a project cost. ","In what circumstances would each type of foreign aid be best? Answer the question using only the information provided in the context and do not use any outside sources. Types of Foreign Aid Foreign assistance takes various forms. It may include the direct provision of commodities and equipment (e.g., food and generators); capacity-building technical assistance to partner governments or local beneficiaries; funding for transportation, water, or energy infrastructure; support to the general budget of foreign governments and international organizations; and direct lending or loan guarantees to partner governments, among others. For reporting purposes, agencies categorize all of these activities under five aid “types”: Projects, Administrative Costs, Core Contributions, Budget Support, Technical Assistance, and Other. Most U.S. foreign aid in recent years has been classified as projects, funded and managed through aid agencies (see Figure 1). These categories may be misleading. Project-based aid includes certain types of assistance provided directly to partner governments for ongoing operations, or for purchasing commodities delivered directly to disaster-affected communities. U.S. foreign assistance agencies report aid type under a framework agreed and maintained by the Organisation for Economic Co-operation and Development’s (OECD’s) Development Assistance Committee (DAC), a forum of leading bilateral donor countries.8 This reporting paradigm applies to all donors, and it does not account for the U.S. approach to foreign assistance delivery, leading to some apparently anomalous classifications. For instance, aid appropriated as “direct financial support” to the Government of Ukraine in 2022 was structured as a reimbursement for verified government expenditures—such as teachers’ salaries and social assistance payments—and managed by the World Bank. That funding has been classified as a project, including in the above figure, though the funding is meant to support Ukraine’s central budget. The aid type classifications used in reporting are important background to understand agencies’ relationships with an implementing partner, though the partner type is highly consequential for how aid will be implemented (see “Implementing Partner Types ”). While data reported in foreignassistance.gov may lack nuances necessary to understand the nature of each partnership, it still provides useful topline information about relative aid flows. Projects Projects take many forms but generally involve a third-party implementing partner working under an agreement with the managing foreign aid agency (see “Managing, Funding, and Implementing Agencies” text box). Such projects generally have a high-level goal, several objectives to advance that goal, a series of quantitative targets for making progress toward that objective, and a welldefined “scope of work” for the implementing partner (see “Key Terms” text box). Usually, the project goal is aspirational and would require complementary developments outside the project itself to be achieved—such as effective leadership by the central government, receptivity to new practices by local populations, and a relatively stable implementing environment. In practice, projects are diverse. A project’s scope may involve delivery of medicine or food, building a highway, researching a new technology, or advising a government on customs procedures, among others. A nongovernmental organization (NGO) is the most common partner organization for USAID. Of the $181.5 billion in foreign assistance obligations for projects by USAID from FY2013 to 2022, 9 NGOs implemented $109.8 billion (60%). 10 Public international organizations (PIOs) are the second-largest category of project-based implementing partners. Project-based assistance is the predominant method of providing foreign assistance for several reasons. For one, this structure mitigates the risk of implementing partners diverting funding to objectives outside of U.S. priorities.12 Project-based aid expenditures are to be “allowable, allocable, and reasonable” under an agency-designed scope of work. 13 Detailed scopes of work allow audits of project costs and direct oversight of project activities, making reporting lines clearer. USAID typically initiates projects by developing a preliminary design and a research agenda to further scope the concept. 14 Agency staff develop these proposals and then submit them for approval.15 The resulting proposal (1) states a development problem (usually associated with objectives in a country strategy or a global initiative’s strategy), (2) hypothesizes how a project may solve it (a “theory of change”), and (3) proposes an approach to implementing that solution. If approved, USAID then issues a call for proposals from implementing partners, with the implementation approach as the “scope of work.” For instance, a USAID project may identify evidence that professionalizing a government’s revenue collection and budget development processes leads to improved government responsiveness to its constituents more generally, improving faith in government and stabilizing democratic institutions. USAID officials then may propose a fiscal management project intended to build capacity in a partner government’s tax and budget bureaus. 16 Such projects may comprise a single implementing partner award or several. A paradigmatic project contains a dedicated scope of work with established deliverables and performance targets, to be carried out by an implementing partner’s team over a defined time period (typically not to exceed five years). A project may include building infrastructure, technical assistance, supply of goods or services, or some combination of all three. Usually, projects are divided into several work streams, each called “components.” The fiscal management project, for example, may include (1) technical assistance to reform an agency’s administrative procedures, (2) training for bureau staff in modern accounting practices, (3) a quantitative analysis of current tax compliance rates, (4) a marketing campaign encouraging citizens to pay their taxes, and (5) sourcing of new accounting software for each bureau to track finances better. Projects often have “cross-cutting themes” as well, which may include addressing the needs of vulnerable populations and ensuring the views of local residents are taken into account, among others. Budget Support and Core Contributions In contrast to project-based assistance, a U.S. foreign assistance agency may fund the general budget of a recipient organization. The Foreignassistance.gov database uses the label “budget support” for funding provided to a recipient government to support general operating costs rather than a specific scope of work. The label “core contribution” is used when such funding is provided to public international organizations (such as United Nations entities). Since at least 1995, most such assistance has been provided to public international organizations, with a smaller share going to foreign governments. Since 2022, the substantial budget support to Ukraine has reversed this balance, although that aid has been classified as a project. 17 USAID generally has issued budget support to foreign governments in a funding tranche after the government has met a predefined milestone.18 In providing budget support, USAID generally has relinquished exclusive control over spending, and funds instead have been managed according to the recipient’s own budgetary procedures and authorities.19 While USAID has less direct control over the recipient’s use of budget support aid, the agency does control whether it issues a funding tranche. For instance, USAID generally has provided budget support to Jordan (a top recipient of U.S. budget support aid) after the USAID/Jordan mission certifies annually that certain policy reforms have been met. For core contributions, the United States generally has not structured its funding in tranches. Rather, U.S. representatives have a direct role in the organization’s decisionmaking—often as a shareholder, member of the Board of Directors, or in appointing the organization’s leadership. For instance, the United States influences the World Bank’s decisionmaking as a major shareholder and nominates its president. 20 Budget Support: Loans and Loan Guarantees Historically, U.S. budget support to governments included a substantial lending element. From 1962 to 1988, loans represented 28% of total U.S. economic foreign assistance.21 Since 1988, Congress and the executive branch have shifted away from lending toward primarily grant-based assistance, viewing loans as contributing to already-burdensome debt levels among aid recipients.22 There has been some recent renewed interest in converting grant-based budget support to loans, with an FY2024 aid package to Ukraine requiring budget support through a loan rather than a grant.23 More frequently since the end of the Cold War, USAID has provided financing to governments through loan guarantees rather than direct loans. Loan guarantees are a commitment to repay all or part of a loan in the event a borrower stops payments. From 1993 to 2017, USAID issued 20 guarantees of sovereign bond issuances to Middle Eastern states and Ukraine, but only three remain active.24 The most recent such guarantees were issued in support of countries facing fiscal constraints due to political crises (the Arab Spring and the Russian incursion into Crimea and Eastern Ukraine). USAID has not issued any guarantees since 2017.25 Development financing to private entities, including loans and loan guarantees, remains an active area of U.S. support for international development. The U.S. International Development Finance Corporation administers most of those activities, typically by financing private sector projects rather than sovereign debt. 26 This financing generally has been based on market rates and, as a result, has not been accounted as foreign assistance. Administrative Costs Administrative costs are funds used to deliver or implement aid that do not fit the definitions of project aid or budget support/core contributions.27 From FY2013 to FY2022, U.S. assistance agencies directed 7.7% of nonmilitary foreign assistance obligations toward administrative costs. The parameters of administrative costs are highly nuanced and differ from agency to agency: some agencies, for instance, classify monitoring and evaluation as an administrative cost, while others do not. Congressional directives from the 1970s have shaped what USAID classifies as administrative costs. Congress directed that the following two categories be funded by the “Operating Expenses” account: • All salaries and benefits of USAID direct hires, including Foreign Service and Civil Service, including when those employees are working to oversee a project activity. • All costs not directly related to a specific project. 28 USAID classifies all Operating Expenses as an administrative cost. Activities are considered operating expenses if they are inherently governmental or part of the cost of doing business. Examples include developing USAID policies and notices to Congress, drafting contract agreements for projects, and managing USAID accounting.29 Because all USAID salaries are considered administrative costs, work such as supporting project implementation and designing development interventions are considered administrative expenditures. By contrast, administrative work by USAID implementing partners is considered a project cost. ",Financial,Find & Summarize,Text Transformation Your response must be based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge.,How does broadband internet help job seekers?,"The intersection of these three literatures leaves the total effect of broadband internet on mental health and wellbeing ambiguous. There is some evidence that broadband internet may have deleterious effects on mental health (e.g., Donati et al., 2022). However, the evidence that broadband internet has positive economic effects combined with the evidence that positive economic effects lead to fewer deaths by suicide could mean that broadband internet might have positive effects on mental health. The total effect depends on which force predominates. Using all-cause mortality data from the National Center for Health Statistics, we find that the introduction of broadband internet during the initial roll out of broadband from 2000 to 2008 is associated with a reduction in the number of deaths by suicide in a county. We find that a ten percent increase in the proportion of county residents with access to broadband internet in a year leads to 0.11 fewer deaths by suicide in a county, which is a 1.02% reduction in suicides overall. As expected, the effect of access to broadband internet on suicides fades after 2008, when rapid proliferation began to slow. Nevertheless, when estimating the effect of the rollout of broadband internet between 2000 to 2018, we find an overall reduction in deaths by suicide of about 1.6% for a 10% increase in access to broadband. In addition, using data from the Center for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS), we some evidence that increased access to broadband internet leads to improved measures of mental and physical health and less binge drinking, suggesting that improvements in mood is an important mechanism. We further find that this reduction in suicide deaths is likely due to economic improvements in counties that have access to broadband internet. Counties with increased access to broadband internet see reductions in poverty rate and unemployment rate. In addition, zip codes that gain access to broadband internet see increases in the numbers of employees and establishments in those zip codes. In addition, heterogeneity analysis indicates that the positive effects are concentrated in the working age population, those between 25 and 64 years old. This pattern is precisely what is predicted by the literature linking economic conditions to suicide risk. These results provide important support for existing policies that seek to expand broadband access across the country. While some measures of broadband proliferation appear to be nearly complete as early as 2008, there remains a large digital divide between populations with access to broadband internet and those without (Rachfal, 2021). According to FCC data in 2019, 98.8% of Americans living in urban areas had access to fixed broadband internet, but only 82.8% of Americans living in rural areas had access to fixed broadband internet.3 In some states, the percentage of the rural population with access to fixed broadband internet was as low as 63.3%. Our results indicate that closing the digital divide can have tangible mental health benefits. II. Background Broadband Internet, Economic Growth, and Mental Health A robust literature connects access to broadband internet and improved local economic conditions. These improvements occur along two axes: first, broadband internet affects the labor market outcomes of individual workers, and second, broadband internet impacts the behavior of firms. These papers then link to another arm of economic research that explores the ways in which economic conditions impact mental health. Several papers indicate that the internet generally, and broadband specifically, is a useful tool for job seekers. Kunn and Mansour (2014) find that internet job searches are effective at reducing the length of unemployment periods. This is a contradiction of an earlier study finding internet job search to be ineffective, which the authors attribute to the changing nature of internet job search between their two study periods. More recently, Zuo (2021) uses Comcast’s Internet Essentials program to study the effect of broadband internet access. Zuo finds that the program, which was designed to increase broadband access for low-income families, is associated with increased employment, increased labor force participation, decreased unemployment, and increased income. Similarly, Gurtzgen and colleagues (2021) find that broadband access is associated with improved rates of reemployment after the first month of unemployment. These recent studies are consistent with prior papers as well (Atasoy, 2013; Dettling, 2015; Hjort & Poulsen, 2019). Bhuller, Kostol, and Vigtel (2020) suggest that these improved outcomes may be a function of improved job searches. Their examination of the roll out of broadband internet in Norway leads them to draw three conclusions. First, broadband leads to improved recruitment processes. Second, that improved match quality is a benefit to job seekers. Finally, broadband internet facilitates better information flow. At the individual level, it seems, access to the additional informational and communications resources of broadband internet is beneficial for employment outcomes. ","context block: [The intersection of these three literatures leaves the total effect of broadband internet on mental health and wellbeing ambiguous. There is some evidence that broadband internet may have deleterious effects on mental health (e.g., Donati et al., 2022). However, the evidence that broadband internet has positive economic effects combined with the evidence that positive economic effects lead to fewer deaths by suicide could mean that broadband internet might have positive effects on mental health. The total effect depends on which force predominates. Using all-cause mortality data from the National Center for Health Statistics, we find that the introduction of broadband internet during the initial roll out of broadband from 2000 to 2008 is associated with a reduction in the number of deaths by suicide in a county. We find that a ten percent increase in the proportion of county residents with access to broadband internet in a year leads to 0.11 fewer deaths by suicide in a county, which is a 1.02% reduction in suicides overall. As expected, the effect of access to broadband internet on suicides fades after 2008, when rapid proliferation began to slow. Nevertheless, when estimating the effect of the rollout of broadband internet between 2000 to 2018, we find an overall reduction in deaths by suicide of about 1.6% for a 10% increase in access to broadband. In addition, using data from the Center for Disease Control’s Behavioral Risk Factor Surveillance System (BRFSS), we some evidence that increased access to broadband internet leads to improved measures of mental and physical health and less binge drinking, suggesting that improvements in mood is an important mechanism. We further find that this reduction in suicide deaths is likely due to economic improvements in counties that have access to broadband internet. Counties with increased access to broadband internet see reductions in poverty rate and unemployment rate. In addition, zip codes that gain access to broadband internet see increases in the numbers of employees and establishments in those zip codes. In addition, heterogeneity analysis indicates that the positive effects are concentrated in the working age population, those between 25 and 64 years old. This pattern is precisely what is predicted by the literature linking economic conditions to suicide risk. These results provide important support for existing policies that seek to expand broadband access across the country. While some measures of broadband proliferation appear to be nearly complete as early as 2008, there remains a large digital divide between populations with access to broadband internet and those without (Rachfal, 2021). According to FCC data in 2019, 98.8% of Americans living in urban areas had access to fixed broadband internet, but only 82.8% of Americans living in rural areas had access to fixed broadband internet.3 In some states, the percentage of the rural population with access to fixed broadband internet was as low as 63.3%. Our results indicate that closing the digital divide can have tangible mental health benefits. II. Background Broadband Internet, Economic Growth, and Mental Health A robust literature connects access to broadband internet and improved local economic conditions. These improvements occur along two axes: first, broadband internet affects the labor market outcomes of individual workers, and second, broadband internet impacts the behavior of firms. These papers then link to another arm of economic research that explores the ways in which economic conditions impact mental health. Several papers indicate that the internet generally, and broadband specifically, is a useful tool for job seekers. Kunn and Mansour (2014) find that internet job searches are effective at reducing the length of unemployment periods. This is a contradiction of an earlier study finding internet job search to be ineffective, which the authors attribute to the changing nature of internet job search between their two study periods. More recently, Zuo (2021) uses Comcast’s Internet Essentials program to study the effect of broadband internet access. Zuo finds that the program, which was designed to increase broadband access for low-income families, is associated with increased employment, increased labor force participation, decreased unemployment, and increased income. Similarly, Gurtzgen and colleagues (2021) find that broadband access is associated with improved rates of reemployment after the first month of unemployment. These recent studies are consistent with prior papers as well (Atasoy, 2013; Dettling, 2015; Hjort & Poulsen, 2019). Bhuller, Kostol, and Vigtel (2020) suggest that these improved outcomes may be a function of improved job searches. Their examination of the roll out of broadband internet in Norway leads them to draw three conclusions. First, broadband leads to improved recruitment processes. Second, that improved match quality is a benefit to job seekers. Finally, broadband internet facilitates better information flow. At the individual level, it seems, access to the additional informational and communications resources of broadband internet is beneficial for employment outcomes. ] question: [How does broadband internet help job seekers?] system instruction: [Your response must be based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge.]",Internet/Technology,Find & Summarize,Text Transformation Only use the text provided to answer. Do not use outside information.,Please give a summary of how Covid19 has affected behavior health.,"Behavioral Health During the COVID-19 Pandemic Data from multiple sources suggest that mental health symptoms and substance use have increased since the beginning of the COVID-19 pandemic. These symptoms include emotional distress and anxiety, depression, and trauma-related conditions. Substance use refers to the number of individuals using substances such as alcohol or illicit drugs, and the frequency and quantities of use. Typically, comprehensive national morbidity and mortality data on mental health conditions, substance use, associated hospitalizations, and substance-related overdose deaths take months to compile and report. Comprehensive national data for 2020 are not yet available. Several organizations, including multiple federal agencies, have used short surveys and rapid data reporting to monitor mental health symptoms and substance use during the COVID-19 pandemic. Although the methodological differences between these surveys and perennial surveys make comparisons between years imperfect, most of the 2020 data suggest an increase in behavioral health morbidity in the United States over the course of the COVID-19 pandemic. Mental Health Data collected from multiple surveys during the COVID-19 pandemic suggest that Americans experienced increased stress and symptoms of mental health conditions. In a survey conducted in April 2020, the State Health Access Data Assistance Center (SHADAC)—a program of the Robert Wood Johnson Foundation—found that over 90% of U.S. adults reported experiencing additional levels of stress caused by the COVID-19 pandemic. In this context, stress refers to psychological stress, which occurs when individuals believe that the consequences of a situation outweigh their ability to adequately cope with it. Reactions to stressors may include fear and concern about the future, tension and irritability, sadness or depression, or feeling powerless or overwhelmed, among others. Without adequate coping strategies, stress can have detrimental effects on mental health. Coping strategies include any behavioral, social, or cognitive techniques used to mitigate the effects of stress. Coping strategies can be adaptive, meaning they promote better overall functioning (e.g., social connections, physical activities, hobbies, good sleep hygiene), or they can be maladaptive, meaning they are more likely to result in worse overall functioning (e.g., substance use, excessive screen time, risky behaviors). Although maladaptive coping strategies may reduce stress in the moment, they may exacerbate problems in the long term. Many individuals experiencing stress may have adequate coping strategies, meaning that stress is present but does not impair their daily functioning. For others, stress—and in particular stress caused by the pandemic—may have detrimental effects on their mental health. A nationally representative survey conducted by the Kaiser Family Foundation (KFF) throughout the pandemic found that an increasing number of Americans reported that pandemic-related stress was affecting their mental health. In March 2020, 32% of respondents felt that worry or stress related to coronavirus had a negative impact on their mental health. In April 2020 that number rose to 45%, and in July 2020, 53% reported that pandemic-related stress was affecting their mental health. Mental Health Disorders In some cases, extreme or prolonged stress can lead to mental health disorders. According to data collected by the National Center for Health Statistics (NCHS), the percentage of Americans experiencing symptoms of a mental health disorder appears to have increased during the COVID19 pandemic. NCHS—a research agency under the Centers for Disease Control and Prevention (CDC)—partnered with the U.S. Census Bureau on the Household Pulse Survey to monitor the social and economic effects of the pandemic on American households. The nationally representative survey collected data on employment status, food security, housing, physical and mental health, access to health care (including mental health care), and education disruption during the coronavirus pandemic. NCHS survey questions were designed to obtain information on the frequency of anxiety and depression symptoms. Other indicators of psychological distress appear elevated during the first phases of the pandemic. For example, CDC analysis of national emergency department (ED) visits showed that socioeconomic and psychosocial-related visits increased during April 2020 (compared with April 2019), while total ED visits decreased over 40%. Socioeconomic or psychosocial factors were one of a few categories of ED visits that increased; most of the 200 common diagnostic causes of ED visits decreased during that same time. Other research suggests that ED visits for mental health conditions may have decreased during the first few months of the pandemic, to a lesser extent than overall ED visits. Suicide Some evidence suggests that suicidal thoughts may have increased during the pandemic. One CDC analysis found that during the pandemic approximately twice as many U.S. adults reported serious consideration of suicide in the previous 30 days compared with 2018 (10.7% versus4.3%). Although the National Suicide Prevention Lifeline did not report increases in call volume, the Disaster Distress Helpline (part of the Suicide Lifeline) experienced a 335% increase in calls during the first five months of the pandemic. The effects of the pandemic on suicide attempts and suicide deaths is unclear, though it appears that suicide mortality has decreased compared with previous years. An increase in suicidal thoughts does not necessarily equate to an increase in suicide attempts or suicide deaths. Research from CDC shows a decrease in emergency department (ED) visits for suicide attempts between March and October 2020 compared with the same period in 2019, but to a lesser extent than overall ED visits. Preliminary national suicide mortality data in the United States for 2020 show that suicide deaths in the United States may have decreased in 2020 compared with the three previous years. In addition, regional differences may account for changes in suicide mortality. For example, some individual states and municipalities have reported stable rates in suicide deaths during the pandemic, whereas others have reported decreased rates. There may be demographic differences in suicide rates during the pandemic also. For example, CDC reported that in May 2020 ED visits for suspected suicide attempts began to increase among adolescents, especially girls. Researchers in Maryland found that suicide mortality rates increased for Black residents from March 2020 to May 2020, while decreasing for White residents over that same time. Substance Use-Related Overdoses Comprehensive national data on drug-related overdoses and overdose deaths during the pandemic are not yet available. Preliminary data from the Office of National Drug Control Policy (ONDCP) suggest increases in drug-related overdoses during the first few months of the pandemic. The Overdose Detection Mapping Application Program (ODMAP), an ONDCP surveillance system that tracks suspected overdose data nationally in near real-time, reported an increase of 11% in fatal overdoses and a 19% increase in nonfatal overdoses from March through May 2020 compared with the same months in 2019. Nearly 62% of participating counties reported increases from March to May 2020. Other areas have reported stable rates of overdose deaths. Notably, ODMAP overdose submissions appeared to be trending upward prior to the onset of the pandemic, making it difficult to determine the effects of the pandemic and mitigation measures using these data. CDC also noted an increase in drug-related overdose deaths in the beginning of the COVID-19 pandemic. Similar to the ODMAP data, the CDC data showed that overdose deaths were already increasing in the months preceding the pandemic. However, CDC data showed the rate of overdose deaths accelerating after the pandemic began. In an analysis of provisional CDC mortality data, the National Institute for Health Care Management found that the rise is particularly notable for deaths involving synthetic opioids. In addition, the institute reported increases in deaths involving commonly prescribed opioids and heroin—both of which had been declining in recent years. When examining emergency department (ED) visits, CDC found a higher number of drug overdoses—including opioid overdoses—between March and October 2020 compared with the same period in 2019. Put together, the ODMAP and CDC data suggest that drug-related overdoses and overdose deaths have increased during the COVID-19 pandemic. Individuals with substance use disorders may be at higher risk of contracting SARS-CoV-2 due to unstable housing situations, high incarceration rates, or the inability to physically distance themselves. In addition, those with substance use disorders may be at higher risk for complications of COVID-19 because substance use can often suppress the immune system or inhibit respiratory functioning.","System instructions: Only use the text provided to answer. Do not use outside information. Context: Behavioral Health During the COVID-19 Pandemic Data from multiple sources suggest that mental health symptoms and substance use have increased since the beginning of the COVID-19 pandemic. These symptoms include emotional distress and anxiety, depression, and trauma-related conditions. Substance use refers to the number of individuals using substances such as alcohol or illicit drugs, and the frequency and quantities of use. Typically, comprehensive national morbidity and mortality data on mental health conditions, substance use, associated hospitalizations, and substance-related overdose deaths take months to compile and report. Comprehensive national data for 2020 are not yet available. Several organizations, including multiple federal agencies, have used short surveys and rapid data reporting to monitor mental health symptoms and substance use during the COVID-19 pandemic. Although the methodological differences between these surveys and perennial surveys make comparisons between years imperfect, most of the 2020 data suggest an increase in behavioral health morbidity in the United States over the course of the COVID-19 pandemic. Mental Health Data collected from multiple surveys during the COVID-19 pandemic suggest that Americans experienced increased stress and symptoms of mental health conditions. In a survey conducted in April 2020, the State Health Access Data Assistance Center (SHADAC)—a program of the Robert Wood Johnson Foundation—found that over 90% of U.S. adults reported experiencing additional levels of stress caused by the COVID-19 pandemic. In this context, stress refers to psychological stress, which occurs when individuals believe that the consequences of a situation outweigh their ability to adequately cope with it. Reactions to stressors may include fear and concern about the future, tension and irritability, sadness or depression, or feeling powerless or overwhelmed, among others. Without adequate coping strategies, stress can have detrimental effects on mental health. Coping strategies include any behavioral, social, or cognitive techniques used to mitigate the effects of stress. Coping strategies can be adaptive, meaning they promote better overall functioning (e.g., social connections, physical activities, hobbies, good sleep hygiene), or they can be maladaptive, meaning they are more likely to result in worse overall functioning (e.g., substance use, excessive screen time, risky behaviors). Although maladaptive coping strategies may reduce stress in the moment, they may exacerbate problems in the long term. Many individuals experiencing stress may have adequate coping strategies, meaning that stress is present but does not impair their daily functioning. For others, stress—and in particular stress caused by the pandemic—may have detrimental effects on their mental health. A nationally representative survey conducted by the Kaiser Family Foundation (KFF) throughout the pandemic found that an increasing number of Americans reported that pandemic-related stress was affecting their mental health. In March 2020, 32% of respondents felt that worry or stress related to coronavirus had a negative impact on their mental health. In April 2020 that number rose to 45%, and in July 2020, 53% reported that pandemic-related stress was affecting their mental health. Mental Health Disorders In some cases, extreme or prolonged stress can lead to mental health disorders. According to data collected by the National Center for Health Statistics (NCHS), the percentage of Americans experiencing symptoms of a mental health disorder appears to have increased during the COVID19 pandemic. NCHS—a research agency under the Centers for Disease Control and Prevention (CDC)—partnered with the U.S. Census Bureau on the Household Pulse Survey to monitor the social and economic effects of the pandemic on American households. The nationally representative survey collected data on employment status, food security, housing, physical and mental health, access to health care (including mental health care), and education disruption during the coronavirus pandemic. NCHS survey questions were designed to obtain information on the frequency of anxiety and depression symptoms. Other indicators of psychological distress appear elevated during the first phases of the pandemic. For example, CDC analysis of national emergency department (ED) visits showed that socioeconomic and psychosocial-related visits increased during April 2020 (compared with April 2019), while total ED visits decreased over 40%. Socioeconomic or psychosocial factors were one of a few categories of ED visits that increased; most of the 200 common diagnostic causes of ED visits decreased during that same time. Other research suggests that ED visits for mental health conditions may have decreased during the first few months of the pandemic, to a lesser extent than overall ED visits. Suicide Some evidence suggests that suicidal thoughts may have increased during the pandemic. One CDC analysis found that during the pandemic approximately twice as many U.S. adults reported serious consideration of suicide in the previous 30 days compared with 2018 (10.7% versus4.3%). Although the National Suicide Prevention Lifeline did not report increases in call volume, the Disaster Distress Helpline (part of the Suicide Lifeline) experienced a 335% increase in calls during the first five months of the pandemic. The effects of the pandemic on suicide attempts and suicide deaths is unclear, though it appears that suicide mortality has decreased compared with previous years. An increase in suicidal thoughts does not necessarily equate to an increase in suicide attempts or suicide deaths. Research from CDC shows a decrease in emergency department (ED) visits for suicide attempts between March and October 2020 compared with the same period in 2019, but to a lesser extent than overall ED visits. Preliminary national suicide mortality data in the United States for 2020 show that suicide deaths in the United States may have decreased in 2020 compared with the three previous years. In addition, regional differences may account for changes in suicide mortality. For example, some individual states and municipalities have reported stable rates in suicide deaths during the pandemic, whereas others have reported decreased rates. There may be demographic differences in suicide rates during the pandemic also. For example, CDC reported that in May 2020 ED visits for suspected suicide attempts began to increase among adolescents, especially girls. Researchers in Maryland found that suicide mortality rates increased for Black residents from March 2020 to May 2020, while decreasing for White residents over that same time. Substance Use-Related Overdoses Comprehensive national data on drug-related overdoses and overdose deaths during the pandemic are not yet available. Preliminary data from the Office of National Drug Control Policy (ONDCP) suggest increases in drug-related overdoses during the first few months of the pandemic. The Overdose Detection Mapping Application Program (ODMAP), an ONDCP surveillance system that tracks suspected overdose data nationally in near real-time, reported an increase of 11% in fatal overdoses and a 19% increase in nonfatal overdoses from March through May 2020 compared with the same months in 2019. Nearly 62% of participating counties reported increases from March to May 2020. Other areas have reported stable rates of overdose deaths. Notably, ODMAP overdose submissions appeared to be trending upward prior to the onset of the pandemic, making it difficult to determine the effects of the pandemic and mitigation measures using these data. CDC also noted an increase in drug-related overdose deaths in the beginning of the COVID-19 pandemic. Similar to the ODMAP data, the CDC data showed that overdose deaths were already increasing in the months preceding the pandemic. However, CDC data showed the rate of overdose deaths accelerating after the pandemic began. In an analysis of provisional CDC mortality data, the National Institute for Health Care Management found that the rise is particularly notable for deaths involving synthetic opioids. In addition, the institute reported increases in deaths involving commonly prescribed opioids and heroin—both of which had been declining in recent years. When examining emergency department (ED) visits, CDC found a higher number of drug overdoses—including opioid overdoses—between March and October 2020 compared with the same period in 2019. Put together, the ODMAP and CDC data suggest that drug-related overdoses and overdose deaths have increased during the COVID-19 pandemic. Individuals with substance use disorders may be at higher risk of contracting SARS-CoV-2 due to unstable housing situations, high incarceration rates, or the inability to physically distance themselves. In addition, those with substance use disorders may be at higher risk for complications of COVID-19 because substance use can often suppress the immune system or inhibit respiratory functioning. Please give a summary of how Covid19 has affected behavior health.",Medical,Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]","I live in Osceola County, and I intend to open a bottle club where I will serve alcoholic drinks and beverages. This text contains the rules that apply. My neighbor told me that I need to close the club at midnight on Saturday and Sunday, even though these are the busiest times of the nightlife. I don't want to close my bottle club at midnight! I also want you to give me a summary in list format with all the information that might be relevant. Write no more than 150 words.","Chapter 3 - ALCOHOLIC BEVERAGES[1] Footnotes: --- (1) --- Editor's note— Ord. No. 02-06, § 1—6, adopted April 8, 2002, repealed ch. 3 in its entirety and enacted new provisions as herein set out. Formerly, ch. 3 pertained to similar provisions and derived from Ord. No. 71-8, §§ 1—4, and Ord. No. 78-7, §§ 1, 2. Cross reference— Licenses, taxation and miscellaneous business regulations, Ch. 13; adult entertainment centers, § 13-86 et seq.; open containers of alcohol in vehicles, § 14-1. Sec. 3-1. - Jurisdiction and scope. (a)This chapter shall apply to, and be effective within, the unincorporated areas of the county and any municipality which has not adopted an ordinance covering the subject matter, activity, or conduct regulated herein.(b)Any person violating this chapter shall be guilty of a misdemeanor of the second degree, punishable as provided under state law.(c)Nothing in this chapter shall be construed to conflict with F.S. chapters 561—568, the beverage laws of the state. (Ord. No. 02-06, § 1, 4-8-02) Sec. 3-2. - Definitions. Alcoholic beverage shall mean and include all beverages containing more than one (1) percent of alcohol by weight. Bottle club shall mean a place or establishment where a product or article, for a consideration, is sold, dispensed, served, or provided, with the knowledge, either actual or implied, that same will be or is intended to be mixed, combined with or drunk in connection or combination with, an alcoholic beverage, for consumption on the premises of said place or establishment. (Ord. No. 02-06, § 2, 4-8-02) Sec. 3-3. - Hours of sale for on premise consumption and service. (a)No alcoholic beverages, of any kind, may be sold, consumed, or served, either by the package or drink, or permitted to be sold, consumed, or served, either by the package or drink, in, at or on the premises of any place holding a license under the division of alcoholic beverages and tobacco of the state department of business and professional regulation, except between the hours of 7:00 a.m. and 2:00 a.m. on all days of the week except Sunday. Sunday sales of alcoholic beverages shall only be permitted between the hours of 11:00 a.m. Sunday and 2:00 a.m. of the following day except:(1)The sale, consumption and service of alcoholic beverages at any golf course holding a license as required above, may begin at 7:00 a.m. on Sunday.(2)The sale, consumption and service of alcoholic beverages at any private function which is being held at a banquet hall, convention facility, or the like, which holds a license as required above, may begin at 7:00 a.m. on Sunday, provided that the hall or facility has a minimum square footage of two thousand (10,000) square feet available for the private function.(3)The sale, consumption and service of alcoholic beverages in any private guest room of any hotel or motel, holding a license as required above, may begin at 7:00 a.m. on Sunday. (Ord. No. 02-06, § 3, 4-8-02) Sec. 3-4. - Hours of sale for off premise consumption. No alcoholic beverages of any kind may be sold, or permitted to be sold, by any place or establishment holding a license under the division of alcoholic beverages and tobacco of the state department of business and professional regulation, which license permits licensee to sell alcoholic beverages for consumption off of the premises of the licensee, except between the hours of 7:00 a.m. and 2:00 a.m. on all days of the week except Sunday. Sunday sales of alcoholic beverages, to be consumed off of the premises of the licensee, shall only be permitted between the hours of 9:00 a.m. Sunday and 2:00 a.m. of the following day. (Ord. No. 02-06, § 4, 4-8-02) Sec. 3-5. - Closing hours for bottle clubs. All bottle clubs located in the unincorporated areas of the county, shall remain closed from the hours of 3:00 a.m. to 7:00 a.m. on each day of the week except that all such bottle clubs shall remain closed from midnight on each Saturday until 7:00 a.m. on the following Monday. (Ord. No. 02-06, § 5, 4-8-02)"," Only use the provided text to answer the question, no outside sources. I live in Osceola County, and I intend to open a bottle club where I will serve alcoholic drinks and beverages. This text contains the rules that apply. My neighbor told me that I need to close the club at midnight on Saturday and Sunday, even though these are the busiest times of the nightlife. I don't want to close my bottle club at midnight! I also want you to give me a summary in list format with all the information that might be relevant. Write no more than 150 words. Chapter 3 - ALCOHOLIC BEVERAGES[1] Footnotes: --- (1) --- Editor's note— Ord. No. 02-06, § 1—6, adopted April 8, 2002, repealed ch. 3 in its entirety and enacted new provisions as herein set out. Formerly, ch. 3 pertained to similar provisions and derived from Ord. No. 71-8, §§ 1—4, and Ord. No. 78-7, §§ 1, 2. Cross reference— Licenses, taxation and miscellaneous business regulations, Ch. 13; adult entertainment centers, § 13-86 et seq.; open containers of alcohol in vehicles, § 14-1. Sec. 3-1. - Jurisdiction and scope. (a)This chapter shall apply to, and be effective within, the unincorporated areas of the county and any municipality which has not adopted an ordinance covering the subject matter, activity, or conduct regulated herein.(b)Any person violating this chapter shall be guilty of a misdemeanor of the second degree, punishable as provided under state law.(c)Nothing in this chapter shall be construed to conflict with F.S. chapters 561—568, the beverage laws of the state. (Ord. No. 02-06, § 1, 4-8-02) Sec. 3-2. - Definitions. Alcoholic beverage shall mean and include all beverages containing more than one (1) percent of alcohol by weight. Bottle club shall mean a place or establishment where a product or article, for a consideration, is sold, dispensed, served, or provided, with the knowledge, either actual or implied, that same will be or is intended to be mixed, combined with or drunk in connection or combination with, an alcoholic beverage, for consumption on the premises of said place or establishment. (Ord. No. 02-06, § 2, 4-8-02) Sec. 3-3. - Hours of sale for on premise consumption and service. (a)No alcoholic beverages, of any kind, may be sold, consumed, or served, either by the package or drink, or permitted to be sold, consumed, or served, either by the package or drink, in, at or on the premises of any place holding a license under the division of alcoholic beverages and tobacco of the state department of business and professional regulation, except between the hours of 7:00 a.m. and 2:00 a.m. on all days of the week except Sunday. Sunday sales of alcoholic beverages shall only be permitted between the hours of 11:00 a.m. Sunday and 2:00 a.m. of the following day except:(1)The sale, consumption and service of alcoholic beverages at any golf course holding a license as required above, may begin at 7:00 a.m. on Sunday.(2)The sale, consumption and service of alcoholic beverages at any private function which is being held at a banquet hall, convention facility, or the like, which holds a license as required above, may begin at 7:00 a.m. on Sunday, provided that the hall or facility has a minimum square footage of two thousand (10,000) square feet available for the private function.(3)The sale, consumption and service of alcoholic beverages in any private guest room of any hotel or motel, holding a license as required above, may begin at 7:00 a.m. on Sunday. (Ord. No. 02-06, § 3, 4-8-02) Sec. 3-4. - Hours of sale for off premise consumption. No alcoholic beverages of any kind may be sold, or permitted to be sold, by any place or establishment holding a license under the division of alcoholic beverages and tobacco of the state department of business and professional regulation, which license permits licensee to sell alcoholic beverages for consumption off of the premises of the licensee, except between the hours of 7:00 a.m. and 2:00 a.m. on all days of the week except Sunday. Sunday sales of alcoholic beverages, to be consumed off of the premises of the licensee, shall only be permitted between the hours of 9:00 a.m. Sunday and 2:00 a.m. of the following day. (Ord. No. 02-06, § 4, 4-8-02) Sec. 3-5. - Closing hours for bottle clubs. All bottle clubs located in the unincorporated areas of the county, shall remain closed from the hours of 3:00 a.m. to 7:00 a.m. on each day of the week except that all such bottle clubs shall remain closed from midnight on each Saturday until 7:00 a.m. on the following Monday. (Ord. No. 02-06, § 5, 4-8-02) https://library.municode.com/fl/osceola_county/codes/code_of_ordinances?nodeId=PTIIOSCOCOOR_CH3ALBE_S3-1JUSC",Legal,Find & Summarize,Text Transformation "Provide your answer in full sentences, referencing the document using quotations.","According to this document only, what is the specific impacts of internet use on children?","**Are Children Smarter Because of the Internet? Website** Modern children and the adolescents represent the first generation that has grown surrounded by the Internet technology. This can be compared to the children of the 1920s and 1950s who grew up surrounded by the buzz of the radio and television respectively. In this era of advanced technology, it is almost mandatory that school going children acquire the knowledge on internet use because education curricula are quickly transforming towards technology use. Furthermore, with the widespread use of tech-related gadgets in almost all activities, such as mobile phones, play- stations and many others in day to day life, it seems embracing of technology is a foregone conclusion . This paper will aspire to explore the question on whether children are smarter or more socialized due to the Internet. Internet Use among Children The use of internet among children today is ranked in the same category with watching television or using the phone. In developed countries, up to 87% of children aged between twelve and seventeen are online. The internet is however better in comparison to the others due to the platform it offers to enhance interaction. According to a study conducted by Genevieve Marie Johnson, it was found out that children were likely to use Internet more at school than at home. However, they enjoyed using the Internet at home more than at school . Children perceive the use of Internet in a different perspective compared to adults. There is no doubt that the Internet has a significant influence on children. Impact of Internet Use The Internet is used both at school and at home by children. At school, the children’s Internet use is governed by the children’s Internet Protection Act (Yan, 2006). The children’s use of Internet is associated with various risks despite being beneficial is some ways. Parents and guardians need to implement various strategies that favor co-use and interaction rules to children to reduce the risk associated with Internet use among children. However, these strategies were found to be less effective in limiting the risks. In a study conducted regarding the influence of the Internet on children from low income families, it was indicated that children who had access to the Internet recorded high scores compared to those who had limited access to the Internet. It was also found out that age did not have an impact on the performance of the children. Another study conducted on the influence of Internet use by the children on family relationships and parental mediation established that parental recommendations on useful websites and co-using were positively associated with the frequency with children would engage in educative, online activities. Nevertheless, it was found that parental restrictions on time and websites did not impact on the actual Internet use by children. Children are difficult to tame when it comes to unsafe Internet use. It has been established that unsafe Internet use among children is likely to occur within the homes. With the Internet, it is possible to form virtual relationships among various people. In a study that was conducted by Bonetti, Campbell and Gilmore (2010), it was revealed that children who were lonely engaged more in online communications than those who did not report being lonely. Through the Internet, such children are able to fulfill special needs in respect to social interactions, self exposure, and exploring their identity. In a study conducted among the Latino children in Los Angeles, it was observed that strict parental strategies limited children in respect to Internet use. Nevertheless, these children were able to pursue their own interests and motivations online though on a restricted level. The Internet has had far-reaching impacts on the society in general and children have not been spared. From the studies that have been conducted, it can be observed that though parents have been restrictive in allowing access of their children to the Internet, this has come with various challenges. The children have always had a way to access Internet and parents have been left with very little in controlling what the children access. In general, this young generation seems to be inseparable with the internet. Much as some are opposed to internet use among children, the benefits accrued from its use surpass the negative impacts especially when used in controlled environments. Based on numerous studies by academics and social experts, it is clear that the use of internet has provided a chance for children to acquire a wide range of knowledge through easy access to information compared to the scenario in the past where information sources were quite limited. Internet also provides a perfect platform for children to gain vital communication skills that in turn enhance social development. Psychology experts have identified a link between constructive use of internet and student performance in school particularly in language expressivity. Children access information by visiting websites and this enhances their learning skills. The internet also makes learning an enjoyable experience because most websites contain graphics that effectively capture children’s’ imagination and creativity. This is important in stimulating the functioning of their brains and transforming them into effective learners. The process of acquiring the information from the internet is also vital in a child’s developmental skills such as information evaluation, research techniques as well as work planning strategies. Children with prowess in internet gaming demonstrate better levels of visual memory and pattern recognition when compared to those who did not. This has a positive impact on their ability to interpret graphical data and enhanced diagram visualization and interpretation. From the data collected by Jennifer Bremmer from Chicago University; department of Child Psychiatry, up to 84% of parents interviewed, agreed that internet use has had a positive impact on their children’s school life and particularly in academics. Eighty one percent of the respondents said that their children acquired most of their information from the internet. Majority of those interviewed said they felt that without the internet their children would perform poorly. According to government budgetary allocations of the United States in 2000, $4 billion was dedicated for connecting students to internet, a clear indication of the government’s commitment towards use of technology in education. The internet also gives access to more up-dated information compared to books, thus improving on the child’s vocabulary in the offered curriculum and in the research projects. The One Child One Laptop project in Africa is expected to give African children an opportunity to access world wide information and be able to effectively contribute their ideas on a world platform. This could also create a chance for them to earn a living as they mature since they can work on- line and link up with other people in the world. Based on the scientific background information on stimulation and response, it can be conclusively deduced that the use of internet by growing children has a positive effect on their development. The prolonged use of computer while searching for information from the internet could improve the coordination patterns of eye and hand through the use of the mouse, keyboard and screen. Though no specific research has been done on this phenomenon, it’s scientifically proven that habits enhance brain development and the associated physical development. The use of internet also has a social dimension. Antagonists on internet use argue that it has replaced human interactions. On the other hand, the protagonists claim that with professional use, internet use can be a medium to enhance this interaction. The use of the chat rooms, email services and other communication platforms available on the internet, are believed to enhance social skills alongside communication skills. Social and culture exchanges among young children has been enhanced through the internet mailing facility and through the available social sites such as Face book and Twitter. Children get an opportunity to interact in educative and productive communication. A perfect example is the Spank Magazine, which gives a platform for world wide interactions on youth issues where any one can interact and communicate their ideas for free. Social studies analysts have shown that the use of internet by school going children in class work has a marked positive impact on their performance. This has been linked to the fun associated with learning using the internet. The use of internet also enhances cooperation and sharing of ideas among the children, a vital life skill. Studies have indicated improved performances in many pupils using internet as a learning tool, and who initially had difficulties in using the conventional learning models. This in turn, positively influences their attitude toward school works as among other reasons it gives the students a relatively independent environment for learning and interaction. The internet has become a tool of entertainment. Research on internet use has shown that many children use it as a leisure tool to pursue amusement and enjoyment. The family set ups today are more individualized and physical interactions among children mostly at home is limited to a certain extent. Such children resort to internet for companionship. Through the process of enjoying themselves, they are subconsciously benefiting by acquiring other skills such as analyzing skills, creative and critical thinking leading to improved understanding of concepts. Children are also molded socially by the Internet through listening to music, watching movies and documentaries, world news and any other entertainment features. This makes the children smarter on issues happening in the world and prepares them for more networking in the social world. Internet also provides children with physical impairment, an opportunity to find pleasure they may not acquire anywhere else due to their disabilities. The experts’ research data explained above clearly indicates that, yes, internet is useful and almost a basic necessity for today’s school going children, however; on the other hand, utmost care must be observed since uncontrolled use of the internet has been reported to have negative impacts on the children. As is the norm, everything that has benefits comes along with challenges as well. Social psychologists have revealed several negative impacts of internet use on the social, physical and cognitive spheres of their life. Information fatigue syndrome is among the most common and comes as a result of reading and analyzing too much information from the internet. ","[text] ========== **Are Children Smarter Because of the Internet? Website** Modern children and the adolescents represent the first generation that has grown surrounded by the Internet technology. This can be compared to the children of the 1920s and 1950s who grew up surrounded by the buzz of the radio and television respectively. In this era of advanced technology, it is almost mandatory that school going children acquire the knowledge on internet use because education curricula are quickly transforming towards technology use. Furthermore, with the widespread use of tech-related gadgets in almost all activities, such as mobile phones, play- stations and many others in day to day life, it seems embracing of technology is a foregone conclusion . This paper will aspire to explore the question on whether children are smarter or more socialized due to the Internet. Internet Use among Children The use of internet among children today is ranked in the same category with watching television or using the phone. In developed countries, up to 87% of children aged between twelve and seventeen are online. The internet is however better in comparison to the others due to the platform it offers to enhance interaction. According to a study conducted by Genevieve Marie Johnson, it was found out that children were likely to use Internet more at school than at home. However, they enjoyed using the Internet at home more than at school . Children perceive the use of Internet in a different perspective compared to adults. There is no doubt that the Internet has a significant influence on children. Impact of Internet Use The Internet is used both at school and at home by children. At school, the children’s Internet use is governed by the children’s Internet Protection Act (Yan, 2006). The children’s use of Internet is associated with various risks despite being beneficial is some ways. Parents and guardians need to implement various strategies that favor co-use and interaction rules to children to reduce the risk associated with Internet use among children. However, these strategies were found to be less effective in limiting the risks. In a study conducted regarding the influence of the Internet on children from low income families, it was indicated that children who had access to the Internet recorded high scores compared to those who had limited access to the Internet. It was also found out that age did not have an impact on the performance of the children. Another study conducted on the influence of Internet use by the children on family relationships and parental mediation established that parental recommendations on useful websites and co-using were positively associated with the frequency with children would engage in educative, online activities. Nevertheless, it was found that parental restrictions on time and websites did not impact on the actual Internet use by children. Children are difficult to tame when it comes to unsafe Internet use. It has been established that unsafe Internet use among children is likely to occur within the homes. With the Internet, it is possible to form virtual relationships among various people. In a study that was conducted by Bonetti, Campbell and Gilmore (2010), it was revealed that children who were lonely engaged more in online communications than those who did not report being lonely. Through the Internet, such children are able to fulfill special needs in respect to social interactions, self exposure, and exploring their identity. In a study conducted among the Latino children in Los Angeles, it was observed that strict parental strategies limited children in respect to Internet use. Nevertheless, these children were able to pursue their own interests and motivations online though on a restricted level. The Internet has had far-reaching impacts on the society in general and children have not been spared. From the studies that have been conducted, it can be observed that though parents have been restrictive in allowing access of their children to the Internet, this has come with various challenges. The children have always had a way to access Internet and parents have been left with very little in controlling what the children access. In general, this young generation seems to be inseparable with the internet. Much as some are opposed to internet use among children, the benefits accrued from its use surpass the negative impacts especially when used in controlled environments. Based on numerous studies by academics and social experts, it is clear that the use of internet has provided a chance for children to acquire a wide range of knowledge through easy access to information compared to the scenario in the past where information sources were quite limited. Internet also provides a perfect platform for children to gain vital communication skills that in turn enhance social development. Psychology experts have identified a link between constructive use of internet and student performance in school particularly in language expressivity. Children access information by visiting websites and this enhances their learning skills. The internet also makes learning an enjoyable experience because most websites contain graphics that effectively capture children’s’ imagination and creativity. This is important in stimulating the functioning of their brains and transforming them into effective learners. The process of acquiring the information from the internet is also vital in a child’s developmental skills such as information evaluation, research techniques as well as work planning strategies. Children with prowess in internet gaming demonstrate better levels of visual memory and pattern recognition when compared to those who did not. This has a positive impact on their ability to interpret graphical data and enhanced diagram visualization and interpretation. From the data collected by Jennifer Bremmer from Chicago University; department of Child Psychiatry, up to 84% of parents interviewed, agreed that internet use has had a positive impact on their children’s school life and particularly in academics. Eighty one percent of the respondents said that their children acquired most of their information from the internet. Majority of those interviewed said they felt that without the internet their children would perform poorly. According to government budgetary allocations of the United States in 2000, $4 billion was dedicated for connecting students to internet, a clear indication of the government’s commitment towards use of technology in education. The internet also gives access to more up-dated information compared to books, thus improving on the child’s vocabulary in the offered curriculum and in the research projects. The One Child One Laptop project in Africa is expected to give African children an opportunity to access world wide information and be able to effectively contribute their ideas on a world platform. This could also create a chance for them to earn a living as they mature since they can work on- line and link up with other people in the world. Based on the scientific background information on stimulation and response, it can be conclusively deduced that the use of internet by growing children has a positive effect on their development. The prolonged use of computer while searching for information from the internet could improve the coordination patterns of eye and hand through the use of the mouse, keyboard and screen. Though no specific research has been done on this phenomenon, it’s scientifically proven that habits enhance brain development and the associated physical development. The use of internet also has a social dimension. Antagonists on internet use argue that it has replaced human interactions. On the other hand, the protagonists claim that with professional use, internet use can be a medium to enhance this interaction. The use of the chat rooms, email services and other communication platforms available on the internet, are believed to enhance social skills alongside communication skills. Social and culture exchanges among young children has been enhanced through the internet mailing facility and through the available social sites such as Face book and Twitter. Children get an opportunity to interact in educative and productive communication. A perfect example is the Spank Magazine, which gives a platform for world wide interactions on youth issues where any one can interact and communicate their ideas for free. Social studies analysts have shown that the use of internet by school going children in class work has a marked positive impact on their performance. This has been linked to the fun associated with learning using the internet. The use of internet also enhances cooperation and sharing of ideas among the children, a vital life skill. Studies have indicated improved performances in many pupils using internet as a learning tool, and who initially had difficulties in using the conventional learning models. This in turn, positively influences their attitude toward school works as among other reasons it gives the students a relatively independent environment for learning and interaction. The internet has become a tool of entertainment. Research on internet use has shown that many children use it as a leisure tool to pursue amusement and enjoyment. The family set ups today are more individualized and physical interactions among children mostly at home is limited to a certain extent. Such children resort to internet for companionship. Through the process of enjoying themselves, they are subconsciously benefiting by acquiring other skills such as analyzing skills, creative and critical thinking leading to improved understanding of concepts. Children are also molded socially by the Internet through listening to music, watching movies and documentaries, world news and any other entertainment features. This makes the children smarter on issues happening in the world and prepares them for more networking in the social world. Internet also provides children with physical impairment, an opportunity to find pleasure they may not acquire anywhere else due to their disabilities. The experts’ research data explained above clearly indicates that, yes, internet is useful and almost a basic necessity for today’s school going children, however; on the other hand, utmost care must be observed since uncontrolled use of the internet has been reported to have negative impacts on the children. As is the norm, everything that has benefits comes along with challenges as well. Social psychologists have revealed several negative impacts of internet use on the social, physical and cognitive spheres of their life. Information fatigue syndrome is among the most common and comes as a result of reading and analyzing too much information from the internet. ---------------- [query] ========== According to this document only, what is the specific impacts of internet use on children? ---------------- [task instructions] ========== Provide your answer in full sentences, referencing the document using quotations.",Internet/Technology,Effect Analysis,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]",I would like a policy analysis based on this article. I will need you to focus more on the EV parts so make sure to be more detailed on those.,"The Canadian government is imposing a 100 per cent tariff on imports of Chinese-made electric vehicles (EVs), aluminum and steel. The announcement, made by Department of Finance Canada during the Liberal cabinet retreat in Halifax on Monday, follows a 30-day federal consultation period that began in July. The move reflects the government’s growing concerns over China’s trade practices in the EV sector. It aims to address issues related to unfair competition, labour and environmental standards and national security over data. “Canadian workers and critical sectors, including steel and aluminum…are facing an intentional, state-directed policy of overcapacity, undermining Canada’s ability to compete in domestic and global markets,” says Chrystia Freeland, deputy prime minister and minister of finance, in a statement. “That is why our government is moving forward with decisive action to level the playing field, protect Canadian workers, and match measures taken by key trading partners.” The tariffs will take effect on October 1. The EV-related tarrif will apply to a range of vehicles, including electric and certain hybrid passenger vehicles, trucks, buses and delivery vans. The new surtax will be added on top of the existing 6.1 per cent Most-Favoured Nation import tariff already in place for EVs produced in China. In addition to the tariffs on EVs, Canada is imposing a 25 per cent tariff on Chinese steel and aluminum. The government is also taking steps to limit the eligibility of Chinese-made EVs for federal incentives, such as the Incentives for Zero-Emission Vehicles, Medium- and Heavy-Duty Zero-Emission Vehicles, and the Zero-Emission Vehicle Infrastructure Program. Chinese-made cars in Canada The automakers likely to face the most immediate impact from the new EV tariff are Tesla and Polestar, both of which currently sell Chinese-made EVs in Canada. According to federal lobbyist registry documents, Tesla updated its lobbying goals in August (just days before the government’s announcement) to include efforts to “engage with government and provide guidance with regard to policy responses to China’s automotive trade practices, in an effort to protect Canada’s automotive sector, ensure electric vehicle affordability for Canadian consumers, and the achievement of Canada’s greenhouse gas reduction objectives.” (Latest data released by Transport Canada show that Tesla is leading in iZEV rebate claims, with 4,826 in May and a total of 20,293 claims in 2024, so far.) Another automaker that may face negative effects from the sanctions is China’s largest EV manufacturer, BYD. Earlier this month, lobbyist documents revealed BYD’s plans to enter the Canadian electric passenger vehicle market. The new tariffs will potentially complicate the company’s expansion plans here due to increased costs associated with importing Chinese-made vehicles. Elsewhere, BYD’s market strategy has already been influenced by tariffs. In May, the Biden Administration imposed a 100 per cent tariff on Chinese-made EVs, as well as tariffs on advanced batteries, solar cells, steel and aluminum. BYD’s Executive Vice President and CEO of BYD Americas, Stella Li, has previously stated that the company had no plans to enter the U.S. market because of political complications. Europe’s stance on Chinese-made EVs is similar to both Canada and U.S. Last week, the European Commission announced new tariff rates as part of an ongoing investigation into Chinese electric car subsidies. These tariffs, ranging from nine per cent to 36.3 per cent, are slightly lower than the initially proposed range of 17.4 per cent to 38.1 per cent in June. Mixed reactions The announcement of the new tariffs was positively welcomed by Canada’s auto industry and labour unions. “Given the highly integrated nature of the automotive industry across North America, alignment with the U.S. on the approach to China is fundamental to its continued success,” said Brian Kingston, president & CEO of the Canadian Vehicle Manufacturers’ Association, in a press statement. “With an upcoming review of the Canada-United States-Mexico Agreement in 2026 there is simply too much at stake for the automotive industry and the broader economy if Canada is misaligned.” Unifor, the largest private-sector union in Canada, also supports the tariffs, stressing the need to protect Canadian workers and build a forward-looking auto industry that provides “good union jobs” and “economic benefits.” “Canada can and must protect auto and manufacturing jobs here in this country, which thousands of workers rely on for their livelihoods,” said Unifor National president, Lana Payne. “There is no justification to trade away high-paying, high-skilled jobs for cheap high-carbon intensive vehicles built under deplorable working conditions. However, not all groups are in favour of tariffs. Clean Energy Canada raised concerns that the decision could lead to fewer affordable electric vehicles for Canadians, reduced competition and increased climate pollution. “Strong EV demand depends on building and offering EVs that Canadians want — and can afford. If Canadian EV sales drop as a result of the new measures, this might be used as a justification for cancelling, delaying, or downgrading EV ambitions and, ironically, further delaying the domestic production they’re meant to protect.” Clean Energy Canada suggests the federal government complement its trade measures with an EV affordability package, including extending the iZEV program until 2028, lowering the price cap on rebates to $50,000 to compel automakers to drop their EV prices below the cap and introducing rebates for used EVs. More consultations coming The federal government says it will review the tariffs on Chinese-made EVs, aluminum and steel within a year of implementation, with the possibility of extending the policy or introducing additional measures, if necessary. The Canadian government is also concerned that China’s non-market practices are jeopardizing other key sectors within Canada’s EV supply chain, including batteries, semiconductors, solar products and critical minerals. In 2023, China’s battery production alone was enough to meet global demand, according to BloombergNEF. The International Energy Agency reports that China dominates the processing of critical minerals and handles over half of the world’s lithium, cobalt, graphite and rare earth elements. Barclays projects that China’s semiconductor manufacturing capacity could more than double within five to seven years, potentially leading to market oversupply by 2026. In response to these developments, the Government of Canada is launching a second 30-day consultation focused on the vital sectors of batteries, semiconductors, solar products and critical minerals."," Only use the provided text to answer the question, no outside sources. I would like a policy analysis based on this article. I will need you to focus more on the EV parts so make sure to be more detailed on those. The Canadian government is imposing a 100 per cent tariff on imports of Chinese-made electric vehicles (EVs), aluminum and steel. The announcement, made by Department of Finance Canada during the Liberal cabinet retreat in Halifax on Monday, follows a 30-day federal consultation period that began in July. The move reflects the government’s growing concerns over China’s trade practices in the EV sector. It aims to address issues related to unfair competition, labour and environmental standards and national security over data. “Canadian workers and critical sectors, including steel and aluminum…are facing an intentional, state-directed policy of overcapacity, undermining Canada’s ability to compete in domestic and global markets,” says Chrystia Freeland, deputy prime minister and minister of finance, in a statement. “That is why our government is moving forward with decisive action to level the playing field, protect Canadian workers, and match measures taken by key trading partners.” The tariffs will take effect on October 1. The EV-related tarrif will apply to a range of vehicles, including electric and certain hybrid passenger vehicles, trucks, buses and delivery vans. The new surtax will be added on top of the existing 6.1 per cent Most-Favoured Nation import tariff already in place for EVs produced in China. In addition to the tariffs on EVs, Canada is imposing a 25 per cent tariff on Chinese steel and aluminum. The government is also taking steps to limit the eligibility of Chinese-made EVs for federal incentives, such as the Incentives for Zero-Emission Vehicles, Medium- and Heavy-Duty Zero-Emission Vehicles, and the Zero-Emission Vehicle Infrastructure Program. Chinese-made cars in Canada The automakers likely to face the most immediate impact from the new EV tariff are Tesla and Polestar, both of which currently sell Chinese-made EVs in Canada. According to federal lobbyist registry documents, Tesla updated its lobbying goals in August (just days before the government’s announcement) to include efforts to “engage with government and provide guidance with regard to policy responses to China’s automotive trade practices, in an effort to protect Canada’s automotive sector, ensure electric vehicle affordability for Canadian consumers, and the achievement of Canada’s greenhouse gas reduction objectives.” (Latest data released by Transport Canada show that Tesla is leading in iZEV rebate claims, with 4,826 in May and a total of 20,293 claims in 2024, so far.) Another automaker that may face negative effects from the sanctions is China’s largest EV manufacturer, BYD. Earlier this month, lobbyist documents revealed BYD’s plans to enter the Canadian electric passenger vehicle market. The new tariffs will potentially complicate the company’s expansion plans here due to increased costs associated with importing Chinese-made vehicles. Elsewhere, BYD’s market strategy has already been influenced by tariffs. In May, the Biden Administration imposed a 100 per cent tariff on Chinese-made EVs, as well as tariffs on advanced batteries, solar cells, steel and aluminum. BYD’s Executive Vice President and CEO of BYD Americas, Stella Li, has previously stated that the company had no plans to enter the U.S. market because of political complications. Europe’s stance on Chinese-made EVs is similar to both Canada and U.S. Last week, the European Commission announced new tariff rates as part of an ongoing investigation into Chinese electric car subsidies. These tariffs, ranging from nine per cent to 36.3 per cent, are slightly lower than the initially proposed range of 17.4 per cent to 38.1 per cent in June. Mixed reactions The announcement of the new tariffs was positively welcomed by Canada’s auto industry and labour unions. “Given the highly integrated nature of the automotive industry across North America, alignment with the U.S. on the approach to China is fundamental to its continued success,” said Brian Kingston, president & CEO of the Canadian Vehicle Manufacturers’ Association, in a press statement. “With an upcoming review of the Canada-United States-Mexico Agreement in 2026 there is simply too much at stake for the automotive industry and the broader economy if Canada is misaligned.” Unifor, the largest private-sector union in Canada, also supports the tariffs, stressing the need to protect Canadian workers and build a forward-looking auto industry that provides “good union jobs” and “economic benefits.” “Canada can and must protect auto and manufacturing jobs here in this country, which thousands of workers rely on for their livelihoods,” said Unifor National president, Lana Payne. “There is no justification to trade away high-paying, high-skilled jobs for cheap high-carbon intensive vehicles built under deplorable working conditions. However, not all groups are in favour of tariffs. Clean Energy Canada raised concerns that the decision could lead to fewer affordable electric vehicles for Canadians, reduced competition and increased climate pollution. “Strong EV demand depends on building and offering EVs that Canadians want — and can afford. If Canadian EV sales drop as a result of the new measures, this might be used as a justification for cancelling, delaying, or downgrading EV ambitions and, ironically, further delaying the domestic production they’re meant to protect.” Clean Energy Canada suggests the federal government complement its trade measures with an EV affordability package, including extending the iZEV program until 2028, lowering the price cap on rebates to $50,000 to compel automakers to drop their EV prices below the cap and introducing rebates for used EVs. More consultations coming The federal government says it will review the tariffs on Chinese-made EVs, aluminum and steel within a year of implementation, with the possibility of extending the policy or introducing additional measures, if necessary. The Canadian government is also concerned that China’s non-market practices are jeopardizing other key sectors within Canada’s EV supply chain, including batteries, semiconductors, solar products and critical minerals. In 2023, China’s battery production alone was enough to meet global demand, according to BloombergNEF. The International Energy Agency reports that China dominates the processing of critical minerals and handles over half of the world’s lithium, cobalt, graphite and rare earth elements. Barclays projects that China’s semiconductor manufacturing capacity could more than double within five to seven years, potentially leading to market oversupply by 2026. In response to these developments, the Government of Canada is launching a second 30-day consultation focused on the vital sectors of batteries, semiconductors, solar products and critical minerals. https://electricautonomy.ca/policy-regulations/2024-08-27/canada-imposes-tariffs-on-chinese-made-evs-aluminum-steel/",Retail/Product,Effect Analysis,Q&A You must draw your answer from the below text. You may NOT use any outside resources. You may NOT use prior knowledge in any way.,How was the Falcon sensor relevant to this event?,"The use of information technology (IT) across industries has created opportunities for disruptions and vulnerabilities in the supply chain for products and services. For example, some firms may be more susceptible to system failures, data breaches, and cyberattacks than others depending on the security of the IT systems used.1 Recent examples include the February 2024 cyberattack on Change Healthcare, a subsidiary of UnitedHealth Group, Inc.,2 and a series of data breaches beginning in April 2024 that may have affected about 165 organizations using Snowflake, a cloud-based data management platform.3 The impact of these disruptions may be more widespread when components of IT systems are concentrated among a limited number of providers. On July 19, 2024, CrowdStrike Holdings, Inc. (hereinafter CrowdStrike) released a software update with a defective file for devices using the Windows operating system, causing some Windows devices to crash. CrowdStrike and Microsoft subsequently released updated safe files and recovery tools.4 Some users were able to fix the issue by rebooting impacted devices multiple times, while others had to take additional steps.5 CrowdStrike’s faulty update does not appear to be related to a cyberattack or data breach; instead, it is an example of the pervasiveness of some IT components and how an issue with an IT component may affect multiple sectors simultaneously, resulting in a host of disruptions domestically and internationally. This FAQ provides a description of CrowdStrike and the faulty update and discusses how the faulty update affected certain sectors in the United States. How did the faulty CrowdStrike update occur, and what is CrowdStrike? 6 CrowdStrike delivers cybersecurity products and services to its customers via a cloud computing platform—the Falcon platform.7 CrowdStrike, through its cloud-based platform, deploys and installs a software called the Falcon Agent or the Falcon Sensor on each connected endpoint device (e.g., individual computer) of its customers.8 On July 19, 2024, CrowdStrike released “a sensor configuration update” over the cloud to its customers’ endpoint computers that were running the Falcon sensor for Windows operating systems.9 The update “triggered a logic error resulting in a system crash and blue screen [error]” on impacted computers.10 Those computers that were online and downloaded the faulty update within a certain time period on that day “were susceptible to a system crash.”11 CrowdStrike’s faulty update does not appear to be related to a cyberattack or data breach. The outage occurred as part of the company’s effort to deliver its cybersecurity services. CrowdStrike claims that its cybersecurity products through the Falcon Agent can identify and prevent “known and unknown malware and fileless attacks” to protect its customers’ endpoint devices while “capturing and recording … endpoint data.”12 The cyberattack events and data captured by the agent are streamed back to the Falcon platform’s cloud infrastructure in real time “in order to be further analyzed” to optimize its cybersecurity algorithms.13 The agent can also be remotely reconfigured in real time to take other actions “as risk and threat postures change.”14 This agent is built to support major computer operating systems, including Microsoft’s Windows.15 ","You must draw your answer from the below text. You may NOT use any outside resources. You may NOT use prior knowledge in any way. The use of information technology (IT) across industries has created opportunities for disruptions and vulnerabilities in the supply chain for products and services. For example, some firms may be more susceptible to system failures, data breaches, and cyberattacks than others depending on the security of the IT systems used.1 Recent examples include the February 2024 cyberattack on Change Healthcare, a subsidiary of UnitedHealth Group, Inc.,2 and a series of data breaches beginning in April 2024 that may have affected about 165 organizations using Snowflake, a cloud-based data management platform.3 The impact of these disruptions may be more widespread when components of IT systems are concentrated among a limited number of providers. On July 19, 2024, CrowdStrike Holdings, Inc. (hereinafter CrowdStrike) released a software update with a defective file for devices using the Windows operating system, causing some Windows devices to crash. CrowdStrike and Microsoft subsequently released updated safe files and recovery tools.4 Some users were able to fix the issue by rebooting impacted devices multiple times, while others had to take additional steps.5 CrowdStrike’s faulty update does not appear to be related to a cyberattack or data breach; instead, it is an example of the pervasiveness of some IT components and how an issue with an IT component may affect multiple sectors simultaneously, resulting in a host of disruptions domestically and internationally. This FAQ provides a description of CrowdStrike and the faulty update and discusses how the faulty update affected certain sectors in the United States. How did the faulty CrowdStrike update occur, and what is CrowdStrike? 6 CrowdStrike delivers cybersecurity products and services to its customers via a cloud computing platform—the Falcon platform.7 CrowdStrike, through its cloud-based platform, deploys and installs a software called the Falcon Agent or the Falcon Sensor on each connected endpoint device (e.g., individual computer) of its customers.8 On July 19, 2024, CrowdStrike released “a sensor configuration update” over the cloud to its customers’ endpoint computers that were running the Falcon sensor for Windows operating systems.9 The update “triggered a logic error resulting in a system crash and blue screen [error]” on impacted computers.10 Those computers that were online and downloaded the faulty update within a certain time period on that day “were susceptible to a system crash.”11 CrowdStrike’s faulty update does not appear to be related to a cyberattack or data breach. The outage occurred as part of the company’s effort to deliver its cybersecurity services. CrowdStrike claims that its cybersecurity products through the Falcon Agent can identify and prevent “known and unknown malware and fileless attacks” to protect its customers’ endpoint devices while “capturing and recording … endpoint data.”12 The cyberattack events and data captured by the agent are streamed back to the Falcon platform’s cloud infrastructure in real time “in order to be further analyzed” to optimize its cybersecurity algorithms.13 The agent can also be remotely reconfigured in real time to take other actions “as risk and threat postures change.”14 This agent is built to support major computer operating systems, including Microsoft’s Windows.15 How was the Falcon sensor relevant to this event?",Internet/Technology,Fact Finding,Q&A Formulate your answer using only the provided text; do not use your own knowledge or the use of any outside sources.,What would change if marijuana was changed from a schedule I drug to a schedule III drug?,"Drugs and Biologics Aside from Schedule I substances, controlled substances have accepted medical uses and may be lawfully dispensed by prescription under the CSA, subject to various restrictions. Accordingly, rescheduling marijuana from Schedule I to Schedule III would open the door for the medical marijuana industry to market their products consistent with federal law. Any such products must still comply with other federal legal requirements, such as the FD&C Act, before they could be legally marketed in the United States. Rescheduling thus would not automatically legalize medical marijuana in the United States. The FD&C Act requires new drugs, including both small-molecule drugs that are synthesized in a laboratory and biologics that are derived from living organisms (e.g., vaccines), to be approved by FDA before they can be marketed and sold in the United States. For FDA to approve a new drug, the drug sponsor must submit a new drug application (NDA) with “substantial evidence” that the drug is safe and effective for its proposed use. Similarly, for FDA to approve a biologic, a sponsor must submit a biologics license application (BLA) demonstrating that the product is safe, potent, and pure. Certain chemicals related to or derived from marijuana may be considered small-molecule drugs, while other components of the cannabis plant—including marijuana itself—may be considered a biologic. Congressional Research Service 3 Marijuana itself is not an approved drug, but FDA has approved four drugs derived from or related to cannabis. FDA approved a drug containing CBD called Epidiolex, which is used to treat certain kinds of seizures. FDA also approved Marinol and Syndros for the treatment of anorexia associated with weight loss in AIDS patients, as well as Cesamet for the treatment of nausea and vomiting in patients undergoing chemotherapy. Marinol and Syndros contain the active ingredient dronabinol, a synthetic delta-9- tetrahydrocannabinol (THC), which is considered the psychoactive component of cannabis. Cesamet contains the active ingredient nabilone, which is synthetically derived and has a chemical structure similar to THC. Despite obtaining FDA approval, Epidiolex, Marinol, Syndros, and Cesamet could not immediately be marketed in the United States because CBD and synthetic tetrahydrocannabinols were considered Schedule I substances. The DOJ rescheduled each of these drugs within a few months to a couple years of their approval by FDA, thereby allowing the drugs to be marketed and prescribed. The DOJ rescheduled Epidiolex as a Schedule V drug, and the 2018 farm bill completely descheduled Epidiolex because it is considered hemp under the new definition. FDA-approved products containing dronabinol were rescheduled to Schedule II or Schedule III under the CSA, depending on their form, and FDA-approved products containing nabilone were rescheduled to Schedule II. Other tetrahydrocannabinols remain Schedule I substances, and, because they are scheduled separately from marijuana, they are not included in the DOJ’s proposed rule rescheduling marijuana. Drugs Marketed Without FDA Approval New drugs that FDA has not approved cannot legally be marketed in interstate commerce under the FD&C Act. FDA categorizes products based on how they are marketed rather than based on how the manufacturer or seller categorizes them. FDA may therefore consider some products marketed as a food, dietary supplement, tobacco product, or cosmetic to be illegal drugs (assuming they have not obtained FDA approval for marketing as a drug) if the product’s packaging makes claims that it is intended to cure, mitigate, or treat a disease or health-related condition. The FD&C Act defines a “drug” to include “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease.” Therefore, FDA may deem products to be “drugs” under this definition if they are marketed as a treatment for a disease. FDA has issued warning letters to companies marketing cannabis products, including CBD tea and hemp-infused body butter, whose labeling makes these kinds of treatment claims, advising that drugs must undergo the NDA process before they can be marketed in interstate commerce. A manufacturer or seller of one of these products can remedy the issue by submitting an NDA and obtaining FDA approval to market its product as a drug, or by removing the claims. Medical Research To obtain approval for a new drug or biologic, sponsors must conduct research, including clinical trials on human subjects, to generate the required evidence regarding the drug’s safety and effectiveness. Before conducting research with marijuana, a researcher must obtain a DEA registration and an FDA authorization of an investigational new drug application (IND) containing details on how the researcher plans to conduct the study. Then, the researcher must use marijuana from a DEA-registered source. Generally, rescheduling a drug from Schedule I to Schedule III loosens the controls on medical research involving that drug. Researchers and manufacturers of Schedule III substances are subject to less-onerous registration requirements than researchers and manufacturers of Schedule I substances. However, medical researchers and drug sponsors of marijuana or CBD containing drugs would not benefit from these looser restrictions associated with rescheduling without congressional action. In 2022, Congress passed the Medical Marijuana and Cannabidiol Research Expansion Act (P.L. 117-215), which amended the CSA for medical research involving marijuana or CBD to lessen the stringent controls typically applicable for Schedule I substances. The act created separate requirements for marijuana researchers and manufacturers Congressional Research Service 4 to expedite registration with the DEA, and these separate requirements would not be affected by rescheduling without additional congressional action. ","Formulate your answer using only the provided text; do not use your own knowledge or the use of any outside sources. Provided text: Drugs and Biologics Aside from Schedule I substances, controlled substances have accepted medical uses and may be lawfully dispensed by prescription under the CSA, subject to various restrictions. Accordingly, rescheduling marijuana from Schedule I to Schedule III would open the door for the medical marijuana industry to market their products consistent with federal law. Any such products must still comply with other federal legal requirements, such as the FD&C Act, before they could be legally marketed in the United States. Rescheduling thus would not automatically legalize medical marijuana in the United States. The FD&C Act requires new drugs, including both small-molecule drugs that are synthesized in a laboratory and biologics that are derived from living organisms (e.g., vaccines), to be approved by FDA before they can be marketed and sold in the United States. For FDA to approve a new drug, the drug sponsor must submit a new drug application (NDA) with “substantial evidence” that the drug is safe and effective for its proposed use. Similarly, for FDA to approve a biologic, a sponsor must submit a biologics license application (BLA) demonstrating that the product is safe, potent, and pure. Certain chemicals related to or derived from marijuana may be considered small-molecule drugs, while other components of the cannabis plant—including marijuana itself—may be considered a biologic. Congressional Research Service 3 Marijuana itself is not an approved drug, but FDA has approved four drugs derived from or related to cannabis. FDA approved a drug containing CBD called Epidiolex, which is used to treat certain kinds of seizures. FDA also approved Marinol and Syndros for the treatment of anorexia associated with weight loss in AIDS patients, as well as Cesamet for the treatment of nausea and vomiting in patients undergoing chemotherapy. Marinol and Syndros contain the active ingredient dronabinol, a synthetic delta-9- tetrahydrocannabinol (THC), which is considered the psychoactive component of cannabis. Cesamet contains the active ingredient nabilone, which is synthetically derived and has a chemical structure similar to THC. Despite obtaining FDA approval, Epidiolex, Marinol, Syndros, and Cesamet could not immediately be marketed in the United States because CBD and synthetic tetrahydrocannabinols were considered Schedule I substances. The DOJ rescheduled each of these drugs within a few months to a couple years of their approval by FDA, thereby allowing the drugs to be marketed and prescribed. The DOJ rescheduled Epidiolex as a Schedule V drug, and the 2018 farm bill completely descheduled Epidiolex because it is considered hemp under the new definition. FDA-approved products containing dronabinol were rescheduled to Schedule II or Schedule III under the CSA, depending on their form, and FDA-approved products containing nabilone were rescheduled to Schedule II. Other tetrahydrocannabinols remain Schedule I substances, and, because they are scheduled separately from marijuana, they are not included in the DOJ’s proposed rule rescheduling marijuana. Drugs Marketed Without FDA Approval New drugs that FDA has not approved cannot legally be marketed in interstate commerce under the FD&C Act. FDA categorizes products based on how they are marketed rather than based on how the manufacturer or seller categorizes them. FDA may therefore consider some products marketed as a food, dietary supplement, tobacco product, or cosmetic to be illegal drugs (assuming they have not obtained FDA approval for marketing as a drug) if the product’s packaging makes claims that it is intended to cure, mitigate, or treat a disease or health-related condition. The FD&C Act defines a “drug” to include “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease.” Therefore, FDA may deem products to be “drugs” under this definition if they are marketed as a treatment for a disease. FDA has issued warning letters to companies marketing cannabis products, including CBD tea and hemp-infused body butter, whose labeling makes these kinds of treatment claims, advising that drugs must undergo the NDA process before they can be marketed in interstate commerce. A manufacturer or seller of one of these products can remedy the issue by submitting an NDA and obtaining FDA approval to market its product as a drug, or by removing the claims. Medical Research To obtain approval for a new drug or biologic, sponsors must conduct research, including clinical trials on human subjects, to generate the required evidence regarding the drug’s safety and effectiveness. Before conducting research with marijuana, a researcher must obtain a DEA registration and an FDA authorization of an investigational new drug application (IND) containing details on how the researcher plans to conduct the study. Then, the researcher must use marijuana from a DEA-registered source. Generally, rescheduling a drug from Schedule I to Schedule III loosens the controls on medical research involving that drug. Researchers and manufacturers of Schedule III substances are subject to less-onerous registration requirements than researchers and manufacturers of Schedule I substances. However, medical researchers and drug sponsors of marijuana or CBD containing drugs would not benefit from these looser restrictions associated with rescheduling without congressional action. In 2022, Congress passed the Medical Marijuana and Cannabidiol Research Expansion Act (P.L. 117-215), which amended the CSA for medical research involving marijuana or CBD to lessen the stringent controls typically applicable for Schedule I substances. The act created separate requirements for marijuana researchers and manufacturers Congressional Research Service 4 to expedite registration with the DEA, and these separate requirements would not be affected by rescheduling without additional congressional action. What would change if marijuana was changed from a schedule I drug to a schedule III drug?",Legal,Fact Finding,Q&A Answer in a single sentence. Use only the document as your source.,"According to this document, how many patients with COVID-19 had a history of stroke?","**COVID-19 and Stroke Incidence** Coronavirus disease 2019 (COVID-19) has been declared a pandemic for two years already.1,2 As of July 2022, more than 575 million people have been infected, of which around 6.39 million have died.3 Although its case fatality rate of »2% is lower compared to past influenza pandemics, its highly transmissible nature strains the health care systems leading to significant increases in mortalities and unfavorable morbidities even in highly urbanized countries.1,4 With the appearance of delta and other variants, the devastation induced by COVID-19 is not likely to end soon. While most COVID-19 patients present in the hospital with respiratory symptoms, other organ systems may also be affected.5,6 Around 0.8-6% will develop stroke among COVID-19 patients, while 2-3% of admitted stroke patients will harbor severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.7,8 These COVID-19 stroke patients have twice the risk of death and they have 20% more risk of having a moderate disability compared to patients with COVID-19 only.9 Nevertheless, COVID19 stroke patients were usually older and had similar risk factors as those patients with stroke alone, implying that the usual determinants for stroke may be the ones responsible for these increased risks and not COVID-19.1,7,9 However, in smaller case series and cross-sectional studies, COVID-19 patients with stroke were younger, with a cryptogenic type of stroke, and with no identifiable risk factors compared to those without COVID-19.9,10 Since SARS-CoV-2 infection affects organ systems by inducing thrombosis secondary to a hypercoagulable state, the incidence of stroke, especially the ischemic type, may plausibly be increased in COVID-19.1012 While most large studies about the possible association of COVID-19 and stroke were done in high-income countries, only one study with a small sample size have been done in low- to middle-income countries (LMIC) like the Philippines.13 Developed countries have more organized and advanced health care systems and reliable national insurance services; hence, the incidence of stroke, its risk factors and mortality rate among COVID-19 patients may not be comparable to the true situation in LMIC.6,8 A recently concluded nationwide multicenter, comparative, retrospective cohort study was conducted from February to December 2020 to identify the different neurologic manifestations of COVID-19 in the Philippines.6 A total of 10,881 reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed COVID-19 cases were collected.6 Our main objectives were a) to determine the risk factors of stroke among hospitalized COVID19 patients in the Philippines, b) to determine the possible association between these risk factors and stroke among the same cohort, and c) to determine if there is an association between mortality and stroke in this same group. Methodology Study design The data analyzed in this study were obtained from a previously published nationwide retrospective cohort study that identified the different neurologic manifestations of COVID-19 in the Philippines.6 Inclusion and exclusion criteria RT-PCR-confirmed adult COVID-19 patients, more than 18 years of age, with final hospital disposition, were included in the study. Those with pneumonia caused by other etiologies other than SARS-CoV-2 were excluded. A complete enumeration of all patients fulfilling these criteria, who were admitted to the hospitals from February until December 2020, was performed. The definition of neurological symptoms was based on the previously published protocol.6 A patient who developed focal sensory or motor deficit confirmed by either cranial computed tomography (CT) scan or magnetic resonance imaging (MRI) were recorded as a stroke patient, as seen on chart review. The imaging was the basis for classifying the patient as either infarct or hemorrhagic stroke. COVID-19 stroke patients comprised the cases while COVID-19 only patients constituted the control group. Study site Data collection was done in 37 referral hospitals for COVID-19. Identification of these sites and other information regarding methods for data collection were described in the published protocol.6 Study investigators This is a part of the Philippine CORONA Study which aimed to determine the incidence of the different neurological diseases and their association with different risk factors and outcomes in a large cohort of COVID-19 patients. This was headed by four steering committee members with 37 study site teams, of which the principal investigators were all neurologists.6 2 R.D.G. JAMORA ET AL. Data collection The method of data collection has already been published.6 In brief, all COVID-19 confirmed admissions with disposition (discharged or deceased) at the time of data collection were included in the study. A pre-made detailed abstraction form containing the variables of interest was filled out by the field physician by chart review. Possible risk factors for stroke or increased COVID-19 severity such as age, sex, smoking, hypertension, diabetes mellitus (DM), heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), bronchial asthma, chronic kidney disease, liver disease, obesity, malignancy, and human immunodeficiency virus infection was obtained. For stroke, the neurologic symptoms and final diagnosis during admission, and different outcome measures like the severity of the disability, intensive care unit (ICU) admission, duration from admission to final disposition, mortality status, and final disposition were included in the form. Abstraction forms were then assessed for validity and inconsistencies before they were de-identified, encoded, and collated per hospital and sent to the Steering Committee of the Philippine CORONA study. Data analysis Age was presented as mean, while categorical data were presented as proportions. Standard deviation was used as measure of dispersion. Means and proportions were tested for significance using unpaired t-test and test of two proportions, respectively. Prevalence ratio, defined as the ratio of the proportion of patients with a particular risk factor in COVID-19 stroke patients divided by the proportion of patients with the same risk factor among COVID-19 only patients were computed separately. These were used as estimates of relative risks. The incidence of stroke among patients with COVID-19 was computed by dividing the number of stroke patients by the population (n = 10,881). Likewise, the incidence of different outcome measures like mortality, disability, and intensive care unit (ICU) admission in both COVID-19 stroke patients and COVID-19 patients only were obtained by dividing the number of each of these outcome measures by the number of patients who developed stroke and those who did not, respectively. Subsequently, relative risks were computed by dividing the incidence of each outcome measure among COVID-19 stroke patients by the incidence of outcome measure among those with COVID-19 patients only. To determine the association between stroke and different risk factors; and the different outcome measures and stroke among COVID-19 patients, a univariate logistic regression was done. Stroke and outcome measures were used as dependent variables separately, while risk factors for stroke, and stroke were used as their independent variables, respectively. An extended Cox proportional hazard survival analysis was also done using mortality status as the failure event and the duration from admission to either censoring or failure as survival time. Significant risk factors identified in the logistic regression was used as the predictor variables with presence of stroke as the focus. Since the presence of stroke was a time dependent variable based on the usage of scaled and unscaled Schoenfield residuals, an extended Cox model was used. All data were captured and analyzed using Stata Pro BE 17, with alpha set at < 0.05 as indicator of significance. Results Baseline characteristics There were 10,881 RT-PCR confirmed COVID-19 cases included in the Philippine CORONA Study. The patients were mostly males (n = 5780, 53.1%), with history of neurological disorder (n = 7560, 69.5%), with hypertension (n = 3647, 33.5%), and DM (n = 2191, 20.1%). Only 321 patients with COVID-19 (3%) had a history of stroke. The overall incidence of stroke among COVID-19 patients was 3.4% (n = 367). Of these, 262 (71.4%) had acute ischemic stroke (AIS) and 101 (27.5%) had acute hemorrhagic stroke (AHS). The incidence of AIS and AHS were 2.4% and 0.9%, respectively. A total of 1697 COVID-19 patients (15.6%) died due to various etiologies. Most patients who had neurologic symptoms were stable but had persistent deficits at discharge (71.7%). Only 1751 patients (16%) were admitted to the ICU primarily due to acute respiratory failure.","[Query] ================== According to this document, how many patients with COVID-19 had a history of stroke? ================ [Task] ================== Answer in a single sentence. Use only the document as your source. ================ [Text Passage] ================== **COVID-19 and Stroke Incidence** Coronavirus disease 2019 (COVID-19) has been declared a pandemic for two years already.1,2 As of July 2022, more than 575 million people have been infected, of which around 6.39 million have died.3 Although its case fatality rate of »2% is lower compared to past influenza pandemics, its highly transmissible nature strains the health care systems leading to significant increases in mortalities and unfavorable morbidities even in highly urbanized countries.1,4 With the appearance of delta and other variants, the devastation induced by COVID-19 is not likely to end soon. While most COVID-19 patients present in the hospital with respiratory symptoms, other organ systems may also be affected.5,6 Around 0.8-6% will develop stroke among COVID-19 patients, while 2-3% of admitted stroke patients will harbor severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.7,8 These COVID-19 stroke patients have twice the risk of death and they have 20% more risk of having a moderate disability compared to patients with COVID-19 only.9 Nevertheless, COVID19 stroke patients were usually older and had similar risk factors as those patients with stroke alone, implying that the usual determinants for stroke may be the ones responsible for these increased risks and not COVID-19.1,7,9 However, in smaller case series and cross-sectional studies, COVID-19 patients with stroke were younger, with a cryptogenic type of stroke, and with no identifiable risk factors compared to those without COVID-19.9,10 Since SARS-CoV-2 infection affects organ systems by inducing thrombosis secondary to a hypercoagulable state, the incidence of stroke, especially the ischemic type, may plausibly be increased in COVID-19.1012 While most large studies about the possible association of COVID-19 and stroke were done in high-income countries, only one study with a small sample size have been done in low- to middle-income countries (LMIC) like the Philippines.13 Developed countries have more organized and advanced health care systems and reliable national insurance services; hence, the incidence of stroke, its risk factors and mortality rate among COVID-19 patients may not be comparable to the true situation in LMIC.6,8 A recently concluded nationwide multicenter, comparative, retrospective cohort study was conducted from February to December 2020 to identify the different neurologic manifestations of COVID-19 in the Philippines.6 A total of 10,881 reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed COVID-19 cases were collected.6 Our main objectives were a) to determine the risk factors of stroke among hospitalized COVID19 patients in the Philippines, b) to determine the possible association between these risk factors and stroke among the same cohort, and c) to determine if there is an association between mortality and stroke in this same group. Methodology Study design The data analyzed in this study were obtained from a previously published nationwide retrospective cohort study that identified the different neurologic manifestations of COVID-19 in the Philippines.6 Inclusion and exclusion criteria RT-PCR-confirmed adult COVID-19 patients, more than 18 years of age, with final hospital disposition, were included in the study. Those with pneumonia caused by other etiologies other than SARS-CoV-2 were excluded. A complete enumeration of all patients fulfilling these criteria, who were admitted to the hospitals from February until December 2020, was performed. The definition of neurological symptoms was based on the previously published protocol.6 A patient who developed focal sensory or motor deficit confirmed by either cranial computed tomography (CT) scan or magnetic resonance imaging (MRI) were recorded as a stroke patient, as seen on chart review. The imaging was the basis for classifying the patient as either infarct or hemorrhagic stroke. COVID-19 stroke patients comprised the cases while COVID-19 only patients constituted the control group. Study site Data collection was done in 37 referral hospitals for COVID-19. Identification of these sites and other information regarding methods for data collection were described in the published protocol.6 Study investigators This is a part of the Philippine CORONA Study which aimed to determine the incidence of the different neurological diseases and their association with different risk factors and outcomes in a large cohort of COVID-19 patients. This was headed by four steering committee members with 37 study site teams, of which the principal investigators were all neurologists.6 2 R.D.G. JAMORA ET AL. Data collection The method of data collection has already been published.6 In brief, all COVID-19 confirmed admissions with disposition (discharged or deceased) at the time of data collection were included in the study. A pre-made detailed abstraction form containing the variables of interest was filled out by the field physician by chart review. Possible risk factors for stroke or increased COVID-19 severity such as age, sex, smoking, hypertension, diabetes mellitus (DM), heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), bronchial asthma, chronic kidney disease, liver disease, obesity, malignancy, and human immunodeficiency virus infection was obtained. For stroke, the neurologic symptoms and final diagnosis during admission, and different outcome measures like the severity of the disability, intensive care unit (ICU) admission, duration from admission to final disposition, mortality status, and final disposition were included in the form. Abstraction forms were then assessed for validity and inconsistencies before they were de-identified, encoded, and collated per hospital and sent to the Steering Committee of the Philippine CORONA study. Data analysis Age was presented as mean, while categorical data were presented as proportions. Standard deviation was used as measure of dispersion. Means and proportions were tested for significance using unpaired t-test and test of two proportions, respectively. Prevalence ratio, defined as the ratio of the proportion of patients with a particular risk factor in COVID-19 stroke patients divided by the proportion of patients with the same risk factor among COVID-19 only patients were computed separately. These were used as estimates of relative risks. The incidence of stroke among patients with COVID-19 was computed by dividing the number of stroke patients by the population (n = 10,881). Likewise, the incidence of different outcome measures like mortality, disability, and intensive care unit (ICU) admission in both COVID-19 stroke patients and COVID-19 patients only were obtained by dividing the number of each of these outcome measures by the number of patients who developed stroke and those who did not, respectively. Subsequently, relative risks were computed by dividing the incidence of each outcome measure among COVID-19 stroke patients by the incidence of outcome measure among those with COVID-19 patients only. To determine the association between stroke and different risk factors; and the different outcome measures and stroke among COVID-19 patients, a univariate logistic regression was done. Stroke and outcome measures were used as dependent variables separately, while risk factors for stroke, and stroke were used as their independent variables, respectively. An extended Cox proportional hazard survival analysis was also done using mortality status as the failure event and the duration from admission to either censoring or failure as survival time. Significant risk factors identified in the logistic regression was used as the predictor variables with presence of stroke as the focus. Since the presence of stroke was a time dependent variable based on the usage of scaled and unscaled Schoenfield residuals, an extended Cox model was used. All data were captured and analyzed using Stata Pro BE 17, with alpha set at < 0.05 as indicator of significance. Results Baseline characteristics There were 10,881 RT-PCR confirmed COVID-19 cases included in the Philippine CORONA Study. The patients were mostly males (n = 5780, 53.1%), with history of neurological disorder (n = 7560, 69.5%), with hypertension (n = 3647, 33.5%), and DM (n = 2191, 20.1%). Only 321 patients with COVID-19 (3%) had a history of stroke. The overall incidence of stroke among COVID-19 patients was 3.4% (n = 367). Of these, 262 (71.4%) had acute ischemic stroke (AIS) and 101 (27.5%) had acute hemorrhagic stroke (AHS). The incidence of AIS and AHS were 2.4% and 0.9%, respectively. A total of 1697 COVID-19 patients (15.6%) died due to various etiologies. Most patients who had neurologic symptoms were stable but had persistent deficits at discharge (71.7%). Only 1751 patients (16%) were admitted to the ICU primarily due to acute respiratory failure.",Medical,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Examine the dual influence of technological innovation and political diplomacy in shaping the design and use of rooms s-116 and s-117 in the senate foreign relations Committee suite. In your response, connect the symbolic contribution of both robert and benjamin to at least two major us foreign policies debated in the room. Additionally, analyze how frescoes depicting their legaixes impacted both domestic and international legislative decisions; do not mention any historical event that occurred before 1840; and ensure that every sentence references a different artistic or architectural feature if the suite","The U.S. SenaTe Foreign relaTionS CommiTTee SUiTe The U.S. SenaTe Foreign relaTionS Committee The Senate Committee on Foreign Relations was established in 1816 as one of the original eleven permanent standing committees of the Senate. Throughout its history, the Foreign Relations Committee has been instrumental in developing The Senate Foreign Relations Committee Room (S-116) and influencing U.S. foreign policy. The committee tee considers, debates, and negotiates important treaties and legislation that support the national interest. It also holds jurisdiction over all democratic nominations. Through these powers, the committee has helped shape foreign policy of broad significance in matters of war and peace and international relations. The committee receives honored guests and con- ducts official business in its historic, two-room suite, located in the northeast corner of the Senate extension, built between 1851 and 1868. History Like many Senate spaces in the Capitol, S-116 and S-117 have served many different committees and offices. The first known use of S-116 was as the Senate folding room. It was here that publications were stored and where clerks prepared documents, bills, and speeches for distribution. Eventually this service was transferred to the Government printing ing Office. The Senate Committee on Patents, which held jurisdiction over patents and patent law, moved into S-116 in the 1870s. It was during the Patent Committee’s nearly two-decade occu- pancy of the room that artist Constantino Brumidi executed the fresco of American innovator Robert Fulton above the entrance to the committee room. Robert Fulton depicted in the lunette over S-116, then used by the Committee on Patents from 1872-1895 This follows a precedent applied throughout the Capitol’s corridors of relating the figurative murals to the achievements or work of the committee in the nearby room. The fresco above the door to S-116 depicts Fulton with his left hand resting on mechanical diagrams and his right hand gesturing ing towards a steamboat traveling the Hudson River—references to Fulton’s success at harnessing steam engine technology to create the first viable commercial steamboat service in the early 19th century. Brumidi incorporated emblems representing ing science, agriculture, navigation, and the arts on the ceiling in the spacious lobby outside S-116, known as the Patent Corridor. The original occupant of S-117 was the Senate Committee on Post-Offices and Post-Roads. To recognize this committee, Brumidi painted a fresco above the room’s entrance depicting Benjamin Franklin, the first postmaster general, surrounded by his inventions. The Retrenchment Committee using S-116 The two rooms, S-116 and S-117, continued to serve separate purposes until 1931. Occupants of the rooms reflected the concerns of a growing nation, including the committees on Retrenchmentment, Patents, Agriculture, Immigration, Territories, Female Suffrage, and Naval Affairs. In 1931, S-116 and S-117 became associated as a suite to accommodate the needs of the Naval Affairs Committee. Shortly after, in 1933, the Committee on Foreign Relations moved into the two-room suite, an assignment it retains to this day. While the Foreign Relations Com- mittee maintains several offices throughout the Capitol complex, the two rooms in the Capitol have become symbolic of the committee and its notable diplomatic work. Occupancy The following occupancy lists are compiled from a variety of resources, including architectural plans, guidebooks, contemporary records, and the annual directory of the United States Congress— first published in 1869. S–116 1869 Senate Folding Room 1870-1871 Committee on Retrenchment 1872-1881 Committee on Patents 1882-1884 Committee on Patents and Committee on Female Suffrage 1885-1895 Committee on Patents 1896-1914 Senate Post-Office 1915 Committee on Agriculture and Forestry 1916 Committee on Contingent Expenses 1917 Committee on Industrial Expositions 1918-1924 Committee on Immigration 1925 Committee on Territories 1926-1928 Committee on Territories and Insular Possessions 1929-1930 Committee on Printing 1931-1932 Committee on Naval Affairs 1933-present Committee on Foreign Relations S–117 1869-1895 Committee on Post-Offices and Post-Roads 1896-1901 Committee on Foreign Relations 1902-1909 Committee on Printing 1910-1914 Committee on Agriculture and Forestry 1915 Committee on the Library 1915-1917 Committee on Agriculture and Forestry 1918-1920 Committee on Census 1921-1923 Committee on Enrolled Bills 1924-1932 Committee on Naval Affairs 1933-present Committee on Foreign Relations Decorative Highlights The Senate extension and its companion House extension, designed by Thomas U. Walter and built by Montgomery C. Meigs, were meant to inspire visitors to reflect upon the Capitol as a symbol of American democracy and to showcase case the nation’s accomplishments, resources, and wealth. To this end, the extensions featured elaborate wall and ceiling murals, as well as the finest workmanship, the most exquisite building materials, and the latest technologies. Offices boasted high vaulted ceilings, ornamental cast-iron door and window frames, interior wood shutters, carved marble mantels, and marble baseboards, in addition to unique decorative details. Colorful floor tiles from Minton, Hollins & Company of England were used throughout to enliven spaces and add pattern. Accompanying this architectural grandeur, ventilation, heating, water closets, and gas lighting provided valuable comfort to the occupants. The central floor medallion in S-116 Natural light floods S-117 through the four generously ously proportioned windows. Today, the corner room’s windows offer views north to Union Station and east to the Supreme Court building. Ornamental bands of stylized leaves decorate the arched cast-iron window and door frames. The room retains its original marble mantel, crowned by a gilded Neoclassical Revival mirror whose frame features a prominent cornice with bead-and-reel and egg-and-dart ornaments, fluted pilasters, and acan—thus leaves that delicately wrap around the corners of the frame. Aside from the windows, the room is lit by a central crystal chandelier and four inverted crystal tal cone pendants The mantel and mirror in S-117 lights, and eight sconces installed on the window frames. The pendant lights were added in the 1960s and were designed to integrate with the committee room’s existing 19th-century chandelier and sconces. While not the original light fixtures, the chandelier and sconces are early 20th-century pieces reminiscent of new, vibrant chandeliers that were appearing in Senate spaces at the time. The newly constructed 1909 Senate Russell Office Buildinging’s committee rooms sparkled with silver and crystal fixtures, and in 1910, seven striking crystal chandeliers acquired from the White House were installed in the Capitol. These bright, vivid lights offered a welcome contrast to the darker, dull metal ones that hung in most extension spaces, so silver and crystal chandeliers were purchased for many Capitol offices. The painted decoration on the ceiling in S-117 emphasizes the architectural vault lines and dates from the turn of the 20th century, when a comprehensive decorative campaign for the Capitol was implemented. While some of the colors have changed with repainting over the years, the style of ornamentation holds true to the original design. Room S-116, which was first used as the folding ing room, was probably very plainly decorated. Initially, there were not even fireplaces. The two existing marble mantels were presumably installed in 1872, when the prominent Committee on Pensions was assigned the room. The Rococo Revival mirrors that rest on the mantels feature a central cartouche, scrolls, stylized leaves, and flowers. The decorative painted banding on the ceiling in S-116 probably dates to sometime after 1900 and is documented in images as early as 1946. The impressive, obround-shaped committee table fills the room and accommodates every current member of the committee. Each senator has an assigned seat, marked by an engraved brass name- plate. A bronze bust of Cordell Hull by George Conlon oversees the activities of the Foreign Rela- tions Committee from the central window well. Hull’s commemoration in the Foreign Relations Committee Room is fitting given his work as secretary of state, promoting peace and international alliances, and establishing the United Nations."," Only use the provided text to answer the question, no outside sources. Examine the dual influence of technological innovation and political diplomacy in shaping the design and use of rooms s-116 and s-117 in the senate foreign relations Committee suite. In your response, connect the symbolic contribution of both robert and benjamin to at least two major us foreign policies debated in the room. Additionally, analyze how frescoes depicting their legaixes impacted both domestic and international legislative decisions; do not mention any historical event that occurred before 1840; and ensure that every sentence references a different artistic or architectural feature if the suite The U.S. SenaTe Foreign relaTionS CommiTTee SUiTe The U.S. SenaTe Foreign relaTionS Committee The Senate Committee on Foreign Relations was established in 1816 as one of the original eleven permanent standing committees of the Senate. Throughout its history, the Foreign Relations Committee has been instrumental in developing The Senate Foreign Relations Committee Room (S-116) and influencing U.S. foreign policy. The committee tee considers, debates, and negotiates important treaties and legislation that support the national interest. It also holds jurisdiction over all democratic nominations. Through these powers, the committee has helped shape foreign policy of broad significance in matters of war and peace and international relations. The committee receives honored guests and con- ducts official business in its historic, two-room suite, located in the northeast corner of the Senate extension, built between 1851 and 1868. History Like many Senate spaces in the Capitol, S-116 and S-117 have served many different committees and offices. The first known use of S-116 was as the Senate folding room. It was here that publications were stored and where clerks prepared documents, bills, and speeches for distribution. Eventually this service was transferred to the Government printing ing Office. The Senate Committee on Patents, which held jurisdiction over patents and patent law, moved into S-116 in the 1870s. It was during the Patent Committee’s nearly two-decade occu- pancy of the room that artist Constantino Brumidi executed the fresco of American innovator Robert Fulton above the entrance to the committee room. Robert Fulton depicted in the lunette over S-116, then used by the Committee on Patents from 1872-1895 This follows a precedent applied throughout the Capitol’s corridors of relating the figurative murals to the achievements or work of the committee in the nearby room. The fresco above the door to S-116 depicts Fulton with his left hand resting on mechanical diagrams and his right hand gesturing ing towards a steamboat traveling the Hudson River—references to Fulton’s success at harnessing steam engine technology to create the first viable commercial steamboat service in the early 19th century. Brumidi incorporated emblems representing ing science, agriculture, navigation, and the arts on the ceiling in the spacious lobby outside S-116, known as the Patent Corridor. The original occupant of S-117 was the Senate Committee on Post-Offices and Post-Roads. To recognize this committee, Brumidi painted a fresco above the room’s entrance depicting Benjamin Franklin, the first postmaster general, surrounded by his inventions. The Retrenchment Committee using S-116 The two rooms, S-116 and S-117, continued to serve separate purposes until 1931. Occupants of the rooms reflected the concerns of a growing nation, including the committees on Retrenchmentment, Patents, Agriculture, Immigration, Territories, Female Suffrage, and Naval Affairs. In 1931, S-116 and S-117 became associated as a suite to accommodate the needs of the Naval Affairs Committee. Shortly after, in 1933, the Committee on Foreign Relations moved into the two-room suite, an assignment it retains to this day. While the Foreign Relations Com- mittee maintains several offices throughout the Capitol complex, the two rooms in the Capitol have become symbolic of the committee and its notable diplomatic work. Occupancy The following occupancy lists are compiled from a variety of resources, including architectural plans, guidebooks, contemporary records, and the annual directory of the United States Congress— first published in 1869. S–116 1869 Senate Folding Room 1870-1871 Committee on Retrenchment 1872-1881 Committee on Patents 1882-1884 Committee on Patents and Committee on Female Suffrage 1885-1895 Committee on Patents 1896-1914 Senate Post-Office 1915 Committee on Agriculture and Forestry 1916 Committee on Contingent Expenses 1917 Committee on Industrial Expositions 1918-1924 Committee on Immigration 1925 Committee on Territories 1926-1928 Committee on Territories and Insular Possessions 1929-1930 Committee on Printing 1931-1932 Committee on Naval Affairs 1933-present Committee on Foreign Relations S–117 1869-1895 Committee on Post-Offices and Post-Roads 1896-1901 Committee on Foreign Relations 1902-1909 Committee on Printing 1910-1914 Committee on Agriculture and Forestry 1915 Committee on the Library 1915-1917 Committee on Agriculture and Forestry 1918-1920 Committee on Census 1921-1923 Committee on Enrolled Bills 1924-1932 Committee on Naval Affairs 1933-present Committee on Foreign Relations Decorative Highlights The Senate extension and its companion House extension, designed by Thomas U. Walter and built by Montgomery C. Meigs, were meant to inspire visitors to reflect upon the Capitol as a symbol of American democracy and to showcase case the nation’s accomplishments, resources, and wealth. To this end, the extensions featured elaborate wall and ceiling murals, as well as the finest workmanship, the most exquisite building materials, and the latest technologies. Offices boasted high vaulted ceilings, ornamental cast-iron door and window frames, interior wood shutters, carved marble mantels, and marble baseboards, in addition to unique decorative details. Colorful floor tiles from Minton, Hollins & Company of England were used throughout to enliven spaces and add pattern. Accompanying this architectural grandeur, ventilation, heating, water closets, and gas lighting provided valuable comfort to the occupants. The central floor medallion in S-116 Natural light floods S-117 through the four generously ously proportioned windows. Today, the corner room’s windows offer views north to Union Station and east to the Supreme Court building. Ornamental bands of stylized leaves decorate the arched cast-iron window and door frames. The room retains its original marble mantel, crowned by a gilded Neoclassical Revival mirror whose frame features a prominent cornice with bead-and-reel and egg-and-dart ornaments, fluted pilasters, and acan—thus leaves that delicately wrap around the corners of the frame. Aside from the windows, the room is lit by a central crystal chandelier and four inverted crystal tal cone pendants The mantel and mirror in S-117 lights, and eight sconces installed on the window frames. The pendant lights were added in the 1960s and were designed to integrate with the committee room’s existing 19th-century chandelier and sconces. While not the original light fixtures, the chandelier and sconces are early 20th-century pieces reminiscent of new, vibrant chandeliers that were appearing in Senate spaces at the time. The newly constructed 1909 Senate Russell Office Buildinging’s committee rooms sparkled with silver and crystal fixtures, and in 1910, seven striking crystal chandeliers acquired from the White House were installed in the Capitol. These bright, vivid lights offered a welcome contrast to the darker, dull metal ones that hung in most extension spaces, so silver and crystal chandeliers were purchased for many Capitol offices. The painted decoration on the ceiling in S-117 emphasizes the architectural vault lines and dates from the turn of the 20th century, when a comprehensive decorative campaign for the Capitol was implemented. While some of the colors have changed with repainting over the years, the style of ornamentation holds true to the original design. Room S-116, which was first used as the folding ing room, was probably very plainly decorated. Initially, there were not even fireplaces. The two existing marble mantels were presumably installed in 1872, when the prominent Committee on Pensions was assigned the room. The Rococo Revival mirrors that rest on the mantels feature a central cartouche, scrolls, stylized leaves, and flowers. The decorative painted banding on the ceiling in S-116 probably dates to sometime after 1900 and is documented in images as early as 1946. The impressive, obround-shaped committee table fills the room and accommodates every current member of the committee. Each senator has an assigned seat, marked by an engraved brass name- plate. A bronze bust of Cordell Hull by George Conlon oversees the activities of the Foreign Rela- tions Committee from the central window well. Hull’s commemoration in the Foreign Relations Committee Room is fitting given his work as secretary of state, promoting peace and international alliances, and establishing the United Nations. https://www.senate.gov/art-artifacts/publications/pdf/room-foreign-relations.pdf",Legal,Fact Finding,Q&A Only consider the following text in your answer. Format your answer into between 10 and 15 bullet points.,Please summarize this information for a person not familiar with advertising or business models.,"In this paper, we provide a generalizable distribution of television advertising elasticities for established products that can serve as a prior distribution for firms and researchers. Providing generalizable estimates of TV advertising effects necessitates transparent and replicable estimation methods and an a priori relevant population of products. Our analy- sis is based on a sample of 288 large, national CPG brands that are selected using a clear research protocol, and our data sources (Nielsen Ad Intel and RMS scanner data) are widely used by marketing managers and academic researchers. We find that the median of the distribution of estimated long-run advertising elasticities is between 0.0085 and 0.0142, and the corresponding mean is between 0.0098 and 0.0261. We draw two main lessons from these results. First, the estimated advertising elastic- ities are small, and two thirds of the estimates are not statistically distinguishable from zero. The estimates are also economically small, in the sense that more than 80% of all brands have a negative ROI of advertising at the margin. The estimates are roughly half the size of the most comparable prior study, Lodish et al. (1995), which used data from the 1980s. This difference is consistent with an overall decline in TV advertising effectiveness over the last three decades. Second, our results are robust. In particular, across a wide range of specifications, the overall distribution of advertising elasticities is stable. Due to this fact, together with the institutional details of the ad buying process that underlie our identification strategy, it appears implausible that our results are affected by any remaining confounds. Our results have important positive and normative implications. A central finding is the over-investment in advertising for more than 80% of brands, a significant misalloca- tion of resources by firms. Our data are identical to the commercially available data used by firms, and hence it is unlikely that firms observe larger advertising effects because of access to alternative data sources. This raises an economic puzzle. Why do firms spend billions of dollars on TV advertising each year if the return is negative? There are sev- eral possible explanations. First, agency issues, in particular career concerns, may lead managers (or consultants) to overstate the effectiveness of advertising if they expect to lose their jobs if their advertising campaigns are revealed to be unprofitable. Second, an incorrect prior (i.e. conventional wisdom that advertising is typically effective) may lead a decision maker to rationally shrink the estimated advertising effect from their data to an incorrect, inflated prior mean. Third, the estimated advertising effects may be inflated if confounding factors are not adequately adjusted for. The last two explanations do not as- sume irrational behavior, but may simply represent a cost of conducting causal inference 23 to acquire accurate information on the effect of advertising. We view this explanation as plausible given that unified, formal approaches to causal inference have only recently been widely adopted. These proposed explanations are not mutually exclusive. In par- ticular, agency issues may be exacerbated if the general effectiveness of advertising or a specific advertising effect estimate is overstated.13 While we cannot conclusively point to these explanations as the source of the documented over-investment in advertising, our discussions with managers and industry insiders suggest that these may be contributing factors. This brings us back to a key motivating question for this research, the long-run viabil- ity of traditional media markets. The documented over-investment in advertising suggests a threat to the survival of media markets in their current form, once knowledge about the small degree of TV advertising effectiveness becomes common knowledge. But our results also indicate that for a substantial number of brands (34% based on the point estimates), the observed advertising schedules are valuable compared to the counterfactual of no ad- vertising. There is a large degree of statistical uncertainty about the exact ROIs, and only for 12% of brands the predicted ROIs from the observed advertising schedules are positive and statistically different from zero. This suggests a large option value from adopting im- proved methods or research designs, such as A/B tests, to estimate the causal effect and ROI of advertising. Our results also do not foreclose the possibility that advertising can be profitable with alternative scheduling, targeting, or advertising copy strategies. The rise of addressable television, in particular, should allow advertisers and researchers to experiment with individual level targeting in the future. These approaches for improving advertising measurement, scheduling, and targeting may well ensure the long-run viability of media markets. While improvements in targeting technology may theoretically increase the potential for higher advertising returns, they do not solve the underlying agency problems that allow sub-optimal advertising decisions to persist in the traditional TV advertising model we evaluate in this paper. Together with past research documenting similar results in digital advertising markets (Blake et al. 2015; Lewis and Rao 2015), our work should motivate economists to further study the managerial and agency issues in advertising markets.","Only consider the following text in your answer. Format your answer into between 10 and 15 bullet points. In this paper, we provide a generalizable distribution of television advertising elasticities for established products that can serve as a prior distribution for firms and researchers. Providing generalizable estimates of TV advertising effects necessitates transparent and replicable estimation methods and an a priori relevant population of products. Our analy- sis is based on a sample of 288 large, national CPG brands that are selected using a clear research protocol, and our data sources (Nielsen Ad Intel and RMS scanner data) are widely used by marketing managers and academic researchers. We find that the median of the distribution of estimated long-run advertising elasticities is between 0.0085 and 0.0142, and the corresponding mean is between 0.0098 and 0.0261. We draw two main lessons from these results. First, the estimated advertising elastic- ities are small, and two thirds of the estimates are not statistically distinguishable from zero. The estimates are also economically small, in the sense that more than 80% of all brands have a negative ROI of advertising at the margin. The estimates are roughly half the size of the most comparable prior study, Lodish et al. (1995), which used data from the 1980s. This difference is consistent with an overall decline in TV advertising effectiveness over the last three decades. Second, our results are robust. In particular, across a wide range of specifications, the overall distribution of advertising elasticities is stable. Due to this fact, together with the institutional details of the ad buying process that underlie our identification strategy, it appears implausible that our results are affected by any remaining confounds. Our results have important positive and normative implications. A central finding is the over-investment in advertising for more than 80% of brands, a significant misalloca- tion of resources by firms. Our data are identical to the commercially available data used by firms, and hence it is unlikely that firms observe larger advertising effects because of access to alternative data sources. This raises an economic puzzle. Why do firms spend billions of dollars on TV advertising each year if the return is negative? There are sev- eral possible explanations. First, agency issues, in particular career concerns, may lead managers (or consultants) to overstate the effectiveness of advertising if they expect to lose their jobs if their advertising campaigns are revealed to be unprofitable. Second, an incorrect prior (i.e. conventional wisdom that advertising is typically effective) may lead a decision maker to rationally shrink the estimated advertising effect from their data to an incorrect, inflated prior mean. Third, the estimated advertising effects may be inflated if confounding factors are not adequately adjusted for. The last two explanations do not as- sume irrational behavior, but may simply represent a cost of conducting causal inference 23 to acquire accurate information on the effect of advertising. We view this explanation as plausible given that unified, formal approaches to causal inference have only recently been widely adopted. These proposed explanations are not mutually exclusive. In par- ticular, agency issues may be exacerbated if the general effectiveness of advertising or a specific advertising effect estimate is overstated.13 While we cannot conclusively point to these explanations as the source of the documented over-investment in advertising, our discussions with managers and industry insiders suggest that these may be contributing factors. This brings us back to a key motivating question for this research, the long-run viabil- ity of traditional media markets. The documented over-investment in advertising suggests a threat to the survival of media markets in their current form, once knowledge about the small degree of TV advertising effectiveness becomes common knowledge. But our results also indicate that for a substantial number of brands (34% based on the point estimates), the observed advertising schedules are valuable compared to the counterfactual of no ad- vertising. There is a large degree of statistical uncertainty about the exact ROIs, and only for 12% of brands the predicted ROIs from the observed advertising schedules are positive and statistically different from zero. This suggests a large option value from adopting im- proved methods or research designs, such as A/B tests, to estimate the causal effect and ROI of advertising. Our results also do not foreclose the possibility that advertising can be profitable with alternative scheduling, targeting, or advertising copy strategies. The rise of addressable television, in particular, should allow advertisers and researchers to experiment with individual level targeting in the future. These approaches for improving advertising measurement, scheduling, and targeting may well ensure the long-run viability of media markets. While improvements in targeting technology may theoretically increase the potential for higher advertising returns, they do not solve the underlying agency problems that allow sub-optimal advertising decisions to persist in the traditional TV advertising model we evaluate in this paper. Together with past research documenting similar results in digital advertising markets (Blake et al. 2015; Lewis and Rao 2015), our work should motivate economists to further study the managerial and agency issues in advertising markets. Please summarize this information for a person not familiar with advertising or business models.",Retail/Product,Summarize & Simplify,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","I need a thesis statement, fit for a 2nd year undergrad paper, on the potential clinical effects of a training guided by the concept of 'Paideia' on one hand and standard technical training on the other, in no more than 300 words.","In the health area, a habitual behavior is observed among professionals of using knowledge about diseases and treatments (generating authority) over the passivity of those who need care – the patient (perpetuating dependence) – and this marks a strong characteristic of paternalism. For many professionals, it is difficult to assess an individual’s ability to decide on an indication based on clinical and laboratory evaluation. Often, there is still a very strong belief in professional knowledge as sovereign1.Involving patients in decision-making helps professionals ensure that the treatment provided reflects their preferences and values. Ethics, here understood as a reflection on moral and deontological norms and rules and the values that should guide how professionals should behave, is essential to the practice of health care, and respect for patient autonomy is present in the professions’ codes of ethics. Patients must have the exercise of their autonomy fully guaranteed. Thus, all information must be presented, allowing this autonomy to be exercised2-5.It is recommended that professionals make decisions considering clinical, epidemiological, psychosocial and ethical aspects, never forgetting that these complement each other. With this in mind, it is necessary to consider that competencies can be understood as the skills and knowledge that are acquired throughout training. When we talk about healthcare professionals, understanding the user’s role in decision-making is a competency that needs to be acquired by everyone. Thus, we must remember that the logic of training in the dierent specialties in some health courses, such as medicine, nursing and nutrition, including specialization in Nephrology, is focused on the idea of clinical skills, that is, education acts as a teaching guide for including the professionals into the work process, but often it does not work as Paideia (broad, holistic training with cultural identity) and perpetuates the status quo of technical, procedure-centered training5-7.The vision of skills has been changing daily, as the place of study has expanded. As authors have suggested, there is a need for training that understands the reality of the population, and not just the constant identification of diseases and pre-determined treatments. In this sense, providing the training of reflective professionals who are less attentive to the closed content of the disciplines, developing autonomy, focusing on learning to learn and the student’s protagonism, with the aim of creating care practices that go beyond the strict needs of a population that has a specific characteristic, and yes, the look at the extramural scenario that society presents6-7.Most schools that train health specialties rely on educational methods that support technological logic, focusing on imaging and equipment, dispensing with or makinglearning about interpersonal relationships a secondary aspect. The work of the dierent professionals who comprise the team must be orchestrated and aligned, to present a relationship with the user that directs the team’s form and action. The construction of knowledge occurs through collective lines of force, especially when we are talking about health care6,8. When thinking about strategies to improve professional training, we must look at the national curricular guidelines (DCN, Diretrizes Curriculares Nacionais) for undergraduate courses in the health area. Since 2001, the articulation between the training of professionals and the field of health practice has been presented as necessary and essential. The resolutions show the need to promote graduates capable of working in the promotion, prevention, recovery and rehabilitation of health, through generalist, humanist, critical and reflective training to work with quality, competence and respecting the principles of ethics/bioethics, noting that health care goes beyond the technical act of care, requiring the resolution of individual and collective health problems. It is worth noting that the same is expected in the competency matrix for the training of nephrology specialists.","[question] I need a thesis statement, fit for a 2nd year undergrad paper, on the potential clinical effects of a training guided by the concept of 'Paideia' on one hand and standard technical training on the other, in no more than 300 words. ===================== [text] In the health area, a habitual behavior is observed among professionals of using knowledge about diseases and treatments (generating authority) over the passivity of those who need care – the patient (perpetuating dependence) – and this marks a strong characteristic of paternalism. For many professionals, it is difficult to assess an individual’s ability to decide on an indication based on clinical and laboratory evaluation. Often, there is still a very strong belief in professional knowledge as sovereign1.Involving patients in decision-making helps professionals ensure that the treatment provided reflects their preferences and values. Ethics, here understood as a reflection on moral and deontological norms and rules and the values that should guide how professionals should behave, is essential to the practice of health care, and respect for patient autonomy is present in the professions’ codes of ethics. Patients must have the exercise of their autonomy fully guaranteed. Thus, all information must be presented, allowing this autonomy to be exercised2-5.It is recommended that professionals make decisions considering clinical, epidemiological, psychosocial and ethical aspects, never forgetting that these complement each other. With this in mind, it is necessary to consider that competencies can be understood as the skills and knowledge that are acquired throughout training. When we talk about healthcare professionals, understanding the user’s role in decision-making is a competency that needs to be acquired by everyone. Thus, we must remember that the logic of training in the dierent specialties in some health courses, such as medicine, nursing and nutrition, including specialization in Nephrology, is focused on the idea of clinical skills, that is, education acts as a teaching guide for including the professionals into the work process, but often it does not work as Paideia (broad, holistic training with cultural identity) and perpetuates the status quo of technical, procedure-centered training5-7.The vision of skills has been changing daily, as the place of study has expanded. As authors have suggested, there is a need for training that understands the reality of the population, and not just the constant identification of diseases and pre-determined treatments. In this sense, providing the training of reflective professionals who are less attentive to the closed content of the disciplines, developing autonomy, focusing on learning to learn and the student’s protagonism, with the aim of creating care practices that go beyond the strict needs of a population that has a specific characteristic, and yes, the look at the extramural scenario that society presents6-7.Most schools that train health specialties rely on educational methods that support technological logic, focusing on imaging and equipment, dispensing with or makinglearning about interpersonal relationships a secondary aspect. The work of the dierent professionals who comprise the team must be orchestrated and aligned, to present a relationship with the user that directs the team’s form and action. The construction of knowledge occurs through collective lines of force, especially when we are talking about health care6,8. When thinking about strategies to improve professional training, we must look at the national curricular guidelines (DCN, Diretrizes Curriculares Nacionais) for undergraduate courses in the health area. Since 2001, the articulation between the training of professionals and the field of health practice has been presented as necessary and essential. The resolutions show the need to promote graduates capable of working in the promotion, prevention, recovery and rehabilitation of health, through generalist, humanist, critical and reflective training to work with quality, competence and respecting the principles of ethics/bioethics, noting that health care goes beyond the technical act of care, requiring the resolution of individual and collective health problems. It is worth noting that the same is expected in the competency matrix for the training of nephrology specialists. https://www.researchgate.net/publication/384023444_Nephrologist_training_a_bioethical_analysis ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Concept Comparison,Q&A "In this task, your answers must be based solely on information provided in the prompt. Information from prior knowledge and external sources is not permitted.",Summarize the included text in a bullet point list and use bold to highlight any company names.,"Future Possibilities of Big Tech in Finance This report generally provides an overview of Big Tech’s current financial offerings, how the existing regulatory framework applies to these operations, and related policy implications. However, should Big Tech seek to expand its offerings, as its actions have sometimes suggested and some observers have speculated, the relevant concerns may change considerably. At the same time, regulatory treatment may change irrespective of Big Tech’s activities, as policymakers and lawmakers continue to assess various Big Tech financial-services-related activities, such as data practices, and potential antitrust issues. For policymakers concerned about the potential implications of becoming dominant in financial markets, financial products where Big Tech could expand is also relevant for current policy. This section considers the potential evolution of financial services offered by Big Tech and the attendant policy implications. While it considers possible alternatives and issues that may arise from possible paths, the report does not assume that any one is more or less likely or that the companies are considering pursuing any particular strategy. Investment Advisory Services Investment advisory services refer to professionals that provide advice on securities to investors and include asset, portfolio, and wealth managers.156 More than 90% of wealth managers believe Big Tech companies will enter the market, with greater than 50% expecting significant disruption if it happens, according to a November 2021 survey.157 Over the past decade, fintechs have entered the investment management area, using machine learning to offer services such as robo- advising and retail stock trading. If Big Tech companies were to consider this approach, they would have to register as investment advisors with the Securities and Exchange Commission. They may also be required to register with the Financial Industry Regulatory Authority if they plan to offer brokerage services. Insurance According to one major management consulting firm, “[o]utside tech-powered giants … are shaping the insurance market.”158 Both Amazon and Google have partnered with insurance companies, much like they did banks, to offer various insurance products.159 Any intention to push further without relying on a partner would invite regulation at the state level,160 where most of the regulation of insurance occurs: The role of the federal government in regulating private insurance is relatively limited compared with its role in banking and securities. Insurance companies, unlike banks and securities firms, have been chartered and regulated solely by the states for the past 150 years. There are no federal regulators of insurance akin to those for securities or banks, such as the Securities and Exchange Commission (SEC) or the Office of the Comptroller of the Currency (OCC), respectively.161 Banking There are few issues at the nexus of technology and finance that generate greater interest and speculation than the prospect of Big Tech’s entry into banking. As it stands, some have pursued nonbank lending. The “Plex” project (see “Google “Plex” textbox), which Google abandoned in late 2021, was the most direct step to date by the industry, seeming to confirm collective and long-held suspicions that Big Techs were interested in becoming banks. However, if any of the companies were to consider an expansion into more bank-like activities, such as accepting deposits, their only option would likely be to pursue an industrial loan company charter, which has a complex framework and history. Legislative Framework Generally, U.S. law prohibits commercial enterprises (i.e., nonfinancial firms) from operating banks. Since at least as far back as the Glass-Steagall Act (Sections 20, 21, 26, and 32 of the Banking Act of 1933; P.L. 73-66), and then in the Bank Holding Company Act, Congress has sought to separate banking enterprises that take deposits and make loans from commercial enterprises producing and selling goods and services.162 In short, the separation aims to prevent one company from both offering a product and the loan to purchase that product funded with deposits publicly guaranteed by FDIC insurance. One exception to this general separation of commerce and banking is the role of industrial loan companies (ILCs). ILCs are financial institutions charted in six states163 that function much like typical banks. Unlike other banks, ILCs can be owned by nonfinancial, commercial firms. Under the Bank Holding Company Act (12 U.S.C. 1841 (c)(2)(h)), ILCs, provided they meet certain criteria, are exempt from the definition of bank. Pursuant to that exemption, a company that owns a bank is not a bank holding company and as such is not subject to oversight by the Federal Reserve. However, ILCs are considered state banks for the purposes of the FDIC Act (12 U.S.C. 1813 (a)(2)). Under that law, they are defined as banks and thus eligible for deposit insurance. Thus, this patchwork legal framework creates the opportunity for a company with other commercial interests to offer banking services, obtain deposit insurance, and operate nationally without being subject to consolidated supervision by the Federal Reserve System. Relevant History Historically, nonfinancial companies interested in a banking license have taken the ILC approach. In the mid-2000s, both Walmart and Home Depot began unsuccessful attempts to establish or acquire ILCs.165 Both ultimately dropped their attempts in the face of public opposition, after which the FDIC imposed an official moratorium on considering new insurance applications from ILCs between July 2006 and January 2008, and Section 603 of the Dodd-Frank Act imposed another temporary statutory moratorium between July 2010 and July 2013. Though the official moratoria had ended, the FDIC did not grant an ILC insurance application again until March 2020, when it approved two ILCs—Nelnet and Square166—for deposit insurance. Square offers many of the same services as the Big Techs in this report, including mobile wallet with payment and peer-to-peer transfer functions.167 Also relevant is an outstanding application for an ILC charter by Japanese e-commerce company Rakuten. Rakuten filed its most recent ILC application on January 15, 2021, following two previous applications that it withdrew before rulings. Rakuten is sometimes referred to as the “Amazon of Japan”168 and has a similar business model to U.S. Big Tech companies. As such, any decision by the FDIC will have regulatory arbitrage considerations (see “Systemic Risk” above) and is likely to be interpreted by others with similar models considering entering banking. Theoretically, a Big Tech with an ILC charter could benefit from access to deposits and deposit insurance without the increased regulatory burden and costs of consolidated financial oversight by the Federal Reserve System ","In this task, your answers must be based solely on information provided in the prompt. Information from prior knowledge and external sources is not permitted. Summarize the included text in a bullet point list and use bold to highlight any company names. Future Possibilities of Big Tech in Finance This report generally provides an overview of Big Tech’s current financial offerings, how the existing regulatory framework applies to these operations, and related policy implications. However, should Big Tech seek to expand its offerings, as its actions have sometimes suggested and some observers have speculated, the relevant concerns may change considerably. At the same time, regulatory treatment may change irrespective of Big Tech’s activities, as policymakers and lawmakers continue to assess various Big Tech financial-services-related activities, such as data practices, and potential antitrust issues. For policymakers concerned about the potential implications of becoming dominant in financial markets, financial products where Big Tech could expand is also relevant for current policy. This section considers the potential evolution of financial services offered by Big Tech and the attendant policy implications. While it considers possible alternatives and issues that may arise from possible paths, the report does not assume that any one is more or less likely or that the companies are considering pursuing any particular strategy. Investment Advisory Services Investment advisory services refer to professionals that provide advice on securities to investors and include asset, portfolio, and wealth managers.156 More than 90% of wealth managers believe Big Tech companies will enter the market, with greater than 50% expecting significant disruption if it happens, according to a November 2021 survey.157 Over the past decade, fintechs have entered the investment management area, using machine learning to offer services such as robo- advising and retail stock trading. If Big Tech companies were to consider this approach, they would have to register as investment advisors with the Securities and Exchange Commission. They may also be required to register with the Financial Industry Regulatory Authority if they plan to offer brokerage services. Insurance According to one major management consulting firm, “[o]utside tech-powered giants … are shaping the insurance market.”158 Both Amazon and Google have partnered with insurance companies, much like they did banks, to offer various insurance products.159 Any intention to push further without relying on a partner would invite regulation at the state level,160 where most of the regulation of insurance occurs: The role of the federal government in regulating private insurance is relatively limited compared with its role in banking and securities. Insurance companies, unlike banks and securities firms, have been chartered and regulated solely by the states for the past 150 years. There are no federal regulators of insurance akin to those for securities or banks, such as the Securities and Exchange Commission (SEC) or the Office of the Comptroller of the Currency (OCC), respectively.161 Banking There are few issues at the nexus of technology and finance that generate greater interest and speculation than the prospect of Big Tech’s entry into banking. As it stands, some have pursued nonbank lending. The “Plex” project (see “Google “Plex” textbox), which Google abandoned in late 2021, was the most direct step to date by the industry, seeming to confirm collective and long-held suspicions that Big Techs were interested in becoming banks. However, if any of the companies were to consider an expansion into more bank-like activities, such as accepting deposits, their only option would likely be to pursue an industrial loan company charter, which has a complex framework and history. Legislative Framework Generally, U.S. law prohibits commercial enterprises (i.e., nonfinancial firms) from operating banks. Since at least as far back as the Glass-Steagall Act (Sections 20, 21, 26, and 32 of the Banking Act of 1933; P.L. 73-66), and then in the Bank Holding Company Act, Congress has sought to separate banking enterprises that take deposits and make loans from commercial enterprises producing and selling goods and services.162 In short, the separation aims to prevent one company from both offering a product and the loan to purchase that product funded with deposits publicly guaranteed by FDIC insurance. One exception to this general separation of commerce and banking is the role of industrial loan companies (ILCs). ILCs are financial institutions charted in six states163 that function much like typical banks. Unlike other banks, ILCs can be owned by nonfinancial, commercial firms. Under the Bank Holding Company Act (12 U.S.C. 1841 (c)(2)(h)), ILCs, provided they meet certain criteria, are exempt from the definition of bank. Pursuant to that exemption, a company that owns a bank is not a bank holding company and as such is not subject to oversight by the Federal Reserve. However, ILCs are considered state banks for the purposes of the FDIC Act (12 U.S.C. 1813 (a)(2)). Under that law, they are defined as banks and thus eligible for deposit insurance. Thus, this patchwork legal framework creates the opportunity for a company with other commercial interests to offer banking services, obtain deposit insurance, and operate nationally without being subject to consolidated supervision by the Federal Reserve System. Relevant History Historically, nonfinancial companies interested in a banking license have taken the ILC approach. In the mid-2000s, both Walmart and Home Depot began unsuccessful attempts to establish or acquire ILCs.165 Both ultimately dropped their attempts in the face of public opposition, after which the FDIC imposed an official moratorium on considering new insurance applications from ILCs between July 2006 and January 2008, and Section 603 of the Dodd-Frank Act imposed another temporary statutory moratorium between July 2010 and July 2013. Though the official moratoria had ended, the FDIC did not grant an ILC insurance application again until March 2020, when it approved two ILCs—Nelnet and Square166—for deposit insurance. Square offers many of the same services as the Big Techs in this report, including mobile wallet with payment and peer-to-peer transfer functions.167 Also relevant is an outstanding application for an ILC charter by Japanese e-commerce company Rakuten. Rakuten filed its most recent ILC application on January 15, 2021, following two previous applications that it withdrew before rulings. Rakuten is sometimes referred to as the “Amazon of Japan”168 and has a similar business model to U.S. Big Tech companies. As such, any decision by the FDIC will have regulatory arbitrage considerations (see “Systemic Risk” above) and is likely to be interpreted by others with similar models considering entering banking. Theoretically, a Big Tech with an ILC charter could benefit from access to deposits and deposit insurance without the increased regulatory burden and costs of consolidated financial oversight by the Federal Reserve System ",Financial,Summarize & Format,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","I have hypothyroidism, but I just started taking ashwagandha, and I'm noticing decent effects on my stress levels. What are studies showing regarding the helpfulness of this supplement? Is there anything I need to be worried about? What is known about its drug interactions?","Efficacy Stress and anxiety A 2021 systematic review identified seven studies investigating ashwagandha to treat stress and anxiety. A total of 491 adults, all from India, with either self-reported high stress and anxiety or a diagnosed anxiety disorder, were randomized to take ashwagandha or placebo for 6 to 8 weeks. Six of the studies used extracts made from ashwagandha root alone (three studies, KSM-66), root and leaf (two studies, Sensoril or Shoden), or unspecified parts (one study), while the seventh study used dried root powder made into granules. The ashwagandha dose varied from 240 to 1,250 mg/day of extract or 12,000 mg/day of whole root granules equivalent to 6,000 mg of root powder. Overall, the studies found that ashwagandha significantly reduced stress and anxiety levels (subjectively measured by validated rating scales), reduced sleeplessness and fatigue, and reduced serum cortisol (a stress hormone) levels, compared with placebo. In several studies, benefits appeared to be greater with doses of 500 to 600 mg/day compared with lower doses. Results from three additional small studies published after this 2021 review also suggest that ashwagandha has a beneficial impact on perceived stress. One clinical trial conducted in Florida included 60 men and women experiencing perceived stress. Participants took capsules containing 225 mg/day or 400 mg/day of a proprietary ashwagandha root and leaf extract (NooGandha) or placebo for 30 days. Compared with placebo, participants taking both doses of ashwagandha extract reported positive effects on stress, anxiety, depression, and food cravings as measured by validated rating scales. In addition, participants taking the 225 mg dose had lower saliva cortisol levels than those in the placebo group. At the University of Colorado, Colorado Springs, 60 students were randomized to take an ashwagandha root extract (Gaia Herbs) or placebo for 30 days in a double-blind trial . The extract contained 2.5 mg withanolides per 350-mg capsule, and participants took two capsules daily. The investigators gathered qualitative, subjective information from participants during daily check-ins and focus groups. Participants who took ashwagandha extract reported increased well-being, including a sense of calm, improved energy levels, heightened mental clarity, and enhanced sleep quality. While descriptions of stress were comparable in both groups, participants taking ashwagandha were more likely to describe their stress as manageable compared with those taking placebo. Sleep Research is limited, but the results from a few clinical trials suggest that ashwagandha extracts may help with sleep. For example, at one study center in India, 150 healthy men and women age 18 to 65 years with self-reported sleep problems characterized by insomnia and lack of restful sleep were randomized to take an ashwagandha root and leaf extract (Shoden) or placebo for 6 weeks. The extract was standardized to contain 21 mg of withanolide glycosides per 60-mg capsule, and participants took two capsules each day. Both groups reported improvements in sleep quality as measured by a validated rating scale, but the improvements were greater in the ashwagandha group (72%) compared with the placebo group (29%). In addition, participants taking ashwagandha extract showed improvements in sleep efficiency (time in bed spent in sleep), total sleep time, sleep latency (time taken to fall asleep), and awakening after sleep onset as assessed by actigraphy, which involves wearing a watch monitor on the wrist to measure body motion. They also reported improvements in quality of life. In another trial conducted in India, 80 healthy men and women age 18 to 50 years, half of them with insomnia, were randomized to take an ashwagandha root extract (KSM-66) or placebo for 8 weeks. The extract was standardized to a withanolide content of more than 5% per 300-mg capsule, and participants took two capsules each day. Participants with insomnia who took ashwagandha extract showed improvements in sleep quality, sleep onset latency, mental alertness on rising, and perceived anxiety symptoms compared with those taking placebo, as measured by actigraphy and validated rating scales. Participants without insomnia taking ashwagandha also reported improved sleep but not perceived anxiety symptoms or mental alertness on awakening. A 2021 systematic review and meta-analysis included five studies (including the two described above), investigating ashwagandha to promote sleep. All studies were conducted in India. A total of 372 adults, either self-described as healthy or with insomnia, took ashwagandha or placebo for 6 to 12 weeks. The dose of the ashwagandha supplement used in these studies ranged from 250 to 600 mg/day as a root extract (KSM-66) or, in one study, 120 mg/day of a root and leaf extract (Shoden). Overall, the studies found that ashwagandha extract had a small but significant effect on improving sleep compared with placebo. The benefits were more prominent when the dose was 600 mg/day and when the treatment duration was at least 8 weeks. Benefits were also more prominent in participants with insomnia. Safety In the studies described above and in many other clinical trials, ashwagandha has been well tolerated by participants for up to about 3 months of use. Common side effects are mild and include stomach upset, loose stools, nausea, and drowsiness. However, evidence on the safety of longer term ashwagandha use over many months or years is lacking. There are a few reports of more serious side effects associated with ashwagandha use, including adverse effects on liver function. In an early report of liver injury associated with ashwagandha use, a 20-year-old man in Japan developed liver dysfunction and hyperbilirubinemia after using ashwagandha in combination with multiple antianxiety drugs. Since then, the use of ashwagandha has been linked to acute liver injury in other case reports. These include five cases (three men and two women, age range 21 to 62 years), who reportedly took supplements containing 450 to 1,350 mg ashwagandha daily over the course of 1 week to 4 months when signs of liver injury, such as jaundice, pruritus, nausea, lethargy, abdominal discomfort, and hyperbilirubinemia, appeared. In these cases and others, the conditions of the individuals improved over time after they stopped taking the supplement; some also received medical treatment. However, the contents of the products that the individuals took were not independently verified in all cases, and some products were combination products containing ashwagandha and other ingredients. Some research in mice and humans suggests that ashwagandha might affect thyroid function. In one study, three adult men who took 500 mg/day of a standardized ashwagandha extract (Sensoril) for 8 weeks had small increases in blood thyroxine (T4) levels. A small clinical trial with 50 participants with subclinical hypothyroidism found that ashwagandha (KSM-66), at 300 mg twice daily for 8 weeks, lowered serum thyroid stimulating hormone (TSH) and increased triiodothyronine (T3) and T4 levels compared with placebo. These findings suggest that ashwagandha might interact with thyroid hormone medications. Ashwagandha might also interact with other medications including antidiabetes medications, antihypertensives, immunosuppressants, and sedatives. Implications for use Several randomized, placebo-controlled clinical trials, most of them fairly small in size and of short duration, have found that ashwagandha may reduce perceived stress and anxiety and improve the quality and duration of sleep. Because studies have used various ashwagandha preparations (with different extraction and standardization processes) and doses, it is difficult to identify specific extracts or recommended amounts. In addition, most studies have been conducted as part of a traditional medical system, so the potential effects of ashwagandha when used as a dietary supplement outside of that approach remain unclear. Ashwagandha appears to be well tolerated for up to 3 months of use. However, the efficacy and safety of long-term ashwagandha use over months or years for stress, anxiety, or sleep is not known. In addition, ashwagandha may have potential adverse effects on the liver and thyroid and might not be safe for people with prostate cancer or those who are pregnant or nursing.","[question] I have hypothyroidism, but I just started taking ashwagandha, and I'm noticing decent effects on my stress levels. What are studies showing regarding the helpfulness of this supplement? Is there anything I need to be worried about? What is known about its drug interactions? ===================== [text] Efficacy Stress and anxiety A 2021 systematic review identified seven studies investigating ashwagandha to treat stress and anxiety. A total of 491 adults, all from India, with either self-reported high stress and anxiety or a diagnosed anxiety disorder, were randomized to take ashwagandha or placebo for 6 to 8 weeks. Six of the studies used extracts made from ashwagandha root alone (three studies, KSM-66), root and leaf (two studies, Sensoril or Shoden), or unspecified parts (one study), while the seventh study used dried root powder made into granules. The ashwagandha dose varied from 240 to 1,250 mg/day of extract or 12,000 mg/day of whole root granules equivalent to 6,000 mg of root powder. Overall, the studies found that ashwagandha significantly reduced stress and anxiety levels (subjectively measured by validated rating scales), reduced sleeplessness and fatigue, and reduced serum cortisol (a stress hormone) levels, compared with placebo. In several studies, benefits appeared to be greater with doses of 500 to 600 mg/day compared with lower doses. Results from three additional small studies published after this 2021 review also suggest that ashwagandha has a beneficial impact on perceived stress. One clinical trial conducted in Florida included 60 men and women experiencing perceived stress. Participants took capsules containing 225 mg/day or 400 mg/day of a proprietary ashwagandha root and leaf extract (NooGandha) or placebo for 30 days. Compared with placebo, participants taking both doses of ashwagandha extract reported positive effects on stress, anxiety, depression, and food cravings as measured by validated rating scales. In addition, participants taking the 225 mg dose had lower saliva cortisol levels than those in the placebo group. At the University of Colorado, Colorado Springs, 60 students were randomized to take an ashwagandha root extract (Gaia Herbs) or placebo for 30 days in a double-blind trial . The extract contained 2.5 mg withanolides per 350-mg capsule, and participants took two capsules daily. The investigators gathered qualitative, subjective information from participants during daily check-ins and focus groups. Participants who took ashwagandha extract reported increased well-being, including a sense of calm, improved energy levels, heightened mental clarity, and enhanced sleep quality. While descriptions of stress were comparable in both groups, participants taking ashwagandha were more likely to describe their stress as manageable compared with those taking placebo. Sleep Research is limited, but the results from a few clinical trials suggest that ashwagandha extracts may help with sleep. For example, at one study center in India, 150 healthy men and women age 18 to 65 years with self-reported sleep problems characterized by insomnia and lack of restful sleep were randomized to take an ashwagandha root and leaf extract (Shoden) or placebo for 6 weeks. The extract was standardized to contain 21 mg of withanolide glycosides per 60-mg capsule, and participants took two capsules each day. Both groups reported improvements in sleep quality as measured by a validated rating scale, but the improvements were greater in the ashwagandha group (72%) compared with the placebo group (29%). In addition, participants taking ashwagandha extract showed improvements in sleep efficiency (time in bed spent in sleep), total sleep time, sleep latency (time taken to fall asleep), and awakening after sleep onset as assessed by actigraphy, which involves wearing a watch monitor on the wrist to measure body motion. They also reported improvements in quality of life. In another trial conducted in India, 80 healthy men and women age 18 to 50 years, half of them with insomnia, were randomized to take an ashwagandha root extract (KSM-66) or placebo for 8 weeks. The extract was standardized to a withanolide content of more than 5% per 300-mg capsule, and participants took two capsules each day. Participants with insomnia who took ashwagandha extract showed improvements in sleep quality, sleep onset latency, mental alertness on rising, and perceived anxiety symptoms compared with those taking placebo, as measured by actigraphy and validated rating scales. Participants without insomnia taking ashwagandha also reported improved sleep but not perceived anxiety symptoms or mental alertness on awakening. A 2021 systematic review and meta-analysis included five studies (including the two described above), investigating ashwagandha to promote sleep. All studies were conducted in India. A total of 372 adults, either self-described as healthy or with insomnia, took ashwagandha or placebo for 6 to 12 weeks. The dose of the ashwagandha supplement used in these studies ranged from 250 to 600 mg/day as a root extract (KSM-66) or, in one study, 120 mg/day of a root and leaf extract (Shoden). Overall, the studies found that ashwagandha extract had a small but significant effect on improving sleep compared with placebo. The benefits were more prominent when the dose was 600 mg/day and when the treatment duration was at least 8 weeks. Benefits were also more prominent in participants with insomnia. Safety In the studies described above and in many other clinical trials, ashwagandha has been well tolerated by participants for up to about 3 months of use. Common side effects are mild and include stomach upset, loose stools, nausea, and drowsiness. However, evidence on the safety of longer term ashwagandha use over many months or years is lacking. There are a few reports of more serious side effects associated with ashwagandha use, including adverse effects on liver function. In an early report of liver injury associated with ashwagandha use, a 20-year-old man in Japan developed liver dysfunction and hyperbilirubinemia after using ashwagandha in combination with multiple antianxiety drugs. Since then, the use of ashwagandha has been linked to acute liver injury in other case reports. These include five cases (three men and two women, age range 21 to 62 years), who reportedly took supplements containing 450 to 1,350 mg ashwagandha daily over the course of 1 week to 4 months when signs of liver injury, such as jaundice, pruritus, nausea, lethargy, abdominal discomfort, and hyperbilirubinemia, appeared. In these cases and others, the conditions of the individuals improved over time after they stopped taking the supplement; some also received medical treatment. However, the contents of the products that the individuals took were not independently verified in all cases, and some products were combination products containing ashwagandha and other ingredients. Some research in mice and humans suggests that ashwagandha might affect thyroid function. In one study, three adult men who took 500 mg/day of a standardized ashwagandha extract (Sensoril) for 8 weeks had small increases in blood thyroxine (T4) levels. A small clinical trial with 50 participants with subclinical hypothyroidism found that ashwagandha (KSM-66), at 300 mg twice daily for 8 weeks, lowered serum thyroid stimulating hormone (TSH) and increased triiodothyronine (T3) and T4 levels compared with placebo. These findings suggest that ashwagandha might interact with thyroid hormone medications. Ashwagandha might also interact with other medications including antidiabetes medications, antihypertensives, immunosuppressants, and sedatives. Implications for use Several randomized, placebo-controlled clinical trials, most of them fairly small in size and of short duration, have found that ashwagandha may reduce perceived stress and anxiety and improve the quality and duration of sleep. Because studies have used various ashwagandha preparations (with different extraction and standardization processes) and doses, it is difficult to identify specific extracts or recommended amounts. In addition, most studies have been conducted as part of a traditional medical system, so the potential effects of ashwagandha when used as a dietary supplement outside of that approach remain unclear. Ashwagandha appears to be well tolerated for up to 3 months of use. However, the efficacy and safety of long-term ashwagandha use over months or years for stress, anxiety, or sleep is not known. In addition, ashwagandha may have potential adverse effects on the liver and thyroid and might not be safe for people with prostate cancer or those who are pregnant or nursing. https://ods.od.nih.gov/factsheets/Ashwagandha-HealthProfessional/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Fact Finding,Q&A "You are required to answer by only using information in the above text. Don't insert any intro or outro, just the answer to the prompt. Use bullet points and be extremely concise. Don't use hypotheticals in your answers, state only what you can prove to be true based on the text. ",Explain how the proposed framework in the above text relates to python code snippets.,"Adverse Drug Reactions (ADRs) are a leading cause of hospital admissions and healthcare costs. Traditional methods of ADR reporting often rely on post-marketing surveillance, and manual reporting of ADRs to the local or national pharmacovigilance agencies for causality assessment and final reporting to the WHO. High-income countries have their own national (i.e., USFDA) and regional (i.e., European Medicines Agency / EMA) pharmacovigilance agencies. However, this process is slow and inefficient. This article proposes a novel framework for integrating ADR detection into clinical workflows using Electronic Medical Record (EMR) systems, crowdsourced reporting from patients and healthcare professionals, and graph theory for generating automated ADR signals and reports to the local or national pharmacovigilance agencies. The system leverages automated data collection from EMRs (drug prescriptions, clinical notes) by EMR data scraping, integrating ADR dictionaries and drug databases to automate the generation of ranked ADR signals. By applying graph theory, the system filters and upranks connections between drugs and ADRs, considering the temporal relationship between drug administration and ADR occurrence. This automated approach offers a significant improvement in ADR reporting, enabling faster detection and more accurate predictions. Methodologies, framework visualizations and python code snippets are included to aid implementation. ","Adverse Drug Reactions (ADRs) are a leading cause of hospital admissions and healthcare costs. Traditional methods of ADR reporting often rely on post-marketing surveillance, and manual reporting of ADRs to the local or national pharmacovigilance agencies for causality assessment and final reporting to the WHO. High-income countries have their own national (i.e., USFDA) and regional (i.e., European Medicines Agency / EMA) pharmacovigilance agencies. However, this process is slow and inefficient. This article proposes a novel framework for integrating ADR detection into clinical workflows using Electronic Medical Record (EMR) systems, crowdsourced reporting from patients and healthcare professionals, and graph theory for generating automated ADR signals and reports to the local or national pharmacovigilance agencies. The system leverages automated data collection from EMRs (drug prescriptions, clinical notes) by EMR data scraping, integrating ADR dictionaries and drug databases to automate the generation of ranked ADR signals. By applying graph theory, the system filters and upranks connections between drugs and ADRs, considering the temporal relationship between drug administration and ADR occurrence. This automated approach offers a significant improvement in ADR reporting, enabling faster detection and more accurate predictions. Methodologies, framework visualizations and python code snippets are included to aid implementation. Explain how the proposed framework in the above text relates to python code snippets. You are required to answer by only using information in the above text. Don't insert any intro or outro, just the answer to the prompt. Use bullet points and be extremely concise. Don't use hypotheticals in your answers, state only what you can prove to be true based on the text. ",Medical,Effect Analysis,Q&A "Answer the question using only the given context block. Do not use any outside resources or prior knowledge. Format your answer in a paragraph with no more than 150 words. If you cannot answer using the context block alone, respond with ""I'm sorry. I cannot find the answer in the context source.""",What limits the scope of Biden's pardon for marijuana possession?,"Federal Clemency for Marijuana Possession On October 6, 2022, President Biden issued a proclamation granting “a full, complete, and unconditional pardon” to “all current United States citizens and lawful permanent residents” who had committed or been convicted of simple possession of marijuana under the CSA or a related provision of the D.C. Code. President Biden’s invocation of the clemency power means that persons who committed simple possession of marijuana before the date of the proclamation may not be prosecuted or punished for the offense under the relevant provisions of the CSA or the D.C. Code. (Although the District of Columbia has its own criminal code, its criminal justice system has some overlap with the federal system and is subject to the President’s clemency power.) Several factors limit the scope of the pardon. First, it applies only to violations of federal and D.C. law and does not affect other state law marijuana offenses. In announcing the pardon, President Biden also encouraged state governors to take similar steps but, under the United States’ federalist system of government, the President has no direct power to change state law or compel the states to adopt federal policies. While some governors have taken similar steps or expressed willingness to do so, in some states, governors cannot independently grant clemency. Second, the pardon applies only to simple possession of marijuana, not to other marijuana-related CSA offenses such as manufacture, distribution, or possession with intent to distribute or to other federal crimes. Federal prosecutions of simple possession of marijuana are relatively uncommon. The U.S. Sentencing Commission (USSC) reports that about 7,700 people subject to the pardon were convicted of only simple possession since FY1992, none of whom are currently in federal custody. (Additional individuals not subject to the pardon were convicted during that period.) In FY2021, 117 people subject to the pardon were convicted of only simple possession. A smaller number of people were convicted of possessing marijuana and possessing other illicit drugs or committing other crimes. Those people would remain liable for the other offenses. Shortly after the pardon was announced, the USSC issued policy priorities including “consideration of possible amendments to the [Sentencing] Guidelines Manual relating to criminal history to address … the impact of simple possession of marihuana offenses.” Third, the pardon by its terms “does not apply to individuals who were non-citizens not lawfully present in the United States at the time of their offense.” According to a 2016 USSC report, the vast majority of federal marijuana possession arrests occur at the border between the United States and Mexico. Among offenders sentenced for marijuana possession in FY2013, the USSC reports that over 94% of those arrested at the border were not U.S. citizens. To the extent those individuals were not lawfully present in the country, they would not benefit from the pardon. Fourth, the pardon applies only to offenses committed before the proclamation. The Supreme Court has explained that the President may issue a pardon “at any time after [an offense’s] commission, either before legal proceedings are taken, or during their pendency, or after conviction and judgment.” While DOJ is currently not prioritizing prosecuting low-level marijuana offenses, the October 2022 pardon does not prevent prosecution of future offenses if the current Administration or a future Administration adopts a different policy. Fifth, the pardon may not remove all legal consequences of marijuana possession, because it does not expunge convictions. Moreover, some collateral consequences of marijuana-related activities do not depend on a person being charged with or convicted of a CSA violation. Finally, and most fundamentally, the pardon does not change the status of marijuana under federal law. The President lacks the power to make such a change unilaterally. In announcing the grant of clemency, President Biden directed the Attorney General to review the classification of marijuana under the CSA, which is one way the federal government could change the status of the substance consistently with relevant separation-of-powers principles and the CSA’s procedural requirements. Any agency action in response to that directive would likely occur through notice-and-comment rulemaking, subject to judicial review and applicable international treaty obligations. Notwithstanding the foregoing limitations, some commentators have described the October 2022 pardon as a significant development in national marijuana policy that may restore some civic rights to those who benefit from it. Some have expressed concerns that the pardon might benefit offenders who committed more serious offenses but pleaded guilty to simple possession or that relaxing controls on marijuana may generally lead to an increase in crime. Others advocate for further pardons, expungements, and legal reforms to decriminalize marijuana.","Answer the question using only the given context block. Do not use any outside resources or prior knowledge. Format your answer in a paragraph with no more than 150 words. If you cannot answer using the context block alone, respond with ""I'm sorry. I cannot find the answer in the context source."" What limits the scope of Biden's pardon for Marijuana Possession? Federal Clemency for Marijuana Possession On October 6, 2022, President Biden issued a proclamation granting “a full, complete, and unconditional pardon” to “all current United States citizens and lawful permanent residents” who had committed or been convicted of simple possession of marijuana under the CSA or a related provision of the D.C. Code. President Biden’s invocation of the clemency power means that persons who committed simple possession of marijuana before the date of the proclamation may not be prosecuted or punished for the offense under the relevant provisions of the CSA or the D.C. Code. (Although the District of Columbia has its own criminal code, its criminal justice system has some overlap with the federal system and is subject to the President’s clemency power.) Several factors limit the scope of the pardon. First, it applies only to violations of federal and D.C. law and does not affect other state law marijuana offenses. In announcing the pardon, President Biden also encouraged state governors to take similar steps but, under the United States’ federalist system of government, the President has no direct power to change state law or compel the states to adopt federal policies. While some governors have taken similar steps or expressed willingness to do so, in some states, governors cannot independently grant clemency. Second, the pardon applies only to simple possession of marijuana, not to other marijuana-related CSA offenses such as manufacture, distribution, or possession with intent to distribute or to other federal crimes. Federal prosecutions of simple possession of marijuana are relatively uncommon. The U.S. Sentencing Commission (USSC) reports that about 7,700 people subject to the pardon were convicted of only simple possession since FY1992, none of whom are currently in federal custody. (Additional individuals not subject to the pardon were convicted during that period.) In FY2021, 117 people subject to the pardon were convicted of only simple possession. A smaller number of people were convicted of possessing marijuana and possessing other illicit drugs or committing other crimes. Those people would remain liable for the other offenses. Shortly after the pardon was announced, the USSC issued policy priorities including “consideration of possible amendments to the [Sentencing] Guidelines Manual relating to criminal history to address … the impact of simple possession of marihuana offenses.” Third, the pardon by its terms “does not apply to individuals who were non-citizens not lawfully present in the United States at the time of their offense.” According to a 2016 USSC report, the vast majority of federal marijuana possession arrests occur at the border between the United States and Mexico. Among offenders sentenced for marijuana possession in FY2013, the USSC reports that over 94% of those arrested at the border were not U.S. citizens. To the extent those individuals were not lawfully present in the country, they would not benefit from the pardon. Fourth, the pardon applies only to offenses committed before the proclamation. The Supreme Court has explained that the President may issue a pardon “at any time after [an offense’s] commission, either before legal proceedings are taken, or during their pendency, or after conviction and judgment.” While DOJ is currently not prioritizing prosecuting low-level marijuana offenses, the October 2022 pardon does not prevent prosecution of future offenses if the current Administration or a future Administration adopts a different policy. Fifth, the pardon may not remove all legal consequences of marijuana possession, because it does not expunge convictions. Moreover, some collateral consequences of marijuana-related activities do not depend on a person being charged with or convicted of a CSA violation. Finally, and most fundamentally, the pardon does not change the status of marijuana under federal law. The President lacks the power to make such a change unilaterally. In announcing the grant of clemency, President Biden directed the Attorney General to review the classification of marijuana under the CSA, which is one way the federal government could change the status of the substance consistently with relevant separation-of-powers principles and the CSA’s procedural requirements. Any agency action in response to that directive would likely occur through notice-and-comment rulemaking, subject to judicial review and applicable international treaty obligations. Notwithstanding the foregoing limitations, some commentators have described the October 2022 pardon as a significant development in national marijuana policy that may restore some civic rights to those who benefit from it. Some have expressed concerns that the pardon might benefit offenders who committed more serious offenses but pleaded guilty to simple possession or that relaxing controls on marijuana may generally lead to an increase in crime. Others advocate for further pardons, expungements, and legal reforms to decriminalize marijuana.",Legal,Fact Finding,Q&A Draw your answer from the below context block.,I am having trouble understanding the text; please summarize it so that people who are unfamiliar with nanomaterials can understand and learn about them.,"Aim of Work Nanomaterials (nanocrystalline materials) are substances possessing grain sizes on the order of a billionth of a meter. They manifest extraordinarily charming and beneficial properties, which can be exploited for a ramification of structural and nonstructural packages. Seeing that Nanomaterials own unique, beneficial chemical, bodily, and mechanical houses, they may be use for an extensive form of programs, like next era laptop chips, kinetic power (KE) penetrators with more advantageous lethality, better insulation materials, Phosphors for excessive-Defination TV, Low cost Flat-Panel displays, more and more difficult cutting tools, elimination of pollution, excessive strength density, Batteries, excessive power magnets, high sensitive sensors, motors with greater gas efficiency, Aerospace addititives with superior performance characteristics, higher and density weapons platforms, Longer-Lasting Satellites. Longer-Lasting medical implants, Ductile, Machinable ceramics, huge electro chromic show devices. Nanotechnology has the potential to be the key to a brand new world in the field of construction and building materials. Although replication of natural systems is one of the most promising areas of this technology, scientists are still trying to grasp their astonishing complexities. Furthermore, a nanotechnology is a rapidly expanding area of research where novel properties of materials manufactured on nanoscale can be utilized for the benefit of construction infrastructure, Therefore, the main objective of preparing this study is the importance of nanomaterials and their use in many modern industries due to their mechanical, electrical and chemical properties and for the purpose of identifying the most important methods of preparation, detection methods, types and applications of each type. Abstract Nanomaterials (NMs) are gaining significance in technological applications due to their tunable chemical, physical, and mechanical properties and enhanced performance when compared with their bulkier counterparts. This study presents a summary of the general types of NMs and provides an overview of the various synthesis methods of nanoparticles (NPs) and their functionalization via covalent or noncovalent interactions using different methods. It highlights the techniques used for the characterization of NPs and discusses their physical and chemical properties. Due to their unique properties, NMs have several applications and have become part of our daily lives. As a result, research is gaining attention since some NPs are not easily degraded by the environment. Thus, this study also highlights research efforts into the fate, behavior, of different classes of (NMs) in the environment. General Introduction Nanotechnology is an interdisciplinary study which allows us to develop new materials with new, interesting and useful properties. These new materials are nanomaterials made from nanoparticles. Nanoparticles are ultra-small particles with exceptional properties which can direct medicines straight to the place where the human body needs them, they can make materials stronger and they can convert solar energy more efficiently. Nanoparticles possess different properties and behave differently to the classical, larger building blocks of substances. From a scientific point of view, these interesting new properties are not so much the results from the fact that nanoparticles are small, but they result from the fact that a particle consisting of a relatively limited number of molecules behaves and interacts differently with its surroundings for fundamental physical reasons. Nanoparticles and nanomaterials have gained prominence in technological advancements due to their adjustable physicochemical characteristics such as melting point, wettability, electrical and thermal conductivity, catalytic activity, light absorption and scattering resulting in enhanced performance over their bulk counterparts. By controlling the shape, size and internal order of the nanostructures, properties (electrical conductivity, colour, chemical reactivity, elasticity, etc.) can be modified. Some nanomaterials occur naturally, but of particular interest are engineered nanomaterials (EN), which are designed for, and already being used in many commercial products and processes. They can be found in such things as sunscreens, cosmetics, sporting goods, stainresistant clothing, tires, electronics, as well as many other everyday items, and are used in medicine for purposes of diagnosis, imaging and drug delivery. Engineered nanomaterials are resources designed at the molecular (nanometre) level to take advantage of their small size and novel properties which are generally not seen in their conventional, bulk counterparts. The two main reasons why materials at the nano scale can have different properties are increased relative surface area and new quantum effects. Nanomaterials have a much greater surface area to volume ratio than their conventional forms, which can lead to greater chemical reactivity and affect their strength. Also at the nano scale, quantum effects can become much more important in determining the materials properties and characteristics, leading to novel optical, electrical and magnetic behaviors. 1.1 Definition of Nanomaterials Nanoscale materials are defined as a set of substances where at least one dimension is less than approximately 100 nanometers. A nanometer is one millionth of a millimeter - approximately 100,000 times smaller than the diameter of a human hair. Nanomaterials are of interest because at this scale unique optical, magnetic, electrical, and other properties emerge. These emergent properties have the potential for great impacts in electronics, medicine, and other fields [1] . 1.2 History of Nanomaterials Nanotechnology involves the synthesis and application of materials in dimensions of the order of a billionth of a meter (1x10-9). This categorizes them under ultrafine particles. (Figure 1.1) reveals the size comparison of the nanoparticles against different living and nonliving species [2]. The properties of nanoparticles vary from their bulk counterpart and their chemistry [2]. The electronic structure, reactivity, and thermal and mechanical properties tend to change when the particles reach the nanoscale. Through nanotechnology, we can build materials and devices with control down to the level of individual atoms and molecules. In the past two decades, there were reports of colloids and nanoparticles designed by nature [3, 4]. The history of nanomaterials began immediately after the big bang when Nanostructures were formed in the early meteorites. Nature later evolved many other Nanostructures like seashells, skeletons etc. Nanoscaled smoke particles were formed during the use of fire by early humans. The scientific story of nanomaterials however began much later. One of the first scientific report is the colloidal gold particles synthesized by Michael Faraday as early as 1857. Nanostructured catalysts have also been investigated for over 70 years. By the early 1940’s, precipitated and fumed silica nanoparticles were being manufactured and sold in USA and Germany as substitutes for ultrafine carbon black for rubber reinforcements [1]. Over the past few years, nanomaterials (NMs) have attracted the researchers because of their nanosize, physical, biological, and chemical properties compared to their bulk materials. These NMs are classified based on their size, chemical composition, shape, and sources. Different types of NMs have been synthetized from different sources and they are being classified accordingly. Many NMs have been produced in large quantities based on the requirements for many industrial applications. The two main sources through which NMs are being produced are synthetic source and naturally occurring nanoparticles (NPs). In this chapter, we discuss the types and classifications of NMs and broadly discuss the different types of nanomaterials isolated from natural and synthetic sources [5]. 1.3 Main differences between nanomaterials and bulk materials Nanomaterials are particles that have their size in 1-100 nm range at least in one dimension. We cannot see their particles through the naked eye. Moreover, examples of these materials include nanozymes, titanium dioxide nanoparticles, graphene, etc. Bulk materials are particles that have their size above 100 nm in all dimensions. We can see their particles through the naked eye. The examples of these materials include plaster, sand, gravel, cement, ore, slag, salts, etc. ","System Instructions: Draw your answer from the below context block. Question: I am having trouble understanding the text; please summarize it so that people who are unfamiliar with nanomaterials can understand and learn about them. Context Block: Aim of Work Nanomaterials (nanocrystalline materials) are substances possessing grain sizes on the order of a billionth of a meter. They manifest extraordinarily charming and beneficial properties, which can be exploited for a ramification of structural and nonstructural packages. Seeing that Nanomaterials own unique, beneficial chemical, bodily, and mechanical houses, they may be use for an extensive form of programs, like next era laptop chips, kinetic power (KE) penetrators with more advantageous lethality, better insulation materials, Phosphors for excessive-Defination TV, Low cost Flat-Panel displays, more and more difficult cutting tools, elimination of pollution, excessive strength density, Batteries, excessive power magnets, high sensitive sensors, motors with greater gas efficiency, Aerospace addititives with superior performance characteristics, higher and density weapons platforms, Longer-Lasting Satellites. Longer-Lasting medical implants, Ductile, Machinable ceramics, huge electro chromic show devices. Nanotechnology has the potential to be the key to a brand new world in the field of construction and building materials. Although replication of natural systems is one of the most promising areas of this technology, scientists are still trying to grasp their astonishing complexities. Furthermore, a nanotechnology is a rapidly expanding area of research where novel properties of materials manufactured on nanoscale can be utilized for the benefit of construction infrastructure, Therefore, the main objective of preparing this study is the importance of nanomaterials and their use in many modern industries due to their mechanical, electrical and chemical properties and for the purpose of identifying the most important methods of preparation, detection methods, types and applications of each type. Abstract Nanomaterials (NMs) are gaining significance in technological applications due to their tunable chemical, physical, and mechanical properties and enhanced performance when compared with their bulkier counterparts. This study presents a summary of the general types of NMs and provides an overview of the various synthesis methods of nanoparticles (NPs) and their functionalization via covalent or noncovalent interactions using different methods. It highlights the techniques used for the characterization of NPs and discusses their physical and chemical properties. Due to their unique properties, NMs have several applications and have become part of our daily lives. As a result, research is gaining attention since some NPs are not easily degraded by the environment. Thus, this study also highlights research efforts into the fate, behavior, of different classes of (NMs) in the environment. General Introduction Nanotechnology is an interdisciplinary study which allows us to develop new materials with new, interesting and useful properties. These new materials are nanomaterials made from nanoparticles. Nanoparticles are ultra-small particles with exceptional properties which can direct medicines straight to the place where the human body needs them, they can make materials stronger and they can convert solar energy more efficiently. Nanoparticles possess different properties and behave differently to the classical, larger building blocks of substances. From a scientific point of view, these interesting new properties are not so much the results from the fact that nanoparticles are small, but they result from the fact that a particle consisting of a relatively limited number of molecules behaves and interacts differently with its surroundings for fundamental physical reasons. Nanoparticles and nanomaterials have gained prominence in technological advancements due to their adjustable physicochemical characteristics such as melting point, wettability, electrical and thermal conductivity, catalytic activity, light absorption and scattering resulting in enhanced performance over their bulk counterparts. By controlling the shape, size and internal order of the nanostructures, properties (electrical conductivity, colour, chemical reactivity, elasticity, etc.) can be modified. Some nanomaterials occur naturally, but of particular interest are engineered nanomaterials (EN), which are designed for, and already being used in many commercial products and processes. They can be found in such things as sunscreens, cosmetics, sporting goods, stainresistant clothing, tires, electronics, as well as many other everyday items, and are used in medicine for purposes of diagnosis, imaging and drug delivery. Engineered nanomaterials are resources designed at the molecular (nanometre) level to take advantage of their small size and novel properties which are generally not seen in their conventional, bulk counterparts. The two main reasons why materials at the nano scale can have different properties are increased relative surface area and new quantum effects. Nanomaterials have a much greater surface area to volume ratio than their conventional forms, which can lead to greater chemical reactivity and affect their strength. Also at the nano scale, quantum effects can become much more important in determining the materials properties and characteristics, leading to novel optical, electrical and magnetic behaviors. 1.1 Definition of Nanomaterials Nanoscale materials are defined as a set of substances where at least one dimension is less than approximately 100 nanometers. A nanometer is one millionth of a millimeter - approximately 100,000 times smaller than the diameter of a human hair. Nanomaterials are of interest because at this scale unique optical, magnetic, electrical, and other properties emerge. These emergent properties have the potential for great impacts in electronics, medicine, and other fields [1] . 1.2 History of Nanomaterials Nanotechnology involves the synthesis and application of materials in dimensions of the order of a billionth of a meter (1x10-9). This categorizes them under ultrafine particles. (Figure 1.1) reveals the size comparison of the nanoparticles against different living and nonliving species [2]. The properties of nanoparticles vary from their bulk counterpart and their chemistry [2]. The electronic structure, reactivity, and thermal and mechanical properties tend to change when the particles reach the nanoscale. Through nanotechnology, we can build materials and devices with control down to the level of individual atoms and molecules. In the past two decades, there were reports of colloids and nanoparticles designed by nature [3, 4]. The history of nanomaterials began immediately after the big bang when Nanostructures were formed in the early meteorites. Nature later evolved many other Nanostructures like seashells, skeletons etc. Nanoscaled smoke particles were formed during the use of fire by early humans. The scientific story of nanomaterials however began much later. One of the first scientific report is the colloidal gold particles synthesized by Michael Faraday as early as 1857. Nanostructured catalysts have also been investigated for over 70 years. By the early 1940’s, precipitated and fumed silica nanoparticles were being manufactured and sold in USA and Germany as substitutes for ultrafine carbon black for rubber reinforcements [1]. Over the past few years, nanomaterials (NMs) have attracted the researchers because of their nanosize, physical, biological, and chemical properties compared to their bulk materials. These NMs are classified based on their size, chemical composition, shape, and sources. Different types of NMs have been synthetized from different sources and they are being classified accordingly. Many NMs have been produced in large quantities based on the requirements for many industrial applications. The two main sources through which NMs are being produced are synthetic source and naturally occurring nanoparticles (NPs). In this chapter, we discuss the types and classifications of NMs and broadly discuss the different types of nanomaterials isolated from natural and synthetic sources [5]. 1.3 Main differences between nanomaterials and bulk materials Nanomaterials are particles that have their size in 1-100 nm range at least in one dimension. We cannot see their particles through the naked eye. Moreover, examples of these materials include nanozymes, titanium dioxide nanoparticles, graphene, etc. Bulk materials are particles that have their size above 100 nm in all dimensions. We can see their particles through the naked eye. The examples of these materials include plaster, sand, gravel, cement, ore, slag, salts, etc. ",Internet/Technology,Summarize & Simplify,Text Transformation Answer only using information from the provided text. You are not allowed to use any external resources or prior knowledge. Limit the response to 200 words.,Explain the gender unique challenges of women with autism.,"Individuals with Autism Spectrum Disorder (ASD) face an assortment of social, emotional, and mental challenges. Typically, individuals with ASD have different and unexpected communication styles, difficulty recognizing others’ social cues, discomfort when making eye contact, delayed speech and unusual speech styles, and a preference for narrow or extreme groups of interests (Lai, Lombardo, Baron-Cohen, & Simon, 2014). Notable strengths can include an ability to focus on details, a perseverance for completing tasks, and an aptitude in following rules or instructions. While little is understood about the origins of autism, there is evidence to suggest atypical brain development and organization that may be related to genetic and environmental factors (Chaste & Leboyer, 2012). The U.S. Centers for Disease Control and Prevention (2018) reported that in 2014 one out of every fifty-nine individuals was identified with ASD, in contrast to the 1:150 ratio in the year 2000. More recently, research has revealed an even higher uptick, reflecting occurrences as high as one in 40 individuals having ASD (Kogan et al., 2018). Since 2006, when ASD screening became recommended, the familiarity and acceptance of the disorder has grown, leading to a spike in diagnoses in recent years (Wright, 2017). Although ASD has numerous subtypes, many studies depict how females with ASD are characteristically different than their male counterparts across the spectrum. Females with ASD have not only demonstrated a different set of mannerisms, but also face a variety of unique challenges. Females are often under-recognized on the spectrum and are three to four times less likely to be diagnosed with autism than males (Loomes et al., 2017). Males, on the other hand, not only dominate the autism spectrum in numbers, but also in the amount of research done on ASD. This brings into question whether males are more likely to develop ASD or if there is a diagnostic gender bias causing females to be underdiagnosed (Gould & Ashton-Smith, 2011). In this paper, I will evaluate the literature that examines the specific, gender-unique challenges that females with ASD experience. I will be discussing the underdiagnosis of females with ASD, the higher risk of sexual abuse for females with ASD, and the frequent development of secondary mental health concerns in females with ASD. Females with Autism are Underdiagnosed Females with ASD often go undiagnosed or receive a late diagnosis (Mandic-Maravic et al., 2015). An accurate and early diagnosis for individuals with ASD is essential to optimize their social and emotional development (Milner, McIntosh, Colvert, & Happé, 2019). Baldwin and Costley (2016) found that females who did not receive a diagnosis until the age of 18 or older were far more likely to struggle later in life because of the lack of necessary assistance and treatment they could have received in their adolescent years. In this section, I will discuss two common explanations as to why females may be underdiagnosed: camouflaging and differences in presentation than males. Camouflaging Females with ASD are able to camouflage their autistic traits better than males with ASD (Lai et al. 2011). Camouflaging is defined as presenting and behaving oneself as neurotypical in order to fit into society (Milner et al., 2019; Schuck, Flores, & Fung, 2019). Mimicking behaviors, communicating nonverbally, reducing strange behaviors around others, and preparing small talk or “scripts” beforehand are ways females attempt to camouflage (Hull et al., 2017). In one study, women and girls reported to successfully hide their autistic traits by learning stock phrases or studying the appropriate amount of time they needed to maintain eye contact in order to appear normal in conversation (Lai et al., 2019). In another study, some females with autism reported that they camouflage in order to connect with friends, go on dates, get out of the spotlight, get a job, or simply be seen as neurotypical (Hull et al., 2017). Researchers presented a questionnaire to individuals with ASD and found that 89.2% of males with ASD and 90.9% of females with ASD attempt to camouflage their autism in order to fit in (Cassidy, Bradley, Shaw, & Baron-Cohen, 2018). Though both females and males try to hide autistic traits, females attained much higher scores, indicating that they are more adept at camouflaging and do so in more situations than males (Lai et al., 2011). Differences in presentation from males Autistic traits manifest differently between males and females with ASD, which subsequently causes false negative results in females being evaluated ","System instruction: Answer only using information from the provided text. You are not allowed to use any external resources or prior knowledge. Limit the response to 200 words. Context: Individuals with Autism Spectrum Disorder (ASD) face an assortment of social, emotional, and mental challenges. Typically, individuals with ASD have different and unexpected communication styles, difficulty recognizing others’ social cues, discomfort when making eye contact, delayed speech and unusual speech styles, and a preference for narrow or extreme groups of interests (Lai, Lombardo, Baron-Cohen, & Simon, 2014). Notable strengths can include an ability to focus on details, a perseverance for completing tasks, and an aptitude in following rules or instructions. While little is understood about the origins of autism, there is evidence to suggest atypical brain development and organization that may be related to genetic and environmental factors (Chaste & Leboyer, 2012). The U.S. Centers for Disease Control and Prevention (2018) reported that in 2014 one out of every fifty-nine individuals was identified with ASD, in contrast to the 1:150 ratio in the year 2000. More recently, research has revealed an even higher uptick, reflecting occurrences as high as one in 40 individuals having ASD (Kogan et al., 2018). Since 2006, when ASD screening became recommended, the familiarity and acceptance of the disorder has grown, leading to a spike in diagnoses in recent years (Wright, 2017). Although ASD has numerous subtypes, many studies depict how females with ASD are characteristically different than their male counterparts across the spectrum. Females with ASD have not only demonstrated a different set of mannerisms, but also face a variety of unique challenges. Females are often under-recognized on the spectrum and are three to four times less likely to be diagnosed with autism than males (Loomes et al., 2017). Males, on the other hand, not only dominate the autism spectrum in numbers, but also in the amount of research done on ASD. This brings into question whether males are more likely to develop ASD or if there is a diagnostic gender bias causing females to be underdiagnosed (Gould & Ashton-Smith, 2011). In this paper, I will evaluate the literature that examines the specific, gender-unique challenges that females with ASD experience. I will be discussing the underdiagnosis of females with ASD, the higher risk of sexual abuse for females with ASD, and the frequent development of secondary mental health concerns in females with ASD. Females with Autism are Underdiagnosed Females with ASD often go undiagnosed or receive a late diagnosis (Mandic-Maravic et al., 2015). An accurate and early diagnosis for individuals with ASD is essential to optimize their social and emotional development (Milner, McIntosh, Colvert, & Happé, 2019). Baldwin and Costley (2016) found that females who did not receive a diagnosis until the age of 18 or older were far more likely to struggle later in life because of the lack of necessary assistance and treatment they could have received in their adolescent years. In this section, I will discuss two common explanations as to why females may be underdiagnosed: camouflaging and differences in presentation than males. Camouflaging Females with ASD are able to camouflage their autistic traits better than males with ASD (Lai et al. 2011). Camouflaging is defined as presenting and behaving oneself as neurotypical in order to fit into society (Milner et al., 2019; Schuck, Flores, & Fung, 2019). Mimicking behaviors, communicating nonverbally, reducing strange behaviors around others, and preparing small talk or “scripts” beforehand are ways females attempt to camouflage (Hull et al., 2017). In one study, women and girls reported to successfully hide their autistic traits by learning stock phrases or studying the appropriate amount of time they needed to maintain eye contact in order to appear normal in conversation (Lai et al., 2019). In another study, some females with autism reported that they camouflage in order to connect with friends, go on dates, get out of the spotlight, get a job, or simply be seen as neurotypical (Hull et al., 2017). Researchers presented a questionnaire to individuals with ASD and found that 89.2% of males with ASD and 90.9% of females with ASD attempt to camouflage their autism in order to fit in (Cassidy, Bradley, Shaw, & Baron-Cohen, 2018). Though both females and males try to hide autistic traits, females attained much higher scores, indicating that they are more adept at camouflaging and do so in more situations than males (Lai et al., 2011). Differences in presentation from males Autistic traits manifest differently between males and females with ASD, which subsequently causes false negative results in females being evaluated Question: Explain the gender unique challenges of women with autism.",Medical,Fact Finding,Q&A Use only the details found in the text above to inform your answer.,Which composers are credited with creating and expanding the framework for aleatory composition in its early days? ,"8 In section 4 we discussed various tendencies that began to emerge during and after the phase of punctual music. Around 1956 these became much clearer and enabled composers to draw certain conclusions. 1. The statistical approach to music came to the foreground. The primary consideration became the ordering of higher categories of form rather than the organisation of detail. This was already indicated by use of the term 'group' to refer to what is really the smallest unit, characterised by the detailed effect of pitch, duration, timbre, etc.; within the group, however, a certain freedom was possible without encroaching on the characteristic of the group. This freedom was also evident in an easier use of interval proportions than was ever conceivable in classical dodecaphony. It was no longer a question of 'this and this' or 'so and so many notes, but of a certain degree of density. Density, register, direction of movement, degree of periodicity and many other concepts emerged as aspects of music that could be ordered serially. Attention to elements of detail made way for a more global determination, and thus for the concept of form. 2. In this process the series became increasingly neutral, functioning more and more as a regulatory factor. Proportions became decisive: a 3rd from a pitch series is a 5/4 proportion that can be manifest in any other musical ele- ment. In so far as pitch series were still employed, they likewise had a neutral character and were naturally no longer bound to the twelve notes. The series in Gruppen still had twelve notes, and indeed a pronounced shape of its own, presumably to attain large proportional contrasts in the macrofield. The Klavierstücke I-IV however, dating from 1954, retained only the rudiments of the 12-note series. In the second and third pieces, respectively, they are as fol- lows: Nono's Il Canto sospeso (1956) was based on the all-interval series shown in Example 109. Something similiar occurred in Messiaen's Livre d'Orgue (see Example 16). 3. The outstanding scholar Györgi Ligeti, who has already been mentioned, introduced the concept of interval permeability. In section 4 we have already observed how the interval, and indeed other musical elements too, lost its own existence by being taken up in higher, statistically determinable quanti- ties.4 This desensitisation evoked new problems and new possibilities. The music became manifest in layers, no longer characterised by the detail but by a global 'material state' (rough, granular, smooth, etc.). Such layers could be combined, and exact synchronisation was obviously no longer relevant. Indeed, exactness acquired a certain margin: synchronism was not essential, but rather the spatial distribution of 'material states'. Something of the sort had already been achieved by Messiaen, among others, with his modality, in which a certain indifferentiation likewise arose in terms of sequence of notes and intervals. In serial music composers went further: different tempos were combinable, and the new concept of field magnitude emerged, heralding another important phase in new music that is usually described as aleatory composition. 9 This did not appear out of thin air. Directly after the rigorously punctual style of the Structures, Boulez reacted with his Marteau sans Maître, completed in 1954, in which the tempo in particular fluctuates through the many changes, directions such as 'tempo et nuances très instables', etc. The work breathes a freedom and suppleness that reminds one immediately of Debussy. The many short notes, separate or clustered, and the irrational values create a sort of written-out rubato (see Example 35). This differentiation, which was also manifest, though somewhat differently, in Stockhausen's work of the same period, moved the latter to express the following thoughts (freely cited): 'An inaccuracy factor arises in performance. The areas within which this factor is manifest are time fields, and their dimensions are field magnitudes. In the past too this margin existed in performance, but was coincidental. Now we wish to capture these inaccuracies functionally. A series of field magnitudes, rather than a traditional series of fixated durations, can now be determinant.' This meant the abandonment of our quantitative system of fixed-value notation and the creation of a way of indicating the boundaries within which indeterminacy may occur, something that could be done in many ways. In Example 67 Boulez used the sign to indicate the boundaries within which a number of short notes may be freely placed. Stockhausen developed a different method to indicate action duration, based on the principle that note duration is no longer counted, but determined during performance by means of a particular action prescribed by the composer. Thus, the time between two notes, for instance, may depend on that required by the player to move his hand, on the degree of complexity of a given touch or pedal movement, or on breathing considerations, etc. Once again, such physiolog- ical reactions had always existed; but Stockhausen wished to incorporate them functionally in his music. Although it sounds paradoxical, all this revealed a desire to control musical elements that cannot be accurately com- mitted to paper. It is clear, therefore, that it was not a question of the absolute values of these elements, but of their mutual relationships. The rapidity of these innovations was remarkable. While the correspon- dence between macro- and micro-areas discussed in the previous sections was still hardly formulated, new territory was being explored. And each discovery required years of elaboration! Perhaps it was this hurried course of events that caused problems in Stockhausen's first composition in this field. Let us take a closer look at the Klavierstück XI of 1957. Nineteen groups are written down on a large piece of paper, all of very dif- ferent length and without any suggestion of sequence; some are illustrated in Example 110. According to the composer each group is in itself the result of serial ordering, based on different series to organise field magnitude propor- tions. We must take his word for it, since we have arrived at a situation in which serial manipulation can no longer be reconstructed without the help of the composer. Some groups include the familiar notes in small print that are to be played as fast as possible'. Action duration is taken into account, for the composer says that 'difficult chords and large leaps with one hand obviously require more time than simple chords and smaller intervals'. Although the notes in normal print have the customary quantitive notation of duration, an unexpected element is to play a role. Stockhausen prescribes the following: the performer is to glance unintentionally at the page and play the first group that catches his eye, in the tempo, dynamics and touch of his choice. The lat- ter, however, are classified by the composer beforehand: there are six tempos, for instance, ranging from tempo I, very fast, to tempo 6, very slow. Subsequently, the player's eye is caught unintentionally (without any attempt to connect particular groups) by another group which he now plays in accor- dance with directions given at the end of the previous group. Each group can be connected to any of the other eighteen, and all nineteen groups can there- fore be performed in the prescribed degrees of tempo, dynamics and touch. The characteristics of all groups are therefore variable within the chosen boundaries. The field magnitude of a following group is determined by indi- cations at the end of the preceding one. A performance does not necessarily include all the groups. If a group is repeated, indications are given for small modifications in the second render- ing, usually in the form of somewhat elementary octave transpositions. If a group occurs for a third time, it also brings one of the possible realisations of the whole piece to an end. The work is an example of open form, without direction or termination. The groups are spatially juxtaposed and can be com- bined in countless ways. In the many commentaries on this composition two aspects have been neglected or confused. 1. The action duration - a decidedly positive element. Instead of ‘counting' with a margin of inaccuracy, a spontaneous reaction arises, a realisation of the time structure at the moment of the action itself. Such music can therefore no longer be approached from the score, since the time structure is now deter- mined by the perception time of the performer himself, which is inseparable from physical reactions and abilities. Such freedom is therefore ostensible. Nothing is added to an existing structure (unlike jazz or basso continuo tech- nique); on the contrary, the player remains entirely bound to the composer's directions, but he becomes involved right down to his physical reactions. Notice that this action duration takes place within the boundaries of each group. The mutual bond between the groups is quite a different matter; it is created by means of what one could call: 2. the spontaneous decision. The player is required to glance 'unintention- ally' and to link the very first group that catches his eye with the preceding one. The word 'chance' crops up here and is indeed to stay with us, whether relevant or not. But it is not a question of chance, for the performer may choose from no more than the 18 options determined by the composer. All possibilities are already enclosed in the concept. At best there is mention of an unconsidered decision at the last moment - freedom, indeed, but a free- dom without sense. The actual time experience of the action duration is absent, as is the considered decision of the composition process. It is a free- dom that is only possible thanks to another concept of form, that of the open form without causality. These new concepts of form have already been dis- cussed at several points, especially in relation to the theory of musical space. In this light Stockhausen's Klavierstück XI is hardly new, but merely a confir- mation of a concept of form already found in Debussy. Stockhausen's step was to transfer choice from the composer to the per- former; instead of a single notated version, many realisations of a piece become feasible. - Boulez was the first to recognise the real problem of the Klavierstück XI. In the same period, but independently of Stockhausen, he worked on his Third Piano Sonata; at the same time he was confronted by the work of Mallarmé, whose literary preoccupations ran remarkably parallel despite the great dis- parity in time. In Boulez, too, the player gains a more important role, but this does nothing the composer believes - to change the problem of form. He felt the necessity to develop a new form that adapts to the material available to the serial composer, which was constantly becoming more elastic. But form to Boulez was something more than the mosaics of Stockhausen's music, which were really nothing other than constantly changing combinations from millions of options. If the performer was free to choose, then his choice should preferably be made after some consideration, and with only a very lim- ited number of possibilities that were precisely determined by the composer. An example is the overall structure of the Sonata (comprising five move- ments in the first concept): Antiphonie, Trope, Constellation, Strophe, Séquence. The sequence of the movements is free, providing that Constellation is always in the middle. The internal structure reflects the same approach. One of the movements, Trope, has four components: two so-called structures complexes (Parenthèse, Commentaire) and two structures simples (Glose, Texte). In the 'complex structures' the performer is again free to include or omit certain additional variants (given between brackets). The sequence of these components is indicated in an ingenious manner. The unnumbered pages of the score are in a ring binder, and the player may begin where he wishes. The sequence is therefore directed - we usually read from front to back - but not predetermined (Boulez speaks of a forme circu- laire). There are normally four options, therefore, depending on the starting point: - P, C, C, G, T G, T, P G, T, P C T, P, C, G But since the Commentaire section is included twice, four other possibilities become available, depending on where this section is placed (it may only be performed once); this can be represented as in Figure 7. Altogether eight dif- ferent sequences are therefore available; compared to the millions in Stockhausen, this illustrates just how much more control the composer has retained over the final outcome. The Trope from Boulez's Third Piano Sonata provided only a first and simple answer to the new problems of form. Although the composer already estab- lished new structural concepts, the territory as such was as yet hardly explored. This is particularly evident if we bear in mind that the free sequence of sections, which caused the most sensation in the beginning, was merely one aspect of the complex concept of form that awaited exploitation. However the case may be, through these preoccupations, form acquired unprecedented autonomy, despite the astonishing authority granted (for the time being) to the performer. This is already observed in the work of Mallarmé, who concentrated far more on the structure of language than on its significance, or, in other words, attempted to convert this significance into a symbolism of absolute value. Form had a life of its own, bringing the artist to an attitude of anonymity, since the intrusion of purely personal incidents was undesirable. Those with some knowledge of Asian culture will hardly be surprised by this. But in Europe relationships are different, and particularly for those less gifted than Boulez it is fitting to recall the words of Paul Valéry, a confidant of Mallarmé. Concerning the latter's ambitions he spoke later (in his Lettre sur Mallarme) of 'diviniser la chose écrite' (divining that which is written). But, he went on, 'ce n'est point l'œuvre faite et ses apparences ou ses effets dans le monde qui peuvent nous accomplir et nous édifier, mais seule- ment la manière dont nous l'avons faite (it is not the finished work and its appearances, or its effects on the world, which can fulfill and edify us, but only the manner in which we have accomplished it). IO The concept of aleatory music has now broadened considerably, and we must certainly mention one other composer under this heading. We have already examined two aspects: action duration and the sponta- neous decision in Stockhausen, and intervention possibilities in Boulez. In the latter the performer is like a driver who may choose from a limited num- ber of roads, while the road map itself remains the domain of the town plan- ner. Boulez described Stockhausen's solution as chance, while Stockhausen used the term gelenkter Zufall (guided chance); but as we have seen, in reali- ty the element of chance was less present than one might imagine. All this only made the problem of form most acute, and the composer who was to draw particularly radical conclusions was the American John Cage. Cage came to Europe in 1958 - I remember a momentous concert at the World Exhibition in Brussels - and was quick to cause the necessary stir. From his point of view our controversy between tonality and atonality was long out- dated. He believed that modern serialists kept far too much to traditional paths, exposing themselves to a constant risk of academicism. A number of similarities, however, can also be found. Like Boulez, Cage's music reveals a pursuit of objectivity, or rather anonymity, which helps the sound to 'come to itself'. But his conclusions were much more radical. Instead of trying to bind the notes, his school attempted to soak off their adhesive, formed as it was by centuries of convention. If one hangs on to the notes, if one has 'musical' ideas, one cannot allow the notes to be themselves. And 'being themselves' means that there is no superimposed expression. (Many modern composers would go along with him up to this point, and the much older Varèse, with his 'liberation of the sound', was even a precursor.) And it also means that there is no man-made organisation. Thus, Cage reached a conclusion diametrically opposed to our early serialists: not com- plete determination, but rather complete indetermination was essential. (One of the most shocking experiences of recent times is to discover that both points of departure lead to the same degree of indetermination.) In order to achieve this indetermination, Cage used to make particular use of chance actions such as the tossing of coins, etc. Other means may also be employed, such as the oracle of the staves from the ancient Chinese book I-Ching (which illustrates the influence of Zen Buddhism on this composer), or mathemati- cal methods. More recently, however, the accent has shifted towards the unforeseeable- ness of the performance itself, involving the actual performers. It is remark- able how completely different paths form striking parallels with modern European composers! Fifty years earlier Charles Ives, following quite a differ- ent line of thought, created the same sort of music as that of the young Schönberg and Stravinsky. Despite the shift towards live performance, a score was naturally still required as an instruction for the players. But the score must not be viewed as a ready-made, notated form. And this is where Cage differs: the composition is not an autonomous object, but a performance process. Obviously, this process has its boundaries - determined by the action of the players and by a number of characteristics - but essentially the music has no precedence above either note or noise. While it does have its own exis- tence, it remains 'transparent' in relation to its surroundings. Its boundaries become diffuse, and counting is not required, for we exist in time'. Stopwatches rather than bars serve to indicate when an occurrence of sound must take place within this time. Christian Wolff, a composer from the Cage group, replaced Stockhausen's eye ('unintentional glancing') with the ear: cer- tain occurrences of sound, caused by the one player, evoke reactions from the other (Duo for Pianists II). The outcome is determined by the performers themselves; finally, musical form may be conceived as 'the length of the pro- gramme'.7 Cage is among those Westerners who have listened to the Japanese bow- 8 man in chapter 6. Just how far his interpretation is correct, we will leave to the experts. Is this still music? Surely we see an influence on contemporary music that cannot be underestimated. Can everybody do the same? But not everybody does, is Cage's reply. Strong differences of opinion emerge. It is impossible to imagine the fascinating whirlpool of new developments with- out Cage. Whether the music comes from inside or outside, we cannot escape it. 'One day when the windows were open, Christian Wolff played one of his pieces at the piano. Sounds of traffic, boat horns, were heard not only during the silences in the music but, being louder, were more easily heard than the piano sounds themselves. Afterwards, someone asked Christian Wolff to play the piece again with the windows closed. Christian Wolff said he'd be glad to, but that it wasn't really necessary, since the sounds of the environment were in no sense an interruption of those of the music.' II The above discussion helps us to clarify the concept of aleatory music. It is a generic term for all aspects of music that are not predetermined. The rela- tionship between determined and undetermined elements plays a role in all types of music. The undetermined element brings unforeseeableness with it, and can occur both in performance and during the process of composition. Unforeseeableness can be manifest in differing degrees. In the perform- ance of a classical composition, for example, the degree to which the fixated notation can be deviated from is limited. Performance of a piece by John Cage, on the other hand, can involve a high degree of unforeseeableness. But even here general patterns of expectation can be formulated. Finally, with regard to developments in the music of the period 1950-60, the following aspects are of importance: more 1. In Cage's work the element of chance to use this dubious word once - was a means to obtain indetermination and to escape from the human grasp of the music. Young European composers, on the other hand, were con- cerned with gaining even stricter control of the musical material: even this indeterminable area of free choice was consciously incorporated in the of composition. process 2. Bearing in mind changing concepts of musical form, we can say that part of what once belonged to the individual and 'unique' work of art is now ascribed to the material employed by the performers. There is a certain incli- nation to make matters absolute, which corresponds logically to the excessive attention given to musical material that we have observed from 1950 onwards. 3. Expansionism, moreover, is not foreign to serial technique, in the sense that there is an inclination to exploit all the possibilities of the chosen mate- rial. The limited means of dodecaphony of the past have been extended to become an all-embracing permutation procedure; it soon became apparent, however, that this again was not sufficient to harness the wealth of resources that had been rallied. A written serial score realises only a few of the count- less possibilities, and the free choice of the performer can at least compensate this to a certain extent. The element of chance becomes a wider margin in the realisation of the (unforeseeable) permutation process. Far from coincidental is the attendant departure from the unique, once-and-for-all determined work of art. A remarkable dichotomy seems to arise between the realised con- dition of a single work of art and the 'possibly realisable' that is potentially present in the same. Here creative expansionism collides with ultimate boundaries. 4. The element of chance can serve to fill another gap. With all due respect for their sometimes brilliant ideas, one can nonetheless consider that both Stockhausen and Boulez have maintained an only too simple notion of the role of what they call 'surprise' in the musical process. The former wrote: ""The degree of information is therefore at its highest when at any point in a musi- cal discourse the moment of surprise is at its strongest: the music constantly has ""something to say"". (Just before this he specifies: 'Surprise only occurs when the unexpected happens.')"" Boulez shares this opinion: ""... for any music that is a masterpiece is a music that allows the capacity to surprise at any moment. This is not the place to contradict these ideas, but it is clear that from this point of view too, the involvement of the spontaneous decision of the per- former is most welcome: the 'surprise' within the boundaries of a work may increase, and the same goes for each subsequent performance. 5. Increasing differentiation posed considerable problems with regard to traditional notation, which was not at all equal to its task. By involving the performer, this difficulty was eased on the one hand, while on the other new symbols had to be introduced to indicate players' actions. It was inevitable that this issue also had to be tackled once more, as is described in section 14. 12 In the reaction against abstractions, serial music lost more and more influence after 1960. Boulez has remained a bastion of serial academicism, but Stockhausen has changed enormously. He is no longer the great renewer, but continues to react with great flexibility to any external stimulus that he encounters. He is long past the stage of solving problems of form and tech- nique. From Carré (1960) and Originale (1961) onwards his work comprises. ever more heterogeneous elements including happenings, pop, quotations, indeterminate sound production (contact microphones), etc. The use of contact microphones has now become very widespread, and this opens up a new direction in the application of electronic resources. In days past, electronic music was accurately recorded on tape in a studio. Many considered this an advantage: the composer exercised maximum control, while the inconstancies of live performance were eliminated. But this strict view could not be maintained, and in a next step (discussed in section 9) aleatory techniques were introduced, at first very cautiously among Europeans but after 1960 much more freely. Improvisation groups even appeared on stage working with electronic apparatus. The principle is simple: microphones attached to 'instruments' (that may or may not be recognisable as such) pick up vibrations that are normally neither audible nor usable and feed them to loudspeakers via amplifiers and possibly modulators. A new and hitherto unknown world of sound is brought to life. Unexpected surprises may occur too, and with them an immediate response from the performer. This was a typical feature of the post-1960 period. exper- Once again it was Cage who led the way with such experiments. More important, however, was his awareness of the situation. For in his first iments with chance phenomena he discovered that he was still attempting to drag 'successful' results out of chance actions. Realising later on that this atti- tude was equivocal, he came to accept the induced results of chance. The result was no longer important, but rather the attitude of open-mindedness. Thus, he came to distinguish between chance actions and indetermination. In the first case the composer employs chance as a means, but to a limited degree such that he remains within a self-determined global circle. Indetermination, on the contrary, exceeds this circle: the result is in every respect indefinite; such music crops up out of time, undefined and inciden- tal, only to disappear once more without a trace. All things are interrelated,' Cage said, and taken up in the stream of time. Any (human) pursuit of a stat- ed ""aim"" is a simplification, and a departure from reality.' The lessons of Cage were developed further by an American ‘second generation' around 1960. And once again the aesthetic consequences of the concept of indetermination were applied more radically than in Europe. In the work of La Monte Young, Terry Riley, Robert Ashley and the Fluxus Movement, almost all existing values and concepts relating to music were turned well and truly upside down. La Monte Young (1935) worked with long chains of chords that developed systematically. His material is economical, and naturally comprises all that is 'sound', including that produced by nature, machines, and electronic resources. Performances may last a week or more and incorporate other ele- ments such as light, movement and theatre. His contemporary Terry Riley followed the same course. His music consists of long chains of repeated motifs, usually in elementary diatonic note patterns. Tape loops and feedback systems provide the characteristic tone colours; electronic and instrumental resources merge. These and other Americans shared a broad interest in wide- ly different idioms including jazz, pop and non-Western music. Chance action - indetermination: many composers throughout the world now work within these borders. Only few are conscious of the background so brilliantly evoked by Cage in his writings. What is clear, however, is that serial concepts are disappearing; there is a growing reaction to their abstrac- tions and a tendency towards greater directness in music making. This is also expressed in the instrumental works of Berio, Ligeti, Kagel and others: music that is tailor-made for certain specialists, musicians who are required to make a creative contribution of their own rather than only faithfully reproduce a more or less authoritarian score. Such music renounces serial, abstractly deter- mined sound differentiation in favour of a more direct form of expression. Not only the actual notes, but sighs, scratches, shouts and moans become part of music making. The instrument literally becomes an extension of the human body. Similar tendencies are found in music theatre. This rather vague term embodies so much variety that a comprehensive definition can hardly be given. In general, it can be viewed as a reaction to traditional theatrical and operatic forms, which have caused the nineteenth century to live on, leaving current issues to the realm of film. The 'raree show' idea has also been aban- doned, since divisions between audience and stage, between different partic- ipating disciplines, required abolition. Various directions emerged, from the political engagement of Nono (Intolleranza, 1960) to the more light-hearted or autonomous approach of Kagel (Sur Scène, 1960) and Ligeti (Aventures, 1962). Nono connected with traditional opera, while Ligeti created a 'com- position with scenic, verbal and musical means'. Unlike the traditional Gesamtkunstwerk there is a tendency to grant the incorporated elements a life of their own, independent of one another and only joined by a common peri- od of time. Once again, vocal and instrumental techniques are extended to such a degree that the two flow together. All such innovations amount to repeated attempts to break through exist- ing boundaries! From the beginning of the twentieth century, the failure of instrument making to keep pace with musical developments made itself increasingly felt. Factories were usually highly industrialised, geared to the mass production of traditional instruments and leaving no room for altruis- tic research in an artistic sense. Today's composer must still make do with instruments developed hundreds of years ago: thus the continual expansion of playing techniques towards the boundaries of human endeavour; thus the contact microphones; and thus the ongoing specialisation of the few players devoted exclusively to new music. ","8 In section 4 we discussed various tendencies that began to emerge during and after the phase of punctual music. Around 1956 these became much clearer and enabled composers to draw certain conclusions. 1. The statistical approach to music came to the foreground. The primary consideration became the ordering of higher categories of form rather than the organisation of detail. This was already indicated by use of the term 'group' to refer to what is really the smallest unit, characterised by the detailed effect of pitch, duration, timbre, etc.; within the group, however, a certain freedom was possible without encroaching on the characteristic of the group. This freedom was also evident in an easier use of interval proportions than was ever conceivable in classical dodecaphony. It was no longer a question of 'this and this' or 'so and so many notes, but of a certain degree of density. Density, register, direction of movement, degree of periodicity and many other concepts emerged as aspects of music that could be ordered serially. Attention to elements of detail made way for a more global determination, and thus for the concept of form. 2. In this process the series became increasingly neutral, functioning more and more as a regulatory factor. Proportions became decisive: a 3rd from a pitch series is a 5/4 proportion that can be manifest in any other musical ele- ment. In so far as pitch series were still employed, they likewise had a neutral character and were naturally no longer bound to the twelve notes. The series in Gruppen still had twelve notes, and indeed a pronounced shape of its own, presumably to attain large proportional contrasts in the macrofield. The Klavierstücke I-IV however, dating from 1954, retained only the rudiments of the 12-note series. In the second and third pieces, respectively, they are as fol- lows: Nono's Il Canto sospeso (1956) was based on the all-interval series shown in Example 109. Something similiar occurred in Messiaen's Livre d'Orgue (see Example 16). 3. The outstanding scholar Györgi Ligeti, who has already been mentioned, introduced the concept of interval permeability. In section 4 we have already observed how the interval, and indeed other musical elements too, lost its own existence by being taken up in higher, statistically determinable quanti- ties.4 This desensitisation evoked new problems and new possibilities. The music became manifest in layers, no longer characterised by the detail but by a global 'material state' (rough, granular, smooth, etc.). Such layers could be combined, and exact synchronisation was obviously no longer relevant. Indeed, exactness acquired a certain margin: synchronism was not essential, but rather the spatial distribution of 'material states'. Something of the sort had already been achieved by Messiaen, among others, with his modality, in which a certain indifferentiation likewise arose in terms of sequence of notes and intervals. In serial music composers went further: different tempos were combinable, and the new concept of field magnitude emerged, heralding another important phase in new music that is usually described as aleatory composition. 9 This did not appear out of thin air. Directly after the rigorously punctual style of the Structures, Boulez reacted with his Marteau sans Maître, completed in 1954, in which the tempo in particular fluctuates through the many changes, directions such as 'tempo et nuances très instables', etc. The work breathes a freedom and suppleness that reminds one immediately of Debussy. The many short notes, separate or clustered, and the irrational values create a sort of written-out rubato (see Example 35). This differentiation, which was also manifest, though somewhat differently, in Stockhausen's work of the same period, moved the latter to express the following thoughts (freely cited): 'An inaccuracy factor arises in performance. The areas within which this factor is manifest are time fields, and their dimensions are field magnitudes. In the past too this margin existed in performance, but was coincidental. Now we wish to capture these inaccuracies functionally. A series of field magnitudes, rather than a traditional series of fixated durations, can now be determinant.' This meant the abandonment of our quantitative system of fixed-value notation and the creation of a way of indicating the boundaries within which indeterminacy may occur, something that could be done in many ways. In Example 67 Boulez used the sign to indicate the boundaries within which a number of short notes may be freely placed. Stockhausen developed a different method to indicate action duration, based on the principle that note duration is no longer counted, but determined during performance by means of a particular action prescribed by the composer. Thus, the time between two notes, for instance, may depend on that required by the player to move his hand, on the degree of complexity of a given touch or pedal movement, or on breathing considerations, etc. Once again, such physiolog- ical reactions had always existed; but Stockhausen wished to incorporate them functionally in his music. Although it sounds paradoxical, all this revealed a desire to control musical elements that cannot be accurately com- mitted to paper. It is clear, therefore, that it was not a question of the absolute values of these elements, but of their mutual relationships. The rapidity of these innovations was remarkable. While the correspon- dence between macro- and micro-areas discussed in the previous sections was still hardly formulated, new territory was being explored. And each discovery required years of elaboration! Perhaps it was this hurried course of events that caused problems in Stockhausen's first composition in this field. Let us take a closer look at the Klavierstück XI of 1957. Nineteen groups are written down on a large piece of paper, all of very dif- ferent length and without any suggestion of sequence; some are illustrated in Example 110. According to the composer each group is in itself the result of serial ordering, based on different series to organise field magnitude propor- tions. We must take his word for it, since we have arrived at a situation in which serial manipulation can no longer be reconstructed without the help of the composer. Some groups include the familiar notes in small print that are to be played as fast as possible'. Action duration is taken into account, for the composer says that 'difficult chords and large leaps with one hand obviously require more time than simple chords and smaller intervals'. Although the notes in normal print have the customary quantitive notation of duration, an unexpected element is to play a role. Stockhausen prescribes the following: the performer is to glance unintentionally at the page and play the first group that catches his eye, in the tempo, dynamics and touch of his choice. The lat- ter, however, are classified by the composer beforehand: there are six tempos, for instance, ranging from tempo I, very fast, to tempo 6, very slow. Subsequently, the player's eye is caught unintentionally (without any attempt to connect particular groups) by another group which he now plays in accor- dance with directions given at the end of the previous group. Each group can be connected to any of the other eighteen, and all nineteen groups can there- fore be performed in the prescribed degrees of tempo, dynamics and touch. The characteristics of all groups are therefore variable within the chosen boundaries. The field magnitude of a following group is determined by indi- cations at the end of the preceding one. A performance does not necessarily include all the groups. If a group is repeated, indications are given for small modifications in the second render- ing, usually in the form of somewhat elementary octave transpositions. If a group occurs for a third time, it also brings one of the possible realisations of the whole piece to an end. The work is an example of open form, without direction or termination. The groups are spatially juxtaposed and can be com- bined in countless ways. In the many commentaries on this composition two aspects have been neglected or confused. 1. The action duration - a decidedly positive element. Instead of ‘counting' with a margin of inaccuracy, a spontaneous reaction arises, a realisation of the time structure at the moment of the action itself. Such music can therefore no longer be approached from the score, since the time structure is now deter- mined by the perception time of the performer himself, which is inseparable from physical reactions and abilities. Such freedom is therefore ostensible. Nothing is added to an existing structure (unlike jazz or basso continuo tech- nique); on the contrary, the player remains entirely bound to the composer's directions, but he becomes involved right down to his physical reactions. Notice that this action duration takes place within the boundaries of each group. The mutual bond between the groups is quite a different matter; it is created by means of what one could call: 2. the spontaneous decision. The player is required to glance 'unintention- ally' and to link the very first group that catches his eye with the preceding one. The word 'chance' crops up here and is indeed to stay with us, whether relevant or not. But it is not a question of chance, for the performer may choose from no more than the 18 options determined by the composer. All possibilities are already enclosed in the concept. At best there is mention of an unconsidered decision at the last moment - freedom, indeed, but a free- dom without sense. The actual time experience of the action duration is absent, as is the considered decision of the composition process. It is a free- dom that is only possible thanks to another concept of form, that of the open form without causality. These new concepts of form have already been dis- cussed at several points, especially in relation to the theory of musical space. In this light Stockhausen's Klavierstück XI is hardly new, but merely a confir- mation of a concept of form already found in Debussy. Stockhausen's step was to transfer choice from the composer to the per- former; instead of a single notated version, many realisations of a piece become feasible. - Boulez was the first to recognise the real problem of the Klavierstück XI. In the same period, but independently of Stockhausen, he worked on his Third Piano Sonata; at the same time he was confronted by the work of Mallarmé, whose literary preoccupations ran remarkably parallel despite the great dis- parity in time. In Boulez, too, the player gains a more important role, but this does nothing the composer believes - to change the problem of form. He felt the necessity to develop a new form that adapts to the material available to the serial composer, which was constantly becoming more elastic. But form to Boulez was something more than the mosaics of Stockhausen's music, which were really nothing other than constantly changing combinations from millions of options. If the performer was free to choose, then his choice should preferably be made after some consideration, and with only a very lim- ited number of possibilities that were precisely determined by the composer. An example is the overall structure of the Sonata (comprising five move- ments in the first concept): Antiphonie, Trope, Constellation, Strophe, Séquence. The sequence of the movements is free, providing that Constellation is always in the middle. The internal structure reflects the same approach. One of the movements, Trope, has four components: two so-called structures complexes (Parenthèse, Commentaire) and two structures simples (Glose, Texte). In the 'complex structures' the performer is again free to include or omit certain additional variants (given between brackets). The sequence of these components is indicated in an ingenious manner. The unnumbered pages of the score are in a ring binder, and the player may begin where he wishes. The sequence is therefore directed - we usually read from front to back - but not predetermined (Boulez speaks of a forme circu- laire). There are normally four options, therefore, depending on the starting point: - P, C, C, G, T G, T, P G, T, P C T, P, C, G But since the Commentaire section is included twice, four other possibilities become available, depending on where this section is placed (it may only be performed once); this can be represented as in Figure 7. Altogether eight dif- ferent sequences are therefore available; compared to the millions in Stockhausen, this illustrates just how much more control the composer has retained over the final outcome. The Trope from Boulez's Third Piano Sonata provided only a first and simple answer to the new problems of form. Although the composer already estab- lished new structural concepts, the territory as such was as yet hardly explored. This is particularly evident if we bear in mind that the free sequence of sections, which caused the most sensation in the beginning, was merely one aspect of the complex concept of form that awaited exploitation. However the case may be, through these preoccupations, form acquired unprecedented autonomy, despite the astonishing authority granted (for the time being) to the performer. This is already observed in the work of Mallarmé, who concentrated far more on the structure of language than on its significance, or, in other words, attempted to convert this significance into a symbolism of absolute value. Form had a life of its own, bringing the artist to an attitude of anonymity, since the intrusion of purely personal incidents was undesirable. Those with some knowledge of Asian culture will hardly be surprised by this. But in Europe relationships are different, and particularly for those less gifted than Boulez it is fitting to recall the words of Paul Valéry, a confidant of Mallarmé. Concerning the latter's ambitions he spoke later (in his Lettre sur Mallarme) of 'diviniser la chose écrite' (divining that which is written). But, he went on, 'ce n'est point l'œuvre faite et ses apparences ou ses effets dans le monde qui peuvent nous accomplir et nous édifier, mais seule- ment la manière dont nous l'avons faite (it is not the finished work and its appearances, or its effects on the world, which can fulfill and edify us, but only the manner in which we have accomplished it). IO The concept of aleatory music has now broadened considerably, and we must certainly mention one other composer under this heading. We have already examined two aspects: action duration and the sponta- neous decision in Stockhausen, and intervention possibilities in Boulez. In the latter the performer is like a driver who may choose from a limited num- ber of roads, while the road map itself remains the domain of the town plan- ner. Boulez described Stockhausen's solution as chance, while Stockhausen used the term gelenkter Zufall (guided chance); but as we have seen, in reali- ty the element of chance was less present than one might imagine. All this only made the problem of form most acute, and the composer who was to draw particularly radical conclusions was the American John Cage. Cage came to Europe in 1958 - I remember a momentous concert at the World Exhibition in Brussels - and was quick to cause the necessary stir. From his point of view our controversy between tonality and atonality was long out- dated. He believed that modern serialists kept far too much to traditional paths, exposing themselves to a constant risk of academicism. A number of similarities, however, can also be found. Like Boulez, Cage's music reveals a pursuit of objectivity, or rather anonymity, which helps the sound to 'come to itself'. But his conclusions were much more radical. Instead of trying to bind the notes, his school attempted to soak off their adhesive, formed as it was by centuries of convention. If one hangs on to the notes, if one has 'musical' ideas, one cannot allow the notes to be themselves. And 'being themselves' means that there is no superimposed expression. (Many modern composers would go along with him up to this point, and the much older Varèse, with his 'liberation of the sound', was even a precursor.) And it also means that there is no man-made organisation. Thus, Cage reached a conclusion diametrically opposed to our early serialists: not com- plete determination, but rather complete indetermination was essential. (One of the most shocking experiences of recent times is to discover that both points of departure lead to the same degree of indetermination.) In order to achieve this indetermination, Cage used to make particular use of chance actions such as the tossing of coins, etc. Other means may also be employed, such as the oracle of the staves from the ancient Chinese book I-Ching (which illustrates the influence of Zen Buddhism on this composer), or mathemati- cal methods. More recently, however, the accent has shifted towards the unforeseeable- ness of the performance itself, involving the actual performers. It is remark- able how completely different paths form striking parallels with modern European composers! Fifty years earlier Charles Ives, following quite a differ- ent line of thought, created the same sort of music as that of the young Schönberg and Stravinsky. Despite the shift towards live performance, a score was naturally still required as an instruction for the players. But the score must not be viewed as a ready-made, notated form. And this is where Cage differs: the composition is not an autonomous object, but a performance process. Obviously, this process has its boundaries - determined by the action of the players and by a number of characteristics - but essentially the music has no precedence above either note or noise. While it does have its own exis- tence, it remains 'transparent' in relation to its surroundings. Its boundaries become diffuse, and counting is not required, for we exist in time'. Stopwatches rather than bars serve to indicate when an occurrence of sound must take place within this time. Christian Wolff, a composer from the Cage group, replaced Stockhausen's eye ('unintentional glancing') with the ear: cer- tain occurrences of sound, caused by the one player, evoke reactions from the other (Duo for Pianists II). The outcome is determined by the performers themselves; finally, musical form may be conceived as 'the length of the pro- gramme'.7 Cage is among those Westerners who have listened to the Japanese bow- 8 man in chapter 6. Just how far his interpretation is correct, we will leave to the experts. Is this still music? Surely we see an influence on contemporary music that cannot be underestimated. Can everybody do the same? But not everybody does, is Cage's reply. Strong differences of opinion emerge. It is impossible to imagine the fascinating whirlpool of new developments with- out Cage. Whether the music comes from inside or outside, we cannot escape it. 'One day when the windows were open, Christian Wolff played one of his pieces at the piano. Sounds of traffic, boat horns, were heard not only during the silences in the music but, being louder, were more easily heard than the piano sounds themselves. Afterwards, someone asked Christian Wolff to play the piece again with the windows closed. Christian Wolff said he'd be glad to, but that it wasn't really necessary, since the sounds of the environment were in no sense an interruption of those of the music.' II The above discussion helps us to clarify the concept of aleatory music. It is a generic term for all aspects of music that are not predetermined. The rela- tionship between determined and undetermined elements plays a role in all types of music. The undetermined element brings unforeseeableness with it, and can occur both in performance and during the process of composition. Unforeseeableness can be manifest in differing degrees. In the perform- ance of a classical composition, for example, the degree to which the fixated notation can be deviated from is limited. Performance of a piece by John Cage, on the other hand, can involve a high degree of unforeseeableness. But even here general patterns of expectation can be formulated. Finally, with regard to developments in the music of the period 1950-60, the following aspects are of importance: more 1. In Cage's work the element of chance to use this dubious word once - was a means to obtain indetermination and to escape from the human grasp of the music. Young European composers, on the other hand, were con- cerned with gaining even stricter control of the musical material: even this indeterminable area of free choice was consciously incorporated in the of composition. process 2. Bearing in mind changing concepts of musical form, we can say that part of what once belonged to the individual and 'unique' work of art is now ascribed to the material employed by the performers. There is a certain incli- nation to make matters absolute, which corresponds logically to the excessive attention given to musical material that we have observed from 1950 onwards. 3. Expansionism, moreover, is not foreign to serial technique, in the sense that there is an inclination to exploit all the possibilities of the chosen mate- rial. The limited means of dodecaphony of the past have been extended to become an all-embracing permutation procedure; it soon became apparent, however, that this again was not sufficient to harness the wealth of resources that had been rallied. A written serial score realises only a few of the count- less possibilities, and the free choice of the performer can at least compensate this to a certain extent. The element of chance becomes a wider margin in the realisation of the (unforeseeable) permutation process. Far from coincidental is the attendant departure from the unique, once-and-for-all determined work of art. A remarkable dichotomy seems to arise between the realised con- dition of a single work of art and the 'possibly realisable' that is potentially present in the same. Here creative expansionism collides with ultimate boundaries. 4. The element of chance can serve to fill another gap. With all due respect for their sometimes brilliant ideas, one can nonetheless consider that both Stockhausen and Boulez have maintained an only too simple notion of the role of what they call 'surprise' in the musical process. The former wrote: ""The degree of information is therefore at its highest when at any point in a musi- cal discourse the moment of surprise is at its strongest: the music constantly has ""something to say"". (Just before this he specifies: 'Surprise only occurs when the unexpected happens.')"" Boulez shares this opinion: ""... for any music that is a masterpiece is a music that allows the capacity to surprise at any moment. This is not the place to contradict these ideas, but it is clear that from this point of view too, the involvement of the spontaneous decision of the per- former is most welcome: the 'surprise' within the boundaries of a work may increase, and the same goes for each subsequent performance. 5. Increasing differentiation posed considerable problems with regard to traditional notation, which was not at all equal to its task. By involving the performer, this difficulty was eased on the one hand, while on the other new symbols had to be introduced to indicate players' actions. It was inevitable that this issue also had to be tackled once more, as is described in section 14. 12 In the reaction against abstractions, serial music lost more and more influence after 1960. Boulez has remained a bastion of serial academicism, but Stockhausen has changed enormously. He is no longer the great renewer, but continues to react with great flexibility to any external stimulus that he encounters. He is long past the stage of solving problems of form and tech- nique. From Carré (1960) and Originale (1961) onwards his work comprises. ever more heterogeneous elements including happenings, pop, quotations, indeterminate sound production (contact microphones), etc. The use of contact microphones has now become very widespread, and this opens up a new direction in the application of electronic resources. In days past, electronic music was accurately recorded on tape in a studio. Many considered this an advantage: the composer exercised maximum control, while the inconstancies of live performance were eliminated. But this strict view could not be maintained, and in a next step (discussed in section 9) aleatory techniques were introduced, at first very cautiously among Europeans but after 1960 much more freely. Improvisation groups even appeared on stage working with electronic apparatus. The principle is simple: microphones attached to 'instruments' (that may or may not be recognisable as such) pick up vibrations that are normally neither audible nor usable and feed them to loudspeakers via amplifiers and possibly modulators. A new and hitherto unknown world of sound is brought to life. Unexpected surprises may occur too, and with them an immediate response from the performer. This was a typical feature of the post-1960 period. exper- Once again it was Cage who led the way with such experiments. More important, however, was his awareness of the situation. For in his first iments with chance phenomena he discovered that he was still attempting to drag 'successful' results out of chance actions. Realising later on that this atti- tude was equivocal, he came to accept the induced results of chance. The result was no longer important, but rather the attitude of open-mindedness. Thus, he came to distinguish between chance actions and indetermination. In the first case the composer employs chance as a means, but to a limited degree such that he remains within a self-determined global circle. Indetermination, on the contrary, exceeds this circle: the result is in every respect indefinite; such music crops up out of time, undefined and inciden- tal, only to disappear once more without a trace. All things are interrelated,' Cage said, and taken up in the stream of time. Any (human) pursuit of a stat- ed ""aim"" is a simplification, and a departure from reality.' The lessons of Cage were developed further by an American ‘second generation' around 1960. And once again the aesthetic consequences of the concept of indetermination were applied more radically than in Europe. In the work of La Monte Young, Terry Riley, Robert Ashley and the Fluxus Movement, almost all existing values and concepts relating to music were turned well and truly upside down. La Monte Young (1935) worked with long chains of chords that developed systematically. His material is economical, and naturally comprises all that is 'sound', including that produced by nature, machines, and electronic resources. Performances may last a week or more and incorporate other ele- ments such as light, movement and theatre. His contemporary Terry Riley followed the same course. His music consists of long chains of repeated motifs, usually in elementary diatonic note patterns. Tape loops and feedback systems provide the characteristic tone colours; electronic and instrumental resources merge. These and other Americans shared a broad interest in wide- ly different idioms including jazz, pop and non-Western music. Chance action - indetermination: many composers throughout the world now work within these borders. Only few are conscious of the background so brilliantly evoked by Cage in his writings. What is clear, however, is that serial concepts are disappearing; there is a growing reaction to their abstrac- tions and a tendency towards greater directness in music making. This is also expressed in the instrumental works of Berio, Ligeti, Kagel and others: music that is tailor-made for certain specialists, musicians who are required to make a creative contribution of their own rather than only faithfully reproduce a more or less authoritarian score. Such music renounces serial, abstractly deter- mined sound differentiation in favour of a more direct form of expression. Not only the actual notes, but sighs, scratches, shouts and moans become part of music making. The instrument literally becomes an extension of the human body. Similar tendencies are found in music theatre. This rather vague term embodies so much variety that a comprehensive definition can hardly be given. In general, it can be viewed as a reaction to traditional theatrical and operatic forms, which have caused the nineteenth century to live on, leaving current issues to the realm of film. The 'raree show' idea has also been aban- doned, since divisions between audience and stage, between different partic- ipating disciplines, required abolition. Various directions emerged, from the political engagement of Nono (Intolleranza, 1960) to the more light-hearted or autonomous approach of Kagel (Sur Scène, 1960) and Ligeti (Aventures, 1962). Nono connected with traditional opera, while Ligeti created a 'com- position with scenic, verbal and musical means'. Unlike the traditional Gesamtkunstwerk there is a tendency to grant the incorporated elements a life of their own, independent of one another and only joined by a common peri- od of time. Once again, vocal and instrumental techniques are extended to such a degree that the two flow together. All such innovations amount to repeated attempts to break through exist- ing boundaries! From the beginning of the twentieth century, the failure of instrument making to keep pace with musical developments made itself increasingly felt. Factories were usually highly industrialised, geared to the mass production of traditional instruments and leaving no room for altruis- tic research in an artistic sense. Today's composer must still make do with instruments developed hundreds of years ago: thus the continual expansion of playing techniques towards the boundaries of human endeavour; thus the contact microphones; and thus the ongoing specialisation of the few players devoted exclusively to new music. Use only the details found in the text above to inform your answer. Which composers are credited with creating and expanding the framework for aleatory composition in its early days? ",Unknown,Fact Finding,Q&A "The following prompt requires you to answer solely using the information found within the context block. Do not use any additional external information or prior knowledge to aid your response. Focus on the technological aspects rather than providing general information. Use as much of the context block as possible to fully answer the prompt. Keep the response easy-to-digest bullet points, expanding where necessary to provide essential context. Use simplified language that all ages can understand. ",Summarise the stages of compiling and processing 3D graphics," 3D Pipeline 2.4.1.2.1 Vertex Fetch (VF) Stage The VF stage executes 3DPRIMITIVE commands. Some enhancements have been included to better support legacy D3D APIs as well as SGI OpenGL*. 2.4.1.2.2 Vertex Shader (VS) Stage The VS stage performs shading of vertices output by the VF function. The VS unit produces an output vertex reference for every input vertex reference received from the VF unit, in the order received. Figure 7. Integrated Graphics Controller Unit Block Diagram Plane A Cursor B Sprite B Plane B Cursor A Sprite A Pipe B Pipe A Memory M U X VGA Video Engine 2D Engine 3D Engine Clipper Strip & Fan/Setup Alpha Blend/ Gamma /Panel Fitter Geometry Shader Vertex Fetch/Vertex Shader Windower/IZ Intel® FDI eDP Datasheet 29 Interfaces 2.4.1.2.3 Geometry Shader (GS) Stage The GS stage receives inputs from the VS stage. Compiled application-provided GS programs, specifying an algorithm to convert the vertices of an input object into some output primitives. For example, a GS shader may convert lines of a line strip into polygons representing a corresponding segment of a blade of grass centered on the line. Or it could use adjacency information to detect silhouette edges of triangles and output polygons extruding out from the edges. 2.4.1.2.4 Clip Stage The Clip stage performs general processing on incoming 3D objects. However, it also includes specialized logic to perform a Clip Test function on incoming objects. The Clip Test optimizes generalized 3D Clipping. The Clip unit examines the position of incoming vertices, and accepts/rejects 3D objects based on its Clip algorithm. 2.4.1.2.5 Strips and Fans (SF) Stage The SF stage performs setup operations required to rasterize 3D objects. The outputs from the SF stage to the Windower stage contain implementation-specific information required for the rasterization of objects and also supports clipping of primitives to some extent. 2.4.1.2.6 Windower/IZ (WIZ) Stage The WIZ unit performs an early depth test, which removes failing pixels and eliminates unnecessary processing overhead. The Windower uses the parameters provided by the SF unit in the object-specific rasterization algorithms. The WIZ unit rasterizes objects into the corresponding set of pixels. The Windower is also capable of performing dithering, whereby the illusion of a higher resolution when using low-bpp channels in color buffers is possible. Color dithering diffuses the sharp color bands seen on smooth-shaded objects. 2.4.1.3 Video Engine The Video Engine handles the non-3D (media/video) applications. It includes support for VLD and MPEG2 decode in hardware. 2.4.1.4 2D Engine The 2D Engine contains BLT (Block Level Transfer) functionality and an extensive set of 2D instructions. To take advantage of the 3D during engine’s functionality, some BLT functions make use of the 3D renderer. 2.4.1.4.1 Integrated Graphics VGA Registers The 2D registers consists of original VGA registers and others to support graphics modes that have color depths, resolutions, and hardware acceleration features that go beyond the original VGA standard. Interfaces 30 Datasheet 2.4.1.4.2 Logical 128-Bit Fixed BLT and 256 Fill Engine This BLT engine accelerates the GUI of Microsoft Windows* operating systems. The 128-bit BLT engine provides hardware acceleration of block transfers of pixel data for many common Windows operations. The BLT engine can be used for the following: • Move rectangular blocks of data between memory locations • Data alignment • To perform logical operations (raster ops) The rectangular block of data does not change, as it is transferred between memory locations. The allowable memory transfers are between: cacheable system memory and frame buffer memory, frame buffer memory and frame buffer memory, and within system memory. Data to be transferred can consist of regions of memory, patterns, or solid color fills. A pattern is always 8 x 8 pixels wide and may be 8, 16, or 32 bits per pixel. The BLT engine expands monochrome data into a color depth of 8, 16, or 32 bits. BLTs can be either opaque or transparent. Opaque transfers move the data specified to the destination. Transparent transfers compare destination color to source color and write according to the mode of transparency selected. Data is horizontally and vertically aligned at the destination. If the destination for the BLT overlaps with the source memory location, the BLT engine specifies which area in memory to begin the BLT transfer. Hardware is included for all 256 raster operations (source, pattern, and destination) defined by Microsoft, including transparent BLT. The BLT engine has instructions to invoke BLT and stretch BLT operations, permitting software to set up instruction buffers and use batch processing. The BLT engine can perform hardware clipping during BLTs.","System instruction: The following prompt requires you to answer solely using the information found within the context block. Do not use any additional external information or prior knowledge to aid your response. Focus on the technological aspects rather than providing general information. Use as much of the context block as possible to fully answer the prompt. Keep the response easy-to-digest bullet points, expanding where necessary to provide essential context. Use simplified language that all ages can understand. Question: Summarise the stages of compiling and processing 3D graphics 3D Pipeline 2.4.1.2.1 Vertex Fetch (VF) Stage The VF stage executes 3DPRIMITIVE commands. Some enhancements have been included to better support legacy D3D APIs as well as SGI OpenGL*. 2.4.1.2.2 Vertex Shader (VS) Stage The VS stage performs shading of vertices output by the VF function. The VS unit produces an output vertex reference for every input vertex reference received from the VF unit, in the order received. Figure 7. Integrated Graphics Controller Unit Block Diagram Plane A Cursor B Sprite B Plane B Cursor A Sprite A Pipe B Pipe A Memory M U X VGA Video Engine 2D Engine 3D Engine Clipper Strip & Fan/Setup Alpha Blend/ Gamma /Panel Fitter Geometry Shader Vertex Fetch/Vertex Shader Windower/IZ Intel® FDI eDP Datasheet 29 Interfaces 2.4.1.2.3 Geometry Shader (GS) Stage The GS stage receives inputs from the VS stage. Compiled application-provided GS programs, specifying an algorithm to convert the vertices of an input object into some output primitives. For example, a GS shader may convert lines of a line strip into polygons representing a corresponding segment of a blade of grass centered on the line. Or it could use adjacency information to detect silhouette edges of triangles and output polygons extruding out from the edges. 2.4.1.2.4 Clip Stage The Clip stage performs general processing on incoming 3D objects. However, it also includes specialized logic to perform a Clip Test function on incoming objects. The Clip Test optimizes generalized 3D Clipping. The Clip unit examines the position of incoming vertices, and accepts/rejects 3D objects based on its Clip algorithm. 2.4.1.2.5 Strips and Fans (SF) Stage The SF stage performs setup operations required to rasterize 3D objects. The outputs from the SF stage to the Windower stage contain implementation-specific information required for the rasterization of objects and also supports clipping of primitives to some extent. 2.4.1.2.6 Windower/IZ (WIZ) Stage The WIZ unit performs an early depth test, which removes failing pixels and eliminates unnecessary processing overhead. The Windower uses the parameters provided by the SF unit in the object-specific rasterization algorithms. The WIZ unit rasterizes objects into the corresponding set of pixels. The Windower is also capable of performing dithering, whereby the illusion of a higher resolution when using low-bpp channels in color buffers is possible. Color dithering diffuses the sharp color bands seen on smooth-shaded objects. 2.4.1.3 Video Engine The Video Engine handles the non-3D (media/video) applications. It includes support for VLD and MPEG2 decode in hardware. 2.4.1.4 2D Engine The 2D Engine contains BLT (Block Level Transfer) functionality and an extensive set of 2D instructions. To take advantage of the 3D during engine’s functionality, some BLT functions make use of the 3D renderer. 2.4.1.4.1 Integrated Graphics VGA Registers The 2D registers consists of original VGA registers and others to support graphics modes that have color depths, resolutions, and hardware acceleration features that go beyond the original VGA standard. Interfaces 30 Datasheet 2.4.1.4.2 Logical 128-Bit Fixed BLT and 256 Fill Engine This BLT engine accelerates the GUI of Microsoft Windows* operating systems. The 128-bit BLT engine provides hardware acceleration of block transfers of pixel data for many common Windows operations. The BLT engine can be used for the following: • Move rectangular blocks of data between memory locations • Data alignment • To perform logical operations (raster ops) The rectangular block of data does not change, as it is transferred between memory locations. The allowable memory transfers are between: cacheable system memory and frame buffer memory, frame buffer memory and frame buffer memory, and within system memory. Data to be transferred can consist of regions of memory, patterns, or solid color fills. A pattern is always 8 x 8 pixels wide and may be 8, 16, or 32 bits per pixel. The BLT engine expands monochrome data into a color depth of 8, 16, or 32 bits. BLTs can be either opaque or transparent. Opaque transfers move the data specified to the destination. Transparent transfers compare destination color to source color and write according to the mode of transparency selected. Data is horizontally and vertically aligned at the destination. If the destination for the BLT overlaps with the source memory location, the BLT engine specifies which area in memory to begin the BLT transfer. Hardware is included for all 256 raster operations (source, pattern, and destination) defined by Microsoft, including transparent BLT. The BLT engine has instructions to invoke BLT and stretch BLT operations, permitting software to set up instruction buffers and use batch processing. The BLT engine can perform hardware clipping during BLTs.",Internet/Technology,Summarize & Simplify,Text Transformation "Your answer should use only the provided text; do not use any external resources. When responding, keep answers brief: your response should be no more than two short paragraphs, with a maximum of 50 words each. Use simple language that anyone could understand; rephrase complicated words and concepts, if necessary.",What are the most common causal side effects of this vaccine?,"6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine and may not reflect the rates observed in practice. Moderna COVID-19 Vaccine (Original Monovalent) Administered as a Two-Dose Primary Series Participants 18 Years of Age and Older The safety of Moderna COVID-19 Vaccine was evaluated in an ongoing Phase 3 clinical trial with multiple parts. The randomized, placebo-controlled, observer-blind phase of the trial was conducted in the United States involving 30,346 participants 18 years of age and older who received at least one dose of Moderna COVID-19 Vaccine (100 mcg mRNA; n=15,184) or placebo (n=15,162) (Study 1, NCT04470427). Upon issuance of the Emergency Use Authorization (December 18, 2020) for Moderna COVID-19 Vaccine, participants were unblinded in a phased manner over a period of months to offer placebo participants Moderna COVID-19 Vaccine. The median duration of follow-up for safety after the second injection during the blinded phase was 4 months. The median duration of follow up for safety after the second injection including both the blinded phase and the open-label phase was 6 months. In Study 1, the median age of the population was 52 years (range 18-95); 75.2% of participants were 18 years through 64 years of age and 24.8% were 65 years of age and older. Overall, 52.6% of the participants were male, 47.4% were female, 20.5% were Hispanic or Latino, 79.2% were White, 10.2% were African American, 4.6% were Asian, 0.8% were American Indian or Alaska Native, 0.2% were Native Hawaiian or Pacific Islander, 2.0% were other races, and 2.1% were Multiracial. Demographic characteristics were similar between participants who received Moderna COVID-19 Vaccine and those who received placebo. Unsolicited Adverse Events Participants were monitored for unsolicited adverse events for 28 days following each dose. Serious adverse events and medically attended adverse events will be recorded for the entire study duration (2 years). Among the 30,346 participants who had received at least 1 dose of vaccine (N=15,184) or placebo (N=15,162), unsolicited adverse events that occurred within 28 days following any vaccination were reported by 31.3% of participants (n=4,752) who received Moderna COVID-19 Vaccine and 28.6% of participants (n=4,338) who received placebo. During the 28-day follow-up period following any dose, lymphadenopathy-related events were reported by 1.7% of vaccine recipients and 0.8% of placebo recipients. These events included lymphadenopathy, lymphadenitis, lymph node pain, vaccination-site lymphadenopathy, injection-site lymphadenopathy, and axillary mass. This imbalance is consistent with the imbalance observed for solicited axillary swelling/tenderness at the injected arm. During the 7-day follow-up period of any vaccination, hypersensitivity events of injection site 10 rash or injection site urticaria, likely related to vaccination, were reported by 6 participants in the Moderna COVID-19 Vaccine group and none in the placebo group. Delayed injection site reactions that began >7 days after vaccination were reported in 1.4% of vaccine recipients and 0.7% of placebo recipients. Delayed injection site reactions included pain, erythema, and swelling and are likely related to vaccination. In the blinded portion of the study, there were 8 reports of facial paralysis (including Bell’s palsy) in the Moderna COVID-19 Vaccine group, and 3 in the placebo group. In the 28-day follow-up period there were two cases of facial paralysis in the Moderna COVID-19 Vaccine group, which occurred on 8 and 22 days, respectively, after vaccination, and one in the placebo group, which occurred 17 days after vaccination. Currently available information on facial paralysis is insufficient to determine a causal relationship with the vaccine. In the blinded portion of the study, there were 50 reports of herpes zoster in the Moderna COVID-19 Vaccine group, and 23 in the placebo group. In the 28-day period after any vaccination, there were 22 cases of herpes zoster in the Moderna COVID-19 Vaccine group, and 15 in the placebo group. Currently available information on herpes zoster infection is insufficient to determine a causal relationship with the vaccine. There were no other notable patterns or numerical imbalances between treatment groups for specific categories of adverse events (including other neurologic, neuro-inflammatory, and thrombotic events) that would suggest a causal relationship to Moderna COVID-19 Vaccine. Serious Adverse Events During the blinded phase of the study, serious adverse events were reported by 1.8% (n=268) of participants who received Moderna COVID-19 Vaccine and 1.9% (n=292) of participants who received placebo. There were three serious adverse events of angioedema/facial swelling in the vaccine group in recipients with a history of injection of dermatological fillers. The onset of swelling was reported 1-2 days after the second dose and was likely related to vaccination. There were no other notable patterns or imbalances between treatment groups for specific categories of serious adverse events (including neurologic, neuro-inflammatory, and thrombotic events) that would suggest a causal relationship to Moderna COVID-19 Vaccine. Participants 12 Years Through 17 Years of Age The safety of Moderna COVID-19 Vaccine was evaluated in an ongoing Phase 3 clinical trial with multiple parts. The randomized, placebo-controlled, observer-blind clinical trial was conducted in the United States involving 3,726 participants 12 years through 17 years of age who received at least one dose of Moderna COVID-19 Vaccine (100 mcg mRNA; n=2,486) or placebo (n=1,240) (Study 3, NCT04649151). Participants started to enter an open-label, observational phase after May 10, 2021. After October 1, 2021, cases of potential myocarditis and/or pericarditis that were identified by the investigator or Applicant were adjudicated by an 11 independent Cardiac Event Adjudication Committee (CEAC) to determine if they met the CDC definition of confirmed or probable myocarditis and/or pericarditis. A safety analysis was conducted in participants who received Moderna COVID-19 Vaccine (n=2,486) with a cut-off date of January 31, 2022. In these analyses, the median duration of follow-up including both the blinded and open-label phases was 312 days after Dose 2 and 95.7% of study participants had at least 6 months of follow-up after Dose 2. Overall, 51.4% were male, 48.6% were female, 11.6% were Hispanic or Latino, 83.8% were White, 3.4% were African American, 6.0% were Asian, 0.5% were American Indian or Alaska Native, <0.1% were Native Hawaiian or Pacific Islander, 1.0% were other races, and 4.5% were Multiracial. Demographic characteristics were similar among participants who received Moderna COVID-19 Vaccine and those who received placebo. Unsolicited Adverse Events Participants were monitored for unsolicited adverse events for 28 days following each dose. Serious adverse events and medically attended adverse events were recorded for the entire study duration. Among the 3,726 participants who had received at least 1 dose of vaccine (n=2,486) or placebo (n=1,240), unsolicited adverse events that occurred within 28 days following any vaccination were reported by 23.4% of participants (n=582) who received Moderna COVID-19 Vaccine and 19.1% of participants (n=237) who received placebo. ","Your answer should use only the provided text; do not use any external resources. When responding, keep answers brief: your response should be no more than two short paragraphs, with a maximum of 50 words each. Use simple language that anyone could understand; rephrase complicated words and concepts, if necessary. Provided text: 6.1 Clinical Trials Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared with rates in the clinical trials of another vaccine and may not reflect the rates observed in practice. Moderna COVID-19 Vaccine (Original Monovalent) Administered as a Two-Dose Primary Series Participants 18 Years of Age and Older The safety of Moderna COVID-19 Vaccine was evaluated in an ongoing Phase 3 clinical trial with multiple parts. The randomized, placebo-controlled, observer-blind phase of the trial was conducted in the United States involving 30,346 participants 18 years of age and older who received at least one dose of Moderna COVID-19 Vaccine (100 mcg mRNA; n=15,184) or placebo (n=15,162) (Study 1, NCT04470427). Upon issuance of the Emergency Use Authorization (December 18, 2020) for Moderna COVID-19 Vaccine, participants were unblinded in a phased manner over a period of months to offer placebo participants Moderna COVID-19 Vaccine. The median duration of follow-up for safety after the second injection during the blinded phase was 4 months. The median duration of follow up for safety after the second injection including both the blinded phase and the open-label phase was 6 months. In Study 1, the median age of the population was 52 years (range 18-95); 75.2% of participants were 18 years through 64 years of age and 24.8% were 65 years of age and older. Overall, 52.6% of the participants were male, 47.4% were female, 20.5% were Hispanic or Latino, 79.2% were White, 10.2% were African American, 4.6% were Asian, 0.8% were American Indian or Alaska Native, 0.2% were Native Hawaiian or Pacific Islander, 2.0% were other races, and 2.1% were Multiracial. Demographic characteristics were similar between participants who received Moderna COVID-19 Vaccine and those who received placebo. Unsolicited Adverse Events Participants were monitored for unsolicited adverse events for 28 days following each dose. Serious adverse events and medically attended adverse events will be recorded for the entire study duration (2 years). Among the 30,346 participants who had received at least 1 dose of vaccine (N=15,184) or placebo (N=15,162), unsolicited adverse events that occurred within 28 days following any vaccination were reported by 31.3% of participants (n=4,752) who received Moderna COVID-19 Vaccine and 28.6% of participants (n=4,338) who received placebo. During the 28-day follow-up period following any dose, lymphadenopathy-related events were reported by 1.7% of vaccine recipients and 0.8% of placebo recipients. These events included lymphadenopathy, lymphadenitis, lymph node pain, vaccination-site lymphadenopathy, injection-site lymphadenopathy, and axillary mass. This imbalance is consistent with the imbalance observed for solicited axillary swelling/tenderness at the injected arm. During the 7-day follow-up period of any vaccination, hypersensitivity events of injection site 10 rash or injection site urticaria, likely related to vaccination, were reported by 6 participants in the Moderna COVID-19 Vaccine group and none in the placebo group. Delayed injection site reactions that began >7 days after vaccination were reported in 1.4% of vaccine recipients and 0.7% of placebo recipients. Delayed injection site reactions included pain, erythema, and swelling and are likely related to vaccination. In the blinded portion of the study, there were 8 reports of facial paralysis (including Bell’s palsy) in the Moderna COVID-19 Vaccine group, and 3 in the placebo group. In the 28-day follow-up period there were two cases of facial paralysis in the Moderna COVID-19 Vaccine group, which occurred on 8 and 22 days, respectively, after vaccination, and one in the placebo group, which occurred 17 days after vaccination. Currently available information on facial paralysis is insufficient to determine a causal relationship with the vaccine. In the blinded portion of the study, there were 50 reports of herpes zoster in the Moderna COVID-19 Vaccine group, and 23 in the placebo group. In the 28-day period after any vaccination, there were 22 cases of herpes zoster in the Moderna COVID-19 Vaccine group, and 15 in the placebo group. Currently available information on herpes zoster infection is insufficient to determine a causal relationship with the vaccine. There were no other notable patterns or numerical imbalances between treatment groups for specific categories of adverse events (including other neurologic, neuro-inflammatory, and thrombotic events) that would suggest a causal relationship to Moderna COVID-19 Vaccine. Serious Adverse Events During the blinded phase of the study, serious adverse events were reported by 1.8% (n=268) of participants who received Moderna COVID-19 Vaccine and 1.9% (n=292) of participants who received placebo. There were three serious adverse events of angioedema/facial swelling in the vaccine group in recipients with a history of injection of dermatological fillers. The onset of swelling was reported 1-2 days after the second dose and was likely related to vaccination. There were no other notable patterns or imbalances between treatment groups for specific categories of serious adverse events (including neurologic, neuro-inflammatory, and thrombotic events) that would suggest a causal relationship to Moderna COVID-19 Vaccine. Participants 12 Years Through 17 Years of Age The safety of Moderna COVID-19 Vaccine was evaluated in an ongoing Phase 3 clinical trial with multiple parts. The randomized, placebo-controlled, observer-blind clinical trial was conducted in the United States involving 3,726 participants 12 years through 17 years of age who received at least one dose of Moderna COVID-19 Vaccine (100 mcg mRNA; n=2,486) or placebo (n=1,240) (Study 3, NCT04649151). Participants started to enter an open-label, observational phase after May 10, 2021. After October 1, 2021, cases of potential myocarditis and/or pericarditis that were identified by the investigator or Applicant were adjudicated by an 11 independent Cardiac Event Adjudication Committee (CEAC) to determine if they met the CDC definition of confirmed or probable myocarditis and/or pericarditis. A safety analysis was conducted in participants who received Moderna COVID-19 Vaccine (n=2,486) with a cut-off date of January 31, 2022. In these analyses, the median duration of follow-up including both the blinded and open-label phases was 312 days after Dose 2 and 95.7% of study participants had at least 6 months of follow-up after Dose 2. Overall, 51.4% were male, 48.6% were female, 11.6% were Hispanic or Latino, 83.8% were White, 3.4% were African American, 6.0% were Asian, 0.5% were American Indian or Alaska Native, <0.1% were Native Hawaiian or Pacific Islander, 1.0% were other races, and 4.5% were Multiracial. Demographic characteristics were similar among participants who received Moderna COVID-19 Vaccine and those who received placebo. Unsolicited Adverse Events Participants were monitored for unsolicited adverse events for 28 days following each dose. Serious adverse events and medically attended adverse events were recorded for the entire study duration. Among the 3,726 participants who had received at least 1 dose of vaccine (n=2,486) or placebo (n=1,240), unsolicited adverse events that occurred within 28 days following any vaccination were reported by 23.4% of participants (n=582) who received Moderna COVID-19 Vaccine and 19.1% of participants (n=237) who received placebo. What are the most common causal side effects of this vaccine?",Medical,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]",What does cholelithiasis mean and how serious is it? Provide a list of symptoms in bullet points. You're my doctor and have personal experience with gallbladder issues.,"Gallstones Gallstones (cholelithiasis) are hardened pieces of bile that form in your gallbladder or bile ducts. They’re common, especially in women and people assigned female at birth. Gallstones don’t always cause problems, but they can if they get stuck in your biliary tract and block your bile flow. If your gallstones cause you symptoms, you’ll need treatment to remove them — typically, surgery. Contents Overview Symptoms and Causes Diagnosis and Tests Management and Treatment Prevention Outlook / Prognosis Living With Overview Gallstones the gallbladder, along with small intestine and pancreas Gallstones are hardened pieces of bile sediment that can form in your gallbladder. What are gallstones? Gallstones are hardened, concentrated pieces of bile that form in your gallbladder or bile ducts. “Gall” means bile, so gallstones are bile stones. Your gallbladder is your bile bladder. It holds and stores bile for later use. Your liver makes bile, and your bile ducts carry it to the different organs in your biliary tract. Healthcare providers sometimes use the term “cholelithiasis” to describe the condition of having gallstones. “Chole” also means bile, and “lithiasis” means stones forming. Gallstones form when bile sediment collects and crystallizes. Often, the sediment is an excess of one of the main ingredients in bile. How serious are gallstones? Gallstones (cholelithiasis) won’t necessarily cause any problems for you. A lot of people have them and never know it. But gallstones can become dangerous if they start to travel through your biliary tract and get stuck somewhere. They can clog up your biliary tract, causing pain and serious complications. The problem with gallstones is that they grow — slowly, but surely — as bile continues to wash over them and leave another layer of sediment. What begins as a grain of sand can grow big enough to stop the flow of bile, especially if it gets into a narrow space, like a bile duct or the neck of your gallbladder. How common are gallstones (cholelithiasis)? At least 10% of U.S. adults have gallstones, and up to 75% of them are women and people assigned female at birth (AFAB). But only 20% of those diagnosed will ever have symptoms or need treatment for gallstones. Symptoms and Causes Christine Lee, MD explains what gallstones are and how they’re treated. What are gallstones symptoms? Gallstones generally don’t cause symptoms unless they get stuck and create a blockage. This blockage causes symptoms, most commonly upper abdominal pain and nausea. These may come and go, or they may come and stay. You might develop other symptoms if the blockage is severe or lasts a long time, like: Sweating. Fever. Fast heart rate. Abdominal swelling and tenderness. Yellow tint to your skin and eyes. Dark-colored pee and light-colored poop. What is gallstone pain like? Typical gallstone pain is sudden and severe and may make you sick to your stomach. This is called a gallstone attack or gallbladder attack. You might feel it most severely after eating, when your gallbladder contracts, creating more pressure in your biliary system. It might wake you from sleep. Gallstone pain that builds to a peak and then slowly fades is called biliary colic. It comes in episodes that may last minutes to hours. The episode ends when and if the stone moves or the pressure eases. People describe the pain as intense, sharp, stabbing, cramping or squeezing. You might be unable to sit still. Where is gallstone pain located? Your biliary system is located in the upper right quadrant of your abdomen, which is under your right ribcage. Most people feel gallstone pain in this region. But sometimes, it can radiate to other areas. Some people feel it in their right arm or shoulder or in their back between their shoulder blades. Some people feel gallstone pain in the middle of their abdomen or chest. This can be confusing because the feeling might resemble other conditions. Some people mistake gallstone pain for heartburn or indigestion. Others might feel like they’re having a heart attack, which is a different emergency. Are gallstones symptoms different in a female? Gallstone symptoms aren’t different in women or people assigned female at birth (AFAB). But people AFAB may be more likely to experience referred pain — pain that you feel in a different place from where it started. So, they may be more likely to experience gallstone pain in their arm, shoulder, chest or back. People AFAB are also more prone to chronic pain, and they may be more likely to dismiss pain that comes and goes, like biliary colic does. It’s important to see a healthcare provider about any severe or recurring pain, even if it goes away. Once you’ve had a gallstone attack, you’re likely to have another. What triggers gallstone pain? Gallstone pain means that a gallstone has gotten stuck in your biliary tract and caused a blockage. If it’s a major blockage, you might feel it right away. If it’s only a partial blockage, you might not notice until your gallbladder contracts, creating more pressure in your system. Eating triggers this contraction. A rich, heavy or fatty meal will trigger a bigger gallbladder contraction. That’s because your small intestine detects the fat content in your meal and tells your gallbladder how much bile it will need to help break it down. Your gallbladder responds by squeezing the needed bile out into your bile ducts."," Only use the provided text to answer the question, no outside sources. What does cholelithiasis mean and how serious is it? Provide a list of symptoms in bullet points. You're my doctor and have personal experience with gallbladder issues. Gallstones Gallstones (cholelithiasis) are hardened pieces of bile that form in your gallbladder or bile ducts. They’re common, especially in women and people assigned female at birth. Gallstones don’t always cause problems, but they can if they get stuck in your biliary tract and block your bile flow. If your gallstones cause you symptoms, you’ll need treatment to remove them — typically, surgery. Contents Overview Symptoms and Causes Diagnosis and Tests Management and Treatment Prevention Outlook / Prognosis Living With Overview Gallstones the gallbladder, along with small intestine and pancreas Gallstones are hardened pieces of bile sediment that can form in your gallbladder. What are gallstones? Gallstones are hardened, concentrated pieces of bile that form in your gallbladder or bile ducts. “Gall” means bile, so gallstones are bile stones. Your gallbladder is your bile bladder. It holds and stores bile for later use. Your liver makes bile, and your bile ducts carry it to the different organs in your biliary tract. Healthcare providers sometimes use the term “cholelithiasis” to describe the condition of having gallstones. “Chole” also means bile, and “lithiasis” means stones forming. Gallstones form when bile sediment collects and crystallizes. Often, the sediment is an excess of one of the main ingredients in bile. How serious are gallstones? Gallstones (cholelithiasis) won’t necessarily cause any problems for you. A lot of people have them and never know it. But gallstones can become dangerous if they start to travel through your biliary tract and get stuck somewhere. They can clog up your biliary tract, causing pain and serious complications. The problem with gallstones is that they grow — slowly, but surely — as bile continues to wash over them and leave another layer of sediment. What begins as a grain of sand can grow big enough to stop the flow of bile, especially if it gets into a narrow space, like a bile duct or the neck of your gallbladder. How common are gallstones (cholelithiasis)? At least 10% of U.S. adults have gallstones, and up to 75% of them are women and people assigned female at birth (AFAB). But only 20% of those diagnosed will ever have symptoms or need treatment for gallstones. Symptoms and Causes Christine Lee, MD explains what gallstones are and how they’re treated. What are gallstones symptoms? Gallstones generally don’t cause symptoms unless they get stuck and create a blockage. This blockage causes symptoms, most commonly upper abdominal pain and nausea. These may come and go, or they may come and stay. You might develop other symptoms if the blockage is severe or lasts a long time, like: Sweating. Fever. Fast heart rate. Abdominal swelling and tenderness. Yellow tint to your skin and eyes. Dark-colored pee and light-colored poop. What is gallstone pain like? Typical gallstone pain is sudden and severe and may make you sick to your stomach. This is called a gallstone attack or gallbladder attack. You might feel it most severely after eating, when your gallbladder contracts, creating more pressure in your biliary system. It might wake you from sleep. Gallstone pain that builds to a peak and then slowly fades is called biliary colic. It comes in episodes that may last minutes to hours. The episode ends when and if the stone moves or the pressure eases. People describe the pain as intense, sharp, stabbing, cramping or squeezing. You might be unable to sit still. Where is gallstone pain located? Your biliary system is located in the upper right quadrant of your abdomen, which is under your right ribcage. Most people feel gallstone pain in this region. But sometimes, it can radiate to other areas. Some people feel it in their right arm or shoulder or in their back between their shoulder blades. Some people feel gallstone pain in the middle of their abdomen or chest. This can be confusing because the feeling might resemble other conditions. Some people mistake gallstone pain for heartburn or indigestion. Others might feel like they’re having a heart attack, which is a different emergency. Are gallstones symptoms different in a female? Gallstone symptoms aren’t different in women or people assigned female at birth (AFAB). But people AFAB may be more likely to experience referred pain — pain that you feel in a different place from where it started. So, they may be more likely to experience gallstone pain in their arm, shoulder, chest or back. People AFAB are also more prone to chronic pain, and they may be more likely to dismiss pain that comes and goes, like biliary colic does. It’s important to see a healthcare provider about any severe or recurring pain, even if it goes away. Once you’ve had a gallstone attack, you’re likely to have another. What triggers gallstone pain? Gallstone pain means that a gallstone has gotten stuck in your biliary tract and caused a blockage. If it’s a major blockage, you might feel it right away. If it’s only a partial blockage, you might not notice until your gallbladder contracts, creating more pressure in your system. Eating triggers this contraction. A rich, heavy or fatty meal will trigger a bigger gallbladder contraction. That’s because your small intestine detects the fat content in your meal and tells your gallbladder how much bile it will need to help break it down. Your gallbladder responds by squeezing the needed bile out into your bile ducts. https://my.clevelandclinic.org/health/diseases/7313-gallstones",Medical,Explanation/Definition,Q&A Answer the question using only the provided text. No external sources or prior knowledge is allowed.,What are all the positive and negative aspects of drone usage mentioned in the text?,"A Cautionary Tale of Drone (Mis)use Military-grade drones were a restricted technology until local government agencies saw drones’ potential for search-and-rescue missions and private companies wanted to use drones for labor-intensive tasks, such as inspecting pipelines, delivering goods to remote areas, and spraying pesticides on farms. 22 The exploitation of drones for commercial profit soon created a civilian drone industry wherein the United States alone currently contains some 727,000 commercial drones and 1.69 million recreational small drones, with the numbers forecast to continue growing.23 The drone industry’s growth has taken place in the last few years, as the Federal Aviation Administration, concerned more with air safety than terrorist ambitions, did not issue the first commercial drone permit until 2006, lifting some of the restrictions on flying consumer drones for recreational and business purposes. Even then, the authorities were aware that , as Don Rassler has documented, four terrorist groups—the Japanese Aum Shinrikyo, the Colombia-based Revolutionary Armed Forces of Colombia, the Pakistan-based Lashkar-eTaiba, and the Haqqani network—were already exploring the use of unmanned aerial vehicles for terrorist attacks. The Lashkar-e-Taiba case involved a network of US residents who directly acquired sensitive technology from US companies in 2002 to enhance the performance of unmanned airplanes. Lashkar-e-Taiba intended to ship the technologies, which US companies could sell to domestic customers—mainly universities and the US government—without due diligence, for the group’s military use in Kashmir. Several other terrorist groups also had their own drone programs, adapting Iranian models or reverse engineering stolen military drones—initially, for surveillance and the collection of tactical intelligence, external communications, and the smuggling of materiel into denied areas, and then, for use as weapons.24 Perhaps more interesting are the creative uses of drones individuals with no terrorist intent have found but that may cause harm, nonetheless. In December 2008, an American hobbyist successfully attached a pistol with a digital-camera gunsight to a minicopter and remotely fired the pistol. The hobbyist filmed his stunt and posted the footage online. The video did not attract much media attention, but almost seven years later, another American, a teenager, “upped the ante and the shock value” by mounting a homemade flamethrower to a small commercial drone he had modified and displaying the accuracy of the weapon in an online video.25 Violent actors easily could have replicated both stunts to stage terrorist attacks. Even after the hobbyists’ stunts, several influential studies considered terrorists’ use of drones a “niche threat” because few terrorist groups had successfully deployed drones in any meaningful way.26 When the Islamic State of Iraq and Syria began weaponizing civilian drones and filming its attacks for propaganda purposes in 2016, several terrorism experts warned violent extremists could one day use drones as remote-controlled missiles to deliver unconventional weapons, such as deadly nerve agents.27 Meanwhile, the general consensus remained that though drones might complicate conflicts, drones’ broader impact would be limited, given their small payloads, short flight times, and susceptibility to disruption. Additionally, although technological advancements might make civilian drones more capable, “the tools to counter, disable or defeat [drones] will be more capable too,” as will regulatory changes to restrict airspace access and increase export controls to prevent terrorists from acquiring certain technologies.28 Today, many governments require registrations for consumer drones that are heavier than seven kilograms. In addition, most governments have banned consumer drones from flying in cities, near sensitive installations, and over iconic events and other large gatherings, except with special permits. Since those with malevolent intentions usually do not apply for permits, jamming devices have also proliferated, as have geofencing technologies for disabling drones that are approaching designated no-fly zones. Nonetheless, the Houthis’ recent success in disrupting the Red Sea shipping route will likely inspire copycats. The Strait of Malacca, for instance, is another global trade route with several choke points. Any threat to shipping in this narrow channel bordered by Indonesia, Malaysia, Singapore, and Thailand will severely impact economies in East Asia and cause ripple effects throughout the rest of the world. Weaponized drones will be a game changer for Southeast Asian terrorist groups. During the siege of Marawi City, Philippines, in June 2017, pro–Islamic State of Iraq and Syria militants reportedly used consumer-grade quadcopter drones to track, evade, and coordinate attacks on Philippine soldiers, inspiring the Philippine military to use similar drones. 29 But regional authorities apparently judged the drone use in Marawi City to be an outlier, a tactic imported by foreign fighters. The prevailing assessment is Southeast Asian terrorist groups like Jemaah Islamiyah and the various pro–Islamic State of Iraq and Syria offshoots in Indonesia and Malaysia will not expend their limited resources on drones when the supply of suicide bombers is seemingly unlimited. The use of drones for terrorist attacks is nevertheless a growing concern in Southeast Asia. Recent developments indicate Indonesian terrorists are hoping to acquire drone-warfare capability. In May 2023, the Indonesian counterterrorism unit Densus 88 obtained intelligence that Indonesian nationals whom the unit suspected of being affiliated with al-Qaeda in the Arabian Peninsula were undergoing training to fly drones in Yemen. Individuals affiliated with pro–Islamic State of Iraq and Syria militant factions were also sharing tutorials on how to make “drone bombs” with members of their private social-media chat groups.","System instruction: Answer the question using only the provided text. No external sources or prior knowledge is allowed. User question: What are all the positive and negative aspects of drone usage mentioned in the text? Context block: A Cautionary Tale of Drone (Mis)use Military-grade drones were a restricted technology until local government agencies saw drones’ potential for search-and-rescue missions and private companies wanted to use drones for labor-intensive tasks, such as inspecting pipelines, delivering goods to remote areas, and spraying pesticides on farms. 22 The exploitation of drones for commercial profit soon created a civilian drone industry wherein the United States alone currently contains some 727,000 commercial drones and 1.69 million recreational small drones, with the numbers forecast to continue growing.23 The drone industry’s growth has taken place in the last few years, as the Federal Aviation Administration, concerned more with air safety than terrorist ambitions, did not issue the first commercial drone permit until 2006, lifting some of the restrictions on flying consumer drones for recreational and business purposes. Even then, the authorities were aware that , as Don Rassler has documented, four terrorist groups—the Japanese Aum Shinrikyo, the Colombia-based Revolutionary Armed Forces of Colombia, the Pakistan-based Lashkar-eTaiba, and the Haqqani network—were already exploring the use of unmanned aerial vehicles for terrorist attacks. The Lashkar-e-Taiba case involved a network of US residents who directly acquired sensitive technology from US companies in 2002 to enhance the performance of unmanned airplanes. Lashkar-e-Taiba intended to ship the technologies, which US companies could sell to domestic customers—mainly universities and the US government—without due diligence, for the group’s military use in Kashmir. Several other terrorist groups also had their own drone programs, adapting Iranian models or reverse engineering stolen military drones—initially, for surveillance and the collection of tactical intelligence, external communications, and the smuggling of materiel into denied areas, and then, for use as weapons.24 Perhaps more interesting are the creative uses of drones individuals with no terrorist intent have found but that may cause harm, nonetheless. In December 2008, an American hobbyist successfully attached a pistol with a digital-camera gunsight to a minicopter and remotely fired the pistol. The hobbyist filmed his stunt and posted the footage online. The video did not attract much media attention, but almost seven years later, another American, a teenager, “upped the ante and the shock value” by mounting a homemade flamethrower to a small commercial drone he had modified and displaying the accuracy of the weapon in an online video.25 Violent actors easily could have replicated both stunts to stage terrorist attacks. Even after the hobbyists’ stunts, several influential studies considered terrorists’ use of drones a “niche threat” because few terrorist groups had successfully deployed drones in any meaningful way.26 When the Islamic State of Iraq and Syria began weaponizing civilian drones and filming its attacks for propaganda purposes in 2016, several terrorism experts warned violent extremists could one day use drones as remote-controlled missiles to deliver unconventional weapons, such as deadly nerve agents.27 Meanwhile, the general consensus remained that though drones might complicate conflicts, drones’ broader impact would be limited, given their small payloads, short flight times, and susceptibility to disruption. Additionally, although technological advancements might make civilian drones more capable, “the tools to counter, disable or defeat [drones] will be more capable too,” as will regulatory changes to restrict airspace access and increase export controls to prevent terrorists from acquiring certain technologies.28 Today, many governments require registrations for consumer drones that are heavier than seven kilograms. In addition, most governments have banned consumer drones from flying in cities, near sensitive installations, and over iconic events and other large gatherings, except with special permits. Since those with malevolent intentions usually do not apply for permits, jamming devices have also proliferated, as have geofencing technologies for disabling drones that are approaching designated no-fly zones. Nonetheless, the Houthis’ recent success in disrupting the Red Sea shipping route will likely inspire copycats. The Strait of Malacca, for instance, is another global trade route with several choke points. Any threat to shipping in this narrow channel bordered by Indonesia, Malaysia, Singapore, and Thailand will severely impact economies in East Asia and cause ripple effects throughout the rest of the world. Weaponized drones will be a game changer for Southeast Asian terrorist groups. During the siege of Marawi City, Philippines, in June 2017, pro–Islamic State of Iraq and Syria militants reportedly used consumer-grade quadcopter drones to track, evade, and coordinate attacks on Philippine soldiers, inspiring the Philippine military to use similar drones. 29 But regional authorities apparently judged the drone use in Marawi City to be an outlier, a tactic imported by foreign fighters. The prevailing assessment is Southeast Asian terrorist groups like Jemaah Islamiyah and the various pro–Islamic State of Iraq and Syria offshoots in Indonesia and Malaysia will not expend their limited resources on drones when the supply of suicide bombers is seemingly unlimited. The use of drones for terrorist attacks is nevertheless a growing concern in Southeast Asia. Recent developments indicate Indonesian terrorists are hoping to acquire drone-warfare capability. In May 2023, the Indonesian counterterrorism unit Densus 88 obtained intelligence that Indonesian nationals whom the unit suspected of being affiliated with al-Qaeda in the Arabian Peninsula were undergoing training to fly drones in Yemen. Individuals affiliated with pro–Islamic State of Iraq and Syria militant factions were also sharing tutorials on how to make “drone bombs” with members of their private social-media chat groups.",Internet/Technology,Pros & Cons,Q&A Avoid using information outside of the provided text.,What are the benefits of high-quality staff?,"Financial intermediaries reduce transaction, information and search costs mainly by exploiting economies of scale. By increasing the volume of transactions, the cost per unit of transaction decreases. Moreover, by focusing on growing in size, financial intermediaries are able to draw standardised contracts and monitor customers so that they enforce these contracts. They also train high-quality staff to assist in the process of finding and monitoring suitable units in deficit (borrowers). It would be very difficult, time-consuming and costly for an individual to do so. Financial intermediaries can reduce risks by ‘pooling’, or aggregating, individual risks so that in normal circumstances, surplus units will be depositing money as deficit units make withdrawals. This enables banks, for instance, to collect relatively liquid deposits and invest most of them in long-term assets. Another way to look at this situation is that large groups of depositors are able to obtain liquidity from the banks while investing savings in illiquid but more profitable investments (Diamond and Dybvig, 1983). ","Avoid using information outside of the provided text. Financial intermediaries reduce transaction, information and search costs mainly by exploiting economies of scale. By increasing the volume of transactions, the cost per unit of transaction decreases. Moreover, by focusing on growing in size, financial intermediaries are able to draw standardised contracts and monitor customers so that they enforce these contracts. They also train high-quality staff to assist in the process of finding and monitoring suitable units in deficit (borrowers). It would be very difficult, time-consuming and costly for an individual to do so. Financial intermediaries can reduce risks by ‘pooling’, or aggregating, individual risks so that in normal circumstances, surplus units will be depositing money as deficit units make withdrawals. This enables banks, for instance, to collect relatively liquid deposits and invest most of them in long-term assets. Another way to look at this situation is that large groups of depositors are able to obtain liquidity from the banks while investing savings in illiquid but more profitable investments (Diamond and Dybvig, 1983). What are the benefits of high-quality staff?",Financial,Find & Summarize,Text Transformation "When responding, restrict yourself to only information found within the given article - no other information is valid or necessary.",How should we as a labor hire provider respond if a labor hire worker refuses to carry out work due to safety concerns?,"GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 1 of 7 Labour hire: duties of persons conducting a business or undertaking This Guide provides information for persons conducting a business or undertaking (PCBUs) involving the supply of workers (labour hire PCBUs) to work for another business or undertaking (host PCBUs) on complying with their health and safety duties under the model Work Health and Safety (WHS) laws. Model Work Health and Safety Act and labour hire arrangements Labour hire arrangements are covered by the model WHS Act. The primary duty of care under the model WHS Act is owed by a PCBU to a ‘worker’, which includes a labour hire worker. All labour hire PCBUs and host PCBUs have a primary duty of care to ensure, so far as is reasonably practicable, the health and safety of labour hire workers engaged by, or caused to be engaged by them, or whose activities are influenced or directed by the PCBU. The model WHS Act provides that more than one duty holder may have the same duty, in this instance a labour hire PCBU and a host PCBU. Labour hire arrangements can be complex. In some circumstances, there may be more than one labour hire or host PCBU. If more than one person has a duty for the same matter, each person must meet their duty to the extent to which they have the capacity to influence and control the matter. A labour hire PCBU or host PCBU may exercise influence and control over a relevant matter through, for example, the terms of a contract or directing workers in a practical sense. However, duty holders cannot contract out of or transfer their WHS obligations to another person. Consultation between PCBUs All duty holders in a labour hire arrangement must consult, cooperate and coordinate with each other so far as is reasonably practicable. Each duty holder should share information to find out who is doing what and work together in a cooperative and coordinated way to ensure compliance with WHS laws. For example, host and labour hire PCBUs must discuss consultation arrangements, the hazards and risks associated with the work, what precautions will be taken to ensure the health and safety of the labour hire worker and the respective roles the organisations in responding to an incident. Some labour hire PCBUs may have substantial knowledge of WHS issues and risk management practices in their industry that may assist in assessing the practices of a host PCBU and ensuring compliance with WHS laws. Duty holders should not assume that someone else is taking care of a health and GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 2 of 7 safety matter. Find out who is doing what and work together with other duty holders so risks are eliminated or minimised as far as is reasonably practicable. What is reasonable practicable will depend on the circumstances. Relevant issues for duty holders to discuss will depend on the circumstances. These may include: • hazards and risks that may arise, taking into account things like the physical environment where work will occur • control measures to eliminate or minimise risks and the suitability of those measures • compliance with minimum requirements set by legislation, such as the WHS laws • how work will be carried out (including safe work methods and processes that are already in place or need to be in place) • the people involved in the work (including supervision arrangements) • competency and training requirements, including arrangements for the provision of additional training required for the particular work • arrangements for facilitating assessments of the individual worker’s needs and/or competencies, as appropriate • arrangements for health monitoring and relevant vaccinations • the respective roles of the organisations in responding to an incident, as well as relevant policies and procedures, and • any other factors which may impact the work environment and how work is carried out. Like all PCBUs, labour hire and host PCBUs are required to be proactive in managing hazards and risks. The duties in the model WHS Act are ongoing and must be complied with throughout the labour hire arrangement. Be aware that circumstances can change over time and this may result in a change in the hazards and risks or in the ways they may be eliminated or minimised. Changes that may necessitate a review of hazards, risks and control measures may include: • change in a work process • change in the physical environment • different people undertaking the work, with different skills or means of co-ordinating activities • new hazards are identified, and • new ways to eliminate or minimise risks are identified or invented. If a labour hire worker has a reasonable concern that to carry out the work would expose them to a serious health or safety risk, they may cease, or refuse to carry out work. A labour hire and host PCBU must not discriminate against a worker for exercising this or any other right under the model WHS Act. Duties of a host PCBU As a host PCBU under the model WHS Act, you have the same health and safety duties to labour hire workers as you do to other types of workers. It is your duty to ensure, so far as is reasonably practicable, the health and safety of all workers while at work. This duty requires you to eliminate or, if that is not reasonably practicable, to minimise risks to their health and safety. To identify what is reasonably practicable to do, you must take into account all the relevant matters and work with the labour hire PCBU/s to provide the highest level of protection that is both possible and reasonable in the circumstances. GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 3 of 7 As a host PCBU, you must also consult, cooperate and coordinate activities with the labour hire PCBU/s to ensure you meet your obligations. The model WHS Act specifically provides that you cannot contract out of or transfer your WHS obligations to another party, including labour hire or other host PCBUs. Before engaging labour hire workers Before you engage labour hire workers to carry out work, you should consider: • providing the labour hire PCBU/s with detailed information about the nature of work to be carried out including details of, and where possible supporting material, relating to: o the work environment/s o tasks to be performed o accommodation arrangements o any known hazards or risks o any plant or equipment to be used o organisational and WHS arrangements, including supervision arrangements and any other organisations responsible for the worker during the arrangement o health and safety risks associated with the work, and o any skills, knowledge, licenses and qualifications required to safely undertake the work. • verifying, in consultation with the labour hire PCBU, that the selected worker/s have any necessary qualifications, licences, skills and training to carry out the work safely. In limited circumstances, you may be required to verify the worker/s are medically fit to carry out the work (see regulations 168 and 417(3)(b) of the model WHS Regulations) • discussing with the labour hire PCBU arrangements for health monitoring and vaccinations • consulting with the labour hire PCBU/s on WHS matters including in relation to who will provide any necessary equipment such as personal protective equipment (PPE), and relevant points of contact for health and safety between the organisations • ensuring that general health and safety information about the work, workplace and work environment has been provided to the worker/s. Check that you have provided this information in a way that is suitable, adequate and readily understandable for the worker/s • eliminating or, if that is not reasonably practicable, minimising risks in the workplace • establishing, in consultation with the labour hire PCBU/s, a review process for ensuring the ongoing WHS of workers, and • any more you can do to ensure the health and safety of all your workers. During a labour hire worker’s placement While labour hire workers are carrying out work, you should consider: • providing the worker/s with a site specific safety induction outlining WHS duties, policies, procedures and practices in the workplace including consultation methods • where WHS advice or workplace assessments are required, ensuring the persons engaged to conduct GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 4 of 7 those assessments are suitably qualified • treating labour hire workers as you would employees and other workers with respect to health and safety and the provision of a safe working environment and PPE (if PPE is not provided by the labour hire PCBU/s) • providing adequate supervision of the worker/s at all times to ensure that work is being performed safely • consulting with the labour hire PCBU/s and worker/s regarding any changes which may affect WHS. Ensure you do not transfer workers to new tasks or change the nature of their work tasks, work environment or work location until you have consulted with the worker/s and obtained the approval of the labour hire PCBU/s • encouraging labour hire workers to participate in the identification of hazards and risks specific to their work • supporting and encouraging labour hire workers to participate in workplace safety consultative arrangements • working with the labour hire PCBU/s to facilitate appropriate WHS arrangements. For example, allow the labour hire PCBU/s access to workers, the workplace and relevant documents for the purpose of workplace safety assessments and to fulfil their WHS duties as a PCBU • facilitating any assessments conducted by the labour hire PCBU/s, for example, WHS management assessments or work site assessments • providing any further training, instruction or information prior to transferring a labour hire worker to new tasks, in a way that is suitable, adequate and readily understandable to the worker. • encouraging labour hire workers to maintain contact with the labour hire PCBU/s throughout their placement, and • in the event of an incident, notifying the labour hire PCBU/s as soon as practicable and working with them to implement agreed arrangements. For example, allowing the labour hire PCBU/s access to the workplace and to relevant documents to fulfil their WHS duties as a PCBU. Duties of a labour hire PCBU As a labour hire PCBU under the model WHS laws, it is your duty to ensure, so far as is reasonably practicable, the health and safety of workers during their placement with the host PCBU/s. It is your duty to eliminate or, if that is not reasonably practicable, minimise risks to health and safety a labour hire worker may encounter. In some circumstances, this means not placing workers in, or removing workers from, a workplace where you believe there is a risk to their health and safety or where risks have not been adequately controlled. Before placing labour hire workers Before you place labour hire workers, you should consider: • reviewing the host PCBU’s safety record to satisfy yourself that they provide a safe workplace • gathering information about the work and the workplace/s, including the work environment/s, accommodation arrangements, organisational arrangements, health and safety risks associated with the work and any skills and knowledge the worker will require to safely undertake the GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 5 of 7 work. This might include information about facilities, work schedules and environmental factors, such as whether work will be conducted outdoors • providing workers with suitable, adequate and readily understandable WHS induction and training. Include any risks you have identified and consultation methods you have established with workers and the host PCBU/s • verifying and working with the host PCBU to ensure site specific and task specific induction, training and PPE is provided to labour hire workers in a way that is suitable, adequate and readily understandable to them • assessing the workplace/s for any risks to health and safety, as appropriate. Work with the host PCBU/s to gather enough information to make an assessment, for example, by arranging a workplace visit. Where risks are identified, consult with the host/s to ensure they are eliminated, or if that is not reasonably practicable, minimised • ensuring that workers have the necessary qualifications, licences, skills and training to safely carry out the work. In limited circumstances you may be required to verify the worker/s are medically fit to carry out the work (see regulations 168 and 417(3)(b) of the model WHS Regulations). • consulting with the host PCBU and workers to ensure you and the workers understand and are confident in your understanding of the WHS policies, procedures and practices of the host PCBU/s • discussing with the host PCBU arrangements for health monitoring and vaccinations • establishing communication methods workers can use to contact you if they consider there is any risk to their health or safety • discussing consultation arrangements with the host PCBU/s • ensuring workers have the means to identify and take action in an unsafe situation at the host workplace, such as stopping work or bringing it to the attention of the host PCBU/s, a health and safety committee representative or health and safety representative • ensuring workers have the means to raise safety issues with you if they are unsatisfied with the host PCBU’s response • establishing, in consultation with the host PCBU/s, a review process for ensuring the ongoing WHS of workers, and • any more you can do to ensure the health and safety of the labour hire worker. During a labour hire worker’s placement While your workers are placed with the host PCBU, you should consider: • consulting with the host PCBU/s and labour hire workers on any changes which may affect their health and safety. For example, this may include consultation about the use of plant and equipment not envisaged prior to placement • working with the host PCBU/s to undertake workplace safety assessments in accordance with agreed arrangements GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 6 of 7 • where WHS advice or workplace assessments are required, working with the host PCBU to ensure the person/s engaged to conduct those assessments are suitably qualified • monitoring the workplace for new risks to health and safety and consulting with the host PCBU/s about how they might be addressed. This might include regular visits to the host/s workplace • encouraging workers to maintain contact with you and to provide feedback on health and safety matters in the host/s workplace • taking effective action when the worker or host PCBU/s identifies risks or raises concerns about health and safety. This might include removing the worker from the workplace, and • in the event of an incident, working with the host PCBU/s to respond effectively. Further information More information on the topics covered in this Guide can be found here: • How to determine what is reasonably practicable to meet a health and safety duty • The meaning of ‘persons conducting a business or undertaking’ • Work health and safety consultation, cooperation and coordination You can also find further information about other WHS topics on the Safe Work Australia website swa.gov.au. Safe Work Australia is a national policy body responsible for WHS and workers’ compensation arrangements. We do not regulate or enforce WHS or workers’ compensation laws. This guide provides information on the model WHS laws. It is important to consider the WHS laws that apply in your circumstances. To find out more, contact your WHS regulator. Where your business arrangements span multiple jurisdictions, you may need to contact more than one WHS regulator. The relevant contact details are available on our website swa.gov.au/whs-authorities-contactinformation. In most jurisdictions the labour hire PCBU (not the host PCBU) is responsible for providing workers’ compensation to the worker, however there are exemptions to this. However, labour hire and host PCBUs should work together to coordinate return to work arrangements and support workers through the return to work process. It is important to contact your workers’ compensation authority for more information on understanding and complying with your workers’ compensation obligations as penalties can apply. Some jurisdictions have implemented a labour hire licensing scheme. Safe Work Australia cannot provide advice in relation to these schemes. It is your responsibility to identify whether these requirements apply to you. GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 7 of 7 Disclaimer Safe Work Australia is an Australian Government statutory agency established in 2009. Safe Work Australia includes Members from the Commonwealth, and each state and territory, Members representing the interests of workers and Members representing the interests of employers. Safe Work Australia works with the Commonwealth, state and territory governments to improve work health and safety and workers’ compensation arrangements. Safe Work Australia is a national policy body, not a regulator of work health and safety. The Commonwealth, states and territories have responsibility for regulating and enforcing work health and safety laws in their jurisdiction. ISBN 978-1-76051-811-0 (PDF) ISBN 978-1-76051-812-7 (DOCX) Creative Commons With the exception of the Safe Work Australia logo, this copyright work is licensed under a Creative Commons AttributionNoncommercial 4.0 International licence. To view a copy of this licence, visit creativecommons.org/licenses In essence, you are free to copy, communicate and adapt the work for non-commercial purposes, as long as you attribute the work to Safe Work Australia and abide by the other licence terms. Contact information Safe Work Australia | info@swa.gov.au | www.swa.gov.au","When responding, restrict yourself to only information found within the given article - no other information is valid or necessary. How should we as a labor hire provider respond if a labor hire worker refuses to carry out work due to safety concerns? GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 1 of 7 Labour hire: duties of persons conducting a business or undertaking This Guide provides information for persons conducting a business or undertaking (PCBUs) involving the supply of workers (labour hire PCBUs) to work for another business or undertaking (host PCBUs) on complying with their health and safety duties under the model Work Health and Safety (WHS) laws. Model Work Health and Safety Act and labour hire arrangements Labour hire arrangements are covered by the model WHS Act. The primary duty of care under the model WHS Act is owed by a PCBU to a ‘worker’, which includes a labour hire worker. All labour hire PCBUs and host PCBUs have a primary duty of care to ensure, so far as is reasonably practicable, the health and safety of labour hire workers engaged by, or caused to be engaged by them, or whose activities are influenced or directed by the PCBU. The model WHS Act provides that more than one duty holder may have the same duty, in this instance a labour hire PCBU and a host PCBU. Labour hire arrangements can be complex. In some circumstances, there may be more than one labour hire or host PCBU. If more than one person has a duty for the same matter, each person must meet their duty to the extent to which they have the capacity to influence and control the matter. A labour hire PCBU or host PCBU may exercise influence and control over a relevant matter through, for example, the terms of a contract or directing workers in a practical sense. However, duty holders cannot contract out of or transfer their WHS obligations to another person. Consultation between PCBUs All duty holders in a labour hire arrangement must consult, cooperate and coordinate with each other so far as is reasonably practicable. Each duty holder should share information to find out who is doing what and work together in a cooperative and coordinated way to ensure compliance with WHS laws. For example, host and labour hire PCBUs must discuss consultation arrangements, the hazards and risks associated with the work, what precautions will be taken to ensure the health and safety of the labour hire worker and the respective roles the organisations in responding to an incident. Some labour hire PCBUs may have substantial knowledge of WHS issues and risk management practices in their industry that may assist in assessing the practices of a host PCBU and ensuring compliance with WHS laws. Duty holders should not assume that someone else is taking care of a health and GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 2 of 7 safety matter. Find out who is doing what and work together with other duty holders so risks are eliminated or minimised as far as is reasonably practicable. What is reasonable practicable will depend on the circumstances. Relevant issues for duty holders to discuss will depend on the circumstances. These may include: • hazards and risks that may arise, taking into account things like the physical environment where work will occur • control measures to eliminate or minimise risks and the suitability of those measures • compliance with minimum requirements set by legislation, such as the WHS laws • how work will be carried out (including safe work methods and processes that are already in place or need to be in place) • the people involved in the work (including supervision arrangements) • competency and training requirements, including arrangements for the provision of additional training required for the particular work • arrangements for facilitating assessments of the individual worker’s needs and/or competencies, as appropriate • arrangements for health monitoring and relevant vaccinations • the respective roles of the organisations in responding to an incident, as well as relevant policies and procedures, and • any other factors which may impact the work environment and how work is carried out. Like all PCBUs, labour hire and host PCBUs are required to be proactive in managing hazards and risks. The duties in the model WHS Act are ongoing and must be complied with throughout the labour hire arrangement. Be aware that circumstances can change over time and this may result in a change in the hazards and risks or in the ways they may be eliminated or minimised. Changes that may necessitate a review of hazards, risks and control measures may include: • change in a work process • change in the physical environment • different people undertaking the work, with different skills or means of co-ordinating activities • new hazards are identified, and • new ways to eliminate or minimise risks are identified or invented. If a labour hire worker has a reasonable concern that to carry out the work would expose them to a serious health or safety risk, they may cease, or refuse to carry out work. A labour hire and host PCBU must not discriminate against a worker for exercising this or any other right under the model WHS Act. Duties of a host PCBU As a host PCBU under the model WHS Act, you have the same health and safety duties to labour hire workers as you do to other types of workers. It is your duty to ensure, so far as is reasonably practicable, the health and safety of all workers while at work. This duty requires you to eliminate or, if that is not reasonably practicable, to minimise risks to their health and safety. To identify what is reasonably practicable to do, you must take into account all the relevant matters and work with the labour hire PCBU/s to provide the highest level of protection that is both possible and reasonable in the circumstances. GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 3 of 7 As a host PCBU, you must also consult, cooperate and coordinate activities with the labour hire PCBU/s to ensure you meet your obligations. The model WHS Act specifically provides that you cannot contract out of or transfer your WHS obligations to another party, including labour hire or other host PCBUs. Before engaging labour hire workers Before you engage labour hire workers to carry out work, you should consider: • providing the labour hire PCBU/s with detailed information about the nature of work to be carried out including details of, and where possible supporting material, relating to: o the work environment/s o tasks to be performed o accommodation arrangements o any known hazards or risks o any plant or equipment to be used o organisational and WHS arrangements, including supervision arrangements and any other organisations responsible for the worker during the arrangement o health and safety risks associated with the work, and o any skills, knowledge, licenses and qualifications required to safely undertake the work. • verifying, in consultation with the labour hire PCBU, that the selected worker/s have any necessary qualifications, licences, skills and training to carry out the work safely. In limited circumstances, you may be required to verify the worker/s are medically fit to carry out the work (see regulations 168 and 417(3)(b) of the model WHS Regulations) • discussing with the labour hire PCBU arrangements for health monitoring and vaccinations • consulting with the labour hire PCBU/s on WHS matters including in relation to who will provide any necessary equipment such as personal protective equipment (PPE), and relevant points of contact for health and safety between the organisations • ensuring that general health and safety information about the work, workplace and work environment has been provided to the worker/s. Check that you have provided this information in a way that is suitable, adequate and readily understandable for the worker/s • eliminating or, if that is not reasonably practicable, minimising risks in the workplace • establishing, in consultation with the labour hire PCBU/s, a review process for ensuring the ongoing WHS of workers, and • any more you can do to ensure the health and safety of all your workers. During a labour hire worker’s placement While labour hire workers are carrying out work, you should consider: • providing the worker/s with a site specific safety induction outlining WHS duties, policies, procedures and practices in the workplace including consultation methods • where WHS advice or workplace assessments are required, ensuring the persons engaged to conduct GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 4 of 7 those assessments are suitably qualified • treating labour hire workers as you would employees and other workers with respect to health and safety and the provision of a safe working environment and PPE (if PPE is not provided by the labour hire PCBU/s) • providing adequate supervision of the worker/s at all times to ensure that work is being performed safely • consulting with the labour hire PCBU/s and worker/s regarding any changes which may affect WHS. Ensure you do not transfer workers to new tasks or change the nature of their work tasks, work environment or work location until you have consulted with the worker/s and obtained the approval of the labour hire PCBU/s • encouraging labour hire workers to participate in the identification of hazards and risks specific to their work • supporting and encouraging labour hire workers to participate in workplace safety consultative arrangements • working with the labour hire PCBU/s to facilitate appropriate WHS arrangements. For example, allow the labour hire PCBU/s access to workers, the workplace and relevant documents for the purpose of workplace safety assessments and to fulfil their WHS duties as a PCBU • facilitating any assessments conducted by the labour hire PCBU/s, for example, WHS management assessments or work site assessments • providing any further training, instruction or information prior to transferring a labour hire worker to new tasks, in a way that is suitable, adequate and readily understandable to the worker. • encouraging labour hire workers to maintain contact with the labour hire PCBU/s throughout their placement, and • in the event of an incident, notifying the labour hire PCBU/s as soon as practicable and working with them to implement agreed arrangements. For example, allowing the labour hire PCBU/s access to the workplace and to relevant documents to fulfil their WHS duties as a PCBU. Duties of a labour hire PCBU As a labour hire PCBU under the model WHS laws, it is your duty to ensure, so far as is reasonably practicable, the health and safety of workers during their placement with the host PCBU/s. It is your duty to eliminate or, if that is not reasonably practicable, minimise risks to health and safety a labour hire worker may encounter. In some circumstances, this means not placing workers in, or removing workers from, a workplace where you believe there is a risk to their health and safety or where risks have not been adequately controlled. Before placing labour hire workers Before you place labour hire workers, you should consider: • reviewing the host PCBU’s safety record to satisfy yourself that they provide a safe workplace • gathering information about the work and the workplace/s, including the work environment/s, accommodation arrangements, organisational arrangements, health and safety risks associated with the work and any skills and knowledge the worker will require to safely undertake the GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 5 of 7 work. This might include information about facilities, work schedules and environmental factors, such as whether work will be conducted outdoors • providing workers with suitable, adequate and readily understandable WHS induction and training. Include any risks you have identified and consultation methods you have established with workers and the host PCBU/s • verifying and working with the host PCBU to ensure site specific and task specific induction, training and PPE is provided to labour hire workers in a way that is suitable, adequate and readily understandable to them • assessing the workplace/s for any risks to health and safety, as appropriate. Work with the host PCBU/s to gather enough information to make an assessment, for example, by arranging a workplace visit. Where risks are identified, consult with the host/s to ensure they are eliminated, or if that is not reasonably practicable, minimised • ensuring that workers have the necessary qualifications, licences, skills and training to safely carry out the work. In limited circumstances you may be required to verify the worker/s are medically fit to carry out the work (see regulations 168 and 417(3)(b) of the model WHS Regulations). • consulting with the host PCBU and workers to ensure you and the workers understand and are confident in your understanding of the WHS policies, procedures and practices of the host PCBU/s • discussing with the host PCBU arrangements for health monitoring and vaccinations • establishing communication methods workers can use to contact you if they consider there is any risk to their health or safety • discussing consultation arrangements with the host PCBU/s • ensuring workers have the means to identify and take action in an unsafe situation at the host workplace, such as stopping work or bringing it to the attention of the host PCBU/s, a health and safety committee representative or health and safety representative • ensuring workers have the means to raise safety issues with you if they are unsatisfied with the host PCBU’s response • establishing, in consultation with the host PCBU/s, a review process for ensuring the ongoing WHS of workers, and • any more you can do to ensure the health and safety of the labour hire worker. During a labour hire worker’s placement While your workers are placed with the host PCBU, you should consider: • consulting with the host PCBU/s and labour hire workers on any changes which may affect their health and safety. For example, this may include consultation about the use of plant and equipment not envisaged prior to placement • working with the host PCBU/s to undertake workplace safety assessments in accordance with agreed arrangements GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 6 of 7 • where WHS advice or workplace assessments are required, working with the host PCBU to ensure the person/s engaged to conduct those assessments are suitably qualified • monitoring the workplace for new risks to health and safety and consulting with the host PCBU/s about how they might be addressed. This might include regular visits to the host/s workplace • encouraging workers to maintain contact with you and to provide feedback on health and safety matters in the host/s workplace • taking effective action when the worker or host PCBU/s identifies risks or raises concerns about health and safety. This might include removing the worker from the workplace, and • in the event of an incident, working with the host PCBU/s to respond effectively. Further information More information on the topics covered in this Guide can be found here: • How to determine what is reasonably practicable to meet a health and safety duty • The meaning of ‘persons conducting a business or undertaking’ • Work health and safety consultation, cooperation and coordination You can also find further information about other WHS topics on the Safe Work Australia website swa.gov.au. Safe Work Australia is a national policy body responsible for WHS and workers’ compensation arrangements. We do not regulate or enforce WHS or workers’ compensation laws. This guide provides information on the model WHS laws. It is important to consider the WHS laws that apply in your circumstances. To find out more, contact your WHS regulator. Where your business arrangements span multiple jurisdictions, you may need to contact more than one WHS regulator. The relevant contact details are available on our website swa.gov.au/whs-authorities-contactinformation. In most jurisdictions the labour hire PCBU (not the host PCBU) is responsible for providing workers’ compensation to the worker, however there are exemptions to this. However, labour hire and host PCBUs should work together to coordinate return to work arrangements and support workers through the return to work process. It is important to contact your workers’ compensation authority for more information on understanding and complying with your workers’ compensation obligations as penalties can apply. Some jurisdictions have implemented a labour hire licensing scheme. Safe Work Australia cannot provide advice in relation to these schemes. It is your responsibility to identify whether these requirements apply to you. GUIDE | Labour hire: duties of persons conducting a business or undertaking Page 7 of 7 Disclaimer Safe Work Australia is an Australian Government statutory agency established in 2009. Safe Work Australia includes Members from the Commonwealth, and each state and territory, Members representing the interests of workers and Members representing the interests of employers. Safe Work Australia works with the Commonwealth, state and territory governments to improve work health and safety and workers’ compensation arrangements. Safe Work Australia is a national policy body, not a regulator of work health and safety. The Commonwealth, states and territories have responsibility for regulating and enforcing work health and safety laws in their jurisdiction. ISBN 978-1-76051-811-0 (PDF) ISBN 978-1-76051-812-7 (DOCX) Creative Commons With the exception of the Safe Work Australia logo, this copyright work is licensed under a Creative Commons AttributionNoncommercial 4.0 International licence. To view a copy of this licence, visit creativecommons.org/licenses In essence, you are free to copy, communicate and adapt the work for non-commercial purposes, as long as you attribute the work to Safe Work Australia and abide by the other licence terms. Contact information Safe Work Australia | info@swa.gov.au | www.swa.gov.au",Legal,Effect Analysis,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",How does the Celcomen model ensure the robustness and identifiability of the gene-gene interactions through both simulation and biological experiments? What are the specific methodologies used in validating these interactions?,"Simulations testing Celcomen’s identifiability guarantees Simulations were done in Python and completed by first generating a ground truth genegene interaction matrix. This was achieved by creating a n-genes by n-genes matrix of random values; for these experiments four genes were used. We then utilized Celcomen’s generative module, Simcomen, to learn a spatially-resolved counts matrix reflective of the ground truth gene-gene interaction matrix. Comparisons to the randomly initialized count matrix are termed “Raw input” and those to the learned count matrix are termed “SCC output”. To interrogate for self-consistency, we initialized Celcomen’s inference module with a random gene-gene interaction matrix and asked it to utilize the learned count matrix from Simcomen to decipher the ground truth gene-gene interaction matrix. Comparisons to the Celcomen outputted gene-gene interaction matrix are termed “CCC output”. Spearman correlation was used to compare the ground-truth gene-gene interaction values and the simulated-then-inferred gene-gene interaction values to test for model robustness and identifiability. For all exact parameter values utilized during the experiments, see the “analysis.simulations.ipynb” notebook in the reproducibility GitHub. Biological testing of Celcomen’s identifiability guarantees Biological confirmation of Celcomen’s identifiability guarantee was done by training two Celcomen inference module instances at the same time and comparing their derived gene-gene interaction results. The first model instance, which we call sample-specific, was trained only on one sample. The second model instance, which we call rest, was trained on the remaining samples. Thus, these two model instances are never trained on the same samples. Each model is trained to completion utilizing the same model hyperparameters, and their gene-gene interaction matrices are retrieved after the final epoch. We correlate a flattened version of their gene-gene interaction matrices using Spearman’s correlation due to the possible non-linear nature of the matrices’ values. We repeat this experiment for each of the samples in the fetal spleen dataset. The results across each sample’s experiments are aggregated together and compared in a bar plot. We derived a “random” control to compare to by shuffling the order of the flattened genegene interaction matrices and computing a correlation of the shuffled values. MannWhitney U test is used to derive p-values and all p-values are labeled on plot. For the full code utilized, see the “analysis.biological.ipynb” notebook in the reproducibility GitHub. Interferon knockout experiment on Xenium of human glioblastoma Processed Xenium data was subjected to the inference module of Celcomen, CCE, and then these gene-gene interaction values were annotated as containing cytoplasmic, surface membrane (plasma membrane GO ID via GO cellular component), or secreted (extracellular space GO ID also via GO cellular component) genes according to their GO IDs from QuickGO36. IFITM3 was knocked out in a randomly selected previously IFITM3 positive cell. First neighbors were defined as less than 15 µm away and second neighbors were defined as less than 30 µm away. Changes in each gene’s expression in each cell were calculated and these changes in expression pre- and post- perturbation were compared between different specified cellular subsets. These are the differential genes later used for differential expression analysis and pathway enrichment. Gene set enrichment analysis (GSEA) in R (v4.1.2) was utilized to perform pathway enrichment analysis on differentially post-perturbation affected genes. The interferon signature was derived directly from tissue by computing the differentially expressed genes between interferon high and low cells and taking the top 25, excluding the perturbed IFITM3 as that would bias analyses. For the full model parameters and code utilized, see the “analysis.perturbation.ipynb” notebook in the reproducibility GitHub. Counterfactual prediction validation via in vivo perturbed lung tumors Spatial perturbation data was acquired from previously published Perturb-map technology, GSE19346027. Their processed spaceranger output and annotations were read in and wild-type (WT) lesions, as previously annotated, were identified and any spots that were within two degrees of a perturbation specific cluster were trimmed away; this was done via a <100 filter in spatial distance with the value of 100 visually acquired from a histogram of spot-spot spatial distances (i.e. distance of 100 was the second non-zero peak). Lesions were then fed into the Celcomen model to identify gene-gene relationships and the trained gene-gene interaction matrix was used by Simcomen for counterfactual predictions. In detail, each lesion was examined for Tgfbr2+ spots and had a random positive spot knocked out (KO) in terms of Tgfbr2 expression. Simcomen then utilized the learned gene-gene interaction matrix to predict the whole transcriptome of every spot post perturbation. We then compared the change in expression in the KO spot compared to WT spots. Spearman correlation was used to compare model Tgfbr2 KO versus WT gene rankings with those directly derived from experimental Tgfbr2 KO spots and WT, i.e. the published data includes an in vivo bona fide Tgfbr2 KO lesion and this was used as ground truth. We derived “random” controls for each lesion by computing correlations on shuffled gene rankings of the observed and predicted differentials between Tgfbr2 KO and WT. Mann-Whitney U test is used to derive p-value when comparing observed lesion derived gene rankings with those from random shufflings. For the full code utilized, see the “analysis.biological.ipynb” notebook in the reproducibility GitHub.","""================ ======= Simulations testing Celcomen’s identifiability guarantees Simulations were done in Python and completed by first generating a ground truth genegene interaction matrix. This was achieved by creating a n-genes by n-genes matrix of random values; for these experiments four genes were used. We then utilized Celcomen’s generative module, Simcomen, to learn a spatially-resolved counts matrix reflective of the ground truth gene-gene interaction matrix. Comparisons to the randomly initialized count matrix are termed “Raw input” and those to the learned count matrix are termed “SCC output”. To interrogate for self-consistency, we initialized Celcomen’s inference module with a random gene-gene interaction matrix and asked it to utilize the learned count matrix from Simcomen to decipher the ground truth gene-gene interaction matrix. Comparisons to the Celcomen outputted gene-gene interaction matrix are termed “CCC output”. Spearman correlation was used to compare the ground-truth gene-gene interaction values and the simulated-then-inferred gene-gene interaction values to test for model robustness and identifiability. For all exact parameter values utilized during the experiments, see the “analysis.simulations.ipynb” notebook in the reproducibility GitHub. Biological testing of Celcomen’s identifiability guarantees Biological confirmation of Celcomen’s identifiability guarantee was done by training two Celcomen inference module instances at the same time and comparing their derived gene-gene interaction results. The first model instance, which we call sample-specific, was trained only on one sample. The second model instance, which we call rest, was trained on the remaining samples. Thus, these two model instances are never trained on the same samples. Each model is trained to completion utilizing the same model hyperparameters, and their gene-gene interaction matrices are retrieved after the final epoch. We correlate a flattened version of their gene-gene interaction matrices using Spearman’s correlation due to the possible non-linear nature of the matrices’ values. We repeat this experiment for each of the samples in the fetal spleen dataset. The results across each sample’s experiments are aggregated together and compared in a bar plot. We derived a “random” control to compare to by shuffling the order of the flattened genegene interaction matrices and computing a correlation of the shuffled values. MannWhitney U test is used to derive p-values and all p-values are labeled on plot. For the full code utilized, see the “analysis.biological.ipynb” notebook in the reproducibility GitHub. Interferon knockout experiment on Xenium of human glioblastoma Processed Xenium data was subjected to the inference module of Celcomen, CCE, and then these gene-gene interaction values were annotated as containing cytoplasmic, surface membrane (plasma membrane GO ID via GO cellular component), or secreted (extracellular space GO ID also via GO cellular component) genes according to their GO IDs from QuickGO36. IFITM3 was knocked out in a randomly selected previously IFITM3 positive cell. First neighbors were defined as less than 15 µm away and second neighbors were defined as less than 30 µm away. Changes in each gene’s expression in each cell were calculated and these changes in expression pre- and post- perturbation were compared between different specified cellular subsets. These are the differential genes later used for differential expression analysis and pathway enrichment. Gene set enrichment analysis (GSEA) in R (v4.1.2) was utilized to perform pathway enrichment analysis on differentially post-perturbation affected genes. The interferon signature was derived directly from tissue by computing the differentially expressed genes between interferon high and low cells and taking the top 25, excluding the perturbed IFITM3 as that would bias analyses. For the full model parameters and code utilized, see the “analysis.perturbation.ipynb” notebook in the reproducibility GitHub. Counterfactual prediction validation via in vivo perturbed lung tumors Spatial perturbation data was acquired from previously published Perturb-map technology, GSE19346027. Their processed spaceranger output and annotations were read in and wild-type (WT) lesions, as previously annotated, were identified and any spots that were within two degrees of a perturbation specific cluster were trimmed away; this was done via a <100 filter in spatial distance with the value of 100 visually acquired from a histogram of spot-spot spatial distances (i.e. distance of 100 was the second non-zero peak). Lesions were then fed into the Celcomen model to identify gene-gene relationships and the trained gene-gene interaction matrix was used by Simcomen for counterfactual predictions. In detail, each lesion was examined for Tgfbr2+ spots and had a random positive spot knocked out (KO) in terms of Tgfbr2 expression. Simcomen then utilized the learned gene-gene interaction matrix to predict the whole transcriptome of every spot post perturbation. We then compared the change in expression in the KO spot compared to WT spots. Spearman correlation was used to compare model Tgfbr2 KO versus WT gene rankings with those directly derived from experimental Tgfbr2 KO spots and WT, i.e. the published data includes an in vivo bona fide Tgfbr2 KO lesion and this was used as ground truth. We derived “random” controls for each lesion by computing correlations on shuffled gene rankings of the observed and predicted differentials between Tgfbr2 KO and WT. Mann-Whitney U test is used to derive p-value when comparing observed lesion derived gene rankings with those from random shufflings. For the full code utilized, see the “analysis.biological.ipynb” notebook in the reproducibility GitHub. https://arxiv.org/pdf/2409.05804 ================ ======= How does the Celcomen model ensure the robustness and identifiability of the gene-gene interactions through both simulation and biological experiments? What are the specific methodologies used in validating these interactions? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Explanation/Definition,Q&A Use only the Context Block to answer the Question. Your audience is people with limited tech knowledge. ,What is the example provided for the importance of Alert Verification in Intrusion Detection Systems?,"Abstract This chapter describes security threats that systems face when they are connected to the Internet. We discuss their security requirements, potential security threats and different mechanisms to combat these. In addition, the text presents the two most popular protocols (SSL and its successor TLS) to secure data transmitted over the Internet. Finally, we describe wellknown applications such as Secure Shell (ssh) and Secure File Transfer Protocol (sftp) that provide a reasonable level of security for common tasks. They may be utilized as underlying building blocks to create secure, Internet enabled applications. In order to provide useful services or to allow people to perform tasks more conveniently, computer systems are attached to networks and get interconnected. This resulted in the world-wide collection of local and wide-area networks known as the Internet. Unfortunately, the extended access possibilities also entail increased security risks as it opens additional avenues for an attacker. For a closed, local system, the attacker was required to be physically present at the network in order to perform unauthorized actions. In the networked case, each host that can send packets to the victim can be potentially utilized. As certain services (such as web or name servers) need to be publicly available, each machine on the Internet might be the originator of malicious activity. This fact makes attacks very likely to happen on a regularly basis. The following text attempts to give a systematic overview of security requirements of Internetbased systems and potential means to satisfy them. We define properties of a secure system and provide a classification of potential threats to them. We also introduce mechanisms to defend against attacks that attempt to violate desired properties. The most widely used means to secure application data against tampering and eavesdropping, the Secure Sockets Layer (SSL) and its successor, the Transport Layer Security (TLS) protocol are discussed. Finally, we briefly describe popular application programs that can act as building blocks for securing custom applications. Before one can evaluate attacks against a system and decide on appropriate mechanisms against them, it is necessary to specify a security policy [23]. A security policy defines the desired properties for each part of a secure computer system. It is a decision that has to take into account the value of the assets that should be protected, the expected threats and the cost of proper protection mechanisms. A security policy that is sufficient for the data of a normal user at home may not be sufficient for bank applications, as these systems are obviously a more likely target and have to protect more valuable resources. Although often neglected, the formulation of an adequate security policy is a prerequisite before one can identify threats and appropriate mechanisms to face them. Security Attacks and Security Properties For the following discussion, we assume that the function of a system that is the target of an attack is to provide information. In general, there is a flow of data from a source (e.g. host, file, memory) to a destination (e.g. remote host, other file, user) over a communication channel (e.g. wire, data bus). The task of the security system is to restrict access to this information to only those parties (persons or processes) that are authorized to have access according to the security policy in use. In the case of an automation system which is remotely connected to the Internet, the information flow is from/to a control application that manages sensors and actuators via communication lines of the public Internet and the network of the automation system (e.g. a field-bus). The normal information flow and several categories of attacks that target it are shown in Figure 1 and explained below (according to [22]). 1. Interruption: An asset of the system gets destroyed or becomes unavailable. This attack targets the source or the communication channel and prevents information from reaching its intended target (e.g. cut the wire, overload the link so that the information gets dropped because of congestion). Attacks in this category attempt to perform a kind of denial-of-service (DOS). 2. Interception: An unauthorized party gets access to the information by eavesdropping into the communication channel (e.g. wiretapping). 3. Modification: The information is not only intercepted, but modified by an unauthorized party while in transit from the source to the destination. By tampering with the information, it is actively altered (e.g. modifying message content). 4. Fabrication: An attacker inserts counterfeit objects into the system without having the sender doing anything. When a previously intercepted object is inserted, this processes is called replaying. When the attacker pretends to be the legitimate source and inserts his desired information, the attack is called masquerading (e.g. replay an authentication message, add records to a file). The four classes of attacks listed above violate different security properties of the computer system. A security property describes a desired feature of a system with regards to a certain type of attack. A common classification following [5, 13] is listed below. • Confidentiality: This property covers the protection of transmitted data against its release to non-authorized parties. In addition to the protection of the content itself, the information flow should also be resistant against traffic analysis. Traffic analysis is used to gather other information than the transmitted values themselves from the data flow (e.g. timing data, frequency of messages). • Authentication: Authentication is concerned with making sure that the information is authentic. A system implementing the authentication property assures the recipient that the data is from the source that it claims to be. The system must make sure that no third party can masquerade successfully as another source. • Non-repudiation: This property describes the feature that prevents either sender or receiver from denying a transmitted message. When a message has been transferred, the sender can prove that it has been received. Similarly, the receiver can prove that the message has actually been sent. • Availability: Availability characterizes a system whose resources are always ready to be used. Whenever information needs to be transmitted, the communication channel is available and the receiver can cope with the incoming data. This property makes sure that attacks cannot prevent resources from being used for their intended purpose. • Integrity: Integrity protects transmitted information against modifications. This property assures that a single message reaches the receiver as it has left the sender, but integrity also extends to a stream of messages. It means that no messages are lost, duplicated or reordered and it makes sure that messages cannot be replayed. As destruction is also covered under this property, all data must arrive at the receiver. Integrity is not only important as a security property, but also as a property for network protocols. Message integrity must also be ensured in case of random faults, not only in case of malicious modifications. Security Mechanisms Different security mechanisms can be used to enforce the security properties defined in a given security policy. Depending on the anticipated attacks, different means have to be applied to satisfy the desired properties. We divide these measures against attacks into three different classes, namely attack prevention, attack avoidance and attack detection. Attack Prevention Attack prevention is a class of security mechanisms that contains ways of preventing or defending against certain attacks before they can actually reach and affect the target. An important element in this category is access control, a mechanism which can be applied at different levels such as the operating system, the network or the application layer. Access control [23] limits and regulates the access to critical resources. This is done by identifying or authenticating the party that requests a resource and checking its permissions against the rights specified for the demanded object. It is assumed that an attacker is not legitimately permitted to use the target object and is therefore denied access to the resource. As access is a prerequisite for an attack, any possible interference is prevented. The most common form of access control used in multi-user computer systems are access control lists for resources that are based on the user identity of the process that attempts to use them. The identity of a user is determined by an initial authentication process that usually requires a name and a password. The login process retrieves the stored copy of the password corresponding to the user name and compares it with the presented one. When both match, the system grants the user the appropriate user credentials. When a resource should be accessed, the system looks up the user and group in the access control list and grants or denies access as appropriate. An example of this kind of access control is a secure web server. A secure web server delivers certain resources only to clients that have authenticated themselves and that posses sufficient credentials for the desired resource. The authentication process is usually handled by the web client such as the Microsoft Internet Explorer or Mozilla by prompting the user for his name and password. The most important access control system at the network layer is a firewall [4]. The idea of a firewall is based on the separation of a trusted inside network of computers under single administrative control from a potential hostile outside network. The firewall is a central choke point that allows enforcement of access control for services that may run at the inside or outside. The firewall prevents attacks from the outside against the machines in the inside network by denying connection attempts from unauthorized parties located outside. In addition, a firewall may also be utilized to prevent users behind the firewall from using certain services that are outside (e.g. surfing web sites containing pornographic material). For certain installations, a single firewall is not suitable. Networks that consist of several server machines which need to be publicly accessible and workstations that should be completely protected against connections from the outside would benefit from a separation between these two groups. When an attacker compromises a server machine behind a single firewall, all other machines can be attacked from this new base without restrictions. To prevent this, one can use two firewalls and the concept of a demilitarized zone (DMZ) [4] in between as shown in Figure 2. In this setup, one firewall separates the outside network from a segment (DMZ) with the server machines while a second one separates this area from the rest of the network. The second firewall can be configured in a way that denies all incoming connection attempts. Whenever an intruder compromises a server, he is now unable to immediately attack a workstation located in the inside network. The following design goals for firewalls are identified in [4]. 1. All traffic from inside to outside, and vice versa, must pass through the firewall. This is achieved by physically blocking all access to the internal network except via the firewall. 2. Only authorized traffic, as defined by the local security policy, will be allowed to pass. 3. The firewall itself should be immune to penetration. This implies the use of a trusted system with a secure operating system. A trusted, secure operating system is often purpose-built, has heightened security features and only provides the minimal functionality necessary to run the desired applications. These goals can be reached by using a number of general techniques for controlling access. The most common is called service control and determines Internet services that can be accessed. Traffic on the Internet is currently filtered on basis of IP addresses and TCP/UDP port numbers. In addition, there may be proxy software that receives and interprets each service request before passing it on. Direction control is a simple mechanism to control the direction in which particular service requests may be initiated and permitted to flow through. User control grants access to a service based on user credentials similar to the technique used in a multi-user operating system. Controlling external users requires secure authentication over the network (e.g. such as provided in IPSec [10]). A more declarative approach in contrast to the operational variants mentioned above is behavior control. This technique determines how particular services are used. It may be utilized to filter e-mail to eliminate spam or to allow external access to only part of the local web pages. A summary of capabilities and limitations of firewalls is given in [22]. The following benefits can be expected. • A firewall defines a single choke point that keeps unauthorized users out of the protected network. The use of such a point also simplifies security management. • It provides a location for monitoring security related events. Audits, logs and alarms can be implemented on the firewall directly. In addition, it forms a convenient platform for some non-security related functions such as address translation and network management. • A firewall may serve as a platform to implement a virtual private network (e.g. by using IPSec). The list below enumerates the limits of the firewall access control mechanism. • A firewall cannot protect against attacks that bypass it, for example, via a direct dial-up link from the protected network to an ISP (Internet Service Provider). It also does not protect against internal threats from an inside hacker or an insider cooperating with an outside attacker. • A firewall does not help when attacks are against targets whose access has to be permitted. • It cannot protect against the transfer of virus-infected programs or files. It would be impossible, in practice, for the firewall to scan all incoming files and e-mails for viruses. Firewalls can be divided into two main categories. A Packet-Filtering Router, or short packet filter, is an extended router that applies certain rules to the packets which are forwarded. Usually, traffic in each direction (in- and outgoing) is checked against a rule set which determines whether a packet is permitted to continue or should be dropped. The packet filter rules operate on the header fields used by the underlying communication protocols, for the Internet almost always IP, TCP and UDP. Packet filters have the advantage that they are cheap as they can often be built on existing hardware. In addition, they offer a good performance for high traffic loads. An example for a packet filter is the iptables package which is implemented as part of the Linux 2.4 routing software. A different approach is followed by an Application-Level Gateway, also called proxy server. This type of firewall does not forward packets on the network layer but acts as a relay on the application level. The user contacts the gateway which in turn opens a connection to the intended target (on behalf of the user). A gateway completely separates the inside and outside networks at the network level and only provides a certain set of application services. This allows authentication of the user who requests a connection and session-oriented scanning of the exchanged traffic up to the application level data. This feature makes application gateways more secure than packet filters and offers a broader range of log facilities. On the downside, the overhead of such a setup may cause performance problems under heavy load. Another important element in the set of attack prevention mechanisms is system hardening. System hardening is used to describe all steps that are taken to make a computer system more secure. It usually refers to changing the default configuration to a more secure one, possible at the expense of ease-of-use. Vendors usually pre-install a large set of development tools and utilities, which, although beneficial to the new user, might also contain vulnerabilities. The initial configuration changes that are part of system hardening include the removal of services, applications and accounts that are not needed and the enabling of operating system auditing mechanisms (e.g., Event Log in Windows). Hardening also involves a vulnerability assessment of the system. Numerous open-source tools such as network (e.g., nmap [8]) and vulnerability scanners (e.g., Nessus [12]) can help to check a system for open ports and known vulnerabilities. This knowledge then helps to remedy these vulnerabilities and close unnecessary ports. An important and ongoing effort in system hardening is patching. Patching describes a method of updating a file that replaces only the parts being changed, rather than the entire file. It is used to replace parts of a (source or binary) file that contains a vulnerability that is exploitable by an attacker. To be able to patch, it is necessary that the system administrators keep up to date with security advisories that are issued by vendors to inform about security related problems in their products. Attack Avoidance Security mechanisms in this category assume that an intruder may access the desired resource but the information is modified in a way that makes it unusable for the attacker. The information is pre-processed at the sender before it is transmitted over the communication channel and postprocessed at the receiver. While the information is transported over the communication channel, it resists attacks by being nearly useless for an intruder. One notable exception are attacks against the availability of the information as an attacker could still interrupt the message. During the processing step at the receiver, modifications or errors that might have previously occurred can be detected (usually because the information can not be correctly reconstructed). When no modification has taken place, the information at the receiver is identical to the one at the sender before the pre-processing step. The most important member in this category is cryptography which is defined as the science of keeping messages secure [18]. It allows the sender to transform information into a random data stream from the point of view of an attacker but to have it recovered by an authorized receiver (see Figure 3). The original message is called plain text (sometimes clear text). The process of converting it through the application of some transformation rules into a format that hides its substance is called encryption. The corresponding disguised message is denoted cipher text and the operation of turning it back into clear text is called decryption. It is important to notice that the conversion from plain to cipher text has to be loss-less in order to be able to recover the original message at the receiver under all circumstances. The transformation rules are described by a cryptographic algorithm. The function of this algorithm is based on two main principles: substitution and transposition. In the case of substitution, each element of the plain text (e.g. bit, block) is mapped into another element of the used alphabet. Transposition describes the process where elements of the plain text are rearranged. Most systems involve multiple steps (called rounds) of transposition and substitution to be more resistant against cryptanalysis. Cryptanalysis is the science of breaking the cipher, i.e. discovering the substance of the message behind its disguise. When the transformation rules process the input elements one at a time the mechanism is called a stream cipher, in case of operating on fixed-sized input blocks it is called a block cipher. If the security of an algorithm is based on keeping the way how the algorithm works (i.e. the transformation rules) secret, it is called a restricted algorithm. Those algorithms are no longer of any interest today because they don’t allow standardization or public quality control. In addition, when a large group of users is involved, such an approach cannot be used. A single person leaving the group makes it necessary for everyone else to change the algorithm. Modern cryptosystems solve this problem by basing the ability of the receiver to recover encrypted information on the fact that he possesses a secret piece of information (usually called the key). Both encryption and decryption functions have to use a key and they are heavily dependent on it. When the security of the cryptosystem is completely based on the security of the key, the algorithm itself may be revealed. Although the security does not rely on the fact that the algorithm is unknown, the cryptographic function itself and the used key together with its length must be chosen with care. A common assumption is that the attacker has the fastest commercially available hardware at his disposal in his attempt to break the cipher text. The most common attack, called known plain text attack, is executed by obtaining cipher text together with its corresponding plain text. The encryption algorithm must be so complex that even if the code breaker is equipped with plenty of such pairs and powerful machines, it is infeasible for him to retrieve the key. An attack is infeasible when the cost of breaking the cipher exceeds the value of the information or the time it takes to break it exceeds the lifespan of the information. Given pairs of corresponding cipher and plain text, it is obvious that a simple key guessing algorithm will succeed after some time. The approach of successively trying different key values until the correct one is found is called brute force attack because no information about the algorithm is utilized whatsoever. In order to be useful, it is a necessary condition for an encryption algorithm that brute force attacks are infeasible. Depending on the keys that are used, one can distinguish two major cryptographic approaches - public and secret key cryptosystems. Secret Key Cryptography This is the kind of cryptography that has been used for the transmission of secret information for centuries, long before the advent of computers. These algorithms require that the sender and the receiver agree on a key before communication is started. It is common for this variant (which is also called single key or symmetric encryption) that a single secret key is shared between the sender and the receiver. It needs to be communicated in a secure way before the actual encrypted communication can start and has to remain secret as long as the information is to remain secret. Encryption is achieved by applying an agreed function to the plain text using the secret key. Decryption is performed by applying the inverse function using the same key. The classic example of a secret key block cipher which is widely deployed today is the Data Encryption Standard (DES) [6]. DES has been developed in 1977 by IBM and adopted as a standard by the US government for administrative and business use. Recently, it has been replaced by the Advanced Encryption Standard (AES - Rijndael) [1]. It is a block cipher that operates on 64-bit plain text blocks and utilizes a key with 56-bits length. The algorithm uses 16 rounds that are key dependent. During each round 48 key bits are selected and combined with the block that is encrypted. Then, the resulting block is piped through a substitution and a permutation phase (which use known values and are independent of the key) to make cryptanalysis harder. Although there is no known weakness of the DES algorithm itself, its security has been much debated. The small key length makes brute force attacks possible and several cases have occurred where DES protected information has been cracked. A suggested improvement called 3DES uses three rounds of the simple DES with three different keys. This extends the key length to 168 bits while still resting on the very secure DES base. A well known stream cipher that has been debated recently is RC4 [16] which has been developed by RSA. It is used to secure the transmission in wireless networks that follow the IEEE 802.11 standard and forms the core of the WEP (wired equivalent protection) mechanism. Although the cipher itself has not been broken, current implementations are flawed and reduce the security of RC4 down to a level where the used key can be recovered by statistical analysis within a few hours. Public Key Cryptography Since the advent of public key cryptography, the knowledge of the key that is used to encrypt a plain text also allowed the inverse process, the decryption of the cipher text. In 1976, this paradigm of cryptography was changed by Diffie and Hellman [7] when they described their public key approach. Public key cryptography utilizes two different keys, one called the public key, the other one called the private key. The public key is used to encrypt a message while the corresponding private key is used to do the opposite. Their innovation was the fact that it is infeasible to retrieve the private key given the public key. This makes it possible to remove the weakness of secure key transmission from the sender to the receiver. The receiver can simply generate his public/private key pair and announce the public key without fear. Anyone can obtain this key and use it to encrypt messages that only the receiver with his private key is able to decrypt. Mathematically, the process is based on the trap door of one-way functions. A one-way function is a function that is easy to compute but very hard to inverse. That means that given x it is easy to determine f(x) but given f(x) it is hard to get x. Hard is defined as computationally infeasible in the context of cryptographically strong one-way functions. Although it is obvious that some functions are easier to compute than their inverse (e.g. square of a value in contrast to its square root) there is no mathematical proof or definition of one-way functions. There are a number of problems that are considered difficult enough to act as one-way functions but it is more an agreement among crypto analysts than a rigorously defined set (e.g. factorization of large numbers). A one-way function is not directly usable for cryptography, but it becomes so when a trap door exists. A trap door is a mechanism that allows one to easily calculate x from f(x) when an additional information y is provided. A common misunderstanding about public key cryptography is thinking that it makes secret key systems obsolete, either because it is more secure or because it does not have the problem of secretly exchanging keys. As the security of a cryptosystem depends on the length of the used key and the utilized transformation rules, there is no automatic advantage of one approach over the other. Although the key exchange problem is elegantly solved with a public key, the process itself is very slow and has its own problems. Secret key systems are usually a factor of 1000 (see [18] for exact numbers) faster than their public key counterparts. Therefore, most communication is stilled secured using secret key systems and public key systems are only utilized for exchanging the secret key for later communication. This hybrid approach is the common design to benefit from the high-speed of conventional cryptography (which is often implemented directly in hardware) and from a secure key exchange. A problem in public key systems is the authenticity of the public key. An attacker may offer the sender his own public key and pretend that it origins from the legitimate receiver. The sender then uses the faked public key to perform his encryption and the attacker can simply decrypt the message using his private key. In order to thwart an attacker that attempts to substitute his public key for the victim’s one, certificates are used. A certificate combines user information with the user’s public key and the digital signature of a trusted third party that guarantees that the key belongs to the mentioned person. The trusted third party is usually called a certification authority (CA). The certificate of a CA itself is usually verified by a higher level CA that confirms that the CA’s certificate is genuine and contains its public key. The chain of third parties that verify their respective lower level CAs has to end at a certain point which is called the root CA. A user that wants to verify the authenticity of a public key and all involved CAs needs to obtain the self-signed certificate of the root CA via an external channel. Web browsers (e.g. Netscape Navigator, Internet Explorer) usually ship with a number of certificates of globally known root CAs. A framework that implements the distribution of certificates is called a public key infrastructure (PKI). An important protocol for key management is X.509 [25]. Another important issue is revocation, the invalidation of a certificate when the key has been compromised. The best known public key algorithm and textbook classic is RSA [17], named after its inventors Rivest, Shamir and Adleman at MIT. It is a block cipher that is still utilized for the majority of current systems, although the key length has been increased over recent years. This has put a heavier processing load on applications, a burden that has ramifications especially for sites doing electronic commerce. A competitive approach that promises similar security as RSA using far smaller key lengths is elliptic curve cryptography. However, as these systems are new and have not been subject to sustained cryptanalysis, the confidence level in them in not yet as high as in RSA. Authentication and Digital Signatures An interesting and important feature of public key cryptography is its possible use for authentication. In addition to making the information unusable for attackers, a sender may utilize cryptography to prove his identity to the receiver. This feature is realized by digital signatures. A digital signature must have similar properties as a normal handwritten signature. It must be hard to forge and it has to be bound to a certain document. In addition, one has to make sure that a valid signature cannot be used by an attacker to replay the same (or different) messages at a later time. A way to realize such a digital signature is by using the sender’s private key to encrypt a message. When the receiver is capable of successfully decrypting the cipher text with the sender’s public key, he can be sure that the message is authentic. This approach obviously requires a cryptosystem that allows encryption with the private key, but many (such as RSA) offer this option. It is easy for a receiver to verify that a message has been successfully decrypted when the plain text is in a human readable format. For binary data, a checksum or similar integrity checking footer can be added to verify a successful decryption. Replay attacks are prevented by adding a time-stamp to the message (e.g. Kerberos [11] uses timestamps to prevent that messages to the ticket granting service are replayed). Usually, the storage and processing overhead for encrypting a whole document is too high to be practical. This is solved by one-way hash functions. These are functions that map the content of a message onto a short value (called message digest). Similar to one-way functions it is difficult to create a message when given only the hash value itself. Instead of encrypting the whole message, it is enough to simply encrypt the message digest and send it together with the original message. The receiver can then apply the known hash function (e.g. MD5 [15]) to the document and compare it to the decrypted digest. When both values match, the messages is authentic. Attack and Intrusion Detection Attack detection assumes that an attacker can obtain access to his desired targets and is successful in violating a given security policy. Mechanisms in this class are based on the optimistic assumption that most of the time the information is transferred without interference. When undesired actions occur, attack detection has the task of reporting that something went wrong and then to react in an appropriate way. In addition, it is often desirable to identify the exact type of attack. An important facet of attack detection is recovery. Often it is enough to just report that malicious activity has been found, but some systems require that the effect of the attack has to be reverted or that an ongoing and discovered attack is stopped. On the one hand, attack detection has the advantage that it operates under the worst case assumption that the attacker gains access to the communication channel and is able to use or modify the resource. On the other hand, detection is not effective in providing confidentiality of information. When the security policy specifies that interception of information has a serious security impact, then attack detection is not an applicable mechanism. The most important members of the attack detection class, which have received an increasing amount of attention in the last few years, are intrusion detection systems (aka IDS). Intrusion Detection [2, 3] is the process of identifying and responding to malicious activities targeted at computing and network resources. This definition introduces the notion of intrusion detection as a process, which involves technology, people and tools. An intrusion detection system basically monitors and collects data from a target system that should be protected, processes and correlates the gathered information and initiate responses, when evidence for an intrusion is detected. IDS are traditionally classified as anomaly or signature-based. Signature-based systems act similar to virus scanners and look for known, suspicious patterns in their input data. Anomaly- based systems watch for deviations of actual from expected behavior and classify all ‘abnormal’ activities as malicious. The advantage of signature-based designs is the fact that they can identify attacks with an acceptable accuracy and tend to produce fewer false alarms (i.e. classifying an action as malicious when in fact it is not) than their anomaly-based cousins. The systems are more intuitive to build and easier to install and configure, especially in large production networks. Because of this, nearly all commercial systems and most deployed installations utilize signature-based detection. Although anomaly-based variants offer the advantage of being able to find prior unknown intrusions, the costs of having to deal with an order of magnitude more false alarms is often prohibitive. Depending on their source of input data, IDS can be classified as either network or host-based. Network-based systems collect data from network traffic (e.g. packets by network interfaces in promiscuous mode) while host-based systems monitor events at operating system level such as system calls or receive input from applications (e.g. via log files). Host-based designs can collect high quality data directly from the affected system and are not influenced by encrypted network traffic. Nevertheless, they often seriously impact performance of the machines they are running on. Network-based IDS, on the other hand, can be set up in a non-intrusive manner - often as an appliance box without interfering with the existing infrastructure. In many cases, this makes them the preferred choice. As many vendors and research centers have developed their own intrusion detection system versions, the IETF has created the intrusion detection working group [9] to coordinate international standardization efforts. The aim is to allow intrusion detection systems to share information and to communicate via well defined interfaces by proposing a generic architectural description and a message specification and exchange format (IDMEF). A major issue when deploying intrusion detection systems in large network installations are the huge numbers of alerts that are produced. These alerts have to be analyzed by system administrators who have to decide on the appropriate countermeasures. Given the current state-of-the-art of intrusion detection, however, many of the reported incidents are in fact false alerts. This makes the analysis process for the system administrator cumbersome and frustrating, resulting in the problem that IDSs are often disabled or ignored. To address this issue, two new techniques have been proposed: alert correlation and alert verification. Alert correlation is an analysis process that takes as input the alerts produced by intrusion detection systems and produces compact reports on the security status of the network under surveillance. By reducing the total number of individual alerts and aggregating related incidents into a single report, is is easier for a system administrator to distinguish actual and bogus alarms. In addition, alert correlation offers the benefit of recognizing higher-level patterns in an alert stream, helping the administrator to obtain a better overview of the activities on the network. Alert verification is a technique that is directly aimed at the problem that intrusion detection systems often have to analyze data without sufficient contextual information. The classic example is the scenario of a Code Red worm that attacks a Linux web server. It is a valid attack that is seen on the network, however, the alert that an IDS raises is of no use because the Linux server is not vulnerable (as Code Red can only exploit vulnerabilities in Microsoft’s IIS web server). The intrusion detection system would require more information to determine that this attack cannot possibly succeed than available from only looking at network packets. Alert verification is a term that is used for all mechanisms that use additional information or means to determine whether an attack was successful or not. In the example above, the alert verification mechanism could supply the IDS with the knowledge that the attacked Linux server is not vulnerable to a Code Red attack. As a consequence, the IDS can react accordingly and suppress the alert or reduce its priority and thus reduce the workload of the administrator. Secure Network Protocols After the general concepts and mechanisms of network security have been introduced, the following section concentrates on two actual instances of secure network protocols, namely the Secure Sockets Layer (SSL, [20]) and the Transport Layer Security (TLS, [24]) protocol. The idea of secure network protocols is to create an additional layer between the application and the transport/network layer to provide services for a secure end-to-end communication channel. TCP/IP are almost always used as transport/network layer protocols on the Internet and their task is to provide a reliable end-to-end connection between remote tasks on different machines that intend to communicate. The services on that level are usually directly utilized by application protocols to exchange data, for example HTTP (Hypertext Transfer Protocol) for web services. Unfortunately, the network layer transmits this data unencrypted, leaving it vulnerable to eavesdropping or tampering attacks. In addition, the authentication mechanisms of TCP/IP are only minimal, thereby allowing a malicious user to hijack connections and redirect traffic to his machine as well as to impersonate legitimate services. These threats are mitigated by secure network protocols that provide privacy and data integrity between two communicating applications by creating an encrypted and authenticated channel. SSL has emerged as the de-facto standard for secure network protocols. Originally developed by Netscape, its latest version SSL 3.0 is also the base for the standard proposed by the IETF under the name TLS. Both protocols are quite similar and share common ideas, but they unfortunately can not inter-operate. The following discussion will mainly concentrate on SSL and only briefly explain the extensions implemented in TLS. The SSL protocol [21] usually runs above TCP/IP (although it could use any transport protocol) and below higher-level protocols such as HTTP. It uses TCP/IP on behalf of the higher-level protocols, and in the process allows an SSL-enabled server to authenticate itself to an SSL-enabled client, allows the client to authenticate itself to the server, and allows both machines to establish an encrypted connection. These capabilities address fundamental concerns about communication over the Internet and other TCP/IP networks and give protection against message tampering, eavesdropping and spoofing. • SSL server authentication allows a user to confirm a server’s identity. SSL-enabled client software can use standard techniques of public-key cryptography to check that a server’s certificate and public key are valid and have been issued by a certification authority (CA) listed in the client’s list of trusted CAs. This confirmation might be important if the user, for example, is sending a credit card number over the network and wants to check the receiving server’s identity. • SSL client authentication allows a server to confirm a user’s identity. Using the same techniques as those used for server authentication, SSL-enabled server software can check that a client’s certificate and public key are valid and have been issued by a certification authority (CA) listed in the server’s list of trusted CAs. This confirmation might be important if the server, for example, is a bank sending confidential financial information to a customer and wants to check the recipient’s identity. • An encrypted SSL connection requires all information sent between a client and a server to be encrypted by the sending software and decrypted by the receiving software, thus providing a high degree of confidentiality. Confidentiality is important for both parties to any private transaction. In addition, all data sent over an encrypted SSL connection is protected with a mechanism for detecting tampering – that is, for automatically determining whether the data has been altered in transit. SSL uses X.509 certificates for authentication, RSA as its public-key cipher and one of RC4-128, RC2-128, DES, Triple DES or IDEA as its bulk symmetric cipher. The SSL protocol includes two sub-protocols, namely the SSL Record Protocol and the SSL Handshake Protocol. The SSL Record Protocol simply defines the format used to transmit data. The SSL Handshake Protocol (using the SSL Record Protocol) is utilized to exchange a series of messages between an SSL-enabled server and an SSL-enabled client when they first establish an SSL connection. This exchange of messages is designed to facilitate the following actions. • Authenticate the server to the client. • Allow the client and server to select the cryptographic algorithms, or ciphers, that they both support. • Optionally authenticate the client to the server. • Use public-key encryption techniques to generate shared secrets. • Establish an encrypted SSL connection based on the previously exchanged shared secret. The SSL Handshake Protocol is composed of two phases. Phase 1 deals with the selection of a cipher, the exchange of a secret key and the authentication of the server. Phase 2 handles client authentication, if requested and finishes the handshaking. After the handshake stage is complete, the data transfer between client and server begins. All messages during handshaking and after, are sent over the SSL Record Protocol layer. Optionally, session identifiers can be used to re-established a secure connection that has been previously set up. Figure 4 lists in a slightly simplified form the messages that are exchanged between the client C and the server S during a handshake when neither client authentication nor session identifiers are involved. In this figure, {data}key means that data has been encrypted with key. The message exchanges shows that the client first sends a challenge to the server which responds with a X.509 certificate containing its public key. The client then creates a secret key and uses RSA with the server’s public key to encrypt it, sending the result back to the server. Only the server is capable of decrypting that message with its private key and can retrieve the shared, secret key. I order to prove to the client that the secret key has been successfully decrypted, the server encrypts the client’s challenge with the secret key and returns it. When the client is able to decrypt this message and successfully retrieves the original challenge by using the secret key, it can be certain that the server has access to the private key corresponding to its certificate. From this point on, all communication is encrypted using the chosen cipher and the shared secret key. TLS uses the same two protocols shown above and a similar handshake mechanism. Nevertheless, the algorithms for calculating message authentication codes (MACs) and secret keys have been modified to make them cryptographically more secure. In addition, the constraints on padding a message up to the next block size have been relaxed for TLS. This leads to an incompatibility between both protocols. SSL/TLS is widely used to secure web and mail traffic. HTTP as well as the current mail protocols IMAP (Internet Message Access Protocol) and POP3 (post office protocol, version 3) transmit user credential information as well as application data unencrypted. By building them on top of a secure network protocol such as SSL/TLS, they can benefit from secured channels without modifications. The secure communication protocols simply utilize different well-known destination ports (443 for HTTPS, 993 for IMAPS and 995 for POP3S) than their insecure cousins. Secure Applications A variety of popular tools that allow access to remote hosts (such as telnet, rsh and rlogin) or that provide means for file transfer (such as rcp or ftp) exchange user credentials and data in plain text. This makes them vulnerable to eavesdropping, tampering and spoofing attacks. Although the tools mentioned above could have also been built upon SSL/TLS, a different protocol suite called Secure Shell (SSH) [19] has been developed which follows partial overlapping goals. The SSH Transport and User Authentication protocols have features similar to those of SSL/TLS. However, they are different in the following ways. • TLS server authentication is optional and the protocol supports fully anonymous operation, in which neither side is authenticated. As such connections are inherently vulnerable to man-in-the-middle attacks, SSH requires server authentication. • TLS does not provide the range of client authentication options that SSH does - public-key via RSA is the only option. • Most importantly, TLS does not have the extra features provided by the SSH Connection Protocol. The SSH Connection Protocol uses the underlying connection, aka secure tunnel, which has been established by the SSH Transport and User Authentication protocols between two hosts. It provides interactive login sessions, remote execution of commands and forwarded TCP/IP as well as X11 connections. All these terminal sessions and forwarded connections are realized as different logical channels that may be opened by either side on top of the secure tunnel. Channels are flow-controlled which means that no data may be sent to a channel until a message is received to indicate that window space is available. The current version of the SSH protocol is SSH 2. It represents a complete rewrite of SSH 1 and improves some of its structural weaknesses. As it encrypts packets in a different way and has abandoned the notion of server and host keys in favor of host keys only, the protocols are incompatible. For applications built from scratch, SSH 2 should always be the preferred choice. Using the means of logical channels for interactive login sessions and remote execution, a complete replacement for telnet, rsh and rlogin could be easily implemented. A popular site that lists open-source implementations which are freely available for many different platforms can be found under [14]. Recently, a secure file transfer (sftp) application has been developed that makes the use of regular FTP based programs obsolete. Notice that it is possible to tunnel arbitrary application traffic over a connection that has been previously set up by the SSH protocols. Similar to SSL/TLS, web and mail traffic could be securely transmitted over a SSH connection before reaching the server port at the destination host. The difference is that SSH requires that a secure tunnel is created in advance which is bound to a certain port at the destination host. The set up of this secure channel, however, requires that the client that is initiating the connection has to log into the server. Usually, this makes it necessary that the user has an account at the destination host. After the tunnel has been established, all traffic sent into by the client gets forwarded to the desired port at the target machine. Obviously, the connection is encrypted. In contrast to that, SSL/TLS connects directly to a certain point without prior logging into the destination host. The encryption is set up directly between the client and the service listening at the destination port without a prior redirection via the SSH server. The technique of tunneling application traffic is often utilized for mail transactions when the mail server does not support SSL/TLS directly (as users have accounts at the mail server anyway), but it is less common for web traffic. Summary This chapter discuses security threats that systems face when they are connected to the Internet. In order to achieve the security properties that are required by the security policy in use, three different classes of mechanisms can be adopted. The first is attack prevention, which attempts to stop the attacker before it can reach its desired goals. Such techniques fall into the category of access control and firewalls. The second approach aims to make the data unusable for unauthorized persons by applying cryptographic means. Secret key as well as public keys mechanism can be utilized. The third class of mechanisms contains attack detection approaches. They attempt to detect malicious behavior and recover after undesired activity has been identified. The text also covers secure network protocols and applications. SSL/TLS as well as SSH are introduced and its most common fields of operations are highlighted. These protocols form the base of securing traffic that is sent over the Internet in behalf of a variety of different applications. ","Use only the Context Block to answer the Question. Your audience is people with limited tech knowledge. What is the example provided for the importance of Alert Verification in Intrusion Detection Systems? Abstract This chapter describes security threats that systems face when they are connected to the Internet. We discuss their security requirements, potential security threats and different mechanisms to combat these. In addition, the text presents the two most popular protocols (SSL and its successor TLS) to secure data transmitted over the Internet. Finally, we describe wellknown applications such as Secure Shell (ssh) and Secure File Transfer Protocol (sftp) that provide a reasonable level of security for common tasks. They may be utilized as underlying building blocks to create secure, Internet enabled applications. In order to provide useful services or to allow people to perform tasks more conveniently, computer systems are attached to networks and get interconnected. This resulted in the world-wide collection of local and wide-area networks known as the Internet. Unfortunately, the extended access possibilities also entail increased security risks as it opens additional avenues for an attacker. For a closed, local system, the attacker was required to be physically present at the network in order to perform unauthorized actions. In the networked case, each host that can send packets to the victim can be potentially utilized. As certain services (such as web or name servers) need to be publicly available, each machine on the Internet might be the originator of malicious activity. This fact makes attacks very likely to happen on a regularly basis. The following text attempts to give a systematic overview of security requirements of Internetbased systems and potential means to satisfy them. We define properties of a secure system and provide a classification of potential threats to them. We also introduce mechanisms to defend against attacks that attempt to violate desired properties. The most widely used means to secure application data against tampering and eavesdropping, the Secure Sockets Layer (SSL) and its successor, the Transport Layer Security (TLS) protocol are discussed. Finally, we briefly describe popular application programs that can act as building blocks for securing custom applications. Before one can evaluate attacks against a system and decide on appropriate mechanisms against them, it is necessary to specify a security policy [23]. A security policy defines the desired properties for each part of a secure computer system. It is a decision that has to take into account the value of the assets that should be protected, the expected threats and the cost of proper protection mechanisms. A security policy that is sufficient for the data of a normal user at home may not be sufficient for bank applications, as these systems are obviously a more likely target and have to protect more valuable resources. Although often neglected, the formulation of an adequate security policy is a prerequisite before one can identify threats and appropriate mechanisms to face them. Security Attacks and Security Properties For the following discussion, we assume that the function of a system that is the target of an attack is to provide information. In general, there is a flow of data from a source (e.g. host, file, memory) to a destination (e.g. remote host, other file, user) over a communication channel (e.g. wire, data bus). The task of the security system is to restrict access to this information to only those parties (persons or processes) that are authorized to have access according to the security policy in use. In the case of an automation system which is remotely connected to the Internet, the information flow is from/to a control application that manages sensors and actuators via communication lines of the public Internet and the network of the automation system (e.g. a field-bus). The normal information flow and several categories of attacks that target it are shown in Figure 1 and explained below (according to [22]). 1. Interruption: An asset of the system gets destroyed or becomes unavailable. This attack targets the source or the communication channel and prevents information from reaching its intended target (e.g. cut the wire, overload the link so that the information gets dropped because of congestion). Attacks in this category attempt to perform a kind of denial-of-service (DOS). 2. Interception: An unauthorized party gets access to the information by eavesdropping into the communication channel (e.g. wiretapping). 3. Modification: The information is not only intercepted, but modified by an unauthorized party while in transit from the source to the destination. By tampering with the information, it is actively altered (e.g. modifying message content). 4. Fabrication: An attacker inserts counterfeit objects into the system without having the sender doing anything. When a previously intercepted object is inserted, this processes is called replaying. When the attacker pretends to be the legitimate source and inserts his desired information, the attack is called masquerading (e.g. replay an authentication message, add records to a file). The four classes of attacks listed above violate different security properties of the computer system. A security property describes a desired feature of a system with regards to a certain type of attack. A common classification following [5, 13] is listed below. • Confidentiality: This property covers the protection of transmitted data against its release to non-authorized parties. In addition to the protection of the content itself, the information flow should also be resistant against traffic analysis. Traffic analysis is used to gather other information than the transmitted values themselves from the data flow (e.g. timing data, frequency of messages). • Authentication: Authentication is concerned with making sure that the information is authentic. A system implementing the authentication property assures the recipient that the data is from the source that it claims to be. The system must make sure that no third party can masquerade successfully as another source. • Non-repudiation: This property describes the feature that prevents either sender or receiver from denying a transmitted message. When a message has been transferred, the sender can prove that it has been received. Similarly, the receiver can prove that the message has actually been sent. • Availability: Availability characterizes a system whose resources are always ready to be used. Whenever information needs to be transmitted, the communication channel is available and the receiver can cope with the incoming data. This property makes sure that attacks cannot prevent resources from being used for their intended purpose. • Integrity: Integrity protects transmitted information against modifications. This property assures that a single message reaches the receiver as it has left the sender, but integrity also extends to a stream of messages. It means that no messages are lost, duplicated or reordered and it makes sure that messages cannot be replayed. As destruction is also covered under this property, all data must arrive at the receiver. Integrity is not only important as a security property, but also as a property for network protocols. Message integrity must also be ensured in case of random faults, not only in case of malicious modifications. Security Mechanisms Different security mechanisms can be used to enforce the security properties defined in a given security policy. Depending on the anticipated attacks, different means have to be applied to satisfy the desired properties. We divide these measures against attacks into three different classes, namely attack prevention, attack avoidance and attack detection. Attack Prevention Attack prevention is a class of security mechanisms that contains ways of preventing or defending against certain attacks before they can actually reach and affect the target. An important element in this category is access control, a mechanism which can be applied at different levels such as the operating system, the network or the application layer. Access control [23] limits and regulates the access to critical resources. This is done by identifying or authenticating the party that requests a resource and checking its permissions against the rights specified for the demanded object. It is assumed that an attacker is not legitimately permitted to use the target object and is therefore denied access to the resource. As access is a prerequisite for an attack, any possible interference is prevented. The most common form of access control used in multi-user computer systems are access control lists for resources that are based on the user identity of the process that attempts to use them. The identity of a user is determined by an initial authentication process that usually requires a name and a password. The login process retrieves the stored copy of the password corresponding to the user name and compares it with the presented one. When both match, the system grants the user the appropriate user credentials. When a resource should be accessed, the system looks up the user and group in the access control list and grants or denies access as appropriate. An example of this kind of access control is a secure web server. A secure web server delivers certain resources only to clients that have authenticated themselves and that posses sufficient credentials for the desired resource. The authentication process is usually handled by the web client such as the Microsoft Internet Explorer or Mozilla by prompting the user for his name and password. The most important access control system at the network layer is a firewall [4]. The idea of a firewall is based on the separation of a trusted inside network of computers under single administrative control from a potential hostile outside network. The firewall is a central choke point that allows enforcement of access control for services that may run at the inside or outside. The firewall prevents attacks from the outside against the machines in the inside network by denying connection attempts from unauthorized parties located outside. In addition, a firewall may also be utilized to prevent users behind the firewall from using certain services that are outside (e.g. surfing web sites containing pornographic material). For certain installations, a single firewall is not suitable. Networks that consist of several server machines which need to be publicly accessible and workstations that should be completely protected against connections from the outside would benefit from a separation between these two groups. When an attacker compromises a server machine behind a single firewall, all other machines can be attacked from this new base without restrictions. To prevent this, one can use two firewalls and the concept of a demilitarized zone (DMZ) [4] in between as shown in Figure 2. In this setup, one firewall separates the outside network from a segment (DMZ) with the server machines while a second one separates this area from the rest of the network. The second firewall can be configured in a way that denies all incoming connection attempts. Whenever an intruder compromises a server, he is now unable to immediately attack a workstation located in the inside network. The following design goals for firewalls are identified in [4]. 1. All traffic from inside to outside, and vice versa, must pass through the firewall. This is achieved by physically blocking all access to the internal network except via the firewall. 2. Only authorized traffic, as defined by the local security policy, will be allowed to pass. 3. The firewall itself should be immune to penetration. This implies the use of a trusted system with a secure operating system. A trusted, secure operating system is often purpose-built, has heightened security features and only provides the minimal functionality necessary to run the desired applications. These goals can be reached by using a number of general techniques for controlling access. The most common is called service control and determines Internet services that can be accessed. Traffic on the Internet is currently filtered on basis of IP addresses and TCP/UDP port numbers. In addition, there may be proxy software that receives and interprets each service request before passing it on. Direction control is a simple mechanism to control the direction in which particular service requests may be initiated and permitted to flow through. User control grants access to a service based on user credentials similar to the technique used in a multi-user operating system. Controlling external users requires secure authentication over the network (e.g. such as provided in IPSec [10]). A more declarative approach in contrast to the operational variants mentioned above is behavior control. This technique determines how particular services are used. It may be utilized to filter e-mail to eliminate spam or to allow external access to only part of the local web pages. A summary of capabilities and limitations of firewalls is given in [22]. The following benefits can be expected. • A firewall defines a single choke point that keeps unauthorized users out of the protected network. The use of such a point also simplifies security management. • It provides a location for monitoring security related events. Audits, logs and alarms can be implemented on the firewall directly. In addition, it forms a convenient platform for some non-security related functions such as address translation and network management. • A firewall may serve as a platform to implement a virtual private network (e.g. by using IPSec). The list below enumerates the limits of the firewall access control mechanism. • A firewall cannot protect against attacks that bypass it, for example, via a direct dial-up link from the protected network to an ISP (Internet Service Provider). It also does not protect against internal threats from an inside hacker or an insider cooperating with an outside attacker. • A firewall does not help when attacks are against targets whose access has to be permitted. • It cannot protect against the transfer of virus-infected programs or files. It would be impossible, in practice, for the firewall to scan all incoming files and e-mails for viruses. Firewalls can be divided into two main categories. A Packet-Filtering Router, or short packet filter, is an extended router that applies certain rules to the packets which are forwarded. Usually, traffic in each direction (in- and outgoing) is checked against a rule set which determines whether a packet is permitted to continue or should be dropped. The packet filter rules operate on the header fields used by the underlying communication protocols, for the Internet almost always IP, TCP and UDP. Packet filters have the advantage that they are cheap as they can often be built on existing hardware. In addition, they offer a good performance for high traffic loads. An example for a packet filter is the iptables package which is implemented as part of the Linux 2.4 routing software. A different approach is followed by an Application-Level Gateway, also called proxy server. This type of firewall does not forward packets on the network layer but acts as a relay on the application level. The user contacts the gateway which in turn opens a connection to the intended target (on behalf of the user). A gateway completely separates the inside and outside networks at the network level and only provides a certain set of application services. This allows authentication of the user who requests a connection and session-oriented scanning of the exchanged traffic up to the application level data. This feature makes application gateways more secure than packet filters and offers a broader range of log facilities. On the downside, the overhead of such a setup may cause performance problems under heavy load. Another important element in the set of attack prevention mechanisms is system hardening. System hardening is used to describe all steps that are taken to make a computer system more secure. It usually refers to changing the default configuration to a more secure one, possible at the expense of ease-of-use. Vendors usually pre-install a large set of development tools and utilities, which, although beneficial to the new user, might also contain vulnerabilities. The initial configuration changes that are part of system hardening include the removal of services, applications and accounts that are not needed and the enabling of operating system auditing mechanisms (e.g., Event Log in Windows). Hardening also involves a vulnerability assessment of the system. Numerous open-source tools such as network (e.g., nmap [8]) and vulnerability scanners (e.g., Nessus [12]) can help to check a system for open ports and known vulnerabilities. This knowledge then helps to remedy these vulnerabilities and close unnecessary ports. An important and ongoing effort in system hardening is patching. Patching describes a method of updating a file that replaces only the parts being changed, rather than the entire file. It is used to replace parts of a (source or binary) file that contains a vulnerability that is exploitable by an attacker. To be able to patch, it is necessary that the system administrators keep up to date with security advisories that are issued by vendors to inform about security related problems in their products. Attack Avoidance Security mechanisms in this category assume that an intruder may access the desired resource but the information is modified in a way that makes it unusable for the attacker. The information is pre-processed at the sender before it is transmitted over the communication channel and postprocessed at the receiver. While the information is transported over the communication channel, it resists attacks by being nearly useless for an intruder. One notable exception are attacks against the availability of the information as an attacker could still interrupt the message. During the processing step at the receiver, modifications or errors that might have previously occurred can be detected (usually because the information can not be correctly reconstructed). When no modification has taken place, the information at the receiver is identical to the one at the sender before the pre-processing step. The most important member in this category is cryptography which is defined as the science of keeping messages secure [18]. It allows the sender to transform information into a random data stream from the point of view of an attacker but to have it recovered by an authorized receiver (see Figure 3). The original message is called plain text (sometimes clear text). The process of converting it through the application of some transformation rules into a format that hides its substance is called encryption. The corresponding disguised message is denoted cipher text and the operation of turning it back into clear text is called decryption. It is important to notice that the conversion from plain to cipher text has to be loss-less in order to be able to recover the original message at the receiver under all circumstances. The transformation rules are described by a cryptographic algorithm. The function of this algorithm is based on two main principles: substitution and transposition. In the case of substitution, each element of the plain text (e.g. bit, block) is mapped into another element of the used alphabet. Transposition describes the process where elements of the plain text are rearranged. Most systems involve multiple steps (called rounds) of transposition and substitution to be more resistant against cryptanalysis. Cryptanalysis is the science of breaking the cipher, i.e. discovering the substance of the message behind its disguise. When the transformation rules process the input elements one at a time the mechanism is called a stream cipher, in case of operating on fixed-sized input blocks it is called a block cipher. If the security of an algorithm is based on keeping the way how the algorithm works (i.e. the transformation rules) secret, it is called a restricted algorithm. Those algorithms are no longer of any interest today because they don’t allow standardization or public quality control. In addition, when a large group of users is involved, such an approach cannot be used. A single person leaving the group makes it necessary for everyone else to change the algorithm. Modern cryptosystems solve this problem by basing the ability of the receiver to recover encrypted information on the fact that he possesses a secret piece of information (usually called the key). Both encryption and decryption functions have to use a key and they are heavily dependent on it. When the security of the cryptosystem is completely based on the security of the key, the algorithm itself may be revealed. Although the security does not rely on the fact that the algorithm is unknown, the cryptographic function itself and the used key together with its length must be chosen with care. A common assumption is that the attacker has the fastest commercially available hardware at his disposal in his attempt to break the cipher text. The most common attack, called known plain text attack, is executed by obtaining cipher text together with its corresponding plain text. The encryption algorithm must be so complex that even if the code breaker is equipped with plenty of such pairs and powerful machines, it is infeasible for him to retrieve the key. An attack is infeasible when the cost of breaking the cipher exceeds the value of the information or the time it takes to break it exceeds the lifespan of the information. Given pairs of corresponding cipher and plain text, it is obvious that a simple key guessing algorithm will succeed after some time. The approach of successively trying different key values until the correct one is found is called brute force attack because no information about the algorithm is utilized whatsoever. In order to be useful, it is a necessary condition for an encryption algorithm that brute force attacks are infeasible. Depending on the keys that are used, one can distinguish two major cryptographic approaches - public and secret key cryptosystems. Secret Key Cryptography This is the kind of cryptography that has been used for the transmission of secret information for centuries, long before the advent of computers. These algorithms require that the sender and the receiver agree on a key before communication is started. It is common for this variant (which is also called single key or symmetric encryption) that a single secret key is shared between the sender and the receiver. It needs to be communicated in a secure way before the actual encrypted communication can start and has to remain secret as long as the information is to remain secret. Encryption is achieved by applying an agreed function to the plain text using the secret key. Decryption is performed by applying the inverse function using the same key. The classic example of a secret key block cipher which is widely deployed today is the Data Encryption Standard (DES) [6]. DES has been developed in 1977 by IBM and adopted as a standard by the US government for administrative and business use. Recently, it has been replaced by the Advanced Encryption Standard (AES - Rijndael) [1]. It is a block cipher that operates on 64-bit plain text blocks and utilizes a key with 56-bits length. The algorithm uses 16 rounds that are key dependent. During each round 48 key bits are selected and combined with the block that is encrypted. Then, the resulting block is piped through a substitution and a permutation phase (which use known values and are independent of the key) to make cryptanalysis harder. Although there is no known weakness of the DES algorithm itself, its security has been much debated. The small key length makes brute force attacks possible and several cases have occurred where DES protected information has been cracked. A suggested improvement called 3DES uses three rounds of the simple DES with three different keys. This extends the key length to 168 bits while still resting on the very secure DES base. A well known stream cipher that has been debated recently is RC4 [16] which has been developed by RSA. It is used to secure the transmission in wireless networks that follow the IEEE 802.11 standard and forms the core of the WEP (wired equivalent protection) mechanism. Although the cipher itself has not been broken, current implementations are flawed and reduce the security of RC4 down to a level where the used key can be recovered by statistical analysis within a few hours. Public Key Cryptography Since the advent of public key cryptography, the knowledge of the key that is used to encrypt a plain text also allowed the inverse process, the decryption of the cipher text. In 1976, this paradigm of cryptography was changed by Diffie and Hellman [7] when they described their public key approach. Public key cryptography utilizes two different keys, one called the public key, the other one called the private key. The public key is used to encrypt a message while the corresponding private key is used to do the opposite. Their innovation was the fact that it is infeasible to retrieve the private key given the public key. This makes it possible to remove the weakness of secure key transmission from the sender to the receiver. The receiver can simply generate his public/private key pair and announce the public key without fear. Anyone can obtain this key and use it to encrypt messages that only the receiver with his private key is able to decrypt. Mathematically, the process is based on the trap door of one-way functions. A one-way function is a function that is easy to compute but very hard to inverse. That means that given x it is easy to determine f(x) but given f(x) it is hard to get x. Hard is defined as computationally infeasible in the context of cryptographically strong one-way functions. Although it is obvious that some functions are easier to compute than their inverse (e.g. square of a value in contrast to its square root) there is no mathematical proof or definition of one-way functions. There are a number of problems that are considered difficult enough to act as one-way functions but it is more an agreement among crypto analysts than a rigorously defined set (e.g. factorization of large numbers). A one-way function is not directly usable for cryptography, but it becomes so when a trap door exists. A trap door is a mechanism that allows one to easily calculate x from f(x) when an additional information y is provided. A common misunderstanding about public key cryptography is thinking that it makes secret key systems obsolete, either because it is more secure or because it does not have the problem of secretly exchanging keys. As the security of a cryptosystem depends on the length of the used key and the utilized transformation rules, there is no automatic advantage of one approach over the other. Although the key exchange problem is elegantly solved with a public key, the process itself is very slow and has its own problems. Secret key systems are usually a factor of 1000 (see [18] for exact numbers) faster than their public key counterparts. Therefore, most communication is stilled secured using secret key systems and public key systems are only utilized for exchanging the secret key for later communication. This hybrid approach is the common design to benefit from the high-speed of conventional cryptography (which is often implemented directly in hardware) and from a secure key exchange. A problem in public key systems is the authenticity of the public key. An attacker may offer the sender his own public key and pretend that it origins from the legitimate receiver. The sender then uses the faked public key to perform his encryption and the attacker can simply decrypt the message using his private key. In order to thwart an attacker that attempts to substitute his public key for the victim’s one, certificates are used. A certificate combines user information with the user’s public key and the digital signature of a trusted third party that guarantees that the key belongs to the mentioned person. The trusted third party is usually called a certification authority (CA). The certificate of a CA itself is usually verified by a higher level CA that confirms that the CA’s certificate is genuine and contains its public key. The chain of third parties that verify their respective lower level CAs has to end at a certain point which is called the root CA. A user that wants to verify the authenticity of a public key and all involved CAs needs to obtain the self-signed certificate of the root CA via an external channel. Web browsers (e.g. Netscape Navigator, Internet Explorer) usually ship with a number of certificates of globally known root CAs. A framework that implements the distribution of certificates is called a public key infrastructure (PKI). An important protocol for key management is X.509 [25]. Another important issue is revocation, the invalidation of a certificate when the key has been compromised. The best known public key algorithm and textbook classic is RSA [17], named after its inventors Rivest, Shamir and Adleman at MIT. It is a block cipher that is still utilized for the majority of current systems, although the key length has been increased over recent years. This has put a heavier processing load on applications, a burden that has ramifications especially for sites doing electronic commerce. A competitive approach that promises similar security as RSA using far smaller key lengths is elliptic curve cryptography. However, as these systems are new and have not been subject to sustained cryptanalysis, the confidence level in them in not yet as high as in RSA. Authentication and Digital Signatures An interesting and important feature of public key cryptography is its possible use for authentication. In addition to making the information unusable for attackers, a sender may utilize cryptography to prove his identity to the receiver. This feature is realized by digital signatures. A digital signature must have similar properties as a normal handwritten signature. It must be hard to forge and it has to be bound to a certain document. In addition, one has to make sure that a valid signature cannot be used by an attacker to replay the same (or different) messages at a later time. A way to realize such a digital signature is by using the sender’s private key to encrypt a message. When the receiver is capable of successfully decrypting the cipher text with the sender’s public key, he can be sure that the message is authentic. This approach obviously requires a cryptosystem that allows encryption with the private key, but many (such as RSA) offer this option. It is easy for a receiver to verify that a message has been successfully decrypted when the plain text is in a human readable format. For binary data, a checksum or similar integrity checking footer can be added to verify a successful decryption. Replay attacks are prevented by adding a time-stamp to the message (e.g. Kerberos [11] uses timestamps to prevent that messages to the ticket granting service are replayed). Usually, the storage and processing overhead for encrypting a whole document is too high to be practical. This is solved by one-way hash functions. These are functions that map the content of a message onto a short value (called message digest). Similar to one-way functions it is difficult to create a message when given only the hash value itself. Instead of encrypting the whole message, it is enough to simply encrypt the message digest and send it together with the original message. The receiver can then apply the known hash function (e.g. MD5 [15]) to the document and compare it to the decrypted digest. When both values match, the messages is authentic. Attack and Intrusion Detection Attack detection assumes that an attacker can obtain access to his desired targets and is successful in violating a given security policy. Mechanisms in this class are based on the optimistic assumption that most of the time the information is transferred without interference. When undesired actions occur, attack detection has the task of reporting that something went wrong and then to react in an appropriate way. In addition, it is often desirable to identify the exact type of attack. An important facet of attack detection is recovery. Often it is enough to just report that malicious activity has been found, but some systems require that the effect of the attack has to be reverted or that an ongoing and discovered attack is stopped. On the one hand, attack detection has the advantage that it operates under the worst case assumption that the attacker gains access to the communication channel and is able to use or modify the resource. On the other hand, detection is not effective in providing confidentiality of information. When the security policy specifies that interception of information has a serious security impact, then attack detection is not an applicable mechanism. The most important members of the attack detection class, which have received an increasing amount of attention in the last few years, are intrusion detection systems (aka IDS). Intrusion Detection [2, 3] is the process of identifying and responding to malicious activities targeted at computing and network resources. This definition introduces the notion of intrusion detection as a process, which involves technology, people and tools. An intrusion detection system basically monitors and collects data from a target system that should be protected, processes and correlates the gathered information and initiate responses, when evidence for an intrusion is detected. IDS are traditionally classified as anomaly or signature-based. Signature-based systems act similar to virus scanners and look for known, suspicious patterns in their input data. Anomaly- based systems watch for deviations of actual from expected behavior and classify all ‘abnormal’ activities as malicious. The advantage of signature-based designs is the fact that they can identify attacks with an acceptable accuracy and tend to produce fewer false alarms (i.e. classifying an action as malicious when in fact it is not) than their anomaly-based cousins. The systems are more intuitive to build and easier to install and configure, especially in large production networks. Because of this, nearly all commercial systems and most deployed installations utilize signature-based detection. Although anomaly-based variants offer the advantage of being able to find prior unknown intrusions, the costs of having to deal with an order of magnitude more false alarms is often prohibitive. Depending on their source of input data, IDS can be classified as either network or host-based. Network-based systems collect data from network traffic (e.g. packets by network interfaces in promiscuous mode) while host-based systems monitor events at operating system level such as system calls or receive input from applications (e.g. via log files). Host-based designs can collect high quality data directly from the affected system and are not influenced by encrypted network traffic. Nevertheless, they often seriously impact performance of the machines they are running on. Network-based IDS, on the other hand, can be set up in a non-intrusive manner - often as an appliance box without interfering with the existing infrastructure. In many cases, this makes them the preferred choice. As many vendors and research centers have developed their own intrusion detection system versions, the IETF has created the intrusion detection working group [9] to coordinate international standardization efforts. The aim is to allow intrusion detection systems to share information and to communicate via well defined interfaces by proposing a generic architectural description and a message specification and exchange format (IDMEF). A major issue when deploying intrusion detection systems in large network installations are the huge numbers of alerts that are produced. These alerts have to be analyzed by system administrators who have to decide on the appropriate countermeasures. Given the current state-of-the-art of intrusion detection, however, many of the reported incidents are in fact false alerts. This makes the analysis process for the system administrator cumbersome and frustrating, resulting in the problem that IDSs are often disabled or ignored. To address this issue, two new techniques have been proposed: alert correlation and alert verification. Alert correlation is an analysis process that takes as input the alerts produced by intrusion detection systems and produces compact reports on the security status of the network under surveillance. By reducing the total number of individual alerts and aggregating related incidents into a single report, is is easier for a system administrator to distinguish actual and bogus alarms. In addition, alert correlation offers the benefit of recognizing higher-level patterns in an alert stream, helping the administrator to obtain a better overview of the activities on the network. Alert verification is a technique that is directly aimed at the problem that intrusion detection systems often have to analyze data without sufficient contextual information. The classic example is the scenario of a Code Red worm that attacks a Linux web server. It is a valid attack that is seen on the network, however, the alert that an IDS raises is of no use because the Linux server is not vulnerable (as Code Red can only exploit vulnerabilities in Microsoft’s IIS web server). The intrusion detection system would require more information to determine that this attack cannot possibly succeed than available from only looking at network packets. Alert verification is a term that is used for all mechanisms that use additional information or means to determine whether an attack was successful or not. In the example above, the alert verification mechanism could supply the IDS with the knowledge that the attacked Linux server is not vulnerable to a Code Red attack. As a consequence, the IDS can react accordingly and suppress the alert or reduce its priority and thus reduce the workload of the administrator. Secure Network Protocols After the general concepts and mechanisms of network security have been introduced, the following section concentrates on two actual instances of secure network protocols, namely the Secure Sockets Layer (SSL, [20]) and the Transport Layer Security (TLS, [24]) protocol. The idea of secure network protocols is to create an additional layer between the application and the transport/network layer to provide services for a secure end-to-end communication channel. TCP/IP are almost always used as transport/network layer protocols on the Internet and their task is to provide a reliable end-to-end connection between remote tasks on different machines that intend to communicate. The services on that level are usually directly utilized by application protocols to exchange data, for example HTTP (Hypertext Transfer Protocol) for web services. Unfortunately, the network layer transmits this data unencrypted, leaving it vulnerable to eavesdropping or tampering attacks. In addition, the authentication mechanisms of TCP/IP are only minimal, thereby allowing a malicious user to hijack connections and redirect traffic to his machine as well as to impersonate legitimate services. These threats are mitigated by secure network protocols that provide privacy and data integrity between two communicating applications by creating an encrypted and authenticated channel. SSL has emerged as the de-facto standard for secure network protocols. Originally developed by Netscape, its latest version SSL 3.0 is also the base for the standard proposed by the IETF under the name TLS. Both protocols are quite similar and share common ideas, but they unfortunately can not inter-operate. The following discussion will mainly concentrate on SSL and only briefly explain the extensions implemented in TLS. The SSL protocol [21] usually runs above TCP/IP (although it could use any transport protocol) and below higher-level protocols such as HTTP. It uses TCP/IP on behalf of the higher-level protocols, and in the process allows an SSL-enabled server to authenticate itself to an SSL-enabled client, allows the client to authenticate itself to the server, and allows both machines to establish an encrypted connection. These capabilities address fundamental concerns about communication over the Internet and other TCP/IP networks and give protection against message tampering, eavesdropping and spoofing. • SSL server authentication allows a user to confirm a server’s identity. SSL-enabled client software can use standard techniques of public-key cryptography to check that a server’s certificate and public key are valid and have been issued by a certification authority (CA) listed in the client’s list of trusted CAs. This confirmation might be important if the user, for example, is sending a credit card number over the network and wants to check the receiving server’s identity. • SSL client authentication allows a server to confirm a user’s identity. Using the same techniques as those used for server authentication, SSL-enabled server software can check that a client’s certificate and public key are valid and have been issued by a certification authority (CA) listed in the server’s list of trusted CAs. This confirmation might be important if the server, for example, is a bank sending confidential financial information to a customer and wants to check the recipient’s identity. • An encrypted SSL connection requires all information sent between a client and a server to be encrypted by the sending software and decrypted by the receiving software, thus providing a high degree of confidentiality. Confidentiality is important for both parties to any private transaction. In addition, all data sent over an encrypted SSL connection is protected with a mechanism for detecting tampering – that is, for automatically determining whether the data has been altered in transit. SSL uses X.509 certificates for authentication, RSA as its public-key cipher and one of RC4-128, RC2-128, DES, Triple DES or IDEA as its bulk symmetric cipher. The SSL protocol includes two sub-protocols, namely the SSL Record Protocol and the SSL Handshake Protocol. The SSL Record Protocol simply defines the format used to transmit data. The SSL Handshake Protocol (using the SSL Record Protocol) is utilized to exchange a series of messages between an SSL-enabled server and an SSL-enabled client when they first establish an SSL connection. This exchange of messages is designed to facilitate the following actions. • Authenticate the server to the client. • Allow the client and server to select the cryptographic algorithms, or ciphers, that they both support. • Optionally authenticate the client to the server. • Use public-key encryption techniques to generate shared secrets. • Establish an encrypted SSL connection based on the previously exchanged shared secret. The SSL Handshake Protocol is composed of two phases. Phase 1 deals with the selection of a cipher, the exchange of a secret key and the authentication of the server. Phase 2 handles client authentication, if requested and finishes the handshaking. After the handshake stage is complete, the data transfer between client and server begins. All messages during handshaking and after, are sent over the SSL Record Protocol layer. Optionally, session identifiers can be used to re-established a secure connection that has been previously set up. Figure 4 lists in a slightly simplified form the messages that are exchanged between the client C and the server S during a handshake when neither client authentication nor session identifiers are involved. In this figure, {data}key means that data has been encrypted with key. The message exchanges shows that the client first sends a challenge to the server which responds with a X.509 certificate containing its public key. The client then creates a secret key and uses RSA with the server’s public key to encrypt it, sending the result back to the server. Only the server is capable of decrypting that message with its private key and can retrieve the shared, secret key. I order to prove to the client that the secret key has been successfully decrypted, the server encrypts the client’s challenge with the secret key and returns it. When the client is able to decrypt this message and successfully retrieves the original challenge by using the secret key, it can be certain that the server has access to the private key corresponding to its certificate. From this point on, all communication is encrypted using the chosen cipher and the shared secret key. TLS uses the same two protocols shown above and a similar handshake mechanism. Nevertheless, the algorithms for calculating message authentication codes (MACs) and secret keys have been modified to make them cryptographically more secure. In addition, the constraints on padding a message up to the next block size have been relaxed for TLS. This leads to an incompatibility between both protocols. SSL/TLS is widely used to secure web and mail traffic. HTTP as well as the current mail protocols IMAP (Internet Message Access Protocol) and POP3 (post office protocol, version 3) transmit user credential information as well as application data unencrypted. By building them on top of a secure network protocol such as SSL/TLS, they can benefit from secured channels without modifications. The secure communication protocols simply utilize different well-known destination ports (443 for HTTPS, 993 for IMAPS and 995 for POP3S) than their insecure cousins. Secure Applications A variety of popular tools that allow access to remote hosts (such as telnet, rsh and rlogin) or that provide means for file transfer (such as rcp or ftp) exchange user credentials and data in plain text. This makes them vulnerable to eavesdropping, tampering and spoofing attacks. Although the tools mentioned above could have also been built upon SSL/TLS, a different protocol suite called Secure Shell (SSH) [19] has been developed which follows partial overlapping goals. The SSH Transport and User Authentication protocols have features similar to those of SSL/TLS. However, they are different in the following ways. • TLS server authentication is optional and the protocol supports fully anonymous operation, in which neither side is authenticated. As such connections are inherently vulnerable to man-in-the-middle attacks, SSH requires server authentication. • TLS does not provide the range of client authentication options that SSH does - public-key via RSA is the only option. • Most importantly, TLS does not have the extra features provided by the SSH Connection Protocol. The SSH Connection Protocol uses the underlying connection, aka secure tunnel, which has been established by the SSH Transport and User Authentication protocols between two hosts. It provides interactive login sessions, remote execution of commands and forwarded TCP/IP as well as X11 connections. All these terminal sessions and forwarded connections are realized as different logical channels that may be opened by either side on top of the secure tunnel. Channels are flow-controlled which means that no data may be sent to a channel until a message is received to indicate that window space is available. The current version of the SSH protocol is SSH 2. It represents a complete rewrite of SSH 1 and improves some of its structural weaknesses. As it encrypts packets in a different way and has abandoned the notion of server and host keys in favor of host keys only, the protocols are incompatible. For applications built from scratch, SSH 2 should always be the preferred choice. Using the means of logical channels for interactive login sessions and remote execution, a complete replacement for telnet, rsh and rlogin could be easily implemented. A popular site that lists open-source implementations which are freely available for many different platforms can be found under [14]. Recently, a secure file transfer (sftp) application has been developed that makes the use of regular FTP based programs obsolete. Notice that it is possible to tunnel arbitrary application traffic over a connection that has been previously set up by the SSH protocols. Similar to SSL/TLS, web and mail traffic could be securely transmitted over a SSH connection before reaching the server port at the destination host. The difference is that SSH requires that a secure tunnel is created in advance which is bound to a certain port at the destination host. The set up of this secure channel, however, requires that the client that is initiating the connection has to log into the server. Usually, this makes it necessary that the user has an account at the destination host. After the tunnel has been established, all traffic sent into by the client gets forwarded to the desired port at the target machine. Obviously, the connection is encrypted. In contrast to that, SSL/TLS connects directly to a certain point without prior logging into the destination host. The encryption is set up directly between the client and the service listening at the destination port without a prior redirection via the SSH server. The technique of tunneling application traffic is often utilized for mail transactions when the mail server does not support SSL/TLS directly (as users have accounts at the mail server anyway), but it is less common for web traffic. Summary This chapter discuses security threats that systems face when they are connected to the Internet. In order to achieve the security properties that are required by the security policy in use, three different classes of mechanisms can be adopted. The first is attack prevention, which attempts to stop the attacker before it can reach its desired goals. Such techniques fall into the category of access control and firewalls. The second approach aims to make the data unusable for unauthorized persons by applying cryptographic means. Secret key as well as public keys mechanism can be utilized. The third class of mechanisms contains attack detection approaches. They attempt to detect malicious behavior and recover after undesired activity has been identified. The text also covers secure network protocols and applications. SSL/TLS as well as SSH are introduced and its most common fields of operations are highlighted. These protocols form the base of securing traffic that is sent over the Internet in behalf of a variety of different applications. ",Internet/Technology,Find & Summarize,Text Transformation Use only the document provided and nothing else.," How does Herbalife's ""seed to feed"" strategy influence its product quality and sourcing?","2022 Annual Report To Our Shareholders, We all know coming out of the pandemic has caused many companies to relook at their operations. 2022 was a year of change for Herbalife as well as a year of challenge. With every challenge, there is great opportunity. I came back to Herbalife because I believe passionately about what Herbalife does, and what it provides for health and income. Since returning to Herbalife, I along with our management team and distributor leaders from around the world have embarked on a journey to expand our content, enhance the business opportunity, modernize our brand, and expand our digital platform – with the aim to reach more customers and to provide our distributors a better plat- form to operate their business. Our vision is to be the world’s premier health and wellness company and community. As I write this, more than 3,000 distributor leaders from around the world are traveling to Los Angeles to meet together for the first time in three years to learn, to share, to innovate, and to build a path forward for Herbalife. The time is now for us to reconnect, build on our strategic plan, and provide growth for all of our stakeholders. Our digital transformation “Herbalife One” will enhance the Company’s two main platforms: content and busi- ness opportunity. Our content is our product. With obesity levels hitting record highs around the globe and a greater demand for health and wellness support, we have plans to grow our product portfolio through our daily nutrition products with expanded vegan and protein lines. We plan to explore other health and wellness opportunities that will be based on global as well as regional consumer demands. For example, our unique Ayurvedic product line in India has contributed to the success of our fastest growing market. We are unleashing similar innovative products regionally in Europe, Asia and China, and we will continue to look for synergies and opportunities to globalize our regional product offerings. With enhancements to the business opportunity, our global distributor network will continue to give us a com- petitive advantage to reach more consumers with more offerings than ever before. Our distributors give a personal voice and passion to our products. Spanning across 95 markets, our distributors are amazing entrepreneurs who have unique relationships with their customers, and through an expanded use of data, we will be able to assist our distributors to sell more products and work more closely and efficiently with consumers on their health and wellness journey. To this end, we are modernizing our brand and compensation structure, including new promotions to energize and incentivize our distributors to earn early in their Herbalife business opportunity journey. Together with Herbalife One, our business opportunity will differentiate us and strengthen our leadership in the marketplace. 2023 is a start of a new chapter – one that is both motivating and exciting. In March, I marked my 20th year of devoting my time, passion, and energy to Herbalife. I feel more optimistic about where we are headed today than ever before. Our distributors and employees make Herbalife a community unlike any other. I know our distrib- utors and employees are as incredibly excited about the future as I am. Thank you for your trust and support. Michael O. Johnson Chairman and Chief Executive Officer This letter contains “forward-looking statements” within the meaning of the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Although we believe that the expectations reflected in any of our forward-looking statements are reasonable, actual results or outcomes could differ materially from those pro- jected or assumed in any of our forward-looking statements. Our future financial condition and results of oper- ations, as well as any forward-looking statements, are subject to change and to inherent risks and uncertainties, many of which are beyond our control. Additionally, many of these risks and uncertainties are, and may continue to be, amplified by the COVID-19 pandemic. Important factors that could cause our actual results, performance and achievements, or industry results to differ materially from estimates or projections contained in or implied by our forward-looking statements include the following: the potential impacts of the COVID-19 pandemic and current global economic conditions, including inflation, on us; our Members, customers, and supply chain; and the world economy; our ability to attract and retain Members; our relationship with, and our ability to influence the actions of, our Members; our noncompliance with, or improper action by our employees or Members in violation of, applicable U.S. and foreign laws, rules, and regulations; adverse publicity associated with our Company or the direct-selling industry, including our ability to comfort the marketplace and regulators regard- ing our compliance with applicable laws; changing consumer preferences and demands and evolving industry standards, including with respect to climate change, sustainability, and other environmental, social, and gover- nance, or ESG, matters; the competitive nature of our business and industry; legal and regulatory matters, including regulatory actions concerning, or legal challenges to, our products or network marketing program and product liability claims; the Consent Order entered into with the FTC, the effects thereof and any failure to comply therewith; risks associated with operating internationally and in China; our ability to execute our growth and other strategic initiatives, including implementation of our Transformation Program and increased pene- tration of our existing markets; any material disruption to our business caused by natural disasters, other cata- strophic events, acts of war or terrorism, including the war in Ukraine, cybersecurity incidents, pandemics, and/ or other acts by third parties; our ability to adequately source ingredients, packaging materials, and other raw materials and manufacture and distribute our products; our reliance on our information technology infra- structure; noncompliance by us or our Members with any privacy laws, rules, or regulations or any security breach involving the misappropriation, loss, or other unauthorized use or disclosure of confidential information; contractual limitations on our ability to expand or change our direct-selling business model; the sufficiency of our trademarks and other intellectual property; product concentration; our reliance upon, or the loss or departure of any member of, our senior management team; restrictions imposed by covenants in the agreements governing our indebtedness; risks related to our convertible notes; changes in, and uncertainties relating to, the application of transfer pricing, income tax, customs duties, value added taxes, and other tax laws, treaties, and regulations, or their interpretation; our incorporation under the laws of the Cayman Islands; and share price volatility related to, among other things, speculative trading and certain traders shorting our common shares. Forward-looking statements in this letter speak only as of March 14, 2023. We do not undertake any obligation to update or release any revisions to any forward-looking statement or to report any events or circumstances after such date or to reflect the occurrence of unanticipated events, except as required by law. UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 10-K (Mark One) ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2022 OR TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from to Commission file number: 1-32381 HERBALIFE NUTRITION LTD. (Exact name of registrant as specified in its charter) Cayman Islands 98-0377871 (State or other jurisdiction of (I.R.S. Employer incorporation or organization) Identification No.) P.O. Box 309GT Ugland House, South Church Street Grand Cayman, Cayman Islands (Address of principal executive offices) (Zip Code) (213) 745-0500 (Registrant’s telephone number, including area code) Securities registered pursuant to Section 12(b) of the Act: Title of each class: Trading Symbol(s): Name of each exchange on which registered: Common Shares, par value $0.0005 per share HLF New York Stock Exchange Securities registered pursuant to Section 12(g) of the Act: None Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☒ No ☐ Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ☐ No ☒ Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐ Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No ☐ Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act. Large accelerated filer ☒ Accelerated filer ☐ Non-accelerated filer ☐ Smaller reporting company ☐ Emerging growth company ☐ If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐ Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that prepared or issued its audit report. ☒ If securities are registered pursuant to Section 12(b) of the Act, indicate by check mark whether the financial statements of the registrant included in the filing reflect the correction of an error to previously issued financial statements. ☐ Indicate by check mark whether any of those error corrections are restatements that required a recovery analysis of incentive-based compensation received by any of the registrant’s executive officers during the relevant recovery period pursuant to §240.10D-1(b). ☐ Indicate by check mark whether registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒ There were 97,920,728 common shares outstanding as of February 7, 2023. The aggregate market value of the Registrant’s common shares held by non-affiliates was approximately $896 million as of June 30, 2022, based upon the last reported sales price on the New York Stock Exchange on that date of $20.45. For the purposes of this disclosure only, the registrant has assumed that its directors, executive officers, and the beneficial owners of 5% or more of the registrant’s outstanding common stock are the affiliates of the registrant. DOCUMENTS INCORPORATED BY REFERENCE Portions of the registrant’s Definitive Proxy Statement to be filed with the Securities and Exchange Commission no later than 120 days after the end of the Registrant’s fiscal year ended December 31, 2022, are incorporated by reference in Part III of this Annual Report on Form 10-K. 1 TABLE OF CONTENTS Page No. PART I Item 1. Business 5 Item 1A. Risk Factors 19 Item 1B. Unresolved Staff Comments 43 Item 2. Properties 43 Item 3. Legal Proceedings 44 Item 4. Mine Safety Disclosures 44 PART II Item 5. Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity 45 Securities Item 6. [Reserved] 46 Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations 47 Item 7A. Quantitative and Qualitative Disclosures About Market Risk 67 Item 8. Financial Statements and Supplementary Data 69 Item 9. Changes in and Disagreements With Accountants on Accounting and Financial Disclosure 70 Item 9A. Controls and Procedures 70 Item 9B. Other Information 70 Item 9C. Disclosure Regarding Foreign Jurisdictions that Prevent Inspections 70 PART III Item 10. Directors, Executive Officers and Corporate Governance 71 Item 11. Executive Compensation 71 Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters 71 Item 13. Certain Relationships and Related Transactions, and Director Independence 71 Item 14. Principal Accounting Fees and Services 71 PART IV Item 15. Exhibits, Financial Statement Schedules 72 Item 16. Form 10-K Summary 125 2 FORWARD-LOOKING STATEMENTS This Annual Report on Form 10-K contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. All statements other than statements of historical fact are “forward-looking statements” for purposes of federal and state securities laws, including any projections of earnings, revenue or other financial items; any statements of the plans, strategies and objectives of management, including for future operations, capital expenditures, or share repurchases; any statements concerning proposed new products, services, or developments; any statements regarding future economic conditions or performance; any statements of belief or expectation; and any statements of assumptions underlying any of the foregoing or other future events. Forward-looking statements may include, among other, the words “may,” “will,” “estimate,” “intend,” “continue,” “believe,” “expect,” “anticipate” or any other similar words. Although we believe that the expectations reflected in any of our forward-looking statements are reasonable, actual results or outcomes could differ materially from those projected or assumed in any of our forward-looking statements. Our future financial condition and results of operations, as well as any forward-looking statements, are subject to change and to inherent risks and uncertainties, many of which are beyond our control. Additionally, many of these risks and uncertainties are, and may continue to be, amplified by the COVID-19 pandemic. Important factors that could cause our actual results, performance and achievements, or industry results to differ materially from estimates or projections contained in or implied by our forward-looking statements include the following: • the potential impacts of the COVID-19 pandemic and current global economic conditions, including inflation, on us; our Members, customers, and supply chain; and the world economy; • our ability to attract and retain Members; • our relationship with, and our ability to influence the actions of, our Members; • our noncompliance with, or improper action by our employees or Members in violation of, applicable U.S. and foreign laws, rules, and regulations; • adverse publicity associated with our Company or the direct-selling industry, including our ability to comfort the marketplace and regulators regarding our compliance with applicable laws; • changing consumer preferences and demands and evolving industry standards, including with respect to climate change, sustainability, and other environmental, social, and governance, or ESG, matters; • the competitive nature of our business and industry; • legal and regulatory matters, including regulatory actions concerning, or legal challenges to, our products or network marketing program and product liability claims; • the Consent Order entered into with the FTC, the effects thereof and any failure to comply therewith; • risks associated with operating internationally and in China; • our ability to execute our growth and other strategic initiatives, including implementation of our Transformation Program and increased penetration of our existing markets; • any material disruption to our business caused by natural disasters, other catastrophic events, acts of war or terrorism, including the war in Ukraine, cybersecurity incidents, pandemics, and/or other acts by third parties; • our ability to adequately source ingredients, packaging materials, and other raw materials and manufacture and distribute our products; • our reliance on our information technology infrastructure; • noncompliance by us or our Members with any privacy laws, rules, or regulations or any security breach involving the misappropriation, loss, or other unauthorized use or disclosure of confidential information; • contractual limitations on our ability to expand or change our direct-selling business model; • the sufficiency of our trademarks and other intellectual property; • product concentration; • our reliance upon, or the loss or departure of any member of, our senior management team; • restrictions imposed by covenants in the agreements governing our indebtedness; 3 • risks related to our convertible notes; • changes in, and uncertainties relating to, the application of transfer pricing, income tax, customs duties, value added taxes, and other tax laws, treaties, and regulations, or their interpretation; • our incorporation under the laws of the Cayman Islands; and • share price volatility related to, among other things, speculative trading and certain traders shorting our common shares. Additional factors and uncertainties that could cause actual results or outcomes to differ materially from our forward-looking statements are set forth in this Annual Report on Form 10-K, including in Part I, Item 1A, Risk Factors, and Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, and in our Consolidated Financial Statements and the related Notes. In addition, historical, current, and forward-looking sustainability-related statements may be based on standards for measuring progress that are still developing, internal controls and processes that continue to evolve, and assumptions that are subject to change in the future. Forward-looking statements in this Annual Report on Form 10-K speak only as of the date hereof. We do not undertake any obligation to update or release any revisions to any forward-looking statement or to report any events or circumstances after the date hereof or to reflect the occurrence of unanticipated events, except as required by law. The Company “We,” “our,” “us,” “Company,” “Herbalife,” and “Herbalife Nutrition” refer to Herbalife Nutrition Ltd., a Cayman Islands exempted company incorporated with limited liability, and its subsidiaries. Herbalife Nutrition Ltd. is a holding company, with substantially all of its assets consisting of the capital stock of its direct and indirectly-owned subsidiaries. 4 PART I Item 1. Business GENERAL Herbalife Nutrition is a global nutrition company that provides health and wellness products to consumers in 95 markets, which consists of countries and territories, through our direct-selling business model. Our products are primarily in the categories of weight management, sports nutrition, and targeted nutrition. We use a direct-selling business model to distribute and market our nutrition products to and through a global network of independent members, or Members. Members include consumers who purchase products for their own personal use and distributors who wish to resell products or build a sales organization. We believe that direct selling is ideally suited for our business because the distribution and sales of our products with personalized support, coaching, and education provide a supportive and understanding community of like-minded people who prioritize health and nutrition. In addition to the effectiveness of personalized selling through a direct-selling business model, we believe the primary drivers for our success throughout our 43-year operating history have been enhanced consumer awareness and demand for our products due to global trends such as the obesity epidemic, increasing interest in a fit and active lifestyle, living healthier, and the rise of entrepreneurship. PRODUCT SALES Our science-backed products help Members and their customers improve their overall health, enhance their wellness, and achieve their fitness and sport goals. As of December 31, 2022, we marketed and sold approximately 131 product types. Our products are often sold as part of a program and therefore our portfolio is comprised of a series of related products designed to simplify weight management, health and wellness, and overall nutrition for our Members and their customers. Our Formula 1 Nutritional Shake Mix, our best-selling product line, approximated 26% of our net sales for the year ended December 31, 2022. The following table summarizes our products by product category: Percentage of Net Sales 2022 2021 2020 Description Representative Products Weight Management 56.8% 58.1% 59.8% Meal replacement, protein Formula 1 Healthy Meal, shakes, drink mixes, weight Herbal Tea Concentrate, loss enhancers and healthy Protein Drink Mix, snacks Personalized Protein Powder, Total Control®, Formula 2 Multivitamin Complex, Prolessa™ Duo, and Protein Bars Targeted Nutrition 29.1% 28.2% 27.6% Functional beverages and Herbal Aloe Concentrate, dietary and nutritional Active Fiber Complex, supplements containing Niteworks®, and quality herbs, vitamins, Herbalifeline® minerals and other natural ingredients Energy, Sports, and 10.6% 9.5% 7.9% Products that support a Herbalife24® product line, Fitness healthy active lifestyle N-R-G Tea, and Liftoff® energy drink Outer Nutrition 1.6% 1.9% 2.0% Facial skin care, body care, Herbalife SKIN line and and hair care Herbal Aloe Bath and Body Care line Literature, Promotional, 1.9% 2.3% 2.7% Start-up kits, sales tools, Herbalife Member Packs and Other and educational materials and BizWorks 5 Product returns and buyback policies We offer a customer satisfaction guarantee in substantially all markets where our products are sold. If for any reason a customer or preferred member is not satisfied with an Herbalife Nutrition product, they may return it or any unused portion of the product within 30 days from the time of receipt for a full refund or credit toward the exchange of another Herbalife Nutrition product. In addition, in substantially all markets, we maintain a buyback program pursuant to which we will purchase back unsold products from a Member who decides to leave the business. Subject to certain terms and conditions that may vary by market, the buyback program generally permits a Member to return unopened products or sales materials in marketable condition purchased within the prior twelve- month period in exchange for a refund of the net price paid for the product and, in most markets, the cost of returning the products and materials to us. Together, product returns and buybacks were approximately 0.1% of net sales for each of the years ended December 31, 2022, 2021, and 2020. Product development Our products are focused on nutrition and seek to help consumers achieve their goals in the areas of weight management; targeted nutrition (including everyday wellness and healthy aging); energy, sports, and fitness; and outer nutrition. We believe our focus on nutrition and botanical science and the combination of our internal efforts with the scientific expertise of outside resources, including our ingredient suppliers, major universities, and our Nutrition Advisory Board, have resulted in product differentiation that has given our Members and consumers increased confidence in our products. We continue to invest in scientific and technical functions, including research and development associated with creating new or enhancing current product formulations and the advancement of personalized nutrition solutions; clinical studies of existing products or products in development; technical operations to improve current product formulations; quality assurance and quality control to establish the appropriate quality systems, controls, and standards; and rigorous ingredient and product testing to ensure compliance with regulatory requirements, as well as in the areas of regulatory and scientific affairs. Our personalized nutrition solutions include tools which aid in the development of optimal product packages specific to our customers’ individual nutritional needs, based on their expected wellness goals. Our product development strategy is twofold: (1) to increase the value of existing customers by investing in products that address customers’ health, wellness and nutrition considerations, fill perceived gaps in our portfolios, add flavors, increase convenience by developing products like snacks and bars, and expand afternoon and evening consumption with products like savory shakes or soups; and (2) to attract new customers by entering into new categories, offering more choices, increasing individualization, and expanding our current sports line. We have a keen focus on product innovation and aim to launch new products and variations on existing products on a regular basis. Once a particular market opportunity has been identified, our scientists, along with our operations, marketing, and sales teams, work closely with Member leadership to introduce new products and variations on existing products. Our Nutrition Advisory Board and Dieticians Advisory Board are comprised of leading experts around the world in the fields of nutrition and health who educate our Members on the principles of nutrition, physical activity, diet, and healthy lifestyle. We rely on the scientific contributions from members of our Nutrition Advisory Board and our in-house scientific team to continually upgrade existing products or introduce new products as new scientific studies become available and are accepted by regulatory authorities around the world. COMPETITION The nutrition industry is highly competitive. Nutrition products are sold through a number of distribution channels, including direct selling, online retailers, specialty retailers, and the discounted channels of food, drug and mass merchandise. Our competitors include companies such as Conagra Brands, Hain Celestial, and Post. Additionally, we compete for the recruitment of Members from other network marketing organizations, including those that market nutrition products and other entrepreneurial opportunities. Our direct-selling competitors include companies such as Nu Skin, Tupperware, and USANA. Our ability to remain competitive depends on many factors, including having relevant products that meet consumer needs, a rewarding compensation plan, enhanced education and tools, innovation in our products and services, competitive pricing, a strong reputation, and a financially viable company. We have differentiated ourselves from our competitors through our Members’ focus on the consultative sales process, which includes ongoing personal contact, coaching, behavior motivation, education, and the creation of supportive communities. For example, many Members have frequent contact with and provide support to their customers through a community-based approach to help them achieve nutrition goals. Some methods include Nutrition Clubs, Weight Loss Challenges, Wellness Evaluations, and Fit Camps. 6 For additional information regarding competition, see Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K. OUR NETWORK MARKETING PROGRAM General Our products are sold and distributed through a global direct selling business model which individuals may join to become a Member of our network marketing program. We believe that the one-on-one personalized service inherent in the direct-selling business model is ideally suited to marketing and selling our nutrition products. Sales of nutrition products are reinforced by the ongoing personal contact, coaching, behavior motivation, education, and the creation of supportive communities. This frequent, personal contact can enhance consumers’ nutritional and health education as well as motivate healthy behavioral changes in consumers to begin and maintain an active lifestyle through wellness and weight management programs. In addition, our Members consume our products themselves, and, therefore, can provide first-hand testimonials of the use and effectiveness of our products and programs to their customers. The personalized experience of our Members has served as a very powerful sales tool for our products. People become Herbalife Nutrition Members for a number of reasons. Many first start out as consumers of our products who want to lose weight or improve their nutrition, and are customers of our Members. Some later join Herbalife Nutrition and become Members themselves, which makes them eligible to purchase products directly from us, simply to receive a discounted price on products for them and their families. Some Members are interested in the entrepreneurial opportunity to earn compensation based on their own skills and hard work and join Herbalife Nutrition to earn part-time or full-time income. Our objective is sustainable growth in the sales of our products to our Members and their customers by increasing the productivity, retention and recruitment of our Member base through the structure of our network marketing program. Segmentation In many of our markets, including certain of our largest markets such as the United States, Mexico, and India, we have segmented our Member base into two categories: “preferred members” – who are consumers who wish to purchase product for their own household use, and “distributors” – who are Members who also wish to resell products or build a sales organization. This Member segmentation provides a clear differentiation between those interested in retailing our products or building a sales organization, and those simply consuming our products as discount customers. This distinction allows us to more effectively communicate and market to each group, and provides us with better information regarding our Members within the context of their stated intent and goals. As of December 31, 2022, we had approximately 6.2 million Members, including 2.9 million preferred members and 2.0 million distributors in the markets where we have established these two categories and 0.3 million sales representatives and independent service providers in China. The number of preferred members and distributors may change as a result of segmentation and/or conversion, and do not necessarily represent a change in the total number of Members. Any future change in the number of preferred members or distributors is not necessarily indicative of our future expected financial performance. Our Members We believe our Members are the most important differentiator as we go to market with our nutrition products, because of the one- on-one direct contact they have with their customers, along with the education, training and community support services that we believe help improve the nutrition habits of consumers. We work closely with our entrepreneurial Members to improve the sustainability of their businesses and to reach consumers. We require our Members to fairly and honestly market both our products and the Herbalife Nutrition business opportunity. Our relationship with our Members is key to our continued success as they allow us direct access to the voice of consumers. Many of our entrepreneurial Members identify and test new marketing efforts and programs developed by other Members and disseminate successful techniques to their sales organizations. For example, Members in Mexico developed businesses that became known as “Nutrition Clubs,” marketing techniques that improve the productivity and efficiency of our Members as well as the affordability of our weight loss products for their customers. Rather than buying several retail products, these businesses allow consumers to purchase and consume our products each day (a Member marketing technique we refer to as “daily consumption”), while continuing to benefit from the support and interaction with the Member as well as socializing with other customers in a designated location. Other programs to drive daily consumption, whether for weight management or for improved physical fitness, include Member- conducted weight loss contests, or Weight Loss Challenges, Member-led fitness programs, or Fit Camps, and Member-led Wellness Evaluations. We refer to successful Member marketing techniques that we disseminate throughout our Member network, such as Nutrition Clubs, Weight Loss Challenges, and Fit Camps, as Daily Methods of Operations, or DMOs. 7 We believe that personal and professional development is key to our Members’ success and, therefore, we and our sales leader Members – those that achieve certain levels within our Marketing Plan – have meetings and events to support this important objective. We and our Member leadership, which is comprised of sales leaders, conduct in-person and virtual training sessions on local, regional, and global levels attended by thousands of Members to provide updates on product education, sales and marketing training, and instruction on available tools. These events are opportunities to showcase and disseminate our Members’ evolving best marketing practices and DMOs from around the world and to introduce new or upgraded products. A variety of training and development tools are also available through online and mobile platforms. On July 18, 2002, we entered into an agreement with our Members that provides that we will continue to distribute Herbalife Nutrition products exclusively to and through our Members and that, other than changes required by applicable law or necessary in our reasonable business judgment to account for specific local market or currency conditions to achieve a reasonable profit on operations, we will not make any material changes to certain aspects of our Marketing Plan that are adverse to our Members without the support of our Member leadership. Specifically, any such changes would require the approval of at least 51% of our Members then at the level of President’s Team earning at the production bonus level of 6% who vote, provided that at least 50% of those Members entitled to vote do in fact vote. We initiate these types of changes based on the assessment of what will be best for us and our Members and then submit such changes for the requisite vote. We believe that this agreement has strengthened our relationship with our existing Members, improved our ability to recruit new Members and generally increased the long-term stability of our business. Member Compensation and Sales Leader Retention and Requalification In addition to benefiting from discounted prices, Members interested in the entrepreneurial opportunity may earn profit from several sources. First, Members may earn profits by purchasing our products at wholesale prices, discounted depending on the Member’s level within our Marketing Plan, and reselling those products at prices they establish for themselves to generate retail profit. Second, Members who sponsor other Members and establish, maintain, coach, and train their own sales organizations may earn additional income based on the sales of their organization, which may include royalty overrides, production bonuses, and other cash bonuses. Members earning such compensation have generally attained the level of sales leader as described below. There are also many Members, which include distributors, who have not sponsored another Member. Members who have not sponsored another Member are generally considered discount buyers or small retailers. While a number of these Members have also attained the level of sales leader, they do not receive additional income as do Members who have sponsored other Members. We assign point values, known as Volume Points, to each of our products to determine a Member’s level within the Marketing Plan. See Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K for a further description of Volume Points. Typically, a Member accumulates Volume Points for a given sale at the time the Member pays for the product. However, since May 2017, a Member does not receive Volume Points for a transaction in the United States until that product is sold to a customer at a profit and it is documented in compliance with the consent order, or Consent Order, we entered into with the Federal Trade Commission, or the FTC, in 2016. The Member’s level within the Marketing Plan is used to determine the discount applied to their purchase of our products and whether they have qualified to become a sales leader. To become a sales leader, or qualify for a higher level within our Marketing Plan, Members must achieve specified Volume Point thresholds of product sales or earn certain amounts of royalty overrides during specified time periods and generally must re-qualify once each year. Qualification criteria vary somewhat by market. We have initial qualification methods of up to 12 months to encourage a more gradual qualification. We believe a gradual qualification approach is important to the success and retention of new sales leaders and benefits the business in the long term as it allows new Members to obtain product and customer experience as well as additional training and education on Herbalife Nutrition products, daily consumption based DMOs, and the business opportunity prior to becoming a sales leader. The basis for calculating Marketing Plan payouts varies depending on product and market: for 2022, we utilized on a weighted- average basis approximately 90% of suggested retail price, to which we applied discounts of up to 50% for distributor allowances and payout rates of up to 15% for royalty overrides, up to 7% for production bonuses, and approximately 1% for a cash bonus known as the Mark Hughes bonus. We believe that the opportunity for Members to earn royalty overrides and production bonuses contributes significantly to our ability to retain our most active and productive Members. Our Marketing Plan generally requires each sales leader to re-qualify for such status each year, prior to February, in order to maintain their 50% discount on products and be eligible to receive additional income. In February of each year, we demote from the rank of sales leader those Members who did not satisfy the re-qualification requirements during the preceding twelve months. The re- qualification requirement does not apply to new sales leaders (i.e. those who became sales leaders subsequent to the January re- qualification of the prior year). 8 As of December 31, 2022, prior to our February re-qualification process, approximately 772,000 of our Members have attained the level of sales leader, of which approximately 734,000 have attained this level in the 94 markets where we use our Marketing Plan and 38,000 independent service providers operating in our China business. See Business in China below for a description of our business in China. The table below reflects sales leader retention rates by year and by region: Sales Leader Retention Rate 2023 2022 2021 North America 69.7% 58.8% 70.8% Latin America (1) 71.6% 69.3% 67.0% EMEA 64.6% 77.1% 72.7% Asia Pacific 66.6% 66.5% 63.5% Total sales leaders 67.6% 68.9% 67.9% (1) The Company combined the Mexico and South and Central America regions into the Latin America region in 2022. Historical information has been reclassified to conform with the current period geographic presentation. For the latest twelve-month re-qualification period ending January 2023, approximately 67.6% of our sales leaders, excluding China, re-qualified, versus 68.9% for the twelve-month period ended January 2022. The Company throughout its history has adjusted the re-qualification criteria from time to time in response to evolving business objectives and market conditions, and the above results include the effects of all such changes. For example, in recent years certain markets have allowed members to utilize a lower re- qualification volume threshold and the Company has continued to expand this lower re-qualification method to additional markets. Separately, with revised business requirements in place following the Consent Order, as described in Network Marketing Program below, we utilize a re-qualification equalization factor for U.S. Members to better align their re-qualification thresholds with Members in other markets, and retention results for each of the years presented include the effect of the equalization factor. We believe this factor preserves retention rate comparability across markets. Also, for each of the years presented, the retention results exclude certain markets for which, due to local operating conditions, sales leaders were not required to requalify. We believe sales leader retention rates are the result of efforts we have made to try and improve the sustainability of sales leaders’ businesses, such as encouraging Members to obtain experience retailing Herbalife Nutrition products before becoming a sales leader and providing them with advanced technology tools, as well as reflecting market conditions. As our business operations evolve, including the segmentation of our Member base in certain markets and changes in sales leader re-qualification thresholds for other markets, management continues to evaluate the importance of sales leader retention rate information. The table below reflects the number of sales leaders as of the end of February of the year indicated (subsequent to the annual re- qualification process) and by region: Number of Sales Leaders 2022 2021 2020 North America 80,278 95,402 71,202 Latin America (1) 125,726 131,359 134,401 EMEA 183,056 158,153 130,438 Asia Pacific 201,137 173,582 158,815 Total sales leaders 590,197 558,496 494,856 China 33,486 68,301 70,701 Worldwide total sales leaders 623,683 626,797 565,557 (1) The Company combined the Mexico and South and Central America regions into the Latin America region in 2022. Historical information has been reclassified to conform with the current period geographic presentation. The number of sales leaders as of December 31 will exceed the number immediately subsequent to the preceding re-qualification period because sales leaders qualify throughout the year but sales leaders who do not re-qualify are removed from the rank of sales leader the following February. 9 Business in China Our business model in China includes unique features as compared to our traditional business model in order to ensure compliance with Chinese regulations. As a result, our business model in China differs from that used in other markets. Members in China are categorized differently than those in other markets. In China, we sell our products to and through independent service providers and sales representatives to customers and preferred customers, as well as through Company-operated retail platforms when necessary. In China, while multi-level marketing is not permitted, direct selling is permitted. Chinese citizens who apply and become Members are referred to as sales representatives. These sales representatives are permitted to sell away from fixed retail locations in the provinces where we have direct selling licenses, including in the provinces of Jiangsu, Guangdong, Shandong, Zhejiang, Guizhou, Beijing, Fujian, Sichuan, Hubei, Shanxi, Shanghai, Jiangxi, Liaoning, Jilin, Henan, Chongqing, Hebei, Shaanxi, Tianjin, Heilongjiang, Hunan, Guangxi, Hainan, Anhui, Yunnan, Gansu, Ningxia, and Inner Mongolia. In Xinjiang province, where we do not have a direct selling license, we have a Company-operated retail store that can directly serve customers and preferred customers. With online orderings throughout China, there has been a declining demand in Company-operated retail stores. Sales representatives receive scaled rebates based on the volume of products they purchase. Sales representatives who reach certain volume thresholds and meet certain performance criteria are eligible to apply to provide marketing, sales and support services. Once their application is accepted, they are referred to as independent service providers. Independent service providers are independent business entities that are eligible to receive compensation from Herbalife Nutrition for the marketing, sales and support services they provide so long as they satisfy certain conditions, including procuring the requisite business licenses, having a physical business location, and complying with all applicable Chinese laws and Herbalife Nutrition rules. In China, our independent service providers are compensated for marketing, sales support, and other services, instead of the Member allowances and royalty overrides utilized in our global Marketing Plan. The service hours and related fees eligible to be earned by the independent service providers are based on a number of factors, including the sales generated through them and through others to whom they may provide marketing, sales support and other services, the quality of their service, and other factors. Total compensation available to our independent service providers in China can generally be comparable to the total compensation available to other sales leaders globally. The Company does this by performing an analysis in our worldwide system to estimate the potential compensation available to the service providers, which can generally be comparable to that of sales leaders in other countries. After adjusting such amounts for other factors and dividing by each service provider’s hourly rate, we then notify each independent service provider the maximum hours of work for which they are eligible to be compensated in the given month. In order for a service provider to be paid, the Company requires each service provider to invoice the Company for their services. RESOURCES We seek to provide the highest quality products to our Members and their customers through our “seed to feed” strategy, which includes significant investments in obtaining quality ingredients from traceable sources, qualified by scientific personnel through product testing, and increasing the amount of self-manufacturing of our top products. Ingredients Our seed to feed strategy is rooted in using quality ingredients from traceable sources. Our procurement process for many of our botanical products now stretches back to the farms and includes self-processing of teas and herbal ingredients into finished raw materials at our own facilities. Our Changsha, China facility exclusively provides high quality tea and herbal raw materials to our manufacturing facilities as well as our third-party contract manufacturers around the world. We also source ingredients that we do not self-process from companies that are well-established, reputable suppliers in their respective field. These suppliers typically utilize similar quality processes, equipment, expertise, and having traceability as we do with our own modern quality processes. As part of our program to ensure the procurement of high-quality ingredients, we also test our incoming raw materials for compliance to potency, identity, and adherence to strict specifications. 10 Manufacturing The next key component of our seed to feed strategy involves the high-quality manufacturing of these ingredients into finished products, which are produced at both third-party manufacturers and our own manufacturing facilities. As part of our long-term strategy, we seek to expand and increase our self-manufacturing capabilities. Our manufacturing facilities, known as Herbalife Innovation and Manufacturing Facilities, or HIMs, include HIM Lake Forest, HIM Winston-Salem, HIM Suzhou, and HIM Nanjing. HIM Winston- Salem is currently our largest manufacturing facility at approximately 800,000 square feet. Together, our HIM manufacturing facilities produce approximately 51% of our inner nutrition products sold worldwide. Self-manufacturing also enables us greater control to reduce negative environmental impacts of our operations and supply chain. As described in the Sustainability section below, we are focused on developing science-based green-house gas emission reduction targets for our manufacturing facilities as part of our sustainability goals. We are also focused on reducing single-use plastics throughout our global distribution network and incorporating more sustainable content, such as post-consumer recycled resin, into our packaging. Our finished products are analyzed for label claims and tested for microbiological purity, thereby verifying that our products comply with food safety standards, meet label claims and have met other quality standards. For self-manufactured products, we conduct all of our testing in-house at our fully-equipped, modern quality control laboratories in the U.S. and China. We have two quality control laboratories in Southern California and Changsha, China (including a Center of Excellence in both locations). In addition, we also have a Center of Excellence laboratory in Bangalore, India, and a quality control laboratory in Winston-Salem, North Carolina, Suzhou, China, and Nanjing, China. All HIM quality control labs contain modern analytical equipment and are backed by the expertise in testing and methods development of our scientists. In our U.S. HIM facilities, which manufacture products for the U.S. and most of our international markets, we operate and adhere to the regulations established by the U.S. Food and Drug Administration, or FDA, and strict Current Good Manufacturing Practice regulations, or CGMPs, for food, acidified foods, and dietary supplements. We also work closely with our third-party manufacturers to ensure high quality products are produced and tested through a vigorous quality control process at approved contract manufacturer labs or third-party labs. For these products manufactured at other facilities, we combine four elements to ensure quality products: (1) the same selectivity and assurance in ingredients as noted above; (2) use of reputable, CGMP-compliant, quality- and sustainability-minded manufacturing partners; (3) supplier qualification through annual audit programs; and (4) significant product quality testing. During 2022, we purchased approximately 15% of our products from our top three third-party manufacturers. Infrastructure and Technology Our direct-selling business model enables us to grow our business with moderate investment in infrastructure and fixed costs. We incur no direct incremental cost to add a new Member in our existing markets, and our Member compensation varies directly with product sales. In addition, our Members also bear a portion of our consumer marketing expenses, and our sales leaders sponsor and coordinate Member recruiting and most meeting and training initiatives. Additionally, our infrastructure features scalable production and distribution of our products as a result of having our own manufacturing facilities and numerous third-party manufacturing relationships, as well as our global footprint of in-house and third-party distribution centers. An important part of our seed to feed strategy is having an efficient infrastructure to deliver products to our Members and their customers. As the shift in consumption patterns continues to reflect an increasing daily consumption focus, one focus of this strategy is to provide more product access points closer to our Members and their customers. We have both Company-operated and outsourced distribution points ranging from our “hub” distribution centers in Los Angeles, Memphis, and Venray, Netherlands, to mid-size distribution centers in major countries, to small pickup locations spread throughout the world. We also expect to continue to improve our distribution channels relating to home delivery as we expect to see continued increased demands for our products being shipped to our Members in certain of our larger markets. In addition to these distribution points, we partner with certain retail locations to provide Member pickup points in areas which are not well serviced by our distribution points. We have also identified a number of methods and approaches that better support Members by providing access points closer to where they do business and by improving product delivery efficiency through our distribution channels. Specific methods vary by markets and consider local Member needs and available resources. In aggregate, we have over 1,500 distribution points and partner retail locations around the world. In addition to our distribution points, we contract third party-run drop-off locations where we can ship to and Members can pick up ordered products. 11 We leverage our technology infrastructure in order to maintain, protect, and enhance existing systems and develop new systems to keep pace with continuing changes in technology, evolving industry and regulatory standards, emerging data security risks, and changing user patterns and preferences. We also continue to invest in our manufacturing and operational infrastructure to accelerate new products to market and accommodate planned business growth. We invest in business intelligence tools to enable better analysis of our business and to identify opportunities for growth. We will continue to build on these platforms to take advantage of the rapid development of technology around the globe to support a more robust Member and customer experience. In addition, we leverage an Oracle business suite platform to support our business operations, improve productivity and support our strategic initiatives. Our investment in technology infrastructure helps support our capacity to grow. In 2021, we also initiated a global transformation program to optimize global processes for future growth, or the Transformation Program. The Transformation Program involves the investment in certain new technologies and the realignment of infrastructure and the locations of certain functions to better support distributors and customers. The Transformation Program is still ongoing and expected to be completed in 2024 as described further in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K and Note 14, Transformation Program, to the Consolidated Financial Statements included in Part IV, Item 15, Exhibits, Financial Statement Schedules, of this Annual Report on Form 10-K. In addition, many Members rely on the use of technology to support their goals and businesses. As part of our continued investment in technology to further support our Members and drive long-term growth, we have enhanced our product access and distribution network to support higher volumes of online or mobile orders, allowing Members and their customers to select home or business delivery options. We have also implemented information technology systems to support Members and their increasing demand to be more connected to Herbalife Nutrition, their business, and their consumers with tools such as HN MyClub, Engage, HNconnect, BizWorks, MyHerbalife, GoHerbalife, and Herbalife.com. Additionally, we continue to support a growing suite of point-of-sale tools to assist our Members with ordering, tracking, and customer relationship management. These tools allow our Members to manage their business and communicate with their customers more efficiently and effectively. During 2022, we also commenced a Digital Technology Program to develop a new enhanced platform to provide enhanced digital capabilities and experiences to our Members. This is a multi-year program and we expect our capital expenditures to increase in 2023 and future years as result of our investments in this Digital Technology Program as described further in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K. Intellectual Property and Branding Marketing foods and supplement products on the basis of sound science means using ingredients in the composition and quantity as demonstrated to be effective in the relevant scientific literature. Use of these ingredients for their well-established purposes is by definition not novel, and for that reason, most food uses of these ingredients are not subject to patent protection. Notwithstanding the absence of patent protection, we do own proprietary formulations for substantially all of our weight management products and dietary and nutritional supplements. We take care in protecting the intellectual property rights of our proprietary formulas by restricting access to our formulas within the Company to those persons or departments that require access to them to perform their functions, and by requiring our finished goods suppliers and consultants to execute supply and non-disclosure agreements that contractually protect our intellectual property rights. Disclosure of these formulas, in redacted form, is also necessary to obtain product registrations in many countries. We also make efforts to protect certain unique formulations under patent law. We strive to protect all new product developments as the confidential trade secrets of the Company. We use the umbrella trademarks Herbalife®, Herbalife Nutrition®, and the Tri-Leaf design worldwide, and protect several other trademarks and trade names related to our products and operations, such as Niteworks® and Liftoff®. Our trademark registrations are issued through the United States Patent and Trademark Office, or USPTO, and comparable agencies in the foreign countries. We believe our trademarks and trade names contribute to our brand awareness. To increase our brand awareness, we and our Members use a variety of tools and marketing channels. These can include anything from traditional media to social media and alliances with partners who can promote our goal of better living through nutrition. Herbalife Nutrition sponsorships of and partnerships with featured athletes, teams, and events promote brand awareness and the use of Herbalife Nutrition products. We continue to build brand awareness with a goal towards becoming the most trusted brand in nutrition. We also work to leverage the power of our Member base as a marketing and brand-building tool. We maintain a brand style guide and brand asset library so that our Members have access to the Herbalife Nutrition brand logo and marketing materials for use in their marketing efforts. 12 Sustainability Our goals and objectives to nourish people and communities and to improve the planet are part of both our day-to-day activities and our long-term growth strategy. As a signatory of the United Nations Global Compact, or UNGC, we have aligned our sustainability initiatives outlined by the United Nations’ Sustainable Development Goals. Our current sustainability initiatives focus on issues including climate and emissions, packaging, and operational waste. For example, we have implemented projects that have reduced overall packaging materials and incorporated usage of recycled materials in the packaging of our flagship product, Formula 1 Healthy Meal Nutritional Shake in North America, Mexico, and in certain markets where permitted by regulations. We are seeking opportunities across operations to reduce waste-prone materials such as single-use plastics. More information on these efforts is provided in the Manufacturing section above. For information relating to our culture, diversity, equity, and inclusion, please see the Human Capital section below. REGULATION General In our United States and foreign markets, we are affected by extensive laws, governmental regulations, administrative determinations and guidance, court decisions and similar constraints that regulate the conduct of our business. Such laws, regulations and other constraints exist at the federal, state or local levels in the United States and at all levels of government in foreign jurisdictions, and include regulations pertaining to: (1) the formulation, manufacturing, packaging, labeling, distribution, importation, sale, and storage of our products; (2) product claims and advertising, including direct claims and advertising by us, as well as claims and advertising by Members, for which we may be held responsible; (3) our network marketing program; (4) transfer pricing and similar regulations that affect the level of U.S. and foreign taxable income and customs duties; (5) taxation of our Members (which in some instances may impose an obligation on us to collect the taxes and maintain appropriate records); (6) our international operations, such as import/export, currency exchange, repatriation and anti-bribery regulations; (7) antitrust issues; and (8) privacy and data protection. See Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K for additional information. Products In the United States, the formulation, manufacturing, packaging, holding, labeling, promotion, advertising, distribution, and sale of our products are subject to regulation by various federal governmental agencies, including: (1) the FDA; (2) the FTC; (3) the Consumer Product Safety Commission, or CPSC; (4) the United States Department of Agriculture, or USDA; (5) the Environmental Protection Agency, or EPA; (6) the United States Postal Service; (7) United States Customs and Border Protection; and (8) the Drug Enforcement Administration. Our activities also are regulated by various agencies of the states, localities and foreign countries in which our products are manufactured, distributed, or sold. The FDA, in particular, regulates the formulation, manufacture, and labeling of over-the-counter, or OTC, drugs, conventional foods, dietary supplements, and cosmetics such as those distributed by us. The majority of the products marketed by us in the United States are classified as conventional foods or dietary supplements under the Federal Food, Drug and Cosmetic Act, or FFDCA. Internationally, the majority of products marketed by us are classified as foods, health supplements, or food supplements. FDA regulations govern the preparation, packaging, labeling, holding, and distribution of foods, OTC drugs, cosmetics, and dietary supplements. Among other obligations, they require us and our contract manufacturers to meet relevant CGMP regulations for the preparation, packaging, holding, and distribution of OTC drugs and dietary supplements. The FDA also requires identity testing of all incoming dietary ingredients used in dietary supplements, unless a company successfully petitions for an exemption from this testing requirement in accordance with the regulations. The CGMPs are designed to ensure that OTC drugs and dietary supplements are not adulterated with contaminants or impurities, and are labeled to accurately reflect the active ingredients and other ingredients in the products. We have implemented a comprehensive quality assurance program that is designed to maintain compliance with the CGMPs for products manufactured by us or on our behalf for distribution in the United States. As part of this program, we have regularly implemented enhancements, modifications and improvements to our manufacturing and corporate quality processes. We believe that we and our contract manufacturers are compliant with the FDA’s CGMPs and other applicable manufacturing regulations in the United States. The U.S. Dietary Supplement Health and Education Act of 1994, or DSHEA, revised the provisions of FFDCA concerning the composition and labeling of dietary supplements. Under DSHEA, dietary supplement labeling may display structure/function claims that the manufacturer can substantiate, which are claims that the products affect the structure or function of the body, without prior FDA approval, but with notification to the FDA. They may not bear any claim that they can prevent, treat, cure, mitigate or diagnose disease (a drug claim). Apart from DSHEA, the agency permits companies to use FDA-approved full and qualified health claims for food and supplement products containing specific ingredients that meet stated requirements. 13 U.S. law also requires that all serious adverse events occurring within the United States involving dietary supplements or OTC drugs be reported to the FDA. We believe that we are in compliance with this law having implemented a worldwide procedure governing adverse event identification, investigation and reporting. As a result of reported adverse events, we may from time to time elect, or be required, to remove a product from a market, either temporarily or permanently. Some of the products marketed by us are considered conventional foods and are currently labeled as such. Within the United States, this category of products is subject to the federal Nutrition, Labeling and Education Act, or NLEA, and regulations promulgated under the NLEA. The NLEA regulates health claims, ingredient labeling and nutrient content claims characterizing the level of a nutrient in the product. The ingredients in conventional foods must either be generally recognized as safe by experts for the purposes to which they are put in foods, or be approved as food additives under FDA regulations. The federal Food Safety Modernization Act, or FSMA, is also applicable to some of our business. We follow a food safety plan and have implemented preventive measures required by the FSMA. Foreign suppliers of our raw materials are also subject to FSMA requirements, and we have implemented a verification program to comply with the FSMA. Dietary supplements manufactured in accordance with CGMPs and foods manufactured in accordance with the low acid food regulations are exempt. In foreign markets, prior to commencing operations and prior to making or permitting sales of our products in the market, we may be required to obtain an approval, license or certification from the relevant country’s ministry of health or comparable agency. Prior to entering a new market in which a formal approval, license or certificate is required, we work with local authorities in order to obtain the requisite approvals. The approval process generally requires us to present each product and product ingredient to appropriate regulators and, in some instances, arrange for testing of products by local technicians for ingredient analysis. The approvals may be conditioned on reformulation of our products, or may be unavailable with respect to some products or some ingredients. The FTC, which exercises jurisdiction over the advertising of all of our products in the United States, has in the past several years instituted enforcement actions against several dietary supplement and food companies and against manufacturers of weight loss products generally for false and misleading advertising of some of their products. In addition, the FTC has increased its scrutiny of the use of testimonials, which we also utilize, as well as the role of expert endorsers and product clinical studies. We cannot be sure that the FTC, or comparable foreign agencies, will not question our advertising or other operations in the future. In Europe, where an EU Health Claim regulation is in effect, the European Food Safety Authority, or EFSA, issued opinions following its review of a number of proposed claims documents. ESFA’s opinions, which have been accepted by the European Commission, have limited the use of certain nutrition-specific claims made for foods and food supplements. Accordingly, we revised affected product labels to ensure regulatory compliance. We are subject to a permanent injunction issued in October 1986 pursuant to the settlement of an action instituted by the California Attorney General, the State Health Director and the Santa Cruz County District Attorney. We consented to the entry of this injunction without in any way admitting the allegations of the complaint. The injunction prevents us from making specified claims in advertising of our products, but does not prevent us from continuing to make specified claims concerning our products, provided that we have a reasonable basis for making the claims. The injunction also prohibits certain recruiting-related investments from Members and mandates that payments to Members be premised on retail value (as defined); the injunction provides that we may establish a system to verify or document such compliance. Network Marketing Program Our network marketing program is subject to a number of federal and state regulations administered by the FTC and various state regulators as well as regulations in foreign markets administered by foreign regulators. Regulations applicable to network marketing organizations generally are directed at ensuring that product sales ultimately are made to consumers and that advancement within the organization is based on sales of the organization’s products rather than investments in the organization or other non-retail sales related criteria. When required by law, we obtain regulatory approval of our network marketing program or, when this approval is not required, the favorable opinion of local counsel as to regulatory compliance. 14 On July 15, 2016, we reached a settlement with the FTC and entered into a proposed Stipulation to Entry of Order for Permanent Injunction and Monetary Judgment, or the Consent Order, which resolved the FTC’s multi-year investigation of us. The Consent Order became effective on July 25, 2016, or the Effective Date, upon final approval by the U.S. District Court for the Central District of California. Pursuant to the Consent Order, we implemented and continue to enhance certain procedures in the U.S. and agreed to be subject to certain audits by an independent compliance auditor (Affiliated Monitors, Inc.) for a period of seven years. Among other requirements, the Consent Order requires us to categorize all existing and future Members in the U.S. as either “preferred members” – who are simply consumers who only wish to purchase product for their own household use — or “distributors” – who are Members who wish to resell some products or build a sales organization. We also agreed to compensate distributors on U.S. eligible sales within their downline organizations, which include purchases by preferred members, purchases by a distributor for his or her personal consumption within allowable limits and sales of product by a distributor to his or her customers. The Consent Order also requires distributors to meet certain conditions before opening Nutrition Clubs and/or entering into leases for their Herbalife Nutrition business in the United States. The Consent Order also prohibits us from making expressly or by implication, any misrepresentation regarding certain lifestyles or amount or level of income, including full-time or part-time income that a participant can reasonably expect to earn in our network marketing program. The Consent Order also prohibits us and other persons who act in active concert with us from misrepresenting that participation in the network marketing program will result in a lavish lifestyle and from using images or descriptions to represent or imply that participation in the program is likely to result in a lavish lifestyle. In addition, the Consent Order prohibits specified misrepresentations in connection with marketing the program, including misrepresentations regarding any fact material to participation such as the cost to participate or the amount of income likely to be earned. The Consent Order also requires us to clearly and conspicuously disclose information related to our refund and buyback policy on certain company materials and websites. The terms of the Consent Order do not change our going to market through direct selling by independent distributors, and compensating those distributors based upon the product they and their sales organization sell. We have implemented new and enhanced procedures required by the terms of the Consent Order and will continue to do so. We continue to monitor the impact of the Consent Order and our board of directors originally established the Implementation Oversight Committee in connection with monitoring compliance with the Consent Order, and more recently, our Audit Committee assumed oversight of continued compliance with the Consent Order. While we currently do not expect the Consent Order to have a long-term and material adverse impact on our business and our Member base, our business and our Member base, particularly in the U.S., have been in the past, and may in the future, be negatively impacted as we and they adjust to the changes. However, the terms of the Consent Order and the ongoing costs of compliance may adversely affect our business operations, our results of operations, and our financial condition. See Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K for a discussion of risks related to the settlement with the FTC. On January 4, 2018, the FTC released its nonbinding Business Guidance Concerning Multi-Level Marketing, or MLM Guidance. The MLM Guidance explains, among other things, lawful and unlawful compensation structures, the treatment of personal consumption by participants in determining if an MLM’s compensation structure is unfair or deceptive, and how an MLM should approach representations to current and prospective participants. We believe our current business practices, which include new and enhanced procedures implemented in connection with the Consent Order, are in compliance with the MLM Guidance. Additionally, the FTC has promulgated nonbinding Guides Concerning the Use of Endorsements and Testimonials in Advertising, or Guides, which explain how the FTC interprets Section 5 of the FTC Act’s prohibition on unfair or deceptive acts or practices. Consequently, the FTC could bring a Section 5 enforcement action based on practices that are inconsistent with the Guides. Under the Guides, advertisements that feature a consumer and convey his or her atypical experience with a product or service are required to clearly disclose the typical results that consumers can generally expect. The revised Guides also require advertisers to disclose connections between the advertiser and any endorsers that consumers might not expect, known as “material connections.” We have adapted our practices and rules regarding the practices of our Members to comply with the Guides and to comply with the Consent Order. We also are subject to the risk of private party challenges to the legality of our network marketing program both in the United States and internationally. For example, in Webster v. Omnitrition International, Inc., 79 F.3d 776 (9th Cir. 1996), the network marketing program of Omnitrition International, Inc., or Omnitrition, was challenged in a class action by Omnitrition distributors who alleged that it was operating an illegal “pyramid scheme” in violation of federal and state laws. We believe that our network marketing program satisfies federal and other applicable state statutes and case law. In some countries, regulations applicable to the activities of our Members also may affect our business because in some countries we are, or regulators may assert that we are, responsible for our Members’ conduct. In these countries, regulators may request or require that we take steps to ensure that our Members comply with local regulations. The types of regulated conduct include: (1) representations concerning our products; (2) income representations made by us and/or Members; (3) public media advertisements, which in foreign markets may require prior approval by regulators; (4) sales of products in markets in which the products have not been approved, licensed or certified for sale; and (5) classification by government agencies of our Members as employees of the Company. 15 In some markets, it is possible that improper product claims by Members could result in our products being reviewed by regulatory authorities and, as a result, being classified or placed into another category as to which stricter regulations are applicable. In addition, we might be required to make labeling changes. We also are subject to regulations in various foreign markets pertaining to social security assessments and employment and severance pay requirements. As an example, in some markets, we are substantially restricted in the amount and types of rules and termination criteria that we can impose on Members without having to pay social security assessments on behalf of the Members and without incurring severance obligations to terminated Members. In some countries, we may be subject to these obligations in any event. It is an ongoing part of our business to monitor and respond to regulatory and legal developments, including those that may affect our network marketing program. However, the regulatory requirements concerning network marketing programs do not include bright line rules and are inherently fact-based. An adverse judicial or regulatory determination with respect to our network marketing program could have a material adverse effect on our business, financial condition, and operating results and may also result in negative publicity, requirements to modify our network marketing program, or a negative impact on Member morale. In addition, adverse rulings by courts in any proceedings challenging the legality of network marketing systems, even in those not involving us directly, could have a material adverse effect on our operations. Although questions regarding the legality of our network marketing program have come up in the past and may come up from time to time in the future, we believe, based in part upon guidance to the general public from the FTC, that our network marketing program is compliant with applicable law. Income Tax, Transfer Pricing, and Other Taxes In many countries, including the United States, we are subject to income tax, transfer pricing and other tax regulations designed to ensure that appropriate levels of income are reported as earned by our U.S. and local entities and are taxed accordingly. In addition, our operations are subject to regulations designed to ensure that appropriate levels of customs duties are assessed on the importation of our products. Although we believe that we are in substantial compliance with all applicable tax rules, regulations, and restrictions, we are subject to the risk that governmental authorities could assert that additional taxes are owed based on findings of their audit. For example, we are currently subject to pending or proposed audits that are at various levels of review, assessment or appeal in a number of jurisdictions involving transfer pricing issues, income taxes, duties, value added taxes, withholding taxes and related interest and penalties in material amounts. In some circumstances, additional taxes, interest and penalties have been assessed, and we will be required to appeal or litigate to reverse the assessments. We have taken advice from our tax advisors and believe that there are substantial defenses to the allegations that additional taxes are owed, and we are vigorously defending against the imposition of additional proposed taxes. The ultimate resolution of these matters may take several years, and the outcome is uncertain. In the event that the audits or assessments are concluded adversely, we may or may not be able to offset or mitigate the consolidated effect of foreign income tax assessments through the use of U.S. foreign tax credits. The laws and regulations governing U.S. foreign tax credits are complex and subject to periodic legislative amendment, and there are restrictions on the utilization of U.S. foreign tax credits. Therefore, we cannot be sure that we would in fact be able to take advantage of any foreign tax credits in the future. Compliance Procedures As indicated above, Herbalife Nutrition, our products and our network marketing program are subject, both directly and indirectly through Members’ conduct, to numerous federal, state and local regulations, in the United States and foreign markets. In 1985, we began to institute formal compliance measures by developing a system to identify specific complaints against Members and to remedy any violations of Herbalife Nutrition’s rules by Members through appropriate sanctions, including warnings, fines, suspensions and, when necessary, terminations. We prohibit Members from making therapeutic claims for our products or misrepresentations regarding participating in our network marketing program, including in our manuals, seminars, and other training programs and materials. Our general policy is to reject Member applications from individuals who do not reside in one of our approved markets. 16 In order to comply with regulations that apply to both us and our Members, we research the applicable regulatory framework prior to entering any new market to identify necessary licenses and approvals and applicable limitations relating to our operations in that market and then work to bring our operations into compliance with the applicable limitations and to maintain such licenses. Typically, we conduct this research with the assistance of local legal counsel and other representatives. We also research laws applicable to Member operations and revise or alter our Member applications, rules, and other training materials and programs to provide Members with guidelines for operating their independent business, marketing and distributing our products and similar matters, as required by applicable regulations in each market. While we have rules and guidelines for our Members and monitor their market conduct, we are, however, unable to ensure that our Members will not distribute our products in countries where we have not commenced operations. In addition, regulations in existing and new markets often are ambiguous and subject to considerable interpretive and enforcement discretion by the responsible regulators. Moreover, even when we believe that we and our Members are in compliance with all applicable regulations, new regulations are being added regularly and the interpretation of existing regulations is subject to change. Further, the content and impact of regulations to which we are subject may be influenced by public attention directed at us, our products, or our network marketing program, so that extensive adverse publicity about us, our products, or our network marketing program may increase the likelihood regulatory scrutiny or action. HUMAN CAPITAL At Herbalife Nutrition, our commitment to improving lives and our communities is at the core of everything we do. This commitment also informs how we value and treat our employees. We seek to provide a work environment where employees can grow and thrive while supporting our Members and their customers. We believe attracting, developing, and retaining a talented and diverse workforce are critical factors that contribute to the success and growth of our business. We have operations globally, requiring investment to assess local labor market conditions and recruit and retain the appropriate workforce. Having a business presence in multiple domestic and international markets also requires us to monitor local labor and employment laws for which we often engage third-party advisors. We monitor the talent needs of our departments and functions with particular focus on the areas where human capital resources are important to daily operations to ensure we can timely manufacture, distribute, and sell products to our Members. As of December 31, 2022, we had approximately 10,100 employees, of which approximately 2,800 were located in the United States. Diversity, Equity, and Inclusion We believe diversity is a strength and embrace a core vision that a diverse, equitable, and inclusive culture is imperative to enable us to better serve our Members, stakeholders, and communities. As such, we seek to promote a work environment where all people can thrive, and are committed to diversity, equity, and inclusion, or DEI, at all levels, from our employees, management and executive leadership to our board of directors. Our DEI strategy is currently focused on creating opportunities to further recruit and support diverse talent at all levels, encouraging inclusion and belonging, and embedding equity throughout our culture and operations. Current initiatives include the implementation of a global applicant tracking system to deepen our commitment to fair recruitment processes, offering unconscious bias trainings for all employees, the expansion of existing employee networks which help employees build community and foster a culture of belonging, and further development and involvement of Global and Regional DEI Councils to drive DEI progress. Additionally, we have set diversity goals and targets for women in leadership roles globally and for racial and ethnic minorities in leadership roles in the U.S. Talent Acquisition and Development We seek to attract and retain a talented and diverse workforce. To foster an inclusive hiring process in the U.S., we use a tool that helps ensure that job descriptions do not unintentionally exclude potential applicants. Investment in our employees' professional growth and development is important and helps establish a strong foundation for long- term success. At our Company, we strive to create a learning culture, one in which development is an ongoing focus for all employees and managers. We invest in our employees’ development through a variety of programs. These programs are designed to help our employees grow professionally and strengthen their skills throughout their careers. Examples of these programs include the following: • Training Programs – We provide our employees access to an internal learning management system, Herbalife Nutrition University, which provides professional development courses, technical training, and compliance training to all employees globally. 17 • Mentorship Programs – The principle of servant leadership is a crucial part of our culture. We believe that one way to be a servant leader is to mentor others, and, in 2020, we introduced a new mentorship program to help guide junior employees in their professional journey. Through this program, participating employees can be provided with a one-on-one professional development opportunity, in which they receive dedicated coaching, feedback, and encouragement. • Educational Assistance – Another way we support employees’ continual professional development is by offsetting a portion of the cost of higher education. Program offerings and eligibility vary by region, but may include partial reimbursement of tuition fees incurred for undergraduate and graduate degrees, certificate programs, or skills-based courses. Compensation and Benefits Our Board of Directors and its Compensation Committee establish our general compensation philosophy and oversee and approve the development, adoption, and implementation of compensation policies and programs, which are set at a global level, but also adapted to meet local country requirements as needed. We provide base pay that aligns with employee positions, skill levels, experience, contributions, and geographic location. In addition to base pay, we seek to reward employees with annual incentive awards, recognition programs, and equity awards for employees at certain job grades. Our benefit programs are designed to enhance employee well-being and assist employees in the event of illness, injury, or disability. To this end, we offer benefits that vary worldwide, but may include health insurance, retirement savings programs, and wellness incentives designed to promote a healthy and active lifestyle. We believe we offer our employees wages and benefits packages that are in line with respective local labor markets and laws. Safety, Health, and Well-Being As a nutrition company, we believe the safety, health, and well-being of our employees is of the utmost importance. We endeavor to promote these principles by providing a safe and healthy work environment and encouraging healthy, active lifestyles. Our efforts to provide a safe workplace are guided by various formal policies and programs, which are designed to protect employees, contractors, and visitors from accidents, illnesses, and injuries, while operating in compliance with applicable regulations, including OSHA guidelines in the U.S. We also follow policies and programs regarding material health and safety risks, workplace violence prevention, and incident response and management. In the U.S., our manufacturing facilities in Winston-Salem and Lake Forest are ISO 45001 certified, an international standard for occupational health and safety management. While the COVID-19 pandemic has increased the resources required to keep our employees safe and healthy, we continue to make what we believe are the necessary investments to achieve this goal. In response to, and during various phases of, the pandemic, we have taken several actions, including supporting our employees to work from home when possible, offering mental and emotional wellness resources, and implementing safety measures when necessary at our facilities. Over the course of the pandemic, our senior management team has relied on cross-functional teams to monitor, review, and assess the evolving situation. These cross-functional teams are responsible for recommending risk mitigation actions based on the local risks and in accordance with regulatory requirements and guidelines for the health and safety of our employees and, in the U.S., protocols to align with all federal, state, and local public health guidelines. We believe our proactive efforts have been successful in supporting our business growth despite the obstacles and challenges presented by COVID-19. In addition, we believe in the importance of well-being and provide resources for our employees that support their pursuit of a healthy and active lifestyle. Our flagship wellness program in the U.S., “Wellness for Life,” offers employees a suite of activities to achieve overall wellness through improved fitness, nutrition, intellectual well-being, and financial literacy. The variety of activities offered ensures all employees may participate, no matter where they may be in their wellness journey. While we have many existing regional wellness programs, a new and enhanced global wellness program will launch in January 2023 and feature Herbalife fitness, health and nutrition experts from around the globe. We also have facilities and programs in place that allow employees to incorporate fitness into their daily schedule, such as onsite gyms at several facilities and live virtual classes. Our Members We are dependent on our Members to sell and promote our products to their customers. We frequently interact and work directly with our sales leaders to explore ways to support our and our Members’ businesses, and their customers’ personal goals of living a healthier and more active lifestyle. See the Our Network Marketing Program – Member Compensation and Sales Leader Retention and Requalification section above for sales leader and requalification metrics and further discussion on our sales leaders. 18 Available Information Our Internet website address is www.herbalife.com and our investor relations website is ir.herbalife.com. We make available free of charge on our website our Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, proxy statements, and amendments to those reports filed or furnished pursuant to Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended, or the Exchange Act, as soon as reasonably practical after we file such material with, or furnish it to, the Securities and Exchange Commission, or SEC. The SEC maintains an Internet website that contains reports, proxy and information statements, and other information regarding issuers that file electronically with the SEC at www.sec.gov. We also make available free of charge on our investor relations website at ir.herbalife.com our Principles of Corporate Governance, our Code of Conduct, and the Charters of our Audit Committee, Nominating and Corporate Governance Committee, Compensation Committee, and ESG Committee of our board of directors. Unless expressly noted, the information on our website, including our investor relations website, or any other website is not incorporated by reference in this Annual Report on Form 10-K and should not be considered part of this Annual Report on Form 10-K or any other filing we make with the SEC. Item 1A. Risk Factors Please carefully consider the following discussion of significant factors, events, and uncertainties that make an investment decision regarding our securities risky. The factors, events, uncertainties, and consequences discussed in these risk factors could, in circumstances we may not be able to accurately predict, recognize, or control, have a material adverse effect on our business, reputation, prospects, financial condition, operating results, cash flows, liquidity, and share price. These risk factors do not identify all risks that we face. We could also be affected by factors, events, or uncertainties that are not presently known to us or that we currently do not consider to present material risks. Additionally, the COVID-19 pandemic has amplified many of the other risks discussed below to which we are subject. We are unable to predict the duration and extent to which the pandemic and its related impacts will adversely impact our business, financial condition, and operating results as well as our share price. In addition, given the unpredictable, unprecedented, and fluid nature of the pandemic, it may also materially and adversely affect our business, financial condition, and operating results in ways that are not currently anticipated by or known to us or that we currently do not consider to present material risks. Risk Factor Summary This risk factor summary contains a high-level summary of certain of the principal factors, events and uncertainties that make an investment in our securities risky, including risks related to our business and industry, risks related to regulatory and legal matters, risks related to our international operations, risks related to our indebtedness and risks related to our common shares. The following summary is not complete and should be read together with the more detailed discussion of these and the other factors, events, and uncertainties set forth below before making an investment decision regarding our securities. The principal factors, events, and uncertainties that make an investment in our securities risky include the following: Risks Related to Our Business and Industry • Our failure to establish and maintain Member and sales leader relationships could negatively impact sales of our products and materially harm our business, financial condition, and operating results. • Because we cannot exert the same level of influence or control over our Members as we could if they were our employees, our Members could fail to comply with applicable law or our rules and procedures, which could result in claims against us that could materially harm our business, financial condition, and operating results. • Adverse publicity associated with our Company or the direct-selling industry could materially harm our business, financial condition, and operating results. • Our failure to compete successfully could materially harm our business, financial condition, and operating results. • Our contractual obligation to sell our products only through our Member network and to refrain from changing certain aspects of our Marketing Plan may limit our growth. • Our failure to appropriately respond to changing consumer trends, preferences, and demand for new products and product enhancements could materially harm our Member relationships, our Members’ customer relationships, and product sales or otherwise materially harm our business, financial condition, and operating results. • If we fail to further penetrate existing markets, the growth in sales of our products, along with our operating results could be negatively impacted. 19 • Since one of our products constitutes a significant portion of our net sales, significant decreases in consumer demand for this product or our failure to produce a suitable replacement, could materially harm our business, financial condition, and operating results. • Our business could be materially and adversely affected by natural disasters, other catastrophic events, acts of war or terrorism, cybersecurity incidents, pandemics, and/or other acts by third parties. • We depend on the integrity and reliability of our information technology infrastructure, and any related interruptions or inadequacies may have a material adverse effect on our business, financial condition, and operating results. • Disruption of supply, shortage, or increases in the cost of ingredients, packaging materials, and other raw materials as well as climate change could materially harm our business, financial condition, and operating results. • If any of our manufacturing facilities or third-party manufacturers fail to reliably supply products to us at required levels of quality or fail to comply with applicable laws, our financial condition and operating results could be materially and adversely impacted. • If we lose the services of members of our senior management team, our business, financial condition, and operating results could be materially harmed. • Our share price may be adversely affected by third parties who raise allegations about our Company. • ESG matters, including those related to climate change and sustainability, may have an adverse effect on our business, financial condition, and operating results and may damage our reputation. Risks Related to Regulatory and Legal Matters • Our products are affected by extensive regulations, and our failure or our Members’ failure to comply with any regulations could lead to significant penalties or claims, which could materially harm our financial condition and operating results. • Our network marketing program is subject to extensive regulation and scrutiny and any failure to comply, or alteration to our compensation practices in order to comply, with these regulations could materially harm our business, financial condition, and operating results. • We are subject to the Consent Order with the FTC, the effects of which, or any failure to comply therewith, could materially harm our business, financial condition, and operating results. • Our actual or perceived failure to comply with privacy and data protection laws, rules, and regulations could materially harm our business, financial condition, and operating results. • We are subject to material product liability risks, which could increase our costs and materially harm our business, financial condition, and operating results. • If we fail to protect our intellectual property, our ability to compete could be negatively affected, which could materially harm our financial condition and operating results. • If we infringe the intellectual property rights of others, our business, financial condition, and operating results could be materially harmed. • We may be held responsible for additional compensation, certain taxes, or assessments relating to the activities of our Members, which could materially harm our financial condition and operating results. Risks Related to Our International Operations • A substantial portion of our business is conducted in foreign jurisdictions, exposing us to the risks associated with international operations. • We are subject to the anti-bribery laws, rules, and regulations of the United States and the other foreign jurisdictions in which we operate. • If we do not comply with transfer pricing, customs duties VAT, and similar regulations, we may be subject to additional taxes, customs duties, interest, and penalties in material amounts, which could materially harm our financial condition and operating results. • Our business in China is subject to general, as well as industry-specific, economic, political, and legal developments and risks and requires that we utilize a modified version of the business model we use elsewhere in the world. • The United Kingdom’s exit from the European Union could adversely impact us. 20 Risks Related to Our Indebtedness • The terms and covenants in our existing indebtedness could limit our discretion with respect to certain business matters, which could harm our business, financial condition, and operating results. • The conversion or maturity of our convertible notes may adversely affect our financial condition and operating results, and their conversion into common shares could have a dilutive effect that could cause our share price to go down. Risks Related to Our Common Shares • Holders of our common shares may difficulties in protecting their interests because we are incorporated under Cayman Islands law. • Provisions of our articles of association and Cayman Islands law may impede a takeover or make it more difficult for shareholders to change the direction or management of the Company, which could reduce shareholders’ opportunity to influence management of the Company. • There is uncertainty as to shareholders’ ability to enforce certain foreign civil liabilities in the Cayman Islands. • U.S. Tax Reform may adversely impact certain U.S. shareholders of the Company. Risks Related to Our Business and Industry Our failure to establish and maintain Member and sales leader relationships could negatively impact sales of our products and materially harm our business, financial condition, and operating results. We distribute our products exclusively to and through our independent Members, and we depend on them directly for substantially all of our sales. To increase our revenue, we must increase the number and productivity of our Members. Accordingly, our success depends in significant part on our relationships with our sales leaders and our ability to recruit, retain, and motivate a large base of Members, including through an attractive compensation plan, the quality of our reputation, the maintenance of an attractive product portfolio, the breadth and quality of our Member services, and other incentives. The loss of a significant number of Members, changes to our network marketing program, our inability to respond to Member demand or generate sufficient interest in our business opportunities, products, or services, decreases in Member engagement, loss of Member or consumer confidence, or any legal or regulatory impact to our Members’ ability to conduct their business could negatively impact sales of our products and our ability to attract and retain Members, each of which could have a material adverse effect on our business, financial condition, and operating results. In our efforts to attract and retain Members, we compete with other direct-selling organizations. In addition, our Member organization has a high turnover rate, which is common in the direct-selling industry, in part because our Members, including our sales leaders, may easily enter and exit our network marketing program without facing a significant investment or loss of capital. For example, the upfront financial cost to become a Member is low, we do not have time or exclusivity requirements, we do not charge for any required training, and, in substantially all jurisdictions, we maintain a buyback program. We believe the COVID-19 pandemic could have an adverse impact on the pipeline of new Members and our Member turnover rate, and may impact our future net sales. See the COVID-19 Pandemic and Sales by Geographic Region sections in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, of this Annual Report on Form 10-K for further discussion of the impacts of the COVID-19 pandemic on our business and results of operations. For additional information regarding sales leader retention rates, see Part I, Item 1, Business, of this Annual Report on Form 10-K. Because we cannot exert the same level of influence or control over our Members as we could if they were our employees, our Members could fail to comply with applicable law or our rules and procedures, which could result in claims against us that could materially harm our business, financial condition, and operating results. Our Members are independent contractors and, accordingly, we are not in a position to provide the same direction, motivation, and oversight as we could if Members were our employees. As a result, there can be no assurance that our Members will participate in our marketing strategies or plans, accept our introduction of new products, or comply with applicable legal requirements or our rules and procedures. 21 We are subject to extensive federal, state, local, and foreign laws, rules, and regulations that regulate our business, products, direct sales channel, and network marketing program. See the Regulation section of Part I, Item 1, Business, of this Annual Report on Form 10- K for additional information. While we have implemented policies and procedures designed to govern Member conduct and to protect the goodwill associated with Herbalife Nutrition, it can be difficult to enforce these policies and procedures because of our large number of Members and their status as independent contractors and because our policies and procedures differ by jurisdiction as a result of varying local legal requirements. In addition, although we train our Members and attempt to monitor our Members’ marketing materials, we cannot ensure that our Members will comply with applicable legal requirements or our policies and procedures or that such marketing materials or other Member practices comply with applicable laws, rules, and regulations. It is possible that a court could hold us liable for the actions of our Members, which could materially harm our business, financial condition, and operating results. Adverse publicity associated with our Company or the direct-selling industry could materially harm our business, financial condition, and operating results. Our reputation and the quality of our brand are critical to our business, and the size and success of our Member organization, our operating results, and our share price may be significantly affected by the public’s perception of Herbalife Nutrition and other direct- selling companies. This perception is dependent upon opinions concerning a number of factors, including: • the safety, quality, and efficacy of our products, as well as those of similar companies; • our Members; • our network marketing program or the attractiveness or viability of the financial opportunities it may provide; • the direct-selling business generally; • actual or purported failure by us or our Members to comply with applicable laws, rules, and regulations, including those regarding product claims and advertising, good manufacturing practices, the regulation of our network marketing program, the registration of our products for sale in our target markets, or other aspects of our business; • our commitment to ESG matters and our ESG practices; • the security of our information technology infrastructure; and • actual or alleged impropriety, misconduct, or fraudulent activity by any person formerly or currently associated with our Members or us. Adverse publicity concerning any of the foregoing whether or not accurate or resulting in investigation, enforcement, or other legal or regulatory actions or the imposition of fines, penalties, or other sanctions, could negatively impact our reputation, our ability to attract, motivate, and retain Members, and our ability to generate revenue. In addition, our Members’ and consumers’ perception of Herbalife Nutrition and our direct-selling business as well as similar companies can be significantly influenced by media attention, publicized scientific research or findings, product liability claims, and other publicity, whether or not it is legitimate. For example, as a result of the prevalence and marked increase in the use of blogs, social media platforms, and other forms of Internet-based communications, the opportunity for dissemination of information, both accurate and inaccurate, is seemingly limitless and readily available, and often does not provide any opportunity for correction or other redress. Adverse publicity that associates use of our products or any similar products with adverse effects, questions the quality or benefits of any such products, or claims that any such products are ineffective, inappropriately labeled, or have inaccurate instructions as to their use, could lead to lawsuits or other legal or regulatory challenges and could materially and adversely impact our reputation, the demand for our products, and our business, financial condition, and operating results. Adverse publicity relating to us has had, and could again have, a negative effect on our ability to attract, motivate, and retain Members, on consumer perception of Herbalife Nutrition, and on our share price. For example, the resulting adverse publicity from the 1986 permanent injunction entered in California caused a rapid, substantial loss of Members in the United States and a corresponding reduction in sales beginning in 1985. See also the risk factor titled “Our share price may be adversely affected by third parties who raise allegations about our Company.” We expect that adverse publicity will, from time to time, continue to negatively impact our business in particular markets and may adversely affect our share price. 22 Our failure to compete successfully could materially harm our business, financial condition, and operating results. The business of developing and marketing weight management and other nutrition and personal care products is highly competitive and sensitive to the introduction of new products and weight management plans, including various prescription drugs, which may rapidly capture a significant share of the market. Our competitors include numerous manufacturers; distributors; marketers; online, specialty, mass, and other retailers; and physicians that actively compete for the business of consumers both in the United States and abroad. Some of our competitors have longer operating histories, significantly greater resources, better-developed and more innovative sales and distribution channels and platforms, greater name recognition, and larger established customer bases than we do. Our present and future competitors may be able to offer products at lower prices or better withstand reductions in prices or other adverse economic or market conditions than we can; develop products that are comparable or superior to those we offer; adapt more quickly or effectively to new technologies, changing regulatory requirements, evolving industry trends and standards, and customer requirements than we can; and/or devote greater resources to the development, promotion, and sale of their products than we do. We are also subject to significant competition for the recruitment of Members from other direct-selling organizations, including those that market weight management products, dietary and nutritional supplements, personal care products, and other types of products, as well as those organizations in which former employees or Members are involved. In addition, because the industry in which we operate is not particularly capital intensive or otherwise subject to high barriers to entry, it is relatively easy for new competitors to emerge that will compete with us, including for our Members and their customers. Accordingly, competition may intensify and we may not be able to compete effectively in our markets. If we are not able to retain our Members and their customers or otherwise compete successfully, our business, financial condition, and operating results would be materially adversely affected. Our contractual obligation to sell our products only through our Member network and to refrain from changing certain aspects of our Marketing Plan may limit our growth. We are contractually prohibited from expanding our business by selling Herbalife Nutrition products through other distribution channels that may be available to our competitors, such as over the Internet, through wholesale sales, by establishing retail stores, or through mail order systems. To the extent legally permitted, an agreement we entered into with our Members provides assurances that we will not sell Herbalife Nutrition products worldwide through any distribution channel other than our network of Members. Since this is an open-ended commitment, there can be no assurance that we will be able to take advantage of innovative new distribution channels that are developed in the future or appropriately respond to consumer preferences as they continue to evolve. In addition, this agreement with our Members provides that we will not make any material changes adverse to our Members to certain aspects of our Marketing Plan that may negatively impact our Members without their approval as described in further detail below. For example, our agreement with our Members provides that we may increase, but not decrease, the discount percentages available to our Members for the purchase of products or the applicable royalty override percentages and production and other bonus percentages available to our Members at various qualification levels within our Member hierarchy. We may not modify the eligibility or qualification criteria for these discounts, royalty overrides, and production and other bonuses unless we do so in a manner to make eligibility and/or qualification easier than under the applicable criteria in effect as of the date of the agreement. Our agreement with our Members further provides that we may not vary the criteria for qualification for each Member tier within our Member hierarchy, unless we do so in such a way so as to make qualification easier. We reserved the right to make changes to our Marketing Plan without the consent of our Members in the event that changes are required by applicable law or are necessary in our reasonable business judgment to account for specific local market or currency conditions to achieve a reasonable profit on operations. In addition, we may initiate other changes that are adverse to our Members based on an assessment of what will be best for the Company and its Members. Under the agreement with our Members, these other adverse changes would then be submitted to our Member leadership for a vote. The vote would require the approval of at least 51% of our Members then at the level of President’s Team earning at the production bonus level of 6% who vote, provided that at least 50% of those Members entitled to vote do in fact vote. While we believe this agreement has strengthened our relationship with our existing Members, improved our ability to recruit new Members, and generally increased the long-term stability of our business, there can be no assurance that our agreement with our Members will not restrict our ability to adapt our Marketing Plan or our business to the evolving requirements of the markets in which we operate. As a result, our growth may be limited. 23 Our failure to appropriately respond to changing consumer trends, preferences, and demand for new products and product enhancements could materially harm our Member relationships, Members’ customer relationships, and product sales or otherwise materially harm our business, financial condition, and operating results. Our business is subject to rapidly changing consumer trends and preferences and product introductions, especially with respect to our nutrition products. Our continued success depends in part on our ability to anticipate and respond to these changes and introductions, and we may not respond or develop new products or product enhancements in a cost-effective, timely, or commercially appropriate manner, or at all, particularly while the COVID-19 pandemic persists. Current consumer trends and preferences have evolved and will continue to evolve as a result of, among other things, changes in consumer tastes; health, wellness, and nutrition considerations; competitive product and pricing pressures; changes in consumer preferences for certain sales channels; shifts in demographics; and concerns regarding the environmental and sustainability impact of the product manufacturing process. The success of our response to changing consumer trends and preferences and product introductions, including any new product offerings and enhancements, depends on a number of factors, including our ability to: • accurately anticipate consumer needs; • innovate and develop new products and product enhancements that meet these needs; • successfully commercialize new products and product enhancements; • price our products competitively; • manufacture and deliver our products in sufficient volumes, at our required levels of quality, and in a cost-effective and timely manner; and • differentiate our product offerings from those of our competitors and successfully respond to other competitive pressures, including technological advancements, evolving industry standards, and changing regulatory requirements. Our failure to accurately predict changes in consumer demand and technological advancements could negatively impact consumer opinion of our products or our business, which in turn could harm our Member relationships and the Members’ relationships with their customers, and cause a loss of sales. In addition, if we do not introduce new products or make enhancements to meet the changing needs of our Members and their customers in a cost-effective, timely, and commercially appropriate manner, or if our competitors release new products or product enhancements before we do, some of our product offerings could be rendered obsolete, which could cause our market share to decline and negatively impact our business, financial condition, and operating results. If we fail to further penetrate existing markets, the growth in sales of our products, along with our operating results, could be negatively impacted. The success of our business is to a large extent contingent on our ability to further penetrate existing markets, which is subject to numerous factors, many of which are out of our control. Our ability to increase market penetration may be limited by the finite number of persons in a given country inclined to pursue a direct-selling business opportunity or consumers aware of, or willing to purchase, Herbalife Nutrition products. Moreover, our growth in existing markets will depend upon increased brand awareness and improved training and other activities that enhance Member retention in our markets. While we have recently experienced significant growth in certain of our foreign markets, we cannot assure you that such growth levels will continue in the immediate or long-term future. Furthermore, our efforts to support growth in such foreign markets could be hampered to the extent that our infrastructure in such markets is deficient when compared to our infrastructure in our more developed markets, such as the United States. For example, there can be no assurances that we will be able to successfully manage expansion of manufacturing operations and a growing and dynamic sales force in China. If we are unable to effectively scale our supply chain and manufacturing infrastructure to support future growth in China or other foreign markets, our operations in such markets may be adversely impacted. Therefore, we cannot assure you that our general efforts to increase our market penetration and Member retention in existing markets will be successful. If we are unable to further penetrate existing markets, our business, financial condition, and operating results could materially suffer. Since one of our products constitutes a significant portion of our net sales, significant decreases in consumer demand for this product or our failure to produce a suitable replacement could materially harm our business, financial condition, and operating results. Our Formula 1 Healthy Meal, which is our best-selling product line, approximated 26% of our net sales for the year ended December 31, 2022. If consumer demand for this product decreases significantly or we cease offering this product without a suitable replacement, or if the replacement product fails to gain market acceptance, our business, financial condition, and operating results could be materially harmed. 24 Our business could be materially and adversely affected by natural disasters, other catastrophic events, acts of war or terrorism, cybersecurity incidents, pandemics, and/or other acts by third parties. We depend on the ability of our business to run smoothly, including the ability of Members to engage in their day-to-day selling and business building activities. In coordination with our suppliers, third-party manufacturers, and distributors, our ability to make and move our products reasonably unimpeded around the world is critical to our success. Any material disruption to our collective operations or supply, manufacturing, or distribution capabilities caused by unforeseen or catastrophic events, such as (i) natural disasters or severe weather conditions, including droughts, fires, floods, hurricanes, volcanic eruptions, and earthquakes; (ii) power loss or shortages; (iii) telecommunications or information technology infrastructure failures; (iv) acts or threats of war, terrorism, or other armed hostilities; (v) outbreaks of contagious diseases, epidemics, and pandemics; (vi) cybersecurity incidents, including intentional or inadvertent exposure of content perceived to be sensitive data; (vii) employee misconduct or error; and/or (viii) other actions by third parties and other similar disruptions, could materially adversely affect our ability to conduct business and our Members’ selling activities. For example, our operations in Central America were impacted in November 2020 when Hurricanes Eta and Iota made landfall in the region. The storms disrupted our supply chain transportation network and our ability to import product. In addition, our distribution center in Honduras experienced flooding, which damaged or destroyed product. Furthermore, our headquarters and one of our distribution facilities and manufacturing facilities are located in Southern California, an area susceptible to fires and earthquakes. Although the events in Central America did not have a material negative impact on our operations, we cannot make assurances that any future catastrophic events will not adversely affect our ability to operate our business or our financial condition and operating results. In addition, catastrophic events may result in significant cancellations or cessations of Member orders; contribute to a general decrease in local, regional, or global economic activity; directly impact our marketing, manufacturing, financial, or logistics functions; impair our ability to meet Member demands; harm our reputation; and expose us to significant liability, losses, and legal proceedings, any of which could materially and adversely affect our business, financial condition, and operating results. In March 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic. The COVID-19 pandemic has significantly impacted health and economic conditions globally, disrupted global supply chains, and has adversely affected the Company’s business and that of its Members in certain of the Company’s markets and may continue to impact those markets or others in the future. Government, agency, and other regulatory recommendations, guidelines, mandates, and actions to address public health concerns, including restrictions on movement, public gatherings, and travel and restrictions on, or in certain cases outright prohibitions of, companies’ ability to conduct normal business operations, have and may continue to adversely affect our business. Although we have been classified as an essential business in most jurisdictions where we operate, there is no guarantee that this classification will not change. We may also be forced to or voluntarily elect to limit or cease operations in one or more markets for other reasons, such as the health and safety of our employees or because of disruptions in the operation of our supply chain and sources of supply. For example, it is possible that closures of our manufacturing facilities or those of our third-party contract manufacturers or suppliers could impact our distribution centers and our ability to manufacture and deliver products to our Members. In general, our inventory of products continues to be adequate to meet demand, but we do expect our supply chain and our ability to source and/or manufacture products will be negatively impacted if the negative effects of the pandemic continue for a prolonged period of time or worsen. The pandemic has had an adverse impact on our distribution channels and Members’ product access in some markets, which may, and in some cases will, continue until conditions improve. Our third-party contract manufacturers and suppliers and our Members’ businesses are also subject to many of the same risks and uncertainties related to the COVID-19 pandemic, as well as other pandemic-related risks and uncertainties that may not directly impact our operations, any of which could adversely affect demand for our products. For example, limitations on public gatherings have restricted our Members’ ability to hold meetings with their existing customers and to attract new customers. Significant limitations on cash transactions could also have an adverse effect on sales of products in certain markets. The COVID-19 pandemic has also adversely affected the economies and financial markets of many countries, at times causing a significant deceleration of or interruption to economic activity, which during various stages of the pandemic has reduced production, decreased demand for a broad variety of goods and services, diminished trade levels, and led to widespread corporate downsizing. We have also seen periods of significant disruption of and extreme volatility in the global capital markets, which could increase the cost of, or entirely restrict access to, capital. Further, while some countries have progressed in distributing COVID-19 vaccines to the general population, many countries have limited to no access to vaccines at this time. To the extent the global supply of vaccine remains limited or vaccination rates do not significantly increase, government restrictions in the countries with limited to no access or low vaccination rates may persist or increase and economic activity may remain at depressed levels in those countries or regions. 25 Despite the relaxation of pandemic-related constraints in certain markets, considerable uncertainty still surrounds the COVID-19 pandemic, its potential effects, and the extent and effectiveness of government responses to the pandemic. If the pandemic is not contained, or if new variants emerge or effective vaccines are not made available and utilized quickly enough, the adverse impacts of the COVID-19 pandemic could worsen, impacting all segments of the global economy, and result in a significant recession or worse. However, the unprecedented and sweeping nature of the COVID-19 pandemic makes it extremely difficult to predict how our business and operations will be affected in the long run. Further, the resumption of normal business operations after the disruptions caused by the COVID-19 pandemic may be delayed or constrained by the pandemic’s lingering effects on our Members, consumers, and third- party contract manufacturers and suppliers. Accordingly, our ability to conduct our business in the manner previously done or planned for the future could be materially and adversely affected, and any of the foregoing risks, or other cascading effects of the COVID-19 pandemic, or any other pandemic that may emerge in the future, that are not currently foreseeable, could materially and adversely affect our business, financial condition, and operating results. See the COVID-19 Pandemic and Sales by Geographic Region sections in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, of this Annual Report on Form 10- K for further discussion of the impacts of the COVID-19 pandemic on our business and operating results. We depend on the integrity and reliability of our information technology infrastructure, and any related interruptions or inadequacies may have a material adverse effect on our business, financial condition, and operating results. Our business, including our ability to provide products and services to and manage our Members, depends on the performance and availability of our information technology infrastructure, including our core transactional systems. The most important aspect of our information technology infrastructure is the system through which we record and track Member sales, Volume Points, royalty overrides, bonuses, and other incentives. The failure of our information systems to operate effectively, or a breach in security of these systems, could adversely impact the promptness and accuracy of our product distribution and transaction processing. While we continue to invest in our information technology infrastructure, there can be no assurance that there will not be any significant interruptions to such systems, that the systems will be adequate to meet all of our business needs, or that the systems will keep pace with continuing changes in technology, legal and regulatory standards. Further, as discussed in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, we recently commenced a Digital Technology Program to develop a new enhanced platform to provide enhanced digital capabilities and experiences to our Members. Our information technology infrastructure, as well as that of our Members and the other third parties with which we interact, may be damaged, disrupted, or breached or otherwise fail for a number of reasons, including power outages, computer and telecommunication failures, internal design, manual or usage errors, workplace violence or wrongdoing, or catastrophic events such as natural disasters, severe weather conditions, or acts of war or terrorism. In addition, numerous and evolving cybersecurity threats, including advanced and persistent cyberattacks, such as unauthorized attempts to access, disable, improperly modify, exfiltrate, or degrade our information technology infrastructure, or the introduction of computer viruses, malware, “phishing” emails, and other destructive software, and social engineering schemes, could compromise the confidentiality, availability, and integrity of our information technology infrastructure as well as those of the third parties with which we interact. These attacks may come from external sources, such as governments or hackers, or may originate internally from an employee or a third party with which we interact. We have been the target of, and may be the target of in the future, malicious cyberattacks, although to date none of these attacks have had a meaningful adverse impact on our business, financial condition, or operating results. The potential risk of cyberattacks may increase as we introduce new technology systems and services. Additionally, in response to the COVID-19 pandemic, many of our employees have been encouraged to work remotely, which may increase our exposure to significant systems interruptions, cybersecurity attacks, and otherwise compromise the integrity and reliability of our information technology infrastructure and our internal controls. Any disruptions to, or failures or inadequacies of, our information technology infrastructure that we may encounter in the future may result in substantial interruptions to our operations, expose us to significant liability, and may damage our reputation and our relationships with, or cause us to lose, our Members, especially if the disruptions, failures, or inadequacies impair our ability to track sales and pay royalty overrides, bonuses, and other incentives, any of which would harm our business, financial condition, and operating results. Any such disruptions, failures, or inadequacies could also create compliance risks under the Consent Order and result in penalties, fines, or sanctions under any applicable laws or regulations. Furthermore, it may be expensive or difficult to correct or replace any aspect of our information technology infrastructure in a timely manner, if at all, and we may have little or no control over whether any malfunctioning information technology services supplied to us by third parties are appropriately corrected, if at all. We have encountered, and may encounter in the future, errors in our software and our enterprise network, and inadequacies in the software and services supplied by certain of our vendors, although to date none of these errors or inadequacies have had a meaningful adverse impact on our business, financial condition or operating results. In addition, developments in technology are continuing to evolve and affecting all aspects of our business, including how we effectively manage our operations, interact with our Members and their customers, and commercialize opportunities that accompany the evolving digital and data driven economy. Therefore, one of our top priorities is to modernize our technology and data infrastructure by, among other things, creating more relevant and more personalized experiences wherever our systems interact with Members and their customers; and developing ways to create more powerful digital tools and capabilities for Members to enable them to grow their 26 businesses. These initiatives to modernize our technology and data infrastructure are expected to be implemented over the course of many years and to require significant investments. If these initiatives are not successful, our ability to attract and retain Members and their customers, increase sales, and reduce costs may be negatively affected. Further, these initiatives may be subject to cost overruns and delays and may cause disruptions in our operations. These cost overruns and delays and disruptions could adversely impact our business, financial condition, and operating results. Disruption of supply, shortage, or increases in the cost of ingredients, packaging materials, and other raw materials as well as climate change could materially harm our business, financial condition, and operating results. We and our third-party contract manufacturers depend on third-party suppliers to supply us with the various ingredients, packaging materials, and other raw materials that we use in the manufacturing and distribution of our products. Our business could be materially harmed if we experience operational difficulties with our third-party suppliers, such as increases in costs, reductions in the availability of materials or production capacity, errors in complying with specifications or applicable law, insufficient quality control, and failures to meet production or shipment deadlines. If we fail to develop or maintain our relationships with our third-party suppliers or if such suppliers cease doing business with us or go out of business, we could face difficulties in finding or transitioning to alternative suppliers that meet our standards. Many of the ingredients, packaging materials, and other raw materials we use are subject to fluctuations in availability and price due to a number of factors beyond our control, including crop size, ingredient, water, and land scarcity, market demand for raw materials, commodity market speculation, energy costs, currency fluctuations, supplier and logistics service capacities, import and export requirements, tariffs, and other government policies, and drought, excessive rain, temperature extremes, and other severe weather events. If we experience supply shortages, price increases, or supplier or regulatory impediments with respect to any of the materials we use in our products or packaging, we may need to seek alternative supplies or suppliers and may experience difficulties in finding replacements that are comparable in quality and price. For a discussion of the impacts of the COVID-19 pandemic on our supply chain see “If any of our manufacturing facilities or third-party manufacturers fail to reliably supply products to us at required levels of quality or fail to comply with applicable laws, our financial condition and operating results could be materially and adversely impacted” below. Further, the risks related to our ability to adequately source the materials required to meet our needs may be exacerbated by the effects of climate change and the legal, regulatory, or market measures that may be implemented to address climate change. There is growing concern that carbon dioxide and other greenhouse gases in the atmosphere may have an adverse impact on global temperatures, weather patterns, and the frequency and severity of extreme weather and natural disasters. If climate change has a negative effect on agricultural productivity, we may be subject to decreased availability or less favorable pricing for certain raw materials that are necessary for our products, such as soybeans, wheat, tea leaves, and nuts. Severe weather conditions and natural disasters can reduce crop size and crop quality, which in turn could reduce our supplies of raw materials, lower recoveries of usable raw materials, increase the prices of our raw materials, increase our cost of storing and transporting our raw materials, or disrupt production schedules. The impacts of climate change may also cause unpredictable water availability or exacerbate water scarcity. In addition, the increasing concern over climate change and related sustainability matters may also result in more federal, state, local, and foreign legal and regulatory requirements relating to climate change, which may significantly increase our costs of operation and delivery. 27","Use only the document provided and nothing else. How does Herbalife's ""seed to feed"" strategy influence its product quality and sourcing? 2022 Annual Report To Our Shareholders, We all know coming out of the pandemic has caused many companies to relook at their operations. 2022 was a year of change for Herbalife as well as a year of challenge. With every challenge, there is great opportunity. I came back to Herbalife because I believe passionately about what Herbalife does, and what it provides for health and income. Since returning to Herbalife, I along with our management team and distributor leaders from around the world have embarked on a journey to expand our content, enhance the business opportunity, modernize our brand, and expand our digital platform – with the aim to reach more customers and to provide our distributors a better plat- form to operate their business. Our vision is to be the world’s premier health and wellness company and community. As I write this, more than 3,000 distributor leaders from around the world are traveling to Los Angeles to meet together for the first time in three years to learn, to share, to innovate, and to build a path forward for Herbalife. The time is now for us to reconnect, build on our strategic plan, and provide growth for all of our stakeholders. Our digital transformation “Herbalife One” will enhance the Company’s two main platforms: content and busi- ness opportunity. Our content is our product. With obesity levels hitting record highs around the globe and a greater demand for health and wellness support, we have plans to grow our product portfolio through our daily nutrition products with expanded vegan and protein lines. We plan to explore other health and wellness opportunities that will be based on global as well as regional consumer demands. For example, our unique Ayurvedic product line in India has contributed to the success of our fastest growing market. We are unleashing similar innovative products regionally in Europe, Asia and China, and we will continue to look for synergies and opportunities to globalize our regional product offerings. With enhancements to the business opportunity, our global distributor network will continue to give us a com- petitive advantage to reach more consumers with more offerings than ever before. Our distributors give a personal voice and passion to our products. Spanning across 95 markets, our distributors are amazing entrepreneurs who have unique relationships with their customers, and through an expanded use of data, we will be able to assist our distributors to sell more products and work more closely and efficiently with consumers on their health and wellness journey. To this end, we are modernizing our brand and compensation structure, including new promotions to energize and incentivize our distributors to earn early in their Herbalife business opportunity journey. Together with Herbalife One, our business opportunity will differentiate us and strengthen our leadership in the marketplace. 2023 is a start of a new chapter – one that is both motivating and exciting. In March, I marked my 20th year of devoting my time, passion, and energy to Herbalife. I feel more optimistic about where we are headed today than ever before. Our distributors and employees make Herbalife a community unlike any other. I know our distrib- utors and employees are as incredibly excited about the future as I am. Thank you for your trust and support. Michael O. Johnson Chairman and Chief Executive Officer This letter contains “forward-looking statements” within the meaning of the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Although we believe that the expectations reflected in any of our forward-looking statements are reasonable, actual results or outcomes could differ materially from those pro- jected or assumed in any of our forward-looking statements. Our future financial condition and results of oper- ations, as well as any forward-looking statements, are subject to change and to inherent risks and uncertainties, many of which are beyond our control. Additionally, many of these risks and uncertainties are, and may continue to be, amplified by the COVID-19 pandemic. Important factors that could cause our actual results, performance and achievements, or industry results to differ materially from estimates or projections contained in or implied by our forward-looking statements include the following: the potential impacts of the COVID-19 pandemic and current global economic conditions, including inflation, on us; our Members, customers, and supply chain; and the world economy; our ability to attract and retain Members; our relationship with, and our ability to influence the actions of, our Members; our noncompliance with, or improper action by our employees or Members in violation of, applicable U.S. and foreign laws, rules, and regulations; adverse publicity associated with our Company or the direct-selling industry, including our ability to comfort the marketplace and regulators regard- ing our compliance with applicable laws; changing consumer preferences and demands and evolving industry standards, including with respect to climate change, sustainability, and other environmental, social, and gover- nance, or ESG, matters; the competitive nature of our business and industry; legal and regulatory matters, including regulatory actions concerning, or legal challenges to, our products or network marketing program and product liability claims; the Consent Order entered into with the FTC, the effects thereof and any failure to comply therewith; risks associated with operating internationally and in China; our ability to execute our growth and other strategic initiatives, including implementation of our Transformation Program and increased pene- tration of our existing markets; any material disruption to our business caused by natural disasters, other cata- strophic events, acts of war or terrorism, including the war in Ukraine, cybersecurity incidents, pandemics, and/ or other acts by third parties; our ability to adequately source ingredients, packaging materials, and other raw materials and manufacture and distribute our products; our reliance on our information technology infra- structure; noncompliance by us or our Members with any privacy laws, rules, or regulations or any security breach involving the misappropriation, loss, or other unauthorized use or disclosure of confidential information; contractual limitations on our ability to expand or change our direct-selling business model; the sufficiency of our trademarks and other intellectual property; product concentration; our reliance upon, or the loss or departure of any member of, our senior management team; restrictions imposed by covenants in the agreements governing our indebtedness; risks related to our convertible notes; changes in, and uncertainties relating to, the application of transfer pricing, income tax, customs duties, value added taxes, and other tax laws, treaties, and regulations, or their interpretation; our incorporation under the laws of the Cayman Islands; and share price volatility related to, among other things, speculative trading and certain traders shorting our common shares. Forward-looking statements in this letter speak only as of March 14, 2023. We do not undertake any obligation to update or release any revisions to any forward-looking statement or to report any events or circumstances after such date or to reflect the occurrence of unanticipated events, except as required by law. UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Form 10-K (Mark One) ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the fiscal year ended December 31, 2022 OR TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934 For the transition period from to Commission file number: 1-32381 HERBALIFE NUTRITION LTD. (Exact name of registrant as specified in its charter) Cayman Islands 98-0377871 (State or other jurisdiction of (I.R.S. Employer incorporation or organization) Identification No.) P.O. Box 309GT Ugland House, South Church Street Grand Cayman, Cayman Islands (Address of principal executive offices) (Zip Code) (213) 745-0500 (Registrant’s telephone number, including area code) Securities registered pursuant to Section 12(b) of the Act: Title of each class: Trading Symbol(s): Name of each exchange on which registered: Common Shares, par value $0.0005 per share HLF New York Stock Exchange Securities registered pursuant to Section 12(g) of the Act: None Indicate by check mark if the registrant is a well-known seasoned issuer, as defined in Rule 405 of the Securities Act. Yes ☒ No ☐ Indicate by check mark if the registrant is not required to file reports pursuant to Section 13 or Section 15(d) of the Act. Yes ☐ No ☒ Indicate by check mark whether the registrant: (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90 days. Yes ☒ No ☐ Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T (§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No ☐ Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the Exchange Act. Large accelerated filer ☒ Accelerated filer ☐ Non-accelerated filer ☐ Smaller reporting company ☐ Emerging growth company ☐ If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐ Indicate by check mark whether the registrant has filed a report on and attestation to its management’s assessment of the effectiveness of its internal control over financial reporting under Section 404(b) of the Sarbanes-Oxley Act (15 U.S.C. 7262(b)) by the registered public accounting firm that prepared or issued its audit report. ☒ If securities are registered pursuant to Section 12(b) of the Act, indicate by check mark whether the financial statements of the registrant included in the filing reflect the correction of an error to previously issued financial statements. ☐ Indicate by check mark whether any of those error corrections are restatements that required a recovery analysis of incentive-based compensation received by any of the registrant’s executive officers during the relevant recovery period pursuant to §240.10D-1(b). ☐ Indicate by check mark whether registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒ There were 97,920,728 common shares outstanding as of February 7, 2023. The aggregate market value of the Registrant’s common shares held by non-affiliates was approximately $896 million as of June 30, 2022, based upon the last reported sales price on the New York Stock Exchange on that date of $20.45. For the purposes of this disclosure only, the registrant has assumed that its directors, executive officers, and the beneficial owners of 5% or more of the registrant’s outstanding common stock are the affiliates of the registrant. DOCUMENTS INCORPORATED BY REFERENCE Portions of the registrant’s Definitive Proxy Statement to be filed with the Securities and Exchange Commission no later than 120 days after the end of the Registrant’s fiscal year ended December 31, 2022, are incorporated by reference in Part III of this Annual Report on Form 10-K. 1 TABLE OF CONTENTS Page No. PART I Item 1. Business 5 Item 1A. Risk Factors 19 Item 1B. Unresolved Staff Comments 43 Item 2. Properties 43 Item 3. Legal Proceedings 44 Item 4. Mine Safety Disclosures 44 PART II Item 5. Market for Registrant’s Common Equity, Related Stockholder Matters and Issuer Purchases of Equity 45 Securities Item 6. [Reserved] 46 Item 7. Management’s Discussion and Analysis of Financial Condition and Results of Operations 47 Item 7A. Quantitative and Qualitative Disclosures About Market Risk 67 Item 8. Financial Statements and Supplementary Data 69 Item 9. Changes in and Disagreements With Accountants on Accounting and Financial Disclosure 70 Item 9A. Controls and Procedures 70 Item 9B. Other Information 70 Item 9C. Disclosure Regarding Foreign Jurisdictions that Prevent Inspections 70 PART III Item 10. Directors, Executive Officers and Corporate Governance 71 Item 11. Executive Compensation 71 Item 12. Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matters 71 Item 13. Certain Relationships and Related Transactions, and Director Independence 71 Item 14. Principal Accounting Fees and Services 71 PART IV Item 15. Exhibits, Financial Statement Schedules 72 Item 16. Form 10-K Summary 125 2 FORWARD-LOOKING STATEMENTS This Annual Report on Form 10-K contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. All statements other than statements of historical fact are “forward-looking statements” for purposes of federal and state securities laws, including any projections of earnings, revenue or other financial items; any statements of the plans, strategies and objectives of management, including for future operations, capital expenditures, or share repurchases; any statements concerning proposed new products, services, or developments; any statements regarding future economic conditions or performance; any statements of belief or expectation; and any statements of assumptions underlying any of the foregoing or other future events. Forward-looking statements may include, among other, the words “may,” “will,” “estimate,” “intend,” “continue,” “believe,” “expect,” “anticipate” or any other similar words. Although we believe that the expectations reflected in any of our forward-looking statements are reasonable, actual results or outcomes could differ materially from those projected or assumed in any of our forward-looking statements. Our future financial condition and results of operations, as well as any forward-looking statements, are subject to change and to inherent risks and uncertainties, many of which are beyond our control. Additionally, many of these risks and uncertainties are, and may continue to be, amplified by the COVID-19 pandemic. Important factors that could cause our actual results, performance and achievements, or industry results to differ materially from estimates or projections contained in or implied by our forward-looking statements include the following: • the potential impacts of the COVID-19 pandemic and current global economic conditions, including inflation, on us; our Members, customers, and supply chain; and the world economy; • our ability to attract and retain Members; • our relationship with, and our ability to influence the actions of, our Members; • our noncompliance with, or improper action by our employees or Members in violation of, applicable U.S. and foreign laws, rules, and regulations; • adverse publicity associated with our Company or the direct-selling industry, including our ability to comfort the marketplace and regulators regarding our compliance with applicable laws; • changing consumer preferences and demands and evolving industry standards, including with respect to climate change, sustainability, and other environmental, social, and governance, or ESG, matters; • the competitive nature of our business and industry; • legal and regulatory matters, including regulatory actions concerning, or legal challenges to, our products or network marketing program and product liability claims; • the Consent Order entered into with the FTC, the effects thereof and any failure to comply therewith; • risks associated with operating internationally and in China; • our ability to execute our growth and other strategic initiatives, including implementation of our Transformation Program and increased penetration of our existing markets; • any material disruption to our business caused by natural disasters, other catastrophic events, acts of war or terrorism, including the war in Ukraine, cybersecurity incidents, pandemics, and/or other acts by third parties; • our ability to adequately source ingredients, packaging materials, and other raw materials and manufacture and distribute our products; • our reliance on our information technology infrastructure; • noncompliance by us or our Members with any privacy laws, rules, or regulations or any security breach involving the misappropriation, loss, or other unauthorized use or disclosure of confidential information; • contractual limitations on our ability to expand or change our direct-selling business model; • the sufficiency of our trademarks and other intellectual property; • product concentration; • our reliance upon, or the loss or departure of any member of, our senior management team; • restrictions imposed by covenants in the agreements governing our indebtedness; 3 • risks related to our convertible notes; • changes in, and uncertainties relating to, the application of transfer pricing, income tax, customs duties, value added taxes, and other tax laws, treaties, and regulations, or their interpretation; • our incorporation under the laws of the Cayman Islands; and • share price volatility related to, among other things, speculative trading and certain traders shorting our common shares. Additional factors and uncertainties that could cause actual results or outcomes to differ materially from our forward-looking statements are set forth in this Annual Report on Form 10-K, including in Part I, Item 1A, Risk Factors, and Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, and in our Consolidated Financial Statements and the related Notes. In addition, historical, current, and forward-looking sustainability-related statements may be based on standards for measuring progress that are still developing, internal controls and processes that continue to evolve, and assumptions that are subject to change in the future. Forward-looking statements in this Annual Report on Form 10-K speak only as of the date hereof. We do not undertake any obligation to update or release any revisions to any forward-looking statement or to report any events or circumstances after the date hereof or to reflect the occurrence of unanticipated events, except as required by law. The Company “We,” “our,” “us,” “Company,” “Herbalife,” and “Herbalife Nutrition” refer to Herbalife Nutrition Ltd., a Cayman Islands exempted company incorporated with limited liability, and its subsidiaries. Herbalife Nutrition Ltd. is a holding company, with substantially all of its assets consisting of the capital stock of its direct and indirectly-owned subsidiaries. 4 PART I Item 1. Business GENERAL Herbalife Nutrition is a global nutrition company that provides health and wellness products to consumers in 95 markets, which consists of countries and territories, through our direct-selling business model. Our products are primarily in the categories of weight management, sports nutrition, and targeted nutrition. We use a direct-selling business model to distribute and market our nutrition products to and through a global network of independent members, or Members. Members include consumers who purchase products for their own personal use and distributors who wish to resell products or build a sales organization. We believe that direct selling is ideally suited for our business because the distribution and sales of our products with personalized support, coaching, and education provide a supportive and understanding community of like-minded people who prioritize health and nutrition. In addition to the effectiveness of personalized selling through a direct-selling business model, we believe the primary drivers for our success throughout our 43-year operating history have been enhanced consumer awareness and demand for our products due to global trends such as the obesity epidemic, increasing interest in a fit and active lifestyle, living healthier, and the rise of entrepreneurship. PRODUCT SALES Our science-backed products help Members and their customers improve their overall health, enhance their wellness, and achieve their fitness and sport goals. As of December 31, 2022, we marketed and sold approximately 131 product types. Our products are often sold as part of a program and therefore our portfolio is comprised of a series of related products designed to simplify weight management, health and wellness, and overall nutrition for our Members and their customers. Our Formula 1 Nutritional Shake Mix, our best-selling product line, approximated 26% of our net sales for the year ended December 31, 2022. The following table summarizes our products by product category: Percentage of Net Sales 2022 2021 2020 Description Representative Products Weight Management 56.8% 58.1% 59.8% Meal replacement, protein Formula 1 Healthy Meal, shakes, drink mixes, weight Herbal Tea Concentrate, loss enhancers and healthy Protein Drink Mix, snacks Personalized Protein Powder, Total Control®, Formula 2 Multivitamin Complex, Prolessa™ Duo, and Protein Bars Targeted Nutrition 29.1% 28.2% 27.6% Functional beverages and Herbal Aloe Concentrate, dietary and nutritional Active Fiber Complex, supplements containing Niteworks®, and quality herbs, vitamins, Herbalifeline® minerals and other natural ingredients Energy, Sports, and 10.6% 9.5% 7.9% Products that support a Herbalife24® product line, Fitness healthy active lifestyle N-R-G Tea, and Liftoff® energy drink Outer Nutrition 1.6% 1.9% 2.0% Facial skin care, body care, Herbalife SKIN line and and hair care Herbal Aloe Bath and Body Care line Literature, Promotional, 1.9% 2.3% 2.7% Start-up kits, sales tools, Herbalife Member Packs and Other and educational materials and BizWorks 5 Product returns and buyback policies We offer a customer satisfaction guarantee in substantially all markets where our products are sold. If for any reason a customer or preferred member is not satisfied with an Herbalife Nutrition product, they may return it or any unused portion of the product within 30 days from the time of receipt for a full refund or credit toward the exchange of another Herbalife Nutrition product. In addition, in substantially all markets, we maintain a buyback program pursuant to which we will purchase back unsold products from a Member who decides to leave the business. Subject to certain terms and conditions that may vary by market, the buyback program generally permits a Member to return unopened products or sales materials in marketable condition purchased within the prior twelve- month period in exchange for a refund of the net price paid for the product and, in most markets, the cost of returning the products and materials to us. Together, product returns and buybacks were approximately 0.1% of net sales for each of the years ended December 31, 2022, 2021, and 2020. Product development Our products are focused on nutrition and seek to help consumers achieve their goals in the areas of weight management; targeted nutrition (including everyday wellness and healthy aging); energy, sports, and fitness; and outer nutrition. We believe our focus on nutrition and botanical science and the combination of our internal efforts with the scientific expertise of outside resources, including our ingredient suppliers, major universities, and our Nutrition Advisory Board, have resulted in product differentiation that has given our Members and consumers increased confidence in our products. We continue to invest in scientific and technical functions, including research and development associated with creating new or enhancing current product formulations and the advancement of personalized nutrition solutions; clinical studies of existing products or products in development; technical operations to improve current product formulations; quality assurance and quality control to establish the appropriate quality systems, controls, and standards; and rigorous ingredient and product testing to ensure compliance with regulatory requirements, as well as in the areas of regulatory and scientific affairs. Our personalized nutrition solutions include tools which aid in the development of optimal product packages specific to our customers’ individual nutritional needs, based on their expected wellness goals. Our product development strategy is twofold: (1) to increase the value of existing customers by investing in products that address customers’ health, wellness and nutrition considerations, fill perceived gaps in our portfolios, add flavors, increase convenience by developing products like snacks and bars, and expand afternoon and evening consumption with products like savory shakes or soups; and (2) to attract new customers by entering into new categories, offering more choices, increasing individualization, and expanding our current sports line. We have a keen focus on product innovation and aim to launch new products and variations on existing products on a regular basis. Once a particular market opportunity has been identified, our scientists, along with our operations, marketing, and sales teams, work closely with Member leadership to introduce new products and variations on existing products. Our Nutrition Advisory Board and Dieticians Advisory Board are comprised of leading experts around the world in the fields of nutrition and health who educate our Members on the principles of nutrition, physical activity, diet, and healthy lifestyle. We rely on the scientific contributions from members of our Nutrition Advisory Board and our in-house scientific team to continually upgrade existing products or introduce new products as new scientific studies become available and are accepted by regulatory authorities around the world. COMPETITION The nutrition industry is highly competitive. Nutrition products are sold through a number of distribution channels, including direct selling, online retailers, specialty retailers, and the discounted channels of food, drug and mass merchandise. Our competitors include companies such as Conagra Brands, Hain Celestial, and Post. Additionally, we compete for the recruitment of Members from other network marketing organizations, including those that market nutrition products and other entrepreneurial opportunities. Our direct-selling competitors include companies such as Nu Skin, Tupperware, and USANA. Our ability to remain competitive depends on many factors, including having relevant products that meet consumer needs, a rewarding compensation plan, enhanced education and tools, innovation in our products and services, competitive pricing, a strong reputation, and a financially viable company. We have differentiated ourselves from our competitors through our Members’ focus on the consultative sales process, which includes ongoing personal contact, coaching, behavior motivation, education, and the creation of supportive communities. For example, many Members have frequent contact with and provide support to their customers through a community-based approach to help them achieve nutrition goals. Some methods include Nutrition Clubs, Weight Loss Challenges, Wellness Evaluations, and Fit Camps. 6 For additional information regarding competition, see Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K. OUR NETWORK MARKETING PROGRAM General Our products are sold and distributed through a global direct selling business model which individuals may join to become a Member of our network marketing program. We believe that the one-on-one personalized service inherent in the direct-selling business model is ideally suited to marketing and selling our nutrition products. Sales of nutrition products are reinforced by the ongoing personal contact, coaching, behavior motivation, education, and the creation of supportive communities. This frequent, personal contact can enhance consumers’ nutritional and health education as well as motivate healthy behavioral changes in consumers to begin and maintain an active lifestyle through wellness and weight management programs. In addition, our Members consume our products themselves, and, therefore, can provide first-hand testimonials of the use and effectiveness of our products and programs to their customers. The personalized experience of our Members has served as a very powerful sales tool for our products. People become Herbalife Nutrition Members for a number of reasons. Many first start out as consumers of our products who want to lose weight or improve their nutrition, and are customers of our Members. Some later join Herbalife Nutrition and become Members themselves, which makes them eligible to purchase products directly from us, simply to receive a discounted price on products for them and their families. Some Members are interested in the entrepreneurial opportunity to earn compensation based on their own skills and hard work and join Herbalife Nutrition to earn part-time or full-time income. Our objective is sustainable growth in the sales of our products to our Members and their customers by increasing the productivity, retention and recruitment of our Member base through the structure of our network marketing program. Segmentation In many of our markets, including certain of our largest markets such as the United States, Mexico, and India, we have segmented our Member base into two categories: “preferred members” – who are consumers who wish to purchase product for their own household use, and “distributors” – who are Members who also wish to resell products or build a sales organization. This Member segmentation provides a clear differentiation between those interested in retailing our products or building a sales organization, and those simply consuming our products as discount customers. This distinction allows us to more effectively communicate and market to each group, and provides us with better information regarding our Members within the context of their stated intent and goals. As of December 31, 2022, we had approximately 6.2 million Members, including 2.9 million preferred members and 2.0 million distributors in the markets where we have established these two categories and 0.3 million sales representatives and independent service providers in China. The number of preferred members and distributors may change as a result of segmentation and/or conversion, and do not necessarily represent a change in the total number of Members. Any future change in the number of preferred members or distributors is not necessarily indicative of our future expected financial performance. Our Members We believe our Members are the most important differentiator as we go to market with our nutrition products, because of the one- on-one direct contact they have with their customers, along with the education, training and community support services that we believe help improve the nutrition habits of consumers. We work closely with our entrepreneurial Members to improve the sustainability of their businesses and to reach consumers. We require our Members to fairly and honestly market both our products and the Herbalife Nutrition business opportunity. Our relationship with our Members is key to our continued success as they allow us direct access to the voice of consumers. Many of our entrepreneurial Members identify and test new marketing efforts and programs developed by other Members and disseminate successful techniques to their sales organizations. For example, Members in Mexico developed businesses that became known as “Nutrition Clubs,” marketing techniques that improve the productivity and efficiency of our Members as well as the affordability of our weight loss products for their customers. Rather than buying several retail products, these businesses allow consumers to purchase and consume our products each day (a Member marketing technique we refer to as “daily consumption”), while continuing to benefit from the support and interaction with the Member as well as socializing with other customers in a designated location. Other programs to drive daily consumption, whether for weight management or for improved physical fitness, include Member- conducted weight loss contests, or Weight Loss Challenges, Member-led fitness programs, or Fit Camps, and Member-led Wellness Evaluations. We refer to successful Member marketing techniques that we disseminate throughout our Member network, such as Nutrition Clubs, Weight Loss Challenges, and Fit Camps, as Daily Methods of Operations, or DMOs. 7 We believe that personal and professional development is key to our Members’ success and, therefore, we and our sales leader Members – those that achieve certain levels within our Marketing Plan – have meetings and events to support this important objective. We and our Member leadership, which is comprised of sales leaders, conduct in-person and virtual training sessions on local, regional, and global levels attended by thousands of Members to provide updates on product education, sales and marketing training, and instruction on available tools. These events are opportunities to showcase and disseminate our Members’ evolving best marketing practices and DMOs from around the world and to introduce new or upgraded products. A variety of training and development tools are also available through online and mobile platforms. On July 18, 2002, we entered into an agreement with our Members that provides that we will continue to distribute Herbalife Nutrition products exclusively to and through our Members and that, other than changes required by applicable law or necessary in our reasonable business judgment to account for specific local market or currency conditions to achieve a reasonable profit on operations, we will not make any material changes to certain aspects of our Marketing Plan that are adverse to our Members without the support of our Member leadership. Specifically, any such changes would require the approval of at least 51% of our Members then at the level of President’s Team earning at the production bonus level of 6% who vote, provided that at least 50% of those Members entitled to vote do in fact vote. We initiate these types of changes based on the assessment of what will be best for us and our Members and then submit such changes for the requisite vote. We believe that this agreement has strengthened our relationship with our existing Members, improved our ability to recruit new Members and generally increased the long-term stability of our business. Member Compensation and Sales Leader Retention and Requalification In addition to benefiting from discounted prices, Members interested in the entrepreneurial opportunity may earn profit from several sources. First, Members may earn profits by purchasing our products at wholesale prices, discounted depending on the Member’s level within our Marketing Plan, and reselling those products at prices they establish for themselves to generate retail profit. Second, Members who sponsor other Members and establish, maintain, coach, and train their own sales organizations may earn additional income based on the sales of their organization, which may include royalty overrides, production bonuses, and other cash bonuses. Members earning such compensation have generally attained the level of sales leader as described below. There are also many Members, which include distributors, who have not sponsored another Member. Members who have not sponsored another Member are generally considered discount buyers or small retailers. While a number of these Members have also attained the level of sales leader, they do not receive additional income as do Members who have sponsored other Members. We assign point values, known as Volume Points, to each of our products to determine a Member’s level within the Marketing Plan. See Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K for a further description of Volume Points. Typically, a Member accumulates Volume Points for a given sale at the time the Member pays for the product. However, since May 2017, a Member does not receive Volume Points for a transaction in the United States until that product is sold to a customer at a profit and it is documented in compliance with the consent order, or Consent Order, we entered into with the Federal Trade Commission, or the FTC, in 2016. The Member’s level within the Marketing Plan is used to determine the discount applied to their purchase of our products and whether they have qualified to become a sales leader. To become a sales leader, or qualify for a higher level within our Marketing Plan, Members must achieve specified Volume Point thresholds of product sales or earn certain amounts of royalty overrides during specified time periods and generally must re-qualify once each year. Qualification criteria vary somewhat by market. We have initial qualification methods of up to 12 months to encourage a more gradual qualification. We believe a gradual qualification approach is important to the success and retention of new sales leaders and benefits the business in the long term as it allows new Members to obtain product and customer experience as well as additional training and education on Herbalife Nutrition products, daily consumption based DMOs, and the business opportunity prior to becoming a sales leader. The basis for calculating Marketing Plan payouts varies depending on product and market: for 2022, we utilized on a weighted- average basis approximately 90% of suggested retail price, to which we applied discounts of up to 50% for distributor allowances and payout rates of up to 15% for royalty overrides, up to 7% for production bonuses, and approximately 1% for a cash bonus known as the Mark Hughes bonus. We believe that the opportunity for Members to earn royalty overrides and production bonuses contributes significantly to our ability to retain our most active and productive Members. Our Marketing Plan generally requires each sales leader to re-qualify for such status each year, prior to February, in order to maintain their 50% discount on products and be eligible to receive additional income. In February of each year, we demote from the rank of sales leader those Members who did not satisfy the re-qualification requirements during the preceding twelve months. The re- qualification requirement does not apply to new sales leaders (i.e. those who became sales leaders subsequent to the January re- qualification of the prior year). 8 As of December 31, 2022, prior to our February re-qualification process, approximately 772,000 of our Members have attained the level of sales leader, of which approximately 734,000 have attained this level in the 94 markets where we use our Marketing Plan and 38,000 independent service providers operating in our China business. See Business in China below for a description of our business in China. The table below reflects sales leader retention rates by year and by region: Sales Leader Retention Rate 2023 2022 2021 North America 69.7% 58.8% 70.8% Latin America (1) 71.6% 69.3% 67.0% EMEA 64.6% 77.1% 72.7% Asia Pacific 66.6% 66.5% 63.5% Total sales leaders 67.6% 68.9% 67.9% (1) The Company combined the Mexico and South and Central America regions into the Latin America region in 2022. Historical information has been reclassified to conform with the current period geographic presentation. For the latest twelve-month re-qualification period ending January 2023, approximately 67.6% of our sales leaders, excluding China, re-qualified, versus 68.9% for the twelve-month period ended January 2022. The Company throughout its history has adjusted the re-qualification criteria from time to time in response to evolving business objectives and market conditions, and the above results include the effects of all such changes. For example, in recent years certain markets have allowed members to utilize a lower re- qualification volume threshold and the Company has continued to expand this lower re-qualification method to additional markets. Separately, with revised business requirements in place following the Consent Order, as described in Network Marketing Program below, we utilize a re-qualification equalization factor for U.S. Members to better align their re-qualification thresholds with Members in other markets, and retention results for each of the years presented include the effect of the equalization factor. We believe this factor preserves retention rate comparability across markets. Also, for each of the years presented, the retention results exclude certain markets for which, due to local operating conditions, sales leaders were not required to requalify. We believe sales leader retention rates are the result of efforts we have made to try and improve the sustainability of sales leaders’ businesses, such as encouraging Members to obtain experience retailing Herbalife Nutrition products before becoming a sales leader and providing them with advanced technology tools, as well as reflecting market conditions. As our business operations evolve, including the segmentation of our Member base in certain markets and changes in sales leader re-qualification thresholds for other markets, management continues to evaluate the importance of sales leader retention rate information. The table below reflects the number of sales leaders as of the end of February of the year indicated (subsequent to the annual re- qualification process) and by region: Number of Sales Leaders 2022 2021 2020 North America 80,278 95,402 71,202 Latin America (1) 125,726 131,359 134,401 EMEA 183,056 158,153 130,438 Asia Pacific 201,137 173,582 158,815 Total sales leaders 590,197 558,496 494,856 China 33,486 68,301 70,701 Worldwide total sales leaders 623,683 626,797 565,557 (1) The Company combined the Mexico and South and Central America regions into the Latin America region in 2022. Historical information has been reclassified to conform with the current period geographic presentation. The number of sales leaders as of December 31 will exceed the number immediately subsequent to the preceding re-qualification period because sales leaders qualify throughout the year but sales leaders who do not re-qualify are removed from the rank of sales leader the following February. 9 Business in China Our business model in China includes unique features as compared to our traditional business model in order to ensure compliance with Chinese regulations. As a result, our business model in China differs from that used in other markets. Members in China are categorized differently than those in other markets. In China, we sell our products to and through independent service providers and sales representatives to customers and preferred customers, as well as through Company-operated retail platforms when necessary. In China, while multi-level marketing is not permitted, direct selling is permitted. Chinese citizens who apply and become Members are referred to as sales representatives. These sales representatives are permitted to sell away from fixed retail locations in the provinces where we have direct selling licenses, including in the provinces of Jiangsu, Guangdong, Shandong, Zhejiang, Guizhou, Beijing, Fujian, Sichuan, Hubei, Shanxi, Shanghai, Jiangxi, Liaoning, Jilin, Henan, Chongqing, Hebei, Shaanxi, Tianjin, Heilongjiang, Hunan, Guangxi, Hainan, Anhui, Yunnan, Gansu, Ningxia, and Inner Mongolia. In Xinjiang province, where we do not have a direct selling license, we have a Company-operated retail store that can directly serve customers and preferred customers. With online orderings throughout China, there has been a declining demand in Company-operated retail stores. Sales representatives receive scaled rebates based on the volume of products they purchase. Sales representatives who reach certain volume thresholds and meet certain performance criteria are eligible to apply to provide marketing, sales and support services. Once their application is accepted, they are referred to as independent service providers. Independent service providers are independent business entities that are eligible to receive compensation from Herbalife Nutrition for the marketing, sales and support services they provide so long as they satisfy certain conditions, including procuring the requisite business licenses, having a physical business location, and complying with all applicable Chinese laws and Herbalife Nutrition rules. In China, our independent service providers are compensated for marketing, sales support, and other services, instead of the Member allowances and royalty overrides utilized in our global Marketing Plan. The service hours and related fees eligible to be earned by the independent service providers are based on a number of factors, including the sales generated through them and through others to whom they may provide marketing, sales support and other services, the quality of their service, and other factors. Total compensation available to our independent service providers in China can generally be comparable to the total compensation available to other sales leaders globally. The Company does this by performing an analysis in our worldwide system to estimate the potential compensation available to the service providers, which can generally be comparable to that of sales leaders in other countries. After adjusting such amounts for other factors and dividing by each service provider’s hourly rate, we then notify each independent service provider the maximum hours of work for which they are eligible to be compensated in the given month. In order for a service provider to be paid, the Company requires each service provider to invoice the Company for their services. RESOURCES We seek to provide the highest quality products to our Members and their customers through our “seed to feed” strategy, which includes significant investments in obtaining quality ingredients from traceable sources, qualified by scientific personnel through product testing, and increasing the amount of self-manufacturing of our top products. Ingredients Our seed to feed strategy is rooted in using quality ingredients from traceable sources. Our procurement process for many of our botanical products now stretches back to the farms and includes self-processing of teas and herbal ingredients into finished raw materials at our own facilities. Our Changsha, China facility exclusively provides high quality tea and herbal raw materials to our manufacturing facilities as well as our third-party contract manufacturers around the world. We also source ingredients that we do not self-process from companies that are well-established, reputable suppliers in their respective field. These suppliers typically utilize similar quality processes, equipment, expertise, and having traceability as we do with our own modern quality processes. As part of our program to ensure the procurement of high-quality ingredients, we also test our incoming raw materials for compliance to potency, identity, and adherence to strict specifications. 10 Manufacturing The next key component of our seed to feed strategy involves the high-quality manufacturing of these ingredients into finished products, which are produced at both third-party manufacturers and our own manufacturing facilities. As part of our long-term strategy, we seek to expand and increase our self-manufacturing capabilities. Our manufacturing facilities, known as Herbalife Innovation and Manufacturing Facilities, or HIMs, include HIM Lake Forest, HIM Winston-Salem, HIM Suzhou, and HIM Nanjing. HIM Winston- Salem is currently our largest manufacturing facility at approximately 800,000 square feet. Together, our HIM manufacturing facilities produce approximately 51% of our inner nutrition products sold worldwide. Self-manufacturing also enables us greater control to reduce negative environmental impacts of our operations and supply chain. As described in the Sustainability section below, we are focused on developing science-based green-house gas emission reduction targets for our manufacturing facilities as part of our sustainability goals. We are also focused on reducing single-use plastics throughout our global distribution network and incorporating more sustainable content, such as post-consumer recycled resin, into our packaging. Our finished products are analyzed for label claims and tested for microbiological purity, thereby verifying that our products comply with food safety standards, meet label claims and have met other quality standards. For self-manufactured products, we conduct all of our testing in-house at our fully-equipped, modern quality control laboratories in the U.S. and China. We have two quality control laboratories in Southern California and Changsha, China (including a Center of Excellence in both locations). In addition, we also have a Center of Excellence laboratory in Bangalore, India, and a quality control laboratory in Winston-Salem, North Carolina, Suzhou, China, and Nanjing, China. All HIM quality control labs contain modern analytical equipment and are backed by the expertise in testing and methods development of our scientists. In our U.S. HIM facilities, which manufacture products for the U.S. and most of our international markets, we operate and adhere to the regulations established by the U.S. Food and Drug Administration, or FDA, and strict Current Good Manufacturing Practice regulations, or CGMPs, for food, acidified foods, and dietary supplements. We also work closely with our third-party manufacturers to ensure high quality products are produced and tested through a vigorous quality control process at approved contract manufacturer labs or third-party labs. For these products manufactured at other facilities, we combine four elements to ensure quality products: (1) the same selectivity and assurance in ingredients as noted above; (2) use of reputable, CGMP-compliant, quality- and sustainability-minded manufacturing partners; (3) supplier qualification through annual audit programs; and (4) significant product quality testing. During 2022, we purchased approximately 15% of our products from our top three third-party manufacturers. Infrastructure and Technology Our direct-selling business model enables us to grow our business with moderate investment in infrastructure and fixed costs. We incur no direct incremental cost to add a new Member in our existing markets, and our Member compensation varies directly with product sales. In addition, our Members also bear a portion of our consumer marketing expenses, and our sales leaders sponsor and coordinate Member recruiting and most meeting and training initiatives. Additionally, our infrastructure features scalable production and distribution of our products as a result of having our own manufacturing facilities and numerous third-party manufacturing relationships, as well as our global footprint of in-house and third-party distribution centers. An important part of our seed to feed strategy is having an efficient infrastructure to deliver products to our Members and their customers. As the shift in consumption patterns continues to reflect an increasing daily consumption focus, one focus of this strategy is to provide more product access points closer to our Members and their customers. We have both Company-operated and outsourced distribution points ranging from our “hub” distribution centers in Los Angeles, Memphis, and Venray, Netherlands, to mid-size distribution centers in major countries, to small pickup locations spread throughout the world. We also expect to continue to improve our distribution channels relating to home delivery as we expect to see continued increased demands for our products being shipped to our Members in certain of our larger markets. In addition to these distribution points, we partner with certain retail locations to provide Member pickup points in areas which are not well serviced by our distribution points. We have also identified a number of methods and approaches that better support Members by providing access points closer to where they do business and by improving product delivery efficiency through our distribution channels. Specific methods vary by markets and consider local Member needs and available resources. In aggregate, we have over 1,500 distribution points and partner retail locations around the world. In addition to our distribution points, we contract third party-run drop-off locations where we can ship to and Members can pick up ordered products. 11 We leverage our technology infrastructure in order to maintain, protect, and enhance existing systems and develop new systems to keep pace with continuing changes in technology, evolving industry and regulatory standards, emerging data security risks, and changing user patterns and preferences. We also continue to invest in our manufacturing and operational infrastructure to accelerate new products to market and accommodate planned business growth. We invest in business intelligence tools to enable better analysis of our business and to identify opportunities for growth. We will continue to build on these platforms to take advantage of the rapid development of technology around the globe to support a more robust Member and customer experience. In addition, we leverage an Oracle business suite platform to support our business operations, improve productivity and support our strategic initiatives. Our investment in technology infrastructure helps support our capacity to grow. In 2021, we also initiated a global transformation program to optimize global processes for future growth, or the Transformation Program. The Transformation Program involves the investment in certain new technologies and the realignment of infrastructure and the locations of certain functions to better support distributors and customers. The Transformation Program is still ongoing and expected to be completed in 2024 as described further in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K and Note 14, Transformation Program, to the Consolidated Financial Statements included in Part IV, Item 15, Exhibits, Financial Statement Schedules, of this Annual Report on Form 10-K. In addition, many Members rely on the use of technology to support their goals and businesses. As part of our continued investment in technology to further support our Members and drive long-term growth, we have enhanced our product access and distribution network to support higher volumes of online or mobile orders, allowing Members and their customers to select home or business delivery options. We have also implemented information technology systems to support Members and their increasing demand to be more connected to Herbalife Nutrition, their business, and their consumers with tools such as HN MyClub, Engage, HNconnect, BizWorks, MyHerbalife, GoHerbalife, and Herbalife.com. Additionally, we continue to support a growing suite of point-of-sale tools to assist our Members with ordering, tracking, and customer relationship management. These tools allow our Members to manage their business and communicate with their customers more efficiently and effectively. During 2022, we also commenced a Digital Technology Program to develop a new enhanced platform to provide enhanced digital capabilities and experiences to our Members. This is a multi-year program and we expect our capital expenditures to increase in 2023 and future years as result of our investments in this Digital Technology Program as described further in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Operating Results, of this Annual Report on Form 10-K. Intellectual Property and Branding Marketing foods and supplement products on the basis of sound science means using ingredients in the composition and quantity as demonstrated to be effective in the relevant scientific literature. Use of these ingredients for their well-established purposes is by definition not novel, and for that reason, most food uses of these ingredients are not subject to patent protection. Notwithstanding the absence of patent protection, we do own proprietary formulations for substantially all of our weight management products and dietary and nutritional supplements. We take care in protecting the intellectual property rights of our proprietary formulas by restricting access to our formulas within the Company to those persons or departments that require access to them to perform their functions, and by requiring our finished goods suppliers and consultants to execute supply and non-disclosure agreements that contractually protect our intellectual property rights. Disclosure of these formulas, in redacted form, is also necessary to obtain product registrations in many countries. We also make efforts to protect certain unique formulations under patent law. We strive to protect all new product developments as the confidential trade secrets of the Company. We use the umbrella trademarks Herbalife®, Herbalife Nutrition®, and the Tri-Leaf design worldwide, and protect several other trademarks and trade names related to our products and operations, such as Niteworks® and Liftoff®. Our trademark registrations are issued through the United States Patent and Trademark Office, or USPTO, and comparable agencies in the foreign countries. We believe our trademarks and trade names contribute to our brand awareness. To increase our brand awareness, we and our Members use a variety of tools and marketing channels. These can include anything from traditional media to social media and alliances with partners who can promote our goal of better living through nutrition. Herbalife Nutrition sponsorships of and partnerships with featured athletes, teams, and events promote brand awareness and the use of Herbalife Nutrition products. We continue to build brand awareness with a goal towards becoming the most trusted brand in nutrition. We also work to leverage the power of our Member base as a marketing and brand-building tool. We maintain a brand style guide and brand asset library so that our Members have access to the Herbalife Nutrition brand logo and marketing materials for use in their marketing efforts. 12 Sustainability Our goals and objectives to nourish people and communities and to improve the planet are part of both our day-to-day activities and our long-term growth strategy. As a signatory of the United Nations Global Compact, or UNGC, we have aligned our sustainability initiatives outlined by the United Nations’ Sustainable Development Goals. Our current sustainability initiatives focus on issues including climate and emissions, packaging, and operational waste. For example, we have implemented projects that have reduced overall packaging materials and incorporated usage of recycled materials in the packaging of our flagship product, Formula 1 Healthy Meal Nutritional Shake in North America, Mexico, and in certain markets where permitted by regulations. We are seeking opportunities across operations to reduce waste-prone materials such as single-use plastics. More information on these efforts is provided in the Manufacturing section above. For information relating to our culture, diversity, equity, and inclusion, please see the Human Capital section below. REGULATION General In our United States and foreign markets, we are affected by extensive laws, governmental regulations, administrative determinations and guidance, court decisions and similar constraints that regulate the conduct of our business. Such laws, regulations and other constraints exist at the federal, state or local levels in the United States and at all levels of government in foreign jurisdictions, and include regulations pertaining to: (1) the formulation, manufacturing, packaging, labeling, distribution, importation, sale, and storage of our products; (2) product claims and advertising, including direct claims and advertising by us, as well as claims and advertising by Members, for which we may be held responsible; (3) our network marketing program; (4) transfer pricing and similar regulations that affect the level of U.S. and foreign taxable income and customs duties; (5) taxation of our Members (which in some instances may impose an obligation on us to collect the taxes and maintain appropriate records); (6) our international operations, such as import/export, currency exchange, repatriation and anti-bribery regulations; (7) antitrust issues; and (8) privacy and data protection. See Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K for additional information. Products In the United States, the formulation, manufacturing, packaging, holding, labeling, promotion, advertising, distribution, and sale of our products are subject to regulation by various federal governmental agencies, including: (1) the FDA; (2) the FTC; (3) the Consumer Product Safety Commission, or CPSC; (4) the United States Department of Agriculture, or USDA; (5) the Environmental Protection Agency, or EPA; (6) the United States Postal Service; (7) United States Customs and Border Protection; and (8) the Drug Enforcement Administration. Our activities also are regulated by various agencies of the states, localities and foreign countries in which our products are manufactured, distributed, or sold. The FDA, in particular, regulates the formulation, manufacture, and labeling of over-the-counter, or OTC, drugs, conventional foods, dietary supplements, and cosmetics such as those distributed by us. The majority of the products marketed by us in the United States are classified as conventional foods or dietary supplements under the Federal Food, Drug and Cosmetic Act, or FFDCA. Internationally, the majority of products marketed by us are classified as foods, health supplements, or food supplements. FDA regulations govern the preparation, packaging, labeling, holding, and distribution of foods, OTC drugs, cosmetics, and dietary supplements. Among other obligations, they require us and our contract manufacturers to meet relevant CGMP regulations for the preparation, packaging, holding, and distribution of OTC drugs and dietary supplements. The FDA also requires identity testing of all incoming dietary ingredients used in dietary supplements, unless a company successfully petitions for an exemption from this testing requirement in accordance with the regulations. The CGMPs are designed to ensure that OTC drugs and dietary supplements are not adulterated with contaminants or impurities, and are labeled to accurately reflect the active ingredients and other ingredients in the products. We have implemented a comprehensive quality assurance program that is designed to maintain compliance with the CGMPs for products manufactured by us or on our behalf for distribution in the United States. As part of this program, we have regularly implemented enhancements, modifications and improvements to our manufacturing and corporate quality processes. We believe that we and our contract manufacturers are compliant with the FDA’s CGMPs and other applicable manufacturing regulations in the United States. The U.S. Dietary Supplement Health and Education Act of 1994, or DSHEA, revised the provisions of FFDCA concerning the composition and labeling of dietary supplements. Under DSHEA, dietary supplement labeling may display structure/function claims that the manufacturer can substantiate, which are claims that the products affect the structure or function of the body, without prior FDA approval, but with notification to the FDA. They may not bear any claim that they can prevent, treat, cure, mitigate or diagnose disease (a drug claim). Apart from DSHEA, the agency permits companies to use FDA-approved full and qualified health claims for food and supplement products containing specific ingredients that meet stated requirements. 13 U.S. law also requires that all serious adverse events occurring within the United States involving dietary supplements or OTC drugs be reported to the FDA. We believe that we are in compliance with this law having implemented a worldwide procedure governing adverse event identification, investigation and reporting. As a result of reported adverse events, we may from time to time elect, or be required, to remove a product from a market, either temporarily or permanently. Some of the products marketed by us are considered conventional foods and are currently labeled as such. Within the United States, this category of products is subject to the federal Nutrition, Labeling and Education Act, or NLEA, and regulations promulgated under the NLEA. The NLEA regulates health claims, ingredient labeling and nutrient content claims characterizing the level of a nutrient in the product. The ingredients in conventional foods must either be generally recognized as safe by experts for the purposes to which they are put in foods, or be approved as food additives under FDA regulations. The federal Food Safety Modernization Act, or FSMA, is also applicable to some of our business. We follow a food safety plan and have implemented preventive measures required by the FSMA. Foreign suppliers of our raw materials are also subject to FSMA requirements, and we have implemented a verification program to comply with the FSMA. Dietary supplements manufactured in accordance with CGMPs and foods manufactured in accordance with the low acid food regulations are exempt. In foreign markets, prior to commencing operations and prior to making or permitting sales of our products in the market, we may be required to obtain an approval, license or certification from the relevant country’s ministry of health or comparable agency. Prior to entering a new market in which a formal approval, license or certificate is required, we work with local authorities in order to obtain the requisite approvals. The approval process generally requires us to present each product and product ingredient to appropriate regulators and, in some instances, arrange for testing of products by local technicians for ingredient analysis. The approvals may be conditioned on reformulation of our products, or may be unavailable with respect to some products or some ingredients. The FTC, which exercises jurisdiction over the advertising of all of our products in the United States, has in the past several years instituted enforcement actions against several dietary supplement and food companies and against manufacturers of weight loss products generally for false and misleading advertising of some of their products. In addition, the FTC has increased its scrutiny of the use of testimonials, which we also utilize, as well as the role of expert endorsers and product clinical studies. We cannot be sure that the FTC, or comparable foreign agencies, will not question our advertising or other operations in the future. In Europe, where an EU Health Claim regulation is in effect, the European Food Safety Authority, or EFSA, issued opinions following its review of a number of proposed claims documents. ESFA’s opinions, which have been accepted by the European Commission, have limited the use of certain nutrition-specific claims made for foods and food supplements. Accordingly, we revised affected product labels to ensure regulatory compliance. We are subject to a permanent injunction issued in October 1986 pursuant to the settlement of an action instituted by the California Attorney General, the State Health Director and the Santa Cruz County District Attorney. We consented to the entry of this injunction without in any way admitting the allegations of the complaint. The injunction prevents us from making specified claims in advertising of our products, but does not prevent us from continuing to make specified claims concerning our products, provided that we have a reasonable basis for making the claims. The injunction also prohibits certain recruiting-related investments from Members and mandates that payments to Members be premised on retail value (as defined); the injunction provides that we may establish a system to verify or document such compliance. Network Marketing Program Our network marketing program is subject to a number of federal and state regulations administered by the FTC and various state regulators as well as regulations in foreign markets administered by foreign regulators. Regulations applicable to network marketing organizations generally are directed at ensuring that product sales ultimately are made to consumers and that advancement within the organization is based on sales of the organization’s products rather than investments in the organization or other non-retail sales related criteria. When required by law, we obtain regulatory approval of our network marketing program or, when this approval is not required, the favorable opinion of local counsel as to regulatory compliance. 14 On July 15, 2016, we reached a settlement with the FTC and entered into a proposed Stipulation to Entry of Order for Permanent Injunction and Monetary Judgment, or the Consent Order, which resolved the FTC’s multi-year investigation of us. The Consent Order became effective on July 25, 2016, or the Effective Date, upon final approval by the U.S. District Court for the Central District of California. Pursuant to the Consent Order, we implemented and continue to enhance certain procedures in the U.S. and agreed to be subject to certain audits by an independent compliance auditor (Affiliated Monitors, Inc.) for a period of seven years. Among other requirements, the Consent Order requires us to categorize all existing and future Members in the U.S. as either “preferred members” – who are simply consumers who only wish to purchase product for their own household use — or “distributors” – who are Members who wish to resell some products or build a sales organization. We also agreed to compensate distributors on U.S. eligible sales within their downline organizations, which include purchases by preferred members, purchases by a distributor for his or her personal consumption within allowable limits and sales of product by a distributor to his or her customers. The Consent Order also requires distributors to meet certain conditions before opening Nutrition Clubs and/or entering into leases for their Herbalife Nutrition business in the United States. The Consent Order also prohibits us from making expressly or by implication, any misrepresentation regarding certain lifestyles or amount or level of income, including full-time or part-time income that a participant can reasonably expect to earn in our network marketing program. The Consent Order also prohibits us and other persons who act in active concert with us from misrepresenting that participation in the network marketing program will result in a lavish lifestyle and from using images or descriptions to represent or imply that participation in the program is likely to result in a lavish lifestyle. In addition, the Consent Order prohibits specified misrepresentations in connection with marketing the program, including misrepresentations regarding any fact material to participation such as the cost to participate or the amount of income likely to be earned. The Consent Order also requires us to clearly and conspicuously disclose information related to our refund and buyback policy on certain company materials and websites. The terms of the Consent Order do not change our going to market through direct selling by independent distributors, and compensating those distributors based upon the product they and their sales organization sell. We have implemented new and enhanced procedures required by the terms of the Consent Order and will continue to do so. We continue to monitor the impact of the Consent Order and our board of directors originally established the Implementation Oversight Committee in connection with monitoring compliance with the Consent Order, and more recently, our Audit Committee assumed oversight of continued compliance with the Consent Order. While we currently do not expect the Consent Order to have a long-term and material adverse impact on our business and our Member base, our business and our Member base, particularly in the U.S., have been in the past, and may in the future, be negatively impacted as we and they adjust to the changes. However, the terms of the Consent Order and the ongoing costs of compliance may adversely affect our business operations, our results of operations, and our financial condition. See Part I, Item 1A, Risk Factors, of this Annual Report on Form 10-K for a discussion of risks related to the settlement with the FTC. On January 4, 2018, the FTC released its nonbinding Business Guidance Concerning Multi-Level Marketing, or MLM Guidance. The MLM Guidance explains, among other things, lawful and unlawful compensation structures, the treatment of personal consumption by participants in determining if an MLM’s compensation structure is unfair or deceptive, and how an MLM should approach representations to current and prospective participants. We believe our current business practices, which include new and enhanced procedures implemented in connection with the Consent Order, are in compliance with the MLM Guidance. Additionally, the FTC has promulgated nonbinding Guides Concerning the Use of Endorsements and Testimonials in Advertising, or Guides, which explain how the FTC interprets Section 5 of the FTC Act’s prohibition on unfair or deceptive acts or practices. Consequently, the FTC could bring a Section 5 enforcement action based on practices that are inconsistent with the Guides. Under the Guides, advertisements that feature a consumer and convey his or her atypical experience with a product or service are required to clearly disclose the typical results that consumers can generally expect. The revised Guides also require advertisers to disclose connections between the advertiser and any endorsers that consumers might not expect, known as “material connections.” We have adapted our practices and rules regarding the practices of our Members to comply with the Guides and to comply with the Consent Order. We also are subject to the risk of private party challenges to the legality of our network marketing program both in the United States and internationally. For example, in Webster v. Omnitrition International, Inc., 79 F.3d 776 (9th Cir. 1996), the network marketing program of Omnitrition International, Inc., or Omnitrition, was challenged in a class action by Omnitrition distributors who alleged that it was operating an illegal “pyramid scheme” in violation of federal and state laws. We believe that our network marketing program satisfies federal and other applicable state statutes and case law. In some countries, regulations applicable to the activities of our Members also may affect our business because in some countries we are, or regulators may assert that we are, responsible for our Members’ conduct. In these countries, regulators may request or require that we take steps to ensure that our Members comply with local regulations. The types of regulated conduct include: (1) representations concerning our products; (2) income representations made by us and/or Members; (3) public media advertisements, which in foreign markets may require prior approval by regulators; (4) sales of products in markets in which the products have not been approved, licensed or certified for sale; and (5) classification by government agencies of our Members as employees of the Company. 15 In some markets, it is possible that improper product claims by Members could result in our products being reviewed by regulatory authorities and, as a result, being classified or placed into another category as to which stricter regulations are applicable. In addition, we might be required to make labeling changes. We also are subject to regulations in various foreign markets pertaining to social security assessments and employment and severance pay requirements. As an example, in some markets, we are substantially restricted in the amount and types of rules and termination criteria that we can impose on Members without having to pay social security assessments on behalf of the Members and without incurring severance obligations to terminated Members. In some countries, we may be subject to these obligations in any event. It is an ongoing part of our business to monitor and respond to regulatory and legal developments, including those that may affect our network marketing program. However, the regulatory requirements concerning network marketing programs do not include bright line rules and are inherently fact-based. An adverse judicial or regulatory determination with respect to our network marketing program could have a material adverse effect on our business, financial condition, and operating results and may also result in negative publicity, requirements to modify our network marketing program, or a negative impact on Member morale. In addition, adverse rulings by courts in any proceedings challenging the legality of network marketing systems, even in those not involving us directly, could have a material adverse effect on our operations. Although questions regarding the legality of our network marketing program have come up in the past and may come up from time to time in the future, we believe, based in part upon guidance to the general public from the FTC, that our network marketing program is compliant with applicable law. Income Tax, Transfer Pricing, and Other Taxes In many countries, including the United States, we are subject to income tax, transfer pricing and other tax regulations designed to ensure that appropriate levels of income are reported as earned by our U.S. and local entities and are taxed accordingly. In addition, our operations are subject to regulations designed to ensure that appropriate levels of customs duties are assessed on the importation of our products. Although we believe that we are in substantial compliance with all applicable tax rules, regulations, and restrictions, we are subject to the risk that governmental authorities could assert that additional taxes are owed based on findings of their audit. For example, we are currently subject to pending or proposed audits that are at various levels of review, assessment or appeal in a number of jurisdictions involving transfer pricing issues, income taxes, duties, value added taxes, withholding taxes and related interest and penalties in material amounts. In some circumstances, additional taxes, interest and penalties have been assessed, and we will be required to appeal or litigate to reverse the assessments. We have taken advice from our tax advisors and believe that there are substantial defenses to the allegations that additional taxes are owed, and we are vigorously defending against the imposition of additional proposed taxes. The ultimate resolution of these matters may take several years, and the outcome is uncertain. In the event that the audits or assessments are concluded adversely, we may or may not be able to offset or mitigate the consolidated effect of foreign income tax assessments through the use of U.S. foreign tax credits. The laws and regulations governing U.S. foreign tax credits are complex and subject to periodic legislative amendment, and there are restrictions on the utilization of U.S. foreign tax credits. Therefore, we cannot be sure that we would in fact be able to take advantage of any foreign tax credits in the future. Compliance Procedures As indicated above, Herbalife Nutrition, our products and our network marketing program are subject, both directly and indirectly through Members’ conduct, to numerous federal, state and local regulations, in the United States and foreign markets. In 1985, we began to institute formal compliance measures by developing a system to identify specific complaints against Members and to remedy any violations of Herbalife Nutrition’s rules by Members through appropriate sanctions, including warnings, fines, suspensions and, when necessary, terminations. We prohibit Members from making therapeutic claims for our products or misrepresentations regarding participating in our network marketing program, including in our manuals, seminars, and other training programs and materials. Our general policy is to reject Member applications from individuals who do not reside in one of our approved markets. 16 In order to comply with regulations that apply to both us and our Members, we research the applicable regulatory framework prior to entering any new market to identify necessary licenses and approvals and applicable limitations relating to our operations in that market and then work to bring our operations into compliance with the applicable limitations and to maintain such licenses. Typically, we conduct this research with the assistance of local legal counsel and other representatives. We also research laws applicable to Member operations and revise or alter our Member applications, rules, and other training materials and programs to provide Members with guidelines for operating their independent business, marketing and distributing our products and similar matters, as required by applicable regulations in each market. While we have rules and guidelines for our Members and monitor their market conduct, we are, however, unable to ensure that our Members will not distribute our products in countries where we have not commenced operations. In addition, regulations in existing and new markets often are ambiguous and subject to considerable interpretive and enforcement discretion by the responsible regulators. Moreover, even when we believe that we and our Members are in compliance with all applicable regulations, new regulations are being added regularly and the interpretation of existing regulations is subject to change. Further, the content and impact of regulations to which we are subject may be influenced by public attention directed at us, our products, or our network marketing program, so that extensive adverse publicity about us, our products, or our network marketing program may increase the likelihood regulatory scrutiny or action. HUMAN CAPITAL At Herbalife Nutrition, our commitment to improving lives and our communities is at the core of everything we do. This commitment also informs how we value and treat our employees. We seek to provide a work environment where employees can grow and thrive while supporting our Members and their customers. We believe attracting, developing, and retaining a talented and diverse workforce are critical factors that contribute to the success and growth of our business. We have operations globally, requiring investment to assess local labor market conditions and recruit and retain the appropriate workforce. Having a business presence in multiple domestic and international markets also requires us to monitor local labor and employment laws for which we often engage third-party advisors. We monitor the talent needs of our departments and functions with particular focus on the areas where human capital resources are important to daily operations to ensure we can timely manufacture, distribute, and sell products to our Members. As of December 31, 2022, we had approximately 10,100 employees, of which approximately 2,800 were located in the United States. Diversity, Equity, and Inclusion We believe diversity is a strength and embrace a core vision that a diverse, equitable, and inclusive culture is imperative to enable us to better serve our Members, stakeholders, and communities. As such, we seek to promote a work environment where all people can thrive, and are committed to diversity, equity, and inclusion, or DEI, at all levels, from our employees, management and executive leadership to our board of directors. Our DEI strategy is currently focused on creating opportunities to further recruit and support diverse talent at all levels, encouraging inclusion and belonging, and embedding equity throughout our culture and operations. Current initiatives include the implementation of a global applicant tracking system to deepen our commitment to fair recruitment processes, offering unconscious bias trainings for all employees, the expansion of existing employee networks which help employees build community and foster a culture of belonging, and further development and involvement of Global and Regional DEI Councils to drive DEI progress. Additionally, we have set diversity goals and targets for women in leadership roles globally and for racial and ethnic minorities in leadership roles in the U.S. Talent Acquisition and Development We seek to attract and retain a talented and diverse workforce. To foster an inclusive hiring process in the U.S., we use a tool that helps ensure that job descriptions do not unintentionally exclude potential applicants. Investment in our employees' professional growth and development is important and helps establish a strong foundation for long- term success. At our Company, we strive to create a learning culture, one in which development is an ongoing focus for all employees and managers. We invest in our employees’ development through a variety of programs. These programs are designed to help our employees grow professionally and strengthen their skills throughout their careers. Examples of these programs include the following: • Training Programs – We provide our employees access to an internal learning management system, Herbalife Nutrition University, which provides professional development courses, technical training, and compliance training to all employees globally. 17 • Mentorship Programs – The principle of servant leadership is a crucial part of our culture. We believe that one way to be a servant leader is to mentor others, and, in 2020, we introduced a new mentorship program to help guide junior employees in their professional journey. Through this program, participating employees can be provided with a one-on-one professional development opportunity, in which they receive dedicated coaching, feedback, and encouragement. • Educational Assistance – Another way we support employees’ continual professional development is by offsetting a portion of the cost of higher education. Program offerings and eligibility vary by region, but may include partial reimbursement of tuition fees incurred for undergraduate and graduate degrees, certificate programs, or skills-based courses. Compensation and Benefits Our Board of Directors and its Compensation Committee establish our general compensation philosophy and oversee and approve the development, adoption, and implementation of compensation policies and programs, which are set at a global level, but also adapted to meet local country requirements as needed. We provide base pay that aligns with employee positions, skill levels, experience, contributions, and geographic location. In addition to base pay, we seek to reward employees with annual incentive awards, recognition programs, and equity awards for employees at certain job grades. Our benefit programs are designed to enhance employee well-being and assist employees in the event of illness, injury, or disability. To this end, we offer benefits that vary worldwide, but may include health insurance, retirement savings programs, and wellness incentives designed to promote a healthy and active lifestyle. We believe we offer our employees wages and benefits packages that are in line with respective local labor markets and laws. Safety, Health, and Well-Being As a nutrition company, we believe the safety, health, and well-being of our employees is of the utmost importance. We endeavor to promote these principles by providing a safe and healthy work environment and encouraging healthy, active lifestyles. Our efforts to provide a safe workplace are guided by various formal policies and programs, which are designed to protect employees, contractors, and visitors from accidents, illnesses, and injuries, while operating in compliance with applicable regulations, including OSHA guidelines in the U.S. We also follow policies and programs regarding material health and safety risks, workplace violence prevention, and incident response and management. In the U.S., our manufacturing facilities in Winston-Salem and Lake Forest are ISO 45001 certified, an international standard for occupational health and safety management. While the COVID-19 pandemic has increased the resources required to keep our employees safe and healthy, we continue to make what we believe are the necessary investments to achieve this goal. In response to, and during various phases of, the pandemic, we have taken several actions, including supporting our employees to work from home when possible, offering mental and emotional wellness resources, and implementing safety measures when necessary at our facilities. Over the course of the pandemic, our senior management team has relied on cross-functional teams to monitor, review, and assess the evolving situation. These cross-functional teams are responsible for recommending risk mitigation actions based on the local risks and in accordance with regulatory requirements and guidelines for the health and safety of our employees and, in the U.S., protocols to align with all federal, state, and local public health guidelines. We believe our proactive efforts have been successful in supporting our business growth despite the obstacles and challenges presented by COVID-19. In addition, we believe in the importance of well-being and provide resources for our employees that support their pursuit of a healthy and active lifestyle. Our flagship wellness program in the U.S., “Wellness for Life,” offers employees a suite of activities to achieve overall wellness through improved fitness, nutrition, intellectual well-being, and financial literacy. The variety of activities offered ensures all employees may participate, no matter where they may be in their wellness journey. While we have many existing regional wellness programs, a new and enhanced global wellness program will launch in January 2023 and feature Herbalife fitness, health and nutrition experts from around the globe. We also have facilities and programs in place that allow employees to incorporate fitness into their daily schedule, such as onsite gyms at several facilities and live virtual classes. Our Members We are dependent on our Members to sell and promote our products to their customers. We frequently interact and work directly with our sales leaders to explore ways to support our and our Members’ businesses, and their customers’ personal goals of living a healthier and more active lifestyle. See the Our Network Marketing Program – Member Compensation and Sales Leader Retention and Requalification section above for sales leader and requalification metrics and further discussion on our sales leaders. 18 Available Information Our Internet website address is www.herbalife.com and our investor relations website is ir.herbalife.com. We make available free of charge on our website our Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, Current Reports on Form 8-K, proxy statements, and amendments to those reports filed or furnished pursuant to Section 13(a) or 15(d) of the Securities Exchange Act of 1934, as amended, or the Exchange Act, as soon as reasonably practical after we file such material with, or furnish it to, the Securities and Exchange Commission, or SEC. The SEC maintains an Internet website that contains reports, proxy and information statements, and other information regarding issuers that file electronically with the SEC at www.sec.gov. We also make available free of charge on our investor relations website at ir.herbalife.com our Principles of Corporate Governance, our Code of Conduct, and the Charters of our Audit Committee, Nominating and Corporate Governance Committee, Compensation Committee, and ESG Committee of our board of directors. Unless expressly noted, the information on our website, including our investor relations website, or any other website is not incorporated by reference in this Annual Report on Form 10-K and should not be considered part of this Annual Report on Form 10-K or any other filing we make with the SEC. Item 1A. Risk Factors Please carefully consider the following discussion of significant factors, events, and uncertainties that make an investment decision regarding our securities risky. The factors, events, uncertainties, and consequences discussed in these risk factors could, in circumstances we may not be able to accurately predict, recognize, or control, have a material adverse effect on our business, reputation, prospects, financial condition, operating results, cash flows, liquidity, and share price. These risk factors do not identify all risks that we face. We could also be affected by factors, events, or uncertainties that are not presently known to us or that we currently do not consider to present material risks. Additionally, the COVID-19 pandemic has amplified many of the other risks discussed below to which we are subject. We are unable to predict the duration and extent to which the pandemic and its related impacts will adversely impact our business, financial condition, and operating results as well as our share price. In addition, given the unpredictable, unprecedented, and fluid nature of the pandemic, it may also materially and adversely affect our business, financial condition, and operating results in ways that are not currently anticipated by or known to us or that we currently do not consider to present material risks. Risk Factor Summary This risk factor summary contains a high-level summary of certain of the principal factors, events and uncertainties that make an investment in our securities risky, including risks related to our business and industry, risks related to regulatory and legal matters, risks related to our international operations, risks related to our indebtedness and risks related to our common shares. The following summary is not complete and should be read together with the more detailed discussion of these and the other factors, events, and uncertainties set forth below before making an investment decision regarding our securities. The principal factors, events, and uncertainties that make an investment in our securities risky include the following: Risks Related to Our Business and Industry • Our failure to establish and maintain Member and sales leader relationships could negatively impact sales of our products and materially harm our business, financial condition, and operating results. • Because we cannot exert the same level of influence or control over our Members as we could if they were our employees, our Members could fail to comply with applicable law or our rules and procedures, which could result in claims against us that could materially harm our business, financial condition, and operating results. • Adverse publicity associated with our Company or the direct-selling industry could materially harm our business, financial condition, and operating results. • Our failure to compete successfully could materially harm our business, financial condition, and operating results. • Our contractual obligation to sell our products only through our Member network and to refrain from changing certain aspects of our Marketing Plan may limit our growth. • Our failure to appropriately respond to changing consumer trends, preferences, and demand for new products and product enhancements could materially harm our Member relationships, our Members’ customer relationships, and product sales or otherwise materially harm our business, financial condition, and operating results. • If we fail to further penetrate existing markets, the growth in sales of our products, along with our operating results could be negatively impacted. 19 • Since one of our products constitutes a significant portion of our net sales, significant decreases in consumer demand for this product or our failure to produce a suitable replacement, could materially harm our business, financial condition, and operating results. • Our business could be materially and adversely affected by natural disasters, other catastrophic events, acts of war or terrorism, cybersecurity incidents, pandemics, and/or other acts by third parties. • We depend on the integrity and reliability of our information technology infrastructure, and any related interruptions or inadequacies may have a material adverse effect on our business, financial condition, and operating results. • Disruption of supply, shortage, or increases in the cost of ingredients, packaging materials, and other raw materials as well as climate change could materially harm our business, financial condition, and operating results. • If any of our manufacturing facilities or third-party manufacturers fail to reliably supply products to us at required levels of quality or fail to comply with applicable laws, our financial condition and operating results could be materially and adversely impacted. • If we lose the services of members of our senior management team, our business, financial condition, and operating results could be materially harmed. • Our share price may be adversely affected by third parties who raise allegations about our Company. • ESG matters, including those related to climate change and sustainability, may have an adverse effect on our business, financial condition, and operating results and may damage our reputation. Risks Related to Regulatory and Legal Matters • Our products are affected by extensive regulations, and our failure or our Members’ failure to comply with any regulations could lead to significant penalties or claims, which could materially harm our financial condition and operating results. • Our network marketing program is subject to extensive regulation and scrutiny and any failure to comply, or alteration to our compensation practices in order to comply, with these regulations could materially harm our business, financial condition, and operating results. • We are subject to the Consent Order with the FTC, the effects of which, or any failure to comply therewith, could materially harm our business, financial condition, and operating results. • Our actual or perceived failure to comply with privacy and data protection laws, rules, and regulations could materially harm our business, financial condition, and operating results. • We are subject to material product liability risks, which could increase our costs and materially harm our business, financial condition, and operating results. • If we fail to protect our intellectual property, our ability to compete could be negatively affected, which could materially harm our financial condition and operating results. • If we infringe the intellectual property rights of others, our business, financial condition, and operating results could be materially harmed. • We may be held responsible for additional compensation, certain taxes, or assessments relating to the activities of our Members, which could materially harm our financial condition and operating results. Risks Related to Our International Operations • A substantial portion of our business is conducted in foreign jurisdictions, exposing us to the risks associated with international operations. • We are subject to the anti-bribery laws, rules, and regulations of the United States and the other foreign jurisdictions in which we operate. • If we do not comply with transfer pricing, customs duties VAT, and similar regulations, we may be subject to additional taxes, customs duties, interest, and penalties in material amounts, which could materially harm our financial condition and operating results. • Our business in China is subject to general, as well as industry-specific, economic, political, and legal developments and risks and requires that we utilize a modified version of the business model we use elsewhere in the world. • The United Kingdom’s exit from the European Union could adversely impact us. 20 Risks Related to Our Indebtedness • The terms and covenants in our existing indebtedness could limit our discretion with respect to certain business matters, which could harm our business, financial condition, and operating results. • The conversion or maturity of our convertible notes may adversely affect our financial condition and operating results, and their conversion into common shares could have a dilutive effect that could cause our share price to go down. Risks Related to Our Common Shares • Holders of our common shares may difficulties in protecting their interests because we are incorporated under Cayman Islands law. • Provisions of our articles of association and Cayman Islands law may impede a takeover or make it more difficult for shareholders to change the direction or management of the Company, which could reduce shareholders’ opportunity to influence management of the Company. • There is uncertainty as to shareholders’ ability to enforce certain foreign civil liabilities in the Cayman Islands. • U.S. Tax Reform may adversely impact certain U.S. shareholders of the Company. Risks Related to Our Business and Industry Our failure to establish and maintain Member and sales leader relationships could negatively impact sales of our products and materially harm our business, financial condition, and operating results. We distribute our products exclusively to and through our independent Members, and we depend on them directly for substantially all of our sales. To increase our revenue, we must increase the number and productivity of our Members. Accordingly, our success depends in significant part on our relationships with our sales leaders and our ability to recruit, retain, and motivate a large base of Members, including through an attractive compensation plan, the quality of our reputation, the maintenance of an attractive product portfolio, the breadth and quality of our Member services, and other incentives. The loss of a significant number of Members, changes to our network marketing program, our inability to respond to Member demand or generate sufficient interest in our business opportunities, products, or services, decreases in Member engagement, loss of Member or consumer confidence, or any legal or regulatory impact to our Members’ ability to conduct their business could negatively impact sales of our products and our ability to attract and retain Members, each of which could have a material adverse effect on our business, financial condition, and operating results. In our efforts to attract and retain Members, we compete with other direct-selling organizations. In addition, our Member organization has a high turnover rate, which is common in the direct-selling industry, in part because our Members, including our sales leaders, may easily enter and exit our network marketing program without facing a significant investment or loss of capital. For example, the upfront financial cost to become a Member is low, we do not have time or exclusivity requirements, we do not charge for any required training, and, in substantially all jurisdictions, we maintain a buyback program. We believe the COVID-19 pandemic could have an adverse impact on the pipeline of new Members and our Member turnover rate, and may impact our future net sales. See the COVID-19 Pandemic and Sales by Geographic Region sections in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, of this Annual Report on Form 10-K for further discussion of the impacts of the COVID-19 pandemic on our business and results of operations. For additional information regarding sales leader retention rates, see Part I, Item 1, Business, of this Annual Report on Form 10-K. Because we cannot exert the same level of influence or control over our Members as we could if they were our employees, our Members could fail to comply with applicable law or our rules and procedures, which could result in claims against us that could materially harm our business, financial condition, and operating results. Our Members are independent contractors and, accordingly, we are not in a position to provide the same direction, motivation, and oversight as we could if Members were our employees. As a result, there can be no assurance that our Members will participate in our marketing strategies or plans, accept our introduction of new products, or comply with applicable legal requirements or our rules and procedures. 21 We are subject to extensive federal, state, local, and foreign laws, rules, and regulations that regulate our business, products, direct sales channel, and network marketing program. See the Regulation section of Part I, Item 1, Business, of this Annual Report on Form 10- K for additional information. While we have implemented policies and procedures designed to govern Member conduct and to protect the goodwill associated with Herbalife Nutrition, it can be difficult to enforce these policies and procedures because of our large number of Members and their status as independent contractors and because our policies and procedures differ by jurisdiction as a result of varying local legal requirements. In addition, although we train our Members and attempt to monitor our Members’ marketing materials, we cannot ensure that our Members will comply with applicable legal requirements or our policies and procedures or that such marketing materials or other Member practices comply with applicable laws, rules, and regulations. It is possible that a court could hold us liable for the actions of our Members, which could materially harm our business, financial condition, and operating results. Adverse publicity associated with our Company or the direct-selling industry could materially harm our business, financial condition, and operating results. Our reputation and the quality of our brand are critical to our business, and the size and success of our Member organization, our operating results, and our share price may be significantly affected by the public’s perception of Herbalife Nutrition and other direct- selling companies. This perception is dependent upon opinions concerning a number of factors, including: • the safety, quality, and efficacy of our products, as well as those of similar companies; • our Members; • our network marketing program or the attractiveness or viability of the financial opportunities it may provide; • the direct-selling business generally; • actual or purported failure by us or our Members to comply with applicable laws, rules, and regulations, including those regarding product claims and advertising, good manufacturing practices, the regulation of our network marketing program, the registration of our products for sale in our target markets, or other aspects of our business; • our commitment to ESG matters and our ESG practices; • the security of our information technology infrastructure; and • actual or alleged impropriety, misconduct, or fraudulent activity by any person formerly or currently associated with our Members or us. Adverse publicity concerning any of the foregoing whether or not accurate or resulting in investigation, enforcement, or other legal or regulatory actions or the imposition of fines, penalties, or other sanctions, could negatively impact our reputation, our ability to attract, motivate, and retain Members, and our ability to generate revenue. In addition, our Members’ and consumers’ perception of Herbalife Nutrition and our direct-selling business as well as similar companies can be significantly influenced by media attention, publicized scientific research or findings, product liability claims, and other publicity, whether or not it is legitimate. For example, as a result of the prevalence and marked increase in the use of blogs, social media platforms, and other forms of Internet-based communications, the opportunity for dissemination of information, both accurate and inaccurate, is seemingly limitless and readily available, and often does not provide any opportunity for correction or other redress. Adverse publicity that associates use of our products or any similar products with adverse effects, questions the quality or benefits of any such products, or claims that any such products are ineffective, inappropriately labeled, or have inaccurate instructions as to their use, could lead to lawsuits or other legal or regulatory challenges and could materially and adversely impact our reputation, the demand for our products, and our business, financial condition, and operating results. Adverse publicity relating to us has had, and could again have, a negative effect on our ability to attract, motivate, and retain Members, on consumer perception of Herbalife Nutrition, and on our share price. For example, the resulting adverse publicity from the 1986 permanent injunction entered in California caused a rapid, substantial loss of Members in the United States and a corresponding reduction in sales beginning in 1985. See also the risk factor titled “Our share price may be adversely affected by third parties who raise allegations about our Company.” We expect that adverse publicity will, from time to time, continue to negatively impact our business in particular markets and may adversely affect our share price. 22 Our failure to compete successfully could materially harm our business, financial condition, and operating results. The business of developing and marketing weight management and other nutrition and personal care products is highly competitive and sensitive to the introduction of new products and weight management plans, including various prescription drugs, which may rapidly capture a significant share of the market. Our competitors include numerous manufacturers; distributors; marketers; online, specialty, mass, and other retailers; and physicians that actively compete for the business of consumers both in the United States and abroad. Some of our competitors have longer operating histories, significantly greater resources, better-developed and more innovative sales and distribution channels and platforms, greater name recognition, and larger established customer bases than we do. Our present and future competitors may be able to offer products at lower prices or better withstand reductions in prices or other adverse economic or market conditions than we can; develop products that are comparable or superior to those we offer; adapt more quickly or effectively to new technologies, changing regulatory requirements, evolving industry trends and standards, and customer requirements than we can; and/or devote greater resources to the development, promotion, and sale of their products than we do. We are also subject to significant competition for the recruitment of Members from other direct-selling organizations, including those that market weight management products, dietary and nutritional supplements, personal care products, and other types of products, as well as those organizations in which former employees or Members are involved. In addition, because the industry in which we operate is not particularly capital intensive or otherwise subject to high barriers to entry, it is relatively easy for new competitors to emerge that will compete with us, including for our Members and their customers. Accordingly, competition may intensify and we may not be able to compete effectively in our markets. If we are not able to retain our Members and their customers or otherwise compete successfully, our business, financial condition, and operating results would be materially adversely affected. Our contractual obligation to sell our products only through our Member network and to refrain from changing certain aspects of our Marketing Plan may limit our growth. We are contractually prohibited from expanding our business by selling Herbalife Nutrition products through other distribution channels that may be available to our competitors, such as over the Internet, through wholesale sales, by establishing retail stores, or through mail order systems. To the extent legally permitted, an agreement we entered into with our Members provides assurances that we will not sell Herbalife Nutrition products worldwide through any distribution channel other than our network of Members. Since this is an open-ended commitment, there can be no assurance that we will be able to take advantage of innovative new distribution channels that are developed in the future or appropriately respond to consumer preferences as they continue to evolve. In addition, this agreement with our Members provides that we will not make any material changes adverse to our Members to certain aspects of our Marketing Plan that may negatively impact our Members without their approval as described in further detail below. For example, our agreement with our Members provides that we may increase, but not decrease, the discount percentages available to our Members for the purchase of products or the applicable royalty override percentages and production and other bonus percentages available to our Members at various qualification levels within our Member hierarchy. We may not modify the eligibility or qualification criteria for these discounts, royalty overrides, and production and other bonuses unless we do so in a manner to make eligibility and/or qualification easier than under the applicable criteria in effect as of the date of the agreement. Our agreement with our Members further provides that we may not vary the criteria for qualification for each Member tier within our Member hierarchy, unless we do so in such a way so as to make qualification easier. We reserved the right to make changes to our Marketing Plan without the consent of our Members in the event that changes are required by applicable law or are necessary in our reasonable business judgment to account for specific local market or currency conditions to achieve a reasonable profit on operations. In addition, we may initiate other changes that are adverse to our Members based on an assessment of what will be best for the Company and its Members. Under the agreement with our Members, these other adverse changes would then be submitted to our Member leadership for a vote. The vote would require the approval of at least 51% of our Members then at the level of President’s Team earning at the production bonus level of 6% who vote, provided that at least 50% of those Members entitled to vote do in fact vote. While we believe this agreement has strengthened our relationship with our existing Members, improved our ability to recruit new Members, and generally increased the long-term stability of our business, there can be no assurance that our agreement with our Members will not restrict our ability to adapt our Marketing Plan or our business to the evolving requirements of the markets in which we operate. As a result, our growth may be limited. 23 Our failure to appropriately respond to changing consumer trends, preferences, and demand for new products and product enhancements could materially harm our Member relationships, Members’ customer relationships, and product sales or otherwise materially harm our business, financial condition, and operating results. Our business is subject to rapidly changing consumer trends and preferences and product introductions, especially with respect to our nutrition products. Our continued success depends in part on our ability to anticipate and respond to these changes and introductions, and we may not respond or develop new products or product enhancements in a cost-effective, timely, or commercially appropriate manner, or at all, particularly while the COVID-19 pandemic persists. Current consumer trends and preferences have evolved and will continue to evolve as a result of, among other things, changes in consumer tastes; health, wellness, and nutrition considerations; competitive product and pricing pressures; changes in consumer preferences for certain sales channels; shifts in demographics; and concerns regarding the environmental and sustainability impact of the product manufacturing process. The success of our response to changing consumer trends and preferences and product introductions, including any new product offerings and enhancements, depends on a number of factors, including our ability to: • accurately anticipate consumer needs; • innovate and develop new products and product enhancements that meet these needs; • successfully commercialize new products and product enhancements; • price our products competitively; • manufacture and deliver our products in sufficient volumes, at our required levels of quality, and in a cost-effective and timely manner; and • differentiate our product offerings from those of our competitors and successfully respond to other competitive pressures, including technological advancements, evolving industry standards, and changing regulatory requirements. Our failure to accurately predict changes in consumer demand and technological advancements could negatively impact consumer opinion of our products or our business, which in turn could harm our Member relationships and the Members’ relationships with their customers, and cause a loss of sales. In addition, if we do not introduce new products or make enhancements to meet the changing needs of our Members and their customers in a cost-effective, timely, and commercially appropriate manner, or if our competitors release new products or product enhancements before we do, some of our product offerings could be rendered obsolete, which could cause our market share to decline and negatively impact our business, financial condition, and operating results. If we fail to further penetrate existing markets, the growth in sales of our products, along with our operating results, could be negatively impacted. The success of our business is to a large extent contingent on our ability to further penetrate existing markets, which is subject to numerous factors, many of which are out of our control. Our ability to increase market penetration may be limited by the finite number of persons in a given country inclined to pursue a direct-selling business opportunity or consumers aware of, or willing to purchase, Herbalife Nutrition products. Moreover, our growth in existing markets will depend upon increased brand awareness and improved training and other activities that enhance Member retention in our markets. While we have recently experienced significant growth in certain of our foreign markets, we cannot assure you that such growth levels will continue in the immediate or long-term future. Furthermore, our efforts to support growth in such foreign markets could be hampered to the extent that our infrastructure in such markets is deficient when compared to our infrastructure in our more developed markets, such as the United States. For example, there can be no assurances that we will be able to successfully manage expansion of manufacturing operations and a growing and dynamic sales force in China. If we are unable to effectively scale our supply chain and manufacturing infrastructure to support future growth in China or other foreign markets, our operations in such markets may be adversely impacted. Therefore, we cannot assure you that our general efforts to increase our market penetration and Member retention in existing markets will be successful. If we are unable to further penetrate existing markets, our business, financial condition, and operating results could materially suffer. Since one of our products constitutes a significant portion of our net sales, significant decreases in consumer demand for this product or our failure to produce a suitable replacement could materially harm our business, financial condition, and operating results. Our Formula 1 Healthy Meal, which is our best-selling product line, approximated 26% of our net sales for the year ended December 31, 2022. If consumer demand for this product decreases significantly or we cease offering this product without a suitable replacement, or if the replacement product fails to gain market acceptance, our business, financial condition, and operating results could be materially harmed. 24 Our business could be materially and adversely affected by natural disasters, other catastrophic events, acts of war or terrorism, cybersecurity incidents, pandemics, and/or other acts by third parties. We depend on the ability of our business to run smoothly, including the ability of Members to engage in their day-to-day selling and business building activities. In coordination with our suppliers, third-party manufacturers, and distributors, our ability to make and move our products reasonably unimpeded around the world is critical to our success. Any material disruption to our collective operations or supply, manufacturing, or distribution capabilities caused by unforeseen or catastrophic events, such as (i) natural disasters or severe weather conditions, including droughts, fires, floods, hurricanes, volcanic eruptions, and earthquakes; (ii) power loss or shortages; (iii) telecommunications or information technology infrastructure failures; (iv) acts or threats of war, terrorism, or other armed hostilities; (v) outbreaks of contagious diseases, epidemics, and pandemics; (vi) cybersecurity incidents, including intentional or inadvertent exposure of content perceived to be sensitive data; (vii) employee misconduct or error; and/or (viii) other actions by third parties and other similar disruptions, could materially adversely affect our ability to conduct business and our Members’ selling activities. For example, our operations in Central America were impacted in November 2020 when Hurricanes Eta and Iota made landfall in the region. The storms disrupted our supply chain transportation network and our ability to import product. In addition, our distribution center in Honduras experienced flooding, which damaged or destroyed product. Furthermore, our headquarters and one of our distribution facilities and manufacturing facilities are located in Southern California, an area susceptible to fires and earthquakes. Although the events in Central America did not have a material negative impact on our operations, we cannot make assurances that any future catastrophic events will not adversely affect our ability to operate our business or our financial condition and operating results. In addition, catastrophic events may result in significant cancellations or cessations of Member orders; contribute to a general decrease in local, regional, or global economic activity; directly impact our marketing, manufacturing, financial, or logistics functions; impair our ability to meet Member demands; harm our reputation; and expose us to significant liability, losses, and legal proceedings, any of which could materially and adversely affect our business, financial condition, and operating results. In March 2020, the World Health Organization declared the COVID-19 outbreak a global pandemic. The COVID-19 pandemic has significantly impacted health and economic conditions globally, disrupted global supply chains, and has adversely affected the Company’s business and that of its Members in certain of the Company’s markets and may continue to impact those markets or others in the future. Government, agency, and other regulatory recommendations, guidelines, mandates, and actions to address public health concerns, including restrictions on movement, public gatherings, and travel and restrictions on, or in certain cases outright prohibitions of, companies’ ability to conduct normal business operations, have and may continue to adversely affect our business. Although we have been classified as an essential business in most jurisdictions where we operate, there is no guarantee that this classification will not change. We may also be forced to or voluntarily elect to limit or cease operations in one or more markets for other reasons, such as the health and safety of our employees or because of disruptions in the operation of our supply chain and sources of supply. For example, it is possible that closures of our manufacturing facilities or those of our third-party contract manufacturers or suppliers could impact our distribution centers and our ability to manufacture and deliver products to our Members. In general, our inventory of products continues to be adequate to meet demand, but we do expect our supply chain and our ability to source and/or manufacture products will be negatively impacted if the negative effects of the pandemic continue for a prolonged period of time or worsen. The pandemic has had an adverse impact on our distribution channels and Members’ product access in some markets, which may, and in some cases will, continue until conditions improve. Our third-party contract manufacturers and suppliers and our Members’ businesses are also subject to many of the same risks and uncertainties related to the COVID-19 pandemic, as well as other pandemic-related risks and uncertainties that may not directly impact our operations, any of which could adversely affect demand for our products. For example, limitations on public gatherings have restricted our Members’ ability to hold meetings with their existing customers and to attract new customers. Significant limitations on cash transactions could also have an adverse effect on sales of products in certain markets. The COVID-19 pandemic has also adversely affected the economies and financial markets of many countries, at times causing a significant deceleration of or interruption to economic activity, which during various stages of the pandemic has reduced production, decreased demand for a broad variety of goods and services, diminished trade levels, and led to widespread corporate downsizing. We have also seen periods of significant disruption of and extreme volatility in the global capital markets, which could increase the cost of, or entirely restrict access to, capital. Further, while some countries have progressed in distributing COVID-19 vaccines to the general population, many countries have limited to no access to vaccines at this time. To the extent the global supply of vaccine remains limited or vaccination rates do not significantly increase, government restrictions in the countries with limited to no access or low vaccination rates may persist or increase and economic activity may remain at depressed levels in those countries or regions. 25 Despite the relaxation of pandemic-related constraints in certain markets, considerable uncertainty still surrounds the COVID-19 pandemic, its potential effects, and the extent and effectiveness of government responses to the pandemic. If the pandemic is not contained, or if new variants emerge or effective vaccines are not made available and utilized quickly enough, the adverse impacts of the COVID-19 pandemic could worsen, impacting all segments of the global economy, and result in a significant recession or worse. However, the unprecedented and sweeping nature of the COVID-19 pandemic makes it extremely difficult to predict how our business and operations will be affected in the long run. Further, the resumption of normal business operations after the disruptions caused by the COVID-19 pandemic may be delayed or constrained by the pandemic’s lingering effects on our Members, consumers, and third- party contract manufacturers and suppliers. Accordingly, our ability to conduct our business in the manner previously done or planned for the future could be materially and adversely affected, and any of the foregoing risks, or other cascading effects of the COVID-19 pandemic, or any other pandemic that may emerge in the future, that are not currently foreseeable, could materially and adversely affect our business, financial condition, and operating results. See the COVID-19 Pandemic and Sales by Geographic Region sections in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, of this Annual Report on Form 10- K for further discussion of the impacts of the COVID-19 pandemic on our business and operating results. We depend on the integrity and reliability of our information technology infrastructure, and any related interruptions or inadequacies may have a material adverse effect on our business, financial condition, and operating results. Our business, including our ability to provide products and services to and manage our Members, depends on the performance and availability of our information technology infrastructure, including our core transactional systems. The most important aspect of our information technology infrastructure is the system through which we record and track Member sales, Volume Points, royalty overrides, bonuses, and other incentives. The failure of our information systems to operate effectively, or a breach in security of these systems, could adversely impact the promptness and accuracy of our product distribution and transaction processing. While we continue to invest in our information technology infrastructure, there can be no assurance that there will not be any significant interruptions to such systems, that the systems will be adequate to meet all of our business needs, or that the systems will keep pace with continuing changes in technology, legal and regulatory standards. Further, as discussed in Part II, Item 7, Management’s Discussion and Analysis of Financial Condition and Results of Operations, we recently commenced a Digital Technology Program to develop a new enhanced platform to provide enhanced digital capabilities and experiences to our Members. Our information technology infrastructure, as well as that of our Members and the other third parties with which we interact, may be damaged, disrupted, or breached or otherwise fail for a number of reasons, including power outages, computer and telecommunication failures, internal design, manual or usage errors, workplace violence or wrongdoing, or catastrophic events such as natural disasters, severe weather conditions, or acts of war or terrorism. In addition, numerous and evolving cybersecurity threats, including advanced and persistent cyberattacks, such as unauthorized attempts to access, disable, improperly modify, exfiltrate, or degrade our information technology infrastructure, or the introduction of computer viruses, malware, “phishing” emails, and other destructive software, and social engineering schemes, could compromise the confidentiality, availability, and integrity of our information technology infrastructure as well as those of the third parties with which we interact. These attacks may come from external sources, such as governments or hackers, or may originate internally from an employee or a third party with which we interact. We have been the target of, and may be the target of in the future, malicious cyberattacks, although to date none of these attacks have had a meaningful adverse impact on our business, financial condition, or operating results. The potential risk of cyberattacks may increase as we introduce new technology systems and services. Additionally, in response to the COVID-19 pandemic, many of our employees have been encouraged to work remotely, which may increase our exposure to significant systems interruptions, cybersecurity attacks, and otherwise compromise the integrity and reliability of our information technology infrastructure and our internal controls. Any disruptions to, or failures or inadequacies of, our information technology infrastructure that we may encounter in the future may result in substantial interruptions to our operations, expose us to significant liability, and may damage our reputation and our relationships with, or cause us to lose, our Members, especially if the disruptions, failures, or inadequacies impair our ability to track sales and pay royalty overrides, bonuses, and other incentives, any of which would harm our business, financial condition, and operating results. Any such disruptions, failures, or inadequacies could also create compliance risks under the Consent Order and result in penalties, fines, or sanctions under any applicable laws or regulations. Furthermore, it may be expensive or difficult to correct or replace any aspect of our information technology infrastructure in a timely manner, if at all, and we may have little or no control over whether any malfunctioning information technology services supplied to us by third parties are appropriately corrected, if at all. We have encountered, and may encounter in the future, errors in our software and our enterprise network, and inadequacies in the software and services supplied by certain of our vendors, although to date none of these errors or inadequacies have had a meaningful adverse impact on our business, financial condition or operating results. In addition, developments in technology are continuing to evolve and affecting all aspects of our business, including how we effectively manage our operations, interact with our Members and their customers, and commercialize opportunities that accompany the evolving digital and data driven economy. Therefore, one of our top priorities is to modernize our technology and data infrastructure by, among other things, creating more relevant and more personalized experiences wherever our systems interact with Members and their customers; and developing ways to create more powerful digital tools and capabilities for Members to enable them to grow their 26 businesses. These initiatives to modernize our technology and data infrastructure are expected to be implemented over the course of many years and to require significant investments. If these initiatives are not successful, our ability to attract and retain Members and their customers, increase sales, and reduce costs may be negatively affected. Further, these initiatives may be subject to cost overruns and delays and may cause disruptions in our operations. These cost overruns and delays and disruptions could adversely impact our business, financial condition, and operating results. Disruption of supply, shortage, or increases in the cost of ingredients, packaging materials, and other raw materials as well as climate change could materially harm our business, financial condition, and operating results. We and our third-party contract manufacturers depend on third-party suppliers to supply us with the various ingredients, packaging materials, and other raw materials that we use in the manufacturing and distribution of our products. Our business could be materially harmed if we experience operational difficulties with our third-party suppliers, such as increases in costs, reductions in the availability of materials or production capacity, errors in complying with specifications or applicable law, insufficient quality control, and failures to meet production or shipment deadlines. If we fail to develop or maintain our relationships with our third-party suppliers or if such suppliers cease doing business with us or go out of business, we could face difficulties in finding or transitioning to alternative suppliers that meet our standards. Many of the ingredients, packaging materials, and other raw materials we use are subject to fluctuations in availability and price due to a number of factors beyond our control, including crop size, ingredient, water, and land scarcity, market demand for raw materials, commodity market speculation, energy costs, currency fluctuations, supplier and logistics service capacities, import and export requirements, tariffs, and other government policies, and drought, excessive rain, temperature extremes, and other severe weather events. If we experience supply shortages, price increases, or supplier or regulatory impediments with respect to any of the materials we use in our products or packaging, we may need to seek alternative supplies or suppliers and may experience difficulties in finding replacements that are comparable in quality and price. For a discussion of the impacts of the COVID-19 pandemic on our supply chain see “If any of our manufacturing facilities or third-party manufacturers fail to reliably supply products to us at required levels of quality or fail to comply with applicable laws, our financial condition and operating results could be materially and adversely impacted” below. Further, the risks related to our ability to adequately source the materials required to meet our needs may be exacerbated by the effects of climate change and the legal, regulatory, or market measures that may be implemented to address climate change. There is growing concern that carbon dioxide and other greenhouse gases in the atmosphere may have an adverse impact on global temperatures, weather patterns, and the frequency and severity of extreme weather and natural disasters. If climate change has a negative effect on agricultural productivity, we may be subject to decreased availability or less favorable pricing for certain raw materials that are necessary for our products, such as soybeans, wheat, tea leaves, and nuts. Severe weather conditions and natural disasters can reduce crop size and crop quality, which in turn could reduce our supplies of raw materials, lower recoveries of usable raw materials, increase the prices of our raw materials, increase our cost of storing and transporting our raw materials, or disrupt production schedules. The impacts of climate change may also cause unpredictable water availability or exacerbate water scarcity. In addition, the increasing concern over climate change and related sustainability matters may also result in more federal, state, local, and foreign legal and regulatory requirements relating to climate change, which may significantly increase our costs of operation and delivery. 27",Unknown,Effect Analysis,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",Briefly summarize the Ed Sheeran case in no more than 3 bullets and then identify at least 3 other cases mentioned in the article and describe their differences to the Ed Sheeran case in no more than 2 bullets each.,"The Case Between Two Top Hits On May 4, 2023, jurors in a Manhattan federal court sided with pop-star Ed Sheeran in a copyright infringement dispute over his Grammy-winning song “Thinking Out Loud.” The daughter of co-writer Ed Townsend of Marvin Gaye’s classic hit “Let’s Get It On” filed the lawsuit a few years ago. The controversial, closely watched trial saw Sheeran label testimony given by the plaintiff’s musicologist expert witness as “criminal.” He also testified he would “quit music” if he lost this trial. Townsend’s daughter alleged Sheeran used the chords, rhythm, and melody from her father’s hit song. Here, the plaintiff had a high burden to satisfy. While Sheeran argued that the chord progression and rhythmic pattern was generic and not protected by copyright, Townsend’s daughter disagreed. The plaintiff failed to prove the combination of those elements, how they were selected and arranged in the music, was original enough to warrant copyright protection. This is not the first case Sheeran has won regarding infringement. The pop star previously won a lawsuit alleging he infringed on a 2015 song called “Oh Why” by Sami Chokri, another U.K. artist. Chokri’s lawsuit alleged Sheeran copied his song by repeating “Oh, I” in the refrain of “Shape of You,” similar to Chokri’s song. While Sheeran might have prevailed this past week, there is still ongoing litigation brought by Structured Asset Sales (“SAS”), which owns a portion of the Townsend family rights to the same song. However, Sheeran’s legal counsel believes that litigation should be resolved due to the outcome of the Townsend family case. Others have stated that SAS are copyright “trolls,” as they are an entity that purchases copyrights for purely for financial gain. The Status of Copyright Law in Pop Music Copyright infringement has been a hot topic in the pop music industry. As a musical genre that has limited chord progressions and rhythm, artists argue there are going to be very similar songs out there that cannot be prevented. The Copyright Act passed by Congress provides nothing to help solve the question of “how similar is too similar” to determine a song infringed on another. The courts have been trying to answer this question, developing the rules on how to handle these matters. As such, litigation has picked up, with it impossible to avoid going to trial by early dismissal or summary judgment. Recently, Robin Thicke and Pharrell Williams were found to have infringed on another Gaye hit song, “Got to Give it Up” in 2015 on their hit song, “Blurred Lines.” The pair were ordered to pay over $5 million in damages. The judgment brought an uneasiness to the music world, as many criticized the jury verdict and the Ninth Circuit’s decision, arguing the harmonies and rhythmic patterns were basic building blocks that were free for any musician to use. However, Led Zeppelin was able to fight off a similar infringement case based on the chords and rhythm for their song “Stairway to Heaven,” with a ruling passed down by the Ninth Circuit stating some elements of creative works were so common, an infringement claim needed to be based on “virtually identical” versions. These opposing verdicts made the case against Sheeran high stakes for those in the music industry, watching if the verdict would bring some stability to songwriting or further disrupt the longstanding idea that basic genre elements were fair game for songwriters. However, those who are in support of a looser threshold argue that the songwriter and artist need to be protected. Townsend’s daughter here argued that Sheeran stole the “musical heart” of her father’s work and that artists should be given credit when proper. Supporters of Townsend argue that properly crediting the artists who came before does not stifle creativity. The Potential for Change and the Implications of Sheeran’s Win Overall, some argue that the current copyright law must be changed to avoid high amounts of litigation. A law scholar from UC Berkeley, Peter Menell, suggests a system that would mimic the current system that allows artists to record their own versions of existing music, as long as they pay a licensing fee in advance to the original composer. This is the concept of recording covers of songs. The suggested system would introduce mechanical remix royalties, allowing artists to license their compositions to others. This would allow the purchaser of the license to change aspects of the song to make it their own. Menell argues this would create clarity in the intellectual property landscape and reduce the workload of the courts. However, those who side with Sheeran might argue that a licensing aspect to “remix” a song is not necessary when it comes to the basic structure of a songwriting, and it ultimately prohibits creativity. Jennifer Jenkins, a Duke Law professor who specializes in music copyright, argued that privatizing common chord progressions and elements that were commonplace would remove the “essential ingredients from every songwriter’s tool kit.” In a way, this prevents the starving artist from creating if they cannot afford a license to a common chord progression. However, for right now, songwriters should believe the outcome of the Sheeran case is a step in the right direction.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Briefly summarize the Ed Sheeran case in no more than 3 bullets and then identify at least 3 other cases mentioned in the article and describe their differences to the Ed Sheeran case in no more than 2 bullets each. The Case Between Two Top Hits On May 4, 2023, jurors in a Manhattan federal court sided with pop-star Ed Sheeran in a copyright infringement dispute over his Grammy-winning song “Thinking Out Loud.” The daughter of co-writer Ed Townsend of Marvin Gaye’s classic hit “Let’s Get It On” filed the lawsuit a few years ago. The controversial, closely watched trial saw Sheeran label testimony given by the plaintiff’s musicologist expert witness as “criminal.” He also testified he would “quit music” if he lost this trial. Townsend’s daughter alleged Sheeran used the chords, rhythm, and melody from her father’s hit song. Here, the plaintiff had a high burden to satisfy. While Sheeran argued that the chord progression and rhythmic pattern was generic and not protected by copyright, Townsend’s daughter disagreed. The plaintiff failed to prove the combination of those elements, how they were selected and arranged in the music, was original enough to warrant copyright protection. This is not the first case Sheeran has won regarding infringement. The pop star previously won a lawsuit alleging he infringed on a 2015 song called “Oh Why” by Sami Chokri, another U.K. artist. Chokri’s lawsuit alleged Sheeran copied his song by repeating “Oh, I” in the refrain of “Shape of You,” similar to Chokri’s song. While Sheeran might have prevailed this past week, there is still ongoing litigation brought by Structured Asset Sales (“SAS”), which owns a portion of the Townsend family rights to the same song. However, Sheeran’s legal counsel believes that litigation should be resolved due to the outcome of the Townsend family case. Others have stated that SAS are copyright “trolls,” as they are an entity that purchases copyrights for purely for financial gain. The Status of Copyright Law in Pop Music Copyright infringement has been a hot topic in the pop music industry. As a musical genre that has limited chord progressions and rhythm, artists argue there are going to be very similar songs out there that cannot be prevented. The Copyright Act passed by Congress provides nothing to help solve the question of “how similar is too similar” to determine a song infringed on another. The courts have been trying to answer this question, developing the rules on how to handle these matters. As such, litigation has picked up, with it impossible to avoid going to trial by early dismissal or summary judgment. Recently, Robin Thicke and Pharrell Williams were found to have infringed on another Gaye hit song, “Got to Give it Up” in 2015 on their hit song, “Blurred Lines.” The pair were ordered to pay over $5 million in damages. The judgment brought an uneasiness to the music world, as many criticized the jury verdict and the Ninth Circuit’s decision, arguing the harmonies and rhythmic patterns were basic building blocks that were free for any musician to use. However, Led Zeppelin was able to fight off a similar infringement case based on the chords and rhythm for their song “Stairway to Heaven,” with a ruling passed down by the Ninth Circuit stating some elements of creative works were so common, an infringement claim needed to be based on “virtually identical” versions. These opposing verdicts made the case against Sheeran high stakes for those in the music industry, watching if the verdict would bring some stability to songwriting or further disrupt the longstanding idea that basic genre elements were fair game for songwriters. However, those who are in support of a looser threshold argue that the songwriter and artist need to be protected. Townsend’s daughter here argued that Sheeran stole the “musical heart” of her father’s work and that artists should be given credit when proper. Supporters of Townsend argue that properly crediting the artists who came before does not stifle creativity. The Potential for Change and the Implications of Sheeran’s Win Overall, some argue that the current copyright law must be changed to avoid high amounts of litigation. A law scholar from UC Berkeley, Peter Menell, suggests a system that would mimic the current system that allows artists to record their own versions of existing music, as long as they pay a licensing fee in advance to the original composer. This is the concept of recording covers of songs. The suggested system would introduce mechanical remix royalties, allowing artists to license their compositions to others. This would allow the purchaser of the license to change aspects of the song to make it their own. Menell argues this would create clarity in the intellectual property landscape and reduce the workload of the courts. However, those who side with Sheeran might argue that a licensing aspect to “remix” a song is not necessary when it comes to the basic structure of a songwriting, and it ultimately prohibits creativity. Jennifer Jenkins, a Duke Law professor who specializes in music copyright, argued that privatizing common chord progressions and elements that were commonplace would remove the “essential ingredients from every songwriter’s tool kit.” In a way, this prevents the starving artist from creating if they cannot afford a license to a common chord progression. However, for right now, songwriters should believe the outcome of the Sheeran case is a step in the right direction. https://lawreview.syr.edu/stealing-the-heart-of-the-musical-work-sheerans-win-doesnt-necessarily-ease-songwriters-anxieties/",Legal,Summarize & Format,Text Transformation You are given a reference document. You must only use information found in the reference document to answer the question asked.,"What are the six ""recession-proof"" careers?","Top 6 Recession-Proof Careers By Team Stash Here are six examples of jobs that are likely to survive a financial slump. While no career is completely recession proof, plenty of jobs withstand economic downturns well. In fact, people with jobs in healthcare, education, and technical fields often thrive during recessions. Here are six examples of jobs that are likely to survive a financial slump. They’re also unlikely to succumb to automation anytime soon. Learn more >> How to prepare for a recession Mental Health Counselors Counselors and psychologists are often in higher demand during recessions than when the economy is humming. Job loss, or the fear of it, induces financial stress which can negatively impact all areas of a person’s life. Counselors help people learn to cope. Demand for marriage and family therapists also increases during recessions since divorce rates tend to spike during periods of economic uncertainty. Mental health counselors need a post-graduate degree and have a median income of about $44,000 a year. Dental Hygienists People require dental care in every type of economic situation, making the dental field virtually recession proof. Dental hygienists educate patients, clean teeth, and provide assistance during complex procedures. They often have more interaction with patients than dentists do. Dental hygienists need a two-year degree and have a median income of about $73,000 a year. Software Developers Demand for talented software developers is soaring and shows no signs of slowing down, even during times of economic duress. Companies are racing to take advantage of big data and are always looking to improve their mobile presence. App development is still huge, and developers that stay current have a wide range of career options available to them. Software developers have a median income of about $102,000 a year. Educators People need education regardless of the way the economy is performing. In fact, many people head back to school during recessions to shore up their skills or learn new ones, and there’s always a need for preschool, elementary, and secondary teachers. Educators need a bachelor’s degree or higher. High school teachers have a median income of about $58,000 a year, and elementary teachers have a median income of about $55,000 a year. Postsecondary educators have a median income of about $75,000 a year. Information Technology Staff IT professionals are always in high demand. In fact, demand is so high that even if your employer reduces its IT workforce during a recession, it’s likely other companies will expand theirs. While outsourcing is a valid concern for workers in the field, enough jobs must remain on site to make it a great career choice. Network and database administration are two strong areas within the larger IT arena. IT professionals need a bachelor’s degree or higher, although some companies will waive this requirement for employees with the right technical skills. They have a median income of about $82,000 a year. Sales Representatives Sales departments have such an enormous impact on a company’s gross income that employers tend to expand them during recessions. Since sales reps are such an integral part of a company’s success, especially during times of slow or negative economic growth, high-performers can expect significant job security. Many sales reps work on a commission basis; if a sales rep doesn’t produce, his income shrinks. This makes it relatively safe for companies to hire and retain them during recessions. Sales reps in non-technical positions often only need a high school diploma. Reps in technical and scientific areas need a bachelor’s degree or higher in a field related to the products they sell. Pay varies widely according to field and experience, but they have a median income of about $60,000 a year. Finding a recession-proof job that pays well and you enjoy is often challenging, but can be done. Plenty of great options exist. All you have to do is choose one and obtain the necessary skills and education. ","You are given a reference document. You must only use information found in the reference document to answer the question asked. What are the six ""recession-proof"" careers? Top 6 Recession-Proof Careers By Team Stash Here are six examples of jobs that are likely to survive a financial slump. While no career is completely recession proof, plenty of jobs withstand economic downturns well. In fact, people with jobs in healthcare, education, and technical fields often thrive during recessions. Here are six examples of jobs that are likely to survive a financial slump. They’re also unlikely to succumb to automation anytime soon. Learn more >> How to prepare for a recession Mental Health Counselors Counselors and psychologists are often in higher demand during recessions than when the economy is humming. Job loss, or the fear of it, induces financial stress which can negatively impact all areas of a person’s life. Counselors help people learn to cope. Demand for marriage and family therapists also increases during recessions since divorce rates tend to spike during periods of economic uncertainty. Mental health counselors need a post-graduate degree and have a median income of about $44,000 a year. Dental Hygienists People require dental care in every type of economic situation, making the dental field virtually recession proof. Dental hygienists educate patients, clean teeth, and provide assistance during complex procedures. They often have more interaction with patients than dentists do. Dental hygienists need a two-year degree and have a median income of about $73,000 a year. Software Developers Demand for talented software developers is soaring and shows no signs of slowing down, even during times of economic duress. Companies are racing to take advantage of big data and are always looking to improve their mobile presence. App development is still huge, and developers that stay current have a wide range of career options available to them. Software developers have a median income of about $102,000 a year. Educators People need education regardless of the way the economy is performing. In fact, many people head back to school during recessions to shore up their skills or learn new ones, and there’s always a need for preschool, elementary, and secondary teachers. Educators need a bachelor’s degree or higher. High school teachers have a median income of about $58,000 a year, and elementary teachers have a median income of about $55,000 a year. Postsecondary educators have a median income of about $75,000 a year. Information Technology Staff IT professionals are always in high demand. In fact, demand is so high that even if your employer reduces its IT workforce during a recession, it’s likely other companies will expand theirs. While outsourcing is a valid concern for workers in the field, enough jobs must remain on site to make it a great career choice. Network and database administration are two strong areas within the larger IT arena. IT professionals need a bachelor’s degree or higher, although some companies will waive this requirement for employees with the right technical skills. They have a median income of about $82,000 a year. Sales Representatives Sales departments have such an enormous impact on a company’s gross income that employers tend to expand them during recessions. Since sales reps are such an integral part of a company’s success, especially during times of slow or negative economic growth, high-performers can expect significant job security. Many sales reps work on a commission basis; if a sales rep doesn’t produce, his income shrinks. This makes it relatively safe for companies to hire and retain them during recessions. Sales reps in non-technical positions often only need a high school diploma. Reps in technical and scientific areas need a bachelor’s degree or higher in a field related to the products they sell. Pay varies widely according to field and experience, but they have a median income of about $60,000 a year. Finding a recession-proof job that pays well and you enjoy is often challenging, but can be done. Plenty of great options exist. All you have to do is choose one and obtain the necessary skills and education. ",Financial,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","How are smart devices able to spy on people's browsing history, financial transactions, and even health issues? Some apps can bypass security by just tapping into the wifi. how does that work? What do you think about the fact that once a device is connected it can control all of the other devices without consent?","cepro.com New Research Uncovers Litany of Privacy/Security Issues in Consumer IoT Devices Zachary Comeau 5–6 minutes An international team of researchers has unveiled findings on the widespread security and privacy challenges posed by IoT devices in smart homes, delving into the intricacies of local network interactions between 93 different IoT devices and mobile apps. The paper, titled In the Room Where It Happens: Characterizing Local Communication and Threats in Smart Homes, reveals a litany of previously undisclosed security and privacy threats. The research team included researchers from the New York Tandon School of Engineering, Northeastern University, University of Madrid, University of Calgary, the International Computer Science Institute and IMDEA Networks. The research was presented last month at the ACM Internet Measurement Conference last month in Montreal. Researchers narrow in on the local network and how IoT devices can inadvertently compromise consumer privacy through the exposure of sensitive data within those local networks using standard protocols such as UPnP or mDNS. Researchers say this essentially allows nearly any company to learn what devices are in a home, when the user is home, and where the home is. According to the paper, these threats include the exposure of unique device names, UUIDs, and even household geolocation data, all of which can be harvested by companies involved in surveillance capitalism without user awareness. NYU Tandon, quoting PhD student and research co-author Vijay Prakash, says in a writeup that researchers found evidence of IoT devices inadvertently compromising consumer privacy by exposing at least one personally identifiable information, such as unique hardware addresses, UUID, or unique device names, in thousands of existing smart homes. That information can be pieced together to make a house very identifiable, researchers say. The devices included in the research include 93 consumer IP-based smart home devices, as well as their companion apps. Devices included in the study were smart doorbells, smart bulbs, smart thermostats, smart TVs, smart plugs, smart speakers, smart sensors and smart home hubs. Specifically, most of the devices tested are widely available online or in stores, including Amazon Echo devices, Google Nest products, Apple TVs, and more. These local network protocols can be employed as side-channels to access data that is supposedly protected by several mobile app permissions such as household locations, researchers say. Narseo Vallina-Rodriguez, Associate Research Professor of IMDEA Networks and co-founder of AppCensus, says in a statement that side channels are a sneaky way of indirectly accessing sensitive data. “For example, Android app developers are supposed to request and obtain users’ consent to access data like geolocation,” Vallina-Rodriguez says. “However, we have shown that certain spyware apps and advertising companies do abuse local network protocols to silently access such sensitive information without any user awareness. All they have to do is kindly ask for it to other IoT devices deployed in the local network using standard protocols like UPnP.” In addition, Juan Tapiador, professor at Universidad Carlos III de Madrid, says the study shows that local network protocols used by IoT devices are not sufficiently protected and expose sensitive information about the home and the homeowners’ use of the devices. “This information is being collected in an opaque way and makes it easier to create profiles of our habits or socioeconomic level,” Tapiador says. In other comments, Dr. Joel Reardon, PhD, associate professor of computer science at the University of Calgary, says the research shows the home network is not as secure as once thought. “If a new phone connects to a network, then all the apps on it can have direct access to everything else on that network,” Reardon says. “The spyware I found in apps with tens of millions of installs was in fact scanning networks and talking to routers.” The research follows multiple separate cybersecurity threats-related to IoT devices uncovered this month. Towards the middle of the month, the Electronic Frontier Foundation nonprofit put out a call to action for the FTC to block the sales of Android TV boxes potentially infected with botnet malware. Researchers around this time also published a report in FCC filings for the Cyber Trust Mark proceedings warning of ultrasonic commands that could potentially be used to activate and control voice assistants. If you enjoyed this article and want to receive more valuable industry content like this, click here to sign up for our digital newsletters!","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. How are smart devices able to spy on people's browsing history, financial transactions, and even health issues? Some apps can bypass security by just tapping into the wifi. how does that work? What do you think about the fact that once a device is connected it can control all of the other devices without consent? cepro.com New Research Uncovers Litany of Privacy/Security Issues in Consumer IoT Devices Zachary Comeau 5–6 minutes An international team of researchers has unveiled findings on the widespread security and privacy challenges posed by IoT devices in smart homes, delving into the intricacies of local network interactions between 93 different IoT devices and mobile apps. The paper, titled In the Room Where It Happens: Characterizing Local Communication and Threats in Smart Homes, reveals a litany of previously undisclosed security and privacy threats. The research team included researchers from the New York Tandon School of Engineering, Northeastern University, University of Madrid, University of Calgary, the International Computer Science Institute and IMDEA Networks. The research was presented last month at the ACM Internet Measurement Conference last month in Montreal. Researchers narrow in on the local network and how IoT devices can inadvertently compromise consumer privacy through the exposure of sensitive data within those local networks using standard protocols such as UPnP or mDNS. Researchers say this essentially allows nearly any company to learn what devices are in a home, when the user is home, and where the home is. According to the paper, these threats include the exposure of unique device names, UUIDs, and even household geolocation data, all of which can be harvested by companies involved in surveillance capitalism without user awareness. NYU Tandon, quoting PhD student and research co-author Vijay Prakash, says in a writeup that researchers found evidence of IoT devices inadvertently compromising consumer privacy by exposing at least one personally identifiable information, such as unique hardware addresses, UUID, or unique device names, in thousands of existing smart homes. That information can be pieced together to make a house very identifiable, researchers say. The devices included in the research include 93 consumer IP-based smart home devices, as well as their companion apps. Devices included in the study were smart doorbells, smart bulbs, smart thermostats, smart TVs, smart plugs, smart speakers, smart sensors and smart home hubs. Specifically, most of the devices tested are widely available online or in stores, including Amazon Echo devices, Google Nest products, Apple TVs, and more. These local network protocols can be employed as side-channels to access data that is supposedly protected by several mobile app permissions such as household locations, researchers say. Narseo Vallina-Rodriguez, Associate Research Professor of IMDEA Networks and co-founder of AppCensus, says in a statement that side channels are a sneaky way of indirectly accessing sensitive data. “For example, Android app developers are supposed to request and obtain users’ consent to access data like geolocation,” Vallina-Rodriguez says. “However, we have shown that certain spyware apps and advertising companies do abuse local network protocols to silently access such sensitive information without any user awareness. All they have to do is kindly ask for it to other IoT devices deployed in the local network using standard protocols like UPnP.” In addition, Juan Tapiador, professor at Universidad Carlos III de Madrid, says the study shows that local network protocols used by IoT devices are not sufficiently protected and expose sensitive information about the home and the homeowners’ use of the devices. “This information is being collected in an opaque way and makes it easier to create profiles of our habits or socioeconomic level,” Tapiador says. In other comments, Dr. Joel Reardon, PhD, associate professor of computer science at the University of Calgary, says the research shows the home network is not as secure as once thought. “If a new phone connects to a network, then all the apps on it can have direct access to everything else on that network,” Reardon says. “The spyware I found in apps with tens of millions of installs was in fact scanning networks and talking to routers.” The research follows multiple separate cybersecurity threats-related to IoT devices uncovered this month. Towards the middle of the month, the Electronic Frontier Foundation nonprofit put out a call to action for the FTC to block the sales of Android TV boxes potentially infected with botnet malware. Researchers around this time also published a report in FCC filings for the Cyber Trust Mark proceedings warning of ultrasonic commands that could potentially be used to activate and control voice assistants. If you enjoyed this article and want to receive more valuable industry content like this, click here to sign up for our digital newsletters! https://www.cepro.com/networking/new-research-uncovers-litany-of-privacy-security-issues-in-consumer-iot-devices/",Internet/Technology,Fact Finding,Q&A "System Instruction: Use only the following information labeled ""Context"". Do not use any other source of information other than what is provided below. ",Question: According to the Judgement of Myers v. United States is the President legally allowed to remove executive officers of the United States whom he has appointed by and with the advice and consent of the Senate from office? ,"Context: The State Supreme Court’s inclusion of vote counts based on these variant standards exemplifies concerns with the remedial processes that were under way … In addition to these difficulties the actual process by which the votes were to be counted under the Florida Supreme Court’s decision raises further concerns. That order did not specify who would recount the ballots. The county can- vassing boards were forced to pull together ad hoc teams of judges from various Circuits who had no previous training in handling and interpreting ballots. Furthermore, while others were permitted to observe, they were prohibited from objecting during the recount. The recount process, in its features here described, is inconsistent with the minimum procedures necessary to protect the fundamental right of each voter in the special instance of a statewide recount under the authority of a single state judicial officer. Our consideration is limited to the present circumstances, for the problem of equal protection in election processes generally presents many complexities. The question before the Court is not whether local entities, in the exercise of their expertise, may develop different sys- tems for implementing elections. Instead, we are presented with a situation where a state court with the power to assure uniformity has ordered a statewide recount with minimal procedural safeguards. When a court orders a statewide rem- edy, there must be at least some assurance that the rudimentary requirements of equal treatment and fundamental fair- ness are satisfied … Upon due consideration of the difficulties identified to this point, it is obvious that the recount cannot be conducted in compliance with the requirements of equal protection and due process without substantial additional work. It would require not only the adoption (after opportunity for argument) of adequate statewide standards for determining what is a legal vote, and practicable procedures to implement them, but also orderly judicial review of any disputed matters that might arise. In addition, the Secretary has advised that the recount of only a portion of the ballots requires that the vote tabulation equipment be used to screen out undervotes, a function for which the machines were not designed. If a recount of overvotes were also required, perhaps even a second screening would be necessary. Use of the equipment for this purpose, and any new software developed for it, would have to be evaluated for accuracy by the Secretary … Because it is evident that any recount seeking to meet the December 12 date will be unconstitutional for the reasons we have discussed, we reverse the judgment of the Supreme Court of Florida ordering a recount to proceed … None are more conscious of the vital limits on judicial authority than are the Members of this Court, and none stand more in admiration of the Constitution’s design to leave the selection of the President to the people, through their leg- islatures, and to the political sphere. When contending parties invoke the process of the courts, however, it becomes our unsought responsibility to resolve the federal and constitutional issues the judicial system has been forced to confront. The judgment of the Supreme Court of Florida is reversed, and the case is remanded for further proceedings not incon- sistent with this opinion. It is so ordered. STRUCTURE OF THE PRESIDENCY | 60 Excerpted by Alexandria Metzdorf § 61 | STRUCTURE OF THE PRESIDENCY Appointment and Removal Powers Myers v. United States 272 U.S. 52 (1926) Decision: Affirmed Vote: 6-3 Majority: Taft, joined by Van Devanter, Sutherland, Butler, Sanford, Stone Dissent: Holmes Dissent: McReynolds Dissent: Brandeis MR. CHIEF JUSTICE TAFT delivered the opinion of the Court. This case presents the question whether, under the Constitution, the President has the exclusive power of removing exec- utive officers of the United States whom he has appointed by and with the advice and consent of the Senate. Myers … was, on July 21, 1917, appointed by the President, by and with the advice and consent of the Senate, to be a postmaster of the first class at Portland, Oregon, for a term of four years. On January 20, 1920, Myers’ resignation was demanded. He refused the demand. On February 2, 1920, he was removed from office by order of the Postmaster Gen- eral, acting by direction of the President. February 10th, Myers sent a petition to the President and another to the Sen- ate Committee on Post Offices, asking to be heard if any charges were filed. He protested to the Department against his removal, and continued to do so until the end of his term. He pursued no other occupation, and drew compensation for no other service during the interval. On April 21, 1921, he brought this suit in the Court of Claims for his salary from the date of his removal, which, as claimed by supplemental petition filed after July 21, 1921, the end of his term, amounted to $8,838.71 … [By the law] under which Myers was appointed with the advice and consent of the Senate as a first-class postmaster, it is provided that “Postmasters of the first, second and third classes shall be appointed and may be removed by the President by and with the advice and consent of the Senate and shall hold their offices for four years unless sooner removed or suspended accord- ing to law.” The Senate did not consent to the President’s removal of Myers during his term. If this statute, in its requirement that his term should be four years unless sooner removed by the President by and with the consent of the Senate, is valid, the appellant, Myers’ administratrix, is entitled to recover his unpaid salary for his full term, and the judgment of the Court of Claims must be reversed. The Government maintains that the requirement is invalid for the reason that, under Article APPOINTMENT AND REMOVAL POWERS | 62 II of the Constitution the President’s power of removal of executive officers appointed by him with the advice and con- sent of the Senate is full and complete without consent of the Senate … We are therefore confronted by the constitutional question, and cannot avoid it … The question where the power of removal of executive officers appointed by the President by and with the advice and consent of the Senate was vested was presented early in the first session of the First Congress. There is no express pro- vision respecting removals in the Constitution, except as Section 4 of Article II … provides for removal from office by impeachment … It was pointed out in this great debate [constitutional convention] that the power of removal, though equally essential to the executive power is different in its nature from that of appointment. Madison, 1 Annals of Congress, 497 et seq.; Cly- mer, 1 Annals, 489; Sedgwick, 1 Annals, 522; Ames, 1 Annals, 541, 542; Hartley, 1 Annals, 481. A veto by the Senate-a part of the legislative branch of the government-upon removals is a much greater limitation upon the executive branch, and a much more serious blending of the legislative with the executive, than a rejection of a proposed appointment. It is not to be implied. The rejection of a nominee of the President for a particular office does not greatly embarrass him in the conscientious discharge of his high duties in the selection of those who are to aid him, because the President usually has an ample field from which to select for office, according to his preference, competent and capable men. The Senate has full power to reject newly proposed appointees whenever the President shall remove the incumbents. Such a check enables the Senate to prevent the filling of offices with bad or incompetent men, or with those against whom there is ten- able objection. The power to prevent the removal of an officer who has served under the President is different from the authority to con- sent to or reject his appointment. When a nomination is made, it may be presumed that the Senate is, or may become, as well advised as to the fitness of the nominee as the President, but in the nature of things the defects in ability or intel- ligence or loyalty in the administration of the laws of one who has served as an officer under the President are facts as to which the President, or his trusted subordinates, must be better informed than the Senate, and the power to remove him may therefor be regarded as confined for very sound and practical reasons, to the governmental authority which has administrative control. The power of removal is incident to the power of appointment, not to the power of advising and consenting to appointment, and when the grant of the executive power is enforced by the express mandate to take care that the laws be faithfully executed, it emphasizes the necessity for including within the executive power as conferred the exclusive power of removal. … The vesting of the executive power in the President was essentially a grant of the power to execute the laws. But the Pres- ident, alone and unaided, could not execute the laws. He must execute them by the assistance of subordinates. This view has since been repeatedly affirmed by this Court. Wilcox v. Jackson (1839) … It was urged that the natural meaning of the term “executive power” granted the President included the appointment and removal of executive subordinates. If such appointments and removals were not an exercise of the executive power, what were they? They certainly were not the exercise of legislative or judicial power in government as usually understood … It is true that the remedy for the evil of political executive removals of inferior offices is with Congress by a simple expedi- ent, but it includes a change of the power of appointment from the President with the consent of the Senate. Congress 63 | APPOINTMENT AND REMOVAL POWERS must determine first that the office is inferior, and second that it is willing that the office shall be filled by appoint- ment by some other authority than the President with the consent of the Senate. That the latter may be an important consideration is manifest, and is the subject of comment by this Court in its opinion in the case of Shurtleff v. United States, (1903), where this Court said: “To take away this power of removal in relation to an inferior office created by statute, although that statute provided for an appointment thereto by the President and confirmation by the Senate, would require very clear and explicit language. It should not be held to be taken away by mere inference or implication … ” [P]ostmasters were all by law appointed by the Postmaster General. This was because Congress … so provided. But there- after, Congress required certain classes of them to be, as they now are, appointed by the President with the consent of the Senate. This is an indication that Congress deemed appointment by the President with the consent of the Senate essential to the public welfare, and, until it is willing to vest their appointment in the head of the Department, they will be subject to removal by the President alone, and any legislation to the contrary must fall as in conflict with the Consti- tution. Summing up, then, the facts as to acquiescence by all branches of the Government in the legislative decision of 1789, as to executive officers, whether superior or inferior, we find that from 1789 until 1863, a period of 74 years, there was no act of Congress, no executive act, and no decision of this Court at variance with the declaration of the First Congress, but there was, as we have seen, clear, affirmative recognition of it by each branch of the Government. Article II grants to the President … the general administrative control of those executing the laws, including the power of appointment and removal of executive officers … the President’s power of removal is further established as an incident to his specifically enumerated function of appointment by and with the advice of the Senate, but that such incident does not, by implication, extend to removals the Senate’s power of checking appointments, and … to hold otherwise would make it impossible for the President, in case of political or other differences with the Senate or Congress, to take care that the laws be faithfully executed … While this Court has studiously avoided deciding the issue until it was presented in such a way that it could not be avoided, in the references it has made to the history of the question, and in the presumptions it has indulged in favor of a statutory construction not inconsistent with the legislative decision of 1789, it has indicated a trend of view that we should not and cannot ignore. When, on the merits, we find our conclusion strongly favoring the view which prevailed in the First Congress, we have no hesitation in holding that conclusion to be correct, and it therefore follows that the Tenure of Office Act of 1867, insofar as it attempted to prevent the President from removing executive officer who had been appointed by him by and with the advice and consent of the Senate, was invalid, and that subsequent legislation of the same effect was equally so. For the reasons given, we must therefore hold that the provision of the law of 1876, by which the unrestricted power of removal of first class postmasters is denied to the President, is in violation of the Constitution, and invalid. This leads to an affirmance of the judgment of the Court of Claims. Judgment affirmed. APPOINTMENT AND REMOVAL POWERS | 64 Excerpted by Alexandria Metzdorf § Humphrey’s Executor v. United States 295 U.S. 602 (1935) Decision: Affirmed Vote: 9-0 Majority: Sutherland, joined by Hughes, Van Devanter, McReynolds, Brandeis, Butler, Stone, Roberts, and Cardozo Mr. Justice SUTHERLAND delivered the opinion of the Court. Plaintiff brought suit in the Court of Claims against the United States to recover a sum of money alleged to be due the deceased for salary as a Federal Trade Commissioner from October 8, 1933, when the President undertook to remove him from office, to the time of his death on February 14, 1934. The court below has certified to this court two questions … in respect of the power of the President to make the removal. The material facts which give rise to the questions are as follows: William E. Humphrey, the decedent, on December 10, 1931, was nominated by President Hoover to succeed himself as a member of the Federal Trade Commission, and was confirmed by the United States Senate. He was duly commissioned for a term of seven years, expiring September 25, 1938; and, after taking the required oath of office, entered upon his duties. On July 25, 1933, President Roosevelt addressed a letter to the commissioner asking for his resignation, on the ground ‘that the aims and purposes of the Administration with respect to the work of the Commission can be carried out most effectively with personnel of my own selection,’ but disclaiming any reflection upon the commissioner personally or upon his services. The commissioner replied, asking time to consult his friends. After some further correspondence upon the subject, the President on August 31, 1933, wrote the commissioner expressing the hope that the resignation would be forthcoming, and saying: ‘You will, I know, realize that I do not feel that your mind and my mind go along together on either the policies or the administering of the Federal Trade Commission, and, frankly, I think it is best for the people of this country that I should have a full confidence.’ The commissioner declined to resign; and on October 7, 1933, the President wrote him: ‘Effective as of this date you are hereby removed from the office of Commissioner of the Federal Trade Commission.’ Humphrey never acquiesced in this action, but continued thereafter to insist that he was still a member of the commis- sion, entitled to perform its duties and receive the compensation provided by law at the rate of $10,000 per annum. Upon these and other facts set forth in the certificate, which we deem it unnecessary to recite, the following questions are certi- fied: 1. Do the provisions of section 1 of the Federal Trade Commission Act, stating that ‘any commissioner may be removed by the President for inefficiency, neglect of duty, or malfeasance in office’, restrict or limit the power of 65 | APPOINTMENT AND REMOVAL POWERS the President to remove a commissioner except upon one or more of the causes named? If the foregoing question is answered in the affirmative, then— 2. If the power of the President to remove a commissioner is restricted or limited as shown by the foregoing inter- rogatory and the answer made thereto, is such a restriction or limitation valid under the Constitution of the United States?’ The Federal Trade Commission Act … creates a commission of five members to be appointed by the President by and with the advice and consent of the Senate, and section 1 provides: ‘Not more than three of the commissioners shall be members of the same political party. … ‘ [The Act] in part provides that: ‘Unfair methods of competition in commerce are declared unlawful. The commission is empowered and directed to prevent persons, partnerships, or corporations, except banks, and com- mon carriers subject to the Acts to regulate commerce, from using unfair methods of competition in commerce … ‘ First. The question first to be considered is whether, by the provisions of section 1 … the President’s power is limited to removal for the specific causes enumerated therein. The negative contention of the government is based principally upon the decision of this court in Shurtleff v. United States, (1903) … The situation here presented is plainly and wholly different. The statute fixes a term of office, in accordance with many precedents … The words of the act are definite and unambiguous. … The fixing of a definite term subject to removal for cause, unless there be some countervailing provision or circum- stance indicating the contrary, which here we are unable to find, is enough to establish the legislative intent that the term is not to be curtailed in the absence of such cause. But if the intention of Congress that no removal should be made dur- ing the specified term except for one or more of the enumerated causes were not clear upon the face of the statute, as we think it is, it would be made clear by a consideration of the character of the commission and the legislative history which accompanied and preceded the passage of the act. The commission is to be nonpartisan; and it must, from the very nature of its duties, act with entire impartiality. It is charged with the enforcement of no policy except the policy of the law. Its duties are neither political nor executive, but predominantly quasi judicial and quasi legislative. Like the Interstate Commerce Commission, its members are called upon to exercise the trained judgment of a body of experts ‘appointed by law and informed by experience’ … The legislative reports in both houses of Congress clearly reflect the view that a fixed term was necessary to the effective and fair administration of the law … [T]he language of the act, the legislative reports, and the general purposes of the legislation as reflected by the debates, all combine to demonstrate the congressional intent to create a body of experts who shall gain experience by length of service; a body which shall be independent of executive authority, except in its selection, and free to exercise its judgment APPOINTMENT AND REMOVAL POWERS | 66 without the leave or hindrance of any other official … To the accomplishment of these purposes, it is clear that Congress was of opinion that length and certainty of tenure would vitally contribute. And to hold that, nevertheless, the members of the commission continue in office at the mere will of the President, might be to thwart, in large measure, the very ends which Congress sought to realize by definitely fixing the term of office. … Second. To support its contention that the removal provision … is an unconstitutional interference with the executive power of the President, the government’s chief reliance is Myers v. United States (1926) … [T]he narrow point actually decided was only that the President had power to remove a postmaster of the first class, without the advice and consent of the Senate as required by act of Congress. In the course of the opinion of the court, expressions occur which tend to sustain the government’s contention, but these are beyond the point involved and, therefore, do not come within the rule of stare decisis … The office of a postmaster is so essentially unlike the office now involved that the decision in the Myers case cannot be accepted as controlling our decision here. A postmaster is an executive officer restricted to the performance of executive functions. He is charged with no duty at all related to either the legislative or judicial power. The actual decision in the Myers case finds support in the theory that such an officer is merely one of the units in the executive department and, hence, inherently subject to the exclusive and illimitable power of removal by the Chief Executive, whose subordinate and aid he is. Putting aside dicta, which may be followed if sufficiently persuasive but which are not controlling, the nec- essary reach of the decision goes far enough to include all purely executive officers. It goes no farther; much less does it include an officer who occupies no place in the executive department and who exercises no part of the executive power vested by the Constitution in the President. The Federal Trade Commission is an administrative body created by Congress to carry into effect legislative policies embodied in the statute in accordance with the legislative standard therein prescribed, and to perform other specified duties as a legislative or as a judicial aid. Such a body cannot in any proper sense be characterized as an arm or an eye of the executive. Its duties are performed without executive leave and, in the contemplation of the statute, must be free from executive control. In administering the provisions of the statute in respect of ‘unfair methods of competition,’ that is to say, in filling in and administering the details embodied by that general standard, the commission acts in part quasi leg- islatively and in part quasi judicially … To the extent that it exercises any executive function, as distinguished from execu- tive power in the constitutional sense, it does so in the discharge and effectuation of its quasi legislative or quasi judicial powers, or as an agency of the legislative or judicial departments of the government … If Congress is without authority to prescribe causes for removal of members of the trade commission and limit executive power of removal accordingly, that power at once becomes practically all-inclusive in respect of civil officers with the exception of the judiciary provided for by the Constitution … We are thus confronted with the serious question whether not only the members of these quasi legislative and quasi judicial bodies, but the judges of the legislative Court of Claims, exercising judicial power … con- tinue in office only at the pleasure of the President. We think it plain under the Constitution that illimitable power of removal is not possessed by the President in respect of officers of the character of those just named. The authority of Congress, in creating quasi legislative or quasi judicial agencies, to require them to act in discharge of their duties independently of executive control cannot well be doubted. CHIEF JUSTICE REHNQUIST delivered the opinion of the Court. This case presents us with a challenge to the independent counsel provisions of the Ethics in Government Act of 1978 … We hold today that these provisions of the Act do not violate the Appointments Clause of the Constitution, Art. II, § 2, cl. 2, or the limitations of Article III, nor do they impermissibly interfere with the President’s authority under Article II in violation of the constitutional principle of separation of powers. Briefly stated, Title VI of the Ethics in Government Act … allows for the appointment of an “independent counsel” to investigate and, if appropriate, prosecute certain high-ranking Government officials for violations of federal criminal laws … The Act requires the Attorney General, upon receipt of information that he determines is “sufficient to constitute grounds to investigate whether any person [covered by the Act] may have violated any Federal criminal law,” to conduct a preliminary investigation of the matter … If … the Attorney General has determined that there are “reasonable grounds to believe that further investigation or prosecution is warranted,” then he “shall apply to the division of the court for the appointment of an independent counsel … ” With respect to all matters within the independent counsel’s jurisdiction, the Act grants the counsel “full power and independent authority to exercise all investigative and prosecutorial functions and powers of the Department of Justice, the Attorney General, and any other officer or employee of the Department of Justice … ” The functions of the inde- pendent counsel include conducting grand jury proceedings and other investigations, participating in civil and criminal court proceedings and litigation, and appealing any decision in any case in which the counsel participates in an official capacity … the counsel’s powers include “initiating and conducting prosecutions in any court of competent jurisdiction, framing and signing indictments, filing informations, and handling all aspects of any case, in the name of the United States … ” … An independent counsel has “full authority to dismiss matters within [his or her] prosecutorial jurisdiction without conducting an investigation or at any subsequent time before prosecution, if to do so would be consistent” with Department of Justice policy … Two statutory provisions govern the length of an independent counsel’s tenure in office. The first defines the procedure for removing an independent counsel. Section 596(a)(1) provides: “An independent counsel appointed under this chapter may be removed from office, other than by impeachment and conviction, only by the personal action of the Attorney General … ” If an independent counsel is removed pursuant to this section, the Attorney General is required to submit a report to both the Special Division and the Judiciary Committees of the Senate and the House “specifying the facts found and the ultimate grounds for such removal.” § 596(a)(2). Under the current version of the Act, an independent counsel can obtain judicial review of the Attorney General’s action by filing a civil action in the United States District Court for the District of Columbia … The reviewing court is authorized to grant reinstatement or “other appropriate relief.” § 596(a)(3) … The other provision governing the tenure of the independent counsel defines the procedures for “terminating” the coun- sel’s office. Under § 596(b)(1), the office of an independent counsel terminates when he or she notifies the Attorney Gen- eral that he or she has completed or substantially completed any investigations or prosecutions undertaken pursuant to the Act … 69 | APPOINTMENT AND REMOVAL POWERS Finally, the Act provides for congressional oversight of the activities of independent counsel … On April 23, 1986, the Special Division appointed James C. McKay as independent counsel to investigate “whether the testimony of … Olson and his revision of such testimony on March 10, 1983, violated either 18 U. S. C. § 1505 or § 1001, or any other provision of federal law … ” McKay later resigned as independent counsel, and on May 29, 1986, the Division appointed appellant Morrison as his replacement, with the same jurisdiction … [I]n May and June 1987, appellant caused a grand jury to issue and serve … on appellees. All three appellees moved to quash the subpoenas, claiming, among other things, that the independent counsel provisions of the Act were unconsti- tutional and that appellant accordingly had no authority to proceed … The initial question is, accordingly, whether appellant is an “inferior” or a “principal” officer … If she is the latter, as the Court of Appeals concluded, then the Act is in violation of the Appointments Clause. The line between “inferior” and “principal” officers is one that is far from clear, and the Framers provided little guidance into where it should be drawn … [I]n our view appellant clearly falls on the “inferior officer” side of that line. Several factors lead to this conclusion. First, appellant is subject to removal by a higher Executive Branch official. Although appellant may not be “subordinate” to the Attorney General (and the President) insofar as she possesses a degree of independent discretion to exercise the powers delegated to her under the Act, the fact that she can be removed by the Attorney General indicates that she is to some degree “inferior” in rank and authority. Second, appellant is empowered by the Act to perform only certain, limited duties … Admittedly, the Act delegates to appellant “full power and independent authority to exercise all investigative and prosecutorial functions and powers of the Department of Justice,” § 594(a), but this grant of authority does not include any authority to formulate policy for the Government or the Executive Branch, nor does it give appellant any administrative duties outside of those necessary to operate her office. The Act specifically provides that in policy matters appellant is to comply to the extent possible with the policies of the Department … Third, appellant’s office is limited in jurisdiction. Not only is the Act itself restricted in applicability to certain federal officials suspected of certain serious federal crimes, but an independent counsel can only act within the scope of the juris- diction that has been granted by the Special Division pursuant to a request by the Attorney General. Finally, appellant’s office is limited in tenure. There is concededly no time limit on the appointment of a particular counsel. Nonetheless, the office of independent counsel is “temporary” in the sense that an independent counsel is appointed essentially to accomplish a single task, and when that task is over the office is terminated, either by the counsel herself or by action of the Special Division. Unlike other prosecutors, appellant has no ongoing responsibilities that extend beyond the accom- plishment of the mission that she was appointed for and authorized by the Special Division to undertake. In our view, these factors relating to the “ideas of tenure, duration … and duties” of the independent counsel, Germaine, are sufficient to establish that appellant is an “inferior” officer in the constitutional sense. This conclusion is consistent with our few previous decisions that considered the question whether a particular Govern- ment official is a “principal” or an “inferior” officer … APPOINTMENT AND REMOVAL POWERS | 70 Appellees argue that even if appellant is an “inferior” officer, the Clause does not empower Congress to place the power to appoint such an officer outside the Executive Branch. They contend that the Clause does not contemplate congres- sional authorization of “interbranch appointments,” in which an officer of one branch is appointed by officers of another branch. The relevant language of the Appointments Clause is worth repeating. It reads: ” … but the Congress may by Law vest the Appointment of such inferior Officers, as they think proper, in the President alone, in the courts of Law, or in the Heads of Departments.” On its face, the language of this “excepting clause” admits of no limitation on interbranch appointments. Indeed, the inclusion of “as they think proper” seems clearly to give Congress significant discretion to determine whether it is “proper” to vest the appointment of, for example, executive officials in the “courts of Law … ” We also note that the history of the Clause provides no support for appellees’ position … We do not mean to say that Congress’ power to provide for interbranch appointments of “inferior officers” is unlimited. In addition to separation-of-powers concerns, which would arise if such provisions for appointment had the potential to impair the constitutional functions assigned to one of the branches, Ex parte Siebold (1879) itself suggested that Con- gress’ decision to vest the appointment power in the courts would be improper if there was some “incongruity” between the functions normally performed by the courts and the performance of their duty to appoint … In this case, however, we do not think it impermissible for Congress to vest the power to appoint independent counsel in a specially created federal court … We now turn to consider whether the Act is invalid under the constitutional principle of separation of powers. Two related issues must be addressed: The first is whether the provision of the Act restricting the Attorney General’s power to remove the independent counsel to only those instances in which he can show “good cause,” taken by itself, impermis- sibly interferes with the President’s exercise of his constitutionally appointed functions. The second is whether, taken as a whole, the Act violates the separation of powers by reducing the President’s ability to control the prosecutorial powers wielded by the independent counsel. Unlike both Bowsher and Myers, this case does not involve an attempt by Congress itself to gain a role in the removal of executive officials other than its established powers of impeachment and conviction. The Act instead puts the removal power squarely in the hands of the Executive Branch; an independent counsel may be removed from office, “only by the personal action of the Attorney General, and only for good cause.” § 596(a)(1) … There is no requirement of congres- sional approval of the Attorney General’s removal decision, though the decision is subject to judicial review. § 596(a)(3). In our view, the removal provisions of the Act make this case more analogous to Humphrey’s Executor v. United States, (1935), and Wiener v. United States, (1958), than to Myers or Bowsher … Appellees contend that Humphrey’s Executor and Wiener are distinguishable from this case because they did not involve officials who performed a “core executive function.” They argue that our decision in Humphrey’s Executor rests on a distinction between “purely executive” officials and officials who exercise “quasi-legislative” and “quasi-judicial” powers. In their view, when a “purely executive” official is involved, the governing precedent is Myers, not Humphrey’s Executor. And, under Myers, the President must have absolute discretion to discharge “purely” executive officials at will … We undoubtedly did rely on the terms “quasi-legislative” and “quasi-judicial” to distinguish the officials involved in Humphrey’s Executor and Wiener from those in Myers, but our present considered view is that the determination of whether the Constitution allows Congress to impose a “good cause”-type restriction on the President’s power to remove 71 | APPOINTMENT AND REMOVAL POWERS an official cannot be made to turn on whether or not that official is classified as “purely executive … ” The analysis con- tained in our removal cases is designed not to define rigid categories of those officials who may or may not be removed at will by the President … but to ensure that Congress does not interfere with the President’s exercise of the “execu- tive power” and his constitutionally appointed duty to “take care that the laws be faithfully executed” under Article II. Myers was undoubtedly correct in its holding, and in its broader suggestion that there are some “purely executive” officials who must be removable by the President at will if he is to be able to accomplish his constitutional role … But as the Court noted in Wiener: “The assumption was short-lived that the Myers case recognized the President’s inherent constitutional power to remove officials no matter what the relation of the executive to the discharge of their duties and no matter what restrictions Con- gress may have imposed regarding the nature of their tenure … ” [T]he real question is whether the removal restrictions are of such a nature that they impede the President’s ability to perform his constitutional duty, and the functions of the officials in question must be analyzed in that light. Considering for the moment the “good cause” removal provision in isolation from the other parts of the Act at issue in this case, we cannot say that the imposition of a “good cause” standard for removal by itself unduly trammels on executive authority. There is no real dispute that the functions performed by the independent counsel are “executive” in the sense that they are law enforcement functions that typically have been undertaken by officials within the Executive Branch. As we noted above, however, the independent counsel is an inferior officer under the Appointments Clause … we simply do not see how the President’s need to control the exercise of that discretion is so central to the functioning of the Executive Branch as to require as a matter of constitutional law that the counsel be terminable at will by the President … Nor do we think that the “good cause” removal provision at issue here impermissibly burdens the President’s power to control or supervise the independent counsel, as an executive official, in the execution of his or her duties under the Act. This is not a case in which the power to remove an executive official has been completely stripped from the President, thus providing no means for the President to ensure the “faithful execution” of the laws. Rather, because the indepen- dent counsel may be terminated for “good cause,” the Executive, through the Attorney General, retains ample authority to assure that the counsel is competently performing his or her statutory responsibilities in a manner that comports with the provisions of the Act … Here, as with the provision of the Act conferring the appointment authority of the indepen- dent counsel on the special court, the congressional determination to limit the removal power of the Attorney General was essential, in the view of Congress, to establish the necessary independence of the office. We do not think that this limitation as it presently stands sufficiently deprives the President of control over the independent counsel to interfere impermissibly with his constitutional obligation to ensure the faithful execution of the laws … The final question to be addressed is whether the Act, taken as a whole, violates the principle of separation of powers by unduly interfering with the role of the Executive Branch. Time and again we have reaffirmed the importance in our con- stitutional scheme of the separation of governmental powers into the three coordinate branches … We have not hesitated to invalidate provisions of law which violate this principle. On the other hand, we have never held that the Constitution requires that the three branches of Government “operate with absolute independence … ” In the often-quoted words of Justice Jackson: APPOINTMENT AND REMOVAL POWERS | 72 “While the Constitution diffuses power the better to secure liberty, it also contemplates that practice will integrate the dispersed powers into a workable government. It enjoins upon its branches separateness but interdependence, autonomy but reciprocity.” Youngstown Sheet & Tube Co. v. Sawyer, (1952) (concurring opinion). We observe first that this case does not involve an attempt by Congress to increase its own powers at the expense of the Executive Branch … Indeed, with the exception of the power of impeachment — which applies to all officers of the United States — Congress retained for itself no powers of control or supervision over an independent counsel. The Act does empower certain Members of Congress to request the Attorney General to apply for the appointment of an inde- pendent counsel, but the Attorney General has no duty to comply with the request, although he must respond within a certain time limit. § 592(g). Other than that, Congress’ role under the Act is limited to receiving reports or other informa- tion and oversight of the independent counsel’s activities, § 595(a), functions that we have recognized generally as being incidental to the legislative function of Congress … Similarly, we do not think that the Act works any judicial usurpation of properly executive functions. As should be apparent from our discussion of the Appointments Clause above, the power to appoint inferior officers such as indepen- dent counsel is not in itself an “executive” function in the constitutional sense, at least when Congress has exercised its power to vest the appointment of an inferior office in the “courts of Law.” … In addition, once the court has appointed a counsel and defined his or her jurisdiction, it has no power to supervise or control the activities of the counsel. … [T]he various powers delegated by the statute to the Division are not supervisory or administrative, nor are they functions that the Constitution requires be performed by officials within the Executive Branch. The Act does give a federal court the power to review the Attorney General’s decision to remove an independent counsel, but in our view this is a function that is well within the traditional power of the Judiciary. Finally, we do not think that the Act “impermissibly undermine[s]” the powers of the Executive Branch … or “disrupts the proper balance between the coordinate branches [by] prevent[ing] the Executive Branch from accomplishing its con- stitutionally assigned functions … ” It is undeniable that the Act reduces the amount of control or supervision that the Attorney General and, through him, the President exercises over the investigation and prosecution of a certain class of alleged criminal activity … The Act … gives the Executive a degree of control over the power to initiate an investigation by the independent counsel. In addition, the jurisdiction of the independent counsel is defined with reference to the facts submitted by the Attorney General, and once a counsel is appointed, the Act requires that the counsel abide by Justice Department policy unless it is not “possible” to do so. Notwithstanding the fact that the counsel is to some degree “inde- pendent” and free from executive supervision to a greater extent than other federal prosecutors, in our view these features of the Act give the Executive Branch sufficient control over the independent counsel to ensure that the President is able to perform his constitutionally assigned duties. In sum, we conclude today that it does not violate the Appointments Clause for Congress to vest the appointment of independent counsel in the Special Division; that the powers exercised by the Special Division under the Act do not vio- late Article III; and that the Act does not violate the separation-of-powers principle by impermissibly interfering with the functions of the Executive Branch. The decision of the Court of Appeals is therefore Reversed. JUSTICE KENNEDY took no part in the consideration or decision of this case. 73 | APPOINTMENT AND REMOVAL POWERS Original excerpt in Lawrence Lessig, Constitutional Law: Separation of Powers, Federalism, and Fourteenth Amendment, published by H2O. Further excerpted by Alexandria Metzdorf. Licensed under CC BY-NC-SA. § NLRB v. Canning 573 U.S. 513 (2014) Decision: Affirmed Vote: 9-0 Majority: Breyer, joined by Kennedy, Ginsburg, Sotomayor, and Kagan Concurrence: Scalia (in judgment), joined by Roberts, Thomas, and Alito Note: A pro forma session is defined as “From the Latin, meaning ‘as a matter of form,’ a pro forma session is a brief meeting of the Senate, often only a few minutes in duration.” https://www.senate.gov/general/Features/Ses- sions.htm#:~:text=Pro%20Forma%20Session%3A%20From%20the,following%20the%20November%20gen- eral%20elections. Visit https://www.c-span.org/video/?526638-1/senate-pro-forma-session to see the c-span to view a pro forma session. Justice Breyer delivered the opinion of the Court. Ordinarily the President must obtain “the Advice and Consent of the Senate” before appointing an “Office[r] of the United States.” U. S. Const., Art. II, §2, cl. 2. But the Recess Appointments Clause creates an exception. It gives the Pres- ident alone the power “to fill up all Vacancies that may happen during the Recess of the Senate, by granting Commis- sions which shall expire at the End of their next Session.” Art. II, §2, cl. 3. We here consider three questions about the application of this Clause. The first concerns the scope of the words “recess of the Senate.” Does that phrase refer only to an inter-session recess (i.e., a break between formal sessions of Congress), or does it also include an intra-session recess, such as a summer recess in the midst of a session? We conclude that the Clause applies to both kinds of recess. The second question concerns the scope of the words “vacancies that may happen.” Does that phrase refer only to vacan- cies that first come into existence during a recess, or does it also include vacancies that arise prior to a recess but continue to exist during the recess? We conclude that the Clause applies to both kinds of vacancy. The third question concerns calculation of the length of a “recess.” The President made the appointments here at issue on January 4, 2012. At that time the Senate was in recess pursuant to a December 17, 2011, resolution providing for a series of brief recesses punctuated by “pro forma session[s],” with “no business … transacted,” every Tuesday and Friday through January 20, 2012 … In calculating the length of a recess are we to ignore the pro forma sessions, thereby treating the series of brief recesses as a single, month-long recess? We conclude that we cannot ignore these pro forma sessions. APPOINTMENT AND REMOVAL POWERS | 74 Our answer to the third question means that, when the appointments before us took place, the Senate was in the midst of a 3-day recess. Three days is too short a time to bring a recess within the scope of the Clause. Thus we conclude that the President lacked the power to make the recess appointments here at issue. The case before us arises out of a labor dispute. The National Labor Relations Board (NLRB) found that a Pepsi-Cola distributor, Noel Canning, had unlawfully refused to reduce to writing and execute a collective-bargaining agreement with a labor union. The Board ordered the distributor to execute the agreement and to make employees whole for any losses … The Pepsi-Cola distributor subsequently asked the Court of Appeals for the District of Columbia Circuit to set the Board’s order aside. It claimed that three of the five Board members had been invalidly appointed, leaving the Board with- out the three lawfully appointed members necessary for it to act … The three members in question were Sharon Block, Richard Griffin, and Terence Flynn. In 2011 the President had nom- inated each of them to the Board. As of January 2012, Flynn’s nomination had been pending in the Senate awaiting confirmation for approximately a year. The nominations of each of the other two had been pending for a few weeks. On January 4, 2012, the President, invoking the Recess Appointments Clause, appointed all three to the Board. The distributor argued that the Recess Appointments Clause did not authorize those appointments. It pointed out that on December 17, 2011, the Senate, by unanimous consent, had adopted a resolution providing that it would take a series of brief recesses beginning the following day … Pursuant to that resolution, the Senate held pro forma sessions every Tuesday and Friday until it returned for ordinary business on January 23, 2012 … The President’s January 4 appoint- ments were made between the January 3 and January 6 pro forma sessions. In the distributor’s view, each pro forma session terminated the immediately preceding recess. Accordingly, the appointments were made during a 3-day adjourn- ment, which is not long enough to trigger the Recess Appointments Clause. The Court of Appeals agreed that the appointments fell outside the scope of the Clause. But the court set forth different reasons … Since the second session of the 112th Congress began on January 3, 2012, the day before the President’s appointments, those appointments occurred during an intra-session recess, and the appointments consequently fell out- side the scope of the Clause … We asked the parties to address not only the Court of Appeals’ interpretation of the Clause but also the distributor’s initial argument, namely, “[w]hether the President’s recess-appointment power may be exercised when the Senate is con- vening every three days in pro forma sessions … ” … [T]he Recess Appointments Clause reflects the tension between, on the one hand, the President’s continuous need for “the assistance of subordinates,” Myers v. United States, (1926), and, on the other, the Senate’s practice, particularly dur- ing the Republic’s early years, of meeting for a single brief session each year … We seek to interpret the Clause as granting the President the power to make appointments during a recess but not offering the President the authority routinely to avoid the need for Senate confirmation. 75 | APPOINTMENT AND REMOVAL POWERS Second, in interpreting the Clause, we put significant weight upon historical practice. For one thing, the interpretive questions before us concern the allocation of power between two elected branches of Government. Long ago Chief Jus- tice Marshall wrote that “a doubtful question, one on which human reason may pause, and the human judgment be suspended, in the decision of which the great principles of liberty are not concerned, but the respective powers of those who are equally the representa- tives of the people, are to be adjusted; if not put at rest by the practice of the government, ought to receive a considerable impression from that practice.” McCulloch v. Maryland, (1819) … The first question concerns the scope of the phrase “the recess of the Senate … ” The Constitution provides for congres- sional elections every two years. And the 2-year life of each elected Congress typically consists of two formal 1-year ses- sions, each separated from the next by an “inter-session recess … ” The Senate or the House of Representatives announces an inter-session recess by approving a resolution stating that it will “adjourn sine die,” i.e., without specifying a date to return (in which case Congress will reconvene when the next formal session is scheduled to begin). The Senate and the House also take breaks in the midst of a session. The Senate or the House announces any such “intra- session recess” by adopting a resolution stating that it will “adjourn” to a fixed date, a few days or weeks or even months later. All agree that the phrase “the recess of the Senate” covers inter-session recesses. The question is whether it includes intra-session recesses as well. In our view, the phrase “the recess” includes an intra-session recess of substantial length … History … shows only that Congress generally took long breaks between sessions, while taking no significant intra-session breaks at all (five times it took a break of a week or so at Christmas) … In 1867 and 1868, Congress for the first time took substantial, nonholiday intra-session breaks, and President Andrew Johnson made dozens of recess appointments. The Federal Court of Claims upheld one of those specific appointments, writing “[w]e have no doubt that a vacancy occur- ring while the Senate was thus temporarily adjourned” during the “first session of the Fortieth Congress” was “legally filled by appointment of the President alone.” Gould v. United States, (1884) … … [R]estricting the Clause to inter-session recesses would frustrate its purpose. It would make the President’s recess- appointment power dependent on a formalistic distinction of Senate procedure. Moreover, the President has consis- tently and frequently interpreted the word “recess” to apply to intra-session recesses, and has acted on that interpretation. The Senate as a body has done nothing to deny the validity of this practice for at least three-quarters of a century … [A] 3-day recess would be too short … The Adjournments Clause reflects the fact that a 3-day break is not a significant interruption of legislative business. As the Solicitor General says, it is constitutionally de minimis. A Senate recess that is so short that it does not require the consent of the House is not long enough to trigger the President’s recess-appoint- ment power. In sum, we conclude that the phrase “the recess” applies to both intra-session and inter-session recesses. If a Senate recess is so short that it does not require the consent of the House, it is too short to trigger the Recess Appointments Clause. See Art. I, §5, cl. 4. And a recess lasting less than 10 days is presumptively too short as well. Applying this standard, we find that the pro forma sessions were sessions for purposes of the Clause. First, the Senate said it was in session. The Journal of the Senate and the Congressional Record indicate that the Senate convened for a series of twice-weekly “sessions” from December 20 through January 20 … Second, the Senate’s rules make clear that during its pro forma sessions, despite its resolution that it would conduct no business, the Senate retained the power to conduct business. During any pro forma session, the Senate could have con- ducted business simply by passing a unanimous consent agreement … It is consequently unsurprising that the Senate has enacted legislation during pro forma sessions even when it has said that no business will be transacted. Indeed, the Senate passed a bill by unanimous consent during the second pro forma session after its December 17 adjournment … The Recess Appointments Clause responds to a structural difference between the Executive and Legislative Branches: The Executive Branch is perpetually in operation, while the Legislature only acts in intervals separated by recesses. The purpose of the Clause is to allow the Executive to continue operating while the Senate is unavailable. We believe that the Clause’s text, standing alone, is ambiguous. It does not resolve whether the President may make appointments during intra-session recesses, or whether he may fill pre-recess vacancies. But the broader reading better serves the Clause’s struc- tural function. Moreover, that broader reading is reinforced by centuries of history, which we are hesitant to disturb. We thus hold that the Constitution empowers the President to fill any existing vacancy during any recess—intra-session or inter-session—of sufficient length. Given our answer to the last question before us, we conclude that the Recess Appointments Clause does not give the President the constitutional authority to make the appointments here at issue. Because the Court of Appeals reached the same ultimate conclusion (though for reasons we reject), its judgment is affirmed. It is so ordered. Justice Scalia, with whom The Chief Justice, Justice Thomas, and Justice Alito join, concurring in the judgment. Except where the Constitution or a valid federal law provides otherwise, all “Officers of the United States” must be appointed by the President “by and with the Advice and Consent of the Senate.” U. S. Const., Art. II, §2, cl. 2. That general rule is subject to an exception: “The President shall have Power to fill up all Vacancies that may happen during the Recess of the Senate, by granting Commissions which shall expire at the End of their next Session.” Id., §2, cl. 3. This case requires us to decide whether the Recess Appointments Clause authorized three appointments made by President Obama to the National Labor Relations Board in January 2012 without the Senate’s consent. To prevent the President’s recess-appointment power from nullifying the Senate’s role in the appointment process, the Constitution cabins that power in two significant ways. First, it may be exercised only in “the Recess of the Senate,” that is, the intermission between two formal legislative sessions. Second, it may be used to fill only those vacancies that “hap- pen during the Recess,” that is, offices that become vacant during that intermission. Both conditions are clear from the Constitution’s text and struc ture, and both were well understood at the founding. The Court of Appeals correctly held that the appointments here at issue are invalid because they did not meet either condition … The Court’s decision transforms the recess-appointment power from a tool carefully designed to fill a narrow and specific need into a weapon to be wielded by future Presidents against future Senates. To reach that result, the majority casts aside APPOINTMENT AND REMOVAL POWERS | 78 the plain, original meaning of the constitutional text in deference to late-arising historical practices that are ambiguous at best. The majority’s insistence on deferring to the Executive’s untenably broad interpretation of the power is in clear conflict with our precedent and forebodes a diminution of this Court’s role in controversies involving the separation of powers and the structure of government. I concur in the judgment only … The first question presented is whether “the Recess of the Senate,” during which the President’s recess-appointment power is active, is (a) the period between two of the Senate’s formal sessions, or (b) any break in the Senate’s proceedings. I would hold that “the Recess” is the gap between sessions and that the appointments at issue here are invalid because they undisputedly were made during the Senate’s session. The Court’s contrary conclusion—that “the Recess” includes “breaks in the midst of a session,” ante, at 9—is inconsistent with the Constitution’s text and structure, and it requires judicial fabrication of vague, unadministrable limits on the recess-appointment power (thus defined) that overstep the judicial role. And although the majority relies heavily on “historical practice,” no practice worthy of our deference sup- ports the majority’s conclusion on this issue … What does all this amount to? In short: Intra-session recess appointments were virtually unheard of for the first 130 years of the Republic, were deemed unconstitutional by the first Attorney General to address them, were not openly defended by the Executive until 1921, were not made in significant numbers until after World War II, and have been repeatedly criticized as unconstitutional by Senators of both parties. It is astonishing for the majority to assert that this history lends “strong support,” ante, at 11, to its interpretation of the Recess Appointments Clause. The second question presented is whether vacancies that “happen during the Recess of the Senate,” which the President is empowered to fill with recess appointments, are (a) vacancies that arise during the recess, or (b) all vacancies that exist during the recess, regardless of when they arose. I would hold that the recess-appointment power is limited to vacancies that arise during the recess in which they are filled, and I would hold that the appointments at issue here—which undisputedly filled pre-recess vacancies—are invalid for that reason as well as for the reason that they were made during the session. The Court’s contrary conclusion is inconsistent with the Constitution’s text and structure, and it further undermines the balance the Framers struck between Presidential and Senatorial power. Historical practice also fails to support the majority’s conclusion on this issue … In sum: Washington’s and Adams’ Attorneys General read the Constitution to restrict recess appointments to vacancies arising during the recess, and there is no evidence that any of the first four Presidents consciously departed from that reading. The contrary reading was first defended by an executive official in 1823, was vehemently rejected by the Senate in 1863, was vigorously resisted by legislation in place from 1863 until 1940, and is arguably inconsistent with legislation in place from 1940 to the present. The Solicitor General has identified only about 100 appointments that have ever been made under the broader reading, and while it seems likely that a good deal more have been made in the last few decades, there is good reason to doubt that many were made before 1940 (since the appointees could not have been compensated). I can conceive of no sane constitutional theory under which this evidence of “historical practice”—which is actually evi- dence of a long-simmering inter-branch conflict—would require us to defer to the views of the Executive Branch … What the majority needs to sustain its judgment is an ambiguous text and a clear historical practice. What it has is a clear text and an at-best-ambiguous historical practice … 79 | APPOINTMENT AND REMOVAL POWERS The real tragedy of today’s decision is not simply the abolition of the Constitution’s limits on the recess-appointment power and the substitution of a novel framework invented by this Court. It is the damage done to our separation-of- powers jurisprudence more generally. It is not every day that we encounter a proper case or controversy requiring inter- pretation of the Constitution’s structural provisions. Most of the time, the interpretation of those provisions is left to the political branches—which, in deciding how much respect to afford the constitutional text, often take their cues from this Court. We should therefore take every opportunity to affirm the primacy of the Constitution’s enduring principles over the politics of the moment. Our failure to do so today will resonate well beyond the particular dispute at hand. Sad, but true: The Court’s embrace of the adverse-possession theory of executive power (a characterization the majority resists but does not refute) will be cited in diverse contexts, including those presently unimagined, and will have the effect of aggrandizing the Presidency beyond its constitutional bounds and undermining respect for the separation of powers. I concur in the judgment only. Excerpted by Alexandria Metzdorf § Lucia v. SEC 585 U.S. ___ (2018) Decision: Reversed and remanded Vote: 7-2 Majority: Kagan, joined by Roberts, Kennedy, Thomas, Alito, and Gorsuch Concurrence: Thomas, joined by Gorsuch Concur/dissent: Breyer, joined by Ginsburg, and Sotomayor (Part III only) Dissent: Sotomayor, joined by Ginsburg Justice Kagan delivered the opinion of the Court. The Appointments Clause of the Constitution lays out the permissible methods of appointing “Officers of the United States,” a class of government officials distinct from mere employees … This case requires us to decide whether adminis- trative law judges (ALJs) of the Securities and Exchange Commission (SEC or Commission) qualify as such “Officers.” In keeping with Freytag v. Commissioner, (1991), we hold that they do … The SEC has statutory authority to enforce the nation’s securities laws. One way it can do so is by instituting an admin- istrative proceeding against an alleged wrongdoer. By law, the Commission may itself preside over such a proceeding … But the Commission also may, and typically does, delegate that task to an ALJ … The SEC currently has five ALJs. Other staff members, rather than the Commission proper, selected them all … APPOINTMENT AND REMOVAL POWERS | 80 An ALJ assigned to hear an SEC enforcement action has extensive powers—the “authority to do all things necessary and appropriate to discharge his or her duties” and ensure a “fair and orderly” adversarial proceeding … As that list suggests, an SEC ALJ exercises authority “comparable to” that of a federal district judge conducting a bench trial. Butz v. Economou, (1978) … This case began when the SEC instituted an administrative proceeding against petitioner Raymond Lucia and his invest- ment company. Lucia marketed a retirement savings strategy called “Buckets of Money.” In the SEC’s view, Lucia used misleading slideshow presentations to deceive prospective clients. The SEC charged Lucia under the Investment Advis- ers Act, and assigned ALJ Cameron Elliot to adjudicate the case. After nine days of testimony and argument, Judge Elliot issued an initial decision concluding that Lucia had violated the Act and imposing sanctions, including civil penalties of $300,000 and a lifetime bar from the investment industry … On appeal to the SEC, Lucia argued that the administrative proceeding was invalid because Judge Elliot had not been constitutionally appointed. According to Lucia, the Commission’s ALJs are “Officers of the United States” and thus subject to the Appointments Clause … [T]he Commission had left the task of appointing ALJs, including Judge Elliot, to SEC staff members … As a result, Lucia contended, Judge Elliot lacked constitutional authority to do his job … The sole question here is whether the Commission’s ALJs are “Officers of the United States” or simply employees of the Federal Government. The Appointments Clause prescribes the exclusive means of appointing “Officers.” Only the Pres- ident, a court of law, or a head of department can do so. Two decisions set out this Court’s basic framework for distinguishing between officers and employees. Germaine v. US (1879) held that “civil surgeons” (doctors hired to perform various physical exams) were mere employees because their duties were “occasional or temporary” rather than “continuing and permanent … ” Stressing “ideas of tenure [and] dura- tion,” the Court there made clear that an individual must occupy a “continuing” position established by law to qualify as an officer. Buckley v. Valeo (1976) then set out another requirement, central to this case. It determined that members of a federal commission were officers only after finding that they “exercis[ed] significant authority pursuant to the laws of the United States … ” The inquiry thus focused on the extent of power an individual wields in carrying out his assigned functions. Both the amicus and the Government urge us to elaborate on Buckley’s “significant authority” test, but another of our precedents makes that project unnecessary … [I]n Freytag v. Commissioner, (1991), we applied the unadorned “signifi- cant authority” test to adjudicative officials who are near-carbon copies of the Commission’s ALJs. As we now explain, our analysis there (sans any more detailed legal criteria) necessarily decides this case. The officials at issue in Freytag were the “special trial judges” (STJs) of the United States Tax Court. The authority of those judges depended on the significance of the tax dispute before them. In “comparatively narrow and minor matters,” they could both hear and definitively resolve a case for the Tax Court … In more major matters, they could preside over the hearing, but could not issue the final decision; instead, they were to “prepare proposed findings and an opinion” for a regular Tax Court judge to consider … 81 | APPOINTMENT AND REMOVAL POWERS This Court held that the Tax Court’s STJs are officers, not mere employees. Citing Germaine, the Court first found that STJs hold a continuing office established by law … They serve on an ongoing, rather than a “temporary [or] episodic[,] basis”; and their “duties, salary, and means of appointment” are all specified in the Tax Code. For all the reasons we have given, and all those Freytag gave before, the Commission’s ALJs are “Officers of the United States,” subject to the Appointments Clause … This Court has held that “one who makes a timely challenge to the con- stitutional validity of the appointment of an officer who adjudicates his case” is entitled to relief. Ryder v. United States, (1995). Lucia made just such a timely challenge: He contested the validity of Judge Elliot’s appointment before the Com- mission, and continued pressing that claim in the Court of Appeals and this Court. So what relief follows? This Court has also held that the “appropriate” remedy for an adjudication tainted with an appointments violation is a new “hearing before a properly appointed” official … And we add today one thing more. That official cannot be Judge Elliot, even if he has by now received (or receives sometime in the future) a constitutional appointment. Judge Elliot has already both heard Lucia’s case and issued an initial decision on the merits. He cannot be expected to consider the matter as though he had not adjudicated it before. To cure the constitutional error, another ALJ (or the Commission itself) must hold the new hearing to which Lucia is entitled. We accordingly reverse the judgment of the Court of Appeals and remand the case for further proceedings consistent with this opinion. It is so ordered. Note: In June of 2020, Lucia entered a settlement with the SEC which banned Lucia from the securities industry, though he could reapply for admittance, and included a fine of $25,000.00. (see https://www.investmentnews.com/sec-ray-lucia- settle-lawsuit-194238, last accessed on April 27, 2023.) § APPOINTMENT AND REMOVAL POWERS | 82 Executive Privilege United States v. Nixon 418 U.S. 683 (1974) Decision: Affirmed Vote: 8-0 Majority: Burger, joined by Douglas, Brennan, Stewart, White, Marshall, Blackmun, and Powell MR. CHIEF JUSTICE BURGER delivered the opinion of the Court. This litigation presents for review the denial of a motion … to quash a third-party subpoena duces tecum issued … pur- suant to Fed. Rule Crim. Proc. 17 (c). The subpoena directed the President to produce certain tape recordings and doc- uments relating to his conversations with aides and advisers … On March 1, 1974, a grand jury of the United States District Court for the District of Columbia returned an indictment charging seven named individuals with various offenses, including conspiracy to defraud the United States and to obstruct justice. Although he was not designated as such in the indictment, the grand jury named the President, among others, as an unindicted coconspirator … [W]e turn to the claim that the subpoena should be quashed because it demands “confidential conversations between a President and his close advisors that it would be inconsistent with the public interest to produce … ” The first contention is a broad claim that the separation of powers doctrine precludes judicial review of a President’s claim of privilege. The second contention is that if he does not prevail on the claim of absolute privilege, the court should hold as a matter of constitutional law that the privilege prevails over the subpoena duces tecum. In the performance of assigned constitutional duties each branch of the Government must initially interpret the Consti- tution, and the interpretation of its powers by any branch is due great respect from the others. The President’s counsel, as we have noted, reads the Constitution as providing an absolute privilege of confidentiality for all Presidential commu- nications. Many decisions of this Court, however, have unequivocally reaffirmed the holding of Marbury v. Madison, (1803), that “[i]t is emphatically the province and duty of the judicial department to say what the law is … ” Since this Court has consistently exercised the power to construe and delineate claims arising under express powers, it must follow that the Court has authority to interpret claims with respect to powers alleged to derive from enumerated powers … Our system of government “requires that federal courts on occasion interpret the Constitution in a manner at variance with the construction given the document by another branch.” Powell v. McCormack, (1969) … And in Baker v. Carr (1961), the Court stated: 83 | EXECUTIVE PRIVILEGE “Deciding whether a matter has in any measure been committed by the Constitution to another branch of government, or whether the action of that branch exceeds whatever authority has been committed, is itself a delicate exercise in con- stitutional interpretation, and is a responsibility of this Court as ultimate interpreter of the Constitution.” Notwithstanding the deference each branch must accord the others, the “judicial Power of the United States” vested in the federal courts by Art. III, § 1, of the Constitution can no more be shared with the Executive Branch than the Chief Executive, for example, can share with the Judiciary the veto power, or the Congress share with the Judiciary the power to override a Presidential veto. Any other conclusion would be contrary to the basic concept of separation of powers and the checks and balances that flow from the scheme of a tripartite government … We therefore reaffirm that it is the province and duty of this Court “to say what the law is” with respect to the claim of privilege presented in this case. In support of his claim of absolute privilege, the President’s counsel urges two grounds, one of which is common to all governments and one of which is peculiar to our system of separation of powers. The first ground is the valid need for protection of communications between high Government officials and those who advise and assist them in the perfor- mance of their manifold duties; the importance of this confidentiality is too plain to require further discussion … The second ground asserted by the President’s counsel in support of the claim of absolute privilege rests on the doctrine of separation of powers. Here it is argued that the independence of the Executive Branch within its own sphere … insu- lates a President from a judicial subpoena in an ongoing criminal prosecution, and thereby protects confidential Presi- dential communications. However, neither the doctrine of separation of powers, nor the need for confidentiality of high-level communications, without more, can sustain an absolute, unqualified Presidential privilege of immunity from judicial process under all cir- cumstances. The President’s need for complete candor and objectivity from advisers calls for great deference from the courts … [W]e find it difficult to accept the argument that even the very important interest in confidentiality of Presi- dential communications is significantly diminished by production of such material for in camera inspection with all the protection that a district court will be obliged to provide. The impediment that an absolute, unqualified privilege would place in the way of the primary constitutional duty of the Judicial Branch to do justice in criminal prosecutions would plainly conflict with the function of the courts under Art. III. In designing the structure of our Government and dividing and allocating the sovereign power among three co-equal branches, the Framers of the Constitution sought to provide a comprehensive system, but the separate powers were not intended to operate with absolute independence … To read the Art. II powers of the President as providing an absolute privilege as against a subpoena essential to enforce- ment of criminal statutes on no more than a generalized claim of the public interest in confidentiality of nonmilitary and nondiplomatic discussions would upset the constitutional balance of “a workable government” and gravely impair the role of the courts under Art. III. Since we conclude that the legitimate needs of the judicial process may outweigh Presidential privilege, it is necessary to resolve those competing interests in a manner that preserves the essential functions of each branch. The right and indeed the duty to resolve that question does not free the Judiciary from according high respect to the representations made on behalf of the President … EXECUTIVE PRIVILEGE | 84 When he signed the Act into law, President George W. Bush issued a statement declaring his position that § 214 would, “if construed as mandatory rather than advisory, impermissibly interfere with the President’s constitutional authority to formulate the position of the United States, speak for the Nation in international affairs, and determine the terms on which recognition is given to foreign states … ” The President concluded, “U.S. policy regarding Jerusalem has not changed … ” In considering claims of Presidential power this Court refers to Justice Jackson’s familiar tripartite framework from Youngstown Sheet & Tube Co. v. Sawyer, (1952) (concurring opinion) … [W]hen “the President takes measures incompatible with the expressed or implied will of Congress … he can rely only upon his own constitutional powers minus any constitutional powers of Congress over the matter.” To succeed in this third category, the President’s asserted power must be both “exclusive” and “conclusive” on the issue … In this case the Secretary contends that § 214(d) infringes on the President’s exclusive recognition power by “requiring the President to contradict his recognition position regarding Jerusalem in official communications with foreign sover- eigns.” In so doing the Secretary acknowledges the President’s power is “at its lowest ebb … ” Because the President’s refusal to implement § 214(d) falls into Justice Jackson’s third category, his claim must be “scrutinized with caution,” and he may rely solely on powers the Constitution grants to him alone … Recognition is a “formal acknowledgment” that a particular “entity possesses the qualifications for statehood” or “that a particular regime is the effective government of a state … ” Recognition is often effected by an express “written or oral declaration … ” It may also be implied—for example, by concluding a bilateral treaty or by sending or receiving diplo- matic agents … Despite the importance of the recognition power in foreign relations, the Constitution does not use the term “recogni- tion,” either in Article II or elsewhere. The Secretary asserts that the President exercises the recognition power based on the Reception Clause, which directs that the President “shall receive Ambassadors and other public Ministers.” Art. II, § 3. As Zivotofsky notes, the Reception Clause received little attention at the Constitutional Convention … At the time of the founding, however, prominent international scholars suggested that receiving an ambassador was tan- tamount to recognizing the sovereignty of the sending state … It is a logical and proper inference, then, that a Clause directing the President alone to receive ambassadors would be understood to acknowledge his power to recognize other nations … The inference that the President exercises the recognition power is further supported by his additional Article II powers. It is for the President, “by and with the Advice and Consent of the Senate,” to “make Treaties, provided two thirds of the Senators present concur.” Art. II, § 2, cl. 2. In addition, “he shall nominate, and by and with the Advice and Consent of the Senate, shall appoint Ambassadors” as well as “other public Ministers and Consuls.” As a matter of constitutional structure, these additional powers give the President control over recognition decisions. At international law, recognition may be effected by different means, but each means is dependent upon Presidential power. In addition to receiving an ambassador, recognition may occur on “the conclusion of a bilateral treaty,” or the “formal initiation of diplomatic relations,” including the dispatch of an ambassador … The Constitution thus assigns the President means to effect recognition on his own initiative. Congress, by contrast, has no constitutional power that PRESIDENTIAL POWERS IN FOREIGN AFFAIRS | 146 would enable it to initiate diplomatic relations with a foreign nation. Because these specific Clauses confer the recogni- tion power on the President, the Court need not consider whether or to what extent the Vesting Clause, which provides that the “executive Power” shall be vested in the President, provides further support for the President’s action here. Art. II, § 1, cl. 1. The text and structure of the Constitution grant the President the power to recognize foreign nations and governments. The question then becomes whether that power is exclusive. The various ways in which the President may unilaterally effect recognition—and the lack of any similar power vested in Congress—suggest that it is. So, too, do functional con- siderations. Put simply, the Nation must have a single policy regarding which governments are legitimate in the eyes of the United States and which are not. Foreign countries need to know, before entering into diplomatic relations or com- merce with the United States, whether their ambassadors will be received; whether their officials will be immune from suit in federal court; and whether they may initiate lawsuits here to vindicate their rights. These assurances cannot be equivocal … It remains true, of course, that many decisions affecting foreign relations—including decisions that may determine the course of our relations with recognized countries—require congressional action. Congress may “regulate Commerce with foreign Nations,” “establish an uniform Rule of Naturalization,” “define and punish Piracies and Felonies commit- ted on the high Seas, and Offences against the Law of Nations,” “declare War,” “grant Letters of Marque and Reprisal,” and “make Rules for the Government and Regulation of the land and naval Forces … ” Although the President alone effects the formal act of recognition, Congress’ powers, and its central role in making laws, give it substantial authority regarding many of the policy determinations that precede and follow the act of recognition itself. If Congress disagrees with the President’s recognition policy, there may be consequences. Formal recognition may seem a hollow act if it is not accompanied by the dispatch of an ambassador, the easing of trade restrictions, and the con- clusion of treaties. And those decisions require action by the Senate or the whole Congress. In practice, then, the President’s recognition determination is just one part of a political process that may require Con- gress to make laws. The President’s exclusive recognition power encompasses the authority to acknowledge, in a formal sense, the legitimacy of other states and governments, including their territorial bounds. Albeit limited, the exclusive recognition power is essential to the conduct of Presidential duties. The formal act of recognition is an executive power that Congress may not qualify. If the President is to be effective in negotiations over a formal recognition determination, it must be evident to his counterparts abroad that he speaks for the Nation on that precise question … Here, history is not all on one side, but on balance it provides strong support for the conclusion that the recognition power is the President’s alone. As Zivotofsky argues, certain historical incidents can be interpreted to support the posi- tion that recognition is a shared power. But the weight of historical evidence supports the opposite view, which is that the formal determination of recognition is a power to be exercised only by the President … As the power to recognize foreign states resides in the President alone, the question becomes whether § 214(d) infringes on the Executive’s consistent decision to withhold recognition with respect to Jerusalem … Section 214(d) requires that, in a passport or consular report of birth abroad, “the Secretary shall, upon the request of the citizen or the citizen’s legal guardian, record the place of birth as Israel” for a “United States citizen born in the city 147 | PRESIDENTIAL POWERS IN FOREIGN AFFAIRS of Jerusalem.” That is, § 214(d) requires the President, through the Secretary, to identify citizens born in Jerusalem who so request as being born in Israel. But according to the President, those citizens were not born in Israel. As a matter of United States policy, neither Israel nor any other country is acknowledged as having sovereignty over Jerusalem. In this way, § 214(d) “directly contradicts” the “carefully calibrated and longstanding Executive branch policy of neutrality toward Jerusalem.” If the power over recognition is to mean anything, it must mean that the President not only makes the initial, formal recognition determination but also that he may maintain that determination in his and his agent’s statements. This con- clusion is a matter of both common sense and necessity. If Congress could command the President to state a recognition position inconsistent with his own, Congress could override the President’s recognition determination … Although the statement required by § 214(d) would not itself constitute a formal act of recognition, it is a mandate that the Executive contradict his prior recognition determination in an official document issued by the Secretary of State … As a result, it is unconstitutional. This is all the more clear in light of the longstanding treatment of a passport’s place- of-birth section as an official executive statement implicating recognition … The Secretary’s position on this point has been consistent: He will not place information in the place-of-birth section of a passport that contradicts the President’s recognition policy … If a citizen objects to the country listed as sovereign over his place of birth, then the Secretary will accommodate him by listing the city or town of birth rather than the country … But the Secretary will not list a sovereign that contradicts the President’s recognition policy in a passport. Thus, the Secretary will not list “Israel” in a passport as the country containing Jerusalem … From the face of § 214, from the legislative history, and from its reception, it is clear that Congress wanted to express its displeasure with the President’s policy by, among other things, commanding the Executive to contradict his own, earlier stated position on Jerusalem. This Congress may not do. It is true, as Zivotofsky notes, that Congress has substantial authority over passports … The Court does not question the power of Congress to enact passport legislation of wide scope … The problem with § 214(d), however, lies in how Congress exercised its authority over passports. It was an improper act for Congress to “aggrandiz[e] its power at the expense of another branch” by requiring the President to contradict an ear- lier recognition determination in an official document issued by the Executive Branch. Freytag v. Commissioner, (1991). To allow Congress to control the President’s communication in the context of a formal recognition determination is to allow Congress to exercise that exclusive power itself. As a result, the statute is unconstitutional … In holding § 214(d) invalid the Court does not question the substantial powers of Congress over foreign affairs in general or passports in particular. This case is confined solely to the exclusive power of the President to control recognition deter- minations, including formal statements by the Executive Branch acknowledging the legitimacy of a state or government and its territorial bounds. Congress cannot command the President to contradict an earlier recognition determination in the issuance of passports. The judgment of the Court of Appeals for the District of Columbia Circuit is Affirmed. PRESIDENTIAL POWERS IN FOREIGN AFFAIRS | 148 Excerpted by Alexandria Metzdorf Justice Scalia, with whom The Chief Justice and Justice Alito join, dissenting. Before this country declared independence, the law of England entrusted the King with the exclusive care of his king- dom’s foreign affairs. The royal prerogative included the “sole power of sending ambassadors to foreign states, and receiv- ing them at home,” the sole authority to “make treaties, leagues, and alliances with foreign states and princes,” “the sole prerogative of making war and peace,” and the “sole power of raising and regulating fleets and armies.” W. Blackstone, Commentaries. The People of the United States had other ideas when they organized our Government. They considered a sound structure of balanced powers essential to the preservation of just government, and international relations formed no exception to that principle. The People therefore adopted a Constitution that divides responsibility for the Nation’s foreign concerns between the legislative and executive departments. The Constitution gave the President the “executive Power,” authority to send and responsibility to receive ambassadors, power to make treaties, and command of the Army and Navy—though they qual- ified some of these powers by requiring consent of the Senate. Art. II, §§1–3. At the same time, they gave Congress pow- ers over war, foreign commerce, naturalization, and more. Art. I, §8. “Fully eleven of the powers that Article I, §8 grants Congress deal in some way with foreign affairs.” L. Tribe, American Constitutional Law, §5–18, p. 965. This case arises out of a dispute between the Executive and Legislative Branches about whether the United States should treat Jerusalem as a part of Israel. The Constitution contemplates that the political branches will make policy about the territorial claims of foreign nations the same way they make policy about other international matters: The President will exercise his powers on the basis of his views, Congress its powers on the basis of its views. That is just what has happened here. The political branches of our Government agree on the real-world fact that Israel controls the city of Jerusalem … They disagree, however, about how official documents should record the birthplace of an American citizen born in Jerusalem. The Executive does not accept any state’s claim to sovereignty over Jerusalem, and it maintains that the birthplace des- ignation “Israel” would clash with this stance of neutrality. But the National Legislature has enacted a statute that pro- vides: “For purposes of the registration of birth, certification of nationality, or issuance of a passport of a United States citizen born in the city of Jerusalem, the Secretary [of State] shall, upon the request of the citizen or the citizen’s legal guardian, record the place of birth as Israel.” Foreign Relations Authorization Act, Fiscal Year 2003, §214(d). Menachem Zivotofsky’s parents seek enforcement of this statutory right in the issuance of their son’s passport and consular report of birth abroad … Before turning to Presidential power under Article II, I think it well to establish the statute’s basis in congressional power under Article I. Congress’s power to “establish an uniform Rule of Naturalization,” Art. I, §8, cl. 4, enables it to grant American citizenship to someone born abroad. United States v. Wong Kim Ark., (1898). The naturalization power also enables Congress to furnish the people it makes citizens with papers verifying their citizenship—say a consular report of birth abroad (which certifies citizenship of an American born outside the United States) or a passport (which certifies cit- izenship for purposes of international travel). As the Necessary and Proper Clause confirms, every congressional power 149 | PRESIDENTIAL POWERS IN FOREIGN AFFAIRS “carries with it all those incidental powers which are necessary to its complete and effectual execution.” Cohens v. Vir- ginia, (1821). Even on a miserly understanding of Congress’s incidental authority, Congress may make grants of citizen- ship “effectual” by providing for the issuance of certificates authenticating them. One would think that if Congress may grant Zivotofsky a passport and a birth report, it may also require these papers to record his birthplace as “Israel.” … No doubt congressional discretion in executing legislative powers has its limits; Congress’s chosen approach must be not only “necessary” to carrying its powers into execution, but also “proper.” Congress thus may not transcend boundaries upon legislative authority stated or implied elsewhere in the Constitution. But as we shall see, §214(d) does not transgress any such restriction. The Court frames this case as a debate about recognition. Recognition is a sovereign’s official acceptance of a status under international law … To know all this is to realize at once that §214(d) has nothing to do with recognition. Section 214(d) does not require the Secretary to make a formal declaration about Israel’s sovereignty over Jerusalem. And nobody suggests that international custom infers acceptance of sovereignty from the birthplace designation on a passport or birth report, as it does from bilateral treaties or exchanges of ambassadors. Recognition would preclude the United States (as a matter of international law) from later contesting Israeli sovereignty over Jerusalem. But making a notation in a passport or birth report does not encumber the Republic with any international obligations. It leaves the Nation free (so far as international law is con- cerned) to change its mind in the future. That would be true even if the statute required all passports to list “Israel.” But in fact it requires only those passports to list “Israel” for which the citizen (or his guardian) requests “Israel”; all the rest, under the Secretary’s policy, list “Jerusalem.” It is utterly impossible for this deference to private requests to constitute an act that unequivocally manifests an intention to grant recognition. … The best indication that §214(d) does not concern recognition comes from the State Department’s policies concerning Taiwan. According to the Solicitor General, the United States “acknowledges the Chinese position” that Taiwan is a part of China, but “does not take a position” of its own on that issue. Brief for Respondent 51–52. Even so, the State Depart- ment has for a long time recorded the birthplace of a citizen born in Taiwan as “China.” It indeed insisted on doing so until Congress passed a law (on which §214(d) was modeled) giving citizens the option to have their birthplaces recorded as “Taiwan.” The Solicitor General explains that the designation “China” “involves a geographic description, not an asser- tion that Taiwan is … part of sovereign China.” Brief for Respondent 51–52. Quite so. Section 214(d) likewise calls for nothing beyond a “geographic description”; it does not require the Executive even to assert, never mind formally recog- nize, that Jerusalem is a part of sovereign Israel … Even if the Constitution gives the President sole power to extend recognition, it does not give him sole power to make all decisions relating to foreign disputes over sovereignty. To the contrary, a fair reading of Article I allows Congress to decide for itself how its laws should handle these controversies … PRESIDENTIAL POWERS IN FOREIGN AFFAIRS | 150 The Constitution likewise does not give the President exclusive power to determine which claims to statehood and terri- tory “are legitimate in the eyes of the United States,” ante, at 11. Congress may express its own views about these matters by declaring war, restricting trade, denying foreign aid, and much else besides … No consistent or coherent theory supports the Court’s decision … International disputes about statehood and territory are neither rare nor obscure. Leading foreign debates during the 19th century concerned how the United States should respond to revolutions in Latin America, Texas, Mexico, Hawaii, Cuba. During the 20th century, attitudes toward Communist governments in Russia and China became conspicuous subjects of agitation. Disagreements about Taiwan, Kashmir, and Crimea remain prominent today. A President empow- ered to decide all questions relating to these matters, immune from laws embodying congressional disagreement with his position, would have un- controlled mastery of a vast share of the Nation’s foreign affairs. That is not the chief magistrate under which the American People agreed to live when they adopted the national charter. They believed that “[t]he accumulation of all powers, legislative, executive, and judiciary, in the same hands, … may justly be pronounced the very definition of tyranny.” The Federalist No. 47, p. 301 (Madison). For this reason, they did not entrust either the President or Congress with sole power to adopt uncontradictable policies about any subject—foreign- sovereignty disputes included. They instead gave each political department its own powers, and with that the freedom to contradict the other’s policies. Under the Constitution they approved, Congress may require Zivotofsky’s passport and birth report to record his birthplace as Israel, even if that requirement clashes with the President’s preference for neutral- ity about the status of Jerusalem. I dissent. Excerpted by Rorie Solberg § Trump v. Hawaii 585 U.S. ___ (2018) Decision: Reversed and remanded Vote: 5-4 Majority: Roberts, joined by Kennedy, Thomas, Alito, and Gorsuch Concurrence: Kennedy Concurrence: Thomas Dissent: Breyer, joined by Kagan Dissent: Sotomayor, joined by Ginsburg Chief Justice Roberts delivered the opinion of the Court. 151 | PRESIDENTIAL POWERS IN FOREIGN AFFAIRS Under the Immigration and Nationality Act, foreign nationals seeking entry into the United States undergo a vetting process to ensure that they satisfy the numerous requirements for admission. The Act also vests the President with authority to restrict the entry of aliens when- ever he finds that their entry “would be detrimental to the interests of the United States.” 8 U. S. C. §1182(f). Relying on that delegation, the President concluded that it was necessary to impose entry restrictions on nationals of countries that do not share adequate information for an informed entry determination, or that otherwise present national security risks. Presidential Proclamation No. 9645 (Proclamation). The plaintiffs in this litigation, respondents here, challenged the application of those entry restrictions to certain aliens abroad. We now decide whether the President had authority under the Act to issue the Proclamation, and whether the entry policy vio- lates the Establishment Clause of the First Amendment … DHS collected and evaluated data regarding all foreign governments. §1(d). It identified 16 countries as having deficient information-sharing practices and presenting national security concerns, and another 31 countries as “at risk” of similarly failing to meet the baseline. §1(e). The State Department then undertook diplomatic efforts over a 50-day period to encourage all foreign governments to improve their practices. §1(f ). As a result of that effort, numerous countries pro- vided DHS with travel document exemplars and agreed to share information on known or suspected terrorists. Following the 50-day period, the Acting Secretary of Homeland Security concluded that eight countries—Chad, Iran, Iraq, Libya, North Korea, Syria, Venezuela, and Yemen—remained deficient in terms of their risk profile and willingness to provide requested information. The Acting Secretary recommended that the President impose entry restrictions on certain nationals from all of those countries except Iraq … Plaintiffs challenged the Proclamation—except as applied to North Korea and Venezuela—on several grounds. As rele- vant here, they argued that the Proclamation contravenes provisions in the Immigration and Nationality Act (INA) … Plaintiffs further claimed that the Proclamation violates the Establishment Clause of the First Amendment, because it was motivated not by concerns pertaining to national security but by animus toward Islam … The INA establishes numerous grounds on which an alien abroad may be inadmissible to the United States and ineligible for a visa … Congress has also delegated to the President authority to suspend or restrict the entry of aliens in certain cir- cumstances. The principal source of that authority, §1182(f ), enables the President to “suspend the entry of all aliens or any class of aliens” whenever he “finds” that their entry “would be detrimental to the interests of the United States.” Plaintiffs argue that the Proclamation is not a valid exercise of the President’s authority under the INA. In their view, §1182(f ) confers only a residual power to temporarily halt the entry of a discrete group of aliens engaged in harmful conduct. They also assert that the Proclamation violates another provision of the INA— 8 U. S. C. §1152(a)(1)(A)—because it discriminates on the basis of nationality in the issuance of immigrant visas … §1182(f ) exudes deference to the President in every clause. It entrusts to the President the decisions whether and when to suspend entry … whose entry to suspend … for how long … and on what conditions … It is therefore unsurprising that we have previously observed that §1182(f ) vests the President with “ample power” to impose entry restrictions in addition to those elsewhere enumerated in the INA … The Proclamation falls well within this comprehensive delegation. The sole prerequisite set forth in §1182(f ) is that the President “find[ ]” that the entry of the covered aliens “would be detrimental to the interests of the United States.” PRESIDENTIAL POWERS IN FOREIGN AFFAIRS | 152 The President has undoubtedly fulfilled that requirement here … The Proclamation therefore “craft[ed] … country-spe- cific restrictions that would be most likely to encourage cooperation given each country’s distinct circumstances,” while securing the Nation “until such time as improvements occur.” Plaintiffs … argue, as an initial matter, that the Proclamation fails to provide a persuasive rationale for why nationality alone renders the covered foreign nationals a security risk. And they further discount the President’s stated concern about deficient vetting because the Proclamation allows many aliens from the designated countries to enter on nonimmigrant visas. Such arguments are grounded on the premise that §1182(f ) not only requires the President to make a finding that entry “would be detrimental to the interests of the United States,” but also to explain that finding with sufficient detail to enable judicial review. That premise is questionable. But even assuming that some form of review is appropriate, plaintiffs’ attacks on the sufficiency of the President’s findings cannot be sustained. The 12-page Proclamation—which thoroughly describes the process, agency evaluations, and recommendations underlying the President’s chosen restric- tions—is more detailed than any prior order a President has issued under §1182(f ) … Like its predecessors, the Proclamation makes clear that its “conditional restrictions” will remain in force only so long as necessary to “address” the identified “inadequacies and risks” within the covered nations … To that end, the Procla- mation establishes an ongoing process to engage covered nations and assess every 180 days whether the entry restrictions should be modified or terminated. §§4(a), (b). Indeed, after the initial review period, the President determined that Chad had made sufficient improvements to its identity-management protocols, and he accordingly lifted the entry suspension on its nationals … In short, the language of §1182(f ) is clear, and the Proclamation does not exceed any textual limit on the President’s authority … Plaintiffs’ structural argument starts with the premise that §1182(f ) does not give the President authority to counter- mand Congress’s considered policy judgments. The President, they say, may supplement the INA, but he cannot sup- plant it … We may assume that §1182(f ) does not allow the President to expressly override particular provisions of the INA. But plaintiffs have not identified any conflict between the statute and the Proclamation that would implicitly bar the Presi- dent from addressing deficiencies in the Nation’s vetting system … Plaintiffs suggest that the entry restrictions are unnecessary because consular officers can simply deny visas in individual cases when an alien fails to carry his burden of proving admissibility—for example, by failing to produce certified records regarding his criminal history. But that misses the point: A critical finding of the Proclamation is that the failure of certain countries to provide reliable information prevents the Government from accurately determining whether an alien is inadmissible or poses a threat. Proclamation §1(h). Unless consular officers are expected to apply categorical rules and deny entry from those countries across the board, fraudulent or unreliable documentation may thwart their review in individual cases. And at any rate, the INA certainly does not require that systemic problems such as the lack of reliable States, and of compounding the American people into one common mass. Of consequence, when they act, they act in their States. But the measures they adopt do not, on that account, cease to be the measures of the people themselves, or become the measures of the State governments … The assent of the States in their sovereign capacity is implied in calling a convention, and thus submitting that instrument to the people. But the people were at perfect liberty to accept or reject it, and their act was final. It required not the affir- mance, and could not be negatived, by the State Governments. The Constitution, when thus adopted, was of complete obligation, and bound the State sovereignties … From these conventions, the Constitution derives its whole authority. The government proceeds directly from the peo- ple; is ‘ordained and established,’ in the name of the people; and is declared to be ordained, ‘in order to form a more perfect union, establish justice, insure domestic tranquility, and secure the blessings of liberty to themselves and to their posterity.’ The assent of the states, in their sovereign capacity, is implied, in calling a convention, and thus submitting that instrument to the people. But the people were at perfect liberty to accept or reject it; and their act was final. It required not the affirmance, and could not be negatived, by the state governments. The constitution, when thus adopted, was of complete obligation, and bound the state sovereignties … This government is acknowledged by all, to be one of enumerated powers. The principle, that it can exercise only the powers granted to it, would seem too apparent, to have required to be enforced by all those arguments, which its enlight- ened friends, while it was depending before the people, found it necessary to urge; that principle is now universally admitted. But the question respecting the extent of the powers actually granted, is perpetually arising, and will probably continue to arise, so long as our system shall exist … [T]he government of the Union, though limited in its powers, is supreme within its sphere of action. This would seem to result, necessarily, from its nature. It is the government of all; its powers are delegated by all; it represents all, and acts for all. Though any one state may be willing to control its operations, no state is willing to allow others to control them. The nation, on those subjects on which it can act, must necessarily bind its component parts. But this question is not left to mere reason: the people have, in express terms, decided it … Among the enumerated powers, we do not find that of establishing a bank or creating a corporation. But there is no phrase in the instrument which, like the articles of confederation, excludes incidental or implied powers; and which requires that everything granted shall be expressly and minutely described … A constitution, to contain an accurate detail of all the subdivisions of which its great powers will admit, and of all the means by which they may be carried into exe- cution, would partake of the prolixity of a legal code, and could scarcely be embraced by the human mind. It would, probably, never be understood by the public. Its nature, therefore, requires, that only its great outlines should be marked, its important objects designated, and the minor ingredients which compose those objects, be deduced from the nature of the objects themselves. That this idea was entertained by the framers of the American constitution, is not only to be inferred from the nature of the instrument, but from the language. Why else were some of the limitations, found in the 9th section of the 1st article, introduced? It is also, in some degree, warranted, by their having omitted to use any restric- tive term which might prevent its receiving a fair and just interpretation … 161 | SOURCES AND SCOPE OF LEGISLATIVE POWERS Although, among the enumerated powers of government, we do not find the word ‘bank’ or ‘incorporation,’ we find the great powers, to lay and collect taxes; to borrow money; to regulate commerce; to declare and conduct a war; and to raise and support armies and navies. The sword and the purse, all the external relations, and no inconsiderable portion of the industry of the nation, are intrusted to its government. It is not denied, that the powers given to the government imply the ordinary means of execution. That, for example, of raising revenue, and applying it to national purposes, is admitted to imply the power of conveying money from place to place, as the exigencies of the nation may require, and of employing the usual means of conveyance. But it is denied, that the government … may … erect a corporation. On what foundation does this argument rest? On this alone: the power of creating a corporation, is one appertaining to sovereignty, and is not expressly conferred on congress. This is true. But all legislative powers appertain to sovereignty. The original power of giving the law on any subject whatever, is a sovereign power … if the government of the Union is restrained from creating a corporation … on the single reason that the creation of a corporation is an act of sovereignty … there would be some difficulty in sustaining the authority of congress to pass other laws for the accomplishment of the same objects. The government which has a right to do an act, and has imposed on it, the duty of performing that act, must, according to the dictates of reason, be allowed to select the means … those who contend that it may not … take upon themselves the burden of establishing that exception … In America, the powers of sovereignty are divided between the government of the Union, and those of the states. They are each sovereign, with respect to the objects committed to it, and neither sovereign, with respect to the objects commit- ted to the other … Some state constitutions were formed before, some since that of the United States. We cannot believe, that their relation to each other is in any degree dependent upon this circumstance. Their respective powers must, we think, be precisely the same, as if they had been formed at the same time … To [Congress’] enumeration of powers is added, that of making ‘all laws which shall be necessary and proper, for carrying into execution the foregoing powers, and all other powers vested by this constitution, in the government of the United States, or in any department thereof.’ The counsel for the state of Maryland have urged various arguments, to prove that this clause, though, in terms, a grant of power, is not so, in effect; but is really restrictive of the general right, which might otherwise be implied, of selecting means for executing the enumerated powers. In support of this proposition, they have found it necessary to contend, that this clause was inserted for the purpose of conferring on congress the power of mak- ing laws. That, without it, doubts might be entertained, whether congress could exercise its powers in the form of legis- lation … Could it be necessary to say, that a legislature should exercise legislative powers, in the shape of legislation? After allowing each house to prescribe its own course of proceeding, after describing the manner in which a bill should become a law, would it have entered into the mind of a single member of the convention, that an express power to make laws was neces- sary, to enable the legislature to make them? That a legislature, endowed with legislative powers, can legislate, is a propo- sition too self-evident to have been questioned … But the argument which most conclusively demonstrates the error of the construction contended for by the counsel for the state of Maryland, is founded on the intention of the convention, as manifested in the whole clause. To waste time and argument in proving that, without it, congress might carry its powers into execution, would be not much less idle, than to hold a lighted taper to the sun. As little can it be required to prove, that in the absence of this clause, congress SOURCES AND SCOPE OF LEGISLATIVE POWERS | 162 would have some choice of means … This clause, as construed by the state of Maryland, would abridge, and almost anni- hilate, this useful and necessary right of the legislature to select its means. That this could not be intended, is, we should think, had it not been already controverted, too apparent for controversy. We think so for the following reasons: 1st. The clause is placed among the powers of Congress, not among the limitations on those powers. 2d. Its terms purport to enlarge, not to diminish, the powers vested in the Government. It purports to be an additional power, not a restriction on those already granted. No reason has been or can be assigned for thus concealing an intention to narrow the discretion of the National Legislature under words which purport to enlarge it. The framers of the Con- stitution wished its adoption, and well knew that it would be endangered by its strength, not by its weakness. Had they been capable of using language which would convey to the eye one idea and, after deep reflection, impress on the mind another, they would rather have disguised the grant of power than its limitation. If, then, their intention had been, by this clause, to restrain the free use of means which might otherwise have been implied, that intention would have been inserted in another place, and would have been expressed in terms resembling these. “In carrying into execution the fore- going powers, and all others,” &c., “no laws shall be passed but such as are necessary and proper.” Had the intention been to make this clause restrictive, it would unquestionably have been so in form, as well as in effect. The result of the most careful and attentive consideration bestowed upon this clause is that, if it does not enlarge, it can- not be construed to restrain, the powers of Congress, or to impair the right of the legislature to exercise its best judgment in the selection of measures to carry into execution the Constitutional powers of the Government. If no other motive for its insertion can be suggested, a sufficient one is found in the desire to remove all doubts respecting the right to legislate on that vast mass of incidental powers which must be involved in the Constitution if that instrument be not a splendid bauble. We admit, as all must admit, that the powers of the Government are limited, and that its limits are not to be transcended. But we think the sound construction of the Constitution must allow to the national legislature that discretion with respect to the means by which the powers it confers are to be carried into execution which will enable that body to per- form the high duties assigned to it in the manner most beneficial to the people. Let the end be legitimate, let it be within the scope of the Constitution, and all means which are appropriate, which are plainly adapted to that end, which are not prohibited, but consist with the letter and spirit of the Constitution, are Constitutional … After the most deliberate consideration, it is the unanimous and decided opinion of this Court that the act to incorporate the Bank of the United States is a law made in pursuance of the Constitution, and is a part of the supreme law of the land. The branches, proceeding from the same stock and being conducive to the complete accomplishment of the object, are equally constitutional … It being the opinion of the Court that the act incorporating the bank is constitutional, and that the power of establishing a branch in the State of Maryland might be properly exercised by the bank itself, we proceed to inquire: 163 | SOURCES AND SCOPE OF LEGISLATIVE POWERS 2. Whether the State of Maryland may, without violating the Constitution, tax that branch? [See McCulloch v. Maryland in the Federalism chapter.] Excerpted by Alexandria Metzdorf § Chae Chan Ping v. United States 130 U.S. 581 (1889) Decision: Affirmed Vote: Unanimous Majority: Field,, joined by Fuller, Miller, Bradley, Harlan, Gray, Blatchford, and Lamar MR. JUSTICE FIELD delivered the opinion of the Court. The appeal involves a consideration of the validity of the Act of Congress of October 1, 1888, prohibiting Chinese labor- ers from entering the United States who had departed before its passage, having a certificate issued under the act of 1882 as amended by the act of 1884, granting them permission to return. The validity of the act is assailed as being in effect an expulsion from the country of Chinese laborers, in violation of existing treaties between the United States and the government of China, and of rights vested in them under the laws of Congress … British subjects in China were often subjected not only to the violence of mobs, but to insults and outrages from local authorities of the country, which led to retaliatory measures for the punishment of the aggressors. To such an extent were these measures carried and such resistance offered to them that in 1856, the two countries were in open war … England requested of the President the concurrence and active cooperation of the United States … [A]s the rights of citizens of the United States might be seriously affected by the results of existing hostilities, and commercial intercourse between the United States and China be disturbed, it was deemed advisable to send to China a minister plenipotentiary to repre- sent our government and watch our interests there. Accordingly, Mr. William B. Reed, of Philadelphia, was appointed such minister, and instructed, while abstaining from any direct interference, to aid by peaceful cooperation the objects the allied forces were seeking to accomplish … Through him a new treaty was negotiated with the Chinese government. It was concluded in June, 1858, and ratified in August of the following year … [A]dditional articles to the treaty of 1858 were agreed upon which gave expression to the general desire that the two nations and their peoples should be drawn closer together. The new articles, eight in number, were agreed to on the 28th of July, 1868, and ratifications of them were exchanged at Pekin in November of the following year … “ARTICLE VI. Citizens of the United States visiting or residing in China shall enjoy the same privileges, immunities, or exemptions in respect to travel or residence as may there be enjoyed by the citizens or subjects of the most favored nation, and reciprocally, Chinese subjects visiting or residing in the United shall enjoy the same privileges, immunities, SOURCES AND SCOPE OF LEGISLATIVE POWERS | 164 and exemptions in respect to travel or residence as may there be enjoyed by the citizens or subjects of the most favored nation. But nothing herein contained shall be held to confer naturalization upon citizens of the United States in China, nor upon the subjects of China in the United States … ” The discovery of gold in California in 1848, as is well known, was followed by a large immigration thither from all parts of the world, attracted not only by the hope of gain from the mines, but from the great prices paid for all kinds of labor. The news of the discovery penetrated China, and laborers came from there in great numbers, a few with their own means, but by far the greater number under contract with employers for whose benefit they worked. These laborers readily secured employment … They were generally industrious and frugal. Not being accompanied by families except in rare instances, their expenses were small and they were content with the simplest fare, such as would not suffice for our laborers and artisans. The competition between them and our people was for this reason altogether in their favor, and the consequent irritation, proportionately deep and bitter, was followed, in many cases, by open conflicts, to the great disturbance of the public peace. The differences of race added greatly to the difficulties of the situation … As they grew in numbers each year, the people of the coast saw, or believed they saw, in the facility of immigration and in the crowded millions of China, where popu- lation presses upon the means of subsistence, great danger that at no distant day that portion of our country would be overrun by them unless prompt action was taken to restrict their immigration. The people there accordingly petitioned earnestly for protective legislation … So urgent and constant were the prayers for relief against existing and anticipated evils, both from the public authorities of the Pacific coast and from private individuals that Congress was impelled to act on the subject. Many persons, how- ever, both in and out of Congress, were of opinion that so long as the treaty remained unmodified, legislation restricting immigration would be a breach of faith with China. A statute was accordingly passed appropriating money to send com- missioners to China to act with our minister there in negotiating and concluding by treaty a settlement of such matters of interest between the two governments as might be confided to them … ","System Instruction: Use only the following information labeled ""Context"". Do not use any other source of information other than what is provided below. Question: According to the Judgement of Myers v. United States is the President legally allowed to remove executive officers of the United States whom he has appointed by and with the advice and consent of the Senate from office? Context: The State Supreme Court’s inclusion of vote counts based on these variant standards exemplifies concerns with the remedial processes that were under way … In addition to these difficulties the actual process by which the votes were to be counted under the Florida Supreme Court’s decision raises further concerns. That order did not specify who would recount the ballots. The county can- vassing boards were forced to pull together ad hoc teams of judges from various Circuits who had no previous training in handling and interpreting ballots. Furthermore, while others were permitted to observe, they were prohibited from objecting during the recount. The recount process, in its features here described, is inconsistent with the minimum procedures necessary to protect the fundamental right of each voter in the special instance of a statewide recount under the authority of a single state judicial officer. Our consideration is limited to the present circumstances, for the problem of equal protection in election processes generally presents many complexities. The question before the Court is not whether local entities, in the exercise of their expertise, may develop different sys- tems for implementing elections. Instead, we are presented with a situation where a state court with the power to assure uniformity has ordered a statewide recount with minimal procedural safeguards. When a court orders a statewide rem- edy, there must be at least some assurance that the rudimentary requirements of equal treatment and fundamental fair- ness are satisfied … Upon due consideration of the difficulties identified to this point, it is obvious that the recount cannot be conducted in compliance with the requirements of equal protection and due process without substantial additional work. It would require not only the adoption (after opportunity for argument) of adequate statewide standards for determining what is a legal vote, and practicable procedures to implement them, but also orderly judicial review of any disputed matters that might arise. In addition, the Secretary has advised that the recount of only a portion of the ballots requires that the vote tabulation equipment be used to screen out undervotes, a function for which the machines were not designed. If a recount of overvotes were also required, perhaps even a second screening would be necessary. Use of the equipment for this purpose, and any new software developed for it, would have to be evaluated for accuracy by the Secretary … Because it is evident that any recount seeking to meet the December 12 date will be unconstitutional for the reasons we have discussed, we reverse the judgment of the Supreme Court of Florida ordering a recount to proceed … None are more conscious of the vital limits on judicial authority than are the Members of this Court, and none stand more in admiration of the Constitution’s design to leave the selection of the President to the people, through their leg- islatures, and to the political sphere. When contending parties invoke the process of the courts, however, it becomes our unsought responsibility to resolve the federal and constitutional issues the judicial system has been forced to confront. The judgment of the Supreme Court of Florida is reversed, and the case is remanded for further proceedings not incon- sistent with this opinion. It is so ordered. STRUCTURE OF THE PRESIDENCY | 60 Excerpted by Alexandria Metzdorf § 61 | STRUCTURE OF THE PRESIDENCY Appointment and Removal Powers Myers v. United States 272 U.S. 52 (1926) Decision: Affirmed Vote: 6-3 Majority: Taft, joined by Van Devanter, Sutherland, Butler, Sanford, Stone Dissent: Holmes Dissent: McReynolds Dissent: Brandeis MR. CHIEF JUSTICE TAFT delivered the opinion of the Court. This case presents the question whether, under the Constitution, the President has the exclusive power of removing exec- utive officers of the United States whom he has appointed by and with the advice and consent of the Senate. Myers … was, on July 21, 1917, appointed by the President, by and with the advice and consent of the Senate, to be a postmaster of the first class at Portland, Oregon, for a term of four years. On January 20, 1920, Myers’ resignation was demanded. He refused the demand. On February 2, 1920, he was removed from office by order of the Postmaster Gen- eral, acting by direction of the President. February 10th, Myers sent a petition to the President and another to the Sen- ate Committee on Post Offices, asking to be heard if any charges were filed. He protested to the Department against his removal, and continued to do so until the end of his term. He pursued no other occupation, and drew compensation for no other service during the interval. On April 21, 1921, he brought this suit in the Court of Claims for his salary from the date of his removal, which, as claimed by supplemental petition filed after July 21, 1921, the end of his term, amounted to $8,838.71 … [By the law] under which Myers was appointed with the advice and consent of the Senate as a first-class postmaster, it is provided that “Postmasters of the first, second and third classes shall be appointed and may be removed by the President by and with the advice and consent of the Senate and shall hold their offices for four years unless sooner removed or suspended accord- ing to law.” The Senate did not consent to the President’s removal of Myers during his term. If this statute, in its requirement that his term should be four years unless sooner removed by the President by and with the consent of the Senate, is valid, the appellant, Myers’ administratrix, is entitled to recover his unpaid salary for his full term, and the judgment of the Court of Claims must be reversed. The Government maintains that the requirement is invalid for the reason that, under Article APPOINTMENT AND REMOVAL POWERS | 62 II of the Constitution the President’s power of removal of executive officers appointed by him with the advice and con- sent of the Senate is full and complete without consent of the Senate … We are therefore confronted by the constitutional question, and cannot avoid it … The question where the power of removal of executive officers appointed by the President by and with the advice and consent of the Senate was vested was presented early in the first session of the First Congress. There is no express pro- vision respecting removals in the Constitution, except as Section 4 of Article II … provides for removal from office by impeachment … It was pointed out in this great debate [constitutional convention] that the power of removal, though equally essential to the executive power is different in its nature from that of appointment. Madison, 1 Annals of Congress, 497 et seq.; Cly- mer, 1 Annals, 489; Sedgwick, 1 Annals, 522; Ames, 1 Annals, 541, 542; Hartley, 1 Annals, 481. A veto by the Senate-a part of the legislative branch of the government-upon removals is a much greater limitation upon the executive branch, and a much more serious blending of the legislative with the executive, than a rejection of a proposed appointment. It is not to be implied. The rejection of a nominee of the President for a particular office does not greatly embarrass him in the conscientious discharge of his high duties in the selection of those who are to aid him, because the President usually has an ample field from which to select for office, according to his preference, competent and capable men. The Senate has full power to reject newly proposed appointees whenever the President shall remove the incumbents. Such a check enables the Senate to prevent the filling of offices with bad or incompetent men, or with those against whom there is ten- able objection. The power to prevent the removal of an officer who has served under the President is different from the authority to con- sent to or reject his appointment. When a nomination is made, it may be presumed that the Senate is, or may become, as well advised as to the fitness of the nominee as the President, but in the nature of things the defects in ability or intel- ligence or loyalty in the administration of the laws of one who has served as an officer under the President are facts as to which the President, or his trusted subordinates, must be better informed than the Senate, and the power to remove him may therefor be regarded as confined for very sound and practical reasons, to the governmental authority which has administrative control. The power of removal is incident to the power of appointment, not to the power of advising and consenting to appointment, and when the grant of the executive power is enforced by the express mandate to take care that the laws be faithfully executed, it emphasizes the necessity for including within the executive power as conferred the exclusive power of removal. … The vesting of the executive power in the President was essentially a grant of the power to execute the laws. But the Pres- ident, alone and unaided, could not execute the laws. He must execute them by the assistance of subordinates. This view has since been repeatedly affirmed by this Court. Wilcox v. Jackson (1839) … It was urged that the natural meaning of the term “executive power” granted the President included the appointment and removal of executive subordinates. If such appointments and removals were not an exercise of the executive power, what were they? They certainly were not the exercise of legislative or judicial power in government as usually understood … It is true that the remedy for the evil of political executive removals of inferior offices is with Congress by a simple expedi- ent, but it includes a change of the power of appointment from the President with the consent of the Senate. Congress 63 | APPOINTMENT AND REMOVAL POWERS must determine first that the office is inferior, and second that it is willing that the office shall be filled by appoint- ment by some other authority than the President with the consent of the Senate. That the latter may be an important consideration is manifest, and is the subject of comment by this Court in its opinion in the case of Shurtleff v. United States, (1903), where this Court said: “To take away this power of removal in relation to an inferior office created by statute, although that statute provided for an appointment thereto by the President and confirmation by the Senate, would require very clear and explicit language. It should not be held to be taken away by mere inference or implication … ” [P]ostmasters were all by law appointed by the Postmaster General. This was because Congress … so provided. But there- after, Congress required certain classes of them to be, as they now are, appointed by the President with the consent of the Senate. This is an indication that Congress deemed appointment by the President with the consent of the Senate essential to the public welfare, and, until it is willing to vest their appointment in the head of the Department, they will be subject to removal by the President alone, and any legislation to the contrary must fall as in conflict with the Consti- tution. Summing up, then, the facts as to acquiescence by all branches of the Government in the legislative decision of 1789, as to executive officers, whether superior or inferior, we find that from 1789 until 1863, a period of 74 years, there was no act of Congress, no executive act, and no decision of this Court at variance with the declaration of the First Congress, but there was, as we have seen, clear, affirmative recognition of it by each branch of the Government. Article II grants to the President … the general administrative control of those executing the laws, including the power of appointment and removal of executive officers … the President’s power of removal is further established as an incident to his specifically enumerated function of appointment by and with the advice of the Senate, but that such incident does not, by implication, extend to removals the Senate’s power of checking appointments, and … to hold otherwise would make it impossible for the President, in case of political or other differences with the Senate or Congress, to take care that the laws be faithfully executed … While this Court has studiously avoided deciding the issue until it was presented in such a way that it could not be avoided, in the references it has made to the history of the question, and in the presumptions it has indulged in favor of a statutory construction not inconsistent with the legislative decision of 1789, it has indicated a trend of view that we should not and cannot ignore. When, on the merits, we find our conclusion strongly favoring the view which prevailed in the First Congress, we have no hesitation in holding that conclusion to be correct, and it therefore follows that the Tenure of Office Act of 1867, insofar as it attempted to prevent the President from removing executive officer who had been appointed by him by and with the advice and consent of the Senate, was invalid, and that subsequent legislation of the same effect was equally so. For the reasons given, we must therefore hold that the provision of the law of 1876, by which the unrestricted power of removal of first class postmasters is denied to the President, is in violation of the Constitution, and invalid. This leads to an affirmance of the judgment of the Court of Claims. Judgment affirmed. APPOINTMENT AND REMOVAL POWERS | 64 Excerpted by Alexandria Metzdorf § Humphrey’s Executor v. United States 295 U.S. 602 (1935) Decision: Affirmed Vote: 9-0 Majority: Sutherland, joined by Hughes, Van Devanter, McReynolds, Brandeis, Butler, Stone, Roberts, and Cardozo Mr. Justice SUTHERLAND delivered the opinion of the Court. Plaintiff brought suit in the Court of Claims against the United States to recover a sum of money alleged to be due the deceased for salary as a Federal Trade Commissioner from October 8, 1933, when the President undertook to remove him from office, to the time of his death on February 14, 1934. The court below has certified to this court two questions … in respect of the power of the President to make the removal. The material facts which give rise to the questions are as follows: William E. Humphrey, the decedent, on December 10, 1931, was nominated by President Hoover to succeed himself as a member of the Federal Trade Commission, and was confirmed by the United States Senate. He was duly commissioned for a term of seven years, expiring September 25, 1938; and, after taking the required oath of office, entered upon his duties. On July 25, 1933, President Roosevelt addressed a letter to the commissioner asking for his resignation, on the ground ‘that the aims and purposes of the Administration with respect to the work of the Commission can be carried out most effectively with personnel of my own selection,’ but disclaiming any reflection upon the commissioner personally or upon his services. The commissioner replied, asking time to consult his friends. After some further correspondence upon the subject, the President on August 31, 1933, wrote the commissioner expressing the hope that the resignation would be forthcoming, and saying: ‘You will, I know, realize that I do not feel that your mind and my mind go along together on either the policies or the administering of the Federal Trade Commission, and, frankly, I think it is best for the people of this country that I should have a full confidence.’ The commissioner declined to resign; and on October 7, 1933, the President wrote him: ‘Effective as of this date you are hereby removed from the office of Commissioner of the Federal Trade Commission.’ Humphrey never acquiesced in this action, but continued thereafter to insist that he was still a member of the commis- sion, entitled to perform its duties and receive the compensation provided by law at the rate of $10,000 per annum. Upon these and other facts set forth in the certificate, which we deem it unnecessary to recite, the following questions are certi- fied: 1. Do the provisions of section 1 of the Federal Trade Commission Act, stating that ‘any commissioner may be removed by the President for inefficiency, neglect of duty, or malfeasance in office’, restrict or limit the power of 65 | APPOINTMENT AND REMOVAL POWERS the President to remove a commissioner except upon one or more of the causes named? If the foregoing question is answered in the affirmative, then— 2. If the power of the President to remove a commissioner is restricted or limited as shown by the foregoing inter- rogatory and the answer made thereto, is such a restriction or limitation valid under the Constitution of the United States?’ The Federal Trade Commission Act … creates a commission of five members to be appointed by the President by and with the advice and consent of the Senate, and section 1 provides: ‘Not more than three of the commissioners shall be members of the same political party. … ‘ [The Act] in part provides that: ‘Unfair methods of competition in commerce are declared unlawful. The commission is empowered and directed to prevent persons, partnerships, or corporations, except banks, and com- mon carriers subject to the Acts to regulate commerce, from using unfair methods of competition in commerce … ‘ First. The question first to be considered is whether, by the provisions of section 1 … the President’s power is limited to removal for the specific causes enumerated therein. The negative contention of the government is based principally upon the decision of this court in Shurtleff v. United States, (1903) … The situation here presented is plainly and wholly different. The statute fixes a term of office, in accordance with many precedents … The words of the act are definite and unambiguous. … The fixing of a definite term subject to removal for cause, unless there be some countervailing provision or circum- stance indicating the contrary, which here we are unable to find, is enough to establish the legislative intent that the term is not to be curtailed in the absence of such cause. But if the intention of Congress that no removal should be made dur- ing the specified term except for one or more of the enumerated causes were not clear upon the face of the statute, as we think it is, it would be made clear by a consideration of the character of the commission and the legislative history which accompanied and preceded the passage of the act. The commission is to be nonpartisan; and it must, from the very nature of its duties, act with entire impartiality. It is charged with the enforcement of no policy except the policy of the law. Its duties are neither political nor executive, but predominantly quasi judicial and quasi legislative. Like the Interstate Commerce Commission, its members are called upon to exercise the trained judgment of a body of experts ‘appointed by law and informed by experience’ … The legislative reports in both houses of Congress clearly reflect the view that a fixed term was necessary to the effective and fair administration of the law … [T]he language of the act, the legislative reports, and the general purposes of the legislation as reflected by the debates, all combine to demonstrate the congressional intent to create a body of experts who shall gain experience by length of service; a body which shall be independent of executive authority, except in its selection, and free to exercise its judgment APPOINTMENT AND REMOVAL POWERS | 66 without the leave or hindrance of any other official … To the accomplishment of these purposes, it is clear that Congress was of opinion that length and certainty of tenure would vitally contribute. And to hold that, nevertheless, the members of the commission continue in office at the mere will of the President, might be to thwart, in large measure, the very ends which Congress sought to realize by definitely fixing the term of office. … Second. To support its contention that the removal provision … is an unconstitutional interference with the executive power of the President, the government’s chief reliance is Myers v. United States (1926) … [T]he narrow point actually decided was only that the President had power to remove a postmaster of the first class, without the advice and consent of the Senate as required by act of Congress. In the course of the opinion of the court, expressions occur which tend to sustain the government’s contention, but these are beyond the point involved and, therefore, do not come within the rule of stare decisis … The office of a postmaster is so essentially unlike the office now involved that the decision in the Myers case cannot be accepted as controlling our decision here. A postmaster is an executive officer restricted to the performance of executive functions. He is charged with no duty at all related to either the legislative or judicial power. The actual decision in the Myers case finds support in the theory that such an officer is merely one of the units in the executive department and, hence, inherently subject to the exclusive and illimitable power of removal by the Chief Executive, whose subordinate and aid he is. Putting aside dicta, which may be followed if sufficiently persuasive but which are not controlling, the nec- essary reach of the decision goes far enough to include all purely executive officers. It goes no farther; much less does it include an officer who occupies no place in the executive department and who exercises no part of the executive power vested by the Constitution in the President. The Federal Trade Commission is an administrative body created by Congress to carry into effect legislative policies embodied in the statute in accordance with the legislative standard therein prescribed, and to perform other specified duties as a legislative or as a judicial aid. Such a body cannot in any proper sense be characterized as an arm or an eye of the executive. Its duties are performed without executive leave and, in the contemplation of the statute, must be free from executive control. In administering the provisions of the statute in respect of ‘unfair methods of competition,’ that is to say, in filling in and administering the details embodied by that general standard, the commission acts in part quasi leg- islatively and in part quasi judicially … To the extent that it exercises any executive function, as distinguished from execu- tive power in the constitutional sense, it does so in the discharge and effectuation of its quasi legislative or quasi judicial powers, or as an agency of the legislative or judicial departments of the government … If Congress is without authority to prescribe causes for removal of members of the trade commission and limit executive power of removal accordingly, that power at once becomes practically all-inclusive in respect of civil officers with the exception of the judiciary provided for by the Constitution … We are thus confronted with the serious question whether not only the members of these quasi legislative and quasi judicial bodies, but the judges of the legislative Court of Claims, exercising judicial power … con- tinue in office only at the pleasure of the President. We think it plain under the Constitution that illimitable power of removal is not possessed by the President in respect of officers of the character of those just named. The authority of Congress, in creating quasi legislative or quasi judicial agencies, to require them to act in discharge of their duties independently of executive control cannot well be doubted. CHIEF JUSTICE REHNQUIST delivered the opinion of the Court. This case presents us with a challenge to the independent counsel provisions of the Ethics in Government Act of 1978 … We hold today that these provisions of the Act do not violate the Appointments Clause of the Constitution, Art. II, § 2, cl. 2, or the limitations of Article III, nor do they impermissibly interfere with the President’s authority under Article II in violation of the constitutional principle of separation of powers. Briefly stated, Title VI of the Ethics in Government Act … allows for the appointment of an “independent counsel” to investigate and, if appropriate, prosecute certain high-ranking Government officials for violations of federal criminal laws … The Act requires the Attorney General, upon receipt of information that he determines is “sufficient to constitute grounds to investigate whether any person [covered by the Act] may have violated any Federal criminal law,” to conduct a preliminary investigation of the matter … If … the Attorney General has determined that there are “reasonable grounds to believe that further investigation or prosecution is warranted,” then he “shall apply to the division of the court for the appointment of an independent counsel … ” With respect to all matters within the independent counsel’s jurisdiction, the Act grants the counsel “full power and independent authority to exercise all investigative and prosecutorial functions and powers of the Department of Justice, the Attorney General, and any other officer or employee of the Department of Justice … ” The functions of the inde- pendent counsel include conducting grand jury proceedings and other investigations, participating in civil and criminal court proceedings and litigation, and appealing any decision in any case in which the counsel participates in an official capacity … the counsel’s powers include “initiating and conducting prosecutions in any court of competent jurisdiction, framing and signing indictments, filing informations, and handling all aspects of any case, in the name of the United States … ” … An independent counsel has “full authority to dismiss matters within [his or her] prosecutorial jurisdiction without conducting an investigation or at any subsequent time before prosecution, if to do so would be consistent” with Department of Justice policy … Two statutory provisions govern the length of an independent counsel’s tenure in office. The first defines the procedure for removing an independent counsel. Section 596(a)(1) provides: “An independent counsel appointed under this chapter may be removed from office, other than by impeachment and conviction, only by the personal action of the Attorney General … ” If an independent counsel is removed pursuant to this section, the Attorney General is required to submit a report to both the Special Division and the Judiciary Committees of the Senate and the House “specifying the facts found and the ultimate grounds for such removal.” § 596(a)(2). Under the current version of the Act, an independent counsel can obtain judicial review of the Attorney General’s action by filing a civil action in the United States District Court for the District of Columbia … The reviewing court is authorized to grant reinstatement or “other appropriate relief.” § 596(a)(3) … The other provision governing the tenure of the independent counsel defines the procedures for “terminating” the coun- sel’s office. Under § 596(b)(1), the office of an independent counsel terminates when he or she notifies the Attorney Gen- eral that he or she has completed or substantially completed any investigations or prosecutions undertaken pursuant to the Act … 69 | APPOINTMENT AND REMOVAL POWERS Finally, the Act provides for congressional oversight of the activities of independent counsel … On April 23, 1986, the Special Division appointed James C. McKay as independent counsel to investigate “whether the testimony of … Olson and his revision of such testimony on March 10, 1983, violated either 18 U. S. C. § 1505 or § 1001, or any other provision of federal law … ” McKay later resigned as independent counsel, and on May 29, 1986, the Division appointed appellant Morrison as his replacement, with the same jurisdiction … [I]n May and June 1987, appellant caused a grand jury to issue and serve … on appellees. All three appellees moved to quash the subpoenas, claiming, among other things, that the independent counsel provisions of the Act were unconsti- tutional and that appellant accordingly had no authority to proceed … The initial question is, accordingly, whether appellant is an “inferior” or a “principal” officer … If she is the latter, as the Court of Appeals concluded, then the Act is in violation of the Appointments Clause. The line between “inferior” and “principal” officers is one that is far from clear, and the Framers provided little guidance into where it should be drawn … [I]n our view appellant clearly falls on the “inferior officer” side of that line. Several factors lead to this conclusion. First, appellant is subject to removal by a higher Executive Branch official. Although appellant may not be “subordinate” to the Attorney General (and the President) insofar as she possesses a degree of independent discretion to exercise the powers delegated to her under the Act, the fact that she can be removed by the Attorney General indicates that she is to some degree “inferior” in rank and authority. Second, appellant is empowered by the Act to perform only certain, limited duties … Admittedly, the Act delegates to appellant “full power and independent authority to exercise all investigative and prosecutorial functions and powers of the Department of Justice,” § 594(a), but this grant of authority does not include any authority to formulate policy for the Government or the Executive Branch, nor does it give appellant any administrative duties outside of those necessary to operate her office. The Act specifically provides that in policy matters appellant is to comply to the extent possible with the policies of the Department … Third, appellant’s office is limited in jurisdiction. Not only is the Act itself restricted in applicability to certain federal officials suspected of certain serious federal crimes, but an independent counsel can only act within the scope of the juris- diction that has been granted by the Special Division pursuant to a request by the Attorney General. Finally, appellant’s office is limited in tenure. There is concededly no time limit on the appointment of a particular counsel. Nonetheless, the office of independent counsel is “temporary” in the sense that an independent counsel is appointed essentially to accomplish a single task, and when that task is over the office is terminated, either by the counsel herself or by action of the Special Division. Unlike other prosecutors, appellant has no ongoing responsibilities that extend beyond the accom- plishment of the mission that she was appointed for and authorized by the Special Division to undertake. In our view, these factors relating to the “ideas of tenure, duration … and duties” of the independent counsel, Germaine, are sufficient to establish that appellant is an “inferior” officer in the constitutional sense. This conclusion is consistent with our few previous decisions that considered the question whether a particular Govern- ment official is a “principal” or an “inferior” officer … APPOINTMENT AND REMOVAL POWERS | 70 Appellees argue that even if appellant is an “inferior” officer, the Clause does not empower Congress to place the power to appoint such an officer outside the Executive Branch. They contend that the Clause does not contemplate congres- sional authorization of “interbranch appointments,” in which an officer of one branch is appointed by officers of another branch. The relevant language of the Appointments Clause is worth repeating. It reads: ” … but the Congress may by Law vest the Appointment of such inferior Officers, as they think proper, in the President alone, in the courts of Law, or in the Heads of Departments.” On its face, the language of this “excepting clause” admits of no limitation on interbranch appointments. Indeed, the inclusion of “as they think proper” seems clearly to give Congress significant discretion to determine whether it is “proper” to vest the appointment of, for example, executive officials in the “courts of Law … ” We also note that the history of the Clause provides no support for appellees’ position … We do not mean to say that Congress’ power to provide for interbranch appointments of “inferior officers” is unlimited. In addition to separation-of-powers concerns, which would arise if such provisions for appointment had the potential to impair the constitutional functions assigned to one of the branches, Ex parte Siebold (1879) itself suggested that Con- gress’ decision to vest the appointment power in the courts would be improper if there was some “incongruity” between the functions normally performed by the courts and the performance of their duty to appoint … In this case, however, we do not think it impermissible for Congress to vest the power to appoint independent counsel in a specially created federal court … We now turn to consider whether the Act is invalid under the constitutional principle of separation of powers. Two related issues must be addressed: The first is whether the provision of the Act restricting the Attorney General’s power to remove the independent counsel to only those instances in which he can show “good cause,” taken by itself, impermis- sibly interferes with the President’s exercise of his constitutionally appointed functions. The second is whether, taken as a whole, the Act violates the separation of powers by reducing the President’s ability to control the prosecutorial powers wielded by the independent counsel. Unlike both Bowsher and Myers, this case does not involve an attempt by Congress itself to gain a role in the removal of executive officials other than its established powers of impeachment and conviction. The Act instead puts the removal power squarely in the hands of the Executive Branch; an independent counsel may be removed from office, “only by the personal action of the Attorney General, and only for good cause.” § 596(a)(1) … There is no requirement of congres- sional approval of the Attorney General’s removal decision, though the decision is subject to judicial review. § 596(a)(3). In our view, the removal provisions of the Act make this case more analogous to Humphrey’s Executor v. United States, (1935), and Wiener v. United States, (1958), than to Myers or Bowsher … Appellees contend that Humphrey’s Executor and Wiener are distinguishable from this case because they did not involve officials who performed a “core executive function.” They argue that our decision in Humphrey’s Executor rests on a distinction between “purely executive” officials and officials who exercise “quasi-legislative” and “quasi-judicial” powers. In their view, when a “purely executive” official is involved, the governing precedent is Myers, not Humphrey’s Executor. And, under Myers, the President must have absolute discretion to discharge “purely” executive officials at will … We undoubtedly did rely on the terms “quasi-legislative” and “quasi-judicial” to distinguish the officials involved in Humphrey’s Executor and Wiener from those in Myers, but our present considered view is that the determination of whether the Constitution allows Congress to impose a “good cause”-type restriction on the President’s power to remove 71 | APPOINTMENT AND REMOVAL POWERS an official cannot be made to turn on whether or not that official is classified as “purely executive … ” The analysis con- tained in our removal cases is designed not to define rigid categories of those officials who may or may not be removed at will by the President … but to ensure that Congress does not interfere with the President’s exercise of the “execu- tive power” and his constitutionally appointed duty to “take care that the laws be faithfully executed” under Article II. Myers was undoubtedly correct in its holding, and in its broader suggestion that there are some “purely executive” officials who must be removable by the President at will if he is to be able to accomplish his constitutional role … But as the Court noted in Wiener: “The assumption was short-lived that the Myers case recognized the President’s inherent constitutional power to remove officials no matter what the relation of the executive to the discharge of their duties and no matter what restrictions Con- gress may have imposed regarding the nature of their tenure … ” [T]he real question is whether the removal restrictions are of such a nature that they impede the President’s ability to perform his constitutional duty, and the functions of the officials in question must be analyzed in that light. Considering for the moment the “good cause” removal provision in isolation from the other parts of the Act at issue in this case, we cannot say that the imposition of a “good cause” standard for removal by itself unduly trammels on executive authority. There is no real dispute that the functions performed by the independent counsel are “executive” in the sense that they are law enforcement functions that typically have been undertaken by officials within the Executive Branch. As we noted above, however, the independent counsel is an inferior officer under the Appointments Clause … we simply do not see how the President’s need to control the exercise of that discretion is so central to the functioning of the Executive Branch as to require as a matter of constitutional law that the counsel be terminable at will by the President … Nor do we think that the “good cause” removal provision at issue here impermissibly burdens the President’s power to control or supervise the independent counsel, as an executive official, in the execution of his or her duties under the Act. This is not a case in which the power to remove an executive official has been completely stripped from the President, thus providing no means for the President to ensure the “faithful execution” of the laws. Rather, because the indepen- dent counsel may be terminated for “good cause,” the Executive, through the Attorney General, retains ample authority to assure that the counsel is competently performing his or her statutory responsibilities in a manner that comports with the provisions of the Act … Here, as with the provision of the Act conferring the appointment authority of the indepen- dent counsel on the special court, the congressional determination to limit the removal power of the Attorney General was essential, in the view of Congress, to establish the necessary independence of the office. We do not think that this limitation as it presently stands sufficiently deprives the President of control over the independent counsel to interfere impermissibly with his constitutional obligation to ensure the faithful execution of the laws … The final question to be addressed is whether the Act, taken as a whole, violates the principle of separation of powers by unduly interfering with the role of the Executive Branch. Time and again we have reaffirmed the importance in our con- stitutional scheme of the separation of governmental powers into the three coordinate branches … We have not hesitated to invalidate provisions of law which violate this principle. On the other hand, we have never held that the Constitution requires that the three branches of Government “operate with absolute independence … ” In the often-quoted words of Justice Jackson: APPOINTMENT AND REMOVAL POWERS | 72 “While the Constitution diffuses power the better to secure liberty, it also contemplates that practice will integrate the dispersed powers into a workable government. It enjoins upon its branches separateness but interdependence, autonomy but reciprocity.” Youngstown Sheet & Tube Co. v. Sawyer, (1952) (concurring opinion). We observe first that this case does not involve an attempt by Congress to increase its own powers at the expense of the Executive Branch … Indeed, with the exception of the power of impeachment — which applies to all officers of the United States — Congress retained for itself no powers of control or supervision over an independent counsel. The Act does empower certain Members of Congress to request the Attorney General to apply for the appointment of an inde- pendent counsel, but the Attorney General has no duty to comply with the request, although he must respond within a certain time limit. § 592(g). Other than that, Congress’ role under the Act is limited to receiving reports or other informa- tion and oversight of the independent counsel’s activities, § 595(a), functions that we have recognized generally as being incidental to the legislative function of Congress … Similarly, we do not think that the Act works any judicial usurpation of properly executive functions. As should be apparent from our discussion of the Appointments Clause above, the power to appoint inferior officers such as indepen- dent counsel is not in itself an “executive” function in the constitutional sense, at least when Congress has exercised its power to vest the appointment of an inferior office in the “courts of Law.” … In addition, once the court has appointed a counsel and defined his or her jurisdiction, it has no power to supervise or control the activities of the counsel. … [T]he various powers delegated by the statute to the Division are not supervisory or administrative, nor are they functions that the Constitution requires be performed by officials within the Executive Branch. The Act does give a federal court the power to review the Attorney General’s decision to remove an independent counsel, but in our view this is a function that is well within the traditional power of the Judiciary. Finally, we do not think that the Act “impermissibly undermine[s]” the powers of the Executive Branch … or “disrupts the proper balance between the coordinate branches [by] prevent[ing] the Executive Branch from accomplishing its con- stitutionally assigned functions … ” It is undeniable that the Act reduces the amount of control or supervision that the Attorney General and, through him, the President exercises over the investigation and prosecution of a certain class of alleged criminal activity … The Act … gives the Executive a degree of control over the power to initiate an investigation by the independent counsel. In addition, the jurisdiction of the independent counsel is defined with reference to the facts submitted by the Attorney General, and once a counsel is appointed, the Act requires that the counsel abide by Justice Department policy unless it is not “possible” to do so. Notwithstanding the fact that the counsel is to some degree “inde- pendent” and free from executive supervision to a greater extent than other federal prosecutors, in our view these features of the Act give the Executive Branch sufficient control over the independent counsel to ensure that the President is able to perform his constitutionally assigned duties. In sum, we conclude today that it does not violate the Appointments Clause for Congress to vest the appointment of independent counsel in the Special Division; that the powers exercised by the Special Division under the Act do not vio- late Article III; and that the Act does not violate the separation-of-powers principle by impermissibly interfering with the functions of the Executive Branch. The decision of the Court of Appeals is therefore Reversed. JUSTICE KENNEDY took no part in the consideration or decision of this case. 73 | APPOINTMENT AND REMOVAL POWERS Original excerpt in Lawrence Lessig, Constitutional Law: Separation of Powers, Federalism, and Fourteenth Amendment, published by H2O. Further excerpted by Alexandria Metzdorf. Licensed under CC BY-NC-SA. § NLRB v. Canning 573 U.S. 513 (2014) Decision: Affirmed Vote: 9-0 Majority: Breyer, joined by Kennedy, Ginsburg, Sotomayor, and Kagan Concurrence: Scalia (in judgment), joined by Roberts, Thomas, and Alito Note: A pro forma session is defined as “From the Latin, meaning ‘as a matter of form,’ a pro forma session is a brief meeting of the Senate, often only a few minutes in duration.” https://www.senate.gov/general/Features/Ses- sions.htm#:~:text=Pro%20Forma%20Session%3A%20From%20the,following%20the%20November%20gen- eral%20elections. Visit https://www.c-span.org/video/?526638-1/senate-pro-forma-session to see the c-span to view a pro forma session. Justice Breyer delivered the opinion of the Court. Ordinarily the President must obtain “the Advice and Consent of the Senate” before appointing an “Office[r] of the United States.” U. S. Const., Art. II, §2, cl. 2. But the Recess Appointments Clause creates an exception. It gives the Pres- ident alone the power “to fill up all Vacancies that may happen during the Recess of the Senate, by granting Commis- sions which shall expire at the End of their next Session.” Art. II, §2, cl. 3. We here consider three questions about the application of this Clause. The first concerns the scope of the words “recess of the Senate.” Does that phrase refer only to an inter-session recess (i.e., a break between formal sessions of Congress), or does it also include an intra-session recess, such as a summer recess in the midst of a session? We conclude that the Clause applies to both kinds of recess. The second question concerns the scope of the words “vacancies that may happen.” Does that phrase refer only to vacan- cies that first come into existence during a recess, or does it also include vacancies that arise prior to a recess but continue to exist during the recess? We conclude that the Clause applies to both kinds of vacancy. The third question concerns calculation of the length of a “recess.” The President made the appointments here at issue on January 4, 2012. At that time the Senate was in recess pursuant to a December 17, 2011, resolution providing for a series of brief recesses punctuated by “pro forma session[s],” with “no business … transacted,” every Tuesday and Friday through January 20, 2012 … In calculating the length of a recess are we to ignore the pro forma sessions, thereby treating the series of brief recesses as a single, month-long recess? We conclude that we cannot ignore these pro forma sessions. APPOINTMENT AND REMOVAL POWERS | 74 Our answer to the third question means that, when the appointments before us took place, the Senate was in the midst of a 3-day recess. Three days is too short a time to bring a recess within the scope of the Clause. Thus we conclude that the President lacked the power to make the recess appointments here at issue. The case before us arises out of a labor dispute. The National Labor Relations Board (NLRB) found that a Pepsi-Cola distributor, Noel Canning, had unlawfully refused to reduce to writing and execute a collective-bargaining agreement with a labor union. The Board ordered the distributor to execute the agreement and to make employees whole for any losses … The Pepsi-Cola distributor subsequently asked the Court of Appeals for the District of Columbia Circuit to set the Board’s order aside. It claimed that three of the five Board members had been invalidly appointed, leaving the Board with- out the three lawfully appointed members necessary for it to act … The three members in question were Sharon Block, Richard Griffin, and Terence Flynn. In 2011 the President had nom- inated each of them to the Board. As of January 2012, Flynn’s nomination had been pending in the Senate awaiting confirmation for approximately a year. The nominations of each of the other two had been pending for a few weeks. On January 4, 2012, the President, invoking the Recess Appointments Clause, appointed all three to the Board. The distributor argued that the Recess Appointments Clause did not authorize those appointments. It pointed out that on December 17, 2011, the Senate, by unanimous consent, had adopted a resolution providing that it would take a series of brief recesses beginning the following day … Pursuant to that resolution, the Senate held pro forma sessions every Tuesday and Friday until it returned for ordinary business on January 23, 2012 … The President’s January 4 appoint- ments were made between the January 3 and January 6 pro forma sessions. In the distributor’s view, each pro forma session terminated the immediately preceding recess. Accordingly, the appointments were made during a 3-day adjourn- ment, which is not long enough to trigger the Recess Appointments Clause. The Court of Appeals agreed that the appointments fell outside the scope of the Clause. But the court set forth different reasons … Since the second session of the 112th Congress began on January 3, 2012, the day before the President’s appointments, those appointments occurred during an intra-session recess, and the appointments consequently fell out- side the scope of the Clause … We asked the parties to address not only the Court of Appeals’ interpretation of the Clause but also the distributor’s initial argument, namely, “[w]hether the President’s recess-appointment power may be exercised when the Senate is con- vening every three days in pro forma sessions … ” … [T]he Recess Appointments Clause reflects the tension between, on the one hand, the President’s continuous need for “the assistance of subordinates,” Myers v. United States, (1926), and, on the other, the Senate’s practice, particularly dur- ing the Republic’s early years, of meeting for a single brief session each year … We seek to interpret the Clause as granting the President the power to make appointments during a recess but not offering the President the authority routinely to avoid the need for Senate confirmation. 75 | APPOINTMENT AND REMOVAL POWERS Second, in interpreting the Clause, we put significant weight upon historical practice. For one thing, the interpretive questions before us concern the allocation of power between two elected branches of Government. Long ago Chief Jus- tice Marshall wrote that “a doubtful question, one on which human reason may pause, and the human judgment be suspended, in the decision of which the great principles of liberty are not concerned, but the respective powers of those who are equally the representa- tives of the people, are to be adjusted; if not put at rest by the practice of the government, ought to receive a considerable impression from that practice.” McCulloch v. Maryland, (1819) … The first question concerns the scope of the phrase “the recess of the Senate … ” The Constitution provides for congres- sional elections every two years. And the 2-year life of each elected Congress typically consists of two formal 1-year ses- sions, each separated from the next by an “inter-session recess … ” The Senate or the House of Representatives announces an inter-session recess by approving a resolution stating that it will “adjourn sine die,” i.e., without specifying a date to return (in which case Congress will reconvene when the next formal session is scheduled to begin). The Senate and the House also take breaks in the midst of a session. The Senate or the House announces any such “intra- session recess” by adopting a resolution stating that it will “adjourn” to a fixed date, a few days or weeks or even months later. All agree that the phrase “the recess of the Senate” covers inter-session recesses. The question is whether it includes intra-session recesses as well. In our view, the phrase “the recess” includes an intra-session recess of substantial length … History … shows only that Congress generally took long breaks between sessions, while taking no significant intra-session breaks at all (five times it took a break of a week or so at Christmas) … In 1867 and 1868, Congress for the first time took substantial, nonholiday intra-session breaks, and President Andrew Johnson made dozens of recess appointments. The Federal Court of Claims upheld one of those specific appointments, writing “[w]e have no doubt that a vacancy occur- ring while the Senate was thus temporarily adjourned” during the “first session of the Fortieth Congress” was “legally filled by appointment of the President alone.” Gould v. United States, (1884) … … [R]estricting the Clause to inter-session recesses would frustrate its purpose. It would make the President’s recess- appointment power dependent on a formalistic distinction of Senate procedure. Moreover, the President has consis- tently and frequently interpreted the word “recess” to apply to intra-session recesses, and has acted on that interpretation. The Senate as a body has done nothing to deny the validity of this practice for at least three-quarters of a century … [A] 3-day recess would be too short … The Adjournments Clause reflects the fact that a 3-day break is not a significant interruption of legislative business. As the Solicitor General says, it is constitutionally de minimis. A Senate recess that is so short that it does not require the consent of the House is not long enough to trigger the President’s recess-appoint- ment power. In sum, we conclude that the phrase “the recess” applies to both intra-session and inter-session recesses. If a Senate recess is so short that it does not require the consent of the House, it is too short to trigger the Recess Appointments Clause. See Art. I, §5, cl. 4. And a recess lasting less than 10 days is presumptively too short as well. Applying this standard, we find that the pro forma sessions were sessions for purposes of the Clause. First, the Senate said it was in session. The Journal of the Senate and the Congressional Record indicate that the Senate convened for a series of twice-weekly “sessions” from December 20 through January 20 … Second, the Senate’s rules make clear that during its pro forma sessions, despite its resolution that it would conduct no business, the Senate retained the power to conduct business. During any pro forma session, the Senate could have con- ducted business simply by passing a unanimous consent agreement … It is consequently unsurprising that the Senate has enacted legislation during pro forma sessions even when it has said that no business will be transacted. Indeed, the Senate passed a bill by unanimous consent during the second pro forma session after its December 17 adjournment … The Recess Appointments Clause responds to a structural difference between the Executive and Legislative Branches: The Executive Branch is perpetually in operation, while the Legislature only acts in intervals separated by recesses. The purpose of the Clause is to allow the Executive to continue operating while the Senate is unavailable. We believe that the Clause’s text, standing alone, is ambiguous. It does not resolve whether the President may make appointments during intra-session recesses, or whether he may fill pre-recess vacancies. But the broader reading better serves the Clause’s struc- tural function. Moreover, that broader reading is reinforced by centuries of history, which we are hesitant to disturb. We thus hold that the Constitution empowers the President to fill any existing vacancy during any recess—intra-session or inter-session—of sufficient length. Given our answer to the last question before us, we conclude that the Recess Appointments Clause does not give the President the constitutional authority to make the appointments here at issue. Because the Court of Appeals reached the same ultimate conclusion (though for reasons we reject), its judgment is affirmed. It is so ordered. Justice Scalia, with whom The Chief Justice, Justice Thomas, and Justice Alito join, concurring in the judgment. Except where the Constitution or a valid federal law provides otherwise, all “Officers of the United States” must be appointed by the President “by and with the Advice and Consent of the Senate.” U. S. Const., Art. II, §2, cl. 2. That general rule is subject to an exception: “The President shall have Power to fill up all Vacancies that may happen during the Recess of the Senate, by granting Commissions which shall expire at the End of their next Session.” Id., §2, cl. 3. This case requires us to decide whether the Recess Appointments Clause authorized three appointments made by President Obama to the National Labor Relations Board in January 2012 without the Senate’s consent. To prevent the President’s recess-appointment power from nullifying the Senate’s role in the appointment process, the Constitution cabins that power in two significant ways. First, it may be exercised only in “the Recess of the Senate,” that is, the intermission between two formal legislative sessions. Second, it may be used to fill only those vacancies that “hap- pen during the Recess,” that is, offices that become vacant during that intermission. Both conditions are clear from the Constitution’s text and struc ture, and both were well understood at the founding. The Court of Appeals correctly held that the appointments here at issue are invalid because they did not meet either condition … The Court’s decision transforms the recess-appointment power from a tool carefully designed to fill a narrow and specific need into a weapon to be wielded by future Presidents against future Senates. To reach that result, the majority casts aside APPOINTMENT AND REMOVAL POWERS | 78 the plain, original meaning of the constitutional text in deference to late-arising historical practices that are ambiguous at best. The majority’s insistence on deferring to the Executive’s untenably broad interpretation of the power is in clear conflict with our precedent and forebodes a diminution of this Court’s role in controversies involving the separation of powers and the structure of government. I concur in the judgment only … The first question presented is whether “the Recess of the Senate,” during which the President’s recess-appointment power is active, is (a) the period between two of the Senate’s formal sessions, or (b) any break in the Senate’s proceedings. I would hold that “the Recess” is the gap between sessions and that the appointments at issue here are invalid because they undisputedly were made during the Senate’s session. The Court’s contrary conclusion—that “the Recess” includes “breaks in the midst of a session,” ante, at 9—is inconsistent with the Constitution’s text and structure, and it requires judicial fabrication of vague, unadministrable limits on the recess-appointment power (thus defined) that overstep the judicial role. And although the majority relies heavily on “historical practice,” no practice worthy of our deference sup- ports the majority’s conclusion on this issue … What does all this amount to? In short: Intra-session recess appointments were virtually unheard of for the first 130 years of the Republic, were deemed unconstitutional by the first Attorney General to address them, were not openly defended by the Executive until 1921, were not made in significant numbers until after World War II, and have been repeatedly criticized as unconstitutional by Senators of both parties. It is astonishing for the majority to assert that this history lends “strong support,” ante, at 11, to its interpretation of the Recess Appointments Clause. The second question presented is whether vacancies that “happen during the Recess of the Senate,” which the President is empowered to fill with recess appointments, are (a) vacancies that arise during the recess, or (b) all vacancies that exist during the recess, regardless of when they arose. I would hold that the recess-appointment power is limited to vacancies that arise during the recess in which they are filled, and I would hold that the appointments at issue here—which undisputedly filled pre-recess vacancies—are invalid for that reason as well as for the reason that they were made during the session. The Court’s contrary conclusion is inconsistent with the Constitution’s text and structure, and it further undermines the balance the Framers struck between Presidential and Senatorial power. Historical practice also fails to support the majority’s conclusion on this issue … In sum: Washington’s and Adams’ Attorneys General read the Constitution to restrict recess appointments to vacancies arising during the recess, and there is no evidence that any of the first four Presidents consciously departed from that reading. The contrary reading was first defended by an executive official in 1823, was vehemently rejected by the Senate in 1863, was vigorously resisted by legislation in place from 1863 until 1940, and is arguably inconsistent with legislation in place from 1940 to the present. The Solicitor General has identified only about 100 appointments that have ever been made under the broader reading, and while it seems likely that a good deal more have been made in the last few decades, there is good reason to doubt that many were made before 1940 (since the appointees could not have been compensated). I can conceive of no sane constitutional theory under which this evidence of “historical practice”—which is actually evi- dence of a long-simmering inter-branch conflict—would require us to defer to the views of the Executive Branch … What the majority needs to sustain its judgment is an ambiguous text and a clear historical practice. What it has is a clear text and an at-best-ambiguous historical practice … 79 | APPOINTMENT AND REMOVAL POWERS The real tragedy of today’s decision is not simply the abolition of the Constitution’s limits on the recess-appointment power and the substitution of a novel framework invented by this Court. It is the damage done to our separation-of- powers jurisprudence more generally. It is not every day that we encounter a proper case or controversy requiring inter- pretation of the Constitution’s structural provisions. Most of the time, the interpretation of those provisions is left to the political branches—which, in deciding how much respect to afford the constitutional text, often take their cues from this Court. We should therefore take every opportunity to affirm the primacy of the Constitution’s enduring principles over the politics of the moment. Our failure to do so today will resonate well beyond the particular dispute at hand. Sad, but true: The Court’s embrace of the adverse-possession theory of executive power (a characterization the majority resists but does not refute) will be cited in diverse contexts, including those presently unimagined, and will have the effect of aggrandizing the Presidency beyond its constitutional bounds and undermining respect for the separation of powers. I concur in the judgment only. Excerpted by Alexandria Metzdorf § Lucia v. SEC 585 U.S. ___ (2018) Decision: Reversed and remanded Vote: 7-2 Majority: Kagan, joined by Roberts, Kennedy, Thomas, Alito, and Gorsuch Concurrence: Thomas, joined by Gorsuch Concur/dissent: Breyer, joined by Ginsburg, and Sotomayor (Part III only) Dissent: Sotomayor, joined by Ginsburg Justice Kagan delivered the opinion of the Court. The Appointments Clause of the Constitution lays out the permissible methods of appointing “Officers of the United States,” a class of government officials distinct from mere employees … This case requires us to decide whether adminis- trative law judges (ALJs) of the Securities and Exchange Commission (SEC or Commission) qualify as such “Officers.” In keeping with Freytag v. Commissioner, (1991), we hold that they do … The SEC has statutory authority to enforce the nation’s securities laws. One way it can do so is by instituting an admin- istrative proceeding against an alleged wrongdoer. By law, the Commission may itself preside over such a proceeding … But the Commission also may, and typically does, delegate that task to an ALJ … The SEC currently has five ALJs. Other staff members, rather than the Commission proper, selected them all … APPOINTMENT AND REMOVAL POWERS | 80 An ALJ assigned to hear an SEC enforcement action has extensive powers—the “authority to do all things necessary and appropriate to discharge his or her duties” and ensure a “fair and orderly” adversarial proceeding … As that list suggests, an SEC ALJ exercises authority “comparable to” that of a federal district judge conducting a bench trial. Butz v. Economou, (1978) … This case began when the SEC instituted an administrative proceeding against petitioner Raymond Lucia and his invest- ment company. Lucia marketed a retirement savings strategy called “Buckets of Money.” In the SEC’s view, Lucia used misleading slideshow presentations to deceive prospective clients. The SEC charged Lucia under the Investment Advis- ers Act, and assigned ALJ Cameron Elliot to adjudicate the case. After nine days of testimony and argument, Judge Elliot issued an initial decision concluding that Lucia had violated the Act and imposing sanctions, including civil penalties of $300,000 and a lifetime bar from the investment industry … On appeal to the SEC, Lucia argued that the administrative proceeding was invalid because Judge Elliot had not been constitutionally appointed. According to Lucia, the Commission’s ALJs are “Officers of the United States” and thus subject to the Appointments Clause … [T]he Commission had left the task of appointing ALJs, including Judge Elliot, to SEC staff members … As a result, Lucia contended, Judge Elliot lacked constitutional authority to do his job … The sole question here is whether the Commission’s ALJs are “Officers of the United States” or simply employees of the Federal Government. The Appointments Clause prescribes the exclusive means of appointing “Officers.” Only the Pres- ident, a court of law, or a head of department can do so. Two decisions set out this Court’s basic framework for distinguishing between officers and employees. Germaine v. US (1879) held that “civil surgeons” (doctors hired to perform various physical exams) were mere employees because their duties were “occasional or temporary” rather than “continuing and permanent … ” Stressing “ideas of tenure [and] dura- tion,” the Court there made clear that an individual must occupy a “continuing” position established by law to qualify as an officer. Buckley v. Valeo (1976) then set out another requirement, central to this case. It determined that members of a federal commission were officers only after finding that they “exercis[ed] significant authority pursuant to the laws of the United States … ” The inquiry thus focused on the extent of power an individual wields in carrying out his assigned functions. Both the amicus and the Government urge us to elaborate on Buckley’s “significant authority” test, but another of our precedents makes that project unnecessary … [I]n Freytag v. Commissioner, (1991), we applied the unadorned “signifi- cant authority” test to adjudicative officials who are near-carbon copies of the Commission’s ALJs. As we now explain, our analysis there (sans any more detailed legal criteria) necessarily decides this case. The officials at issue in Freytag were the “special trial judges” (STJs) of the United States Tax Court. The authority of those judges depended on the significance of the tax dispute before them. In “comparatively narrow and minor matters,” they could both hear and definitively resolve a case for the Tax Court … In more major matters, they could preside over the hearing, but could not issue the final decision; instead, they were to “prepare proposed findings and an opinion” for a regular Tax Court judge to consider … 81 | APPOINTMENT AND REMOVAL POWERS This Court held that the Tax Court’s STJs are officers, not mere employees. Citing Germaine, the Court first found that STJs hold a continuing office established by law … They serve on an ongoing, rather than a “temporary [or] episodic[,] basis”; and their “duties, salary, and means of appointment” are all specified in the Tax Code. For all the reasons we have given, and all those Freytag gave before, the Commission’s ALJs are “Officers of the United States,” subject to the Appointments Clause … This Court has held that “one who makes a timely challenge to the con- stitutional validity of the appointment of an officer who adjudicates his case” is entitled to relief. Ryder v. United States, (1995). Lucia made just such a timely challenge: He contested the validity of Judge Elliot’s appointment before the Com- mission, and continued pressing that claim in the Court of Appeals and this Court. So what relief follows? This Court has also held that the “appropriate” remedy for an adjudication tainted with an appointments violation is a new “hearing before a properly appointed” official … And we add today one thing more. That official cannot be Judge Elliot, even if he has by now received (or receives sometime in the future) a constitutional appointment. Judge Elliot has already both heard Lucia’s case and issued an initial decision on the merits. He cannot be expected to consider the matter as though he had not adjudicated it before. To cure the constitutional error, another ALJ (or the Commission itself) must hold the new hearing to which Lucia is entitled. We accordingly reverse the judgment of the Court of Appeals and remand the case for further proceedings consistent with this opinion. It is so ordered. Note: In June of 2020, Lucia entered a settlement with the SEC which banned Lucia from the securities industry, though he could reapply for admittance, and included a fine of $25,000.00. (see https://www.investmentnews.com/sec-ray-lucia- settle-lawsuit-194238, last accessed on April 27, 2023.) § APPOINTMENT AND REMOVAL POWERS | 82 Executive Privilege United States v. Nixon 418 U.S. 683 (1974) Decision: Affirmed Vote: 8-0 Majority: Burger, joined by Douglas, Brennan, Stewart, White, Marshall, Blackmun, and Powell MR. CHIEF JUSTICE BURGER delivered the opinion of the Court. This litigation presents for review the denial of a motion … to quash a third-party subpoena duces tecum issued … pur- suant to Fed. Rule Crim. Proc. 17 (c). The subpoena directed the President to produce certain tape recordings and doc- uments relating to his conversations with aides and advisers … On March 1, 1974, a grand jury of the United States District Court for the District of Columbia returned an indictment charging seven named individuals with various offenses, including conspiracy to defraud the United States and to obstruct justice. Although he was not designated as such in the indictment, the grand jury named the President, among others, as an unindicted coconspirator … [W]e turn to the claim that the subpoena should be quashed because it demands “confidential conversations between a President and his close advisors that it would be inconsistent with the public interest to produce … ” The first contention is a broad claim that the separation of powers doctrine precludes judicial review of a President’s claim of privilege. The second contention is that if he does not prevail on the claim of absolute privilege, the court should hold as a matter of constitutional law that the privilege prevails over the subpoena duces tecum. In the performance of assigned constitutional duties each branch of the Government must initially interpret the Consti- tution, and the interpretation of its powers by any branch is due great respect from the others. The President’s counsel, as we have noted, reads the Constitution as providing an absolute privilege of confidentiality for all Presidential commu- nications. Many decisions of this Court, however, have unequivocally reaffirmed the holding of Marbury v. Madison, (1803), that “[i]t is emphatically the province and duty of the judicial department to say what the law is … ” Since this Court has consistently exercised the power to construe and delineate claims arising under express powers, it must follow that the Court has authority to interpret claims with respect to powers alleged to derive from enumerated powers … Our system of government “requires that federal courts on occasion interpret the Constitution in a manner at variance with the construction given the document by another branch.” Powell v. McCormack, (1969) … And in Baker v. Carr (1961), the Court stated: 83 | EXECUTIVE PRIVILEGE “Deciding whether a matter has in any measure been committed by the Constitution to another branch of government, or whether the action of that branch exceeds whatever authority has been committed, is itself a delicate exercise in con- stitutional interpretation, and is a responsibility of this Court as ultimate interpreter of the Constitution.” Notwithstanding the deference each branch must accord the others, the “judicial Power of the United States” vested in the federal courts by Art. III, § 1, of the Constitution can no more be shared with the Executive Branch than the Chief Executive, for example, can share with the Judiciary the veto power, or the Congress share with the Judiciary the power to override a Presidential veto. Any other conclusion would be contrary to the basic concept of separation of powers and the checks and balances that flow from the scheme of a tripartite government … We therefore reaffirm that it is the province and duty of this Court “to say what the law is” with respect to the claim of privilege presented in this case. In support of his claim of absolute privilege, the President’s counsel urges two grounds, one of which is common to all governments and one of which is peculiar to our system of separation of powers. The first ground is the valid need for protection of communications between high Government officials and those who advise and assist them in the perfor- mance of their manifold duties; the importance of this confidentiality is too plain to require further discussion … The second ground asserted by the President’s counsel in support of the claim of absolute privilege rests on the doctrine of separation of powers. Here it is argued that the independence of the Executive Branch within its own sphere … insu- lates a President from a judicial subpoena in an ongoing criminal prosecution, and thereby protects confidential Presi- dential communications. However, neither the doctrine of separation of powers, nor the need for confidentiality of high-level communications, without more, can sustain an absolute, unqualified Presidential privilege of immunity from judicial process under all cir- cumstances. The President’s need for complete candor and objectivity from advisers calls for great deference from the courts … [W]e find it difficult to accept the argument that even the very important interest in confidentiality of Presi- dential communications is significantly diminished by production of such material for in camera inspection with all the protection that a district court will be obliged to provide. The impediment that an absolute, unqualified privilege would place in the way of the primary constitutional duty of the Judicial Branch to do justice in criminal prosecutions would plainly conflict with the function of the courts under Art. III. In designing the structure of our Government and dividing and allocating the sovereign power among three co-equal branches, the Framers of the Constitution sought to provide a comprehensive system, but the separate powers were not intended to operate with absolute independence … To read the Art. II powers of the President as providing an absolute privilege as against a subpoena essential to enforce- ment of criminal statutes on no more than a generalized claim of the public interest in confidentiality of nonmilitary and nondiplomatic discussions would upset the constitutional balance of “a workable government” and gravely impair the role of the courts under Art. III. Since we conclude that the legitimate needs of the judicial process may outweigh Presidential privilege, it is necessary to resolve those competing interests in a manner that preserves the essential functions of each branch. The right and indeed the duty to resolve that question does not free the Judiciary from according high respect to the representations made on behalf of the President … EXECUTIVE PRIVILEGE | 84 When he signed the Act into law, President George W. Bush issued a statement declaring his position that § 214 would, “if construed as mandatory rather than advisory, impermissibly interfere with the President’s constitutional authority to formulate the position of the United States, speak for the Nation in international affairs, and determine the terms on which recognition is given to foreign states … ” The President concluded, “U.S. policy regarding Jerusalem has not changed … ” In considering claims of Presidential power this Court refers to Justice Jackson’s familiar tripartite framework from Youngstown Sheet & Tube Co. v. Sawyer, (1952) (concurring opinion) … [W]hen “the President takes measures incompatible with the expressed or implied will of Congress … he can rely only upon his own constitutional powers minus any constitutional powers of Congress over the matter.” To succeed in this third category, the President’s asserted power must be both “exclusive” and “conclusive” on the issue … In this case the Secretary contends that § 214(d) infringes on the President’s exclusive recognition power by “requiring the President to contradict his recognition position regarding Jerusalem in official communications with foreign sover- eigns.” In so doing the Secretary acknowledges the President’s power is “at its lowest ebb … ” Because the President’s refusal to implement § 214(d) falls into Justice Jackson’s third category, his claim must be “scrutinized with caution,” and he may rely solely on powers the Constitution grants to him alone … Recognition is a “formal acknowledgment” that a particular “entity possesses the qualifications for statehood” or “that a particular regime is the effective government of a state … ” Recognition is often effected by an express “written or oral declaration … ” It may also be implied—for example, by concluding a bilateral treaty or by sending or receiving diplo- matic agents … Despite the importance of the recognition power in foreign relations, the Constitution does not use the term “recogni- tion,” either in Article II or elsewhere. The Secretary asserts that the President exercises the recognition power based on the Reception Clause, which directs that the President “shall receive Ambassadors and other public Ministers.” Art. II, § 3. As Zivotofsky notes, the Reception Clause received little attention at the Constitutional Convention … At the time of the founding, however, prominent international scholars suggested that receiving an ambassador was tan- tamount to recognizing the sovereignty of the sending state … It is a logical and proper inference, then, that a Clause directing the President alone to receive ambassadors would be understood to acknowledge his power to recognize other nations … The inference that the President exercises the recognition power is further supported by his additional Article II powers. It is for the President, “by and with the Advice and Consent of the Senate,” to “make Treaties, provided two thirds of the Senators present concur.” Art. II, § 2, cl. 2. In addition, “he shall nominate, and by and with the Advice and Consent of the Senate, shall appoint Ambassadors” as well as “other public Ministers and Consuls.” As a matter of constitutional structure, these additional powers give the President control over recognition decisions. At international law, recognition may be effected by different means, but each means is dependent upon Presidential power. In addition to receiving an ambassador, recognition may occur on “the conclusion of a bilateral treaty,” or the “formal initiation of diplomatic relations,” including the dispatch of an ambassador … The Constitution thus assigns the President means to effect recognition on his own initiative. Congress, by contrast, has no constitutional power that PRESIDENTIAL POWERS IN FOREIGN AFFAIRS | 146 would enable it to initiate diplomatic relations with a foreign nation. Because these specific Clauses confer the recogni- tion power on the President, the Court need not consider whether or to what extent the Vesting Clause, which provides that the “executive Power” shall be vested in the President, provides further support for the President’s action here. Art. II, § 1, cl. 1. The text and structure of the Constitution grant the President the power to recognize foreign nations and governments. The question then becomes whether that power is exclusive. The various ways in which the President may unilaterally effect recognition—and the lack of any similar power vested in Congress—suggest that it is. So, too, do functional con- siderations. Put simply, the Nation must have a single policy regarding which governments are legitimate in the eyes of the United States and which are not. Foreign countries need to know, before entering into diplomatic relations or com- merce with the United States, whether their ambassadors will be received; whether their officials will be immune from suit in federal court; and whether they may initiate lawsuits here to vindicate their rights. These assurances cannot be equivocal … It remains true, of course, that many decisions affecting foreign relations—including decisions that may determine the course of our relations with recognized countries—require congressional action. Congress may “regulate Commerce with foreign Nations,” “establish an uniform Rule of Naturalization,” “define and punish Piracies and Felonies commit- ted on the high Seas, and Offences against the Law of Nations,” “declare War,” “grant Letters of Marque and Reprisal,” and “make Rules for the Government and Regulation of the land and naval Forces … ” Although the President alone effects the formal act of recognition, Congress’ powers, and its central role in making laws, give it substantial authority regarding many of the policy determinations that precede and follow the act of recognition itself. If Congress disagrees with the President’s recognition policy, there may be consequences. Formal recognition may seem a hollow act if it is not accompanied by the dispatch of an ambassador, the easing of trade restrictions, and the con- clusion of treaties. And those decisions require action by the Senate or the whole Congress. In practice, then, the President’s recognition determination is just one part of a political process that may require Con- gress to make laws. The President’s exclusive recognition power encompasses the authority to acknowledge, in a formal sense, the legitimacy of other states and governments, including their territorial bounds. Albeit limited, the exclusive recognition power is essential to the conduct of Presidential duties. The formal act of recognition is an executive power that Congress may not qualify. If the President is to be effective in negotiations over a formal recognition determination, it must be evident to his counterparts abroad that he speaks for the Nation on that precise question … Here, history is not all on one side, but on balance it provides strong support for the conclusion that the recognition power is the President’s alone. As Zivotofsky argues, certain historical incidents can be interpreted to support the posi- tion that recognition is a shared power. But the weight of historical evidence supports the opposite view, which is that the formal determination of recognition is a power to be exercised only by the President … As the power to recognize foreign states resides in the President alone, the question becomes whether § 214(d) infringes on the Executive’s consistent decision to withhold recognition with respect to Jerusalem … Section 214(d) requires that, in a passport or consular report of birth abroad, “the Secretary shall, upon the request of the citizen or the citizen’s legal guardian, record the place of birth as Israel” for a “United States citizen born in the city 147 | PRESIDENTIAL POWERS IN FOREIGN AFFAIRS of Jerusalem.” That is, § 214(d) requires the President, through the Secretary, to identify citizens born in Jerusalem who so request as being born in Israel. But according to the President, those citizens were not born in Israel. As a matter of United States policy, neither Israel nor any other country is acknowledged as having sovereignty over Jerusalem. In this way, § 214(d) “directly contradicts” the “carefully calibrated and longstanding Executive branch policy of neutrality toward Jerusalem.” If the power over recognition is to mean anything, it must mean that the President not only makes the initial, formal recognition determination but also that he may maintain that determination in his and his agent’s statements. This con- clusion is a matter of both common sense and necessity. If Congress could command the President to state a recognition position inconsistent with his own, Congress could override the President’s recognition determination … Although the statement required by § 214(d) would not itself constitute a formal act of recognition, it is a mandate that the Executive contradict his prior recognition determination in an official document issued by the Secretary of State … As a result, it is unconstitutional. This is all the more clear in light of the longstanding treatment of a passport’s place- of-birth section as an official executive statement implicating recognition … The Secretary’s position on this point has been consistent: He will not place information in the place-of-birth section of a passport that contradicts the President’s recognition policy … If a citizen objects to the country listed as sovereign over his place of birth, then the Secretary will accommodate him by listing the city or town of birth rather than the country … But the Secretary will not list a sovereign that contradicts the President’s recognition policy in a passport. Thus, the Secretary will not list “Israel” in a passport as the country containing Jerusalem … From the face of § 214, from the legislative history, and from its reception, it is clear that Congress wanted to express its displeasure with the President’s policy by, among other things, commanding the Executive to contradict his own, earlier stated position on Jerusalem. This Congress may not do. It is true, as Zivotofsky notes, that Congress has substantial authority over passports … The Court does not question the power of Congress to enact passport legislation of wide scope … The problem with § 214(d), however, lies in how Congress exercised its authority over passports. It was an improper act for Congress to “aggrandiz[e] its power at the expense of another branch” by requiring the President to contradict an ear- lier recognition determination in an official document issued by the Executive Branch. Freytag v. Commissioner, (1991). To allow Congress to control the President’s communication in the context of a formal recognition determination is to allow Congress to exercise that exclusive power itself. As a result, the statute is unconstitutional … In holding § 214(d) invalid the Court does not question the substantial powers of Congress over foreign affairs in general or passports in particular. This case is confined solely to the exclusive power of the President to control recognition deter- minations, including formal statements by the Executive Branch acknowledging the legitimacy of a state or government and its territorial bounds. Congress cannot command the President to contradict an earlier recognition determination in the issuance of passports. The judgment of the Court of Appeals for the District of Columbia Circuit is Affirmed. PRESIDENTIAL POWERS IN FOREIGN AFFAIRS | 148 Excerpted by Alexandria Metzdorf Justice Scalia, with whom The Chief Justice and Justice Alito join, dissenting. Before this country declared independence, the law of England entrusted the King with the exclusive care of his king- dom’s foreign affairs. The royal prerogative included the “sole power of sending ambassadors to foreign states, and receiv- ing them at home,” the sole authority to “make treaties, leagues, and alliances with foreign states and princes,” “the sole prerogative of making war and peace,” and the “sole power of raising and regulating fleets and armies.” W. Blackstone, Commentaries. The People of the United States had other ideas when they organized our Government. They considered a sound structure of balanced powers essential to the preservation of just government, and international relations formed no exception to that principle. The People therefore adopted a Constitution that divides responsibility for the Nation’s foreign concerns between the legislative and executive departments. The Constitution gave the President the “executive Power,” authority to send and responsibility to receive ambassadors, power to make treaties, and command of the Army and Navy—though they qual- ified some of these powers by requiring consent of the Senate. Art. II, §§1–3. At the same time, they gave Congress pow- ers over war, foreign commerce, naturalization, and more. Art. I, §8. “Fully eleven of the powers that Article I, §8 grants Congress deal in some way with foreign affairs.” L. Tribe, American Constitutional Law, §5–18, p. 965. This case arises out of a dispute between the Executive and Legislative Branches about whether the United States should treat Jerusalem as a part of Israel. The Constitution contemplates that the political branches will make policy about the territorial claims of foreign nations the same way they make policy about other international matters: The President will exercise his powers on the basis of his views, Congress its powers on the basis of its views. That is just what has happened here. The political branches of our Government agree on the real-world fact that Israel controls the city of Jerusalem … They disagree, however, about how official documents should record the birthplace of an American citizen born in Jerusalem. The Executive does not accept any state’s claim to sovereignty over Jerusalem, and it maintains that the birthplace des- ignation “Israel” would clash with this stance of neutrality. But the National Legislature has enacted a statute that pro- vides: “For purposes of the registration of birth, certification of nationality, or issuance of a passport of a United States citizen born in the city of Jerusalem, the Secretary [of State] shall, upon the request of the citizen or the citizen’s legal guardian, record the place of birth as Israel.” Foreign Relations Authorization Act, Fiscal Year 2003, §214(d). Menachem Zivotofsky’s parents seek enforcement of this statutory right in the issuance of their son’s passport and consular report of birth abroad … Before turning to Presidential power under Article II, I think it well to establish the statute’s basis in congressional power under Article I. Congress’s power to “establish an uniform Rule of Naturalization,” Art. I, §8, cl. 4, enables it to grant American citizenship to someone born abroad. United States v. Wong Kim Ark., (1898). The naturalization power also enables Congress to furnish the people it makes citizens with papers verifying their citizenship—say a consular report of birth abroad (which certifies citizenship of an American born outside the United States) or a passport (which certifies cit- izenship for purposes of international travel). As the Necessary and Proper Clause confirms, every congressional power 149 | PRESIDENTIAL POWERS IN FOREIGN AFFAIRS “carries with it all those incidental powers which are necessary to its complete and effectual execution.” Cohens v. Vir- ginia, (1821). Even on a miserly understanding of Congress’s incidental authority, Congress may make grants of citizen- ship “effectual” by providing for the issuance of certificates authenticating them. One would think that if Congress may grant Zivotofsky a passport and a birth report, it may also require these papers to record his birthplace as “Israel.” … No doubt congressional discretion in executing legislative powers has its limits; Congress’s chosen approach must be not only “necessary” to carrying its powers into execution, but also “proper.” Congress thus may not transcend boundaries upon legislative authority stated or implied elsewhere in the Constitution. But as we shall see, §214(d) does not transgress any such restriction. The Court frames this case as a debate about recognition. Recognition is a sovereign’s official acceptance of a status under international law … To know all this is to realize at once that §214(d) has nothing to do with recognition. Section 214(d) does not require the Secretary to make a formal declaration about Israel’s sovereignty over Jerusalem. And nobody suggests that international custom infers acceptance of sovereignty from the birthplace designation on a passport or birth report, as it does from bilateral treaties or exchanges of ambassadors. Recognition would preclude the United States (as a matter of international law) from later contesting Israeli sovereignty over Jerusalem. But making a notation in a passport or birth report does not encumber the Republic with any international obligations. It leaves the Nation free (so far as international law is con- cerned) to change its mind in the future. That would be true even if the statute required all passports to list “Israel.” But in fact it requires only those passports to list “Israel” for which the citizen (or his guardian) requests “Israel”; all the rest, under the Secretary’s policy, list “Jerusalem.” It is utterly impossible for this deference to private requests to constitute an act that unequivocally manifests an intention to grant recognition. … The best indication that §214(d) does not concern recognition comes from the State Department’s policies concerning Taiwan. According to the Solicitor General, the United States “acknowledges the Chinese position” that Taiwan is a part of China, but “does not take a position” of its own on that issue. Brief for Respondent 51–52. Even so, the State Depart- ment has for a long time recorded the birthplace of a citizen born in Taiwan as “China.” It indeed insisted on doing so until Congress passed a law (on which §214(d) was modeled) giving citizens the option to have their birthplaces recorded as “Taiwan.” The Solicitor General explains that the designation “China” “involves a geographic description, not an asser- tion that Taiwan is … part of sovereign China.” Brief for Respondent 51–52. Quite so. Section 214(d) likewise calls for nothing beyond a “geographic description”; it does not require the Executive even to assert, never mind formally recog- nize, that Jerusalem is a part of sovereign Israel … Even if the Constitution gives the President sole power to extend recognition, it does not give him sole power to make all decisions relating to foreign disputes over sovereignty. To the contrary, a fair reading of Article I allows Congress to decide for itself how its laws should handle these controversies … PRESIDENTIAL POWERS IN FOREIGN AFFAIRS | 150 The Constitution likewise does not give the President exclusive power to determine which claims to statehood and terri- tory “are legitimate in the eyes of the United States,” ante, at 11. Congress may express its own views about these matters by declaring war, restricting trade, denying foreign aid, and much else besides … No consistent or coherent theory supports the Court’s decision … International disputes about statehood and territory are neither rare nor obscure. Leading foreign debates during the 19th century concerned how the United States should respond to revolutions in Latin America, Texas, Mexico, Hawaii, Cuba. During the 20th century, attitudes toward Communist governments in Russia and China became conspicuous subjects of agitation. Disagreements about Taiwan, Kashmir, and Crimea remain prominent today. A President empow- ered to decide all questions relating to these matters, immune from laws embodying congressional disagreement with his position, would have un- controlled mastery of a vast share of the Nation’s foreign affairs. That is not the chief magistrate under which the American People agreed to live when they adopted the national charter. They believed that “[t]he accumulation of all powers, legislative, executive, and judiciary, in the same hands, … may justly be pronounced the very definition of tyranny.” The Federalist No. 47, p. 301 (Madison). For this reason, they did not entrust either the President or Congress with sole power to adopt uncontradictable policies about any subject—foreign- sovereignty disputes included. They instead gave each political department its own powers, and with that the freedom to contradict the other’s policies. Under the Constitution they approved, Congress may require Zivotofsky’s passport and birth report to record his birthplace as Israel, even if that requirement clashes with the President’s preference for neutral- ity about the status of Jerusalem. I dissent. Excerpted by Rorie Solberg § Trump v. Hawaii 585 U.S. ___ (2018) Decision: Reversed and remanded Vote: 5-4 Majority: Roberts, joined by Kennedy, Thomas, Alito, and Gorsuch Concurrence: Kennedy Concurrence: Thomas Dissent: Breyer, joined by Kagan Dissent: Sotomayor, joined by Ginsburg Chief Justice Roberts delivered the opinion of the Court. 151 | PRESIDENTIAL POWERS IN FOREIGN AFFAIRS Under the Immigration and Nationality Act, foreign nationals seeking entry into the United States undergo a vetting process to ensure that they satisfy the numerous requirements for admission. The Act also vests the President with authority to restrict the entry of aliens when- ever he finds that their entry “would be detrimental to the interests of the United States.” 8 U. S. C. §1182(f). Relying on that delegation, the President concluded that it was necessary to impose entry restrictions on nationals of countries that do not share adequate information for an informed entry determination, or that otherwise present national security risks. Presidential Proclamation No. 9645 (Proclamation). The plaintiffs in this litigation, respondents here, challenged the application of those entry restrictions to certain aliens abroad. We now decide whether the President had authority under the Act to issue the Proclamation, and whether the entry policy vio- lates the Establishment Clause of the First Amendment … DHS collected and evaluated data regarding all foreign governments. §1(d). It identified 16 countries as having deficient information-sharing practices and presenting national security concerns, and another 31 countries as “at risk” of similarly failing to meet the baseline. §1(e). The State Department then undertook diplomatic efforts over a 50-day period to encourage all foreign governments to improve their practices. §1(f ). As a result of that effort, numerous countries pro- vided DHS with travel document exemplars and agreed to share information on known or suspected terrorists. Following the 50-day period, the Acting Secretary of Homeland Security concluded that eight countries—Chad, Iran, Iraq, Libya, North Korea, Syria, Venezuela, and Yemen—remained deficient in terms of their risk profile and willingness to provide requested information. The Acting Secretary recommended that the President impose entry restrictions on certain nationals from all of those countries except Iraq … Plaintiffs challenged the Proclamation—except as applied to North Korea and Venezuela—on several grounds. As rele- vant here, they argued that the Proclamation contravenes provisions in the Immigration and Nationality Act (INA) … Plaintiffs further claimed that the Proclamation violates the Establishment Clause of the First Amendment, because it was motivated not by concerns pertaining to national security but by animus toward Islam … The INA establishes numerous grounds on which an alien abroad may be inadmissible to the United States and ineligible for a visa … Congress has also delegated to the President authority to suspend or restrict the entry of aliens in certain cir- cumstances. The principal source of that authority, §1182(f ), enables the President to “suspend the entry of all aliens or any class of aliens” whenever he “finds” that their entry “would be detrimental to the interests of the United States.” Plaintiffs argue that the Proclamation is not a valid exercise of the President’s authority under the INA. In their view, §1182(f ) confers only a residual power to temporarily halt the entry of a discrete group of aliens engaged in harmful conduct. They also assert that the Proclamation violates another provision of the INA— 8 U. S. C. §1152(a)(1)(A)—because it discriminates on the basis of nationality in the issuance of immigrant visas … §1182(f ) exudes deference to the President in every clause. It entrusts to the President the decisions whether and when to suspend entry … whose entry to suspend … for how long … and on what conditions … It is therefore unsurprising that we have previously observed that §1182(f ) vests the President with “ample power” to impose entry restrictions in addition to those elsewhere enumerated in the INA … The Proclamation falls well within this comprehensive delegation. The sole prerequisite set forth in §1182(f ) is that the President “find[ ]” that the entry of the covered aliens “would be detrimental to the interests of the United States.” PRESIDENTIAL POWERS IN FOREIGN AFFAIRS | 152 The President has undoubtedly fulfilled that requirement here … The Proclamation therefore “craft[ed] … country-spe- cific restrictions that would be most likely to encourage cooperation given each country’s distinct circumstances,” while securing the Nation “until such time as improvements occur.” Plaintiffs … argue, as an initial matter, that the Proclamation fails to provide a persuasive rationale for why nationality alone renders the covered foreign nationals a security risk. And they further discount the President’s stated concern about deficient vetting because the Proclamation allows many aliens from the designated countries to enter on nonimmigrant visas. Such arguments are grounded on the premise that §1182(f ) not only requires the President to make a finding that entry “would be detrimental to the interests of the United States,” but also to explain that finding with sufficient detail to enable judicial review. That premise is questionable. But even assuming that some form of review is appropriate, plaintiffs’ attacks on the sufficiency of the President’s findings cannot be sustained. The 12-page Proclamation—which thoroughly describes the process, agency evaluations, and recommendations underlying the President’s chosen restric- tions—is more detailed than any prior order a President has issued under §1182(f ) … Like its predecessors, the Proclamation makes clear that its “conditional restrictions” will remain in force only so long as necessary to “address” the identified “inadequacies and risks” within the covered nations … To that end, the Procla- mation establishes an ongoing process to engage covered nations and assess every 180 days whether the entry restrictions should be modified or terminated. §§4(a), (b). Indeed, after the initial review period, the President determined that Chad had made sufficient improvements to its identity-management protocols, and he accordingly lifted the entry suspension on its nationals … In short, the language of §1182(f ) is clear, and the Proclamation does not exceed any textual limit on the President’s authority … Plaintiffs’ structural argument starts with the premise that §1182(f ) does not give the President authority to counter- mand Congress’s considered policy judgments. The President, they say, may supplement the INA, but he cannot sup- plant it … We may assume that §1182(f ) does not allow the President to expressly override particular provisions of the INA. But plaintiffs have not identified any conflict between the statute and the Proclamation that would implicitly bar the Presi- dent from addressing deficiencies in the Nation’s vetting system … Plaintiffs suggest that the entry restrictions are unnecessary because consular officers can simply deny visas in individual cases when an alien fails to carry his burden of proving admissibility—for example, by failing to produce certified records regarding his criminal history. But that misses the point: A critical finding of the Proclamation is that the failure of certain countries to provide reliable information prevents the Government from accurately determining whether an alien is inadmissible or poses a threat. Proclamation §1(h). Unless consular officers are expected to apply categorical rules and deny entry from those countries across the board, fraudulent or unreliable documentation may thwart their review in individual cases. And at any rate, the INA certainly does not require that systemic problems such as the lack of reliable States, and of compounding the American people into one common mass. Of consequence, when they act, they act in their States. But the measures they adopt do not, on that account, cease to be the measures of the people themselves, or become the measures of the State governments … The assent of the States in their sovereign capacity is implied in calling a convention, and thus submitting that instrument to the people. But the people were at perfect liberty to accept or reject it, and their act was final. It required not the affir- mance, and could not be negatived, by the State Governments. The Constitution, when thus adopted, was of complete obligation, and bound the State sovereignties … From these conventions, the Constitution derives its whole authority. The government proceeds directly from the peo- ple; is ‘ordained and established,’ in the name of the people; and is declared to be ordained, ‘in order to form a more perfect union, establish justice, insure domestic tranquility, and secure the blessings of liberty to themselves and to their posterity.’ The assent of the states, in their sovereign capacity, is implied, in calling a convention, and thus submitting that instrument to the people. But the people were at perfect liberty to accept or reject it; and their act was final. It required not the affirmance, and could not be negatived, by the state governments. The constitution, when thus adopted, was of complete obligation, and bound the state sovereignties … This government is acknowledged by all, to be one of enumerated powers. The principle, that it can exercise only the powers granted to it, would seem too apparent, to have required to be enforced by all those arguments, which its enlight- ened friends, while it was depending before the people, found it necessary to urge; that principle is now universally admitted. But the question respecting the extent of the powers actually granted, is perpetually arising, and will probably continue to arise, so long as our system shall exist … [T]he government of the Union, though limited in its powers, is supreme within its sphere of action. This would seem to result, necessarily, from its nature. It is the government of all; its powers are delegated by all; it represents all, and acts for all. Though any one state may be willing to control its operations, no state is willing to allow others to control them. The nation, on those subjects on which it can act, must necessarily bind its component parts. But this question is not left to mere reason: the people have, in express terms, decided it … Among the enumerated powers, we do not find that of establishing a bank or creating a corporation. But there is no phrase in the instrument which, like the articles of confederation, excludes incidental or implied powers; and which requires that everything granted shall be expressly and minutely described … A constitution, to contain an accurate detail of all the subdivisions of which its great powers will admit, and of all the means by which they may be carried into exe- cution, would partake of the prolixity of a legal code, and could scarcely be embraced by the human mind. It would, probably, never be understood by the public. Its nature, therefore, requires, that only its great outlines should be marked, its important objects designated, and the minor ingredients which compose those objects, be deduced from the nature of the objects themselves. That this idea was entertained by the framers of the American constitution, is not only to be inferred from the nature of the instrument, but from the language. Why else were some of the limitations, found in the 9th section of the 1st article, introduced? It is also, in some degree, warranted, by their having omitted to use any restric- tive term which might prevent its receiving a fair and just interpretation … 161 | SOURCES AND SCOPE OF LEGISLATIVE POWERS Although, among the enumerated powers of government, we do not find the word ‘bank’ or ‘incorporation,’ we find the great powers, to lay and collect taxes; to borrow money; to regulate commerce; to declare and conduct a war; and to raise and support armies and navies. The sword and the purse, all the external relations, and no inconsiderable portion of the industry of the nation, are intrusted to its government. It is not denied, that the powers given to the government imply the ordinary means of execution. That, for example, of raising revenue, and applying it to national purposes, is admitted to imply the power of conveying money from place to place, as the exigencies of the nation may require, and of employing the usual means of conveyance. But it is denied, that the government … may … erect a corporation. On what foundation does this argument rest? On this alone: the power of creating a corporation, is one appertaining to sovereignty, and is not expressly conferred on congress. This is true. But all legislative powers appertain to sovereignty. The original power of giving the law on any subject whatever, is a sovereign power … if the government of the Union is restrained from creating a corporation … on the single reason that the creation of a corporation is an act of sovereignty … there would be some difficulty in sustaining the authority of congress to pass other laws for the accomplishment of the same objects. The government which has a right to do an act, and has imposed on it, the duty of performing that act, must, according to the dictates of reason, be allowed to select the means … those who contend that it may not … take upon themselves the burden of establishing that exception … In America, the powers of sovereignty are divided between the government of the Union, and those of the states. They are each sovereign, with respect to the objects committed to it, and neither sovereign, with respect to the objects commit- ted to the other … Some state constitutions were formed before, some since that of the United States. We cannot believe, that their relation to each other is in any degree dependent upon this circumstance. Their respective powers must, we think, be precisely the same, as if they had been formed at the same time … To [Congress’] enumeration of powers is added, that of making ‘all laws which shall be necessary and proper, for carrying into execution the foregoing powers, and all other powers vested by this constitution, in the government of the United States, or in any department thereof.’ The counsel for the state of Maryland have urged various arguments, to prove that this clause, though, in terms, a grant of power, is not so, in effect; but is really restrictive of the general right, which might otherwise be implied, of selecting means for executing the enumerated powers. In support of this proposition, they have found it necessary to contend, that this clause was inserted for the purpose of conferring on congress the power of mak- ing laws. That, without it, doubts might be entertained, whether congress could exercise its powers in the form of legis- lation … Could it be necessary to say, that a legislature should exercise legislative powers, in the shape of legislation? After allowing each house to prescribe its own course of proceeding, after describing the manner in which a bill should become a law, would it have entered into the mind of a single member of the convention, that an express power to make laws was neces- sary, to enable the legislature to make them? That a legislature, endowed with legislative powers, can legislate, is a propo- sition too self-evident to have been questioned … But the argument which most conclusively demonstrates the error of the construction contended for by the counsel for the state of Maryland, is founded on the intention of the convention, as manifested in the whole clause. To waste time and argument in proving that, without it, congress might carry its powers into execution, would be not much less idle, than to hold a lighted taper to the sun. As little can it be required to prove, that in the absence of this clause, congress SOURCES AND SCOPE OF LEGISLATIVE POWERS | 162 would have some choice of means … This clause, as construed by the state of Maryland, would abridge, and almost anni- hilate, this useful and necessary right of the legislature to select its means. That this could not be intended, is, we should think, had it not been already controverted, too apparent for controversy. We think so for the following reasons: 1st. The clause is placed among the powers of Congress, not among the limitations on those powers. 2d. Its terms purport to enlarge, not to diminish, the powers vested in the Government. It purports to be an additional power, not a restriction on those already granted. No reason has been or can be assigned for thus concealing an intention to narrow the discretion of the National Legislature under words which purport to enlarge it. The framers of the Con- stitution wished its adoption, and well knew that it would be endangered by its strength, not by its weakness. Had they been capable of using language which would convey to the eye one idea and, after deep reflection, impress on the mind another, they would rather have disguised the grant of power than its limitation. If, then, their intention had been, by this clause, to restrain the free use of means which might otherwise have been implied, that intention would have been inserted in another place, and would have been expressed in terms resembling these. “In carrying into execution the fore- going powers, and all others,” &c., “no laws shall be passed but such as are necessary and proper.” Had the intention been to make this clause restrictive, it would unquestionably have been so in form, as well as in effect. The result of the most careful and attentive consideration bestowed upon this clause is that, if it does not enlarge, it can- not be construed to restrain, the powers of Congress, or to impair the right of the legislature to exercise its best judgment in the selection of measures to carry into execution the Constitutional powers of the Government. If no other motive for its insertion can be suggested, a sufficient one is found in the desire to remove all doubts respecting the right to legislate on that vast mass of incidental powers which must be involved in the Constitution if that instrument be not a splendid bauble. We admit, as all must admit, that the powers of the Government are limited, and that its limits are not to be transcended. But we think the sound construction of the Constitution must allow to the national legislature that discretion with respect to the means by which the powers it confers are to be carried into execution which will enable that body to per- form the high duties assigned to it in the manner most beneficial to the people. Let the end be legitimate, let it be within the scope of the Constitution, and all means which are appropriate, which are plainly adapted to that end, which are not prohibited, but consist with the letter and spirit of the Constitution, are Constitutional … After the most deliberate consideration, it is the unanimous and decided opinion of this Court that the act to incorporate the Bank of the United States is a law made in pursuance of the Constitution, and is a part of the supreme law of the land. The branches, proceeding from the same stock and being conducive to the complete accomplishment of the object, are equally constitutional … It being the opinion of the Court that the act incorporating the bank is constitutional, and that the power of establishing a branch in the State of Maryland might be properly exercised by the bank itself, we proceed to inquire: 163 | SOURCES AND SCOPE OF LEGISLATIVE POWERS 2. Whether the State of Maryland may, without violating the Constitution, tax that branch? [See McCulloch v. Maryland in the Federalism chapter.] Excerpted by Alexandria Metzdorf § Chae Chan Ping v. United States 130 U.S. 581 (1889) Decision: Affirmed Vote: Unanimous Majority: Field,, joined by Fuller, Miller, Bradley, Harlan, Gray, Blatchford, and Lamar MR. JUSTICE FIELD delivered the opinion of the Court. The appeal involves a consideration of the validity of the Act of Congress of October 1, 1888, prohibiting Chinese labor- ers from entering the United States who had departed before its passage, having a certificate issued under the act of 1882 as amended by the act of 1884, granting them permission to return. The validity of the act is assailed as being in effect an expulsion from the country of Chinese laborers, in violation of existing treaties between the United States and the government of China, and of rights vested in them under the laws of Congress … British subjects in China were often subjected not only to the violence of mobs, but to insults and outrages from local authorities of the country, which led to retaliatory measures for the punishment of the aggressors. To such an extent were these measures carried and such resistance offered to them that in 1856, the two countries were in open war … England requested of the President the concurrence and active cooperation of the United States … [A]s the rights of citizens of the United States might be seriously affected by the results of existing hostilities, and commercial intercourse between the United States and China be disturbed, it was deemed advisable to send to China a minister plenipotentiary to repre- sent our government and watch our interests there. Accordingly, Mr. William B. Reed, of Philadelphia, was appointed such minister, and instructed, while abstaining from any direct interference, to aid by peaceful cooperation the objects the allied forces were seeking to accomplish … Through him a new treaty was negotiated with the Chinese government. It was concluded in June, 1858, and ratified in August of the following year … [A]dditional articles to the treaty of 1858 were agreed upon which gave expression to the general desire that the two nations and their peoples should be drawn closer together. The new articles, eight in number, were agreed to on the 28th of July, 1868, and ratifications of them were exchanged at Pekin in November of the following year … “ARTICLE VI. Citizens of the United States visiting or residing in China shall enjoy the same privileges, immunities, or exemptions in respect to travel or residence as may there be enjoyed by the citizens or subjects of the most favored nation, and reciprocally, Chinese subjects visiting or residing in the United shall enjoy the same privileges, immunities, SOURCES AND SCOPE OF LEGISLATIVE POWERS | 164 and exemptions in respect to travel or residence as may there be enjoyed by the citizens or subjects of the most favored nation. But nothing herein contained shall be held to confer naturalization upon citizens of the United States in China, nor upon the subjects of China in the United States … ” The discovery of gold in California in 1848, as is well known, was followed by a large immigration thither from all parts of the world, attracted not only by the hope of gain from the mines, but from the great prices paid for all kinds of labor. The news of the discovery penetrated China, and laborers came from there in great numbers, a few with their own means, but by far the greater number under contract with employers for whose benefit they worked. These laborers readily secured employment … They were generally industrious and frugal. Not being accompanied by families except in rare instances, their expenses were small and they were content with the simplest fare, such as would not suffice for our laborers and artisans. The competition between them and our people was for this reason altogether in their favor, and the consequent irritation, proportionately deep and bitter, was followed, in many cases, by open conflicts, to the great disturbance of the public peace. The differences of race added greatly to the difficulties of the situation … As they grew in numbers each year, the people of the coast saw, or believed they saw, in the facility of immigration and in the crowded millions of China, where popu- lation presses upon the means of subsistence, great danger that at no distant day that portion of our country would be overrun by them unless prompt action was taken to restrict their immigration. The people there accordingly petitioned earnestly for protective legislation … So urgent and constant were the prayers for relief against existing and anticipated evils, both from the public authorities of the Pacific coast and from private individuals that Congress was impelled to act on the subject. Many persons, how- ever, both in and out of Congress, were of opinion that so long as the treaty remained unmodified, legislation restricting immigration would be a breach of faith with China. A statute was accordingly passed appropriating money to send com- missioners to China to act with our minister there in negotiating and concluding by treaty a settlement of such matters of interest between the two governments as might be confided to them … ",Legal,Fact Finding,Q&A This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Respond in a bulleted list with additional information for each point.,How can I distinguish different forms of seizures or epilepsy?,"Generalized seizures are produced by electrical impulses from throughout the entire brain, whereas partial seizures are produced (at least initially) by a relatively small part of the brain. The part of the brain generating the seizures is sometimes called the focus. Generalized Seizures • The most common and most dramatic is the generalized convulsion, also called the generalized tonic clonic (“grand mal”) seizure. The patient loses consciousness and usually collapses. There is generalized body stiffening (called the “tonic” phase) for 30 to 60 seconds, followed by violent jerking (the “clonic” phase) for 30 to 60 seconds, after which the patient goes into a deep sleep (the “postictal” or after-seizure phase). During these seizures, injuries and accidents may occur, such as tongue biting and urinary incontinence. • Absence seizures cause a short loss of consciousness (just a few seconds) with few or no other symptoms. The patient, most often a child, typically interrupts an activity and stares blankly. These seizures begin and end abruptly and may occur several times a day. Patients are usually not aware that they are having a seizure, except that they may be aware of “losing time.” • Myoclonic seizures consist of sporadic jerks, usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent, these seizures may result in dropping or involuntarily throwing objects. • Clonic seizures are repetitive, rhythmic jerks that involve both sides of the body at the same time. • Tonic seizures are characterized by stiffening of the muscles. • Atonic seizures consist of a sudden and general loss of muscle tone, particularly in the arms and legs, which often result in a fall. Partial Seizures Partial seizures are divided into simple, complex, and those that evolve into (secondary) generalized seizures. The difference between simple and complex partial seizures is that during simple partial seizures, patients retain awareness; during complex partial seizures, they lose awareness. • Simple partial seizures are further subdivided into four categories according to the nature of their symptoms: motor, sensory, autonomic or psychological. o Motor symptoms include movements such as jerking and stiffening. o Sensory symptoms caused by seizures involve unusual sensations affecting any of the five senses (vision, hearing, smell, taste or touch). o When simple partial seizures cause sensory symptoms only (and no motor symptoms), they are called “auras.” o The only common autonomic symptom is a peculiar sensation in the stomach that is experienced by many patients with temporal lobe epilepsy. o Finally, simple partial seizures with psychological symptoms are characterized by various experiences involving memory (the sensation of deja-vu), emotions (such as fear or pleasure), or other complex psychological phenomena. • Complex partial seizures, by definition, include impairment of awareness. Patients seem to be “out of touch,” “out of it” or “staring into space” or “in a trance” during these seizures. There are often odd movements called automatisms, which are involuntary but coordinated movements that tend to be purposeless and repetitive. Common automatisms include lip smacking, chewing, fidgeting and walking. • The third kind of partial seizure is one that begins as a focal seizure and evolves into a generalized convulsive (“tonic clonic”) seizure. Most types of seizures occur in different types of epilepsy, and most patients with epilepsy experience more than one seizure type. This is because seizures are only symptoms. Therefore, it is essential that your neurologist diagnose your type of EPILEPSY, not just the type(s) of SEIZURE you are having. Epilepsy can be divided into two broad categories: idiopathic and symptomatic. Idiopathic epilepsy is caused by genetic factors, as opposed to brain damage. Symptomatic epilepsy is caused by physical defects in the brain. Based on the type of seizure affecting the patient, idiopathic and symptomatic epilepsies can be further categorized. Type 1: Idiopathic Generalized Epilepsy • This is a genetic and inherited group of disorders, so there is often, but not always, a family history of epilepsy. • Idiopathic generalized epilepsy tends to appear during childhood or adolescence, although it may not be diagnosed until adulthood. • In this type of epilepsy, there are no nervous system abnormalities other than the seizures; the brain is structurally normal. • People with idiopathic generalized epilepsy have normal intelligence, and the results of the neurological examination and brain scan are normal. • The results of the electroencephalogram (EEG - a test which measures electrical impulses in the brain) are also normal, except for the discharges associated with epilepsy. • The types of seizures affecting patients with idiopathic generalized epilepsy may include myoclonic, absence, and generalized tonic-clonic seizures, with one type predominating. Idiopathic generalized epilepsy is usually treated with medications and is a condition that is commonly outgrown, as in childhood absence epilepsy. Type 2: Idiopathic Partial Epilepsies • Idiopathic partial epilepsy begins in childhood (between ages 5 and 8) and runs in families. • Also known as benign focal epilepsy of childhood or benign Rolandic epilepsy, this is one of the mildest types of epilepsy. • It is almost always outgrown by puberty and is never diagnosed in adults. • Seizures tend to occur during sleep and are most often simple partial motor seizures that involve the face and secondarily generalized (grand mal) seizures. Type 3: Symptomatic Generalized Epilepsy • This is caused by widespread brain damage, and injury during birth is the most common cause. • When the cause of symptomatic general epilepsy cannot be identified, the disorder may be referred to as cryptogenic epilepsy. • Specific, inherited brain diseases, such as adrenoleukodystrophy (ADL, which was featured in the movie “Lorenzo’s Oil”), or brain infections (such as meningitis and encephalitis) can also cause symptomatic generalized epilepsy. • In addition to seizures, these patients often have other neurological problems, such as developmental delay, mental retardation or cerebral palsy. • These epilepsies include different subtypes—the most typical is the Lennox-Gastaut syndrome. Multiple types of seizures (generalized tonic-clonic, tonic, myoclonic, tonic, atonic and absence seizures) are common and can be difficult to control. Type 4: Symptomatic Partial Epilepsy • This is the most common type of epilepsy to begin in adulthood. • It is caused by a localized abnormality of the brain, which can result from strokes, tumors, trauma, scarring or “sclerosis” of brain tissue (common in the temporal lobe), cysts or infections. • Sometimes these brain abnormalities can be seen on magnetic resonance imaging (MRI) scans, but often they cannot be identified, despite repeated attempts, because they are microscopic. • When the cause of symptomatic partial epilepsy cannot be identified, the disorder may be referred to as cryptogenic epilepsy. The diagnosis is based on: • The patient’s medical history, including any family history of seizures, associated medical conditions and current medications. Some important questions you will be asked include: o At what age did the seizures begin? o What circumstances surrounded your first seizure? o What factors seem to bring on the seizures? o What do you feel before, during and after the seizures? o How long do the seizures last? o Have you been treated for epilepsy before? What medications were prescribed and in what dosages? Was the treatment effective? o Others who have often seen you before, during and after seizures, such as family and close friends, should be present to provide details of your seizures if they involve loss of consciousness. • A complete physical and neurological examination —your muscle strength, reflexes, eye sight, hearing and ability to detect various sensations are tested so your doctors can better understand the cause of your seizures • An electroencephalogram (EEG), which measures electrical impulses in the brain. o This is the only test that directly detects electrical activity in the brain, and seizures are defined by abnormal electrical activity in the brain. During an EEG, electrodes (small metal disks) are attached to specific locations on your head. The electrodes are attached to a monitor to record the brain’s electrical activity. The EEG is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy. o A routine EEG only records about 20 minutes of brain waves (however, the routine EEG procedure takes about 90 minutes). Because 20 minutes is such a short amount of time, the results of routine EEG studies are often normal, even in people known to have epilepsy. Therefore, prolonged EEG monitoring may be necessary. Prolonged o EEG-video monitoring is an even better diagnostic method. During this type of monitoring, an EEG monitors the brain’s activity and cameras videotape body movements and behavior during a seizure. Prolonged monitoring often requires the patient to spend time in a special facility for several days. Prolonged EEG-video monitoring is the only definitive way to diagnose epilepsy. • Imaging studies of the brain, such as those provided by magnetic resonance imaging (MRI). This can identify the cause of the seizures, but the vast majority of patients with epilepsy have normal MRIs.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Respond in a bulleted list with additional information for each point. How can I distinguish different forms of seizures or epilepsy? Generalized seizures are produced by electrical impulses from throughout the entire brain, whereas partial seizures are produced (at least initially) by a relatively small part of the brain. The part of the brain generating the seizures is sometimes called the focus. Generalized Seizures • The most common and most dramatic is the generalized convulsion, also called the generalized tonic clonic (“grand mal”) seizure. The patient loses consciousness and usually collapses. There is generalized body stiffening (called the “tonic” phase) for 30 to 60 seconds, followed by violent jerking (the “clonic” phase) for 30 to 60 seconds, after which the patient goes into a deep sleep (the “postictal” or after-seizure phase). During these seizures, injuries and accidents may occur, such as tongue biting and urinary incontinence. • Absence seizures cause a short loss of consciousness (just a few seconds) with few or no other symptoms. The patient, most often a child, typically interrupts an activity and stares blankly. These seizures begin and end abruptly and may occur several times a day. Patients are usually not aware that they are having a seizure, except that they may be aware of “losing time.” • Myoclonic seizures consist of sporadic jerks, usually on both sides of the body. Patients sometimes describe the jerks as brief electrical shocks. When violent, these seizures may result in dropping or involuntarily throwing objects. • Clonic seizures are repetitive, rhythmic jerks that involve both sides of the body at the same time. • Tonic seizures are characterized by stiffening of the muscles. • Atonic seizures consist of a sudden and general loss of muscle tone, particularly in the arms and legs, which often result in a fall. Partial Seizures Partial seizures are divided into simple, complex, and those that evolve into (secondary) generalized seizures. The difference between simple and complex partial seizures is that during simple partial seizures, patients retain awareness; during complex partial seizures, they lose awareness. • Simple partial seizures are further subdivided into four categories according to the nature of their symptoms: motor, sensory, autonomic or psychological. o Motor symptoms include movements such as jerking and stiffening. o Sensory symptoms caused by seizures involve unusual sensations affecting any of the five senses (vision, hearing, smell, taste or touch). o When simple partial seizures cause sensory symptoms only (and no motor symptoms), they are called “auras.” o The only common autonomic symptom is a peculiar sensation in the stomach that is experienced by many patients with temporal lobe epilepsy. o Finally, simple partial seizures with psychological symptoms are characterized by various experiences involving memory (the sensation of deja-vu), emotions (such as fear or pleasure), or other complex psychological phenomena. • Complex partial seizures, by definition, include impairment of awareness. Patients seem to be “out of touch,” “out of it” or “staring into space” or “in a trance” during these seizures. There are often odd movements called automatisms, which are involuntary but coordinated movements that tend to be purposeless and repetitive. Common automatisms include lip smacking, chewing, fidgeting and walking. • The third kind of partial seizure is one that begins as a focal seizure and evolves into a generalized convulsive (“tonic clonic”) seizure. Most types of seizures occur in different types of epilepsy, and most patients with epilepsy experience more than one seizure type. This is because seizures are only symptoms. Therefore, it is essential that your neurologist diagnose your type of EPILEPSY, not just the type(s) of SEIZURE you are having. Epilepsy can be divided into two broad categories: idiopathic and symptomatic. Idiopathic epilepsy is caused by genetic factors, as opposed to brain damage. Symptomatic epilepsy is caused by physical defects in the brain. Based on the type of seizure affecting the patient, idiopathic and symptomatic epilepsies can be further categorized. Type 1: Idiopathic Generalized Epilepsy • This is a genetic and inherited group of disorders, so there is often, but not always, a family history of epilepsy. • Idiopathic generalized epilepsy tends to appear during childhood or adolescence, although it may not be diagnosed until adulthood. • In this type of epilepsy, there are no nervous system abnormalities other than the seizures; the brain is structurally normal. • People with idiopathic generalized epilepsy have normal intelligence, and the results of the neurological examination and brain scan are normal. • The results of the electroencephalogram (EEG - a test which measures electrical impulses in the brain) are also normal, except for the discharges associated with epilepsy. • The types of seizures affecting patients with idiopathic generalized epilepsy may include myoclonic, absence, and generalized tonic-clonic seizures, with one type predominating. Idiopathic generalized epilepsy is usually treated with medications and is a condition that is commonly outgrown, as in childhood absence epilepsy. Type 2: Idiopathic Partial Epilepsies • Idiopathic partial epilepsy begins in childhood (between ages 5 and 8) and runs in families. • Also known as benign focal epilepsy of childhood or benign Rolandic epilepsy, this is one of the mildest types of epilepsy. • It is almost always outgrown by puberty and is never diagnosed in adults. • Seizures tend to occur during sleep and are most often simple partial motor seizures that involve the face and secondarily generalized (grand mal) seizures. Type 3: Symptomatic Generalized Epilepsy • This is caused by widespread brain damage, and injury during birth is the most common cause. • When the cause of symptomatic general epilepsy cannot be identified, the disorder may be referred to as cryptogenic epilepsy. • Specific, inherited brain diseases, such as adrenoleukodystrophy (ADL, which was featured in the movie “Lorenzo’s Oil”), or brain infections (such as meningitis and encephalitis) can also cause symptomatic generalized epilepsy. • In addition to seizures, these patients often have other neurological problems, such as developmental delay, mental retardation or cerebral palsy. • These epilepsies include different subtypes—the most typical is the Lennox-Gastaut syndrome. Multiple types of seizures (generalized tonic-clonic, tonic, myoclonic, tonic, atonic and absence seizures) are common and can be difficult to control. Type 4: Symptomatic Partial Epilepsy • This is the most common type of epilepsy to begin in adulthood. • It is caused by a localized abnormality of the brain, which can result from strokes, tumors, trauma, scarring or “sclerosis” of brain tissue (common in the temporal lobe), cysts or infections. • Sometimes these brain abnormalities can be seen on magnetic resonance imaging (MRI) scans, but often they cannot be identified, despite repeated attempts, because they are microscopic. • When the cause of symptomatic partial epilepsy cannot be identified, the disorder may be referred to as cryptogenic epilepsy. The diagnosis is based on: • The patient’s medical history, including any family history of seizures, associated medical conditions and current medications. Some important questions you will be asked include: o At what age did the seizures begin? o What circumstances surrounded your first seizure? o What factors seem to bring on the seizures? o What do you feel before, during and after the seizures? o How long do the seizures last? o Have you been treated for epilepsy before? What medications were prescribed and in what dosages? Was the treatment effective? o Others who have often seen you before, during and after seizures, such as family and close friends, should be present to provide details of your seizures if they involve loss of consciousness. • A complete physical and neurological examination —your muscle strength, reflexes, eye sight, hearing and ability to detect various sensations are tested so your doctors can better understand the cause of your seizures • An electroencephalogram (EEG), which measures electrical impulses in the brain. o This is the only test that directly detects electrical activity in the brain, and seizures are defined by abnormal electrical activity in the brain. During an EEG, electrodes (small metal disks) are attached to specific locations on your head. The electrodes are attached to a monitor to record the brain’s electrical activity. The EEG is useful not only to confirm a diagnosis of epilepsy, but also to determine the type of epilepsy.",Medical,Concept Comparison,Q&A The user will provide a question. Answer based exclusively on the context block. Do not use any outside knowledge or any prior knowledge.,What could cause the flavor of my espresso to be kind of charred?,"Thank you for choosing the Capresso Steam PRO Espresso & Cappuccino Machine. It is the perfect starter machine for espressos, cappuccinos and lattes. With a bit of practice you will be able to produce two to four cappuccinos or lattes at a time. Please read all of the instructions in this booklet before operating your new machine. Understanding and complying with these instructions is essential to ensure that the machine is utilized without risk and to ensure safety during operation and maintenance. 2. HOW TO REACH JURA-CAPRESSO Should you require further information or if particular problems occur that are not covered in this manual, please • CALL our toll free HELP LINE: 1-800-767-3554 Monday -Thursday 8AM to 9PM, Friday 8AM to 8PM and Saturday 9AM to 5PM Eastern Standard Time. Feel free to call at any time. If you are connected to our voicemail, PLEASE DO NOT HANG UP. Leave your name, telephone number and we will return your call. Please also leave the model number of your Capresso product, in this case it is #304. • FAX us at 1-201-767-9684 • E-MAIL us at contact@jura-capresso.com • VISIT our website at www.capresso.com • WRITE to Jura Capresso, Inc., Customer Service, P.O. Box 775, Closter, NJ 07624 3. DE-PRESSURIZING CAUTION! Never open the boiler cap and never remove the filter holder as long as there is pressure in the boiler container. In order to check if the machine is still under pressure follow these steps: 1. The machine is on, the filter holder is inserted and the boiler cap is closed. 2. Place an empty cup under the frother nozzle (fig. 10). 3. Move the coffee/steam selector to the steam symbol (fig. 8). 4. Open the steam knob (fig. 9). Wait until all steam is released. 6 5. Turn the power switch off (fig. 6). 6. Open and remove the boiler cap (see chapter 5) 7. It is now safe to remove the filter holder. 8. Move the coffee/steam selector to the cup symbol (fig. 8). Caution: Never try to remove the filter holder with the carafe in place. Pressure could force the filter holder down, smashing the carafe and causing severe injuries. Always remove the carafe first. Caution: Never leave machine unattended when it is turned on (red light in the power switch is illuminated). Always turn the machine off when finished. 5. SAFETY BOILER CAP To open the boiler cap: turn the cap a quarter turn counter clockwise. Slightly lift the cap and turn another quarter turn counter clockwise and lift the cap. To close the boiler cap: Place the cap onto the boiler neck and turn clockwise until cap sinks into the groove. Continue turning the cap until firmly locked. 6. HELPFUL HINTS • Espresso Drink: An espresso is a far richer drink with a more intense taste than regular brewed drip coffee. An espresso is normally 1 1/2 to 2 oz. of strong coffee. Espresso should be served immediately after brewing. If the espresso is too strong, you can add hot water. Add sugar to taste. • Preparing espresso is different than preparing regular drip coffee. The machine works under pressure, bringing the water to a boil and then forcing it through the ground coffee in a short period of time. • Important: The water in the boiler of the machine will get hotter during the brewing process. Towards the end of the brewing process the water will be so hot that it would burn your espresso. Therefore you never want to process all the water through the coffee as this will result in a burnt taste. • Which Coffee? Any coffee labeled ""espresso"" is suitable for your machine. Any coffee with at least 80% Arabica beans is ideal for espresso preparation. Check with your local coffee store • Which Grind? Steam boiler espresso machines, do not require a fine espresso grind. For maximum flavor and aroma we recommend a medium espresso grind or a fine drip grind. If you grind your own coffee we recommend using a burr or disk/burr grinder. Small blade grinders can create ""coffee dust"". Coffee dust can dramatically slow down the water flow during brewing resulting in bitter and overheated coffee taste. • Cappuccino: 1 1/2 to 2 oz. of espresso coffee with 3 to 4 oz. of steamed and frothed milk on top. Sprinkle chocolate shavings or cinnamon on top of 7 the milk froth. For a stronger taste increase the amount of coffee. For a milder taste increase the amount of milk. • Latte: 1 1/2 to 2 oz. of espresso coffee with 3 to 4 oz. of steamed milk (very little or no milk froth). • Frothing: Foamy layer of milk froth on top of hot milk. • Which kind of milk? Skim milk and 1% milk will produce more milk froth than 2% or regular milk. • Markings on Glass Carafe: The markings on the glass carafe help you in the preparation of brewing and frothing. Upper rim of metal band: Maximum capacity of boiler (approx. 10 oz.). For best results always fill the boiler with 10 oz. of fresh cold water. 4 cup marking: Maximum amount of espresso you should brew (approx. 8 oz.). If you brew more than 8 oz. the coffee will taste burnt. Depending on the coffee roast you might even want to brew a little less to avoid a bitter aroma. 2 cup marking: (approx. 4 oz.), guide line for a double shot of espresso. Bottom line marking: Once the coffee has reached this level there is enough pressure in the boiler for steaming and frothing. 7. PREPARING ESPRESSO Caution: Do not leave the machine alone during brewing. Keep children away during brewing. 1. Make sure the machine is plugged in and turned off. The glass carafe is removed from the drip tray. Important: The steam knob (fig. 9) must be in the closed position. The coffee/steam selector points to the cup symbol in front of the machine (stronger coffee). Moving the coffee/steam selector to the right, accelerates brewing and decreases coffee strength. 2. Fill the basket with ground coffee, using the measuring scoop (fig.1). The basket is marked on the inside indicating ""2 cups"" and ""4 cups"". Never overfill the basket. Clear any excess coffee from the rim of the filter holder. Important: it is not necessary to tamp (press down) the coffee. 3. Insert the basket into the filter holder (fig. 2), then insert the filter holder into the machine (fig. 3). 4. Turn filter holder to the right until it reaches the ""locked"" position (fig.1,8). 5. Fill the glass carafe to the upper rim of the metal band (approx. 10 oz.) with fresh, cold water. 6. Unscrew the boiler cap (see chapter 5). Using the glass carafe, fill the boiler with water (fig. 4) and close the boiler cap securely (see chapter 5). 7. Place the carafe lid on the carafe so that the opening on the lid points towards the pouring spout of the carafe (fig. 7). Place the carafe on the drip tray as shown in fig. 1. 8. Turn the power switch on (fig. 6). The power switch illuminates and the machine starts heating the water. 9. After approx. 2 1/2 to 3 minutes hot water will start forcing its way through the filter holder into the carafe. When you have enough espresso in the glass carafe turn the power switch off and turn the coffee/steam selector to the steam symbol on the left to stop the flow. Remove the carafe and serve. Add a bit of sugar and enjoy. Tip: To avoid a ""burnt taste"" never process all the water through the coffee. Once the brewing noise increases and steam develops, stop the brewing. 8 10. Important: Do not open the boiler cap. Do not remove the filter holder. First depressurize the machine. See chapter 3. 11. After de-pressurizing remove the filter holder by turning it to the left to the ""open lock"" symbol. Then push the thumb-guard of filter holder over the hot rim of the basket. Dump the used coffee (fig. 13) and rinse the basket and the filter holder under running water. Return the coffee/steam selector to the cup symbol.","The user will provide a question. Answer based exclusively on the context block. Do not use any outside knowledge or any prior knowledge. Thank you for choosing the Capresso Steam PRO Espresso & Cappuccino Machine. It is the perfect starter machine for espressos, cappuccinos and lattes. With a bit of practice you will be able to produce two to four cappuccinos or lattes at a time. Please read all of the instructions in this booklet before operating your new machine. Understanding and complying with these instructions is essential to ensure that the machine is utilized without risk and to ensure safety during operation and maintenance. 2. HOW TO REACH JURA-CAPRESSO Should you require further information or if particular problems occur that are not covered in this manual, please • CALL our toll free HELP LINE: 1-800-767-3554 Monday -Thursday 8AM to 9PM, Friday 8AM to 8PM and Saturday 9AM to 5PM Eastern Standard Time. Feel free to call at any time. If you are connected to our voicemail, PLEASE DO NOT HANG UP. Leave your name, telephone number and we will return your call. Please also leave the model number of your Capresso product, in this case it is #304. • FAX us at 1-201-767-9684 • E-MAIL us at contact@jura-capresso.com • VISIT our website at www.capresso.com • WRITE to Jura Capresso, Inc., Customer Service, P.O. Box 775, Closter, NJ 07624 3. DE-PRESSURIZING CAUTION! Never open the boiler cap and never remove the filter holder as long as there is pressure in the boiler container. In order to check if the machine is still under pressure follow these steps: 1. The machine is on, the filter holder is inserted and the boiler cap is closed. 2. Place an empty cup under the frother nozzle (fig. 10). 3. Move the coffee/steam selector to the steam symbol (fig. 8). 4. Open the steam knob (fig. 9). Wait until all steam is released. 6 5. Turn the power switch off (fig. 6). 6. Open and remove the boiler cap (see chapter 5) 7. It is now safe to remove the filter holder. 8. Move the coffee/steam selector to the cup symbol (fig. 8). Caution: Never try to remove the filter holder with the carafe in place. Pressure could force the filter holder down, smashing the carafe and causing severe injuries. Always remove the carafe first. Caution: Never leave machine unattended when it is turned on (red light in the power switch is illuminated). Always turn the machine off when finished. 5. SAFETY BOILER CAP To open the boiler cap: turn the cap a quarter turn counter clockwise. Slightly lift the cap and turn another quarter turn counter clockwise and lift the cap. To close the boiler cap: Place the cap onto the boiler neck and turn clockwise until cap sinks into the groove. Continue turning the cap until firmly locked. 6. HELPFUL HINTS • Espresso Drink: An espresso is a far richer drink with a more intense taste than regular brewed drip coffee. An espresso is normally 1 1/2 to 2 oz. of strong coffee. Espresso should be served immediately after brewing. If the espresso is too strong, you can add hot water. Add sugar to taste. • Preparing espresso is different than preparing regular drip coffee. The machine works under pressure, bringing the water to a boil and then forcing it through the ground coffee in a short period of time. • Important: The water in the boiler of the machine will get hotter during the brewing process. Towards the end of the brewing process the water will be so hot that it would burn your espresso. Therefore you never want to process all the water through the coffee as this will result in a burnt taste. • Which Coffee? Any coffee labeled ""espresso"" is suitable for your machine. Any coffee with at least 80% Arabica beans is ideal for espresso preparation. Check with your local coffee store • Which Grind? Steam boiler espresso machines, do not require a fine espresso grind. For maximum flavor and aroma we recommend a medium espresso grind or a fine drip grind. If you grind your own coffee we recommend using a burr or disk/burr grinder. Small blade grinders can create ""coffee dust"". Coffee dust can dramatically slow down the water flow during brewing resulting in bitter and overheated coffee taste. • Cappuccino: 1 1/2 to 2 oz. of espresso coffee with 3 to 4 oz. of steamed and frothed milk on top. Sprinkle chocolate shavings or cinnamon on top of 7 the milk froth. For a stronger taste increase the amount of coffee. For a milder taste increase the amount of milk. • Latte: 1 1/2 to 2 oz. of espresso coffee with 3 to 4 oz. of steamed milk (very little or no milk froth). • Frothing: Foamy layer of milk froth on top of hot milk. • Which kind of milk? Skim milk and 1% milk will produce more milk froth than 2% or regular milk. • Markings on Glass Carafe: The markings on the glass carafe help you in the preparation of brewing and frothing. Upper rim of metal band: Maximum capacity of boiler (approx. 10 oz.). For best results always fill the boiler with 10 oz. of fresh cold water. 4 cup marking: Maximum amount of espresso you should brew (approx. 8 oz.). If you brew more than 8 oz. the coffee will taste burnt. Depending on the coffee roast you might even want to brew a little less to avoid a bitter aroma. 2 cup marking: (approx. 4 oz.), guide line for a double shot of espresso. Bottom line marking: Once the coffee has reached this level there is enough pressure in the boiler for steaming and frothing. 7. PREPARING ESPRESSO Caution: Do not leave the machine alone during brewing. Keep children away during brewing. 1. Make sure the machine is plugged in and turned off. The glass carafe is removed from the drip tray. Important: The steam knob (fig. 9) must be in the closed position. The coffee/steam selector points to the cup symbol in front of the machine (stronger coffee). Moving the coffee/steam selector to the right, accelerates brewing and decreases coffee strength. 2. Fill the basket with ground coffee, using the measuring scoop (fig.1). The basket is marked on the inside indicating ""2 cups"" and ""4 cups"". Never overfill the basket. Clear any excess coffee from the rim of the filter holder. Important: it is not necessary to tamp (press down) the coffee. 3. Insert the basket into the filter holder (fig. 2), then insert the filter holder into the machine (fig. 3). 4. Turn filter holder to the right until it reaches the ""locked"" position (fig.1,8). 5. Fill the glass carafe to the upper rim of the metal band (approx. 10 oz.) with fresh, cold water. 6. Unscrew the boiler cap (see chapter 5). Using the glass carafe, fill the boiler with water (fig. 4) and close the boiler cap securely (see chapter 5). 7. Place the carafe lid on the carafe so that the opening on the lid points towards the pouring spout of the carafe (fig. 7). Place the carafe on the drip tray as shown in fig. 1. 8. Turn the power switch on (fig. 6). The power switch illuminates and the machine starts heating the water. 9. After approx. 2 1/2 to 3 minutes hot water will start forcing its way through the filter holder into the carafe. When you have enough espresso in the glass carafe turn the power switch off and turn the coffee/steam selector to the steam symbol on the left to stop the flow. Remove the carafe and serve. Add a bit of sugar and enjoy. Tip: To avoid a ""burnt taste"" never process all the water through the coffee. Once the brewing noise increases and steam develops, stop the brewing. 8 10. Important: Do not open the boiler cap. Do not remove the filter holder. First depressurize the machine. See chapter 3. 11. After de-pressurizing remove the filter holder by turning it to the left to the ""open lock"" symbol. Then push the thumb-guard of filter holder over the hot rim of the basket. Dump the used coffee (fig. 13) and rinse the basket and the filter holder under running water. Return the coffee/steam selector to the cup symbol. What could cause the flavor of my espresso to be kind of charred?",Retail/Product,Fact Finding,Q&A Only answer using the text I provide. Answer in four sentences that are no longer than 24 words each.,What are the pros and cons of restitution orders specifically related to victims?,"Participation in restorative justice programs is voluntary. As a result, offenders often comply with restitution agreements when they have followed a restorative justice program (Van Hecke & Wemmers, 1992). Offenders who do not accept their responsibility and who are not open to the idea of reparation will not enter a program. Thus, once admitted into a restorative justice program, offenders are prone to accept responsibility for their behaviour and repair the harm caused to the victim and, as a result, the victims of these offenders are likely to receive reparation. In their meta-analysis, Umbreit, Coates and Vos (2001) found that 90% of cases that are addressed through mediation end in an agreement. In most cases, these agreements consisted of a monetary sum, community service, or services rendered directly to the victim, and around 80-90% of the agreements were respected. Several researchers studying restorative justice have also observed a very high rate of satisfaction among participants in victim-offender mediation who frequently perceive the process and the result as fair (Umbreit, Coates & Vos 2001; Wemmers & Canuto 2002; Strang 2002; Wemmers & Cyr 2005; Van Camp 2016). According to Carriere, Malsch, Vermunt and De Keijser (1998), victims are generally more satisfied with restitution when they suffer less psychological damages and when their damages are primarily material. In contrast, other researchers find that restorative justice is particularly satisfying for victims of serious violent crimes and that when these victims participate in restorative justice programs they are usually satisfied with mediation, and the restorative justice process often has a positive impact on their well-being (Strang 20 2002; Strang et al 2006; Van Camp 2015; Wemmers 2016). Besides financial needs, other needs often expressed by victims of crime are the need for recognition and validation (Wemmers, 2017). Victims of serious violent crime generally seek other forms of reparation besides compensation, such as recognition of the wrong done by the offender, which is often very important to the victims (Van Camp & Wemmers 2015; Van Camp 2016). In restorative justice, victims’ needs are important and reparation aims to address the consequences of victimization (Wemmers, 2014; 2017). As such, restorative justice is more flexible than restitution orders and, for this reason, it is better able to adapt to the specific needs of the victim. Restitution is an integral part of victim reparation, and its necessity is well recognized by the UN as well as in the Canadian Victims’ Bill of Rights. In Canada, the Criminal Code highlights restitution orders and their application. However, before the introduction of the Victims’ Bill of Rights, restitution orders were a seldom-used measure in the Canadian criminal justice system: Only 2.3% of cases where the offender was found guilty included a restitution order. In order to encourage and facilitate requests by victims for restitution, a standard form was introduced in 2015. Restitution includes numerous advantages, but also has important limitations. It lessens the consequences of the crime for the victim, can reinstate their confidence in the criminal justice system, and can increase denunciation (Hoskins, Care & Ruback, 2015). Nevertheless, Canadian criminal law gives priority to the offender’s rehabilitation and social reintegration. As such, the needs of the victim are secondary. An important obstacle observed across the different models presented, is the conflict between criminal law and civil law. This legal distinction makes it so that judges are often reluctant to issue a restitution order and, if they do so, damages must be easy to determine, which leads to the inapplicability of restitution for emotional or psychological injury. Although lawyers place great importance on this distinction, it is perceived by victims as artificial and is often misunderstood (Helby, Van Dongen & Lindenberg, 2014). Even if restitution is ordered by a criminal court, it is the offender’s civil obligation. The restitution order as well as the civil party pose difficulties for victims with regards to the collection of their money. Civil law is complex and victims lack information on the procedures to undertake in order to obtain restitution. We have seen that the state can implement services to facilitate the collection of restitution. For example, the state can treat the order as a fine and take responsibility for its collection. The state can even advance money to the victim and then use subrogation in order to recover the money from the offender. Studies are nevertheless necessary to evaluate the effects of these types of services on victims and their impact on the effectiveness of restitution. Victim reparation is wider than restitution. Restorative justice programs do not suffer from the same limitations as restitution orders. They give an important place to the victim and can recognize all their needs including recognition, validation, as well as their financial needs. Hence, they are not limited by the offender’s financial insolvency. Restitution remains, after all, a right clearly defined in the Canadian Victims’ Bill of Rights, and significant effort must be deployed in order to ensure its effective application. The information presented in this article clearly points to a lack of data on the implementation and effectiveness of restitution orders. It also highlights the necessity to give more attention to the needs of victims of crime, as well as address the obstacles that hinder the satisfaction of victims’ needs, in order to maximize the benefits of this penal measure for victims, offenders and society as a whole. ","Only answer using the text I provide. Answer in four sentences that are no longer than 24 words each. Participation in restorative justice programs is voluntary. As a result, offenders often comply with restitution agreements when they have followed a restorative justice program (Van Hecke & Wemmers, 1992). Offenders who do not accept their responsibility and who are not open to the idea of reparation will not enter a program. Thus, once admitted into a restorative justice program, offenders are prone to accept responsibility for their behaviour and repair the harm caused to the victim and, as a result, the victims of these offenders are likely to receive reparation. In their meta-analysis, Umbreit, Coates and Vos (2001) found that 90% of cases that are addressed through mediation end in an agreement. In most cases, these agreements consisted of a monetary sum, community service, or services rendered directly to the victim, and around 80-90% of the agreements were respected. Several researchers studying restorative justice have also observed a very high rate of satisfaction among participants in victim-offender mediation who frequently perceive the process and the result as fair (Umbreit, Coates & Vos 2001; Wemmers & Canuto 2002; Strang 2002; Wemmers & Cyr 2005; Van Camp 2016). According to Carriere, Malsch, Vermunt and De Keijser (1998), victims are generally more satisfied with restitution when they suffer less psychological damages and when their damages are primarily material. In contrast, other researchers find that restorative justice is particularly satisfying for victims of serious violent crimes and that when these victims participate in restorative justice programs they are usually satisfied with mediation, and the restorative justice process often has a positive impact on their well-being (Strang 20 2002; Strang et al 2006; Van Camp 2015; Wemmers 2016). Besides financial needs, other needs often expressed by victims of crime are the need for recognition and validation (Wemmers, 2017). Victims of serious violent crime generally seek other forms of reparation besides compensation, such as recognition of the wrong done by the offender, which is often very important to the victims (Van Camp & Wemmers 2015; Van Camp 2016). In restorative justice, victims’ needs are important and reparation aims to address the consequences of victimization (Wemmers, 2014; 2017). As such, restorative justice is more flexible than restitution orders and, for this reason, it is better able to adapt to the specific needs of the victim. Restitution is an integral part of victim reparation, and its necessity is well recognized by the UN as well as in the Canadian Victims’ Bill of Rights. In Canada, the Criminal Code highlights restitution orders and their application. However, before the introduction of the Victims’ Bill of Rights, restitution orders were a seldom-used measure in the Canadian criminal justice system: Only 2.3% of cases where the offender was found guilty included a restitution order. In order to encourage and facilitate requests by victims for restitution, a standard form was introduced in 2015. Restitution includes numerous advantages, but also has important limitations. It lessens the consequences of the crime for the victim, can reinstate their confidence in the criminal justice system, and can increase denunciation (Hoskins, Care & Ruback, 2015). Nevertheless, Canadian criminal law gives priority to the offender’s rehabilitation and social reintegration. As such, the needs of the victim are secondary. An important obstacle observed across the different models presented, is the conflict between criminal law and civil law. This legal distinction makes it so that judges are often reluctant to issue a restitution order and, if they do so, damages must be easy to determine, which leads to the inapplicability of restitution for emotional or psychological injury. Although lawyers place great importance on this distinction, it is perceived by victims as artificial and is often misunderstood (Helby, Van Dongen & Lindenberg, 2014). Even if restitution is ordered by a criminal court, it is the offender’s civil obligation. The restitution order as well as the civil party pose difficulties for victims with regards to the collection of their money. Civil law is complex and victims lack information on the procedures to undertake in order to obtain restitution. We have seen that the state can implement services to facilitate the collection of restitution. For example, the state can treat the order as a fine and take responsibility for its collection. The state can even advance money to the victim and then use subrogation in order to recover the money from the offender. Studies are nevertheless necessary to evaluate the effects of these types of services on victims and their impact on the effectiveness of restitution. Victim reparation is wider than restitution. Restorative justice programs do not suffer from the same limitations as restitution orders. They give an important place to the victim and can recognize all their needs including recognition, validation, as well as their financial needs. Hence, they are not limited by the offender’s financial insolvency. Restitution remains, after all, a right clearly defined in the Canadian Victims’ Bill of Rights, and significant effort must be deployed in order to ensure its effective application. The information presented in this article clearly points to a lack of data on the implementation and effectiveness of restitution orders. It also highlights the necessity to give more attention to the needs of victims of crime, as well as address the obstacles that hinder the satisfaction of victims’ needs, in order to maximize the benefits of this penal measure for victims, offenders and society as a whole. What are the pros and cons of restitution orders specifically related to victims?",Legal,Find & Summarize,Text Transformation Answer this question in one concise paragraph. Use the text provided. Do not use text from any other online source.,How can review mining ensure it represents low-frequency terms in customer reviews?,"**Mining and Summarizing Customer Reviews** Minqing Hu and Bing Liu Department of Computer Science University of Illinois at Chicago 851 South Morgan Street Chicago, IL 60607-7053 {mhu1, liub}@cs.uic.edu 1. INTRODUCTION With the rapid expansion of e-commerce, more and more products are sold on the Web, and more and more people are also buying products online. In order to enhance customer satisfaction and shopping experience, it has become a common practice for online merchants to enable their customers to review or to express opinions on the products that they have purchased. With more and more common users becoming comfortable with the Web, an increasing number of people are writing reviews. As a result, the number of reviews that a product receives grows rapidly. Some popular products can get hundreds of reviews at some large merchant sites. Furthermore, many reviews are long and have only a few sentences containing opinions on the product. This makes it hard for a potential customer to read them to make an informed decision on whether to purchase the product. If he/she only reads a few reviews, he/she may get a biased view. The large number of reviews also makes it hard for product manufacturers to keep track of customer opinions of their products. For a product manufacturer, there are additional difficulties because many merchant sites may sell its products, and the manufacturer may (almost always) produce many kinds of products. In this research, we study the problem of generating feature-based summaries of customer reviews of products sold online. Here, features broadly mean product features (or attributes) and functions. Given a set of customer reviews of a particular product, the task involves three subtasks: (1) identifying features of the product that customers have expressed their opinions on (called product features); (2) for each feature, identifying review sentences that give positive or negative opinions; and (3) producing a summary using the discovered information. Let us use an example to illustrate a feature-based summary. Assume that we summarize the reviews of a particular digital camera, digital_camera_1. The summary looks like the following: Digital_camera_1: Feature: **picture quality** Positive: 253 Negative: 6 Feature: **size** Positive: 134 Negative: 10 … **Figure 1: An example summary** In Figure 1, picture quality and (camera) size are the product features. There are 253 customer reviews that express positive opinions about the picture quality, and only 6 that express negative opinions. The link points to the specific sentences and/or the whole reviews that give positive or negative comments about the feature. With such a feature-based summary, a potential customer can easily see how the existing customers feel about the digital camera. If he/she is very interested in a particular feature, he/she can drill down by following the link to see why existing customers like it and/or what they complain about. For a manufacturer, it is possible to combine summaries from multiple merchant sites to produce a single report for each of its products. Our task is different from traditional text summarization in a number of ways. First of all, a summary in our case is structured rather than another (but shorter) free text document as produced by most text summarization systems. Second, we are only interested in features of the product that customers have opinions on and also whether the opinions are positive or negative. We do not summarize the reviews by selecting or rewriting a subset of the original sentences from the reviews to capture their main points as in traditional text summarization. As indicated above, our task is performed in three main steps: (1) Mining product features that have been commented on by customers. We make use of both data mining and natural language processing techniques to perform this task. For completeness, we will summarize its techniques in this paper and also present a comparative evaluation. (2) Identifying opinion sentences in each review and deciding whether each opinion sentence is positive or negative. Note that these opinion sentences must contain one or more product features identified above. To decide the opinion orientation of each sentence (whether the opinion expressed in the sentence is positive or negative), we perform three subtasks. First, a set of adjective words (which are normally used to express opinions) is identified using a natural language processing method. These words are also called opinion words in this paper. Second, for each opinion word, we determine its semantic orientation, e.g., positive or negative. A bootstrapping technique is proposed to perform this task using WordNet. Finally, we decide the opinion orientation of each sentence. An effective algorithm is also given for this purpose. (3) Summarizing the results. This step aggregates the results of previous steps and presents them in the format of Figure 1. 2. RELATED WORK Existing text summarization techniques mainly fall in one of the two categories: template instantiation and passage extraction. Work in the former framework emphasizes on identification and extraction of certain core entities and facts in a document, which are packaged in a template. This framework requires background knowledge in order to instantiate a template to a suitable level of detail. Therefore, it is not domain or genre independent. This is different from our work as our techniques do not fill any template and are domain independent. The passage extraction framework identifies certain segments of the text (typically sentences) that are the most representative of the document’s content. Our work is different in that we do not extract representative sentences, but identify and extract those specific product features and the opinions related to them. Boguraev and Kennedy propose to find a few very prominent expressions, objects or events in a document and use them to help summarize the document. Our work is again different as we find all product features in a set of customer reviews regardless whether they are prominent or not. Thus, our summary is not a traditional text summary. Most existing works on text summarization focus on a single document. Some researchers also studied summarization of multiple documents covering similar information. Their main purpose is to summarize the similarities and differences in the information content among these documents. Our work is related but quite different because we aim to find the key features that are talked about in multiple reviews. We do not summarize similarities and differences of reviews. In terminology finding, there are basically two techniques for discovering terms in corpora: symbolic approaches that rely on syntactic description of terms, namely noun phrases, and statistical approaches that exploit the fact that the words composing a term tend to be found close to each other and reoccurring. However, using noun phrases tends to produce too many non-terms (low precision), while using reoccurring phrases misses many low frequency terms, terms with variations, and terms with only one word. Our association mining based technique does not have these problems, and we can also find infrequent features by exploiting the fact that we are only interested in features that the users have expressed opinions on. 3. THE PROPOSED TECHNIQUES The inputs to the system are a product name and an entry Web page for all the reviews of the product. The output is the summary of the reviews as the one shown in the introduction section. The system performs the summarization in three main steps (as discussed before): (1) mining product features that have been commented on by customers; (2) identifying opinion sentences in each review and deciding whether each opinion sentence is positive or negative; (3) summarizing the results. These steps are performed in multiple sub-steps. Given the inputs, the system first downloads (or crawls) all the reviews, and put them in the review database. It then finds those “hot” (or frequent) features that many people have expressed their opinions on. After that, the opinion words are extracted using the resulting frequent features, and semantic orientations of the opinion words are identified with the help of WordNet. Using the extracted opinion words, the system then finds those infrequent features. In the last two steps, the orientation of each opinion sentence is identified and a final summary is produced. Note that POS tagging is the part-of-speech tagging from natural language processing, which helps us to find opinion features. 4. CONCLUSIONS Our experimental results indicate that the proposed techniques are very promising in performing their tasks. We believe that this problem will become increasingly important as more people are buying and expressing their opinions on the Web. Summarizing the reviews is not only useful to common shoppers, but also crucial to product manufacturers. In our future work, we plan to further improve and refine our techniques, and to deal with the outstanding problems identified above, i.e., pronoun resolution, determining the strength of opinions, and investigating opinions expressed with adverbs, verbs and nouns. Finally, we will also look into monitoring of customer reviews. We believe that monitoring will be particularly useful to product manufacturers because they want to know any new positive or negative comments on their products whenever they are available. The keyword here is new. Although a new review may be added, it may not contain any new information.","{Question} ================== How can review mining ensure it represents low-frequency terms in customer reviews? ---------------- {System Instruction} ================== Answer this question in one concise paragraph. Use the text provided. Do not use text from any other online source. ---------------- {Document} ================== **Mining and Summarizing Customer Reviews** Minqing Hu and Bing Liu Department of Computer Science University of Illinois at Chicago 851 South Morgan Street Chicago, IL 60607-7053 {mhu1, liub}@cs.uic.edu 1. INTRODUCTION With the rapid expansion of e-commerce, more and more products are sold on the Web, and more and more people are also buying products online. In order to enhance customer satisfaction and shopping experience, it has become a common practice for online merchants to enable their customers to review or to express opinions on the products that they have purchased. With more and more common users becoming comfortable with the Web, an increasing number of people are writing reviews. As a result, the number of reviews that a product receives grows rapidly. Some popular products can get hundreds of reviews at some large merchant sites. Furthermore, many reviews are long and have only a few sentences containing opinions on the product. This makes it hard for a potential customer to read them to make an informed decision on whether to purchase the product. If he/she only reads a few reviews, he/she may get a biased view. The large number of reviews also makes it hard for product manufacturers to keep track of customer opinions of their products. For a product manufacturer, there are additional difficulties because many merchant sites may sell its products, and the manufacturer may (almost always) produce many kinds of products. In this research, we study the problem of generating feature-based summaries of customer reviews of products sold online. Here, features broadly mean product features (or attributes) and functions. Given a set of customer reviews of a particular product, the task involves three subtasks: (1) identifying features of the product that customers have expressed their opinions on (called product features); (2) for each feature, identifying review sentences that give positive or negative opinions; and (3) producing a summary using the discovered information. Let us use an example to illustrate a feature-based summary. Assume that we summarize the reviews of a particular digital camera, digital_camera_1. The summary looks like the following: Digital_camera_1: Feature: **picture quality** Positive: 253 Negative: 6 Feature: **size** Positive: 134 Negative: 10 … **Figure 1: An example summary** In Figure 1, picture quality and (camera) size are the product features. There are 253 customer reviews that express positive opinions about the picture quality, and only 6 that express negative opinions. The link points to the specific sentences and/or the whole reviews that give positive or negative comments about the feature. With such a feature-based summary, a potential customer can easily see how the existing customers feel about the digital camera. If he/she is very interested in a particular feature, he/she can drill down by following the link to see why existing customers like it and/or what they complain about. For a manufacturer, it is possible to combine summaries from multiple merchant sites to produce a single report for each of its products. Our task is different from traditional text summarization in a number of ways. First of all, a summary in our case is structured rather than another (but shorter) free text document as produced by most text summarization systems. Second, we are only interested in features of the product that customers have opinions on and also whether the opinions are positive or negative. We do not summarize the reviews by selecting or rewriting a subset of the original sentences from the reviews to capture their main points as in traditional text summarization. As indicated above, our task is performed in three main steps: (1) Mining product features that have been commented on by customers. We make use of both data mining and natural language processing techniques to perform this task. For completeness, we will summarize its techniques in this paper and also present a comparative evaluation. (2) Identifying opinion sentences in each review and deciding whether each opinion sentence is positive or negative. Note that these opinion sentences must contain one or more product features identified above. To decide the opinion orientation of each sentence (whether the opinion expressed in the sentence is positive or negative), we perform three subtasks. First, a set of adjective words (which are normally used to express opinions) is identified using a natural language processing method. These words are also called opinion words in this paper. Second, for each opinion word, we determine its semantic orientation, e.g., positive or negative. A bootstrapping technique is proposed to perform this task using WordNet. Finally, we decide the opinion orientation of each sentence. An effective algorithm is also given for this purpose. (3) Summarizing the results. This step aggregates the results of previous steps and presents them in the format of Figure 1. 2. RELATED WORK Existing text summarization techniques mainly fall in one of the two categories: template instantiation and passage extraction. Work in the former framework emphasizes on identification and extraction of certain core entities and facts in a document, which are packaged in a template. This framework requires background knowledge in order to instantiate a template to a suitable level of detail. Therefore, it is not domain or genre independent. This is different from our work as our techniques do not fill any template and are domain independent. The passage extraction framework identifies certain segments of the text (typically sentences) that are the most representative of the document’s content. Our work is different in that we do not extract representative sentences, but identify and extract those specific product features and the opinions related to them. Boguraev and Kennedy propose to find a few very prominent expressions, objects or events in a document and use them to help summarize the document. Our work is again different as we find all product features in a set of customer reviews regardless whether they are prominent or not. Thus, our summary is not a traditional text summary. Most existing works on text summarization focus on a single document. Some researchers also studied summarization of multiple documents covering similar information. Their main purpose is to summarize the similarities and differences in the information content among these documents. Our work is related but quite different because we aim to find the key features that are talked about in multiple reviews. We do not summarize similarities and differences of reviews. In terminology finding, there are basically two techniques for discovering terms in corpora: symbolic approaches that rely on syntactic description of terms, namely noun phrases, and statistical approaches that exploit the fact that the words composing a term tend to be found close to each other and reoccurring. However, using noun phrases tends to produce too many non-terms (low precision), while using reoccurring phrases misses many low frequency terms, terms with variations, and terms with only one word. Our association mining based technique does not have these problems, and we can also find infrequent features by exploiting the fact that we are only interested in features that the users have expressed opinions on. 3. THE PROPOSED TECHNIQUES The inputs to the system are a product name and an entry Web page for all the reviews of the product. The output is the summary of the reviews as the one shown in the introduction section. The system performs the summarization in three main steps (as discussed before): (1) mining product features that have been commented on by customers; (2) identifying opinion sentences in each review and deciding whether each opinion sentence is positive or negative; (3) summarizing the results. These steps are performed in multiple sub-steps. Given the inputs, the system first downloads (or crawls) all the reviews, and put them in the review database. It then finds those “hot” (or frequent) features that many people have expressed their opinions on. After that, the opinion words are extracted using the resulting frequent features, and semantic orientations of the opinion words are identified with the help of WordNet. Using the extracted opinion words, the system then finds those infrequent features. In the last two steps, the orientation of each opinion sentence is identified and a final summary is produced. Note that POS tagging is the part-of-speech tagging from natural language processing, which helps us to find opinion features. 4. CONCLUSIONS Our experimental results indicate that the proposed techniques are very promising in performing their tasks. We believe that this problem will become increasingly important as more people are buying and expressing their opinions on the Web. Summarizing the reviews is not only useful to common shoppers, but also crucial to product manufacturers. In our future work, we plan to further improve and refine our techniques, and to deal with the outstanding problems identified above, i.e., pronoun resolution, determining the strength of opinions, and investigating opinions expressed with adverbs, verbs and nouns. Finally, we will also look into monitoring of customer reviews. We believe that monitoring will be particularly useful to product manufacturers because they want to know any new positive or negative comments on their products whenever they are available. The keyword here is new. Although a new review may be added, it may not contain any new information.",Retail/Product,Effect Analysis,Q&A Answer using only information from the prompt and context block. Answer using only bullet points.,Compare and contrast the power sources used by the Mars Pathfinder during its cruise phase and after landing on Mars.,"If the lander comes to rest on a rock, the entire lander may be tilted, but further maneuvering of the petals can be performed during surface operations to lower the overall tilt of the lander. Telecommunications during entry should provide significant information about the behavior of the entry, descent and landing subsystem. Digital data will not be acquired, however, because of the extremely weak signal. 25 The amplitude and frequency of the spacecraft will be observed in real-time during entry and descent, and may be seen during petal deployment, depending on the lander's orientation once it comes to a stop on the Martian surface. Changes in amplitude are expected at cruise stage separation, parachute deployment, surface impact and during the airbag retraction and petal deployment. Changes in frequency reflect changes in the spacecraft's speed and will be most pronounced during the period of peak deceleration. The spacecraft also will deliberately change the frequency of the subcarrier to signal other key events. These include heat shield separation, bridle deployment, crossing the threshold altitude of 600 meters (about 2,000 feet) above the surface, completion of airbag retraction and completion of the petal deployment sequence. These planned frequency changes -- called ""semaphores"" -- are not likely to be detected in real-time, but can be extracted by post-processing the recorded data. In addition, key spacecraft telemetry data will be recorded and played back after landing. Other key data to be transmitted to Earth include accelerometer measurements and selected atmospheric structure instrument measurements. The Deep Space Network's 70-meter (230-foot) and 34-meter (110-foot) antennas in Madrid, Spain, will be used to support entry communications. Prime Mission Mars Pathfinder's primary mission begins when its lander petals have been fully unfolded and the lander switches to a sequence of computer commands that will control its functions. The spacecraft lands about 2-1/2 hours before sunrise on Mars and will spend the time in darkness retracting its airbags, standing itself upright and opening the petals so that solar panels can be powered up after sunrise. The lander's first task will be to transmit engineering and science data collected during its descent through the thin atmosphere of Mars. If no errors are detected in these data and the spacecraft is basically healthy, a real-time command will be sent from Earth instructing the lander to unlock the imager camera head, deploy and point the high-gain antenna. If conditions are different than expected, which is not unlikely, the opeation team will execute a contingency plan that has been placed onboard the spacecraft in expectation of such conditions. In the normal plan, the lander's camera will begin taking images -- including a panoramic view of the Martian landscape -- and will begin transmitting the data directly to Earth at 2,250 bits per second. The first images of the Martian landscape will tell engineers whether the airbags are fully retracted and whether the rover's exit ramp can be safely and successfully deployed. Once either or both ramps are deployed, additional images will be acquired to show the terrain beyond the ramps so that engineers can decide on the safest exit route. If the highgain antenna is not available, data will be sent over the lander’s low-gain antenna at a much lower rate of 40 bits per second. In this case, only a few, highly compressed images will be sent. 26 Once a decision on the route has been made, commands will be sent to deploy the rover. Sojourner will spend about a quarter of an hour exiting its ramp. The rover should be deployed within the first three days after landing. Driving off onto the floor of an old outflow channel, Sojourner will explore the surface at the command of Earth-based operators, who will rely on lander-based images to select a path and target for the rover. The six-wheeled Sojourner travels at 1 centimeter (0.4 inch) per second, performing mobility tests, imaging its surroundings and deploying an alpha proton x-ray spectrometer designed to study the elemental composition of rocks. During its prime mission, the rover will likely range a few tens of meters (yards) from the lander. Also mounted on the lander are wind sensors, wind socks and high- and low-gain antennas. Instruments will be used to measure the pressure, temperature and density of the Martian atmosphere. Magnets mounted on the lander will collect magnetic specimens of Martian dust and soil as small as 100 microns (about 1/250th of an inch). Extended Missions The primary mission lasts seven Martian days, or ""sols,"" for the rover, and 30 Martian days, or ""sols,"" for the lander. The rover could carry out an extended mission beyond that period, depending on how long its power sources and electronics last; engineers expect that the most probable reason for it to stop functioning is hot-cold cycling of its onboard electronics between Martian day and night. Sojourner's extended mission activities would include repeating soil mechanics experiments on various soils; additional spectrometer measurements of both rocks and soil; obtaining images of selected areas with the rover camera, including close-ups of the lander; obtaining images of the lander's landing and tumbling path; and traveling longer distances, with the possibility of going over the horizon, up to hundreds of meters (yards). For the lander, an extended mission lasting up to one year after landing is possible. Lander activities in the extended mission would include continued use of the lander camera to obtain images of the terrain and atmosphere, collection of key engineering telemetry and continued collection of meteorology data. Mission Operations All operations for Mars Pathfinder will be conducted at JPL, where the operations and science teams reside. Science data, both raw and processed, will be transferred after a period of validation to NASA's Planetary Data System archive for access and use by the planetary community at large and the general public. The Planetary Data System home page is at http://pds.jpl.nasa.gov/pds_home.html . Images from planetary missions are also available via the web from NASA’s Planetary Photojournal at http://photojournal.jpl.nasa.gov . 27 Spacecraft At launch the Mars Pathfinder spacecraft weighed about 895 kilograms (1,973 pounds), including its cruise stage, heat shield and backshell (or aeroshell), solar panels, propulsion stage, medium- and- high-gain antennas and 94 kilograms (207 pounds) of cruise propellant. The cruise vehicle measures 2.65 meters (8.5 feet) in diameter and stands 1.5 meters (5 feet) tall. The lander is a tetrahedron, a small pyramid standing about 0.9 meter (3 feet) tall with three triangular-shaped sides and a base. When Pathfinder is poised to enter the Martian atmosphere, its main components are the aeroshell, folded lander and rover, parachute, airbag system and three rocket engines. Combined, the spacecraft’s mass is about 570 kilograms (1,256 pounds) at entry. Once it has landed and its airbags have been deflated, Pathfinder’s mass will be about 360 kilograms (793 pounds). Subsystems contributing to its landed weight include the opening/uprighting mechanism, lander cabling and electronics, instruments and rover. When it is unfolded and lying flat on the surface, the spacecraft will measure 2.75 meters (9 feet) across with a mast-mounted camera standing up about 1.5 meters (5 feet) from the ground. The lander is controlled by a derivative of the commercially available IBM 6000 computer. This processor and associated components are radiation-hardened and mounted on a single electronics board. The computer has a 32-bit architecture which executes about 20 million instructions per second. The computer will store flight software as well as engineering and science data, including images and rover information, in 128 megabytes of dynamic random access memory. During interplanetary cruise, the spacecraft requires 178 watts of electrical power, provided by 2.5 square meters (27 square feet) of gallium arsenide solar cells. The lander has three solar panels, with a total area of 2.8 square meters (30 square feet) and supplying up to 1,200 watt-hours of power per day on clear days. At night, the lander will operate on rechargeable silver zinc batteries with a capacity at the beginning of the Mars surface mission of more than 40 amp-hours. The Pathfinder lander carries a camera on a mast to survey its immediate surroundings. The camera has two optical paths for stereo imaging, each with a filter wheel giving 12 color bands in the 0.35 to 1.1 micron range; exposures through different filters can be combined to produce color images. The camera’s field-of-view is 14 degrees in both horizontal and vertical directions, and it will be able to take one frame (256 by 256 pixels) every two seconds.","Answer using only information from the prompt and context block. Answer using only bullet points. Compare and contrast the power sources used by the Mars Pathfinder during its cruise phase and after landing on Mars. If the lander comes to rest on a rock, the entire lander may be tilted, but further maneuvering of the petals can be performed during surface operations to lower the overall tilt of the lander. Telecommunications during entry should provide significant information about the behavior of the entry, descent and landing subsystem. Digital data will not be acquired, however, because of the extremely weak signal. 25 The amplitude and frequency of the spacecraft will be observed in real-time during entry and descent, and may be seen during petal deployment, depending on the lander's orientation once it comes to a stop on the Martian surface. Changes in amplitude are expected at cruise stage separation, parachute deployment, surface impact and during the airbag retraction and petal deployment. Changes in frequency reflect changes in the spacecraft's speed and will be most pronounced during the period of peak deceleration. The spacecraft also will deliberately change the frequency of the subcarrier to signal other key events. These include heat shield separation, bridle deployment, crossing the threshold altitude of 600 meters (about 2,000 feet) above the surface, completion of airbag retraction and completion of the petal deployment sequence. These planned frequency changes -- called ""semaphores"" -- are not likely to be detected in real-time, but can be extracted by post-processing the recorded data. In addition, key spacecraft telemetry data will be recorded and played back after landing. Other key data to be transmitted to Earth include accelerometer measurements and selected atmospheric structure instrument measurements. The Deep Space Network's 70-meter (230-foot) and 34-meter (110-foot) antennas in Madrid, Spain, will be used to support entry communications. Prime Mission Mars Pathfinder's primary mission begins when its lander petals have been fully unfolded and the lander switches to a sequence of computer commands that will control its functions. The spacecraft lands about 2-1/2 hours before sunrise on Mars and will spend the time in darkness retracting its airbags, standing itself upright and opening the petals so that solar panels can be powered up after sunrise. The lander's first task will be to transmit engineering and science data collected during its descent through the thin atmosphere of Mars. If no errors are detected in these data and the spacecraft is basically healthy, a real-time command will be sent from Earth instructing the lander to unlock the imager camera head, deploy and point the high-gain antenna. If conditions are different than expected, which is not unlikely, the opeation team will execute a contingency plan that has been placed onboard the spacecraft in expectation of such conditions. In the normal plan, the lander's camera will begin taking images -- including a panoramic view of the Martian landscape -- and will begin transmitting the data directly to Earth at 2,250 bits per second. The first images of the Martian landscape will tell engineers whether the airbags are fully retracted and whether the rover's exit ramp can be safely and successfully deployed. Once either or both ramps are deployed, additional images will be acquired to show the terrain beyond the ramps so that engineers can decide on the safest exit route. If the highgain antenna is not available, data will be sent over the lander’s low-gain antenna at a much lower rate of 40 bits per second. In this case, only a few, highly compressed images will be sent. 26 Once a decision on the route has been made, commands will be sent to deploy the rover. Sojourner will spend about a quarter of an hour exiting its ramp. The rover should be deployed within the first three days after landing. Driving off onto the floor of an old outflow channel, Sojourner will explore the surface at the command of Earth-based operators, who will rely on lander-based images to select a path and target for the rover. The six-wheeled Sojourner travels at 1 centimeter (0.4 inch) per second, performing mobility tests, imaging its surroundings and deploying an alpha proton x-ray spectrometer designed to study the elemental composition of rocks. During its prime mission, the rover will likely range a few tens of meters (yards) from the lander. Also mounted on the lander are wind sensors, wind socks and high- and low-gain antennas. Instruments will be used to measure the pressure, temperature and density of the Martian atmosphere. Magnets mounted on the lander will collect magnetic specimens of Martian dust and soil as small as 100 microns (about 1/250th of an inch). Extended Missions The primary mission lasts seven Martian days, or ""sols,"" for the rover, and 30 Martian days, or ""sols,"" for the lander. The rover could carry out an extended mission beyond that period, depending on how long its power sources and electronics last; engineers expect that the most probable reason for it to stop functioning is hot-cold cycling of its onboard electronics between Martian day and night. Sojourner's extended mission activities would include repeating soil mechanics experiments on various soils; additional spectrometer measurements of both rocks and soil; obtaining images of selected areas with the rover camera, including close-ups of the lander; obtaining images of the lander's landing and tumbling path; and traveling longer distances, with the possibility of going over the horizon, up to hundreds of meters (yards). For the lander, an extended mission lasting up to one year after landing is possible. Lander activities in the extended mission would include continued use of the lander camera to obtain images of the terrain and atmosphere, collection of key engineering telemetry and continued collection of meteorology data. Mission Operations All operations for Mars Pathfinder will be conducted at JPL, where the operations and science teams reside. Science data, both raw and processed, will be transferred after a period of validation to NASA's Planetary Data System archive for access and use by the planetary community at large and the general public. The Planetary Data System home page is at http://pds.jpl.nasa.gov/pds_home.html . Images from planetary missions are also available via the web from NASA’s Planetary Photojournal at http://photojournal.jpl.nasa.gov . 27 Spacecraft At launch the Mars Pathfinder spacecraft weighed about 895 kilograms (1,973 pounds), including its cruise stage, heat shield and backshell (or aeroshell), solar panels, propulsion stage, medium- and- high-gain antennas and 94 kilograms (207 pounds) of cruise propellant. The cruise vehicle measures 2.65 meters (8.5 feet) in diameter and stands 1.5 meters (5 feet) tall. The lander is a tetrahedron, a small pyramid standing about 0.9 meter (3 feet) tall with three triangular-shaped sides and a base. When Pathfinder is poised to enter the Martian atmosphere, its main components are the aeroshell, folded lander and rover, parachute, airbag system and three rocket engines. Combined, the spacecraft’s mass is about 570 kilograms (1,256 pounds) at entry. Once it has landed and its airbags have been deflated, Pathfinder’s mass will be about 360 kilograms (793 pounds). Subsystems contributing to its landed weight include the opening/uprighting mechanism, lander cabling and electronics, instruments and rover. When it is unfolded and lying flat on the surface, the spacecraft will measure 2.75 meters (9 feet) across with a mast-mounted camera standing up about 1.5 meters (5 feet) from the ground. The lander is controlled by a derivative of the commercially available IBM 6000 computer. This processor and associated components are radiation-hardened and mounted on a single electronics board. The computer has a 32-bit architecture which executes about 20 million instructions per second. The computer will store flight software as well as engineering and science data, including images and rover information, in 128 megabytes of dynamic random access memory. During interplanetary cruise, the spacecraft requires 178 watts of electrical power, provided by 2.5 square meters (27 square feet) of gallium arsenide solar cells. The lander has three solar panels, with a total area of 2.8 square meters (30 square feet) and supplying up to 1,200 watt-hours of power per day on clear days. At night, the lander will operate on rechargeable silver zinc batteries with a capacity at the beginning of the Mars surface mission of more than 40 amp-hours. The Pathfinder lander carries a camera on a mast to survey its immediate surroundings. The camera has two optical paths for stereo imaging, each with a filter wheel giving 12 color bands in the 0.35 to 1.1 micron range; exposures through different filters can be combined to produce color images. The camera’s field-of-view is 14 degrees in both horizontal and vertical directions, and it will be able to take one frame (256 by 256 pixels) every two seconds.",Internet/Technology,Concept Comparison,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",I have a hernia in my lower back and my doctor wants to do a laminotomy. I want to know more information about this surgery. Please explain the different types of spinal decompression surgeries and what I should expect. Use more than 400 words.,"What is spinal decompression surgery? Spinal decompression surgery is performed to relieve symptoms related to compression of the spinal cord or its roots, which may include back or neck pain and radiating limb pain (radiculopathy). What symptoms does spinal decompression surgery treat? Spinal nerve compression symptoms include pain, altered sensations, muscle weakness or dysfunction, and even gait abnormalities. These symptoms can be caused by a wide variety of conditions. In some of these, such as in cervical spinal stenosis that leads to cervical myelopathy, you may feel symptoms in the arms, hands, legs or feet, and/or have balance problems, or even incontinence issues (bowel dysfunction, unexpected need to urinate, etc.). A rapid onset of these symptoms can indicate a condition known as cauda equina syndrome, which can cause paralysis and other serious problems if not addressed in a timely manner. Pain and other symptoms treated by these surgeries are most common in the lower back (lumbar spine), followed by the neck (cervical spine). Symptoms in the upper back (thoracic spine) are possible but less common because it is the most stable part of the spine, due in part to its being connected to the rib cage. Neuropathies may involve feelings of numbness or a ""pins and needles"" tingling sensation and cause weakness or instability, primarily in lower the back. What happens during spinal decompression surgery? Every type of spinal decompression modifies or removes bone, spinal disc or soft tissues that are causing compression of a nerve. The techniques vary according to which tissues are causing the compression. For example, laminoplasty involves the reshaping of part of a vertebral lamina, a laminotomy the making of a small hole the lamina, and a laminectomy the complete removal of a lamina, all to relieve pressure on the nerves. What types of spine decompression surgery are there? Types of spine decompression surgery performed at HSS include laminectomy, laminotomy, laminoplasty, discectomy and microdiscectomy, among others. Lumbar decompression surgery may be used to address problems in the lower back, such as lumbar laminectomy, laminotomy, or microdiscectomy. Types of spinal decompression surgery Laminectomy is the removal in one or more vertebrae of the lamina (bony roof over the spinal canal). This decompresses both sides (left and right) of the canal. Laminotomy is removal of a small portion of the lamina to decompress one side (left or right) of the canal. This leaves most of the lamina intact. Microsurgical laminoplasty is a minimally invasive surgical decompression technique that uses small incisions viewed through an operating microscope. (Find a laminoplasty spine specialist.) Microdiscectomy (also known as spinal microdecompression surgery): This minimally invasive spine procedure is commonly performed on patients who have sciatica and/or a herniated disc in the lumbar section of the spine (lower back). Using muscle-sparing incisions, this removes portions of a herniated disc that is putting pressure on the spinal nerve and causing pain. Minimally invasive lumbar discectomy (also known as endoscopic percutaneous disc removal) is similar to microdiscectomy and uses a scope to make very small incisions in the skin, through which a portion of the herniated disc that is compressing spinal nerves is removed. Decompression with fusion Some decompression surgeries may require the addition of a fusion procedure simultaneously. This depends on the type of disease being treated and the technique being used to address the disease. This includes lumbar decompressions, such as lumbar interbody fusion (LIF) techniques, which may indirectly decompress the spine, or cervical decompressions, such as anterior cervical discectomy and fusion (ACDF surgery), which are dependent on the differential anatomy of the spine. Who is a good candidate for spinal decompression surgery? Decompression surgery can be a good option for people who have back or neck pain and/or neuropathies due to nerve compression caused by a herniated disc, spinal stenosis, spondylolisthesis, and for whom nonsurgical methods such as physical therapy, epidural steroid injections or pain management regimens have failed to provide relief. Find an HSS spine surgeon by decompression procedure all spinal decompression laminectomy laminoplasty discectomy and microdiscectomy Will I have to go under anesthesia for spinal decompression surgery? Most spinal decompression surgeries will be performed under general anesthesia, with the patient completely unconscious. Some modern techniques allow for spinal surgery under regional anesthesia (either spinal or epidural anesthesia). These techniques allow patients to breathe on their own without the need for mechanical assistance. These techniques may reduce complications associated with general anesthesia but are not widely available and may be performed on a case-by-case basis. How long will I stay in the hospital after spinal decompression surgery? In many cases, patients undergoing decompressions such as a laminectomy, discectomy, or microdiscectomy can go home the same day. This is often the case with a laminectomy, microdiscectomy, and there is research to suggest that even multilevel ACDF surgeries may be safely done on an outpatient basis. Some patients having spinal decompression may need to stay one or more nights including those who have chronic diseases or sleep. Some patients require a spinal fusion may stay overnight and return home one or two days after surgery. Rarely, a patient may need to stay as many longer. In addition, some decompression spine surgeries may be planned as an ambulatory (outpatient) procedure, but then converted to an overnight stay to monitor the patient. In one study of more than 1,000 patients who underwent an ambulatory one- or two-level lumbar decompression, 58% ended up staying over at least one night. How soon can I walk after a decompression spine surgery? At HSS patients are encouraged to walk the same day of most decompression surgeries. How soon can I return to work after spinal decompression? Depending on the specific procedure and other factors, patients generally are able to return to work between two and four weeks after surgery. Some patients who have a microdiscectomy decompression may be able to return to work after less than two weeks. What is the recovery time of spinal decompression surgery? The recovery time for decompression surgery alone is generally faster compared to procedures that include a fusion. Owing to the wide range of decompression surgery types and the number of spinal levels addressed with surgery there is likewise some variability in recovery duration. There is recent evidence that microdiscectomy patients can return to physical therapy and low impact aerobic exercise within four weeks of surgery. Patients undergoing laminectomy procedure can expect surgery pain to ease within two to four weeks of surgery and starting physical therapy and other activities by about six weeks. Fusion procedures are likewise highly variable and recovery times prolonged, approaching three to six months before patients can return to exercise or sports activities. Please confer with your surgeon regarding your procedure and expected recovery. What is the success rate of spinal decompression surgery? Precise success rates of spinal decompression surgery can be difficult to calculate due to the wide variety of procedures, severity of spinal conditions, and the age and health of individual patients. Patients can expect a significant decrease in their pain and an improvement in their overall function.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I have a hernia in my lower back and my doctor wants to do a laminotomy. I want to know more information about this surgery. Please explain the different types of spinal decompression surgeries and what I should expect. Use more than 400 words. What is spinal decompression surgery? Spinal decompression surgery is performed to relieve symptoms related to compression of the spinal cord or its roots, which may include back or neck pain and radiating limb pain (radiculopathy). What symptoms does spinal decompression surgery treat? Spinal nerve compression symptoms include pain, altered sensations, muscle weakness or dysfunction, and even gait abnormalities. These symptoms can be caused by a wide variety of conditions. In some of these, such as in cervical spinal stenosis that leads to cervical myelopathy, you may feel symptoms in the arms, hands, legs or feet, and/or have balance problems, or even incontinence issues (bowel dysfunction, unexpected need to urinate, etc.). A rapid onset of these symptoms can indicate a condition known as cauda equina syndrome, which can cause paralysis and other serious problems if not addressed in a timely manner. Pain and other symptoms treated by these surgeries are most common in the lower back (lumbar spine), followed by the neck (cervical spine). Symptoms in the upper back (thoracic spine) are possible but less common because it is the most stable part of the spine, due in part to its being connected to the rib cage. Neuropathies may involve feelings of numbness or a ""pins and needles"" tingling sensation and cause weakness or instability, primarily in lower the back. What happens during spinal decompression surgery? Every type of spinal decompression modifies or removes bone, spinal disc or soft tissues that are causing compression of a nerve. The techniques vary according to which tissues are causing the compression. For example, laminoplasty involves the reshaping of part of a vertebral lamina, a laminotomy the making of a small hole the lamina, and a laminectomy the complete removal of a lamina, all to relieve pressure on the nerves. What types of spine decompression surgery are there? Types of spine decompression surgery performed at HSS include laminectomy, laminotomy, laminoplasty, discectomy and microdiscectomy, among others. Lumbar decompression surgery may be used to address problems in the lower back, such as lumbar laminectomy, laminotomy, or microdiscectomy. Types of spinal decompression surgery Laminectomy is the removal in one or more vertebrae of the lamina (bony roof over the spinal canal). This decompresses both sides (left and right) of the canal. Laminotomy is removal of a small portion of the lamina to decompress one side (left or right) of the canal. This leaves most of the lamina intact. Microsurgical laminoplasty is a minimally invasive surgical decompression technique that uses small incisions viewed through an operating microscope. (Find a laminoplasty spine specialist.) Microdiscectomy (also known as spinal microdecompression surgery): This minimally invasive spine procedure is commonly performed on patients who have sciatica and/or a herniated disc in the lumbar section of the spine (lower back). Using muscle-sparing incisions, this removes portions of a herniated disc that is putting pressure on the spinal nerve and causing pain. Minimally invasive lumbar discectomy (also known as endoscopic percutaneous disc removal) is similar to microdiscectomy and uses a scope to make very small incisions in the skin, through which a portion of the herniated disc that is compressing spinal nerves is removed. Decompression with fusion Some decompression surgeries may require the addition of a fusion procedure simultaneously. This depends on the type of disease being treated and the technique being used to address the disease. This includes lumbar decompressions, such as lumbar interbody fusion (LIF) techniques, which may indirectly decompress the spine, or cervical decompressions, such as anterior cervical discectomy and fusion (ACDF surgery), which are dependent on the differential anatomy of the spine. Who is a good candidate for spinal decompression surgery? Decompression surgery can be a good option for people who have back or neck pain and/or neuropathies due to nerve compression caused by a herniated disc, spinal stenosis, spondylolisthesis, and for whom nonsurgical methods such as physical therapy, epidural steroid injections or pain management regimens have failed to provide relief. Find an HSS spine surgeon by decompression procedure all spinal decompression laminectomy laminoplasty discectomy and microdiscectomy Will I have to go under anesthesia for spinal decompression surgery? Most spinal decompression surgeries will be performed under general anesthesia, with the patient completely unconscious. Some modern techniques allow for spinal surgery under regional anesthesia (either spinal or epidural anesthesia). These techniques allow patients to breathe on their own without the need for mechanical assistance. These techniques may reduce complications associated with general anesthesia but are not widely available and may be performed on a case-by-case basis. How long will I stay in the hospital after spinal decompression surgery? In many cases, patients undergoing decompressions such as a laminectomy, discectomy, or microdiscectomy can go home the same day. This is often the case with a laminectomy, microdiscectomy, and there is research to suggest that even multilevel ACDF surgeries may be safely done on an outpatient basis. Some patients having spinal decompression may need to stay one or more nights including those who have chronic diseases or sleep. Some patients require a spinal fusion may stay overnight and return home one or two days after surgery. Rarely, a patient may need to stay as many longer. In addition, some decompression spine surgeries may be planned as an ambulatory (outpatient) procedure, but then converted to an overnight stay to monitor the patient. In one study of more than 1,000 patients who underwent an ambulatory one- or two-level lumbar decompression, 58% ended up staying over at least one night. How soon can I walk after a decompression spine surgery? At HSS patients are encouraged to walk the same day of most decompression surgeries. How soon can I return to work after spinal decompression? Depending on the specific procedure and other factors, patients generally are able to return to work between two and four weeks after surgery. Some patients who have a microdiscectomy decompression may be able to return to work after less than two weeks. What is the recovery time of spinal decompression surgery? The recovery time for decompression surgery alone is generally faster compared to procedures that include a fusion. Owing to the wide range of decompression surgery types and the number of spinal levels addressed with surgery there is likewise some variability in recovery duration. There is recent evidence that microdiscectomy patients can return to physical therapy and low impact aerobic exercise within four weeks of surgery. Patients undergoing laminectomy procedure can expect surgery pain to ease within two to four weeks of surgery and starting physical therapy and other activities by about six weeks. Fusion procedures are likewise highly variable and recovery times prolonged, approaching three to six months before patients can return to exercise or sports activities. Please confer with your surgeon regarding your procedure and expected recovery. What is the success rate of spinal decompression surgery? Precise success rates of spinal decompression surgery can be difficult to calculate due to the wide variety of procedures, severity of spinal conditions, and the age and health of individual patients. Patients can expect a significant decrease in their pain and an improvement in their overall function. https://www.hss.edu/condition-list_spinal-decompression-surgery.asp",Medical,Explanation/Definition,Q&A "For this task, you are only to answer questions based entirely on the information provided in the prompt. No external resources or prior knowledge are allowed in this case.","In simple language, tell me about the Supreme Court's Code of Conduct?","Recent Changes to Supreme Court Financial Disclosure Requirements Statutory Updates On May 13, 2022, President Biden signed the Courthouse Ethics and Transparency Act, which requires online publication of financial disclosure reports of judicial officers (including Supreme Court Justices), bankruptcy judges, and magistrate judges. While the EIGA always mandated public access to judicial officer financial disclosure reports, there was no central database to access the filings, and reports were available only “in paper documents or on thumb drives.” The new law directed the Administrative Office of the United States Courts (AO) to establish a “searchable internet database to enable public access to any report required to be filed” under the EIGA. The AO launched the public database on November 7, 2022, and the public can now access electronic versions of federal judges’ reports. The EIGA’s allowance for security-related redactions in judicial branch financial disclosure reports remains unchanged. The Courthouse Ethics and Transparency Act also extended the STOCK Act’s PTR requirements to judicial officers (including Supreme Court Justices), bankruptcy judges, and magistrate judges. Under the provisions discussed above, federal judges are now required to report any purchase, sale, or exchange of securities that exceeds $1,000 within 45 days of the transaction. The new public database includes access to all of these periodic transaction reports. Regulatory Updates Interpretation of the EIGA’s financial disclosure requirements as applied to judicial officers and employees has also recently changed. As mentioned above, the Committee on Financial Disclosure within the Judicial Conference prescribes rules regarding financial disclosure by judicial officers. Those rules are found in Volume 2, Part D, of the Guide to Judiciary Policy. As noted above, as part of their financial disclosure reports, all covered individuals are statutorily required to report gifts received from any source other than a relative with the exception of “food, lodging, or entertainment received as personal hospitality.” The EIGA defines personal hospitality of any individual as “hospitality extended for a nonbusiness purpose by an individual, not a corporation or organization, at the personal residence of that individual or the individual’s family or on property or facilities owned by that individual or the individual’s family.” According to a March 2023 letter from the director of the AO, the Committee on Financial Disclosure revised its regulations, effective March 14, 2023, specifically regarding the definition of personal hospitality. These updated regulations appear in the notes that accompany the definition of personal hospitality: (1) The personal hospitality gift reporting exemption applies only to food, lodging, or entertainment and is intended to cover such gifts of a personal, non-business nature. Therefore, the reporting exemption does not include: gifts other than food, lodging or entertainment, such as transportation that substitutes for commercial transportation; gifts extended for a business purpose; Congressional Research Service 4 gifts extended at property or facilities owned by an entity, rather than by an individual or an individual’s family, even if the entity is owned wholly or in part by an individual or an individual’s family; gifts paid for by any individual or entity other than the individual providing the hospitality, or for which the individual providing the hospitality receives reimbursement or a tax deduction related to furnishing the hospitality; or gifts extended at a commercial property, e.g., a resort or restaurant, or at a property that is regularly rented out to others for a business purpose. The notes also clarify that judicial officers and employees are never permitted “to solicit or accept anything of value from a person seeking official action from or doing business with the court or other entity served by the judicial officer or employee, or from any other person whose interests may be substantially affected by the performance or nonperformance of the judge’s official duties.” There is some uncertainty as to whether these regulations apply to the Supreme Court. Although the regulations explicitly include Justices in the definition of judicial officer, some have questioned whether the Judicial Conference has authority over the Supreme Court. In his 2011 Year-End Report, the Chief Justice explained that because the “Judicial Conference is an instrument for the management of the lower federal courts, its committees have no mandate to prescribe rules or standards for any other body.” Nonetheless, at least one Associate Justice has indicated his intention to follow the 2023 guidance going forward, and, as discussed further below, the Justices have stated that they comply with current Judicial Conference regulations on financial disclosure. Supreme Court Code of Conduct On November 13, 2023, the United States Supreme Court announced it was, for the first time, adopting a Code of Conduct “to set out succinctly and gather in one place the ethics rules and principles that guide the conduct of the Members of the Court.” Noting that most of the rules and principles within the Code “are not new,” the Court explained that the Code “largely represents a codification of principles that we have long regarded as governing our conduct.” The Code, discussed in more detail in another Legal Sidebar, is a set of five ethical canons and accompanying commentary. The canons are nearly the same as the existing canons in the Code of Conduct for U.S. Judges, which applies only to lower federal judges. While many provisions of the Supreme Court Code generally address conflicts of interest and appearances of impropriety, specific Code provisions discuss requirements related to financial activities and compliance with the EIGA. For example, Canon 4(H) declares the Justices’ commitment to comply with financial disclosure laws, and the commentary accompanying the Code states that the Justices comply with the EIGA, STOCK Act, and current Judicial Conference regulations on financial disclosure. Although the Code affirms the Justices’ compliance with existing financial disclosure laws and regulations, it seemingly does not impose any new financial disclosure requirements on the Justices. Considerations for Congress Financial disclosure laws are used to identify potential or actual conflicts of interest in order to promote integrity in the federal government. Congress may consider options to modify or clarify current financial disclosure requirements for judicial officers. For example, the Supreme Court Ethics, Recusal, and Transparency Act would, according to its sponsor, “improve disclosure of travel and hospitality for judges” by requiring the counselor to the Chief Justice (with approval of the Chief Justice) to adopt rules regarding disclosure of gifts, travel, and income that are “at least as rigorous as the House and Senate disclosure rules.” This proposal was introduced before the Justices released their November 2023 Code of Conduct, and it is unclear to what extent the Code may overlap with some of the requirements that this bill would impose. Congressional Research Service 5 LSB10949 · VERSION 2 · UPDATED Financial disclosure is only one facet of a wider theme of government ethics. The EIGA, as amended, includes not only the financial disclosure requirements discussed above but also gift and outside earned income and employment limitations that apply to all officers and employees of the government. While the Judicial Conference’s implementing regulations for these laws exclude Supreme Court Justices from coverage, the commentary accompanying the recent Supreme Court Code of Conduct states that the Justices comply with current Judicial Conference regulations on gifts, foreign gifts and decorations, and outside earned income, honoraria, and employment in addition to regulations about financial disclosure. This is consistent with the Justices’ long-standing voluntary compliance with certain Judicial Conference regulations. The Code, however, does not include any enforcement mechanisms, meaning there is no process to address alleged violations of the Code. Proposed legislation about Supreme Court financial disclosure and other ethics requirements, including congressional attempts to enforce the Supreme Court Code of Conduct through legislation or oversight, may raise questions regarding Congress’s authority to regulate the Supreme Court. Some scholars have suggested that Chief Justice Roberts in his 2011 Year-End Report questioned whether Congress may impose ethical requirements on the Supreme Court. Other scholars have argued that while constitutional obstacles—such as separation-of-powers issues—may exist, the Constitution does provide Congress with authority to regulate Supreme Court ethics. This authority, however, is untested, leaving a wide array of questions unanswered regarding the validity of current law and the extent to which Congress may impose future regulations. Despite any doubts as to congressional authority, the Justices, through their newly released Code of Conduct, have acknowledged that they file “the same financial disclosure reports as other federal judges.” Without enforcement mechanisms in the Code, however, compliance with federal ethics laws may be left to the discretion of the Justices.","[For this task, you are only to answer questions based entirely on the information provided in the prompt. No external resources or prior knowledge are allowed in this case.] [In simple language, tell me about the Supreme Court's Code of Conduct?] [Recent Changes to Supreme Court Financial Disclosure Requirements Statutory Updates On May 13, 2022, President Biden signed the Courthouse Ethics and Transparency Act, which requires online publication of financial disclosure reports of judicial officers (including Supreme Court Justices), bankruptcy judges, and magistrate judges. While the EIGA always mandated public access to judicial officer financial disclosure reports, there was no central database to access the filings, and reports were available only “in paper documents or on thumb drives.” The new law directed the Administrative Office of the United States Courts (AO) to establish a “searchable internet database to enable public access to any report required to be filed” under the EIGA. The AO launched the public database on November 7, 2022, and the public can now access electronic versions of federal judges’ reports. The EIGA’s allowance for security-related redactions in judicial branch financial disclosure reports remains unchanged. The Courthouse Ethics and Transparency Act also extended the STOCK Act’s PTR requirements to judicial officers (including Supreme Court Justices), bankruptcy judges, and magistrate judges. Under the provisions discussed above, federal judges are now required to report any purchase, sale, or exchange of securities that exceeds $1,000 within 45 days of the transaction. The new public database includes access to all of these periodic transaction reports. Regulatory Updates Interpretation of the EIGA’s financial disclosure requirements as applied to judicial officers and employees has also recently changed. As mentioned above, the Committee on Financial Disclosure within the Judicial Conference prescribes rules regarding financial disclosure by judicial officers. Those rules are found in Volume 2, Part D, of the Guide to Judiciary Policy. As noted above, as part of their financial disclosure reports, all covered individuals are statutorily required to report gifts received from any source other than a relative with the exception of “food, lodging, or entertainment received as personal hospitality.” The EIGA defines personal hospitality of any individual as “hospitality extended for a nonbusiness purpose by an individual, not a corporation or organization, at the personal residence of that individual or the individual’s family or on property or facilities owned by that individual or the individual’s family.” According to a March 2023 letter from the director of the AO, the Committee on Financial Disclosure revised its regulations, effective March 14, 2023, specifically regarding the definition of personal hospitality. These updated regulations appear in the notes that accompany the definition of personal hospitality: (1) The personal hospitality gift reporting exemption applies only to food, lodging, or entertainment and is intended to cover such gifts of a personal, non-business nature. Therefore, the reporting exemption does not include: gifts other than food, lodging or entertainment, such as transportation that substitutes for commercial transportation; gifts extended for a business purpose; Congressional Research Service 4 gifts extended at property or facilities owned by an entity, rather than by an individual or an individual’s family, even if the entity is owned wholly or in part by an individual or an individual’s family; gifts paid for by any individual or entity other than the individual providing the hospitality, or for which the individual providing the hospitality receives reimbursement or a tax deduction related to furnishing the hospitality; or gifts extended at a commercial property, e.g., a resort or restaurant, or at a property that is regularly rented out to others for a business purpose. The notes also clarify that judicial officers and employees are never permitted “to solicit or accept anything of value from a person seeking official action from or doing business with the court or other entity served by the judicial officer or employee, or from any other person whose interests may be substantially affected by the performance or nonperformance of the judge’s official duties.” There is some uncertainty as to whether these regulations apply to the Supreme Court. Although the regulations explicitly include Justices in the definition of judicial officer, some have questioned whether the Judicial Conference has authority over the Supreme Court. In his 2011 Year-End Report, the Chief Justice explained that because the “Judicial Conference is an instrument for the management of the lower federal courts, its committees have no mandate to prescribe rules or standards for any other body.” Nonetheless, at least one Associate Justice has indicated his intention to follow the 2023 guidance going forward, and, as discussed further below, the Justices have stated that they comply with current Judicial Conference regulations on financial disclosure. Supreme Court Code of Conduct On November 13, 2023, the United States Supreme Court announced it was, for the first time, adopting a Code of Conduct “to set out succinctly and gather in one place the ethics rules and principles that guide the conduct of the Members of the Court.” Noting that most of the rules and principles within the Code “are not new,” the Court explained that the Code “largely represents a codification of principles that we have long regarded as governing our conduct.” The Code, discussed in more detail in another Legal Sidebar, is a set of five ethical canons and accompanying commentary. The canons are nearly the same as the existing canons in the Code of Conduct for U.S. Judges, which applies only to lower federal judges. While many provisions of the Supreme Court Code generally address conflicts of interest and appearances of impropriety, specific Code provisions discuss requirements related to financial activities and compliance with the EIGA. For example, Canon 4(H) declares the Justices’ commitment to comply with financial disclosure laws, and the commentary accompanying the Code states that the Justices comply with the EIGA, STOCK Act, and current Judicial Conference regulations on financial disclosure. Although the Code affirms the Justices’ compliance with existing financial disclosure laws and regulations, it seemingly does not impose any new financial disclosure requirements on the Justices. Considerations for Congress Financial disclosure laws are used to identify potential or actual conflicts of interest in order to promote integrity in the federal government. Congress may consider options to modify or clarify current financial disclosure requirements for judicial officers. For example, the Supreme Court Ethics, Recusal, and Transparency Act would, according to its sponsor, “improve disclosure of travel and hospitality for judges” by requiring the counselor to the Chief Justice (with approval of the Chief Justice) to adopt rules regarding disclosure of gifts, travel, and income that are “at least as rigorous as the House and Senate disclosure rules.” This proposal was introduced before the Justices released their November 2023 Code of Conduct, and it is unclear to what extent the Code may overlap with some of the requirements that this bill would impose. Congressional Research Service 5 LSB10949 · VERSION 2 · UPDATED Financial disclosure is only one facet of a wider theme of government ethics. The EIGA, as amended, includes not only the financial disclosure requirements discussed above but also gift and outside earned income and employment limitations that apply to all officers and employees of the government. While the Judicial Conference’s implementing regulations for these laws exclude Supreme Court Justices from coverage, the commentary accompanying the recent Supreme Court Code of Conduct states that the Justices comply with current Judicial Conference regulations on gifts, foreign gifts and decorations, and outside earned income, honoraria, and employment in addition to regulations about financial disclosure. This is consistent with the Justices’ long-standing voluntary compliance with certain Judicial Conference regulations. The Code, however, does not include any enforcement mechanisms, meaning there is no process to address alleged violations of the Code. Proposed legislation about Supreme Court financial disclosure and other ethics requirements, including congressional attempts to enforce the Supreme Court Code of Conduct through legislation or oversight, may raise questions regarding Congress’s authority to regulate the Supreme Court. Some scholars have suggested that Chief Justice Roberts in his 2011 Year-End Report questioned whether Congress may impose ethical requirements on the Supreme Court. Other scholars have argued that while constitutional obstacles—such as separation-of-powers issues—may exist, the Constitution does provide Congress with authority to regulate Supreme Court ethics. This authority, however, is untested, leaving a wide array of questions unanswered regarding the validity of current law and the extent to which Congress may impose future regulations. Despite any doubts as to congressional authority, the Justices, through their newly released Code of Conduct, have acknowledged that they file “the same financial disclosure reports as other federal judges.” Without enforcement mechanisms in the Code, however, compliance with federal ethics laws may be left to the discretion of the Justices.]",Financial,Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Can you explain to me why staphylococcus aureus is a pathogen that is of particular worry for humans? What disease does it cause? What are the reasons behinds its success?,"Staphylococcus aureus is a Gram-positive, nonmotile, coagulase-positive coccoid bacterium of the Firmicutes phylum. Although the Staphylococcus genus includes 52 species and 28 subspecies (List of Prokaryotic names with Standing in Nomenclature), S. aureus is by far the most clinically relevant. S. aureus is found in the human commensal microbiota of the nasal mucosa in 20–40% of the general population1,2. The reported prevalence varies owing to differences in the size and demographics of the study populations, quality of sampling and culture techniques utilized3. When the cutaneous and mucosal barriers are disrupted, for example, owing to chronic skin conditions, wounds or surgical intervention, S. aureus can gain access to the underlying tissues or the bloodstream and cause infection. Persons with invasive medical devices (such as peripheral and central venous catheters) or compromised immune systems are particularly vulnerable to S. aureus infection4. Methicillin-resistant S. aureus (MRSA) was first described in England in 1961 (Ref.5), soon after methicillin was introduced into clinical practice. Methicillin was initially widely used; however, because of its toxicity, it is now no longer marketed for human use and has largely been replaced by similar, more-stable penicillins such as oxacillin, flucloxacillin and dicloxacillin6. Nevertheless, the term methicillin-resistant S. aureus continues to be used. In the decade following its initial description, MRSA was responsible for hospital outbreaks (health-care-associated MRSA (HA-MRSA)) in many parts of the world7. A substantial change in MRSA epidemiology was observed when it was detected in individuals without previous health-care contact (referred to as community-associated MRSA (CA-MRSA)), notably among indigenous populations in Australia in the 1980s8 and otherwise healthy persons, including children, in the United States in the 1990s9. Since the mid-2000s, it has also been associated with livestock exposure (livestock-associated MRSA (LA-MRSA))10. Several S. aureus clones (that is, bacteria that are indistinguishable from each other by a variety of genetic tests (for example, pulsed-field gel electrophoresis, multilocus enzyme electrophoresis or ribotyping) or that are so similar that they are presumed to be derived from a common parent11) have developed into MRSA by uptake via horizontal gene transfer of staphylococcal cassette chromosome mec (SCCmec)12, a mobile genetic element that encodes the genes mecA or mecC, which confer resistance to methicillin and, therefore, to most β-lactam antibiotics. MRSA is often also resistant to multiple other antibiotic classes. Indeed, S. aureus has the remarkable ability to acquire resistance to any antibiotic7, which has major implications for current as well as future treatment options for this pathogen. Individuals with MRSA colonization or carriage (that is, the presence of bacteria that do not cause a detectable host immune response, cellular damage or clinical signs and symptoms of infection) have an increased risk of subsequent infection and are an important source of person-to-person transmission. Health-care facilities host persons who are predisposed to infection (for example, owing to invasive procedures and/or immune compromise) and are environments with high antibiotic selection pressure (which can contribute to the selection of antimicrobial resistance in bacteria) and frequent contact between individuals. These conditions have facilitated the epidemic spread of MRSA in hospitals; MRSA is now endemic in many health-care facilities throughout the world and, as a consequence, it has become a major focus for infection control efforts globally.","""================ ======= Staphylococcus aureus is a Gram-positive, nonmotile, coagulase-positive coccoid bacterium of the Firmicutes phylum. Although the Staphylococcus genus includes 52 species and 28 subspecies (List of Prokaryotic names with Standing in Nomenclature), S. aureus is by far the most clinically relevant. S. aureus is found in the human commensal microbiota of the nasal mucosa in 20–40% of the general population1,2. The reported prevalence varies owing to differences in the size and demographics of the study populations, quality of sampling and culture techniques utilized3. When the cutaneous and mucosal barriers are disrupted, for example, owing to chronic skin conditions, wounds or surgical intervention, S. aureus can gain access to the underlying tissues or the bloodstream and cause infection. Persons with invasive medical devices (such as peripheral and central venous catheters) or compromised immune systems are particularly vulnerable to S. aureus infection4. Methicillin-resistant S. aureus (MRSA) was first described in England in 1961 (Ref.5), soon after methicillin was introduced into clinical practice. Methicillin was initially widely used; however, because of its toxicity, it is now no longer marketed for human use and has largely been replaced by similar, more-stable penicillins such as oxacillin, flucloxacillin and dicloxacillin6. Nevertheless, the term methicillin-resistant S. aureus continues to be used. In the decade following its initial description, MRSA was responsible for hospital outbreaks (health-care-associated MRSA (HA-MRSA)) in many parts of the world7. A substantial change in MRSA epidemiology was observed when it was detected in individuals without previous health-care contact (referred to as community-associated MRSA (CA-MRSA)), notably among indigenous populations in Australia in the 1980s8 and otherwise healthy persons, including children, in the United States in the 1990s9. Since the mid-2000s, it has also been associated with livestock exposure (livestock-associated MRSA (LA-MRSA))10. Several S. aureus clones (that is, bacteria that are indistinguishable from each other by a variety of genetic tests (for example, pulsed-field gel electrophoresis, multilocus enzyme electrophoresis or ribotyping) or that are so similar that they are presumed to be derived from a common parent11) have developed into MRSA by uptake via horizontal gene transfer of staphylococcal cassette chromosome mec (SCCmec)12, a mobile genetic element that encodes the genes mecA or mecC, which confer resistance to methicillin and, therefore, to most β-lactam antibiotics. MRSA is often also resistant to multiple other antibiotic classes. Indeed, S. aureus has the remarkable ability to acquire resistance to any antibiotic7, which has major implications for current as well as future treatment options for this pathogen. Individuals with MRSA colonization or carriage (that is, the presence of bacteria that do not cause a detectable host immune response, cellular damage or clinical signs and symptoms of infection) have an increased risk of subsequent infection and are an important source of person-to-person transmission. Health-care facilities host persons who are predisposed to infection (for example, owing to invasive procedures and/or immune compromise) and are environments with high antibiotic selection pressure (which can contribute to the selection of antimicrobial resistance in bacteria) and frequent contact between individuals. These conditions have facilitated the epidemic spread of MRSA in hospitals; MRSA is now endemic in many health-care facilities throughout the world and, as a consequence, it has become a major focus for infection control efforts globally. https://www.nature.com/articles/nrdp201833 ================ ======= Can you explain to me why staphylococcus aureus is a pathogen that is of particular worry for humans? What disease does it cause? What are the reasons behinds its success? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","A streamer I like was recently diagnosed with bronchitis, and now I'm curious about what it is. Summarize this article on bronchitis for me and format your response in bullet form.","Cough is the most common illness-related reason for ambulatory care visits in the United States. Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia. Pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted. Pertussis should be suspected in patients with cough persisting for more than two weeks that is accompanied by symptoms such as paroxysmal cough, whooping cough, and post-tussive emesis, or recent pertussis exposure. The cough associated with acute bronchitis typically lasts about two to three weeks, and this should be emphasized with patients. Acute bronchitis is usually caused by viruses, and antibiotics are not indicated in patients without chronic lung disease. Antibiotics have been shown to provide only minimal benefit, reducing the cough or illness by about half a day, and have adverse effects, including allergic reactions, nausea and vomiting, and Clostridium difficile infection. Evaluation and treatment of bronchitis include ruling out secondary causes for cough, such as pneumonia; educating patients about the natural course of the disease; and recommending symptomatic treatment and avoidance of unnecessary antibiotic use. Strategies to reduce inappropriate antibiotic use include delayed prescriptions, patient education, and calling the infection a chest cold. Acute bronchitis is most often caused by a viral infection.3,4 The most commonly identified viruses are rhinovirus, enterovirus, influenza A and B, parainfluenza, coronavirus, human metapneumovirus, and respiratory syncytial virus.3 Bacteria are detected in 1% to 10% of cases of acute bronchitis.3–5 Atypical bacteria, such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis, are rare causes of acute bronchitis. In a study of sputum samples of adults with acute cough for more than five days, M. pneumoniae was isolated in less than 1% of cases and C. pneumoniae was not identified.6 Approximately 10% of patients presenting with a cough lasting at least two weeks have evidence of B. pertussis infection.7,8 During outbreaks, pertussis detection is more likely in children and those with prolonged coughs.6,9 Antibiotics can eradicate B. pertussis from the nasopharynx. They do not seem to shorten the course of illness unless given in the first one to two weeks.10 Isolated outbreaks of pertussis occur throughout the United States, and increased testing of adults and children should be considered during these periods. Cough is the predominant and defining symptom of acute bronchitis. The primary diagnostic consideration in patients with suspected acute bronchitis is ruling out more serious causes of cough, such as asthma, exacerbation of chronic obstructive pulmonary disease, heart failure, or pneumonia. The diagnoses that have the most overlap with acute bronchitis are upper respiratory tract infections and pneumonia. Whereas acute bronchitis and the common cold are self-limited illnesses that do not require antibiotic treatment, the standard therapy for pneumonia is antibiotics. Besides cough, other signs and symptoms of acute bronchitis include sputum production, dyspnea, nasal congestion, headache, and fever.4,11,12 The first few days of an acute bronchitis infection may be indistinguishable from the common cold. Patients may have substernal or chest wall pain when coughing. Fever is not a typical finding after the first few days, and presence of a fever greater than 100°F (37.8°C) should prompt consideration of influenza or pneumonia. Production of sputum, even purulent, is common and does not correlate with bacterial infection.13,14 Because the cough associated with bronchitis is so bothersome and slow to resolve, patients often seek treatment. Patients and clinicians may underestimate the time required to fully recover from acute bronchitis.15 The duration of acute bronchitis–related cough is typically two to three weeks, with a pooled estimate of 18 days in one systematic review.15 This corresponds to results of a prospective trial, which found that patients who had a cough for at least five days had a median of 18 days of coughing.16 On physical examination, patients with acute bronchitis may be mildly ill-appearing, and fever is present in about one-third of patients.4,11 Lung auscultation may reveal wheezes, as well as rhonchi that typically improve with coughing. It is important to rule out pneumonia. High fever; moderate to severe ill-appearance; hypoxia; and signs of lung consolidation, such as decreased breath sounds, bronchial breath sounds, crackles, egophony, and increased tactile fremitus, are concerning for pneumonia. Pneumonia is unlikely in nonfrail older adults who have normal vital signs and normal lung examination findings.17–20","""================ ======= Cough is the most common illness-related reason for ambulatory care visits in the United States. Acute bronchitis is a clinical diagnosis characterized by cough due to acute inflammation of the trachea and large airways without evidence of pneumonia. Pneumonia should be suspected in patients with tachypnea, tachycardia, dyspnea, or lung findings suggestive of pneumonia, and radiography is warranted. Pertussis should be suspected in patients with cough persisting for more than two weeks that is accompanied by symptoms such as paroxysmal cough, whooping cough, and post-tussive emesis, or recent pertussis exposure. The cough associated with acute bronchitis typically lasts about two to three weeks, and this should be emphasized with patients. Acute bronchitis is usually caused by viruses, and antibiotics are not indicated in patients without chronic lung disease. Antibiotics have been shown to provide only minimal benefit, reducing the cough or illness by about half a day, and have adverse effects, including allergic reactions, nausea and vomiting, and Clostridium difficile infection. Evaluation and treatment of bronchitis include ruling out secondary causes for cough, such as pneumonia; educating patients about the natural course of the disease; and recommending symptomatic treatment and avoidance of unnecessary antibiotic use. Strategies to reduce inappropriate antibiotic use include delayed prescriptions, patient education, and calling the infection a chest cold. Acute bronchitis is most often caused by a viral infection.3,4 The most commonly identified viruses are rhinovirus, enterovirus, influenza A and B, parainfluenza, coronavirus, human metapneumovirus, and respiratory syncytial virus.3 Bacteria are detected in 1% to 10% of cases of acute bronchitis.3–5 Atypical bacteria, such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Bordetella pertussis, are rare causes of acute bronchitis. In a study of sputum samples of adults with acute cough for more than five days, M. pneumoniae was isolated in less than 1% of cases and C. pneumoniae was not identified.6 Approximately 10% of patients presenting with a cough lasting at least two weeks have evidence of B. pertussis infection.7,8 During outbreaks, pertussis detection is more likely in children and those with prolonged coughs.6,9 Antibiotics can eradicate B. pertussis from the nasopharynx. They do not seem to shorten the course of illness unless given in the first one to two weeks.10 Isolated outbreaks of pertussis occur throughout the United States, and increased testing of adults and children should be considered during these periods. Cough is the predominant and defining symptom of acute bronchitis. The primary diagnostic consideration in patients with suspected acute bronchitis is ruling out more serious causes of cough, such as asthma, exacerbation of chronic obstructive pulmonary disease, heart failure, or pneumonia. The diagnoses that have the most overlap with acute bronchitis are upper respiratory tract infections and pneumonia. Whereas acute bronchitis and the common cold are self-limited illnesses that do not require antibiotic treatment, the standard therapy for pneumonia is antibiotics. Besides cough, other signs and symptoms of acute bronchitis include sputum production, dyspnea, nasal congestion, headache, and fever.4,11,12 The first few days of an acute bronchitis infection may be indistinguishable from the common cold. Patients may have substernal or chest wall pain when coughing. Fever is not a typical finding after the first few days, and presence of a fever greater than 100°F (37.8°C) should prompt consideration of influenza or pneumonia. Production of sputum, even purulent, is common and does not correlate with bacterial infection.13,14 Because the cough associated with bronchitis is so bothersome and slow to resolve, patients often seek treatment. Patients and clinicians may underestimate the time required to fully recover from acute bronchitis.15 The duration of acute bronchitis–related cough is typically two to three weeks, with a pooled estimate of 18 days in one systematic review.15 This corresponds to results of a prospective trial, which found that patients who had a cough for at least five days had a median of 18 days of coughing.16 On physical examination, patients with acute bronchitis may be mildly ill-appearing, and fever is present in about one-third of patients.4,11 Lung auscultation may reveal wheezes, as well as rhonchi that typically improve with coughing. It is important to rule out pneumonia. High fever; moderate to severe ill-appearance; hypoxia; and signs of lung consolidation, such as decreased breath sounds, bronchial breath sounds, crackles, egophony, and increased tactile fremitus, are concerning for pneumonia. Pneumonia is unlikely in nonfrail older adults who have normal vital signs and normal lung examination findings.17–20 https://www.aafp.org/pubs/afp/issues/2016/1001/p560.html ================ ======= A streamer I like was recently diagnosed with bronchitis, and now I'm curious about what it is. Summarize this article on bronchitis for me and format your response in bullet form. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Summarize & Format,Text Transformation "In your response, you must only ever answer the question based on the information in the prompt. No external information may be used, nor prior knowledge you have about the topic. Each time you mention a sex or gender, replace it with the equivalent word for chickens. Split the answer into two sections, one for women, one for men. Respond in bullet points, with a short explanation after each point. ",What factors might go into female and male athletes having different cardiovascular exercise requirements?,"Fasted cardiovascular exercise was recommended by approximately two-thirds of par- ticipant coaches, with the most common reason for preference being the added utilization of yohimbine, growth hormone, and clenbuterol (their combination with fasted exercise is thought to enhance fat loss). A systematic review reported that fasted cardiovascular exercise is not more effective than fed cardiovascular exercise [13 ]. Notably, none of the studies included in the systematic review recruited competitive bodybuilders as subjects, nor did they look at subjects utilizing fasted cardiovascular exercise in tandem with these specific PEDs for an additional fat-burning effect. A review article by Escalante et al. sug- gests that physique athletes may perform fasted cardio at varying intensities, but it is not suggested for longer than 60 min to prevent fat-free mass losses [14]. Future research in this population is needed in which fasted cardiovascular exercise is paired with fat-burning compounds to determine if this pairing is (1) safe and (2) efficacious for fat loss outcomes. Participant coaches notably did not prefer HIIT cardiovascular exercise over LISS or MISS cardiovascular exercise for any of the populations. This recommendation is in line with previous research, as a systematic review and meta-analysis reported similarly effective fat-burning effects between HIIT and MISS [15 ]. Furthermore, authors of a narrative review suggested that HIIT cardiovascular exercise should not be used too frequently due to the increased recovery demands during natural bodybuilding contest preparation [16]. Further research in both enhanced and natural populations is warranted on this topic. Participant coaches recommended that female athletes perform more cardiovascular exercise during contest preparation, up to 740 min (12+ h) per week, and male bodybuilding athletes up to 480 min (8 h) per week. Given the potential of high volumes of resistance training to induce additional fatigue while dieting, authors of some reviews recommend the lowest amount of cardiovascular exercise needed to achieve the desired result to mitigate any negative impact of cardiovascular training [16 , 17]. The range of cardiovascular exercise frequencies and durations for athletes is notably very wide, and this is likely due to the individuality of every athlete’s energy expenditure, current body composition, genetics, timeline to achieve stage-leanness, required leanness for their respective division, and indi- vidual preference. Neither coaches nor researchers may be able to provide generalizations about the amount of cardiovascular exercise that will be required to obtain the desired leanness for specific divisions due to the individuality of each athlete.","System instruction: [In your response, you must only ever answer the question based on the information in the prompt. No external information may be used, nor prior knowledge you have about the topic. Each time you mention a sex or gender, replace it with the equivalent word for chickens. Split the answer into two sections, one for women, one for men. Respond in bullet points, with a short explanation after each point.] Question: [What factors might go into female and male athletes having different cardiovascular exercise requirements?] Context: [Fasted cardiovascular exercise was recommended by approximately two-thirds of par- ticipant coaches, with the most common reason for preference being the added utilization of yohimbine, growth hormone, and clenbuterol (their combination with fasted exercise is thought to enhance fat loss). A systematic review reported that fasted cardiovascular exercise is not more effective than fed cardiovascular exercise [13 ]. Notably, none of the studies included in the systematic review recruited competitive bodybuilders as subjects, nor did they look at subjects utilizing fasted cardiovascular exercise in tandem with these specific PEDs for an additional fat-burning effect. A review article by Escalante et al. sug- gests that physique athletes may perform fasted cardio at varying intensities, but it is not suggested for longer than 60 min to prevent fat-free mass losses [14]. Future research in this population is needed in which fasted cardiovascular exercise is paired with fat-burning compounds to determine if this pairing is (1) safe and (2) efficacious for fat loss outcomes. Participant coaches notably did not prefer HIIT cardiovascular exercise over LISS or MISS cardiovascular exercise for any of the populations. This recommendation is in line with previous research, as a systematic review and meta-analysis reported similarly effective fat-burning effects between HIIT and MISS [15 ]. Furthermore, authors of a narrative review suggested that HIIT cardiovascular exercise should not be used too frequently due to the increased recovery demands during natural bodybuilding contest preparation [16]. Further research in both enhanced and natural populations is warranted on this topic. Participant coaches recommended that female athletes perform more cardiovascular exercise during contest preparation, up to 740 min (12+ h) per week, and male bodybuilding athletes up to 480 min (8 h) per week. Given the potential of high volumes of resistance training to induce additional fatigue while dieting, authors of some reviews recommend the lowest amount of cardiovascular exercise needed to achieve the desired result to mitigate any negative impact of cardiovascular training [16 , 17]. The range of cardiovascular exercise frequencies and durations for athletes is notably very wide, and this is likely due to the individuality of every athlete’s energy expenditure, current body composition, genetics, timeline to achieve stage-leanness, required leanness for their respective division, and indi- vidual preference. Neither coaches nor researchers may be able to provide generalizations about the amount of cardiovascular exercise that will be required to obtain the desired leanness for specific divisions due to the individuality of each athlete.]",Medical,Fact Finding,Q&A "Your response should be based only on the text provided. No external resources or prior knowledge may be used to answer questions. Format your response using markdown where appropriate, and use numbered lists to structure your response.","What is known about gun ownership rule changes and their impact on suicide rates, according to Every-Palmer et al (2021)?","Restriction of other means of suicide Ease of access to certain means and substances used as methods of suicide are commonly associated with increased rates of suicides, and present key opportunities for prevention. These include restriction of gun ownership, pesticides, carbon monoxide gas, paracetamol, opioids, alcohol, and the modification of specific settings to reduce ease of hanging, and modifications to road networks outlined below. Gun ownership is associated with increased rates of suicide overall, as well as death by suicide using a firearm (Jin, Khazem, & Anestis, 2016; Mann & Michel, 2016) and non- suicide related firearm mortality among children (Zeoli et al., 2019). Like other approaches to means restriction, reducing suicide deaths by firearms requires multiple strategies including the use of locked gun cabinets, storing guns unloaded, separate storage of guns and ammunition and outside of the USA, a focus on more stringent licencing. Changes to licencing in New Zealand after the 1990 Aramoana tragedy reduced firearm suicides, particularly among young people (Beautrais, Fergusson, & Horwood, 2006; Mann & Michel, 2016). Most firearms deaths in New Zealand occurring among older men, who have lower than average rates of GP contacts and antidepressant prescriptions in the year prior to their death (see the Suicide Mortality Review Committee report here for more detail). The impact of more recent firearms amendments following the 2019 Christchurch tragedy (Every- Palmer, Cunningham, Jenkins, & Bell, 2021) is not yet clear, but needs to be evaluated from a suicide prevention perspective. Lethal means counselling usually focuses on firearms or medication advice and on parents taking care of a suicidal young person. Studies to date have focused on those presenting to Emergency Departments (ED’s) and have identified clinician hesitancy, perceived lack of skill and clinician sceptism about effectiveness as barriers to routine delivery of this approach to suicide prevention (Hunter et al., 2021). Ingestion of pesticides is a method of suicide associated with a number of agricultural communities and in low and low middle income countries (LMIC) particularly in the Western Pacific region (Mew et al., 2017). Consideration of pesticide ingestion as a method of suicide is becoming more relevant to prevention in New Zealand as we become more diverse as a nation. The evidence to date suggests that national bans, rather than safe storage (Reifels et al., 2019) or sales restrictions (Gunnell et al., 2017) of the most highly hazardous pesticides (HHP) is the most effective method of reducing deaths both by suicide and overall, without impacting agricultural outputs (Bonvoisin, Utyasheva, Knipe, Gunnell, & Eddleston, 2020; Gunnell et al., 2017; Mew et al., 2017). Means restriction to carbon monoxide gas has been the focus of a number of studies in the UK following changes in supply source for domestic gas (Sarchiapone, Mandelli, Iosue, Andrisano, & Roy, 2011). In New Zealand there has been a positive impact of regulations for catalytic convertors in motor vehicles (Suicide Mortality Review Committee, 2016), against a backdrop of reduced deaths (intentional and unintentional) due to carbon monoxide poisoning in Australasia (Long, Sun, Zhao, Liu, & Peng, 2021). Deaths by this method may further decline as the proportion of petrol vehicles in the fleet decreases over time. Paracetamol is a cheap, widely available compound which is commonly used in intentional self-poisoning and is associated with morbidity and mortality. Paracetamol controls, reducing both the number of tablets available in a package, and number of packs that can be purchased at once have been effective in reducing deaths associated with this method in the UK (Hawton et al., 2013) and Ireland. However, both countries report ongoing issues with paracetamol overdoses and researchers recommend further reductions in availability such as making this a pharmacy only medication (Casey et al., 2020; Daly et al., 2021). Paracetamol control in Scotland had some initial success following the introduction of pack size controls, but then returned to previous levels (Gorman, Bain, Inglis, Murphy, & Bateman, 2007). A number of Australian states have moved to implement paracetamol control based on the international evidence (Lim, Buckley, Chitty, Moles, & Cairns, 2021). In addition to paracetamol, interventions to reduce access to salicylates, dextropropoxyphene, barbiturates, and caffeine tablets have also been found to effective across a number of countries (Lim et al., 2021). Hanging has an extremely high case fatality rate and is the most common method of suicide among every population group in Aotearoa New Zealand, which makes this an important aspect of prevention to consider. In general population settings reducing access to ligatures and ligature points is not entirely feasible. However there is still scope for a reduction in deaths by this method in institutional settings such as hospitals, prisons and police custody using design for safety principles, ensuring adequate staffing and service user visibility (Jin et al., 2016; Sakinofsky, 2014). Internationally, certain common ligature points have been targeted for re-design to ensure they collapse under weight. There may be scope for this in New Zealand also, given that most deaths by hanging occur in the home. In addition, reducing unsafe reporting or social media content about this method is an important approach to reducing cognitive valence of this method (Cai, Junus, Chang, & Yip, 2022). Alcohol consumption is associated with elevated risk of suicide, at both an individual and population level. Both acute intoxication and alcohol misuse are potential targets for intervention given their association with low mood, loss of behaviour regulation and hopelessness (Norstrom & Rossow, 2016). Reducing access to alcohol, and increasing price are feasible and effective strategies for reducing alcohol related harm generally, and for reducing suicide in particular (Altavini et al., 2022), particularly among men and younger people (Kolves et al., 2020). Reducing access has been shown to be effective in Europe and North America, including with indigenous populations (Leske et al., 2020). The clinical treatment literature relating to alcohol is addressed in a later section. In terms of roading, New Zealand has a large road network, and each year there are transport- related suicides in which the deceased may be a driver or pedestrian. International evidence suggests that a proportion of transport accidents are suicides and suicide should be considered particularly in single vehicle accidents, for men 25 to 35 years and where the person has a prior experience of suicide attempt (Okolie et al., 2020a). There has been relatively little work in this area in New Zealand (Fortune, McDonald, Chafer, Lilley, & Mulder, 2022) and a recent review was unable to identify any intervention studies (Okolie et al., 2020a). There has been extensive coverage in both the mainstream media and academic publications on the impact on opioid prescribing on opioid related deaths, particularly in the USA. Opioids are of interest to suicide prevention practitioners in New Zealand. First, we already have intentional self-poisoning deaths due to opioid compounds particularly among older men (Fortune et al., 2022). Secondly, there is a known overlap between accidental and intentional self-poisoning deaths internationally, and thirdly, there has been recent media coverage suggesting that compounds such as fentanyl are being distributed in the community (see here for more details). A full consideration of this topic is beyond the scope of this review; however, it is likely a strong prescription drug monitoring system (in terms of dose, duration and frequency), patient and clinician education, (Ansari, Tote, Rosenberg, & Martin, 2020) (e.g., Beaudoin, Banerjee, & Mello, 2016) in addition to harm reduction measures such as the availability of naloxone is likely to be needed. The evidence for the latter is; however, mixed (e.g., (Ansari et al., 2020)).","Your response should be based only on the text provided. No external resources or prior knowledge may be used to answer questions. Format your response using markdown where appropriate, and use numbered lists to structure your response. What is known about gun ownership rule changes and their impact on suicide rates, according to Every-Palmer et al (2021)? Restriction of other means of suicide Ease of access to certain means and substances used as methods of suicide are commonly associated with increased rates of suicides, and present key opportunities for prevention. These include restriction of gun ownership, pesticides, carbon monoxide gas, paracetamol, opioids, alcohol, and the modification of specific settings to reduce ease of hanging, and modifications to road networks outlined below. Gun ownership is associated with increased rates of suicide overall, as well as death by suicide using a firearm (Jin, Khazem, & Anestis, 2016; Mann & Michel, 2016) and non- suicide related firearm mortality among children (Zeoli et al., 2019). Like other approaches to means restriction, reducing suicide deaths by firearms requires multiple strategies including the use of locked gun cabinets, storing guns unloaded, separate storage of guns and ammunition and outside of the USA, a focus on more stringent licencing. Changes to licencing in New Zealand after the 1990 Aramoana tragedy reduced firearm suicides, particularly among young people (Beautrais, Fergusson, & Horwood, 2006; Mann & Michel, 2016). Most firearms deaths in New Zealand occurring among older men, who have lower than average rates of GP contacts and antidepressant prescriptions in the year prior to their death (see the Suicide Mortality Review Committee report here for more detail). The impact of more recent firearms amendments following the 2019 Christchurch tragedy (Every- Palmer, Cunningham, Jenkins, & Bell, 2021) is not yet clear, but needs to be evaluated from a suicide prevention perspective. Lethal means counselling usually focuses on firearms or medication advice and on parents taking care of a suicidal young person. Studies to date have focused on those presenting to Emergency Departments (ED’s) and have identified clinician hesitancy, perceived lack of skill and clinician sceptism about effectiveness as barriers to routine delivery of this approach to suicide prevention (Hunter et al., 2021). Ingestion of pesticides is a method of suicide associated with a number of agricultural communities and in low and low middle income countries (LMIC) particularly in the Western Pacific region (Mew et al., 2017). Consideration of pesticide ingestion as a method of suicide is becoming more relevant to prevention in New Zealand as we become more diverse as a nation. The evidence to date suggests that national bans, rather than safe storage (Reifels et al., 2019) or sales restrictions (Gunnell et al., 2017) of the most highly hazardous pesticides (HHP) is the most effective method of reducing deaths both by suicide and overall, without impacting agricultural outputs (Bonvoisin, Utyasheva, Knipe, Gunnell, & Eddleston, 2020; Gunnell et al., 2017; Mew et al., 2017). Means restriction to carbon monoxide gas has been the focus of a number of studies in the UK following changes in supply source for domestic gas (Sarchiapone, Mandelli, Iosue, Andrisano, & Roy, 2011). In New Zealand there has been a positive impact of regulations for catalytic convertors in motor vehicles (Suicide Mortality Review Committee, 2016), against a backdrop of reduced deaths (intentional and unintentional) due to carbon monoxide poisoning in Australasia (Long, Sun, Zhao, Liu, & Peng, 2021). Deaths by this method may further decline as the proportion of petrol vehicles in the fleet decreases over time. Paracetamol is a cheap, widely available compound which is commonly used in intentional self-poisoning and is associated with morbidity and mortality. Paracetamol controls, reducing both the number of tablets available in a package, and number of packs that can be purchased at once have been effective in reducing deaths associated with this method in the UK (Hawton et al., 2013) and Ireland. However, both countries report ongoing issues with paracetamol overdoses and researchers recommend further reductions in availability such as making this a pharmacy only medication (Casey et al., 2020; Daly et al., 2021). Paracetamol control in Scotland had some initial success following the introduction of pack size controls, but then returned to previous levels (Gorman, Bain, Inglis, Murphy, & Bateman, 2007). A number of Australian states have moved to implement paracetamol control based on the international evidence (Lim, Buckley, Chitty, Moles, & Cairns, 2021). In addition to paracetamol, interventions to reduce access to salicylates, dextropropoxyphene, barbiturates, and caffeine tablets have also been found to effective across a number of countries (Lim et al., 2021). Hanging has an extremely high case fatality rate and is the most common method of suicide among every population group in Aotearoa New Zealand, which makes this an important aspect of prevention to consider. In general population settings reducing access to ligatures and ligature points is not entirely feasible. However there is still scope for a reduction in deaths by this method in institutional settings such as hospitals, prisons and police custody using design for safety principles, ensuring adequate staffing and service user visibility (Jin et al., 2016; Sakinofsky, 2014). Internationally, certain common ligature points have been targeted for re-design to ensure they collapse under weight. There may be scope for this in New Zealand also, given that most deaths by hanging occur in the home. In addition, reducing unsafe reporting or social media content about this method is an important approach to reducing cognitive valence of this method (Cai, Junus, Chang, & Yip, 2022). Alcohol consumption is associated with elevated risk of suicide, at both an individual and population level. Both acute intoxication and alcohol misuse are potential targets for intervention given their association with low mood, loss of behaviour regulation and hopelessness (Norstrom & Rossow, 2016). Reducing access to alcohol, and increasing price are feasible and effective strategies for reducing alcohol related harm generally, and for reducing suicide in particular (Altavini et al., 2022), particularly among men and younger people (Kolves et al., 2020). Reducing access has been shown to be effective in Europe and North America, including with indigenous populations (Leske et al., 2020). The clinical treatment literature relating to alcohol is addressed in a later section. In terms of roading, New Zealand has a large road network, and each year there are transport- related suicides in which the deceased may be a driver or pedestrian. International evidence suggests that a proportion of transport accidents are suicides and suicide should be considered particularly in single vehicle accidents, for men 25 to 35 years and where the person has a prior experience of suicide attempt (Okolie et al., 2020a). There has been relatively little work in this area in New Zealand (Fortune, McDonald, Chafer, Lilley, & Mulder, 2022) and a recent review was unable to identify any intervention studies (Okolie et al., 2020a). There has been extensive coverage in both the mainstream media and academic publications on the impact on opioid prescribing on opioid related deaths, particularly in the USA. Opioids are of interest to suicide prevention practitioners in New Zealand. First, we already have intentional self-poisoning deaths due to opioid compounds particularly among older men (Fortune et al., 2022). Secondly, there is a known overlap between accidental and intentional self-poisoning deaths internationally, and thirdly, there has been recent media coverage suggesting that compounds such as fentanyl are being distributed in the community (see here for more details). A full consideration of this topic is beyond the scope of this review; however, it is likely a strong prescription drug monitoring system (in terms of dose, duration and frequency), patient and clinician education, (Ansari, Tote, Rosenberg, & Martin, 2020) (e.g., Beaudoin, Banerjee, & Mello, 2016) in addition to harm reduction measures such as the availability of naloxone is likely to be needed. The evidence for the latter is; however, mixed (e.g., (Ansari et al., 2020)).",Medical,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","There's this case i can't find anything about, Schembri, but it's in this attached text. Can you summarize the facts and law of the case? Also, don't bother referencing legislative sections, as I'm not a specialist and won't look at the EI Act ever.",". Molchan v. Canada (Attorney General) [49] The issue in Schembri was whether the Commission was bound to take into account the claimant’s financial circumstances when determining the penalty to impose. The claimant in that case had failed to report his earnings and collected unemployment benefits for several months. The Commission had calculated that the claimant had received a benefit overpayment of $4,130, which it sought to recover. It had also assessed a penalty under section 38 of the EIA, because the claimant had received unemployment benefits by knowingly misreporting his income contrary to paragraph 38(1)(c) of the EIA. In determining the amount of penalty payable, the Commission considered the claimant’s gambling addiction and his efforts to deal with it, and reduced the penalty by 25% to $3,097. The Board of Referees later exonerated the claimant from any penalty. The Umpire then found that the Commission had erred when it failed to undertake, on its own initiative, an inquiry into the claimant’s financial circumstances and whether it would cause the claimant undue hardship to pay the proposed penalty. The Umpire reduced the penalty imposed by the Commission from 75% to 10% of the amount of the overpayment. [50] On judicial review, this Court held that the Commission was not required to initiate its own inquiries into a person’s financial circumstances before it imposed a penalty, noting that claimants have ample opportunities to request a reduction of the penalty on the ground of financial hardship at various stages of the process: before the penalty is imposed, on request for reconsideration and on appeal to the Board of Referees (Schembri at para. 14). Since the claimant had not raised the issue with the Commission and the Board of Referees, this Court decided that the Umpire should have held that the Board had no basis to interfere with the penalty. [51] In my view, this Court’s findings in Schembri do not extend to the reconsideration of a claimant’s entitlement to benefits. The overpayment in Schembri was not in dispute, only the amount of penalty the claimant would have to pay. Subsection 38(1) of the EIA specifies the acts or omissions for which a claimant may be subject to a penalty and subsection 38(2) sets the maximum penalties the Commission may impose. Under section 41 of the EIA, the Commission may rescind the imposition of a penalty or reduce it, on the presentation of new facts or on being satisfied that the penalty was imposed without knowledge of, or on the basis of a mistake as to, some material fact. Furthermore the Commission may issue, under section 41.1, a warning instead of setting the amount of a penalty for an act or omission under subsections 38(2) and 39(2) of the EIA. The Commission thus enjoys a wide discretion in assessing the amount of penalty and may consider financial hardship to the claimant as a mitigating factor. [52] This is consistent with the Commission’s policy regarding penalties, which mentions financial hardship as a possible mitigating circumstance when determining penalties (Digest of Benefit Entitlement Principles, section 18.5.2.2). It appears from the record that the Commission did not apply a penalty in Ms. Molchan’s case despite her false statements (Applicant’s record at 130, 173, 178). ..... [55] In my view, the Appeal Division’s comments regarding Ms. Molchan’s ability to seek a write-off of her debt are consistent with the legislation, which sets out a specific procedure, a write-off, for undue hardship cases. Subparagraph 56(1)(f)(ii) of the Employment Insurance Regulations explicitly provides the Commission with the authority to write off an amount payable under section 43 of the EIA if repayment of the amount due would result in undue hardship to the claimant. [56] That said, I am nonetheless of the view that the Appeal Division was clearly cognizant of and empathetic to the financial hardship to Ms. Molchan in having to repay her debt. Like the General Division, the Appeal Division implored the Commission and the Canada Revenue Agency to consider any request by Ms. Molchan to write off her debt, given the circumstances in which the overpayment arose. The Appeal Division even went as far as providing in a footnote the telephone number where she could call to seek relief.","[question] There's this case i can't find anything about, Schembri, but it's in this attached text. Can you summarize the facts and law of the case? Also, don't bother referencing legislative sections, as I'm not a specialist and won't look at the EI Act ever. ===================== [text] . Molchan v. Canada (Attorney General) [49] The issue in Schembri was whether the Commission was bound to take into account the claimant’s financial circumstances when determining the penalty to impose. The claimant in that case had failed to report his earnings and collected unemployment benefits for several months. The Commission had calculated that the claimant had received a benefit overpayment of $4,130, which it sought to recover. It had also assessed a penalty under section 38 of the EIA, because the claimant had received unemployment benefits by knowingly misreporting his income contrary to paragraph 38(1)(c) of the EIA. In determining the amount of penalty payable, the Commission considered the claimant’s gambling addiction and his efforts to deal with it, and reduced the penalty by 25% to $3,097. The Board of Referees later exonerated the claimant from any penalty. The Umpire then found that the Commission had erred when it failed to undertake, on its own initiative, an inquiry into the claimant’s financial circumstances and whether it would cause the claimant undue hardship to pay the proposed penalty. The Umpire reduced the penalty imposed by the Commission from 75% to 10% of the amount of the overpayment. [50] On judicial review, this Court held that the Commission was not required to initiate its own inquiries into a person’s financial circumstances before it imposed a penalty, noting that claimants have ample opportunities to request a reduction of the penalty on the ground of financial hardship at various stages of the process: before the penalty is imposed, on request for reconsideration and on appeal to the Board of Referees (Schembri at para. 14). Since the claimant had not raised the issue with the Commission and the Board of Referees, this Court decided that the Umpire should have held that the Board had no basis to interfere with the penalty. [51] In my view, this Court’s findings in Schembri do not extend to the reconsideration of a claimant’s entitlement to benefits. The overpayment in Schembri was not in dispute, only the amount of penalty the claimant would have to pay. Subsection 38(1) of the EIA specifies the acts or omissions for which a claimant may be subject to a penalty and subsection 38(2) sets the maximum penalties the Commission may impose. Under section 41 of the EIA, the Commission may rescind the imposition of a penalty or reduce it, on the presentation of new facts or on being satisfied that the penalty was imposed without knowledge of, or on the basis of a mistake as to, some material fact. Furthermore the Commission may issue, under section 41.1, a warning instead of setting the amount of a penalty for an act or omission under subsections 38(2) and 39(2) of the EIA. The Commission thus enjoys a wide discretion in assessing the amount of penalty and may consider financial hardship to the claimant as a mitigating factor. [52] This is consistent with the Commission’s policy regarding penalties, which mentions financial hardship as a possible mitigating circumstance when determining penalties (Digest of Benefit Entitlement Principles, section 18.5.2.2). It appears from the record that the Commission did not apply a penalty in Ms. Molchan’s case despite her false statements (Applicant’s record at 130, 173, 178). ..... [55] In my view, the Appeal Division’s comments regarding Ms. Molchan’s ability to seek a write-off of her debt are consistent with the legislation, which sets out a specific procedure, a write-off, for undue hardship cases. Subparagraph 56(1)(f)(ii) of the Employment Insurance Regulations explicitly provides the Commission with the authority to write off an amount payable under section 43 of the EIA if repayment of the amount due would result in undue hardship to the claimant. [56] That said, I am nonetheless of the view that the Appeal Division was clearly cognizant of and empathetic to the financial hardship to Ms. Molchan in having to repay her debt. Like the General Division, the Appeal Division implored the Commission and the Canada Revenue Agency to consider any request by Ms. Molchan to write off her debt, given the circumstances in which the overpayment arose. The Appeal Division even went as far as providing in a footnote the telephone number where she could call to seek relief. http://isthatlegal.ca/index.php?name=EI.penalties ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Find & Summarize,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",I have the ps5 already and really like it. I recently heard the ps5 pro was revealed but people hate! What is the main reason the ps5 pro has garnered such negative attention? My boyfriend wants to get an xbox and I'm more of a PC person. What would be the point of getting the new console if I already have the first one?Give me more than 400 words.,"PS5 Pro Reveal Breaks Unfortunate Record for Sony 4 By Raul Landaverde Published 2 days ago Thread 3 Follow Share Link copied to clipboard PlayStation 5 Pro Related Spider-Man and Aloy with PS5 Pro All Games Confirmed to Be Getting PS5 Pro Upgrades ps5 pro pre-order exclusive to playstation direct PS5 Pro Pre-Orders Come With a Catch ps5 pro inflation comparison PS5 Pro Price Compared to Past PlayStation Consoles When Adjusted for Inflation Sign in to your Game Rant account PS5 Pro reveal breaks a record for Sony Key Takeaways The PS5 Pro reveals video received over 141,000 dislikes in a single day, an unfortunate new record for Sony. The PS5 Pro has been met with outrage over its pricing, especially in the US, UK, and EU. Despite skepticism, analysts expect the PS5 Pro to sell better than expected once it launches in November. The PlayStation 5 Pro reveal set an unfortunate new record for Sony as the most disliked console reveal in the company's history on YouTube. As made clear on social media, many gamers are frustrated about the price of the PS5 Pro, which can exceed over $800 in certain cases. The PS5 Pro releases on November 7 as a disc-less console that offers a 45% boost in rendering power over the base PS5. The lead architect for the PS5, Mark Cerny, stated that the console is capable of running games at 60 frames per second with the visual fidelity that players can expect from a Graphics Mode, without needing to toggle a Performance Mode. This is thanks to the PS5 Pro's upgraded GPU, which features 67% more compute units compared to the PS5's GPU. The console's advanced ray tracing capabilities can double and triple the speeds of the current PS5, and the new AI-driven upscaling feature, PlayStation Spectral Super Resolution, ensures that performance and visual clarity is maintained with ray tracing effects. However, the steep $699.99 price point and lack of an included vertical stand or disc drive are making the PS5 Pro a hard sell for many gamers, and they've made their disappointment known on the YouTube video for the PS5 Pro reveal. Spider-Man and Aloy with PS5 Pro Related All Games Confirmed to Be Getting PS5 Pro Upgrades Sony has already confirmed over a dozen games that will be receiving the PS5 Pro enhancement treatment, and there are still dozens more to come. The PS5 Pro technical presentation is Sony's most disliked console reveal on YouTube with well over 141,000 dislikes in just a day, according to Push Square. There are over 93,000 likes on the PS5 Pro reveal video, which highlights a clear split in the gaming community's sentiment toward the new console. When compared to the 69,000 dislikes accrued over the four years following the original PS5 console's reveal, the PS5 Pro received more than doubled the amount of dislikes in record time. PS5 Pro is the Most Disliked Console in Sony's History on YouTube The PS5 Pro reveal video received over 141,000 dislikes in a day. The backlash is especially prevalent in the video's comments, with many fans being outraged at the pricing of the PS5 Pro in the US, UK, and EU especially. For example, YouTube users in the EU are confused and angered by Sony's decision to price the PS5 Pro at €799.99 (roughly $881), which is $180 more than US gamers would need to pay for the console at $699.99 (roughly €635). Analysts believe the PS5 Pro will sell better than expected, despite skepticism from tens of thousands of gamers online. The PS5 Pro was always meant to be a niche product by Sony that caters to PlayStation enthusiasts, but it's clear that many gamers believe the console's performance and visual upgrades are not enough to warrant the $699.99 price. The lack of new game announcements that highlight the PS5 Pro's improvements did not help, either.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I have the ps5 already and really like it. I recently heard the ps5 pro was revealed but people hate! What is the main reason the ps5 pro has garnered such negative attention? My boyfriend wants to get an xbox and I'm more of a PC person. What would be the point of getting the new console if I already have the first one?Give me more than 400 words. PS5 Pro Reveal Breaks Unfortunate Record for Sony 4 By Raul Landaverde Published 2 days ago Thread 3 Follow Share Link copied to clipboard PlayStation 5 Pro Related Spider-Man and Aloy with PS5 Pro All Games Confirmed to Be Getting PS5 Pro Upgrades ps5 pro pre-order exclusive to playstation direct PS5 Pro Pre-Orders Come With a Catch ps5 pro inflation comparison PS5 Pro Price Compared to Past PlayStation Consoles When Adjusted for Inflation Sign in to your Game Rant account PS5 Pro reveal breaks a record for Sony Key Takeaways The PS5 Pro reveals video received over 141,000 dislikes in a single day, an unfortunate new record for Sony. The PS5 Pro has been met with outrage over its pricing, especially in the US, UK, and EU. Despite skepticism, analysts expect the PS5 Pro to sell better than expected once it launches in November. The PlayStation 5 Pro reveal set an unfortunate new record for Sony as the most disliked console reveal in the company's history on YouTube. As made clear on social media, many gamers are frustrated about the price of the PS5 Pro, which can exceed over $800 in certain cases. The PS5 Pro releases on November 7 as a disc-less console that offers a 45% boost in rendering power over the base PS5. The lead architect for the PS5, Mark Cerny, stated that the console is capable of running games at 60 frames per second with the visual fidelity that players can expect from a Graphics Mode, without needing to toggle a Performance Mode. This is thanks to the PS5 Pro's upgraded GPU, which features 67% more compute units compared to the PS5's GPU. The console's advanced ray tracing capabilities can double and triple the speeds of the current PS5, and the new AI-driven upscaling feature, PlayStation Spectral Super Resolution, ensures that performance and visual clarity is maintained with ray tracing effects. However, the steep $699.99 price point and lack of an included vertical stand or disc drive are making the PS5 Pro a hard sell for many gamers, and they've made their disappointment known on the YouTube video for the PS5 Pro reveal. Spider-Man and Aloy with PS5 Pro Related All Games Confirmed to Be Getting PS5 Pro Upgrades Sony has already confirmed over a dozen games that will be receiving the PS5 Pro enhancement treatment, and there are still dozens more to come. The PS5 Pro technical presentation is Sony's most disliked console reveal on YouTube with well over 141,000 dislikes in just a day, according to Push Square. There are over 93,000 likes on the PS5 Pro reveal video, which highlights a clear split in the gaming community's sentiment toward the new console. When compared to the 69,000 dislikes accrued over the four years following the original PS5 console's reveal, the PS5 Pro received more than doubled the amount of dislikes in record time. PS5 Pro is the Most Disliked Console in Sony's History on YouTube The PS5 Pro reveal video received over 141,000 dislikes in a day. The backlash is especially prevalent in the video's comments, with many fans being outraged at the pricing of the PS5 Pro in the US, UK, and EU especially. For example, YouTube users in the EU are confused and angered by Sony's decision to price the PS5 Pro at €799.99 (roughly $881), which is $180 more than US gamers would need to pay for the console at $699.99 (roughly €635). Analysts believe the PS5 Pro will sell better than expected, despite skepticism from tens of thousands of gamers online. The PS5 Pro was always meant to be a niche product by Sony that caters to PlayStation enthusiasts, but it's clear that many gamers believe the console's performance and visual upgrades are not enough to warrant the $699.99 price. The lack of new game announcements that highlight the PS5 Pro's improvements did not help, either. https://gamerant.com/ps5-pro-reveal-most-disliked-record/",Retail/Product,Find & Summarize,Text Transformation You are required to use only information provided in the prompt.,Explain the responsibilities of each department during Mr. Taylor's disability claim. Use a separate paragraph for each department.,"Procedural History In 2007, Mr. Taylor filed a claim for service-connected disability benefits with VA. A VA medical examiner diagnosed Mr. Taylor with post-traumatic stress disorder (PTSD) resulting from his time at Edgewood, which was reaggravated during his time serving in Vietnam. Mr. Taylor was ultimately granted a total disability rating with an effective date of February 28, 2007, the day VA received his claim. VA relied on 38 U.S.C. § 5110 (implemented under 38 C.F.R. § 3.400) to establish this effective date. The provision specifies that, absent certain exceptions, the effective date for veterans benefits “shall not be earlier than the date of receipt of application therefor.” Mr. Taylor appealed the VA determination to the Board of Veterans’ Appeals (BVA) seeking an effective date of September 7, 1971, the day he was discharged from service. Mr. Taylor alleged that, since the secrecy oath prevented him from filing a claim, the effective date that he would have received in the absence of the oath should apply. The BVA, in July 2010, held that 38 U.S.C. § 5110 prevented the effective date for Mr. Taylor’s benefits from being any earlier than the day he filed his claim. The BVA stated that “there was nothing stopping [Mr. Taylor] from filing the claim . . . earlier and [VA] asking for a delay in the adjudication of the case following the obtaining of important evidence.” Mr. Taylor then appealed to the U.S. Court of Appeals for Veterans Claims (CAVC). In June 2013, the CAVC, in a single-judge decision, held that the BVA “failed to provide an adequate statement of reasons or bases for its . . . decision.” Specifically, the CAVC sought the language of the original secrecy oath. The CAVC vacated the BVA’s decision and remanded the case. The BVA, in February 2014, remanded the case to VA to ascertain the secrecy oath’s language and reassess the case. On remand, after VA procured a secrecy oath that most participants in the Edgewood program signed, VA and the BVA again concluded that Mr. Taylor was entitled to VA benefits starting February 28, 2007, the day VA received his claim, not September 7, 1971, the day he was discharged. The BVA made its determination in April 2017 and provided three reasons for its holding: (1) Mr. Taylor could have filed a disability claim earlier than 2007 premised on his experiences serving in Vietnam, which were partially responsible for his PTSD; (2) Mr. Taylor could have divulged his participation in the Edgewood program because he had done so on a previous occasion in pursuit of care, though the health care provider at that time did not believe him; and (3) Section 5110 delineates when VA benefits can begin and does not provide for equitable tolling (that is, exceptions to delineated time requirements to promote fairness). Mr. Taylor appealed to the CAVC for a second time. In April 2019, in a 2-1 decision, a panel of CAVC judges affirmed the BVA’s determination that Mr. Taylor was only entitled to VA disability benefits beginning February 28, 2007. The CAVC detailed three components of its analysis. First, Mr. Taylor was not entitled to relief under the Constitution’s Fifth Amendment Due Process Clause because he did not have a property interest in his VA benefits prior to February 28, 2007. Relying on Federal Circuit precedent, the CAVC held that individuals only gain a constitutionally cognizable property interest in VA benefits upon filing claims for such benefits. Second, the court determined that it lacked authority to provide Mr. Taylor with equitable relief by ordering VA to establish a process through which he and similarly situated veterans could establish effective dates for VA Congressional Research Service 3 benefits preceding their claim-filing dates. Third, the CAVC held that 38 U.S.C. § 5110 required the effective date for Mr. Taylor’s VA benefits to be February 28, 2007, the date he filed his claim. Mr. Taylor appealed the CAVC’s decision to the Federal Circuit. A three-judge Federal Circuit panel issued its opinion in June 2021, ruling in favor of Mr. Taylor. The court held the following: (1) “the Veterans Court may exercise such equitable powers, within the scope of its statutory jurisdiction, to ensure that all veterans entitled to benefits receive them” (that is, the CAVC had equitable powers beyond those specifically delineated by Congress); (2) the effective date requirement under 38 U.S.C. § 5110(a)(1) is not jurisdictional and can therefore be subject to equitable considerations and relief; (3) where “the Government has affirmatively and intentionally prevented” veterans from seeking medical care and VA benefits to which they are entitled under threat of criminal prosecution, the CAVC “is within its authority to hold the Government equitably estopped from asserting that those veterans are not entitled to an earlier effective date”; and (4) the government is equitably estopped from asserting 38 U.S.C. § 5110(a)(1) against Mr. Taylor because the government’s actions caused Mr. Taylor to file his benefits claim when he did. The Federal Circuit reversed the CAVC’s decision and remanded the case. In July 2021, however, the Federal Circuit voted to hear this case en banc. The full court heard oral argument on February 10, 2022, but weeks later, the U.S. Supreme Court granted review of Arellano v. McDonough, a case concerning whether 38 U.S.C. § 5110(b)(1), an exception to subsection (a)(1)’s requirements, is subject to equitable tolling. Section 5110(b)(1) mandates that “[t]he effective date of an award of disability compensation to a veteran shall be the day following the date of the veteran’s discharge or release if application therefor is received within one year from such date.” The Federal Circuit stayed all proceedings in Taylor until the Supreme Court decided Arellano. In January 2023, the Supreme Court held, in relevant part, that subsection (b)(1) is not subject to equitable tolling because “[t]he structure of §5110 reinforces Congress’s choice to set effective dates solely as prescribed in the text,” and because subsection (a)(1) provides “an instruction to attend to specifically enacted language to the exclusion of general, unenacted carveouts.” Following the Arellano decision, the Federal Circuit requested supplemental briefing by the parties in light of the Supreme Court’s holding. Taylor v. McDonough In June 2023, the full Federal Circuit decided in favor of Mr. Taylor. After finding equitable estoppel unavailable under Section 5110(a)(1) in light of Supreme Court precedent, the court held that the government violated Mr. Taylor’s constitutional right to due process under the Fifth Amendment. The court concluded that Mr. Taylor had “a constitutional right of access to adjudicatory forums” to vindicate his legal entitlements, and that the VA adjudicatory system and VA benefits are such a forum and entitlement, respectively. The Federal Circuit further held that the government unconstitutionally denied Mr. Taylor “access to the adjudication system of VA, the exclusive forum for securing his legal entitlement to the benefits at issue,” through the secrecy oath and threat of criminal prosecution for violating it. Thus, the court ruled that the relevant statutory limits on effective dates were “unconstitutional as applied” in Mr. Taylor’s case. The Federal Circuit determined that Mr. Taylor was entitled to “the effective date he would have had if no unconstitutional denial of access had occurred,” which could be September 7, 1971, the date Mr. Taylor was discharged, pending VA assessment of this issue on remand in accordance with the court’s decision. The Federal Circuit summarized its holding’s implications in the following terms: [W]hen a veteran has been determined to be entitled to benefits for one or more disabilities connected to participation in the Edgewood program at issue, the required effective date of such benefits is the date that the veteran would have had in the absence of the challenged government Congressional Research Service 4 conduct—imposition of the secrecy oath with no VA route for claim presentation and proof to vindicate the benefits entitlement. The court reversed the CAVC’s decision and remanded the case. The government has not sought Supreme Court review as of this writing, though it still has time to do so—petitions must be filed within 90 days of judgment. ","Explain the responsibilities of each department during Mr. Taylor's disability claim. Use a separate paragraph for each department. Procedural History In 2007, Mr. Taylor filed a claim for service-connected disability benefits with VA. A VA medical examiner diagnosed Mr. Taylor with post-traumatic stress disorder (PTSD) resulting from his time at Edgewood, which was reaggravated during his time serving in Vietnam. Mr. Taylor was ultimately granted a total disability rating with an effective date of February 28, 2007, the day VA received his claim. VA relied on 38 U.S.C. § 5110 (implemented under 38 C.F.R. § 3.400) to establish this effective date. The provision specifies that, absent certain exceptions, the effective date for veterans benefits “shall not be earlier than the date of receipt of application therefor.” Mr. Taylor appealed the VA determination to the Board of Veterans’ Appeals (BVA) seeking an effective date of September 7, 1971, the day he was discharged from service. Mr. Taylor alleged that, since the secrecy oath prevented him from filing a claim, the effective date that he would have received in the absence of the oath should apply. The BVA, in July 2010, held that 38 U.S.C. § 5110 prevented the effective date for Mr. Taylor’s benefits from being any earlier than the day he filed his claim. The BVA stated that “there was nothing stopping [Mr. Taylor] from filing the claim . . . earlier and [VA] asking for a delay in the adjudication of the case following the obtaining of important evidence.” Mr. Taylor then appealed to the U.S. Court of Appeals for Veterans Claims (CAVC). In June 2013, the CAVC, in a single-judge decision, held that the BVA “failed to provide an adequate statement of reasons or bases for its . . . decision.” Specifically, the CAVC sought the language of the original secrecy oath. The CAVC vacated the BVA’s decision and remanded the case. The BVA, in February 2014, remanded the case to VA to ascertain the secrecy oath’s language and reassess the case. On remand, after VA procured a secrecy oath that most participants in the Edgewood program signed, VA and the BVA again concluded that Mr. Taylor was entitled to VA benefits starting February 28, 2007, the day VA received his claim, not September 7, 1971, the day he was discharged. The BVA made its determination in April 2017 and provided three reasons for its holding: (1) Mr. Taylor could have filed a disability claim earlier than 2007 premised on his experiences serving in Vietnam, which were partially responsible for his PTSD; (2) Mr. Taylor could have divulged his participation in the Edgewood program because he had done so on a previous occasion in pursuit of care, though the health care provider at that time did not believe him; and (3) Section 5110 delineates when VA benefits can begin and does not provide for equitable tolling (that is, exceptions to delineated time requirements to promote fairness). Mr. Taylor appealed to the CAVC for a second time. In April 2019, in a 2-1 decision, a panel of CAVC judges affirmed the BVA’s determination that Mr. Taylor was only entitled to VA disability benefits beginning February 28, 2007. The CAVC detailed three components of its analysis. First, Mr. Taylor was not entitled to relief under the Constitution’s Fifth Amendment Due Process Clause because he did not have a property interest in his VA benefits prior to February 28, 2007. Relying on Federal Circuit precedent, the CAVC held that individuals only gain a constitutionally cognizable property interest in VA benefits upon filing claims for such benefits. Second, the court determined that it lacked authority to provide Mr. Taylor with equitable relief by ordering VA to establish a process through which he and similarly situated veterans could establish effective dates for VA Congressional Research Service 3 benefits preceding their claim-filing dates. Third, the CAVC held that 38 U.S.C. § 5110 required the effective date for Mr. Taylor’s VA benefits to be February 28, 2007, the date he filed his claim. Mr. Taylor appealed the CAVC’s decision to the Federal Circuit. A three-judge Federal Circuit panel issued its opinion in June 2021, ruling in favor of Mr. Taylor. The court held the following: (1) “the Veterans Court may exercise such equitable powers, within the scope of its statutory jurisdiction, to ensure that all veterans entitled to benefits receive them” (that is, the CAVC had equitable powers beyond those specifically delineated by Congress); (2) the effective date requirement under 38 U.S.C. § 5110(a)(1) is not jurisdictional and can therefore be subject to equitable considerations and relief; (3) where “the Government has affirmatively and intentionally prevented” veterans from seeking medical care and VA benefits to which they are entitled under threat of criminal prosecution, the CAVC “is within its authority to hold the Government equitably estopped from asserting that those veterans are not entitled to an earlier effective date”; and (4) the government is equitably estopped from asserting 38 U.S.C. § 5110(a)(1) against Mr. Taylor because the government’s actions caused Mr. Taylor to file his benefits claim when he did. The Federal Circuit reversed the CAVC’s decision and remanded the case. In July 2021, however, the Federal Circuit voted to hear this case en banc. The full court heard oral argument on February 10, 2022, but weeks later, the U.S. Supreme Court granted review of Arellano v. McDonough, a case concerning whether 38 U.S.C. § 5110(b)(1), an exception to subsection (a)(1)’s requirements, is subject to equitable tolling. Section 5110(b)(1) mandates that “[t]he effective date of an award of disability compensation to a veteran shall be the day following the date of the veteran’s discharge or release if application therefor is received within one year from such date.” The Federal Circuit stayed all proceedings in Taylor until the Supreme Court decided Arellano. In January 2023, the Supreme Court held, in relevant part, that subsection (b)(1) is not subject to equitable tolling because “[t]he structure of §5110 reinforces Congress’s choice to set effective dates solely as prescribed in the text,” and because subsection (a)(1) provides “an instruction to attend to specifically enacted language to the exclusion of general, unenacted carveouts.” Following the Arellano decision, the Federal Circuit requested supplemental briefing by the parties in light of the Supreme Court’s holding. Taylor v. McDonough In June 2023, the full Federal Circuit decided in favor of Mr. Taylor. After finding equitable estoppel unavailable under Section 5110(a)(1) in light of Supreme Court precedent, the court held that the government violated Mr. Taylor’s constitutional right to due process under the Fifth Amendment. The court concluded that Mr. Taylor had “a constitutional right of access to adjudicatory forums” to vindicate his legal entitlements, and that the VA adjudicatory system and VA benefits are such a forum and entitlement, respectively. The Federal Circuit further held that the government unconstitutionally denied Mr. Taylor “access to the adjudication system of VA, the exclusive forum for securing his legal entitlement to the benefits at issue,” through the secrecy oath and threat of criminal prosecution for violating it. Thus, the court ruled that the relevant statutory limits on effective dates were “unconstitutional as applied” in Mr. Taylor’s case. The Federal Circuit determined that Mr. Taylor was entitled to “the effective date he would have had if no unconstitutional denial of access had occurred,” which could be September 7, 1971, the date Mr. Taylor was discharged, pending VA assessment of this issue on remand in accordance with the court’s decision. The Federal Circuit summarized its holding’s implications in the following terms: [W]hen a veteran has been determined to be entitled to benefits for one or more disabilities connected to participation in the Edgewood program at issue, the required effective date of such benefits is the date that the veteran would have had in the absence of the challenged government Congressional Research Service 4 conduct—imposition of the secrecy oath with no VA route for claim presentation and proof to vindicate the benefits entitlement. The court reversed the CAVC’s decision and remanded the case. The government has not sought Supreme Court review as of this writing, though it still has time to do so—petitions must be filed within 90 days of judgment. You are required to use only information provided in the prompt.",Legal,Explanation/Definition,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]",I'm considering a VBAC with my current pregnancy. My doctor has cautiously told me that it's an option. Can you tell me the benefits of this? I would also like to know the risks involved and the success rate. What are the criteria to work towards making this a successful option?,"What is a VBAC in pregnancy? A vaginal birth after cesarean or VBAC is when you give birth through your vagina after previously having a C-section (cesarean section) delivery. A C-section involves your pregnancy care provider making a surgical cut (incision) through your belly and uterus to deliver your baby. The goal of a VBAC is to give a person who had a C-section the chance to have a vaginal delivery for their next pregnancy. It can sometimes be unsafe to have a vaginal delivery after having one or more C-section deliveries. The decision on whether to attempt a VBAC involves considering factors like: The type of incision your surgeon used for your C-section(s) and if you have had more than one C-section. Your health history. If you have any medical conditions. The position of the fetus and if the fetus has any known medical conditions. Your pregnancy care provider will tell you if they believe a VBAC is safe to try. They can discuss potential risks and benefits with you. Then, you can choose if you’d like to pursue a VBAC or have another C-section based on your discussions. Studies show that up to 75% of people who had one C-section went on to have a successful vaginal birth in their next pregnancy. But your chance of having a successful VBAC drops to about 50% if you’ve had two or more prior C-section deliveries. Healthcare providers sometimes refer to a VBAC as a trial of labor after cesarean (TOLAC). A TOLAC is an attempt to have a VBAC. If a TOLAC is successful, the result is a VBAC. If it’s not successful, the result is another C-section delivery. Why do people prefer a VBAC instead of another C-section? It’s mostly a personal preference. Some people prefer a vaginal delivery, but for some reason, they haven’t been able to have one. Or a person might prefer a vaginal delivery because recovering from a C-section typically takes longer. Even if you want a vaginal delivery, your healthcare provider may recommend another C-section due to the risks of a VBAC. Or they may tell you it’s OK to try for a VBAC. The benefits of VBAC compared to a C-section include: Faster recovery and shorter hospital stay. No abdominal surgery. Avoiding or lowering C-section risks like heavy bleeding and infection. Vaginal birth helps clear amniotic fluid from your baby’s lungs as it passes through the birth canal. This better prepares your baby to breathe oxygen after birth. Your baby gets an immune system boost as it travels through the birth canal during a vaginal delivery. Less risk of complications from repeat surgeries like scarring or injuries to nearby organs. Personal preference. Some people want the experience of a vaginal birth. What are the risks of a VBAC? Because a C-section leaves a scar on your uterus, the pressure of labor could cause your uterus to open (rupture) along your C-section scar. But recent studies show it’s possible to have a safe VBAC after having a C-section in most cases. Although rare, a uterine rupture is a serious complication that can have life-threatening results. If you’re at a high risk for uterine rupture, your healthcare provider will typically not attempt a VBAC. Other risks of attempting a VBAC are: Blood loss. Infection. Emergency C-section (which is riskier than a planned C-section). What’s the risk of a uterine rupture if you’ve had a previous C-section? The risk of uterine rupture if you’ve had a C-section with a transverse cut (sideways across the lower part of the uterus) is about 0.9% or slightly less than 1 in 100. Does the type of incision I got from my last C-section matter if I want a VBAC? Yes. There are different types of C-section incisions: A low transverse incision has the lowest risk of uterine rupture. This horizontal cut is made across the lower, thinner part of your uterus. A low vertical incision (up and down cut) has a higher risk of rupture than a low transverse incision. This vertical cut is made in the lower, thinner part of your uterus. A high vertical incision (“classical” incision) in the upper part of your uterus has the highest risk of uterine rupture. Surgeons may need to use this type of incision for a premature baby or one that’s in a difficult position to deliver. The location and direction of the outer incision on your belly doesn’t mean that the incision in your uterus is in the same location or the same direction. For example, it may appear that the scar on your belly is transverse, yet the scar on your uterus is vertical. The information about the location and direction of the incision on your uterus should be in your medical records. When you talk about how safe VBAC is with your provider, make sure they look at your medical records and the reasons for any C-sections you’ve had. Is a VBAC safer than a repeat C-section? Talk with your healthcare provider about your health history, current pregnancy and why you had a C-section in your last pregnancy. Your chances of having a successful VBAC may be higher if you: Have had previous C-section deliveries (one or two) with low transverse incisions. Have had a vaginal birth before. Haven’t had any other uterine surgeries (such as fibroid removal, also called myomectomy). Have no history of uterine rupture. Don’t have a medical condition (like fibroids or problems with the location of your placenta) that makes a vaginal delivery risky. Go into labor on your own before your due date. If you’ve already had a successful VBAC — without complications such as ruptured uterus — you’re more likely to have successful future vaginal deliveries. Your chances of having a successful VBAC may be lower if you: Had a prior C-section due to labor not progressing. This means you didn’t dilate (cervix opens) or efface (cervix shortens) during a vaginal delivery. Are older than 35. Have obesity or overweight. Are giving birth to a large fetus or expecting multiples. Are past your due date. Had a baby within the last 18 months (short time between pregnancies). Have preeclampsia. (Healthcare providers may prefer a C-section delivery.) What are the risks of multiple C-sections? There isn’t a set number of C-sections you can have. But some evidence shows that people who have many C-sections are at a higher risk for: Heavy bleeding. Bladder and bowel injury. Infection. Placental conditions like placenta previa or placenta accreta in a future pregnancy where the placenta is abnormally attached. Uterine rupture. Adhesions (scarring). These risks vary and depend mostly on your health history and the specific circumstances of each pregnancy and delivery. Your healthcare provider is the best person to talk to about the risks and benefits of a repeat C-section versus a VBAC. Topics to discuss with your pregnancy care provider include: Past pregnancies and deliveries. Reason(s) you had a C-section. Safety of VBAC and a repeat C-section for you and your baby. Reasons you should or shouldn’t consider VBAC. Reasons you should or shouldn’t consider repeat C-section. A plan for inducing labor (or not). If the healthcare facility can manage emergency deliveries. Your plan for more children. Just because you had a C-section delivery in the past, doesn’t mean you can’t have a VBAC in the future. You may have heard or read that the scars from a C-section may rupture in a future pregnancy. But every situation is unique. Discuss your wishes and concerns with your pregnancy care provider early in your pregnancy. They can discuss the risks and benefits with you and help you decide if a VBAC is safe. As your pregnancy progresses, make sure you and your provider discuss and review your delivery plan at your prenatal visits."," Only use the provided text to answer the question, no outside sources. I'm considering a VBAC with my current pregnancy. My doctor has cautiously told me that it's an option. Can you tell me the benefits of this? I would also like to know the risks involved and the success rate. What are the criteria to work towards making this a successful option? What is a VBAC in pregnancy? A vaginal birth after cesarean or VBAC is when you give birth through your vagina after previously having a C-section (cesarean section) delivery. A C-section involves your pregnancy care provider making a surgical cut (incision) through your belly and uterus to deliver your baby. The goal of a VBAC is to give a person who had a C-section the chance to have a vaginal delivery for their next pregnancy. It can sometimes be unsafe to have a vaginal delivery after having one or more C-section deliveries. The decision on whether to attempt a VBAC involves considering factors like: The type of incision your surgeon used for your C-section(s) and if you have had more than one C-section. Your health history. If you have any medical conditions. The position of the fetus and if the fetus has any known medical conditions. Your pregnancy care provider will tell you if they believe a VBAC is safe to try. They can discuss potential risks and benefits with you. Then, you can choose if you’d like to pursue a VBAC or have another C-section based on your discussions. Studies show that up to 75% of people who had one C-section went on to have a successful vaginal birth in their next pregnancy. But your chance of having a successful VBAC drops to about 50% if you’ve had two or more prior C-section deliveries. Healthcare providers sometimes refer to a VBAC as a trial of labor after cesarean (TOLAC). A TOLAC is an attempt to have a VBAC. If a TOLAC is successful, the result is a VBAC. If it’s not successful, the result is another C-section delivery. Why do people prefer a VBAC instead of another C-section? It’s mostly a personal preference. Some people prefer a vaginal delivery, but for some reason, they haven’t been able to have one. Or a person might prefer a vaginal delivery because recovering from a C-section typically takes longer. Even if you want a vaginal delivery, your healthcare provider may recommend another C-section due to the risks of a VBAC. Or they may tell you it’s OK to try for a VBAC. The benefits of VBAC compared to a C-section include: Faster recovery and shorter hospital stay. No abdominal surgery. Avoiding or lowering C-section risks like heavy bleeding and infection. Vaginal birth helps clear amniotic fluid from your baby’s lungs as it passes through the birth canal. This better prepares your baby to breathe oxygen after birth. Your baby gets an immune system boost as it travels through the birth canal during a vaginal delivery. Less risk of complications from repeat surgeries like scarring or injuries to nearby organs. Personal preference. Some people want the experience of a vaginal birth. What are the risks of a VBAC? Because a C-section leaves a scar on your uterus, the pressure of labor could cause your uterus to open (rupture) along your C-section scar. But recent studies show it’s possible to have a safe VBAC after having a C-section in most cases. Although rare, a uterine rupture is a serious complication that can have life-threatening results. If you’re at a high risk for uterine rupture, your healthcare provider will typically not attempt a VBAC. Other risks of attempting a VBAC are: Blood loss. Infection. Emergency C-section (which is riskier than a planned C-section). What’s the risk of a uterine rupture if you’ve had a previous C-section? The risk of uterine rupture if you’ve had a C-section with a transverse cut (sideways across the lower part of the uterus) is about 0.9% or slightly less than 1 in 100. Does the type of incision I got from my last C-section matter if I want a VBAC? Yes. There are different types of C-section incisions: A low transverse incision has the lowest risk of uterine rupture. This horizontal cut is made across the lower, thinner part of your uterus. A low vertical incision (up and down cut) has a higher risk of rupture than a low transverse incision. This vertical cut is made in the lower, thinner part of your uterus. A high vertical incision (“classical” incision) in the upper part of your uterus has the highest risk of uterine rupture. Surgeons may need to use this type of incision for a premature baby or one that’s in a difficult position to deliver. The location and direction of the outer incision on your belly doesn’t mean that the incision in your uterus is in the same location or the same direction. For example, it may appear that the scar on your belly is transverse, yet the scar on your uterus is vertical. The information about the location and direction of the incision on your uterus should be in your medical records. When you talk about how safe VBAC is with your provider, make sure they look at your medical records and the reasons for any C-sections you’ve had. Is a VBAC safer than a repeat C-section? Talk with your healthcare provider about your health history, current pregnancy and why you had a C-section in your last pregnancy. Your chances of having a successful VBAC may be higher if you: Have had previous C-section deliveries (one or two) with low transverse incisions. Have had a vaginal birth before. Haven’t had any other uterine surgeries (such as fibroid removal, also called myomectomy). Have no history of uterine rupture. Don’t have a medical condition (like fibroids or problems with the location of your placenta) that makes a vaginal delivery risky. Go into labor on your own before your due date. If you’ve already had a successful VBAC — without complications such as ruptured uterus — you’re more likely to have successful future vaginal deliveries. Your chances of having a successful VBAC may be lower if you: Had a prior C-section due to labor not progressing. This means you didn’t dilate (cervix opens) or efface (cervix shortens) during a vaginal delivery. Are older than 35. Have obesity or overweight. Are giving birth to a large fetus or expecting multiples. Are past your due date. Had a baby within the last 18 months (short time between pregnancies). Have preeclampsia. (Healthcare providers may prefer a C-section delivery.) What are the risks of multiple C-sections? There isn’t a set number of C-sections you can have. But some evidence shows that people who have many C-sections are at a higher risk for: Heavy bleeding. Bladder and bowel injury. Infection. Placental conditions like placenta previa or placenta accreta in a future pregnancy where the placenta is abnormally attached. Uterine rupture. Adhesions (scarring). These risks vary and depend mostly on your health history and the specific circumstances of each pregnancy and delivery. Your healthcare provider is the best person to talk to about the risks and benefits of a repeat C-section versus a VBAC. Topics to discuss with your pregnancy care provider include: Past pregnancies and deliveries. Reason(s) you had a C-section. Safety of VBAC and a repeat C-section for you and your baby. Reasons you should or shouldn’t consider VBAC. Reasons you should or shouldn’t consider repeat C-section. A plan for inducing labor (or not). If the healthcare facility can manage emergency deliveries. Your plan for more children. Just because you had a C-section delivery in the past, doesn’t mean you can’t have a VBAC in the future. You may have heard or read that the scars from a C-section may rupture in a future pregnancy. But every situation is unique. Discuss your wishes and concerns with your pregnancy care provider early in your pregnancy. They can discuss the risks and benefits with you and help you decide if a VBAC is safe. As your pregnancy progresses, make sure you and your provider discuss and review your delivery plan at your prenatal visits. https://my.clevelandclinic.org/health/articles/21687-vaginal-birth-after-cesarean-vbac",Medical,Fact Finding,Q&A Do not draw on external or prior knowledge to respond to the user prompt. Only use the context block. Respond in five sentences or fewer.,Paraphrase the measures the company has taken to improve the quality of life of cows.,"In 2022, 50 farms in Ben & Jerry’s Northeast dairy supply chain participated in the Milk with Dignity Program. They employed over 200 farmworkers covered through the program. During 2022, participating farm owners and farmworkers made over 300 inquiries to MDSC, 25% of which related to workplace health and safety, 22% to wages and related issues, 12% to schedules and rest, and 18% to housing conditions. Additionally, since the program launched, over $4.4 million from Ben & Jerry’s has supported farms’ improvements to working and housing conditions, including $2.9 million in raises to meet minimum wages (which reached $12.55 per hour in Vermont in 2022) and $1.49 million in bonuses, paid vacation and sick time, housing improvements, new personal protective equipment, and other safety improvements. Farms have continued to make concrete progress toward full compliance with standards such as the rights to at least eight consecutive hours of per workday, one day of per week, and comprehensive occupational safety and health protections. Excellent Life for Cows The care for dairy cows is critically important and we rely on independent third-party standards to advance animal care in our supply. In 2021 and 2022, we audited farms to both our Caring Dairy Standard and the Global Animal Partnership (GAP) Dairy care standard. The audits identifed specifc opportunities to improve care while also highlighting industry-level barriers that may impede broader adoption of higher-level certifcations. Our farm partners are interested in continuous improvements with approximately 20% becoming GAP certifed, a not insignifcant step above standard industry performance, after undergoing the rigorous audits. Regenerative and Circular Agriculture Our farm partners recognize the growing pressure to fnd viable solutions to the climate crisis and are thoughtful and engaged collaborators in trialing new on-farm management practices to track and increase carbon sequestration, biodiversity, and build soil health. In preparation for a deeper dive into low carbon dairy, we conducted individual farm greenhouse gas (GHG) footprints using the Cool Farm Tool. 2022 also marked the third, and last, year of Prove It Projects carried out by Ben & Jerry’s Caring Dairy Farmer Innovators. Prove It Projects were designed to provide farmers with insights and opportunities to test run practices in regenerative concepts in the real-life laboratory of their own farms. The practices farmers “proved” to have value are then adopted into their own farm management and shared with the broader Ben & Jerry’s community. In 2022, each of the 27 Farmer Innovators selected two on-farm research projects from a list of 11 previously identifed projects, implementing a total of 54 projects. Several practices farmers tested stood out as providing benefcial outcomes: Nitrogen inhibitors showed advantages in yield and reduced input needs. • Changes to grazing management could help increase on-farm forage and cut production costs. • Multi-species cover crops were more viable with diferent planting techniques. • Farmers are still addressing habitat biodiversity, in what is a multi-year endeavor. In all, the three years of Prove It Projects have provided farmers with valuable insights while also informing the next iteration of Ben & Jerry’s farmer innovation pilots in hopes to drive Low Carbon Dairy farming.","system instructions: Do not draw on external or prior knowledge to respond to the user prompt. Only use the context block. Respond in five sentences or fewer. user prompt: Paraphrase the measures the company has taken to improve the quality of life of cows. context block: In 2022, 50 farms in Ben & Jerry’s Northeast dairy supply chain participated in the Milk with Dignity Program. They employed over 200 farmworkers covered through the program. During 2022, participating farm owners and farmworkers made over 300 inquiries to MDSC, 25% of which related to workplace health and safety, 22% to wages and related issues, 12% to schedules and rest, and 18% to housing conditions. Additionally, since the program launched, over $4.4 million from Ben & Jerry’s has supported farms’ improvements to working and housing conditions, including $2.9 million in raises to meet minimum wages (which reached $12.55 per hour in Vermont in 2022) and $1.49 million in bonuses, paid vacation and sick time, housing improvements, new personal protective equipment, and other safety improvements. Farms have continued to make concrete progress toward full compliance with standards such as the rights to at least eight consecutive hours of per workday, one day of per week, and comprehensive occupational safety and health protections. Excellent Life for Cows The care for dairy cows is critically important and we rely on independent third-party standards to advance animal care in our supply. In 2021 and 2022, we audited farms to both our Caring Dairy Standard and the Global Animal Partnership (GAP) Dairy care standard. The audits identifed specifc opportunities to improve care while also highlighting industry-level barriers that may impede broader adoption of higher-level certifcations. Our farm partners are interested in continuous improvements with approximately 20% becoming GAP certifed, a not insignifcant step above standard industry performance, after undergoing the rigorous audits. Regenerative and Circular Agriculture Our farm partners recognize the growing pressure to fnd viable solutions to the climate crisis and are thoughtful and engaged collaborators in trialing new on-farm management practices to track and increase carbon sequestration, biodiversity, and build soil health. In preparation for a deeper dive into low carbon dairy, we conducted individual farm greenhouse gas (GHG) footprints using the Cool Farm Tool. 2022 also marked the third, and last, year of Prove It Projects carried out by Ben & Jerry’s Caring Dairy Farmer Innovators. Prove It Projects were designed to provide farmers with insights and opportunities to test run practices in regenerative concepts in the real-life laboratory of their own farms. The practices farmers “proved” to have value are then adopted into their own farm management and shared with the broader Ben & Jerry’s community. In 2022, each of the 27 Farmer Innovators selected two on-farm research projects from a list of 11 previously identifed projects, implementing a total of 54 projects. Several practices farmers tested stood out as providing benefcial outcomes: Nitrogen inhibitors showed advantages in yield and reduced input needs. • Changes to grazing management could help increase on-farm forage and cut production costs. • Multi-species cover crops were more viable with diferent planting techniques. • Farmers are still addressing habitat biodiversity, in what is a multi-year endeavor. In all, the three years of Prove It Projects have provided farmers with valuable insights while also informing the next iteration of Ben & Jerry’s farmer innovation pilots in hopes to drive Low Carbon Dairy farming.",Retail/Product,Paraphrase,Text Transformation "Respond using only the information contained in the prompt. Format the response in bullet points, with two sentences per bullet point.","Based on this report, summarize the details of the Term Loans taken by squarespace.","Indebtedness On December 12, 2019, we entered into a credit agreement with various financial institutions that provided for a $350.0 million term loan (the “2019 Term Loan”) and a $25.0 million revolving credit facility (the “Revolving Credit Facility”), which included a $15.0 million letter of credit sub-facility. On December 11, 2020, we amended the credit agreement (as amended, the “2020 Credit Agreement”) to increase the size of the 2019 Term Loan to $550.0 million (as amended, the “2020 Term Loan”) and extend the maturity date for the 2019 Term Loan and the Revolving Credit Facility to December 11, 2025. On June 15, 2023, we amended the 2020 Credit Agreement (as amended, the “Credit Agreement”) to increase the total size of the 2020 Term Loan to $650.0 million (the “Term Loan”) upon the closing of the Google Domains Asset Acquisition and, effective June 30, 2023, replaced LIBOR as the benchmark rate with SOFR. The borrowings under the 2019 Term Loan were used to provide for the repurchase, and subsequent retirement, of outstanding capital stock. The borrowings under the 2020 Term Loan were used to provide for a dividend on all outstanding capital stock. The additional borrowings of $100.0 million under the Term Loan were used to partially fund the Google Domains Asset Acquisition, together with cash on hand. Borrowings under the 2020 Credit Agreement were subject to an interest rate equal to, at our option, LIBOR or the bank's alternative base rate (the ""ABR""), in either case, plus an applicable margin prior to June 30, 2023. Effective June 30, 2023, under the Credit Agreement, LIBOR as the benchmark rate was replaced with SOFR. The ABR is the greater of the prime rate, the federal funds effective rate plus the applicable margin or the SOFR quoted rate plus the applicable margin. The applicable margin is based on an indebtedness to consolidated EBITDA ratio as prescribed under the Credit Agreement 39 Table of Contents and ranges from 1.25% to 2.25% on applicable SOFR loans and 0.25% to 1.25% on ABR loans. In addition, the Revolving Credit Facility is subject to an unused commitment fee, payable quarterly, of 0.20% to 0.25% of the unutilized commitments (subject to reduction in certain circumstances). Consolidated EBITDA is defined in the Credit Agreement and is not comparable to our definition of adjusted EBITDA used elsewhere in the Quarterly Report on Form 10-Q since the Credit Agreement allows for additional adjustments to net income/(loss) including the exclusion of transaction costs, changes in deferred revenue and other costs that may be considered non-recurring. Further, consolidated EBITDA, as defined in the Credit Agreement, may be different from similarly titled EBITDA financial measures used by other companies. The definition of consolidated EBITDA is contained in Section 1.1 of the Credit Agreement. As of June 30, 2024, $546.9 million was outstanding under the Term Loan. The Term Loan requires scheduled quarterly principal payments in aggregate annual amounts equal to 7.50% for 2023 and 2024, and 10.00% for 2025, in each case, on the Term Loan principal amount, with the balance due at maturity. In addition, the Credit Agreement includes certain customary prepayment requirements for the Term Loan, which are triggered by events such as asset sales, incurrence of indebtedness and sale leasebacks. As of June 30, 2024, $7.3 million was outstanding under the Revolving Credit Facility in the form of outstanding letters of credit and $17.7 million remained available for borrowing by us. The outstanding letters of credit relate to security deposits for certain of our leased locations. The Credit Agreement contains certain customary affirmative covenants and events of default. The negative covenants in the Credit Agreement include, among others, limitations on our ability (subject to negotiated exceptions) to incur additional indebtedness or issue additional preferred stock, incur liens on assets, enter into agreements related to mergers and acquisitions, dispose of assets or pay dividends and distributions. The Credit Agreement contains certain negative covenants for an indebtedness to consolidated EBITDA ratio, as defined by the Credit Agreement, and commencing with December 31, 2020 and all fiscal quarters thereafter through maturity. For the fiscal quarter ended June 30, 2024, and each fiscal quarter thereafter, the Company is required to maintain an indebtedness to consolidated EBITDA ratio of not more than 3.75 (the “Financial Covenant”), subject to customary equity cure rights. The Financial Covenant is subject to a 0.50 step-up in the event of a material permitted acquisition, which we can elect to implement up to two times during the life of the facility. As of June 30, 2024, we have not elected to implement this set-up as a result of any of our acquisitions. If we are not in compliance with the covenants under the Credit Agreement or we otherwise experience an event of default, the lenders would be entitled to take various actions, including acceleration of amounts due under the Credit Agreement. As of June 30, 2024, we were in compliance with all applicable covenants, including the Financial Covenant. The obligations under the Credit Agreement are guaranteed by our wholly-owned domestic subsidiaries and are secured by substantially all of the assets of the guarantors, subject to certain exceptions. Total interest expense related to our indebtedness was $10.1 million and $20.5 million for the three and six months ended June 30, 2024, respectively, and $8.6 million and $16.7 million for the three and six months ended June 30, 2023, respectively. Stock Repurchase Plan On May 10, 2022, the board of directors authorized a general share repurchase program of the Company’s Class A common stock of up to $200.0 million. On February 26, 2024, the board of directors authorized a new general share repurchase program of the Company's Class A common stock of up to $500.0 million with no fixed expiration (the ""Stock Repurchase Plan"") to replace the previous repurchase plan. During the three and six months ended June 30, 2024, the Company repurchased 0.2 million and 0.5 million shares and paid cash of $4.1 million and $16.3 million, under the Stock Repurchase Plan through open market purchases. The weighted-average price per share for the share repurchases was $36.53 and $34.36 during the three and six months ended June 30, 2024. As of June 30, 2024, approximately $483.7 million remained available for stock repurchase pursuant to the Stock Repurchase Plan.","System instruction: Respond using only the information contained in the prompt. Format the response in bullet points, with two sentences per bullet point. question: Based on this report, summarize the details of the Term Loans taken by squarespace. context: Indebtedness On December 12, 2019, we entered into a credit agreement with various financial institutions that provided for a $350.0 million term loan (the “2019 Term Loan”) and a $25.0 million revolving credit facility (the “Revolving Credit Facility”), which included a $15.0 million letter of credit sub-facility. On December 11, 2020, we amended the credit agreement (as amended, the “2020 Credit Agreement”) to increase the size of the 2019 Term Loan to $550.0 million (as amended, the “2020 Term Loan”) and extend the maturity date for the 2019 Term Loan and the Revolving Credit Facility to December 11, 2025. On June 15, 2023, we amended the 2020 Credit Agreement (as amended, the “Credit Agreement”) to increase the total size of the 2020 Term Loan to $650.0 million (the “Term Loan”) upon the closing of the Google Domains Asset Acquisition and, effective June 30, 2023, replaced LIBOR as the benchmark rate with SOFR. The borrowings under the 2019 Term Loan were used to provide for the repurchase, and subsequent retirement, of outstanding capital stock. The borrowings under the 2020 Term Loan were used to provide for a dividend on all outstanding capital stock. The additional borrowings of $100.0 million under the Term Loan were used to partially fund the Google Domains Asset Acquisition, together with cash on hand. Borrowings under the 2020 Credit Agreement were subject to an interest rate equal to, at our option, LIBOR or the bank's alternative base rate (the ""ABR""), in either case, plus an applicable margin prior to June 30, 2023. Effective June 30, 2023, under the Credit Agreement, LIBOR as the benchmark rate was replaced with SOFR. The ABR is the greater of the prime rate, the federal funds effective rate plus the applicable margin or the SOFR quoted rate plus the applicable margin. The applicable margin is based on an indebtedness to consolidated EBITDA ratio as prescribed under the Credit Agreement 39 Table of Contents and ranges from 1.25% to 2.25% on applicable SOFR loans and 0.25% to 1.25% on ABR loans. In addition, the Revolving Credit Facility is subject to an unused commitment fee, payable quarterly, of 0.20% to 0.25% of the unutilized commitments (subject to reduction in certain circumstances). Consolidated EBITDA is defined in the Credit Agreement and is not comparable to our definition of adjusted EBITDA used elsewhere in the Quarterly Report on Form 10-Q since the Credit Agreement allows for additional adjustments to net income/(loss) including the exclusion of transaction costs, changes in deferred revenue and other costs that may be considered non-recurring. Further, consolidated EBITDA, as defined in the Credit Agreement, may be different from similarly titled EBITDA financial measures used by other companies. The definition of consolidated EBITDA is contained in Section 1.1 of the Credit Agreement. As of June 30, 2024, $546.9 million was outstanding under the Term Loan. The Term Loan requires scheduled quarterly principal payments in aggregate annual amounts equal to 7.50% for 2023 and 2024, and 10.00% for 2025, in each case, on the Term Loan principal amount, with the balance due at maturity. In addition, the Credit Agreement includes certain customary prepayment requirements for the Term Loan, which are triggered by events such as asset sales, incurrence of indebtedness and sale leasebacks. As of June 30, 2024, $7.3 million was outstanding under the Revolving Credit Facility in the form of outstanding letters of credit and $17.7 million remained available for borrowing by us. The outstanding letters of credit relate to security deposits for certain of our leased locations. The Credit Agreement contains certain customary affirmative covenants and events of default. The negative covenants in the Credit Agreement include, among others, limitations on our ability (subject to negotiated exceptions) to incur additional indebtedness or issue additional preferred stock, incur liens on assets, enter into agreements related to mergers and acquisitions, dispose of assets or pay dividends and distributions. The Credit Agreement contains certain negative covenants for an indebtedness to consolidated EBITDA ratio, as defined by the Credit Agreement, and commencing with December 31, 2020 and all fiscal quarters thereafter through maturity. For the fiscal quarter ended June 30, 2024, and each fiscal quarter thereafter, the Company is required to maintain an indebtedness to consolidated EBITDA ratio of not more than 3.75 (the “Financial Covenant”), subject to customary equity cure rights. The Financial Covenant is subject to a 0.50 step-up in the event of a material permitted acquisition, which we can elect to implement up to two times during the life of the facility. As of June 30, 2024, we have not elected to implement this set-up as a result of any of our acquisitions. If we are not in compliance with the covenants under the Credit Agreement or we otherwise experience an event of default, the lenders would be entitled to take various actions, including acceleration of amounts due under the Credit Agreement. As of June 30, 2024, we were in compliance with all applicable covenants, including the Financial Covenant. The obligations under the Credit Agreement are guaranteed by our wholly-owned domestic subsidiaries and are secured by substantially all of the assets of the guarantors, subject to certain exceptions. Total interest expense related to our indebtedness was $10.1 million and $20.5 million for the three and six months ended June 30, 2024, respectively, and $8.6 million and $16.7 million for the three and six months ended June 30, 2023, respectively. Stock Repurchase Plan On May 10, 2022, the board of directors authorized a general share repurchase program of the Company’s Class A common stock of up to $200.0 million. On February 26, 2024, the board of directors authorized a new general share repurchase program of the Company's Class A common stock of up to $500.0 million with no fixed expiration (the ""Stock Repurchase Plan"") to replace the previous repurchase plan. During the three and six months ended June 30, 2024, the Company repurchased 0.2 million and 0.5 million shares and paid cash of $4.1 million and $16.3 million, under the Stock Repurchase Plan through open market purchases. The weighted-average price per share for the share repurchases was $36.53 and $34.36 during the three and six months ended June 30, 2024. As of June 30, 2024, approximately $483.7 million remained available for stock repurchase pursuant to the Stock Repurchase Plan.",Financial,Find & Summarize,Text Transformation Only use information from the provided context. Produce two paragraphs of 8 sentences each when answering.,Does a school participating in NSLP also have to participate in SBP and Seamless Summer Option?,"NSLP and SBP (the school meals programs) provide federal support for meals served in roughly 90,000 public and private elementary and secondary schools nationwide. They also support meals served in a smaller number of residential child care institutions. Schools receive federal aid in the form of cash reimbursements for every meal they serve that meets federal nutritional requirements (limited to one breakfast and lunch per child daily). The largest subsidies are provided for free and reduced-price meals served to eligible students based on income eligibility and categorical eligibility rules (discussed below). Schools also receive a certain amount of commodity assistance per lunch served (discussed previously). Schools participating in NSLP have the option of providing afterschool snacks through the program, and schools participating in NSLP or SBP have the option of providing summer meals and snacks through the Seamless Summer Option (discussed in the “After-School Meals and Snacks” and “Seamless Summer Option” sections). Schools are not required by federal law to participate in NSLP or SBP; however, some states require schools to have a school lunch and/or breakfast program, and some require schools to operate such programs through NSLP and/or SBP. Some states also provide state funding for the school meals programs, including nine states (as of the cover date of this report) that have authorized funding to provide free meals to all students. Schools that do not participate in the federal school meals programs may still operate locally funded meal programs. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA; P.L. 111-296) made several changes to the school meals programs. Among those changes was a requirement that USDA update the nutrition standards for school meals and create new nutritional requirements for foods sold in NSLP and SBP schools within a certain timeframe. The law also created the Community Eligibility Provision, through which eligible schools can provide free meals to all students. These changes are discussed further within this section. NSLP and SBP are two separate programs, and schools can choose to operate one and not the other. The programs are discussed together in this report because they share many of the same requirements. Differences between the programs are noted where applicable. Participation in SBP tends to be lower than in NSLP for several reasons, including the traditionally required early arrival by students in order to receive a meal before school starts. This section discusses topics specific to the school meals programs. Other food service topics relevant to child nutrition programs more broadly (e.g., the farm to school program) are discussed in the “Other Child Nutrition Activities” section. ","System Instruction: Only use information from the provided context. Produce two paragraphs of 8 sentences each when answering. Question: Does a school participating in NSLP also have to participate in SBP and Seamless Summer Option? Context: NSLP and SBP (the school meals programs) provide federal support for meals served in roughly 90,000 public and private elementary and secondary schools nationwide. They also support meals served in a smaller number of residential child care institutions. Schools receive federal aid in the form of cash reimbursements for every meal they serve that meets federal nutritional requirements (limited to one breakfast and lunch per child daily). The largest subsidies are provided for free and reduced-price meals served to eligible students based on income eligibility and categorical eligibility rules (discussed below). Schools also receive a certain amount of commodity assistance per lunch served (discussed previously). Schools participating in NSLP have the option of providing afterschool snacks through the program, and schools participating in NSLP or SBP have the option of providing summer meals and snacks through the Seamless Summer Option (discussed in the “After-School Meals and Snacks” and “Seamless Summer Option” sections). Schools are not required by federal law to participate in NSLP or SBP; however, some states require schools to have a school lunch and/or breakfast program, and some require schools to operate such programs through NSLP and/or SBP. Some states also provide state funding for the school meals programs, including nine states (as of the cover date of this report) that have authorized funding to provide free meals to all students. Schools that do not participate in the federal school meals programs may still operate locally funded meal programs. The Healthy, Hunger-Free Kids Act of 2010 (HHFKA; P.L. 111-296) made several changes to the school meals programs. Among those changes was a requirement that USDA update the nutrition standards for school meals and create new nutritional requirements for foods sold in NSLP and SBP schools within a certain timeframe. The law also created the Community Eligibility Provision, through which eligible schools can provide free meals to all students. These changes are discussed further within this section. NSLP and SBP are two separate programs, and schools can choose to operate one and not the other. The programs are discussed together in this report because they share many of the same requirements. Differences between the programs are noted where applicable. Participation in SBP tends to be lower than in NSLP for several reasons, including the traditionally required early arrival by students in order to receive a meal before school starts. This section discusses topics specific to the school meals programs. Other food service topics relevant to child nutrition programs more broadly (e.g., the farm to school program) are discussed in the “Other Child Nutrition Activities” section.",Financial,Fact Finding,Q&A "Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.",What investigations should be done on the patients with the recurrent miscarrages?,"Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited 23 Review J Clin Gynecol Obstet. 2022;11(2):23-26 Recurrent First Trimester Miscarriage: A Typical Case Presentation and Evidence-Based Management Review Vikram Talaulikar Abstract Recurrent miscarriage (RM), also known as recurrent pregnancy loss, is a distressing condition which affects about 1% of couples trying to achieve a pregnancy. It can be challenging for both patients and clinicians as the cause remains unexplained in at least 50% of cou- ples despite multiple investigations. A systematic and evidence-based approach to testing and management is important to avoid tests or treatments which are unnecessary or of unproven benefit. Access to specialist RM clinic services and psychological support forms a key part of the management of couples with RM. Keywords: Recurrent miscarriage; Treatment; Progesterone Introduction It is estimated that up to one in four natural pregnancies end up in a miscarriage which is defined as loss of pregnancy prior to viability (24 weeks’ gestation) [1]. Recurrent miscarriage (RM) is traditionally defined in the United Kingdom (UK) as three or more consecutive miscarriages and it can affect about 1% of couples trying for a pregnancy [2]. The definition of RM varies between countries with some clinical guidelines recom- mending investigations and treatment following two or more miscarriages. The Royal College of Obstetricians and Gynecologists (RCOG) has issued guidance on management of RM in the UK [2]. An updated version of this guideline is currently under consultation and will be released shortly. This article describes an illustrative typical clinical sce- nario related to RM and reviews the current best practice rec- ommendations for management of RM. Clinical Case The patient, 37 years old, has attended her general practition- er’s clinic following a recent pregnancy loss. She and her part- ner have been trying for a pregnancy for past 18 months but have suffered from three miscarriages between 6 and 8 weeks’ gestation. Her last miscarriage happened 2 months ago, and she has resumed her periods 2 weeks back. All the miscar- riages were managed conservatively without any medical or surgical interventions. She has regular menstrual cycles (25 - 26 days long) and does not report any dysmenorrhea or menor- rhagia. She is upset about the pregnancy losses, wondering if it was her fault and whether something can be done in the next pregnancy to change the outcome. History Consultations referring to RM should be performed in a sensi- tive manner. When discussing previous miscarriages, it is im- portant to enquire about the gestation at which pregnancy loss occurred. Pregnancy loss before 9 - 10 weeks usually (but not always) indicates a pre-placental cause, which may be either fetal (chromosomal) or endometrial (implantation disorder) in origin while that after this gestation could indicate problems such as thrombophilia, placental disorders, or problems with uterine structure. History of pregnancy loss after 12 weeks as- sociated with painless cervical dilatation and rupture of mem- branes suggests cervical weakness. Information should be obtained about how the previous miscarriages were managed: was the miscarriage completed naturally or whether medical or surgical management was required? Any possibility of uterine infection following miscarriage should be explored. Changes in the menstrual flow (hypomenorrhea) following possible infection of re- tained products of conception or uterine curettage could in- dicate the possibility of intrauterine adhesions. History of excess alcohol consumption or smoking should be obtained to offer advice on reducing risk of future miscarriage. Medi- cal and relevant family history should be obtained as un- controlled maternal medical conditions such as diabetes, thyroid or rheumatological disorders can impact the risk of miscarriage in future pregnancies. All miscarriages which the patient suffered from happened before 8 weeks gesta- Manuscript submitted February 11, 2022, accepted March 29, 2022 Published online April 12, 2022 University College London Hospital, London NW1 2BU, UK. Email: vikram.talaulikar@nhs.net doi: https://doi.org/10.14740/jcgo797 24 Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org Management of Recurrent Miscarriage J Clin Gynecol Obstet. 2022;11(2):23-26 tion and she bled naturally on all occasions suggesting a likely pre-placental fetal or endometrial cause for her preg- nancy loss. Examination On examination, patient’s body mass index (BMI) was within a normal range (23). Pelvic or speculum examination, guided by clinical history, can be useful as part of initial assessment especially if the woman has presented with irregular bleeding or abnormal vaginal discharge in which case cervix should be visualized to rule out other gynecological pathology such as ectropion/polyp and triple swabs should be obtained. The patient did not report any changes to her menstrual cycles or abnormal discharge following miscarriage. Risk factors and investigations The patient and her partner should be referred to and cared for in a dedicated RM clinic [2]. Psychological support and com- munication in a sensitive manner are extremely important. A discussion about potential risk factors for future miscarriage and testing should cover the following. Age Increasing female age increases the chances of a genetically abnormal pregnancy as the number and quality of oocytes decrease [1]. Women between 20 and 35 years old have the lowest risk of miscarriage while women above the age of 40 years have at least a 50% chance of miscarriage with every pregnancy [3, 4]. BMI High BMI (> 30) increases the risk of miscarriage [5]. Other risk factors Other risk factors include previous miscarriages, smoking and excess alcohol consumption. The patient is 37 years old and has already had three mis- carriages which increase her risk of future miscarriage to about 40% [6]. Causes of RM investigations The patient should be offered investigations for the causes of RM as listed in Table 1. Antiphospholipid syndrome (APS) This is an acquired thrombophilia which affects 15% of women with RM [2] and is diagnosed based on high levels of anticardiolipin antibodies and/or lupus anticoagulant along with evidence of adverse pregnancy outcomes (RM before 10 weeks or loss of one genetically normal pregnancy after 10 weeks or one or more preterm births before 34 weeks due to placental dysfunction) or unprovoked thrombosis. APS causes inhibition of trophoblast function, activation of complement system and thrombosis at the uteroplacental interface and is treated with a combination of aspirin and low molecular weight heparin in pregnancy [1]. Inherited thrombophilias such as factor V Leiden mutation, prothrombin mutation, protein C, protein S and antithrombin III deficiency have an uncertain role in first trimester RM and currently such tests should only be offered in the context of research. The patient had a negative APS screen. Genetic Parental balanced structural chromosomal anomalies can cause RM (2-5% of couples with RM). The risk of miscar- riage is influenced by the size and the genetic content of the rearranged chromosomal segments. Karyotyping of products of conception should be offered at the time of any future mis- carriage and parental karyotyping should follow if analysis of products of conception indicates that a genetic abnormal- ity may have resulted from an unbalanced translocation [2, 3]. Parental karyotyping is not recommended routinely due to low incidence of translocations and relatively high cost as- sociated with testing. Table 1. Causes and Relevant Investigations for Recurrent First Trimester Miscarriage Cause Test Genetic-balanced chromosomal translocations Karyotyping of products of conception (if abnormal result detected - parental karyotyping) Antiphospholipid syndrome Blood test for anticardiolipin antibodies and/or lupus anticoagulant (blood tests should be performed at least 6 weeks after any pregnancy loss and a repeat confirmatory test should be arranged at least 12 weeks after an initial positive screen) Endocrine (if evidence of clinical disorder or risk factors): thyroid, diabetes Thyroid function test (serum free T4 and thyroid-stimulating hormone levels); thyroid peroxidase antibodies; HbA1c Uterine abnormalities such as septate uterus or intracavitary lesions Transvaginal ultrasound scan Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org 25 Talaulikar J Clin Gynecol Obstet. 2022;11(2):23-26 Endocrine If there is clinical evidence of poorly controlled diabetes or thyroid dysfunction, appropriate blood tests should be per- formed [2]. The patient did not have any symptoms or signs suggestive of endocrine problems and had had a thyroid hor- mone profile at the time of her last miscarriage which revealed normal results. Uterine abnormalities Uterine abnormalities such as septate uterus or any other uter- ine cavity pathology such as intrauterine adhesions (especially following an episode of uterine instrumentation and infection), submucous fibroids or polyps should be ruled out by offering a pelvic ultrasound as these may be amenable to treatment by surgery (hysteroscopy +/- laparoscopy) [2, 7]. The patient was offered a transvaginal scan which showed a regular uterine cavity. The evidence regarding the effects of male partners on RM is weak and no specific testing can be recommended as part of investigations [1]. Advice Lifestyle advice should always be offered to couples with RM. The patient should be advised to maintain a normal BMI, avoid excess alcohol/smoking, and take pre-conception folic acid [2, 3]. Currently, there is lack of evidence that preimplantation genetic testing for aneuploidy screening (PGT-A) is superior to expectant management in RM patients [3]. If chromosomal translocation was identified at the time of future miscarriage, genetic counselling should be offered to the patient. Repro- ductive options following genetic counselling would include proceeding to a further natural pregnancy with or without a prenatal diagnosis test, gamete donation and adoption [2]. As in this case, despite thorough investigations, no clear underlying pathology is identifiable in at least 50% of cou- ples with RM (often labelled as “unexplained RM”) [7, 8]. The couple should be reassured about good prognosis for a live birth in future pregnancies and offered supportive care in dedi- cated early pregnancy unit. Many RM units offer empirical treatment with low dose oral aspirin (75 mg daily) and vaginal natural progesterone (400 mg once/twice daily) from positive pregnancy test until 12 - 14 weeks of pregnancy on a “low harm, possible benefit” basis for unexplained RM. The use of aspirin is not recommended in current clinical guidelines due to debate over its clinical effectiveness. Based on the evidence so far, it appears that the use of progesterone supplements is beneficial particularly in women with previous miscarriages who bleed in early pregnancy [9, 10]. The patient conceived again 5 months following her third miscarriage and had a successful pregnancy and live birth. She was prescribed vaginal progesterone pessaries from 7 weeks until 14 weeks of pregnancy following one episode of vaginal bleeding. Conclusions Couples with RM should be offered psychological support and be referred to a dedicated RM service for investigations. Most couples will have no identifiable pathology, and in such cases, there is good prognosis for future successful pregnancy. Learning points RM affects about 1% of couples trying for a pregnancy and no clear underlying pathology is identifiable despite investiga- tions in at least 50% of couples. Refer couples with RM to a dedicated RM service for in- vestigations and plan for future pregnancies. Offer psychological support and reassure couples with no identifiable pathology about good prognosis for future preg- nancy without pharmacological intervention. Acknowledgments None to declare. Financial Disclosure No funding was received for preparation of this manuscript. Conflict of Interest There is no conflict of interest to declare. Author Contributions VT wrote and finalized the manuscript. Data Availability The author declares that data supporting the findings of this study are available within the article. References 1. Shields R, Hawkes A, Quenby S. Clinical approach to recurrent pregnancy loss. Review, Obstetrics, Gynae- cology and Reproductive Medicine. 2020:30(11):331- 336. 2. The investigation and treatment of couples with recurrent first trimester and second-trimester miscarriage. 2011. Green-top Guideline No. 17 April. https://www.rcog.org. uk/globalassets/documents/guidelines/gtg_17.pdf. 3. Homer HA. Modern management of recurrent miscar- 26 Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org Management of Recurrent Miscarriage J Clin Gynecol Obstet. 2022;11(2):23-26 riage. Aust N Z J Obstet Gynaecol. 2019;59(1):36-44. 4. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320(7251):1708-1712. 5. Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med. 2011;29(6):507-513. 6. Regan L, Braude PR, Trembath PL. Influence of past re- productive performance on risk of spontaneous abortion. BMJ. 1989;299(6698):541-545. 7. Jaslow CR, Carney JL, Kutteh WH. Diagnostic factors identified in 1020 women with two versus three or more recurrent pregnancy losses. Fertil Steril. 2010;93(4):1234- 1243. 8. Stirrat GM. Recurrent miscarriage. Lancet. 1990; 336(8716):673-675. 9. Coomarasamy A, Devall AJ, Cheed V, Harb H, Middleton LJ, Gallos ID, Williams H, et al. A randomized trial of progesterone in women with bleeding in early pregnancy. N Engl J Med. 2019;380(19):1815-1824. 10. Coomarasamy A, Williams H, Truchanowicz E, Seed PT, Small R, Quenby S, Gupta P, et al. A randomized trial of progesterone in women with recurrent miscarriages. N Engl J Med. 2015;373(22):2141-2148. ","Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand. What investigations should be done on the patients with the recurrent miscarrages? Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited 23 Review J Clin Gynecol Obstet. 2022;11(2):23-26 Recurrent First Trimester Miscarriage: A Typical Case Presentation and Evidence-Based Management Review Vikram Talaulikar Abstract Recurrent miscarriage (RM), also known as recurrent pregnancy loss, is a distressing condition which affects about 1% of couples trying to achieve a pregnancy. It can be challenging for both patients and clinicians as the cause remains unexplained in at least 50% of cou- ples despite multiple investigations. A systematic and evidence-based approach to testing and management is important to avoid tests or treatments which are unnecessary or of unproven benefit. Access to specialist RM clinic services and psychological support forms a key part of the management of couples with RM. Keywords: Recurrent miscarriage; Treatment; Progesterone Introduction It is estimated that up to one in four natural pregnancies end up in a miscarriage which is defined as loss of pregnancy prior to viability (24 weeks’ gestation) [1]. Recurrent miscarriage (RM) is traditionally defined in the United Kingdom (UK) as three or more consecutive miscarriages and it can affect about 1% of couples trying for a pregnancy [2]. The definition of RM varies between countries with some clinical guidelines recom- mending investigations and treatment following two or more miscarriages. The Royal College of Obstetricians and Gynecologists (RCOG) has issued guidance on management of RM in the UK [2]. An updated version of this guideline is currently under consultation and will be released shortly. This article describes an illustrative typical clinical sce- nario related to RM and reviews the current best practice rec- ommendations for management of RM. Clinical Case The patient, 37 years old, has attended her general practition- er’s clinic following a recent pregnancy loss. She and her part- ner have been trying for a pregnancy for past 18 months but have suffered from three miscarriages between 6 and 8 weeks’ gestation. Her last miscarriage happened 2 months ago, and she has resumed her periods 2 weeks back. All the miscar- riages were managed conservatively without any medical or surgical interventions. She has regular menstrual cycles (25 - 26 days long) and does not report any dysmenorrhea or menor- rhagia. She is upset about the pregnancy losses, wondering if it was her fault and whether something can be done in the next pregnancy to change the outcome. History Consultations referring to RM should be performed in a sensi- tive manner. When discussing previous miscarriages, it is im- portant to enquire about the gestation at which pregnancy loss occurred. Pregnancy loss before 9 - 10 weeks usually (but not always) indicates a pre-placental cause, which may be either fetal (chromosomal) or endometrial (implantation disorder) in origin while that after this gestation could indicate problems such as thrombophilia, placental disorders, or problems with uterine structure. History of pregnancy loss after 12 weeks as- sociated with painless cervical dilatation and rupture of mem- branes suggests cervical weakness. Information should be obtained about how the previous miscarriages were managed: was the miscarriage completed naturally or whether medical or surgical management was required? Any possibility of uterine infection following miscarriage should be explored. Changes in the menstrual flow (hypomenorrhea) following possible infection of re- tained products of conception or uterine curettage could in- dicate the possibility of intrauterine adhesions. History of excess alcohol consumption or smoking should be obtained to offer advice on reducing risk of future miscarriage. Medi- cal and relevant family history should be obtained as un- controlled maternal medical conditions such as diabetes, thyroid or rheumatological disorders can impact the risk of miscarriage in future pregnancies. All miscarriages which the patient suffered from happened before 8 weeks gesta- Manuscript submitted February 11, 2022, accepted March 29, 2022 Published online April 12, 2022 University College London Hospital, London NW1 2BU, UK. Email: vikram.talaulikar@nhs.net doi: https://doi.org/10.14740/jcgo797 24 Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org Management of Recurrent Miscarriage J Clin Gynecol Obstet. 2022;11(2):23-26 tion and she bled naturally on all occasions suggesting a likely pre-placental fetal or endometrial cause for her preg- nancy loss. Examination On examination, patient’s body mass index (BMI) was within a normal range (23). Pelvic or speculum examination, guided by clinical history, can be useful as part of initial assessment especially if the woman has presented with irregular bleeding or abnormal vaginal discharge in which case cervix should be visualized to rule out other gynecological pathology such as ectropion/polyp and triple swabs should be obtained. The patient did not report any changes to her menstrual cycles or abnormal discharge following miscarriage. Risk factors and investigations The patient and her partner should be referred to and cared for in a dedicated RM clinic [2]. Psychological support and com- munication in a sensitive manner are extremely important. A discussion about potential risk factors for future miscarriage and testing should cover the following. Age Increasing female age increases the chances of a genetically abnormal pregnancy as the number and quality of oocytes decrease [1]. Women between 20 and 35 years old have the lowest risk of miscarriage while women above the age of 40 years have at least a 50% chance of miscarriage with every pregnancy [3, 4]. BMI High BMI (> 30) increases the risk of miscarriage [5]. Other risk factors Other risk factors include previous miscarriages, smoking and excess alcohol consumption. The patient is 37 years old and has already had three mis- carriages which increase her risk of future miscarriage to about 40% [6]. Causes of RM investigations The patient should be offered investigations for the causes of RM as listed in Table 1. Antiphospholipid syndrome (APS) This is an acquired thrombophilia which affects 15% of women with RM [2] and is diagnosed based on high levels of anticardiolipin antibodies and/or lupus anticoagulant along with evidence of adverse pregnancy outcomes (RM before 10 weeks or loss of one genetically normal pregnancy after 10 weeks or one or more preterm births before 34 weeks due to placental dysfunction) or unprovoked thrombosis. APS causes inhibition of trophoblast function, activation of complement system and thrombosis at the uteroplacental interface and is treated with a combination of aspirin and low molecular weight heparin in pregnancy [1]. Inherited thrombophilias such as factor V Leiden mutation, prothrombin mutation, protein C, protein S and antithrombin III deficiency have an uncertain role in first trimester RM and currently such tests should only be offered in the context of research. The patient had a negative APS screen. Genetic Parental balanced structural chromosomal anomalies can cause RM (2-5% of couples with RM). The risk of miscar- riage is influenced by the size and the genetic content of the rearranged chromosomal segments. Karyotyping of products of conception should be offered at the time of any future mis- carriage and parental karyotyping should follow if analysis of products of conception indicates that a genetic abnormal- ity may have resulted from an unbalanced translocation [2, 3]. Parental karyotyping is not recommended routinely due to low incidence of translocations and relatively high cost as- sociated with testing. Table 1. Causes and Relevant Investigations for Recurrent First Trimester Miscarriage Cause Test Genetic-balanced chromosomal translocations Karyotyping of products of conception (if abnormal result detected - parental karyotyping) Antiphospholipid syndrome Blood test for anticardiolipin antibodies and/or lupus anticoagulant (blood tests should be performed at least 6 weeks after any pregnancy loss and a repeat confirmatory test should be arranged at least 12 weeks after an initial positive screen) Endocrine (if evidence of clinical disorder or risk factors): thyroid, diabetes Thyroid function test (serum free T4 and thyroid-stimulating hormone levels); thyroid peroxidase antibodies; HbA1c Uterine abnormalities such as septate uterus or intracavitary lesions Transvaginal ultrasound scan Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org 25 Talaulikar J Clin Gynecol Obstet. 2022;11(2):23-26 Endocrine If there is clinical evidence of poorly controlled diabetes or thyroid dysfunction, appropriate blood tests should be per- formed [2]. The patient did not have any symptoms or signs suggestive of endocrine problems and had had a thyroid hor- mone profile at the time of her last miscarriage which revealed normal results. Uterine abnormalities Uterine abnormalities such as septate uterus or any other uter- ine cavity pathology such as intrauterine adhesions (especially following an episode of uterine instrumentation and infection), submucous fibroids or polyps should be ruled out by offering a pelvic ultrasound as these may be amenable to treatment by surgery (hysteroscopy +/- laparoscopy) [2, 7]. The patient was offered a transvaginal scan which showed a regular uterine cavity. The evidence regarding the effects of male partners on RM is weak and no specific testing can be recommended as part of investigations [1]. Advice Lifestyle advice should always be offered to couples with RM. The patient should be advised to maintain a normal BMI, avoid excess alcohol/smoking, and take pre-conception folic acid [2, 3]. Currently, there is lack of evidence that preimplantation genetic testing for aneuploidy screening (PGT-A) is superior to expectant management in RM patients [3]. If chromosomal translocation was identified at the time of future miscarriage, genetic counselling should be offered to the patient. Repro- ductive options following genetic counselling would include proceeding to a further natural pregnancy with or without a prenatal diagnosis test, gamete donation and adoption [2]. As in this case, despite thorough investigations, no clear underlying pathology is identifiable in at least 50% of cou- ples with RM (often labelled as “unexplained RM”) [7, 8]. The couple should be reassured about good prognosis for a live birth in future pregnancies and offered supportive care in dedi- cated early pregnancy unit. Many RM units offer empirical treatment with low dose oral aspirin (75 mg daily) and vaginal natural progesterone (400 mg once/twice daily) from positive pregnancy test until 12 - 14 weeks of pregnancy on a “low harm, possible benefit” basis for unexplained RM. The use of aspirin is not recommended in current clinical guidelines due to debate over its clinical effectiveness. Based on the evidence so far, it appears that the use of progesterone supplements is beneficial particularly in women with previous miscarriages who bleed in early pregnancy [9, 10]. The patient conceived again 5 months following her third miscarriage and had a successful pregnancy and live birth. She was prescribed vaginal progesterone pessaries from 7 weeks until 14 weeks of pregnancy following one episode of vaginal bleeding. Conclusions Couples with RM should be offered psychological support and be referred to a dedicated RM service for investigations. Most couples will have no identifiable pathology, and in such cases, there is good prognosis for future successful pregnancy. Learning points RM affects about 1% of couples trying for a pregnancy and no clear underlying pathology is identifiable despite investiga- tions in at least 50% of couples. Refer couples with RM to a dedicated RM service for in- vestigations and plan for future pregnancies. Offer psychological support and reassure couples with no identifiable pathology about good prognosis for future preg- nancy without pharmacological intervention. Acknowledgments None to declare. Financial Disclosure No funding was received for preparation of this manuscript. Conflict of Interest There is no conflict of interest to declare. Author Contributions VT wrote and finalized the manuscript. Data Availability The author declares that data supporting the findings of this study are available within the article. References 1. Shields R, Hawkes A, Quenby S. Clinical approach to recurrent pregnancy loss. Review, Obstetrics, Gynae- cology and Reproductive Medicine. 2020:30(11):331- 336. 2. The investigation and treatment of couples with recurrent first trimester and second-trimester miscarriage. 2011. Green-top Guideline No. 17 April. https://www.rcog.org. uk/globalassets/documents/guidelines/gtg_17.pdf. 3. Homer HA. Modern management of recurrent miscar- 26 Articles © The authors | Journal compilation © J Clin Gynecol Obstet and Elmer Press Inc™ | www.jcgo.org Management of Recurrent Miscarriage J Clin Gynecol Obstet. 2022;11(2):23-26 riage. Aust N Z J Obstet Gynaecol. 2019;59(1):36-44. 4. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320(7251):1708-1712. 5. Boots C, Stephenson MD. Does obesity increase the risk of miscarriage in spontaneous conception: a systematic review. Semin Reprod Med. 2011;29(6):507-513. 6. Regan L, Braude PR, Trembath PL. Influence of past re- productive performance on risk of spontaneous abortion. BMJ. 1989;299(6698):541-545. 7. Jaslow CR, Carney JL, Kutteh WH. Diagnostic factors identified in 1020 women with two versus three or more recurrent pregnancy losses. Fertil Steril. 2010;93(4):1234- 1243. 8. Stirrat GM. Recurrent miscarriage. Lancet. 1990; 336(8716):673-675. 9. Coomarasamy A, Devall AJ, Cheed V, Harb H, Middleton LJ, Gallos ID, Williams H, et al. A randomized trial of progesterone in women with bleeding in early pregnancy. N Engl J Med. 2019;380(19):1815-1824. 10. Coomarasamy A, Williams H, Truchanowicz E, Seed PT, Small R, Quenby S, Gupta P, et al. A randomized trial of progesterone in women with recurrent miscarriages. N Engl J Med. 2015;373(22):2141-2148. ",Medical,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Are the GDPR, CCPA, and Japan's PIPL effective in shaping global data protection legislation? Support your answer. Explore the ways that these laws have affected business operations and provide examples of other territories that have followed same approach.","In the age of digital connectivity, the protection of personal data has become a paramount concern, prompting the evolution of comprehensive global data privacy laws (Quach et al., 2022). As we traverse the intricate landscape of these regulations, it's essential to delve into key frameworks that have shaped the way organizations handle user information. This section takes you on a journey through the evolution of global data privacy laws, highlighting three pivotal regulations viz the General Data Protection Regulation (GDPR), the California Consumer Privacy Act (CCPA), and various other regional legislations. The General Data Protection Regulation (GDPR) implemented by the European Union in May 2018, stands as a watershed moment in the realm of data protection. Built on the principles of transparency, fairness, and accountability, the regulation brings forth a comprehensive framework for safeguarding the privacy rights of individuals (Bennett and Raab, 2020). A key principle of GDPR is transparency. Organizations must be clear about how they process personal data. Secondly, Data collection must have a specific, legitimate purpose. Thirdly, is data minimization. Organization should collect only the data necessary for the intended purpose. And users have the right to control and access their personal information. The Impact on Businesses and Users are here presented. The GDPR has significantly enhanced user control over personal data. Its stringent requirements have forced businesses worldwide to reassess and fortify their data protection measures. The regulation also introduces severe penalties for non-compliance, emphasizing the urgency for organizations to prioritize data privacy. The GDPR's influence extends far beyond the borders of the European Union. It has become a benchmark for data protection laws globally, inspiring similar legislation and shaping discussions on user rights and corporate responsibilities (Rustad and Koenig, 2019). The California Consumer Privacy Act (CCPA) is aimed at empowering Consumers in the Golden State. Enacted in January 2020, the CCPA heralds a new era of consumer-centric data protection in the United States. Originating in California, this legislation has spurred conversations about the need for federal privacy laws and has influenced other states to explore or enact similar measures (Chander et al., 2020). The key Provisions of CCPA include right to know, right to delete, opt-out rights, and non-discriminiation. Consumers can inquire about the data collected about them. Consumers can request the deletion of their personal information. Consumers can opt-out of the sale of their personal information. Consumers exercising their privacy rights cannot be discriminated against. The CCPA has catalyzed a shift in the way businesses handle personal data, while empowering consumers, it has presented compliance challenges for organizations, requiring them to reevaluate data processing practices and ensure adherence to the stipulated rights (Chander et al., 2021). Beyond California, the CCPA has acted as a catalyst for discussions about federal privacy legislation in the United States. Policymakers are grappling with the need for a unified approach to protect the privacy rights of citizens across the nation. The Other Regional Legislations are here discussed. The evolution of data privacy laws is not confined to Europe and North America; it extends to every corner of the globe, various regions have enacted or are in the process of enacting comprehensive data protection laws to address the challenges posed by the digital age (Rustad and Koenig, 2019.). The Asia-Pacific which include China and Japan. In China, the Personal Data Protection Law regulates the processing of personal data. And in Japan, the Personal Information Protection Law (PIPL) strengthens protections for personal information. For Latin America, the Lei Geral de Proteção de Dados (LGPD) governs the use of personal data in Brazil. The Protection of Personal Information Act (POPIA) governs the lawful processing of personal information in South Africa, in the United Arab Emirates various Emirates are implementing data protection laws (Gottardo, 2023). Diverse approaches to data protection reflect unique cultural, legal, and economic considerations, and a global mosaic of legislations shapes a complex, interconnected framework for data privacy (Comandè and Schneider, 2022). The evolution of global data privacy laws underscores the urgency of adapting legal frameworks to the rapidly changing digital landscape. From the GDPR's pioneering role in Europe to the CCPA's influence in the United States and diverse legislations across regions, the world is awakening to the importance of safeguarding individual privacy rights (Souza et al., 2021). As we move forward, it's crucial for businesses, policymakers, and users alike to stay informed about these evolving regulations. The global conversation on data privacy is far from over, and it's a collective responsibility to ensure that our digital future is one where innovation thrives alongside the protection of individual privacy Comparative Analysis of Global Frameworks In the intricate tapestry of global data privacy laws, a comparative analysis becomes crucial to discern the diverse approaches adopted by different regions (Shukla et al., 2023). As the digital era propels us forward, understanding how various frameworks align or diverge is paramount. World Journal of Advanced Research and Reviews, 2024, 21(02), 1058–1070 1061 The General Data Protection Regulation (GDPR) serves as the cornerstone of data protection in Europe. Its principles of transparency, purpose limitation, and individual rights have set a gold standard, emphasizing user control and organizational accountability. The GDPR provides a harmonized framework across the European Union, promoting consistency and a single set of rules for businesses operating within its jurisdiction (Prasad and Perez, 2020, Adebukola et al., 2022). With potential fines reaching up to 4% of global annual turnover, the GDPR instills a strong deterrent against non-compliance. The GDPR's comprehensive nature can pose challenges for businesses navigating intricate compliance requirements, ensuring compliance across borders can be challenging, especially for multinational corporations (Chander et al., 2021). The California Consumer Privacy Act (CCPA) emerged as a trailblazer in U.S. data privacy legislation. Enacted in the state of California, it grants consumers unprecedented control over their personal information. The CCPA focuses on empowering consumers with the right to know, delete, and opt-out, fostering a culture of transparency. The CCPA has sparked discussions about the need for comprehensive federal privacy legislation in the United States. Like the GDPR, CCPA compliance can be intricate, requiring businesses to adapt their data practices, while influencing other states, the lack of a federal law may lead to varying privacy standards across the country (Chander et al., 2021, Okunade et al., 2023). The Asia-Pacific region reflects a diverse landscape of data protection laws. China's Personal Data Protection Law and Japan's Personal Information Protection Law (PIPL) exemplify the region's commitment to adapting to the digital age (Raposo and Du, 2023). Asian countries are actively modernizing their data protection laws to address contemporary challenges. Regulations in the region are increasingly focused on empowering individuals with control over their personal data (Janssen et al., 2020). Diverse cultural norms and legal traditions contribute to varying interpretations and implementations of data protection laws. The rapid pace of technological advancements requires continuous adaptation, which can pose challenges for regulatory frameworks.","[question] Are the GDPR, CCPA, and Japan's PIPL effective in shaping global data protection legislation? Support your answer. Explore the ways that these laws have affected business operations and provide examples of other territories that have followed same approach. ===================== [text] In the age of digital connectivity, the protection of personal data has become a paramount concern, prompting the evolution of comprehensive global data privacy laws (Quach et al., 2022). As we traverse the intricate landscape of these regulations, it's essential to delve into key frameworks that have shaped the way organizations handle user information. This section takes you on a journey through the evolution of global data privacy laws, highlighting three pivotal regulations viz the General Data Protection Regulation (GDPR), the California Consumer Privacy Act (CCPA), and various other regional legislations. The General Data Protection Regulation (GDPR) implemented by the European Union in May 2018, stands as a watershed moment in the realm of data protection. Built on the principles of transparency, fairness, and accountability, the regulation brings forth a comprehensive framework for safeguarding the privacy rights of individuals (Bennett and Raab, 2020). A key principle of GDPR is transparency. Organizations must be clear about how they process personal data. Secondly, Data collection must have a specific, legitimate purpose. Thirdly, is data minimization. Organization should collect only the data necessary for the intended purpose. And users have the right to control and access their personal information. The Impact on Businesses and Users are here presented. The GDPR has significantly enhanced user control over personal data. Its stringent requirements have forced businesses worldwide to reassess and fortify their data protection measures. The regulation also introduces severe penalties for non-compliance, emphasizing the urgency for organizations to prioritize data privacy. The GDPR's influence extends far beyond the borders of the European Union. It has become a benchmark for data protection laws globally, inspiring similar legislation and shaping discussions on user rights and corporate responsibilities (Rustad and Koenig, 2019). The California Consumer Privacy Act (CCPA) is aimed at empowering Consumers in the Golden State. Enacted in January 2020, the CCPA heralds a new era of consumer-centric data protection in the United States. Originating in California, this legislation has spurred conversations about the need for federal privacy laws and has influenced other states to explore or enact similar measures (Chander et al., 2020). The key Provisions of CCPA include right to know, right to delete, opt-out rights, and non-discriminiation. Consumers can inquire about the data collected about them. Consumers can request the deletion of their personal information. Consumers can opt-out of the sale of their personal information. Consumers exercising their privacy rights cannot be discriminated against. The CCPA has catalyzed a shift in the way businesses handle personal data, while empowering consumers, it has presented compliance challenges for organizations, requiring them to reevaluate data processing practices and ensure adherence to the stipulated rights (Chander et al., 2021). Beyond California, the CCPA has acted as a catalyst for discussions about federal privacy legislation in the United States. Policymakers are grappling with the need for a unified approach to protect the privacy rights of citizens across the nation. The Other Regional Legislations are here discussed. The evolution of data privacy laws is not confined to Europe and North America; it extends to every corner of the globe, various regions have enacted or are in the process of enacting comprehensive data protection laws to address the challenges posed by the digital age (Rustad and Koenig, 2019.). The Asia-Pacific which include China and Japan. In China, the Personal Data Protection Law regulates the processing of personal data. And in Japan, the Personal Information Protection Law (PIPL) strengthens protections for personal information. For Latin America, the Lei Geral de Proteção de Dados (LGPD) governs the use of personal data in Brazil. The Protection of Personal Information Act (POPIA) governs the lawful processing of personal information in South Africa, in the United Arab Emirates various Emirates are implementing data protection laws (Gottardo, 2023). Diverse approaches to data protection reflect unique cultural, legal, and economic considerations, and a global mosaic of legislations shapes a complex, interconnected framework for data privacy (Comandè and Schneider, 2022). The evolution of global data privacy laws underscores the urgency of adapting legal frameworks to the rapidly changing digital landscape. From the GDPR's pioneering role in Europe to the CCPA's influence in the United States and diverse legislations across regions, the world is awakening to the importance of safeguarding individual privacy rights (Souza et al., 2021). As we move forward, it's crucial for businesses, policymakers, and users alike to stay informed about these evolving regulations. The global conversation on data privacy is far from over, and it's a collective responsibility to ensure that our digital future is one where innovation thrives alongside the protection of individual privacy Comparative Analysis of Global Frameworks In the intricate tapestry of global data privacy laws, a comparative analysis becomes crucial to discern the diverse approaches adopted by different regions (Shukla et al., 2023). As the digital era propels us forward, understanding how various frameworks align or diverge is paramount. World Journal of Advanced Research and Reviews, 2024, 21(02), 1058–1070 1061 The General Data Protection Regulation (GDPR) serves as the cornerstone of data protection in Europe. Its principles of transparency, purpose limitation, and individual rights have set a gold standard, emphasizing user control and organizational accountability. The GDPR provides a harmonized framework across the European Union, promoting consistency and a single set of rules for businesses operating within its jurisdiction (Prasad and Perez, 2020, Adebukola et al., 2022). With potential fines reaching up to 4% of global annual turnover, the GDPR instills a strong deterrent against non-compliance. The GDPR's comprehensive nature can pose challenges for businesses navigating intricate compliance requirements, ensuring compliance across borders can be challenging, especially for multinational corporations (Chander et al., 2021). The California Consumer Privacy Act (CCPA) emerged as a trailblazer in U.S. data privacy legislation. Enacted in the state of California, it grants consumers unprecedented control over their personal information. The CCPA focuses on empowering consumers with the right to know, delete, and opt-out, fostering a culture of transparency. The CCPA has sparked discussions about the need for comprehensive federal privacy legislation in the United States. Like the GDPR, CCPA compliance can be intricate, requiring businesses to adapt their data practices, while influencing other states, the lack of a federal law may lead to varying privacy standards across the country (Chander et al., 2021, Okunade et al., 2023). The Asia-Pacific region reflects a diverse landscape of data protection laws. China's Personal Data Protection Law and Japan's Personal Information Protection Law (PIPL) exemplify the region's commitment to adapting to the digital age (Raposo and Du, 2023). Asian countries are actively modernizing their data protection laws to address contemporary challenges. Regulations in the region are increasingly focused on empowering individuals with control over their personal data (Janssen et al., 2020). Diverse cultural norms and legal traditions contribute to varying interpretations and implementations of data protection laws. The rapid pace of technological advancements requires continuous adaptation, which can pose challenges for regulatory frameworks. https://wjarr.com/sites/default/files/WJARR-2024-0369.pdf ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Fact Finding,Q&A "ONLY USE THE DATA I PROVIDE Limit your response to 100 words Provide a definition and explanation If you cannot answer using the contexts alone, say ""I cannot determine the answer to that due to lack of context""",What is the holistic approach to financial planning?,"**How To Build Wealth In Your 40s** Is It Too Late To Start Building Wealth At 40? Many people wonder whether it's too late to start building wealth once they reach their 40s. The truth is, it's never too late to begin saving and taking steps toward financial security, no matter your age. While starting late may present some challenges, such as having a shorter timeline to reach your financial goals, it's still possible to make significant progress toward building a better financial future. The key is to take a holistic approach to planning. This means identifying areas where you can cut expenses, increase income, and make smarter investment decisions. Establishing an emergency fund, reducing debt, and maximizing contributions to retirement accounts can also help you achieve financial stability. Remember, building wealth is a journey, not a destination. With the right mindset, dedication, and expert guidance, you can overcome any obstacles and achieve financial success. Keep reading for more tips and strategies on how to build wealth in your 40s! 9 Ways To Build Wealth In Your 40s If you're looking to secure your financial future and make the most of your prime earning years, we're here to provide you with expert advice and proven strategies on how to build wealth in your 40s. With a little dedication and hard work, you can build a solid financial foundation and create the life you desire. 1. Settle Mortgage Early Paying off your mortgage early can be a smart move in your 40s. By reducing or eliminating this significant expense, you can free up funds to invest in your future, such as contributing extra income to retirement accounts or creating multiple income streams. To settle your mortgage early, consider making extra payments towards the principal, refinancing to a shorter term, or accelerating your payment schedule. By doing so, you can reduce your overall interest payments and save money over the life of the loan. Keep in mind that settling your mortgage early may not be the best option for everyone, depending on your individual circumstances. 2. Be Debt-Free Debt can be a significant obstacle to building wealth in your 40s. With high-interest rates and fees, it can eat away at your income and make it difficult to save for retirement or invest in your future. However, being debt-free should be a top priority in your financial plan. By reducing or eliminating your debt, you can free up funds to invest in your future, create multiple income streams, or build your emergency savings. To start, consider creating a debt reduction plan that prioritizes high-interest debt, such as credit card debt or personal loans. Consolidating debt or negotiating with creditors to reduce interest rates and fees can also help you make progress toward being debt-free. Another key strategy is to avoid high-interest debt, such as credit card bills, medical bills, and car loans. By reducing your debt load, you can free up funds to invest in your future and build your retirement savings. 3. Don't Be A Spendthrift It's easy to fall into the trap of overspending and indulging in luxurious lifestyle expenses. However, if you want to build wealth in your 40s, you need to be mindful of your spending habits and live within your means. One effective strategy is to create a budget and stick to it. By tracking your expenses and identifying areas where you can cut back, you can save more money and invest it towards your financial goals. 4. Build Your Investment Portfolio Building a diversified investment portfolio can be a smart move in your 40s. By investing in a mix of stocks, bonds, and other assets, you can reduce your overall risk and maximize your potential returns. To get your retirement contributions started, consider opening a retirement account, such as a Roth IRA or a 401(k), and making regular contributions. You can also explore other investment accounts, such as brokerage accounts or mutual funds, to diversify your portfolio and achieve your financial goals. Keep in mind that building an investment portfolio requires careful planning and attention to your financial situation. 5. Expand Your Income Sources In your 40s, it's important to find ways to expand your income sources to maximize your earnings potential and achieve your financial goals. Consider investment accounts or high-growth stocks to boost your retirement savings options and build your net worth. Starting a small business can also be a great way to create multiple passive income- streams and increase your monthly income. In addition, seeking the help of an advisor can guide you in developing a financial plan that can explore opportunities to expand your income sources. They can provide you with practical strategies to increase your monthly income and net worth, making your financial future more secure. 6. Build An Emergency Fund Setting aside an emergency fund is essential to achieving financial stability in your 40s. It can help cover unexpected expenses such as medical bills, funeral expenses, or other debts, allowing you to maintain your lifestyle expenses and stay financially secure. To build an emergency fund, consider setting up a savings plan dedicated to unexpected expenses. This can also include exploring options for life insurance policies or personal finance strategies to protect your financial future and minimize the impact of unexpected expenses. 7. Invest In Index Funds Investing in index funds can be a smart way to build wealth in your 40s. Index funds are a type of mutual fund that tracks a specific index, such as the S&P 500, and provides a low-cost way to diversify your investment portfolio. One of the main benefits of investing in index funds is that they offer a high level of stability and consistency, making them an attractive option for risk-averse investors. Additionally, index funds typically have lower expense ratios compared to actively managed funds, which can result in higher returns for investors over the long term. With index funds, you can invest in a wide range of assets, including stocks, bonds, and real estate, which can provide you with greater exposure to different sectors and industries. Another advantage of index funds is their passive management style, which means that you don't need to constantly monitor and adjust your investments. This can be particularly beneficial for busy professionals in their 40s who don't have the time or expertise to actively manage their investment portfolios. However, it's important to note that investing in index funds still involves risk and requires careful consideration of your financial goals and risk tolerance. It's also important to regularly review and rebalance your portfolio to ensure that it aligns with your investment objectives. 8. Invest In A Skill Developing a new skill is one of the most effective ways to build wealth in your 40s. Whether it's learning a new language or taking courses to enhance your professional expertise, investing in yourself can lead to a higher salary, increased job security, and, ultimately, greater financial stability. By doing so, you can open up opportunities to expand your income sources, explore higher-paying job roles, or even start a small business on the side. With additional income, you can pay off mortgage payments or credit card debt, save for retirement, or even free money to invest in other areas of your financial plan. Moreover, upskilling also allows you to stay competitive in the job market and adapt to changing industry trends. This can lead to increased job security and the ability to negotiate a higher salary or better benefits. However, it's important to note that investing in a skill requires an investment - both time and money. You may need to take courses, attend conferences, or pay for specialized training. It's important to include these expenses in your planning and consider them as part of your retirement savings goals. Ultimately, learning a skill or improving on existing ones can be a wise financial decision that can pay off in the long run. By enhancing your knowledge and expertise, you can secure a brighter financial future and achieve greater personal and professional fulfillment. 9. Hire A Financial Advisor If You’re Earning Good Working with a financial advisor can also help you identify opportunities to save more money and optimize your investment portfolio. They can help you explore the world of financial planning, retirement plans, savings options, and various investment areas. Furthermore, an advisor can assist you in evaluating your financial situation and developing a long-term strategy that helps you achieve financial stability and security. Conclusion As you embark on your journey to building wealth in your 40s, it's important to remember that financial stability is within reach. By implementing the strategies we've discussed, including settling your mortgage early, being debt-free, expanding your income sources, building an emergency fund, and investing wisely, you can take control of your financial situation and achieve your retirement savings goals. Managing your living expenses and obtaining good health insurance are essential parts of building a secure financial future. By following these principles and seeking expert guidance as necessary, you can build a solid financial foundation that will serve you well throughout your life. Remember, building wealth takes time and patience, but with perseverance and smart decision-making, you can achieve financial stability and enjoy a prosperous future."," ONLY USE THE DATA I PROVIDE Limit your response to 100 words Provide a definition and explanation If you cannot answer using the contexts alone, say ""I cannot determine the answer to that due to lack of context"" **How To Build Wealth In Your 40s** Is It Too Late To Start Building Wealth At 40? Many people wonder whether it's too late to start building wealth once they reach their 40s. The truth is, it's never too late to begin saving and taking steps toward financial security, no matter your age. While starting late may present some challenges, such as having a shorter timeline to reach your financial goals, it's still possible to make significant progress toward building a better financial future. The key is to take a holistic approach to planning. This means identifying areas where you can cut expenses, increase income, and make smarter investment decisions. Establishing an emergency fund, reducing debt, and maximizing contributions to retirement accounts can also help you achieve financial stability. Remember, building wealth is a journey, not a destination. With the right mindset, dedication, and expert guidance, you can overcome any obstacles and achieve financial success. Keep reading for more tips and strategies on how to build wealth in your 40s! 9 Ways To Build Wealth In Your 40s If you're looking to secure your financial future and make the most of your prime earning years, we're here to provide you with expert advice and proven strategies on how to build wealth in your 40s. With a little dedication and hard work, you can build a solid financial foundation and create the life you desire. 1. Settle Mortgage Early Paying off your mortgage early can be a smart move in your 40s. By reducing or eliminating this significant expense, you can free up funds to invest in your future, such as contributing extra income to retirement accounts or creating multiple income streams. To settle your mortgage early, consider making extra payments towards the principal, refinancing to a shorter term, or accelerating your payment schedule. By doing so, you can reduce your overall interest payments and save money over the life of the loan. Keep in mind that settling your mortgage early may not be the best option for everyone, depending on your individual circumstances. 2. Be Debt-Free Debt can be a significant obstacle to building wealth in your 40s. With high-interest rates and fees, it can eat away at your income and make it difficult to save for retirement or invest in your future. However, being debt-free should be a top priority in your financial plan. By reducing or eliminating your debt, you can free up funds to invest in your future, create multiple income streams, or build your emergency savings. To start, consider creating a debt reduction plan that prioritizes high-interest debt, such as credit card debt or personal loans. Consolidating debt or negotiating with creditors to reduce interest rates and fees can also help you make progress toward being debt-free. Another key strategy is to avoid high-interest debt, such as credit card bills, medical bills, and car loans. By reducing your debt load, you can free up funds to invest in your future and build your retirement savings. 3. Don't Be A Spendthrift It's easy to fall into the trap of overspending and indulging in luxurious lifestyle expenses. However, if you want to build wealth in your 40s, you need to be mindful of your spending habits and live within your means. One effective strategy is to create a budget and stick to it. By tracking your expenses and identifying areas where you can cut back, you can save more money and invest it towards your financial goals. 4. Build Your Investment Portfolio Building a diversified investment portfolio can be a smart move in your 40s. By investing in a mix of stocks, bonds, and other assets, you can reduce your overall risk and maximize your potential returns. To get your retirement contributions started, consider opening a retirement account, such as a Roth IRA or a 401(k), and making regular contributions. You can also explore other investment accounts, such as brokerage accounts or mutual funds, to diversify your portfolio and achieve your financial goals. Keep in mind that building an investment portfolio requires careful planning and attention to your financial situation. 5. Expand Your Income Sources In your 40s, it's important to find ways to expand your income sources to maximize your earnings potential and achieve your financial goals. Consider investment accounts or high-growth stocks to boost your retirement savings options and build your net worth. Starting a small business can also be a great way to create multiple passive income- streams and increase your monthly income. In addition, seeking the help of an advisor can guide you in developing a financial plan that can explore opportunities to expand your income sources. They can provide you with practical strategies to increase your monthly income and net worth, making your financial future more secure. 6. Build An Emergency Fund Setting aside an emergency fund is essential to achieving financial stability in your 40s. It can help cover unexpected expenses such as medical bills, funeral expenses, or other debts, allowing you to maintain your lifestyle expenses and stay financially secure. To build an emergency fund, consider setting up a savings plan dedicated to unexpected expenses. This can also include exploring options for life insurance policies or personal finance strategies to protect your financial future and minimize the impact of unexpected expenses. 7. Invest In Index Funds Investing in index funds can be a smart way to build wealth in your 40s. Index funds are a type of mutual fund that tracks a specific index, such as the S&P 500, and provides a low-cost way to diversify your investment portfolio. One of the main benefits of investing in index funds is that they offer a high level of stability and consistency, making them an attractive option for risk-averse investors. Additionally, index funds typically have lower expense ratios compared to actively managed funds, which can result in higher returns for investors over the long term. With index funds, you can invest in a wide range of assets, including stocks, bonds, and real estate, which can provide you with greater exposure to different sectors and industries. Another advantage of index funds is their passive management style, which means that you don't need to constantly monitor and adjust your investments. This can be particularly beneficial for busy professionals in their 40s who don't have the time or expertise to actively manage their investment portfolios. However, it's important to note that investing in index funds still involves risk and requires careful consideration of your financial goals and risk tolerance. It's also important to regularly review and rebalance your portfolio to ensure that it aligns with your investment objectives. 8. Invest In A Skill Developing a new skill is one of the most effective ways to build wealth in your 40s. Whether it's learning a new language or taking courses to enhance your professional expertise, investing in yourself can lead to a higher salary, increased job security, and, ultimately, greater financial stability. By doing so, you can open up opportunities to expand your income sources, explore higher-paying job roles, or even start a small business on the side. With additional income, you can pay off mortgage payments or credit card debt, save for retirement, or even free money to invest in other areas of your financial plan. Moreover, upskilling also allows you to stay competitive in the job market and adapt to changing industry trends. This can lead to increased job security and the ability to negotiate a higher salary or better benefits. However, it's important to note that investing in a skill requires an investment - both time and money. You may need to take courses, attend conferences, or pay for specialized training. It's important to include these expenses in your planning and consider them as part of your retirement savings goals. Ultimately, learning a skill or improving on existing ones can be a wise financial decision that can pay off in the long run. By enhancing your knowledge and expertise, you can secure a brighter financial future and achieve greater personal and professional fulfillment. 9. Hire A Financial Advisor If You’re Earning Good Working with a financial advisor can also help you identify opportunities to save more money and optimize your investment portfolio. They can help you explore the world of financial planning, retirement plans, savings options, and various investment areas. Furthermore, an advisor can assist you in evaluating your financial situation and developing a long-term strategy that helps you achieve financial stability and security. Conclusion As you embark on your journey to building wealth in your 40s, it's important to remember that financial stability is within reach. By implementing the strategies we've discussed, including settling your mortgage early, being debt-free, expanding your income sources, building an emergency fund, and investing wisely, you can take control of your financial situation and achieve your retirement savings goals. Managing your living expenses and obtaining good health insurance are essential parts of building a secure financial future. By following these principles and seeking expert guidance as necessary, you can build a solid financial foundation that will serve you well throughout your life. Remember, building wealth takes time and patience, but with perseverance and smart decision-making, you can achieve financial stability and enjoy a prosperous future. What is the holistic approach to financial planning?",Financial,Explanation/Definition,Q&A "You may only respond to the prompt using the information in the context block. If you cannot answer based on the context block alone, say, ""I am unable to answer that due to lack of context."" Do not use more than 300 words in your response. ",Summarize the argument for not holding companies to contracts signed before the pandemic but fulfilled during the pandemic.," THE ROLE OF CONTRACT LAW IN SUPPLY CHAINS Food supply chains are normally composed of vertical and horizontal chains of contracts connecting various core value-chain actors from producers to consumers, as well as contractual relations among operators of support services (e.g. purchase of inputs, financial agreements). All contracts in the chain should be fair and equitable for all parties and administered in good faith. The contracts should clarify the parties’ rights and responsibilities, paying attention to the essential elements of a contract as stipulated in the national contract law. Commonly, these essential elements would include, at least, the identification of the parties, offer and acceptance, obligations, price determination, remedies in case of partial or non-compliance, termination and provisions on dispute resolution, including alternative dispute resolution (ADR). In the context of a pandemic, the risk thatsome of these elements may be compromised is increased. Contracts should always ensure fair and equitable risk allocation and management. Certain risk allocation and management would – to some extent – be covered by the concepts of force majeure and/or change of circumstances, which are designed to respond to both natural disasters (disease outbreaks, disasters, etc.) and societal events (export bans, movement restrictions, etc.). Domestic legislation often requires four simultaneous conditions to be fulfilled before the application of force majeure: the event should be 1) unforeseeable, 2) unavoidable 3) outside the parties’ control and 4) it should objectively prevent one or both of them from performing. Change of circumstances (hardship-like situations) generally requires the first three pre-conditions. Such change in circumstances would not necessarily prevent parties from performing, but it would fundamentally change the basis on which the contract was formed and alter the balance of the relationship, making it unfair to hold either or both parties to their original obligations (UNIDROIT, FAO and IFAD, 2015). Parties who concluded a contract prior to the outbreak of COVID-19 and the subsequent imposition of related restrictions, may claim that either force majeure or change of circumstances, depending on the legal and factual context, apply to their ongoing contractual relationship. The final application of force majeure or change of circumstances would depend on a national court’s or an ADR mechanism’s interpretation of the applicable criteria and may excuse compliance with, or suspend, the affected obligations or lead to renegotiation of the contract. For contracts concluded after the declaration of the emergency, the application or not of these clauses would depend on whether further changes in circumstances, connected to the emergency, can be considered “unforeseeable”, months into the pandemic. This uncertainty needs to be taken into account by those who enter into new contracts under current conditions. The negotiation and drafting of new contracts should aim at providing clarity on what should happen to the contractual relationship due to the continuing and emerging impacts of COVID-19. Considerable contractual innovation, as supported and protected by the principle of freedom of contract, is required to ensure equitable risk allocation. One option could be to explicitly agree in the contract to consider COVID-19 and its related upheavals as force majeure, or change of circumstances, where the domestic legislation allows partiesto depart from the standard andmost probably narrowlegal definitions of these terms. Another option would be for the contract to mandate the parties to renegotiate the contract, either after some time has passed or if a certain event triggers the need to do so (such as new movement restrictions imposed by the government). Finally, the contracts could also explicitly consider COVID-19 and its effects when drafting remedies for contractual breaches, such as waiving the use of remedies or opting for less disruptive and more lenient options when the underlying breach was demonstrably caused by the pandemic. Unfortunately, contractual innovation may also open the door for the stronger party in a contract to take advantage and impose imbalancesin risk allocation between the parties through the introduction of unfair contractual terms and practices. A classic example of an unfair practice would be for the contract to allow only one party to unilaterally terminate the contract without notifying or discussing it in advance with the other party. On a general level, this requires governments to either adopt, or increase enforcement of, unfair contractual practices legislation to prohibit the use of contractual terms and practices that are considered unfair. Enhanced enforcement should begin immediately, as abuses may already be happening. At the same time, if there are gaps, the reform of the legislative framework should commence in earnest as it requires an investment of effort and time and will likely go beyond the duration of the current COVID-19 crisis. In the context of food supply chains, at least for nodessuch as contracts between smallholder producers and their buyers, governments may consider creating either mandatory or voluntary registries for contracts. These can increase transparency and legal certainty for parties, when they know that their contract (with sensitive commercial information removed) may be accessible to a defined audience (Viinikainen and Bullón, 2018). Greater prominence and application of the common, but not universally accepted, principle of good faith should be promoted in this time of uncertainty and can be effective if it is backed by the threat of enforcement. The principle of good faith requires the parties to interact honestly and fairly, and refrain from taking actions that would deny their counterparty from receiving the expected benefits of the contract. Essentially, good faith infuses the contract relationship with the kind of flexibility required to address the complications that come with a pandemic or any other global emergency. Good faith may involve applying, orrefraining from adopting, certain conduct (UNIDROIT, FAO and IFAD, 2015). In the context of COVID-19 this could include greater flexibility for delivery times, honest and timely exchange of information between the parties on the impacts that the emergency has had to better anticipate difficulties, as well as willingnessto renegotiate to better adjust the contractual relationship to the rapidly changing circumstances. Finally, as good contractual practice, it is important to include reference to grievance mechanisms in the contract. This is even more important in the uncertainty created by COVID19, which may increase the likelihood of both breaches and disputes. Deciding on the method of dispute resolution in advance is important as, once a dispute has arisen, it may be difficult for the parties to agree on how to resolve it. In general, for smallholders in particular, the use of ADR mechanisms, such as arbitration and mediation, may be preferable as they tend to be less costly, less formal and faster in dealing with disputes than the courts.","[Context Block] THE ROLE OF CONTRACT LAW IN SUPPLY CHAINS Food supply chains are normally composed of vertical and horizontal chains of contracts connecting various core value-chain actors from producers to consumers, as well as contractual relations among operators of support services (e.g. purchase of inputs, financial agreements). All contracts in the chain should be fair and equitable for all parties and administered in good faith. The contracts should clarify the parties’ rights and responsibilities, paying attention to the essential elements of a contract as stipulated in the national contract law. Commonly, these essential elements would include, at least, the identification of the parties, offer and acceptance, obligations, price determination, remedies in case of partial or non-compliance, termination and provisions on dispute resolution, including alternative dispute resolution (ADR). In the context of a pandemic, the risk thatsome of these elements may be compromised is increased. Contracts should always ensure fair and equitable risk allocation and management. Certain risk allocation and management would – to some extent – be covered by the concepts of force majeure and/or change of circumstances, which are designed to respond to both natural disasters (disease outbreaks, disasters, etc.) and societal events (export bans, movement restrictions, etc.). Domestic legislation often requires four simultaneous conditions to be fulfilled before the application of force majeure: the event should be 1) unforeseeable, 2) unavoidable 3) outside the parties’ control and 4) it should objectively prevent one or both of them from performing. Change of circumstances (hardship-like situations) generally requires the first three pre-conditions. Such change in circumstances would not necessarily prevent parties from performing, but it would fundamentally change the basis on which the contract was formed and alter the balance of the relationship, making it unfair to hold either or both parties to their original obligations (UNIDROIT, FAO and IFAD, 2015). Parties who concluded a contract prior to the outbreak of COVID-19 and the subsequent imposition of related restrictions, may claim that either force majeure or change of circumstances, depending on the legal and factual context, apply to their ongoing contractual relationship. The final application of force majeure or change of circumstances would depend on a national court’s or an ADR mechanism’s interpretation of the applicable criteria and may excuse compliance with, or suspend, the affected obligations or lead to renegotiation of the contract. For contracts concluded after the declaration of the emergency, the application or not of these clauses would depend on whether further changes in circumstances, connected to the emergency, can be considered “unforeseeable”, months into the pandemic. This uncertainty needs to be taken into account by those who enter into new contracts under current conditions. The negotiation and drafting of new contracts should aim at providing clarity on what should happen to the contractual relationship due to the continuing and emerging impacts of COVID-19. Considerable contractual innovation, as supported and protected by the principle of freedom of contract, is required to ensure equitable risk allocation. One option could be to explicitly agree in the contract to consider COVID-19 and its related upheavals as force majeure, or change of circumstances, where the domestic legislation allows partiesto depart from the standard andmost probably narrowlegal definitions of these terms. Another option would be for the contract to mandate the parties to renegotiate the contract, either after some time has passed or if a certain event triggers the need to do so (such as new movement restrictions imposed by the government). Finally, the contracts could also explicitly consider COVID-19 and its effects when drafting remedies for contractual breaches, such as waiving the use of remedies or opting for less disruptive and more lenient options when the underlying breach was demonstrably caused by the pandemic. Unfortunately, contractual innovation may also open the door for the stronger party in a contract to take advantage and impose imbalancesin risk allocation between the parties through the introduction of unfair contractual terms and practices. A classic example of an unfair practice would be for the contract to allow only one party to unilaterally terminate the contract without notifying or discussing it in advance with the other party. On a general level, this requires governments to either adopt, or increase enforcement of, unfair contractual practices legislation to prohibit the use of contractual terms and practices that are considered unfair. Enhanced enforcement should begin immediately, as abuses may already be happening. At the same time, if there are gaps, the reform of the legislative framework should commence in earnest as it requires an investment of effort and time and will likely go beyond the duration of the current COVID-19 crisis. In the context of food supply chains, at least for nodessuch as contracts between smallholder producers and their buyers, governments may consider creating either mandatory or voluntary registries for contracts. These can increase transparency and legal certainty for parties, when they know that their contract (with sensitive commercial information removed) may be accessible to a defined audience (Viinikainen and Bullón, 2018). Greater prominence and application of the common, but not universally accepted, principle of good faith should be promoted in this time of uncertainty and can be effective if it is backed by the threat of enforcement. The principle of good faith requires the parties to interact honestly and fairly, and refrain from taking actions that would deny their counterparty from receiving the expected benefits of the contract. Essentially, good faith infuses the contract relationship with the kind of flexibility required to address the complications that come with a pandemic or any other global emergency. Good faith may involve applying, orrefraining from adopting, certain conduct (UNIDROIT, FAO and IFAD, 2015). In the context of COVID-19 this could include greater flexibility for delivery times, honest and timely exchange of information between the parties on the impacts that the emergency has had to better anticipate difficulties, as well as willingnessto renegotiate to better adjust the contractual relationship to the rapidly changing circumstances. Finally, as good contractual practice, it is important to include reference to grievance mechanisms in the contract. This is even more important in the uncertainty created by COVID19, which may increase the likelihood of both breaches and disputes. Deciding on the method of dispute resolution in advance is important as, once a dispute has arisen, it may be difficult for the parties to agree on how to resolve it. In general, for smallholders in particular, the use of ADR mechanisms, such as arbitration and mediation, may be preferable as they tend to be less costly, less formal and faster in dealing with disputes than the courts. [System Instruction] You may only respond to the prompt using the information in the context block. If you cannot answer based on the context block alone, say, ""I am unable to answer that due to lack of context."" Do not use more than 300 words in your response. [Question] Summarize the argument for not holding companies to contracts signed before the pandemic but fulfilled during the pandemic. ",Legal,Find & Summarize,Text Transformation The document should be the only source used to answer the question.,Does chewing gum cause tooth decay?,"**Oral Effects of Chewing Gum** Chewing gum after a meal can increase salivary flow by stimulating both mechanical and taste receptors in the mouth. The average unstimulated salivary flow rate for healthy people is 0.3-0.4 mL/min.6 The physical act of chewing stimulates salivary flow: simply chewing unsweetened, unflavored chewing gum base stimulates the salivary flow rate by 10-12 times that of the unstimulated rate.7 Flavors also act as salivary stimulants.6 The stimulated salivary flow rate is significantly greater while chewing sweetened and flavored gum as opposed to unsweetened, unflavored chewing gum base.7, 8 Increasing saliva volume helps to dilute and neutralize acids produced by the bacteria in plaque on teeth. Over time, these acids can damage tooth enamel, potentially resulting in decay. There are several mechanisms by which stimulated saliva flow may protect against dental caries. Increased saliva flow carries with it calcium and phosphate ions, which can contribute to remineralization of tooth enamel; the presence of fluoride in the saliva can serve to replace enamel components magnesium and carbonate with the stronger, more caries-resistant fluorapatite crystals.9 Saliva can buffer the effects of acids in foods or drinks that could otherwise soften teeth’s enamel surface, and swallowing excess saliva created by stimulation clears acid.8 While unstimulated saliva does not have a strong buffering capacity against acid, stimulated saliva has higher concentrations of protein, sodium, calcium, chloride, and bicarbonate increasing its buffering capacity.6 Additionally, saliva contributes proteins to dental surfaces, creating an acquired enamel pellicle that protects against dental erosion.6, 8 Sugar-containing Chewing Gum Monosaccharides and disaccharides may be used in sugar-containing chewing gum. These fermentable carbohydrates can be metabolized by oral bacteria. The bacteria (particularly S. mutans and Lactobacillus spp.) in turn produce dental biofilm and acid, which can lead to enamel demineralization and caries.10 The potential cariogenicity of sugar-containing gum depends on the physical consistency, oral retention time of the gum, the frequency with which it is chewed, and the sequence of consumption (for instance, chewing sugar-containing gum before eating foods that reduce acid production will be less cariogenic than the reverse).10 Sugar-free Chewing Gum As defined by the Food and Drug Administration (FDA) in the Code of Federal Regulations (CFR) a food or food substance such as chewing gum, can be labeled as “sugar-free” if it contains less than 0.5 g of sugars per serving.11 In place of sugar, these gums use high-intensity sweeteners such as aspartame, acesulfame-K, neotame, saccharin, sucralose or stevia.12 They also may be sweetened with sugar alcohols such as erythritol, isomalt, maltitol, mannitol, sorbitol, or xylitol.12 These high-intensity sweeteners, with the exception of aspartame, are considered non-nutritive and contain fewer calories than sugar, but the FDA categorizes aspartame, as well as the aforementioned sugar alcohols, to be nutritive sweeteners, since they contain more than 2% of the calories in an equivalent amount of sugar.13 Clinical trials have found decreased caries incidence in subjects who chewed sugar-free gum for 20 minutes after meals.14, 15 Unlike sugar, these sweeteners are noncariogenic, since they are metabolized slowly or not at all by cariogenic plaque bacteria.16 A 2021 systematic review and meta-analysis by Nasseripour et al.17 examined the use of sugar-free gum sweetened with xylitol and reported that the use of sugar-free chewing gum resulted in a statistically significant reduction in the S. mutans load. The authors reported an effect size of -0.42 (95% CI: -0.60 to -0.25), which is suggestive of its benefit as an adjunct to recommended home oral hygiene.","{QUERY} ========== Does chewing gum cause tooth decay? {SYSTEM INSTRUCTION} ========== The document should be the only source used to answer the question. {PASSAGE} ========== **Oral Effects of Chewing Gum** Chewing gum after a meal can increase salivary flow by stimulating both mechanical and taste receptors in the mouth. The average unstimulated salivary flow rate for healthy people is 0.3-0.4 mL/min.6 The physical act of chewing stimulates salivary flow: simply chewing unsweetened, unflavored chewing gum base stimulates the salivary flow rate by 10-12 times that of the unstimulated rate.7 Flavors also act as salivary stimulants.6 The stimulated salivary flow rate is significantly greater while chewing sweetened and flavored gum as opposed to unsweetened, unflavored chewing gum base.7, 8 Increasing saliva volume helps to dilute and neutralize acids produced by the bacteria in plaque on teeth. Over time, these acids can damage tooth enamel, potentially resulting in decay. There are several mechanisms by which stimulated saliva flow may protect against dental caries. Increased saliva flow carries with it calcium and phosphate ions, which can contribute to remineralization of tooth enamel; the presence of fluoride in the saliva can serve to replace enamel components magnesium and carbonate with the stronger, more caries-resistant fluorapatite crystals.9 Saliva can buffer the effects of acids in foods or drinks that could otherwise soften teeth’s enamel surface, and swallowing excess saliva created by stimulation clears acid.8 While unstimulated saliva does not have a strong buffering capacity against acid, stimulated saliva has higher concentrations of protein, sodium, calcium, chloride, and bicarbonate increasing its buffering capacity.6 Additionally, saliva contributes proteins to dental surfaces, creating an acquired enamel pellicle that protects against dental erosion.6, 8 Sugar-containing Chewing Gum Monosaccharides and disaccharides may be used in sugar-containing chewing gum. These fermentable carbohydrates can be metabolized by oral bacteria. The bacteria (particularly S. mutans and Lactobacillus spp.) in turn produce dental biofilm and acid, which can lead to enamel demineralization and caries.10 The potential cariogenicity of sugar-containing gum depends on the physical consistency, oral retention time of the gum, the frequency with which it is chewed, and the sequence of consumption (for instance, chewing sugar-containing gum before eating foods that reduce acid production will be less cariogenic than the reverse).10 Sugar-free Chewing Gum As defined by the Food and Drug Administration (FDA) in the Code of Federal Regulations (CFR) a food or food substance such as chewing gum, can be labeled as “sugar-free” if it contains less than 0.5 g of sugars per serving.11 In place of sugar, these gums use high-intensity sweeteners such as aspartame, acesulfame-K, neotame, saccharin, sucralose or stevia.12 They also may be sweetened with sugar alcohols such as erythritol, isomalt, maltitol, mannitol, sorbitol, or xylitol.12 These high-intensity sweeteners, with the exception of aspartame, are considered non-nutritive and contain fewer calories than sugar, but the FDA categorizes aspartame, as well as the aforementioned sugar alcohols, to be nutritive sweeteners, since they contain more than 2% of the calories in an equivalent amount of sugar.13 Clinical trials have found decreased caries incidence in subjects who chewed sugar-free gum for 20 minutes after meals.14, 15 Unlike sugar, these sweeteners are noncariogenic, since they are metabolized slowly or not at all by cariogenic plaque bacteria.16 A 2021 systematic review and meta-analysis by Nasseripour et al.17 examined the use of sugar-free gum sweetened with xylitol and reported that the use of sugar-free chewing gum resulted in a statistically significant reduction in the S. mutans load. The authors reported an effect size of -0.42 (95% CI: -0.60 to -0.25), which is suggestive of its benefit as an adjunct to recommended home oral hygiene.",Medical,Fact Finding,Q&A Only use the provided text in the prompt to answer questions. Do not use external knowledge.,How does hypermobile EDS compare to classic EDS?,"Ehlers-Danlos syndrome is a group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. Defects in connective tissues cause the signs and symptoms of these conditions, which range from mildly loose joints to life-threatening complications. The various forms of Ehlers-Danlos syndrome have been classified in several different ways. Originally, 11 forms of Ehlers-Danlos syndrome were named using Roman numerals to indicate the types (type I, type II, and so on). In 1997, researchers proposed a simpler classification (the Villefranche nomenclature) that reduced the number of types to six and gave them descriptive names based on their major features. In 2017, the classification was updated to include rare forms of Ehlers-Danlos syndrome that were identified more recently. The 2017 classification describes 13 types of Ehlers- Danlos syndrome. An unusually large range of joint movement (hypermobility) occurs in most forms of Ehlers-Danlos syndrome, and it is a hallmark feature of the hypermobile type. Infants and children with hypermobility often have weak muscle tone (hypotonia), which can delay the development of motor skills such as sitting, standing, and walking. The loose joints are unstable and prone to dislocation and chronic pain. In the arthrochalasia type of Ehlers-Danlos syndrome, infants have hypermobility and dislocations of both hips at birth. Many people with the Ehlers-Danlos syndromes have soft, velvety skin that is highly stretchy (elastic) and fragile. Affected individuals tend to bruise easily, and some types of the condition also cause abnormal scarring. People with the classical form of Ehlers- Danlos syndrome experience wounds that split open with little bleeding and leave scars that widen over time to create characteristic ""cigarette paper"" scars. The dermatosparaxis type of the disorder is characterized by loose skin that sags and wrinkles, and extra (redundant) folds of skin may be present. Bleeding problems are common in the vascular type of Ehlers-Danlos syndrome and are caused by unpredictable tearing (rupture) of blood vessels and organs. These complications can lead to easy bruising, internal bleeding, a hole in the wall of the intestine (intestinal perforation), or stroke. During pregnancy, women with vascular Ehlers-Danlos syndrome may experience rupture of the uterus. Additional forms of Ehlers-Danlos syndrome that involve rupture of the blood vessels include the kyphoscoliotic, classical, and classical-like types. Other types of Ehlers-Danlos syndrome have additional signs and symptoms. The cardiac-valvular type causes severe problems with the valves that control the movement of blood through the heart. People with the kyphoscoliotic type experience severe curvature of the spine that worsens over time and can interfere with breathing by restricting lung expansion. A type of Ehlers-Danlos syndrome called brittle cornea syndrome is characterized by thinness of the clear covering of the eye (the cornea) and other eye abnormalities. The spondylodysplastic type features short stature and skeletal abnormalities such as abnormally curved (bowed) limbs. Abnormalities of muscles, including hypotonia and permanently bent joints (contractures), are among the characteristic signs of the musculocontractural and myopathic forms of Ehlers-Danlos syndrome. The periodontal type causes abnormalities of the teeth and gums. Frequency The combined prevalence of all types of Ehlers-Danlos syndrome appears to be at least 1 in 5,000 individuals worldwide. The hypermobile and classical forms are most common; the hypermobile type may affect as many as 1 in 5,000 to 20,000 people, while the classical type probably occurs in 1 in 20,000 to 40,000 people. Other forms of Ehlers-Danlos syndrome are rare, often with only a few cases or affected families described in the medical literature.Variants (also known as mutations) in at least 20 genes have been found to cause the Ehlers-Danlos syndromes. Variants in the COL5A1 or COL5A2 gene, or rarely in the COL1A1 gene, can cause the classical type. Variants in the TNXB gene cause the classical-like type and have been reported in a very small percentage of cases of the hypermobile type (although in most people with this type, the cause is unknown). The cardiac-valvular type and some cases of the arthrochalasia type are caused by COL1A2 gene variants; variants in the COL1A1 gene have also been found in people with the arthrochalasia type. Most cases of the vascular type result from variants in the COL3A1 gene, although rarely this type is caused by certain COL1A1 gene variants. The dermatosparaxis type is caused by variants in the ADAMTS2 gene. PLOD1 or FKBP14 gene variants result in the kyphoscoliotic type. Other rare forms of Ehlers-Danlos syndrome result from variants in other genes. Some of the genes associated with the Ehlers-Danlos syndromes, including COL1A1, COL1A2, COL3A1, COL5A1, and COL5A2, provide instructions for making pieces of several different types of collagen. These pieces assemble to form mature collagen molecules that give structure and strength to connective tissues throughout the body. Other genes, including ADAMTS2, FKBP14, PLOD1, and TNXB, provide instructions for making proteins that process, fold, or interact with collagen. Variants in any of these genes disrupt the production or processing of collagen, preventing these molecules from being assembled properly. These changes weaken connective tissues in the skin, bones, and other parts of the body, resulting in the characteristic features of the Ehlers- Danlos syndromes.","system instruction: [Only use the provided text in the prompt to answer questions. Do not use external knowledge.] question: [How does hypermobile EDS compare to classic EDS?] context block: [Ehlers-Danlos syndrome is a group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues. Defects in connective tissues cause the signs and symptoms of these conditions, which range from mildly loose joints to life-threatening complications. The various forms of Ehlers-Danlos syndrome have been classified in several different ways. Originally, 11 forms of Ehlers-Danlos syndrome were named using Roman numerals to indicate the types (type I, type II, and so on). In 1997, researchers proposed a simpler classification (the Villefranche nomenclature) that reduced the number of types to six and gave them descriptive names based on their major features. In 2017, the classification was updated to include rare forms of Ehlers-Danlos syndrome that were identified more recently. The 2017 classification describes 13 types of Ehlers- Danlos syndrome. An unusually large range of joint movement (hypermobility) occurs in most forms of Ehlers-Danlos syndrome, and it is a hallmark feature of the hypermobile type. Infants and children with hypermobility often have weak muscle tone (hypotonia), which can delay the development of motor skills such as sitting, standing, and walking. The loose joints are unstable and prone to dislocation and chronic pain. In the arthrochalasia type of Ehlers-Danlos syndrome, infants have hypermobility and dislocations of both hips at birth. Many people with the Ehlers-Danlos syndromes have soft, velvety skin that is highly stretchy (elastic) and fragile. Affected individuals tend to bruise easily, and some types of the condition also cause abnormal scarring. People with the classical form of Ehlers- Danlos syndrome experience wounds that split open with little bleeding and leave scars that widen over time to create characteristic ""cigarette paper"" scars. The dermatosparaxis type of the disorder is characterized by loose skin that sags and wrinkles, and extra (redundant) folds of skin may be present. Bleeding problems are common in the vascular type of Ehlers-Danlos syndrome and are caused by unpredictable tearing (rupture) of blood vessels and organs. These complications can lead to easy bruising, internal bleeding, a hole in the wall of the intestine (intestinal perforation), or stroke. During pregnancy, women with vascular Ehlers-Danlos syndrome may experience rupture of the uterus. Additional forms of Ehlers-Danlos syndrome that involve rupture of the blood vessels include the kyphoscoliotic, classical, and classical-like types. Other types of Ehlers-Danlos syndrome have additional signs and symptoms. The cardiac-valvular type causes severe problems with the valves that control the movement of blood through the heart. People with the kyphoscoliotic type experience severe curvature of the spine that worsens over time and can interfere with breathing by restricting lung expansion. A type of Ehlers-Danlos syndrome called brittle cornea syndrome is characterized by thinness of the clear covering of the eye (the cornea) and other eye abnormalities. The spondylodysplastic type features short stature and skeletal abnormalities such as abnormally curved (bowed) limbs. Abnormalities of muscles, including hypotonia and permanently bent joints (contractures), are among the characteristic signs of the musculocontractural and myopathic forms of Ehlers-Danlos syndrome. The periodontal type causes abnormalities of the teeth and gums. Frequency The combined prevalence of all types of Ehlers-Danlos syndrome appears to be at least 1 in 5,000 individuals worldwide. The hypermobile and classical forms are most common; the hypermobile type may affect as many as 1 in 5,000 to 20,000 people, while the classical type probably occurs in 1 in 20,000 to 40,000 people. Other forms of Ehlers-Danlos syndrome are rare, often with only a few cases or affected families described in the medical literature.Variants (also known as mutations) in at least 20 genes have been found to cause the Ehlers-Danlos syndromes. Variants in the COL5A1 or COL5A2 gene, or rarely in the COL1A1 gene, can cause the classical type. Variants in the TNXB gene cause the classical-like type and have been reported in a very small percentage of cases of the hypermobile type (although in most people with this type, the cause is unknown). The cardiac-valvular type and some cases of the arthrochalasia type are caused by COL1A2 gene variants; variants in the COL1A1 gene have also been found in people with the arthrochalasia type. Most cases of the vascular type result from variants in the COL3A1 gene, although rarely this type is caused by certain COL1A1 gene variants. The dermatosparaxis type is caused by variants in the ADAMTS2 gene. PLOD1 or FKBP14 gene variants result in the kyphoscoliotic type. Other rare forms of Ehlers-Danlos syndrome result from variants in other genes. Some of the genes associated with the Ehlers-Danlos syndromes, including COL1A1, COL1A2, COL3A1, COL5A1, and COL5A2, provide instructions for making pieces of several different types of collagen. These pieces assemble to form mature collagen molecules that give structure and strength to connective tissues throughout the body. Other genes, including ADAMTS2, FKBP14, PLOD1, and TNXB, provide instructions for making proteins that process, fold, or interact with collagen. Variants in any of these genes disrupt the production or processing of collagen, preventing these molecules from being assembled properly. These changes weaken connective tissues in the skin, bones, and other parts of the body, resulting in the characteristic features of the Ehlers- Danlos syndromes.]",Medical,Concept Comparison,Q&A Answer only using the information in the provided context and limit your answer to 200 words.,"Why is it important for patients with chronic illnesses to engage with their own care? ","2.1.1. Importance of social networks, family support, and peer relationships in chronic disease management Social networks, family support, and peer relationships play a vital role in the effective management of chronic diseases. These forms of support provide emotional, practical, and informational assistance, which are crucial for helping individuals navigate the complexities of their conditions [23]. Family support, for instance, can offer direct help with daily tasks, medication management, and encouragement to adhere to treatment plans, thereby reducing the patient's stress and burden. Strong social networks, including friends and community connections, contribute to a sense of belonging and emotional well-being, which can buffer against the psychological challenges of chronic illness. Peer relationships, such as those found in support groups, provide opportunities for individuals to share experiences, exchange coping strategies, and receive empathy and understanding from others facing similar challenges. These interactions can enhance motivation, reduce feelings of isolation, and improve overall mental health. By leveraging these social resources, patients with chronic diseases are better equipped to manage their health, adhere to treatment regimens, and maintain a higher quality of life [24]. 2.1.2. Impact of social isolation and loneliness on treatment adherence and health-related behaviors Social isolation and loneliness have profound negative impacts on treatment adherence and health-related behaviors in individuals with chronic diseases. When patients feel isolated, they often experience higher levels of stress, anxiety, and depression, which can diminish their motivation to follow treatment regimens and engage in self-care activities. The absence of a supportive social network means there is no one to remind or encourage them to take their medications, attend medical appointments, or maintain healthy lifestyle practices such as regular exercise and proper nutrition [25]. Loneliness can also lead to unhealthy behaviors, such as poor diet, lack of physical activity, and increased substance use, further exacerbating the patient's condition. Furthermore, isolated individuals may lack access to crucial health information and resources that could aid in their disease management. Consequently, social isolation and loneliness not only hinder effective disease management but also contribute to a decline in overall physical and mental health, highlighting the importance of fostering social connections and support systems for individuals with chronic illnesses [26] 2.2. Coping Strategies and Resilience Effective coping strategies are essential for managing chronic illness. Adaptive coping mechanisms, such as problemfocused coping, which involves tackling the problem directly, and emotion-focused coping, which aims to manage emotional responses, can help patients better manage the challenges of chronic disease [27]. These strategies can mitigate the adverse effects of stress and improve overall quality of life. Resilience factors, such as optimism, selfefficacy, and the ability to find meaning in the face of illness, play a significant role in enhancing a patient's ability to cope with chronic conditions. Resilient individuals are more likely to maintain a positive outlook, adhere to treatment regimens, and engage in proactive health behaviors, all of which contribute to better health outcomes and improved quality of life [28]. 2.2.1. Adaptive coping mechanisms Adaptive coping mechanisms play a critical role in managing chronic illness by helping individuals navigate the emotional and practical challenges associated with their condition. Problem-focused coping involves actively addressing the issues causing stress, such as developing a structured treatment plan, seeking information about the illness, or finding solutions to daily obstacles related to the condition [29][30]. This approach empowers patients to take control of their health by directly tackling the problems at hand. Emotion-focused coping, on the other hand, helps individuals manage the emotional responses to their illness. Techniques such as relaxation exercises, mindfulness, and seeking emotional support from friends and family can reduce feelings of anxiety, depression, and frustration. By employing these adaptive coping strategies, patients can mitigate the adverse effects of stress, improve their psychological well-being, and enhance their ability to adhere to treatment plans. Ultimately, these coping mechanisms contribute to a better quality of life and more effective management of chronic illness [31]. 2.2.2. Resilience factors and their role in mitigating stress and enhancing quality of life Resilience factors, such as optimism, self-efficacy, and a strong sense of purpose, play a crucial role in mitigating stress and enhancing the quality of life for individuals managing chronic illness. Optimism helps patients maintain a positive outlook despite their challenges, fostering hope and a belief in positive outcomes [32]. This positive mindset can buffer the impact of stress and encourage proactive health behaviors. Self-efficacy, or the belief in one's ability to manage and control life events, empowers patients to take charge of their treatment and make informed decisions about their health. A strong sense of purpose provides motivation and direction, helping patients find meaning and value in their experiences, which can be particularly important in coping with long-term health issues. These resilience factors collectively reduce the psychological burden of chronic illness, promote better adherence to treatment regimens, and enhance overall well-being, leading to an improved quality of life. By fostering resilience, healthcare providers can help patients build the mental and emotional strength needed to navigate the complexities of chronic disease management [33][34]. 3. Health Beliefs and Patient Engagement Health beliefs, including perceptions of illness and beliefs about treatment efficacy, significantly influence patient behaviors and engagement in self-care. Patients who believe their condition is manageable and that their treatment plan is effective are more likely to adhere to medical advice and participate actively in their care[26]. Conversely, negative health beliefs can lead to disengagement and poor adherence to treatment regimens. Strategies to promote patient engagement include education about the disease and its management, motivational interviewing to build confidence and commitment, and creating a collaborative care environment where patients feel empowered to take an active role in their health. By fostering positive health beliefs and encouraging active participation, healthcare providers can improve treatment adherence and health outcomes [28]. 3.1. Influence of health beliefs, perceptions of illness, and treatment efficacy on patient behaviors Health beliefs, perceptions of illness, and views on treatment efficacy significantly influence patient behaviors and their approach to managing chronic disease. Patients' beliefs about their health, including how they perceive their illness and its severity, can determine their willingness to adhere to treatment plans and engage in self-care activities [35][36]. For instance, if a patient believes that their condition is manageable and that the prescribed treatment is effective, they are more likely to follow medical advice, take medications as directed, and make necessary lifestyle changes. Conversely, if a patient perceives their illness as overwhelming or doubts the efficacy of the treatment, they may be less motivated to adhere to their treatment regimen, potentially leading to poorer health outcomes. These health beliefs also affect psychological responses to illness; patients with a positive outlook are more likely to experience lower levels of stress and anxiety, further promoting better health behaviors. Understanding and addressing these beliefs through patient education and motivational interviewing can help healthcare providers enhance patient engagement, encourage active participation in care, and ultimately improve health outcomes [37]. 3.2. Strategies for promoting patient engagement and active participation in self-care Promoting patient engagement and active participation in self-care involves implementing strategies that empower patients and enhance their motivation to manage their health effectively. One key approach is patient education, which provides individuals with comprehensive information about their condition, treatment options, and the importance of adherence to medical advice. This education can be delivered through various mediums such as brochures, workshops, or digital platforms [39]. Motivational interviewing is another effective technique, where healthcare providers engage in open-ended discussions to explore patients' beliefs and barriers, helping them set achievable goals and find intrinsic motivation for self-care. Building a collaborative care environment is also crucial, where patients are encouraged to take an active role in decision-making processes regarding their treatment plans. Additionally, providing tools and resources, such as self-monitoring apps and support groups, can facilitate self-management by offering continuous support and tracking progress. By creating a supportive and informative environment, healthcare providers can foster greater patient engagement, leading to improved adherence to treatment regimens and better health outcomes [40].","2.1.1. Importance of social networks, family support, and peer relationships in chronic disease management Social networks, family support, and peer relationships play a vital role in the effective management of chronic diseases. These forms of support provide emotional, practical, and informational assistance, which are crucial for helping individuals navigate the complexities of their conditions [23]. Family support, for instance, can offer direct help with daily tasks, medication management, and encouragement to adhere to treatment plans, thereby reducing the patient's stress and burden. Strong social networks, including friends and community connections, contribute to a sense of belonging and emotional well-being, which can buffer against the psychological challenges of chronic illness. Peer relationships, such as those found in support groups, provide opportunities for individuals to share experiences, exchange coping strategies, and receive empathy and understanding from others facing similar challenges. These interactions can enhance motivation, reduce feelings of isolation, and improve overall mental health. By leveraging these social resources, patients with chronic diseases are better equipped to manage their health, adhere to treatment regimens, and maintain a higher quality of life [24]. 2.1.2. Impact of social isolation and loneliness on treatment adherence and health-related behaviors Social isolation and loneliness have profound negative impacts on treatment adherence and health-related behaviors in individuals with chronic diseases. When patients feel isolated, they often experience higher levels of stress, anxiety, and depression, which can diminish their motivation to follow treatment regimens and engage in self-care activities. The absence of a supportive social network means there is no one to remind or encourage them to take their medications, attend medical appointments, or maintain healthy lifestyle practices such as regular exercise and proper nutrition [25]. Loneliness can also lead to unhealthy behaviors, such as poor diet, lack of physical activity, and increased substance use, further exacerbating the patient's condition. Furthermore, isolated individuals may lack access to crucial health information and resources that could aid in their disease management. Consequently, social isolation and loneliness not only hinder effective disease management but also contribute to a decline in overall physical and mental health, highlighting the importance of fostering social connections and support systems for individuals with chronic illnesses [26] 2.2. Coping Strategies and Resilience Effective coping strategies are essential for managing chronic illness. Adaptive coping mechanisms, such as problemfocused coping, which involves tackling the problem directly, and emotion-focused coping, which aims to manage emotional responses, can help patients better manage the challenges of chronic disease [27]. These strategies can mitigate the adverse effects of stress and improve overall quality of life. Resilience factors, such as optimism, selfefficacy, and the ability to find meaning in the face of illness, play a significant role in enhancing a patient's ability to cope with chronic conditions. Resilient individuals are more likely to maintain a positive outlook, adhere to treatment regimens, and engage in proactive health behaviors, all of which contribute to better health outcomes and improved quality of life [28]. 2.2.1. Adaptive coping mechanisms Adaptive coping mechanisms play a critical role in managing chronic illness by helping individuals navigate the emotional and practical challenges associated with their condition. Problem-focused coping involves actively addressing the issues causing stress, such as developing a structured treatment plan, seeking information about the illness, or finding solutions to daily obstacles related to the condition [29][30]. This approach empowers patients to take control of their health by directly tackling the problems at hand. Emotion-focused coping, on the other hand, helps individuals manage the emotional responses to their illness. Techniques such as relaxation exercises, mindfulness, and seeking emotional support from friends and family can reduce feelings of anxiety, depression, and frustration. By employing these adaptive coping strategies, patients can mitigate the adverse effects of stress, improve their psychological well-being, and enhance their ability to adhere to treatment plans. Ultimately, these coping mechanisms contribute to a better quality of life and more effective management of chronic illness [31]. 2.2.2. Resilience factors and their role in mitigating stress and enhancing quality of life Resilience factors, such as optimism, self-efficacy, and a strong sense of purpose, play a crucial role in mitigating stress and enhancing the quality of life for individuals managing chronic illness. Optimism helps patients maintain a positive outlook despite their challenges, fostering hope and a belief in positive outcomes [32]. This positive mindset can buffer the impact of stress and encourage proactive health behaviors. Self-efficacy, or the belief in one's ability to manage and control life events, empowers patients to take charge of their treatment and make informed decisions about their health. A strong sense of purpose provides motivation and direction, helping patients find meaning and value in their experiences, which can be particularly important in coping with long-term health issues. These resilience factors collectively reduce the psychological burden of chronic illness, promote better adherence to treatment regimens, and enhance overall well-being, leading to an improved quality of life. By fostering resilience, healthcare providers can help patients build the mental and emotional strength needed to navigate the complexities of chronic disease management [33][34]. 3. Health Beliefs and Patient Engagement Health beliefs, including perceptions of illness and beliefs about treatment efficacy, significantly influence patient behaviors and engagement in self-care. Patients who believe their condition is manageable and that their treatment plan is effective are more likely to adhere to medical advice and participate actively in their care[26]. Conversely, negative health beliefs can lead to disengagement and poor adherence to treatment regimens. Strategies to promote patient engagement include education about the disease and its management, motivational interviewing to build confidence and commitment, and creating a collaborative care environment where patients feel empowered to take an active role in their health. By fostering positive health beliefs and encouraging active participation, healthcare providers can improve treatment adherence and health outcomes [28]. 3.1. Influence of health beliefs, perceptions of illness, and treatment efficacy on patient behaviors Health beliefs, perceptions of illness, and views on treatment efficacy significantly influence patient behaviors and their approach to managing chronic disease. Patients' beliefs about their health, including how they perceive their illness and its severity, can determine their willingness to adhere to treatment plans and engage in self-care activities [35][36]. For instance, if a patient believes that their condition is manageable and that the prescribed treatment is effective, they are more likely to follow medical advice, take medications as directed, and make necessary lifestyle changes. Conversely, if a patient perceives their illness as overwhelming or doubts the efficacy of the treatment, they may be less motivated to adhere to their treatment regimen, potentially leading to poorer health outcomes. These health beliefs also affect psychological responses to illness; patients with a positive outlook are more likely to experience lower levels of stress and anxiety, further promoting better health behaviors. Understanding and addressing these beliefs through patient education and motivational interviewing can help healthcare providers enhance patient engagement, encourage active participation in care, and ultimately improve health outcomes [37]. 3.2. Strategies for promoting patient engagement and active participation in self-care Promoting patient engagement and active participation in self-care involves implementing strategies that empower patients and enhance their motivation to manage their health effectively. One key approach is patient education, which provides individuals with comprehensive information about their condition, treatment options, and the importance of adherence to medical advice. This education can be delivered through various mediums such as brochures, workshops, or digital platforms [39]. Motivational interviewing is another effective technique, where healthcare providers engage in open-ended discussions to explore patients' beliefs and barriers, helping them set achievable goals and find intrinsic motivation for self-care. Building a collaborative care environment is also crucial, where patients are encouraged to take an active role in decision-making processes regarding their treatment plans. Additionally, providing tools and resources, such as self-monitoring apps and support groups, can facilitate self-management by offering continuous support and tracking progress. By creating a supportive and informative environment, healthcare providers can foster greater patient engagement, leading to improved adherence to treatment regimens and better health outcomes [40]. Why is it important for patients with chronic illnesses to engage with their own care? Answer only using the information in the provided context and limit your answer to 200 words. ",Medical,Effect Analysis,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",I would like to understand the differences between traditional and self-publishing. How do I know which route to go? Which route has the potential for a greater profit?,"Your two main options are traditional publishing with a publishing company, or self-publishing through a platform like IngramSpark, Amazon Kindle Direct, or Indie Author Project / Biblioboard. Many authors have strong opinions about which publishing path is best. Traditional publishing offers support from a full team of experts, including editors, designers, and salespeople, often leading to higher sales and a more polished product. However, traditional publishing is notoriously slow and has historically excluded writers from marginalized groups. Self-publishing offers a quicker way to share your book with readers, as well as freedom from industry pressure to write something “sellable.” However, self-published books can suffer from the lack of professional editing and design, and self-published authors take on the hard work of sales, marketing, and distribution. There’s no one right answer. It depends on your personal goals for writing and publication. Below are three questions to help you decide whether traditional publishing or self-publishing is right for you. You want to spend it writing, of course! However, writing is only one part of an author’s career. Authors also spend time revising, marketing their books, and, if you’re pursuing traditional publishing, finding an agent. Most major publishers do not accept submissions directly from writers. Instead, writers find agents who sell their work to publishers in return for around 15% of profits. Having an agent signals to publishers that your book is good enough for at least one person to stake their career on it. And having an agent means you can focus on writing your next book instead of researching every editor at every imprint of every publishing house, and then becoming an expert in negotiating your own publishing contract. However, you will have to put that research and negotiation power toward querying agents. During the querying process, writers email a brief pitch of their work to agents who may be interested. Querying is often considered one of the most difficult parts of traditional publishing, as writers may receive hundreds of rejections over multiple books. Rejection isn’t always bad, though. It can be an invitation to revise and improve your work. Writing is hard, and no one gets it right on the first try. Early drafts of a book get the idea out of your brain and into words. Later drafts make the story reach its full potential. Traditional publishing has multiple rounds of agent and editor revisions baked into the process. Self-publishing does not. Self-published writers decide for themselves how much to revise their work before sharing it. Some self-published authors hire freelance editors. Some trust friends and family for feedback. Others skip revisions, share the work as-is, and move on to their next project. Skipping revisions can have negative impacts on book quality, but ultimately, it’s a question of whether you’d prefer to spend your time telling new stories or polishing old ones. Before publication, it may seem like traditional publishing takes a lot more work than self-publishing. However, once a book is published, the tables turn. Traditional publishing includes whole teams of people working behind the scenes to determine how much books should cost, negotiate deals with booksellers, review books so teachers and librarians know which ones to buy, and more. If you’re self-publishing, you are those teams of people. You do all the work of pricing, formatting, selling, marketing, distributing, and more. Even if you only want to e-publish, you still have to format your own manuscript, or hire a professional to do it for you, and submit to the online platform(s) of your choice. You have to figure out a marketing strategy that will make you stand out, not only among self-published or indie authors, but also against professional marketing teams from billion-dollar publishing companies. It’s hard work! And it takes time away from writing. Whether you choose traditional or self-publishing, writing is only one aspect of your career. It’s worth asking whether you’d prefer to spend time querying agents or becoming an expert in everything from typesetting to book distribution. It’s also worth considering why you want a writing career in the first place. Every writer has their own reasons for writing. We love it. We don’t know how to live without it. We want to tell our story or make the world a better place. Usually, the answer is not money. And that’s okay! Creative expression can be fun and freeing and deeply meaningful, even if you never monetize it. If you know up front—before sending 100 query letters or spending hours and hours typesetting your manuscript—that writing is not a financial or career goal, you can save yourself a lot of stress and rejection. However, if you do want to make writing a financially viable career, it’s important to know how and when you get paid through traditional or self-publishing. In traditional publishing, when your agent sells your book to a publisher, you are paid an advance. An advance is a lump sum that the company expects to earn back later through your book sales. Advances vary wildly in amount. Small, indie publishers might pay as low as $1,000-$2,000. Large publishers might offer up to six figures or more. The amount depends on factors like genre, target age group, and whether it’s your first book or you’re more advanced in your career. After your book earns out its advance—meaning the publisher made back the money they paid you—then you earn royalties on every additional copy sold. In traditional publishing, writers do not pay anything up front. If your agent or editor charges “reading fees,” or if you are asked to pay for any part of book design or production, you are being scammed. This is an important distinction because self-publishing works differently. In self-publishing, your income depends entirely on how many books you sell. There are no advances. You may also have to pay up-front, depending on which parts of book production you want to tackle yourself and which parts (if any) you’d like to hire experts to manage for you. Up-front self-publishing costs could include hiring a freelance editor or book designer, or paying to print your book if you plan to sell hard copies. There are free e-publishing options, such as Kindle Direct or Indie Author Project / Biblioboard. For hard copies, a print-on-demand model like IngramSpark can save you from paying to print and warehouse extra books that you’re unable to sell. It can be difficult to know whether it’s financially better to shop around your manuscript a little longer, waiting for that big advance, or whether you should go ahead and self-publish to start selling copies now. The answer can depend on what genre you’re writing in and what age group you’re writing for. Your book’s length and genre, as well as the age of your readers, can have a huge impact on whether you’re able to make money in traditional or self-publishing. Sometimes, both can be profitable. Romance is a rare genre that both tops traditional publishing sales and has recently seen significant income growth for self-published authors. In fact, many romance writers are now “hybrid,” writing both traditional and self-published books. Other genres are trickier, however. Memoirs are notoriously hard to sell, either to publishing companies or self-published to readers, unless you’re already famous. Niche topics, like regional history, might have too small an audience for big publishers to profit, making self-publishing the only way to share the information. On the other hand, children’s books tend to struggle with self-publishing. Many self-published books are e-books only, and fewer children have e-readers. Most children’s books are also bought by adults, like parents or grandparents, who are looking for physical gifts and are worried about screen time.","""================ ======= Your two main options are traditional publishing with a publishing company, or self-publishing through a platform like IngramSpark, Amazon Kindle Direct, or Indie Author Project / Biblioboard. Many authors have strong opinions about which publishing path is best. Traditional publishing offers support from a full team of experts, including editors, designers, and salespeople, often leading to higher sales and a more polished product. However, traditional publishing is notoriously slow and has historically excluded writers from marginalized groups. Self-publishing offers a quicker way to share your book with readers, as well as freedom from industry pressure to write something “sellable.” However, self-published books can suffer from the lack of professional editing and design, and self-published authors take on the hard work of sales, marketing, and distribution. There’s no one right answer. It depends on your personal goals for writing and publication. Below are three questions to help you decide whether traditional publishing or self-publishing is right for you. You want to spend it writing, of course! However, writing is only one part of an author’s career. Authors also spend time revising, marketing their books, and, if you’re pursuing traditional publishing, finding an agent. Most major publishers do not accept submissions directly from writers. Instead, writers find agents who sell their work to publishers in return for around 15% of profits. Having an agent signals to publishers that your book is good enough for at least one person to stake their career on it. And having an agent means you can focus on writing your next book instead of researching every editor at every imprint of every publishing house, and then becoming an expert in negotiating your own publishing contract. However, you will have to put that research and negotiation power toward querying agents. During the querying process, writers email a brief pitch of their work to agents who may be interested. Querying is often considered one of the most difficult parts of traditional publishing, as writers may receive hundreds of rejections over multiple books. Rejection isn’t always bad, though. It can be an invitation to revise and improve your work. Writing is hard, and no one gets it right on the first try. Early drafts of a book get the idea out of your brain and into words. Later drafts make the story reach its full potential. Traditional publishing has multiple rounds of agent and editor revisions baked into the process. Self-publishing does not. Self-published writers decide for themselves how much to revise their work before sharing it. Some self-published authors hire freelance editors. Some trust friends and family for feedback. Others skip revisions, share the work as-is, and move on to their next project. Skipping revisions can have negative impacts on book quality, but ultimately, it’s a question of whether you’d prefer to spend your time telling new stories or polishing old ones. Before publication, it may seem like traditional publishing takes a lot more work than self-publishing. However, once a book is published, the tables turn. Traditional publishing includes whole teams of people working behind the scenes to determine how much books should cost, negotiate deals with booksellers, review books so teachers and librarians know which ones to buy, and more. If you’re self-publishing, you are those teams of people. You do all the work of pricing, formatting, selling, marketing, distributing, and more. Even if you only want to e-publish, you still have to format your own manuscript, or hire a professional to do it for you, and submit to the online platform(s) of your choice. You have to figure out a marketing strategy that will make you stand out, not only among self-published or indie authors, but also against professional marketing teams from billion-dollar publishing companies. It’s hard work! And it takes time away from writing. Whether you choose traditional or self-publishing, writing is only one aspect of your career. It’s worth asking whether you’d prefer to spend time querying agents or becoming an expert in everything from typesetting to book distribution. It’s also worth considering why you want a writing career in the first place. Every writer has their own reasons for writing. We love it. We don’t know how to live without it. We want to tell our story or make the world a better place. Usually, the answer is not money. And that’s okay! Creative expression can be fun and freeing and deeply meaningful, even if you never monetize it. If you know up front—before sending 100 query letters or spending hours and hours typesetting your manuscript—that writing is not a financial or career goal, you can save yourself a lot of stress and rejection. However, if you do want to make writing a financially viable career, it’s important to know how and when you get paid through traditional or self-publishing. In traditional publishing, when your agent sells your book to a publisher, you are paid an advance. An advance is a lump sum that the company expects to earn back later through your book sales. Advances vary wildly in amount. Small, indie publishers might pay as low as $1,000-$2,000. Large publishers might offer up to six figures or more. The amount depends on factors like genre, target age group, and whether it’s your first book or you’re more advanced in your career. After your book earns out its advance—meaning the publisher made back the money they paid you—then you earn royalties on every additional copy sold. In traditional publishing, writers do not pay anything up front. If your agent or editor charges “reading fees,” or if you are asked to pay for any part of book design or production, you are being scammed. This is an important distinction because self-publishing works differently. In self-publishing, your income depends entirely on how many books you sell. There are no advances. You may also have to pay up-front, depending on which parts of book production you want to tackle yourself and which parts (if any) you’d like to hire experts to manage for you. Up-front self-publishing costs could include hiring a freelance editor or book designer, or paying to print your book if you plan to sell hard copies. There are free e-publishing options, such as Kindle Direct or Indie Author Project / Biblioboard. For hard copies, a print-on-demand model like IngramSpark can save you from paying to print and warehouse extra books that you’re unable to sell. It can be difficult to know whether it’s financially better to shop around your manuscript a little longer, waiting for that big advance, or whether you should go ahead and self-publish to start selling copies now. The answer can depend on what genre you’re writing in and what age group you’re writing for. Your book’s length and genre, as well as the age of your readers, can have a huge impact on whether you’re able to make money in traditional or self-publishing. Sometimes, both can be profitable. Romance is a rare genre that both tops traditional publishing sales and has recently seen significant income growth for self-published authors. In fact, many romance writers are now “hybrid,” writing both traditional and self-published books. Other genres are trickier, however. Memoirs are notoriously hard to sell, either to publishing companies or self-published to readers, unless you’re already famous. Niche topics, like regional history, might have too small an audience for big publishers to profit, making self-publishing the only way to share the information. On the other hand, children’s books tend to struggle with self-publishing. Many self-published books are e-books only, and fewer children have e-readers. Most children’s books are also bought by adults, like parents or grandparents, who are looking for physical gifts and are worried about screen time. https://nolalibrary.org/2023/06/27/traditional-publishing-vs-self-publishing/ ================ ======= I would like to understand the differences between traditional and self-publishing. How do I know which route to go? Which route has the potential for a greater profit? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Retail/Product,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","I recently acquired a collection of about 50 glass plate photographs, and I want to digitize them. Please list and give detailed descriptions of the steps needed to do this. Also include a list of equipment I'll need.","Digitizing Glass Plate Photography Digitization refers to the process of creating digital images of physical items, yet this process requires many steps. And while the equipment needed for digitizing glass photographs exists in a variety of price points, the basic tenets remain the same: imaging, editing, describing (with metadata), archiving, and sharing. Imaging To image glass photographs, it is necessary to have a camera and a light source, as glass photographs must be backlit to render the images visible. Best practices recommend a flat lightboard for consistent illumination, a camera copy stand, and a camera with focus peaking and aperture priority to achieve the highest quality images. For the lightboard, also known as a light table, it is recommended to use one with a coloring rendering index of 90+ and 5000-5500k light temperature. Cameras should be mounted to the copy stand with overhead mounts to ensure consistent imaging; best practice is to use a level to ensure the camera and light table are parallel to each other. Editing While editing images for commercial or marketing practices is acceptable, editing photographs of physical items for archival purposes is typically not recommended. To edit the images for archival purposes, it is best practice to make only minimal adjustments, such as converting negatives to positives. For copies of the digitized images to be used for marketing purposes, etc., it is acceptable to edit the contrast, exposure, brightness, etc. or to touchup breaks in the glass or emulsion. It is also acceptable at this phase to add watermarks or logos to copies of the digitized images, however this should again only be done with non-archival copies of the images. Description—Metadata The metadata for glass photographs may come in the form of supplemental materials; institutional, personal, or expert knowledge; or may even be on the plates themselves, written onto the paper edgings or directly on the glass. Metadata from this information can be created for the entire collection, specific boxes or containers, individual images, or a combination thereof. This information not only helps users in the search and discovery phases of seeking digitized images, but it also helps organize and adds context and provenance to digital images. Workflows for adding metadata vary. Some prefer to work with the metadata after the glass photographs are imaged, while others prefer to have the metadata completely organized before imaging. The timing of metadata inclusion must be made by considering the conditions of the glass photographs and their storage facilities, the level of metadata available, and the availability of staff dedicated to the process. The best way to add metadata to digitized images is to use a program that embeds metadata within the image. This guarantees that the metadata is always connected to the image and can be extracted from the EXIF data. Adobe Lightroom and similar programs can perform this function. In addition, it is also helpful to keep local files, software, or databases that detail the metadata associated with the images in the glass photographs. Storage—Digital Archives To archive the digitized images, it is important to follow the 3-2-1 digital preservation standard by saving three copies of every digital image, in two different file formats, with one copy saved in a different location. RAW or TIFF file types are best for long-term storage because they are less prone to bit-rot and therefore less likely to degrade over time. Uncompressed TIFF files are typically quite large, which allows for printing at considerable scale without pixelating, however they also take up much more storage space. These file formats are typically best saved in rarely used storage locations, as their size slows down most computing processes, and the full-size uncompressed images are not frequently needed for everyday use. In practice, the authors have found it best to take the initial images of the glass plates in RAW format, and then save additional copies in compressed file formats. Commonly used compressed file formats include JPEG and PNG. These files are smaller and load faster on websites and computers, which allows for easier shared use. Sharing Finally, it is important to share digitized images of glass photographs, both to educate others on the unique existence of these items while also limiting contact and handling. For the authors, sharing digitized images and the standards for doing so are the key additions to the updated literature on best practices for glass photographs. Much of the previous literature was written at least a decade ago, and much has changed in the information and communication technology landscape in that time. For glass photograph imaging projects, it is necessary to create multiple points of access to the visual and historical information obtained from these glass plates. Publishing collection information in multimedia form creates a rich resource for researchers and specialists. Images accompanying textual records enhance the collections for audiences of different ages and interests across the world and create a basic resource for interpretative applications to be built on. Work in digital humanities, digital archives, and museum informatics can attest to the audience for and varied applications of these materials. Through the digitization of cultural collections, these resources can be used for multiple purposes, including educational and interpretive research. Digitized collections allow viewers to zoom in and examine details of glass photographs which would not otherwise be seen in a display case or by the naked eye. For cultural institutions, digitization offers the ability to display an entire collection, as large parts of it would not typically be on public display, and to reach those who cannot visit in person. Other benefits include the ability to adjust interpretative applications for users with disabilities or special needs. While social media sites are a natural place to promote such images, they should be used as a secondary location. Best practices recommend a primary location for all images to be shared with the public, such as a website, digital asset management system (DAMS), database with a strong graphical user interface (GUI), or dedicated photo storage site such as Flickr. With new technologies and protocols for database searching, the importance of cultural institutions offering digital access to their collections allows for the possibility of cross-collection and cross-institutional searching.","[question] I recently acquired a collection of about 50 glass plate photographs, and I want to digitize them. Please list and give detailed descriptions of the steps needed to do this. Also include a list of equipment I'll need. ===================== [text] Digitizing Glass Plate Photography Digitization refers to the process of creating digital images of physical items, yet this process requires many steps. And while the equipment needed for digitizing glass photographs exists in a variety of price points, the basic tenets remain the same: imaging, editing, describing (with metadata), archiving, and sharing. Imaging To image glass photographs, it is necessary to have a camera and a light source, as glass photographs must be backlit to render the images visible. Best practices recommend a flat lightboard for consistent illumination, a camera copy stand, and a camera with focus peaking and aperture priority to achieve the highest quality images. For the lightboard, also known as a light table, it is recommended to use one with a coloring rendering index of 90+ and 5000-5500k light temperature. Cameras should be mounted to the copy stand with overhead mounts to ensure consistent imaging; best practice is to use a level to ensure the camera and light table are parallel to each other. Editing While editing images for commercial or marketing practices is acceptable, editing photographs of physical items for archival purposes is typically not recommended. To edit the images for archival purposes, it is best practice to make only minimal adjustments, such as converting negatives to positives. For copies of the digitized images to be used for marketing purposes, etc., it is acceptable to edit the contrast, exposure, brightness, etc. or to touchup breaks in the glass or emulsion. It is also acceptable at this phase to add watermarks or logos to copies of the digitized images, however this should again only be done with non-archival copies of the images. Description—Metadata The metadata for glass photographs may come in the form of supplemental materials; institutional, personal, or expert knowledge; or may even be on the plates themselves, written onto the paper edgings or directly on the glass. Metadata from this information can be created for the entire collection, specific boxes or containers, individual images, or a combination thereof. This information not only helps users in the search and discovery phases of seeking digitized images, but it also helps organize and adds context and provenance to digital images. Workflows for adding metadata vary. Some prefer to work with the metadata after the glass photographs are imaged, while others prefer to have the metadata completely organized before imaging. The timing of metadata inclusion must be made by considering the conditions of the glass photographs and their storage facilities, the level of metadata available, and the availability of staff dedicated to the process. The best way to add metadata to digitized images is to use a program that embeds metadata within the image. This guarantees that the metadata is always connected to the image and can be extracted from the EXIF data. Adobe Lightroom and similar programs can perform this function. In addition, it is also helpful to keep local files, software, or databases that detail the metadata associated with the images in the glass photographs. Storage—Digital Archives To archive the digitized images, it is important to follow the 3-2-1 digital preservation standard by saving three copies of every digital image, in two different file formats, with one copy saved in a different location. RAW or TIFF file types are best for long-term storage because they are less prone to bit-rot and therefore less likely to degrade over time. Uncompressed TIFF files are typically quite large, which allows for printing at considerable scale without pixelating, however they also take up much more storage space. These file formats are typically best saved in rarely used storage locations, as their size slows down most computing processes, and the full-size uncompressed images are not frequently needed for everyday use. In practice, the authors have found it best to take the initial images of the glass plates in RAW format, and then save additional copies in compressed file formats. Commonly used compressed file formats include JPEG and PNG. These files are smaller and load faster on websites and computers, which allows for easier shared use. Sharing Finally, it is important to share digitized images of glass photographs, both to educate others on the unique existence of these items while also limiting contact and handling. For the authors, sharing digitized images and the standards for doing so are the key additions to the updated literature on best practices for glass photographs. Much of the previous literature was written at least a decade ago, and much has changed in the information and communication technology landscape in that time. For glass photograph imaging projects, it is necessary to create multiple points of access to the visual and historical information obtained from these glass plates. Publishing collection information in multimedia form creates a rich resource for researchers and specialists. Images accompanying textual records enhance the collections for audiences of different ages and interests across the world and create a basic resource for interpretative applications to be built on. Work in digital humanities, digital archives, and museum informatics can attest to the audience for and varied applications of these materials. Through the digitization of cultural collections, these resources can be used for multiple purposes, including educational and interpretive research. Digitized collections allow viewers to zoom in and examine details of glass photographs which would not otherwise be seen in a display case or by the naked eye. For cultural institutions, digitization offers the ability to display an entire collection, as large parts of it would not typically be on public display, and to reach those who cannot visit in person. Other benefits include the ability to adjust interpretative applications for users with disabilities or special needs. While social media sites are a natural place to promote such images, they should be used as a secondary location. Best practices recommend a primary location for all images to be shared with the public, such as a website, digital asset management system (DAMS), database with a strong graphical user interface (GUI), or dedicated photo storage site such as Flickr. With new technologies and protocols for database searching, the importance of cultural institutions offering digital access to their collections allows for the possibility of cross-collection and cross-institutional searching. https://digitalcommons.usu.edu/cgi/viewcontent.cgi?article=1173&context=westernarchives ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Summarize & Format,Text Transformation Draw your answer from the passage below only.,Write a short summary about how this acquisition will affect the video game market as a whole.,"On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The Video Game Industry The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format. The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 ","Write a short summary about how this acquisition will affect the video game market as a whole. Draw your answer from the passage below only. Use 100 words or less. On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The Video Game Industry The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format. The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 ",Retail/Product,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","I recently got a credit card that offers cash back when I shop in certain places but I'm new to the concept. In 200 words or less, what are some great ways that it can be used? Additionally, what other credit card would be great for me when it comes to retail deals through the card?","Take advantage of issuers’ shopping portals Before you shop, whether in-person or online, look for card-linked offers from your credit card issuer. If you have the Chase Freedom Flex or Chase Freedom Unlimited, for example, check the Shop through Chase portal to earn more cash back on all your purchases. Although the stores in the Chase shopping portal vary, they frequently include options like Walmart, Sephora, Best Buy and Macy’s. Other issues have their own portals — with Barclaycard you can shop on RewardsBoost, and with a Capital One card you get access to Capital One Shopping. Some issuers offer additional rewards opportunities as well. American Express, Chase, and Capital One have programs — Amex Offers, Chase Offers and Capital One Offers, respectively — through which you can opt in to earn additional cash back from select retailers. For example, with the Capital One QuicksilverOne Cash Rewards Credit Card, you can earn more cash back with particular retailers. To do so, log in to your Capital One account and navigate to the offers portal. In the portal, click “Get this deal” to be taken to a retailer’s site to shop and earn additional rewards at check out. Generally speaking, these offers are found in your online account, have limited redemption windows and must be accepted individually. Cash back percentages vary from store to store, and there are usually limits that cap how much additional cash back you can earn. Make the most of cash back apps If you want to earn more cash back for online purchases, you often can increase your earnings through the use of cash back apps. Cash back apps and sites like Dosh, Ibotta and Rakuten (formerly Ebates) give you a percentage of your spending back on qualifying purchases — on top of the cash back you’re earning on your credit card. For example, Rakuten lets you earn additional cash back when you click through the website before you shop with stores like Kohl’s, Macy’s, Nordstrom, Old Navy and Priceline.com. Use your cash back wisely While maximizing cash back earned on spending always makes sense, that’s only part of the equation. You also need to redeem your cash back in ways that make sense for your goals, whether you want to reduce the amount you owe on your credit card bill, you want to splurge for a fun purchase or you hope to utilize rewards to improve your finances in some way. Consider the following tips to get the most out of your cash back rewards each year: Redeem your cash back as statement credits One of the easiest ways to redeem cash back is for statement credits to your account. This redemption effectively lowers the amount you owe on your credit card bill, thus helping you save money over time. If you sign up for the Wells Fargo Active Cash® Card to earn 2% cash back on all purchases and redeem your rewards for cash back, for example, you would ultimately save 2% on everything you buy with your card. Just remember that rewards only get you “ahead” if you pay your credit card bill in full each month and avoid interest. If you’re paying 20% in credit card interest or more to earn 2% cash back, you’re not doing yourself any favors. Save your cash back for a big purchase You can also save up your rewards for a purchase you want to make down the line, whether it’s a splurge purchase you don’t want to cover in cash or you need to buy something for your everyday life. In either case, most cash back credit cards let you grow your rewards balance over time until you’re ready to use it. Keep in mind: Using rewards for merchandise won't always get you the best value, and that you'll want to be strategic if you go this route. As an example, cash back credit cards from Chase offer 1 cent per point for statement credit redemptions but only 0.8 cents per point for purchases through Amazon.com or PayPal. If you wanted to use rewards for an Amazon or PayPal purchase, it would make more sense to pay for the purchase with your card outright then redeem rewards for statement credits after the fact. Use your cash back to pay down debt You can also use rewards to pay off some types of debt, either directly depending on the card you have or indirectly by redeeming for cash back. In terms of options that let you redeem rewards for debt payments, some Wells Fargo credit cards (including the Wells Fargo Active Cash® Card) let you redeem cash back toward a Wells Fargo mortgage in addition to options like gift cards and statement credits. Many cash back credit cards also let you redeem rewards for a check in the mail, which you could deposit into a bank account and use for debt payments.","[question] I recently got a credit card that offers cash back when I shop in certain places but I'm new to the concept. In 200 words or less, what are some great ways that it can be used? Additionally, what other credit card would be great for me when it comes to retail deals through the card? ===================== [text] Take advantage of issuers’ shopping portals Before you shop, whether in-person or online, look for card-linked offers from your credit card issuer. If you have the Chase Freedom Flex or Chase Freedom Unlimited, for example, check the Shop through Chase portal to earn more cash back on all your purchases. Although the stores in the Chase shopping portal vary, they frequently include options like Walmart, Sephora, Best Buy and Macy’s. Other issues have their own portals — with Barclaycard you can shop on RewardsBoost, and with a Capital One card you get access to Capital One Shopping. Some issuers offer additional rewards opportunities as well. American Express, Chase, and Capital One have programs — Amex Offers, Chase Offers and Capital One Offers, respectively — through which you can opt in to earn additional cash back from select retailers. For example, with the Capital One QuicksilverOne Cash Rewards Credit Card, you can earn more cash back with particular retailers. To do so, log in to your Capital One account and navigate to the offers portal. In the portal, click “Get this deal” to be taken to a retailer’s site to shop and earn additional rewards at check out. Generally speaking, these offers are found in your online account, have limited redemption windows and must be accepted individually. Cash back percentages vary from store to store, and there are usually limits that cap how much additional cash back you can earn. Make the most of cash back apps If you want to earn more cash back for online purchases, you often can increase your earnings through the use of cash back apps. Cash back apps and sites like Dosh, Ibotta and Rakuten (formerly Ebates) give you a percentage of your spending back on qualifying purchases — on top of the cash back you’re earning on your credit card. For example, Rakuten lets you earn additional cash back when you click through the website before you shop with stores like Kohl’s, Macy’s, Nordstrom, Old Navy and Priceline.com. Use your cash back wisely While maximizing cash back earned on spending always makes sense, that’s only part of the equation. You also need to redeem your cash back in ways that make sense for your goals, whether you want to reduce the amount you owe on your credit card bill, you want to splurge for a fun purchase or you hope to utilize rewards to improve your finances in some way. Consider the following tips to get the most out of your cash back rewards each year: Redeem your cash back as statement credits One of the easiest ways to redeem cash back is for statement credits to your account. This redemption effectively lowers the amount you owe on your credit card bill, thus helping you save money over time. If you sign up for the Wells Fargo Active Cash® Card to earn 2% cash back on all purchases and redeem your rewards for cash back, for example, you would ultimately save 2% on everything you buy with your card. Just remember that rewards only get you “ahead” if you pay your credit card bill in full each month and avoid interest. If you’re paying 20% in credit card interest or more to earn 2% cash back, you’re not doing yourself any favors. Save your cash back for a big purchase You can also save up your rewards for a purchase you want to make down the line, whether it’s a splurge purchase you don’t want to cover in cash or you need to buy something for your everyday life. In either case, most cash back credit cards let you grow your rewards balance over time until you’re ready to use it. Keep in mind: Using rewards for merchandise won't always get you the best value, and that you'll want to be strategic if you go this route. As an example, cash back credit cards from Chase offer 1 cent per point for statement credit redemptions but only 0.8 cents per point for purchases through Amazon.com or PayPal. If you wanted to use rewards for an Amazon or PayPal purchase, it would make more sense to pay for the purchase with your card outright then redeem rewards for statement credits after the fact. Use your cash back to pay down debt You can also use rewards to pay off some types of debt, either directly depending on the card you have or indirectly by redeeming for cash back. In terms of options that let you redeem rewards for debt payments, some Wells Fargo credit cards (including the Wells Fargo Active Cash® Card) let you redeem cash back toward a Wells Fargo mortgage in addition to options like gift cards and statement credits. Many cash back credit cards also let you redeem rewards for a check in the mail, which you could deposit into a bank account and use for debt payments. https://www.bankrate.com/credit-cards/cash-back/maximize-cash-back-strategy/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Financial,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",What is the medication Metformin used for and what are some potential side effects involved in its usage? Make your response no less than 150 words.,"Why is this medication prescribed? Metformin is used alone or with other medications, including insulin, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body's response to insulin, a natural substance that controls the amount of glucose in the blood. Metformin is not used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood). Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes. How should this medicine be used? Metformin comes as a tablet, an extended-release (long-acting) tablet, and a solution (liquid) to take by mouth. The solution is usually taken with meals one or two times a day. The regular tablet is usually taken with meals two or three times a day. The extended-release tablet is usually taken once daily with the evening meal. To help you remember to take metformin, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metformin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow metformin extended-release tablets whole; do not split, chew, or crush them. Your doctor may start you on a low dose of metformin and gradually increase your dose not more often than once every 1–2 weeks. You will need to monitor your blood sugar carefully so your doctor will be able to tell how well metformin is working. Metformin controls diabetes but does not cure it. Continue to take metformin even if you feel well. Do not stop taking metformin without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking metformin, tell your doctor and pharmacist if you are allergic to metformin, any of the ingredients of metformin liquid or tablets, or any other medications. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients. tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have or have ever had low levels of vitamin B12 in your body or any other medical conditions, especially those mentioned in the IMPORTANT WARNING section. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking metformin, call your doctor. tell your doctor if you eat less or exercise more than usual. This can affect your blood sugar. Your doctor will give you instructions if this happens. What special dietary instructions should I follow? Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. It is important to eat a healthful diet. What should I do if I forget a dose? Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? This medication may cause changes in your blood sugar. You should know the symptoms of low and high blood sugar and what to do if you have these symptoms. Metformin may cause side effects. Tell your doctor if any of these symptoms are severe, do not go away, go away and come back, or do not begin for some time after you begin taking metformin: diarrhea nausea stomach discomfort gas indigestion constipation lack of energy or weakness change in sense of taste headache Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency treatment: chest pain Metformin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).","""================ ======= Why is this medication prescribed? Metformin is used alone or with other medications, including insulin, to treat type 2 diabetes (condition in which the body does not use insulin normally and, therefore, cannot control the amount of sugar in the blood). Metformin is in a class of drugs called biguanides. Metformin helps to control the amount of glucose (sugar) in your blood. It decreases the amount of glucose you absorb from your food and the amount of glucose made by your liver. Metformin also increases your body's response to insulin, a natural substance that controls the amount of glucose in the blood. Metformin is not used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood). Over time, people who have diabetes and high blood sugar can develop serious or life-threatening complications, including heart disease, stroke, kidney problems, nerve damage, and eye problems. Taking medication(s), making lifestyle changes (e.g., diet, exercise, quitting smoking), and regularly checking your blood sugar may help to manage your diabetes and improve your health. This therapy may also decrease your chances of having a heart attack, stroke, or other diabetes-related complications such as kidney failure, nerve damage (numb, cold legs or feet; decreased sexual ability in men and women), eye problems, including changes or loss of vision, or gum disease. Your doctor and other healthcare providers will talk to you about the best way to manage your diabetes. How should this medicine be used? Metformin comes as a tablet, an extended-release (long-acting) tablet, and a solution (liquid) to take by mouth. The solution is usually taken with meals one or two times a day. The regular tablet is usually taken with meals two or three times a day. The extended-release tablet is usually taken once daily with the evening meal. To help you remember to take metformin, take it around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take metformin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Swallow metformin extended-release tablets whole; do not split, chew, or crush them. Your doctor may start you on a low dose of metformin and gradually increase your dose not more often than once every 1–2 weeks. You will need to monitor your blood sugar carefully so your doctor will be able to tell how well metformin is working. Metformin controls diabetes but does not cure it. Continue to take metformin even if you feel well. Do not stop taking metformin without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking metformin, tell your doctor and pharmacist if you are allergic to metformin, any of the ingredients of metformin liquid or tablets, or any other medications. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients. tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Your doctor may need to change the doses of your medications or monitor you carefully for side effects. tell your doctor if you have or have ever had low levels of vitamin B12 in your body or any other medical conditions, especially those mentioned in the IMPORTANT WARNING section. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking metformin, call your doctor. tell your doctor if you eat less or exercise more than usual. This can affect your blood sugar. Your doctor will give you instructions if this happens. What special dietary instructions should I follow? Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. It is important to eat a healthful diet. What should I do if I forget a dose? Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. What side effects can this medication cause? This medication may cause changes in your blood sugar. You should know the symptoms of low and high blood sugar and what to do if you have these symptoms. Metformin may cause side effects. Tell your doctor if any of these symptoms are severe, do not go away, go away and come back, or do not begin for some time after you begin taking metformin: diarrhea nausea stomach discomfort gas indigestion constipation lack of energy or weakness change in sense of taste headache Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency treatment: chest pain Metformin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication. If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088). https://medlineplus.gov/druginfo/meds/a696005.html ================ ======= What is the medication Metformin used for and what are some potential side effects involved in its usage? Make your response no less than 150 words. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Fact Finding,Q&A Answer the question using only the text provided with no help from external sources or prior knowledge.,What are the challenges associated with mobile AI?,"With dedicated on-device AI chipsets, mobile devices will have better knowledge of the user's needs, being able to deliver personalized services that will make smartphones more intelligent. Beyond speed and efficiency, on-device AI offers greater security by providing real-time malware detection, recognizing if the device is being misused by identifying user behavior, and spam detection over emails and other apps. Among the applications and features that will benefit first from on-device AI are:  Virtual digital assistants. By being less dependent on cloud AI and connectivity, virtual assistants can become the main method for users to interact with the devices.  Augmented reality. Augmented reality will also see similar benefits, as it requires computation to take place in the cloud.  Cameras. Having an on-device processor that constantly analyzes what the camera ""sees"" as users take photos or adjust the brightness, ISO sensitivity, color temperature, and exposure duration every time they press the shutter button, and accurately selecting the right scene mode automatically, will have an impact on the user experience.  Well-being and healthcare. By delivering faster performance — regardless of the quality of the network, while providing optimal protection of user data — many apps will be able to send notifications to the user (and his or her doctor) in response to real-time analysis of patient data and data collected from wearable devices. This will predict health events, enabling users to seek medical advice and for doctors to assist patients when a medical condition or threat is detected by an AI algorithm. Bringing Intelligent Mobile Devices Into Our Lives AI will disrupt the way users interact with smartphones in the future, making it work for us. Going to the cinema, for example, will be a completely different experience from the one we have today: 1. Someone with an intelligent phone is walking down the street and sees an ad for the latest blockbuster movie. On pointing the phone at the ad, the camera recognizes the movie, suggests how likely they are to enjoy it, how much it matches their preferences, and prompting them to ask if it should buy tickets. 2. The phone checks the calendar and suggests when to get the tickets, based on the commitments and appointments for the week, as well as the best theater based on the predicted location for the day. The phone then sends a message to the person who usually goes along, suggesting the movie and asking if they want to come. 3. The phone buys the tickets and stores them in its digital wallet. 4. On the day, the phone confirms availability and suggests having dinner before the movie, at a nearby restaurant bookmarked on the maps app, reminding the user about the type of food served. After confirmation by the user, the phone makes reservations on their behalf. 5. Based on the traffic, the phone sends a reminder when it is time to leave and, if late, it sends an email to the restaurant with an estimated time of arrival. It automatically provides directions to the restaurant from the car park. 6. At the theater the phone automatically displays the ticket on the home screen for faster scan. One single action triggered from the camera will create a chain of actions that will help people manage their lives. AI will make technology work for everyone, rather than people having to adapt to the technology's limitations. Smartphones will learn who the users are, what they do and what they want to do, and deliver a new user experience, one that is not yet available, effortlessly. AI will enable phones to become intelligent and truly personal digital assistants, and it is on-device AI that will be the engine to make this happen. Benefits of Mobile AI The opportunities for always-on devices that do most of their intelligent computing on the device are enormous. Running AI on the device rather than in the cloud offers different benefits too:  No latency. In many cases, running AI entirely in the cloud will have an impact for applications that need to work in real time and are latency-sensitive, such as missioncritical applications and driverless cars. Such applications need to rely on instantaneous responses and cannot afford the roundtrip time or operate when there is variable network coverage.  Increased security and privacy. AI algorithms look for patterns in the data at an unprecedented scale. The data collected by the phone will require a roundtrip to the cloud if no AI capability is available on the device. Being able to perform AI algorithms on the device will provide better security due to the low volumes of data exchanged over the network. But it will also provide better privacy, as the AI algorithms will not have to process and store the information in the cloud. The cloud is used only to train the algorithms. This is paramount in today's environment with new European legislation (GDPR) that aims to provide a set of standardized data protection laws across member countries, but also to reinforce the data protection rights of individuals.  On-device learning. Although most of the training will happen in the cloud, and the smartphone has inference capabilities, it still needs to learn the user's behavior so it can deliver automated, personalized experiences. On-device learning enables training capabilities on the mobile device, so the data does not need to travel to the cloud or be stored outside the device. This process can be triggered while the device is idle, which allows power saving and ensures no interruptions of other features.  Efficiency. Running AI on the device reduces network traffic, as less data is transferred via the network to the cloud, and improves performance as apps that need to run in real time can achieve lower latency levels on the device.  Power saving. Power consumption will be reduced, as the device does not need to constantly upload and download AI-related data to be able to process AI algorithms. This will have a positive effect on battery life and, by extending it, will improve user experience. Challenges of Delivering Mobile AI Bringing machine learning and deep learning algorithms to the edge is essential to lower their data computation requirements, while enabling mobile devices with chipsets that can process some of those algorithms on the device. AI workloads are very compute-intensive. Optimizing AI algorithms for use on mobile is a huge challenge, as is the impact on battery life of the intensive computational AI algorithms on a real-time and always-on environment. Another important challenge with on-device AI is the need to train the algorithms. This requires vast amounts of data. The quality and quantity of data is key to successful machine learning. Depending on the complexity of the model and the amount of data, training can take place in the device or in the cloud. Large models tend to require a lot of processing, which is only available in cloud platforms. Some of the predictions needed from AI algorithms require data that is already available on the user's device and no other sources are needed to be trained. However, to train and run large, complicated neural-network models on mobile devices with less capabilities than large servers is a challenge. A fundamental challenge of offering on-device AI is related to the nature of the smartphone. Designing a chipset that delivers the performance required by highly demanding AI algorithms with the restrictions of smartphones in terms of size, power supply, power consumption, and heat management is a major challenge. ""Mobile SoCs have to deliver the best possible performance, while ensuring the highest possible density of core functions with optimal use of energy. The [Huawei] Kirin 970's development team introduced a new, innovative HiAI mobile computing architecture with a dedicated NPU,"" said Victor Dragnea from Huawei. Developing an AI Ecosystem AI platforms provide developer toolkits to build applications using AI algorithms. They combine a variety of algorithms with data that can be used directly by developers, without having to build them from scratch. Some of the functionality includes image recognition, natural language processing, voice recognition, predictive analytics, and other machine learning and deep learning capabilities. An important part of bringing AI to smartphones is the creation of an AI ecosystem. This is vital to expand the capabilities of the dedicated AI chipsets from a few features on the phone to third-party apps. By providing SDKs and APIs, phone makers will enable developers and partners to find new uses for AI computing capabilities. Huawei is positioning the Kirin 970 as an ""open platform for mobile AI."" The company emphasizes that the chipset will work with any AI framework, such as Caffe2 and TensorFlow, in order for any app to access the capabilities of the NPU and AI features.","System Instruction: Answer the question using only the text provided with no help from external sources or prior knowledge. User question: What are the challenges associated with mobile AI? Context block: With dedicated on-device AI chipsets, mobile devices will have better knowledge of the user's needs, being able to deliver personalized services that will make smartphones more intelligent. Beyond speed and efficiency, on-device AI offers greater security by providing real-time malware detection, recognizing if the device is being misused by identifying user behavior, and spam detection over emails and other apps. Among the applications and features that will benefit first from on-device AI are:  Virtual digital assistants. By being less dependent on cloud AI and connectivity, virtual assistants can become the main method for users to interact with the devices.  Augmented reality. Augmented reality will also see similar benefits, as it requires computation to take place in the cloud.  Cameras. Having an on-device processor that constantly analyzes what the camera ""sees"" as users take photos or adjust the brightness, ISO sensitivity, color temperature, and exposure duration every time they press the shutter button, and accurately selecting the right scene mode automatically, will have an impact on the user experience.  Well-being and healthcare. By delivering faster performance — regardless of the quality of the network, while providing optimal protection of user data — many apps will be able to send notifications to the user (and his or her doctor) in response to real-time analysis of patient data and data collected from wearable devices. This will predict health events, enabling users to seek medical advice and for doctors to assist patients when a medical condition or threat is detected by an AI algorithm. Bringing Intelligent Mobile Devices Into Our Lives AI will disrupt the way users interact with smartphones in the future, making it work for us. Going to the cinema, for example, will be a completely different experience from the one we have today: 1. Someone with an intelligent phone is walking down the street and sees an ad for the latest blockbuster movie. On pointing the phone at the ad, the camera recognizes the movie, suggests how likely they are to enjoy it, how much it matches their preferences, and prompting them to ask if it should buy tickets. 2. The phone checks the calendar and suggests when to get the tickets, based on the commitments and appointments for the week, as well as the best theater based on the predicted location for the day. The phone then sends a message to the person who usually goes along, suggesting the movie and asking if they want to come. 3. The phone buys the tickets and stores them in its digital wallet. 4. On the day, the phone confirms availability and suggests having dinner before the movie, at a nearby restaurant bookmarked on the maps app, reminding the user about the type of food served. After confirmation by the user, the phone makes reservations on their behalf. 5. Based on the traffic, the phone sends a reminder when it is time to leave and, if late, it sends an email to the restaurant with an estimated time of arrival. It automatically provides directions to the restaurant from the car park. 6. At the theater the phone automatically displays the ticket on the home screen for faster scan. One single action triggered from the camera will create a chain of actions that will help people manage their lives. AI will make technology work for everyone, rather than people having to adapt to the technology's limitations. Smartphones will learn who the users are, what they do and what they want to do, and deliver a new user experience, one that is not yet available, effortlessly. AI will enable phones to become intelligent and truly personal digital assistants, and it is on-device AI that will be the engine to make this happen. Benefits of Mobile AI The opportunities for always-on devices that do most of their intelligent computing on the device are enormous. Running AI on the device rather than in the cloud offers different benefits too:  No latency. In many cases, running AI entirely in the cloud will have an impact for applications that need to work in real time and are latency-sensitive, such as missioncritical applications and driverless cars. Such applications need to rely on instantaneous responses and cannot afford the roundtrip time or operate when there is variable network coverage.  Increased security and privacy. AI algorithms look for patterns in the data at an unprecedented scale. The data collected by the phone will require a roundtrip to the cloud if no AI capability is available on the device. Being able to perform AI algorithms on the device will provide better security due to the low volumes of data exchanged over the network. But it will also provide better privacy, as the AI algorithms will not have to process and store the information in the cloud. The cloud is used only to train the algorithms. This is paramount in today's environment with new European legislation (GDPR) that aims to provide a set of standardized data protection laws across member countries, but also to reinforce the data protection rights of individuals.  On-device learning. Although most of the training will happen in the cloud, and the smartphone has inference capabilities, it still needs to learn the user's behavior so it can deliver automated, personalized experiences. On-device learning enables training capabilities on the mobile device, so the data does not need to travel to the cloud or be stored outside the device. This process can be triggered while the device is idle, which allows power saving and ensures no interruptions of other features.  Efficiency. Running AI on the device reduces network traffic, as less data is transferred via the network to the cloud, and improves performance as apps that need to run in real time can achieve lower latency levels on the device.  Power saving. Power consumption will be reduced, as the device does not need to constantly upload and download AI-related data to be able to process AI algorithms. This will have a positive effect on battery life and, by extending it, will improve user experience. Challenges of Delivering Mobile AI Bringing machine learning and deep learning algorithms to the edge is essential to lower their data computation requirements, while enabling mobile devices with chipsets that can process some of those algorithms on the device. AI workloads are very compute-intensive. Optimizing AI algorithms for use on mobile is a huge challenge, as is the impact on battery life of the intensive computational AI algorithms on a real-time and always-on environment. Another important challenge with on-device AI is the need to train the algorithms. This requires vast amounts of data. The quality and quantity of data is key to successful machine learning. Depending on the complexity of the model and the amount of data, training can take place in the device or in the cloud. Large models tend to require a lot of processing, which is only available in cloud platforms. Some of the predictions needed from AI algorithms require data that is already available on the user's device and no other sources are needed to be trained. However, to train and run large, complicated neural-network models on mobile devices with less capabilities than large servers is a challenge. A fundamental challenge of offering on-device AI is related to the nature of the smartphone. Designing a chipset that delivers the performance required by highly demanding AI algorithms with the restrictions of smartphones in terms of size, power supply, power consumption, and heat management is a major challenge. ""Mobile SoCs have to deliver the best possible performance, while ensuring the highest possible density of core functions with optimal use of energy. The [Huawei] Kirin 970's development team introduced a new, innovative HiAI mobile computing architecture with a dedicated NPU,"" said Victor Dragnea from Huawei. Developing an AI Ecosystem AI platforms provide developer toolkits to build applications using AI algorithms. They combine a variety of algorithms with data that can be used directly by developers, without having to build them from scratch. Some of the functionality includes image recognition, natural language processing, voice recognition, predictive analytics, and other machine learning and deep learning capabilities. An important part of bringing AI to smartphones is the creation of an AI ecosystem. This is vital to expand the capabilities of the dedicated AI chipsets from a few features on the phone to third-party apps. By providing SDKs and APIs, phone makers will enable developers and partners to find new uses for AI computing capabilities. Huawei is positioning the Kirin 970 as an ""open platform for mobile AI."" The company emphasizes that the chipset will work with any AI framework, such as Caffe2 and TensorFlow, in order for any app to access the capabilities of the NPU and AI features.",Internet/Technology,Fact Finding,Q&A You must answer the prompt by only using the information from the provided context.,What types of risk does Northrup Grumman face within the cyber threat landscape?,"Item 1C. Cybersecurity We recognize the critical importance of maintaining the safety and security of our systems and data and have a holistic process for overseeing and managing cybersecurity and related risks. This process is supported by both management and our Board of Directors. The Chief Information Office, which maintains our cybersecurity function, is led by our Chief Information Officer (CIO), who reports to our CEO. The Chief Information Security Officer (CISO) reports to the CIO and generally is responsible for management of cybersecurity risk and the protection and defense of our networks and systems. The CISO manages a team of cybersecurity professionals with broad experience and expertise, including in cybersecurity threat assessments and detection, mitigation technologies, cybersecurity training, incident response, cyber forensics, insider threats and regulatory compliance. Our Board of Directors is responsible for overseeing our enterprise risk management activities in general, and each of our Board committees assists the Board in the role of risk oversight. The full Board receives an update on the Company’s risk management process and the risk trends related to cybersecurity at least annually. The Audit and Risk Committee specifically assists the Board in its oversight of risks related to cybersecurity. To help ensure effective oversight, the Audit and Risk Committee receives reports on information security and cybersecurity from the CISO at least four times a year. In addition, the Company’s Enterprise Risk Management Council (ERMC) considers risks relating to cybersecurity, among other significant risks, and applicable mitigation plans to address such risks. The ERMC is comprised of the Executive Leadership Team, as well as the Chief Accounting Officer, Chief Compliance Officer, Corporate Secretary, Chief Sustainability Officer, Treasurer and Vice President, Internal Audit. The CIO and CISO attend each ERMC meeting. The ERMC meets during the year and receives periodic updates on cybersecurity risks from the CIO and CISO. We have an established process and playbook led by our CISO governing our assessment, response and notifications internally and externally upon the occurrence of a cybersecurity incident. Depending on the nature and severity of an incident, this process provides for escalating notification to our CEO and the Board (including our Lead Independent Director and the Audit and Risk Committee chair). NORTHROP GRUMMAN CORPORATION -22- Our approach to cybersecurity risk management includes the following key elements: • Multi-Layered Defense and Continuous Monitoring – We work to protect our computing environments and products from cybersecurity threats through multi-layered defenses and apply lessons learned from our defense and monitoring efforts to help prevent future attacks. We utilize data analytics to detect anomalies and search for cyber threats. Our Cybersecurity Operations Center provides comprehensive cyber threat detection and response capabilities and maintains a 24x7 monitoring system which complements the technology, processes and threat detection techniques we use to monitor, manage and mitigate cybersecurity threats. From time to time, we engage third party consultants or other advisors to assist in assessing, identifying and/or managing cybersecurity threats. We also periodically use our Internal Audit function to conduct additional reviews and assessments. • Insider Threats – We maintain an insider threat program designed to identify, assess, and address potential risks from within our Company. Our program evaluates potential risks consistent with industry practices, customer requirements and applicable law, including privacy and other considerations. • Information Sharing and Collaboration – We work with government, customer, industry and/or supplier partners, such as the National Defense Information Sharing and Analysis Center and other governmentindustry partnerships, to gather and develop best practices and share information to address cyber threats. These relationships enable the rapid sharing of threat and vulnerability mitigation information across the defense industrial base and supply chain. • Third Party Risk Assessments – We conduct information security assessments before sharing or allowing the hosting of sensitive data in computing environments managed by third parties, and our standard terms and conditions contain contractual provisions requiring certain security protections. • Training and Awareness – We provide awareness training to our employees to help identify, avoid and mitigate cybersecurity threats. Our employees with network access participate annually in required training, including spear phishing and other awareness training. We also periodically host tabletop exercises with management and other employees to practice rapid cyber incident response. • Supplier Engagement – We provide training and other resources to our suppliers to support cybersecurity resiliency in our supply chain. We also require our suppliers to comply with our standard information security terms and conditions, in addition to any requirements from our customers, as a condition of doing business with us, and require them to complete information security questionnaires to review and assess any potential cyber-related risks depending on the nature of the services being provided. While we have experienced cybersecurity incidents in the past, to date none have materially affected the Company or our financial position, results of operations and/or cash flows. We continue to invest in the cybersecurity and resiliency of our networks and to enhance our internal controls and processes, which are designed to help protect our systems and infrastructure, and the information they contain. For more information regarding the risks we face from cybersecurity threats, please see “Risk Factors.” FORWARD-LOOKING STATEMENTS AND PROJECTIONS This Annual Report on Form 10-K and the information we are incorporating by reference contain statements that constitute “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. Words such as “will,” “expect,” “anticipate,” “intend,” “may,” “could,” “should,” “plan,” “project,” “forecast,” “believe,” “estimate,” “guidance,” “outlook,” “trends,” “goals” and similar expressions generally identify these forward-looking statements. Forward-looking statements include, among other things, statements relating to our future financial condition, results of operations and/or cash flows. Forward-looking statements are based upon assumptions, expectations, plans and projections that we believe to be reasonable when made, but which may change over time. These statements are not guarantees of future performance and inherently involve a wide range of risks and uncertainties that are difficult to predict. Specific risks that could cause actual results to differ materially from those expressed or implied in these forward-looking statements include, but are not limited to, those identified under “Risk Factors” and other important factors disclosed in this report and from time to time in our other SEC filings. These risks and uncertainties are amplified by the global macroeconomic, security and political environments, including inflationary pressures, labor and supply chain challenges, which have caused and will continue to cause significant challenges, instability and uncertainty. They include: Industry and Economic Risks • our dependence on the U.S. government for a substantial portion of our business NORTHROP GRUMMAN CORPORATION","You must answer the prompt by only using the information from the provided context. What types of risk does Northrup Grumman face within the cyber threat landscape? Item 1C. Cybersecurity We recognize the critical importance of maintaining the safety and security of our systems and data and have a holistic process for overseeing and managing cybersecurity and related risks. This process is supported by both management and our Board of Directors. The Chief Information Office, which maintains our cybersecurity function, is led by our Chief Information Officer (CIO), who reports to our CEO. The Chief Information Security Officer (CISO) reports to the CIO and generally is responsible for management of cybersecurity risk and the protection and defense of our networks and systems. The CISO manages a team of cybersecurity professionals with broad experience and expertise, including in cybersecurity threat assessments and detection, mitigation technologies, cybersecurity training, incident response, cyber forensics, insider threats and regulatory compliance. Our Board of Directors is responsible for overseeing our enterprise risk management activities in general, and each of our Board committees assists the Board in the role of risk oversight. The full Board receives an update on the Company’s risk management process and the risk trends related to cybersecurity at least annually. The Audit and Risk Committee specifically assists the Board in its oversight of risks related to cybersecurity. To help ensure effective oversight, the Audit and Risk Committee receives reports on information security and cybersecurity from the CISO at least four times a year. In addition, the Company’s Enterprise Risk Management Council (ERMC) considers risks relating to cybersecurity, among other significant risks, and applicable mitigation plans to address such risks. The ERMC is comprised of the Executive Leadership Team, as well as the Chief Accounting Officer, Chief Compliance Officer, Corporate Secretary, Chief Sustainability Officer, Treasurer and Vice President, Internal Audit. The CIO and CISO attend each ERMC meeting. The ERMC meets during the year and receives periodic updates on cybersecurity risks from the CIO and CISO. We have an established process and playbook led by our CISO governing our assessment, response and notifications internally and externally upon the occurrence of a cybersecurity incident. Depending on the nature and severity of an incident, this process provides for escalating notification to our CEO and the Board (including our Lead Independent Director and the Audit and Risk Committee chair). NORTHROP GRUMMAN CORPORATION -22- Our approach to cybersecurity risk management includes the following key elements: • Multi-Layered Defense and Continuous Monitoring – We work to protect our computing environments and products from cybersecurity threats through multi-layered defenses and apply lessons learned from our defense and monitoring efforts to help prevent future attacks. We utilize data analytics to detect anomalies and search for cyber threats. Our Cybersecurity Operations Center provides comprehensive cyber threat detection and response capabilities and maintains a 24x7 monitoring system which complements the technology, processes and threat detection techniques we use to monitor, manage and mitigate cybersecurity threats. From time to time, we engage third party consultants or other advisors to assist in assessing, identifying and/or managing cybersecurity threats. We also periodically use our Internal Audit function to conduct additional reviews and assessments. • Insider Threats – We maintain an insider threat program designed to identify, assess, and address potential risks from within our Company. Our program evaluates potential risks consistent with industry practices, customer requirements and applicable law, including privacy and other considerations. • Information Sharing and Collaboration – We work with government, customer, industry and/or supplier partners, such as the National Defense Information Sharing and Analysis Center and other governmentindustry partnerships, to gather and develop best practices and share information to address cyber threats. These relationships enable the rapid sharing of threat and vulnerability mitigation information across the defense industrial base and supply chain. • Third Party Risk Assessments – We conduct information security assessments before sharing or allowing the hosting of sensitive data in computing environments managed by third parties, and our standard terms and conditions contain contractual provisions requiring certain security protections. • Training and Awareness – We provide awareness training to our employees to help identify, avoid and mitigate cybersecurity threats. Our employees with network access participate annually in required training, including spear phishing and other awareness training. We also periodically host tabletop exercises with management and other employees to practice rapid cyber incident response. • Supplier Engagement – We provide training and other resources to our suppliers to support cybersecurity resiliency in our supply chain. We also require our suppliers to comply with our standard information security terms and conditions, in addition to any requirements from our customers, as a condition of doing business with us, and require them to complete information security questionnaires to review and assess any potential cyber-related risks depending on the nature of the services being provided. While we have experienced cybersecurity incidents in the past, to date none have materially affected the Company or our financial position, results of operations and/or cash flows. We continue to invest in the cybersecurity and resiliency of our networks and to enhance our internal controls and processes, which are designed to help protect our systems and infrastructure, and the information they contain. For more information regarding the risks we face from cybersecurity threats, please see “Risk Factors.” FORWARD-LOOKING STATEMENTS AND PROJECTIONS This Annual Report on Form 10-K and the information we are incorporating by reference contain statements that constitute “forward-looking statements” within the meaning of the Private Securities Litigation Reform Act of 1995. Words such as “will,” “expect,” “anticipate,” “intend,” “may,” “could,” “should,” “plan,” “project,” “forecast,” “believe,” “estimate,” “guidance,” “outlook,” “trends,” “goals” and similar expressions generally identify these forward-looking statements. Forward-looking statements include, among other things, statements relating to our future financial condition, results of operations and/or cash flows. Forward-looking statements are based upon assumptions, expectations, plans and projections that we believe to be reasonable when made, but which may change over time. These statements are not guarantees of future performance and inherently involve a wide range of risks and uncertainties that are difficult to predict. Specific risks that could cause actual results to differ materially from those expressed or implied in these forward-looking statements include, but are not limited to, those identified under “Risk Factors” and other important factors disclosed in this report and from time to time in our other SEC filings. These risks and uncertainties are amplified by the global macroeconomic, security and political environments, including inflationary pressures, labor and supply chain challenges, which have caused and will continue to cause significant challenges, instability and uncertainty. They include: Industry and Economic Risks • our dependence on the U.S. government for a substantial portion of our business NORTHROP GRUMMAN CORPORATION",Internet/Technology,Find & Summarize,Text Transformation "You base your responses on the provided text and do not use any external knowledge. You also do not use any prior knowledge. Your response should be 3-5 bullet points long, with each bullet point no longer than 1 sentence.",What is pixel density?,"1. Introduction This step-by-step guide helps you select the best cameras for your operational requirements and surveillance scenarios. Lack of industry standards and the complexity of the matter cause many integrators to lose sight of a key prerequisite in any installation: the operational requirements or the true purpose of the surveillance. In this guide, we present the Pixel Density Model – a method that allows you to relate the operational requirements of your system to modern surveillance video and IP cameras. 2. Moving into IP Selecting the appropriate surveillance camera to fulfill operational requirements has always been a challenge. With the introduction of IP cameras, and especially through the development of megapixel and HDTV cameras, the need has emerged for a new way to determine how to meet operational requirements. In these six steps, we describe a model to relate operational requirements to modern video and IP cameras. When recommending cameras and discussing what is the “best” camera on the market, it is easy to focus on datasheets and technical specifications. This causes many integrators to lose sight of a key prerequisite in any installation, namely the operational requirements or the actual purpose of the surveillance. Previously when surveillance was all analog, selecting a camera to match an operational requirement was mostly about selecting the appropriate lens since there wasn’t a wide variety of resolutions to choose from. Most CCTV systems are designed to monitor human behavior, so the human body was used as a yardstick. In order to differentiate between diverse types of scenarios, various categories were established based on percentage representation of the height of a human body within the field of view. While not a global standard in any way, it became quite common to distinguish between the need for detection, recognition, and identification. As correct as the percentages in Figure 1 might be for a standard analog resolution, they pose a few challenges when moving into the diverse resolutions of IP cameras. To bridge the gap, attempts have been made to translate from TV lines to pixels to produce tables like the one shown in Figure 2, where the way of thinking about analog operational requirements in terms of percentages has been translated for IP. This might be correct, but it is difficult – if not impossible – to work with complexity such as this in a real-life context. Surely there must be a better way 3. Pixel density The growth of IP surveillance forces us to a make paradigm shift in the way we define our operational requirements. Advancements in camera technology have resulted in a multitude of resolutions and formats. Instead of using vertical height and percentage, we should focus on pixel density in the horizontal dimension. The term pixel density in this context refers to the number of pixels representing the object of our operational requirement – commonly a human, or more specifically, a human face. One reason why we have chosen to use the face is its distinct identifying features. Furthermore, the variances in face widths are less than those of body lengths or widths, which results in a smaller margin of error. The average human face is 16 centimeters wide (= 6.3 inches wide). Following suggested operational requirements from SKL, the Swedish National Laboratory of Forensic Science, and supported by our own test results at Axis Communications, we have chosen to use 80 pixels as the requirement for facial identification for challenging conditions . (see Figure 3). To some, this number might sound high, and in fact some vendors or independent sources recommend 40 pixels for a face or 100 pixels per foot for recognition. The argument behind the higher number is that for identification, there are limited other telltale signs. For recognition, previous knowledge adds factors such as how a person moves – a property easy to observe and recognize, but difficult to identify and describe accurately. To ensure sufficient video quality even if the object isn’t facing the camera straight on, or if the lighting is not optimal, the higher number provides an adequate safety margin. 1 Challenging conditions: Situations with very varying or weak lighting. People, objects and vehicles are seen from an angle where details are in shade, or facing away from the camera. It could also occur in situations where people, objects and vehicles are moving at very high speed through an area. More often occurring in outdoor situations without additional lighting, or indoor situations during very dark conditions. 2 See European Standard EN 50132-7:2012 by CENELEC www.cenelec.eu 3 Good conditions: Situations with decent lighting. People, objects and vehicles are moving at reasonable speed, and seen from an angle where sufficient details are visible. More often occurring in indoor situations where lighting is even, or outdoor situations with additional lighting.","1. Introduction This step-by-step guide helps you select the best cameras for your operational requirements and surveillance scenarios. Lack of industry standards and the complexity of the matter cause many integrators to lose sight of a key prerequisite in any installation: the operational requirements or the true purpose of the surveillance. In this guide, we present the Pixel Density Model – a method that allows you to relate the operational requirements of your system to modern surveillance video and IP cameras. 2. Moving into IP Selecting the appropriate surveillance camera to fulfill operational requirements has always been a challenge. With the introduction of IP cameras, and especially through the development of megapixel and HDTV cameras, the need has emerged for a new way to determine how to meet operational requirements. In these six steps, we describe a model to relate operational requirements to modern video and IP cameras. When recommending cameras and discussing what is the “best” camera on the market, it is easy to focus on datasheets and technical specifications. This causes many integrators to lose sight of a key prerequisite in any installation, namely the operational requirements or the actual purpose of the surveillance. Previously when surveillance was all analog, selecting a camera to match an operational requirement was mostly about selecting the appropriate lens since there wasn’t a wide variety of resolutions to choose from. Most CCTV systems are designed to monitor human behavior, so the human body was used as a yardstick. In order to differentiate between diverse types of scenarios, various categories were established based on percentage representation of the height of a human body within the field of view. While not a global standard in any way, it became quite common to distinguish between the need for detection, recognition, and identification. As correct as the percentages in Figure 1 might be for a standard analog resolution, they pose a few challenges when moving into the diverse resolutions of IP cameras. To bridge the gap, attempts have been made to translate from TV lines to pixels to produce tables like the one shown in Figure 2, where the way of thinking about analog operational requirements in terms of percentages has been translated for IP. This might be correct, but it is difficult – if not impossible – to work with complexity such as this in a real-life context. Surely there must be a better way 3. Pixel density The growth of IP surveillance forces us to a make paradigm shift in the way we define our operational requirements. Advancements in camera technology have resulted in a multitude of resolutions and formats. Instead of using vertical height and percentage, we should focus on pixel density in the horizontal dimension. The term pixel density in this context refers to the number of pixels representing the object of our operational requirement – commonly a human, or more specifically, a human face. One reason why we have chosen to use the face is its distinct identifying features. Furthermore, the variances in face widths are less than those of body lengths or widths, which results in a smaller margin of error. The average human face is 16 centimeters wide (= 6.3 inches wide). Following suggested operational requirements from SKL, the Swedish National Laboratory of Forensic Science, and supported by our own test results at Axis Communications, we have chosen to use 80 pixels as the requirement for facial identification for challenging conditions . (see Figure 3). To some, this number might sound high, and in fact some vendors or independent sources recommend 40 pixels for a face or 100 pixels per foot for recognition. The argument behind the higher number is that for identification, there are limited other telltale signs. For recognition, previous knowledge adds factors such as how a person moves – a property easy to observe and recognize, but difficult to identify and describe accurately. To ensure sufficient video quality even if the object isn’t facing the camera straight on, or if the lighting is not optimal, the higher number provides an adequate safety margin. 1 Challenging conditions: Situations with very varying or weak lighting. People, objects and vehicles are seen from an angle where details are in shade, or facing away from the camera. It could also occur in situations where people, objects and vehicles are moving at very high speed through an area. More often occurring in outdoor situations without additional lighting, or indoor situations during very dark conditions. 2 See European Standard EN 50132-7:2012 by CENELEC www.cenelec.eu 3 Good conditions: Situations with decent lighting. People, objects and vehicles are moving at reasonable speed, and seen from an angle where sufficient details are visible. More often occurring in indoor situations where lighting is even, or outdoor situations with additional lighting. What is pixel density? You base your responses on the provided text and do not use any external knowledge. You also do not use any prior knowledge. Your response should be 3-5 bullet points long, with each bullet point no longer than 1 sentence.",Internet/Technology,Explanation/Definition,Q&A "Rely only on the context document, with no outside information.","Based on the document, was the user satisfied with the product?","**AirPod Pro (2nd Gen) Customer Review** the sound quality and bass of these earphones are clear and exceptional for listening to both music and podcasts; it's like i'm hearing all of my favorite music again with new ears, including background harmonies and production qualities that i didn't notice before. they are so lightweight and comfortable, and i haven't had any issues with them falling out, which was a concern for me as someone who goes to the gym and wears glasses. they connected to my apple devices quickly and effortlessly, and they're very aesthetically beautiful and stylish in person. the noise cancellation feature is excellent and effectively blocks out background noise, sometimes so much so that i'm unaware of my surroundings, but the level of noise cancellation and volume can be adjusted based on your surroundings. there is also a feature where siri can read your notifications as they come in, which some people may find useful. you can answer, mute, unmute, and end calls by pressing them, and there are even more features that i haven't played with yet. they are SO worth the hype and the price tag. i am beyond satisfied with my purchase, and as a music lover, i think they're really going to improve my quality of life. i will never go back to any other earphone brand. thank you! "," ========== Rely only on the context document, with no outside information. ---------- ========== **AirPod Pro (2nd Gen) Customer Review** the sound quality and bass of these earphones are clear and exceptional for listening to both music and podcasts; it's like i'm hearing all of my favorite music again with new ears, including background harmonies and production qualities that i didn't notice before. they are so lightweight and comfortable, and i haven't had any issues with them falling out, which was a concern for me as someone who goes to the gym and wears glasses. they connected to my apple devices quickly and effortlessly, and they're very aesthetically beautiful and stylish in person. the noise cancellation feature is excellent and effectively blocks out background noise, sometimes so much so that i'm unaware of my surroundings, but the level of noise cancellation and volume can be adjusted based on your surroundings. there is also a feature where siri can read your notifications as they come in, which some people may find useful. you can answer, mute, unmute, and end calls by pressing them, and there are even more features that i haven't played with yet. they are SO worth the hype and the price tag. i am beyond satisfied with my purchase, and as a music lover, i think they're really going to improve my quality of life. i will never go back to any other earphone brand. thank you! ---------- ========== Based on the document, was the user satisfied with the product?",Internet/Technology,Effect Analysis,Q&A "You must use the information provided in the prompt to answer any questions. Do not use any previous knowledge or additional information from any sources. Do not write more than 200 words for each response. If a list is included in the response, use bullet points, never numbers. When numbers are necessary in your response, write each one in text with the number in brackets after, for example, two (2) or twenty seven (27). ",What are the pros and cons of each beta blocker?,"Pharmacology of Intravenous β-Adrenergic Blockers propranolol Propranolol has an equal affinity for β1- and β2-receptors, lacks intrinsic sympathomimetic activity (ISA), and has no α-adrenergic receptor activity. It is the most lipidsoluble β-blocker and generally has the most central nervous system side effects. First-pass liver metabolism (90%) is very high, requiring much higher oral doses than intravenous doses for pharmacodynamic effect. The usual intravenous dose of propranolol initially is 0.5 to 1.0 mg titrated to effect. A titrated dose resulting in maximum pharmacologic serum levels is 0.1 mg/kg. The use of continuous infusions of propranolol has been reported after noncardiac surgery in patients with cardiac disease. A continuous infusion of 1 to 3 mg/hr can prevent tachycardia and hypertension but must be used cautiously because of the potential of cumulative effects. metoprolol Metoprolol was the first clinically used cardioselective β-blocker (Table 8-2). Its affinity for β1-receptors is 30 times higher than its affinity for β2-receptors, as demonstrated by radioligand binding. Metoprolol is lipid soluble, with 50% of the drug metabolized during first-pass hepatic metabolism and with only 3% BOX 8-3 Effects of β-Adrenergic Blockers on Myocardial Ischemia • Reductions in myocardial oxygen consumption • Improvements in coronary blood flow • Prolonged diastolic perfusion period • Improved collateral flow • Increased flow to ischemic areas • Overall improvement in supply/demand ratio • Stabilization of cellular membranes • Improved oxygen dissociation from hemoglobin • Inhibition of platelet aggregation • Reduced mortality after myocardial infarction BOX 8-4 Recommendations for Perioperative Medical Therapy • Class I β-Blockers required in the recent past to control symptoms of angina or symptomatic arrhythmias or hypertension; β-blockers: patients at high cardiac risk, owing to the finding of ischemia on preoperative testing, who are undergoing vascular surgery • Class IIa β-Blockers: preoperative assessment identifies untreated hypertension, known coronary disease, or major risk factors for coronary disease • Class III β-Blockers: contraindication to β-blockade Adapted from Eagle KA, Berger PB, Calkins H, et al: ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery-executive summary: A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 39:542, 2002. iICARDIOVASCULAR PHYSIOLOGY, PHARMACOLOGY, AND MOLECULAR BIOLOGY 124 excreted renally. Protein binding is less than 10%. Metoprolol’s serum half-life is 3 to 4 hours. As with any cardioselective β-blocker, higher serum levels may result in greater incidence of β2-blocking effects. Metoprolol is administered intravenously in 1- to 2-mg doses, titrated to effect. The potency of metoprolol is approximately one half that of propranolol. Maximum β-blocker effect is achieved with 0.2 mg/kg given intravenously. esmolol Esmolol’s chemical structure is similar to that of metoprolol and propranolol, except it has a methylester group in the para position of the phenyl ring, making it susceptible to rapid hydrolysis by red blood cell esterases (9-minute half-life). Esmolol is not metabolized by plasma cholinesterase. Hydrolysis results in an acid metabolite and methanol with clinically insignificant levels. Ninety percent of the drug is eliminated in the form of the acid metabolite, normally within 24 hours. A loading dose of 500 μg/kg given intravenously, followed by a 50- to 300- μg/kg/min infusion, will reach steadystate concentrations within 5 minutes. Without the loading dose, steady-state concentrations are reached in 30 minutes. Esmolol is cardioselective, blocking primarily β1-receptors. It lacks ISA and membrane-stabilizing effects and is mildly lipid soluble. Esmolol produced significant reductions in BP, HR, and cardiac index after a loading dose of 500 μg/kg and an infusion of 300 μg/kg/min in patients with coronary artery disease, and the effects were completely reversed 30 minutes after discontinuation of the infusion. Initial therapy during anesthesia may require significant reductions in both the loading and infusion doses. Hypotension is a common side effect of intravenous esmolol. The incidence of hypotension was higher with esmolol (36%) than with propranolol (6%) at equal therapeutic endpoints. The cardioselective drugs may cause more hypotension because of β1-induced myocardial depression and the failure to block β2 peripheral vasodilation. Esmolol appears safe in patients with bronchospastic disease. In another comparative study with propranolol, esmolol and placebo did not change airway resistance whereas 50% of patients treated with propranolol developed clinically significant bronchospasm. labetalol Labetalol provides selective α1-receptor blockade and nonselective β1- and β2-blockade. The potency of β-adrenergic blockade is 5- to 10-fold greater than α1-adrenergic blockade. Labetalol has partial β2-agonist effects that promote vasodilation. Labetalol is moderately lipid soluble and is completely absorbed after oral administration. First-pass hepatic metabolism is significant with production of inactive metabolites. Renal excretion of the unchanged drug is minimal. Elimination half-life is approximately 6 hours. In contrast to other β-blockers, clinically, labetalol should be considered a peripheral vasodilator that does not cause a reflex tachycardia. BP and systolic vascular resistance decrease after an intravenous dose. Stroke volume (SV) and CO remain unchanged, with HR decreasing slightly. The reduction in BP is dose related, and acutely hypertensive patients usually respond within 3 to 5 minutes after a bolus dose of 100 to 250 μg/kg. However, the more critically ill or anesthetized patients should have their BP titrated beginning with 5- to 10-mg intravenous increments. Reduction in BP may last as long as 6 hours after intravenous dosing.","You must use the information provided in the prompt to answer any questions. Do not use any previous knowledge or additional information from any sources. Do not write more than 200 words for each response. If a list is included in the response, use bullet points, never numbers. When numbers are necessary in your response, write each one in text with the number in brackets after, for example, two (2) or twenty seven (27). Pharmacology of Intravenous β-Adrenergic Blockers propranolol Propranolol has an equal affinity for β1- and β2-receptors, lacks intrinsic sympathomimetic activity (ISA), and has no α-adrenergic receptor activity. It is the most lipidsoluble β-blocker and generally has the most central nervous system side effects. First-pass liver metabolism (90%) is very high, requiring much higher oral doses than intravenous doses for pharmacodynamic effect. The usual intravenous dose of propranolol initially is 0.5 to 1.0 mg titrated to effect. A titrated dose resulting in maximum pharmacologic serum levels is 0.1 mg/kg. The use of continuous infusions of propranolol has been reported after noncardiac surgery in patients with cardiac disease. A continuous infusion of 1 to 3 mg/hr can prevent tachycardia and hypertension but must be used cautiously because of the potential of cumulative effects. metoprolol Metoprolol was the first clinically used cardioselective β-blocker (Table 8-2). Its affinity for β1-receptors is 30 times higher than its affinity for β2-receptors, as demonstrated by radioligand binding. Metoprolol is lipid soluble, with 50% of the drug metabolized during first-pass hepatic metabolism and with only 3% BOX 8-3 Effects of β-Adrenergic Blockers on Myocardial Ischemia • Reductions in myocardial oxygen consumption • Improvements in coronary blood flow • Prolonged diastolic perfusion period • Improved collateral flow • Increased flow to ischemic areas • Overall improvement in supply/demand ratio • Stabilization of cellular membranes • Improved oxygen dissociation from hemoglobin • Inhibition of platelet aggregation • Reduced mortality after myocardial infarction BOX 8-4 Recommendations for Perioperative Medical Therapy • Class I β-Blockers required in the recent past to control symptoms of angina or symptomatic arrhythmias or hypertension; β-blockers: patients at high cardiac risk, owing to the finding of ischemia on preoperative testing, who are undergoing vascular surgery • Class IIa β-Blockers: preoperative assessment identifies untreated hypertension, known coronary disease, or major risk factors for coronary disease • Class III β-Blockers: contraindication to β-blockade Adapted from Eagle KA, Berger PB, Calkins H, et al: ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery-executive summary: A report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Update the 1996 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery). J Am Coll Cardiol 39:542, 2002. iICARDIOVASCULAR PHYSIOLOGY, PHARMACOLOGY, AND MOLECULAR BIOLOGY 124 excreted renally. Protein binding is less than 10%. Metoprolol’s serum half-life is 3 to 4 hours. As with any cardioselective β-blocker, higher serum levels may result in greater incidence of β2-blocking effects. Metoprolol is administered intravenously in 1- to 2-mg doses, titrated to effect. The potency of metoprolol is approximately one half that of propranolol. Maximum β-blocker effect is achieved with 0.2 mg/kg given intravenously. esmolol Esmolol’s chemical structure is similar to that of metoprolol and propranolol, except it has a methylester group in the para position of the phenyl ring, making it susceptible to rapid hydrolysis by red blood cell esterases (9-minute half-life). Esmolol is not metabolized by plasma cholinesterase. Hydrolysis results in an acid metabolite and methanol with clinically insignificant levels. Ninety percent of the drug is eliminated in the form of the acid metabolite, normally within 24 hours. A loading dose of 500 μg/kg given intravenously, followed by a 50- to 300- μg/kg/min infusion, will reach steadystate concentrations within 5 minutes. Without the loading dose, steady-state concentrations are reached in 30 minutes. Esmolol is cardioselective, blocking primarily β1-receptors. It lacks ISA and membrane-stabilizing effects and is mildly lipid soluble. Esmolol produced significant reductions in BP, HR, and cardiac index after a loading dose of 500 μg/kg and an infusion of 300 μg/kg/min in patients with coronary artery disease, and the effects were completely reversed 30 minutes after discontinuation of the infusion. Initial therapy during anesthesia may require significant reductions in both the loading and infusion doses. Hypotension is a common side effect of intravenous esmolol. The incidence of hypotension was higher with esmolol (36%) than with propranolol (6%) at equal therapeutic endpoints. The cardioselective drugs may cause more hypotension because of β1-induced myocardial depression and the failure to block β2 peripheral vasodilation. Esmolol appears safe in patients with bronchospastic disease. In another comparative study with propranolol, esmolol and placebo did not change airway resistance whereas 50% of patients treated with propranolol developed clinically significant bronchospasm. labetalol Labetalol provides selective α1-receptor blockade and nonselective β1- and β2-blockade. The potency of β-adrenergic blockade is 5- to 10-fold greater than α1-adrenergic blockade. Labetalol has partial β2-agonist effects that promote vasodilation. Labetalol is moderately lipid soluble and is completely absorbed after oral administration. First-pass hepatic metabolism is significant with production of inactive metabolites. Renal excretion of the unchanged drug is minimal. Elimination half-life is approximately 6 hours. In contrast to other β-blockers, clinically, labetalol should be considered a peripheral vasodilator that does not cause a reflex tachycardia. BP and systolic vascular resistance decrease after an intravenous dose. Stroke volume (SV) and CO remain unchanged, with HR decreasing slightly. The reduction in BP is dose related, and acutely hypertensive patients usually respond within 3 to 5 minutes after a bolus dose of 100 to 250 μg/kg. However, the more critically ill or anesthetized patients should have their BP titrated beginning with 5- to 10-mg intravenous increments. Reduction in BP may last as long as 6 hours after intravenous dosing. What are the pros and cons of each beta blocker?",Medical,Pros & Cons,Q&A I'm providing you with your source material. You will not be using any outside material. Your job is to answer questions about the material.,What are the main takeaways?,"Low Interest Rates: Causes and Consequences∗ Robert E. Hall Hoover Institution and Department of Economics, Stanford University National Bureau of Economic Research World interest rates have been declining for several decades. In a general equilibrium setting, the interest rate is determined by the interaction of a number of types of behavior: the policy of the central bank, investment in productive assets, the choice between current and future consumption, and the responses of wealth holders to risk. Central banks devote consider effort to determining equilibrium real rates, around which they set their policy rates, though measuring the equilibrium rate is challenging. The real interest rate is also connected to the marginal product of capital, though the connection is loose. Similarly, the real interest rate is connected to consumption growth through a Euler equation, but again many other influ- ences enter the relationship between the two variables. Finally, the idea of the “global saving glut” suggests that the rise of income in countries with high propensities to save may be a factor in the decline in real rates. That idea receives support in a simple model of global financial equilibrium between coun- tries with risk tolerance (the United States) and ones with high risk aversion (China). JEL Codes: E21, E22, E43, E52. Low world interest rates have stimulated new interest in the determination of the safe real rate. As a threshold matter, Rachel and Smith’s figure 1 (this issue) and Juselius et al.’s figure 1 (this issue) document the pronounced downward trend of world real inter- est rates since the 1980s. For the purposes of this commentary, I take ∗ This research was supported by the Hoover Institution. Complete backup for all of the calculations is available from my website, http://www.stanford. edu/∼rehall. Author contact: rehall@stanford.edu; stanford.edu/∼rehall. 103 104 International Journal of Central Banking September 2017 the real rate to be the yield net of inflation of safe government debt of maturity around one to two years. Thus I abstract from liquidity effects at the short end of the yield curve and from issues related to the slope of the yield curve. Structural relations governing the real interest rate include its relation to • the central bank’s payment on reserves and the extent of sat- uration of the financial system in reserves • the marginal product of capital • the rate of consumption growth (through the Euler equation) • the terms of trade between risk-tolerant and risk-averse investors In a complete macro model one or more equations would describe each of these structural relations. It would not be possible to divide up responsibility among them for the overall decline in the real rate. One can fashion a set of highly simplified models, each containing only one or two of the structural relations. For example, Krugman (1998) considers an economy with no capital and no uncertainty to focus on monetary policy and consumption growth and illuminate issues of the zero lower bound. But a set of models along those lines would not result in an additive breakdown of the sources of the decline in the real interest rate. 1. Monetary Policy and the Real Interest Rate Traditional monetary policy kept the interest paid on reserves at zero nominal and manipulated the quantity of reserves. Explaining how the central bank influenced interest rates involved consideration of the liquidity value of scarce reserves. Today, all major central banks have saturated their financial systems with reserves, so the liquid- ity value is zero, and the central banks execute monetary policy exclusively by manipulation of the payment made to reserve hold- ers (in the United States, a new kind of reserves, reverse repurchase agreements, play this role). Powerful forces of arbitrage link the central bank’s policy rate paid on reserves to similar short-term government obligations. The Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 105 central bank thus controls short rates directly. But the fact of central bank control does not mean that we need look no further to under- stand the movements of short rates. For one thing, it is the behavior of real rates that matters and all central banks set nominal rates, though there would be no obstacle to direct setting of real rates. Hall and Reis (2016) discusses these topics in detail. Thus the behavior of inflation needs to be brought into the picture. More important, however, is that changing the policy rate has effects on output and employment relatively quickly and on inflation, with a longer lag, according to most views. As a result of the influence of the central bank’s policy rate on the other key macro variables, the other structural relations listed above come into play in the central bank’s choice of the policy rate. Only the most naive observer thinks that the central bank can pick its policy rate by unilateral whim. Friedman (1968), following Wick- sell, set forth a framework that remains influential fifty years later: There is a level of the real interest rate, r∗ , the natural rate, with the property that it is infeasible for the central bank to run a mon- etary policy that results in a real rate permanently above or below the natural rate. Thus many discussions of the behavior of the real rate focus on quantifying r∗ , generally as a quantity that varies over time. Since 1980, it has had a downward trend. The foundations of the hypothesis that rt∗ is a cognizable fea- ture of the economy are weak, in my opinion—see Hall (2005). It takes an economic or statistical model to extract rt∗ from data on rt and other variables. The results are model specific. Laubach and Williams (2003) is the canon of this literature. Notwithstand- ing my doubts about the foundations, these authors’ results seem completely reasonable. Juselius et al. (this issue) refine the canon. The middle of their figure 6 shows the real rate, which is volatile and cyclical. The Laubach-Williams natural rate is a plausibly smoothed version of the actual real rate. As Friedman’s analysis predicted, the actual real rate exceeds its natural level in booms and falls below in busts. The natural rate of Juselius et al. has higher volatility and, surprisingly, a higher level. Friedman’s analysis suggested fairly per- suasively that the real rate should deviate above about as much as below the natural rate, but the new construction has almost all of the deviations below. 106 International Journal of Central Banking September 2017 Figure 1. Spread between the Return to Capital and the Safe Real Interest Rate 2. The Marginal Product of Capital and the Return to Capital In an economy without uncertainty, the return to capital is linked to the marginal product by the rental price of capital. Provided the rental price includes the fluctuations in Tobin’s q—the ratio of the value of installed capital to the acquisition price of capital— arbitrage should equate the marginal product of capital to the rental price. To put it differently, if the rate of return is calculated from data that accounts for q, the rate of return will track the inter- est rate (measured over the same interval) period by period. With uncertainty, the rate of return will include a risk premium, which may vary over time. The recent macro literature has studied finan- cial frictions that interpose between wealth holders and businesses seeking to attract wealth to form business capital. Figure 1 shows the spread between the calculated return to cap- ital and the one-year safe real interest rate, from Hall (2015). Note that the spread is remarkably volatile, upward trending, and high except in recessions. Gomme, Ravikumar, and Rupert (2015) have made similar calculations. The notion that there is a tight connec- tion between the safe interest rate and the return to capital receives Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 107 Figure 2. U.S. Real Rate and Consumption Growth little support from this evidence. Rather, there is apparently large scope for variations over time in risk premiums, financial frictions, and other sources of the wedge between the earnings of capital and the risk-free cost of borrowing. These variations are almost certainly endogenous. 3. Consumption Growth and the Interest Rate Many macro models, including the New Keynesian models that have proliferated at central banks, contain an upward-sloping structural relation between expected consumption growth and the real interest rate—Rachel and Smith’s equation (1) describes the Euler equation reflecting this relation. The logic is that a higher real interest rate makes future consumption cheaper than current consumption, so households consume less currently and more in the future. To put it another way, higher growth rates should have correspondingly higher real interest rates. Figure 2 shows that this proposition is somewhat true in U.S. data averaged over decades. The proposition encounters some serious obstacles. First, Carroll and Summers (1991) observed that across countries that can trade goods and financial claims, all countries should have the same rate of growth of consumption, in accord with the worldwide real interest 108 International Journal of Central Banking September 2017 rate, irrespective of their rates of growth of income. Countries with high expected income growth should borrow from slower-growing countries and gradually pay the debt off as growth occurs. In fact, the evidence shows that consumption growth is tightly linked to income growth across countries. And growth rates differ markedly across countries, with the highest growth in recent decades in east and south Asia. Second, a household does not have a single Euler equation, but rather a different one for each asset. Hansen and Singleton (1983) is the classic citation on this point. There is nothing special about the safe real interest rate. Their paper showed that the data rejected the hypothesis that households satisfied all of the Euler equations. Third, data on household financial holdings make it clear that households with collectively an important fraction of total income face binding constraints on borrowing. They would like to obey the Euler-equation model but cannot commit to repaying the debt that they would incur if they did. They obey a related model where a shadow borrowing rate, higher than the measured one, tracks con- sumption growth. I conclude that research on consumption choices has a far richer view than the one expressed in the simple interest-only Euler equation. 4. The Role of the Interest Rate in an Economy where Risk-Tolerant Investors Insure Risk-Averse Ones by Borrowing from Them Hall (2016) demonstrates the theoretical and practical importance of trade among heterogeneous investors. In effect, the risk-tolerant investors insure the risk-averse ones. Debt has a key role in this risk- motivated trade. By borrowing from the risk averse, the risk-tolerant investors provide the risk averse with protection against future ran- dom shocks, because the payoff of the debt is unaffected by the shocks (provided no default occurs). The interest rate on the debt describes the terms of the risk trade. If the risk tolerant have high resources relative to the risk averse, collectively, the risk averse com- mand a good deal—they receive a high rate of interest on the funds they loan to the risk tolerant. But if there is an upward trend in the resources of the risk averse, the deal shifts disadvantageously away Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 109 from the risk averse—they earn less and less interest on the funds they lend. The paper shows that China behaves risk aversely, lending large volumes of funds to western Europe and the United States. But the Chinese resource base—measured by GDP—is growing faster than the resource base of the risk-tolerant borrowers. Hence the world real interest rate is declining on account of the differential growth. The model backing up this analysis is rigged to avoid the other issues discussed earlier in this commentary. There is no central bank intervening in the world financial market. There is no capital, so no issue of the relation of the marginal product of capital to the interest rate. Resources are growing at the rate of zero among the risk averse and the risk tolerant, so there are no issues of growth affecting the interest rate. The model embodies standard ideas from financial markets, including the hypothesis that investors attribute a small but positive probability that a truly bad event will occur and the hypothesis that the risk-averse investors place a somewhat higher probability on that event. My paper pursues the ideas in Bernanke et al. (2011) that there is a “global savings glut” and in Gourinchas, Rey, and Govillot (2010) and Caballero and Farhi (2016) that low real interest rates are the result of a “shortage” of safe assets. The paper derives results along those lines from the equilibrium of an Arrow-Debreu economy with complete capital markets. In place of gluts and shortages, the model hypothesizes changes over time in the resources held by the risk tolerant in relation to those held by the risk averse. Figure 3 shows how the safe real interest rate in the model declines as the fraction of resources held by the risk tolerant declines. The decline is similar to the decline that actually occurred from 1990 to the present, with real rates at or below zero. The risk-tolerant investors in the model have modestly lower coefficients of relative risk aversion and believe that the probability of bad conditions is modestly lower, compared with the risk-averse investors. The conclusion of the model is that heterogeneity coupled with a shift in relative resources toward the risk-averse investors can explain observed changes in the real interest rate without bringing in the declining growth rate or rising financial frictions. The paper makes no claim that the other forces are not actually influential, however. Fundamental to the success of the model is its hypothesis that both 110 International Journal of Central Banking September 2017 Figure 3. As the Fraction of Resources in the Hands of the Risk Tolerant Declines, the Interest Rate Falls types of investors behave as if they assigned small but important probabilities to a substantial negative shock, worse than has actu- ally occurred since the Great Depression. In this respect, the model follows the trend in recent financial economics, which finds, for exam- ple, that such beliefs about rare disasters are the most plausible way to explain the equity premium. One of the manifestations of heterogeneity in investors’ risk aver- sion is across countries. Investors in some countries, notably the United States, collectively take on risk from other parts of the world by maintaining positive net positions in foreign equity and negative net positions in debt—in effect, these countries borrow from the risk- averse countries and use the proceeds to buy foreign equity. Thus the United States is like a leveraged hedge fund. Countries can be divided into three groups: (i) those that absorb risk by borrowing in the global debt market and buying foreign equity, (ii) those that shed risk by lending to the risk absorbers and letting those countries take on the risk of their own equity, and (iii) those whose risk preferences are in the middle and choose not to absorb or shed risk and those whose financial markets are undeveloped and do not participate in global financial markets. Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 111 Figure 4. Countries that Absorb Risk by Holding Positive Amounts of Net Foreign Equity or by Borrowing from Foreign Lenders Note: Risk-absorbing countries are shown by dark shading. Created with mapchart.net. Figure 4 shows the countries that absorb risk. They are the advanced countries of western Europe and the countries scattered around the globe that fell under the influence of those countries and became advanced themselves. There appears to be a negative cor- relation between risk aversion and income per person, as the risk absorbers are all high-income countries. By far the largest absorber of risk is the United States. Figure 5 shows the countries that shed risk. Most are lower income. China is by far the largest of the shedders. China holds large amounts of dollar debt claims on the United States, with recent growth in its euro debt claims on western Europe. One high-income country, Japan, is a major risk shedder. The United States and other risk absorbers hold positive net amounts of foreign equity. Figure 6 shows the growth of risk absorption by the United States. The upper line shows U.S. net borrowing in the debt market and the lower line net U.S. holdings of foreign equity. The upward path in debt began in the mid-1980s and the upward path of equity in the 1990s. Debt continued to rise through 2011 (the last year for which I have data) while equity fell slightly after the 2008 financial 112 International Journal of Central Banking September 2017 Figure 5. Countries that Shed Risk by Holding Negative Amounts of Net Foreign Equity or by Lending Positive Amounts to Foreign Borrowers Note: Risk-shedding countries are shown by dark shading. Created with mapchart.net. Figure 6. Risk Absorption by the United States, 1970–2011 Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 113 Figure 7. Risk Shedding by China, 1981–2011 crisis. The average of the two measures—taken as an overall measure of risk absorption—rose from the 1980s and reached a plateau of 0.3 years of GDP. Figure 7 shows similar data for China starting in 1981—in ear- lier years, China was effectively walled off from the global economy. Starting in the early 1990s, China shed risk aggressively, reaching the point just before the crisis of the average of foreign debt owned and net foreign holdings of Chinese equity claims equal to 0.4 years of GDP. Following the crisis, Chinese risk shedding has remained at that level but has not grown. Risk splitting occurs within the United States in large volumes as well. Table 1 shows decade averages of a variety of financial institutions that hold risky financial positions funded in part by debt—held by risk-averse investors such as pension funds—and by correspondingly riskier equity held by risk-tolerant investors such as high-wealth households. Government debt is a prominent part of the risk splitting. In the case of government, the taxpayers make up the risk-tolerant side—the marginal taxpayer with substantially higher than average wealth takes on magnified risk by insuring the holders of government debt. On the private side, numerous types of financial institutions and securities have the effect of splitting risk between a tranche of low-risk debt and high-risk residual equity claims. 114 Table 1. Examples of the Scale of Risk-Splitting Institutions Government Private Consolidated GSE Private Non-mortgage Government GSE Guaranteed Equity Securiti- Non-financial Household Decade Debt Debt Debt Funds zations Corporate Debt Repos Debt 1980s 0.469 0.061 0.091 — 0.012 0.163 0.103 0.186 1990s 0.611 0.101 0.204 — 0.086 0.211 0.166 0.204 2000s 0.574 0.203 0.293 0.058 0.233 0.238 0.237 0.239 2010s 0.936 0.126 0.347 0.140 0.109 0.275 0.221 0.251 International Journal of Central Banking September 2017 Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 115 Figure 8. Scale of Risk-Splitting Institutions Relative to GDP Private equity is a rapidly growing example of this type of financial arrangement. Securitizations with overcollateralized debtlike securi- ties held by or on behalf of risk-averse investors and residual equity claims held by risk-tolerant investors grew rapidly until the crisis but have shrunk since then. Repurchase agreements split risk by overcollateralization to the extent of the repo haircut. These too have shrunk relative to GDP since the crisis. Figure 8 shows the generally upward trend of the volume of risk splitting in the United States, stated relative to GDP. Both gov- ernment and non-government contributions have risen, with some moderation after the crisis. 5. Concluding Remarks Prior to the financial crisis in 2008, risk splitting grew steadily, as revealed in data on both international and domestic financial posi- tions. Safe real interest rates declined in parallel. The crisis resulted in a downward jump in real rates corresponding to the fall in nom- inal short rates to essentially zero soon after the crisis struck. The corresponding real rate was between –1 percent and –2 percent. Real rates have risen in the United States recently, as nominal rates have 116 International Journal of Central Banking September 2017 become positive and inflation has risen close to the Federal Reserve’s target of 2 percent, but real rates in other markets remain as nega- tive as ever in the eight years since the crisis. Because the crisis hit GDP and asset value harder in advanced countries than in others, especially China, the influence studied in my analysis may explain some part of the drop in the global safe real short rate. In addition, the crisis may have raised investors’ beliefs about the probability of adverse events in the future, as in Kozlowski, Veldkamp, and Venkateswaran (2015). According to the principles considered here, the safe real rate would fall if the disaster probability rose more for the risk-averse investors than for the risk tolerant. I emphasize again that heterogeneity in risk aversion is only one of the factors entering a full explanation of the behavior of real rates over recent decades. Expansionary monetary policy, rising financial frictions, and slowing consumption growth need to be brought into a full analysis. References Bernanke, B. S., C. Bertaut, L. Pounder DeMarco, and S. Kamin. 2011. “International Capital Flows and the Returns to Safe Assets in the United States, 2003–2007.” International Finance Discussion Paper No. 1014, Board of Governors of the Federal Reserve System (February). Caballero, R. J., and E. Farhi. 2016. “The Safety Trap.” March. Harvard University, Department of Economics. Carroll, C. D., and L. H. Summers. 1991. “Consumption Growth Parallels Income Growth: Some New Evidence.” In National Sav- ing and Economic Performance, ed. B. D. Bernheim and J. B. Shovin, 305–48 (chapter 10). University of Chicago Press. Friedman, M. 1968. “The Role of Monetary Policy.” Presidential address delivered at the 80th Annual Meeting of the American Economics Association, Washington, DC, December 29, 1967. American Economic Review 58 (1): 1–15. Gomme, P., B. Ravikumar, and P. Rupert. 2015. “Secular Stagnation and Returns on Capital.” Economic Synopses (Federal Reserve Bank of St. Louis) (19): 1–3. Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 117 Gourinchas, P.-O., H. Rey, and N. Govillot. 2010. “Exorbitant Priv- ilege and Exorbitant Duty.” Discussion Paper No. 10-E-20, Insti- tute for Monetary and Economic Studies, Bank of Japan. Hall, R. E. 2005. “Separating the Business Cycle from Other Eco- nomic Fluctuations.” In The Greenspan Era: Lessons for the Future, 133–79. Proceedings of a symposium sponsored by the Federal Reserve Bank of Kansas City, August 25–27. ———. 2015. “Quantifying the Lasting Harm to the U.S. Economy from the Financial Crisis.” NBER Macroeconomics Annual 2014, Vol. 29, ed. J. A. Parker and M. Woodford, 71–128. University of Chicago Press. ———. 2016. “The Role of the Growth of Risk-Averse Wealth in the Decline of the Safe Real Interest Rate.” Hoover Institution (November). Hall, R. E., and R. Reis. 2016. “Achieving Price Stability by Manipu- lating the Central Bank’s Payment on Reserves.” NBER Working Paper No. 22761 (October). Hansen, L. P., and K. J. Singleton. 1983. “Stochastic Consumption, Risk Aversion, and the Temporal Behavior of Asset Returns.” Journal of Political Economy 91 (2): 249–65. Kozlowski, J., L. Veldkamp, and V. Venkateswaran. 2015. “The Tail that Wags the Economy: Beliefs and Persistent Stagnation.” NBER Working Paper No. 21719 (November). Krugman, P. R. 1998. “It’s Baaack: Japan’s Slump and the Return of the Liquidity Trap.” Brookings Papers on Economic Activity (2): 137–205. Laubach, T., and J. C Williams. 2003. “Measuring the Natural Rate of Interest.” Review of Economics and Statistics 85 (4): 1063–70. ","I'm providing you with your source material. You will not be using any outside material. Your job is to answer questions about the material. What are the main takeaways? Low Interest Rates: Causes and Consequences∗ Robert E. Hall Hoover Institution and Department of Economics, Stanford University National Bureau of Economic Research World interest rates have been declining for several decades. In a general equilibrium setting, the interest rate is determined by the interaction of a number of types of behavior: the policy of the central bank, investment in productive assets, the choice between current and future consumption, and the responses of wealth holders to risk. Central banks devote consider effort to determining equilibrium real rates, around which they set their policy rates, though measuring the equilibrium rate is challenging. The real interest rate is also connected to the marginal product of capital, though the connection is loose. Similarly, the real interest rate is connected to consumption growth through a Euler equation, but again many other influ- ences enter the relationship between the two variables. Finally, the idea of the “global saving glut” suggests that the rise of income in countries with high propensities to save may be a factor in the decline in real rates. That idea receives support in a simple model of global financial equilibrium between coun- tries with risk tolerance (the United States) and ones with high risk aversion (China). JEL Codes: E21, E22, E43, E52. Low world interest rates have stimulated new interest in the determination of the safe real rate. As a threshold matter, Rachel and Smith’s figure 1 (this issue) and Juselius et al.’s figure 1 (this issue) document the pronounced downward trend of world real inter- est rates since the 1980s. For the purposes of this commentary, I take ∗ This research was supported by the Hoover Institution. Complete backup for all of the calculations is available from my website, http://www.stanford. edu/∼rehall. Author contact: rehall@stanford.edu; stanford.edu/∼rehall. 103 104 International Journal of Central Banking September 2017 the real rate to be the yield net of inflation of safe government debt of maturity around one to two years. Thus I abstract from liquidity effects at the short end of the yield curve and from issues related to the slope of the yield curve. Structural relations governing the real interest rate include its relation to • the central bank’s payment on reserves and the extent of sat- uration of the financial system in reserves • the marginal product of capital • the rate of consumption growth (through the Euler equation) • the terms of trade between risk-tolerant and risk-averse investors In a complete macro model one or more equations would describe each of these structural relations. It would not be possible to divide up responsibility among them for the overall decline in the real rate. One can fashion a set of highly simplified models, each containing only one or two of the structural relations. For example, Krugman (1998) considers an economy with no capital and no uncertainty to focus on monetary policy and consumption growth and illuminate issues of the zero lower bound. But a set of models along those lines would not result in an additive breakdown of the sources of the decline in the real interest rate. 1. Monetary Policy and the Real Interest Rate Traditional monetary policy kept the interest paid on reserves at zero nominal and manipulated the quantity of reserves. Explaining how the central bank influenced interest rates involved consideration of the liquidity value of scarce reserves. Today, all major central banks have saturated their financial systems with reserves, so the liquid- ity value is zero, and the central banks execute monetary policy exclusively by manipulation of the payment made to reserve hold- ers (in the United States, a new kind of reserves, reverse repurchase agreements, play this role). Powerful forces of arbitrage link the central bank’s policy rate paid on reserves to similar short-term government obligations. The Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 105 central bank thus controls short rates directly. But the fact of central bank control does not mean that we need look no further to under- stand the movements of short rates. For one thing, it is the behavior of real rates that matters and all central banks set nominal rates, though there would be no obstacle to direct setting of real rates. Hall and Reis (2016) discusses these topics in detail. Thus the behavior of inflation needs to be brought into the picture. More important, however, is that changing the policy rate has effects on output and employment relatively quickly and on inflation, with a longer lag, according to most views. As a result of the influence of the central bank’s policy rate on the other key macro variables, the other structural relations listed above come into play in the central bank’s choice of the policy rate. Only the most naive observer thinks that the central bank can pick its policy rate by unilateral whim. Friedman (1968), following Wick- sell, set forth a framework that remains influential fifty years later: There is a level of the real interest rate, r∗ , the natural rate, with the property that it is infeasible for the central bank to run a mon- etary policy that results in a real rate permanently above or below the natural rate. Thus many discussions of the behavior of the real rate focus on quantifying r∗ , generally as a quantity that varies over time. Since 1980, it has had a downward trend. The foundations of the hypothesis that rt∗ is a cognizable fea- ture of the economy are weak, in my opinion—see Hall (2005). It takes an economic or statistical model to extract rt∗ from data on rt and other variables. The results are model specific. Laubach and Williams (2003) is the canon of this literature. Notwithstand- ing my doubts about the foundations, these authors’ results seem completely reasonable. Juselius et al. (this issue) refine the canon. The middle of their figure 6 shows the real rate, which is volatile and cyclical. The Laubach-Williams natural rate is a plausibly smoothed version of the actual real rate. As Friedman’s analysis predicted, the actual real rate exceeds its natural level in booms and falls below in busts. The natural rate of Juselius et al. has higher volatility and, surprisingly, a higher level. Friedman’s analysis suggested fairly per- suasively that the real rate should deviate above about as much as below the natural rate, but the new construction has almost all of the deviations below. 106 International Journal of Central Banking September 2017 Figure 1. Spread between the Return to Capital and the Safe Real Interest Rate 2. The Marginal Product of Capital and the Return to Capital In an economy without uncertainty, the return to capital is linked to the marginal product by the rental price of capital. Provided the rental price includes the fluctuations in Tobin’s q—the ratio of the value of installed capital to the acquisition price of capital— arbitrage should equate the marginal product of capital to the rental price. To put it differently, if the rate of return is calculated from data that accounts for q, the rate of return will track the inter- est rate (measured over the same interval) period by period. With uncertainty, the rate of return will include a risk premium, which may vary over time. The recent macro literature has studied finan- cial frictions that interpose between wealth holders and businesses seeking to attract wealth to form business capital. Figure 1 shows the spread between the calculated return to cap- ital and the one-year safe real interest rate, from Hall (2015). Note that the spread is remarkably volatile, upward trending, and high except in recessions. Gomme, Ravikumar, and Rupert (2015) have made similar calculations. The notion that there is a tight connec- tion between the safe interest rate and the return to capital receives Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 107 Figure 2. U.S. Real Rate and Consumption Growth little support from this evidence. Rather, there is apparently large scope for variations over time in risk premiums, financial frictions, and other sources of the wedge between the earnings of capital and the risk-free cost of borrowing. These variations are almost certainly endogenous. 3. Consumption Growth and the Interest Rate Many macro models, including the New Keynesian models that have proliferated at central banks, contain an upward-sloping structural relation between expected consumption growth and the real interest rate—Rachel and Smith’s equation (1) describes the Euler equation reflecting this relation. The logic is that a higher real interest rate makes future consumption cheaper than current consumption, so households consume less currently and more in the future. To put it another way, higher growth rates should have correspondingly higher real interest rates. Figure 2 shows that this proposition is somewhat true in U.S. data averaged over decades. The proposition encounters some serious obstacles. First, Carroll and Summers (1991) observed that across countries that can trade goods and financial claims, all countries should have the same rate of growth of consumption, in accord with the worldwide real interest 108 International Journal of Central Banking September 2017 rate, irrespective of their rates of growth of income. Countries with high expected income growth should borrow from slower-growing countries and gradually pay the debt off as growth occurs. In fact, the evidence shows that consumption growth is tightly linked to income growth across countries. And growth rates differ markedly across countries, with the highest growth in recent decades in east and south Asia. Second, a household does not have a single Euler equation, but rather a different one for each asset. Hansen and Singleton (1983) is the classic citation on this point. There is nothing special about the safe real interest rate. Their paper showed that the data rejected the hypothesis that households satisfied all of the Euler equations. Third, data on household financial holdings make it clear that households with collectively an important fraction of total income face binding constraints on borrowing. They would like to obey the Euler-equation model but cannot commit to repaying the debt that they would incur if they did. They obey a related model where a shadow borrowing rate, higher than the measured one, tracks con- sumption growth. I conclude that research on consumption choices has a far richer view than the one expressed in the simple interest-only Euler equation. 4. The Role of the Interest Rate in an Economy where Risk-Tolerant Investors Insure Risk-Averse Ones by Borrowing from Them Hall (2016) demonstrates the theoretical and practical importance of trade among heterogeneous investors. In effect, the risk-tolerant investors insure the risk-averse ones. Debt has a key role in this risk- motivated trade. By borrowing from the risk averse, the risk-tolerant investors provide the risk averse with protection against future ran- dom shocks, because the payoff of the debt is unaffected by the shocks (provided no default occurs). The interest rate on the debt describes the terms of the risk trade. If the risk tolerant have high resources relative to the risk averse, collectively, the risk averse com- mand a good deal—they receive a high rate of interest on the funds they loan to the risk tolerant. But if there is an upward trend in the resources of the risk averse, the deal shifts disadvantageously away Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 109 from the risk averse—they earn less and less interest on the funds they lend. The paper shows that China behaves risk aversely, lending large volumes of funds to western Europe and the United States. But the Chinese resource base—measured by GDP—is growing faster than the resource base of the risk-tolerant borrowers. Hence the world real interest rate is declining on account of the differential growth. The model backing up this analysis is rigged to avoid the other issues discussed earlier in this commentary. There is no central bank intervening in the world financial market. There is no capital, so no issue of the relation of the marginal product of capital to the interest rate. Resources are growing at the rate of zero among the risk averse and the risk tolerant, so there are no issues of growth affecting the interest rate. The model embodies standard ideas from financial markets, including the hypothesis that investors attribute a small but positive probability that a truly bad event will occur and the hypothesis that the risk-averse investors place a somewhat higher probability on that event. My paper pursues the ideas in Bernanke et al. (2011) that there is a “global savings glut” and in Gourinchas, Rey, and Govillot (2010) and Caballero and Farhi (2016) that low real interest rates are the result of a “shortage” of safe assets. The paper derives results along those lines from the equilibrium of an Arrow-Debreu economy with complete capital markets. In place of gluts and shortages, the model hypothesizes changes over time in the resources held by the risk tolerant in relation to those held by the risk averse. Figure 3 shows how the safe real interest rate in the model declines as the fraction of resources held by the risk tolerant declines. The decline is similar to the decline that actually occurred from 1990 to the present, with real rates at or below zero. The risk-tolerant investors in the model have modestly lower coefficients of relative risk aversion and believe that the probability of bad conditions is modestly lower, compared with the risk-averse investors. The conclusion of the model is that heterogeneity coupled with a shift in relative resources toward the risk-averse investors can explain observed changes in the real interest rate without bringing in the declining growth rate or rising financial frictions. The paper makes no claim that the other forces are not actually influential, however. Fundamental to the success of the model is its hypothesis that both 110 International Journal of Central Banking September 2017 Figure 3. As the Fraction of Resources in the Hands of the Risk Tolerant Declines, the Interest Rate Falls types of investors behave as if they assigned small but important probabilities to a substantial negative shock, worse than has actu- ally occurred since the Great Depression. In this respect, the model follows the trend in recent financial economics, which finds, for exam- ple, that such beliefs about rare disasters are the most plausible way to explain the equity premium. One of the manifestations of heterogeneity in investors’ risk aver- sion is across countries. Investors in some countries, notably the United States, collectively take on risk from other parts of the world by maintaining positive net positions in foreign equity and negative net positions in debt—in effect, these countries borrow from the risk- averse countries and use the proceeds to buy foreign equity. Thus the United States is like a leveraged hedge fund. Countries can be divided into three groups: (i) those that absorb risk by borrowing in the global debt market and buying foreign equity, (ii) those that shed risk by lending to the risk absorbers and letting those countries take on the risk of their own equity, and (iii) those whose risk preferences are in the middle and choose not to absorb or shed risk and those whose financial markets are undeveloped and do not participate in global financial markets. Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 111 Figure 4. Countries that Absorb Risk by Holding Positive Amounts of Net Foreign Equity or by Borrowing from Foreign Lenders Note: Risk-absorbing countries are shown by dark shading. Created with mapchart.net. Figure 4 shows the countries that absorb risk. They are the advanced countries of western Europe and the countries scattered around the globe that fell under the influence of those countries and became advanced themselves. There appears to be a negative cor- relation between risk aversion and income per person, as the risk absorbers are all high-income countries. By far the largest absorber of risk is the United States. Figure 5 shows the countries that shed risk. Most are lower income. China is by far the largest of the shedders. China holds large amounts of dollar debt claims on the United States, with recent growth in its euro debt claims on western Europe. One high-income country, Japan, is a major risk shedder. The United States and other risk absorbers hold positive net amounts of foreign equity. Figure 6 shows the growth of risk absorption by the United States. The upper line shows U.S. net borrowing in the debt market and the lower line net U.S. holdings of foreign equity. The upward path in debt began in the mid-1980s and the upward path of equity in the 1990s. Debt continued to rise through 2011 (the last year for which I have data) while equity fell slightly after the 2008 financial 112 International Journal of Central Banking September 2017 Figure 5. Countries that Shed Risk by Holding Negative Amounts of Net Foreign Equity or by Lending Positive Amounts to Foreign Borrowers Note: Risk-shedding countries are shown by dark shading. Created with mapchart.net. Figure 6. Risk Absorption by the United States, 1970–2011 Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 113 Figure 7. Risk Shedding by China, 1981–2011 crisis. The average of the two measures—taken as an overall measure of risk absorption—rose from the 1980s and reached a plateau of 0.3 years of GDP. Figure 7 shows similar data for China starting in 1981—in ear- lier years, China was effectively walled off from the global economy. Starting in the early 1990s, China shed risk aggressively, reaching the point just before the crisis of the average of foreign debt owned and net foreign holdings of Chinese equity claims equal to 0.4 years of GDP. Following the crisis, Chinese risk shedding has remained at that level but has not grown. Risk splitting occurs within the United States in large volumes as well. Table 1 shows decade averages of a variety of financial institutions that hold risky financial positions funded in part by debt—held by risk-averse investors such as pension funds—and by correspondingly riskier equity held by risk-tolerant investors such as high-wealth households. Government debt is a prominent part of the risk splitting. In the case of government, the taxpayers make up the risk-tolerant side—the marginal taxpayer with substantially higher than average wealth takes on magnified risk by insuring the holders of government debt. On the private side, numerous types of financial institutions and securities have the effect of splitting risk between a tranche of low-risk debt and high-risk residual equity claims. 114 Table 1. Examples of the Scale of Risk-Splitting Institutions Government Private Consolidated GSE Private Non-mortgage Government GSE Guaranteed Equity Securiti- Non-financial Household Decade Debt Debt Debt Funds zations Corporate Debt Repos Debt 1980s 0.469 0.061 0.091 — 0.012 0.163 0.103 0.186 1990s 0.611 0.101 0.204 — 0.086 0.211 0.166 0.204 2000s 0.574 0.203 0.293 0.058 0.233 0.238 0.237 0.239 2010s 0.936 0.126 0.347 0.140 0.109 0.275 0.221 0.251 International Journal of Central Banking September 2017 Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 115 Figure 8. Scale of Risk-Splitting Institutions Relative to GDP Private equity is a rapidly growing example of this type of financial arrangement. Securitizations with overcollateralized debtlike securi- ties held by or on behalf of risk-averse investors and residual equity claims held by risk-tolerant investors grew rapidly until the crisis but have shrunk since then. Repurchase agreements split risk by overcollateralization to the extent of the repo haircut. These too have shrunk relative to GDP since the crisis. Figure 8 shows the generally upward trend of the volume of risk splitting in the United States, stated relative to GDP. Both gov- ernment and non-government contributions have risen, with some moderation after the crisis. 5. Concluding Remarks Prior to the financial crisis in 2008, risk splitting grew steadily, as revealed in data on both international and domestic financial posi- tions. Safe real interest rates declined in parallel. The crisis resulted in a downward jump in real rates corresponding to the fall in nom- inal short rates to essentially zero soon after the crisis struck. The corresponding real rate was between –1 percent and –2 percent. Real rates have risen in the United States recently, as nominal rates have 116 International Journal of Central Banking September 2017 become positive and inflation has risen close to the Federal Reserve’s target of 2 percent, but real rates in other markets remain as nega- tive as ever in the eight years since the crisis. Because the crisis hit GDP and asset value harder in advanced countries than in others, especially China, the influence studied in my analysis may explain some part of the drop in the global safe real short rate. In addition, the crisis may have raised investors’ beliefs about the probability of adverse events in the future, as in Kozlowski, Veldkamp, and Venkateswaran (2015). According to the principles considered here, the safe real rate would fall if the disaster probability rose more for the risk-averse investors than for the risk tolerant. I emphasize again that heterogeneity in risk aversion is only one of the factors entering a full explanation of the behavior of real rates over recent decades. Expansionary monetary policy, rising financial frictions, and slowing consumption growth need to be brought into a full analysis. References Bernanke, B. S., C. Bertaut, L. Pounder DeMarco, and S. Kamin. 2011. “International Capital Flows and the Returns to Safe Assets in the United States, 2003–2007.” International Finance Discussion Paper No. 1014, Board of Governors of the Federal Reserve System (February). Caballero, R. J., and E. Farhi. 2016. “The Safety Trap.” March. Harvard University, Department of Economics. Carroll, C. D., and L. H. Summers. 1991. “Consumption Growth Parallels Income Growth: Some New Evidence.” In National Sav- ing and Economic Performance, ed. B. D. Bernheim and J. B. Shovin, 305–48 (chapter 10). University of Chicago Press. Friedman, M. 1968. “The Role of Monetary Policy.” Presidential address delivered at the 80th Annual Meeting of the American Economics Association, Washington, DC, December 29, 1967. American Economic Review 58 (1): 1–15. Gomme, P., B. Ravikumar, and P. Rupert. 2015. “Secular Stagnation and Returns on Capital.” Economic Synopses (Federal Reserve Bank of St. Louis) (19): 1–3. Vol. 13 No. 3 Low Interest Rates: Causes and Consequences 117 Gourinchas, P.-O., H. Rey, and N. Govillot. 2010. “Exorbitant Priv- ilege and Exorbitant Duty.” Discussion Paper No. 10-E-20, Insti- tute for Monetary and Economic Studies, Bank of Japan. Hall, R. E. 2005. “Separating the Business Cycle from Other Eco- nomic Fluctuations.” In The Greenspan Era: Lessons for the Future, 133–79. Proceedings of a symposium sponsored by the Federal Reserve Bank of Kansas City, August 25–27. ———. 2015. “Quantifying the Lasting Harm to the U.S. Economy from the Financial Crisis.” NBER Macroeconomics Annual 2014, Vol. 29, ed. J. A. Parker and M. Woodford, 71–128. University of Chicago Press. ———. 2016. “The Role of the Growth of Risk-Averse Wealth in the Decline of the Safe Real Interest Rate.” Hoover Institution (November). Hall, R. E., and R. Reis. 2016. “Achieving Price Stability by Manipu- lating the Central Bank’s Payment on Reserves.” NBER Working Paper No. 22761 (October). Hansen, L. P., and K. J. Singleton. 1983. “Stochastic Consumption, Risk Aversion, and the Temporal Behavior of Asset Returns.” Journal of Political Economy 91 (2): 249–65. Kozlowski, J., L. Veldkamp, and V. Venkateswaran. 2015. “The Tail that Wags the Economy: Beliefs and Persistent Stagnation.” NBER Working Paper No. 21719 (November). Krugman, P. R. 1998. “It’s Baaack: Japan’s Slump and the Return of the Liquidity Trap.” Brookings Papers on Economic Activity (2): 137–205. Laubach, T., and J. C Williams. 2003. “Measuring the Natural Rate of Interest.” Review of Economics and Statistics 85 (4): 1063–70. ",Financial,Summarize,Text Transformation This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge.,Explain the difference between the World Wide Web and the Internet.,"What is the Internet? The Internet began in 1969 as a project of the U.S. Department of Defense called ARPANET, or Advanced Research Projects Agency Network. The goal of this project was to design a nationwide computer network that could withstand major disasters. If one part of the network was destroyed, the other parts would continue to function due to the decentralized structure of the network. In the early days of ARPANET, there were four computers in the United States attached to the network. Today, there are millions all over the world. Most people define the Internet as a collection of computer networks, but what exactly is a network? A network is a group of two or more computers connected together with cables that allow the computers to share information. Computers that are “on the Internet” all use the same protocols to send information back and forth, allowing them to communicate with each other. As long as a computer uses these protocols, it doesn't matter what type of hardware or software it uses. In the Internet's early days (the 1960s and 1970s), only government, military, and educational institutions had computers connected to the Internet. The Internet was originally designed for research and scholarly communication. But as it grew, its services became more popular, and new ways of using the Internet multiplied. For example, the Internet began to be used for informal communication, entertainment, and eventually commerce, as more businesses connected to the Internet in the 1990s. According to statistics compiled by Nua Internet Surveys Ltd., some 605.60 million people worldwide were connected to the Internet as of September 2002. Today, the Internet remains decentralized, but it is no longer structured entirely around government computers. It is comprised of independently owned and managed individual networks of all sizes. The larger networks with high-speed connections are sometimes called backbone providers. Internet Service Providers (ISPs) lease Internet connections from the backbone providers and sell connections (also called Internet accounts) to consumers. Most home and small business users connect to the Internet with dial-up accounts to ISPs using a modem and special communications software. Uses for the Internet The Internet has a special significance for the library community because it allows patrons -- both children and adults -- who do not have computers to keep up with the Internet for business and academic purposes. Libraries, to a great extent, help bridge what is called the ""digital divide."" The services listed below would be unattainable for many unless they were provided free of charge by the community's public library. · E-mail allows libraries and patrons to send messages back and forth to individuals or groups. · Telnet allows libraries and patrons to connect to a remote computer and use it as if you were there. · File Transfer Protocol (FTP) allows libraries to transfer files to and from other computers. · Usenet allows libraries and patrons to participate in group discussions on specific topics. · Internet Relay Chat (IRC) allows libraries and patrons to chat in real time with one or many users. · World Wide Web allows libraries and patrons access to literally millions of Web sites worldwide. What is the World Wide Web? One reason for the Internet's growth explosion is the ease of use and popularity of the World Wide Web and its graphical, “point-and-click” user interface. The World Wide Web was invented in 1989 by Tim Berners-Lee, a scientist at the European Particle Physics Laboratory (CERN) in Geneva, Switzerland. Lee wanted to make the information he used for research on the Internet more organized and accessible. The World Wide Web is based on hypertext, which is a method of linking documents using embedded hyperlinks. Hyperlinks can be text, which is usually underlined or a different color than the main text, or graphics. World Wide Web documents are created using a special computer language called HTML (Hypertext Markup Language). HTML coding embeds clickable links in documents and enables simple formatting. Documents written in HTML are stored in computers called servers. Any Internet user who has a Web browser can retrieve the documents. A Web browser is a computer program that knows how to read and display hypertext documents. It also knows how to communicate with servers that store HTML files. The protocol used for this kind of communication is called Hypertext Transfer Protocol (HTTP). Documents on the World Wide Web are called Web pages. Web pages are organized into Web sites. Each Web page has its own address, known formally as a Uniform Resource Locator or URL. Here is a made-up example of a URL for a page on the CNN site: http://www.cnn.com/WEATHER/cities/asiapcf.html. · http:// is the protocol used to retrieve the document. · www.cnn.com is the domain name for the server where the document is stored. · /WEATHER/cities/ is the path to the document in the server's directory structure. · asiapcf.html is the name of the actual HTML file. When you enter a URL in a Web browser, or if you click a hypertext link, the browser sends a message using the HTTP protocol to the computer identified in the URL. This message contains a request for the document specified in the URL. The server sends a copy of the document back to the browser, and it is displayed on your screen. Understanding a few things about URLs and other Internet addresses can make using the Web a lot easier. The domain name (the name of the computer) in a URL can be assigned by a large number of businesses. Just type ""domain name"" into your search engine, and you will find companies who can register your top level domain name. The Internet Corporation for Assigned Names and Numbers (ICANN) Web site at www.icann.org has a long list of accredited domain name registrars. There are standard suffixes for domain names, called extensions, which help identify what type of organization owns the domain. For example, domain names ending in .com indicate a commercial organization. Common extensions to domain names include: · .net is used for major networks (such as a backbone provider), but is also in general use · .edu is used for colleges and universities. · .gov is used for U.S. federal government agencies. · .mil is used for U.S. military organizations. · .org is commonly used for nonprofit and other organizations. Because so many domain names were snapped up at a rapid pace, more top level domains have been created. In the latter part of 2000, ICANN selected seven new top-level domains (TLDs): · .aero is used to the air transport industry. · .biz is used for all-purpose business sites. · .coop is used for cooperatives. · .info has unrestricted use. · .museum is used for museums. · .name is used for individual Web sites. · .pro is used for professionals such as doctors, lawyers, accountants, and others. Domain names in countries outside the United States usually end with a two-letter code representing the country; for example, Canadian Web sites end in .ca. Some state and county Web pages, including many belonging to libraries, have domain names ending in .us.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. What is the Internet? The Internet began in 1969 as a project of the U.S. Department of Defense called ARPANET, or Advanced Research Projects Agency Network. The goal of this project was to design a nationwide computer network that could withstand major disasters. If one part of the network was destroyed, the other parts would continue to function due to the decentralized structure of the network. In the early days of ARPANET, there were four computers in the United States attached to the network. Today, there are millions all over the world. Most people define the Internet as a collection of computer networks, but what exactly is a network? A network is a group of two or more computers connected together with cables that allow the computers to share information. Computers that are “on the Internet” all use the same protocols to send information back and forth, allowing them to communicate with each other. As long as a computer uses these protocols, it doesn't matter what type of hardware or software it uses. In the Internet's early days (the 1960s and 1970s), only government, military, and educational institutions had computers connected to the Internet. The Internet was originally designed for research and scholarly communication. But as it grew, its services became more popular, and new ways of using the Internet multiplied. For example, the Internet began to be used for informal communication, entertainment, and eventually commerce, as more businesses connected to the Internet in the 1990s. According to statistics compiled by Nua Internet Surveys Ltd., some 605.60 million people worldwide were connected to the Internet as of September 2002. Today, the Internet remains decentralized, but it is no longer structured entirely around government computers. It is comprised of independently owned and managed individual networks of all sizes. The larger networks with high-speed connections are sometimes called backbone providers. Internet Service Providers (ISPs) lease Internet connections from the backbone providers and sell connections (also called Internet accounts) to consumers. Most home and small business users connect to the Internet with dial-up accounts to ISPs using a modem and special communications software. Uses for the Internet The Internet has a special significance for the library community because it allows patrons -- both children and adults -- who do not have computers to keep up with the Internet for business and academic purposes. Libraries, to a great extent, help bridge what is called the ""digital divide."" The services listed below would be unattainable for many unless they were provided free of charge by the community's public library. · E-mail allows libraries and patrons to send messages back and forth to individuals or groups. · Telnet allows libraries and patrons to connect to a remote computer and use it as if you were there. · File Transfer Protocol (FTP) allows libraries to transfer files to and from other computers. · Usenet allows libraries and patrons to participate in group discussions on specific topics. · Internet Relay Chat (IRC) allows libraries and patrons to chat in real time with one or many users. · World Wide Web allows libraries and patrons access to literally millions of Web sites worldwide. What is the World Wide Web? One reason for the Internet's growth explosion is the ease of use and popularity of the World Wide Web and its graphical, “point-and-click” user interface. The World Wide Web was invented in 1989 by Tim Berners-Lee, a scientist at the European Particle Physics Laboratory (CERN) in Geneva, Switzerland. Lee wanted to make the information he used for research on the Internet more organized and accessible. The World Wide Web is based on hypertext, which is a method of linking documents using embedded hyperlinks. Hyperlinks can be text, which is usually underlined or a different color than the main text, or graphics. World Wide Web documents are created using a special computer language called HTML (Hypertext Markup Language). HTML coding embeds clickable links in documents and enables simple formatting. Documents written in HTML are stored in computers called servers. Any Internet user who has a Web browser can retrieve the documents. A Web browser is a computer program that knows how to read and display hypertext documents. It also knows how to communicate with servers that store HTML files. The protocol used for this kind of communication is called Hypertext Transfer Protocol (HTTP). Documents on the World Wide Web are called Web pages. Web pages are organized into Web sites. Each Web page has its own address, known formally as a Uniform Resource Locator or URL. Here is a made-up example of a URL for a page on the CNN site: http://www.cnn.com/WEATHER/cities/asiapcf.html. · http:// is the protocol used to retrieve the document. · www.cnn.com is the domain name for the server where the document is stored. · /WEATHER/cities/ is the path to the document in the server's directory structure. · asiapcf.html is the name of the actual HTML file. When you enter a URL in a Web browser, or if you click a hypertext link, the browser sends a message using the HTTP protocol to the computer identified in the URL. This message contains a request for the document specified in the URL. The server sends a copy of the document back to the browser, and it is displayed on your screen. Understanding a few things about URLs and other Internet addresses can make using the Web a lot easier. The domain name (the name of the computer) in a URL can be assigned by a large number of businesses. Just type ""domain name"" into your search engine, and you will find companies who can register your top level domain name. The Internet Corporation for Assigned Names and Numbers (ICANN) Web site at www.icann.org has a long list of accredited domain name registrars. There are standard suffixes for domain names, called extensions, which help identify what type of organization owns the domain. For example, domain names ending in .com indicate a commercial organization. Common extensions to domain names include: · .net is used for major networks (such as a backbone provider), but is also in general use · .edu is used for colleges and universities. · .gov is used for U.S. federal government agencies. · .mil is used for U.S. military organizations. · .org is commonly used for nonprofit and other organizations. Because so many domain names were snapped up at a rapid pace, more top level domains have been created. In the latter part of 2000, ICANN selected seven new top-level domains (TLDs): · .aero is used to the air transport industry. · .biz is used for all-purpose business sites. · .coop is used for cooperatives. · .info has unrestricted use. · .museum is used for museums. · .name is used for individual Web sites. · .pro is used for professionals such as doctors, lawyers, accountants, and others. Domain names in countries outside the United States usually end with a two-letter code representing the country; for example, Canadian Web sites end in .ca. Some state and county Web pages, including many belonging to libraries, have domain names ending in .us. Explain the difference between the World Wide Web and the Internet. ",Internet/Technology,Explanation/Definition,Q&A "Using the provided information only, list the answers in bullet points with concise explanations. ",When is prompt outside help needed?,"Please note that Oura Services are not intended to diagnose, treat, cure, or prevent any disease or medical condition. The information and guidance in Oura Services are there for informational purposes only and cannot replace the services of health professionals or physicians. You should always consult a physician if you have any questions regarding a medical condition or any changes you intend to make to your sleep or activity based on information or guidance from Oura Services. Never disregard or delay in seeking professional medical advice because of something you’ve read from Oura Services. We are not responsible for any health problems that may result from information or guidance you receive from Oura Services. If you make any change to your sleep or activity based on Oura Services, you agree that you do so fully at your own risk. It is important to be sensitive to your body’s responses. For example, if you feel unexpected, repeated or long term pain, fatigue or discomfort due to having made changes to your sleep or activity, it is recommended that you consult a physician before continuing with such changes. The information and guidance in Oura Services may be misleading if your physiological functions and responses differ significantly from population averages due to medical conditions or rare natural differences. Please be cautious that the ring or any other Oura product you wear does not get caught on fixed structures or heavy objects when moving yourself or said heavier objects. If you experience redness or skin irritation on your finger due to the ring or any other Oura product, remove it immediately. If symptoms persist longer than 2-3 days of not using your Oura product, please contact a dermatologist. Finger size can vary depending on the time of the day, and sometimes it may be difficult to remove the ring from your finger. In case the ring gets stuck: → Use cold water and gentle soap to wet your finger, and slowly twist the ring to remove it. → Hold your hand up above your heart until the blood pressure gets lower, and then try to remove it. → In cases of emergency and/or discomfort, when you can’t remove the ring yourself, seek immediate medical attention. Use a soft cloth or hand wash with mild soap and water to clean the ring. Your Oura Ring can be worn during showers, baths, swimming, and snorkeling. Try to avoid wearing the ring when strength training, working with a shovel or other heavy tools, or carrying heavy objects made of metal, ceramics or stone. In addition, try to avoid wearing the ring next to other rings or objects which are made of metal, ceramics, stones or diamonds. The Oura Ring may get scratched and can itself scratch softer metal jewelry or other objects in close contact with the ring like phone covers made of gold, silver, or aluminum. Some ceramic phone covers with a soft coating may also get scratched. Keep the ring away from children. This product is not intended for individuals under the age of 18. Seek immediate medical attention if you know or suspect that a child has swallowed the ring. Do not leave the ring exposed to heat, such as in a vehicle or in the sun. Do not puncture the ring or its battery. Please avoid handling batteries, or working on devices and with machinery that contain batteries while wearing your Oura Ring. In certain cases, where both the cathode and the anode of another battery touch the ring, there is a risk of a short circuit which is similar to standard metallic rings. This can result in a potentially dangerous shock. Please take the proper precautions to avoid these situations.","Using the provided information only, list the answers in bullet points with concise explanations. When is prompt outside help needed? [Please note that Oura Services are not intended to diagnose, treat, cure, or prevent any disease or medical condition. The information and guidance in Oura Services are there for informational purposes only and cannot replace the services of health professionals or physicians. You should always consult a physician if you have any questions regarding a medical condition or any changes you intend to make to your sleep or activity based on information or guidance from Oura Services. Never disregard or delay in seeking professional medical advice because of something you’ve read from Oura Services. We are not responsible for any health problems that may result from information or guidance you receive from Oura Services. If you make any change to your sleep or activity based on Oura Services, you agree that you do so fully at your own risk. It is important to be sensitive to your body’s responses. For example, if you feel unexpected, repeated or long term pain, fatigue or discomfort due to having made changes to your sleep or activity, it is recommended that you consult a physician before continuing with such changes. The information and guidance in Oura Services may be misleading if your physiological functions and responses differ significantly from population averages due to medical conditions or rare natural differences. Please be cautious that the ring or any other Oura product you wear does not get caught on fixed structures or heavy objects when moving yourself or said heavier objects. If you experience redness or skin irritation on your finger due to the ring or any other Oura product, remove it immediately. If symptoms persist longer than 2-3 days of not using your Oura product, please contact a dermatologist. Finger size can vary depending on the time of the day, and sometimes it may be difficult to remove the ring from your finger. In case the ring gets stuck: → Use cold water and gentle soap to wet your finger, and slowly twist the ring to remove it. → Hold your hand up above your heart until the blood pressure gets lower, and then try to remove it. → In cases of emergency and/or discomfort, when you can’t remove the ring yourself, seek immediate medical attention. Use a soft cloth or hand wash with mild soap and water to clean the ring. Your Oura Ring can be worn during showers, baths, swimming, and snorkeling. Try to avoid wearing the ring when strength training, working with a shovel or other heavy tools, or carrying heavy objects made of metal, ceramics or stone. In addition, try to avoid wearing the ring next to other rings or objects which are made of metal, ceramics, stones or diamonds. The Oura Ring may get scratched and can itself scratch softer metal jewelry or other objects in close contact with the ring like phone covers made of gold, silver, or aluminum. Some ceramic phone covers with a soft coating may also get scratched. Keep the ring away from children. This product is not intended for individuals under the age of 18. Seek immediate medical attention if you know or suspect that a child has swallowed the ring. Do not leave the ring exposed to heat, such as in a vehicle or in the sun. Do not puncture the ring or its battery. Please avoid handling batteries, or working on devices and with machinery that contain batteries while wearing your Oura Ring. In certain cases, where both the cathode and the anode of another battery touch the ring, there is a risk of a short circuit which is similar to standard metallic rings. This can result in a potentially dangerous shock. Please take the proper precautions to avoid these situations.]",Retail/Product,Fact Finding,Q&A "You must generate a response using only this provided document. Do not use any other outside source to support your claims. If you are unable to answer the request using the supporting document only, then you must respond with ""please support more relevant documents so that I may answer your request accurately"".",What is neurotechnology?,"3/9/24, 4:11 PM Neurotechnology | Technology Networks Neurotechnology Imagine you could control your computer's mouse with your brain instead of your hand1. Imagine helping a patient with spinal cord injury to walk again2 by using a brain implant. It might sound like science fiction, but researchers have figured out how to make both scenarios a reality. It's all thanks to neurotechnology. There are many different types of neurotechnology, each with their role to play. From improving therapeutics for neurological and psychiatric disorders to augmenting current human capability (ever wanted to read someone's mind?) neurotechnology has a wide range of applications that make it a blossoming field worth paying attention to. What is neurotechnology? In its simplest form, neurotechnology is the integration of technical components3 with the nervous system. These components can be computers, electrodes or any other piece of engineering that can be set up to interface with the electric pulses coursing through our bodies. Neurotechnology has two main objectives - either to record signals from the brain and “translate” them into technical control commands (like our braincontrolled computer mouse), or to manipulate brain activity by applying electrical or optical stimuli (to help our paralysis patient). https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 1/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks The applications of neurotechnology are wide-ranging - from furthering the potential of academic research, to therapeutics, to developing brain/machine interfaces and more - and there are a lot of different types of neurotechnologies, some less invasive than others, which we will cover in this article. Electrophysiology In the 1780s, while experimenting with frogs’ legs, Luigi Galvani noticed that applying electric shocks made the legs twitch4 - even though they were disconnected from the frog's brain and body. That breakthrough instigated two centuries of research which would teach us a substantial amount5 about how neurons fire in response to stimuli, and how that firing is carried across different areas of the brain. It was the key that unlocked our understanding of how the brain is organized. In a nutshell6, electrophysiology involves the use of electrodes to understand the electrical properties of neurons. Researchers can record the activity of hundreds of cells at once, or home in on single cells using the patch-clamp technique. An electroencephalogram (EEG) is a type of electrophysiological monitoring method used to record electrical activity of several neurons at once.1 It is typically noninvasive, with the electrodes arranged in a cap and placed over the scalp, which measures voltage fluctuations of the brain regions beneath7. By contrast, an electrocorticogram (ECoG) involves placing electrodes in direct contact with the surface of the brain and measuring the brain waves in those specific brain regions. It is typically used intraoperatively to map epileptic regions of the brain and facilitate their safe removal8. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 2/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks Figure 1: Patch-clamp electrophysiology. Credit: Technology Networks In patch-clamp electrophysiology9, a glass micropipette with diameter < 3 microns10 is inserted into the membrane of a single cell. Electrically charged ions passing from the inside to the outside of the cell through the transmembrane channels charge the pipette solution. The electric current generated by this transmembrane movement of ions is detected by a metal electrode, which relays the data to an amplifier. This technique gives researchers incredible precision and certainty in their readings. Researchers can also measure the activity of several neurons at once. There are two main ways of doing this11. Firstly, a microelectrode array can be used. This is a grid of dozens of electrodes which can record the activity of multiple neurons on the surface of the brain. Despite being small in size, it is still too large to be inserted deep in the brain, so this technique is reserved for neurons on the surface of the brain. The second technique involves tetrodes. Tetrodes are microelectrode arrays composed of just four active electrodes - making them small enough to insert https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 3/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks into these deeper regions. Measuring large swathes of neurons like this leads to more uncertainty.5 Some types of neurons have a distinctive waveform, making them easily identifiable. However, these are the exception rather than the rule. Most neurons have ambiguous waveforms, making it difficult to ascertain exactly which neurons have been studied. Deep brain stimulation Deep brain stimulation refers to a technique12 that involves surgically implanting an electrode into specific areas of the brain to modulate the way it operates. These electrodes produce electrical impulses that regulate abnormal neuronal activity in the patient. The stimulation delivered to the brain is regulated by a pacemaker-like device that is implanted under the skin in the upper chest. A wire runs under the skin from this pacemaker to the electrodes. Though highly invasive, this procedure is reversible13 and generally doesn't lead to many side effects. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 4/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks Figure 2: A deep brain stimulator includes a pacemaker connected to electrodes in the brain. Credit: Technology Networks. While the exact mechanism of action isn't clear, the therapeutic effects14 of deep brain stimulation can be significant. For example, implanting electrodes into the ventral intermediate nucleus of the thalamus has been shown15 to dramatically decrease tremor, and even halt disease progression in essential tremor patients for more than 6 years after implantation. Additionally, stimulation of either the internal segment of the globus pallidus or the subthalamic nucleus has been shown14 to decrease the symptoms of bradykinesia, rigidity and gait impairment in patients with Parkinson's Disease. Other conditions that benefit from treatment with deep brain stimulation include epilepsy, OCD and dystonia. Transcranial magnetic stimulation https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 5/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks Transcranial magnetic stimulation (TMS)16 is a recently developed technique used in the treatment of psychiatric and neurological disorders. It belongs to a growing field of non-invasive brain stimulation (NIBS)17 techniques. TMS exposes the scalp to a magnetic field, which can modulate the electrical signals fired from neurons in the target region. Usually the magnetic field emanates from a ""wand-like"" device. Though the exact biological mechanism of TMS is not understood, it has been shown to provide relief18 from depressive symptoms and improve mood in some patients. Transcranial direct current stimulation Transcranial direct current stimulation (tDCS) is a method of brain stimulation19 that centers on modulating behavioral and cognitive processes, as well as the neural circuits underlying motor function. Like TMS, tDCS is a painless and non-invasive procedure. Two electrodes are placed on the scalp of the participant - a smaller target electrode on one hemisphere, and a larger reference electrode on the other hemisphere. A weak electrical current passes from the target electrode, through the brain, to the reference electrode - and in doing so, modulates the behavior of the patient. One line of study currently in the spotlight is ADHD therapy. Cognitive control tasks rely on good prefrontal cortex function - the impairment of this region can lead to impulse control issues. Studies have found that adolescents with ADHD exhibit reduced activity in certain prefrontal cortex regions, specifically the left dorsolateral prefrontal cortex (DLPFC). Using tDCS to stimulate the left https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 6/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks DLPFC has been shown to reduce impulsivity in patients with ADHD, by effectively making up for the deficit in activity20. Figure 3: tDCS may be delivered through cap-mounted electrodes. Credit: iStock It is generally accepted21 that a positive anodal, or excitatory, current is associated with upregulation of behaviors regulated by the brain region under the target electrode. On the other hand, negative cathodal, or inhibitory, current is associated with downregulation of said behaviors. tDCS is used to identify22 brain-behavior relationships across cognitive, motor, social and affective domains. Applications of tDCS on healthy populations have been demonstrated23 to temporarily modify behavior, accelerate learning, and boost task performance. Focused ultrasound https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 7/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks Breakthrough research24 at Carnegie Mellon University has recently shown that low-intensity ultrasound techniques can be applied to manipulate neurons in a cell-type selective manner. In other words, focused ultrasound (FUS) gives researchers the power to modulate specific neuro-circuits, making FUS a more highly targeted neurotherapy25 than deep brain stimulation, TMS, and tDCS. Figure 4: A diagram showing the mechanisms behind focused ultrasound (FUS). Credit: Technology Networks. FUS neuromodulation works by directing ultrasonic wave energy, through the skull, at highly-targeted brain regions. By tuning the parameters, scientists can either excite or inhibit specific neural circuits. FUS is FDA-approved in the US for treatment of essential tremor26. However, it is still not widely used in hospitals - it is a relatively novel therapy, barely a decade old. It carries several advantages over older therapies for essential tremor, namely being non-invasive, not relying on radiation, and not posing https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 8/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks any risk of infection27. For these reasons, we may see its presence pick up in the coming years. Brain-computer interfaces Simply put, a brain-computer interface (BCI)28 is a computer-based system that receives brain signals, analyzes them and then translates them into commands for devices, which produce a desired output. The main function of BCI in a medical context is therapeutic - restoring normal neuromuscular function to patients with disorders such as amyotrophic lateral sclerosis (ALS), cerebral palsy, stroke or spinal cord injury. Turning brain signals into commands for a computer system means patients will be able to move a cursor, type on a keyboard, manipulate a prosthetic just by using their brain. In 2015, researchers at the University of Houston succeeded in making an amputee control his prosthetic hand using only his mind for the first time - without the need for an invasive brain implant. Instead, the subject wore an 64-channel EEG headset, which monitored brain activity across motor, decision-making and action observation regions of the brain. The neuronal activity in these regions preceded the movement of the prosthetic hand by 50 - 90 milliseconds, proving that the brain was anticipating the movement before it happened29. Beyond this, BCIs also have a role to play in making surgery safer30. For example, BCIs can be used to monitor the surgeon's mental focus while they are performing a procedure, and then use this information to make the procedure safer. This system can train the surgeon to regulate their own mental state while performing surgery-like tasks using a robotic system. The https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 9/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks system presents augmented reality feedback to the surgeon, which helps their effort in maintaining a high level of mental focus during the task. Brain Implants The below video shows a monkey playing Pong with its mind31. As well as being, let’s be honest, pretty strange to watch, it is a beautiful illustration of a brain-computer interface in action. This technology, developed by Elon Musk's company Neuralink, is part of a revival of interest in brain implants. Monkey MindPong Though they might sound like something belonging to the future, the human fascination with brain implants has been around since the early 20th century, with the development of electroencephalography (EEG) by Hans Berger in 1929.32 Brain implants are one of the ways brains and computers interface in the first place. They allow users to communicate to computers and other external devices such as robotic hands. This makes them strong candidates as a therapy for patients who may have nerve damage in their limbs or spinal cord, as the brain implant allows these nerves to be bypassed entirely while still achieving the desired output. The implants record action potentials and local field potentials of neurons with high temporal and spatial resolution and high channel count33. This lets researchers cover lots of neural tissue at once. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 10/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks The implantation is currently delivered manually, by a surgeon, via a craniotomy. While it is certainly invasive, the procedure is reversible34 without any serious side-effects, at least in the pigs that Musk has also experimented on. While Musk's vision for Neuralink is to offer its brain technology as an elective procedure35 for any average person, other brain implant companies are thinking differently. For example, Florian Solzbacher is clear that the development of nonimplantable BCIs32 are also of great interest to his company Blackrock Neurotech. According to the company, just 34 people in the world currently have a device implanted in their brains - this neurotechnology is clearly still in its infancy. That said, Blackrock's MoveAgain BCI implant recently gained Breakthrough Device designation from the FDA, and the company intends to commercialize MoveAgain this year36. It wouldn't be a stretch to imagine we may be standing on the precipice of brain implants taking off as a standard therapy for several debilitating, chronic conditions. Ethics of neurotechnology If reading about all these developments in neurotechnology has made you uncomfortable, you're not alone. Continue reading below... https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 11/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks Neurotechnology, while therapeutically very promising, is an ethical minefield. It raises questions around rights to data, privacy, and the risk of side-stepping regulations in the name of easier marketing. Let's think back to our Pong-playing monkey. The researchers monitoring Pager's neuroactivity have that data on their computers. Who owns that data? Is it Pager's, or Neuralink's? Moving a cursor on a screen is one thing, but what if the neural activity encoded is more sensitive than that? What kind of rules around privacy exist to protect the user? These are all questions that need to be considered. The rapid rise in interest in neurotechnology has also meant regulation has been slow to keep up. Because the way products are marketed informs the regulations they need to comply with, there is a fear that companies are sidestepping critical checks37 by marketing their neurotechnologies as ""wellness"" products rather than medical devices. Conclusion The field of neurotechnology encompasses many techniques and types of technology. From being able to record the activity of a single neuron firing, to https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 12/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks modulating the activity of entire brain regions, there's no doubt neurotechnology is and will continue to change the way we treat neurological and psychiatric conditions. As Florien Solzbacher of Blackrock Neurotech put it, ""I do foresee that in 20-30 years, these types of implants will be just as common and acceptable as cardiac pacemakers are today.""33 If Solzbacher's predictions come true, it will change the game for sufferers of dementia, mood disorders and neurodegenerative diseases. Neurotechnology has the potential to help us diminish the symptoms of these diseases, but also to augment the human experience. We just have to be open to it. About the author: Julia is a location-independent writer with a passion for communicating scientific ideas to the public. She holds a BSc (Hons) in Medical Science and a MSc in Sustainable Agriculture, and loves writing about neuroscience, behaviour, agriculture, ecology, conservation, and more. In her free time she loves dancing, hiking, and making music. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 13/13 ","You must generate a response using only this provided document. Do not use any other outside source to support your claims. If you are unable to answer the request using the supporting document only, then you must respond with ""please support more relevant documents so that I may answer your request accurately"". What is neurotechnology? 3/9/24, 4:11 PM Neurotechnology | Technology Networks Neurotechnology Imagine you could control your computer's mouse with your brain instead of your hand1. Imagine helping a patient with spinal cord injury to walk again2 by using a brain implant. It might sound like science fiction, but researchers have figured out how to make both scenarios a reality. It's all thanks to neurotechnology. There are many different types of neurotechnology, each with their role to play. From improving therapeutics for neurological and psychiatric disorders to augmenting current human capability (ever wanted to read someone's mind?) neurotechnology has a wide range of applications that make it a blossoming field worth paying attention to. What is neurotechnology? In its simplest form, neurotechnology is the integration of technical components3 with the nervous system. These components can be computers, electrodes or any other piece of engineering that can be set up to interface with the electric pulses coursing through our bodies. Neurotechnology has two main objectives - either to record signals from the brain and “translate” them into technical control commands (like our braincontrolled computer mouse), or to manipulate brain activity by applying electrical or optical stimuli (to help our paralysis patient). https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 1/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks The applications of neurotechnology are wide-ranging - from furthering the potential of academic research, to therapeutics, to developing brain/machine interfaces and more - and there are a lot of different types of neurotechnologies, some less invasive than others, which we will cover in this article. Electrophysiology In the 1780s, while experimenting with frogs’ legs, Luigi Galvani noticed that applying electric shocks made the legs twitch4 - even though they were disconnected from the frog's brain and body. That breakthrough instigated two centuries of research which would teach us a substantial amount5 about how neurons fire in response to stimuli, and how that firing is carried across different areas of the brain. It was the key that unlocked our understanding of how the brain is organized. In a nutshell6, electrophysiology involves the use of electrodes to understand the electrical properties of neurons. Researchers can record the activity of hundreds of cells at once, or home in on single cells using the patch-clamp technique. An electroencephalogram (EEG) is a type of electrophysiological monitoring method used to record electrical activity of several neurons at once.1 It is typically noninvasive, with the electrodes arranged in a cap and placed over the scalp, which measures voltage fluctuations of the brain regions beneath7. By contrast, an electrocorticogram (ECoG) involves placing electrodes in direct contact with the surface of the brain and measuring the brain waves in those specific brain regions. It is typically used intraoperatively to map epileptic regions of the brain and facilitate their safe removal8. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 2/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks Figure 1: Patch-clamp electrophysiology. Credit: Technology Networks In patch-clamp electrophysiology9, a glass micropipette with diameter < 3 microns10 is inserted into the membrane of a single cell. Electrically charged ions passing from the inside to the outside of the cell through the transmembrane channels charge the pipette solution. The electric current generated by this transmembrane movement of ions is detected by a metal electrode, which relays the data to an amplifier. This technique gives researchers incredible precision and certainty in their readings. Researchers can also measure the activity of several neurons at once. There are two main ways of doing this11. Firstly, a microelectrode array can be used. This is a grid of dozens of electrodes which can record the activity of multiple neurons on the surface of the brain. Despite being small in size, it is still too large to be inserted deep in the brain, so this technique is reserved for neurons on the surface of the brain. The second technique involves tetrodes. Tetrodes are microelectrode arrays composed of just four active electrodes - making them small enough to insert https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 3/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks into these deeper regions. Measuring large swathes of neurons like this leads to more uncertainty.5 Some types of neurons have a distinctive waveform, making them easily identifiable. However, these are the exception rather than the rule. Most neurons have ambiguous waveforms, making it difficult to ascertain exactly which neurons have been studied. Deep brain stimulation Deep brain stimulation refers to a technique12 that involves surgically implanting an electrode into specific areas of the brain to modulate the way it operates. These electrodes produce electrical impulses that regulate abnormal neuronal activity in the patient. The stimulation delivered to the brain is regulated by a pacemaker-like device that is implanted under the skin in the upper chest. A wire runs under the skin from this pacemaker to the electrodes. Though highly invasive, this procedure is reversible13 and generally doesn't lead to many side effects. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 4/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks Figure 2: A deep brain stimulator includes a pacemaker connected to electrodes in the brain. Credit: Technology Networks. While the exact mechanism of action isn't clear, the therapeutic effects14 of deep brain stimulation can be significant. For example, implanting electrodes into the ventral intermediate nucleus of the thalamus has been shown15 to dramatically decrease tremor, and even halt disease progression in essential tremor patients for more than 6 years after implantation. Additionally, stimulation of either the internal segment of the globus pallidus or the subthalamic nucleus has been shown14 to decrease the symptoms of bradykinesia, rigidity and gait impairment in patients with Parkinson's Disease. Other conditions that benefit from treatment with deep brain stimulation include epilepsy, OCD and dystonia. Transcranial magnetic stimulation https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 5/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks Transcranial magnetic stimulation (TMS)16 is a recently developed technique used in the treatment of psychiatric and neurological disorders. It belongs to a growing field of non-invasive brain stimulation (NIBS)17 techniques. TMS exposes the scalp to a magnetic field, which can modulate the electrical signals fired from neurons in the target region. Usually the magnetic field emanates from a ""wand-like"" device. Though the exact biological mechanism of TMS is not understood, it has been shown to provide relief18 from depressive symptoms and improve mood in some patients. Transcranial direct current stimulation Transcranial direct current stimulation (tDCS) is a method of brain stimulation19 that centers on modulating behavioral and cognitive processes, as well as the neural circuits underlying motor function. Like TMS, tDCS is a painless and non-invasive procedure. Two electrodes are placed on the scalp of the participant - a smaller target electrode on one hemisphere, and a larger reference electrode on the other hemisphere. A weak electrical current passes from the target electrode, through the brain, to the reference electrode - and in doing so, modulates the behavior of the patient. One line of study currently in the spotlight is ADHD therapy. Cognitive control tasks rely on good prefrontal cortex function - the impairment of this region can lead to impulse control issues. Studies have found that adolescents with ADHD exhibit reduced activity in certain prefrontal cortex regions, specifically the left dorsolateral prefrontal cortex (DLPFC). Using tDCS to stimulate the left https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 6/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks DLPFC has been shown to reduce impulsivity in patients with ADHD, by effectively making up for the deficit in activity20. Figure 3: tDCS may be delivered through cap-mounted electrodes. Credit: iStock It is generally accepted21 that a positive anodal, or excitatory, current is associated with upregulation of behaviors regulated by the brain region under the target electrode. On the other hand, negative cathodal, or inhibitory, current is associated with downregulation of said behaviors. tDCS is used to identify22 brain-behavior relationships across cognitive, motor, social and affective domains. Applications of tDCS on healthy populations have been demonstrated23 to temporarily modify behavior, accelerate learning, and boost task performance. Focused ultrasound https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 7/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks Breakthrough research24 at Carnegie Mellon University has recently shown that low-intensity ultrasound techniques can be applied to manipulate neurons in a cell-type selective manner. In other words, focused ultrasound (FUS) gives researchers the power to modulate specific neuro-circuits, making FUS a more highly targeted neurotherapy25 than deep brain stimulation, TMS, and tDCS. Figure 4: A diagram showing the mechanisms behind focused ultrasound (FUS). Credit: Technology Networks. FUS neuromodulation works by directing ultrasonic wave energy, through the skull, at highly-targeted brain regions. By tuning the parameters, scientists can either excite or inhibit specific neural circuits. FUS is FDA-approved in the US for treatment of essential tremor26. However, it is still not widely used in hospitals - it is a relatively novel therapy, barely a decade old. It carries several advantages over older therapies for essential tremor, namely being non-invasive, not relying on radiation, and not posing https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 8/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks any risk of infection27. For these reasons, we may see its presence pick up in the coming years. Brain-computer interfaces Simply put, a brain-computer interface (BCI)28 is a computer-based system that receives brain signals, analyzes them and then translates them into commands for devices, which produce a desired output. The main function of BCI in a medical context is therapeutic - restoring normal neuromuscular function to patients with disorders such as amyotrophic lateral sclerosis (ALS), cerebral palsy, stroke or spinal cord injury. Turning brain signals into commands for a computer system means patients will be able to move a cursor, type on a keyboard, manipulate a prosthetic just by using their brain. In 2015, researchers at the University of Houston succeeded in making an amputee control his prosthetic hand using only his mind for the first time - without the need for an invasive brain implant. Instead, the subject wore an 64-channel EEG headset, which monitored brain activity across motor, decision-making and action observation regions of the brain. The neuronal activity in these regions preceded the movement of the prosthetic hand by 50 - 90 milliseconds, proving that the brain was anticipating the movement before it happened29. Beyond this, BCIs also have a role to play in making surgery safer30. For example, BCIs can be used to monitor the surgeon's mental focus while they are performing a procedure, and then use this information to make the procedure safer. This system can train the surgeon to regulate their own mental state while performing surgery-like tasks using a robotic system. The https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 9/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks system presents augmented reality feedback to the surgeon, which helps their effort in maintaining a high level of mental focus during the task. Brain Implants The below video shows a monkey playing Pong with its mind31. As well as being, let’s be honest, pretty strange to watch, it is a beautiful illustration of a brain-computer interface in action. This technology, developed by Elon Musk's company Neuralink, is part of a revival of interest in brain implants. Monkey MindPong Though they might sound like something belonging to the future, the human fascination with brain implants has been around since the early 20th century, with the development of electroencephalography (EEG) by Hans Berger in 1929.32 Brain implants are one of the ways brains and computers interface in the first place. They allow users to communicate to computers and other external devices such as robotic hands. This makes them strong candidates as a therapy for patients who may have nerve damage in their limbs or spinal cord, as the brain implant allows these nerves to be bypassed entirely while still achieving the desired output. The implants record action potentials and local field potentials of neurons with high temporal and spatial resolution and high channel count33. This lets researchers cover lots of neural tissue at once. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 10/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks The implantation is currently delivered manually, by a surgeon, via a craniotomy. While it is certainly invasive, the procedure is reversible34 without any serious side-effects, at least in the pigs that Musk has also experimented on. While Musk's vision for Neuralink is to offer its brain technology as an elective procedure35 for any average person, other brain implant companies are thinking differently. For example, Florian Solzbacher is clear that the development of nonimplantable BCIs32 are also of great interest to his company Blackrock Neurotech. According to the company, just 34 people in the world currently have a device implanted in their brains - this neurotechnology is clearly still in its infancy. That said, Blackrock's MoveAgain BCI implant recently gained Breakthrough Device designation from the FDA, and the company intends to commercialize MoveAgain this year36. It wouldn't be a stretch to imagine we may be standing on the precipice of brain implants taking off as a standard therapy for several debilitating, chronic conditions. Ethics of neurotechnology If reading about all these developments in neurotechnology has made you uncomfortable, you're not alone. Continue reading below... https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 11/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks Neurotechnology, while therapeutically very promising, is an ethical minefield. It raises questions around rights to data, privacy, and the risk of side-stepping regulations in the name of easier marketing. Let's think back to our Pong-playing monkey. The researchers monitoring Pager's neuroactivity have that data on their computers. Who owns that data? Is it Pager's, or Neuralink's? Moving a cursor on a screen is one thing, but what if the neural activity encoded is more sensitive than that? What kind of rules around privacy exist to protect the user? These are all questions that need to be considered. The rapid rise in interest in neurotechnology has also meant regulation has been slow to keep up. Because the way products are marketed informs the regulations they need to comply with, there is a fear that companies are sidestepping critical checks37 by marketing their neurotechnologies as ""wellness"" products rather than medical devices. Conclusion The field of neurotechnology encompasses many techniques and types of technology. From being able to record the activity of a single neuron firing, to https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 12/13 3/9/24, 4:11 PM Neurotechnology | Technology Networks modulating the activity of entire brain regions, there's no doubt neurotechnology is and will continue to change the way we treat neurological and psychiatric conditions. As Florien Solzbacher of Blackrock Neurotech put it, ""I do foresee that in 20-30 years, these types of implants will be just as common and acceptable as cardiac pacemakers are today.""33 If Solzbacher's predictions come true, it will change the game for sufferers of dementia, mood disorders and neurodegenerative diseases. Neurotechnology has the potential to help us diminish the symptoms of these diseases, but also to augment the human experience. We just have to be open to it. About the author: Julia is a location-independent writer with a passion for communicating scientific ideas to the public. She holds a BSc (Hons) in Medical Science and a MSc in Sustainable Agriculture, and loves writing about neuroscience, behaviour, agriculture, ecology, conservation, and more. In her free time she loves dancing, hiking, and making music. https://www.technologynetworks.com/neuroscience/articles/neurotechnology-358488 13/13 ",Internet/Technology,Explanation/Definition,Q&A Simplify the language used so it's easier to understand. Only pull information from the provided document.,What is the short title of the act?,"1ST SESSION, 43RD LEGISLATURE, ONTARIO 2 CHARLES III, 2023 Bill 152 An Act to amend the Highway Traffic Act to prohibit passing on a highway painted with double solid yellow lines Mr. G. Bourgouin Private Member’s Bill 1st Reading November 21, 2023 2nd Reading 3rd Reading Royal Assent Bill 152 2023 An Act to amend the Highway Traffic Act to prohibit passing on a highway painted with double solid yellow lines His Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows: 1 Section 148 of the Highway Traffic Act is amended by adding the following subsection: Double solid yellow lines (9) No person in charge of a vehicle shall pass or attempt to pass another vehicle going in the same direction on a highway if doing so would require the crossing of double solid yellow lines painted on the roadway. Offence (10) Every person who contravenes subsection (9) is guilty of an offence and on conviction is liable to, (a) a fine of $400; and (b) three or more demerit points under Ontario Regulation 339/94 (Demerit Point System) made under this Act. Commencement 2 This Act comes into force on the day it receives Royal Assent. Short title 3 The short title of this Act is the Chad’s Law (Enforcing Safer Passing), 2023. ______________ EXPLANATORY NOTE Section 148 of the Highway Traffic Act is amended to prohibit passing or attempting to pass another vehicle going in the same direction on a highway if doing so would require the crossing of double solid yellow lines painted on the roadway. Every person who contravenes this prohibition is guilty of an offence and on conviction is liable to a fine of $400 and three or more demerit points.","Simplify the language used so it's easier to understand. Only pull information from the provided document. What is the short title of the act? 1ST SESSION, 43RD LEGISLATURE, ONTARIO 2 CHARLES III, 2023 Bill 152 An Act to amend the Highway Traffic Act to prohibit passing on a highway painted with double solid yellow lines Mr. G. Bourgouin Private Member’s Bill 1st Reading November 21, 2023 2nd Reading 3rd Reading Royal Assent Bill 152 2023 An Act to amend the Highway Traffic Act to prohibit passing on a highway painted with double solid yellow lines His Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows: 1 Section 148 of the Highway Traffic Act is amended by adding the following subsection: Double solid yellow lines (9) No person in charge of a vehicle shall pass or attempt to pass another vehicle going in the same direction on a highway if doing so would require the crossing of double solid yellow lines painted on the roadway. Offence (10) Every person who contravenes subsection (9) is guilty of an offence and on conviction is liable to, (a) a fine of $400; and (b) three or more demerit points under Ontario Regulation 339/94 (Demerit Point System) made under this Act. Commencement 2 This Act comes into force on the day it receives Royal Assent. Short title 3 The short title of this Act is the Chad’s Law (Enforcing Safer Passing), 2023. ______________ EXPLANATORY NOTE Section 148 of the Highway Traffic Act is amended to prohibit passing or attempting to pass another vehicle going in the same direction on a highway if doing so would require the crossing of double solid yellow lines painted on the roadway. Every person who contravenes this prohibition is guilty of an offence and on conviction is liable to a fine of $400 and three or more demerit points.",Legal,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Over the past 50 the percentage of Americans suffering from obesity has increased dramatically. Is it our fault we're becoming fatter? What role does the quality of food and crops play? What role do additives, synthetic chemicals, hormones, and GMO crops play? Is the government doing enough to protect us? How do we avoid or lessen our exposure to toxic chemicals?","Chemicals in our food may be contributing to weight gain It’s no secret rates of overweight, obesity and other metabolic diseases are skyrocketing. And food is a big part of the problem, though not in the way you might think. It isn’t just how many calories we consume and burn. The nutritional value of food and how much it’s processed also play a role in how what we eat affects our weight. Another likely culprit behind weight gain is the harmful chemicals in what we consume. Some of these substances, called obesogens, can contribute to weight gain and lead to obesity, in turn raising a person’s risk of heart disease and other serious health problems. Scientists have found evidence of about 50 of these chemicals. They can be found in many consumer products, as well as in polluted air and water. But one of the most important ways we’re exposed is by consuming contaminated food. Harmful ingredients hiding in plain sight Studies show a link between highly processed foods – typically not very nutritious, with high levels of trans fat, sugar and sodium – and higher risk of metabolic diseases that, in turn, can lead to health problems, including heart disease, stroke and cancer, which are significant causes of preventable illness and death. Processed foods, from fast food to some “healthy” products like protein bars and vegetarian microwave meals, often have many artificial ingredients, such as sweeteners, flavor enhancers and preservatives, some of which are obesogens. Some obesogens occur naturally in food. One, fructose, accounts for about 40 percent of sweeteners we consume. But most obesogens in food are artificial chemicals, some added intentionally, particularly in highly processed food. Others contaminate food indirectly, through packaging, residual pesticides, or legacy environmental contamination from industrial chemicals, pesticides and heavy metals. Food additives MSG is a common flavor enhancer that shows obesogenic effects in animals. Artificial sweeteners – particularly aspartame, sucralose and saccharin – is another obesogen found in a wide range of low-calorie and diet food and beverage products. Research suggests some may be obesogenic and others, like most chemicals, haven’t been studied enough for us to know whether they are or not. The preservatives BHA and methyl and butyl paraben are likely obesogenic and can be found in everything from vegetable oils to processed meat and chewing gum to potato chips. Several emulsifiers are potential obesogens. Food contaminants BPA migrates from food packaging into food. PFOA is one of the most notorious types of the “forever chemicals” known as PFAS, used in nonstick cookware, cooking implements and food packaging like takeout containers. PCBs, once used in industrial materials like paint, varnish, plastic, pesticides and coolants, still make their way into some animal products, though they’ve been banned since 1979. Flame retardants – used to treat clothing, bedding, electronics and children’s products, among other items – get into our waterways and eventually our food. Many pesticides have obesogenic properties. Even banned pesticides enter the food supply, because they persist in land used for crops. Regulating or banning obesogens in food Our focus must shift from considering overweight and obesity the result of a personal, moral failing to treating it as a result of environmental exposures and inequitable access to healthy food. This change may already be starting: Some physicians are beginning to approach obesity in their clinical practices from this perspective and looking for ways to limit exposures as an approach to weight loss. But it’s up to the government to protect us from these chemicals: The FDA, Department of Defense and Environmental Protection Agency must ban or restrict the most pervasive and harmful food chemicals. To make sure we face less exposure to these harmful chemicals, lawmakers and regulators must: • Develop greater transparency in food labeling. • Issue stronger recommendations in the Dietary Guidelines, to address other food additives, in addition to natural and artificial sweeteners, sodium and saturated fat. • Provide more funding for programs improving accessibility and availability of healthier food options. • Look for new ways to address environmental injustices that promote racial and ethnic disparities in exposure to obesogens in food. In addition, the White House Conference on Hunger, Nutrition, and Health on September 28 will shine a light on obesogens, among other issues – a chance to meaningfully reduce our exposure to these chemicals. EWG is part of a coalition of organizations that called on President Joe Biden to implement numerous changes to improve Americans’ food, nutrition and health. Two changes would protect us from ongoing exposure to obesogens: • Closing the regulatory loophole that allows chemical companies to introduce new chemicals, some of them obesogens, into the supply chain without approval from the FDA. Many of these substances have never undergone a safety review by the FDA. • Requiring the FDA to identify and reassess food chemicals of concern, including obesogens, already in use. The FDA doesn’t have to routinely reassess the safety of these chemicals. So substances like PFAS, BPA and phthalates remain in use long after evidence emerges linking them to harm to our metabolism and other health risks. What you can do Many obesogens are, at best, tough to avoid. But you can limit your exposure to chemicals added to food intentionally, especially some artificial sweeteners, preservatives and added sugars, like high-fructose corn syrup. To reduce your exposure to harmful chemicals: • Find out about additive names and study the labels of foods you buy to learn what you’re consuming (and can avoid). • Eat lower on the food chain – fresh produce, beans and whole grains don’t contain food additives. • Choose organic fruit and vegetables, when you can, to lower your exposure to pesticides. Consult EWG’s Shopper’s Guide to Pesticides in Produce™ to see which are best to eat organic and which are OK to eat non-organic, if necessary. • Choose organic animal products – or eat less and find other protein sources instead. Antibiotics and hormones accumulate in non-organic animal products. • Avoid plastic and grease- and waterproof food packaging. (And eat less takeout – the packaging may contain PFAS or plastic additives.) • Use glass, ceramic or stainless steel instead of nonstick for cookware, and wood and stainless steel for cooking utensils. • Instead of plastic, use glass, ceramic, or stainless steel containers to store and microwave food. • For water on the go, use stainless steel bottles rather than plastic, which may leach phthalates and BPA. • Avoid plastic labeled with code 7, which indicates the presence of BPA, or 3, which indicates PVC. • Consult EWG’s Tap Water Database to see what’s in your water. Then see which filter is best for your own situation. Avoid bottled water – it may be no better than tap water, and the plastic leaches into the water."," Only use the provided text to answer the question, no outside sources. Over the past 50 the percentage of Americans suffering from obesity has increased dramatically. Is it our fault we're becoming fatter? What role does the quality of food and crops play? What role do additives, synthetic chemicals, hormones, and GMO crops play? Is the government doing enough to protect us? How do we avoid or lessen our exposure to toxic chemicals? Chemicals in our food may be contributing to weight gain It’s no secret rates of overweight, obesity and other metabolic diseases are skyrocketing. And food is a big part of the problem, though not in the way you might think. It isn’t just how many calories we consume and burn. The nutritional value of food and how much it’s processed also play a role in how what we eat affects our weight. Another likely culprit behind weight gain is the harmful chemicals in what we consume. Some of these substances, called obesogens, can contribute to weight gain and lead to obesity, in turn raising a person’s risk of heart disease and other serious health problems. Scientists have found evidence of about 50 of these chemicals. They can be found in many consumer products, as well as in polluted air and water. But one of the most important ways we’re exposed is by consuming contaminated food. Harmful ingredients hiding in plain sight Studies show a link between highly processed foods – typically not very nutritious, with high levels of trans fat, sugar and sodium – and higher risk of metabolic diseases that, in turn, can lead to health problems, including heart disease, stroke and cancer, which are significant causes of preventable illness and death. Processed foods, from fast food to some “healthy” products like protein bars and vegetarian microwave meals, often have many artificial ingredients, such as sweeteners, flavor enhancers and preservatives, some of which are obesogens. Some obesogens occur naturally in food. One, fructose, accounts for about 40 percent of sweeteners we consume. But most obesogens in food are artificial chemicals, some added intentionally, particularly in highly processed food. Others contaminate food indirectly, through packaging, residual pesticides, or legacy environmental contamination from industrial chemicals, pesticides and heavy metals. Food additives MSG is a common flavor enhancer that shows obesogenic effects in animals. Artificial sweeteners – particularly aspartame, sucralose and saccharin – is another obesogen found in a wide range of low-calorie and diet food and beverage products. Research suggests some may be obesogenic and others, like most chemicals, haven’t been studied enough for us to know whether they are or not. The preservatives BHA and methyl and butyl paraben are likely obesogenic and can be found in everything from vegetable oils to processed meat and chewing gum to potato chips. Several emulsifiers are potential obesogens. Food contaminants BPA migrates from food packaging into food. PFOA is one of the most notorious types of the “forever chemicals” known as PFAS, used in nonstick cookware, cooking implements and food packaging like takeout containers. PCBs, once used in industrial materials like paint, varnish, plastic, pesticides and coolants, still make their way into some animal products, though they’ve been banned since 1979. Flame retardants – used to treat clothing, bedding, electronics and children’s products, among other items – get into our waterways and eventually our food. Many pesticides have obesogenic properties. Even banned pesticides enter the food supply, because they persist in land used for crops. Regulating or banning obesogens in food Our focus must shift from considering overweight and obesity the result of a personal, moral failing to treating it as a result of environmental exposures and inequitable access to healthy food. This change may already be starting: Some physicians are beginning to approach obesity in their clinical practices from this perspective and looking for ways to limit exposures as an approach to weight loss. But it’s up to the government to protect us from these chemicals: The FDA, Department of Defense and Environmental Protection Agency must ban or restrict the most pervasive and harmful food chemicals. To make sure we face less exposure to these harmful chemicals, lawmakers and regulators must: • Develop greater transparency in food labeling. • Issue stronger recommendations in the Dietary Guidelines, to address other food additives, in addition to natural and artificial sweeteners, sodium and saturated fat. • Provide more funding for programs improving accessibility and availability of healthier food options. • Look for new ways to address environmental injustices that promote racial and ethnic disparities in exposure to obesogens in food. In addition, the White House Conference on Hunger, Nutrition, and Health on September 28 will shine a light on obesogens, among other issues – a chance to meaningfully reduce our exposure to these chemicals. EWG is part of a coalition of organizations that called on President Joe Biden to implement numerous changes to improve Americans’ food, nutrition and health. Two changes would protect us from ongoing exposure to obesogens: • Closing the regulatory loophole that allows chemical companies to introduce new chemicals, some of them obesogens, into the supply chain without approval from the FDA. Many of these substances have never undergone a safety review by the FDA. • Requiring the FDA to identify and reassess food chemicals of concern, including obesogens, already in use. The FDA doesn’t have to routinely reassess the safety of these chemicals. So substances like PFAS, BPA and phthalates remain in use long after evidence emerges linking them to harm to our metabolism and other health risks. What you can do Many obesogens are, at best, tough to avoid. But you can limit your exposure to chemicals added to food intentionally, especially some artificial sweeteners, preservatives and added sugars, like high-fructose corn syrup. To reduce your exposure to harmful chemicals: • Find out about additive names and study the labels of foods you buy to learn what you’re consuming (and can avoid). • Eat lower on the food chain – fresh produce, beans and whole grains don’t contain food additives. • Choose organic fruit and vegetables, when you can, to lower your exposure to pesticides. Consult EWG’s Shopper’s Guide to Pesticides in Produce™ to see which are best to eat organic and which are OK to eat non-organic, if necessary. • Choose organic animal products – or eat less and find other protein sources instead. Antibiotics and hormones accumulate in non-organic animal products. • Avoid plastic and grease- and waterproof food packaging. (And eat less takeout – the packaging may contain PFAS or plastic additives.) • Use glass, ceramic or stainless steel instead of nonstick for cookware, and wood and stainless steel for cooking utensils. • Instead of plastic, use glass, ceramic, or stainless steel containers to store and microwave food. • For water on the go, use stainless steel bottles rather than plastic, which may leach phthalates and BPA. • Avoid plastic labeled with code 7, which indicates the presence of BPA, or 3, which indicates PVC. • Consult EWG’s Tap Water Database to see what’s in your water. Then see which filter is best for your own situation. Avoid bottled water – it may be no better than tap water, and the plastic leaches into the water. https://www.ewg.org/news-insights/news/2022/09/chemicals-our-food-may-be-contributing-weight-gain",Medical,Fact Finding,Q&A "Your answer must be drawn from the context block provided, only. You are prohibited from using other sources or drawing from prior knowledge. Provide a brief, bolded heading for your response that gives context. The body of the answer should be no longer than 200 words.",What new requirements for states would the proposed FY2024 legislation create?,"Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 12 President’s Budget Proposal for FY2024 The FY2024 budget request included several provisions intended to improve the administration and integrity of the UI program.51 These provisions included updating the factors used in determining administrative funding levels, a package of integrity-focused provisions, funding to continue to address fraud and IT modernization within the UI system, and additional funding to continue to build and support the UI Integrity Center’s Integrity Data Hub (IDH) cross-match systems. It also included an additional, broader package of proposed reforms to address systemic fraud such as identity theft and other fraud in the UI program, increase funding for the COVID-19 Fraud Strike Force Teams, and provide additional funding for Inspectors General (including the DOL Inspector General). Proposed UI Program Administrative Funding The FY2024 budget request included $3.5 billion for administration of the UI system, which was an increase over the FY2023 budget request amount of $3.1 billion.52 This amount included almost $3.0 billion “reflecting the Administration’s economic assumptions and updated workload- processing and salary factors” to administer UI.53 Additionally, the budget request for UI administration included $550 million in funding for RESEA. Separately, the budget request would have provided a fourth installment of $6 million to modernize IT infrastructure and would also have provided $150 million for program integrity purposes, including state grants to reduce fraud through identity verification services and other IT infrastructure improvements. The President’s budget proposal for FY2024 also proposed an alteration to the formula that determines the federal appropriation for state UI administration, which would have been the first substantive update in decades. Specifically, this proposal would have updated assumptions related to UI claims processing and state UI workforce salary rates, as prior assumptions for these factors were not capturing current administrative costs in states. Proposed Program Integrity Legislation The President’s FY2024 budget request also recommended a package of legislative changes to improve UI program integrity and to provide additional funding to states to help ensure proper UI payments. These proposals would have • codifed the requirement for states to data match with the National Directory of New Hires (NDNH; administered by the Department of Health and Human Services) and the Prisoner Update Processing System (PUPS, administered by the Social Security Administration) to help ensure that UI benefits are correctly paid to eligible individuals in a timely manner;54 51 DOL, Fiscal 2024 Budget, Volume 1: FY2024 Congressional Budget Justification, Employment and Training Administration, State Unemployment Insurance and Employment Service Operations, https://www.dol.gov/sites/ dolgov/files/general/budget/2024/CBJ-2024-V1-07.pdf (hereinafter “FY24 SUIESO Chapter”). 52 For an overview of current funding for UI administration, see CRS In Focus IF10838, Funding the State Administration of Unemployment Compensation (UC) Benefits. 53 FY24 SUIESO Chapter, Page 23, available at https://www.dol.gov/sites/dolgov/files/general/budget/2024/CBJ-2024- V1-07.pdf#page=27. 54 One way that states can ensure that UI benefits are correctly paid to eligible individuals in a timely manner is by accessing available data sources to match claimant information with eligibility-related characteristics. States are (continued...) Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 13 • required states to disclose information to the DOL Office of the Inspector General (DOL-OIG) in order to streamline DOL-OIG’s ability to conduct audits and investigations in the UI program; this includes authorizing DOL-OIG to have direct access to the Interstate Connection Network (ICON), which is used for the electronic transmission of interstate claims, as well as the IDH system, which is used in cross matching UI claimants against other databases to prevent and detect fraud and improper payments;55 • allowed the DOL Secretary to require a portion of a state’s administrative grant to be used to correct failing performance and/or have the state participate in required technical assistance activities offered by DOL;56 • authorized states to retain up to 5% of recovered fraudulent UI overpayments for program integrity use;57 • required states to use penalty and interest collections solely for UI administration;58 • provided states the authority to issue a formal warning when claimants do not clearly meet the work search requirements;59 and • allowed states to use contract support in recovery efforts under the Treasury Offset Program (TOP).60 President’s Budget Proposal for FY2025 As in FY2024, the President’s Budget Proposal for FY2025 budget request includes the same reform proposals intended to improve the administration and integrity of the UI program (see the section on “Proposed Program Integrity Legislation”).61 currently required, via DOL program guidance, to use the National Directory of New Hires (NDNH) to make sure, for instance, that UI claimants have not returned to work (for permanent-law UI programs, see DOL, ETA, “National Effort to Reduce Improper Payments in the Unemployment Insurance (UI) Program,” UIPL No. 19-11, June 10, 2011, https://wdr.doleta.gov/directives/attach/UIPL/UIPL19-11.pdf; and DOL, ETA, “National Directory of New Hires (NDNH) and State Directory of New Hires (SDNH) Guidance and Best Practices,” UIPL No. 13-19, June 17, 2019, https://wdr.doleta.gov/directives/attach/UIPL/UIPL_13-19.pdf). Currently, there is no statutory requirement for states to use NDNH or several other related data cross matches. 55 For background on recent DOL-OIG challenges related to direct access to state UI data, see the section on “Data Access” at https://www.oig.dol.gov/doloiguioversightwork.htm. 56 For an overview of the federal funding of state UI administration, see CRS In Focus IF10838, Funding the State Administration of Unemployment Compensation (UC) Benefits. 57 For an overview of UI fraud recovery issues, see CRS Insight IN12127, Unemployment Insurance Overpayment and Fraud Recovery and H.R. 1163. 58 In some situations, states apply fines and civil penalties when fraud is involved with UI benefit overpayments. See DOL, 2022 Comparison of State Unemployment Insurance Laws, Table 6-3, https://oui.doleta.gov/unemploy/pdf/ uilawcompar/2022/overpayments.pdf#page=6. 59 Under federal law (SSA §303(a)(12)), each state’s UI laws must require that individuals be able to work, available for work, and actively seeking work, as a condition of benefit eligibility, among other requirements. 60 Under federal law (SSA §303(m)), states must recover UI overpayments due to fraud and to misreported work from an individual’s federal income tax refund through the TOP. States may use contractors for recovery of SUTA debts but are prohibited from using contractors for recovery of UC and EB payments. For details, see DOL, ETA, “Recovery of Certain Unemployment Compensation Debts under the Treasury Offset Program,” UIPL 02-19, December 12, 2018, https://www.dol.gov/agencies/eta/advisories/unemployment-insurance-program-letter-no-02-19. 61 DOL, Fiscal 2025 Budget, Volume 1: FY2024 Congressional Budget Justification, Employment and Training (continued...) Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 14 The FY2025 budget request includes $3.4 billion for administration of the UI system.62 This amount is $84 million less than the FY2024 budget request, but $280 million more that the FY2024 enacted appropriation of $3.1 billion.63 The budget request also includes $388 million in funding for RESEA and proposes changes to the distribution formula for RESEA grants to states. Separately, the budget would also request a fifth installment of $6 million to modernize critical information technology infrastructure essential to the states’ administration of the UI program and $25 million to fund the national identity verification offering that the Department launched to help states combat identity fraud in the UI system. Laws Enacted in the 118th Congress This section provides summary information on the one piece of legislation with UI provisions enacted in the 118th Congress, at the time of this report. P.L. 118-5, the Fiscal Responsibility Act of 2023 The Fiscal Responsibility Act of 2023 (FRA; P.L. 118-5; June 3, 2023) included three provisions that (1) rescinded specified amounts of unobligated UI administrative funding made available by the American Rescue Plan Act of 2021 (ARPA; P.L. 117-2; March 11, 2021), (2) effectively reduced budgetary adjustments to discretionary spending limits for Reemployment Services and Eligibility Assessments, and (3) rescinded all unobligated funds for Short-Time Compensation grants created under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136; March 27, 2020). ARPA provided $2 billion in additional UI administrative funding to the U.S. DOL in FY2021 to “detect and prevent fraud, promote equitable access, and ensure the timely payment of benefits.” This funding was made available until expended and can be used for (1) federal administrative costs, (2) system-wide infrastructure, and (3) grants to states and territories administering all UI benefits for program integrity and fraud prevention purposes, including for identity verification and faster claims processing.","Your answer must be drawn from the context block provided, only. You are prohibited from using other sources or drawing from prior knowledge. Provide a brief, bolded heading for your response that gives context. The body of the answer should be no longer than 200 words. What new requirements for states would the proposed FY2024 legislation create? Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 12 President’s Budget Proposal for FY2024 The FY2024 budget request included several provisions intended to improve the administration and integrity of the UI program.51 These provisions included updating the factors used in determining administrative funding levels, a package of integrity-focused provisions, funding to continue to address fraud and IT modernization within the UI system, and additional funding to continue to build and support the UI Integrity Center’s Integrity Data Hub (IDH) cross-match systems. It also included an additional, broader package of proposed reforms to address systemic fraud such as identity theft and other fraud in the UI program, increase funding for the COVID-19 Fraud Strike Force Teams, and provide additional funding for Inspectors General (including the DOL Inspector General). Proposed UI Program Administrative Funding The FY2024 budget request included $3.5 billion for administration of the UI system, which was an increase over the FY2023 budget request amount of $3.1 billion.52 This amount included almost $3.0 billion “reflecting the Administration’s economic assumptions and updated workload- processing and salary factors” to administer UI.53 Additionally, the budget request for UI administration included $550 million in funding for RESEA. Separately, the budget request would have provided a fourth installment of $6 million to modernize IT infrastructure and would also have provided $150 million for program integrity purposes, including state grants to reduce fraud through identity verification services and other IT infrastructure improvements. The President’s budget proposal for FY2024 also proposed an alteration to the formula that determines the federal appropriation for state UI administration, which would have been the first substantive update in decades. Specifically, this proposal would have updated assumptions related to UI claims processing and state UI workforce salary rates, as prior assumptions for these factors were not capturing current administrative costs in states. Proposed Program Integrity Legislation The President’s FY2024 budget request also recommended a package of legislative changes to improve UI program integrity and to provide additional funding to states to help ensure proper UI payments. These proposals would have • codifed the requirement for states to data match with the National Directory of New Hires (NDNH; administered by the Department of Health and Human Services) and the Prisoner Update Processing System (PUPS, administered by the Social Security Administration) to help ensure that UI benefits are correctly paid to eligible individuals in a timely manner;54 51 DOL, Fiscal 2024 Budget, Volume 1: FY2024 Congressional Budget Justification, Employment and Training Administration, State Unemployment Insurance and Employment Service Operations, https://www.dol.gov/sites/ dolgov/files/general/budget/2024/CBJ-2024-V1-07.pdf (hereinafter “FY24 SUIESO Chapter”). 52 For an overview of current funding for UI administration, see CRS In Focus IF10838, Funding the State Administration of Unemployment Compensation (UC) Benefits. 53 FY24 SUIESO Chapter, Page 23, available at https://www.dol.gov/sites/dolgov/files/general/budget/2024/CBJ-2024- V1-07.pdf#page=27. 54 One way that states can ensure that UI benefits are correctly paid to eligible individuals in a timely manner is by accessing available data sources to match claimant information with eligibility-related characteristics. States are (continued...) Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 13 • required states to disclose information to the DOL Office of the Inspector General (DOL-OIG) in order to streamline DOL-OIG’s ability to conduct audits and investigations in the UI program; this includes authorizing DOL-OIG to have direct access to the Interstate Connection Network (ICON), which is used for the electronic transmission of interstate claims, as well as the IDH system, which is used in cross matching UI claimants against other databases to prevent and detect fraud and improper payments;55 • allowed the DOL Secretary to require a portion of a state’s administrative grant to be used to correct failing performance and/or have the state participate in required technical assistance activities offered by DOL;56 • authorized states to retain up to 5% of recovered fraudulent UI overpayments for program integrity use;57 • required states to use penalty and interest collections solely for UI administration;58 • provided states the authority to issue a formal warning when claimants do not clearly meet the work search requirements;59 and • allowed states to use contract support in recovery efforts under the Treasury Offset Program (TOP).60 President’s Budget Proposal for FY2025 As in FY2024, the President’s Budget Proposal for FY2025 budget request includes the same reform proposals intended to improve the administration and integrity of the UI program (see the section on “Proposed Program Integrity Legislation”).61 currently required, via DOL program guidance, to use the National Directory of New Hires (NDNH) to make sure, for instance, that UI claimants have not returned to work (for permanent-law UI programs, see DOL, ETA, “National Effort to Reduce Improper Payments in the Unemployment Insurance (UI) Program,” UIPL No. 19-11, June 10, 2011, https://wdr.doleta.gov/directives/attach/UIPL/UIPL19-11.pdf; and DOL, ETA, “National Directory of New Hires (NDNH) and State Directory of New Hires (SDNH) Guidance and Best Practices,” UIPL No. 13-19, June 17, 2019, https://wdr.doleta.gov/directives/attach/UIPL/UIPL_13-19.pdf). Currently, there is no statutory requirement for states to use NDNH or several other related data cross matches. 55 For background on recent DOL-OIG challenges related to direct access to state UI data, see the section on “Data Access” at https://www.oig.dol.gov/doloiguioversightwork.htm. 56 For an overview of the federal funding of state UI administration, see CRS In Focus IF10838, Funding the State Administration of Unemployment Compensation (UC) Benefits. 57 For an overview of UI fraud recovery issues, see CRS Insight IN12127, Unemployment Insurance Overpayment and Fraud Recovery and H.R. 1163. 58 In some situations, states apply fines and civil penalties when fraud is involved with UI benefit overpayments. See DOL, 2022 Comparison of State Unemployment Insurance Laws, Table 6-3, https://oui.doleta.gov/unemploy/pdf/ uilawcompar/2022/overpayments.pdf#page=6. 59 Under federal law (SSA §303(a)(12)), each state’s UI laws must require that individuals be able to work, available for work, and actively seeking work, as a condition of benefit eligibility, among other requirements. 60 Under federal law (SSA §303(m)), states must recover UI overpayments due to fraud and to misreported work from an individual’s federal income tax refund through the TOP. States may use contractors for recovery of SUTA debts but are prohibited from using contractors for recovery of UC and EB payments. For details, see DOL, ETA, “Recovery of Certain Unemployment Compensation Debts under the Treasury Offset Program,” UIPL 02-19, December 12, 2018, https://www.dol.gov/agencies/eta/advisories/unemployment-insurance-program-letter-no-02-19. 61 DOL, Fiscal 2025 Budget, Volume 1: FY2024 Congressional Budget Justification, Employment and Training (continued...) Unemployment Insurance: Legislative Issues in the 118th Congress Congressional Research Service 14 The FY2025 budget request includes $3.4 billion for administration of the UI system.62 This amount is $84 million less than the FY2024 budget request, but $280 million more that the FY2024 enacted appropriation of $3.1 billion.63 The budget request also includes $388 million in funding for RESEA and proposes changes to the distribution formula for RESEA grants to states. Separately, the budget would also request a fifth installment of $6 million to modernize critical information technology infrastructure essential to the states’ administration of the UI program and $25 million to fund the national identity verification offering that the Department launched to help states combat identity fraud in the UI system. Laws Enacted in the 118th Congress This section provides summary information on the one piece of legislation with UI provisions enacted in the 118th Congress, at the time of this report. P.L. 118-5, the Fiscal Responsibility Act of 2023 The Fiscal Responsibility Act of 2023 (FRA; P.L. 118-5; June 3, 2023) included three provisions that (1) rescinded specified amounts of unobligated UI administrative funding made available by the American Rescue Plan Act of 2021 (ARPA; P.L. 117-2; March 11, 2021), (2) effectively reduced budgetary adjustments to discretionary spending limits for Reemployment Services and Eligibility Assessments, and (3) rescinded all unobligated funds for Short-Time Compensation grants created under the Coronavirus Aid, Relief, and Economic Security Act (CARES Act; P.L. 116-136; March 27, 2020). ARPA provided $2 billion in additional UI administrative funding to the U.S. DOL in FY2021 to “detect and prevent fraud, promote equitable access, and ensure the timely payment of benefits.” This funding was made available until expended and can be used for (1) federal administrative costs, (2) system-wide infrastructure, and (3) grants to states and territories administering all UI benefits for program integrity and fraud prevention purposes, including for identity verification and faster claims processing.",Legal,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Summarize Section 1 in simple terms with a bullet point for each paragraph. Exclude the paragraph about the history of the section, and limit each bullet point to 30 words or less. Then, explain the importance of a pre-kindergarten program.","SECTION 1. Public education.— (a) The education of children is a fundamental value of the people of the State of Florida. It is, therefore, a paramount duty of the state to make adequate provision for the education of all children residing within its borders. Adequate provision shall be made by law for a uniform, efficient, safe, secure, and high quality system of free public schools that allows students to obtain a high quality education and for the establishment, maintenance, and operation of institutions of higher learning and other public education programs that the needs of the people may require. To assure that children attending public schools obtain a high quality education, the legislature shall make adequate provision to ensure that, by the beginning of the 2010 school year, there are a sufficient number of classrooms so that: (1) The maximum number of students who are assigned to each teacher who is teaching in public school classrooms for prekindergarten through grade 3 does not exceed 18 students; (2) The maximum number of students who are assigned to each teacher who is teaching in public school classrooms for grades 4 through 8 does not exceed 22 students; and (3) The maximum number of students who are assigned to each teacher who is teaching in public school classrooms for grades 9 through 12 does not exceed 25 students. The class size requirements of this subsection do not apply to extracurricular classes. Payment of the costs associated with reducing class size to meet these requirements is the responsibility of the state and not of local schools districts. Beginning with the 2003-2004 fiscal year, the legislature shall provide sufficient funds to reduce the average number of students in each classroom by at least two students per year until the maximum number of students per classroom does not exceed the requirements of this subsection. (b) Every four-year old child in Florida shall be provided by the State a high quality pre-kindergarten learning opportunity in the form of an early childhood development and education program which shall be voluntary, high quality, free, and delivered according to professionally accepted standards. An early childhood development and education program means an organized program designed to address and enhance each child’s ability to make age appropriate progress in an appropriate range of settings in the development of language and cognitive capabilities and emotional, social, regulatory and moral capacities through education in basic skills and such other skills as the Legislature may determine to be appropriate. (c) The early childhood education and development programs provided by reason of subparagraph (b) shall be implemented no later than the beginning of the 2005 school year through funds generated in addition to those used for existing education, health, and development programs. Existing education, health, and development programs are those funded by the State as of January 1, 2002 that provided for child or adult education, health care, or development. History.—Am. proposed by Constitution Revision Commission, Revision No. 6, 1998, filed with the Secretary of State May 5, 1998; adopted 1998; Ams. by Initiative Petitions filed with the Secretary of State April 13, 2001, and January 25, 2002; adopted 2002. SECTION 2. State board of education.—The state board of education shall be a body corporate and have such supervision of the system of free public education as is provided by law. The state board of education shall consist of seven members appointed by the governor to staggered 4-year terms, subject to confirmation by the senate. The state board of education shall appoint the commissioner of education. History.—Am. proposed by Constitution Revision Commission, Revision No. 8, 1998, filed with the Secretary of State May 5, 1998; adopted 1998. SECTION 3. Terms of appointive board members.—Members of any appointive board dealing with education may serve terms in excess of four years as provided by law. SECTION 4. School districts; school boards.— (a) Each county shall constitute a school district; provided, two or more contiguous counties, upon vote of the electors of each county pursuant to law, may be combined into one school district. In each school district there shall be a school board composed of five or more members chosen by vote of the electors in a nonpartisan election for appropriately staggered terms of four years, as provided by law. (b) The school board shall operate, control and supervise all free public schools within the school district and determine the rate of school district taxes within the limits prescribed herein. Two or more school districts may operate and finance joint educational programs. History.—Am. proposed by Constitution Revision Commission, Revision No. 11, 1998, filed with the Secretary of State May 5, 1998; adopted 1998. SECTION 5. Superintendent of schools.—In each school district there shall be a superintendent of schools who shall be elected at the general election in each year the number of which is a multiple of four for a term of four years; or, when provided by resolution of the district school board, or by special law, approved by vote of the electors, the district school superintendent in any school district shall be employed by the district school board as provided by general law. The resolution or special law may be rescinded or repealed by either procedure after four years. History.—Am. proposed by Constitution Revision Commission, Revision No. 13, 1998, filed with the Secretary of State May 5, 1998; adopted 1998. SECTION 6. State school fund.—The income derived from the state school fund shall, and the principal of the fund may, be appropriated, but only to the support and maintenance of free public schools. SECTION 7. State University System.— (a) PURPOSES. In order to achieve excellence through teaching students, advancing research and providing public service for the benefit of Florida’s citizens, their communities and economies, the people hereby establish a system of governance for the state university system of Florida. (b) STATE UNIVERSITY SYSTEM. There shall be a single state university system comprised of all public universities. A board of trustees shall administer each public university and a board of governors shall govern the state university system. (c) LOCAL BOARDS OF TRUSTEES. Each local constituent university shall be administered by a board of trustees consisting of thirteen members dedicated to the purposes of the state university system. The board of governors shall establish the powers and duties of the boards of trustees. Each board of trustees shall consist of six citizen members appointed by the governor and five citizen members appointed by the board of governors. The appointed members shall be confirmed by the senate and serve staggered terms of five years as provided by law. The chair of the faculty senate, or the equivalent, and the president of the student body of the university shall also be members.","[question] Summarize Section 1 in simple terms with a bullet point for each paragraph. Exclude the paragraph about the history of the section, and limit each bullet point to 30 words or less. Then, explain the importance of a pre-kindergarten program. ===================== [text] SECTION 1. Public education.— (a) The education of children is a fundamental value of the people of the State of Florida. It is, therefore, a paramount duty of the state to make adequate provision for the education of all children residing within its borders. Adequate provision shall be made by law for a uniform, efficient, safe, secure, and high quality system of free public schools that allows students to obtain a high quality education and for the establishment, maintenance, and operation of institutions of higher learning and other public education programs that the needs of the people may require. To assure that children attending public schools obtain a high quality education, the legislature shall make adequate provision to ensure that, by the beginning of the 2010 school year, there are a sufficient number of classrooms so that: (1) The maximum number of students who are assigned to each teacher who is teaching in public school classrooms for prekindergarten through grade 3 does not exceed 18 students; (2) The maximum number of students who are assigned to each teacher who is teaching in public school classrooms for grades 4 through 8 does not exceed 22 students; and (3) The maximum number of students who are assigned to each teacher who is teaching in public school classrooms for grades 9 through 12 does not exceed 25 students. The class size requirements of this subsection do not apply to extracurricular classes. Payment of the costs associated with reducing class size to meet these requirements is the responsibility of the state and not of local schools districts. Beginning with the 2003-2004 fiscal year, the legislature shall provide sufficient funds to reduce the average number of students in each classroom by at least two students per year until the maximum number of students per classroom does not exceed the requirements of this subsection. (b) Every four-year old child in Florida shall be provided by the State a high quality pre-kindergarten learning opportunity in the form of an early childhood development and education program which shall be voluntary, high quality, free, and delivered according to professionally accepted standards. An early childhood development and education program means an organized program designed to address and enhance each child’s ability to make age appropriate progress in an appropriate range of settings in the development of language and cognitive capabilities and emotional, social, regulatory and moral capacities through education in basic skills and such other skills as the Legislature may determine to be appropriate. (c) The early childhood education and development programs provided by reason of subparagraph (b) shall be implemented no later than the beginning of the 2005 school year through funds generated in addition to those used for existing education, health, and development programs. Existing education, health, and development programs are those funded by the State as of January 1, 2002 that provided for child or adult education, health care, or development. History.—Am. proposed by Constitution Revision Commission, Revision No. 6, 1998, filed with the Secretary of State May 5, 1998; adopted 1998; Ams. by Initiative Petitions filed with the Secretary of State April 13, 2001, and January 25, 2002; adopted 2002. SECTION 2. State board of education.—The state board of education shall be a body corporate and have such supervision of the system of free public education as is provided by law. The state board of education shall consist of seven members appointed by the governor to staggered 4-year terms, subject to confirmation by the senate. The state board of education shall appoint the commissioner of education. History.—Am. proposed by Constitution Revision Commission, Revision No. 8, 1998, filed with the Secretary of State May 5, 1998; adopted 1998. SECTION 3. Terms of appointive board members.—Members of any appointive board dealing with education may serve terms in excess of four years as provided by law. SECTION 4. School districts; school boards.— (a) Each county shall constitute a school district; provided, two or more contiguous counties, upon vote of the electors of each county pursuant to law, may be combined into one school district. In each school district there shall be a school board composed of five or more members chosen by vote of the electors in a nonpartisan election for appropriately staggered terms of four years, as provided by law. (b) The school board shall operate, control and supervise all free public schools within the school district and determine the rate of school district taxes within the limits prescribed herein. Two or more school districts may operate and finance joint educational programs. History.—Am. proposed by Constitution Revision Commission, Revision No. 11, 1998, filed with the Secretary of State May 5, 1998; adopted 1998. SECTION 5. Superintendent of schools.—In each school district there shall be a superintendent of schools who shall be elected at the general election in each year the number of which is a multiple of four for a term of four years; or, when provided by resolution of the district school board, or by special law, approved by vote of the electors, the district school superintendent in any school district shall be employed by the district school board as provided by general law. The resolution or special law may be rescinded or repealed by either procedure after four years. History.—Am. proposed by Constitution Revision Commission, Revision No. 13, 1998, filed with the Secretary of State May 5, 1998; adopted 1998. SECTION 6. State school fund.—The income derived from the state school fund shall, and the principal of the fund may, be appropriated, but only to the support and maintenance of free public schools. SECTION 7. State University System.— (a) PURPOSES. In order to achieve excellence through teaching students, advancing research and providing public service for the benefit of Florida’s citizens, their communities and economies, the people hereby establish a system of governance for the state university system of Florida. (b) STATE UNIVERSITY SYSTEM. There shall be a single state university system comprised of all public universities. A board of trustees shall administer each public university and a board of governors shall govern the state university system. (c) LOCAL BOARDS OF TRUSTEES. Each local constituent university shall be administered by a board of trustees consisting of thirteen members dedicated to the purposes of the state university system. The board of governors shall establish the powers and duties of the boards of trustees. Each board of trustees shall consist of six citizen members appointed by the governor and five citizen members appointed by the board of governors. The appointed members shall be confirmed by the senate and serve staggered terms of five years as provided by law. The chair of the faculty senate, or the equivalent, and the president of the student body of the university shall also be members. https://www.flsenate.gov/Laws/Constitution#A9 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Summarize & Format,Text Transformation Answer in paragraph format. Only use the context provided for your answer.,What factors led to Temu's success?,"THE RISE OF TEMU: A Shopping App Revolutionizing the Retail Experience Introduction In recent years, the retail industry has witnessed a significant shift towards online shopping. The emergence of E-commerce platforms has transformed the way consumers shop, providing convenience and access to a wide range of products. This case study explores the rise of Temu, a shopping app that has disrupted the traditional retail landscape and revolutionized the shopping experience for millions of users. Temu, a rising star in the world of online shopping, offers a vast array of fashion products, beauty items, and home goods. This Chinese-owned digital marketplace has quickly become the top free shopping app, outshining giants like Shein, Amazon, and Walmart. Temu’s business model connects customers directly to suppliers. By forging strong relationships with retailers, they’ve managed to keep prices low and maintain a vast network of suppliers. At the core of Temu’s rapid growth and competitive pricing is their innovative Next-Gen Manufacturing (NGM) model. Launched in September 2022, this Boston-based e-commerce platform serves markets in the US, Canada, Australia, and New Zealand. The NGM model revolutionizes the retail process by enabling manufacturers to produce merchandise with more precision, reducing unsold inventory and waste. However customers do complain about longer delivery times. It is unknown to what extent this is a result of the NGM model. By connecting shoppers directly with manufacturers and offering real-time insights, Temu is able to cut warehousing and transportation costs, resulting in savings of at least 50% compared to traditional processes. This cost-saving approach allows the company to offer near-wholesale prices, as they remove hidden costs and focus on accurately forecasting sales and demand. While Temu.com is gaining popularity, it faces stiff competition from other Chinese online wholesale stores like AliExpress, DHGate, Banggood, and DealExtreme. These platforms offer a wide range of products at competitive prices, along with diverse shipping options and payment methods. However, Temu stands out with its NGM model, which empowers manufacturers to create customized products. The increased visibility of demand and supply accelerates distribution and eliminates the need for large warehouses. Another distinguishing factor of Temu is its claims on sustainability and social responsibility. The NGM model promotes a more sustainable e-commerce landscape by enabling manufacturers to produce merchandise that fits the needs of consumers, leading to lower unsold inventory and waste. Significance of Temu’s Innovative approach to Shopping In the rapidly evolving world of e-commerce, convenience and speed have become the pillars on which success is built. As consumers increasingly turn to online shopping to meet their needs, the demand for faster shopping times has never been higher. Enter TEMU, the innovative new ecommerce platform that promises to redefine the shopping experience with lightning-fast shipping. TEMU's shopping prowess to traditional e-commerce platforms, makes it stand out and elevates the shopping journey for customers. Speed of Delivery: One of the most glaring advantages TEMU brings to the table is its lightning-fast shipping times. Unlike traditional platforms that often offer standard shipping that can take days or even weeks, TEMU has set a new standard with its express delivery options. With strategically located warehouses and a streamlined logistics network, TEMU ensures that customers receive their orders in record time, sometimes as soon as within a few hours of placing an order. This kind of speed sets TEMU apart from traditional e-commerce platforms, where delays in processing and shipping can often lead to frustration and disappointment for customers. Inventory Management: TEMU's commitment to swift delivery is closely tied to its advanced inventory management system. Traditional platforms often struggle to keep up with the demand, leading to instances where popular items are out of stock or on backorder. TEMU's innovative approach utilizes real-time data analytics to predict customer demands and stock products accordingly. This approach significantly reduces the chances of running out of stock, thus ensuring that customers can find what they want when they want it. Customer Satisfaction: In the world of e-commerce, customer satisfaction is paramount. TEMU's emphasis on fast shipping addresses one of the most common pain points for online shoppers – the waiting game. Traditional platforms often face challenges in providing consistent shipping times, leading to varied customer experiences. TEMU's commitment to speedy delivery contributes to higher levels of customer satisfaction by providing a more reliable and predictable shopping experience. Competitive Edge: As e-commerce continues to grow, the market becomes increasingly saturated with both established giants and new entrants. TEMU's focus on faster shipping times gives it a distinct competitive edge. It appeals to consumers who prioritize efficiency and convenience in their shopping experience. In contrast, traditional platforms may find themselves having to adapt quickly or risk losing customers to the allure of TEMU's swiffer service. Sustainability and Environmental Impact: While speed is a significant selling point for TEMU, it's essential to consider the environmental impact of such rapid shipping. Expedited shipping often requires additional resources, such as expedited transportation and packaging materials. Traditional platforms might adopt more sustainable shipping practices, such as grouping orders or optimizing delivery routes to reduce their carbon footprint. TEMU must balance its commitment to speed with environmental responsibility to ensure a positive long-term impact. Brief Overview of Temu Temu (pronounced ‘tee-moo’) is a Boston-based online marketplace founded by Pinduoduo’s parent company PDD Holding. Its business model is likened to Chinese shopping platforms SHEIN, Wish, and Alibaba – which are based on the sale of large quantities of products at prices that are so low they are almost unbelievable. Temu was founded in the USA in 2022 and is a subsidiary of PDD Holdings Inc., which is listed on Nasdaq and headquartered in Shanghai. Temu operates as an online marketplace similar to AliExpress, Walmart, and Wish, focusing on offering affordable goods. Temu allows Chinese vendors to sell to shoppers and ship directly to them without having to store products in U.S. warehouses.The company acts as an intermediary between sellers (primarily from China) and buyers without maintaining its own inventory. Temu promotes social commerce, encouraging potential buyers to find more buyers to avail discounts. The app employs gamification to engage customers and offers free shipping by circumventing customs duties. The platform allows suppliers based in China to sell and ship directly to customers without having to rely on warehouses in the destination countries . Online purchases on Temu can be made using a web browser or via a dedicated mobile application.Temu offers free products to some users which encourage new people to install the app through affiliate codes, social media and gamification. It also uses online advertising on Facebook and Instagram and many online platforms. The Temu platform went live for the first time in the United States in September 2022 and in February 2023, Temu was launched in Canada. That same month, the company aired a Super Bowl commercial advert . In March 2023, Temu was launched in Australia and New Zealand. The following month, Temu was launched in France , Italy , Germany , the Netherlands , Spain and the United Kingdom. Naturally, the prices charged by the site defy all competition (sneakers for €11, manicure kit for less than €5, phone holder for €1.80, etc.), so much so that the platform has adopted an eloquent slogan: “Buy like a Billionaire”. As the specialist in Chinese digital companies Jeffrey Towson explains to Le Monde, the platform does not yet make a margin, in order to establish itself quickly in the targeted countries. At the end of 2022, the Temu application became the most downloaded application in the United States. The TEMU (Shop Like a Millionaire) Shopping app is now boasting over 100 million Downloads on PlayStore and AppStore with over 4.7 Million reviews and about 12+ Ratings. Three months after its launch in the United States, the application was at the top of downloads. In the European Union, where the platform arrived in April (in France, the United Kingdom, Italy, the Netherlands, Spain and Germany), the success is similar. In recent days, it has been the most downloaded application in France on iOS and Android. As of April 2023, the app has been downloaded 10 million times since its launch in September 2022 and it is currently available in around 100 countries. Temu’s wide range of products is particularly appealing to consumers, combined with a gamified online shopping experience that encourages customers to try their luck and buy more and more. With its impressive growth and distinct strategy, Temu’s business model warrants a closer look. Key Factors that contributed to its initial success Leveraging the power of mobile technology, Temu aimed to bridge the gap between online and offline retail, offering a unique platform that combined the benefits of both worlds. It introduced several innovative features for better customer experience that set it apart from competitors and propelled its rapid rise to popularity. These Key Features and Functionality are; Augmented Reality (AR) Shopping: Temu integrated AR technology into its app, allowing users to virtually try on clothing, visualize furniture in their homes, and experience products before making a purchase. This feature enhanced the shopping experience and reduced the need for physical store visits. Personalized Recommendations: Temu leveraged artificial intelligence and machine learning algorithms to analyze user preferences, browsing history, and purchase behavior. Based on these insights, the app provided personalized product recommendations to users, leading to higher customer satisfaction and increased sales.Certainly! Temu's personalized recommendations were generated through a combination of artificial intelligence (AI) and machine learning algorithms. Here's an overview of how the feature worked: Data Collection: Temu collected vast amounts of user data to understand individual preferences and behavior. This data included user interactions within the app, such as product searches, views, clicks, and purchases, as well as demographic information and user-provided preferences. Data Processing and Analysis: The collected data was processed and analyzed using AI and machine learning algorithms. These algorithms examined patterns, correlations, and relationships within the data to identify user preferences, interests, and buying patterns. User Profiling: Based on the analysis, Temu created user profiles that encompassed various attributes, such as preferred product categories, brands, price ranges, and style preferences. The profiles were continually updated and refined as new data was collected and analyzed. Collaborative Filtering: One common technique used by Temu was collaborative filtering. This approach compares a user's profile with the profiles of other similar users to identify products or items that users with similar preferences enjoyed or purchased. By finding similarities between users, collaborative filtering could suggest relevant products to a particular user based on the preferences of users with similar tastes. Content-Based Filtering: Another technique employed by Temu was content-based filtering. This method focused on the characteristics and attributes of products themselves. It analyzed product descriptions, features, tags, and other metadata to identify similarities and correlations between products. For example, if a user showed a preference for certain brands or specific features, content-based filtering could recommend similar products that match those preferences. Machine Learning and Iterative Refinement: Temu's algorithms continuously learned and improved over time. As users interacted with the app and provided feedback, the algorithms adjusted their recommendations based on the user's responses and behavior. Machine learning techniques enabled the system to adapt and refine its recommendations based on real-time user feedback. Real-Time Contextual Factors: In addition to user preferences, Temu also considered real-time contextual factors, such as trending products, seasonal trends, and popular items in the user's location. These factors were incorporated into the recommendation algorithms to ensure up-to-date and relevant suggestions. By leveraging AI, machine learning, and user data, Temu's personalized recommendation system aimed to understand each user's unique preferences and deliver tailored product suggestions. The algorithms continually evolved to provide increasingly accurate and relevant recommendations, enhancing the user experience and facilitating personalized shopping journeys. Social Commerce Integration: Recognizing the power of social media, Temu incorporated social commerce features, enabling users to share products, create wish lists, and seek recommendations from friends and influencers. This integration expanded Temu's reach and facilitated organic growth through user-generated content. Seamless Checkout and Delivery: Temu prioritized a frictionless shopping experience by streamlining the checkout process and offering multiple secure payment options. Additionally, it partnered with reliable logistics providers to ensure prompt and efficient product delivery, enhancing customer satisfaction and loyalty. Seamless Checkout and Payment Options: Temu focused on streamlining the checkout process to provide a seamless and hassle-free experience for users. It offered multiple secure payment options, including credit/debit cards, mobile wallets, and payment gateways, allowing users to choose their preferred method. This flexibility and ease of payment contributed to a smoother transaction process and reduced cart abandonment rates.Temu implemented several measures to ensure the security of payment options for its users; Secure Payment Gateways: Temu has partnered with trusted and secure payment gateways to handle the processing of user payments. These payment gateways employ robust security measures such as encryption, tokenization, and secure socket layer (SSL) protocols to protect sensitive payment information during transmission. Encryption: Temu has implemented encryption protocols to safeguard user payment data. This involves encrypting sensitive information such as credit card details, bank account numbers, and personal information to prevent unauthorized access or interception. Encryption ensures that even if the data is intercepted, it remains unreadable and unusable to unauthorized parties. Compliance with Payment Card Industry Data Security Standards (PCI DSS): Temu has adhered to the Payment Card Industry Data Security Standards, which are industry-wide standards established to ensure the secure handling of cardholder data. Compliance with PCI DSS involves maintaining a secure network, implementing strong access controls, regularly monitoring and testing systems, and maintaining an information security policy. Two-Factor Authentication (2FA): Temu has implemented two-factor authentication as an additional layer of security for payment transactions. This requires users to provide two forms of verification, such as a password and a unique code sent to their mobile device, to authenticate their identity before completing a payment. Fraud Detection Systems: Temu has employed fraud detection systems and algorithms to identify and prevent fraudulent payment activities. These systems analyze various factors, such as user behavior, transaction patterns, and known fraud indicators, to detect and flag suspicious transactions for further verification or intervention. Regular Security Audits: Temu has conducted regular security audits and assessments to identify vulnerabilities and ensure that all payment systems and processes meet the highest security standards. This includes conducting penetration testing, code reviews, and vulnerability scans to proactively identify and address any potential security weaknesses. User Education and Awareness: Temu has implemented user education programs to raise awareness about safe online payment practices. This could include educating users about the importance of strong passwords, avoiding phishing attempts, and regularly monitoring their payment transactions for any unauthorized activity. Order Tracking and Delivery Updates: Temu provided users with real-time order tracking and delivery updates. Users could monitor the progress of their orders and receive notifications regarding shipment status, estimated delivery time, and any delays. This feature enhanced transparency and kept users informed throughout the delivery process, improving overall customer satisfaction. User Reviews and Ratings: To facilitate informed purchasing decisions, Temu incorporated user reviews and ratings for products. Users could leave feedback and rate their purchases, helping others make well-informed choices. This feature added a layer of trust and credibility to the shopping experience and fostered a community-driven approach to product evaluation. Virtual Stylist and Fashion Advice: Temu introduced a virtual stylist feature that offered personalized fashion advice and styling tips. Users could provide information about their preferences, body type, and occasion, and receive tailored recommendations for outfits and accessories. This feature catered to users seeking fashion inspiration and guidance, enhancing their shopping experience. Temu’s Virtual Stylist feature works in the following ways; It helps Users of the Temu app to create a profile by providing information about their preferences, body type, style preferences, and any specific fashion requirements they may have. The virtual stylist feature uses algorithms and machine learning techniques to analyze the user's profile and understand their style preferences. It considers factors such as color preferences, patterns, clothing types, and previous purchases. The feature assists users in recommendations. Based on the user's profile and preferences, the virtual stylist recommends outfits, clothing items, or accessories that align with their style. These recommendations may include images, descriptions, and links to purchase the recommended items. The feature also provides style tips, fashion trends, and suggestions to help users stay updated and make informed fashion choices. It helps users in Interactive Communication. The virtual stylist often offers Interactive communication channels such as chatbots or messaging systems. Users ask questions, seek styling advice, or provide feedback to further refine the recommendations. The feature helps Integration with User Feedback,it learns and improves over time by incorporating user feedback and preferences. As users interact with the feature, their feedback and engagement help train the algorithm to provide more accurate and personalized recommendations Growth and Adoption over time Temu was ranked No. 12 in the 2022 holiday traffic, topping retailers like Kohl’s and Wayfair. With an average of 41.0 million visitors in November and December, Temu surpassed major ecommerce sites like Kohl’s, Wayfair, and Nordstrom, and was within striking distance of Macy’s. Temu surged ahead of low-price Chinese goods sellers Shein and Wish.com in dramatic fashion. Not only did Temu quickly surpass Wish.com amid its recent downswing, it also managed to leapfrog Shein’s impressive recent gains. Shein’s steady rise has the company now looking to raise capital at a reported $64 billion valuation as reported by Reuters. Wish.com, by comparison, has been hemorrhaging money and has plummeted 98% from its peak stock price, with a market cap below $400 million. Using cheap wares to attract customers can work, but profitability is a challenge when operating under tight margins. High acquisition costs can be a killer, and there will also be a need to pivot into higher-margin goods. Temu is keying on its mobile app for loyalty. Temu’s bargain-basement prices make purchases a low consideration in most cases. Its best use case is when customers realize a need (“Shoot, I left my iPhone charger at the hotel and need another one”) and can buy quickly and cheaply. The app can drive habit formation around this, and the more that shoppers rely on the app the less likely Temu will have to pay for ads to drive conversions. Temu exploded out of the gates and its rapid rise warrants attention. As something of a Wish.com clone, there’s reason to be skeptical it can find long-term profitable growth when its early stage capital eventually rationalizes. Whether Temu avoids a similar fate will come down to whether it can improve upon the Wish.com playbook to build a loyal and engaged user base and drastically reduce customer acquisition costs over time. A killer TikTok strategy and sticky mobile app was key to achieving what its predecessor could not. As originally featured in the Retail Daily newsletter, Amazon has been the most downloaded shopping app in the US for a very long time. It managed to beat local competitors like Walmart, and even international competition from apps like Wish. But with the coming of Temu it looked like Amazon had finally met its match. Going all the way back to 2020, Amazon's shopping app was averaging around 550K downloads per week in the US, according to our estimates. The summer of 2022 was strong, pushing Amazon's downloads to more than double with a range between 800K and 1.2M weekly downloads. And that spike didn't slow down until February, 2023, after which downloads really started sloping down. SHEIN, a clothing retailer that sells ""fast fashion"" shipped from China, has been chasing Amazon's tail since it launched. Key word being ""chasing"". SHEIN averaged a little over half of Amazon's downloads back in 2020. They got close a few times but not enough to really take the lead. In January of 2023, that changed and SHEIN's downloads are now about double those of Amazon in the US. SHEIN saw 617K downloads from the App Store + Google Play in the US last week, according to our estimates. And SHEIN isn't even Amazon's biggest threat right now but Temu, a China-based retailer that sells a variety of goods, from clothes to furniture, at very low prices, since its launch late last year. The holiday shopping season was big for Temu. It averaged 2M new downloads every week between November and December, according to our estimates. Downloads dropped since, which makes sense overall, but are still astronomically high in comparison. Temu saw 1.3M new downloads last week in the US. This is a big problem for Amazon which may mean the next Prime Day will be a little more exciting than the last few. And yes, Temu is one of the biggest spends on Apple Search Ads which helps it get those downloads. Challenges Addressed by Temu The traditional retail model is almost getting outdated thereby posing several challenges. While the “customer is always right” mantra has held true for quite some time, the amount of power wielded by consumers has never been higher than it is right now. Customers are no longer forced to choose between just a couple of options when looking to purchase new luxury goods. Not only has the number of retailers expanded exponentially in recent years, but so has the information available to customers. The amount of choice people enjoy today has also led to a waning of brand loyalty, with customers switching between retailers and online/in-store channels from purchase to purchase, depending which best serves their needs at the time. Luxury retailers are not immune to this trend either, as even wealthy customers now tend to shop around for the best option. This decline in brand loyalty customers presents a unique retailing problem, as retailers try to find new and innovative ways to appeal to buyers – both existing and potential; Consumers are Choosing Multichannel Buying Experiences: With more complete e-retail experiences available, and shipping times greatly reduced, it is little wonder around 96% of Americans utilize online shopping in one way or another. However, those same Americans spend about 65% of their total shopping budget in traditional brick-and-mortar locations. In other words, while almost everyone is shopping online, they are making more purchases in stores. Customers are moving seamlessly between online and offline experiences, and are open to retailers who can best facilitate these transitions. Closing the divide between online and offline retail, Temu solves some issues. It is focused on creating a second-to-none customer experience across all channels. Customers are looking for retailers they can trust to deliver exceptional service time and again. They have the right customer which has helped them to create an omnichannel customer experience for consumers to interact wherever and however they wish by incorporating real-time feedback across channels and devices – engaging the customer wherever they may be. Customers Expect a Seamless Experience: When transitioning between online and in-store experiences, customers not only want the same products to be available, they also want their experience to be seamless. This means, if they are a regular online customer, they want to be treated like a regular customer when they visit a brick-andmortar location. This is quite problematic. However, Temu has created this type of fluid online/offline experience for their customers, it has ceased pitting its channels against one another. Centralized customer data has helped it build a seamless, fluid experience beginning with an easily-accessible customer profile. Retailers lacks an outstanding Experience To Attract Customer Loyalty: Customer experience is the biggest contributor towards brand loyalty, the Traditional Retail model makes it difficult to build a good customer experience.Negative experience being the most significant factor in affecting a customer’s likelihood to make a repeat visit. Most customers also serve people in their own working lives, meaning when they are on the other side of the counter, they want to feel important.While promotions and offers can certainly contribute towards helping customers feel like they are special, the real key to an outstanding experience is personalization which the retail model falls short of. Getting to know customers from their previous purchases and interests can help retailers drive loyalty. These insights can be gleaned from data, or even a simple conversation.Temu addresses this challenge by rendering coupons, bonuses and reduced cost to existing and new customers. It is equally personalized with the user. A Siloed Marketing Infrastructure Makes It Expensive and Unwieldy to get Your Message Across; The traditional retail model features separate channels, which makes customer data to become siloed very easily. If all the moving parts of a marketing department are not communicating efficiently and working together, customers become overwhelmed with conflicting or repeated messages. This bombardment of marketing communications has easily had the opposite of the intended effect and driven customers to competitors with a clearer and more congruent message. The right technology and communication procedures can ensure all arms of a marketing team are on the same page. Temu as a modern retailer has been engaging with their customers across many different channels. From SMS, to email and social media, multi-channel communications are essential to engagement which, in turn, drives the creation of the perfect customer experience. So Many Technologies Exist to Drive Marketing and Sales, but They Don’t Seem to Work Together: While the amount of data gathered by businesses keeps growing at an alarming rate, the number of staff available to analyze it is staying more-or-less the same. What’s important, then, is making sure all this data is being used in the correct way and not contributing towards the data silo problem. This means finding a technology solution which can handle the huge amount of data being generated and ensure it is focused in a direction which best benefits rather than overwhelms marketing efforts. The data scientist approach to marketing is only going to become more prevalent as time goes on when creating a truly unified omnichannel service.Temu has ensured that all existing technologies work together which is why they get best results. Only in the combining of streamlined un-siloed data science, seamless cross-channel customer service and marketing, and authentic personalization, can traditional retailers create buyer experiences which can combat the fickle nature of the modern consumer and lead just like Temu. Strategies Implemented to Revolutionize The Retail Industry Temu adopted and implemented some strategies which accounted for its success. Temu’s business model is built around low prices. It offers even more discounts and lower prices than SHEIN, with special offers such as items sold for as little as one cent. Temu further differentiates itself by offering free shipping and returns to customers, which is made possible by PDD Holding’s extensive network of suppliers and shipping partners. An efficient logistics network is not to be underestimated, as problems with supply and distribution networks are seen as a major factor in the failure of Alibaba and Wish to break into the Western market.. Aside this, the following strategies were implemented; Combining Shopping and Entertainment: One-fifth of online shoppers in the U.S. say they miss the in-store shopping experience when they shop online. Temu aimed to bridge this gap and introduced games into the shopping process. By playing games like Fishland, Coin Spin, Card Flip, and others, customers can win rewards that ultimately lead to more time spent on the site and a dopamine rush from winning free items. To keep people playing these games, however, the app relies heavily on referrals, another core business strategy. These games were designed to be simple, addictive, rewarding, and increase user engagement and retention. According to app intelligence firm Sensor Tower, Temu’s average daily sessions per user in the US increased by 23% from October 2022 to January 2023. Some other games in Canada include scratch cards, card games, and cash games. Temu: Shared Shopping Experience: Group Buying is a familiar concept in Asia that Temu has extended to its Western customer base. Essentially, it has increased customers’ bargaining power by forming groups to share a bulk discount. This plays into the aforementioned referral program, which gives discounts to customers who bring new clients to the app and enables a shared shopping experience. Affiliate Programs and Heavy Advertising: As SHEIN had already proven effective, Temu sent free items to a large number of influencers and micro-influencers to promote Temu on YouTube and TikTok. A younger customer base of users under the age of 35 is particularly attractive to Temu, as younger consumers are typically less able and willing to pay large sums for products. Seeing a favorite internet personality or a personal acquaintance promoting the products has led to many young customers to imitate the purchase. Temu’s omnipresence on TikTok and YouTube is seen as a key factor in why this marketplace has taken off so quickly. A strong presence on TikTok and YouTube: Temu has leveraged the power of social media platforms, especially TikTok and YouTube, to spread awareness and generate buzz about its products and offers. The hashtag #temu on TikTok has amassed over 1.3 billion views, while Temu’s official YouTube account videos have grossed over 215 million views since last August. Temu’s marketing strategy relies on creating viral content that showcases its products entertainingly and engagingly, such as unboxing videos, product reviews, challenges, and giveaways. Temu also collaborates with influencers and celebrities with large followings on these platforms. Temu’s Audience: Temu’s primary target audience has been the young and price-conscious generation of online shoppers looking for bargains and discounts. According to a report by Daxue Consulting, the majority of Temu’s followers (32.68%) are aged 25-34, followed by 18-24 (28.57%) and 35-44 (21.43%). Temu appeals to these consumers by offering personalized recommendations based on their preferences and browsing history and gamified features that allow them to earn credits, gifts, and better deals by playing in-app games or inviting their friends to join the app. Referrals: A Win-Win Strategy for Users and Temu Temu has implemented a referral program encouraging users to invite friends and contacts to join the app in exchange for credits and gifts. Users can share their referral links or codes on social media platforms like Facebook, Instagram, and TikTok. For example, users can join a “Fashion Lovers” team and get $20 in credits by inviting five friends who also love fashion within 24 hours. These referrals help users save money on their purchases, help Temu acquire new customers, and expand its network of sellers. Temu’s Marketing and Growth Strategy that led to its Rise Temu's growth has been remarkable in a short period of time. It reached the top downloads in the shopping category of both Apple's App Store and Google Play and is quickly establishing itself as a high-potential and innovative player in the e-commerce industry. Its success is ultimately its low prices, unlocked by their innovative Next-Gen Manufacturing (NGM) model. It employed a multifaceted marketing strategy to drive user acquisition and brand awareness which has been working greatly for them; Influencer Collaborations: To reach a wider audience, Temu has been collaborating with popular social media influencers and celebrities who promoted the app and shared their shopping experiences. Influencers came from a wide range of individuals, including fashion bloggers, lifestyle influencers, beauty gurus, tech enthusiasts, or experts in specific product categories.This strategy generated buzz and created a sense of credibility and trust among potential users. This marketing strategy was successfully implemented through; Influencer Selection: Temu carefully identified and selected influencers who aligned with its target audience, brand values, and product offerings. These influencers typically had a strong online presence, a relevant niche or expertise, and a sizable following. Temu considered factors such as engagement rates, authenticity, and the influencer's ability to create appealing and relatable content. Exclusive Partnerships: Temu forged exclusive partnerships with influencers, often signing them as brand ambassadors or collaborators. These collaborations involved long-term commitments, where influencers actively promoted Temu's app and its features on their social media platforms, websites, or blogs. The exclusivity of these partnerships helped establish a strong association between the influencers and Temu, increasing brand loyalty and credibility. Sponsored Content: Temu engaged influencers to create sponsored content that showcased the app's features, user experience, and the benefits of using Temu for shopping. Influencers shared their personal experiences, demonstrated the app's functionalities, and highlighted the unique advantages of using Temu over other shopping platforms. This content was often shared through blog posts, social media posts, videos, and live streams. Product Reviews and Recommendations: Influencers played a crucial role in reviewing and recommending products available on Temu. They shared their honest opinions and experiences using products from various brands. Their reviews and recommendations helped build trust and credibility among their followers, encouraging them to explore and purchase products through Temu. Giveaways and Contests: Temu collaborated with influencers to host giveaways and contests, where users had the chance to win exclusive prizes or discounts by engaging with the app or participating in specific promotional activities. These initiatives created buzz, generated user excitement, and attracted new users to the platform. Affiliate Marketing: Temu employed affiliate marketing strategies with influencers, where influencers received a commission or referral fee for every user who downloaded the app or made a purchase through their unique referral links. This incentivized influencers to actively promote Temu and its offerings, as their earnings were directly tied to the success of their referrals. Event Participation: Temu partnered with influencers for events such as product launches, fashion shows, or brand campaigns. Influencers attended these events, shared live updates, and provided behind-the-scenes content to their followers, creating a sense of exclusivity and fostering excitement around Temu's activities. User-generated Content: Temu encouraged influencers and their followers to create usergenerated content related to the app. This could include unboxing videos, styling tips, or hauls showcasing products purchased through Temu. Such content served as social proof and encouraged other users to engage with the app and make purchases. Overall, Temu's collaborations with influencers helped amplify its brand message, expand its reach to new audiences, and establish credibility within the social media landscape. By leveraging the influence and creative abilities of influencers, Temu successfully tapped into their followers' trust and engagement, driving user acquisition, and fostering a positive brand image. User Referral Program: Temu has been incentivizing existing users to refer the app to their friends and family by offering discounts or exclusive rewards. This word-of-mouth marketing approach contributed to the app's exponential growth and user acquisition. Targeted Digital Advertising: Temu has been leveraging targeted digital advertising campaigns across various digital platforms like Facebook, Instagram, Twitter, TikTok and soon Telegram focusing on specific demographics and user segments. By tailoring their messaging and creative assets, Temu effectively reached potential users with personalized content. Expansion into New Markets: After gaining traction in its home market, Temu has been expanding its operations into international markets. It strategically entered regions with high smartphone penetration and a growing ecommerce ecosystem. This expansion allowed Temu to tap into a larger customer base and establish itself as a global player in the shopping app industry. Partnerships with Brands and Retailers: Recognizing the importance of strategic alliances, Temu has been forging partnerships with renowned brands and retailers. These collaborations involved exclusive product launches, limitededition collections, and promotional campaigns. By aligning with established names in the retail industry, Temu gained credibility and attracted a wider range of customers. Continuous Innovation: Temu has been prioritizing continuous innovation to stay ahead of the competition. It regularly updated its app with new features and enhancements based on user feedback and emerging trends. For example, it introduced a virtual stylist feature that offered personalized fashion advice and styling tips, further enhancing the user experience. Data-driven Insights: Temu has been leveraging the vast amount of user data it collected to gain valuable insights into consumer behavior, preferences, and trends. These insights were used to refine its product offering, improve targeted advertising efforts, and optimize the overall shopping experience. By harnessing the power of data, Temu was able to make data-informed decisions and stay attuned to evolving customer needs. Seamless Integration with Physical Stores: Recognizing the importance of the omnichannel experience, Temu has been integrating its app with physical stores. It introduced features like in-store barcode scanning, which allowed users to access product information, read reviews, and make purchases directly from their smartphones while inside partner retail locations. This integration blurred the lines between online and offline shopping and provided a seamless and unified experience. Social Impact Initiatives: Temu also has also been focusing on social impact initiatives to connect with socially conscious consumers. It launched sustainable product collections, partnered with NGOs for charitable causes, and implemented eco-friendly packaging practices. These initiatives resonated with environmentally and socially conscious users, further strengthening Temu's brand reputation and loyalty. Continuous Customer Support: Temu has been placing strong emphasis on customer support and responsiveness. It established dedicated customer service channels, including live chat support and a comprehensive FAQ section. Timely and effective customer support enhanced user satisfaction, resolved issues promptly, and fostered a positive brand image. A heavy paid media strategy: Like other well-funded internet companies, Temu appears to be spending heavily for app installs and on search ads. Search for almost any commodity product—especially if your search includes the word “cheap”—and you’re likely to find a Google result for Temu. Temu also gained attention with multiple Super Bowl spots, putting it on the map for many US consumers for the first time. Results and Impacts The rise of Temu as a shopping app has revolutionized the Retail Industry and also Consumer Experience; User Base and Revenue Growth: Within two years of its launch, Temu has amassed millions of active users and experienced exponential revenue growth. Its user-centric approach and innovative features resonated with consumers, driving adoption and usage. Enhanced Customer Experience: Temu's focus on personalization, convenience, and seamless shopping experiences has elevated customer satisfaction levels. Users appreciated the ability to try on products virtually, receive tailored recommendations, and enjoy hassle-free transactions. Disruption of Traditional Retail: The Traditional Retail industry has suffered relatively as a result of the rise of Temu as a Shopping App. It has greatly disrupted traditional brick-and-mortar retail, with many businesses. This is so because with their new innovation, they have explored other parts(online) which the traditional retailers do not have. Its rise has posed several challenges for traditional retailers as they struggle to adapt to the changing landscape; Online Presence and Digital Transformation: Traditional retailers are still struggling with establishing a strong online presence and undergoing digital transformation. Building and maintaining an effective e-commerce website or app requires technical expertise, investment in infrastructure, and a shift in mindset. Adapting to the digital realm is now very challenging for retailers who have primarily operated in brick-and-mortar stores. Competition with E-commerce Giants: E-commerce platforms like Temu with significant resources, a broad customer base, and strong brand recognition which makes it difficult for Traditional retailers to compete with in terms of pricing, product selection, and customer convenience. It can be challenging for them to match the speed, efficiency, and scale of operations offered by online marketplaces. Supply Chain and Logistics: Traditional retailers have gotten used to managing inventory primarily for physical stores and now face challenges in adapting their supply chain and logistics operations to accommodate online sales. Efficient inventory management, order fulfillment, and last-mile delivery is quite complex and requires adjustments to meet the demands of e-commerce customers. Customer Expectations and Experience: Online shoppers have come to expect a seamless and personalized shopping experience. Traditional retailers now struggle to meet these expectations, especially provided they have very limited experience in online customer engagement, personalization, and tailoring recommendations. Adapting to a customer-centric approach and providing a consistent omnichannel experience can be a significant challenge. Data and Analytics: E-commerce platforms like Temu rely heavily on data and analytics to understand customer behavior, preferences, and trends. Traditional retailers have limited experience in collecting, analyzing, and utilizing customer data effectively. Harnessing data to make data-driven decisions and optimize operations is now a significant hurdle for retailers transitioning to an online model. Operational Costs and Margins: Traditional retailers are facing financial challenges to adapt to ecommerce. Online operations require investments in technology, infrastructure, marketing, and fulfillment capabilities. Retailers need to reevaluate their pricing strategies, optimize operational costs, and find ways to maintain profitability in the face of increased competition and potentially lower margins. Brand Differentiation and Customer Loyalty: Building a strong brand and fostering customer loyalty has proven to be more challenging in the online space. Traditional retailers may have developed a loyal customer base through in-person interactions and personalized service. Translating that loyalty to the digital realm and effectively differentiating their brand from competitors needs innovative strategies and marketing efforts which will take time. By leveraging technology and understanding evolving consumer behaviors, Temu has disrupted the retail industry, reshaped shopping habits, and set new standards for convenience and engagement in the digital age; Temu’s Setbacks Despite its rapid rise, its relationship with sister company Pinduoduo has brought about several challenges in delivery of goods as compared to its competitors and other areas; According to reports published in Times, Temu is beginning to develop a reputation for undelivered packages, mysterious charges, incorrect orders and unresponsive customer service. Temu itself acknowledges that its orders take longer to arrive than those from Amazon—typically 7-15 business days as they come from “overseas warehouses.” In a series of Facebook messages with Times, Roper Malloy, a client complained of spending $178 on gifts from Temu for her family, including two drones and some makeup for her daughter which has never arrived. She said she has contacted the company several times for a refund, which has also yet to arrive. On May 17, 2023, Montana Governor Greg Gianforte banned Temu from statewide government devices, as well as ByteDance apps (including TikTok ) , Telegram , and WeChat. In June 2023, the U.S. House Select Committee on U.S.- Chinese Communist Party Strategic Competition stated that Temu did not maintain ""even the facade of a meaningful compliance program"" with the law. Uyghur on Forced Labor Prevention to keep goods made by forced labor off its platform. In October, the Boston branch of the Better Business Bureau opened up a file on Temu and has received 31 complaints about the website. Temu currently has a C rating on the BBB, and an average customer rating of 1.4 stars out of 5, although from only 20 reviews. (Complaints are separate from reviews, which do not factor into BBB’s official rating.) McGovern at the BBB mentioned that, it’s unusual for such a new company to receive so many complaints in such a short amount of time. Temu has acknowledged and responded to every complaint posted to the BBB website, but many of those complaints remain unresolved. Temu’s sister company, Pinduoduo, has long been accused of hosting sales of counterfeits, illegal goods, or products that do not match their descriptions. (Pinduoduo wrote in its SEC filings that it immediately removes unauthorized products or misleading information on its platform, and freezes the accounts of sellers on the site who violate its policies.) There have been no BBB complaints that allege the goods Temu ships are counterfeit or fake. Additionally, in 2021, the deaths of two Pinduoduo employees spurred investigations and boycotts over the company’s working conditions, according to the New York Times. How Temu could affect the U.S. economy In May 2023, the U.S.-China Economic and Security Review Commission raised concerns about risks to users' personal data on Temu as a shopping app affiliated with Pinduoduo, which was removed from Google Play after some of its versions were found to contain malware. Schmidt, at Vanderbilt, who specializes in security and privacy, is of the opinion that Temu’s data and privacy practices aren’t out of the ordinary; The company collects lots of personal data about users and then deploys that data to sell ads. However, he says that Temu’s rise could have a bigger impact not in terms of privacy concerns, but in terms of pressure on American companies and workers. If more and more American consumers flock to Temu to buy cut-rate goods, that could pressure Amazon and other competitors to slash their prices too which would affect wages. Areas for Improvements Despite its innovative business model and commitment to sustainability, Temu still has some areas that need improvement; Real-Time Shopping: Cost-Effectiveness vs. Plagiarism and Exploitation: Temu’s most innovative and effective strategy has been highly ambivalent and criticized. Similar to SHEIN, Temu has been using a reverse-manufacturing model that relays customer feedback directly to manufacturers. Starting off with smaller quantities that are offered on the marketplace, products in high demand are reordered, while others are replaced. According to Temu, this results in environmental efficiency because product inventory is aligned with customer demand in real time. In addition, a greater number of products can be offered than with traditional retail strategies. With this method, SHEIN was able to launch 150,000 new items in 2020, beating its competitors by a wide margin. Temu Has to Fight Criticism: Critics point to several detrimental effects of this type of 'ultra-fast' commerce: To ensure low prices, manufacturers must keep costs down, contributing to the continued poverty of workers in manufacturing countries. The same goes for product quality and environmental friendliness: Cheap products that break easily contribute to increasing amounts of waste, returned products tend to be dumped rather than recycled or resold, and the high number of new products sold is only possible by ripping off SME fashion designers and creators. TrustPilot reviews reveal a 2.9-star average, with the majority of one-star reviews citing long shipping times, low-quality items, and poor customer service. Low quality items can become a sustainability issue in itself, since those products have a higher chance of ending up in landfill. It’s essential for Temu to address these concerns and maintain a balance between low prices and customer satisfaction. Lessons Learned Temu's rise as a shopping app exemplifies the transformative power of technology in the retail industry. Its success serves as an inspiration for other businesses seeking to adapt and thrive in the digital era. Overall, the rise of Temu as a shopping app has been driven by its commitment to innovation, personalized experiences, strategic partnerships, and a customer-centric approach. The marketplace Temu has achieved impressive success with its business model of offering low-priced products and free shipping, combined with a gamified shopping experience. Temu's strategy also includes group buying, referrals, affiliate programs, and heavy advertising on social media platforms. While Temu's real-time shopping model, which involves relaying customer feedback directly to manufacturers, is seen as innovative and cost-effective, it has also garnered criticism. Critics argue that this approach can lead to environmental issues, exploitation of workers, and plagiarism of designs from small and medium-sized fashion creators. Despite these concerns, Temu's combination of low prices, gamified shopping, and heavy advertising on platforms like TikTok and YouTube has made it a major player in the ultra-fast eCommerce sector. However, Temu's most controversial strategy is its real-time shopping model akin to that of SHEIN, which relays customer feedback directly to manufacturers. While this model increases costeffectiveness and product variety, critics argue that it contributes to environmental degradation, exploitation of workers, and plagiarism of fashion designers. Nonetheless, Temu's growth and distinct strategy make it a noteworthy player in this emerging business model of ultra-fast eCommerce, and it will be interesting to see how this trend plays out in the future. Actionable Takeaways for other Businesses in the Retail Industry Traditional Retailers who wish to also rise like Temu should consider the following steps; Develop a User-Friendly E-commerce Website: Create a well-designed, intuitive, and user-friendly e-commerce website that offers a seamless shopping experience. Ensure that the website is responsive, optimized for mobile devices, and provides easy navigation, product search, and checkout processes. Emphasize Branding and Differentiation: Clearly define the brand identity and unique selling propositions of your retail business. Highlight what sets your products apart from competitors and communicate a compelling brand story to engage online customers. Use high-quality visuals and persuasive copywriting to convey your brand message effectively. Optimize for Search Engines: Implement search engine optimization (SEO) techniques to improve the visibility of your website in search engine results. Conduct keyword research to understand the terms and phrases your target audience is searching for, and optimize your website's content, meta tags, and URLs accordingly. Leverage Social Media: Use social media platforms to build an online community, engage with customers, and promote your products. Regularly post engaging content, including product updates, customer testimonials, and behind-the-scenes glimpses. Encourage user-generated content and respond promptly to customer inquiries and feedback. Invest in Digital Marketing: Develop a comprehensive digital marketing strategy that includes online advertising, email marketing, influencer collaborations, and content marketing. Target specific customer segments and utilize data-driven approaches to reach your audience effectively and drive traffic to your website. Provide Excellent Customer Service: Offer exceptional customer service across all online channels, including live chat, email, and social media. Respond promptly to customer inquiries, provide accurate product information, and address any issues or concerns in a timely manner. Personalize the customer experience as much as possible to build trust and loyalty. Implement Online Customer Engagement Tools: Incorporate tools such as live chat, product reviews, ratings, and personalized recommendations to enhance customer engagement and create a sense of interactivity on your website. Encourage customer feedback and testimonials to build social proof and credibility. Collaborate with Influencers and Online Communities: Partner with relevant influencers or online communities in your industry to extend your reach and tap into their established audiences. Engage in collaborations, product reviews, or sponsorships to increase brand visibility and credibility. Analyze and Optimize: Continuously monitor and analyze website metrics, customer behavior, and online marketing campaigns. Utilize analytics tools to gain insights into what is working and what needs improvement. Optimize your online presence based on data-driven decisions to enhance the user experience and drive conversions. Adapt to Changing Trends: Stay up to date with the latest e-commerce trends, technologies, and consumer preferences. Be willing to experiment, adapt, and embrace new technologies or platforms that can enhance your online presence and provide a competitive edge. By implementing these strategies, traditional retailers can establish a strong online presence, attract online customers, and compete effectively in the digital marketplace. It's important to continuously evaluate and refine your online presence based on customer feedback, market trends, and emerging technologies to stay ahead of the competition. Future Outlook The rise of Temu as a shopping app has been remarkable, and it has successfully disrupted the retail experience by implementing innovative strategies and business models. Looking ahead, there are several key factors that will shape the future outlook of Temu and determine its continued success in the competitive online shopping market; Expansion into New Markets: Temu has already expanded its operations to several countries, including the US, Canada, Australia, New Zealand, France, Italy, Germany, the Netherlands, Spain, and the United Kingdom. To sustain its growth, Temu will likely continue to explore opportunities for expansion into new markets, both within and outside of these regions. This expansion will allow the platform to reach a larger customer base and tap into new consumer preferences and demands. Improvement in Delivery Times: One area of concern for customers is the longer delivery times associated with Temu's Next-Gen Manufacturing (NGM) model. To address this issue, Temu may invest in optimizing its supply chain and logistics processes. By streamlining operations and partnering with efficient shipping providers, Temu can reduce delivery times and enhance the overall customer experience. Enhanced Customer Engagement: Temu's success is partly attributed to its gamification strategies and social commerce approach. To maintain customer engagement and loyalty, Temu will need to continuously innovate and introduce new features that incentivize users to stay active on the platform. This could include personalized recommendations, rewards programs, and interactive shopping experiences. Sustainability and Social Responsibility: Temu has positioned itself as a platform that promotes sustainability and social responsibility through its NGM model, which reduces unsold inventory and waste. Going forward, it will be crucial for Temu to uphold these values and communicate its commitment to sustainability to customers. This can be achieved through transparent supply chain practices, eco-friendly packaging options, and partnerships with ethical suppliers. Competition and Differentiation: While Temu has gained significant traction, it faces strong competition from other Chinese online wholesale platforms and established e-commerce giants. To stay ahead, Temu will need to continue differentiating itself through its NGM model, competitive pricing, and unique product offerings. It should also focus on building a strong brand identity and nurturing customer trust through excellent customer service and reliable purchase protection. navigate the competitive landscape. With its innovative approach and commitment to customer satisfaction, Temu has the potential to continue reshaping the online Conclusion Conclusively, Temu has emerged as a shopping app that is revolutionizing the retail experience through its Next-Gen Manufacturing model and direct-to-supplier approach. By focusing on cost savings, customization, and sustainability, Temu has gained a competitive edge in the market. With a lot of consumer goods being produced in China it makes sense that more and more e-commerce platforms are Chinese. The success of Temu and its competitors showcases the power of connecting customers directly with suppliers, ultimately reshaping the way people shop online. TEMU's emergence in the e-commerce landscape with its lightning-fast shipping times has undoubtedly stirred the industry. By setting new standards for efficiency and customer satisfaction, TEMU challenges traditional platforms to step up their game. While the convenience of rapid shipping is undeniable, the long-term sustainability and overall impact of this approach must also be considered. As consumers continue to prioritize convenience and speed, the success of TEMU may very well influence how the e-commerce ecosystem evolves in the years to come. However, to sustain its growth and success, Temu must adapt to evolving customer preferences, optimize its operations, and effectively.","Answer in paragraph format. Only use the context provided for your answer. What factors led to Temu's success? THE RISE OF TEMU: A Shopping App Revolutionizing the Retail Experience Introduction In recent years, the retail industry has witnessed a significant shift towards online shopping. The emergence of E-commerce platforms has transformed the way consumers shop, providing convenience and access to a wide range of products. This case study explores the rise of Temu, a shopping app that has disrupted the traditional retail landscape and revolutionized the shopping experience for millions of users. Temu, a rising star in the world of online shopping, offers a vast array of fashion products, beauty items, and home goods. This Chinese-owned digital marketplace has quickly become the top free shopping app, outshining giants like Shein, Amazon, and Walmart. Temu’s business model connects customers directly to suppliers. By forging strong relationships with retailers, they’ve managed to keep prices low and maintain a vast network of suppliers. At the core of Temu’s rapid growth and competitive pricing is their innovative Next-Gen Manufacturing (NGM) model. Launched in September 2022, this Boston-based e-commerce platform serves markets in the US, Canada, Australia, and New Zealand. The NGM model revolutionizes the retail process by enabling manufacturers to produce merchandise with more precision, reducing unsold inventory and waste. However customers do complain about longer delivery times. It is unknown to what extent this is a result of the NGM model. By connecting shoppers directly with manufacturers and offering real-time insights, Temu is able to cut warehousing and transportation costs, resulting in savings of at least 50% compared to traditional processes. This cost-saving approach allows the company to offer near-wholesale prices, as they remove hidden costs and focus on accurately forecasting sales and demand. While Temu.com is gaining popularity, it faces stiff competition from other Chinese online wholesale stores like AliExpress, DHGate, Banggood, and DealExtreme. These platforms offer a wide range of products at competitive prices, along with diverse shipping options and payment methods. However, Temu stands out with its NGM model, which empowers manufacturers to create customized products. The increased visibility of demand and supply accelerates distribution and eliminates the need for large warehouses. Another distinguishing factor of Temu is its claims on sustainability and social responsibility. The NGM model promotes a more sustainable e-commerce landscape by enabling manufacturers to produce merchandise that fits the needs of consumers, leading to lower unsold inventory and waste. Significance of Temu’s Innovative approach to Shopping In the rapidly evolving world of e-commerce, convenience and speed have become the pillars on which success is built. As consumers increasingly turn to online shopping to meet their needs, the demand for faster shopping times has never been higher. Enter TEMU, the innovative new ecommerce platform that promises to redefine the shopping experience with lightning-fast shipping. TEMU's shopping prowess to traditional e-commerce platforms, makes it stand out and elevates the shopping journey for customers. Speed of Delivery: One of the most glaring advantages TEMU brings to the table is its lightning-fast shipping times. Unlike traditional platforms that often offer standard shipping that can take days or even weeks, TEMU has set a new standard with its express delivery options. With strategically located warehouses and a streamlined logistics network, TEMU ensures that customers receive their orders in record time, sometimes as soon as within a few hours of placing an order. This kind of speed sets TEMU apart from traditional e-commerce platforms, where delays in processing and shipping can often lead to frustration and disappointment for customers. Inventory Management: TEMU's commitment to swift delivery is closely tied to its advanced inventory management system. Traditional platforms often struggle to keep up with the demand, leading to instances where popular items are out of stock or on backorder. TEMU's innovative approach utilizes real-time data analytics to predict customer demands and stock products accordingly. This approach significantly reduces the chances of running out of stock, thus ensuring that customers can find what they want when they want it. Customer Satisfaction: In the world of e-commerce, customer satisfaction is paramount. TEMU's emphasis on fast shipping addresses one of the most common pain points for online shoppers – the waiting game. Traditional platforms often face challenges in providing consistent shipping times, leading to varied customer experiences. TEMU's commitment to speedy delivery contributes to higher levels of customer satisfaction by providing a more reliable and predictable shopping experience. Competitive Edge: As e-commerce continues to grow, the market becomes increasingly saturated with both established giants and new entrants. TEMU's focus on faster shipping times gives it a distinct competitive edge. It appeals to consumers who prioritize efficiency and convenience in their shopping experience. In contrast, traditional platforms may find themselves having to adapt quickly or risk losing customers to the allure of TEMU's swiffer service. Sustainability and Environmental Impact: While speed is a significant selling point for TEMU, it's essential to consider the environmental impact of such rapid shipping. Expedited shipping often requires additional resources, such as expedited transportation and packaging materials. Traditional platforms might adopt more sustainable shipping practices, such as grouping orders or optimizing delivery routes to reduce their carbon footprint. TEMU must balance its commitment to speed with environmental responsibility to ensure a positive long-term impact. Brief Overview of Temu Temu (pronounced ‘tee-moo’) is a Boston-based online marketplace founded by Pinduoduo’s parent company PDD Holding. Its business model is likened to Chinese shopping platforms SHEIN, Wish, and Alibaba – which are based on the sale of large quantities of products at prices that are so low they are almost unbelievable. Temu was founded in the USA in 2022 and is a subsidiary of PDD Holdings Inc., which is listed on Nasdaq and headquartered in Shanghai. Temu operates as an online marketplace similar to AliExpress, Walmart, and Wish, focusing on offering affordable goods. Temu allows Chinese vendors to sell to shoppers and ship directly to them without having to store products in U.S. warehouses.The company acts as an intermediary between sellers (primarily from China) and buyers without maintaining its own inventory. Temu promotes social commerce, encouraging potential buyers to find more buyers to avail discounts. The app employs gamification to engage customers and offers free shipping by circumventing customs duties. The platform allows suppliers based in China to sell and ship directly to customers without having to rely on warehouses in the destination countries . Online purchases on Temu can be made using a web browser or via a dedicated mobile application.Temu offers free products to some users which encourage new people to install the app through affiliate codes, social media and gamification. It also uses online advertising on Facebook and Instagram and many online platforms. The Temu platform went live for the first time in the United States in September 2022 and in February 2023, Temu was launched in Canada. That same month, the company aired a Super Bowl commercial advert . In March 2023, Temu was launched in Australia and New Zealand. The following month, Temu was launched in France , Italy , Germany , the Netherlands , Spain and the United Kingdom. Naturally, the prices charged by the site defy all competition (sneakers for €11, manicure kit for less than €5, phone holder for €1.80, etc.), so much so that the platform has adopted an eloquent slogan: “Buy like a Billionaire”. As the specialist in Chinese digital companies Jeffrey Towson explains to Le Monde, the platform does not yet make a margin, in order to establish itself quickly in the targeted countries. At the end of 2022, the Temu application became the most downloaded application in the United States. The TEMU (Shop Like a Millionaire) Shopping app is now boasting over 100 million Downloads on PlayStore and AppStore with over 4.7 Million reviews and about 12+ Ratings. Three months after its launch in the United States, the application was at the top of downloads. In the European Union, where the platform arrived in April (in France, the United Kingdom, Italy, the Netherlands, Spain and Germany), the success is similar. In recent days, it has been the most downloaded application in France on iOS and Android. As of April 2023, the app has been downloaded 10 million times since its launch in September 2022 and it is currently available in around 100 countries. Temu’s wide range of products is particularly appealing to consumers, combined with a gamified online shopping experience that encourages customers to try their luck and buy more and more. With its impressive growth and distinct strategy, Temu’s business model warrants a closer look. Key Factors that contributed to its initial success Leveraging the power of mobile technology, Temu aimed to bridge the gap between online and offline retail, offering a unique platform that combined the benefits of both worlds. It introduced several innovative features for better customer experience that set it apart from competitors and propelled its rapid rise to popularity. These Key Features and Functionality are; Augmented Reality (AR) Shopping: Temu integrated AR technology into its app, allowing users to virtually try on clothing, visualize furniture in their homes, and experience products before making a purchase. This feature enhanced the shopping experience and reduced the need for physical store visits. Personalized Recommendations: Temu leveraged artificial intelligence and machine learning algorithms to analyze user preferences, browsing history, and purchase behavior. Based on these insights, the app provided personalized product recommendations to users, leading to higher customer satisfaction and increased sales.Certainly! Temu's personalized recommendations were generated through a combination of artificial intelligence (AI) and machine learning algorithms. Here's an overview of how the feature worked: Data Collection: Temu collected vast amounts of user data to understand individual preferences and behavior. This data included user interactions within the app, such as product searches, views, clicks, and purchases, as well as demographic information and user-provided preferences. Data Processing and Analysis: The collected data was processed and analyzed using AI and machine learning algorithms. These algorithms examined patterns, correlations, and relationships within the data to identify user preferences, interests, and buying patterns. User Profiling: Based on the analysis, Temu created user profiles that encompassed various attributes, such as preferred product categories, brands, price ranges, and style preferences. The profiles were continually updated and refined as new data was collected and analyzed. Collaborative Filtering: One common technique used by Temu was collaborative filtering. This approach compares a user's profile with the profiles of other similar users to identify products or items that users with similar preferences enjoyed or purchased. By finding similarities between users, collaborative filtering could suggest relevant products to a particular user based on the preferences of users with similar tastes. Content-Based Filtering: Another technique employed by Temu was content-based filtering. This method focused on the characteristics and attributes of products themselves. It analyzed product descriptions, features, tags, and other metadata to identify similarities and correlations between products. For example, if a user showed a preference for certain brands or specific features, content-based filtering could recommend similar products that match those preferences. Machine Learning and Iterative Refinement: Temu's algorithms continuously learned and improved over time. As users interacted with the app and provided feedback, the algorithms adjusted their recommendations based on the user's responses and behavior. Machine learning techniques enabled the system to adapt and refine its recommendations based on real-time user feedback. Real-Time Contextual Factors: In addition to user preferences, Temu also considered real-time contextual factors, such as trending products, seasonal trends, and popular items in the user's location. These factors were incorporated into the recommendation algorithms to ensure up-to-date and relevant suggestions. By leveraging AI, machine learning, and user data, Temu's personalized recommendation system aimed to understand each user's unique preferences and deliver tailored product suggestions. The algorithms continually evolved to provide increasingly accurate and relevant recommendations, enhancing the user experience and facilitating personalized shopping journeys. Social Commerce Integration: Recognizing the power of social media, Temu incorporated social commerce features, enabling users to share products, create wish lists, and seek recommendations from friends and influencers. This integration expanded Temu's reach and facilitated organic growth through user-generated content. Seamless Checkout and Delivery: Temu prioritized a frictionless shopping experience by streamlining the checkout process and offering multiple secure payment options. Additionally, it partnered with reliable logistics providers to ensure prompt and efficient product delivery, enhancing customer satisfaction and loyalty. Seamless Checkout and Payment Options: Temu focused on streamlining the checkout process to provide a seamless and hassle-free experience for users. It offered multiple secure payment options, including credit/debit cards, mobile wallets, and payment gateways, allowing users to choose their preferred method. This flexibility and ease of payment contributed to a smoother transaction process and reduced cart abandonment rates.Temu implemented several measures to ensure the security of payment options for its users; Secure Payment Gateways: Temu has partnered with trusted and secure payment gateways to handle the processing of user payments. These payment gateways employ robust security measures such as encryption, tokenization, and secure socket layer (SSL) protocols to protect sensitive payment information during transmission. Encryption: Temu has implemented encryption protocols to safeguard user payment data. This involves encrypting sensitive information such as credit card details, bank account numbers, and personal information to prevent unauthorized access or interception. Encryption ensures that even if the data is intercepted, it remains unreadable and unusable to unauthorized parties. Compliance with Payment Card Industry Data Security Standards (PCI DSS): Temu has adhered to the Payment Card Industry Data Security Standards, which are industry-wide standards established to ensure the secure handling of cardholder data. Compliance with PCI DSS involves maintaining a secure network, implementing strong access controls, regularly monitoring and testing systems, and maintaining an information security policy. Two-Factor Authentication (2FA): Temu has implemented two-factor authentication as an additional layer of security for payment transactions. This requires users to provide two forms of verification, such as a password and a unique code sent to their mobile device, to authenticate their identity before completing a payment. Fraud Detection Systems: Temu has employed fraud detection systems and algorithms to identify and prevent fraudulent payment activities. These systems analyze various factors, such as user behavior, transaction patterns, and known fraud indicators, to detect and flag suspicious transactions for further verification or intervention. Regular Security Audits: Temu has conducted regular security audits and assessments to identify vulnerabilities and ensure that all payment systems and processes meet the highest security standards. This includes conducting penetration testing, code reviews, and vulnerability scans to proactively identify and address any potential security weaknesses. User Education and Awareness: Temu has implemented user education programs to raise awareness about safe online payment practices. This could include educating users about the importance of strong passwords, avoiding phishing attempts, and regularly monitoring their payment transactions for any unauthorized activity. Order Tracking and Delivery Updates: Temu provided users with real-time order tracking and delivery updates. Users could monitor the progress of their orders and receive notifications regarding shipment status, estimated delivery time, and any delays. This feature enhanced transparency and kept users informed throughout the delivery process, improving overall customer satisfaction. User Reviews and Ratings: To facilitate informed purchasing decisions, Temu incorporated user reviews and ratings for products. Users could leave feedback and rate their purchases, helping others make well-informed choices. This feature added a layer of trust and credibility to the shopping experience and fostered a community-driven approach to product evaluation. Virtual Stylist and Fashion Advice: Temu introduced a virtual stylist feature that offered personalized fashion advice and styling tips. Users could provide information about their preferences, body type, and occasion, and receive tailored recommendations for outfits and accessories. This feature catered to users seeking fashion inspiration and guidance, enhancing their shopping experience. Temu’s Virtual Stylist feature works in the following ways; It helps Users of the Temu app to create a profile by providing information about their preferences, body type, style preferences, and any specific fashion requirements they may have. The virtual stylist feature uses algorithms and machine learning techniques to analyze the user's profile and understand their style preferences. It considers factors such as color preferences, patterns, clothing types, and previous purchases. The feature assists users in recommendations. Based on the user's profile and preferences, the virtual stylist recommends outfits, clothing items, or accessories that align with their style. These recommendations may include images, descriptions, and links to purchase the recommended items. The feature also provides style tips, fashion trends, and suggestions to help users stay updated and make informed fashion choices. It helps users in Interactive Communication. The virtual stylist often offers Interactive communication channels such as chatbots or messaging systems. Users ask questions, seek styling advice, or provide feedback to further refine the recommendations. The feature helps Integration with User Feedback,it learns and improves over time by incorporating user feedback and preferences. As users interact with the feature, their feedback and engagement help train the algorithm to provide more accurate and personalized recommendations Growth and Adoption over time Temu was ranked No. 12 in the 2022 holiday traffic, topping retailers like Kohl’s and Wayfair. With an average of 41.0 million visitors in November and December, Temu surpassed major ecommerce sites like Kohl’s, Wayfair, and Nordstrom, and was within striking distance of Macy’s. Temu surged ahead of low-price Chinese goods sellers Shein and Wish.com in dramatic fashion. Not only did Temu quickly surpass Wish.com amid its recent downswing, it also managed to leapfrog Shein’s impressive recent gains. Shein’s steady rise has the company now looking to raise capital at a reported $64 billion valuation as reported by Reuters. Wish.com, by comparison, has been hemorrhaging money and has plummeted 98% from its peak stock price, with a market cap below $400 million. Using cheap wares to attract customers can work, but profitability is a challenge when operating under tight margins. High acquisition costs can be a killer, and there will also be a need to pivot into higher-margin goods. Temu is keying on its mobile app for loyalty. Temu’s bargain-basement prices make purchases a low consideration in most cases. Its best use case is when customers realize a need (“Shoot, I left my iPhone charger at the hotel and need another one”) and can buy quickly and cheaply. The app can drive habit formation around this, and the more that shoppers rely on the app the less likely Temu will have to pay for ads to drive conversions. Temu exploded out of the gates and its rapid rise warrants attention. As something of a Wish.com clone, there’s reason to be skeptical it can find long-term profitable growth when its early stage capital eventually rationalizes. Whether Temu avoids a similar fate will come down to whether it can improve upon the Wish.com playbook to build a loyal and engaged user base and drastically reduce customer acquisition costs over time. A killer TikTok strategy and sticky mobile app was key to achieving what its predecessor could not. As originally featured in the Retail Daily newsletter, Amazon has been the most downloaded shopping app in the US for a very long time. It managed to beat local competitors like Walmart, and even international competition from apps like Wish. But with the coming of Temu it looked like Amazon had finally met its match. Going all the way back to 2020, Amazon's shopping app was averaging around 550K downloads per week in the US, according to our estimates. The summer of 2022 was strong, pushing Amazon's downloads to more than double with a range between 800K and 1.2M weekly downloads. And that spike didn't slow down until February, 2023, after which downloads really started sloping down. SHEIN, a clothing retailer that sells ""fast fashion"" shipped from China, has been chasing Amazon's tail since it launched. Key word being ""chasing"". SHEIN averaged a little over half of Amazon's downloads back in 2020. They got close a few times but not enough to really take the lead. In January of 2023, that changed and SHEIN's downloads are now about double those of Amazon in the US. SHEIN saw 617K downloads from the App Store + Google Play in the US last week, according to our estimates. And SHEIN isn't even Amazon's biggest threat right now but Temu, a China-based retailer that sells a variety of goods, from clothes to furniture, at very low prices, since its launch late last year. The holiday shopping season was big for Temu. It averaged 2M new downloads every week between November and December, according to our estimates. Downloads dropped since, which makes sense overall, but are still astronomically high in comparison. Temu saw 1.3M new downloads last week in the US. This is a big problem for Amazon which may mean the next Prime Day will be a little more exciting than the last few. And yes, Temu is one of the biggest spends on Apple Search Ads which helps it get those downloads. Challenges Addressed by Temu The traditional retail model is almost getting outdated thereby posing several challenges. While the “customer is always right” mantra has held true for quite some time, the amount of power wielded by consumers has never been higher than it is right now. Customers are no longer forced to choose between just a couple of options when looking to purchase new luxury goods. Not only has the number of retailers expanded exponentially in recent years, but so has the information available to customers. The amount of choice people enjoy today has also led to a waning of brand loyalty, with customers switching between retailers and online/in-store channels from purchase to purchase, depending which best serves their needs at the time. Luxury retailers are not immune to this trend either, as even wealthy customers now tend to shop around for the best option. This decline in brand loyalty customers presents a unique retailing problem, as retailers try to find new and innovative ways to appeal to buyers – both existing and potential; Consumers are Choosing Multichannel Buying Experiences: With more complete e-retail experiences available, and shipping times greatly reduced, it is little wonder around 96% of Americans utilize online shopping in one way or another. However, those same Americans spend about 65% of their total shopping budget in traditional brick-and-mortar locations. In other words, while almost everyone is shopping online, they are making more purchases in stores. Customers are moving seamlessly between online and offline experiences, and are open to retailers who can best facilitate these transitions. Closing the divide between online and offline retail, Temu solves some issues. It is focused on creating a second-to-none customer experience across all channels. Customers are looking for retailers they can trust to deliver exceptional service time and again. They have the right customer which has helped them to create an omnichannel customer experience for consumers to interact wherever and however they wish by incorporating real-time feedback across channels and devices – engaging the customer wherever they may be. Customers Expect a Seamless Experience: When transitioning between online and in-store experiences, customers not only want the same products to be available, they also want their experience to be seamless. This means, if they are a regular online customer, they want to be treated like a regular customer when they visit a brick-andmortar location. This is quite problematic. However, Temu has created this type of fluid online/offline experience for their customers, it has ceased pitting its channels against one another. Centralized customer data has helped it build a seamless, fluid experience beginning with an easily-accessible customer profile. Retailers lacks an outstanding Experience To Attract Customer Loyalty: Customer experience is the biggest contributor towards brand loyalty, the Traditional Retail model makes it difficult to build a good customer experience.Negative experience being the most significant factor in affecting a customer’s likelihood to make a repeat visit. Most customers also serve people in their own working lives, meaning when they are on the other side of the counter, they want to feel important.While promotions and offers can certainly contribute towards helping customers feel like they are special, the real key to an outstanding experience is personalization which the retail model falls short of. Getting to know customers from their previous purchases and interests can help retailers drive loyalty. These insights can be gleaned from data, or even a simple conversation.Temu addresses this challenge by rendering coupons, bonuses and reduced cost to existing and new customers. It is equally personalized with the user. A Siloed Marketing Infrastructure Makes It Expensive and Unwieldy to get Your Message Across; The traditional retail model features separate channels, which makes customer data to become siloed very easily. If all the moving parts of a marketing department are not communicating efficiently and working together, customers become overwhelmed with conflicting or repeated messages. This bombardment of marketing communications has easily had the opposite of the intended effect and driven customers to competitors with a clearer and more congruent message. The right technology and communication procedures can ensure all arms of a marketing team are on the same page. Temu as a modern retailer has been engaging with their customers across many different channels. From SMS, to email and social media, multi-channel communications are essential to engagement which, in turn, drives the creation of the perfect customer experience. So Many Technologies Exist to Drive Marketing and Sales, but They Don’t Seem to Work Together: While the amount of data gathered by businesses keeps growing at an alarming rate, the number of staff available to analyze it is staying more-or-less the same. What’s important, then, is making sure all this data is being used in the correct way and not contributing towards the data silo problem. This means finding a technology solution which can handle the huge amount of data being generated and ensure it is focused in a direction which best benefits rather than overwhelms marketing efforts. The data scientist approach to marketing is only going to become more prevalent as time goes on when creating a truly unified omnichannel service.Temu has ensured that all existing technologies work together which is why they get best results. Only in the combining of streamlined un-siloed data science, seamless cross-channel customer service and marketing, and authentic personalization, can traditional retailers create buyer experiences which can combat the fickle nature of the modern consumer and lead just like Temu. Strategies Implemented to Revolutionize The Retail Industry Temu adopted and implemented some strategies which accounted for its success. Temu’s business model is built around low prices. It offers even more discounts and lower prices than SHEIN, with special offers such as items sold for as little as one cent. Temu further differentiates itself by offering free shipping and returns to customers, which is made possible by PDD Holding’s extensive network of suppliers and shipping partners. An efficient logistics network is not to be underestimated, as problems with supply and distribution networks are seen as a major factor in the failure of Alibaba and Wish to break into the Western market.. Aside this, the following strategies were implemented; Combining Shopping and Entertainment: One-fifth of online shoppers in the U.S. say they miss the in-store shopping experience when they shop online. Temu aimed to bridge this gap and introduced games into the shopping process. By playing games like Fishland, Coin Spin, Card Flip, and others, customers can win rewards that ultimately lead to more time spent on the site and a dopamine rush from winning free items. To keep people playing these games, however, the app relies heavily on referrals, another core business strategy. These games were designed to be simple, addictive, rewarding, and increase user engagement and retention. According to app intelligence firm Sensor Tower, Temu’s average daily sessions per user in the US increased by 23% from October 2022 to January 2023. Some other games in Canada include scratch cards, card games, and cash games. Temu: Shared Shopping Experience: Group Buying is a familiar concept in Asia that Temu has extended to its Western customer base. Essentially, it has increased customers’ bargaining power by forming groups to share a bulk discount. This plays into the aforementioned referral program, which gives discounts to customers who bring new clients to the app and enables a shared shopping experience. Affiliate Programs and Heavy Advertising: As SHEIN had already proven effective, Temu sent free items to a large number of influencers and micro-influencers to promote Temu on YouTube and TikTok. A younger customer base of users under the age of 35 is particularly attractive to Temu, as younger consumers are typically less able and willing to pay large sums for products. Seeing a favorite internet personality or a personal acquaintance promoting the products has led to many young customers to imitate the purchase. Temu’s omnipresence on TikTok and YouTube is seen as a key factor in why this marketplace has taken off so quickly. A strong presence on TikTok and YouTube: Temu has leveraged the power of social media platforms, especially TikTok and YouTube, to spread awareness and generate buzz about its products and offers. The hashtag #temu on TikTok has amassed over 1.3 billion views, while Temu’s official YouTube account videos have grossed over 215 million views since last August. Temu’s marketing strategy relies on creating viral content that showcases its products entertainingly and engagingly, such as unboxing videos, product reviews, challenges, and giveaways. Temu also collaborates with influencers and celebrities with large followings on these platforms. Temu’s Audience: Temu’s primary target audience has been the young and price-conscious generation of online shoppers looking for bargains and discounts. According to a report by Daxue Consulting, the majority of Temu’s followers (32.68%) are aged 25-34, followed by 18-24 (28.57%) and 35-44 (21.43%). Temu appeals to these consumers by offering personalized recommendations based on their preferences and browsing history and gamified features that allow them to earn credits, gifts, and better deals by playing in-app games or inviting their friends to join the app. Referrals: A Win-Win Strategy for Users and Temu Temu has implemented a referral program encouraging users to invite friends and contacts to join the app in exchange for credits and gifts. Users can share their referral links or codes on social media platforms like Facebook, Instagram, and TikTok. For example, users can join a “Fashion Lovers” team and get $20 in credits by inviting five friends who also love fashion within 24 hours. These referrals help users save money on their purchases, help Temu acquire new customers, and expand its network of sellers. Temu’s Marketing and Growth Strategy that led to its Rise Temu's growth has been remarkable in a short period of time. It reached the top downloads in the shopping category of both Apple's App Store and Google Play and is quickly establishing itself as a high-potential and innovative player in the e-commerce industry. Its success is ultimately its low prices, unlocked by their innovative Next-Gen Manufacturing (NGM) model. It employed a multifaceted marketing strategy to drive user acquisition and brand awareness which has been working greatly for them; Influencer Collaborations: To reach a wider audience, Temu has been collaborating with popular social media influencers and celebrities who promoted the app and shared their shopping experiences. Influencers came from a wide range of individuals, including fashion bloggers, lifestyle influencers, beauty gurus, tech enthusiasts, or experts in specific product categories.This strategy generated buzz and created a sense of credibility and trust among potential users. This marketing strategy was successfully implemented through; Influencer Selection: Temu carefully identified and selected influencers who aligned with its target audience, brand values, and product offerings. These influencers typically had a strong online presence, a relevant niche or expertise, and a sizable following. Temu considered factors such as engagement rates, authenticity, and the influencer's ability to create appealing and relatable content. Exclusive Partnerships: Temu forged exclusive partnerships with influencers, often signing them as brand ambassadors or collaborators. These collaborations involved long-term commitments, where influencers actively promoted Temu's app and its features on their social media platforms, websites, or blogs. The exclusivity of these partnerships helped establish a strong association between the influencers and Temu, increasing brand loyalty and credibility. Sponsored Content: Temu engaged influencers to create sponsored content that showcased the app's features, user experience, and the benefits of using Temu for shopping. Influencers shared their personal experiences, demonstrated the app's functionalities, and highlighted the unique advantages of using Temu over other shopping platforms. This content was often shared through blog posts, social media posts, videos, and live streams. Product Reviews and Recommendations: Influencers played a crucial role in reviewing and recommending products available on Temu. They shared their honest opinions and experiences using products from various brands. Their reviews and recommendations helped build trust and credibility among their followers, encouraging them to explore and purchase products through Temu. Giveaways and Contests: Temu collaborated with influencers to host giveaways and contests, where users had the chance to win exclusive prizes or discounts by engaging with the app or participating in specific promotional activities. These initiatives created buzz, generated user excitement, and attracted new users to the platform. Affiliate Marketing: Temu employed affiliate marketing strategies with influencers, where influencers received a commission or referral fee for every user who downloaded the app or made a purchase through their unique referral links. This incentivized influencers to actively promote Temu and its offerings, as their earnings were directly tied to the success of their referrals. Event Participation: Temu partnered with influencers for events such as product launches, fashion shows, or brand campaigns. Influencers attended these events, shared live updates, and provided behind-the-scenes content to their followers, creating a sense of exclusivity and fostering excitement around Temu's activities. User-generated Content: Temu encouraged influencers and their followers to create usergenerated content related to the app. This could include unboxing videos, styling tips, or hauls showcasing products purchased through Temu. Such content served as social proof and encouraged other users to engage with the app and make purchases. Overall, Temu's collaborations with influencers helped amplify its brand message, expand its reach to new audiences, and establish credibility within the social media landscape. By leveraging the influence and creative abilities of influencers, Temu successfully tapped into their followers' trust and engagement, driving user acquisition, and fostering a positive brand image. User Referral Program: Temu has been incentivizing existing users to refer the app to their friends and family by offering discounts or exclusive rewards. This word-of-mouth marketing approach contributed to the app's exponential growth and user acquisition. Targeted Digital Advertising: Temu has been leveraging targeted digital advertising campaigns across various digital platforms like Facebook, Instagram, Twitter, TikTok and soon Telegram focusing on specific demographics and user segments. By tailoring their messaging and creative assets, Temu effectively reached potential users with personalized content. Expansion into New Markets: After gaining traction in its home market, Temu has been expanding its operations into international markets. It strategically entered regions with high smartphone penetration and a growing ecommerce ecosystem. This expansion allowed Temu to tap into a larger customer base and establish itself as a global player in the shopping app industry. Partnerships with Brands and Retailers: Recognizing the importance of strategic alliances, Temu has been forging partnerships with renowned brands and retailers. These collaborations involved exclusive product launches, limitededition collections, and promotional campaigns. By aligning with established names in the retail industry, Temu gained credibility and attracted a wider range of customers. Continuous Innovation: Temu has been prioritizing continuous innovation to stay ahead of the competition. It regularly updated its app with new features and enhancements based on user feedback and emerging trends. For example, it introduced a virtual stylist feature that offered personalized fashion advice and styling tips, further enhancing the user experience. Data-driven Insights: Temu has been leveraging the vast amount of user data it collected to gain valuable insights into consumer behavior, preferences, and trends. These insights were used to refine its product offering, improve targeted advertising efforts, and optimize the overall shopping experience. By harnessing the power of data, Temu was able to make data-informed decisions and stay attuned to evolving customer needs. Seamless Integration with Physical Stores: Recognizing the importance of the omnichannel experience, Temu has been integrating its app with physical stores. It introduced features like in-store barcode scanning, which allowed users to access product information, read reviews, and make purchases directly from their smartphones while inside partner retail locations. This integration blurred the lines between online and offline shopping and provided a seamless and unified experience. Social Impact Initiatives: Temu also has also been focusing on social impact initiatives to connect with socially conscious consumers. It launched sustainable product collections, partnered with NGOs for charitable causes, and implemented eco-friendly packaging practices. These initiatives resonated with environmentally and socially conscious users, further strengthening Temu's brand reputation and loyalty. Continuous Customer Support: Temu has been placing strong emphasis on customer support and responsiveness. It established dedicated customer service channels, including live chat support and a comprehensive FAQ section. Timely and effective customer support enhanced user satisfaction, resolved issues promptly, and fostered a positive brand image. A heavy paid media strategy: Like other well-funded internet companies, Temu appears to be spending heavily for app installs and on search ads. Search for almost any commodity product—especially if your search includes the word “cheap”—and you’re likely to find a Google result for Temu. Temu also gained attention with multiple Super Bowl spots, putting it on the map for many US consumers for the first time. Results and Impacts The rise of Temu as a shopping app has revolutionized the Retail Industry and also Consumer Experience; User Base and Revenue Growth: Within two years of its launch, Temu has amassed millions of active users and experienced exponential revenue growth. Its user-centric approach and innovative features resonated with consumers, driving adoption and usage. Enhanced Customer Experience: Temu's focus on personalization, convenience, and seamless shopping experiences has elevated customer satisfaction levels. Users appreciated the ability to try on products virtually, receive tailored recommendations, and enjoy hassle-free transactions. Disruption of Traditional Retail: The Traditional Retail industry has suffered relatively as a result of the rise of Temu as a Shopping App. It has greatly disrupted traditional brick-and-mortar retail, with many businesses. This is so because with their new innovation, they have explored other parts(online) which the traditional retailers do not have. Its rise has posed several challenges for traditional retailers as they struggle to adapt to the changing landscape; Online Presence and Digital Transformation: Traditional retailers are still struggling with establishing a strong online presence and undergoing digital transformation. Building and maintaining an effective e-commerce website or app requires technical expertise, investment in infrastructure, and a shift in mindset. Adapting to the digital realm is now very challenging for retailers who have primarily operated in brick-and-mortar stores. Competition with E-commerce Giants: E-commerce platforms like Temu with significant resources, a broad customer base, and strong brand recognition which makes it difficult for Traditional retailers to compete with in terms of pricing, product selection, and customer convenience. It can be challenging for them to match the speed, efficiency, and scale of operations offered by online marketplaces. Supply Chain and Logistics: Traditional retailers have gotten used to managing inventory primarily for physical stores and now face challenges in adapting their supply chain and logistics operations to accommodate online sales. Efficient inventory management, order fulfillment, and last-mile delivery is quite complex and requires adjustments to meet the demands of e-commerce customers. Customer Expectations and Experience: Online shoppers have come to expect a seamless and personalized shopping experience. Traditional retailers now struggle to meet these expectations, especially provided they have very limited experience in online customer engagement, personalization, and tailoring recommendations. Adapting to a customer-centric approach and providing a consistent omnichannel experience can be a significant challenge. Data and Analytics: E-commerce platforms like Temu rely heavily on data and analytics to understand customer behavior, preferences, and trends. Traditional retailers have limited experience in collecting, analyzing, and utilizing customer data effectively. Harnessing data to make data-driven decisions and optimize operations is now a significant hurdle for retailers transitioning to an online model. Operational Costs and Margins: Traditional retailers are facing financial challenges to adapt to ecommerce. Online operations require investments in technology, infrastructure, marketing, and fulfillment capabilities. Retailers need to reevaluate their pricing strategies, optimize operational costs, and find ways to maintain profitability in the face of increased competition and potentially lower margins. Brand Differentiation and Customer Loyalty: Building a strong brand and fostering customer loyalty has proven to be more challenging in the online space. Traditional retailers may have developed a loyal customer base through in-person interactions and personalized service. Translating that loyalty to the digital realm and effectively differentiating their brand from competitors needs innovative strategies and marketing efforts which will take time. By leveraging technology and understanding evolving consumer behaviors, Temu has disrupted the retail industry, reshaped shopping habits, and set new standards for convenience and engagement in the digital age; Temu’s Setbacks Despite its rapid rise, its relationship with sister company Pinduoduo has brought about several challenges in delivery of goods as compared to its competitors and other areas; According to reports published in Times, Temu is beginning to develop a reputation for undelivered packages, mysterious charges, incorrect orders and unresponsive customer service. Temu itself acknowledges that its orders take longer to arrive than those from Amazon—typically 7-15 business days as they come from “overseas warehouses.” In a series of Facebook messages with Times, Roper Malloy, a client complained of spending $178 on gifts from Temu for her family, including two drones and some makeup for her daughter which has never arrived. She said she has contacted the company several times for a refund, which has also yet to arrive. On May 17, 2023, Montana Governor Greg Gianforte banned Temu from statewide government devices, as well as ByteDance apps (including TikTok ) , Telegram , and WeChat. In June 2023, the U.S. House Select Committee on U.S.- Chinese Communist Party Strategic Competition stated that Temu did not maintain ""even the facade of a meaningful compliance program"" with the law. Uyghur on Forced Labor Prevention to keep goods made by forced labor off its platform. In October, the Boston branch of the Better Business Bureau opened up a file on Temu and has received 31 complaints about the website. Temu currently has a C rating on the BBB, and an average customer rating of 1.4 stars out of 5, although from only 20 reviews. (Complaints are separate from reviews, which do not factor into BBB’s official rating.) McGovern at the BBB mentioned that, it’s unusual for such a new company to receive so many complaints in such a short amount of time. Temu has acknowledged and responded to every complaint posted to the BBB website, but many of those complaints remain unresolved. Temu’s sister company, Pinduoduo, has long been accused of hosting sales of counterfeits, illegal goods, or products that do not match their descriptions. (Pinduoduo wrote in its SEC filings that it immediately removes unauthorized products or misleading information on its platform, and freezes the accounts of sellers on the site who violate its policies.) There have been no BBB complaints that allege the goods Temu ships are counterfeit or fake. Additionally, in 2021, the deaths of two Pinduoduo employees spurred investigations and boycotts over the company’s working conditions, according to the New York Times. How Temu could affect the U.S. economy In May 2023, the U.S.-China Economic and Security Review Commission raised concerns about risks to users' personal data on Temu as a shopping app affiliated with Pinduoduo, which was removed from Google Play after some of its versions were found to contain malware. Schmidt, at Vanderbilt, who specializes in security and privacy, is of the opinion that Temu’s data and privacy practices aren’t out of the ordinary; The company collects lots of personal data about users and then deploys that data to sell ads. However, he says that Temu’s rise could have a bigger impact not in terms of privacy concerns, but in terms of pressure on American companies and workers. If more and more American consumers flock to Temu to buy cut-rate goods, that could pressure Amazon and other competitors to slash their prices too which would affect wages. Areas for Improvements Despite its innovative business model and commitment to sustainability, Temu still has some areas that need improvement; Real-Time Shopping: Cost-Effectiveness vs. Plagiarism and Exploitation: Temu’s most innovative and effective strategy has been highly ambivalent and criticized. Similar to SHEIN, Temu has been using a reverse-manufacturing model that relays customer feedback directly to manufacturers. Starting off with smaller quantities that are offered on the marketplace, products in high demand are reordered, while others are replaced. According to Temu, this results in environmental efficiency because product inventory is aligned with customer demand in real time. In addition, a greater number of products can be offered than with traditional retail strategies. With this method, SHEIN was able to launch 150,000 new items in 2020, beating its competitors by a wide margin. Temu Has to Fight Criticism: Critics point to several detrimental effects of this type of 'ultra-fast' commerce: To ensure low prices, manufacturers must keep costs down, contributing to the continued poverty of workers in manufacturing countries. The same goes for product quality and environmental friendliness: Cheap products that break easily contribute to increasing amounts of waste, returned products tend to be dumped rather than recycled or resold, and the high number of new products sold is only possible by ripping off SME fashion designers and creators. TrustPilot reviews reveal a 2.9-star average, with the majority of one-star reviews citing long shipping times, low-quality items, and poor customer service. Low quality items can become a sustainability issue in itself, since those products have a higher chance of ending up in landfill. It’s essential for Temu to address these concerns and maintain a balance between low prices and customer satisfaction. Lessons Learned Temu's rise as a shopping app exemplifies the transformative power of technology in the retail industry. Its success serves as an inspiration for other businesses seeking to adapt and thrive in the digital era. Overall, the rise of Temu as a shopping app has been driven by its commitment to innovation, personalized experiences, strategic partnerships, and a customer-centric approach. The marketplace Temu has achieved impressive success with its business model of offering low-priced products and free shipping, combined with a gamified shopping experience. Temu's strategy also includes group buying, referrals, affiliate programs, and heavy advertising on social media platforms. While Temu's real-time shopping model, which involves relaying customer feedback directly to manufacturers, is seen as innovative and cost-effective, it has also garnered criticism. Critics argue that this approach can lead to environmental issues, exploitation of workers, and plagiarism of designs from small and medium-sized fashion creators. Despite these concerns, Temu's combination of low prices, gamified shopping, and heavy advertising on platforms like TikTok and YouTube has made it a major player in the ultra-fast eCommerce sector. However, Temu's most controversial strategy is its real-time shopping model akin to that of SHEIN, which relays customer feedback directly to manufacturers. While this model increases costeffectiveness and product variety, critics argue that it contributes to environmental degradation, exploitation of workers, and plagiarism of fashion designers. Nonetheless, Temu's growth and distinct strategy make it a noteworthy player in this emerging business model of ultra-fast eCommerce, and it will be interesting to see how this trend plays out in the future. Actionable Takeaways for other Businesses in the Retail Industry Traditional Retailers who wish to also rise like Temu should consider the following steps; Develop a User-Friendly E-commerce Website: Create a well-designed, intuitive, and user-friendly e-commerce website that offers a seamless shopping experience. Ensure that the website is responsive, optimized for mobile devices, and provides easy navigation, product search, and checkout processes. Emphasize Branding and Differentiation: Clearly define the brand identity and unique selling propositions of your retail business. Highlight what sets your products apart from competitors and communicate a compelling brand story to engage online customers. Use high-quality visuals and persuasive copywriting to convey your brand message effectively. Optimize for Search Engines: Implement search engine optimization (SEO) techniques to improve the visibility of your website in search engine results. Conduct keyword research to understand the terms and phrases your target audience is searching for, and optimize your website's content, meta tags, and URLs accordingly. Leverage Social Media: Use social media platforms to build an online community, engage with customers, and promote your products. Regularly post engaging content, including product updates, customer testimonials, and behind-the-scenes glimpses. Encourage user-generated content and respond promptly to customer inquiries and feedback. Invest in Digital Marketing: Develop a comprehensive digital marketing strategy that includes online advertising, email marketing, influencer collaborations, and content marketing. Target specific customer segments and utilize data-driven approaches to reach your audience effectively and drive traffic to your website. Provide Excellent Customer Service: Offer exceptional customer service across all online channels, including live chat, email, and social media. Respond promptly to customer inquiries, provide accurate product information, and address any issues or concerns in a timely manner. Personalize the customer experience as much as possible to build trust and loyalty. Implement Online Customer Engagement Tools: Incorporate tools such as live chat, product reviews, ratings, and personalized recommendations to enhance customer engagement and create a sense of interactivity on your website. Encourage customer feedback and testimonials to build social proof and credibility. Collaborate with Influencers and Online Communities: Partner with relevant influencers or online communities in your industry to extend your reach and tap into their established audiences. Engage in collaborations, product reviews, or sponsorships to increase brand visibility and credibility. Analyze and Optimize: Continuously monitor and analyze website metrics, customer behavior, and online marketing campaigns. Utilize analytics tools to gain insights into what is working and what needs improvement. Optimize your online presence based on data-driven decisions to enhance the user experience and drive conversions. Adapt to Changing Trends: Stay up to date with the latest e-commerce trends, technologies, and consumer preferences. Be willing to experiment, adapt, and embrace new technologies or platforms that can enhance your online presence and provide a competitive edge. By implementing these strategies, traditional retailers can establish a strong online presence, attract online customers, and compete effectively in the digital marketplace. It's important to continuously evaluate and refine your online presence based on customer feedback, market trends, and emerging technologies to stay ahead of the competition. Future Outlook The rise of Temu as a shopping app has been remarkable, and it has successfully disrupted the retail experience by implementing innovative strategies and business models. Looking ahead, there are several key factors that will shape the future outlook of Temu and determine its continued success in the competitive online shopping market; Expansion into New Markets: Temu has already expanded its operations to several countries, including the US, Canada, Australia, New Zealand, France, Italy, Germany, the Netherlands, Spain, and the United Kingdom. To sustain its growth, Temu will likely continue to explore opportunities for expansion into new markets, both within and outside of these regions. This expansion will allow the platform to reach a larger customer base and tap into new consumer preferences and demands. Improvement in Delivery Times: One area of concern for customers is the longer delivery times associated with Temu's Next-Gen Manufacturing (NGM) model. To address this issue, Temu may invest in optimizing its supply chain and logistics processes. By streamlining operations and partnering with efficient shipping providers, Temu can reduce delivery times and enhance the overall customer experience. Enhanced Customer Engagement: Temu's success is partly attributed to its gamification strategies and social commerce approach. To maintain customer engagement and loyalty, Temu will need to continuously innovate and introduce new features that incentivize users to stay active on the platform. This could include personalized recommendations, rewards programs, and interactive shopping experiences. Sustainability and Social Responsibility: Temu has positioned itself as a platform that promotes sustainability and social responsibility through its NGM model, which reduces unsold inventory and waste. Going forward, it will be crucial for Temu to uphold these values and communicate its commitment to sustainability to customers. This can be achieved through transparent supply chain practices, eco-friendly packaging options, and partnerships with ethical suppliers. Competition and Differentiation: While Temu has gained significant traction, it faces strong competition from other Chinese online wholesale platforms and established e-commerce giants. To stay ahead, Temu will need to continue differentiating itself through its NGM model, competitive pricing, and unique product offerings. It should also focus on building a strong brand identity and nurturing customer trust through excellent customer service and reliable purchase protection. navigate the competitive landscape. With its innovative approach and commitment to customer satisfaction, Temu has the potential to continue reshaping the online Conclusion Conclusively, Temu has emerged as a shopping app that is revolutionizing the retail experience through its Next-Gen Manufacturing model and direct-to-supplier approach. By focusing on cost savings, customization, and sustainability, Temu has gained a competitive edge in the market. With a lot of consumer goods being produced in China it makes sense that more and more e-commerce platforms are Chinese. The success of Temu and its competitors showcases the power of connecting customers directly with suppliers, ultimately reshaping the way people shop online. TEMU's emergence in the e-commerce landscape with its lightning-fast shipping times has undoubtedly stirred the industry. By setting new standards for efficiency and customer satisfaction, TEMU challenges traditional platforms to step up their game. While the convenience of rapid shipping is undeniable, the long-term sustainability and overall impact of this approach must also be considered. As consumers continue to prioritize convenience and speed, the success of TEMU may very well influence how the e-commerce ecosystem evolves in the years to come. However, to sustain its growth and success, Temu must adapt to evolving customer preferences, optimize its operations, and effectively.",Retail/Product,Find & Summarize,Text Transformation Only provide commentary from the context included.,Is acupuncture a beneficial treatment for leg pain in patients with sciatica?,"1 Effect of acupuncture on leg pain in patients with sciatica due to lumbar disc 2 herniation: A prospective, randomised, controlled trial 3 4 Guang-Xia Shia , Fang-Ting Yua , Guang-Xia Nib , Wen-Jun Wanc , Xiao-Qing Zhoud , 5 Li-Qiong Wanga , Jian-Feng Tua , Shi-Yan Yana , Xiu-Li Menge , Jing-Wen Yanga , 6 Hong-Chun Xiangf , Hai-Yang Fug , Lei Tangc , Beng Zhangd , Xiao-Lan Jie , Guo-Wei 7 Caif*, Cun-Zhi Liua,h** 8 a International Acupuncture and Moxibustion Innovation Institute, School of 9 Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, 10 Beijing, China 11 bSchool of Acupuncture-Moxibustion and Tuina, School of Health and Rehabilitation, 12 Nanjing University of Chinese Medicine, Nanjing, China 13 cDepartment of Rehabilitation, The Central Hospital of Wuhan, Tongji Medical 14 College, Huazhong University of Science and Technology, Wuhan, China 15 dDepartment of Acupuncture and Moxibustion, Shenzhen Hospital, Beijing University 16 of Chinese Medicine, Shenzhen, China 17 ePain Medicine Center, Peking University Third Hospital, Beijing, China 18 fDepartment of Acupuncture, Union Hospital, Tongji Medical College, Huazhong 19 University of Science and Technology, Wuhan, China 20 gDepartment of Acupuncture, Affiliated Hospital of Nanjing University of Chinese 21 Medicine, Nanjing, China 22 hDepartment of Acupuncture, Dongzhimen Hospital Affiliated to Beijing University 23 of Chinese Medicine, Beijing, China 24 Corresponding author* 25 Department of Acupuncture, Union Hospital, Tongji Medical College, Huazhong 26 University of Science and Technology, Wuhan, China. No. 1277 Jiefang Avenue, 27 Jianghan District, Wuhan 430022,China. 28 E-mail Address: cgw645@163.com (G.-W. Cai) 29 Corresponding author** 30 International Acupuncture and Moxibustion Innovation Institute, School of 31 Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No.11 32 Bei San Huan Dong Lu, Chaoyang District, Beijing 100021, China. E-mail 33 Address:cunzhiliu@bucm.edu.cn (C.-Z. Liu) 34 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 35 Summary 36 Background Sciatica is a condition including unilateral leg pain that is more severe 37 than low back pain, and causes severe discomfort and functional limitation. We 38 investigated the effect of acupuncture on leg pain in patients with sciatica due to 39 lumbar disc herniation. 40 Methods In this multi-centre, prospective, randomised trial, we enrolled patients with 41 sciatica due to lumbar disc herniation at 6 hospitals in China. Patients were randomly 42 assigned (1:1:1) to receive either acupuncture at the acupoints on the disease-affected 43 meridian (DAM), or the non-affected meridian (NAM), or the sham acupuncture (SA) 44 3 times weekly for 4 weeks. The primary end point was the change in visual analogue 45 scale (VAS, 0-100) of leg pain intensity from baseline to week 4. This study is 46 registered with Chictr.org.cn, ChiCTR2000030680. 47 Finding Between Jun 9th, 2020, and Sep 27th, 2020, 142 patients were assessed for 48 eligibility, 90 patients (30 patients per group) were enrolled and included in the 49 intention-to-treat analysis. A greater reduction of leg pain intensity was observed in 50 the DAM group than in the other groups: -22.2 mm than the SA group (95%CI, -31.4 51 to -13.0, P <0.001) , and -19.3mm than the NAM group (95% CI, -28.4 to -10.1; P 52 <0.001). However, we did not observe a significant difference in the change of leg 53 pain intensity between the NAM group and the SA group (between-group difference 54 -3.0 [95% CI, -12.0 to 6.1], P=0.520). There were no serious adverse events. 55 Interpretation Compared with SA, acupuncture at the acupoints on the 56 disease-affected meridian, but not the non-affected meridian, significantly reduces the 57 leg pain intensity in patients with sciatica due to lumbar disc herniation. These 58 findings suggest that the meridian-based specificity of acupoint is a considerable 59 factor in the acupuncture treatment. A larger, sufficiently powered trial is needed to 60 accurately assess efficacy. 61 62 Funding The National Key R&D Program of China (No: 2019YFC1712103) and the 63 National Science Fund for Distinguished Young Scholars (No:81825024). 64 Keywords: Acupuncture; leg pain; Acupoint selection; Meridian-based; Sciatica 65 66 67 68 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 69 Research in context 70 Evidence before this study 71 Using the key words ""sciatica"" and ""acupuncture""，we searched PubMed for articles 72 published between Jan 1, 1947 and Jan 5, 2024. Despite an extensive literature search, 73 only a limited number of studies were available. There is ambiguous evidence about 74 the use of acupuncture, with most studies contrasting one another in addition to the 75 lack of high-quality trials. Since the choice of more appropriate acupoints for 76 stimulation is meaningful for acupuncture, studies that investigate the effect of 77 acupuncture on different acupoint program are urgently needed. 78 Added value of this study 79 This multi-centre, assessor and statistician-blinded trial addressed the above 80 limitations by showing that, compared with sham acupuncture, acupuncture at the 81 acupoints on the disease-affected meridian, but not the non-affected meridian, 82 significantly reduces the leg pain intensity in patients with sciatica due to lumbar disc 83 herniation. 84 Implications of all the available evidence 85 We found that acupuncture at the acupoint on the disease-affected meridian had 86 superior and clinically relevant benefits in reducing pain intensity to a greater degree 87 than acupuncture at NAM or SA. The finding is of vital significance to clinical work, 88 as meridian-based specificity of acupoint is one of the most determining factors in the 89 efficacy of acupuncture. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 90 Introduction 91 Sciatica is a common health problem in the general population with a lifetime 92 prevalence of 10% to 43%, depending on different etiologies [1-2]. It is characterised 93 by radiating leg pain starting from the low back, at times accompanied by sensory or 94 motor deficits. In most cases, sciatica is attributable to lumbar disk disorders [3]. The 95 overall prognosis is worse than low back pain, particularly if leg pain extends distal to 96 the knee with signs of nerve root compression, increasing risk for unfavorable 97 outcomes and health care use [4]. Spontaneous recovery occurs in most patients; 98 however, many endure substantial pain and prolonged disability, as 34% reported 99 chronic pain beyond 2 years [5-6]. Optimal pharmacological treatment is unclear due 100 to uncertain benefits or high rates of adverse effects[7-8]. Surgery has been 101 demonstrated to ameliorate sciatica in the early stage, but a proportion of patients do 102 not meet surgical standards or hesitate about the potential complications [9]. The 103 dilemma has led to a soaring increase in complementary and alternative medicine, 104 such as acupuncture [10]. 105 Acupuncture has been recommended for management of low back pain by clinical 106 practice guideline from the American College of Physicians [11-12]. Several studies 107 have also shown that acupuncture was beneficial in treating leg pain, although others 108 have reported discrepancies concerning the efficacy of true vs sham acupuncture[10]. 109 The inconsistent findings may result from variations in study design and insufficient 110 sample size. We conducted this trial to preliminarily evaluate the efficacy and safety 111 of acupuncture in terms of reduction in leg pain with sciatica patients. 112 Acupuncture is garnering increased attention as an effective treatment for pain 113 managemengt, one important issue is whether acupoint choice influences the benefits 114 of acupuncture[10]. However, a well-recognized acupoint program has yet not been 115 established, yielding heterogeneous results across relative studies[13]. Therefore, the 116 second aim of this study was to compare the difference of acupuncture efficacy in 117 patients receiving acupuncture at the acupoints of the disease-affected meridian 118 (DAM), the non-affected meridian (NAM), or sham acupuncture (SA). 119 120 Methods 121 Study design and participants 122 This mult-centre, three-arm, prospective randomised trial was conducted in the 123 inpatient departments of 6 tertiary hospitals in China between Jun 9, 2020 and Sep27, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 124 2020. The study protocol was approved by the local ethics committee at the 125 coordinating center and each study site (No. 2020BZHYLL0105), and registered with 126 the Chinese Clinical Trial Registry on Chictr.org.cn, ChiCTR2000030680. The 127 protocol has been published previously [14] and is available in open-access full text 128 and in Supplement 1. All patients provided written informed consent before 129 enrolment. 130 Eligible patients were aged 18 to 70 years old , reported leg pain extending below 131 the knee in a nerve root distribution over 4 weeks, had a lumbar disc herniation 132 confirmed by examination signs (positive result on straight leg raise test or sensory or 133 motor deficit in a pattern consistent with a lumbar nerve root) [15], and scored 40 mm 134 or higher on the 100-mm VAS [16]. Imaging (magnetic resonance imaging with or 135 without computed tomography) corroborating a root-level lesion concordant with 136 symptoms and/or signs was determined by the trial clinician. Exclusion criteria were a 137 history or diagnostic result that suggested an inherited neuropathy or neuropathy 138 attributable to other causes, had undergone surgery for lumbar disc herniation within 139 the past 6 months or plan to have spinal surgery or other interventional therapies 140 during next 4 weeks, continually took antiepileptic medication, antidepressant 141 medication, opioids or corticosteroids; had cardiovascular, liver, kidney, or 142 hematopoietic system diseases, mental health disorders, other severe coexisting 143 diseases (e.g., cancer), pregnant, breastfeeding, or women planning conception during 144 the study. Patients participating in other clinical studies within the past 3 months or 145 receiving acupuncture within 6 months were also excluded. The screening process 146 was conducted in the way of in-person visits by trial clinicians. 147 Randomisation and masking 148 The study protocol was explained to all enrolled patients before randomisation. 149 After written informed consent was obtained, patients were allocated randomly (1:1:1) 150 to the three arms: DAM, NAM or SA. Randomisation was performed with a random 151 block size of six. A randomisation sequence was created by a biostatistician who did 152 not participate in the implementation or statistical analysis of trial. The assessor and 153 statistician were blinded to treatment allocation throughout data collection and 154 analysis. 155 Procedures and interventions 156 To exploratively observe whether the effects of acupoint located on two kinds of 157 meridians are different, this trial set two acupuncture groups, in which patients This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 158 received acupuncture at acupoints on the disease-affected meridian (DAM), or the 159 non-affected meridian (NAM), respectively. The bladder (BL) and gallbladder (GB) 160 meridians are directly in the same dermatomes of the sciatic nerve. Since these 161 meridians are consistent with sciatic pain distribution, they are regarded as the 162 disease-affected meridians. 163 Patients assigned to the DAM group received semi-standardized treatment at 164 acupoints on the bladder/gallbladder meridians. Bilateral BL25 and BL26, which 165 localized at the same level as the inferior border of the spinous process of the fourth 166 and the fifth lumbar vertebra (the commonest positions of disc rupture), were needled 167 as obligatory acupoints. For those having symptoms at the posterior side of the leg, 168 BL54, BL36, BL40, BL57, and BL60 were needled as adjunctive acupoints; similarly, 169 GB30, GB31, GB33, GB34, and GB39 were adjunctive acupoints for patients with 170 symptoms at lateral side. For patients who had pain at both posterior and lateral sides, 171 acupuncturists were instructed to select 5 of the 10 adjunctive acupoints. 172 According to the principle of the Traditional Chinese Medicine theory, the liver 173 meridian, the spleen meridian, and the kidney meridian are commonly treated to 174 improve the functional status of the body. These meridians distribute at the inner side, 175 less related to sciatica symptoms, and are regarded as non-affected meridians. For 176 patients in the NAM group, bilateral EX-B7, EX-B4, and unilateral LR9, LR8, LR5, 177 KI7, and SP4 that on the non-affected meridians were selected . 178 Patients assigned to the SA group received acupuncture at 7 non-acupoints which 179 not localized on meridians and with no manipulations. 180 All acupuncture treatments were performed by two senior acupuncturists (length of 181 services ≥5 years), who consistently applied the same standardised protocols. After 182 identifying the location of acupoints, sterile acupuncture needles (length 40 mm, 183 diameter 0.30 mm; Hwato, Suzhou Medical Appliance Factory, China) were inserted, 184 followed by 30s manipulation to acquire Deqi (a sensation of aching, soreness, 185 swelling, heaviness, or numbness). Blunt-tipped placebo needles with similar 186 appearances to conventional needles but no skin penetration were used in the SA 187 group. To maximize the blinding of patients and to fix blunt-tipped placebo needles, 188 adhesive pads were placed on points in all groups. Patients in all groups started 189 treatment on the day of randomization and received twelve 30-minute sessions over 4 190 consecutive weeks at 3 sessions per week (ideally every other day). This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 191 Pain medication was offered if necessary and included paracetamol and optionally 192 non-steroidal anti-inflammatory drugs (Celebrex), short acting opioids, or both. We 193 used questionnaires to monitor the use of pain medication and other co-interventions. 194 Outcomes 195 The primary outcome was the change of leg pain intensity over the preceding 24 196 hours from baseline to week 4 as measured on the VAS. Participants were asked to 197 rate their average leg pain during the last 24 hours out of 100, with 0 representing no 198 leg pain and 100 representing the worst pain imaginable. 199 Secondary outcomes included VAS for leg pain and back pain intensity at other 200 time points. We observed the Oswestry Disability Index (ODI, examining perceived 201 functional disability in 10 activities of daily living), Sciatica Frequency and 202 Bothersomeness Index (SFBI, rating the extent of frequency and bothersomeness of 203 sciatica respectively), 36-item Short Form Health Survey (SF-36, evaluating the 204 quality of life with physical and mental components) . 205 We also assessed levels on the global perceived recovery (assessed by a 7-point 206 Likert self-rating scale with options from “completely recovered” to “worse than 207 ever”) and degrees of the straight leg raise test. 208 The Credibility/Expectancy Questionnaire (CEQ) was used to assess the credibility 209 and expectancy of patients to acupuncture treatment after the first treatment. 210 Moreover, patients were also invited to guess their group for blinding assessment at 211 week 2 and week 4. Adverse events were documented by patients and outcome 212 assessors throughout the trial. All adverse events were categorized as 213 treatment-related or non-treatment-related and followed up until resolution. 214 The researchers in charge of the scale assessment were asked to use the fixed 215 guiding words on the questionnaires to have a conversation with the patient without 216 redundant communication. Due to the trial site and population, we used Chinese 217 versions of the assessment scales that were confirmed to have moderate or higher 218 clinical responsiveness and are suitable for clinical efficacy evaluation. 219 Statistical analysis 220 We designed our trial to determine whether there was a difference between each 221 acupuncture group and the sham acupuncture group in terms of leg pain intensity. 222 According to the method of upper confidence limit, a sample size ranging from 20 to 223 40 could be the guideline for choosing the size of a pilot sample. Considering the 224 overall resource input issues (eg, funding availability and expected completion time), This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 225 the total sample size was preset at 90 patients, 30 patients per group. We performed 226 analyses following the intention-to-treat principle with all randomly assigned patients 227 included. 228 For the primary outcome, analysis of covariance was applied to test the difference 229 between groups in leg pain intensity with baseline values adjusted. Missing data were 230 imputed using multiple imputation method. To address the robustness of the results, 231 we performed a per-protocol analysis for the primary outcome, covering patients who 232 complete 10 sessions or more and had no major protocol violations (e.g., using 233 additional treatments during the treatment period). One-way ANOVA was performed 234 for the secondary outcomes including leg pain at each measuring time point, back 235 pain, ODI, SFBI, SF-36, CEQ, PDQ, global perceived recovery scores, and degrees of 236 straight leg raise test. The blinding assessment, the proportion of patients using 237 additional treatments and adverse event rates were analyzed using the χ2 test or Fisher 238 exact test. Between-group differences were tested through the least significance 239 difference (LSD)-t test. Categorical variables are presented as n (%) and continuous 240 variables are presented as the mean (SD) or median (interquartile range, IQR) . All 241 tests applied were two-tailed, p < 0.05 was considered statistically significant. An 242 independent statistician completed the analyses using IBM SPSS Statistics version 20 243 (IBM Corp, Armonk, NY). 244 Role of the funding source 245 The funder of the study had no role in the study design, data collection, data 246 analysis, or writing of the report. All authors had full access to the data in the study 247 and gave the final approval of the manuscript and agree to be accountable for all 248 aspects of work. 249 Results 250 Patient characteristics 251 Between Jun 9th, 2020, and Sep 27th, 2020, 142 patients were assessed for 252 eligibility, 90 patients (30 patients per group) were enrolled and included in the 253 intention-to-treat analysis (Figure 1). Mean age of patients was 44.2 (SD 14.9) years, 254 and 51 (56.7%) were female. Mean symptom duration was 2.0 years (IQR 0.7 to 4.1) 255 with a mean VAS score of 62.3 (SD 14.3) mm for their leg pain intensity. Overall, 75 256 (83.3%) patients completed the assigned 12 sessions of study interventions, and 82 257 (91.1%) received at least 10 sessions. The primary outcome visit was attended by 82 258 patients at week 4, corresponding to a follow-up rate of 91.1%, which was maintained This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 259 to week 26. There was no difference among groups regarding the usual risk factors for 260 sciatica, such as gender, age, body-mass index, or Disk herniation level, which 261 confirmed that the groups were well matched. The baseline characteristics of patients 262 are summarized in Table 1. 263 After receiving 4-week treatment, the change of leg pain intensity decreased by 264 -36.6 mm (95% CI, -43.1 to -30.2) in the DAM group, by -17.4 mm in the NAM 265 group and by -14.4 mm (95% CI, -20.9 to -8.0) in the SA group. Changes in the leg 266 pain intensity over 4-week period differed significantly among the 3 groups. A greater 267 reduction was observed in the DAM group than in the other groups: -22.2 mm 268 reduction in leg pain intensity than in the SA group (95% CI, -31.4 to -13.0, P＜ 269 0.001) , and -19.3 mm reduction in leg pain intensity than in the NAM group (95% CI, 270 -28.4 to -10.1; P <0.001). While no significant change in leg pain intensity was 271 observed between the NAM and SA groups (mean difference, -3.0 mm, 95% CI, -12.0 272 to 6.1, P=0.52) (Figure 2). 273 We observed that outcomes at the 26-week follow-up were similar in direction to 274 the those at the end of an 4-week period. At week 26, a difference in the change of leg 275 pain intensity were present between the DAM and SA groups (mean difference, -13.3 276 mm, 95% CI, -23.2 to -2.8, P=0.01), between the DAM and NAM groups (mean 277 difference, -13.4 mm, 95%CI, -23.6 to -3.1, P=0.011), but not between the NAM and 278 SA groups (mean difference, 0.1 mm, 95% CI, -10.3 to 10.5, P=0.99) (Figure 2). 279 Sensitive analyses did not alter the result in the primary analysis (eTable 1 and eTable 280 2 in Supplement 2). 281 We found a greater reduction in back pain intensity over SA for patients who 282 received DAM at week 4 (mean difference, -18.0 mm, 95% CI, -27.7 to -8.4, P＜ 283 0.001). The difference in back pain changes was not significant between the NAM 284 and SA groups at week 4 (mean difference, -4.2 mm, 95% CI, -13.6 to 5.3, P=0.38). 285 At week 26, no difference was detected in back pain relief across the 3 groups. 286 We also found a greater decrease in disability scores in the DAM group over SA at 287 week 4 (mean difference, -10.7 points, 95% CI, -18.3 to -3.1, P=0.007), while there 288 was no difference between the NAM and SA groups (mean difference, -3.1 points, 289 95%CI, -10.6 to 4.3, P=0.41). Similar results were observed at week 26, which 290 favored acupuncture at DAM (mean difference between DAM and SA, -11.1 points, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 291 95%CI, -19.4 to -2.8, P=0.01) rather than acupuncture at the NAM (mean difference 292 between NAM and SA, -2.7 points, 95%CI, -11.0 to -5.7, P=0.53). 293 Compared to SA, patients in the DAM group reported better symptom 294 improvement on the global perceived recovery test, and lower scores in both 295 frequency and bothersomeness scales on the SFBI. Nonetheless, the measurement of 296 the quality of life, or the degree of the straight leg raise test did not show a difference 297 across the 3 groups (Table 2). Five (16.7%) patients in the DAM group and 4 (13.3%) 298 patients in the SA group take rescue medicine for a short period (eTable 3 in 299 Supplement 2). For blinding assessment, we found no difference across groups in the 300 proportion of patients who correctly guessed the kind of intervention they had 301 received at week 2 and week 4 (eTable 4 in Supplement 2). Outcomes measured at 302 other time points were shown in eTable 5 and e Figure in Supplement 2. 303 Adverse events 304 Three (10%) patients in the NAM group reported post-needling pain which 305 decreased in the following week spontaneously. Adverse events unrelated to the study 306 interventions including increased leg pain, dizziness, insomnia, etc, were all rated as 307 mild to moderate (eTable 6 in Supplement 2). No serious adverse event occurred 308 during the study period. 309 Interpretation 310 To our knowledge, our study is a multi-center clinical trial to show the beneficial 311 effect of acupuncture for patients with moderate-to-severe sciatica of varying duration 312 and is the first to explore the meridian-based acupoint program in this field. We found 313 that acupuncture at the DAM had superior and clinically relevant benefits in reducing 314 leg pain intensity to a greater degree than acupuncture at NAM or SA. Improvements 315 in functional disability, back pain, frequency and bothersomeness and global 316 perceived recovery were also found. Moreover, no significant differences was 317 observed with respect to any outcome between NAM and SA groups. 318 The findings of the current study demonstrate that acupuncture at the acupoints on 319 the disease-affected meridian was clinically beneficial and superior to SA for leg pain. 320 We acknowledge the commonly recognised minimally clinically important difference 321 (MCID) is 10-20 of 100 for pain intensity [16]. The clinically important mean leg 322 pain reduction at the 4-week of treatment in DAM group was -22.2 mm, and 323 continued the trend of a mean clinical important result at 26-week follow-up (-13.3 324 mm). Before our study, Liu and colleagues evaluated the effect of acupuncture in This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 325 relieving leg pain for patients with chronic discogenic sciatica compared with sham 326 acupuncture [13]. Acupuncture showed a small but not clinically relevant effect, with 327 a between-group difference in the 4-week on mean VAS score for leg pain was 7.28， 328 which is not reach the MCID. More acupoints on the disease-affected meridian were 329 adapted in our trial (7 v 4 acupoints on the bladder and/or the gallbladder meridian) 330 which may interpret the discrepancy. 331 Our findings are consistent with a meta-analysis showing that acupuncture was 332 more effective than conventional medicine in managing the pain associated with 333 sciatica, with a significantly greater reduction in pain intensity by 12.5 (95% CI: 334 −16.3 to −8.6) [17]. It is worth noting that the most commonly used acupoints were 335 Huantiao (GB 32), Weizhong (BL 40), and Yanglingquan (GB 34), all on the bladder 336 and/or gallbladder meridians that were directly related with dermatomal distributions 337 of sciatic nerve. Acupuncture at the DAM was more effective than at the NAM in 338 alleviating pain severity during the 4-week treatment and the follow-up period. The 339 acupoints in NAM group are mainly located on the Liver, Spleen and Kidney 340 meridian, which are not affected directly by sciatica in Traditional Chinese Medicine. 341 We speculate that the varied efficacy between the DAM and NAM relate to 342 meridian-based acupoint specificity. 343 Acupuncture at the DAM showed significant superiority in the primary outcome 344 and in most of the second outcomes at the end of therapy. However, no significant 345 differences were observed in the quality of life or the degree of the straight leg raise 346 test among the three groups. The health status and body function are more likely be 347 affected by physical factors and psychological factors [18-19]. In addition, pain may 348 limit function, so as pain decreases, function (straight leg raise) may increase until 349 pain again limits functional capacity. This may explain the improvement in pain 350 without measurable proved function [20]. 351 In Dr. Vickers’ and his groups 2018 update of the meta-analysis of acupuncture for 352 chronic pain study, the authors did not finding any statistically significant influence 353 from point selection on treatment outcome by acupuncture [11]. Another two clinical 354 trials on acupuncture for low back pain, where the first showed no difference between 355 two different acupuncture recipes [21] and the subsequent detected no difference 356 between and real and sham acupuncture (where the sham treatment involved different 357 bodily locations) [22]. The efficacy of acupuncture is related to the dose, point This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 358 selection and treatment time (duration and frequency), and we could not isolate which 359 components contributed to the benefits. Our study only partially answer that acupoint 360 choice could influence the efficacy of acupuncture. 361 Practice guidelines recommend an initial period of conservative care focused on 362 non-pharmacologic treatments for persons with recent-onset sciatica, except in rare 363 instances of rapidly progressing or severe neurologic deficits that may require 364 immediate surgical intervention. In this study, acupuncture hastened pain and 365 functional improvement, indicating that acupuncture could be offered to patients with 366 sciatica lasting at least 4 weeks (mean duration of 2.0 years) as promising 367 non-pharmacologic care. However, prior studies enrolled patients with more acute 368 conditions who may have been more prone to spontaneous recovery than our 369 participants, which limit the generalizability of the trial findings. 370 Acupuncture has regionally specific effect or segmental effect [23-24]. Acupoints 371 located directly on injured nerves could inhibit the nociceptive pathway at the same 372 spinal level and give an analgesic effect at the same dermatomal level [25]. However, 373 the underlying mechanism is not fully elucidated and is worthy of further study. 374 This study had several strengths. Rigorous methods have been used to test the 375 preliminary efficacy of acupuncture in this pilot study. The use of blunt-tipped 376 placebo needles ensured the implementation of blinding, which can make the patients 377 have the feeling of acupuncture under the premise that the needle tip does not 378 penetrate the skin. The high recruitment rate has reflected the willingness to 379 participate among patients with sciatica. The compliance rate (83.3%) and follow-up 380 rate (91.1%) for this pilot trial are satisfactory. Therefore, the current study may 381 provide a more accurate basis for assessing the sample size and selection of 382 acupuncture acupoints for the large-scale trial to be conducted. 383 Limitations 384 Some limitations have to be acknowledged. First, we run this multi-center trial in 385 order to text the feasiblity to implement a large-scale RCT to further confirm the 386 efficacy of acupuncture in this regard. However, with only 90 participants spread over 387 six centers, the effect from the numerous treatment centers should be probably 388 accounted. Second, due to the nature of acupuncture, it was not possible to blind 389 acupuncturists to treatment assignment. But they were trained in advance to follow a 390 standard operating procedure and keep equal communication with patients. Third, 391 although sensitive analysis indicated similar conclusions, the robustness of our This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 392 finding was decreased by the small sample size with a wide credible interval 393 generated, thus further studies with sufficient sample size are needed. Fourth, a 394 treatment that offered 3 sessions per week for continuous 4 weeks was proposed to be 395 burdensome for part of the patients, especially for those who are employed. Treatment 396 with a gradually decreased frequency should be applied in future studies. 397 Conclusion 398 Acupuncture was safely administered in patients with mild to moderate sciatica 399 caused by lumbar disc herniation. To accurately assess the efficacy, a larger, 400 sufficiently powered trial is needed. Acupuncture at the acupoint on the 401 disease-affected meridian had superior and clinically relevant benefits in reducing 402 pain intensity to a greater degree than acupuncture at NAM or SA. Data supported the 403 meridian-based specificity of acupoint is one of the most determining factors in the 404 efficacy of acupuncture. 405 406 References 407 1. Gadjradj PS, Rubinstein SM, Peul WC, et al. Full endoscopic versus open 408 discectomy for sciatica: randomised controlled non-inferiority trial. BMJ. 2022; 409 376:e065846. 410 2. Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and 411 prevalence estimates. Spine. 2008; 33:2464-2472. 412 3. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 413 2007; 334:1313-1317. 414 4. Deyo RA, Mirza SK. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016; 415 374:1763-1772. 416 5. Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015; 372:1240-1248. 417 6. Mehling WE, Gopisetty V, Bartmess E, et al. The prognosis of acute low back 418 pain in primary care in the United States: a 2-year prospective cohort study. Spine. 419 2012; 37:678-684. 420 7. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. 421 BMJ. 2019; 367:l6273. 422 8. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for 423 the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 424 2014 ;14(1):180-191. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 425 9. Manchikanti L, Knezevic E, Latchaw RE, et al. Comparative Systematic Review 426 and Meta-Analysis of Cochrane Review of Epidural Injections for Lumbar 427 Radiculopathy or Sciatica. Pain physician. 2022; 25:E889-e916. 428 10. Ji M, Wang X, Chen M, et al. The Efficacy of Acupuncture for the Treatment of 429 Sciatica: A Systematic Review and Meta-Analysis. Evid Based Complement 430 Alternat Med. 2015;2015:192808. 431 11. Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for Chronic Pain: 432 Update of an Individual Patient Data Meta-Analysis. J Pain. 2018;19(5):455-474. 433 12. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive Treatments for Acute, 434 Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the 435 American College of Physicians. Ann Intern Med. 2017;166(7):514-530. 436 13. Huang Z, Liu S, Zhou J, Yao Q, Liu Z. Efficacy and Safety of Acupuncture for 437 Chronic Discogenic Sciatica, a Randomized Controlled Sham Acupuncture Trial. 438 Pain Med. 2019;20(11): 2303-2310. 439 14. Yu FT, Ni GX, Cai GW, et al. Efficacy of acupuncture for sciatica: study 440 protocol for a randomized controlled pilot trial. Trials. 2021;22:34. 441 15. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. 442 BMJ 2019;367:l6273. 443 16. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: 444 what is moderate pain in millimetres? Pain. 1997;72:95-7. 445 17. Schroeder K, Richards S. Non-specific low back pain. Lancet 2012;379:482-91 446 18. Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context 447 effects on health outcomes: A systematic review. Lancet 448 2001;357(9258):757-762 449 19. Ropper AH, Zafonte RD. Sciatica. New Engl J Med 2015;372(13):1225–1240. 450 20. Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney 451 K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial 452 comparing acupuncture, simulated acupuncture, and usual care for chronic low 453 back pain. Arch Intern Med. 2009;169(9):858-866. 454 21. Donna Kalauokalani, Daniel C Cherkin, Karen J Sherman. A comparison of 455 physician and nonphysician acupuncture treatment for chronic low back pain. 456 Clin J Pain. 2005;21(5):406-411. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 457 22. Goldberg H, Firtch W, Tyburski M, et al. Oral steroids for acute radiculopathy 458 due to a herniated lumbar disk: a randomized clinical trial. JAMA. 459 2015;313:1915-1923. 460 23. Zhang R, Lao L, Ren K, Berman B. Mechanisms of 461 acupuncture-electroacupuncture on persistent pain. Anesthesiology. 462 2014;120(2):482-503. 463 24. Cheng K. Neuroanatomical basis of acupuncture treatment for some common 464 illnesses. Acupunct Med. 2009;27(2):61-4. 465 25. Cheng KJ. Neuroanatomical basis of acupuncture treatment for some common 466 illnesses. Acupuncture in medicine: journal of the British Medical Acupuncture 467 Society. 2009;27:61-64. 468 469 Figure legends 470 Figure 1. Modified CONSORT flow diagram. 471 Figure 2. VAS scores for leg pain intensity. 472 Tables 473 Table 1. Baseline characteristics of participants. 474 Table 2. Primary and secondary outcomes measured at week 4 and week 26. 475 476 Contributors 477 CZL is the guarantor for the article. CZL, GXS and FTY designed the trial. GWC, 478 GXN, WJW, XQZ, and XLM offered administrative support. FTY, HCX, HYF, LT, 479 BZ, and XLJ recruited and followed up patients. LQW, JFT and JWY were 480 responsible for study monitoring. SYY and JWY take responsibility for the accuracy 481 of the data analysis. All authors had full access to the data in the study and gave the 482 final approval of the manuscript and agree to be accountable for all aspects of work. 483 484 Data sharing statement 485 Data are available from the corresponding author on reasonable request. 486 Declaration of interests 487 The authors declare no conflict of interest. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed Figure 1. Modified CONSORT flow diagram. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed Figure 2. VAS scores for leg pain intensity. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 1 Table 1. Baseline characteristics of participants. Characteristic DAM group (n=30) NAM group (n=30) SA group (n=30) Age, year, mean (SD) 41.6 (14.7) 44.8 (15.0) 46.1 (15.1) Sex, no. (%) Female 21 (70.0) 16 (53.3) 14 (46.7) Male 9 (30.0) 14 (46.7) 16 (53.3) Marital status, no. (%) Married 22 (73.3) 23 (76.7) 24 (80.0) Single 8 (26.7) 7 (23.3) 6 (20.0) Occupation, no. (%) Mental work 24 (80.0) 24 (80.0) 20 (66.7) Manual work 6 (20.0) 6 (20.0) 10 (33.3) BMI, kg/m2, mean (SD) 22.6 (3.1) 23.3 (2.5) 23.0 (2.7) Duration of sciatica, year, median (IQR) 1.7 (0.4, 5.0) 1.8 (0.7, 3.3) 2.1 (0.7, 6.3) History of acupuncture, no. (%) Yes 13 (43.3) 15 (50.0) 9 (30.0) No 17 (56.7) 15 (50.0) 21 (70.0) Positive straight leg raise test, no. (%) 12 (40.0) 19 (63.3) 16 (53.3) Numbness, no. (%) 20 (66.7) 17 (56.7) 23 (76.7) Tingling, no. (%) 17 (56.7) 21 (70.0) 17 (56.7) Sensory deficit, no. (%) 4 (13.3) 3 (10.0) 3 (10.0) Muscle weakness, no. (%) 8 (26.7) 8 (26.7) 8 (26.7) This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 2 Reflex changes, no. (%) 1 (3.3) 1 (3.3) 1 (3.3) Disk herniation level, no. (%) L3-L4 2 (6.7) 0 (0.0) 0 (0.0) L4-L5 6 (20.0) 14 (46.7) 7 (23.3) L5-S1 9 (30.0) 4 (13.3) 8 (26.7) More than one level 13 (43.3) 12 (40.0) 15 (50.0) Leg pain intensity*, mm, mean (SD) 59.5 (12.3) 63.2 (14.8) 64.3 (15.7) Back pain intensity*, mm, mean (SD) 58.9 (25.2) 56.2 (23.6) 54.6 (26.0) ODI score†, mean (SD) 38.3 (13.0) 38.0 (15.7) 38.2 (14.8) SFBI score‡, mean (SD) Frequency 13.7 (4.4) 14.5 (4.5) 13.7 (5.2) Bothersomeness 12.3 (3.6) 12.5 (3.9) 12.9 (5.0) SF-36 score§, mean (SD) Physical Component 28.5 (10.4) 33.5 (11.5) 31.0 (10.3) Mental Component 52.4 (12.1) 47.6 (15.3) 49.9 (13.1) PDQ score¶, mean (SD) 10.5 (5.5) 12.3 (5.4) 10.7 (6.3) Credibility score**, mean (SD) 0.3 (2.5) 0 (2.6) -0.3 (2.8) Expectancy score**, mean (SD) 0.5 (2.6) -0.4 (3.0) -0.1 (2.7) * Scores range from 0 to 100, with higher scores indicating more severe pain. † Scores range from 0 to 100, with higher scores indicating worse disability. ‡ Scores range from 0 to 24, with higher scores indicating more severe symptoms. § Scores are based on normative data and have a mean (±SD) of 50±10, with higher scores indicating a better This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 3 quality of life. ¶ Scores range from 0 to 30, with higher scores indicating more neuropathic pain. ** Scale has Mean = 0.0 (SD = 1.0) since the items were converted to z-scores before averaging. DAM, the disease-affected meridian; NAM, the non-affected meridian; SA, Sham acupuncture. SD, standard deviation; IQR, interquartile range; BMI, body mass index; ODI, Oswestry Disability Index; SFBI, Sciatica Frequency and Bothersomeness Index; SF-36, 36-item Short Form Health Survey; PDQ, PainDETECT questionnaire. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 4 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 1 Table 2. Primary and secondary outcomes at week 4 and week 26 DAM vs SA NAM vs SA DAM vs NAM Outcome DAM group NAM group SA group P value Difference P value Difference P value Difference P value Primary outcome Change of leg pain intensity at week 4* -36.6 (-43.1, -30.2) -17.4 (-23.8, -11.0) -14.4 (-20.9, -8.0) ＜0.001 -22.2 (-31.4, -13.0) ＜0.001 -3.0 (-12.0, 6.1) 0.520 -19.3 (-28.4, -10.1) ＜0.001 Secondary outcomes Change of leg pain intensity at week 26‡ -35.5 (-42.8, –28.3) -22.2 (-29.3, -15.0) -22.2 (-29.7, -14.7) 0.016 -13.3 (-23.2, -2.8) 0.014 0.1 (-10.3, -10.5) 0.989 -13.4 (-23.6, -3.1) 0.011 Change of back pain intensity Week 4† -34.9 (-41.7, -28.2) -21.1 (-27.6, -14.6) -16.9 (-23.8, -10.0) 0.001 -18.0 (-27.7, -8.4) ＜0.001 -4.2 (-13.6, 5.3) 0.380 -13.8 (-23.2, -4.5) 0.004 Week 26‡ -33.5 (-41.6, -25.4) -23.6 (-31.8, -15.5) -22.7 (-31.1, -14.2) 0.128 -10.8 (-22.6, 0.9) 0.07 -1.0 (-12.7, 10.8) 0.871 -9.9 (-21.4, -1.6) 0.092 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 2 ODI score Week 4† 18.0 (13.9, 22.1) 25.5 (19.6, 31.5) 28.7 (22.6, 34.7) 0.019 -10.7 (-18.3, -3.1) 0.007 -3.1 (-10.6, 4.3) 0.406 -7.5 (-14.9, -0.1) 0.046 Week 26‡ 14.9 (10.0, 19.8) 23.3 (17.1, 29.5) 26.0 (19.1, 32.8) 0.025 -11.1 (-19.4, -2.8) 0.010 -2.7 (-11.0, 5.7) 0.527 -8.4 (-16.6, -0.3) 0.043 SFBI frequency score Week 4† 6.6 (4.9, 8.4) 10.6 (8.7, 12.5) 10.8 (8.5, 13.1) 0.005 -4.1 (-6.9, -1.4) 0.004 -0.2 (-2.9, 2.5) 0.874 -3.9 (-6.6, -1.2) 0.005 Week 26‡ 5.8 (3.7, 7.8) 10.1 (7.8, 12.5) 10.0 (7.4, 12.5) 0.010 -4.2 (-7.4, -1.0) 0.011 0.2 (-3.1, 3.4) 0.928 -4.4 (-7.5, -1.2) 0.007 SFBI bothersomeness score Week 4† 5.6 (4.0, 7.1) 8.9 (7.2, 10.6) 10.2 (8.1, 12.2) 0.001 -4.6 (-7.1, -2.1) ＜0.001 -1.3 (-3.7, 1.2) 0.306 -3.3 (-5.8, -0.9) 0.007 Week 26‡ 4.9 (3.2, 6.6) 8.5 (6.5, 10.5) 9.0 (6.6, 11.4) 0.007 -4.1 (-6.9, -1.3) 0.004 -0.5 (-3.3, 2.3) 0.742 -3.7 (-6.4, -0.9) 0.009 SF-36 physical component score Week 4† 37.3 (32.8, 41.7) 37.7 (33.7, 41.6) 33.8 (28.9, 38.7) 0.390 3.5 (-2.7, 9.6) 0.268 3.9 (-2.2, 9.9) 0.206 -0.4 (-6.4, 5.6) 0.888 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 3 Week 26§ 44.7 (39.9, 49.4) 40.1 (35.3, 44.8) 37.4 (32.0, 42.8) 0.104 7.3 (0.4, 14.2) 0.038 2.7 (-4.2, 9.5) 0.443 4.6 (-2.0, 11.3) 0.166 SF-36 mental component score Week 4† 53.7 (49.7, 57.6) 48.6 (43.2, 54.0) 51.9 (47.2, 56.7) 0.287 1.8 (-4.9, 8.4) 0.600 -3.3 (-9.9, 3.2) 0.314 5.1 (-1.4, 11.6) 0.122 Week 26§ 55.1 (51.7, 58.4) 51.2 (46.0, 56.4) 53.3 (48.6, 58.1) 0.438 1.7 (-4.5, 8.0) 0.580 -2.1 (-8.4, 4.1) 0.496 3.9 (-2.1, 9.8) 0.201 Degree of straight leg raise test Week 4¶ 70.1 (63.8, 76.5) 67.2 (61.0, 73.4) 68.5 (61.6, 75.3) 0.797 1.7 (-7.3, 10.6) 0.708 -1.3 (-10.1, 7.6) 0.774 3.0 (-5.8, 11.7) 0.502 Week 26** 74.9 (70.7, 79.1) 70.3 (62.7, 77.9) 69.8 (64.1, 75.4) 0.402 5.1 (-3.2, 13.4) 0.222 0.5 (-7.7, 8.7) 0.902 4.6 (-3.6, 12.8) 0.267 PDQ score Week 4† 6.7 (4.4, 9.2) 9.3 (7.8, 10.8) 8.0 (5.8, 10.2) 0.193 -2.5 (-5.3, 0.2) 0.071 1.3 (-1.5, 4.1) 0.351 -1.2 (-4.1, 1.6) 0.392 Week 26‡ 4.9 (3.3, 6.4) 9.0 (7.7, 10.4) 8.1 (6.0, 10.1) 0.001 -4.1 (-6.4, -1.9) ＜0.001 1.0 (-1.3, 3.3) 0.408 -3.2 (-5.5, -0.9) 0.007 Global perceived This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 4 recovery Week 4† 1.5 (1.2, 1.9) 2.6 (2.1, 3.1) 2.9 (2.4, 3.5) ＜0.001 -1.4 (-2.1, -0.7) ＜0.001 -0.3 (-1.0, 0.3) 0.301 -1.1 (-1.7, -0.4) 0.001 Week 26‡ 1.8 (1.4, 2.2) 2.6 (2.1, 3.0) 2.8 (2.3, 3.3) 0.005 -1.0 (-1.7, -0.4) 0.002 -0.2 (-0.9, 0.4) 0.460 -0.8 (-1.4, -0.2) 0.014 Estimates are expressed as mean (95%CI). * Data imputed through the last observation carried forward approach. † The number of participants providing data was 27 in the DAM group, 29 in the NAM group and 26 in the SA group at week 4. ‡ The number of participants providing data was 28 in the DAM group, 28 in the NAM group and 26 in the SA group at week 26. §The number of participants providing data was 28 in the DAM group, 28 in the NAM group and 24 in the SA group at week 26. ¶ The number of participants providing data was 27 in the DAM group, 28 in the NAM group and 26 in the SA group at week 4. ** The number of participants providing data was 25 in the DAM group, 26 in the NAM group and 25 in the SA group at week 26. DAM, the disease-affected meridian; NAM, the non-affected meridian; SA, Sham acupuncture. ODI, Oswestry Disability Index; SFBI, Sciatica Frequency and Bothersomeness Index; SF-36, 36-item Short Form Health Survey; PDQ, PainDETECT questionnaire. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 5 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed","Only provide commentary from the context included. Is acupuncture a beneficial treatment for leg pain in patients with sciatica? 1 Effect of acupuncture on leg pain in patients with sciatica due to lumbar disc 2 herniation: A prospective, randomised, controlled trial 3 4 Guang-Xia Shia , Fang-Ting Yua , Guang-Xia Nib , Wen-Jun Wanc , Xiao-Qing Zhoud , 5 Li-Qiong Wanga , Jian-Feng Tua , Shi-Yan Yana , Xiu-Li Menge , Jing-Wen Yanga , 6 Hong-Chun Xiangf , Hai-Yang Fug , Lei Tangc , Beng Zhangd , Xiao-Lan Jie , Guo-Wei 7 Caif*, Cun-Zhi Liua,h** 8 a International Acupuncture and Moxibustion Innovation Institute, School of 9 Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, 10 Beijing, China 11 bSchool of Acupuncture-Moxibustion and Tuina, School of Health and Rehabilitation, 12 Nanjing University of Chinese Medicine, Nanjing, China 13 cDepartment of Rehabilitation, The Central Hospital of Wuhan, Tongji Medical 14 College, Huazhong University of Science and Technology, Wuhan, China 15 dDepartment of Acupuncture and Moxibustion, Shenzhen Hospital, Beijing University 16 of Chinese Medicine, Shenzhen, China 17 ePain Medicine Center, Peking University Third Hospital, Beijing, China 18 fDepartment of Acupuncture, Union Hospital, Tongji Medical College, Huazhong 19 University of Science and Technology, Wuhan, China 20 gDepartment of Acupuncture, Affiliated Hospital of Nanjing University of Chinese 21 Medicine, Nanjing, China 22 hDepartment of Acupuncture, Dongzhimen Hospital Affiliated to Beijing University 23 of Chinese Medicine, Beijing, China 24 Corresponding author* 25 Department of Acupuncture, Union Hospital, Tongji Medical College, Huazhong 26 University of Science and Technology, Wuhan, China. No. 1277 Jiefang Avenue, 27 Jianghan District, Wuhan 430022,China. 28 E-mail Address: cgw645@163.com (G.-W. Cai) 29 Corresponding author** 30 International Acupuncture and Moxibustion Innovation Institute, School of 31 Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, No.11 32 Bei San Huan Dong Lu, Chaoyang District, Beijing 100021, China. E-mail 33 Address:cunzhiliu@bucm.edu.cn (C.-Z. Liu) 34 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 35 Summary 36 Background Sciatica is a condition including unilateral leg pain that is more severe 37 than low back pain, and causes severe discomfort and functional limitation. We 38 investigated the effect of acupuncture on leg pain in patients with sciatica due to 39 lumbar disc herniation. 40 Methods In this multi-centre, prospective, randomised trial, we enrolled patients with 41 sciatica due to lumbar disc herniation at 6 hospitals in China. Patients were randomly 42 assigned (1:1:1) to receive either acupuncture at the acupoints on the disease-affected 43 meridian (DAM), or the non-affected meridian (NAM), or the sham acupuncture (SA) 44 3 times weekly for 4 weeks. The primary end point was the change in visual analogue 45 scale (VAS, 0-100) of leg pain intensity from baseline to week 4. This study is 46 registered with Chictr.org.cn, ChiCTR2000030680. 47 Finding Between Jun 9th, 2020, and Sep 27th, 2020, 142 patients were assessed for 48 eligibility, 90 patients (30 patients per group) were enrolled and included in the 49 intention-to-treat analysis. A greater reduction of leg pain intensity was observed in 50 the DAM group than in the other groups: -22.2 mm than the SA group (95%CI, -31.4 51 to -13.0, P <0.001) , and -19.3mm than the NAM group (95% CI, -28.4 to -10.1; P 52 <0.001). However, we did not observe a significant difference in the change of leg 53 pain intensity between the NAM group and the SA group (between-group difference 54 -3.0 [95% CI, -12.0 to 6.1], P=0.520). There were no serious adverse events. 55 Interpretation Compared with SA, acupuncture at the acupoints on the 56 disease-affected meridian, but not the non-affected meridian, significantly reduces the 57 leg pain intensity in patients with sciatica due to lumbar disc herniation. These 58 findings suggest that the meridian-based specificity of acupoint is a considerable 59 factor in the acupuncture treatment. A larger, sufficiently powered trial is needed to 60 accurately assess efficacy. 61 62 Funding The National Key R&D Program of China (No: 2019YFC1712103) and the 63 National Science Fund for Distinguished Young Scholars (No:81825024). 64 Keywords: Acupuncture; leg pain; Acupoint selection; Meridian-based; Sciatica 65 66 67 68 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 69 Research in context 70 Evidence before this study 71 Using the key words ""sciatica"" and ""acupuncture""，we searched PubMed for articles 72 published between Jan 1, 1947 and Jan 5, 2024. Despite an extensive literature search, 73 only a limited number of studies were available. There is ambiguous evidence about 74 the use of acupuncture, with most studies contrasting one another in addition to the 75 lack of high-quality trials. Since the choice of more appropriate acupoints for 76 stimulation is meaningful for acupuncture, studies that investigate the effect of 77 acupuncture on different acupoint program are urgently needed. 78 Added value of this study 79 This multi-centre, assessor and statistician-blinded trial addressed the above 80 limitations by showing that, compared with sham acupuncture, acupuncture at the 81 acupoints on the disease-affected meridian, but not the non-affected meridian, 82 significantly reduces the leg pain intensity in patients with sciatica due to lumbar disc 83 herniation. 84 Implications of all the available evidence 85 We found that acupuncture at the acupoint on the disease-affected meridian had 86 superior and clinically relevant benefits in reducing pain intensity to a greater degree 87 than acupuncture at NAM or SA. The finding is of vital significance to clinical work, 88 as meridian-based specificity of acupoint is one of the most determining factors in the 89 efficacy of acupuncture. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 90 Introduction 91 Sciatica is a common health problem in the general population with a lifetime 92 prevalence of 10% to 43%, depending on different etiologies [1-2]. It is characterised 93 by radiating leg pain starting from the low back, at times accompanied by sensory or 94 motor deficits. In most cases, sciatica is attributable to lumbar disk disorders [3]. The 95 overall prognosis is worse than low back pain, particularly if leg pain extends distal to 96 the knee with signs of nerve root compression, increasing risk for unfavorable 97 outcomes and health care use [4]. Spontaneous recovery occurs in most patients; 98 however, many endure substantial pain and prolonged disability, as 34% reported 99 chronic pain beyond 2 years [5-6]. Optimal pharmacological treatment is unclear due 100 to uncertain benefits or high rates of adverse effects[7-8]. Surgery has been 101 demonstrated to ameliorate sciatica in the early stage, but a proportion of patients do 102 not meet surgical standards or hesitate about the potential complications [9]. The 103 dilemma has led to a soaring increase in complementary and alternative medicine, 104 such as acupuncture [10]. 105 Acupuncture has been recommended for management of low back pain by clinical 106 practice guideline from the American College of Physicians [11-12]. Several studies 107 have also shown that acupuncture was beneficial in treating leg pain, although others 108 have reported discrepancies concerning the efficacy of true vs sham acupuncture[10]. 109 The inconsistent findings may result from variations in study design and insufficient 110 sample size. We conducted this trial to preliminarily evaluate the efficacy and safety 111 of acupuncture in terms of reduction in leg pain with sciatica patients. 112 Acupuncture is garnering increased attention as an effective treatment for pain 113 managemengt, one important issue is whether acupoint choice influences the benefits 114 of acupuncture[10]. However, a well-recognized acupoint program has yet not been 115 established, yielding heterogeneous results across relative studies[13]. Therefore, the 116 second aim of this study was to compare the difference of acupuncture efficacy in 117 patients receiving acupuncture at the acupoints of the disease-affected meridian 118 (DAM), the non-affected meridian (NAM), or sham acupuncture (SA). 119 120 Methods 121 Study design and participants 122 This mult-centre, three-arm, prospective randomised trial was conducted in the 123 inpatient departments of 6 tertiary hospitals in China between Jun 9, 2020 and Sep27, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 124 2020. The study protocol was approved by the local ethics committee at the 125 coordinating center and each study site (No. 2020BZHYLL0105), and registered with 126 the Chinese Clinical Trial Registry on Chictr.org.cn, ChiCTR2000030680. The 127 protocol has been published previously [14] and is available in open-access full text 128 and in Supplement 1. All patients provided written informed consent before 129 enrolment. 130 Eligible patients were aged 18 to 70 years old , reported leg pain extending below 131 the knee in a nerve root distribution over 4 weeks, had a lumbar disc herniation 132 confirmed by examination signs (positive result on straight leg raise test or sensory or 133 motor deficit in a pattern consistent with a lumbar nerve root) [15], and scored 40 mm 134 or higher on the 100-mm VAS [16]. Imaging (magnetic resonance imaging with or 135 without computed tomography) corroborating a root-level lesion concordant with 136 symptoms and/or signs was determined by the trial clinician. Exclusion criteria were a 137 history or diagnostic result that suggested an inherited neuropathy or neuropathy 138 attributable to other causes, had undergone surgery for lumbar disc herniation within 139 the past 6 months or plan to have spinal surgery or other interventional therapies 140 during next 4 weeks, continually took antiepileptic medication, antidepressant 141 medication, opioids or corticosteroids; had cardiovascular, liver, kidney, or 142 hematopoietic system diseases, mental health disorders, other severe coexisting 143 diseases (e.g., cancer), pregnant, breastfeeding, or women planning conception during 144 the study. Patients participating in other clinical studies within the past 3 months or 145 receiving acupuncture within 6 months were also excluded. The screening process 146 was conducted in the way of in-person visits by trial clinicians. 147 Randomisation and masking 148 The study protocol was explained to all enrolled patients before randomisation. 149 After written informed consent was obtained, patients were allocated randomly (1:1:1) 150 to the three arms: DAM, NAM or SA. Randomisation was performed with a random 151 block size of six. A randomisation sequence was created by a biostatistician who did 152 not participate in the implementation or statistical analysis of trial. The assessor and 153 statistician were blinded to treatment allocation throughout data collection and 154 analysis. 155 Procedures and interventions 156 To exploratively observe whether the effects of acupoint located on two kinds of 157 meridians are different, this trial set two acupuncture groups, in which patients This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 158 received acupuncture at acupoints on the disease-affected meridian (DAM), or the 159 non-affected meridian (NAM), respectively. The bladder (BL) and gallbladder (GB) 160 meridians are directly in the same dermatomes of the sciatic nerve. Since these 161 meridians are consistent with sciatic pain distribution, they are regarded as the 162 disease-affected meridians. 163 Patients assigned to the DAM group received semi-standardized treatment at 164 acupoints on the bladder/gallbladder meridians. Bilateral BL25 and BL26, which 165 localized at the same level as the inferior border of the spinous process of the fourth 166 and the fifth lumbar vertebra (the commonest positions of disc rupture), were needled 167 as obligatory acupoints. For those having symptoms at the posterior side of the leg, 168 BL54, BL36, BL40, BL57, and BL60 were needled as adjunctive acupoints; similarly, 169 GB30, GB31, GB33, GB34, and GB39 were adjunctive acupoints for patients with 170 symptoms at lateral side. For patients who had pain at both posterior and lateral sides, 171 acupuncturists were instructed to select 5 of the 10 adjunctive acupoints. 172 According to the principle of the Traditional Chinese Medicine theory, the liver 173 meridian, the spleen meridian, and the kidney meridian are commonly treated to 174 improve the functional status of the body. These meridians distribute at the inner side, 175 less related to sciatica symptoms, and are regarded as non-affected meridians. For 176 patients in the NAM group, bilateral EX-B7, EX-B4, and unilateral LR9, LR8, LR5, 177 KI7, and SP4 that on the non-affected meridians were selected . 178 Patients assigned to the SA group received acupuncture at 7 non-acupoints which 179 not localized on meridians and with no manipulations. 180 All acupuncture treatments were performed by two senior acupuncturists (length of 181 services ≥5 years), who consistently applied the same standardised protocols. After 182 identifying the location of acupoints, sterile acupuncture needles (length 40 mm, 183 diameter 0.30 mm; Hwato, Suzhou Medical Appliance Factory, China) were inserted, 184 followed by 30s manipulation to acquire Deqi (a sensation of aching, soreness, 185 swelling, heaviness, or numbness). Blunt-tipped placebo needles with similar 186 appearances to conventional needles but no skin penetration were used in the SA 187 group. To maximize the blinding of patients and to fix blunt-tipped placebo needles, 188 adhesive pads were placed on points in all groups. Patients in all groups started 189 treatment on the day of randomization and received twelve 30-minute sessions over 4 190 consecutive weeks at 3 sessions per week (ideally every other day). This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 191 Pain medication was offered if necessary and included paracetamol and optionally 192 non-steroidal anti-inflammatory drugs (Celebrex), short acting opioids, or both. We 193 used questionnaires to monitor the use of pain medication and other co-interventions. 194 Outcomes 195 The primary outcome was the change of leg pain intensity over the preceding 24 196 hours from baseline to week 4 as measured on the VAS. Participants were asked to 197 rate their average leg pain during the last 24 hours out of 100, with 0 representing no 198 leg pain and 100 representing the worst pain imaginable. 199 Secondary outcomes included VAS for leg pain and back pain intensity at other 200 time points. We observed the Oswestry Disability Index (ODI, examining perceived 201 functional disability in 10 activities of daily living), Sciatica Frequency and 202 Bothersomeness Index (SFBI, rating the extent of frequency and bothersomeness of 203 sciatica respectively), 36-item Short Form Health Survey (SF-36, evaluating the 204 quality of life with physical and mental components) . 205 We also assessed levels on the global perceived recovery (assessed by a 7-point 206 Likert self-rating scale with options from “completely recovered” to “worse than 207 ever”) and degrees of the straight leg raise test. 208 The Credibility/Expectancy Questionnaire (CEQ) was used to assess the credibility 209 and expectancy of patients to acupuncture treatment after the first treatment. 210 Moreover, patients were also invited to guess their group for blinding assessment at 211 week 2 and week 4. Adverse events were documented by patients and outcome 212 assessors throughout the trial. All adverse events were categorized as 213 treatment-related or non-treatment-related and followed up until resolution. 214 The researchers in charge of the scale assessment were asked to use the fixed 215 guiding words on the questionnaires to have a conversation with the patient without 216 redundant communication. Due to the trial site and population, we used Chinese 217 versions of the assessment scales that were confirmed to have moderate or higher 218 clinical responsiveness and are suitable for clinical efficacy evaluation. 219 Statistical analysis 220 We designed our trial to determine whether there was a difference between each 221 acupuncture group and the sham acupuncture group in terms of leg pain intensity. 222 According to the method of upper confidence limit, a sample size ranging from 20 to 223 40 could be the guideline for choosing the size of a pilot sample. Considering the 224 overall resource input issues (eg, funding availability and expected completion time), This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 225 the total sample size was preset at 90 patients, 30 patients per group. We performed 226 analyses following the intention-to-treat principle with all randomly assigned patients 227 included. 228 For the primary outcome, analysis of covariance was applied to test the difference 229 between groups in leg pain intensity with baseline values adjusted. Missing data were 230 imputed using multiple imputation method. To address the robustness of the results, 231 we performed a per-protocol analysis for the primary outcome, covering patients who 232 complete 10 sessions or more and had no major protocol violations (e.g., using 233 additional treatments during the treatment period). One-way ANOVA was performed 234 for the secondary outcomes including leg pain at each measuring time point, back 235 pain, ODI, SFBI, SF-36, CEQ, PDQ, global perceived recovery scores, and degrees of 236 straight leg raise test. The blinding assessment, the proportion of patients using 237 additional treatments and adverse event rates were analyzed using the χ2 test or Fisher 238 exact test. Between-group differences were tested through the least significance 239 difference (LSD)-t test. Categorical variables are presented as n (%) and continuous 240 variables are presented as the mean (SD) or median (interquartile range, IQR) . All 241 tests applied were two-tailed, p < 0.05 was considered statistically significant. An 242 independent statistician completed the analyses using IBM SPSS Statistics version 20 243 (IBM Corp, Armonk, NY). 244 Role of the funding source 245 The funder of the study had no role in the study design, data collection, data 246 analysis, or writing of the report. All authors had full access to the data in the study 247 and gave the final approval of the manuscript and agree to be accountable for all 248 aspects of work. 249 Results 250 Patient characteristics 251 Between Jun 9th, 2020, and Sep 27th, 2020, 142 patients were assessed for 252 eligibility, 90 patients (30 patients per group) were enrolled and included in the 253 intention-to-treat analysis (Figure 1). Mean age of patients was 44.2 (SD 14.9) years, 254 and 51 (56.7%) were female. Mean symptom duration was 2.0 years (IQR 0.7 to 4.1) 255 with a mean VAS score of 62.3 (SD 14.3) mm for their leg pain intensity. Overall, 75 256 (83.3%) patients completed the assigned 12 sessions of study interventions, and 82 257 (91.1%) received at least 10 sessions. The primary outcome visit was attended by 82 258 patients at week 4, corresponding to a follow-up rate of 91.1%, which was maintained This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 259 to week 26. There was no difference among groups regarding the usual risk factors for 260 sciatica, such as gender, age, body-mass index, or Disk herniation level, which 261 confirmed that the groups were well matched. The baseline characteristics of patients 262 are summarized in Table 1. 263 After receiving 4-week treatment, the change of leg pain intensity decreased by 264 -36.6 mm (95% CI, -43.1 to -30.2) in the DAM group, by -17.4 mm in the NAM 265 group and by -14.4 mm (95% CI, -20.9 to -8.0) in the SA group. Changes in the leg 266 pain intensity over 4-week period differed significantly among the 3 groups. A greater 267 reduction was observed in the DAM group than in the other groups: -22.2 mm 268 reduction in leg pain intensity than in the SA group (95% CI, -31.4 to -13.0, P＜ 269 0.001) , and -19.3 mm reduction in leg pain intensity than in the NAM group (95% CI, 270 -28.4 to -10.1; P <0.001). While no significant change in leg pain intensity was 271 observed between the NAM and SA groups (mean difference, -3.0 mm, 95% CI, -12.0 272 to 6.1, P=0.52) (Figure 2). 273 We observed that outcomes at the 26-week follow-up were similar in direction to 274 the those at the end of an 4-week period. At week 26, a difference in the change of leg 275 pain intensity were present between the DAM and SA groups (mean difference, -13.3 276 mm, 95% CI, -23.2 to -2.8, P=0.01), between the DAM and NAM groups (mean 277 difference, -13.4 mm, 95%CI, -23.6 to -3.1, P=0.011), but not between the NAM and 278 SA groups (mean difference, 0.1 mm, 95% CI, -10.3 to 10.5, P=0.99) (Figure 2). 279 Sensitive analyses did not alter the result in the primary analysis (eTable 1 and eTable 280 2 in Supplement 2). 281 We found a greater reduction in back pain intensity over SA for patients who 282 received DAM at week 4 (mean difference, -18.0 mm, 95% CI, -27.7 to -8.4, P＜ 283 0.001). The difference in back pain changes was not significant between the NAM 284 and SA groups at week 4 (mean difference, -4.2 mm, 95% CI, -13.6 to 5.3, P=0.38). 285 At week 26, no difference was detected in back pain relief across the 3 groups. 286 We also found a greater decrease in disability scores in the DAM group over SA at 287 week 4 (mean difference, -10.7 points, 95% CI, -18.3 to -3.1, P=0.007), while there 288 was no difference between the NAM and SA groups (mean difference, -3.1 points, 289 95%CI, -10.6 to 4.3, P=0.41). Similar results were observed at week 26, which 290 favored acupuncture at DAM (mean difference between DAM and SA, -11.1 points, This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 291 95%CI, -19.4 to -2.8, P=0.01) rather than acupuncture at the NAM (mean difference 292 between NAM and SA, -2.7 points, 95%CI, -11.0 to -5.7, P=0.53). 293 Compared to SA, patients in the DAM group reported better symptom 294 improvement on the global perceived recovery test, and lower scores in both 295 frequency and bothersomeness scales on the SFBI. Nonetheless, the measurement of 296 the quality of life, or the degree of the straight leg raise test did not show a difference 297 across the 3 groups (Table 2). Five (16.7%) patients in the DAM group and 4 (13.3%) 298 patients in the SA group take rescue medicine for a short period (eTable 3 in 299 Supplement 2). For blinding assessment, we found no difference across groups in the 300 proportion of patients who correctly guessed the kind of intervention they had 301 received at week 2 and week 4 (eTable 4 in Supplement 2). Outcomes measured at 302 other time points were shown in eTable 5 and e Figure in Supplement 2. 303 Adverse events 304 Three (10%) patients in the NAM group reported post-needling pain which 305 decreased in the following week spontaneously. Adverse events unrelated to the study 306 interventions including increased leg pain, dizziness, insomnia, etc, were all rated as 307 mild to moderate (eTable 6 in Supplement 2). No serious adverse event occurred 308 during the study period. 309 Interpretation 310 To our knowledge, our study is a multi-center clinical trial to show the beneficial 311 effect of acupuncture for patients with moderate-to-severe sciatica of varying duration 312 and is the first to explore the meridian-based acupoint program in this field. We found 313 that acupuncture at the DAM had superior and clinically relevant benefits in reducing 314 leg pain intensity to a greater degree than acupuncture at NAM or SA. Improvements 315 in functional disability, back pain, frequency and bothersomeness and global 316 perceived recovery were also found. Moreover, no significant differences was 317 observed with respect to any outcome between NAM and SA groups. 318 The findings of the current study demonstrate that acupuncture at the acupoints on 319 the disease-affected meridian was clinically beneficial and superior to SA for leg pain. 320 We acknowledge the commonly recognised minimally clinically important difference 321 (MCID) is 10-20 of 100 for pain intensity [16]. The clinically important mean leg 322 pain reduction at the 4-week of treatment in DAM group was -22.2 mm, and 323 continued the trend of a mean clinical important result at 26-week follow-up (-13.3 324 mm). Before our study, Liu and colleagues evaluated the effect of acupuncture in This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 325 relieving leg pain for patients with chronic discogenic sciatica compared with sham 326 acupuncture [13]. Acupuncture showed a small but not clinically relevant effect, with 327 a between-group difference in the 4-week on mean VAS score for leg pain was 7.28， 328 which is not reach the MCID. More acupoints on the disease-affected meridian were 329 adapted in our trial (7 v 4 acupoints on the bladder and/or the gallbladder meridian) 330 which may interpret the discrepancy. 331 Our findings are consistent with a meta-analysis showing that acupuncture was 332 more effective than conventional medicine in managing the pain associated with 333 sciatica, with a significantly greater reduction in pain intensity by 12.5 (95% CI: 334 −16.3 to −8.6) [17]. It is worth noting that the most commonly used acupoints were 335 Huantiao (GB 32), Weizhong (BL 40), and Yanglingquan (GB 34), all on the bladder 336 and/or gallbladder meridians that were directly related with dermatomal distributions 337 of sciatic nerve. Acupuncture at the DAM was more effective than at the NAM in 338 alleviating pain severity during the 4-week treatment and the follow-up period. The 339 acupoints in NAM group are mainly located on the Liver, Spleen and Kidney 340 meridian, which are not affected directly by sciatica in Traditional Chinese Medicine. 341 We speculate that the varied efficacy between the DAM and NAM relate to 342 meridian-based acupoint specificity. 343 Acupuncture at the DAM showed significant superiority in the primary outcome 344 and in most of the second outcomes at the end of therapy. However, no significant 345 differences were observed in the quality of life or the degree of the straight leg raise 346 test among the three groups. The health status and body function are more likely be 347 affected by physical factors and psychological factors [18-19]. In addition, pain may 348 limit function, so as pain decreases, function (straight leg raise) may increase until 349 pain again limits functional capacity. This may explain the improvement in pain 350 without measurable proved function [20]. 351 In Dr. Vickers’ and his groups 2018 update of the meta-analysis of acupuncture for 352 chronic pain study, the authors did not finding any statistically significant influence 353 from point selection on treatment outcome by acupuncture [11]. Another two clinical 354 trials on acupuncture for low back pain, where the first showed no difference between 355 two different acupuncture recipes [21] and the subsequent detected no difference 356 between and real and sham acupuncture (where the sham treatment involved different 357 bodily locations) [22]. The efficacy of acupuncture is related to the dose, point This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 358 selection and treatment time (duration and frequency), and we could not isolate which 359 components contributed to the benefits. Our study only partially answer that acupoint 360 choice could influence the efficacy of acupuncture. 361 Practice guidelines recommend an initial period of conservative care focused on 362 non-pharmacologic treatments for persons with recent-onset sciatica, except in rare 363 instances of rapidly progressing or severe neurologic deficits that may require 364 immediate surgical intervention. In this study, acupuncture hastened pain and 365 functional improvement, indicating that acupuncture could be offered to patients with 366 sciatica lasting at least 4 weeks (mean duration of 2.0 years) as promising 367 non-pharmacologic care. However, prior studies enrolled patients with more acute 368 conditions who may have been more prone to spontaneous recovery than our 369 participants, which limit the generalizability of the trial findings. 370 Acupuncture has regionally specific effect or segmental effect [23-24]. Acupoints 371 located directly on injured nerves could inhibit the nociceptive pathway at the same 372 spinal level and give an analgesic effect at the same dermatomal level [25]. However, 373 the underlying mechanism is not fully elucidated and is worthy of further study. 374 This study had several strengths. Rigorous methods have been used to test the 375 preliminary efficacy of acupuncture in this pilot study. The use of blunt-tipped 376 placebo needles ensured the implementation of blinding, which can make the patients 377 have the feeling of acupuncture under the premise that the needle tip does not 378 penetrate the skin. The high recruitment rate has reflected the willingness to 379 participate among patients with sciatica. The compliance rate (83.3%) and follow-up 380 rate (91.1%) for this pilot trial are satisfactory. Therefore, the current study may 381 provide a more accurate basis for assessing the sample size and selection of 382 acupuncture acupoints for the large-scale trial to be conducted. 383 Limitations 384 Some limitations have to be acknowledged. First, we run this multi-center trial in 385 order to text the feasiblity to implement a large-scale RCT to further confirm the 386 efficacy of acupuncture in this regard. However, with only 90 participants spread over 387 six centers, the effect from the numerous treatment centers should be probably 388 accounted. Second, due to the nature of acupuncture, it was not possible to blind 389 acupuncturists to treatment assignment. But they were trained in advance to follow a 390 standard operating procedure and keep equal communication with patients. Third, 391 although sensitive analysis indicated similar conclusions, the robustness of our This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 392 finding was decreased by the small sample size with a wide credible interval 393 generated, thus further studies with sufficient sample size are needed. Fourth, a 394 treatment that offered 3 sessions per week for continuous 4 weeks was proposed to be 395 burdensome for part of the patients, especially for those who are employed. Treatment 396 with a gradually decreased frequency should be applied in future studies. 397 Conclusion 398 Acupuncture was safely administered in patients with mild to moderate sciatica 399 caused by lumbar disc herniation. To accurately assess the efficacy, a larger, 400 sufficiently powered trial is needed. Acupuncture at the acupoint on the 401 disease-affected meridian had superior and clinically relevant benefits in reducing 402 pain intensity to a greater degree than acupuncture at NAM or SA. Data supported the 403 meridian-based specificity of acupoint is one of the most determining factors in the 404 efficacy of acupuncture. 405 406 References 407 1. Gadjradj PS, Rubinstein SM, Peul WC, et al. Full endoscopic versus open 408 discectomy for sciatica: randomised controlled non-inferiority trial. BMJ. 2022; 409 376:e065846. 410 2. Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and 411 prevalence estimates. Spine. 2008; 33:2464-2472. 412 3. Koes BW, van Tulder MW, Peul WC. Diagnosis and treatment of sciatica. BMJ. 413 2007; 334:1313-1317. 414 4. Deyo RA, Mirza SK. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016; 415 374:1763-1772. 416 5. Ropper AH, Zafonte RD. Sciatica. N Engl J Med. 2015; 372:1240-1248. 417 6. Mehling WE, Gopisetty V, Bartmess E, et al. The prognosis of acute low back 418 pain in primary care in the United States: a 2-year prospective cohort study. Spine. 419 2012; 37:678-684. 420 7. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. 421 BMJ. 2019; 367:l6273. 422 8. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for 423 the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 424 2014 ;14(1):180-191. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 425 9. Manchikanti L, Knezevic E, Latchaw RE, et al. Comparative Systematic Review 426 and Meta-Analysis of Cochrane Review of Epidural Injections for Lumbar 427 Radiculopathy or Sciatica. Pain physician. 2022; 25:E889-e916. 428 10. Ji M, Wang X, Chen M, et al. The Efficacy of Acupuncture for the Treatment of 429 Sciatica: A Systematic Review and Meta-Analysis. Evid Based Complement 430 Alternat Med. 2015;2015:192808. 431 11. Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for Chronic Pain: 432 Update of an Individual Patient Data Meta-Analysis. J Pain. 2018;19(5):455-474. 433 12. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive Treatments for Acute, 434 Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the 435 American College of Physicians. Ann Intern Med. 2017;166(7):514-530. 436 13. Huang Z, Liu S, Zhou J, Yao Q, Liu Z. Efficacy and Safety of Acupuncture for 437 Chronic Discogenic Sciatica, a Randomized Controlled Sham Acupuncture Trial. 438 Pain Med. 2019;20(11): 2303-2310. 439 14. Yu FT, Ni GX, Cai GW, et al. Efficacy of acupuncture for sciatica: study 440 protocol for a randomized controlled pilot trial. Trials. 2021;22:34. 441 15. Jensen RK, Kongsted A, Kjaer P, Koes B. Diagnosis and treatment of sciatica. 442 BMJ 2019;367:l6273. 443 16. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: 444 what is moderate pain in millimetres? Pain. 1997;72:95-7. 445 17. Schroeder K, Richards S. Non-specific low back pain. Lancet 2012;379:482-91 446 18. Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context 447 effects on health outcomes: A systematic review. Lancet 448 2001;357(9258):757-762 449 19. Ropper AH, Zafonte RD. Sciatica. New Engl J Med 2015;372(13):1225–1240. 450 20. Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney 451 K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial 452 comparing acupuncture, simulated acupuncture, and usual care for chronic low 453 back pain. Arch Intern Med. 2009;169(9):858-866. 454 21. Donna Kalauokalani, Daniel C Cherkin, Karen J Sherman. A comparison of 455 physician and nonphysician acupuncture treatment for chronic low back pain. 456 Clin J Pain. 2005;21(5):406-411. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 457 22. Goldberg H, Firtch W, Tyburski M, et al. Oral steroids for acute radiculopathy 458 due to a herniated lumbar disk: a randomized clinical trial. JAMA. 459 2015;313:1915-1923. 460 23. Zhang R, Lao L, Ren K, Berman B. Mechanisms of 461 acupuncture-electroacupuncture on persistent pain. Anesthesiology. 462 2014;120(2):482-503. 463 24. Cheng K. Neuroanatomical basis of acupuncture treatment for some common 464 illnesses. Acupunct Med. 2009;27(2):61-4. 465 25. Cheng KJ. Neuroanatomical basis of acupuncture treatment for some common 466 illnesses. Acupuncture in medicine: journal of the British Medical Acupuncture 467 Society. 2009;27:61-64. 468 469 Figure legends 470 Figure 1. Modified CONSORT flow diagram. 471 Figure 2. VAS scores for leg pain intensity. 472 Tables 473 Table 1. Baseline characteristics of participants. 474 Table 2. Primary and secondary outcomes measured at week 4 and week 26. 475 476 Contributors 477 CZL is the guarantor for the article. CZL, GXS and FTY designed the trial. GWC, 478 GXN, WJW, XQZ, and XLM offered administrative support. FTY, HCX, HYF, LT, 479 BZ, and XLJ recruited and followed up patients. LQW, JFT and JWY were 480 responsible for study monitoring. SYY and JWY take responsibility for the accuracy 481 of the data analysis. All authors had full access to the data in the study and gave the 482 final approval of the manuscript and agree to be accountable for all aspects of work. 483 484 Data sharing statement 485 Data are available from the corresponding author on reasonable request. 486 Declaration of interests 487 The authors declare no conflict of interest. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed Figure 1. Modified CONSORT flow diagram. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed Figure 2. VAS scores for leg pain intensity. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 1 Table 1. Baseline characteristics of participants. Characteristic DAM group (n=30) NAM group (n=30) SA group (n=30) Age, year, mean (SD) 41.6 (14.7) 44.8 (15.0) 46.1 (15.1) Sex, no. (%) Female 21 (70.0) 16 (53.3) 14 (46.7) Male 9 (30.0) 14 (46.7) 16 (53.3) Marital status, no. (%) Married 22 (73.3) 23 (76.7) 24 (80.0) Single 8 (26.7) 7 (23.3) 6 (20.0) Occupation, no. (%) Mental work 24 (80.0) 24 (80.0) 20 (66.7) Manual work 6 (20.0) 6 (20.0) 10 (33.3) BMI, kg/m2, mean (SD) 22.6 (3.1) 23.3 (2.5) 23.0 (2.7) Duration of sciatica, year, median (IQR) 1.7 (0.4, 5.0) 1.8 (0.7, 3.3) 2.1 (0.7, 6.3) History of acupuncture, no. (%) Yes 13 (43.3) 15 (50.0) 9 (30.0) No 17 (56.7) 15 (50.0) 21 (70.0) Positive straight leg raise test, no. (%) 12 (40.0) 19 (63.3) 16 (53.3) Numbness, no. (%) 20 (66.7) 17 (56.7) 23 (76.7) Tingling, no. (%) 17 (56.7) 21 (70.0) 17 (56.7) Sensory deficit, no. (%) 4 (13.3) 3 (10.0) 3 (10.0) Muscle weakness, no. (%) 8 (26.7) 8 (26.7) 8 (26.7) This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 2 Reflex changes, no. (%) 1 (3.3) 1 (3.3) 1 (3.3) Disk herniation level, no. (%) L3-L4 2 (6.7) 0 (0.0) 0 (0.0) L4-L5 6 (20.0) 14 (46.7) 7 (23.3) L5-S1 9 (30.0) 4 (13.3) 8 (26.7) More than one level 13 (43.3) 12 (40.0) 15 (50.0) Leg pain intensity*, mm, mean (SD) 59.5 (12.3) 63.2 (14.8) 64.3 (15.7) Back pain intensity*, mm, mean (SD) 58.9 (25.2) 56.2 (23.6) 54.6 (26.0) ODI score†, mean (SD) 38.3 (13.0) 38.0 (15.7) 38.2 (14.8) SFBI score‡, mean (SD) Frequency 13.7 (4.4) 14.5 (4.5) 13.7 (5.2) Bothersomeness 12.3 (3.6) 12.5 (3.9) 12.9 (5.0) SF-36 score§, mean (SD) Physical Component 28.5 (10.4) 33.5 (11.5) 31.0 (10.3) Mental Component 52.4 (12.1) 47.6 (15.3) 49.9 (13.1) PDQ score¶, mean (SD) 10.5 (5.5) 12.3 (5.4) 10.7 (6.3) Credibility score**, mean (SD) 0.3 (2.5) 0 (2.6) -0.3 (2.8) Expectancy score**, mean (SD) 0.5 (2.6) -0.4 (3.0) -0.1 (2.7) * Scores range from 0 to 100, with higher scores indicating more severe pain. † Scores range from 0 to 100, with higher scores indicating worse disability. ‡ Scores range from 0 to 24, with higher scores indicating more severe symptoms. § Scores are based on normative data and have a mean (±SD) of 50±10, with higher scores indicating a better This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 3 quality of life. ¶ Scores range from 0 to 30, with higher scores indicating more neuropathic pain. ** Scale has Mean = 0.0 (SD = 1.0) since the items were converted to z-scores before averaging. DAM, the disease-affected meridian; NAM, the non-affected meridian; SA, Sham acupuncture. SD, standard deviation; IQR, interquartile range; BMI, body mass index; ODI, Oswestry Disability Index; SFBI, Sciatica Frequency and Bothersomeness Index; SF-36, 36-item Short Form Health Survey; PDQ, PainDETECT questionnaire. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 4 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 1 Table 2. Primary and secondary outcomes at week 4 and week 26 DAM vs SA NAM vs SA DAM vs NAM Outcome DAM group NAM group SA group P value Difference P value Difference P value Difference P value Primary outcome Change of leg pain intensity at week 4* -36.6 (-43.1, -30.2) -17.4 (-23.8, -11.0) -14.4 (-20.9, -8.0) ＜0.001 -22.2 (-31.4, -13.0) ＜0.001 -3.0 (-12.0, 6.1) 0.520 -19.3 (-28.4, -10.1) ＜0.001 Secondary outcomes Change of leg pain intensity at week 26‡ -35.5 (-42.8, –28.3) -22.2 (-29.3, -15.0) -22.2 (-29.7, -14.7) 0.016 -13.3 (-23.2, -2.8) 0.014 0.1 (-10.3, -10.5) 0.989 -13.4 (-23.6, -3.1) 0.011 Change of back pain intensity Week 4† -34.9 (-41.7, -28.2) -21.1 (-27.6, -14.6) -16.9 (-23.8, -10.0) 0.001 -18.0 (-27.7, -8.4) ＜0.001 -4.2 (-13.6, 5.3) 0.380 -13.8 (-23.2, -4.5) 0.004 Week 26‡ -33.5 (-41.6, -25.4) -23.6 (-31.8, -15.5) -22.7 (-31.1, -14.2) 0.128 -10.8 (-22.6, 0.9) 0.07 -1.0 (-12.7, 10.8) 0.871 -9.9 (-21.4, -1.6) 0.092 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 2 ODI score Week 4† 18.0 (13.9, 22.1) 25.5 (19.6, 31.5) 28.7 (22.6, 34.7) 0.019 -10.7 (-18.3, -3.1) 0.007 -3.1 (-10.6, 4.3) 0.406 -7.5 (-14.9, -0.1) 0.046 Week 26‡ 14.9 (10.0, 19.8) 23.3 (17.1, 29.5) 26.0 (19.1, 32.8) 0.025 -11.1 (-19.4, -2.8) 0.010 -2.7 (-11.0, 5.7) 0.527 -8.4 (-16.6, -0.3) 0.043 SFBI frequency score Week 4† 6.6 (4.9, 8.4) 10.6 (8.7, 12.5) 10.8 (8.5, 13.1) 0.005 -4.1 (-6.9, -1.4) 0.004 -0.2 (-2.9, 2.5) 0.874 -3.9 (-6.6, -1.2) 0.005 Week 26‡ 5.8 (3.7, 7.8) 10.1 (7.8, 12.5) 10.0 (7.4, 12.5) 0.010 -4.2 (-7.4, -1.0) 0.011 0.2 (-3.1, 3.4) 0.928 -4.4 (-7.5, -1.2) 0.007 SFBI bothersomeness score Week 4† 5.6 (4.0, 7.1) 8.9 (7.2, 10.6) 10.2 (8.1, 12.2) 0.001 -4.6 (-7.1, -2.1) ＜0.001 -1.3 (-3.7, 1.2) 0.306 -3.3 (-5.8, -0.9) 0.007 Week 26‡ 4.9 (3.2, 6.6) 8.5 (6.5, 10.5) 9.0 (6.6, 11.4) 0.007 -4.1 (-6.9, -1.3) 0.004 -0.5 (-3.3, 2.3) 0.742 -3.7 (-6.4, -0.9) 0.009 SF-36 physical component score Week 4† 37.3 (32.8, 41.7) 37.7 (33.7, 41.6) 33.8 (28.9, 38.7) 0.390 3.5 (-2.7, 9.6) 0.268 3.9 (-2.2, 9.9) 0.206 -0.4 (-6.4, 5.6) 0.888 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 3 Week 26§ 44.7 (39.9, 49.4) 40.1 (35.3, 44.8) 37.4 (32.0, 42.8) 0.104 7.3 (0.4, 14.2) 0.038 2.7 (-4.2, 9.5) 0.443 4.6 (-2.0, 11.3) 0.166 SF-36 mental component score Week 4† 53.7 (49.7, 57.6) 48.6 (43.2, 54.0) 51.9 (47.2, 56.7) 0.287 1.8 (-4.9, 8.4) 0.600 -3.3 (-9.9, 3.2) 0.314 5.1 (-1.4, 11.6) 0.122 Week 26§ 55.1 (51.7, 58.4) 51.2 (46.0, 56.4) 53.3 (48.6, 58.1) 0.438 1.7 (-4.5, 8.0) 0.580 -2.1 (-8.4, 4.1) 0.496 3.9 (-2.1, 9.8) 0.201 Degree of straight leg raise test Week 4¶ 70.1 (63.8, 76.5) 67.2 (61.0, 73.4) 68.5 (61.6, 75.3) 0.797 1.7 (-7.3, 10.6) 0.708 -1.3 (-10.1, 7.6) 0.774 3.0 (-5.8, 11.7) 0.502 Week 26** 74.9 (70.7, 79.1) 70.3 (62.7, 77.9) 69.8 (64.1, 75.4) 0.402 5.1 (-3.2, 13.4) 0.222 0.5 (-7.7, 8.7) 0.902 4.6 (-3.6, 12.8) 0.267 PDQ score Week 4† 6.7 (4.4, 9.2) 9.3 (7.8, 10.8) 8.0 (5.8, 10.2) 0.193 -2.5 (-5.3, 0.2) 0.071 1.3 (-1.5, 4.1) 0.351 -1.2 (-4.1, 1.6) 0.392 Week 26‡ 4.9 (3.3, 6.4) 9.0 (7.7, 10.4) 8.1 (6.0, 10.1) 0.001 -4.1 (-6.4, -1.9) ＜0.001 1.0 (-1.3, 3.3) 0.408 -3.2 (-5.5, -0.9) 0.007 Global perceived This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 4 recovery Week 4† 1.5 (1.2, 1.9) 2.6 (2.1, 3.1) 2.9 (2.4, 3.5) ＜0.001 -1.4 (-2.1, -0.7) ＜0.001 -0.3 (-1.0, 0.3) 0.301 -1.1 (-1.7, -0.4) 0.001 Week 26‡ 1.8 (1.4, 2.2) 2.6 (2.1, 3.0) 2.8 (2.3, 3.3) 0.005 -1.0 (-1.7, -0.4) 0.002 -0.2 (-0.9, 0.4) 0.460 -0.8 (-1.4, -0.2) 0.014 Estimates are expressed as mean (95%CI). * Data imputed through the last observation carried forward approach. † The number of participants providing data was 27 in the DAM group, 29 in the NAM group and 26 in the SA group at week 4. ‡ The number of participants providing data was 28 in the DAM group, 28 in the NAM group and 26 in the SA group at week 26. §The number of participants providing data was 28 in the DAM group, 28 in the NAM group and 24 in the SA group at week 26. ¶ The number of participants providing data was 27 in the DAM group, 28 in the NAM group and 26 in the SA group at week 4. ** The number of participants providing data was 25 in the DAM group, 26 in the NAM group and 25 in the SA group at week 26. DAM, the disease-affected meridian; NAM, the non-affected meridian; SA, Sham acupuncture. ODI, Oswestry Disability Index; SFBI, Sciatica Frequency and Bothersomeness Index; SF-36, 36-item Short Form Health Survey; PDQ, PainDETECT questionnaire. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed 5 This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=4723062 Preprint not peer reviewed",Medical,Fact Finding,Q&A Only give responses with information found in the text below. Limit your response to 200 words or less. Focus on historical significance that could be linked to current practices. Keep in the style of formal writing for a college institution. ,What were the negatives of having such low biodiversity for the coffee plant? ,"Context: tall bushes to promote branching and the production of new leaves, as well as to facilitate plucking them. Various processing methods are used to attain different levels of oxidation and produce certain kinds of tea, such as black, white, oolong, green, and pu’erh. Basic processing includes plucking, withering (to wilt and soften the leaves), rolling (to shape the leaves and slow drying), oxidizing, and drying. However, depending on the tea type, some steps are repeated or omitted. For example, green tea is made by withering and rolling leaves at a low heat, and oxidation is skipped; for oolong, rolling and oxidizing are performed repeatedly; and for black, extensive oxidation (fermentation) is employed. 3.5.1 The Discovery of Tea Tea was discovered in 2700 BCE by the ancient Chinese emperor Shen Nung, who had a keen interest in herbal medicine and introduced the practice of drinking boiled water to prevent stomach ailments. According to legend, once, when the emperor camped in a forest during one of his excursions, his servants set up a pot of boiling water under a tree. A fragrance attracted his attention, and he found that a few dry leaves from the tree had Colonial Agriculture | 53 fallen accidentally into the boiling pot and changed the color of the water; this was the source of the aroma. He took a few sips of that water and noticed its stimulative effect instantly. The emperor experimented with the leaves of that tree, now called Camellia sinensis, and thus the drink “cha” came into existence. Initially, it was used as a tonic, but it became a popular beverage around 350 BCE. The historian Lu Yu of the Tang dynasty (618–907 CE) has written a poetry book on tea called Cha jing (The Classic of Tea) that contains a detailed description of how to cultivate, process, and brew tea. Tea spread to Japan and Korea in the seventh century thanks to Buddhist monks, and drinking it became an essential cultural ritual. Formal tea ceremonies soon began. However, tea reached other countries only after the sixteenth century. In 1557, the Portuguese established their first trading center in Macau, and the Dutch soon followed suit. In 1610, some Dutch traders in Macau took tea back to the Dutch royal family as a gift. The royal family took an immediate liking to it. When the Dutch princess Catherine of Braganza married King Charles II of England around 1650, she introduced tea to England. Tea passed from the royal family to the nobles, but for an extended period, it remained unknown and unaffordable to common folks in Europe. The supply of tea in Europe was scant and very costly: one pound of tea was equal to nine months’ wages for a British laborer. As European trade with China increased, more tea reached Europe, and consumption of tea increased proportionally. For example, in 1680, Britain imported a hundred pounds of tea; however, in 1700, it brought in a million. The British government allowed the British East India Company to monopolize the trade, and by 1785, the company was buying 15 million pounds of tea from China annually and selling it worldwide. Eventually, in the early eighteenth century, tea reached the homes of British commoners. 3.5.2 Tea and the “Opium War” China was self-sufficient; its people wanted nothing from Europe in exchange for tea. But in Europe, the demand for tea increased rapidly in the mid-eighteenth century. Large quantities were being purchased, and Europeans had to pay in silver and gold. The East India Company was buying so much of it that it caused a crisis for the mercantilist British economy. The company came up with a plan to buy tea in exchange for opium instead of gold and silver. Although opium was banned within China, it was in demand and sold at very high prices on the black market. After the Battle of Plassey in 1757, several northern provinces in India came under the control of the East India Company, and the company began cultivating poppy in Bengal, Bihar, Orissa, and eastern Uttar Pradesh. Such cultivation was compulsory, and the 54 | Colonial Agriculture company also banned farmers from growing grain and built opium factories in Patna and Banaras. The opium was then transported to Calcutta for auction before British ships carried it to the Chinese border. The East India Company also helped set up an extensive network of opium smugglers in China, who then transported opium domestically and sold it on the black market. After the successful establishment of this smuggling network, British ships bought tea on credit at the port of Canton (now Guangzhou), China, and later paid for it with opium in Calcutta (now Kolkata). The company not only acquired the tea that was so in demand but also started making huge profits from selling opium. This mixed business of opium and tea began to strengthen the British economy and made it easier for the British to become front-runners among the European powers. By the 1830s, British traders were selling 1,400 tons of opium to China every year, and as a result, a large number of Chinese became opium addicts. The Chinese government began a crackdown on smugglers and further tightened the laws related to opium, and in 1838, it imposed death sentences on opium smugglers. Furthermore, despite immense pressure from the East India Company to allow the open trading of opium, the Chinese emperor would not capitulate. However, that did not curb his subjects’ addiction and the growing demand for opium. In 1839, by order of the Chinese emperor, a British ship was detained in the port of Canton, and the opium therein was destroyed. The British government asked the Chinese emperor to apologize and demanded compensation; he refused. British retaliated by attacking a number of Chinese ports and coastal cities. China could not compete with Britain’s state-of- the-art weapons, and defeated, China accepted the terms of the Treaty of Nanjing in 1842 and the Treaty of Bog in 1843, which opened the ports of Canton, Fujian, and Shanghai, among others, to British merchants and other Europeans. In 1856, another small war broke out between China and Britain, which ended with a treaty that made the sale of opium legal and allowed Christian missionaries to operate in China. But the tension between China and Europe remained. In 1859, the British and French seized Beijing and burned the royal Summer Palace. The subsequent Beijing Convention of 1860 ended China’s sovereignty, and the British gained a monopoly on the tea trade. 3.5.3 The Co-option of Tea and the Establishment of Plantations in European Colonies Unlike the British, the Dutch, Portuguese, and French had less success in the tea trade. To overcome British domination, the Portuguese planned to develop tea gardens outside China. Camellia is native to China, and it was not found in any other country. There was Colonial Agriculture | 55 a law against taking these plants out of the country, and the method for processing tea was also a trade secret. In the mid-eighteenth century, many Europeans smuggled the seeds and plants from China, but they were unable to grow them. Then, in 1750, the Portuguese smuggled the Camellia plants and some trained specialists out of China and succeeded in establishing tea gardens in the mountainous regions of the Azores Islands, which have a climate favorable for tea cultivation. With the help of Chinese laborers and experts, black and green tea were successfully produced in the Portuguese tea plantations. Soon, Portugal and its colonies no longer needed to import tea at all. As the owners of the first tea plantations outside China, the Portuguese remained vigilant in protecting their monopoly. It was some time before other European powers gained the ability to grow and process tea themselves. In the early nineteenth century, the British began exploring the idea of planting tea saplings in India. In 1824, Robert Bruce, an officer of the British East India Company, came across a variety of tea popular among the Singpho clan of Assam, India. He used this variety to develop the first tea garden in the Chauba area of Assam, and in 1840, the Assam Tea Company began production. This success was instrumental to the establishment of tea estates throughout India and in other British colonies. In 1848, the East India Company hired Robert Fortune, a plant hunter, to smuggle tea saplings and information about tea processing from China. Fortune was the superintendent of the hothouse department of the British Horticultural Society in Cheswick, London. He had visited China three times before this assignment; the first, in 1843, had been sponsored by the horticultural society, which was interested in acquiring important botanical treasures from China by exploiting the opportunity offered by the 1842 Treaty of Nanking after the First Opium War. Fortune managed to visit the interior of China (where foreigners were forbidden) and also gathered valuable information about the cultivation of important plants, successfully smuggling over 120 plant species into Britain. In the autumn of 1848, Fortune entered China and traveled for nearly three years while carefully collecting information related to tea cultivation and processing. He noted that black and green teas were made from the leaves of the same plant, Camellia sinensis, except that the former was “fermented” for a longer period. Eventually, Fortune succeeded in smuggling 20,000 saplings of Camellia sinensis to Calcutta, India, in Wardian cases.4 4. The Wardian case, a precursor to the modern terrarium, was a special type of sealed glass box made by British doctor Nathaniel Bagshaw Ward in 1829. The delicate plants within them could thrive for months. Plant hunter Joseph Hooker successfully used Wardian cases to bring some plants from the Antarctic to England. In 1933, Nathaniel Ward also succeeded in sending hundreds of small ornamental plants from England to Australia in these boxes. After two years, another voyage carried 56 | Colonial Agriculture He also brought trained artisans from China to India. These plants and artisans were transported from Calcutta to Darjeeling, Assam. At Darjeeling, a nursery was set up for the propagation of tea saplings at a large scale, supplying plantlets to all the tea gardens in India, Sri Lanka, and other British colonies. The British forced the poor tribal population of the Assam, Bengal, Bihar, and Orissa provinces out of their land, and they were sent to work in tea estates. Tamils from the southern province of India were also sent to work in the tea plantation of Sri Lanka. Tea plantations were modeled on the sugar colonies of the Caribbean, and thus the plight of the workers was in some ways similar to that of the slaves from Caribbean plantations. Samuel Davidson’s Sirocco tea dryer, the first tea-processing machine, was introduced in Sri Lanka in 1877, followed by John Walker’s tea-rolling machine in 1880. These machines were soon adopted by tea estates in India and other British colonies as well. As a result, British tea production increased greatly. By 1888, India became the number-one exporter of tea to Britain, sending the country 86 million pounds of tea. After India, Sri Lanka became prime ground for tea plantations. In the last decades of the nineteenth century, an outbreak of the fungal pathogen Hemilia vastatrix, a causal agent of rust, resulted in the destruction of the coffee plantations in Sri Lanka. The British owners of those estates quickly opted to plant tea instead, and a decade later, tea plantations covered nearly 400,000 acres of land in Sri Lanka. By 1927, Sri Lanka alone produced 100,000 tons per year. All this tea was for export. Within the British Empire, fermented black tea was produced, for which Assam, Ceylon, and Darjeeling tea are still famous. Black tea produced in India and Sri Lanka was considered of lesser quality than Chinese tea, but it was very cheap and easily became popular in Asian and African countries. In addition to India and Ceylon, British planters introduced tea plantations to fifty other countries. 3.6 The Story of Coffee Coffee is made from the roasted seeds of the coffee plant, a shrub belonging to the Rubiaceae family of flowering plants. There are over 120 species in the genus Coffea, and all are of tropical African origin. Only Coffea arabica and Coffea canephora are used for making coffee. Coffea arabica (figure 3.10) is preferred for its sweeter taste and is the source of 60–80 percent of the world’s coffee. It is an allotetraploid species that resulted from hybridization between the diploids Coffea canephora and Coffea eugenioides. In the Colonial Agriculture | 57 wild, coffee plants grow between thirty and forty feet tall and produce berries throughout the year. A coffee berry usually contains two seeds (a.k.a. beans). Coffee berries are nonclimacteric fruits, which ripen slowly on the plant itself (and unlike apples, bananas, mangoes, etc., their ripening cannot be induced after harvest by ethylene). Thus ripe berries, known as “cherries,” are picked every other week as they naturally ripen. To facilitate the manual picking of cherries, plants are pruned to a height of three to four feet. Pruning coffee plants is also essential to maximizing coffee production to maintain the correct balance of leaf to fruit, prevent overbearing, stimulate root growth, and effectively deter pests. Coffee is also a stimulative, and the secret of this elixir is the caffeine present in high quantities in its fruits and seeds. In its normal state, when our bodies are exhausted, there is an increase in adenosine molecules. The adenosine molecules bind to adenosine receptors in our brains, resulting in the transduction of sleep signals. The structure of caffeine is similar to that of adenosine, so when it reaches a weary brain, caffeine can also bind to the adenosine receptor and block adenosine molecules from accessing it, thus disrupting sleep signals. 58 | Colonial Agriculture 3.6.1 The History of Coffee Coffea arabica is native to Ethiopia. The people of Ethiopia first recognized the stimulative properties of coffee in the ninth century. According to legend, one day, a shepherd named Kaldi, who hailed from a small village in the highlands of Ethiopia, saw his goats dancing energetically after eating berries from a wild bush. Out of curiosity, he ate a few berries and felt refreshed. Kaldi took some berries back to the village to share, and the people there enjoyed them too. Hence the local custom of eating raw coffee berries began. There are records that coffee berries were often found in the pockets of slaves brought to the port of Mokha from the highlands of Ethiopia. Later, the people of Ethiopia started mixing ground berries with butter and herbs to make balls. The coffee we drink today was first brewed in Yemen in the thirteenth century. It became popular among Yemen’s clerics and Sufis, who routinely held religious and philosophical discussions late into the night; coffee rescued them from sleep and exhaustion. Gradually, coffee became popular, and coffeehouses opened up all over Arabia, where travelers, artists, poets, and common folks visited and had a chance to gossip and debate on a variety of topics, including politics. Often, governments shut down coffeehouses for fear of political unrest and revolution. Between the sixteenth and seventeenth centuries, coffeehouses were banned several times in many Arab countries, including Turkey, Mecca, and Egypt. But coffeehouses always opened again, and coffee became ingrained in Arab culture. Arabs developed many methods of processing coffee beans. Usually, these methods included drying coffee cherries to separate the beans. Dried coffee beans can be stored for many years. Larger and heavier beans are considered better. The taste and aroma develop during roasting, which determines the quality and price of the coffee. Dried coffee beans are dark green, but roasting them at a controlled temperature causes a slow transformation. First, they turn yellow, then light brown, while also popping up and doubling in size. After continued roasting, all the water inside them dries up, and the beans turn black like charcoal. The starch inside the beans first turns into sugar, and then sugar turns into caramel, at which point many aromatic compounds come out of the cells of the beans. Roasting coffee beans is an art, and a skilled roaster is a very important part of the coffee trade. 3.6.2 The Spread of Coffee out of Arabia Coffee was introduced to Europeans in the seventeenth century, when trade between the Ottoman Empire and Europe increased. In 1669, Turkish ambassador Suleiman Agha (Müteferrika Süleyman Ağa) arrived in the court of Louis XIV with many valuable gifts, Colonial Agriculture | 59 including coffee. The French subsequently became obsessed with the sophisticated etiquettes of the Ottoman Empire. In the company of Aga, the royal court and other elites of Parisian society indulged in drinking coffee. Aga held extravagant coffee ceremonies at his residence in Paris, where waiters dressed in Ottoman costumes served coffee to Parisian society women. Suleiman’s visit piqued French elites’ interest in Turquerie and Orientalism, which became fashionable. In the history of France, 1669 is thought of as the year of “Turkmenia.” A decade later, coffee reached Vienna, when Turkey was defeated in the Battle of 1683. After the victory, the Viennese seized the goods left behind by the Turkish soldiers, including several thousand sacks of coffee beans. The soldiers of Vienna didn’t know what it was and simply discarded it, but one man, Kolshitsky, snatched it up. Kolshitsky knew how to make coffee, and he opened the first coffeehouse in Vienna with the spoils. By the end of the seventeenth century, coffeehouses had become common in all the main cities of Europe. In London alone, by 1715, there were more than 2,000 coffeehouses. As in Arabia, the coffeehouses of Europe also became the bases of sociopolitical debates and were known as “penny universities.” 3.6.3 Coffee Plantations By the fifteenth century, demand for coffee had increased so much that the harvest of berries from the wild was not enough, and thus in Yemen, people began to plant coffee. Following Yemen’s lead, other Arab countries also started coffee plantations. Until the seventeenth century, coffee was cultivated only within North African and Arab countries. Arabs were very protective of their monopoly on the coffee trade. The cultivation of coffee and the processing of seeds was a mystery to the world outside of Arabia. Foreigners were not allowed to visit coffee farms, and only roasted coffee beans (incapable of producing new plants) were exported. Around 1600, Baba Budan, a Sufi who was on the Haj pilgrimage, successfully smuggled seven coffee seeds into India and started a small coffee nursery in Mysore. The early coffee plantations of South India used propagations of plants from Budan’s garden. In 1616, a Dutch spy also succeeded in stealing coffee beans from Arabia, and these were used by the Dutch East India Company as starters for coffee plantations in Java, Sumatra, Bali, Sri Lanka, Timur, and Suriname (Dutch Guiana). In 1706, a coffee plant from Java was brought to the botanic gardens of Amsterdam, and from there, its offspring reached Jardin de plantes in Paris. A clone of the Parisian plant was sent to the French colony Martinique, and then its offspring spread to the French colonies in the Caribbean, South America, and Africa. In 1728, a Portuguese officer from Dutch Guiana brought coffee seeds to Brazil, 60 | Colonial Agriculture which served as starters for the coffee plantations there. The Portuguese also introduced coffee to African countries and Indonesia, and the British established plantations in their Caribbean colonies, India, and Sri Lanka from Dutch stock. In summary, all European coffee plants came from the same Arabian mother plant. So the biodiversity within their coffee plantations was almost zero, which had devastating consequences. In the last decades of the nineteenth century, the fungal pathogen Haemilia vestatrix severely infected coffee plantations in Sri Lanka, India, Java, Sumatra, and Malaysia. As a result, rust disease destroyed the coffee plantations one by one. Later, in some of the coffee plantations, Coffea canephora (syn. Coffea robusta), which has a natural resistance to rust, was planted, but others were converted into tea plantations (as in the case of Sri Lanka, discussed earlier). European coffee plantations used the same model as tea or sugar plantations, and so their workers lived under the same conditions. European powers forcefully employed the poor native population in these plantations and used indentured laborers as needed. For example, in Sri Lanka, the Sinhalese population refused to work in the coffee farms, so British planters recruited 100,000 indentured Tamil workers from India to work the farms and tea plantations there. 3.7 The Heritage of Plantations In the twentieth century, most former European colonies became independent countries. In these countries, private, cooperative, or semigovernmental institutions manage plantations of sugarcane, tea, coffee, or other commercial crops. Though these plantations remain a significant source of revenue and contribute significantly to the national GDP of many countries, their workers still often operate under abject conditions. References Johannessen, C. L., & Sorenson, J. L. (2009). World trade and biological exchanges before 1492. iUniverse. (↵ Return)","Only give responses with information found in the text below. Limit your response to 200 words or less. Focus on historical significance that could be linked to current practices. Keep in the style of formal writing for a college institution. What were the negatives of having such low biodiversity for the coffee plant? Context: tall bushes to promote branching and the production of new leaves, as well as to facilitate plucking them. Various processing methods are used to attain different levels of oxidation and produce certain kinds of tea, such as black, white, oolong, green, and pu’erh. Basic processing includes plucking, withering (to wilt and soften the leaves), rolling (to shape the leaves and slow drying), oxidizing, and drying. However, depending on the tea type, some steps are repeated or omitted. For example, green tea is made by withering and rolling leaves at a low heat, and oxidation is skipped; for oolong, rolling and oxidizing are performed repeatedly; and for black, extensive oxidation (fermentation) is employed. 3.5.1 The Discovery of Tea Tea was discovered in 2700 BCE by the ancient Chinese emperor Shen Nung, who had a keen interest in herbal medicine and introduced the practice of drinking boiled water to prevent stomach ailments. According to legend, once, when the emperor camped in a forest during one of his excursions, his servants set up a pot of boiling water under a tree. A fragrance attracted his attention, and he found that a few dry leaves from the tree had Colonial Agriculture | 53 fallen accidentally into the boiling pot and changed the color of the water; this was the source of the aroma. He took a few sips of that water and noticed its stimulative effect instantly. The emperor experimented with the leaves of that tree, now called Camellia sinensis, and thus the drink “cha” came into existence. Initially, it was used as a tonic, but it became a popular beverage around 350 BCE. The historian Lu Yu of the Tang dynasty (618–907 CE) has written a poetry book on tea called Cha jing (The Classic of Tea) that contains a detailed description of how to cultivate, process, and brew tea. Tea spread to Japan and Korea in the seventh century thanks to Buddhist monks, and drinking it became an essential cultural ritual. Formal tea ceremonies soon began. However, tea reached other countries only after the sixteenth century. In 1557, the Portuguese established their first trading center in Macau, and the Dutch soon followed suit. In 1610, some Dutch traders in Macau took tea back to the Dutch royal family as a gift. The royal family took an immediate liking to it. When the Dutch princess Catherine of Braganza married King Charles II of England around 1650, she introduced tea to England. Tea passed from the royal family to the nobles, but for an extended period, it remained unknown and unaffordable to common folks in Europe. The supply of tea in Europe was scant and very costly: one pound of tea was equal to nine months’ wages for a British laborer. As European trade with China increased, more tea reached Europe, and consumption of tea increased proportionally. For example, in 1680, Britain imported a hundred pounds of tea; however, in 1700, it brought in a million. The British government allowed the British East India Company to monopolize the trade, and by 1785, the company was buying 15 million pounds of tea from China annually and selling it worldwide. Eventually, in the early eighteenth century, tea reached the homes of British commoners. 3.5.2 Tea and the “Opium War” China was self-sufficient; its people wanted nothing from Europe in exchange for tea. But in Europe, the demand for tea increased rapidly in the mid-eighteenth century. Large quantities were being purchased, and Europeans had to pay in silver and gold. The East India Company was buying so much of it that it caused a crisis for the mercantilist British economy. The company came up with a plan to buy tea in exchange for opium instead of gold and silver. Although opium was banned within China, it was in demand and sold at very high prices on the black market. After the Battle of Plassey in 1757, several northern provinces in India came under the control of the East India Company, and the company began cultivating poppy in Bengal, Bihar, Orissa, and eastern Uttar Pradesh. Such cultivation was compulsory, and the 54 | Colonial Agriculture company also banned farmers from growing grain and built opium factories in Patna and Banaras. The opium was then transported to Calcutta for auction before British ships carried it to the Chinese border. The East India Company also helped set up an extensive network of opium smugglers in China, who then transported opium domestically and sold it on the black market. After the successful establishment of this smuggling network, British ships bought tea on credit at the port of Canton (now Guangzhou), China, and later paid for it with opium in Calcutta (now Kolkata). The company not only acquired the tea that was so in demand but also started making huge profits from selling opium. This mixed business of opium and tea began to strengthen the British economy and made it easier for the British to become front-runners among the European powers. By the 1830s, British traders were selling 1,400 tons of opium to China every year, and as a result, a large number of Chinese became opium addicts. The Chinese government began a crackdown on smugglers and further tightened the laws related to opium, and in 1838, it imposed death sentences on opium smugglers. Furthermore, despite immense pressure from the East India Company to allow the open trading of opium, the Chinese emperor would not capitulate. However, that did not curb his subjects’ addiction and the growing demand for opium. In 1839, by order of the Chinese emperor, a British ship was detained in the port of Canton, and the opium therein was destroyed. The British government asked the Chinese emperor to apologize and demanded compensation; he refused. British retaliated by attacking a number of Chinese ports and coastal cities. China could not compete with Britain’s state-of- the-art weapons, and defeated, China accepted the terms of the Treaty of Nanjing in 1842 and the Treaty of Bog in 1843, which opened the ports of Canton, Fujian, and Shanghai, among others, to British merchants and other Europeans. In 1856, another small war broke out between China and Britain, which ended with a treaty that made the sale of opium legal and allowed Christian missionaries to operate in China. But the tension between China and Europe remained. In 1859, the British and French seized Beijing and burned the royal Summer Palace. The subsequent Beijing Convention of 1860 ended China’s sovereignty, and the British gained a monopoly on the tea trade. 3.5.3 The Co-option of Tea and the Establishment of Plantations in European Colonies Unlike the British, the Dutch, Portuguese, and French had less success in the tea trade. To overcome British domination, the Portuguese planned to develop tea gardens outside China. Camellia is native to China, and it was not found in any other country. There was Colonial Agriculture | 55 a law against taking these plants out of the country, and the method for processing tea was also a trade secret. In the mid-eighteenth century, many Europeans smuggled the seeds and plants from China, but they were unable to grow them. Then, in 1750, the Portuguese smuggled the Camellia plants and some trained specialists out of China and succeeded in establishing tea gardens in the mountainous regions of the Azores Islands, which have a climate favorable for tea cultivation. With the help of Chinese laborers and experts, black and green tea were successfully produced in the Portuguese tea plantations. Soon, Portugal and its colonies no longer needed to import tea at all. As the owners of the first tea plantations outside China, the Portuguese remained vigilant in protecting their monopoly. It was some time before other European powers gained the ability to grow and process tea themselves. In the early nineteenth century, the British began exploring the idea of planting tea saplings in India. In 1824, Robert Bruce, an officer of the British East India Company, came across a variety of tea popular among the Singpho clan of Assam, India. He used this variety to develop the first tea garden in the Chauba area of Assam, and in 1840, the Assam Tea Company began production. This success was instrumental to the establishment of tea estates throughout India and in other British colonies. In 1848, the East India Company hired Robert Fortune, a plant hunter, to smuggle tea saplings and information about tea processing from China. Fortune was the superintendent of the hothouse department of the British Horticultural Society in Cheswick, London. He had visited China three times before this assignment; the first, in 1843, had been sponsored by the horticultural society, which was interested in acquiring important botanical treasures from China by exploiting the opportunity offered by the 1842 Treaty of Nanking after the First Opium War. Fortune managed to visit the interior of China (where foreigners were forbidden) and also gathered valuable information about the cultivation of important plants, successfully smuggling over 120 plant species into Britain. In the autumn of 1848, Fortune entered China and traveled for nearly three years while carefully collecting information related to tea cultivation and processing. He noted that black and green teas were made from the leaves of the same plant, Camellia sinensis, except that the former was “fermented” for a longer period. Eventually, Fortune succeeded in smuggling 20,000 saplings of Camellia sinensis to Calcutta, India, in Wardian cases.4 4. The Wardian case, a precursor to the modern terrarium, was a special type of sealed glass box made by British doctor Nathaniel Bagshaw Ward in 1829. The delicate plants within them could thrive for months. Plant hunter Joseph Hooker successfully used Wardian cases to bring some plants from the Antarctic to England. In 1933, Nathaniel Ward also succeeded in sending hundreds of small ornamental plants from England to Australia in these boxes. After two years, another voyage carried 56 | Colonial Agriculture He also brought trained artisans from China to India. These plants and artisans were transported from Calcutta to Darjeeling, Assam. At Darjeeling, a nursery was set up for the propagation of tea saplings at a large scale, supplying plantlets to all the tea gardens in India, Sri Lanka, and other British colonies. The British forced the poor tribal population of the Assam, Bengal, Bihar, and Orissa provinces out of their land, and they were sent to work in tea estates. Tamils from the southern province of India were also sent to work in the tea plantation of Sri Lanka. Tea plantations were modeled on the sugar colonies of the Caribbean, and thus the plight of the workers was in some ways similar to that of the slaves from Caribbean plantations. Samuel Davidson’s Sirocco tea dryer, the first tea-processing machine, was introduced in Sri Lanka in 1877, followed by John Walker’s tea-rolling machine in 1880. These machines were soon adopted by tea estates in India and other British colonies as well. As a result, British tea production increased greatly. By 1888, India became the number-one exporter of tea to Britain, sending the country 86 million pounds of tea. After India, Sri Lanka became prime ground for tea plantations. In the last decades of the nineteenth century, an outbreak of the fungal pathogen Hemilia vastatrix, a causal agent of rust, resulted in the destruction of the coffee plantations in Sri Lanka. The British owners of those estates quickly opted to plant tea instead, and a decade later, tea plantations covered nearly 400,000 acres of land in Sri Lanka. By 1927, Sri Lanka alone produced 100,000 tons per year. All this tea was for export. Within the British Empire, fermented black tea was produced, for which Assam, Ceylon, and Darjeeling tea are still famous. Black tea produced in India and Sri Lanka was considered of lesser quality than Chinese tea, but it was very cheap and easily became popular in Asian and African countries. In addition to India and Ceylon, British planters introduced tea plantations to fifty other countries. 3.6 The Story of Coffee Coffee is made from the roasted seeds of the coffee plant, a shrub belonging to the Rubiaceae family of flowering plants. There are over 120 species in the genus Coffea, and all are of tropical African origin. Only Coffea arabica and Coffea canephora are used for making coffee. Coffea arabica (figure 3.10) is preferred for its sweeter taste and is the source of 60–80 percent of the world’s coffee. It is an allotetraploid species that resulted from hybridization between the diploids Coffea canephora and Coffea eugenioides. In the Colonial Agriculture | 57 wild, coffee plants grow between thirty and forty feet tall and produce berries throughout the year. A coffee berry usually contains two seeds (a.k.a. beans). Coffee berries are nonclimacteric fruits, which ripen slowly on the plant itself (and unlike apples, bananas, mangoes, etc., their ripening cannot be induced after harvest by ethylene). Thus ripe berries, known as “cherries,” are picked every other week as they naturally ripen. To facilitate the manual picking of cherries, plants are pruned to a height of three to four feet. Pruning coffee plants is also essential to maximizing coffee production to maintain the correct balance of leaf to fruit, prevent overbearing, stimulate root growth, and effectively deter pests. Coffee is also a stimulative, and the secret of this elixir is the caffeine present in high quantities in its fruits and seeds. In its normal state, when our bodies are exhausted, there is an increase in adenosine molecules. The adenosine molecules bind to adenosine receptors in our brains, resulting in the transduction of sleep signals. The structure of caffeine is similar to that of adenosine, so when it reaches a weary brain, caffeine can also bind to the adenosine receptor and block adenosine molecules from accessing it, thus disrupting sleep signals. 58 | Colonial Agriculture 3.6.1 The History of Coffee Coffea arabica is native to Ethiopia. The people of Ethiopia first recognized the stimulative properties of coffee in the ninth century. According to legend, one day, a shepherd named Kaldi, who hailed from a small village in the highlands of Ethiopia, saw his goats dancing energetically after eating berries from a wild bush. Out of curiosity, he ate a few berries and felt refreshed. Kaldi took some berries back to the village to share, and the people there enjoyed them too. Hence the local custom of eating raw coffee berries began. There are records that coffee berries were often found in the pockets of slaves brought to the port of Mokha from the highlands of Ethiopia. Later, the people of Ethiopia started mixing ground berries with butter and herbs to make balls. The coffee we drink today was first brewed in Yemen in the thirteenth century. It became popular among Yemen’s clerics and Sufis, who routinely held religious and philosophical discussions late into the night; coffee rescued them from sleep and exhaustion. Gradually, coffee became popular, and coffeehouses opened up all over Arabia, where travelers, artists, poets, and common folks visited and had a chance to gossip and debate on a variety of topics, including politics. Often, governments shut down coffeehouses for fear of political unrest and revolution. Between the sixteenth and seventeenth centuries, coffeehouses were banned several times in many Arab countries, including Turkey, Mecca, and Egypt. But coffeehouses always opened again, and coffee became ingrained in Arab culture. Arabs developed many methods of processing coffee beans. Usually, these methods included drying coffee cherries to separate the beans. Dried coffee beans can be stored for many years. Larger and heavier beans are considered better. The taste and aroma develop during roasting, which determines the quality and price of the coffee. Dried coffee beans are dark green, but roasting them at a controlled temperature causes a slow transformation. First, they turn yellow, then light brown, while also popping up and doubling in size. After continued roasting, all the water inside them dries up, and the beans turn black like charcoal. The starch inside the beans first turns into sugar, and then sugar turns into caramel, at which point many aromatic compounds come out of the cells of the beans. Roasting coffee beans is an art, and a skilled roaster is a very important part of the coffee trade. 3.6.2 The Spread of Coffee out of Arabia Coffee was introduced to Europeans in the seventeenth century, when trade between the Ottoman Empire and Europe increased. In 1669, Turkish ambassador Suleiman Agha (Müteferrika Süleyman Ağa) arrived in the court of Louis XIV with many valuable gifts, Colonial Agriculture | 59 including coffee. The French subsequently became obsessed with the sophisticated etiquettes of the Ottoman Empire. In the company of Aga, the royal court and other elites of Parisian society indulged in drinking coffee. Aga held extravagant coffee ceremonies at his residence in Paris, where waiters dressed in Ottoman costumes served coffee to Parisian society women. Suleiman’s visit piqued French elites’ interest in Turquerie and Orientalism, which became fashionable. In the history of France, 1669 is thought of as the year of “Turkmenia.” A decade later, coffee reached Vienna, when Turkey was defeated in the Battle of 1683. After the victory, the Viennese seized the goods left behind by the Turkish soldiers, including several thousand sacks of coffee beans. The soldiers of Vienna didn’t know what it was and simply discarded it, but one man, Kolshitsky, snatched it up. Kolshitsky knew how to make coffee, and he opened the first coffeehouse in Vienna with the spoils. By the end of the seventeenth century, coffeehouses had become common in all the main cities of Europe. In London alone, by 1715, there were more than 2,000 coffeehouses. As in Arabia, the coffeehouses of Europe also became the bases of sociopolitical debates and were known as “penny universities.” 3.6.3 Coffee Plantations By the fifteenth century, demand for coffee had increased so much that the harvest of berries from the wild was not enough, and thus in Yemen, people began to plant coffee. Following Yemen’s lead, other Arab countries also started coffee plantations. Until the seventeenth century, coffee was cultivated only within North African and Arab countries. Arabs were very protective of their monopoly on the coffee trade. The cultivation of coffee and the processing of seeds was a mystery to the world outside of Arabia. Foreigners were not allowed to visit coffee farms, and only roasted coffee beans (incapable of producing new plants) were exported. Around 1600, Baba Budan, a Sufi who was on the Haj pilgrimage, successfully smuggled seven coffee seeds into India and started a small coffee nursery in Mysore. The early coffee plantations of South India used propagations of plants from Budan’s garden. In 1616, a Dutch spy also succeeded in stealing coffee beans from Arabia, and these were used by the Dutch East India Company as starters for coffee plantations in Java, Sumatra, Bali, Sri Lanka, Timur, and Suriname (Dutch Guiana). In 1706, a coffee plant from Java was brought to the botanic gardens of Amsterdam, and from there, its offspring reached Jardin de plantes in Paris. A clone of the Parisian plant was sent to the French colony Martinique, and then its offspring spread to the French colonies in the Caribbean, South America, and Africa. In 1728, a Portuguese officer from Dutch Guiana brought coffee seeds to Brazil, 60 | Colonial Agriculture which served as starters for the coffee plantations there. The Portuguese also introduced coffee to African countries and Indonesia, and the British established plantations in their Caribbean colonies, India, and Sri Lanka from Dutch stock. In summary, all European coffee plants came from the same Arabian mother plant. So the biodiversity within their coffee plantations was almost zero, which had devastating consequences. In the last decades of the nineteenth century, the fungal pathogen Haemilia vestatrix severely infected coffee plantations in Sri Lanka, India, Java, Sumatra, and Malaysia. As a result, rust disease destroyed the coffee plantations one by one. Later, in some of the coffee plantations, Coffea canephora (syn. Coffea robusta), which has a natural resistance to rust, was planted, but others were converted into tea plantations (as in the case of Sri Lanka, discussed earlier). European coffee plantations used the same model as tea or sugar plantations, and so their workers lived under the same conditions. European powers forcefully employed the poor native population in these plantations and used indentured laborers as needed. For example, in Sri Lanka, the Sinhalese population refused to work in the coffee farms, so British planters recruited 100,000 indentured Tamil workers from India to work the farms and tea plantations there. 3.7 The Heritage of Plantations In the twentieth century, most former European colonies became independent countries. In these countries, private, cooperative, or semigovernmental institutions manage plantations of sugarcane, tea, coffee, or other commercial crops. Though these plantations remain a significant source of revenue and contribute significantly to the national GDP of many countries, their workers still often operate under abject conditions. References Johannessen, C. L., & Sorenson, J. L. (2009). World trade and biological exchanges before 1492. iUniverse. (↵ Return)",Unknown,Find & Summarize,Text Transformation "Provide responses in clear, concise and simple manner. The target audience has no knowledge of the subject and are not experts. You response should only rely on the provided context.",In what ways is Biden trying to improve the life of the average American?,"Biden Portrays Next Phase of Economic Agenda as Middle-Class Lifeline The president used his State of the Union speech to pitch tax increases for the rich, along with plans to cut costs and protect consumers. President Biden used his State of the Union speech on Thursday to remind Americans of his efforts to steer the nation’s economy out of a pandemic recession, and to lay the groundwork for a second term focused on making the economy more equitable by raising taxes on companies and the wealthy while taking steps to reduce costs for the middle class. Mr. Biden offered a blitz of policies squarely targeting the middle class, including efforts to make housing more affordable for first-time home buyers. The president used his speech to try and differentiate his economic proposals with those supported by Republicans, including former President Donald J. Trump. Those proposals have largely centered on cutting taxes, rolling back the Biden administration’s investments in clean energy and gutting the Internal Revenue Service. Many of Mr. Biden’s policy proposals would require acts of Congress and hinge on Democrats winning control of the House and the Senate. However, the president also unveiled plans to direct federal agencies to use their powers to reduce costs for big-ticket items like housing at a time when the lingering effects of inflation continue to weigh on economic sentiment. From taxes and housing to inflation and consumer protection, Mr. Biden had his eye on pocketbook issues. Raising Taxes on the Rich Many of the tax cuts that Mr. Trump signed into law in 2017 are set to expire next year, making tax policy among the most critical issues on the ballot this year. On Thursday night, Mr. Biden built upon many of the tax proposals that he has been promoting for the last three years, calling for big corporations and the wealthiest Americans to pay more. He proposed raising a new corporate minimum tax to 21 percent from 15 percent and proposed a new 25 percent minimum tax rate for billionaires, which he said would raise $500 billion over a decade. Criticizing the cost of the 2017 tax cuts, Mr. Biden asked, “Do you really think the wealthy and big corporations need another $2 trillion in tax breaks?” Help for the Housing Market High interest rates have made housing unaffordable for many Americans, and Mr. Biden called for a mix of measures to help ease those costs. That included tax credits and mortgage assistance for first-time home buyers and new incentives to encourage the construction and renovation of affordable housing. Mr. Biden called on Congress to make certain first-time buyers eligible for a $10,000 credit, along with making some “first generation” home buyers eligible for up to $25,000 toward a down payment. The president also unveiled new grants and incentives to encourage the construction of affordable housing. He also said the Consumer Financial Protection Bureau would be pursuing new rules to address “anticompetitive” closing costs that lenders impose on buyers and sellers, and called for more scrutiny of landlords who collude to raise rents and sneak hidden fees into rental agreements. Our politics reporters. Times journalists are not allowed to endorse or campaign for candidates or political causes. That includes participating in rallies and donating money to a candidate or cause. Learn more about our process. Protecting Consumers From “Shrinkflation” There is only so much that a president can do to tame rapid inflation, but Mr. Biden used his remarks to lean into his favorite new boogeyman: shrinkflation. “Same size bag, put fewer chips in it,” Mr. Biden said. He called on lawmakers to pass legislation to put an end to the corporate practice of reducing the size of products without reducing their price tag. The president also touted his efforts to cut credit card late charges and “junk” fees and to eliminate surprise fees for online ticket sales, and he claimed to be saving Americans billions of dollars from various forms of price gouging. Building and Buying American One of the mysteries that consume Mr. Biden’s advisers is why he does not get sufficient credit for the major pieces of legislation that have been enacted during the last three years. The president blitzed through those accomplishments, reminding his audience of the construction of new roads and bridges and investments in the development of microchips and clean energy manufacturing. Veering off script, Mr. Biden ribbed Republicans for voting against some of those policies while reaping the benefits of the investments in their states. Tackling China As president, Mr. Biden has prioritized stabilizing America’s economic relationship with China while also trying to reduce the United States’ reliance on Chinese products. Mr. Biden took aim at Mr. Trump, saying that while the former president portrayed himself as tough on China, the Biden administration’s policies were having a bigger impact on shrinking the bilateral trade deficit and powering U.S. economic growth. The president added that his administration had been pushing back against China’s unfair trade practices and keeping exports of sensitive American technology away from the Chinese military. He said that Republicans who claim that the U.S. is falling behind China were wrong. “America is rising,” Mr. Biden said. “We have the best economy in the world.”","Provide responses in clear, concise and simple manner. The target audience has no knowledge of the subject and are not experts. You response should only rely on the provided context. In what ways is Biden trying to improve the life of the average American? Biden Portrays Next Phase of Economic Agenda as Middle-Class Lifeline The president used his State of the Union speech to pitch tax increases for the rich, along with plans to cut costs and protect consumers. President Biden used his State of the Union speech on Thursday to remind Americans of his efforts to steer the nation’s economy out of a pandemic recession, and to lay the groundwork for a second term focused on making the economy more equitable by raising taxes on companies and the wealthy while taking steps to reduce costs for the middle class. Mr. Biden offered a blitz of policies squarely targeting the middle class, including efforts to make housing more affordable for first-time home buyers. The president used his speech to try and differentiate his economic proposals with those supported by Republicans, including former President Donald J. Trump. Those proposals have largely centered on cutting taxes, rolling back the Biden administration’s investments in clean energy and gutting the Internal Revenue Service. Many of Mr. Biden’s policy proposals would require acts of Congress and hinge on Democrats winning control of the House and the Senate. However, the president also unveiled plans to direct federal agencies to use their powers to reduce costs for big-ticket items like housing at a time when the lingering effects of inflation continue to weigh on economic sentiment. From taxes and housing to inflation and consumer protection, Mr. Biden had his eye on pocketbook issues. Raising Taxes on the Rich Many of the tax cuts that Mr. Trump signed into law in 2017 are set to expire next year, making tax policy among the most critical issues on the ballot this year. On Thursday night, Mr. Biden built upon many of the tax proposals that he has been promoting for the last three years, calling for big corporations and the wealthiest Americans to pay more. He proposed raising a new corporate minimum tax to 21 percent from 15 percent and proposed a new 25 percent minimum tax rate for billionaires, which he said would raise $500 billion over a decade. Criticizing the cost of the 2017 tax cuts, Mr. Biden asked, “Do you really think the wealthy and big corporations need another $2 trillion in tax breaks?” Help for the Housing Market High interest rates have made housing unaffordable for many Americans, and Mr. Biden called for a mix of measures to help ease those costs. That included tax credits and mortgage assistance for first-time home buyers and new incentives to encourage the construction and renovation of affordable housing. Mr. Biden called on Congress to make certain first-time buyers eligible for a $10,000 credit, along with making some “first generation” home buyers eligible for up to $25,000 toward a down payment. The president also unveiled new grants and incentives to encourage the construction of affordable housing. He also said the Consumer Financial Protection Bureau would be pursuing new rules to address “anticompetitive” closing costs that lenders impose on buyers and sellers, and called for more scrutiny of landlords who collude to raise rents and sneak hidden fees into rental agreements. Our politics reporters. Times journalists are not allowed to endorse or campaign for candidates or political causes. That includes participating in rallies and donating money to a candidate or cause. Learn more about our process. Protecting Consumers From “Shrinkflation” There is only so much that a president can do to tame rapid inflation, but Mr. Biden used his remarks to lean into his favorite new boogeyman: shrinkflation. “Same size bag, put fewer chips in it,” Mr. Biden said. He called on lawmakers to pass legislation to put an end to the corporate practice of reducing the size of products without reducing their price tag. The president also touted his efforts to cut credit card late charges and “junk” fees and to eliminate surprise fees for online ticket sales, and he claimed to be saving Americans billions of dollars from various forms of price gouging. Building and Buying American One of the mysteries that consume Mr. Biden’s advisers is why he does not get sufficient credit for the major pieces of legislation that have been enacted during the last three years. The president blitzed through those accomplishments, reminding his audience of the construction of new roads and bridges and investments in the development of microchips and clean energy manufacturing. Veering off script, Mr. Biden ribbed Republicans for voting against some of those policies while reaping the benefits of the investments in their states. Tackling China As president, Mr. Biden has prioritized stabilizing America’s economic relationship with China while also trying to reduce the United States’ reliance on Chinese products. Mr. Biden took aim at Mr. Trump, saying that while the former president portrayed himself as tough on China, the Biden administration’s policies were having a bigger impact on shrinking the bilateral trade deficit and powering U.S. economic growth. The president added that his administration had been pushing back against China’s unfair trade practices and keeping exports of sensitive American technology away from the Chinese military. He said that Republicans who claim that the U.S. is falling behind China were wrong. “America is rising,” Mr. Biden said. “We have the best economy in the world.”",Financial,Effect Analysis,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",How does a 10-week diet rich in fermented foods regulate the immune system? What are the implications of regulating the immune system for inflammation? Please give examples.,"Fermented-food diet increases microbiome diversity, decreases inflammatory proteins, study finds Stanford researchers discover that a 10-week diet high in fermented foods boosts microbiome diversity and improves immune responses. July 12, 2021 - By Janelle Weaver A diet rich in fermented foods enhances the diversity of gut microbes and decreases molecular signs of inflammation, according to researchers at the Stanford School of Medicine. In a clinical trial, 36 healthy adults were randomly assigned to a 10-week diet that included either fermented or high-fiber foods. The two diets resulted in different effects on the gut microbiome and the immune system. Eating foods such as yogurt, kefir, fermented cottage cheese, kimchi and other fermented vegetables, vegetable brine drinks, and kombucha tea led to an increase in overall microbial diversity, with stronger effects from larger servings. “This is a stunning finding,” said Justin Sonnenburg, PhD, an associate professor of microbiology and immunology. “It provides one of the first examples of how a simple change in diet can reproducibly remodel the microbiota across a cohort of healthy adults.” In addition, four types of immune cells showed less activation in the fermented-food group. The levels of 19 inflammatory proteins measured in blood samples also decreased. One of these proteins, interleukin 6, has been linked to conditions such as rheumatoid arthritis, Type 2 diabetes and chronic stress. “Microbiota-targeted diets can change immune status, providing a promising avenue for decreasing inflammation in healthy adults,” said Christopher Gardner, PhD, the Rehnborg Farquhar Professor and director of nutrition studies at the Stanford Prevention Research Center. “This finding was consistent across all participants in the study who were assigned to the higher fermented food group.” Justin Sonnenburg Justin Sonnenburg Microbe diversity stable in fiber-rich diet By contrast, none of these 19 inflammatory proteins decreased in participants assigned to a high-fiber diet rich in legumes, seeds, whole grains, nuts, vegetables and fruits. On average, the diversity of their gut microbes also remained stable. “We expected high fiber to have a more universally beneficial effect and increase microbiota diversity,” said Erica Sonnenburg, PhD, a senior research scientist in basic life sciences, microbiology and immunology. “The data suggest that increased fiber intake alone over a short time period is insufficient to increase microbiota diversity.” The study published online July 12 in Cell. Justin and Erica Sonnenburg and Christopher Gardner are co-senior authors. The lead authors are Hannah Wastyk, a PhD student in bioengineering, and former postdoctoral scholar Gabriela Fragiadakis, PhD, who is now an assistant professor of medicine at UC-San Francisco. A wide body of evidence has demonstrated that diet shapes the gut microbiome, which can affect the immune system and overall health. According to Gardner, low microbiome diversity has been linked to obesity and diabetes. “We wanted to conduct a proof-of-concept study that could test whether microbiota-targeted food could be an avenue for combatting the overwhelming rise in chronic inflammatory diseases,” Gardner said. The researchers focused on fiber and fermented foods due to previous reports of their potential health benefits. While high-fiber diets have been associated with lower rates of mortality, the consumption of fermented foods can help with weight maintenance and may decrease the risk of diabetes, cancer and cardiovascular disease. Erica Sonnenburg Erica Sonnenburg The researchers analyzed blood and stool samples collected during a three-week pre-trial period, the 10 weeks of the diet, and a four-week period after the diet when the participants ate as they chose. The findings paint a nuanced picture of the influence of diet on gut microbes and immune status. On one hand, those who increased their consumption of fermented foods showed similar effects on their microbiome diversity and inflammatory markers, consistent with prior research showing that short-term changes in diet can rapidly alter the gut microbiome. On the other hand, the limited change in the microbiome within the high-fiber group dovetails with the researchers’ previous reports of a general resilience of the human microbiome over short time periods.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. How does a 10-week diet rich in fermented foods regulate the immune system? What are the implications of regulating the immune system for inflammation? Please give examples. Fermented-food diet increases microbiome diversity, decreases inflammatory proteins, study finds Stanford researchers discover that a 10-week diet high in fermented foods boosts microbiome diversity and improves immune responses. July 12, 2021 - By Janelle Weaver A diet rich in fermented foods enhances the diversity of gut microbes and decreases molecular signs of inflammation, according to researchers at the Stanford School of Medicine. In a clinical trial, 36 healthy adults were randomly assigned to a 10-week diet that included either fermented or high-fiber foods. The two diets resulted in different effects on the gut microbiome and the immune system. Eating foods such as yogurt, kefir, fermented cottage cheese, kimchi and other fermented vegetables, vegetable brine drinks, and kombucha tea led to an increase in overall microbial diversity, with stronger effects from larger servings. “This is a stunning finding,” said Justin Sonnenburg, PhD, an associate professor of microbiology and immunology. “It provides one of the first examples of how a simple change in diet can reproducibly remodel the microbiota across a cohort of healthy adults.” In addition, four types of immune cells showed less activation in the fermented-food group. The levels of 19 inflammatory proteins measured in blood samples also decreased. One of these proteins, interleukin 6, has been linked to conditions such as rheumatoid arthritis, Type 2 diabetes and chronic stress. “Microbiota-targeted diets can change immune status, providing a promising avenue for decreasing inflammation in healthy adults,” said Christopher Gardner, PhD, the Rehnborg Farquhar Professor and director of nutrition studies at the Stanford Prevention Research Center. “This finding was consistent across all participants in the study who were assigned to the higher fermented food group.” Justin Sonnenburg Justin Sonnenburg Microbe diversity stable in fiber-rich diet By contrast, none of these 19 inflammatory proteins decreased in participants assigned to a high-fiber diet rich in legumes, seeds, whole grains, nuts, vegetables and fruits. On average, the diversity of their gut microbes also remained stable. “We expected high fiber to have a more universally beneficial effect and increase microbiota diversity,” said Erica Sonnenburg, PhD, a senior research scientist in basic life sciences, microbiology and immunology. “The data suggest that increased fiber intake alone over a short time period is insufficient to increase microbiota diversity.” The study published online July 12 in Cell. Justin and Erica Sonnenburg and Christopher Gardner are co-senior authors. The lead authors are Hannah Wastyk, a PhD student in bioengineering, and former postdoctoral scholar Gabriela Fragiadakis, PhD, who is now an assistant professor of medicine at UC-San Francisco. A wide body of evidence has demonstrated that diet shapes the gut microbiome, which can affect the immune system and overall health. According to Gardner, low microbiome diversity has been linked to obesity and diabetes. “We wanted to conduct a proof-of-concept study that could test whether microbiota-targeted food could be an avenue for combatting the overwhelming rise in chronic inflammatory diseases,” Gardner said. The researchers focused on fiber and fermented foods due to previous reports of their potential health benefits. While high-fiber diets have been associated with lower rates of mortality, the consumption of fermented foods can help with weight maintenance and may decrease the risk of diabetes, cancer and cardiovascular disease. Erica Sonnenburg Erica Sonnenburg The researchers analyzed blood and stool samples collected during a three-week pre-trial period, the 10 weeks of the diet, and a four-week period after the diet when the participants ate as they chose. The findings paint a nuanced picture of the influence of diet on gut microbes and immune status. On one hand, those who increased their consumption of fermented foods showed similar effects on their microbiome diversity and inflammatory markers, consistent with prior research showing that short-term changes in diet can rapidly alter the gut microbiome. On the other hand, the limited change in the microbiome within the high-fiber group dovetails with the researchers’ previous reports of a general resilience of the human microbiome over short time periods. https://med.stanford.edu/news/all-news/2021/07/fermented-food-diet-increases-microbiome-diversity-lowers-inflammation",Medical,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",I need to know what is effective primary and secondary line therapy. Are there any specific genes to look out for? What are some targeted antibodies? Make your response in bullet points and be sure to keep it less than 400 words.,"Ovarian cancer often progresses significantly before a patient is diagnosed. This is because the symptoms of ovarian cancer can be easily confused with less life-threatening digestive issues such as bloating, constipation, and gas. Roughly only 20 percent of ovarian cancers are detected before it spreads beyond the ovaries. Unfortunately, to date, no screening tests have been demonstrated to improve early detection and outcomes of people with ovarian cancer. The most prominent risk factor for this disease is a family history that includes breast or ovarian cancer. People who test positive for the inherited mutations in the BRCA1 or BRCA2 genes are at significantly greater risk—45% to 65% risk of developing breast cancer and 10% to 20% risk of developing ovarian cancer by age 70. Globally, ovarian cancer is diagnosed in an estimated 300,000 people each year, and causes roughly 180,000 deaths. In 2023, ovarian cancer will be diagnosed in approximately 20,000 people and cause about 13,000 deaths in the United States. While significant advances have been made in surgical and chemo-based treatments for ovarian cancer, the survival rates have only modestly improved. The poor survival in advanced ovarian cancer is due both to late diagnosis as well as to the lack of effective second-line therapy for patients who relapse. Many people affected by advanced ovarian cancer respond to chemotherapy, but effects are not typically long-lasting. The clinical course of ovarian cancer patients is marked by periods of remission and relapse of sequentially shortening duration until chemotherapy resistance develops. More than 80% of ovarian cancer patients experience recurrent disease, and more than 50% of these patients die from the disease in less than five years post-diagnosis. There is an urgent need for new treatments for advanced stage, recurring ovarian cancer. Subscribe To Email Alerts Ovarian Cancer Treatment Options First-line treatment for ovarian cancer includes surgery followed by a chemotherapy regimen combining a platinum-based (usually carboplatin) and a taxane-based (usually paclitaxel) treatment. This course of treatment leads to a complete response in approximately 80% of patients. A complete response means no visible evidence of disease on imaging scans and normal blood tests. After completion of upfront chemotherapy, patients may be eligible to receive maintenance therapy with a new class of drugs called PARP inhibitors, which have been demonstrated to significantly delay and possibly even prevent disease relapse in some patients, particularly patients whose tumor carry mutations in BRCA1 and BRCA2 genes. Patients who initially respond to treatment but then relapse after a period of six months or more may undergo the same therapy. Patients who progress during first-line treatment or who relapse within six months following successful first-line treatment are considered refractory or resistant to platinum-based treatments. For these patients, there are several chemotherapeutic options; however, each has shown only marginal benefit. Immunotherapy is class of treatments that take advantage of a person’s own immune system to help kill cancer cells. There are currently three FDA-approved immunotherapy options for ovarian cancer. Targeted Antibodies Bevacizumab (Avastin®): a monoclonal antibody that targets the VEGF/VEGFR pathway and inhibits tumor blood vessel growth; approved for patients with newly-diagnosed and with relapsed ovarian cancer Mirvetuximab soravtansine (ElahereTM): an antibody-drug conjugate that targets the folate receptor apathway and delivers toxic drugs to tumors; approved for subsets of patients with advanced ovarian cancer Immunomodulators Dostarlimab (Jemperli): a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced ovarian cancer that has DNA mismatch repair deficiency (dMMR) Pembrolizumab (Keytruda®): a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced ovarian cancer that has high microsatellite instability (MSI-H), DNA mismatch repair deficiency (dMMR), or high tumor mutational burden (TMB-H)","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I need to know what is effective primary and secondary line therapy. Are there any specific genes to look out for? What are some targeted antibodies? Make your response in bullet points and be sure to keep it less than 400 words. Ovarian cancer often progresses significantly before a patient is diagnosed. This is because the symptoms of ovarian cancer can be easily confused with less life-threatening digestive issues such as bloating, constipation, and gas. Roughly only 20 percent of ovarian cancers are detected before it spreads beyond the ovaries. Unfortunately, to date, no screening tests have been demonstrated to improve early detection and outcomes of people with ovarian cancer. The most prominent risk factor for this disease is a family history that includes breast or ovarian cancer. People who test positive for the inherited mutations in the BRCA1 or BRCA2 genes are at significantly greater risk—45% to 65% risk of developing breast cancer and 10% to 20% risk of developing ovarian cancer by age 70. Globally, ovarian cancer is diagnosed in an estimated 300,000 people each year, and causes roughly 180,000 deaths. In 2023, ovarian cancer will be diagnosed in approximately 20,000 people and cause about 13,000 deaths in the United States. While significant advances have been made in surgical and chemo-based treatments for ovarian cancer, the survival rates have only modestly improved. The poor survival in advanced ovarian cancer is due both to late diagnosis as well as to the lack of effective second-line therapy for patients who relapse. Many people affected by advanced ovarian cancer respond to chemotherapy, but effects are not typically long-lasting. The clinical course of ovarian cancer patients is marked by periods of remission and relapse of sequentially shortening duration until chemotherapy resistance develops. More than 80% of ovarian cancer patients experience recurrent disease, and more than 50% of these patients die from the disease in less than five years post-diagnosis. There is an urgent need for new treatments for advanced stage, recurring ovarian cancer. Subscribe To Email Alerts Ovarian Cancer Treatment Options First-line treatment for ovarian cancer includes surgery followed by a chemotherapy regimen combining a platinum-based (usually carboplatin) and a taxane-based (usually paclitaxel) treatment. This course of treatment leads to a complete response in approximately 80% of patients. A complete response means no visible evidence of disease on imaging scans and normal blood tests. After completion of upfront chemotherapy, patients may be eligible to receive maintenance therapy with a new class of drugs called PARP inhibitors, which have been demonstrated to significantly delay and possibly even prevent disease relapse in some patients, particularly patients whose tumor carry mutations in BRCA1 and BRCA2 genes. Patients who initially respond to treatment but then relapse after a period of six months or more may undergo the same therapy. Patients who progress during first-line treatment or who relapse within six months following successful first-line treatment are considered refractory or resistant to platinum-based treatments. For these patients, there are several chemotherapeutic options; however, each has shown only marginal benefit. Immunotherapy is class of treatments that take advantage of a person’s own immune system to help kill cancer cells. There are currently three FDA-approved immunotherapy options for ovarian cancer. Targeted Antibodies Bevacizumab (Avastin®): a monoclonal antibody that targets the VEGF/VEGFR pathway and inhibits tumor blood vessel growth; approved for patients with newly-diagnosed and with relapsed ovarian cancer Mirvetuximab soravtansine (ElahereTM): an antibody-drug conjugate that targets the folate receptor apathway and delivers toxic drugs to tumors; approved for subsets of patients with advanced ovarian cancer Immunomodulators Dostarlimab (Jemperli): a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced ovarian cancer that has DNA mismatch repair deficiency (dMMR) Pembrolizumab (Keytruda®): a checkpoint inhibitor that targets the PD-1/PD-L1 pathway; approved for subsets of patients with advanced ovarian cancer that has high microsatellite instability (MSI-H), DNA mismatch repair deficiency (dMMR), or high tumor mutational burden (TMB-H) https://www.cancerresearch.org/cancer-types/ovarian-cancer",Medical,Find & Summarize,Text Transformation "Use only the information provided below to formulate your answer, and format the answer using bullet points where appropriate. ",Compare the financial facts and figures of families with children to families without children.,"Many families are in financial distress, and families with children are especially vulnerable. Thirty-eight percent of families with children under age 18 living at home are struggling to get by, compared with 33 percent of families without children at home (figure 1). Financial distress can arise from a range of factors, from a specific hardship— 28 percent of families with children experienced a financial hardship in the past year, compared with 23 percent of families without children—to a simple lack of sufficient income. Twenty-four percent of families with children spent more than their income last year, compared with 19 percent of families without children. Raising children is expensive, and the costs have been rising over time. According to the USDA, the typical two-parent family can expect to spend between $13,000 and $15,000 per child per year for children born in 2013, meaning that the average cost of raising a child is expected to be $245,000 over 18 years (Lino 2014). A family with two children can expect to spend almost half its income on its children each year. Not only are children expensive, but families with children tend to have lower incomes than families without children. In 2014, the median income for families with children was about $62,000, compared with about $68,000 for families without children (figure 2). While men’s earnings increase after fatherhood, women with children have lower average earnings than women without children. These differences hold true even when looking only at working people and when controlling for years of experience and other attributes (Budig 2014; Pal and Waldfogel 2014). As single-mother families become more common, the “fatherhood bump” no longer offsets the “motherhood penalty” for many families. Public benefits are not enough to offset the increased cost of having children. Available federal programs such as Medicaid, SNAP (the Supplemental Nutrition Assistance Program), and TANF, as well as tax incentives such as the EITC (the earned income tax credit) lift millions of families with children out of poverty (Sherman, Trisi, and Parrott 2013), but they are often not enough to lift families out of financial distress. Many of the programs that focus on families with children are shrinking, despite the increased costs of having children. Total federal spending on children, currently 10 percent of the federal budget, is projected to decline to less than 8 percent in 2025, while adult Social Security, Medicare, and Medicaid spending is projected to increase to 49 percent (Isaacs et al. 2015). Some of the differences between families with and without children at home may be attributable to older families whose children are no longer at home or younger families who do not have children yet, rather than adults of childrearing age without children. If we look only at families where the survey respondent is under age 65, we see that families with and without children are equally likely to be struggling to get by and to experience a hardship, but families with children are still more likely to spend more than their incomes. This suggests that older families are doing better than younger families. Because many of these adults are retired and not earning income, households headed by adults 65 years and older have a lower median income than the general population: $40,000 versus $54,000 in 2014 (US Census Bureau 2014). However, these households also have higher wealth. The mean net worth of families headed by someone ages 65–74 was over $1 million in 2013, compared with just $75,500 for families with heads under age 35 (Bricker et al. 2014). Families with children are more likely to think that they are doing better than they were five years ago than families without children (47 and 38 percent, respectively; figure 3). Yet while 47 percent of families with children think they are doing better than they were in 2009, only 31 percent think they are doing better than they were in 2013 (not shown). This is consistent with recovery from the recession occurring after 2009 but before 2013. After adjusting for inflation, median incomes for families with children decreased 1.9 percent between 2009 and 2014 while incomes for families without children increased by 2.6 percent over the same period. Even though families with children appear less financially healthy than years past, they are more likely to feel their situations have improved. This feeling may reflect improved economic security as children age and child care costs decline.","Use only the information provided below to formulate your answer, and format the answer using bullet points where appropriate. Compare the financial facts and figures of families with children to families without children. Many families are in financial distress, and families with children are especially vulnerable. Thirty-eight percent of families with children under age 18 living at home are struggling to get by, compared with 33 percent of families without children at home (figure 1). Financial distress can arise from a range of factors, from a specific hardship— 28 percent of families with children experienced a financial hardship in the past year, compared with 23 percent of families without children—to a simple lack of sufficient income. Twenty-four percent of families with children spent more than their income last year, compared with 19 percent of families without children. Raising children is expensive, and the costs have been rising over time. According to the USDA, the typical two-parent family can expect to spend between $13,000 and $15,000 per child per year for children born in 2013, meaning that the average cost of raising a child is expected to be $245,000 over 18 years (Lino 2014). A family with two children can expect to spend almost half its income on its children each year. Not only are children expensive, but families with children tend to have lower incomes than families without children. In 2014, the median income for families with children was about $62,000, compared with about $68,000 for families without children (figure 2). While men’s earnings increase after fatherhood, women with children have lower average earnings than women without children. These differences hold true even when looking only at working people and when controlling for years of experience and other attributes (Budig 2014; Pal and Waldfogel 2014). As single-mother families become more common, the “fatherhood bump” no longer offsets the “motherhood penalty” for many families. Public benefits are not enough to offset the increased cost of having children. Available federal programs such as Medicaid, SNAP (the Supplemental Nutrition Assistance Program), and TANF, as well as tax incentives such as the EITC (the earned income tax credit) lift millions of families with children out of poverty (Sherman, Trisi, and Parrott 2013), but they are often not enough to lift families out of financial distress. Many of the programs that focus on families with children are shrinking, despite the increased costs of having children. Total federal spending on children, currently 10 percent of the federal budget, is projected to decline to less than 8 percent in 2025, while adult Social Security, Medicare, and Medicaid spending is projected to increase to 49 percent (Isaacs et al. 2015). Some of the differences between families with and without children at home may be attributable to older families whose children are no longer at home or younger families who do not have children yet, rather than adults of childrearing age without children. If we look only at families where the survey respondent is under age 65, we see that families with and without children are equally likely to be struggling to get by and to experience a hardship, but families with children are still more likely to spend more than their incomes. This suggests that older families are doing better than younger families. Because many of these adults are retired and not earning income, households headed by adults 65 years and older have a lower median income than the general population: $40,000 versus $54,000 in 2014 (US Census Bureau 2014). However, these households also have higher wealth. The mean net worth of families headed by someone ages 65–74 was over $1 million in 2013, compared with just $75,500 for families with heads under age 35 (Bricker et al. 2014). Families with children are more likely to think that they are doing better than they were five years ago than families without children (47 and 38 percent, respectively; figure 3). Yet while 47 percent of families with children think they are doing better than they were in 2009, only 31 percent think they are doing better than they were in 2013 (not shown). This is consistent with recovery from the recession occurring after 2009 but before 2013. After adjusting for inflation, median incomes for families with children decreased 1.9 percent between 2009 and 2014 while incomes for families without children increased by 2.6 percent over the same period. Even though families with children appear less financially healthy than years past, they are more likely to feel their situations have improved. This feeling may reflect improved economic security as children age and child care costs decline.",Financial,Concept Comparison,Q&A You will only respond using the given context and include no information not readily available in the text. ,What were the immediate and long-term impacts of Right-to-Work laws on employment and wages?,"Federal Policies and American Labor Relations The National Labor Relations Act/Wagner Act (NLRA) of 1935 was passed by Congress to protect workers’ rights to unionization. NLRA states and defines the rights of employees to organize and bargain collectively with their employers through representatives of their own choosing (i.e., elected union leaders). The NLRA identified workers’ rights to form a union, join a union, and to strike in an effort to secure better working conditions (National Labor Relations Board, 1997). “The act also created a new National Labor Relations Board (NLRB) to arbitrate deadlocked labor- management disputes, guarantee democratic union elections and penalize unfair labor practices by employers” (Cooper, 2004, p. 2). Furthermore, NLRA prohibited employers from setting up a company union and firing or otherwise discriminating against workers who organized or joined unions (Encyclopedia Britannica, 2007). Prior to the passage of NLRA, the federal government had been largely antagonistic to union organizing. Labor unions across the country faced significant challenges in social action initiatives aimed at ensuring adequate wages, benefits and the reduction of industry health hazards. During the first half of the twentieth century, for example, laborers who attempted to organize protective associations frequently found themselves prosecuted for and convicted of conspiracy (to do what?) (Beik, 2005). With the onset of the Great Depression, and an unemployment rate of 24.9 percent in 1933 , the national political framework shifted its focus from the protection of the business sector to the protection of workers and individuals through the creation of New Deal policies (e.g., Social Security and Civilian Conservation Corps). These policies hoped to create a social safety net that would prevent further economic disaster. Due to the power of business interests and persons advocating a free market society, many New Deal policies had been declared unconstitutional by the United States Supreme Court, including the previous labor legislation – the National Industry Recovery Act of 1933 which authorized the President to regulate businesses in the interests of promoting fair competition, supporting prices and competition, creating jobs for the unemployed, and stimulating the United States economy to recover from the Great Depression (Babson, 1999). Thus, many businesses believed that the NLRA would follow the same path. In April of 1937, however, the NLRA was declared constitutional by the Supreme Court, highlighting the increased power of labor unions on national politics and policymaking (Beik, 2005). In 1935, 15 percent of American workers were unionized. By 1945, the proportion had risen to 35 percent (Babson, 1999). During this time there were three primary types of union/employer structural arrangements: the agency shop, the union shop, and the closed shop. Cooper (2004) describes the arrangements as follows: • Agency Shop: The union’s contract does not mandate that all employees join the union, but it does mandate that the employees pay agency fees. • Union Shop: The union’s contract requires that all employees join the union within a specified amount of time after becoming employed. • Closed Shop: The union’s contract mandates that the employer only hire union members (pg. 2). 1945 marked the peak of American unionization with over one-third of American workers belonging to labor unions. Organized labor reached the zenith of its power in the U.S. from 1935 – 1947 (Beik, 2005). Many business leaders, however, began to lobby for a loosening of union power insisting that businesses and individuals were, due to the NLRA, prevented from exercising their right of association and employment procedures. At the same time, the political landscape was changing and anti-communism was used as a key argument to stymie the power of unions. Labor unions were seen as a corrupt socialist tactic and, thus, could be associated with the red scare. The public also began to demand action after the World War Two coal strikes and the postwar strikes in steel, autos and other industries were perceived to have damaged the economy. With the increasing constituent pressure and the election in 1944 of the pro-business and pro-states’ rights Republican congress, the second significant piece of national labor legislation was passed, the 1947 Taft-Hartley Act. Taft-Hartley effectively overturned many of the rights guaranteed by NLRA and outlawed the closed shop arrangement (Cooper, 2004). Moreover, “section 14(b) of Taft-Hartley made Right-to-Work laws legal and gave states the power to pass laws to outlaw both agency and union shops” (Cooper, 2004, p. 10). This provision afforded states the opportunity to pass laws that forbade the establishment of businesses and/or union contracts where union membership was a condition of employment; thus, the age of RTW began. Right-to-Work Laws Immediately following the passage of the Taft-Hartley Act states began to enact Right-to- Work laws. The basic concept of RTW is that workers should not be obligated to join or give support to a union as a condition of employment (Kersey, 2007).2 The main objectives of RTW laws have, to this day, shared similar purposes. These objectives include: a. the promotion of individual freedom; b. the creation of a pro-business atmosphere aimed at spurring economic growth; c. the elimination of the power of union organization. As of January 1, 2006, 22 states had passed RTW legislation. It is important to note that a regional divide exists with regard to the establishment of RTW laws... most of the states with RTW laws are located in the southeast, Midwest and Rocky Mountain States. These states have traditionally maintained lower rates of unionization -- 18% in 1947, 52% lower than their non-RTW counterparts (Beik, 1998). Right-to-Work Laws and Employment One of the key arguments offered by proponents of RTW legislation is that the laws increase employment. Proponents believe that, if businesses are not required to operate under union wage contracts, they will remain profitable due to decreased labor costs and the economic landscape will encourage cross-state relocation of businesses; thus, employment opportunities will increase for all citizens. “Opponents, however, argue that most job growth occurs from in-state business expansion not the relocation of businesses from a non-RTW to a RTW state” (Oklahoma League of Economists, 1996, paragraph 2). The unemployment rates in RTW states pre and post RTW passage, as well as the comparison of RTW to non-RTW states, provide important insights in to the impact of RTW legislation on employment across jurisdictions. Overall, the unemployment rates in RTW states are lower than non-RTW states. For example, the unemployment rate between 1978 and 2000 averaged 5.8percent in RTW states versus 6.3percent in non-RTW states. Additionally, between 1970 and 2000 overall employment increased by 2.9percent annually in RTW states versus 2.0percent in non-RTW states. This trend has continued, although tightening, into the 2000s; between 2001 and 2006 RTW states had a median 4.8percent unemployment rate compared to 5.1 percent for non-RTW states (Kersey, 2007). As of March 2010, RTW states had an average unemployment rate of 8.6% while the rate in non-RTW states stood at 9.4% (Bureau of Labor Statistics [BLS], 2010). Another aspect of the impact that RTW laws have on employment relates to the type and condition of employment between the two types of states. The share of manufacturing employment in the U.S. in 1950 was 35percent of the workforce. This figure declined to 13 percent in 2004 (Fischer & Rupert, 2005). Many RTW advocates believe pro-business laws, such as RTW, lessen manufacturing losses by creating a conducive business atmosphere. While both types of states have not been able to stem the national tide, data indicates that manufacturing employment in RTW states has decreased at a much lower rate than in their non-RTW counterparts where manufacturing employment has seen significant decreases. Between 2001 and 2006 the typical RTW state saw manufacturing employment decline 1.5percent annually, equaling 7.1percent overall. Non-RTW states, however, faced even sharper declines, averaging 3.0 percent annually and 13.7 percent over the five year period. Every non-RTW state but one, Alaska, lost manufacturing jobs during that period, while five RTW states registered at least modest gains in this area (Wright, 2007). In terms of job conditions, the government data shows that in 2003 the rate of workplace fatalities per 100,000 workers was highest in right-to-work states. The rate of workplace deaths is 51 percent higher in RTW states (BLS, 2006). Nineteen of the top 25 states for worker fatality rates were RTW states, while three of the bottom 25 states were RTW states (Bureau of Labor Statistics [BLS], 2003). Further, in a study of New York City construction site fatalities, it was found that 93 percent of deaths happened at non-union sites (Walter, 2007). The same holds true in the coal mining industry where 87 percent of fatalities between 2007 and 2009 occurred at non-union mines (U.S. House of Representatives Committee on Education and Labor, 2007). Right-to-Work and Job Growth Holmes (1998) argues that large manufacturing establishments are more likely to be attracted to RTW states because larger plants are more likely to be unionized. RTW laws, according to manufacturers, help maintain competiveness and encourage development in the strained sector. He also found that eight of the ten states with the highest manufacturing employment growth rates are RTW states. All ten states with the lowest growth rates are non-RTW states. Opponents charge that the laws depress individual worker wages at the expense of profits and capitalist objectives. From 1977 through 1999, Gross State Product (GSP), the market value of all goods and services produced in a state, increased 0.5 percent faster in RTW states than in non-RTW states (Wilson, 2002). Right-to-Work Laws and Wages One condition of employment is the impact of RTW laws on wages. This includes both absolute wages and the overall wage distribution across income and racial lines following RTW passage. There are currently 132,604,980 workers in the United States (U.S.). The American worker, as of July 2009, earned an average of $44,901 per year. This translates in to an average hourly wage of $22.36 (Bureau of Labor Statistics [BLS], 2009). Leading researchers disagree on the impact of RTW laws on wages. For example, 16 of the 18 states are estimated to have had higher average wages in 2000 as a result of their RTW status (Reed, 2003). On the other hand, Bureau of Labor Statistics (BLS) data reveals that average annual pay is higher in non-RTW states. In addition, income polarization is higher in RTW states, with a higher percentage of workers earning the minimum wage (even when controlling for education level) than in non-RTW states. After years of economic development, the portion of heads of household earning around the minimum wage is still 35.5 percent (4.4 percentage points) higher in RTW than in high-union-density states"" (Cassell, 2001). Lawrence Mishel (2001) of the Economic Policy Institute found that in 2000 the median wage for workers living in RTW states was $11.45, while wages for those living in non -RTW states were $13.00, indicating that wages were 11.9 percent lower in RTW states. He further concluded that previous research citing wage increases in RTW states were directly attributable to the improved income characteristics of those residing in large cities located on a state border with a non-RTW state. At the same time, when looking at weekly and hourly wages by industry between RTW and non-RTW states adjusted for cost-of-living, RTW states have higher wages in two key industries. For example, in manufacturing workers in RTW states earn an average of $717 weekly and $17.89 hourly while their non-RTW counterparts earn $672 and $16.80. In education and health services, those amounts are $717 and $21.34 for RTW and $650 and $20.06 for non-RTW. These differing statistics question the true RTW impact on wage increases and the quality of employment.","You will only respond using the given context and include no information not readily available in the text. What were the immediate and long-term impacts of Right-to-Work laws on employment and wages? Federal Policies and American Labor Relations The National Labor Relations Act/Wagner Act (NLRA) of 1935 was passed by Congress to protect workers’ rights to unionization. NLRA states and defines the rights of employees to organize and bargain collectively with their employers through representatives of their own choosing (i.e., elected union leaders). The NLRA identified workers’ rights to form a union, join a union, and to strike in an effort to secure better working conditions (National Labor Relations Board, 1997). “The act also created a new National Labor Relations Board (NLRB) to arbitrate deadlocked labor- management disputes, guarantee democratic union elections and penalize unfair labor practices by employers” (Cooper, 2004, p. 2). Furthermore, NLRA prohibited employers from setting up a company union and firing or otherwise discriminating against workers who organized or joined unions (Encyclopedia Britannica, 2007). Prior to the passage of NLRA, the federal government had been largely antagonistic to union organizing. Labor unions across the country faced significant challenges in social action initiatives aimed at ensuring adequate wages, benefits and the reduction of industry health hazards. During the first half of the twentieth century, for example, laborers who attempted to organize protective associations frequently found themselves prosecuted for and convicted of conspiracy (to do what?) (Beik, 2005). With the onset of the Great Depression, and an unemployment rate of 24.9 percent in 1933 , the national political framework shifted its focus from the protection of the business sector to the protection of workers and individuals through the creation of New Deal policies (e.g., Social Security and Civilian Conservation Corps). These policies hoped to create a social safety net that would prevent further economic disaster. Due to the power of business interests and persons advocating a free market society, many New Deal policies had been declared unconstitutional by the United States Supreme Court, including the previous labor legislation – the National Industry Recovery Act of 1933 which authorized the President to regulate businesses in the interests of promoting fair competition, supporting prices and competition, creating jobs for the unemployed, and stimulating the United States economy to recover from the Great Depression (Babson, 1999). Thus, many businesses believed that the NLRA would follow the same path. In April of 1937, however, the NLRA was declared constitutional by the Supreme Court, highlighting the increased power of labor unions on national politics and policymaking (Beik, 2005). In 1935, 15 percent of American workers were unionized. By 1945, the proportion had risen to 35 percent (Babson, 1999). During this time there were three primary types of union/employer structural arrangements: the agency shop, the union shop, and the closed shop. Cooper (2004) describes the arrangements as follows: • Agency Shop: The union’s contract does not mandate that all employees join the union, but it does mandate that the employees pay agency fees. • Union Shop: The union’s contract requires that all employees join the union within a specified amount of time after becoming employed. • Closed Shop: The union’s contract mandates that the employer only hire union members (pg. 2). 1945 marked the peak of American unionization with over one-third of American workers belonging to labor unions. Organized labor reached the zenith of its power in the U.S. from 1935 – 1947 (Beik, 2005). Many business leaders, however, began to lobby for a loosening of union power insisting that businesses and individuals were, due to the NLRA, prevented from exercising their right of association and employment procedures. At the same time, the political landscape was changing and anti-communism was used as a key argument to stymie the power of unions. Labor unions were seen as a corrupt socialist tactic and, thus, could be associated with the red scare. The public also began to demand action after the World War Two coal strikes and the postwar strikes in steel, autos and other industries were perceived to have damaged the economy. With the increasing constituent pressure and the election in 1944 of the pro-business and pro-states’ rights Republican congress, the second significant piece of national labor legislation was passed, the 1947 Taft-Hartley Act. Taft-Hartley effectively overturned many of the rights guaranteed by NLRA and outlawed the closed shop arrangement (Cooper, 2004). Moreover, “section 14(b) of Taft-Hartley made Right-to-Work laws legal and gave states the power to pass laws to outlaw both agency and union shops” (Cooper, 2004, p. 10). This provision afforded states the opportunity to pass laws that forbade the establishment of businesses and/or union contracts where union membership was a condition of employment; thus, the age of RTW began. Right-to-Work Laws Immediately following the passage of the Taft-Hartley Act states began to enact Right-to- Work laws. The basic concept of RTW is that workers should not be obligated to join or give support to a union as a condition of employment (Kersey, 2007).2 The main objectives of RTW laws have, to this day, shared similar purposes. These objectives include: a. the promotion of individual freedom; b. the creation of a pro-business atmosphere aimed at spurring economic growth; c. the elimination of the power of union organization. As of January 1, 2006, 22 states had passed RTW legislation. It is important to note that a regional divide exists with regard to the establishment of RTW laws... most of the states with RTW laws are located in the southeast, Midwest and Rocky Mountain States. These states have traditionally maintained lower rates of unionization -- 18% in 1947, 52% lower than their non-RTW counterparts (Beik, 1998). Right-to-Work Laws and Employment One of the key arguments offered by proponents of RTW legislation is that the laws increase employment. Proponents believe that, if businesses are not required to operate under union wage contracts, they will remain profitable due to decreased labor costs and the economic landscape will encourage cross-state relocation of businesses; thus, employment opportunities will increase for all citizens. “Opponents, however, argue that most job growth occurs from in-state business expansion not the relocation of businesses from a non-RTW to a RTW state” (Oklahoma League of Economists, 1996, paragraph 2). The unemployment rates in RTW states pre and post RTW passage, as well as the comparison of RTW to non-RTW states, provide important insights in to the impact of RTW legislation on employment across jurisdictions. Overall, the unemployment rates in RTW states are lower than non-RTW states. For example, the unemployment rate between 1978 and 2000 averaged 5.8percent in RTW states versus 6.3percent in non-RTW states. Additionally, between 1970 and 2000 overall employment increased by 2.9percent annually in RTW states versus 2.0percent in non-RTW states. This trend has continued, although tightening, into the 2000s; between 2001 and 2006 RTW states had a median 4.8percent unemployment rate compared to 5.1 percent for non-RTW states (Kersey, 2007). As of March 2010, RTW states had an average unemployment rate of 8.6% while the rate in non-RTW states stood at 9.4% (Bureau of Labor Statistics [BLS], 2010). Another aspect of the impact that RTW laws have on employment relates to the type and condition of employment between the two types of states. The share of manufacturing employment in the U.S. in 1950 was 35percent of the workforce. This figure declined to 13 percent in 2004 (Fischer & Rupert, 2005). Many RTW advocates believe pro-business laws, such as RTW, lessen manufacturing losses by creating a conducive business atmosphere. While both types of states have not been able to stem the national tide, data indicates that manufacturing employment in RTW states has decreased at a much lower rate than in their non-RTW counterparts where manufacturing employment has seen significant decreases. Between 2001 and 2006 the typical RTW state saw manufacturing employment decline 1.5percent annually, equaling 7.1percent overall. Non-RTW states, however, faced even sharper declines, averaging 3.0 percent annually and 13.7 percent over the five year period. Every non-RTW state but one, Alaska, lost manufacturing jobs during that period, while five RTW states registered at least modest gains in this area (Wright, 2007). In terms of job conditions, the government data shows that in 2003 the rate of workplace fatalities per 100,000 workers was highest in right-to-work states. The rate of workplace deaths is 51 percent higher in RTW states (BLS, 2006). Nineteen of the top 25 states for worker fatality rates were RTW states, while three of the bottom 25 states were RTW states (Bureau of Labor Statistics [BLS], 2003). Further, in a study of New York City construction site fatalities, it was found that 93 percent of deaths happened at non-union sites (Walter, 2007). The same holds true in the coal mining industry where 87 percent of fatalities between 2007 and 2009 occurred at non-union mines (U.S. House of Representatives Committee on Education and Labor, 2007). Right-to-Work and Job Growth Holmes (1998) argues that large manufacturing establishments are more likely to be attracted to RTW states because larger plants are more likely to be unionized. RTW laws, according to manufacturers, help maintain competiveness and encourage development in the strained sector. He also found that eight of the ten states with the highest manufacturing employment growth rates are RTW states. All ten states with the lowest growth rates are non-RTW states. Opponents charge that the laws depress individual worker wages at the expense of profits and capitalist objectives. From 1977 through 1999, Gross State Product (GSP), the market value of all goods and services produced in a state, increased 0.5 percent faster in RTW states than in non-RTW states (Wilson, 2002). Right-to-Work Laws and Wages One condition of employment is the impact of RTW laws on wages. This includes both absolute wages and the overall wage distribution across income and racial lines following RTW passage. There are currently 132,604,980 workers in the United States (U.S.). The American worker, as of July 2009, earned an average of $44,901 per year. This translates in to an average hourly wage of $22.36 (Bureau of Labor Statistics [BLS], 2009). Leading researchers disagree on the impact of RTW laws on wages. For example, 16 of the 18 states are estimated to have had higher average wages in 2000 as a result of their RTW status (Reed, 2003). On the other hand, Bureau of Labor Statistics (BLS) data reveals that average annual pay is higher in non-RTW states. In addition, income polarization is higher in RTW states, with a higher percentage of workers earning the minimum wage (even when controlling for education level) than in non-RTW states. After years of economic development, the portion of heads of household earning around the minimum wage is still 35.5 percent (4.4 percentage points) higher in RTW than in high-union-density states"" (Cassell, 2001). Lawrence Mishel (2001) of the Economic Policy Institute found that in 2000 the median wage for workers living in RTW states was $11.45, while wages for those living in non -RTW states were $13.00, indicating that wages were 11.9 percent lower in RTW states. He further concluded that previous research citing wage increases in RTW states were directly attributable to the improved income characteristics of those residing in large cities located on a state border with a non-RTW state. At the same time, when looking at weekly and hourly wages by industry between RTW and non-RTW states adjusted for cost-of-living, RTW states have higher wages in two key industries. For example, in manufacturing workers in RTW states earn an average of $717 weekly and $17.89 hourly while their non-RTW counterparts earn $672 and $16.80. In education and health services, those amounts are $717 and $21.34 for RTW and $650 and $20.06 for non-RTW. These differing statistics question the true RTW impact on wage increases and the quality of employment.",Legal,Find & Summarize,Text Transformation Respond only using information contained within the prompt. Do not use any external information or knowledge when answering. Answer as a non-expert only. Give your answer simply with easy to understand language.,What are the potential harmful side effects of semaglutide?,"According to the EPAR for semaglutide, eight completed phase 3 trials and a cardiovascular outcomes trial provided safety data relating to approximately 4,800 patients and over 5,600 patient years of exposure. [12] Additional safety data is also available from the SUSTAIN 7 which assessed semaglutide and dulaglutide. [9] Adverse events The EPAR states that “The safety profile of semaglutide is generally consistent with those reported for other drugs in the GLP-1 RA class”. The EMA noted that the rates of gastrointestinal adverse events were higher for semaglutide compared to exenatide, sitagliptin and insulin glargine. [12] However the open label SUSTAIN 7 study found that the frequency of gastrointestinal adverse effects were similar between semaglutide and dulaglutide groups. [9] A significantly increased risk of diabetic retinopathy complications was observed with semaglutide as compared with placebo. This increased risk was particularly marked in patients with preexisting diabetic retinopathy at baseline and co-use of insulin. Although it is recognised that intensified glycaemic control may precipitate early worsening of diabetic retinopathy, clinical trials data did not demonstrate a decrease in the risk of diabetic retinopathy over the course of two years, and data also suggests that semaglutide was associated with retinopathy in patients with only small HbA1c reductions. [12] A specific warning has been included in the SPC for semaglutide outlining the increased risk of diabetic retinopathy complications in patients with existing diabetic retinopathy treated with insulin. [15] The SPC for semaglutide lists the following adverse events [13]: Table 2. Adverse reactions from long-term controlled phase 3a trials including the cardiovascular 7 Date: December 2018 outcomes trial. MedDRA system organ class Very common Common Uncommon Rare Immune system disorders Anaphylactic reaction Metabolism and nutrition disorders Hypoglycaemia when used with insulin or sulfonylurea Hypoglycaemia when used with other OADs Decreased appetite Nervous system disorders Dizziness Dysgeusia Eye disorders Diabetic retinopathy complications Cardiac disorders Increased heart rate Gastrointestinal disorders Nausea Diarrhoea Vomiting Abdominal pain Abdominal distension Constipation Dyspepsia Gastritis Gastrooesophageal reflux disease Eructation Flatulence Hepatobiliary disorders Cholelithiasis General disorders and administration site conditions Fatigue Injection site reactions Investigations Increased lipase Increased amylase Weight decreased","What are the potential harmful side effects of semaglutide? Respond only using information contained within the prompt. Do not use any external information or knowledge when answering. Answer as a non-expert only. Give your answer simply with easy to understand language. The text: According to the EPAR for semaglutide, eight completed phase 3 trials and a cardiovascular outcomes trial provided safety data relating to approximately 4,800 patients and over 5,600 patient years of exposure. [12] Additional safety data is also available from the SUSTAIN 7 which assessed semaglutide and dulaglutide. [9] Adverse events The EPAR states that “The safety profile of semaglutide is generally consistent with those reported for other drugs in the GLP-1 RA class”. The EMA noted that the rates of gastrointestinal adverse events were higher for semaglutide compared to exenatide, sitagliptin and insulin glargine. [12] However the open label SUSTAIN 7 study found that the frequency of gastrointestinal adverse effects were similar between semaglutide and dulaglutide groups. [9] A significantly increased risk of diabetic retinopathy complications was observed with semaglutide as compared with placebo. This increased risk was particularly marked in patients with preexisting diabetic retinopathy at baseline and co-use of insulin. Although it is recognised that intensified glycaemic control may precipitate early worsening of diabetic retinopathy, clinical trials data did not demonstrate a decrease in the risk of diabetic retinopathy over the course of two years, and data also suggests that semaglutide was associated with retinopathy in patients with only small HbA1c reductions. [12] A specific warning has been included in the SPC for semaglutide outlining the increased risk of diabetic retinopathy complications in patients with existing diabetic retinopathy treated with insulin. [15] The SPC for semaglutide lists the following adverse events [13]: Table 2. Adverse reactions from long-term controlled phase 3a trials including the cardiovascular 7 Date: December 2018 outcomes trial. MedDRA system organ class Very common Common Uncommon Rare Immune system disorders Anaphylactic reaction Metabolism and nutrition disorders Hypoglycaemia when used with insulin or sulfonylurea Hypoglycaemia when used with other OADs Decreased appetite Nervous system disorders Dizziness Dysgeusia Eye disorders Diabetic retinopathy complications Cardiac disorders Increased heart rate Gastrointestinal disorders Nausea Diarrhoea Vomiting Abdominal pain Abdominal distension Constipation Dyspepsia Gastritis Gastrooesophageal reflux disease Eructation Flatulence Hepatobiliary disorders Cholelithiasis General disorders and administration site conditions Fatigue Injection site reactions Investigations Increased lipase Increased amylase Weight decreased",Medical,Pros & Cons,Q&A "Only use information contained in the prompt to answer your questions. Use bulleted formatting when listing more than 2 items. If listing cases, use italic formatting for the case names. If there's not enough information available to answer a question then state so but answer the parts that you can, if any.","What conclusions were reached by the courts in the cases mentioned in the excerpt below regarding AI, including generative AI?","State v. Loomis, 371 Wis.2d 235, 881 N.W.2d 749 (2016), cert. denied, 137 S. Ct. 2290 (2017) The defendant was convicted of various offenses arising out of a drive-by shooting. His presentence report included an evidence-based risk assessment that indicated a high risk of recidivism. On appeal, the defendant argued that consideration of the risk assessment by the sentencing judge violated his right to due process. The Supreme Court rejected the argument. However, it imposed conditions on the use of risk assessments. State v. Morrill, No. A-1-CA-36490, 2019 WL 3765586 (N.M. App. July 24, 2019) Defendant asks this Court to ‘find that the attestations made by a computer program constitute ‘statements,’ whether attributable to an artificial intelligence software or the software developer who implicitly offers the program’s conclusions as their own.’ (Emphasis omitted.) Based on that contention, Defendant further argues that the automated conclusions from Roundup and Forensic Toolkit constitute inadmissible hearsay statements that are not admissible under the business record exception. In so arguing, Defendant acknowledges that such a holding would diverge from the plain language of our hearsay rule’s relevant definitions that reference statements of a ‘person.’ *** Based on the following, we conclude the district court correctly determined that the computer generated evidence produced by Roundup and Forensic Toolkit was 11 not hearsay. Agent Peña testified that his computer runs Roundup twenty-four hours a day, seven days a week and automatically attempts to make connections with and downloads from IP addresses that are suspected to be sharing child pornography. As it does so, Roundup logs every action it takes. Detective Hartsock testified that Forensic Toolkit organizes information stored on seized electronic devices into various categories including graphics, videos, word documents, and internet history. Because the software programs make the relevant assertions, without any intervention or modification by a person using the software, we conclude that the assertions are not statements by a person governed by our hearsay rules. State v. Pickett, 466 N.J. Super. 270 (App. Div. 2021), motions to expand record, for leave to appeal, and for stay denied, State v. Pickett, 246 N.J. 48 (2021) In this case of first impression addressing the proliferation of forensic evidentiary technology in criminal prosecutions, we must determine whether defendant is entitled to trade secrets of a private company for the sole purpose of challenging at a Frye hearing the reliability of the science underlying novel DNA analysis software and expert testimony. At the hearing, the State produced an expert who relied on his company’s complex probabilistic genotyping software program to testify that defendant’s DNA was present, thereby connecting defendant to a murder and other crimes. Before crossexamination of the expert, the judge denied defendant access to the trade secrets, which include the software’s source code and related documentation. This is the first appeal in New Jersey addressing the science underlying the proffered testimony by the State’s expert, who designed, utilized, and relied upon TrueAllele, the program at issue. TrueAllele is technology not yet used or tested in New Jersey; it is designed to address intricate interpretational challenges of testing low levels or complex mixtures of DNA. TrueAllele’s computer software utilizes and implements an elaborate mathematical model to estimate the statistical probability that a particular individual’s DNA is consistent with data from a given sample, as compared with genetic material from another, unrelated individual from the broader relevant population. For this reason, TrueAllele, and other probabilistic genotyping software, marks a profound shift in DNA forensics. TrueAllele’s software integrates multiple scientific disciplines. At issue here—in determining the reliability of TrueAllele—is whether defendant is entitled to the trade secrets to cross-examine the State’s expert at the Frye hearing to challenge whether his testimony has gained general acceptance within the computer science community, which is one of the disciplines. The defense expert’s access to the proprietary information is directly relevant to that question and would allow that expert to independently test whether the evidentiary software operates as intended. Without that opportunity, 12 defendant is relegated to blindly accepting the company’s assertions as to its reliability. And importantly, the judge would be unable to reach an informed reliability determination at the Frye hearing as part of his gatekeeping function. Hiding the source code is not the answer. The solution is producing it under a protective order. Doing so safeguards the company’s intellectual property rights and defendant’s constitutional liberty interest alike. Intellectual property law aims to prevent business competitorsfrom stealing confidential commercial information in the marketplace; it was never meant to justify concealing relevant information from parties to a criminal prosecution in the context of a Frye hearing. [footnote omitted]. State v. Saylor, 2019 Ohio 1025 (Ct. App. 2019) (concurring opinion of Froelich, J.) {¶ 49} Saylor is a 27-year-old heroin addict, who the court commented has ‘no adult record [* * * and] has led a law-abiding life for a significant number of years’; his juvenile record, according to the prosecutor, was ‘virtually nothing.’ The prosecutor requested an aggregate sentence of five to seven years, and defense counsel requested a three-year sentence. The trial court sentenced Saylor to 12 1/2 years in prison. Although it found Saylor to be indigent and did not impose the mandatory fine, the court imposed a $500 fine and assessed attorney fees and costs; the court also specifically disapproved a Risk Reduction sentence or placement in the Intensive Program Prison (IPP). {¶ 50} I have previously voiced my concerns about the almost unfettered discretion available to a sentencing court when the current case law apparently does not permit a review for abuse of discretion. State v. Roberts, 2d Dist. Clark No. 2017-CA-98, 2018-Ohio4885, ¶ 42-45, (Froelich, J., dissenting). However, in this case, the trial court considered the statutory factors in R.C. 2929.11 and R.C. 2929.12, the individual sentences were within the statutory ranges, and the court’s consecutive sentencing findings, including the course-of-conduct finding under R.C. 2929.14(C)(4)(b), were supported by the record. {¶ 51} As for the trial court’s consideration of ORAS, the ‘algorithmization’ of sentencing is perhaps a good-faith attempt to remove unbridled discretion – and its inherent biases – from sentencing. Compare State v. Lawson, 2018-Ohio-1532, 111 N.E.3d 98, ¶ 20-21 (2d Dist.) (Froelich, J., concurring). However, ‘recidivism risk modeling still involves human choices about what characteristics and factors should be assessed, what hierarchy governs their application, and what relative weight should be ascribed to each.’ Hillman, The Use of Artificial Intelligence in Gauging the Risk of Recidivism, 58 The Judges Journal 40 (2019). {¶ 52} The court’s statement that the ‘moderate’ score was ‘awfully high,’ given the lack of criminal history, could imply that the court believed there must be other factors reflected in the score that increased Saylor’s probable recidivism. There is nothing on this record to refute or confirm the relevance of Saylor’s ORAS score or any ORAS score. 13 Certainly, the law of averages is not the law. The trial court’s comment further suggested that its own assessment of Saylor’s risk of recidivism differed from the ORAS score. The decision of the trial court is not clearly and convincingly unsupported by the record, regardless of any weight potentially given to the ORAS score by the trial court. Therefore, on this record, I find no basis for reversal","Only use information contained in the prompt to answer your questions. Use bulleted formatting when listing more than 2 items. If listing cases, use italic formatting for the case names. If there's not enough information available to answer a question then state so but answer the parts that you can, if any. What conclusions were reached by the courts in the cases mentioned in the excerpt below regarding AI, including generative AI? State v. Loomis, 371 Wis.2d 235, 881 N.W.2d 749 (2016), cert. denied, 137 S. Ct. 2290 (2017) The defendant was convicted of various offenses arising out of a drive-by shooting. His presentence report included an evidence-based risk assessment that indicated a high risk of recidivism. On appeal, the defendant argued that consideration of the risk assessment by the sentencing judge violated his right to due process. The Supreme Court rejected the argument. However, it imposed conditions on the use of risk assessments. State v. Morrill, No. A-1-CA-36490, 2019 WL 3765586 (N.M. App. July 24, 2019) Defendant asks this Court to ‘find that the attestations made by a computer program constitute ‘statements,’ whether attributable to an artificial intelligence software or the software developer who implicitly offers the program’s conclusions as their own.’ (Emphasis omitted.) Based on that contention, Defendant further argues that the automated conclusions from Roundup and Forensic Toolkit constitute inadmissible hearsay statements that are not admissible under the business record exception. In so arguing, Defendant acknowledges that such a holding would diverge from the plain language of our hearsay rule’s relevant definitions that reference statements of a ‘person.’ *** Based on the following, we conclude the district court correctly determined that the computer generated evidence produced by Roundup and Forensic Toolkit was 11 not hearsay. Agent Peña testified that his computer runs Roundup twenty-four hours a day, seven days a week and automatically attempts to make connections with and downloads from IP addresses that are suspected to be sharing child pornography. As it does so, Roundup logs every action it takes. Detective Hartsock testified that Forensic Toolkit organizes information stored on seized electronic devices into various categories including graphics, videos, word documents, and internet history. Because the software programs make the relevant assertions, without any intervention or modification by a person using the software, we conclude that the assertions are not statements by a person governed by our hearsay rules. State v. Pickett, 466 N.J. Super. 270 (App. Div. 2021), motions to expand record, for leave to appeal, and for stay denied, State v. Pickett, 246 N.J. 48 (2021) In this case of first impression addressing the proliferation of forensic evidentiary technology in criminal prosecutions, we must determine whether defendant is entitled to trade secrets of a private company for the sole purpose of challenging at a Frye hearing the reliability of the science underlying novel DNA analysis software and expert testimony. At the hearing, the State produced an expert who relied on his company’s complex probabilistic genotyping software program to testify that defendant’s DNA was present, thereby connecting defendant to a murder and other crimes. Before crossexamination of the expert, the judge denied defendant access to the trade secrets, which include the software’s source code and related documentation. This is the first appeal in New Jersey addressing the science underlying the proffered testimony by the State’s expert, who designed, utilized, and relied upon TrueAllele, the program at issue. TrueAllele is technology not yet used or tested in New Jersey; it is designed to address intricate interpretational challenges of testing low levels or complex mixtures of DNA. TrueAllele’s computer software utilizes and implements an elaborate mathematical model to estimate the statistical probability that a particular individual’s DNA is consistent with data from a given sample, as compared with genetic material from another, unrelated individual from the broader relevant population. For this reason, TrueAllele, and other probabilistic genotyping software, marks a profound shift in DNA forensics. TrueAllele’s software integrates multiple scientific disciplines. At issue here—in determining the reliability of TrueAllele—is whether defendant is entitled to the trade secrets to cross-examine the State’s expert at the Frye hearing to challenge whether his testimony has gained general acceptance within the computer science community, which is one of the disciplines. The defense expert’s access to the proprietary information is directly relevant to that question and would allow that expert to independently test whether the evidentiary software operates as intended. Without that opportunity, 12 defendant is relegated to blindly accepting the company’s assertions as to its reliability. And importantly, the judge would be unable to reach an informed reliability determination at the Frye hearing as part of his gatekeeping function. Hiding the source code is not the answer. The solution is producing it under a protective order. Doing so safeguards the company’s intellectual property rights and defendant’s constitutional liberty interest alike. Intellectual property law aims to prevent business competitorsfrom stealing confidential commercial information in the marketplace; it was never meant to justify concealing relevant information from parties to a criminal prosecution in the context of a Frye hearing. [footnote omitted]. State v. Saylor, 2019 Ohio 1025 (Ct. App. 2019) (concurring opinion of Froelich, J.) {¶ 49} Saylor is a 27-year-old heroin addict, who the court commented has ‘no adult record [* * * and] has led a law-abiding life for a significant number of years’; his juvenile record, according to the prosecutor, was ‘virtually nothing.’ The prosecutor requested an aggregate sentence of five to seven years, and defense counsel requested a three-year sentence. The trial court sentenced Saylor to 12 1/2 years in prison. Although it found Saylor to be indigent and did not impose the mandatory fine, the court imposed a $500 fine and assessed attorney fees and costs; the court also specifically disapproved a Risk Reduction sentence or placement in the Intensive Program Prison (IPP). {¶ 50} I have previously voiced my concerns about the almost unfettered discretion available to a sentencing court when the current case law apparently does not permit a review for abuse of discretion. State v. Roberts, 2d Dist. Clark No. 2017-CA-98, 2018-Ohio4885, ¶ 42-45, (Froelich, J., dissenting). However, in this case, the trial court considered the statutory factors in R.C. 2929.11 and R.C. 2929.12, the individual sentences were within the statutory ranges, and the court’s consecutive sentencing findings, including the course-of-conduct finding under R.C. 2929.14(C)(4)(b), were supported by the record. {¶ 51} As for the trial court’s consideration of ORAS, the ‘algorithmization’ of sentencing is perhaps a good-faith attempt to remove unbridled discretion – and its inherent biases – from sentencing. Compare State v. Lawson, 2018-Ohio-1532, 111 N.E.3d 98, ¶ 20-21 (2d Dist.) (Froelich, J., concurring). However, ‘recidivism risk modeling still involves human choices about what characteristics and factors should be assessed, what hierarchy governs their application, and what relative weight should be ascribed to each.’ Hillman, The Use of Artificial Intelligence in Gauging the Risk of Recidivism, 58 The Judges Journal 40 (2019). {¶ 52} The court’s statement that the ‘moderate’ score was ‘awfully high,’ given the lack of criminal history, could imply that the court believed there must be other factors reflected in the score that increased Saylor’s probable recidivism. There is nothing on this record to refute or confirm the relevance of Saylor’s ORAS score or any ORAS score. 13 Certainly, the law of averages is not the law. The trial court’s comment further suggested that its own assessment of Saylor’s risk of recidivism differed from the ORAS score. The decision of the trial court is not clearly and convincingly unsupported by the record, regardless of any weight potentially given to the ORAS score by the trial court. Therefore, on this record, I find no basis for reversal ",Legal,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","I'm working on a thesis related to AI in cybersecurity and came across Google's new AI Cyber Defense Initiative. I'm trying to understand how this initiative shifts the ""Defender's Dilemma"" in practical terms. Can AI really anticipate threats, and if so, wouldn't this create a new challenge of false positives or over-reliance on automated systems? Also, could the open-sourcing of Magika actually expose vulnerabilities, given it's now public? How does this balance with Google's push for collaboration and security transparency?","Google LLC today announced a new AI Cyber Defense Initiative and proposed a new policy and technology agenda aimed at harnessing the power of artificial intelligence to bolster cybersecurity defenses globally. The new initiative is designed to counteract evolving threats by leveraging AI’s capabilities to enhance threat detection, automate vulnerability management and improve incident response efficiency. Google argues that the main challenge in cybersecurity is that attackers need only one successful, novel threat to break through the best defenses. On the flip side, defenders need to deploy the best defenses at all times across increasingly complex digital terrain with no margin for error. Google calls this the “Defender’s Dilemma,” and there has never been a reliable way to tip that balance. This is where AI enters the picture. Google believes AI at scale can tackle the Defender’s Dilemma. AI can do so by allowing security professionals and defenders to scale up their work in threat detection and related cybersecurity defense requirements. The AI Cyber Defense initiative aims to employ AI not only to respond to threats but to anticipate and neutralize them before they can cause harm. The idea behind the initiative is that the traditional reactive cybersecurity model is no longer sufficient in a world where cyberthreats are becoming increasingly sophisticated and pervasive. The new initiative includes deploying AI-driven algorithms designed to identify and analyze patterns indicative of cyber threats. Using data generated across its global network, Google will train AI systems to learn from the full range of threats and teach them to adapt to new tactics employed by cybercriminals. As part of the initiative, Google is also using AI to drive significant advances in vulnerability management. The idea is that by identifying vulnerabilities within software and systems, AI can significantly reduce the window of opportunity for attackers to exploit these weaknesses. Thrown into the mix is AI’s ability to suggest and implement fixes to vulnerabilities, streaming the patching process and, in doing so, further reducing the risk of a breach. The initiative further outlines the use of AI in incident response and automates the analysis of indices to identify the source, method and extent of an attack. Google is calling for a collaborative approach to recognizing the global nature of cyberthreats and calls for partnerships between industries and governments to share intelligence, best practices and advancements in AI-driven security measures. As part of the program, Google is expanding its Google.org Cybersecurity Seminars Program to cover all of Europe. Finally, Google announced today that it’s open-sourcing Magika, a new, AI-powered tool to aid defenders through file type identification, essential for detecting malware. Magika is already used to help protect products, including Gmail, Drive and Safe Browsing and is used by Google’s VirusTotal team to foster a safer digital environment. Google says Magika outperforms conventional file identification methods, providing an overall 30% accuracy boost and up to 95% higher precision on traditionally hard-to-identify but potentially problematic content such as VBA, JavaScript and Powershell. “The AI revolution is already underway,” Google concludes in a blog post on the announcements. “While people rightly applaud the promise of new medicines and scientific breakthroughs, we’re also excited about AI’s potential to solve generational security challenges while bringing us close to the safe, secure and trusted digital world we deserve.”","""================ ======= Google LLC today announced a new AI Cyber Defense Initiative and proposed a new policy and technology agenda aimed at harnessing the power of artificial intelligence to bolster cybersecurity defenses globally. The new initiative is designed to counteract evolving threats by leveraging AI’s capabilities to enhance threat detection, automate vulnerability management and improve incident response efficiency. Google argues that the main challenge in cybersecurity is that attackers need only one successful, novel threat to break through the best defenses. On the flip side, defenders need to deploy the best defenses at all times across increasingly complex digital terrain with no margin for error. Google calls this the “Defender’s Dilemma,” and there has never been a reliable way to tip that balance. This is where AI enters the picture. Google believes AI at scale can tackle the Defender’s Dilemma. AI can do so by allowing security professionals and defenders to scale up their work in threat detection and related cybersecurity defense requirements. The AI Cyber Defense initiative aims to employ AI not only to respond to threats but to anticipate and neutralize them before they can cause harm. The idea behind the initiative is that the traditional reactive cybersecurity model is no longer sufficient in a world where cyberthreats are becoming increasingly sophisticated and pervasive. The new initiative includes deploying AI-driven algorithms designed to identify and analyze patterns indicative of cyber threats. Using data generated across its global network, Google will train AI systems to learn from the full range of threats and teach them to adapt to new tactics employed by cybercriminals. As part of the initiative, Google is also using AI to drive significant advances in vulnerability management. The idea is that by identifying vulnerabilities within software and systems, AI can significantly reduce the window of opportunity for attackers to exploit these weaknesses. Thrown into the mix is AI’s ability to suggest and implement fixes to vulnerabilities, streaming the patching process and, in doing so, further reducing the risk of a breach. The initiative further outlines the use of AI in incident response and automates the analysis of indices to identify the source, method and extent of an attack. Google is calling for a collaborative approach to recognizing the global nature of cyberthreats and calls for partnerships between industries and governments to share intelligence, best practices and advancements in AI-driven security measures. As part of the program, Google is expanding its Google.org Cybersecurity Seminars Program to cover all of Europe. Finally, Google announced today that it’s open-sourcing Magika, a new, AI-powered tool to aid defenders through file type identification, essential for detecting malware. Magika is already used to help protect products, including Gmail, Drive and Safe Browsing and is used by Google’s VirusTotal team to foster a safer digital environment. Google says Magika outperforms conventional file identification methods, providing an overall 30% accuracy boost and up to 95% higher precision on traditionally hard-to-identify but potentially problematic content such as VBA, JavaScript and Powershell. “The AI revolution is already underway,” Google concludes in a blog post on the announcements. “While people rightly applaud the promise of new medicines and scientific breakthroughs, we’re also excited about AI’s potential to solve generational security challenges while bringing us close to the safe, secure and trusted digital world we deserve.” https://siliconangle.com/2024/02/15/google-announces-ai-cyber-defense-initiative-enhance-global-cybersecurity/ ================ ======= I'm working on a thesis related to AI in cybersecurity and came across Google's new AI Cyber Defense Initiative. I'm trying to understand how this initiative shifts the ""Defender's Dilemma"" in practical terms. Can AI really anticipate threats, and if so, wouldn't this create a new challenge of false positives or over-reliance on automated systems? Also, could the open-sourcing of Magika actually expose vulnerabilities, given it's now public? How does this balance with Google's push for collaboration and security transparency? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Internet/Technology,Effect Analysis,Q&A You can only respond using information from the context provided. Arrange the answers in numbered list with headers.,What are the differences between the types of cells described and some life forms they make up.,"CELL STRUCTURE Cells are the building blocks of life. A cell is chemical system that is able to maintain its structure and reproduce. Cells are the fundamental unit of life. All living things are cells or composed of cells. Although different living things may be as unlike as a violet and an octopus, they are all built in essentially the same way. The most basic similarity is that all living things are composed of one or more cells. This is known as the Cell Theory. Our knowledge of cells is built on work done with microscopes. English scientist Robert Hooke in 1665 first described cells from his observations of cork slices. Hooke first used the word ""cell"". Dutch amateur scientist Antonie van Leeuwenhoek discovered microscopic animals in water. German scientists Schleiden and Schwann in 1830's were first to say that all organisms are made of one or more cells. German biologist Virchow in 1858 stated that all cells come from the division of pre-existing cells. The Cell Theory can be summarized as: Cells are the fundamental unit of life - nothing less than a cell is alive. All organisms are constructed of and by cells. All cells arise from preexisting cells. Cells contain the information necessary for their own reproduction. No new cells are originating spontaneously on earth today. Cells are the functional units of life. All biochemical processes are carried out by cells. • Groups of cells can be organized and function as multicellular organisms Cells of multicellular organisms can become specialized in form and function to carry out subprocesses of the multicellular organism. Cells are common to all living beings, and provide information about all forms of life. Because all cells come from existing cells, scientists can study cells to learn about growth, reproduction, and all other functions that living things perform. By learning about cells and how they function, we can learn about all types of living things. Classification of cells: All living organisms (bacteria, blue green algae, plants and animals) have cellular organization and may contain one or many cells. The organisms with only one cell in their body are called unicellular organisms (bacteria, blue green algae, some algae, Protozoa, etc.). The organisms having many cells in their body are called multicellular organisms (fungi, most plants and animals). Any living organism may contain only one type of cell either A. Prokaryotic cells; B. Eukaryotic cells. The terms prokaryotic and eukaryotic were suggested by Hans Ris in the 1960’s. This classification is based on their complexity. Further based on the kingdom into which they may fall i.e the plant or the animal kingdom, plant and animal cells bear many differences. These will be studied in detail in the upcoming sections PROKARYOTIC CELLS Prokaryote comes from the Greek words for pre-nucleus. Prokaryotes: i. One circular chromosome, not contained in a membrane. ii. No histones or introns are present in Bacteria; both are found in Eukaryotes and Archaea. iii. No membrane-bound organelles. (Only contain non membrane-bound organelles). iv. Bacteria contain peptidoglycan in cell walls; Eukaryotes and Archaea do not. v. Binary fission. 2 Size, Shape, and Arrangement of Bacterial Cells. i. Average size of prokaryotic cells: 0.2 -2.0 μm in diameter 1-10 μm (0.001 – 0.01 mm) [book says 2 – 8 μm] in length. 1. Typical eukaryote 10-500 μm in length (0.01 – 0.5 mm). 2. Typical virus 20-1000 nm in length (0.00000002 – 0.000001 m). 3. Thiomargarita is the largest bacterium known. It is about the size of a typed period (0.75 mm). 4. Nanoarchaeum is the smallest cell known. It is at the lower theoretical limit for cell size (0.4 μm). ii. Basic bacterial shapes: 1. Coccus (sphere/round). 2. Bacillus (staff/rod-shaped). 3. Spirilla (rigid with a spiral/corkscrew shape). a. Flagella propel these bacteria. 4. Vibrio (curved rod). 5. Spirochetes (flexible with a spiral shape). Axial filaments (endoflagella) propel these bacteria. iii. Descriptive prefixes: 1. Diplo (two cells). 2. Tetra (four cells). 3. Sarcinae (cube of 8 cells). 4. Staphylo (clusters of cells). 5. Strepto (chains of cells). iv. Unusual bacterial shapes: 1. Star-shaped Stella. 2. Square/rectangular Haloarcula. v. Arrangements: 1. Pairs: diplococci, diplobacilli 2. Clusters: staphylococci 3. Chains: streptococci, streptobacilli. vi. Most bacteria are monomorphic. They do not change shape unless environmental conditions change. vii. A few are pleomorphic. These species have individuals that can come in a variety of shapes Structures External to the Prokaryotic Cell Wall. a. Glycocalyx (sugar coat). i. Usually very sticky. ii. Found external to cell wall. iii. Composed of polysaccharide and/or polypeptide. iv. It can be broken down and used as an energy source when resources are scarce. v. It can protect against dehydration. vi. It helps keep nutrients from moving out of the cell. 1. A capsule is a glycocalyx that is neatly organized and is firmly attached to the cell wall. a. Capsules prevent phagocytosis by the host’s immune system. 2. A slime layer is a glycocalyx that is unorganized and is loosely attached to the cell wall. b. Extracellular polysaccharide (extracellular polymeric substance) is a glycocalyx made of sugars and allows bacterial cells to attach to various surfaces.Prokaryotic Flagella. i. Long, semi-rigid, helical, cellular appendage used for locomotion. ii. Made of chains of the protein flagellin. 1. Attached to a protein hook. iii. Anchored to the cell wall and cell membrane by the basal body. iv. Motile Cells. 1. Rotate flagella to run and tumble. 2. Move toward or away from stimuli (taxis). a. Chemotaxis. b. Phototaxis. c. Axial Filaments (Endoflagella). i. In spirochetes: 1. Anchored at one end of a cell. 2. Covered by an outer sheath. 3. Rotation causes cell to move like a corkscrew through a cork. d. Fimbriae. i. Shorter, straighter, thinner than flagella. ii. Not used for locomotion. iii. Allow for the attachment of bacteria to surfaces. iv. Can be found at the poles of the cell, or covering the cell’s entire surface. v. There may be few or many fimbriae on a single bacterium. e. Pili (sex pili). i. Longer than fimbriae. ii. Only one or two per cell. iii. Are used to transfer DNA from one bacterial cell to another, and in twitching & gliding motility. IV. The Prokaryotic Cell Wall. a. Chemically and structurally complex, semi-rigid, gives structure to and protects the cell. b. Surrounds the underlying plasma membrane. 4 c. Prevents osmotic lysis. d. Contributes to the ability to cause disease in some species, and is the site of action for some antibiotics. e. Made of peptidoglycan (in bacteria). i. Polymer of a disaccharide. 1. N-acetylglucosamine (NAG) & N-acetylmuramic acid (NAM). ii. Disaccharides linked by polypeptides to form lattice surrounding the cell. Fig. iii. Penicillin inhibits this lattice formation, and leads to cellular lysis. f. Gram-positive cell walls. Fig. i. Many layers of peptidoglycan, resulting in a thick, rigid structure. ii. Teichoic acids. 1. May regulate movement of cations (+). 2. May be involved in cell growth, preventing extensive wall breakdown and lysis. 3. Contribute to antigenic specificity for each Gram-positive bacterial species. 4. Lipoteichoic acid links to plasma membrane. 5. Wall teichoic acid links to peptidoglycan. g. Gram-negative cell walls. i. Contains only one or a few layers of peptidoglycan. 1. Peptidoglycan is found in the periplasm, a fluid-filled space between the outer membrane and plasma membrane. a. Periplasm contains many digestive enzymes and transport proteins. ii. No teichoic acids are found in Gram-negative cell walls. iii. More susceptible to rupture than Gram-positive cells. iv. Outer membrane: 1. Composed of lipopolysaccharides, lipoproteins, and phospholipids. 2. Protects the cell from phagocytes, complement, antibiotics, lysozyme, detergents, heavy metals, bile salts, and certain dyes. 3. Contains transport proteins called porins. 4. Lipopolysaccharide is composed of: a. O polysaccharide (antigen) that can be used to ID certain Gram- negative bacterial species. b. Lipid A (endotoxin) can cause shock, fever, and even death if enough is released into the host’s blood. h. Gram Stain Mechanism. i. Crystal Violet-Iodine (CV-I) crystals form within the cell. ii. Gram-positive: 1. Alcohol dehydrates peptidoglycan. 2. CV-I crystals cannot leave. iii. Gram-negative: 1. Alcohol dissolves outer membrane and leaves holes in peptidoglycan. 2. CV-I washes out. 3. Safranin stains the cell pink. iv. Table 1, pg. 94, compares Gram-positive and Gram-negative bacteria. i. Damage to Prokaryotic Cell Walls. i. Because prokaryotic cell walls contain substances not normally found in animal 5 cells, drugs or chemicals that disrupt prokaryotic cell wall structures are often used in medicine, or by the host to combat the bacteria. 1. Lysozyme digests the disaccharides in peptidoglycan. 2. Penicillin inhibits the formation of peptide bridges in peptidoglycan. ii. A protoplast is a Gram-positive cell whose cell wall has been destroyed, but that is still alive and functional. (Lost its peptidoglycan). iii. A spheroplast is a wall-less Gram-negative cell. (Lost its outer membrane and peptidoglycan). iv. L forms are wall-less cells that swell into irregular shapes. They can live, divide, and may return to a walled state. v. Protoplasts and spheroplasts are susceptible to osmotic lysis. vi. Gram-negative bacteria are not as susceptible to penicillin due to the outer membrane and the small amount of peptidoglycan in their walls. vii. Gram-negative bacteria are susceptible to antibiotics that can penetrate the outer membrane (Streptomycin, chloramphenicol, tetracycline). V. Structures Internal to the Cell Wall. a. Plasma Membrane (Inner Membrane). a. Phospholipid bilayer lying inside the cell wall. 1. The phospholipid bilayer is the basic framework of the plasma membrane. 2. The bilayer arrangement occurs because the phospholipids are amphipathic molecules. They have both polar (charged) and nonpolar (uncharged) parts with the polar “head” of the phospholipid pointing out and the nonpolar “tails” pointing toward the center of the membrane, forming a nonpolar, hydrophobic region in the membrane’s interior. b. Much of the metabolic machinery is located on the plasma membrane. Photosynthesis, aerobic cellular respiration, and anaerobic cellular respiration reactions occur here. This means that there is a surface area to volume ratio at which bacteria reach a critical size threshold, beyond which bacteria can’t survive. i. Thiomargarita (0.75 mm) is the largest known bacterium and is larger than most eukaryotic cells. It has many invaginations of the plasma membrane, which increases it surface area relative to its volume. c. Peripheral proteins. i. Enzymes. ii. Structural proteins. iii. Some assist the cell in changing membrane shape. d. Integral proteins and transmembrane proteins. i. Provide channels for movement of materials into and out of the cell. e. Fluid Mosaic Model. i. Membrane is as viscous as olive oil. ii. Proteins move to function. iii. Phospholipids rotate and move laterally. f. Selective permeability allows the passage of some molecules but not others across the plasma membrane. i. Large molecules cannot pass through. ii. Ions pass through very slowly or not at all. iii. Lipid soluble molecules pass through easily. iv.Smaller molecules (water, oxygen, carbon dioxide, some simple sugars) 6 usually pass through easily. g. The plasma membrane contains enzymes for ATP production. h. Photosynthetic pigments are found on in-foldings of the plasma membrane called chromatophores or thylakoids. Fig. 15. i. Damage to the plasma membrane by alcohols, quaternary ammonium compounds (a class of disinfectants) and polymyxin antibiotics causes leakage of cell contents. j. Movement of Materials Across Membranes. 1. Passive Processes: a. Simple diffusion: Movement of a solute from an area of high concentration to an area of low concentration (down its concentration gradient) until equilibrium is reached. b. Facilitated diffusion: Solute combines with a transport protein in the membrane, to pass from one side of the membrane to the other. The molecule is still moving down its concentration gradient. The transport proteins are specific. c. Osmosis. i. Movement of water across a selectively permeable membrane from an area of higher water concentration to an area of lower water concentration. ii. Osmotic pressure. The pressure needed to stop the movement of water across the membrane. iii. Isotonic, hypotonic, and hypertonic solutions. 2. Active Processes: a. Active transport of substances requires a transporter protein and ATP. The solute molecule is pumped against its concentration gradient. Transport proteins are specific. i. In group translocation (a special form of active transport found only in prokaryotes) movement of a substance requires a specific transport protein. 1. The substance is chemically altered during transport, preventing it from escaping the cell after it is transported inside. 2. This process requires high-energy phosphate compounds like phosphoenolpyruvic acid (PEP) to phosphorylate the transported molecule, preventing its movement out of the cell. b. Cytoplasm. i. Cytoplasm is the substance inside the plasma membrane. ii. It is about 80% water. iii. Contains proteins, enzymes, carbohydrates, lipids, inorganic ions, various compounds, a nuclear area, ribosomes, and inclusions. c. Nuclear Area (Nucleoid). i. Contains a single circular chromosome made of DNA. 1. No histones or introns in bacteria. 2. The chromosome is attached to the plasma membrane at a point along its length, where proteins synthesize and partition new DNA for division during binary fission. ii. Is not surrounded by a nuclear envelope the way eukaryotic chromosomes are. iii. Also contains small circular DNA molecules called plasmids. 1. Plasmids can be gained or lost without harming the cell. 2. Usually contain less than 100 genes. 3. Can be beneficial if they contain genes for antibiotic resistance, tolerance to toxic metals, production of toxins, or synthesis of enzymes. 4. They can be transferred from one bacterium to another. 7 5. Plasmids are used in genetic engineering. d. Ribosomes. i. Site of protein synthesis. ii. Composed of a large and small subunit, both made of protein and rRNA. iii. Prokaryotic ribosomes are 70S ribosomes. 1. Made of a small 30S subunit and a larger 50S subunit. iv. Eukaryotic ribosomes are 80S ribosomes. 1. Made of a small 40S subunit and a larger 60S subunit. v. Certain antibiotics target only prokaryotic ribosomal subunits without targeting eukaryotic ribosomal subunits. e. Inclusions. i. Reserve deposits of nutrients that can be used in times of low resource availability. ii. Include: 1. Metachromatic granules (volutin). Reserve of inorganic phosphate for ATP. 2. Polysaccharide granules. Glycogen and starch. 3. Lipid inclusions. 4. Sulfur granules. Energy reserve for “sulfur bacteria” that derive energy by oxidizing sulfur and sulfur compounds. 5. Carboxysomes. Contain an enzyme necessary for bacteria that use carbon dioxide as their only source of carbon for carbon dioxide fixation. 6. Gas vacuoles. Help bacteria maintain buoyancy. 7. Magnetosomes. Made of iron oxide, they serve as ballast to help some bacteria sink until reaching an appropriate attachment site. They also decompose hydrogen peroxide. f. Endospores. i. Resting Gram-positive bacterial cells that form when essential nutrients can no longer be obtained. ii. Resistant to desiccation, heat, chemicals, radiation. iii. Bacillus anthracis (anthrax), Clostridium spp. (gangrene, tetanus, botulism, food poisoning). iv. Sporulation (sporogenesis): the process of endospore formation within the vegetative (functional) cell. This takes several hours. 1. Spore septum (invagination of plasma membrane) begins to isolate the newly replicated DNA and a small portion of cytoplasm. This results in the formation of two separate membrane bound structures. 2. The plasma membrane starts to surround the DNA, cytoplasm, and the new membrane encircling the material isolated in step 1, forming a double-layered membrane-bound structure called a forespore. 3. Thick peptidoglycan layers are laid down between the two membranes of the forespore. 4. Then a thick spore coat of protein forms around the outer membrane of the forespore, which is responsible for the durability of the endospore. 5. When the endospore matures, the vegetative cell wall ruptures, killing the cell, and freeing the endospore. a. The endospore is metabolically inert, and contains the chromosome, 8 some RNA, ribosomes, enzymes, other molecules, and very little water. b. Endospores can remain dormant for millions of years. v. Germination: the return to the vegetative state. 1. Triggered by damage to the endospore coat. The enzymes activate, breaking down the protective layers. Water then can enter, and metabolism resumes. vi. Endospores can survive conditions that vegetative cells cannot: boiling, freezing, desiccation, chemical exposure, radiation, etc. EUKARYOTES: a. Make up algae, protozoa, fungi, higher plants, and animals. Flagella and Cilia. Rotate Cilia are numerous, short, hair-like projections extending from the surface of a cell. They function to move materials across the surface of the cell, or move the cell around in its environment. i. Flagella are similar to cilia but are much longer, usually moving an entire cell. The only example of a flagellum in the human body is the sperm cell tail. 1. Eukaryotic flagella move in a whip-like manner, while prokaryotic flagella 9 b. Cell Wall. i. Simple compared to prokaryotes. 1. No peptidoglycan in eukaryotes. a. Antibiotics that target peptidoglycan (penicillins and cephalosporins) do not harm us. ii. Cell walls are found in plants, algae, and fungi. iii. Made of carbohydrates. 1. Cellulose in algae, plants, and some fungi. 2. Chitin in most fungi. 3. Glucan and mannan in yeasts (unicellular fungi). c. Glycocalyx. i. Sticky carbohydrates extending from an animal cell’s plasma membrane. ii. Glycoproteins and glycolipids form a sugary coat around the cell—the glycocalyx— which helps cells recognize one another, adhere to one another in some tissues, and protects the cell from digestion by enzymes in the extracellular fluid. 1. The glycocalyx also attracts a film of fluid to the surface of many cells, such as RBC’s, making them slippery so they can pass through narrow vessels. d. Plasma Membrane. i. The plasma membrane is a flexible, sturdy barrier that surrounds and contains the cytoplasm of the cell. 1. The fluid mosaic model describes its structure. 2. The membrane consists of proteins in a sea of phospholipids. a. Some proteins float freely while others are anchored at specific locations. b. The membrane lipids allow passage of several types of lipid-soluble molecules but act as a barrier to the passage of charged or polar substances. c. Channel and transport proteins allow movement of polar molecules and ions across the membrane. ii. Phospholipid bilayer. 1. Has the same basic arrangement as the prokaryotic plasma membrane. iii. Arrangement of Membrane Proteins. 1. The membrane proteins are divided into integral and peripheral proteins. a. Integral proteins extend into or across the entire lipid bilayer among the fatty acid tails of the phospholipid molecules, and are firmly anchored in place. i. Most are transmembrane proteins, which span the entire lipid bilayer and protrude into both the cytosol and extracellular fluid. b. Peripheral proteins associate loosely with the polar heads of membrane lipids, and are found at the inner or outer surface of the membrane. 10 2. Many membrane proteins are glycoproteins (proteins with carbohydrate groups attached to the ends that protrude into the extracellular fluid). iv. Functions of Membrane Proteins. 1. Membrane proteins vary in different cells and function as: a. Ion channels (pores): Allow ions such as sodium or potassium to cross the cell membrane; (they can't diffuse through the bilayer). Most are selective—they allow only a single type of ion to pass. Some ion channels open and close. b. Transporters: selectively move a polar substance from one side of the membrane to the other. c. Receptors: recognize and bind a specific molecule. The chemical binding to the receptor is called a ligand. d. Enzymes: catalyze specific chemical reactions at the inside or outside surface of the cell. e. Cell-identity markers (often glycoproteins and glycolipids), such as human leukocyte antigens. f. Linkers: anchor proteins in the plasma membrane of neighboring cells to each other or to protein filaments inside and outside the cell. 2. The different proteins help to determine many of the functions of the plasma membrane. v. Selective permeability of the plasma membrane allows passage of some molecules. 1. Transport mechanisms: a. Simple diffusion. b. Facilitated diffusion. c. Osmosis. d. Active transport. (No group translocation in Eukaryotes). e. Vesicular Transport. i. A vesicle is a small membranous sac formed by budding off from an existing membrane. ii. Two types of vesicular transport are endocytosis and exocytosis. 1. Endocytosis. a. In endocytosis, materials move into a cell in a vesicle formed from the plasma membrane. b. Viruses can take advantage of this mechanism to enter cells. c. Phagocytosis is the ingestion of solid particles, such as worn out cells, bacteria, or viruses. Pseudopods extend and engulf particles. d. Pinocytosis is the ingestion of extracellular fluid. The membrane folds inward bringing in fluid and dissolved substances. 2. In exocytosis, membrane-enclosed structures called secretory vesicles that form inside the cell fuse with the plasma membrane and release their contents into the extracellular fluid. f. Cytoplasm. i. Substance inside the plasma membrane and outside nucleus. ii. Cytosol is the fluid portion of cytoplasm. iii. Cytoskeleton. 1. The cytoskeleton is a network of several kinds of protein filaments that extend throughout the cytoplasm, and provides a structural framework for the cell. 2. It consists of microfilaments, intermediate filaments, and microtubules. 11 a. Most microfilaments (the smallest cytoskeletal elements) are composed of actin and function in movement (muscle contraction and cell division) and mechanical support for the cell itself and for microvilli. b. Intermediate filaments are composed of several different proteins and function in support and to help anchor organelles such as the nucleus. c. Microtubules (the largest cytoskeletal elements) are composed of a protein called tubulin and help determine cell shape; they function in the intracellular transport of organelles and the migration of chromosome during cell division. They also function in the movement of cilia and flagella. iv. Cytoplasmic streaming. 1. Movement of cytoplasm and nutrients throughout cells. 2. Moves the cell over surfaces. g. Organelles. i. Organelles are specialized structures that have characteristic shapes and perform specific functions in eukaryotic cellular growth, maintenance, reproduction. 2.1.RIBOSOMES. Nucleus. The nucleus is usually the most prominent feature of a eukaryotic cell. b. Most have a single nucleus; some cells (human red blood cells) have none, whereas others (human skeletal muscle fibers) have several in each cell. c. The parts of the nucleus include the: i. Nuclear envelope (a double membrane), which is perforated by channels called nuclear pores, that control the movement of substances between the nucleus and the cytoplasm. 1. Small molecules and ions diffuse passively, while movement of most large molecules out of the nucleus involves active transport. ii. Nucleoli function in producing ribosomes. d. Genetic material (DNA). Within the nucleus are the cell’s hereditary units, called genes, which are arranged in single file along chromosomes. Each chromosome is a long molecule of DNA that is coiled together with several proteins (including histones). a. Sites of protein synthesis. b. 80S in eukaryotes. i. Membrane-bound ribosomes found on rough ER. ii. Free ribosomes found in cytoplasm. c. 70S in prokaryotes. i. Also found in chloroplasts and mitochondria. 3. Endoplasmic Reticulum. a. The endoplasmic reticulum (ER) is a network of membranes extending from the nuclear membrane that form flattened sacs or tubules. b. Rough ER is continuous with the nuclear membrane and has its outer surface studded with ribosomes, which synthesize proteins. The proteins then enter the space inside the ER for processing (into glycoproteins or for attachment to phospholipids) and sorting, 12 and are then either incorporated into organelle membranes, inserted into the plasma membrane, or secreted via exocytosis. c. Smooth ER extends from the rough ER to form a network of membrane tubules, but it does not contain ribosomes on its membrane surface. In humans, it synthesizes fatty acids and steroids, detoxifies drugs, removes phosphate from glucose 6-phosphate (allowing free glucose to enter the blood), and stores and releases calcium ions involved in muscle contraction. 4. Golgi Complex. The Golgi complex consists of four to six stacked, flattened membranous sacs (cisterns). The cis (entry) face faces the rough ER, and trans (exit) face faces the cell’s plasma membrane. Between the cis and trans faces are the medial cisternae. b. The cis, medial, and trans cisternae each contain different enzymes that permit each to modify, sort, and package proteins received from the rough ER for transport to different destinations (such as the plasma membrane, to other organelles, or for export out of the cell). 5. Lysosomes. a. Lysosomes are membrane-enclosed vesicles that form from the Golgi complex and contain powerful digestive enzymes. b. Lysosomes function in digestion of substances that enter the cell by endocytosis, and transport the final products of digestion into the cytosol. c. They digest worn-out organelles (autophagy). d. They digest their own cellular contents (autolysis). e. They carry out extracellular digestion (as happens when sperm release lysosomal enzymes to aid in penetrating an oocyte). 6. Vacuoles. a. Space in the cytoplasm enclosed by a membrane called a tonoplast. b. Derived from the Golgi complex. c. They serve in the following ways: i. Temporary storage for biological molecules and ions. ii. Bring food into cells. iii. Provide structural support. iv. Store metabolic wastes. 7. Peroxisomes. a. Peroxisomes are similar in structure to lysosomes, but are smaller. b. They contain enzymes (oxidases) that use molecular oxygen to oxidize (remove hydrogen atoms from) various organic substances. 13 c. They take part in normal metabolic reactions such as the oxidation of amino and fatty acids. d. New peroxisomes form by budding off from preexisting ones. e. They produce and then destroy H2O2 (hydrogen peroxide) in the process of their metabolic activities. 8. Centrosomes. a. Centrosomes are dense areas of cytoplasm containing the centrioles, which are paired cylinders arranged at right angles to one another, and serve as centers for organizing microtubules and the mitotic spindle during mitosis. 9. Mitochondria. a. Found in nearly all eukaryotic cells. b. A mitochondrion is bound by a double membrane, with a fluid-filled space between called the intermembranous space. The outer membrane is smooth, while the inner membrane is arranged in folds called cristae. The mitochondrial matrix is found inside the inner mitochondrial membrane. c. The folds of the cristae provide a large surface area for the chemical reactions that are part of the aerobic phase of cellular respiration. These reactions produce most of a eukaryotic cell’s ATP, and the enzymes that catalyze them are located on the cristae and in the matrix. d. Mitochondria self-replicate using their own DNA and contain 70S ribosomes. They grow and reproduce on their own in a way that is similar to binary fission. Mitochondrial DNA (genes) is inherited only from the mother, since sperm normally lack most organelles such as mitochondria, ribosomes, ER, and the Golgi complex. Any sperm mitochondria that do enter the oocyte are soon destroyed. 10. Chloroplasts. a. Found only in algae and green plants. b. Contain the pigment chlorophyll and enzymes necessary for photosynthesis. c. Chloroplasts self-replicate using their own DNA and contain 70S ribosomes. They grow and reproduce on their own in a way that is similar to binary fission. VII. Endosymbiotic Theory. a. Large bacterial cells lost their cell walls and engulfed smaller bacteria. b. A symbiotic (mutualistic) relationship developed. i. The host cell supplied the nutrients. ii. The engulfed cell produced excess energy that the host could use. iii. The relationship evolved. c. Evidence: 14 i. Mitochondria and chloroplasts resemble bacteria in size and shape. 1. They divide on their own—independently of the host, and contain their own DNA (single circular chromosome). This process is nearly identical to binary fission seen in bacteria. 2. They contain 70S ribosomes. 3. Their method of protein synthesis is more like that of prokaryotes (no RNA processing). 4. Antibiotics that inhibit protein synthesis on ribosomes in bacteria also inhibit protein Difference among eukaryotic cells There are many different types of eukaryotic cells, though animals and plants are the most familiar eukaryotes, and thus provide an excellent starting point for understanding eukaryotic structure. Fungi and many protists have some substantial differences, however. Animal cell An animal cell is a form of eukaryotic cell that makes up many tissues in animals. Animal cells are distinct from other eukaryotes, most notably plant cells, as they lack cell walls and chloroplasts. They also have smaller vacuoles. Due to the lack of a cell wall, animal cells can adopt a variety of shapes. A phagocytic cell can even engulf other structures. There are many different types of cell. For instance, there are approximately 210 distinct cell types in the adult human body. Plant cell Plant cells are quite different from the cells of the other eukaryotic organisms. Their distinctive features are: A large central vacuole (enclosed by a membrane, the tonoplast), which maintains the cell's turgor and controls movement ofmolecules between the cytosol and sap A primary cell wall containing cellulose, hemicellulose and pectin, deposited by the protoplast on the outside of the cell membrane; this contrasts with the cell walls of fungi, which contain chitin, and the cell envelopes of prokaryotes, in which peptidoglycans are the main structural molecules The plasmodesmata, linking pores in the cell wall that allow each plant cell to communicate with other adjacent cells; this is different from the functionally analogous system of gap junctions between animal cells. 15 Plastids, especially chloroplasts that contain chlorophyll, the pigment that gives plants their green color and allows them to perform photosynthesis Bryophytes and seedless vascular plants lack flagellae and centrioles except in the sperm cells.[16] Sperm of cycads and Ginkgoare large, complex cells that swim with hundreds to thousands of flagellae. Conifers (Pinophyta) and flowering plants (Angiospermae) lack the flagellae and centrioles that are present in animal cells. ","You can only respond using information from the context provided. Arrange the answers in numbered list with headers. What are the differences between the types of cells described and some life forms they make up. CELL STRUCTURE Cells are the building blocks of life. A cell is chemical system that is able to maintain its structure and reproduce. Cells are the fundamental unit of life. All living things are cells or composed of cells. Although different living things may be as unlike as a violet and an octopus, they are all built in essentially the same way. The most basic similarity is that all living things are composed of one or more cells. This is known as the Cell Theory. Our knowledge of cells is built on work done with microscopes. English scientist Robert Hooke in 1665 first described cells from his observations of cork slices. Hooke first used the word ""cell"". Dutch amateur scientist Antonie van Leeuwenhoek discovered microscopic animals in water. German scientists Schleiden and Schwann in 1830's were first to say that all organisms are made of one or more cells. German biologist Virchow in 1858 stated that all cells come from the division of pre-existing cells. The Cell Theory can be summarized as: Cells are the fundamental unit of life - nothing less than a cell is alive. All organisms are constructed of and by cells. All cells arise from preexisting cells. Cells contain the information necessary for their own reproduction. No new cells are originating spontaneously on earth today. Cells are the functional units of life. All biochemical processes are carried out by cells. • Groups of cells can be organized and function as multicellular organisms Cells of multicellular organisms can become specialized in form and function to carry out subprocesses of the multicellular organism. Cells are common to all living beings, and provide information about all forms of life. Because all cells come from existing cells, scientists can study cells to learn about growth, reproduction, and all other functions that living things perform. By learning about cells and how they function, we can learn about all types of living things. Classification of cells: All living organisms (bacteria, blue green algae, plants and animals) have cellular organization and may contain one or many cells. The organisms with only one cell in their body are called unicellular organisms (bacteria, blue green algae, some algae, Protozoa, etc.). The organisms having many cells in their body are called multicellular organisms (fungi, most plants and animals). Any living organism may contain only one type of cell either A. Prokaryotic cells; B. Eukaryotic cells. The terms prokaryotic and eukaryotic were suggested by Hans Ris in the 1960’s. This classification is based on their complexity. Further based on the kingdom into which they may fall i.e the plant or the animal kingdom, plant and animal cells bear many differences. These will be studied in detail in the upcoming sections PROKARYOTIC CELLS Prokaryote comes from the Greek words for pre-nucleus. Prokaryotes: i. One circular chromosome, not contained in a membrane. ii. No histones or introns are present in Bacteria; both are found in Eukaryotes and Archaea. iii. No membrane-bound organelles. (Only contain non membrane-bound organelles). iv. Bacteria contain peptidoglycan in cell walls; Eukaryotes and Archaea do not. v. Binary fission. 2 Size, Shape, and Arrangement of Bacterial Cells. i. Average size of prokaryotic cells: 0.2 -2.0 μm in diameter 1-10 μm (0.001 – 0.01 mm) [book says 2 – 8 μm] in length. 1. Typical eukaryote 10-500 μm in length (0.01 – 0.5 mm). 2. Typical virus 20-1000 nm in length (0.00000002 – 0.000001 m). 3. Thiomargarita is the largest bacterium known. It is about the size of a typed period (0.75 mm). 4. Nanoarchaeum is the smallest cell known. It is at the lower theoretical limit for cell size (0.4 μm). ii. Basic bacterial shapes: 1. Coccus (sphere/round). 2. Bacillus (staff/rod-shaped). 3. Spirilla (rigid with a spiral/corkscrew shape). a. Flagella propel these bacteria. 4. Vibrio (curved rod). 5. Spirochetes (flexible with a spiral shape). Axial filaments (endoflagella) propel these bacteria. iii. Descriptive prefixes: 1. Diplo (two cells). 2. Tetra (four cells). 3. Sarcinae (cube of 8 cells). 4. Staphylo (clusters of cells). 5. Strepto (chains of cells). iv. Unusual bacterial shapes: 1. Star-shaped Stella. 2. Square/rectangular Haloarcula. v. Arrangements: 1. Pairs: diplococci, diplobacilli 2. Clusters: staphylococci 3. Chains: streptococci, streptobacilli. vi. Most bacteria are monomorphic. They do not change shape unless environmental conditions change. vii. A few are pleomorphic. These species have individuals that can come in a variety of shapes Structures External to the Prokaryotic Cell Wall. a. Glycocalyx (sugar coat). i. Usually very sticky. ii. Found external to cell wall. iii. Composed of polysaccharide and/or polypeptide. iv. It can be broken down and used as an energy source when resources are scarce. v. It can protect against dehydration. vi. It helps keep nutrients from moving out of the cell. 1. A capsule is a glycocalyx that is neatly organized and is firmly attached to the cell wall. a. Capsules prevent phagocytosis by the host’s immune system. 2. A slime layer is a glycocalyx that is unorganized and is loosely attached to the cell wall. b. Extracellular polysaccharide (extracellular polymeric substance) is a glycocalyx made of sugars and allows bacterial cells to attach to various surfaces.Prokaryotic Flagella. i. Long, semi-rigid, helical, cellular appendage used for locomotion. ii. Made of chains of the protein flagellin. 1. Attached to a protein hook. iii. Anchored to the cell wall and cell membrane by the basal body. iv. Motile Cells. 1. Rotate flagella to run and tumble. 2. Move toward or away from stimuli (taxis). a. Chemotaxis. b. Phototaxis. c. Axial Filaments (Endoflagella). i. In spirochetes: 1. Anchored at one end of a cell. 2. Covered by an outer sheath. 3. Rotation causes cell to move like a corkscrew through a cork. d. Fimbriae. i. Shorter, straighter, thinner than flagella. ii. Not used for locomotion. iii. Allow for the attachment of bacteria to surfaces. iv. Can be found at the poles of the cell, or covering the cell’s entire surface. v. There may be few or many fimbriae on a single bacterium. e. Pili (sex pili). i. Longer than fimbriae. ii. Only one or two per cell. iii. Are used to transfer DNA from one bacterial cell to another, and in twitching & gliding motility. IV. The Prokaryotic Cell Wall. a. Chemically and structurally complex, semi-rigid, gives structure to and protects the cell. b. Surrounds the underlying plasma membrane. 4 c. Prevents osmotic lysis. d. Contributes to the ability to cause disease in some species, and is the site of action for some antibiotics. e. Made of peptidoglycan (in bacteria). i. Polymer of a disaccharide. 1. N-acetylglucosamine (NAG) & N-acetylmuramic acid (NAM). ii. Disaccharides linked by polypeptides to form lattice surrounding the cell. Fig. iii. Penicillin inhibits this lattice formation, and leads to cellular lysis. f. Gram-positive cell walls. Fig. i. Many layers of peptidoglycan, resulting in a thick, rigid structure. ii. Teichoic acids. 1. May regulate movement of cations (+). 2. May be involved in cell growth, preventing extensive wall breakdown and lysis. 3. Contribute to antigenic specificity for each Gram-positive bacterial species. 4. Lipoteichoic acid links to plasma membrane. 5. Wall teichoic acid links to peptidoglycan. g. Gram-negative cell walls. i. Contains only one or a few layers of peptidoglycan. 1. Peptidoglycan is found in the periplasm, a fluid-filled space between the outer membrane and plasma membrane. a. Periplasm contains many digestive enzymes and transport proteins. ii. No teichoic acids are found in Gram-negative cell walls. iii. More susceptible to rupture than Gram-positive cells. iv. Outer membrane: 1. Composed of lipopolysaccharides, lipoproteins, and phospholipids. 2. Protects the cell from phagocytes, complement, antibiotics, lysozyme, detergents, heavy metals, bile salts, and certain dyes. 3. Contains transport proteins called porins. 4. Lipopolysaccharide is composed of: a. O polysaccharide (antigen) that can be used to ID certain Gram- negative bacterial species. b. Lipid A (endotoxin) can cause shock, fever, and even death if enough is released into the host’s blood. h. Gram Stain Mechanism. i. Crystal Violet-Iodine (CV-I) crystals form within the cell. ii. Gram-positive: 1. Alcohol dehydrates peptidoglycan. 2. CV-I crystals cannot leave. iii. Gram-negative: 1. Alcohol dissolves outer membrane and leaves holes in peptidoglycan. 2. CV-I washes out. 3. Safranin stains the cell pink. iv. Table 1, pg. 94, compares Gram-positive and Gram-negative bacteria. i. Damage to Prokaryotic Cell Walls. i. Because prokaryotic cell walls contain substances not normally found in animal 5 cells, drugs or chemicals that disrupt prokaryotic cell wall structures are often used in medicine, or by the host to combat the bacteria. 1. Lysozyme digests the disaccharides in peptidoglycan. 2. Penicillin inhibits the formation of peptide bridges in peptidoglycan. ii. A protoplast is a Gram-positive cell whose cell wall has been destroyed, but that is still alive and functional. (Lost its peptidoglycan). iii. A spheroplast is a wall-less Gram-negative cell. (Lost its outer membrane and peptidoglycan). iv. L forms are wall-less cells that swell into irregular shapes. They can live, divide, and may return to a walled state. v. Protoplasts and spheroplasts are susceptible to osmotic lysis. vi. Gram-negative bacteria are not as susceptible to penicillin due to the outer membrane and the small amount of peptidoglycan in their walls. vii. Gram-negative bacteria are susceptible to antibiotics that can penetrate the outer membrane (Streptomycin, chloramphenicol, tetracycline). V. Structures Internal to the Cell Wall. a. Plasma Membrane (Inner Membrane). a. Phospholipid bilayer lying inside the cell wall. 1. The phospholipid bilayer is the basic framework of the plasma membrane. 2. The bilayer arrangement occurs because the phospholipids are amphipathic molecules. They have both polar (charged) and nonpolar (uncharged) parts with the polar “head” of the phospholipid pointing out and the nonpolar “tails” pointing toward the center of the membrane, forming a nonpolar, hydrophobic region in the membrane’s interior. b. Much of the metabolic machinery is located on the plasma membrane. Photosynthesis, aerobic cellular respiration, and anaerobic cellular respiration reactions occur here. This means that there is a surface area to volume ratio at which bacteria reach a critical size threshold, beyond which bacteria can’t survive. i. Thiomargarita (0.75 mm) is the largest known bacterium and is larger than most eukaryotic cells. It has many invaginations of the plasma membrane, which increases it surface area relative to its volume. c. Peripheral proteins. i. Enzymes. ii. Structural proteins. iii. Some assist the cell in changing membrane shape. d. Integral proteins and transmembrane proteins. i. Provide channels for movement of materials into and out of the cell. e. Fluid Mosaic Model. i. Membrane is as viscous as olive oil. ii. Proteins move to function. iii. Phospholipids rotate and move laterally. f. Selective permeability allows the passage of some molecules but not others across the plasma membrane. i. Large molecules cannot pass through. ii. Ions pass through very slowly or not at all. iii. Lipid soluble molecules pass through easily. iv.Smaller molecules (water, oxygen, carbon dioxide, some simple sugars) 6 usually pass through easily. g. The plasma membrane contains enzymes for ATP production. h. Photosynthetic pigments are found on in-foldings of the plasma membrane called chromatophores or thylakoids. Fig. 15. i. Damage to the plasma membrane by alcohols, quaternary ammonium compounds (a class of disinfectants) and polymyxin antibiotics causes leakage of cell contents. j. Movement of Materials Across Membranes. 1. Passive Processes: a. Simple diffusion: Movement of a solute from an area of high concentration to an area of low concentration (down its concentration gradient) until equilibrium is reached. b. Facilitated diffusion: Solute combines with a transport protein in the membrane, to pass from one side of the membrane to the other. The molecule is still moving down its concentration gradient. The transport proteins are specific. c. Osmosis. i. Movement of water across a selectively permeable membrane from an area of higher water concentration to an area of lower water concentration. ii. Osmotic pressure. The pressure needed to stop the movement of water across the membrane. iii. Isotonic, hypotonic, and hypertonic solutions. 2. Active Processes: a. Active transport of substances requires a transporter protein and ATP. The solute molecule is pumped against its concentration gradient. Transport proteins are specific. i. In group translocation (a special form of active transport found only in prokaryotes) movement of a substance requires a specific transport protein. 1. The substance is chemically altered during transport, preventing it from escaping the cell after it is transported inside. 2. This process requires high-energy phosphate compounds like phosphoenolpyruvic acid (PEP) to phosphorylate the transported molecule, preventing its movement out of the cell. b. Cytoplasm. i. Cytoplasm is the substance inside the plasma membrane. ii. It is about 80% water. iii. Contains proteins, enzymes, carbohydrates, lipids, inorganic ions, various compounds, a nuclear area, ribosomes, and inclusions. c. Nuclear Area (Nucleoid). i. Contains a single circular chromosome made of DNA. 1. No histones or introns in bacteria. 2. The chromosome is attached to the plasma membrane at a point along its length, where proteins synthesize and partition new DNA for division during binary fission. ii. Is not surrounded by a nuclear envelope the way eukaryotic chromosomes are. iii. Also contains small circular DNA molecules called plasmids. 1. Plasmids can be gained or lost without harming the cell. 2. Usually contain less than 100 genes. 3. Can be beneficial if they contain genes for antibiotic resistance, tolerance to toxic metals, production of toxins, or synthesis of enzymes. 4. They can be transferred from one bacterium to another. 7 5. Plasmids are used in genetic engineering. d. Ribosomes. i. Site of protein synthesis. ii. Composed of a large and small subunit, both made of protein and rRNA. iii. Prokaryotic ribosomes are 70S ribosomes. 1. Made of a small 30S subunit and a larger 50S subunit. iv. Eukaryotic ribosomes are 80S ribosomes. 1. Made of a small 40S subunit and a larger 60S subunit. v. Certain antibiotics target only prokaryotic ribosomal subunits without targeting eukaryotic ribosomal subunits. e. Inclusions. i. Reserve deposits of nutrients that can be used in times of low resource availability. ii. Include: 1. Metachromatic granules (volutin). Reserve of inorganic phosphate for ATP. 2. Polysaccharide granules. Glycogen and starch. 3. Lipid inclusions. 4. Sulfur granules. Energy reserve for “sulfur bacteria” that derive energy by oxidizing sulfur and sulfur compounds. 5. Carboxysomes. Contain an enzyme necessary for bacteria that use carbon dioxide as their only source of carbon for carbon dioxide fixation. 6. Gas vacuoles. Help bacteria maintain buoyancy. 7. Magnetosomes. Made of iron oxide, they serve as ballast to help some bacteria sink until reaching an appropriate attachment site. They also decompose hydrogen peroxide. f. Endospores. i. Resting Gram-positive bacterial cells that form when essential nutrients can no longer be obtained. ii. Resistant to desiccation, heat, chemicals, radiation. iii. Bacillus anthracis (anthrax), Clostridium spp. (gangrene, tetanus, botulism, food poisoning). iv. Sporulation (sporogenesis): the process of endospore formation within the vegetative (functional) cell. This takes several hours. 1. Spore septum (invagination of plasma membrane) begins to isolate the newly replicated DNA and a small portion of cytoplasm. This results in the formation of two separate membrane bound structures. 2. The plasma membrane starts to surround the DNA, cytoplasm, and the new membrane encircling the material isolated in step 1, forming a double-layered membrane-bound structure called a forespore. 3. Thick peptidoglycan layers are laid down between the two membranes of the forespore. 4. Then a thick spore coat of protein forms around the outer membrane of the forespore, which is responsible for the durability of the endospore. 5. When the endospore matures, the vegetative cell wall ruptures, killing the cell, and freeing the endospore. a. The endospore is metabolically inert, and contains the chromosome, 8 some RNA, ribosomes, enzymes, other molecules, and very little water. b. Endospores can remain dormant for millions of years. v. Germination: the return to the vegetative state. 1. Triggered by damage to the endospore coat. The enzymes activate, breaking down the protective layers. Water then can enter, and metabolism resumes. vi. Endospores can survive conditions that vegetative cells cannot: boiling, freezing, desiccation, chemical exposure, radiation, etc. EUKARYOTES: a. Make up algae, protozoa, fungi, higher plants, and animals. Flagella and Cilia. Rotate Cilia are numerous, short, hair-like projections extending from the surface of a cell. They function to move materials across the surface of the cell, or move the cell around in its environment. i. Flagella are similar to cilia but are much longer, usually moving an entire cell. The only example of a flagellum in the human body is the sperm cell tail. 1. Eukaryotic flagella move in a whip-like manner, while prokaryotic flagella 9 b. Cell Wall. i. Simple compared to prokaryotes. 1. No peptidoglycan in eukaryotes. a. Antibiotics that target peptidoglycan (penicillins and cephalosporins) do not harm us. ii. Cell walls are found in plants, algae, and fungi. iii. Made of carbohydrates. 1. Cellulose in algae, plants, and some fungi. 2. Chitin in most fungi. 3. Glucan and mannan in yeasts (unicellular fungi). c. Glycocalyx. i. Sticky carbohydrates extending from an animal cell’s plasma membrane. ii. Glycoproteins and glycolipids form a sugary coat around the cell—the glycocalyx— which helps cells recognize one another, adhere to one another in some tissues, and protects the cell from digestion by enzymes in the extracellular fluid. 1. The glycocalyx also attracts a film of fluid to the surface of many cells, such as RBC’s, making them slippery so they can pass through narrow vessels. d. Plasma Membrane. i. The plasma membrane is a flexible, sturdy barrier that surrounds and contains the cytoplasm of the cell. 1. The fluid mosaic model describes its structure. 2. The membrane consists of proteins in a sea of phospholipids. a. Some proteins float freely while others are anchored at specific locations. b. The membrane lipids allow passage of several types of lipid-soluble molecules but act as a barrier to the passage of charged or polar substances. c. Channel and transport proteins allow movement of polar molecules and ions across the membrane. ii. Phospholipid bilayer. 1. Has the same basic arrangement as the prokaryotic plasma membrane. iii. Arrangement of Membrane Proteins. 1. The membrane proteins are divided into integral and peripheral proteins. a. Integral proteins extend into or across the entire lipid bilayer among the fatty acid tails of the phospholipid molecules, and are firmly anchored in place. i. Most are transmembrane proteins, which span the entire lipid bilayer and protrude into both the cytosol and extracellular fluid. b. Peripheral proteins associate loosely with the polar heads of membrane lipids, and are found at the inner or outer surface of the membrane. 10 2. Many membrane proteins are glycoproteins (proteins with carbohydrate groups attached to the ends that protrude into the extracellular fluid). iv. Functions of Membrane Proteins. 1. Membrane proteins vary in different cells and function as: a. Ion channels (pores): Allow ions such as sodium or potassium to cross the cell membrane; (they can't diffuse through the bilayer). Most are selective—they allow only a single type of ion to pass. Some ion channels open and close. b. Transporters: selectively move a polar substance from one side of the membrane to the other. c. Receptors: recognize and bind a specific molecule. The chemical binding to the receptor is called a ligand. d. Enzymes: catalyze specific chemical reactions at the inside or outside surface of the cell. e. Cell-identity markers (often glycoproteins and glycolipids), such as human leukocyte antigens. f. Linkers: anchor proteins in the plasma membrane of neighboring cells to each other or to protein filaments inside and outside the cell. 2. The different proteins help to determine many of the functions of the plasma membrane. v. Selective permeability of the plasma membrane allows passage of some molecules. 1. Transport mechanisms: a. Simple diffusion. b. Facilitated diffusion. c. Osmosis. d. Active transport. (No group translocation in Eukaryotes). e. Vesicular Transport. i. A vesicle is a small membranous sac formed by budding off from an existing membrane. ii. Two types of vesicular transport are endocytosis and exocytosis. 1. Endocytosis. a. In endocytosis, materials move into a cell in a vesicle formed from the plasma membrane. b. Viruses can take advantage of this mechanism to enter cells. c. Phagocytosis is the ingestion of solid particles, such as worn out cells, bacteria, or viruses. Pseudopods extend and engulf particles. d. Pinocytosis is the ingestion of extracellular fluid. The membrane folds inward bringing in fluid and dissolved substances. 2. In exocytosis, membrane-enclosed structures called secretory vesicles that form inside the cell fuse with the plasma membrane and release their contents into the extracellular fluid. f. Cytoplasm. i. Substance inside the plasma membrane and outside nucleus. ii. Cytosol is the fluid portion of cytoplasm. iii. Cytoskeleton. 1. The cytoskeleton is a network of several kinds of protein filaments that extend throughout the cytoplasm, and provides a structural framework for the cell. 2. It consists of microfilaments, intermediate filaments, and microtubules. 11 a. Most microfilaments (the smallest cytoskeletal elements) are composed of actin and function in movement (muscle contraction and cell division) and mechanical support for the cell itself and for microvilli. b. Intermediate filaments are composed of several different proteins and function in support and to help anchor organelles such as the nucleus. c. Microtubules (the largest cytoskeletal elements) are composed of a protein called tubulin and help determine cell shape; they function in the intracellular transport of organelles and the migration of chromosome during cell division. They also function in the movement of cilia and flagella. iv. Cytoplasmic streaming. 1. Movement of cytoplasm and nutrients throughout cells. 2. Moves the cell over surfaces. g. Organelles. i. Organelles are specialized structures that have characteristic shapes and perform specific functions in eukaryotic cellular growth, maintenance, reproduction. 2.1.RIBOSOMES. Nucleus. The nucleus is usually the most prominent feature of a eukaryotic cell. b. Most have a single nucleus; some cells (human red blood cells) have none, whereas others (human skeletal muscle fibers) have several in each cell. c. The parts of the nucleus include the: i. Nuclear envelope (a double membrane), which is perforated by channels called nuclear pores, that control the movement of substances between the nucleus and the cytoplasm. 1. Small molecules and ions diffuse passively, while movement of most large molecules out of the nucleus involves active transport. ii. Nucleoli function in producing ribosomes. d. Genetic material (DNA). Within the nucleus are the cell’s hereditary units, called genes, which are arranged in single file along chromosomes. Each chromosome is a long molecule of DNA that is coiled together with several proteins (including histones). a. Sites of protein synthesis. b. 80S in eukaryotes. i. Membrane-bound ribosomes found on rough ER. ii. Free ribosomes found in cytoplasm. c. 70S in prokaryotes. i. Also found in chloroplasts and mitochondria. 3. Endoplasmic Reticulum. a. The endoplasmic reticulum (ER) is a network of membranes extending from the nuclear membrane that form flattened sacs or tubules. b. Rough ER is continuous with the nuclear membrane and has its outer surface studded with ribosomes, which synthesize proteins. The proteins then enter the space inside the ER for processing (into glycoproteins or for attachment to phospholipids) and sorting, 12 and are then either incorporated into organelle membranes, inserted into the plasma membrane, or secreted via exocytosis. c. Smooth ER extends from the rough ER to form a network of membrane tubules, but it does not contain ribosomes on its membrane surface. In humans, it synthesizes fatty acids and steroids, detoxifies drugs, removes phosphate from glucose 6-phosphate (allowing free glucose to enter the blood), and stores and releases calcium ions involved in muscle contraction. 4. Golgi Complex. The Golgi complex consists of four to six stacked, flattened membranous sacs (cisterns). The cis (entry) face faces the rough ER, and trans (exit) face faces the cell’s plasma membrane. Between the cis and trans faces are the medial cisternae. b. The cis, medial, and trans cisternae each contain different enzymes that permit each to modify, sort, and package proteins received from the rough ER for transport to different destinations (such as the plasma membrane, to other organelles, or for export out of the cell). 5. Lysosomes. a. Lysosomes are membrane-enclosed vesicles that form from the Golgi complex and contain powerful digestive enzymes. b. Lysosomes function in digestion of substances that enter the cell by endocytosis, and transport the final products of digestion into the cytosol. c. They digest worn-out organelles (autophagy). d. They digest their own cellular contents (autolysis). e. They carry out extracellular digestion (as happens when sperm release lysosomal enzymes to aid in penetrating an oocyte). 6. Vacuoles. a. Space in the cytoplasm enclosed by a membrane called a tonoplast. b. Derived from the Golgi complex. c. They serve in the following ways: i. Temporary storage for biological molecules and ions. ii. Bring food into cells. iii. Provide structural support. iv. Store metabolic wastes. 7. Peroxisomes. a. Peroxisomes are similar in structure to lysosomes, but are smaller. b. They contain enzymes (oxidases) that use molecular oxygen to oxidize (remove hydrogen atoms from) various organic substances. 13 c. They take part in normal metabolic reactions such as the oxidation of amino and fatty acids. d. New peroxisomes form by budding off from preexisting ones. e. They produce and then destroy H2O2 (hydrogen peroxide) in the process of their metabolic activities. 8. Centrosomes. a. Centrosomes are dense areas of cytoplasm containing the centrioles, which are paired cylinders arranged at right angles to one another, and serve as centers for organizing microtubules and the mitotic spindle during mitosis. 9. Mitochondria. a. Found in nearly all eukaryotic cells. b. A mitochondrion is bound by a double membrane, with a fluid-filled space between called the intermembranous space. The outer membrane is smooth, while the inner membrane is arranged in folds called cristae. The mitochondrial matrix is found inside the inner mitochondrial membrane. c. The folds of the cristae provide a large surface area for the chemical reactions that are part of the aerobic phase of cellular respiration. These reactions produce most of a eukaryotic cell’s ATP, and the enzymes that catalyze them are located on the cristae and in the matrix. d. Mitochondria self-replicate using their own DNA and contain 70S ribosomes. They grow and reproduce on their own in a way that is similar to binary fission. Mitochondrial DNA (genes) is inherited only from the mother, since sperm normally lack most organelles such as mitochondria, ribosomes, ER, and the Golgi complex. Any sperm mitochondria that do enter the oocyte are soon destroyed. 10. Chloroplasts. a. Found only in algae and green plants. b. Contain the pigment chlorophyll and enzymes necessary for photosynthesis. c. Chloroplasts self-replicate using their own DNA and contain 70S ribosomes. They grow and reproduce on their own in a way that is similar to binary fission. VII. Endosymbiotic Theory. a. Large bacterial cells lost their cell walls and engulfed smaller bacteria. b. A symbiotic (mutualistic) relationship developed. i. The host cell supplied the nutrients. ii. The engulfed cell produced excess energy that the host could use. iii. The relationship evolved. c. Evidence: 14 i. Mitochondria and chloroplasts resemble bacteria in size and shape. 1. They divide on their own—independently of the host, and contain their own DNA (single circular chromosome). This process is nearly identical to binary fission seen in bacteria. 2. They contain 70S ribosomes. 3. Their method of protein synthesis is more like that of prokaryotes (no RNA processing). 4. Antibiotics that inhibit protein synthesis on ribosomes in bacteria also inhibit protein Difference among eukaryotic cells There are many different types of eukaryotic cells, though animals and plants are the most familiar eukaryotes, and thus provide an excellent starting point for understanding eukaryotic structure. Fungi and many protists have some substantial differences, however. Animal cell An animal cell is a form of eukaryotic cell that makes up many tissues in animals. Animal cells are distinct from other eukaryotes, most notably plant cells, as they lack cell walls and chloroplasts. They also have smaller vacuoles. Due to the lack of a cell wall, animal cells can adopt a variety of shapes. A phagocytic cell can even engulf other structures. There are many different types of cell. For instance, there are approximately 210 distinct cell types in the adult human body. Plant cell Plant cells are quite different from the cells of the other eukaryotic organisms. Their distinctive features are: A large central vacuole (enclosed by a membrane, the tonoplast), which maintains the cell's turgor and controls movement ofmolecules between the cytosol and sap A primary cell wall containing cellulose, hemicellulose and pectin, deposited by the protoplast on the outside of the cell membrane; this contrasts with the cell walls of fungi, which contain chitin, and the cell envelopes of prokaryotes, in which peptidoglycans are the main structural molecules The plasmodesmata, linking pores in the cell wall that allow each plant cell to communicate with other adjacent cells; this is different from the functionally analogous system of gap junctions between animal cells. 15 Plastids, especially chloroplasts that contain chlorophyll, the pigment that gives plants their green color and allows them to perform photosynthesis Bryophytes and seedless vascular plants lack flagellae and centrioles except in the sperm cells.[16] Sperm of cycads and Ginkgoare large, complex cells that swim with hundreds to thousands of flagellae. Conifers (Pinophyta) and flowering plants (Angiospermae) lack the flagellae and centrioles that are present in animal cells. ",Medical,Concept Comparison,Q&A Answer the user query using only the information in the provided text.,How did verbal ability impact the results?,"Background: Individuals on the autism spectrum experience various challenges related to social behaviors and may often display increased irritability and hyperactivity. Some studies have suggested that reduced levels of a hormone called oxytocin, which is known for its role in promoting social bonding, may be responsible for difculties in social interactions in autism. Oxytocin therapy has been used of-label in some individuals on the autism spectrum as a potential intervention to improve social behavior, but previous studies have not been able to confrm its efcacy. Earlier clinical trials examining oxytocin in autism have shown widely varying results. This large randomized controlled trial sought to resolve the previous contradictory fndings and determine whether extended use of oxytocin can help to improve social behaviors in children and teenagers on the autism spectrum. Methods & Findings: Tis study evaluated whether a nasal oxytocin spray could afect social interactions and other behaviors (e.g., irritability, social withdrawal, and hyperactivity) in children and adolescents on the autism spectrum during a 24-week clinical trial. Individuals between the ages of 3 and 17 were assessed by trained researchers and were selected for participation if they met the criteria for autism. Participants were then randomly assigned to receive either a nasal oxytocin spray or a placebo (i.e., a comparison nasal spray that did not contain oxytocin) every day at a series of gradually increasing doses. Participants received social interaction scores every 4 weeks based on multiple assessments that were completed by caregivers or the participant. Separate analyses were performed in groups of individuals with minimal verbal fuency and high verbal fuency. Tis study found no diference in social interaction scores between the oxytocin group and the placebo group and no diference between the groups with difering levels of verbal ability. Implications: Te fndings of this study demonstrate that extended use of a nasal oxytocin spray over a 24-week period does not make a detectable diference in measured social interactions or behaviors in children and adolescents with autism. While this study showed no observable social beneft with the use of intranasal oxytocin, there are remaining questions around issues such as the ideal dose, whether current formulations are able to penetrate the blood-brain barrier, and whether a longer intervention time course could reveal efects. In addition, future studies that use techniques such as brain imaging may reveal new information on how oxytocin might be used in autism. ","Answer the user query using only the information in the provided text. Background: Individuals on the autism spectrum experience various challenges related to social behaviors and may often display increased irritability and hyperactivity. Some studies have suggested that reduced levels of a hormone called oxytocin, which is known for its role in promoting social bonding, may be responsible for difculties in social interactions in autism. Oxytocin therapy has been used of-label in some individuals on the autism spectrum as a potential intervention to improve social behavior, but previous studies have not been able to confrm its efcacy. Earlier clinical trials examining oxytocin in autism have shown widely varying results. This large randomized controlled trial sought to resolve the previous contradictory fndings and determine whether extended use of oxytocin can help to improve social behaviors in children and teenagers on the autism spectrum. Methods & Findings: Tis study evaluated whether a nasal oxytocin spray could afect social interactions and other behaviors (e.g., irritability, social withdrawal, and hyperactivity) in children and adolescents on the autism spectrum during a 24-week clinical trial. Individuals between the ages of 3 and 17 were assessed by trained researchers and were selected for participation if they met the criteria for autism. Participants were then randomly assigned to receive either a nasal oxytocin spray or a placebo (i.e., a comparison nasal spray that did not contain oxytocin) every day at a series of gradually increasing doses. Participants received social interaction scores every 4 weeks based on multiple assessments that were completed by caregivers or the participant. Separate analyses were performed in groups of individuals with minimal verbal fuency and high verbal fuency. Tis study found no diference in social interaction scores between the oxytocin group and the placebo group and no diference between the groups with difering levels of verbal ability. Implications: Te fndings of this study demonstrate that extended use of a nasal oxytocin spray over a 24-week period does not make a detectable diference in measured social interactions or behaviors in children and adolescents with autism. While this study showed no observable social beneft with the use of intranasal oxytocin, there are remaining questions around issues such as the ideal dose, whether current formulations are able to penetrate the blood-brain barrier, and whether a longer intervention time course could reveal efects. In addition, future studies that use techniques such as brain imaging may reveal new information on how oxytocin might be used in autism. What is oxytocin therapy?",Medical,Explanation/Definition,Q&A "Read the attached text, and then answer the question that follows using only details from the context provided. You will NOT refer to outside sources for your response. ","Based on the text above, what factors can contribute to wealth accumulation through homeownership?","Introduction In many respects, the notion that owning a home is an effective means of accumulating wealth among low-income and minority households has been the keystone underlying efforts to support homeownership in recent decades. The renewed emphasis on boosting homeownership rates as a policy goal that arose in the early 1990s can be traced in no small part to the seminal work by Oliver and Shapiro (1990) and Sherraden (1991) highlighting the importance of assets as a fundamental determinant of the long-run well-being of families and individuals. The efforts of these scholars led to a heightened awareness of the importance of assets in determining life's opportunities, enabling investments in education and businesses, providing economic security in times of lost jobs or poor health, and passing on advantages to children. Assessments of differences in asset ownership placed particularly emphasis on the tremendous gaps in homeownership rates by race/ethnicity and income and the importance of these gaps in explaining differences in wealth. In announcing their own initiatives to close these homeownership gaps, both President Clinton and President Bush gave prominent attention to the foundational role that homeownership plays in providing financial security (Herbert and Belsky, 2006). But while faith in homeownership's financial benefits are widely subscribed to, there have long been challenges to the view that owning a home is necessarily an effective means of producing wealth for lower-income and minority households. In 2001 the Joint Center for Housing Studies hosted a symposium with the goal of ""examining the unexamined goal"" of boosting low-income homeownership (Retsinas and Belsky, 2002a). The general conclusion that emerged from this collection of papers was that lower-income households do benefit from owning homes, although this conclusion was subject to a variety of ""caveats and codicils"" (Retsinas and Belsky, 2002b, page 11). A few of these caveats related to whether financial benefits were likely to materialize, with papers finding that all too commonly homebuyers sold their homes for real losses while alternative investments offered higher returns (Belsky and Duda, 2002; Goetzmann and Speigel, 2002). In perhaps the most comprehensive critique of the policy emphasis of fostering low-income homeownership, Shlay (2006) reviewed existing scholarly evidence to cast doubt on the likelihood that either the financial or social benefits of owning would be realized. These criticisms have only grown louder in the aftermath of the housing bust, as trillions of dollars in wealth evaporated leaving more than 10 million homeowners owing more than their homes are worth and leading to more than 4 million owners losing their homes to foreclosure (Joint Center for Housing Studies, 2012; Kiviat, 2010; Li and Yang, 2010; Davis, 2012). Many of the criticisms raised about 1 the financial risks of homeownership are not new, but the experience of the last five years has certainly given new impetus to these arguments. But there are also concerns that changes in the mortgage market and in consumer behavior may have exacerbated these risks, increasing the odds that owners will, at best, be less likely to realize any financial gains from owning and, at worse, face a heightened risk of foreclosure. The goal of this paper is to reassess in the light of recent experience whether homeownership is likely to be an effective means of wealth creation for low-income and minority households. Has the experience of the last decade proven the arguments of earlier critics of homeownership? Have changes in the market affected whether these benefits are likely to be realized? The paper takes three approaches to address these questions. We begin by presenting a conceptualization of the risks and rewards of homeownership as a financial choice, with a particular eye toward whether the odds of a beneficial outcome are lower for lower-income and minority owners. This review also assesses whether recent experience has altered this calculus-as opposed to just raising our awareness of the proper weighting of the likelihood of realizing the benefits while sidestepping the risks. Next, we review the existing literature examining the financial benefits of owning a home, including both studies simulating the returns to owning and renting as well as studies using panel surveys to track actual wealth accumulation among owners and renters. Finally, we examine data from the Survey of Consumer Finance (SCF) and the Panel Study of Income Dynamics (PSID) covering the last decade to assess how owning a home has been associated with changes in household financial balance sheets over this period. To preview our conclusions, we find that while there is no doubt that homeownership entails real financial risks, there continues to be strong support for the association between owning a home and accumulating wealth. This relationship held even during the tumultuous period from 1999 to 2009, under less than ideal conditions. Importantly, while homeownership is associated with somewhat lower gains in wealth among minorities and lower-income households, these gains are on average still positive and substantial. In contrast, renters generally do not see any gains in wealth. Those who buy homes but do not sustain this ownership also do not experience any gains in wealth, but are generally left no worse off in wealth terms than they were prior to buying a home-although of course there may still be substantial costs from these failed attempts at owning in terms of physical and mental health as well as future costs of credit. We conclude that homeownership continues to represent an important opportunity for individuals and families of limited means to accumulate wealth. As such, policies to support homeownership can be justified as a means of alleviating wealth disparities by extending this 2 opportunity to those who are in a position to succeed as owners under the right conditions. The key, of course, is to identify the conditions where lower-income and minority households are most likely to succeed as owners and so realize this potential while avoiding the significant costs of failure. Assessing the Financial Risks and Rewards of Homeownership Before turning to evidence about the financial returns to homeownership, it is helpful to start by framing the arguments about why homeownership is thought to be an effective means of generating wealth as well as the counter arguments about why these benefits may not materialize, particularly for lower-income and minority homeowners. We then consider how changes in mortgage markets and consumer behavior may have altered the likelihood that owning will lead to financial gains. This framing helps provide a basis for interpreting the findings from the following two sections of the paper that examine evidence about the association between homeowning and wealth accumulation. The Potential Financial Benefits of Owning The belief that homeownership can be an important means of creating wealth has its roots in five factors. First, the widespread use of amortizing mortgages to finance the acquisition of the home results in forced savings as a portion of the financing cost each month goes toward principal reduction. While modest in the early years of repayment, the share of the payment going toward principal increases over time. For example, assuming a 30-year loan with a 5 percent interest rate, a homeowner will have paid off about 8 percent of the mortgage after 5 years, 19 percent after 10 years, and nearly a third after 15 years. Assuming a household purchases a home in their early 30s and keeps on a path to pay off the mortgage over a thirty-year period, these forced savings will represent a sizable nest egg when they reach retirement age. In addition, an often overlooked aspect of forced savings associated with homeownership is the accumulation of the downpayment itself, which often entails a committed effort to accumulate savings in a short period. Second, homes are generally assumed to experience some degree of real appreciation over time, reflecting increased overall demand for housing due to growth in both population and incomes against a backdrop of a fixed supply of land located near centers of economic activity. Shiller (2005) has been the most notable critic of this point of view, arguing that over the very long-run real house prices have only barely exceeded inflation. Lawler (2012), however, has argued that Shiller's house price estimates and measures of inflation result in an underestimate of real house price growth. Analysis of trends in real house prices across a range of market areas support the conclusion that these trends 3 reflect a complex interaction of supply and demand factors in local markets that defy simple categorization (Capozza et al. 2002, Gallin, 2006). At a national level the Federal Housing Finance Agency house price index indicates that between 1975 and 2012 the compound annual growth rate in house prices has exceed inflation by 0.8 percentage points. Even at a modest rate of increase, the compounding of these returns over a longer period of time can be produce substantial increase in real home values. Assuming just a 0.8 percent annual real increase in house values over 30 years an owner will experience a real gain of about 26 percent in the overall house value. The use of financing can further leverage these returns. A homebuyer with a modest downpayment gets the benefit of increases in the overall asset value despite their small equity stake. While the cost of financing can create a situation of negative leverage if the increase in house values is lower than the cost of financing (so that the financing costs exceed the increase in the asset value), this risk diminishes over time as the value of the house compounds while the debt payment is fixed. Through leverage, the rate of return on an investment in a home can be substantial even when the increase in house values is modest. Consider the case where a buyer puts down 5 percent and the house appreciates at 4 percent annually. After 5 years the home will have increased in value by nearly 22 percent or more than 4 times the initial 5 percent downpayment. Even allowing for selling costs of 6 percent, this would represent an annualized return of 31 percent on the owner's initial investment. Due to leverage, even nominal increases in home values that do not exceed inflation can result in real returns. In the above example, if inflation matched the 4 percent growth in home prices, the owner would still have earned a substantial real return on their initial investment. Federal income tax benefits from owning a home can also be substantial. The ability to deduct mortgage interest and property taxes is the most apparent of these benefits. Taxpayers who are able to make full use of these deductions receive a discount on these portions of ongoing housing costs at the taxpayer's marginal tax rate, ranging from 15 percent for moderate income households up to 39 percent for the highest tax bracket. In addition, capital gains on the sale of a principal residence up to $250,000 for single persons and $500,000 for married couples are also excluded from capital gains taxation, which is currently 15 percent for most households and 20 percent for the highest income bracket.1 1 An additional tax benefit that is often overlooked is the fact that while owner occupants benefit from the use of their home as a residence they do not have to pay any tax on these benefits, referred to as the implicit rental income from the property (that is, the rent one would have to pay to occupy the home) (Ozanne, 2012). The loss of revenue to the U.S. Treasury from this exclusion is substantial, outweighing the costs of the mortgage interest deduction. 4 Finally, owning a home provides a hedge against inflation in rents over time. Sinai and Souleles (2005) find that homeownership rates and housing values are both higher in markets where rents are more volatile, indicating the value placed on being able to protect against rent fluctuations. Under most circumstances, mortgage payments also decline in real terms over time, reducing housing costs as a share of income. For long-term owners, this can result in fairly substantial savings in the out of pocket costs for required for housing. Assuming a fixed rate mortgage, inflation of 3 percent, 1 percent growth in both real house prices and the costs of property taxes, insurance and maintenance, real monthly housing costs would decline by about 10 percent after 5 years, 15 percent after 10 years, and 30 percent by the last year of the mortgage. Once the mortgage is paid off, the out of pocket costs of owning in real terms are less than half the payments made at the time of purchase. Housing costs for renters, in contrast, would be expected to keep pace with inflation in housing prices. The Potential Financial Risks of Owning Combined, the financial benefits outlined above can fuel significant wealth accumulation. But as the last few years have made painfully clear, the financial benefits associated with owning a home are not without risk. To begin with, house prices can be volatile. That was certainly the case in the wake of the housing bust, as nominal prices fell nationally by some 25 percent or more (depending upon the specific price index used), with the hardest hit markets experiencing declines of more than 40 percent. Almost no area of the country was spared from some degree of decline. According to the FHFA index, nominal prices fell in every state with the exception of North Dakota. But while recent experience is notable for the breadth and depth of price declines, there are other examples of fairly significant price declines over the last few decades, including declines of between 10 and 20 percent in some Oil Patch states in the 1980s and in New England, California and Hawaii in the early 1990s. There are also a number of markets where house prices trends have historically been more stable, but in these areas long-run real price increases have either not kept pace with inflation or have been modest. House price growth has been particularly weak in a number of markets in the Midwest and South where population and income growth have been low. Based on long-run state level indexes from FHFA, between 1975 and 2012 there were 10 states in these regions where the compound annual growth in house prices did not exceed general price inflation. Even before the bust, homeowners in these markets did not have the benefit of real growth in house prices over the long term. In nine other states house price growth did beat inflation, but by less than 0.25 percent on an annual basis. Thus, in about two-fifths of states real house price growth was either non-existent or trivial. At the other 5 extreme there were 17 states, mostly along the Pacific coast and in the Northeast that experienced real house price growth of more than 1 percent, including 5 states that exceeded 2 percent. There are also peculiar aspects of owning a home that further exacerbate the financial risks of these investments. Homeowners make a significant investment in a specific location and cannot diversify the risk of home price declines by spreading this investment across assets or across markets. Homes values are also high relative to incomes and so account for a large share of household wealth. Wolff (2012) reports that in 2010 the value of the principal residence accounted for two-thirds of total wealth among households in the middle three quintiles of the wealth distribution. With so much wealth tied up in one asset, homeowners are particularly vulnerable to changes in home values. The use of debt financing for a large share of the purchase further magnifies these risks, with even small drops in prices wiping out substantial shares of homeowner equity. Indeed, at the height of the housing bust the number of households underwater on their mortgages was estimated by CoreLogic to have exceeded 11 million while Zillow placed the number closer to 15 million. When assessed purely on the basis of real growth in values over time, housing also compares poorly to the returns offered by investments in diversified portfolios of stock or bonds. Geotzmann and Speigel (2002) compare the change in home prices in 12 market areas between 1980 and 1999 to a range of alternative investments and find that housing was consistently dominated as an investment asset by all of the financial alternatives considered, leading them to conclude that it is ""surprising that housing continues to represent a significant portion of American household portfolios"" (page 260). However, Flavin and Yamashita (2002) take a more expansive view of the returns on housing investments by including the value derived from occupying the unit, the use of financial leverage, and the ability to claim income tax deductions. This fuller treatment of housing's returns finds that the average rate of return was slightly below returns for investments in stocks, but the variance of these returns were also lower and so somewhat less risky. Still, even if the returns to housing are deemed to be competitive with alternative investments the concern remains that it accounts for an excessive share of low-wealth household's portfolios. Housing investments are also handicapped by high transaction costs associated with buying and selling these assets. Home buyers face fees for mortgage origination, title search and insurance, state and local taxes, home inspections, and legal fees, all of which can add up to several percentage points of the home value. Real estate broker commissions typically also command 6 percent of the sales price. These high transaction costs can absorb a significant share of home price appreciation from the first few years of occupancy. Given these high costs, home owners who are forced by circumstances to move 6 within a few years of buying will face the risk of loss of at least some share of their initial investment even if home values have risen modestly. The need to maintain the home also imposes financial risks on owners. While routine maintenance can keep both the physical structure and the home's major systems in good working order, major investments are periodically needed, such as painting the exterior or replacing the roof or heating system. These projects incur high costs that may be difficult for owners to afford. While owners may have the opportunity to plan for these investments over time, in some cases a system will fail with little warning and produce an unexpected cost that the owner cannot afford, creating a financial strain that in the most extreme cases can jeopardize the ability to maintain ownership. Finally, the financial costs of failing to sustain homeownership are high-in addition to the traumatic impacts that foreclosures can have on the health and psychic well-being of the owner (Carr and Anacker, 2012). Owners who default on their mortgage will not only lose whatever equity stake they had in the home, they are also likely to deplete their savings in a bid to maintain ownership and suffer significant damage to their credit history making it difficult and costly to obtain credit for several years to come. Factors Contributing to Wealth Accumulation Through Homeownership Whether and to what extent a homebuyer will realize the potential benefits of owning while avoiding succumbing to the risks depends on a complex set of factors. Herbert and Belsky (2006) present a detailed conceptual model of the factors that contribute to whether homeownership produces wealth over the life course, which is briefly summarized here. The most obvious factor is the timing of purchase relative to housing price cycles. The recent boom and bust in house prices presents a prime example. Homebuyers who bought in the early 2000s were poised to benefit from the massive run-up in prices that occurred in many markets, while those that bought in the mid 2000s entered just in time for the historic freefall in prices that followed. While other price cycles in recent decades may not have been as dramatic, the consequences of buying near troughs or peaks on wealth accumulation would have been similar. Belsky and Duda (2002) examined data on repeat sales in four market areas between 1982 and 1999 and found that roughly half of owners who bought and sold their homes within this time period failed to realize gains that beat inflation after assuming a 6 percent sales cost (although most did earn a return in nominal terms). Whether owners realized a positive return depended strongly on where in the housing price cycle they bought and sold their homes. 7 Belsky and Duda (2002) conclude that ""although the golden rule of real estate is often cited as location, location, location, an equally golden rule is timing, timing, timing"" (Page 223). Their conclusion points to another critical factor in how likely a home is to appreciate in value - in what market and in which specific neighborhood the home is located. As noted above, there have been sizeable differences across market areas in long-term house price trends, with areas along the coasts experiencing real gains of one percent or more over the last several decades while areas in the Midwest and South have had little or no gains. But there are also substantial variations in price trends across neighborhoods within a single market (for reviews of this literature see Herbert and Belsky, 2006; Dietz and Haurin, 2003; and McCarthy, Van Zandt and Rohe, 2001). Whether a household bought a home in Boston or Cleveland is an important factor in the returns realized, but so is whether the home was in a desirable area or a declining neighborhood. The terms of financing used to buy the home also matter. Higher interest rates lower the share of payments that are devoted to principal reduction in the early years of repayment, slowing wealth accumulation. The higher monthly costs of the mortgage also erode the ability of the household to meet other expenses and to save on an ongoing basis as additional interest payments over the life of the mortgage can be substantial. For example, over a thirty-year term a loan for $150,000 at 7 percent interest will require $69,000 more in interest payments than a 5 percent loan. Higher origination fees also sap savings, reducing the quality and size of home that is affordable and lowering the rate of return on housing investments. Choices about refinancing over time can also exert a strong influence on wealth accumulation. Taking advantage of declines in mortgage interest rates to reduce financing costs can save owners hundreds of dollars each month, and tens of thousands over the life of a mortgage-although continually resetting the term of the mortgage will reduce opportunities for forced savings. On the other hand, refinancing to take cash out of the property can erode wealth accumulation, particularly if the extracted funds are used to finance consumption rather than investments in the home, education, business or financial opportunities. Wealth accumulation will be further undermined if the new loan comes with high fees and higher interest rates. Of course, the ability to tap housing wealth as a buffer against income shocks is one of the virtues of developing this cushion, but using home equity to finance an unaffordable lifestyle is an unsustainable path. A host of other factors come into play in determining how much housing wealth is realized over the span of a lifetime. For example, buying higher valued homes-if successful-can produce more wealth both through forced savings and by earning returns on a higher valued asset. By the same 8 means, those who trade up to more expensive homes over time may also accrue greater housing wealth. The age at which a first home is purchased can also be significant, giving the household a longer period to accumulate wealth. Of course, the quality of the home purchased and the owner's ability to maintain it will also affect both ongoing maintenance costs and how much the home appreciates over time. But arguably the most fundamental factor-the true golden rule of how to accumulate wealth. through homeownership-is whether ownership is sustained over the long term. Housing booms aside, many of the financial benefits are slow to accumulate, including the slow build up of forced savings, the compounding of values at low appreciation rates, and the decline in monthly housing costs in real terms over time. The expression ""time heals all wounds"" may also be applicable to many of homeownerships most critical risks. The losses associated with buying near the peak of a price cycle will diminish over time as owners benefit from the next upswing in prices. And even in areas whether real growth in house prices does not occur or is limited, over the long term owners will still amass some degree of wealth through paying off the mortgage and as a result of savings from lower housing costs. On the flip side, a failure to sustain homeownership-particularly when the end result is a foreclosure-will wipe out any accrued wealth and bring additional costs in the form a damaged credit history that will incur further costs over time and limit opportunities to buy another home in the near term. To some degree whether ownership is sustained will depend on choices that owners make over time - including whether the home they buy is affordable, whether they make prudent choices about refinancing, and whether they maintain the home to avoid larger home repair bills. But whether owning is sustained also will depend on whether the household can weather any number of significant events that can fundamentally alter their financial circumstances, such as loss of a job, a serious health problem, or change in the family composition due to the birth of a child, death, divorce, or the need to care for a parent or relative. Over the course of a lifetime, these events are likely to befall most everyone. Whether homeownership can be sustained in the wake of these events will depend on the ability of the household to adjust to their changed circumstances and whether they have enough available savings to cushion the blow. Impediments to Wealth Creation among Lower-Income and Minority Homeowners Up to this point the discussion presented has considered homeownership's financial risks and rewards in a general sense. But the concern of this paper is specifically with the potential for homeownership to serve as an effective means of wealth accumulation for lower-income and minority 9 households. How are the odds of generating wealth as a homeowner likely to differ for these households?? In keeping with the fundamental importance of sustained homeownership to accumulate wealth, the chief concern is that these groups of homebuyers face a more difficult time in maintaining ownership. Studies analyzing panel data to document homeownership spells among first-time buyers consistently find that low-income and minority owners have a lower probability of maintaining homeownership for at least five years. In an analysis of the National Longitudinal Survey of Youth (NLSY) from 1979 through 2000 Haurin and Rosenthal (2004) find that ownership is less likely to be sustained among both these groups. Specifically, only 57 percent of low-income buyers were found to still own their first home five years later, compared to 70 percent of high-income owners (with income categories defined by income quartiles at age 25). First homeownership spells were also found to be much shorter for minorities, averaging 6.5 years among whites, compared to 4.4 years for blacks and 5.4 years for Hispanics. In an analysis of the PSID covering the period from 1976 through 1993 Reid (2004) had similar results, with only 47 percent of low-income owners still owning their first homes 5 years later compared to 77 percent of high income owners (with incomes here defined based on average income in the years prior to homeownership compared to area median incomes). Reid further found that minorities had a harder time staying in their first home, with 42 percent of low-income non-whites still owning after five years compared to 54 percent of low-income whites. While these results raise clear concerns about the high risk of failed homeownership among these groups, the focus on a single homeownership spell may overstate the extent to which homeowning is not sustained in the long run. Haurin and Rosenthal (2004) also examine subsequent tenure experience in their panel and find that the share of households that return to owning a second time is very high for both whites and minorities. Over the 21 year period in their panel, 86 percent of whites who ever bought a home either never returned to renting or regained owning after a subsequent spell as a renter, with only slightly lower rates for blacks (81 percent) and Hispanics (84 percent). However, they do find that minorities spend more years in their intervening spells as renters, which reduces the overall amount of time they can accumulate benefits from owning. Another critical difference in the financial returns to owning for low-income households is that the ability to deduct mortgage interest and property taxes from federal taxable income may be of little or no value. In order to benefit from these tax provisions, the amount of available deductions must 2 Galster and Santiago (2008) provide a useful framing of this issues and a comprehensive review of the relevant literature. 10 exceed the standard deduction, which stood at $5,950 for individuals and $11,900 for married couples in 2012. For taxpayers with lower valued homes, particularly married couples, the costs of mortgage interest and property taxes even when added to other deductions for state taxes and charitable contributions, may not greatly exceed the standard deduction. In addition, the value of these deductions depends on the taxpayer's marginal tax rate, which will lower for low- and moderate-income households. In fact the share of the total value of the mortgage interest deduction going to moderate income households is fairly small. According to estimates from the Joint Committee on Taxation (2013), only 3 percent of the total deductions went to filers with incomes under $50,000, 9 percent to those with incomes between $50,000 and $75,000, and 11 percent to those with income between $75,000 and $100,000, leaving 77 percent of the benefit going to those earning above $100,000. To the extent that these tax benefits swing the financial scales in favor homeownership, this tilting of the calculus is not very evident for low- and moderate-income tax filers. There are also systematic differences in mortgage terms and characteristics by income and race/ethnicity that can also affect the financial returns to owning. The development of the nonprime lending industry that began in the 1990s and came to full blossom during the housing boom produced much greater variation in mortgage terms and pricing than had previously been evident. A fairly extensive literature has documented the greater prevalence of subprime lending among minorities and, to a lesser extent, low-income borrowers and communities (see, for example, Bradford, 2002; Calem, Gillen and Wachter, 2004; Apgar and Calder, 2005; Avery, Brevort, and Canner, 2007; Belsky and Richardson, 2010). As described above, higher costs of financing can significantly reduce the financial benefits of owning. While the expansion of financing options beyond a ""one size fits all who qualify"" approach to lending has the potential to extend homeownership opportunities to a greater range of households, there is significant evidence that the cost of credit was often higher than risk alone would warrant. Bocian, Ernst and Li (2008) present perhaps the most compelling evidence through an analysis of a large data set on nonprime loans that documents a wide range of risk measures, including credit scores as well as income and race/ethnicity. They find that even after controlling for observable differences in credit quality both blacks and Hispanics were significantly more likely to obtain high- priced mortgages for home purchase, while blacks were also more likely to obtain higher-priced refinance loans. These higher costs of borrowing not only limit the wealth producing capacity of homeownership, they also increase the risk of failing to sustain homeownership. In fact, Haurin and Rosenthal (2004) find that a 1 percentage point increase in the mortgage interest rate increases the rate of homeownership termination by 30 percent. 11 Low-income and minority borrowers are also less likely to refinance when interest rates decline. In an analysis of loans guaranteed by Freddie Mac during the 1990s Van Order and Zorn (2002) find that low-income and minority borrowers were less likely to refinance as interest rates fell. Their analysis also found that once borrower risk measures and loan characteristics were taken into account there were no remaining differences in refinance rates by income-although this just indicates that refinancing may be constrained by credit factors. Minorities, on the other hand, still had lower rates of refinancing even after controlling for these factors, suggesting that there were impediments to refinancing by these borrowers that were in addition to measurable credit factors. Nothaft and Chang (2005) analyze data from the American Housing Survey (AHS) from the late 1980s through 2001 and also find that minority and low-income owners were less likely to refinance when interest rates declined. These authors use their results to estimate the foregone savings from missed refinance opportunities, which are more than $20 billion each for black and low-income homeowners. To the extent that low-income and minority homebuyers may be more likely to purchase homes in poor condition they are also exposed to greater risks of high costs of maintenance and repair. Herbert and Belsky (2006) find that compared to whites, black and Hispanic first-time homebuyers were more likely to buy homes that were moderately or severely inadequate as characterized by the AHS- 6.5 percent for blacks and 8.8 percent for Hispanics compared to 4.3 percent among whites. A similar gap was also evident between low- and high-income households. While there has been little study of the incidence of unexpected home repair needs, a study by Rohe and his colleagues (2003) of participants in homeownership counseling programs found a fairly significant incidence of the need for unexpected repairs. Roughly half of 343 recent homebuyers reported that they had experienced a major unexpected cost in the first few years after buying their home, with the most common problem being a repair to one of the home's major systems. Finally, there are also concerns that lower-income households and minorities may be more likely to purchase homes in neighborhoods with less potential for house price appreciation. This is a particularly salient issue for minorities given the high degree of residential segregation by race and ethnicity that continues to be evident in the US. However, Herbert and Belsky (2006) present a detailed review of this literature and conclude that ""taken as a whole the literature indicates that there is no reason to believe that low-value segments of the housing market will necessarily experience less appreciation than higher-valued homes. In fact, at different points in time and in different market areas, low-valued homes and neighborhoods have experienced greater appreciation rates. Although the opposite is also true."" (Page 76) The evidence about differences in appreciation rates by neighborhood 12 racial composition is less definitive. Here Herbert and Belsky (2006) conclude that ""it does appear that homes in mostly black areas may be less likely to experience appreciation, but this conclusion is tempered by the small number of studies and the fact that they mostly analyzed trends from the 1970s. and 1980s, which may no longer be relevant"" (page 77). Findings by Boehm and Schlottmann (2004) regarding differences in wealth gains from homeownership by race and income are instructive in this regard. They find that over the period from 1984 to 1992 there was little difference in appreciation rates in the specific neighborhoods where minorities and low-income households lived. Instead, they found that differences in housing equity accumulation were tied to the lower valued homes and the shorter duration of ownership for lower- income and minority households. Thus, differences in appreciation rates may be less of a concern in whether housing leads to wealth accumulation than these other considerations. Re-assessing the Calculus of Wealth Accumulation through Homeownership As the above review has shown, there were significant concerns about the risks of homeownership as an investment well before the housing bubble burst. For critics of homeownership as a wealth building tool the experience of the housing bust was in many respects a confirmation of their fears. Still, there were several markets developments during the boom years that magnified these preexisting risks. Most notably there was a marked increase in the prevalence of riskier mortgages, including those calling for little or no documentation of income, adjustable rate loans that exposed borrowers to payment shocks from the expiration of initial teaser rates or reduced payment options, allowances for higher debt to income ratios, and greater availability of loans for borrowers with very low credit scores. Downpayment requirements also eased as loan-to-value ratios (LTVs) of 95 percent or more became more common and borrowers also used ""piggyback"" second mortgages to finance much of the difference between the homes' value and a conforming first mortgage at an 80-percent LTV. Not unrelated to the greater availability of mortgage credit, house prices also exhibited much greater volatility than in the past, with a dramatic increase in prices that greatly outpaced trends in both incomes and rents and belied an unsustainable bubble. The greater availability of credit also increased the opportunity for lower-income households to miss-time the market. Belsky and Duda (2002) found that during the 1980s and 1990s lower-valued homes were less likely to be transacted around market peaks, so buyers of these homes were less likely to buy high and sell low. They speculated that this was due to the natural affordability constraints that took hold as markets peaked. But during the boom of 13 the 2000s lower-valued homes experienced greater volatility in prices, arguably reflecting much greater credit availability at the peak than was true in past cycles (Joint Center for Housing Studies, 2011). However, there are good reasons to believe-or certainly to hope-that the conditions that gave rise to this excessive risk taking and associated housing bubble will not be repeated any time soon. The Dodd-Frank Act includes a number of provisions to reduce the degree of risk for both borrowers and investors in the mortgage market. The Qualified Mortgage (QM) is aimed at ensuring that borrowers have the ability to repay mortgages by requiring full documentation of income and assets, setting tighter debt to income standards, and excluding a variety of mortgage terms that expose borrowers to payment shocks. The Qualified Residential Mortgage (QRM) is aimed at ensuring greater protections for investors in mortgage backed securities by requiring the creators of these securities to retain an interest in these investments if the loans included in the loan pool do not conform to certain risk standards that essentially mirror those of the Qualified Mortgage. Dodd-Frank also established the Consumer Financial Protection Bureau to fill a gap in the regulatory structure by creating an agency charged with looking out for consumers' interests in financial transactions. Beyond these regulatory changes, there is also a heightened awareness of the risks of mortgage investments on the part of private sector actors who have suffered significant financial losses with the bursting of the housing bubble. Regulatory changes aside, these private actors are unlikely to embrace riskier lending any time soon. The Federal Reserve and other federal regulators are certainly more attuned to the possibility of a bubble in housing prices and so are more likely to act in the event that signs of a bubble re-emerge. But even in the absence of the excessive risks of the last decade, homeownership will remain a risky proposition. Thus, at best, we may return to the market conditions that existed prior to the boom and the real risks that these conditions posed for investments in owner-occupied housing. In that regard, an assessment of experience in wealth creation through homeownership prior to the boom is relevant for what we might expect in the future. On the other hand it does seem likely-and arguably even desirable given how tight credit has become-that some greater degree of risk taking will emerge to make credit available to the many lower-income and lower-wealth households that would like to own a home. In fact, the QM standard of a total debt-to-income ratio of up to 43 percent does curtail the higher levels that became evident during the boom, but this cutoff still represents a liberalization from standards for conventional mortgages that prevailed in the 1990s. There may also have been a shift in consumer attitudes toward mortgage debt, with fewer households seeking to pay off mortgages over time and thus exposing themselves for longer periods to the risks associated with these leveraged investments. Over time, as 14 conditions return to normal and the market adjusts to new regulatory structures, we are likely to see mortgages originated outside of the QM and QRM boxes. In that regard, an assessment of the experience of homeowners through the boom and bust is instructive as a stress test of how likely homeownership is to build wealth under more extreme market conditions. The next two sections of the paper look to assess homeownership's potential for wealth building from these two perspectives. First by presenting a review of the literature assessing homeownerships' association with wealth building prior to the 2000s and then by analyzing data from the last decade to examine how homeownership was associated with changes in wealth through the turbulent conditions of the 2000s. Review of Previous Studies Assessing the Financial Returns to Homeownership As the discussion up to this point has intended to illustrate, whether owning a home will lead to the accumulation of wealth is the result of complex set of factors related to the choices that households make in buying their home and how these choices interact with market conditions both at the time of purchase and over time. This complexity makes it quite difficult to assess whether in practice owning is likely to be an effective means of increasing a household's wealth. A further complicating factor is that there is a substantial selection bias in who becomes a homeowner, as there is reason to believe that those who are most secure in their financial condition and most inclined to save are more likely to become owners. For this reason, comparisons of the wealth profiles of owners and renters may not be able to attribute any observed differences solely to the influence of homeownership on the ability to accrue wealth. There are two broad classes of studies that have attempted to assess the financial benefits of homeownership in light of these challenges. One group relies on simulations that compare the theoretical costs and benefits of owning and renting under a variety of assumptions about market conditions and household choices. A key appeal of these studies is that they essentially remove concerns about selection bias by assuming otherwise identical households operate under a consistent set of decision rules. They can also isolate the influence of specific factors to shed light on the paths that are most likely to make owning or renting financially beneficial. But while these studies highlight the potential financial returns to owning and renting, they do not capture how households are likely to actually behave in these situations and so leave open the question of whether the potential returns of these tenure choices are likely to be realized in practice. 15 Another group of studies rely on panel studies that track households over time to examine how choices about owning and renting are correlated with changes in wealth. The findings from this type of analysis provide evidence of whether in practice owners are more likely to accrue wealth than renters and how this experience differs by income and race/ethnicity. Where the theoretical comparisons of owning and renting also generally focus on a single spell of homeownership - that is, the financial outcome associated with the period between buying and selling a single home - panel studies can track households through multiple transitions in and out of owning to assess outcomes from a series of tenure choices over time. The main drawback of these studies is the lingering concern that owners may be inherently different from renters in ways that observable household characteristics cannot capture. Some of these studies employ statistical methods to try to control for this selection bias, although it is doubtful that these controls can fully account for these differences. Both classes of studies provide important insights into the opportunities and drawbacks of homeownership as a means of increasing household wealth. When viewed as a whole the findings from both streams of research help paint a clearer picture of whether and how homeownership may help foster wealth creation. The sections that follow highlight key findings from each of these literature strands. Simulations of the Financial Returns to Owning and Renting Beginning with Mills (1990) there have been a number of studies that have simulated the financial returns to owning and renting under a variety of assumptions to identify whether and under what circumstances owning or renting is likely to be more financially beneficial (Capone, 1995; Belsky, Retsinas, and Duda, 2007; Rappaport, 2010; Beracha and Johnson, 2012). While the studies differ in important respects, the general approach is to compare the ""all-in"" costs of owning - including mortgage interest, property taxes, insurance, maintenance, and transaction costs along with offsetting gains in property value - to the costs of renting a comparable housing unit. Either implicit or explicit in these comparisons is that renters save and invest both the initial investment that owners make in buying their homes as well as any annual savings in housing costs. There are a host of assumptions that underlie these calculations, but among the most influential factors are the estimate of rents as a share of house value, the length of time the home is owned, the basis for simulating trends in house prices and rents over time, and the treatment of income tax benefits. The studies differ in fundamental ways related to the range of assumptions tested and the method for comparing returns to owning and renting and, as a result, individually reach somewhat 16 different conclusions about which tenure choice is likely to be preferred. But collectively the studies lead to some general conclusions about the relative financial merits of owning and renting. Perhaps the most fundamental conclusion from these studies that runs counter to the prevailing sense that homeownership is a powerful source of wealth is that under a variety of conditions renting is often more likely to be a better financial choice than owning. Belsky, Retsinas and Duda (2007) compare owning and renting in four different market areas chosen to represent different degrees of price appreciation and volatility over the period studied from 1983 through 2001. They focus on holding periods of 3, 5 and 7 years during their window of study and report the share of different holding periods where owning results in higher financial returns than renting. Overall they find that in only 53 percent of the 3-year holding periods would owning be preferred to renting. Increasing the holding period to 7 years-which allows for more time to work off the high transaction costs of buying and selling a home-only increases this proportion to 63 percent. Rappaport (2010) reaches a similar conclusion based on an analysis of national trends in market conditions between 1970 and 1999 and an assumed 10-year period of owning a home. He finds that owning a home unambiguously built more wealth in about half of the possible 10-year periods, renting was clearly better in another quarter and likely, but not unambiguously, preferred in the remaining periods. Finally, Beracha and Johnson (2012) come to a similar conclusion in an analysis of all possible 8-year holding periods given actual market conditions at both the national and regional level between 1978 and 2009. They find that between 65 and 75 percent of cases renting offered greater opportunities for accruing wealth than owning, depending on whether renters employing a more conservative or aggressive investment approach. In parsing the findings of these studies, there are several factors that are the critical drivers of the results. Perhaps the most obvious is the importance of the timing of home purchase relative to market cycles in prices and interest rates. Depending on the future course of prices, rents and interest rates one or the other tenure would be strongly preferred at different points in time. The importance of timing may be most clearly demonstrated in Belsky, Retsinas and Duda (2007) when they consider different holding periods among owners. In general, it would be expected that longer holding periods should favor owning as more time is allowed to overcome high transaction costs, pay down additional principal, and ride out price cycles. Instead, they find that in most markets the likelihood of owning being preferred to renting was little changed by the holding period as short holding periods offered the possibility of catching only the upswing in prices while longer holds made it more likely that owners would share in some portion of a downturn. Only in Chicago, which did not experience such dramatic swings in prices, were longer holding periods found to be much more likely to benefit owning. 17 Still, the issue of holding period is an important consideration. The analysis by both Mills and Capone solved for the holding period that was needed for owning to yield a higher return than renting on the assumption that longer holding periods would always favor homeownership. In his base case scenario Mills found a holding period of slightly longer than 7 years was needed for owning to be preferred. The more recent studies that have showed the importance of market timing either assumed a single fixed holding period of 8 to 10 years (as in Beracha and Johnson and Rappaport) or a range of relative short holding periods (as in Belsky, Retsinas and Duda). If owning does become more favorable over a longer period of time - for example, slightly longer than 8 to 10 years - these assessments would not capture this. In fact, many households move in and out of homeownership over time so a more complete assessment of the financial implications of tenure choice would take into account multiple homeownership spells. While one spell of owning may yield low returns, if homeowning is sustained or resumed then the household may yet benefit from the next upswing. Another important factor driving the findings are assumptions made about rents as a share of house value. This ratio is difficult to estimate both because of systematic differences in the nature of the owner and renter occupied stock and because market values and rents are hard to observe simultaneously. How much renters have to pay to rent a comparable home is obviously a key driver of financial outcomes as it determines how much they can save annually by renting, thereby adding to their wealth. Mills (1990) found that among the variables used in his simulation, his results were most sensitive to the ratio of rents to house values as a single percentage point change up or down leading to fluctuations in the required holding period from 3 to 23 years. Capone (1995) built on Mills study to examine the rent-versus-buy decision specifically for lower income households. He makes note of the importance of the rent-to-price ratio assumption and argues that Mills assumption of 7 percent was well below the ratios observed in low-cost segments of the market, where ratios of 10 to 12 percent were more reasonable. Under Capone's assumption that renters faced much higher rents he found that owners only needed to hold onto their homes for about 3 years for owning to be preferred. In contrast, Belsky, Retsinas and Duda rely on rent to price ratios is in the range of 5 to 7 percent, while the series used by Beracha and Johnson derived by Davis, Lehnert, and Martin (2008) appears to average about 5 percent. In both cases these assumptions are more favorable to renting than the assumptions used by either Mills or Capone. In recognition of the importance of this assumption, Rappaport structures his analysis to estimate the rent-to-price ratio that is the breakeven point between owning and renting. He then compares this estimate to what he feels is a plausible range for this ratio of 18 between 5 and 10 percent based on analysis of different market areas over time. At the higher end of this range owning would almost always be preferred, while the lower end leads to his conclusion that owning is clearly preferred to renting in only about half of the holding periods considered. In short, high or low values of this ratio can swamp other considerations, yet, as Rappaport demonstrates, pinning down actual values for this ratio is not an easy task. Several of the studies have examined the issue of whether tax benefits are important to whether owning makes more financial sense than renting. Mills assumes that owners can take full advantage of tax benefits at a 28 percent marginal rate. When he reduces the marginal rate to 15 percent he finds that owning is never preferred. Capone, though, demonstrates, that this knife edge does not hold if a higher rent to price ratio is assumed. In his base case analysis, owners are only assumed to benefit from tax benefits if they exceed the standard deduction and since he assumes a much more modest house in keeping with his focus on lower-income households, the tax benefits are essentially non-existent. As a result, reducing the tax benefits in his analysis does not change his conclusion that owning is a better financial choice even after only a few years. Belsky, Retsinas and Duda also examine the importance of tax benefits for lower-income owners. Like Capone, they adjust the value of tax deductions to account for the size of the home purchased and the amount of the standard deduction. They also find that tax benefits by themselves generally do not change the calculus of whether owning beats renting financially. So while tax benefits are an important factor among higher income households, as Mills found, it has little effect on the calculus for lower-income households. Despite getting limited benefits from tax breaks under a variety of circumstances Capone and Belsky, Retsinas and Duda find that lower-income households can fare better financially by owning. Belsky, Retsinas and Duda also make a unique contribution by examining how the returns to homeownership are affected by higher mortgage costs. They examine two scenarios: one where owners face interest rates that are 2 percentage points higher than prime rates and another where they are 5 percentage points higher. Under the first scenario, the likelihood that owning would be preferred to renting is decreased by moderate amounts (between 6 and 17 percentage points), while under the later scenario owning is rarely a better financial choice than renting. In short, they find that higher interest rates do reduce the financial appeal of homeownership, although the impact is most pronounced at extremely high levels. Lastly, and in some ways most critically, the finding that renting offers the potential for higher returns than owners depends in large part on renters taking steps to invest the annual savings in housing costs compared to renting. Building on Beracha and Johnson (2012), Beracha, Skiba, and 19 Johnson (2012) examine how variations in key assumptions regarding trends in prices, rents, interest rates, downpayment shares, and the returns available from alternative investments affect the buy versus rent financial calculus. They find that modifying most factors in isolation have only a moderate effect on whether renting is favored over owning. However, when they drop the assumption that renters actual invest any annual savings in housing costs on top of the initial downpayment they find that renting rarely results in higher wealth than owning. Thus, they find that the forced savings aspect of homeownership is of fundamental importance in determining whether owning will lead to greater wealth. This finding is echoed in the results of Boehm and Schlottmann (2004) who employ a somewhat unique approach to simulating the impact of homeownership on wealth accumulation. This study uses the Panel Study of Income Dynamics (PSID) to model the probability of moving in and out of homeownership on an annual basis over the period from 1984 through 1992. These same data are also used to estimate the house value that a household would opt for if a home were purchased in a given year. The estimated house value is then inflated based on house price trends in the census tract where the household resided to yield each household's expected gain in wealth from homeownership. This analysis finds that while minorities and low-income households do accrue wealth from homeownership, the amounts are much less than for higher income whites both because they own for fewer years and because they buy lower valued homes. But importantly, while the expected wealth accumulation among these households is less than that earned by higher income whites it is still positive. The authors also use the PSID to document that these same low-income and minority households essentially had no growth. in non-housing wealth over the same period. So in that regard the estimates of potential wealth created through homeownership were all the more important. Evidence from Panel Surveys about Wealth Accumulation through Homeownership As the findings from Beracha and Johnson (2012) and Boehm and Schlottmann (2004) suggest, the theoretical advantages of renting may not be realized if in practice renters do not take advantage of the opportunities afforded to them for saving and investing derived from the lower cost of renting. In contrast, studies making use of panel surveys that track households over time provide insights into the wealth accumulation associated with actual choices about renting and owning. These studies universally find that owning a home is associated with higher levels of wealth accumulation even after controlling for a range of household characteristics. While the gains are also consistently smaller in magnitude for lower-income and minority households, these studies also find that in contrast to owners similar renters 20 experience little or no gains in wealth. These findings hold even when steps are taken to account for selection bias in who becomes a homeowner. Although these methods may not fully account for the differences between owners and renters, there remains a strong case that homeowning does make a positive contribution to household balance sheets regardless of income or race/ethnicity. Haurin, Hendershott and Wachter (1996) was among the first studies to use panel survey data to track wealth trajectories associated with homeownership. The primary focus of this study was on the accumulation of wealth in anticipation of becoming an owner rather than how owning a home over time contributes to wealth accumulation, but their findings provide important insights into one way in which homeownership adds to wealth. They use the National Longitudinal Survey of Youth (NLSY) to track young renters age 20 to 28 in 1985 through 1990 and observe both their annual wealth levels and the timing of any transitions into homeownership. They find that household wealth goes up markedly during the transition to homeownership, increasing by 33 percent on average in the year prior to buying a home and then more than doubling in the year they first own. When they examine factors that contribute to this jump in wealth they find that marrying makes a significant contribution along with an increase in hours worked and a slightly higher incidence of inheritance and gifts. Their results suggest that an important mechanism by which homeownership adds to wealth is through the incentive to save in anticipation of buying a home. Even before realizing any returns on the investment in the home itself, the drive to become an owner results in substantially higher wealth than those who remain renters. Adding to this effect Haurin and his colleagues also find that wealth increases more rapidly in the years after becoming a homeowner-by 17 percent on average annually among their sample. Reid (2004) uses panel data from the PSID for the period 1976 through 1994 to examine the financial outcomes of homeownership among low-income households who bought their first home at some point during this period (with low-income defined as those with incomes consistently below 80 percent of area median income before first buying a home). She takes two approaches to examining the returns to homeownership for this group. First, she estimates the change in home values for both low- income and minority homeowners compared to higher-income and white owners. She finds that the rate of increase in home values for these groups was fairly modest, failing to beat the returns that would have been earned on an investment in Treasury bills over the same time. Reid then examines wealth holdings of households by tenure status at the end of her period of observation. She finds that while low-income and minority owners generally built much less wealth than higher-income and white households, the amount of their housing wealth was non-trivial and was many times larger than their other forms of wealth. Like Boehm and Schlottmann, she also finds that those who were renters at the 21 end of the period essentially held no wealth of any kind. Reid, however, does not undertake a multivariate analysis to control for other factors that may account for the differences between owners and renters. Nor does she factor in the impact of failed efforts at homeownership on wealth. But the fact that home equity accounts for such a large share of wealth among low-income and minority households points to the important role that owning a home played in fostering wealth accumulation. Di, Belsky and Liu (2007) was the first study to directly assess the relationship between homeownership and wealth accumulation over time while attempting to account for household characteristics and to include some measure of potential selection bias in who becomes an owner. The study uses the PSID to track households who were renters in 1989 through 2001 to observe transitions into and out of homeownership. The change in household wealth over time is then modeled as a function of starting wealth, a range of household characteristics thought to influence wealth, and, their principal measure of interest, the amount of time spent as an owner. In order to take into account a household's propensity to save, the study uses the PSID from 1984 through 1989 to estimate the share of income that was saved as an indication of savings behavior prior to the period when tenure transitions are observed as a means of controlling for this tendency in assessing differences in savings behavior after buying a home. Their principal finding is a positive and statistically significant association between additional years of homeownership and changes in wealth. The authors include a square term for the number of years owned to take into account anticipated impacts of the timing of moves into homeownership over the period as there was an initial decline in house values during the first years of their panel followed by more robust increases in later years. This square term is negative and significant indicating those who bought earlier in the period had lower cumulative gains in wealth. The largest estimated gains in wealth of $13,000 per year of ownership occurred among those who owned for 8 years. But for those who owned for the maximum possible period of 12 years the gains were only $3,333 per year. Prior savings tendency was positively associated with increases in wealth as expected, but was not statistically significant and so did not appear to capture any important difference in household behavior that was not already accounted for by other explanatory variables. Turner and Luea (2009) undertake a very similar analysis using the PSID sample for the period from 1987 to 2001. In contrast to Di, Belsky and Liu who only include initial renters, their study sample includes all households in the sample as of 2001 that were age 65 or younger regardless of whether they were renters at the start of the period. The study pools observations for the sample on household wealth from three points in time: 1994, 1999, and 2001. For each observation they include a count of the number of years the household has owned a home since 1988 as their explanatory variable of 22 interest. The approach used in this study attempts to control for selection bias into homeownership by estimating a random effects model that includes a household specific constant term. Turner and Luea also separate the sample into two income classes to see whether the association between homeownership and wealth growth differs by income. Low- and moderate-income (LMI) households were those who had incomes below 120 percent of area median income in all three periods when wealth was observed. The results indicate that each year of homeownership is associated with nearly $14,000 in additional wealth, perhaps not surprisingly quite similar to the amount found by Di, Belsky and Liu using the same survey over a nearly identical period (although with a somewhat different sample). When controls are included for LMI status, Turner and Luea find that these households have somewhat lower wealth accumulation of between $6,000 and $10,000 per year. But they note that since the average wealth holding of LMI households in 2001 was about $89,000 this annual rate of increase accounts for a fairly sizeable share of total wealth. In an unpublished dissertation, Mamgain (2011) extends the work of Turner and Luea by employing a two-stage model to add stronger controls for selection into homeownership. Like most of the other studies, Mamgain also uses the PSID, but his period of observation is from 1999 through 2007. Despite the different time period examined, when he replicates Turner and Luea his analysis yields similar results regarding the magnitude of the association between homeownership and wealth (although by ending the study period in 2007 it does not include the sharp loss of both housing and financial wealth that followed 2007). When Mamgain adds additional controls to his model to capture the intention to move, the respondent's health status, their ownership of other real estate and an estimate of current LTV he finds a somewhat lower impact of additional years of owning, but the estimate is still significant and positive. Importantly, when he employs his two-stage approach to include both a selection term and an instrumental measure of current tenure his estimate of the impact of each. additional year on owning does not change. He also estimates separate models by income level and finds that there is no difference in the impact of owning across income classes—all are positive and significant. In short, like other studies he does not find a significant impact of selection bias on his findings and he also finds that low-income owners are also likely to benefit from owning homes. 3 3 He does differ from previous studies in how he estimates the contribution of owning to wealth gains, by focusing on impacts at much lower household wealth levels. He finds that assuming wealth of about $2,500 for the lowest income group (at or below 150 percent of the poverty level) owning a home only adds a few hundred dollars a year to the household's bottom line. But with total wealth set a level well below the median among owners in this income class this result seems implausible. 23 None of the studies estimating statistical models to assess the contribution of homeownership to wealth accumulation analyzed whether there were differences in this experience by race and ethnicity. As discussed above, there are significant racial and ethnic differences in residential location, size of home, and characteristics of financing used, all of which could contribute to differences in wealth outcomes. Shapiro, Meschede, and Osoro (2013) use the PSID from 1984 through 2009 specifically to examine the factors associated with more rapid growth in wealth among whites over this period compared to blacks. Tracking the same set of households over this period they find that gains in median wealth among whites exceeded those among blacks by $152,000. Based on the results of a multivariate analysis they found that the single largest driver of this divergence in wealth was the additional time whites spend as homeowners, which they estimate accounted for 27 percent of the additional white gains. The next most significant factors were differences in income (20 percent), unemployment spells (9 percent), lower shares with a college education (5 percent), and differences in inheritance and financial support from family (5 percent). They also find that years of homeownership exerted a stronger influence on gains in wealth for blacks than it did for whites. While the authors do not attempt to control for any selection bias to control for who becomes a homeowner, none of the previous studies that have taken these steps have found these controls to change their findings. Conclusions Drawn from the Previous Literature Studies presenting simulations of the financial returns to renting and owning make a convincing case that in many markets over many periods of time and under a variety of assumptions renting ought to support greater wealth accumulation than owning. However, as virtually all of the panel studies document, in practice owning has consistently been found to be associated with greater increases in wealth even after controlling for differences in household income, education, marital status, starting wealth, inheritances, and other factors. Importantly, these same studies also consistently find that owning has a positive effect on wealth accumulation among both lower-income households and minorities, although the gains are smaller than for higher-income households and whites generally. Housing wealth among lower-income and minority households also often accounts a substantial share of total wealth for these groups. On the other hand, renters in these same demographic groups are consistently found to accrue little to no wealth over time. How can we reconcile the findings from simulation studies that renting should often be more financially advantageous than owning with the findings from the analysis of panel surveys that unambiguously find owning to be more favorable? One explanation may be that behavioral issues play 24 a key role. Efforts to save for a downpayment lead to a large jump in wealth that is then further supported by at least modest appreciation and some pay down of principal over time. Renters may have the opportunity to accrue savings and invest them in higher yielding opportunities but lack strong incentives and effective mechanisms for carrying through on this opportunity. There is also likely some degree of selection bias at work in who becomes a homeowner. While studies do control for income, education, marital status and other factors that would contribute in differences in the ability to save, there are likely differences in motivation and personal attributes that are related to both savings practices and whether someone becomes an owner. While controls included in studies to capture this effect have not diluted the association between homeownership and increases in wealth, this may simply reflect the challenge of capturing these difficult to measure factors. Studies using panel surveys may also make the benefits of homeownership appear more assured than they actually are by not fully capturing the impact of failed attempts at owning on changes in wealth. Studies to date have focused on measuring homeownership as the number of years spent as a homeowner, which does not distinguish between short sustained spells of owning from similar periods of owning that end in foreclosure or other financial distress. So while homeownership on average may increase wealth, it is undoubtedly the case that for some share of households owning a home had a negative impact on their balance sheet. Finally, the studies reviewed here may also not fully reflect changes that have occurred over time in both market conditions and household behavior. Most of the studies cited reflect experiences as owners during the 1980s and 1990s and so do not capture the market dynamics that began in the late 1990s but came to full bloom during the boom years of the 2000s, including the much greater availability of and appetite for high loan-to-value loans, higher cost loans, sharp swings in house prices, and much higher risks of default even before the national foreclosure crisis began. The next section turns to an analysis of data from the 2000s to examine whether findings about homeownership's positive association with wealth accumulation held over this period, particularly for low-income and minority households who were most likely to have used high cost mortgage products. Experience with Homeownership and Wealth Accumulation through the Boom and Bust Given the substantial changes in the availability, cost and terms of mortgage financing that began in the 1990s and accelerated through the mid-2000s and the accompanying boom and bust in home prices, there is good reason to believe that the experience of homeowners in accumulating wealth over the last decade has been substantially different from what is documented in much of the existing 25 literature for earlier periods. In this section of the paper we present information on wealth accumulation through homeownership during the housing market boom and bust of the 2000s. In the first section, we present findings from the tri-annual Survey of Consumer Finance (SCF) to present a high level picture of the contribution of homeownership to household balance sheets over time. The SCF also provides insights into how a greater tendency both to use high loan-to-value (LTV) loans to purchase homes and to take cash out through refinancing may have reduced wealth associated with homeownership. While the SCF does document the substantial decline in housing wealth following the bust, it also shows that, despite these losses, average homeownership wealth is generally higher than it was in the mid-1990s and continues to represent a substantial portion of household wealth for minorities and lower-income households. The SCF also shows that while the degree of leverage in the housing market showed a marked increase in the years following the Tax Reform Act of 1986, the distribution of LTVs did not change a great deal between the mid 1990s and the housing boom years. However, the crash in housing prices did push LTVs to historic highs. We then turn to an analysis of the PSID for the period from 1999 to 2009 to examine how homeownership spells contributed to trends in household wealth over this period. While house prices grew substantially for much of this period, it also captures most of the decline in prices as well. Whereas previous studies have focused solely on how each additional year of homeownership contributes to household wealth, we are also interested in assessing how failed attempts at homeownership affect wealth to assess the downside risks of owning as well. We find that on average homeownership's contribution to household wealth over this period was remarkably similar to that found in earlier periods. The results also confirm previous findings that while lower-income households and minorities realized lower wealth gains from owning, on average these gains were positive and significant. The results also show that a failure to sustain homeownership is associated with a substantial loss of wealth for established owners, although those who made a failed transition from owning to renting are no worse off financially than those who remained renters over the whole period. Thus, despite the many ways in which market conditions over this period might have been expected to undermine homeownership's wealth building potential, our analysis of the PSID finds that owning maintained a strong association with improvements in wealth over the decade from 1999 to 2009. Long-Run Trends in Housing Wealth and Mortgage Debt The sharp rise in home prices in many parts of the country is reflected in the substantial increase in average real housing equity among homeowners, roughly doubling (a gain of 96 percent) between 26 1995 and 2007 among all homeowners (Table 1). The gains were nearly as large among African- Americans (88 percent) and even larger among Hispanics (123 percent), although generally lower among households in the bottom two income quartiles where home equity increased by only 56 and 42 percent, respectively. The loss in housing equity between 2007 and 2010 was substantial, erasing 26 percent of home equity on average for all homeowners and taking back much of the gains made since 2001 for most groups. Mirroring their larger gains during the boom, Hispanics suffered the greatest loss of housing wealth, dropping by nearly half. Across income groups the declines were more moderate among those in the bottom half of the income distribution. But despite these substantial losses, average real home equity in 2010 was still higher on average than in 1995 for all of the groups shown, and in many cases considerably higher. Whites and those in the highest income quartile had the largest gains, with average home equity up by 51 percent and 78 percent respectively. African-Americans and the lowest income quartile also maintained substantial gains of 39 percent and 35 percent, respectively. Hispanics and those in the middle income quartiles made the least progress, with average home equity up by only 12 to 18 percent. Throughout this period the share of net wealth accounted for by home equity among all homeowners fluctuated between 22 and 29 percent, with much of the movement due to changes in non-housing net wealth. Between 1989 and 1998 home equity's share of average wealth fell from 29 to 22 percent as the stock market boomed while home values languished. Between 1998 and 2007 home equity's share of net wealth rose to 25 percent as the stock market absorbed the dot com bust while housing prices soared. Between 2007 and 2010 losses in housing wealth outpaced losses in other financial assets so housing's share of wealth fell back to 22 percent. Thus, despite the significant growth in housing equity in the first half of the 2000s it never came to account for an outsized portion of household net wealth among all homeowners. ","Read the attached text, and then answer the question that follows using only details from the context provided. You will NOT refer to outside sources for your response. Based on the text above, what factors can contribute to wealth accumulation through homeownership? Introduction In many respects, the notion that owning a home is an effective means of accumulating wealth among low-income and minority households has been the keystone underlying efforts to support homeownership in recent decades. The renewed emphasis on boosting homeownership rates as a policy goal that arose in the early 1990s can be traced in no small part to the seminal work by Oliver and Shapiro (1990) and Sherraden (1991) highlighting the importance of assets as a fundamental determinant of the long-run well-being of families and individuals. The efforts of these scholars led to a heightened awareness of the importance of assets in determining life's opportunities, enabling investments in education and businesses, providing economic security in times of lost jobs or poor health, and passing on advantages to children. Assessments of differences in asset ownership placed particularly emphasis on the tremendous gaps in homeownership rates by race/ethnicity and income and the importance of these gaps in explaining differences in wealth. In announcing their own initiatives to close these homeownership gaps, both President Clinton and President Bush gave prominent attention to the foundational role that homeownership plays in providing financial security (Herbert and Belsky, 2006). But while faith in homeownership's financial benefits are widely subscribed to, there have long been challenges to the view that owning a home is necessarily an effective means of producing wealth for lower-income and minority households. In 2001 the Joint Center for Housing Studies hosted a symposium with the goal of ""examining the unexamined goal"" of boosting low-income homeownership (Retsinas and Belsky, 2002a). The general conclusion that emerged from this collection of papers was that lower-income households do benefit from owning homes, although this conclusion was subject to a variety of ""caveats and codicils"" (Retsinas and Belsky, 2002b, page 11). A few of these caveats related to whether financial benefits were likely to materialize, with papers finding that all too commonly homebuyers sold their homes for real losses while alternative investments offered higher returns (Belsky and Duda, 2002; Goetzmann and Speigel, 2002). In perhaps the most comprehensive critique of the policy emphasis of fostering low-income homeownership, Shlay (2006) reviewed existing scholarly evidence to cast doubt on the likelihood that either the financial or social benefits of owning would be realized. These criticisms have only grown louder in the aftermath of the housing bust, as trillions of dollars in wealth evaporated leaving more than 10 million homeowners owing more than their homes are worth and leading to more than 4 million owners losing their homes to foreclosure (Joint Center for Housing Studies, 2012; Kiviat, 2010; Li and Yang, 2010; Davis, 2012). Many of the criticisms raised about 1 the financial risks of homeownership are not new, but the experience of the last five years has certainly given new impetus to these arguments. But there are also concerns that changes in the mortgage market and in consumer behavior may have exacerbated these risks, increasing the odds that owners will, at best, be less likely to realize any financial gains from owning and, at worse, face a heightened risk of foreclosure. The goal of this paper is to reassess in the light of recent experience whether homeownership is likely to be an effective means of wealth creation for low-income and minority households. Has the experience of the last decade proven the arguments of earlier critics of homeownership? Have changes in the market affected whether these benefits are likely to be realized? The paper takes three approaches to address these questions. We begin by presenting a conceptualization of the risks and rewards of homeownership as a financial choice, with a particular eye toward whether the odds of a beneficial outcome are lower for lower-income and minority owners. This review also assesses whether recent experience has altered this calculus-as opposed to just raising our awareness of the proper weighting of the likelihood of realizing the benefits while sidestepping the risks. Next, we review the existing literature examining the financial benefits of owning a home, including both studies simulating the returns to owning and renting as well as studies using panel surveys to track actual wealth accumulation among owners and renters. Finally, we examine data from the Survey of Consumer Finance (SCF) and the Panel Study of Income Dynamics (PSID) covering the last decade to assess how owning a home has been associated with changes in household financial balance sheets over this period. To preview our conclusions, we find that while there is no doubt that homeownership entails real financial risks, there continues to be strong support for the association between owning a home and accumulating wealth. This relationship held even during the tumultuous period from 1999 to 2009, under less than ideal conditions. Importantly, while homeownership is associated with somewhat lower gains in wealth among minorities and lower-income households, these gains are on average still positive and substantial. In contrast, renters generally do not see any gains in wealth. Those who buy homes but do not sustain this ownership also do not experience any gains in wealth, but are generally left no worse off in wealth terms than they were prior to buying a home-although of course there may still be substantial costs from these failed attempts at owning in terms of physical and mental health as well as future costs of credit. We conclude that homeownership continues to represent an important opportunity for individuals and families of limited means to accumulate wealth. As such, policies to support homeownership can be justified as a means of alleviating wealth disparities by extending this 2 opportunity to those who are in a position to succeed as owners under the right conditions. The key, of course, is to identify the conditions where lower-income and minority households are most likely to succeed as owners and so realize this potential while avoiding the significant costs of failure. Assessing the Financial Risks and Rewards of Homeownership Before turning to evidence about the financial returns to homeownership, it is helpful to start by framing the arguments about why homeownership is thought to be an effective means of generating wealth as well as the counter arguments about why these benefits may not materialize, particularly for lower-income and minority homeowners. We then consider how changes in mortgage markets and consumer behavior may have altered the likelihood that owning will lead to financial gains. This framing helps provide a basis for interpreting the findings from the following two sections of the paper that examine evidence about the association between homeowning and wealth accumulation. The Potential Financial Benefits of Owning The belief that homeownership can be an important means of creating wealth has its roots in five factors. First, the widespread use of amortizing mortgages to finance the acquisition of the home results in forced savings as a portion of the financing cost each month goes toward principal reduction. While modest in the early years of repayment, the share of the payment going toward principal increases over time. For example, assuming a 30-year loan with a 5 percent interest rate, a homeowner will have paid off about 8 percent of the mortgage after 5 years, 19 percent after 10 years, and nearly a third after 15 years. Assuming a household purchases a home in their early 30s and keeps on a path to pay off the mortgage over a thirty-year period, these forced savings will represent a sizable nest egg when they reach retirement age. In addition, an often overlooked aspect of forced savings associated with homeownership is the accumulation of the downpayment itself, which often entails a committed effort to accumulate savings in a short period. Second, homes are generally assumed to experience some degree of real appreciation over time, reflecting increased overall demand for housing due to growth in both population and incomes against a backdrop of a fixed supply of land located near centers of economic activity. Shiller (2005) has been the most notable critic of this point of view, arguing that over the very long-run real house prices have only barely exceeded inflation. Lawler (2012), however, has argued that Shiller's house price estimates and measures of inflation result in an underestimate of real house price growth. Analysis of trends in real house prices across a range of market areas support the conclusion that these trends 3 reflect a complex interaction of supply and demand factors in local markets that defy simple categorization (Capozza et al. 2002, Gallin, 2006). At a national level the Federal Housing Finance Agency house price index indicates that between 1975 and 2012 the compound annual growth rate in house prices has exceed inflation by 0.8 percentage points. Even at a modest rate of increase, the compounding of these returns over a longer period of time can be produce substantial increase in real home values. Assuming just a 0.8 percent annual real increase in house values over 30 years an owner will experience a real gain of about 26 percent in the overall house value. The use of financing can further leverage these returns. A homebuyer with a modest downpayment gets the benefit of increases in the overall asset value despite their small equity stake. While the cost of financing can create a situation of negative leverage if the increase in house values is lower than the cost of financing (so that the financing costs exceed the increase in the asset value), this risk diminishes over time as the value of the house compounds while the debt payment is fixed. Through leverage, the rate of return on an investment in a home can be substantial even when the increase in house values is modest. Consider the case where a buyer puts down 5 percent and the house appreciates at 4 percent annually. After 5 years the home will have increased in value by nearly 22 percent or more than 4 times the initial 5 percent downpayment. Even allowing for selling costs of 6 percent, this would represent an annualized return of 31 percent on the owner's initial investment. Due to leverage, even nominal increases in home values that do not exceed inflation can result in real returns. In the above example, if inflation matched the 4 percent growth in home prices, the owner would still have earned a substantial real return on their initial investment. Federal income tax benefits from owning a home can also be substantial. The ability to deduct mortgage interest and property taxes is the most apparent of these benefits. Taxpayers who are able to make full use of these deductions receive a discount on these portions of ongoing housing costs at the taxpayer's marginal tax rate, ranging from 15 percent for moderate income households up to 39 percent for the highest tax bracket. In addition, capital gains on the sale of a principal residence up to $250,000 for single persons and $500,000 for married couples are also excluded from capital gains taxation, which is currently 15 percent for most households and 20 percent for the highest income bracket.1 1 An additional tax benefit that is often overlooked is the fact that while owner occupants benefit from the use of their home as a residence they do not have to pay any tax on these benefits, referred to as the implicit rental income from the property (that is, the rent one would have to pay to occupy the home) (Ozanne, 2012). The loss of revenue to the U.S. Treasury from this exclusion is substantial, outweighing the costs of the mortgage interest deduction. 4 Finally, owning a home provides a hedge against inflation in rents over time. Sinai and Souleles (2005) find that homeownership rates and housing values are both higher in markets where rents are more volatile, indicating the value placed on being able to protect against rent fluctuations. Under most circumstances, mortgage payments also decline in real terms over time, reducing housing costs as a share of income. For long-term owners, this can result in fairly substantial savings in the out of pocket costs for required for housing. Assuming a fixed rate mortgage, inflation of 3 percent, 1 percent growth in both real house prices and the costs of property taxes, insurance and maintenance, real monthly housing costs would decline by about 10 percent after 5 years, 15 percent after 10 years, and 30 percent by the last year of the mortgage. Once the mortgage is paid off, the out of pocket costs of owning in real terms are less than half the payments made at the time of purchase. Housing costs for renters, in contrast, would be expected to keep pace with inflation in housing prices. The Potential Financial Risks of Owning Combined, the financial benefits outlined above can fuel significant wealth accumulation. But as the last few years have made painfully clear, the financial benefits associated with owning a home are not without risk. To begin with, house prices can be volatile. That was certainly the case in the wake of the housing bust, as nominal prices fell nationally by some 25 percent or more (depending upon the specific price index used), with the hardest hit markets experiencing declines of more than 40 percent. Almost no area of the country was spared from some degree of decline. According to the FHFA index, nominal prices fell in every state with the exception of North Dakota. But while recent experience is notable for the breadth and depth of price declines, there are other examples of fairly significant price declines over the last few decades, including declines of between 10 and 20 percent in some Oil Patch states in the 1980s and in New England, California and Hawaii in the early 1990s. There are also a number of markets where house prices trends have historically been more stable, but in these areas long-run real price increases have either not kept pace with inflation or have been modest. House price growth has been particularly weak in a number of markets in the Midwest and South where population and income growth have been low. Based on long-run state level indexes from FHFA, between 1975 and 2012 there were 10 states in these regions where the compound annual growth in house prices did not exceed general price inflation. Even before the bust, homeowners in these markets did not have the benefit of real growth in house prices over the long term. In nine other states house price growth did beat inflation, but by less than 0.25 percent on an annual basis. Thus, in about two-fifths of states real house price growth was either non-existent or trivial. At the other 5 extreme there were 17 states, mostly along the Pacific coast and in the Northeast that experienced real house price growth of more than 1 percent, including 5 states that exceeded 2 percent. There are also peculiar aspects of owning a home that further exacerbate the financial risks of these investments. Homeowners make a significant investment in a specific location and cannot diversify the risk of home price declines by spreading this investment across assets or across markets. Homes values are also high relative to incomes and so account for a large share of household wealth. Wolff (2012) reports that in 2010 the value of the principal residence accounted for two-thirds of total wealth among households in the middle three quintiles of the wealth distribution. With so much wealth tied up in one asset, homeowners are particularly vulnerable to changes in home values. The use of debt financing for a large share of the purchase further magnifies these risks, with even small drops in prices wiping out substantial shares of homeowner equity. Indeed, at the height of the housing bust the number of households underwater on their mortgages was estimated by CoreLogic to have exceeded 11 million while Zillow placed the number closer to 15 million. When assessed purely on the basis of real growth in values over time, housing also compares poorly to the returns offered by investments in diversified portfolios of stock or bonds. Geotzmann and Speigel (2002) compare the change in home prices in 12 market areas between 1980 and 1999 to a range of alternative investments and find that housing was consistently dominated as an investment asset by all of the financial alternatives considered, leading them to conclude that it is ""surprising that housing continues to represent a significant portion of American household portfolios"" (page 260). However, Flavin and Yamashita (2002) take a more expansive view of the returns on housing investments by including the value derived from occupying the unit, the use of financial leverage, and the ability to claim income tax deductions. This fuller treatment of housing's returns finds that the average rate of return was slightly below returns for investments in stocks, but the variance of these returns were also lower and so somewhat less risky. Still, even if the returns to housing are deemed to be competitive with alternative investments the concern remains that it accounts for an excessive share of low-wealth household's portfolios. Housing investments are also handicapped by high transaction costs associated with buying and selling these assets. Home buyers face fees for mortgage origination, title search and insurance, state and local taxes, home inspections, and legal fees, all of which can add up to several percentage points of the home value. Real estate broker commissions typically also command 6 percent of the sales price. These high transaction costs can absorb a significant share of home price appreciation from the first few years of occupancy. Given these high costs, home owners who are forced by circumstances to move 6 within a few years of buying will face the risk of loss of at least some share of their initial investment even if home values have risen modestly. The need to maintain the home also imposes financial risks on owners. While routine maintenance can keep both the physical structure and the home's major systems in good working order, major investments are periodically needed, such as painting the exterior or replacing the roof or heating system. These projects incur high costs that may be difficult for owners to afford. While owners may have the opportunity to plan for these investments over time, in some cases a system will fail with little warning and produce an unexpected cost that the owner cannot afford, creating a financial strain that in the most extreme cases can jeopardize the ability to maintain ownership. Finally, the financial costs of failing to sustain homeownership are high-in addition to the traumatic impacts that foreclosures can have on the health and psychic well-being of the owner (Carr and Anacker, 2012). Owners who default on their mortgage will not only lose whatever equity stake they had in the home, they are also likely to deplete their savings in a bid to maintain ownership and suffer significant damage to their credit history making it difficult and costly to obtain credit for several years to come. Factors Contributing to Wealth Accumulation Through Homeownership Whether and to what extent a homebuyer will realize the potential benefits of owning while avoiding succumbing to the risks depends on a complex set of factors. Herbert and Belsky (2006) present a detailed conceptual model of the factors that contribute to whether homeownership produces wealth over the life course, which is briefly summarized here. The most obvious factor is the timing of purchase relative to housing price cycles. The recent boom and bust in house prices presents a prime example. Homebuyers who bought in the early 2000s were poised to benefit from the massive run-up in prices that occurred in many markets, while those that bought in the mid 2000s entered just in time for the historic freefall in prices that followed. While other price cycles in recent decades may not have been as dramatic, the consequences of buying near troughs or peaks on wealth accumulation would have been similar. Belsky and Duda (2002) examined data on repeat sales in four market areas between 1982 and 1999 and found that roughly half of owners who bought and sold their homes within this time period failed to realize gains that beat inflation after assuming a 6 percent sales cost (although most did earn a return in nominal terms). Whether owners realized a positive return depended strongly on where in the housing price cycle they bought and sold their homes. 7 Belsky and Duda (2002) conclude that ""although the golden rule of real estate is often cited as location, location, location, an equally golden rule is timing, timing, timing"" (Page 223). Their conclusion points to another critical factor in how likely a home is to appreciate in value - in what market and in which specific neighborhood the home is located. As noted above, there have been sizeable differences across market areas in long-term house price trends, with areas along the coasts experiencing real gains of one percent or more over the last several decades while areas in the Midwest and South have had little or no gains. But there are also substantial variations in price trends across neighborhoods within a single market (for reviews of this literature see Herbert and Belsky, 2006; Dietz and Haurin, 2003; and McCarthy, Van Zandt and Rohe, 2001). Whether a household bought a home in Boston or Cleveland is an important factor in the returns realized, but so is whether the home was in a desirable area or a declining neighborhood. The terms of financing used to buy the home also matter. Higher interest rates lower the share of payments that are devoted to principal reduction in the early years of repayment, slowing wealth accumulation. The higher monthly costs of the mortgage also erode the ability of the household to meet other expenses and to save on an ongoing basis as additional interest payments over the life of the mortgage can be substantial. For example, over a thirty-year term a loan for $150,000 at 7 percent interest will require $69,000 more in interest payments than a 5 percent loan. Higher origination fees also sap savings, reducing the quality and size of home that is affordable and lowering the rate of return on housing investments. Choices about refinancing over time can also exert a strong influence on wealth accumulation. Taking advantage of declines in mortgage interest rates to reduce financing costs can save owners hundreds of dollars each month, and tens of thousands over the life of a mortgage-although continually resetting the term of the mortgage will reduce opportunities for forced savings. On the other hand, refinancing to take cash out of the property can erode wealth accumulation, particularly if the extracted funds are used to finance consumption rather than investments in the home, education, business or financial opportunities. Wealth accumulation will be further undermined if the new loan comes with high fees and higher interest rates. Of course, the ability to tap housing wealth as a buffer against income shocks is one of the virtues of developing this cushion, but using home equity to finance an unaffordable lifestyle is an unsustainable path. A host of other factors come into play in determining how much housing wealth is realized over the span of a lifetime. For example, buying higher valued homes-if successful-can produce more wealth both through forced savings and by earning returns on a higher valued asset. By the same 8 means, those who trade up to more expensive homes over time may also accrue greater housing wealth. The age at which a first home is purchased can also be significant, giving the household a longer period to accumulate wealth. Of course, the quality of the home purchased and the owner's ability to maintain it will also affect both ongoing maintenance costs and how much the home appreciates over time. But arguably the most fundamental factor-the true golden rule of how to accumulate wealth. through homeownership-is whether ownership is sustained over the long term. Housing booms aside, many of the financial benefits are slow to accumulate, including the slow build up of forced savings, the compounding of values at low appreciation rates, and the decline in monthly housing costs in real terms over time. The expression ""time heals all wounds"" may also be applicable to many of homeownerships most critical risks. The losses associated with buying near the peak of a price cycle will diminish over time as owners benefit from the next upswing in prices. And even in areas whether real growth in house prices does not occur or is limited, over the long term owners will still amass some degree of wealth through paying off the mortgage and as a result of savings from lower housing costs. On the flip side, a failure to sustain homeownership-particularly when the end result is a foreclosure-will wipe out any accrued wealth and bring additional costs in the form a damaged credit history that will incur further costs over time and limit opportunities to buy another home in the near term. To some degree whether ownership is sustained will depend on choices that owners make over time - including whether the home they buy is affordable, whether they make prudent choices about refinancing, and whether they maintain the home to avoid larger home repair bills. But whether owning is sustained also will depend on whether the household can weather any number of significant events that can fundamentally alter their financial circumstances, such as loss of a job, a serious health problem, or change in the family composition due to the birth of a child, death, divorce, or the need to care for a parent or relative. Over the course of a lifetime, these events are likely to befall most everyone. Whether homeownership can be sustained in the wake of these events will depend on the ability of the household to adjust to their changed circumstances and whether they have enough available savings to cushion the blow. Impediments to Wealth Creation among Lower-Income and Minority Homeowners Up to this point the discussion presented has considered homeownership's financial risks and rewards in a general sense. But the concern of this paper is specifically with the potential for homeownership to serve as an effective means of wealth accumulation for lower-income and minority 9 households. How are the odds of generating wealth as a homeowner likely to differ for these households?? In keeping with the fundamental importance of sustained homeownership to accumulate wealth, the chief concern is that these groups of homebuyers face a more difficult time in maintaining ownership. Studies analyzing panel data to document homeownership spells among first-time buyers consistently find that low-income and minority owners have a lower probability of maintaining homeownership for at least five years. In an analysis of the National Longitudinal Survey of Youth (NLSY) from 1979 through 2000 Haurin and Rosenthal (2004) find that ownership is less likely to be sustained among both these groups. Specifically, only 57 percent of low-income buyers were found to still own their first home five years later, compared to 70 percent of high-income owners (with income categories defined by income quartiles at age 25). First homeownership spells were also found to be much shorter for minorities, averaging 6.5 years among whites, compared to 4.4 years for blacks and 5.4 years for Hispanics. In an analysis of the PSID covering the period from 1976 through 1993 Reid (2004) had similar results, with only 47 percent of low-income owners still owning their first homes 5 years later compared to 77 percent of high income owners (with incomes here defined based on average income in the years prior to homeownership compared to area median incomes). Reid further found that minorities had a harder time staying in their first home, with 42 percent of low-income non-whites still owning after five years compared to 54 percent of low-income whites. While these results raise clear concerns about the high risk of failed homeownership among these groups, the focus on a single homeownership spell may overstate the extent to which homeowning is not sustained in the long run. Haurin and Rosenthal (2004) also examine subsequent tenure experience in their panel and find that the share of households that return to owning a second time is very high for both whites and minorities. Over the 21 year period in their panel, 86 percent of whites who ever bought a home either never returned to renting or regained owning after a subsequent spell as a renter, with only slightly lower rates for blacks (81 percent) and Hispanics (84 percent). However, they do find that minorities spend more years in their intervening spells as renters, which reduces the overall amount of time they can accumulate benefits from owning. Another critical difference in the financial returns to owning for low-income households is that the ability to deduct mortgage interest and property taxes from federal taxable income may be of little or no value. In order to benefit from these tax provisions, the amount of available deductions must 2 Galster and Santiago (2008) provide a useful framing of this issues and a comprehensive review of the relevant literature. 10 exceed the standard deduction, which stood at $5,950 for individuals and $11,900 for married couples in 2012. For taxpayers with lower valued homes, particularly married couples, the costs of mortgage interest and property taxes even when added to other deductions for state taxes and charitable contributions, may not greatly exceed the standard deduction. In addition, the value of these deductions depends on the taxpayer's marginal tax rate, which will lower for low- and moderate-income households. In fact the share of the total value of the mortgage interest deduction going to moderate income households is fairly small. According to estimates from the Joint Committee on Taxation (2013), only 3 percent of the total deductions went to filers with incomes under $50,000, 9 percent to those with incomes between $50,000 and $75,000, and 11 percent to those with income between $75,000 and $100,000, leaving 77 percent of the benefit going to those earning above $100,000. To the extent that these tax benefits swing the financial scales in favor homeownership, this tilting of the calculus is not very evident for low- and moderate-income tax filers. There are also systematic differences in mortgage terms and characteristics by income and race/ethnicity that can also affect the financial returns to owning. The development of the nonprime lending industry that began in the 1990s and came to full blossom during the housing boom produced much greater variation in mortgage terms and pricing than had previously been evident. A fairly extensive literature has documented the greater prevalence of subprime lending among minorities and, to a lesser extent, low-income borrowers and communities (see, for example, Bradford, 2002; Calem, Gillen and Wachter, 2004; Apgar and Calder, 2005; Avery, Brevort, and Canner, 2007; Belsky and Richardson, 2010). As described above, higher costs of financing can significantly reduce the financial benefits of owning. While the expansion of financing options beyond a ""one size fits all who qualify"" approach to lending has the potential to extend homeownership opportunities to a greater range of households, there is significant evidence that the cost of credit was often higher than risk alone would warrant. Bocian, Ernst and Li (2008) present perhaps the most compelling evidence through an analysis of a large data set on nonprime loans that documents a wide range of risk measures, including credit scores as well as income and race/ethnicity. They find that even after controlling for observable differences in credit quality both blacks and Hispanics were significantly more likely to obtain high- priced mortgages for home purchase, while blacks were also more likely to obtain higher-priced refinance loans. These higher costs of borrowing not only limit the wealth producing capacity of homeownership, they also increase the risk of failing to sustain homeownership. In fact, Haurin and Rosenthal (2004) find that a 1 percentage point increase in the mortgage interest rate increases the rate of homeownership termination by 30 percent. 11 Low-income and minority borrowers are also less likely to refinance when interest rates decline. In an analysis of loans guaranteed by Freddie Mac during the 1990s Van Order and Zorn (2002) find that low-income and minority borrowers were less likely to refinance as interest rates fell. Their analysis also found that once borrower risk measures and loan characteristics were taken into account there were no remaining differences in refinance rates by income-although this just indicates that refinancing may be constrained by credit factors. Minorities, on the other hand, still had lower rates of refinancing even after controlling for these factors, suggesting that there were impediments to refinancing by these borrowers that were in addition to measurable credit factors. Nothaft and Chang (2005) analyze data from the American Housing Survey (AHS) from the late 1980s through 2001 and also find that minority and low-income owners were less likely to refinance when interest rates declined. These authors use their results to estimate the foregone savings from missed refinance opportunities, which are more than $20 billion each for black and low-income homeowners. To the extent that low-income and minority homebuyers may be more likely to purchase homes in poor condition they are also exposed to greater risks of high costs of maintenance and repair. Herbert and Belsky (2006) find that compared to whites, black and Hispanic first-time homebuyers were more likely to buy homes that were moderately or severely inadequate as characterized by the AHS- 6.5 percent for blacks and 8.8 percent for Hispanics compared to 4.3 percent among whites. A similar gap was also evident between low- and high-income households. While there has been little study of the incidence of unexpected home repair needs, a study by Rohe and his colleagues (2003) of participants in homeownership counseling programs found a fairly significant incidence of the need for unexpected repairs. Roughly half of 343 recent homebuyers reported that they had experienced a major unexpected cost in the first few years after buying their home, with the most common problem being a repair to one of the home's major systems. Finally, there are also concerns that lower-income households and minorities may be more likely to purchase homes in neighborhoods with less potential for house price appreciation. This is a particularly salient issue for minorities given the high degree of residential segregation by race and ethnicity that continues to be evident in the US. However, Herbert and Belsky (2006) present a detailed review of this literature and conclude that ""taken as a whole the literature indicates that there is no reason to believe that low-value segments of the housing market will necessarily experience less appreciation than higher-valued homes. In fact, at different points in time and in different market areas, low-valued homes and neighborhoods have experienced greater appreciation rates. Although the opposite is also true."" (Page 76) The evidence about differences in appreciation rates by neighborhood 12 racial composition is less definitive. Here Herbert and Belsky (2006) conclude that ""it does appear that homes in mostly black areas may be less likely to experience appreciation, but this conclusion is tempered by the small number of studies and the fact that they mostly analyzed trends from the 1970s. and 1980s, which may no longer be relevant"" (page 77). Findings by Boehm and Schlottmann (2004) regarding differences in wealth gains from homeownership by race and income are instructive in this regard. They find that over the period from 1984 to 1992 there was little difference in appreciation rates in the specific neighborhoods where minorities and low-income households lived. Instead, they found that differences in housing equity accumulation were tied to the lower valued homes and the shorter duration of ownership for lower- income and minority households. Thus, differences in appreciation rates may be less of a concern in whether housing leads to wealth accumulation than these other considerations. Re-assessing the Calculus of Wealth Accumulation through Homeownership As the above review has shown, there were significant concerns about the risks of homeownership as an investment well before the housing bubble burst. For critics of homeownership as a wealth building tool the experience of the housing bust was in many respects a confirmation of their fears. Still, there were several markets developments during the boom years that magnified these preexisting risks. Most notably there was a marked increase in the prevalence of riskier mortgages, including those calling for little or no documentation of income, adjustable rate loans that exposed borrowers to payment shocks from the expiration of initial teaser rates or reduced payment options, allowances for higher debt to income ratios, and greater availability of loans for borrowers with very low credit scores. Downpayment requirements also eased as loan-to-value ratios (LTVs) of 95 percent or more became more common and borrowers also used ""piggyback"" second mortgages to finance much of the difference between the homes' value and a conforming first mortgage at an 80-percent LTV. Not unrelated to the greater availability of mortgage credit, house prices also exhibited much greater volatility than in the past, with a dramatic increase in prices that greatly outpaced trends in both incomes and rents and belied an unsustainable bubble. The greater availability of credit also increased the opportunity for lower-income households to miss-time the market. Belsky and Duda (2002) found that during the 1980s and 1990s lower-valued homes were less likely to be transacted around market peaks, so buyers of these homes were less likely to buy high and sell low. They speculated that this was due to the natural affordability constraints that took hold as markets peaked. But during the boom of 13 the 2000s lower-valued homes experienced greater volatility in prices, arguably reflecting much greater credit availability at the peak than was true in past cycles (Joint Center for Housing Studies, 2011). However, there are good reasons to believe-or certainly to hope-that the conditions that gave rise to this excessive risk taking and associated housing bubble will not be repeated any time soon. The Dodd-Frank Act includes a number of provisions to reduce the degree of risk for both borrowers and investors in the mortgage market. The Qualified Mortgage (QM) is aimed at ensuring that borrowers have the ability to repay mortgages by requiring full documentation of income and assets, setting tighter debt to income standards, and excluding a variety of mortgage terms that expose borrowers to payment shocks. The Qualified Residential Mortgage (QRM) is aimed at ensuring greater protections for investors in mortgage backed securities by requiring the creators of these securities to retain an interest in these investments if the loans included in the loan pool do not conform to certain risk standards that essentially mirror those of the Qualified Mortgage. Dodd-Frank also established the Consumer Financial Protection Bureau to fill a gap in the regulatory structure by creating an agency charged with looking out for consumers' interests in financial transactions. Beyond these regulatory changes, there is also a heightened awareness of the risks of mortgage investments on the part of private sector actors who have suffered significant financial losses with the bursting of the housing bubble. Regulatory changes aside, these private actors are unlikely to embrace riskier lending any time soon. The Federal Reserve and other federal regulators are certainly more attuned to the possibility of a bubble in housing prices and so are more likely to act in the event that signs of a bubble re-emerge. But even in the absence of the excessive risks of the last decade, homeownership will remain a risky proposition. Thus, at best, we may return to the market conditions that existed prior to the boom and the real risks that these conditions posed for investments in owner-occupied housing. In that regard, an assessment of experience in wealth creation through homeownership prior to the boom is relevant for what we might expect in the future. On the other hand it does seem likely-and arguably even desirable given how tight credit has become-that some greater degree of risk taking will emerge to make credit available to the many lower-income and lower-wealth households that would like to own a home. In fact, the QM standard of a total debt-to-income ratio of up to 43 percent does curtail the higher levels that became evident during the boom, but this cutoff still represents a liberalization from standards for conventional mortgages that prevailed in the 1990s. There may also have been a shift in consumer attitudes toward mortgage debt, with fewer households seeking to pay off mortgages over time and thus exposing themselves for longer periods to the risks associated with these leveraged investments. Over time, as 14 conditions return to normal and the market adjusts to new regulatory structures, we are likely to see mortgages originated outside of the QM and QRM boxes. In that regard, an assessment of the experience of homeowners through the boom and bust is instructive as a stress test of how likely homeownership is to build wealth under more extreme market conditions. The next two sections of the paper look to assess homeownership's potential for wealth building from these two perspectives. First by presenting a review of the literature assessing homeownerships' association with wealth building prior to the 2000s and then by analyzing data from the last decade to examine how homeownership was associated with changes in wealth through the turbulent conditions of the 2000s. Review of Previous Studies Assessing the Financial Returns to Homeownership As the discussion up to this point has intended to illustrate, whether owning a home will lead to the accumulation of wealth is the result of complex set of factors related to the choices that households make in buying their home and how these choices interact with market conditions both at the time of purchase and over time. This complexity makes it quite difficult to assess whether in practice owning is likely to be an effective means of increasing a household's wealth. A further complicating factor is that there is a substantial selection bias in who becomes a homeowner, as there is reason to believe that those who are most secure in their financial condition and most inclined to save are more likely to become owners. For this reason, comparisons of the wealth profiles of owners and renters may not be able to attribute any observed differences solely to the influence of homeownership on the ability to accrue wealth. There are two broad classes of studies that have attempted to assess the financial benefits of homeownership in light of these challenges. One group relies on simulations that compare the theoretical costs and benefits of owning and renting under a variety of assumptions about market conditions and household choices. A key appeal of these studies is that they essentially remove concerns about selection bias by assuming otherwise identical households operate under a consistent set of decision rules. They can also isolate the influence of specific factors to shed light on the paths that are most likely to make owning or renting financially beneficial. But while these studies highlight the potential financial returns to owning and renting, they do not capture how households are likely to actually behave in these situations and so leave open the question of whether the potential returns of these tenure choices are likely to be realized in practice. 15 Another group of studies rely on panel studies that track households over time to examine how choices about owning and renting are correlated with changes in wealth. The findings from this type of analysis provide evidence of whether in practice owners are more likely to accrue wealth than renters and how this experience differs by income and race/ethnicity. Where the theoretical comparisons of owning and renting also generally focus on a single spell of homeownership - that is, the financial outcome associated with the period between buying and selling a single home - panel studies can track households through multiple transitions in and out of owning to assess outcomes from a series of tenure choices over time. The main drawback of these studies is the lingering concern that owners may be inherently different from renters in ways that observable household characteristics cannot capture. Some of these studies employ statistical methods to try to control for this selection bias, although it is doubtful that these controls can fully account for these differences. Both classes of studies provide important insights into the opportunities and drawbacks of homeownership as a means of increasing household wealth. When viewed as a whole the findings from both streams of research help paint a clearer picture of whether and how homeownership may help foster wealth creation. The sections that follow highlight key findings from each of these literature strands. Simulations of the Financial Returns to Owning and Renting Beginning with Mills (1990) there have been a number of studies that have simulated the financial returns to owning and renting under a variety of assumptions to identify whether and under what circumstances owning or renting is likely to be more financially beneficial (Capone, 1995; Belsky, Retsinas, and Duda, 2007; Rappaport, 2010; Beracha and Johnson, 2012). While the studies differ in important respects, the general approach is to compare the ""all-in"" costs of owning - including mortgage interest, property taxes, insurance, maintenance, and transaction costs along with offsetting gains in property value - to the costs of renting a comparable housing unit. Either implicit or explicit in these comparisons is that renters save and invest both the initial investment that owners make in buying their homes as well as any annual savings in housing costs. There are a host of assumptions that underlie these calculations, but among the most influential factors are the estimate of rents as a share of house value, the length of time the home is owned, the basis for simulating trends in house prices and rents over time, and the treatment of income tax benefits. The studies differ in fundamental ways related to the range of assumptions tested and the method for comparing returns to owning and renting and, as a result, individually reach somewhat 16 different conclusions about which tenure choice is likely to be preferred. But collectively the studies lead to some general conclusions about the relative financial merits of owning and renting. Perhaps the most fundamental conclusion from these studies that runs counter to the prevailing sense that homeownership is a powerful source of wealth is that under a variety of conditions renting is often more likely to be a better financial choice than owning. Belsky, Retsinas and Duda (2007) compare owning and renting in four different market areas chosen to represent different degrees of price appreciation and volatility over the period studied from 1983 through 2001. They focus on holding periods of 3, 5 and 7 years during their window of study and report the share of different holding periods where owning results in higher financial returns than renting. Overall they find that in only 53 percent of the 3-year holding periods would owning be preferred to renting. Increasing the holding period to 7 years-which allows for more time to work off the high transaction costs of buying and selling a home-only increases this proportion to 63 percent. Rappaport (2010) reaches a similar conclusion based on an analysis of national trends in market conditions between 1970 and 1999 and an assumed 10-year period of owning a home. He finds that owning a home unambiguously built more wealth in about half of the possible 10-year periods, renting was clearly better in another quarter and likely, but not unambiguously, preferred in the remaining periods. Finally, Beracha and Johnson (2012) come to a similar conclusion in an analysis of all possible 8-year holding periods given actual market conditions at both the national and regional level between 1978 and 2009. They find that between 65 and 75 percent of cases renting offered greater opportunities for accruing wealth than owning, depending on whether renters employing a more conservative or aggressive investment approach. In parsing the findings of these studies, there are several factors that are the critical drivers of the results. Perhaps the most obvious is the importance of the timing of home purchase relative to market cycles in prices and interest rates. Depending on the future course of prices, rents and interest rates one or the other tenure would be strongly preferred at different points in time. The importance of timing may be most clearly demonstrated in Belsky, Retsinas and Duda (2007) when they consider different holding periods among owners. In general, it would be expected that longer holding periods should favor owning as more time is allowed to overcome high transaction costs, pay down additional principal, and ride out price cycles. Instead, they find that in most markets the likelihood of owning being preferred to renting was little changed by the holding period as short holding periods offered the possibility of catching only the upswing in prices while longer holds made it more likely that owners would share in some portion of a downturn. Only in Chicago, which did not experience such dramatic swings in prices, were longer holding periods found to be much more likely to benefit owning. 17 Still, the issue of holding period is an important consideration. The analysis by both Mills and Capone solved for the holding period that was needed for owning to yield a higher return than renting on the assumption that longer holding periods would always favor homeownership. In his base case scenario Mills found a holding period of slightly longer than 7 years was needed for owning to be preferred. The more recent studies that have showed the importance of market timing either assumed a single fixed holding period of 8 to 10 years (as in Beracha and Johnson and Rappaport) or a range of relative short holding periods (as in Belsky, Retsinas and Duda). If owning does become more favorable over a longer period of time - for example, slightly longer than 8 to 10 years - these assessments would not capture this. In fact, many households move in and out of homeownership over time so a more complete assessment of the financial implications of tenure choice would take into account multiple homeownership spells. While one spell of owning may yield low returns, if homeowning is sustained or resumed then the household may yet benefit from the next upswing. Another important factor driving the findings are assumptions made about rents as a share of house value. This ratio is difficult to estimate both because of systematic differences in the nature of the owner and renter occupied stock and because market values and rents are hard to observe simultaneously. How much renters have to pay to rent a comparable home is obviously a key driver of financial outcomes as it determines how much they can save annually by renting, thereby adding to their wealth. Mills (1990) found that among the variables used in his simulation, his results were most sensitive to the ratio of rents to house values as a single percentage point change up or down leading to fluctuations in the required holding period from 3 to 23 years. Capone (1995) built on Mills study to examine the rent-versus-buy decision specifically for lower income households. He makes note of the importance of the rent-to-price ratio assumption and argues that Mills assumption of 7 percent was well below the ratios observed in low-cost segments of the market, where ratios of 10 to 12 percent were more reasonable. Under Capone's assumption that renters faced much higher rents he found that owners only needed to hold onto their homes for about 3 years for owning to be preferred. In contrast, Belsky, Retsinas and Duda rely on rent to price ratios is in the range of 5 to 7 percent, while the series used by Beracha and Johnson derived by Davis, Lehnert, and Martin (2008) appears to average about 5 percent. In both cases these assumptions are more favorable to renting than the assumptions used by either Mills or Capone. In recognition of the importance of this assumption, Rappaport structures his analysis to estimate the rent-to-price ratio that is the breakeven point between owning and renting. He then compares this estimate to what he feels is a plausible range for this ratio of 18 between 5 and 10 percent based on analysis of different market areas over time. At the higher end of this range owning would almost always be preferred, while the lower end leads to his conclusion that owning is clearly preferred to renting in only about half of the holding periods considered. In short, high or low values of this ratio can swamp other considerations, yet, as Rappaport demonstrates, pinning down actual values for this ratio is not an easy task. Several of the studies have examined the issue of whether tax benefits are important to whether owning makes more financial sense than renting. Mills assumes that owners can take full advantage of tax benefits at a 28 percent marginal rate. When he reduces the marginal rate to 15 percent he finds that owning is never preferred. Capone, though, demonstrates, that this knife edge does not hold if a higher rent to price ratio is assumed. In his base case analysis, owners are only assumed to benefit from tax benefits if they exceed the standard deduction and since he assumes a much more modest house in keeping with his focus on lower-income households, the tax benefits are essentially non-existent. As a result, reducing the tax benefits in his analysis does not change his conclusion that owning is a better financial choice even after only a few years. Belsky, Retsinas and Duda also examine the importance of tax benefits for lower-income owners. Like Capone, they adjust the value of tax deductions to account for the size of the home purchased and the amount of the standard deduction. They also find that tax benefits by themselves generally do not change the calculus of whether owning beats renting financially. So while tax benefits are an important factor among higher income households, as Mills found, it has little effect on the calculus for lower-income households. Despite getting limited benefits from tax breaks under a variety of circumstances Capone and Belsky, Retsinas and Duda find that lower-income households can fare better financially by owning. Belsky, Retsinas and Duda also make a unique contribution by examining how the returns to homeownership are affected by higher mortgage costs. They examine two scenarios: one where owners face interest rates that are 2 percentage points higher than prime rates and another where they are 5 percentage points higher. Under the first scenario, the likelihood that owning would be preferred to renting is decreased by moderate amounts (between 6 and 17 percentage points), while under the later scenario owning is rarely a better financial choice than renting. In short, they find that higher interest rates do reduce the financial appeal of homeownership, although the impact is most pronounced at extremely high levels. Lastly, and in some ways most critically, the finding that renting offers the potential for higher returns than owners depends in large part on renters taking steps to invest the annual savings in housing costs compared to renting. Building on Beracha and Johnson (2012), Beracha, Skiba, and 19 Johnson (2012) examine how variations in key assumptions regarding trends in prices, rents, interest rates, downpayment shares, and the returns available from alternative investments affect the buy versus rent financial calculus. They find that modifying most factors in isolation have only a moderate effect on whether renting is favored over owning. However, when they drop the assumption that renters actual invest any annual savings in housing costs on top of the initial downpayment they find that renting rarely results in higher wealth than owning. Thus, they find that the forced savings aspect of homeownership is of fundamental importance in determining whether owning will lead to greater wealth. This finding is echoed in the results of Boehm and Schlottmann (2004) who employ a somewhat unique approach to simulating the impact of homeownership on wealth accumulation. This study uses the Panel Study of Income Dynamics (PSID) to model the probability of moving in and out of homeownership on an annual basis over the period from 1984 through 1992. These same data are also used to estimate the house value that a household would opt for if a home were purchased in a given year. The estimated house value is then inflated based on house price trends in the census tract where the household resided to yield each household's expected gain in wealth from homeownership. This analysis finds that while minorities and low-income households do accrue wealth from homeownership, the amounts are much less than for higher income whites both because they own for fewer years and because they buy lower valued homes. But importantly, while the expected wealth accumulation among these households is less than that earned by higher income whites it is still positive. The authors also use the PSID to document that these same low-income and minority households essentially had no growth. in non-housing wealth over the same period. So in that regard the estimates of potential wealth created through homeownership were all the more important. Evidence from Panel Surveys about Wealth Accumulation through Homeownership As the findings from Beracha and Johnson (2012) and Boehm and Schlottmann (2004) suggest, the theoretical advantages of renting may not be realized if in practice renters do not take advantage of the opportunities afforded to them for saving and investing derived from the lower cost of renting. In contrast, studies making use of panel surveys that track households over time provide insights into the wealth accumulation associated with actual choices about renting and owning. These studies universally find that owning a home is associated with higher levels of wealth accumulation even after controlling for a range of household characteristics. While the gains are also consistently smaller in magnitude for lower-income and minority households, these studies also find that in contrast to owners similar renters 20 experience little or no gains in wealth. These findings hold even when steps are taken to account for selection bias in who becomes a homeowner. Although these methods may not fully account for the differences between owners and renters, there remains a strong case that homeowning does make a positive contribution to household balance sheets regardless of income or race/ethnicity. Haurin, Hendershott and Wachter (1996) was among the first studies to use panel survey data to track wealth trajectories associated with homeownership. The primary focus of this study was on the accumulation of wealth in anticipation of becoming an owner rather than how owning a home over time contributes to wealth accumulation, but their findings provide important insights into one way in which homeownership adds to wealth. They use the National Longitudinal Survey of Youth (NLSY) to track young renters age 20 to 28 in 1985 through 1990 and observe both their annual wealth levels and the timing of any transitions into homeownership. They find that household wealth goes up markedly during the transition to homeownership, increasing by 33 percent on average in the year prior to buying a home and then more than doubling in the year they first own. When they examine factors that contribute to this jump in wealth they find that marrying makes a significant contribution along with an increase in hours worked and a slightly higher incidence of inheritance and gifts. Their results suggest that an important mechanism by which homeownership adds to wealth is through the incentive to save in anticipation of buying a home. Even before realizing any returns on the investment in the home itself, the drive to become an owner results in substantially higher wealth than those who remain renters. Adding to this effect Haurin and his colleagues also find that wealth increases more rapidly in the years after becoming a homeowner-by 17 percent on average annually among their sample. Reid (2004) uses panel data from the PSID for the period 1976 through 1994 to examine the financial outcomes of homeownership among low-income households who bought their first home at some point during this period (with low-income defined as those with incomes consistently below 80 percent of area median income before first buying a home). She takes two approaches to examining the returns to homeownership for this group. First, she estimates the change in home values for both low- income and minority homeowners compared to higher-income and white owners. She finds that the rate of increase in home values for these groups was fairly modest, failing to beat the returns that would have been earned on an investment in Treasury bills over the same time. Reid then examines wealth holdings of households by tenure status at the end of her period of observation. She finds that while low-income and minority owners generally built much less wealth than higher-income and white households, the amount of their housing wealth was non-trivial and was many times larger than their other forms of wealth. Like Boehm and Schlottmann, she also finds that those who were renters at the 21 end of the period essentially held no wealth of any kind. Reid, however, does not undertake a multivariate analysis to control for other factors that may account for the differences between owners and renters. Nor does she factor in the impact of failed efforts at homeownership on wealth. But the fact that home equity accounts for such a large share of wealth among low-income and minority households points to the important role that owning a home played in fostering wealth accumulation. Di, Belsky and Liu (2007) was the first study to directly assess the relationship between homeownership and wealth accumulation over time while attempting to account for household characteristics and to include some measure of potential selection bias in who becomes an owner. The study uses the PSID to track households who were renters in 1989 through 2001 to observe transitions into and out of homeownership. The change in household wealth over time is then modeled as a function of starting wealth, a range of household characteristics thought to influence wealth, and, their principal measure of interest, the amount of time spent as an owner. In order to take into account a household's propensity to save, the study uses the PSID from 1984 through 1989 to estimate the share of income that was saved as an indication of savings behavior prior to the period when tenure transitions are observed as a means of controlling for this tendency in assessing differences in savings behavior after buying a home. Their principal finding is a positive and statistically significant association between additional years of homeownership and changes in wealth. The authors include a square term for the number of years owned to take into account anticipated impacts of the timing of moves into homeownership over the period as there was an initial decline in house values during the first years of their panel followed by more robust increases in later years. This square term is negative and significant indicating those who bought earlier in the period had lower cumulative gains in wealth. The largest estimated gains in wealth of $13,000 per year of ownership occurred among those who owned for 8 years. But for those who owned for the maximum possible period of 12 years the gains were only $3,333 per year. Prior savings tendency was positively associated with increases in wealth as expected, but was not statistically significant and so did not appear to capture any important difference in household behavior that was not already accounted for by other explanatory variables. Turner and Luea (2009) undertake a very similar analysis using the PSID sample for the period from 1987 to 2001. In contrast to Di, Belsky and Liu who only include initial renters, their study sample includes all households in the sample as of 2001 that were age 65 or younger regardless of whether they were renters at the start of the period. The study pools observations for the sample on household wealth from three points in time: 1994, 1999, and 2001. For each observation they include a count of the number of years the household has owned a home since 1988 as their explanatory variable of 22 interest. The approach used in this study attempts to control for selection bias into homeownership by estimating a random effects model that includes a household specific constant term. Turner and Luea also separate the sample into two income classes to see whether the association between homeownership and wealth growth differs by income. Low- and moderate-income (LMI) households were those who had incomes below 120 percent of area median income in all three periods when wealth was observed. The results indicate that each year of homeownership is associated with nearly $14,000 in additional wealth, perhaps not surprisingly quite similar to the amount found by Di, Belsky and Liu using the same survey over a nearly identical period (although with a somewhat different sample). When controls are included for LMI status, Turner and Luea find that these households have somewhat lower wealth accumulation of between $6,000 and $10,000 per year. But they note that since the average wealth holding of LMI households in 2001 was about $89,000 this annual rate of increase accounts for a fairly sizeable share of total wealth. In an unpublished dissertation, Mamgain (2011) extends the work of Turner and Luea by employing a two-stage model to add stronger controls for selection into homeownership. Like most of the other studies, Mamgain also uses the PSID, but his period of observation is from 1999 through 2007. Despite the different time period examined, when he replicates Turner and Luea his analysis yields similar results regarding the magnitude of the association between homeownership and wealth (although by ending the study period in 2007 it does not include the sharp loss of both housing and financial wealth that followed 2007). When Mamgain adds additional controls to his model to capture the intention to move, the respondent's health status, their ownership of other real estate and an estimate of current LTV he finds a somewhat lower impact of additional years of owning, but the estimate is still significant and positive. Importantly, when he employs his two-stage approach to include both a selection term and an instrumental measure of current tenure his estimate of the impact of each. additional year on owning does not change. He also estimates separate models by income level and finds that there is no difference in the impact of owning across income classes—all are positive and significant. In short, like other studies he does not find a significant impact of selection bias on his findings and he also finds that low-income owners are also likely to benefit from owning homes. 3 3 He does differ from previous studies in how he estimates the contribution of owning to wealth gains, by focusing on impacts at much lower household wealth levels. He finds that assuming wealth of about $2,500 for the lowest income group (at or below 150 percent of the poverty level) owning a home only adds a few hundred dollars a year to the household's bottom line. But with total wealth set a level well below the median among owners in this income class this result seems implausible. 23 None of the studies estimating statistical models to assess the contribution of homeownership to wealth accumulation analyzed whether there were differences in this experience by race and ethnicity. As discussed above, there are significant racial and ethnic differences in residential location, size of home, and characteristics of financing used, all of which could contribute to differences in wealth outcomes. Shapiro, Meschede, and Osoro (2013) use the PSID from 1984 through 2009 specifically to examine the factors associated with more rapid growth in wealth among whites over this period compared to blacks. Tracking the same set of households over this period they find that gains in median wealth among whites exceeded those among blacks by $152,000. Based on the results of a multivariate analysis they found that the single largest driver of this divergence in wealth was the additional time whites spend as homeowners, which they estimate accounted for 27 percent of the additional white gains. The next most significant factors were differences in income (20 percent), unemployment spells (9 percent), lower shares with a college education (5 percent), and differences in inheritance and financial support from family (5 percent). They also find that years of homeownership exerted a stronger influence on gains in wealth for blacks than it did for whites. While the authors do not attempt to control for any selection bias to control for who becomes a homeowner, none of the previous studies that have taken these steps have found these controls to change their findings. Conclusions Drawn from the Previous Literature Studies presenting simulations of the financial returns to renting and owning make a convincing case that in many markets over many periods of time and under a variety of assumptions renting ought to support greater wealth accumulation than owning. However, as virtually all of the panel studies document, in practice owning has consistently been found to be associated with greater increases in wealth even after controlling for differences in household income, education, marital status, starting wealth, inheritances, and other factors. Importantly, these same studies also consistently find that owning has a positive effect on wealth accumulation among both lower-income households and minorities, although the gains are smaller than for higher-income households and whites generally. Housing wealth among lower-income and minority households also often accounts a substantial share of total wealth for these groups. On the other hand, renters in these same demographic groups are consistently found to accrue little to no wealth over time. How can we reconcile the findings from simulation studies that renting should often be more financially advantageous than owning with the findings from the analysis of panel surveys that unambiguously find owning to be more favorable? One explanation may be that behavioral issues play 24 a key role. Efforts to save for a downpayment lead to a large jump in wealth that is then further supported by at least modest appreciation and some pay down of principal over time. Renters may have the opportunity to accrue savings and invest them in higher yielding opportunities but lack strong incentives and effective mechanisms for carrying through on this opportunity. There is also likely some degree of selection bias at work in who becomes a homeowner. While studies do control for income, education, marital status and other factors that would contribute in differences in the ability to save, there are likely differences in motivation and personal attributes that are related to both savings practices and whether someone becomes an owner. While controls included in studies to capture this effect have not diluted the association between homeownership and increases in wealth, this may simply reflect the challenge of capturing these difficult to measure factors. Studies using panel surveys may also make the benefits of homeownership appear more assured than they actually are by not fully capturing the impact of failed attempts at owning on changes in wealth. Studies to date have focused on measuring homeownership as the number of years spent as a homeowner, which does not distinguish between short sustained spells of owning from similar periods of owning that end in foreclosure or other financial distress. So while homeownership on average may increase wealth, it is undoubtedly the case that for some share of households owning a home had a negative impact on their balance sheet. Finally, the studies reviewed here may also not fully reflect changes that have occurred over time in both market conditions and household behavior. Most of the studies cited reflect experiences as owners during the 1980s and 1990s and so do not capture the market dynamics that began in the late 1990s but came to full bloom during the boom years of the 2000s, including the much greater availability of and appetite for high loan-to-value loans, higher cost loans, sharp swings in house prices, and much higher risks of default even before the national foreclosure crisis began. The next section turns to an analysis of data from the 2000s to examine whether findings about homeownership's positive association with wealth accumulation held over this period, particularly for low-income and minority households who were most likely to have used high cost mortgage products. Experience with Homeownership and Wealth Accumulation through the Boom and Bust Given the substantial changes in the availability, cost and terms of mortgage financing that began in the 1990s and accelerated through the mid-2000s and the accompanying boom and bust in home prices, there is good reason to believe that the experience of homeowners in accumulating wealth over the last decade has been substantially different from what is documented in much of the existing 25 literature for earlier periods. In this section of the paper we present information on wealth accumulation through homeownership during the housing market boom and bust of the 2000s. In the first section, we present findings from the tri-annual Survey of Consumer Finance (SCF) to present a high level picture of the contribution of homeownership to household balance sheets over time. The SCF also provides insights into how a greater tendency both to use high loan-to-value (LTV) loans to purchase homes and to take cash out through refinancing may have reduced wealth associated with homeownership. While the SCF does document the substantial decline in housing wealth following the bust, it also shows that, despite these losses, average homeownership wealth is generally higher than it was in the mid-1990s and continues to represent a substantial portion of household wealth for minorities and lower-income households. The SCF also shows that while the degree of leverage in the housing market showed a marked increase in the years following the Tax Reform Act of 1986, the distribution of LTVs did not change a great deal between the mid 1990s and the housing boom years. However, the crash in housing prices did push LTVs to historic highs. We then turn to an analysis of the PSID for the period from 1999 to 2009 to examine how homeownership spells contributed to trends in household wealth over this period. While house prices grew substantially for much of this period, it also captures most of the decline in prices as well. Whereas previous studies have focused solely on how each additional year of homeownership contributes to household wealth, we are also interested in assessing how failed attempts at homeownership affect wealth to assess the downside risks of owning as well. We find that on average homeownership's contribution to household wealth over this period was remarkably similar to that found in earlier periods. The results also confirm previous findings that while lower-income households and minorities realized lower wealth gains from owning, on average these gains were positive and significant. The results also show that a failure to sustain homeownership is associated with a substantial loss of wealth for established owners, although those who made a failed transition from owning to renting are no worse off financially than those who remained renters over the whole period. Thus, despite the many ways in which market conditions over this period might have been expected to undermine homeownership's wealth building potential, our analysis of the PSID finds that owning maintained a strong association with improvements in wealth over the decade from 1999 to 2009. Long-Run Trends in Housing Wealth and Mortgage Debt The sharp rise in home prices in many parts of the country is reflected in the substantial increase in average real housing equity among homeowners, roughly doubling (a gain of 96 percent) between 26 1995 and 2007 among all homeowners (Table 1). The gains were nearly as large among African- Americans (88 percent) and even larger among Hispanics (123 percent), although generally lower among households in the bottom two income quartiles where home equity increased by only 56 and 42 percent, respectively. The loss in housing equity between 2007 and 2010 was substantial, erasing 26 percent of home equity on average for all homeowners and taking back much of the gains made since 2001 for most groups. Mirroring their larger gains during the boom, Hispanics suffered the greatest loss of housing wealth, dropping by nearly half. Across income groups the declines were more moderate among those in the bottom half of the income distribution. But despite these substantial losses, average real home equity in 2010 was still higher on average than in 1995 for all of the groups shown, and in many cases considerably higher. Whites and those in the highest income quartile had the largest gains, with average home equity up by 51 percent and 78 percent respectively. African-Americans and the lowest income quartile also maintained substantial gains of 39 percent and 35 percent, respectively. Hispanics and those in the middle income quartiles made the least progress, with average home equity up by only 12 to 18 percent. Throughout this period the share of net wealth accounted for by home equity among all homeowners fluctuated between 22 and 29 percent, with much of the movement due to changes in non-housing net wealth. Between 1989 and 1998 home equity's share of average wealth fell from 29 to 22 percent as the stock market boomed while home values languished. Between 1998 and 2007 home equity's share of net wealth rose to 25 percent as the stock market absorbed the dot com bust while housing prices soared. Between 2007 and 2010 losses in housing wealth outpaced losses in other financial assets so housing's share of wealth fell back to 22 percent. Thus, despite the significant growth in housing equity in the first half of the 2000s it never came to account for an outsized portion of household net wealth among all homeowners. ",Financial,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",What did researchers find to be the cause of the anti-PD-1 therapy side effects? How did testing mice help in finding the cause? Will these findings help prevent the side effects for cancer patients?,"Treatments that enhance the defenses the body already has in place have greatly advanced the fight against cancer. Such a boost is the mechanism underlying an established therapy used for solid cancers, such as melanomas and small-cell lung cancers, and trials are underway for other cancer types. The treatment blocks a protein on immune cells that can lead to cell death, which keeps the immune system in a hyperalert state that makes it better at destroying cancer cells. However, oncologists such as Robert Zeiser at the University of Freiburg in Germany began to see that some patients on this type of cancer immunotherapy experienced neurological side effects such as memory loss, which in a few cases were serious enough to lead to encephalitis or coma. In a recent study in Science Translational Medicine, Zeiser and his postdoctoral researcher Janaki Manoja Vinnakota, along with their colleagues, untangled the reasons why these side effects occur. The protein targeted by this cancer immunotherapy is called PD-1, short for programmed cell death protein-1. The therapy uses an antibody to block this protein’s receptor on T cells. Cancer cells produce markers that turn off immune cells and fool them into seeing the cancer as normal cells. The therapy keeps immune cells active so they don’t recognize these repressive markers and will kill the cancer cells. But keeping the immune system in this hyperactivated state can have negative consequences, because another type of immune cell that resides in the nervous system, called microglia, also have the same receptor. These cells have close interactions with neurons, and help control many brain activities. “Once microglia are active, they also meddle with the normal cognitive processes, which might cause neurotoxicity,” Vinnakota explains. J. M. Vinnakota, et al., 2024, Science Translational Medicine 16:eadj9672 (all 4 images) To see if microglia could be behind the neurological side effects, the team first treated a cell culture of microglia with two different clinically approved anti-PD-1 antibodies. They found an increased level of a marker associated with microglia activity. They next treated healthy mice with the anti-PD-1 therapy. Tissue samples from these mice likewise showed that microglia were activated after the therapy. “Microglia, under normal conditions, are highly branched; they tend to look around for any potential threat,” Vinnakota explains. “If there is one, they retract their processes and attain an amoeboid phenotype.” When the team then tested mice that had a knocked-out immune system, they didn’t see as much activity. One curiosity the researchers had about their findings was that the blood–brain barrier should keep the anti-PD-1 therapy out of the nervous system. But Vinnakota and her colleagues found that the therapy actually causes inflammatory damage to the barrier that allows it to pass through. The team next treated mice with tumors and found that they showed cognitive deficits similar to those seen in human patients. The mice did not favor new objects over ones that they had already been extensively exposed to, indicating that they did not have memory of objects that should have been familiar. The markers produced when the microglia are activated seem to cause the cognitive damage. These markers include a type of enzyme called a tyrosine kinase that acts as a sort of protein switch—in this case, one called Syk. Kinases are important for the function of the immune system, but they also promote inflammation. “Increased levels of Syk activation are somehow damaging the neurons in the vicinity, which is why we see cognitive deficits in the treated mice,” Vinnakota said. The good news, however, is that there are already commercially available inhibitors that work on Syk. When the team treated the cognitively impaired mice with these inhibitors, they were able to reverse the decline. Although the studies so far have been limited to mice, Vinnakota thinks that, following further research, there could one day be the option of blocking Syk in patients receiving anti-PD-1 therapy who start to show indications of cognitive decline. “The people who get cognitive decline are suffering a lot, so they have to stop this anti-PD-1 therapy, and that increases the relapse of the tumor, and then they have to look for some other treatment options,” she says. “It’s really bad for the ones who are suffering.” Optimally, Vinnakota hopes, researchers will develop early-diagnostic tools that can spot patients who are likely to have side effects from anti-PD-1 therapy, so they can be preemptively treated with blockers for Syk. “That would be really helpful to treat them better,” she says, “so that we can still have the anti-PD-1 therapy ongoing, because it is an effective therapy for many of the patients.”","[question] What did researchers find to be the cause of the anti-PD-1 therapy side effects? How did testing mice help in finding the cause? Will these findings help prevent the side effects for cancer patients? ===================== [text] Treatments that enhance the defenses the body already has in place have greatly advanced the fight against cancer. Such a boost is the mechanism underlying an established therapy used for solid cancers, such as melanomas and small-cell lung cancers, and trials are underway for other cancer types. The treatment blocks a protein on immune cells that can lead to cell death, which keeps the immune system in a hyperalert state that makes it better at destroying cancer cells. However, oncologists such as Robert Zeiser at the University of Freiburg in Germany began to see that some patients on this type of cancer immunotherapy experienced neurological side effects such as memory loss, which in a few cases were serious enough to lead to encephalitis or coma. In a recent study in Science Translational Medicine, Zeiser and his postdoctoral researcher Janaki Manoja Vinnakota, along with their colleagues, untangled the reasons why these side effects occur. The protein targeted by this cancer immunotherapy is called PD-1, short for programmed cell death protein-1. The therapy uses an antibody to block this protein’s receptor on T cells. Cancer cells produce markers that turn off immune cells and fool them into seeing the cancer as normal cells. The therapy keeps immune cells active so they don’t recognize these repressive markers and will kill the cancer cells. But keeping the immune system in this hyperactivated state can have negative consequences, because another type of immune cell that resides in the nervous system, called microglia, also have the same receptor. These cells have close interactions with neurons, and help control many brain activities. “Once microglia are active, they also meddle with the normal cognitive processes, which might cause neurotoxicity,” Vinnakota explains. J. M. Vinnakota, et al., 2024, Science Translational Medicine 16:eadj9672 (all 4 images) To see if microglia could be behind the neurological side effects, the team first treated a cell culture of microglia with two different clinically approved anti-PD-1 antibodies. They found an increased level of a marker associated with microglia activity. They next treated healthy mice with the anti-PD-1 therapy. Tissue samples from these mice likewise showed that microglia were activated after the therapy. “Microglia, under normal conditions, are highly branched; they tend to look around for any potential threat,” Vinnakota explains. “If there is one, they retract their processes and attain an amoeboid phenotype.” When the team then tested mice that had a knocked-out immune system, they didn’t see as much activity. One curiosity the researchers had about their findings was that the blood–brain barrier should keep the anti-PD-1 therapy out of the nervous system. But Vinnakota and her colleagues found that the therapy actually causes inflammatory damage to the barrier that allows it to pass through. The team next treated mice with tumors and found that they showed cognitive deficits similar to those seen in human patients. The mice did not favor new objects over ones that they had already been extensively exposed to, indicating that they did not have memory of objects that should have been familiar. The markers produced when the microglia are activated seem to cause the cognitive damage. These markers include a type of enzyme called a tyrosine kinase that acts as a sort of protein switch—in this case, one called Syk. Kinases are important for the function of the immune system, but they also promote inflammation. “Increased levels of Syk activation are somehow damaging the neurons in the vicinity, which is why we see cognitive deficits in the treated mice,” Vinnakota said. The good news, however, is that there are already commercially available inhibitors that work on Syk. When the team treated the cognitively impaired mice with these inhibitors, they were able to reverse the decline. Although the studies so far have been limited to mice, Vinnakota thinks that, following further research, there could one day be the option of blocking Syk in patients receiving anti-PD-1 therapy who start to show indications of cognitive decline. “The people who get cognitive decline are suffering a lot, so they have to stop this anti-PD-1 therapy, and that increases the relapse of the tumor, and then they have to look for some other treatment options,” she says. “It’s really bad for the ones who are suffering.” Optimally, Vinnakota hopes, researchers will develop early-diagnostic tools that can spot patients who are likely to have side effects from anti-PD-1 therapy, so they can be preemptively treated with blockers for Syk. “That would be really helpful to treat them better,” she says, “so that we can still have the anti-PD-1 therapy ongoing, because it is an effective therapy for many of the patients.” https://www.americanscientist.org/article/treating-the-side-effects ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Fact Finding,Q&A "For this question, make sure you only use the information I give to you. Focus on terms the average person would understand. ",Identify the difference between dividends and earnings.,"1. Amortization: Refers to the process of gradually paying off a debt or loan over a specific period of time through regular, scheduled payments. These payments typically consist of both principal and interest. 2. Backlog: A buildup of work that has not been completed or processed within a specific period. When a company receives an order or new contract for a product, undelivered products to fulfill that contract become part of the company’s backlog. 3. Balance Sheet: Financial statement that provides a snapshot of a company's financial position at a specific point in time. It is one of the financial statements used by businesses, investors, creditors, and analysts to assess the company's financial health and performance. The balance sheet follows the accounting equation that assets must equal liabilities plus equity. 4. Bid & Proposal Costs: Refers to the costs incurred in preparing, submitting, and supporting bids and proposals (whether or not solicited) on potential contracts (Government or not). These typically indirect costs are allowable to the extent they are allocable, reasonable, and not otherwise unallowable. 5. Booking (e.g., Orders): Refers to the value of new contracts, modifications, task orders, or options signed in an accounting period. 6. Cash Flow: Refers to the inflows (coming in) and outflows (going out) of cash of a company. 7. Cash Flow Statement: Financial statement that provides an overview of the cash generated and used by a business during a specific period of time. It is one of the key financial statements used by businesses, investors, and analysts to assess the financial health and liquidity of a company. The cash flow statement is divided into three main sections: 1) Operating Activities: Reports the cash generated or used in the core operating activities of the business. 2) Investing Activities: Details cash transactions related to the purchase and sale of long-term assets and investments. 3) Financing Activities: Reflects cash transactions related to the company's financing activities. It includes activities such as issuing or repurchasing stock, borrowing, or repaying debt, and paying dividends. 8. Common Size Financial Analysis: Method of evaluating and comparing financial statements by expressing each line item as a percentage of a base item (e.g., revenue for income statement or assets for balance sheet). The purpose of common size analysis is to provide insights into the relative proportions of different components within a financial statement, allowing for better comparison of companies of different sizes or of the same company over different periods. 9. Cost of Sales or Cost of Goods Sold: Represents the costs associated with producing or purchasing the goods that a company sells during a specific period. It is a crucial metric for businesses, as it is subtracted from the total revenue to calculate the gross profit 10. Current Assets: Any balance sheet accounts owned by a company that can be converted to cash through liquidation, sales, or use within one year. Examples may include cash (or equivalent), accounts receivable, prepaid expenses, raw materials, inventory (work-in-process or finished goods), short-term investments, etc. 11. Current Liabilities: Any balance sheet accounts that are obligations by a company that are due to be paid within one year. Examples may include accounts payable, payroll, taxes, utilities, rental fees, shortterm notes payable, etc. 12. Debt Ratio: A financial leverage metric based on a company’s total debt to total assets from the Balance Sheet. Debt Ratio = Total Liabilities / Total Assets (less Depreciation). 13. Depreciation: Refers to the decrease in the value of an asset over time due to various factors such as wear and tear, obsolescence, or other forms of reduction in its usefulness. It is a common accounting concept used to allocate the cost of a tangible asset (like machinery, vehicles, buildings, etc.) over its useful life. Often an expense item on the Income Statement. 14. Discount rate: Refers to the interest rate used to determine the present value of future cash flows. The concept is fundamental in the field of discounted cash flow (DCF) analysis, which is a method used to value an investment or project by discounting its expected future cash flows back to their present value. 15. Dividends: Payments made by a company to its shareholders, typically in the form of cash or additional shares of stock. They represent a portion of the company's profits that is distributed to its owners. 16. Earnings: Typically refers to the profits or net income of a business during a specific period. Earnings represent the financial performance of a company and are a key indicator of its profitability, 17. Earnings per Share (EPS, ratio): Financial profitability metric that represents the portion of a company's profit allocated to each outstanding share of common stock. It is a widely used indicator of a company's profitability and is often considered a key measure of financial performance. Calculated as net income minus preferred dividends divided by average number of common shares. 18. Earnings Before Interest and Taxes (EBIT): A measure of a company's operating performance and profitability before deducting interest expenses and taxes. EBIT is often used to analyze a company's core operating profitability without the influence of financial structure or tax considerations. EBIT provides a metric that allows for comparisons of the operating performance of different companies, as it excludes the impact of financing and taxation. (See operating income) 19. Free Cash Flow (FCF): Metric that represents the cash generated by a company's operations that is available for distribution to creditors and investors (both equity and debt holders) after all operating expenses, capital expenditures, and taxes have been deducted. It means the company has the ability to distribute cash to investors, pay down debt, or reinvest in the business. FCF=Operating Cash Flow - Capital Expenditures 20. Gross Profit: Metric represents the difference between revenue and the cost of sales during a specific period. While gross profit provides useful insights, it doesn't consider other operating expenses or nonoperating income, so it's often used in conjunction with other financial metrics to get a more comprehensive view of a company's overall financial health. Gross Profit = Sales – Cost of Sales. 21. Gross Profit Margin: Financial metric that measures the percentage of revenue that exceeds the cost of sales. It is a key indicator of a company's profitability and efficiency in managing its production and supply chain costs. 22. Income (or Profit): This is a metric that reflects the Income Statement’s bottom line or the amount of money a business has left over after all expenses. Gross income is the amount earned before expenses. (also known as gross profit). See Net Income. 23. Income Statement: Financial statement used to summarize company revenue, costs, and expenses over a specific period, usually a fiscal quarter or year. The main purpose of an income statement is to provide a snapshot of a company's financial performance during a given time frame. 24. Internal Rate of Return (IRR): Metric in financial analysis to estimate and compare the profitability of potential investments. Represents the expected compound annual rate of return that will be earned on a project. Typically, investments with higher IRRs are preferred as companies decide which projects to invest in.","For this question, make sure you only use the information I give to you. Focus on terms the average person would understand. 1. Amortization: Refers to the process of gradually paying off a debt or loan over a specific period of time through regular, scheduled payments. These payments typically consist of both principal and interest. 2. Backlog: A buildup of work that has not been completed or processed within a specific period. When a company receives an order or new contract for a product, undelivered products to fulfill that contract become part of the company’s backlog. 3. Balance Sheet: Financial statement that provides a snapshot of a company's financial position at a specific point in time. It is one of the financial statements used by businesses, investors, creditors, and analysts to assess the company's financial health and performance. The balance sheet follows the accounting equation that assets must equal liabilities plus equity. 4. Bid & Proposal Costs: Refers to the costs incurred in preparing, submitting, and supporting bids and proposals (whether or not solicited) on potential contracts (Government or not). These typically indirect costs are allowable to the extent they are allocable, reasonable, and not otherwise unallowable. 5. Booking (e.g., Orders): Refers to the value of new contracts, modifications, task orders, or options signed in an accounting period. 6. Cash Flow: Refers to the inflows (coming in) and outflows (going out) of cash of a company. 7. Cash Flow Statement: Financial statement that provides an overview of the cash generated and used by a business during a specific period of time. It is one of the key financial statements used by businesses, investors, and analysts to assess the financial health and liquidity of a company. The cash flow statement is divided into three main sections: 1) Operating Activities: Reports the cash generated or used in the core operating activities of the business. 2) Investing Activities: Details cash transactions related to the purchase and sale of long-term assets and investments. 3) Financing Activities: Reflects cash transactions related to the company's financing activities. It includes activities such as issuing or repurchasing stock, borrowing, or repaying debt, and paying dividends. 8. Common Size Financial Analysis: Method of evaluating and comparing financial statements by expressing each line item as a percentage of a base item (e.g., revenue for income statement or assets for balance sheet). The purpose of common size analysis is to provide insights into the relative proportions of different components within a financial statement, allowing for better comparison of companies of different sizes or of the same company over different periods. 9. Cost of Sales or Cost of Goods Sold: Represents the costs associated with producing or purchasing the goods that a company sells during a specific period. It is a crucial metric for businesses, as it is subtracted from the total revenue to calculate the gross profit 10. Current Assets: Any balance sheet accounts owned by a company that can be converted to cash through liquidation, sales, or use within one year. Examples may include cash (or equivalent), accounts receivable, prepaid expenses, raw materials, inventory (work-in-process or finished goods), short-term investments, etc. 11. Current Liabilities: Any balance sheet accounts that are obligations by a company that are due to be paid within one year. Examples may include accounts payable, payroll, taxes, utilities, rental fees, shortterm notes payable, etc. 12. Debt Ratio: A financial leverage metric based on a company’s total debt to total assets from the Balance Sheet. Debt Ratio = Total Liabilities / Total Assets (less Depreciation). 13. Depreciation: Refers to the decrease in the value of an asset over time due to various factors such as wear and tear, obsolescence, or other forms of reduction in its usefulness. It is a common accounting concept used to allocate the cost of a tangible asset (like machinery, vehicles, buildings, etc.) over its useful life. Often an expense item on the Income Statement. 14. Discount rate: Refers to the interest rate used to determine the present value of future cash flows. The concept is fundamental in the field of discounted cash flow (DCF) analysis, which is a method used to value an investment or project by discounting its expected future cash flows back to their present value. 15. Dividends: Payments made by a company to its shareholders, typically in the form of cash or additional shares of stock. They represent a portion of the company's profits that is distributed to its owners. 16. Earnings: Typically refers to the profits or net income of a business during a specific period. Earnings represent the financial performance of a company and are a key indicator of its profitability, 17. Earnings per Share (EPS, ratio): Financial profitability metric that represents the portion of a company's profit allocated to each outstanding share of common stock. It is a widely used indicator of a company's profitability and is often considered a key measure of financial performance. Calculated as net income minus preferred dividends divided by average number of common shares. 18. Earnings Before Interest and Taxes (EBIT): A measure of a company's operating performance and profitability before deducting interest expenses and taxes. EBIT is often used to analyze a company's core operating profitability without the influence of financial structure or tax considerations. EBIT provides a metric that allows for comparisons of the operating performance of different companies, as it excludes the impact of financing and taxation. (See operating income) 19. Free Cash Flow (FCF): Metric that represents the cash generated by a company's operations that is available for distribution to creditors and investors (both equity and debt holders) after all operating expenses, capital expenditures, and taxes have been deducted. It means the company has the ability to distribute cash to investors, pay down debt, or reinvest in the business. FCF=Operating Cash Flow - Capital Expenditures 20. Gross Profit: Metric represents the difference between revenue and the cost of sales during a specific period. While gross profit provides useful insights, it doesn't consider other operating expenses or nonoperating income, so it's often used in conjunction with other financial metrics to get a more comprehensive view of a company's overall financial health. Gross Profit = Sales – Cost of Sales. 21. Gross Profit Margin: Financial metric that measures the percentage of revenue that exceeds the cost of sales. It is a key indicator of a company's profitability and efficiency in managing its production and supply chain costs. 22. Income (or Profit): This is a metric that reflects the Income Statement’s bottom line or the amount of money a business has left over after all expenses. Gross income is the amount earned before expenses. (also known as gross profit). See Net Income. 23. Income Statement: Financial statement used to summarize company revenue, costs, and expenses over a specific period, usually a fiscal quarter or year. The main purpose of an income statement is to provide a snapshot of a company's financial performance during a given time frame. 24. Internal Rate of Return (IRR): Metric in financial analysis to estimate and compare the profitability of potential investments. Represents the expected compound annual rate of return that will be earned on a project. Typically, investments with higher IRRs are preferred as companies decide which projects to invest in. Identify the difference between dividends and earnings. ",Financial,Concept Comparison,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Should internet providers be protected from all liability for information posted on their websites by third parties? Describe the pros and cons of keeping such protection in place, in a bullet list, and give a final judgment of which side is more persuasive.","DEPARTMENT OF JUSTICE’S REVIEW OF SECTION 230 OF THE COMMUNICATIONS DECENCY ACT OF 1996 Office of the Attorney General As part of the President's Executive Order on Preventing Online Censorship, and as a result of the Department's long standing review of Section 230, the Department has put together the following legislative package to reform Section 230. The proposal focuses on the two big areas of concern that were highlighted by victims, businesses, and other stakeholders in the conversations and meetings the Department held to discuss the issue. First, it addresses unclear and inconsistent moderation practices that limit speech and go beyond the text of the existing statute. Second, it addresses the proliferation of illicit and harmful content online that leaves victims without any civil recourse. Taken together, the Department's legislative package provides a clear path forward on modernizing Section 230 to encourage a safer and more open internet. Cover Letter: A letter to Congress explaining the need for Section 230 reform and how the Department proposes to reform it. Redline: A copy of the existing law with the Department's proposed changes in redline. Section by Section: An accompanying document to the redline that provides a detailed description and purpose for each edit to the existing statute. Read More As part of its broader review of market-leading online platforms, the U.S. Department of Justice analyzed Section 230 of the Communications Decency Act of 1996, which provides immunity to online platforms from civil liability based on third-party content and for the removal of content in certain circumstances. Congress originally enacted the statute to nurture a nascent industry while also incentivizing online platforms to remove content harmful to children. The combination of significant technological changes since 1996 and the expansive interpretation that courts have given Section 230, however, has left online platforms both immune for a wide array of illicit activity on their services and free to moderate content with little transparency or accountability. The Department of Justice has concluded that the time is ripe to realign the scope of Section 230 with the realities of the modern internet. Reform is important now more than ever. Every year, more citizens—including young children—are relying on the internet for everyday activities, while online criminal activity continues to grow. We must ensure that the internet is both an open and safe space for our society. Based on engagement with experts, industry, thought-leaders, lawmakers, and the public, the Department has identified a set of concrete reform proposals to provide stronger incentives for online platforms to address illicit material on their services, while continuing to foster innovation and free speech. Read the Department’s Key Takeaways. The Department's review of Section 230 arose in the context of our broader review of market-leading online platforms and their practices, announced in July 2019. While competition has been a core part of the Department’s review, we also recognize that not all concerns raised about online platforms (including internet-based businesses and social media platforms) fall squarely within the U.S. antitrust laws. Our review has therefore looked broadly at other legal and policy frameworks applicable to online platforms. One key part of that legal landscape is Section 230, which provides immunity to online platforms from civil liability based on third-party content as well as immunity for removal of content in certain circumstances. Drafted in the early years of internet commerce, Section 230 was enacted in response to a problem that incipient online platforms were facing. In the years leading up to Section 230, courts had held that an online platform that passively hosted third-party content was not liable as a publisher if any of that content was defamatory, but that a platform would be liable as a publisher for all its third-party content if it exercised discretion to remove any third-party material. Platforms therefore faced a dilemma: They could try to moderate third-party content but risk being held liable for any and all content posted by third parties, or choose not to moderate content to avoid liability but risk having their services overrun with obscene or unlawful content. Congress enacted Section 230 in part to resolve this quandary by providing immunity to online platforms both for third-party content on their services or for removal of certain categories of content. The statute was meant to nurture emerging internet businesses while also incentivizing them to regulate harmful online content. The internet has changed dramatically in the 25 years since Section 230’s enactment in ways that no one, including the drafters of Section 230, could have predicted. Several online platforms have transformed into some of the nation’s largest and most valuable companies, and today’s online services bear little resemblance to the rudimentary offerings in 1996. Platforms no longer function as simple forums for posting third-party content, but instead use sophisticated algorithms to promote content and connect users. Platforms also now offer an ever-expanding array of services, playing an increasingly essential role in how Americans communicate, access media, engage in commerce, and generally carry on their everyday lives. These developments have brought enormous benefits to society. But they have also had downsides. Criminals and other wrongdoers are increasingly turning to online platforms to engage in a host of unlawful activities, including child sexual exploitation, selling illicit drugs, cyberstalking, human trafficking, and terrorism. At the same time, courts have interpreted the scope of Section 230 immunity very broadly, diverging from its original purpose. This expansive statutory interpretation, combined with technological developments, has reduced the incentives of online platforms to address illicit activity on their services and, at the same time, left them free to moderate lawful content without transparency or accountability. The time has therefore come to realign the scope of Section 230 with the realities of the modern internet so that it continues to foster innovation and free speech but also provides stronger incentives for online platforms to address illicit material on their services. Much of the modern debate over Section 230 has been at opposite ends of the spectrum. Many have called for an outright repeal of the statute in light of the changed technological landscape and growing online harms. Others, meanwhile, have insisted that Section 230 be left alone and claimed that any reform will crumble the tech industry. Based on our analysis and external engagement, the Department believes there is productive middle ground and has identified a set of measured, yet concrete proposals that address many of the concerns raised about Section 230. A reassessment of America’s laws governing the internet could not be timelier. Citizens are relying on the internet more than ever for commerce, entertainment, education, employment, and public discourse. School closings in light of the COVID-19 pandemic mean that children are spending more time online, at times unsupervised, while more and more criminal activity is moving online. All of these factors make it imperative that we maintain the internet as an open and safe space.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Should internet providers be protected from all liability for information posted on their websites by third parties? Describe the pros and cons of keeping such protection in place, in a bullet list, and give a final judgment of which side is more persuasive. {passage 0} ========== DEPARTMENT OF JUSTICE’S REVIEW OF SECTION 230 OF THE COMMUNICATIONS DECENCY ACT OF 1996 Office of the Attorney General As part of the President's Executive Order on Preventing Online Censorship, and as a result of the Department's long standing review of Section 230, the Department has put together the following legislative package to reform Section 230. The proposal focuses on the two big areas of concern that were highlighted by victims, businesses, and other stakeholders in the conversations and meetings the Department held to discuss the issue. First, it addresses unclear and inconsistent moderation practices that limit speech and go beyond the text of the existing statute. Second, it addresses the proliferation of illicit and harmful content online that leaves victims without any civil recourse. Taken together, the Department's legislative package provides a clear path forward on modernizing Section 230 to encourage a safer and more open internet. Cover Letter: A letter to Congress explaining the need for Section 230 reform and how the Department proposes to reform it. Redline: A copy of the existing law with the Department's proposed changes in redline. Section by Section: An accompanying document to the redline that provides a detailed description and purpose for each edit to the existing statute. Read More As part of its broader review of market-leading online platforms, the U.S. Department of Justice analyzed Section 230 of the Communications Decency Act of 1996, which provides immunity to online platforms from civil liability based on third-party content and for the removal of content in certain circumstances. Congress originally enacted the statute to nurture a nascent industry while also incentivizing online platforms to remove content harmful to children. The combination of significant technological changes since 1996 and the expansive interpretation that courts have given Section 230, however, has left online platforms both immune for a wide array of illicit activity on their services and free to moderate content with little transparency or accountability. The Department of Justice has concluded that the time is ripe to realign the scope of Section 230 with the realities of the modern internet. Reform is important now more than ever. Every year, more citizens—including young children—are relying on the internet for everyday activities, while online criminal activity continues to grow. We must ensure that the internet is both an open and safe space for our society. Based on engagement with experts, industry, thought-leaders, lawmakers, and the public, the Department has identified a set of concrete reform proposals to provide stronger incentives for online platforms to address illicit material on their services, while continuing to foster innovation and free speech. Read the Department’s Key Takeaways. The Department's review of Section 230 arose in the context of our broader review of market-leading online platforms and their practices, announced in July 2019. While competition has been a core part of the Department’s review, we also recognize that not all concerns raised about online platforms (including internet-based businesses and social media platforms) fall squarely within the U.S. antitrust laws. Our review has therefore looked broadly at other legal and policy frameworks applicable to online platforms. One key part of that legal landscape is Section 230, which provides immunity to online platforms from civil liability based on third-party content as well as immunity for removal of content in certain circumstances. Drafted in the early years of internet commerce, Section 230 was enacted in response to a problem that incipient online platforms were facing. In the years leading up to Section 230, courts had held that an online platform that passively hosted third-party content was not liable as a publisher if any of that content was defamatory, but that a platform would be liable as a publisher for all its third-party content if it exercised discretion to remove any third-party material. Platforms therefore faced a dilemma: They could try to moderate third-party content but risk being held liable for any and all content posted by third parties, or choose not to moderate content to avoid liability but risk having their services overrun with obscene or unlawful content. Congress enacted Section 230 in part to resolve this quandary by providing immunity to online platforms both for third-party content on their services or for removal of certain categories of content. The statute was meant to nurture emerging internet businesses while also incentivizing them to regulate harmful online content. The internet has changed dramatically in the 25 years since Section 230’s enactment in ways that no one, including the drafters of Section 230, could have predicted. Several online platforms have transformed into some of the nation’s largest and most valuable companies, and today’s online services bear little resemblance to the rudimentary offerings in 1996. Platforms no longer function as simple forums for posting third-party content, but instead use sophisticated algorithms to promote content and connect users. Platforms also now offer an ever-expanding array of services, playing an increasingly essential role in how Americans communicate, access media, engage in commerce, and generally carry on their everyday lives. These developments have brought enormous benefits to society. But they have also had downsides. Criminals and other wrongdoers are increasingly turning to online platforms to engage in a host of unlawful activities, including child sexual exploitation, selling illicit drugs, cyberstalking, human trafficking, and terrorism. At the same time, courts have interpreted the scope of Section 230 immunity very broadly, diverging from its original purpose. This expansive statutory interpretation, combined with technological developments, has reduced the incentives of online platforms to address illicit activity on their services and, at the same time, left them free to moderate lawful content without transparency or accountability. The time has therefore come to realign the scope of Section 230 with the realities of the modern internet so that it continues to foster innovation and free speech but also provides stronger incentives for online platforms to address illicit material on their services. Much of the modern debate over Section 230 has been at opposite ends of the spectrum. Many have called for an outright repeal of the statute in light of the changed technological landscape and growing online harms. Others, meanwhile, have insisted that Section 230 be left alone and claimed that any reform will crumble the tech industry. Based on our analysis and external engagement, the Department believes there is productive middle ground and has identified a set of measured, yet concrete proposals that address many of the concerns raised about Section 230. A reassessment of America’s laws governing the internet could not be timelier. Citizens are relying on the internet more than ever for commerce, entertainment, education, employment, and public discourse. School closings in light of the COVID-19 pandemic mean that children are spending more time online, at times unsupervised, while more and more criminal activity is moving online. All of these factors make it imperative that we maintain the internet as an open and safe space. https://www.justice.gov/archives/ag/department-justice-s-review-section-230-communications-decency-act-1996",Legal,Pros & Cons,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",I find the nasal swabs when I get a COVID-19 test really uncomfortable. I don't know what alternatives I have. Are there other ways to collect a sample?,"Laboratory results One included studies collected the main specimens from nasopharyngeal and throat of 42 confirmed patients. However, they assessed the possibility of detection of SARS-CoV-2 from saliva specimen in just one confirmed case [17]. The results of this study showed that the viral load in saliva specimen of patient was 5.9 × 106 copies per ml and 3.3 × 106 in pooled nasopharyngeal and throat swab. In another study, 12 patient with laboratory-confirmed SARS-CoV-2 infection (nasopharyngeal or sputum specimens) were included [9]. The researchers reported that the SARS-CoV-2 was detected in saliva specimens of 11 patients (91.7%) in this trial. The median viral load of these 11 patients was 3.3 × 106 copies per ml. It is interesting that among these SARS-CoV-2 positive cases, viral cultures were positive for three patients. Later in another article, this research team published the complementary results of their cohort study. In this paper they reported the results of investigation among 23 COVID-19 patients. The results were in accordance with the previous study and showed that the SARS-CoV-2 was detected in saliva specimens of 87% of included subjects [20]. Based on the results of included studies, three of them were performed among the Chinese participants. One of these studies included 65 cases and the other one recruited 31 confirmed COVID-19 patients [18, 19]. The results of the first project showed that the detection rate of SARS-CoV-2 based on sputum (95.65%) and saliva (88.09%) specimens were significantly higher than throat or nasal swabs (P < 0.001, 20). The authors also reported no significant difference between sputum and saliva samples regarding viral load (P < 0.05). The study from Chen et al. showed that among the 13 patients whose oropharyngeal swab tests were positive, 4 cases were also positive for their saliva specimens [19]. The latest study among the Chinese patients, reported the results based on a total of 1846 respiratory samples (1178 saliva and 668 sputum specimens) from 96 confirmed cases [22]. The authors reported that the SARS-CoV-2 was detected in all 96 patients by testing respiratory samples [22]. The other two studies conducted in Australia and Italy among confirmed COVID-19 patients. These studies reported a detection rate of 84.6 and 100% respectively, based on saliva specimens [21, 24]. One of the included studies in this review is a case-report regarding a confirmed SARS-CoV-2 neonate [23]. In this case, the SARS-CoV-2 was detected in all of the neonate’s clinical specimens, including blood, urine, stool, and saliva along with the upper respiratory tract specimens. Discussion One of the main concerns regarding epidemic prevention and control of any infectious disease is rapid and accurate screening of suspected patients. Apart from the level of sensitivity and specificity of laboratory techniques, selecting the appropriate sites to collect samples is very important. Selection of proper sampling method should be based on the tissue affinity of targeted virus, cost-effectiveness of method and also safety of patients and clinicians [18, 25]. In this study we classified the current evidence regarding the reliability of saliva as a diagnostic specimen in COVID-19 patients. Most of the studies included in this review, reported that there is no statistically significant difference between nasopharyngeal or sputum specimens and saliva samples regarding viral load. These studies suggested saliva as a non-invasive specimen type for the diagnosis and viral load monitoring of SARS-CoV-2 [9, 17, 18, 20,21,22, 24]. Previous studies also reported a high overall agreement between saliva and nasopharyngeal aspirate specimens when tested by an automated multiplex molecular assay approved for point-of-care testing [12, 26, 27]. Based on these studies, the method of collection of saliva and collection device types are critical issues in the way of using saliva as diagnostic specimen. In this regard there are three main types of human saliva (whole saliva, parotid gland and minor gland) and the method of collection of each type varies accordingly [26]. When the aim of sampling is detecting the respiratory viruses with molecular assays, collecting the whole saliva from the suspected patients is useful [26]. In this regard the patients should be instructed to expectorate saliva into a sterile container. The volume of saliva should be ranged between 0.5 and 1 ml. Then 2 ml of viral transport medium (VTM) should be added to the container [11]. The next procedures will be conducted based on instructions of related RT-PCR technique in the microbiology laboratory. The low concordance rate of saliva with nasopharyngeal specimens reported in the research of Chen et al. might be explained by the differences in the method of obtaining the samples [19]. This study reported the detection rate of SARS-CoV-2 in pure saliva fluid secreted from the opening of salivary gland canals. However in other studies patients were asked to cough out saliva from their throat into sterile containers, and hence the saliva samples were mainly sputum from the lower respiratory tract [9, 17, 18]. Thus for increasing the sensitivity of salivary tests in the way of diagnosing the suspected COVID-19 patients, the instructions should clearly explain the correct procedure to the individuals. The use of saliva samples for diagnosis of SARS-CoV-2 has many advantages in clinical practice. First, collecting saliva is a non-invasive procedure and rather than nasal or throat swabs avoids patient discomfort. The second advantage of using saliva as specimen is related to possibility of collecting samples outside the hospitals. This sampling method doesn’t require the intervention of healthcare personnel and the suspected patients can provide it by themselves. Therefore this method can decrease the risk of nosocomial SARS-CoV-2 transmission. Furthermore, because there is not necessary for presence of trained healthcare workers for collecting saliva specimen, the waiting time for suspected patients will be reduced. This is crucial in busy clinical settings where a large number of individuals require screening. The results of viral culture in one of the included studies showed that saliva collected from COVID-19 patients, may contain live viruses which may allow transmission of virus from person to person [9]. These finding reinforce the use of barrier-protection equipment as a control measure, for all healthcare workers in the clinic/hospital settings during the epidemic period of COVID-19. It should be mentioned that this study has several limitations. Firstly, the outbreak and detection of SARS-CoV-2 has begun very recently; therefore the available data in this regard is very scarce. Secondly the included studies of this review didn’t evaluate other factors such as severity of disease or disease progression that may impact on detection rate of the virus. Finally as all of the selected studies only included hospitalized confirmed COVID-19 patients, further studies should be performed in outpatient settings. Conclusions In conclusion, although further research is warranted as the weight of the evidence increases, saliva can be considered as a non-invasive specimen for screening SARS-CoV-2 suspected patients. This method of sampling has proper accuracy and reliability regarding viral load monitoring of SARS-CoV-2 based on RT-PCR technique. Since oropharyngeal samples may cause discomfort to patients, saliva sampling after deep cough, could be recommended as an appropriate alternative.","""================ ======= Laboratory results One included studies collected the main specimens from nasopharyngeal and throat of 42 confirmed patients. However, they assessed the possibility of detection of SARS-CoV-2 from saliva specimen in just one confirmed case [17]. The results of this study showed that the viral load in saliva specimen of patient was 5.9 × 106 copies per ml and 3.3 × 106 in pooled nasopharyngeal and throat swab. In another study, 12 patient with laboratory-confirmed SARS-CoV-2 infection (nasopharyngeal or sputum specimens) were included [9]. The researchers reported that the SARS-CoV-2 was detected in saliva specimens of 11 patients (91.7%) in this trial. The median viral load of these 11 patients was 3.3 × 106 copies per ml. It is interesting that among these SARS-CoV-2 positive cases, viral cultures were positive for three patients. Later in another article, this research team published the complementary results of their cohort study. In this paper they reported the results of investigation among 23 COVID-19 patients. The results were in accordance with the previous study and showed that the SARS-CoV-2 was detected in saliva specimens of 87% of included subjects [20]. Based on the results of included studies, three of them were performed among the Chinese participants. One of these studies included 65 cases and the other one recruited 31 confirmed COVID-19 patients [18, 19]. The results of the first project showed that the detection rate of SARS-CoV-2 based on sputum (95.65%) and saliva (88.09%) specimens were significantly higher than throat or nasal swabs (P < 0.001, 20). The authors also reported no significant difference between sputum and saliva samples regarding viral load (P < 0.05). The study from Chen et al. showed that among the 13 patients whose oropharyngeal swab tests were positive, 4 cases were also positive for their saliva specimens [19]. The latest study among the Chinese patients, reported the results based on a total of 1846 respiratory samples (1178 saliva and 668 sputum specimens) from 96 confirmed cases [22]. The authors reported that the SARS-CoV-2 was detected in all 96 patients by testing respiratory samples [22]. The other two studies conducted in Australia and Italy among confirmed COVID-19 patients. These studies reported a detection rate of 84.6 and 100% respectively, based on saliva specimens [21, 24]. One of the included studies in this review is a case-report regarding a confirmed SARS-CoV-2 neonate [23]. In this case, the SARS-CoV-2 was detected in all of the neonate’s clinical specimens, including blood, urine, stool, and saliva along with the upper respiratory tract specimens. Discussion One of the main concerns regarding epidemic prevention and control of any infectious disease is rapid and accurate screening of suspected patients. Apart from the level of sensitivity and specificity of laboratory techniques, selecting the appropriate sites to collect samples is very important. Selection of proper sampling method should be based on the tissue affinity of targeted virus, cost-effectiveness of method and also safety of patients and clinicians [18, 25]. In this study we classified the current evidence regarding the reliability of saliva as a diagnostic specimen in COVID-19 patients. Most of the studies included in this review, reported that there is no statistically significant difference between nasopharyngeal or sputum specimens and saliva samples regarding viral load. These studies suggested saliva as a non-invasive specimen type for the diagnosis and viral load monitoring of SARS-CoV-2 [9, 17, 18, 20,21,22, 24]. Previous studies also reported a high overall agreement between saliva and nasopharyngeal aspirate specimens when tested by an automated multiplex molecular assay approved for point-of-care testing [12, 26, 27]. Based on these studies, the method of collection of saliva and collection device types are critical issues in the way of using saliva as diagnostic specimen. In this regard there are three main types of human saliva (whole saliva, parotid gland and minor gland) and the method of collection of each type varies accordingly [26]. When the aim of sampling is detecting the respiratory viruses with molecular assays, collecting the whole saliva from the suspected patients is useful [26]. In this regard the patients should be instructed to expectorate saliva into a sterile container. The volume of saliva should be ranged between 0.5 and 1 ml. Then 2 ml of viral transport medium (VTM) should be added to the container [11]. The next procedures will be conducted based on instructions of related RT-PCR technique in the microbiology laboratory. The low concordance rate of saliva with nasopharyngeal specimens reported in the research of Chen et al. might be explained by the differences in the method of obtaining the samples [19]. This study reported the detection rate of SARS-CoV-2 in pure saliva fluid secreted from the opening of salivary gland canals. However in other studies patients were asked to cough out saliva from their throat into sterile containers, and hence the saliva samples were mainly sputum from the lower respiratory tract [9, 17, 18]. Thus for increasing the sensitivity of salivary tests in the way of diagnosing the suspected COVID-19 patients, the instructions should clearly explain the correct procedure to the individuals. The use of saliva samples for diagnosis of SARS-CoV-2 has many advantages in clinical practice. First, collecting saliva is a non-invasive procedure and rather than nasal or throat swabs avoids patient discomfort. The second advantage of using saliva as specimen is related to possibility of collecting samples outside the hospitals. This sampling method doesn’t require the intervention of healthcare personnel and the suspected patients can provide it by themselves. Therefore this method can decrease the risk of nosocomial SARS-CoV-2 transmission. Furthermore, because there is not necessary for presence of trained healthcare workers for collecting saliva specimen, the waiting time for suspected patients will be reduced. This is crucial in busy clinical settings where a large number of individuals require screening. The results of viral culture in one of the included studies showed that saliva collected from COVID-19 patients, may contain live viruses which may allow transmission of virus from person to person [9]. These finding reinforce the use of barrier-protection equipment as a control measure, for all healthcare workers in the clinic/hospital settings during the epidemic period of COVID-19. It should be mentioned that this study has several limitations. Firstly, the outbreak and detection of SARS-CoV-2 has begun very recently; therefore the available data in this regard is very scarce. Secondly the included studies of this review didn’t evaluate other factors such as severity of disease or disease progression that may impact on detection rate of the virus. Finally as all of the selected studies only included hospitalized confirmed COVID-19 patients, further studies should be performed in outpatient settings. Conclusions In conclusion, although further research is warranted as the weight of the evidence increases, saliva can be considered as a non-invasive specimen for screening SARS-CoV-2 suspected patients. This method of sampling has proper accuracy and reliability regarding viral load monitoring of SARS-CoV-2 based on RT-PCR technique. Since oropharyngeal samples may cause discomfort to patients, saliva sampling after deep cough, could be recommended as an appropriate alternative. https://idpjournal.biomedcentral.com/articles/10.1186/s40249-020-00728-w ================ ======= I find the nasal swabs when I get a COVID-19 test really uncomfortable. I don't know what alternatives I have. Are there other ways to collect a sample? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Find & Summarize,Text Transformation Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document.,What are the key points from this release?,"DonorPro and CardConnect Team Up to Offer Integrated Payment Processing for Nonprofits Partnership brings payment acceptance and security to medical providers through HRP’s healthcare self-pay platform PHILADELPHIA (January 7, 2014) – CardConnect, a rapidly growing payments technology company, today announced its partnership with Health Recovery Partners (HRP), a premier provider of HIPAA compliant self-pay software solutions. HRP has added CardConnect’s Payment Gateway and CardSecure tokenization technology to its end-to-end healthcare self-pay platform, Decision Partner™. By partnering with CardConnect, HRP can now provide its customers with lower costs for credit card processing and enhanced security for protecting patients’ sensitive payment data. “With abundant changes to the healthcare industry that have increased the cost of managing self-pay accounts, medical providers are increasingly seeking an easy-to-manage and low-cost self-pay software platform,” said Jeff Shanahan, President at CardConnect. “We were very impressed by HRP’s self-pay platform and are excited to include our technology in their end-to-end solution.” For HRP, finding the right payments solution provider was crucial. “Quite frankly, payment processing has always been a pain point for healthcare providers,” said Michael Sarajian, President of Health Recovery Partners. “After learning about CardConnect’s Payment Gateway, which analyzes interchange costs to ensure our customers receive the lowest rates possible, and CardSecure, the tokenization technology trusted by Fortune 500 companies, we knew we could alleviate this pain. CardConnect has made secure payment acceptance an integral part of our end-to-end solution.” Decision Partner™ is HRP’s most patient-centric self-pay solution, centralizing an array of tools and activities to guarantee the highest collection rates – and, now with CardConnect, the lowest processing costs. Decision Partner™ allows the patient to create, or medical provider to automate, personalized payment plans based on each patient’s ability to pay, as well as segment and manage probate, litigation, bankruptcy, and no-fault auto self-pay accounts. Decision Partner™ is available to healthcare providers of all sizes. For more information, visit www.healthrecoverypartners.com. ","Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document. What are the key points from this release? DonorPro and CardConnect Team Up to Offer Integrated Payment Processing for Nonprofits Partnership brings payment acceptance and security to medical providers through HRP’s healthcare self-pay platform PHILADELPHIA (January 7, 2014) – CardConnect, a rapidly growing payments technology company, today announced its partnership with Health Recovery Partners (HRP), a premier provider of HIPAA compliant self-pay software solutions. HRP has added CardConnect’s Payment Gateway and CardSecure tokenization technology to its end-to-end healthcare self-pay platform, Decision Partner™. By partnering with CardConnect, HRP can now provide its customers with lower costs for credit card processing and enhanced security for protecting patients’ sensitive payment data. “With abundant changes to the healthcare industry that have increased the cost of managing self-pay accounts, medical providers are increasingly seeking an easy-to-manage and low-cost self-pay software platform,” said Jeff Shanahan, President at CardConnect. “We were very impressed by HRP’s self-pay platform and are excited to include our technology in their end-to-end solution.” For HRP, finding the right payments solution provider was crucial. “Quite frankly, payment processing has always been a pain point for healthcare providers,” said Michael Sarajian, President of Health Recovery Partners. “After learning about CardConnect’s Payment Gateway, which analyzes interchange costs to ensure our customers receive the lowest rates possible, and CardSecure, the tokenization technology trusted by Fortune 500 companies, we knew we could alleviate this pain. CardConnect has made secure payment acceptance an integral part of our end-to-end solution.” Decision Partner™ is HRP’s most patient-centric self-pay solution, centralizing an array of tools and activities to guarantee the highest collection rates – and, now with CardConnect, the lowest processing costs. Decision Partner™ allows the patient to create, or medical provider to automate, personalized payment plans based on each patient’s ability to pay, as well as segment and manage probate, litigation, bankruptcy, and no-fault auto self-pay accounts. Decision Partner™ is available to healthcare providers of all sizes. For more information, visit www.healthrecoverypartners.com. ",Financial,Summarize,Text Transformation No information from beyond the provided context block can be used in formulating your answer. Formulate your response using full paragraphs.,Provide a summary of all of the facets that are checked for compliance.,"2 General Principles and Legality Checking 3.2.1 Objective of Article 3 An important objective of the Regulations in Article 3 is to enable cars to race closely, by ensuring that the aerodynamic performance loss of a car following another car is kept to a minimum. In order to verify whether this objective has been achieved, Competitors may be required on request to supply the FIA with any relevant information. 2024 Formula 1 Technical Regulations 13 25 April 2023 © 2023 Fédération Internationale de l’Automobile Issue 1 In any case the Intellectual Property of this information, will remain the property of the Competitor, will be protected and not divulged to any third party. 3.2.2 Aerodynamic Influence With the exception of the driver adjustable bodywork described in Article 3.10.10 (in addition to minimal parts solely associated with its actuation) and the flexible seals specifically permitted by Articles 3.13 and 3.14.4, all aerodynamic components or bodywork influencing the car’s aerodynamic performance must be rigidly secured and immobile with respect to their frame of reference defined in Article 3.3. Furthermore, these components must produce a uniform, solid, hard, continuous, impervious surface under all circumstances. Any device or construction that is designed to bridge the gap between the sprung part of the car and the ground is prohibited under all circumstances. With the exception of the parts necessary for the adjustment described in Article 3.10.10, or any incidental movement due to the steering system, any car system, device or procedure which uses driver movement as a means of altering the aerodynamic characteristics of the car is prohibited. The Aerodynamic influence of any component of the car not considered to be bodywork must be incidental to its main function. Any design which aims to maximise such an aerodynamic influence is prohibited. 3.2.3 Symmetry All bodywork must be nominally symmetrical with respect to Y=0. Consequently, and unless otherwise specified, any regulation in Article 3 concerning one side of the car will be assumed to be valid for the other side of the car and references to maximum permissible numbers of components in Article 3 will also refer to the one side of the car. Minimal exceptions to the requirement of symmetry of this Article will be accepted for the installation of non-symmetrical mechanical components of the car, for asymmetrical cooling requirements or for asymmetrical angle adjustment of the front flap defined in Article 3.9.7. Bodywork on the unsprung mass must respect this Article when the suspension position of each wheel is virtually re-orientated so that its wheel coordinate system axes (described in Article 2.11.3) are parallel to their respective axis of the car coordinate system (described in Article 2.11.1). 3.2.4 Digital legality checking The assessment of the car’s compliance with the Aerodynamic Regulations will be carried out digitally using CAD models provided by the teams. In these models: a. Components may only be designed to the edge of a Reference Volume or with a precise geometrical feature, or to the limit of a geometrical criterion (save for the normal round-off discrepancies of the CAD system), when the regulations specifically require an aspect of the bodywork to be designed to this limit, or it can be demonstrated that the design does not rely on lying exactly on this limit to conform to the regulations, such that it is possible for the physical bodywork to comply. b. Components which must follow a precise shape, surface or plane must be designed without any tolerance, save for the normal round-off discrepancies of the CAD system. 3.2.5 Physical legality checking The cars may be measured during a Competition in order to check their conformance to the CAD models discussed in Article 3.2.4 and to ensure they remain inside the Reference Volumes. a. Unless otherwise specified, a tolerance of ±3mm will be accepted for manufacturing purposes only with respect to the CAD surfaces. Where measured surfaces lie outside of this tolerance but remain within the Reference Volumes, a Competitor may be required to provide additional information (e.g. revised CAD geometry) to demonstrate compliance with the regulations. Any discrepancies contrived to create a special aerodynamic effect or surface finish will not be permitted. 2024 Formula 1 Technical Regulations 14 25 April 2023 © 2023 Fédération Internationale de l’Automobile Issue 1 b. Irrespective of a), geometrical discrepancies at the limits of the Reference Volumes must be such that the measured component remains inside the Reference Volume. c. A positional tolerance of +/- 2mm will be accepted for the Front Wing Bodywork, Rear Wing Bodywork, Exhaust Tailpipe, Floor Bodywork behind XR=0, and Tail. This will be assessed by realigning each of the groups of Reference Volumes and Reference Surfaces that define the assemblies, by up to 2mm from their original position, to best fit the measured geometry. d. Irrespective of b), a tolerance of Z=+/-2mm will be accepted for parts of the car lying on the Z=0 plane, with -375 ≤ Y ≤ 375 and ahead of XR=0. e. Minimal discrepancies from the CAD surfaces will also be accepted in the following cases: i. Minimal repairs carried out on aerodynamic components and approved by the FIA ii. Tape, provided it does not achieve an aerodynamic effect otherwise not permitted by Article 3 iii. Junctions between bodywork panels iv. Local bodywork fixing details 3.2.6 Datum Points All cars must be equipped with mountings for optical targets that enable the car’s datum to be determined for scrutineering in the following locations: i. One on the forward part of the top of the survival cell. ii. Two positioned symmetrically about Y=0 on the top of the survival cell close to XB=0. iii. Two positioned symmetrically about Y=0 on the side of the survival cell close to XB=0. iv. Two positioned symmetrically about Y=0 on the side of the survival cell close to the rear mounts of the secondary roll structure. v. Two positioned symmetrically about Y=0 within an axis-aligned cuboid with an interior diagonal defined by points [XC=0, 175, 970] and [XC=150, -175, 870]. vi. One probed point on the RIS or gearbox case. In all cases, a file with required datum points must be supplied for each survival cell. For deflection testing, all cars must be provided with a means of mounting a reference artefact to the RIS. This mounting may be temporary, but must be rigid with respect to the underlying car structure. Full details of the requirements are given in the Appendix the Technical and Sporting Regulations. 3.2.7 Section titles and Article titles within this article have no regulatory value. 3.2.8 Static pressure tappings are permitted in surfaces, provided that they; i. Have an internal diameter of no more than 2mm. ii. They are flush with the underlying geometry. iii. Are only connected to pressure sensors, or are blanked, without leakage. 3.3.1 Bodywork which is part of the sprung mass of the car The only sprung mass bodywork permitted is that defined under Articles 3.5 to 3.12 and under Articles 3.1.1.a.ii to iv. The frame of reference for every part of the car classified as Sprung Mass Bodywork is the coordinate system defined in Article 2.11.1. Any bodywork that is trimmed or filleted in Article 3.11 must first be declared as belonging to one of the groups defined in Articles 3.5 to 3.10. Unless otherwise stated, the compliance of an individual bodywork group to Article 3 will be assessed independently and prior to any trimming, filleting and assembly operation referred to in Article 3.11, and the FIA may request to see any discarded geometry after final assembly. Once the final assembly is completed, any bodywork surfaces no longer exposed to an external airstream or internal duct may be modified, providing they remain unexposed. 3.3.2 Wheel Bodywork The only wheel bodywork permitted is that defined under Article 3.13. With the exception of wheel covers, as defined in Article 3.13.7, the frame of reference for every part of the car classified as Wheel Bodywork is the corresponding upright structure and the corresponding coordinate system defined in Article 2.11.3. The frame of reference for any wheel cover, as defined in Article 3.13.7 is the corresponding wheel rim. 3.3.3 Suspension Fairings The only suspension fairings permitted are those defined under Article 3.14. In order to assess compliance with Article 3.2.2, the frame of reference of any suspension fairing is the structural suspension member that it is attached to.","System Instructions: No information from beyond the provided context block can be used in formulating your answer. Formulate your response using full paragraphs. Question: Provide a summary of all of the facets that are checked for compliance. Context Block: 2 General Principles and Legality Checking 3.2.1 Objective of Article 3 An important objective of the Regulations in Article 3 is to enable cars to race closely, by ensuring that the aerodynamic performance loss of a car following another car is kept to a minimum. In order to verify whether this objective has been achieved, Competitors may be required on request to supply the FIA with any relevant information. 2024 Formula 1 Technical Regulations 13 25 April 2023 © 2023 Fédération Internationale de l’Automobile Issue 1 In any case the Intellectual Property of this information, will remain the property of the Competitor, will be protected and not divulged to any third party. 3.2.2 Aerodynamic Influence With the exception of the driver adjustable bodywork described in Article 3.10.10 (in addition to minimal parts solely associated with its actuation) and the flexible seals specifically permitted by Articles 3.13 and 3.14.4, all aerodynamic components or bodywork influencing the car’s aerodynamic performance must be rigidly secured and immobile with respect to their frame of reference defined in Article 3.3. Furthermore, these components must produce a uniform, solid, hard, continuous, impervious surface under all circumstances. Any device or construction that is designed to bridge the gap between the sprung part of the car and the ground is prohibited under all circumstances. With the exception of the parts necessary for the adjustment described in Article 3.10.10, or any incidental movement due to the steering system, any car system, device or procedure which uses driver movement as a means of altering the aerodynamic characteristics of the car is prohibited. The Aerodynamic influence of any component of the car not considered to be bodywork must be incidental to its main function. Any design which aims to maximise such an aerodynamic influence is prohibited. 3.2.3 Symmetry All bodywork must be nominally symmetrical with respect to Y=0. Consequently, and unless otherwise specified, any regulation in Article 3 concerning one side of the car will be assumed to be valid for the other side of the car and references to maximum permissible numbers of components in Article 3 will also refer to the one side of the car. Minimal exceptions to the requirement of symmetry of this Article will be accepted for the installation of non-symmetrical mechanical components of the car, for asymmetrical cooling requirements or for asymmetrical angle adjustment of the front flap defined in Article 3.9.7. Bodywork on the unsprung mass must respect this Article when the suspension position of each wheel is virtually re-orientated so that its wheel coordinate system axes (described in Article 2.11.3) are parallel to their respective axis of the car coordinate system (described in Article 2.11.1). 3.2.4 Digital legality checking The assessment of the car’s compliance with the Aerodynamic Regulations will be carried out digitally using CAD models provided by the teams. In these models: a. Components may only be designed to the edge of a Reference Volume or with a precise geometrical feature, or to the limit of a geometrical criterion (save for the normal round-off discrepancies of the CAD system), when the regulations specifically require an aspect of the bodywork to be designed to this limit, or it can be demonstrated that the design does not rely on lying exactly on this limit to conform to the regulations, such that it is possible for the physical bodywork to comply. b. Components which must follow a precise shape, surface or plane must be designed without any tolerance, save for the normal round-off discrepancies of the CAD system. 3.2.5 Physical legality checking The cars may be measured during a Competition in order to check their conformance to the CAD models discussed in Article 3.2.4 and to ensure they remain inside the Reference Volumes. a. Unless otherwise specified, a tolerance of ±3mm will be accepted for manufacturing purposes only with respect to the CAD surfaces. Where measured surfaces lie outside of this tolerance but remain within the Reference Volumes, a Competitor may be required to provide additional information (e.g. revised CAD geometry) to demonstrate compliance with the regulations. Any discrepancies contrived to create a special aerodynamic effect or surface finish will not be permitted. 2024 Formula 1 Technical Regulations 14 25 April 2023 © 2023 Fédération Internationale de l’Automobile Issue 1 b. Irrespective of a), geometrical discrepancies at the limits of the Reference Volumes must be such that the measured component remains inside the Reference Volume. c. A positional tolerance of +/- 2mm will be accepted for the Front Wing Bodywork, Rear Wing Bodywork, Exhaust Tailpipe, Floor Bodywork behind XR=0, and Tail. This will be assessed by realigning each of the groups of Reference Volumes and Reference Surfaces that define the assemblies, by up to 2mm from their original position, to best fit the measured geometry. d. Irrespective of b), a tolerance of Z=+/-2mm will be accepted for parts of the car lying on the Z=0 plane, with -375 ≤ Y ≤ 375 and ahead of XR=0. e. Minimal discrepancies from the CAD surfaces will also be accepted in the following cases: i. Minimal repairs carried out on aerodynamic components and approved by the FIA ii. Tape, provided it does not achieve an aerodynamic effect otherwise not permitted by Article 3 iii. Junctions between bodywork panels iv. Local bodywork fixing details 3.2.6 Datum Points All cars must be equipped with mountings for optical targets that enable the car’s datum to be determined for scrutineering in the following locations: i. One on the forward part of the top of the survival cell. ii. Two positioned symmetrically about Y=0 on the top of the survival cell close to XB=0. iii. Two positioned symmetrically about Y=0 on the side of the survival cell close to XB=0. iv. Two positioned symmetrically about Y=0 on the side of the survival cell close to the rear mounts of the secondary roll structure. v. Two positioned symmetrically about Y=0 within an axis-aligned cuboid with an interior diagonal defined by points [XC=0, 175, 970] and [XC=150, -175, 870]. vi. One probed point on the RIS or gearbox case. In all cases, a file with required datum points must be supplied for each survival cell. For deflection testing, all cars must be provided with a means of mounting a reference artefact to the RIS. This mounting may be temporary, but must be rigid with respect to the underlying car structure. Full details of the requirements are given in the Appendix the Technical and Sporting Regulations. 3.2.7 Section titles and Article titles within this article have no regulatory value. 3.2.8 Static pressure tappings are permitted in surfaces, provided that they; i. Have an internal diameter of no more than 2mm. ii. They are flush with the underlying geometry. iii. Are only connected to pressure sensors, or are blanked, without leakage. 3.3.1 Bodywork which is part of the sprung mass of the car The only sprung mass bodywork permitted is that defined under Articles 3.5 to 3.12 and under Articles 3.1.1.a.ii to iv. The frame of reference for every part of the car classified as Sprung Mass Bodywork is the coordinate system defined in Article 2.11.1. Any bodywork that is trimmed or filleted in Article 3.11 must first be declared as belonging to one of the groups defined in Articles 3.5 to 3.10. Unless otherwise stated, the compliance of an individual bodywork group to Article 3 will be assessed independently and prior to any trimming, filleting and assembly operation referred to in Article 3.11, and the FIA may request to see any discarded geometry after final assembly. Once the final assembly is completed, any bodywork surfaces no longer exposed to an external airstream or internal duct may be modified, providing they remain unexposed. 3.3.2 Wheel Bodywork The only wheel bodywork permitted is that defined under Article 3.13. With the exception of wheel covers, as defined in Article 3.13.7, the frame of reference for every part of the car classified as Wheel Bodywork is the corresponding upright structure and the corresponding coordinate system defined in Article 2.11.3. The frame of reference for any wheel cover, as defined in Article 3.13.7 is the corresponding wheel rim. 3.3.3 Suspension Fairings The only suspension fairings permitted are those defined under Article 3.14. In order to assess compliance with Article 3.2.2, the frame of reference of any suspension fairing is the structural suspension member that it is attached to.",Retail/Product,Find & Summarize,Text Transformation Create your answer using only information found in the given context.,What are some factors that stop people from eating meat?,"Recent research has identified the major motivations and constraints around vegetarian and vegan diets [30 ]. The main motivations to move towards a vegetarian or vegan diet are animal welfare, the environment and personal health, whilst the major barriers are sensory enjoyment of animal Sustainability 2019, 11, 6844 3 of 17 products, convenience and financial cost [ 30 ]. Mullee et al. [31 ] found that, when asked about possible reasons for eating a more vegetarian diet, the most popular option chosen by omnivores and semivegetarians was their health. The environment and animal welfare were chosen by fewer participants, and for omnivores, these reasons ranked below ‘to discover new tastes’, ‘to reduce weight’, and ‘no reason’. This finding has been replicated elsewhere [32 ,33 ] and implies that, for those not currently reducing their meat consumption, potential personal benefits are more important than environmental or ethical benefits. More specifically, consumers often recognise health benefits such as decreased saturated fat intake, increased fruit and vegetable intake and disease prevention [ 32, 34]. On the other hand, some worry about not getting enough protein or iron from a vegetarian diet [35]. Interestingly, this prioritisation of health motives appears to be reversed for vegetarians and vegans. According to a survey published by Humane League Labs [36], whilst health and nutrition reasons for reducing animal product consumption are the most commonly cited by omnivores and semivegetarians, animal welfare is the most common reason given by vegetarians and vegans. This is logical, because improving one’s health or reducing one’s environmental impact can be achieved by consuming incrementally fewer animal products; viewing animal products as the product of animal suffering and exploitation, however, is more conducive to eschewing them altogether. In a systematic review of consumer perceptions of sustainable protein consumption, Hartmann and Siegrist [37 ] found that it is common for consumers to underestimate the ecological impact of meat consumption. This has been observed in many different studies [33 ,38 – 40 ] and may imply a lack of knowledge about the environmental impact of meat consumption. Alternatively, this could reflect that consumers are generally unwilling to reduce their meat consumption [40 ] and are subsequently motivated to minimise their perceptions of the negative consequences of their choices [41]. Indeed, such motivated reasoning appears to be evident with respect to animal welfare issues. Most people eat meat but disapprove of harming animals, a conflict that has been dubbed ‘the meat paradox’ [42 ]. Rothgerber [ 43] identified a number of ways in which dissonance around harming animals arises in meat-eaters, and a number of strategies which are used to reduce this dissonance. Dissonance-reducing strategies include denial of animal mind, denial of animals’ ability to feel pain and dissociating meat from its animal origin [ 43 ]. This motivated reasoning results in a number of odd conclusions, such as lower mental capacity being ascribed to food animals compared to nonfood animals and increased denial of animal mind when one anticipates immediate meat consumption [ 44]. One can understand the motivation to continue eating animal products; the literature has identified several considerable constraints to adopting a vegetarian or vegan diet. Studies have consistently found that the strongest of these is simply enjoyment of eating meat [34 , 45, 46]. This was by far the number one reason for not being vegetarian in a recent UK survey [ 47 ] and was the biggest constraint for online survey respondents who indicated that they do not want to go vegetarian or vegan [ 36]. Despite the many potential benefits, the taste of meat and animal products is enough of a barrier to prevent dietary change for most people. The second most important barrier is convenience, with many consumers saying vegetarian dishes are difficult to prepare and that there is a lack of options when eating out [ 33 ,38 ,48 ]. Humane League Labs [36 ] found that a lack of options when eating out was the most common factor that people said made it difficult to eat meat-free meals, whilst Schenk, Rössel and Scholz [30 ] have argued that the additional time, knowledge and effort required to buy and prepare vegetarian or vegan food is especially a barrier to those newly transitioning diets. Finally, for some, there is a financial barrier [49], although there is considerably less consensus on this in the literature [30]. A UK survey found that the high cost of meat substitutes was a barrier for 58% of consumers, though this survey conducted by VoucherCodesPro [ 47 ] may have been inclined to focus on financial considerations. Another study found that a vegetarian diet is actually cheaper than one containing meat, but that a vegan diet is most expensive of all [ 22 ]. This may be due to the relatively high cost of plant-based milks and other specialist products. Sustainability 2019, 11, 6844 4 of 17 The present study investigates UK meat-eaters’ views of various aspects of vegetarianism and veganism. Whilst the common motivators and constraints to vegetarian and vegan diets are well documented, there is a paucity of open data assessing how meat-eaters evaluate the relevant aspects of each of these diets. This study seeks to address this gap by providing quantitative evaluations of the relevant aspects of vegetarian and vegan diets. Additionally, there is currently no quantitative comparison of these factors with respect to vegetarianism versus veganism. Therefore, this study compares ratings of common motivators and barriers between vegetarian and vegan diets. Finally, little is known about how these evaluations of vegetarian and vegan diets vary amongst different demographic groups. Therefore, this study examines the overall mean ratings of each of these factors and investigates how these views vary between different demographics. 2. Methods 2.1. Participants Meat-eaters living in the UK aged 18 and over were recruited (n = 1000). Participants were recruited through the online research platform, Prolific, and each participant was paid £0.45 for a 5 min survey. Recruiting participants through this type of online platform has its limitations, including the possibility of recruiting an unrepresentative sample, and asking questions in a contrived setting which may not be ecologically valid [ 50]. Nonetheless, this sampling technique does offer low cost and fast recruitment of specifiable samples, and the use of Prolific as a recruitment tool in academic research is therefore increasingly common and generally considered acceptable [51 –53 ]. Although recruitment was for meat-eaters only, there was a small number of vegetarians in the original dataset (n = 25); these participants were removed, and their responses were replaced with more meat-eaters. The final sample was 49.8% male and 49.8% female (0.3% did not disclose gender, 0.1% ‘other’), and the mean age was 34.02 (SD = 11.67). 2.2. Procedure This study received ethical approval from the University of Bath’s Department of Psychology Ethics Committee (PREC 18-219). The full anonymised dataset is available via OSF (see Supplementary Materials). First, participants read some brief information about the study and gave their consent to take part. They were then given definitions of vegetarianism and veganism and asked to give their opinions about 11 different aspects of vegetarian and vegan diets using 7-point bipolar scales. The order of these scales and the order in which participants were asked about vegetarianism and veganism were randomised to control for order effects. Next, participants answered questions about their intended consumption of meat and their intended consumption of animal products ‘one month from today’. On 6-point scales, participants could indicate that they would eliminate, greatly reduce, slightly reduce, maintain about the same, slightly increase or greatly increase their consumption of both meat, and animal products generally. Similar scales have been used in previous research [54,55]. It is worth noting that this measure is conservative. Compared to asking about intentions to reduce consumption in general, defining a specific action and a specific, short time period is likely to make participants reflect critically about their own likely behaviour. Additionally, as participants answered this question, they saw the phrase ‘Thank you for being honest!’ which was intended to mitigate the social desirability effect (i.e., over-reporting of intentions to reduce animal product consumption). Finally, participants gave demographic information, including their age, gender, political orientation, education and income. They also indicated whether they ate ‘at least occasionally’ beef, lamb, pork, chicken, fish, eggs and dairy. Participants were then debriefed and compensated.","What are some factors that stop people from eating meat? Create your answer using only information found in the given context. Recent research has identified the major motivations and constraints around vegetarian and vegan diets [30 ]. The main motivations to move towards a vegetarian or vegan diet are animal welfare, the environment and personal health, whilst the major barriers are sensory enjoyment of animal products, convenience and financial cost [ 30 ]. Mullee et al. [31 ] found that, when asked about possible reasons for eating a more vegetarian diet, the most popular option chosen by omnivores and semivegetarians was their health. The environment and animal welfare were chosen by fewer participants, and for omnivores, these reasons ranked below ‘to discover new tastes’, ‘to reduce weight’, and ‘no reason’. This finding has been replicated elsewhere [32 ,33 ] and implies that, for those not currently reducing their meat consumption, potential personal benefits are more important than environmental or ethical benefits. More specifically, consumers often recognise health benefits such as decreased saturated fat intake, increased fruit and vegetable intake and disease prevention [ 32, 34]. On the other hand, some worry about not getting enough protein or iron from a vegetarian diet [35]. Interestingly, this prioritisation of health motives appears to be reversed for vegetarians and vegans. According to a survey published by Humane League Labs [36], whilst health and nutrition reasons for reducing animal product consumption are the most commonly cited by omnivores and semivegetarians, animal welfare is the most common reason given by vegetarians and vegans. This is logical, because improving one’s health or reducing one’s environmental impact can be achieved by consuming incrementally fewer animal products; viewing animal products as the product of animal suffering and exploitation, however, is more conducive to eschewing them altogether. In a systematic review of consumer perceptions of sustainable protein consumption, Hartmann and Siegrist [37 ] found that it is common for consumers to underestimate the ecological impact of meat consumption. This has been observed in many different studies [33 ,38 – 40 ] and may imply a lack of knowledge about the environmental impact of meat consumption. Alternatively, this could reflect that consumers are generally unwilling to reduce their meat consumption [40 ] and are subsequently motivated to minimise their perceptions of the negative consequences of their choices [41]. Indeed, such motivated reasoning appears to be evident with respect to animal welfare issues. Most people eat meat but disapprove of harming animals, a conflict that has been dubbed ‘the meat paradox’ [42 ]. Rothgerber [ 43] identified a number of ways in which dissonance around harming animals arises in meat-eaters, and a number of strategies which are used to reduce this dissonance. Dissonance-reducing strategies include denial of animal mind, denial of animals’ ability to feel pain and dissociating meat from its animal origin [ 43 ]. This motivated reasoning results in a number of odd conclusions, such as lower mental capacity being ascribed to food animals compared to nonfood animals and increased denial of animal mind when one anticipates immediate meat consumption [ 44]. One can understand the motivation to continue eating animal products; the literature has identified several considerable constraints to adopting a vegetarian or vegan diet. Studies have consistently found that the strongest of these is simply enjoyment of eating meat [34 , 45, 46]. This was by far the number one reason for not being vegetarian in a recent UK survey [ 47 ] and was the biggest constraint for online survey respondents who indicated that they do not want to go vegetarian or vegan [ 36]. Despite the many potential benefits, the taste of meat and animal products is enough of a barrier to prevent dietary change for most people. The second most important barrier is convenience, with many consumers saying vegetarian dishes are difficult to prepare and that there is a lack of options when eating out [ 33 ,38 ,48 ]. Humane League Labs [36 ] found that a lack of options when eating out was the most common factor that people said made it difficult to eat meat-free meals, whilst Schenk, Rössel and Scholz [30 ] have argued that the additional time, knowledge and effort required to buy and prepare vegetarian or vegan food is especially a barrier to those newly transitioning diets. Finally, for some, there is a financial barrier [49], although there is considerably less consensus on this in the literature [30]. A UK survey found that the high cost of meat substitutes was a barrier for 58% of consumers, though this survey conducted by VoucherCodesPro [ 47 ] may have been inclined to focus on financial considerations. Another study found that a vegetarian diet is actually cheaper than one containing meat, but that a vegan diet is most expensive of all [ 22 ]. This may be due to the relatively high cost of plant-based milks and other specialist products. The present study investigates UK meat-eaters’ views of various aspects of vegetarianism and veganism. Whilst the common motivators and constraints to vegetarian and vegan diets are well documented, there is a paucity of open data assessing how meat-eaters evaluate the relevant aspects of each of these diets. This study seeks to address this gap by providing quantitative evaluations of the relevant aspects of vegetarian and vegan diets. Additionally, there is currently no quantitative comparison of these factors with respect to vegetarianism versus veganism. Therefore, this study compares ratings of common motivators and barriers between vegetarian and vegan diets. Finally, little is known about how these evaluations of vegetarian and vegan diets vary amongst different demographic groups. Therefore, this study examines the overall mean ratings of each of these factors and investigates how these views vary between different demographics. 2. Methods 2.1. Participants Meat-eaters living in the UK aged 18 and over were recruited (n = 1000). Participants were recruited through the online research platform, Prolific, and each participant was paid £0.45 for a 5 min survey. Recruiting participants through this type of online platform has its limitations, including the possibility of recruiting an unrepresentative sample, and asking questions in a contrived setting which may not be ecologically valid [ 50]. Nonetheless, this sampling technique does offer low cost and fast recruitment of specifiable samples, and the use of Prolific as a recruitment tool in academic research is therefore increasingly common and generally considered acceptable [51 –53 ]. Although recruitment was for meat-eaters only, there was a small number of vegetarians in the original dataset (n = 25); these participants were removed, and their responses were replaced with more meat-eaters. The final sample was 49.8% male and 49.8% female (0.3% did not disclose gender, 0.1% ‘other’), and the mean age was 34.02 (SD = 11.67). 2.2. Procedure This study received ethical approval from the University of Bath’s Department of Psychology Ethics Committee (PREC 18-219). The full anonymised dataset is available via OSF (see Supplementary Materials). First, participants read some brief information about the study and gave their consent to take part. They were then given definitions of vegetarianism and veganism and asked to give their opinions about 11 different aspects of vegetarian and vegan diets using 7-point bipolar scales. The order of these scales and the order in which participants were asked about vegetarianism and veganism were randomised to control for order effects. Next, participants answered questions about their intended consumption of meat and their intended consumption of animal products ‘one month from today’. On 6-point scales, participants could indicate that they would eliminate, greatly reduce, slightly reduce, maintain about the same, slightly increase or greatly increase their consumption of both meat, and animal products generally. Similar scales have been used in previous research [54,55]. It is worth noting that this measure is conservative. Compared to asking about intentions to reduce consumption in general, defining a specific action and a specific, short time period is likely to make participants reflect critically about their own likely behaviour. Additionally, as participants answered this question, they saw the phrase ‘Thank you for being honest!’ which was intended to mitigate the social desirability effect (i.e., over-reporting of intentions to reduce animal product consumption). Finally, participants gave demographic information, including their age, gender, political orientation, education and income. They also indicated whether they ate ‘at least occasionally’ beef, lamb, pork, chicken, fish, eggs and dairy. Participants were then debriefed and compensated.",Medical,Fact Finding,Q&A Please base your answer on the information provided in this document only. Do not embellish your response or add any details that are unnecessary to answer the question. Use simple words and avoid any jargon that may be foreign to the layman.,What figures are given to indicate the rising use of cannabis consumption in the United States?,"**Study of smoking cannabis in adults EXCERPT** Abstract Background We examined the association between cannabis use and cardiovascular outcomes among the general population, among never‐tobacco smokers, and among younger individuals. Conclusions Cannabis use is associated with adverse cardiovascular outcomes, with heavier use (more days per month) associated with higher odds of adverse outcomes. Clinical Perspective What Is New? Cannabis use is associated with increased risk of myocardial infarction and stroke, with higher odds of events associated with more days of use per month, controlling for demographic factors and tobacco smoking. Similar increases in risk associated with cannabis use are found in never‐tobacco smokers. What Are the Clinical Implications? Patients should be screened for cannabis use and advised to avoid smoking cannabis to reduce their risk of premature cardiovascular disease and cardiac events. Nonstandard Abbreviations and Acronyms BRFSS Behavioral Risk Factor Surveillance System Cannabis use is increasing in the US population.1 From 2002 to 2019, past‐year prevalence of US adult cannabis use increased from 10.4% to 18.0%, whereas daily/almost daily use (300+ days per year) increased from 1.3% to 3.9%. Rising diagnoses of cannabis use disorder suggest that this increase in use is not confined to reporting of use.2, 3 At the same time, perceptions of the harmfulness of cannabis are decreasing. National surveys reported that adult belief in great risk of weekly cannabis use fell from 50% in 2002 to 28.6% in 2019.4 Despite common use, little is known about the risks of cannabis use and, in particular, the cardiovascular disease risks. Cardiovascular‐related death is the leading cause of mortality, and cannabis use could be an important, unappreciated risk factor leading to many preventable deaths.5 There are reasons to believe that cannabis use is associated with atherosclerotic heart disease. Endocannabinoid receptors are ubiquitous throughout the cardiovascular system.6 Tetrahydrocannabinol, the active component of cannabis, has hemodynamic effects and may result in syncope, stroke, and myocardial infarction.7, 8, 9 Smoking, the predominant method of cannabis use,10 may pose additional cardiovascular risks as a result of inhalation of particulate matter.11 Furthermore, studies in rats have demonstrated that secondhand cannabis smoke exposure is associated with endothelial dysfunction, a precursor to cardiovascular disease.11 Past studies on the association between cannabis use and cardiovascular outcomes have been limited by the dearth of adults with frequent cannabis use.7, 12, 13 Moreover, most studies have been in younger populations at low risk for cardiovascular disease, and therefore without sufficient power to detect an association between cannabis use and atherosclerotic heart disease outcomes.7, 12, 14 In addition, tobacco use among adults who use cannabis is common, and small sample sizes prevented analyses on the association of cannabis use with cardiovascular outcomes among nontobacco users. Any independent effects of cannabis and tobacco in the general adult population and effects of cannabis use among those who have never smoked tobacco cigarettes is of interest, because some have questioned whether cannabis has any effect beyond that of being associated with concurrent tobacco use.15, 16, 17 The National Academy of Sciences report on the health effects of cannabis use suggested that “testing the interaction between cannabis and tobacco use and performing stratified analyses to test the association of cannabis use with clinical endpoints in nonusers of tobacco” is necessary to elucidate the effect of cannabis use on cardiovascular health independent of tobacco use.12 We performed these tests and controlled for potential confounders. The Behavioral Risk Factor Surveillance System (BRFSS) is a national cross‐sectional survey performed annually by the Centers for Disease Control and Prevention. Beginning in 2016, an optional cannabis module was included supporting an analysis examining the association of cannabis use with cardiovascular outcomes.18 Although there have been 3 other studies examining the association of cannabis use with cardiovascular events using the BRFSS cannabis module,19, 20, 21 our much larger sample size enabled us to investigate whether cannabis use was associated with atherosclerotic heart disease outcomes among the general adult population, among nontobacco cigarette users, and among younger adults. Methods Study Sample We combined 2016 to 2020 BRFSS data from 27 American states and 2 territories participating in the cannabis module during at least 1 of these years (Table S1). BRFSS is a telephone survey that collects data from a representative sample of US adults on risk factors, chronic conditions, and health care access.18 The BRFSS questions used are summarized in Table S2. Because this study was based on publicly available data and exempt from institutional review board review, informed consent was not obtained. The data and corresponding materials that support the findings of this study are available from the corresponding author upon request. Our sample included those 18 to 74 years old from the BRFSS (N=434 104) who answered the question, “During the past 30 days, on how many days did you use marijuana or hashish?”, excluding (<1%) those who answered “Don't know” or refused to answer. We excluded adults >74 years old because cannabis use is uncommon in this population. Measures We quantified cannabis use as a continuous variable, days of cannabis use in the past 30 days divided by 30. Thus, daily cannabis use is scored 1, and less than daily use scores were proportionately lower. Specifically, daily use was scored as 1=30/30, 15 days per month was scored 0.5=15/30, and nonuse was scored 0=(0/30). Nonusers’ score was 0. Therefore, a 1‐unit change in our cannabis use frequency metric is equivalent to a comparison of 0 days of cannabis use within past 30 days to daily cannabis use. Demographic variables included age, sex, and self‐identified race and ethnicity. Socioeconomic status was represented by educational attainment, categorized as less than high school, high school, some college, or college graduate. Cardiovascular risk factors included tobacco cigarette use (never, former, current), current alcohol consumption (nonuse, nondaily use, daily use), body mass index, diabetes, and physical activity. Nicotine e‐cigarette use was similarly classified as never, former, or current. Outcomes were assessed when respondents were asked, “Has a doctor, nurse, or other health professional ever told you that you had any of the following….?”. Coronary heart disease (CHD) was assessed by: “(Ever told) you had angina or coronary heart disease?” The lifetime occurrence of myocardial infarction (MI): “(Ever told) you had a heart attack, also called a myocardial infarction?” Stroke: “(Ever told) you had a stroke?” Finally, we created composite indicator for cardiovascular disease, which included any CHD, MI, or stroke. Statistical Analysis Complete case‐weighted estimates of demographic and socioeconomic factors, health behaviors, and chronic conditions were calculated using survey strata, primary sampling units clusters, and sampling weights for the 5 years of combined data to obtain nationally representative results for the states using the cannabis module.22P values for bivariate analyses were calculated by the Rao‐Scott corrected χ2 test. We conducted 3 multivariable logistic analyses of the association of lifetime occurrence of CHD, MI, stroke, and the composite of the 3 with cannabis use ([days per month]/30) as a function of demographic and socioeconomic factors, health‐related behaviors, and other chronic conditions, accounting for the complex survey design. The first analysis included the entire sample 18 to 74 years old controlling for tobacco cigarette use and other covariates. The second was conducted among the respondents who had never used tobacco cigarettes. The third was conducted among respondents who had never used tobacco cigarettes or e‐cigarettes. In the first analysis, we tested for an interaction between current cannabis use (any cannabis use frequency between 1 and 30 days) and current tobacco cigarette use to see if there were synergistic effects of cannabis and conventional tobacco use by measuring the coefficient. An interaction was coded as present if frequency of cannabis use was at least 1 day per month, and conventional tobacco use was coded as current. In addition, we examined the variance inflation factors for the cannabis and tobacco use variables to ensure that they were quantifying statistically independent effects. An upper bound of 5 for the variance inflation factor was used for determination of independent effects.23 We performed supplemental analyses restricting the 3 main analyses to younger adults at risk for premature cardiovascular disease, which we defined as men <55 years old and women <65 years old. The difference in age cutoff by sex is due to the protective effect of estrogen.24 We also conducted sensitivity analyses limiting the comparison to daily versus nonusers using the same multivariate model as in the main analysis and using propensity‐score matching (details in Data S1). We used R statistical software version 4.0 (R Core Team, 2020, Vienna, Austria) and survey package to produce complex survey‐adjusted statistics.25, 26 We used the package car to estimate the survey‐adjusted variance inflation factors.27 Results Baseline Characteristics Among the 434 104 respondents 18 to 74 years old who answered the cannabis module, the weighted prevalence of daily cannabis use was 4.0%, nondaily use was 7.1% (median: 5 days per month; interquartile range, 2–14), and nonuse was 88.9%. The most common form of cannabis consumption was smoking (73.8% of current users). The mean age of the respondents was 45.4 years. About half (51.1%) were women, and the majority of the respondents were White (60.2%), whereas 11.6% were Black, 19.3% Hispanic, and 8.9% other race and ethnicity (eg, non‐Hispanic Asian, Native American, Native Hawaiian and Pacific Islander, and those self‐reporting as multiracial) (Table 1). Daily alcohol use and physical activity had a prevalence of 4.3% and 75.0%, respectively. Most of the sample had never used tobacco cigarettes (61.1%). The prevalence of CHD, MI, stroke, and the composite outcome of all 3 were 3.5% (N=20 009), 3.6% (N=20 563), 2.8% (N=14 922), and 7.4% (N=40 759), respectively. The percentage of missing values for each variable was <1% of the total sample size except for race (1.64%) and alcohol use (1.06%).","question: What figures are given to indicate the rising use of cannabis consumption in the United States? task: Please base your answer on the information provided in this document only. Do not embellish your response or add any details that are unnecessary to answer the question. Use simple words and avoid any jargon that may be foreign to the layman. document: **Study of smoking cannabis in adults EXCERPT** Abstract Background We examined the association between cannabis use and cardiovascular outcomes among the general population, among never‐tobacco smokers, and among younger individuals. Conclusions Cannabis use is associated with adverse cardiovascular outcomes, with heavier use (more days per month) associated with higher odds of adverse outcomes. Clinical Perspective What Is New? Cannabis use is associated with increased risk of myocardial infarction and stroke, with higher odds of events associated with more days of use per month, controlling for demographic factors and tobacco smoking. Similar increases in risk associated with cannabis use are found in never‐tobacco smokers. What Are the Clinical Implications? Patients should be screened for cannabis use and advised to avoid smoking cannabis to reduce their risk of premature cardiovascular disease and cardiac events. Nonstandard Abbreviations and Acronyms BRFSS Behavioral Risk Factor Surveillance System Cannabis use is increasing in the US population.1 From 2002 to 2019, past‐year prevalence of US adult cannabis use increased from 10.4% to 18.0%, whereas daily/almost daily use (300+ days per year) increased from 1.3% to 3.9%. Rising diagnoses of cannabis use disorder suggest that this increase in use is not confined to reporting of use.2, 3 At the same time, perceptions of the harmfulness of cannabis are decreasing. National surveys reported that adult belief in great risk of weekly cannabis use fell from 50% in 2002 to 28.6% in 2019.4 Despite common use, little is known about the risks of cannabis use and, in particular, the cardiovascular disease risks. Cardiovascular‐related death is the leading cause of mortality, and cannabis use could be an important, unappreciated risk factor leading to many preventable deaths.5 There are reasons to believe that cannabis use is associated with atherosclerotic heart disease. Endocannabinoid receptors are ubiquitous throughout the cardiovascular system.6 Tetrahydrocannabinol, the active component of cannabis, has hemodynamic effects and may result in syncope, stroke, and myocardial infarction.7, 8, 9 Smoking, the predominant method of cannabis use,10 may pose additional cardiovascular risks as a result of inhalation of particulate matter.11 Furthermore, studies in rats have demonstrated that secondhand cannabis smoke exposure is associated with endothelial dysfunction, a precursor to cardiovascular disease.11 Past studies on the association between cannabis use and cardiovascular outcomes have been limited by the dearth of adults with frequent cannabis use.7, 12, 13 Moreover, most studies have been in younger populations at low risk for cardiovascular disease, and therefore without sufficient power to detect an association between cannabis use and atherosclerotic heart disease outcomes.7, 12, 14 In addition, tobacco use among adults who use cannabis is common, and small sample sizes prevented analyses on the association of cannabis use with cardiovascular outcomes among nontobacco users. Any independent effects of cannabis and tobacco in the general adult population and effects of cannabis use among those who have never smoked tobacco cigarettes is of interest, because some have questioned whether cannabis has any effect beyond that of being associated with concurrent tobacco use.15, 16, 17 The National Academy of Sciences report on the health effects of cannabis use suggested that “testing the interaction between cannabis and tobacco use and performing stratified analyses to test the association of cannabis use with clinical endpoints in nonusers of tobacco” is necessary to elucidate the effect of cannabis use on cardiovascular health independent of tobacco use.12 We performed these tests and controlled for potential confounders. The Behavioral Risk Factor Surveillance System (BRFSS) is a national cross‐sectional survey performed annually by the Centers for Disease Control and Prevention. Beginning in 2016, an optional cannabis module was included supporting an analysis examining the association of cannabis use with cardiovascular outcomes.18 Although there have been 3 other studies examining the association of cannabis use with cardiovascular events using the BRFSS cannabis module,19, 20, 21 our much larger sample size enabled us to investigate whether cannabis use was associated with atherosclerotic heart disease outcomes among the general adult population, among nontobacco cigarette users, and among younger adults. Methods Study Sample We combined 2016 to 2020 BRFSS data from 27 American states and 2 territories participating in the cannabis module during at least 1 of these years (Table S1). BRFSS is a telephone survey that collects data from a representative sample of US adults on risk factors, chronic conditions, and health care access.18 The BRFSS questions used are summarized in Table S2. Because this study was based on publicly available data and exempt from institutional review board review, informed consent was not obtained. The data and corresponding materials that support the findings of this study are available from the corresponding author upon request. Our sample included those 18 to 74 years old from the BRFSS (N=434 104) who answered the question, “During the past 30 days, on how many days did you use marijuana or hashish?”, excluding (<1%) those who answered “Don't know” or refused to answer. We excluded adults >74 years old because cannabis use is uncommon in this population. Measures We quantified cannabis use as a continuous variable, days of cannabis use in the past 30 days divided by 30. Thus, daily cannabis use is scored 1, and less than daily use scores were proportionately lower. Specifically, daily use was scored as 1=30/30, 15 days per month was scored 0.5=15/30, and nonuse was scored 0=(0/30). Nonusers’ score was 0. Therefore, a 1‐unit change in our cannabis use frequency metric is equivalent to a comparison of 0 days of cannabis use within past 30 days to daily cannabis use. Demographic variables included age, sex, and self‐identified race and ethnicity. Socioeconomic status was represented by educational attainment, categorized as less than high school, high school, some college, or college graduate. Cardiovascular risk factors included tobacco cigarette use (never, former, current), current alcohol consumption (nonuse, nondaily use, daily use), body mass index, diabetes, and physical activity. Nicotine e‐cigarette use was similarly classified as never, former, or current. Outcomes were assessed when respondents were asked, “Has a doctor, nurse, or other health professional ever told you that you had any of the following….?”. Coronary heart disease (CHD) was assessed by: “(Ever told) you had angina or coronary heart disease?” The lifetime occurrence of myocardial infarction (MI): “(Ever told) you had a heart attack, also called a myocardial infarction?” Stroke: “(Ever told) you had a stroke?” Finally, we created composite indicator for cardiovascular disease, which included any CHD, MI, or stroke. Statistical Analysis Complete case‐weighted estimates of demographic and socioeconomic factors, health behaviors, and chronic conditions were calculated using survey strata, primary sampling units clusters, and sampling weights for the 5 years of combined data to obtain nationally representative results for the states using the cannabis module.22P values for bivariate analyses were calculated by the Rao‐Scott corrected χ2 test. We conducted 3 multivariable logistic analyses of the association of lifetime occurrence of CHD, MI, stroke, and the composite of the 3 with cannabis use ([days per month]/30) as a function of demographic and socioeconomic factors, health‐related behaviors, and other chronic conditions, accounting for the complex survey design. The first analysis included the entire sample 18 to 74 years old controlling for tobacco cigarette use and other covariates. The second was conducted among the respondents who had never used tobacco cigarettes. The third was conducted among respondents who had never used tobacco cigarettes or e‐cigarettes. In the first analysis, we tested for an interaction between current cannabis use (any cannabis use frequency between 1 and 30 days) and current tobacco cigarette use to see if there were synergistic effects of cannabis and conventional tobacco use by measuring the coefficient. An interaction was coded as present if frequency of cannabis use was at least 1 day per month, and conventional tobacco use was coded as current. In addition, we examined the variance inflation factors for the cannabis and tobacco use variables to ensure that they were quantifying statistically independent effects. An upper bound of 5 for the variance inflation factor was used for determination of independent effects.23 We performed supplemental analyses restricting the 3 main analyses to younger adults at risk for premature cardiovascular disease, which we defined as men <55 years old and women <65 years old. The difference in age cutoff by sex is due to the protective effect of estrogen.24 We also conducted sensitivity analyses limiting the comparison to daily versus nonusers using the same multivariate model as in the main analysis and using propensity‐score matching (details in Data S1). We used R statistical software version 4.0 (R Core Team, 2020, Vienna, Austria) and survey package to produce complex survey‐adjusted statistics.25, 26 We used the package car to estimate the survey‐adjusted variance inflation factors.27 Results Baseline Characteristics Among the 434 104 respondents 18 to 74 years old who answered the cannabis module, the weighted prevalence of daily cannabis use was 4.0%, nondaily use was 7.1% (median: 5 days per month; interquartile range, 2–14), and nonuse was 88.9%. The most common form of cannabis consumption was smoking (73.8% of current users). The mean age of the respondents was 45.4 years. About half (51.1%) were women, and the majority of the respondents were White (60.2%), whereas 11.6% were Black, 19.3% Hispanic, and 8.9% other race and ethnicity (eg, non‐Hispanic Asian, Native American, Native Hawaiian and Pacific Islander, and those self‐reporting as multiracial) (Table 1). Daily alcohol use and physical activity had a prevalence of 4.3% and 75.0%, respectively. Most of the sample had never used tobacco cigarettes (61.1%). The prevalence of CHD, MI, stroke, and the composite outcome of all 3 were 3.5% (N=20 009), 3.6% (N=20 563), 2.8% (N=14 922), and 7.4% (N=40 759), respectively. The percentage of missing values for each variable was <1% of the total sample size except for race (1.64%) and alcohol use (1.06%).",Medical,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Explain simply in 250 words or less the goal of this study, how it was conducted, the results, and whether or not niPGT-A might be a viable method for genetic testing of human embryos.","Fertil Steril. 2024 Jul;122(1):42-51. doi: 10.1016/j.fertnstert.2024.02.030. Epub 2024 Feb 19. A pilot study to investigate the clinically predictive values of copy number variations detected by next-generation sequencing of cell-free deoxyribonucleic acid in spent culture media Gary Nakhuda 1, Sally Rodriguez 2, Sophia Tormasi 2, Catherine Welch 2 Affiliations Expand PMID: 38382698 DOI: 10.1016/j.fertnstert.2024.02.030 Free article Abstract Objective: To investigate the positive predictive value and false positive risk of copy number variations (CNV's) detected in cell free deoxyribonucleic acid (DNA) from spent culture media for nonviable or aneuploid embryos. Design: Diagnostic/prognostic accuracy study. Patient(s): Patients aged 35 and younger with an indication for IVF-ICSI and elective single frozen embryo transfer at a single, private IVF center. Intervention: Embryo selection was performed according to the conventional grading, blinded to noninvasive preimplantation genetic testing for aneuploidy (niPGT-A) results. After clinical outcomes were established, spent culture media samples were analyzed. Main outcome measures: Prognostic accuracy of CNVs according to niPGT-A results to predict nonviability or clinical aneuploidy. Results: One hundred twenty patients completed the study. Interpretations of next-generation sequencing (NGS) profiles were as follows: 7.5% (n = 9) failed quality control; 62.5% (n = 75) no CNVs detected; and 30% (n = 36) abnormal copy number detected. Stratification of abnormal NGS profiles was as follows: 15% (n = 18) whole chromosome and 15% (n = 18) uncertain reproductive potential. An intermediate CNV was evident in 27.8% (n = 5) of the whole chromosome abnormalities. The negative predictive value for samples with no detected abnormality was 57.3% (43/75). Whole chromosome abnormality was associated with a positive predictive value of 94.4% (17/18), lower sustained implantation rate (5.6%, 1/18), and higher relative risk (RR) for nonviability compared with no detected abnormalities (RR 2.21, 95% CI: 1.66-2.94). No other CNVs were associated with significant differences in the sustained implantation or RRs for nonviability. Unequal sex chromosome proportions suggested that maternal contamination was not uncommon. A secondary descriptive analysis of 705 supernumerary embryos revealed proportions of NGS profile interpretations similar to the transferred cohort. Significant median absolute pairwise differences between certain subcategories of CNV abnormalities were apparent. Conclusion: Whole chromosome abnormalities were associated with a high positive predictive value and significant RR for nonviability. Embryos associated with other CNVs had sustained implantation rates similar to those with no abnormalities detected. Further studies are required to validate the clinical applicability of niPGT-A. Clinical trial registration number: clinicaltrials.gov (NCT04732013). Keywords: Noninvasive PGT-A; PGT-A; cfDNA; niPGT-A; nonselection. Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved. PubMed Disclaimer Conflict of interest statement Declaration of Interests G.N. is a shareholder in The Fertility Partners (TFP), the parent company of Olive Fertility Centre. S.R. has minority ownership interests in Sequence46. S.T. has minority ownership interests in Sequence46; C.W. has minority ownership interests in Sequence46. Thermo Fisher Scientific is a vendor to Sequence46 but does not have any other affiliations with the authors. Thermo Fisher provided consumables for the NGS methods required for the study but no direct financial support.","[question] Explain simply in 250 words or less the goal of this study, how it was conducted, the results, and whether or not niPGT-A might be a viable method for genetic testing of human embryos. ===================== [text] Fertil Steril. 2024 Jul;122(1):42-51. doi: 10.1016/j.fertnstert.2024.02.030. Epub 2024 Feb 19. A pilot study to investigate the clinically predictive values of copy number variations detected by next-generation sequencing of cell-free deoxyribonucleic acid in spent culture media Gary Nakhuda 1, Sally Rodriguez 2, Sophia Tormasi 2, Catherine Welch 2 Affiliations Expand PMID: 38382698 DOI: 10.1016/j.fertnstert.2024.02.030 Free article Abstract Objective: To investigate the positive predictive value and false positive risk of copy number variations (CNV's) detected in cell free deoxyribonucleic acid (DNA) from spent culture media for nonviable or aneuploid embryos. Design: Diagnostic/prognostic accuracy study. Patient(s): Patients aged 35 and younger with an indication for IVF-ICSI and elective single frozen embryo transfer at a single, private IVF center. Intervention: Embryo selection was performed according to the conventional grading, blinded to noninvasive preimplantation genetic testing for aneuploidy (niPGT-A) results. After clinical outcomes were established, spent culture media samples were analyzed. Main outcome measures: Prognostic accuracy of CNVs according to niPGT-A results to predict nonviability or clinical aneuploidy. Results: One hundred twenty patients completed the study. Interpretations of next-generation sequencing (NGS) profiles were as follows: 7.5% (n = 9) failed quality control; 62.5% (n = 75) no CNVs detected; and 30% (n = 36) abnormal copy number detected. Stratification of abnormal NGS profiles was as follows: 15% (n = 18) whole chromosome and 15% (n = 18) uncertain reproductive potential. An intermediate CNV was evident in 27.8% (n = 5) of the whole chromosome abnormalities. The negative predictive value for samples with no detected abnormality was 57.3% (43/75). Whole chromosome abnormality was associated with a positive predictive value of 94.4% (17/18), lower sustained implantation rate (5.6%, 1/18), and higher relative risk (RR) for nonviability compared with no detected abnormalities (RR 2.21, 95% CI: 1.66-2.94). No other CNVs were associated with significant differences in the sustained implantation or RRs for nonviability. Unequal sex chromosome proportions suggested that maternal contamination was not uncommon. A secondary descriptive analysis of 705 supernumerary embryos revealed proportions of NGS profile interpretations similar to the transferred cohort. Significant median absolute pairwise differences between certain subcategories of CNV abnormalities were apparent. Conclusion: Whole chromosome abnormalities were associated with a high positive predictive value and significant RR for nonviability. Embryos associated with other CNVs had sustained implantation rates similar to those with no abnormalities detected. Further studies are required to validate the clinical applicability of niPGT-A. Clinical trial registration number: clinicaltrials.gov (NCT04732013). Keywords: Noninvasive PGT-A; PGT-A; cfDNA; niPGT-A; nonselection. Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved. PubMed Disclaimer Conflict of interest statement Declaration of Interests G.N. is a shareholder in The Fertility Partners (TFP), the parent company of Olive Fertility Centre. S.R. has minority ownership interests in Sequence46. S.T. has minority ownership interests in Sequence46; C.W. has minority ownership interests in Sequence46. Thermo Fisher Scientific is a vendor to Sequence46 but does not have any other affiliations with the authors. Thermo Fisher provided consumables for the NGS methods required for the study but no direct financial support. https://pubmed.ncbi.nlm.nih.gov/38382698/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Summarize & Simplify,Text Transformation Answer using only the information provided below. Include a quote from the text to support each point.,What are the pros and cons of the Supreme Court having a Code of Conduct?,"Ethics and the Supreme Court By its explicit terms, the Code governs only the judges of the lower federal courts. It does not apply to Supreme Court Justices, nor has the Supreme Court formally promulgated its own ethical code. As a result, there is presently no single body of ethical canons with which the nation’s highest court must comply when discharging its judicial duties. The absence of such a body of canons does not mean that Supreme Court Justices are wholly unconstrained by ethical norms and guidelines. Even though the Code does not formally apply to Supreme Court Justices, the Justices “consult the Code of Conduct” and other authorities “to resolve specific ethical issues.” Moreover, although Congress has not enacted legislation mandating the adoption of a Supreme Court code of conduct, several statutes do impose various other ethical requirements upon the Justices. For example, 28 U.S.C. § 455 requires federal judges, including Supreme Court Justices, to recuse themselves from particular cases under specified circumstances, such as when the judge or Justice “has a personal bias or prejudice concerning a party” or “a financial interest in the subject matter in controversy.” Congress has also directed Supreme Court Justices to comply with certain financial disclosure requirements that apply to federal officials generally. In addition, the Court has voluntarily resolved to comply with certain Judicial Conference regulations pertaining to the receipt of gifts by judicial officers, even though those regulations would otherwise not apply to Supreme Court Justices. In response to calls to mandate a code of ethics for the Supreme Court, some Members of the 117th Congress introduced the For the People Act of 2021 (H.R. 1/S. 1), which, among other things, would require “the Judicial Conference [to] issue a code of conduct, which applies to each justice … of the United States.” The Supreme Court Ethics Act (H.R. 4766/S. 2512) would impose the same requirement through standalone legislation. These proposals echo similar bills from past Congresses that would have likewise subjected the Supreme Court to a code of judicial conduct. Legal Considerations for Congress Legislative proposals to impose a code of conduct on the Supreme Court raise an array of legal questions. The first is a question of statutory design: Which institution would Congress charge with formulating the ethical standards to govern the Justices? A legislative proposal introduced in the 115th Congress would have entrusted the Supreme Court itself with the task of “promulgat[ing] a code of ethics” and would have given the Justices substantial (albeit not unbounded) freedom to design the rules that would govern their own conduct. Similarly, a House resolution introduced during the 117th Congress would express “the sense of the House of Representatives that the Justices of the Supreme Court should make themselves subject to the existing and operative ethics guidelines set out in the Code of Conduct for United States Judges, or should promulgate their own code of conduct.” The For the People Act and the Supreme Court Ethics Act, by contrast, would not allow the Court to design its own ethical code; those proposals would instead grant that authority to the Judicial Conference. A related question is whether legislative efforts to require the Supreme Court to abide by a code of judicial conduct would violate the constitutional separation of powers. To ensure that federal judges would decide cases impartially without fear of political retaliation, the Framers of the Constitution purposefully insulated the federal judiciary from political control. Chief Justice John Roberts invoked those ideals in his 2021 Year-End Report on the Federal Judiciary, asserting that the courts “require ample institutional independence” and that “[t]he Judiciary’s power to manage its internal affairs insulates courts from inappropriate political influence and is crucial to preserving public trust in its work as a separate and coequal branch of government.” Some observers have argued that imposing a code of conduct upon the Supreme Court would amount to an unconstitutional legislative usurpation of judicial authority. The House resolution discussed above notes that separation of powers and the independence of the judiciary “may be compromised by extensive legislative or executive interference into that branch’s functions” and would thus avoid imposing any binding requirement on the Court. On the other hand, some commentators emphasize the ways that Congress may validly act with respect to the Supreme Court, for example through its authority to impeach Justices and decide whether Justices are entitled to salary increases. By extension, according to this argument, requiring the Supreme Court to adopt a code of conduct would constitute a permissible exercise of Congress’s authority. Because the Supreme Court possesses the authority to determine the constitutionality of legislative enactments, the Supreme Court itself would appear to have a critical role in determining whether Congress may validly impose a code of ethical conduct upon it. It is difficult to predict whether the Court would uphold the constitutionality of a legislatively mandated code of conduct, as existing judicial precedent offers minimal guidance on how the Court might resolve this constitutional question. For instance, the Supreme Court has never explicitly decided whether the federal statute requiring Supreme Court Justices to recuse themselves from particular cases is an unconstitutional legislative encroachment upon the judiciary, nor has the Court ever directly addressed whether Congress may subject Supreme Court Justices to financial reporting requirements or limitations upon the receipt of gifts. Distinct from this separation-of-powers issue is the question of whether Congress may authorize the Judicial Conference—which is composed almost entirely of judges from the inferior federal courts—to promulgate ethical rules to govern Justices on the High Court. The Constitution explicitly contemplates that the Supreme Court will remain “supreme” over any “inferior” courts that “Congress may from time to time ordain and establish,” such as the federal district and appellate courts. Some observers have therefore suggested that it would be unconstitutional, or at least inappropriate, for the Judicial Conference to make rules for the Supreme Court. As one example, Senior Associate Justice Anthony Kennedy has stated that it would raise a “legal problem” and would be “structurally unprecedented for district and circuit judges to make rules that Supreme Court judges have to follow.” A Supreme Court code of conduct could also raise practical issues to the extent that it would require Justices to disqualify themselves from particular cases. Unlike in the lower courts, where a district or circuit judge from the same court may step in to take a recused judge’s place, neither retired Justices of the Supreme Court nor lower court judges may hear a case in a recused Justice’s stead. The disqualification of a Supreme Court Justice from a particular case could leave the Court with an even number of Justices to decide the case and thus increase the likelihood that the Court would be evenly divided and unable to create binding precedent for future litigants. Conversely, if the other Justices would otherwise be evenly divided, it may be even more critical for a Justice with an appearance of partiality to avoid casting the deciding vote. If one or more Justices refused or failed to comply with a newly created code of conduct, Congress might also encounter difficulties enforcing its tenets. The Constitution forbids Congress from reducing Supreme Court Justices’ salaries or removing them from office except via the extraordinary and blunt remedy of impeachment. Thus, Congress may lack precise tools to induce recalcitrant Justices to behave ethically. Ultimately, the foregoing questions related to a Supreme Court code of conduct may be largely academic. Promulgating an ethical code for the Supreme Court could establish norms for proper judicial behavior that guide the Justices’ actions. Thus, if Congress sought to compel the Supreme Court to comply with a code of judicial conduct, the Justices might simply comply with its mandates without challenging Congress’s constitutional authority to impose them. The Court has often acquiesced to congressional attempts to subject Justices to specific ethical standards. For example, when Congress decided to subject the Justices to financial disclosure requirements, the Justices opted to comply with those provisions rather than challenge their constitutionality in court. Justices have likewise implicitly accepted the validity of 28 U.S.C. § 455, discussed above, and recused themselves pursuant to that statute without questioning whether Congress possesses the constitutional authority to enact a judicial disqualification statute. ","Question: What are the pros and cons of the Supreme Court having a Code of Conduct? System Instruction: Answer using only the information provided below. Include a quote from the text to support each point. Context: Ethics and the Supreme Court By its explicit terms, the Code governs only the judges of the lower federal courts. It does not apply to Supreme Court Justices, nor has the Supreme Court formally promulgated its own ethical code. As a result, there is presently no single body of ethical canons with which the nation’s highest court must comply when discharging its judicial duties. The absence of such a body of canons does not mean that Supreme Court Justices are wholly unconstrained by ethical norms and guidelines. Even though the Code does not formally apply to Supreme Court Justices, the Justices “consult the Code of Conduct” and other authorities “to resolve specific ethical issues.” Moreover, although Congress has not enacted legislation mandating the adoption of a Supreme Court code of conduct, several statutes do impose various other ethical requirements upon the Justices. For example, 28 U.S.C. § 455 requires federal judges, including Supreme Court Justices, to recuse themselves from particular cases under specified circumstances, such as when the judge or Justice “has a personal bias or prejudice concerning a party” or “a financial interest in the subject matter in controversy.” Congress has also directed Supreme Court Justices to comply with certain financial disclosure requirements that apply to federal officials generally. In addition, the Court has voluntarily resolved to comply with certain Judicial Conference regulations pertaining to the receipt of gifts by judicial officers, even though those regulations would otherwise not apply to Supreme Court Justices. In response to calls to mandate a code of ethics for the Supreme Court, some Members of the 117th Congress introduced the For the People Act of 2021 (H.R. 1/S. 1), which, among other things, would require “the Judicial Conference [to] issue a code of conduct, which applies to each justice … of the United States.” The Supreme Court Ethics Act (H.R. 4766/S. 2512) would impose the same requirement through standalone legislation. These proposals echo similar bills from past Congresses that would have likewise subjected the Supreme Court to a code of judicial conduct. Legal Considerations for Congress Legislative proposals to impose a code of conduct on the Supreme Court raise an array of legal questions. The first is a question of statutory design: Which institution would Congress charge with formulating the ethical standards to govern the Justices? A legislative proposal introduced in the 115th Congress would have entrusted the Supreme Court itself with the task of “promulgat[ing] a code of ethics” and would have given the Justices substantial (albeit not unbounded) freedom to design the rules that would govern their own conduct. Similarly, a House resolution introduced during the 117th Congress would express “the sense of the House of Representatives that the Justices of the Supreme Court should make themselves subject to the existing and operative ethics guidelines set out in the Code of Conduct for United States Judges, or should promulgate their own code of conduct.” The For the People Act and the Supreme Court Ethics Act, by contrast, would not allow the Court to design its own ethical code; those proposals would instead grant that authority to the Judicial Conference. A related question is whether legislative efforts to require the Supreme Court to abide by a code of judicial conduct would violate the constitutional separation of powers. To ensure that federal judges would decide cases impartially without fear of political retaliation, the Framers of the Constitution purposefully insulated the federal judiciary from political control. Chief Justice John Roberts invoked those ideals in his 2021 Year-End Report on the Federal Judiciary, asserting that the courts “require ample institutional independence” and that “[t]he Judiciary’s power to manage its internal affairs insulates courts from inappropriate political influence and is crucial to preserving public trust in its work as a separate and coequal branch of government.” Some observers have argued that imposing a code of conduct upon the Supreme Court would amount to an unconstitutional legislative usurpation of judicial authority. The House resolution discussed above notes that separation of powers and the independence of the judiciary “may be compromised by extensive legislative or executive interference into that branch’s functions” and would thus avoid imposing any binding requirement on the Court. On the other hand, some commentators emphasize the ways that Congress may validly act with respect to the Supreme Court, for example through its authority to impeach Justices and decide whether Justices are entitled to salary increases. By extension, according to this argument, requiring the Supreme Court to adopt a code of conduct would constitute a permissible exercise of Congress’s authority. Because the Supreme Court possesses the authority to determine the constitutionality of legislative enactments, the Supreme Court itself would appear to have a critical role in determining whether Congress may validly impose a code of ethical conduct upon it. It is difficult to predict whether the Court would uphold the constitutionality of a legislatively mandated code of conduct, as existing judicial precedent offers minimal guidance on how the Court might resolve this constitutional question. For instance, the Supreme Court has never explicitly decided whether the federal statute requiring Supreme Court Justices to recuse themselves from particular cases is an unconstitutional legislative encroachment upon the judiciary, nor has the Court ever directly addressed whether Congress may subject Supreme Court Justices to financial reporting requirements or limitations upon the receipt of gifts. Distinct from this separation-of-powers issue is the question of whether Congress may authorize the Judicial Conference—which is composed almost entirely of judges from the inferior federal courts—to promulgate ethical rules to govern Justices on the High Court. The Constitution explicitly contemplates that the Supreme Court will remain “supreme” over any “inferior” courts that “Congress may from time to time ordain and establish,” such as the federal district and appellate courts. Some observers have therefore suggested that it would be unconstitutional, or at least inappropriate, for the Judicial Conference to make rules for the Supreme Court. As one example, Senior Associate Justice Anthony Kennedy has stated that it would raise a “legal problem” and would be “structurally unprecedented for district and circuit judges to make rules that Supreme Court judges have to follow.” A Supreme Court code of conduct could also raise practical issues to the extent that it would require Justices to disqualify themselves from particular cases. Unlike in the lower courts, where a district or circuit judge from the same court may step in to take a recused judge’s place, neither retired Justices of the Supreme Court nor lower court judges may hear a case in a recused Justice’s stead. The disqualification of a Supreme Court Justice from a particular case could leave the Court with an even number of Justices to decide the case and thus increase the likelihood that the Court would be evenly divided and unable to create binding precedent for future litigants. Conversely, if the other Justices would otherwise be evenly divided, it may be even more critical for a Justice with an appearance of partiality to avoid casting the deciding vote. If one or more Justices refused or failed to comply with a newly created code of conduct, Congress might also encounter difficulties enforcing its tenets. The Constitution forbids Congress from reducing Supreme Court Justices’ salaries or removing them from office except via the extraordinary and blunt remedy of impeachment. Thus, Congress may lack precise tools to induce recalcitrant Justices to behave ethically. Ultimately, the foregoing questions related to a Supreme Court code of conduct may be largely academic. Promulgating an ethical code for the Supreme Court could establish norms for proper judicial behavior that guide the Justices’ actions. Thus, if Congress sought to compel the Supreme Court to comply with a code of judicial conduct, the Justices might simply comply with its mandates without challenging Congress’s constitutional authority to impose them. The Court has often acquiesced to congressional attempts to subject Justices to specific ethical standards. For example, when Congress decided to subject the Justices to financial disclosure requirements, the Justices opted to comply with those provisions rather than challenge their constitutionality in court. Justices have likewise implicitly accepted the validity of 28 U.S.C. § 455, discussed above, and recused themselves pursuant to that statute without questioning whether Congress possesses the constitutional authority to enact a judicial disqualification statute.",Legal,Pros & Cons,Q&A You can only answer using from the text provided in the prompt. You can not use any other external resources or prior knowledge. Provide your answer in 5 sentences or less.,What are families' emotional experiences with a child with rare disease before a diagnosis is received?,"In the absence of correct diagnosis, emergency units are not in a position to treat the patient appropriately, e.g. headache treated as migraine in a neurological emergency unit, whereas a brain tumour is the underlying cause of the pain. Without a diagnosis, when the patient is a child, the family feels particularly guilty because the child is “acting weird” and is not performing normally in terms of mental and psychomotor development. Any abnormal eating behaviour, which accompanies many rare diseases, is frequently blamed on the mother, causing guilt and insecurity. Incomprehension, depression, isolation and anxiety are an intrinsic part of the everyday life of most parents of a child affected by a rare disease, especially in the pre-diagnosis phase. The whole family of a rare disease patient, whether children or adults, is affected by the disease of the loved one and becomes marginalized: psychologically, socially, culturally and economically vulnerable. In many cases, the birth of a child with a rare disease is a cause for parental splitting. Another crucial moment for rare disease patients is the disclosure of diagnosis: despite the progress made over the last ten years, the diagnosis of a rare disease is all too often poorly communicated. Many patients and their families describe the insensitive and uninformative manner in which diagnosis is given. This problem is common among health care practitioners, who are too often neither organised nor trained in good practice for communicating diagnosis. Up to 50% of patients have suffered from poor or unacceptable conditions of disclosure. In order to avoid face-to-face disclosure, doctors often give the terrible diagnosis by phone, in writing - with or even without explanation – or standing in the corridor of a hospital. Training professionals on appropriate ways of disclosure would avoid this additional and unnecessary pain to already anguished patients and 4 More information about the EurordisCare 2 survey can be found on the following websites: http://www.eurordis.org and http://www.rare-luxembourg2005.org/ “Rare Diseases : Understanding this Public Health Priority” 9/14 Eurordis, November 2005 – www.eurordis.org families. Further schooling in “breaking in bad news” to patients constitutes an important aspect of medical training. A father tells: “When I went to pick up my one year-old daughter in the hospital after I had to leave her for many hours of examinations and testing, I anxiously asked the paediatrician what my baby was suffering from. The doctor hardly looked at me and, rushing down the corridor, shouted: “This baby, you better throw her away, and get another child”. Whatever the conditions of disclosure are, the diagnosis of a rare disease means that life is toppling. In order to help rare disease patients and their families face the future and avoid their world collapsing, psychological support is greatly needed. Every mother and father knows how many worries and hopes are involved in having a child. But what it means to be diagnosed - or having a child diagnosed - with a rare disease cannot be explained.","You can only answer using from the text provided in the prompt. You can not use any other external resources or prior knowledge. Provide your answer in 5 sentences or less. What are families' emotional experiences with a child with rare disease before a diagnosis is received? In the absence of correct diagnosis, emergency units are not in a position to treat the patient appropriately, e.g. headache treated as migraine in a neurological emergency unit, whereas a brain tumour is the underlying cause of the pain. Without a diagnosis, when the patient is a child, the family feels particularly guilty because the child is “acting weird” and is not performing normally in terms of mental and psychomotor development. Any abnormal eating behaviour, which accompanies many rare diseases, is frequently blamed on the mother, causing guilt and insecurity. Incomprehension, depression, isolation and anxiety are an intrinsic part of the everyday life of most parents of a child affected by a rare disease, especially in the pre-diagnosis phase. The whole family of a rare disease patient, whether children or adults, is affected by the disease of the loved one and becomes marginalized: psychologically, socially, culturally and economically vulnerable. In many cases, the birth of a child with a rare disease is a cause for parental splitting. Another crucial moment for rare disease patients is the disclosure of diagnosis: despite the progress made over the last ten years, the diagnosis of a rare disease is all too often poorly communicated. Many patients and their families describe the insensitive and uninformative manner in which diagnosis is given. This problem is common among health care practitioners, who are too often neither organised nor trained in good practice for communicating diagnosis. Up to 50% of patients have suffered from poor or unacceptable conditions of disclosure. In order to avoid face-to-face disclosure, doctors often give the terrible diagnosis by phone, in writing - with or even without explanation – or standing in the corridor of a hospital. Training professionals on appropriate ways of disclosure would avoid this additional and unnecessary pain to already anguished patients and 4 More information about the EurordisCare 2 survey can be found on the following websites: http://www.eurordis.org and http://www.rare-luxembourg2005.org/ “Rare Diseases : Understanding this Public Health Priority” 9/14 Eurordis, November 2005 – www.eurordis.org families. Further schooling in “breaking in bad news” to patients constitutes an important aspect of medical training. A father tells: “When I went to pick up my one year-old daughter in the hospital after I had to leave her for many hours of examinations and testing, I anxiously asked the paediatrician what my baby was suffering from. The doctor hardly looked at me and, rushing down the corridor, shouted: “This baby, you better throw her away, and get another child”. Whatever the conditions of disclosure are, the diagnosis of a rare disease means that life is toppling. In order to help rare disease patients and their families face the future and avoid their world collapsing, psychological support is greatly needed. Every mother and father knows how many worries and hopes are involved in having a child. But what it means to be diagnosed - or having a child diagnosed - with a rare disease cannot be explained.",Medical,Fact Finding,Q&A You must respond using only information provided in the prompt. Explain your reasoning with at least three supporting points.,What are some examples of spillover related to one's level of financial literacy?,"A lack of information is sometimes the cause of poor financial decisions. When one party has more information than the other party, economists describe this imbalance as “asymmetric information.” In the market for financial services, where the provider often knows more about the product, there is a potential risk to the consumer and the economy. Financial education is a tool for helping individuals manage and mitigate risk. Individuals who are better financially prepared can avoid unexpected expenses, steer away from frauds and scams, and avoid taking on risks that they do not understand or cannot afford to bear. By improving financial literacy and education, the federal government can play an important role in facilitating a vibrant and efficient marketplace, which in turn empowers individuals to make informed financial decisions. In supporting financial literacy and education, the government can create positive spillovers (or positive externalities) from a more financially literate population. A more informed population tends to be more productive and thus boosts economic activity. A stronger economy can result in more jobs and higher wages for others. Financial education can also help avoid negative spillovers (or negative externalities) from a less financially literate population. A negative externality is an economic 26. GAO, April 2014. 14 Federal Financial Literacy Reform: Coordinating and Improving Financial Literacy Efforts activity that imposes a cost or negative impact on an unrelated third party. These negative externalities cause inefficiencies in the market.27 For example, when a borrower with low financial literacy defaults on an ill-advised loan, the lender will bear some of these costs. On the other hand, friends and family members, the government and others may also bear the cost of that decision. Family members may directly help pay off a loan, or cosign on future loans, increasing their own debt-to-income ratios. Thus, the original two parties to the loan do not bear the entire cost of the transaction. The financial crisis of 2007-2008 demonstrated how individuals and families with limited financial literacy can be among those most dramatically affected by downturns in the economy. Since Treasury’s mission includes a mandate to maintain a strong economy “by promoting the conditions that enable economic growth and stability at home and abroad,”28 it is important to keep in mind the role that individual financial capability has in the prosperity and financial health of the nation. The federal government cannot, and should not, bear the sole responsibility for ensuring the financial capability of individuals and households. Since the creation of the FLEC, it has been clear that federal agencies are not solely, or even predominantly, responsible for providing financial education to Americans. State and local governments, nonprofits and the private sector rightly have interests in promoting better financial decision-making. For example, some employers view financial health similar to physical health and include this as part of their benefits package because of its impact on their bottom line. These non-government entities are able to respond to needs more quickly, develop customized strategies to deliver financial education, and remain engaged and follow up with those served over time. Given the substantial accomplishments and opportunities for improved financial education provided by various stakeholders outside of the federal government, it is appropriate to consider the suitable federal role. Treasury’s outreach to stakeholders has revealed the desire for the federal government to play an overarching leadership and guidance role, rather than trying to directly reach all Americans with financial education lessons. By embracing this role, the federal government can improve the quality and reach of financial education activities by promoting best practices, sharing evidence, creating specific resources where appropriate, and deploying policy solutions to support the U.S. financial education infrastructure. The federal government, then, can be a partner, a source of trusted information and tools, and a leader to the many financial education providers striving to improve financial literacy and capability of their nation. 27. See, for example: Hastings, Justine S., Madrian, Brigitte C. and Skimmyhorn,William L. “Financial Literacy, Financial Education and Economic Outcomes,” Annu Rev Econom. 2013 May 1; 5: 347–373, 2013, available at: https://dx.doi. org/10.1146%2Fannurev-economics-082312-125807; Lusardi, Annamaria and Mitchell, Olivia S. “The Economic Importance of Financial Literacy: Theory and Evidence”, Journal of Economic Literature 2014, 52(1), 5-44, 2014, available at: https://www. aeaweb.org/articles?id=10.1257/jel.52.1.5. 28. U.S. Department of the Treasury, “Role of the Treasury”, webpage, available at: https://home.treasury.gov/about/general-information/ role-of-the-treasury. Section 1: Governance of Federal Financial Literacy and Education Efforts 15 Recommendation Treasury recommends that the primary federal role for financial literacy and education should be to empower financial education providers as opposed to trying to directly reach every American household. This federal role could include developing and implementing policy, encouraging research, and other activities, including conducting financial education programs, and developing educational resources as needed to advance best practices and standards to equip Americans with the skills, knowledge, and tools to confidently make informed financial decisions and improve their financial well-being. The federal government should also consider the impact of the lack of financial literacy on households and the risk to the economy from negative externalities and market failures. Financial literacy and education should be seen as a vehicle to guard against market failures and foster competitive markets. Leadership and Accountability for Federal Financial Literacy and Education The FLEC’s structure and operations have been informal, with the Treasury providing staff support and management, including organizing public meetings, scheduling informal briefings, and managing reports to Congress and the public. While it is clear that there is an important federal role in financial education, the structure of financial education across the federal government has not been conducive to both attaining measurable outcomes and coordinating activities in order to maximize the government’s return on investment. As noted by the OMB Report and the GAO report, financial education activities exist in many different agencies, often without a requirement that they use or build on programs or resources already paid for by taxpayers. Congress created the FLEC with a purpose to coordinate these activities, yet the authorities of the FLEC, as well as its structure, do not provide it with the ability to hold members accountable for coordination, efficiency or outcomes. As GAO noted, “We acknowledge that the governance structure of the Commission presents challenges in addressing resource issues: it relies on the consensus of multiple agencies, has no independent budget, and no legal authority to compel members to act.”29 The FLEC’s lack of clear decision-making processes and defined roles and responsibilities has impeded its ability to effectively carry out its national strategy for financial literacy, and its statutory mandates of both improving financial education, and streamlining and improving federal financial education activities. As a result, the FLEC lacks an effective organizational structure to facilitate goal-setting and decision-making and accountability for outcomes. A more clear and focused leadership structure is needed to guide the work of the FLEC. In addition to structural impediments to coordination, performance and outcome data have not been used systematically to assess the effectiveness of federal activities 29. GAO, April 2014. 16 Federal Financial Literacy Reform: Coordinating and Improving Financial Literacy Efforts and provide a basis to streamline, augment or improve them. Outcomes should reflect the ability of Americans to attain improved financial decision-making as opposed to being activity driven. The GAO has noted that “financial literacy program evaluations are most reliable and effective when they measure the programs’ impact on consumers’ behavior.”30 By adopting measures that member agencies directly impact (performance measures), and indirectly affect (outcome measures), the FLEC will be able to better assess the effectiveness of financial education activities and thus make improvements in the future. Recommendations Treasury recommends the FLEC establish bylaws to set clear expectations for its decision-making and roles, including establishing a six-member Executive Committee comprised of Treasury (chair), CFPB (vice chair), and ED, HUD, DOL and DoD. The Executive Committee will be responsible for crafting, with input from other FLEC members, a shared agenda for action and priorities, and be accountable to report on achievement of that agenda. The agenda would be voted on and approved by a majority of the members.","You must respond using only information provided in the prompt. Explain your reasoning with at least three supporting points. A lack of information is sometimes the cause of poor financial decisions. When one party has more information than the other party, economists describe this imbalance as “asymmetric information.” In the market for financial services, where the provider often knows more about the product, there is a potential risk to the consumer and the economy. Financial education is a tool for helping individuals manage and mitigate risk. Individuals who are better financially prepared can avoid unexpected expenses, steer away from frauds and scams, and avoid taking on risks that they do not understand or cannot afford to bear. By improving financial literacy and education, the federal government can play an important role in facilitating a vibrant and efficient marketplace, which in turn empowers individuals to make informed financial decisions. In supporting financial literacy and education, the government can create positive spillovers (or positive externalities) from a more financially literate population. A more informed population tends to be more productive and thus boosts economic activity. A stronger economy can result in more jobs and higher wages for others. Financial education can also help avoid negative spillovers (or negative externalities) from a less financially literate population. A negative externality is an economic 26. GAO, April 2014. 14 Federal Financial Literacy Reform: Coordinating and Improving Financial Literacy Efforts activity that imposes a cost or negative impact on an unrelated third party. These negative externalities cause inefficiencies in the market.27 For example, when a borrower with low financial literacy defaults on an ill-advised loan, the lender will bear some of these costs. On the other hand, friends and family members, the government and others may also bear the cost of that decision. Family members may directly help pay off a loan, or cosign on future loans, increasing their own debt-to-income ratios. Thus, the original two parties to the loan do not bear the entire cost of the transaction. The financial crisis of 2007-2008 demonstrated how individuals and families with limited financial literacy can be among those most dramatically affected by downturns in the economy. Since Treasury’s mission includes a mandate to maintain a strong economy “by promoting the conditions that enable economic growth and stability at home and abroad,”28 it is important to keep in mind the role that individual financial capability has in the prosperity and financial health of the nation. The federal government cannot, and should not, bear the sole responsibility for ensuring the financial capability of individuals and households. Since the creation of the FLEC, it has been clear that federal agencies are not solely, or even predominantly, responsible for providing financial education to Americans. State and local governments, nonprofits and the private sector rightly have interests in promoting better financial decision-making. For example, some employers view financial health similar to physical health and include this as part of their benefits package because of its impact on their bottom line. These non-government entities are able to respond to needs more quickly, develop customized strategies to deliver financial education, and remain engaged and follow up with those served over time. Given the substantial accomplishments and opportunities for improved financial education provided by various stakeholders outside of the federal government, it is appropriate to consider the suitable federal role. Treasury’s outreach to stakeholders has revealed the desire for the federal government to play an overarching leadership and guidance role, rather than trying to directly reach all Americans with financial education lessons. By embracing this role, the federal government can improve the quality and reach of financial education activities by promoting best practices, sharing evidence, creating specific resources where appropriate, and deploying policy solutions to support the U.S. financial education infrastructure. The federal government, then, can be a partner, a source of trusted information and tools, and a leader to the many financial education providers striving to improve financial literacy and capability of their nation. 27. See, for example: Hastings, Justine S., Madrian, Brigitte C. and Skimmyhorn,William L. “Financial Literacy, Financial Education and Economic Outcomes,” Annu Rev Econom. 2013 May 1; 5: 347–373, 2013, available at: https://dx.doi. org/10.1146%2Fannurev-economics-082312-125807; Lusardi, Annamaria and Mitchell, Olivia S. “The Economic Importance of Financial Literacy: Theory and Evidence”, Journal of Economic Literature 2014, 52(1), 5-44, 2014, available at: https://www. aeaweb.org/articles?id=10.1257/jel.52.1.5. 28. U.S. Department of the Treasury, “Role of the Treasury”, webpage, available at: https://home.treasury.gov/about/general-information/ role-of-the-treasury. Section 1: Governance of Federal Financial Literacy and Education Efforts 15 Recommendation Treasury recommends that the primary federal role for financial literacy and education should be to empower financial education providers as opposed to trying to directly reach every American household. This federal role could include developing and implementing policy, encouraging research, and other activities, including conducting financial education programs, and developing educational resources as needed to advance best practices and standards to equip Americans with the skills, knowledge, and tools to confidently make informed financial decisions and improve their financial well-being. The federal government should also consider the impact of the lack of financial literacy on households and the risk to the economy from negative externalities and market failures. Financial literacy and education should be seen as a vehicle to guard against market failures and foster competitive markets. Leadership and Accountability for Federal Financial Literacy and Education The FLEC’s structure and operations have been informal, with the Treasury providing staff support and management, including organizing public meetings, scheduling informal briefings, and managing reports to Congress and the public. While it is clear that there is an important federal role in financial education, the structure of financial education across the federal government has not been conducive to both attaining measurable outcomes and coordinating activities in order to maximize the government’s return on investment. As noted by the OMB Report and the GAO report, financial education activities exist in many different agencies, often without a requirement that they use or build on programs or resources already paid for by taxpayers. Congress created the FLEC with a purpose to coordinate these activities, yet the authorities of the FLEC, as well as its structure, do not provide it with the ability to hold members accountable for coordination, efficiency or outcomes. As GAO noted, “We acknowledge that the governance structure of the Commission presents challenges in addressing resource issues: it relies on the consensus of multiple agencies, has no independent budget, and no legal authority to compel members to act.”29 The FLEC’s lack of clear decision-making processes and defined roles and responsibilities has impeded its ability to effectively carry out its national strategy for financial literacy, and its statutory mandates of both improving financial education, and streamlining and improving federal financial education activities. As a result, the FLEC lacks an effective organizational structure to facilitate goal-setting and decision-making and accountability for outcomes. A more clear and focused leadership structure is needed to guide the work of the FLEC. In addition to structural impediments to coordination, performance and outcome data have not been used systematically to assess the effectiveness of federal activities 29. GAO, April 2014. 16 Federal Financial Literacy Reform: Coordinating and Improving Financial Literacy Efforts and provide a basis to streamline, augment or improve them. Outcomes should reflect the ability of Americans to attain improved financial decision-making as opposed to being activity driven. The GAO has noted that “financial literacy program evaluations are most reliable and effective when they measure the programs’ impact on consumers’ behavior.”30 By adopting measures that member agencies directly impact (performance measures), and indirectly affect (outcome measures), the FLEC will be able to better assess the effectiveness of financial education activities and thus make improvements in the future. Recommendations Treasury recommends the FLEC establish bylaws to set clear expectations for its decision-making and roles, including establishing a six-member Executive Committee comprised of Treasury (chair), CFPB (vice chair), and ED, HUD, DOL and DoD. The Executive Committee will be responsible for crafting, with input from other FLEC members, a shared agenda for action and priorities, and be accountable to report on achievement of that agenda. The agenda would be voted on and approved by a majority of the members. What are some examples of spillover related to one's level of financial literacy? ",Financial,Find & Summarize,Text Transformation Only form your answer with the information provided in the text. Give your answer in a bullet point format.,What are all the price breakdowns the Build Back Better plan provides in its two examples?,"As part of the Build Back Better plan, the Biden Administration has proposed several policies to address these long-standing cost pressures. Families with young children will tend to benefit most from the proposed expansion of the Child Tax Credit (CTC), universal preschool, and improvements in the quality of childcare and a reduction in associated out-of-pocket costs. Proposals to lower prescription drug cost through Medicare-negotiated prices, add dental and vision benefits to Medicare, and expand access to home- and community-based care through Medicaid are likely to be more beneficial to households with elderly members. Here, we present two illustrative families as benchmarks for how pieces of Build Back Better aim to help different types of families meet their needs. Specific numbers will vary depending on factors like age, state of residence, and number of children, but these examples try to convey the breadth of the different family policies included in the Administration’s plans. The first example is a family of four with two young children age 4 and 6 living in Indiana. The parents are both 28 years old, have full-time jobs, and together earn $65,000 per year. While the parents are at work, they send the younger child to a high-quality Indiana preschool that costs $9,000 annually.11 Build Back Better would dramatically reduce costs for this Indiana family example. Under Build Back Better’s CTC expansion, the family would receive an extra $2,600 in tax credits.12 Universal preschool would erase the $9,000 they currently spend. All told, Build Back Better would help the Indiana family make ends meet with $11,600 in family cost reductions. The second illustrative family lives in Arizona, with two parents who together earn $85,000 per year and an adult child who lives with them and attends a community college. The family also cares for an elderly parent who needs arthritis medicine, which costs $5,500 per year out-ofpocket, and an eye exam to get a new pair of glasses. Build Back Better would help this Arizona family by making education and health care more affordable. The community college student would be eligible for two years of free community college education, saving the family $2,400 per year.13 Prescription drug reform would cap outof-pocket costs for the elderly parent’s prescription drugs, saving the family another $2,400 per year.14 Finally, new vision benefits under Medicare would pay for the elderly parent’s eye exam and new glasses and lenses, saving $450.15 All told, Build Back Better policies would save this Arizona family $5,250 in annual costs.","System instruction: Only form your answer with the information provided in the text. Give your answer in a bullet point format. Question: What are all the price breakdowns the Build Back Better plan provides in its two examples? Context: As part of the Build Back Better plan, the Biden Administration has proposed several policies to address these long-standing cost pressures. Families with young children will tend to benefit most from the proposed expansion of the Child Tax Credit (CTC), universal preschool, and improvements in the quality of childcare and a reduction in associated out-of-pocket costs. Proposals to lower prescription drug cost through Medicare-negotiated prices, add dental and vision benefits to Medicare, and expand access to home- and community-based care through Medicaid are likely to be more beneficial to households with elderly members. Here, we present two illustrative families as benchmarks for how pieces of Build Back Better aim to help different types of families meet their needs. Specific numbers will vary depending on factors like age, state of residence, and number of children, but these examples try to convey the breadth of the different family policies included in the Administration’s plans. The first example is a family of four with two young children age 4 and 6 living in Indiana. The parents are both 28 years old, have full-time jobs, and together earn $65,000 per year. While the parents are at work, they send the younger child to a high-quality Indiana preschool that costs $9,000 annually.11 Build Back Better would dramatically reduce costs for this Indiana family example. Under Build Back Better’s CTC expansion, the family would receive an extra $2,600 in tax credits.12 Universal preschool would erase the $9,000 they currently spend. All told, Build Back Better would help the Indiana family make ends meet with $11,600 in family cost reductions. The second illustrative family lives in Arizona, with two parents who together earn $85,000 per year and an adult child who lives with them and attends a community college. The family also cares for an elderly parent who needs arthritis medicine, which costs $5,500 per year out-ofpocket, and an eye exam to get a new pair of glasses. Build Back Better would help this Arizona family by making education and health care more affordable. The community college student would be eligible for two years of free community college education, saving the family $2,400 per year.13 Prescription drug reform would cap outof-pocket costs for the elderly parent’s prescription drugs, saving the family another $2,400 per year.14 Finally, new vision benefits under Medicare would pay for the elderly parent’s eye exam and new glasses and lenses, saving $450.15 All told, Build Back Better policies would save this Arizona family $5,250 in annual costs.",Financial,Find & Summarize,Text Transformation Only use the information contained within the provided text to answer the question. Do not use outside sources. Write a full sentence and use a bullet point. Ensure the entire sentence is in italics.,Why is a digital detox so important?,"Digital Detox Guide Do you check your email, texts, voicemails, Facebook, or Twitter feed within an hour of waking up or going to sleep? While you’re in line at the store? During dinner with your family? Would you check it at a church while waiting for a funeral to start? Do a little thought experiment with me here. Imagine yourself sitting in a public place, not doing anything, just staring into space. How would you feel? Although many of us spent most of our childhoods daydreaming, adulthood seems to be about trying to keeping our minds from wandering, and trying to stay on task. Rarely do we just let ourselves stare into space these days. Look around: We can’t even stand to wait at a stoplight for 10 seconds without checking our smartphones. Why not? Because it’s uncomfortable for us not to be doing anything. At the very least, it’s boring. More than being boring, however, downtime and daydreaming are threatening to our sense of self. If busyness and multi-tasking and being pressed for time can be equated with significance, success, and productivity then downtime and daydreaming must be signs of insignificance, failure, and inefficiency. And when we feel insignificant and unsuccessful, we also tend to feel guilty for not working, ashamed that we aren’t important enough to be doing something, and anxious about our status. In the lab, these emotions are more painful than the actual physical pain of an electric shock. I’m endlessly fascinated by a series of studies led by Tim Wilson where the research subjects were put alone in a room, with nothing to do. The researchers describe their work: In 11 studies, we found that participants typically did not enjoy spending 6 to 15 minutes in a room by themselves with nothing to do but think, that they enjoyed doing mundane external activities much more, and that many preferred to administer electric shocks to themselves instead of being left alone with their thoughts. Most people seem to prefer to be doing something rather than nothing, even if that something is negative. You read that right: Many people (67 percent of men and 25 percent of women, to be exact) actually gave themselves painful electric shocks instead of just sitting there doing nothing–after they had indicated to the researchers that they would pay money NOT to be shocked again. One guy shocked himself 190 times in 15 minutes. When we can’t tolerate the feelings that come up when we aren’t doing anything, or when we can’t tolerate a lack of stimulation, we feel uncomfortable when we have downtime. As a result, we forfeit our downtime and all its benefits by seeking external stimulation, which is usually readily available in our purse or pocket (rather than an electric shock machine). Instead of just staring out the window on the bus, we read through our Facebook feed. Instead of being alone with our thoughts for a minute, we check our email waiting in line at the grocery store. Instead of enjoying our dinner, we mindlessly shovel food in our mouths while staring at a screen. THE BENEFITS OF UNPLUGGING In the grand scheme of things, digital usage rarely leads to meaning or fulfillment. But unplugging for at least one day per week will make you happier (in addition to giving you hours and hours to do the things that bring meaning to your life). Here’s why: 1. Detoxing from social media and digital information promotes overall wellbeing and mental health. Social media use is associated with narcissism, depression, loneliness, and other negative feelings like anger, envy, misery, and frustration. So, it’s hardly surprising that taking a break for a few days can improve our mood and overall happiness. 2. Your sleep will become more restorative, and sleep improves everything from health and happiness to performance and productivity. Physiologically, you’ll have an easier time sleeping because the low-energy blue light emitted by our tablets and smartphones stimulates chemical messengers in our brains that make us more alert and suppresses others (like melatonin) that help us fall asleep. In addition, you’ll have an easier time sleeping because you won’t be exciting your brain with new or stimulating information right efore bedtime. Social media, messages, and email can easily trigger the release of adrenalin, which makes it nearly impossible to fall asleep quickly. And needless to say, the less time it takes you to fall asleep at night, the more time you’ll have in the morning. 3. Bonus: You’ll feel less lonely and more connected, and feeling connected is the best predictor of happiness that we have. Though we think social media makes us feel more connected to others, ironically, it can also make us feel quite alone. Seeing friends and acquaintances post about how happy they are can actually trigger feelings of misery and loneliness, research shows. The benefits of unplugging from time to time are clearly enormous. But if unplugging isn’t undertaken properly, people often experience withdrawal symptoms, like feelings of agitation, guilt, and a compulsive and distracting desire to check our phones. THE SCIENCE OF CHECKING One survey found that 80% of 18 to 44-year-olds check their smartphones within the first 15 minutes of waking up–and that 89% of younger users, those ages 18- 24, reach for their device within 15 minutes of waking up. Seventy-four percent reach for it immediately after waking up. A quarter of those surveyed could not recall a time during the day that their device was not within reach or in the same room. Another study found that people tend to check their email about every 15 minutes; another found that in 2007 the average knowledge worker opened their email 50 times a day, while using instant messaging 77 times a day—imagine what that might be today, over a decade later, now that smartphones are ubiquitous and given the evidence that we spend more time checking than ever before. So, we check our smartphones constantly. Is that bad? A study of college students at Kent State University found that people who check their phones frequently tend to experience higher levels of distress during their leisure time (when they intend to relax). Similarly, Elizabeth Dunn and Kostadin Kushlev regulated how frequently participants checked their email throughout the day. Those striving to check only three times a day were less tense and less stressed overall. Moreover, checking constantly reduces our productivity. All that checking interrupts us from accomplishing our more important work; with each derailment, it takes us on average about a half hour to get back on track. So why do we check constantly, and first thing in the morning, if it just makes us tense and keeps us from getting our work done? Because it also feels, well…awesome. The Internet and electronic communications engage many of our senses—often simultaneously. All that checking excites our brain, providing the novelty and stimulation it adores. So even though disconnecting from the devices and communications that make us tense and decrease our productivity seems like a logical thing to do, your novelty-and-stimulation-seeking brain won’t want to do it. In fact, it will tell you that you are being more productive when you are online and connected to your messages than when you are disconnected and focusing on something important. This point is worth lingering on: how productive we are does not correlate well with how productive we feel. Multitasking and checking a lot feel productive because our brains are so stimulated when we are doing it. But it isn’t actually productive; one Stanford study showed that while media multitaskers tended to perceive themselves to be performing better, they actually tended to perform worse on every measure the researchers studied. Much of our checking and busyness, to paraphrase Shakespeare, is all sound and fury, no meaning or significance. You can sit all day in front of your computer checking and responding to email but accomplish not one of your priorities. It may feel like a more valuable activity, because it feels more productive. But it is neither. Now that we’ve established the benefits of unplugging and the dangers of checking, here’s how to unplug in a way that will lead to the best weekend EVER. Going unplugged for one day over the weekend will send many people into withdrawal. They will literally experience jitters, anxiety, and discomfort akin to physical pain. If you were in rehab for Opioid addiction, they might give you medication (like Methadone) to ease the pain. Unplugging is like a detox because the symptoms we experience when we stop checking our phones compulsively are uncomfortable; remember, many people would rather receive a painful electric shock than stand the pain of not checking, of not being “productive.” If you need rehab, here’s how to invent your own methadone. The idea is to do something naturally rewarding for your brain to ease the boredom, anxiety, and general twitchiness that tends to descend upon us when we unplug from technology. Unless you are some sort of superhero, you will not be able to cure yourself of your internet/device/email addiction perfectly the first time. So what to do if you’re struggling? 1. Don’t get too emotional about your slip or succumb to selfcriticism. Instead, forgive yourself. Remind yourself that lapses are part of the process, and that feeling guilty or bad about your behavior will not increase your future success. 2. Figure out what the problem is. This may be blazingly obvious, but in order to do better tomorrow, you’ll need to know what is causing your trip-ups. What temptation can you remove? Were you stressed or tired or hungry—and if so, how can you prevent that the next time? 3. Beware the “What the Hell” effect. Say you’ve sworn not to check your email before breakfast, but you’ve been online since your alarm went off…three hours ago. You’re now at risk for what researchers formally call the Abstinence Violation Effect (AVE) and jokingly call the “what the hell effect.” 4. Rededicate yourself to your detox (now, in this instant, not tomorrow). Why do you want to make the changes that you do? How will you benefit? Do a little deep breathing and calm contemplation of your goals. 5. Beware of moral licensing. This is a potential landmine to avoid on your better days: as you notice how well you are doing staying unplugged, don’t let yourself feel so good about the progress you are making that you unleash what researchers call the “licensing effect.” ","[DOCUMENT] Digital Detox Guide Do you check your email, texts, voicemails, Facebook, or Twitter feed within an hour of waking up or going to sleep? While you’re in line at the store? During dinner with your family? Would you check it at a church while waiting for a funeral to start? Do a little thought experiment with me here. Imagine yourself sitting in a public place, not doing anything, just staring into space. How would you feel? Although many of us spent most of our childhoods daydreaming, adulthood seems to be about trying to keeping our minds from wandering, and trying to stay on task. Rarely do we just let ourselves stare into space these days. Look around: We can’t even stand to wait at a stoplight for 10 seconds without checking our smartphones. Why not? Because it’s uncomfortable for us not to be doing anything. At the very least, it’s boring. More than being boring, however, downtime and daydreaming are threatening to our sense of self. If busyness and multi-tasking and being pressed for time can be equated with significance, success, and productivity then downtime and daydreaming must be signs of insignificance, failure, and inefficiency. And when we feel insignificant and unsuccessful, we also tend to feel guilty for not working, ashamed that we aren’t important enough to be doing something, and anxious about our status. In the lab, these emotions are more painful than the actual physical pain of an electric shock. I’m endlessly fascinated by a series of studies led by Tim Wilson where the research subjects were put alone in a room, with nothing to do. The researchers describe their work: In 11 studies, we found that participants typically did not enjoy spending 6 to 15 minutes in a room by themselves with nothing to do but think, that they enjoyed doing mundane external activities much more, and that many preferred to administer electric shocks to themselves instead of being left alone with their thoughts. Most people seem to prefer to be doing something rather than nothing, even if that something is negative. You read that right: Many people (67 percent of men and 25 percent of women, to be exact) actually gave themselves painful electric shocks instead of just sitting there doing nothing–after they had indicated to the researchers that they would pay money NOT to be shocked again. One guy shocked himself 190 times in 15 minutes. When we can’t tolerate the feelings that come up when we aren’t doing anything, or when we can’t tolerate a lack of stimulation, we feel uncomfortable when we have downtime. As a result, we forfeit our downtime and all its benefits by seeking external stimulation, which is usually readily available in our purse or pocket (rather than an electric shock machine). Instead of just staring out the window on the bus, we read through our Facebook feed. Instead of being alone with our thoughts for a minute, we check our email waiting in line at the grocery store. Instead of enjoying our dinner, we mindlessly shovel food in our mouths while staring at a screen. THE BENEFITS OF UNPLUGGING In the grand scheme of things, digital usage rarely leads to meaning or fulfillment. But unplugging for at least one day per week will make you happier (in addition to giving you hours and hours to do the things that bring meaning to your life). Here’s why: 1. Detoxing from social media and digital information promotes overall wellbeing and mental health. Social media use is associated with narcissism, depression, loneliness, and other negative feelings like anger, envy, misery, and frustration. So, it’s hardly surprising that taking a break for a few days can improve our mood and overall happiness. 2. Your sleep will become more restorative, and sleep improves everything from health and happiness to performance and productivity. Physiologically, you’ll have an easier time sleeping because the low-energy blue light emitted by our tablets and smartphones stimulates chemical messengers in our brains that make us more alert and suppresses others (like melatonin) that help us fall asleep. In addition, you’ll have an easier time sleeping because you won’t be exciting your brain with new or stimulating information right efore bedtime. Social media, messages, and email can easily trigger the release of adrenalin, which makes it nearly impossible to fall asleep quickly. And needless to say, the less time it takes you to fall asleep at night, the more time you’ll have in the morning. 3. Bonus: You’ll feel less lonely and more connected, and feeling connected is the best predictor of happiness that we have. Though we think social media makes us feel more connected to others, ironically, it can also make us feel quite alone. Seeing friends and acquaintances post about how happy they are can actually trigger feelings of misery and loneliness, research shows. The benefits of unplugging from time to time are clearly enormous. But if unplugging isn’t undertaken properly, people often experience withdrawal symptoms, like feelings of agitation, guilt, and a compulsive and distracting desire to check our phones. THE SCIENCE OF CHECKING One survey found that 80% of 18 to 44-year-olds check their smartphones within the first 15 minutes of waking up–and that 89% of younger users, those ages 18- 24, reach for their device within 15 minutes of waking up. Seventy-four percent reach for it immediately after waking up. A quarter of those surveyed could not recall a time during the day that their device was not within reach or in the same room. Another study found that people tend to check their email about every 15 minutes; another found that in 2007 the average knowledge worker opened their email 50 times a day, while using instant messaging 77 times a day—imagine what that might be today, over a decade later, now that smartphones are ubiquitous and given the evidence that we spend more time checking than ever before. So, we check our smartphones constantly. Is that bad? A study of college students at Kent State University found that people who check their phones frequently tend to experience higher levels of distress during their leisure time (when they intend to relax). Similarly, Elizabeth Dunn and Kostadin Kushlev regulated how frequently participants checked their email throughout the day. Those striving to check only three times a day were less tense and less stressed overall. Moreover, checking constantly reduces our productivity. All that checking interrupts us from accomplishing our more important work; with each derailment, it takes us on average about a half hour to get back on track. So why do we check constantly, and first thing in the morning, if it just makes us tense and keeps us from getting our work done? Because it also feels, well…awesome. The Internet and electronic communications engage many of our senses—often simultaneously. All that checking excites our brain, providing the novelty and stimulation it adores. So even though disconnecting from the devices and communications that make us tense and decrease our productivity seems like a logical thing to do, your novelty-and-stimulation-seeking brain won’t want to do it. In fact, it will tell you that you are being more productive when you are online and connected to your messages than when you are disconnected and focusing on something important. This point is worth lingering on: how productive we are does not correlate well with how productive we feel. Multitasking and checking a lot feel productive because our brains are so stimulated when we are doing it. But it isn’t actually productive; one Stanford study showed that while media multitaskers tended to perceive themselves to be performing better, they actually tended to perform worse on every measure the researchers studied. Much of our checking and busyness, to paraphrase Shakespeare, is all sound and fury, no meaning or significance. You can sit all day in front of your computer checking and responding to email but accomplish not one of your priorities. It may feel like a more valuable activity, because it feels more productive. But it is neither. Now that we’ve established the benefits of unplugging and the dangers of checking, here’s how to unplug in a way that will lead to the best weekend EVER. Going unplugged for one day over the weekend will send many people into withdrawal. They will literally experience jitters, anxiety, and discomfort akin to physical pain. If you were in rehab for Opioid addiction, they might give you medication (like Methadone) to ease the pain. Unplugging is like a detox because the symptoms we experience when we stop checking our phones compulsively are uncomfortable; remember, many people would rather receive a painful electric shock than stand the pain of not checking, of not being “productive.” If you need rehab, here’s how to invent your own methadone. The idea is to do something naturally rewarding for your brain to ease the boredom, anxiety, and general twitchiness that tends to descend upon us when we unplug from technology. Unless you are some sort of superhero, you will not be able to cure yourself of your internet/device/email addiction perfectly the first time. So what to do if you’re struggling? 1. Don’t get too emotional about your slip or succumb to selfcriticism. Instead, forgive yourself. Remind yourself that lapses are part of the process, and that feeling guilty or bad about your behavior will not increase your future success. 2. Figure out what the problem is. This may be blazingly obvious, but in order to do better tomorrow, you’ll need to know what is causing your trip-ups. What temptation can you remove? Were you stressed or tired or hungry—and if so, how can you prevent that the next time? 3. Beware the “What the Hell” effect. Say you’ve sworn not to check your email before breakfast, but you’ve been online since your alarm went off…three hours ago. You’re now at risk for what researchers formally call the Abstinence Violation Effect (AVE) and jokingly call the “what the hell effect.” 4. Rededicate yourself to your detox (now, in this instant, not tomorrow). Why do you want to make the changes that you do? How will you benefit? Do a little deep breathing and calm contemplation of your goals. 5. Beware of moral licensing. This is a potential landmine to avoid on your better days: as you notice how well you are doing staying unplugged, don’t let yourself feel so good about the progress you are making that you unleash what researchers call the “licensing effect.” [QUESTION] Why is a digital detox so important? [TASK INSTRUCTIONS] Only use the information contained within the provided text to answer the question. Do not use outside sources. Write a full sentence and use a bullet point. Ensure the entire sentence is in italics.",Internet/Technology,Explanation/Definition,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","What does author and professor Vauhini Vara have to say about the role of artificial intelligence and literature? Is it a positive perspective? If so, what is her argument?","If artificial intelligence (AI) continues to evolve and becomes capable of producing first-rate literature, will the technology eventually replace human writers? Author, journalist and professor Vauhini Vara addressed the topic during a recent lecture at The Ohio State University’s Columbus campus. Vara spoke on Dec. 7 at Pomerene Hall as part of Ohio State’s “ART-ificial: An Intelligence Co-Lab” project, which is funded by the university’s Artificial Intelligence in the Arts, Humanities and Engineering: Interdisciplinary Collaborations program. The project included a speaker series throughout the spring and autumn semesters that was organized by Elissa Washuta, an associate professor in the Department of English, and Austen Osworth, a lecturer in the School of Creative Writing at the University of British Columbia. “I think we need to talk at length about what these tools are for and what they’re not for and what they can do and what they can’t do and what writing is for,” Washuta said. “A lot of these things are not immediately apparent to students who are learning about writing for the first time in college. They’re having their first encounters with writing studies in college in composition classes.” In her presentation titled “If Computers Can Write, Why Should We?” Vara discussed her relationship with AI as a writing tool. She has written for The New York Times Magazine and Wired, among other publications. She also teaches at Colorado State University as a 2023-24 visiting assistant professor of creative writing. “In the years ahead, scientists are definitely going to work to make AI better and better and better at producing language in the form of literature,” Vara said. “I have no doubt that writers will, like I did, find it interesting and even moving to experiment with AI in their own work.” Vara is the author of “This is Salvaged,” which was named one of the best books of 2023 by Publisher’s Weekly, and “The Immortal King Rao” (2022), which was a finalist for the Pulitzer Prize and was shortlisted for the National Book Critics Circle’s John Leonard Prize and the Dayton Literary Peace Prize. “The Immortal King Rao,” Vara’s debut novel, imagines a future in which those in power deploy AI to remake all aspects of society — criminal justice, education, communication. AI also figured prominently in Vara’s essay “Ghosts,” about her grief over her older sister’s death. She used GPT-3, an AI technology that evolved into ChatGPT, as a writing tool while composing the essay. “Ghosts” went viral upon its publication in The Believer Magazine in 2021. The essay was adapted for an episode of National Public Radio’s “This American Life” and anthologized in “Best American Essays 2022.” “It was more well-received by far than anything else I’d written at that point. And I thought I should feel proud of that to an extent, and I sort of did,” Vara said. “But I was also ambivalent because even though GPT-3 didn’t share the byline with me, I felt like on an artistic level, I could only take partial credit for the piece.” In addition to casting doubt on writers’ originality, AI may replicate the blind spots of the humans who program the technology, Vara said. “The companies behind AI models were training these models by feeding them existing texts … everything from internet message boards to Wikipedia to published books written by human authors,” she said. “The trainings have been used without the consent of the people who’ve written [the published texts]. It was also becoming clear that the models’ outputs … reflected biases, including racial and gender stereotypes.” Though her experiment with AI resulted in a well-received essay, Vara said she has since returned to writing without technological assistance. However, she continues to explore the potential consequences of AI. “I think it’s important to keep in mind that the publishing industry has an incentive to pursue AI-based writing in some form, being that it will almost certainly be cheaper than hiring human writers or paying human writers to produce literature,” she said. “I do hope that as much as that’s all true, we stay aware as readers, as a society, of what it would mean to cede ground to computers entirely in a form that has traditionally been meant for humans to convey what it’s like to be human living in the world to other humans.” Discussions are underway to continue the “ART-ificial: An Intelligence Co-Lab” project next year, Washuta said. “We’re hoping to see if we can continue our work together,” she said. “I think everybody who’s been involved in the planning and who’s presented has been really energized by the conversations that we’ve had.”","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What does author and professor Vauhini Vara have to say about the role of artificial intelligence and literature? Is it a positive perspective? If so, what is her argument? {passage 0} ========== If artificial intelligence (AI) continues to evolve and becomes capable of producing first-rate literature, will the technology eventually replace human writers? Author, journalist and professor Vauhini Vara addressed the topic during a recent lecture at The Ohio State University’s Columbus campus. Vara spoke on Dec. 7 at Pomerene Hall as part of Ohio State’s “ART-ificial: An Intelligence Co-Lab” project, which is funded by the university’s Artificial Intelligence in the Arts, Humanities and Engineering: Interdisciplinary Collaborations program. The project included a speaker series throughout the spring and autumn semesters that was organized by Elissa Washuta, an associate professor in the Department of English, and Austen Osworth, a lecturer in the School of Creative Writing at the University of British Columbia. “I think we need to talk at length about what these tools are for and what they’re not for and what they can do and what they can’t do and what writing is for,” Washuta said. “A lot of these things are not immediately apparent to students who are learning about writing for the first time in college. They’re having their first encounters with writing studies in college in composition classes.” In her presentation titled “If Computers Can Write, Why Should We?” Vara discussed her relationship with AI as a writing tool. She has written for The New York Times Magazine and Wired, among other publications. She also teaches at Colorado State University as a 2023-24 visiting assistant professor of creative writing. “In the years ahead, scientists are definitely going to work to make AI better and better and better at producing language in the form of literature,” Vara said. “I have no doubt that writers will, like I did, find it interesting and even moving to experiment with AI in their own work.” Vara is the author of “This is Salvaged,” which was named one of the best books of 2023 by Publisher’s Weekly, and “The Immortal King Rao” (2022), which was a finalist for the Pulitzer Prize and was shortlisted for the National Book Critics Circle’s John Leonard Prize and the Dayton Literary Peace Prize. “The Immortal King Rao,” Vara’s debut novel, imagines a future in which those in power deploy AI to remake all aspects of society — criminal justice, education, communication. AI also figured prominently in Vara’s essay “Ghosts,” about her grief over her older sister’s death. She used GPT-3, an AI technology that evolved into ChatGPT, as a writing tool while composing the essay. “Ghosts” went viral upon its publication in The Believer Magazine in 2021. The essay was adapted for an episode of National Public Radio’s “This American Life” and anthologized in “Best American Essays 2022.” “It was more well-received by far than anything else I’d written at that point. And I thought I should feel proud of that to an extent, and I sort of did,” Vara said. “But I was also ambivalent because even though GPT-3 didn’t share the byline with me, I felt like on an artistic level, I could only take partial credit for the piece.” In addition to casting doubt on writers’ originality, AI may replicate the blind spots of the humans who program the technology, Vara said. “The companies behind AI models were training these models by feeding them existing texts … everything from internet message boards to Wikipedia to published books written by human authors,” she said. “The trainings have been used without the consent of the people who’ve written [the published texts]. It was also becoming clear that the models’ outputs … reflected biases, including racial and gender stereotypes.” Though her experiment with AI resulted in a well-received essay, Vara said she has since returned to writing without technological assistance. However, she continues to explore the potential consequences of AI. “I think it’s important to keep in mind that the publishing industry has an incentive to pursue AI-based writing in some form, being that it will almost certainly be cheaper than hiring human writers or paying human writers to produce literature,” she said. “I do hope that as much as that’s all true, we stay aware as readers, as a society, of what it would mean to cede ground to computers entirely in a form that has traditionally been meant for humans to convey what it’s like to be human living in the world to other humans.” Discussions are underway to continue the “ART-ificial: An Intelligence Co-Lab” project next year, Washuta said. “We’re hoping to see if we can continue our work together,” she said. “I think everybody who’s been involved in the planning and who’s presented has been really energized by the conversations that we’ve had.” https://english.osu.edu/alumni-newsletter/winter-2024/role-ai-literature",Internet/Technology,Find & Summarize,Text Transformation Answer the following question using only information from the text included below. You must not utilize any other sources or your own reasoning in your response.,What are some examples of informal financial services?,"Current debates in microfinance 1 1.1 Subsidised credit provision From the 1950s, governments and international aid donors subsidised credit delivery to small farmers in rural areas of many developing countries. It was assumed that poor people found great difficulty in obtaining adequate volumes of credit and were charged high rates of interest by monopolistic money-lenders. Development finance institutions, such as Agricultural Development Banks, were responsible for the delivery of cheap credit to poor farmers. These institutions attempted to supervise the uses to which loans were put, and repayment schedules were based on the expected income flow from the investment. Returns were often overestimated. For example, calculations would be based on agricultural yields for good years (Adams and Von Pischke, 1992). As a result, loans were often not repaid. The credibility and financial viability of these subsidised credit schemes were further weakened by the use of public money to waive outstanding and overdue loans at election time (Adams and Von Pischke, 1992; Lipton, 1996; Wiggins and Rogaly, 1989). A dependence on the fluctuating whims of governments and donors, together with poor investment decisions and low repayment rates made many of these development finance institutions unable to sustain their lend- ing programmes. Credit provision for poor people was transitory and limited. 1.2 The move to market-based solutions This model of subsidised credit was subjected to steady criticism from the mid-1970s as donors and other resource allocators switched attention from state intervention to market-based solutions. Policy-makers were reminded 5 Microfinance and Poverty Reduction that credit could also be described as debt and that the over-supply of subsidised credit without realistic assessment of people's ability to repay could result in impoverishment for borrowers. At the same time the concept of 'transaction costs', and the notion that full information about borrowers was not available to lenders, were used by the opponents of subsidised credit to justify the high interest-rates charged by money-lenders. Lending money carries with it the risk of non-repayment. In order to know who is creditworthy and who is not, and so reduce this risk, the lender screens potential borrowers. This involves gathering information on the circumstances of individuals, which may not be easy to obtain. Then enforcement costs are incurred to ensure repayment. Through this process risks are reduced, though not eliminated. Where a loan is disbursed on condition that it is used for a particular purpose, supervision costs also arise. Using these tools of analysis it was argued that private money-lenders charged interest rates which were higher than formal bank-rates because of the high costs they faced in terms of risk, particularly when lending without physical collateral. At the same time, it was argued that money-lenders were an efficient source of credit because their greater knowledge of the people to whom they were lending lowered screening costs. Moreover, potential borrowers faced high transaction costs when they sought loans from formal-sector finance institutions. These costs included the time, travel, and paperwork involved in obtaining credit, and were often pro- hibitive for poor clients, especially those most geographically isolated. On the basis of this analysis, a group of economists based at Ohio State University (USA), notably Dale Adams and J D Von Pischke, put forward the view that the provision of credit should be left almost entirely to the private sector. In concentrating on the problems of publicly subsidised credit, these economists ignored the social ties, power relations, and coercion associated with the activities of money-lenders. However, detailed micro-level research has demonstrated the widespread use of interlocked' contracts to force exchange to the disadvantage of poor people (Bhaduri, 1981). Powerful local people, including landlords, employers, and traders, are able to influence the terms of loans made to tenants, workers, and small producers via conditions set in transactions involving land, labour, or crops. For example, traders frequently lend working capital to small farmers on condition that their crops are sold to that trader at a pre-determined price. Similarly, loans are made to workers against the promise of labour to be provided at below the going rate at a set future date (Rogaly, 1996b). Against the background of these debates, recent developments in the design of microfinance schemes have generated an understandably high degree of excitement. This is because innovative features in design have 6 Current debates in microfinance reduced the costs and risks of making loans to poor and isolated people, and made financial services available to people who were previously excluded. 1.3 Making use of social collateral There was little knowledge among formal-sector financial intermediaries of alternatives to physical collateral, until the 1970s, when the Grameen Bank in Bangladesh began using 'peer-group monitoring' to reduce lending risk. The model for credit delivery in the Grameen Bank is as follows: • Groups of five self-select themselves; men's and women's group are kept separate but the members of a single group should have a similar economic background. • Membership is restricted to those with assets worth less than half an acre of land. ⚫ Activities begin with savings of Taka 1 per week per person and these savings remain compulsory throughout membership. • Loans are made to two members at a time and must be repaid in equal instalments over 50 weeks. . Each time a loan is taken the borrower must pay 5 per cent of the loan amount into a group fund. • The group is ultimately responsible for repayment if the individual defaults. • Between five and eight groups form a 'development centre' led by a chair- person and secretary and assisted by a Grameen Bank staff member. • Attendance at weekly group and centre meetings is compulsory. • All transactions are openly conducted at centre meetings. • Each member may purchase a share in the Bank worth Taka 100 Through this system the Grameen Bank has provided credit to over 2 million people in Bangladesh (94 per cent women) with a very low default rate. (Source: Khandker, Khalily and Khan, 1995.) However, peer-group monitoring has not proved necessary to other instit- utions seeking to do away with physical collateral. In Indonesia, government- sponsored banks have successfully used character references and locally- recruited lending agents (Chaves and Gonzales Vega, 1996). The peer-group 7 Microfinance and Poverty Reduction method of Grameen and the individual-user approach of the Bank Rakyat Indonesia (see 1.4) can both be seen as attempts to lower screening costs by using local 'insider' information about the creditworthiness of borrowers. The degree to which Grameen Bank employees themselves implement peer-group monitoring has recently been questioned. It is argued that the reason for the Grameen Bank's high repayment rates is the practice of weekly public meetings at which attendance is compulsory, for the payment of loan instalments and the collection of savings. The meetings reinforce a culture of discipline, routine payments, and staff accountability (Jain, 1996). Another means of improving loan recovery is to insist on regularity of repayment. This is likely to reflect the actual income-flow of the borrower much better than a lump-sum demand at the end of the loan period. Borrowers can make repayments out of their normal income rather than relying on the returns from a new-often untested-mini-business. Neverthe- less, where seasonal agriculture is the main source of income, and borrowers face seasonal hardship, regular repayment scheduling may cause problems. Microfinance specialists have argued that the prospects for scheme's stability are improved by innovations such as social collateral and regular repayments instalments. Indeed, financial sustainability has become an important goal in itself. To achieve sustainability, microfinance institutions, be they NGOs, government agencies, or commercial banks, need to ensure that the costs of providing the service are kept low and are covered by income earned through interest and fees on loans (see Havers, 1996). As microfinance deals, by definition, with small loans, the income generated through interest payments is also small in comparison with administration costs. To generate profits, therefore, it is necessary to increase scale - in other words, to lend to a large number of people (Otero and Rhyne, 1994). 1.4 Savings The regular repayments on loans required by large non-governmental micro- finance institutions in Bangladesh (including BRAC, ASA and Grameen) provide evidence that poor people can save in cash (Rutherford, 1995a). These intensive repayment regimes are very similar to those of rotating savings and credit associations: steady weekly payments, enforced by social collateral, in return for a lump sum. Loans made are, in reality, advances against this stream of savings. By insisting on regular savings, microfinance institutions can screen out some potential defaulters, build up the financial security of individuals, increase funds available for lending, and develop among members a degree of identification with the financial health of the institution. People involved in 8 Current debates in microfinance such schemes may previously have been unable to reach formal-sector banks, complete their procedures, qualify for loans or open savings accounts. 'A savings facility is an extremely valuable service in its own right, which often attracts many more clients than a credit programme, particularly from among the poorest' (Hulme and Mosley, 1996, p147). This evidence that poor people can save in cash has opened up further debate. A distinction is made between schemes in which borrowers must save small and regular amounts in order to obtain loans (termed 'compulsory' saving) and those which offer flexible savings facilities. In the latter case people can deposit and withdraw cash in whatever amounts, and as often, as they wish. This distinction is made especially strongly by Robinson (1995) in her account of the Bank Rakyat Indonesia. The BRI local banking system has about six times as many deposit accounts as loans. On 31 December 1993, BRI's local banking system had $2.1 billion in deposits. These were all voluntary savings. By 31 December 1995, there were 14.5 million savings accounts. Savers with BRI bave access to savings whenever they want. BRI deals with individuals rather than groups. Its savings programme was designed specifically to meet local demand for security, convenience of location, and choice of savings instruments offering different mixtures of liquidity and returns. BRI's local banking system has a loan limit of about $11,000. The idea is that good borrowers should not be forced to leave until they can qualify for the loans provided by ordinary commercial banks. In addition, BRI has a system which gives its borrowers an incentive to repay on time. An additional 25 per cent of the interest rate is added to the monthly payment. This amount is paid back to borrowers at the end of the loan period if they have made every payment in full and on time. There is a corresponding in-built penalty for those who have not. (Source: Robinson, 1994.) Robinson argues that there is an enormous unmet demand for flexible savings services. However, she also warns that managing a savings system of this type is much more complex than running a simple credit programme. Schemes which operate under these 'new' savings and credit technologies are an improvement on the old model of subsidised agricultural and micro- enterprise finance. The story of how they have succeeded in reaching poor people is now the subject of a large literature (for example, Rutherford, 1995b; Hulme and Mosley, 1996; Mansell-Carstens, 1995). That many more poor people can now obtain financial services is a major achievement of these 9 Microfinance and Poverty Reduction schemes. However, the questions of which poor people have been reached, and of whether poverty has been reduced, still remain. 1.5 Can microfinance interventions reduce poverty? If poverty is understood as low levels of annual income per household, reducing poverty is about raising average income levels. If a particular level of annual income per head is used as a poverty line, poverty reduction could be measured by counting the number or proportion of people who cross that line-who are promoted out of poverty. Providers of financial services who aim to enable people to cross such a poverty line have focused on credit, in particular credit for small enterprises, including agricultural production. However, attention to annual income can obscure fluctuations in that income during any given year. Poverty can also be understood as vulner- ability to downward fluctuations in income. Such fluctuations can be relat- ively predictable, such as the seasonal decline in employment for agricultural workers, or a shortage of income and trading opportunities in the dry season or before harvest. Alternatively, fluctuations in income may result from unexpected shocks such as crop failure, illness, funeral expenses or loss of an asset such as livestock through theft or death, or a natural disaster such as a cyclone (Montgomery, 1996). Vulnerability can be heightened by the lack of saleable or pawnable assets and by debt obligations. Interventions which reduce such vulnerability and protect livelihoods also reduce poverty. 1.5.1 Poverty as powerlessness A further dimension of poverty which is often the focus of NGO interventions is powerlessness, whether in an absolute sense or in relation to others. Economic inequality between and within households is likely to be associated with concentrations of political and social power. Inequality can increase whenever better-off people are able to improve their incomes faster than others. Even if the absolute level of material well-being of the worst-off people does not change, relative poverty (Beck, 1994) may increase, and with it a sense of powerlessness among very poor people. Power relations are partly determined by norms of expected behaviour. Neither the relations nor the norms are static; they are contested and change over time. Powerlessness can be experienced in a variety of situations: within the household, as a result of differences in gender and age; and within the community, between socio-economic groups, as a result of caste, ethnicity, and wealth. Defining poverty in terms of power relations implies that assessment of the impact of microfinance interventions should focus on their 10 Current debates in microfinance influence on social relations and the circumstances which reproduce them. Even in a similar geographical and historical context, it is important to disting- uish between the ways in which specific groups of poor people (women and men, landed and landless, particular ethnic groups) are able to benefit from financial services or are excluded from doing so. 1.5.2 Credit for micro-enterprises While there are methodological difficulties involved in measuring increases in incomes brought about by the provision of credit (see further discussion in Chapter 5), studies have demonstrated that the availability of credit for micro- enterprises can have positive effects. A recent survey collected data from government, NGOs, and banks involved in providing financial services for poor people. Twelve programmes were selected from seven countries (six of these are included in Table 1, Annex 1). Households which had received credit were compared with households which had not. The results demon- strated that credit provision can enable household incomes to rise. However, taking the analysis further, Hulme and Mosley demonstrated that the better-off the borrower, the greater the increase in income from a micro- enterprise loan. Borrowers who already have assets and skills are able to make better use of credit. The poorest are less able to take risks or use credit to increase their income. Indeed, some of the poorest borrowers interviewed became worse off as a result of micro-enterprise credit, which exposed these vulnerable people to high risks. For them, business failure was more likely to provoke a livelihood crisis than it was for borrowers with a more secure asset base. Specific crises included bankruptcy, forced seizure of assets, and unofficial pledging of assets to other members of a borrowing group. There have even been reports of suicide following peer-group pressure to repay failed loans (Hulme and Mosley, 1996, pp120-122). A much smaller survey comparing micro-enterprise programmes in El Salvador and Vanuatu found that the development of successful enterprises and the improvement of the incomes of very poor people were conflicting rather than complementary objectives. By selecting those most likely to be successful for credit and training, the programmes inevitably moved away from working with the poorest people (Tomlinson, 1995). Reviews of Oxfam's experiences with income-generating projects for women raised serious questions about the profitability of such activities. Full input costings, which would have revealed many income-generating projects as loss- making, were not carried out. Omissions included depreciation on capital, the opportunity cost of labour (the earnings participants could have had through spending the time on other activities), and subsidisation of income- 11 Microfinance and Poverty Reduction generating projects with income from other sources. Market research and training in other business skills had often been inadequate (Piza Lopez and March, 1990; Mukhopadhyay and March, 1992). 1.5.3 Reaching the poorest Whether income promotion is based on loans for individual micro-enterprises or on group-based income generation projects, its appropriateness as a strategy for poverty reduction in the case of the poorest people is questionable. Other evidence suggests that self-selected groups for peer-monitoring have not been inclusive of the poorest people (Montgomery, 1995). People select those with whom they want to form a group on the basis of their own know- ledge of the likelihood that these people will make timely payment of loan and savings instalments: X will only have Y in her group if she believes Y is capable of making regular repayments and has much to lose from the social ostracism associated with default. This system might well be expected to lead to the exclusion of the poorest (Montgomery, op. cit.). Even the low asset and land-holding ceiling which the big microfinance institutions in Bangladesh have successfully used to target loans away from better-off people has not necessarily meant that the poorest, who are often landless, are included (Osmani, 1989). So while the innovations referred to earlier appear to have made loans more available to poor people, there is still debate over the design of appro- priate financial services for the poorest. Hulme and Mosley's study strongly suggests that providing credit for micro-enterprises is unlikely to help the poorest people to increase their incomes. However, detailed research with users has found that some design features of savings and credit schemes are able to meet the needs of very poor people. For example, it was found that easy access to savings and the provision of emergency loans by SANASA (see 3.4.2) enabled poor people to cope better with seasonal income fluctuations (Montgomery, 1996). Microfinance specialists increasingly, therefore, view improvements in economic security income protection rather than promotion (Dreze and Sen, 1989) as the first step in poverty reduction. ...from the perspective of poverty reduction, access to reliable, monetized savings facilities can help the poor smooth consumption over periods of cyclical or unexpected crises, thus greatly improving their economic security.' It is only when people have some economic security that 'access to credit can help them move out of poverty by improving the productivity of their enterprises or creating new sources of livelihood' (Bennet and Cuevas, 1996, authors' emphasis). Current debates in microfinance 1.6 Financial interventions and social change Interventions have an impact on social relations partly through their econ- omic effects. In many instances implementors of credit schemes have claimed that the work will lead to progressive social change, for example by empow- ering women and changing gender relations in the household and in the community (Ackerly, 1995). In five out of the six schemes summarised in Table 1 (Annex 1), over half of the borrowers were women. Much of the work that has been done in assessing the impact of credit programmes on women has been in Bangladesh. One approach was to look at the control women retained over loans extended to them by four different credit programmes: the Grameen Bank, BRAC, a large government scheme (the Rural Poor Programme RD-12), and a small NGO (Thangemara Mahila Senbuj Sengstha) (Goetz and Sen Gupta, 1996). Results suggested that women retained significant control over the use to which the loan was put in 37 per cent of cases; 63 per cent fell into the categories of partial, limited or no control over loan use. Goetz and Sen Gupta found single, divorced, and widowed women more likely to retain control than others. Control was also retained more often when loan sizes were small and when loan use was based on activities which did not challenge notions of appropriate work for women and men. The question of whether women were empowered is not answered: even when they did not control loans, they may have used the fact that the loan had been disbursed to them as women to increase their status and strengthen their position in the household. However, in some cases women reported an increase in domestic violence because of disputes over cash for repayment instalments. A second major piece of research has assessed the effect of Grameen and BRAC programmes on eight indicators of women's empowerment: mobility, economic security, ability to make small purchases, ability to make larger purchases, involvement in major household decisions, relative freedom from domination by the family, political and legal awareness, and participation in public protests and political campaigning (Hashemi et al, 1996). The study concludes that, on balance, access to credit has enabled women to negotiate within the household to improve their position. However, unlike the Goetz and Sen Gupta study, which is based on 275 detailed loan-use histories, Hashemi et al attempted to compare villages where Grameen or BRAC were present with villages where they were not. Because of difficulties inherent in finding perfect control villages (which the authors acknowledge), the conclusions of the study do not signify the end of the debate. It has also been argued that focusing on women is much more to do with financial objectives than with the aim of empowerment. According to 13 Microfinance and Poverty Reduction Rutherford (1995b) the real reasons for targeting women in Bangladesh are that they are seen as accessible (being at home during working hours); more likely to repay on time; more pliable and patient than men; and cheaper to service (as mainly female staff can be hired). Thus the process of loan supervision and recovery may be deliberately internalised inside the household (Goetz and Sen Gupta, op. cit.). Goetz and Sen Gupta do not use this as an argument against the provision of finance for women in Bangladesh, but rather suggest that to avoid aggravating gender- based conflict, loans should be given to men directly as well as to women and, at the same time, that efforts should be made to change men's attitudes to women's worth. 1.7 Treading carefully in microfinance interventions This brief summary of evidence and argument suggests that microfinance interventions may increase incomes, contribute to individual and household livelihood security, and change social relations for the better. But that they can not always be assumed to be doing so. Financial services are not always the most appropriate intervention. The poorest, in particular, often face pressing needs in terms of primary health care, education, and employment opportunities. Lipton has recently argued for anti-poverty resources to be allocated across sectors on the basis that a concentration on a single interven- tion mechanism, say credit, is much less effective in poverty reduction than simultaneous credit, primary health, and education work, even if this entails narrowing geographical focus (op. cit.). The particular combinations which will be most effective will depend on the nature of poverty in a specific context. Although microfinance provision appears to be evolving towards greater sustainability, relevance, and usefulness, there are few certainties and the search for better practice continues. Decisions on whether and how to intervene in local financial markets should not be taken without prior knowledge of the working of those markets. If the intervention is intended to reduce poverty, it is especially important to know the degree to which poor people use existing services and on what terms. Only then can an intervening agency or bank make an informed decision on whether their work is likely to augment or displace existing 'pro-poor' financial services. If the terms of informal financial trans- actions are likely to work against the interests of poor people (cases in which the stereotype of 'the wicked money-lender' corresponds to reality) the inter- vention may attempt to compete with and possibly replace part of the informal system. However, making such an informed assessment is not straight- forward, as one study of the power relations between informal financial 14 Current debates in microfinance service providers and agricultural producers in Tamil Nadu demonstrated. Grain merchants based in the market town of Dindigul were found to dictate the terms of product sale when lending working capital to very small-scale farmers, but to be much the weaker party when lending to larger-scale farmers (Rogaly, 1985). The structure of a credit market can change, partly under the influence of outside intervention. Rutherford has studied the changing market in financial services for poor people in Bangladesh. Competition between NGOs is leading to users being less subservient to NGO staff and protesting about unpopular financial obligations, such as the 5 per cent deducted from loans by Grameen for a 'group fund'. Private individuals have set up offices imitating the Grameen style but charging higher interest rates on loans than the big NGOS, and also offering higher rates on savings deposits. Private urban finance companies have expanded. Despite the tendency for NGOs to become more like banks, other formal-sector lenders are still reluctant to lend to poor people (see also McGregor, 1994). The expansion of NGO credit in Bangladesh has been made possible by the flood of donor money to that country. One study of BRAC showed that loan disbursal and recovery had become more important than group forma- tion (Montgomery, 1996). In 1992, Grameen Bank and BRAC employees were found to be offering 'immediate loans' to women in villages where smaller NGOs had been attempting longer-term group-based finance (Ebdon, 1995). Ebdon attributed this behaviour to fairly strict targets for loan disbursal in the case of BRAC, and in both cases to an imperative for job security for staff and a desire on the part of the organisations to expand their influence and strengthen their reputations (p52). This anxiety to increase the number of users can undercut the very basis of the new model: the creation of sustainable financial institutions. Studies of credit schemes have consistently demonstrated that unless borrowers and savers believed they would benefit from the long-term survival of the institution, and have a sense of ownership, repayment rates would decline (Rogaly, 1991; Copestake, 1996a). The sense of ownership is weakened by attempts by large microfinance institutions in Bangladesh to claim territory by encroachment. In India, in the absence of equivalent flows of external finance, thrift and credit co-operatives based much more on borrowers' requirements have emerged (Rutherford, 1995b, p136). An understanding of the way in which the institutions themselves change and respond to incentives is therefore necessary for the design of relevant anti-poverty interventions, including financial services. 15 2 Informal financial services 2.1 Introduction In recent years research into informal financial services and systems has significantly deepened understanding of the way they operate and their strengths and weaknesses. A simplistic belief that local money-lenders charged extortionate interest rates lay behind the provision of subsidised finance in the past. More thorough investigation has highlighted a range of savings, credit, and insurance facilities accessible to poor people. The appar- ently usurious interest charges reportedly made by private money-lenders may be explainable in terms of transaction costs, lack of information, and high risk. Informal financial services may be well-equipped, because of local 'insider' knowledge, and lower overheads, to respond to the requirements of poor people; they may also be exploitative. This chapter starts with a brief overview of the types of informal services that have been found to exist in a wide variety of countries and social contexts. Some of the broad characteristics of these services are identified, and lessons drawn for the design of NGO or semi-formal systems. In describ- ing informal financial services it is useful to distinguish between those which are owned by their users and those which are offered by an individual, usually on a profit-making basis. The distinction can be a helpful one in analysing the ways in which financial services enable or exploit poor people. NGOs considering microfinance interventions need first to find out what informal financial services are available, and how they operate. Such services are capable of supporting poor people's livelihoods as well as perpetuating 1 This chapter draws heavily on a background paper commissioned for the purposes of this book: A Critical Typology of Financial Services for the Poor, Stuart Rutherford, November 1996. Examples are drawn from Rutherford's own experience unless otherwise stated. 16 Informal financial services structures which undermine them. It is necessary, therefore, to understand under what circumstances and to what degree these services are enabling or exploitative for poor people. On the whole, user-owned services are likely to be more enabling than services provided for profit. Investigating the scope and nature of existing services is an essential pre- liminary before considering whether an intervention is necessary. However, NGOs themselves may not have the right skills to become direct providers of financial services. Furthermore, financial services are needed by poor people on a permanent basis to enable them to plan and manage their finances; NGO programmes which might be here today and gone tomorrow may be an inap- propriate means through which to provide them. Therefore NGOs should seriously consider whether direct intervention is in fact the best response for them to make. The chapter closes by discussing alternative strategies NGOs might employ. 2.2 User-owned informal financial services Systems which facilitate financial transactions and are owned by their users are many and varied, and range from simple reciprocal arrangements between neighbours, savings clubs and rotating savings and credit associa- tions (ROSCAS), to forms of insurance, building societies, and systems of co- operative business finance. An example of each of these types is described below. All of these systems can be found in a variety of country settings. Rotating savings and credit associations (ROSCAS) in particular, are an extremely common phenomenon. They exist in almost every country (for example, 'partners' in Jamaica and Britain, bui in Vietnam, and njangi in Cameroon). (See Bouman, 1995; Ardener and Burman, 1995 for detailed and extensive surveys of ROSCA operations in a range of settings.) The principle is very simple: a number of people agree to save a fixed amount of money at regular intervals; at each meeting, for example weekly, each member contri- butes an agreed amount, resulting in a single lump sum becoming available, which is then allocated to one of the members. There are three basic varia- tions in the way in which this lump sum or 'prize' is allocated. First, it can be allocated on the basis of strict rotation between members of the group; second, on the basis of a lottery of members; third, it may be auctioned to the member who is willing to accept the biggest discount. The group will usually meet (but does not always need to) and undertake this transaction on as many occasions as there are members of the group, thus ensuring that each member gets the 'prize' once. The ROSCA demonstrates the basic principle of financial intermediation: collecting many small savings from many people, turning this into a lump sum for one person, and repeating this procedure over time. 17 Microfinance and Poverty Reduction ROSCA finance is used for many purposes. Some ROSCAS operate to enable an asset to be purchased, such as a rickshaw or fishing equipment for each member, and may have been set up specifically for the purpose. 'Merry- go-rounds', as ROSCAS are called among Kikuyu women in Kenya, are sometimes used by women as a means of accumulating enough money to buy new household utensils or clothes. The technology of the ROSCA is not unique to poor communities but is also used by salaried professionals to purchase major consumption items or assets such as refrigerators or cars. A further example of a user-owned device is the insurance fund which makes pay-outs conditional on certain circumstances occurring. These are int- ended to cover large expenses such as those connected with marriage or death. 2.2.1 Some examples of user-owned financial services Neighbourhood reciprocity in Southern India Reciprocal lending may be extended to involve several or even all the members of a community. Among Moslems in Kerala State in southern India kuri kalyanam are invitations to a feast to which the guest is expected to bring a cash gift. When the host in his turn is invited to a feast by one of the guests he is expected to return double the amount (less if he is perceived as poor). In Vietnam one kind of hui (a generic name for various financial devices) involves a similar pooling of resources for one person on one occasion to be reciprocated later by others, at different times. Rickshaw ROSCAS in Bangladesh Very poor men driven by poverty from their home villages to the Bangladesh capital, Dhaka, often earn a living there by driving bired rickshaws. In the last ten years they have begun to run ROSCAS. A group of drivers forms, and each driver saves a set amount from his daily takings. When the fund is large enough (this usually takes about 15 days) a rickshaw is bought and distributed by lottery to one of the members. In between prizes' the cash is held by a trustworthy outsider, usually a local shopkeeper from whom the members buy their tea or cigarettes. In a further adaptation, those who have already received their rickshaw double their daily contribution. This progressively reduces the time-gap between prizes, and is seen as a fair way of rewarding those members who win the lottery late in the cycle, because their gross contribution is smaller than earlier winners. The extra payment made by the winners is roughly equivalent to what they save by no longer having to hire a rickshaw. 18 An accumulating savings club in Mexico Informal financial services In towns and villages in Mexico neighbours place frequent but irregular savings with trusted shopkeepers. Just before Christmas, the cash is returned to the saver. No interest is paid, but the saver has a lump sum to spend, and the shopkeeper has had the use of the money over the year and can now look forward to a good sales season. Building societies for the middle classes in Bangladesh In a lower-middle-class area of Dhaka, 165 employees in the Public Works Department belong to their own building society' which was started over 16 years ago. Each saves 200 taka ($5) a month out of his wages. As the cash accumulates it is lent out to members, who buy land and building materials. Interest rates are high and interest on the out- standing balance has to be paid each month, to encourage modest loans and rapid repayment. But loan sizes are generous and such workers would have few or no alternative sources for loans of this kind. Popular insurance: funeral funds (iddir) in Ethiopia Originally burial societies, iddir have extended to provide a wide range of insurance services in urban Ethiopia. Aredo (1993), study- ing these in Addis Ababa, estimated that 50 per cent of urban house- holds were members of some kind of iddir. Groups of people come together on the basis of location, occupation, friendship or family ties. Each iddir sets its own rules and regulations but usually pays out for funeral expenses or financial assistance to families of the deceased, and sometimes to cover other costs, such as medical expenses and losses due to fire or theft. 2.3 Informal financial services for profit Those offering informal financial services for profit fall into two groups: deposit takers (often also called money-guards) and lenders. What is most interesting about the situation of deposit takers is that, as in the Nigerian example below, savers usually pay for the service by obtaining a negative interest rate on their funds. This demonstrates the pressing need that people have for places to put their savings which are safe and secure not only from physical risks such as theft, fire or flood, but also from the demands of their family. For women, in particular, the ability to save small amounts in places to which their husbands and families cannot gain access (although they might know about them) has been shown to be particularly important. It may enable them to meet obligations in the family or household, such as the payment of children's school fees, for which they have particular responsibility. 19 Microfinance and Poverty Reduction Forms of lending also operate in a variety of ways, such as money-lenders; pawnbrokers, who take collateral in the form of physical assets; and forms of trade credit and hire purchase. The term 'money-lender' can cause confusion because it conjures up the image of a class of people whose main source of income is usury. In reality, many small farmers, for example, obtain credit from employers, landlords, traders, relatives, and other people who combine a number of economic activities. In some places money-lenders may be a more professionalised class, such as the Tamilians' in Cochin described below, but even in this case it is not necessarily their main source of income. Lending money can be exploitative of, as well as enabling for, poor people. People facing seasonal shortages may have only one source of credit, for example, an employer. The employer may agree to provide a loan, but only if the borrower promises to work when required at below the going wage-rate. As described below for Indonesia, crop traders may provide producers with seasonal credit on the understanding that the crop is sold through the same trader at low post-harvest prices. Tied credit of this type, whether in cash or kind, may be the only means of survival for poor people. But arrangements such as these can maintain and even exacerbate inequalities in power and position. In contrast, user-owned devices are likely to be more supportive and enabling, because the profits made are pooled, and shared or fed back into the system, and ownership and control of the funds are in the hands of the users. Such devices are unlikely to be exploitative of those involved, although they may widen inequalities between users and non-users. The comparison with services for profit is clear. However, loans from private lenders after harvest may enable small traders to make the most of the increased liquidity in the local economy. This emphasises the need for interveners to understand the workings of real markets and to question untested assumptions. It is essential to find out for which groups of poor people-women, men, landless labourers, subsistence farmers, migrant workers and under what circumstances these arrange- ments may be no more than a means of survival, while supporting wealth creation for others. 2.3.1 Some examples of informal financial services provided for profit Deposit takers: a mobile alajo in Nigeria One consequence of Nigeria's current political difficulties is a drop in public confidence in formal banks, according to Gemini News. This has allowed an old tradition to flourish again- alajos, or peripatetic deposit takers. Idowu Alakpere uses a bicycle to go 20 Informal financial services door-to-door round the outer suburb of Lagos where he lives. He has 500 customers who each save about 10 or 15 naira with him (about 50 to 75 cents US) at each daily visit. Customers withdraw money whenever they like, and Idowu charges them one day's savings per month, which he deducts from the withdrawal. Since deposits are made evenly over the month, the negative interest rate for one-month deposits is 1/15, or 6.6 per cent a month, an Annual Percentage Rate (APR) of 80 per cent. Some alajos, including Idowu, store the cash in a reliable bank, others use it to make loans. The Gemini News reporter was told by many local people that they trusted these alajos more than banks. When it was pointed out that some alajos are dishonest, they retorted that so are many banks. Professional money-lenders in Cochin, India 'Tamilians' provide a money-lending service to poor slum dwellers on a daily basis. They have set terms, which are well-known all over Cochin. For each 100 rupees lent, 3 rupees are deducted at source as a fee. Thereafter, 12.50 rupees per week must be repaid for ten weeks. This works out at an APR of 300 per cent (28 rupees paid on an average size loan of 48.50 rupees [97/2) for 10/52 of a year). Most non-poor observers regard this rate as outrageously exploitative. However, poor users of the service tend to take a favourable view of it. The 'Tamilians' do not needlessly harass their clients over repay- ment but take an 'understanding' view which includes a willingness to accept loan losses. These money-lenders know their clients well and (out of self-interest) will not lend more than they think the client can repay out of normal income over the next ten weeks. Lending against collateral: pawnbrokers in Western India Residents of the slums of Vijayawada use their local pawnbroker when they need money quickly. He is reliably available at his gold- smithing shop and he charges 3 per cent a month for loans pledged against gold, 5 per cent for silver and 9 per cent for brass. The inclu- sion of brass means that even the very poor can get a small advance by pawning kitchen pots and pans. He lends up to two-thirds the value of the pawn. He gives a receipt, and because the borrower can be sure of getting her pawn back when she repays the loan, she can risk pawning objects of sentimental value. Unlike those who lend without collateral the broker does not need to know his clients well: the unambiguous collateral provided by the pawn means that the broker can lend to more or less anyone at any time. 21 Microfinance and Poverty Reduction Advance crop sales in Indonesia A practice common in many countries is known as ijon in some areas of Indonesia. Farmers often need cash to get them through the 'bungry' season when their main crop is in the ground and there is not much else to do except sit and wait. They are forced to make an advance sale of the crop, usually to a grain buyer or his agent. Ijon transactions of this sort, if seen as loans, show an interest rate of anything from 10 to 40 per cent a month. (Source: Bouman and Moll in Adams and Fitchett, 1992.) Two examples of trade credit In many markets it is common to see poor people squatting on the ground with a small amount of fertiliser spread out on a mat. The fertiliser doesn't necessarily belong to the man or woman (or, often, child). Lacking capital themselves to buy stock, such people obtain the fertiliser on credit from a nearby shop. At the close of the market they return the money from sales and any balance of the stock to the shopkeeper, retaining a small proportion of the money. The system allows people to trade (safely if not profitably) without capital, and gives the shopkeeper a cheap extra outlet. The dadon credit system used to finance prawn cultivation in Bangladesh is an example of a trading system in which credit is passed on through a chain of intermediaries between the prawn farmer and exporters to Europe. The prawn market is a highly com- petitive business in which everyone in the chain is short of capital. The 'commission agent' at the port buys prawns on behalf of the exporters in the capital. To ensure their share of the market they provide credit early in the season which finds its way through a number of intermediaries before reaching the hands of the farmer. The intermediaries are 'depot' owners, then farias', or merchants, and finally local traders, who in turn lend to the farmers. In accepting the credit the farmer commits himself to selling exclusively to this particular trader. 2.4 Turning the informal into the formal In some countries such informal systems have evolved into formal systems which have had a major impact on their users. In the UK, for example, 'mutual' or friendly societies which began as small thrift groups in the nineteenth century turned into building societies in the first half of the twentieth, and have been the main source of housing finance for 50 years. Informal financial services There are further examples of such informal systems becoming increas- ingly formalised. Aredo (1993) reports that the iddir in Addis Ababa run by the Ethiopia Teachers' Association is of the scale of a medium-size insurance business. In Cameroon some of the traditional ROSCAS known as njangi have evolved into small banks offering finance for small businesses which have difficulty using formal banks (Haggblade, 1978). ROSCAS may thus be a transitional phenomenon. Chit funds in India are a formalised version of a ROSCA, for which govern- ment legislation exists. In contrast to the ROSCA, members of the chit fund do not normally know each other and are merely customers of the chit companies. The company advertises for and selects members, makes arrange- ments for collection of subscriptions, and holds auctions for the prizes. However, such funds are of limited use to poor people, who lack both the income to pay subscriptions and the social position to gain the confidence of the company. The transition to formalised services is not inevitable. Informal and formal arrangements continue to exist side-by-side even in industrialised countries. In Oxford, UK, ROSCAS have enabled people with very limited capital of their own to increase their chances of obtaining a small business loan (Srinivasan, 1995). A detailed comparative study of credit use among low-income Pakistani, Bangladeshi, and Carribean immigrants in the UK revealed enormous differ- ences in their use of financial services. In all cases sources of credit were class- ified into high-street credit, local commercial credit, mail order, social fund, community-based credit, and 'miscellaneous' (including friends, family, and employer). Unlike the Bangladeshis, the Pakistani and Carribean respond- ents reported community-based, ROSCA-like arrangements. Bangladeshi respondents made much more use of formal bank credit than the others, although they had at least as high a proportion of applications rejected, apparently on racial grounds (Herbert and Kempson, 1996). Abugre (1994) points out that transition and change can be rapid, discon- tinuous, and turbulent rather than smooth and linear. There is therefore likely to be a multiplicity of arrangements, some of which become formalised, while others die out, and yet others are initiated. The implication for those interested in providing financial services is that such a role must be carefully thought through, and be flexible and responsive to changing circumstances. 2.5 What can be learned from informal finance? Having briefly explored the range of financial services which may exist, it is clear that informal finance is a regular feature of poor people's lives. What can be learned from this? The continuation of a large number of different forms suggest the following points (partly adapted from Adams, 1992). 23 Microfinance and Poverty Reduction There is clearly a demand for financial services The range of informal financial services available partly reflects the varied requirements which people, both rich and poor, have for financial services. They may also be explained in terms of the actions of people with excess cash seeking to earn income from lending. In some cases, especially where there is a monopoly, or collusion among providers, this can be exploitative for the borrower. Informal services available include savings facilities, provision of credit for consumption, and funding for predictable but expensive events such as marriages and funerals. This is in significant contrast to the services that NGOs have generally offered, which have usually been limited to the provision of credit for production. Transaction costs are low. Transaction costs are the costs, other than interest payments, which are incurred in making a deposit or taking a loan. They include travel, time away from other activities, related 'gifts' which might have to be offered to bank or government officials, costs in obtaining documenta- tion required, such as land certificates, and so on. Compared to formal services, local informal services generally require very little form-filling or travel. However, the advantage to the borrower of low transaction costs may be more than counterbalanced by their lack of power in setting the terms of a loan, which may be exploitative. Informal services impose their own discipline. The flow of information locally and the small number of providers of informal finance often act as powerful incentives to users to repay loans or save in a disciplined way. A ROSCA member failing to pay their instalment risks social ostracism from neighbours, friends, and relatives; they may be less likely to receive help from these people in times of severe difficulty in future. Poor people are capable of saving The evidence of informal systems disproves the assumption that poor people cannot save. Saving 'in kind' has long been a recognised part of people's livelihood management: saving in cash is a necessity of interaction with the cash economy. Indeed it is often the poorest, who are landless or for other reasons dependent on casual, poorly-paid jobs, who gain a large proportion of their incomes in cash and therefore have most need of savings facilities. The evidence shows that poor people are not only willing to save but at present often pay highly for savings facilities. 24 Informal systems are adaptable. Informal financial services The variety of forms and functions of informal finance demonstrates the adaptability of these systems to different economic conditions and changing circumstances. This contrasts with formal systems which often have to be based on a uniform delivery model. There is thus much to be learned from informal financial systems. Indeed aspects of these systems have found their way into the design of NGO and semi-formal financial services programmes. In particular, both group-based and individual-based schemes have made use of the 'insider knowledge' of other local people: individual-based schemes, such as BRI, through personal references from local representatives, and group- based schemes, such as Grameen, through self-selecting groups of borrowers (see Chapter 1). This brief overview has not identified for whom these services exist - women and men, poor or poorest. The poorest people may find it difficult to save the amount that a ROSCA requires and hence find participation a burden or are excluded. Even if there are a number of people in similar situations, they are often marginalised or isolated and lack the social networks to create their own ROSCA with a lower fee. Indebtedness may also make it difficult for the poorest to save and build up a small asset base - a situation that will be illustrated in the case of low-income and unemployed members of the Ladywood Credit Union in the UK, a case-study scheme described in Chapter 6. There are therefore limitations to the extent to which savings-based user- owned facilities can be of use to very poor people. However, systems that allow flexible amounts to be deposited are more likely to be appropriate. 2.6 Deciding when and how to intervene Before going on to discuss ways of intervening which are useful and relevant to poor people (see Chapter 3), it is necessary to issue some warnings. Several commentators, among them NGO practitioners, have questioned the appropri- ateness of NGOs acting as providers of financial services. Abugre (1992) identifies a range of dangers, and points to the dire consequences of the job being done badly: ⚫ NGOs remain averse to charging positive real interest rates and may, consciously or otherwise, undermine traditional financial systems. ⚫ NGOs do not submit themselves to the discipline required for the provision of sustainable financial services. 25 Microfinance and Poverty Reduction ⚫ Schemes are managed by entirely unprofessional and untrained staff and are often carelessly conceived, designed, and implemented. . There are cases where NGOs have flooded the market with credit, resulting in indebtedness on the part of borrowers, and potentially regressive effects on income and wealth distribution. By extending loans which poor people are unable to pay due to factors beyond their control, or which may have simply been inappropriate in the first place, NGOs can cause a level of indebtedness which may result in the borrower having to liquidate assets in order to repay. Abugre therefore warns against the hasty introduction of new financial services by NGOs and concludes that they should concentrate on what they do well, such as providing social services and acting as confidence brokers in coinmunities. Direct provision may be a risky and problematic strategy for an NGO, particularly as the NGO may not have the range of skills required to develop microfinance interventions, nor experience of the financial skills and respon- sibility required to ensure funds are properly safeguarded and accounted for. A further range of managerial skills are also necessary in managing a portfolio of financial assets such as loans and deposits. NGOS with experience of welfare and relief have more experience of channelling funds than managing them (Bouman, 1995). An NGO must ask itself whether it has the skills to become a banker.. An organisation lacking the relevant skills may consider acquiring them either through recruitment or staff development. Such a strategy itself has important consequences. These skills may be in short supply and recruit- ment prove difficult; they take time to develop and are acquired through experience as well as training. There is often a strong impetus to start work even if the skills of staff are still weak. This can endanger the intervention itself since it is at this early stage that users gain an impression of the nature of the operation, and inexperienced staff are likely to make mistakes. Embarking on direct intervention also raises questions about the long-term sustainability of the service on offer. Financial services should not be provided on a transient or temporary basis. There needs to be a degree of permanence to enable people to plan for their future finan- cial needs. Consideration of the long-term future for a system of finan- cial service provision is therefore important at the outset. Direct provision by an NGO which expects to move away from the area would seldom be appropriate. 26 Informal financial services There is a further range of issues at the level of the macro-economy which should also be considered when deciding whether to intervene. Macro- economic stability is an important pre-requisite for getting a scheme off the ground. Hyper-inflation and economic instability do not encourage individuals to save, and loans under such circumstances are difficult to manage. (However, in Mexico, while formal-sector banks were reeling from massive default caused by the high interest rates and high inflation of 1995, URAC, one of the case-study institutions discussed in Chapter 6, continued to thrive.) Political stability is also needed, since without it there is unlikely to be much confidence in the long-term future of new financial institutions. Before considering scheme design an NGO must also investigate the formal legal regulatory requirements for organisations involved in financial service provision, especially for savings (see Chapter 3). 2.6.1 Research questions on existing informal financial services In carrying out research into the services available, and how they are used, an intervener should try to find answers to a wide range of questions, such as: How do people manage their savings deposits? Are there savings banks, or deposit takers, insurance salesmen, or savings clubs? Do poor people have access to them? If not, how do they save (for example, gold, livestock). Who among the poor uses them (men, women, landless labourers, subsistence farmers etc)? (Extensive use of expensive deposit takers might indicate that the NGO should look first at the reasons why alternatives are not in place: and second at whether there is any possibility for the NGO to get involved, either as promoter or as provider, in savings collection.) How do people temporarily realise the value of assets they hold? Are there pawnbrokers or are there schemes that allow them to pawn land or other major assets (eg jewellery) safely? Who uses these services? (If such devices exist, are they exploitative or enabling? If they are clearly exploitative, there might be a case for an NGO to try to provide or promote an alternative.) How do people get access to the current value of future savings? Are there money-lenders willing to advance small loans against future savings? Are there ROSCAS or managed or commercial chits, or co-operative 2 In a background paper commissioned for the purposes of this book, Shahin Yaqub examined the 'Macroeconomic Conditions for Successful Microfinance for Poor People'. The paper is available from the Policy Department, Oxfam (UK and Ireland). 27 banks? Do poor people have access? Which poor people use them? (If money-lenders appear to be exploiting users, for example by imposing very high interest rates or linking loans to disadvantageous deals over land, labour or commodities, then there might be a case for the NGO to introduce ROSCAS or annual savings clubs, or work as a promoter of self-help groups or credit unions.) How do people make provision for known life-cycle expenses? Do they provide for daughters' marriages, their own old age and funeral, for their heirs? Are there clubs that satisfy these needs, or general savings services or insurance companies that will do as well? Are there government or employer-run schemes? Are there particular expenses for which women have responsibility? How do people cope with emergencies? What happens when a breadwinner is ill, or when a flood or drought occurs? Does the government have schemes that reach poor people in these circumstances? If not, what local provision do people make? How do small-scale entrepreneurs get access to business finance? If so, in what amounts and at what cost? Do women entrepreneurs have access? During the exploratory work done to answer these questions another set of information will come to light-the absolute quantities of cash involved in local financial intermediation. This can be of immense value to scheme designers in cases where a decision is made to intervene. For example, information about amounts repaid regularly to money-lenders will be useful in setting loan sizes and repayment schedules for loan schemes. (Source: Rutherford, 1996.) Much can be learned from the way in which people are already managing their finances. A further aspect is the social relations involved-the groups of people who get together to form ROSCAS, those from whom loans are taken, and those with whom deposits are lodged. Tierney's work on the Oxfam- funded Youth Employment Groups in Tabora Region of Tanzania demon- strates that the design of the intervention, which was based around groups of people with the same occupational background, did not correspond to the pattern of existing financial intermediation, which was organised around small kin-based groups, each including diverse enterprises. Tierney argues that 'the formation of development groups can, ironically, divert people's energy away from improving their lives, because forming the kind of groups which are eligible for financial assistance is a time-consuming activity involving skill 28 Informal financial services in manipulating and maintaining public relations' (Tierneyforthcoming). This illustrates the value of understanding how indigenous financial systems operate, before designing a new microfinance initiative. 2.7 Filling the gaps As well as alerting people to the potential pitfalls of intervention, research to answer the kind of questions suggested above is likely to identify gaps in existing services. There are many ways in which such gaps can be filled and below are some examples of financial service interventions in insurance and hire purchase which can be of use to poor people. For those agencies whose motivation is poverty reduction it is important to link the identification of gaps with a poverty analysis to determine who is excluded from existing services and how such exclusion perpetuates poverty. 2.7.1 Some examples of innovative services Hire-then-purchase for the poor in Bangladesh ACTIONAID found, through the experience of running a group- based lending programme similar to that of the Grameen Bank, that many very poor people were nervous of taking a large loan — the 5,000 taka ($125) needed to buy a rickshaw, for example — in case they were not able to repay it. AA therefore devised a bire-then- purchase scheme for such people. AA bought its own rickshaws and bired them out to group members. A rickshaw driver could hire a rickshaw from AA instead of hiring one from a local 'mohajan'. If he then decided to convert bis contract with AA from hiring to buying, a proportion of the total hiring fees he had already paid was denoted as his down-payment, and be took a regular (smaller) AA loan to pay off the rest. Door-step insurance agents, Cuttack, Orissa In Cuttack, insurance agents from the Peerless company visit house- bolds in low-income areas. They offer simple endowment schemes, which from the point of view of the customers are like accumulating fixed deposit schemes: the customer puts in a fixed amount regularly and then on maturity gets it back plus profits. Life insurance cover is included in the contract. 'Bankassurance: group-based insurance for the rural poor In Bangladesh, one insurance company is pioneering an attempt to match, in the field of insurance, Grameen Bank's success in lending. 29 Delta Life Insurance has been experimenting since 1988 with cut- price basic life-insurance for rural people. Customers are arranged in groups, there is no medical examination and no age-bar, and premiums are tiny and collected weekly. Agents are also involved in Grameen-Bank-style lending and earn an extra commission for the insurance work. In fact the insurance premiums are invested directly in lending (on which healthy interest may be earned). In 1996 Delta was looking for a big NGO partner which could offer the two services- lending and insurance- side by side. Experience so far has shown that demand for such a service is high. Delta is exploring how it can extend this initiative beyond life insurance. 2.8 Promotion: an alternative strategy for NGOS Having identified the gaps in existing financial service provision, an NGO might involve itself in promotion rather than provision. The main alternatives to direct provision of financial services are ones which involve the NGO in a transitional or support role whereby activities such as mobilisation, training, and making links to other organisations are provided. A range of possible approaches are outlined. 2.8.1 Formation of savings groups and development of internal credit facilities Where ROSCAS do not exist or have limited coverage, the NGO might act as a facilitator of their formation or enable them to develop slightly more sophisti- cated systems of internal on-lending which allows savings and loans to take on more flexible formats. This approach has been used by Friends of Women's World Banking in India. In this case the NGO is mainly involved in training and organising the groups. Self-help groups (SHGs) are NGO-led attempts to promote savings clubs, or simple forms of credit union. Those initiated by Friends of Women's World Banking in India are aimed at poor rural women. FWWB (or its partner NGOs) persuades women from the same neigh- bourhood and from similar backgrounds to form small groups of 12 to 15 members. NGO workers encourage the women to meet regularly and frequently and during these meetings the women discuss their financial problems and ways of solving them. The solution they are steered towards involves regular small savings and the immediate conversion of those savings into small loans taken by one or two members at each meeting. Care is taken to Informal financial services involve all group members in the discussion and formulation of rules (how often to meet, the interest to be charged on loans, and repayment arrangements) and then to ensure that every member experiences for herself the activities of saving and of taking and repaying a loan. The group is asked to choose leaders who are trained to manage the group's affairs: if illiteracy or very poor educational levels are a problem then rules are kept deliberately simple (fixed equal savings, and annual dividends rather than monthly interest on savings, for example). These preparations are intended to equip the group for independent survival after the NGO stops sending workers regularly to the meetings. Groups which perform well over several months are able to obtain small bulk loans made by FWWB to the group as a collective. Where there are a number of groups in an area, FWWB may help them form a federation' (apex body') to help with liquidity problems: groups with excess savings deposit them with the federa- tion which on-lends to groups with a strong demand for loans. (Source: WWB, 1993.) However, although this type of intervention can succeed with agency help, it has yet to be proved whether savings and credit groups which are promoted by outsiders can achieve long-term independence (Rutherford, 1996). A range of questions remain: can they save sufficient funds among themselves to satisfy their own demand for loans? Can external funds be introduced into these groups without destroying their independence? 2.8.2 Promotion of small-scale formalised approaches National legislation may allow for credit unions (the World Council of Credit Unions has national and regional affiliates all over the world) or thrift and credit co-operatives (as in Sri Lanka, see 3.4.2). Another approach an NGO might adopt could be the linking up of people interested in establishing such services for themselves with other credit unions or umbrella and apex bodies that are able to promote and advise on particular financial services. Oxfam Hyderabad worked with the Federation of Thrift and Credit Associations in Andhra Pradesh, encouraging exposure visits to flourishing thrift and credit societies by potential members from other areas. The members now have a source of consumption credit based on their own savings. Oxfam Hyderabad saw its support for linking potential groups with an existing thrift and credit structure as a move away from direct funding of NGOs to provide credit. (Source: Oxfam (India) Trust, 1993.) 31 2.8.3 Linking groups to the formal system Existing savings groups or ROSCAS may already have bank savings accounts but are unable to take loans because the bank does not understand their operations or believe them to be creditworthy. The NGO might work with groups to encourage them to build up savings and deposit them in formal institutions. The NGO may then be able to work with a local bank to encour- age it to extend its services to groups. In Ghana, rural banking legislation was designed to create semi- autonomous local banks which would serve people cut off from financial services. However, the banks have experienced a range of problems which led to only 23 out of a total of 123 being classified as operating satisfactorily in 1992 (Onumah, 1995). In 1991 the Garu Bank, a small rural bank set up in 1983 in Ghana, was near to collapse as a result of embezzlement and bad loans. The people of Garu persuaded a member of their own community who was working in Accra to come back to the area and become theman- ager. The Bank is a unit bank and operates relatively autonomously. Share capital of the Bank is owned by the local community, the Catholic Mission, the local Agricultural Station and a Disabled Rehabilitation Centre. Helped by an additional capital injection of $30,000 received from overseas donors via the Catholic Mission the manager trans- formed the situation, and expected to report a profit for the first time. The bank has a range of clients, including local salaried workers such as teachers and government employees. These people are good customers because they take loans which are easily recoverable in the form of deductions made from their salaries at source. Alongside these customers, the Bank provides services to some 300 farmers' groups. Some of these groups were originally formed by the local Agricultural Station and the Catholic Mission and bought shares in the Bank when it was first set up. The manager went to meet the groups to discuss their needs with them. He has developed his own approach to the groups, and stresses that they should be concerned with working together rather than just obtaining credit. He has set up his own criteria for lending to the groups: savings balances of at least 10 per cent of the loan amount; regularity of savings as an indicator of group cohesion; and that the group should have been operating for at least six months. Repayment of the loan on time results in almost automatic qualification for a new loan the following year (although be bad refused loans to a number of groups the previous year due to poor performance). (Source: Abugre, Johnson et al, 1995.) ","Answer the following question using only information from the text included below. You must not utilize any other sources or your own reasoning in your response. What are some examples of informal financial services? Current debates in microfinance 1 1.1 Subsidised credit provision From the 1950s, governments and international aid donors subsidised credit delivery to small farmers in rural areas of many developing countries. It was assumed that poor people found great difficulty in obtaining adequate volumes of credit and were charged high rates of interest by monopolistic money-lenders. Development finance institutions, such as Agricultural Development Banks, were responsible for the delivery of cheap credit to poor farmers. These institutions attempted to supervise the uses to which loans were put, and repayment schedules were based on the expected income flow from the investment. Returns were often overestimated. For example, calculations would be based on agricultural yields for good years (Adams and Von Pischke, 1992). As a result, loans were often not repaid. The credibility and financial viability of these subsidised credit schemes were further weakened by the use of public money to waive outstanding and overdue loans at election time (Adams and Von Pischke, 1992; Lipton, 1996; Wiggins and Rogaly, 1989). A dependence on the fluctuating whims of governments and donors, together with poor investment decisions and low repayment rates made many of these development finance institutions unable to sustain their lend- ing programmes. Credit provision for poor people was transitory and limited. 1.2 The move to market-based solutions This model of subsidised credit was subjected to steady criticism from the mid-1970s as donors and other resource allocators switched attention from state intervention to market-based solutions. Policy-makers were reminded 5 Microfinance and Poverty Reduction that credit could also be described as debt and that the over-supply of subsidised credit without realistic assessment of people's ability to repay could result in impoverishment for borrowers. At the same time the concept of 'transaction costs', and the notion that full information about borrowers was not available to lenders, were used by the opponents of subsidised credit to justify the high interest-rates charged by money-lenders. Lending money carries with it the risk of non-repayment. In order to know who is creditworthy and who is not, and so reduce this risk, the lender screens potential borrowers. This involves gathering information on the circumstances of individuals, which may not be easy to obtain. Then enforcement costs are incurred to ensure repayment. Through this process risks are reduced, though not eliminated. Where a loan is disbursed on condition that it is used for a particular purpose, supervision costs also arise. Using these tools of analysis it was argued that private money-lenders charged interest rates which were higher than formal bank-rates because of the high costs they faced in terms of risk, particularly when lending without physical collateral. At the same time, it was argued that money-lenders were an efficient source of credit because their greater knowledge of the people to whom they were lending lowered screening costs. Moreover, potential borrowers faced high transaction costs when they sought loans from formal-sector finance institutions. These costs included the time, travel, and paperwork involved in obtaining credit, and were often pro- hibitive for poor clients, especially those most geographically isolated. On the basis of this analysis, a group of economists based at Ohio State University (USA), notably Dale Adams and J D Von Pischke, put forward the view that the provision of credit should be left almost entirely to the private sector. In concentrating on the problems of publicly subsidised credit, these economists ignored the social ties, power relations, and coercion associated with the activities of money-lenders. However, detailed micro-level research has demonstrated the widespread use of interlocked' contracts to force exchange to the disadvantage of poor people (Bhaduri, 1981). Powerful local people, including landlords, employers, and traders, are able to influence the terms of loans made to tenants, workers, and small producers via conditions set in transactions involving land, labour, or crops. For example, traders frequently lend working capital to small farmers on condition that their crops are sold to that trader at a pre-determined price. Similarly, loans are made to workers against the promise of labour to be provided at below the going rate at a set future date (Rogaly, 1996b). Against the background of these debates, recent developments in the design of microfinance schemes have generated an understandably high degree of excitement. This is because innovative features in design have 6 Current debates in microfinance reduced the costs and risks of making loans to poor and isolated people, and made financial services available to people who were previously excluded. 1.3 Making use of social collateral There was little knowledge among formal-sector financial intermediaries of alternatives to physical collateral, until the 1970s, when the Grameen Bank in Bangladesh began using 'peer-group monitoring' to reduce lending risk. The model for credit delivery in the Grameen Bank is as follows: • Groups of five self-select themselves; men's and women's group are kept separate but the members of a single group should have a similar economic background. • Membership is restricted to those with assets worth less than half an acre of land. ⚫ Activities begin with savings of Taka 1 per week per person and these savings remain compulsory throughout membership. • Loans are made to two members at a time and must be repaid in equal instalments over 50 weeks. . Each time a loan is taken the borrower must pay 5 per cent of the loan amount into a group fund. • The group is ultimately responsible for repayment if the individual defaults. • Between five and eight groups form a 'development centre' led by a chair- person and secretary and assisted by a Grameen Bank staff member. • Attendance at weekly group and centre meetings is compulsory. • All transactions are openly conducted at centre meetings. • Each member may purchase a share in the Bank worth Taka 100 Through this system the Grameen Bank has provided credit to over 2 million people in Bangladesh (94 per cent women) with a very low default rate. (Source: Khandker, Khalily and Khan, 1995.) However, peer-group monitoring has not proved necessary to other instit- utions seeking to do away with physical collateral. In Indonesia, government- sponsored banks have successfully used character references and locally- recruited lending agents (Chaves and Gonzales Vega, 1996). The peer-group 7 Microfinance and Poverty Reduction method of Grameen and the individual-user approach of the Bank Rakyat Indonesia (see 1.4) can both be seen as attempts to lower screening costs by using local 'insider' information about the creditworthiness of borrowers. The degree to which Grameen Bank employees themselves implement peer-group monitoring has recently been questioned. It is argued that the reason for the Grameen Bank's high repayment rates is the practice of weekly public meetings at which attendance is compulsory, for the payment of loan instalments and the collection of savings. The meetings reinforce a culture of discipline, routine payments, and staff accountability (Jain, 1996). Another means of improving loan recovery is to insist on regularity of repayment. This is likely to reflect the actual income-flow of the borrower much better than a lump-sum demand at the end of the loan period. Borrowers can make repayments out of their normal income rather than relying on the returns from a new-often untested-mini-business. Neverthe- less, where seasonal agriculture is the main source of income, and borrowers face seasonal hardship, regular repayment scheduling may cause problems. Microfinance specialists have argued that the prospects for scheme's stability are improved by innovations such as social collateral and regular repayments instalments. Indeed, financial sustainability has become an important goal in itself. To achieve sustainability, microfinance institutions, be they NGOs, government agencies, or commercial banks, need to ensure that the costs of providing the service are kept low and are covered by income earned through interest and fees on loans (see Havers, 1996). As microfinance deals, by definition, with small loans, the income generated through interest payments is also small in comparison with administration costs. To generate profits, therefore, it is necessary to increase scale - in other words, to lend to a large number of people (Otero and Rhyne, 1994). 1.4 Savings The regular repayments on loans required by large non-governmental micro- finance institutions in Bangladesh (including BRAC, ASA and Grameen) provide evidence that poor people can save in cash (Rutherford, 1995a). These intensive repayment regimes are very similar to those of rotating savings and credit associations: steady weekly payments, enforced by social collateral, in return for a lump sum. Loans made are, in reality, advances against this stream of savings. By insisting on regular savings, microfinance institutions can screen out some potential defaulters, build up the financial security of individuals, increase funds available for lending, and develop among members a degree of identification with the financial health of the institution. People involved in 8 Current debates in microfinance such schemes may previously have been unable to reach formal-sector banks, complete their procedures, qualify for loans or open savings accounts. 'A savings facility is an extremely valuable service in its own right, which often attracts many more clients than a credit programme, particularly from among the poorest' (Hulme and Mosley, 1996, p147). This evidence that poor people can save in cash has opened up further debate. A distinction is made between schemes in which borrowers must save small and regular amounts in order to obtain loans (termed 'compulsory' saving) and those which offer flexible savings facilities. In the latter case people can deposit and withdraw cash in whatever amounts, and as often, as they wish. This distinction is made especially strongly by Robinson (1995) in her account of the Bank Rakyat Indonesia. The BRI local banking system has about six times as many deposit accounts as loans. On 31 December 1993, BRI's local banking system had $2.1 billion in deposits. These were all voluntary savings. By 31 December 1995, there were 14.5 million savings accounts. Savers with BRI bave access to savings whenever they want. BRI deals with individuals rather than groups. Its savings programme was designed specifically to meet local demand for security, convenience of location, and choice of savings instruments offering different mixtures of liquidity and returns. BRI's local banking system has a loan limit of about $11,000. The idea is that good borrowers should not be forced to leave until they can qualify for the loans provided by ordinary commercial banks. In addition, BRI has a system which gives its borrowers an incentive to repay on time. An additional 25 per cent of the interest rate is added to the monthly payment. This amount is paid back to borrowers at the end of the loan period if they have made every payment in full and on time. There is a corresponding in-built penalty for those who have not. (Source: Robinson, 1994.) Robinson argues that there is an enormous unmet demand for flexible savings services. However, she also warns that managing a savings system of this type is much more complex than running a simple credit programme. Schemes which operate under these 'new' savings and credit technologies are an improvement on the old model of subsidised agricultural and micro- enterprise finance. The story of how they have succeeded in reaching poor people is now the subject of a large literature (for example, Rutherford, 1995b; Hulme and Mosley, 1996; Mansell-Carstens, 1995). That many more poor people can now obtain financial services is a major achievement of these 9 Microfinance and Poverty Reduction schemes. However, the questions of which poor people have been reached, and of whether poverty has been reduced, still remain. 1.5 Can microfinance interventions reduce poverty? If poverty is understood as low levels of annual income per household, reducing poverty is about raising average income levels. If a particular level of annual income per head is used as a poverty line, poverty reduction could be measured by counting the number or proportion of people who cross that line-who are promoted out of poverty. Providers of financial services who aim to enable people to cross such a poverty line have focused on credit, in particular credit for small enterprises, including agricultural production. However, attention to annual income can obscure fluctuations in that income during any given year. Poverty can also be understood as vulner- ability to downward fluctuations in income. Such fluctuations can be relat- ively predictable, such as the seasonal decline in employment for agricultural workers, or a shortage of income and trading opportunities in the dry season or before harvest. Alternatively, fluctuations in income may result from unexpected shocks such as crop failure, illness, funeral expenses or loss of an asset such as livestock through theft or death, or a natural disaster such as a cyclone (Montgomery, 1996). Vulnerability can be heightened by the lack of saleable or pawnable assets and by debt obligations. Interventions which reduce such vulnerability and protect livelihoods also reduce poverty. 1.5.1 Poverty as powerlessness A further dimension of poverty which is often the focus of NGO interventions is powerlessness, whether in an absolute sense or in relation to others. Economic inequality between and within households is likely to be associated with concentrations of political and social power. Inequality can increase whenever better-off people are able to improve their incomes faster than others. Even if the absolute level of material well-being of the worst-off people does not change, relative poverty (Beck, 1994) may increase, and with it a sense of powerlessness among very poor people. Power relations are partly determined by norms of expected behaviour. Neither the relations nor the norms are static; they are contested and change over time. Powerlessness can be experienced in a variety of situations: within the household, as a result of differences in gender and age; and within the community, between socio-economic groups, as a result of caste, ethnicity, and wealth. Defining poverty in terms of power relations implies that assessment of the impact of microfinance interventions should focus on their 10 Current debates in microfinance influence on social relations and the circumstances which reproduce them. Even in a similar geographical and historical context, it is important to disting- uish between the ways in which specific groups of poor people (women and men, landed and landless, particular ethnic groups) are able to benefit from financial services or are excluded from doing so. 1.5.2 Credit for micro-enterprises While there are methodological difficulties involved in measuring increases in incomes brought about by the provision of credit (see further discussion in Chapter 5), studies have demonstrated that the availability of credit for micro- enterprises can have positive effects. A recent survey collected data from government, NGOs, and banks involved in providing financial services for poor people. Twelve programmes were selected from seven countries (six of these are included in Table 1, Annex 1). Households which had received credit were compared with households which had not. The results demon- strated that credit provision can enable household incomes to rise. However, taking the analysis further, Hulme and Mosley demonstrated that the better-off the borrower, the greater the increase in income from a micro- enterprise loan. Borrowers who already have assets and skills are able to make better use of credit. The poorest are less able to take risks or use credit to increase their income. Indeed, some of the poorest borrowers interviewed became worse off as a result of micro-enterprise credit, which exposed these vulnerable people to high risks. For them, business failure was more likely to provoke a livelihood crisis than it was for borrowers with a more secure asset base. Specific crises included bankruptcy, forced seizure of assets, and unofficial pledging of assets to other members of a borrowing group. There have even been reports of suicide following peer-group pressure to repay failed loans (Hulme and Mosley, 1996, pp120-122). A much smaller survey comparing micro-enterprise programmes in El Salvador and Vanuatu found that the development of successful enterprises and the improvement of the incomes of very poor people were conflicting rather than complementary objectives. By selecting those most likely to be successful for credit and training, the programmes inevitably moved away from working with the poorest people (Tomlinson, 1995). Reviews of Oxfam's experiences with income-generating projects for women raised serious questions about the profitability of such activities. Full input costings, which would have revealed many income-generating projects as loss- making, were not carried out. Omissions included depreciation on capital, the opportunity cost of labour (the earnings participants could have had through spending the time on other activities), and subsidisation of income- 11 Microfinance and Poverty Reduction generating projects with income from other sources. Market research and training in other business skills had often been inadequate (Piza Lopez and March, 1990; Mukhopadhyay and March, 1992). 1.5.3 Reaching the poorest Whether income promotion is based on loans for individual micro-enterprises or on group-based income generation projects, its appropriateness as a strategy for poverty reduction in the case of the poorest people is questionable. Other evidence suggests that self-selected groups for peer-monitoring have not been inclusive of the poorest people (Montgomery, 1995). People select those with whom they want to form a group on the basis of their own know- ledge of the likelihood that these people will make timely payment of loan and savings instalments: X will only have Y in her group if she believes Y is capable of making regular repayments and has much to lose from the social ostracism associated with default. This system might well be expected to lead to the exclusion of the poorest (Montgomery, op. cit.). Even the low asset and land-holding ceiling which the big microfinance institutions in Bangladesh have successfully used to target loans away from better-off people has not necessarily meant that the poorest, who are often landless, are included (Osmani, 1989). So while the innovations referred to earlier appear to have made loans more available to poor people, there is still debate over the design of appro- priate financial services for the poorest. Hulme and Mosley's study strongly suggests that providing credit for micro-enterprises is unlikely to help the poorest people to increase their incomes. However, detailed research with users has found that some design features of savings and credit schemes are able to meet the needs of very poor people. For example, it was found that easy access to savings and the provision of emergency loans by SANASA (see 3.4.2) enabled poor people to cope better with seasonal income fluctuations (Montgomery, 1996). Microfinance specialists increasingly, therefore, view improvements in economic security income protection rather than promotion (Dreze and Sen, 1989) as the first step in poverty reduction. ...from the perspective of poverty reduction, access to reliable, monetized savings facilities can help the poor smooth consumption over periods of cyclical or unexpected crises, thus greatly improving their economic security.' It is only when people have some economic security that 'access to credit can help them move out of poverty by improving the productivity of their enterprises or creating new sources of livelihood' (Bennet and Cuevas, 1996, authors' emphasis). Current debates in microfinance 1.6 Financial interventions and social change Interventions have an impact on social relations partly through their econ- omic effects. In many instances implementors of credit schemes have claimed that the work will lead to progressive social change, for example by empow- ering women and changing gender relations in the household and in the community (Ackerly, 1995). In five out of the six schemes summarised in Table 1 (Annex 1), over half of the borrowers were women. Much of the work that has been done in assessing the impact of credit programmes on women has been in Bangladesh. One approach was to look at the control women retained over loans extended to them by four different credit programmes: the Grameen Bank, BRAC, a large government scheme (the Rural Poor Programme RD-12), and a small NGO (Thangemara Mahila Senbuj Sengstha) (Goetz and Sen Gupta, 1996). Results suggested that women retained significant control over the use to which the loan was put in 37 per cent of cases; 63 per cent fell into the categories of partial, limited or no control over loan use. Goetz and Sen Gupta found single, divorced, and widowed women more likely to retain control than others. Control was also retained more often when loan sizes were small and when loan use was based on activities which did not challenge notions of appropriate work for women and men. The question of whether women were empowered is not answered: even when they did not control loans, they may have used the fact that the loan had been disbursed to them as women to increase their status and strengthen their position in the household. However, in some cases women reported an increase in domestic violence because of disputes over cash for repayment instalments. A second major piece of research has assessed the effect of Grameen and BRAC programmes on eight indicators of women's empowerment: mobility, economic security, ability to make small purchases, ability to make larger purchases, involvement in major household decisions, relative freedom from domination by the family, political and legal awareness, and participation in public protests and political campaigning (Hashemi et al, 1996). The study concludes that, on balance, access to credit has enabled women to negotiate within the household to improve their position. However, unlike the Goetz and Sen Gupta study, which is based on 275 detailed loan-use histories, Hashemi et al attempted to compare villages where Grameen or BRAC were present with villages where they were not. Because of difficulties inherent in finding perfect control villages (which the authors acknowledge), the conclusions of the study do not signify the end of the debate. It has also been argued that focusing on women is much more to do with financial objectives than with the aim of empowerment. According to 13 Microfinance and Poverty Reduction Rutherford (1995b) the real reasons for targeting women in Bangladesh are that they are seen as accessible (being at home during working hours); more likely to repay on time; more pliable and patient than men; and cheaper to service (as mainly female staff can be hired). Thus the process of loan supervision and recovery may be deliberately internalised inside the household (Goetz and Sen Gupta, op. cit.). Goetz and Sen Gupta do not use this as an argument against the provision of finance for women in Bangladesh, but rather suggest that to avoid aggravating gender- based conflict, loans should be given to men directly as well as to women and, at the same time, that efforts should be made to change men's attitudes to women's worth. 1.7 Treading carefully in microfinance interventions This brief summary of evidence and argument suggests that microfinance interventions may increase incomes, contribute to individual and household livelihood security, and change social relations for the better. But that they can not always be assumed to be doing so. Financial services are not always the most appropriate intervention. The poorest, in particular, often face pressing needs in terms of primary health care, education, and employment opportunities. Lipton has recently argued for anti-poverty resources to be allocated across sectors on the basis that a concentration on a single interven- tion mechanism, say credit, is much less effective in poverty reduction than simultaneous credit, primary health, and education work, even if this entails narrowing geographical focus (op. cit.). The particular combinations which will be most effective will depend on the nature of poverty in a specific context. Although microfinance provision appears to be evolving towards greater sustainability, relevance, and usefulness, there are few certainties and the search for better practice continues. Decisions on whether and how to intervene in local financial markets should not be taken without prior knowledge of the working of those markets. If the intervention is intended to reduce poverty, it is especially important to know the degree to which poor people use existing services and on what terms. Only then can an intervening agency or bank make an informed decision on whether their work is likely to augment or displace existing 'pro-poor' financial services. If the terms of informal financial trans- actions are likely to work against the interests of poor people (cases in which the stereotype of 'the wicked money-lender' corresponds to reality) the inter- vention may attempt to compete with and possibly replace part of the informal system. However, making such an informed assessment is not straight- forward, as one study of the power relations between informal financial 14 Current debates in microfinance service providers and agricultural producers in Tamil Nadu demonstrated. Grain merchants based in the market town of Dindigul were found to dictate the terms of product sale when lending working capital to very small-scale farmers, but to be much the weaker party when lending to larger-scale farmers (Rogaly, 1985). The structure of a credit market can change, partly under the influence of outside intervention. Rutherford has studied the changing market in financial services for poor people in Bangladesh. Competition between NGOs is leading to users being less subservient to NGO staff and protesting about unpopular financial obligations, such as the 5 per cent deducted from loans by Grameen for a 'group fund'. Private individuals have set up offices imitating the Grameen style but charging higher interest rates on loans than the big NGOS, and also offering higher rates on savings deposits. Private urban finance companies have expanded. Despite the tendency for NGOs to become more like banks, other formal-sector lenders are still reluctant to lend to poor people (see also McGregor, 1994). The expansion of NGO credit in Bangladesh has been made possible by the flood of donor money to that country. One study of BRAC showed that loan disbursal and recovery had become more important than group forma- tion (Montgomery, 1996). In 1992, Grameen Bank and BRAC employees were found to be offering 'immediate loans' to women in villages where smaller NGOs had been attempting longer-term group-based finance (Ebdon, 1995). Ebdon attributed this behaviour to fairly strict targets for loan disbursal in the case of BRAC, and in both cases to an imperative for job security for staff and a desire on the part of the organisations to expand their influence and strengthen their reputations (p52). This anxiety to increase the number of users can undercut the very basis of the new model: the creation of sustainable financial institutions. Studies of credit schemes have consistently demonstrated that unless borrowers and savers believed they would benefit from the long-term survival of the institution, and have a sense of ownership, repayment rates would decline (Rogaly, 1991; Copestake, 1996a). The sense of ownership is weakened by attempts by large microfinance institutions in Bangladesh to claim territory by encroachment. In India, in the absence of equivalent flows of external finance, thrift and credit co-operatives based much more on borrowers' requirements have emerged (Rutherford, 1995b, p136). An understanding of the way in which the institutions themselves change and respond to incentives is therefore necessary for the design of relevant anti-poverty interventions, including financial services. 15 2 Informal financial services 2.1 Introduction In recent years research into informal financial services and systems has significantly deepened understanding of the way they operate and their strengths and weaknesses. A simplistic belief that local money-lenders charged extortionate interest rates lay behind the provision of subsidised finance in the past. More thorough investigation has highlighted a range of savings, credit, and insurance facilities accessible to poor people. The appar- ently usurious interest charges reportedly made by private money-lenders may be explainable in terms of transaction costs, lack of information, and high risk. Informal financial services may be well-equipped, because of local 'insider' knowledge, and lower overheads, to respond to the requirements of poor people; they may also be exploitative. This chapter starts with a brief overview of the types of informal services that have been found to exist in a wide variety of countries and social contexts. Some of the broad characteristics of these services are identified, and lessons drawn for the design of NGO or semi-formal systems. In describ- ing informal financial services it is useful to distinguish between those which are owned by their users and those which are offered by an individual, usually on a profit-making basis. The distinction can be a helpful one in analysing the ways in which financial services enable or exploit poor people. NGOs considering microfinance interventions need first to find out what informal financial services are available, and how they operate. Such services are capable of supporting poor people's livelihoods as well as perpetuating 1 This chapter draws heavily on a background paper commissioned for the purposes of this book: A Critical Typology of Financial Services for the Poor, Stuart Rutherford, November 1996. Examples are drawn from Rutherford's own experience unless otherwise stated. 16 Informal financial services structures which undermine them. It is necessary, therefore, to understand under what circumstances and to what degree these services are enabling or exploitative for poor people. On the whole, user-owned services are likely to be more enabling than services provided for profit. Investigating the scope and nature of existing services is an essential pre- liminary before considering whether an intervention is necessary. However, NGOs themselves may not have the right skills to become direct providers of financial services. Furthermore, financial services are needed by poor people on a permanent basis to enable them to plan and manage their finances; NGO programmes which might be here today and gone tomorrow may be an inap- propriate means through which to provide them. Therefore NGOs should seriously consider whether direct intervention is in fact the best response for them to make. The chapter closes by discussing alternative strategies NGOs might employ. 2.2 User-owned informal financial services Systems which facilitate financial transactions and are owned by their users are many and varied, and range from simple reciprocal arrangements between neighbours, savings clubs and rotating savings and credit associa- tions (ROSCAS), to forms of insurance, building societies, and systems of co- operative business finance. An example of each of these types is described below. All of these systems can be found in a variety of country settings. Rotating savings and credit associations (ROSCAS) in particular, are an extremely common phenomenon. They exist in almost every country (for example, 'partners' in Jamaica and Britain, bui in Vietnam, and njangi in Cameroon). (See Bouman, 1995; Ardener and Burman, 1995 for detailed and extensive surveys of ROSCA operations in a range of settings.) The principle is very simple: a number of people agree to save a fixed amount of money at regular intervals; at each meeting, for example weekly, each member contri- butes an agreed amount, resulting in a single lump sum becoming available, which is then allocated to one of the members. There are three basic varia- tions in the way in which this lump sum or 'prize' is allocated. First, it can be allocated on the basis of strict rotation between members of the group; second, on the basis of a lottery of members; third, it may be auctioned to the member who is willing to accept the biggest discount. The group will usually meet (but does not always need to) and undertake this transaction on as many occasions as there are members of the group, thus ensuring that each member gets the 'prize' once. The ROSCA demonstrates the basic principle of financial intermediation: collecting many small savings from many people, turning this into a lump sum for one person, and repeating this procedure over time. 17 Microfinance and Poverty Reduction ROSCA finance is used for many purposes. Some ROSCAS operate to enable an asset to be purchased, such as a rickshaw or fishing equipment for each member, and may have been set up specifically for the purpose. 'Merry- go-rounds', as ROSCAS are called among Kikuyu women in Kenya, are sometimes used by women as a means of accumulating enough money to buy new household utensils or clothes. The technology of the ROSCA is not unique to poor communities but is also used by salaried professionals to purchase major consumption items or assets such as refrigerators or cars. A further example of a user-owned device is the insurance fund which makes pay-outs conditional on certain circumstances occurring. These are int- ended to cover large expenses such as those connected with marriage or death. 2.2.1 Some examples of user-owned financial services Neighbourhood reciprocity in Southern India Reciprocal lending may be extended to involve several or even all the members of a community. Among Moslems in Kerala State in southern India kuri kalyanam are invitations to a feast to which the guest is expected to bring a cash gift. When the host in his turn is invited to a feast by one of the guests he is expected to return double the amount (less if he is perceived as poor). In Vietnam one kind of hui (a generic name for various financial devices) involves a similar pooling of resources for one person on one occasion to be reciprocated later by others, at different times. Rickshaw ROSCAS in Bangladesh Very poor men driven by poverty from their home villages to the Bangladesh capital, Dhaka, often earn a living there by driving bired rickshaws. In the last ten years they have begun to run ROSCAS. A group of drivers forms, and each driver saves a set amount from his daily takings. When the fund is large enough (this usually takes about 15 days) a rickshaw is bought and distributed by lottery to one of the members. In between prizes' the cash is held by a trustworthy outsider, usually a local shopkeeper from whom the members buy their tea or cigarettes. In a further adaptation, those who have already received their rickshaw double their daily contribution. This progressively reduces the time-gap between prizes, and is seen as a fair way of rewarding those members who win the lottery late in the cycle, because their gross contribution is smaller than earlier winners. The extra payment made by the winners is roughly equivalent to what they save by no longer having to hire a rickshaw. 18 An accumulating savings club in Mexico Informal financial services In towns and villages in Mexico neighbours place frequent but irregular savings with trusted shopkeepers. Just before Christmas, the cash is returned to the saver. No interest is paid, but the saver has a lump sum to spend, and the shopkeeper has had the use of the money over the year and can now look forward to a good sales season. Building societies for the middle classes in Bangladesh In a lower-middle-class area of Dhaka, 165 employees in the Public Works Department belong to their own building society' which was started over 16 years ago. Each saves 200 taka ($5) a month out of his wages. As the cash accumulates it is lent out to members, who buy land and building materials. Interest rates are high and interest on the out- standing balance has to be paid each month, to encourage modest loans and rapid repayment. But loan sizes are generous and such workers would have few or no alternative sources for loans of this kind. Popular insurance: funeral funds (iddir) in Ethiopia Originally burial societies, iddir have extended to provide a wide range of insurance services in urban Ethiopia. Aredo (1993), study- ing these in Addis Ababa, estimated that 50 per cent of urban house- holds were members of some kind of iddir. Groups of people come together on the basis of location, occupation, friendship or family ties. Each iddir sets its own rules and regulations but usually pays out for funeral expenses or financial assistance to families of the deceased, and sometimes to cover other costs, such as medical expenses and losses due to fire or theft. 2.3 Informal financial services for profit Those offering informal financial services for profit fall into two groups: deposit takers (often also called money-guards) and lenders. What is most interesting about the situation of deposit takers is that, as in the Nigerian example below, savers usually pay for the service by obtaining a negative interest rate on their funds. This demonstrates the pressing need that people have for places to put their savings which are safe and secure not only from physical risks such as theft, fire or flood, but also from the demands of their family. For women, in particular, the ability to save small amounts in places to which their husbands and families cannot gain access (although they might know about them) has been shown to be particularly important. It may enable them to meet obligations in the family or household, such as the payment of children's school fees, for which they have particular responsibility. 19 Microfinance and Poverty Reduction Forms of lending also operate in a variety of ways, such as money-lenders; pawnbrokers, who take collateral in the form of physical assets; and forms of trade credit and hire purchase. The term 'money-lender' can cause confusion because it conjures up the image of a class of people whose main source of income is usury. In reality, many small farmers, for example, obtain credit from employers, landlords, traders, relatives, and other people who combine a number of economic activities. In some places money-lenders may be a more professionalised class, such as the Tamilians' in Cochin described below, but even in this case it is not necessarily their main source of income. Lending money can be exploitative of, as well as enabling for, poor people. People facing seasonal shortages may have only one source of credit, for example, an employer. The employer may agree to provide a loan, but only if the borrower promises to work when required at below the going wage-rate. As described below for Indonesia, crop traders may provide producers with seasonal credit on the understanding that the crop is sold through the same trader at low post-harvest prices. Tied credit of this type, whether in cash or kind, may be the only means of survival for poor people. But arrangements such as these can maintain and even exacerbate inequalities in power and position. In contrast, user-owned devices are likely to be more supportive and enabling, because the profits made are pooled, and shared or fed back into the system, and ownership and control of the funds are in the hands of the users. Such devices are unlikely to be exploitative of those involved, although they may widen inequalities between users and non-users. The comparison with services for profit is clear. However, loans from private lenders after harvest may enable small traders to make the most of the increased liquidity in the local economy. This emphasises the need for interveners to understand the workings of real markets and to question untested assumptions. It is essential to find out for which groups of poor people-women, men, landless labourers, subsistence farmers, migrant workers and under what circumstances these arrange- ments may be no more than a means of survival, while supporting wealth creation for others. 2.3.1 Some examples of informal financial services provided for profit Deposit takers: a mobile alajo in Nigeria One consequence of Nigeria's current political difficulties is a drop in public confidence in formal banks, according to Gemini News. This has allowed an old tradition to flourish again- alajos, or peripatetic deposit takers. Idowu Alakpere uses a bicycle to go 20 Informal financial services door-to-door round the outer suburb of Lagos where he lives. He has 500 customers who each save about 10 or 15 naira with him (about 50 to 75 cents US) at each daily visit. Customers withdraw money whenever they like, and Idowu charges them one day's savings per month, which he deducts from the withdrawal. Since deposits are made evenly over the month, the negative interest rate for one-month deposits is 1/15, or 6.6 per cent a month, an Annual Percentage Rate (APR) of 80 per cent. Some alajos, including Idowu, store the cash in a reliable bank, others use it to make loans. The Gemini News reporter was told by many local people that they trusted these alajos more than banks. When it was pointed out that some alajos are dishonest, they retorted that so are many banks. Professional money-lenders in Cochin, India 'Tamilians' provide a money-lending service to poor slum dwellers on a daily basis. They have set terms, which are well-known all over Cochin. For each 100 rupees lent, 3 rupees are deducted at source as a fee. Thereafter, 12.50 rupees per week must be repaid for ten weeks. This works out at an APR of 300 per cent (28 rupees paid on an average size loan of 48.50 rupees [97/2) for 10/52 of a year). Most non-poor observers regard this rate as outrageously exploitative. However, poor users of the service tend to take a favourable view of it. The 'Tamilians' do not needlessly harass their clients over repay- ment but take an 'understanding' view which includes a willingness to accept loan losses. These money-lenders know their clients well and (out of self-interest) will not lend more than they think the client can repay out of normal income over the next ten weeks. Lending against collateral: pawnbrokers in Western India Residents of the slums of Vijayawada use their local pawnbroker when they need money quickly. He is reliably available at his gold- smithing shop and he charges 3 per cent a month for loans pledged against gold, 5 per cent for silver and 9 per cent for brass. The inclu- sion of brass means that even the very poor can get a small advance by pawning kitchen pots and pans. He lends up to two-thirds the value of the pawn. He gives a receipt, and because the borrower can be sure of getting her pawn back when she repays the loan, she can risk pawning objects of sentimental value. Unlike those who lend without collateral the broker does not need to know his clients well: the unambiguous collateral provided by the pawn means that the broker can lend to more or less anyone at any time. 21 Microfinance and Poverty Reduction Advance crop sales in Indonesia A practice common in many countries is known as ijon in some areas of Indonesia. Farmers often need cash to get them through the 'bungry' season when their main crop is in the ground and there is not much else to do except sit and wait. They are forced to make an advance sale of the crop, usually to a grain buyer or his agent. Ijon transactions of this sort, if seen as loans, show an interest rate of anything from 10 to 40 per cent a month. (Source: Bouman and Moll in Adams and Fitchett, 1992.) Two examples of trade credit In many markets it is common to see poor people squatting on the ground with a small amount of fertiliser spread out on a mat. The fertiliser doesn't necessarily belong to the man or woman (or, often, child). Lacking capital themselves to buy stock, such people obtain the fertiliser on credit from a nearby shop. At the close of the market they return the money from sales and any balance of the stock to the shopkeeper, retaining a small proportion of the money. The system allows people to trade (safely if not profitably) without capital, and gives the shopkeeper a cheap extra outlet. The dadon credit system used to finance prawn cultivation in Bangladesh is an example of a trading system in which credit is passed on through a chain of intermediaries between the prawn farmer and exporters to Europe. The prawn market is a highly com- petitive business in which everyone in the chain is short of capital. The 'commission agent' at the port buys prawns on behalf of the exporters in the capital. To ensure their share of the market they provide credit early in the season which finds its way through a number of intermediaries before reaching the hands of the farmer. The intermediaries are 'depot' owners, then farias', or merchants, and finally local traders, who in turn lend to the farmers. In accepting the credit the farmer commits himself to selling exclusively to this particular trader. 2.4 Turning the informal into the formal In some countries such informal systems have evolved into formal systems which have had a major impact on their users. In the UK, for example, 'mutual' or friendly societies which began as small thrift groups in the nineteenth century turned into building societies in the first half of the twentieth, and have been the main source of housing finance for 50 years. Informal financial services There are further examples of such informal systems becoming increas- ingly formalised. Aredo (1993) reports that the iddir in Addis Ababa run by the Ethiopia Teachers' Association is of the scale of a medium-size insurance business. In Cameroon some of the traditional ROSCAS known as njangi have evolved into small banks offering finance for small businesses which have difficulty using formal banks (Haggblade, 1978). ROSCAS may thus be a transitional phenomenon. Chit funds in India are a formalised version of a ROSCA, for which govern- ment legislation exists. In contrast to the ROSCA, members of the chit fund do not normally know each other and are merely customers of the chit companies. The company advertises for and selects members, makes arrange- ments for collection of subscriptions, and holds auctions for the prizes. However, such funds are of limited use to poor people, who lack both the income to pay subscriptions and the social position to gain the confidence of the company. The transition to formalised services is not inevitable. Informal and formal arrangements continue to exist side-by-side even in industrialised countries. In Oxford, UK, ROSCAS have enabled people with very limited capital of their own to increase their chances of obtaining a small business loan (Srinivasan, 1995). A detailed comparative study of credit use among low-income Pakistani, Bangladeshi, and Carribean immigrants in the UK revealed enormous differ- ences in their use of financial services. In all cases sources of credit were class- ified into high-street credit, local commercial credit, mail order, social fund, community-based credit, and 'miscellaneous' (including friends, family, and employer). Unlike the Bangladeshis, the Pakistani and Carribean respond- ents reported community-based, ROSCA-like arrangements. Bangladeshi respondents made much more use of formal bank credit than the others, although they had at least as high a proportion of applications rejected, apparently on racial grounds (Herbert and Kempson, 1996). Abugre (1994) points out that transition and change can be rapid, discon- tinuous, and turbulent rather than smooth and linear. There is therefore likely to be a multiplicity of arrangements, some of which become formalised, while others die out, and yet others are initiated. The implication for those interested in providing financial services is that such a role must be carefully thought through, and be flexible and responsive to changing circumstances. 2.5 What can be learned from informal finance? Having briefly explored the range of financial services which may exist, it is clear that informal finance is a regular feature of poor people's lives. What can be learned from this? The continuation of a large number of different forms suggest the following points (partly adapted from Adams, 1992). 23 Microfinance and Poverty Reduction There is clearly a demand for financial services The range of informal financial services available partly reflects the varied requirements which people, both rich and poor, have for financial services. They may also be explained in terms of the actions of people with excess cash seeking to earn income from lending. In some cases, especially where there is a monopoly, or collusion among providers, this can be exploitative for the borrower. Informal services available include savings facilities, provision of credit for consumption, and funding for predictable but expensive events such as marriages and funerals. This is in significant contrast to the services that NGOs have generally offered, which have usually been limited to the provision of credit for production. Transaction costs are low. Transaction costs are the costs, other than interest payments, which are incurred in making a deposit or taking a loan. They include travel, time away from other activities, related 'gifts' which might have to be offered to bank or government officials, costs in obtaining documenta- tion required, such as land certificates, and so on. Compared to formal services, local informal services generally require very little form-filling or travel. However, the advantage to the borrower of low transaction costs may be more than counterbalanced by their lack of power in setting the terms of a loan, which may be exploitative. Informal services impose their own discipline. The flow of information locally and the small number of providers of informal finance often act as powerful incentives to users to repay loans or save in a disciplined way. A ROSCA member failing to pay their instalment risks social ostracism from neighbours, friends, and relatives; they may be less likely to receive help from these people in times of severe difficulty in future. Poor people are capable of saving The evidence of informal systems disproves the assumption that poor people cannot save. Saving 'in kind' has long been a recognised part of people's livelihood management: saving in cash is a necessity of interaction with the cash economy. Indeed it is often the poorest, who are landless or for other reasons dependent on casual, poorly-paid jobs, who gain a large proportion of their incomes in cash and therefore have most need of savings facilities. The evidence shows that poor people are not only willing to save but at present often pay highly for savings facilities. 24 Informal systems are adaptable. Informal financial services The variety of forms and functions of informal finance demonstrates the adaptability of these systems to different economic conditions and changing circumstances. This contrasts with formal systems which often have to be based on a uniform delivery model. There is thus much to be learned from informal financial systems. Indeed aspects of these systems have found their way into the design of NGO and semi-formal financial services programmes. In particular, both group-based and individual-based schemes have made use of the 'insider knowledge' of other local people: individual-based schemes, such as BRI, through personal references from local representatives, and group- based schemes, such as Grameen, through self-selecting groups of borrowers (see Chapter 1). This brief overview has not identified for whom these services exist - women and men, poor or poorest. The poorest people may find it difficult to save the amount that a ROSCA requires and hence find participation a burden or are excluded. Even if there are a number of people in similar situations, they are often marginalised or isolated and lack the social networks to create their own ROSCA with a lower fee. Indebtedness may also make it difficult for the poorest to save and build up a small asset base - a situation that will be illustrated in the case of low-income and unemployed members of the Ladywood Credit Union in the UK, a case-study scheme described in Chapter 6. There are therefore limitations to the extent to which savings-based user- owned facilities can be of use to very poor people. However, systems that allow flexible amounts to be deposited are more likely to be appropriate. 2.6 Deciding when and how to intervene Before going on to discuss ways of intervening which are useful and relevant to poor people (see Chapter 3), it is necessary to issue some warnings. Several commentators, among them NGO practitioners, have questioned the appropri- ateness of NGOs acting as providers of financial services. Abugre (1992) identifies a range of dangers, and points to the dire consequences of the job being done badly: ⚫ NGOs remain averse to charging positive real interest rates and may, consciously or otherwise, undermine traditional financial systems. ⚫ NGOs do not submit themselves to the discipline required for the provision of sustainable financial services. 25 Microfinance and Poverty Reduction ⚫ Schemes are managed by entirely unprofessional and untrained staff and are often carelessly conceived, designed, and implemented. . There are cases where NGOs have flooded the market with credit, resulting in indebtedness on the part of borrowers, and potentially regressive effects on income and wealth distribution. By extending loans which poor people are unable to pay due to factors beyond their control, or which may have simply been inappropriate in the first place, NGOs can cause a level of indebtedness which may result in the borrower having to liquidate assets in order to repay. Abugre therefore warns against the hasty introduction of new financial services by NGOs and concludes that they should concentrate on what they do well, such as providing social services and acting as confidence brokers in coinmunities. Direct provision may be a risky and problematic strategy for an NGO, particularly as the NGO may not have the range of skills required to develop microfinance interventions, nor experience of the financial skills and respon- sibility required to ensure funds are properly safeguarded and accounted for. A further range of managerial skills are also necessary in managing a portfolio of financial assets such as loans and deposits. NGOS with experience of welfare and relief have more experience of channelling funds than managing them (Bouman, 1995). An NGO must ask itself whether it has the skills to become a banker.. An organisation lacking the relevant skills may consider acquiring them either through recruitment or staff development. Such a strategy itself has important consequences. These skills may be in short supply and recruit- ment prove difficult; they take time to develop and are acquired through experience as well as training. There is often a strong impetus to start work even if the skills of staff are still weak. This can endanger the intervention itself since it is at this early stage that users gain an impression of the nature of the operation, and inexperienced staff are likely to make mistakes. Embarking on direct intervention also raises questions about the long-term sustainability of the service on offer. Financial services should not be provided on a transient or temporary basis. There needs to be a degree of permanence to enable people to plan for their future finan- cial needs. Consideration of the long-term future for a system of finan- cial service provision is therefore important at the outset. Direct provision by an NGO which expects to move away from the area would seldom be appropriate. 26 Informal financial services There is a further range of issues at the level of the macro-economy which should also be considered when deciding whether to intervene. Macro- economic stability is an important pre-requisite for getting a scheme off the ground. Hyper-inflation and economic instability do not encourage individuals to save, and loans under such circumstances are difficult to manage. (However, in Mexico, while formal-sector banks were reeling from massive default caused by the high interest rates and high inflation of 1995, URAC, one of the case-study institutions discussed in Chapter 6, continued to thrive.) Political stability is also needed, since without it there is unlikely to be much confidence in the long-term future of new financial institutions. Before considering scheme design an NGO must also investigate the formal legal regulatory requirements for organisations involved in financial service provision, especially for savings (see Chapter 3). 2.6.1 Research questions on existing informal financial services In carrying out research into the services available, and how they are used, an intervener should try to find answers to a wide range of questions, such as: How do people manage their savings deposits? Are there savings banks, or deposit takers, insurance salesmen, or savings clubs? Do poor people have access to them? If not, how do they save (for example, gold, livestock). Who among the poor uses them (men, women, landless labourers, subsistence farmers etc)? (Extensive use of expensive deposit takers might indicate that the NGO should look first at the reasons why alternatives are not in place: and second at whether there is any possibility for the NGO to get involved, either as promoter or as provider, in savings collection.) How do people temporarily realise the value of assets they hold? Are there pawnbrokers or are there schemes that allow them to pawn land or other major assets (eg jewellery) safely? Who uses these services? (If such devices exist, are they exploitative or enabling? If they are clearly exploitative, there might be a case for an NGO to try to provide or promote an alternative.) How do people get access to the current value of future savings? Are there money-lenders willing to advance small loans against future savings? Are there ROSCAS or managed or commercial chits, or co-operative 2 In a background paper commissioned for the purposes of this book, Shahin Yaqub examined the 'Macroeconomic Conditions for Successful Microfinance for Poor People'. The paper is available from the Policy Department, Oxfam (UK and Ireland). 27 banks? Do poor people have access? Which poor people use them? (If money-lenders appear to be exploiting users, for example by imposing very high interest rates or linking loans to disadvantageous deals over land, labour or commodities, then there might be a case for the NGO to introduce ROSCAS or annual savings clubs, or work as a promoter of self-help groups or credit unions.) How do people make provision for known life-cycle expenses? Do they provide for daughters' marriages, their own old age and funeral, for their heirs? Are there clubs that satisfy these needs, or general savings services or insurance companies that will do as well? Are there government or employer-run schemes? Are there particular expenses for which women have responsibility? How do people cope with emergencies? What happens when a breadwinner is ill, or when a flood or drought occurs? Does the government have schemes that reach poor people in these circumstances? If not, what local provision do people make? How do small-scale entrepreneurs get access to business finance? If so, in what amounts and at what cost? Do women entrepreneurs have access? During the exploratory work done to answer these questions another set of information will come to light-the absolute quantities of cash involved in local financial intermediation. This can be of immense value to scheme designers in cases where a decision is made to intervene. For example, information about amounts repaid regularly to money-lenders will be useful in setting loan sizes and repayment schedules for loan schemes. (Source: Rutherford, 1996.) Much can be learned from the way in which people are already managing their finances. A further aspect is the social relations involved-the groups of people who get together to form ROSCAS, those from whom loans are taken, and those with whom deposits are lodged. Tierney's work on the Oxfam- funded Youth Employment Groups in Tabora Region of Tanzania demon- strates that the design of the intervention, which was based around groups of people with the same occupational background, did not correspond to the pattern of existing financial intermediation, which was organised around small kin-based groups, each including diverse enterprises. Tierney argues that 'the formation of development groups can, ironically, divert people's energy away from improving their lives, because forming the kind of groups which are eligible for financial assistance is a time-consuming activity involving skill 28 Informal financial services in manipulating and maintaining public relations' (Tierneyforthcoming). This illustrates the value of understanding how indigenous financial systems operate, before designing a new microfinance initiative. 2.7 Filling the gaps As well as alerting people to the potential pitfalls of intervention, research to answer the kind of questions suggested above is likely to identify gaps in existing services. There are many ways in which such gaps can be filled and below are some examples of financial service interventions in insurance and hire purchase which can be of use to poor people. For those agencies whose motivation is poverty reduction it is important to link the identification of gaps with a poverty analysis to determine who is excluded from existing services and how such exclusion perpetuates poverty. 2.7.1 Some examples of innovative services Hire-then-purchase for the poor in Bangladesh ACTIONAID found, through the experience of running a group- based lending programme similar to that of the Grameen Bank, that many very poor people were nervous of taking a large loan — the 5,000 taka ($125) needed to buy a rickshaw, for example — in case they were not able to repay it. AA therefore devised a bire-then- purchase scheme for such people. AA bought its own rickshaws and bired them out to group members. A rickshaw driver could hire a rickshaw from AA instead of hiring one from a local 'mohajan'. If he then decided to convert bis contract with AA from hiring to buying, a proportion of the total hiring fees he had already paid was denoted as his down-payment, and be took a regular (smaller) AA loan to pay off the rest. Door-step insurance agents, Cuttack, Orissa In Cuttack, insurance agents from the Peerless company visit house- bolds in low-income areas. They offer simple endowment schemes, which from the point of view of the customers are like accumulating fixed deposit schemes: the customer puts in a fixed amount regularly and then on maturity gets it back plus profits. Life insurance cover is included in the contract. 'Bankassurance: group-based insurance for the rural poor In Bangladesh, one insurance company is pioneering an attempt to match, in the field of insurance, Grameen Bank's success in lending. 29 Delta Life Insurance has been experimenting since 1988 with cut- price basic life-insurance for rural people. Customers are arranged in groups, there is no medical examination and no age-bar, and premiums are tiny and collected weekly. Agents are also involved in Grameen-Bank-style lending and earn an extra commission for the insurance work. In fact the insurance premiums are invested directly in lending (on which healthy interest may be earned). In 1996 Delta was looking for a big NGO partner which could offer the two services- lending and insurance- side by side. Experience so far has shown that demand for such a service is high. Delta is exploring how it can extend this initiative beyond life insurance. 2.8 Promotion: an alternative strategy for NGOS Having identified the gaps in existing financial service provision, an NGO might involve itself in promotion rather than provision. The main alternatives to direct provision of financial services are ones which involve the NGO in a transitional or support role whereby activities such as mobilisation, training, and making links to other organisations are provided. A range of possible approaches are outlined. 2.8.1 Formation of savings groups and development of internal credit facilities Where ROSCAS do not exist or have limited coverage, the NGO might act as a facilitator of their formation or enable them to develop slightly more sophisti- cated systems of internal on-lending which allows savings and loans to take on more flexible formats. This approach has been used by Friends of Women's World Banking in India. In this case the NGO is mainly involved in training and organising the groups. Self-help groups (SHGs) are NGO-led attempts to promote savings clubs, or simple forms of credit union. Those initiated by Friends of Women's World Banking in India are aimed at poor rural women. FWWB (or its partner NGOs) persuades women from the same neigh- bourhood and from similar backgrounds to form small groups of 12 to 15 members. NGO workers encourage the women to meet regularly and frequently and during these meetings the women discuss their financial problems and ways of solving them. The solution they are steered towards involves regular small savings and the immediate conversion of those savings into small loans taken by one or two members at each meeting. Care is taken to Informal financial services involve all group members in the discussion and formulation of rules (how often to meet, the interest to be charged on loans, and repayment arrangements) and then to ensure that every member experiences for herself the activities of saving and of taking and repaying a loan. The group is asked to choose leaders who are trained to manage the group's affairs: if illiteracy or very poor educational levels are a problem then rules are kept deliberately simple (fixed equal savings, and annual dividends rather than monthly interest on savings, for example). These preparations are intended to equip the group for independent survival after the NGO stops sending workers regularly to the meetings. Groups which perform well over several months are able to obtain small bulk loans made by FWWB to the group as a collective. Where there are a number of groups in an area, FWWB may help them form a federation' (apex body') to help with liquidity problems: groups with excess savings deposit them with the federa- tion which on-lends to groups with a strong demand for loans. (Source: WWB, 1993.) However, although this type of intervention can succeed with agency help, it has yet to be proved whether savings and credit groups which are promoted by outsiders can achieve long-term independence (Rutherford, 1996). A range of questions remain: can they save sufficient funds among themselves to satisfy their own demand for loans? Can external funds be introduced into these groups without destroying their independence? 2.8.2 Promotion of small-scale formalised approaches National legislation may allow for credit unions (the World Council of Credit Unions has national and regional affiliates all over the world) or thrift and credit co-operatives (as in Sri Lanka, see 3.4.2). Another approach an NGO might adopt could be the linking up of people interested in establishing such services for themselves with other credit unions or umbrella and apex bodies that are able to promote and advise on particular financial services. Oxfam Hyderabad worked with the Federation of Thrift and Credit Associations in Andhra Pradesh, encouraging exposure visits to flourishing thrift and credit societies by potential members from other areas. The members now have a source of consumption credit based on their own savings. Oxfam Hyderabad saw its support for linking potential groups with an existing thrift and credit structure as a move away from direct funding of NGOs to provide credit. (Source: Oxfam (India) Trust, 1993.) 31 2.8.3 Linking groups to the formal system Existing savings groups or ROSCAS may already have bank savings accounts but are unable to take loans because the bank does not understand their operations or believe them to be creditworthy. The NGO might work with groups to encourage them to build up savings and deposit them in formal institutions. The NGO may then be able to work with a local bank to encour- age it to extend its services to groups. In Ghana, rural banking legislation was designed to create semi- autonomous local banks which would serve people cut off from financial services. However, the banks have experienced a range of problems which led to only 23 out of a total of 123 being classified as operating satisfactorily in 1992 (Onumah, 1995). In 1991 the Garu Bank, a small rural bank set up in 1983 in Ghana, was near to collapse as a result of embezzlement and bad loans. The people of Garu persuaded a member of their own community who was working in Accra to come back to the area and become theman- ager. The Bank is a unit bank and operates relatively autonomously. Share capital of the Bank is owned by the local community, the Catholic Mission, the local Agricultural Station and a Disabled Rehabilitation Centre. Helped by an additional capital injection of $30,000 received from overseas donors via the Catholic Mission the manager trans- formed the situation, and expected to report a profit for the first time. The bank has a range of clients, including local salaried workers such as teachers and government employees. These people are good customers because they take loans which are easily recoverable in the form of deductions made from their salaries at source. Alongside these customers, the Bank provides services to some 300 farmers' groups. Some of these groups were originally formed by the local Agricultural Station and the Catholic Mission and bought shares in the Bank when it was first set up. The manager went to meet the groups to discuss their needs with them. He has developed his own approach to the groups, and stresses that they should be concerned with working together rather than just obtaining credit. He has set up his own criteria for lending to the groups: savings balances of at least 10 per cent of the loan amount; regularity of savings as an indicator of group cohesion; and that the group should have been operating for at least six months. Repayment of the loan on time results in almost automatic qualification for a new loan the following year (although be bad refused loans to a number of groups the previous year due to poor performance). (Source: Abugre, Johnson et al, 1995.) ",Financial,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","My family loves to eat cereal but there's a lot of unhealthy cereal at supermarkets. When I go shopping for cereal, what do I look for to get healthy cereal?","Cereal is a quick, easy and delicious breakfast option. It can be healthy, too — if you’re filling your cereal bowl from the right box. Many of the eye-catching boxes in the cereal aisle are more sugar bombs than balanced breakfasts, says registered dietitian Beth Czerwony, RD. (Spoiler alert: Funny-shaped marshmallows DO NOT offer much nutritional value.) So, how can you choose a breakfast cereal worthy of spooning for the most important meal of the day? Czerwony has a few suggestions. All the information you need to separate the healthy cereal options from those that are sweet treats in disguise is readily available. All it takes is some nutrition label reading while you’re shopping. “Want to know what cereal is healthy?” asks Czerwony. “The answer is on the side of the box.” Here’s what you want to find: Whole grains supply a healthy foundation for cereals. It doesn’t matter whether it’s whole wheat, whole-grain flour, whole-grain oats or whole-grain brown rice either. “When it comes to nutritional value, whole grains provide quite a payoff,” says Czerwony. Compared to white flour and other refined grains, whole grains are higher in fiber, protein and nutrients, like iron, magnesium, selenium and B vitamins. The reason? Those processed grains lose much of their nutritional value during the milling process. A diet rich in whole grains also can lower your risk of heart disease and help prevent diabetes. (Talk about getting a lot done at breakfast!) Another bonus of whole grain? Fiber, which is fabulous for digestion and your gut health “Fiber slows down digestion so that sugars from what you ate trickle into your bloodstream,” explains Czerwony. “You don’t have those highs and lows, which keeps your body in better balance.” Fiber helps you stay full, too — which means a hearty bowl of fiber-rich cereal for breakfast can help hold you over until lunch and keep your stomach from rumbling during a mid-morning meeting. Pro tip: Aim for at least 3 grams of fiber per serving with cereal. Protein can also help you feel full. While sweet cereals may have only 1 or 2 grams of protein, healthier options can have closer to 10 grams. (Oatmeal can run even higher in the protein count, too, if you count it as a cereal.) Let’s start with this basic fact: Most Americans eat way more than the recommended daily limit on sugar. (In case you’re wondering, the general rule of thumb for daily sugar intake is no more than 36 grams for men and 25 grams for women). To start your day on the right foot, look for lower-sugar cereals with less than 9 grams of sugar per serving. “Keep it in the single digits,” recommends Czerwony. Another good guideline: Don’t pick cereals with sugar listed in the top five ingredients. And beware of “sugar imposters” such as glucose, maltodextrin, high fructose corn syrup and evaporated cane juice. Salt in cereal? You bet — and sweeter cereals are more likely to have elevated sodium levels. “Sweet and salt go together,” says Czerwony. “Manufacturers will add that sodium in to make something sweet taste even sweeter.” Look to choose a cereal with less than 140 milligrams of sodium per serving. Aim for an even lower number if you have high blood pressure (hypertension) or kidney issues. Cereal can be pretty sneaky. Healthy-sounding options like granola, for instance, can pack a surprising amount of fat, sugar and unwanted carbohydrates into those crunchy breakfast nuggets. “A cereal may contain whole grains and be high in fiber and still not be the best choice depending on what else is tossed in there,” cautions Czerwony. “It’s easy to make something unhealthy.” That means it’s up to you to be savvy when looking at the nutrition label and ingredients list. (Want to learn more about reading a nutrition label? Then check out these tips from a registered dietitian.) Your best bet for cereals is to keep your selection plain. “That’s code for skipping flavored and frosted varieties,” says Czerwony. So, you’re going to make a healthy choice and select a basic cereal without magical marshmallows or miniature cookies. The good news? It’s pretty easy to add some excitement to that plain bowl. “A lot of cereals are a neutral when it comes to taste,” notes Czerwony. “That gives you a lot of room to drop in some healthy flavor.” She suggests adding: Fresh fruit. “Topping your cereal with blueberries or some other fresh fruit adds a lot of zing while also being good for you, says Czerwony. (Try to avoid sprinkling in dried fruits, though, as they can be high in sugar.) Nuts. Dropping a few almonds or walnuts on top of your cereal brings crunchy goodness, and nuts are full of health benefits. But watch quantities, as a big pile of nuts can be high in calories. Spices. A dash of cinnamon or another favorite spice can punch up a bowl of cereal. “Spices are great alternatives because they add flavor without adding extra sugar or fats,” says Czerwony. Natural sweeteners. Still craving some sweetness? If so, a drizzle of pure maple syrup or honey may satisfy your sweet tooth. “They’re better for you than refined sugars,” she says. “Moderation is still key, though.”","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== My family loves to eat cereal but there's a lot of unhealthy cereal at supermarkets. When I go shopping for cereal, what do I look for to get healthy cereal? {passage 0} ========== Cereal is a quick, easy and delicious breakfast option. It can be healthy, too — if you’re filling your cereal bowl from the right box. Many of the eye-catching boxes in the cereal aisle are more sugar bombs than balanced breakfasts, says registered dietitian Beth Czerwony, RD. (Spoiler alert: Funny-shaped marshmallows DO NOT offer much nutritional value.) So, how can you choose a breakfast cereal worthy of spooning for the most important meal of the day? Czerwony has a few suggestions. All the information you need to separate the healthy cereal options from those that are sweet treats in disguise is readily available. All it takes is some nutrition label reading while you’re shopping. “Want to know what cereal is healthy?” asks Czerwony. “The answer is on the side of the box.” Here’s what you want to find: Whole grains supply a healthy foundation for cereals. It doesn’t matter whether it’s whole wheat, whole-grain flour, whole-grain oats or whole-grain brown rice either. “When it comes to nutritional value, whole grains provide quite a payoff,” says Czerwony. Compared to white flour and other refined grains, whole grains are higher in fiber, protein and nutrients, like iron, magnesium, selenium and B vitamins. The reason? Those processed grains lose much of their nutritional value during the milling process. A diet rich in whole grains also can lower your risk of heart disease and help prevent diabetes. (Talk about getting a lot done at breakfast!) Another bonus of whole grain? Fiber, which is fabulous for digestion and your gut health “Fiber slows down digestion so that sugars from what you ate trickle into your bloodstream,” explains Czerwony. “You don’t have those highs and lows, which keeps your body in better balance.” Fiber helps you stay full, too — which means a hearty bowl of fiber-rich cereal for breakfast can help hold you over until lunch and keep your stomach from rumbling during a mid-morning meeting. Pro tip: Aim for at least 3 grams of fiber per serving with cereal. Protein can also help you feel full. While sweet cereals may have only 1 or 2 grams of protein, healthier options can have closer to 10 grams. (Oatmeal can run even higher in the protein count, too, if you count it as a cereal.) Let’s start with this basic fact: Most Americans eat way more than the recommended daily limit on sugar. (In case you’re wondering, the general rule of thumb for daily sugar intake is no more than 36 grams for men and 25 grams for women). To start your day on the right foot, look for lower-sugar cereals with less than 9 grams of sugar per serving. “Keep it in the single digits,” recommends Czerwony. Another good guideline: Don’t pick cereals with sugar listed in the top five ingredients. And beware of “sugar imposters” such as glucose, maltodextrin, high fructose corn syrup and evaporated cane juice. Salt in cereal? You bet — and sweeter cereals are more likely to have elevated sodium levels. “Sweet and salt go together,” says Czerwony. “Manufacturers will add that sodium in to make something sweet taste even sweeter.” Look to choose a cereal with less than 140 milligrams of sodium per serving. Aim for an even lower number if you have high blood pressure (hypertension) or kidney issues. Cereal can be pretty sneaky. Healthy-sounding options like granola, for instance, can pack a surprising amount of fat, sugar and unwanted carbohydrates into those crunchy breakfast nuggets. “A cereal may contain whole grains and be high in fiber and still not be the best choice depending on what else is tossed in there,” cautions Czerwony. “It’s easy to make something unhealthy.” That means it’s up to you to be savvy when looking at the nutrition label and ingredients list. (Want to learn more about reading a nutrition label? Then check out these tips from a registered dietitian.) Your best bet for cereals is to keep your selection plain. “That’s code for skipping flavored and frosted varieties,” says Czerwony. So, you’re going to make a healthy choice and select a basic cereal without magical marshmallows or miniature cookies. The good news? It’s pretty easy to add some excitement to that plain bowl. “A lot of cereals are a neutral when it comes to taste,” notes Czerwony. “That gives you a lot of room to drop in some healthy flavor.” She suggests adding: Fresh fruit. “Topping your cereal with blueberries or some other fresh fruit adds a lot of zing while also being good for you, says Czerwony. (Try to avoid sprinkling in dried fruits, though, as they can be high in sugar.) Nuts. Dropping a few almonds or walnuts on top of your cereal brings crunchy goodness, and nuts are full of health benefits. But watch quantities, as a big pile of nuts can be high in calories. Spices. A dash of cinnamon or another favorite spice can punch up a bowl of cereal. “Spices are great alternatives because they add flavor without adding extra sugar or fats,” says Czerwony. Natural sweeteners. Still craving some sweetness? If so, a drizzle of pure maple syrup or honey may satisfy your sweet tooth. “They’re better for you than refined sugars,” she says. “Moderation is still key, though.” https://health.clevelandclinic.org/how-to-pick-a-healthy-cereal",Retail/Product,Find & Summarize,Text Transformation Use only information found in this text to provide your answer.,How many citations are found in this text? List them.,"How Much Debt is Outstanding? Gross federal debt is composed of debt held by the public and intragovernmental debt. Debt held by the public—issued through the Bureau of the Fiscal Service—is the total amount the federal government has borrowed from the public and remains outstanding. This measure is generally considered to be the most relevant in macroeconomic terms because it is the amount of debt sold in credit markets. Intragovernmental debt is the amount owed by the federal government to other federal agencies, primarily in the Social Security, Medicare, and Civil Service Retirement and Disability trust funds, to be paid by Treasury.33 The Bureau of the Fiscal Service provides various breakdowns of debt figures. The most up-todate data on federal debt can be found on the “Debt to the Penny” section of the Bureau’s Treasury Direct website.34 The Daily Treasury Statement (DTS) and Monthly Treasury Statement (MTS) provide greater detail on the composition of federal debt, including the operating cash balance, the types of debt sold, the amount of debt subject to the debt limit, and federal tax deposits.35 The Monthly Statement of the Public Debt (MSPD) includes figures from the DTS as well as more detailed information on the types of Treasury securities outstanding.36","TEXT BLOCK: How Much Debt is Outstanding? Gross federal debt is composed of debt held by the public and intragovernmental debt. Debt held by the public—issued through the Bureau of the Fiscal Service—is the total amount the federal government has borrowed from the public and remains outstanding. This measure is generally considered to be the most relevant in macroeconomic terms because it is the amount of debt sold in credit markets. Intragovernmental debt is the amount owed by the federal government to other federal agencies, primarily in the Social Security, Medicare, and Civil Service Retirement and Disability trust funds, to be paid by Treasury.33 The Bureau of the Fiscal Service provides various breakdowns of debt figures. The most up-todate data on federal debt can be found on the “Debt to the Penny” section of the Bureau’s Treasury Direct website.34 The Daily Treasury Statement (DTS) and Monthly Treasury Statement (MTS) provide greater detail on the composition of federal debt, including the operating cash balance, the types of debt sold, the amount of debt subject to the debt limit, and federal tax deposits.35 The Monthly Statement of the Public Debt (MSPD) includes figures from the DTS as well as more detailed information on the types of Treasury securities outstanding.36 SYSTEM INSTRUCTION: Use only information found in this text to provide your answer. QUESTION: How many citations are found in this text? List them.",Financial,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","In this paper, describe the proposed method about deep reinforcement learning based on LSTM. Explain how the usage of an unlicensed spectrum is optimized by the DRL system.","C. Channel Coding A noticeable feature of the air interface of the 5G is the use of new channel coding techniques: Data channels use lowdensity parity-check (LDPC) codes, and control channels use polar codes [18]. However, the use of these techniques have some limitations. For instance, polar codes can achieve excellent performance, but it takes several iterations to achieve this performance, and there is no way to predict how fast polar codes can reach this desired performance. In addition, LDPC codes suffer from high complexity of decoding when either it is used with large block or the channel is under colored noise. Deep learning is well-known for its high parallelism structure, which can implement one-shot coding/decoding. Thus, many researchers predict that deep learning-based channel coding is a propitious method to enable 5G NR. For instance, the authors of [19] proposed reinforcement learning for effective decoding strategies for binary linear codes such as ReedMuller and BCH codes, and as a case study, they considered bit-flipping decoding. The authors mapped learned bit-flipping decoding to a Markov decision process and reformulated the decoding problem using both standards and fitted Q-learning with a neural network. The neural network architecture consists of two hidden layers with 500 and 1500 neurons with ReLu activation functions. For the training hyperparameters, the authors considered ten iterations and 0.99 as a discount factor. The SNR is ranging from -2dB to 8dB. The authors considered two types of channels, binary symmetric channel, and Additive White Gaussian Noise (AWGN) channel. The authors of [20] proposed three types of deep neural networks for channel decoding for 5G, multi-layer perceptron, convolutional neural network, and recurrent neural network. The authors used polar codes with rate 1/2 and three codeword lengths 8, 16, and 32. The signal to noise ratio is from -2 dB to 20 dB. The authors showed that the recurrent neural network has the best decoding performance but at the cost of high computation time. The authors of [21] studied a low latency, robust, and scalable convolutional neural network-based decoder of convolutional and LPDC codes. The convolution decoder is trained to decode in a single-shot using Mixed-SNR independent sampling. The CNN decoder is tested with different block lengths of 100, 200, and 1000 under the AWGN channel and with total samples of 109 samples, and SNR is ranging from -4dB to 4dB. The proposed model is compared with Viterbi, BiGRY, and bit flipping based decoders using bit error rate and block error rate. The authors showed that CNN outperforms the previously mentioned decoders regarding BER and BLER. Also, CNN decoder is eight times faster than RNN decoders. Another example of deep learning-based channel decoder is proposed in [22]. The proposed deep learning models consists of an iterative belief propagation concatenated with a convolutional neural network (BP-CNN) LDPC decoding under correlated noise, CNN for denoising the received signal and BP for decoding. The authors considered the AWGN channel and BPSK modulation. The authors showed that BPCNN reduces the decoding bit error rate with low complexity. Further studies are required to investigate the performance of deep learning under communication channels which exhibit correlations in fading. Deep learning-based channel coding can achieve a good range of performance–complexity trade-offs, if the training is performed correctly as the choice of code-word length, causes over-fitting and under-fitting. D. Intelligent Radio Resource and Network Management Radio resources are scarce, and there is an increasing demand of wireless traffic. Intelligent wireless network management is the way forward to meet these increasing demands. Machine learning/deep learning can be a promising feature for resource allocation in 5G wireless communication networks. Deep learning can be a good alternative for interference management, spectrum management, multi-path usage, link adaptation, multi-channel access, and traffic congestion. For instance, the authors of [23] proposed an AI scheduler to infer the free slots in a multiple frequencies time division multiple access to avoid congestion and high packet loss. Four last frames state are fed to a neural network, which consists of two fully connected hidden layers. The proposed AI scheduler was tested in a wireless sensor network of 5 nodes and can reduce the collisions with other networks with 50%. The authors of [24] proposed the addition of the artificial intelligence module instead of replacing conventional scheduling module in LTE systems. This AI module can provide conventional scheduling algorithms with the flexibility and speed up the convergence time. As scheduling for cooperative localization is a critical process to elevate the coverage and the localization precision, the authors of [25] presented a deep reinforcement learning for decentralized cooperative localization scheduling in vehicular networks. The authors of [26] proposed a deep reinforcement learning (DRL) based on LSTM to enables small base stations to perform dynamic spectrum access to an unlicensed spectrum. The model enables the dynamic selection of wireless channel, carrier aggregation, and fractional spectrum access. The coexistence of WLAN and other LTE-LAA operators transmitting on the same channel is formulated as a game between the two and each of which aims to maximize its rate while achieving long-term equal-weighted fairness. This game is solved using DRL-LSTM. The proposed framework showed significant improvement. The authors of [27] proposed an AI framework for smart wireless network management based on CNN and RNN to extract both the sequential and spatial features from the raw signals. These features serve as a state of deep reinforcement learning which defines the optimal network policy. The proposed framework was tested using real-experiment an experiment using a real-time heterogeneous wireless network test-bed. The proposed AI framework enhances the average throughput by approximately 36%. However, the proposed framework is costly in terms of training time and memory usage. The authors of [28] proposed a deep-reinforcement learning approach for SDN routing optimization. To evaluate the performance of the proposed DRL based routing model, the scalefree network topology of 14 nodes, and 21 full-duplex links, with uniform link capacities and average node degree of 3, and traffic intensity levels from 12.5% to 125% of the total network capacity. The trained DRL routing model can achieve similar configurations that of methods such as analytical optimization or local-search heuristic methods with minimal delays. Some other work on routing can be found in [29], [30]. Another aspect of network management is interference management. Interference management often relays on algorithms such as WMMSE. This algorithm is costly as it uses matrix inversion, to solve the problem of numerical optimization in signal processing, the authors of [31] proposed to approximate the WMMSE used for interference management, which is has a central role in enabling Massive MIMO systems. The authors showed that SP optimization algorithms could be approximated by a finite-size neural network.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. In this paper, describe the proposed method about deep reinforcement learning based on LSTM. Explain how the usage of an unlicensed spectrum is optimized by the DRL system. C. Channel Coding A noticeable feature of the air interface of the 5G is the use of new channel coding techniques: Data channels use lowdensity parity-check (LDPC) codes, and control channels use polar codes [18]. However, the use of these techniques have some limitations. For instance, polar codes can achieve excellent performance, but it takes several iterations to achieve this performance, and there is no way to predict how fast polar codes can reach this desired performance. In addition, LDPC codes suffer from high complexity of decoding when either it is used with large block or the channel is under colored noise. Deep learning is well-known for its high parallelism structure, which can implement one-shot coding/decoding. Thus, many researchers predict that deep learning-based channel coding is a propitious method to enable 5G NR. For instance, the authors of [19] proposed reinforcement learning for effective decoding strategies for binary linear codes such as ReedMuller and BCH codes, and as a case study, they considered bit-flipping decoding. The authors mapped learned bit-flipping decoding to a Markov decision process and reformulated the decoding problem using both standards and fitted Q-learning with a neural network. The neural network architecture consists of two hidden layers with 500 and 1500 neurons with ReLu activation functions. For the training hyperparameters, the authors considered ten iterations and 0.99 as a discount factor. The SNR is ranging from -2dB to 8dB. The authors considered two types of channels, binary symmetric channel, and Additive White Gaussian Noise (AWGN) channel. The authors of [20] proposed three types of deep neural networks for channel decoding for 5G, multi-layer perceptron, convolutional neural network, and recurrent neural network. The authors used polar codes with rate 1/2 and three codeword lengths 8, 16, and 32. The signal to noise ratio is from -2 dB to 20 dB. The authors showed that the recurrent neural network has the best decoding performance but at the cost of high computation time. The authors of [21] studied a low latency, robust, and scalable convolutional neural network-based decoder of convolutional and LPDC codes. The convolution decoder is trained to decode in a single-shot using Mixed-SNR independent sampling. The CNN decoder is tested with different block lengths of 100, 200, and 1000 under the AWGN channel and with total samples of 109 samples, and SNR is ranging from -4dB to 4dB. The proposed model is compared with Viterbi, BiGRY, and bit flipping based decoders using bit error rate and block error rate. The authors showed that CNN outperforms the previously mentioned decoders regarding BER and BLER. Also, CNN decoder is eight times faster than RNN decoders. Another example of deep learning-based channel decoder is proposed in [22]. The proposed deep learning models consists of an iterative belief propagation concatenated with a convolutional neural network (BP-CNN) LDPC decoding under correlated noise, CNN for denoising the received signal and BP for decoding. The authors considered the AWGN channel and BPSK modulation. The authors showed that BPCNN reduces the decoding bit error rate with low complexity. Further studies are required to investigate the performance of deep learning under communication channels which exhibit correlations in fading. Deep learning-based channel coding can achieve a good range of performance–complexity trade-offs, if the training is performed correctly as the choice of code-word length, causes over-fitting and under-fitting. D. Intelligent Radio Resource and Network Management Radio resources are scarce, and there is an increasing demand of wireless traffic. Intelligent wireless network management is the way forward to meet these increasing demands. Machine learning/deep learning can be a promising feature for resource allocation in 5G wireless communication networks. Deep learning can be a good alternative for interference management, spectrum management, multi-path usage, link adaptation, multi-channel access, and traffic congestion. For instance, the authors of [23] proposed an AI scheduler to infer the free slots in a multiple frequencies time division multiple access to avoid congestion and high packet loss. Four last frames state are fed to a neural network, which consists of two fully connected hidden layers. The proposed AI scheduler was tested in a wireless sensor network of 5 nodes and can reduce the collisions with other networks with 50%. The authors of [24] proposed the addition of the artificial intelligence module instead of replacing conventional scheduling module in LTE systems. This AI module can provide conventional scheduling algorithms with the flexibility and speed up the convergence time. As scheduling for cooperative localization is a critical process to elevate the coverage and the localization precision, the authors of [25] presented a deep reinforcement learning for decentralized cooperative localization scheduling in vehicular networks. The authors of [26] proposed a deep reinforcement learning (DRL) based on LSTM to enables small base stations to perform dynamic spectrum access to an unlicensed spectrum. The model enables the dynamic selection of wireless channel, carrier aggregation, and fractional spectrum access. The coexistence of WLAN and other LTE-LAA operators transmitting on the same channel is formulated as a game between the two and each of which aims to maximize its rate while achieving long-term equal-weighted fairness. This game is solved using DRL-LSTM. The proposed framework showed significant improvement. The authors of [27] proposed an AI framework for smart wireless network management based on CNN and RNN to extract both the sequential and spatial features from the raw signals. These features serve as a state of deep reinforcement learning which defines the optimal network policy. The proposed framework was tested using real-experiment an experiment using a real-time heterogeneous wireless network test-bed. The proposed AI framework enhances the average throughput by approximately 36%. However, the proposed framework is costly in terms of training time and memory usage. The authors of [28] proposed a deep-reinforcement learning approach for SDN routing optimization. To evaluate the performance of the proposed DRL based routing model, the scalefree network topology of 14 nodes, and 21 full-duplex links, with uniform link capacities and average node degree of 3, and traffic intensity levels from 12.5% to 125% of the total network capacity. The trained DRL routing model can achieve similar configurations that of methods such as analytical optimization or local-search heuristic methods with minimal delays. Some other work on routing can be found in [29], [30]. Another aspect of network management is interference management. Interference management often relays on algorithms such as WMMSE. This algorithm is costly as it uses matrix inversion, to solve the problem of numerical optimization in signal processing, the authors of [31] proposed to approximate the WMMSE used for interference management, which is has a central role in enabling Massive MIMO systems. The authors showed that SP optimization algorithms could be approximated by a finite-size neural network. https://arxiv.org/pdf/2009.04943",Internet/Technology,Explanation/Definition,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","What is SpaceX about? What are its achievements, missions, and prospects if any mentioned? Summarize all these in a bulleted list of about 500 words.","SpaceX, American aerospace company founded in 2002 that helped usher in the era of commercial spaceflight. It was the first private company to successfully launch and return a spacecraft from Earth orbit and the first to launch a crewed spacecraft and dock it with the International Space Station (ISS). Headquarters are in Hawthorne, California. SpaceX was formed by entrepreneur Elon Musk in the hopes of revolutionizing the aerospace industry and making affordable spaceflight a reality. The company entered the arena with the Falcon 1 rocket, a two-stage liquid-fueled craft designed to send small satellites into orbit. The Falcon 1 was vastly cheaper to build and operate than its competitors, a field largely populated by spacecraft built by publicly owned and government-funded companies such as Lockheed Martin and Boeing. Part of the rocket’s cost-effectiveness was made possible by the SpaceX-developed Merlin engine, a cheaper alternative to those used by other companies. SpaceX also focused on making reusable rockets (other launch vehicles are generally made for one-time use). Falcon 1 rocketLaunch of a Falcon 1 rocket from the SpaceX launch site on Kwajalein Atoll, Marshall Islands, September 28, 2008. Dragon on recovery shipThe SpaceX Dragon spacecraft secured aboard the deck of a recovery ship after its first successful orbital flight, December 8, 2010. In March 2006 SpaceX made its first Falcon 1 launch, which began successfully but ended prematurely because of a fuel leak and fire. By this time, however, the company had already earned millions of dollars in launching orders, many of them from the U.S. government. In August of that year SpaceX was a winner of a NASA competition for funds to build and demonstrate spacecraft that could potentially service the ISS after the decommissioning of the space shuttle. Falcon 1 launches that failed to attain Earth orbit followed in March 2007 and August 2008, but in September 2008 SpaceX became the first privately owned company to send a liquid-fueled rocket into orbit. Three months later it won a NASA contract for servicing the ISS that was worth more than $1 billion. Witness the launch of the SpaceX Dragon capsule, May 25, 2012 Witness the launch of the SpaceX Dragon capsule, May 25, 2012Video released by spacecraft maker SpaceX celebrating its Dragon capsule, which on May 25, 2012, became the first commercial spacecraft to dock with the International Space Station. See all videos for this article Learn about SpaceX, the first private company in history to send a spacecraft, which it named Dragon, to the International Space Station Learn about SpaceX, the first private company in history to send a spacecraft, which it named Dragon, to the International Space StationVideo released by the spacecraft maker SpaceX in August 2012 after it won a contract with NASA to prepare its Dragon spacecraft to carry astronauts into space. See all videos for this article In 2010 SpaceX first launched its Falcon 9, a bigger craft so named for its use of nine engines, and the following year it broke ground on a launch site for the Falcon Heavy, a craft the company hoped would be the first to break the $1,000-per-pound-to-orbit cost barrier and that might one day be used to transport astronauts into deep space. In December 2010 the company reached another milestone, becoming the first commercial company to release a spacecraft—the Dragon capsule—into orbit and successfully return it to Earth. Dragon again made history on May 25, 2012, when it became the first commercial spacecraft to dock with the ISS, to which it successfully delivered cargo. In August that year, SpaceX announced that it had won a contract from NASA to develop a successor to the space shuttle that would transport astronauts into space. Falcon 9 first-stage landingThe landing of a Falcon 9 first stage at Cape Canaveral, Florida, December 21, 2015. This was the first time a rocket stage launched a spacecraft into orbit and then returned to a landing on Earth. SpaceX: Falcon Heavy rocketLaunch of the SpaceX Falcon Heavy rocket from the Kennedy Space Center, Cape Canaveral, Florida, February 6, 2018. The Falcon 9 was designed so that its first stage could be reused. In 2015 a Falcon 9 first stage successfully returned to Earth near its launch site. Beginning in 2016, SpaceX also began using drone ships for rocket stage landings. A rocket stage that had returned to Earth was successfully reused in a 2017 launch. That same year, a Dragon capsule was reused on a flight to the ISS. The Falcon Heavy rocket had its first test flight in 2018. Two of the three first stages landed successfully; the third hit the water near the drone ship. That Falcon Heavy did not carry a satellite but instead placed into orbit around the Sun a Tesla Roadster with a mannequin in a space suit buckled into the driver’s seat. The first operational flight of the Falcon Heavy launched on April 11, 2019. In 2019 SpaceX began launching satellites for its Starlink megaconstellation, which provides satellite Internet service. About 50 Starlink satellites are launched at a time on a Falcon 9 flight. As of 2023, Starlink had 3,660 active satellites, half of all active satellites in orbit. A further 7,500 satellites have been approved by the U.S. Federal Communications Commission, and SpaceX ultimately seeks to have 29,988 satellites orbiting between 340 and 614 km (211 and 381 miles) above Earth. The first crewed flight of a Dragon capsule to the ISS launched on May 30, 2020, with astronauts Doug Hurley and Robert Behnken. SpaceX also announced the successor to the Falcon 9 and the Falcon Heavy: the Super Heavy–Starship system (originally called the BFR [Big Falcon Rocket]). The Super Heavy first stage would be capable of lifting 100,000 kg (220,000 pounds) to low Earth orbit. The payload would be the Starship, a spacecraft designed for several purposes, including providing fast transportation between cities on Earth and building bases on the Moon and Mars. SpaceX planned to use the Starship for a flight around the Moon carrying Japanese businessman Maezawa Yusaku and several artists in 2023, for flights to land astronauts on the Moon as part of NASA’s Artemis program, and eventually to launch settlers to Mars.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What is SpaceX about? What are its achievements, missions, and prospects if any mentioned? Summarize all these in a bulleted list of about 500 words. {passage 0} ========== SpaceX, American aerospace company founded in 2002 that helped usher in the era of commercial spaceflight. It was the first private company to successfully launch and return a spacecraft from Earth orbit and the first to launch a crewed spacecraft and dock it with the International Space Station (ISS). Headquarters are in Hawthorne, California. SpaceX was formed by entrepreneur Elon Musk in the hopes of revolutionizing the aerospace industry and making affordable spaceflight a reality. The company entered the arena with the Falcon 1 rocket, a two-stage liquid-fueled craft designed to send small satellites into orbit. The Falcon 1 was vastly cheaper to build and operate than its competitors, a field largely populated by spacecraft built by publicly owned and government-funded companies such as Lockheed Martin and Boeing. Part of the rocket’s cost-effectiveness was made possible by the SpaceX-developed Merlin engine, a cheaper alternative to those used by other companies. SpaceX also focused on making reusable rockets (other launch vehicles are generally made for one-time use). Falcon 1 rocketLaunch of a Falcon 1 rocket from the SpaceX launch site on Kwajalein Atoll, Marshall Islands, September 28, 2008. Dragon on recovery shipThe SpaceX Dragon spacecraft secured aboard the deck of a recovery ship after its first successful orbital flight, December 8, 2010. In March 2006 SpaceX made its first Falcon 1 launch, which began successfully but ended prematurely because of a fuel leak and fire. By this time, however, the company had already earned millions of dollars in launching orders, many of them from the U.S. government. In August of that year SpaceX was a winner of a NASA competition for funds to build and demonstrate spacecraft that could potentially service the ISS after the decommissioning of the space shuttle. Falcon 1 launches that failed to attain Earth orbit followed in March 2007 and August 2008, but in September 2008 SpaceX became the first privately owned company to send a liquid-fueled rocket into orbit. Three months later it won a NASA contract for servicing the ISS that was worth more than $1 billion. Witness the launch of the SpaceX Dragon capsule, May 25, 2012 Witness the launch of the SpaceX Dragon capsule, May 25, 2012Video released by spacecraft maker SpaceX celebrating its Dragon capsule, which on May 25, 2012, became the first commercial spacecraft to dock with the International Space Station. See all videos for this article Learn about SpaceX, the first private company in history to send a spacecraft, which it named Dragon, to the International Space Station Learn about SpaceX, the first private company in history to send a spacecraft, which it named Dragon, to the International Space StationVideo released by the spacecraft maker SpaceX in August 2012 after it won a contract with NASA to prepare its Dragon spacecraft to carry astronauts into space. See all videos for this article In 2010 SpaceX first launched its Falcon 9, a bigger craft so named for its use of nine engines, and the following year it broke ground on a launch site for the Falcon Heavy, a craft the company hoped would be the first to break the $1,000-per-pound-to-orbit cost barrier and that might one day be used to transport astronauts into deep space. In December 2010 the company reached another milestone, becoming the first commercial company to release a spacecraft—the Dragon capsule—into orbit and successfully return it to Earth. Dragon again made history on May 25, 2012, when it became the first commercial spacecraft to dock with the ISS, to which it successfully delivered cargo. In August that year, SpaceX announced that it had won a contract from NASA to develop a successor to the space shuttle that would transport astronauts into space. Falcon 9 first-stage landingThe landing of a Falcon 9 first stage at Cape Canaveral, Florida, December 21, 2015. This was the first time a rocket stage launched a spacecraft into orbit and then returned to a landing on Earth. SpaceX: Falcon Heavy rocketLaunch of the SpaceX Falcon Heavy rocket from the Kennedy Space Center, Cape Canaveral, Florida, February 6, 2018. The Falcon 9 was designed so that its first stage could be reused. In 2015 a Falcon 9 first stage successfully returned to Earth near its launch site. Beginning in 2016, SpaceX also began using drone ships for rocket stage landings. A rocket stage that had returned to Earth was successfully reused in a 2017 launch. That same year, a Dragon capsule was reused on a flight to the ISS. The Falcon Heavy rocket had its first test flight in 2018. Two of the three first stages landed successfully; the third hit the water near the drone ship. That Falcon Heavy did not carry a satellite but instead placed into orbit around the Sun a Tesla Roadster with a mannequin in a space suit buckled into the driver’s seat. The first operational flight of the Falcon Heavy launched on April 11, 2019. In 2019 SpaceX began launching satellites for its Starlink megaconstellation, which provides satellite Internet service. About 50 Starlink satellites are launched at a time on a Falcon 9 flight. As of 2023, Starlink had 3,660 active satellites, half of all active satellites in orbit. A further 7,500 satellites have been approved by the U.S. Federal Communications Commission, and SpaceX ultimately seeks to have 29,988 satellites orbiting between 340 and 614 km (211 and 381 miles) above Earth. The first crewed flight of a Dragon capsule to the ISS launched on May 30, 2020, with astronauts Doug Hurley and Robert Behnken. SpaceX also announced the successor to the Falcon 9 and the Falcon Heavy: the Super Heavy–Starship system (originally called the BFR [Big Falcon Rocket]). The Super Heavy first stage would be capable of lifting 100,000 kg (220,000 pounds) to low Earth orbit. The payload would be the Starship, a spacecraft designed for several purposes, including providing fast transportation between cities on Earth and building bases on the Moon and Mars. SpaceX planned to use the Starship for a flight around the Moon carrying Japanese businessman Maezawa Yusaku and several artists in 2023, for flights to land astronauts on the Moon as part of NASA’s Artemis program, and eventually to launch settlers to Mars. https://www.britannica.com/topic/SpaceX",Internet/Technology,Summarize & Format,Text Transformation "You can only answer a prompt using the information contained in the prompt context, you cannot rely on your own knowledge or outside knowledge to answer, only what is shown in the literal text of the prompt.",Please summarise what the Animal Welfare Act is and what/who is affected by this act.,"In 1966, Congress passed legislation that later became known as the Animal Welfare Act (P.L. 89-544) with goals of preventing the theft and sale of pets to research laboratories and regulating the humane care and handling of dogs, cats, and other laboratory animals. The Animal Welfare Act as amended (AWA, 7 U.S.C. §§2131-2156) is the central federal statute governing the humane care and handling of mammals and certain other animals. Since its enactment, Congress has amended the law to expand the types of animals it covers and activities it regulates and to clarify various provisions. These amendments have strengthened enforcement, expanded coverage to more animals and activities, and curtailed cruel practices (e.g., animal fighting), among other things. The AWA covers any live or dead warm-blooded animal, as defined, determined by the U.S. Department of Agriculture (USDA) to be used for research, exhibition, or as a pet. In addition, the AWA addresses animal fighting and the importation of certain dogs into the United States. The AWA’s statutory definition of animal excludes birds, rats, and mice bred for research; horses not used for research; and other farm animals used in the production of food and fiber. The act applies to animal dealers (e.g., pet breeders, medical research suppliers), exhibitors (e.g., zoos, circuses), research facilities (e.g., private and federal laboratories that use animals in research), and transporters (e.g., airlines, railroads, truckers). Covered entities must meet certain standards described in law and regulation and keep certain records. The AWA establishes penalties for noncompliance. USDA’s Animal and Plant Health Inspection Service (APHIS) administers the AWA. In carrying out this responsibility, APHIS promulgates and updates AWA regulations; licenses and registers entities subject to the AWA; inspects the premises of licensed and registered entities; investigates potential violations; and enforces AWA provisions. Animal welfare issues generate significant attention from stakeholder groups. For example, animal welfare advocates have called on Congress to define specific standards for animal care within AWA legislation, increase AWA enforcement, and expand AWA coverage to even more covered animals, entities, and activities. Other stakeholders, including entities regulated under the AWA, have called on Congress to streamline USDA’s AWA oversight and enforcement. Additional issues debated in recent years include the role and care of research animals and federal oversight of pet breeding operations, circuses, and animal shelters.","You can only answer a prompt using the information contained in the prompt context, you cannot rely on your own knowledge or outside knowledge to answer, only what is shown in the literal text of the prompt. In 1966, Congress passed legislation that later became known as the Animal Welfare Act (P.L. 89-544) with goals of preventing the theft and sale of pets to research laboratories and regulating the humane care and handling of dogs, cats, and other laboratory animals. The Animal Welfare Act as amended (AWA, 7 U.S.C. §§2131-2156) is the central federal statute governing the humane care and handling of mammals and certain other animals. Since its enactment, Congress has amended the law to expand the types of animals it covers and activities it regulates and to clarify various provisions. These amendments have strengthened enforcement, expanded coverage to more animals and activities, and curtailed cruel practices (e.g., animal fighting), among other things. The AWA covers any live or dead warm-blooded animal, as defined, determined by the U.S. Department of Agriculture (USDA) to be used for research, exhibition, or as a pet. In addition, the AWA addresses animal fighting and the importation of certain dogs into the United States. The AWA’s statutory definition of animal excludes birds, rats, and mice bred for research; horses not used for research; and other farm animals used in the production of food and fiber. The act applies to animal dealers (e.g., pet breeders, medical research suppliers), exhibitors (e.g., zoos, circuses), research facilities (e.g., private and federal laboratories that use animals in research), and transporters (e.g., airlines, railroads, truckers). Covered entities must meet certain standards described in law and regulation and keep certain records. The AWA establishes penalties for noncompliance. USDA’s Animal and Plant Health Inspection Service (APHIS) administers the AWA. In carrying out this responsibility, APHIS promulgates and updates AWA regulations; licenses and registers entities subject to the AWA; inspects the premises of licensed and registered entities; investigates potential violations; and enforces AWA provisions. Animal welfare issues generate significant attention from stakeholder groups. For example, animal welfare advocates have called on Congress to define specific standards for animal care within AWA legislation, increase AWA enforcement, and expand AWA coverage to even more covered animals, entities, and activities. Other stakeholders, including entities regulated under the AWA, have called on Congress to streamline USDA’s AWA oversight and enforcement. Additional issues debated in recent years include the role and care of research animals and federal oversight of pet breeding operations, circuses, and animal shelters. Please summarise what the Animal Welfare Act is and what/who is affected by this act.",Legal,Summarize & Format,Text Transformation Use the info in this document and not any other source.,"Categorize the terms into ""Device"", ""Procedure"", and ""Other"", and exclude any financial or insurance related terms.","N Non-covered charges: Costs for dental care your insurer does not cover. In some cases the service is a covered service, but the insurer is not responsible for the entire charge. In these cases, you will be responsible for any charge not covered by your dental plan. You may wish to call your insurer or consult your dental plan or dental policy to determine whether certain services are included in your plan before you receive those services from your dentist. Non-Covered Services: Dental services not listed as a benefit. If you receive non-covered services, your dental plan will not pay for them. Your provider will bill you. You will be responsible for the full cost. Usually payments count toward deductible. Check with your insurer. Make sure you know what services are covered before you see your dentist. Nonduplication of Benefits: Occurs when you have two insurance plans. It’s how our second insurance carrier calculates its payment. The secondary carrier calculates what it would have paid if it were your primary plan. Then it subtracts what the other plan paid. Examples: Your primary carrier paid 80 percent. Your secondary carrier normally covers 80 percent. Your secondary carrier would not make any additional payment. If the primary carrier paid 50 percent. The secondary carrier would pay up to 30 percent. O Occlusion: Any contact between biting or chewing surfaces of upper and lower teeth. Occlusal Guard: A removable device worn between the upper and lower teeth to prevent clenching or grinding. [NOTE: ODONTOPLASTY WAS REMOVED] Open Enrollment/Open Enrollment Period: Time of year when an eligible person may add, change or terminate a dental plan or dental policy for the next contract year. Open Panel: Allows you to receive care from any dentist. It allows any dentist to participate. Any dentist may accept or refuse to treat patients enrolled in the plan. Open panel plans often are described as freedom of choice plans. Orthodontic Retainer: Appliance to stabilize teeth following orthodontic treatment. Glossary of Dental Insurance and Dental Care Terms 12 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Orthodontics and dentofacial orthopedics: Branch of dentistry. Includes the diagnosis, prevention, interception, and correction of malocclusion. Also includes neuromuscular and skeletal abnormalities of the developing or mature orofacial structures. Orthodontist: Specialist who treats malocclusion and other neuromuscular and skeletal abnormalities of the teeth and their surrounding structures. Orthotic device: Dental appliance used to support, align, prevent or correct deformities, or to improve the function of the oral Out-of-Network: Care from providers not on your plan. This includes dentists and clinics. Usually, you will pay more out of your own pocket when you receive dental care out-of-network providers. Out-of-network benefits: Coverage for services from providers who are not under a contract with your dental plan. Out-of-pocket cost: The amount plan members must pay for care. Includes the difference between the amount charged by a provider and what a health plan pays for such services. Out-of-Pocket Maximum: The most a dental plan requires a member to pay in a year. Deductibles, co-payments and co-insurance count toward the out-of-pocket maximum. The only dental benefits that have out-of-pocket maximums are child benefits purchased through public exchanges, or purchased as an individual or through a small group. The out-of-pocket maximum for one child is $350 and for more than one child is $700 in all states. After reaching an out-of-pocket maximum, the plan pays 100% of the cost of pediatric dental services. This only applies to covered services. Members are still responsible for services that are not covered by the plan. Members also continue to pay their monthly premiums. Overbilling: Stating fees as higher than actual charges. Example: when you are charged one fee and an insurance company is billed a higher fee. This is done to use your co-payment. It also done to increase your fees solely because you are covered under a dental benefits plan. Overdenture: See Denture/Overdenture. P Palate: The hard and soft tissues forming the roof of the mouth. It separates the oral and nasal cavities. Palliative: Treatment that relieves pain but may not remove the cause of the pain. Partial Denture: See Denture/Partial Denture. Glossary of Dental Insurance and Dental Care Terms 13 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Participating Provider: Dentists and other licensed dental providers on your plan. They have a contract with your plan. The contract includes set service fees. Payer: Party responsible for paying your claims. It can be a self-insured employer, insurance company or governmental agency. Pediatric dentist: A dental specialist. Treats children from birth through adolescence. Provides primary and comprehensive preventive and therapeutic oral health care. Formerly known as a pedodontist. Periodontal: Branch of dentistry that involves the prevention and treatment of gum disease. Periodontal disease: Inflammation process of gums and/or periodontal membrane of the teeth. Results in an abnormally deep gingival sulcus. Possibly produces periodontal pockets and loss of supporting alveolar bone. Periodontist: A dental specialist. Treats diseases of the supporting and surrounding tissues of the teeth. Periodontitis: Inflammation and loss of the connective tissue of the supporting or surrounding structure of teeth. With loss of attachment. [NOTE: PIN REMOVED] Plan Year: See Benefit Year. Plaque: A soft sticky substance. Composed largely of bacteria and bacterial derivatives. It forms on teeth daily. Point of Service (POS) Plan: A dental plan that allows you to choose at the time of dental service whether you will go to a provider within your dental plan's network or get dental care from a provider outside the network. [NOTE: PORCELAIN/CERAMIC REMOVED] [NOTE: POST REMOVED] Preauthorization: A process that your dental plan or insurer uses to make a decision that particular dental services are covered. Your plan may require preauthorization for certain services, such as crowns, before you receive them. Preauthorization requirements are generally waived if you need emergency care. Sometimes called prior authorization. [NOTE: PRECERTIFICATION REMOVED] Predetermination: A process where a dentist submits a treatment plan to the payer before treatment begins. The payer reviews the treatment plan. The payer notifies you and your dentist about one or more of the following: your eligibility, covered services, amounts payable, co-payment and deductibles and plan maximums. See preauthorization. Glossary of Dental Insurance and Dental Care Terms 14 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Pre-existing condition: A dental condition that exists for a set time prior to enrollment in a dental plan, regardless of whether the condition has been formally diagnosed. The only pre-existing condition that is common for dental plans or policies is a missing tooth. [REMOVED PRECIOUS OR HIGH NOBLE METALS – SEE METALS, CLASSIFICATIONS –ACCORDING TO CDT] Pretreatement Estimate: See predetermination. ** Preferred Provider Organization (PPO): See DPPO. Premedication: The use of medications prior to dental procedures. Prepaid dental plan: A method of funding dental care costs in advance of services. For a defined population. Premium: The amount you pay to a dental insurance company for dental coverage. The dental insurance company generally recalculates the premium each policy year. This amount is usually paid in monthly installments. When you receive dental insurance through an employer, the employer may pay a portion of the premium and you pay the rest, often through payroll deductions. Preventive Services: See diagnostic and preventive services. Primary dentition: Another name for baby teeth. See deciduous. Primary payer: The third party payer with first responsibility in a benefit determination. Prophylaxis: Scaling and polishing procedure. Performed to remove coronal plaque, calculus and stains. ** Prosthodontic: Branch of dentistry that deals with the repair of teeth by crowns, inlays or onlays and/or the replacement of missing teeth and related mouth or jaw structures by bridges, dentures, implants or other artificial devises. Prosthodontist: A dental specialist. Restores natural teeth. Replaces missing teeth with artificial substitutes. Provider: A dentist or other dental care professional, or clinic that is accredited, licensed or certified to provide dental services in their state, and is providing services within the scope of that accreditation, license or certification. Provider network: Dentists and other dental care professionals who agree to provide dental care to members of a dental plan, under the terms of a contract.","N Non-covered charges: Costs for dental care your insurer does not cover. In some cases the service is a covered service, but the insurer is not responsible for the entire charge. In these cases, you will be responsible for any charge not covered by your dental plan. You may wish to call your insurer or consult your dental plan or dental policy to determine whether certain services are included in your plan before you receive those services from your dentist. Non-Covered Services: Dental services not listed as a benefit. If you receive non-covered services, your dental plan will not pay for them. Your provider will bill you. You will be responsible for the full cost. Usually payments count toward deductible. Check with your insurer. Make sure you know what services are covered before you see your dentist. Nonduplication of Benefits: Occurs when you have two insurance plans. It’s how our second insurance carrier calculates its payment. The secondary carrier calculates what it would have paid if it were your primary plan. Then it subtracts what the other plan paid. Examples: Your primary carrier paid 80 percent. Your secondary carrier normally covers 80 percent. Your secondary carrier would not make any additional payment. If the primary carrier paid 50 percent. The secondary carrier would pay up to 30 percent. O Occlusion: Any contact between biting or chewing surfaces of upper and lower teeth. Occlusal Guard: A removable device worn between the upper and lower teeth to prevent clenching or grinding. [NOTE: ODONTOPLASTY WAS REMOVED] Open Enrollment/Open Enrollment Period: Time of year when an eligible person may add, change or terminate a dental plan or dental policy for the next contract year. Open Panel: Allows you to receive care from any dentist. It allows any dentist to participate. Any dentist may accept or refuse to treat patients enrolled in the plan. Open panel plans often are described as freedom of choice plans. Orthodontic Retainer: Appliance to stabilize teeth following orthodontic treatment. Glossary of Dental Insurance and Dental Care Terms 12 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Orthodontics and dentofacial orthopedics: Branch of dentistry. Includes the diagnosis, prevention, interception, and correction of malocclusion. Also includes neuromuscular and skeletal abnormalities of the developing or mature orofacial structures. Orthodontist: Specialist who treats malocclusion and other neuromuscular and skeletal abnormalities of the teeth and their surrounding structures. Orthotic device: Dental appliance used to support, align, prevent or correct deformities, or to improve the function of the oral Out-of-Network: Care from providers not on your plan. This includes dentists and clinics. Usually, you will pay more out of your own pocket when you receive dental care out-of-network providers. Out-of-network benefits: Coverage for services from providers who are not under a contract with your dental plan. Out-of-pocket cost: The amount plan members must pay for care. Includes the difference between the amount charged by a provider and what a health plan pays for such services. Out-of-Pocket Maximum: The most a dental plan requires a member to pay in a year. Deductibles, co-payments and co-insurance count toward the out-of-pocket maximum. The only dental benefits that have out-of-pocket maximums are child benefits purchased through public exchanges, or purchased as an individual or through a small group. The out-of-pocket maximum for one child is $350 and for more than one child is $700 in all states. After reaching an out-of-pocket maximum, the plan pays 100% of the cost of pediatric dental services. This only applies to covered services. Members are still responsible for services that are not covered by the plan. Members also continue to pay their monthly premiums. Overbilling: Stating fees as higher than actual charges. Example: when you are charged one fee and an insurance company is billed a higher fee. This is done to use your co-payment. It also done to increase your fees solely because you are covered under a dental benefits plan. Overdenture: See Denture/Overdenture. P Palate: The hard and soft tissues forming the roof of the mouth. It separates the oral and nasal cavities. Palliative: Treatment that relieves pain but may not remove the cause of the pain. Partial Denture: See Denture/Partial Denture. Glossary of Dental Insurance and Dental Care Terms 13 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Participating Provider: Dentists and other licensed dental providers on your plan. They have a contract with your plan. The contract includes set service fees. Payer: Party responsible for paying your claims. It can be a self-insured employer, insurance company or governmental agency. Pediatric dentist: A dental specialist. Treats children from birth through adolescence. Provides primary and comprehensive preventive and therapeutic oral health care. Formerly known as a pedodontist. Periodontal: Branch of dentistry that involves the prevention and treatment of gum disease. Periodontal disease: Inflammation process of gums and/or periodontal membrane of the teeth. Results in an abnormally deep gingival sulcus. Possibly produces periodontal pockets and loss of supporting alveolar bone. Periodontist: A dental specialist. Treats diseases of the supporting and surrounding tissues of the teeth. Periodontitis: Inflammation and loss of the connective tissue of the supporting or surrounding structure of teeth. With loss of attachment. [NOTE: PIN REMOVED] Plan Year: See Benefit Year. Plaque: A soft sticky substance. Composed largely of bacteria and bacterial derivatives. It forms on teeth daily. Point of Service (POS) Plan: A dental plan that allows you to choose at the time of dental service whether you will go to a provider within your dental plan's network or get dental care from a provider outside the network. [NOTE: PORCELAIN/CERAMIC REMOVED] [NOTE: POST REMOVED] Preauthorization: A process that your dental plan or insurer uses to make a decision that particular dental services are covered. Your plan may require preauthorization for certain services, such as crowns, before you receive them. Preauthorization requirements are generally waived if you need emergency care. Sometimes called prior authorization. [NOTE: PRECERTIFICATION REMOVED] Predetermination: A process where a dentist submits a treatment plan to the payer before treatment begins. The payer reviews the treatment plan. The payer notifies you and your dentist about one or more of the following: your eligibility, covered services, amounts payable, co-payment and deductibles and plan maximums. See preauthorization. Glossary of Dental Insurance and Dental Care Terms 14 * American Dental Association Current Dental Terminology 2011-2012, glossary. **Dental Benefits: A Guide to Dental PPOs, HMOs And Other Managed Plans, Don Mayes, Revised Edition, 2002. **FDA/ADA radiograph guidelines. National Association of Dental Plans, www.nadp.org Pre-existing condition: A dental condition that exists for a set time prior to enrollment in a dental plan, regardless of whether the condition has been formally diagnosed. The only pre-existing condition that is common for dental plans or policies is a missing tooth. [REMOVED PRECIOUS OR HIGH NOBLE METALS – SEE METALS, CLASSIFICATIONS –ACCORDING TO CDT] Pretreatement Estimate: See predetermination. ** Preferred Provider Organization (PPO): See DPPO. Premedication: The use of medications prior to dental procedures. Prepaid dental plan: A method of funding dental care costs in advance of services. For a defined population. Premium: The amount you pay to a dental insurance company for dental coverage. The dental insurance company generally recalculates the premium each policy year. This amount is usually paid in monthly installments. When you receive dental insurance through an employer, the employer may pay a portion of the premium and you pay the rest, often through payroll deductions. Preventive Services: See diagnostic and preventive services. Primary dentition: Another name for baby teeth. See deciduous. Primary payer: The third party payer with first responsibility in a benefit determination. Prophylaxis: Scaling and polishing procedure. Performed to remove coronal plaque, calculus and stains. ** Prosthodontic: Branch of dentistry that deals with the repair of teeth by crowns, inlays or onlays and/or the replacement of missing teeth and related mouth or jaw structures by bridges, dentures, implants or other artificial devises. Prosthodontist: A dental specialist. Restores natural teeth. Replaces missing teeth with artificial substitutes. Provider: A dentist or other dental care professional, or clinic that is accredited, licensed or certified to provide dental services in their state, and is providing services within the scope of that accreditation, license or certification. Provider network: Dentists and other dental care professionals who agree to provide dental care to members of a dental plan, under the terms of a contract. Use the info in this document and not any other source. Categorize the terms into ""Device"", ""Procedure"", and ""Other"", and exclude any financial or insurance related terms.",Medical,Summarize & Format,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Considering Zimbabwe's effort to reduce the financial crisis through focusing on re engaging policies in 2014. How much more was raised in 2017 compared to the money that was raised through bond trading within the first 2 years .Also explain how these bonds have affected the government debt management . Keep the response at 300 words or Less,"In 2014, the government for the first time started to trade infrastructure bonds (GoZ, 2014b). The introduction of the 5-year tenor infrastructure bonds at a fixed interest of 9.5 percent, has not only enhanced financial deepening in the economy but also contributed to a paradigm shift in the structure of government debt. Also, the introduction of long term debt instruments by the government was intended at minimising rollover risk and lessen borrowing expenses associated with short term debt (Infrastructure Development Bank of Zimbabwe “IDBZ”, 2016). Until now, the government has raised US$5 million, $15 million and $22 million in 2015, 2016 and 2017, respectively, through the trading of infrastructure bonds on the capital markets (IDBZ, 2015, 2016; GoZ, 2017). At present, the government debt securities are being traded on the Zimbabwe Stock Exchange in the same manner as other stocks. To provide for the management of public debt in Zimbabwe on a statutory basis, mainly foreign public debt, the public debt reforms included public sector financial reforms and the institutionalisation and operationalisation of a Debt Management Office, which is currently housed in the Ministry of Finance and Economic Development. The responsibilities of the Debt Office are among others, to ensure public debt database validation and reconciliation with all creditors and to provide for the raising, management and servicing of loans by the state (GoZ, 2015b). The Public Management Act Amended (2015) further stipulates that the Debt Office shall (1) formulate and publish a Medium Term Debt Management Strategy, (2) formulate and publish an annual borrowing plan, which includes a borrowing limit, and (3) undertake an annual debt sustainability analyses (MOFED, 2012). In 2011, the GNU instituted several foreign policy shifts, intended at reducing the country’s foreign public debt overhang, by re-engaging with creditors and the global community. The intention of the new re engagement policy reform was to seek comprehensive debt relief initiatives, as well as opening up new lines of offshore financing. Accordingly, in 2011, the government started to make paltry debt payments to the Bretton Woods institutions and the African Development Bank, an initiative that was aimed at seeking debt rescheduling (RBZ, 2014). To spearhead the re-engagement process, the government formulated the Accelerated Re-engagement Economic Programme (ZAREP). More so, the formulation of ZAREP was meant to promote fiscal sustainability through proper expenditure management, monitoring and wage policy reviews (GoZ, 2015c: 14). The emergence of Staff Monitored Programme (SMP) between the Zimbabwean government and the International Monetary Fund in 2013 is an indication of the success of the re-engagement policy with its traditional creditors (IMF, 2015). The Staff Monitored Programme focuses on putting public finances on a sustainable course, enhancing public financial management, facilitating diamond revenue transparency, and restructuring the central bank (IMF, 2013). In related institutional and revenue structural reforms, the government in 2015 managed to amalgamate all diamond companies into one, under the name Zimbabwe Consolidated Diamond Corporation (ZCDC) (Parliament of Zimbabwe, 2017: 12). The Zimbabwe Consolidated Diamond Corporation came as result of the IMF’s recommendations to improve on diamond revenue transparency and accountability (","""================ ======= In 2014, the government for the first time started to trade infrastructure bonds (GoZ, 2014b). The introduction of the 5-year tenor infrastructure bonds at a fixed interest of 9.5 percent, has not only enhanced financial deepening in the economy but also contributed to a paradigm shift in the structure of government debt. Also, the introduction of long term debt instruments by the government was intended at minimising rollover risk and lessen borrowing expenses associated with short term debt (Infrastructure Development Bank of Zimbabwe “IDBZ”, 2016). Until now, the government has raised US$5 million, $15 million and $22 million in 2015, 2016 and 2017, respectively, through the trading of infrastructure bonds on the capital markets (IDBZ, 2015, 2016; GoZ, 2017). At present, the government debt securities are being traded on the Zimbabwe Stock Exchange in the same manner as other stocks. To provide for the management of public debt in Zimbabwe on a statutory basis, mainly foreign public debt, the public debt reforms included public sector financial reforms and the institutionalisation and operationalisation of a Debt Management Office, which is currently housed in the Ministry of Finance and Economic Development. The responsibilities of the Debt Office are among others, to ensure public debt database validation and reconciliation with all creditors and to provide for the raising, management and servicing of loans by the state (GoZ, 2015b). The Public Management Act Amended (2015) further stipulates that the Debt Office shall (1) formulate and publish a Medium Term Debt Management Strategy, (2) formulate and publish an annual borrowing plan, which includes a borrowing limit, and (3) undertake an annual debt sustainability analyses (MOFED, 2012). In 2011, the GNU instituted several foreign policy shifts, intended at reducing the country’s foreign public debt overhang, by re-engaging with creditors and the global community. The intention of the new re engagement policy reform was to seek comprehensive debt relief initiatives, as well as opening up new lines of offshore financing. Accordingly, in 2011, the government started to make paltry debt payments to the Bretton Woods institutions and the African Development Bank, an initiative that was aimed at seeking debt rescheduling (RBZ, 2014). To spearhead the re-engagement process, the government formulated the Accelerated Re-engagement Economic Programme (ZAREP). More so, the formulation of ZAREP was meant to promote fiscal sustainability through proper expenditure management, monitoring and wage policy reviews (GoZ, 2015c: 14). The emergence of Staff Monitored Programme (SMP) between the Zimbabwean government and the International Monetary Fund in 2013 is an indication of the success of the re-engagement policy with its traditional creditors (IMF, 2015). The Staff Monitored Programme focuses on putting public finances on a sustainable course, enhancing public financial management, facilitating diamond revenue transparency, and restructuring the central bank (IMF, 2013). In related institutional and revenue structural reforms, the government in 2015 managed to amalgamate all diamond companies into one, under the name Zimbabwe Consolidated Diamond Corporation (ZCDC) (Parliament of Zimbabwe, 2017: 12). The Zimbabwe Consolidated Diamond Corporation came as result of the IMF’s recommendations to improve on diamond revenue transparency and accountability ( http://www.ijqr.net/journal/v12-n1/6.pdf ================ ======= Considering Zimbabwe's effort to reduce the financial crisis through focusing on re engaging policies in 2014. How much more was raised in 2017 compared to the money that was raised through bond trading within the first 2 years .Also explain how these bonds have affected the government debt management . Keep the response at 300 words or Less ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Financial,Fact Finding,Q&A "Model must only respond using information contained in the context block. Model must not rely on its own knowledge or outside sources of information when responding. ",What measures did the federal reserve implement in March 2020 to stabilize the commercial paper market during the COVID pandemic?,"CRS INSIGHT Prepared for Members and Committees of Congress INSIGHTi COVID-19: Commercial Paper Market Strains and Federal Government Support April 13, 2020 What Is Commercial Paper and Why Is It Important? As COVID-19 spread rapidly in the United States, fears of its economic effects led to strains in the commercial paper (CP) market, one of the main funding sources for many firms and for providers of credit to individuals. Commercial paper is short-term debt issued primarily by corporations and generally is unsecured. The CP market is an important source of short-term credit for a range of financial and nonfinancial businesses, who may rely on it as an alternative to bank loans—for example, in making payroll or for other short-term funding needs. The CP market also helps provide credit to individuals through short-term asset-backed commercial paper (ABCP), which finances certain consumer loans such as auto loans or other consumer debt. Municipalities also issue CP for short-term funding needs. Some money market funds (MMFs) are key purchasers of CP, which plays a significant role in this short-term funding market. As of March 31, 2020, about 24% of total CP outstanding was ABCP; 47% of total CP was from financial issuers; and 28% was from nonfinancial issuers. The total CP market in the United States was $1.092 trillion as of the end of March 2020, though this amount can fluctuate based on market conditions. For a sense of scale, this is roughly 65% of the amount of currency in circulation by the public ($1.73 trillion as of March 9, 2020). The CP market grew rapidly in the 1970s and 1980s in the United States, as a lower-cost alternative to bank loans. A provision in the securities laws allowing for an exemption from more elaborate Securities and Exchange Commission (SEC) registration requirements for debt securities with maturities of 270 days or less helped fuel this market’s rapid expansion. From 1970 to 1991, outstanding commercial paper grew at an annual rate of 14%. The subsequent growth of securitization, in which loans are packaged into bonds and sold to investors as securities, also fueled a rapid expansion of ABCP. Between 1997 and 2007, ABCP grew from $250 billion to more than $1 trillion. This growth was partly fueled by the expansion of residential mortgage securitization. In August 2007, ABCP comprised over 52% of the total CP; financial CP accounted for 38%; and nonfinancial CP constituted 10%. The amount of CP outstanding peaked at $2.2 trillion in August 2007, before shrinking considerably during and after the 2008 financial crisis. Congressional Research Service https://crsreports.congress.gov IN11332 Congressional Research Service 2 Because CP involves short maturities (much CP matures in 30 days or less), many firms have to “roll over” maturing CP—issuing new CP as existing CP matures. Thus, the CP market is generally susceptible to roll-over risk, meaning the risk that market conditions may change and the usual buyers of CP might decline to purchase new notes when existing ones expire, preferring perhaps to hold cash. This is often sparked by credit risk, wherein fears over a CP issuer’s credit, or even the bankruptcy of a CP issuer, lead to depressed demand for commercial paper. The risk of being unable to roll over maturing commercial paper due to credit risk has been demonstrated as real in recent financial history, both in the financial crisis following Lehman Brothers’ collapse and in prior sudden corporate bankruptcies. When credit and liquidity become unavailable through the CP market, the effects can spill over into credit markets more generally. Commercial Paper Market Stress and Federal Government Support As concerns over the spread of COVID-19 grew, stresses in the CP market became linked to the supply of business credit, putting pressure on banks and heightening the market demand for cash. Such strains on credit markets can sharply increase borrowing costs for financial and nonfinancial firms. When investment bank Lehman Brothers failed during the 2008 crisis, the cost of borrowing in CP, as measured by the spread for CP borrowing rates over more stable overnight index swap rates, rose by about 200 basis points (2%) in the following week, and the rates for financial firms’ CP notes eventually climbed higher. Data from the Federal Reserve shown in Figure 1 indicate that CP borrowing rates for financial issuers, as measured in spreads for CP borrowing rates over Treasuries, spiked by about 200 basis points in March 2020, as investors grew reluctant to buy new CP. To add liquidity and foster credit provision in the CP market, the Federal Reserve intervened on March 17, 2020, with a credit facility. Figure 1. Spreads Between 1-Month and 3-Month AA-rated Financial Commercial Paper and 3-Month Constant Maturity Treasury Rates Source: CRS, based on data obtained from the Federal Reserve Bank of St. Louis FRED website. Congressional Research Service 3 IN11332 · VERSION 1 · NEW Note: “AA-rated” is the second-highest credit rating. For more information, see the Federal Reserve Bank of New York website. On March 17, the Federal Reserve (Fed) announced that it was establishing a Commercial Paper Funding Facility (CPFF) to support the flow of credit to households and businesses. This facility is backed by funding from the Treasury’s Economic Stabilization Fund. The Fed noted the CPFF was designed to support the CP markets, which “directly finance a wide range of economic activity, supplying credit and funding for auto loans and mortgages as well as liquidity to meet the operational needs of a range of companies.” The Fed aims to provide a liquidity backstop to CP issuers by buying both ABCP and regular, unsecured CP of a minimum credit quality from eligible companies. By acting as a buyer of the last resort, the Fed program aims to reduce investors’ risk that CP issuers would not repay them because they became unable to roll over any maturing CP. On March 23, the Fed expanded the CPFF to facilitate the flow of credit to municipalities by including high-quality, tax-exempt commercial paper as eligible securities, and also reduced the pricing of the facility. (For more information, see CRS Insight IN11259, Federal Reserve: Recent Actions in Response to COVID-19, by Marc Labonte; and CRS Report R44185, Federal Reserve: Emergency Lending, by Marc Labonte.) Author Information Rena S. Miller Specialist in Financial Economics Disclaimer This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you wish to copy or otherwise use copyrighted material.","CRS INSIGHT Prepared for Members and Committees of Congress INSIGHTi COVID-19: Commercial Paper Market Strains and Federal Government Support April 13, 2020 What Is Commercial Paper and Why Is It Important? As COVID-19 spread rapidly in the United States, fears of its economic effects led to strains in the commercial paper (CP) market, one of the main funding sources for many firms and for providers of credit to individuals. Commercial paper is short-term debt issued primarily by corporations and generally is unsecured. The CP market is an important source of short-term credit for a range of financial and nonfinancial businesses, who may rely on it as an alternative to bank loans—for example, in making payroll or for other short-term funding needs. The CP market also helps provide credit to individuals through short-term asset-backed commercial paper (ABCP), which finances certain consumer loans such as auto loans or other consumer debt. Municipalities also issue CP for short-term funding needs. Some money market funds (MMFs) are key purchasers of CP, which plays a significant role in this short-term funding market. As of March 31, 2020, about 24% of total CP outstanding was ABCP; 47% of total CP was from financial issuers; and 28% was from nonfinancial issuers. The total CP market in the United States was $1.092 trillion as of the end of March 2020, though this amount can fluctuate based on market conditions. For a sense of scale, this is roughly 65% of the amount of currency in circulation by the public ($1.73 trillion as of March 9, 2020). The CP market grew rapidly in the 1970s and 1980s in the United States, as a lower-cost alternative to bank loans. A provision in the securities laws allowing for an exemption from more elaborate Securities and Exchange Commission (SEC) registration requirements for debt securities with maturities of 270 days or less helped fuel this market’s rapid expansion. From 1970 to 1991, outstanding commercial paper grew at an annual rate of 14%. The subsequent growth of securitization, in which loans are packaged into bonds and sold to investors as securities, also fueled a rapid expansion of ABCP. Between 1997 and 2007, ABCP grew from $250 billion to more than $1 trillion. This growth was partly fueled by the expansion of residential mortgage securitization. In August 2007, ABCP comprised over 52% of the total CP; financial CP accounted for 38%; and nonfinancial CP constituted 10%. The amount of CP outstanding peaked at $2.2 trillion in August 2007, before shrinking considerably during and after the 2008 financial crisis. Congressional Research Service https://crsreports.congress.gov IN11332 Congressional Research Service 2 Because CP involves short maturities (much CP matures in 30 days or less), many firms have to “roll over” maturing CP—issuing new CP as existing CP matures. Thus, the CP market is generally susceptible to roll-over risk, meaning the risk that market conditions may change and the usual buyers of CP might decline to purchase new notes when existing ones expire, preferring perhaps to hold cash. This is often sparked by credit risk, wherein fears over a CP issuer’s credit, or even the bankruptcy of a CP issuer, lead to depressed demand for commercial paper. The risk of being unable to roll over maturing commercial paper due to credit risk has been demonstrated as real in recent financial history, both in the financial crisis following Lehman Brothers’ collapse and in prior sudden corporate bankruptcies. When credit and liquidity become unavailable through the CP market, the effects can spill over into credit markets more generally. Commercial Paper Market Stress and Federal Government Support As concerns over the spread of COVID-19 grew, stresses in the CP market became linked to the supply of business credit, putting pressure on banks and heightening the market demand for cash. Such strains on credit markets can sharply increase borrowing costs for financial and nonfinancial firms. When investment bank Lehman Brothers failed during the 2008 crisis, the cost of borrowing in CP, as measured by the spread for CP borrowing rates over more stable overnight index swap rates, rose by about 200 basis points (2%) in the following week, and the rates for financial firms’ CP notes eventually climbed higher. Data from the Federal Reserve shown in Figure 1 indicate that CP borrowing rates for financial issuers, as measured in spreads for CP borrowing rates over Treasuries, spiked by about 200 basis points in March 2020, as investors grew reluctant to buy new CP. To add liquidity and foster credit provision in the CP market, the Federal Reserve intervened on March 17, 2020, with a credit facility. Figure 1. Spreads Between 1-Month and 3-Month AA-rated Financial Commercial Paper and 3-Month Constant Maturity Treasury Rates Source: CRS, based on data obtained from the Federal Reserve Bank of St. Louis FRED website. Congressional Research Service 3 IN11332 · VERSION 1 · NEW Note: “AA-rated” is the second-highest credit rating. For more information, see the Federal Reserve Bank of New York website. On March 17, the Federal Reserve (Fed) announced that it was establishing a Commercial Paper Funding Facility (CPFF) to support the flow of credit to households and businesses. This facility is backed by funding from the Treasury’s Economic Stabilization Fund. The Fed noted the CPFF was designed to support the CP markets, which “directly finance a wide range of economic activity, supplying credit and funding for auto loans and mortgages as well as liquidity to meet the operational needs of a range of companies.” The Fed aims to provide a liquidity backstop to CP issuers by buying both ABCP and regular, unsecured CP of a minimum credit quality from eligible companies. By acting as a buyer of the last resort, the Fed program aims to reduce investors’ risk that CP issuers would not repay them because they became unable to roll over any maturing CP. On March 23, the Fed expanded the CPFF to facilitate the flow of credit to municipalities by including high-quality, tax-exempt commercial paper as eligible securities, and also reduced the pricing of the facility. (For more information, see CRS Insight IN11259, Federal Reserve: Recent Actions in Response to COVID-19, by Marc Labonte; and CRS Report R44185, Federal Reserve: Emergency Lending, by Marc Labonte.) Author Information Rena S. Miller Specialist in Financial Economics Disclaimer This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role. CRS Reports, as a work of the United States Government, are not subject to copyright protection in the United States. Any CRS Report may be reproduced and distributed in its entirety without permission from CRS. However, as a CRS Report may include copyrighted images or material from a third party, you may need to obtain the permission of the copyright holder if you wish to copy or otherwise use copyrighted material. Model must only respond using information contained in the context block. Model must not rely on its own knowledge or outside sources of information when responding. What measures did the federal reserve implement in March 2020 to stabilize the commercial paper market during the COVID pandemic?",Financial,Find & Summarize,Text Transformation I'm providing you with your source material. You will not be using any outside material. Your job is to answer questions about the material.,"What are the essential steps and key points from the customer discovery process outlined in ""Talking to Humans""?","TALKING TO HUMANS Success starts with understanding your customers GIFF CONSTABLE with Frank Rimalovski illustrations by Tom Fishburne and foreword by Steve Blank Copyright ©2014 Gif Constable First edition, v1.71 All rights reserved. Book design: Gif Constable Illustrations by Tom Fishburne Cover design assistance: Jono Mallanyk Lean Startup is trademarked by Eric Ries Customer Discovery is a phrase coined by Steve Blank ISBN: 978-0-9908009-0-3 Special thanks to the NYU Entrepreneurial Institute for their collaboration and support in the creation of Talking to Humans Acclaim for Talking to Humans “If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have.” Steve Blank, entrepreneur, educator and author of Four Steps to the Epiphany and The Startup Owner’s Manual “If entrepreneurship 101 is talking to customers, this is the syllabus. Talking to Humans is a thoughtful guide to the customer informed product development that lies at the foundation of successful start-ups.” Phin Barnes, Partner, First Round Capital “Getting started on your Customer Discovery journey is the most important step to becoming a successful entrepreneur and reading Talking To Humans is the smartest frst step to fnding and solving real problems for paying customers.” Andre Marquis, Executive Director, Lester Center for Entrepreneurship University of California Berkeley “A lot of entrepreneurs pay lip service to talking to customers but you have to know how. Talking to Humans ofers concrete examples on how to how to recruit candidates, how to conduct interviews, and how to prioritize learning from customers more through listening versus talking.” Ash Maurya, Founder Spark59 and Author of Running Lean “Tis is a great how-to guide for entrepreneurs that provides practical guidance and examples on one of the most important and ofen under practiced requirements of building a great startup—getting out of the ofce, talking directly with customers and partners, and beginning the critical process of building a community.” David Aronoff, General Partner, Flybridge Capital “Gif has been one of the thought leaders in the lean startup movement from the very beginning. Entrepreneurs in all industries will fnd Talking to Humans practical, insightful, and incredibly useful.” Patrick Vlaskovits, New York Times bestselling author of The Lean Entpreneur “Current and future customers are the best source of feedback and insight for your new product ideas. Talking to them is intimidating and seemingly time-consuming. In this focused, practical, down-to-earth book Gif Constable demystifes the art (not science) of customer discovery helping entrepreneurs and product veterans alike learn how to build a continuous conversation with their market and ensure the best chances of success for their ideas. Want to know what your audience is thinking? Read this book!” Jeff Gothelf, author of LeanUX “When getting ‘out of the building,’ too many people crash and burn right out of the gate and wonder what happened. Talking to Humans is a quick and efective guide for how Lean Startup interviews should be done: who to talk to, how to talk your way in the door, and how to gain the most insight and learning. Don’t crash and burn – read Talking to Humans!” Dean Chang, Associate Vice President for Innovation & Entrepreneurship University of Maryland “A must read for anyone who is considering creating a startup, developing a new product or starting a new division. Read this book frst – a great guide to the evolving art of customer discovery. Don’t waste your time building products that your customer may or may not want. Before you write the frst line of code, pitch your idea to investors or build the frst prototype, do your self a favor, read this book and follow the advice! I guarantee you will make better decisions, build a better product and have a more successful company.” John Burke, Partner, True Ventures “Primary market research has been around for a long time because it has stood the test of time and proved that it is fundamental to building a successful venture; it underlies all that we do at MIT in entrepreneurship. Te question is how we more broadly deployed appropriate skills to entrepreneurs so they can be guided to do this in an efcient and efective manner while maintaining rigor. With all the sloganeering out there on the topic, this book stands out in that it delivers real value to the practitioner in this regard.” Bill Aulet, Managing Director, Martin Trust Center for MIT Entrepreneurship “Talking to strangers can be scary, but it’s vital to launching any new product. Trough storytelling, Gif Constable makes customer development concepts accessible. Tis book will show you how to articulate assumptions, get useful information and turn it into meaningful insights. Ten it delivers practical advice you can use immediately to test your ideas. Fear holds people back. Tis book will give you the confdence to jump.” Andres Glusman, Chief Strategy Offcer, Meetup.com Table of Contents 8 Foreword 11 Introduction 14 The Story 28 Lessons Learned 30 How To 31 Getting Started with Customer Discovery 32 Who Do You Want to Learn From? 36 What Do You Want to Learn? 44 How Do You Find Your Interview Subjects? 52 How to Ensure an Effective Session? 58 How Do You Make Sense of What You Learn? 65 Conclusion 66 Appendix 67 Cold Approach Examples 69 Business Assumptions Exercise 72 Teaching Exercise #1: Mock Interviews 74 Teaching Exercise #2: Mock Approach 76 Screwing Up Customer Discovery 80 Glossary 82 Other Learning Resources 83 Behind the Book 8 Talking to Humans Foreword “Get out of the building!” Tat’s been the key lesson in building startups since I frst started teaching customer development and the Lean Launchpad curriculum in 2002. Since then, a lot has happened. Te concepts I frst outlined in my book Te Four Steps to the Epiphany have grown into an international movement: Te Lean Startup. Te class I developed - Te Lean Launchpad - is now taught at Stanford, UC Berkeley, Columbia University, UCSF, and most recently New York University (NYU). More than 200 college and university faculty have taken my Lean Launchpad Educators Seminar, and have gone on to teach the curriculum at hundreds of universities around the globe. Te National Science Foundation, and now the National Institute of Health, use it to commercialize scientifc research as part of their Innovation Corps (I-Corps) program. My How to Build a Startup class on Udacity has been viewed by over 225,000 students worldwide. During the past few years, we’ve seen dozens of large companies including General Electric, Qualcomm and Intuit begin to adopt the lean startup methodology. Te Lean Startup turns the decades-old formula of writing a business plan, pitching it to investors, assembling a team, and launching and selling a product on its head. While terms like “pivot” and “minimum viable product” have become widely used, they are not understood by many. Te same can be said of “getting out of the building”. Many entrepreneurs “get out” and get in front of customers, but take a simplistic view and ask their customers what they want, or if they would buy their startup’s (half-baked) product. Te “getting out” part is easy. It is the application of the customer Foreword & Introduction 9 development methodology and the testing of their hypotheses with users, customers and partners that is both critical and ofen difcult for entrepreneurs to grasp in the search for a scalable and repeatable business model. Since the Four Steps, many other books have been written on customer development including Te Startup Owner’s Manual, Business Model Generation, Te Lean Startup, and others. Each of these texts has advanced our understanding of the customer development methodology in one way or another, teaching aspiring students and entrepreneurs the what, when and why we should get out of the building, but have only skimmed the surface on “how” to get out of the building. For both my own classes as well as I-Corps, I always made Gif Constable’s blog post “12 Tips for Early Customer Development Interviews” required reading. It answered the “how” question as well. Now Gif has turned those 12 tips into an entire book of great advice. In a comprehensive, yet concise and accessible manner, Talking to Humans teaches you how to get out of the building. It guides students and entrepreneurs through the critical elements: how to fnd interview candidates, structure and conduct efective interviews and synthesize your learning. Gif provides ample anecdotes as well as useful strategies, tactics and best practices to help you hit the ground running in your customer discovery interviews. If you are a student, aspiring entrepreneur or product manager trying to bring the value of getting out of the building to an existing company, Talking to Humans is a must read. It is chock full of lessons learned and actionable advice that will enable you to make the most of your time out of the building. Talking to Humans is the perfect complement to the existing 10 Talking to Humans body of work on customer development. If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have. Steve Blank September 3, 2014 Foreword & Introduction 11 Introduction 12 Talking to Humans Te art of being a great entrepreneur is fnding the right balance between vision and reality. You are probably opening this book because you want to put something new in the world. Tat’s an incredibly powerful and meaningful endeavor. It’s also scary and extremely risky. How can you get ahead of that risk and beat the odds? Every new business idea is built upon a stack of assumptions. We agree with Steve Blank’s insight that it is better to challenge your risky assumptions right at the start. You can’t challenge anything sitting in a conference room. You have to get into the market, or, as Blank likes to say, “Get out of the building!” Tere are two efective ways to do this: 1. talk directly to your customers and partners, and observe their behavior; 2. run experiments in which you put people through an experience and track what happens. Tis book focuses on the frst. Te qualitative part of customer discovery is surprisingly hard for most people, partly because talking to strangers can feel intimidating, and partially because our instincts on how to do it are ofen wrong. Here’s what customer discovery is not: It is not asking people to design your product for you. It is not about abdicating your vision. It is also not about pitching. A natural tendency is to try to sell other people on your idea, but your job in customer discovery is to learn. You are a detective. You are looking for clues that help confrm or deny your assumptions. Whether you are a tiny startup or an intrapreneurial team within a big company, your goal is not to compile statistically signifcant answers. Instead you want to look for patterns that will help you make better decisions. Tose decisions should lead to action, and smart action is what you need for success. Foreword & Introduction 13 Tis book was written as a focused primer on qualitative research to help you get started. You should view it as a complement to the other excellent resources out there on customer development and lean innovation. It is not a rulebook, but hopefully you will fnd the principles included here useful. Te book comes in two parts. It begins with a fctional story of two entrepreneurs doing customer research for the frst time. Te second part is a mix of theory and tactics to guide you through the core steps of customer discovery. While the fctional story highlights a consumer-facing business, I should note that there are plenty of tips in this book for teams who sell to the enterprise. Some last words to kick things of: entrepreneurs have a tendency to over-obsess about their product to the neglect of other business risks. Tey also tend to stay inside their heads for far too long. I urge you to be brave, get out of the building, and go talk to real human beings. Gif Constable August 2014 Some Thanks Are Due Many thanks to Frank Rimalovski for encouraging me to write this, and his students and team at NYU for providing early feedback, Steve Blank for the foreword and his inspiration and leadership on the topic of entrepreneurship, Tom Fishburne for his great illustrations, Josh Seiden and Jef Gothelf for their insights, my colleagues at Neo for continuing to push forward the craf of customer development, the many speakers and members of New York’s Lean Lessons Learned meetup who have shared their stories with me, and Eric Ries for inspiring me and so many others. The Story PART ONE The Story 15 Breakthrough Koshi and Roberta had so much adrenaline pumping through their systems that neither could sleep that night. Afer a year of challenging lab work, they had fnally cracked it. Tey were now sure they could manufacture artifcial down feathers cost-efectively. Teir insomnia was ironic, since their very dream was to transform the quality of people’s sleep through the invention of a better pillow. Tey knew they had a technical advantage. Teir artifcial down had heightened levels of insulation, a better resilience/resistance quotient, and was kinder to both animals and the environment. Now the question was, did they have a business? The Advisor Tey called a meeting with their entrepreneurial advisor the next day. Samantha had built four companies, successfully exiting two of them. She was now an angel investor and believed frmly in giving back by working with frst-time entrepreneurs. “We fnally cracked it!” Roberta blurted out. “What she means,” Koshi said, “is that we’re convinced we can manufacture NewDown in a cost-efective and repeatable manner. Now we think we can make a real business.” “So you want to know if the time has come to jump in feet frst?” asked Samantha. Te two scientists nodded. “If you want to be successful bringing something to market, you need to understand the market. Do you feel like you know when and why people buy pillows today?” “Not really,” Roberta said. “We’ve spent our time in the lab focused on the product side.” “I suspected so. Founders commonly obsess about product at the 16 Talking to Humans expense of the understanding the customer or the business model. You need to work on it all, and you have to challenge your thinking. Behind your startup is a belief system about how your business will work. Some of your assumptions will be right, but the ones that are wrong could crater your business. I want you to get ahead of the risky hypotheses that might cause failure.” Samantha had the founders list out the riskiest hypotheses. 1. We believe that people care about sleep quality when making a pillow purchase decision. 2. We believe that we can sell online directly to customers. 3. We believe that our customers will be young urban professionals. 4. We believe that our very frst customers will be new graduates who need to outft their apartments. 5. We believe that we can sell our pillows at a high enough price to cover our costs. 6. We believe that we can raise enough capital to cover investments in manufacturing. “Let’s put aside the fundraising risk right now,” Samantha said. “It’s what everyone jumps to, but you need to strengthen your story frst. Many of your risks are tied to your customer. I like attacking a problem from multiple directions and recommend three approaches. First, I want you to walk a day in your customer’s shoes and actually go out and buy a pillow. Second, I want you to observe people in the process of buying a pillow. And third, I want you to talk directly to them.” “Talk to people?” said Koshi. “I’m a scientist, not a salesperson. If I simply asked someone if my pillow was better, they would have no idea. If I asked them if they would buy my pillow, I couldn’t trust The Story 17 the answer. So what is the point?” “Your job right now isn’t to sell, but rather to learn. You are right, though: getting the customer to speculate is rarely useful,” Samantha said. “You need to understand your market. How does your customer buy? When do they buy? Why do they buy? Where do they buy? As a scientist, you are fully capable of doing research, gathering data, and seeing if your data supports your hypotheses. I promise you, if you are polite and creative, people will be more receptive to you than you might think.” “Buying. Observing. Talking. Do we really need to do all three? Can we really aford to spend the time?” “Can you aford not to? Each of the three approaches is imperfect, but together you should see patterns. By walking in your customer’s shoes you will gain empathy and personal understanding, but you don’t want to rely solely on your own experience. By watching people shop, you can witness honest behavior, but you won’t be able to get into their heads to know their motivations. By talking to people, you gather intel on both behavior and motivation, but you have to be careful not to take what you hear too literally. Each method has strengths and weaknesses, but taken together you will learn a ton. You will have a lot more confdence that you are either on the right track, or that you have to make changes to your plans. It is far better to discover bad assumptions now, before you have invested a lot! Now, how do you think you should proceed?” “We want our customers to buy online from us, so I guess we should also buy our own pillow online,” said Roberta. “And we can observe people shopping by going to a home goods store.” “Tat sounds good,” said Samantha. “You will want to talk to some of those people in the store as well. I see one catch: you will be 18 Talking to Humans targeting the moment of purchase but not the type of customer you are hoping for. One of your risk assumptions was specifcally about young urban professionals and new graduates, so what can you also do to target and connect with them?” “What about going to a cofee shop near the downtown ofce buildings as people are going to work?” Koshi said. “Can’t we just hit up some of the people we used to know in college who are now in the working world?” Roberta said. “Why don’t you try both, and see which approach works better,” said Samantha. “Roberta, I would also ask your friends if they will refer you to their friends. It’s best to talk to people who aren’t too close to you. You don’t want a someone’s afection for you to steer what they have to say. “Let’s start by thinking through the questions you want to ask. It always makes sense to prioritize what you want to learn. You should write down an interview plan, even if you don’t completely stick to it. Break the ice, and then get them to tell you a story about buying a pillow!” Te scientists sketched out a plan: Intro: hello, I’m a PhD candidate at Hillside University and I’m researching sleep quality. I’m asking people about the last time they bought a pillow. Would you mind if I asked a few questions? When was the last time you bought a pillow? Why did you go looking for a pillow? How did you start shopping for a pillow? Why did you choose the one you bought? After you bought, how did you feel about the pillow you purchased? The Story 19 Are you going to be in the market for a pillow anytime soon? “Tat’s a great start,” Samantha said. “Keep good notes as you go, and remember to regularly regroup to review your fndings and look for patterns. Be mindful of which method you used as you discuss your observations.” Walking in the Customer’s Shoes Koshi and Roberta got together the next day afer both purchasing a pillow online. “I found it all a bit frustrating,” said Roberta. “It was hard to learn why you would choose down feathers, cotton, or foam. Te manufacturer websites felt like they were from the 1990s. Tere were some reviews available on Amazon and Bed Bath & Beyond, which helped. In my interpretation, about 65% of reviews talked about sleep quality, which seems like a good sign for our frst risk. A lot of the reviews had to do with personal preference for frm versus sof pillows. I think we can ofer both kinds eventually, but we likely need to choose one at the beginning and that could impact some of our assumptions around market size. ” “I started out by searching Google,” said Koshi. “Amazon and BB&B dominated the results, as we expected, but there were a few specialty providers like BestPillow that ranked high. BestPillow lets you navigate their website by sleep issue, such as snoring or neck pain, which I found interesting. While I see some makers pushing hypoallergenic oferings, I didn’t see anyone who could meet our claims of being environmentally friendly. I agree that all the manufacturer websites felt ancient. I think there’s an opportunity to be smart about search engine optimization and really stand out if we can get the messaging right. I guess our next step is to visit the retail 20 Talking to Humans stores.” Observing the Customer Roberta ended up going to a Bed Bath & Beyond while Koshi went to a local department store. She watched three diferent people come in and pick through several diferent pillows, puzzling over the packaging material. One of them asked a store employee for help, and two pulled out their mobile phones to look online. She then watched a woman go right to a particular shelf, grab a pillow and head back to the aisle. Roberta’s plan was to balance observation and interaction, so she decided to jump in. “Pardon me,” she said “I am trying to fgure out which pillow to purchase and noticed that you went right to that one. Might I ask why you chose that pillow?” “Oh, I replaced some ratty old pillows in my house a few weeks ago,” the woman said, “and I liked this one so much that I thought I would replace my whole set.” “Do you mind if I ask how you decided to buy that pillow in the frst place? My name is Roberta, by the way.” “Nice to meet you, Roberta. I’m Susan. Well, I guess I started by researching online and...” A day later, the founders met to compare notes. “Te BB&B had good foot trafc,” Roberta said, “and I was able to watch ffeen people, and speak to ten. Of the ten, one knew what she wanted going into the store, three were basing their purchase just on packaging and store price, and six did Google searches on their phones, right there in the store. Tey were looking up reviews and pricing. You mentioned search engine optimization earlier — I think it could be even stronger with a fabulous mobile experience.” She looked down at her notes. “I also found that seven out of ten were trying to choose a pillow specifcally for better sleep, although their sleep problems were diverse. Finally, when I asked The Story 21 them why they were buying a pillow, the folks over 40 seemed to be in replacement mode, while the folks under 40 seemed to be reacting to a life change. Two people were moving to a bigger house from an apartment. Another person was moving in with their girlfriend, and another said that she got a new job and could now aford nicer things.” “I went to the home goods section of a high-end department store,” said Koshi. “I saw eighteen people, and fve of them knew what they wanted already. Te rest spent time puzzling over the packaging and, like your group, going online with their mobile phone. I spoke to nine shoppers. I said that I was a scientist trying to invent a new pillow. People thought that was pretty cool. Two of them admitted that they were buying the highest price pillow because they assumed that it had to be the best. Two got the cheapest because it was the cheapest. Te others had specifc preferences for down, cotton or foam based on the frmness they were looking for in a pillow. Te frmness preference seemed to be tied to a belief that they would sleep more soundly. On price, I was relieved to see that the prices of the better pillows were in line with what we were hoping to charge.” Roberta pulled out a pad. “So we saw thirty-three people and spoke to nineteen. Our sample set is still small, but Samantha told us to look for patterns and not worry about statistical signifcance right now. If we break our observations into a few metrics, what have we learned?” • 24% of shoppers knew what they wanted when they walked in • 52% looked up information on their phone in the store • 45% of shoppers purchased a mid-priced or high-priced pillow • 68% of the people we spoke to indicated that better sleep was a major driver of their choice 22 Talking to Humans • 37% of the people we spoke to were reacting to a life change • 37% of the people we spoke to were in replacement mode “I think the use of mobile phones is something we need to pay attention to and work into our strategy,” Koshi said. “I guess for our next step, we should follow Samantha’s suggestions to target urban professionals.” Regrouping A week and many interviews later, the team sat down with Samantha. “How did things go?” she asked. “I went to a downtown cofee shop at peak hour,” Koshi said. “At frst, everyone was in such a hurry to get to work that I didn’t get much response, but then I made a little sign I held up outside that promised ‘cofee for science,’ which started to get laughs and a lot of curiosity. I ended up talking to about ffeen people who matched our target of young urban professionals. I got to talk to them for about fve to twenty minutes each. It was actually very enjoyable. “One clear pattern was that people right out of school tended to have no clue. Tey either had never bought a pillow themselves, or if they had, it had been the cheapest thing they could get. A few admitted that they were probably going to buy new bedding. I know it is speculation, but I asked them to guess how they might go about looking for a pillow, based on how they shop for other things. Te common responses were searching on Google or Amazon, or walking into a Bed Bath & Beyond. “Te few folks in their later twenties or thirties whom I spoke to had usually bought at least one pillow — some from Amazon and some from retailers. Te ones who liked a frm pillow avoided The Story 23 down feathers. Te ones who wanted to upgrade to fancier duvets and high thread-count sheets all seemed to go with duck and goose feathers. Tey didn’t know any brands and instead relied on product packaging. Amazon buyers did actually read the reviews. All these folks were only planning on buying new pillows when they were moving to a bigger apartment because they were getting married or something.” “Yes, that aligns with what we learned when we spoke to people in the retail stores and what I saw with my other interviews,” said Roberta. “Pillow buying seems to be tied to life events like moving and marriage and such. I interviewed a diferent group. A whole bunch of our old classmates responded to my email or my Facebook post. I even had some folks pass me on to their friends, and so I got to talk to some people who didn’t go to school with us. “Like you, I saw a lag efect afer someone graduated from college. When new graduates told me that they had not spent any money on their linens yet, I inquired further and found out that their initial spending money was predominately going towards clothes. I spoke to twelve people between 22 and 25, and roughly 60% had actually bought a pillow in the last few years. I saw similar trends as you, although most went right to Google, Amazon or a few specialty online retailers. It seemed like a very online crowd. Te price sensitive ones stayed away from down. Tey didn’t have much to go on for brand, but the reviews helped. Te women defnitely cared more about quality and put more efort into their hunt.” “Te good news is that everyone thought inventing a new pillow was an awesome idea!” said Koshi. Samantha chuckled. “Of everything I’ve heard you say, that last bit is probably the least useful. It’s easy to say something is cool. It’s another thing to actually buy. Te good news is, you are a lot more educated about your market than you were last time we met. 24 Talking to Humans I see from your notes that you have either spoken to or observed 72 people. We should be able to see some patterns from that. Let’s revisit our critical assumptions.” Challenging Assumptions Te team looked at their initial list. 1. We believe that people care about sleep quality when making a purchase decision. “68% of the retail shoppers indicated that this was a major factor,” said Roberta. “Of our young urban professionals, we were able to ask this of only a portion of our interviewees. Only 56% indicated that it was a factor, but if we factor out the new graduates, it was more like 70%. We’ve also read a lot of online reviews and have seen this come up repeatedly. We feel reasonably confdent that this is a common decision point in choosing a pillow,” said Koshi. “I’m glad you are approaching this with rigor and actually calculating metrics from your observations,” said Samantha. “Tat will prevent you from letting innate biases override your actual results. However, one word of advice. At this stage, don’t take any of your statistics too literally and don’t let any single number dominate your strategic thinking. Just as we’re not looking for statistical signifcance at this point, we also don’t want to start treating our results as if they are indisputable facts. How about the next assumption?” 2. We believe that we can sell online directly to customers. “We have seen some promising signs. 77% of our urban professionals start researching purchases with a search engine. Te question is whether they would discover, visit, or convert with our The Story 25 online store. We did see a ton of mobile usage in the retail stores and think there might be a chance to steal those customers if we have good enough search engine optimization. Overall, our conclusion is that we need more data here.” 3. We believe that our customers will be young urban professionals. “I need to run some numbers on size of market and the number of purchases we might expect from this group, but we still feel like this is a good group for us. We clearly saw purchase behavior. Tey want, and can aford, quality things, and prefer to buy things online.” 4. We believe that our very frst customers will be new graduates who need to outft their apartments. “Tis is where we were totally wrong. Buying behavior, or at least the willingness to buy something that isn’t the cheapest option, did not seem to be very prevalent among new grads. Only 25% of the newly minted grads we spoke with had purchased a pillow on their own. Instead, the evidence points us towards people in their mid-tolate twenties or early thirties. “We also saw a correlation between purchasing and life changes. While this was only 37% with our retail shoppers, it was 70% of our urban professionals. From an early adopter perspective, I wonder if we can do well targeting people who are getting married or moving to a larger apartment or house?” 5. We believe we can sell our pillows at a high enough price to cover our costs. “45% of our retail shoppers bought at least a mid-priced pillow. We admit that we visited reasonably high-end stores, but that was still a nice statistic to see. Te good news is that our initial target price is comparable with the high-end of the current market. We 26 Talking to Humans won’t be proftable at the beginning, but if we can scale and improve our manufacturing process then we can move into the black. Of course, they have to want to buy our pillow.” Samantha nodded. “To test that, you will need to actually try selling a few, which ties back to your second risk. But I’m glad you have spent time learning rather than rushing to sell. Overall, it sounds like you have gotten some solid intel. I’m also glad you caught the issue with college grads before you spent a lot of money and energy trying to target them. Have your eforts uncovered new risks or worries?” “I’m both excited and worried by how confused customers are,” Koshi said. “Every brand promises a better night’s sleep. I’m also worried about signals we picked up that the market might be divided into those who want a frm pillow versus a sof pillow. We think that’s erroneous thinking. Our pillow lands in the middle, and our studies show better results. I don’t know if people will believe our data. We really need to get the messaging right.” “As for me,” Roberta said, “I’m most worried about the size of our initial market, how quickly we could grow, and if we can survive to proftability.” “I’m not surprised,” said Samantha. “I have some suggestions. One of you should continue doing these interviews, but try adding a new spin. You are both worried about diferentiation and if people will understand or appreciate the proof from your scientifc studies. Let’s test some messaging. Given what you have said about mobile usage, maybe create an infographic that tries to make your case. Show it to people on a phone. Ask them to explain it to you. First you can see if they understand it, and then if they fnd it meaningful. “Expanding from qualitative research, I also think one of you should create a fnancial model that lets you play with how much The Story 27 you charge, how many items you might sell, and what your costs will be. Take into account what you have learned so far and see if your business model adds up. “Finally, I think you’ve learned enough to run some experiments around customer acquisition and sales. It is straightforward to create a basic online store using one of the hosted services. You can test selling a few pillows before you invest in manufacturing capability. Try driving trafc through Google or Facebook ads, and run some A/B tests around ad copy, landing-page messaging and price points. Study your metrics. Ten follow up with your customers and interview them on their buying process and decision.” Roberta’s eyes widened. “Wow. Maybe we can get our frst paying customer!” “Exactly,” said Samantha. “Just remember Steve Blank’s phrase about startups: you are in search of a scalable and repeatable business model. Run these experiments and keep in mind that your mission at this point is to learn before you scale. Don’t stop talking directly to customers. Your questions will likely evolve, but no matter what stage you are in, you’ll usually fnd that your best insights will come from talking to real people and observing real behavior.” 28 Talking to Humans Lessons Learned The Story 29 So what are the key takeaways from Roberta and Koshi’s adventure? 1. Customer discovery is about gaining much deeper insight into your customer, or your partners, or your market 2. Being told your idea is cool is not useful; seeing behavior that validates your customer’s willingness to buy is very useful 3. Prepare an interview guide before you get out of the building 4. To ask the right questions, you need to understand your risks and assumptions 5. Get creative when trying to recruit people — if at frst you don’t succeed, try something new 6. Sometimes observation is as powerful as interviews 7. Take good notes, especially on your key risks, so that you can calculate metrics later. Even better, set your target goals ahead of time! 8. Bring learning back and analyze your patterns as a team 9. Never stop asking hard questions about your business In the next section of this book, we’re going to dive into tactics and talk about all this and more in detail. How To PART TWO How To 31 Getting Started with Customer Discovery Qualitative research, i.e. talking to humans, is something you never want to stop doing, but it can defnitely feel intimidating at frst. Te good news is that if you go about it in a professional and thoughtful way, you will fnd lots of people who are willing to help and give you some of their valuable time. You need to begin with a core set of questions: t Who do you want to learn from? t What do you want to learn? t How will you get to them? t How can you ensure an efective session? t How do you make sense of what you learn? 32 Talking to Humans Who Do You Want to Learn From? How To 33 If your desired customer is a doctor, it stands to reason that it won’t help you much talking to a plumber. If you were aiming for teenagers, would you talk to grandparents? Te frst step in trying to learn from the market is having an opinion about who your market actually is. I recommend thinking about a few categories: t Te typical customer you envision if you get traction with your idea t Your early adopter, i.e. the people who will take a chance on your product before anyone else t Critical partners for distribution, fulfllment, or other parts of your business You might think you are creating a product for “everyone”, but that is not an actionable or useful description in the early stages. You need to get more specifc. Your job is to think through the kinds of people who have the problem you are interested in solving. Sometimes they have a particular job, or a state of mind, live in a particular part of the world, or belong to a certain age group. Standard demographics might be useful, or they might be irrelevant. What are the commonalities across your customer base? Here are some examples: • A hospital management system has to think about the hospital administrator who will buy their software and the actual hospital workers who would use it • An on-call veterinarian service needs to talk to pet owners • An online marketplace for plumbers might consider plumbers on the sell side, and home owners on the buy side 34 Talking to Humans You also want to think about your early adopters. Why do they matter? Most new products ft alongside a “technology adoption curve,” as illustrated below. New founders tend to obsess about their mainstream customer (represented in the chart as the early and late majority). However, by defnition, the mainstream is waiting for proof from early adopters before they try something. If you cannot get early adopters, you cannot move on. Early adopters are usually folks who feel a pain point acutely, or love to try new products and services. In our story of Koshi and Roberta, the scientists hypothesized that their early adopter would be urban professionals in their mid to late twenties. For the three customer examples we just gave, here are examples of early adopters: • Our hospital management system might target hospital chains still stuck with an archaic vendor • Our vet service might target busy 20-somethings in a major city • Our online market for plumbers might target solo practices on the sellside and frst-time home owners on the buy-side How To 35 Tere is no prescription for how narrowly or broadly you should cast your net for customer discovery interviews. However, the more focused you can be, the easier it is to make sense of your evidence. Special Note for B2B Products If you are selling to the enterprise, you should also think about the diferent kinds of participants in your sales process. In a classic enterprise sale, you will ofen have a strategic buyer (who is excited about the change you can bring), an economic buyer (who controls the purse), a technical buyer (who might have approval/blocker rights), and then the actual users of your product. Can you identify your champion? Can you identify who might be a saboteur? For B2B companies, Steve Blank also recommends that you start by talking to mid-level managers rather than the C-suite. It can be easier to get their time, it is ofen easier to get repeat conversations, and, most importantly, it will allow you to get better educated before you go up the chain. 36 Talking to Humans What Do You Want to Learn? How To 37 Go into every customer interview with a prepared list of questions. Tis list, which we refer to as an interview guide, will keep you organized. You will appear more professional, and it will ensure that you get to your most important questions early. How do you know your most important questions? I like to begin by understanding my most important, and most risky, assumptions. Tose tend to be the areas where you need to gather insights most urgently. You can uncover your assumptions in a myriad of ways. You can use Alex Osterwalder’s business model canvas or Ash Maurya’s lean canvas. Personally, I ask these questions (see the Appendix for a worksheet and tips): • My target customer will be? • The problem my customer wants to solve is? • My customer’s need can be solved with? • Why can’t my customer solve this today? • The measurable outcome my customer wants to achieve is? • My primary customer acquisition tactic will be? • My earliest adopter will be? • I will make money (revenue) by? • My primary competition will be? • I will beat my competitors primarily because of? • My biggest risk to fnancial viability is? • My biggest technical or engineering risk is? • What assumptions do we have that, if proven wrong, would cause this business to fail? (Tip: include market size in this list) You should be able to look at this list and spot the assumptions that are both highly important and fairly uncertain. Be honest. You want to focus on the most important issues. 38 Talking to Humans In the case of our pillow entrepreneurs, they chose six initial risks which drove their research approach and frst set of questions. To give another scenario, in the last chapter we shared the example of an on-call veterinarian service. Te founders might identify a set of risks: 1. Pet owners are frustrated having to go to a vet and would rather have someone come to them 2. Customers are willing to pay a big premium to have a vet show up at their door 3. We think busy urbanite pet owners will be our early adopters 4. We think people currently discover their vets either through word of mouth or online searches 5. We can affordably acquire our customers through targeted Google search ads 6. We can recruit enough vets across the country to make this a big enough business 7. With travel baked in, our vets can see enough people in a day to be fnancially viable Not every assumption can be tested efectively through qualitative research, but in this case, our founders can probably get some insights on risks 1, 3, 4, and 6 just by talking to people. Risks 1, 3 and 4 would be focused on pet owners, while #6 would be focused on vets. Get Stories, Not Speculation When you are contemplating your questions, be careful with speculation. Humans are spectacularly bad at predicting their future behavior. It is tempting to say, “Would you like this idea?” or “Would you buy this product?” Unfortunately, you really have to treat those How To 39 answers with a great deal of skepticism. It is more efective to ask your interview subject to share a story about the past. For example, when our fctional scientists Koshi and Roberta created their interview plan, the questions were focused on getting the interviewee to tell a story about their last pillow buying experience. Keeping with our second example of an on-call vet service, the team might have a loose interview plan that looks like the following: • Warm up: concise intro on the purpose of the conversation • Warm up: basic questions about person and pet (name, age, picture) • Who is your current vet? Can you tell me about how you found and chose him/her? • Please describe the last time you had to take your pet to the vet for a checkup • Walk me through the process of scheduling a time to visit the vet. • What was frustrating about that experience? • What did you like about that experience? • Have you ever had an emergency visit to a vet? if yes, can you describe that experience for me? • Have you ever thought about changing vets? why / why not? Ask Open-Ended Questions Your goal is to talk little and get the other person sharing openly. To that end, it is imperative that you structure open-ended questions, or at minimum follow up yes/no questions with an open-ended question that gets them talking. One tip is to try to ask questions that start with words like who, what, why and how. Avoid questions that start with is, are, would, and do you. But remember, if you do get a yes/no answer to a 40 Talking to Humans question, you can always follow up in a way that gets them talking. An interesting open-ended question, which Steve Blank likes to use to conclude his interviews, is: “What should I have asked you that I didn’t?” Testing for Price Two of the hardest questions to answer through qualitative research are: will people pay? and how much will they pay? Speculative answers on this topic are extremely suspect. You can learn a lot, however, by asking questions like: • How much do you currently spend to address this problem? • What budget do you have allocated to this, and who controls it? • How much would you pay to make this problem go away? (this can lead to interesting answers as long as you don’t take answers too literally) My recommendation is to set up a situation where the subject thinks they are actually buying something, even if they know the thing doesn’t exist yet. Kickstarter and other crowdfunding platforms are used by a lot of teams to test pre-order demand. For expensive corporate products, you can also try to get customers to buy in advance or sign a non-binding letter of intent to buy. Te key thing to remember is that people don’t honestly think about willingness to pay unless they feel like it is a real transaction. Getting Feedback on a Prototype Sometimes you will want to get reactions to a product solution. You can learn a lot by putting mockups or prototypes in front of people, but, as with all speculation, you should interpret reactions with a degree of skepticism. If you show your interview subject a proposed solution, you need to separate this step from your questions about their behavior. How To 41 Ask your questions about behavior and challenges frst, so that the discussion about product features does not poison or take over the conversation. People do love talking features! The Magic Wand Question Some people like to ask, “if you could wave a magic wand and have this product do whatever you want, what would it do?” Personally, I avoid questions like this because customers are too constrained by their current reality to design efective solutions. It is the customer’s job to explain their behavior, goals, and challenges. It is the product designer’s job to come up with the best solution. Tere is one variation to the magic wand question that I do like, however, because it focuses on problems and not solutions: “If you could wave a magic wand and solve any problem, what would you want to solve?” I suspect, however, that you will fnd many people struggle with such an open question. Design “Pass/Fail” Tests Customer discovery is made up of a lot of qualitative research, but it helps to take a quantitative mindset. Set goals for key questions and track results. For example, halfway through their initial research, our scientists Koshi and Roberta already knew stats like: • 24% of shoppers knew what they wanted when they walked in • 45% of shoppers purchased a mid-priced or high-priced pillow • 68% of the shoppers we spoke to indicated that better sleep was a major driver of their choice Even better would have been if they had set targets ahead of time. For example, they might have set the following goals: • Because we are a new brand, we are hoping that most shoppers are undecided. We want to see that 40% or fewer shoppers already know what 42 Talking to Humans they want when they walk in • Because our pillow is expensive, we want to see that at least 40% of the shoppers buy mid or high-end models • Because we believe that sleep quality is a major differentiator for our product, we want over 60% of shoppers to indicate that this is a major factor in their decision making process Te numerical target you choose can be an educated guess. You do not need to stress over picking the perfect number. It is more important that you set a goal and really track what is happening. Setting a target forces you carefully think through what you are hoping to see, and makes decisions and judgment calls a bit easier as you review your data. A Guide, Not a Script An interview guide is not a script. You do not need to read from it like an automaton. You should feel free to veer of of it if the conversation brings up something interesting and new. It will likely evolve as you learn from the market and unearth new questions. But always plan, prioritize and prep your questions before any session. Observation Can Be As Powerful As Questions Sometimes the best thing you can do is sit back and watch someone’s behavior. You might watch their purchase process, or examine how they go about solving a particular problem. As you think about what you want to learn, also think through how you might gather data through observation rather than direct interviews. In our story of Koshi and Roberta, the two got some of their most valuable insights by going to linen stores and watching potential customers struggle to buy a pillow. Tey observed behavior and only then jumped in to ask questions. Tis technique cannot always be used. For example, when my How To 43 team was trying to validate a weight loss product idea, it did not feel practical to watch people go about their diet. Instead we did interviews and then put a group of customers through a two-week concierge experiment (see Glossary) where we manually acted out the diet experience. But, where possible, observing uninfuenced behavior can lead to great insights. 44 Talking to Humans How Do You Find Your Interview Subjects? How To 45 Entrepreneurs new to customer development are ofen intimidated at the thought of approaching complete strangers. It might surprise you to hear that people are ofen very willing to help out. Tis is especially true if you are working on a topic that interests them and you approach them nicely and professionally. Tere are three general rules to keep in mind when recruiting candidates to speak with: 1. Try to get one degree of separation away (don’t interview your mom, your uncle, or your best friends) 2. Be creative (and don’t expect people to come to you) 3. Fish where the fsh are (and not where they are not) Get Creative One aspiring entrepreneur wanted to target mothers of young children. She had heard stories about talking to people in a cofee shop, but felt like it was too unfocused. So she tried hanging around school pickup zones, but the moms were too busy and refused to speak to her. Next, she tried the playground, where she fgured moms would be bored watching their kids play. Tis worked reasonably well, but she was only able to get a few minutes of anyone’s time. So instead, she started organizing evening events for moms at a local spa where she bought them pedicures and wine. Te time of day worked because the moms could leave the kids at home with their partner. Te attendees had a great time and were happy to talk while they were getting their nails done. Find the Moment of Pain If you can connect with people at the moment of their theoretical pain, it can be very illuminating. My colleague Alexa Roman was working with an automotive company and they had a concept tied 46 Talking to Humans to the experience of getting gas. So Alexa and team visited a series of gas stations. Tey watched consumers go through the process of buying gas. Ten they approached them and asked questions. By thinking about the moment of pain they wanted to address, they knew exactly where to fnd their consumers and they were able to gather valuable observational research. Make Referrals Happen Use referrals to your advantage. Let’s say you want to talk to doctors. Tey are busy and have strong gatekeepers. I bet you know how to get to at least one doctor, however. Tat doctor will know other doctors. Even if your doctor happens to be a close friend and thus breaks the “more than one degree of separation” guideline, she can still give you advice on when might be a good time to talk to a doctor. She can also connect you with other doctors. You should use referrals as much as possible. Set a goal of walking out of every interview with 2 or 3 new candidates. When you end an interview, ask the person if they know others who face the problem you are trying to solve. If they feel like you have respected their time, they will ofen be willing to introduce you to others. Conferences & Meetups Conferences and meetups can be an amazing recruiting ground, because they bring a group of people with shared interests into one place. You just need to be respectful of people’s time. I have found that it is extremely efective to ask people for their time, but for later, afer the conference or meetup. Get their business card, let them get back to networking, and then have an in-depth conversation when it fts their schedule. Immediately afer the conference while their memories are still fresh, send them a short email that reminds them where you met, and give your ask for a conversation. Tis How To 47 works as efectively for in-demand panel speakers as it does for other attendees. Meetups are usually inexpensive, but conference tickets can be pricey. If you are on a budget, you can “hack” expensive conferences by intercepting people outside of the building, or, if you can get access to the attendee or speaker lists ahead of time, contacting people directly and meeting them near the event. Meetup.com has decent search tools to discover relevant events in your area, and a few good Google search queries can usually get you to a short list of conferences that ft your needs. Enterprise Customers Finding interviewees can be harder when you are focused on an enterprise customer. You need laser-like targeting. In addition to conferences, LinkedIn can be extremely useful. If you have hypotheses on the titles of the people you are seeking, run searches on LinkedIn. You might be able to get to them through a referral over LinkedIn, or you might need to cold call them through their company’s main phone number. You then have to decide on your approach method. You can either ask for advice (where you make it clear that you are not selling anything), or you can go in as if you were selling something specifc. Advice vs Selling Asking for advice should be your default method early in your customer discovery process. You will have better luck gaining access. People like being asked (it makes them feel important). Steve Blank used to call people up and say something like, “My name is Steve and [dropped name] told me you were one of the smartest people in the industry and you had really valuable advice to ofer. I’m not trying to sell you anything, but was hoping to get 20 minutes of your time.” 48 Talking to Humans Another efective spin on “asking for advice” is to create a blog focused on your problem space, and ask people if you can interview them for an article. When do you approach someone as if you were selling a product? Tis method is useful if you are past initial learning and want to test your assumptions around customer acquisition and messaging. Just don’t jump into sales mode too early. Beneftting from Gatekeepers If LinkedIn isn’t helping you and you need to reach high up in an organization, another approach is to call the CEO’s ofce. Your goal is not to talk to the CEO but actually their executive assistant. His job is to be an efective gatekeeper, so if you explain, “I’m looking to talk to the person who handles X”, they will ofen connect you to the right person (especially if you are pleasant and professional — notice the trend on that one?). Te added advantage of this method is if you end up leaving a voice mail for your intended contact, you can say “Jim from [CEO’s name]’s ofce gave me your name”. Dropping the boss’ name tends to improve response rates. Another approach is to send a targeted email into an organization with a very short email that asks for an introduction to the right person to speak to. You can make guesses as to email addresses based on LinkedIn queries. For this tactic to work, you must keep your emails extremely concise. Students and Researchers While people are willing to grant time to polite people who ask for advice, you have an extra advantage if you are a student or academic researcher. In other words, if you are a student or researcher, say so. As an extra incentive, you might also ofer to share the results of your research with your interview subjects. How To 49 You Might Be Surprised Another colleague of mine, Jonathan Irwin, was working with a Fortune 50 company. Te client team wanted to interview a special kind of oil platform engineer, of which there were less than 20 in the world! To access these people required security clearance and safety training. We challenged the team to fnd a way, expecting that they would have to rely on video conferencing or phone calls. However, the team started researching this speciality profession through Google and discovered that there was an onshore training facility just an hour away. Te moral of the story is that it ofen isn’t as hard as you think. No Fish in the Sea When I say fsh where the fsh are, it is really important to remember the fip side to that statement: don’t fsh where the fsh are not. If a method isn’t working, try something new. We were doing a project with a major magazine testing out new product ideas. Our target was busy women, and we knew that the readership correlated closely with shoppers of Te Container Store (a retail store). So we parked out front of a store and intercepted folks as they came in and out. People were willing to speak for a few minutes, but many were in a bit too much of a rush. Ten one of our teammates discovered a sample sale happening around the corner. Tere were probably 200 bored women waiting in line, most of whom were happy to talk to us to pass the time. (Note: fnding bored people stuck in line is a common recruiting hack.) Still, we didn’t feel like we were targeting quite as narrowly as we wanted (busy, working women) or as geographically broadly (we didn’t want to just talk to New Yorkers). So we turned to the magazine’s social media presence. We created a short online survey to help us qualify responses, and the magazine posted a link to their Twitter and Facebook pages with a catchy sentence. We had hundreds of women fll out the survey, and then we picked our top 50 Talking to Humans thirty candidates and scheduled calls. Online Forms & Landing Pages In a similar vein, one efective tactic is to create an online form or landing page and build up a list of people to contact. Below is an example of a landing page. Our team was testing a product idea for better home organization. Tis landing page test actually consisted of a three-step funnel with a call to action, a price choice, and then a request for an email address. We tracked the conversion metrics carefully and used the emails to schedule interviews. Caveat: driving trafc is never a trivial process. If you have budget, Google or Facebook ads can work. Otherwise, you can try to generate some word of mouth on social media or through bloggers. How To 51 Conclusion Hopefully what you are picking up through these examples is that there is no single way to get to people. It takes some creativity and hustle, but it isn’t as hard as you might think. Trust me, people will not think you are rude if you carry yourself well and act professionally. Check Out the Appendix for Examples Te Appendix has more tips and examples for cold email and voice mail approaches. 52 Talking to Humans How to Ensure an Effective Session? How To 53 I recommend the following guidelines for running a productive interview session. Do Your Interviews In Person Te quality of your learning can vary a lot depending on your communication method. Talking in person is by far the best approach. You can read body language and build rapport much easier. Remember that a huge percentage of human communication is non-verbal, so why blind your senses if you don’t have to? Te next best approach is video conferencing, because at least you can still read someone’s facial expressions. Phone calls should be your method of last resort (sometimes there is no choice), and I would entirely avoid using text-based mediums like email or chat. Talk to One Person at a Time I believe in talking to one person at a time. It is useful to have a second person on your side quietly taking notes. I strongly recommend avoiding focus groups for two reasons: 1. you want to avoid group think; 2. you will really struggle to focus on one person’s stories, and drill into areas of interest, when you are juggling multiple people. Adding a Note Taker Bringing a note taker will allow you to stay in the moment without worrying about getting every bit down on paper. You can stay focused on the topics, the body language, and where to take the conversation. If you have to take your own notes, that’s not the end of the world. It can sometimes make for a more intimate conversation. Just remember to write up your notes right afer the session or you will lose a lot of detail and color that you weren’t able to write down. You can also ask the interview subject if you can record them, 54 Talking to Humans and many people are willing. Te risk is that a recorder can inhibit the conversation, but most people forget that they are being recorded once the discussion is fowing. I highly recommend that you play back the audio and write up your notes soon afer the session, both because writing up notes will reinforce what you learned in your own mind, and also because written notes are easier and faster for both you and your teammates to scan. I’ve found that once audio or video is more than a couple weeks old, somehow they never get touched again. Start With a Warm Up & Keep It Human When you kick things of, concisely explain why you are there, and thank them for the time. Launch into things with one or two easy warm up questions. For example, if you are talking to a consumer, you might ask where they are from and what they do for a living. If you are talking to enterprise, you might ask how long they have been with their company. You don’t want to spend a lot of time on this stuf, but it does get the ball rolling. Have a written or printed list of questions, but don’t rigidly read from your list. Be in the moment. Make the interview subject feel like you are really listening to them. Disarm Your Own Biases Human beings have an amazing ability to hear what they want to hear (this is called “confrmation bias”). Go into each session prepared to hear things that you might not want to hear. Some entrepreneurs even take the mindset that they are trying to kill their idea, rather than support it, just to set the bar high and prevent themselves from leading the witness. Get Them to Tell a Story As I mentioned in the chapter “What Do You Want to Learn,” How To 55 humans are terrible at predicting their own behavior. If you ask any speculative questions, be prepared to listen with a healthy dose of skepticism. I far prefer to get people telling stories about how they experienced a problem area in the past. In particular, try to fnd out if they have tried to solve the problem. What triggered their search for a solution? How did they look for a solution? What did they think the solution would do, before they tried it? How did that particular solution work out? And if they are struggling to remember specifcs, help them set the scene of their story: what part of the year or time of day? Were you with anyone? As they are telling their story, follow up with questions about their emotional state. You might get some historical revisionism, but what you hear can be very illuminating. Te researchers at Meetup.com, who borrow from Clayton Christensen’s Jobs To Be Done framework, use an interesting tactic to help their subjects get in story mode. When they are asking someone to take them through a purchase experience, from frst thought through purchase and then actual product usage, they say: “Imagine you are flming the documentary of your life. Pretend you are flming the scene, watching the actor playing you. At this moment, what is their emotion, what are they feeling?” Look for Solution Hacks One of the best indicators that the market needs a new or better solution is that some people are not just accepting their frustration with a particular problem, but they are actively trying to solve it. Maybe they have tried a few diferent solutions. Maybe they have tried hacking together their own solution. Tese stories are a great indicator of market need. Understanding Priority For someone to try a new product, their pain usually needs to be 56 Talking to Humans acute enough that they will change their behavior, take a risk, and even pay for it. If you feel like you are seeing good evidence that someone actually has a problem, it is worth asking where it ranks in their list of things to solve. Is it their #1 pain, or something too low in priority to warrant attention and budget? Listen, Don’t Talk Try to shut up as much as possible. Try to keep your questions short and unbiased (i.e. don’t embed the answer you want to hear into the question). Don’t rush to fll the “space” when the customer pauses, because they might be thinking or have more to say. Make sure you are learning, not selling! Or, at least make sure you are not in “sales” mode until the point when you actually do try to close a sale as part of an experiment. Follow Your Nose and Drill Down Anytime something tweaks your antenna, drill down with follow up questions. Don’t be afraid to ask for clarifcations and the “why” behind the “what.” You can even try drilling into multiple layers of “why” (run an Internet search for “Five Whys” for more info), as long as the interviewee doesn’t start getting annoyed. Parrot Back or Misrepresent to Confrm For important topics, try repeating back what the person said. You can occasionally get one of two interesting results. Tey might correct you because you’ve misinterpreted what they said. Or, by hearing their own thoughts, they’ll actually realize that their true opinion is slightly diferent, and they will give you a second, more sophisticated answer. Another approach is to purposefully misrepresent what they just said when you parrot it back, and then see if they correct you. But How To 57 use this technique sparingly, if at all. Do a Dry Run If you are a beginner at customer discovery, do a dry run with a friend or colleague. See how your questions feel coming out of your mouth. Get a sense of what it is like to listen carefully and occasionally improvise. Getting Feedback on Your Product If you want to get feedback on your product ideas, whether you show simple mockups or a more polished demo, there are a few important tips to keep in mind: As I mentioned before, separate the storytelling part of your session from the feedback part. People love to brainstorm on features and solutions, and this will end up infuencing the stories they might tell. So dig into their stories frst, and gather any feedback second. Second, disarm their politeness training. People are trained not to call your baby ugly. You need to make them feel safe to do this. Ask them up-front to be brutally honest, and explain that it is the very best way for them to help you. If they seem confused, explain that the worst thing that could happen is to build something people didn’t care about. Finally, keep in mind that it is incredibly easy for people to tell you that they like your product. Don’t trust this feedback. Instead, you need to put people through an actual experience and watch their behavior or try to get them to open their wallet. Tere is no right answer on how polished your early mockups need to be. If you are in the fashion space, you need to have a high degree of visual polish as table stakes. If you are creating a solution for engineers, you probably need much less. Just don’t wait for perfection, because initial product versions rarely get everything right. You need to spot your errors sooner rather than later. 58 Talking to Humans How Do You Make Sense of What You Learn? How To 59 Your goal is not to learn for learning’s sake. Your goal is to make better decisions that increase the odds of success. So how do you translate your observations into decisions? Te frst step is to make sense of your patterns. Take Good Notes To fnd your patterns, frst you need to track the data. Tis is easy if you bring a good notetaker to the interview, but otherwise, make sure that you write up your notes as soon afer your conversation as possible. Make them available to the entire team with Google Docs or the equivalent. At the start of every entry, note the following information: • Name of interview subject • Date and time • Name of interviewer • In person or video conference • Photo (if you have one) Ten at the start of your notes, include basic descriptive information of the interview subject. Quantitative Measures If you are setting specifc metric goals for your interviews, you might set up a shared spreadsheet that essentially acts as a running scorecard for how you are doing and how you are tracking to targets. EXAMPLE Let’s imagine that you have invented a new air purifer that triples the growth speed of greenhouse plants. Now you plan to talk to 20 60 Talking to Humans farmers, and you have a few core questions: • Will their business actually beneft from increased growth speed? You are assuming that increased volume will help rather than hurt. You plan to talk to growers of different crops with the goal of fnding crops where 60% or more of farmers want increased volume. • Are farmers spending any money today on growth accelerator solutions? Your qualitative research will drill into what and why, but your metrics goal says that you hope at least 50% of the market is already spending at least some money. • Do they have the facilities to support your purifer? In this case, you need your purifer to be both in a specifc location, but also have access to an electrical outlet. You are hoping that 70% of the farmers have an outlet 20 feet or closer to your spot. Here is the kind of spreadsheet that you and your team might track: As Samantha advised Koshi and Roberta in the fctional story, turning your observations into quantifable metrics is both useful and tricky. Our brains like to infuence our thinking with cognitive biases, especially fltering results for what we want to hear. Calculating actual metrics helps fght against that dynamic. How To 61 At the same time, you have to beware a diferent kind of bias: our desire to turn statistics into facts. Hopefully you are getting enough data points that you can trust the patterns, but do not confuse this with statistical signifcance or take your results too literally. My advice is to calculate metrics, but remain skeptical of them, don’t obsess over any one particular metric, and continue to question what is behind your numbers. Dump and Sort Exercise Bring your team together and arm them with sticky notes and sharpies. Give everyone 10 minutes to jot down as many patterns and observations as they saw during their interviews. Put all the sticky notes on a wall and have someone sort them into groups. As a team, discuss the patterns, and then re-review your assumptions or business canvas and see what might need to change or require greater investigation. Look for Patterns and Apply Judgement Customer development interviews will not give you statistically signifcant data, but they will give you insights based on patterns. Tey can be very tricky to interpret, because what people say is not always what they do. You don’t want to react too strongly to any single person’s comments. You don’t want to take things too literally. But neither do you want to be bogged down trying to talk to thousands of people before you can make a decision. You need to use your judgement to read between the lines, to read body language, to try to understand context and agendas, and to flter out biases based on the types of people in your pool of interviewees. But it is exactly the ability to use human judgement based on human connections that make interviews so much more useful than surveys. Ultimately, you are better of moving fast and making decisions 62 Talking to Humans from credible patterns than dithering about in analysis paralysis. Don’t Abdicate Your Role As Product Designer It is not the job of the customer to design your product. It is yours. As you are gathering information and making decisions, act like a intelligent flter, not an order-taker. Expect False Positives While all entrepreneurs get their fair share of naysayers and skeptics, you have to be wary of the opposite problem in customer development interviews. People will want to be helpful and nice, and your brain will want to hear nice things. As you are weighing what you have learned, just keep this in mind. The Truth Curve I am a big believer in qualitative research. I think a good product team should build a regular cadence of talking to relevant people into their process. However, you don’t want your only source of learning to be talking to people. You don’t really know the absolute truth about your product until it is live and people are truly using it and you are making real money from it. But that does not mean you should jump straight to a live product, because that is a very expensive and slow way to iterate your new business. Get into the market early and begin testing your assumptions right away, starting with conversations and proceeding from there. It will dramatically increase the odds that you will create a product that customers actually want. As you build confdence, test with increasing levels of fdelity. I think of it like peeling an onion in reverse. I created the accompanying chart to demonstrate the levels of believability for diferent kinds of experiments. How To 63 Talking to people is powerful. It tends to give you your biggest leaps of insight, but, as I keep on repeating, what people say is not what they do. You might show people mockups and that might give you another level of learning and feedback, but reactions still need to be taken with skepticism. Concierge and “Wizard of Oz” experiments, where you fake the product through manual labor (see Glossary) will give you stronger evidence, because you put people through an experience and watch their actions. Te next layers of the onion are to test with a truly functional “Minimum Viable Product” (see Glossary) and beyond. Te point I want to make is that all of the steps on the curve can be very useful to help you learn, make smarter decisions, and reduce risk, but you need to use your head, and apply judgement to everything you are learning. 64 Talking to Humans How many people to talk to? Tere is no pat answer to this question. A consumer business should talk to an order of magnitude more people than a business that sells to enterprise. If you are in the consumer space and haven’t spoken to at least 50 to 100 people, you probably have not done enough research. In his I-Corps course, Steve Blank requires his teams, many of which are B2B, to talk to at least 100 people over 7 weeks. I advise that you never stop talking to potential customers, but you will probably evolve what you seek to learn. If you see the same patterns over and over again, you might change things up and examine diferent assumptions and risks. For example, if you feel like you have a frm understanding of your customer’s true need, you might move on to exploring how they learn about and purchase solutions in your product category today. And don’t forget that observing your customers can be as powerful as directly talking to them. Lead with Vision Customer Development and lean startup techniques are some of the most powerful ways to increase your odds of success, but they are not a replacement for vision. You need to start with vision. You need to start with how you want to improve the world and add value to people’s lives. Te techniques we’ve discussed in this book are among a body of techniques that let you reality check your vision, and optimize the path you will take to achieve your vision. How To 65 Conclusion Toughtful qualitative research is a critical tool for any entrepreneur. Hopefully this book has given you some new strategies for how to put it to work for your needs. Creating a new business is tremendously challenging. Te ways you can fail are numerous. t You have to get the customer and market right t You have to get the revenue model right t You have to get the cost structure right t You have to get customer acquisition right t You have to get the product right t You have to get the team right t You have to get your timing right Screw up any one of those and you are toast. Tere is a reason why entrepreneurship is not for the faint of heart. But we’re not here to be faint of heart. We are here to change the world. Dream big. Be passionate. Just be ruthless with your ideas and assumptions. Customer discovery and lean experimentation can truly help you chart a better path and fnd success faster and with more capital efciency. Don’t forget that as your business grows and changes, so too will your customer base. Keep on reality-checking your hypotheses. Keep on talking to humans. Appendix PART THREE Appendix 67 Cold Approach Examples When you are trying to reach someone you do not know, there are a few things to remember: 1. Keep things concise 2. Keep things convenient (meet near their ofce, etc) 3. Name drop when you can 4. Follow up if you don’t hear an answer, but don’t be annoying 5. If you are leaving a voice mail, practice it frst (you might think it sounds practiced, but to others, it will sound more professional) Example Email 1 To: john.smith@mayfower.com From: me@me.com John, I received your name from James Smith. He said that you had a lot of expertise in an area I am researching and recommended that we speak. I’m trying to study how companies are handling their expense report management workfows and the frustrations they are experiencing. I would be happy to share my research conclusions with you. Would you have 30 minutes to spare next week when I could buy you a cup of coffee and ask you a few questions? Many thanks for your time and I look forward to hearing from you, Jane Doe 68 Talking to Humans Example Email 2 To: john.smith@mayfower.com From: me@me.com John, I have been working on some new solutions in the area of expense report management, and I was told that you have a lot of expertise in this area. We started this journey because of personal frustration, and we’re trying to fgure out how to make expense reporting much less painful. Would you have 30 minutes to give us some advice, and share some of your experiences in this domain? I assure you that I’m not selling anything. I would be happy to come by your offce or arrange a quick video conference, at your preference. Many thanks, Jane Doe Example Voice Mail Message “Hello, my name is Jane Doe. I was referred to you by James Smith, who said I would beneft from your advice. I am currently researching how companies are handling their expense management workfows. I understand you have a lot of expertise in this area. I was hoping to take just 30 minutes of your time to ask you a few questions. I’m not selling anything and I would be happy to share my research conclusions with you. You can reach me at 555-555-5555. Again, this is Jane Doe, at 555-555-5555, and thank you for your time.” Final Note Cold calling is never anyone’s favorite thing to do, but it isn’t nearly as painful as you imagine. You have nothing to lose and everything to gain. So give yourself a determined smile in the mirror, and go get them! Appendix 69 Business Assumptions Exercise I am agnostic about the framework you choose to use to map out your business assumptions. Alexander Osterwalder’s business model canvas and Ash Maurya’s lean canvas are both powerful tools. I also ofen fnd myself using this simple set of questions to lay out a belief system around an idea: Try to make your assumptions as concise and specifc as possible. You want to be able to run an experiment against it to see if it is true. My target customer will be? (Tip: how would you describe your primary target customer) The problem my customer wants to solve is? (Tip: what does your customer struggle with or what need do they want to fulfll) My customer’s need can be solved with? (Tip: give a very concise description / elevator pitch of your product) Why can’t my customer solve this today? (Tip: what are the obstacles that have prevented my customer from solving this already) The measurable outcome my customer wants to achieve is? (Tip: what measurable change in your your customer’s life makes them love your product) 70 Talking to Humans My primary customer acquisition tactic will be? (Tip: you will likely have multiple marketing channels, but there is often one method, at most two, that dominates your customer acquisition — what is your current guess) My earliest adopter will be? (Tip: remember that you can’t get to the mainstream customer without getting early adopters frst) I will make money (revenue) by? (Tip: don’t list all the ideas for making money, but pick your primary one) My primary competition will be? (Tip: think about both direct and indirect competition) I will beat my competitors primarily because of? (Tip: what truly differentiates you from the competition?) My biggest risk to fnancial viability is? (Tip: what could prevent you from getting to breakeven? is there something baked into your revenue or cost model that you can de-risk?) My biggest technical or engineering risk is? (Tip: is there a major technical challenge that might hinder building your product?) And then answer the following open-ended question. Be creative and really examine your points of failure. Appendix 71 What assumptions do we have that, if proven wrong, would cause this business to fail? 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Afer you have looked at your business holistically and also answered the broad fnal question, mark the assumptions that would have a large impact on your business and feel highly uncertain. Now you know your priorities for customer discovery and the experiments you need to run! 72 Talking to Humans Teaching Exercise #1: Mock Interviews If you are using this book to try to teach customer discovery/ development, there is nothing like real-world practice to make learning stick. Before you send your class out into the world to conduct their own interviews, however, you might try a compact exercise like the following: Tools All participants should have pen and paper Preface: Choose a Topic Everyone in the class will interview each other based on the same topic, which means it needs to be something most people can relate two. Tere are two angles you might take: 1. Something that helps the interviewer dig up past behavior. For example, “Tell me about the last thing you purchased over $100.” Have the interview subject explain what they bought, what the purchase process was like from desire to actual ownership, how they made their purchase decision, etc. 2. Something that helps the interviewer unlock deeper motivations and desires. For example, “Tell me about your dream car.” Prompt your students not just to get people to describe the car, but to dig into the reasons behind the choice; they can also prompt for whether the interview subject has ever experienced driving the car. Appendix 73 Exercise Step 1: Intro, 5 minutes Explain the exercise, the topic that the students will use, and give a few specifc suggestions for questions they might ask. Example questions for the dream car: when did you fall in love with the car and why? of the reasons you shared, why are these the most important to you? how have you imagined using the car? etc Step 2: Interview Plan, 2 minutes Give your class the topic and let them spend 5 minutes on their own. Tey should write down no more than 6 questions to ask. Step 3: Pair Interviews, 5 - 7 minutes each Pair up your students. One will begin as the interviewer, and their opposite will be interviewed. Give them 7 minutes, and then switch the roles, keeping the pairs unchanged. Te new interviewer gets 7 minutes. Te person doing the interviewing should also take notes, which will give them some exposure to doing an interview solo as opposed to bringing a note-taker to help (which is what most people prefer to do when possible). Step 4: Observations and Questions, 5-10 minutes Ask the room to share observations, challenges, lessons or questions on what it was like to do a live interview. 74 Talking to Humans Teaching Exercise #2: Mock Approach Dean Chang, the Associate VP of Entrepreneurship at the University of Maryland, recommends a class exercise where one or more teams of students takes on the role of cold calling an “expert.” Te team has to do it over and over until they get it right. For this exercise, select one team and have them come to the front of the classroom. Teir job is to “cold call” a selected member of the teaching team. Te teacher will pretend to be an expert in the team’s target feld. Te team needs to get the expert to take the call, and smoothly transition into asking questions. Te job of the person playing the “expert” is to block the team’s misguided attempts to engage. When the team does something wrong, the expert declines the interview request, or ends the conversation, or gives them a gong. Ten the team has to start over again. Classic mistakes that should trigger the team starting over include long or unclear introductions, pitching the product/technology too soon, implying that the expert has problems and desperately needs help, and/or generally making the expert feel uncomfortable with the line of questioning. As Dean describes it, “We let the other teams ofer critiques and suggest plans of attack for winning over the expert and then the chosen team tries it again. Eventually afer being gonged several times in a row, they stop making the same mistakes and start to Appendix 75 converge on a good elevator pitch that praises and disarms the expert and paves the way to entering into an interview. Ten we stop the exercise.” Te exercise will probably be humorous and painful at the same time, but there is nothing like stumbling, or watching a team stumble, to realize why best practices are best practices. 76 Talking to Humans Screwing Up Customer Discovery So how do people screw up customer discovery? Here are a few antipatterns: 1. You treat speculation as confrmation Here are some question types that I don’t like — and if you ask them, you should heavily discount the answer: “would you use this?” “would you pay for this?” “would you like this?” I can’t say that I never ask these questions, but I always prefer behavioral questions over speculation. As contrast, here is a behavior-focused interaction: “Tell me about a time when you bought airline tickets online.” “What did you enjoy about the process? What frustrated you about the process?” “What diferent systems or methods have you tried in the past to book tickets?” 2. You lead the witness Leading the witness is putting the answer in the interviewee’s mouth in the way you ask the question. For example: “We don’t think most people really want to book tickets online, but what do you think?” Examine both how you phrase your questions and your tone of voice. Are you steering the answer? Ask open-ended, neutral questions before you drill down: “what was that experience of buying online tickets like?” 3. You just can’t stop talking Some entrepreneurs can’t help themselves — they are overfowing with excitement and just have to pitch pitch pitch. Tere is nothing Appendix 77 wrong with trying to pre-sell your product — that is an interesting experiment unto itself — but you should not mix this in with behavioral learning. If you do try to pre-sell, don’t just ask, “Would you pay for this?” but rather ask them to actually pay, and see what happens. Some people ask the question, “How much would you pay for this?” but I do not. Instead, try actually selling at diferent price points (albeit one at a time). I much prefer having the potential customer experience something, rather than speculate over something. 4. You only hear what you want to hear I see some people go into interviews with strong beliefs about what they like and dislike. When you debrief afer their custdev conversation, it is magical how everything they heard aligns perfectly with their opinions. Our brains are amazing flters. Leave your agenda at the door before starting a conversation. One way to solve this is to have two people for each interview — one person to ask questions, and the other to take notes. 5. You treat a single conversation as ultimate truth You’ve just spoken to a potential customer and they have really strong opinions. One instinct is to jump to conclusions and rush to make changes. Instead, you need to be patient. Tere is no defnitive answer for how many similar answers equals the truth. Look for patterns and use your judgement. A clear, consistent pattern at even 5 or 10 people is a signal. 6. Fear of rejection wins out Tis is one of the biggest blockers to people doing qualitative research, in my experience, because of fear of a stranger rejecting your advance or rejecting your idea. Many excuses, such as “I don’t know how to fnd people to talk to,” are rooted in this fear. JFDI. Customer development isn’t just about street intercepts. You can 78 Talking to Humans recruit people on Craigslist, Facebook and LinkedIn groups, and good old fashioned networking. 7. You talk to anyone with a pulse I see some teams taking a shotgun approach. Instead, defne your assumptions around who your customer will be and who your early adopter will be. You might even do a lightweight persona (see the book Lean UX for examples). Zoom in on those people and try to validate or invalidate your assumptions about your customers. It is ok to occasionally go outside your target zone for learning, but don’t boil the ocean. Focus, learn, and pivot if necessary. 8. You wing the conversation If you go into a conversation unprepared, it will be evident. Write up your questions ahead of time and force-rank them based on the risks and assumptions you are worried about. To defne your assumptions, you can answer the questions in the business assumptions exercise (previous section), or do a business model canvas or a lean canvas. Your exact method doesn’t matter as much as the act of prioritizing your risk areas. During your actual interview, do not literally read your questions from a piece of paper, but rather keep things conversational (remember, you are getting the subject to tell you stories). If you uncover something interesting, follow your nose and don’t be afraid to diverge from your initial priorities. 9. You try to learn everything in one sitting Rather than trying to go as broad as possible in every conversation, you are actually better of zooming in on a few areas which are critical to your business. If you have a huge range of questions, do more interviews and split the questions. Appendix 79 10. Only the designer does qualitative research It is ok to divide and conquer most of the time, but everyone on the team should be forced to get out and talk to real people. Note: you will probably have to coach newcomers on #5’s point about not jumping to conclusions. 11. You did customer development your frst week, but haven’t felt a need to do it since It is always sad to see product teams start things of with customer development, and then completely stop once they get going. It is perfectly fne to let customer discovery work ebb and fow. If your learning curve fattens, it can make sense to press pause or change up your approach. However, you want to build a regular qualitative cadence into your product process. It will provide a necessary complement to your quantitative metrics, because it will help you understand the reasons why things are happening. 12. You ask the customer to design your product for you Tere’s a famous line attributed to Henry Ford, “If I had asked people what they wanted, they would have said faster horses.” Remember, it is not the customer’s job to design the solution. It is your job. It is the customer’s job to tell you if your solution sucks. Get feedback, yes. Remember that the further away you are from a working product, the more you have to flter what you hear through your judgement and vision. Disclaimer As with all tips on lean and agile, there are always places and times to break the rules and do what is right for your context, and your business. 80 Talking to Humans Glossary Concierge and “Wizard of Oz” Experiments A concierge experiment is where you manually act out your product. An example in Eric Ries’ book Te Lean Startup shows an entrepreneur serving as a personal shopper for people before trying to design an automated solution. When my colleagues were testing a diet plan service, we did not want to rush to sofware before testing our assumptions. Instead, we interviewed participants about their food preferences, manually created meal plans which were emailed to them over two weeks, and interviewed them at various points in the process. At the end of the two weeks, we asked them to pay a set amount to continue, and tracked the conversion rate. A “Wizard of Oz” experiment is similar, with the diference being that the manual work is hidden from the customer. For example, another set of colleagues tested an idea for a smart task management system for married couples. Te twenty couples participating in the test thought that they were interacting with a computer system, but in reality they were emailing in to our team, who then processed the emails accordingly. We just said that the servers would be “down” at night! Minimum Viable Product (MVP) An MVP is the smallest thing you can create that gives you meaningful learning about your product. MVP is ofen used interchangeably with “experiment” in the broader community. I personally tend to reserve it specifcally for tests around the product, and not for experiments related to other business assumptions. It is best to think about MVPs as an ongoing process, rather than a single release. Validation is rarely that neat and tidy. Appendix 81 Scientifc Method I think the best way to explain the scientifc method is to quote the theoretical physicist, Richard Feynman: “In general we look for a new law by the following process: frst we guess it. Don’t laugh -- that’s really true. Ten we compute the consequences of the guess to see what, if this law is right, what it would imply. Ten we compare those computation results to nature, i.e. experiment and experience. We compare it directly to observation to see if it works. “If it disagrees with experiment, it’s wrong. Tat simple statement is the key to science. It doesn’t make a diference how beautiful your guess is, it doesn’t make a diference how smart you are, who made the guess or what his name is -- if it disagrees with experiment, it’s wrong. Tat’s all there is to it.” (Cornell lecture, 1964) It is relatively straightforward to apply the scientifc method to business. You accept that your ideas are hypotheses. You make them as specifc as possible so that you can guess the results, i.e. the implications, of your hypotheses. You design and run an experiment. If your hypothesized results do not match the results of your experiment, your hypothesis is proven wrong. However, business is about people, and people are highly complex and inconsistent compared to laws of nature. So if your experiment fails, you will still need to apply judgement about whether the errors are in the hypothesis or in the experiment. 82 Talking to Humans Other Learning Resources Authors Te two seminal books on the topics of lean innovation and customer development are Steve Blank and Bob Dorf ’s Te Startup Owner’s Manual and Eric Ries’ Te Lean Startup. Tere are a ton of other resources out there, from books to videos and blog posts. Rather than link to particular items and thus miss out on newer developments, here are a few names that I recommend you pay attention to: Alex Osterwalder, Alistair Croll, Ash Maurya, Ben Yoskowitz, Brant Cooper, Cindy Alvarez, David Bland, Jef Gothelf, Joel Gascoigne, Josh Seiden, Kevin Dewalt, Laura Klein, Patrick Vlaskovits, Rob Fitzpatrick, Salim Virani, and Tristan Kromer. Talking to Humans Website On our website talkingtohumans.com, you can get worksheet pdfs and sign up for our email list, where we send occasional notes based on useful resources we discover. Behind the Book 83 Gif Constable (gifconstable.com) is a repeat entrepreneur and currently the CEO of Neo, a global product innovation consulting company. He has held product design and business roles in six startups, and provided M&A and IPO services to technology frms while at Broadview/Jeferies. He was one of the earliest adopters & bloggers of the Lean Startup movement, co-organizes the 4,700-person Lean Lessons Learned meetup in New York, and tries to give back to the entrepreneurial community through mentoring and speaking engagements. He lives outside of New York City with his wife, two children, and an excessively rambunctious retriever. Giff Constable Talking to Humans was written by Gif Constable, at the instigation and with the collaboration of Frank Rimalovski of NYU’s Entrepreneurial Institute, and with the wonderful illustrations of Tom Fishburne. Behind the Book 84 Guide to Customer Discovery Frank Rimalovski brings over 20 years of experience in technology commercialization, startups and early-stage venture capital investing. He is executive director of the NYU Entrepreneurial Institute, managing director of the NYU Innovation Venture Fund, Adjunct Faculty at NYU’s Polytechnic School of Engineering, and an Instructor in the NSF’s I-Corps program, having trained and mentored hundreds of entrepreneurs in customer development and lean startup methodologies. Previously, he was a founding partner of New Venture Partners, director/entrepreneur-in-residence at Lucent’s New Ventures Group, and has held various positions in product management, marketing and business development at Sun Microsystems, Apple and NeXT. He lives outside of New York City with his wife, two daughters and his increasingly mellow mutt. Frank Rimalovski Tom Fishburne (marketoonist.com) started drawing cartoons on the backs of Harvard Business School cases. His cartoons have grown by word of mouth to reach 100,000 business readers a week and have been featured by the Wall Street Journal, Fast Company, and the New York Times. Tom is the Founder and CEO of Marketoon Studios, a content marketing studio that helps businesses such as Google, Kronos, and Rocketfuel reach their audiences with cartoons. Tom draws from 19 years in the marketing and innovation trenches at Method Products, Nestle, and General Mills. He lives near San Francisco with his wife and two daughters. Tom Fishburne Behind the Book 85 Like The Book? When Frank approached me to write this book, we both had the same goal of giving back to the community. We debated charging for the book, and pondered whether the question of free versus paid would afect how it was perceived. But ultimately, we decided to put it out into the world for free. Should you like Talking to Humans, and feel a need to contribute back to something, we would encourage you to think about doing one or all of the following: 1. Pay it back (and forward!) by mentoring another student or entrepreneur 2. Donate to one of our favorite causes: Charity: Water, Girls Who Code, Kiva or the NYU Entrepreneurial Institute 3. Share a link to the talkingtohumans.com website or give someone a copy of the book If this book has helped you in some small way, then that is reward enough for us. It’s why we did it. Gif Constable and Frank Rimalovski September 2014 talkingtohumans.com page intentionally blank Acclaim for Talking to Humans “Talking to Humans is the perfect complement to the existing body of work on customer development. If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have.” Steve Blank, entrepreneur and author of The Startup Owner’s Manual “Getting started on your Customer Discovery journey is the most important step to becoming a successful entrepreneur and reading Talking To Humans is the smartest frst step to fnding and solving real problems for paying customers.” Andre Marquis, Executive Director, Lester Center for Entrepreneurship, University of California Berkeley “If entrepreneurship 101 is talking to customers, this is the syllabus. Talking to Humans is a thoughtful guide to the customer informed product development that lies at the foundation of successful start-ups.” Phin Barnes, Partner, First Round Capital “A lot of entrepreneurs pay lip service to talking to customers but you have to know how. Talking to Humans ofers concrete examples on how to how to recruit candidates, how to conduct interviews, and how to prioritize learning from customers more through listening versus talking.” Ash Maurya, Founder of Spark59 and author of Running Lean “When getting ‘out of the building,’ too many people crash and burn right out of the gate and wonder what happened. Talking to Humans is a quick and efective guide for how Lean Startup interviews should be done.” Dean Chang, Associate VP for Innovation & Entrepreneurship, University of Maryland #talkingtohumans talkingtohumans.com","I'm providing you with your source material. You will not be using any outside material. Your job is to answer questions about the material. What are the essential steps and key points from the customer discovery process outlined in ""Talking to Humans""? TALKING TO HUMANS Success starts with understanding your customers GIFF CONSTABLE with Frank Rimalovski illustrations by Tom Fishburne and foreword by Steve Blank Copyright ©2014 Gif Constable First edition, v1.71 All rights reserved. Book design: Gif Constable Illustrations by Tom Fishburne Cover design assistance: Jono Mallanyk Lean Startup is trademarked by Eric Ries Customer Discovery is a phrase coined by Steve Blank ISBN: 978-0-9908009-0-3 Special thanks to the NYU Entrepreneurial Institute for their collaboration and support in the creation of Talking to Humans Acclaim for Talking to Humans “If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have.” Steve Blank, entrepreneur, educator and author of Four Steps to the Epiphany and The Startup Owner’s Manual “If entrepreneurship 101 is talking to customers, this is the syllabus. Talking to Humans is a thoughtful guide to the customer informed product development that lies at the foundation of successful start-ups.” Phin Barnes, Partner, First Round Capital “Getting started on your Customer Discovery journey is the most important step to becoming a successful entrepreneur and reading Talking To Humans is the smartest frst step to fnding and solving real problems for paying customers.” Andre Marquis, Executive Director, Lester Center for Entrepreneurship University of California Berkeley “A lot of entrepreneurs pay lip service to talking to customers but you have to know how. Talking to Humans ofers concrete examples on how to how to recruit candidates, how to conduct interviews, and how to prioritize learning from customers more through listening versus talking.” Ash Maurya, Founder Spark59 and Author of Running Lean “Tis is a great how-to guide for entrepreneurs that provides practical guidance and examples on one of the most important and ofen under practiced requirements of building a great startup—getting out of the ofce, talking directly with customers and partners, and beginning the critical process of building a community.” David Aronoff, General Partner, Flybridge Capital “Gif has been one of the thought leaders in the lean startup movement from the very beginning. Entrepreneurs in all industries will fnd Talking to Humans practical, insightful, and incredibly useful.” Patrick Vlaskovits, New York Times bestselling author of The Lean Entpreneur “Current and future customers are the best source of feedback and insight for your new product ideas. Talking to them is intimidating and seemingly time-consuming. In this focused, practical, down-to-earth book Gif Constable demystifes the art (not science) of customer discovery helping entrepreneurs and product veterans alike learn how to build a continuous conversation with their market and ensure the best chances of success for their ideas. Want to know what your audience is thinking? Read this book!” Jeff Gothelf, author of LeanUX “When getting ‘out of the building,’ too many people crash and burn right out of the gate and wonder what happened. Talking to Humans is a quick and efective guide for how Lean Startup interviews should be done: who to talk to, how to talk your way in the door, and how to gain the most insight and learning. Don’t crash and burn – read Talking to Humans!” Dean Chang, Associate Vice President for Innovation & Entrepreneurship University of Maryland “A must read for anyone who is considering creating a startup, developing a new product or starting a new division. Read this book frst – a great guide to the evolving art of customer discovery. Don’t waste your time building products that your customer may or may not want. Before you write the frst line of code, pitch your idea to investors or build the frst prototype, do your self a favor, read this book and follow the advice! I guarantee you will make better decisions, build a better product and have a more successful company.” John Burke, Partner, True Ventures “Primary market research has been around for a long time because it has stood the test of time and proved that it is fundamental to building a successful venture; it underlies all that we do at MIT in entrepreneurship. Te question is how we more broadly deployed appropriate skills to entrepreneurs so they can be guided to do this in an efcient and efective manner while maintaining rigor. With all the sloganeering out there on the topic, this book stands out in that it delivers real value to the practitioner in this regard.” Bill Aulet, Managing Director, Martin Trust Center for MIT Entrepreneurship “Talking to strangers can be scary, but it’s vital to launching any new product. Trough storytelling, Gif Constable makes customer development concepts accessible. Tis book will show you how to articulate assumptions, get useful information and turn it into meaningful insights. Ten it delivers practical advice you can use immediately to test your ideas. Fear holds people back. Tis book will give you the confdence to jump.” Andres Glusman, Chief Strategy Offcer, Meetup.com Table of Contents 8 Foreword 11 Introduction 14 The Story 28 Lessons Learned 30 How To 31 Getting Started with Customer Discovery 32 Who Do You Want to Learn From? 36 What Do You Want to Learn? 44 How Do You Find Your Interview Subjects? 52 How to Ensure an Effective Session? 58 How Do You Make Sense of What You Learn? 65 Conclusion 66 Appendix 67 Cold Approach Examples 69 Business Assumptions Exercise 72 Teaching Exercise #1: Mock Interviews 74 Teaching Exercise #2: Mock Approach 76 Screwing Up Customer Discovery 80 Glossary 82 Other Learning Resources 83 Behind the Book 8 Talking to Humans Foreword “Get out of the building!” Tat’s been the key lesson in building startups since I frst started teaching customer development and the Lean Launchpad curriculum in 2002. Since then, a lot has happened. Te concepts I frst outlined in my book Te Four Steps to the Epiphany have grown into an international movement: Te Lean Startup. Te class I developed - Te Lean Launchpad - is now taught at Stanford, UC Berkeley, Columbia University, UCSF, and most recently New York University (NYU). More than 200 college and university faculty have taken my Lean Launchpad Educators Seminar, and have gone on to teach the curriculum at hundreds of universities around the globe. Te National Science Foundation, and now the National Institute of Health, use it to commercialize scientifc research as part of their Innovation Corps (I-Corps) program. My How to Build a Startup class on Udacity has been viewed by over 225,000 students worldwide. During the past few years, we’ve seen dozens of large companies including General Electric, Qualcomm and Intuit begin to adopt the lean startup methodology. Te Lean Startup turns the decades-old formula of writing a business plan, pitching it to investors, assembling a team, and launching and selling a product on its head. While terms like “pivot” and “minimum viable product” have become widely used, they are not understood by many. Te same can be said of “getting out of the building”. Many entrepreneurs “get out” and get in front of customers, but take a simplistic view and ask their customers what they want, or if they would buy their startup’s (half-baked) product. Te “getting out” part is easy. It is the application of the customer Foreword & Introduction 9 development methodology and the testing of their hypotheses with users, customers and partners that is both critical and ofen difcult for entrepreneurs to grasp in the search for a scalable and repeatable business model. Since the Four Steps, many other books have been written on customer development including Te Startup Owner’s Manual, Business Model Generation, Te Lean Startup, and others. Each of these texts has advanced our understanding of the customer development methodology in one way or another, teaching aspiring students and entrepreneurs the what, when and why we should get out of the building, but have only skimmed the surface on “how” to get out of the building. For both my own classes as well as I-Corps, I always made Gif Constable’s blog post “12 Tips for Early Customer Development Interviews” required reading. It answered the “how” question as well. Now Gif has turned those 12 tips into an entire book of great advice. In a comprehensive, yet concise and accessible manner, Talking to Humans teaches you how to get out of the building. It guides students and entrepreneurs through the critical elements: how to fnd interview candidates, structure and conduct efective interviews and synthesize your learning. Gif provides ample anecdotes as well as useful strategies, tactics and best practices to help you hit the ground running in your customer discovery interviews. If you are a student, aspiring entrepreneur or product manager trying to bring the value of getting out of the building to an existing company, Talking to Humans is a must read. It is chock full of lessons learned and actionable advice that will enable you to make the most of your time out of the building. Talking to Humans is the perfect complement to the existing 10 Talking to Humans body of work on customer development. If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have. Steve Blank September 3, 2014 Foreword & Introduction 11 Introduction 12 Talking to Humans Te art of being a great entrepreneur is fnding the right balance between vision and reality. You are probably opening this book because you want to put something new in the world. Tat’s an incredibly powerful and meaningful endeavor. It’s also scary and extremely risky. How can you get ahead of that risk and beat the odds? Every new business idea is built upon a stack of assumptions. We agree with Steve Blank’s insight that it is better to challenge your risky assumptions right at the start. You can’t challenge anything sitting in a conference room. You have to get into the market, or, as Blank likes to say, “Get out of the building!” Tere are two efective ways to do this: 1. talk directly to your customers and partners, and observe their behavior; 2. run experiments in which you put people through an experience and track what happens. Tis book focuses on the frst. Te qualitative part of customer discovery is surprisingly hard for most people, partly because talking to strangers can feel intimidating, and partially because our instincts on how to do it are ofen wrong. Here’s what customer discovery is not: It is not asking people to design your product for you. It is not about abdicating your vision. It is also not about pitching. A natural tendency is to try to sell other people on your idea, but your job in customer discovery is to learn. You are a detective. You are looking for clues that help confrm or deny your assumptions. Whether you are a tiny startup or an intrapreneurial team within a big company, your goal is not to compile statistically signifcant answers. Instead you want to look for patterns that will help you make better decisions. Tose decisions should lead to action, and smart action is what you need for success. Foreword & Introduction 13 Tis book was written as a focused primer on qualitative research to help you get started. You should view it as a complement to the other excellent resources out there on customer development and lean innovation. It is not a rulebook, but hopefully you will fnd the principles included here useful. Te book comes in two parts. It begins with a fctional story of two entrepreneurs doing customer research for the frst time. Te second part is a mix of theory and tactics to guide you through the core steps of customer discovery. While the fctional story highlights a consumer-facing business, I should note that there are plenty of tips in this book for teams who sell to the enterprise. Some last words to kick things of: entrepreneurs have a tendency to over-obsess about their product to the neglect of other business risks. Tey also tend to stay inside their heads for far too long. I urge you to be brave, get out of the building, and go talk to real human beings. Gif Constable August 2014 Some Thanks Are Due Many thanks to Frank Rimalovski for encouraging me to write this, and his students and team at NYU for providing early feedback, Steve Blank for the foreword and his inspiration and leadership on the topic of entrepreneurship, Tom Fishburne for his great illustrations, Josh Seiden and Jef Gothelf for their insights, my colleagues at Neo for continuing to push forward the craf of customer development, the many speakers and members of New York’s Lean Lessons Learned meetup who have shared their stories with me, and Eric Ries for inspiring me and so many others. The Story PART ONE The Story 15 Breakthrough Koshi and Roberta had so much adrenaline pumping through their systems that neither could sleep that night. Afer a year of challenging lab work, they had fnally cracked it. Tey were now sure they could manufacture artifcial down feathers cost-efectively. Teir insomnia was ironic, since their very dream was to transform the quality of people’s sleep through the invention of a better pillow. Tey knew they had a technical advantage. Teir artifcial down had heightened levels of insulation, a better resilience/resistance quotient, and was kinder to both animals and the environment. Now the question was, did they have a business? The Advisor Tey called a meeting with their entrepreneurial advisor the next day. Samantha had built four companies, successfully exiting two of them. She was now an angel investor and believed frmly in giving back by working with frst-time entrepreneurs. “We fnally cracked it!” Roberta blurted out. “What she means,” Koshi said, “is that we’re convinced we can manufacture NewDown in a cost-efective and repeatable manner. Now we think we can make a real business.” “So you want to know if the time has come to jump in feet frst?” asked Samantha. Te two scientists nodded. “If you want to be successful bringing something to market, you need to understand the market. Do you feel like you know when and why people buy pillows today?” “Not really,” Roberta said. “We’ve spent our time in the lab focused on the product side.” “I suspected so. Founders commonly obsess about product at the 16 Talking to Humans expense of the understanding the customer or the business model. You need to work on it all, and you have to challenge your thinking. Behind your startup is a belief system about how your business will work. Some of your assumptions will be right, but the ones that are wrong could crater your business. I want you to get ahead of the risky hypotheses that might cause failure.” Samantha had the founders list out the riskiest hypotheses. 1. We believe that people care about sleep quality when making a pillow purchase decision. 2. We believe that we can sell online directly to customers. 3. We believe that our customers will be young urban professionals. 4. We believe that our very frst customers will be new graduates who need to outft their apartments. 5. We believe that we can sell our pillows at a high enough price to cover our costs. 6. We believe that we can raise enough capital to cover investments in manufacturing. “Let’s put aside the fundraising risk right now,” Samantha said. “It’s what everyone jumps to, but you need to strengthen your story frst. Many of your risks are tied to your customer. I like attacking a problem from multiple directions and recommend three approaches. First, I want you to walk a day in your customer’s shoes and actually go out and buy a pillow. Second, I want you to observe people in the process of buying a pillow. And third, I want you to talk directly to them.” “Talk to people?” said Koshi. “I’m a scientist, not a salesperson. If I simply asked someone if my pillow was better, they would have no idea. If I asked them if they would buy my pillow, I couldn’t trust The Story 17 the answer. So what is the point?” “Your job right now isn’t to sell, but rather to learn. You are right, though: getting the customer to speculate is rarely useful,” Samantha said. “You need to understand your market. How does your customer buy? When do they buy? Why do they buy? Where do they buy? As a scientist, you are fully capable of doing research, gathering data, and seeing if your data supports your hypotheses. I promise you, if you are polite and creative, people will be more receptive to you than you might think.” “Buying. Observing. Talking. Do we really need to do all three? Can we really aford to spend the time?” “Can you aford not to? Each of the three approaches is imperfect, but together you should see patterns. By walking in your customer’s shoes you will gain empathy and personal understanding, but you don’t want to rely solely on your own experience. By watching people shop, you can witness honest behavior, but you won’t be able to get into their heads to know their motivations. By talking to people, you gather intel on both behavior and motivation, but you have to be careful not to take what you hear too literally. Each method has strengths and weaknesses, but taken together you will learn a ton. You will have a lot more confdence that you are either on the right track, or that you have to make changes to your plans. It is far better to discover bad assumptions now, before you have invested a lot! Now, how do you think you should proceed?” “We want our customers to buy online from us, so I guess we should also buy our own pillow online,” said Roberta. “And we can observe people shopping by going to a home goods store.” “Tat sounds good,” said Samantha. “You will want to talk to some of those people in the store as well. I see one catch: you will be 18 Talking to Humans targeting the moment of purchase but not the type of customer you are hoping for. One of your risk assumptions was specifcally about young urban professionals and new graduates, so what can you also do to target and connect with them?” “What about going to a cofee shop near the downtown ofce buildings as people are going to work?” Koshi said. “Can’t we just hit up some of the people we used to know in college who are now in the working world?” Roberta said. “Why don’t you try both, and see which approach works better,” said Samantha. “Roberta, I would also ask your friends if they will refer you to their friends. It’s best to talk to people who aren’t too close to you. You don’t want a someone’s afection for you to steer what they have to say. “Let’s start by thinking through the questions you want to ask. It always makes sense to prioritize what you want to learn. You should write down an interview plan, even if you don’t completely stick to it. Break the ice, and then get them to tell you a story about buying a pillow!” Te scientists sketched out a plan: Intro: hello, I’m a PhD candidate at Hillside University and I’m researching sleep quality. I’m asking people about the last time they bought a pillow. Would you mind if I asked a few questions? When was the last time you bought a pillow? Why did you go looking for a pillow? How did you start shopping for a pillow? Why did you choose the one you bought? After you bought, how did you feel about the pillow you purchased? The Story 19 Are you going to be in the market for a pillow anytime soon? “Tat’s a great start,” Samantha said. “Keep good notes as you go, and remember to regularly regroup to review your fndings and look for patterns. Be mindful of which method you used as you discuss your observations.” Walking in the Customer’s Shoes Koshi and Roberta got together the next day afer both purchasing a pillow online. “I found it all a bit frustrating,” said Roberta. “It was hard to learn why you would choose down feathers, cotton, or foam. Te manufacturer websites felt like they were from the 1990s. Tere were some reviews available on Amazon and Bed Bath & Beyond, which helped. In my interpretation, about 65% of reviews talked about sleep quality, which seems like a good sign for our frst risk. A lot of the reviews had to do with personal preference for frm versus sof pillows. I think we can ofer both kinds eventually, but we likely need to choose one at the beginning and that could impact some of our assumptions around market size. ” “I started out by searching Google,” said Koshi. “Amazon and BB&B dominated the results, as we expected, but there were a few specialty providers like BestPillow that ranked high. BestPillow lets you navigate their website by sleep issue, such as snoring or neck pain, which I found interesting. While I see some makers pushing hypoallergenic oferings, I didn’t see anyone who could meet our claims of being environmentally friendly. I agree that all the manufacturer websites felt ancient. I think there’s an opportunity to be smart about search engine optimization and really stand out if we can get the messaging right. I guess our next step is to visit the retail 20 Talking to Humans stores.” Observing the Customer Roberta ended up going to a Bed Bath & Beyond while Koshi went to a local department store. She watched three diferent people come in and pick through several diferent pillows, puzzling over the packaging material. One of them asked a store employee for help, and two pulled out their mobile phones to look online. She then watched a woman go right to a particular shelf, grab a pillow and head back to the aisle. Roberta’s plan was to balance observation and interaction, so she decided to jump in. “Pardon me,” she said “I am trying to fgure out which pillow to purchase and noticed that you went right to that one. Might I ask why you chose that pillow?” “Oh, I replaced some ratty old pillows in my house a few weeks ago,” the woman said, “and I liked this one so much that I thought I would replace my whole set.” “Do you mind if I ask how you decided to buy that pillow in the frst place? My name is Roberta, by the way.” “Nice to meet you, Roberta. I’m Susan. Well, I guess I started by researching online and...” A day later, the founders met to compare notes. “Te BB&B had good foot trafc,” Roberta said, “and I was able to watch ffeen people, and speak to ten. Of the ten, one knew what she wanted going into the store, three were basing their purchase just on packaging and store price, and six did Google searches on their phones, right there in the store. Tey were looking up reviews and pricing. You mentioned search engine optimization earlier — I think it could be even stronger with a fabulous mobile experience.” She looked down at her notes. “I also found that seven out of ten were trying to choose a pillow specifcally for better sleep, although their sleep problems were diverse. Finally, when I asked The Story 21 them why they were buying a pillow, the folks over 40 seemed to be in replacement mode, while the folks under 40 seemed to be reacting to a life change. Two people were moving to a bigger house from an apartment. Another person was moving in with their girlfriend, and another said that she got a new job and could now aford nicer things.” “I went to the home goods section of a high-end department store,” said Koshi. “I saw eighteen people, and fve of them knew what they wanted already. Te rest spent time puzzling over the packaging and, like your group, going online with their mobile phone. I spoke to nine shoppers. I said that I was a scientist trying to invent a new pillow. People thought that was pretty cool. Two of them admitted that they were buying the highest price pillow because they assumed that it had to be the best. Two got the cheapest because it was the cheapest. Te others had specifc preferences for down, cotton or foam based on the frmness they were looking for in a pillow. Te frmness preference seemed to be tied to a belief that they would sleep more soundly. On price, I was relieved to see that the prices of the better pillows were in line with what we were hoping to charge.” Roberta pulled out a pad. “So we saw thirty-three people and spoke to nineteen. Our sample set is still small, but Samantha told us to look for patterns and not worry about statistical signifcance right now. If we break our observations into a few metrics, what have we learned?” • 24% of shoppers knew what they wanted when they walked in • 52% looked up information on their phone in the store • 45% of shoppers purchased a mid-priced or high-priced pillow • 68% of the people we spoke to indicated that better sleep was a major driver of their choice 22 Talking to Humans • 37% of the people we spoke to were reacting to a life change • 37% of the people we spoke to were in replacement mode “I think the use of mobile phones is something we need to pay attention to and work into our strategy,” Koshi said. “I guess for our next step, we should follow Samantha’s suggestions to target urban professionals.” Regrouping A week and many interviews later, the team sat down with Samantha. “How did things go?” she asked. “I went to a downtown cofee shop at peak hour,” Koshi said. “At frst, everyone was in such a hurry to get to work that I didn’t get much response, but then I made a little sign I held up outside that promised ‘cofee for science,’ which started to get laughs and a lot of curiosity. I ended up talking to about ffeen people who matched our target of young urban professionals. I got to talk to them for about fve to twenty minutes each. It was actually very enjoyable. “One clear pattern was that people right out of school tended to have no clue. Tey either had never bought a pillow themselves, or if they had, it had been the cheapest thing they could get. A few admitted that they were probably going to buy new bedding. I know it is speculation, but I asked them to guess how they might go about looking for a pillow, based on how they shop for other things. Te common responses were searching on Google or Amazon, or walking into a Bed Bath & Beyond. “Te few folks in their later twenties or thirties whom I spoke to had usually bought at least one pillow — some from Amazon and some from retailers. Te ones who liked a frm pillow avoided The Story 23 down feathers. Te ones who wanted to upgrade to fancier duvets and high thread-count sheets all seemed to go with duck and goose feathers. Tey didn’t know any brands and instead relied on product packaging. Amazon buyers did actually read the reviews. All these folks were only planning on buying new pillows when they were moving to a bigger apartment because they were getting married or something.” “Yes, that aligns with what we learned when we spoke to people in the retail stores and what I saw with my other interviews,” said Roberta. “Pillow buying seems to be tied to life events like moving and marriage and such. I interviewed a diferent group. A whole bunch of our old classmates responded to my email or my Facebook post. I even had some folks pass me on to their friends, and so I got to talk to some people who didn’t go to school with us. “Like you, I saw a lag efect afer someone graduated from college. When new graduates told me that they had not spent any money on their linens yet, I inquired further and found out that their initial spending money was predominately going towards clothes. I spoke to twelve people between 22 and 25, and roughly 60% had actually bought a pillow in the last few years. I saw similar trends as you, although most went right to Google, Amazon or a few specialty online retailers. It seemed like a very online crowd. Te price sensitive ones stayed away from down. Tey didn’t have much to go on for brand, but the reviews helped. Te women defnitely cared more about quality and put more efort into their hunt.” “Te good news is that everyone thought inventing a new pillow was an awesome idea!” said Koshi. Samantha chuckled. “Of everything I’ve heard you say, that last bit is probably the least useful. It’s easy to say something is cool. It’s another thing to actually buy. Te good news is, you are a lot more educated about your market than you were last time we met. 24 Talking to Humans I see from your notes that you have either spoken to or observed 72 people. We should be able to see some patterns from that. Let’s revisit our critical assumptions.” Challenging Assumptions Te team looked at their initial list. 1. We believe that people care about sleep quality when making a purchase decision. “68% of the retail shoppers indicated that this was a major factor,” said Roberta. “Of our young urban professionals, we were able to ask this of only a portion of our interviewees. Only 56% indicated that it was a factor, but if we factor out the new graduates, it was more like 70%. We’ve also read a lot of online reviews and have seen this come up repeatedly. We feel reasonably confdent that this is a common decision point in choosing a pillow,” said Koshi. “I’m glad you are approaching this with rigor and actually calculating metrics from your observations,” said Samantha. “Tat will prevent you from letting innate biases override your actual results. However, one word of advice. At this stage, don’t take any of your statistics too literally and don’t let any single number dominate your strategic thinking. Just as we’re not looking for statistical signifcance at this point, we also don’t want to start treating our results as if they are indisputable facts. How about the next assumption?” 2. We believe that we can sell online directly to customers. “We have seen some promising signs. 77% of our urban professionals start researching purchases with a search engine. Te question is whether they would discover, visit, or convert with our The Story 25 online store. We did see a ton of mobile usage in the retail stores and think there might be a chance to steal those customers if we have good enough search engine optimization. Overall, our conclusion is that we need more data here.” 3. We believe that our customers will be young urban professionals. “I need to run some numbers on size of market and the number of purchases we might expect from this group, but we still feel like this is a good group for us. We clearly saw purchase behavior. Tey want, and can aford, quality things, and prefer to buy things online.” 4. We believe that our very frst customers will be new graduates who need to outft their apartments. “Tis is where we were totally wrong. Buying behavior, or at least the willingness to buy something that isn’t the cheapest option, did not seem to be very prevalent among new grads. Only 25% of the newly minted grads we spoke with had purchased a pillow on their own. Instead, the evidence points us towards people in their mid-tolate twenties or early thirties. “We also saw a correlation between purchasing and life changes. While this was only 37% with our retail shoppers, it was 70% of our urban professionals. From an early adopter perspective, I wonder if we can do well targeting people who are getting married or moving to a larger apartment or house?” 5. We believe we can sell our pillows at a high enough price to cover our costs. “45% of our retail shoppers bought at least a mid-priced pillow. We admit that we visited reasonably high-end stores, but that was still a nice statistic to see. Te good news is that our initial target price is comparable with the high-end of the current market. We 26 Talking to Humans won’t be proftable at the beginning, but if we can scale and improve our manufacturing process then we can move into the black. Of course, they have to want to buy our pillow.” Samantha nodded. “To test that, you will need to actually try selling a few, which ties back to your second risk. But I’m glad you have spent time learning rather than rushing to sell. Overall, it sounds like you have gotten some solid intel. I’m also glad you caught the issue with college grads before you spent a lot of money and energy trying to target them. Have your eforts uncovered new risks or worries?” “I’m both excited and worried by how confused customers are,” Koshi said. “Every brand promises a better night’s sleep. I’m also worried about signals we picked up that the market might be divided into those who want a frm pillow versus a sof pillow. We think that’s erroneous thinking. Our pillow lands in the middle, and our studies show better results. I don’t know if people will believe our data. We really need to get the messaging right.” “As for me,” Roberta said, “I’m most worried about the size of our initial market, how quickly we could grow, and if we can survive to proftability.” “I’m not surprised,” said Samantha. “I have some suggestions. One of you should continue doing these interviews, but try adding a new spin. You are both worried about diferentiation and if people will understand or appreciate the proof from your scientifc studies. Let’s test some messaging. Given what you have said about mobile usage, maybe create an infographic that tries to make your case. Show it to people on a phone. Ask them to explain it to you. First you can see if they understand it, and then if they fnd it meaningful. “Expanding from qualitative research, I also think one of you should create a fnancial model that lets you play with how much The Story 27 you charge, how many items you might sell, and what your costs will be. Take into account what you have learned so far and see if your business model adds up. “Finally, I think you’ve learned enough to run some experiments around customer acquisition and sales. It is straightforward to create a basic online store using one of the hosted services. You can test selling a few pillows before you invest in manufacturing capability. Try driving trafc through Google or Facebook ads, and run some A/B tests around ad copy, landing-page messaging and price points. Study your metrics. Ten follow up with your customers and interview them on their buying process and decision.” Roberta’s eyes widened. “Wow. Maybe we can get our frst paying customer!” “Exactly,” said Samantha. “Just remember Steve Blank’s phrase about startups: you are in search of a scalable and repeatable business model. Run these experiments and keep in mind that your mission at this point is to learn before you scale. Don’t stop talking directly to customers. Your questions will likely evolve, but no matter what stage you are in, you’ll usually fnd that your best insights will come from talking to real people and observing real behavior.” 28 Talking to Humans Lessons Learned The Story 29 So what are the key takeaways from Roberta and Koshi’s adventure? 1. Customer discovery is about gaining much deeper insight into your customer, or your partners, or your market 2. Being told your idea is cool is not useful; seeing behavior that validates your customer’s willingness to buy is very useful 3. Prepare an interview guide before you get out of the building 4. To ask the right questions, you need to understand your risks and assumptions 5. Get creative when trying to recruit people — if at frst you don’t succeed, try something new 6. Sometimes observation is as powerful as interviews 7. Take good notes, especially on your key risks, so that you can calculate metrics later. Even better, set your target goals ahead of time! 8. Bring learning back and analyze your patterns as a team 9. Never stop asking hard questions about your business In the next section of this book, we’re going to dive into tactics and talk about all this and more in detail. How To PART TWO How To 31 Getting Started with Customer Discovery Qualitative research, i.e. talking to humans, is something you never want to stop doing, but it can defnitely feel intimidating at frst. Te good news is that if you go about it in a professional and thoughtful way, you will fnd lots of people who are willing to help and give you some of their valuable time. You need to begin with a core set of questions: t Who do you want to learn from? t What do you want to learn? t How will you get to them? t How can you ensure an efective session? t How do you make sense of what you learn? 32 Talking to Humans Who Do You Want to Learn From? How To 33 If your desired customer is a doctor, it stands to reason that it won’t help you much talking to a plumber. If you were aiming for teenagers, would you talk to grandparents? Te frst step in trying to learn from the market is having an opinion about who your market actually is. I recommend thinking about a few categories: t Te typical customer you envision if you get traction with your idea t Your early adopter, i.e. the people who will take a chance on your product before anyone else t Critical partners for distribution, fulfllment, or other parts of your business You might think you are creating a product for “everyone”, but that is not an actionable or useful description in the early stages. You need to get more specifc. Your job is to think through the kinds of people who have the problem you are interested in solving. Sometimes they have a particular job, or a state of mind, live in a particular part of the world, or belong to a certain age group. Standard demographics might be useful, or they might be irrelevant. What are the commonalities across your customer base? Here are some examples: • A hospital management system has to think about the hospital administrator who will buy their software and the actual hospital workers who would use it • An on-call veterinarian service needs to talk to pet owners • An online marketplace for plumbers might consider plumbers on the sell side, and home owners on the buy side 34 Talking to Humans You also want to think about your early adopters. Why do they matter? Most new products ft alongside a “technology adoption curve,” as illustrated below. New founders tend to obsess about their mainstream customer (represented in the chart as the early and late majority). However, by defnition, the mainstream is waiting for proof from early adopters before they try something. If you cannot get early adopters, you cannot move on. Early adopters are usually folks who feel a pain point acutely, or love to try new products and services. In our story of Koshi and Roberta, the scientists hypothesized that their early adopter would be urban professionals in their mid to late twenties. For the three customer examples we just gave, here are examples of early adopters: • Our hospital management system might target hospital chains still stuck with an archaic vendor • Our vet service might target busy 20-somethings in a major city • Our online market for plumbers might target solo practices on the sellside and frst-time home owners on the buy-side How To 35 Tere is no prescription for how narrowly or broadly you should cast your net for customer discovery interviews. However, the more focused you can be, the easier it is to make sense of your evidence. Special Note for B2B Products If you are selling to the enterprise, you should also think about the diferent kinds of participants in your sales process. In a classic enterprise sale, you will ofen have a strategic buyer (who is excited about the change you can bring), an economic buyer (who controls the purse), a technical buyer (who might have approval/blocker rights), and then the actual users of your product. Can you identify your champion? Can you identify who might be a saboteur? For B2B companies, Steve Blank also recommends that you start by talking to mid-level managers rather than the C-suite. It can be easier to get their time, it is ofen easier to get repeat conversations, and, most importantly, it will allow you to get better educated before you go up the chain. 36 Talking to Humans What Do You Want to Learn? How To 37 Go into every customer interview with a prepared list of questions. Tis list, which we refer to as an interview guide, will keep you organized. You will appear more professional, and it will ensure that you get to your most important questions early. How do you know your most important questions? I like to begin by understanding my most important, and most risky, assumptions. Tose tend to be the areas where you need to gather insights most urgently. You can uncover your assumptions in a myriad of ways. You can use Alex Osterwalder’s business model canvas or Ash Maurya’s lean canvas. Personally, I ask these questions (see the Appendix for a worksheet and tips): • My target customer will be? • The problem my customer wants to solve is? • My customer’s need can be solved with? • Why can’t my customer solve this today? • The measurable outcome my customer wants to achieve is? • My primary customer acquisition tactic will be? • My earliest adopter will be? • I will make money (revenue) by? • My primary competition will be? • I will beat my competitors primarily because of? • My biggest risk to fnancial viability is? • My biggest technical or engineering risk is? • What assumptions do we have that, if proven wrong, would cause this business to fail? (Tip: include market size in this list) You should be able to look at this list and spot the assumptions that are both highly important and fairly uncertain. Be honest. You want to focus on the most important issues. 38 Talking to Humans In the case of our pillow entrepreneurs, they chose six initial risks which drove their research approach and frst set of questions. To give another scenario, in the last chapter we shared the example of an on-call veterinarian service. Te founders might identify a set of risks: 1. Pet owners are frustrated having to go to a vet and would rather have someone come to them 2. Customers are willing to pay a big premium to have a vet show up at their door 3. We think busy urbanite pet owners will be our early adopters 4. We think people currently discover their vets either through word of mouth or online searches 5. We can affordably acquire our customers through targeted Google search ads 6. We can recruit enough vets across the country to make this a big enough business 7. With travel baked in, our vets can see enough people in a day to be fnancially viable Not every assumption can be tested efectively through qualitative research, but in this case, our founders can probably get some insights on risks 1, 3, 4, and 6 just by talking to people. Risks 1, 3 and 4 would be focused on pet owners, while #6 would be focused on vets. Get Stories, Not Speculation When you are contemplating your questions, be careful with speculation. Humans are spectacularly bad at predicting their future behavior. It is tempting to say, “Would you like this idea?” or “Would you buy this product?” Unfortunately, you really have to treat those How To 39 answers with a great deal of skepticism. It is more efective to ask your interview subject to share a story about the past. For example, when our fctional scientists Koshi and Roberta created their interview plan, the questions were focused on getting the interviewee to tell a story about their last pillow buying experience. Keeping with our second example of an on-call vet service, the team might have a loose interview plan that looks like the following: • Warm up: concise intro on the purpose of the conversation • Warm up: basic questions about person and pet (name, age, picture) • Who is your current vet? Can you tell me about how you found and chose him/her? • Please describe the last time you had to take your pet to the vet for a checkup • Walk me through the process of scheduling a time to visit the vet. • What was frustrating about that experience? • What did you like about that experience? • Have you ever had an emergency visit to a vet? if yes, can you describe that experience for me? • Have you ever thought about changing vets? why / why not? Ask Open-Ended Questions Your goal is to talk little and get the other person sharing openly. To that end, it is imperative that you structure open-ended questions, or at minimum follow up yes/no questions with an open-ended question that gets them talking. One tip is to try to ask questions that start with words like who, what, why and how. Avoid questions that start with is, are, would, and do you. But remember, if you do get a yes/no answer to a 40 Talking to Humans question, you can always follow up in a way that gets them talking. An interesting open-ended question, which Steve Blank likes to use to conclude his interviews, is: “What should I have asked you that I didn’t?” Testing for Price Two of the hardest questions to answer through qualitative research are: will people pay? and how much will they pay? Speculative answers on this topic are extremely suspect. You can learn a lot, however, by asking questions like: • How much do you currently spend to address this problem? • What budget do you have allocated to this, and who controls it? • How much would you pay to make this problem go away? (this can lead to interesting answers as long as you don’t take answers too literally) My recommendation is to set up a situation where the subject thinks they are actually buying something, even if they know the thing doesn’t exist yet. Kickstarter and other crowdfunding platforms are used by a lot of teams to test pre-order demand. For expensive corporate products, you can also try to get customers to buy in advance or sign a non-binding letter of intent to buy. Te key thing to remember is that people don’t honestly think about willingness to pay unless they feel like it is a real transaction. Getting Feedback on a Prototype Sometimes you will want to get reactions to a product solution. You can learn a lot by putting mockups or prototypes in front of people, but, as with all speculation, you should interpret reactions with a degree of skepticism. If you show your interview subject a proposed solution, you need to separate this step from your questions about their behavior. How To 41 Ask your questions about behavior and challenges frst, so that the discussion about product features does not poison or take over the conversation. People do love talking features! The Magic Wand Question Some people like to ask, “if you could wave a magic wand and have this product do whatever you want, what would it do?” Personally, I avoid questions like this because customers are too constrained by their current reality to design efective solutions. It is the customer’s job to explain their behavior, goals, and challenges. It is the product designer’s job to come up with the best solution. Tere is one variation to the magic wand question that I do like, however, because it focuses on problems and not solutions: “If you could wave a magic wand and solve any problem, what would you want to solve?” I suspect, however, that you will fnd many people struggle with such an open question. Design “Pass/Fail” Tests Customer discovery is made up of a lot of qualitative research, but it helps to take a quantitative mindset. Set goals for key questions and track results. For example, halfway through their initial research, our scientists Koshi and Roberta already knew stats like: • 24% of shoppers knew what they wanted when they walked in • 45% of shoppers purchased a mid-priced or high-priced pillow • 68% of the shoppers we spoke to indicated that better sleep was a major driver of their choice Even better would have been if they had set targets ahead of time. For example, they might have set the following goals: • Because we are a new brand, we are hoping that most shoppers are undecided. We want to see that 40% or fewer shoppers already know what 42 Talking to Humans they want when they walk in • Because our pillow is expensive, we want to see that at least 40% of the shoppers buy mid or high-end models • Because we believe that sleep quality is a major differentiator for our product, we want over 60% of shoppers to indicate that this is a major factor in their decision making process Te numerical target you choose can be an educated guess. You do not need to stress over picking the perfect number. It is more important that you set a goal and really track what is happening. Setting a target forces you carefully think through what you are hoping to see, and makes decisions and judgment calls a bit easier as you review your data. A Guide, Not a Script An interview guide is not a script. You do not need to read from it like an automaton. You should feel free to veer of of it if the conversation brings up something interesting and new. It will likely evolve as you learn from the market and unearth new questions. But always plan, prioritize and prep your questions before any session. Observation Can Be As Powerful As Questions Sometimes the best thing you can do is sit back and watch someone’s behavior. You might watch their purchase process, or examine how they go about solving a particular problem. As you think about what you want to learn, also think through how you might gather data through observation rather than direct interviews. In our story of Koshi and Roberta, the two got some of their most valuable insights by going to linen stores and watching potential customers struggle to buy a pillow. Tey observed behavior and only then jumped in to ask questions. Tis technique cannot always be used. For example, when my How To 43 team was trying to validate a weight loss product idea, it did not feel practical to watch people go about their diet. Instead we did interviews and then put a group of customers through a two-week concierge experiment (see Glossary) where we manually acted out the diet experience. But, where possible, observing uninfuenced behavior can lead to great insights. 44 Talking to Humans How Do You Find Your Interview Subjects? How To 45 Entrepreneurs new to customer development are ofen intimidated at the thought of approaching complete strangers. It might surprise you to hear that people are ofen very willing to help out. Tis is especially true if you are working on a topic that interests them and you approach them nicely and professionally. Tere are three general rules to keep in mind when recruiting candidates to speak with: 1. Try to get one degree of separation away (don’t interview your mom, your uncle, or your best friends) 2. Be creative (and don’t expect people to come to you) 3. Fish where the fsh are (and not where they are not) Get Creative One aspiring entrepreneur wanted to target mothers of young children. She had heard stories about talking to people in a cofee shop, but felt like it was too unfocused. So she tried hanging around school pickup zones, but the moms were too busy and refused to speak to her. Next, she tried the playground, where she fgured moms would be bored watching their kids play. Tis worked reasonably well, but she was only able to get a few minutes of anyone’s time. So instead, she started organizing evening events for moms at a local spa where she bought them pedicures and wine. Te time of day worked because the moms could leave the kids at home with their partner. Te attendees had a great time and were happy to talk while they were getting their nails done. Find the Moment of Pain If you can connect with people at the moment of their theoretical pain, it can be very illuminating. My colleague Alexa Roman was working with an automotive company and they had a concept tied 46 Talking to Humans to the experience of getting gas. So Alexa and team visited a series of gas stations. Tey watched consumers go through the process of buying gas. Ten they approached them and asked questions. By thinking about the moment of pain they wanted to address, they knew exactly where to fnd their consumers and they were able to gather valuable observational research. Make Referrals Happen Use referrals to your advantage. Let’s say you want to talk to doctors. Tey are busy and have strong gatekeepers. I bet you know how to get to at least one doctor, however. Tat doctor will know other doctors. Even if your doctor happens to be a close friend and thus breaks the “more than one degree of separation” guideline, she can still give you advice on when might be a good time to talk to a doctor. She can also connect you with other doctors. You should use referrals as much as possible. Set a goal of walking out of every interview with 2 or 3 new candidates. When you end an interview, ask the person if they know others who face the problem you are trying to solve. If they feel like you have respected their time, they will ofen be willing to introduce you to others. Conferences & Meetups Conferences and meetups can be an amazing recruiting ground, because they bring a group of people with shared interests into one place. You just need to be respectful of people’s time. I have found that it is extremely efective to ask people for their time, but for later, afer the conference or meetup. Get their business card, let them get back to networking, and then have an in-depth conversation when it fts their schedule. Immediately afer the conference while their memories are still fresh, send them a short email that reminds them where you met, and give your ask for a conversation. Tis How To 47 works as efectively for in-demand panel speakers as it does for other attendees. Meetups are usually inexpensive, but conference tickets can be pricey. If you are on a budget, you can “hack” expensive conferences by intercepting people outside of the building, or, if you can get access to the attendee or speaker lists ahead of time, contacting people directly and meeting them near the event. Meetup.com has decent search tools to discover relevant events in your area, and a few good Google search queries can usually get you to a short list of conferences that ft your needs. Enterprise Customers Finding interviewees can be harder when you are focused on an enterprise customer. You need laser-like targeting. In addition to conferences, LinkedIn can be extremely useful. If you have hypotheses on the titles of the people you are seeking, run searches on LinkedIn. You might be able to get to them through a referral over LinkedIn, or you might need to cold call them through their company’s main phone number. You then have to decide on your approach method. You can either ask for advice (where you make it clear that you are not selling anything), or you can go in as if you were selling something specifc. Advice vs Selling Asking for advice should be your default method early in your customer discovery process. You will have better luck gaining access. People like being asked (it makes them feel important). Steve Blank used to call people up and say something like, “My name is Steve and [dropped name] told me you were one of the smartest people in the industry and you had really valuable advice to ofer. I’m not trying to sell you anything, but was hoping to get 20 minutes of your time.” 48 Talking to Humans Another efective spin on “asking for advice” is to create a blog focused on your problem space, and ask people if you can interview them for an article. When do you approach someone as if you were selling a product? Tis method is useful if you are past initial learning and want to test your assumptions around customer acquisition and messaging. Just don’t jump into sales mode too early. Beneftting from Gatekeepers If LinkedIn isn’t helping you and you need to reach high up in an organization, another approach is to call the CEO’s ofce. Your goal is not to talk to the CEO but actually their executive assistant. His job is to be an efective gatekeeper, so if you explain, “I’m looking to talk to the person who handles X”, they will ofen connect you to the right person (especially if you are pleasant and professional — notice the trend on that one?). Te added advantage of this method is if you end up leaving a voice mail for your intended contact, you can say “Jim from [CEO’s name]’s ofce gave me your name”. Dropping the boss’ name tends to improve response rates. Another approach is to send a targeted email into an organization with a very short email that asks for an introduction to the right person to speak to. You can make guesses as to email addresses based on LinkedIn queries. For this tactic to work, you must keep your emails extremely concise. Students and Researchers While people are willing to grant time to polite people who ask for advice, you have an extra advantage if you are a student or academic researcher. In other words, if you are a student or researcher, say so. As an extra incentive, you might also ofer to share the results of your research with your interview subjects. How To 49 You Might Be Surprised Another colleague of mine, Jonathan Irwin, was working with a Fortune 50 company. Te client team wanted to interview a special kind of oil platform engineer, of which there were less than 20 in the world! To access these people required security clearance and safety training. We challenged the team to fnd a way, expecting that they would have to rely on video conferencing or phone calls. However, the team started researching this speciality profession through Google and discovered that there was an onshore training facility just an hour away. Te moral of the story is that it ofen isn’t as hard as you think. No Fish in the Sea When I say fsh where the fsh are, it is really important to remember the fip side to that statement: don’t fsh where the fsh are not. If a method isn’t working, try something new. We were doing a project with a major magazine testing out new product ideas. Our target was busy women, and we knew that the readership correlated closely with shoppers of Te Container Store (a retail store). So we parked out front of a store and intercepted folks as they came in and out. People were willing to speak for a few minutes, but many were in a bit too much of a rush. Ten one of our teammates discovered a sample sale happening around the corner. Tere were probably 200 bored women waiting in line, most of whom were happy to talk to us to pass the time. (Note: fnding bored people stuck in line is a common recruiting hack.) Still, we didn’t feel like we were targeting quite as narrowly as we wanted (busy, working women) or as geographically broadly (we didn’t want to just talk to New Yorkers). So we turned to the magazine’s social media presence. We created a short online survey to help us qualify responses, and the magazine posted a link to their Twitter and Facebook pages with a catchy sentence. We had hundreds of women fll out the survey, and then we picked our top 50 Talking to Humans thirty candidates and scheduled calls. Online Forms & Landing Pages In a similar vein, one efective tactic is to create an online form or landing page and build up a list of people to contact. Below is an example of a landing page. Our team was testing a product idea for better home organization. Tis landing page test actually consisted of a three-step funnel with a call to action, a price choice, and then a request for an email address. We tracked the conversion metrics carefully and used the emails to schedule interviews. Caveat: driving trafc is never a trivial process. If you have budget, Google or Facebook ads can work. Otherwise, you can try to generate some word of mouth on social media or through bloggers. How To 51 Conclusion Hopefully what you are picking up through these examples is that there is no single way to get to people. It takes some creativity and hustle, but it isn’t as hard as you might think. Trust me, people will not think you are rude if you carry yourself well and act professionally. Check Out the Appendix for Examples Te Appendix has more tips and examples for cold email and voice mail approaches. 52 Talking to Humans How to Ensure an Effective Session? How To 53 I recommend the following guidelines for running a productive interview session. Do Your Interviews In Person Te quality of your learning can vary a lot depending on your communication method. Talking in person is by far the best approach. You can read body language and build rapport much easier. Remember that a huge percentage of human communication is non-verbal, so why blind your senses if you don’t have to? Te next best approach is video conferencing, because at least you can still read someone’s facial expressions. Phone calls should be your method of last resort (sometimes there is no choice), and I would entirely avoid using text-based mediums like email or chat. Talk to One Person at a Time I believe in talking to one person at a time. It is useful to have a second person on your side quietly taking notes. I strongly recommend avoiding focus groups for two reasons: 1. you want to avoid group think; 2. you will really struggle to focus on one person’s stories, and drill into areas of interest, when you are juggling multiple people. Adding a Note Taker Bringing a note taker will allow you to stay in the moment without worrying about getting every bit down on paper. You can stay focused on the topics, the body language, and where to take the conversation. If you have to take your own notes, that’s not the end of the world. It can sometimes make for a more intimate conversation. Just remember to write up your notes right afer the session or you will lose a lot of detail and color that you weren’t able to write down. You can also ask the interview subject if you can record them, 54 Talking to Humans and many people are willing. Te risk is that a recorder can inhibit the conversation, but most people forget that they are being recorded once the discussion is fowing. I highly recommend that you play back the audio and write up your notes soon afer the session, both because writing up notes will reinforce what you learned in your own mind, and also because written notes are easier and faster for both you and your teammates to scan. I’ve found that once audio or video is more than a couple weeks old, somehow they never get touched again. Start With a Warm Up & Keep It Human When you kick things of, concisely explain why you are there, and thank them for the time. Launch into things with one or two easy warm up questions. For example, if you are talking to a consumer, you might ask where they are from and what they do for a living. If you are talking to enterprise, you might ask how long they have been with their company. You don’t want to spend a lot of time on this stuf, but it does get the ball rolling. Have a written or printed list of questions, but don’t rigidly read from your list. Be in the moment. Make the interview subject feel like you are really listening to them. Disarm Your Own Biases Human beings have an amazing ability to hear what they want to hear (this is called “confrmation bias”). Go into each session prepared to hear things that you might not want to hear. Some entrepreneurs even take the mindset that they are trying to kill their idea, rather than support it, just to set the bar high and prevent themselves from leading the witness. Get Them to Tell a Story As I mentioned in the chapter “What Do You Want to Learn,” How To 55 humans are terrible at predicting their own behavior. If you ask any speculative questions, be prepared to listen with a healthy dose of skepticism. I far prefer to get people telling stories about how they experienced a problem area in the past. In particular, try to fnd out if they have tried to solve the problem. What triggered their search for a solution? How did they look for a solution? What did they think the solution would do, before they tried it? How did that particular solution work out? And if they are struggling to remember specifcs, help them set the scene of their story: what part of the year or time of day? Were you with anyone? As they are telling their story, follow up with questions about their emotional state. You might get some historical revisionism, but what you hear can be very illuminating. Te researchers at Meetup.com, who borrow from Clayton Christensen’s Jobs To Be Done framework, use an interesting tactic to help their subjects get in story mode. When they are asking someone to take them through a purchase experience, from frst thought through purchase and then actual product usage, they say: “Imagine you are flming the documentary of your life. Pretend you are flming the scene, watching the actor playing you. At this moment, what is their emotion, what are they feeling?” Look for Solution Hacks One of the best indicators that the market needs a new or better solution is that some people are not just accepting their frustration with a particular problem, but they are actively trying to solve it. Maybe they have tried a few diferent solutions. Maybe they have tried hacking together their own solution. Tese stories are a great indicator of market need. Understanding Priority For someone to try a new product, their pain usually needs to be 56 Talking to Humans acute enough that they will change their behavior, take a risk, and even pay for it. If you feel like you are seeing good evidence that someone actually has a problem, it is worth asking where it ranks in their list of things to solve. Is it their #1 pain, or something too low in priority to warrant attention and budget? Listen, Don’t Talk Try to shut up as much as possible. Try to keep your questions short and unbiased (i.e. don’t embed the answer you want to hear into the question). Don’t rush to fll the “space” when the customer pauses, because they might be thinking or have more to say. Make sure you are learning, not selling! Or, at least make sure you are not in “sales” mode until the point when you actually do try to close a sale as part of an experiment. Follow Your Nose and Drill Down Anytime something tweaks your antenna, drill down with follow up questions. Don’t be afraid to ask for clarifcations and the “why” behind the “what.” You can even try drilling into multiple layers of “why” (run an Internet search for “Five Whys” for more info), as long as the interviewee doesn’t start getting annoyed. Parrot Back or Misrepresent to Confrm For important topics, try repeating back what the person said. You can occasionally get one of two interesting results. Tey might correct you because you’ve misinterpreted what they said. Or, by hearing their own thoughts, they’ll actually realize that their true opinion is slightly diferent, and they will give you a second, more sophisticated answer. Another approach is to purposefully misrepresent what they just said when you parrot it back, and then see if they correct you. But How To 57 use this technique sparingly, if at all. Do a Dry Run If you are a beginner at customer discovery, do a dry run with a friend or colleague. See how your questions feel coming out of your mouth. Get a sense of what it is like to listen carefully and occasionally improvise. Getting Feedback on Your Product If you want to get feedback on your product ideas, whether you show simple mockups or a more polished demo, there are a few important tips to keep in mind: As I mentioned before, separate the storytelling part of your session from the feedback part. People love to brainstorm on features and solutions, and this will end up infuencing the stories they might tell. So dig into their stories frst, and gather any feedback second. Second, disarm their politeness training. People are trained not to call your baby ugly. You need to make them feel safe to do this. Ask them up-front to be brutally honest, and explain that it is the very best way for them to help you. If they seem confused, explain that the worst thing that could happen is to build something people didn’t care about. Finally, keep in mind that it is incredibly easy for people to tell you that they like your product. Don’t trust this feedback. Instead, you need to put people through an actual experience and watch their behavior or try to get them to open their wallet. Tere is no right answer on how polished your early mockups need to be. If you are in the fashion space, you need to have a high degree of visual polish as table stakes. If you are creating a solution for engineers, you probably need much less. Just don’t wait for perfection, because initial product versions rarely get everything right. You need to spot your errors sooner rather than later. 58 Talking to Humans How Do You Make Sense of What You Learn? How To 59 Your goal is not to learn for learning’s sake. Your goal is to make better decisions that increase the odds of success. So how do you translate your observations into decisions? Te frst step is to make sense of your patterns. Take Good Notes To fnd your patterns, frst you need to track the data. Tis is easy if you bring a good notetaker to the interview, but otherwise, make sure that you write up your notes as soon afer your conversation as possible. Make them available to the entire team with Google Docs or the equivalent. At the start of every entry, note the following information: • Name of interview subject • Date and time • Name of interviewer • In person or video conference • Photo (if you have one) Ten at the start of your notes, include basic descriptive information of the interview subject. Quantitative Measures If you are setting specifc metric goals for your interviews, you might set up a shared spreadsheet that essentially acts as a running scorecard for how you are doing and how you are tracking to targets. EXAMPLE Let’s imagine that you have invented a new air purifer that triples the growth speed of greenhouse plants. Now you plan to talk to 20 60 Talking to Humans farmers, and you have a few core questions: • Will their business actually beneft from increased growth speed? You are assuming that increased volume will help rather than hurt. You plan to talk to growers of different crops with the goal of fnding crops where 60% or more of farmers want increased volume. • Are farmers spending any money today on growth accelerator solutions? Your qualitative research will drill into what and why, but your metrics goal says that you hope at least 50% of the market is already spending at least some money. • Do they have the facilities to support your purifer? In this case, you need your purifer to be both in a specifc location, but also have access to an electrical outlet. You are hoping that 70% of the farmers have an outlet 20 feet or closer to your spot. Here is the kind of spreadsheet that you and your team might track: As Samantha advised Koshi and Roberta in the fctional story, turning your observations into quantifable metrics is both useful and tricky. Our brains like to infuence our thinking with cognitive biases, especially fltering results for what we want to hear. Calculating actual metrics helps fght against that dynamic. How To 61 At the same time, you have to beware a diferent kind of bias: our desire to turn statistics into facts. Hopefully you are getting enough data points that you can trust the patterns, but do not confuse this with statistical signifcance or take your results too literally. My advice is to calculate metrics, but remain skeptical of them, don’t obsess over any one particular metric, and continue to question what is behind your numbers. Dump and Sort Exercise Bring your team together and arm them with sticky notes and sharpies. Give everyone 10 minutes to jot down as many patterns and observations as they saw during their interviews. Put all the sticky notes on a wall and have someone sort them into groups. As a team, discuss the patterns, and then re-review your assumptions or business canvas and see what might need to change or require greater investigation. Look for Patterns and Apply Judgement Customer development interviews will not give you statistically signifcant data, but they will give you insights based on patterns. Tey can be very tricky to interpret, because what people say is not always what they do. You don’t want to react too strongly to any single person’s comments. You don’t want to take things too literally. But neither do you want to be bogged down trying to talk to thousands of people before you can make a decision. You need to use your judgement to read between the lines, to read body language, to try to understand context and agendas, and to flter out biases based on the types of people in your pool of interviewees. But it is exactly the ability to use human judgement based on human connections that make interviews so much more useful than surveys. Ultimately, you are better of moving fast and making decisions 62 Talking to Humans from credible patterns than dithering about in analysis paralysis. Don’t Abdicate Your Role As Product Designer It is not the job of the customer to design your product. It is yours. As you are gathering information and making decisions, act like a intelligent flter, not an order-taker. Expect False Positives While all entrepreneurs get their fair share of naysayers and skeptics, you have to be wary of the opposite problem in customer development interviews. People will want to be helpful and nice, and your brain will want to hear nice things. As you are weighing what you have learned, just keep this in mind. The Truth Curve I am a big believer in qualitative research. I think a good product team should build a regular cadence of talking to relevant people into their process. However, you don’t want your only source of learning to be talking to people. You don’t really know the absolute truth about your product until it is live and people are truly using it and you are making real money from it. But that does not mean you should jump straight to a live product, because that is a very expensive and slow way to iterate your new business. Get into the market early and begin testing your assumptions right away, starting with conversations and proceeding from there. It will dramatically increase the odds that you will create a product that customers actually want. As you build confdence, test with increasing levels of fdelity. I think of it like peeling an onion in reverse. I created the accompanying chart to demonstrate the levels of believability for diferent kinds of experiments. How To 63 Talking to people is powerful. It tends to give you your biggest leaps of insight, but, as I keep on repeating, what people say is not what they do. You might show people mockups and that might give you another level of learning and feedback, but reactions still need to be taken with skepticism. Concierge and “Wizard of Oz” experiments, where you fake the product through manual labor (see Glossary) will give you stronger evidence, because you put people through an experience and watch their actions. Te next layers of the onion are to test with a truly functional “Minimum Viable Product” (see Glossary) and beyond. Te point I want to make is that all of the steps on the curve can be very useful to help you learn, make smarter decisions, and reduce risk, but you need to use your head, and apply judgement to everything you are learning. 64 Talking to Humans How many people to talk to? Tere is no pat answer to this question. A consumer business should talk to an order of magnitude more people than a business that sells to enterprise. If you are in the consumer space and haven’t spoken to at least 50 to 100 people, you probably have not done enough research. In his I-Corps course, Steve Blank requires his teams, many of which are B2B, to talk to at least 100 people over 7 weeks. I advise that you never stop talking to potential customers, but you will probably evolve what you seek to learn. If you see the same patterns over and over again, you might change things up and examine diferent assumptions and risks. For example, if you feel like you have a frm understanding of your customer’s true need, you might move on to exploring how they learn about and purchase solutions in your product category today. And don’t forget that observing your customers can be as powerful as directly talking to them. Lead with Vision Customer Development and lean startup techniques are some of the most powerful ways to increase your odds of success, but they are not a replacement for vision. You need to start with vision. You need to start with how you want to improve the world and add value to people’s lives. Te techniques we’ve discussed in this book are among a body of techniques that let you reality check your vision, and optimize the path you will take to achieve your vision. How To 65 Conclusion Toughtful qualitative research is a critical tool for any entrepreneur. Hopefully this book has given you some new strategies for how to put it to work for your needs. Creating a new business is tremendously challenging. Te ways you can fail are numerous. t You have to get the customer and market right t You have to get the revenue model right t You have to get the cost structure right t You have to get customer acquisition right t You have to get the product right t You have to get the team right t You have to get your timing right Screw up any one of those and you are toast. Tere is a reason why entrepreneurship is not for the faint of heart. But we’re not here to be faint of heart. We are here to change the world. Dream big. Be passionate. Just be ruthless with your ideas and assumptions. Customer discovery and lean experimentation can truly help you chart a better path and fnd success faster and with more capital efciency. Don’t forget that as your business grows and changes, so too will your customer base. Keep on reality-checking your hypotheses. Keep on talking to humans. Appendix PART THREE Appendix 67 Cold Approach Examples When you are trying to reach someone you do not know, there are a few things to remember: 1. Keep things concise 2. Keep things convenient (meet near their ofce, etc) 3. Name drop when you can 4. Follow up if you don’t hear an answer, but don’t be annoying 5. If you are leaving a voice mail, practice it frst (you might think it sounds practiced, but to others, it will sound more professional) Example Email 1 To: john.smith@mayfower.com From: me@me.com John, I received your name from James Smith. He said that you had a lot of expertise in an area I am researching and recommended that we speak. I’m trying to study how companies are handling their expense report management workfows and the frustrations they are experiencing. I would be happy to share my research conclusions with you. Would you have 30 minutes to spare next week when I could buy you a cup of coffee and ask you a few questions? Many thanks for your time and I look forward to hearing from you, Jane Doe 68 Talking to Humans Example Email 2 To: john.smith@mayfower.com From: me@me.com John, I have been working on some new solutions in the area of expense report management, and I was told that you have a lot of expertise in this area. We started this journey because of personal frustration, and we’re trying to fgure out how to make expense reporting much less painful. Would you have 30 minutes to give us some advice, and share some of your experiences in this domain? I assure you that I’m not selling anything. I would be happy to come by your offce or arrange a quick video conference, at your preference. Many thanks, Jane Doe Example Voice Mail Message “Hello, my name is Jane Doe. I was referred to you by James Smith, who said I would beneft from your advice. I am currently researching how companies are handling their expense management workfows. I understand you have a lot of expertise in this area. I was hoping to take just 30 minutes of your time to ask you a few questions. I’m not selling anything and I would be happy to share my research conclusions with you. You can reach me at 555-555-5555. Again, this is Jane Doe, at 555-555-5555, and thank you for your time.” Final Note Cold calling is never anyone’s favorite thing to do, but it isn’t nearly as painful as you imagine. You have nothing to lose and everything to gain. So give yourself a determined smile in the mirror, and go get them! Appendix 69 Business Assumptions Exercise I am agnostic about the framework you choose to use to map out your business assumptions. Alexander Osterwalder’s business model canvas and Ash Maurya’s lean canvas are both powerful tools. I also ofen fnd myself using this simple set of questions to lay out a belief system around an idea: Try to make your assumptions as concise and specifc as possible. You want to be able to run an experiment against it to see if it is true. My target customer will be? (Tip: how would you describe your primary target customer) The problem my customer wants to solve is? (Tip: what does your customer struggle with or what need do they want to fulfll) My customer’s need can be solved with? (Tip: give a very concise description / elevator pitch of your product) Why can’t my customer solve this today? (Tip: what are the obstacles that have prevented my customer from solving this already) The measurable outcome my customer wants to achieve is? (Tip: what measurable change in your your customer’s life makes them love your product) 70 Talking to Humans My primary customer acquisition tactic will be? (Tip: you will likely have multiple marketing channels, but there is often one method, at most two, that dominates your customer acquisition — what is your current guess) My earliest adopter will be? (Tip: remember that you can’t get to the mainstream customer without getting early adopters frst) I will make money (revenue) by? (Tip: don’t list all the ideas for making money, but pick your primary one) My primary competition will be? (Tip: think about both direct and indirect competition) I will beat my competitors primarily because of? (Tip: what truly differentiates you from the competition?) My biggest risk to fnancial viability is? (Tip: what could prevent you from getting to breakeven? is there something baked into your revenue or cost model that you can de-risk?) My biggest technical or engineering risk is? (Tip: is there a major technical challenge that might hinder building your product?) And then answer the following open-ended question. Be creative and really examine your points of failure. Appendix 71 What assumptions do we have that, if proven wrong, would cause this business to fail? 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Afer you have looked at your business holistically and also answered the broad fnal question, mark the assumptions that would have a large impact on your business and feel highly uncertain. Now you know your priorities for customer discovery and the experiments you need to run! 72 Talking to Humans Teaching Exercise #1: Mock Interviews If you are using this book to try to teach customer discovery/ development, there is nothing like real-world practice to make learning stick. Before you send your class out into the world to conduct their own interviews, however, you might try a compact exercise like the following: Tools All participants should have pen and paper Preface: Choose a Topic Everyone in the class will interview each other based on the same topic, which means it needs to be something most people can relate two. Tere are two angles you might take: 1. Something that helps the interviewer dig up past behavior. For example, “Tell me about the last thing you purchased over $100.” Have the interview subject explain what they bought, what the purchase process was like from desire to actual ownership, how they made their purchase decision, etc. 2. Something that helps the interviewer unlock deeper motivations and desires. For example, “Tell me about your dream car.” Prompt your students not just to get people to describe the car, but to dig into the reasons behind the choice; they can also prompt for whether the interview subject has ever experienced driving the car. Appendix 73 Exercise Step 1: Intro, 5 minutes Explain the exercise, the topic that the students will use, and give a few specifc suggestions for questions they might ask. Example questions for the dream car: when did you fall in love with the car and why? of the reasons you shared, why are these the most important to you? how have you imagined using the car? etc Step 2: Interview Plan, 2 minutes Give your class the topic and let them spend 5 minutes on their own. Tey should write down no more than 6 questions to ask. Step 3: Pair Interviews, 5 - 7 minutes each Pair up your students. One will begin as the interviewer, and their opposite will be interviewed. Give them 7 minutes, and then switch the roles, keeping the pairs unchanged. Te new interviewer gets 7 minutes. Te person doing the interviewing should also take notes, which will give them some exposure to doing an interview solo as opposed to bringing a note-taker to help (which is what most people prefer to do when possible). Step 4: Observations and Questions, 5-10 minutes Ask the room to share observations, challenges, lessons or questions on what it was like to do a live interview. 74 Talking to Humans Teaching Exercise #2: Mock Approach Dean Chang, the Associate VP of Entrepreneurship at the University of Maryland, recommends a class exercise where one or more teams of students takes on the role of cold calling an “expert.” Te team has to do it over and over until they get it right. For this exercise, select one team and have them come to the front of the classroom. Teir job is to “cold call” a selected member of the teaching team. Te teacher will pretend to be an expert in the team’s target feld. Te team needs to get the expert to take the call, and smoothly transition into asking questions. Te job of the person playing the “expert” is to block the team’s misguided attempts to engage. When the team does something wrong, the expert declines the interview request, or ends the conversation, or gives them a gong. Ten the team has to start over again. Classic mistakes that should trigger the team starting over include long or unclear introductions, pitching the product/technology too soon, implying that the expert has problems and desperately needs help, and/or generally making the expert feel uncomfortable with the line of questioning. As Dean describes it, “We let the other teams ofer critiques and suggest plans of attack for winning over the expert and then the chosen team tries it again. Eventually afer being gonged several times in a row, they stop making the same mistakes and start to Appendix 75 converge on a good elevator pitch that praises and disarms the expert and paves the way to entering into an interview. Ten we stop the exercise.” Te exercise will probably be humorous and painful at the same time, but there is nothing like stumbling, or watching a team stumble, to realize why best practices are best practices. 76 Talking to Humans Screwing Up Customer Discovery So how do people screw up customer discovery? Here are a few antipatterns: 1. You treat speculation as confrmation Here are some question types that I don’t like — and if you ask them, you should heavily discount the answer: “would you use this?” “would you pay for this?” “would you like this?” I can’t say that I never ask these questions, but I always prefer behavioral questions over speculation. As contrast, here is a behavior-focused interaction: “Tell me about a time when you bought airline tickets online.” “What did you enjoy about the process? What frustrated you about the process?” “What diferent systems or methods have you tried in the past to book tickets?” 2. You lead the witness Leading the witness is putting the answer in the interviewee’s mouth in the way you ask the question. For example: “We don’t think most people really want to book tickets online, but what do you think?” Examine both how you phrase your questions and your tone of voice. Are you steering the answer? Ask open-ended, neutral questions before you drill down: “what was that experience of buying online tickets like?” 3. You just can’t stop talking Some entrepreneurs can’t help themselves — they are overfowing with excitement and just have to pitch pitch pitch. Tere is nothing Appendix 77 wrong with trying to pre-sell your product — that is an interesting experiment unto itself — but you should not mix this in with behavioral learning. If you do try to pre-sell, don’t just ask, “Would you pay for this?” but rather ask them to actually pay, and see what happens. Some people ask the question, “How much would you pay for this?” but I do not. Instead, try actually selling at diferent price points (albeit one at a time). I much prefer having the potential customer experience something, rather than speculate over something. 4. You only hear what you want to hear I see some people go into interviews with strong beliefs about what they like and dislike. When you debrief afer their custdev conversation, it is magical how everything they heard aligns perfectly with their opinions. Our brains are amazing flters. Leave your agenda at the door before starting a conversation. One way to solve this is to have two people for each interview — one person to ask questions, and the other to take notes. 5. You treat a single conversation as ultimate truth You’ve just spoken to a potential customer and they have really strong opinions. One instinct is to jump to conclusions and rush to make changes. Instead, you need to be patient. Tere is no defnitive answer for how many similar answers equals the truth. Look for patterns and use your judgement. A clear, consistent pattern at even 5 or 10 people is a signal. 6. Fear of rejection wins out Tis is one of the biggest blockers to people doing qualitative research, in my experience, because of fear of a stranger rejecting your advance or rejecting your idea. Many excuses, such as “I don’t know how to fnd people to talk to,” are rooted in this fear. JFDI. Customer development isn’t just about street intercepts. You can 78 Talking to Humans recruit people on Craigslist, Facebook and LinkedIn groups, and good old fashioned networking. 7. You talk to anyone with a pulse I see some teams taking a shotgun approach. Instead, defne your assumptions around who your customer will be and who your early adopter will be. You might even do a lightweight persona (see the book Lean UX for examples). Zoom in on those people and try to validate or invalidate your assumptions about your customers. It is ok to occasionally go outside your target zone for learning, but don’t boil the ocean. Focus, learn, and pivot if necessary. 8. You wing the conversation If you go into a conversation unprepared, it will be evident. Write up your questions ahead of time and force-rank them based on the risks and assumptions you are worried about. To defne your assumptions, you can answer the questions in the business assumptions exercise (previous section), or do a business model canvas or a lean canvas. Your exact method doesn’t matter as much as the act of prioritizing your risk areas. During your actual interview, do not literally read your questions from a piece of paper, but rather keep things conversational (remember, you are getting the subject to tell you stories). If you uncover something interesting, follow your nose and don’t be afraid to diverge from your initial priorities. 9. You try to learn everything in one sitting Rather than trying to go as broad as possible in every conversation, you are actually better of zooming in on a few areas which are critical to your business. If you have a huge range of questions, do more interviews and split the questions. Appendix 79 10. Only the designer does qualitative research It is ok to divide and conquer most of the time, but everyone on the team should be forced to get out and talk to real people. Note: you will probably have to coach newcomers on #5’s point about not jumping to conclusions. 11. You did customer development your frst week, but haven’t felt a need to do it since It is always sad to see product teams start things of with customer development, and then completely stop once they get going. It is perfectly fne to let customer discovery work ebb and fow. If your learning curve fattens, it can make sense to press pause or change up your approach. However, you want to build a regular qualitative cadence into your product process. It will provide a necessary complement to your quantitative metrics, because it will help you understand the reasons why things are happening. 12. You ask the customer to design your product for you Tere’s a famous line attributed to Henry Ford, “If I had asked people what they wanted, they would have said faster horses.” Remember, it is not the customer’s job to design the solution. It is your job. It is the customer’s job to tell you if your solution sucks. Get feedback, yes. Remember that the further away you are from a working product, the more you have to flter what you hear through your judgement and vision. Disclaimer As with all tips on lean and agile, there are always places and times to break the rules and do what is right for your context, and your business. 80 Talking to Humans Glossary Concierge and “Wizard of Oz” Experiments A concierge experiment is where you manually act out your product. An example in Eric Ries’ book Te Lean Startup shows an entrepreneur serving as a personal shopper for people before trying to design an automated solution. When my colleagues were testing a diet plan service, we did not want to rush to sofware before testing our assumptions. Instead, we interviewed participants about their food preferences, manually created meal plans which were emailed to them over two weeks, and interviewed them at various points in the process. At the end of the two weeks, we asked them to pay a set amount to continue, and tracked the conversion rate. A “Wizard of Oz” experiment is similar, with the diference being that the manual work is hidden from the customer. For example, another set of colleagues tested an idea for a smart task management system for married couples. Te twenty couples participating in the test thought that they were interacting with a computer system, but in reality they were emailing in to our team, who then processed the emails accordingly. We just said that the servers would be “down” at night! Minimum Viable Product (MVP) An MVP is the smallest thing you can create that gives you meaningful learning about your product. MVP is ofen used interchangeably with “experiment” in the broader community. I personally tend to reserve it specifcally for tests around the product, and not for experiments related to other business assumptions. It is best to think about MVPs as an ongoing process, rather than a single release. Validation is rarely that neat and tidy. Appendix 81 Scientifc Method I think the best way to explain the scientifc method is to quote the theoretical physicist, Richard Feynman: “In general we look for a new law by the following process: frst we guess it. Don’t laugh -- that’s really true. Ten we compute the consequences of the guess to see what, if this law is right, what it would imply. Ten we compare those computation results to nature, i.e. experiment and experience. We compare it directly to observation to see if it works. “If it disagrees with experiment, it’s wrong. Tat simple statement is the key to science. It doesn’t make a diference how beautiful your guess is, it doesn’t make a diference how smart you are, who made the guess or what his name is -- if it disagrees with experiment, it’s wrong. Tat’s all there is to it.” (Cornell lecture, 1964) It is relatively straightforward to apply the scientifc method to business. You accept that your ideas are hypotheses. You make them as specifc as possible so that you can guess the results, i.e. the implications, of your hypotheses. You design and run an experiment. If your hypothesized results do not match the results of your experiment, your hypothesis is proven wrong. However, business is about people, and people are highly complex and inconsistent compared to laws of nature. So if your experiment fails, you will still need to apply judgement about whether the errors are in the hypothesis or in the experiment. 82 Talking to Humans Other Learning Resources Authors Te two seminal books on the topics of lean innovation and customer development are Steve Blank and Bob Dorf ’s Te Startup Owner’s Manual and Eric Ries’ Te Lean Startup. Tere are a ton of other resources out there, from books to videos and blog posts. Rather than link to particular items and thus miss out on newer developments, here are a few names that I recommend you pay attention to: Alex Osterwalder, Alistair Croll, Ash Maurya, Ben Yoskowitz, Brant Cooper, Cindy Alvarez, David Bland, Jef Gothelf, Joel Gascoigne, Josh Seiden, Kevin Dewalt, Laura Klein, Patrick Vlaskovits, Rob Fitzpatrick, Salim Virani, and Tristan Kromer. Talking to Humans Website On our website talkingtohumans.com, you can get worksheet pdfs and sign up for our email list, where we send occasional notes based on useful resources we discover. Behind the Book 83 Gif Constable (gifconstable.com) is a repeat entrepreneur and currently the CEO of Neo, a global product innovation consulting company. He has held product design and business roles in six startups, and provided M&A and IPO services to technology frms while at Broadview/Jeferies. He was one of the earliest adopters & bloggers of the Lean Startup movement, co-organizes the 4,700-person Lean Lessons Learned meetup in New York, and tries to give back to the entrepreneurial community through mentoring and speaking engagements. He lives outside of New York City with his wife, two children, and an excessively rambunctious retriever. Giff Constable Talking to Humans was written by Gif Constable, at the instigation and with the collaboration of Frank Rimalovski of NYU’s Entrepreneurial Institute, and with the wonderful illustrations of Tom Fishburne. Behind the Book 84 Guide to Customer Discovery Frank Rimalovski brings over 20 years of experience in technology commercialization, startups and early-stage venture capital investing. He is executive director of the NYU Entrepreneurial Institute, managing director of the NYU Innovation Venture Fund, Adjunct Faculty at NYU’s Polytechnic School of Engineering, and an Instructor in the NSF’s I-Corps program, having trained and mentored hundreds of entrepreneurs in customer development and lean startup methodologies. Previously, he was a founding partner of New Venture Partners, director/entrepreneur-in-residence at Lucent’s New Ventures Group, and has held various positions in product management, marketing and business development at Sun Microsystems, Apple and NeXT. He lives outside of New York City with his wife, two daughters and his increasingly mellow mutt. Frank Rimalovski Tom Fishburne (marketoonist.com) started drawing cartoons on the backs of Harvard Business School cases. His cartoons have grown by word of mouth to reach 100,000 business readers a week and have been featured by the Wall Street Journal, Fast Company, and the New York Times. Tom is the Founder and CEO of Marketoon Studios, a content marketing studio that helps businesses such as Google, Kronos, and Rocketfuel reach their audiences with cartoons. Tom draws from 19 years in the marketing and innovation trenches at Method Products, Nestle, and General Mills. He lives near San Francisco with his wife and two daughters. Tom Fishburne Behind the Book 85 Like The Book? When Frank approached me to write this book, we both had the same goal of giving back to the community. We debated charging for the book, and pondered whether the question of free versus paid would afect how it was perceived. But ultimately, we decided to put it out into the world for free. Should you like Talking to Humans, and feel a need to contribute back to something, we would encourage you to think about doing one or all of the following: 1. Pay it back (and forward!) by mentoring another student or entrepreneur 2. Donate to one of our favorite causes: Charity: Water, Girls Who Code, Kiva or the NYU Entrepreneurial Institute 3. Share a link to the talkingtohumans.com website or give someone a copy of the book If this book has helped you in some small way, then that is reward enough for us. It’s why we did it. Gif Constable and Frank Rimalovski September 2014 talkingtohumans.com page intentionally blank Acclaim for Talking to Humans “Talking to Humans is the perfect complement to the existing body of work on customer development. If you are teaching entrepreneurship or running a startup accelerator, you need to make it required reading for your students and teams. I have.” Steve Blank, entrepreneur and author of The Startup Owner’s Manual “Getting started on your Customer Discovery journey is the most important step to becoming a successful entrepreneur and reading Talking To Humans is the smartest frst step to fnding and solving real problems for paying customers.” Andre Marquis, Executive Director, Lester Center for Entrepreneurship, University of California Berkeley “If entrepreneurship 101 is talking to customers, this is the syllabus. Talking to Humans is a thoughtful guide to the customer informed product development that lies at the foundation of successful start-ups.” Phin Barnes, Partner, First Round Capital “A lot of entrepreneurs pay lip service to talking to customers but you have to know how. Talking to Humans ofers concrete examples on how to how to recruit candidates, how to conduct interviews, and how to prioritize learning from customers more through listening versus talking.” Ash Maurya, Founder of Spark59 and author of Running Lean “When getting ‘out of the building,’ too many people crash and burn right out of the gate and wonder what happened. Talking to Humans is a quick and efective guide for how Lean Startup interviews should be done.” Dean Chang, Associate VP for Innovation & Entrepreneurship, University of Maryland #talkingtohumans talkingtohumans.com",Internet/Technology,Find & Summarize,Text Transformation Refer only to the context document in your answer. Do not employ any outside information. Use complete sentences.,"Summarize the possible uses, that are addressed in the provided document, of Google Gemini.","**What is Google Gemini (formerly Bard)?** Google Gemini -- formerly called Bard -- is an artificial intelligence (AI) chatbot tool designed by Google to simulate human conversations using natural language processing (NLP) and machine learning. In addition to supplementing Google Search, Gemini can be integrated into websites, messaging platforms or applications to provide realistic, natural language responses to user questions. List of tasks Google Gemini can perform. Google Gemini can be applied pragmatically to complete various tasks. Google Gemini is a family of multimodal AI large language models (LLMs) that have capabilities in language, audio, code and video understanding. Gemini 1.0 was announced on Dec. 6, 2023, and built by Alphabet's Google DeepMind business unit, which is focused on advanced AI research and development. Google co-founder Sergey Brin is credited with helping to develop the Gemini LLMs, alongside other Google staff. At its release, Gemini was the most advanced set of LLMs at Google, powering Bard before Bard's renaming and superseding the company's Pathways Language Model (Palm 2). As was the case with Palm 2, Gemini was integrated into multiple Google technologies to provide generative AI capabilities. Gemini integrates NLP capabilities, which provide the ability to understand and process language. Gemini is also used to comprehend input queries as well as data. It's able to understand and recognize images, enabling it to parse complex visuals, such as charts and figures, without the need for external optical character recognition (OCR). It also has broad multilingual capabilities for translation tasks and functionality across different languages. How does Google Gemini work? Google Gemini works by first being trained on a massive corpus of data. After training, the model uses several neural network techniques to be able to understand content, answer questions, generate text and produce outputs. Specifically, the Gemini LLMs use a transformer model-based neural network architecture. The Gemini architecture has been enhanced to process lengthy contextual sequences across different data types, including text, audio and video. Google DeepMind makes use of efficient attention mechanisms in the transformer decoder to help the models process long contexts, spanning different modalities. Gemini models have been trained on diverse multimodal and multilingual data sets of text, images, audio and video with Google DeepMind using advanced data filtering to optimize training. As different Gemini models are deployed in support of specific Google services, there's a process of targeted fine-tuning that can be used to further optimize a model for a use case. During both the training and inference phases, Gemini benefits from the use of Google's latest tensor processing unit chips, TPU v5, which are optimized custom AI accelerators designed to efficiently train and deploy large models. A key challenge for LLMs is the risk of bias and potentially toxic content. According to Google, Gemini underwent extensive safety testing and mitigation around risks such as bias and toxicity to help provide a degree of LLM safety. To help further ensure Gemini works as it should, the models were tested against academic benchmarks spanning language, image, audio, video and code domains. Google has assured the public it adheres to a list of AI principles. At launch on Dec. 6, 2023, Gemini was announced to be made up of a series of different model sizes, each designed for a specific set of use cases and deployment environments. The Ultra model is the top end and is designed for highly complex tasks. The Pro model is designed for performance and deployment at scale. As of Dec. 13, 2023, Google enabled access to Gemini Pro in Google Cloud Vertex AI and Google AI Studio. For code, a version of Gemini Pro is being used to power the Google AlphaCode 2 generative AI coding technology. The Nano model is targeted at on-device use cases. There are two different versions of Gemini Nano: Nano-1 is a 1.8 billion-parameter model, while Nano-2 is a 3.25 billion-parameter model. Among the places where Nano is being embedded is the Google Pixel 8 Pro smartphone. When was Google Bard first released? Google initially announced Bard, its AI-powered chatbot, on Feb. 6, 2023, with a vague release date. It opened access to Bard on March 21, 2023, inviting users to join a waitlist. On May 10, 2023, Google removed the waitlist and made Bard available in more than 180 countries and territories. Almost precisely a year after its initial announcement, Bard was renamed Gemini. Many believed that Google felt the pressure of ChatGPT's success and positive press, leading the company to rush Bard out before it was ready. For example, during a live demo by Google and Alphabet CEO Sundar Pichai, it responded to a query with a wrong answer. In the demo, a user asked Bard the question: ""What new discoveries from the James Webb Space Telescope can I tell my 9-year-old about?"" In Bard's response, it mentioned that the telescope ""took the very first pictures of a planet outside of our own solar system."" Astronomers quickly took to social media to point out that the first image of an exoplanet was taken by an earthbound observatory in 2004, making Bard's answer incorrect. The next day, Google lost $100 billion in market value -- a decline attributed to the embarrassing mistake. Why did Google rename Bard to Gemini and when did it happen? Bard was renamed Gemini on Feb. 8, 2024. Gemini was already the LLM powering Bard. Rebranding the platform as Gemini some believe might have been done to draw attention away from the Bard moniker and the criticism the chatbot faced when it was first released. It also simplified Google's AI effort and focused on the success of the Gemini LLM. The name change also made sense from a marketing perspective, as Google aims to expand its AI services. It's a way for Google to increase awareness of its advanced LLM offering as AI democratization and advancements show no signs of slowing. Who can use Google Gemini? Gemini is widely available around the world. Gemini Pro is available in more than 230 countries and territories, while Gemini Advanced is available in more than 150 countries at the time of this writing. However, there are age limits in place to comply with laws and regulations that exist to govern AI. Users must be at least 18 years old and have a personal Google account. However, age restrictions vary for the Gemini web app. Users in Europe must be 18 or older. In other countries where the platform is available, the minimum age is 13 unless otherwise specified by local laws. Also, users younger than 18 can only use the Gemini web app in English. Is Gemini free to use? When Bard became available, Google gave no indication that it would charge for use. Google has no history of charging customers for services, excluding enterprise-level usage of Google Cloud. The assumption was that the chatbot would be integrated into Google's basic search engine, and therefore be free to use. After rebranding Bard to Gemini on Feb. 8, 2024, Google introduced a paid tier in addition to the free web application. Pro and Nano currently are free to use via registration. However, users can only get access to Ultra through the Gemini Advanced option for $20 per month. Users sign up for Gemini Advanced through a Google One AI Premium subscription, which also includes Google Workspace features and 2 terabytes of storage. What can you use Gemini for? Use cases and applications The Google Gemini models are used in many different ways, including text, image, audio and video understanding. The multimodal nature of Gemini also enables these different types of input to be combined for generating output. Use cases Businesses can use Gemini to perform various tasks that include the following: Text summarization. Gemini models can summarize content from different types of data. Text generation. Gemini can generate text based on user prompts. That text can also be driven by a Q&A-type chatbot interface. Text translation. The Gemini models have broad multilingual capabilities, enabling translation and understanding of more than 100 languages. Image understanding. Gemini can parse complex visuals, such as charts, figures and diagrams, without external OCR tools. It can be used for image captioning and visual Q&A capabilities. Audio processing. Gemini has support for speech recognition across more than 100 languages and audio translation tasks. Video understanding. Gemini can process and understand video clip frames to answer questions and generate descriptions. Multimodal reasoning. A key strength of Gemini is its use of multimodal AI reasoning, where different types of data can be mixed for a prompt to generate an output. Code analysis and generation. Gemini can understand, explain and generate code in popular programming languages, including Python, Java, C++ and Go. Applications Google developed Gemini as a foundation model to be widely integrated across various Google services. It's also available for developers to use in building their own applications. Applications that use Gemini include the following: AlphaCode 2. Google DeepMind's AlphaCode 2 code generation tool makes use of a customized version of Gemini Pro. Google Pixel. The Google-built Pixel 8 Pro smartphone is the first device engineered to run Gemini Nano. Gemini powers new features in existing Google apps, such as summarization in Recorder and Smart Reply in Gboard for messaging apps. Android 14. The Pixel 8 Pro is the first Android smartphone to benefit from Gemini. Android developers can build with Gemini Nano through the AICore system capability. Vertex AI. Google Cloud's Vertex AI service, which provides foundation models that developers can use to build applications, also provides access to Gemini Pro. Google AI Studio. Developers can build prototypes and apps with Gemini via the Google AI Studio web-based tool. Search. Google is experimenting with using Gemini in its Search Generative Experience to reduce latency and improve quality.","{Question} Summarize the possible uses, that are addressed in the provided document, of Google Gemini. ================ {Context} **What is Google Gemini (formerly Bard)?** Google Gemini -- formerly called Bard -- is an artificial intelligence (AI) chatbot tool designed by Google to simulate human conversations using natural language processing (NLP) and machine learning. In addition to supplementing Google Search, Gemini can be integrated into websites, messaging platforms or applications to provide realistic, natural language responses to user questions. List of tasks Google Gemini can perform. Google Gemini can be applied pragmatically to complete various tasks. Google Gemini is a family of multimodal AI large language models (LLMs) that have capabilities in language, audio, code and video understanding. Gemini 1.0 was announced on Dec. 6, 2023, and built by Alphabet's Google DeepMind business unit, which is focused on advanced AI research and development. Google co-founder Sergey Brin is credited with helping to develop the Gemini LLMs, alongside other Google staff. At its release, Gemini was the most advanced set of LLMs at Google, powering Bard before Bard's renaming and superseding the company's Pathways Language Model (Palm 2). As was the case with Palm 2, Gemini was integrated into multiple Google technologies to provide generative AI capabilities. Gemini integrates NLP capabilities, which provide the ability to understand and process language. Gemini is also used to comprehend input queries as well as data. It's able to understand and recognize images, enabling it to parse complex visuals, such as charts and figures, without the need for external optical character recognition (OCR). It also has broad multilingual capabilities for translation tasks and functionality across different languages. How does Google Gemini work? Google Gemini works by first being trained on a massive corpus of data. After training, the model uses several neural network techniques to be able to understand content, answer questions, generate text and produce outputs. Specifically, the Gemini LLMs use a transformer model-based neural network architecture. The Gemini architecture has been enhanced to process lengthy contextual sequences across different data types, including text, audio and video. Google DeepMind makes use of efficient attention mechanisms in the transformer decoder to help the models process long contexts, spanning different modalities. Gemini models have been trained on diverse multimodal and multilingual data sets of text, images, audio and video with Google DeepMind using advanced data filtering to optimize training. As different Gemini models are deployed in support of specific Google services, there's a process of targeted fine-tuning that can be used to further optimize a model for a use case. During both the training and inference phases, Gemini benefits from the use of Google's latest tensor processing unit chips, TPU v5, which are optimized custom AI accelerators designed to efficiently train and deploy large models. A key challenge for LLMs is the risk of bias and potentially toxic content. According to Google, Gemini underwent extensive safety testing and mitigation around risks such as bias and toxicity to help provide a degree of LLM safety. To help further ensure Gemini works as it should, the models were tested against academic benchmarks spanning language, image, audio, video and code domains. Google has assured the public it adheres to a list of AI principles. At launch on Dec. 6, 2023, Gemini was announced to be made up of a series of different model sizes, each designed for a specific set of use cases and deployment environments. The Ultra model is the top end and is designed for highly complex tasks. The Pro model is designed for performance and deployment at scale. As of Dec. 13, 2023, Google enabled access to Gemini Pro in Google Cloud Vertex AI and Google AI Studio. For code, a version of Gemini Pro is being used to power the Google AlphaCode 2 generative AI coding technology. The Nano model is targeted at on-device use cases. There are two different versions of Gemini Nano: Nano-1 is a 1.8 billion-parameter model, while Nano-2 is a 3.25 billion-parameter model. Among the places where Nano is being embedded is the Google Pixel 8 Pro smartphone. When was Google Bard first released? Google initially announced Bard, its AI-powered chatbot, on Feb. 6, 2023, with a vague release date. It opened access to Bard on March 21, 2023, inviting users to join a waitlist. On May 10, 2023, Google removed the waitlist and made Bard available in more than 180 countries and territories. Almost precisely a year after its initial announcement, Bard was renamed Gemini. Many believed that Google felt the pressure of ChatGPT's success and positive press, leading the company to rush Bard out before it was ready. For example, during a live demo by Google and Alphabet CEO Sundar Pichai, it responded to a query with a wrong answer. In the demo, a user asked Bard the question: ""What new discoveries from the James Webb Space Telescope can I tell my 9-year-old about?"" In Bard's response, it mentioned that the telescope ""took the very first pictures of a planet outside of our own solar system."" Astronomers quickly took to social media to point out that the first image of an exoplanet was taken by an earthbound observatory in 2004, making Bard's answer incorrect. The next day, Google lost $100 billion in market value -- a decline attributed to the embarrassing mistake. Why did Google rename Bard to Gemini and when did it happen? Bard was renamed Gemini on Feb. 8, 2024. Gemini was already the LLM powering Bard. Rebranding the platform as Gemini some believe might have been done to draw attention away from the Bard moniker and the criticism the chatbot faced when it was first released. It also simplified Google's AI effort and focused on the success of the Gemini LLM. The name change also made sense from a marketing perspective, as Google aims to expand its AI services. It's a way for Google to increase awareness of its advanced LLM offering as AI democratization and advancements show no signs of slowing. Who can use Google Gemini? Gemini is widely available around the world. Gemini Pro is available in more than 230 countries and territories, while Gemini Advanced is available in more than 150 countries at the time of this writing. However, there are age limits in place to comply with laws and regulations that exist to govern AI. Users must be at least 18 years old and have a personal Google account. However, age restrictions vary for the Gemini web app. Users in Europe must be 18 or older. In other countries where the platform is available, the minimum age is 13 unless otherwise specified by local laws. Also, users younger than 18 can only use the Gemini web app in English. Is Gemini free to use? When Bard became available, Google gave no indication that it would charge for use. Google has no history of charging customers for services, excluding enterprise-level usage of Google Cloud. The assumption was that the chatbot would be integrated into Google's basic search engine, and therefore be free to use. After rebranding Bard to Gemini on Feb. 8, 2024, Google introduced a paid tier in addition to the free web application. Pro and Nano currently are free to use via registration. However, users can only get access to Ultra through the Gemini Advanced option for $20 per month. Users sign up for Gemini Advanced through a Google One AI Premium subscription, which also includes Google Workspace features and 2 terabytes of storage. What can you use Gemini for? Use cases and applications The Google Gemini models are used in many different ways, including text, image, audio and video understanding. The multimodal nature of Gemini also enables these different types of input to be combined for generating output. Use cases Businesses can use Gemini to perform various tasks that include the following: Text summarization. Gemini models can summarize content from different types of data. Text generation. Gemini can generate text based on user prompts. That text can also be driven by a Q&A-type chatbot interface. Text translation. The Gemini models have broad multilingual capabilities, enabling translation and understanding of more than 100 languages. Image understanding. Gemini can parse complex visuals, such as charts, figures and diagrams, without external OCR tools. It can be used for image captioning and visual Q&A capabilities. Audio processing. Gemini has support for speech recognition across more than 100 languages and audio translation tasks. Video understanding. Gemini can process and understand video clip frames to answer questions and generate descriptions. Multimodal reasoning. A key strength of Gemini is its use of multimodal AI reasoning, where different types of data can be mixed for a prompt to generate an output. Code analysis and generation. Gemini can understand, explain and generate code in popular programming languages, including Python, Java, C++ and Go. Applications Google developed Gemini as a foundation model to be widely integrated across various Google services. It's also available for developers to use in building their own applications. Applications that use Gemini include the following: AlphaCode 2. Google DeepMind's AlphaCode 2 code generation tool makes use of a customized version of Gemini Pro. Google Pixel. The Google-built Pixel 8 Pro smartphone is the first device engineered to run Gemini Nano. Gemini powers new features in existing Google apps, such as summarization in Recorder and Smart Reply in Gboard for messaging apps. Android 14. The Pixel 8 Pro is the first Android smartphone to benefit from Gemini. Android developers can build with Gemini Nano through the AICore system capability. Vertex AI. Google Cloud's Vertex AI service, which provides foundation models that developers can use to build applications, also provides access to Gemini Pro. Google AI Studio. Developers can build prototypes and apps with Gemini via the Google AI Studio web-based tool. Search. Google is experimenting with using Gemini in its Search Generative Experience to reduce latency and improve quality. ================ {Task Information} Refer only to the context document in your answer. Do not employ any outside information. Use complete sentences.",Internet/Technology,Find & Summarize,Text Transformation Base your answer purely in the provided context. Answer in only one sentence.,"Based only on the article provided, what is the difference between how SoundCloud's recommendation algorithm works and those of other streaming services?","**WHAT’S NEW WITH SOUNDCLOUD IN FEBRUARY: CARPLAY, 2FA, AND MORE** As winter is winding down, we’re starting to get hot. Read on for more information about our latest launches and updates to SoundCloud. In case you missed it: Apple CarPlay is here Road trips just got better: SoundCloud is available on Apple Carplay for Go, Go+, and Next Pro subscribers. Protect your account with 2FA We know how much time it took to create that track or curate that perfect playlist. At SoundCloud, we love people who love music and are committed to keeping their data as safe as possible. That’s why your security is such a priority to us, and why we’re encouraging you to up your security game by enabling two-factor authorization (2FA). After pairing your device with a 2FA app, you will now be asked to enter a quick security code whenever you log in to your account to prove it’s you, not a bot or hacker. Learn how to enable two-factor authentication here. Refreshed music algorithms and recommendations Most streaming services recommend tracks based on what similar people are listening to. If someone similar to me listens to and likes “Fred Again”, chances are I’ll be recommended “Fred Again”. That obviously works well for artists who are already being heard. But what about all of the songs that don’t have any plays yet? Well, that’s exactly the problem with most music algorithms. They simply can’t recommend tracks with zero plays. If no one has listened yet, they’ve got no signals. Next Pro changes the game. Using AI, we can quickly analyze tracks and surface them to listeners who are likely to enjoy them. Even if they were just uploaded and have zero plays. If you’re not already on Next Pro, sign up today and get your first 100 plays. Bulk edits in Track Manager page We recently updated the Track Manager to make the creator workflow more intuitive and easy. Now, you can bulk edit multiple tracks at once, add tracks to playlists, and quickly edit a single track. It’s part of a greater revamp to improve our web experience and refresh our product over the coming months, so watch this space. Removal of Sync with SoundCloud We removed a massive amount of friction and frustration within the “Monetize” tab. Previously artists had to manually push a button to sync the data to see their tracks, resulting in confusion. Now, tracks are automatically synced. Stay tuned and make sure to follow us at @SCSupport for the latest."," ========== Based only on the article provided, what is the difference between how SoundCloud's recommendation algorithm works and those of other streaming services? ---------------- ========== Base your answer purely in the provided context. Answer in only one sentence. ---------------- ========== **WHAT’S NEW WITH SOUNDCLOUD IN FEBRUARY: CARPLAY, 2FA, AND MORE** As winter is winding down, we’re starting to get hot. Read on for more information about our latest launches and updates to SoundCloud. In case you missed it: Apple CarPlay is here Road trips just got better: SoundCloud is available on Apple Carplay for Go, Go+, and Next Pro subscribers. Protect your account with 2FA We know how much time it took to create that track or curate that perfect playlist. At SoundCloud, we love people who love music and are committed to keeping their data as safe as possible. That’s why your security is such a priority to us, and why we’re encouraging you to up your security game by enabling two-factor authorization (2FA). After pairing your device with a 2FA app, you will now be asked to enter a quick security code whenever you log in to your account to prove it’s you, not a bot or hacker. Learn how to enable two-factor authentication here. Refreshed music algorithms and recommendations Most streaming services recommend tracks based on what similar people are listening to. If someone similar to me listens to and likes “Fred Again”, chances are I’ll be recommended “Fred Again”. That obviously works well for artists who are already being heard. But what about all of the songs that don’t have any plays yet? Well, that’s exactly the problem with most music algorithms. They simply can’t recommend tracks with zero plays. If no one has listened yet, they’ve got no signals. Next Pro changes the game. Using AI, we can quickly analyze tracks and surface them to listeners who are likely to enjoy them. Even if they were just uploaded and have zero plays. If you’re not already on Next Pro, sign up today and get your first 100 plays. Bulk edits in Track Manager page We recently updated the Track Manager to make the creator workflow more intuitive and easy. Now, you can bulk edit multiple tracks at once, add tracks to playlists, and quickly edit a single track. It’s part of a greater revamp to improve our web experience and refresh our product over the coming months, so watch this space. Removal of Sync with SoundCloud We removed a massive amount of friction and frustration within the “Monetize” tab. Previously artists had to manually push a button to sync the data to see their tracks, resulting in confusion. Now, tracks are automatically synced. Stay tuned and make sure to follow us at @SCSupport for the latest.",Retail/Product,Concept Comparison,Q&A Use only the information provided in the Prompt to answer any questions. You may not use any previous knowledge or external resources. Limit your answer to a maximum of 150 words.,"Please summarize the given text into two paragraphs at most, and do not include multiple subheadings; all of the information should be under a singular title.","Program Caps Program caps, sometimes called aggregate capacity limits, set limits on the number of customers or amount of generation capacity that may participate. Program caps can be expressed in units of power (e.g., megawatts; MW),39 a percentage of electricity demand over some period of time, or other measures as determined by a state. The choice of whether to have program caps and, if so, how to define them can affect the amount of DG that a state’s net metering policy might promote.40 Program caps may be established to reduce risks to the electricity system, such as potential reliability risks from DG, or reduce the likelihood that cross-subsidies would occur. Caps also might reduce the potential for sales losses or other negative financial impacts for utilities.41 On the other hand, program caps might create a barrier to achieving other policy goals, for example the renewable energy goals that some states have. Source Eligibility States specify which generation sources can participate in net metering, often based on capacity limits (i.e., generator size) and technology type. Solar energy is the dominant energy source for net metering capacity, but some states allow other energy types to participate as well. Whether a non-solar project will participate is usually due to cost factors, but other factors such as customer type (e.g., residential, commercial, or industrial) and location (e.g., urban, rural) may be influential as well. For example, combined heat and power facilities might be attractive mostly to large commercial and industrial customers that use steam. Distributed wind projects might be attractive mostly to farms or other customers with relatively large acreage.","Use only the information provided in the Prompt to answer any questions. You may not use any previous knowledge or external resources. Limit your answer to a maximum of 150 words. Please summarize the given text into two paragraphs at most, and do not include multiple subheadings; all of the information should be under a singular title. Program Caps Program caps, sometimes called aggregate capacity limits, set limits on the number of customers or amount of generation capacity that may participate. Program caps can be expressed in units of power (e.g., megawatts; MW),39 a percentage of electricity demand over some period of time, or other measures as determined by a state. The choice of whether to have program caps and, if so, how to define them can affect the amount of DG that a state’s net metering policy might promote.40 Program caps may be established to reduce risks to the electricity system, such as potential reliability risks from DG, or reduce the likelihood that cross-subsidies would occur. Caps also might reduce the potential for sales losses or other negative financial impacts for utilities.41 On the other hand, program caps might create a barrier to achieving other policy goals, for example the renewable energy goals that some states have. Source Eligibility States specify which generation sources can participate in net metering, often based on capacity limits (i.e., generator size) and technology type. Solar energy is the dominant energy source for net metering capacity, but some states allow other energy types to participate as well. Whether a non-solar project will participate is usually due to cost factors, but other factors such as customer type (e.g., residential, commercial, or industrial) and location (e.g., urban, rural) may be influential as well. For example, combined heat and power facilities might be attractive mostly to large commercial and industrial customers that use steam. Distributed wind projects might be attractive mostly to farms or other customers with relatively large acreage.",Retail/Product,Summarize & Format,Text Transformation Provide a response using only information in the context block. Limit the response to 300 words.,"Based on the context, would an owner of a business owning less than 10% of an insurance company regulated by the state of New Jersey be considered a legal entity customer and/or be required to report the identity of the beneficial owner? ","Under the Beneficial Ownership Rule, 1 a bank must establish and maintain written procedures that are reasonably designed to identify and verify beneficial owner(s) of legal entity customers and to include such procedures in its anti-money laundering compliance program. Legal entities, whether domestic or foreign, can be used to facilitate money laundering and other crimes because their true ownership can be concealed. The collection of beneficial ownership information by banks about legal entity customers can provide law enforcement with key details about suspected criminals who use legal entity structures to conceal their illicit activity and assets. Requiring legal entity customers seeking access to banks to disclose identifying information, such as the name, date of birth, and Social Security number of natural persons who own or control them will make such entities more transparent, and thus less attractive to criminals and those who assist them. Similar to other customer information that a bank may gather, beneficial ownership information collected under the rule may be relevant to other regulatory requirements. These other regulatory requirements include, but are not limited to, identifying suspicious activity, and determining Office of Foreign Assets Control (OFAC) sanctioned parties. Banks should define in their policies, procedures, and processes how beneficial ownership information will be used to meet other regulatory requirements. Legal Entity Customers For the purposes of the Beneficial Ownership Rule, 2 a legal entity customer is defined as a corporation, limited liability company, or other entity that is created by the filing of a public document with a Secretary of State or other similar office, a general partnership, and any similar entity formed under the laws of a foreign jurisdiction that opens an account. A number of types of business entities are excluded from the definition of legal entity customer under the Beneficial Ownership rule. In addition, and subject to certain limitations, banks are not required to identify and verify the identity of the beneficial owner(s) of a legal entity customer when the customer opens certain types of accounts. For further information on exclusions and exemptions to the Beneficial Ownership Rule, see Appendix 1. These exclusions and exemptions do not alter or supersede other existing requirements related to BSA/AML and OFAC sanctions. Beneficial Owner(s) Beneficial ownership is determined under both a control prong and an ownership prong. Under the control prong, the beneficial owner is a single individual with significant responsibility to control, manage or direct a legal entity customer.3 This includes, an executive officer or senior manager (Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, President), or any other individual who regularly performs similar functions. One beneficial owner must be identified under the control prong for each legal entity customer. Under the ownership prong, a beneficial owner is each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of a legal entity customer.4 If a trust owns directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, 25 percent or more of the equity interests of a legal entity customer, the beneficial owner is the trustee.5 Identification of a beneficial owner under the ownership prong is not required if no individual owns 25 percent or more of a legal entity customer. Therefore, all legal entity customers will have a total of between one and five beneficial owner(s) – one individual under the control prong and zero to four individuals under the ownership prong. Exclusions from the definition of Legal Entity Customer Under 31 CFR 1010.230(e)(2) a legal entity customer does not include: • A financial institution regulated by a federal functional regulator14 or a bank regulated by a state bank regulator; • A person described in 31 CFR 1020.315(b)(2) through (5): o A department or agency of the United States, of any state, or of any political subdivision of any State; o Any entity established under the laws of the United States, of any state, or of any political subdivision of any state, or under an interstate compact between two or more states, that exercises governmental authority on behalf of the United States or any such state or political subdivision; o Any entity (other than a bank) whose common stock or analogous equity interests are listed on the New York Stock Exchange or the American Stock Exchange (currently known as the NYSE American) or have been designated as a NASDAQ National Market Security listed on the NASDAQ stock exchange (with some exceptions); o Any subsidiary (other than a bank) of any “listed entity” that is organized under the laws of the United States or of any state and at least 51 percent of whose common stock or analogous equity interest is owned by the listed entity, provided that a person that is a financial institution, other than a bank, is an exempt person only to the extent of its domestic operations; • An issuer of a class of securities registered under section 12 of the Securities Exchange Act of 1934 or that is required to file reports under section 15(d) of that Act; • An investment company, investment adviser, an exchange or clearing agency, or any other entity that is registered with the SEC; • A registered entity, commodity pool operator, commodity trading advisor, retail foreign exchange dealer, swap dealer, or major swap participant that is registered with the CFTC; • A public accounting firm registered under section 102 of the Sarbanes-Oxley Act; • A bank holding company or savings and loan holding company; • A pooled investment vehicle that is operated or advised by a financial institution that is excluded under paragraph (e)(2); • An insurance company that is regulated by a state;","Provide a response using only information in the context block. Limit the response to 300 words. Based on the context, would an owner of a business owning less than 10% of an insurance company regulated by the state of New Jersey be considered a legal entity customer and/or be required to report the identity of the beneficial owner? Under the Beneficial Ownership Rule, 1 a bank must establish and maintain written procedures that are reasonably designed to identify and verify beneficial owner(s) of legal entity customers and to include such procedures in its anti-money laundering compliance program. Legal entities, whether domestic or foreign, can be used to facilitate money laundering and other crimes because their true ownership can be concealed. The collection of beneficial ownership information by banks about legal entity customers can provide law enforcement with key details about suspected criminals who use legal entity structures to conceal their illicit activity and assets. Requiring legal entity customers seeking access to banks to disclose identifying information, such as the name, date of birth, and Social Security number of natural persons who own or control them will make such entities more transparent, and thus less attractive to criminals and those who assist them. Similar to other customer information that a bank may gather, beneficial ownership information collected under the rule may be relevant to other regulatory requirements. These other regulatory requirements include, but are not limited to, identifying suspicious activity, and determining Office of Foreign Assets Control (OFAC) sanctioned parties. Banks should define in their policies, procedures, and processes how beneficial ownership information will be used to meet other regulatory requirements. Legal Entity Customers For the purposes of the Beneficial Ownership Rule, 2 a legal entity customer is defined as a corporation, limited liability company, or other entity that is created by the filing of a public document with a Secretary of State or other similar office, a general partnership, and any similar entity formed under the laws of a foreign jurisdiction that opens an account. A number of types of business entities are excluded from the definition of legal entity customer under the Beneficial Ownership rule. In addition, and subject to certain limitations, banks are not required to identify and verify the identity of the beneficial owner(s) of a legal entity customer when the customer opens certain types of accounts. For further information on exclusions and exemptions to the Beneficial Ownership Rule, see Appendix 1. These exclusions and exemptions do not alter or supersede other existing requirements related to BSA/AML and OFAC sanctions. Beneficial Owner(s) Beneficial ownership is determined under both a control prong and an ownership prong. Under the control prong, the beneficial owner is a single individual with significant responsibility to control, manage or direct a legal entity customer.3 This includes, an executive officer or senior manager (Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, President), or any other individual who regularly performs similar functions. One beneficial owner must be identified under the control prong for each legal entity customer. Under the ownership prong, a beneficial owner is each individual, if any, who, directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, owns 25 percent or more of the equity interests of a legal entity customer.4 If a trust owns directly or indirectly, through any contract, arrangement, understanding, relationship or otherwise, 25 percent or more of the equity interests of a legal entity customer, the beneficial owner is the trustee.5 Identification of a beneficial owner under the ownership prong is not required if no individual owns 25 percent or more of a legal entity customer. Therefore, all legal entity customers will have a total of between one and five beneficial owner(s) – one individual under the control prong and zero to four individuals under the ownership prong. Exclusions from the definition of Legal Entity Customer Under 31 CFR 1010.230(e)(2) a legal entity customer does not include: • A financial institution regulated by a federal functional regulator14 or a bank regulated by a state bank regulator; • A person described in 31 CFR 1020.315(b)(2) through (5): o A department or agency of the United States, of any state, or of any political subdivision of any State; o Any entity established under the laws of the United States, of any state, or of any political subdivision of any state, or under an interstate compact between two or more states, that exercises governmental authority on behalf of the United States or any such state or political subdivision; o Any entity (other than a bank) whose common stock or analogous equity interests are listed on the New York Stock Exchange or the American Stock Exchange (currently known as the NYSE American) or have been designated as a NASDAQ National Market Security listed on the NASDAQ stock exchange (with some exceptions); o Any subsidiary (other than a bank) of any “listed entity” that is organized under the laws of the United States or of any state and at least 51 percent of whose common stock or analogous equity interest is owned by the listed entity, provided that a person that is a financial institution, other than a bank, is an exempt person only to the extent of its domestic operations; • An issuer of a class of securities registered under section 12 of the Securities Exchange Act of 1934 or that is required to file reports under section 15(d) of that Act; • An investment company, investment adviser, an exchange or clearing agency, or any other entity that is registered with the SEC; • A registered entity, commodity pool operator, commodity trading advisor, retail foreign exchange dealer, swap dealer, or major swap participant that is registered with the CFTC; • A public accounting firm registered under section 102 of the Sarbanes-Oxley Act; • A bank holding company or savings and loan holding company; • A pooled investment vehicle that is operated or advised by a financial institution that is excluded under paragraph (e)(2); • An insurance company that is regulated by a state;",Legal,Effect Analysis,Q&A Use only the document provided and nothing else.,What is the RMS delay spread with a 30° antenna beam width compared to an omnidirectional antenna?,"International Journal of Engineering Inventions ISSN: 2278-7461, www.ijeijournal.com Volume 1, Issue 3 (September 2012) PP: 06-11 Bit Error Rate of Mobile Wimax (Phy) Under Different Communication Channels and Modulation Technique T.Manochandar 1 , R.Krithika 2 'Department of Electronics and Communication Engineering, VRS College of engineering and technology, Villupuram- 607 107 '.TamilNadu 2 Department of Electronics and Communication Engineering, E.S College oj < I in , , ""• and technology, ViUupuram-605 602. TamilNadu Abstract — Mobile Wimax is a broadband wireless solution that enables the convergence of mobile and fixed broadband network, through a common wide area broadband radio access technology and flexible network architecture. The Performance of mobile Wimax under varying channel is one of the interesting research interests. Most of the most existing systems, based on performance and evaluation under channel condition are limited to AWGN, ITU etc in mobile Wimax. In this paper the performance of mobile Wimax (PHY layer) under SUI channel models in addition to different data rates and modulation techniques were analyzed. The simulation cavers important performance parameters like Bit Error Rate and Signal to Noise Ratio. Keywords— Wimax, BER, SNR, BPSK, OFDMA I. INTRODUCTION IEEE802.16e is a global broadband wireless access standard capable of delivering high data rates to fixed users as well as portable and mobile ones over long distance [l].In mobile Wimax air interface adopts orthogonal frequency division multiple access (OFDMA) for improved multi-path performance in non-line-of sight (NLOS) environment. Mobile Wimax extends the OFDM PHY layer to support terminal mobility and multiple-access. The resulting technology is Scalable OFDMA. Data streams to and from indh idual users are multiplexed to groups of sub channel on the downlink and uplink. By adopting Scalable PHY architecture, mobile Wimax is able to support a wide range of bandwidths. The performance of the WiMAX (Worldwide Interoperability for Microwave Access) can be evaluated by using the Stanford University Interim (SUI) channel models which has a set of six channels for terrain types [3J.With different data rates, coding schemes and modulation techniques. The mobile WiMAX standard builds on the principles of OFDM by adopting a Scalable OFDMA-based PHY layer (SOFDMA) [4J. SOFDMA supports a wide range of operating bandwidths to flexibl) address the need for various spectrum allocation and application requirements. The simulation done in the paper covers important performance such as Bit Error Rate and Signal to Noise Ratio. II. WIMAX PHYSICAL LAYER This project deals with the performances of Bit Error Rate and Signal to Noise Ratio in mobile WiMAX physical layer. The block diagram of the physical layer of mobile WiMAX diagram is given in Figure 1 . The transferring of data or receiving the data is done through the physical layer of WiMAX. So the uplink and the downlink of the message were done on the physical layer of WiMAX. There are three levels in the physical layer of mobile WiMAX physical layer are • Bit level processing • OFDM symbol level processing • Digital IF processing Each levels of physical layer of WiMAX consist of certain processes for transferring the data at uplink region and receiving of data at downlink region consists of encoder, decoder, symbol mapper and randomizer etc., Every processes were done in order to improve the performance of the mobility condition of mobile wimax. In this paper the perfor analyzed by the signal to noise ratio and the bit error rate Bit Error Rale Of Mobile Wimax (Plix) Under Different Communication,,, m^v Figure: 1. Block Diagram of Wimax Physical Layer Table. 1 Parameter of mobile wima x physical layer Parameter Value FFT size 128 512 1024 2048 Channel Bandwidth(MHz) 1.25 5 10 20 Subcarrier Frequency spacing (KHz) 10.94 Useful Symbol Period 91.4 Guard Time 1/32,1/8,1/6,1/4 III. CHANNEL The medium between the transmitting antenna and the receiving antenna is said to be the channel. The profile of received signal can be obtained from that of the transmitted signal, if we have a model of the medium between the two. The model of the medium is called channel model. Bit Error Rate Of Mobile Winuix (Plix) Under Different Communication... Y (f) ->oulpui signal H (f) ->channel response X (f) ->input signal Y (f) =X (f) H (f) +n (f) A. Stanford Universit) [nterim (SUI) Channel Models: It is a set of six channel models representing three terrain types and a variety of Doppler spreads, delay spread and mainly the line-of-sight/non-line-of-site conditions that are typical of the continental. The terrain type A, B, C is same as those defined in Erceg model [10]. The multipath fading is modeled as a tapped delay line with 3 taps with non-uniform delays. The gain associated w ith each tap is characterized by a Rician Distribution and the maximum Doppler frequency. In a multipath environment, the received power r has a Rician distribution, whose Pdf is given by: o LOS component and the pdf of the power becomes Pdf(r)=r/o 2 e [ -* ac2+A2a2] Io(rA/o 2 ) < r < a This is also known as Raleigh distribution. The ratio K=A / (2o2) in the Rician case represents the ratio of LOS component to NLOS component and is called the ""K- Factor"" or ""Rician Factor."" The general structure for the SUI channel model is as shown below in figure. This structure is for Multiple Input Multiple Output (MIMO) channels and includes other configurations like Single Input Single Output (SISO) and Single Input Multiple Output (SIMO) as subsets. Figure 2.SUI Channel Model Power Distribution For each tap a set of complex zero-mean Gaussian distributed numbers is generated with a e of 0.5 for the real and imaginary part, so that the total average power of this distribution is 1. This yields a normalized Rayleigh distribution (equivalent to Rice with K=0) for the magnitude of the complex coefficients. If a Rician distribution (K>0 implied) is needed, a constant path component m is added to the Rayleigh set of coefficients. The ratio of powers between this constant part and the Rayleigh (variable) part is specified by the K-factor. For this general case, we show how to distribute the power correctly by first stating die total power P of each tap: Where m is the comple: of the complex Gaussian set. Second, the ratio of powers is K=m 2 /|o 2 l. T able 2: Terrain type and Doppler spread for SUI channel mod el Channel Terrain Type spread Spread LOS SUI-1 C Low Low High SUI-2 C Low Low High SUI-3 B Low Low Low SUI-4 B High Moderate Low SUI-5 A Low High Low SUI-6 A High High High Bit Error Rale Of Mobile Wimax (Phy) Under Different Communication... In the SUI channel model, parameter for the SUI 1 and SUI 2 channel model has been tabulated in 3 and 4 respectively for the reference. BER performance is evaluated in this channel models. Depending on the performance parameter for the SUI channel, the performances of wimax physical layer are evaluated through the performance graph. Table 3 SUI -1 Channel Model Tapl Tap 2 Tap 3 Units Delay 0.4 0.9 [IS Power(omni antenna) 90% K-facto) Table 4 SUI -2 Channel Mo del Tapl Tap 2 3 Units Delay 0.4 1.1 us Power(ortmi antenna) 90% K-factooulpui signal H (f) ->channel response X (f) ->input signal Y (f) =X (f) H (f) +n (f) A. Stanford Universit) [nterim (SUI) Channel Models: It is a set of six channel models representing three terrain types and a variety of Doppler spreads, delay spread and mainly the line-of-sight/non-line-of-site conditions that are typical of the continental. The terrain type A, B, C is same as those defined in Erceg model [10]. The multipath fading is modeled as a tapped delay line with 3 taps with non-uniform delays. The gain associated w ith each tap is characterized by a Rician Distribution and the maximum Doppler frequency. In a multipath environment, the received power r has a Rician distribution, whose Pdf is given by: o LOS component and the pdf of the power becomes Pdf(r)=r/o 2 e [ -* ac2+A2a2] Io(rA/o 2 ) < r < a This is also known as Raleigh distribution. The ratio K=A / (2o2) in the Rician case represents the ratio of LOS component to NLOS component and is called the ""K- Factor"" or ""Rician Factor."" The general structure for the SUI channel model is as shown below in figure. This structure is for Multiple Input Multiple Output (MIMO) channels and includes other configurations like Single Input Single Output (SISO) and Single Input Multiple Output (SIMO) as subsets. Figure 2.SUI Channel Model Power Distribution For each tap a set of complex zero-mean Gaussian distributed numbers is generated with a e of 0.5 for the real and imaginary part, so that the total average power of this distribution is 1. This yields a normalized Rayleigh distribution (equivalent to Rice with K=0) for the magnitude of the complex coefficients. If a Rician distribution (K>0 implied) is needed, a constant path component m is added to the Rayleigh set of coefficients. The ratio of powers between this constant part and the Rayleigh (variable) part is specified by the K-factor. For this general case, we show how to distribute the power correctly by first stating die total power P of each tap: Where m is the comple: of the complex Gaussian set. Second, the ratio of powers is K=m 2 /|o 2 l. T able 2: Terrain type and Doppler spread for SUI channel mod el Channel Terrain Type spread Spread LOS SUI-1 C Low Low High SUI-2 C Low Low High SUI-3 B Low Low Low SUI-4 B High Moderate Low SUI-5 A Low High Low SUI-6 A High High High Bit Error Rale Of Mobile Wimax (Phy) Under Different Communication... In the SUI channel model, parameter for the SUI 1 and SUI 2 channel model has been tabulated in 3 and 4 respectively for the reference. BER performance is evaluated in this channel models. Depending on the performance parameter for the SUI channel, the performances of wimax physical layer are evaluated through the performance graph. Table 3 SUI -1 Channel Model Tapl Tap 2 Tap 3 Units Delay 0.4 0.9 [IS Power(omni antenna) 90% K-facto) Table 4 SUI -2 Channel Mo del Tapl Tap 2 3 Units Delay 0.4 1.1 us Power(ortmi antenna) 90% K-facto ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","I moved to an apartment in a duplex building two months ago. My landlord lives in the other apartment in the same building. I am an adept of Santería, and, after a small ceremony in my living room using incense, I received a notice from my landlord. He asked me to leave the premises because the contract stipulates that only Protestants might rent his apartments and that utilization of incense is prohibited. The contract contains this provision indeed, but I can't accept it! That's open discrimination! My state follows the FHA's broad dispositions. Who will prevail?","A Guide To The Fair Housing Act And Its Exemptions Everyone deserves a stable, affordable place to live. But the unfortunate truth is that discrimination in housing has prevented some vulnerable groups from achieving this cornerstone of the American Dream. The good news is that there are laws in place to protect people from being discriminated against when securing housing. One of the most important is the Fair Housing Act (FHA). Here’s what the FHA covers and how you can protect yourself from discriminatory practices. Faster, easier mortgage lending Check your rates today with Better Mortgage. View Rates What Is the Fair Housing Act of 1968? The Fair Housing Act is a critical set of guidelines that prevent prospective homeowners and renters from discrimination through the sale, rental agreement or financing of their home. The act was signed into law by President Lydon Johnson in 1968 after several years of policymakers struggling to push it through until the assassination of Rev. Dr. Martin Luther King, Jr. prompted congressional action. Today, the U.S. Department of Housing and Urban Development (HUD) oversees and enforces the Fair Housing Act. It prohibits discrimination in housing based on: race or color, national origin, religion, sex (including sexual orientation and gender identity, per a new executive order), familial status and disabilty. Anyone who attempts to rent, buy or sell a home, take out a mortgage or obtain housing assistance, is protected. The act also applies to most housing types, with a few exceptions. How the Fair Housing Act Protects Against Housing Discrimination Housing is a broad term. So who, exactly, is prohibited from engaging in discrimination? The FHA outlaws discrimination by: Landlords Property owners and managers Developers Real estate agents Mortgage lenders and brokers Homeowner associations Insurance providers Anyone else who impacts housing opportunities Essentially, any person or entity that’s involved in the process of securing housing is required to follow FHA guidelines. If someone believes they were discriminated against, they can contact HUD, which they will then investigate. Examples of Housing Discrimination Discrimination can occur in many ways and to different classes of people. Here are a few examples: Selling or renting. It’s illegal to refuse a home sale or rental to someone based on race, sex or any of the other factors outlined in the FHA. That includes falsely stating that a home is no longer on the market when it is, or providing different terms or facilities to one person over another. It’s also against the law to persuade homeowners to sell or rent their property based on the fact that people of a particular race or other protected class are moving into the neighborhood, intending to earn a profit. Mortgage lending. Lenders can also discriminate against mortgage applicants if the lender refuses to provide information about a loan, rejected the applicant entirely or imposed different terms and conditions (interest rates, fees, etc.) based on the applicant’s race, color, religion, sex, disability, familial status or national origin. Similar discrimination can occur during the appraisal process. Homeowners insurance. If an insurance company refuses to provide homeowners insurance to an owner or occupant of a dwelling because of their race, color, religion, sex, disability, familial status or national origin, it’s considered discrimination. It’s also discrimination to offer different terms or conditions, or provide limited or information about an insurance product based on those same factors. Accommodating disabilities. People who have mental or physical disabilities (such as mobility impairment or chronic mental illness) that “substantially limits one or more major life activities” are entitled to certain housing accommodations. If reasonable accommodations aren’t allowed even at your own expense, it may be considered discrimination. For example, a building that usually doesn’t permit tenants to have pets would need to allow a visually impaired tenant to keep a guide animal. Advertising. When advertising the sale or rental availability of a dwelling, any language published that indicates preference or limitations based on race, color, religion, sex, disability, familial status or national origin is discrimination. This also applies to advertising for single-family and owner-occupied housing, which is otherwise exempt from the FHA. Fair Housing Act Exemptions Though the Fair Housing Act applies to most situations, there are some exemptions. For example, if a dwelling has four or fewer units and the owner lives in one of them, they are exempt from the FHA. However, they would not be exempt under the Pennsylvania Human Relations Act unless the dwelling contained only two units and one was owner-occupied. Additionally, any single-family housing that’s sold or rented without the use of a broker is exempt from the FHA, as long as the owner is a private individual who doesn’t own more than three such homes at one time. Again, they would not be exempt in the state of Pennsylvania due to the Pennsylvania Human Relations Act. Housing communities for the elderly are also exempt from the FHA in most cases. In order to not violate the family status provision, it must meet one of several conditions. For instance, HUD must have determined that it’s specifically designed for and occupied by elderly occupants under a federal, state or local government program. Alternatively, it can be 100% occupied by people age 62 or older. Another option is that the community houses at least one person age 55 or older in at least 80% of the occupied units. The property must also have a policy demonstrating that the intent of the community is to house people age 55 or older. Finally, religious organizations and private clubs are allowed to give preference to members as long as they don’t discriminate in their membership. How Fair Housing Laws Are Enforced The HUD is the federal agency in charge of implementing and enforcing the Fair Housing Act. It does so through its Office of Fair Housing and Equal Opportunity (FHEO), which is headquartered in Washington, with 10 regional offices across the U.S. The purpose of these offices is to enforce FHA compliance, administer fair housing programs and educate consumers. The FHEO primarily enforces fair housing programs by funding third-party organizations. For instance, the Fair Housing Initiatives Program provides grants to private organizations that investigate complaints, and even place people undercover to find FHA violations. How to Protect Yourself Against Fair Housing Violations If you believe your rights were violated under the Fair Housing Act, it’s important to file a complaint right away. HUD will investigate claims made within one year of the violation. When filing a complaint, be prepared to provide the following information: Your name and address Name and address of the person or company your complaint is against (also known as the respondent) Address or other identification of the housing involved The date and a brief description of the incident that led to your rights being violated You can file a complaint with the FHEO online, using the HUD Form 903. You can also download this form and email it to your local FHEO office. You can also mail a letter or call an office directly. Once your complaint is received and accepted, HUD will notify you in writing. It will also notify the respondent that you filed a complaint and give them some time to submit a written response. The FHEO will investigate your complaint and decide whether or not there is reasonable cause to believe that the respondent violated the FHA. Additionally, HUD will offer you and the respondent the opportunity to voluntarily resolve the complaint with a Conciliation Agreement. If it’s determined there was a rights violation and you don’t come to an agreement with the respondent, you may need to consult with a lawyer and determine the next steps.","""================ ======= A Guide To The Fair Housing Act And Its Exemptions Everyone deserves a stable, affordable place to live. But the unfortunate truth is that discrimination in housing has prevented some vulnerable groups from achieving this cornerstone of the American Dream. The good news is that there are laws in place to protect people from being discriminated against when securing housing. One of the most important is the Fair Housing Act (FHA). Here’s what the FHA covers and how you can protect yourself from discriminatory practices. Faster, easier mortgage lending Check your rates today with Better Mortgage. View Rates What Is the Fair Housing Act of 1968? The Fair Housing Act is a critical set of guidelines that prevent prospective homeowners and renters from discrimination through the sale, rental agreement or financing of their home. The act was signed into law by President Lydon Johnson in 1968 after several years of policymakers struggling to push it through until the assassination of Rev. Dr. Martin Luther King, Jr. prompted congressional action. Today, the U.S. Department of Housing and Urban Development (HUD) oversees and enforces the Fair Housing Act. It prohibits discrimination in housing based on: race or color, national origin, religion, sex (including sexual orientation and gender identity, per a new executive order), familial status and disabilty. Anyone who attempts to rent, buy or sell a home, take out a mortgage or obtain housing assistance, is protected. The act also applies to most housing types, with a few exceptions. How the Fair Housing Act Protects Against Housing Discrimination Housing is a broad term. So who, exactly, is prohibited from engaging in discrimination? The FHA outlaws discrimination by: Landlords Property owners and managers Developers Real estate agents Mortgage lenders and brokers Homeowner associations Insurance providers Anyone else who impacts housing opportunities Essentially, any person or entity that’s involved in the process of securing housing is required to follow FHA guidelines. If someone believes they were discriminated against, they can contact HUD, which they will then investigate. Examples of Housing Discrimination Discrimination can occur in many ways and to different classes of people. Here are a few examples: Selling or renting. It’s illegal to refuse a home sale or rental to someone based on race, sex or any of the other factors outlined in the FHA. That includes falsely stating that a home is no longer on the market when it is, or providing different terms or facilities to one person over another. It’s also against the law to persuade homeowners to sell or rent their property based on the fact that people of a particular race or other protected class are moving into the neighborhood, intending to earn a profit. Mortgage lending. Lenders can also discriminate against mortgage applicants if the lender refuses to provide information about a loan, rejected the applicant entirely or imposed different terms and conditions (interest rates, fees, etc.) based on the applicant’s race, color, religion, sex, disability, familial status or national origin. Similar discrimination can occur during the appraisal process. Homeowners insurance. If an insurance company refuses to provide homeowners insurance to an owner or occupant of a dwelling because of their race, color, religion, sex, disability, familial status or national origin, it’s considered discrimination. It’s also discrimination to offer different terms or conditions, or provide limited or information about an insurance product based on those same factors. Accommodating disabilities. People who have mental or physical disabilities (such as mobility impairment or chronic mental illness) that “substantially limits one or more major life activities” are entitled to certain housing accommodations. If reasonable accommodations aren’t allowed even at your own expense, it may be considered discrimination. For example, a building that usually doesn’t permit tenants to have pets would need to allow a visually impaired tenant to keep a guide animal. Advertising. When advertising the sale or rental availability of a dwelling, any language published that indicates preference or limitations based on race, color, religion, sex, disability, familial status or national origin is discrimination. This also applies to advertising for single-family and owner-occupied housing, which is otherwise exempt from the FHA. Fair Housing Act Exemptions Though the Fair Housing Act applies to most situations, there are some exemptions. For example, if a dwelling has four or fewer units and the owner lives in one of them, they are exempt from the FHA. However, they would not be exempt under the Pennsylvania Human Relations Act unless the dwelling contained only two units and one was owner-occupied. Additionally, any single-family housing that’s sold or rented without the use of a broker is exempt from the FHA, as long as the owner is a private individual who doesn’t own more than three such homes at one time. Again, they would not be exempt in the state of Pennsylvania due to the Pennsylvania Human Relations Act. Housing communities for the elderly are also exempt from the FHA in most cases. In order to not violate the family status provision, it must meet one of several conditions. For instance, HUD must have determined that it’s specifically designed for and occupied by elderly occupants under a federal, state or local government program. Alternatively, it can be 100% occupied by people age 62 or older. Another option is that the community houses at least one person age 55 or older in at least 80% of the occupied units. The property must also have a policy demonstrating that the intent of the community is to house people age 55 or older. Finally, religious organizations and private clubs are allowed to give preference to members as long as they don’t discriminate in their membership. How Fair Housing Laws Are Enforced The HUD is the federal agency in charge of implementing and enforcing the Fair Housing Act. It does so through its Office of Fair Housing and Equal Opportunity (FHEO), which is headquartered in Washington, with 10 regional offices across the U.S. The purpose of these offices is to enforce FHA compliance, administer fair housing programs and educate consumers. The FHEO primarily enforces fair housing programs by funding third-party organizations. For instance, the Fair Housing Initiatives Program provides grants to private organizations that investigate complaints, and even place people undercover to find FHA violations. How to Protect Yourself Against Fair Housing Violations If you believe your rights were violated under the Fair Housing Act, it’s important to file a complaint right away. HUD will investigate claims made within one year of the violation. When filing a complaint, be prepared to provide the following information: Your name and address Name and address of the person or company your complaint is against (also known as the respondent) Address or other identification of the housing involved The date and a brief description of the incident that led to your rights being violated You can file a complaint with the FHEO online, using the HUD Form 903. You can also download this form and email it to your local FHEO office. You can also mail a letter or call an office directly. Once your complaint is received and accepted, HUD will notify you in writing. It will also notify the respondent that you filed a complaint and give them some time to submit a written response. The FHEO will investigate your complaint and decide whether or not there is reasonable cause to believe that the respondent violated the FHA. Additionally, HUD will offer you and the respondent the opportunity to voluntarily resolve the complaint with a Conciliation Agreement. If it’s determined there was a rights violation and you don’t come to an agreement with the respondent, you may need to consult with a lawyer and determine the next steps. https://www.forbes.com/advisor/mortgages/fair-housing-act/ ================ ======= I moved to an apartment in a duplex building two months ago. My landlord lives in the other apartment in the same building. I am an adept of Santería, and, after a small ceremony in my living room using incense, I received a notice from my landlord. He asked me to leave the premises because the contract stipulates that only Protestants might rent his apartments and that utilization of incense is prohibited. The contract contains this provision indeed, but I can't accept it! That's open discrimination! My state follows the FHA's broad dispositions. Who will prevail? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Legal,Effect Analysis,Q&A "Only provide the opinions that were given in the context document. If you cannot answer a question using the provided context alone, then say ""I'm sorry, but I do not have the context to answer this question.""","Using a Chromebook, how do I locate the text app? ","Skip to content Tech Time With Timmy logo Home Videos Articles About Us Contact Us SearchSearch Search... How To Create A Text File On A Chromebook August 9, 2022 This Article May Contain Affiliate Links how to create a text file on chromebook Table of Contents How To Create A TXT file On A Chromebook How To Save The TXT File How To Open The TXT File Text files (or .txt files) are useful files that contain plain, unformatted text. And if you ever want to create a new .txt file on your Chromebook, you’re in luck. Because that’s exactly what I’m going to show you how to do in this article. Prefer to watch a video about how to create a text file on a Chromebook? Click here. Before we begin, I’d just like to point out that a .txt file is a very basic file that contains only unformatted plain text. And if you want to create a file with nicer looking formatted text on a Chromebook, I would recommend something like Google Docs. But if you do want to create a .txt file, let’s proceed with the tutorial. How To Create A TXT file On A Chromebook Chrome OS comes with a built in app for creating, saving, opening, and editing .txt files. So to create a text on your Chromebook, you’ll just need to open an app called “Text” which should already be preinstalled on your Chromebook. So just click on the circle in the bottom left hand corner to view all your apps… txt chromebook And you should find the “Text” app somewhere in here. how to create a text file on a chromebook Now you’ll be in the “Text” app, and if you’ve never used the text app before, it will automatically create a new .txt file for you, and you’ll be ready to start typing! how to create a txt file on a chromebook However, if you’ve opened a different .txt file on your Chromebook in the past, it would have opened in the Text app, and now whenever you open the Text app you’ll just be looking at that old file. how to create a txt file on chromebook But don’t worry, if this happens, just click “New” at the top of the left hand menu and it will create a new blank .txt file just like it would if you opened the app for the first time. how to create text file on chromebook But once you’ve got a blank text file like this, you’re ready to type whatever you want in it. how to create txt file on chromebook How To Save The TXT File Once you’ve typed your text into your new text file, all that’s left to do is save it. In the future, when you’re saving changes to an existing text file, you’ll do that by clicking the “Save” button. But, when you’re saving a brand new text file like this one, you’ll need to click “Save As” instead. how to create text file on a chromebook Now, a files window will appear, and you’ll need to name your .txt file, and choose a location for it. how to create txt file on a chromebook By default, the name of the text file will be whatever you typed in the first line of the file, which in my case is “Hello”. If you’re happy with that name, you don’t have to change it, but if you do want to give the file a propper name, you can do that here. (Just make sure you leave .txt on the end of it so that your computer knows it’s a .txt file). how to make a text file on a chromebook And you can also choose where you want the file to be saved. I’m just going to save mine in the “My files” folder to keep things simple, but if you wanted to save your file in Google Drive, or perhaps in a specific folder inside the “My Files” folder, you could do that now by double clicking the folder you want to save it in. But, once you’re happy with both the file name and the location, you can go ahead and click the “Save” button and your .txt file will be saved! how to make a txt file on a chromebook Now that your .txt file is saved, you can safely close the Text app if you want to. And if you open the files app and open the folder where you saved your .txt file, you will see it somewhere there! how to make text file on chromebook How To Open The TXT File Now that you’ve created your text file, if you want to open it in the future, you’ll just need to find it in the files app in the folder you saved it to, and double click on it… how to make text file on chromebook And the file will open up in the Text app. how to make a txt file on chromebook Just remember, if you make any changes to the file while it’s open, you’ll need to click “Save” before you close the Text app to save the changes. how to make text file on a chromebook And because you clicked the “Save” button instead of “Save As”, you won’t have to choose the name and location or anything, it will just update the existing file with the new changes. And that’s all there is to creating and using text files on a Chromebook! But if you want more Chromebook tutorials, you’ll find them all here. Prev Previous How To Crop A Picture On A Chromebook Don't Miss an Episode Email Your Email Address Subscribe Leave a Comment Your email address will not be published. Required fields are marked * Type here.. Type here.. Name* Name* Email* Email* Subscribe On Youtube! Subscribe! Popular Posts How To Delete Files On A Chromebook How To Delete Files On A Chromebook If you have files on your Chromebook that you want to delete, you’re in the right place! Because in this article, I’m going to show Read More » How To Open Zip File In Android How To Unzip Files On An Android Phone If you have a zip file on your Android phone that you want to unzip, you’re in the right place. Because in this article, I’m Read More » google photos change date How To Change The Date Of Photos In Google Photos Google Photos is very useful for storing and organizing all your photos. But if some of your photos say they were taken on the wrong Read More » How To Create A Folder On A Chromebook How To Create A Folder On A Chromebook If you want to create a folder on your Chromebook to keep your files organized, you’re in the right place, because today, that’s exactly what Read More » how to change wallpaper on chromebook How To Change Your Wallpaper On A Chromebook If you want to change the wallpaper on your Chromebook to give it a bit of a different look and feel, you’re in the right Read More » How To Delete Files From Google Drive On Android How To Delete Files From Google Drive On Android If you have files on Google Drive that you want to delete using your Android phone, you’re in the right place, because in this article, Read More » how to open rar files on chromebook How To Open RAR Files On A Chromebook RAR files are a type of file similar to zip files that can store multiple files inside them. They’re quite handy for uploading, downloading, and Read More » How To Change All Caps To Lowercase In Google Docs How To Change All Caps To Lowercase In Google Docs We’ve all been there, you type out an entire sentence in Google docs, and then look up at the screen only to discover that caps Read More » how to open rar file in google drive How To Open A Rar File In Google Drive A RAR file is a cool file that can store multiple files inside it. But if you have a RAR file stored in Google Drive, Read More » Categories All Articles Google Docs Tips Google Drive Tutorials Chrome OS Other Tech Tips And Tutorials Latest Videos How To Log Other Devices Out Of Your Google Account How To Log Other Devices Out Of Your Google Account In this video, Timmy shows you how to log other devices out of your Google account. Whether you’ve logged in to your Google account on a borrowed device… Watch Video » How To Use Floating Windows On A Chromebook How To Use Floating Windows On A Chromebook In this video, Timmy shows you how to use a really handy multitasking feature in Chrome OS called Floating Windows. This allows you to have one… Watch Video » How To Transfer Google Drive Files From One Account To Another How To Transfer Google Drive Files From One Account To Another In this video, Timmy shows you how to move files from one Google Drive to another without having to download and re-upload them! If you have files… Watch Video » how to make chromebook sleep How To Make Your Chromebook Sleep In this video, Timmy shows you all four of the different ways to make your Chromebook go to sleep. So whatever your situation, if you want your… Watch Video » How To Close All Tabs In Chrome How To Close All Tabs In Chrome In this video, Timmy shows you how to easily close all of your open tabs in Google Chrome. Without having to manually click the cross icon on each of them… Watch Video » Tech Time With Timmy logo We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites. Twitter Facebook Youtube Instagram Search Search... Search Sitemap Privacy Policy Terms And Conditions Affiliate Disclosure Work With Us © Tech Time With Timmy 2016 – 2022 ","Only provide the opinions that were given in the context document. If you cannot answer a question using the provided context alone, then say ""I'm sorry, but I do not have the context to answer this question."" Using a Chromebook, how do I locate the text app? Skip to content Tech Time With Timmy logo Home Videos Articles About Us Contact Us SearchSearch Search... How To Create A Text File On A Chromebook August 9, 2022 This Article May Contain Affiliate Links how to create a text file on chromebook Table of Contents How To Create A TXT file On A Chromebook How To Save The TXT File How To Open The TXT File Text files (or .txt files) are useful files that contain plain, unformatted text. And if you ever want to create a new .txt file on your Chromebook, you’re in luck. Because that’s exactly what I’m going to show you how to do in this article. Prefer to watch a video about how to create a text file on a Chromebook? Click here. Before we begin, I’d just like to point out that a .txt file is a very basic file that contains only unformatted plain text. And if you want to create a file with nicer looking formatted text on a Chromebook, I would recommend something like Google Docs. But if you do want to create a .txt file, let’s proceed with the tutorial. How To Create A TXT file On A Chromebook Chrome OS comes with a built in app for creating, saving, opening, and editing .txt files. So to create a text on your Chromebook, you’ll just need to open an app called “Text” which should already be preinstalled on your Chromebook. So just click on the circle in the bottom left hand corner to view all your apps… txt chromebook And you should find the “Text” app somewhere in here. how to create a text file on a chromebook Now you’ll be in the “Text” app, and if you’ve never used the text app before, it will automatically create a new .txt file for you, and you’ll be ready to start typing! how to create a txt file on a chromebook However, if you’ve opened a different .txt file on your Chromebook in the past, it would have opened in the Text app, and now whenever you open the Text app you’ll just be looking at that old file. how to create a txt file on chromebook But don’t worry, if this happens, just click “New” at the top of the left hand menu and it will create a new blank .txt file just like it would if you opened the app for the first time. how to create text file on chromebook But once you’ve got a blank text file like this, you’re ready to type whatever you want in it. how to create txt file on chromebook How To Save The TXT File Once you’ve typed your text into your new text file, all that’s left to do is save it. In the future, when you’re saving changes to an existing text file, you’ll do that by clicking the “Save” button. But, when you’re saving a brand new text file like this one, you’ll need to click “Save As” instead. how to create text file on a chromebook Now, a files window will appear, and you’ll need to name your .txt file, and choose a location for it. how to create txt file on a chromebook By default, the name of the text file will be whatever you typed in the first line of the file, which in my case is “Hello”. If you’re happy with that name, you don’t have to change it, but if you do want to give the file a propper name, you can do that here. (Just make sure you leave .txt on the end of it so that your computer knows it’s a .txt file). how to make a text file on a chromebook And you can also choose where you want the file to be saved. I’m just going to save mine in the “My files” folder to keep things simple, but if you wanted to save your file in Google Drive, or perhaps in a specific folder inside the “My Files” folder, you could do that now by double clicking the folder you want to save it in. But, once you’re happy with both the file name and the location, you can go ahead and click the “Save” button and your .txt file will be saved! how to make a txt file on a chromebook Now that your .txt file is saved, you can safely close the Text app if you want to. And if you open the files app and open the folder where you saved your .txt file, you will see it somewhere there! how to make text file on chromebook How To Open The TXT File Now that you’ve created your text file, if you want to open it in the future, you’ll just need to find it in the files app in the folder you saved it to, and double click on it… how to make text file on chromebook And the file will open up in the Text app. how to make a txt file on chromebook Just remember, if you make any changes to the file while it’s open, you’ll need to click “Save” before you close the Text app to save the changes. how to make text file on a chromebook And because you clicked the “Save” button instead of “Save As”, you won’t have to choose the name and location or anything, it will just update the existing file with the new changes. And that’s all there is to creating and using text files on a Chromebook! But if you want more Chromebook tutorials, you’ll find them all here. Prev Previous How To Crop A Picture On A Chromebook Don't Miss an Episode Email Your Email Address Subscribe Leave a Comment Your email address will not be published. Required fields are marked * Type here.. Type here.. Name* Name* Email* Email* Subscribe On Youtube! Subscribe! Popular Posts How To Delete Files On A Chromebook How To Delete Files On A Chromebook If you have files on your Chromebook that you want to delete, you’re in the right place! Because in this article, I’m going to show Read More » How To Open Zip File In Android How To Unzip Files On An Android Phone If you have a zip file on your Android phone that you want to unzip, you’re in the right place. Because in this article, I’m Read More » google photos change date How To Change The Date Of Photos In Google Photos Google Photos is very useful for storing and organizing all your photos. But if some of your photos say they were taken on the wrong Read More » How To Create A Folder On A Chromebook How To Create A Folder On A Chromebook If you want to create a folder on your Chromebook to keep your files organized, you’re in the right place, because today, that’s exactly what Read More » how to change wallpaper on chromebook How To Change Your Wallpaper On A Chromebook If you want to change the wallpaper on your Chromebook to give it a bit of a different look and feel, you’re in the right Read More » How To Delete Files From Google Drive On Android How To Delete Files From Google Drive On Android If you have files on Google Drive that you want to delete using your Android phone, you’re in the right place, because in this article, Read More » how to open rar files on chromebook How To Open RAR Files On A Chromebook RAR files are a type of file similar to zip files that can store multiple files inside them. They’re quite handy for uploading, downloading, and Read More » How To Change All Caps To Lowercase In Google Docs How To Change All Caps To Lowercase In Google Docs We’ve all been there, you type out an entire sentence in Google docs, and then look up at the screen only to discover that caps Read More » how to open rar file in google drive How To Open A Rar File In Google Drive A RAR file is a cool file that can store multiple files inside it. But if you have a RAR file stored in Google Drive, Read More » Categories All Articles Google Docs Tips Google Drive Tutorials Chrome OS Other Tech Tips And Tutorials Latest Videos How To Log Other Devices Out Of Your Google Account How To Log Other Devices Out Of Your Google Account In this video, Timmy shows you how to log other devices out of your Google account. Whether you’ve logged in to your Google account on a borrowed device… Watch Video » How To Use Floating Windows On A Chromebook How To Use Floating Windows On A Chromebook In this video, Timmy shows you how to use a really handy multitasking feature in Chrome OS called Floating Windows. This allows you to have one… Watch Video » How To Transfer Google Drive Files From One Account To Another How To Transfer Google Drive Files From One Account To Another In this video, Timmy shows you how to move files from one Google Drive to another without having to download and re-upload them! If you have files… Watch Video » how to make chromebook sleep How To Make Your Chromebook Sleep In this video, Timmy shows you all four of the different ways to make your Chromebook go to sleep. So whatever your situation, if you want your… Watch Video » How To Close All Tabs In Chrome How To Close All Tabs In Chrome In this video, Timmy shows you how to easily close all of your open tabs in Google Chrome. Without having to manually click the cross icon on each of them… Watch Video » Tech Time With Timmy logo We are a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for us to earn fees by linking to Amazon.com and affiliated sites. Twitter Facebook Youtube Instagram Search Search... Search Sitemap Privacy Policy Terms And Conditions Affiliate Disclosure Work With Us © Tech Time With Timmy 2016 – 2022 ",Unknown,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","According to this reference text, explain how Vitamin K helps with bone and vascular health, and explain how vitamin K -dependent proteins play a role in vascular health. For brevity, use no more than 200 words.","Vitamin K is best known for promoting proper blood clotting and bone health.1 A meta-analysis of randomized controlled trials revealed that vitamin K supplementation also has favorable effects on glucose metabolism parameters and risk of developing type II diabetes.2 In observational studies, higher intake of vitamin K has been associated with a reduced risk of type II diabetes and improved markers of glucose control.3-5 Clinical trials have shown that vitamin K supplementation can improve metabolic health in adults with diabetes and prediabetes, significantly reducing elevated glucose and insulin levels.6-8 That may help prevent the damage caused by high blood sugar in diabetics and reduce the risk of developing type II diabetes in the first place. The Importance of Vitamin K Vitamin K is found in green leafy vegetables, fermented foods, and some animal products, particularly organ meats. It occurs in two general forms, vitamin K1 and vitamin K2.1 Vitamin K is required for the proper function and activation of different proteins known as vitamin K-dependent proteins. These proteins include several clotting factors that control blood coagulation as well as osteocalcin, a protein tied to vascular and bone health. Some of these vitamin K-dependent proteins help keep calcium in the bones, and out of blood vessels. Calcified blood vessels are one of the hallmarks of atherosclerosis and vascular dysfunction. Without adequate vitamin K, the risk of cardiovascular disease, osteoporosis, and osteopenia rises.1,9 Other vitamin K-dependent proteins have favorable t effects on metabolic function.3,10 Link to Metabolic Health Multiple types of research indicate that Vitamin K2 intake may lower risk of developing type II diabetes.11 The vitamin's role in glucose homeostasis may be due in part to the activation of osteocalcin. In addition to its role in bone mineralization, osteocalcin stimulates healthy insulin and adiponectin expression.12 Studies show that people with higher intake of vitamin K tend to have better insulin sensitivity, better control of blood glucose levels, and a decreased risk of developing type II diabetes.3,5 In an observational study embedded in a randomized controlled trial of the Mediterranean diet for prevention of cardiovascular disease, men and women without cardiovascular disease were followed for 5.5 years. Dietary information was collected annually through questionnaires. It was found that baseline intake of vitamin K1 was lower in participants who developed diabetes during the study. It was also found that the risk of developing diabetes dropped by approximately 17% for every 100 mcg of vitamin K1 consumed per day. Subjects who increased their dietary vitamin K1 intake over those 5.5 years had a 51% reduction in risk for developing diabetes, compared with those who did not increase vitamin K intake. The authors concluded that dietary vitamin K1 is associated with reduced risk of type II diabetes.13 How It Works Vitamin K appears to improve insulin function and glucose metabolism in at least two main ways: Activating vitamin K-dependent proteins is involved in regulating glucose metabolism.3 Suppressing chronic inflammation and production of pro-inflammatory compounds, which is a major contributor to diminished insulin sensitivity and metabolic disease.3 Together, these actions could help reduce elevated glycemic markers and lower risk for diabetic complications.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== According to this reference text, explain how Vitamin K helps with bone and vascular health, and explain how vitamin K -dependent proteins play a role in vascular health. For brevity, use no more than 200 words. {passage 0} ========== Vitamin K is best known for promoting proper blood clotting and bone health.1 A meta-analysis of randomized controlled trials revealed that vitamin K supplementation also has favorable effects on glucose metabolism parameters and risk of developing type II diabetes.2 In observational studies, higher intake of vitamin K has been associated with a reduced risk of type II diabetes and improved markers of glucose control.3-5 Clinical trials have shown that vitamin K supplementation can improve metabolic health in adults with diabetes and prediabetes, significantly reducing elevated glucose and insulin levels.6-8 That may help prevent the damage caused by high blood sugar in diabetics and reduce the risk of developing type II diabetes in the first place. The Importance of Vitamin K Vitamin K is found in green leafy vegetables, fermented foods, and some animal products, particularly organ meats. It occurs in two general forms, vitamin K1 and vitamin K2.1 Vitamin K is required for the proper function and activation of different proteins known as vitamin K-dependent proteins. These proteins include several clotting factors that control blood coagulation as well as osteocalcin, a protein tied to vascular and bone health. Some of these vitamin K-dependent proteins help keep calcium in the bones, and out of blood vessels. Calcified blood vessels are one of the hallmarks of atherosclerosis and vascular dysfunction. Without adequate vitamin K, the risk of cardiovascular disease, osteoporosis, and osteopenia rises.1,9 Other vitamin K-dependent proteins have favorable t effects on metabolic function.3,10 Link to Metabolic Health Multiple types of research indicate that Vitamin K2 intake may lower risk of developing type II diabetes.11 The vitamin's role in glucose homeostasis may be due in part to the activation of osteocalcin. In addition to its role in bone mineralization, osteocalcin stimulates healthy insulin and adiponectin expression.12 Studies show that people with higher intake of vitamin K tend to have better insulin sensitivity, better control of blood glucose levels, and a decreased risk of developing type II diabetes.3,5 In an observational study embedded in a randomized controlled trial of the Mediterranean diet for prevention of cardiovascular disease, men and women without cardiovascular disease were followed for 5.5 years. Dietary information was collected annually through questionnaires. It was found that baseline intake of vitamin K1 was lower in participants who developed diabetes during the study. It was also found that the risk of developing diabetes dropped by approximately 17% for every 100 mcg of vitamin K1 consumed per day. Subjects who increased their dietary vitamin K1 intake over those 5.5 years had a 51% reduction in risk for developing diabetes, compared with those who did not increase vitamin K intake. The authors concluded that dietary vitamin K1 is associated with reduced risk of type II diabetes.13 How It Works Vitamin K appears to improve insulin function and glucose metabolism in at least two main ways: Activating vitamin K-dependent proteins is involved in regulating glucose metabolism.3 Suppressing chronic inflammation and production of pro-inflammatory compounds, which is a major contributor to diminished insulin sensitivity and metabolic disease.3 Together, these actions could help reduce elevated glycemic markers and lower risk for diabetic complications. https://www.lifeextension.com/magazine/2024/10/vitamin-k-and-blood-sugar",Medical,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Provide as much detail as possible on the active ingredients in Zyrtec, Claritin, and other similar allergy medications. Also, what type of allergic reactions can happen from taking them? Provide your answer in two separate paragraphs, one for the active ingredients and one for the allergic reactions.","Many people use antihistamines to treat allergy symptoms. Zyrtec (cetirizine) and Claritin (loratadine) are two popular brands. They contain different compounds but appear to be equally effective. Antihistamines can reduce allergy symptoms, such as watering eyes, itchy skin, hives, and swelling. They may also help with dermatitis or mosquito bites, but manufacturers usually market them for specific allergies. Zyrtec is a brand name for the drug cetirizine. Claritin is the brand name for loratadine. Zyretc and Claritin are in the same class of medications. Both are second-generation antihistamines and generally work the same way in the body. Neither is clearly better than the other. In this article, we provide details about the differences between Zyrtec and Claritin. We also compare them to two other popular brands of antihistamines: Benadryl and Allegra. Zyrtec and Claritin are brand-name medications that people can buy over the counter (OTC). They are available in various forms, including pills, chewable tablets, and syrups. Regardless of marketing claims, little scientific evidence shows that either is more effective. Active ingredients Zyrtec and Claritin have different active compounds. Zyrtec contains cetirizine hydrochloride, while Claritin contains loratadine. Drowsiness Zyrtec and Claritin are second-generation antihistamines. They are less likely to make a person feel drowsy or otherwise affect alertness than older, first-generation antihistamines. The labeling of Zyrtec says that a person should not take it when driving a vehicle or using machinery. People should avoid taking Zyrtec with alcohol or other medicines that could cause drowsiness. Timescales Zyrtec and Claritin are effective for about 24 hours. A person should only take one dose per day. The body absorbs both antihistamines quickly, but Zyrtec seems to work faster for some people. A 2019 article states that antihistamines reach their peak concentration between 30 minutes and 3 hours after swallowing them. Comparisons with other allergy medications Researchers are often studying, comparing, and improving antihistamines. Other popular brands on the market today are Allegra and Benadryl. Allegra: Allegra is non-sedating, so drowsiness is not a common side effect, although it is possible. Allegra is also a second-generation antihistamine. Benadryl: This can last up to 24 hours, which is longer than the other three. It aims to treat minor skin reactions and seasonal allergies. Benadryl is a first-generation antihistamine, which makes it sedating, so people tend to feel drowsy after taking it. How do allergy medications work? When people come into contact with an allergen, their immune system reacts and produces a chemical called histamine. Histamine causes many allergy symptoms, including inflammation of the skin or sinuses, pain, redness, and wheezing. Immune responses also encourage extra mucus to develop, which helps to clear allergens from the nose and throat. Allergy medications block histamine responses. This dulls the body’s response to minor or harmless allergens, such as pollen, dust, and pet dander. Precautions Claritin and Zyrtec are effective and safe for most people with minor allergies. However, as with all medications, there may be some side effects. Side effects Everyone reacts to medications differently, but Claritin and Zyrtec may have the following side effects: drowsiness, which is more likely when taking Zyrtec than Claritin a headache dizziness or light-headedness a sore throat dry mouth constipation or diarrhea abdominal cramps and pain eye redness Allergic reactions Some people experience a severe allergic response called anaphylaxis after taking antihistamines. A person should seek emergency medical attention if any of the following symptoms are present: hives a swollen throat swollen lips or face trouble breathing or other respiratory symptoms a racing heartbeat Children Some antihistamines are safe for children, but it is a good idea to talk with a doctor or pharmacist and check the label carefully before giving antihistamines to a child. Pregnancy A 2020 article examined the association between antihistamine use during early pregnancy and birth defects. Contrary to findings from older studies, the authors stated there was a lack of evidence to support an association. The American College of Obstetricians and Gynecologists states that Zyrtec (citirizine) and Claritin (loratadine) may be safe during pregnancy. The labeling for Zyrtec states that it is unsuitable during breastfeeding. Pregnant people should check with a doctor before using an antihistamine or any other drug."," Only use the provided text to answer the question, no outside sources. Provide as much detail as possible on the active ingredients in Zyrtec, Claritin, and other similar allergy medications. Also, what type of allergic reactions can happen from taking them? Provide your answer in two separate paragraphs, one for the active ingredients and one for the allergic reactions. Many people use antihistamines to treat allergy symptoms. Zyrtec (cetirizine) and Claritin (loratadine) are two popular brands. They contain different compounds but appear to be equally effective. Antihistamines can reduce allergy symptoms, such as watering eyes, itchy skin, hives, and swelling. They may also help with dermatitis or mosquito bites, but manufacturers usually market them for specific allergies. Zyrtec is a brand name for the drug cetirizine. Claritin is the brand name for loratadine. Zyretc and Claritin are in the same class of medications. Both are second-generation antihistamines and generally work the same way in the body. Neither is clearly better than the other. In this article, we provide details about the differences between Zyrtec and Claritin. We also compare them to two other popular brands of antihistamines: Benadryl and Allegra. Zyrtec and Claritin are brand-name medications that people can buy over the counter (OTC). They are available in various forms, including pills, chewable tablets, and syrups. Regardless of marketing claims, little scientific evidence shows that either is more effective. Active ingredients Zyrtec and Claritin have different active compounds. Zyrtec contains cetirizine hydrochloride, while Claritin contains loratadine. Drowsiness Zyrtec and Claritin are second-generation antihistamines. They are less likely to make a person feel drowsy or otherwise affect alertness than older, first-generation antihistamines. The labeling of Zyrtec says that a person should not take it when driving a vehicle or using machinery. People should avoid taking Zyrtec with alcohol or other medicines that could cause drowsiness. Timescales Zyrtec and Claritin are effective for about 24 hours. A person should only take one dose per day. The body absorbs both antihistamines quickly, but Zyrtec seems to work faster for some people. A 2019 article states that antihistamines reach their peak concentration between 30 minutes and 3 hours after swallowing them. Comparisons with other allergy medications Researchers are often studying, comparing, and improving antihistamines. Other popular brands on the market today are Allegra and Benadryl. Allegra: Allegra is non-sedating, so drowsiness is not a common side effect, although it is possible. Allegra is also a second-generation antihistamine. Benadryl: This can last up to 24 hours, which is longer than the other three. It aims to treat minor skin reactions and seasonal allergies. Benadryl is a first-generation antihistamine, which makes it sedating, so people tend to feel drowsy after taking it. How do allergy medications work? When people come into contact with an allergen, their immune system reacts and produces a chemical called histamine. Histamine causes many allergy symptoms, including inflammation of the skin or sinuses, pain, redness, and wheezing. Immune responses also encourage extra mucus to develop, which helps to clear allergens from the nose and throat. Allergy medications block histamine responses. This dulls the body’s response to minor or harmless allergens, such as pollen, dust, and pet dander. Precautions Claritin and Zyrtec are effective and safe for most people with minor allergies. However, as with all medications, there may be some side effects. Side effects Everyone reacts to medications differently, but Claritin and Zyrtec may have the following side effects: drowsiness, which is more likely when taking Zyrtec than Claritin a headache dizziness or light-headedness a sore throat dry mouth constipation or diarrhea abdominal cramps and pain eye redness Allergic reactions Some people experience a severe allergic response called anaphylaxis after taking antihistamines. A person should seek emergency medical attention if any of the following symptoms are present: hives a swollen throat swollen lips or face trouble breathing or other respiratory symptoms a racing heartbeat Children Some antihistamines are safe for children, but it is a good idea to talk with a doctor or pharmacist and check the label carefully before giving antihistamines to a child. Pregnancy A 2020 article examined the association between antihistamine use during early pregnancy and birth defects. Contrary to findings from older studies, the authors stated there was a lack of evidence to support an association. The American College of Obstetricians and Gynecologists states that Zyrtec (citirizine) and Claritin (loratadine) may be safe during pregnancy. The labeling for Zyrtec states that it is unsuitable during breastfeeding. Pregnant people should check with a doctor before using an antihistamine or any other drug. https://www.medicalnewstoday.com/articles/321465#comparisons",Medical,Find & Summarize,Text Transformation You may only use information from the text in the prompt; use no outside or internal sources of knowledge or information.,What's Biden's involvement with this?,"U.S. Policies Several executive branch and congressional actions have set the stage for increased development and deployment of offshore wind energy on the U.S. OCS.13 For example, Section 388 of the Energy Policy Act of 2005 (P.L. 109-58) amended the Outer Continental Shelf Lands Act (43 U.S.C. §§1331-1356c) to authorize the Secretary of the Interior to offer leases, easements, and rights-of-way for offshore renewable energy activities on the U.S. OCS.14 BOEM is the lead agency for the U.S. OCS renewable energy leasing program.15 In the 117th Congress, Section 50251 of the Inflation Reduction Act of 2022 (P.L. 117-196) expanded BOEM’s authority to pursue offshore wind leasing in federal waters in the southeastern Atlantic region, in the eastern Gulf of Mexico, and off U.S. territories.16 On the executive side, the Biden Administration suggested a doubling of offshore wind by 2030 as one potential approach to address climate change in Executive Order (E.O.) 14008, “Tackling the Climate Crisis at Home and Abroad.”17 In March 2021, the Biden Administration announced a government-wide effort to deploy 30 gigawatts (or 30,000 megawatts) of offshore wind energy by 2030.18 In September 2022, the Administration announced a related goal to deploy 15 gigawatts (or 15,000 megawatts) of installed floating offshore wind (i.e., structures that are not set into the ocean floor) by 2035.19 As of December 2023, BOEM has conducted 12 competitive wind energy lease sales for areas on the OCS, representing more than 2.5 million acres of commercial wind energy lease areas offshore of Delaware, Louisiana, Maryland, Massachusetts, New Jersey, New York, North Carolina, Rhode Island, South Carolina, Virginia, and California.20 Background on Offshore Wind Energy Project Development Stakeholders have expressed concerns regarding potential impacts to the marine ecosystem and associated species that pertain to offshore wind project activities associated with site development, construction, operation, and decommissioning.21 The following sections provide background on offshore wind energy turbine structures and discuss activities associated with offshore wind projects, including the potential impacts of these activities on the marine ecosystem and species. Potential Impacts of Offshore Wind Energy on the Marine Ecosystem and Associated Species Offshore wind projects may affect the marine ecosystem and associated species. Not all impacts may be adverse; some may be beneficial (e.g., the artificial reef effect, discussed below). In general, OWF activities can impact wildlife through atmospheric and oceanic change,43 • marine habitat alteration, • collision risk, • electromagnetic field (EMF) effects associated with power cables,44 • noise effects, and • water quality (e.g., pollution).45 The scientific literature analyzes the short-term adverse impacts and benefits of offshore wind development to marine mammals, invertebrates, fish, sea turtles, birds, bats, and other components of the marine ecosystem (Table 1).46 Modeling and observational studies (mostly derived from the North Sea) show that most impacts (e.g., habitat alteration) occur within the immediate vicinity of the wind turbine array, with other impacts (e.g., noise effects) extending up to tens of kilometers outside the array.47 Some of these analyses use land-based wind energy observations to model potential offshore wind scenarios, and other analyses extrapolate observations from existing OWFs (again, mostly in the North Sea) to planned offshore wind energy projects. Other potential impacts are informed by laboratory studies mimicking conditions (e.g., noise levels) often associated with offshore wind projects. The sections below discuss the potential OWF impacts (both adverse and beneficial) to the ocean environment and selected wildlife. Issues for Congress The full extent of impacts of offshore wind activities on the marine ecosystem of the U.S. OCS remains unclear, in part because the development of U.S. offshore wind projects is relatively recent. If interest in the climate mitigation benefits derived from offshore wind energy grows in the United States and BOEM continues to issue leases for offshore wind development, Congress may continue to consider how offshore wind energy development may impact the marine ecosystem and associated species.231 In the 118th Congress, some Members called for additional research into the potential harm offshore wind projects may cause to marine wildlife or expressed concern about the potential impacts offshore wind activities might have on other ocean uses (e.g., H.R. 1). ","You may only use information from the text in the prompt; use no outside or internal sources of knowledge or information. What's Biden's involvement with this? U.S. Policies Several executive branch and congressional actions have set the stage for increased development and deployment of offshore wind energy on the U.S. OCS.13 For example, Section 388 of the Energy Policy Act of 2005 (P.L. 109-58) amended the Outer Continental Shelf Lands Act (43 U.S.C. §§1331-1356c) to authorize the Secretary of the Interior to offer leases, easements, and rights-of-way for offshore renewable energy activities on the U.S. OCS.14 BOEM is the lead agency for the U.S. OCS renewable energy leasing program.15 In the 117th Congress, Section 50251 of the Inflation Reduction Act of 2022 (P.L. 117-196) expanded BOEM’s authority to pursue offshore wind leasing in federal waters in the southeastern Atlantic region, in the eastern Gulf of Mexico, and off U.S. territories.16 On the executive side, the Biden Administration suggested a doubling of offshore wind by 2030 as one potential approach to address climate change in Executive Order (E.O.) 14008, “Tackling the Climate Crisis at Home and Abroad.”17 In March 2021, the Biden Administration announced a government-wide effort to deploy 30 gigawatts (or 30,000 megawatts) of offshore wind energy by 2030.18 In September 2022, the Administration announced a related goal to deploy 15 gigawatts (or 15,000 megawatts) of installed floating offshore wind (i.e., structures that are not set into the ocean floor) by 2035.19 As of December 2023, BOEM has conducted 12 competitive wind energy lease sales for areas on the OCS, representing more than 2.5 million acres of commercial wind energy lease areas offshore of Delaware, Louisiana, Maryland, Massachusetts, New Jersey, New York, North Carolina, Rhode Island, South Carolina, Virginia, and California.20 Background on Offshore Wind Energy Project Development Stakeholders have expressed concerns regarding potential impacts to the marine ecosystem and associated species that pertain to offshore wind project activities associated with site development, construction, operation, and decommissioning.21 The following sections provide background on offshore wind energy turbine structures and discuss activities associated with offshore wind projects, including the potential impacts of these activities on the marine ecosystem and species. Potential Impacts of Offshore Wind Energy on the Marine Ecosystem and Associated Species Offshore wind projects may affect the marine ecosystem and associated species. Not all impacts may be adverse; some may be beneficial (e.g., the artificial reef effect, discussed below). In general, OWF activities can impact wildlife through atmospheric and oceanic change,43 • marine habitat alteration, • collision risk, • electromagnetic field (EMF) effects associated with power cables,44 • noise effects, and • water quality (e.g., pollution).45 The scientific literature analyzes the short-term adverse impacts and benefits of offshore wind development to marine mammals, invertebrates, fish, sea turtles, birds, bats, and other components of the marine ecosystem (Table 1).46 Modeling and observational studies (mostly derived from the North Sea) show that most impacts (e.g., habitat alteration) occur within the immediate vicinity of the wind turbine array, with other impacts (e.g., noise effects) extending up to tens of kilometers outside the array.47 Some of these analyses use land-based wind energy observations to model potential offshore wind scenarios, and other analyses extrapolate observations from existing OWFs (again, mostly in the North Sea) to planned offshore wind energy projects. Other potential impacts are informed by laboratory studies mimicking conditions (e.g., noise levels) often associated with offshore wind projects. The sections below discuss the potential OWF impacts (both adverse and beneficial) to the ocean environment and selected wildlife. Issues for Congress The full extent of impacts of offshore wind activities on the marine ecosystem of the U.S. OCS remains unclear, in part because the development of U.S. offshore wind projects is relatively recent. If interest in the climate mitigation benefits derived from offshore wind energy grows in the United States and BOEM continues to issue leases for offshore wind development, Congress may continue to consider how offshore wind energy development may impact the marine ecosystem and associated species.231 In the 118th Congress, some Members called for additional research into the potential harm offshore wind projects may cause to marine wildlife or expressed concern about the potential impacts offshore wind activities might have on other ocean uses (e.g., H.R. 1). ",Legal,Find & Summarize,Text Transformation Please answer the question using only the provided context. Format your answer as a list.,How can the Adobe Experience Platform make a business more profitable?,"Adobe Experience Platform helps customers to centralise and standardise their customer data and content across the enterprise – powering 360° customer profiles, enabling data science, and data governance to drive real-time personalised experiences. Experience Platform provides services that includes capabilities for data ingestion, wrangling and analysing data and building predictive models and next best action. Experience Platform makes the data, content and insights available to experience-delivery systems to act upon in real time, yielding compelling experiences in the relevant moment. With Experience Platform, enterprises will be able to utilise completely coordinated marketing and analytics solutions for driving meaningful customer interactions, leading to positive business results. An integral part of Experience Platform is sharing customer experience data to improve experiences for our customers as they work to deliver real-time experiences through our open and extensible platform. Companies want to leverage their customer experience data and share data and insights across all their experience applications (both Adobe applications and third-party applications). Sharing customer experience data in multiple formats from multiple sources can require too much time and too many resources. Adobe’s Experience Data Model (XDM) is a formal specification that you can integrate into your own data model to create a true 360-degree view of your customer, which saves you time and makes moving your data into Adobe Experience Cloud products a seamless process. Company executives in a variety of industries have found themselves thinking about a single issue: how to create a better user experience by delivering the right offer (or right message) at the right time. In order to find an answer to that issue, we need to understand the entire journey of a customer across multiple touchpoints both online and offline. It’s not enough knowing how the customer interacts within a website. You also have to know how the customer responds to emails and how they respond to any offline touchpoints (such as customer support calls or marketing postcards). Knowing the details of the complete journey will give businesses information they need for better personalisation and that will allow them to use machine learning to analyse the journey and deliver an individualised experience. Nine in ten marketers say data is their most underutilised asset. Why aren’t they deriving more value from the terabytes of information they collect? Primarily, it’s because that data isn’t immediately usable. Information compiled from varied sources — like websites, emails, sales, third-party vendors and even offline channels — tends to be siloed and structured in different formats. Even when one department within a firm gets relevant data into a format it can understand, the resulting intel is still largely unintelligible to other teams and departments. If all that data were translated into a single language — one that is equally useful and informative to sales representatives, IT departments, social-media marketers and customer service reps — companies could offer customers more compelling, personalised experiences in real time. Adobe’s Experience Data Model (XDM) is a formal specification used to describe this journey of experiences, as well as the resulting actions and events. XDM describes not only the journey, but also the measurement, content offers and other details of the journey. XDM is more than just a “data dictionary” for companies working with data from customer experiences — it’s a complete language for the experience business. XDM has been developed by Adobe as a way to make experience data easier to interpret and to share. Companies have been chasing the 360-degree customer view for years. The biggest problem is that every bit of data seems to be in a different format or on a different platform. You have your website, your email offers, your customer support system, your retail store and a rewards card, not to mention your search, display, social and video advertising across the web. Many of the systems you use to track those items don’t talk to each other or even store the information in a format the other systems can use. Since you want to use machine learning to derive insights and intelligence from the data, and then use those insights to drive company actions, those separate systems make getting a better view of your customer a difficult and time-consuming task. How can you talk about delivering a personalised experience for your customers if every system has a different definition of who the customer is? To make all these disparate data sets work together and be understood, Data Engineers and Data Scientists are in a constant process of translating and re-translating the data at every step. A large amount of that time is spent understanding the structure of the data before they can turn the data into something meaningful that you can use to create a better experience for your customers. But streamlining that data is easier said than done. Almost 40 percent of advertisers employ three or more data management platforms and 44 percent use three or more analytics platforms. By juggling multiple different data platforms, companies are more likely drop sales leads. Data flowing in from a company’s smartphone app, for instance, might be in a completely different language than the data acquired from an email marketing campaign, a third-party vendor or from the point of sale. The average data scientist spends about 80 percent of their day preparing raw data for analysis, according to a recent poll from data mining company CrowdFlower. Every hour spent cleaning and structuring data is time that could be better spent drawing useful insights from that data, so companies can devise engaging customer experiences. Imagine if sales and marketing data existed in a single, standardised language from the moment it’s compiled — the same way Adobe standardised PDF for documents. Every business is an Experience Business. Whether you’re selling a product, a service or even an event, as long as another person is expected to interact with your company or product or service, then you are creating an experience. This is especially true for any business (or department) that deals with a customer’s ongoing interaction, such as customer support or loyalty clubs. XDM is a specification that describes the elements of those interactions. XDM can describe a consumer’s preferences and qualify what audiences they are part of and then categorise information about their online journey (such as what buttons they click on or what they add to a shopping cart). XDM can also define offline interactions such as loyalty-club memberships. XDM is a core part of the Adobe Experience Platform, built with partners and global brands that are strategically investing in this shared vision of omnipresent and consistent first-class customer experience. Modern customer interactions are unique because they go beyond what historically common data modelling can support. Interacting with digital audiences requires capabilities such as engaging content, insights from data at scale, complete data awareness, identity management, unified profiles, omni-channel and experiencecentric metadata, and the blending of real-time with historical behavioural data. Often, this data comes from multiple different vendors representing online behaviour across web and mobile and offline behavior for instore purchases, demographic information and user preferences. It is a labour-intensive process to combine all of these disparate data sources to get a 360-degree view of a consumer and speak to them with one voice across the various channels. XDM is the language to express these experiences.","Adobe Experience Platform helps customers to centralise and standardise their customer data and content across the enterprise – powering 360° customer profiles, enabling data science, and data governance to drive real-time personalised experiences. Experience Platform provides services that includes capabilities for data ingestion, wrangling and analysing data and building predictive models and next best action. Experience Platform makes the data, content and insights available to experience-delivery systems to act upon in real time, yielding compelling experiences in the relevant moment. With Experience Platform, enterprises will be able to utilise completely coordinated marketing and analytics solutions for driving meaningful customer interactions, leading to positive business results. An integral part of Experience Platform is sharing customer experience data to improve experiences for our customers as they work to deliver real-time experiences through our open and extensible platform. Companies want to leverage their customer experience data and share data and insights across all their experience applications (both Adobe applications and third-party applications). Sharing customer experience data in multiple formats from multiple sources can require too much time and too many resources. Adobe’s Experience Data Model (XDM) is a formal specification that you can integrate into your own data model to create a true 360-degree view of your customer, which saves you time and makes moving your data into Adobe Experience Cloud products a seamless process. Company executives in a variety of industries have found themselves thinking about a single issue: how to create a better user experience by delivering the right offer (or right message) at the right time. In order to find an answer to that issue, we need to understand the entire journey of a customer across multiple touchpoints both online and offline. It’s not enough knowing how the customer interacts within a website. You also have to know how the customer responds to emails and how they respond to any offline touchpoints (such as customer support calls or marketing postcards). Knowing the details of the complete journey will give businesses information they need for better personalisation and that will allow them to use machine learning to analyse the journey and deliver an individualised experience. Nine in ten marketers say data is their most underutilised asset. Why aren’t they deriving more value from the terabytes of information they collect? Primarily, it’s because that data isn’t immediately usable. Information compiled from varied sources — like websites, emails, sales, third-party vendors and even offline channels — tends to be siloed and structured in different formats. Even when one department within a firm gets relevant data into a format it can understand, the resulting intel is still largely unintelligible to other teams and departments. If all that data were translated into a single language — one that is equally useful and informative to sales representatives, IT departments, social-media marketers and customer service reps — companies could offer customers more compelling, personalised experiences in real time. Adobe’s Experience Data Model (XDM) is a formal specification used to describe this journey of experiences, as well as the resulting actions and events. XDM describes not only the journey, but also the measurement, content offers and other details of the journey. XDM is more than just a “data dictionary” for companies working with data from customer experiences — it’s a complete language for the experience business. XDM has been developed by Adobe as a way to make experience data easier to interpret and to share. Companies have been chasing the 360-degree customer view for years. The biggest problem is that every bit of data seems to be in a different format or on a different platform. You have your website, your email offers, your customer support system, your retail store and a rewards card, not to mention your search, display, social and video advertising across the web. Many of the systems you use to track those items don’t talk to each other or even store the information in a format the other systems can use. Since you want to use machine learning to derive insights and intelligence from the data, and then use those insights to drive company actions, those separate systems make getting a better view of your customer a difficult and time-consuming task. How can you talk about delivering a personalised experience for your customers if every system has a different definition of who the customer is? To make all these disparate data sets work together and be understood, Data Engineers and Data Scientists are in a constant process of translating and re-translating the data at every step. A large amount of that time is spent understanding the structure of the data before they can turn the data into something meaningful that you can use to create a better experience for your customers. But streamlining that data is easier said than done. Almost 40 percent of advertisers employ three or more data management platforms and 44 percent use three or more analytics platforms. By juggling multiple different data platforms, companies are more likely drop sales leads. Data flowing in from a company’s smartphone app, for instance, might be in a completely different language than the data acquired from an email marketing campaign, a third-party vendor or from the point of sale. The average data scientist spends about 80 percent of their day preparing raw data for analysis, according to a recent poll from data mining company CrowdFlower. Every hour spent cleaning and structuring data is time that could be better spent drawing useful insights from that data, so companies can devise engaging customer experiences. Imagine if sales and marketing data existed in a single, standardised language from the moment it’s compiled — the same way Adobe standardised PDF for documents. Every business is an Experience Business. Whether you’re selling a product, a service or even an event, as long as another person is expected to interact with your company or product or service, then you are creating an experience. This is especially true for any business (or department) that deals with a customer’s ongoing interaction, such as customer support or loyalty clubs. XDM is a specification that describes the elements of those interactions. XDM can describe a consumer’s preferences and qualify what audiences they are part of and then categorise information about their online journey (such as what buttons they click on or what they add to a shopping cart). XDM can also define offline interactions such as loyalty-club memberships. XDM is a core part of the Adobe Experience Platform, built with partners and global brands that are strategically investing in this shared vision of omnipresent and consistent first-class customer experience. Modern customer interactions are unique because they go beyond what historically common data modelling can support. Interacting with digital audiences requires capabilities such as engaging content, insights from data at scale, complete data awareness, identity management, unified profiles, omni-channel and experiencecentric metadata, and the blending of real-time with historical behavioural data. Often, this data comes from multiple different vendors representing online behaviour across web and mobile and offline behavior for instore purchases, demographic information and user preferences. It is a labour-intensive process to combine all of these disparate data sources to get a 360-degree view of a consumer and speak to them with one voice across the various channels. XDM is the language to express these experiences. Please answer the question using only the provided context. Format your answer as a list. How can the Adobe Experience Platform make a business more profitable?",Retail/Product,Explanation/Definition,Q&A "Answer the question using only the information provided below. If the question has multiple items in the answer then provide the answer in a numbered list. Otherwise, provide the answer in no more than three paragraphs.",What risks or concerns have been identified regarding the use of facial recognition technology by law enforcement agencies?,"Law enforcement agencies’ use of facial recognition technology (FRT), while not a new practice, has received increased attention from policymakers and the public. In the course of carrying out their duties, federal law enforcement agencies may use FRT for a variety of purposes. For instance, the Federal Bureau of Investigation (FBI) uses the technology to aid its investigations, and the bureau provides facial recognition assistance to federal, state, local, and tribal law enforcement partners. State, local, and tribal law enforcement have also adopted facial recognition software systems to assist in various phases of investigations. In addition, border officials use facial recognition for identity verification purposes. The use of FRT by law enforcement agencies has spurred questions on a range of topics. Some primary concerns revolve around the accuracy of the technology, including potential race-, gender-, and age-related biases; the collection, retention, and security of images contained in various facial recognition databases; public notification regarding the use of facial recognition and other image capturing technology; and policies or standards governing law enforcement agencies’ use of the technology. Some of these concerns have manifested in actions such as federal, state, and city efforts to prohibit or bound law enforcement agencies’ use of FRT. In addition, some companies producing facial recognition software, such as Microsoft, IBM, and Amazon, have enacted new barriers to law enforcement using their technologies. This report provides an overview of federal law enforcement agencies’ use of FRT, including the current status of scientific standards for its use. The report includes a discussion of how FRT may be used by law enforcement agencies with traditional policing missions as well as by those charged with securing the U.S. borders. It also discusses considerations for policymakers debating whether or how to influence federal, state, and local law enforcement agencies’ use of FRT. The term facial recognition technology can have different meanings for law enforcement agencies, policymakers, and the public, and the process of using facial recognition in a law enforcement context can involve various technologies and actors. Broadly, as technology experts have noted, “[t]here is no one standard system design for facial recognition systems. Not only do organizations build their systems differently, and for different environments, but they also use different terms to describe how their systems work.” 3 The following key terms are provided to help in understanding facial recognition technologies and processes in this report. 4 Face detection technology determines whether a digital image contains a face. Facial classification algorithms analyze a face image to produce an estimate of age, sex, or some other property, but do not identify the individual. An example application of this would be retail stores using facial classification to gather data on the gender and age ranges of people visiting a store, without identifying each shopper individually. Facial comparison and facial identification are often used in the same context. They involve a human manually examining the differences and similarities between facial images, or between a live subject and facial images, for the purpose of determining if they represent the same person. Facial comparison has three broad categories: assessment, review, and examination. Facial assessment is a quick image-to-image or image-to-person comparison, typically carried out in screening or access control situations, and is the least rigorous form of facial comparison. Facial review (often used in investigative, operational, or intelligence gathering applications) and facial examination (often used in a forensic applications) are increasingly rigorous levels of image comparison and should involve verification by an additional reviewer or examiner. They may involve a formal, systematic examination of facial images. Facial recognition broadly involves the automated searching of a facial image (a probe) against a known collection or database of photos. Facial recognition algorithms compare identity information from facial features in two face image samples and produce a measure of similarity (sometimes called a match score) between them; this information can be used to determine whether the same person is in both images. Images that have a similarity score above a defined threshold are presented to the user. There are two ways in which facial recognition algorithms work to compare images: • One-to-one verification algorithms compare a photo of someone claiming a specific identity with a stored image(s) of that known identity to determine if it is the same person. Uses of these algorithms can include unlocking a smartphone and verifying identities at a security checkpoint. • One-to-many identification search algorithms compare features of a probe photo with all those in a gallery of images. The algorithms can provide either a fixed number of the most similar candidates, or all candidates with a similarity score above a preset threshold, for human review. These algorithms may be used for purposes such as identifying potential suspect leads from a mugshot database. Probe refers to the facial image or template searched against a gallery or database of photos in a facial recognition system. Real-time facial recognition involves facial recognition algorithms that can be used while a video recording is taking place in order to determine in real time whether an individual in a video matches with a list of candidates in a database of photos. Threshold refers to any real number against which similarity scores are compared to produce a verification decision or gallery of images. Law enforcement agencies’ use of FRT has received attention from policymakers and the public over the past several years. There have been heightened concerns following several revelations, including that Clearview AI, a company that developed image-search technology used by law enforcement agencies around the country, had amassed a database of over 3 billion images against which probe photos could be compared. FRT is one of several biometric technologies employed by law enforcement agencies, which also include fingerprint, palm print, DNA and iris scans. FRT can be used by law enforcement for a variety of purposes such as generating investigative leads, identifying victims of crimes, facilitating the examination of forensic evidence, and helping verify the identity of individuals being released from prison. Press releases and statements from the Department of Justice highlight how the technology has been used in the criminal justice system. FRT has been used to help generate suspect leads. In one case, FBI agents used the technology, via the Mississippi Fusion Center, to identify a potential suspect in an interstate stalking case who had allegedly been harassing high school girls through their Twitter accounts.The suspect was later sentenced to 46 months imprisonment and three years of supervised release for this stalking.FRT may also be used to help identify victims. For example, officials have noted FRT was used to help identify “an accident victim lying unconscious on the side of the road.”FRT, along with other pieces of evidence, has been used to support probable cause in affidavits in support of criminal complaints. In one case, an FBI agent cited the use of FRT in a criminal complaint against a bank robbery suspect. The agent noted that images from the bank’s surveillance footage were run against facial recognition software, and a photo of the suspect was returned as a possible match. Investigators then interviewed associates of the suspect, who identified him as the man in the bank surveillance footage. Notably, the frequency and extent to which FRT is used at various phases of the criminal justice system (from generating leads and helping establish probable cause for an arrest or indictment, to serving as evidence in courtrooms) is unknown. It is most often discussed as being employed during investigations by law enforcement officials. Of note, FRT is generally used by law enforcement in one-to-many searches to produce a gallery of potential suspects ranked by similarity and not to provide a single affirmative match. As such, the technology currently might not be relied upon in the same way that other biometric evidence might. Rather, it is the results of an investigator’s facial review between a probe face and the gallery of images produced from running a probe face through facial recognition software that might be used as evidence contributing to an arrest and prosecution. ","What risks or concerns have been identified regarding the use of facial recognition technology by law enforcement agencies? Answer the question using only the information provided below. If the question has multiple items in the answer then provide the answer in a numbered list. Otherwise, provide the answer in no more than three paragraphs. Law enforcement agencies’ use of facial recognition technology (FRT), while not a new practice, has received increased attention from policymakers and the public. In the course of carrying out their duties, federal law enforcement agencies may use FRT for a variety of purposes. For instance, the Federal Bureau of Investigation (FBI) uses the technology to aid its investigations, and the bureau provides facial recognition assistance to federal, state, local, and tribal law enforcement partners. State, local, and tribal law enforcement have also adopted facial recognition software systems to assist in various phases of investigations. In addition, border officials use facial recognition for identity verification purposes. The use of FRT by law enforcement agencies has spurred questions on a range of topics. Some primary concerns revolve around the accuracy of the technology, including potential race-, gender-, and age-related biases; the collection, retention, and security of images contained in various facial recognition databases; public notification regarding the use of facial recognition and other image capturing technology; and policies or standards governing law enforcement agencies’ use of the technology. Some of these concerns have manifested in actions such as federal, state, and city efforts to prohibit or bound law enforcement agencies’ use of FRT. In addition, some companies producing facial recognition software, such as Microsoft, IBM, and Amazon, have enacted new barriers to law enforcement using their technologies. This report provides an overview of federal law enforcement agencies’ use of FRT, including the current status of scientific standards for its use. The report includes a discussion of how FRT may be used by law enforcement agencies with traditional policing missions as well as by those charged with securing the U.S. borders. It also discusses considerations for policymakers debating whether or how to influence federal, state, and local law enforcement agencies’ use of FRT. The term facial recognition technology can have different meanings for law enforcement agencies, policymakers, and the public, and the process of using facial recognition in a law enforcement context can involve various technologies and actors. Broadly, as technology experts have noted, “[t]here is no one standard system design for facial recognition systems. Not only do organizations build their systems differently, and for different environments, but they also use different terms to describe how their systems work.” 3 The following key terms are provided to help in understanding facial recognition technologies and processes in this report. 4 Face detection technology determines whether a digital image contains a face. Facial classification algorithms analyze a face image to produce an estimate of age, sex, or some other property, but do not identify the individual. An example application of this would be retail stores using facial classification to gather data on the gender and age ranges of people visiting a store, without identifying each shopper individually. Facial comparison and facial identification are often used in the same context. They involve a human manually examining the differences and similarities between facial images, or between a live subject and facial images, for the purpose of determining if they represent the same person. Facial comparison has three broad categories: assessment, review, and examination. Facial assessment is a quick image-to-image or image-to-person comparison, typically carried out in screening or access control situations, and is the least rigorous form of facial comparison. Facial review (often used in investigative, operational, or intelligence gathering applications) and facial examination (often used in a forensic applications) are increasingly rigorous levels of image comparison and should involve verification by an additional reviewer or examiner. They may involve a formal, systematic examination of facial images. Facial recognition broadly involves the automated searching of a facial image (a probe) against a known collection or database of photos. Facial recognition algorithms compare identity information from facial features in two face image samples and produce a measure of similarity (sometimes called a match score) between them; this information can be used to determine whether the same person is in both images. Images that have a similarity score above a defined threshold are presented to the user. There are two ways in which facial recognition algorithms work to compare images: • One-to-one verification algorithms compare a photo of someone claiming a specific identity with a stored image(s) of that known identity to determine if it is the same person. Uses of these algorithms can include unlocking a smartphone and verifying identities at a security checkpoint. • One-to-many identification search algorithms compare features of a probe photo with all those in a gallery of images. The algorithms can provide either a fixed number of the most similar candidates, or all candidates with a similarity score above a preset threshold, for human review. These algorithms may be used for purposes such as identifying potential suspect leads from a mugshot database. Probe refers to the facial image or template searched against a gallery or database of photos in a facial recognition system. Real-time facial recognition involves facial recognition algorithms that can be used while a video recording is taking place in order to determine in real time whether an individual in a video matches with a list of candidates in a database of photos. Threshold refers to any real number against which similarity scores are compared to produce a verification decision or gallery of images. Law enforcement agencies’ use of FRT has received attention from policymakers and the public over the past several years. There have been heightened concerns following several revelations, including that Clearview AI, a company that developed image-search technology used by law enforcement agencies around the country, had amassed a database of over 3 billion images against which probe photos could be compared. FRT is one of several biometric technologies employed by law enforcement agencies, which also include fingerprint, palm print, DNA and iris scans. FRT can be used by law enforcement for a variety of purposes such as generating investigative leads, identifying victims of crimes, facilitating the examination of forensic evidence, and helping verify the identity of individuals being released from prison. Press releases and statements from the Department of Justice highlight how the technology has been used in the criminal justice system. FRT has been used to help generate suspect leads. In one case, FBI agents used the technology, via the Mississippi Fusion Center, to identify a potential suspect in an interstate stalking case who had allegedly been harassing high school girls through their Twitter accounts.The suspect was later sentenced to 46 months imprisonment and three years of supervised release for this stalking.FRT may also be used to help identify victims. For example, officials have noted FRT was used to help identify “an accident victim lying unconscious on the side of the road.”FRT, along with other pieces of evidence, has been used to support probable cause in affidavits in support of criminal complaints. In one case, an FBI agent cited the use of FRT in a criminal complaint against a bank robbery suspect. The agent noted that images from the bank’s surveillance footage were run against facial recognition software, and a photo of the suspect was returned as a possible match. Investigators then interviewed associates of the suspect, who identified him as the man in the bank surveillance footage. Notably, the frequency and extent to which FRT is used at various phases of the criminal justice system (from generating leads and helping establish probable cause for an arrest or indictment, to serving as evidence in courtrooms) is unknown. It is most often discussed as being employed during investigations by law enforcement officials. Of note, FRT is generally used by law enforcement in one-to-many searches to produce a gallery of potential suspects ranked by similarity and not to provide a single affirmative match. As such, the technology currently might not be relied upon in the same way that other biometric evidence might. Rather, it is the results of an investigator’s facial review between a probe face and the gallery of images produced from running a probe face through facial recognition software that might be used as evidence contributing to an arrest and prosecution. ",Internet/Technology,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",My doctor said I have a herniated disc. Is there something that can permanently help with this diagnosis? What are the pros and cons of each surgical option?,"What to know about herniated disc surgery What is a herniated disc? Who needs surgery? Procedures Recovery Risks Alternatives Summary A person who has a herniated disc may experience pain that affects their daily activities. While it is not always necessary, some people may require herniated disc surgery to alleviate pain and other symptoms. The type of surgery a person has depends on several factors. These include the location of the herniated disc, the severity of the pain, and the disability it causes. In this article, we discuss the different types of herniated disc surgeries and their risks. We will also explore how long it takes to recover from herniated disc surgery. What is a herniated disc? The pain from a herniated disc may affect a person’s daily activities. The spine is made up of individual bones known as vertebrae. Intervertebral discs are discs of cartilage that sit between the vertebrae. The function of the intervertebral discs is to support the spine and act as shock absorbers between the vertebrae. There are normally 23 discs in the human spine. Each disc is made up of three components: Nucleus pulposus: This is the inner gel-like portion of the disc that gives the spine its flexibility and strength. Annulus fibrosis: This is a tough outer layer that surrounds the nucleus pulposus. Cartilaginous endplates: These are pieces of cartilage that sit between the disc and its adjoining vertebrae. In a herniated disc, the annulus fibrosis is torn or ruptured. This damage allows part of the nucleus pulposus to push through into the spinal canal. Sometimes, the herniated material can press on a nerve, causing pain and affecting movement. Each year, herniated discs affect around 5–20 of every 1,000 adults between the ages of 20 and 49 years old. A herniated disc can occur anywhere in the spine. The two most common locations are the lumbar spine and the cervical spine. The lumbar spine refers to the lower back, while the cervical spine refers to the neck region. Procedures There is a variety of procedures that a surgeon can carry out to treat a herniated disc. The purpose of herniated disc surgery is to ease pressure on the nerve, thereby alleviating pain and other symptoms. A doctor may use one of the following three techniques Source to alleviate pressure on the nerve: Open discectomy: The surgeon performs open surgery to remove the herniated section of the disc. Endoscopic spine surgery: The surgeon uses a long thin tube, or endoscope, to remove the herniated section of the disc. The procedure is minimally invasive, requiring a tiny incision. Only a small scar will form, resulting in a quicker recovery. Surgery on the core of the spinal disc: The surgeon uses instruments to access the core of the spinal disc then uses a vacuum to remove the core. This makes the spinal disc smaller, which reduces pressure on the nerve. The surgery is only possible if the outer layer of the disc is not damaged. Other surgical interventions for a herniated disc include: Laminotomy or laminectomy The lamina is a part of the vertebrae that covers and protects the spinal canal. Sometimes, doctors need to remove part or all of the lamina to repair a herniated disc. A laminotomy involves the removal of part of the lamina, while a laminectomy is removal of the entire lamina. Both procedures involve making a small incision down the center of the back or neck over the area of the herniated disc. After removing part or all of the lamina, the surgeon performs a discectomy to remove the herniated disc. Laminotomies and laminectomies can be lumbar or cervical: Lumbar procedures: These help to relieve leg pain or sciatic pain that a herniated disc causes in the lower back region. Cervical procedures: These help to relieve pain in the neck and upper limbs that a herniated disc causes in the neck region. Spinal fusion Following a laminotomy or laminectomy, a spinal fusion (SF) may be necessary to stabilize the spine. An SF involves joining two bones together with screws. People who have undergone an SF may experience pain and feel as if the treatment is restricting certain movements. The likelihood of needing an SF depends on the location of the herniated disc. Typically, lumbar laminotomies require an SF. Cervical laminotomies require an SF if the surgeon operates from the front of the neck. The same procedures rarely require an SF if the surgeon operates from the back of the neck. The point the surgeon works from depends on the exact location of the herniated disc. Some people who undergo laminotomy may be candidates for artificial disc surgery instead of an SF. Artificial disc surgery Artificial disc surgery (ADS) is an alternative to spinal fusion. In ADS, the surgeon replaces the damaged disc with an artificial one. A surgeon will usually associate this method with less pain and less restricted movement in comparison to SF procedures. Recovery process and timeline According to the North American Spine Society, people who undergo surgery for a herniated disc earlier rather than later may have a faster recovery time. They may also experience improved long term health. Typically, most people can go home 24 hours after a herniated disc operation. Some may even be able to go home the same day. Doctors recommend that people recovering from herniated disc surgery avoid the following activities for around 4 weeks: driving sitting for long periods lifting heavy weights bending over Some exercises may be beneficial for people who have had herniated disc surgery. However, they should consult their doctor or surgeon before attempting any strenuous activities. Sometimes, doctors may suggest rehabilitation therapy after surgery. People who follow a rehabilitation program after herniated disc surgery may achieve a shorter recovery time and improved mobility. Risks Discectomies hardly ever result in complications. However, in rare cases, people may experience the following: bleeding infections tears in the spine’s protective lining injury to the nerve In around 5% of people, the problematic disc may rupture again, causing symptoms to recur. Herniated disc surgery can be an effective treatment for many people with challenging pain. However, surgeons cannot guarantee that symptoms will disappear after surgery. Some people may continue to experience herniated disc pain after the recovery period. In some cases, the pain may worsen over time. Other treatment options Taking pain medication may ease symptoms of a herniated disc. People who develop a herniated disc should limit their activities for 2 to 3 days. Limiting movement will reduce inflammation at the site of the nerve. Although it may seem counterintuitive, doctors do not recommend bed rest, however. People who have pinched nerves in the neck and leg due to a herniated disc may try NSAIDs and physical therapy. If those treatments are ineffective, doctors may recommend other nonsurgical options, such as selective nerve root blocks. These treatments are local numbing agents that doctors inject into the spinal cord to alleviate herniated disc pain. Summary A herniated disc can cause disabling pain. In many cases, nonsurgical treatment options offer effective pain relief. If there is no improvement, a doctor may recommend herniated disc surgery. The type of surgical procedure a person undergoes depends on several factors. These include the location of the herniated disc, the severity of the pain, and level of disability it causes. Most people can return to their usual activities around 4 weeks after herniated disc surgery. People who follow a rehabilitation program after surgery may experience a shorter recovery time and better mobility.","[question] My doctor said I have a herniated disc. Is there something that can permanently help with this diagnosis? What are the pros and cons of each surgical option? ===================== [text] What to know about herniated disc surgery What is a herniated disc? Who needs surgery? Procedures Recovery Risks Alternatives Summary A person who has a herniated disc may experience pain that affects their daily activities. While it is not always necessary, some people may require herniated disc surgery to alleviate pain and other symptoms. The type of surgery a person has depends on several factors. These include the location of the herniated disc, the severity of the pain, and the disability it causes. In this article, we discuss the different types of herniated disc surgeries and their risks. We will also explore how long it takes to recover from herniated disc surgery. What is a herniated disc? The pain from a herniated disc may affect a person’s daily activities. The spine is made up of individual bones known as vertebrae. Intervertebral discs are discs of cartilage that sit between the vertebrae. The function of the intervertebral discs is to support the spine and act as shock absorbers between the vertebrae. There are normally 23 discs in the human spine. Each disc is made up of three components: Nucleus pulposus: This is the inner gel-like portion of the disc that gives the spine its flexibility and strength. Annulus fibrosis: This is a tough outer layer that surrounds the nucleus pulposus. Cartilaginous endplates: These are pieces of cartilage that sit between the disc and its adjoining vertebrae. In a herniated disc, the annulus fibrosis is torn or ruptured. This damage allows part of the nucleus pulposus to push through into the spinal canal. Sometimes, the herniated material can press on a nerve, causing pain and affecting movement. Each year, herniated discs affect around 5–20 of every 1,000 adults between the ages of 20 and 49 years old. A herniated disc can occur anywhere in the spine. The two most common locations are the lumbar spine and the cervical spine. The lumbar spine refers to the lower back, while the cervical spine refers to the neck region. Procedures There is a variety of procedures that a surgeon can carry out to treat a herniated disc. The purpose of herniated disc surgery is to ease pressure on the nerve, thereby alleviating pain and other symptoms. A doctor may use one of the following three techniques Source to alleviate pressure on the nerve: Open discectomy: The surgeon performs open surgery to remove the herniated section of the disc. Endoscopic spine surgery: The surgeon uses a long thin tube, or endoscope, to remove the herniated section of the disc. The procedure is minimally invasive, requiring a tiny incision. Only a small scar will form, resulting in a quicker recovery. Surgery on the core of the spinal disc: The surgeon uses instruments to access the core of the spinal disc then uses a vacuum to remove the core. This makes the spinal disc smaller, which reduces pressure on the nerve. The surgery is only possible if the outer layer of the disc is not damaged. Other surgical interventions for a herniated disc include: Laminotomy or laminectomy The lamina is a part of the vertebrae that covers and protects the spinal canal. Sometimes, doctors need to remove part or all of the lamina to repair a herniated disc. A laminotomy involves the removal of part of the lamina, while a laminectomy is removal of the entire lamina. Both procedures involve making a small incision down the center of the back or neck over the area of the herniated disc. After removing part or all of the lamina, the surgeon performs a discectomy to remove the herniated disc. Laminotomies and laminectomies can be lumbar or cervical: Lumbar procedures: These help to relieve leg pain or sciatic pain that a herniated disc causes in the lower back region. Cervical procedures: These help to relieve pain in the neck and upper limbs that a herniated disc causes in the neck region. Spinal fusion Following a laminotomy or laminectomy, a spinal fusion (SF) may be necessary to stabilize the spine. An SF involves joining two bones together with screws. People who have undergone an SF may experience pain and feel as if the treatment is restricting certain movements. The likelihood of needing an SF depends on the location of the herniated disc. Typically, lumbar laminotomies require an SF. Cervical laminotomies require an SF if the surgeon operates from the front of the neck. The same procedures rarely require an SF if the surgeon operates from the back of the neck. The point the surgeon works from depends on the exact location of the herniated disc. Some people who undergo laminotomy may be candidates for artificial disc surgery instead of an SF. Artificial disc surgery Artificial disc surgery (ADS) is an alternative to spinal fusion. In ADS, the surgeon replaces the damaged disc with an artificial one. A surgeon will usually associate this method with less pain and less restricted movement in comparison to SF procedures. Recovery process and timeline According to the North American Spine Society, people who undergo surgery for a herniated disc earlier rather than later may have a faster recovery time. They may also experience improved long term health. Typically, most people can go home 24 hours after a herniated disc operation. Some may even be able to go home the same day. Doctors recommend that people recovering from herniated disc surgery avoid the following activities for around 4 weeks: driving sitting for long periods lifting heavy weights bending over Some exercises may be beneficial for people who have had herniated disc surgery. However, they should consult their doctor or surgeon before attempting any strenuous activities. Sometimes, doctors may suggest rehabilitation therapy after surgery. People who follow a rehabilitation program after herniated disc surgery may achieve a shorter recovery time and improved mobility. Risks Discectomies hardly ever result in complications. However, in rare cases, people may experience the following: bleeding infections tears in the spine’s protective lining injury to the nerve In around 5% of people, the problematic disc may rupture again, causing symptoms to recur. Herniated disc surgery can be an effective treatment for many people with challenging pain. However, surgeons cannot guarantee that symptoms will disappear after surgery. Some people may continue to experience herniated disc pain after the recovery period. In some cases, the pain may worsen over time. Other treatment options Taking pain medication may ease symptoms of a herniated disc. People who develop a herniated disc should limit their activities for 2 to 3 days. Limiting movement will reduce inflammation at the site of the nerve. Although it may seem counterintuitive, doctors do not recommend bed rest, however. People who have pinched nerves in the neck and leg due to a herniated disc may try NSAIDs and physical therapy. If those treatments are ineffective, doctors may recommend other nonsurgical options, such as selective nerve root blocks. These treatments are local numbing agents that doctors inject into the spinal cord to alleviate herniated disc pain. Summary A herniated disc can cause disabling pain. In many cases, nonsurgical treatment options offer effective pain relief. If there is no improvement, a doctor may recommend herniated disc surgery. The type of surgical procedure a person undergoes depends on several factors. These include the location of the herniated disc, the severity of the pain, and level of disability it causes. Most people can return to their usual activities around 4 weeks after herniated disc surgery. People who follow a rehabilitation program after surgery may experience a shorter recovery time and better mobility. https://www.medicalnewstoday.com/articles/326780#who-needs-surgery ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Pros & Cons,Q&A "Reference the prompt text for your answer only. Do not use outside sources or internal knowledge. If you cannot locate the information in the text, please respond with ""I cannot locate the answer using the context block at this time.""",Is it lawful to market flavored ENDS products?,"Circuit Split over the Food and Drug Administration’s Denial of Applications Seeking to Market Flavored E-Cigarettes, Part 1 of 2 April 5, 2024 Electronic nicotine delivery system (ENDS) products—products that go by many common names, such as e-cigarettes and vape pens—are generally required to receive prior authorization from the Food and Drug Administration (FDA) before they can be lawfully marketed in the United States. Before FDA issued regulations in 2016 to subject these products to the premarket review process, however, many of them were already being sold on the U.S. market and were allowed to remain there while FDA implemented the application and review process. These products come in a variety of forms and flavors, from tobacco and menthol flavors based on the flavors of traditional combustible cigarettes to other flavors based on the flavors of fruit, candy, and other sweets (“flavored ENDS products”). While limited studies of certain ENDS products show that they contain substantially lower levels of toxins than combustible cigarettes, indicating a benefit to current adult smokers who switch completely to using ENDS products, flavored ENDS products have been shown to be particularly attractive to youth. In a 2016-2017 study, for instance, 93.2% of youth ENDS product users reported that their first use was with a flavored product. In 2018, the Surgeon General issued an advisory on the “e-cigarette epidemic among youth.” Since the initial deadline in September 2020 for ENDS product manufacturers to submit their premarket tobacco product applications (PMTAs), FDA has received millions of applications for ENDS products. To date, the agency has authorized 23 tobacco-flavored ENDS products for lawful marketing and has not authorized any flavored ENDS products. Many applicants that have received a marketing denial order (MDO) for their flavored ENDS products have filed petitions in U.S. Courts of Appeals throughout the country to challenge the denial of their PMTAs. Of the courts that have considered these petitions, the Second, Third, Fourth, Sixth, Seventh, Ninth, Tenth, and D.C. Circuits have sided with FDA and denied the petitions or requests to stay the agency’s MDOs. The Eleventh and Fifth Circuits, on the other hand, have sided with the ENDS manufacturers and vacated FDA’s MDOs, remanding the applications to FDA for reconsideration. This circuit split sets the stage for potential Supreme Court review regarding what information FDA may require applicants seeking to market flavored ENDS products to provide as part of their PMTAs. This two-part Sidebar examines the circuit split. Part I provides an overview of the Family Smoking Prevention and Tobacco Control Act (TCA) regulatory framework, relevant FDA actions related to ENDS products, and the agency’s review and denial of the PMTAs involving flavored ENDS products. Part II provides an overview of the litigation challenging those FDA orders, the court decisions to date, and certain preliminary observations for consideration by Congress.","Reference the prompt text for your answer only. Do not use outside sources or internal knowledge. If you cannot locate the information in the text, please respond with ""I cannot locate the answer using the context block at this time."" Question: Is it lawful to market flavored ENDS products? Circuit Split over the Food and Drug Administration’s Denial of Applications Seeking to Market Flavored E-Cigarettes, Part 1 of 2 April 5, 2024 Electronic nicotine delivery system (ENDS) products—products that go by many common names, such as e-cigarettes and vape pens—are generally required to receive prior authorization from the Food and Drug Administration (FDA) before they can be lawfully marketed in the United States. Before FDA issued regulations in 2016 to subject these products to the premarket review process, however, many of them were already being sold on the U.S. market and were allowed to remain there while FDA implemented the application and review process. These products come in a variety of forms and flavors, from tobacco and menthol flavors based on the flavors of traditional combustible cigarettes to other flavors based on the flavors of fruit, candy, and other sweets (“flavored ENDS products”). While limited studies of certain ENDS products show that they contain substantially lower levels of toxins than combustible cigarettes, indicating a benefit to current adult smokers who switch completely to using ENDS products, flavored ENDS products have been shown to be particularly attractive to youth. In a 2016-2017 study, for instance, 93.2% of youth ENDS product users reported that their first use was with a flavored product. In 2018, the Surgeon General issued an advisory on the “e-cigarette epidemic among youth.” Since the initial deadline in September 2020 for ENDS product manufacturers to submit their premarket tobacco product applications (PMTAs), FDA has received millions of applications for ENDS products. To date, the agency has authorized 23 tobacco-flavored ENDS products for lawful marketing and has not authorized any flavored ENDS products. Many applicants that have received a marketing denial order (MDO) for their flavored ENDS products have filed petitions in U.S. Courts of Appeals throughout the country to challenge the denial of their PMTAs. Of the courts that have considered these petitions, the Second, Third, Fourth, Sixth, Seventh, Ninth, Tenth, and D.C. Circuits have sided with FDA and denied the petitions or requests to stay the agency’s MDOs. The Eleventh and Fifth Circuits, on the other hand, have sided with the ENDS manufacturers and vacated FDA’s MDOs, remanding the applications to FDA for reconsideration. This circuit split sets the stage for potential Supreme Court review regarding what information FDA may require applicants seeking to market flavored ENDS products to provide as part of their PMTAs. This two-part Sidebar examines the circuit split. Part I provides an overview of the Family Smoking Prevention and Tobacco Control Act (TCA) regulatory framework, relevant FDA actions related to ENDS products, and the agency’s review and denial of the PMTAs involving flavored ENDS products. Part II provides an overview of the litigation challenging those FDA orders, the court decisions to date, and certain preliminary observations for consideration by Congress.",Retail/Product,Fact Finding,Q&A Your response should be based only on the text provided below. Do not use any outside resources or prior knowledge in formulating your answer.,Tell me in a bullet-pointed list what differential diagnoses of Hypertensive Retinopathy are not shared with HIV Retinopathy or with Diabetic Retinopathy.,"Diabetic Retinopathy ■ Essentials of Diagnosis • May have decreased or fluctuating vision or floaters; often asymptomatic early in the course of the disease • Nonproliferative: Dot and blot hemorrhages, microaneurysms, hard exudates, cotton-wool spots, venous beading, and intraretinal microvascular abnormalities • Proliferative: Neovascularization of optic disk, retina, or iris; preretinal or vitreous hemorrhages; tractional retinal detachment ■ Differential Diagnosis • Hypertensive retinopathy • HIV retinopathy • Radiation retinopathy • Central or branch retinal vein occlusion • Ocular ischemic syndrome • Sickle cell retinopathy • Retinopathy of severe anemia • Embolization from intravenous drug abuse (talc retinopathy) • Collagen vascular disease • Sarcoidosis • Eales’ disease ■ Treatment • Ophthalmologic referral and regular follow-up in all diabetics • Laser photocoagulation, intravitreal Kenalog, intravitreal antiangiogenesis drugs (eg, Lucentis or Avastin) for macular edema and proliferative disease • Pars plana vitrectomy for nonclearing vitreous hemorrhage and tractional retinal detachment involving or threatening the macula ■ Pearl Though a debate about this has lasted decades, it appears that aggressive glycemic control prevents progression; be sure your patients understand and know their A1c. Reference El-Asrar AM, Al-Mezaine HS, Ola MS. Changing paradigms in the treatment of diabetic retinopathy. Curr Opin Ophthalmol 2009;20:532. [PMID: 19644368] 20 518 Current Essentials of Medicine HIV Retinopathy ■ Essentials of Diagnosis • Cotton-wool spots, intraretinal hemorrhages, microaneurysms seen on funduscopic examination in a patient with known or suspected HIV infection • Typically asymptomatic unless accompanied by other HIV-related retinal pathology (eg, cytomegalovirus retinitis) ■ Differential Diagnosis • Diabetic retinopathy • Hypertensive retinopathy • Radiation retinopathy • Retinopathy of severe anemia • Central or branch retinal vein occlusion • Sickle cell retinopathy • Embolization from intravenous drug abuse (talc retinopathy) • Sarcoidosis • Eales’ disease ■ Treatment • Treat the underlying HIV disease • Ophthalmologic referral is appropriate for any patient with HIV, especially with a low CD4 count and/or visual symptoms ■ Pearl HIV retinopathy is the most common ophthalmologic manifestation of HIV infection; it usually indicates a low CD4 count. Reference Holland GN. AIDS and ophthalmology: the first quarter century. Am J Ophthalmol 2008;145:397. [PMID: 18282490] Hypertensive Retinopathy ■ Essentials of Diagnosis • Usually asymptomatic; may have decreased vision • Generalized or localized retinal arteriolar narrowing, almost always bilateral • Arteriovenous crossing changes (AV nicking), retinal arteriolar sclerosis (copper or silver wiring), cotton-wool spots, hard exudates, flame-shaped hemorrhages, retinal edema, arterial macroaneurysms, chorioretinal atrophy • Optic disk edema in malignant hypertension ■ Differential Diagnosis • Diabetic retinopathy • Radiation retinopathy • HIV retinopathy • Central or branch retinal vein occlusion • Sickle cell retinopathy • Retinopathy of severe anemia • Embolization from intravenous drug abuse (talc retinopathy) • Autoimmune disease • Sarcoidosis • Eales’ disease ■ Treatment • Treat the hypertension • Ophthalmologic referral ■ Pearl The only pathognomonic funduscopic change of hypertension is focal arteriolar narrowing due to spasm, and it is typically seen in hypertensive crisis. Reference DellaCroce JT, Vitale AT. Hypertension and the eye. Curr Opin Ophthalmol 2008;19:493. [PMID: 18854694]","Your response should be based only on the text provided below. Do not use any outside resources or prior knowledge in formulating your answer. Diabetic Retinopathy ■ Essentials of Diagnosis • May have decreased or fluctuating vision or floaters; often asymptomatic early in the course of the disease • Nonproliferative: Dot and blot hemorrhages, microaneurysms, hard exudates, cotton-wool spots, venous beading, and intraretinal microvascular abnormalities • Proliferative: Neovascularization of optic disk, retina, or iris; preretinal or vitreous hemorrhages; tractional retinal detachment ■ Differential Diagnosis • Hypertensive retinopathy • HIV retinopathy • Radiation retinopathy • Central or branch retinal vein occlusion • Ocular ischemic syndrome • Sickle cell retinopathy • Retinopathy of severe anemia • Embolization from intravenous drug abuse (talc retinopathy) • Collagen vascular disease • Sarcoidosis • Eales’ disease ■ Treatment • Ophthalmologic referral and regular follow-up in all diabetics • Laser photocoagulation, intravitreal Kenalog, intravitreal antiangiogenesis drugs (eg, Lucentis or Avastin) for macular edema and proliferative disease • Pars plana vitrectomy for nonclearing vitreous hemorrhage and tractional retinal detachment involving or threatening the macula ■ Pearl Though a debate about this has lasted decades, it appears that aggressive glycemic control prevents progression; be sure your patients understand and know their A1c. Reference El-Asrar AM, Al-Mezaine HS, Ola MS. Changing paradigms in the treatment of diabetic retinopathy. Curr Opin Ophthalmol 2009;20:532. [PMID: 19644368] 20 518 Current Essentials of Medicine HIV Retinopathy ■ Essentials of Diagnosis • Cotton-wool spots, intraretinal hemorrhages, microaneurysms seen on funduscopic examination in a patient with known or suspected HIV infection • Typically asymptomatic unless accompanied by other HIV-related retinal pathology (eg, cytomegalovirus retinitis) ■ Differential Diagnosis • Diabetic retinopathy • Hypertensive retinopathy • Radiation retinopathy • Retinopathy of severe anemia • Central or branch retinal vein occlusion • Sickle cell retinopathy • Embolization from intravenous drug abuse (talc retinopathy) • Sarcoidosis • Eales’ disease ■ Treatment • Treat the underlying HIV disease • Ophthalmologic referral is appropriate for any patient with HIV, especially with a low CD4 count and/or visual symptoms ■ Pearl HIV retinopathy is the most common ophthalmologic manifestation of HIV infection; it usually indicates a low CD4 count. Reference Holland GN. AIDS and ophthalmology: the first quarter century. Am J Ophthalmol 2008;145:397. [PMID: 18282490] Hypertensive Retinopathy ■ Essentials of Diagnosis • Usually asymptomatic; may have decreased vision • Generalized or localized retinal arteriolar narrowing, almost always bilateral • Arteriovenous crossing changes (AV nicking), retinal arteriolar sclerosis (copper or silver wiring), cotton-wool spots, hard exudates, flame-shaped hemorrhages, retinal edema, arterial macroaneurysms, chorioretinal atrophy • Optic disk edema in malignant hypertension ■ Differential Diagnosis • Diabetic retinopathy • Radiation retinopathy • HIV retinopathy • Central or branch retinal vein occlusion • Sickle cell retinopathy • Retinopathy of severe anemia • Embolization from intravenous drug abuse (talc retinopathy) • Autoimmune disease • Sarcoidosis • Eales’ disease ■ Treatment • Treat the hypertension • Ophthalmologic referral ■ Pearl The only pathognomonic funduscopic change of hypertension is focal arteriolar narrowing due to spasm, and it is typically seen in hypertensive crisis. Reference DellaCroce JT, Vitale AT. Hypertension and the eye. Curr Opin Ophthalmol 2008;19:493. [PMID: 18854694] Tell me in a bullet-pointed list what differential diagnoses of Hypertensive Retinopathy are not shared with HIV Retinopathy or with Diabetic Retinopathy.",Medical,Fact Finding,Q&A "Your task is to answer questions using information provided in the context block, without referring to external sources or prior knowledge. Format your response using bullet points.",List the reasons that resulted in decreased emission of GHGs from ethanol production.,"A new USDA report, titled “A Life-Cycle Analysis of the Greenhouse Gas Emissions of Corn-Based Ethanol,” finds that greenhouse gas (GHG) emissions associated with producing corn-based ethanol in the United States are about 43 percent lower than gasoline when measured on an energy equivalent basis. Unlike other studies of GHG benefits, which relied on forecasts of future ethanol production systems and expected impacts on the farm sector, this study reviewed how the industry and farm sectors have performed over the past decade to assess the current GHG profile of corn-based ethanol. The report shows that the reductions in GHG emissions were driven by a variety of improvements in ethanol production, spanning from the corn field to the ethanol refinery. Farmers are producing corn more efficiently and using conservation practices that reduce GHG emissions, including reduced tillage, cover crops, and improved nitrogen management. Both corn yields and the efficiency of ethanol production technologies are also improving. Previous estimates of ethanol’s GHG balance report lower efficiencies, largely due to anticipated conversion of grasslands and forests to commodity production as a result of increased demand for corn used in ethanol production. However, recent studies of international agricultural land use trends show that since 2004, the primary land use change response of the world's farmers to rising commodity prices has been to use available land resources more efficiently rather than to expand the amount of land used for farming.","A new USDA report, titled “A Life-Cycle Analysis of the Greenhouse Gas Emissions of Corn-Based Ethanol,” finds that greenhouse gas (GHG) emissions associated with producing corn-based ethanol in the United States are about 43 percent lower than gasoline when measured on an energy equivalent basis. Unlike other studies of GHG benefits, which relied on forecasts of future ethanol production systems and expected impacts on the farm sector, this study reviewed how the industry and farm sectors have performed over the past decade to assess the current GHG profile of corn-based ethanol. The report shows that the reductions in GHG emissions were driven by a variety of improvements in ethanol production, spanning from the corn field to the ethanol refinery. Farmers are producing corn more efficiently and using conservation practices that reduce GHG emissions, including reduced tillage, cover crops, and improved nitrogen management. Both corn yields and the efficiency of ethanol production technologies are also improving. Previous estimates of ethanol’s GHG balance report lower efficiencies, largely due to anticipated conversion of grasslands and forests to commodity production as a result of increased demand for corn used in ethanol production. However, recent studies of international agricultural land use trends show that since 2004, the primary land use change response of the world's farmers to rising commodity prices has been to use available land resources more efficiently rather than to expand the amount of land used for farming. Ethanol GHG Balance Highlights  Ethanol production in the United States increased significantly over the past decade—from 3.9 to 14.8 billion gallons per year between 2005 and 2015.  The report projects that the GHG profile of corn ethanol will be almost 50 percent lower than gasoline in 2022 if current trends in corn yields, process fuel switching, and improvements in trucking fuel efficiency continue.  If additional conservation practices and efficiency improvements are pursued, such as the practices outlined in USDA’s Building Blocks for Climate Smart Agriculture and Forestry strategy, the GHG benefits of corn ethanol are even more pronounced over gasoline—about 76 percent.  On-farm conservation practices, such as reduced tillage, cover crops, and nitrogen management, are estimated to improve the GHG balance of corn ethanol by about 14 percent Your task is to answer questions using information provided in the above text, without referring to external sources or prior knowledge. Format your response using bullet points. Question: List the reasons that resulted in decreased emission of GHGs from ethanol production.",Legal,Fact Finding,Q&A "When responding, restrict yourself to only information found within the given article - no other information is valid or necessary.",What are the current therapy practices to treat fibromyalgia according to the document?," International Journal of Molecular Sciences Review Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies Massimo E. Ma↵ei Department of Life Sciences and Systems Biology, University of Turin, 10135 Turin, Italy; massimo.ma↵eil@unito.it; Tel.: +39-011-670-5967 !""#!$%&'(! Received: 6 October 2020; Accepted: 22 October 2020; Published: 23 October 2020 !""#$%&' Abstract: Fibromyalgia (FM) is a syndrome that does not present a well-defined underlying organic disease. FM is a condition which has been associated with diseases such as infections, diabetes, psychiatric or neurological disorders, rheumatic pathologies, and is a disorder that rather than diagnosis of exclusion requires positive diagnosis. A multidimensional approach is required for the management of FM, including pain management, pharmacological therapies, behavioral therapy, patient education, and exercise. The purpose of this review is to summarize the recent advances in classification criteria and diagnostic criteria for FM as well as to explore pharmacotherapy and the use of alternative therapies including the use of plant bioactive molecules. Keywords: fibromyalgia; diagnosis; pharmacotherapy; alternative therapies; plant extracts; natural products 1. Introduction Fibromyalgia (FM) (earlier considered to be fibrositis, to stress the role of peripheral inflammation in the pathogenesis) is a syndrome that does not present a well-defined underlying organic disease. The primary driver of FM is sensitization, which includes central sensitivity syndromes generally referred to joint sti↵ness, chronic pain at multiple tender points, and systemic symptoms including cognitive dysfunction, sleep disturbances, anxiety, fatigue, and depressive episodes [1,2]. FM is a heterogeneous condition that is often associated to specific diseases such as infections, psychiatric or neurological disorders, diabetes and rheumatic pathologies. FM is more frequent in females, where it causes musculoskeletal pain [3] and a↵ects significantly the quality of life, often requiring an unexpected healthcare e↵ort and consistent social costs [4,5]. Usually, a patient-tailored approach requires a pharmacological treatment by considering the risk-benefit ratio of any medication. Being the third most common diagnosis in rheumatology clinics, FM prevalence within the general population appears to range from 1.3–8% [2]. To date there are no specific tests specific for FM. FM is currently recognized by the widespread pain index (which divides the body into 19 regions and scores how many regions are reported as painful) and a symptom severity score (SSS) that assesses cognitive symptoms, unrefreshing sleep and severity of fatigue [6]. It is not clear what causes FM and diagnosing assist the patients to face polysymptomatic distress, thereby reducing doubt and fear which are main psychological factors contributing to this central amplification mechanism [7]. In this review, an update on diagnosis and therapy of FM is provided along the discussion on the possibility of using pharmacological drugs, bioactive natural substances and alternative therapies to alleviate the symptomatology in combination or as alternative remedies to drugs. Int. J. Mol. Sci. 2020, 21, 7877 2 of 27 2. Diagnosis To date there is still a considerable controversy on the assessment and diagnosis of FM. Despite advances in the understanding of the pathologic process, FM remains undiagnosed in as many as 75% of people with the condition [8]. The first attempt for the FM classification criteria is dated 1990 and is based on studies performed in 16 centers in the U.S.A. and Canada in clinical and academic settings, gathering the both doubters and proponents [9]. Since then, several alternative methods of diagnosis have been proposed. In general, most of the researchers agree on the need to assess multiple domains in FM including pain, sleep, mood, functional status, fatigue, problems with concentration/memory (i.e. dyscognition) and tenderness/sti↵ness [5]. Four core areas were initially assessed: (1) pain intensity, (2) physical functioning, (3) emotional functioning, and (4) overall improvement/well-being [10]. About 70–80% of patients with FM also report having sleep disturbances and fatigue. Depressive symptoms, anxiety and mood states have also been included in FM diagnosis. An impairment in multiple areas of function, especially physical function is often reported by patients with FM [11] with a markedly impaired function and quality of life [8]. Since the late 19900 s, a top priority was the development of new disease-specific measures for each of the relevant domains in FM. Also, much attention was paid to studies supporting the valid use of existing instruments specifically in the context of FM [5]. Later on, in 2010, the tender point count was abandoned and the American College of Rheumatology (ACR) suggested preliminary diagnostic criteria which were considering the number of painful body regions evaluating the presence and severity of fatigue, cognitive difficulty, unrefreshed sleep and the extent of somatic symptoms. The diagnostic criteria are not based on laboratory or radiologic testing to diagnose FM and rely on a 0–12 Symptom Severity Scale (SSS) which is used to quantify FM-type symptom severity [12]. Furthermore, the SSS was proposed to be combined with the Widespread Pain Index (WPI) into a 0–31 Fibromyalgianess Scale (FS) [13]. With a specificity of 96.6% and sensitivity of 91.8%, a score 13 for FS was able to correctly classify 93% of patients identified as having FM based on the 1990 criteria [14]. ACR 2010 criteria were also found to be more sensitive than the ACR 1990 criteria, allowing underdiagnosed FM patients to be correctly identified and giving a treatment opportunity to those who had previously been untreated [15]. It is still unclear whether the diagnosis of FM has the same meaning with respect to severity in primary FM (PFM, a dominant disorder that occurs in the absence of another clinically important and dominant pain disorder) and secondary FM (SFM, which occurs in the presence of another clinically important and dominant medical disorder) [16]. Figure 1 shows the ACR 1990 criteria for the classification of fibromyalgia, whereas Figure 2 shows a graphical representation of the Symptom Severity Scale (SSS) plus the Extent of Somatic Symptoms (ESS). Figure 1. Widespread Pain Index from ACR 1990 criteria for the classification of fibromyalgia and related regions. Int. J. Mol. Sci. 2020, 21, 7877 3 of 27 Figure 2. Symptom Severity scale (SSS) and Extent of Somatic Symptoms (ESS). Table 1 shows a holist approach based on the assumption that a multitude of potential diagnoses is fundamental in order to avoid an FM misdiagnosis [17]. In 2013, alternative diagnostic criteria have been developed by some clinicians in the USA including more pain locations and a large range of symptoms than ACR 2010. A self-reported survey was composed of the 28-area pain location inventory and the 10 symptom items from the Symptom Impact Questionnaire (SIQ) [18]. However, when compared to the early 2010 criteria, these alternative criteria did not significantly contribute in di↵erentiating common chronic pain disorders from FM [1]. In 2015, the view of diagnostic criteria was altered by ACR by providing approval only for classification criteria and no longer considering endorsement of diagnostic criteria, stressing that diagnostic criteria are di↵erent from classification criteria and are beyond the remit of the ACR [19]. However, the suggestion that diagnostic and classification criteria represent 2 ends of a continuum implies that the continuum represents the accuracy of the criteria [20]. Classification criteria and diagnostic criteria could intersect; however, according to some authors the terms “diagnosis” and “classification criteria” should be considered as qualitatively distinct concepts. The proposed concept of “diagnostic criteria” [19] is challenging and may be hardly realizable, while diagnostic guidelines based on proper modelling techniques may be helpful for clinicians in particular settings [20]. In 2016, based on a generalized pain criterion and clinic usage data, a new revision of the 2010/2011 FM criteria was developed including the following criteria: 1) generalized pain, defined as pain present in at least 4 of 5 regions; 2) symptoms present at a similar level for at least three months; 3) a WPI 7 and SSS 5 or WPI of 4–6 and SSS 9; 4) a diagnosis of FM is valid irrespective of other diagnoses. Another important point is that the presence of other clinically important illnesses does not exclude a diagnosis of FM [21]. In 2018, considering important but less visible factors that have a profound influence on under- or over-diagnosis of FM provided a new gate to a holistic and real understanding of FM diagnosis, beyond existing arbitrary and constructional scores [22]. Int. J. Mol. Sci. 2020, 21, 7877 4 of 27 Table 1. ACR2010 and modified criteria for the diagnosis of fibromyalgia. Widespread pain index (WPI) Areas specification Number of areas in which the patient has had 0–19 points pain over the past week shoulder girdle, hip (buttock, trochanter), jaw, upper back, lower back, upper arm, upper leg, chest, neck, abdomen, lower arm, Areas to be considered and lower leg (all these areas should be considered bilaterally) Symptom Severity Scale (SSS) score Symptom Level of severity Symptom level Score For each of these 3 symptoms, indicate the level of severity over the past week Considering somatic symptoms in using the following scale: Fatigue general, indicate whether the patient has 0 = no problem Waking unrefreshed the following: 1 = slight or mild problems, generally Cognitive symptoms (e.g., working memory 0 = no symptoms Final score between 0 and 12 mild or intermittent capacity, recognition memory, verbal knowledge, 1 = few symptoms 2 = moderate; considerable problems, anxiety, and depression) 2 = a moderate number of symptoms often present and/or at a moderate level 3 = a great deal of symptoms 3 = severe; pervasive, continuous, life-disturbing problems Criteria Specification Conditions A patient satisfies diagnostic criteria for (a)WPI 7/19 and SS scale score 5 or WPI 3–6 and SS scale score 9 fibromyalgia if the following 3 conditions (b) symptoms have been present as a similar level for at least 3 months are met (c) the patient does not have a disorder that would otherwise explain the pain Modified criteria Specification Conditions Final Score (a)WPI (as above) A patient satisfies diagnostic criteria for (b) SS scale score (as above, but without The number of pain sites (WPI), the SS scale score, and the presence of associated fibromyalgia if the following 3 conditions extent of somatic symptoms) symptoms are summed to give a final score between 0 and 31 are met (c) presence of abdominal pain, depression, headaches (yes = 1, no = 0) Int. J. Mol. Sci. 2020, 21, 7877 5 of 27 In 2019, in cooperation with the WHO, an IASP Working Group has developed a classification system included in the International Classification of Diseases (ICD-11) where FM has been classified as chronic primary pain, to distinguish it from pain which is secondary to an underlying disease [23]. More recently, a study of about 500 patients under diagnosis of FM, revealed that 24.3% satisfied the FM criteria, while 20.9% received a clinician International Classification of Diseases (ICD) diagnosis of FM, with a 79.2% agreement between clinicians and criteria. The conclusions of this study pointed out a disagreement between ICD clinical diagnosis and criteria-based diagnosis of FM, calling into question meaning of a FM diagnosis, the validity of physician diagnosis and clinician bias [24]. FM is a disorder that cannot be based on diagnosis of exclusion, rather needing positive diagnosis [6], through a multidimensional FM diagnostic approach making diagnosis encompassing psychosocial stressors, subjective belief, psychological factors and somatic complaints [25]. The advent of the PSD scale identified a number of problems in FM research [16]. Recently, immunophenotyping analysis performed on blood samples of FM patients revealed a role of the Mu opioid receptor on B lymphocytes as a specific biomarker for FM [26]. Moreover, a rapid biomarker-based method for diagnosing FM has been developed by using vibrational spectroscopy to di↵erentiate patients with FM from those with other pain-related diseases. Unique IR and Raman spectral signatures were correlated with FM pain severity measured with FM impact questionnaire revised version (FIQR) [27]. Overall, these findings provide reliable diagnostic tests for di↵erentiating FM from other disorders, for establishing serologic biomarkers of FM-associated pain and were useful for the contribution of the legitimacy of FM as a truly painful disease. In summarizing aspects of FM learned through applications of criteria to patients and trials, Wolfe [28] identified 7 main concepts: 1) there is no way of objectively testing FM which also has no binding definition; 2) prevalence and acceptance of FM depend on factors largely external to the patient; 3) FM is a continuum and not a categorical disorder; 4) every feeling, symptom, physical finding, neuroscience measure, cost and outcome tells one very little about the disorder and its mechanisms when fibromyalgia to “normal subjects” is compared; 5) the range and content of symptoms might indicate that FM may not truly be a syndrome; 6) “pain and distress” type of FM subject identified in the general population [29] might be considered as part of the FM definition and; 7) caution is needed when accepting the current reductive neurobiological causal explanations as sufficient, since FM is a socially constructed and arbitrarily defined and diagnosed dimensional disorder. 3. Therapy 3.1. Pharmacotherapy of FM Clinical trials have failed to conclusively provide overall benefits of specific therapies to treat FM; therefore, current pharmacological treatments for patients su↵ering from FM are mainly directed to palliate some symptoms, with relevant clinical benefits experienced only by a minority of individuals from any one intervention. In those treated with pharmacotherapy, a 50%reduction in pain intensity is generally achieved only by 10% to 25% [30] However, some treatments seem to significantly improve the quality of life of certain FM patients [31]. Only a few drugs have been approved for use in the treatment of FM by the US FDA, whereas no drug has been approved for this indication by the European Medicines Agency. Thus patients with FM frequently need to be treated on an o↵-label basis [32]. Currently, only 25% to 40% pain reduction is granted by drugs and meaningful relief occurs in only 40% to 60%, in part due to dose-limiting adverse e↵ects and incomplete drug efficacy [33]. These limitations in clinical practice have led some to hypothesize that a combination of di↵erent analgesic drugs acting through di↵erent mechanisms may provide superior outcomes compared to monotherapy [34]. Moreover, drugs should be started at low doses and cautiously increased because some patients, either do not tolerate or benefit from drug therapy. Because sleep disturbance, pain and psychological distress are the most amenable to drug therapy, drugs should be chosen to manage the individual’s predominant symptoms [35]. Currently, several drugs are frequently used alone Int. J. Mol. Sci. 2020, 21, 7877 6 of 27 or in combination to manage FM symptoms; however, the US FDA indicated for FM only three: two selective serotonin and norepinephrine reuptake inhibitors (SNRIs), duloxetine and milnacipran, and an anticonvulsant, pregabalin [36]. In the next sections, the use of selected drugs aimed to alleviate FM will be described. 3.1.1. Cannabinoids in FM Therapy The cannabinoid system is ubiquitous in the animal kingdom and plays multiple functions with stabilizing e↵ects for the organism, including modulation of pain and stress, and the management of FM may have therapeutic potential by manipulating this system. The cannabinoid system contributes in maintaining equilibrium and stabilizing e↵ects on FM [37]. Moreover, the endocannabinoid neuromodulatory system is involved in multiple physiological functions, such as inflammation and immune recognition, endocrine function, cognition and memory, nausea, antinociception and vomiting, [38]. Deficiency in the endocannabinoid system has been correlated to FM [39], but without clear clinical evidence in support of this assumption [40]. The endocannabinoid system consists of two cannabinoid receptors, the CB1 and CB2 receptors [41]. In acute and chronic pain models, analgesic e↵ects are associated to CB1 agonists that act at many sites along pain transmission pathways, including activation of spinal, supraspinal and peripheral CB1 receptors, each independently decreasing nociception [42]. Delta 9-tetrahydrocannabinol (D9-THC or Dronabinol, 1) is the main active constituent of Cannabis sativa var indica, with psychoactive and pain-relieving properties. The non-selective binding to G-protein-coupled CB receptors is responsible for the pharmacological e↵ects induced by D9-THC. Cannabidiol (CBD, 2), a non-psychotropic constituent of cannabis, is a high potency antagonist of CB receptor agonists and an inverse agonist at the CB2 receptor [43]. CBD displays CB2 receptor inverse agonism, an action that appears to be responsible for its antagonism of CP55940 at the human CB2 receptor [44]. This CB2 receptor inverse agonist ability of CBD may contribute to its documented anti-inflammatory properties [44]. The main endocannabinoids are anandamide (N-arachidonoylethanolamine, AEA, 3) and 2-arachidonoylglycerol (2-AG, 4), AG), the activity of which is modulated by the hydrolyzing fatty acid palmitoylethanolamide (PEA, 5) and the endocannabinoid precursor arachidonic acid (AA, 6) [45]. AEA and 2-AG are functionally related to D9-THC [46]. It was found that stress induces a rapid anandamide release in several CNS regions resulting in stress-induced analgesia via CB1 receptors [47]. FM patients had significantly higher anandamide plasma levels [39,46]; however, it has been suggested that the origin of FM and chronic pain depend on a deficiency in the endocannabinoid signaling [45]. Monotherapies of FM based on D9-THC are based on the assumption that this compound acts as an analgesic drug; however, although a sub-population of FM patients reported significant benefits from the use of D9-THC, this statement cannot be made [48]. When the quality of life of FM patients who consumed cannabis was compared with FM subjects who were not cannabis users, a significant improvement of symptoms of FM in patients using cannabis was observed, although there was a variability of patterns [49]. The synthetic cannabinoid nabilone (7) showed of a superiority over placebo to reduce FM symptoms, with significant reductions in Visual Analog Scale (VAS) for pain, FM Impact Questionnaire (FIQ), and anxiety [42], indicating the efficacy of treating people with FM with nabilone. Nabilone was also e↵ective in improving sleep [50]; however, participants taking nabilone experienced more adverse events (such as dizziness/drowsiness, dry mouth and vertigo) than did participants taking placebo or amitriptyline (see below). The self-medication practice of herbal cannabis was associated with negative psychosocial parameters. Therefore, caution should be exercised in recommending the use of cannabinoids pending clarification of general health and psychosocial problems [51,52]. Figure 3 illustrates the chemical formulas of some cannabinoids and endocannabinoids. Int. J. Mol. Sci. 2020, 21, 7877 7 of 27 Figure 3. Structure formulae of some cannabinoids and related compounds. Numbers correspond to compound names cited in the text. 3.1.2. Opioids in FM Therapy One of the major natural sources of opioids is the medicinal plant Papaver somniferum. Although clinical evidence demonstrating the efficacy or e↵ectiveness of opioids analgesics is scanty, these molecules are widely used for the treatment of FM [53]. However, the long-term use of opioids in FM has been discouraged by several medical guidelines [54]. The use of opioids is documented in studies demonstrating increased endogenous opioid levels in the cerebrospinal fluid of patients with FM vs. controls [55]. These results prompted the interesting hypothesis that a more activated opioid system can be detected in individuals with FM, reflecting reduced receptor availability and increased release of endogenous opioids [54]. There is evidence from both single center, prospective, longitudinal and multicenter and observational clinical studies of negative e↵ects of the use of opioids in FM on patient outcomes compared with other therapies [56,57]. Moreover, opioid user groups showed less improvement in the SFM-36 subscale scores of general health perception and in the FIQ subscale scores of job ability, fatigue and physical impairment [58]. Furthermore, altered endogenous opioid analgesic activity in FM has been demonstrated and suggested as a possible reason for why exogenous opiates appear to have reduced efficacy [59]. Despite these facts, opioids have been prescribed for 10% to 60% of patients with FM as reported in large database sets [54]. When considered, the preference of patients appears towards opioids. In a survey, 75% of patients considered hydrocodone (8) plus acetaminophen to be helpful, and 67% considered oxycodone (9) plus acetaminophen to be helpful [60]. FM has been associated with preoperative opioid use, including hydrocodone [61], whereas there is limited information from randomized controlled trials on the benefits or harms of oxycodone when used to treat pain in FM [62]. A pilot study showed that naltrexone (10) reduced self-reported symptoms of FM (primarily daily pain and fatigue) [63] and further studies showed that low-dose naltrexone had a specific and clinically beneficial impact on FM. This opioid, which is widely available and inexpensive, Int. J. Mol. Sci. 2020, 21, 7877 8 of 27 was found to be safe and well-tolerated. Blocking peripheral opioid receptors with naloxone (11) was observed to prevent acute and chronic training-induced analgesia in a rat model of FM [64]; however, there were no significant e↵ects of naloxone nor nocebo on pressure pain threshold, deep tissue pain, temporal summation or conditioned pain modulation in chronic fatigue syndrome/FM patients [65]. A synthetic opioid receptor agonist that shows serotonin-norepinephrine reuptake inhibitor properties is tramadol (12); this compound is often prescribed for painful conditions [66]. Tramadol has been studied in humans who su↵er from FM [56], suggesting that tramadol may be e↵ective in treating FM [67]. The use of tramadol provides change in pain assessed by visual analogue scale and FM impact questionnaire; however, the reported side e↵ects include dizziness, headache, constipation, addiction, withdrawal, nausea, serotonin syndrome, somnolence, pruritus seizures, drug–drug interactions with antimigraine and antidepressants medications [66]. Therefore, it is recommended that tramadol application should be considered in refractory and more treatment-resistant cases of FM. Another weak opioid is codeine (13). In a comparative study, there was a significantly higher proportion of patients in the codeine-acetaminophen group reporting somnolence or constipation and a larger proportion of patients in the tramadol-acetaminophen group reporting headache. The overall results suggested that tramadol-acetaminophen tablets (37.5 mg/325 mg) were as e↵ective as codeine-acetaminophen capsules (30 mg/300 mg) in the treatment of chronic pain [68]. Fentanyl (14) works primarily by activating µ-opioid receptors and was found to be around 100 times stronger than morphine (15), although its e↵ects are more localized. Fentanyl injections reduced second pain from repeated heat taps in FM patients. Similar to reports of e↵ects of morphine on first and second pain, fentanyl had larger inhibitory e↵ects on slow temporal summation of second pain than on first pain from a nociceptor stimulation [69]. Since fentanyl can inhibit windup of second pain in FM patients, it can prevent the occurrence of intense summated second pain and thereby reduce its intensity by a greater extent than first or second pains evoked by single stimuli. Among the 70,237 drug-related deaths estimated in 2017 in the US, the sharpest increase occurred among those related to fentanyl analogs with almost 29,000 overdose deaths which represents more than 45% increase from 2016 to 2017 [70]. Because the numbers of overdoses and deaths due to fentanyl will continue to increase in the coming years, studies are needed to elucidate the physiological mechanisms underlying fentanyl overdose in order to develop e↵ective treatments aimed to reduce the risk of death [71]. Glial cell activation is one of the several other possible pathophysiologic mechanisms underlying the development of FM by contributing to central nervous system sensitization to nociceptive stimuli [72]. Pentoxifylline (16), a xanthine derivative used as a drug to treat muscle pain in people with peripheral artery disease, is a nonspecific cytokine inhibitor that has been shown to attenuate glial cell activation and to inhibit the synthesis of TNF↵, IL-1 , and IL-6 [73]. In theory, attenuating glial cell activation via the administration of pentoxifylline to individuals su↵ering from FM might be efficient in ameliorating their symptoms without being a globalist therapeutic approach targeting all possible pathophysiologic mechanisms of development of the syndrome [74]. With regards FM pathophysiology, serum brain-derived neurotrophic factors (BDNF) were found at higher levels in FM patients while BDNF methylation in exon 9 accounted for the regulation of protein expression. These data suggest that altered BDNF levels might represent a key mechanism explaining FM pathophysiology [75]. Opioid users were also observed to experience a decreased pain and symptom severity when ca↵eine (17) was consumed, but this was not observed in opioid nonusers, indicating ca↵eine may act as an opioid adjuvant in FM-like chronic pain patients. Therefore the consumption of ca↵eine along with the use of opioid analgesics could represent an alternative therapy with respect to opioids or ca↵eine alone [76]. Figure 4 shows the chemical formulae of some opioids used in FM therapy. Int. J. Mol. Sci. 2020, 21, 7877 9 of 27 Figure 4. Structure formulae of some opioids and related compounds. Numbers correspond to molecules cited in the text. 3.1.3. Gabapentinoids in FM Therapy Gabapentinoid drugs are US Food and Drug Administration (FDA) (but not in Europe) anticonvulsants approved for treatment of pain syndromes, including FM. However, FDA approved pregabalin (18) but not gabapentin (19) for FM treatment; nevertheless, gabapentin is often prescribed o↵-label for FM, presumably because it is substantially less expensive [77]. Pregabalin is a gamma-aminobutyric acid (GABA) analog and is a ligand for the ↵2 subunit of the calcium channel being able of reducing the ability of docked vesicles to fuse and release neurotransmitters [78]. Pregabalin shows e↵ects on cortical neural networks, particularly when basal neurons are under hyperexcitability. The pain measures and pregabalin impact on the cortical excitability was observed only in FM patients [79]. Pregabalin was also found to increase norepinephrine levels in reserpine-induced myalgia rats [80]. Because of its tolerability when used in combination with antidepressants, pregabalin use showed a very good benefit to risk ratio [81]. The starting approved dosage for pregabalin is at 150 mg daily [82]; however, the drug shows a higher e↵ectiveness when used at a dose of 300 or 600 mg/day. Lower pregabalin doses than those of clinical trials are used in clinical practice because higher doses are more likely to be intolerable [83]. A recent systematic review shows that a minority of people with moderate to severe pain due to FM treated with a daily dose of 300 to 600 mg of pregabalin had a reduction of pain intensity over a follow-up period of 12 to 26 weeks, with tolerable adverse e↵ects [84]. Thus, pregabalin is one of cardinal drugs used in the treatment of FM, and its clinical utility has been comprehensively demonstrated [85,86]. Nevertheless, there is still insufficient evidence to support or refute that gabapentin may reduce pain in FM [87]. Figure 5 depicts the chemical formulae of some gabapentinoids. Int. J. Mol. Sci. 2020, 21, 7877 10 of 27 Figure 5. Structure formulae of some gabapentinoids. Numbers correspond to molecules cited in the text. 3.1.4. Serotonin–Norepinephrine Reuptake Inhibitors in FM Therapy There is a wide use of serotonin and noradrenaline reuptake inhibitors (SNRIs). There is no unbiased evidence that serotonin selective reuptake inhibitors (SSRIs) are superior to placebo in treating depression in people with FM and for treating the key symptoms of FM, namely sleep problems, fatigue and pain. However, it should be considered that young adults aged 18 to 24, with major depressive disorder, showed an increased suicidal tendency when treated with SSRIs [88]. A recent Cochrane review evaluated the use of SNRIs including eighteen studies with a total of 7,903 adults diagnosed with FM, by using desvenlafaxine (20) and venlafaxine (21) in addition to duloxetine (22) and milnacipran (23), by considering various outcomes for SNRIs including health related quality of life, fatigue, sleep problems, pain and patient general impression, as well as safety and tolerability [89]. Fifty two percent of those receiving duloxetine and milnacipran had a clinically relevant benefit over placebo compared to 29% of those on placebo, with much or very much improvements in the intervention. On the other hand, reduction of pain intensity was not significantly di↵erent from placebo when desvenlafaxine was used. However, pain relief and reduction of fatigue was not clinically relevant for duloxetine and milnacipran in 50% or greater and did not improve the quality of life [90]. Same negative outcomes were found for reducing problems in sleep and the potential general benefits of duloxetine and milnacipran were outweighed by their potential harms. The efficacy of venlafaxine in the treatment of FM was studied to a lesser extent. The lack of consistency in venlafaxine dosing, placebo control and blinding make difficult to understand whether the molecule is e↵ective in treating FM. Nevertheless, tolerability and the lower cost of venlafaxine increases its potential use for the treatment of FM, by rendering the molecule a more a↵ordable option compared to the other, more expensive SNRIs [91]. Mirtazapine (24) promotes the release of noradrenaline and serotonin by blocking ↵2 -adrenergic autoreceptors and ↵2 -adrenergic heteroreceptors, respectively. Mirtazapine, by acting through 5-HT1A receptors and by blocking postsynaptic 5-HT2A , 5-HT2C , and 5-HT3 receptors is able to enhance serotonin neurotransmission [92]. For these properties, mirtazapine is classified as a noradrenergic and specific serotonergic antidepressant [93]. Mirtazapine appears to be a promising therapy to improve sleep, pain, and quality of life in patients with FM [94]. In Japanese patients with FM, mirtazapine caused a significantly greater reduction in the mean numerical rating scale pain score and remained significantly greater from week 6 onward, compared with placebo. However, Adverse mirtazapine caused adverse events including weight gain, somnolence and increased appetite when compared to placebo [92]. Among antidepressants, the tricyclic antidepressant (TCAs) amitriptyline (25) was studied more than other antidepressants. It is frequently used to assess comparative efficacy [95] and for many years amitriptyline has been a first-line treatment for FM. Although there is no supportive unbiased evidence for a beneficial e↵ect, the drug was successful for the treatment in many patients with FM. However, amitriptyline achieve satisfactory pain relief only by a minority of FM patients and is unlikely that any large randomized trials of amitriptyline will be conducted in FM to establish efficacy Int. J. Mol. Sci. 2020, 21, 7877 11 of 27 statistically, or measure the size of the e↵ect [96]. Figure 6 depicts the chemical formulae of some SNRIs and TCA. Figure 6. Chemical structure of some serotonin and noradrenaline reuptake inhibitors and a tricyclic antidepressant. Numbers correspond to molecules cited in the text. 3.2. Alternative Therapies for FM A survey of the European guidelines shows that most of the pharmacological therapies are relatively modest providing only weak recommendations for FM [97]. A multidimensional approach is therefore required for the management of FM, including pharmacological therapies along with behavioral therapy, exercise, patient education and pain management. A multidisciplinary approach combines pharmacotherapy with physical or cognitive interventions and natural remedies. Very often, patients seek help in alternative therapies due to the limited efficacy of the therapeutic options. The following sections discuss some of the most used alternative therapies to treat FM. 3.2.1. Acupunture Acupuncture shows low to moderate-level in improving pain and sti↵ness in people with FM. In some cases, acupuncture does not di↵er from sham acupuncture in improving sleep or global well-being or reducing pain or fatigue. The mechanisms of acupuncture action in FM treatment appears to be correlated to changes in serum serotonin levels [98]. Electro-acupuncture (EA) was more e↵ective than manual acupuncture (MA) for improving sleep, global well-being and fatigue and in the reduction of pain and sti↵ness. Although e↵ective, the e↵ect of acupuncture is not maintained at six months follow-up [99]. Moreover, there is a lack of evidence that real acupuncture significantly di↵ers from sham acupuncture with respect to improving the quality of life, both in the short and long term. However, acupuncture therapy is a safe treatment for patients with FM [100,101]. 3.2.2. Electric Stimulation As we discussed, FM, aside pain, is characterized by anxiety, depression and sleep disturbances, and by a complex cognitive dysfunctioning status known as “fibrofog” which is characterized by disturbance in working memory, attention and executive functions globally often referred by the patients as a sense of slowing down, clumsiness and confusion that have a profound impact on the ability to perform and e↵ectively plan daily activities [102,103]. Besides stimulation with acupuncture, the e↵ective modulation of brain areas has been obtained through non-invasive brain stimulation by Int. J. Mol. Sci. 2020, 21, 7877 12 of 27 magnetic or electric currents applied to the scalp like transcranial magnetic and electrical stimulation. In many cases, to relieve pain and improve general FM-related function, the use of anodal transcranial direct current stimulation over the primary motor cortex was found to be significantly more e↵ective than sham transcranial direct current stimulation [104]. If we consider that pharmacological and non-pharmacological treatments are often ine↵ective or transitory in their e↵ect on FM, therapeutic electrical stimulation appears to have a potential role [105]. Cognitive functions such as memory have been enhanced in FM patients by anodal transcranial direct current stimulation over the dorsolateral prefrontal cortex and has clinical relevance for top-down treatment approaches in FM [106]. In FM patients, modulation of hemodynamic responses by transcutaneous electrical nerve stimulation during delivery of nociceptive stimulation was also investigated and shown to be an e↵ective factor in FM treatment, although the underlying mechanism for these findings still needs to be clarified [107]. It has been recently demonstrated that both transcutaneous electric nerve stimulation and acupuncture applications seem to be beneficial in FM patients [108]. In a recent Positron Emission Tomography H2 15 O activation study it was shown that occipital nerve field stimulation acts through activation of the descending pain inhibitory pathway and the lateral pain pathway in FM, while electroencephalogram shows activation of those cortical areas that could be responsible for descending inhibition system recruitment [109]. Microcirculation is of great concern in patients with FM. Recently low-energy pulsed electromagnetic field therapy was found to increase a promising therapy to increase microcirlulation [110]; however, neither pain and sti↵ness were reduced nor functioning was improved by this therapy in women with FM [111]. The European Academy of Neurology, based on the method of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) judged anodal transcranial direct currents stimulation of motor cortex as still inconclusive for treatment of FM [112]. Therefore, further studies are needed to determine optimal treatment protocols and to elucidate the mechanisms involved [113]. 3.2.3. Vibroacoustic and Rhythmic Sensory Stimulation Stimulation with sensory events such as pulsed or continuous auditory, vibrotactile and visual flickering stimuli are referred as rhythmic sensory stimulation [114]. Clinical studies have reported the application of vibroacoustic stimulation in the treatment of FM. In a clinal study, one group of patients with FM listened to a sequence of Bach’s compositions, another was subjected to vibratory stimuli on a combination of acupuncture points on the skin and a third group received no stimulation. The results showed that a greater e↵ect on FM symptoms was achieved by the combined use of music and vibration [115]. However, in another study, neither music nor musically fluctuating vibration had a significant e↵ect on tender point pain in FM patients when compared to placebo treatment [116]. Because thalamocortical dysrhythmia is implicated in FM and that low-frequency sound stimulation can play a regulatory function by driving neural rhythmic oscillatory activity, volunteers with FM were subjected to 23 min of low-frequency sound stimulation at 40 Hz, delivered using transducers in a supine position. Although no adverse e↵ects in patients receiving the treatment, no statistically and clinically relevant improvement were observed [117]. On the other hand, gamma-frequency rhythmic vibroacoustic stimulation was found to decrease FM symptoms (depression, sleep quality and pain interference) and ease associated comorbidities (depression and sleep disturbances), opening new avenues for further investigation of the e↵ects of rhythmic sensory stimulation on chronic pain conditions [118]. 3.2.4. Thermal Therapies Thermal therapies have been used to treat FM. Two main therapies are currently used: body warming and cryotherapy. Int. J. Mol. Sci. 2020, 21, 7877 13 of 27 Because FM is strongly linked to rheumatic aches, the application of heat by spa therapy (balneotherapy) appears as a natural choice for the treatment of FM [119]. Spa therapy is a popular treatment for FM in many European countries, as well as in Japan and Israel. A randomized prospective study of a 10-day treatment was done on 48 FM patients improving their quality of life [120] and showed that treatment of FM at the Dead Sea was both e↵ective and safe [121]. FM patients who were poorly responding to pharmacological therapies were subjected to mud-bath treatment. A cycle of mud bath applications showed beneficial e↵ects on FM patients whose evaluation parameters remained stable after 16 weeks in comparison to baseline [122]. In patients su↵ering from FM, mud bathing was also found to prevent muscle atrophy and inflammation and improve nutritional condition [123]. Nevertheless, despite positive results, the methodological limitations of available clinical studies, such as the lack of placebo double-blinded trials, preclude definitive conclusions on the e↵ect of body-warming therapies to treat FM [119,124]. A remedy widely used in sports related trauma is the application of cold as a therapeutic agent for pain relief. Cryotherapy refers to the use of low temperatures to decrease the inflammatory reaction, including oedema [125]. Cryotherapy induces several organism physiological reactions like increasing anti-inflammatory cytokines, beta-endorphins, ACTH, white blood cells, catecholamines and cortisol, immunostimulation due to noradrenalin response to cold, the increase in the level of plasma total antioxidant status and the reduction of pain through the alteration of nerve conduction [126]. When compared to control FM subjects, cryotherapy-treated FM patients reported a more pronounced improvement of the quality of life [127]. Whole body cryotherapy was also found to be a useful adjuvant therapy for FM [126]. 3.2.5. Hyperbaric Treatment Hyperbaric oxygen therapy (HBOT) has shown beneficial e↵ects for the prevention and treatment of pain [128], including migraine, cluster headache [129] and FM [130]. HBOT is supposed to induce neuroplasticity that leads to repair of chronically impaired brain functions. HBOT was also found to it improve the quality of life in post-stroke patients and mild traumatic brain injury patients [131]. Therefore, the increased oxygen concentration caused by HBOT is supposed to change the brain metabolism and glial function with a potential e↵ect on reducing the FM-associated brain abnormal activity [132]. HBOT was found to a↵ect the mitochondrial mechanisms resulting in functional brain changes, stimulate nitric oxide production thus alleviating hyperalgesia and promoting the NO-dependent release of endogenous opioids which appear to be involved in the antinociception prompted by HBOT [133]. In a clinical study, a significant di↵erence between the HBOT and control groups was found in the reduction in tender points and VAS scores after the first and fifteenth therapy sessions [130]. These results indicate that HBOT may play an important role in managing FM. 3.2.6. Laser Therapy and Phototherapy The use of di↵erent light wavelengths has been found to be an alternative therapy for FM. It is known that low-level laser therapy is a therapeutic factor, being able not only to target one event in the painful reception, but rather the extend its e↵ectiveness on the whole hierarchy of mechanisms of its origin and regulation [134]. Laser photobiomodulation therapy has been reported to be e↵ective in the treatment of a variety of myofascial musculoskeletal disorders, including FM [135]. The combination of laser therapy and the administration of the drug amitriptyline was found to be e↵ective on clinical symptoms and quality of life in FM; furthermore, gallium-arsenide laser therapy was found to be a safe and e↵ective treatment which can be used as a monotherapy or as a supplementary treatment to other therapeutic procedures in FM [136]. Evidence supported also the use of laser therapy in women su↵ering FM to improve pain and upper body range of motion, ultimately reducing the impact of FM [137,138]. Finally, a combination of phototherapy and exercise training was evaluated in patients with FM in a randomized controlled trial for chronic pain to o↵er valuable clinical evidence for objective assessment of the potential benefits and risks of procedures [139]. Int. J. Mol. Sci. 2020, 21, 7877 14 of 27 3.2.7. Exercise and Massage Exercise therapy seems to be an e↵ective component of treatment, yielding improvement in pain and other symptoms, as well as decreasing the burden of FM on the quality of life [140]. Exercise is generally acceptable by individuals with FM and was found to improve the ability to do daily activities and the quality of life and to decrease tiredness and pain [141]. However, it is important to know the e↵ects and specificities of di↵erent types of exercise. For instance, two or more types of exercise may combine strengthening, aerobic or stretching exercise; however, there is no substantial evidence that mixed exercise may improve sti↵ness [142]. Quality of life may be improved by muscle stretching exercise, especially with regard to physical functioning and pain, whereas depression is reduced by resistance training. A trial including a control group and two intervention groups, both of which receiving exercise programs created specifically for patients with FM, showed that both modalities were e↵ective in an exercise therapy program for FM [143]. A progressive muscle strengthening activity was also found to be a safe and e↵ective mode of exercise for FM patients [144]. Furthermore, strength and flexibility exercises in aerobic exercise rehabilitation for FM patients led to improvements in patients’ shoulder/hip range of motion and handgrip strength [145]. Among women with FM, the association between physical activity and daily function is mediated by the intensity of musculoskeletal pain, rather than depressive symptoms or body mass [146], with a link between clinical and experimental pain relief after the performance of isometric contractions [147]. A randomized controlled trial evaluated the e↵ects of yoga intervention on FM symptoms. Women performing yoga showed a significant improvement on standardized measures of FM symptoms and functioning, including fatigue, mood and pain, and in pain acceptance and other coping strategies [148]. Moreover, the combination with massage therapy program during three months influenced perceived stress index, cortisol concentrations, intensity of pain and quality of life of patients with FM [149]. In terms of societal costs and health care costs, quality of life and physical fitness in females with FM was improved by aquatic training and subsequent detraining [150,151]. Aquatic physical training was e↵ective in promoting increased oxygen uptake at peak cardiopulmonary exercise test in women with FM [152]. A systematic evaluation of the harms and benefits of aquatic exercise training in adults with FM showed that it may be beneficial for improving wellness, symptoms, and fitness in adults with FM [153,154]. A safe and clinically efficacious treatment of pain and other FM symptoms was also achieved by the combination of osteopathic manipulative medicine and pharmacologic treatment with gabapentin [155]. Dancing is a type of aerobic exercise that may be used in FM alternative therapy. Belly dancing was found to be e↵ective in improving functional capacity, pain, quality of life and improving body image of women with FM [156]. More recently, three months treatment of patients with FM with Zumba dancing was found to be e↵ective in improving pain and physical functioning [157]. Finally, Tai chi mind-body treatment was found to improve FM symptoms as much as aerobic exercise and longer duration of Tai chi showed greater improvement. According to a recent report, mind-body approaches may take part of the multidisciplinary management of FM and be considered an alternative therapeutic option [158]. 3.2.8. Probiotics and FM Therapy A tractable strategy for developing novel therapeutics for complex central nervous system disorders could rely on the so called microbiota-gut-brain axis management, because intestinal homeostasis may directly a↵ect brain functioning [159,160]. The pain intensity of patients with FM has been reported to be correlated with the degree of small intestinal bacterial overgrowth, which is often associated with an increased intestinal permeability whose values were significantly increased in the FM patients [161]. Preclinical trials indicate that the microbiota and its metabolome are likely involved in modulating brain processes and behaviors [162]. Therefore, FM patients should show better performance after the treatment with probiotics. In a double-blind, placebo-controlled, randomized design probiotic Int. J. Mol. Sci. 2020, 21, 7877 15 of 27 improved impulsive choice and decision-making in FM patients, but no other e↵ects were observed on cognition, quality of life, self-reported pain, FM impact, depressive or anxiety symptoms [163]. 3.2.9. Use of Plant Extracts and Natural Products for FM Treatment About 40% of drugs used to treat FM originate from natural products [164]; however, there are a few studies that prove the safe and e↵ective use of various plant extracts in FM therapy. Several plant extracts are currently used for their antinociceptive properties and potential to treat FM [165]. Papaver somniferum is probably the most ancient plant used for its antinociceptive properties [166], with chemical components able to interact with opioid receptors; among these morphine (15) which is not only the oldest, but is still the most e↵ective drug for the management of severe pain in clinical practice [167]. The use of opioids for FM treatment has been discussed above. Another important plant is Cannabis sativa. The major active constituent of Cannabis, D9-THC (1), has been shown to possess antinociceptive properties when assessed in several experimental models [168] (see also the discussion above on cannabinoids). Although there is still scarce evidence to support its role in the treatment of FM, a large consensus indicates that medical cannabis could be an e↵ective alternative for the treatment of FM symptoms [169]. The illicit use of herbal cannabis for FM treatment has been correlated to the inefficacy of current available medications, but is also linked to popular advocacy or familiarity with marijuana from recreational use. Therefore, physicians are requested to examine the global psychosocial well-being, and not focus only on the single outcome measure of pain [52,170]. Although medical cannabis treatment has a significant favorable e↵ect on patients with FM, 30% of patients experience adverse e↵ects [171] and 8% report dependence on cannabis [172]. VAS scores measured in 28 FM patients after 2 hours of cannabis use showed enhancement of relaxation and feeling of well-being, a reduction of pain and sti↵ness which were accompanied by an increase in somnolence. The mental health component summary score of the Short Form 36 Health Survey was higher in cannabis users than in non-users [49]. Among terpenoids, administration of trans- -caryophyllene (BCP, 26), a bicyclic sesquiterpene compound existing in the essential oil of many plants like Copaifera langsdforffii, Cananga odorata, Humulus lupulus, Piper nigrum and Syzygium aromaticum, which provide a high percentage of BCP along with interesting essential oil yields [173], significantly minimized the pain in both acute and chronic pain models [174]. BCP selectively binds to the cannabinoid 2 (CB2 ) receptor and is a functional CB2 agonist. Upon binding to the CB2 receptor, BCP inhibits adenylate cylcase, leads to intracellular calcium transients and weakly activates the mitogen-activated kinases Erk1/2 and p38 in primary human monocytes [175]. BCP, a safe compound with toxicity at doses higher than 2000 mg/kg body weight [176], was found to reduce the primary and secondary hyperalgesia produced by a chronic muscle pain model (which is considered to be an animal model for FM) [177]. Significant and dose-dependent antinociceptive response was produced by BCP without the presence of gastric damage [178]. Antiallodynic actions of BCP are exerted only through activation of local peripheral CB2 [179]. In neuropathic pain models, BCP reduced spinal neuroinflammation and the oral administration was more e↵ective than the subcutaneously injected synthetic CB2 agonist JWH-133 [180]. Recently, BCP was found to exert an analgesic e↵ect in an FM animal model through activation of the descending inhibitory pain pathway [181]. Thus, BCP may be highly e↵ective in the treatment of long-lasting, debilitating pain states, suggesting the interesting application of BCP in FM therapy. The analgesic properties of myrrh (Commiphora myrrha) have been known since ancient times and depend on the presence of bioactive sesquiterpenes with furanodiene skeletons which are able to interact with the opioid receptors [182,183]. C. myrrha extracts exerted a stronger suppression on carrageenan-induced mice paw edema with significant analgesic e↵ects [184] and were e↵ective against chronic inflammatory joint disease such as osteoarthritis [185]. In a preclinical trial, pain alleviation was obtained with C. myrrha extracts for many pathologies [186], indicating that extracts from this plant may have the potential to treat FM. Int. J. Mol. Sci. 2020, 21, 7877 16 of 27 Preclinical studies indicate a potential use of Hypericum perforatum (Hypericaceae), popularly known as St. John’s wort, in medical pain management [187] due to its phenolic compounds. Many phenolic compounds (e.g., flavonoids) from medicinal plants are promising candidates for new natural analgesic drugs [188]. Quercetin (27) showed analgesic activity and could reduce neuropathic pain by inhibiting mTOR/p70S6K pathway-mediated changes of synaptic morphology and synaptic protein levels in spinal dorsal horn neurons of db/db mice [189], while rutin (28) could inhibit the writhing response of mice induced by potassium antimony tartrate and showed to be a promising pharmacological approach to treat pain [190]. The analgesia potency of hyperin (29) was approximately 20-fold of morphine, while luteolin (30) presented e↵ective analgesic activities for both acute and chronic pain management. Some glycosides of kaempferol (e.g., kaempferol 3-O-sophoroside, 31) possess significant analgesic activity in the tail clip, tail flick, tail immersion, and acetic acid-induced writhing models, whereas baicalin (32) shows analgesic e↵ects in several kinds of pain [191]. Fisetin (33), a plant flavonoid polyphenol, has been reported to possess potent antioxidant, antinociceptive and neuroprotective activities. In rats, fisetin acts via modulation of decreased levels of biogenic amines and elevatesoxido-nitrosative stress and ROS to ameliorate allodynia, hyperalgesia, and depression in experimental reserpine-induced FM [192]. In a double-blind parallel-group clinical trial, outpatients with FM were randomized to receive either 15 mg of Crocus sativus (sa↵ron) extract or 30 mg duloxetine (22). No significant di↵erence was detected for any of the scales neither in terms of score changes from baseline to endpoint between the two treatment arms, indicating that sa↵ron and duloxetine had comparable efficacy in treatment of FM symptoms [193]. It is still unclear the efficacy of natural products extracted from plants in treating FM. However, some clinical data show promising results and more studies with adequate methodological quality are necessary in order to investigate the efficacy and safety of natural products as a support in FM therapy. Figure 7 depicts the chemical formulae of some antinociceptive natural products. Figure 7. Chemical structure of some natural compounds with antinociceptive activity. Int. J. Mol. Sci. 2020, 21, 7877 17 of 27 4. Conclusions Diagnosis of FM is based on clinical feature and criteria that still lack either a gold standard or at least supportive laboratory findings. FM diagnostic criteria may include heterogeneous patients also in clinical trials and this may impair evaluation of clinically meaningful treatment e↵ect. The review of the literature suggests that a multidisciplinary therapeutic approach, based on the combination of pharmacologic and alternative therapy (including thermal, light, electrostimulatory and body exercise treatments) could improve the quality of life and reduce pain and other symptoms related to FM. However, sometimes the ability of patients to participate to alternative therapies is impeded by the level of pain fatigue, poor sleep, and cognitive dysfunction. These patients may need to be managed with medications before initiating nonpharmacologic therapies. Although the use of some natural phytochemicals like BCP and phenolic compounds might replace other natural products such as D9-THC, because of reduced side e↵ects and higher tolerability, FM self medication practice may be ine↵ective and in some cases even detrimental. Therefore, providing FM patients with the correct information about their disorders may help monitoring pharmacological and alternative therapies. At the same time maintaining information will help patients to receive the appropriate medications and therapies [194]. Funding: This research received no external funding. Conflicts of Interest: The author declares no conflict of interest Abbreviations 2-AG 2-ArachidonoylGlycerol AA Arachidonic Acid ACR American College of Rheumatology ACTH Adrenocorticotropic hormone AEA N-arachidonoylethanolamine BDNF Brain-Derived Neurotrophic Factors CB1 Cannabinoid Receptor 1 CB2 Cannabinoid Receptor 2 CBD Cannabidiol CNS Central Nervous System EA Electro-Acupuncture ESS Extent of Somatic Symptoms FIQ FM Impact Questionnaire FIQR FM Impact Questionnaire Revised version FM Fibromyalgia FS Fibromyalgianess Scale GABA Gamma-Aminobutyric Acid Grading of Recommendations, Assessment, GRADE Development, and Evaluation HBOT Hyperbaric Oxygen Therapy ICD-11 International Classification of Diseases IL-1 Interleukin 1 beta IL-6 Interleukin 6 MA Manual Acupuncture PEA Palmitoylethanolamide PFM Primary FM ROS Reactive Oxygen Species SIQ Symptom Impact Questionnaire SFM Secondary FM SNRIs Serotonin and Norepinephrine Reuptake Inhibitors SSRIs Serotonin Selective Reuptake Inhibitors SSS Symptom Severity Scale TCAs Tricyclic Antidepressant TNF↵ Tumor necrosis factor alpha VAS Visual Analog Scale WPI Widespread Pain Index D9-THC Delta 9-tetrahydrocannabinol Int. J. Mol. Sci. 2020, 21, 7877 18 of 27 References 1. Wang, S.M.; Han, C.; Lee, S.J.; Patkar, A.A.; Masand, P.S.; Pae, C.U. Fibromyalgia diagnosis: A review of the past, present and future. Expert Rev. Neurother. 2015, 15, 667–679. [CrossRef] [PubMed] 2. Chinn, S.; Caldwell, W.; Gritsenko, K. Fibromyalgia pathogenesis and treatment options update. Curr. Pain Headache Rep. 2016, 20, 25. [CrossRef] [PubMed] 3. Blanco, I.; Beritze, N.; Arguelles, M.; Carcaba, V.; Fernandez, F.; Janciauskiene, S.; Oikonomopoulou, K.; de Serres, F.J.; Fernandez-Bustillo, E.; Hollenberg, M.D. Abnormal overexpression of mastocytes in skin biopsies of fibromyalgia patients. Clin. Rheumatol. 2010, 29, 1403–1412. [CrossRef] [PubMed] 4. Cabo-Meseguer, A.; Cerda-Olmedo, G.; Trillo-Mata, J.L. Fibromyalgia: Prevalence, epidemiologic profiles and economic costs. Med. Clin. 2017, 149, 441–448. [CrossRef] [PubMed] 5. Williams, D.A.; Schilling, S. Advances in the assessment of fibromyalgia. Rheum. Dis. Clin. N. Am. 2009, 35, 339–357. [CrossRef] [PubMed] 6. Rahman, A.; Underwood, M.; Carnes, D. Fibromyalgia. BMJ Br. Med. J. 2014, 348. [CrossRef] [PubMed] 7. McBeth, J.; Mulvey, M.R. Fibromyalgia: Mechanisms and potential impact of the acr 2010 classification criteria. Nat. Rev. Rheumatol. 2012, 8, 108–116. [CrossRef] [PubMed] 8. Arnold, L.M.; Clauw, D.J.; McCarberg, B.H.; FibroCollaborative. Improving the recognition and diagnosis of fibromyalgia. Mayo Clin. Proc. 2011, 86, 457–464. [CrossRef] 9. Wolfe, F.; Smythe, H.A.; Yunus, M.B.; Bennett, R.M.; Bombardier, C.; Goldenberg, D.L.; Tugwell, P.; Campbell, S.M.; Abeles, M.; Clark, P.; et al. The american-college-of-rheumatology 1990 criteria for the classification of fibromyalgia—Report of the multicenter criteria committee. Arthritis Rheum. 1990, 33, 160–172. [CrossRef] 10. Dworkin, R.H.; Turk, D.C.; McDermott, M.P.; Peirce-Sandner, S.; Burke, L.B.; Cowan, P.; Farrar, J.T.; Hertz, S.; Raja, S.N.; Rappaport, B.A.; et al. Interpreting the clinical importance of group di↵erences in chronic pain clinical trials: Immpact recommendations. Pain 2009, 146, 238–244. [CrossRef] 11. Arnold, L.M.; Cro↵ord, L.J.; Mease, P.J.; Burgess, S.M.; Palmer, S.C.; Abetz, L.; Martin, S.A. Patient perspectives on the impact of fibromyalgia. Patient Educ. Couns. 2008, 73, 114–120. [CrossRef] [PubMed] 12. Wolfe, F.; Hauser, W. Fibromyalgia diagnosis and diagnostic criteria. Ann. Med. 2011, 43, 495–502. [CrossRef] [PubMed] 13. Wolfe, F. New american college of rheumatology criteria for fibromyalgia: A twenty-year journey. Arthritis Care Res. 2010, 62, 583–584. [CrossRef] [PubMed] 14. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.A.; Goldenberg, D.L.; Hauser, W.; Katz, R.S.; Mease, P.; Russell, A.S.; Russell, I.J.; Winfield, J.B. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the acr preliminary diagnostic criteria for fibromyalgia. J. Rheumatol. 2011, 38, 1113–1122. [CrossRef] 15. Oncu, J.; Iliser, R.; Kuran, B. Do new diagnostic criteria for fibromyalgia provide treatment opportunity to those previously untreated? J. Back Musculoskelet. Rehabil. 2013, 26, 437–443. [CrossRef] 16. Wolfe, F.; Walitt, B.; Rasker, J.J.; Hauser, W. Primary and secondary fibromyalgia are the same: The universality of polysymptomatic distress. J. Rheumatol. 2019, 46, 204–212. [CrossRef] 17. Bellato, E.; Marini, E.; Castoldi, F.; Barbasetti, N.; Mattei, L.; Bonasia, D.E.; Blonna, D. Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Pain Res. Treat. 2012, 2012, 426130. [CrossRef] 18. Bennett, R.M.; Friend, R.; Marcus, D.; Bernstein, C.; Han, B.K.; Yachoui, R.; Deodhar, A.; Kaell, A.; Bonafede, P.; Chino, A.; et al. Criteria for the diagnosis of fibromyalgia: Validation of the modified 2010 preliminary american college of rheumatology criteria and the development of alternative criteria. Arthritis Care Res. 2014, 66, 1364–1373. [CrossRef] 19. Aggarwal, R.; Ringold, S.; Khanna, D.; Neogi, T.; Johnson, S.R.; Miller, A.; Brunner, H.I.; Ogawa, R.; Felson, D.; Ogdie, A.; et al. Distinctions between diagnostic and classification criteria? Arthritis Care Res. 2015, 67, 891–897. [CrossRef] 20. Taylor, W.J.; Fransen, J. Distinctions between diagnostic and classification criteria: Comment on the article by Aggarwal et al. Arthritis Care Res. 2016, 68, 149–150. [CrossRef] 21. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.A.; Goldenberg, D.L.; Hauser, W.; Katz, R.L.; Mease, P.J.; Russell, A.S.; Russell, I.J.; Walitt, B. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin. Arthritis Rheum. 2016, 46, 319–329. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 19 of 27 22. Bidari, A.; Parsa, B.G.; Ghalehbaghi, B. Challenges in fibromyalgia diagnosis: From meaning of symptoms to fibromyalgia labeling. Korean J. Pain 2018, 31, 147–154. [CrossRef] 23. Treede, R.D.; Rief, W.; Barke, A.; Aziz, Q.; Bennett, M.I.; Benoliel, R.; Cohen, M.; Evers, S.; Finnerup, N.B.; First, M.B.; et al. Chronic pain as a symptom or a disease: The IASP classification of chronic pain for the international classification of diseases (ICD-11). Pain 2019, 160, 19–27. [CrossRef] 24. Wolfe, F.; Schmukler, J.; Jamal, S.; Castrejon, I.; Gibson, K.A.; Srinivasan, S.; Hauser, W.; Pincus, T. Diagnosis of fibromyalgia: Disagreement between fibromyalgia criteria and clinician-based fibromyalgia diagnosis in a university clinic. Arthritis Care Res. 2019, 71, 343–351. [CrossRef] [PubMed] 25. Eich, W.; Bar, K.J.; Bernateck, M.; Burgmer, M.; Dexl, C.; Petzke, F.; Sommer, C.; Winkelmann, A.; Hauser, W. Definition, classification, clinical diagnosis and prognosis of fibromyalgia syndrome: Updated guidelines 2017 and overview of systematic review articles. Schmerz 2017, 31, 231–238. [CrossRef] [PubMed] 26. Ra↵aeli, W.; Malafoglia, V.; Bonci, A.; Tenti, M.; Ilari, S.; Gremigni, P.; Iannuccelli, C.; Gioia, C.; Di Franco, M.; Mollace, V.; et al. Identification of mor-positive b cell as possible innovative biomarker (mu lympho-marker) for chronic pain diagnosis in patients with fibromyalgia and osteoarthritis diseases. Int. J. Mol. Sci. 2020, 21, 15. [CrossRef] [PubMed] 27. Hackshaw, K.V.; Aykas, D.P.; Sigurdson, G.T.; Plans, M.; Madiai, F.; Yu, L.B.; Buffington, C.A.T.; Giusti, M.M.; Rodriguez-Saona, L. Metabolic fingerprinting for diagnosis of fibromyalgia and other rheumatologic disorders. J. Biol. Chem. 2019, 294, 2555–2568. [CrossRef] 28. Wolfe, F. Criteria for fibromyalgia? What is fibromyalgia? Limitations to current concepts of fibromyalgia and fibromyalgia criteria. Clin. Exp. Rheumatol. 2017, 35, S3–S5. 29. Walitt, B.; Nahin, R.L.; Katz, R.S.; Bergman, M.J.; Wolfe, F. The prevalence and characteristics of fibromyalgia in the 2012 national health interview survey. PLoS ONE 2015, 10, e0138024. [CrossRef] 30. Moore, R.A.; Straube, S.; Aldington, D. Pain measures and cut-o↵s—No worse than mild pain as a simple, universal outcome. Anaesthesia 2013, 68, 400–412. [CrossRef] 31. Espejo, J.A.; Garcia-Escudero, M.; Oltra, E. Unraveling the molecular determinants of manual therapy: An approach to integrative therapeutics for the treatment of fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis. Int. J. Mol. Sci. 2018, 19, 19. [CrossRef] [PubMed] 32. Calandre, E.P.; Rico-Villademoros, F.; Slim, M. An update on pharmacotherapy for the treatment of fibromyalgia. Expert Opin. Pharmacother. 2015, 16, 1347–1368. [CrossRef] [PubMed] 33. Thorpe, J.; Shum, B.; Moore, R.A.; Wi↵en, P.J.; Gilron, I. Combination pharmacotherapy for the treatment of fibromyalgia in adults. Cochrane Database Syst. Rev. 2018, 2. [CrossRef] [PubMed] 34. Mease, P.J.; Seymour, K. Fibromyalgia: Should the treatment paradigm be monotherapy or combination pharmacotherapy? Curr. Pain Headache Rep. 2008, 12, 399–405. [CrossRef] 35. Kwiatek, R. Treatment of fibromyalgia. Aust. Prescr. 2017, 40, 179–183. [CrossRef] 36. Wright, C.L.; Mist, S.D.; Ross, R.L.; Jones, K.D. Duloxetine for the treatment of fibromyalgia. Expert Rev. Clin. Immunol. 2010, 6, 745–756. [CrossRef] 37. Pacher, P.; Batkai, S.; Kunos, G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol. Rev. 2006, 58, 389–462. [CrossRef] 38. De Vries, M.; van Rijckevorsel, D.C.M.; Wilder-Smith, O.H.G.; van Goor, H. Dronabinol and chronic pain: Importance of mechanistic considerations. Expert Opin. Pharmacother. 2014, 15, 1525–1534. [CrossRef] 39. Russo, E.B. Clinical endocannabinoid deficiency (CECD)—Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocr. Lett. 2004, 25. (Reprinted from Neuroendocrinilogy, 2004, 25, 31–39). 40. Smith, S.C.; Wagner, M.S. Clinical endocannabinoid deficiency (CECD) revisited: Can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocr. Lett. 2014, 35, 198–201. 41. Munro, S.; Thomas, K.L.; Abushaar, M. Molecular characterization of a peripheral receptor for cannabinoids. Nature 1993, 365, 61–65. [CrossRef] [PubMed] 42. Skrabek, R.Q.; Gallmova, L.; Ethans, K.; Perry, D. Nabilone for the treatment of pain in fibromyalgia. J. Pain 2008, 9, 164–173. [CrossRef] [PubMed] 43. Walitt, B.; Klose, P.; Fitzcharles, M.A.; Phillips, T.; Hauser, W. Cannabinoids for fibromyalgia. Cochrane Database Syst. Rev. 2016. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 20 of 27 44. Thomas, A.; Baillie, G.L.; Phillips, A.M.; Razdan, R.K.; Ross, R.A.; Pertwee, R.G. Cannabidiol displays unexpectedly high potency as an antagonist of cb1 and cb2 receptor agonists in vitro. Br. J. Pharmacol. 2007, 150, 613–623. [CrossRef] 45. Baumeister, D.; Eich, W.; Lerner, R.; Lutz, B.; Bindila, L.; Tesarz, J. Plasma parameters of the endocannabinoid system are unaltered in fibromyalgia. Psychother. Psychosom. 2018, 87, 377–379. [CrossRef] 46. Kaufmann, I.; Schelling, G.; Eisner, C.; Richter, H.P.; Krauseneck, T.; Vogeser, M.; Hauer, D.; Campolongo, P.; Chouker, A.; Beyer, A.; et al. Anandamide and neutrophil function in patients with fibromyalgia. Psychoneuroendocrinology 2008, 33, 676–685. [CrossRef] 47. Agarwal, N.; Pacher, P.; Tegeder, I.; Amaya, F.; Constantin, C.E.; Brenner, G.J.; Rubino, T.; Michalski, C.W.; Marsicano, G.; Monory, K.; et al. Cannabinoids mediate analgesia largely via peripheral type 1 cannabinoid receptors in nociceptors. Nat. Neurosci. 2007, 10, 870–879. [CrossRef] 48. Schley, M.; Legler, A.; Skopp, G.; Schmelz, M.; Konrad, C.; Rukwied, R. Delta-9-thc based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Curr. Med. Res. Opin. 2006, 22, 1269–1276. [CrossRef] 49. Fiz, J.; Duran, M.; Capella, D.; Carbonell, J.; Farre, M. Cannabis use in patients with fibromyalgia: E↵ect on symptoms relief and health-related quality of life. PLoS ONE 2011, 6, 5. [CrossRef] 50. Ware, M.A.; Fitzcharles, M.A.; Joseph, L.; Shir, Y. The e↵ects of nabilone on sleep in fibromyalgia: Results of a randomized controlled trial. Anesth. Analg. 2010, 110, 604–610. [CrossRef] 51. Fitzcharles, M.A.; Ste-Marie, P.A.; Goldenberg, D.L.; Pereira, J.X.; Abbey, S.; Choiniere, M.; Ko, G.; Moulin, D.E.; Panopalis, P.; Proulx, J.; et al. 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: Executive summary. Pain Res. Manag. 2013, 18, 119–126. [CrossRef] 52. Ste-Marie, P.A.; Fitzcharles, M.A.; Gamsa, A.; Ware, M.A.; Shir, Y. Association of herbal cannabis use with negative psychosocial parameters in patients with fibromyalgia. Arthritis Care Res. 2012, 64, 1202–1208. [CrossRef] [PubMed] 53. Painter, J.T.; Cro↵ord, L.J. Chronic opioid use in fibromyalgia syndrome a clinical review. JCR J. Clin. Rheumatol. 2013, 19, 72–77. [CrossRef] [PubMed] 54. Goldenberg, D.L.; Clauw, D.J.; Palmer, R.E.; Clair, A.G. Opioid use in fibromyalgia: A cautionary tale. Mayo Clin. Proc. 2016, 91, 640–648. [CrossRef] [PubMed] 55. Baraniuk, J.N.; Whalen, G.; Cunningham, J.; Clauw, D.J. Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain. BMC Musculoskelet. Disord. 2004, 5, 48. [CrossRef] 56. Fitzcharles, M.-A.; Faregh, N.; Ste-Marie, P.A.; Shir, Y. Opioid use in fibromyalgia is associated with negative health related measures in a prospective cohort study. Pain Res. Treat. 2013, 2013, 7. [CrossRef] 57. Peng, X.M.; Robinson, R.L.; Mease, P.; Kroenke, K.; Williams, D.A.; Chen, Y.; Faries, D.; Wohlreich, M.; McCarberg, B.; Hann, D. Long-term evaluation of opioid treatment in fibromyalgia. Clin. J. Pain 2015, 31, 7–13. [CrossRef] 58. Hwang, J.M.; Lee, B.J.; Oh, T.H.; Park, D.; Kim, C.H. Association between initial opioid use and response to a brief interdisciplinary treatment program in fibromyalgia. Medicine 2019, 98, 8. [CrossRef] 59. Harris, R.E.; Clauw, D.J.; Scott, D.J.; McLean, S.A.; Gracely, R.H.; Zubieta, J.K. Decreased central mu-opioid receptor availability in fibromyalgia. J. Neurosci. 2007, 27, 10000–10006. [CrossRef] 60. Bennett, R.M.; Jones, J.; Turk, D.C.; Russell, I.J.; Matallana, L. An internet survey of 2596 people with fibromyalgia. BMC Musculoskelet. Disord. 2007, 8, 27. 61. Hilliard, P.E.; Waljee, J.; Moser, S.; Metz, L.; Mathis, M.; Goesling, J.; Cron, D.; Clauw, D.J.; Englesbe, M.; Abecasis, G.; et al. Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgeryprevalence of preoperative opioid use and associated patient characteristicsprevalence of preoperative opioid use and associated patient characteristics. JAMA Surg. 2018, 153, 929–937. [PubMed] 62. Gaskell, H.; Moore, R.A.; Derry, S.; Stannard, C. Oxycodone for pain in fibromyalgia in adults. Cochrane Database Syst. Rev. 2016, 23. [CrossRef] 63. Ruette, P.; Stuyck, J.; Debeer, P. Neuropathic arthropathy of the shoulder and elbow associated with syringomyelia: A report of 3 cases. Acta Orthop. Belg. 2007, 73, 525–529. [PubMed] 64. Williams, E.R.; Ford, C.M.; Simonds, J.G.; Leal, A.K. Blocking peripheral opioid receptors with naloxone methiodide prevents acute and chronic training-induced analgesia in a rat model of fibromyalgia. FASEB J. 2017, 31, 1. Int. J. Mol. Sci. 2020, 21, 7877 21 of 27 65. Hermans, L.; Nijs, J.; Calders, P.; De Clerck, L.; Moorkens, G.; Hans, G.; Grosemans, S.; De Mettelinge, T.R.; Tuynman, J.; Meeus, M. Influence of morphine and naloxone on pain modulation in rheumatoid arthritis, chronic fatigue syndrome/fibromyalgia, and controls: A double-blind, randomized, placebo-controlled, cross-over study. Pain Pract. 2018, 18, 418–430. [CrossRef] 66. MacLean, A.J.B.; Schwartz, T.L. Tramadol for the treatment of fibromyalgia. Expert Rev. Neurother. 2015, 15, 469–475. [CrossRef] 67. Gur, A.; Calgan, N.; Nas, K.; Cevik, R.; Sarac, A.J. Low dose of tramadol in the treatment of fibromyalgia syndrome: A controlled clinical trial versus placebo. Ann. Rheum. Dis. 2006, 65, 556. 68. Mullican, W.S.; Lacy, J.R.; TRAMAP-ANAG-006 Study Group. Tramadol/acetaminophen combination tablets and codeine/acetaminophen combination capsules for the management of chronic pain: A comparative trial. Clin. Ther. 2001, 23, 1429–1445. [CrossRef] 69. Price, D.D.; Staud, R.; Robinson, M.E.; Mauderli, A.P.; Cannon, R.; Vierck, C.J. Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients. Pain 2002, 99, 49–59. [CrossRef] 70. Larabi, I.A.; Martin, M.; Fabresse, N.; Etting, I.; Edel, Y.; Pfau, G.; Alvarez, J.C. Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by lc-ms/ms after unintentional overdose. Forensic Toxicol. 2020, 38, 277–286. [CrossRef] 71. Comer, S.D.; Cahill, C.M. Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neurosci. Biobehav. Rev. 2019, 106, 49–57. [CrossRef] [PubMed] 72. Abeles, A.M.; Pillinger, M.H.; Solitar, B.M.; Abeles, M. Narrative review: The pathophysiology of fibromyalgia. Ann. Intern. Med. 2007, 146, 726–734. [CrossRef] 73. Watkins, L.R.; Maier, S.F. Immune regulation of central nervous system functions: From sickness responses to pathological pain. J. Intern. Med. 2005, 257, 139–155. [CrossRef] 74. Khalil, R.B. Pentoxifylline’s theoretical efficacy in the treatment of fibromyalgia syndrome. Pain Med. 2013, 14, 549–550. [CrossRef] 75. Polli, A.; Ghosh, M.; Bakusic, J.; Ickmans, K.; Monteyne, D.; Velkeniers, B.; Bekaert, B.; Godderis, L.; Nijs, J. DNA methylation and brain-derived neurotrophic factor expression account for symptoms and widespread hyperalgesia in patients with chronic fatigue syndrome and comorbid fibromyalgia. Arthritis Rheumatol. 2020. [CrossRef] 76. Scott, J.R.; Hassett, A.L.; Brummett, C.M.; Harris, R.E.; Clauw, D.J.; Harte, S.E. Ca↵eine as an opioid analgesic adjuvant in fibromyalgia. J. Pain Res. 2017, 10, 1801–1809. [CrossRef] [PubMed] 77. Goodman, C.W.; Brett, A.S. A clinical overview of o↵-label use of gabapentinoid drugs. JAMA Intern. Med. 2019, 179, 695–701. [CrossRef] 78. Micheva, K.D.; Buchanan, J.; Holz, R.W.; Smith, S.J. Retrograde regulation of synaptic vesicle endocytosis and recycling. Nat. Neurosci. 2003, 6, 925–932. [CrossRef] 79. Deitos, A.; Soldatelli, M.D.; Dussan-Sarria, J.A.; Souza, A.; Torres, I.L.D.; Fregni, F.; Caumo, W. Novel insights of e↵ects of pregabalin on neural mechanisms of intracortical disinhibition in physiopathology of fibromyalgia: An explanatory, randomized, double-blind crossover study. Front. Hum. Neurosci. 2018, 12, 14. [CrossRef] 80. Kiso, T.; Moriyama, A.; Furutani, M.; Matsuda, R.; Funatsu, Y. E↵ects of pregabalin and duloxetine on neurotransmitters in the dorsal horn of the spinal cord in a rat model of fibromyalgia. Eur. J. Pharmacol. 2018, 827, 117–124. [CrossRef] 81. Gerardi, M.C.; Atzeni, F.; Batticciotto, A.; Di Franco, M.; Rizzi, M.; Sarzi-Puttini, P. The safety of pregabalin in the treatment of fibromyalgia. Expert Opin. Drug Saf. 2016, 15, 1541–1548. [CrossRef] [PubMed] 82. Hirakata, M.; Yoshida, S.; Tanaka-Mizuno, S.; Kuwauchi, A.; Kawakami, K. Pregabalin prescription for neuropathic pain and fibromyalgia: A descriptive study using administrative database in Japan. Pain Res. Manag. 2018, 10. [CrossRef] [PubMed] 83. Asomaning, K.; Abramsky, S.; Liu, Q.; Zhou, X.; Sobel, R.E.; Watt, S. Pregabalin prescriptions in the United Kingdom: A drug utilisation study of the health improvement network (thin) primary care database. Int J. Clin. Pr. 2016, 70, 380–388. [CrossRef] 84. Ferreira-Dos-Santos, G.; Sousa, D.C.; Costa, J.; Vaz-Carneiro, A. Analysis of the cochrane review: Pregabalin for pain in fibromyalgia in adults. Cochrane database syst rev. 2016; 9: Cd011790 and 2016; 4: Cd009002. Acta Med. Port. 2018, 31, 376–381. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 22 of 27 85. Bhusal, S.; Diomampo, S.; Magrey, M.N. Clinical utility, safety, and efficacy of pregabalin in the treatment of fibromyalgia. Drug Healthc. Patient Saf. 2016, 8, 13–23. [CrossRef] 86. Arnold, L.M.; Choy, E.; Clauw, D.J.; Oka, H.; Whalen, E.; Semel, D.; Pauer, L.; Knapp, L. An evidence-based review of pregabalin for the treatment of fibromyalgia. Curr. Med. Res. Opin. 2018, 34, 1397–1409. [CrossRef] [PubMed] 87. Cooper, T.E.; Derry, S.; Wi↵en, P.J.; Moore, R.A. Gabapentin for fibromyalgia pain in adults. Cochrane Database Syst. Rev. 2017. [CrossRef] [PubMed] 88. Walitt, B.; Urrutia, G.; Nishishinya, M.B.; Cantrell, S.E.; Hauser, W. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst. Rev. 2015, 66. [CrossRef] 89. Welsch, P.; Uceyler, N.; Klose, P.; Walitt, B.; Hauser, W. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst. Rev. 2018, 111. [CrossRef] 90. Grubisic, F. Are serotonin and noradrenaline reuptake inhibitors e↵ective, tolerable, and safe for adults with fibromyalgia? A cochrane review summary with commentary. J. Musculoskelet. Neuronal. Interact. 2018, 18, 404–406. 91. VanderWeide, L.A.; Smith, S.M.; Trinkley, K.E. A systematic review of the efficacy of venlafaxine for the treatment of fibromyalgia. J. Clin. Pharm. Ther. 2015, 40, 1–6. [CrossRef] [PubMed] 92. Miki, K.; Murakami, M.; Oka, H.; Onozawa, K.; Yoshida, S.; Osada, K. Efficacy of mirtazapine for the treatment of fibromyalgia without concomitant depression: A randomized, double-blind, placebo-controlled phase IIa study in Japan. Pain 2016, 157, 2089–2096. [CrossRef] 93. Deboer, T. The pharmacologic profile of mirtazapine. J. Clin. Psychiatry 1996, 57, 19–25. 94. Ottman, A.A.; Warner, C.B.; Brown, J.N. The role of mirtazapine in patients with fibromyalgia: A systematic review. Rheumatol. Int. 2018, 38, 2217–2224. [CrossRef] [PubMed] 95. Rico-Villademoros, F.; Slim, M.; Calandre, E.P. Amitriptyline for the treatment of fibromyalgia: A comprehensive review. Expert Rev. Neurother. 2015, 15, 1123–1150. [CrossRef] 96. Moore, R.A.; Derry, S.; Aldington, D.; Cole, P.; Wi↵en, P.J. Amitriptyline for fibromyalgia in adults. Cochrane Database Syst. Rev. 2015. [CrossRef] 97. De Tommaso, M.; Delussi, M.; Ricci, K.; D’Angelo, G. Abdominal acupuncture changes cortical responses to nociceptive stimuli in fibromyalgia patients. CNS Neurosci. Ther. 2014, 20, 565–567. [CrossRef] 98. Karatay, S.; Okur, S.C.; Uzkeser, H.; Yildirim, K.; Akcay, F. E↵ects of acupuncture treatment on fibromyalgia symptoms, serotonin, and substance p levels: A randomized sham and placebo-controlled clinical trial. Pain Med. 2018, 19, 615–628. [CrossRef] 99. Deare, J.C.; Zheng, Z.; Xue, C.C.L.; Liu, J.P.; Shang, J.S.; Scott, S.W.; Littlejohn, G. Acupuncture for treating fibromyalgia. Cochrane Database Syst. Rev. 2013. [CrossRef] 100. Cao, H.J.; Li, X.; Han, M.; Liu, J.P. Acupoint stimulation for fibromyalgia: A systematic review of randomized controlled trials. Evid. Based Complementary Altern. Med. 2013, 2013, 1–15. [CrossRef] 101. Zhang, X.C.; Chen, H.; Xu, W.T.; Song, Y.Y.; Gu, Y.H.; Ni, G.X. Acupuncture therapy for fibromyalgia: A systematic review and meta-analysis of randomized controlled trials. J. Pain Res. 2019, 12, 527–542. [CrossRef] [PubMed] 102. Tesio, V.; Torta, D.M.E.; Colonna, F.; Leombruni, P.; Ghiggia, A.; Fusaro, E.; Geminiani, G.C.; Torta, R.; Castelli, L. Are fibromyalgia patients cognitively impaired? Objective and subjective neuropsychological evidence. Arthritis Care Res. 2015, 67, 143–150. [CrossRef] [PubMed] 103. Gelonch, O.; Garolera, M.; Valls, J.; Rossello, L.; Pifarre, J. Executive function in fibromyalgia: Comparing subjective and objective measures. Compr. Psychiatry 2016, 66, 113–122. [CrossRef] [PubMed] 104. Zhu, C.E.; Yu, B.; Zhang, W.; Chen, W.H.; Qi, Q.; Miao, Y. E↵ectiveness and safety of transcranial direct current stimulation in fibromyalgia: A systematic review and meta-analysis. J. Rehabil. Med. 2017, 49, 2–9. [CrossRef] 105. Brighina, F.; Curatolo, M.; Cosentino, G.; De Tommaso, M.; Battaglia, G.; Sarzi-Puttini, P.C.; Guggino, G.; Fierro, B. Brain modulation by electric currents in fibromyalgia: A structured review on non-invasive approach with transcranial electrical stimulation. Front. Hum. Neurosci. 2019, 13, 14. [CrossRef] 106. Dos Santos, V.S.; Zortea, M.; Alves, R.L.; Naziazeno, C.C.D.; Saldanha, J.S.; de Carvalho, S.D.R.; Leite, A.J.D.; Torres, I.L.D.; de Souza, A.; Calvetti, P.U.; et al. Cognitive e↵ects of transcranial direct current stimulation combined with working memory training in fibromyalgia: A randomized clinical trial. Sci Rep. 2018, 8, 11. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 23 of 27 107. Eken, A.; Kara, M.; Baskak, B.; Baltaci, A.; Gokcay, D. Di↵erential efficiency of transcutaneous electrical nerve stimulation in dominant versus nondominant hands in fibromyalgia: Placebo-controlled functional near-infrared spectroscopy study. Neurophotonics 2018, 5, 15. [CrossRef] 108. Yuksel, M.; Ayas, S.; Cabioglu, M.T.; Yilmaz, D.; Cabioglu, C. Quantitative data for transcutaneous electrical nerve stimulation and acupuncture e↵ectiveness in treatment of fibromyalgia syndrome. Evid. Based Complementary Altern. Med. 2019, 12, 362831. [CrossRef] 109. Ahmed, S.; Plazier, M.; Ost, J.; Stassijns, G.; Deleye, S.; Ceyssens, S.; Dupont, P.; Stroobants, S.; Staelens, S.; De Ridder, D.; et al. The e↵ect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: A water pet and EEG imaging study. BMC Neurol. 2018, 18, 10. [CrossRef] 110. Sutbeyaz, S.T.; Sezer, N.; Koseoglu, F.; Kibar, S. Low-frequency pulsed electromagnetic field therapy in fibromyalgia a randomized, double-blind, sham-controlled clinical study. Clin. J. Pain 2009, 25, 722–728. [CrossRef] 111. Multanen, J.; Hakkinen, A.; Heikkinen, P.; Kautiainen, H.; Mustalampi, S.; Ylinen, J. Pulsed electromagnetic field therapy in the treatment of pain and other symptoms in fibromyalgia: A randomized controlled study. Bioelectromagnetics 2018, 39, 405–413. [CrossRef] 112. Cruccu, G.; Garcia-Larrea, L.; Hansson, P.; Keindl, M.; Lefaucheur, J.P.; Paulus, W.; Taylor, R.; Tronnier, V.; Truini, A.; Attal, N. Ean guidelines on central neurostimulation therapy in chronic pain conditions. Eur. J. Neurol. 2016, 23, 1489–1499. [CrossRef] 113. Knijnik, L.M.; Dussan-Sarria, J.A.; Rozisky, J.R.; Torres, I.L.S.; Brunoni, A.R.; Fregni, F.; Caumo, W. Repetitive transcranial magnetic stimulation for fibromyalgia: Systematic review and meta-analysis. Pain Pract. 2016, 16, 294–304. [CrossRef] 114. Thut, G.; Schyns, P.G.; Gross, J. Entrainment of perceptually relevant brain oscillations by non-invasive rhythmic stimulation of the human brain. Front. Psychol. 2011, 2, 170. [CrossRef] 115. Weber, A.; Werneck, L.; Paiva, E.; Gans, P. E↵ects of music in combination with vibration in acupuncture points on the treatment of fibromyalgia. J. Altern. Complement. Med. 2015, 21, 77–82. [CrossRef] 116. Chesky, K.S.; Russell, I.J.; Lopez, Y.; Kondraske, G.V. Fibromyalgia tender point pain: A double-blind, placebo-controlled pilot study of music vibration using the music vibration table. J. Musculoskelet. Pain 1997, 5, 33–52. [CrossRef] 117. Naghdi, L.; Ahonen, H.; Macario, P.; Bartel, L. The e↵ect of low-frequency sound stimulation on patients with fibromyalgia: A clinical study. Pain Res. Manag. 2015, 20, E21–E27. [CrossRef] [PubMed] 118. Janzen, T.B.; Paneduro, D.; Picard, L.; Gordon, A.; Bartel, L.R. A parallel randomized controlled trial examining the e↵ects of rhythmic sensory stimulation on fibromyalgia symptoms. PLoS ONE 2019, 14, 19. [CrossRef] [PubMed] 119. Ablin, J.N.; Hauser, W.; Buskila, D. Spa Treatment (Balneotherapy) for Fibromyalgia—A Qualitative-Narrative Review and a Historical Perspective. Evid. Based Complementary Altern. Med. 2013, 2013, 638050. [CrossRef] [PubMed] 120. Neumann, L.; Sukenik, S.; Bolotin, A.; Abu-Shakra, M.; Amir, A.; Flusser, D.; Buskila, D. The e↵ect of balneotherapy at the dead sea on the quality of life of patients with fibromyalgia syndrome. Clin. Rheumatol. 2001, 20, 15–19. [CrossRef] 121. Mist, S.D.; Firestone, K.A.; Jones, K.D. Complementary and alternative exercise for fibromyalgia: A meta-analysis. J. Pain Res. 2013, 6, 247–260. [CrossRef] 122. Fioravanti, A.; Perpignano, G.; Tirri, G.; Cardinale, G.; Gianniti, C.; Lanza, C.E.; Loi, A.; Tirri, E.; Sfriso, P.; Cozzi, F. E↵ects of mud-bath treatment on fibromyalgia patients: A randomized clinical trial. Rheumatol. Int. 2007, 27, 1157–1161. [CrossRef] 123. Maeda, T.; Kudo, Y.; Horiuchi, T.; Makino, N. Clinical and anti-aging e↵ect of mud-bathing therapy for patients with fibromyalgia. Mol. Cell. Biochem. 2018, 444, 87–92. [CrossRef] 124. Guidelli, G.M.; Tenti, S.; De Nobili, E.; Fioravanti, A. Fibromyalgia syndrome and spa therapy: Myth or reality? Clin. Med. Insights Arthritis Musculoskelet. Disord. 2012, 5, 19–26. [CrossRef] 125. Ernst, E.; Fialka, V. Ice freezes pain—A review of the clinical e↵ectiveness of analgesic cold therapy. J. Pain Symptom Manag. 1994, 9, 56–59. [CrossRef] 126. Rivera, J.; Tercero, M.J.; Salas, J.S.; Gimeno, J.H.; Alejo, J.S. The e↵ect of cryotherapy on fibromyalgia: A randomised clinical trial carried out in a cryosauna cabin. Rheumatol. Int. 2018, 38, 2243–2250. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 24 of 27 127. Bettoni, L.; Bonomi, F.G.; Zani, V.; Manisco, L.; Indelicato, A.; Lanteri, P.; Banfi, G.; Lombardi, G. E↵ects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients. Clin. Rheumatol. 2013, 32, 1337–1345. [CrossRef] 128. Sutherland, A.M.; Clarke, H.A.; Katz, J.; Katznelson, R. Hyperbaric oxygen therapy: A new treatment for chronic pain? Pain Pract. 2016, 16, 620–628. [CrossRef] 129. Bennett, M.H.; French, C.; Schnabel, A.; Wasiak, J.; Kranke, P.; Weibel, S. Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. Cochrane Database Syst. Rev. 2015. [CrossRef] 130. Yildiz, S.; Kiralp, M.Z.; Akin, A.; Keskin, I.; Ay, H.; Dursun, H.; Cimsit, M. A new treatment modality for fibromyalgia syndrome: Hyperbaric oxygen therapy. J. Int. Med Res. 2004, 32, 263–267. [CrossRef] [PubMed] 131. Boussi-Gross, R.; Golan, H.; Fishlev, G.; Bechor, Y.; Volkov, O.; Bergan, J.; Friedman, M.; Hoofien, D.; Shlamkovitch, N.; Ben-Jacob, E.; et al. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury—Randomized prospective trial. PLoS ONE 2013, 8, e79995. [CrossRef] [PubMed] 132. Efrati, S.; Golan, H.; Bechor, Y.; Faran, Y.; Daphna-Tekoah, S.; Sekler, G.; Fishlev, G.; Ablin, J.N.; Bergan, J.; Volkov, O.; et al. Hyperbaric oxygen therapy can diminish fibromyalgia syndrome—Prospective clinical trial. PLoS ONE 2015, 10, e0127012. [CrossRef] [PubMed] 133. El-Shewy, K.M.; Kunbaz, A.; Gad, M.M.; Al-Husseini, M.J.; Saad, A.M.; Sammour, Y.M.; Abdel-Daim, M.M. Hyperbaric oxygen and aerobic exercise in the long-term treatment of fibromyalgia: A narrative review. Biomed. Pharmacother. 2019, 109, 629–638. [CrossRef] [PubMed] 134. Kisselev, S.B.; Moskvin, S.V. The use of laser therapy for patients with fibromyalgia: A critical literary review. J. Lasers Med. Sci. 2019, 10, 12–20. [CrossRef] 135. White, P.F.; Zafereo, J.; Elvir-Lazo, O.L.; Hernandez, H. Treatment of drug-resistant fibromyalgia symptoms using high-intensity laser therapy: A case-based review. Rheumatol. Int. 2018, 38, 517–523. [CrossRef] 136. Gur, A.; Karakoc, M.; Nas, K.; Cevik, R.; Sarac, A.J.; Ataoglu, S. E↵ects of low power laser and low dose amitriptyline therapy on clinical symptoms and quality of life in fibromyalgia: A single-blind, placebo-controlled trial. Rheumatol. Int. 2002, 22, 188–193. 137. Panton, L.; Simonavice, E.; Williams, K.; Mojock, C.; Kim, J.S.; Kingsley, J.D.; McMillan, V.; Mathis, R. E↵ects of class IV laser therapy on fibromyalgia impact and function in women with fibromyalgia. J. Altern. Complement. Med. 2013, 19, 445–452. [CrossRef] 138. Ruaro, J.A.; Frez, A.R.; Ruaro, M.B.; Nicolau, R.A. Low-level laser therapy to treat fibromyalgia. Lasers Med. Sci. 2014, 29, 1815–1819. [CrossRef] 139. Da Silva, M.M.; Albertini, R.; Leal, E.C.P.; de Carvalho, P.D.C.; Silva, J.A.; Bussadori, S.K.; de Oliveira, L.V.F.; Casarin, C.A.S.; Andrade, E.L.; Bocalini, D.S.; et al. E↵ects of exercise training and photobiomodulation therapy (extraphoto) on pain in women with fibromyalgia and temporomandibular disorder: Study protocol for a randomized controlled trial. Trials 2015, 16, 8. [CrossRef] 140. Busch, A.J.; Webber, S.C.; Brachaniec, M.; Bidonde, J.; Dal Bello-Haas, V.; Danyliw, A.D.; Overend, T.J.; Richards, R.S.; Sawant, A.; Schachter, C.L. Exercise therapy for fibromyalgia. Curr. Pain Headache Rep. 2011, 15, 358–367. [CrossRef] 141. Jones, K.D.; Adams, D.; Winters-Stone, K.; Burckhardt, C.S. A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988–2005). Health Qual. Life Outcomes 2006, 4, 67. [CrossRef] [PubMed] 142. Bidonde, J.; Busch, A.J.; Schachter, C.L.; Webber, S.C.; Musselman, K.E.; Overend, T.J.; Goes, S.M.; Dal Bello-Haas, V.; Boden, C. Mixed exercise training for adults with fibromyalgia. Cochrane Database Syst. Rev. 2019, 208. [CrossRef] 143. Assumpção, A.; Matsutani, L.A.; Yuan, S.L.; Santo, A.S.; Sauer, J.; Mango, P.; Marques, A.P. Muscle stretching exercises and resistance training in fibromyalgia: Which is better? A three-arm randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2018, 54, 663–670. [CrossRef] 144. Nelson, N.L. Muscle strengthening activities and fibromyalgia: A review of pain and strength outcomes. J. Bodyw. Mov. Ther. 2015, 19, 370–376. [CrossRef] 145. Sanudo, B.; Galiano, D.; Carrasco, L.; Blagojevic, M.; de Hoyo, M.; Saxton, J. Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: A randomized controlled trial. Arch. Phys. Med. Rehabil. 2010, 91, 1838–1843. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 25 of 27 146. Umeda, M.; Corbin, L.W.; Maluf, K.S. Pain mediates the association between physical activity and the impact of fibromyalgia on daily function. Clin. Rheumatol. 2015, 34, 143–149. [CrossRef] [PubMed] 147. Bement, M.K.H.; Weyer, A.; Hartley, S.; Drewek, B.; Harkins, A.L.; Hunter, S.K. Pain perception after isometric exercise in women with fibromyalgia. Arch. Phys. Med. Rehabil. 2011, 92, 89–95. [CrossRef] 148. Carson, J.W.; Carson, K.M.; Jones, K.D.; Bennett, R.M.; Wright, C.L.; Mist, S.D. A pilot randomized controlled trial of the yoga of awareness program in the management of fibromyalgia. Pain 2010, 151, 530–539. [CrossRef] 149. De Oliveira, F.R.; Goncalves, L.C.V.; Borghi, F.; da Silva, L.; Gomes, A.E.; Trevisan, G.; de Souza, A.L.; Grassi-Kassisse, D.M.; Crege, D. Massage therapy in cortisol circadian rhythm, pain intensity, perceived stress index and quality of life of fibromyalgia syndrome patients. Complement. Ther. Clin. Pract. 2018, 30, 85–90. [CrossRef] 150. Tomas-Carus, P.; Hakkinen, A.; Gusi, N.; Leal, A.; Hakkinen, K.; Ortega-Alonso, A. Aquatic training and detraining on fitness and quality of life in fibromyalgia. Med. Sci. Sports Exerc. 2007, 39, 1044–1050. [CrossRef] 151. Gusi, N.; Tomas-Carus, P. Cost-utility of an 8-month aquatic training for women with fibromyalgia: A randomized controlled trial. Arthritis Res. Ther. 2008, 10, 8. [CrossRef] [PubMed] 152. Andrade, C.P.; Zamuner, A.R.; Forti, M.; Franca, T.F.; Tamburus, N.Y.; Silva, E. Oxygen uptake and body composition after aquatic physical training in women with fibromyalgia: A randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2017, 53, 751–758. 153. Bidonde, J.; Busch, A.J.; Schachter, C.L.; Overend, T.J.; Kim, S.Y.; Goes, S.; Boden, C.; Foulds, H.J.A. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst. Rev. 2017. [CrossRef] 154. Bidonde, J.; Busch, A.J.; Webber, S.C.; Schachter, C.L.; Danyliw, A.; Overend, T.J.; Richards, R.S.; Rader, T. Aquatic exercise training for fibromyalgia. Cochrane Database Syst. Rev. 2014, 177. [CrossRef] [PubMed] 155. Marske, C.; Bernard, N.; Palacios, A.; Wheeler, C.; Preiss, B.; Brown, M.; Bhattacharya, S.; Klapstein, G. Fibromyalgia with gabapentin and osteopathic manipulative medicine: A pilot study. J. Altern. Complement. Med. 2018, 24, 395–402. [CrossRef] [PubMed] 156. Baptista, A.S.; Villela, A.L.; Jones, A.; Natour, J. E↵ectiveness of dance in patients with fibromyalgia: A randomised, single-blind, controlled study. Clin. Exp. Rheumatol. 2012, 30, S18–S23. 157. Assunção, J.C.; Silva, H.J.D.; da Silva, J.F.C.; Cruz, R.D.; Lins, C.A.D.; de Souza, M.C. Zumba dancing can improve the pain and functional capacity in women with fibromyalgia. J. Bodyw. Mov. Ther. 2018, 22, 455–459. [CrossRef] 158. Wang, C.C.; Schmid, C.H.; Fielding, R.A.; Harvey, W.F.; Reid, K.F.; Price, L.L.; Driban, J.B.; Kalish, R.; Rones, R.; McAlindon, T. E↵ect of tai chi versus aerobic exercise for fibromyalgia: Comparative e↵ectiveness randomized controlled trial. BMJ Br. Med J. 2018, 360, 14. [CrossRef] 159. Cryan, J.F.; Dinan, T.G. Mind-altering microorganisms: The impact of the gut microbiota on brain and behaviour. Nat. Rev. Neurosci. 2012, 13, 701–712. [CrossRef] 160. Galland, L. The gut microbiome and the brain. J. Med. Food 2014, 17, 1261–1272. [CrossRef] 161. Goebel, A.; Buhner, S.; Schedel, R.; Lochs, H.; Sprotte, G. Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome. Rheumatology 2008, 47, 1223–1227. [CrossRef] 162. Mayer, E.A.; Tillisch, K.; Gupta, A. Gut/brain axis and the microbiota. J. Clin. Investig. 2015, 125, 926–938. [CrossRef] 163. Roman, P.; Estevez, A.F.; Mires, A.; Sanchez-Labraca, N.; Canadas, F.; Vivas, A.B.; Cardona, D. A pilot randomized controlled trial to explore cognitive and emotional e↵ects of probiotics in fibromyalgia. Sci Rep. 2018, 8, 9. [CrossRef] [PubMed] 164. Butler, D. Translational research: Crossing the valley of death. Nature 2008, 453, 840–842. [CrossRef] 165. Nascimento, S.D.; DeSantana, J.M.; Nampo, F.K.; Ribeiro, E.A.N.; da Silva, D.L.; Araujo, J.X.; Almeida, J.; Bonjardim, L.R.; Araujo, A.A.D.; Quintans, L.J. Efficacy and safety of medicinal plants or related natural products for fibromyalgia: A systematic review. Evid. Based Complementary Altern. Med. 2013. [CrossRef] [PubMed] 166. Brownstein, M.J. A brief-history of opiates, opioid-peptides, and opioid receptors. Proc. Natl. Acad. Sci. USA 1993, 90, 5391–5393. [CrossRef] 167. Benyhe, S. Morphine—New aspects in the study of an ancient compound. Life Sci. 1994, 55, 969–979. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 26 of 27 168. Meng, I.D.; Manning, B.H.; Martin, W.J.; Fields, H.L. An analgesia circuit activated by cannabinoids. Nature 1998, 395, 381–383. [CrossRef] 169. Sagy, I.; Schleider, L.B.L.; Abu-Shakra, M.; Novack, V. Safety and efficacy of medical cannabis in fibromyalgia. J. Clin. Med. 2019, 8, 12. [CrossRef] 170. Van de Donk, T.; Niesters, M.; Kowal, M.A.; Olofsen, E.; Dahan, A.; van Velzen, M. An experimental randomized study on the analgesic e↵ects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain 2019, 160, 860–869. [CrossRef] 171. Habib, G.; Artul, S. Medical cannabis for the treatment of fibromyalgia. JCR J. Clin. Rheumatol. 2018, 24, 255–258. [CrossRef] [PubMed] 172. Habib, G.; Avisar, I. The consumption of cannabis by fibromyalgia patients in Israel. Pain Res. Treat. 2018, 5, 7829427. [CrossRef] 173. Ma↵ei, M.E. Plant natural sources of the endocannabinoid (e)- -caryophyllene: A systematic quantitative analysis of published literature. Int. J. Mol. Sci. 2020, 21, 6540. [CrossRef] [PubMed] 174. Paula-Freire, L.I.G.; Andersen, M.L.; Gama, V.S.; Molska, G.R.; Carlini, E.L.A. The oral administration of trans-caryophyllene attenuates acute and chronic pain in mice. Phytomedicine 2014, 21, 356–362. [CrossRef] [PubMed] 175. Gertsch, J.; Leonti, M.; Raduner, S.; Racz, I.; Chen, J.Z.; Xie, X.Q.; Altmann, K.H.; Karsak, M.; Zimmer, A. Beta-caryophyllene is a dietary cannabinoid. Proc. Natl. Acad. Sci. USA 2008, 105, 9099–9104. [CrossRef] 176. Oliveira, G.L.D.; Machado, K.C.; Machado, K.C.; da Silva, A.; Feitosa, C.M.; Almeida, F.R.D. Non-clinical toxicity of beta-caryophyllene, a dietary cannabinoid: Absence of adverse e↵ects in female swiss mice. Regul. Toxicol. Pharmacol. 2018, 92, 338–346. [CrossRef] 177. Quintans, L.J.; Araujo, A.A.S.; Brito, R.G.; Santos, P.L.; Quintans, J.S.S.; Menezes, P.P.; Serafini, M.R.; Silva, G.F.; Carvalho, F.M.S.; Brogden, N.K.; et al. Beta-caryophyllene, a dietary cannabinoid, complexed with beta-cyclodextrin produced anti-hyperalgesic e↵ect involving the inhibition of Fos expression in superficial dorsal horn. Life Sci. 2016, 149, 34–41. [CrossRef] 178. Ibrahim, M.M.; Porreca, F.; Lai, J.; Albrecht, P.J.; Rice, F.L.; Khodorova, A.; Davar, G.; Makriyannis, A.; Vanderah, T.W.; Mata, H.P.; et al. Cb2 cannabinoid receptor activation produces antinociception by stimulating peripheral release of endogenous opioids. Proc. Natl. Acad. Sci. USA 2005, 102, 3093–3098. [CrossRef] 179. Fidyt, K.; Fiedorowicz, A.; Strzadala, L.; Szumny, A. Beta-caryophyllene and beta-caryophyllene oxide-natural compounds of anticancer and analgesic properties. Cancer Med. 2016, 5, 3007–3017. [CrossRef] 180. Klauke, A.L.; Racz, I.; Pradier, B.; Markert, A.; Zimmer, A.M.; Gertsch, J.; Zimmer, A. The cannabinoid cb2 receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic e↵ects in mouse models of inflammatory and neuropathic pain. Eur. Neuropsychopharmacol. 2014, 24, 608–620. [CrossRef] 181. Melo, A.J.D.; Heimarth, L.; Carvalho, A.M.D.; Quintans, J.D.S.; Serafini, M.R.; Araujo, A.A.D.; Alves, P.B.; Ribeiro, A.M.; Shanmugam, S.; Quintans, L.J.; et al. Eplingiella fruticosa (Lamiaceae) Essential Oil Complexed with Beta-Cyclodextrin Improves Its Anti-Hyperalgesic E↵ect in a Chronic Widespread Non-Inflammatory Muscle Pain Animal Model. Food Chem. Toxicol. 2020, 135, 7. 182. Dolara, P.; Luceri, C.; Ghelardini, C.; Monserrat, C.; Aiolli, S.; Luceri, F.; Lodovici, M.; Menichetti, S.; Romanelli, M.N. Analgesic e↵ects of myrrh. Nature 1996, 379, 29. [CrossRef] [PubMed] 183. Borchardt, J.K. Myrrh: An analgesic with a 4000-year history. Drug News Perspect. 1996, 9, 554–557. 184. Su, S.L.; Hua, Y.Q.; Wang, Y.Y.; Gu, W.; Zhou, W.; Duan, J.A.; Jiang, H.F.; Chen, T.; Tang, Y.P. Evaluation of the anti-inflammatory and analgesic properties of individual and combined extracts from Commiphora myrrha, and Boswellia carterii. J. Ethnopharmacol. 2012, 139, 649–656. [CrossRef] 185. Lee, D.; Ju, M.K.; Kim, H. Commiphora extract mixture ameliorates monosodium iodoacetate-induced osteoarthritis. Nutrients 2020, 12, 17. [CrossRef] 186. Germano, A.; Occhipinti, A.; Barbero, F.; Ma↵ei, M.E. A pilot study on bioactive constituents and analgesic e↵ects of myrliq® , a Commiphora myrrha extract with a high furanodiene content. Biomed. Res. Int 2017, 2017, 3804356. [CrossRef] 187. Galeotti, N. Hypericum perforatum (St John’s Wort) beyond Depression: A Therapeutic Perspective for Pain Conditions. J. Ethnopharmacol. 2017, 200, 136–146. [CrossRef] 188. Khan, H.; Pervaiz, A.; Intagliata, S.; Das, N.; Venkata, K.C.N.; Atanasov, A.G.; Najda, A.; Nabavi, S.M.; Wang, D.D.; Pittala, V.; et al. The analgesic potential of glycosides derived from medicinal plants. DARU 2020, 28, 387–401. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 27 of 27 189. Wang, R.Y.; Qiu, Z.; Wang, G.Z.; Hu, Q.; Shi, N.H.; Zhang, Z.Q.; Wu, Y.Q.; Zhou, C.H. Quercetin attenuates diabetic neuropathic pain by inhibiting mtor/p70s6k pathway-mediated changes of synaptic morphology and synaptic protein levels in spinal dorsal horn of db/db mice. Eur. J. Pharmacol. 2020, 882, 7. [CrossRef] 190. Carvalho, T.T.; Mizokami, S.S.; Ferraz, C.R.; Manchope, M.F.; Borghi, S.M.; Fattori, V.; Calixto-Campos, C.; Camilios-Neto, D.; Casagrande, R.; Verri, W.A. The granulopoietic cytokine granulocyte colony-stimulating factor (G-CSF) induces pain: Analgesia by rutin. Inflammopharmacology 2019, 27, 1285–1296. [CrossRef] 191. Xiao, X.; Wang, X.Y.; Gui, X.; Chen, L.; Huang, B.K. Natural flavonoids as promising analgesic candidates: A systematic review. Chem. Biodivers. 2016, 13, 1427–1440. [CrossRef] 192. Yao, X.L.; Li, L.; Kandhare, A.D.; Mukherjee-Kandhare, A.A.; Bodhankar, S.L. Attenuation of reserpine-induced fibromyalgia via ros and serotonergic pathway modulation by fisetin, a plant flavonoid polyphenol. Exp. Ther. Med. 2020, 19, 1343–1355. [CrossRef] 193. Shakiba, M.; Moazen-Zadeh, E.; Noorbala, A.A.; Jafarinia, M.; Divsalar, P.; Kashani, L.; Shahmansouri, N.; Tafakhori, A.; Bayat, H.; Akhondzadeh, S. Sa↵ron (Crocus sativus) versus duloxetine for treatment of patients with fibromyalgia: A randomized double-blind clinical trial. Avicenna J. Phytomedicine 2018, 8, 513–523. 194. McCarberg, B.H. Clinical overview of fibromyalgia. Am. J. Ther. 2012, 19, 357–368. [CrossRef] [PubMed] Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. © 2020 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). ","When responding, restrict yourself to only information found within the given article - no other information is valid or necessary. What are the current therapy practices to treat fibromyalgia according to the document? International Journal of Molecular Sciences Review Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies Massimo E. Ma↵ei Department of Life Sciences and Systems Biology, University of Turin, 10135 Turin, Italy; massimo.ma↵eil@unito.it; Tel.: +39-011-670-5967 !""#!$%&'(! Received: 6 October 2020; Accepted: 22 October 2020; Published: 23 October 2020 !""#$%&' Abstract: Fibromyalgia (FM) is a syndrome that does not present a well-defined underlying organic disease. FM is a condition which has been associated with diseases such as infections, diabetes, psychiatric or neurological disorders, rheumatic pathologies, and is a disorder that rather than diagnosis of exclusion requires positive diagnosis. A multidimensional approach is required for the management of FM, including pain management, pharmacological therapies, behavioral therapy, patient education, and exercise. The purpose of this review is to summarize the recent advances in classification criteria and diagnostic criteria for FM as well as to explore pharmacotherapy and the use of alternative therapies including the use of plant bioactive molecules. Keywords: fibromyalgia; diagnosis; pharmacotherapy; alternative therapies; plant extracts; natural products 1. Introduction Fibromyalgia (FM) (earlier considered to be fibrositis, to stress the role of peripheral inflammation in the pathogenesis) is a syndrome that does not present a well-defined underlying organic disease. The primary driver of FM is sensitization, which includes central sensitivity syndromes generally referred to joint sti↵ness, chronic pain at multiple tender points, and systemic symptoms including cognitive dysfunction, sleep disturbances, anxiety, fatigue, and depressive episodes [1,2]. FM is a heterogeneous condition that is often associated to specific diseases such as infections, psychiatric or neurological disorders, diabetes and rheumatic pathologies. FM is more frequent in females, where it causes musculoskeletal pain [3] and a↵ects significantly the quality of life, often requiring an unexpected healthcare e↵ort and consistent social costs [4,5]. Usually, a patient-tailored approach requires a pharmacological treatment by considering the risk-benefit ratio of any medication. Being the third most common diagnosis in rheumatology clinics, FM prevalence within the general population appears to range from 1.3–8% [2]. To date there are no specific tests specific for FM. FM is currently recognized by the widespread pain index (which divides the body into 19 regions and scores how many regions are reported as painful) and a symptom severity score (SSS) that assesses cognitive symptoms, unrefreshing sleep and severity of fatigue [6]. It is not clear what causes FM and diagnosing assist the patients to face polysymptomatic distress, thereby reducing doubt and fear which are main psychological factors contributing to this central amplification mechanism [7]. In this review, an update on diagnosis and therapy of FM is provided along the discussion on the possibility of using pharmacological drugs, bioactive natural substances and alternative therapies to alleviate the symptomatology in combination or as alternative remedies to drugs. Int. J. Mol. Sci. 2020, 21, 7877 2 of 27 2. Diagnosis To date there is still a considerable controversy on the assessment and diagnosis of FM. Despite advances in the understanding of the pathologic process, FM remains undiagnosed in as many as 75% of people with the condition [8]. The first attempt for the FM classification criteria is dated 1990 and is based on studies performed in 16 centers in the U.S.A. and Canada in clinical and academic settings, gathering the both doubters and proponents [9]. Since then, several alternative methods of diagnosis have been proposed. In general, most of the researchers agree on the need to assess multiple domains in FM including pain, sleep, mood, functional status, fatigue, problems with concentration/memory (i.e. dyscognition) and tenderness/sti↵ness [5]. Four core areas were initially assessed: (1) pain intensity, (2) physical functioning, (3) emotional functioning, and (4) overall improvement/well-being [10]. About 70–80% of patients with FM also report having sleep disturbances and fatigue. Depressive symptoms, anxiety and mood states have also been included in FM diagnosis. An impairment in multiple areas of function, especially physical function is often reported by patients with FM [11] with a markedly impaired function and quality of life [8]. Since the late 19900 s, a top priority was the development of new disease-specific measures for each of the relevant domains in FM. Also, much attention was paid to studies supporting the valid use of existing instruments specifically in the context of FM [5]. Later on, in 2010, the tender point count was abandoned and the American College of Rheumatology (ACR) suggested preliminary diagnostic criteria which were considering the number of painful body regions evaluating the presence and severity of fatigue, cognitive difficulty, unrefreshed sleep and the extent of somatic symptoms. The diagnostic criteria are not based on laboratory or radiologic testing to diagnose FM and rely on a 0–12 Symptom Severity Scale (SSS) which is used to quantify FM-type symptom severity [12]. Furthermore, the SSS was proposed to be combined with the Widespread Pain Index (WPI) into a 0–31 Fibromyalgianess Scale (FS) [13]. With a specificity of 96.6% and sensitivity of 91.8%, a score 13 for FS was able to correctly classify 93% of patients identified as having FM based on the 1990 criteria [14]. ACR 2010 criteria were also found to be more sensitive than the ACR 1990 criteria, allowing underdiagnosed FM patients to be correctly identified and giving a treatment opportunity to those who had previously been untreated [15]. It is still unclear whether the diagnosis of FM has the same meaning with respect to severity in primary FM (PFM, a dominant disorder that occurs in the absence of another clinically important and dominant pain disorder) and secondary FM (SFM, which occurs in the presence of another clinically important and dominant medical disorder) [16]. Figure 1 shows the ACR 1990 criteria for the classification of fibromyalgia, whereas Figure 2 shows a graphical representation of the Symptom Severity Scale (SSS) plus the Extent of Somatic Symptoms (ESS). Figure 1. Widespread Pain Index from ACR 1990 criteria for the classification of fibromyalgia and related regions. Int. J. Mol. Sci. 2020, 21, 7877 3 of 27 Figure 2. Symptom Severity scale (SSS) and Extent of Somatic Symptoms (ESS). Table 1 shows a holist approach based on the assumption that a multitude of potential diagnoses is fundamental in order to avoid an FM misdiagnosis [17]. In 2013, alternative diagnostic criteria have been developed by some clinicians in the USA including more pain locations and a large range of symptoms than ACR 2010. A self-reported survey was composed of the 28-area pain location inventory and the 10 symptom items from the Symptom Impact Questionnaire (SIQ) [18]. However, when compared to the early 2010 criteria, these alternative criteria did not significantly contribute in di↵erentiating common chronic pain disorders from FM [1]. In 2015, the view of diagnostic criteria was altered by ACR by providing approval only for classification criteria and no longer considering endorsement of diagnostic criteria, stressing that diagnostic criteria are di↵erent from classification criteria and are beyond the remit of the ACR [19]. However, the suggestion that diagnostic and classification criteria represent 2 ends of a continuum implies that the continuum represents the accuracy of the criteria [20]. Classification criteria and diagnostic criteria could intersect; however, according to some authors the terms “diagnosis” and “classification criteria” should be considered as qualitatively distinct concepts. The proposed concept of “diagnostic criteria” [19] is challenging and may be hardly realizable, while diagnostic guidelines based on proper modelling techniques may be helpful for clinicians in particular settings [20]. In 2016, based on a generalized pain criterion and clinic usage data, a new revision of the 2010/2011 FM criteria was developed including the following criteria: 1) generalized pain, defined as pain present in at least 4 of 5 regions; 2) symptoms present at a similar level for at least three months; 3) a WPI 7 and SSS 5 or WPI of 4–6 and SSS 9; 4) a diagnosis of FM is valid irrespective of other diagnoses. Another important point is that the presence of other clinically important illnesses does not exclude a diagnosis of FM [21]. In 2018, considering important but less visible factors that have a profound influence on under- or over-diagnosis of FM provided a new gate to a holistic and real understanding of FM diagnosis, beyond existing arbitrary and constructional scores [22]. Int. J. Mol. Sci. 2020, 21, 7877 4 of 27 Table 1. ACR2010 and modified criteria for the diagnosis of fibromyalgia. Widespread pain index (WPI) Areas specification Number of areas in which the patient has had 0–19 points pain over the past week shoulder girdle, hip (buttock, trochanter), jaw, upper back, lower back, upper arm, upper leg, chest, neck, abdomen, lower arm, Areas to be considered and lower leg (all these areas should be considered bilaterally) Symptom Severity Scale (SSS) score Symptom Level of severity Symptom level Score For each of these 3 symptoms, indicate the level of severity over the past week Considering somatic symptoms in using the following scale: Fatigue general, indicate whether the patient has 0 = no problem Waking unrefreshed the following: 1 = slight or mild problems, generally Cognitive symptoms (e.g., working memory 0 = no symptoms Final score between 0 and 12 mild or intermittent capacity, recognition memory, verbal knowledge, 1 = few symptoms 2 = moderate; considerable problems, anxiety, and depression) 2 = a moderate number of symptoms often present and/or at a moderate level 3 = a great deal of symptoms 3 = severe; pervasive, continuous, life-disturbing problems Criteria Specification Conditions A patient satisfies diagnostic criteria for (a)WPI 7/19 and SS scale score 5 or WPI 3–6 and SS scale score 9 fibromyalgia if the following 3 conditions (b) symptoms have been present as a similar level for at least 3 months are met (c) the patient does not have a disorder that would otherwise explain the pain Modified criteria Specification Conditions Final Score (a)WPI (as above) A patient satisfies diagnostic criteria for (b) SS scale score (as above, but without The number of pain sites (WPI), the SS scale score, and the presence of associated fibromyalgia if the following 3 conditions extent of somatic symptoms) symptoms are summed to give a final score between 0 and 31 are met (c) presence of abdominal pain, depression, headaches (yes = 1, no = 0) Int. J. Mol. Sci. 2020, 21, 7877 5 of 27 In 2019, in cooperation with the WHO, an IASP Working Group has developed a classification system included in the International Classification of Diseases (ICD-11) where FM has been classified as chronic primary pain, to distinguish it from pain which is secondary to an underlying disease [23]. More recently, a study of about 500 patients under diagnosis of FM, revealed that 24.3% satisfied the FM criteria, while 20.9% received a clinician International Classification of Diseases (ICD) diagnosis of FM, with a 79.2% agreement between clinicians and criteria. The conclusions of this study pointed out a disagreement between ICD clinical diagnosis and criteria-based diagnosis of FM, calling into question meaning of a FM diagnosis, the validity of physician diagnosis and clinician bias [24]. FM is a disorder that cannot be based on diagnosis of exclusion, rather needing positive diagnosis [6], through a multidimensional FM diagnostic approach making diagnosis encompassing psychosocial stressors, subjective belief, psychological factors and somatic complaints [25]. The advent of the PSD scale identified a number of problems in FM research [16]. Recently, immunophenotyping analysis performed on blood samples of FM patients revealed a role of the Mu opioid receptor on B lymphocytes as a specific biomarker for FM [26]. Moreover, a rapid biomarker-based method for diagnosing FM has been developed by using vibrational spectroscopy to di↵erentiate patients with FM from those with other pain-related diseases. Unique IR and Raman spectral signatures were correlated with FM pain severity measured with FM impact questionnaire revised version (FIQR) [27]. Overall, these findings provide reliable diagnostic tests for di↵erentiating FM from other disorders, for establishing serologic biomarkers of FM-associated pain and were useful for the contribution of the legitimacy of FM as a truly painful disease. In summarizing aspects of FM learned through applications of criteria to patients and trials, Wolfe [28] identified 7 main concepts: 1) there is no way of objectively testing FM which also has no binding definition; 2) prevalence and acceptance of FM depend on factors largely external to the patient; 3) FM is a continuum and not a categorical disorder; 4) every feeling, symptom, physical finding, neuroscience measure, cost and outcome tells one very little about the disorder and its mechanisms when fibromyalgia to “normal subjects” is compared; 5) the range and content of symptoms might indicate that FM may not truly be a syndrome; 6) “pain and distress” type of FM subject identified in the general population [29] might be considered as part of the FM definition and; 7) caution is needed when accepting the current reductive neurobiological causal explanations as sufficient, since FM is a socially constructed and arbitrarily defined and diagnosed dimensional disorder. 3. Therapy 3.1. Pharmacotherapy of FM Clinical trials have failed to conclusively provide overall benefits of specific therapies to treat FM; therefore, current pharmacological treatments for patients su↵ering from FM are mainly directed to palliate some symptoms, with relevant clinical benefits experienced only by a minority of individuals from any one intervention. In those treated with pharmacotherapy, a 50%reduction in pain intensity is generally achieved only by 10% to 25% [30] However, some treatments seem to significantly improve the quality of life of certain FM patients [31]. Only a few drugs have been approved for use in the treatment of FM by the US FDA, whereas no drug has been approved for this indication by the European Medicines Agency. Thus patients with FM frequently need to be treated on an o↵-label basis [32]. Currently, only 25% to 40% pain reduction is granted by drugs and meaningful relief occurs in only 40% to 60%, in part due to dose-limiting adverse e↵ects and incomplete drug efficacy [33]. These limitations in clinical practice have led some to hypothesize that a combination of di↵erent analgesic drugs acting through di↵erent mechanisms may provide superior outcomes compared to monotherapy [34]. Moreover, drugs should be started at low doses and cautiously increased because some patients, either do not tolerate or benefit from drug therapy. Because sleep disturbance, pain and psychological distress are the most amenable to drug therapy, drugs should be chosen to manage the individual’s predominant symptoms [35]. Currently, several drugs are frequently used alone Int. J. Mol. Sci. 2020, 21, 7877 6 of 27 or in combination to manage FM symptoms; however, the US FDA indicated for FM only three: two selective serotonin and norepinephrine reuptake inhibitors (SNRIs), duloxetine and milnacipran, and an anticonvulsant, pregabalin [36]. In the next sections, the use of selected drugs aimed to alleviate FM will be described. 3.1.1. Cannabinoids in FM Therapy The cannabinoid system is ubiquitous in the animal kingdom and plays multiple functions with stabilizing e↵ects for the organism, including modulation of pain and stress, and the management of FM may have therapeutic potential by manipulating this system. The cannabinoid system contributes in maintaining equilibrium and stabilizing e↵ects on FM [37]. Moreover, the endocannabinoid neuromodulatory system is involved in multiple physiological functions, such as inflammation and immune recognition, endocrine function, cognition and memory, nausea, antinociception and vomiting, [38]. Deficiency in the endocannabinoid system has been correlated to FM [39], but without clear clinical evidence in support of this assumption [40]. The endocannabinoid system consists of two cannabinoid receptors, the CB1 and CB2 receptors [41]. In acute and chronic pain models, analgesic e↵ects are associated to CB1 agonists that act at many sites along pain transmission pathways, including activation of spinal, supraspinal and peripheral CB1 receptors, each independently decreasing nociception [42]. Delta 9-tetrahydrocannabinol (D9-THC or Dronabinol, 1) is the main active constituent of Cannabis sativa var indica, with psychoactive and pain-relieving properties. The non-selective binding to G-protein-coupled CB receptors is responsible for the pharmacological e↵ects induced by D9-THC. Cannabidiol (CBD, 2), a non-psychotropic constituent of cannabis, is a high potency antagonist of CB receptor agonists and an inverse agonist at the CB2 receptor [43]. CBD displays CB2 receptor inverse agonism, an action that appears to be responsible for its antagonism of CP55940 at the human CB2 receptor [44]. This CB2 receptor inverse agonist ability of CBD may contribute to its documented anti-inflammatory properties [44]. The main endocannabinoids are anandamide (N-arachidonoylethanolamine, AEA, 3) and 2-arachidonoylglycerol (2-AG, 4), AG), the activity of which is modulated by the hydrolyzing fatty acid palmitoylethanolamide (PEA, 5) and the endocannabinoid precursor arachidonic acid (AA, 6) [45]. AEA and 2-AG are functionally related to D9-THC [46]. It was found that stress induces a rapid anandamide release in several CNS regions resulting in stress-induced analgesia via CB1 receptors [47]. FM patients had significantly higher anandamide plasma levels [39,46]; however, it has been suggested that the origin of FM and chronic pain depend on a deficiency in the endocannabinoid signaling [45]. Monotherapies of FM based on D9-THC are based on the assumption that this compound acts as an analgesic drug; however, although a sub-population of FM patients reported significant benefits from the use of D9-THC, this statement cannot be made [48]. When the quality of life of FM patients who consumed cannabis was compared with FM subjects who were not cannabis users, a significant improvement of symptoms of FM in patients using cannabis was observed, although there was a variability of patterns [49]. The synthetic cannabinoid nabilone (7) showed of a superiority over placebo to reduce FM symptoms, with significant reductions in Visual Analog Scale (VAS) for pain, FM Impact Questionnaire (FIQ), and anxiety [42], indicating the efficacy of treating people with FM with nabilone. Nabilone was also e↵ective in improving sleep [50]; however, participants taking nabilone experienced more adverse events (such as dizziness/drowsiness, dry mouth and vertigo) than did participants taking placebo or amitriptyline (see below). The self-medication practice of herbal cannabis was associated with negative psychosocial parameters. Therefore, caution should be exercised in recommending the use of cannabinoids pending clarification of general health and psychosocial problems [51,52]. Figure 3 illustrates the chemical formulas of some cannabinoids and endocannabinoids. Int. J. Mol. Sci. 2020, 21, 7877 7 of 27 Figure 3. Structure formulae of some cannabinoids and related compounds. Numbers correspond to compound names cited in the text. 3.1.2. Opioids in FM Therapy One of the major natural sources of opioids is the medicinal plant Papaver somniferum. Although clinical evidence demonstrating the efficacy or e↵ectiveness of opioids analgesics is scanty, these molecules are widely used for the treatment of FM [53]. However, the long-term use of opioids in FM has been discouraged by several medical guidelines [54]. The use of opioids is documented in studies demonstrating increased endogenous opioid levels in the cerebrospinal fluid of patients with FM vs. controls [55]. These results prompted the interesting hypothesis that a more activated opioid system can be detected in individuals with FM, reflecting reduced receptor availability and increased release of endogenous opioids [54]. There is evidence from both single center, prospective, longitudinal and multicenter and observational clinical studies of negative e↵ects of the use of opioids in FM on patient outcomes compared with other therapies [56,57]. Moreover, opioid user groups showed less improvement in the SFM-36 subscale scores of general health perception and in the FIQ subscale scores of job ability, fatigue and physical impairment [58]. Furthermore, altered endogenous opioid analgesic activity in FM has been demonstrated and suggested as a possible reason for why exogenous opiates appear to have reduced efficacy [59]. Despite these facts, opioids have been prescribed for 10% to 60% of patients with FM as reported in large database sets [54]. When considered, the preference of patients appears towards opioids. In a survey, 75% of patients considered hydrocodone (8) plus acetaminophen to be helpful, and 67% considered oxycodone (9) plus acetaminophen to be helpful [60]. FM has been associated with preoperative opioid use, including hydrocodone [61], whereas there is limited information from randomized controlled trials on the benefits or harms of oxycodone when used to treat pain in FM [62]. A pilot study showed that naltrexone (10) reduced self-reported symptoms of FM (primarily daily pain and fatigue) [63] and further studies showed that low-dose naltrexone had a specific and clinically beneficial impact on FM. This opioid, which is widely available and inexpensive, Int. J. Mol. Sci. 2020, 21, 7877 8 of 27 was found to be safe and well-tolerated. Blocking peripheral opioid receptors with naloxone (11) was observed to prevent acute and chronic training-induced analgesia in a rat model of FM [64]; however, there were no significant e↵ects of naloxone nor nocebo on pressure pain threshold, deep tissue pain, temporal summation or conditioned pain modulation in chronic fatigue syndrome/FM patients [65]. A synthetic opioid receptor agonist that shows serotonin-norepinephrine reuptake inhibitor properties is tramadol (12); this compound is often prescribed for painful conditions [66]. Tramadol has been studied in humans who su↵er from FM [56], suggesting that tramadol may be e↵ective in treating FM [67]. The use of tramadol provides change in pain assessed by visual analogue scale and FM impact questionnaire; however, the reported side e↵ects include dizziness, headache, constipation, addiction, withdrawal, nausea, serotonin syndrome, somnolence, pruritus seizures, drug–drug interactions with antimigraine and antidepressants medications [66]. Therefore, it is recommended that tramadol application should be considered in refractory and more treatment-resistant cases of FM. Another weak opioid is codeine (13). In a comparative study, there was a significantly higher proportion of patients in the codeine-acetaminophen group reporting somnolence or constipation and a larger proportion of patients in the tramadol-acetaminophen group reporting headache. The overall results suggested that tramadol-acetaminophen tablets (37.5 mg/325 mg) were as e↵ective as codeine-acetaminophen capsules (30 mg/300 mg) in the treatment of chronic pain [68]. Fentanyl (14) works primarily by activating µ-opioid receptors and was found to be around 100 times stronger than morphine (15), although its e↵ects are more localized. Fentanyl injections reduced second pain from repeated heat taps in FM patients. Similar to reports of e↵ects of morphine on first and second pain, fentanyl had larger inhibitory e↵ects on slow temporal summation of second pain than on first pain from a nociceptor stimulation [69]. Since fentanyl can inhibit windup of second pain in FM patients, it can prevent the occurrence of intense summated second pain and thereby reduce its intensity by a greater extent than first or second pains evoked by single stimuli. Among the 70,237 drug-related deaths estimated in 2017 in the US, the sharpest increase occurred among those related to fentanyl analogs with almost 29,000 overdose deaths which represents more than 45% increase from 2016 to 2017 [70]. Because the numbers of overdoses and deaths due to fentanyl will continue to increase in the coming years, studies are needed to elucidate the physiological mechanisms underlying fentanyl overdose in order to develop e↵ective treatments aimed to reduce the risk of death [71]. Glial cell activation is one of the several other possible pathophysiologic mechanisms underlying the development of FM by contributing to central nervous system sensitization to nociceptive stimuli [72]. Pentoxifylline (16), a xanthine derivative used as a drug to treat muscle pain in people with peripheral artery disease, is a nonspecific cytokine inhibitor that has been shown to attenuate glial cell activation and to inhibit the synthesis of TNF↵, IL-1 , and IL-6 [73]. In theory, attenuating glial cell activation via the administration of pentoxifylline to individuals su↵ering from FM might be efficient in ameliorating their symptoms without being a globalist therapeutic approach targeting all possible pathophysiologic mechanisms of development of the syndrome [74]. With regards FM pathophysiology, serum brain-derived neurotrophic factors (BDNF) were found at higher levels in FM patients while BDNF methylation in exon 9 accounted for the regulation of protein expression. These data suggest that altered BDNF levels might represent a key mechanism explaining FM pathophysiology [75]. Opioid users were also observed to experience a decreased pain and symptom severity when ca↵eine (17) was consumed, but this was not observed in opioid nonusers, indicating ca↵eine may act as an opioid adjuvant in FM-like chronic pain patients. Therefore the consumption of ca↵eine along with the use of opioid analgesics could represent an alternative therapy with respect to opioids or ca↵eine alone [76]. Figure 4 shows the chemical formulae of some opioids used in FM therapy. Int. J. Mol. Sci. 2020, 21, 7877 9 of 27 Figure 4. Structure formulae of some opioids and related compounds. Numbers correspond to molecules cited in the text. 3.1.3. Gabapentinoids in FM Therapy Gabapentinoid drugs are US Food and Drug Administration (FDA) (but not in Europe) anticonvulsants approved for treatment of pain syndromes, including FM. However, FDA approved pregabalin (18) but not gabapentin (19) for FM treatment; nevertheless, gabapentin is often prescribed o↵-label for FM, presumably because it is substantially less expensive [77]. Pregabalin is a gamma-aminobutyric acid (GABA) analog and is a ligand for the ↵2 subunit of the calcium channel being able of reducing the ability of docked vesicles to fuse and release neurotransmitters [78]. Pregabalin shows e↵ects on cortical neural networks, particularly when basal neurons are under hyperexcitability. The pain measures and pregabalin impact on the cortical excitability was observed only in FM patients [79]. Pregabalin was also found to increase norepinephrine levels in reserpine-induced myalgia rats [80]. Because of its tolerability when used in combination with antidepressants, pregabalin use showed a very good benefit to risk ratio [81]. The starting approved dosage for pregabalin is at 150 mg daily [82]; however, the drug shows a higher e↵ectiveness when used at a dose of 300 or 600 mg/day. Lower pregabalin doses than those of clinical trials are used in clinical practice because higher doses are more likely to be intolerable [83]. A recent systematic review shows that a minority of people with moderate to severe pain due to FM treated with a daily dose of 300 to 600 mg of pregabalin had a reduction of pain intensity over a follow-up period of 12 to 26 weeks, with tolerable adverse e↵ects [84]. Thus, pregabalin is one of cardinal drugs used in the treatment of FM, and its clinical utility has been comprehensively demonstrated [85,86]. Nevertheless, there is still insufficient evidence to support or refute that gabapentin may reduce pain in FM [87]. Figure 5 depicts the chemical formulae of some gabapentinoids. Int. J. Mol. Sci. 2020, 21, 7877 10 of 27 Figure 5. Structure formulae of some gabapentinoids. Numbers correspond to molecules cited in the text. 3.1.4. Serotonin–Norepinephrine Reuptake Inhibitors in FM Therapy There is a wide use of serotonin and noradrenaline reuptake inhibitors (SNRIs). There is no unbiased evidence that serotonin selective reuptake inhibitors (SSRIs) are superior to placebo in treating depression in people with FM and for treating the key symptoms of FM, namely sleep problems, fatigue and pain. However, it should be considered that young adults aged 18 to 24, with major depressive disorder, showed an increased suicidal tendency when treated with SSRIs [88]. A recent Cochrane review evaluated the use of SNRIs including eighteen studies with a total of 7,903 adults diagnosed with FM, by using desvenlafaxine (20) and venlafaxine (21) in addition to duloxetine (22) and milnacipran (23), by considering various outcomes for SNRIs including health related quality of life, fatigue, sleep problems, pain and patient general impression, as well as safety and tolerability [89]. Fifty two percent of those receiving duloxetine and milnacipran had a clinically relevant benefit over placebo compared to 29% of those on placebo, with much or very much improvements in the intervention. On the other hand, reduction of pain intensity was not significantly di↵erent from placebo when desvenlafaxine was used. However, pain relief and reduction of fatigue was not clinically relevant for duloxetine and milnacipran in 50% or greater and did not improve the quality of life [90]. Same negative outcomes were found for reducing problems in sleep and the potential general benefits of duloxetine and milnacipran were outweighed by their potential harms. The efficacy of venlafaxine in the treatment of FM was studied to a lesser extent. The lack of consistency in venlafaxine dosing, placebo control and blinding make difficult to understand whether the molecule is e↵ective in treating FM. Nevertheless, tolerability and the lower cost of venlafaxine increases its potential use for the treatment of FM, by rendering the molecule a more a↵ordable option compared to the other, more expensive SNRIs [91]. Mirtazapine (24) promotes the release of noradrenaline and serotonin by blocking ↵2 -adrenergic autoreceptors and ↵2 -adrenergic heteroreceptors, respectively. Mirtazapine, by acting through 5-HT1A receptors and by blocking postsynaptic 5-HT2A , 5-HT2C , and 5-HT3 receptors is able to enhance serotonin neurotransmission [92]. For these properties, mirtazapine is classified as a noradrenergic and specific serotonergic antidepressant [93]. Mirtazapine appears to be a promising therapy to improve sleep, pain, and quality of life in patients with FM [94]. In Japanese patients with FM, mirtazapine caused a significantly greater reduction in the mean numerical rating scale pain score and remained significantly greater from week 6 onward, compared with placebo. However, Adverse mirtazapine caused adverse events including weight gain, somnolence and increased appetite when compared to placebo [92]. Among antidepressants, the tricyclic antidepressant (TCAs) amitriptyline (25) was studied more than other antidepressants. It is frequently used to assess comparative efficacy [95] and for many years amitriptyline has been a first-line treatment for FM. Although there is no supportive unbiased evidence for a beneficial e↵ect, the drug was successful for the treatment in many patients with FM. However, amitriptyline achieve satisfactory pain relief only by a minority of FM patients and is unlikely that any large randomized trials of amitriptyline will be conducted in FM to establish efficacy Int. J. Mol. Sci. 2020, 21, 7877 11 of 27 statistically, or measure the size of the e↵ect [96]. Figure 6 depicts the chemical formulae of some SNRIs and TCA. Figure 6. Chemical structure of some serotonin and noradrenaline reuptake inhibitors and a tricyclic antidepressant. Numbers correspond to molecules cited in the text. 3.2. Alternative Therapies for FM A survey of the European guidelines shows that most of the pharmacological therapies are relatively modest providing only weak recommendations for FM [97]. A multidimensional approach is therefore required for the management of FM, including pharmacological therapies along with behavioral therapy, exercise, patient education and pain management. A multidisciplinary approach combines pharmacotherapy with physical or cognitive interventions and natural remedies. Very often, patients seek help in alternative therapies due to the limited efficacy of the therapeutic options. The following sections discuss some of the most used alternative therapies to treat FM. 3.2.1. Acupunture Acupuncture shows low to moderate-level in improving pain and sti↵ness in people with FM. In some cases, acupuncture does not di↵er from sham acupuncture in improving sleep or global well-being or reducing pain or fatigue. The mechanisms of acupuncture action in FM treatment appears to be correlated to changes in serum serotonin levels [98]. Electro-acupuncture (EA) was more e↵ective than manual acupuncture (MA) for improving sleep, global well-being and fatigue and in the reduction of pain and sti↵ness. Although e↵ective, the e↵ect of acupuncture is not maintained at six months follow-up [99]. Moreover, there is a lack of evidence that real acupuncture significantly di↵ers from sham acupuncture with respect to improving the quality of life, both in the short and long term. However, acupuncture therapy is a safe treatment for patients with FM [100,101]. 3.2.2. Electric Stimulation As we discussed, FM, aside pain, is characterized by anxiety, depression and sleep disturbances, and by a complex cognitive dysfunctioning status known as “fibrofog” which is characterized by disturbance in working memory, attention and executive functions globally often referred by the patients as a sense of slowing down, clumsiness and confusion that have a profound impact on the ability to perform and e↵ectively plan daily activities [102,103]. Besides stimulation with acupuncture, the e↵ective modulation of brain areas has been obtained through non-invasive brain stimulation by Int. J. Mol. Sci. 2020, 21, 7877 12 of 27 magnetic or electric currents applied to the scalp like transcranial magnetic and electrical stimulation. In many cases, to relieve pain and improve general FM-related function, the use of anodal transcranial direct current stimulation over the primary motor cortex was found to be significantly more e↵ective than sham transcranial direct current stimulation [104]. If we consider that pharmacological and non-pharmacological treatments are often ine↵ective or transitory in their e↵ect on FM, therapeutic electrical stimulation appears to have a potential role [105]. Cognitive functions such as memory have been enhanced in FM patients by anodal transcranial direct current stimulation over the dorsolateral prefrontal cortex and has clinical relevance for top-down treatment approaches in FM [106]. In FM patients, modulation of hemodynamic responses by transcutaneous electrical nerve stimulation during delivery of nociceptive stimulation was also investigated and shown to be an e↵ective factor in FM treatment, although the underlying mechanism for these findings still needs to be clarified [107]. It has been recently demonstrated that both transcutaneous electric nerve stimulation and acupuncture applications seem to be beneficial in FM patients [108]. In a recent Positron Emission Tomography H2 15 O activation study it was shown that occipital nerve field stimulation acts through activation of the descending pain inhibitory pathway and the lateral pain pathway in FM, while electroencephalogram shows activation of those cortical areas that could be responsible for descending inhibition system recruitment [109]. Microcirculation is of great concern in patients with FM. Recently low-energy pulsed electromagnetic field therapy was found to increase a promising therapy to increase microcirlulation [110]; however, neither pain and sti↵ness were reduced nor functioning was improved by this therapy in women with FM [111]. The European Academy of Neurology, based on the method of GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) judged anodal transcranial direct currents stimulation of motor cortex as still inconclusive for treatment of FM [112]. Therefore, further studies are needed to determine optimal treatment protocols and to elucidate the mechanisms involved [113]. 3.2.3. Vibroacoustic and Rhythmic Sensory Stimulation Stimulation with sensory events such as pulsed or continuous auditory, vibrotactile and visual flickering stimuli are referred as rhythmic sensory stimulation [114]. Clinical studies have reported the application of vibroacoustic stimulation in the treatment of FM. In a clinal study, one group of patients with FM listened to a sequence of Bach’s compositions, another was subjected to vibratory stimuli on a combination of acupuncture points on the skin and a third group received no stimulation. The results showed that a greater e↵ect on FM symptoms was achieved by the combined use of music and vibration [115]. However, in another study, neither music nor musically fluctuating vibration had a significant e↵ect on tender point pain in FM patients when compared to placebo treatment [116]. Because thalamocortical dysrhythmia is implicated in FM and that low-frequency sound stimulation can play a regulatory function by driving neural rhythmic oscillatory activity, volunteers with FM were subjected to 23 min of low-frequency sound stimulation at 40 Hz, delivered using transducers in a supine position. Although no adverse e↵ects in patients receiving the treatment, no statistically and clinically relevant improvement were observed [117]. On the other hand, gamma-frequency rhythmic vibroacoustic stimulation was found to decrease FM symptoms (depression, sleep quality and pain interference) and ease associated comorbidities (depression and sleep disturbances), opening new avenues for further investigation of the e↵ects of rhythmic sensory stimulation on chronic pain conditions [118]. 3.2.4. Thermal Therapies Thermal therapies have been used to treat FM. Two main therapies are currently used: body warming and cryotherapy. Int. J. Mol. Sci. 2020, 21, 7877 13 of 27 Because FM is strongly linked to rheumatic aches, the application of heat by spa therapy (balneotherapy) appears as a natural choice for the treatment of FM [119]. Spa therapy is a popular treatment for FM in many European countries, as well as in Japan and Israel. A randomized prospective study of a 10-day treatment was done on 48 FM patients improving their quality of life [120] and showed that treatment of FM at the Dead Sea was both e↵ective and safe [121]. FM patients who were poorly responding to pharmacological therapies were subjected to mud-bath treatment. A cycle of mud bath applications showed beneficial e↵ects on FM patients whose evaluation parameters remained stable after 16 weeks in comparison to baseline [122]. In patients su↵ering from FM, mud bathing was also found to prevent muscle atrophy and inflammation and improve nutritional condition [123]. Nevertheless, despite positive results, the methodological limitations of available clinical studies, such as the lack of placebo double-blinded trials, preclude definitive conclusions on the e↵ect of body-warming therapies to treat FM [119,124]. A remedy widely used in sports related trauma is the application of cold as a therapeutic agent for pain relief. Cryotherapy refers to the use of low temperatures to decrease the inflammatory reaction, including oedema [125]. Cryotherapy induces several organism physiological reactions like increasing anti-inflammatory cytokines, beta-endorphins, ACTH, white blood cells, catecholamines and cortisol, immunostimulation due to noradrenalin response to cold, the increase in the level of plasma total antioxidant status and the reduction of pain through the alteration of nerve conduction [126]. When compared to control FM subjects, cryotherapy-treated FM patients reported a more pronounced improvement of the quality of life [127]. Whole body cryotherapy was also found to be a useful adjuvant therapy for FM [126]. 3.2.5. Hyperbaric Treatment Hyperbaric oxygen therapy (HBOT) has shown beneficial e↵ects for the prevention and treatment of pain [128], including migraine, cluster headache [129] and FM [130]. HBOT is supposed to induce neuroplasticity that leads to repair of chronically impaired brain functions. HBOT was also found to it improve the quality of life in post-stroke patients and mild traumatic brain injury patients [131]. Therefore, the increased oxygen concentration caused by HBOT is supposed to change the brain metabolism and glial function with a potential e↵ect on reducing the FM-associated brain abnormal activity [132]. HBOT was found to a↵ect the mitochondrial mechanisms resulting in functional brain changes, stimulate nitric oxide production thus alleviating hyperalgesia and promoting the NO-dependent release of endogenous opioids which appear to be involved in the antinociception prompted by HBOT [133]. In a clinical study, a significant di↵erence between the HBOT and control groups was found in the reduction in tender points and VAS scores after the first and fifteenth therapy sessions [130]. These results indicate that HBOT may play an important role in managing FM. 3.2.6. Laser Therapy and Phototherapy The use of di↵erent light wavelengths has been found to be an alternative therapy for FM. It is known that low-level laser therapy is a therapeutic factor, being able not only to target one event in the painful reception, but rather the extend its e↵ectiveness on the whole hierarchy of mechanisms of its origin and regulation [134]. Laser photobiomodulation therapy has been reported to be e↵ective in the treatment of a variety of myofascial musculoskeletal disorders, including FM [135]. The combination of laser therapy and the administration of the drug amitriptyline was found to be e↵ective on clinical symptoms and quality of life in FM; furthermore, gallium-arsenide laser therapy was found to be a safe and e↵ective treatment which can be used as a monotherapy or as a supplementary treatment to other therapeutic procedures in FM [136]. Evidence supported also the use of laser therapy in women su↵ering FM to improve pain and upper body range of motion, ultimately reducing the impact of FM [137,138]. Finally, a combination of phototherapy and exercise training was evaluated in patients with FM in a randomized controlled trial for chronic pain to o↵er valuable clinical evidence for objective assessment of the potential benefits and risks of procedures [139]. Int. J. Mol. Sci. 2020, 21, 7877 14 of 27 3.2.7. Exercise and Massage Exercise therapy seems to be an e↵ective component of treatment, yielding improvement in pain and other symptoms, as well as decreasing the burden of FM on the quality of life [140]. Exercise is generally acceptable by individuals with FM and was found to improve the ability to do daily activities and the quality of life and to decrease tiredness and pain [141]. However, it is important to know the e↵ects and specificities of di↵erent types of exercise. For instance, two or more types of exercise may combine strengthening, aerobic or stretching exercise; however, there is no substantial evidence that mixed exercise may improve sti↵ness [142]. Quality of life may be improved by muscle stretching exercise, especially with regard to physical functioning and pain, whereas depression is reduced by resistance training. A trial including a control group and two intervention groups, both of which receiving exercise programs created specifically for patients with FM, showed that both modalities were e↵ective in an exercise therapy program for FM [143]. A progressive muscle strengthening activity was also found to be a safe and e↵ective mode of exercise for FM patients [144]. Furthermore, strength and flexibility exercises in aerobic exercise rehabilitation for FM patients led to improvements in patients’ shoulder/hip range of motion and handgrip strength [145]. Among women with FM, the association between physical activity and daily function is mediated by the intensity of musculoskeletal pain, rather than depressive symptoms or body mass [146], with a link between clinical and experimental pain relief after the performance of isometric contractions [147]. A randomized controlled trial evaluated the e↵ects of yoga intervention on FM symptoms. Women performing yoga showed a significant improvement on standardized measures of FM symptoms and functioning, including fatigue, mood and pain, and in pain acceptance and other coping strategies [148]. Moreover, the combination with massage therapy program during three months influenced perceived stress index, cortisol concentrations, intensity of pain and quality of life of patients with FM [149]. In terms of societal costs and health care costs, quality of life and physical fitness in females with FM was improved by aquatic training and subsequent detraining [150,151]. Aquatic physical training was e↵ective in promoting increased oxygen uptake at peak cardiopulmonary exercise test in women with FM [152]. A systematic evaluation of the harms and benefits of aquatic exercise training in adults with FM showed that it may be beneficial for improving wellness, symptoms, and fitness in adults with FM [153,154]. A safe and clinically efficacious treatment of pain and other FM symptoms was also achieved by the combination of osteopathic manipulative medicine and pharmacologic treatment with gabapentin [155]. Dancing is a type of aerobic exercise that may be used in FM alternative therapy. Belly dancing was found to be e↵ective in improving functional capacity, pain, quality of life and improving body image of women with FM [156]. More recently, three months treatment of patients with FM with Zumba dancing was found to be e↵ective in improving pain and physical functioning [157]. Finally, Tai chi mind-body treatment was found to improve FM symptoms as much as aerobic exercise and longer duration of Tai chi showed greater improvement. According to a recent report, mind-body approaches may take part of the multidisciplinary management of FM and be considered an alternative therapeutic option [158]. 3.2.8. Probiotics and FM Therapy A tractable strategy for developing novel therapeutics for complex central nervous system disorders could rely on the so called microbiota-gut-brain axis management, because intestinal homeostasis may directly a↵ect brain functioning [159,160]. The pain intensity of patients with FM has been reported to be correlated with the degree of small intestinal bacterial overgrowth, which is often associated with an increased intestinal permeability whose values were significantly increased in the FM patients [161]. Preclinical trials indicate that the microbiota and its metabolome are likely involved in modulating brain processes and behaviors [162]. Therefore, FM patients should show better performance after the treatment with probiotics. In a double-blind, placebo-controlled, randomized design probiotic Int. J. Mol. Sci. 2020, 21, 7877 15 of 27 improved impulsive choice and decision-making in FM patients, but no other e↵ects were observed on cognition, quality of life, self-reported pain, FM impact, depressive or anxiety symptoms [163]. 3.2.9. Use of Plant Extracts and Natural Products for FM Treatment About 40% of drugs used to treat FM originate from natural products [164]; however, there are a few studies that prove the safe and e↵ective use of various plant extracts in FM therapy. Several plant extracts are currently used for their antinociceptive properties and potential to treat FM [165]. Papaver somniferum is probably the most ancient plant used for its antinociceptive properties [166], with chemical components able to interact with opioid receptors; among these morphine (15) which is not only the oldest, but is still the most e↵ective drug for the management of severe pain in clinical practice [167]. The use of opioids for FM treatment has been discussed above. Another important plant is Cannabis sativa. The major active constituent of Cannabis, D9-THC (1), has been shown to possess antinociceptive properties when assessed in several experimental models [168] (see also the discussion above on cannabinoids). Although there is still scarce evidence to support its role in the treatment of FM, a large consensus indicates that medical cannabis could be an e↵ective alternative for the treatment of FM symptoms [169]. The illicit use of herbal cannabis for FM treatment has been correlated to the inefficacy of current available medications, but is also linked to popular advocacy or familiarity with marijuana from recreational use. Therefore, physicians are requested to examine the global psychosocial well-being, and not focus only on the single outcome measure of pain [52,170]. Although medical cannabis treatment has a significant favorable e↵ect on patients with FM, 30% of patients experience adverse e↵ects [171] and 8% report dependence on cannabis [172]. VAS scores measured in 28 FM patients after 2 hours of cannabis use showed enhancement of relaxation and feeling of well-being, a reduction of pain and sti↵ness which were accompanied by an increase in somnolence. The mental health component summary score of the Short Form 36 Health Survey was higher in cannabis users than in non-users [49]. Among terpenoids, administration of trans- -caryophyllene (BCP, 26), a bicyclic sesquiterpene compound existing in the essential oil of many plants like Copaifera langsdforffii, Cananga odorata, Humulus lupulus, Piper nigrum and Syzygium aromaticum, which provide a high percentage of BCP along with interesting essential oil yields [173], significantly minimized the pain in both acute and chronic pain models [174]. BCP selectively binds to the cannabinoid 2 (CB2 ) receptor and is a functional CB2 agonist. Upon binding to the CB2 receptor, BCP inhibits adenylate cylcase, leads to intracellular calcium transients and weakly activates the mitogen-activated kinases Erk1/2 and p38 in primary human monocytes [175]. BCP, a safe compound with toxicity at doses higher than 2000 mg/kg body weight [176], was found to reduce the primary and secondary hyperalgesia produced by a chronic muscle pain model (which is considered to be an animal model for FM) [177]. Significant and dose-dependent antinociceptive response was produced by BCP without the presence of gastric damage [178]. Antiallodynic actions of BCP are exerted only through activation of local peripheral CB2 [179]. In neuropathic pain models, BCP reduced spinal neuroinflammation and the oral administration was more e↵ective than the subcutaneously injected synthetic CB2 agonist JWH-133 [180]. Recently, BCP was found to exert an analgesic e↵ect in an FM animal model through activation of the descending inhibitory pain pathway [181]. Thus, BCP may be highly e↵ective in the treatment of long-lasting, debilitating pain states, suggesting the interesting application of BCP in FM therapy. The analgesic properties of myrrh (Commiphora myrrha) have been known since ancient times and depend on the presence of bioactive sesquiterpenes with furanodiene skeletons which are able to interact with the opioid receptors [182,183]. C. myrrha extracts exerted a stronger suppression on carrageenan-induced mice paw edema with significant analgesic e↵ects [184] and were e↵ective against chronic inflammatory joint disease such as osteoarthritis [185]. In a preclinical trial, pain alleviation was obtained with C. myrrha extracts for many pathologies [186], indicating that extracts from this plant may have the potential to treat FM. Int. J. Mol. Sci. 2020, 21, 7877 16 of 27 Preclinical studies indicate a potential use of Hypericum perforatum (Hypericaceae), popularly known as St. John’s wort, in medical pain management [187] due to its phenolic compounds. Many phenolic compounds (e.g., flavonoids) from medicinal plants are promising candidates for new natural analgesic drugs [188]. Quercetin (27) showed analgesic activity and could reduce neuropathic pain by inhibiting mTOR/p70S6K pathway-mediated changes of synaptic morphology and synaptic protein levels in spinal dorsal horn neurons of db/db mice [189], while rutin (28) could inhibit the writhing response of mice induced by potassium antimony tartrate and showed to be a promising pharmacological approach to treat pain [190]. The analgesia potency of hyperin (29) was approximately 20-fold of morphine, while luteolin (30) presented e↵ective analgesic activities for both acute and chronic pain management. Some glycosides of kaempferol (e.g., kaempferol 3-O-sophoroside, 31) possess significant analgesic activity in the tail clip, tail flick, tail immersion, and acetic acid-induced writhing models, whereas baicalin (32) shows analgesic e↵ects in several kinds of pain [191]. Fisetin (33), a plant flavonoid polyphenol, has been reported to possess potent antioxidant, antinociceptive and neuroprotective activities. In rats, fisetin acts via modulation of decreased levels of biogenic amines and elevatesoxido-nitrosative stress and ROS to ameliorate allodynia, hyperalgesia, and depression in experimental reserpine-induced FM [192]. In a double-blind parallel-group clinical trial, outpatients with FM were randomized to receive either 15 mg of Crocus sativus (sa↵ron) extract or 30 mg duloxetine (22). No significant di↵erence was detected for any of the scales neither in terms of score changes from baseline to endpoint between the two treatment arms, indicating that sa↵ron and duloxetine had comparable efficacy in treatment of FM symptoms [193]. It is still unclear the efficacy of natural products extracted from plants in treating FM. However, some clinical data show promising results and more studies with adequate methodological quality are necessary in order to investigate the efficacy and safety of natural products as a support in FM therapy. Figure 7 depicts the chemical formulae of some antinociceptive natural products. Figure 7. Chemical structure of some natural compounds with antinociceptive activity. Int. J. Mol. Sci. 2020, 21, 7877 17 of 27 4. Conclusions Diagnosis of FM is based on clinical feature and criteria that still lack either a gold standard or at least supportive laboratory findings. FM diagnostic criteria may include heterogeneous patients also in clinical trials and this may impair evaluation of clinically meaningful treatment e↵ect. The review of the literature suggests that a multidisciplinary therapeutic approach, based on the combination of pharmacologic and alternative therapy (including thermal, light, electrostimulatory and body exercise treatments) could improve the quality of life and reduce pain and other symptoms related to FM. However, sometimes the ability of patients to participate to alternative therapies is impeded by the level of pain fatigue, poor sleep, and cognitive dysfunction. These patients may need to be managed with medications before initiating nonpharmacologic therapies. Although the use of some natural phytochemicals like BCP and phenolic compounds might replace other natural products such as D9-THC, because of reduced side e↵ects and higher tolerability, FM self medication practice may be ine↵ective and in some cases even detrimental. Therefore, providing FM patients with the correct information about their disorders may help monitoring pharmacological and alternative therapies. At the same time maintaining information will help patients to receive the appropriate medications and therapies [194]. Funding: This research received no external funding. Conflicts of Interest: The author declares no conflict of interest Abbreviations 2-AG 2-ArachidonoylGlycerol AA Arachidonic Acid ACR American College of Rheumatology ACTH Adrenocorticotropic hormone AEA N-arachidonoylethanolamine BDNF Brain-Derived Neurotrophic Factors CB1 Cannabinoid Receptor 1 CB2 Cannabinoid Receptor 2 CBD Cannabidiol CNS Central Nervous System EA Electro-Acupuncture ESS Extent of Somatic Symptoms FIQ FM Impact Questionnaire FIQR FM Impact Questionnaire Revised version FM Fibromyalgia FS Fibromyalgianess Scale GABA Gamma-Aminobutyric Acid Grading of Recommendations, Assessment, GRADE Development, and Evaluation HBOT Hyperbaric Oxygen Therapy ICD-11 International Classification of Diseases IL-1 Interleukin 1 beta IL-6 Interleukin 6 MA Manual Acupuncture PEA Palmitoylethanolamide PFM Primary FM ROS Reactive Oxygen Species SIQ Symptom Impact Questionnaire SFM Secondary FM SNRIs Serotonin and Norepinephrine Reuptake Inhibitors SSRIs Serotonin Selective Reuptake Inhibitors SSS Symptom Severity Scale TCAs Tricyclic Antidepressant TNF↵ Tumor necrosis factor alpha VAS Visual Analog Scale WPI Widespread Pain Index D9-THC Delta 9-tetrahydrocannabinol Int. J. Mol. Sci. 2020, 21, 7877 18 of 27 References 1. Wang, S.M.; Han, C.; Lee, S.J.; Patkar, A.A.; Masand, P.S.; Pae, C.U. Fibromyalgia diagnosis: A review of the past, present and future. Expert Rev. Neurother. 2015, 15, 667–679. [CrossRef] [PubMed] 2. Chinn, S.; Caldwell, W.; Gritsenko, K. Fibromyalgia pathogenesis and treatment options update. Curr. Pain Headache Rep. 2016, 20, 25. [CrossRef] [PubMed] 3. Blanco, I.; Beritze, N.; Arguelles, M.; Carcaba, V.; Fernandez, F.; Janciauskiene, S.; Oikonomopoulou, K.; de Serres, F.J.; Fernandez-Bustillo, E.; Hollenberg, M.D. Abnormal overexpression of mastocytes in skin biopsies of fibromyalgia patients. Clin. Rheumatol. 2010, 29, 1403–1412. [CrossRef] [PubMed] 4. Cabo-Meseguer, A.; Cerda-Olmedo, G.; Trillo-Mata, J.L. Fibromyalgia: Prevalence, epidemiologic profiles and economic costs. Med. Clin. 2017, 149, 441–448. [CrossRef] [PubMed] 5. Williams, D.A.; Schilling, S. Advances in the assessment of fibromyalgia. Rheum. Dis. Clin. N. Am. 2009, 35, 339–357. [CrossRef] [PubMed] 6. Rahman, A.; Underwood, M.; Carnes, D. Fibromyalgia. BMJ Br. Med. J. 2014, 348. [CrossRef] [PubMed] 7. McBeth, J.; Mulvey, M.R. Fibromyalgia: Mechanisms and potential impact of the acr 2010 classification criteria. Nat. Rev. Rheumatol. 2012, 8, 108–116. [CrossRef] [PubMed] 8. Arnold, L.M.; Clauw, D.J.; McCarberg, B.H.; FibroCollaborative. Improving the recognition and diagnosis of fibromyalgia. Mayo Clin. Proc. 2011, 86, 457–464. [CrossRef] 9. Wolfe, F.; Smythe, H.A.; Yunus, M.B.; Bennett, R.M.; Bombardier, C.; Goldenberg, D.L.; Tugwell, P.; Campbell, S.M.; Abeles, M.; Clark, P.; et al. The american-college-of-rheumatology 1990 criteria for the classification of fibromyalgia—Report of the multicenter criteria committee. Arthritis Rheum. 1990, 33, 160–172. [CrossRef] 10. Dworkin, R.H.; Turk, D.C.; McDermott, M.P.; Peirce-Sandner, S.; Burke, L.B.; Cowan, P.; Farrar, J.T.; Hertz, S.; Raja, S.N.; Rappaport, B.A.; et al. Interpreting the clinical importance of group di↵erences in chronic pain clinical trials: Immpact recommendations. Pain 2009, 146, 238–244. [CrossRef] 11. Arnold, L.M.; Cro↵ord, L.J.; Mease, P.J.; Burgess, S.M.; Palmer, S.C.; Abetz, L.; Martin, S.A. Patient perspectives on the impact of fibromyalgia. Patient Educ. Couns. 2008, 73, 114–120. [CrossRef] [PubMed] 12. Wolfe, F.; Hauser, W. Fibromyalgia diagnosis and diagnostic criteria. Ann. Med. 2011, 43, 495–502. [CrossRef] [PubMed] 13. Wolfe, F. New american college of rheumatology criteria for fibromyalgia: A twenty-year journey. Arthritis Care Res. 2010, 62, 583–584. [CrossRef] [PubMed] 14. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.A.; Goldenberg, D.L.; Hauser, W.; Katz, R.S.; Mease, P.; Russell, A.S.; Russell, I.J.; Winfield, J.B. Fibromyalgia criteria and severity scales for clinical and epidemiological studies: A modification of the acr preliminary diagnostic criteria for fibromyalgia. J. Rheumatol. 2011, 38, 1113–1122. [CrossRef] 15. Oncu, J.; Iliser, R.; Kuran, B. Do new diagnostic criteria for fibromyalgia provide treatment opportunity to those previously untreated? J. Back Musculoskelet. Rehabil. 2013, 26, 437–443. [CrossRef] 16. Wolfe, F.; Walitt, B.; Rasker, J.J.; Hauser, W. Primary and secondary fibromyalgia are the same: The universality of polysymptomatic distress. J. Rheumatol. 2019, 46, 204–212. [CrossRef] 17. Bellato, E.; Marini, E.; Castoldi, F.; Barbasetti, N.; Mattei, L.; Bonasia, D.E.; Blonna, D. Fibromyalgia syndrome: Etiology, pathogenesis, diagnosis, and treatment. Pain Res. Treat. 2012, 2012, 426130. [CrossRef] 18. Bennett, R.M.; Friend, R.; Marcus, D.; Bernstein, C.; Han, B.K.; Yachoui, R.; Deodhar, A.; Kaell, A.; Bonafede, P.; Chino, A.; et al. Criteria for the diagnosis of fibromyalgia: Validation of the modified 2010 preliminary american college of rheumatology criteria and the development of alternative criteria. Arthritis Care Res. 2014, 66, 1364–1373. [CrossRef] 19. Aggarwal, R.; Ringold, S.; Khanna, D.; Neogi, T.; Johnson, S.R.; Miller, A.; Brunner, H.I.; Ogawa, R.; Felson, D.; Ogdie, A.; et al. Distinctions between diagnostic and classification criteria? Arthritis Care Res. 2015, 67, 891–897. [CrossRef] 20. Taylor, W.J.; Fransen, J. Distinctions between diagnostic and classification criteria: Comment on the article by Aggarwal et al. Arthritis Care Res. 2016, 68, 149–150. [CrossRef] 21. Wolfe, F.; Clauw, D.J.; Fitzcharles, M.A.; Goldenberg, D.L.; Hauser, W.; Katz, R.L.; Mease, P.J.; Russell, A.S.; Russell, I.J.; Walitt, B. 2016 revisions to the 2010/2011 fibromyalgia diagnostic criteria. Semin. Arthritis Rheum. 2016, 46, 319–329. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 19 of 27 22. Bidari, A.; Parsa, B.G.; Ghalehbaghi, B. Challenges in fibromyalgia diagnosis: From meaning of symptoms to fibromyalgia labeling. Korean J. Pain 2018, 31, 147–154. [CrossRef] 23. Treede, R.D.; Rief, W.; Barke, A.; Aziz, Q.; Bennett, M.I.; Benoliel, R.; Cohen, M.; Evers, S.; Finnerup, N.B.; First, M.B.; et al. Chronic pain as a symptom or a disease: The IASP classification of chronic pain for the international classification of diseases (ICD-11). Pain 2019, 160, 19–27. [CrossRef] 24. Wolfe, F.; Schmukler, J.; Jamal, S.; Castrejon, I.; Gibson, K.A.; Srinivasan, S.; Hauser, W.; Pincus, T. Diagnosis of fibromyalgia: Disagreement between fibromyalgia criteria and clinician-based fibromyalgia diagnosis in a university clinic. Arthritis Care Res. 2019, 71, 343–351. [CrossRef] [PubMed] 25. Eich, W.; Bar, K.J.; Bernateck, M.; Burgmer, M.; Dexl, C.; Petzke, F.; Sommer, C.; Winkelmann, A.; Hauser, W. Definition, classification, clinical diagnosis and prognosis of fibromyalgia syndrome: Updated guidelines 2017 and overview of systematic review articles. Schmerz 2017, 31, 231–238. [CrossRef] [PubMed] 26. Ra↵aeli, W.; Malafoglia, V.; Bonci, A.; Tenti, M.; Ilari, S.; Gremigni, P.; Iannuccelli, C.; Gioia, C.; Di Franco, M.; Mollace, V.; et al. Identification of mor-positive b cell as possible innovative biomarker (mu lympho-marker) for chronic pain diagnosis in patients with fibromyalgia and osteoarthritis diseases. Int. J. Mol. Sci. 2020, 21, 15. [CrossRef] [PubMed] 27. Hackshaw, K.V.; Aykas, D.P.; Sigurdson, G.T.; Plans, M.; Madiai, F.; Yu, L.B.; Buffington, C.A.T.; Giusti, M.M.; Rodriguez-Saona, L. Metabolic fingerprinting for diagnosis of fibromyalgia and other rheumatologic disorders. J. Biol. Chem. 2019, 294, 2555–2568. [CrossRef] 28. Wolfe, F. Criteria for fibromyalgia? What is fibromyalgia? Limitations to current concepts of fibromyalgia and fibromyalgia criteria. Clin. Exp. Rheumatol. 2017, 35, S3–S5. 29. Walitt, B.; Nahin, R.L.; Katz, R.S.; Bergman, M.J.; Wolfe, F. The prevalence and characteristics of fibromyalgia in the 2012 national health interview survey. PLoS ONE 2015, 10, e0138024. [CrossRef] 30. Moore, R.A.; Straube, S.; Aldington, D. Pain measures and cut-o↵s—No worse than mild pain as a simple, universal outcome. Anaesthesia 2013, 68, 400–412. [CrossRef] 31. Espejo, J.A.; Garcia-Escudero, M.; Oltra, E. Unraveling the molecular determinants of manual therapy: An approach to integrative therapeutics for the treatment of fibromyalgia and chronic fatigue syndrome/myalgic encephalomyelitis. Int. J. Mol. Sci. 2018, 19, 19. [CrossRef] [PubMed] 32. Calandre, E.P.; Rico-Villademoros, F.; Slim, M. An update on pharmacotherapy for the treatment of fibromyalgia. Expert Opin. Pharmacother. 2015, 16, 1347–1368. [CrossRef] [PubMed] 33. Thorpe, J.; Shum, B.; Moore, R.A.; Wi↵en, P.J.; Gilron, I. Combination pharmacotherapy for the treatment of fibromyalgia in adults. Cochrane Database Syst. Rev. 2018, 2. [CrossRef] [PubMed] 34. Mease, P.J.; Seymour, K. Fibromyalgia: Should the treatment paradigm be monotherapy or combination pharmacotherapy? Curr. Pain Headache Rep. 2008, 12, 399–405. [CrossRef] 35. Kwiatek, R. Treatment of fibromyalgia. Aust. Prescr. 2017, 40, 179–183. [CrossRef] 36. Wright, C.L.; Mist, S.D.; Ross, R.L.; Jones, K.D. Duloxetine for the treatment of fibromyalgia. Expert Rev. Clin. Immunol. 2010, 6, 745–756. [CrossRef] 37. Pacher, P.; Batkai, S.; Kunos, G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol. Rev. 2006, 58, 389–462. [CrossRef] 38. De Vries, M.; van Rijckevorsel, D.C.M.; Wilder-Smith, O.H.G.; van Goor, H. Dronabinol and chronic pain: Importance of mechanistic considerations. Expert Opin. Pharmacother. 2014, 15, 1525–1534. [CrossRef] 39. Russo, E.B. Clinical endocannabinoid deficiency (CECD)—Can this concept explain therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocr. Lett. 2004, 25. (Reprinted from Neuroendocrinilogy, 2004, 25, 31–39). 40. Smith, S.C.; Wagner, M.S. Clinical endocannabinoid deficiency (CECD) revisited: Can this concept explain the therapeutic benefits of cannabis in migraine, fibromyalgia, irritable bowel syndrome and other treatment-resistant conditions? Neuroendocr. Lett. 2014, 35, 198–201. 41. Munro, S.; Thomas, K.L.; Abushaar, M. Molecular characterization of a peripheral receptor for cannabinoids. Nature 1993, 365, 61–65. [CrossRef] [PubMed] 42. Skrabek, R.Q.; Gallmova, L.; Ethans, K.; Perry, D. Nabilone for the treatment of pain in fibromyalgia. J. Pain 2008, 9, 164–173. [CrossRef] [PubMed] 43. Walitt, B.; Klose, P.; Fitzcharles, M.A.; Phillips, T.; Hauser, W. Cannabinoids for fibromyalgia. Cochrane Database Syst. Rev. 2016. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 20 of 27 44. Thomas, A.; Baillie, G.L.; Phillips, A.M.; Razdan, R.K.; Ross, R.A.; Pertwee, R.G. Cannabidiol displays unexpectedly high potency as an antagonist of cb1 and cb2 receptor agonists in vitro. Br. J. Pharmacol. 2007, 150, 613–623. [CrossRef] 45. Baumeister, D.; Eich, W.; Lerner, R.; Lutz, B.; Bindila, L.; Tesarz, J. Plasma parameters of the endocannabinoid system are unaltered in fibromyalgia. Psychother. Psychosom. 2018, 87, 377–379. [CrossRef] 46. Kaufmann, I.; Schelling, G.; Eisner, C.; Richter, H.P.; Krauseneck, T.; Vogeser, M.; Hauer, D.; Campolongo, P.; Chouker, A.; Beyer, A.; et al. Anandamide and neutrophil function in patients with fibromyalgia. Psychoneuroendocrinology 2008, 33, 676–685. [CrossRef] 47. Agarwal, N.; Pacher, P.; Tegeder, I.; Amaya, F.; Constantin, C.E.; Brenner, G.J.; Rubino, T.; Michalski, C.W.; Marsicano, G.; Monory, K.; et al. Cannabinoids mediate analgesia largely via peripheral type 1 cannabinoid receptors in nociceptors. Nat. Neurosci. 2007, 10, 870–879. [CrossRef] 48. Schley, M.; Legler, A.; Skopp, G.; Schmelz, M.; Konrad, C.; Rukwied, R. Delta-9-thc based monotherapy in fibromyalgia patients on experimentally induced pain, axon reflex flare, and pain relief. Curr. Med. Res. Opin. 2006, 22, 1269–1276. [CrossRef] 49. Fiz, J.; Duran, M.; Capella, D.; Carbonell, J.; Farre, M. Cannabis use in patients with fibromyalgia: E↵ect on symptoms relief and health-related quality of life. PLoS ONE 2011, 6, 5. [CrossRef] 50. Ware, M.A.; Fitzcharles, M.A.; Joseph, L.; Shir, Y. The e↵ects of nabilone on sleep in fibromyalgia: Results of a randomized controlled trial. Anesth. Analg. 2010, 110, 604–610. [CrossRef] 51. Fitzcharles, M.A.; Ste-Marie, P.A.; Goldenberg, D.L.; Pereira, J.X.; Abbey, S.; Choiniere, M.; Ko, G.; Moulin, D.E.; Panopalis, P.; Proulx, J.; et al. 2012 Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: Executive summary. Pain Res. Manag. 2013, 18, 119–126. [CrossRef] 52. Ste-Marie, P.A.; Fitzcharles, M.A.; Gamsa, A.; Ware, M.A.; Shir, Y. Association of herbal cannabis use with negative psychosocial parameters in patients with fibromyalgia. Arthritis Care Res. 2012, 64, 1202–1208. [CrossRef] [PubMed] 53. Painter, J.T.; Cro↵ord, L.J. Chronic opioid use in fibromyalgia syndrome a clinical review. JCR J. Clin. Rheumatol. 2013, 19, 72–77. [CrossRef] [PubMed] 54. Goldenberg, D.L.; Clauw, D.J.; Palmer, R.E.; Clair, A.G. Opioid use in fibromyalgia: A cautionary tale. Mayo Clin. Proc. 2016, 91, 640–648. [CrossRef] [PubMed] 55. Baraniuk, J.N.; Whalen, G.; Cunningham, J.; Clauw, D.J. Cerebrospinal fluid levels of opioid peptides in fibromyalgia and chronic low back pain. BMC Musculoskelet. Disord. 2004, 5, 48. [CrossRef] 56. Fitzcharles, M.-A.; Faregh, N.; Ste-Marie, P.A.; Shir, Y. Opioid use in fibromyalgia is associated with negative health related measures in a prospective cohort study. Pain Res. Treat. 2013, 2013, 7. [CrossRef] 57. Peng, X.M.; Robinson, R.L.; Mease, P.; Kroenke, K.; Williams, D.A.; Chen, Y.; Faries, D.; Wohlreich, M.; McCarberg, B.; Hann, D. Long-term evaluation of opioid treatment in fibromyalgia. Clin. J. Pain 2015, 31, 7–13. [CrossRef] 58. Hwang, J.M.; Lee, B.J.; Oh, T.H.; Park, D.; Kim, C.H. Association between initial opioid use and response to a brief interdisciplinary treatment program in fibromyalgia. Medicine 2019, 98, 8. [CrossRef] 59. Harris, R.E.; Clauw, D.J.; Scott, D.J.; McLean, S.A.; Gracely, R.H.; Zubieta, J.K. Decreased central mu-opioid receptor availability in fibromyalgia. J. Neurosci. 2007, 27, 10000–10006. [CrossRef] 60. Bennett, R.M.; Jones, J.; Turk, D.C.; Russell, I.J.; Matallana, L. An internet survey of 2596 people with fibromyalgia. BMC Musculoskelet. Disord. 2007, 8, 27. 61. Hilliard, P.E.; Waljee, J.; Moser, S.; Metz, L.; Mathis, M.; Goesling, J.; Cron, D.; Clauw, D.J.; Englesbe, M.; Abecasis, G.; et al. Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgeryprevalence of preoperative opioid use and associated patient characteristicsprevalence of preoperative opioid use and associated patient characteristics. JAMA Surg. 2018, 153, 929–937. [PubMed] 62. Gaskell, H.; Moore, R.A.; Derry, S.; Stannard, C. Oxycodone for pain in fibromyalgia in adults. Cochrane Database Syst. Rev. 2016, 23. [CrossRef] 63. Ruette, P.; Stuyck, J.; Debeer, P. Neuropathic arthropathy of the shoulder and elbow associated with syringomyelia: A report of 3 cases. Acta Orthop. Belg. 2007, 73, 525–529. [PubMed] 64. Williams, E.R.; Ford, C.M.; Simonds, J.G.; Leal, A.K. Blocking peripheral opioid receptors with naloxone methiodide prevents acute and chronic training-induced analgesia in a rat model of fibromyalgia. FASEB J. 2017, 31, 1. Int. J. Mol. Sci. 2020, 21, 7877 21 of 27 65. Hermans, L.; Nijs, J.; Calders, P.; De Clerck, L.; Moorkens, G.; Hans, G.; Grosemans, S.; De Mettelinge, T.R.; Tuynman, J.; Meeus, M. Influence of morphine and naloxone on pain modulation in rheumatoid arthritis, chronic fatigue syndrome/fibromyalgia, and controls: A double-blind, randomized, placebo-controlled, cross-over study. Pain Pract. 2018, 18, 418–430. [CrossRef] 66. MacLean, A.J.B.; Schwartz, T.L. Tramadol for the treatment of fibromyalgia. Expert Rev. Neurother. 2015, 15, 469–475. [CrossRef] 67. Gur, A.; Calgan, N.; Nas, K.; Cevik, R.; Sarac, A.J. Low dose of tramadol in the treatment of fibromyalgia syndrome: A controlled clinical trial versus placebo. Ann. Rheum. Dis. 2006, 65, 556. 68. Mullican, W.S.; Lacy, J.R.; TRAMAP-ANAG-006 Study Group. Tramadol/acetaminophen combination tablets and codeine/acetaminophen combination capsules for the management of chronic pain: A comparative trial. Clin. Ther. 2001, 23, 1429–1445. [CrossRef] 69. Price, D.D.; Staud, R.; Robinson, M.E.; Mauderli, A.P.; Cannon, R.; Vierck, C.J. Enhanced temporal summation of second pain and its central modulation in fibromyalgia patients. Pain 2002, 99, 49–59. [CrossRef] 70. Larabi, I.A.; Martin, M.; Fabresse, N.; Etting, I.; Edel, Y.; Pfau, G.; Alvarez, J.C. Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by lc-ms/ms after unintentional overdose. Forensic Toxicol. 2020, 38, 277–286. [CrossRef] 71. Comer, S.D.; Cahill, C.M. Fentanyl: Receptor pharmacology, abuse potential, and implications for treatment. Neurosci. Biobehav. Rev. 2019, 106, 49–57. [CrossRef] [PubMed] 72. Abeles, A.M.; Pillinger, M.H.; Solitar, B.M.; Abeles, M. Narrative review: The pathophysiology of fibromyalgia. Ann. Intern. Med. 2007, 146, 726–734. [CrossRef] 73. Watkins, L.R.; Maier, S.F. Immune regulation of central nervous system functions: From sickness responses to pathological pain. J. Intern. Med. 2005, 257, 139–155. [CrossRef] 74. Khalil, R.B. Pentoxifylline’s theoretical efficacy in the treatment of fibromyalgia syndrome. Pain Med. 2013, 14, 549–550. [CrossRef] 75. Polli, A.; Ghosh, M.; Bakusic, J.; Ickmans, K.; Monteyne, D.; Velkeniers, B.; Bekaert, B.; Godderis, L.; Nijs, J. DNA methylation and brain-derived neurotrophic factor expression account for symptoms and widespread hyperalgesia in patients with chronic fatigue syndrome and comorbid fibromyalgia. Arthritis Rheumatol. 2020. [CrossRef] 76. Scott, J.R.; Hassett, A.L.; Brummett, C.M.; Harris, R.E.; Clauw, D.J.; Harte, S.E. Ca↵eine as an opioid analgesic adjuvant in fibromyalgia. J. Pain Res. 2017, 10, 1801–1809. [CrossRef] [PubMed] 77. Goodman, C.W.; Brett, A.S. A clinical overview of o↵-label use of gabapentinoid drugs. JAMA Intern. Med. 2019, 179, 695–701. [CrossRef] 78. Micheva, K.D.; Buchanan, J.; Holz, R.W.; Smith, S.J. Retrograde regulation of synaptic vesicle endocytosis and recycling. Nat. Neurosci. 2003, 6, 925–932. [CrossRef] 79. Deitos, A.; Soldatelli, M.D.; Dussan-Sarria, J.A.; Souza, A.; Torres, I.L.D.; Fregni, F.; Caumo, W. Novel insights of e↵ects of pregabalin on neural mechanisms of intracortical disinhibition in physiopathology of fibromyalgia: An explanatory, randomized, double-blind crossover study. Front. Hum. Neurosci. 2018, 12, 14. [CrossRef] 80. Kiso, T.; Moriyama, A.; Furutani, M.; Matsuda, R.; Funatsu, Y. E↵ects of pregabalin and duloxetine on neurotransmitters in the dorsal horn of the spinal cord in a rat model of fibromyalgia. Eur. J. Pharmacol. 2018, 827, 117–124. [CrossRef] 81. Gerardi, M.C.; Atzeni, F.; Batticciotto, A.; Di Franco, M.; Rizzi, M.; Sarzi-Puttini, P. The safety of pregabalin in the treatment of fibromyalgia. Expert Opin. Drug Saf. 2016, 15, 1541–1548. [CrossRef] [PubMed] 82. Hirakata, M.; Yoshida, S.; Tanaka-Mizuno, S.; Kuwauchi, A.; Kawakami, K. Pregabalin prescription for neuropathic pain and fibromyalgia: A descriptive study using administrative database in Japan. Pain Res. Manag. 2018, 10. [CrossRef] [PubMed] 83. Asomaning, K.; Abramsky, S.; Liu, Q.; Zhou, X.; Sobel, R.E.; Watt, S. Pregabalin prescriptions in the United Kingdom: A drug utilisation study of the health improvement network (thin) primary care database. Int J. Clin. Pr. 2016, 70, 380–388. [CrossRef] 84. Ferreira-Dos-Santos, G.; Sousa, D.C.; Costa, J.; Vaz-Carneiro, A. Analysis of the cochrane review: Pregabalin for pain in fibromyalgia in adults. Cochrane database syst rev. 2016; 9: Cd011790 and 2016; 4: Cd009002. Acta Med. Port. 2018, 31, 376–381. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 22 of 27 85. Bhusal, S.; Diomampo, S.; Magrey, M.N. Clinical utility, safety, and efficacy of pregabalin in the treatment of fibromyalgia. Drug Healthc. Patient Saf. 2016, 8, 13–23. [CrossRef] 86. Arnold, L.M.; Choy, E.; Clauw, D.J.; Oka, H.; Whalen, E.; Semel, D.; Pauer, L.; Knapp, L. An evidence-based review of pregabalin for the treatment of fibromyalgia. Curr. Med. Res. Opin. 2018, 34, 1397–1409. [CrossRef] [PubMed] 87. Cooper, T.E.; Derry, S.; Wi↵en, P.J.; Moore, R.A. Gabapentin for fibromyalgia pain in adults. Cochrane Database Syst. Rev. 2017. [CrossRef] [PubMed] 88. Walitt, B.; Urrutia, G.; Nishishinya, M.B.; Cantrell, S.E.; Hauser, W. Selective serotonin reuptake inhibitors for fibromyalgia syndrome. Cochrane Database Syst. Rev. 2015, 66. [CrossRef] 89. Welsch, P.; Uceyler, N.; Klose, P.; Walitt, B.; Hauser, W. Serotonin and noradrenaline reuptake inhibitors (SNRIs) for fibromyalgia. Cochrane Database Syst. Rev. 2018, 111. [CrossRef] 90. Grubisic, F. Are serotonin and noradrenaline reuptake inhibitors e↵ective, tolerable, and safe for adults with fibromyalgia? A cochrane review summary with commentary. J. Musculoskelet. Neuronal. Interact. 2018, 18, 404–406. 91. VanderWeide, L.A.; Smith, S.M.; Trinkley, K.E. A systematic review of the efficacy of venlafaxine for the treatment of fibromyalgia. J. Clin. Pharm. Ther. 2015, 40, 1–6. [CrossRef] [PubMed] 92. Miki, K.; Murakami, M.; Oka, H.; Onozawa, K.; Yoshida, S.; Osada, K. Efficacy of mirtazapine for the treatment of fibromyalgia without concomitant depression: A randomized, double-blind, placebo-controlled phase IIa study in Japan. Pain 2016, 157, 2089–2096. [CrossRef] 93. Deboer, T. The pharmacologic profile of mirtazapine. J. Clin. Psychiatry 1996, 57, 19–25. 94. Ottman, A.A.; Warner, C.B.; Brown, J.N. The role of mirtazapine in patients with fibromyalgia: A systematic review. Rheumatol. Int. 2018, 38, 2217–2224. [CrossRef] [PubMed] 95. Rico-Villademoros, F.; Slim, M.; Calandre, E.P. Amitriptyline for the treatment of fibromyalgia: A comprehensive review. Expert Rev. Neurother. 2015, 15, 1123–1150. [CrossRef] 96. Moore, R.A.; Derry, S.; Aldington, D.; Cole, P.; Wi↵en, P.J. Amitriptyline for fibromyalgia in adults. Cochrane Database Syst. Rev. 2015. [CrossRef] 97. De Tommaso, M.; Delussi, M.; Ricci, K.; D’Angelo, G. Abdominal acupuncture changes cortical responses to nociceptive stimuli in fibromyalgia patients. CNS Neurosci. Ther. 2014, 20, 565–567. [CrossRef] 98. Karatay, S.; Okur, S.C.; Uzkeser, H.; Yildirim, K.; Akcay, F. E↵ects of acupuncture treatment on fibromyalgia symptoms, serotonin, and substance p levels: A randomized sham and placebo-controlled clinical trial. Pain Med. 2018, 19, 615–628. [CrossRef] 99. Deare, J.C.; Zheng, Z.; Xue, C.C.L.; Liu, J.P.; Shang, J.S.; Scott, S.W.; Littlejohn, G. Acupuncture for treating fibromyalgia. Cochrane Database Syst. Rev. 2013. [CrossRef] 100. Cao, H.J.; Li, X.; Han, M.; Liu, J.P. Acupoint stimulation for fibromyalgia: A systematic review of randomized controlled trials. Evid. Based Complementary Altern. Med. 2013, 2013, 1–15. [CrossRef] 101. Zhang, X.C.; Chen, H.; Xu, W.T.; Song, Y.Y.; Gu, Y.H.; Ni, G.X. Acupuncture therapy for fibromyalgia: A systematic review and meta-analysis of randomized controlled trials. J. Pain Res. 2019, 12, 527–542. [CrossRef] [PubMed] 102. Tesio, V.; Torta, D.M.E.; Colonna, F.; Leombruni, P.; Ghiggia, A.; Fusaro, E.; Geminiani, G.C.; Torta, R.; Castelli, L. Are fibromyalgia patients cognitively impaired? Objective and subjective neuropsychological evidence. Arthritis Care Res. 2015, 67, 143–150. [CrossRef] [PubMed] 103. Gelonch, O.; Garolera, M.; Valls, J.; Rossello, L.; Pifarre, J. Executive function in fibromyalgia: Comparing subjective and objective measures. Compr. Psychiatry 2016, 66, 113–122. [CrossRef] [PubMed] 104. Zhu, C.E.; Yu, B.; Zhang, W.; Chen, W.H.; Qi, Q.; Miao, Y. E↵ectiveness and safety of transcranial direct current stimulation in fibromyalgia: A systematic review and meta-analysis. J. Rehabil. Med. 2017, 49, 2–9. [CrossRef] 105. Brighina, F.; Curatolo, M.; Cosentino, G.; De Tommaso, M.; Battaglia, G.; Sarzi-Puttini, P.C.; Guggino, G.; Fierro, B. Brain modulation by electric currents in fibromyalgia: A structured review on non-invasive approach with transcranial electrical stimulation. Front. Hum. Neurosci. 2019, 13, 14. [CrossRef] 106. Dos Santos, V.S.; Zortea, M.; Alves, R.L.; Naziazeno, C.C.D.; Saldanha, J.S.; de Carvalho, S.D.R.; Leite, A.J.D.; Torres, I.L.D.; de Souza, A.; Calvetti, P.U.; et al. Cognitive e↵ects of transcranial direct current stimulation combined with working memory training in fibromyalgia: A randomized clinical trial. Sci Rep. 2018, 8, 11. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 23 of 27 107. Eken, A.; Kara, M.; Baskak, B.; Baltaci, A.; Gokcay, D. Di↵erential efficiency of transcutaneous electrical nerve stimulation in dominant versus nondominant hands in fibromyalgia: Placebo-controlled functional near-infrared spectroscopy study. Neurophotonics 2018, 5, 15. [CrossRef] 108. Yuksel, M.; Ayas, S.; Cabioglu, M.T.; Yilmaz, D.; Cabioglu, C. Quantitative data for transcutaneous electrical nerve stimulation and acupuncture e↵ectiveness in treatment of fibromyalgia syndrome. Evid. Based Complementary Altern. Med. 2019, 12, 362831. [CrossRef] 109. Ahmed, S.; Plazier, M.; Ost, J.; Stassijns, G.; Deleye, S.; Ceyssens, S.; Dupont, P.; Stroobants, S.; Staelens, S.; De Ridder, D.; et al. The e↵ect of occipital nerve field stimulation on the descending pain pathway in patients with fibromyalgia: A water pet and EEG imaging study. BMC Neurol. 2018, 18, 10. [CrossRef] 110. Sutbeyaz, S.T.; Sezer, N.; Koseoglu, F.; Kibar, S. Low-frequency pulsed electromagnetic field therapy in fibromyalgia a randomized, double-blind, sham-controlled clinical study. Clin. J. Pain 2009, 25, 722–728. [CrossRef] 111. Multanen, J.; Hakkinen, A.; Heikkinen, P.; Kautiainen, H.; Mustalampi, S.; Ylinen, J. Pulsed electromagnetic field therapy in the treatment of pain and other symptoms in fibromyalgia: A randomized controlled study. Bioelectromagnetics 2018, 39, 405–413. [CrossRef] 112. Cruccu, G.; Garcia-Larrea, L.; Hansson, P.; Keindl, M.; Lefaucheur, J.P.; Paulus, W.; Taylor, R.; Tronnier, V.; Truini, A.; Attal, N. Ean guidelines on central neurostimulation therapy in chronic pain conditions. Eur. J. Neurol. 2016, 23, 1489–1499. [CrossRef] 113. Knijnik, L.M.; Dussan-Sarria, J.A.; Rozisky, J.R.; Torres, I.L.S.; Brunoni, A.R.; Fregni, F.; Caumo, W. Repetitive transcranial magnetic stimulation for fibromyalgia: Systematic review and meta-analysis. Pain Pract. 2016, 16, 294–304. [CrossRef] 114. Thut, G.; Schyns, P.G.; Gross, J. Entrainment of perceptually relevant brain oscillations by non-invasive rhythmic stimulation of the human brain. Front. Psychol. 2011, 2, 170. [CrossRef] 115. Weber, A.; Werneck, L.; Paiva, E.; Gans, P. E↵ects of music in combination with vibration in acupuncture points on the treatment of fibromyalgia. J. Altern. Complement. Med. 2015, 21, 77–82. [CrossRef] 116. Chesky, K.S.; Russell, I.J.; Lopez, Y.; Kondraske, G.V. Fibromyalgia tender point pain: A double-blind, placebo-controlled pilot study of music vibration using the music vibration table. J. Musculoskelet. Pain 1997, 5, 33–52. [CrossRef] 117. Naghdi, L.; Ahonen, H.; Macario, P.; Bartel, L. The e↵ect of low-frequency sound stimulation on patients with fibromyalgia: A clinical study. Pain Res. Manag. 2015, 20, E21–E27. [CrossRef] [PubMed] 118. Janzen, T.B.; Paneduro, D.; Picard, L.; Gordon, A.; Bartel, L.R. A parallel randomized controlled trial examining the e↵ects of rhythmic sensory stimulation on fibromyalgia symptoms. PLoS ONE 2019, 14, 19. [CrossRef] [PubMed] 119. Ablin, J.N.; Hauser, W.; Buskila, D. Spa Treatment (Balneotherapy) for Fibromyalgia—A Qualitative-Narrative Review and a Historical Perspective. Evid. Based Complementary Altern. Med. 2013, 2013, 638050. [CrossRef] [PubMed] 120. Neumann, L.; Sukenik, S.; Bolotin, A.; Abu-Shakra, M.; Amir, A.; Flusser, D.; Buskila, D. The e↵ect of balneotherapy at the dead sea on the quality of life of patients with fibromyalgia syndrome. Clin. Rheumatol. 2001, 20, 15–19. [CrossRef] 121. Mist, S.D.; Firestone, K.A.; Jones, K.D. Complementary and alternative exercise for fibromyalgia: A meta-analysis. J. Pain Res. 2013, 6, 247–260. [CrossRef] 122. Fioravanti, A.; Perpignano, G.; Tirri, G.; Cardinale, G.; Gianniti, C.; Lanza, C.E.; Loi, A.; Tirri, E.; Sfriso, P.; Cozzi, F. E↵ects of mud-bath treatment on fibromyalgia patients: A randomized clinical trial. Rheumatol. Int. 2007, 27, 1157–1161. [CrossRef] 123. Maeda, T.; Kudo, Y.; Horiuchi, T.; Makino, N. Clinical and anti-aging e↵ect of mud-bathing therapy for patients with fibromyalgia. Mol. Cell. Biochem. 2018, 444, 87–92. [CrossRef] 124. Guidelli, G.M.; Tenti, S.; De Nobili, E.; Fioravanti, A. Fibromyalgia syndrome and spa therapy: Myth or reality? Clin. Med. Insights Arthritis Musculoskelet. Disord. 2012, 5, 19–26. [CrossRef] 125. Ernst, E.; Fialka, V. Ice freezes pain—A review of the clinical e↵ectiveness of analgesic cold therapy. J. Pain Symptom Manag. 1994, 9, 56–59. [CrossRef] 126. Rivera, J.; Tercero, M.J.; Salas, J.S.; Gimeno, J.H.; Alejo, J.S. The e↵ect of cryotherapy on fibromyalgia: A randomised clinical trial carried out in a cryosauna cabin. Rheumatol. Int. 2018, 38, 2243–2250. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 24 of 27 127. Bettoni, L.; Bonomi, F.G.; Zani, V.; Manisco, L.; Indelicato, A.; Lanteri, P.; Banfi, G.; Lombardi, G. E↵ects of 15 consecutive cryotherapy sessions on the clinical output of fibromyalgic patients. Clin. Rheumatol. 2013, 32, 1337–1345. [CrossRef] 128. Sutherland, A.M.; Clarke, H.A.; Katz, J.; Katznelson, R. Hyperbaric oxygen therapy: A new treatment for chronic pain? Pain Pract. 2016, 16, 620–628. [CrossRef] 129. Bennett, M.H.; French, C.; Schnabel, A.; Wasiak, J.; Kranke, P.; Weibel, S. Normobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. Cochrane Database Syst. Rev. 2015. [CrossRef] 130. Yildiz, S.; Kiralp, M.Z.; Akin, A.; Keskin, I.; Ay, H.; Dursun, H.; Cimsit, M. A new treatment modality for fibromyalgia syndrome: Hyperbaric oxygen therapy. J. Int. Med Res. 2004, 32, 263–267. [CrossRef] [PubMed] 131. Boussi-Gross, R.; Golan, H.; Fishlev, G.; Bechor, Y.; Volkov, O.; Bergan, J.; Friedman, M.; Hoofien, D.; Shlamkovitch, N.; Ben-Jacob, E.; et al. Hyperbaric oxygen therapy can improve post concussion syndrome years after mild traumatic brain injury—Randomized prospective trial. PLoS ONE 2013, 8, e79995. [CrossRef] [PubMed] 132. Efrati, S.; Golan, H.; Bechor, Y.; Faran, Y.; Daphna-Tekoah, S.; Sekler, G.; Fishlev, G.; Ablin, J.N.; Bergan, J.; Volkov, O.; et al. Hyperbaric oxygen therapy can diminish fibromyalgia syndrome—Prospective clinical trial. PLoS ONE 2015, 10, e0127012. [CrossRef] [PubMed] 133. El-Shewy, K.M.; Kunbaz, A.; Gad, M.M.; Al-Husseini, M.J.; Saad, A.M.; Sammour, Y.M.; Abdel-Daim, M.M. Hyperbaric oxygen and aerobic exercise in the long-term treatment of fibromyalgia: A narrative review. Biomed. Pharmacother. 2019, 109, 629–638. [CrossRef] [PubMed] 134. Kisselev, S.B.; Moskvin, S.V. The use of laser therapy for patients with fibromyalgia: A critical literary review. J. Lasers Med. Sci. 2019, 10, 12–20. [CrossRef] 135. White, P.F.; Zafereo, J.; Elvir-Lazo, O.L.; Hernandez, H. Treatment of drug-resistant fibromyalgia symptoms using high-intensity laser therapy: A case-based review. Rheumatol. Int. 2018, 38, 517–523. [CrossRef] 136. Gur, A.; Karakoc, M.; Nas, K.; Cevik, R.; Sarac, A.J.; Ataoglu, S. E↵ects of low power laser and low dose amitriptyline therapy on clinical symptoms and quality of life in fibromyalgia: A single-blind, placebo-controlled trial. Rheumatol. Int. 2002, 22, 188–193. 137. Panton, L.; Simonavice, E.; Williams, K.; Mojock, C.; Kim, J.S.; Kingsley, J.D.; McMillan, V.; Mathis, R. E↵ects of class IV laser therapy on fibromyalgia impact and function in women with fibromyalgia. J. Altern. Complement. Med. 2013, 19, 445–452. [CrossRef] 138. Ruaro, J.A.; Frez, A.R.; Ruaro, M.B.; Nicolau, R.A. Low-level laser therapy to treat fibromyalgia. Lasers Med. Sci. 2014, 29, 1815–1819. [CrossRef] 139. Da Silva, M.M.; Albertini, R.; Leal, E.C.P.; de Carvalho, P.D.C.; Silva, J.A.; Bussadori, S.K.; de Oliveira, L.V.F.; Casarin, C.A.S.; Andrade, E.L.; Bocalini, D.S.; et al. E↵ects of exercise training and photobiomodulation therapy (extraphoto) on pain in women with fibromyalgia and temporomandibular disorder: Study protocol for a randomized controlled trial. Trials 2015, 16, 8. [CrossRef] 140. Busch, A.J.; Webber, S.C.; Brachaniec, M.; Bidonde, J.; Dal Bello-Haas, V.; Danyliw, A.D.; Overend, T.J.; Richards, R.S.; Sawant, A.; Schachter, C.L. Exercise therapy for fibromyalgia. Curr. Pain Headache Rep. 2011, 15, 358–367. [CrossRef] 141. Jones, K.D.; Adams, D.; Winters-Stone, K.; Burckhardt, C.S. A comprehensive review of 46 exercise treatment studies in fibromyalgia (1988–2005). Health Qual. Life Outcomes 2006, 4, 67. [CrossRef] [PubMed] 142. Bidonde, J.; Busch, A.J.; Schachter, C.L.; Webber, S.C.; Musselman, K.E.; Overend, T.J.; Goes, S.M.; Dal Bello-Haas, V.; Boden, C. Mixed exercise training for adults with fibromyalgia. Cochrane Database Syst. Rev. 2019, 208. [CrossRef] 143. Assumpção, A.; Matsutani, L.A.; Yuan, S.L.; Santo, A.S.; Sauer, J.; Mango, P.; Marques, A.P. Muscle stretching exercises and resistance training in fibromyalgia: Which is better? A three-arm randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2018, 54, 663–670. [CrossRef] 144. Nelson, N.L. Muscle strengthening activities and fibromyalgia: A review of pain and strength outcomes. J. Bodyw. Mov. Ther. 2015, 19, 370–376. [CrossRef] 145. Sanudo, B.; Galiano, D.; Carrasco, L.; Blagojevic, M.; de Hoyo, M.; Saxton, J. Aerobic exercise versus combined exercise therapy in women with fibromyalgia syndrome: A randomized controlled trial. Arch. Phys. Med. Rehabil. 2010, 91, 1838–1843. [CrossRef] [PubMed] Int. J. Mol. Sci. 2020, 21, 7877 25 of 27 146. Umeda, M.; Corbin, L.W.; Maluf, K.S. Pain mediates the association between physical activity and the impact of fibromyalgia on daily function. Clin. Rheumatol. 2015, 34, 143–149. [CrossRef] [PubMed] 147. Bement, M.K.H.; Weyer, A.; Hartley, S.; Drewek, B.; Harkins, A.L.; Hunter, S.K. Pain perception after isometric exercise in women with fibromyalgia. Arch. Phys. Med. Rehabil. 2011, 92, 89–95. [CrossRef] 148. Carson, J.W.; Carson, K.M.; Jones, K.D.; Bennett, R.M.; Wright, C.L.; Mist, S.D. A pilot randomized controlled trial of the yoga of awareness program in the management of fibromyalgia. Pain 2010, 151, 530–539. [CrossRef] 149. De Oliveira, F.R.; Goncalves, L.C.V.; Borghi, F.; da Silva, L.; Gomes, A.E.; Trevisan, G.; de Souza, A.L.; Grassi-Kassisse, D.M.; Crege, D. Massage therapy in cortisol circadian rhythm, pain intensity, perceived stress index and quality of life of fibromyalgia syndrome patients. Complement. Ther. Clin. Pract. 2018, 30, 85–90. [CrossRef] 150. Tomas-Carus, P.; Hakkinen, A.; Gusi, N.; Leal, A.; Hakkinen, K.; Ortega-Alonso, A. Aquatic training and detraining on fitness and quality of life in fibromyalgia. Med. Sci. Sports Exerc. 2007, 39, 1044–1050. [CrossRef] 151. Gusi, N.; Tomas-Carus, P. Cost-utility of an 8-month aquatic training for women with fibromyalgia: A randomized controlled trial. Arthritis Res. Ther. 2008, 10, 8. [CrossRef] [PubMed] 152. Andrade, C.P.; Zamuner, A.R.; Forti, M.; Franca, T.F.; Tamburus, N.Y.; Silva, E. Oxygen uptake and body composition after aquatic physical training in women with fibromyalgia: A randomized controlled trial. Eur. J. Phys. Rehabil. Med. 2017, 53, 751–758. 153. Bidonde, J.; Busch, A.J.; Schachter, C.L.; Overend, T.J.; Kim, S.Y.; Goes, S.; Boden, C.; Foulds, H.J.A. Aerobic exercise training for adults with fibromyalgia. Cochrane Database Syst. Rev. 2017. [CrossRef] 154. Bidonde, J.; Busch, A.J.; Webber, S.C.; Schachter, C.L.; Danyliw, A.; Overend, T.J.; Richards, R.S.; Rader, T. Aquatic exercise training for fibromyalgia. Cochrane Database Syst. Rev. 2014, 177. [CrossRef] [PubMed] 155. Marske, C.; Bernard, N.; Palacios, A.; Wheeler, C.; Preiss, B.; Brown, M.; Bhattacharya, S.; Klapstein, G. Fibromyalgia with gabapentin and osteopathic manipulative medicine: A pilot study. J. Altern. Complement. Med. 2018, 24, 395–402. [CrossRef] [PubMed] 156. Baptista, A.S.; Villela, A.L.; Jones, A.; Natour, J. E↵ectiveness of dance in patients with fibromyalgia: A randomised, single-blind, controlled study. Clin. Exp. Rheumatol. 2012, 30, S18–S23. 157. Assunção, J.C.; Silva, H.J.D.; da Silva, J.F.C.; Cruz, R.D.; Lins, C.A.D.; de Souza, M.C. Zumba dancing can improve the pain and functional capacity in women with fibromyalgia. J. Bodyw. Mov. Ther. 2018, 22, 455–459. [CrossRef] 158. Wang, C.C.; Schmid, C.H.; Fielding, R.A.; Harvey, W.F.; Reid, K.F.; Price, L.L.; Driban, J.B.; Kalish, R.; Rones, R.; McAlindon, T. E↵ect of tai chi versus aerobic exercise for fibromyalgia: Comparative e↵ectiveness randomized controlled trial. BMJ Br. Med J. 2018, 360, 14. [CrossRef] 159. Cryan, J.F.; Dinan, T.G. Mind-altering microorganisms: The impact of the gut microbiota on brain and behaviour. Nat. Rev. Neurosci. 2012, 13, 701–712. [CrossRef] 160. Galland, L. The gut microbiome and the brain. J. Med. Food 2014, 17, 1261–1272. [CrossRef] 161. Goebel, A.; Buhner, S.; Schedel, R.; Lochs, H.; Sprotte, G. Altered intestinal permeability in patients with primary fibromyalgia and in patients with complex regional pain syndrome. Rheumatology 2008, 47, 1223–1227. [CrossRef] 162. Mayer, E.A.; Tillisch, K.; Gupta, A. Gut/brain axis and the microbiota. J. Clin. Investig. 2015, 125, 926–938. [CrossRef] 163. Roman, P.; Estevez, A.F.; Mires, A.; Sanchez-Labraca, N.; Canadas, F.; Vivas, A.B.; Cardona, D. A pilot randomized controlled trial to explore cognitive and emotional e↵ects of probiotics in fibromyalgia. Sci Rep. 2018, 8, 9. [CrossRef] [PubMed] 164. Butler, D. Translational research: Crossing the valley of death. Nature 2008, 453, 840–842. [CrossRef] 165. Nascimento, S.D.; DeSantana, J.M.; Nampo, F.K.; Ribeiro, E.A.N.; da Silva, D.L.; Araujo, J.X.; Almeida, J.; Bonjardim, L.R.; Araujo, A.A.D.; Quintans, L.J. Efficacy and safety of medicinal plants or related natural products for fibromyalgia: A systematic review. Evid. Based Complementary Altern. Med. 2013. [CrossRef] [PubMed] 166. Brownstein, M.J. A brief-history of opiates, opioid-peptides, and opioid receptors. Proc. Natl. Acad. Sci. USA 1993, 90, 5391–5393. [CrossRef] 167. Benyhe, S. Morphine—New aspects in the study of an ancient compound. Life Sci. 1994, 55, 969–979. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 26 of 27 168. Meng, I.D.; Manning, B.H.; Martin, W.J.; Fields, H.L. An analgesia circuit activated by cannabinoids. Nature 1998, 395, 381–383. [CrossRef] 169. Sagy, I.; Schleider, L.B.L.; Abu-Shakra, M.; Novack, V. Safety and efficacy of medical cannabis in fibromyalgia. J. Clin. Med. 2019, 8, 12. [CrossRef] 170. Van de Donk, T.; Niesters, M.; Kowal, M.A.; Olofsen, E.; Dahan, A.; van Velzen, M. An experimental randomized study on the analgesic e↵ects of pharmaceutical-grade cannabis in chronic pain patients with fibromyalgia. Pain 2019, 160, 860–869. [CrossRef] 171. Habib, G.; Artul, S. Medical cannabis for the treatment of fibromyalgia. JCR J. Clin. Rheumatol. 2018, 24, 255–258. [CrossRef] [PubMed] 172. Habib, G.; Avisar, I. The consumption of cannabis by fibromyalgia patients in Israel. Pain Res. Treat. 2018, 5, 7829427. [CrossRef] 173. Ma↵ei, M.E. Plant natural sources of the endocannabinoid (e)- -caryophyllene: A systematic quantitative analysis of published literature. Int. J. Mol. Sci. 2020, 21, 6540. [CrossRef] [PubMed] 174. Paula-Freire, L.I.G.; Andersen, M.L.; Gama, V.S.; Molska, G.R.; Carlini, E.L.A. The oral administration of trans-caryophyllene attenuates acute and chronic pain in mice. Phytomedicine 2014, 21, 356–362. [CrossRef] [PubMed] 175. Gertsch, J.; Leonti, M.; Raduner, S.; Racz, I.; Chen, J.Z.; Xie, X.Q.; Altmann, K.H.; Karsak, M.; Zimmer, A. Beta-caryophyllene is a dietary cannabinoid. Proc. Natl. Acad. Sci. USA 2008, 105, 9099–9104. [CrossRef] 176. Oliveira, G.L.D.; Machado, K.C.; Machado, K.C.; da Silva, A.; Feitosa, C.M.; Almeida, F.R.D. Non-clinical toxicity of beta-caryophyllene, a dietary cannabinoid: Absence of adverse e↵ects in female swiss mice. Regul. Toxicol. Pharmacol. 2018, 92, 338–346. [CrossRef] 177. Quintans, L.J.; Araujo, A.A.S.; Brito, R.G.; Santos, P.L.; Quintans, J.S.S.; Menezes, P.P.; Serafini, M.R.; Silva, G.F.; Carvalho, F.M.S.; Brogden, N.K.; et al. Beta-caryophyllene, a dietary cannabinoid, complexed with beta-cyclodextrin produced anti-hyperalgesic e↵ect involving the inhibition of Fos expression in superficial dorsal horn. Life Sci. 2016, 149, 34–41. [CrossRef] 178. Ibrahim, M.M.; Porreca, F.; Lai, J.; Albrecht, P.J.; Rice, F.L.; Khodorova, A.; Davar, G.; Makriyannis, A.; Vanderah, T.W.; Mata, H.P.; et al. Cb2 cannabinoid receptor activation produces antinociception by stimulating peripheral release of endogenous opioids. Proc. Natl. Acad. Sci. USA 2005, 102, 3093–3098. [CrossRef] 179. Fidyt, K.; Fiedorowicz, A.; Strzadala, L.; Szumny, A. Beta-caryophyllene and beta-caryophyllene oxide-natural compounds of anticancer and analgesic properties. Cancer Med. 2016, 5, 3007–3017. [CrossRef] 180. Klauke, A.L.; Racz, I.; Pradier, B.; Markert, A.; Zimmer, A.M.; Gertsch, J.; Zimmer, A. The cannabinoid cb2 receptor-selective phytocannabinoid beta-caryophyllene exerts analgesic e↵ects in mouse models of inflammatory and neuropathic pain. Eur. Neuropsychopharmacol. 2014, 24, 608–620. [CrossRef] 181. Melo, A.J.D.; Heimarth, L.; Carvalho, A.M.D.; Quintans, J.D.S.; Serafini, M.R.; Araujo, A.A.D.; Alves, P.B.; Ribeiro, A.M.; Shanmugam, S.; Quintans, L.J.; et al. Eplingiella fruticosa (Lamiaceae) Essential Oil Complexed with Beta-Cyclodextrin Improves Its Anti-Hyperalgesic E↵ect in a Chronic Widespread Non-Inflammatory Muscle Pain Animal Model. Food Chem. Toxicol. 2020, 135, 7. 182. Dolara, P.; Luceri, C.; Ghelardini, C.; Monserrat, C.; Aiolli, S.; Luceri, F.; Lodovici, M.; Menichetti, S.; Romanelli, M.N. Analgesic e↵ects of myrrh. Nature 1996, 379, 29. [CrossRef] [PubMed] 183. Borchardt, J.K. Myrrh: An analgesic with a 4000-year history. Drug News Perspect. 1996, 9, 554–557. 184. Su, S.L.; Hua, Y.Q.; Wang, Y.Y.; Gu, W.; Zhou, W.; Duan, J.A.; Jiang, H.F.; Chen, T.; Tang, Y.P. Evaluation of the anti-inflammatory and analgesic properties of individual and combined extracts from Commiphora myrrha, and Boswellia carterii. J. Ethnopharmacol. 2012, 139, 649–656. [CrossRef] 185. Lee, D.; Ju, M.K.; Kim, H. Commiphora extract mixture ameliorates monosodium iodoacetate-induced osteoarthritis. Nutrients 2020, 12, 17. [CrossRef] 186. Germano, A.; Occhipinti, A.; Barbero, F.; Ma↵ei, M.E. A pilot study on bioactive constituents and analgesic e↵ects of myrliq® , a Commiphora myrrha extract with a high furanodiene content. Biomed. Res. Int 2017, 2017, 3804356. [CrossRef] 187. Galeotti, N. Hypericum perforatum (St John’s Wort) beyond Depression: A Therapeutic Perspective for Pain Conditions. J. Ethnopharmacol. 2017, 200, 136–146. [CrossRef] 188. Khan, H.; Pervaiz, A.; Intagliata, S.; Das, N.; Venkata, K.C.N.; Atanasov, A.G.; Najda, A.; Nabavi, S.M.; Wang, D.D.; Pittala, V.; et al. The analgesic potential of glycosides derived from medicinal plants. DARU 2020, 28, 387–401. [CrossRef] Int. J. Mol. Sci. 2020, 21, 7877 27 of 27 189. Wang, R.Y.; Qiu, Z.; Wang, G.Z.; Hu, Q.; Shi, N.H.; Zhang, Z.Q.; Wu, Y.Q.; Zhou, C.H. Quercetin attenuates diabetic neuropathic pain by inhibiting mtor/p70s6k pathway-mediated changes of synaptic morphology and synaptic protein levels in spinal dorsal horn of db/db mice. Eur. J. Pharmacol. 2020, 882, 7. [CrossRef] 190. Carvalho, T.T.; Mizokami, S.S.; Ferraz, C.R.; Manchope, M.F.; Borghi, S.M.; Fattori, V.; Calixto-Campos, C.; Camilios-Neto, D.; Casagrande, R.; Verri, W.A. The granulopoietic cytokine granulocyte colony-stimulating factor (G-CSF) induces pain: Analgesia by rutin. Inflammopharmacology 2019, 27, 1285–1296. [CrossRef] 191. Xiao, X.; Wang, X.Y.; Gui, X.; Chen, L.; Huang, B.K. Natural flavonoids as promising analgesic candidates: A systematic review. Chem. Biodivers. 2016, 13, 1427–1440. [CrossRef] 192. Yao, X.L.; Li, L.; Kandhare, A.D.; Mukherjee-Kandhare, A.A.; Bodhankar, S.L. Attenuation of reserpine-induced fibromyalgia via ros and serotonergic pathway modulation by fisetin, a plant flavonoid polyphenol. Exp. Ther. Med. 2020, 19, 1343–1355. [CrossRef] 193. Shakiba, M.; Moazen-Zadeh, E.; Noorbala, A.A.; Jafarinia, M.; Divsalar, P.; Kashani, L.; Shahmansouri, N.; Tafakhori, A.; Bayat, H.; Akhondzadeh, S. Sa↵ron (Crocus sativus) versus duloxetine for treatment of patients with fibromyalgia: A randomized double-blind clinical trial. Avicenna J. Phytomedicine 2018, 8, 513–523. 194. McCarberg, B.H. Clinical overview of fibromyalgia. Am. J. Ther. 2012, 19, 357–368. [CrossRef] [PubMed] Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. © 2020 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). ",Medical,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Analyze the development of gene therapies for Metachromatic Leukodystrophy (MLD) and Severe Combined Immunodeficiency (SCID), focusing on the role of lentiviral vectors in their success. Discuss the mechanisms by which Libmeldy and OTL-101 function. Evaluate the long-term clinical efficacy of these therapies, particularly in terms of enzyme activity levels in patients, and the associated impact on survival rates.","Revolutionary gene therapy technique, developed with support from MRC, has led to life-saving treatment for rare genetic childhood disease. Metachromatic leukodystrophy (MLD) is a rare genetic disease that effects children and causes severe damage to the nervous system and organs, resulting in a life expectancy of between just five and eight years. In February 2023, it was announced by the NHS that a 19-month-old baby had become the first child in the UK to receive a life-saving gene therapy treatment for MLD. Previously, it was not possible to stop the disease and treatment was aimed at relieving symptoms using a variety of drugs to ease muscle spasms, treat infections and control seizures. Metachromatic leukodystrophy MLD is caused by an abnormal build-up of substances called sulphatides in the nerve cells, particularly in the white matter of the brain. The build-up takes the place of myelin, the insulating material which is essential for normal transmission of messages between nerves. Normally this build-up is broken down and removed from the body by an enzyme called arylsulphatase A. But in MLD the gene responsible for producing the enzyme is faulty so the normal process cannot occur. Curing the disease requires adding in a good version of the gene for the enzyme by a one-time therapy called ‘Libmeldy’. The therapy works by removing the patient’s stems cells and using lentiviral vectors, a type of virus-based delivery system, to introduce the correct gene, and then injecting the treated cells back into the patient. Gene therapy using lentiviral vectors The development of gene therapy for inherited childhood diseases such as MLD has required long term research funding investment. The Medical Research Council (MRC) has been a major funder of UK gene therapy research for more than 20 years. This includes Professor Gaspar’s studies of rare inherited childhood diseases and lentiviral vectors that have formed the basis of this MLD breakthrough. ‘Bubble boy disease’ Young patient stood with doctor, both are smiling Professor Bobby Gaspar and Teigan, who received treatment for severe combined immunodeficiency. Credit: Great Ormond Street Hospital One of Professor Gaspar’s early successes was the development of a treatment of the rare immune disorder ‘bubble boy disease’. ‘Bubble boy disease’ is so called because affected children have severe combined immunodeficiency (SCID) and are extremely vulnerable to infectious diseases, some of them had become famous for living in a sterile environment. In the most severe forms, children with SCID are unable to fight off even very mild infections and, without treatment, will usually die within the first year of life. Several years of research was done by Bobby Gaspar at Great Ormond Street Hospital and the UCL Institute of Child Health. This focused on developing a gene therapy treatment for a type of SCID known as adenosine deaminase deficiency (ADA), characterised by the lack of an enzyme called adenosine deaminase. Support from MRC’s Developmental Pathway Funding Scheme took this therapy, now called OTL-101, into the clinic and supported the establishment of Orchard Therapeutics. Orchard Therapeutics In 2017, both US and UK drug regulatory authorities granted OTL-101 designations reserved for treatments addressing high unmet need. These developments showed the commercial potential of Professor Gaspar’s work and highlight gene therapy’s ability to improve human health. In April 2018, GlaxoSmithKline signed a strategic agreement to transfer its rare disease gene therapy portfolio to Orchard Therapeutics, strengthening Orchard’s position as a global leader in gene therapy for rare diseases. In May 2021 the researchers followed up 50 patients treated for ADA-SCID with OTL-101, and the results showed 100% survival. Over 95% of the patients had sustained expression of the ADA enzyme showing that the gene therapy was successful, after two to three years following the treatment."," Only use the provided text to answer the question, no outside sources. Analyze the development of gene therapies for Metachromatic Leukodystrophy (MLD) and Severe Combined Immunodeficiency (SCID), focusing on the role of lentiviral vectors in their success. Discuss the mechanisms by which Libmeldy and OTL-101 function. Evaluate the long-term clinical efficacy of these therapies, particularly in terms of enzyme activity levels in patients, and the associated impact on survival rates. Revolutionary gene therapy technique, developed with support from MRC, has led to life-saving treatment for rare genetic childhood disease. Metachromatic leukodystrophy (MLD) is a rare genetic disease that effects children and causes severe damage to the nervous system and organs, resulting in a life expectancy of between just five and eight years. In February 2023, it was announced by the NHS that a 19-month-old baby had become the first child in the UK to receive a life-saving gene therapy treatment for MLD. Previously, it was not possible to stop the disease and treatment was aimed at relieving symptoms using a variety of drugs to ease muscle spasms, treat infections and control seizures. Metachromatic leukodystrophy MLD is caused by an abnormal build-up of substances called sulphatides in the nerve cells, particularly in the white matter of the brain. The build-up takes the place of myelin, the insulating material which is essential for normal transmission of messages between nerves. Normally this build-up is broken down and removed from the body by an enzyme called arylsulphatase A. But in MLD the gene responsible for producing the enzyme is faulty so the normal process cannot occur. Curing the disease requires adding in a good version of the gene for the enzyme by a one-time therapy called ‘Libmeldy’. The therapy works by removing the patient’s stems cells and using lentiviral vectors, a type of virus-based delivery system, to introduce the correct gene, and then injecting the treated cells back into the patient. Gene therapy using lentiviral vectors The development of gene therapy for inherited childhood diseases such as MLD has required long term research funding investment. The Medical Research Council (MRC) has been a major funder of UK gene therapy research for more than 20 years. This includes Professor Gaspar’s studies of rare inherited childhood diseases and lentiviral vectors that have formed the basis of this MLD breakthrough. ‘Bubble boy disease’ Young patient stood with doctor, both are smiling Professor Bobby Gaspar and Teigan, who received treatment for severe combined immunodeficiency. Credit: Great Ormond Street Hospital One of Professor Gaspar’s early successes was the development of a treatment of the rare immune disorder ‘bubble boy disease’. ‘Bubble boy disease’ is so called because affected children have severe combined immunodeficiency (SCID) and are extremely vulnerable to infectious diseases, some of them had become famous for living in a sterile environment. In the most severe forms, children with SCID are unable to fight off even very mild infections and, without treatment, will usually die within the first year of life. Several years of research was done by Bobby Gaspar at Great Ormond Street Hospital and the UCL Institute of Child Health. This focused on developing a gene therapy treatment for a type of SCID known as adenosine deaminase deficiency (ADA), characterised by the lack of an enzyme called adenosine deaminase. Support from MRC’s Developmental Pathway Funding Scheme took this therapy, now called OTL-101, into the clinic and supported the establishment of Orchard Therapeutics. Orchard Therapeutics In 2017, both US and UK drug regulatory authorities granted OTL-101 designations reserved for treatments addressing high unmet need. These developments showed the commercial potential of Professor Gaspar’s work and highlight gene therapy’s ability to improve human health. In April 2018, GlaxoSmithKline signed a strategic agreement to transfer its rare disease gene therapy portfolio to Orchard Therapeutics, strengthening Orchard’s position as a global leader in gene therapy for rare diseases. In May 2021 the researchers followed up 50 patients treated for ADA-SCID with OTL-101, and the results showed 100% survival. Over 95% of the patients had sustained expression of the ADA enzyme showing that the gene therapy was successful, after two to three years following the treatment. https://www.ukri.org/who-we-are/how-we-are-doing/research-outcomes-and-impact/mrc/mrc-funded-discovery-science-underpins-gene-therapy-cures/",Medical,Effect Analysis,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","What does each option's Greek measure and how is it used to determine options pricing?Also, even though it's not a Greek, also include an explanation of implied volatility.","Delta Delta measures how much an option's price can be expected to move for every $1 change in the price of the underlying security or index. For example, a Delta of 0.40 means the option's price will theoretically move $0.40 for every $1 change in the price of the underlying stock or index. As you might guess, this means the higher the Delta, the bigger the price change. Traders often use Delta to predict whether a given option will expire ITM. So, a Delta of 0.40 is taken to mean that at that moment in time, the option has about a 40% chance of being ITM at expiration. This doesn't mean higher-Delta options are always profitable. After all, if you paid a large premium for an option that expires ITM, you might not make any money. You can also think of Delta as the number of shares of the underlying stock the option behaves like. So, a Delta of 0.40 suggests that given a $1 move in the underlying stock, the option will likely gain or lose about the same amount of money as 40 shares of the stock. Call options Call options have a positive Delta that can range from 0.00 to 1.00. At-the-money options usually have a Delta near 0.50. The Delta will increase (and approach 1.00) as the option gets deeper ITM. The Delta of ITM call options will get closer to 1.00 as expiration approaches. The Delta of out-of-the-money call options will get closer to 0.00 as expiration approaches. Put options Put options have a negative Delta that can range from 0.00 to –1.00. At-the-money options usually have a Delta near –0.50. The Delta will decrease (and approach –1.00) as the option gets deeper ITM. The Delta of ITM put options will get closer to –1.00 as expiration approaches. The Delta of out-of-the-money put options will get closer to 0.00 as expiration approaches. Gamma Where Delta is a snapshot in time, Gamma measures the rate of change in an option's Delta over time. If you remember high school physics class, you can think of Delta as speed and Gamma as acceleration. In practice, Gamma is the rate of change in an option's Delta per $1 change in the price of the underlying stock. In the example above, we imagined an option with a Delta of .40. If the underlying stock moves $1 and the option moves $.40 along with it, the option's Delta is no longer 0.40. Why? This $1 move would mean the call option is now even deeper ITM, and so its Delta should move even closer to 1.00. So, let's assume that as a result the Delta is now 0.55. The change in Delta from 0.40 to 0.55 is 0.15—this is the option's Gamma. Because Delta can't exceed 1.00, Gamma decreases as an option gets further ITM and Delta approaches 1.00. After all, there's less room for acceleration as you approach top speed. Theta Theta tells you how much the price of an option should decrease each day as the option nears expiration, if all other factors remain the same. This kind of price erosion over time is known as time decay. Time-value erosion is not linear, meaning the price erosion of at-the-money (ATM), just slightly out-of-the-money, and ITM options generally increases as expiration approaches, while that of far out-of-the-money (OOTM) options generally decreases as expiration approaches. Time-value erosion Source: Schwab Center for Financial Research Vega Vega measures the rate of change in an option's price per one-percentage-point change in the implied volatility of the underlying stock. (There's more on implied volatility below.) While Vega is not a real Greek letter, it is intended to tell you how much an option's price should move when the volatility of the underlying security or index increases or decreases. More about Vega: Volatility is one of the most important factors affecting the value of options. A drop in Vega will typically cause both calls and puts to lose value. An increase in Vega will typically cause both calls and puts to gain value. Neglecting Vega can cause you to potentially overpay when buying options. All other factors being equal, when determining strategy, consider buying options when Vega is below ""normal"" levels and selling options when Vega is above ""normal"" levels. One way to determine this is to compare the historical volatility to the implied volatility. Chart studies for both values are available on StreetSmart Edge®. Rho Rho measures the expected change in an option's price per one-percentage-point change in interest rates. It tells you how much the price of an option should rise or fall if the risk-free interest rate (U.S. Treasury-bills)* increases or decreases. More about Rho: As interest rates increase, the value of call options will generally increase. As interest rates increase, the value of put options will usually decrease. For these reasons, call options have positive Rho and put options have negative Rho. Consider a hypothetical stock that's trading exactly at its strike price. If the stock is trading at $25, the 25 calls and the 25 puts would both be exactly at the money. You might see the calls trading at, say, $0.60, while the puts could be trading at $0.50. When interest rates are low, the price difference between puts and calls will be relatively small. If interest rates increase, the gap will get wider—calls will become more expensive and puts will become less so. Rho is generally not a huge factor in the price of an option, but should be considered if prevailing interest rates are expected to change, such as just before a Federal Open Market Committee (FOMC) meeting. Long-Term Equity AnticiPation Securities® (LEAPS®) options are far more sensitive to changes in interest rates than are shorter-term options. Implied volatility: like a Greek Though not actually a Greek, implied volatility is closely related. Implied volatility is a forecast of how volatile an underlying stock is expected to be in the future—but it's strictly theoretical. While it's possible to forecast a stock's future moves by looking at its historical volatility, among other factors, the implied volatility reflected in the price of an option is an inference based on other factors, too, such as upcoming earnings reports, merger and acquisition rumors, pending product launches, etc. Key points to remember: Figuring out exactly how volatile a stock will be at any given time is difficult, but looking at implied volatility can give you a sense of what assumptions market makers are using to determine their quoted bid and ask prices. As such, implied volatility can be a helpful proxy in gauging the market. Higher-than-normal implied volatilities are usually more favorable for options sellers, while lower-than-normal implied volatilities are more favorable for option buyers, because volatility often reverts back to its mean over time. Implied volatility is often provided on options trading platforms because it is typically more useful for traders to know how volatile a market maker thinks a stock will be than to try to estimate it themselves. Implied volatility is usually not consistent for all options of a particular security or index and will generally be lowest for at-the-money and near-the-money options.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. What does each option's Greek measure and how is it used to determine options pricing?Also, even though it's not a Greek, also include an explanation of implied volatility. Delta Delta measures how much an option's price can be expected to move for every $1 change in the price of the underlying security or index. For example, a Delta of 0.40 means the option's price will theoretically move $0.40 for every $1 change in the price of the underlying stock or index. As you might guess, this means the higher the Delta, the bigger the price change. Traders often use Delta to predict whether a given option will expire ITM. So, a Delta of 0.40 is taken to mean that at that moment in time, the option has about a 40% chance of being ITM at expiration. This doesn't mean higher-Delta options are always profitable. After all, if you paid a large premium for an option that expires ITM, you might not make any money. You can also think of Delta as the number of shares of the underlying stock the option behaves like. So, a Delta of 0.40 suggests that given a $1 move in the underlying stock, the option will likely gain or lose about the same amount of money as 40 shares of the stock. Call options Call options have a positive Delta that can range from 0.00 to 1.00. At-the-money options usually have a Delta near 0.50. The Delta will increase (and approach 1.00) as the option gets deeper ITM. The Delta of ITM call options will get closer to 1.00 as expiration approaches. The Delta of out-of-the-money call options will get closer to 0.00 as expiration approaches. Put options Put options have a negative Delta that can range from 0.00 to –1.00. At-the-money options usually have a Delta near –0.50. The Delta will decrease (and approach –1.00) as the option gets deeper ITM. The Delta of ITM put options will get closer to –1.00 as expiration approaches. The Delta of out-of-the-money put options will get closer to 0.00 as expiration approaches. Gamma Where Delta is a snapshot in time, Gamma measures the rate of change in an option's Delta over time. If you remember high school physics class, you can think of Delta as speed and Gamma as acceleration. In practice, Gamma is the rate of change in an option's Delta per $1 change in the price of the underlying stock. In the example above, we imagined an option with a Delta of .40. If the underlying stock moves $1 and the option moves $.40 along with it, the option's Delta is no longer 0.40. Why? This $1 move would mean the call option is now even deeper ITM, and so its Delta should move even closer to 1.00. So, let's assume that as a result the Delta is now 0.55. The change in Delta from 0.40 to 0.55 is 0.15—this is the option's Gamma. Because Delta can't exceed 1.00, Gamma decreases as an option gets further ITM and Delta approaches 1.00. After all, there's less room for acceleration as you approach top speed. Theta Theta tells you how much the price of an option should decrease each day as the option nears expiration, if all other factors remain the same. This kind of price erosion over time is known as time decay. Time-value erosion is not linear, meaning the price erosion of at-the-money (ATM), just slightly out-of-the-money, and ITM options generally increases as expiration approaches, while that of far out-of-the-money (OOTM) options generally decreases as expiration approaches. Time-value erosion Source: Schwab Center for Financial Research Vega Vega measures the rate of change in an option's price per one-percentage-point change in the implied volatility of the underlying stock. (There's more on implied volatility below.) While Vega is not a real Greek letter, it is intended to tell you how much an option's price should move when the volatility of the underlying security or index increases or decreases. More about Vega: Volatility is one of the most important factors affecting the value of options. A drop in Vega will typically cause both calls and puts to lose value. An increase in Vega will typically cause both calls and puts to gain value. Neglecting Vega can cause you to potentially overpay when buying options. All other factors being equal, when determining strategy, consider buying options when Vega is below ""normal"" levels and selling options when Vega is above ""normal"" levels. One way to determine this is to compare the historical volatility to the implied volatility. Chart studies for both values are available on StreetSmart Edge®. Rho Rho measures the expected change in an option's price per one-percentage-point change in interest rates. It tells you how much the price of an option should rise or fall if the risk-free interest rate (U.S. Treasury-bills)* increases or decreases. More about Rho: As interest rates increase, the value of call options will generally increase. As interest rates increase, the value of put options will usually decrease. For these reasons, call options have positive Rho and put options have negative Rho. Consider a hypothetical stock that's trading exactly at its strike price. If the stock is trading at $25, the 25 calls and the 25 puts would both be exactly at the money. You might see the calls trading at, say, $0.60, while the puts could be trading at $0.50. When interest rates are low, the price difference between puts and calls will be relatively small. If interest rates increase, the gap will get wider—calls will become more expensive and puts will become less so. Rho is generally not a huge factor in the price of an option, but should be considered if prevailing interest rates are expected to change, such as just before a Federal Open Market Committee (FOMC) meeting. Long-Term Equity AnticiPation Securities® (LEAPS®) options are far more sensitive to changes in interest rates than are shorter-term options. Implied volatility: like a Greek Though not actually a Greek, implied volatility is closely related. Implied volatility is a forecast of how volatile an underlying stock is expected to be in the future—but it's strictly theoretical. While it's possible to forecast a stock's future moves by looking at its historical volatility, among other factors, the implied volatility reflected in the price of an option is an inference based on other factors, too, such as upcoming earnings reports, merger and acquisition rumors, pending product launches, etc. Key points to remember: Figuring out exactly how volatile a stock will be at any given time is difficult, but looking at implied volatility can give you a sense of what assumptions market makers are using to determine their quoted bid and ask prices. As such, implied volatility can be a helpful proxy in gauging the market. Higher-than-normal implied volatilities are usually more favorable for options sellers, while lower-than-normal implied volatilities are more favorable for option buyers, because volatility often reverts back to its mean over time. Implied volatility is often provided on options trading platforms because it is typically more useful for traders to know how volatile a market maker thinks a stock will be than to try to estimate it themselves. Implied volatility is usually not consistent for all options of a particular security or index and will generally be lowest for at-the-money and near-the-money options. https://www.schwab.com/learn/story/get-to-know-option-greeks",Financial,Find & Summarize,Text Transformation "Your responses are always thorough covering all bases to ensure the user has all the information they need, but you find a happy medium to not be to wordy. You always explain how you came to each conclusion and you only use the text that is provided to you to answer questions. ",What acronyms are mentioned?,"AI technologies, including GenAI tools, have many potential benefits, such as accelerating and providing insights into data processing, augmenting human decisionmaking, and optimizing performance for complex systems and tasks. GenAI tools, for example, are increasingly capable of performing a broad range of tasks, such as text analysis, image generation, and speech recognition. However, AI systems may perpetuate or amplify biases in the datasets on which they are trained; may not yet be able to fully explain their decisionmaking; and often depend on such vast amounts of data and other resources that they are not widely accessible for research, development, and commercialization beyond a handful of technology companies. Numerous federal laws on AI have been enacted over the past few Congresses, either as standalone legislation or as AIfocused provisions in broader acts. These include the expansive National Artificial Intelligence Initiative Act of 2020 (Division E of P.L. 116-283), which included the establishment of an American AI Initiative and direction for AI research, development, and evaluation activities at federal science agencies. Additional acts have directed certain agencies to undertake activities to guide AI programs and policies across the federal government (e.g., the AI in Government Act of 2020, P.L. 116- 260; and the Advancing American AI Act, Subtitle B of P.L. 117-263). In the 117th Congress, at least 75 bills were introduced that either focused on AI and ML or had AI/ML-focused provisions. Six of those were enacted. In the 118th Congress, as of June 2023, at least 40 bills had been introduced that either focused on AI/ML or contained AI/ML-focused provisions, and none has been enacted. Collectively, bills in the 118th Congress address a range of topics, including federal government oversight of AI; training for federal employees; disclosure of AI use; export controls; usespecific prohibitions; and support for the use of AI in particular sectors, such as cybersecurity, weather modeling, wildfire detection, precision agriculture, and airport safety. AI technologies have potential applications across a wide range of sectors. A selection of broad, crosscutting issues with application-specific examples of ongoing congressional interest are discussed in the CRS report Artificial Intelligence: Background, Selected Issues, and Policy Considerations. 17 Those issues and examples include implications for the U.S. workforce, international competition and federal investment in AI R&D, standards development, and ethical AI—including questions about bias, fairness, and algorithm transparency (for example, in criminal justice applications). In addition to those issues and applications, three areas of potential use that may be of growing interest to Congress—particularly in light of the advances in, and widespread availability of, GenAI tools—are health care, education, and national security. In other parts of the federal government, experts have asserted a need to understand the impacts and future directions of AI applications in these areas. For example, the chief AI officer at the Department of Health and Human Services, Greg Singleton, at a June 2023 Health Innovation Summit discussed “the role that AI will play in healthcare, as well as the importance of regulations.” 18 A May 2023 Department of Education report, Artificial Intelligence and the Future of Teaching and Learning, describes the rising interest in AI in education and highlights reasons to address AI in education now.19 And the 2023 Annual Threat Assessment of the U.S. Intelligence Community states, “New technologies—particularly in the fields of AI and biotechnology—are being developed and are proliferating faster than companies and governments can shape norms, protect privacy, and prevent dangerous outcomes.”20 This section will discuss some of the potential benefits and concerns with the use of AI technologies in these sectors. Federal laws addressing AI or including AI-focused provisions have been enacted over the past few Congresses. Arguably the most expansive law was the National Artificial Intelligence Initiative (NAII) Act of 2020 (Division E of the William M. (Mac) Thornberry National Defense Authorization Act [NDAA] of FY2021, P.L. 116-283). The NAII Act included sections • codifying the establishment of an American AI Initiative, • establishing a National Artificial Intelligence Initiative Office to support federal AI activities, • establishing an interagency committee at the Office of Science and Technology Policy to coordinate federal programs and activities in support of the NAII, and • establishing a National AI Advisory Committee. The NAII Act further directed AI activities at the National Science Foundation (NSF), National Institute of Standards and Technology (NIST),40 National Oceanic and Atmospheric Administration, and Department of Energy. Specific provisions include mandating (1) NSF support for a network of National AI Research Institutes; (2) a National Academies of Sciences, Engineering, and Medicine study on the current and future impact of AI on the U.S. workforce across sectors;41 and (3) a task force to investigate the feasibility of, and plan for, a National AI Research Resource.42 Individual agencies—including the General Services Administration (GSA), the Office of Management and Budget (OMB), and the Office of Personnel Management (OPM)—have also been statutorily directed to undertake activities to support the use of AI across the federal government: • GSA. The AI in Government Act of 2020 (AGA, Division U, Title I, of the Consolidated Appropriations Act, 2021, P.L. 116-260) created within GSA an AI Center of Excellence to facilitate the adoption of AI technologies in the federal government and collect and publicly publish information regarding federal programs, pilots, and other initiatives.43 • OMB. The AGA required OMB to issue a memorandum to federal agencies regarding the development of AI policies; approaches for removing barriers to using AI technologies; and best practices for identifying, assessing, and mitigating any discriminatory impact or bias and any unintended consequences of using AI. The Advancing American AI Act (Subtitle B of the James M. Inhofe National Defense Authorization Act for Fiscal Year 2023, P.L. 117-263) required OMB to (1) incorporate additional considerations when developing guidance for the use of AI in the federal government; (2) develop an initial means to ensure that contracts for acquiring AI address privacy, civil rights and liberties, and the protection of government data and information; (3) require the head of each federal agency (except DOD) to prepare and maintain an inventory of current and planned AI use cases; and (4) lead a pilot program to initiate four new AI use case applications to support interagency or intra-agency modernization initiatives. Additionally, the AI Training Act (P.L. 117-207) required OMB to establish an AI training program for the acquisition workforce of executive agencies. • OPM. The AGA required OPM to establish or update an occupational job series to include positions with primary duties in AI and to estimate current and future numbers of federal employment positions related to AI at each agency. NDAAs have also included provisions focused on AI in the defense, national security, and intelligence communities each year beginning with the FY2019 John S. McCain NDAA, which included the first definition of AI in federal statute.44 These provisions have included a focus on AI development, acquisition, and policies; AI data repositories; recruiting and retaining personnel in AI; and implementation of recommendations from the 2021 final report of the National Security Commission on AI.45 Additionally, some enacted legislation has focused on AI R&D or the use of AI in particular federal programs. For example: • The CHIPS and Science Act (P.L. 117-167) included numerous AI-related provisions directing the Department of Energy, NIST, and NSF to support AI and ML R&D activities and the development of technical standards and guidelines related to safe and trustworthy AI systems. NSF was further directed to (1) evaluate the establishment of an AI scholarship-for-service program to recruit and train AI professionals to support AI work in federal, state, local, and tribal governments; and (2) study AI research capacity at U.S. institutions of higher education.","Your responses are always thorough covering all bases to ensure the user has all the information they need, but you find a happy medium to not be to wordy. You always explain how you came to each conclusion and you only use the text that is provided to you to answer questions. AI technologies, including GenAI tools, have many potential benefits, such as accelerating and providing insights into data processing, augmenting human decisionmaking, and optimizing performance for complex systems and tasks. GenAI tools, for example, are increasingly capable of performing a broad range of tasks, such as text analysis, image generation, and speech recognition. However, AI systems may perpetuate or amplify biases in the datasets on which they are trained; may not yet be able to fully explain their decisionmaking; and often depend on such vast amounts of data and other resources that they are not widely accessible for research, development, and commercialization beyond a handful of technology companies. Numerous federal laws on AI have been enacted over the past few Congresses, either as standalone legislation or as AIfocused provisions in broader acts. These include the expansive National Artificial Intelligence Initiative Act of 2020 (Division E of P.L. 116-283), which included the establishment of an American AI Initiative and direction for AI research, development, and evaluation activities at federal science agencies. Additional acts have directed certain agencies to undertake activities to guide AI programs and policies across the federal government (e.g., the AI in Government Act of 2020, P.L. 116- 260; and the Advancing American AI Act, Subtitle B of P.L. 117-263). In the 117th Congress, at least 75 bills were introduced that either focused on AI and ML or had AI/ML-focused provisions. Six of those were enacted. In the 118th Congress, as of June 2023, at least 40 bills had been introduced that either focused on AI/ML or contained AI/ML-focused provisions, and none has been enacted. Collectively, bills in the 118th Congress address a range of topics, including federal government oversight of AI; training for federal employees; disclosure of AI use; export controls; usespecific prohibitions; and support for the use of AI in particular sectors, such as cybersecurity, weather modeling, wildfire detection, precision agriculture, and airport safety. AI technologies have potential applications across a wide range of sectors. A selection of broad, crosscutting issues with application-specific examples of ongoing congressional interest are discussed in the CRS report Artificial Intelligence: Background, Selected Issues, and Policy Considerations. 17 Those issues and examples include implications for the U.S. workforce, international competition and federal investment in AI R&D, standards development, and ethical AI—including questions about bias, fairness, and algorithm transparency (for example, in criminal justice applications). In addition to those issues and applications, three areas of potential use that may be of growing interest to Congress—particularly in light of the advances in, and widespread availability of, GenAI tools—are health care, education, and national security. In other parts of the federal government, experts have asserted a need to understand the impacts and future directions of AI applications in these areas. For example, the chief AI officer at the Department of Health and Human Services, Greg Singleton, at a June 2023 Health Innovation Summit discussed “the role that AI will play in healthcare, as well as the importance of regulations.” 18 A May 2023 Department of Education report, Artificial Intelligence and the Future of Teaching and Learning, describes the rising interest in AI in education and highlights reasons to address AI in education now.19 And the 2023 Annual Threat Assessment of the U.S. Intelligence Community states, “New technologies—particularly in the fields of AI and biotechnology—are being developed and are proliferating faster than companies and governments can shape norms, protect privacy, and prevent dangerous outcomes.”20 This section will discuss some of the potential benefits and concerns with the use of AI technologies in these sectors. Federal laws addressing AI or including AI-focused provisions have been enacted over the past few Congresses. Arguably the most expansive law was the National Artificial Intelligence Initiative (NAII) Act of 2020 (Division E of the William M. (Mac) Thornberry National Defense Authorization Act [NDAA] of FY2021, P.L. 116-283). The NAII Act included sections • codifying the establishment of an American AI Initiative, • establishing a National Artificial Intelligence Initiative Office to support federal AI activities, • establishing an interagency committee at the Office of Science and Technology Policy to coordinate federal programs and activities in support of the NAII, and • establishing a National AI Advisory Committee. The NAII Act further directed AI activities at the National Science Foundation (NSF), National Institute of Standards and Technology (NIST),40 National Oceanic and Atmospheric Administration, and Department of Energy. Specific provisions include mandating (1) NSF support for a network of National AI Research Institutes; (2) a National Academies of Sciences, Engineering, and Medicine study on the current and future impact of AI on the U.S. workforce across sectors;41 and (3) a task force to investigate the feasibility of, and plan for, a National AI Research Resource.42 Individual agencies—including the General Services Administration (GSA), the Office of Management and Budget (OMB), and the Office of Personnel Management (OPM)—have also been statutorily directed to undertake activities to support the use of AI across the federal government: • GSA. The AI in Government Act of 2020 (AGA, Division U, Title I, of the Consolidated Appropriations Act, 2021, P.L. 116-260) created within GSA an AI Center of Excellence to facilitate the adoption of AI technologies in the federal government and collect and publicly publish information regarding federal programs, pilots, and other initiatives.43 • OMB. The AGA required OMB to issue a memorandum to federal agencies regarding the development of AI policies; approaches for removing barriers to using AI technologies; and best practices for identifying, assessing, and mitigating any discriminatory impact or bias and any unintended consequences of using AI. The Advancing American AI Act (Subtitle B of the James M. Inhofe National Defense Authorization Act for Fiscal Year 2023, P.L. 117-263) required OMB to (1) incorporate additional considerations when developing guidance for the use of AI in the federal government; (2) develop an initial means to ensure that contracts for acquiring AI address privacy, civil rights and liberties, and the protection of government data and information; (3) require the head of each federal agency (except DOD) to prepare and maintain an inventory of current and planned AI use cases; and (4) lead a pilot program to initiate four new AI use case applications to support interagency or intra-agency modernization initiatives. Additionally, the AI Training Act (P.L. 117-207) required OMB to establish an AI training program for the acquisition workforce of executive agencies. • OPM. The AGA required OPM to establish or update an occupational job series to include positions with primary duties in AI and to estimate current and future numbers of federal employment positions related to AI at each agency. NDAAs have also included provisions focused on AI in the defense, national security, and intelligence communities each year beginning with the FY2019 John S. McCain NDAA, which included the first definition of AI in federal statute.44 These provisions have included a focus on AI development, acquisition, and policies; AI data repositories; recruiting and retaining personnel in AI; and implementation of recommendations from the 2021 final report of the National Security Commission on AI.45 Additionally, some enacted legislation has focused on AI R&D or the use of AI in particular federal programs. For example: • The CHIPS and Science Act (P.L. 117-167) included numerous AI-related provisions directing the Department of Energy, NIST, and NSF to support AI and ML R&D activities and the development of technical standards and guidelines related to safe and trustworthy AI systems. NSF was further directed to (1) evaluate the establishment of an AI scholarship-for-service program to recruit and train AI professionals to support AI work in federal, state, local, and tribal governments; and (2) study AI research capacity at U.S. institutions of higher education. What acronyms are mentioned?",Internet/Technology,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","My daughter has just been tested and we have learned she has a severe allergy to tree nuts. I'm freaking out. We have been given an epipen and using it scares me too. How and where do I inject it? Are there certain places it would be harmful? What are the signs of anaphylaxis? Also, what are the potential side effects of an EpiPen?","What is EpiPen? EpiPen and Epipen Jr are used to treat life-threatening allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs, and other allergens, and also treat exercise-induced anaphylaxis. EpiPen Auto-Injectors reduce wheezing and improve low blood pressure, hives, severe low blood pressure, and other symptoms of an allergic reaction. EpiPen contains epinephrine from a class of medications called sympathomimetic agents which works by relaxing the muscles in the airways and tightening the blood vessels. Epinephrine is also called adrenaline. EpiPen Auto-Injectors are hand-held devices that automatically inject a measured dose of medicine. EpiPen Auto-Injectors make it easier to give epinephrine in an emergency when anaphylaxis occurs. Anaphylaxis can be life-threatening and can happen within minutes and, if untreated, can lead to death. Each EpiPen or EpiPen Jr auto-injector can be used only 1 time (single-use). What is anaphylaxis? Anaphylaxis is a life-threatening allergic reaction to insect stings or bites, foods, drugs, exercise-induced anaphylaxis, and other allergens. Sometimes the cause of anaphylaxis is unknown. EpiPen and Epi-pen Jr Auto-Injectors reduce wheezing and improve low blood pressure, hives, severe low blood pressure, and other symptoms of an allergic reaction. Anaphylaxis can happen within minutes and, left untreated, can lead to death Symptoms of anaphylaxis may include: trouble breathing wheezing hoarseness (changes in the way your voice sounds) hives (raised reddened rash that may itch) severe itching swelling of your face, lips, mouth, or tongue skin rash, redness, or swelling fast heartbeat weak pulse feeling very anxious confusion stomach pain losing control of urine or bowel movements (incontinence) diarrhea or stomach cramps dizziness, fainting, or “passing out” (unconsciousness). Anaphylaxis is treated with epinephrine injections such as Epipen, but you must seek emergency medical treatment right away, even if you have used the EpiPen or EpiPen Jr auto-injector. Seek emergency medical attention even after you use EpiPen to treat a severe allergic reaction. You will need to receive further treatment and observation. Before using EpiPen a second time, tell your doctor if your first injection caused a serious side effect such as increased breathing difficulty, or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure). It is recommended that patients at risk of anaphylaxis carry 2 auto-injectors in case the first auto-injector is activated before the dose can be given, or you need a second dose. You may not know when anaphylaxis will happen. Talk to your healthcare provider if you need more auto-injectors to keep at work, school, or other locations. Make sure your family members, caregivers, and others where you keep your EpiPen or EpiPen Jr auto-injectors and they know how to use it before you need it. You may be unable to speak in an allergic emergency. A “trainer pen” is available to teach and practice giving an injection. The trainer pen contains no medicine and no needle. The EpiPen Auto-Injector device is a disposable single-use system. An Auto-Injector can only be used one time. You may need to use a second EpiPen auto-injector if symptoms continue or come back while you wait for emergency help or if the first auto-injector is activated before the dose can be given. Do not remove the safety cap until you are ready to use the Auto-Injector. Never put your fingers over the injector tip after the safety cap has been removed. Do not give this medicine to a child without medical advice. EpiPen is injected into the skin or muscle of your outer thigh. In an emergency, this injection can be given through your clothing. Do not inject into a vein or into the buttocks, fingers, toes, hands or feet. To use an EpiPen Auto-Injector: Form a fist around the Auto-Injector with the orange end pointing down. Pull the blue safety top straight up and away from the auto-injector. Place the orange tip against the fleshy portion of the outer thigh. You may give the injection directly through your clothing. Do not put your thumb over the end of the unit. Hold the leg firmly when giving this injection to a child or infant. Push the Auto-Injector firmly against the outer thigh and hold the EpiPen or Epi-pen Jr auto-injector down firmly on the middle of the outer thigh (upper leg) for at least 3 full seconds. If you do not hold it in place long enough, the EpiPen or EpiPen Jr auto-injector might not have time to deliver the correct dose of medicine. Remove the Auto-Injector from the thigh. The EpiPen or EpiPen Jr auto-injector has been activated when the blue safety top is removed and a “pop” is heard, the orange needle end of the auto-injector is extended, or the medicine viewing window is blocked. Carefully re-insert the used device needle-first into the carrying tube. Re-cap the tube and take it with you to the emergency room so that anyone who treats you will know how much epinephrine you have received. If you accidentally inject yourself while giving EpiPen to another person you must seek medical attention. Accidental injection into fingers, hands or feet may cause a loss of blood flow to these areas. If an accidental injection happens, go immediately to the nearest emergency room. Use an Auto-Injector only once, then throw away in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets. Your medicine may also come with a ""trainer pen."" The trainer pen contains no medicine and no needle. It is only for non-emergency use to practice giving yourself an injection. Dosing information Usual Epipen dose patients over 30kg (66 lbs): EpiPen 0.3 mg. Usual Epipen dose patients 15 to 30 kg (33 lbs to 66 lbs): EpiPen Jr 0.15 mg. Inject intramuscularly or subcutaneously into the outer thigh, through clothing if necessary. Each device is a single-dose injection. Epipen is available as: EpiPen Auto-Injector 0.3 mg (0.3 mg/0.3 mL) single-dose pre-filled auto-injector EpiPen Jr Auto-Injector: 0.15 mg (0.15 mg/0.3 mL) single-dose pre-filled auto-injectorkilograms). To make sure this medicine is safe for you, tell your doctor if you have ever had: heart disease or high blood pressure; asthma; Parkinson's disease; depression or mental illness; a thyroid disorder; or diabetes. Pregnancy and breastfeeding Having an allergic reaction while pregnant or nursing could harm both mother and baby. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include numbness or weakness, severe headache, blurred vision, pounding in your neck or ears, sweating, chills, chest pain, fast or slow heartbeats, severe shortness of breath, or cough with foamy mucus. What should I avoid while using EpiPen? Do not inject EpiPen into a vein or into the muscles of your buttocks, or it may not work as well. Inject it only into the fleshy outer portion of the thigh. EpiPen side effects Before using EpiPen, tell your doctor if any past use has caused an allergic reaction to get worse. Call your doctor at once if you notice pain, swelling, warmth, redness, or other signs of infection around the area where you gave an injection. Common EpiPen side effects may include: breathing problems; fast, irregular, or pounding heartbeats; pale skin, sweating; nausea and vomiting; dizziness; weakness or tremors; headache; or feeling restless, fearful, nervous, anxious, or excited. This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. My daughter has just been tested and we have learned she has a severe allergy to tree nuts. I'm freaking out. We have been given an epipen and using it scares me too. How and where do I inject it? Are there certain places it would be harmful? What are the signs of anaphylaxis? Also, what are the potential side effects of an EpiPen? What is EpiPen? EpiPen and Epipen Jr are used to treat life-threatening allergic reactions (anaphylaxis) to insect stings or bites, foods, drugs, and other allergens, and also treat exercise-induced anaphylaxis. EpiPen Auto-Injectors reduce wheezing and improve low blood pressure, hives, severe low blood pressure, and other symptoms of an allergic reaction. EpiPen contains epinephrine from a class of medications called sympathomimetic agents which works by relaxing the muscles in the airways and tightening the blood vessels. Epinephrine is also called adrenaline. EpiPen Auto-Injectors are hand-held devices that automatically inject a measured dose of medicine. EpiPen Auto-Injectors make it easier to give epinephrine in an emergency when anaphylaxis occurs. Anaphylaxis can be life-threatening and can happen within minutes and, if untreated, can lead to death. Each EpiPen or EpiPen Jr auto-injector can be used only 1 time (single-use). What is anaphylaxis? Anaphylaxis is a life-threatening allergic reaction to insect stings or bites, foods, drugs, exercise-induced anaphylaxis, and other allergens. Sometimes the cause of anaphylaxis is unknown. EpiPen and Epi-pen Jr Auto-Injectors reduce wheezing and improve low blood pressure, hives, severe low blood pressure, and other symptoms of an allergic reaction. Anaphylaxis can happen within minutes and, left untreated, can lead to death Symptoms of anaphylaxis may include: trouble breathing wheezing hoarseness (changes in the way your voice sounds) hives (raised reddened rash that may itch) severe itching swelling of your face, lips, mouth, or tongue skin rash, redness, or swelling fast heartbeat weak pulse feeling very anxious confusion stomach pain losing control of urine or bowel movements (incontinence) diarrhea or stomach cramps dizziness, fainting, or “passing out” (unconsciousness). Anaphylaxis is treated with epinephrine injections such as Epipen, but you must seek emergency medical treatment right away, even if you have used the EpiPen or EpiPen Jr auto-injector. Seek emergency medical attention even after you use EpiPen to treat a severe allergic reaction. You will need to receive further treatment and observation. Before using EpiPen a second time, tell your doctor if your first injection caused a serious side effect such as increased breathing difficulty, or dangerously high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, seizure). It is recommended that patients at risk of anaphylaxis carry 2 auto-injectors in case the first auto-injector is activated before the dose can be given, or you need a second dose. You may not know when anaphylaxis will happen. Talk to your healthcare provider if you need more auto-injectors to keep at work, school, or other locations. Make sure your family members, caregivers, and others where you keep your EpiPen or EpiPen Jr auto-injectors and they know how to use it before you need it. You may be unable to speak in an allergic emergency. A “trainer pen” is available to teach and practice giving an injection. The trainer pen contains no medicine and no needle. The EpiPen Auto-Injector device is a disposable single-use system. An Auto-Injector can only be used one time. You may need to use a second EpiPen auto-injector if symptoms continue or come back while you wait for emergency help or if the first auto-injector is activated before the dose can be given. Do not remove the safety cap until you are ready to use the Auto-Injector. Never put your fingers over the injector tip after the safety cap has been removed. Do not give this medicine to a child without medical advice. EpiPen is injected into the skin or muscle of your outer thigh. In an emergency, this injection can be given through your clothing. Do not inject into a vein or into the buttocks, fingers, toes, hands or feet. To use an EpiPen Auto-Injector: Form a fist around the Auto-Injector with the orange end pointing down. Pull the blue safety top straight up and away from the auto-injector. Place the orange tip against the fleshy portion of the outer thigh. You may give the injection directly through your clothing. Do not put your thumb over the end of the unit. Hold the leg firmly when giving this injection to a child or infant. Push the Auto-Injector firmly against the outer thigh and hold the EpiPen or Epi-pen Jr auto-injector down firmly on the middle of the outer thigh (upper leg) for at least 3 full seconds. If you do not hold it in place long enough, the EpiPen or EpiPen Jr auto-injector might not have time to deliver the correct dose of medicine. Remove the Auto-Injector from the thigh. The EpiPen or EpiPen Jr auto-injector has been activated when the blue safety top is removed and a “pop” is heard, the orange needle end of the auto-injector is extended, or the medicine viewing window is blocked. Carefully re-insert the used device needle-first into the carrying tube. Re-cap the tube and take it with you to the emergency room so that anyone who treats you will know how much epinephrine you have received. If you accidentally inject yourself while giving EpiPen to another person you must seek medical attention. Accidental injection into fingers, hands or feet may cause a loss of blood flow to these areas. If an accidental injection happens, go immediately to the nearest emergency room. Use an Auto-Injector only once, then throw away in a puncture-proof container (ask your pharmacist where you can get one and how to dispose of it). Keep this container out of the reach of children and pets. Your medicine may also come with a ""trainer pen."" The trainer pen contains no medicine and no needle. It is only for non-emergency use to practice giving yourself an injection. Dosing information Usual Epipen dose patients over 30kg (66 lbs): EpiPen 0.3 mg. Usual Epipen dose patients 15 to 30 kg (33 lbs to 66 lbs): EpiPen Jr 0.15 mg. Inject intramuscularly or subcutaneously into the outer thigh, through clothing if necessary. Each device is a single-dose injection. Epipen is available as: EpiPen Auto-Injector 0.3 mg (0.3 mg/0.3 mL) single-dose pre-filled auto-injector EpiPen Jr Auto-Injector: 0.15 mg (0.15 mg/0.3 mL) single-dose pre-filled auto-injectorkilograms). To make sure this medicine is safe for you, tell your doctor if you have ever had: heart disease or high blood pressure; asthma; Parkinson's disease; depression or mental illness; a thyroid disorder; or diabetes. Pregnancy and breastfeeding Having an allergic reaction while pregnant or nursing could harm both mother and baby. What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include numbness or weakness, severe headache, blurred vision, pounding in your neck or ears, sweating, chills, chest pain, fast or slow heartbeats, severe shortness of breath, or cough with foamy mucus. What should I avoid while using EpiPen? Do not inject EpiPen into a vein or into the muscles of your buttocks, or it may not work as well. Inject it only into the fleshy outer portion of the thigh. EpiPen side effects Before using EpiPen, tell your doctor if any past use has caused an allergic reaction to get worse. Call your doctor at once if you notice pain, swelling, warmth, redness, or other signs of infection around the area where you gave an injection. Common EpiPen side effects may include: breathing problems; fast, irregular, or pounding heartbeats; pale skin, sweating; nausea and vomiting; dizziness; weakness or tremors; headache; or feeling restless, fearful, nervous, anxious, or excited. This is not a complete list of side effects, and others may occur. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088. https://www.drugs.com/epipen-auto-injector.html",Medical,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","In what specific use cases should someone prefer o1-mini or o1-preview. Use evidence from the reference text wherever possible, including the name of the metric and the results.","OpenAI o1-mini Advancing cost-efficient reasoning. Contributions We're releasing OpenAI o1-mini, a cost-efficient reasoning model. o1-mini excels at STEM, especially math and coding—nearly matching the performance of OpenAI o1 on evaluation benchmarks such as AIME and Codeforces. We expect o1-mini will be a faster, cost-effective model for applications that require reasoning without broad world knowledge. Today, we are launching o1-mini to tier 5 API users(opens in a new window) at a cost that is 80% cheaper than OpenAI o1-preview. ChatGPT Plus, Team, Enterprise, and Edu users can use o1-mini as an alternative to o1-preview, with higher rate limits and lower latency (see Model Speed). Optimized for STEM Reasoning Large language models such as o1 are pre-trained on vast text datasets. While these high-capacity models have broad world knowledge, they can be expensive and slow for real-world applications. In contrast, o1-mini is a smaller model optimized for STEM reasoning during pretraining. After training with the same high-compute reinforcement learning (RL) pipeline as o1, o1-mini achieves comparable performance on many useful reasoning tasks, while being significantly more cost efficient. When evaluated on benchmarks requiring intelligence and reasoning, o1-mini performs well compared to o1-preview and o1. However, o1-mini performs worse on tasks requiring non-STEM factual knowledge (see Limitations). Math Performance vs Inference Cost GPT-4o GPT-4o mini o1-preview o1-mini o1 0 10 20 30 40 50 60 70 80 90 100 Inference Cost (%) 0% 20% 40% 60% 80% AIME Mathematics: In the high school AIME math competition, o1-mini (70.0%) is competitive with o1 (74.4%)–while being significantly cheaper–and outperforms o1-preview (44.6%). o1-mini’s score (about 11/15 questions) places it in approximately the top 500 US high-school students. Coding: On the Codeforces competition website, o1-mini achieves 1650 Elo, which is again competitive with o1 (1673) and higher than o1-preview (1258). This Elo score puts the model at approximately the 86th percentile of programmers who compete on the Codeforces platform. o1-mini also performs well on the HumanEval coding benchmark and high-school level cybersecurity capture the flag challenges (CTFs). Codeforces 1650 1258 900 o1-mini o1-preview GPT-4o 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800 Elo HumanEval 92.4% 92.4% 90.2% o1-mini o1-preview GPT-4o 0 10 20 30 40 50 60 70 80 90 100 Accuracy Cybersecurity CTFs 28.7% 43.0% 20.0% o1-mini o1-preview GPT-4o 0 5 10 15 20 25 30 35 40 45 Accuracy (Pass@12) STEM: On some academic benchmarks requiring reasoning, such as GPQA (science) and MATH-500, o1-mini outperforms GPT-4o. o1-mini does not perform as well as GPT-4o on tasks such as MMLU and lags behind o1-preview on GPQA due to its lack of broad world knowledge. MMLU 0-shot CoT 88.7% 85.2% 90.8% 92.3% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 GPQA Diamond, 0-shot CoT 53.6% 60.0% 73.3% 77.3% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 MATH-500 0-shot CoT 60.3% 90.0% 85.5% 94.8% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 Human preference evaluation: We had human raters compare o1-mini to GPT-4o on challenging, open-ended prompts in various domains, using the same methodology as our o1-preview vs GPT-4o comparison. Similar to o1-preview, o1-mini is preferred to GPT-4o in reasoning-heavy domains, but is not preferred to GPT-4o in language-focused domains. Human preference evaluation vs chatgpt-4o-latest o1-preview o1-mini Personal Writing Editing Text Computer Programming Data Analysis Mathematical Calculation 0 20 40 60 80 100 Win Rate vs GPT-4o (%) Domain Model Speed As a concrete example, we compared responses from GPT-4o, o1-mini, and o1-preview on a word reasoning question. While GPT-4o did not answer correctly, both o1-mini and o1-preview did, and o1-mini reached the answer around 3-5x faster. Chat speed comparison Safety o1-mini is trained using the same alignment and safety techniques as o1-preview. The model has 59% higher jailbreak robustness on an internal version of the StrongREJECT dataset compared to GPT-4o. Before deployment, we carefully assessed the safety risks of o1-mini using the same approach to preparedness, external red-teaming, and safety evaluations as o1-preview. We are publishing the detailed results from these evaluations in the accompanying system card. Metric GPT-4o o1-mini % Safe completions refusal on harmful prompts (standard) 0.99 0.99 % Safe completions on harmful prompts (Challenging: jailbreaks & edge cases) 0.714 0.932 % Compliance on benign edge cases (“not over-refusal”) 0.91 0.923 Goodness@0.1 StrongREJECT jailbreak eval (Souly et al. 2024(opens in a new window)) 0.22 0.83 Human sourced jailbreak eval 0.77 0.95 Limitations and What’s Next Due to its specialization on STEM reasoning capabilities, o1-mini’s factual knowledge on non-STEM topics such as dates, biographies, and trivia is comparable to small LLMs such as GPT-4o mini. We will improve these limitations in future versions, as well as experiment with extending the model to other modalities and specialities outside of STEM.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. In what specific use cases should someone prefer o1-mini or o1-preview. Use evidence from the reference text wherever possible, including the name of the metric and the results. OpenAI o1-mini Advancing cost-efficient reasoning. Contributions We're releasing OpenAI o1-mini, a cost-efficient reasoning model. o1-mini excels at STEM, especially math and coding—nearly matching the performance of OpenAI o1 on evaluation benchmarks such as AIME and Codeforces. We expect o1-mini will be a faster, cost-effective model for applications that require reasoning without broad world knowledge. Today, we are launching o1-mini to tier 5 API users(opens in a new window) at a cost that is 80% cheaper than OpenAI o1-preview. ChatGPT Plus, Team, Enterprise, and Edu users can use o1-mini as an alternative to o1-preview, with higher rate limits and lower latency (see Model Speed). Optimized for STEM Reasoning Large language models such as o1 are pre-trained on vast text datasets. While these high-capacity models have broad world knowledge, they can be expensive and slow for real-world applications. In contrast, o1-mini is a smaller model optimized for STEM reasoning during pretraining. After training with the same high-compute reinforcement learning (RL) pipeline as o1, o1-mini achieves comparable performance on many useful reasoning tasks, while being significantly more cost efficient. When evaluated on benchmarks requiring intelligence and reasoning, o1-mini performs well compared to o1-preview and o1. However, o1-mini performs worse on tasks requiring non-STEM factual knowledge (see Limitations). Math Performance vs Inference Cost GPT-4o GPT-4o mini o1-preview o1-mini o1 0 10 20 30 40 50 60 70 80 90 100 Inference Cost (%) 0% 20% 40% 60% 80% AIME Mathematics: In the high school AIME math competition, o1-mini (70.0%) is competitive with o1 (74.4%)–while being significantly cheaper–and outperforms o1-preview (44.6%). o1-mini’s score (about 11/15 questions) places it in approximately the top 500 US high-school students. Coding: On the Codeforces competition website, o1-mini achieves 1650 Elo, which is again competitive with o1 (1673) and higher than o1-preview (1258). This Elo score puts the model at approximately the 86th percentile of programmers who compete on the Codeforces platform. o1-mini also performs well on the HumanEval coding benchmark and high-school level cybersecurity capture the flag challenges (CTFs). Codeforces 1650 1258 900 o1-mini o1-preview GPT-4o 0 200 400 600 800 1,000 1,200 1,400 1,600 1,800 Elo HumanEval 92.4% 92.4% 90.2% o1-mini o1-preview GPT-4o 0 10 20 30 40 50 60 70 80 90 100 Accuracy Cybersecurity CTFs 28.7% 43.0% 20.0% o1-mini o1-preview GPT-4o 0 5 10 15 20 25 30 35 40 45 Accuracy (Pass@12) STEM: On some academic benchmarks requiring reasoning, such as GPQA (science) and MATH-500, o1-mini outperforms GPT-4o. o1-mini does not perform as well as GPT-4o on tasks such as MMLU and lags behind o1-preview on GPQA due to its lack of broad world knowledge. MMLU 0-shot CoT 88.7% 85.2% 90.8% 92.3% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 GPQA Diamond, 0-shot CoT 53.6% 60.0% 73.3% 77.3% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 MATH-500 0-shot CoT 60.3% 90.0% 85.5% 94.8% GPT-4o o1-mini o1-preview o1 0 10 20 30 40 50 60 70 80 90 100 Human preference evaluation: We had human raters compare o1-mini to GPT-4o on challenging, open-ended prompts in various domains, using the same methodology as our o1-preview vs GPT-4o comparison. Similar to o1-preview, o1-mini is preferred to GPT-4o in reasoning-heavy domains, but is not preferred to GPT-4o in language-focused domains. Human preference evaluation vs chatgpt-4o-latest o1-preview o1-mini Personal Writing Editing Text Computer Programming Data Analysis Mathematical Calculation 0 20 40 60 80 100 Win Rate vs GPT-4o (%) Domain Model Speed As a concrete example, we compared responses from GPT-4o, o1-mini, and o1-preview on a word reasoning question. While GPT-4o did not answer correctly, both o1-mini and o1-preview did, and o1-mini reached the answer around 3-5x faster. Chat speed comparison Safety o1-mini is trained using the same alignment and safety techniques as o1-preview. The model has 59% higher jailbreak robustness on an internal version of the StrongREJECT dataset compared to GPT-4o. Before deployment, we carefully assessed the safety risks of o1-mini using the same approach to preparedness, external red-teaming, and safety evaluations as o1-preview. We are publishing the detailed results from these evaluations in the accompanying system card. Metric GPT-4o o1-mini % Safe completions refusal on harmful prompts (standard) 0.99 0.99 % Safe completions on harmful prompts (Challenging: jailbreaks & edge cases) 0.714 0.932 % Compliance on benign edge cases (“not over-refusal”) 0.91 0.923 Goodness@0.1 StrongREJECT jailbreak eval (Souly et al. 2024(opens in a new window)) 0.22 0.83 Human sourced jailbreak eval 0.77 0.95 Limitations and What’s Next Due to its specialization on STEM reasoning capabilities, o1-mini’s factual knowledge on non-STEM topics such as dates, biographies, and trivia is comparable to small LLMs such as GPT-4o mini. We will improve these limitations in future versions, as well as experiment with extending the model to other modalities and specialities outside of STEM. https://openai.com/index/openai-o1-mini-advancing-cost-efficient-reasoning/",Internet/Technology,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]","explain, in plain language, why looser access to methadone medications is more important than ever because of the current fetnanyl epidemic in the united states","Over the past several years, the increasing prevalence of fentanyl in the drug supply has created an unprecedented overdose death rate and other devastating consequences. People with an opioid use disorder (OUD) urgently need treatment not just to protect them from overdosing but also to help them achieve recovery, but highly effective medications like buprenorphine and methadone remain underused. Amid this crisis, it is critical that methadone, in particular, be made more accessible, as it may hold unique clinical advantages in the age of fentanyl. Growing evidence suggests that methadone is as safe and effective as buprenorphine for patients who use fentanyl. In a 2020 naturalistic follow-up study, 53% of patients admitted to methadone treatment who tested positive for fentanyl at intake were still in treatment a year later, compared to 47% for patients who tested negative. Almost all (99%) of those retained in treatment achieved remission. An earlier study similarly found that 89% of patients who tested positive for fentanyl at methadone treatment intake and who remained in treatment at 6 months achieved abstinence. Methadone may even be preferable for patients considered to be at high risk for leaving OUD treatment and overdosing on fentanyl. Comparative effectiveness evidence is emerging which shows that people with OUD in British Columbia given buprenorphine/naloxone when initiating treatment were 60% more likely to discontinue treatment than those who received methadone (1). More research is needed on optimal methadone dosing in patients with high opioid tolerance due to use of fentanyl, as well as on induction protocols for these patients. It is possible that escalation to a therapeutic dose may need to be more rapid. It remains the case that only a fraction of people who could benefit from medication treatment for OUD (MOUD) receive it, due to a combination of structural and attitudinal barriers. A study using data from the National Survey on Drug Use and Health (NSDUH) from 2019—that is, pre-pandemic—found that only slightly more than a quarter (27.8%) of people who needed OUD treatment in the past year had received medication to treat their disorder. But a year into the pandemic, in 2021, the proportion had dropped to just 1 in 5. Efforts have been made to expand access to MOUD. For instance, in 2021, the U.S. Department of Health and Human Services (HHS) advanced the most comprehensive Overdose Prevention Strategy to date. Under this strategy, in 2023, HHS eliminated the X-waiver requirement for buprenorphine. But in the fentanyl era, expanded access to methadone too is essential, although there are even greater attitudinal and structural barriers to overcome with this medication. People in methadone treatment, who must regularly visit an opioid treatment program (OTP), face stigma from their community and from providers. People in rural areas may have difficulty accessing or sticking with methadone treatment if they live far from an OTP. SAMHSA’s changes to 42 CFR Part 8 (“Medications for the Treatment of Opioid Use Disorder”) on January 30, 2024 were another positive step taken under the HHS Overdose Prevention Strategy. The new rule makes permanent the increased take-home doses of methadone established in March 2020 during the COVID pandemic, along with other provisions aimed to broaden access like the ability to initiate methadone treatment via telehealth. Studies show that telehealth is associated with increased likelihood of receiving MOUD and that take-home doses increase treatment retention. Those changes that were implemented during the COVID pandemic have not been associated with adverse outcomes. An analysis of CDC overdose death data from January 2019 to August 2021 found that the percentage of overdose deaths involving methadone relative to all drug overdose deaths declined from 4.5% to 3.2% in that period. Expanded methadone access also was not associated with significant changes in urine drug test results, emergency department visits, or increases in overdose deaths involving methadone. An analysis of reports to poison control centers found a small increase in intentional methadone exposures in the year following the loosening of federal methadone regulations, but no significant increases in exposure severity, hospitalizations, or deaths. Patients themselves reported significant benefits from increased take-home methadone and other COVID-19 protocols. Patients at one California OTP in a small qualitative study reported increased autonomy and treatment engagement. Patients at three rural OTPs in Oregon reported increased self-efficacy, strengthened recovery, and reduced interpersonal conflict. The U.S. still restricts methadone prescribing and dispensing more than most other countries, but worries over methadone’s safety and concerns about diversion have made some physicians and policymakers hesitant about policy changes that would further lower the guardrails around this medication. Methadone treatment, whether for OUD or pain, is not without risks. Some studies have found elevated rates of overdose during the induction and stabilization phase of maintenance treatment, potentially due to starting at too high a dose, escalating too rapidly, or drug interactions. Although greatly increased prescribing of methadone to treat pain two decades ago was associated with diversion and a rise in methadone overdoses, overdoses declined after 2006, along with methadone’s use as an analgesic, even as its use for OUD increased. Most methadone overdoses are associated with diversion and, less often, prescription for chronic pain; currently, 70 percent of methadone overdoses involve other opioids (like fentanyl) or benzodiazepines. Recent trials of models of methadone dispensing in pharmacies and models of care based in other settings than OTPs have not supported concerns that making methadone more widely available will lead to harms like overdose. In two feasibility studies, stably maintained patients from OTPs in Baltimore, Maryland and Raleigh, North Carolina who received their methadone from a local pharmacy found this model to be highly satisfactory, with no positive urine screens, adverse events, or safety issues. An older pilot study in New Mexico found that prescribing methadone in a doctor’s office and dispensing in a community pharmacy, as well as methadone treatment delivered by social workers, produced better outcomes than standard care in an OTP for a sample of stably maintained female methadone patients. Critics of expanded access to methadone outside OTPs sometimes argue that the medication should not be offered without accompanying behavioral treatment. Data suggest that counseling is not essential. In wait-list studies, methadone treatment was effective at reducing opioid use on its own, and patients stayed in treatment. However, counseling may have benefits or even be indispensable for some patients to help them improve their psychosocial functioning and reduce other drug use. How to personalize the intensity and the level of support needed is a question that requires further investigation. Over the past two decades, the opioid crisis has accelerated the integration of addiction care in the U.S. with mainstream medicine. Yet methadone, the oldest and still one of the most effective medications in our OUD treatment toolkit, remains siloed. In the current era of powerful synthetic opioids like fentanyl dominating the statistics on drug addiction and overdose, it is time to make this effective medication more accessible to all who could benefit. The recent rules making permanent the COVID-19 provisions are an essential step in the right direction, but it will be critical to pursue other ways that methadone can safely be made more available to a wider range of patients with OUD. Although more research would be of value, the initial evidence suggests that providing methadone outside of OTPs is feasible, acceptable, and leads to good outcomes."," Only use the provided text to answer the question, no outside sources. explain, in plain language, why looser access to methadone medications is more important than ever because of the current fetnanyl epidemic in the united states Over the past several years, the increasing prevalence of fentanyl in the drug supply has created an unprecedented overdose death rate and other devastating consequences. People with an opioid use disorder (OUD) urgently need treatment not just to protect them from overdosing but also to help them achieve recovery, but highly effective medications like buprenorphine and methadone remain underused. Amid this crisis, it is critical that methadone, in particular, be made more accessible, as it may hold unique clinical advantages in the age of fentanyl. Growing evidence suggests that methadone is as safe and effective as buprenorphine for patients who use fentanyl. In a 2020 naturalistic follow-up study, 53% of patients admitted to methadone treatment who tested positive for fentanyl at intake were still in treatment a year later, compared to 47% for patients who tested negative. Almost all (99%) of those retained in treatment achieved remission. An earlier study similarly found that 89% of patients who tested positive for fentanyl at methadone treatment intake and who remained in treatment at 6 months achieved abstinence. Methadone may even be preferable for patients considered to be at high risk for leaving OUD treatment and overdosing on fentanyl. Comparative effectiveness evidence is emerging which shows that people with OUD in British Columbia given buprenorphine/naloxone when initiating treatment were 60% more likely to discontinue treatment than those who received methadone (1). More research is needed on optimal methadone dosing in patients with high opioid tolerance due to use of fentanyl, as well as on induction protocols for these patients. It is possible that escalation to a therapeutic dose may need to be more rapid. It remains the case that only a fraction of people who could benefit from medication treatment for OUD (MOUD) receive it, due to a combination of structural and attitudinal barriers. A study using data from the National Survey on Drug Use and Health (NSDUH) from 2019—that is, pre-pandemic—found that only slightly more than a quarter (27.8%) of people who needed OUD treatment in the past year had received medication to treat their disorder. But a year into the pandemic, in 2021, the proportion had dropped to just 1 in 5. Efforts have been made to expand access to MOUD. For instance, in 2021, the U.S. Department of Health and Human Services (HHS) advanced the most comprehensive Overdose Prevention Strategy to date. Under this strategy, in 2023, HHS eliminated the X-waiver requirement for buprenorphine. But in the fentanyl era, expanded access to methadone too is essential, although there are even greater attitudinal and structural barriers to overcome with this medication. People in methadone treatment, who must regularly visit an opioid treatment program (OTP), face stigma from their community and from providers. People in rural areas may have difficulty accessing or sticking with methadone treatment if they live far from an OTP. SAMHSA’s changes to 42 CFR Part 8 (“Medications for the Treatment of Opioid Use Disorder”) on January 30, 2024 were another positive step taken under the HHS Overdose Prevention Strategy. The new rule makes permanent the increased take-home doses of methadone established in March 2020 during the COVID pandemic, along with other provisions aimed to broaden access like the ability to initiate methadone treatment via telehealth. Studies show that telehealth is associated with increased likelihood of receiving MOUD and that take-home doses increase treatment retention. Those changes that were implemented during the COVID pandemic have not been associated with adverse outcomes. An analysis of CDC overdose death data from January 2019 to August 2021 found that the percentage of overdose deaths involving methadone relative to all drug overdose deaths declined from 4.5% to 3.2% in that period. Expanded methadone access also was not associated with significant changes in urine drug test results, emergency department visits, or increases in overdose deaths involving methadone. An analysis of reports to poison control centers found a small increase in intentional methadone exposures in the year following the loosening of federal methadone regulations, but no significant increases in exposure severity, hospitalizations, or deaths. Patients themselves reported significant benefits from increased take-home methadone and other COVID-19 protocols. Patients at one California OTP in a small qualitative study reported increased autonomy and treatment engagement. Patients at three rural OTPs in Oregon reported increased self-efficacy, strengthened recovery, and reduced interpersonal conflict. The U.S. still restricts methadone prescribing and dispensing more than most other countries, but worries over methadone’s safety and concerns about diversion have made some physicians and policymakers hesitant about policy changes that would further lower the guardrails around this medication. Methadone treatment, whether for OUD or pain, is not without risks. Some studies have found elevated rates of overdose during the induction and stabilization phase of maintenance treatment, potentially due to starting at too high a dose, escalating too rapidly, or drug interactions. Although greatly increased prescribing of methadone to treat pain two decades ago was associated with diversion and a rise in methadone overdoses, overdoses declined after 2006, along with methadone’s use as an analgesic, even as its use for OUD increased. Most methadone overdoses are associated with diversion and, less often, prescription for chronic pain; currently, 70 percent of methadone overdoses involve other opioids (like fentanyl) or benzodiazepines. Recent trials of models of methadone dispensing in pharmacies and models of care based in other settings than OTPs have not supported concerns that making methadone more widely available will lead to harms like overdose. In two feasibility studies, stably maintained patients from OTPs in Baltimore, Maryland and Raleigh, North Carolina who received their methadone from a local pharmacy found this model to be highly satisfactory, with no positive urine screens, adverse events, or safety issues. An older pilot study in New Mexico found that prescribing methadone in a doctor’s office and dispensing in a community pharmacy, as well as methadone treatment delivered by social workers, produced better outcomes than standard care in an OTP for a sample of stably maintained female methadone patients. Critics of expanded access to methadone outside OTPs sometimes argue that the medication should not be offered without accompanying behavioral treatment. Data suggest that counseling is not essential. In wait-list studies, methadone treatment was effective at reducing opioid use on its own, and patients stayed in treatment. However, counseling may have benefits or even be indispensable for some patients to help them improve their psychosocial functioning and reduce other drug use. How to personalize the intensity and the level of support needed is a question that requires further investigation. Over the past two decades, the opioid crisis has accelerated the integration of addiction care in the U.S. with mainstream medicine. Yet methadone, the oldest and still one of the most effective medications in our OUD treatment toolkit, remains siloed. In the current era of powerful synthetic opioids like fentanyl dominating the statistics on drug addiction and overdose, it is time to make this effective medication more accessible to all who could benefit. The recent rules making permanent the COVID-19 provisions are an essential step in the right direction, but it will be critical to pursue other ways that methadone can safely be made more available to a wider range of patients with OUD. Although more research would be of value, the initial evidence suggests that providing methadone outside of OTPs is feasible, acceptable, and leads to good outcomes. https://nida.nih.gov/about-nida/noras-blog/2024/07/to-address-the-fentanyl-crisis-greater-access-to-methadone-is-needed",Medical,Effect Analysis,Q&A Please limit your knowledge to the document. Avoid generalizations and ensure accuracy by directly referencing the document's arguments and examples.,What are the main ideas presented in this study and what are the benefits ad consequences?,"The biggest mistakes Canadians make on their taxes — and how to fix them Fizkes / Shutterstock By Tamar Satov We adhere to strict standards of editorial integrity to help you make decisions with confidence. Please be aware this post may contain links to products from our partners. We may receive a commission for products or services you sign up for through partner links. Maximize your tax savings by avoiding these common errors on Canadian income tax returns. Already goofed and want to know how to fix a mistake on your tax return? Here’s how to change your return after you’ve filed. Filing income taxes is a complicated process, so it’s not surprising that taxpayers often get things wrong on their returns. Sometimes, your mistake could have you paying more in taxes than you should. In other situations, you may have to give back the benefits you already received or face penalties or other fees. To help you get your return right the first time, we’ve come up with a list of the most common mistakes Canadians make on their taxes. But, if you already made one of these errors and want to know, “How do I fix a mistake on my tax return?” — don’t worry. We also explain how to correct your tax return after you’ve filed. Mistake #1: Forgetting allowable deductions or credits It’s hard to know which income tax deductions and credits you qualify for from year to year, especially since the government continually tinkers with the rules for existing tax breaks, adding new ones and eliminating others. If you don’t claim all the deductions and credits you are entitled to, you’ll pay more taxes than necessary — which you obviously want to avoid. Some of the more frequently overlooked credits and deductions include: o A non-refundable tax credit for the interest you paid on student loans; o A tax deduction for union or professional dues; o The $5,000 non-refundable home buyer’s tax credit, for those who bought a qualifying home in the past year and have not lived in a home they (or their spouse) owned in the past four years; o A tax deduction for work-related expenses that you paid for out of pocket — even if you are salaried. This year, the CRA has made it even easier to qualify for this deduction if you worked from home during the COVID-19 pandemic. One of the benefits of using tax software to file your taxes is that the better ones, such as TurboTax, will ask you a series of questions to determine which of the more than 400 deductions and credits you may be eligible for. That means you won’t leave tax savings on the table. READ MORE: The best tax return software in Canada Mistake #2: Claiming ineligible expenses On the flip side of missing tax breaks is claiming deductions or credits that don’t exist. According to the CRA, one of the classic examples here is related to moving expenses. Taxpayers who move at least 40 km closer to a new place of work or to study full-time at a post-secondary program can deduct a variety of moving costs, including transportation and storage, travel expenses, utility hookups and disconnections, and fees for cancelling a lease. But some taxpayers push the envelope by writing off ineligible expenses such as home staging, household repairs, and the cost of having their mail forwarded to the new address. Similarly, some students try to claim the student loan tax credit on interest fees they paid on personal loans, student lines of credit, or foreign student loans — even though these forms of borrowing are not eligible for the credit. Mistake #3: Getting rid of slips and receipts With the rise of online tax filing, which does not require taxpayers to send in all their slips and receipts along with their returns, some people fail to keep that paperwork handy. This is a problem since the CRA can (and often does) request to see receipts for things like childcare expenses, charitable donations, tuition fees, or any other expense related to a claim you’ve made. (Such requests are separate from an audit, which is much less likely, but could also happen.) Individuals are required to keep seven years’ worth of records on hand, and the CRA will only accept receipts (not invoices) that include the date of payment. If you cannot provide these documents when asked, your claims will be denied. Mistake #4: Misreporting your marital status You may not think of your squeeze as your spouse, but if you have been living together for at least 12 months, or you reside together and share a child (by birth or adoption), the CRA considers you to be in a common-law relationship, which must be declared on your tax return. It’s important that you correctly indicate your marital status, because some benefits that you may be eligible to receive, such as the GST/HST tax credit or the Canada Child Benefit, are based on spouses’ combined incomes. If you file as single, it could delay your payments, or you may even have to pay back some of the money you receive. On the plus side, spouses can pool or transfer some of their tax credits, which can lead to greater tax savings. This is another benefit of using tax software, as it will automatically optimize claims for medical expenses, charitable donations, pension splitting, and other credits when spouses prepare their returns at the same time. Mistake #5: Neglecting to transfer unused tax credits to other family Mmembers As mentioned above, individuals can transfer some of their tax credits to a spouse if they don’t have enough income or taxes owing to make full use of them. In some cases, such as the $5,000 tuition tax credit, unused amounts can also be transferred to a parent or grandparent. So, for example, if you are a full-time student at an eligible education institution, you can claim a non-refundable tax credit equal to 15% of the tuition you paid (up to $5,000). Because it is a non-refundable tax credit — which can only reduce the amount of tax you owe, it can’t pay out any extra benefit — you can only use the portion of the credit that reduces your taxes to zero. At that point, any remaining amount may be transferred to a spouse, parent or grandparent, which can lead to greater tax savings (especially if they are in a higher tax bracket than you are). Mistake #6: Missing the tax deadline Because of COVID-19, the 2019 tax filing deadline was extended dramatically in 2020. But deadlines returned to normal in 2021, and 2022 appears to be the same. You’ll need to file your 2021 taxes by May 2, 2022, for employed Canadians and by June 15, 2022, if you are self-employed. o You won’t get your refund on time. If you’re owed a refund, as is the case for more than 60% of tax filers, it will be delayed — and the government won’t pay you any interest even though it kept your money longer than necessary. o It could delay benefit payments. The government can’t assess your eligibility for payments such as the GST/HST Credit or Canada Child Benefit until you file your tax return. o You may face interest charges and penalty fees. If you have taxes owing and don’t file by the deadline, the CRA will charge you compound daily interest on your unpaid balance starting the very next day. Furthermore, you will be subject to a 5% late-filing penalty, and an extra 1% for every month after that (up to 12 months). These fees can really snowball over time, as the penalties rise to 10% (and 2% extra for every month) if you’ve already been late with your taxes in the past three years. Plus, the CRA will even charge you interest on your penalties Mistake #7: Not realizing some benefits are taxable If you received COVID-19 emergency relief from the government (like the Canada Emergency Response Benefit or CERB), that benefit most likely helped keep your finances afloat during some very financially turbulent times. But the money you received under this program and others like it wasn’t without strings attached. You’ll need to declare any benefits you received on your upcoming income tax return. On top of that, these benefits are taxable, which means they do not have income tax deducted at the source. So if you claimed CERB or other COVID benefits during 2020, you would have to pay a portion of it back at tax time as income tax. It’s smart to do your calculations early using a simple income tax calculator to help you determine how much you might owe, so you aren’t shocked at tax time. Mistake #8: Ignoring mistakes you made on previous returns So, now that you know about the most common mistakes Canadians make on their taxes, you can avoid them when you prepare this year’s return. But what if upon reviewing this list you realize you made some of these mistakes in the past? Or perhaps you found a misplaced T-slip, or it arrived late. Like many Canadians, you may be wondering, “Can I correct my tax return?” Thankfully, you don’t have to accept that you missed out on tax savings, or sit around in fear that the CRA may come after you for additional payments. Instead, you can (and should) correct your tax return, as we explain below. ","Please limit your knowledge to the document. Avoid generalizations and ensure accuracy by directly referencing the document's arguments and examples. What are the main ideas presented in this study and what are the benefits ad consequences? The biggest mistakes Canadians make on their taxes — and how to fix them Fizkes / Shutterstock By Tamar Satov We adhere to strict standards of editorial integrity to help you make decisions with confidence. Please be aware this post may contain links to products from our partners. We may receive a commission for products or services you sign up for through partner links. Maximize your tax savings by avoiding these common errors on Canadian income tax returns. Already goofed and want to know how to fix a mistake on your tax return? Here’s how to change your return after you’ve filed. Filing income taxes is a complicated process, so it’s not surprising that taxpayers often get things wrong on their returns. Sometimes, your mistake could have you paying more in taxes than you should. In other situations, you may have to give back the benefits you already received or face penalties or other fees. To help you get your return right the first time, we’ve come up with a list of the most common mistakes Canadians make on their taxes. But, if you already made one of these errors and want to know, “How do I fix a mistake on my tax return?” — don’t worry. We also explain how to correct your tax return after you’ve filed. Mistake #1: Forgetting allowable deductions or credits It’s hard to know which income tax deductions and credits you qualify for from year to year, especially since the government continually tinkers with the rules for existing tax breaks, adding new ones and eliminating others. If you don’t claim all the deductions and credits you are entitled to, you’ll pay more taxes than necessary — which you obviously want to avoid. Some of the more frequently overlooked credits and deductions include: o A non-refundable tax credit for the interest you paid on student loans; o A tax deduction for union or professional dues; o The $5,000 non-refundable home buyer’s tax credit, for those who bought a qualifying home in the past year and have not lived in a home they (or their spouse) owned in the past four years; o A tax deduction for work-related expenses that you paid for out of pocket — even if you are salaried. This year, the CRA has made it even easier to qualify for this deduction if you worked from home during the COVID-19 pandemic. One of the benefits of using tax software to file your taxes is that the better ones, such as TurboTax, will ask you a series of questions to determine which of the more than 400 deductions and credits you may be eligible for. That means you won’t leave tax savings on the table. READ MORE: The best tax return software in Canada Mistake #2: Claiming ineligible expenses On the flip side of missing tax breaks is claiming deductions or credits that don’t exist. According to the CRA, one of the classic examples here is related to moving expenses. Taxpayers who move at least 40 km closer to a new place of work or to study full-time at a post-secondary program can deduct a variety of moving costs, including transportation and storage, travel expenses, utility hookups and disconnections, and fees for cancelling a lease. But some taxpayers push the envelope by writing off ineligible expenses such as home staging, household repairs, and the cost of having their mail forwarded to the new address. Similarly, some students try to claim the student loan tax credit on interest fees they paid on personal loans, student lines of credit, or foreign student loans — even though these forms of borrowing are not eligible for the credit. Mistake #3: Getting rid of slips and receipts With the rise of online tax filing, which does not require taxpayers to send in all their slips and receipts along with their returns, some people fail to keep that paperwork handy. This is a problem since the CRA can (and often does) request to see receipts for things like childcare expenses, charitable donations, tuition fees, or any other expense related to a claim you’ve made. (Such requests are separate from an audit, which is much less likely, but could also happen.) Individuals are required to keep seven years’ worth of records on hand, and the CRA will only accept receipts (not invoices) that include the date of payment. If you cannot provide these documents when asked, your claims will be denied. Mistake #4: Misreporting your marital status You may not think of your squeeze as your spouse, but if you have been living together for at least 12 months, or you reside together and share a child (by birth or adoption), the CRA considers you to be in a common-law relationship, which must be declared on your tax return. It’s important that you correctly indicate your marital status, because some benefits that you may be eligible to receive, such as the GST/HST tax credit or the Canada Child Benefit, are based on spouses’ combined incomes. If you file as single, it could delay your payments, or you may even have to pay back some of the money you receive. On the plus side, spouses can pool or transfer some of their tax credits, which can lead to greater tax savings. This is another benefit of using tax software, as it will automatically optimize claims for medical expenses, charitable donations, pension splitting, and other credits when spouses prepare their returns at the same time. Mistake #5: Neglecting to transfer unused tax credits to other family Mmembers As mentioned above, individuals can transfer some of their tax credits to a spouse if they don’t have enough income or taxes owing to make full use of them. In some cases, such as the $5,000 tuition tax credit, unused amounts can also be transferred to a parent or grandparent. So, for example, if you are a full-time student at an eligible education institution, you can claim a non-refundable tax credit equal to 15% of the tuition you paid (up to $5,000). Because it is a non-refundable tax credit — which can only reduce the amount of tax you owe, it can’t pay out any extra benefit — you can only use the portion of the credit that reduces your taxes to zero. At that point, any remaining amount may be transferred to a spouse, parent or grandparent, which can lead to greater tax savings (especially if they are in a higher tax bracket than you are). Mistake #6: Missing the tax deadline Because of COVID-19, the 2019 tax filing deadline was extended dramatically in 2020. But deadlines returned to normal in 2021, and 2022 appears to be the same. You’ll need to file your 2021 taxes by May 2, 2022, for employed Canadians and by June 15, 2022, if you are self-employed. o You won’t get your refund on time. If you’re owed a refund, as is the case for more than 60% of tax filers, it will be delayed — and the government won’t pay you any interest even though it kept your money longer than necessary. o It could delay benefit payments. The government can’t assess your eligibility for payments such as the GST/HST Credit or Canada Child Benefit until you file your tax return. o You may face interest charges and penalty fees. If you have taxes owing and don’t file by the deadline, the CRA will charge you compound daily interest on your unpaid balance starting the very next day. Furthermore, you will be subject to a 5% late-filing penalty, and an extra 1% for every month after that (up to 12 months). These fees can really snowball over time, as the penalties rise to 10% (and 2% extra for every month) if you’ve already been late with your taxes in the past three years. Plus, the CRA will even charge you interest on your penalties Mistake #7: Not realizing some benefits are taxable If you received COVID-19 emergency relief from the government (like the Canada Emergency Response Benefit or CERB), that benefit most likely helped keep your finances afloat during some very financially turbulent times. But the money you received under this program and others like it wasn’t without strings attached. You’ll need to declare any benefits you received on your upcoming income tax return. On top of that, these benefits are taxable, which means they do not have income tax deducted at the source. So if you claimed CERB or other COVID benefits during 2020, you would have to pay a portion of it back at tax time as income tax. It’s smart to do your calculations early using a simple income tax calculator to help you determine how much you might owe, so you aren’t shocked at tax time. Mistake #8: Ignoring mistakes you made on previous returns So, now that you know about the most common mistakes Canadians make on their taxes, you can avoid them when you prepare this year’s return. But what if upon reviewing this list you realize you made some of these mistakes in the past? Or perhaps you found a misplaced T-slip, or it arrived late. Like many Canadians, you may be wondering, “Can I correct my tax return?” Thankfully, you don’t have to accept that you missed out on tax savings, or sit around in fear that the CRA may come after you for additional payments. Instead, you can (and should) correct your tax return, as we explain below. ",Financial,Effect Analysis,Q&A You can only respond to the prompt using information in the context block. ,Discuss the concept of military necessity as outlined in this article and its relationship to contemporary asymmetric conflict.,"Abstract Inequality in arms, indeed, significant disparity between belligerents, has become a prominent feature of various contemporary armed conflicts. Such asymmetries, albeit not at all a new phenomenon in the field of warfare, no longer constitute a random occurrence of singular battles. As a structural characteristic of modern-day warfare asymmetric conflict structures have repercussions on the application of fundamental principles of international humanitarian law. How, for example, can the concept of military necessity, commonly understood to justify the degree of force necessary to secure military defeat of the enemy, be reconciled with a constellation in which one side in the conflict is from the outset bereft of any chance of winning the conflict militarily? Moreover, military imbalances of this scope evidently carry incentives for the inferior party to level out its inferiority by circumventing accepted rules of warfare. This article attempts tentatively to assess the repercussions this could have on the principle of reciprocity, especially the risk of the instigation of a destabilizing dynamic of negative reciprocity which ultimately could lead to a gradual intensification of a mutual disregard of international humanitarian law. Introduction With only one remaining superpower and more generally the considerable and predictably widening technological divide, an imbalance in the military capacity of warring parties has become a characteristic feature of contemporary armed conflicts. Coupled with a growing involvement of non-state entities, the disparity between belligerents is steadily increasing, and various contemporary armed conflicts appear to be more and more asymmetric in structure. Unlike the geostrategic set-up that prevailed throughout the cold war period, it is a widely perceived paradox of today’s strategic environment that military superiority may actually accentuate the threat of nuclear, biological, chemical and, generally speaking, perfidious attack. Indeed, direct attacks against civilians, hostage-taking and the use of human shields – practices that have long been outlawed in armed conflicts– have seen a revival in recent conflicts in which the far weaker party has often sought to gain a comparative advantage over the militarily superior enemy by resorting to such practices as a matter of strategy. International terrorism, although not necessarily conducted within the context of an armed conflict triggering the application of international humanitarian law (IHL), is often regarded as the epitome of such asymmetry. At the same time militarily superior parties at the other end of the spectrum have had recourse to indiscriminate attacks, illegal interrogation practices and renditions, as well as legally dubious practices such as targeted killings or hardly reviewable covert operations, in order to strike at their frequently amorphous enemy. Significant inequality of arms, that is a disparate distribution of military strength and technological capability in a given conflict, seemingly creates incentives for adversaries to resort to means and methods of warfare that undermine and are sometimes an outright violation of long-accepted standards of international humanitarian law. The war between the US-led Coalition and Iraq or the war in Afghanistan are clear examples. This tendency is reinforced if belligerents differ in nature, as in the recent conflict between Israel and Hezbollah (‘‘party of God’’)– the Lebanon-based Shia Islamic militia and political organization– or if factual asymmetries are combined with a legal asymmetry, that is in a constellation in which one side is accorded little or no legal standing. To be sure, perfect symmetries have rarely been present in war. However, the patterns of non-compliance displayed in various contemporary conflicts seem to be more structured and systematic than ever before. The present study first seeks to verify this assumption. It considers whether factual and potentially legal asymmetries do indeed constitute an incentive for breaches of international humanitarian law provisions, and, if so, how patterns of contemporary conflicts differ from those of previous conflicts that likewise exhibited discernible asymmetries. In a second step, closer scrutiny is given to the actual patterns of non-compliance in asymmetric scenarios, particularly in the light of the interplay of the principle of distinction and the principle of proportionality. Neither the term ‘‘asymmetric warfare’’ nor the sometimes synonymously employed terms ‘‘fourth-generation warfare’’ or ‘‘non-linear war’’ have thus far been concordantly defined.3 It is not the intention of this study to venture into this perhaps impenetrable terrain. Analysis shows, however, that there is a noticeable tendency in contemporary conflicts towards an increasing inequality between belligerents in terms of weaponry. While this is a long-known phenomenon in non-international armed conflicts, evaluation of the effects of military disparity in international armed conflicts continues, as does the debate over the extent to which transnational conflicts involving states and non-state entities should be subject to the laws of war. In attempting to approach this debate from a somewhat different angle, it is the overall purpose of this study to gauge the long-term repercussions that asymmetric conflict structures may have on the fundamental principles of international humanitarian law and thereby tentatively to assess the degree of asymmetry– that is, the level of military disparity between belligerents– that can still be reconciled with the legal regime applicable in times of war.5 To this end the study, in a third step, weighs the traditional concept of military necessity as laid down in the Lieber Code of 1863 against the promulgated necessities in asymmetric conflicts of our time. Even though the fundamental concepts and principles of the laws of war have been designed as prophylactic mechanisms flexible enough to outlast changes in the way in which wars are waged, it is here contended that the concept of military necessity and the principle of distinction presuppose a minimum degree of symmetry and therefore cannot be applied in subordinative constellations akin to human rights patterns, as are commonly seen in the fight against international terrorism. The vantage point for the fourth and final part of the analysis is the principle of reciprocity. As the military mismatch between conflicting parties in numerous modern armed conflicts becomes more marked, the balancing influence of the reciprocity entailed by the traditional concept of symmetric warfare is gradually being undermined.6 While the deterrent effects of an increasingly effective system of international criminal law and of media coverage and public opinion– although the last two are ambivalent factors that could also be used for the opposite purpose– could arguably help to contain non-compliant behaviour in war, international humanitarian law might thus be simultaneously bereft of its own inherent regulating mechanisms which have traditionally taken effect in the combat zone itself. The destabilizing dynamic of reciprocity could lead to a gradual and perhaps insidious erosion of the protective scope of core principles of international humanitarian law. Repeated violations of, for example, the principle of distinction by one party to a conflict are likely to induce the other side to expand its perception of what is militarily necessary, and hence proportional, when engaging in battle against such an enemy. In the final stage, and admittedly only as a worst-case scenario, an intentional and deceitful deviation from accepted standards regulating the conduct of hostilities carries the considerable risk of starting a vicious circle of ever greater negative reciprocity, in which the expectations of the warring parties are transformed into an escalating mutual noncompliance with international humanitarian law. A heightened risk of structural non-compliance? Historically, the majority of laws on international armed conflict have been designed on the basis of Clausewitz’s arguably rather Eurocentric conception of war, that is, the assumption of symmetric conflicts taking place between state armies of roughly equal military strength or at least comparable organizational structures. Throughout most of the nineteenth and twentieth centuries the dominant powers engaged in sustained arms races either to maintain a peace ensuring symmetry or to establish a tactical asymmetry vis-a `-vis their opponents as a guarantee of military victory in war.7 But quite apart from the biblical story of David and Goliath it is evident that asymmetry in the sense of military disparity is no new phenomenon.8 Nor is it a concept entirely alien to IHL. With the intrinsic disparity of the parties concerned, and even though the threshold criteria of Article 1 of Additional Protocol II to the 1949 Geneva Conventions arguably help to ensure a minimum degree of comparability between those parties, non-international armed conflicts are inherently asymmetric. It was moreover already accepted in the classic concept of symmetric warfare that the structure of conflicts could shift from symmetric to asymmetric, for by the time a conflict drew to its close and one party had gained the upper hand, the initial military balance would be out of kilter. More recently, during the Diplomatic Conference that led to the adoption of Additional Protocol I, states taking part not only acknowledged the persistence of significant disparities in military capacity but accepted that factual disparity between opponents may even lead to differing humanitarian law obligations. For example, with respect to Article 57 of Additional Protocol I on the obligation to take precautions in attack,9 the Indian delegation pointed out that according to the chosen wording the content of the due diligence obligation enshrined therein– that is, the precise identification of objectives as military or civilian– largely depended on the technical means of detection available to the belligerents.10 Despite these concerns, the present wording was accepted on the implicit understanding that because of prevailing factual disparities, international humanitarian law obligations may impose differing burdens in practice.11 Schwarzenberger has pointed out that the protective scope of the laws of war has historically been the strongest in duel-type wars between comparable belligerents that were fought for limited purposes, such as the Crimean War of 1853–6 or the Franco-German War of 1870–1, whereas in major wars such as the Napoleonic wars or the two world wars of the twentieth century– wars that were fought to the bitter end– the weaker side often tended to seek short-term advantages by violating the laws of war.12 Indeed, violations of the laws of war have occurred in nearly every case in which IHL has been applicable,13 and the risk that one party may order or connive in large-scale violations of the laws of war in order to gain a tempting advantage or stave off in some way an otherwise threatening defeat has always hovered over the legal regime intended to regulate conduct in armed conflicts.14 However, in symmetric constellations such instances have tended to remain marginal, often limited to the final stages of a war and confined to individual battles in which defeat seemed inevitable, or resort to perfidy or similarly prohibited tactics was perceived as guaranteeing an immediate tactical breakthrough in what was otherwise a military stalemate. As a result of the evident disparate military capabilities of opponents in certain contemporary conflicts, incentives for violations of IHL seem in comparison to have reached a new height. Non-compliance with the provisions of IHL is no longer a random event, confined to temporally and spatially limited incidents within a conflict, but has become a recurrent structural feature that characterizes many of today’s armed conflicts from the outset. The reason is that, faced with an enemy of overwhelming technological superiority, the weaker party ab initio has no chance of winning the war militarily. Figures from the recent war against Iraq illustrate this imbalance of power and capacity quite well. While the Iraqi air force reportedly never left the ground, Coalition forces flew rather more than 20,000 sorties, during which only one fixed-wing aircraft and only seven aircraft in all were lost to hostile fire.15 Evidence of a comparable inequality in the military capability of belligerents will probably become available in the aftermath of the recent conflict in Lebanon. Without anticipating the more detailed analysis below, it should be noted that the Iraqi army’s widespread infringements during the international conflict against the US-led Coalition, as well as Hezbollah’s indiscriminate attacks, stem to a significant extent from the blatant inequality in weaponry. Practices employed by the Iraqi army included recourse to human shields, abuse of the red cross and red crescent emblems, the use of anti-personnel mines and the placing of military objects in protected areas such as mosques and hospitals. Clearly, there is thus an elevated risk that the militarily inferior party, unable to identify any military weaknesses of its superior opponent, may feel compelled systematically to offset the enemy’s superiority by resorting to means and methods of warfare outside the realm of international humanitarian law. At the same time the use of ‘‘unthinkable’’ tactics as well as the tactical circumvention of accepted IHL standards creates a barrier that cannot be readily overcome by military superiority alone. Apart from the ongoing hostilities in Iraq, the tactics employed by the Somali tribal leader Farah Aydid in 1993 are a good example of this. In conventional terms, his forces were no match for heavily armed and technologically sophisticated airborne US troops. However, by using primitive weapons and communication systems– which reportedly varied from cellular phones to tribal drums– and by resorting to ‘‘unthinkable’’ tactics and to ‘‘barbaric’’ acts perpetrated for the benefit of the news media, the militia convinced the leadership of the United States that despite the military backwardness of the Somali forces the price of involvement in Somalia was very high. In the course of the war against Iraq the use of cluster munitions in populated areas, as well as the alleged use of white phosphorus and the continued recourse by US and British forces to ‘‘decapitation’’ strikes that caused high numbers of civilian casualties, partly constituted indiscriminate attacks and arguably a failure to take ‘‘all feasible precautions’’ as required by IHL. There are thus apparent incentives for both sides to give increasing priority, potentially to the detriment of humanitarian considerations, to the necessities of such a kind of warfare. Patterns of non-compliance: the interplay between the principle of distinction and the principle of proportionality Recent conflict patterns suggest that militarily inferior parties, in order to evade attack by an enemy of insurmountable superiority or to level out inequalities in military power, tend in particular to instrumentalize and intentionally manipulate the principle of distinction. This manipulation may occur in different ways.18 Similarly, superior parties are likely to lower the barrier of proportionality in response to a systematic misuse of the principle of distinction and their resulting inability to tackle the enemy effectively. The following description of potential strategies that belligerents may feel compelled to adopt when faced with overwhelming odds or systematic deviations from accepted legal rules is merely intended to facilitate understanding of likely patterns of non-compliance and does not claim to be comprehensive. It is part of the very nature of asymmetric strategies that they are impossible to predict. The principle of distinction As a defensive strategy when facing a technologically superior enemy it is essential, but ever more difficult, to stay out of reach and conceal one’s presence as a combatant. Hiding in mountainous areas, caves, underground facilities and tunnels is one way. However, another means of doing so quickly and efficiently is readily available by virtue of the provisions of IHL themselves. In view of the various forms of protection accorded to civilians, assuming civilian guise is an easy way to evade the enemy and, unlike the more traditional guerrilla-style tactics of hiding underground or in inaccessible areas, it cannot be countered by the development of advanced discovery technologies. Indeed, in order to keep Coalition forces from identifying them as enemies, that is as legitimate targets, many Iraqi soldiers in the recent war reportedly quite often discarded their uniforms. This is not a prohibited tactic, as long as such practices are not used to launch an attack under the cover of protected status; according to Article 4 of the Third Geneva Convention the absence of any fixed distinctive sign recognizable at a distance merely leads to the loss of combatant status and the corresponding privileges. Still, despite its legality such a practice will, if employed as a matter of strategy, create considerable uncertainty about a person’s status and thus subtly erode the effectiveness of the fundamental and, in the words of the International Court of Justice (ICJ), intransgressible principle of distinction. Evidently the notion of distinction, that is, the legally prescribed invulnerability of certain persons and objects, can if manipulated offer manifold loopholes for the evasion of attack.22 The dividing line between legal tactics and illegitimate practices is easily crossed. The misuse of protective emblems for the concealment of military objects is a case in point, and the marking of the Ba’ath Party building in Basra with the ICRC emblem is a flagrant example of such tactics.23 To protect military objects whose nature could not be so readily concealed, weaker warring parties have repeatedly utilized the proportionality barrier: in order to manipulate the adversary’s proportionality equation, immobile military objects are shielded by civilians, while mobile military equipment is intentionally sited close to civilian installations or other specifically protected locations. For example, in the recent conflict in the Middle East Hezbollah hid its rockets and military equipment in civilian neighbourhoods, and UN UnderSecretary-General Jan Egeland’s statement clearly points to the vicious circle that might be triggered by such a practice.24 Similar modes of conduct have been employed with regard to offensive tactics. The reported seizure of ambulance vehicles in order to feign protected status and thus improve the chances of attacking is a typical example, as is the fact that during the battle of Fallujah in November 2004 sixty of the city’s one hundred mosques were reportedly used as bases for military operations.25 It should be noted that, besides violating the principle of distinction, creating the false impression of legal entitlement to immunity from attack and exploiting the enemy’s confidence in that status also amount to perfidy and are prohibited as such.26 Not each and every strategy employed to circumvent superior military power by cunning, surprise, indirect approach or ruthlessness automatically constitutes prohibited conduct; it may, depending on the circumstances, amount to no more than good tactics. However, if unable to identify any military weaknesses of a superior enemy, the weaker opponent may ultimately see no other alternative than to aim for the stronger state’s soft underbelly and attack civilians or civilian objects directly, in outright violation of the principle of distinction. The series of terrorist attacks in the aftermath of 9/11, that is, the attacks in Bali, Mombasa and Djerba in 2002, Riyadh and Casablanca in 2003, Madrid in 2004, London and Cairo in 2005 and Mumbai in 2006– to mention only those which have received the greatest media attention– and the constant attacks in Afghanistan and Iraq, shows that this tendency is increasing. Avoiding the risks of attacking well-protected military installations, it enables the weaker opponent to wage an offensive war on the television screens and in the homes of the stronger state and to benefit from the repercussive effects of mass media coverage.27 The principle of proportionality Over time there is a considerable risk that in view of the aforesaid practices, international humanitarian law itself, with its clear-cut categorizations and differentiations between military and civil, may be perceived by a belligerent confronted with repeated violations by its opponent as opening the doors to a kind of war which intentionally does away with such clear demarcations.28 However, the more immediate risk is that the adversary, faced with such a misuse of the principle of distinction, could feel compelled gradually to lower the proportionality barrier. Evidently, if the use of human shields or the concealment of military equipment among civilian facilities occurs only sporadically and at random in an armed conflict, humanitarian concerns are likely to outweigh the necessity to attack using disproportionate force, whereas if such tactics are systematically employed for a strategic purpose, the enemy may feel a compelling and overriding necessity to attack irrespective of the anticipated civilian casualties and damage. Indeed, the explanation given by the Israeli government for the mounting number of civilian casualties in its recent military operations against Hezbollah in Lebanon29 confirms that systematic violation of, for example, the principle of distinction by one side during a conflict is likely adversely to affect the other side’s interpretation and application of the proportionality principle. Military necessity in asymmetric conflicts Although the concept of military necessity is invoked now and then as a separate justification for violations of the laws of war, today there can be no doubt that in contemporary international humanitarian law the element of military necessity must be balanced against the principle of humanity, and that there is no such elasticity in the laws of war that military necessity can be claimed as a reason to deviate from accepted humanitarian standards. Nevertheless, asymmetric conflict arguably entails a certain risk of the emergence of a modern-day Kriegsrason because obstacles seen as insurmountable could make both sides feel inclined and ultimately compelled vastly to expand their perception of what is necessary to overcome the enemy. Since military necessity is a component of the ius in bello equation of proportionality, to expand or overemphasize the concept of military necessity would impair the protective scope of the proportionality principle.33 The principle of military necessity is closely linked to the objectives of war. However, the objectives sought in asymmetric conflicts vary significantly from those sought in the kind of symmetric conflict constellations which the drafting fathers of the principle of military necessity had in mind. Modern authorities on the laws of war continue to refer to the definition of military necessity laid down in Article 14 of the Lieber Code, according to which ‘‘Military necessity, as understood by modern civilized nations, consists in the necessity of those measures which are indispensable for securing the ends of the war, and which are lawful according to the modern law and usages of war.’’ In view of the formulation ‘‘indispensable for securing the ends of war’’, the principle of military necessity is commonly understood to justify only that degree of force necessary to secure military defeat and the prompt submission of the enemy.37 Indeed, the Declaration of St Petersburg states as early as 1868 that ‘‘the only legitimate object which States should endeavour to accomplish during war is to weaken the military forces of the enemy’’38 and the US Army Field Manual stipulates that ‘‘The law of war … requires that belligerents refrain from employing any kind or degree of violence which is not actually necessary for military purposes’’ and defines military necessity as ‘‘that principle which justifies those measures not forbidden by international law which are indispensable for the complete submission of the enemy as soon as possible’’. Historically, the rather strict alignment of the concept of military necessity with exclusively military objectives, that is, military defeat and the prompt military submission of the enemy, is due to the fact that the concept was originally designed to restrain violence in war. Although sometimes overlooked today, restrictions on violence in war do not merely stem from balancing the principle of military necessity against the principle of humanity.41 The principle of military necessity in and of itself constitutes an important restrictive factor by prescribing that to be legitimate, violence in war first of all has to be militarily necessary.42 A gradual, clandestine widening of this concept, or simply a more lenient understanding of the factors that determine military necessity and hence the notion of military advantage, would therefore undermine the restrictive standards imposed on the use of violence in armed conflicts. Such a process seems particularly likely in view of asymmetric constellations which, owing to their complexity and intangibility, escape any military apprehension stricto sensu. For example, application of the rule of proportionality as laid down in Articles 51 and 57 of Additional Protocol I is significantly affected, even in traditional armed conflicts, by whether the notion of military advantage is understood to mean the advantage anticipated from an attack considered as a whole or merely from isolated or particular parts of the attack.43 In asymmetric constellations that elude both temporal and spatial boundaries– in other words, the traditional concept of the ‘‘battlefield’’ altogether– it would seem somewhat difficult to delineate and determine with any degree of precision what is meant by the notion of ‘‘an attack considered as a whole’’.44 More generally, as the asymmetry between belligerents increases, the distinction between political and military objectives and necessities becomes more and more blurred. Especially in conflicts such as those against al Qaeda or Hezbollah, that is, conflicts between a state or group of states and a non-state entity, that entity’s ultimate aim in using military force will be to exert pressure on the politics of the enemy rather than even attempt to achieve the latter’s military submission. Conversely, the superior party is likely to adopt a far more holistic approach, inseparably combining political and military efforts to bring about the entire political eradication or dissolution of the enemy and not just the enemy’s military submission– especially if it is battling against a non-state entity it categorizes as a terrorist organization.45 To be sure, the separation of military and political aims already present in traditional warfare has always been axiomatic to some extent, given that each and every military operation emanates from both military and political motivations.46 The so-called Christmas bombing of North Vietnam in 1972 is a typical example: even though solely military objectives within the definition thereof were targeted, its purpose was to induce the North Vietnamese government to proceed with political negotiations. Nonetheless, symmetric warfare with its identifiable battlefields in terms of space and duration did allow, at least in theory, a relatively clear separation of military and political necessities and objectives in the actual conduct of warfare. In asymmetric scenarios, however, the weaker adversary is militarily outmatched from the start, military superiority in itself is no longer a reliable guarantee for winning such conflicts and the very notions of ‘‘victory’’ or ‘‘defeat’’ thus become more and more indistinct. If these parameters remain undefined or even indefinable, straightforward determinations of what is militarily necessary are impeded. Military necessities have always been subject to change as warfare has developed, and the concept of military necessity has been flexible enough to adapt accordingly as long as that development largely resulted from technological advances in weaponry. Yet it seems doubtful whether asymmetric constellations akin to law enforcement patterns could still be grasped by and measured against the concept of military necessity,48 for the complexities and intangibility of such scenarios escape its traditionally narrow delimitations. To compromise the concept’s very narrowness, however, would mean compromising long-achieved humanitarian protections that flow directly from the concept itself and could shift the focus of the proportionality equation away from humanitarian considerations and towards military necessities.","You can only respond to the prompt using information in the context block. Discuss the concept of military necessity as outlined in this article and its relationship to contemporary asymmetric conflict. Abstract Inequality in arms, indeed, significant disparity between belligerents, has become a prominent feature of various contemporary armed conflicts. Such asymmetries, albeit not at all a new phenomenon in the field of warfare, no longer constitute a random occurrence of singular battles. As a structural characteristic of modern-day warfare asymmetric conflict structures have repercussions on the application of fundamental principles of international humanitarian law. How, for example, can the concept of military necessity, commonly understood to justify the degree of force necessary to secure military defeat of the enemy, be reconciled with a constellation in which one side in the conflict is from the outset bereft of any chance of winning the conflict militarily? Moreover, military imbalances of this scope evidently carry incentives for the inferior party to level out its inferiority by circumventing accepted rules of warfare. This article attempts tentatively to assess the repercussions this could have on the principle of reciprocity, especially the risk of the instigation of a destabilizing dynamic of negative reciprocity which ultimately could lead to a gradual intensification of a mutual disregard of international humanitarian law. Introduction With only one remaining superpower and more generally the considerable and predictably widening technological divide, an imbalance in the military capacity of warring parties has become a characteristic feature of contemporary armed conflicts. Coupled with a growing involvement of non-state entities, the disparity between belligerents is steadily increasing, and various contemporary armed conflicts appear to be more and more asymmetric in structure. Unlike the geostrategic set-up that prevailed throughout the cold war period, it is a widely perceived paradox of today’s strategic environment that military superiority may actually accentuate the threat of nuclear, biological, chemical and, generally speaking, perfidious attack. Indeed, direct attacks against civilians, hostage-taking and the use of human shields – practices that have long been outlawed in armed conflicts– have seen a revival in recent conflicts in which the far weaker party has often sought to gain a comparative advantage over the militarily superior enemy by resorting to such practices as a matter of strategy. International terrorism, although not necessarily conducted within the context of an armed conflict triggering the application of international humanitarian law (IHL), is often regarded as the epitome of such asymmetry. At the same time militarily superior parties at the other end of the spectrum have had recourse to indiscriminate attacks, illegal interrogation practices and renditions, as well as legally dubious practices such as targeted killings or hardly reviewable covert operations, in order to strike at their frequently amorphous enemy. Significant inequality of arms, that is a disparate distribution of military strength and technological capability in a given conflict, seemingly creates incentives for adversaries to resort to means and methods of warfare that undermine and are sometimes an outright violation of long-accepted standards of international humanitarian law. The war between the US-led Coalition and Iraq or the war in Afghanistan are clear examples. This tendency is reinforced if belligerents differ in nature, as in the recent conflict between Israel and Hezbollah (‘‘party of God’’)– the Lebanon-based Shia Islamic militia and political organization– or if factual asymmetries are combined with a legal asymmetry, that is in a constellation in which one side is accorded little or no legal standing. To be sure, perfect symmetries have rarely been present in war. However, the patterns of non-compliance displayed in various contemporary conflicts seem to be more structured and systematic than ever before. The present study first seeks to verify this assumption. It considers whether factual and potentially legal asymmetries do indeed constitute an incentive for breaches of international humanitarian law provisions, and, if so, how patterns of contemporary conflicts differ from those of previous conflicts that likewise exhibited discernible asymmetries. In a second step, closer scrutiny is given to the actual patterns of non-compliance in asymmetric scenarios, particularly in the light of the interplay of the principle of distinction and the principle of proportionality. Neither the term ‘‘asymmetric warfare’’ nor the sometimes synonymously employed terms ‘‘fourth-generation warfare’’ or ‘‘non-linear war’’ have thus far been concordantly defined.3 It is not the intention of this study to venture into this perhaps impenetrable terrain. Analysis shows, however, that there is a noticeable tendency in contemporary conflicts towards an increasing inequality between belligerents in terms of weaponry. While this is a long-known phenomenon in non-international armed conflicts, evaluation of the effects of military disparity in international armed conflicts continues, as does the debate over the extent to which transnational conflicts involving states and non-state entities should be subject to the laws of war. In attempting to approach this debate from a somewhat different angle, it is the overall purpose of this study to gauge the long-term repercussions that asymmetric conflict structures may have on the fundamental principles of international humanitarian law and thereby tentatively to assess the degree of asymmetry– that is, the level of military disparity between belligerents– that can still be reconciled with the legal regime applicable in times of war.5 To this end the study, in a third step, weighs the traditional concept of military necessity as laid down in the Lieber Code of 1863 against the promulgated necessities in asymmetric conflicts of our time. Even though the fundamental concepts and principles of the laws of war have been designed as prophylactic mechanisms flexible enough to outlast changes in the way in which wars are waged, it is here contended that the concept of military necessity and the principle of distinction presuppose a minimum degree of symmetry and therefore cannot be applied in subordinative constellations akin to human rights patterns, as are commonly seen in the fight against international terrorism. The vantage point for the fourth and final part of the analysis is the principle of reciprocity. As the military mismatch between conflicting parties in numerous modern armed conflicts becomes more marked, the balancing influence of the reciprocity entailed by the traditional concept of symmetric warfare is gradually being undermined.6 While the deterrent effects of an increasingly effective system of international criminal law and of media coverage and public opinion– although the last two are ambivalent factors that could also be used for the opposite purpose– could arguably help to contain non-compliant behaviour in war, international humanitarian law might thus be simultaneously bereft of its own inherent regulating mechanisms which have traditionally taken effect in the combat zone itself. The destabilizing dynamic of reciprocity could lead to a gradual and perhaps insidious erosion of the protective scope of core principles of international humanitarian law. Repeated violations of, for example, the principle of distinction by one party to a conflict are likely to induce the other side to expand its perception of what is militarily necessary, and hence proportional, when engaging in battle against such an enemy. In the final stage, and admittedly only as a worst-case scenario, an intentional and deceitful deviation from accepted standards regulating the conduct of hostilities carries the considerable risk of starting a vicious circle of ever greater negative reciprocity, in which the expectations of the warring parties are transformed into an escalating mutual noncompliance with international humanitarian law. A heightened risk of structural non-compliance? Historically, the majority of laws on international armed conflict have been designed on the basis of Clausewitz’s arguably rather Eurocentric conception of war, that is, the assumption of symmetric conflicts taking place between state armies of roughly equal military strength or at least comparable organizational structures. Throughout most of the nineteenth and twentieth centuries the dominant powers engaged in sustained arms races either to maintain a peace ensuring symmetry or to establish a tactical asymmetry vis-a `-vis their opponents as a guarantee of military victory in war.7 But quite apart from the biblical story of David and Goliath it is evident that asymmetry in the sense of military disparity is no new phenomenon.8 Nor is it a concept entirely alien to IHL. With the intrinsic disparity of the parties concerned, and even though the threshold criteria of Article 1 of Additional Protocol II to the 1949 Geneva Conventions arguably help to ensure a minimum degree of comparability between those parties, non-international armed conflicts are inherently asymmetric. It was moreover already accepted in the classic concept of symmetric warfare that the structure of conflicts could shift from symmetric to asymmetric, for by the time a conflict drew to its close and one party had gained the upper hand, the initial military balance would be out of kilter. More recently, during the Diplomatic Conference that led to the adoption of Additional Protocol I, states taking part not only acknowledged the persistence of significant disparities in military capacity but accepted that factual disparity between opponents may even lead to differing humanitarian law obligations. For example, with respect to Article 57 of Additional Protocol I on the obligation to take precautions in attack,9 the Indian delegation pointed out that according to the chosen wording the content of the due diligence obligation enshrined therein– that is, the precise identification of objectives as military or civilian– largely depended on the technical means of detection available to the belligerents.10 Despite these concerns, the present wording was accepted on the implicit understanding that because of prevailing factual disparities, international humanitarian law obligations may impose differing burdens in practice.11 Schwarzenberger has pointed out that the protective scope of the laws of war has historically been the strongest in duel-type wars between comparable belligerents that were fought for limited purposes, such as the Crimean War of 1853–6 or the Franco-German War of 1870–1, whereas in major wars such as the Napoleonic wars or the two world wars of the twentieth century– wars that were fought to the bitter end– the weaker side often tended to seek short-term advantages by violating the laws of war.12 Indeed, violations of the laws of war have occurred in nearly every case in which IHL has been applicable,13 and the risk that one party may order or connive in large-scale violations of the laws of war in order to gain a tempting advantage or stave off in some way an otherwise threatening defeat has always hovered over the legal regime intended to regulate conduct in armed conflicts.14 However, in symmetric constellations such instances have tended to remain marginal, often limited to the final stages of a war and confined to individual battles in which defeat seemed inevitable, or resort to perfidy or similarly prohibited tactics was perceived as guaranteeing an immediate tactical breakthrough in what was otherwise a military stalemate. As a result of the evident disparate military capabilities of opponents in certain contemporary conflicts, incentives for violations of IHL seem in comparison to have reached a new height. Non-compliance with the provisions of IHL is no longer a random event, confined to temporally and spatially limited incidents within a conflict, but has become a recurrent structural feature that characterizes many of today’s armed conflicts from the outset. The reason is that, faced with an enemy of overwhelming technological superiority, the weaker party ab initio has no chance of winning the war militarily. Figures from the recent war against Iraq illustrate this imbalance of power and capacity quite well. While the Iraqi air force reportedly never left the ground, Coalition forces flew rather more than 20,000 sorties, during which only one fixed-wing aircraft and only seven aircraft in all were lost to hostile fire.15 Evidence of a comparable inequality in the military capability of belligerents will probably become available in the aftermath of the recent conflict in Lebanon. Without anticipating the more detailed analysis below, it should be noted that the Iraqi army’s widespread infringements during the international conflict against the US-led Coalition, as well as Hezbollah’s indiscriminate attacks, stem to a significant extent from the blatant inequality in weaponry. Practices employed by the Iraqi army included recourse to human shields, abuse of the red cross and red crescent emblems, the use of anti-personnel mines and the placing of military objects in protected areas such as mosques and hospitals. Clearly, there is thus an elevated risk that the militarily inferior party, unable to identify any military weaknesses of its superior opponent, may feel compelled systematically to offset the enemy’s superiority by resorting to means and methods of warfare outside the realm of international humanitarian law. At the same time the use of ‘‘unthinkable’’ tactics as well as the tactical circumvention of accepted IHL standards creates a barrier that cannot be readily overcome by military superiority alone. Apart from the ongoing hostilities in Iraq, the tactics employed by the Somali tribal leader Farah Aydid in 1993 are a good example of this. In conventional terms, his forces were no match for heavily armed and technologically sophisticated airborne US troops. However, by using primitive weapons and communication systems– which reportedly varied from cellular phones to tribal drums– and by resorting to ‘‘unthinkable’’ tactics and to ‘‘barbaric’’ acts perpetrated for the benefit of the news media, the militia convinced the leadership of the United States that despite the military backwardness of the Somali forces the price of involvement in Somalia was very high. In the course of the war against Iraq the use of cluster munitions in populated areas, as well as the alleged use of white phosphorus and the continued recourse by US and British forces to ‘‘decapitation’’ strikes that caused high numbers of civilian casualties, partly constituted indiscriminate attacks and arguably a failure to take ‘‘all feasible precautions’’ as required by IHL. There are thus apparent incentives for both sides to give increasing priority, potentially to the detriment of humanitarian considerations, to the necessities of such a kind of warfare. Patterns of non-compliance: the interplay between the principle of distinction and the principle of proportionality Recent conflict patterns suggest that militarily inferior parties, in order to evade attack by an enemy of insurmountable superiority or to level out inequalities in military power, tend in particular to instrumentalize and intentionally manipulate the principle of distinction. This manipulation may occur in different ways.18 Similarly, superior parties are likely to lower the barrier of proportionality in response to a systematic misuse of the principle of distinction and their resulting inability to tackle the enemy effectively. The following description of potential strategies that belligerents may feel compelled to adopt when faced with overwhelming odds or systematic deviations from accepted legal rules is merely intended to facilitate understanding of likely patterns of non-compliance and does not claim to be comprehensive. It is part of the very nature of asymmetric strategies that they are impossible to predict. The principle of distinction As a defensive strategy when facing a technologically superior enemy it is essential, but ever more difficult, to stay out of reach and conceal one’s presence as a combatant. Hiding in mountainous areas, caves, underground facilities and tunnels is one way. However, another means of doing so quickly and efficiently is readily available by virtue of the provisions of IHL themselves. In view of the various forms of protection accorded to civilians, assuming civilian guise is an easy way to evade the enemy and, unlike the more traditional guerrilla-style tactics of hiding underground or in inaccessible areas, it cannot be countered by the development of advanced discovery technologies. Indeed, in order to keep Coalition forces from identifying them as enemies, that is as legitimate targets, many Iraqi soldiers in the recent war reportedly quite often discarded their uniforms. This is not a prohibited tactic, as long as such practices are not used to launch an attack under the cover of protected status; according to Article 4 of the Third Geneva Convention the absence of any fixed distinctive sign recognizable at a distance merely leads to the loss of combatant status and the corresponding privileges. Still, despite its legality such a practice will, if employed as a matter of strategy, create considerable uncertainty about a person’s status and thus subtly erode the effectiveness of the fundamental and, in the words of the International Court of Justice (ICJ), intransgressible principle of distinction. Evidently the notion of distinction, that is, the legally prescribed invulnerability of certain persons and objects, can if manipulated offer manifold loopholes for the evasion of attack.22 The dividing line between legal tactics and illegitimate practices is easily crossed. The misuse of protective emblems for the concealment of military objects is a case in point, and the marking of the Ba’ath Party building in Basra with the ICRC emblem is a flagrant example of such tactics.23 To protect military objects whose nature could not be so readily concealed, weaker warring parties have repeatedly utilized the proportionality barrier: in order to manipulate the adversary’s proportionality equation, immobile military objects are shielded by civilians, while mobile military equipment is intentionally sited close to civilian installations or other specifically protected locations. For example, in the recent conflict in the Middle East Hezbollah hid its rockets and military equipment in civilian neighbourhoods, and UN UnderSecretary-General Jan Egeland’s statement clearly points to the vicious circle that might be triggered by such a practice.24 Similar modes of conduct have been employed with regard to offensive tactics. The reported seizure of ambulance vehicles in order to feign protected status and thus improve the chances of attacking is a typical example, as is the fact that during the battle of Fallujah in November 2004 sixty of the city’s one hundred mosques were reportedly used as bases for military operations.25 It should be noted that, besides violating the principle of distinction, creating the false impression of legal entitlement to immunity from attack and exploiting the enemy’s confidence in that status also amount to perfidy and are prohibited as such.26 Not each and every strategy employed to circumvent superior military power by cunning, surprise, indirect approach or ruthlessness automatically constitutes prohibited conduct; it may, depending on the circumstances, amount to no more than good tactics. However, if unable to identify any military weaknesses of a superior enemy, the weaker opponent may ultimately see no other alternative than to aim for the stronger state’s soft underbelly and attack civilians or civilian objects directly, in outright violation of the principle of distinction. The series of terrorist attacks in the aftermath of 9/11, that is, the attacks in Bali, Mombasa and Djerba in 2002, Riyadh and Casablanca in 2003, Madrid in 2004, London and Cairo in 2005 and Mumbai in 2006– to mention only those which have received the greatest media attention– and the constant attacks in Afghanistan and Iraq, shows that this tendency is increasing. Avoiding the risks of attacking well-protected military installations, it enables the weaker opponent to wage an offensive war on the television screens and in the homes of the stronger state and to benefit from the repercussive effects of mass media coverage.27 The principle of proportionality Over time there is a considerable risk that in view of the aforesaid practices, international humanitarian law itself, with its clear-cut categorizations and differentiations between military and civil, may be perceived by a belligerent confronted with repeated violations by its opponent as opening the doors to a kind of war which intentionally does away with such clear demarcations.28 However, the more immediate risk is that the adversary, faced with such a misuse of the principle of distinction, could feel compelled gradually to lower the proportionality barrier. Evidently, if the use of human shields or the concealment of military equipment among civilian facilities occurs only sporadically and at random in an armed conflict, humanitarian concerns are likely to outweigh the necessity to attack using disproportionate force, whereas if such tactics are systematically employed for a strategic purpose, the enemy may feel a compelling and overriding necessity to attack irrespective of the anticipated civilian casualties and damage. Indeed, the explanation given by the Israeli government for the mounting number of civilian casualties in its recent military operations against Hezbollah in Lebanon29 confirms that systematic violation of, for example, the principle of distinction by one side during a conflict is likely adversely to affect the other side’s interpretation and application of the proportionality principle. Military necessity in asymmetric conflicts Although the concept of military necessity is invoked now and then as a separate justification for violations of the laws of war, today there can be no doubt that in contemporary international humanitarian law the element of military necessity must be balanced against the principle of humanity, and that there is no such elasticity in the laws of war that military necessity can be claimed as a reason to deviate from accepted humanitarian standards. Nevertheless, asymmetric conflict arguably entails a certain risk of the emergence of a modern-day Kriegsrason because obstacles seen as insurmountable could make both sides feel inclined and ultimately compelled vastly to expand their perception of what is necessary to overcome the enemy. Since military necessity is a component of the ius in bello equation of proportionality, to expand or overemphasize the concept of military necessity would impair the protective scope of the proportionality principle.33 The principle of military necessity is closely linked to the objectives of war. However, the objectives sought in asymmetric conflicts vary significantly from those sought in the kind of symmetric conflict constellations which the drafting fathers of the principle of military necessity had in mind. Modern authorities on the laws of war continue to refer to the definition of military necessity laid down in Article 14 of the Lieber Code, according to which ‘‘Military necessity, as understood by modern civilized nations, consists in the necessity of those measures which are indispensable for securing the ends of the war, and which are lawful according to the modern law and usages of war.’’ In view of the formulation ‘‘indispensable for securing the ends of war’’, the principle of military necessity is commonly understood to justify only that degree of force necessary to secure military defeat and the prompt submission of the enemy.37 Indeed, the Declaration of St Petersburg states as early as 1868 that ‘‘the only legitimate object which States should endeavour to accomplish during war is to weaken the military forces of the enemy’’38 and the US Army Field Manual stipulates that ‘‘The law of war … requires that belligerents refrain from employing any kind or degree of violence which is not actually necessary for military purposes’’ and defines military necessity as ‘‘that principle which justifies those measures not forbidden by international law which are indispensable for the complete submission of the enemy as soon as possible’’. Historically, the rather strict alignment of the concept of military necessity with exclusively military objectives, that is, military defeat and the prompt military submission of the enemy, is due to the fact that the concept was originally designed to restrain violence in war. Although sometimes overlooked today, restrictions on violence in war do not merely stem from balancing the principle of military necessity against the principle of humanity.41 The principle of military necessity in and of itself constitutes an important restrictive factor by prescribing that to be legitimate, violence in war first of all has to be militarily necessary.42 A gradual, clandestine widening of this concept, or simply a more lenient understanding of the factors that determine military necessity and hence the notion of military advantage, would therefore undermine the restrictive standards imposed on the use of violence in armed conflicts. Such a process seems particularly likely in view of asymmetric constellations which, owing to their complexity and intangibility, escape any military apprehension stricto sensu. For example, application of the rule of proportionality as laid down in Articles 51 and 57 of Additional Protocol I is significantly affected, even in traditional armed conflicts, by whether the notion of military advantage is understood to mean the advantage anticipated from an attack considered as a whole or merely from isolated or particular parts of the attack.43 In asymmetric constellations that elude both temporal and spatial boundaries– in other words, the traditional concept of the ‘‘battlefield’’ altogether– it would seem somewhat difficult to delineate and determine with any degree of precision what is meant by the notion of ‘‘an attack considered as a whole’’.44 More generally, as the asymmetry between belligerents increases, the distinction between political and military objectives and necessities becomes more and more blurred. Especially in conflicts such as those against al Qaeda or Hezbollah, that is, conflicts between a state or group of states and a non-state entity, that entity’s ultimate aim in using military force will be to exert pressure on the politics of the enemy rather than even attempt to achieve the latter’s military submission. Conversely, the superior party is likely to adopt a far more holistic approach, inseparably combining political and military efforts to bring about the entire political eradication or dissolution of the enemy and not just the enemy’s military submission– especially if it is battling against a non-state entity it categorizes as a terrorist organization.45 To be sure, the separation of military and political aims already present in traditional warfare has always been axiomatic to some extent, given that each and every military operation emanates from both military and political motivations.46 The so-called Christmas bombing of North Vietnam in 1972 is a typical example: even though solely military objectives within the definition thereof were targeted, its purpose was to induce the North Vietnamese government to proceed with political negotiations. Nonetheless, symmetric warfare with its identifiable battlefields in terms of space and duration did allow, at least in theory, a relatively clear separation of military and political necessities and objectives in the actual conduct of warfare. In asymmetric scenarios, however, the weaker adversary is militarily outmatched from the start, military superiority in itself is no longer a reliable guarantee for winning such conflicts and the very notions of ‘‘victory’’ or ‘‘defeat’’ thus become more and more indistinct. If these parameters remain undefined or even indefinable, straightforward determinations of what is militarily necessary are impeded. Military necessities have always been subject to change as warfare has developed, and the concept of military necessity has been flexible enough to adapt accordingly as long as that development largely resulted from technological advances in weaponry. Yet it seems doubtful whether asymmetric constellations akin to law enforcement patterns could still be grasped by and measured against the concept of military necessity,48 for the complexities and intangibility of such scenarios escape its traditionally narrow delimitations. To compromise the concept’s very narrowness, however, would mean compromising long-achieved humanitarian protections that flow directly from the concept itself and could shift the focus of the proportionality equation away from humanitarian considerations and towards military necessities.",Unknown,Effect Analysis,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Please summarize this article about new a eczema treatment. I would like bullet points with the important key features of the treatment. Include details about the researched probiotic and what it does for the skin. Keep the answer under 500 words/,"NIAID research has led to the availability of a new over-the-counter topical eczema probiotic. The probiotic is based on the discovery by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, that bacteria present on healthy skin called Roseomonas mucosa can safely relieve eczema symptoms in adults and children. R. mucosa-based topical interventions could simplify or complement current eczema management, when used in consultation with an individual's healthcare provider. A milestone for eczema sufferers, the availability of an R. mucosa-based probiotic is the result of seven years of scientific discovery and research in NIAID's Laboratory of Clinical Immunology and Microbiology (LCIM). Eczema-;also known as atopic dermatitis-;is a chronic inflammatory skin condition that affects approximately 20% of children and 10% of adults worldwide. The condition is characterized by dry, itchy skin that can compromise the skin's barrier, which functions to retain moisture and keep out allergens. This can make people with eczema more vulnerable to bacterial, viral and fungal skin infections. R. mucosa is a commensal bacterium, meaning it occurs naturally as part of a typical skin microbiome. Individuals with eczema experience imbalances in the microbiome and are deficient in certain skin lipids (oils). NIAID researchers demonstrated that R. mucosa can help restore those lipids. Scientists led by Ian Myles, M.D., M.P.H., chief of the LCIM Epithelial Research Unit, found specific strains of R. mucosa reduced eczema-related skin inflammation and enhanced the skin's natural barrier function in both adults and children. To arrive at this finding, Dr. Myles and colleagues spearheaded a spectrum of translational research on R. mucosa. They isolated and cultured R. mucosa in the laboratory, conducted preclinical (laboratory/animal) and clinical (human) studies, and made the bacteria available for commercial, non-therapeutic development. The R. mucosa-based probiotic released this week is formulated by Skinesa and called Defensin. In Phase 1/2 open-label and Phase 2 blinded, placebo-controlled clinical studies, most people experienced greater than 75% improvement in eczema severity following application of R. mucosa. Improvement was seen on all treated skin sites, including the inner elbows, inner knees, hands, trunk and neck. The researchers also observed improvement in skin barrier function. Additionally, most participants needed fewer corticosteroids to manage their eczema, experienced less itching, and reported a better quality of life following R. mucosa therapy. These benefits persisted after treatment ended: therapeutic R. mucosa strains remained on the skin for up to eight months in study participants who were observed for that duration. eBook: How to Implement Colony Picking Workflows eBook This eBook aims to assist scientists in selecting the most suitable automated colony-picking solution, taking into account the requirements for high throughput, various applications, and key challenges of the process. Download the latest edition To expand the potential use of R. mucosa, NIAID will conduct an additional clinical trial to generate further evidence on its efficacy in reducing eczema symptoms. Those data could form the basis of an application to the Food and Drug Administration to enable the product to be regulated as a nonprescription drug and made accessible to a broader population of people with eczema. Study results are expected in 2024. Source:","""================ ======= NIAID research has led to the availability of a new over-the-counter topical eczema probiotic. The probiotic is based on the discovery by scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, that bacteria present on healthy skin called Roseomonas mucosa can safely relieve eczema symptoms in adults and children. R. mucosa-based topical interventions could simplify or complement current eczema management, when used in consultation with an individual's healthcare provider. A milestone for eczema sufferers, the availability of an R. mucosa-based probiotic is the result of seven years of scientific discovery and research in NIAID's Laboratory of Clinical Immunology and Microbiology (LCIM). Eczema-;also known as atopic dermatitis-;is a chronic inflammatory skin condition that affects approximately 20% of children and 10% of adults worldwide. The condition is characterized by dry, itchy skin that can compromise the skin's barrier, which functions to retain moisture and keep out allergens. This can make people with eczema more vulnerable to bacterial, viral and fungal skin infections. R. mucosa is a commensal bacterium, meaning it occurs naturally as part of a typical skin microbiome. Individuals with eczema experience imbalances in the microbiome and are deficient in certain skin lipids (oils). NIAID researchers demonstrated that R. mucosa can help restore those lipids. Scientists led by Ian Myles, M.D., M.P.H., chief of the LCIM Epithelial Research Unit, found specific strains of R. mucosa reduced eczema-related skin inflammation and enhanced the skin's natural barrier function in both adults and children. To arrive at this finding, Dr. Myles and colleagues spearheaded a spectrum of translational research on R. mucosa. They isolated and cultured R. mucosa in the laboratory, conducted preclinical (laboratory/animal) and clinical (human) studies, and made the bacteria available for commercial, non-therapeutic development. The R. mucosa-based probiotic released this week is formulated by Skinesa and called Defensin. In Phase 1/2 open-label and Phase 2 blinded, placebo-controlled clinical studies, most people experienced greater than 75% improvement in eczema severity following application of R. mucosa. Improvement was seen on all treated skin sites, including the inner elbows, inner knees, hands, trunk and neck. The researchers also observed improvement in skin barrier function. Additionally, most participants needed fewer corticosteroids to manage their eczema, experienced less itching, and reported a better quality of life following R. mucosa therapy. These benefits persisted after treatment ended: therapeutic R. mucosa strains remained on the skin for up to eight months in study participants who were observed for that duration. eBook: How to Implement Colony Picking Workflows eBook This eBook aims to assist scientists in selecting the most suitable automated colony-picking solution, taking into account the requirements for high throughput, various applications, and key challenges of the process. Download the latest edition To expand the potential use of R. mucosa, NIAID will conduct an additional clinical trial to generate further evidence on its efficacy in reducing eczema symptoms. Those data could form the basis of an application to the Food and Drug Administration to enable the product to be regulated as a nonprescription drug and made accessible to a broader population of people with eczema. Study results are expected in 2024. Source: https://www.news-medical.net/news/20240626/NIAID-scientists-discover-probiotic-treatment-for-eczema.aspx ================ ======= Please summarize this article about new a eczema treatment. I would like bullet points with the important key features of the treatment. Include details about the researched probiotic and what it does for the skin. Keep the answer under 500 words/ ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Summarize & Format,Text Transformation "Only use the information provided to you in the prompt, NEVER use external resources or prior knowledge. Responses should be exactly two paragraphs in length. If you don't know something because it's not provided in the document, say ""Don't know - information not found."" Bullet points or sentence fragments should never be used unless specifically requested. Focus on common-sense, obvious conclusions with specific factual support from the prompt.","My patient, patient X, has a 3,000 kilocalorie per day diet. I deem the kilocalorie intake to be healthy, due to his profession of blacksmith, however I am concerned that he may not be following the most up-to-date guidelines issued by the federal Dietary Guidelines Advisory Committee. Here is his current weekly diet: 1 kilogram bacon 2 dozen eggs 500 g butter 500 g lard 4 kilograms cheese, assorted 7 carrots 1/2 kilogram spinach 2 kilograms roast beef 1 baguette (large) 1/2 kilogram mushrooms 3 extra-sweet vidalia onions 4 liters organic sulfite-free red wine 1 free-range chicken assorted sauces, gravies, and condiments Detailed analysis shows that patient X consumes 300 calories, which is 10% of his daily total, of added sugars per day from all sources. To what extent is Patient X's diet aligned with the DGAC policy recommendations referenced in the included document? ","Which Key Issues Were Raised by Stakeholders with the 2015 DGAC’s Report? The DGAC’s report addressed many issues of concern to public health, nutrition, and agricultural stakeholders. HHS and USDA received over 29,000 written comments during the 75-day comment period, as well as 73 oral comments at a March 2015 public meeting.25 Stakeholders flagged several issues with the 2015 DGAC’s report, particularly with the scope of the DGAC’s recommendations, the process by which the DGAC made its conclusions and recommendations, and concerns over several specific recommendations.26 Scope One concern noted by stakeholders with the DGAC’s report was its scope, with some maintaining that the committee exceeded the scope of its charter by making certain policy recommendations. For example, although the 2015 DGAC’s report noted that no food groups need to be entirely eliminated to improve food sustainability outcomes, the DGAC concluded that individuals should eat less red and processed meat in favor of a plant-based diet, as “a diet higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in calories and animal-based foods is more health promoting and is associated with less environmental impact than is the current U.S. diet.” The DGAC added that due to high consumption of animal-based foods (e.g., meat, eggs, and dairy products) and low intake of plant-based foods, the average U.S. diet may have a large impact on the environment in terms of increased Greenhouse Gas (GHG) emissions, land use, water use, and energy use. In addition, the DGAC made several policy recommendations that raised concern among some stakeholders, including FDA revision of the Nutrition Facts label to include a mandatory declaration for added sugars, in both grams and teaspoons per serving, as well as a % daily value (DV);27 alignment of federal nutrition assistance programs (e.g., SNAP and WIC) with the DGA; and use of economic and tax policies to encourage the production and consumption of healthy foods and to reduce consumption of unhealthy foods (e.g., by taxing sugar-sweetened beverages, snack foods, and desserts, and by restricting marketing of certain foods to children and teens).28 Some Members of Congress have said that the DGAC “had neither the expertise, evidence, nor charter” to make recommendations about matters of sustainability and tax policy,29 and this 24 Scientific Report of the 2015 Dietary Guidelines Advisory Committee, February 19, 2015, see http://www.health.gov/ dietaryguidelines/. 25 Testimony of Secretary of USDA Tom Vilsack, October 7, 2015, Committee on Agriculture Hearing, U.S. House of Representatives. 26 Please note that this is not an exhaustive list of all the concerns surrounding the DGAC report. 27 Per FDA’s proposed supplemental rule, this %DV would be based on the recommendation that the daily intake of calories from added sugars not exceed 10% of total calories. For a 2,000 calorie diet, 10% would equate to approximately 50 grams of added sugar per day (10% of 2,000 equals 200 calories from added sugar; there are 4 calories per gram of sugar, so 200 calories divided by 4 equals 50 grams of added sugar per day). 28 Scientific Report of the 2015 DGAC, Part D: Chapter 6: Cross-Cutting Topics of Public Health Importance; see http://health.gov/dietaryguidelines/2015-scientific-report/pdfs/scientific-report-of-the-2015-dietary-guidelinesadvisory-committee.pdf. 29 Letter from various Members of Congress to Secretaries Vilsack and Burwell, March 31, 2015; see concern has been reiterated by some meat industry groups.30 Meanwhile, others have supported the discussion surrounding sustainability, saying that it is important to have an understanding of how food production affects the environment.31 In response to these concerns, the HHS and USDA Secretaries determined that issues of sustainability and tax policy would not be part of the final policy document and that the DGA would “remain within the scope of our mandate in the 1990 National Nutrition Monitoring and Related Research Act (P.L. 101-445, NNMRRA), which is to provide ‘nutritional and dietary information and guidelines’ ... ‘based on the preponderance of the scientific and medical knowledge.’” 32 Process Another stakeholder concern with the 2015 DGAC’s report was the process used to evaluate the evidence. After the 2005 edition of the DGA, HHS and USDA committed to using an evidencebased, systematic review methodology (i.e., the NEL) to support the development of the 2010 DGAC report, and the same process was expected to be used in the development of the 2015 DGAC report. The 2015 DGAC used the NEL to answer approximately 27% of its questions, relying on existing sources of evidence (e.g., existing reports and systematic reviews) to answer another 45%, and data analyses and food pattern modeling analyses to answer an additional 30%. 33 This approach is in contrast to the 2010 DGAC, which used the NEL to answer the majority of its research questions.34 According to the 2015 DGAC, the majority of the scientific community now regularly uses systematic reviews, so unlike the 2010 DGAC, the 2015 DGAC was able to rely more heavily on existing sources of evidence (e.g., existing systematic reviews, meta-analyses, and reports) and to avoid duplicative efforts.35 Some criticized this use of existing reviews, questioning the scientific rigor and objectivity of the advisory report. For example, some argued that the 2015 DGAC bypassed the NEL process for certain issues (e.g., added sugars) and “almost solely used pre-existing and hand-picked http://agriculture.house.gov/uploadedfiles/ag_dietaryguidelineslettertosecsvilsackburwell.pdf. 30 National Cattleman’s Beef Association, NCBA Urges Secretaries to Reject Dietary Guidelines Advisory Committee’s Flawed Recommendations May 8, 2015; see http://www.beefusa.org/newsreleases1.aspx?newsid= 4912#sthash.gecc7dMk.dpuf. 31 A Aubrey, “New Dietary Guidelines Will not Include Sustainability Goal,” NPR, October 13, 2015; see http://www.npr.org/sections/thesalt/2015/10/06/446369955/new-dietary-guidelines-will-not-include-sustainability-goal. 32 Secretaries Vilsack and Burwell, “2015 Dietary Guidelines: Giving You the Tools You Need to Make Healthy Choices,” USDA blog, October 6, 2015; see http://blogs.usda.gov/2015/10/06/2015-dietary-guidelines-giving-you-thetools-you-need-to-make-healthy-choices/. 33 These numbers were taken directly from the Scientific Report of the 2015 DGAC, Part C: Methodology. They do not add up to 100% for reasons unknown to CRS, but one explanation may be that multiple sources were used to answer certain questions. 34 Report of the 2010 DGAC on the Dietary Guidelines for Americans, 2010, Part A: Executive Summary, page 1. 35 Scientific Report of the 2015 DGAC, Part C: Methodology; see http://health.gov/dietaryguidelines/2015-scientificreport/pdfs/scientific-report-of-the-2015-dietary-guidelines-advisory-committee.pdf.","System Instruction: Only use the information provided to you in the prompt, NEVER use external resources or prior knowledge. Responses should be exactly two paragraphs in length. If you don't know something because it's not provided in the document, say ""Don't know - information not found."" Bullet points or sentence fragments should never be used unless specifically requested. Focus on common-sense, obvious conclusions with specific factual support from the prompt. Question: My patient, patient X, has a 3,000 kilocalorie per day diet. I deem the kilocalorie intake to be healthy, due to his profession of blacksmith, however I am concerned that he may not be following the most up-to-date guidelines issued by the federal Dietary Guidelines Advisory Committee. Here is his current weekly diet: 1 kilogram bacon 2 dozen eggs 500 g butter 500 g lard 4 kilograms cheese, assorted 7 carrots 1/2 kilogram spinach 2 kilograms roast beef 1 baguette (large) 1/2 kilogram mushrooms 3 extra-sweet vidalia onions 4 liters organic sulfite-free red wine 1 free-range chicken assorted sauces, gravies, and condiments Detailed analysis shows that patient X consumes 300 calories, which is 10% of his daily total, of added sugars per day from all sources. To what extent is Patient X's diet aligned with the DGAC policy recommendations referenced in the included document? Context: Which Key Issues Were Raised by Stakeholders with the 2015 DGAC’s Report? The DGAC’s report addressed many issues of concern to public health, nutrition, and agricultural stakeholders. HHS and USDA received over 29,000 written comments during the 75-day comment period, as well as 73 oral comments at a March 2015 public meeting.25 Stakeholders flagged several issues with the 2015 DGAC’s report, particularly with the scope of the DGAC’s recommendations, the process by which the DGAC made its conclusions and recommendations, and concerns over several specific recommendations.26 Scope One concern noted by stakeholders with the DGAC’s report was its scope, with some maintaining that the committee exceeded the scope of its charter by making certain policy recommendations. For example, although the 2015 DGAC’s report noted that no food groups need to be entirely eliminated to improve food sustainability outcomes, the DGAC concluded that individuals should eat less red and processed meat in favor of a plant-based diet, as “a diet higher in plant-based foods, such as vegetables, fruits, whole grains, legumes, nuts, and seeds, and lower in calories and animal-based foods is more health promoting and is associated with less environmental impact than is the current U.S. diet.” The DGAC added that due to high consumption of animal-based foods (e.g., meat, eggs, and dairy products) and low intake of plant-based foods, the average U.S. diet may have a large impact on the environment in terms of increased Greenhouse Gas (GHG) emissions, land use, water use, and energy use. In addition, the DGAC made several policy recommendations that raised concern among some stakeholders, including FDA revision of the Nutrition Facts label to include a mandatory declaration for added sugars, in both grams and teaspoons per serving, as well as a % daily value (DV);27 alignment of federal nutrition assistance programs (e.g., SNAP and WIC) with the DGA; and use of economic and tax policies to encourage the production and consumption of healthy foods and to reduce consumption of unhealthy foods (e.g., by taxing sugar-sweetened beverages, snack foods, and desserts, and by restricting marketing of certain foods to children and teens).28 Some Members of Congress have said that the DGAC “had neither the expertise, evidence, nor charter” to make recommendations about matters of sustainability and tax policy,29 and this 24 Scientific Report of the 2015 Dietary Guidelines Advisory Committee, February 19, 2015, see http://www.health.gov/ dietaryguidelines/. 25 Testimony of Secretary of USDA Tom Vilsack, October 7, 2015, Committee on Agriculture Hearing, U.S. House of Representatives. 26 Please note that this is not an exhaustive list of all the concerns surrounding the DGAC report. 27 Per FDA’s proposed supplemental rule, this %DV would be based on the recommendation that the daily intake of calories from added sugars not exceed 10% of total calories. For a 2,000 calorie diet, 10% would equate to approximately 50 grams of added sugar per day (10% of 2,000 equals 200 calories from added sugar; there are 4 calories per gram of sugar, so 200 calories divided by 4 equals 50 grams of added sugar per day). 28 Scientific Report of the 2015 DGAC, Part D: Chapter 6: Cross-Cutting Topics of Public Health Importance; see http://health.gov/dietaryguidelines/2015-scientific-report/pdfs/scientific-report-of-the-2015-dietary-guidelinesadvisory-committee.pdf. 29 Letter from various Members of Congress to Secretaries Vilsack and Burwell, March 31, 2015; see concern has been reiterated by some meat industry groups.30 Meanwhile, others have supported the discussion surrounding sustainability, saying that it is important to have an understanding of how food production affects the environment.31 In response to these concerns, the HHS and USDA Secretaries determined that issues of sustainability and tax policy would not be part of the final policy document and that the DGA would “remain within the scope of our mandate in the 1990 National Nutrition Monitoring and Related Research Act (P.L. 101-445, NNMRRA), which is to provide ‘nutritional and dietary information and guidelines’ ... ‘based on the preponderance of the scientific and medical knowledge.’” 32 Process Another stakeholder concern with the 2015 DGAC’s report was the process used to evaluate the evidence. After the 2005 edition of the DGA, HHS and USDA committed to using an evidencebased, systematic review methodology (i.e., the NEL) to support the development of the 2010 DGAC report, and the same process was expected to be used in the development of the 2015 DGAC report. The 2015 DGAC used the NEL to answer approximately 27% of its questions, relying on existing sources of evidence (e.g., existing reports and systematic reviews) to answer another 45%, and data analyses and food pattern modeling analyses to answer an additional 30%. 33 This approach is in contrast to the 2010 DGAC, which used the NEL to answer the majority of its research questions.34 According to the 2015 DGAC, the majority of the scientific community now regularly uses systematic reviews, so unlike the 2010 DGAC, the 2015 DGAC was able to rely more heavily on existing sources of evidence (e.g., existing systematic reviews, meta-analyses, and reports) and to avoid duplicative efforts.35 Some criticized this use of existing reviews, questioning the scientific rigor and objectivity of the advisory report. For example, some argued that the 2015 DGAC bypassed the NEL process for certain issues (e.g., added sugars) and “almost solely used pre-existing and hand-picked http://agriculture.house.gov/uploadedfiles/ag_dietaryguidelineslettertosecsvilsackburwell.pdf. 30 National Cattleman’s Beef Association, NCBA Urges Secretaries to Reject Dietary Guidelines Advisory Committee’s Flawed Recommendations May 8, 2015; see http://www.beefusa.org/newsreleases1.aspx?newsid= 4912#sthash.gecc7dMk.dpuf. 31 A Aubrey, “New Dietary Guidelines Will not Include Sustainability Goal,” NPR, October 13, 2015; see http://www.npr.org/sections/thesalt/2015/10/06/446369955/new-dietary-guidelines-will-not-include-sustainability-goal. 32 Secretaries Vilsack and Burwell, “2015 Dietary Guidelines: Giving You the Tools You Need to Make Healthy Choices,” USDA blog, October 6, 2015; see http://blogs.usda.gov/2015/10/06/2015-dietary-guidelines-giving-you-thetools-you-need-to-make-healthy-choices/. 33 These numbers were taken directly from the Scientific Report of the 2015 DGAC, Part C: Methodology. They do not add up to 100% for reasons unknown to CRS, but one explanation may be that multiple sources were used to answer certain questions. 34 Report of the 2010 DGAC on the Dietary Guidelines for Americans, 2010, Part A: Executive Summary, page 1. 35 Scientific Report of the 2015 DGAC, Part C: Methodology; see http://health.gov/dietaryguidelines/2015-scientificreport/pdfs/scientific-report-of-the-2015-dietary-guidelines-advisory-committee.pdf.",Medical,Fact Finding,Q&A "You must generate a response using only this provided document. Do not use any other outside source to support your claims. If you are unable to answer the request using the supporting document only, then you must respond with ""please support more relevant documents so that I may answer your request accurately"".",How does hormonal imbalance in women affect mood and what can be done to minimize these affects?,"MOOD SWINGS IN WOMEN DUE TO HORMONE IMBALANCE A mood swing is defined as “an abrupt and apparently unaccountable change of mood.” Mood swings can be triggered by any number of events or situations, but in many cases, the root cause of a mood swing is a shift in hormone levels. One minute you are feeling elated and happy, but the next you are expressing anger and hostility. Mood swings are common in women who are experiencing hormonal fluctuations due to physiological events, such menstruation or menopause. Chronic mood swings can significantly affect a woman’s health and are often the result of a hormonal imbalance. The good news is that mood swings is another hormonal imbalance symptom that could be treated safely and effectively with hormone therapy. What Causes Mood Swings? Mood swings can be a side effect of lifestyle choices, life events or physiological changes, including: Stress It’s no secret that stress influences mood. Stress has a number of effects on the body— physical and psychological. Hormones and neurotransmitters that regulate mood can be affected by stress levels. Too much stress can cause cortisol levels to rise, leading to fatigue, poor sleep and appetite changes, further impacting changes in mood and behavior. Psychiatric Issues Mood disorders are not always related to a hormonal imbalance. In some cases, psychological disorders or mental health conditions may be to blame. ADHD (attention deficit hyperactive disorder), bipolar disorder, panic disorder and depression are just a few examples of psychological issues that may cause mood swings. PMS (premenstrual syndrome) For many women, uncomfortable symptoms can occur approximately one to two weeks before menstruation. This period of time is known as PMS, or premenstrual syndrome. Premenstrual mood swings are just one symptoms and may be influenced by other common symptoms, including bloating, fatigue, changes in appetite and depression. The cause of these symptoms is related to shifts in progesterone and estrogen levels, which rise and fall throughout the full menstrual cycle. PMDD (premenstrual dysmorphic disorder) PMDD, or premenstrual dysmorphic disorder, is a more severe form of PMS, affecting approximately 8 percent of premenopausal women. The symptoms of PMDD are similar to those experienced with PMS, but mood swings tend to be more extreme, along with other emotions, such irritability, sadness, and anxiety. The cause of PMDD is not well understood, but it is speculated that it is the effect of an abnormal response of the brain to hormonal shifts that occur before menstruation leading to a deficiency in the neurotransmitter, serotonin. Menopause Mood swings are one of the most common symptoms of menopause. During perimenopause, severe mood swings can occur due to hormonal shifts affecting estrogen and progesterone. The hormonal shifts are generally more extreme in the earlier phases of the transition into menopause. Other menopausal symptoms, such as hot flashes and night sweats, can cause undue stress, poor sleep and anxiety that can lead to mood swings as well. Thyroid Dysfunction Thyroid dysfunction can influence mood and cause mood swings. Hypothyroidism can be the result of low thyroid hormone and high cortisol levels. This can affect sleep, energy and appetite, all of which can impact mood. Hormonal Imbalance In general, out of balance hormones can affect mood. Estrogen and progesterone are well-known for their role in female physiology and fluctuate frequently throughout the female life cycle. However, other hormones may become imbalanced due to age or illness and cause mood swings. For example, low testosterone in women can impact energy, weight, and sex drive. High cortisol can lead to anxiety, sleeplessness, and weight gain. Any of these factors can cause mood swings simply due to the effects on a woman’`s lifestyle or overall health and wellbeing. How Mood Swings Affect Women&’s Health** Mood swings can damage relationships, interfere with work productivity and limit social interactions. This can negatively affect your mental health and become a source of stress—both of which can increase the risk of more serious disease. If your mood swings are more than occasional bouts of moodiness before your period or after a particularly bad day, it might be time to seek help. Identifying the root cause of your mood swings with the help of a qualified professional can you ensure you get the most effective treatment. Female Hormone Balance Therapy for Mood Swings Mood swings are not something any woman should ignore. If you are experiencing frequent mood swings, seek help from a qualified professional. If your mood swings are related to a hormonal imbalance, you are likely experiencing other symptoms or events in your lifecycle. For example, women who are perimenopausal will likely be experiencing hot flashes, foggy thinking or joint pain along with mood swings. If you have a thyroid disorder, you may notice that your mood swings are accompanied by feeling tired all the time, a change in appetite and an inability to regulate your body temperature. These are signs that your mood swings may be related to a hormonal imbalance. Advanced lab testing can help pinpoint which hormones are out of balance and may causing your mood swings and other symptoms. Following lab testing, you can meet with one of the expert physicians of the BodyLogicMD network for a one-on-one consultation. Each practitioner is highly trained and specializes in hormone health and balance. He/she will review your lab results, discuss your symptoms and medical history, as well as come to understand how your life has been affected by hormone imbalance. Your doctor will partner with you to develop a comprehensive treatment plan that will correct any hormone imbalance safely and effectively to help relieve you from the unwelcome symptoms, like mood swings. Your treatment plan may include bioidentical hormone replacement therapy to restore hormone balance, along with nutritional guidance, fitness recommendations, stressreduction techniques and pharmaceutical-grade supplements. Each element in your treatment plan will be designed to fit your lifestyle, while ensuring your medical needs are met and your wellness goals are achieved.","You must generate a response using only this provided document. Do not use any other outside source to support your claims. If you are unable to answer the request using the supporting document only, then you must respond with ""please support more relevant documents so that I may answer your request accurately"". How does hormonal imbalance in women affect mood and what can be done to minimize these affects? MOOD SWINGS IN WOMEN DUE TO HORMONE IMBALANCE A mood swing is defined as “an abrupt and apparently unaccountable change of mood.” Mood swings can be triggered by any number of events or situations, but in many cases, the root cause of a mood swing is a shift in hormone levels. One minute you are feeling elated and happy, but the next you are expressing anger and hostility. Mood swings are common in women who are experiencing hormonal fluctuations due to physiological events, such menstruation or menopause. Chronic mood swings can significantly affect a woman’s health and are often the result of a hormonal imbalance. The good news is that mood swings is another hormonal imbalance symptom that could be treated safely and effectively with hormone therapy. What Causes Mood Swings? Mood swings can be a side effect of lifestyle choices, life events or physiological changes, including: Stress It’s no secret that stress influences mood. Stress has a number of effects on the body— physical and psychological. Hormones and neurotransmitters that regulate mood can be affected by stress levels. Too much stress can cause cortisol levels to rise, leading to fatigue, poor sleep and appetite changes, further impacting changes in mood and behavior. Psychiatric Issues Mood disorders are not always related to a hormonal imbalance. In some cases, psychological disorders or mental health conditions may be to blame. ADHD (attention deficit hyperactive disorder), bipolar disorder, panic disorder and depression are just a few examples of psychological issues that may cause mood swings. PMS (premenstrual syndrome) For many women, uncomfortable symptoms can occur approximately one to two weeks before menstruation. This period of time is known as PMS, or premenstrual syndrome. Premenstrual mood swings are just one symptoms and may be influenced by other common symptoms, including bloating, fatigue, changes in appetite and depression. The cause of these symptoms is related to shifts in progesterone and estrogen levels, which rise and fall throughout the full menstrual cycle. PMDD (premenstrual dysmorphic disorder) PMDD, or premenstrual dysmorphic disorder, is a more severe form of PMS, affecting approximately 8 percent of premenopausal women. The symptoms of PMDD are similar to those experienced with PMS, but mood swings tend to be more extreme, along with other emotions, such irritability, sadness, and anxiety. The cause of PMDD is not well understood, but it is speculated that it is the effect of an abnormal response of the brain to hormonal shifts that occur before menstruation leading to a deficiency in the neurotransmitter, serotonin. Menopause Mood swings are one of the most common symptoms of menopause. During perimenopause, severe mood swings can occur due to hormonal shifts affecting estrogen and progesterone. The hormonal shifts are generally more extreme in the earlier phases of the transition into menopause. Other menopausal symptoms, such as hot flashes and night sweats, can cause undue stress, poor sleep and anxiety that can lead to mood swings as well. Thyroid Dysfunction Thyroid dysfunction can influence mood and cause mood swings. Hypothyroidism can be the result of low thyroid hormone and high cortisol levels. This can affect sleep, energy and appetite, all of which can impact mood. Hormonal Imbalance In general, out of balance hormones can affect mood. Estrogen and progesterone are well-known for their role in female physiology and fluctuate frequently throughout the female life cycle. However, other hormones may become imbalanced due to age or illness and cause mood swings. For example, low testosterone in women can impact energy, weight, and sex drive. High cortisol can lead to anxiety, sleeplessness, and weight gain. Any of these factors can cause mood swings simply due to the effects on a woman’`s lifestyle or overall health and wellbeing. How Mood Swings Affect Women&’s Health** Mood swings can damage relationships, interfere with work productivity and limit social interactions. This can negatively affect your mental health and become a source of stress—both of which can increase the risk of more serious disease. If your mood swings are more than occasional bouts of moodiness before your period or after a particularly bad day, it might be time to seek help. Identifying the root cause of your mood swings with the help of a qualified professional can you ensure you get the most effective treatment. Female Hormone Balance Therapy for Mood Swings Mood swings are not something any woman should ignore. If you are experiencing frequent mood swings, seek help from a qualified professional. If your mood swings are related to a hormonal imbalance, you are likely experiencing other symptoms or events in your lifecycle. For example, women who are perimenopausal will likely be experiencing hot flashes, foggy thinking or joint pain along with mood swings. If you have a thyroid disorder, you may notice that your mood swings are accompanied by feeling tired all the time, a change in appetite and an inability to regulate your body temperature. These are signs that your mood swings may be related to a hormonal imbalance. Advanced lab testing can help pinpoint which hormones are out of balance and may causing your mood swings and other symptoms. Following lab testing, you can meet with one of the expert physicians of the BodyLogicMD network for a one-on-one consultation. Each practitioner is highly trained and specializes in hormone health and balance. He/she will review your lab results, discuss your symptoms and medical history, as well as come to understand how your life has been affected by hormone imbalance. Your doctor will partner with you to develop a comprehensive treatment plan that will correct any hormone imbalance safely and effectively to help relieve you from the unwelcome symptoms, like mood swings. Your treatment plan may include bioidentical hormone replacement therapy to restore hormone balance, along with nutritional guidance, fitness recommendations, stressreduction techniques and pharmaceutical-grade supplements. Each element in your treatment plan will be designed to fit your lifestyle, while ensuring your medical needs are met and your wellness goals are achieved.",Medical,Find & Summarize,Text Transformation Respond using only the information contained in the text. The response must be no more than 250 words.,"According to the document, what are some limitations of big data sets when conducting research?","Collectively, this research suggests that big data offers both new potential discriminatory harms and new potential solutions to discriminatory harms. To maximize the benefits and limit the harms, companies should consider the questions raised by research in this area. These questions include the following: 1. How representative is your data set? Workshop participants and researchers note that the data sets, on which all big data analysis relies, may be missing information about certain populations, e.g., individuals who are more careful about revealing information about themselves, who are less involved in the formal economy, who have unequal access or less fluency in technology resulting in a digital divide148 or data desert,149 or whose behaviors are simply not observed because they are believed to be less profitable constituencies.150 Recent examples demonstrate the impact of missing information about particular populations on data analytics. For example, Hurricane Sandy generated more than twenty million tweets between October 27 and November 1, 2012.151 If organizations were to use this data to determine where services should be deployed, the people who needed services the most may not have received them. The greatest number of tweets about Hurricane Sandy came from Manhattan, creating the illusion that Manhattan was the hub of the disaster. Very few messages originated from more severely affected locations, such as Breezy Point, Coney Island, and Rockaway—areas with lower levels of smartphone ownership and Twitter usage. As extended power blackouts drained batteries and limited cellular access, even fewer tweets came from the worst hit areas. As one researcher noted, “data are assumed to accurately reflect the social world, but there are significant gaps, with little or no signal coming from particular communities.”152 Organizations have developed ways to overcome this issue. For example, the city of Boston developed an application called Street Bump that utilizes smartphone features such as GPS feeds to collect and report to the city information about road conditions, including potholes. However, after the release of the application, the Street Bump team recognized that because lower income individuals may be less likely to carry smartphones, the data was likely not fully representative of all road conditions. If the city had continued relying on the biased data, it might have skewed road services to higher income neighborhoods. The team addressed this problem by issuing its application to city workers who service the whole city and supplementing the data with that from the public.153 This example demonstrates why it is important to consider the digital divide and other issues of underrepresentation and overrepresentation in data inputs before launching a product or service in order to avoid skewed and potentially unfair ramifications. 2. Does your data model account for biases? While large data sets can give insight into previously intractable challenges, hidden biases at both the collection and analytics stages of big data’s life cycle could lead to disparate impact.154 Researchers have noted that big data analytics “can reproduce existing patterns of discrimination, inherit the prejudice of prior decision-makers, or simply reflect the widespread biases that persist in society.”155 For example, if an employer uses big data analytics to synthesize information gathered on successful existing employees to define a “good employee candidate,” the employer could risk incorporating previous discrimination in employment decisions into new employment decisions.156 Even prior to the widespread use of big data, there is some evidence of the use of data leading to the reproduction of existing biases. For example, one researcher has noted that a hospital developed a computer model to help identify “good medical school applicants” based on performance levels of previous and existing students, but, in doing so, the model reproduced prejudices in prior admission decisions.157 Companies can also design big data algorithms that learn from human behavior; these algorithms may “learn” to generate biased results. For example, one academic found that Reuters and Google queries for names identified by researchers to be associated with African-Americans were more likely to return advertisements for arrest records than for names identified by researchers to be associated with white Americans.158 The academic concluded that determining why this discrimination was occurring was beyyond the scope of her research, but reasoned that search engines’ algorithms may learn to prioritize arrest record ads for searches of names associated with African-Americans if people click on such ads more frequently than other ads.159 This could reinforce the display of such ads and perpetuate the cycle. Companies should therefore think carefully about how the data sets and the algorithms they use have been generated. Indeed, if they identify potential biases in the creation of these data sets or the algorithms, companies should develop strategies to overcome them. As noted above, Google changed its interview and hiring process to ask more behavioral questions and to focus less on academic grades after discovering that replicating its existing definitions of a “good employee” was resulting in a homogeneous tech workforce.160 More broadly, companies are starting to recognize that if their big data algorithms only consider applicants from “top tier” colleges to help them make hiring decisions, they may be incorporating previous biases in college admission decisions.161 As in the examples discussed above, companies should develop ways to use big data to expand the pool of qualified applicants they will consider.162 3. How accurate are your predictions based on big data? Some researchers have also found that big data analysis does not give sufficient attention to traditional applied statistics issues, thus leading to incorrect results and predictions.163 They note that while big data is very good at detecting correlations, it does not explain which correlations are meaningful.164 A prime example that demonstrates the limitations of big data analytics is Google Flu Trends, a machinelearning algorithm for predicting the number of flu cases based on Google search terms. To predict the spread of influenza across the United States, the Google team analyzed the top fifty million search terms for indications that the flu had broken out in particular locations. While, at first, the algorithms appeared to create accurate predictions of where the flu was more prevalent, it generated highly inaccurate estimates over time.165 This could be because the algorithm failed to take into account certain variables. For example, the algorithm may not have taken into account that people would be more likely to search for flu-related terms if the local news ran a story on a flu outbreak, even if the outbreak occurred halfway around the world. As one researcher has noted, Google Flu Trends demonstrates that a “theory-free analysis of mere correlations is inevitably fragile. If you have no idea what is behind a correlation, you have no idea what might cause that correlation to break down.”166 As another example, workshop participants discussed the fact that lenders can improve access to credit by using non-traditional indicators, e.g., rental or utility bill payment history.167 Consumers, however, have the right to withhold rent if their landlord does not provide heat or basic sanitation services. In these instances, simply compiling rental payment history would not necessarily demonstrate whether the person is a good credit risk.168 In some cases, these sources of inaccuracies are unlikely to have significant negative effects on consumers. For example, it may be that big data analytics shows that 30 percent of consumers who buy diapers will respond to an ad for baby formula. That response rate may be enough for a marketer to find it worthwhile to send buyers of diapers an advertisement for baby formula. The 70 percent of consumers who buy diapers but are not interested in formula can disregard the ad or discard it at little cost. Similarly, consumers who are interested in formula and who do not buy diapers are unlikely to be substantially harmed because they did not get the ad. On the other hand, if big data analytics are used as the basis for access to credit, housing, or other similar benefits, the potential effects on consumers from inaccuracies could be substantial.169 For example, suppose big data analytics predict that people who do not participate in social media are 30 percent more likely to be identity thieves, leading a fraud detection tool to flag such people as “risky.” Suppose further that a wireless company uses this tool and requires “risky” people to submit additional documentation before they can obtain a cell phone contract. These people may not be able to obtain the contract if they do not have the required documentation.","Respond using only the information contained in the text. The response must be no more than 250 words. Collectively, this research suggests that big data offers both new potential discriminatory harms and new potential solutions to discriminatory harms. To maximize the benefits and limit the harms, companies should consider the questions raised by research in this area. These questions include the following: 1. How representative is your data set? Workshop participants and researchers note that the data sets, on which all big data analysis relies, may be missing information about certain populations, e.g., individuals who are more careful about revealing information about themselves, who are less involved in the formal economy, who have unequal access or less fluency in technology resulting in a digital divide148 or data desert,149 or whose behaviors are simply not observed because they are believed to be less profitable constituencies.150 Recent examples demonstrate the impact of missing information about particular populations on data analytics. For example, Hurricane Sandy generated more than twenty million tweets between October 27 and November 1, 2012.151 If organizations were to use this data to determine where services should be deployed, the people who needed services the most may not have received them. The greatest number of tweets about Hurricane Sandy came from Manhattan, creating the illusion that Manhattan was the hub of the disaster. Very few messages originated from more severely affected locations, such as Breezy Point, Coney Island, and Rockaway—areas with lower levels of smartphone ownership and Twitter usage. As extended power blackouts drained batteries and limited cellular access, even fewer tweets came from the worst hit areas. As one researcher noted, “data are assumed to accurately reflect the social world, but there are significant gaps, with little or no signal coming from particular communities.”152 Organizations have developed ways to overcome this issue. For example, the city of Boston developed an application called Street Bump that utilizes smartphone features such as GPS feeds to collect and report to the city information about road conditions, including potholes. However, after the release of the application, the Street Bump team recognized that because lower income individuals may be less likely to carry smartphones, the data was likely not fully representative of all road conditions. If the city had continued relying on the biased data, it might have skewed road services to higher income neighborhoods. The team addressed this problem by issuing its application to city workers who service the whole city and supplementing the data with that from the public.153 This example demonstrates why it is important to consider the digital divide and other issues of underrepresentation and overrepresentation in data inputs before launching a product or service in order to avoid skewed and potentially unfair ramifications. 2. Does your data model account for biases? While large data sets can give insight into previously intractable challenges, hidden biases at both the collection and analytics stages of big data’s life cycle could lead to disparate impact.154 Researchers have noted that big data analytics “can reproduce existing patterns of discrimination, inherit the prejudice of prior decision-makers, or simply reflect the widespread biases that persist in society.”155 For example, if an employer uses big data analytics to synthesize information gathered on successful existing employees to define a “good employee candidate,” the employer could risk incorporating previous discrimination in employment decisions into new employment decisions.156 Even prior to the widespread use of big data, there is some evidence of the use of data leading to the reproduction of existing biases. For example, one researcher has noted that a hospital developed a computer model to help identify “good medical school applicants” based on performance levels of previous and existing students, but, in doing so, the model reproduced prejudices in prior admission decisions.157 Companies can also design big data algorithms that learn from human behavior; these algorithms may “learn” to generate biased results. For example, one academic found that Reuters and Google queries for names identified by researchers to be associated with African-Americans were more likely to return advertisements for arrest records than for names identified by researchers to be associated with white Americans.158 The academic concluded that determining why this discrimination was occurring was beyyond the scope of her research, but reasoned that search engines’ algorithms may learn to prioritize arrest record ads for searches of names associated with African-Americans if people click on such ads more frequently than other ads.159 This could reinforce the display of such ads and perpetuate the cycle. Companies should therefore think carefully about how the data sets and the algorithms they use have been generated. Indeed, if they identify potential biases in the creation of these data sets or the algorithms, companies should develop strategies to overcome them. As noted above, Google changed its interview and hiring process to ask more behavioral questions and to focus less on academic grades after discovering that replicating its existing definitions of a “good employee” was resulting in a homogeneous tech workforce.160 More broadly, companies are starting to recognize that if their big data algorithms only consider applicants from “top tier” colleges to help them make hiring decisions, they may be incorporating previous biases in college admission decisions.161 As in the examples discussed above, companies should develop ways to use big data to expand the pool of qualified applicants they will consider.162 3. How accurate are your predictions based on big data? Some researchers have also found that big data analysis does not give sufficient attention to traditional applied statistics issues, thus leading to incorrect results and predictions.163 They note that while big data is very good at detecting correlations, it does not explain which correlations are meaningful.164 A prime example that demonstrates the limitations of big data analytics is Google Flu Trends, a machinelearning algorithm for predicting the number of flu cases based on Google search terms. To predict the spread of influenza across the United States, the Google team analyzed the top fifty million search terms for indications that the flu had broken out in particular locations. While, at first, the algorithms appeared to create accurate predictions of where the flu was more prevalent, it generated highly inaccurate estimates over time.165 This could be because the algorithm failed to take into account certain variables. For example, the algorithm may not have taken into account that people would be more likely to search for flu-related terms if the local news ran a story on a flu outbreak, even if the outbreak occurred halfway around the world. As one researcher has noted, Google Flu Trends demonstrates that a “theory-free analysis of mere correlations is inevitably fragile. If you have no idea what is behind a correlation, you have no idea what might cause that correlation to break down.”166 As another example, workshop participants discussed the fact that lenders can improve access to credit by using non-traditional indicators, e.g., rental or utility bill payment history.167 Consumers, however, have the right to withhold rent if their landlord does not provide heat or basic sanitation services. In these instances, simply compiling rental payment history would not necessarily demonstrate whether the person is a good credit risk.168 In some cases, these sources of inaccuracies are unlikely to have significant negative effects on consumers. For example, it may be that big data analytics shows that 30 percent of consumers who buy diapers will respond to an ad for baby formula. That response rate may be enough for a marketer to find it worthwhile to send buyers of diapers an advertisement for baby formula. The 70 percent of consumers who buy diapers but are not interested in formula can disregard the ad or discard it at little cost. Similarly, consumers who are interested in formula and who do not buy diapers are unlikely to be substantially harmed because they did not get the ad. On the other hand, if big data analytics are used as the basis for access to credit, housing, or other similar benefits, the potential effects on consumers from inaccuracies could be substantial.169 For example, suppose big data analytics predict that people who do not participate in social media are 30 percent more likely to be identity thieves, leading a fraud detection tool to flag such people as “risky.” Suppose further that a wireless company uses this tool and requires “risky” people to submit additional documentation before they can obtain a cell phone contract. These people may not be able to obtain the contract if they do not have the required documentation. According to the document, what are some limitations of big data sets when conducting research?",Internet/Technology,Fact Finding,Q&A Simplify the language used so it's easier to understand. Only pull information from the provided document.,What are the pros and cons mentioned in this reviews?,"Dependable Mic I do sound for small bands and these mics are very dependable and sound great. The work for vocals and instruments. A good buy. by Aj from Salinas, Ca on November 29, 2023 Music background: Dj/Live Sound Best Dynamic Mic ever This mix is amazing. It will always be a classic. Still putting it through its paces but it sounds great. by VenoMUZIK from Columbus, OH on August 10, 2023 Music background: Singer/songwriter, composer, producer Great sounding mic for the money Have been impressed with the pickup and sound quality of these mics compared to some of the other mics I use by Lee Yoritomo from Montgomery Village, MD on February 16, 2024 Shure SM 58 Microphone.. No matter what type of venue you do you're SM 58 microphone is always ready to go no batteries to change out and it's always spot on! by Sweetwater Customer from Alaska on February 6, 2024 Shure SM 58 Microphone.. No matter what type of venue you do you're SM 58 microphone is always ready to go no batteries to change out and it's always spot on! by Sweetwater Customer from Kenai, Alaska on February 6, 2024 Twenty years ago I quickly acquired a Realistic microphone to use when I served as the disc jockey at wedding receptions and class reunions. When it recently rolled off the table at an event and broke into a few pieces I wanted to order a replacement. I purchased the Shure SM 58 Handheld Dynamic Vocal Microphone (based on a co-worker's recommendation). When a microphone was needed at a recent festival I gave it the first testing. It was much lower and less powerful than my previous ""cheaper"" microphone (which had been purchased at a local Radio Shack affiliate). I am currently involved with testing it at my workplace to see if it is truly defective or needs some sort of power boost to effectively broadcast voices loud enough through my gear. parts not interchangeable By daniel graves from California on May 10, 2017 Music Background: performer Many reviews will tell you that the sms58S is just the sm58 with a switch added. But when trying to exchange the microphone element between the two, I discovered that the parts are not interchangeable. The thread count is different on the collar and different on the mike head, with different rubber gaskets, the diameter of the mike elements are different, and wiring colors are different. Possibly this is a difference in year of manufacture, One mike is a year old, the other unknown but at least 5yrs old (these mikes have been around since the 60's, so who knows). One other difference is that the SMS58 is more insulated,and less prone to noise from handling the mike (or did they just make the the housing quieter in the older models? Shure SM58 By Timothy Connelly from Pacifin North West on December 22, 2023 Music Background: Garage band, Open Mic, Gigs The mic works well, however I wish it had a on/off switch' On another matter, I was hoping to review the purchase of my JBL EONONE 1 Perhaps it is my age (72), but I find it very confusing in regards to the operation of the unit. I realize Sweetwater is not the manufacturer of the JBL EONONE, however it would be great if Sweetwater could produce an owners manual that a senior citizen could understand. I have managed to program 2 out of 5 channels. I have not solved all of the special affects including reverb, chorus and delay, Maybe for a younger consumer who is better educated in the ""tech"" world , this is not a problem. I can promise you for this consumer, it is more than frustrating. Sincerely Timothy Connelly","Simplify the language used so it's easier to understand. Only pull information from the provided document. What are the pros and cons mentioned in this reviews? Dependable Mic I do sound for small bands and these mics are very dependable and sound great. The work for vocals and instruments. A good buy. by Aj from Salinas, Ca on November 29, 2023 Music background: Dj/Live Sound Best Dynamic Mic ever This mix is amazing. It will always be a classic. Still putting it through its paces but it sounds great. by VenoMUZIK from Columbus, OH on August 10, 2023 Music background: Singer/songwriter, composer, producer Great sounding mic for the money Have been impressed with the pickup and sound quality of these mics compared to some of the other mics I use by Lee Yoritomo from Montgomery Village, MD on February 16, 2024 Shure SM 58 Microphone.. No matter what type of venue you do you're SM 58 microphone is always ready to go no batteries to change out and it's always spot on! by Sweetwater Customer from Alaska on February 6, 2024 Shure SM 58 Microphone.. No matter what type of venue you do you're SM 58 microphone is always ready to go no batteries to change out and it's always spot on! by Sweetwater Customer from Kenai, Alaska on February 6, 2024 Twenty years ago I quickly acquired a Realistic microphone to use when I served as the disc jockey at wedding receptions and class reunions. When it recently rolled off the table at an event and broke into a few pieces I wanted to order a replacement. I purchased the Shure SM 58 Handheld Dynamic Vocal Microphone (based on a co-worker's recommendation). When a microphone was needed at a recent festival I gave it the first testing. It was much lower and less powerful than my previous ""cheaper"" microphone (which had been purchased at a local Radio Shack affiliate). I am currently involved with testing it at my workplace to see if it is truly defective or needs some sort of power boost to effectively broadcast voices loud enough through my gear. parts not interchangeable By daniel graves from California on May 10, 2017 Music Background: performer Many reviews will tell you that the sms58S is just the sm58 with a switch added. But when trying to exchange the microphone element between the two, I discovered that the parts are not interchangeable. The thread count is different on the collar and different on the mike head, with different rubber gaskets, the diameter of the mike elements are different, and wiring colors are different. Possibly this is a difference in year of manufacture, One mike is a year old, the other unknown but at least 5yrs old (these mikes have been around since the 60's, so who knows). One other difference is that the SMS58 is more insulated,and less prone to noise from handling the mike (or did they just make the the housing quieter in the older models? Shure SM58 By Timothy Connelly from Pacifin North West on December 22, 2023 Music Background: Garage band, Open Mic, Gigs The mic works well, however I wish it had a on/off switch' On another matter, I was hoping to review the purchase of my JBL EONONE 1 Perhaps it is my age (72), but I find it very confusing in regards to the operation of the unit. I realize Sweetwater is not the manufacturer of the JBL EONONE, however it would be great if Sweetwater could produce an owners manual that a senior citizen could understand. I have managed to program 2 out of 5 channels. I have not solved all of the special affects including reverb, chorus and delay, Maybe for a younger consumer who is better educated in the ""tech"" world , this is not a problem. I can promise you for this consumer, it is more than frustrating. Sincerely Timothy Connelly",Internet/Technology,Pros & Cons,Q&A Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here.,What are some effects of overexposure to glucocorticoids?,"5756Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Adult & Aging Brain 8Adult & Aging Brain8 memory, which requires a high degree of synaptic plasticity. The loss of thin dendritic spines could impair neuro- nal communication and contribute to cognitive decline. So far, direct evidence of their role in cognitive decline is lacking, and more studies are needed. Finally, the formation of new neurons also declines with age. Although neurogenesis was once believed to halt after birth, we now know of two brain regions that con- tinue to add new neurons through- out life: the olfactory bulbs and the dentate gyrus of the hippocampus. Studies suggest that the rate of neu- rogenesis plummets with age in mice, but recent human studies suggest a more modest decline. It is not yet clear whether neurogenesis apprecia- bly affects cognition in the aging hu- man brain, but mouse studies indicate that strategies that boost neurogenesis can enhance cognitive function. Chemical Changes The amount of neurotransmit- ters and the number of their recep- tors might also decline with age. Several studies have reported that less dopamine is synthesized in the aged brain, and there are fewer re- ceptors to bind the neurotransmitter. Less robust evidence indicates that the amount of serotonin might also decline with age. WHY DOES THE BRAIN AGE? From cortical thinning to the loss of dendritic spines, you’ve seen how the brain ages. But what causes these changes? Many different theories have been advanced to explain why neurons, and cells in general, age. One possibility is that changes in gene expression play a role. Researchers have found that genes important for synaptic plasticity are expressed less in the brains of older people than in the brains of younger adults. The underexpressed genes also showed more signs of damage. Oxidative Stress and DNA Damage DNA damage that accumulates over a lifetime could contribute to aging processes throughout the brain and body, and DNA damage due to oxidative stress has received a great deal of attention. Every cell in your body contains organelles called mitochondria, which function a bit like cellular power plants, carrying out chemical reactions that provide energy for cell use. Some of these metabolic reactions produce harmful byproducts called free radicals, highly reactive molecules which, if left un- checked, can destroy fats and proteins vital to normal cell function and can damage DNA as well. Your body has natural defense mechanisms to neutralize free radi- cals. Unfortunately, these mechanisms decline with age, leaving aging tissues more vulnerable to oxidative damage by the free radicals. Studies of brain cells have shown that damage to their mitochondrial DNA accumulates with age. In addition, the brains of people with mild cognitive impairment and Alzheimer’s disease show more signs of oxidative damage than the brains of healthy people. Studies in rodents also link increased oxidative damage to memory impairments. Your brain is one of the most metabolically active organs, demand- ing around 20 percent of the body’s fuel. Its enormous energy require- ments might make the brain even more vulnerable than other tissues to the metabolic changes that occur in aging. While the brain’s energy demands remain high, its energy supply can no longer keep pace; the brain’s ability to take up and use glu- cose diminishes and mitochondrial metabolism declines. Immune Dysfunction Immune dysfunction often occurs in conjunction with the metabolic changes seen in aging. Microglia, the brain’s resident immune cells, per- form many important jobs: defending against pathogens, cleaning up cellular debris, and helping maintain and re- model synapses. These inflammatory responses are protective, but a pro- longed inflammatory state is harmful to brain health. Microglia become more reactive with age, increasing the inflammatory response in the brain while also damping production of helpful anti-inflammatory molecules. Mouse studies suggest that excessive microglial activity also contributes to cognitive impairments. Impaired Protein Recycling We know that excessive buildup of abnormal proteins in the brain contributes to age-related neurode- generative diseases like Alzheimer’s and Parkinson’s. Buildup of proteins and other cell components can also contribute to cellular degeneration in the healthy brain. Cells normally break down and recycle damaged proteins and molecules, using a pro- cess that is usually efficient but not perfect. Over time, damaged mole- cules can build up in cells and prevent them from functioning normally. Because neurons in the brain are not replaced as often as cells in other parts of the body (for example, bone marrow, intestinal lining, hair folli- cles), brain cells might be even more vulnerable to this buildup of damaged molecules. Also, the cellular ma- chinery involved in breakdown and recycling processes degrades with age, reducing the efficiency of the “waste removal” systems. Finally, remember that changes in the aging brain occur within the context of other changes throughout the body. Researchers speculate that worsening cardiovascular health, for example, could contribute to, or even drive, many changes seen in the aging brain. HEALTHY AGING We have learned how the brain changes with age and why these changes can occur. Now let’s turn our attention to a growing field in neuroscience that explores ways to slow these changes and preserve healthy brain function. Diet and Exercise Strong evidence now suggests that habits and choices that keep your body healthy also benefit your mind. Poor cardiovascular health puts a person at increased risk of age-related cognitive impairment. Diets rich in vegetables, fruits, and whole grains, and low in meat and dairy products, can reduce cardiovascular risk factors linked to cognitive impairment, such as high blood pressure and high levels of LDL cholesterol. Indeed, observa- tional studies have found that people who follow plant-rich diets such as the Mediterranean diet or Dietary Approaches to Stop Hypertension (DASH) are less likely to develop cognitive decline and dementia. Specific nutrients have been linked to improved cognitive performance and lower rates of dementia. Anti- oxidants, such as vitamins C and E, flavonoids, and omega-3 fatty acids have received considerable attention, with observational studies showing that high dietary intake of these compounds is beneficial. However, the results of lifestyle intervention studies using supplements have been more mixed. Finally, caloric restriction — substantially reducing the number of calories eaten without leading to malnutrition — has been linked to Many different theories have been advanced to explain why neurons, and cells in general, age. Synapses begin to weaken as a person ages, which can contribute to normal cognitive decline. Brain Facts society for neuroscience| Adult & Aging Brain85958 improved cognitive health as well as a longer lifespan. Growing evidence shows that aerobic exercise can improve cognitive function and offset some of the de- clines seen in aging. Numerous studies have found that people who engage in regular physical activity show improved learning, improved mem- ory, and a reduced risk of developing dementia. Physical activity might even slow the progression of Alzheimer’s disease and dementia, and higher levels of physical activity have been linked to improvements in some markers of structural brain health, such as reduced cortical thinning and less shrinkage in the hippocampus. Exercise exerts its neuroprotec- tive effects in the brain by improving neuroplasticity — the brain’s ability to form and reorganize connections be- tween neurons in response to changes in behavior and environment. Scien- tists also believe that exercise increases neurogenesis (the formation of new nerve cells) which, in turn, enhances neuroplasticity. Evidence from rodent studies confirms that exercise increases neurogenesis: Older mice allowed to run on a wheel have higher rates of neurogenesis in the hippocampus than sedentary mice, and they perform bet- ter on learning and memory tests. Ex- ercise can also improve blood flow and increase production of neurotrophic factors that support new neurons and synapses. For humans, starting exercise later in life can be beneficial, but the studies suggest that adopting an exer- cise program earlier in life could yield even more neuroprotective benefits. Mental Stimulation and Social Networks Mental stimulation and large so- cial networks can also improve cogni- tive function in aging. In lab studies, mice housed in cognitively stimulat- ing environments with many oppor- tunities for social interaction perform better on learning and memory tests as they age compared to mice housed in standard cages. Much like physical exercise, cognitive stimulation appears to enhance neuroplasticity by increas- ing neurogenesis and boosting levels of important neurotrophic factors. People who perform cognitive- ly-demanding work or engage in stimulating activities such as reading, solving puzzles, or playing a musical instrument have lower rates of cog- nitive decline with aging. An active social life has also been shown to be beneficial for cognition as we age. Neuroscientists have learned a lot about the aging brain — how it changes, why it changes, and how to maintain healthy cognitive func- tioning as we age. Even so, many questions remain. Answers to those questions could identify new strate- gies for protecting the brain, not only in our later years, but throughout our lives. Exercise has been shown to increase neurogenesis in the adult brain, and can slow the cognitive decline associated with aging. iStock.com/artyme83. Have you ever considered the ups and downs that occur during your day? Speaking literally, you are up and awake during the day and lying down sleeping at night. Speaking figuratively, ups and downs could mean that you experi- ence periods of elevated alertness and arousal compared with your mood when you are tired or relaxed. Asleep, awake, aroused, and relaxed are different brain states, meaning that the brain’s activity is different during each of these peri- ods. Scientists have looked deep inside the brain to understand what sleep is and how rest differs from being alert. This research is especially important for people like doctors, pilots, and shift workers who sometimes must focus and make important decisions with very little sleep. Research on brain states can also help people who have disorders of sleep, attention, and learning. SLEEP How many hours of sleep do you get every night? Most people spend one-third of their lives asleep. While that might appear to be a lot of time spent doing nothing, our brains are active while we rest each night. The activity in our brains during sleep is important for brain health and for solidifying memories. Most people feel tired and un- able to focus if they don’t get enough sleep. In some cases, too little sleep can impair a person’s driving as much as drinking alcohol. The long-term ef- fects of lacking sleep also involve many health risks. Several studies in humans have revealed that sleep-deprived people are at increased risk for a wide range of health issues including diabe- tes, stress, obesity, high blood pres- sure, anxiety, cognitive impairment, and depression. CHAPTER Brain States 9 Brain Facts 6160Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Brain States 9Brain States9 Brain Activity During Sleep Scientists can measure the brain’s electrical activity using electroenceph- alography (EEG). Electrodes attached to the scalp detect and record the net electrical activity of hundreds of thou- sands of cortical nerve cells. When a neuron is active, ions move in and out of the cell, altering the electrical charge across the cell membrane. An EEG de- tects the net electrical charge produced when neurons increase and decrease their activity as a group, in synchrony. The results are “brain waves” — the cyclic rising and falling of brain activ- ity that can be important indicators of brain function. In sleep studies, scien- tists now recognize two main states: slow wave sleep (SWS) and rapid eye movement sleep (REM). SWS gets its name from the high amplitude, low frequency, brain waves in EEG recordings. The high amplitude of slow waves indicates that many cortical neu- rons are switching their activity in a synchronized way from a depolarized (more excitable) state to a hyperpo- larized (less excitable) state and back again. These slow waves appear to be important to sleep function — the longer a person stays awake, the more slow waves they will experience during the SWS state. Slow waves become less frequent the longer the person is asleep. If awakened during SWS, most people recall only frag- mented thoughts, not active dreams. Have you ever seen a cat dream- ing — twitching its whiskers or paws while it sleeps? Dreaming happens mainly during REM sleep, which takes its name from the periodic rapid eye movements people make in this state. Brain activity recorded during REM looks very similar to EEGs recorded while awake. EEG waves during REM sleep have much lower amplitudes than the SWS slow waves, because neuron activity is less synchronized — some nerve cells depolarize while others hyperpolarize, and the “sum” of their electrical states is less positive (or negative) than if they acted in synchro- ny. Paradoxically, the fast, waking-like EEG activity during REM sleep is ac- companied by atonia, a loss of muscle tone causing the body to become tem- porarily paralyzed. The only muscles remaining active are those that enable breathing and control eye movements. Oddly enough, the neurons of our motor cortex fire as rapidly during REM sleep as they do during waking movement — a fact that explains why movements like a kitten’s twitching paws can coincide with dreams. During the night, periods of SWS and REM sleep alternate in 90-minute cycles with 75–80 minutes of SWS followed by 10–15 minutes of REM sleep. This cycle repeats, typically with deeper and longer peri- ods of REM sleep towards morning. To study sleep disorders, researchers often use mice that have sleep struc- tures qualitatively very similar to hu- mans; however, rodents have shorter This chart shows the brain waves of an individual being recorded by an EEG machine during a night’s sleep. As the person falls asleep, the brain waves slow down and become larger. Throughout the night, the individual cycles though sleep stages, including REM sleep, where brain activity is similar to wakefulness. and more frequent sleep episodes lasting 3–30 minutes (sometimes lon- ger). Rodents also sleep more during the day and are more active at night. Compare that to human adults, who are typically more active during the day and have one sleep episode at night lasting about 8 hours. Sleep Regulation How does the brain keep us awake? Wakefulness is main- tained by the brain’s arousal systems, each regulating different aspects of the awake state. Many arousal systems are in the upper brainstem, where neurons connecting with the forebrain use the neurotransmitters acetylcholine, norepinephrine, serotonin, and glutamate to keep us awake. Orexin- producing neurons, located in the hypothalamus, send projections to the brainstem and spinal cord, the thala- mus and basal ganglia, as well as to the forebrain, the amygdala, and dopa- mine-producing neurons. In studies of rats and monkeys, orexin appears to exert excitatory effects on other arousal systems. Orexins (there are two types, both small neuropeptides) increase metabolic rate, and their production can be activated by insulin-induced low blood sugar. Thus, they are involved in energy metabolism. Given these functions, it comes as no surprise that orexin-producing neurons are important for preventing a sudden transition to sleep; their loss causes narcolepsy, as described below. Orexin neurons also connect to hypothalamic neurons containing the neurotransmit- ter histamine, which plays a role in staying awake. The balance of neurotransmitters in the brain is critically important for maintaining certain brain states. For example, the balance of acetylcholine and norepinephrine can affect wheth- er we are awake (high acetylcholine and norepinephrine) or in SWS (low acetylcholine and norepinephrine). During REM, norepinephrine re- mains low while acetylcholine is high, activating the thalamus and neocortex enough for dreaming to occur; in this brain state, forebrain excitation without external sensory stimuli pro- duces dreams. The forebrain becomes excited by signals from the REM sleep generator (special brainstem neurons), leading to rapid eye move- ments and suppression of muscle tone — hallmark signs of REM. During SWS, the brain systems that keep us awake are actively sup- pressed. This active suppression of arousal systems is caused by the ven- trolateral preoptic (VLPO) nucleus, a group of nerve cells in the hypothala- mus. Cells in the VLPO release the in- hibitory neurotransmitters galanin and gamma-aminobutyric acid (GABA), which can suppress the arousal sys- tems. Damage to the VLPO nucleus causes irreversible insomnia. Sleep-Wake Cycle Two main factors drive your body to crave sleep: the time of day or night (circadian system) and how long you have been awake (homeostatic system). The homeostatic and circadian systems are separate and act independently. The circadian timing system is regulated by the suprachiasmatic nucleus, a small group of nerve cells in the hypothalamus that functions as a master clock. These cells express “clock proteins,” which go through a biochemical cycle of about 24 hours, setting the pace for daily cycles of activity, sleep, hormone release, and other bodily functions. The master clock neurons also receive input directly from the retina of the eye. Thus, light can reset the master clock, adjusting it to the outside world’s day/night cycle — this explains how your sleep cycles can shift when you change time zones during travel. In addition, the suprachiasmatic nucleus sends signals through different brain regions, eventually contacting the VLPO and the orexin neurons in the lateral hypothalamus, which directly regulate arousal. What happens in the brain when we don’t get enough sleep? The second system that regulates sleepiness is the The balance of neurotransmitters in the brain is critically important for maintaining certain brain states. 6362Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Brain States 9Brain States9 homeostatic system, which makes you feel sleepy if you stay awake longer than usual. One important sleep factor is a chemical in the brain called adenosine. When you stay awake for a long time, adenosine levels in the brain increase. The increased ade- nosine binds to specific receptors on nerve cells in arousal centers to slow cellular activity and reduce arousal. Adenosine can increase the number of slow waves during SWS. As you get more sleep, adenosine levels fall and slow waves decrease in number. Caf- feine acts as a stimulant by binding to adenosine receptors throughout the brain and preventing their interaction with adenosine. As a result, in the presence of caffeine, fewer receptors are available for the slowing influence of adenosine. People often say they need to “catch up on sleep.” But can you really make up for lost sleep? Normally, the homeostatic and circadian systems act in a complementary fashion to produce a normal 24-hour cycle of sleep and wakefulness. Nonetheless, activating the brain’s arousal system can keep us awake even after a long pe- riod of wakefulness — for example, a late-night study session to prepare for an important exam. In normal circum- stances, the homeostatic system will respond to the loss of sleep by increas- ing the duration of ensuing sleep and increasing the number of slow waves during the SWS episodes. As noted above, this rebound slow wave activity correlates with the previous time spent awake and is mediated by adenosine. Sleep Disorders The most common sleep disorder, and the one most people are familiar with, is insomnia. Some people with insomnia have difficulty falling asleep initially; others fall asleep, then awak- en part way through the night and can’t fall back asleep. Several common disorders, listed below, disrupt sleep and prevent people from getting an adequate amount of sleep. Daytime sleepiness (not narcolep- sy), characterized by excessive feelings of tiredness during the day, has many causes including sleep apnea (see be- low). Increased daytime sleepiness can increase the risk of daytime accidents, especially car accidents. Sleep apnea occurs when the air- way muscles of the throat relax during sleep, to the point of collapse, closing the airway. People with sleep apnea have difficulty breathing and wake up without entering the deeper stages of SWS. This condition can cause high blood pressure and may increase the risk of heart attack. Treatments for sleep apnea focus on reducing airway collapse during sleep; simple changes that may help include losing weight, avoiding alcohol or sedating drugs prior to sleep, and avoiding sleeping on one’s back. However, most people with sleep apnea require breathing machines to keep their airway open. One such device, called a continuous positive airway pressure or “CPAP” machine, uses a small mask that fits over the nose to provide an airstream under pressure during sleep. In some cases, people need surgery to correct their airway anatomy. REM sleep behavior disorder occurs when nerve pathways in the brain that prevent muscle movement during REM sleep do not work. Remember that dreaming happens during REM sleep, so imagine people literally acting out their dreams by getting up and moving around. This can be very disruptive to a normal night’s sleep. The cause of REM be- havior disorder is unknown, but it is more common in people with degen- erative neural disease such as Parkin- son’s, stroke, and types of dementia. The disorder can be treated with drugs for Parkinson’s or with a ben- zodiazepine drug, clonazepam, which enhances the effects of the inhibitory neurotransmitter GABA. FPO Electroencephalography measures brain activity through sensors placed on the head. It can record how the brain reacts to all kinds of stimuli and activities, including sleep. Simon Fraser University. Narcolepsy: An Example of Sleep Disorder Research Narcolepsy is a relatively uncommon sleep disorder — only 1 case per 2,000 people in the United States — in which the brain lacks the special neurons that help control the transition into sleep, so that the regular cycling is disrupted. People with narcolepsy have sleep attacks during the day, causing them to suddenly fall asleep, which is especially dangerous if they are driving. The problem is caused by the loss of orexin neurons in the lateral hypothalamus. People with narcolep- sy tend to enter REM sleep very quickly and may even enter a dream- ing state while still partially awake, a condition known as hypnagogic hallucination. Some people with narcolepsy also have attacks in which they lose muscle tone — similar to what happens in REM sleep, but while they’re awake. These attacks of paralysis, known as cataplexy, can be triggered by emotional experiences and even by hearing a funny joke. Recent research into the mech- anisms of narcolepsy has provided important insights into the processes that control the mysterious transitions between waking, slow wave sleep, and REM sleep states. Orexin (in the lateral hypothalamus) is critical for preventing abnormal transitions into REM sleep during the day. In one study, scientists inactivated the gene for orexin in mice and measured their sleep patterns. They found that mice lacking the orexin gene showed symp- toms of narcolepsy. Similarly, humans with narcolepsy have abnormally low levels of orexin levels in their brain and spinal fluid. Because orexin levels are disrupt- ed in narcolepsy, scientists also began studying neurons that were neighbors to orexin neurons to see what hap- pened if the neighboring neurons were activated in narcoleptic mice. Those neurons contained melanin-concen- trating hormone, and stimulating them (using a technique called opto- genetics) induced sleep — opposite to the effect of stimulating orexin neu- rons. A balance between the activation of orexin neurons and their neighbor- ing neurons could control the tran- sition between waking and sleeping. These findings will be important in developing treatments for narcolepsy. AROUSAL Think about what happens in your body and mind when you speak in front of a crowd — your brain state is very different from when you are asleep. Perhaps you notice changes in your breathing, heart rate, or stomach. Maybe your thoughts are racing or panicked. Or maybe you are energized and excited to perform for your audience. These are exam- ples of the complex brain state called arousal. Rather than merely being awake, arousal involves changes in the body and brain that provide motivations to do an action — teaching a class, speaking in public, or focusing your attention. People experience arousal daily when searching for food while hungry, or when talking with other people (social interaction). Arousal is also important for reproduction and for avoiding danger. The level of arousal varies across a spectrum from low to high. When arousal falls below a certain threshold we can transition from wake to sleep, for example. But under heightened arousal, like intense anxiety, we cannot reach this threshold and we stay awake. Neurotransmitters During arousal, the brain must de- vote resources to specific brain regions, much as an emergency call center redirects resources like ambulances and fire trucks during a fire. Specific types of neurons in the brain regions involved in arousal release multiple neurotransmitters, telling the rest of the brain and the body to be on alert. These neurotransmitters are dopamine (for movement), norepinephrine (for alertness), serotonin (for emotion), and acetylcholine and histamine, which help the brain communicate with the body to increase arousal. Sensory Input While neurotransmitters provide the internal signals for arousal, external signals from the outside world — like the bright lights (visual input) and cheering crowds (auditory input) at a stage performance — can also stimu- late arousal. Sensory input gets sorted in the brain region called the thala- mus. Often called a “sensory clearing house,” the thalamus regulates arous- al, receiving and processing sensory inputs from brain regions important in senses like vision and hearing and relaying these inputs to the cortex. Autonomic Nervous System Once the brain is aroused, what does the body do? The reticular activating system, in the brainstem, co- ordinates signals coming from sensory inputs and neurotransmitters to make sense of events in the brain and pass that information to the rest of the body. The reticular activating system specifically controls the autonomic nervous system, which affects heart rate, blood flow, and breathing. By controlling these automatic body pro- cesses, the reticular activating system 6564Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Brain States 9Brain States9 sets up the physical state of arousal, bringing important resources like oxy- gen and nutrients to parts of the body where they are needed. Together, the changes that happen in the brain and body during arous- al enable us to be alert and focused, which helps us process information quickly. Using this information, we can choose the appropriate emotional response or physical action for a given situation. Sexual Arousal Several complex brain systems and endocrine (hormone) systems contrib- ute to sexual arousal and behaviors, but the brain regions, neurotransmitters, and body systems are similar to those involved in general arousal. The dis- tinguishing factor is that sexual arousal also involves hormones such as estrogen and testosterone, which then activate neurons that release the same neu- rotransmitters that are released during general arousal. Many human and ani- mal studies report interactions between sex hormones and neurotransmitters dopamine, serotonin, GABA, and glutamate. Researchers have also found that brain regions such as the hypo- thalamus, amygdala, and hippocampus contain many estrogen and progester- one receptors, and brain regions that mediate feelings of reward (nucleus accumbens) and emotions like pleasure (amygdala) motivate sexual behaviors. Overall, the primary involvement of sex hormones is a key in defining the brain state of sexual arousal. ATTENTION If you are paying attention right now, there should be detectable changes in your heart rate, breathing, and blood flow. If that sounds familiar, it’s because those same physiological changes occur during arousal, which is necessary for being alert and paying attention. As mentioned previously, the state of arousal calls for reactions to the environment. To make deci- sions about what to do, you need to focus on what’s happening in the environment, especially involving anything relevant to your goals. For example, if your goal is to run away from an angry bear, you need to be alert and pay attention to where you’re running so you don’t trip and fall. Scientists have theorized that the state of arousal speeds processing and improves comprehension of environ- mental details. Otherwise, your brain would need an infinite amount of time and energy to process all of its sensory inputs (sounds, sights, smells, and other feelings), because the environment is always changing. Focus Even with multitasking, it is impossible for the brain to process all its sensory inputs. Instead, people focus their attention on one thing at a time. Attention is a fascinating abil- ity, because it enables you to have so much control and the ability to fine- tune your focus to different locations, times, and topics. Consider the page you are reading right now. Although you can see the whole page, you focus on only one line at a time. Alterna- tively, you can turn your attention to the past — just minutes ago when you were reading about arousal. Or you can ignore the sentences alto- gether and focus on the number of times the word “you” occurs on this page. Scientists recognize two types of attention, which involve different brain processes: voluntary (endog- enous) attention and involuntary (exogenous) attention. Voluntary attention happens when you choose what to focus on — like finding a loved one in a crowd. The frontal and parietal cortices of the brain are active when you control your attention or direct it towards a specific object or location. Involun- tary attention occurs when something in the environment (like a sudden noise or movement) grabs your atten- tion. Involuntary attention is a dis- traction from your chosen goals and, in fact, researchers often use distrac- tor objects in attention experiments. Distractors can be emotional, like pictures of family, or non-emotional images that stand out from other stimuli, like a red circle surrounded by gray squares. Brain regions in the right hemisphere, collectively known as the ventral frontoparietal network, form a system that processes new and interesting stimuli that distract you from the task at hand. Research on at- tention can help us understand visual tasks, learning, child development, and disorders of attention. Disorders of Attention Paying attention for long periods of time, such as a 3-hour lecture, can be difficult for many people. For some people, even focusing for a short time can be hard. Several disorders that affect the ability to pay attention are attention deficit hyperactivity disorder (ADHD), schizophrenia, prosopagnosia, and hemineglect syndrome. It may seem strange to regard schizophrenia as an attention disturbance, but some psychiatric studies suggest that it involves a failure of selective attention. Prosopagnosia, or face blindness, is a cognitive disorder in which a person is unable to recognize faces — even their own family members. The severity of this condition varies, and genetic factors might be involved. Attention disorders have various causes, but we will focus on hemineglect syndrome, caused by damage to the right parietal cortex, a brain region important in involuntary attention. Between 50–82 percent of pa- tients who suffer stroke in the right hemisphere experience hemineglect syndrome, also known as spatial ne- glect and unilateral neglect. In these cases, patients with neglect ignore the left side of their visual field. Some- times they ignore the left side of the body and the left side of individual objects, as well. Diagnosis of hemine- glect syndrome can be done with a pen and paper. For example, patients can be instructed to draw a copy of a picture like a butterfly or a castle, and those patients with hemineglect usually draw only the right half of the picture or leave out details of the left side. Research on patients with hemineglect syndrome contributes to our understanding of rehabilitation after stroke, as well as the role of the right parietal cortex in attention and perception. REST: DEFAULT MODE NETWORK What is the difference between being alert and resting while awake? During times of rest and relaxation, you’re usually avoiding heavy thinking or complicat- ed tasks, and parts of the brain called the default mode network are more active. You may think of the default mode network as a personal lullaby or a playlist that turns on when you are ready to relax. Activity of the default mode network decreases (the lullaby gets quieter) when you start doing or thinking about a demanding task. Human studies using imaging tech- niques such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have identified which brain regions belong to the default mode network. These brain areas, which are involved in emotion, personality, introspection, and memory, include frontal brain regions (ventromedial prefrontal cortex, dorsomedial prefrontal cortex, and anterior cingulate cortex), as well as the posterior cingulate cortex, lateral parietal cortex, and precuneus. Although the exact role of the default mode network is unclear, the functions of its “participating” brain regions provide hints about its purpose. Studies on emotion have revealed that activity in the ventro- medial PFC is directly related to how anxious a subject feels while performing a task — suggesting that the default mode network may play a role in regulating emotion and mood. Activity in the dorsomedial PFC (a region involved in self-referential or introspective thoughts) increases when a person is at rest and day- dreaming. The dorsomedial PFC is also involved in stream-of-conscious- ness thoughts and thoughts about oneself in the past, present, or future (autobiographical self ). The roles of these regions suggest that the default mode network may also function in self-reflection and our sense of self in time. The posterior brain regions of the default mode network (posterior cin- gulate cortex, lateral parietal cortex, and precuneus) become more active when remembering concrete mem- ories from past experiences. These brain regions are connected with the hippocampus, which is important for learning and forming memories. Both the hippocampus and the default mode network are more active when a person is at rest in the evening and less active when waking up early in the day. These patterns indicate that the default mode network helps to process and remember the events of the day. Future studies using electrical re- cordings from inside the human brain can be paired with fMRI to tell us more about the brain activity patterns of the default mode network and how brain regions coordinate their activity during tasks that utilize the functions of this network. Scientists recognize two types of attention, which involve different brain processes: voluntary attention and involuntary attention. 67Brain Factssociety for neuroscience | The Body in Balance 10 The cells of your body are immersed in a constantly changing environment. The nutrients that sustain them rise and fall with each meal. Gases, ions, and other solutes flow back and forth between your cells and blood. Chemicals bind to cells and trigger the building and re- lease of proteins. Your cells digest food, get rid of wastes, build new tissues, and destroy old cells. Environmental changes, both internal and external, ripple through your body’s physio- logical systems. One of your brain’s less-visible jobs is to cope with all these changes, keep them within a normal range, and maintain the healthy func- tions of your body. The tendency of your body’s tissues and organ systems to maintain a condi- tion of balance or equilibrium is called homeostasis. Homeostasis depends on active regulation, with dynamic adjustments that keep the environ- ment of your cells and tissues relatively constant. The brain is part of many homeostatic systems, providing signals that coordinate your body’s internal clocks and regulating hormone secre- tion by the endocrine system. These functions often involve a region of the forebrain called the hypothalamus. CIRCADIAN RHYTHMS Almost every cell in your body has an internal clock that tells it when to become active, when to rest, and when to divide. These clocks broker changes in many of the body’s physiological systems over a 24-hour, or circadian, period. For example, the clocks cause faster pulses of peristaltic waves in your gut during the day and make your blood pressure dip at night. But because these clocks are deep inside your body and cannot detect daylight, none of them can tell time CHAPTER The Body in Balance 10 on its own. Instead, daily rhythms are coordinated by the suprachiasmatic nucleus (SCN), a tiny group of neurons in the hypothalamus. Neurons in the SCN act like a met- ronome for the rest of the body, emit- ting a steady stream of action potentials during the day and becoming quiet at night. The shift between active and silent states is controlled by cyclic in- teractions between two sets of proteins encoded by your body’s “clock” genes. Researchers first identified clock genes in the fruit fly Drosophila melanogaster and studied how they keep time; since then, a nearly identical set of genes has been found in mammals. The SCN also tracks what time it is based on signals it receives from photoreceptors in the retina, which keeps its activity in sync with the Earth’s actual day/night cycle. That little nudge is very important be- cause, on their own, clock proteins take slightly more than 24 hours to complete a full cycle. Studies of animals deprived of light have discovered that they go to sleep and wake up a bit later each day. An autonomic neural pathway ties the daily rhythmic activity of the SCN directly to other clocks in the body. Neurons in the SCN stimulate an adjacent region of the brain called the paraventricular nucleus (PVN), which in turn sends signals down a chain of neurons through the spinal cord to the peripheral organs of the body. You’ve al- ready learned how signals in part of this neural pathway stimulate orexin neu- rons to regulate the body’s sleep/wake cycle. Related pathways also govern the secretion of melatonin, a hormone that influences sleep behaviors. Specifically, electrical activity originating in the SCN enters the PVN’s neural network and sends signals up to the pineal gland, a small pinecone-shaped gland embedded between the cerebral hemispheres. The pineal gland secretes melatonin into the bloodstream at night. Melatonin binds to cells in many tissues, and although it has no direct effect on clock gene expression in the SCN, its systemic effects seem to reduce alertness and increase sleepiness. Light exposure trig- gers signals that stop melatonin secre- tion, promoting wakeful behaviors. Together, these signals keep all the body’s clocks synchronized to the same 24-hour cycle. Coordinated body clocks enable your body’s physiological systems to work together at the right times. When your body prepares to wake from sleep, 1) levels of the stress hormone cortisol peak in the blood, releasing sugars from storage and increasing appetite, and 2) core body temperature begins to drift upwards, raising your body’s metabolic rate. These events, synchronized with others, prepare your body for a new day’s activity. Desynchronizing the body’s phys- iological clocks can cause noticeable and sometimes serious health effects. You might have experienced a familiar example of circadian rhythm distur- bance: jet lag. After crossing many time zones in a short time period, a person’s patterns of wakefulness and hunger are out of sync with day and night. Exposure to the local day/night cycle resets the brain and body, but it can take several days to get fully resynchro- nized. Circadian rhythms can also be disturbed by situations like late-shift jobs or blindness, which decouple nor- mal daylight signals from wake/sleep cycles. Long-term circadian disruptions are associated with health problems including weight gain, increased rates of insomnia, depression, and cancers. HORMONES, HOMEOSTASIS, AND BEHAVIOR Neurons can quickly deliver the brain’s messages to precise targets in the body. Hormones, on the other hand, deliver messages more slowly but can affect a larger set of tissues, producing large- scale changes in metabolism, growth, and behavior. The brain is one of the tissues that “listens” for hormonal signals — neurons throughout the brain are studded with hormone receptors — and the brain’s responses play an important part in regulating hormone secretion and changing behaviors to keep the body systems in Coordinated body clocks enable your body’s physiological systems to work together at the right times. Brain Factssociety for neuroscience |Brain Facts society for neuroscience| The Body in Balance 10The Body in Balance1068 equilibrium. The brain regions involved in hormone release are called the neuroendocrine system. The hypothalamus oversees the production and release of many hor- mones through its close ties to the pi- tuitary gland. The paraventricular and supraoptic nuclei of the hypothalamus send axons into the posterior part of the pituitary gland; activation of spe- cific neurons releases either vasopressin or oxytocin into capillaries within the pituitary. Both of these molecules act as neurotransmitters inside the brain, but they are also hormones that affect distant tissues of the body. Vasopressin (also called antidiuretic hormone) in- creases water retention in the kidneys and constricts blood vessels (vasocon- striction). Oxytocin promotes uterine contractions during labor and milk release during nursing. Other hypothalamic regions send axons to a capillary-rich area above the pituitary called the median eminence. When these neurons are activated, they release their hormones into the blood. These releasing (and inhibiting) hormones travel through local blood vessels to the anterior pituitary, where they trigger (or inhibit) secretion of a second specific hormone. Of the seven anterior pituitary hormones, five are trophic hormones — these travel in the bloodstream to stimulate activity in specific endocrine glands (thyroid, adrenal cortex, ovaries, etc.) throughout the body. The remaining two hormones act on non-endocrine tissues. Growth hormone stimulates the growth of bone and soft tissues, and prolactin stimulates milk produc- tion by the breasts. Hormones released from the anterior pituitary influence growth, cellular metabolism, emotion, and the physiology of reproduction, hunger, thirst, and stress. Many hormones produced by the pituitary and its target endocrine glands affect receptors inside the brain — thus, these hormones can alter neuronal function and gene transcrip- tion in the hypothalamus. The effect is to reduce the amount of hormone released by the hypothalamus when those circuits become active. These negative feedback loops enable precise doses of hormones to be delivered to body tissues, and ensure that the hor- mone levels are narrowly regulated. One of these three-hormone cascades regulates reproduction in mammals. Its underlying pattern is the same in both sexes: 1) gonadotropin- releasing hormone (GnRH) from the hypothalamus makes the anterior pi- tuitary release 2) luteinizing hormone (LH) and follicle stimulating hormone (FSH), which in turn make the gonads secrete 3) sex hormones and start the development of mature eggs or sperm. The neuroendocrine system maintains homeostasis, the body’s normal equilibrium, and controls the response to stress. The adrenal gland releases the stress hormones norepineph- rine, epinephrine, and cortisol, which quicken heart rate and prepare muscles for action. Corticotrophin releasing hormone (CRH) is released from the hypothalamus and travels to the pituitary gland, where it triggers the release of adrenocorticotropic hormone (ACTH). ACTH travels in the blood to the adrenal glands, where it stimulates the release of cortisol. 69 Sex hormones, in turn, attach to receptors in the hypothalamus and an- terior pituitary and modify the release of the hypothalamic and pituitary hormones. However, sex hormones regulate these feedback loops differ- ently in males and females. Male sex hormones induce simple negative feedback loops that reduce the secretion of gonadotropin-releas- ing hormone, luteinizing hormone, and follicle stimulating hormone. The interplay among these hormones creates a repetitive pulse of GnRH that peaks every 90 minutes. The waxing and wan- ing of GnRH keeps testosterone levels relatively steady within body tissues, maintains male libido, and keeps the testes producing new sperm each day. Female feedback patterns are more complex. Over the course of the month-long menstrual cycle, female sex hormones exert both positive and nega- tive feedback on GnRH, FSH, and LH. When circulating levels of the female sex hormones estrogen and progesterone are low, rising follicle stimulating hormone levels trigger egg maturation and estrogen production. Rising estrogen levels induce luteiniz- ing hormone levels to rise. As the levels of female sex hormones rise, they exert negative feedback on FSH secretion, limiting the number of eggs that ma- ture in a month, but positive feedback on LH, eventually producing the LH surge that triggers ovulation. After ovulation, high serum levels of sex hor- mones again exert negative feedback on GnRH, FSH, and LH which in turn reduces ovarian activity. Levels of fe- male sex hormones therefore decrease, allowing the cycle to start over again. Many other hormones are not regulated by the pituitary gland, but are released by specific tissues in response to physiological changes. The brain contains receptors for many of these hormones but, unlike pituitary hormones, it does not directly regulate their secretion. Instead, when these hormones bind to receptors on neu- rons, they modify the output of neural circuits, producing behavioral changes that have homeostatic effects. One example of this is a pair of hormones called leptin and ghrelin. Leptin and ghrelin change eating behavior by regulating food intake and energy balance. Both hormones affect hunger, and both are released in response to changes in an animal’s internal energy stores. However, they have different effects on the circuits they regulate. Ghrelin keeps the body fed. Released by the wall of the gastrointestinal tract when the stom- ach is empty, ghrelin activates hunger circuits in the hypothalamus that drive a search for food. Once the stomach is full, ghrelin production stops, reduc- ing the desire to eat. In contrast, leptin helps maintain body weight within a set range. Leptin is produced by fat cells and is released when fat stores are large. When it binds to neurons in the hypothalamus, leptin suppresses the activity of hunger circuits and reduces the desire to eat. As fat stores are used up, leptin levels decline, driving be- havior that makes an animal eat more often and replenish its fat stores. STRESS Your body reacts in stereotyped ways when you feel threatened. You breathe faster, your heartbeat speeds up, your muscles tense and prepare for action. These reactions may have helped our ancestors run from preda- tors, but any stressful situation — ar- guing with your parents, a blind date, a looming deadline at work, abdominal cramps, discovering your apartment was robbed, trying karaoke for the first time — has the potential to set them off. Scientists call this reaction the stress response, and your body turns it on to some degree in response to any external or internal threat to homeostasis. The Stress Response The stress response weaves togeth- er three of the brain’s parallel com- munication systems, coordinating the activity of voluntary and involuntary nervous systems, muscles, and metabo- lism to achieve one defensive goal. Messages sent to muscles through the somatic (voluntary) nervous system prime the body to fight or run from danger (the fight-or-flight response). Messages sent through the autonomic (involuntary) nervous system redirect nutrients and oxygen to those mus- cles. The sympathetic branch tells the adrenal medulla to release the hor- mone epinephrine (also called adren- aline), which makes the heart pump faster and relaxes the arterial walls that supply muscles with blood so they can respond more quickly. At the same time, the autonomic system’s parasym- pathetic branch restricts blood flow to other organs including the skin, gonads, digestive tract, and kidneys. Finally, a cascade of neuroendocrine hormones originating in the hypothal- amus and anterior pituitary circulates in the bloodstream, affecting processes like metabolic rate and sexual func- tion, and telling the adrenal cortex to release glucocorticoid hormones — like cortisol — into the blood. Glucocorticoid hormones bind to many body tissues and produce wide- spread effects that prepare the body to respond to potential threat. These hor- mones stimulate the production and release of sugar from storage sites such as the liver, making energy available to Brain Facts society for neuroscience| The Body in Balance1070 muscles. They also bind to brain areas that ramp up attention and learning. And they help inhibit nonessential functions like growth and immune responses until the crisis ends. It’s easy to imagine how (and why) these physiological changes make your body alert and ready for action. But when it comes to stress, your body can’t tell the difference between the danger of facing down a bull elephant and the frustration of being stuck in traffic. When stress is chronic, whatever its cause, your adrenal glands keep pump- ing out epinephrine and glucocorti- coids. Many animal and human studies have shown that long-term exposure to these hormones can be detrimental. Chronic Stress Overexposure to glucocorticoids can damage a wide range of physiological systems. It can cause muscles to atrophy, push the body to store energy as fat, and keep blood sugar abnormal- ly high — all of these can worsen the symptoms of diabetes. Overexposure to glucocorticoids also contributes to the development of hypertension (high blood pressure) and atherosclerosis (hardening of the arteries), increasing the risk of heart attacks. Because the hormones inhibit immune system function, they also reduce resistance to infection and inflammation, some- times pushing the immune system to attack the body’s own tissues. Chronic stress can also have specif- ic negative effects on brain tissue and function. Persistently high levels of glucocorticoids inhibit neuron growth inside the hippocampus, impairing the normal processes of memory forma- tion and recall. Stress hormones can also suppress neural pathways that are normally active in decision-making and cognition, and speed the deteri- oration in brain function caused by aging. They may worsen the damage caused by a stroke. And they can lead to sleep disorders — cortisol is also an important wakeful signal in the brain, so the high cortisol levels due to chronic stress may delay sleep. Stress-induced insomnia can then start a vicious cycle, as the stress of sleep deprivation leads to the release of even more glucocorticoids. The effects of chronic stress may even extend beyond a single indi- vidual, because glucocorticoids play important roles in brain development. If a pregnant woman suffers from chronic stress, the elevated stress hor- mones can cross the placenta and shift the developmental trajectory of her fetus. Glucocorticoids are transcription factors, which can bind to DNA and modify which genes will be expressed as proteins. Studies with animal mod- els have shown that mothers with high blood levels of glucocorticoids during pregnancy often have babies with low- er birth weights, developmental delays, and more sensitive stress responses throughout their lives. Because metabolic stressors such as starvation induce high glucocorticoid levels, it’s been suggested that these hormones might help prepare the fetus for the environment it will be born into. Tough, stressful environments push fetuses to develop stress-sensitive “thrifty” metabolisms that store fat eas- ily. Unfortunately, these stress-sensitive metabolisms increase a person’s risk of developing chronic metabolic diseases like obesity or diabetes, especially if they subsequently grow up in lower-stress environments with plentiful food. The effects of stress can even be passed to subsequent generations by epigenetic mechanisms. Chronic stress can change the markers on DNA molecules that indicate which of the genes in a cell are expressed and which are silenced. Some animal studies indicate that when changes in markers occur in cells that develop into eggs or sperm, these changes can be passed on and expressed in the animal’s offspring. Further research might reveal wheth- er chronic stress has similar effects in humans, and whether inheriting silenced or activated genes contributes to family histories of cancer, obesity, cardiovascular, psychiatric, or neurode- velopmental disease. Chronic stress can also have specific negative effects on brain tissue and function. AUTISM SPECTRUM DISORDERS Autism is often considered a childhood condition, although many of its symptoms persist lifelong. Some people with autism also have mood and anxiety disorders, seizures, intellectual disability, attention deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD). However, more than 40 percent of people with autism have normal or above-average intelligence. With symptoms that range from mildly to severely disabling, autism is considered a spectrum. Autism spectrum disorders (ASD) are diagnosed based on two main criteria: impaired social commu- nication and interaction, and repetitive behaviors or narrow, obsessive inter- ests. For example, some people on the autism spectrum are unable to speak, while others are socially awkward but highly articulate. Many adults with an autism diagnosis think of their autism as a strength — enabling or motivating them to develop deep expertise in an area or a different perspective on the world — rather than a disorder that needs to be cured. Currently, 1 of every 68 American 8-year-olds is estimated to meet the diagnostic criteria for an autism spec- trum disorder. The prevalence of ASD has risen dramatically since the 1970s, but it is unclear whether changes to diagnostic criteria and wider recogni- tion of ASD have contributed to the increase in diagnoses. Four to five times more boys than girls are diagnosed with autism, although it is not clear whether some of that pattern is because of underdi- agnosis of girls. Environmental factors such as parents having children later in life, fever and infection during preg- nancy, and premature birth have been CHAPTER Childhood Disorders 11 71Brain Facts 7372Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Childhood Disorders 11Childhood Disorders11 linked to an increased risk of autism in children. A huge number of studies have found no connection between childhood vaccination and the increase in autism diagnoses. Autism is believed to be at least partially driven by genetics, but how do scientists know that for sure? One low-tech approach uses twin studies: If one of a pair of identical twins receives an autism diagnosis, the other twin has greater than a 50 percent chance of also being diagnosed with ASD. Children who have an older sibling on the spectrum also have a higher likelihood of being diagnosed with autism — nearly one in five also receives a diagnosis of ASD. The genetics of autism is very complicated in most cases, involving dozens (or more) of genes, leading to a unique condition in nearly every person. Recently, however, high-throughput genomic analyses have broadened the pool of potential genes, revealed their roles in the body, and suggested possible new therapies. It appears that many genes, each with a small effect, contribute to the inheritance of most ASDs. But such small effects make these genes hard to identify in genome-wide association studies. Scientists are now looking at the rare variants associated with ASD. These afflict fewer people with ASD, but their effects are larger and easier to detect. Some of these rare mutations are in single genes whose impairment is already known to cause intellectu- al disability and social dysfunction. These genes include FMR1 (codes for fragile X mental retardation protein, but its non-mutant form is needed for normal cognitive development); PTEN (codes for a tumor suppressor enzyme that regulates cell division, so cells don’t divide or grow too fast); and TSC1 or TSC2 (tuberous sclerosis complex 1 and 2), which also code for proteins that help control cell growth and size. Between 50 to 60 percent of people with fragile X syndrome and approximately 40 percent of people with tuberous sclerosis complex have ASD. Children with a variant of the gene NF-1 develop tumors in child- hood (neurofibromatosis) and a 2011 study found that nearly 10 percent met the criteria for autism. Intriguingly, these ASD-related genes influence a major signaling pathway for regulating cell metabo- lism, growth, and proliferation, the mTOR pathway. This suggests a very real potential for treating autism with drugs that target the mTOR pathway. For example, mouse models with mutations in PTEN show traits simi- lar to humans with these gene vari- ants: altered sociability, anxiety, and repetitive behaviors. These behaviors can be relieved or reversed by drugs that inhibit the mTOR pathway. Clinical trials of these drugs (rapamy- cin and lovastatin) are underway. Despite this progress, autism genetics is so complicated that it can’t be used to diagnose the condition. And unlike diabetes, kidney disease, or thyroid disease, there are no biochem- ical or other biomarkers of autism. Currently, autism diagnosis is based on behavioral analysis, but efforts are un- derway to use more objective criteria such as tracking eye movements and functional neuroimaging, which can even be done in infants. How early can autism be detect- ed? Parents often notice develop- mental issues before their child’s first birthday, and autism can be reliably diagnosed based on behavioral characteristics at age 2. Despite these possibilities for early detection, most American children aren’t diagnosed until they’re about 4½ years old. With evidence mounting that interventions are more effective the earlier they be- gin, researchers are hoping that more objective measures will enable earlier diagnoses and interventions. Although the molecular caus- es and characteristics of autism are unclear, it appears that the condition results from unusual cellular develop- ment within the cerebral cortex — a brain region that is crucial to mem- ory, attention, perception, language, and other functions. Both white and gray matter of the brain show consistent, but subtle, alterations in people with ASD. Long-term studies also have found that a minority of children on the autism spectrum have abnormally large brain volumes and faster brain growth. Other toddlers with autism have shown unusual development and network inefficien- cies at the back of the cerebral cortex. There is evidence that some atypical activity occurs in the cortex of people with ASD from older childhood into adulthood, and information might not be integrated in the usual way across distributed brain networks. At this point, no medications have been proven to reverse autism. Some people get symptomatic relief from drugs designed for other uses, such as anxiety conditions, and several stud- ies have reported social benefits from treatment with oxytocin — a hormone known to improve social bonding — but the findings have been mixed. For this challenging disorder, behavioral therapies are still the only proven treat- ments for autism, and early interven- tions are the most effective. ATTENTION DEFICIT HYPERACTIVITY DISORDER Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed childhood conditions. In 2014, approximately 11 percent of American parents with a child between the ages of 4 and 17 reported that their son or daughter had received an ADHD diagnosis. In at least 30 percent of those diagnosed with ADHD, the disorder continues into adulthood. ADHD is usually characterized by inattentiveness, as well as hyperactivity or impulsive behaviors. Although all young children can be hyperactive, impulsive, and inattentive from time to time, these symptoms are more extreme and last longer in children with ADHD. They often struggle to form strong friendships, and their grades in school can reflect their behavior instead of their academic ability. Executive functions, such as finishing what they start, remembering to bring homework back to school, and following multistep directions, can be especially challenging for those with ADHD. Young people with ADHD also have lower rates of high school graduation and a higher risk of suicide. No objective diagnostic test exists for ADHD, so diagnosis requires a comprehensive evaluation, including a clinical interview and parent and teacher ratings. Because problems with attention and hyperactivity can be caused by other conditions such as depression, sleep issues, and learning disorders, careful evaluation is always needed to determine whether ADHD is truly the cause of the symptoms. To warrant an ADHD diagnosis, atten- tion and behavioral problems must be severe enough that they interfere with normal functioning. In addition, the behavioral issues must be present in more than one context — not only at home or at school, but in both settings. Although ADHD tends to run in families, no well-defined set of genes is known to be responsible for the condition. Environmental risk factors, such as extreme early adversity, expo- sure to lead, and low birthweight, can also be involved. People with ADHD do not demonstrate any obvious brain alterations, but research has found that people with ADHD might have dif- ferences in the structure of brain cells and in the brain’s ability to remodel itself. Some people with ADHD show unusual activity in brain cells that re- lease dopamine, a chemical messenger involved in rewarding behavior. ADHD has no cure, but treat- ments include drugs, behavioral interventions, or both. Interestingly, ADHD medications include stimu- lants such as methylphenidate, as well as newer, non-stimulant drugs. The drugs are available in long-acting for- mulations so children do not have to interrupt the school day to take their medication. Determining the right drug and the right dose might require a period of experimentation and sup- port from a specialist, since dosage is adjusted to how fast a child metaboliz- es the drug, and to minimize the side effects. Nevertheless, most children with ADHD are diagnosed and treated by their pediatricians. Effective behav- ioral treatments include organizational support, exercise, and meditation. DOWN SYNDROME Down syndrome is named for the English physician who first described it in 1866, but nearly 100 years passed before scientists determined what caused the condition: possessing an extra copy of all or part of the 21st chromosome. People with this syn- drome have three copies of this genetic material, instead of two. In some cases, the extra copy, or trisomy, does not occur in every cell, producing what’s known as mosaicism. Currently, about 250,000 people in the United States are living with Down syndrome. There is no clear cause of the genetic glitch, although maternal age is a major risk factor for Down syn- drome. Mothers older than 40 are 8.5 times more likely to have a child with Down syndrome than mothers aged 20 to 24. Advanced paternal age has also been linked to higher incidence of Down syndrome. The genetics of autism is very complicated in most cases, involving dozens of genes, leading to a unique condition in nearly every person. 7574Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Childhood Disorders 11Childhood Disorders11 Since late 2011, fetuses can be screened for Down syndrome using the mother’s blood. In the past, the risk of test procedures meant that only older mothers (whose likelihood of having a Down syndrome child was known to be higher) should be screened. Younger mothers didn’t know until delivery whether their child would have Down syndrome. The new blood test, unlike amniocentesis and chorionic villus sampling, poses no risk to the baby, so it can also be used for younger moth- ers whose chance of having a child with Down syndrome is quite small. Children born with Down syn- drome have distinctive facial features, including a flattened face and bridge of the nose, eyes that slant upward, and small ears. They usually have small hands and feet, short stature, and poor muscle tone as well. The intellectual abilities of people with Down syndrome are typically low to moderate, although some graduate from high school and college, and many successfully hold jobs. Other symptoms of Down syndrome can include hearing loss and heart defects, and virtually everyone born with Down will develop early-on- set Alzheimer’s disease, often in their 40s or 50s. Chromosome 21 contains the gene that encodes amyloid precur- sor protein (APP), an Alzheimer’s dis- ease risk factor, and possessing an extra copy of this gene might cause the early onset of this fatal disease. Interestingly, people with mosaic Down syndrome seem to have milder symptoms and are more likely to live past 50. There is no real treatment for Down syndrome, nor any clear expla- nation of what occurs in the brain. Poor connections among nerve cells in the hippocampus, the part of the brain involved in memory (and the first brain area affected by Alzheimer’s disease), are believed to be a key factor in brain or intellectual differences in Down syn- drome. Dysfunction in the mitochon- dria, the cell’s power plants, might also play a role in development of related disorders that involve energy metabo- lism, such as diabetes and Alzheimer’s. Scientists have grown stem cells from fetuses with Down syndrome and used them to test potential treatments and confirm which molecular path- ways are involved in the condition. In one such laboratory study, researchers took a gene that normally inactivates the second X chromosome in female mammals and spliced it into a stem cell that had three copies of chromosome 21. In these cells, the inactivation gene muted the expression of genes on the extra chromosome 21, believed to con- tribute to Down syndrome. Although this is a long way from any clinical ap- plications, the model is being used to test the changes and cellular problems that occur with the tripling of the 21st chromosome, in hopes of eventually finding a treatment. DYSLEXIA Dyslexia is the most common and best-studied of the learning disabilities, affecting as many as 15 to 20 percent of all Americans. People with dyslexia have a pro- nounced difficulty with reading despite having normal intelligence, education, and motivation. Symptoms include trouble with pronunciation, lack of fluency, diffi- culty retrieving words, poor spelling, and hesitancy in speaking. People with dyslexia might need more time to respond orally to a question and might read much more slowly than their peers. Dyslexia is usually diagnosed in elemen- tary school, when a child is slow to read or struggling with reading. Although reading skills and fluency can improve, dyslexia persists lifelong. Deciphering printed letters and words and recalling their sounds and meaning involves many areas of the brain. Brain imaging studies indicate these areas can be less well connected in people with dyslexia. One of these areas is a region on the left side of the brain called the “word-form area,” which is involved in the recognition of printed letters and words. People with dyslexia also show less brain activity in the left occipitotemporal cortex, which is considered essential for skilled read- ing. Researchers believe that the brain differences are present before the read- ing and language difficulties become apparent — although it is possible that people with dyslexia read less and, therefore, their brains develop less in regions associated with reading. Those with dyslexia appear to compensate for reduced activity on the left side of the brain by relying more heavily on the right side. Genetic analyses have revealed a handful of susceptibility genes, with animal models suggesting that these genes affect the migration of brain cells during development, leading to differences in brain circuitry. Dyslexia runs in families, with roughly half of dyslexics sharing the condition with a close relative. When one twin is diagnosed with dyslexia, the second twin is found to have the condition 55-70 percent of the time. But the genetics of dyslexia is complex, and likely involves a wide range of genes and environmental factors. Treatment for dyslexia involves behavioral and educational interven- tion, especially exercises like breaking words down into sounds and linking the sounds to specific letter patterns. Some researchers use a child’s ability to rapidly and automatically name things as an early indicator of dyslexia. This rapid automatic naming, and the ability to recognize and work with the sounds of language, are often impaired in people with dyslexia. Both skills can be used in preschoolers and kinder- gartners to predict their later reading skills. Research suggests that treat- ments targeting phonology, as well as multiple levels of language skills, show the greatest promise. EPILEPSY If someone has two or more seizures that cannot be explained by a temporary underlying medical condi- tion such as a high fever or low blood sugar, their medical diagnosis will be “epilepsy” — from the Greek words meaning to “seize,” “attack,” or “take hold of.” About 1 percent of Ameri- can children and 1.8 percent of adults have been diagnosed with this brain disorder. Seizures result from irregular activities in brain cells that can last five or more minutes at a time. Some seizures look like staring spells, while others cause people to collapse, shake, and become unaware of what is going on around them. The pattern of symp- toms and after-seizure brain recordings using EEGs are used to distinguish between different types of epilepsy and determine whether the true cause of the seizures is epilepsy or a different medical condition. Seizures are classified by where they occur in the brain. General- ized seizures affect both sides of the brain. They include absence or petit mal seizures, which can cause rapid blinking or a few seconds of staring into space, and tonic-clonic or grand mal seizures, which can make some- one fall, have muscle spasms, cry out, and/or lose consciousness. Focal or partial seizures are localized to one area of the brain. A simple focal sei- zure can cause twitching or a change in sensation, triggering strange smells or tastes. Complex focal seizures can leave a person confused and unable to answer questions or follow direc- tions. A person can also have so-called secondary generalized seizures, which begin in one part of the brain but spread to become generalized seizures. In some patients with severe epilepsy, multiple types of seizure can occur at the same time. Epilepsy has many possible causes and thus is considered a spectrum rather than a single disorder. Causes include premature birth, brain trauma, and abnormal development due to genetic factors. Attributes of epilepsy patients such as head size, movement disorders, and family history suggest that genetics is involved. Seizures can also accompany or cause intellectual or psychiatric prob- lems. For example, some seizures may suppress the growth of dendrites, leav- ing the person emotionally unsettled or less able to learn. Treatments for epilepsy are direct- ed toward controlling seizures with medication or diet. For most patients, a single medication is enough to control seizures, although a significant minority cannot get adequate control from drugs. About half of epilepsy pa- tients, particularly those with general- ized epilepsy, can reduce their seizures by eating a ketogenic diet, which relies heavily on high-fat, low-carbohydrate foods, although it’s unclear why this diet is effective. For severe cases that are not relieved by medication, doctors might recommend surgery to remove or inactivate the seizure-initiating part of the brain. In the most severe cases, if one side of the brain triggers sei- zures on the other side, surgeons may perform “split-brain surgery,” cutting the corpus callosum, a thick band of white matter that connects the two sides of the brain. Once their seizures are controlled, people with epilepsy can resume their normal lives. Epilepsy has many possible causes and thus is considered a spectrum rather than a single disorder.","Base your entire response on the document I gave you. I need to know the absolute basic information about what is being said here. What are some effects of overexposure to glucocorticoids? 5756Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Adult & Aging Brain 8Adult & Aging Brain8 memory, which requires a high degree of synaptic plasticity. The loss of thin dendritic spines could impair neuro- nal communication and contribute to cognitive decline. So far, direct evidence of their role in cognitive decline is lacking, and more studies are needed. Finally, the formation of new neurons also declines with age. Although neurogenesis was once believed to halt after birth, we now know of two brain regions that con- tinue to add new neurons through- out life: the olfactory bulbs and the dentate gyrus of the hippocampus. Studies suggest that the rate of neu- rogenesis plummets with age in mice, but recent human studies suggest a more modest decline. It is not yet clear whether neurogenesis apprecia- bly affects cognition in the aging hu- man brain, but mouse studies indicate that strategies that boost neurogenesis can enhance cognitive function. Chemical Changes The amount of neurotransmit- ters and the number of their recep- tors might also decline with age. Several studies have reported that less dopamine is synthesized in the aged brain, and there are fewer re- ceptors to bind the neurotransmitter. Less robust evidence indicates that the amount of serotonin might also decline with age. WHY DOES THE BRAIN AGE? From cortical thinning to the loss of dendritic spines, you’ve seen how the brain ages. But what causes these changes? Many different theories have been advanced to explain why neurons, and cells in general, age. One possibility is that changes in gene expression play a role. Researchers have found that genes important for synaptic plasticity are expressed less in the brains of older people than in the brains of younger adults. The underexpressed genes also showed more signs of damage. Oxidative Stress and DNA Damage DNA damage that accumulates over a lifetime could contribute to aging processes throughout the brain and body, and DNA damage due to oxidative stress has received a great deal of attention. Every cell in your body contains organelles called mitochondria, which function a bit like cellular power plants, carrying out chemical reactions that provide energy for cell use. Some of these metabolic reactions produce harmful byproducts called free radicals, highly reactive molecules which, if left un- checked, can destroy fats and proteins vital to normal cell function and can damage DNA as well. Your body has natural defense mechanisms to neutralize free radi- cals. Unfortunately, these mechanisms decline with age, leaving aging tissues more vulnerable to oxidative damage by the free radicals. Studies of brain cells have shown that damage to their mitochondrial DNA accumulates with age. In addition, the brains of people with mild cognitive impairment and Alzheimer’s disease show more signs of oxidative damage than the brains of healthy people. Studies in rodents also link increased oxidative damage to memory impairments. Your brain is one of the most metabolically active organs, demand- ing around 20 percent of the body’s fuel. Its enormous energy require- ments might make the brain even more vulnerable than other tissues to the metabolic changes that occur in aging. While the brain’s energy demands remain high, its energy supply can no longer keep pace; the brain’s ability to take up and use glu- cose diminishes and mitochondrial metabolism declines. Immune Dysfunction Immune dysfunction often occurs in conjunction with the metabolic changes seen in aging. Microglia, the brain’s resident immune cells, per- form many important jobs: defending against pathogens, cleaning up cellular debris, and helping maintain and re- model synapses. These inflammatory responses are protective, but a pro- longed inflammatory state is harmful to brain health. Microglia become more reactive with age, increasing the inflammatory response in the brain while also damping production of helpful anti-inflammatory molecules. Mouse studies suggest that excessive microglial activity also contributes to cognitive impairments. Impaired Protein Recycling We know that excessive buildup of abnormal proteins in the brain contributes to age-related neurode- generative diseases like Alzheimer’s and Parkinson’s. Buildup of proteins and other cell components can also contribute to cellular degeneration in the healthy brain. Cells normally break down and recycle damaged proteins and molecules, using a pro- cess that is usually efficient but not perfect. Over time, damaged mole- cules can build up in cells and prevent them from functioning normally. Because neurons in the brain are not replaced as often as cells in other parts of the body (for example, bone marrow, intestinal lining, hair folli- cles), brain cells might be even more vulnerable to this buildup of damaged molecules. Also, the cellular ma- chinery involved in breakdown and recycling processes degrades with age, reducing the efficiency of the “waste removal” systems. Finally, remember that changes in the aging brain occur within the context of other changes throughout the body. Researchers speculate that worsening cardiovascular health, for example, could contribute to, or even drive, many changes seen in the aging brain. HEALTHY AGING We have learned how the brain changes with age and why these changes can occur. Now let’s turn our attention to a growing field in neuroscience that explores ways to slow these changes and preserve healthy brain function. Diet and Exercise Strong evidence now suggests that habits and choices that keep your body healthy also benefit your mind. Poor cardiovascular health puts a person at increased risk of age-related cognitive impairment. Diets rich in vegetables, fruits, and whole grains, and low in meat and dairy products, can reduce cardiovascular risk factors linked to cognitive impairment, such as high blood pressure and high levels of LDL cholesterol. Indeed, observa- tional studies have found that people who follow plant-rich diets such as the Mediterranean diet or Dietary Approaches to Stop Hypertension (DASH) are less likely to develop cognitive decline and dementia. Specific nutrients have been linked to improved cognitive performance and lower rates of dementia. Anti- oxidants, such as vitamins C and E, flavonoids, and omega-3 fatty acids have received considerable attention, with observational studies showing that high dietary intake of these compounds is beneficial. However, the results of lifestyle intervention studies using supplements have been more mixed. Finally, caloric restriction — substantially reducing the number of calories eaten without leading to malnutrition — has been linked to Many different theories have been advanced to explain why neurons, and cells in general, age. Synapses begin to weaken as a person ages, which can contribute to normal cognitive decline. Brain Facts society for neuroscience| Adult & Aging Brain85958 improved cognitive health as well as a longer lifespan. Growing evidence shows that aerobic exercise can improve cognitive function and offset some of the de- clines seen in aging. Numerous studies have found that people who engage in regular physical activity show improved learning, improved mem- ory, and a reduced risk of developing dementia. Physical activity might even slow the progression of Alzheimer’s disease and dementia, and higher levels of physical activity have been linked to improvements in some markers of structural brain health, such as reduced cortical thinning and less shrinkage in the hippocampus. Exercise exerts its neuroprotec- tive effects in the brain by improving neuroplasticity — the brain’s ability to form and reorganize connections be- tween neurons in response to changes in behavior and environment. Scien- tists also believe that exercise increases neurogenesis (the formation of new nerve cells) which, in turn, enhances neuroplasticity. Evidence from rodent studies confirms that exercise increases neurogenesis: Older mice allowed to run on a wheel have higher rates of neurogenesis in the hippocampus than sedentary mice, and they perform bet- ter on learning and memory tests. Ex- ercise can also improve blood flow and increase production of neurotrophic factors that support new neurons and synapses. For humans, starting exercise later in life can be beneficial, but the studies suggest that adopting an exer- cise program earlier in life could yield even more neuroprotective benefits. Mental Stimulation and Social Networks Mental stimulation and large so- cial networks can also improve cogni- tive function in aging. In lab studies, mice housed in cognitively stimulat- ing environments with many oppor- tunities for social interaction perform better on learning and memory tests as they age compared to mice housed in standard cages. Much like physical exercise, cognitive stimulation appears to enhance neuroplasticity by increas- ing neurogenesis and boosting levels of important neurotrophic factors. People who perform cognitive- ly-demanding work or engage in stimulating activities such as reading, solving puzzles, or playing a musical instrument have lower rates of cog- nitive decline with aging. An active social life has also been shown to be beneficial for cognition as we age. Neuroscientists have learned a lot about the aging brain — how it changes, why it changes, and how to maintain healthy cognitive func- tioning as we age. Even so, many questions remain. Answers to those questions could identify new strate- gies for protecting the brain, not only in our later years, but throughout our lives. Exercise has been shown to increase neurogenesis in the adult brain, and can slow the cognitive decline associated with aging. iStock.com/artyme83. Have you ever considered the ups and downs that occur during your day? Speaking literally, you are up and awake during the day and lying down sleeping at night. Speaking figuratively, ups and downs could mean that you experi- ence periods of elevated alertness and arousal compared with your mood when you are tired or relaxed. Asleep, awake, aroused, and relaxed are different brain states, meaning that the brain’s activity is different during each of these peri- ods. Scientists have looked deep inside the brain to understand what sleep is and how rest differs from being alert. This research is especially important for people like doctors, pilots, and shift workers who sometimes must focus and make important decisions with very little sleep. Research on brain states can also help people who have disorders of sleep, attention, and learning. SLEEP How many hours of sleep do you get every night? Most people spend one-third of their lives asleep. While that might appear to be a lot of time spent doing nothing, our brains are active while we rest each night. The activity in our brains during sleep is important for brain health and for solidifying memories. Most people feel tired and un- able to focus if they don’t get enough sleep. In some cases, too little sleep can impair a person’s driving as much as drinking alcohol. The long-term ef- fects of lacking sleep also involve many health risks. Several studies in humans have revealed that sleep-deprived people are at increased risk for a wide range of health issues including diabe- tes, stress, obesity, high blood pres- sure, anxiety, cognitive impairment, and depression. CHAPTER Brain States 9 Brain Facts 6160Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Brain States 9Brain States9 Brain Activity During Sleep Scientists can measure the brain’s electrical activity using electroenceph- alography (EEG). Electrodes attached to the scalp detect and record the net electrical activity of hundreds of thou- sands of cortical nerve cells. When a neuron is active, ions move in and out of the cell, altering the electrical charge across the cell membrane. An EEG de- tects the net electrical charge produced when neurons increase and decrease their activity as a group, in synchrony. The results are “brain waves” — the cyclic rising and falling of brain activ- ity that can be important indicators of brain function. In sleep studies, scien- tists now recognize two main states: slow wave sleep (SWS) and rapid eye movement sleep (REM). SWS gets its name from the high amplitude, low frequency, brain waves in EEG recordings. The high amplitude of slow waves indicates that many cortical neu- rons are switching their activity in a synchronized way from a depolarized (more excitable) state to a hyperpo- larized (less excitable) state and back again. These slow waves appear to be important to sleep function — the longer a person stays awake, the more slow waves they will experience during the SWS state. Slow waves become less frequent the longer the person is asleep. If awakened during SWS, most people recall only frag- mented thoughts, not active dreams. Have you ever seen a cat dream- ing — twitching its whiskers or paws while it sleeps? Dreaming happens mainly during REM sleep, which takes its name from the periodic rapid eye movements people make in this state. Brain activity recorded during REM looks very similar to EEGs recorded while awake. EEG waves during REM sleep have much lower amplitudes than the SWS slow waves, because neuron activity is less synchronized — some nerve cells depolarize while others hyperpolarize, and the “sum” of their electrical states is less positive (or negative) than if they acted in synchro- ny. Paradoxically, the fast, waking-like EEG activity during REM sleep is ac- companied by atonia, a loss of muscle tone causing the body to become tem- porarily paralyzed. The only muscles remaining active are those that enable breathing and control eye movements. Oddly enough, the neurons of our motor cortex fire as rapidly during REM sleep as they do during waking movement — a fact that explains why movements like a kitten’s twitching paws can coincide with dreams. During the night, periods of SWS and REM sleep alternate in 90-minute cycles with 75–80 minutes of SWS followed by 10–15 minutes of REM sleep. This cycle repeats, typically with deeper and longer peri- ods of REM sleep towards morning. To study sleep disorders, researchers often use mice that have sleep struc- tures qualitatively very similar to hu- mans; however, rodents have shorter This chart shows the brain waves of an individual being recorded by an EEG machine during a night’s sleep. As the person falls asleep, the brain waves slow down and become larger. Throughout the night, the individual cycles though sleep stages, including REM sleep, where brain activity is similar to wakefulness. and more frequent sleep episodes lasting 3–30 minutes (sometimes lon- ger). Rodents also sleep more during the day and are more active at night. Compare that to human adults, who are typically more active during the day and have one sleep episode at night lasting about 8 hours. Sleep Regulation How does the brain keep us awake? Wakefulness is main- tained by the brain’s arousal systems, each regulating different aspects of the awake state. Many arousal systems are in the upper brainstem, where neurons connecting with the forebrain use the neurotransmitters acetylcholine, norepinephrine, serotonin, and glutamate to keep us awake. Orexin- producing neurons, located in the hypothalamus, send projections to the brainstem and spinal cord, the thala- mus and basal ganglia, as well as to the forebrain, the amygdala, and dopa- mine-producing neurons. In studies of rats and monkeys, orexin appears to exert excitatory effects on other arousal systems. Orexins (there are two types, both small neuropeptides) increase metabolic rate, and their production can be activated by insulin-induced low blood sugar. Thus, they are involved in energy metabolism. Given these functions, it comes as no surprise that orexin-producing neurons are important for preventing a sudden transition to sleep; their loss causes narcolepsy, as described below. Orexin neurons also connect to hypothalamic neurons containing the neurotransmit- ter histamine, which plays a role in staying awake. The balance of neurotransmitters in the brain is critically important for maintaining certain brain states. For example, the balance of acetylcholine and norepinephrine can affect wheth- er we are awake (high acetylcholine and norepinephrine) or in SWS (low acetylcholine and norepinephrine). During REM, norepinephrine re- mains low while acetylcholine is high, activating the thalamus and neocortex enough for dreaming to occur; in this brain state, forebrain excitation without external sensory stimuli pro- duces dreams. The forebrain becomes excited by signals from the REM sleep generator (special brainstem neurons), leading to rapid eye move- ments and suppression of muscle tone — hallmark signs of REM. During SWS, the brain systems that keep us awake are actively sup- pressed. This active suppression of arousal systems is caused by the ven- trolateral preoptic (VLPO) nucleus, a group of nerve cells in the hypothala- mus. Cells in the VLPO release the in- hibitory neurotransmitters galanin and gamma-aminobutyric acid (GABA), which can suppress the arousal sys- tems. Damage to the VLPO nucleus causes irreversible insomnia. Sleep-Wake Cycle Two main factors drive your body to crave sleep: the time of day or night (circadian system) and how long you have been awake (homeostatic system). The homeostatic and circadian systems are separate and act independently. The circadian timing system is regulated by the suprachiasmatic nucleus, a small group of nerve cells in the hypothalamus that functions as a master clock. These cells express “clock proteins,” which go through a biochemical cycle of about 24 hours, setting the pace for daily cycles of activity, sleep, hormone release, and other bodily functions. The master clock neurons also receive input directly from the retina of the eye. Thus, light can reset the master clock, adjusting it to the outside world’s day/night cycle — this explains how your sleep cycles can shift when you change time zones during travel. In addition, the suprachiasmatic nucleus sends signals through different brain regions, eventually contacting the VLPO and the orexin neurons in the lateral hypothalamus, which directly regulate arousal. What happens in the brain when we don’t get enough sleep? The second system that regulates sleepiness is the The balance of neurotransmitters in the brain is critically important for maintaining certain brain states. 6362Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Brain States 9Brain States9 homeostatic system, which makes you feel sleepy if you stay awake longer than usual. One important sleep factor is a chemical in the brain called adenosine. When you stay awake for a long time, adenosine levels in the brain increase. The increased ade- nosine binds to specific receptors on nerve cells in arousal centers to slow cellular activity and reduce arousal. Adenosine can increase the number of slow waves during SWS. As you get more sleep, adenosine levels fall and slow waves decrease in number. Caf- feine acts as a stimulant by binding to adenosine receptors throughout the brain and preventing their interaction with adenosine. As a result, in the presence of caffeine, fewer receptors are available for the slowing influence of adenosine. People often say they need to “catch up on sleep.” But can you really make up for lost sleep? Normally, the homeostatic and circadian systems act in a complementary fashion to produce a normal 24-hour cycle of sleep and wakefulness. Nonetheless, activating the brain’s arousal system can keep us awake even after a long pe- riod of wakefulness — for example, a late-night study session to prepare for an important exam. In normal circum- stances, the homeostatic system will respond to the loss of sleep by increas- ing the duration of ensuing sleep and increasing the number of slow waves during the SWS episodes. As noted above, this rebound slow wave activity correlates with the previous time spent awake and is mediated by adenosine. Sleep Disorders The most common sleep disorder, and the one most people are familiar with, is insomnia. Some people with insomnia have difficulty falling asleep initially; others fall asleep, then awak- en part way through the night and can’t fall back asleep. Several common disorders, listed below, disrupt sleep and prevent people from getting an adequate amount of sleep. Daytime sleepiness (not narcolep- sy), characterized by excessive feelings of tiredness during the day, has many causes including sleep apnea (see be- low). Increased daytime sleepiness can increase the risk of daytime accidents, especially car accidents. Sleep apnea occurs when the air- way muscles of the throat relax during sleep, to the point of collapse, closing the airway. People with sleep apnea have difficulty breathing and wake up without entering the deeper stages of SWS. This condition can cause high blood pressure and may increase the risk of heart attack. Treatments for sleep apnea focus on reducing airway collapse during sleep; simple changes that may help include losing weight, avoiding alcohol or sedating drugs prior to sleep, and avoiding sleeping on one’s back. However, most people with sleep apnea require breathing machines to keep their airway open. One such device, called a continuous positive airway pressure or “CPAP” machine, uses a small mask that fits over the nose to provide an airstream under pressure during sleep. In some cases, people need surgery to correct their airway anatomy. REM sleep behavior disorder occurs when nerve pathways in the brain that prevent muscle movement during REM sleep do not work. Remember that dreaming happens during REM sleep, so imagine people literally acting out their dreams by getting up and moving around. This can be very disruptive to a normal night’s sleep. The cause of REM be- havior disorder is unknown, but it is more common in people with degen- erative neural disease such as Parkin- son’s, stroke, and types of dementia. The disorder can be treated with drugs for Parkinson’s or with a ben- zodiazepine drug, clonazepam, which enhances the effects of the inhibitory neurotransmitter GABA. FPO Electroencephalography measures brain activity through sensors placed on the head. It can record how the brain reacts to all kinds of stimuli and activities, including sleep. Simon Fraser University. Narcolepsy: An Example of Sleep Disorder Research Narcolepsy is a relatively uncommon sleep disorder — only 1 case per 2,000 people in the United States — in which the brain lacks the special neurons that help control the transition into sleep, so that the regular cycling is disrupted. People with narcolepsy have sleep attacks during the day, causing them to suddenly fall asleep, which is especially dangerous if they are driving. The problem is caused by the loss of orexin neurons in the lateral hypothalamus. People with narcolep- sy tend to enter REM sleep very quickly and may even enter a dream- ing state while still partially awake, a condition known as hypnagogic hallucination. Some people with narcolepsy also have attacks in which they lose muscle tone — similar to what happens in REM sleep, but while they’re awake. These attacks of paralysis, known as cataplexy, can be triggered by emotional experiences and even by hearing a funny joke. Recent research into the mech- anisms of narcolepsy has provided important insights into the processes that control the mysterious transitions between waking, slow wave sleep, and REM sleep states. Orexin (in the lateral hypothalamus) is critical for preventing abnormal transitions into REM sleep during the day. In one study, scientists inactivated the gene for orexin in mice and measured their sleep patterns. They found that mice lacking the orexin gene showed symp- toms of narcolepsy. Similarly, humans with narcolepsy have abnormally low levels of orexin levels in their brain and spinal fluid. Because orexin levels are disrupt- ed in narcolepsy, scientists also began studying neurons that were neighbors to orexin neurons to see what hap- pened if the neighboring neurons were activated in narcoleptic mice. Those neurons contained melanin-concen- trating hormone, and stimulating them (using a technique called opto- genetics) induced sleep — opposite to the effect of stimulating orexin neu- rons. A balance between the activation of orexin neurons and their neighbor- ing neurons could control the tran- sition between waking and sleeping. These findings will be important in developing treatments for narcolepsy. AROUSAL Think about what happens in your body and mind when you speak in front of a crowd — your brain state is very different from when you are asleep. Perhaps you notice changes in your breathing, heart rate, or stomach. Maybe your thoughts are racing or panicked. Or maybe you are energized and excited to perform for your audience. These are exam- ples of the complex brain state called arousal. Rather than merely being awake, arousal involves changes in the body and brain that provide motivations to do an action — teaching a class, speaking in public, or focusing your attention. People experience arousal daily when searching for food while hungry, or when talking with other people (social interaction). Arousal is also important for reproduction and for avoiding danger. The level of arousal varies across a spectrum from low to high. When arousal falls below a certain threshold we can transition from wake to sleep, for example. But under heightened arousal, like intense anxiety, we cannot reach this threshold and we stay awake. Neurotransmitters During arousal, the brain must de- vote resources to specific brain regions, much as an emergency call center redirects resources like ambulances and fire trucks during a fire. Specific types of neurons in the brain regions involved in arousal release multiple neurotransmitters, telling the rest of the brain and the body to be on alert. These neurotransmitters are dopamine (for movement), norepinephrine (for alertness), serotonin (for emotion), and acetylcholine and histamine, which help the brain communicate with the body to increase arousal. Sensory Input While neurotransmitters provide the internal signals for arousal, external signals from the outside world — like the bright lights (visual input) and cheering crowds (auditory input) at a stage performance — can also stimu- late arousal. Sensory input gets sorted in the brain region called the thala- mus. Often called a “sensory clearing house,” the thalamus regulates arous- al, receiving and processing sensory inputs from brain regions important in senses like vision and hearing and relaying these inputs to the cortex. Autonomic Nervous System Once the brain is aroused, what does the body do? The reticular activating system, in the brainstem, co- ordinates signals coming from sensory inputs and neurotransmitters to make sense of events in the brain and pass that information to the rest of the body. The reticular activating system specifically controls the autonomic nervous system, which affects heart rate, blood flow, and breathing. By controlling these automatic body pro- cesses, the reticular activating system 6564Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Brain States 9Brain States9 sets up the physical state of arousal, bringing important resources like oxy- gen and nutrients to parts of the body where they are needed. Together, the changes that happen in the brain and body during arous- al enable us to be alert and focused, which helps us process information quickly. Using this information, we can choose the appropriate emotional response or physical action for a given situation. Sexual Arousal Several complex brain systems and endocrine (hormone) systems contrib- ute to sexual arousal and behaviors, but the brain regions, neurotransmitters, and body systems are similar to those involved in general arousal. The dis- tinguishing factor is that sexual arousal also involves hormones such as estrogen and testosterone, which then activate neurons that release the same neu- rotransmitters that are released during general arousal. Many human and ani- mal studies report interactions between sex hormones and neurotransmitters dopamine, serotonin, GABA, and glutamate. Researchers have also found that brain regions such as the hypo- thalamus, amygdala, and hippocampus contain many estrogen and progester- one receptors, and brain regions that mediate feelings of reward (nucleus accumbens) and emotions like pleasure (amygdala) motivate sexual behaviors. Overall, the primary involvement of sex hormones is a key in defining the brain state of sexual arousal. ATTENTION If you are paying attention right now, there should be detectable changes in your heart rate, breathing, and blood flow. If that sounds familiar, it’s because those same physiological changes occur during arousal, which is necessary for being alert and paying attention. As mentioned previously, the state of arousal calls for reactions to the environment. To make deci- sions about what to do, you need to focus on what’s happening in the environment, especially involving anything relevant to your goals. For example, if your goal is to run away from an angry bear, you need to be alert and pay attention to where you’re running so you don’t trip and fall. Scientists have theorized that the state of arousal speeds processing and improves comprehension of environ- mental details. Otherwise, your brain would need an infinite amount of time and energy to process all of its sensory inputs (sounds, sights, smells, and other feelings), because the environment is always changing. Focus Even with multitasking, it is impossible for the brain to process all its sensory inputs. Instead, people focus their attention on one thing at a time. Attention is a fascinating abil- ity, because it enables you to have so much control and the ability to fine- tune your focus to different locations, times, and topics. Consider the page you are reading right now. Although you can see the whole page, you focus on only one line at a time. Alterna- tively, you can turn your attention to the past — just minutes ago when you were reading about arousal. Or you can ignore the sentences alto- gether and focus on the number of times the word “you” occurs on this page. Scientists recognize two types of attention, which involve different brain processes: voluntary (endog- enous) attention and involuntary (exogenous) attention. Voluntary attention happens when you choose what to focus on — like finding a loved one in a crowd. The frontal and parietal cortices of the brain are active when you control your attention or direct it towards a specific object or location. Involun- tary attention occurs when something in the environment (like a sudden noise or movement) grabs your atten- tion. Involuntary attention is a dis- traction from your chosen goals and, in fact, researchers often use distrac- tor objects in attention experiments. Distractors can be emotional, like pictures of family, or non-emotional images that stand out from other stimuli, like a red circle surrounded by gray squares. Brain regions in the right hemisphere, collectively known as the ventral frontoparietal network, form a system that processes new and interesting stimuli that distract you from the task at hand. Research on at- tention can help us understand visual tasks, learning, child development, and disorders of attention. Disorders of Attention Paying attention for long periods of time, such as a 3-hour lecture, can be difficult for many people. For some people, even focusing for a short time can be hard. Several disorders that affect the ability to pay attention are attention deficit hyperactivity disorder (ADHD), schizophrenia, prosopagnosia, and hemineglect syndrome. It may seem strange to regard schizophrenia as an attention disturbance, but some psychiatric studies suggest that it involves a failure of selective attention. Prosopagnosia, or face blindness, is a cognitive disorder in which a person is unable to recognize faces — even their own family members. The severity of this condition varies, and genetic factors might be involved. Attention disorders have various causes, but we will focus on hemineglect syndrome, caused by damage to the right parietal cortex, a brain region important in involuntary attention. Between 50–82 percent of pa- tients who suffer stroke in the right hemisphere experience hemineglect syndrome, also known as spatial ne- glect and unilateral neglect. In these cases, patients with neglect ignore the left side of their visual field. Some- times they ignore the left side of the body and the left side of individual objects, as well. Diagnosis of hemine- glect syndrome can be done with a pen and paper. For example, patients can be instructed to draw a copy of a picture like a butterfly or a castle, and those patients with hemineglect usually draw only the right half of the picture or leave out details of the left side. Research on patients with hemineglect syndrome contributes to our understanding of rehabilitation after stroke, as well as the role of the right parietal cortex in attention and perception. REST: DEFAULT MODE NETWORK What is the difference between being alert and resting while awake? During times of rest and relaxation, you’re usually avoiding heavy thinking or complicat- ed tasks, and parts of the brain called the default mode network are more active. You may think of the default mode network as a personal lullaby or a playlist that turns on when you are ready to relax. Activity of the default mode network decreases (the lullaby gets quieter) when you start doing or thinking about a demanding task. Human studies using imaging tech- niques such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET) have identified which brain regions belong to the default mode network. These brain areas, which are involved in emotion, personality, introspection, and memory, include frontal brain regions (ventromedial prefrontal cortex, dorsomedial prefrontal cortex, and anterior cingulate cortex), as well as the posterior cingulate cortex, lateral parietal cortex, and precuneus. Although the exact role of the default mode network is unclear, the functions of its “participating” brain regions provide hints about its purpose. Studies on emotion have revealed that activity in the ventro- medial PFC is directly related to how anxious a subject feels while performing a task — suggesting that the default mode network may play a role in regulating emotion and mood. Activity in the dorsomedial PFC (a region involved in self-referential or introspective thoughts) increases when a person is at rest and day- dreaming. The dorsomedial PFC is also involved in stream-of-conscious- ness thoughts and thoughts about oneself in the past, present, or future (autobiographical self ). The roles of these regions suggest that the default mode network may also function in self-reflection and our sense of self in time. The posterior brain regions of the default mode network (posterior cin- gulate cortex, lateral parietal cortex, and precuneus) become more active when remembering concrete mem- ories from past experiences. These brain regions are connected with the hippocampus, which is important for learning and forming memories. Both the hippocampus and the default mode network are more active when a person is at rest in the evening and less active when waking up early in the day. These patterns indicate that the default mode network helps to process and remember the events of the day. Future studies using electrical re- cordings from inside the human brain can be paired with fMRI to tell us more about the brain activity patterns of the default mode network and how brain regions coordinate their activity during tasks that utilize the functions of this network. Scientists recognize two types of attention, which involve different brain processes: voluntary attention and involuntary attention. 67Brain Factssociety for neuroscience | The Body in Balance 10 The cells of your body are immersed in a constantly changing environment. The nutrients that sustain them rise and fall with each meal. Gases, ions, and other solutes flow back and forth between your cells and blood. Chemicals bind to cells and trigger the building and re- lease of proteins. Your cells digest food, get rid of wastes, build new tissues, and destroy old cells. Environmental changes, both internal and external, ripple through your body’s physio- logical systems. One of your brain’s less-visible jobs is to cope with all these changes, keep them within a normal range, and maintain the healthy func- tions of your body. The tendency of your body’s tissues and organ systems to maintain a condi- tion of balance or equilibrium is called homeostasis. Homeostasis depends on active regulation, with dynamic adjustments that keep the environ- ment of your cells and tissues relatively constant. The brain is part of many homeostatic systems, providing signals that coordinate your body’s internal clocks and regulating hormone secre- tion by the endocrine system. These functions often involve a region of the forebrain called the hypothalamus. CIRCADIAN RHYTHMS Almost every cell in your body has an internal clock that tells it when to become active, when to rest, and when to divide. These clocks broker changes in many of the body’s physiological systems over a 24-hour, or circadian, period. For example, the clocks cause faster pulses of peristaltic waves in your gut during the day and make your blood pressure dip at night. But because these clocks are deep inside your body and cannot detect daylight, none of them can tell time CHAPTER The Body in Balance 10 on its own. Instead, daily rhythms are coordinated by the suprachiasmatic nucleus (SCN), a tiny group of neurons in the hypothalamus. Neurons in the SCN act like a met- ronome for the rest of the body, emit- ting a steady stream of action potentials during the day and becoming quiet at night. The shift between active and silent states is controlled by cyclic in- teractions between two sets of proteins encoded by your body’s “clock” genes. Researchers first identified clock genes in the fruit fly Drosophila melanogaster and studied how they keep time; since then, a nearly identical set of genes has been found in mammals. The SCN also tracks what time it is based on signals it receives from photoreceptors in the retina, which keeps its activity in sync with the Earth’s actual day/night cycle. That little nudge is very important be- cause, on their own, clock proteins take slightly more than 24 hours to complete a full cycle. Studies of animals deprived of light have discovered that they go to sleep and wake up a bit later each day. An autonomic neural pathway ties the daily rhythmic activity of the SCN directly to other clocks in the body. Neurons in the SCN stimulate an adjacent region of the brain called the paraventricular nucleus (PVN), which in turn sends signals down a chain of neurons through the spinal cord to the peripheral organs of the body. You’ve al- ready learned how signals in part of this neural pathway stimulate orexin neu- rons to regulate the body’s sleep/wake cycle. Related pathways also govern the secretion of melatonin, a hormone that influences sleep behaviors. Specifically, electrical activity originating in the SCN enters the PVN’s neural network and sends signals up to the pineal gland, a small pinecone-shaped gland embedded between the cerebral hemispheres. The pineal gland secretes melatonin into the bloodstream at night. Melatonin binds to cells in many tissues, and although it has no direct effect on clock gene expression in the SCN, its systemic effects seem to reduce alertness and increase sleepiness. Light exposure trig- gers signals that stop melatonin secre- tion, promoting wakeful behaviors. Together, these signals keep all the body’s clocks synchronized to the same 24-hour cycle. Coordinated body clocks enable your body’s physiological systems to work together at the right times. When your body prepares to wake from sleep, 1) levels of the stress hormone cortisol peak in the blood, releasing sugars from storage and increasing appetite, and 2) core body temperature begins to drift upwards, raising your body’s metabolic rate. These events, synchronized with others, prepare your body for a new day’s activity. Desynchronizing the body’s phys- iological clocks can cause noticeable and sometimes serious health effects. You might have experienced a familiar example of circadian rhythm distur- bance: jet lag. After crossing many time zones in a short time period, a person’s patterns of wakefulness and hunger are out of sync with day and night. Exposure to the local day/night cycle resets the brain and body, but it can take several days to get fully resynchro- nized. Circadian rhythms can also be disturbed by situations like late-shift jobs or blindness, which decouple nor- mal daylight signals from wake/sleep cycles. Long-term circadian disruptions are associated with health problems including weight gain, increased rates of insomnia, depression, and cancers. HORMONES, HOMEOSTASIS, AND BEHAVIOR Neurons can quickly deliver the brain’s messages to precise targets in the body. Hormones, on the other hand, deliver messages more slowly but can affect a larger set of tissues, producing large- scale changes in metabolism, growth, and behavior. The brain is one of the tissues that “listens” for hormonal signals — neurons throughout the brain are studded with hormone receptors — and the brain’s responses play an important part in regulating hormone secretion and changing behaviors to keep the body systems in Coordinated body clocks enable your body’s physiological systems to work together at the right times. Brain Factssociety for neuroscience |Brain Facts society for neuroscience| The Body in Balance 10The Body in Balance1068 equilibrium. The brain regions involved in hormone release are called the neuroendocrine system. The hypothalamus oversees the production and release of many hor- mones through its close ties to the pi- tuitary gland. The paraventricular and supraoptic nuclei of the hypothalamus send axons into the posterior part of the pituitary gland; activation of spe- cific neurons releases either vasopressin or oxytocin into capillaries within the pituitary. Both of these molecules act as neurotransmitters inside the brain, but they are also hormones that affect distant tissues of the body. Vasopressin (also called antidiuretic hormone) in- creases water retention in the kidneys and constricts blood vessels (vasocon- striction). Oxytocin promotes uterine contractions during labor and milk release during nursing. Other hypothalamic regions send axons to a capillary-rich area above the pituitary called the median eminence. When these neurons are activated, they release their hormones into the blood. These releasing (and inhibiting) hormones travel through local blood vessels to the anterior pituitary, where they trigger (or inhibit) secretion of a second specific hormone. Of the seven anterior pituitary hormones, five are trophic hormones — these travel in the bloodstream to stimulate activity in specific endocrine glands (thyroid, adrenal cortex, ovaries, etc.) throughout the body. The remaining two hormones act on non-endocrine tissues. Growth hormone stimulates the growth of bone and soft tissues, and prolactin stimulates milk produc- tion by the breasts. Hormones released from the anterior pituitary influence growth, cellular metabolism, emotion, and the physiology of reproduction, hunger, thirst, and stress. Many hormones produced by the pituitary and its target endocrine glands affect receptors inside the brain — thus, these hormones can alter neuronal function and gene transcrip- tion in the hypothalamus. The effect is to reduce the amount of hormone released by the hypothalamus when those circuits become active. These negative feedback loops enable precise doses of hormones to be delivered to body tissues, and ensure that the hor- mone levels are narrowly regulated. One of these three-hormone cascades regulates reproduction in mammals. Its underlying pattern is the same in both sexes: 1) gonadotropin- releasing hormone (GnRH) from the hypothalamus makes the anterior pi- tuitary release 2) luteinizing hormone (LH) and follicle stimulating hormone (FSH), which in turn make the gonads secrete 3) sex hormones and start the development of mature eggs or sperm. The neuroendocrine system maintains homeostasis, the body’s normal equilibrium, and controls the response to stress. The adrenal gland releases the stress hormones norepineph- rine, epinephrine, and cortisol, which quicken heart rate and prepare muscles for action. Corticotrophin releasing hormone (CRH) is released from the hypothalamus and travels to the pituitary gland, where it triggers the release of adrenocorticotropic hormone (ACTH). ACTH travels in the blood to the adrenal glands, where it stimulates the release of cortisol. 69 Sex hormones, in turn, attach to receptors in the hypothalamus and an- terior pituitary and modify the release of the hypothalamic and pituitary hormones. However, sex hormones regulate these feedback loops differ- ently in males and females. Male sex hormones induce simple negative feedback loops that reduce the secretion of gonadotropin-releas- ing hormone, luteinizing hormone, and follicle stimulating hormone. The interplay among these hormones creates a repetitive pulse of GnRH that peaks every 90 minutes. The waxing and wan- ing of GnRH keeps testosterone levels relatively steady within body tissues, maintains male libido, and keeps the testes producing new sperm each day. Female feedback patterns are more complex. Over the course of the month-long menstrual cycle, female sex hormones exert both positive and nega- tive feedback on GnRH, FSH, and LH. When circulating levels of the female sex hormones estrogen and progesterone are low, rising follicle stimulating hormone levels trigger egg maturation and estrogen production. Rising estrogen levels induce luteiniz- ing hormone levels to rise. As the levels of female sex hormones rise, they exert negative feedback on FSH secretion, limiting the number of eggs that ma- ture in a month, but positive feedback on LH, eventually producing the LH surge that triggers ovulation. After ovulation, high serum levels of sex hor- mones again exert negative feedback on GnRH, FSH, and LH which in turn reduces ovarian activity. Levels of fe- male sex hormones therefore decrease, allowing the cycle to start over again. Many other hormones are not regulated by the pituitary gland, but are released by specific tissues in response to physiological changes. The brain contains receptors for many of these hormones but, unlike pituitary hormones, it does not directly regulate their secretion. Instead, when these hormones bind to receptors on neu- rons, they modify the output of neural circuits, producing behavioral changes that have homeostatic effects. One example of this is a pair of hormones called leptin and ghrelin. Leptin and ghrelin change eating behavior by regulating food intake and energy balance. Both hormones affect hunger, and both are released in response to changes in an animal’s internal energy stores. However, they have different effects on the circuits they regulate. Ghrelin keeps the body fed. Released by the wall of the gastrointestinal tract when the stom- ach is empty, ghrelin activates hunger circuits in the hypothalamus that drive a search for food. Once the stomach is full, ghrelin production stops, reduc- ing the desire to eat. In contrast, leptin helps maintain body weight within a set range. Leptin is produced by fat cells and is released when fat stores are large. When it binds to neurons in the hypothalamus, leptin suppresses the activity of hunger circuits and reduces the desire to eat. As fat stores are used up, leptin levels decline, driving be- havior that makes an animal eat more often and replenish its fat stores. STRESS Your body reacts in stereotyped ways when you feel threatened. You breathe faster, your heartbeat speeds up, your muscles tense and prepare for action. These reactions may have helped our ancestors run from preda- tors, but any stressful situation — ar- guing with your parents, a blind date, a looming deadline at work, abdominal cramps, discovering your apartment was robbed, trying karaoke for the first time — has the potential to set them off. Scientists call this reaction the stress response, and your body turns it on to some degree in response to any external or internal threat to homeostasis. The Stress Response The stress response weaves togeth- er three of the brain’s parallel com- munication systems, coordinating the activity of voluntary and involuntary nervous systems, muscles, and metabo- lism to achieve one defensive goal. Messages sent to muscles through the somatic (voluntary) nervous system prime the body to fight or run from danger (the fight-or-flight response). Messages sent through the autonomic (involuntary) nervous system redirect nutrients and oxygen to those mus- cles. The sympathetic branch tells the adrenal medulla to release the hor- mone epinephrine (also called adren- aline), which makes the heart pump faster and relaxes the arterial walls that supply muscles with blood so they can respond more quickly. At the same time, the autonomic system’s parasym- pathetic branch restricts blood flow to other organs including the skin, gonads, digestive tract, and kidneys. Finally, a cascade of neuroendocrine hormones originating in the hypothal- amus and anterior pituitary circulates in the bloodstream, affecting processes like metabolic rate and sexual func- tion, and telling the adrenal cortex to release glucocorticoid hormones — like cortisol — into the blood. Glucocorticoid hormones bind to many body tissues and produce wide- spread effects that prepare the body to respond to potential threat. These hor- mones stimulate the production and release of sugar from storage sites such as the liver, making energy available to Brain Facts society for neuroscience| The Body in Balance1070 muscles. They also bind to brain areas that ramp up attention and learning. And they help inhibit nonessential functions like growth and immune responses until the crisis ends. It’s easy to imagine how (and why) these physiological changes make your body alert and ready for action. But when it comes to stress, your body can’t tell the difference between the danger of facing down a bull elephant and the frustration of being stuck in traffic. When stress is chronic, whatever its cause, your adrenal glands keep pump- ing out epinephrine and glucocorti- coids. Many animal and human studies have shown that long-term exposure to these hormones can be detrimental. Chronic Stress Overexposure to glucocorticoids can damage a wide range of physiological systems. It can cause muscles to atrophy, push the body to store energy as fat, and keep blood sugar abnormal- ly high — all of these can worsen the symptoms of diabetes. Overexposure to glucocorticoids also contributes to the development of hypertension (high blood pressure) and atherosclerosis (hardening of the arteries), increasing the risk of heart attacks. Because the hormones inhibit immune system function, they also reduce resistance to infection and inflammation, some- times pushing the immune system to attack the body’s own tissues. Chronic stress can also have specif- ic negative effects on brain tissue and function. Persistently high levels of glucocorticoids inhibit neuron growth inside the hippocampus, impairing the normal processes of memory forma- tion and recall. Stress hormones can also suppress neural pathways that are normally active in decision-making and cognition, and speed the deteri- oration in brain function caused by aging. They may worsen the damage caused by a stroke. And they can lead to sleep disorders — cortisol is also an important wakeful signal in the brain, so the high cortisol levels due to chronic stress may delay sleep. Stress-induced insomnia can then start a vicious cycle, as the stress of sleep deprivation leads to the release of even more glucocorticoids. The effects of chronic stress may even extend beyond a single indi- vidual, because glucocorticoids play important roles in brain development. If a pregnant woman suffers from chronic stress, the elevated stress hor- mones can cross the placenta and shift the developmental trajectory of her fetus. Glucocorticoids are transcription factors, which can bind to DNA and modify which genes will be expressed as proteins. Studies with animal mod- els have shown that mothers with high blood levels of glucocorticoids during pregnancy often have babies with low- er birth weights, developmental delays, and more sensitive stress responses throughout their lives. Because metabolic stressors such as starvation induce high glucocorticoid levels, it’s been suggested that these hormones might help prepare the fetus for the environment it will be born into. Tough, stressful environments push fetuses to develop stress-sensitive “thrifty” metabolisms that store fat eas- ily. Unfortunately, these stress-sensitive metabolisms increase a person’s risk of developing chronic metabolic diseases like obesity or diabetes, especially if they subsequently grow up in lower-stress environments with plentiful food. The effects of stress can even be passed to subsequent generations by epigenetic mechanisms. Chronic stress can change the markers on DNA molecules that indicate which of the genes in a cell are expressed and which are silenced. Some animal studies indicate that when changes in markers occur in cells that develop into eggs or sperm, these changes can be passed on and expressed in the animal’s offspring. Further research might reveal wheth- er chronic stress has similar effects in humans, and whether inheriting silenced or activated genes contributes to family histories of cancer, obesity, cardiovascular, psychiatric, or neurode- velopmental disease. Chronic stress can also have specific negative effects on brain tissue and function. AUTISM SPECTRUM DISORDERS Autism is often considered a childhood condition, although many of its symptoms persist lifelong. Some people with autism also have mood and anxiety disorders, seizures, intellectual disability, attention deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD). However, more than 40 percent of people with autism have normal or above-average intelligence. With symptoms that range from mildly to severely disabling, autism is considered a spectrum. Autism spectrum disorders (ASD) are diagnosed based on two main criteria: impaired social commu- nication and interaction, and repetitive behaviors or narrow, obsessive inter- ests. For example, some people on the autism spectrum are unable to speak, while others are socially awkward but highly articulate. Many adults with an autism diagnosis think of their autism as a strength — enabling or motivating them to develop deep expertise in an area or a different perspective on the world — rather than a disorder that needs to be cured. Currently, 1 of every 68 American 8-year-olds is estimated to meet the diagnostic criteria for an autism spec- trum disorder. The prevalence of ASD has risen dramatically since the 1970s, but it is unclear whether changes to diagnostic criteria and wider recogni- tion of ASD have contributed to the increase in diagnoses. Four to five times more boys than girls are diagnosed with autism, although it is not clear whether some of that pattern is because of underdi- agnosis of girls. Environmental factors such as parents having children later in life, fever and infection during preg- nancy, and premature birth have been CHAPTER Childhood Disorders 11 71Brain Facts 7372Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Childhood Disorders 11Childhood Disorders11 linked to an increased risk of autism in children. A huge number of studies have found no connection between childhood vaccination and the increase in autism diagnoses. Autism is believed to be at least partially driven by genetics, but how do scientists know that for sure? One low-tech approach uses twin studies: If one of a pair of identical twins receives an autism diagnosis, the other twin has greater than a 50 percent chance of also being diagnosed with ASD. Children who have an older sibling on the spectrum also have a higher likelihood of being diagnosed with autism — nearly one in five also receives a diagnosis of ASD. The genetics of autism is very complicated in most cases, involving dozens (or more) of genes, leading to a unique condition in nearly every person. Recently, however, high-throughput genomic analyses have broadened the pool of potential genes, revealed their roles in the body, and suggested possible new therapies. It appears that many genes, each with a small effect, contribute to the inheritance of most ASDs. But such small effects make these genes hard to identify in genome-wide association studies. Scientists are now looking at the rare variants associated with ASD. These afflict fewer people with ASD, but their effects are larger and easier to detect. Some of these rare mutations are in single genes whose impairment is already known to cause intellectu- al disability and social dysfunction. These genes include FMR1 (codes for fragile X mental retardation protein, but its non-mutant form is needed for normal cognitive development); PTEN (codes for a tumor suppressor enzyme that regulates cell division, so cells don’t divide or grow too fast); and TSC1 or TSC2 (tuberous sclerosis complex 1 and 2), which also code for proteins that help control cell growth and size. Between 50 to 60 percent of people with fragile X syndrome and approximately 40 percent of people with tuberous sclerosis complex have ASD. Children with a variant of the gene NF-1 develop tumors in child- hood (neurofibromatosis) and a 2011 study found that nearly 10 percent met the criteria for autism. Intriguingly, these ASD-related genes influence a major signaling pathway for regulating cell metabo- lism, growth, and proliferation, the mTOR pathway. This suggests a very real potential for treating autism with drugs that target the mTOR pathway. For example, mouse models with mutations in PTEN show traits simi- lar to humans with these gene vari- ants: altered sociability, anxiety, and repetitive behaviors. These behaviors can be relieved or reversed by drugs that inhibit the mTOR pathway. Clinical trials of these drugs (rapamy- cin and lovastatin) are underway. Despite this progress, autism genetics is so complicated that it can’t be used to diagnose the condition. And unlike diabetes, kidney disease, or thyroid disease, there are no biochem- ical or other biomarkers of autism. Currently, autism diagnosis is based on behavioral analysis, but efforts are un- derway to use more objective criteria such as tracking eye movements and functional neuroimaging, which can even be done in infants. How early can autism be detect- ed? Parents often notice develop- mental issues before their child’s first birthday, and autism can be reliably diagnosed based on behavioral characteristics at age 2. Despite these possibilities for early detection, most American children aren’t diagnosed until they’re about 4½ years old. With evidence mounting that interventions are more effective the earlier they be- gin, researchers are hoping that more objective measures will enable earlier diagnoses and interventions. Although the molecular caus- es and characteristics of autism are unclear, it appears that the condition results from unusual cellular develop- ment within the cerebral cortex — a brain region that is crucial to mem- ory, attention, perception, language, and other functions. Both white and gray matter of the brain show consistent, but subtle, alterations in people with ASD. Long-term studies also have found that a minority of children on the autism spectrum have abnormally large brain volumes and faster brain growth. Other toddlers with autism have shown unusual development and network inefficien- cies at the back of the cerebral cortex. There is evidence that some atypical activity occurs in the cortex of people with ASD from older childhood into adulthood, and information might not be integrated in the usual way across distributed brain networks. At this point, no medications have been proven to reverse autism. Some people get symptomatic relief from drugs designed for other uses, such as anxiety conditions, and several stud- ies have reported social benefits from treatment with oxytocin — a hormone known to improve social bonding — but the findings have been mixed. For this challenging disorder, behavioral therapies are still the only proven treat- ments for autism, and early interven- tions are the most effective. ATTENTION DEFICIT HYPERACTIVITY DISORDER Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed childhood conditions. In 2014, approximately 11 percent of American parents with a child between the ages of 4 and 17 reported that their son or daughter had received an ADHD diagnosis. In at least 30 percent of those diagnosed with ADHD, the disorder continues into adulthood. ADHD is usually characterized by inattentiveness, as well as hyperactivity or impulsive behaviors. Although all young children can be hyperactive, impulsive, and inattentive from time to time, these symptoms are more extreme and last longer in children with ADHD. They often struggle to form strong friendships, and their grades in school can reflect their behavior instead of their academic ability. Executive functions, such as finishing what they start, remembering to bring homework back to school, and following multistep directions, can be especially challenging for those with ADHD. Young people with ADHD also have lower rates of high school graduation and a higher risk of suicide. No objective diagnostic test exists for ADHD, so diagnosis requires a comprehensive evaluation, including a clinical interview and parent and teacher ratings. Because problems with attention and hyperactivity can be caused by other conditions such as depression, sleep issues, and learning disorders, careful evaluation is always needed to determine whether ADHD is truly the cause of the symptoms. To warrant an ADHD diagnosis, atten- tion and behavioral problems must be severe enough that they interfere with normal functioning. In addition, the behavioral issues must be present in more than one context — not only at home or at school, but in both settings. Although ADHD tends to run in families, no well-defined set of genes is known to be responsible for the condition. Environmental risk factors, such as extreme early adversity, expo- sure to lead, and low birthweight, can also be involved. People with ADHD do not demonstrate any obvious brain alterations, but research has found that people with ADHD might have dif- ferences in the structure of brain cells and in the brain’s ability to remodel itself. Some people with ADHD show unusual activity in brain cells that re- lease dopamine, a chemical messenger involved in rewarding behavior. ADHD has no cure, but treat- ments include drugs, behavioral interventions, or both. Interestingly, ADHD medications include stimu- lants such as methylphenidate, as well as newer, non-stimulant drugs. The drugs are available in long-acting for- mulations so children do not have to interrupt the school day to take their medication. Determining the right drug and the right dose might require a period of experimentation and sup- port from a specialist, since dosage is adjusted to how fast a child metaboliz- es the drug, and to minimize the side effects. Nevertheless, most children with ADHD are diagnosed and treated by their pediatricians. Effective behav- ioral treatments include organizational support, exercise, and meditation. DOWN SYNDROME Down syndrome is named for the English physician who first described it in 1866, but nearly 100 years passed before scientists determined what caused the condition: possessing an extra copy of all or part of the 21st chromosome. People with this syn- drome have three copies of this genetic material, instead of two. In some cases, the extra copy, or trisomy, does not occur in every cell, producing what’s known as mosaicism. Currently, about 250,000 people in the United States are living with Down syndrome. There is no clear cause of the genetic glitch, although maternal age is a major risk factor for Down syn- drome. Mothers older than 40 are 8.5 times more likely to have a child with Down syndrome than mothers aged 20 to 24. Advanced paternal age has also been linked to higher incidence of Down syndrome. The genetics of autism is very complicated in most cases, involving dozens of genes, leading to a unique condition in nearly every person. 7574Brain Factssociety for neuroscience |Brain Facts society for neuroscience| Childhood Disorders 11Childhood Disorders11 Since late 2011, fetuses can be screened for Down syndrome using the mother’s blood. In the past, the risk of test procedures meant that only older mothers (whose likelihood of having a Down syndrome child was known to be higher) should be screened. Younger mothers didn’t know until delivery whether their child would have Down syndrome. The new blood test, unlike amniocentesis and chorionic villus sampling, poses no risk to the baby, so it can also be used for younger moth- ers whose chance of having a child with Down syndrome is quite small. Children born with Down syn- drome have distinctive facial features, including a flattened face and bridge of the nose, eyes that slant upward, and small ears. They usually have small hands and feet, short stature, and poor muscle tone as well. The intellectual abilities of people with Down syndrome are typically low to moderate, although some graduate from high school and college, and many successfully hold jobs. Other symptoms of Down syndrome can include hearing loss and heart defects, and virtually everyone born with Down will develop early-on- set Alzheimer’s disease, often in their 40s or 50s. Chromosome 21 contains the gene that encodes amyloid precur- sor protein (APP), an Alzheimer’s dis- ease risk factor, and possessing an extra copy of this gene might cause the early onset of this fatal disease. Interestingly, people with mosaic Down syndrome seem to have milder symptoms and are more likely to live past 50. There is no real treatment for Down syndrome, nor any clear expla- nation of what occurs in the brain. Poor connections among nerve cells in the hippocampus, the part of the brain involved in memory (and the first brain area affected by Alzheimer’s disease), are believed to be a key factor in brain or intellectual differences in Down syn- drome. Dysfunction in the mitochon- dria, the cell’s power plants, might also play a role in development of related disorders that involve energy metabo- lism, such as diabetes and Alzheimer’s. Scientists have grown stem cells from fetuses with Down syndrome and used them to test potential treatments and confirm which molecular path- ways are involved in the condition. In one such laboratory study, researchers took a gene that normally inactivates the second X chromosome in female mammals and spliced it into a stem cell that had three copies of chromosome 21. In these cells, the inactivation gene muted the expression of genes on the extra chromosome 21, believed to con- tribute to Down syndrome. Although this is a long way from any clinical ap- plications, the model is being used to test the changes and cellular problems that occur with the tripling of the 21st chromosome, in hopes of eventually finding a treatment. DYSLEXIA Dyslexia is the most common and best-studied of the learning disabilities, affecting as many as 15 to 20 percent of all Americans. People with dyslexia have a pro- nounced difficulty with reading despite having normal intelligence, education, and motivation. Symptoms include trouble with pronunciation, lack of fluency, diffi- culty retrieving words, poor spelling, and hesitancy in speaking. People with dyslexia might need more time to respond orally to a question and might read much more slowly than their peers. Dyslexia is usually diagnosed in elemen- tary school, when a child is slow to read or struggling with reading. Although reading skills and fluency can improve, dyslexia persists lifelong. Deciphering printed letters and words and recalling their sounds and meaning involves many areas of the brain. Brain imaging studies indicate these areas can be less well connected in people with dyslexia. One of these areas is a region on the left side of the brain called the “word-form area,” which is involved in the recognition of printed letters and words. People with dyslexia also show less brain activity in the left occipitotemporal cortex, which is considered essential for skilled read- ing. Researchers believe that the brain differences are present before the read- ing and language difficulties become apparent — although it is possible that people with dyslexia read less and, therefore, their brains develop less in regions associated with reading. Those with dyslexia appear to compensate for reduced activity on the left side of the brain by relying more heavily on the right side. Genetic analyses have revealed a handful of susceptibility genes, with animal models suggesting that these genes affect the migration of brain cells during development, leading to differences in brain circuitry. Dyslexia runs in families, with roughly half of dyslexics sharing the condition with a close relative. When one twin is diagnosed with dyslexia, the second twin is found to have the condition 55-70 percent of the time. But the genetics of dyslexia is complex, and likely involves a wide range of genes and environmental factors. Treatment for dyslexia involves behavioral and educational interven- tion, especially exercises like breaking words down into sounds and linking the sounds to specific letter patterns. Some researchers use a child’s ability to rapidly and automatically name things as an early indicator of dyslexia. This rapid automatic naming, and the ability to recognize and work with the sounds of language, are often impaired in people with dyslexia. Both skills can be used in preschoolers and kinder- gartners to predict their later reading skills. Research suggests that treat- ments targeting phonology, as well as multiple levels of language skills, show the greatest promise. EPILEPSY If someone has two or more seizures that cannot be explained by a temporary underlying medical condi- tion such as a high fever or low blood sugar, their medical diagnosis will be “epilepsy” — from the Greek words meaning to “seize,” “attack,” or “take hold of.” About 1 percent of Ameri- can children and 1.8 percent of adults have been diagnosed with this brain disorder. Seizures result from irregular activities in brain cells that can last five or more minutes at a time. Some seizures look like staring spells, while others cause people to collapse, shake, and become unaware of what is going on around them. The pattern of symp- toms and after-seizure brain recordings using EEGs are used to distinguish between different types of epilepsy and determine whether the true cause of the seizures is epilepsy or a different medical condition. Seizures are classified by where they occur in the brain. General- ized seizures affect both sides of the brain. They include absence or petit mal seizures, which can cause rapid blinking or a few seconds of staring into space, and tonic-clonic or grand mal seizures, which can make some- one fall, have muscle spasms, cry out, and/or lose consciousness. Focal or partial seizures are localized to one area of the brain. A simple focal sei- zure can cause twitching or a change in sensation, triggering strange smells or tastes. Complex focal seizures can leave a person confused and unable to answer questions or follow direc- tions. A person can also have so-called secondary generalized seizures, which begin in one part of the brain but spread to become generalized seizures. In some patients with severe epilepsy, multiple types of seizure can occur at the same time. Epilepsy has many possible causes and thus is considered a spectrum rather than a single disorder. Causes include premature birth, brain trauma, and abnormal development due to genetic factors. Attributes of epilepsy patients such as head size, movement disorders, and family history suggest that genetics is involved. Seizures can also accompany or cause intellectual or psychiatric prob- lems. For example, some seizures may suppress the growth of dendrites, leav- ing the person emotionally unsettled or less able to learn. Treatments for epilepsy are direct- ed toward controlling seizures with medication or diet. For most patients, a single medication is enough to control seizures, although a significant minority cannot get adequate control from drugs. About half of epilepsy pa- tients, particularly those with general- ized epilepsy, can reduce their seizures by eating a ketogenic diet, which relies heavily on high-fat, low-carbohydrate foods, although it’s unclear why this diet is effective. For severe cases that are not relieved by medication, doctors might recommend surgery to remove or inactivate the seizure-initiating part of the brain. In the most severe cases, if one side of the brain triggers sei- zures on the other side, surgeons may perform “split-brain surgery,” cutting the corpus callosum, a thick band of white matter that connects the two sides of the brain. Once their seizures are controlled, people with epilepsy can resume their normal lives. Epilepsy has many possible causes and thus is considered a spectrum rather than a single disorder.",Medical,Fact Finding,Q&A "You can only respond to the prompt using information in the context block. Give your answer in bullet points. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context""","What actions did the UN Secretary General, U Thant, take in response to the trial of Sheikh Mujibur Rahman in August 1971?","See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/381796770 The United Nations' Involvement in Bangladesh's Liberation War: A Detailed Analysis Article in International Journal of Politics & Social Sciences Review (IJPSSR) · June 2024 CITATIONS 0 3 authors, including: Md. Ruhul Amin Comilla University 33 PUBLICATIONS 9 CITATIONS SEE PROFILE All content following this page was uploaded by Md. Ruhul Amin on 28 June 2024. The user has requested enhancement of the downloaded file. ISSN 2959-6467 (Online) :: ISSN 2959-6459 (Print) ISSN 2959-6459 (ISSN-L) Vol. 3, Issue I, 2024 (January – June) International Journal of Politics & Social Sciences Review (IJPSSR) Website: https://ijpssr.org.pk/ OJS: https://ojs.ijpssr.org.pk/ Email: info@ijpssr.org.pk Page | 10 The United Nations' Involvement in Bangladesh's Liberation War: A Detailed Analysis Md. Firoz Al Mamun 1 , Md. Mehbub Hasan 2 & Md. Ruhul Amin, PhD 3 1 Assistant Professor, Department of Political Science, Islamic University, Kushtia, Bangladesh 2 Researcher and Student, Department of Government and Politics, Jahangirnagar University, Savar, Dhaka1342 3 (Corresponding Author), Associate Professor, Department of Public Administration, Comilla University, Cumilla, Bangladesh Abstract Liberation War, Bangladesh, United Nations, International Intervention, Conflict Resolution. Introduction The 1971 Bengali nation's armed struggle for independence took on an international dimension; as the conflict came to an end, India and Pakistan got directly involved, and the major powers and their powerful allies started to actively compete with one another to establish an independent state of Bangladesh. This effort included international and multinational aspects in addition to bilateral and regional forms (Jahan, 2008:245). The bigger forum in this instance, where the major powers and stakeholders participated in various capacities, was the UN. The major powers usually agree on decisions made and carried out by the United Nations, a global institution. The decision-making process is primarily a reflection of how the major powers see a given situation. The UN Security Council may reach an impasse, in which case the General Assembly may adopt certain restricted actions. Everything that occurred in 1971 took place during the Bangladesh crisis (Matin, 1990: 23). With Bangladesh's ascent on December 16, the subcontinent's map underwent a reconfiguration. Furthermore, the United Nations' involvement in these matters has primarily been restricted to humanitarian efforts and relief activities. The Pakistan military attempted to stifle the calls for freedom of the people of East Pakistan by genocide and ethnic oppression, which was thwarted by the On March 26, 1971, the Bangladeshi independence struggle against domestic imperialism and ethnic discrimination in Pakistan got underway. March 26, 1971, saw the start of the Bangladeshi independence movement against domestic imperialism and ethnic discrimination in Pakistan. The United Nations gave relief and humanitarian activities first priority starting in the Liberation War and continuing until November. The UN Security Council was called in when India and Pakistan entered the Liberation War on December 3. The Security Council meetings continued as different suggestions and counterproposals were presented. In the Security Council, there was a clash between the USSR and US. While the USSR helped Bangladesh, China and the US helped Pakistan. Keeping their positions neutral, France and Britain did not cast votes in the Security Council. The Security Council could not therefore come to an agreement. On December 6, after discussion and an official decision, the Security Council sent the agenda to the General Assembly. On December 7, a resolution headed ""Unity Formula for Peace"" was overwhelmingly approved at the General Assembly. As India and Bangladesh rejected this idea, the US called a second Security Council session. Sessions of the Security Council were held at various intervals between December 12 and 21. Everything changed dramatically when Bangladesh gained its independence on December 16. The protracted Bangladesh war was essentially resolved on December 21 when the Security Council unanimously approved a ceasefire resolution. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 11 establishment of Bangladesh, under the standard pretexts of national integrity, internal affairs, etc. For this reason, it is plausible to argue that Bangladesh's establishment following the dissolution of the post-World War II state structure was a highly justifiable event. Following its declaration of independence, Bangladesh joined a number of UN bodies in 1972 and attained full membership status in 1974 (Hussain, 2012:189). There is a dearth of scholarship on the United Nations' involvement in the Great War of Liberation. The discussion research is highly significant, and the author has logically made a concentrated effort to examine and unearth material on the role of the organization in charge of maintaining world peace and security throughout the Great War of Liberation. Research Methodology The article titled 'The Role of the United Nations in the Great Liberation War of Bangladesh: An Analysis' has all of the basic aspects of social research. Data was gathered from secondary sources for research purposes. The research was done using both qualitative and quantitative methods. The research paper titled 'Role of the United Nations in the Great Liberation War of Bangladesh - An Analysis' was analyzed using the 'Content Analysis Methodology'. Basically, the study effort was done using secondary sources to acquire and analyze data and information. The research relies on secondary sources, either directly or indirectly. The study was done by gathering information from worldwide media coverage, UN documents, publications, research papers, reports, archives relating to the liberation war, and records housed in the museum during Bangladesh's War of Liberation (1971). The Role of the United Nations in the early stages of the Liberation War All UN employees were evacuated from Dhaka on March 25, 1971, the night the Pakistani armed forces declared the liberation war through ""Operation Searchlight."" But it has not moved to halt the atrocities against human rights and genocide in East Pakistan. On April 1st, nonetheless, the Secretary General sent an emergency humanitarian offer to the Pakistani government for the inhabitants of East Pakistan. Nevertheless, the Pakistani government turned down the offer of humanitarian assistance and even forbade the Red Cross relief aircraft from landing in Dhaka (Hossein, 2012: 150). President Yahya Khan gave the UN authorization to carry out rescue operations after the UN Secretary General appealed to the Pakistani government on April 22 for immediate humanitarian aid. Beginning on June 7, 1971, the United Nations started assistance efforts in East Pakistan. The acronym UNROD stood for the United Nations Relief and Works Agency for East Pakistan. United Nations recognized the name ""Bangladesh"" on December 21 and dubbed the rescue agency ""UNROD"" (Time Magazine, January 1, 1971). The surge of refugees entering India on April 23 was the reason the Indian government made its first plea for outside assistance since the start of the liberation struggle. Coordination in this respect was taken up by the United Nations High Commissioner for Refugees (UNHCR). Other than UNHCR, UNICEF and WFP are involved in Indian refugee camps actively. The World Bank estimates that the Indian government spent $1 billion on refugees overall up to December, of which just $215 million came from UN assistance. By far the biggest airlift in UN history (International Herald Tribune, July 8, 1971). India's committed and received monies from the UN and other sources up to June were: International Aid to India (June, 1971) United Nation Other Sources Total 9,80,00,000 16,50,00,000 26,30,00,000 Source: International Herald Tribune, 8 July, 1971. United Nations product aid to India Topics Quantity 1. Food Aid 6267 tons 2. Vehicles 2200 piece 3. Medical supplies 700 tons 4. Polythene for making shelters What is needed for 3 million refugees Source: Rahman, Hasan Hafizur (ed.) (1984) Bangladesh Liberation War Documents, Volume- 13, Dhaka: Ministry of Liberation War Affairs, Government of the People's Republic of Bangladesh, page 783-87. Though the UN participated in the relief effort, until September, no talks on matters like the liberation struggle in Bangladesh, genocide, abuses of human rights, etc. were held in the UN. Even Bangladesh was left from the September UN Annual General Discussion agenda. Still, throughout their statements, the leaders of several nations brought up Bangladesh. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 12 Proposal for deployment of United Nations observers in East Pakistan Early in the Liberation War, India asked the UN to step in and handle the refugee crisis and put an end to the genocide in East Pakistan. Yet, at first, Pakistan opposed the UN's intervention in the refugee crisis, viewing any UN action as meddling in its domestic affairs (Hasan, 1994: 251–53). However, Yahya Khan consented to embrace all UN measures as of May on US advice. Pakistan started participating actively in diplomatic efforts in a number of UN forums during this period, with support from Muslim nations and the United States. In order for India to be compelled to cease aiding Bangladesh's independence movement as a result of UN pressure. Acknowledging this, India vehemently objected to the UN's political role, which it concealed behind humanitarian endeavors. Despite the fact that the UN Secretary General has mostly been mute on ending genocide and breaches of human rights since the start of the Liberation War, on July 19 he suggested that ""UN peacekeepers or observers be deployed on the India-Pakistan border to resolve the refugee problem."" But the UN Secretary General's plan to send out troops or monitors was shelved after the Mujibnagar administration and India turned down this offer (Hossein, 2012: 87). According to Article 99 of the United Nations, the initiative of the Secretary General The UN Secretary-General, U Thant, submitted a memorandum under Article 99 to the president of the Security Council and member nations on July 20, 1971, the day following the request for the deployment of observers. There were eight paragraphs or suggestions in the Secretary General's letter. ""Obviously, it is for the members of the Security Council themselves to decide whether such consideration should be taken place formally or informally, in public or private,"" he stated in the note (UN Doc, A/8401). India, the primary backer of Bangladesh's independence movement, was put in a humiliating position by the Secretary General's suggestions. The Soviet Union supported India in this circumstance. India's principal foreign benefactor in the wake of the Soviet-Indian alliance's signature was the Soviet Union. The Soviet Union asked the Secretary-General on August 20th not to call a meeting of the Security Council to discuss the East Pakistan issue. As a result, the Security Council did not meet, even on the Secretary General's suggestion. Major nations and interested parties maintained their diplomatic efforts in anticipation of the United Nations General Assembly's 26th session, which is scheduled to take place on September 21 (The Year Book of World Affairs, 1972). United Nations Intervention in the Question of Bangabandhu's Trial Sheikh Mujibur Rahman is set to face trial for treason in the final week of July, as reported by many media sources. The Mujibnagar government promptly raised alarm following the publication of this news. Sheikh Mujib is the unquestionable leader of Bangladesh's liberation movement. Consequently, the Mujibnagar government formally requested the international community and influential nations to ensure the safety and well-being of Sheikh Mujib's life (Joy Bangla, July 30, 1971). The trial of Sheikh Mujibur Rahman commenced on August 9, 1971, under the authority of the Pakistani government. On August 10, U Thant, the Secretary General of the United Nations, intervened in the Pakistani military junta's attempt to bring Sheikh Mujibur Rahman to trial. The Secretary General stated clearly that the topic at hand is highly sensitive and delicate, and it is the responsibility of the legal system of Pakistan, as a member state, to handle it. It is also a subject of great curiosity and worry in several spheres, encompassing both humanitarian and political domains. The Secretary General has been regularly receiving expressions of grave concern from government representatives regarding the situation in East Pakistan. It is widely believed that unless some form of agreement is reached, the restoration of peace and normalcy in the region is unlikely. The Secretary General concurs with several members that any advancements about the destiny of Sheikh Mujibur Rahman would undoubtedly have repercussions beyond the borders of Pakistan. The article is from The International Herald Tribune, dated August 10, 1971. Delegation of Bangladesh to the United Nations The United Nations General Assembly meets every September. On September 21, the Mujibnagar administration (1st government of independent Bangladesh) agreed to dispatch a 16-member team led by Justice Abu Saeed stationed in London. On September 25, the Bangladesh delegation convened and nominated Fakir Shahabuddin as the party's member secretary. Bangladesh was not a member of the United Nations before then. In this situation, the delegation had a tough time entering the UN building. Pakistan, in particular, tried to label the delegation as'rebellious elements. Even in this International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 13 hostile climate, this group continued to engage in creative and intellectual activities as the Mujibnagar government's representation on the United Nations premises. Currently, the President of the United Nations Association of Journalists. Yogendranath Banerjee assisted the team in entering the United Nations building. at October, the Bangladesh delegation conducted a plenary news conference at a space at the Church Center, located on the west side of 777 United Nations Plaza. As a result, the Bangladeshi representation to the United Nations actively participated in mobilizing global opinion on Bangladesh's favor. The 26th meeting of the General Assembly The latter portion of the September 1971 UN headquarters conference focused on the membership of the People's Republic of China and the status of Bangladesh. The 26th session failed to resolve the issue of the 'Bangladesh dilemma'. Bangladesh has been cited in the annual report of the Secretary General and in remarks made by national representatives. In his report, UN Secretary-General U Thant emphasized the imperative for the international community to provide comprehensive assistance to governments and peoples in the event of a large-scale disaster. In UN Document A/8411, I have asserted that the only viable resolution to the underlying issue lies in a political approach centered around reconciliation and humanitarian principles. This session's official and informal assembly of country representatives at the UN headquarters focused on China's UN membership and Bangladesh. New Zealand, Madagascar, Luxembourg, Belgium, Norway, and Sweden stressed the subcontinental situation before the UN General Assembly and demanded a quick settlement. Pakistan was told to restore a popular administration in East Pakistan by France and Britain. The Soviet Union no longer regarded the situation a Pakistani issue. Pakistan only had ambivalence and leniency from the US. Luxembourg's delegate asked, ""When we witness millions of people suffering indescribably, being brutally punished in the guise of national security, and civilized society's weakest losing their rights, In the sake of national sovereignty and security, should such cruelty continue? On Sept. 29, Canadian Foreign Minister Michelle Sharpe said, 'When an internal conflict is moving so many nations so directly, would it be right to consider it an internal matter?' Pakistan was advised to be flexible by Sweden. He remarked that ""it would behove Pakistan to respect human rights and accept the public opinion declared through voting"". The US sessionally backed Pakistan and said, ""Pakistan's internal issues will be dealt with by the people and government of Pakistan."" The East Pakistan problem had generated a worldwide catastrophe, and Pakistan's ruthlessness had caused millions of refugees to cross the border and seek asylum in other nations. In session, the French foreign minister remarked, ""If this injustice cannot be corrected at the root, the flow of refugees will not stop."" Belgians repeated Schumann's query, ""Will the return of the refugees be possible?"" He noted ""a political and constitutional solution to this crisis must be found”. This remedy should come from public opinion. Only when they are confident in the future that human rights will not be abused will refugees return home. British Foreign Secretary Sir Alec Hume was clear about the solution (Muhith, 2014). The statements of these countries are arranged in a table and some important questions are answered for it. These are: a. States that have identified the Bangladesh question as a political issue; b. b. States that have termed it only as a humanitarian problem; c. States that have identified the matter as Pakistan's internal affairs; d. Only those countries that have spoken of genocide and human rights violations; Country Problem description References to both political and humanitarian aspects Paying attention to humanitarian issues Internal Affairs of Pakistan Genocide and human rights violations Afghanistan * * Albania Algeria * * Argentina * * * Australia * * * Austria * * Bahrain Barbados Belgium * * Bhutan International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 14 Bolivia Botswana Brazil Bulgaria Burma Burundi Belarus Cameroon Canada Central African Republic Sri Lanka (Ceylon) * * Chad Chile * * China * * Colombia Congo Costa Rica Cuba Cyprus * * Czechoslovakia Secretary General's Good Office Proposal At the 26th General Session, governments, the international media, and the people put pressure on UN Secretary General ""U Thant"" to take a new crisis action for Bangladesh. On October 20, he gave India and Pakistan his good office. The Secretary General said, ""In this potentially very dangerous situation, I feel that it is my duty as Secretary General to do everything I can to help the government immediately concerned avoid any disaster."" I want you to know that my offices are always open if you need help (UN Doc, S/10410:6). This letter of the Secretary General implies that he views the matter as an India-Pakistan war. President Yahya Khan also wanted a Pak-India confrontation. Yahya Khan informed the Secretary General a day later that Pakistan had accepted this idea. I appreciate your willingness to provide your good offices and hope you can visit India and Pakistan immediately to negotiate force withdrawal. I am convinced this will benefit and advance peace. UN Doc, S/10410: 7 However, India did not reject the UN Secretary General's 'good office'. According to the status of UN Secretary General and diplomatic etiquette, India could not reject this plan outright, therefore it rejected it indirectly. The Secretary General's recommendation came as Indira Gandhi was touring the world to promote Bangladesh's liberation fight. Upon returning from abroad, he informed the Secretary General on November 16 that the military rule of Pakistan was a severe threat to national life and security. Indira Gandhi said that Pakistan wants to make problems within Pakistan into problems between India and Pakistan. Second, we can't ignore the reason why people are crossing borders as refugees. Indira Gandhi kindly told the Secretary General that instead of India and Pakistan meeting, Yahya Khan and the leaders of the Awami League should do it. ""It's always nice to meet you and talk about our ideas,"" she said. We will back your efforts to find a political solution in East Bengal that meets the stated needs of the people, as long as you are ready to look at the situation in a broader context (Keesings, 1972). In his response, the Indian Prime Minister said that the UN Secretary-General was guilty. In order to protect the Pakistani junta, the Secretary General is avoiding the main problem. In a message to the Prime Minister of India on November 22, the Secretary-General denied the charges, saying that good office requires everyone to work together. In this very important and complicated case, there doesn't seem to be a reason for the Secretary General to help. 10 (UN Doc S/10410). The UN Secretary-General's ""Good Office"" project in the subcontinent stopped when this message was sent. 1606th Session of the Security Council (December 4, 1971) On December 3, India entered the Pakistan War, threatening peace and stability in one of the world's most populated areas. Both nations reported the incident to the UN Secretary General on December 4. After thoroughly evaluating the problem, the Secretary-General requested a Security Council session from Council President Jakob Malik (Soviet Union) (The New York Times, 4 December 1971). International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 15 The 1606th Security Council session (5 permanents—US, Soviet Union, China, UK, France— and 10 non-permanents—Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria) meets on December 4, 1971. Justice Abu Saeed Chowdhury, the Bangladesh delegation leader, asked the Security Council President to advocate for the Mujibnagar administration before the meeting. The Security Council President proposed listening to Justice Abu Saeed Chowdhury's remarks as Bangladesh's envoy at the start of the meeting. A lengthy Security Council debate on hearing Justice Abu Saeed Chowdhury's remarks from Bangladesh. The council president presented two ideas in response to criticism. a. Permit the letter to be circulated as a Security Council document from Justice Abu Saeed Chowdhury, the representative of Bangladesh. b. The council should allow Justice Abu Saeed Chowdhury to speak as a representative of the people of Bangladesh. The majority of nations did not object to the speech's delivery on the grounds of principle, thus the Council President issued an order granting the request to present the resolution. However, because to a lack of required support, the President rejected Justice Chowdhury's second motion to join the Security Council debate (UN Doc, S/PV/1606). The Security Council extended an invitation to the representatives of India and Pakistan to make remarks. The first speaker was Agha Shahi, Pakistan's Permanent Representative to the UN. He charged India with breaking Articles 2(4) and 2(7) of the UN Charter in his long statement, and he called on the UN to take responsibility for safeguarding Pakistan's territorial integrity (UN Doc, S/PV/1606: 49–148). In his remarks, Samar Sen, India's Permanent Representative to the UN, stated, ""The enemy is sidestepping the core problem and falsely condemning India. According to him, this problem has resulted from the strategy of putting seven crore Bengalis under weapons control. Despite the fact that Sheikh Mujib was predicted by Yahya Khan to become Pakistan's prime minister, nobody is certain of his current whereabouts. Bengalis have won elections but have not been granted authority, which is why Samar Sen supports their independence. This led them to launch nonviolent movements as well, but these were also put down by massacres. They are therefore quite justified in demanding their right to self-determination. According to UN Doc, S/PV/1606: 150–85, he stated that the ceasefire should be between the Pakistan Army and Bangladesh, not between India and Pakistan. 1. The United States of America's Security Council Resolution (S/10416) Following the keynote addresses by the Indian and Pakistani delegates, US Representative George Bush Sr. charged India of aggressiveness. 'Immediate ceasefire between India and Pakistan, withdrawal of the armies of both countries to their respective borders, deployment of United Nations observers on the India-Pakistan border, taking all necessary steps for the repatriation of refugees' (UN Doc, S/10416) was one of the seven points of his resolution. Every Security Council member participated in the discussion of the US proposal. 2. Belgium, Italy, and Japan's Proposals (S/10417) Belgium, Italy, and Japan submitted a five-point draft resolution to the Security Council in response to the US proposal. In line with the UN Charter's tenets, the draft resolution calls on ""the governments of both countries to immediately cease hostilities and all forms of hostilities and to take necessary measures for the rapid and voluntary repatriation of refugees"" (UN Doc, S/10417). 3. The Soviet Union's Security Council Resolution (S/10418) At opposition to the American plan, the Soviet Union put out a two-point draft resolution at the UN Security Council's 1606th resolution calling for an end to hostilities in East Pakistan. ""A political solution in East Pakistan, which would end hostilities there and at the same time stop all terrorist activities by the Pakistan Army in East Pakistan,"" was what the Soviet proposal demanded (UN Doc, S/10418). 4. The Argentine, Nicaraguan, Sierra Leonean, and Somalian proposals (S/10419) Argentina, Nicaragua, Sierra Leone, and Somalia sent the Security Council a two-point draft resolution (S/10419) at the Soviet Union's advice. Under the draft resolution (UN Doc, S/10416), both nations must ""immediately ceasefire and withdraw"" and the Secretary-General is to ""keep the Security Council regularly informed of the situation."" The Security Council heard four resolutions during its 1606th meeting. Following a thorough discussion and debate, the president of the Security Council presented the US proposal—one of four draft proposals—for voting among the Security Council's member nations for acceptance. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 16 1 st veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10416) In favor of the US proposal Abstain from voting Against the US proposal Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria. United Kingdom, France Soviet Union, Poland When the US accused India of withdrawing soldiers in the Security Council, 11 voted yes and the Soviets and Poland no. Neither the UK nor France voted. Permanent Security Council member the Soviet Union vetoed the motion. Soviet Union's 106th UN Security Council veto (UN Doc, S/PV/1606: 357-71). 1607th Emergency Session of the Security Council (December 5, 1971) The Security Council convened its 1607th session on December 4 at 2.30 p.m. on December 5. The fact that Tunisia from Africa and Saudi Arabia from Asia, neither Security Council members, can speak makes this session unique. They attended at the Security Council President's request. I.B. Tarlor-Kamara (Sierra Leone) chaired this Security Council session (UN Doc, S/PV/1607). The Resolution of China (S/10421) This session featured a Chinese resolution draft. China's plan termed India an aggressor and chastised it for establishing Bangladesh. China ""demands the unconditional and immediate withdrawal of the Indian army occupying Pakistani territory"" (UN Doc, S/10421). After China's draft proposal, the Tunisian ambassador spoke for Africa. He said, ""The Security Council should also call for a ceasefire, so that peace can be established according to the various clauses of the Charter"". The Asian Saudi representative then spoke. According to Saudi envoy Jamil Baroodi, ""He called for a meeting of Asian heads of state on the subcontinent to get rid of the politics of the big powers."" After the Saudi delegate, the Soviet representative mentioned a draft proposal (S/10422, December 5, 1971). The Soviet Union said a 'ceasefire may be a temporary solution but a permanent one would need a political accord between India and Pakistan'. The Soviet delegate accused the US and China of disregarding two major issues for ""temporary interests"". Pakistan and India spoke in the Security Council after the Soviet representative. After Pakistan and India spoke, the Council President informed the Security Council that the Council now has three resolutions: S/10418 (Soviet Union), S/10421 (China), and S/10423 (8 Nations). S/10417 and S/10419 are no longer before the House since the same state presented the 8-nation resolution (S/10423), which complements them. The Council President voted on the Soviet proposal first (UN Doc, S/PV/1607:75-201). Consequences of the Soviet Union's (S/10418) proposal In favor of the Soviet Union Abstain from voting Against the proposal Soviet Union Soviet Union, Poland United States, United Kingdom, France, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria China The Chinese veto caused the idea to be rejected. The majority of members were not convinced by this suggestion either. Furthermore, throughout the speech, those who chose not to vote expressed their opposition to the idea. When the Chinese proposal (S/10421) was put to a vote by the Council President following the vote on the Soviet proposal, the Chinese delegate stated that they were still in consultation with other Council members. No vote was held on the Chinese proposal as China indicated no interest in holding a vote on it. The eight-nation draft proposal, headed by Argentina, was then put to a vote by the Council President. 2 nd veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10423) In favor of the 8 nation proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria. United Kingdom, France Soviet Union, Poland This idea received 11 votes. UK and France refused to vote. Soviet and Polish votes were no. After the Soviet Union vetoed it again, the eight-nation armistice failed (UN Doc, S/PV/1607: 230- 331). The French delegate called such motions and counter-motions 'presumptive' after the 8 Nations' resolution voting. After voting on the 8 Nations resolution, the Council President notified the Council of two further resolutions (S/10421) and (S/10425). The Security Council President exhorted member nations to find a solution and postponed the discussion until 3.30 pm the next day. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 17 The Proposals by 8 Nations (S/10423) In this session of the Security Council, the 8 member states of the Provisional Council (Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone and Somalia) led by Argentina put forward a proposal of three points. The resolution called for a ceasefire and the creation of an environment for refugee return (UN Doc, S/10423). The Proposals by 6 Nations (S/10425) At the 1607th session of the Security Council, six nations—Belgium, Italy, Japan, Nicaragua, Sierra Leone and Tunisia—proposed another three-point resolution. This proposal statesa. Urges governments to immediately implement a cease-fire. b. Request the Secretary General to update the Council on the resolution's implementation. c. The UN Doc, S/10425, recommends continuing to consider methods to restore peace in the region. 1608th meeting of the Security Council (December 6, 1971) The 1608th Security Council session was place at 3.30 pm on December 6, 1971. This session, like the previous ones, allowed India, Pakistan, and Tunisia from Africa and Saudi Arabia from Asia to debate. I.B. Tarlor Kamara (Sierra Leone) convened this Security Council session (UN Doc, S/PV/1608:1-5). Soviet Union Resolution (S/10426) Soviet delegate offered a new resolution with two revisions to the six-nation draft resolution (S/10425) early in this session. (In operative paragraph 1, replace ‘the Governments concerned’ with 'all parties concerned' and add 'and cessation of all hostilities'). Peace Proposal Unity Formula (S/10429) In the wake of Security Council impasse, the 11 member nations discussed bringing the issue to the General Assembly informally. Following discussions, Argentina, Somalia, Nicaragua, Sierra Leone, Burundi, and Japan presented a draft resolution (S/10429) to the Security Council, recommending a special session of the UN General Assembly if permanent members failed to reach consensus at the 1606th and 1607th meetings. This proposal followed the 3 November 1950 General Assembly decision [377 A (V)]. Many call it 'Unity for Peace Exercise'. Since the UN Security Council is deadlocked, the General Assembly implements portions of this formula for world peace and security. Soviet Union Resolution (S/10428) The Soviet Union introduced another draft resolution late in this session. In a five-point draft resolution, the USSR urged that ""all parties concerned should immediately cease hostilities and implement a cease-fire."" The 1970 elections called for a political solution in Pakistan to cease hostilities. The UN Secretary-General should execute this decision and continue peace talks in the area. After briefly discussing the draft resolutions in the Security Council, the President decided to vote for the Unity Formula for Peace resolution (S/10429) to take initiative because the Soviet and Chinese resolutions (S/10428) and (S/10421) would fail. Consequences of the Unity Formula for Peace proposal in the Security Council In favor of the US proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria *** United Kingdom, France, Soviet Union, Poland After this proposal was passed, the United Nations started to implement the Unity Formula for Peace (UN Doc, S/PV/1608) with the aim of ending the war in the subcontinent. To protect Pakistan, China took the initiative to send this proposal to the UN General Assembly. 26th (Special Session) of the General Assembly According to the Security Council's December 6 decision, the 26th extraordinary session of the General Assembly was convened at the UN on December 7. The 26th Special Session of the General Assembly saw three proposals: A. Proposal by 13 nations (A/L/647). B. The 34-nation Argentine-led plan (A/L/647 Rev.) and Soviet proposal (A/L/646) were detailed. For 12 hours on December 7, the General Assembly considered 3 draft proposals. debate included 58 of 131 General Assembly nations. The Resolution of 13 States to the General Assembly (A/L/647) Thirteen member states introduced a draft resolution for General Assembly debate at the start of this session. The 13 states' suggestions mainly included the following: International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 18 a. Urge Pakistan and India to immediately halt hostilities and return their soldiers to their respective boundaries. b. Boost attempts to repatriate refugees. c. (c) The Secretary-General will urge that decisions of the Security Council and the General Assembly be implemented. d. In view of the existing resolution (UN Doc, A/L 647), urge the Security Council to respond appropriately. The Resolution of 34 States to the General Assembly (A/L/647 Rev-1) The General Assembly received a draft resolution from 34 governments, chaired by Argentina and backed by the US, Muslim nations, and China. 'Immediately effective Indo-Pakistani ceasefire and evacuation of Indian troops from East Pakistan, respecting the concept of the integrity of Pakistan' was the 34-state resolution's heart. The Resolution of Soviet Union (A/L/648) The Soviet Union's proposal states, ""Ceasefire may be a temporary solution, but a permanent solution requires a political agreement between India and Pakistan"" (UN Doc, A/L 648). Countries Participating in the Debate in the Special Session (26th) of the United Nations General Assembly Asia Africa Europe Middle and South America Others Bhutan Algeria Albania Argentina Australia Sri Lanka Burundi Bulgaria Brazil Fiji China Chad Czechoslovakia Chile New Zealand Cyprus Gabon Denmark Ecuador United States India Ghana France Mexico Indonesia Ivory Coast Greece Nicaragua Iran Madagascar Italy Peru Japan Mauritania Netherlands Uruguay Lebanon Sierra Leone Poland Malaysia Somalia Portugal Mongolia Sudan Soviet Union Nepal Tanzania Sweden Pakistan Togo Britain Saudi Arabia Tunisia Yugoslavia Turkey Hungary Jordan Quake 17 country 14 country 15 country 8 country 4 country Source: Prepared by reviewing various UN documents. Following deliberation in the General Assembly, the President of the Assembly, Adam Malik (former Minister of Foreign Affairs of Indonesia), approved the motion put up by 34 nations, spearheaded by Argentina, for vote in the General Assembly (amended). This decision was made in accordance with Rule 93 of the Rules of Procedure, which governs the process. Voting results on 34 state resolutions in the General Assembly 34 in favor of the State proposal Abstain from voting Against the proposal of 34 states 104 states 11 states 16 states It was supported by 104 nations, Negative vote from 16 nations and 11 nations cast no votes. General Assembly resolution sent to Security Council for execution same day. UN Under-SecretaryGeneral telegraphed India and Pakistan of the General Assembly's resolution (UNGA Resolution, 2793). 1611th Meeting of the Security Council (December 12, 1971) While the UN General Assembly adopted the ceasefire resolution, the battle continued and Pakistan soldiers in Dhaka fell. On December 12, George Bush (Senior) requested a quick ceasefire from the Secretary General in the Security Council (S/10444). Thus, the 1611th Security Council meeting took place at 4 p.m. A large delegation from India led by Foreign Minister Sardar Swaran Singh attended this summit. Pakistan sent a mission led by recently appointed Deputy Prime Minister and Foreign Minister Zulfiqar Ali Bhutto to boost diplomatic efforts (UN Doc, S/PV/1611). International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 19 The Resolution of the United States (S/10446) The US proposed a draft resolution to a Security Council emergency meeting on 12 December. The seven-point resolution demanded 'prompt ceasefire and army withdrawal' (UN Doc, S/10446). In this Security Council resolution, the US and USSR had opposite stances. The US and China publicly supported Pakistan. The council president adjourned the meeting at 12.35 pm to meet again the next day. 1613th meeting of the Security Council (December 13, 1971) The Security Council had its 1613th session at 3 p.m. on December 13. In addition to Security Council members, India, Pakistan, Saudi Arabia, and Tunisia attended this meeting. The meeting opened with US draft resolution (S/10446) talks. The Council president let Poland's representative speak first. George Bush, US representative, said, India bears the major responsibility for broadening the crisis by rejecting the UN's efforts to become involved, even in a humanitarian way, in relation to the refugees, rejecting proposals like our Secretary General's offer of good offices, which could have defused the crisis, and rejecting proposals that could have started a political dialogue. (UN Doc, A/PV 2002: 130-141). Chinese envoy Chiao remarked, ""India conspires with Bengali refugees like Tibetan refugees."" He called India a ""outright aggressor"" pursuing South Asian domination. He further said the Soviet Union is the principal backer of Indian aggression. China wants a ceasefire and the evacuation of both nations' forces (UN). Doc, A/PV 2002: 141-146). In his speech, the Soviet Union delegate observed, 'The businesspeople and fanatics who brought this subject before the General Assembly have blinded their eyes to the true situation in the Indian subcontinent. They are concealing the major reasons of the dispute without examining the issue. He dubbed this project China-US Collude. China asserts it uses the forum for anti-Soviet propaganda (UN Doc, A/PV 2003: 173-185). The President of the Council voted on the United States' updated draft resolution (S/10446/Rev.1) for Security Council approval after debate. The third veto by the Soviet Union, a permanent UN Security Council member, reversed the cease-fire resolution (UN Doc, S/PV/1613: 174). 3 rd veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10446/Rev.1) In favor of the US proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria United Kingdom, France Soviet Union, Poland The Proposal by Italy and Japan (S/10451) After voting on the US proposal, Italy and Japan jointly presented another draft resolution at this session of the Security Council. There were total of nine points in this proposal. The main point of the resolution was to 'maintain the national integrity of Pakistan and reach a comprehensive political solution to this crisis' (UN Doc, S/10451). The 1614th meeting of the Security Council took place on December 14, 1971. The 1614th Security Council meeting commenced at 12.10 pm on December 14th. The meeting did not achieve a consensus. Britain engaged in discussions with other members of the Council, namely France, in order to develop a new proposal that would meet the approval of all parties involved. Poland has presented a draft resolution (S/10453) to the President of the Council, outlining a six-point plan for a ceasefire. Here, the Security Council meeting system was addressed. After discussing their recommendations, Britain and Poland requested that the conference be deferred until the next day for government orders. All Council members agreed, save China's moderate reservations. To permit formal deliberations on the British-French and Polish proposals, the Council President postponed the meeting (UN Doc, S/PV/1614: 49). 1615th meeting of the Security Council (December 15, 1971) The 1615th Security Council meeting was conducted at 7.20 pm on December 15. At the Council President's request, India and Pakistan delegates attended this meeting. Meeting attendees discussed four draft suggestions. Polish proposal (UN Doc, S/10453/Rev-1), France and Britain's resolution, Syria's resolution, and Soviet Union's resolution. Polish proposals included 'ceasefire and departure of West Pakistani soldiers from East Pakistan'. ""Pakistani political prisoners should be released, so that they can implement their mandate in East Pakistan"" declared the Syrian draft resolution. After negotiations, the UK and France proposed a Syrian-like draft resolution. The concept addresses International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 20 ceasefire in the east and west of the subcontinent individually. The idea called for political settlement discussions with elected officials. Britain, France, and the Soviet Union made similar proposals. The Soviet Union demanded a thorough political solution with East Pakistan's elected representatives. A cease-fire must also be announced (UN Doc, S/PV/1615). The Chinese representative began with a speech. China's representative said, 'The Security Council should respect Pakistan's independence, sovereignty, national unity and geographical integrity' (UN Doc, S/PV/1615: 13). The President of the Council asked the Sri Lankan representative to speak after the Chinese speaker (UN Doc, S/PV/1615: 13). The Council President invited the Sri Lankan delegate to speak after the Chinese representative. Sri Lankan representative: ""Sri Lanka seeks a neutral solution. He said, 'This solution should be one where triumph is devoid of difficulties, loss is without consequence and above all peace prevails' (UN Doc, S/PV/1615: 22). Pakistan's Deputy Prime Minister and Foreign Minister Zulfikar Ali Bhutto's statement on these suggestions was spectacular. The Security Council was strongly criticized in his passionate address. He called the Security Council stage of deceit and farce' He instructed the Security Council to legitimize every unlawful occurrence until December 15, establish a harsher treaty than Versailles, and legalize the occupation. We will fight without me. I shall withdraw but fight again. My country calls. Why waste time on the Security Council? I refuse to participate in such a disgraceful surrender of my nation. He urged the General and Security Council to remove the ‘monument of failure' He concluded his Security Council remarks. They rip up draft resolutions of four nations, including Poland, and I go (UN Doc, S/PV/1615: 84). Pakistani delegates left the Security Council. Pakistani delegates left the Security Council. Accepting Poland's suggestion (UN Doc, S/10453) may have benefited Pakistan. India 'although grudgingly' approved the idea with Soviet help. The Pakistani military would not have surrendered humiliatingly if the delegates had accepted the idea. The Council President called Poland's proposal timely out of 4 drafts. The Security Council discussed four draft ideas, but none of the member nations indicated interest in voting. Instead, they continued to deliberate. Thus, the Council President adjourned the meeting till 10.30 am on December 16 (UN Doc, S/PV/1615:139). 1616th meeting of the Security Council (December 16, 1971) The 1616th Security Council meeting was conducted at 10:30 am on December 16. The Security Council President invited Indian Foreign Minister Sardar Swaran Singh, Saudi Ambassador Mr. Jamal Baroodi, Tunisian representative, and Sri Lankan representative to this meeting. The President stated that five draft resolutions await decision before the Council: Italy and Japan (S/10451), Poland (UN Doc, S/10453/Rev-1), Syria (UN Doc, S/10456), France and Britain (UN Doc, S/10455), and the Soviet Union (UN Doc, S/10457). The Chinese and Soviet draft resolutions (S/10421) and (S/10428) were not vetoed (UN Doc, S/PV/1616: 3). Indian External Affairs Minister Sardar Swaran Singh read Indira Gandhi's statement after the President's opening remarks. This statement included two main points. a. Pakistani army surrendering in Dhaka created Bangladesh. b. India's Western Front ceasefire (UN Doc, S/PV/1616:5). At 1.10 pm, the 1616th Security Council meeting finished. 1617th meeting of the Security Council (December 16, 1971) The Foreign Minister of India proclaimed the creation of Bangladesh via the surrender of Pakistani soldiers in Dhaka at 3.00 pm in the 1616th and 1617th Security Council meetings. Besides Security Council members, India, Pakistan, Tunisia, and Saudi Arabia attended this meeting. A Soviet draft resolution (S/10458) welcomed India's ceasefire proposal during this conference. Japan and the US presented a seven-point draft resolution (S/10450) on Geneva Conventions (1949) compliance, including refugee safe return, during the conference. It then proposed S/10459/Rev.1, revising this plan. Meeting terminated at 9.45 pm without Security Council resolution (UN Doc, S/PV/1617). 1620th meeting (Final meeting) of the Security Council (December 21, 1971) The UN Security Council was unable to achieve a compromise despite the increasing tensions in Bangladesh and the unilateral ceasefire declared by India. Argentina, Burundi, Italy, Japan, Nicaragua, Sierra Leone, and Somalia together presented Security Council resolution S/10465 on December 21. The resolution sought to 'monitor a cessation of hostilities and encourage all relevant parties to comply with the provisions of the Geneva Conventions'. During the plenary session, the International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 21 resolution received support from 13 states, but the Soviet Union and Poland chose not to vote (UN Doc, S/PV/1620). Consequences of the provisional 7 state resolution of the Security Council In favor of the proposal Abstain from voting Against the proposal United States, China, United Kingdom, France, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria Soviet Union, Poland *** The Security Council eventually approved the ceasefire. The eventful 26th (special) General Assembly session ended on 22 December after the Security Council passed the resolution. Bangladesh attained independence without UN assistance. Conclusion The Bengali liberation war with Pakistani forces in besieged Bangladesh lasted from March 26 to December 16, 1971. The UN did nothing to address genocide and human rights in East Pakistan during the Liberation War. Due to its dependency on the US, the UN could not address East Pakistan's genocide and human rights abuses. The UN's good contribution in alleviating refugees' immediate concerns in India has always been noted. The UN's greatest refugee aid effort in Bangladesh occurred in 1971. At the time, the UN did not prioritize political issues in establishing a lasting refugee solution. Major nations preferred geopolitical and national solutions outside the UN. Bangladesh has not been resolved by the UN Security and General Assembly. The US and China had a 'leaning strategy' toward Pakistan and the USSR toward India. The Soviet Union's veto has frequently thwarted China-US Security Council efforts to unify Pakistan and prevent Bangladesh's accession. Pakistan's statehood was supported by 104–11 votes in the UN General Assembly's Bangladesh resolution. The vote supported national integration (United Pakistan) in 1971. However, superpowers like France and Britain remained neutral, helping Bangladesh gain independence. Bangladesh became independent on December 21, 1971, when the Security Council passed an anti-war resolution (S/10465) without UN involvement. References Ayoob, M. (1972). The United Nations and the India-Pakistan Conflict. Asian Survey, 12(11), 977- 988. https://doi.org/10.2307/2642776 Azad, A. K. (2013). Bangladesh: From Nationhood to Security State. International Journal of Asian Social Science, 3(7), 1516-1529. Bina, D. (2011). The Role of External Powers in Bangladesh's Liberation War. Journal of South Asian and Middle Eastern Studies, 35(2), 27-42. Hossain, K. (2014). International Legal Aspects of the Bangladesh Liberation War of 1971. Journal of Asian and African Studies, 49(5), 613-628. https://doi.org/10.1177/0021909613490131 Islam, S. M. (2012). The United Nations and the Bangladesh Crisis of 1971: A Legal Perspective. Asian Journal of International Law, 2(2), 401-421. https://doi.org/10.1017/S2044251312000 172 Mookherjee, N. (2011). The Bangladesh Genocide: The Plight of Women during the 1971 Liberation War. Gender, Technology and Development, 15(1), 101-114. https://doi.org/10.1177/097185 241001500105 Raghavan, S. (2013). 1971: A Global History of the Creation of Bangladesh. Harvard University Press. Sisson, R., & Rose, L. E. (1991). War and Secession: Pakistan, India, and the Creation of Bangladesh. University of California Press. Sobhan, R. (1982). The Crisis of External Dependence: The Political Economy of Foreign Aid to Bangladesh. University Press Limited. Tahmina, Q. (2001). The UN and the Bangladesh Liberation War of 1971: Interventions and Consequences. Journal of International Affairs, 55(2), 453-469.UN Doc, S/10410, Para 6-10. UN Doc, S/PV/1606, Para 1-371, 5 December, 1971. UN Doc, S/10416, 4 December, 1971. UN Doc, S/10417, 4 December, 1971. UN Doc, S/10418, 4 December, 1971. UN Doc, S/10419, 4 December, 1971. UN Doc, S/PV/1607, Para 1-234, 5 December, 1971. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 22 UN Doc, S/10421, 5 December, 1971. UN Doc, S/10423, 5 December, 1971. UN Doc, S/10425, 5 December, 1971. UN Doc, S/PV/1608, Para 1-187, 6 December, 1971. UN Doc, S/10426, 6 December, 1971. UN Doc, S/10428, 6 December, 1971. UN Doc, S/10429, 6 December, 1971. UN Doc, A/L 647, 7 December 1971. UN Doc, A/L 647/Rev-1, 7 December 1971. UN Doc, A/L 648, 7 December 1971. UN General Assembly Resolution 2793, Vol- XXVI. UN Doc, S/PV/1611, 12 December 1971. UN Doc, S/10446, 12 December 1971. UN Doc, S/PV/1613, Para1-174, 13 December 1971. UN Doc, A/PV 2002, PP.130-146. UN Doc, A/PV 2003, PP.173-185. UN Doc, S/10451, 13 December 1971. UN Doc, S/PV/1614, Para1-49, 14 December 1971. View publication stats","You can only respond to the prompt using information in the context block. Give your answer in bullet points. If you cannot answer using the context alone, say ""I cannot determine the answer to that due to lack of context"" See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/381796770 The United Nations' Involvement in Bangladesh's Liberation War: A Detailed Analysis Article in International Journal of Politics & Social Sciences Review (IJPSSR) · June 2024 CITATIONS 0 3 authors, including: Md. Ruhul Amin Comilla University 33 PUBLICATIONS 9 CITATIONS SEE PROFILE All content following this page was uploaded by Md. Ruhul Amin on 28 June 2024. The user has requested enhancement of the downloaded file. ISSN 2959-6467 (Online) :: ISSN 2959-6459 (Print) ISSN 2959-6459 (ISSN-L) Vol. 3, Issue I, 2024 (January – June) International Journal of Politics & Social Sciences Review (IJPSSR) Website: https://ijpssr.org.pk/ OJS: https://ojs.ijpssr.org.pk/ Email: info@ijpssr.org.pk Page | 10 The United Nations' Involvement in Bangladesh's Liberation War: A Detailed Analysis Md. Firoz Al Mamun 1 , Md. Mehbub Hasan 2 & Md. Ruhul Amin, PhD 3 1 Assistant Professor, Department of Political Science, Islamic University, Kushtia, Bangladesh 2 Researcher and Student, Department of Government and Politics, Jahangirnagar University, Savar, Dhaka1342 3 (Corresponding Author), Associate Professor, Department of Public Administration, Comilla University, Cumilla, Bangladesh Abstract Liberation War, Bangladesh, United Nations, International Intervention, Conflict Resolution. Introduction The 1971 Bengali nation's armed struggle for independence took on an international dimension; as the conflict came to an end, India and Pakistan got directly involved, and the major powers and their powerful allies started to actively compete with one another to establish an independent state of Bangladesh. This effort included international and multinational aspects in addition to bilateral and regional forms (Jahan, 2008:245). The bigger forum in this instance, where the major powers and stakeholders participated in various capacities, was the UN. The major powers usually agree on decisions made and carried out by the United Nations, a global institution. The decision-making process is primarily a reflection of how the major powers see a given situation. The UN Security Council may reach an impasse, in which case the General Assembly may adopt certain restricted actions. Everything that occurred in 1971 took place during the Bangladesh crisis (Matin, 1990: 23). With Bangladesh's ascent on December 16, the subcontinent's map underwent a reconfiguration. Furthermore, the United Nations' involvement in these matters has primarily been restricted to humanitarian efforts and relief activities. The Pakistan military attempted to stifle the calls for freedom of the people of East Pakistan by genocide and ethnic oppression, which was thwarted by the On March 26, 1971, the Bangladeshi independence struggle against domestic imperialism and ethnic discrimination in Pakistan got underway. March 26, 1971, saw the start of the Bangladeshi independence movement against domestic imperialism and ethnic discrimination in Pakistan. The United Nations gave relief and humanitarian activities first priority starting in the Liberation War and continuing until November. The UN Security Council was called in when India and Pakistan entered the Liberation War on December 3. The Security Council meetings continued as different suggestions and counterproposals were presented. In the Security Council, there was a clash between the USSR and US. While the USSR helped Bangladesh, China and the US helped Pakistan. Keeping their positions neutral, France and Britain did not cast votes in the Security Council. The Security Council could not therefore come to an agreement. On December 6, after discussion and an official decision, the Security Council sent the agenda to the General Assembly. On December 7, a resolution headed ""Unity Formula for Peace"" was overwhelmingly approved at the General Assembly. As India and Bangladesh rejected this idea, the US called a second Security Council session. Sessions of the Security Council were held at various intervals between December 12 and 21. Everything changed dramatically when Bangladesh gained its independence on December 16. The protracted Bangladesh war was essentially resolved on December 21 when the Security Council unanimously approved a ceasefire resolution. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 11 establishment of Bangladesh, under the standard pretexts of national integrity, internal affairs, etc. For this reason, it is plausible to argue that Bangladesh's establishment following the dissolution of the post-World War II state structure was a highly justifiable event. Following its declaration of independence, Bangladesh joined a number of UN bodies in 1972 and attained full membership status in 1974 (Hussain, 2012:189). There is a dearth of scholarship on the United Nations' involvement in the Great War of Liberation. The discussion research is highly significant, and the author has logically made a concentrated effort to examine and unearth material on the role of the organization in charge of maintaining world peace and security throughout the Great War of Liberation. Research Methodology The article titled 'The Role of the United Nations in the Great Liberation War of Bangladesh: An Analysis' has all of the basic aspects of social research. Data was gathered from secondary sources for research purposes. The research was done using both qualitative and quantitative methods. The research paper titled 'Role of the United Nations in the Great Liberation War of Bangladesh - An Analysis' was analyzed using the 'Content Analysis Methodology'. Basically, the study effort was done using secondary sources to acquire and analyze data and information. The research relies on secondary sources, either directly or indirectly. The study was done by gathering information from worldwide media coverage, UN documents, publications, research papers, reports, archives relating to the liberation war, and records housed in the museum during Bangladesh's War of Liberation (1971). The Role of the United Nations in the early stages of the Liberation War All UN employees were evacuated from Dhaka on March 25, 1971, the night the Pakistani armed forces declared the liberation war through ""Operation Searchlight."" But it has not moved to halt the atrocities against human rights and genocide in East Pakistan. On April 1st, nonetheless, the Secretary General sent an emergency humanitarian offer to the Pakistani government for the inhabitants of East Pakistan. Nevertheless, the Pakistani government turned down the offer of humanitarian assistance and even forbade the Red Cross relief aircraft from landing in Dhaka (Hossein, 2012: 150). President Yahya Khan gave the UN authorization to carry out rescue operations after the UN Secretary General appealed to the Pakistani government on April 22 for immediate humanitarian aid. Beginning on June 7, 1971, the United Nations started assistance efforts in East Pakistan. The acronym UNROD stood for the United Nations Relief and Works Agency for East Pakistan. United Nations recognized the name ""Bangladesh"" on December 21 and dubbed the rescue agency ""UNROD"" (Time Magazine, January 1, 1971). The surge of refugees entering India on April 23 was the reason the Indian government made its first plea for outside assistance since the start of the liberation struggle. Coordination in this respect was taken up by the United Nations High Commissioner for Refugees (UNHCR). Other than UNHCR, UNICEF and WFP are involved in Indian refugee camps actively. The World Bank estimates that the Indian government spent $1 billion on refugees overall up to December, of which just $215 million came from UN assistance. By far the biggest airlift in UN history (International Herald Tribune, July 8, 1971). India's committed and received monies from the UN and other sources up to June were: International Aid to India (June, 1971) United Nation Other Sources Total 9,80,00,000 16,50,00,000 26,30,00,000 Source: International Herald Tribune, 8 July, 1971. United Nations product aid to India Topics Quantity 1. Food Aid 6267 tons 2. Vehicles 2200 piece 3. Medical supplies 700 tons 4. Polythene for making shelters What is needed for 3 million refugees Source: Rahman, Hasan Hafizur (ed.) (1984) Bangladesh Liberation War Documents, Volume- 13, Dhaka: Ministry of Liberation War Affairs, Government of the People's Republic of Bangladesh, page 783-87. Though the UN participated in the relief effort, until September, no talks on matters like the liberation struggle in Bangladesh, genocide, abuses of human rights, etc. were held in the UN. Even Bangladesh was left from the September UN Annual General Discussion agenda. Still, throughout their statements, the leaders of several nations brought up Bangladesh. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 12 Proposal for deployment of United Nations observers in East Pakistan Early in the Liberation War, India asked the UN to step in and handle the refugee crisis and put an end to the genocide in East Pakistan. Yet, at first, Pakistan opposed the UN's intervention in the refugee crisis, viewing any UN action as meddling in its domestic affairs (Hasan, 1994: 251–53). However, Yahya Khan consented to embrace all UN measures as of May on US advice. Pakistan started participating actively in diplomatic efforts in a number of UN forums during this period, with support from Muslim nations and the United States. In order for India to be compelled to cease aiding Bangladesh's independence movement as a result of UN pressure. Acknowledging this, India vehemently objected to the UN's political role, which it concealed behind humanitarian endeavors. Despite the fact that the UN Secretary General has mostly been mute on ending genocide and breaches of human rights since the start of the Liberation War, on July 19 he suggested that ""UN peacekeepers or observers be deployed on the India-Pakistan border to resolve the refugee problem."" But the UN Secretary General's plan to send out troops or monitors was shelved after the Mujibnagar administration and India turned down this offer (Hossein, 2012: 87). According to Article 99 of the United Nations, the initiative of the Secretary General The UN Secretary-General, U Thant, submitted a memorandum under Article 99 to the president of the Security Council and member nations on July 20, 1971, the day following the request for the deployment of observers. There were eight paragraphs or suggestions in the Secretary General's letter. ""Obviously, it is for the members of the Security Council themselves to decide whether such consideration should be taken place formally or informally, in public or private,"" he stated in the note (UN Doc, A/8401). India, the primary backer of Bangladesh's independence movement, was put in a humiliating position by the Secretary General's suggestions. The Soviet Union supported India in this circumstance. India's principal foreign benefactor in the wake of the Soviet-Indian alliance's signature was the Soviet Union. The Soviet Union asked the Secretary-General on August 20th not to call a meeting of the Security Council to discuss the East Pakistan issue. As a result, the Security Council did not meet, even on the Secretary General's suggestion. Major nations and interested parties maintained their diplomatic efforts in anticipation of the United Nations General Assembly's 26th session, which is scheduled to take place on September 21 (The Year Book of World Affairs, 1972). United Nations Intervention in the Question of Bangabandhu's Trial Sheikh Mujibur Rahman is set to face trial for treason in the final week of July, as reported by many media sources. The Mujibnagar government promptly raised alarm following the publication of this news. Sheikh Mujib is the unquestionable leader of Bangladesh's liberation movement. Consequently, the Mujibnagar government formally requested the international community and influential nations to ensure the safety and well-being of Sheikh Mujib's life (Joy Bangla, July 30, 1971). The trial of Sheikh Mujibur Rahman commenced on August 9, 1971, under the authority of the Pakistani government. On August 10, U Thant, the Secretary General of the United Nations, intervened in the Pakistani military junta's attempt to bring Sheikh Mujibur Rahman to trial. The Secretary General stated clearly that the topic at hand is highly sensitive and delicate, and it is the responsibility of the legal system of Pakistan, as a member state, to handle it. It is also a subject of great curiosity and worry in several spheres, encompassing both humanitarian and political domains. The Secretary General has been regularly receiving expressions of grave concern from government representatives regarding the situation in East Pakistan. It is widely believed that unless some form of agreement is reached, the restoration of peace and normalcy in the region is unlikely. The Secretary General concurs with several members that any advancements about the destiny of Sheikh Mujibur Rahman would undoubtedly have repercussions beyond the borders of Pakistan. The article is from The International Herald Tribune, dated August 10, 1971. Delegation of Bangladesh to the United Nations The United Nations General Assembly meets every September. On September 21, the Mujibnagar administration (1st government of independent Bangladesh) agreed to dispatch a 16-member team led by Justice Abu Saeed stationed in London. On September 25, the Bangladesh delegation convened and nominated Fakir Shahabuddin as the party's member secretary. Bangladesh was not a member of the United Nations before then. In this situation, the delegation had a tough time entering the UN building. Pakistan, in particular, tried to label the delegation as'rebellious elements. Even in this International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 13 hostile climate, this group continued to engage in creative and intellectual activities as the Mujibnagar government's representation on the United Nations premises. Currently, the President of the United Nations Association of Journalists. Yogendranath Banerjee assisted the team in entering the United Nations building. at October, the Bangladesh delegation conducted a plenary news conference at a space at the Church Center, located on the west side of 777 United Nations Plaza. As a result, the Bangladeshi representation to the United Nations actively participated in mobilizing global opinion on Bangladesh's favor. The 26th meeting of the General Assembly The latter portion of the September 1971 UN headquarters conference focused on the membership of the People's Republic of China and the status of Bangladesh. The 26th session failed to resolve the issue of the 'Bangladesh dilemma'. Bangladesh has been cited in the annual report of the Secretary General and in remarks made by national representatives. In his report, UN Secretary-General U Thant emphasized the imperative for the international community to provide comprehensive assistance to governments and peoples in the event of a large-scale disaster. In UN Document A/8411, I have asserted that the only viable resolution to the underlying issue lies in a political approach centered around reconciliation and humanitarian principles. This session's official and informal assembly of country representatives at the UN headquarters focused on China's UN membership and Bangladesh. New Zealand, Madagascar, Luxembourg, Belgium, Norway, and Sweden stressed the subcontinental situation before the UN General Assembly and demanded a quick settlement. Pakistan was told to restore a popular administration in East Pakistan by France and Britain. The Soviet Union no longer regarded the situation a Pakistani issue. Pakistan only had ambivalence and leniency from the US. Luxembourg's delegate asked, ""When we witness millions of people suffering indescribably, being brutally punished in the guise of national security, and civilized society's weakest losing their rights, In the sake of national sovereignty and security, should such cruelty continue? On Sept. 29, Canadian Foreign Minister Michelle Sharpe said, 'When an internal conflict is moving so many nations so directly, would it be right to consider it an internal matter?' Pakistan was advised to be flexible by Sweden. He remarked that ""it would behove Pakistan to respect human rights and accept the public opinion declared through voting"". The US sessionally backed Pakistan and said, ""Pakistan's internal issues will be dealt with by the people and government of Pakistan."" The East Pakistan problem had generated a worldwide catastrophe, and Pakistan's ruthlessness had caused millions of refugees to cross the border and seek asylum in other nations. In session, the French foreign minister remarked, ""If this injustice cannot be corrected at the root, the flow of refugees will not stop."" Belgians repeated Schumann's query, ""Will the return of the refugees be possible?"" He noted ""a political and constitutional solution to this crisis must be found”. This remedy should come from public opinion. Only when they are confident in the future that human rights will not be abused will refugees return home. British Foreign Secretary Sir Alec Hume was clear about the solution (Muhith, 2014). The statements of these countries are arranged in a table and some important questions are answered for it. These are: a. States that have identified the Bangladesh question as a political issue; b. b. States that have termed it only as a humanitarian problem; c. States that have identified the matter as Pakistan's internal affairs; d. Only those countries that have spoken of genocide and human rights violations; Country Problem description References to both political and humanitarian aspects Paying attention to humanitarian issues Internal Affairs of Pakistan Genocide and human rights violations Afghanistan * * Albania Algeria * * Argentina * * * Australia * * * Austria * * Bahrain Barbados Belgium * * Bhutan International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 14 Bolivia Botswana Brazil Bulgaria Burma Burundi Belarus Cameroon Canada Central African Republic Sri Lanka (Ceylon) * * Chad Chile * * China * * Colombia Congo Costa Rica Cuba Cyprus * * Czechoslovakia Secretary General's Good Office Proposal At the 26th General Session, governments, the international media, and the people put pressure on UN Secretary General ""U Thant"" to take a new crisis action for Bangladesh. On October 20, he gave India and Pakistan his good office. The Secretary General said, ""In this potentially very dangerous situation, I feel that it is my duty as Secretary General to do everything I can to help the government immediately concerned avoid any disaster."" I want you to know that my offices are always open if you need help (UN Doc, S/10410:6). This letter of the Secretary General implies that he views the matter as an India-Pakistan war. President Yahya Khan also wanted a Pak-India confrontation. Yahya Khan informed the Secretary General a day later that Pakistan had accepted this idea. I appreciate your willingness to provide your good offices and hope you can visit India and Pakistan immediately to negotiate force withdrawal. I am convinced this will benefit and advance peace. UN Doc, S/10410: 7 However, India did not reject the UN Secretary General's 'good office'. According to the status of UN Secretary General and diplomatic etiquette, India could not reject this plan outright, therefore it rejected it indirectly. The Secretary General's recommendation came as Indira Gandhi was touring the world to promote Bangladesh's liberation fight. Upon returning from abroad, he informed the Secretary General on November 16 that the military rule of Pakistan was a severe threat to national life and security. Indira Gandhi said that Pakistan wants to make problems within Pakistan into problems between India and Pakistan. Second, we can't ignore the reason why people are crossing borders as refugees. Indira Gandhi kindly told the Secretary General that instead of India and Pakistan meeting, Yahya Khan and the leaders of the Awami League should do it. ""It's always nice to meet you and talk about our ideas,"" she said. We will back your efforts to find a political solution in East Bengal that meets the stated needs of the people, as long as you are ready to look at the situation in a broader context (Keesings, 1972). In his response, the Indian Prime Minister said that the UN Secretary-General was guilty. In order to protect the Pakistani junta, the Secretary General is avoiding the main problem. In a message to the Prime Minister of India on November 22, the Secretary-General denied the charges, saying that good office requires everyone to work together. In this very important and complicated case, there doesn't seem to be a reason for the Secretary General to help. 10 (UN Doc S/10410). The UN Secretary-General's ""Good Office"" project in the subcontinent stopped when this message was sent. 1606th Session of the Security Council (December 4, 1971) On December 3, India entered the Pakistan War, threatening peace and stability in one of the world's most populated areas. Both nations reported the incident to the UN Secretary General on December 4. After thoroughly evaluating the problem, the Secretary-General requested a Security Council session from Council President Jakob Malik (Soviet Union) (The New York Times, 4 December 1971). International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 15 The 1606th Security Council session (5 permanents—US, Soviet Union, China, UK, France— and 10 non-permanents—Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria) meets on December 4, 1971. Justice Abu Saeed Chowdhury, the Bangladesh delegation leader, asked the Security Council President to advocate for the Mujibnagar administration before the meeting. The Security Council President proposed listening to Justice Abu Saeed Chowdhury's remarks as Bangladesh's envoy at the start of the meeting. A lengthy Security Council debate on hearing Justice Abu Saeed Chowdhury's remarks from Bangladesh. The council president presented two ideas in response to criticism. a. Permit the letter to be circulated as a Security Council document from Justice Abu Saeed Chowdhury, the representative of Bangladesh. b. The council should allow Justice Abu Saeed Chowdhury to speak as a representative of the people of Bangladesh. The majority of nations did not object to the speech's delivery on the grounds of principle, thus the Council President issued an order granting the request to present the resolution. However, because to a lack of required support, the President rejected Justice Chowdhury's second motion to join the Security Council debate (UN Doc, S/PV/1606). The Security Council extended an invitation to the representatives of India and Pakistan to make remarks. The first speaker was Agha Shahi, Pakistan's Permanent Representative to the UN. He charged India with breaking Articles 2(4) and 2(7) of the UN Charter in his long statement, and he called on the UN to take responsibility for safeguarding Pakistan's territorial integrity (UN Doc, S/PV/1606: 49–148). In his remarks, Samar Sen, India's Permanent Representative to the UN, stated, ""The enemy is sidestepping the core problem and falsely condemning India. According to him, this problem has resulted from the strategy of putting seven crore Bengalis under weapons control. Despite the fact that Sheikh Mujib was predicted by Yahya Khan to become Pakistan's prime minister, nobody is certain of his current whereabouts. Bengalis have won elections but have not been granted authority, which is why Samar Sen supports their independence. This led them to launch nonviolent movements as well, but these were also put down by massacres. They are therefore quite justified in demanding their right to self-determination. According to UN Doc, S/PV/1606: 150–85, he stated that the ceasefire should be between the Pakistan Army and Bangladesh, not between India and Pakistan. 1. The United States of America's Security Council Resolution (S/10416) Following the keynote addresses by the Indian and Pakistani delegates, US Representative George Bush Sr. charged India of aggressiveness. 'Immediate ceasefire between India and Pakistan, withdrawal of the armies of both countries to their respective borders, deployment of United Nations observers on the India-Pakistan border, taking all necessary steps for the repatriation of refugees' (UN Doc, S/10416) was one of the seven points of his resolution. Every Security Council member participated in the discussion of the US proposal. 2. Belgium, Italy, and Japan's Proposals (S/10417) Belgium, Italy, and Japan submitted a five-point draft resolution to the Security Council in response to the US proposal. In line with the UN Charter's tenets, the draft resolution calls on ""the governments of both countries to immediately cease hostilities and all forms of hostilities and to take necessary measures for the rapid and voluntary repatriation of refugees"" (UN Doc, S/10417). 3. The Soviet Union's Security Council Resolution (S/10418) At opposition to the American plan, the Soviet Union put out a two-point draft resolution at the UN Security Council's 1606th resolution calling for an end to hostilities in East Pakistan. ""A political solution in East Pakistan, which would end hostilities there and at the same time stop all terrorist activities by the Pakistan Army in East Pakistan,"" was what the Soviet proposal demanded (UN Doc, S/10418). 4. The Argentine, Nicaraguan, Sierra Leonean, and Somalian proposals (S/10419) Argentina, Nicaragua, Sierra Leone, and Somalia sent the Security Council a two-point draft resolution (S/10419) at the Soviet Union's advice. Under the draft resolution (UN Doc, S/10416), both nations must ""immediately ceasefire and withdraw"" and the Secretary-General is to ""keep the Security Council regularly informed of the situation."" The Security Council heard four resolutions during its 1606th meeting. Following a thorough discussion and debate, the president of the Security Council presented the US proposal—one of four draft proposals—for voting among the Security Council's member nations for acceptance. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 16 1 st veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10416) In favor of the US proposal Abstain from voting Against the US proposal Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria. United Kingdom, France Soviet Union, Poland When the US accused India of withdrawing soldiers in the Security Council, 11 voted yes and the Soviets and Poland no. Neither the UK nor France voted. Permanent Security Council member the Soviet Union vetoed the motion. Soviet Union's 106th UN Security Council veto (UN Doc, S/PV/1606: 357-71). 1607th Emergency Session of the Security Council (December 5, 1971) The Security Council convened its 1607th session on December 4 at 2.30 p.m. on December 5. The fact that Tunisia from Africa and Saudi Arabia from Asia, neither Security Council members, can speak makes this session unique. They attended at the Security Council President's request. I.B. Tarlor-Kamara (Sierra Leone) chaired this Security Council session (UN Doc, S/PV/1607). The Resolution of China (S/10421) This session featured a Chinese resolution draft. China's plan termed India an aggressor and chastised it for establishing Bangladesh. China ""demands the unconditional and immediate withdrawal of the Indian army occupying Pakistani territory"" (UN Doc, S/10421). After China's draft proposal, the Tunisian ambassador spoke for Africa. He said, ""The Security Council should also call for a ceasefire, so that peace can be established according to the various clauses of the Charter"". The Asian Saudi representative then spoke. According to Saudi envoy Jamil Baroodi, ""He called for a meeting of Asian heads of state on the subcontinent to get rid of the politics of the big powers."" After the Saudi delegate, the Soviet representative mentioned a draft proposal (S/10422, December 5, 1971). The Soviet Union said a 'ceasefire may be a temporary solution but a permanent one would need a political accord between India and Pakistan'. The Soviet delegate accused the US and China of disregarding two major issues for ""temporary interests"". Pakistan and India spoke in the Security Council after the Soviet representative. After Pakistan and India spoke, the Council President informed the Security Council that the Council now has three resolutions: S/10418 (Soviet Union), S/10421 (China), and S/10423 (8 Nations). S/10417 and S/10419 are no longer before the House since the same state presented the 8-nation resolution (S/10423), which complements them. The Council President voted on the Soviet proposal first (UN Doc, S/PV/1607:75-201). Consequences of the Soviet Union's (S/10418) proposal In favor of the Soviet Union Abstain from voting Against the proposal Soviet Union Soviet Union, Poland United States, United Kingdom, France, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria China The Chinese veto caused the idea to be rejected. The majority of members were not convinced by this suggestion either. Furthermore, throughout the speech, those who chose not to vote expressed their opposition to the idea. When the Chinese proposal (S/10421) was put to a vote by the Council President following the vote on the Soviet proposal, the Chinese delegate stated that they were still in consultation with other Council members. No vote was held on the Chinese proposal as China indicated no interest in holding a vote on it. The eight-nation draft proposal, headed by Argentina, was then put to a vote by the Council President. 2 nd veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10423) In favor of the 8 nation proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria. United Kingdom, France Soviet Union, Poland This idea received 11 votes. UK and France refused to vote. Soviet and Polish votes were no. After the Soviet Union vetoed it again, the eight-nation armistice failed (UN Doc, S/PV/1607: 230- 331). The French delegate called such motions and counter-motions 'presumptive' after the 8 Nations' resolution voting. After voting on the 8 Nations resolution, the Council President notified the Council of two further resolutions (S/10421) and (S/10425). The Security Council President exhorted member nations to find a solution and postponed the discussion until 3.30 pm the next day. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 17 The Proposals by 8 Nations (S/10423) In this session of the Security Council, the 8 member states of the Provisional Council (Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone and Somalia) led by Argentina put forward a proposal of three points. The resolution called for a ceasefire and the creation of an environment for refugee return (UN Doc, S/10423). The Proposals by 6 Nations (S/10425) At the 1607th session of the Security Council, six nations—Belgium, Italy, Japan, Nicaragua, Sierra Leone and Tunisia—proposed another three-point resolution. This proposal statesa. Urges governments to immediately implement a cease-fire. b. Request the Secretary General to update the Council on the resolution's implementation. c. The UN Doc, S/10425, recommends continuing to consider methods to restore peace in the region. 1608th meeting of the Security Council (December 6, 1971) The 1608th Security Council session was place at 3.30 pm on December 6, 1971. This session, like the previous ones, allowed India, Pakistan, and Tunisia from Africa and Saudi Arabia from Asia to debate. I.B. Tarlor Kamara (Sierra Leone) convened this Security Council session (UN Doc, S/PV/1608:1-5). Soviet Union Resolution (S/10426) Soviet delegate offered a new resolution with two revisions to the six-nation draft resolution (S/10425) early in this session. (In operative paragraph 1, replace ‘the Governments concerned’ with 'all parties concerned' and add 'and cessation of all hostilities'). Peace Proposal Unity Formula (S/10429) In the wake of Security Council impasse, the 11 member nations discussed bringing the issue to the General Assembly informally. Following discussions, Argentina, Somalia, Nicaragua, Sierra Leone, Burundi, and Japan presented a draft resolution (S/10429) to the Security Council, recommending a special session of the UN General Assembly if permanent members failed to reach consensus at the 1606th and 1607th meetings. This proposal followed the 3 November 1950 General Assembly decision [377 A (V)]. Many call it 'Unity for Peace Exercise'. Since the UN Security Council is deadlocked, the General Assembly implements portions of this formula for world peace and security. Soviet Union Resolution (S/10428) The Soviet Union introduced another draft resolution late in this session. In a five-point draft resolution, the USSR urged that ""all parties concerned should immediately cease hostilities and implement a cease-fire."" The 1970 elections called for a political solution in Pakistan to cease hostilities. The UN Secretary-General should execute this decision and continue peace talks in the area. After briefly discussing the draft resolutions in the Security Council, the President decided to vote for the Unity Formula for Peace resolution (S/10429) to take initiative because the Soviet and Chinese resolutions (S/10428) and (S/10421) would fail. Consequences of the Unity Formula for Peace proposal in the Security Council In favor of the US proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria *** United Kingdom, France, Soviet Union, Poland After this proposal was passed, the United Nations started to implement the Unity Formula for Peace (UN Doc, S/PV/1608) with the aim of ending the war in the subcontinent. To protect Pakistan, China took the initiative to send this proposal to the UN General Assembly. 26th (Special Session) of the General Assembly According to the Security Council's December 6 decision, the 26th extraordinary session of the General Assembly was convened at the UN on December 7. The 26th Special Session of the General Assembly saw three proposals: A. Proposal by 13 nations (A/L/647). B. The 34-nation Argentine-led plan (A/L/647 Rev.) and Soviet proposal (A/L/646) were detailed. For 12 hours on December 7, the General Assembly considered 3 draft proposals. debate included 58 of 131 General Assembly nations. The Resolution of 13 States to the General Assembly (A/L/647) Thirteen member states introduced a draft resolution for General Assembly debate at the start of this session. The 13 states' suggestions mainly included the following: International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 18 a. Urge Pakistan and India to immediately halt hostilities and return their soldiers to their respective boundaries. b. Boost attempts to repatriate refugees. c. (c) The Secretary-General will urge that decisions of the Security Council and the General Assembly be implemented. d. In view of the existing resolution (UN Doc, A/L 647), urge the Security Council to respond appropriately. The Resolution of 34 States to the General Assembly (A/L/647 Rev-1) The General Assembly received a draft resolution from 34 governments, chaired by Argentina and backed by the US, Muslim nations, and China. 'Immediately effective Indo-Pakistani ceasefire and evacuation of Indian troops from East Pakistan, respecting the concept of the integrity of Pakistan' was the 34-state resolution's heart. The Resolution of Soviet Union (A/L/648) The Soviet Union's proposal states, ""Ceasefire may be a temporary solution, but a permanent solution requires a political agreement between India and Pakistan"" (UN Doc, A/L 648). Countries Participating in the Debate in the Special Session (26th) of the United Nations General Assembly Asia Africa Europe Middle and South America Others Bhutan Algeria Albania Argentina Australia Sri Lanka Burundi Bulgaria Brazil Fiji China Chad Czechoslovakia Chile New Zealand Cyprus Gabon Denmark Ecuador United States India Ghana France Mexico Indonesia Ivory Coast Greece Nicaragua Iran Madagascar Italy Peru Japan Mauritania Netherlands Uruguay Lebanon Sierra Leone Poland Malaysia Somalia Portugal Mongolia Sudan Soviet Union Nepal Tanzania Sweden Pakistan Togo Britain Saudi Arabia Tunisia Yugoslavia Turkey Hungary Jordan Quake 17 country 14 country 15 country 8 country 4 country Source: Prepared by reviewing various UN documents. Following deliberation in the General Assembly, the President of the Assembly, Adam Malik (former Minister of Foreign Affairs of Indonesia), approved the motion put up by 34 nations, spearheaded by Argentina, for vote in the General Assembly (amended). This decision was made in accordance with Rule 93 of the Rules of Procedure, which governs the process. Voting results on 34 state resolutions in the General Assembly 34 in favor of the State proposal Abstain from voting Against the proposal of 34 states 104 states 11 states 16 states It was supported by 104 nations, Negative vote from 16 nations and 11 nations cast no votes. General Assembly resolution sent to Security Council for execution same day. UN Under-SecretaryGeneral telegraphed India and Pakistan of the General Assembly's resolution (UNGA Resolution, 2793). 1611th Meeting of the Security Council (December 12, 1971) While the UN General Assembly adopted the ceasefire resolution, the battle continued and Pakistan soldiers in Dhaka fell. On December 12, George Bush (Senior) requested a quick ceasefire from the Secretary General in the Security Council (S/10444). Thus, the 1611th Security Council meeting took place at 4 p.m. A large delegation from India led by Foreign Minister Sardar Swaran Singh attended this summit. Pakistan sent a mission led by recently appointed Deputy Prime Minister and Foreign Minister Zulfiqar Ali Bhutto to boost diplomatic efforts (UN Doc, S/PV/1611). International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 19 The Resolution of the United States (S/10446) The US proposed a draft resolution to a Security Council emergency meeting on 12 December. The seven-point resolution demanded 'prompt ceasefire and army withdrawal' (UN Doc, S/10446). In this Security Council resolution, the US and USSR had opposite stances. The US and China publicly supported Pakistan. The council president adjourned the meeting at 12.35 pm to meet again the next day. 1613th meeting of the Security Council (December 13, 1971) The Security Council had its 1613th session at 3 p.m. on December 13. In addition to Security Council members, India, Pakistan, Saudi Arabia, and Tunisia attended this meeting. The meeting opened with US draft resolution (S/10446) talks. The Council president let Poland's representative speak first. George Bush, US representative, said, India bears the major responsibility for broadening the crisis by rejecting the UN's efforts to become involved, even in a humanitarian way, in relation to the refugees, rejecting proposals like our Secretary General's offer of good offices, which could have defused the crisis, and rejecting proposals that could have started a political dialogue. (UN Doc, A/PV 2002: 130-141). Chinese envoy Chiao remarked, ""India conspires with Bengali refugees like Tibetan refugees."" He called India a ""outright aggressor"" pursuing South Asian domination. He further said the Soviet Union is the principal backer of Indian aggression. China wants a ceasefire and the evacuation of both nations' forces (UN). Doc, A/PV 2002: 141-146). In his speech, the Soviet Union delegate observed, 'The businesspeople and fanatics who brought this subject before the General Assembly have blinded their eyes to the true situation in the Indian subcontinent. They are concealing the major reasons of the dispute without examining the issue. He dubbed this project China-US Collude. China asserts it uses the forum for anti-Soviet propaganda (UN Doc, A/PV 2003: 173-185). The President of the Council voted on the United States' updated draft resolution (S/10446/Rev.1) for Security Council approval after debate. The third veto by the Soviet Union, a permanent UN Security Council member, reversed the cease-fire resolution (UN Doc, S/PV/1613: 174). 3 rd veto of the Soviet Union in favor of Bangladesh in the Security Council (S/10446/Rev.1) In favor of the US proposal Abstain from voting Against the US proposal USA, China, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria United Kingdom, France Soviet Union, Poland The Proposal by Italy and Japan (S/10451) After voting on the US proposal, Italy and Japan jointly presented another draft resolution at this session of the Security Council. There were total of nine points in this proposal. The main point of the resolution was to 'maintain the national integrity of Pakistan and reach a comprehensive political solution to this crisis' (UN Doc, S/10451). The 1614th meeting of the Security Council took place on December 14, 1971. The 1614th Security Council meeting commenced at 12.10 pm on December 14th. The meeting did not achieve a consensus. Britain engaged in discussions with other members of the Council, namely France, in order to develop a new proposal that would meet the approval of all parties involved. Poland has presented a draft resolution (S/10453) to the President of the Council, outlining a six-point plan for a ceasefire. Here, the Security Council meeting system was addressed. After discussing their recommendations, Britain and Poland requested that the conference be deferred until the next day for government orders. All Council members agreed, save China's moderate reservations. To permit formal deliberations on the British-French and Polish proposals, the Council President postponed the meeting (UN Doc, S/PV/1614: 49). 1615th meeting of the Security Council (December 15, 1971) The 1615th Security Council meeting was conducted at 7.20 pm on December 15. At the Council President's request, India and Pakistan delegates attended this meeting. Meeting attendees discussed four draft suggestions. Polish proposal (UN Doc, S/10453/Rev-1), France and Britain's resolution, Syria's resolution, and Soviet Union's resolution. Polish proposals included 'ceasefire and departure of West Pakistani soldiers from East Pakistan'. ""Pakistani political prisoners should be released, so that they can implement their mandate in East Pakistan"" declared the Syrian draft resolution. After negotiations, the UK and France proposed a Syrian-like draft resolution. The concept addresses International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 20 ceasefire in the east and west of the subcontinent individually. The idea called for political settlement discussions with elected officials. Britain, France, and the Soviet Union made similar proposals. The Soviet Union demanded a thorough political solution with East Pakistan's elected representatives. A cease-fire must also be announced (UN Doc, S/PV/1615). The Chinese representative began with a speech. China's representative said, 'The Security Council should respect Pakistan's independence, sovereignty, national unity and geographical integrity' (UN Doc, S/PV/1615: 13). The President of the Council asked the Sri Lankan representative to speak after the Chinese speaker (UN Doc, S/PV/1615: 13). The Council President invited the Sri Lankan delegate to speak after the Chinese representative. Sri Lankan representative: ""Sri Lanka seeks a neutral solution. He said, 'This solution should be one where triumph is devoid of difficulties, loss is without consequence and above all peace prevails' (UN Doc, S/PV/1615: 22). Pakistan's Deputy Prime Minister and Foreign Minister Zulfikar Ali Bhutto's statement on these suggestions was spectacular. The Security Council was strongly criticized in his passionate address. He called the Security Council stage of deceit and farce' He instructed the Security Council to legitimize every unlawful occurrence until December 15, establish a harsher treaty than Versailles, and legalize the occupation. We will fight without me. I shall withdraw but fight again. My country calls. Why waste time on the Security Council? I refuse to participate in such a disgraceful surrender of my nation. He urged the General and Security Council to remove the ‘monument of failure' He concluded his Security Council remarks. They rip up draft resolutions of four nations, including Poland, and I go (UN Doc, S/PV/1615: 84). Pakistani delegates left the Security Council. Pakistani delegates left the Security Council. Accepting Poland's suggestion (UN Doc, S/10453) may have benefited Pakistan. India 'although grudgingly' approved the idea with Soviet help. The Pakistani military would not have surrendered humiliatingly if the delegates had accepted the idea. The Council President called Poland's proposal timely out of 4 drafts. The Security Council discussed four draft ideas, but none of the member nations indicated interest in voting. Instead, they continued to deliberate. Thus, the Council President adjourned the meeting till 10.30 am on December 16 (UN Doc, S/PV/1615:139). 1616th meeting of the Security Council (December 16, 1971) The 1616th Security Council meeting was conducted at 10:30 am on December 16. The Security Council President invited Indian Foreign Minister Sardar Swaran Singh, Saudi Ambassador Mr. Jamal Baroodi, Tunisian representative, and Sri Lankan representative to this meeting. The President stated that five draft resolutions await decision before the Council: Italy and Japan (S/10451), Poland (UN Doc, S/10453/Rev-1), Syria (UN Doc, S/10456), France and Britain (UN Doc, S/10455), and the Soviet Union (UN Doc, S/10457). The Chinese and Soviet draft resolutions (S/10421) and (S/10428) were not vetoed (UN Doc, S/PV/1616: 3). Indian External Affairs Minister Sardar Swaran Singh read Indira Gandhi's statement after the President's opening remarks. This statement included two main points. a. Pakistani army surrendering in Dhaka created Bangladesh. b. India's Western Front ceasefire (UN Doc, S/PV/1616:5). At 1.10 pm, the 1616th Security Council meeting finished. 1617th meeting of the Security Council (December 16, 1971) The Foreign Minister of India proclaimed the creation of Bangladesh via the surrender of Pakistani soldiers in Dhaka at 3.00 pm in the 1616th and 1617th Security Council meetings. Besides Security Council members, India, Pakistan, Tunisia, and Saudi Arabia attended this meeting. A Soviet draft resolution (S/10458) welcomed India's ceasefire proposal during this conference. Japan and the US presented a seven-point draft resolution (S/10450) on Geneva Conventions (1949) compliance, including refugee safe return, during the conference. It then proposed S/10459/Rev.1, revising this plan. Meeting terminated at 9.45 pm without Security Council resolution (UN Doc, S/PV/1617). 1620th meeting (Final meeting) of the Security Council (December 21, 1971) The UN Security Council was unable to achieve a compromise despite the increasing tensions in Bangladesh and the unilateral ceasefire declared by India. Argentina, Burundi, Italy, Japan, Nicaragua, Sierra Leone, and Somalia together presented Security Council resolution S/10465 on December 21. The resolution sought to 'monitor a cessation of hostilities and encourage all relevant parties to comply with the provisions of the Geneva Conventions'. During the plenary session, the International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 21 resolution received support from 13 states, but the Soviet Union and Poland chose not to vote (UN Doc, S/PV/1620). Consequences of the provisional 7 state resolution of the Security Council In favor of the proposal Abstain from voting Against the proposal United States, China, United Kingdom, France, Argentina, Belgium, Burundi, Italy, Japan, Nicaragua, Sierra Leone, Somalia, Syria Soviet Union, Poland *** The Security Council eventually approved the ceasefire. The eventful 26th (special) General Assembly session ended on 22 December after the Security Council passed the resolution. Bangladesh attained independence without UN assistance. Conclusion The Bengali liberation war with Pakistani forces in besieged Bangladesh lasted from March 26 to December 16, 1971. The UN did nothing to address genocide and human rights in East Pakistan during the Liberation War. Due to its dependency on the US, the UN could not address East Pakistan's genocide and human rights abuses. The UN's good contribution in alleviating refugees' immediate concerns in India has always been noted. The UN's greatest refugee aid effort in Bangladesh occurred in 1971. At the time, the UN did not prioritize political issues in establishing a lasting refugee solution. Major nations preferred geopolitical and national solutions outside the UN. Bangladesh has not been resolved by the UN Security and General Assembly. The US and China had a 'leaning strategy' toward Pakistan and the USSR toward India. The Soviet Union's veto has frequently thwarted China-US Security Council efforts to unify Pakistan and prevent Bangladesh's accession. Pakistan's statehood was supported by 104–11 votes in the UN General Assembly's Bangladesh resolution. The vote supported national integration (United Pakistan) in 1971. However, superpowers like France and Britain remained neutral, helping Bangladesh gain independence. Bangladesh became independent on December 21, 1971, when the Security Council passed an anti-war resolution (S/10465) without UN involvement. References Ayoob, M. (1972). The United Nations and the India-Pakistan Conflict. Asian Survey, 12(11), 977- 988. https://doi.org/10.2307/2642776 Azad, A. K. (2013). Bangladesh: From Nationhood to Security State. International Journal of Asian Social Science, 3(7), 1516-1529. Bina, D. (2011). The Role of External Powers in Bangladesh's Liberation War. Journal of South Asian and Middle Eastern Studies, 35(2), 27-42. Hossain, K. (2014). International Legal Aspects of the Bangladesh Liberation War of 1971. Journal of Asian and African Studies, 49(5), 613-628. https://doi.org/10.1177/0021909613490131 Islam, S. M. (2012). The United Nations and the Bangladesh Crisis of 1971: A Legal Perspective. Asian Journal of International Law, 2(2), 401-421. https://doi.org/10.1017/S2044251312000 172 Mookherjee, N. (2011). The Bangladesh Genocide: The Plight of Women during the 1971 Liberation War. Gender, Technology and Development, 15(1), 101-114. https://doi.org/10.1177/097185 241001500105 Raghavan, S. (2013). 1971: A Global History of the Creation of Bangladesh. Harvard University Press. Sisson, R., & Rose, L. E. (1991). War and Secession: Pakistan, India, and the Creation of Bangladesh. University of California Press. Sobhan, R. (1982). The Crisis of External Dependence: The Political Economy of Foreign Aid to Bangladesh. University Press Limited. Tahmina, Q. (2001). The UN and the Bangladesh Liberation War of 1971: Interventions and Consequences. Journal of International Affairs, 55(2), 453-469.UN Doc, S/10410, Para 6-10. UN Doc, S/PV/1606, Para 1-371, 5 December, 1971. UN Doc, S/10416, 4 December, 1971. UN Doc, S/10417, 4 December, 1971. UN Doc, S/10418, 4 December, 1971. UN Doc, S/10419, 4 December, 1971. UN Doc, S/PV/1607, Para 1-234, 5 December, 1971. International Journal of Politics & Social Sciences Review (IJPSSR)………………………………Vol. 3, Issue I, 2024 The United Nations' Involvement in Bangladesh's Liberation War ------Mamun, Hasan & Amin Page | 22 UN Doc, S/10421, 5 December, 1971. UN Doc, S/10423, 5 December, 1971. UN Doc, S/10425, 5 December, 1971. UN Doc, S/PV/1608, Para 1-187, 6 December, 1971. UN Doc, S/10426, 6 December, 1971. UN Doc, S/10428, 6 December, 1971. UN Doc, S/10429, 6 December, 1971. UN Doc, A/L 647, 7 December 1971. UN Doc, A/L 647/Rev-1, 7 December 1971. UN Doc, A/L 648, 7 December 1971. UN General Assembly Resolution 2793, Vol- XXVI. UN Doc, S/PV/1611, 12 December 1971. UN Doc, S/10446, 12 December 1971. UN Doc, S/PV/1613, Para1-174, 13 December 1971. UN Doc, A/PV 2002, PP.130-146. UN Doc, A/PV 2003, PP.173-185. UN Doc, S/10451, 13 December 1971. UN Doc, S/PV/1614, Para1-49, 14 December 1971. View publication stats What actions did the UN Secretary General, U Thant, take in response to the trial of Sheikh Mujibur Rahman in August 1971?",Unknown,Find & Summarize,Text Transformation You may only respond using the context block provided.,Is the United States currently in a recession?,"There is no theoretical reason why the criteria used in the Sahm rule is associated with a recession—it is an observed historical relationship for a small sample and may not always hold going forward. Sahm herself has indicated that despite her rule getting triggered, she does not believe that the United States is currently in a recession, although she believes that the risk of recession has increased. The primary indicators used by the NBER are not currently consistent with a recession, and several remain strong. For example, real gross domestic product has been positive since the third quarter of 2022 and grew by 1.4% and 2.8% in the first and second quarters of 2024, with real personal consumption expenditures up 1.5% and 2.3% over the same period. Real personal income less transfers grew in May and June 2024 and were up 1.8% over the year in June. Thus far, the only indications of a weakening economy are coming from the labor market, and even there, indicators are inconsistent. Although there has been a 0.9 percentage point increase in the unemployment rate and nonfarm payroll employment growth has slowed, employment growth remained positive, which is inconsistent with a recession. (Recessions typically feature falling employment within the first three months.) Employment as measured by a different survey has shown some decreases, but the NBER does not track this measure as closely. The unemployment rate could be rising for reasons associated with a weakening economy (e.g., workers losing their jobs) or for neutral reasons (e.g., new entrants to the labor force). Data on the reasons for unemployment suggest that the unemployment rate has risen at least partly because the economy has weakened. Almost two-thirds of the increase in unemployment in the past year has come from people who have lost their jobs (mostly via temporary layoffs or jobs ending), whereas around one-third has come from people entering or reentering the labor force. On the other hand, the rise in unemployment has not coincided with a rise in layoffs and discharges—which are still lower than during the expansion that preceded the pandemic—as would be expected if the economy were entering a recession. Additionally, many economists assessed that the unemployment rate was unsustainably low for over two years. Some cooling in the labor market could indicate a rise to a more sustainable rate. Now the key question is whether it will continue to rise. Unemployment remains low by historical standards, and if it does not rise much further, a recession can be avoided. ",Using only the context block provided is the United States in a recession?,Financial,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Can you explain the new funding approved for passenger rail in the Investing in America Agenda? What were some of the passenger corridors approved for funding? Answer in a minimum of 300 words.,"President Biden’s Investing in America Agenda – a key pillar of Bidenomics – is delivering world class-infrastructure across the country, expanding access to economic opportunity, and creating good-paying jobs. By delivering $66 billion from the Bipartisan Infrastructure Law – the largest investment in passenger rail since the creation of Amtrak 50 years ago – President Biden is delivering on his vision to rebuild America and win the global competition for the 21st century. Today, the Biden-Harris Administration is announcing $8.2 billion in new funding for 10 major passenger rail projects across the country, including the first world-class high-speed rail projects in our country’s history. Key selected projects include: building a new high-speed rail system between California and Nevada, which will serve more than 11 million passengers annually; creating a high-speed rail line through California’s Central Valley to ultimately link Los Angeles and San Francisco, supporting travel with speeds up to 220 mph; delivering significant upgrades to frequently-traveled rail corridors in Virginia, North Carolina, and the District of Columbia; and upgrading and expanding capacity at Chicago Union Station in Illinois, one of the nation’s busiest rail hubs. These historic projects will create tens of thousands of good-paying, union jobs, unlock economic opportunity for communities across the country, and open up safe, comfortable, and climate-friendly travel options to get people to their destinations in a fraction of the time it takes to drive. The Biden-Harris Administration is building out a pipeline of passenger rail projects in every region of the country in order to achieve the President’s vision of world-class passenger rail. Announced projects will add new passenger rail service to cities that have historically lacked access to America’s rail network, connecting residents to jobs, healthcare, and educational opportunities. Investments will repair aging rail infrastructure to increase train speeds, reduce delays, benefit freight rail supply chains to boost America’s economy, significantly reduce greenhouse emissions, and create good-paying union jobs. Additionally, electric high-speed rail trains will take millions of cars off the roads and reduce emissions, further cementing intercity rail as an environmentally-friendly alternative to flying or driving and saving time for millions of Americans. These investments will also create tens of thousands of good-paying union jobs in construction and related industries – adding to over 100,000 jobs that the President is creating through historic investments in world-class rail. Today’s investment includes $8.2 billion through the Federal Railroad Administration’s Federal-State Partnership for Intercity Passenger Rail Program, as well as $34.5 million through the Corridor Identification and Development program to guide passenger rail development on 69 rail corridors across 44 states, ensuring that intercity rail projects are ready for implementation. President Biden will travel to Las Vegas, Nevada to make this announcement. To date, President Biden has announced $30 billion for rail projects across the country – including $16.4 billion on the Northeast Corridor, $1.4 billion for passenger rail and freight rail safety projects, and $570 million to upgrade or mitigate railroad crossings. Fed-State National Project selections include: The Brightline West High-Speed Intercity Passenger Rail System Project will receive up to $3 billion for a new 218-mile intercity passenger rail system between Las Vegas, Nevada, and Rancho Cucamonga, California. The project will create a new high-speed rail system, resulting in trip times of just over 2 hours – nearly twice as fast as driving. This route is expected to serve more than 11 million passengers annually, taking millions of cars off the road and, thanks to all-electric train sets, removing an estimated 400,000 tons of carbon dioxide per year. This project will create 35,000 jobs supporting construction and support 1,000 permanent jobs in operations and maintenance once in service. Brightline’s agreement with the California State and Southern Nevada Building Trades will ensure that this project is built with good-paying union labor, and the project has reached a separate agreement with Rail Labor to employ union workers for its ongoing operations and maintenance. The project will also allow for connections to the Los Angeles Metro area via the Metrolink commuter rail system. The California Inaugural High-Speed Rail Service Project will receive up to $3.07 billion to help deliver high-speed rail service in California’s Central Valley by designing and extending the rail line between Bakersfield and Merced, procuring new high-speed trainsets, and constructing the Fresno station, which will connect communities to urban centers in Northern and Southern California. This 171-mile rail corridor will support high-speed travel with speeds up to 220mph. The project will improve connectivity and increase travel options, along with providing more frequent passenger rail service, from the Central Valley to urban centers in northern and Southern California. New all-electric trainsets will produce zero emissions and be powered by 100% renewable energy. By separating passenger and freight lines, this project will benefit freight rail operations throughout California as well. This project has already created over 11,000 good-paying union construction jobs and has committed to using union labor for operations and maintenance. The Raleigh to Richmond (R2R) Innovating Rail Program Phases IA and II project will receive up to $1.1 billion to build approximately additional parts of the Southeast Corridor from Raleigh to Wake Forest, North Carolina, including new and upgraded track, eleven grade separations and closure of multiple at-grade crossings. The investment will improve system and service performance by developing a resilient and reliable passenger rail route that will also contribute to freight and supply chain resiliency in the southeastern U.S. The proposed project is part of a multi-phased effort to develop a new passenger rail route between Raleigh, North Carolina, and Richmond, Virginia, and better connect the southern states to DC and the Northeast Corridor. Once completed, this new route will save passengers an estimated 90 minutes per trip. The Long Bridge project, part of the Transforming Rail in Virginia – Phase II program, will receive $729 million to construct a new two-track rail bridge over the Potomac River to expand passenger rail capacity between Washington, D.C. and Richmond, VA. Nearly 6 million passengers travel over the existing bridge every year on Amtrak and Virginia Railway Express lines. This upgrade will reduce congestion and delays on this heavily-traveled corridor to our nation’s capital. As part of President Biden’s vision for world-class passenger rail, the Administration is planning for future rail growth in new and unprecedented ways through the Bipartisan Infrastructure Law-created Corridor ID Program. The program establishes a new planning framework for future investments, and corridor selections announced today stand to upgrade 15 existing rail routes, establish 47 extensions to existing and new conventional corridor routes, and advance 7 new high-speed rail projects, creating a pipeline of intercity passenger rail projects ready for future investment. Project selections include: Scranton to New York, reviving a dormant rail corridor between Pennsylvania, New Jersey, and New York, to provide up to three daily trips for commuters and other passengers; Colorado Front Range, a new rail corridor connecting Fort Collins, CO, and Pueblo, CO, to serve an area that currently has no passenger rail options; The Northern Lights Express, connecting Minneapolis, MN and Duluth, MN, with several stops in Wisconsin, for greater regional connectivity; Cascadia High-Speed Rail, a proposed new high-speed rail corridor linking Oregon, Washington, and Vancouver, with entirely new service; Charlotte to Atlanta, a new high-speed rail corridor linking the Southeast and providing connection to Hartsfield-Jackson Airport, the busiest airport in the world;","[question] Can you explain the new funding approved for passenger rail in the Investing in America Agenda? What were some of the passenger corridors approved for funding? Answer in a minimum of 300 words. ===================== [text] President Biden’s Investing in America Agenda – a key pillar of Bidenomics – is delivering world class-infrastructure across the country, expanding access to economic opportunity, and creating good-paying jobs. By delivering $66 billion from the Bipartisan Infrastructure Law – the largest investment in passenger rail since the creation of Amtrak 50 years ago – President Biden is delivering on his vision to rebuild America and win the global competition for the 21st century. Today, the Biden-Harris Administration is announcing $8.2 billion in new funding for 10 major passenger rail projects across the country, including the first world-class high-speed rail projects in our country’s history. Key selected projects include: building a new high-speed rail system between California and Nevada, which will serve more than 11 million passengers annually; creating a high-speed rail line through California’s Central Valley to ultimately link Los Angeles and San Francisco, supporting travel with speeds up to 220 mph; delivering significant upgrades to frequently-traveled rail corridors in Virginia, North Carolina, and the District of Columbia; and upgrading and expanding capacity at Chicago Union Station in Illinois, one of the nation’s busiest rail hubs. These historic projects will create tens of thousands of good-paying, union jobs, unlock economic opportunity for communities across the country, and open up safe, comfortable, and climate-friendly travel options to get people to their destinations in a fraction of the time it takes to drive. The Biden-Harris Administration is building out a pipeline of passenger rail projects in every region of the country in order to achieve the President’s vision of world-class passenger rail. Announced projects will add new passenger rail service to cities that have historically lacked access to America’s rail network, connecting residents to jobs, healthcare, and educational opportunities. Investments will repair aging rail infrastructure to increase train speeds, reduce delays, benefit freight rail supply chains to boost America’s economy, significantly reduce greenhouse emissions, and create good-paying union jobs. Additionally, electric high-speed rail trains will take millions of cars off the roads and reduce emissions, further cementing intercity rail as an environmentally-friendly alternative to flying or driving and saving time for millions of Americans. These investments will also create tens of thousands of good-paying union jobs in construction and related industries – adding to over 100,000 jobs that the President is creating through historic investments in world-class rail. Today’s investment includes $8.2 billion through the Federal Railroad Administration’s Federal-State Partnership for Intercity Passenger Rail Program, as well as $34.5 million through the Corridor Identification and Development program to guide passenger rail development on 69 rail corridors across 44 states, ensuring that intercity rail projects are ready for implementation. President Biden will travel to Las Vegas, Nevada to make this announcement. To date, President Biden has announced $30 billion for rail projects across the country – including $16.4 billion on the Northeast Corridor, $1.4 billion for passenger rail and freight rail safety projects, and $570 million to upgrade or mitigate railroad crossings. Fed-State National Project selections include: The Brightline West High-Speed Intercity Passenger Rail System Project will receive up to $3 billion for a new 218-mile intercity passenger rail system between Las Vegas, Nevada, and Rancho Cucamonga, California. The project will create a new high-speed rail system, resulting in trip times of just over 2 hours – nearly twice as fast as driving. This route is expected to serve more than 11 million passengers annually, taking millions of cars off the road and, thanks to all-electric train sets, removing an estimated 400,000 tons of carbon dioxide per year. This project will create 35,000 jobs supporting construction and support 1,000 permanent jobs in operations and maintenance once in service. Brightline’s agreement with the California State and Southern Nevada Building Trades will ensure that this project is built with good-paying union labor, and the project has reached a separate agreement with Rail Labor to employ union workers for its ongoing operations and maintenance. The project will also allow for connections to the Los Angeles Metro area via the Metrolink commuter rail system. The California Inaugural High-Speed Rail Service Project will receive up to $3.07 billion to help deliver high-speed rail service in California’s Central Valley by designing and extending the rail line between Bakersfield and Merced, procuring new high-speed trainsets, and constructing the Fresno station, which will connect communities to urban centers in Northern and Southern California. This 171-mile rail corridor will support high-speed travel with speeds up to 220mph. The project will improve connectivity and increase travel options, along with providing more frequent passenger rail service, from the Central Valley to urban centers in northern and Southern California. New all-electric trainsets will produce zero emissions and be powered by 100% renewable energy. By separating passenger and freight lines, this project will benefit freight rail operations throughout California as well. This project has already created over 11,000 good-paying union construction jobs and has committed to using union labor for operations and maintenance. The Raleigh to Richmond (R2R) Innovating Rail Program Phases IA and II project will receive up to $1.1 billion to build approximately additional parts of the Southeast Corridor from Raleigh to Wake Forest, North Carolina, including new and upgraded track, eleven grade separations and closure of multiple at-grade crossings. The investment will improve system and service performance by developing a resilient and reliable passenger rail route that will also contribute to freight and supply chain resiliency in the southeastern U.S. The proposed project is part of a multi-phased effort to develop a new passenger rail route between Raleigh, North Carolina, and Richmond, Virginia, and better connect the southern states to DC and the Northeast Corridor. Once completed, this new route will save passengers an estimated 90 minutes per trip. The Long Bridge project, part of the Transforming Rail in Virginia – Phase II program, will receive $729 million to construct a new two-track rail bridge over the Potomac River to expand passenger rail capacity between Washington, D.C. and Richmond, VA. Nearly 6 million passengers travel over the existing bridge every year on Amtrak and Virginia Railway Express lines. This upgrade will reduce congestion and delays on this heavily-traveled corridor to our nation’s capital. As part of President Biden’s vision for world-class passenger rail, the Administration is planning for future rail growth in new and unprecedented ways through the Bipartisan Infrastructure Law-created Corridor ID Program. The program establishes a new planning framework for future investments, and corridor selections announced today stand to upgrade 15 existing rail routes, establish 47 extensions to existing and new conventional corridor routes, and advance 7 new high-speed rail projects, creating a pipeline of intercity passenger rail projects ready for future investment. Project selections include: Scranton to New York, reviving a dormant rail corridor between Pennsylvania, New Jersey, and New York, to provide up to three daily trips for commuters and other passengers; Colorado Front Range, a new rail corridor connecting Fort Collins, CO, and Pueblo, CO, to serve an area that currently has no passenger rail options; The Northern Lights Express, connecting Minneapolis, MN and Duluth, MN, with several stops in Wisconsin, for greater regional connectivity; Cascadia High-Speed Rail, a proposed new high-speed rail corridor linking Oregon, Washington, and Vancouver, with entirely new service; Charlotte to Atlanta, a new high-speed rail corridor linking the Southeast and providing connection to Hartsfield-Jackson Airport, the busiest airport in the world; https://www.whitehouse.gov/briefing-room/statements-releases/2023/12/08/fact-sheet-president-biden-announces-billions-to-deliver-world-class-high-speed-rail-and-launch-new-passenger-rail-corridors-across-the-country/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Summarize,Text Transformation You must only respond to the prompt using information in the context block and no other sources.,How do licenses negotiated for theaters carry over to television?,"The PROs As mentioned above, although musical compositions were expressly made subject to copyright protection starting in 1831, Congress did not grant music creators the exclusive right to publicly perform their compositions until 1897.108 Though this right represented a new way for copyright owners to derive profit from their musical works, the sheer number and fleeting nature of public performances made it impossible for copyright owners to individually negotiate with each user for every use, or detect every case of infringement.109 ASCAP was established in 1914, followed by other PROs, to address the logistical issue of how to license and collect payment for the public performance of musical works in a wide range of settings.110 Today, the PROs provide various different types of licenses depending upon the nature of the use. Anyone who publicly performs a musical work may obtain a license from a PRO, including terrestrial, satellite and internet radio stations, broadcast and cable television stations, online services, bars, restaurants, live performance venues, and commercial establishments that play background music. Most commonly, licensees obtain a blanket license, which allows the licensee to publicly perform any of the musical works in a PRO’s repertoire for a flat fee or a percentage of total revenues.111 Some users opt for a blanket license due to its broad coverage of musical works and relative simplicity as compared to other types of licenses. Large commercial establishments such as bars, restaurants, concert venues, stores, and hotels often enter into blanket licenses to cover their uses, paying either a percentage of gross revenues or an annual flat fee, depending on the establishment and the type and amount of use.112 Terrestrial radio stations obtain blanket licenses from PROs as well, usually by means of the RMLC.113 Many television stations, through the TMLC, also obtain blanket licenses.114 Less commonly used licenses include the per-program or per-segment license, which allows the licensee to publicly perform any of the musical works in the PRO’s repertoire for specified programs or parts of their programming, in exchange for a flat fee or a percentage of that program’s advertising revenue.115 Unlike a blanket license, the perprogram or per-segment license requires more detailed reporting information, including program titles, the specific music selections used, and usage dates, making the license more burdensome for the licensee to administer.116 Users can also license music directly from music publishers through a direct license or a source license. A direct license is simply a license agreement directly negotiated between the copyright owner and the user who intends to publicly perform the musical work. Source licenses are commonly used in the motion picture industry, because the PROs are prohibited from licensing public performance rights directly to movie theater owners.117 Instead, film producers license public performance rights for the music used in films at the same time as the synchronization rights, and pass the performance rights along to the theaters that will be showing their films.118 In the context of motion pictures, source licenses do not typically encompass non-theatrical performances, such as on television. Thus, television stations, cable companies, and online services such as Netflix and Hulu must obtain public performance licenses from the PROs to cover the public performance of musical works in the shows and movies they transmit to end users.119","System instruction: You must only respond to the prompt using information in the context block and no other sources. Prompt: How do licenses negotiated for theaters carry over to television? Context block: The PROs As mentioned above, although musical compositions were expressly made subject to copyright protection starting in 1831, Congress did not grant music creators the exclusive right to publicly perform their compositions until 1897.108 Though this right represented a new way for copyright owners to derive profit from their musical works, the sheer number and fleeting nature of public performances made it impossible for copyright owners to individually negotiate with each user for every use, or detect every case of infringement.109 ASCAP was established in 1914, followed by other PROs, to address the logistical issue of how to license and collect payment for the public performance of musical works in a wide range of settings.110 Today, the PROs provide various different types of licenses depending upon the nature of the use. Anyone who publicly performs a musical work may obtain a license from a PRO, including terrestrial, satellite and internet radio stations, broadcast and cable television stations, online services, bars, restaurants, live performance venues, and commercial establishments that play background music. Most commonly, licensees obtain a blanket license, which allows the licensee to publicly perform any of the musical works in a PRO’s repertoire for a flat fee or a percentage of total revenues.111 Some users opt for a blanket license due to its broad coverage of musical works and relative simplicity as compared to other types of licenses. Large commercial establishments such as bars, restaurants, concert venues, stores, and hotels often enter into blanket licenses to cover their uses, paying either a percentage of gross revenues or an annual flat fee, depending on the establishment and the type and amount of use.112 Terrestrial radio stations obtain blanket licenses from PROs as well, usually by means of the RMLC.113 Many television stations, through the TMLC, also obtain blanket licenses.114 Less commonly used licenses include the per-program or per-segment license, which allows the licensee to publicly perform any of the musical works in the PRO’s repertoire for specified programs or parts of their programming, in exchange for a flat fee or a percentage of that program’s advertising revenue.115 Unlike a blanket license, the perprogram or per-segment license requires more detailed reporting information, including program titles, the specific music selections used, and usage dates, making the license more burdensome for the licensee to administer.116 Users can also license music directly from music publishers through a direct license or a source license. A direct license is simply a license agreement directly negotiated between the copyright owner and the user who intends to publicly perform the musical work. Source licenses are commonly used in the motion picture industry, because the PROs are prohibited from licensing public performance rights directly to movie theater owners.117 Instead, film producers license public performance rights for the music used in films at the same time as the synchronization rights, and pass the performance rights along to the theaters that will be showing their films.118 In the context of motion pictures, source licenses do not typically encompass non-theatrical performances, such as on television. Thus, television stations, cable companies, and online services such as Netflix and Hulu must obtain public performance licenses from the PROs to cover the public performance of musical works in the shows and movies they transmit to end users.119 ",Legal,Explanation/Definition,Q&A I'm providing you with your source material. You will not be using any outside material. Your job is to answer questions about the material.,What are the key points of this paper?,"ORIGINAL RESEARCH published: 06 May 2021 doi: 10.3389/fpsyg.2021.637929 Revisiting False-Positive and Imitated Dissociative Identity Disorder Igor Jacob Pietkiewicz* , Anna Bańbura-Nowak, Radosław Tomalski and Suzette Boon Research Centre for Trauma & Dissociation, SWPS University of Social Sciences and Humanities, Katowice, Poland Edited by: Hamed Ekhtiari, Laureate Institute for Brain Research, United States Reviewed by: Hosein Mohaddes Ardabili, Mashhad University of Medical Sciences, Iran Bo Bach, Psychiatry Region Zealand, Denmark *Correspondence: Igor Jacob Pietkiewicz ipietkiewicz@swps.edu.pl Specialty section: This article was submitted to Psychopathology, a section of the journal Frontiers in Psychology Received: 04 December 2020 Accepted: 14 April 2021 Published: 06 May 2021 Citation: Pietkiewicz IJ, Bańbura-Nowak A, Tomalski R and Boon S (2021) Revisiting False-Positive and Imitated Dissociative Identity Disorder. Front. Psychol. 12:637929. doi: 10.3389/fpsyg.2021.637929 ICD-10 and DSM-5 do not provide clear diagnosing guidelines for DID, making it difficult to distinguish ‘genuine’ DID from imitated or false-positive cases. This study explores meaning which patients with false-positive or imitated DID attributed to their diagnosis. 85 people who reported elevated levels of dissociative symptoms in SDQ20 participated in clinical assessment using the Trauma and Dissociation Symptoms Interview, followed by a psychiatric interview. The recordings of six women, whose earlier DID diagnosis was disconfirmed, were transcribed and subjected to interpretative phenomenological analysis. Five main themes were identified: (1) endorsement and identification with the diagnosis. (2) The notion of dissociative parts justifies identity confusion and conflicting ego-states. (3) Gaining knowledge about DID affects the clinical presentation. (4) Fragmented personality becomes an important discussion topic with others. (5) Ruling out DID leads to disappointment or anger. To avoid misdiagnoses, clinicians should receive more systematic training in the assessment of dissociative disorders, enabling them to better understand subtle differences in the quality of symptoms and how dissociative and non-dissociative patients report them. This would lead to a better understanding of how patients with and without a dissociative disorder report core dissociative symptoms. Some guidelines for a differential diagnosis are provided. Keywords: dissociative identity disorder (DID), false-positive cases, personality disorder, dissociation, differential diagnosis INTRODUCTION Multiple Personality Disorder (MPD) was first introduced in DSM-III in 1980 and re-named Dissociative Identity Disorder (DID) in subsequent editions of the diagnostic manual (American Psychiatric Association, 2013). Table 1 shows diagnostic criteria of this disorder in ICD-10, ICD11, and DSM-5. Some healthcare providers perceive it as fairly uncommon or associated with temporary trends (Brand et al., 2016). Even its description in ICD-10 (World Health Organization, 1993) starts with: “This disorder is rare, and controversy exists about the extent to which it is iatrogenic or culture-specific” (p. 160). Yet, according to the guidelines of the International Society for the Study of Trauma and Dissociation (International Society for the Study of Trauma and Dissociation, 2011), the prevalence of DID in the general population is estimated between 1 and 3%. The review of global studies on DID in clinical settings by Sar (2011) shows the rate from Frontiers in Psychology | www.frontiersin.org 1 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID TABLE 1 | Diagnostic criteria for dissociative identity disorder. ICD-10 Multiple personality disorder F44.81 (A) Two or more distinct personalities exist within the individual, only one being evident at a time. (B) Each personality has its own memories, preferences, and behavior patterns, and at some time (and recurrently) takes full control of the individual’s behavior. (C) There is inability to recall important personal information which is too extensive to be explained by ordinary forgetfulness. (D) The symptoms are not due to organic mental disorders (F00–F09) (e.g., in epileptic disorders) or to psychoactive substance-related disorders (F10–F19) (e.g., intoxication or withdrawal). ICD-11 Dissociative identity disorder 6B64 Dissociative identity disorder is characterized by disruption of identity in which there are two or more distinct personality states (dissociative identities) associated with marked discontinuities in the sense of self and agency. Each personality state includes its own pattern of experiencing, perceiving, conceiving, and relating to self, the body, and the environment. At least two distinct personality states recurrently take executive control of the individual’s consciousness and functioning in interacting with others or with the environment, such as in the performance of specific aspects of daily life such as parenting, or work, or in response to specific situations (e.g., those that are perceived as threatening). Changes in personality state are accompanied by related alterations in sensation, perception, affect, cognition, memory, motor control, and behavior. There are typically episodes of amnesia, which may be severe. The symptoms are not better explained by another mental, behavioral or neurodevelopmental disorder and are not due to the direct effects of a substance or medication on the central nervous system, including withdrawal effects, and are not due to a disease of the nervous system or a sleep-wake disorder. The symptoms result in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. DSM-5 Dissociative identity disorder 300.14 (A) Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual. (B) Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. (C) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (D) The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play. (E) The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures). a false positive diagnosis, which is unfavorable for the patient, because using treatment developed for DID with patients without autonomous dissociative parts may be inefficient or even reinforce their pathology. Authors who wrote about patients inappropriately diagnosed with this disorder used terms such as ‘malingering’ or ‘factitious’ DID (Coons and Milstein, 1994; Thomas, 2001). According to Draijer and Boon (1999), both labels imply that patients intentionally simulate symptoms, either for external gains (financial benefits or justification for one’s actions in court) or for other forms of gratification (e.g., interest from others), while in many cases their motivation is not fully conscious. Getting a DID diagnosis can also provide structure for inner chaos and incomprehensible experiences, and be associated with hope and belief it is real. On the other hand, diagnostic errors often result in inappropriate treatment plans and procedures. Already in 1995 Boon and Draijer stressed that a growing number of people self-diagnosed themselves based on information from literature and the Internet, and reported symptoms by the book during psychiatric or psychological assessment. Based on their observation of 36 patients in whom DID had been ruled out after applying the structured clinical interview SCID-D, these clinicians identified differences between genuine and imitated DID. They classified their participants into three groups: (1) borderline personality disorder, (2) histrionic personality disorder, or (3) persons with severe dissociative symptoms but not DID. Participants in that study reported symptoms similar to DID patients, including: amnesia (but only for unacceptable behavior), depersonalisation, derealisation, identity confusion, and identity alteration. However, they presented themselves and interacted with the therapist in very 0.4 to 14%. However, in studies using clinical diagnostic interviews among psychiatric in-patients, and in European studies these numbers were lower (Friedl et al., 2000). The discrepancies apparently depend on the sample, the methodology and diagnostic interviews used by researchers. Diagnosing complex dissociative disorders (DID or Other Specified Dissociative Disorder, OSDD) is challenging for several reasons. Firstly, patients present a lot of avoidance and rarely report dissociative symptoms spontaneously without direct questioning (Boon and Draijer, 1993; International Society for the Study of Trauma and Dissociation, 2011; Dorahy et al., 2014). In addition, standard mental state examination does not include these symptoms and healthcare professionals do not receive appropriate training in diagnosing dissociative disorders (Leonard et al., 2005). Secondly, complex dissociative disorders are polysymptomatic, and specialists would rather diagnose these patients with disorders more familiar to them from clinical practice, e.g., anxiety disorders, eating disorders, schizophrenia, or borderline personality disorder (Boon and Draijer, 1995; Dell, 2006; Brand et al., 2016). For these reasons, complex dissociative disorders are underdiagnosed and often mis-diagnosed. For example, 26.5–40.8% of DID patients would already have been diagnosed and treated for schizophrenia (Putnam et al., 1986; Ross et al., 1989). On the other hand, because there is so much information about DID in the media (Hollywood productions, interviews and testimonies published on YouTube, blogs), people who are confused about themselves and try to find an accurate diagnosis for themselves may learn about DID symptoms on the Internet, identify themselves with the disorder, and later (even unintentionally) report core symptoms in a very convincing way (Draijer and Boon, 1999). This presents a risk of making Frontiers in Psychology | www.frontiersin.org 2 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID different ways. While DID patients are usually reluctant to talk about their symptoms and experience their intrusions as shameful, people who imitated DID were eager to present their problems, sometimes in an exaggerated way, in an attempt to convince the clinician that they suffered from DID (Boon and Draijer, 1995; Draijer and Boon, 1999). Similar observations were expressed by Thomas (2001) saying that people with imitated DID can present their history chronologically, using the first person even when they are highly distressed or allegedly presenting an altered personality, and are comfortable with disclosing information about experiences of abuse. They can talk about intrusions of dissociative parts, hearing voices or difficulties controlling emotions, without shame. Unfortunately, ICD-10, ICD-11, and DSM-5 offer no specific guidelines on how to differentiate patients with personality disorders and dissociative disorders by the manner in which they report symptoms. There are also limited instruments to distinguish between false-positive and false-negative DID. From the clinical perspective, it is also crucial to understand the motives for being diagnosed with DID, and disappointment when this diagnosis is disconfirmed. Accurate assessment can contribute to developing appropriate psychotherapeutic procedures (Boon and Draijer, 1995; Draijer and Boon, 1999). Apart from observations already referred to earlier in this article, there are no qualitative analyses of false-positive DID cases in the past 20 years. Most research was quantitative and compared DID patients and simulators in terms of cognitive functions (Boysen and VanBergen, 2014). This interpretative phenomenological analysis is an idiographic study which explores personal experiences and meaning attributed to conflicting emotions and behaviors in six women who had previously been diagnosed with DID and referred to the Research Centre for Trauma and Dissociation for re-evaluation. It explores how they came to believe they have DID and what had led clinicians to assume that these patients could be suffering from this disorder. Procedure This study is part of a larger project examining alterations in consciousness and dissociative symptoms in clinical and non-clinical groups, held at the Research Centre for Trauma & Dissociation, financed by the National Science Centre, and approved by the Ethical Review Board at the SWPS University of Social Sciences & Humanities. Potential candidates enrolled themselves or were registered by healthcare providers via an application integrated with the website www.e-psyche.eu. They filled in demographic information and completed online tests, including: Somatoform Dissociation Questionnaire (SDQ-20, Pietkiewicz et al., 2018) and Trauma Experiences Checklist (Nijenhuis et al., 2002). Those with elevated SDQ-20 scores (above 28 points) or those referred for differential diagnosis were consulted and if dissociative symptoms were confirmed, they were invited to participate in an in-depth clinical assessment including a series of interviews, video-recorded and performed at the researcher’s office by the first author who is a psychotherapist and supervisor experienced in the dissociation field. In Poland, there are no gold standards for diagnosing dissociative disorders. The first interview was semi-structured, open-ended and explored the patient’s history, main complaints and motives for participation. It included questions such as: What made you participate in this study? What are your main difficulties or symptoms in daily life? What do you think caused them? Further questions were then asked to explore participants’ experiences and meaning-making. This was followed by the Trauma and Dissociation Symptoms Interview (TADS-I, Boon and Matthess, 2017). The TADS-I is a new semi-structured interview intended to identify DSM-5 and ICD-11 dissociative disorders. The TADS-I differs in several ways from other semi-structured interviews for the assessment of dissociative disorders. Firstly, it includes a significant section on somatoform dissociative symptoms. Secondly, it includes a section addressing other trauma-related symptoms for several reasons: (1) to obtain a more comprehensive clinical picture of possible comorbidities, including symptoms of PTSD and complex PTSD, (2) to gain a better insight into the (possible) dissociative organization of the personality: patient’s dissociative parts hold many of these comorbid symptoms and amnesia, voices or depersonalisation experiences are often associated with these symptoms; and (3) to better distinguish between complex dissociative disorders, personality disorders and other Axis I disorders and false positive DID. Finally, the TADS-I also aims to distinguish between symptoms of pathological dissociation indicating a division of the personality and symptoms which are related to a narrowing or a lowering of consciousness, and not to the structural dissociation of the personality. Validation testing of the TADS-I is currently underway. TADS interviews ranging from 2 to 4 h were usually held in sessions of 90 min. Interview recordings were assessed by three healthcare professionals experienced in the dissociation field, who discussed each case and consensually came up with a diagnosis based on ICD-10. An additional mental state examination was performed by the third author who is a psychiatrist, also experienced in the differential diagnosis of dissociative disorders. He collected medical data, double-checked the most important symptoms, communicated the results and discussed treatment indications. Qualitative data collected from MATERIALS AND METHODS This study was carried out in Poland in 2018 and 2019. Rich qualitative material collected during in-depth clinical assessments was subjected to the interpretative phenomenological analysis (IPA), a popular methodological framework in psychology for exploring people’s personal experiences and interpretations of phenomena (Smith and Osborn, 2008). IPA was selected to build a deeper understanding of how patients who endorsed and identified with dissociative identity disorder made sense of the diagnosis and what it meant for them to be classified as false-positive cases during reassessment. Interpretative phenomenological analysis uses phenomenological, hermeneutic, and idiographic principles. It employs ‘double hermeneutics,’ in which participants share their experiences and interpretations, followed by researchers trying to make sense and comment on these interpretations. IPA uses small, homogenous, purposefully selected samples, and data are carefully analyzed case-by-case (Smith and Osborn, 2008; Pietkiewicz and Smith, 2014). Frontiers in Psychology | www.frontiersin.org 3 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID who also developed the TADS-I. They are all mentors and trainers of the European Society for Trauma and Dissociation, with significant expertise in the assessment of post-traumatic conditions. The first co-investigator (AB) has a master’s degree in psychology and is a Ph.D. candidate. She is also a psychotherapist in training. All authors coded and discussed their understanding of data. Their understanding and interpretations of symptoms reported by participants were influenced by their background knowledge and experience in diagnosing and treating patients with personality disorders and dissociative disorders. six patients out of 85 were selected for this interpretative phenomenological analysis, based on the following criteria for inclusion, which could ensure a homogenous sample expected of IPA studies – (a) female, (b) previously diagnosed or referred to rule in/out DID, (c) endorsement and identification with DID, (d) dissociative disorder disconfirmed in the assessment. Interviews with every participant in this study ranged from 3 h 15 min to 7 h 20 min (mean: 6 h). Participants Participants of this IPA were six female patients aged between 22 and 42 years who were selected out of 86 people examined in a larger study exploring dissociation and alterations in consciousness in clinical and non-clinical groups. (Participants in the larger study met criteria of different diagnoses and seven among them had ‘genuine’ DID). These six patients did not meet DID criteria on the TADS-I interview but believed themselves that they qualified for that diagnosis. Four of them had higher education, two were secondary school graduates. All of them registered in the study by themselves hoping to confirm their diagnosis but two (Olga and Katia) were referred by psychiatrists, and the others by psychotherapists. All of them traveled from far away, which showed their strong motivation to participate in the assessment. Four had previously had psychiatric treatment and five had been in psychotherapy due to problems with emotional regulation and relationships. In the cases of Victoria and Dominique, psychotherapy involved working with dissociative parts. None of them recalled any physical or sexual abuse, but three (Dominique, Victoria, and Mary), following therapists’ suggestions, were trying to seek such traumatic memories to justify their diagnosis. They all felt emotionally neglected by carriers in childhood and emotionally abused by significant others. None of them reported symptoms indicating the existence of autonomous dissociative parts. None had symptoms indicating amnesia for daily events, but four declared not remembering single situations associated with conflicting emotions, shame, guilt, or conversations during which they were more focused on internal experiences rather than their interlocutors. None experienced PTSD symptoms (e.g., intrusive traumatic memories and avoidance), autoscopic phenomena (e.g., out-of-body experiences), or clinically significant somatoform symptoms. None had auditory verbal hallucinations but four intensely engaged in daydreaming and experienced imagined conversations as very real. All of them had been seeking information about DID in literature and the Internet. For more information about them see Table 2. Their names have been changed to protect their confidentiality. Data Analysis Verbatim transcriptions were made of all video recordings, which were analyzed together with researchers’ notes using qualitative data-analysis software – NVivo11. Consecutive analytical steps recommended for IPA were employed in the study (Pietkiewicz and Smith, 2014). For each interview, researchers watched the recording and carefully read the transcript several times. They individually made notes about body language, facial expressions, the content and language use, and wrote down their interpretative comments using the ‘annotation’ feature in NVivo10. Next, they categorized their notes into emergent themes by allocating descriptive labels (nodes). The team then compared and discussed their coding and interpretations. They analyzed connections between themes in each interview and between cases, and grouped themes according to conceptual similarities into main themes and sub-themes. Credibility Checks During each interview, participants were encouraged to give examples illustrating reported symptoms or experiences. Clarification questions were asked to negotiate the meaning participants wanted to convey. At the end of the interview, they were also asked questions to check that their responses were thorough. The researchers discussed each case thoroughly and also compared their interpretative notes to compare their understanding of the content and its meaning (the second hermeneutics). RESULTS Participants in this study explained how they concluded they were suffering from DID, developed knowledge about the syndrome and an identity of a DID patient, and how this affected their everyday life and relationships. Five salient themes appeared in all interviews, as listed in Table 3. Each theme is discussed and illustrated with verbatim excerpts from the interviews, in accordance with IPA principles. The Researchers Theme 1: Endorsement and Identification With the Diagnosis The principal investigator (IJP) is a psychotherapist, supervisor, and researcher in the field of community health psychology and clinical psychology. The second co-investigator (RT) is a psychiatrist, psychotherapist, and supervisor. The third coinvestigator (SB) is a clinical psychologist, psychotherapist, supervisor, and a consulting expert in forensic psychology, Frontiers in Psychology | www.frontiersin.org All six participants hoped to confirm they had DID. They read books and browsed the Internet seeking information about dissociation, and watched YouTube videos presenting people describing multiple personalities. Dominique, Victoria, Mary, 4 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID TABLE 2 | Study participants. Name Participant’s characteristics Victoria Age 22, single, lives with parents and younger brother. Stopped her studies after 3 years and was hospitalized in a psychiatric facility for a short period due to problems with emotions and relationships. Reports difficulties with recognizing and expressing emotions, emptiness, feels easily hurt and rejected, afraid of abandonment. Perceives herself as unimportant and worthless, sometimes cuts herself for emotional relief. Maintains superficial relationships, does not trust people; in childhood was frequently left alone with grandparents because her parents traveed; described her parents as setting high expectations, mother as getting easily upset and impulsive. No substance use. No history of physical or sexual trauma. Her maternal grandfather abused alcohol but was not violent; no history of suicides in her family. Scored 38 points in SDQ-20 but no significant somatoform symptoms reported during clinical assessment. Karina Age 22, single, secondary education. Enrolled in university programs twice but stopped. Acting is a hobby; recently worked as a waitress or hostess, currently unemployed. Has had psychiatric treatment for 17 years due to anxiety and problems in relationships. Two short hospital admissions; in psychodynamic psychotherapy in last 2 years. Reports emotional instability, feeling depressed, anxious, and lonely; maintains few relationships; experiences conflicts with expressing anger and needs for dependency, no self-harm. She had periods of using alcohol excessively in the past, currently once a month, no drugs. No family members used psychiatric help. Reports abandonment, emotional and physical abuse in childhood and eagerly talks about these experiences. Scored 68 points in SDQ-20 but no significant somatoform symptoms reported during clinical assessment. Dominique Age 33, higher education, married, three children. Works as a playwright, comes from an artistic family. Was given away to her grandparents as a baby and returned to parents and brothers when she was seven; often felt abandoned and neglected. She had learning difficulties and problems in relationships, mood regulation, auto-aggressive behavior, feelings of emptiness and loneliness. Denies using alcohol or drugs; at secondary school abused marihuana. Her paternal grandmother had psychosis, her father abused marihuana and mother was treated for depression. Reports poverty at home. No suicides in family. Often retreated into her fantasy world in which she developed a story about boys kept in a resocialisation center. Has had psychiatric treatment and counseling for 20 years. Scored 52 points in SDQ-20 but no somatoform symptoms confirmed during clinical assessment. Mary Age 34, higher education, married. Works in the creative industry and engaged in proselytic activities as an active Jehovah’s Witness (joined the organization 10 years earlier, encouraged by her mother). Has had EMDR therapy for 2 years due to problems maintaining relationships and managing anger. When her therapist asked if she felt there were different parts inside her, she started exploring information about DID. She denies smoking or using any drugs, alcohol. Mother suffered from mild depression. No suicides in family. Scored 48 points in SDQ-20 but no somatoform symptoms confirmed during clinical assessment. Olga Age 40, higher education, single. Works in social care. Reports depressive mood, low self-esteem, difficulties with concentration, problems with social contacts. Occasionally uses alcohol in small doses, no drugs. Describes her mother as demanding but also distant and negligent because she was busy with her medical practice. Father withdrawn and depressed but never used psychiatric treatment. No other trauma history. No suicides in family. Tried psychotherapy four times but usually terminated treatment after a while. Her psychiatrist referred her for evaluation of memory problems, and confirming DID. Scored 31 points in SDQ-20; confirms a few somatoform symptoms: headaches, symptoms associated with cystitis, detachment from bodily sensations. Katia Age 42, post-graduate education. Unemployed. On social benefits for 15 years due to neurological and pulmonary symptoms, complications after urological surgeries. Reports low self-esteem, self-loathing, problems in establishing or maintaining relationships, feeling lonely, rejected and not understood. Inclinations toward passive-aggressive behavior toward people representing authority, fatigue, insecurity about her financial situation. Reports no alcohol or drug use. Mother treated for depression. No suicides in family. Scored 69 points in SDQ-20; multiple somatic complaints associated with Lyme disease, describes mother as emotionally and physically abusive, and father as abandoning and unprotecting. Has never used psychotherapy; was referred for consultation by a psychiatrist after persuading him that she had DID symptoms. Participants names have been changed to protect their confidentiality. During an argument with my mother I felt as if some incredible force took control and I smashed the glass in the cabinet with my hand. It was like being under control of an alien force. I started reading about borderline and I thought I had it. I found a webpage about that and told my mother I should see a psychiatrist. I went for a consultation and told her my story. This lady said: “Child, you don’t have borderline, but multiple personality.” She wanted to keep me in the psychiatric unit but I did not agree to stay for observation. (Dominique). TABLE 3 | Salient themes identified during the interpretative phenomenological analysis. Theme 1: Endorsement and identification with the diagnosis Theme 2: Using the notion of dissociative parts to justify identity confusion and conflicting ego-states Theme 3: Gaining knowledge about DID affects the clinical presentation Theme 4: Fragmented personality becomes an important discussion topic with others Theme 5: Ruling out DID leads to disappointment or anger. This led Dominique to research the new diagnosis. Karina also said she was encouraged to seek information about DID, when a doctor suggested she might be suffering with it. When I was 11, I had problems at school and home. Other children made fun of me. My mom took me to a doctor and he said I had borderline, but later I was diagnosed with an anxiety disorder. That doctor also suggested I had DID and told me that I should read more about this diagnosis. (Karina). and Karina said that a mental health professional suggested this diagnosis to them. Dominique remembers consulting a psychiatrist when she was 15, because she had problems controlling anger at home or in public places. She initially found descriptions of borderline personality captured her experiences well enough, but a psychiatrist refuted the idea and recommended further diagnostics toward a dissociative disorder. However, the girl refused to go to hospital for observation. Frontiers in Psychology | www.frontiersin.org Victoria and Mary shared similar stories about psychotherapists suggesting the existence of dissociative parts, having readily accepted this new category as a good explanation 5 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID for aggressive impulses or problems with recalling situations evoking guilt or shame. Dominique and Victoria stressed, however, that, apart from feeling emotionally abandoned, they could not trace any significant traumas in their early childhoods, although therapists maintained that such events must be present in dissociative patients. different expectations. Whoever comes up front, then I have these ideas. (Dominique). Dominique neither had amnesia nor found evidence for leading separate lives and engaging herself in activities associated with her characters. She maintained her job as a playwright, and merely imagined alternative scenarios of her life, expressed by her inner heroes. In other parts of the interview, she referred to them as ‘voices inside,’ but admitted she never heard them acoustically. They were her own vivid thoughts representing different, conflicting opinions or impulses. Katia said she felt internally fragmented. There were times when she engaged in certain interests, knowledge and skills, but she later changed her goals. Fifteen years ago she gave up her academic career and went on sickness benefit when she became disabled due to medical problems; she experienced this as a great loss, a failure, which affected her sense of identity and purpose. I have no idea why I have this [DID]. My therapist looked for evidence of childhood trauma, which sounds like the easiest explanation, but I don’t feel I had any horrific memories which I threw out of my consciousness. (Victoria). Katia and Olga had used psychiatric treatment for anxiety and depression for years. After exploring information about different mental disorders they concluded they had DID. They thought there was a similarity between their personal experiences and those of people publishing testimonials about multiple personalities. In recent years I have a growing sense of identity fragmentation. I have problems with defining my identity because it changes. I used to feel more stable in the past. I had these versions of myself which were more dominating, so I had a stronger sense of identity. For example, 20 years ago there was this scientist. I was studying and felt like a scientist, attending conferences. Now I don’t have that and I don’t know who I am. [. . .] I also have changing interests and hobbies because of different personalities. Long ago I liked certain music, played the guitar, sang songs. I don’t do that anymore, I suddenly lost interest in all that. (Katia). I tried to understand this battle inside, leading me to stagnation. I didn’t know how to describe that but I recently bought a book Healing the fragmented selves of trauma survivors, and everything was explained there. Some of these things I have discovered myself and some were new to me. (Olga). Subsequently, Katia presented to her doctor a review of literature about DID, trying to persuade him that she had this disorder. Theme 2: Using the Notion of Dissociative Parts to Justify Identity Confusion and Conflicting Ego-States She described changes in her professional and social lives in terms of switches between dissociative parts. Although she maintained the first person narrative (“I was studying,” “I played,” or “I sang”), indicating some sense of continuity, she thought it proved the existence of two or more distinct personalities. Participants also reported thoughts, temptations, impulses or actions which seemed to evoke conflicting feelings. Attributing them to ‘something inside that is not-me’ could free them from guilt or shame, so they used a metaphor of someone taking over, logging in, or switching. Dominique thought it was inappropriate to express disappointment or anger, but she accepted the thought that her dissociative parts were doing this. Once participants had embraced the idea of having multiple personalities, they seemed to construct inner reality and justify conflicting needs, impulses or behaviors as an expression of dissociative parts. They referred to being uncertain about who they were and having difficulties recognizing personal emotions, needs or interests. Some of them felt it was connected to a negative cognition about themselves as worthless, unimportant, and not deserving to express what they felt or wanted. Victoria said she would rather define herself through the eyes of others: When I’m angry at my therapist, it is not really me but somebody inside who gets angry easily. Greg often switches on in such situations and says: “Tell her this and this”. [. . .] I went to a shop once and discovered that the price on the label was not for a whole package of batteries but a single one. And suddenly Greg switched on and had a row with the cashier. I mean, I did it, but wound up by his anger. This is so weird, I wouldn’t react like that. They just charged incorrectly and I would normally ignore that but Greg said: “I give a shit about their mistakes. I won’t accept that.” What a failure! (Dominique). My therapist asked what I wanted or needed. It turned out that without other people’s expectations or preferences to which I normally adjust, I wouldn’t know who I am or what I want. I usually engage in my friends’ hobbies and do what I think gives them pleasure. Otherwise, I think they will not like me and reject me, because I have nothing to offer. (Victoria). Since a young age, Dominique tended to immerse herself in a fantasy world, developing elaborated scenarios about people living in a youth center administered by a vicious boss. Different characters in her ‘Story’ represented specific features, interests and plans she had. Mary said she had parts that expressed anger, sadness, and needs associated with attachment. She observed them and allowed them to step in, when situations required. Well, there is John who is a teacher and researcher. He teaches mathematics. I have no skills in maths at all. Tim is a philosopher and would like to train philosophers, enroll doctoral studies. He would like me to study philosophy but the rest of the system wants me to be a worrier. Ralf is a caring nurse and would like to become a paramedic. It is difficult to reconcile all these Frontiers in Psychology | www.frontiersin.org There were situations in my life when the teenager must have been active. She protected me. She is ready to fight; I am not like that at all. I hate violence, and that teenager likes using force to protect me. [. . .] My therapist suggested I call her after this interview if I 6 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID but not necessarily related to trauma. Katia said she recently remembered the picture of the house and garden where she played as a child and associated these experiences with moments of joy. Karina also exemplified her flashbacks with ‘intrusions of happy memories’ which belonged to other personalities: do not feel well. I didn’t accept that but the [inner] girls got upset and told me I needed her help. They made me comply, so I agreed to call her if I do not feel well. It has always been like this. (Mary). During assessment, no participant provided evidence for the existence of autonomous dissociative parts. It seems that the inner characters described by them personified unintegrated egostates which used to evoke conflicting feelings. Sometimes I begin to laugh but this is not my laughter, but the laughter of sheer joy. Someone inside me is very happy and wants to talk about happy childhood memories, make jokes. (Karina). Theme 3: Exploring Personal Experiences via the Lens of Dissociation Mary said a child part of her was responsible for flashbacks and making comments about current situations. However, she later denied hearing voices or having any other Schneider’s symptoms. Reading books, websites and watching videos of people who claimed to have DID, encouraged them to compare themselves, talk about and express ‘multiple personalities.’ The participants became familiar with specialist terms and learned about core symptoms mentioned in psychiatric manuals. I can hear her comments, that she does not like something. I can be flooded by emotions and have flashbacks associated with that child. For example, there is a trigger and I can see things that this child has seen. She is showing me what was happening in her life. (Mary). I read First person plural which helped me understand what this is all about. The drama of the gifted child and The body keeps the score. More and more girls started to appear. There is a 6-month old baby which showed up only 2 months ago, a sad 11-year old teenager, and a 16-year old who thinks I am a loser. I was a teenager like that. Now she is having problems and becoming withdrawn there are fewer switches, because she knows we need to help the little one first. (Mary). Participants discussed their dissociative parts, their names and features, exhibiting neither avoidance nor fear or shame. On the contrary, they seemed to draw pleasure by smiling, showing excitement and eagerness to produce more examples of their unusual experiences. At the beginning of the interview, Karina was very enthusiastic and said, “My heart is beating so fast, as if I were in fight-or-flight mode.” Olga was also inspired by books. Not only did she find similarities to trauma survivors but she made new discoveries and thought there were other experiences she had been unaware of earlier. Victoria started using techniques which literature recommended for stabilization in dissociative disorders. She said these books helped her understand intense emotions and improve concentration. Theme 4: Talking About DID Attracts Attention Not only were multiple personalities a helpful metaphor for expressing conflicting feelings or needs (already mentioned in Theme 2), but they also became an important topic of conversations with family or friends. This explains everything that happens to me, why I get so angry. I also found anchors helpful. I focus on certain objects, sounds or smells which remind me where I am, instead of drifting away into my thoughts. (Victoria). My husband says sometimes: “I would like to talk to the little girl.” He then says that I start behaving differently. I also talk to my therapist using different voices. Sometimes, she addresses them asking questions. If questions are asked directly, they respond, but there are times I do not allow them to speak, because the teenager part can be very mean and attacks people. (Mary). It seemed that exploring information about DID encouraged changes in participants’ clinical presentation. At first, they merely struggled with emotional liability or detachment, internal conflicts, and concentration problems. Later, they started reporting intrusions of dissociative parts or using clinical terms (e.g., flashback) for experiences which were not necessarily clinical symptoms. Dominique said that the characters of her story would often ‘log in’ and take control. She demonstrated that during the interview by changing her voice and going into a ‘trance.’ She created her own metaphors, explaining these experiences and comparing them with those described in literature. She stressed that she never had amnesia and remained aware of what was happening during her ‘trance.’ It may have been easier for Mary to express her needs for dependency and care by ascribing them to a little girl and, because she felt awkward about feeling angry with the therapist, attributing hostile impulses to a teenager could give her a sense of control and reduce guilt. Karina decided to create a videoblog for documenting dissociative parts, and shared her videos with people interested in DID. She said she was surprised to find clips in which she looked dreadful, having her make-up smeared all over the face, because she had no memory of doing that. However, she showed no signs that it bothered her. She discussed the videos with her best friend, a DID fan who had encouraged her to enroll in the study in order to confirm her diagnosis. They were collecting evidence to support the idea that she had a dissociative disorder, which she presented one by one, before being asked about details. I think it is a form of dissociation on the emotional level. I read a lot. . . The minds of Billy Milligan or First person plural. For sure, I do not have an alteration of personality. I have co-consciousness. My theory is, we are like a glove, we all stem from one trunk, but we are like separate fingers. (Dominique). Mark [her friend] reads a lot about DID. He says I sometimes talk in a high voice which is not the way I usually talk. He refers to us as plural. [. . .] In some of these videos I do not move or blink While participants maintained they had flashbacks, they understood them as sudden recollections of past memories Frontiers in Psychology | www.frontiersin.org 7 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID for a minute. I look at some point and there is no expression on my face. I can remember things until this moment, and later I discover myself looking like something from Creepypastas. I am so sorry for people who have to see this. . . and I found my diary. I have been writing diaries since I was seven. I sometimes have no memory for having written something. I need to find these notes because I would like to write a book about a fantasy world and inner conflicts. (Karina). another possibility. It is some information but I have not heard anything new. (Karina). Only Victoria seemed relieved that her DID diagnosis was not confirmed. She was happy to discuss how attachment problems or conflicts with expressing emotions and needs affected her social life and career, and receive guidelines for future treatment. She felt liberated from having to uncover childhood traumas that her therapist expected her to have as a dissociative patient. Dominique and Katia also wrote journals to record dissociative experiences. Katia hoped to be recognized as an expert-by-experience and develop her career in relation to that. She brought with her a script of a book she hoped to publish 1 day. I was hoping that you would find another explanation for my problems. . . for what is wrong with me, why I feel so sensitive or spaced out, because it is annoying. I would like to know what is going on. I don’t think I’ve had any severe trauma but everybody wants to talk about trauma all the time. (Victoria). Theme 5: Ruling Out DID Leads to Disappointment or Anger DISCUSSION Four participants were openly disappointed that their DID diagnosis was not confirmed. They doubted if their descriptions were accurate enough, or they challenged the interviewer’s understanding of the symptoms. Katia also suggested that she was incapable of providing appropriate answers supporting her diagnosis due to amnesia and personality alterations. ICD-10 and DSM-5 provide inadequate criteria for diagnosing DID, basically limited to patients having distinct dissociative identities with their own memories, preferences and behavioral patterns, and episodes of amnesia (American Psychiatric Association, 2013; World Health Organization, 1993). Clinicians without experience of DID may therefore expect patients to present disruptions of identity during a consultation and spontaneously report memory problems. However, trauma specialists view DID as a ‘disorder of hiddenness’ because patients often find their dissociative symptoms bizarre and confusing and do not disclose them readily due to their shame and the phobia of inner experiences (Steele et al., 2005, 2016; Van der Hart et al., 2006). Instead, they tend to undermine their significance, hide them and not report them during consultations unless asked about them directly. Dissociative patients can also be unaware of their amnesia and ignore evidence for having done things they cannot remember because realizing that is too upsetting. Contrary to that, this study and the one conducted in 1999 in the Netherlands by Draijer and Boon, show that some people with personality disorders enthusiastically report DID symptoms by the book, and use the notion of multiple personalities to justify problems with emotional regulation, inner conflicts, or to seek attention. As with Dutch patients, Polish participants were preoccupied with their alternate personalities and two tried to present a ‘switch’ between parts. Their presentations were naïve and often mixed with lay information on DID. However, what they reported could be misleading for clinicians inexperienced in the dissociation field or those lacking the appropriate tools to distinguish a genuine dissociative disorder from an imitated one. Therefore, understanding the subtleties about DID clinical presentation, especially those which are not thoroughly described in psychiatric manuals, is important to come up with a correct diagnosis and treatment plan. Various clinicians stress the importance of understanding the quality of symptoms and the mechanisms behind them in order to distinguish on the phenomenological level between borderline and DID patients (Boon and Draijer, 1993; Laddis et al., 2017). Participants in this study reported problems with identity, affect regulation Do you even consider that I might give different answers if you had asked these questions 2 or 5 years ago? I must have erased some examples from my memory and not all experiences belong to me. I know that people can unconsciously modify their narratives and that is why I wanted an objective assessment. [. . .] Nobody believed I was resistant to anesthetics until I was diagnosed with some abnormalities. It was once written in my medical report that I was a hypochondriac. One signature and things become clear to everyone. Sometimes it is better to have the worst diagnosis, but have it. (Katia). She expected that the diagnosis would legitimize her inability to establish satisfactory relationships, work, and become financially independent. For this reason, she also insisted that the final report produced for her should contain information about how she felt maltreated by family or doctors, and revealed her hopes to claim damages for health injury. Mary and Karina were also upset that the interviewers did not believe they had DID. Can you try to imagine how hard it is? I am not making things up? You don’t believe me. I am telling you things and you must be thinking, from the adult perspective: “You are making this up.” Nothing pisses me off more than someone who is trying to prove to others that they have just imagined things. They [dissociative parts] feel neglected again, as always! (Mary). Karina tried to hide her disappointment and claimed she was glad she didn’t have a severe mental illness. However, she thought she would need to build another theory explaining her symptoms. After the interview, she sent more videos trying to prove the assessment results were not accurate. What about my problems then? I am unable to set boundaries, I have anxiety, I fear that a war might break out. If this is not dissociation, then what? I had tests and they ruled out any neurological problems. I came here and ruled out Frontiers in Psychology | www.frontiersin.org 8 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID dissociative parts which are stuck in trauma. In addition to avoidance, this is another characteristic PTSD feature observed in the clinical presentation of DID patients (Van der Hart et al., 2010). Interestingly, participants in this study showed no evidence for intrusions (images, emotions or somatosensory experiences directly related to trauma), but rather problems with emotional regulation (illustrated in sections “Themes 1 and 2”). Asked about intrusive images, emotions or thoughts, some gave examples of distressing thoughts attacking self-image and blaming for their behavior. This, however, was related to attachment problems and difficulties with self-soothing. They also revealed a tendency to indulge themselves in these auto-critical thoughts instead of actively avoiding them, which is often a case in dissociative patients. Some intrusions reported by DID patients are somatoform in nature and connected with dissociative parts stuck in trauma time (Pietkiewicz et al., 2018). Although three participants in this study had very high scores in SDQ-20 indicating that they may have a dissociative disorder (scores of 50–60 are common in DID), further interviews revealed that they aggravated their symptoms and, in fact, had low levels of somatoform dissociation. This shows that tests results should be interpreted with caution and clinicians should always ask patients for specific examples of the symptoms they report. and internal conflicts about expressing their impulses. Some of them also had somatic complaints. These symptoms are common in personality disorders and also in dissociative disorders, which are polysymptomatic by nature. However, the quality of these symptoms and psychological mechanisms behind them may be different. For a differential diagnosis, clinicians need to become familiar with the unique internal dynamics in people who have developed a structural dissociation of personality as a result of trauma. These patients try to cope with everyday life and avoid actively thinking about and discussing traumatic memories, or experiencing symptoms associated with them. Because of that avoidance, they find it challenging to talk about dissociative symptoms with a clinician. Besides experiencing fear of being labeled as insane and sent to hospital, there may be internal conflicts associated with disclosing information. For example, dissociative parts may forbid them to talk about symptoms or past experiences. This conflict can sometimes be indicated by facial expression, involuntary movements, spasms, and also felt by the clinician in his or her countertransference. In other words, it is not only what patients say about their experiences, but how they do this. Therapists’ observations and countertransference may help in assessing the quality of avoidance: How openly or easily do patients report symptoms or adverse life experiences? Is that associated with strong depersonalisation (detachment from feelings and sensations, being absent)? Is there evidence for internal conflicts, shame, fear or feeling blocked when talking about symptoms (often observed in facial expression, tone of voice)? Participants in this study were eager to talk about how others mistreated them and wanted to have that documented on paper. Difficult experiences in the past sometimes triggered intense emotions in them (anger, resentment, and deep sadness) but they did not avoid exploring and communicating these states. On the contrary, they eagerly shared an elaborate narrative of their sorrows and about their inner characters – the multiple personalities they were convinced they had. They became keen on DID and used a variety of resources to familiarize themselves with core symptoms. They also spontaneously reported them, as if they wanted to provide sound evidence about having DID and were ready to defend their diagnosis. Some planned their future based on it (an academic career, writing a book, or a film). During the interviews, it became clear that some perceived having an exotic diagnosis as an opportunity for seeking attention and feeling unique, exhibiting the drama of an ‘unseen child’ (see section “Theme 4”). Understanding a few of the symptoms identified in this study can be useful for differential diagnosis: intrusions, voices, switches, amnesia, use of language, depersonalisation. How they are presented by patients and interpreted by clinicians is important. Voices It is common for DID patients to experience auditory hallucinations (Dorahy et al., 2009; Longden et al., 2019). The voices usually belong to dissociative parts and comment on actions, express needs, likes and dislikes, and encourage self-mutilation. Subsequently, there may be conflicts between ‘voices,’ and the relationship with them is quite complex. Dorahy et al., 2009 observe that auditory hallucinations are more common in DID than in schizophrenia. In dissociative patients they are more complex and responsive, and already appear in childhood. Specifically, child voices are also to be expected in DID (97% in comparison to 6% in psychosis). None of our participants reported auditory hallucinations although one (Dominique) said she had imaginary friends from childhood. While this could sound like a dissociative experience, exploring their experiences showed she had a tendency to absorb herself in her fantasy world and vividly imagine characters in her story (see section “Theme 2”). Switches Literature also shows that it is uncommon for avoidant dissociative patients to present autonomous dissociative parts to a therapist before a good relationship has been established and the phobia for inner experiences reduced (Steele et al., 2005). Sudden switches between dissociative personalities may occur only when the patient is triggered and cannot exercise enough control to hide his or her symptoms. Two participants in this study (Dominique and Karina) tried to present ‘alternate personalities’ and they actually announced this would happen, so that the interviewer did not miss them. Later on, they could Intrusions Triggered by external or internal factors (memories or anything associated with trauma) dissociative patients tend to relive traumatic experiences. In other words, they have intrusive memories, emotions or sensorimotor sensations contained by Frontiers in Psychology | www.frontiersin.org 9 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID attacks to other parts, not-me (see: Dominique in section “Theme 2”). One might suspect it could be evidence for autonomous dissociative parts. However, these participants seem to have had unintegrated, unaccepted self-states and used the concept of DID to make meaning of their internal conflicts. In their narrative they maintained the first-person narrative. None of them provided sound evidence for extreme forms of depersonalisation, such as not feeling the body altogether or out-of-body experiences. There can be many reasons why people develop symptoms which resemble those typical of DID. Suggestions about a dissociative disorder made by healthcare providers can help people justify and explain inner conflicts or interpersonal problems. In this study several clinicians had suggested a dissociative disorder or DID to the patient. Literature on multiple personalities and therapy focused on them, and using expressions such as ‘parts’, ‘dissociating’, ‘switches,’ can also encourage demonstrating such symptoms. There are also secondary gains explained in this study, such as receiving attention and care. Draijer and Boon (1999) observe that people with borderline features justified shameful behavior and avoided responsibility by attributing their actions to ‘alter personalities.’ Such people can declare amnesia for their outbursts of anger, or hitting partners. Others explained their identity confusion and extreme emptiness using the DID model. All their participants reported emotional neglect and felt unseen in their childhood, so they adopted a new DID-patient identity to fill up inner emptiness (Draijer and Boon, 1999). Just like the participants in this study, they were angry when that diagnosis was disconfirmed during the assessment, as if the clinician had taken away something precious from them. This shows that communicating the results should be done with understanding, empathy and care. Patients and clinicians need to understand and discuss reasons for developing a DID-patient identity, its advantages and pitfalls. In countries where clinicians are less familiar with the dissociative pathology, there may be a greater risk for both falsenegative and false-positive DID diagnoses. The latter is caused by the growing popularity of that disorder in media and social networks. People who try to make meaning of their emotional conflicts, attachment problems and difficulties in establishing satisfactory relationships, may find the DID concept attractive. It is important that clinicians who rule out or disconfirm DID, also provide patients with friendly feedback that encourages using treatment for their actual problems. Nevertheless, this may still evoke strong reactions in patients whose feelings and needs have been neglected, rejected or invalidated by significant others. Disconfirming DID may be experienced by them as an attack, taking something away from them, or an indication that they lie. relate to what happened during the alleged switch (no amnesia), maintaining the first-person perspective (I was saying/doing). Contrary to that, dissociative patients experience much shame and fear of disclosing their internal parts (Draijer and Boon, 1999). If they become aware that switches had occurred, they try to make reasonable explanations for the intrusions of parts and unusual behavior (e.g., I must have been very tired and affected by the new medicine I am taking). Amnesia Dell (2006) mentions various indicators of amnesia in patients with DID. However, losing memory for unpleasant experiences may occur in different disorders, usually for behaviors evoking shame or guilt, or for actions under extreme stress (Laddis et al., 2017). All patients in this study had problems with emotional regulation and some said they could not remember what they said or did when they became very upset. With some priming, they could recall and describe events. For this reason, it is recommended to explore evidence for amnesia for pleasant or neutral activities (e.g., doing shopping or cleaning, socializing). According to Laddis et al. (2017) there are different mechanisms underlying memory problems in personality and dissociative disorders. Use of Language Participants in this study often used clinical jargon (e.g., flashbacks, switches, and feeling depersonalized) which indicates they had read about dissociative psychopathology or received psycho-education. However, they often had lay understanding of clinical terms. A good example in this study was having ‘flashbacks’ of neutral or pleasant situations which had once been forgotten. Examples of nightmares did not necessarily indicate reliving traumatic events during sleep (as in PTSD) but expressed conflicts and agitation through symbolic, unrealistic, sometimes upsetting dreams. When talking about behavior of other parts and their preferences, they often maintained a first-person perspective. Requesting patients to provide specific examples is thus crucial. Depersonalisation Detachment from feelings and emotions, bodily sensations and external reality is often present in various disorders (Simeon and Abugel, 2006). While these phenomena have been commonly associated with dissociation, Holmes et al. (2005) stress the differences between detachment (which can be experienced by both dissociative and non-dissociative patients) and compartmentalisation, associated with the existence of dissociative parts. Allen et al. (1999) also stress that extreme absorptive detachment can interfere with noticing feelings and bodily sensations, and also memory. Some participants in this study tended to enter trance-like states or get absorbed in their inner reality, subsequently getting detached from bodily sensations. They also described their feeling of emptiness in terms of detachment from feelings. Nevertheless, none of them disclosed evidence for having distinct dissociative parts. Some of their statements might have been misleading; for example, when they attributed anger Frontiers in Psychology | www.frontiersin.org Limitations and Further Directions Among the 85 people who participated in a thorough diagnostic assessment, there were six false-positive DID cases, and this study focused on their personal experiences and meaning attributed to the diagnosis. Because IPA studies are highly idiographic, 10 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID TABLE 4 | Red flags for identifying false-positive or imitated DID. This table enumerates suggestive features of false positive or imitated DID cases identified in this study, which should be taken into consideration during diagnostic assessment. 1. Directly or indirectly expects to confirm self-diagnosed DID. 2. DID previously suggested by someone (friend, psychologist, and doctor) without thorough clinical assessment. 3. Keen on DID diagnosis and familiarized with symptoms: read books, watched videos, talked to other patients, participated in a support group for dissociative patients. 4. Uses clinical jargon: parts, alters, dissociating, switch, depersonalisation, etc. 5. Reveals little avoidance: eagerly talks about painful experiences and dissociation, no indicators for genuine shame or inner conflicts associated with disclosing symptoms or parts. 6. Readily justifies losing control of emotions and unacceptable or shameful behavior in terms of not being oneself or being influenced by an alternative personality. 7. No evidence for the intrusions of unwanted and avoided traumatic memories or re-experiencing them in the present. 8. Denies having ego-dystonic thoughts or voices, especially starting in early childhood and child-like voices. Note: Dissociative patients may be afraid, ashamed, or feel it is forbidden to talk about the voices. 9. No evidence of amnesia for neutral or pleasant everyday activities, e.g., working, doing shopping, socializing, playing with children. 10. Tries to control the interview and provide evidence for having DID, e.g., eagerly reports dissociative symptoms without being asked about them. 11. Announces and performs a switch between personalities during clinical assessment, especially before a good relationship with the clinician and trust has been established. 12. Finds apparent gains associated with having DID: receives special interest from family and friends with whom symptoms and personalities are eagerly discussed, runs support groups, blogs or video channels for people with dissociative disorders. 13. Gets upset or disappointed when DID is not confirmed, e.g., demands re-evaluation, excuses oneself for not being accurate enough in giving right answers, wants to provide more evidence. which suggested it was probable they had a dissociative disorder. However, during a clinical diagnostic interview they did not report a cluster of somatoform or psychoform dissociative symptoms and did not meet criteria for any dissociative disorder diagnosis. Clinicians also need to go beyond the face value of a patient’s responses, ask for specific examples, and notice one’s own countertransference. Draijer and Boon (1999) observed that DID patients were often experienced by clinicians as very fragile, and exploring symptoms with people with personality disorders (who try to aggravate them and control the interview) can evoke tiredness or even irritability. It is important that clinicians understand their own responses and use them in the diagnostic process. While psycho-education is considered a crucial element in the initial treatment of dissociative disorders (Van der Hart et al., 2006; Howell, 2011; Steele et al., 2016), patients whose diagnosis has not been confirmed by a thorough diagnostic assessment should not be encouraged to develop knowledge about DID symptomatology, because this may affect their clinical presentation and how they make meaning of their problems. Subsequently, this may lead to a wrong diagnosis and treatment, which can become iatrogenic. they are by nature limited to a small number of participants. There were two important limitations in this research. Firstly, information about the level of psychoform symptoms has not been given, because the validation of the Polish instrument used for that purpose is not complete. Secondly, TADS-I used for collecting clinical data about trauma-related symptoms and dissociation has not been validated, either. Because there are no gold standards in Poland for diagnosing dissociative disorders, video-recordings of diagnostic interviews were carefully analyzed and discussed by all authors to agree upon the diagnosis. Taking this into consideration, further qualitative and quantitative research is recommended to formulate and validate more specific diagnostic criteria for DID and guidelines for the differential diagnosis. CONCLUSION Clinicians need to understand the complexity of DID symptoms and psychological mechanisms responsible for them in order to differentiate between genuine and imitated post-traumatic conditions. There are several features identified in this study which may indicate false-positive or imitated DID shown in Table 4, which should be taken into consideration during diagnostic assessment. In Poland, as in many countries, this requires more systematic training in diagnosis for psychiatrists and clinical psychologists in order to prevent under- and over-diagnosis of dissociative disorders, DID in particular. It is not uncommon that patients exaggerate on self-report questionnaires when they are invested in certain symptoms. In this study, all participants had scores above the cut-off score of 28 on the SDQ-20, a measure to assess somatoform dissociation, Frontiers in Psychology | www.frontiersin.org DATA AVAILABILITY STATEMENT The datasets generated for this study are not readily available because data contain highly sensitive clinical material, including medical data which cannot be shared according to local regulations. Requests to access the datasets should be directed to IP, ipietkiewicz@swps.edu.pl. 11 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID interviews and helped in literature review and manuscript preparation. RT performed psychiatric assessment and helped in data analysis and manuscript preparation. SB helped in data analysis and manuscript preparation. All authors contributed to the article and approved the submitted version. ETHICS STATEMENT The studies involving human participants were reviewed and approved by Ethical Review Board at the SWPS University of Social Sciences and Humanities. The patients/participants provided their written informed consent to participate in this study. FUNDING AUTHOR CONTRIBUTIONS Grant number 2016/22/E/HS6/00306 was obtained for the study “Interpretative phenomenological analysis of depersonalization and derealization in clinical and non-clinical groups.” IP collected qualitative data, performed the analysis, and prepared the manuscript. AB-N transcribed and analyzed the REFERENCES Leonard, D., Brann, S., and Tiller, J. (2005). Dissociative disorders: pathways to diagnosis, clinician attitudes and their impact. Aust. N. Z, J. Psychiatry 39, 940–946. doi: 10.1080/j.1440-1614.2005.01700.x Longden, E., Moskowitz, A., Dorahy, M. J., and Perona-Garcelán, S. (2019). Auditory Verbal Hallucinations: Prevalence, Phenomenology, and the Dissociation Hypothesis Psychosis, Trauma and Dissociation: Evolving Perspectives on Severe Psychopathology. (Hoboken, NJ: John Wiley & Sons Ltd.), 207–222. Nijenhuis, E., van der Hart, O., and Kruger, K. (2002). The psychometric characteristics of the traumatic experiences checklist (TEC): first findings among psychiatric outpatients. Clin. Psychol. Psychother. 9, 200–210. doi: 10. 1002/cpp.332 Pietkiewicz, I. J., Hełka, A., and Tomalski, R. (2018). Validity and reliability of the Polish online and pen-and-paper versions of the somatoform dissociation questionnaires (SDQ-20 and PSDQ-5). Eur. J. Trauma Dissociation 3, 23–31. doi: 10.1016/j.ejtd.2018.05.002 Pietkiewicz, I. J., and Smith, J. A. (2014). A practical guide to using interpretative phenomenological analysis in qualitative research psychology. Psychol. J. 20, 7–14. doi: 10.14691/CPPJ.20.1.7 Putnam, F. W., Guroff, J. J., Silberman, E. K., Barban, L., and Post, R. M. (1986). The clinical phenomenology of multiple personality disorder: review of 100 recent cases. J. Clin. Psychiatry 47, 285–293. Ross, C. A., Norton, G. R., and Wozney, K. (1989). Multiple personality disorder: an analysis of 236 cases. Can. J. Psychiatry 34, 413–418. doi: 10.1177/ 070674378903400509 Sar, V. (2011). Epidemiology of dissociative disorders: an overview. Epidemiol. Res. Int. 2011, 404538. doi: 10.1155/2011/404538 Simeon, D., and Abugel, J. (2006). Feeling Unreal. Depersonalization Disorder and the Loss of the Self. New York, NY: Oxford University Press. Smith, J. A., and Osborn, M. (2008). “Interpretative phenomenological analysis,” in Qualitative Psychology: A Practical Guide to Research Methods, ed. J. Smith (London: Sage), 53–80. Steele, K., Boon, S., and Van der Hart, O. (2016). Treating Trauma-Related Dissociation. A Practical, Integrative Approach. New York, NY: W. W. Norton & Company. Steele, K., Van Der Hart, O., and Nijenhuis, E. R. (2005). Phase-oriented treatment of structural dissociation in complex traumatization: overcoming traumarelated phobias. J. Trauma Dissociation 6, 11–53. Thomas, A. (2001). Factitious and malingered dissociative identity disorder: clinical features observed in 18 cases. J. Trauma Dissociation 2, 59–77. doi: 10.1300/J229v02n04_04 Van der Hart, O., Nijenhuis, E., and Steele, K. (2006). The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. London: W.W. Norton & Co. Van der Hart, O., Nijenhuis, E. R., and Solomon, R. (2010). Dissociation of the personality in complex trauma-related disorders and EMDR: theoretical considerations. J. EMDR Pract. Res. 4, 76–92. doi: 10.1891/1933-3196. 4.2.76 Allen, J. G., Console, D. A., and Lewis, L. (1999). Dissociative detachment and memory impairment: reversible amnesia or encoding failure? Compre. Psychiatry 40, 160–171. doi: 10.1016/S0010-440X(99)90121-9 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth Edn. Arlington, VA: American Psychiatric Publishing. Boon, S., and Draijer, N. (1993). The differentiation of patients with MPD or DDNOS from patients with a cluster B personality disorder. Dissociation 6, 126–135. Boon, S., and Matthess, H. (2017). Trauma and Dissociation Symptoms Interview (TADS-I), version 1.9. Boon, S. A., and Draijer, P. J. (1995). Screening en Diagnostiek van Dissociatieve Stoornissen. Lisse: Swets & Zeitlinger. Boysen, G. A., and VanBergen, A. (2014). Simulation of multiple personalities: a review of research comparing diagnosed and simulated dissociative identity disorder. Clin. Psychol. Rev. 34, 14–28. doi: 10.1016/j.cpr.2013.10.008 Brand, B. L., Webermann, A. R., and Frankel, A. S. (2016). Assessment of complex dissociative disorder patients and simulated dissociation in forensic contexts. Int. J. Law Psychiatry 49, 197–204. doi: 10.1016/j.ijlp.2016.10.006 Coons, P. M., and Milstein, V. (1994). Factitious or malingered multiple personality disorder: eleven cases. Dissociation 7, 81–85. Dell, P. F. (2006). A new model of dissociative identity disorder. Psychiatr. Clin. 29, 1–26. doi: 10.1016/j.psc.2005.10.013 Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., et al. (2014). Dissociative identity disorder: an empirical overview. Aust. N. Z. J. Psychiatry 48, 402–417. doi: 10.1177/0004867414527523 Dorahy, M. J., Shannon, C., Seagar, L., Corr, M., Stewart, K., Hanna, D., et al. (2009). Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history: similarities and differences. J. Nerv. Ment. Dis. 197, 892–898. doi: 10.1097/NMD.0b013e3181c299ea Draijer, N., and Boon, S. (1999). The imitation of dissociative identity disorder: patients at risk, therapists at risk. J. Psychiatry Law 27, 423–458. doi: 10.1177/ 009318539902700304 Friedl, M., Draijer, N., and De Jonge, P. (2000). Prevalence of dissociative disorders in psychiatric in−patients: the impact of study characteristics. Acta Psychiatr. Scand. 102, 423–428. doi: 10.1034/j.1600-0447.2000.102006423.x Holmes, E. A., Brown, R. J., Mansell, W., Fearon, R. P., Hunter, E. C., Frasquilho, F., et al. (2005). Are there two qualitatively distinct forms of dissociation? a review and some clinical implications. Clin. Psychol. Rev. 25, 1–23. Howell, E. F. (2011). Understanding and Treating Dissociative Identity Disorder: A Relational Approach. New York, NY: Routledge. International Society for the Study of Trauma and Dissociation (2011). Guidelines for treating dissociative identity disorder in adults, third revision. J. Trauma Dissociation 12, 115–187. doi: 10.1080/15299732.2011.537247 Laddis, A., Dell, P. F., and Korzekwa, M. (2017). Comparing the symptoms and mechanisms of “dissociation” in dissociative identity disorder and borderline personality disorder. J. Trauma Dissociation 18, 139–173. Frontiers in Psychology | www.frontiersin.org 12 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID World Health Organization (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization. Copyright © 2021 Pietkiewicz, Bańbura-Nowak, Tomalski and Boon. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Frontiers in Psychology | www.frontiersin.org 13 May 2021 | Volume 12 | Article 637929 ","I'm providing you with your source material. You will not be using any outside material. Your job is to answer questions about the material. What are the key points of this paper? ORIGINAL RESEARCH published: 06 May 2021 doi: 10.3389/fpsyg.2021.637929 Revisiting False-Positive and Imitated Dissociative Identity Disorder Igor Jacob Pietkiewicz* , Anna Bańbura-Nowak, Radosław Tomalski and Suzette Boon Research Centre for Trauma & Dissociation, SWPS University of Social Sciences and Humanities, Katowice, Poland Edited by: Hamed Ekhtiari, Laureate Institute for Brain Research, United States Reviewed by: Hosein Mohaddes Ardabili, Mashhad University of Medical Sciences, Iran Bo Bach, Psychiatry Region Zealand, Denmark *Correspondence: Igor Jacob Pietkiewicz ipietkiewicz@swps.edu.pl Specialty section: This article was submitted to Psychopathology, a section of the journal Frontiers in Psychology Received: 04 December 2020 Accepted: 14 April 2021 Published: 06 May 2021 Citation: Pietkiewicz IJ, Bańbura-Nowak A, Tomalski R and Boon S (2021) Revisiting False-Positive and Imitated Dissociative Identity Disorder. Front. Psychol. 12:637929. doi: 10.3389/fpsyg.2021.637929 ICD-10 and DSM-5 do not provide clear diagnosing guidelines for DID, making it difficult to distinguish ‘genuine’ DID from imitated or false-positive cases. This study explores meaning which patients with false-positive or imitated DID attributed to their diagnosis. 85 people who reported elevated levels of dissociative symptoms in SDQ20 participated in clinical assessment using the Trauma and Dissociation Symptoms Interview, followed by a psychiatric interview. The recordings of six women, whose earlier DID diagnosis was disconfirmed, were transcribed and subjected to interpretative phenomenological analysis. Five main themes were identified: (1) endorsement and identification with the diagnosis. (2) The notion of dissociative parts justifies identity confusion and conflicting ego-states. (3) Gaining knowledge about DID affects the clinical presentation. (4) Fragmented personality becomes an important discussion topic with others. (5) Ruling out DID leads to disappointment or anger. To avoid misdiagnoses, clinicians should receive more systematic training in the assessment of dissociative disorders, enabling them to better understand subtle differences in the quality of symptoms and how dissociative and non-dissociative patients report them. This would lead to a better understanding of how patients with and without a dissociative disorder report core dissociative symptoms. Some guidelines for a differential diagnosis are provided. Keywords: dissociative identity disorder (DID), false-positive cases, personality disorder, dissociation, differential diagnosis INTRODUCTION Multiple Personality Disorder (MPD) was first introduced in DSM-III in 1980 and re-named Dissociative Identity Disorder (DID) in subsequent editions of the diagnostic manual (American Psychiatric Association, 2013). Table 1 shows diagnostic criteria of this disorder in ICD-10, ICD11, and DSM-5. Some healthcare providers perceive it as fairly uncommon or associated with temporary trends (Brand et al., 2016). Even its description in ICD-10 (World Health Organization, 1993) starts with: “This disorder is rare, and controversy exists about the extent to which it is iatrogenic or culture-specific” (p. 160). Yet, according to the guidelines of the International Society for the Study of Trauma and Dissociation (International Society for the Study of Trauma and Dissociation, 2011), the prevalence of DID in the general population is estimated between 1 and 3%. The review of global studies on DID in clinical settings by Sar (2011) shows the rate from Frontiers in Psychology | www.frontiersin.org 1 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID TABLE 1 | Diagnostic criteria for dissociative identity disorder. ICD-10 Multiple personality disorder F44.81 (A) Two or more distinct personalities exist within the individual, only one being evident at a time. (B) Each personality has its own memories, preferences, and behavior patterns, and at some time (and recurrently) takes full control of the individual’s behavior. (C) There is inability to recall important personal information which is too extensive to be explained by ordinary forgetfulness. (D) The symptoms are not due to organic mental disorders (F00–F09) (e.g., in epileptic disorders) or to psychoactive substance-related disorders (F10–F19) (e.g., intoxication or withdrawal). ICD-11 Dissociative identity disorder 6B64 Dissociative identity disorder is characterized by disruption of identity in which there are two or more distinct personality states (dissociative identities) associated with marked discontinuities in the sense of self and agency. Each personality state includes its own pattern of experiencing, perceiving, conceiving, and relating to self, the body, and the environment. At least two distinct personality states recurrently take executive control of the individual’s consciousness and functioning in interacting with others or with the environment, such as in the performance of specific aspects of daily life such as parenting, or work, or in response to specific situations (e.g., those that are perceived as threatening). Changes in personality state are accompanied by related alterations in sensation, perception, affect, cognition, memory, motor control, and behavior. There are typically episodes of amnesia, which may be severe. The symptoms are not better explained by another mental, behavioral or neurodevelopmental disorder and are not due to the direct effects of a substance or medication on the central nervous system, including withdrawal effects, and are not due to a disease of the nervous system or a sleep-wake disorder. The symptoms result in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. DSM-5 Dissociative identity disorder 300.14 (A) Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual. (B) Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. (C) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (D) The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play. (E) The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures). a false positive diagnosis, which is unfavorable for the patient, because using treatment developed for DID with patients without autonomous dissociative parts may be inefficient or even reinforce their pathology. Authors who wrote about patients inappropriately diagnosed with this disorder used terms such as ‘malingering’ or ‘factitious’ DID (Coons and Milstein, 1994; Thomas, 2001). According to Draijer and Boon (1999), both labels imply that patients intentionally simulate symptoms, either for external gains (financial benefits or justification for one’s actions in court) or for other forms of gratification (e.g., interest from others), while in many cases their motivation is not fully conscious. Getting a DID diagnosis can also provide structure for inner chaos and incomprehensible experiences, and be associated with hope and belief it is real. On the other hand, diagnostic errors often result in inappropriate treatment plans and procedures. Already in 1995 Boon and Draijer stressed that a growing number of people self-diagnosed themselves based on information from literature and the Internet, and reported symptoms by the book during psychiatric or psychological assessment. Based on their observation of 36 patients in whom DID had been ruled out after applying the structured clinical interview SCID-D, these clinicians identified differences between genuine and imitated DID. They classified their participants into three groups: (1) borderline personality disorder, (2) histrionic personality disorder, or (3) persons with severe dissociative symptoms but not DID. Participants in that study reported symptoms similar to DID patients, including: amnesia (but only for unacceptable behavior), depersonalisation, derealisation, identity confusion, and identity alteration. However, they presented themselves and interacted with the therapist in very 0.4 to 14%. However, in studies using clinical diagnostic interviews among psychiatric in-patients, and in European studies these numbers were lower (Friedl et al., 2000). The discrepancies apparently depend on the sample, the methodology and diagnostic interviews used by researchers. Diagnosing complex dissociative disorders (DID or Other Specified Dissociative Disorder, OSDD) is challenging for several reasons. Firstly, patients present a lot of avoidance and rarely report dissociative symptoms spontaneously without direct questioning (Boon and Draijer, 1993; International Society for the Study of Trauma and Dissociation, 2011; Dorahy et al., 2014). In addition, standard mental state examination does not include these symptoms and healthcare professionals do not receive appropriate training in diagnosing dissociative disorders (Leonard et al., 2005). Secondly, complex dissociative disorders are polysymptomatic, and specialists would rather diagnose these patients with disorders more familiar to them from clinical practice, e.g., anxiety disorders, eating disorders, schizophrenia, or borderline personality disorder (Boon and Draijer, 1995; Dell, 2006; Brand et al., 2016). For these reasons, complex dissociative disorders are underdiagnosed and often mis-diagnosed. For example, 26.5–40.8% of DID patients would already have been diagnosed and treated for schizophrenia (Putnam et al., 1986; Ross et al., 1989). On the other hand, because there is so much information about DID in the media (Hollywood productions, interviews and testimonies published on YouTube, blogs), people who are confused about themselves and try to find an accurate diagnosis for themselves may learn about DID symptoms on the Internet, identify themselves with the disorder, and later (even unintentionally) report core symptoms in a very convincing way (Draijer and Boon, 1999). This presents a risk of making Frontiers in Psychology | www.frontiersin.org 2 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID different ways. While DID patients are usually reluctant to talk about their symptoms and experience their intrusions as shameful, people who imitated DID were eager to present their problems, sometimes in an exaggerated way, in an attempt to convince the clinician that they suffered from DID (Boon and Draijer, 1995; Draijer and Boon, 1999). Similar observations were expressed by Thomas (2001) saying that people with imitated DID can present their history chronologically, using the first person even when they are highly distressed or allegedly presenting an altered personality, and are comfortable with disclosing information about experiences of abuse. They can talk about intrusions of dissociative parts, hearing voices or difficulties controlling emotions, without shame. Unfortunately, ICD-10, ICD-11, and DSM-5 offer no specific guidelines on how to differentiate patients with personality disorders and dissociative disorders by the manner in which they report symptoms. There are also limited instruments to distinguish between false-positive and false-negative DID. From the clinical perspective, it is also crucial to understand the motives for being diagnosed with DID, and disappointment when this diagnosis is disconfirmed. Accurate assessment can contribute to developing appropriate psychotherapeutic procedures (Boon and Draijer, 1995; Draijer and Boon, 1999). Apart from observations already referred to earlier in this article, there are no qualitative analyses of false-positive DID cases in the past 20 years. Most research was quantitative and compared DID patients and simulators in terms of cognitive functions (Boysen and VanBergen, 2014). This interpretative phenomenological analysis is an idiographic study which explores personal experiences and meaning attributed to conflicting emotions and behaviors in six women who had previously been diagnosed with DID and referred to the Research Centre for Trauma and Dissociation for re-evaluation. It explores how they came to believe they have DID and what had led clinicians to assume that these patients could be suffering from this disorder. Procedure This study is part of a larger project examining alterations in consciousness and dissociative symptoms in clinical and non-clinical groups, held at the Research Centre for Trauma & Dissociation, financed by the National Science Centre, and approved by the Ethical Review Board at the SWPS University of Social Sciences & Humanities. Potential candidates enrolled themselves or were registered by healthcare providers via an application integrated with the website www.e-psyche.eu. They filled in demographic information and completed online tests, including: Somatoform Dissociation Questionnaire (SDQ-20, Pietkiewicz et al., 2018) and Trauma Experiences Checklist (Nijenhuis et al., 2002). Those with elevated SDQ-20 scores (above 28 points) or those referred for differential diagnosis were consulted and if dissociative symptoms were confirmed, they were invited to participate in an in-depth clinical assessment including a series of interviews, video-recorded and performed at the researcher’s office by the first author who is a psychotherapist and supervisor experienced in the dissociation field. In Poland, there are no gold standards for diagnosing dissociative disorders. The first interview was semi-structured, open-ended and explored the patient’s history, main complaints and motives for participation. It included questions such as: What made you participate in this study? What are your main difficulties or symptoms in daily life? What do you think caused them? Further questions were then asked to explore participants’ experiences and meaning-making. This was followed by the Trauma and Dissociation Symptoms Interview (TADS-I, Boon and Matthess, 2017). The TADS-I is a new semi-structured interview intended to identify DSM-5 and ICD-11 dissociative disorders. The TADS-I differs in several ways from other semi-structured interviews for the assessment of dissociative disorders. Firstly, it includes a significant section on somatoform dissociative symptoms. Secondly, it includes a section addressing other trauma-related symptoms for several reasons: (1) to obtain a more comprehensive clinical picture of possible comorbidities, including symptoms of PTSD and complex PTSD, (2) to gain a better insight into the (possible) dissociative organization of the personality: patient’s dissociative parts hold many of these comorbid symptoms and amnesia, voices or depersonalisation experiences are often associated with these symptoms; and (3) to better distinguish between complex dissociative disorders, personality disorders and other Axis I disorders and false positive DID. Finally, the TADS-I also aims to distinguish between symptoms of pathological dissociation indicating a division of the personality and symptoms which are related to a narrowing or a lowering of consciousness, and not to the structural dissociation of the personality. Validation testing of the TADS-I is currently underway. TADS interviews ranging from 2 to 4 h were usually held in sessions of 90 min. Interview recordings were assessed by three healthcare professionals experienced in the dissociation field, who discussed each case and consensually came up with a diagnosis based on ICD-10. An additional mental state examination was performed by the third author who is a psychiatrist, also experienced in the differential diagnosis of dissociative disorders. He collected medical data, double-checked the most important symptoms, communicated the results and discussed treatment indications. Qualitative data collected from MATERIALS AND METHODS This study was carried out in Poland in 2018 and 2019. Rich qualitative material collected during in-depth clinical assessments was subjected to the interpretative phenomenological analysis (IPA), a popular methodological framework in psychology for exploring people’s personal experiences and interpretations of phenomena (Smith and Osborn, 2008). IPA was selected to build a deeper understanding of how patients who endorsed and identified with dissociative identity disorder made sense of the diagnosis and what it meant for them to be classified as false-positive cases during reassessment. Interpretative phenomenological analysis uses phenomenological, hermeneutic, and idiographic principles. It employs ‘double hermeneutics,’ in which participants share their experiences and interpretations, followed by researchers trying to make sense and comment on these interpretations. IPA uses small, homogenous, purposefully selected samples, and data are carefully analyzed case-by-case (Smith and Osborn, 2008; Pietkiewicz and Smith, 2014). Frontiers in Psychology | www.frontiersin.org 3 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID who also developed the TADS-I. They are all mentors and trainers of the European Society for Trauma and Dissociation, with significant expertise in the assessment of post-traumatic conditions. The first co-investigator (AB) has a master’s degree in psychology and is a Ph.D. candidate. She is also a psychotherapist in training. All authors coded and discussed their understanding of data. Their understanding and interpretations of symptoms reported by participants were influenced by their background knowledge and experience in diagnosing and treating patients with personality disorders and dissociative disorders. six patients out of 85 were selected for this interpretative phenomenological analysis, based on the following criteria for inclusion, which could ensure a homogenous sample expected of IPA studies – (a) female, (b) previously diagnosed or referred to rule in/out DID, (c) endorsement and identification with DID, (d) dissociative disorder disconfirmed in the assessment. Interviews with every participant in this study ranged from 3 h 15 min to 7 h 20 min (mean: 6 h). Participants Participants of this IPA were six female patients aged between 22 and 42 years who were selected out of 86 people examined in a larger study exploring dissociation and alterations in consciousness in clinical and non-clinical groups. (Participants in the larger study met criteria of different diagnoses and seven among them had ‘genuine’ DID). These six patients did not meet DID criteria on the TADS-I interview but believed themselves that they qualified for that diagnosis. Four of them had higher education, two were secondary school graduates. All of them registered in the study by themselves hoping to confirm their diagnosis but two (Olga and Katia) were referred by psychiatrists, and the others by psychotherapists. All of them traveled from far away, which showed their strong motivation to participate in the assessment. Four had previously had psychiatric treatment and five had been in psychotherapy due to problems with emotional regulation and relationships. In the cases of Victoria and Dominique, psychotherapy involved working with dissociative parts. None of them recalled any physical or sexual abuse, but three (Dominique, Victoria, and Mary), following therapists’ suggestions, were trying to seek such traumatic memories to justify their diagnosis. They all felt emotionally neglected by carriers in childhood and emotionally abused by significant others. None of them reported symptoms indicating the existence of autonomous dissociative parts. None had symptoms indicating amnesia for daily events, but four declared not remembering single situations associated with conflicting emotions, shame, guilt, or conversations during which they were more focused on internal experiences rather than their interlocutors. None experienced PTSD symptoms (e.g., intrusive traumatic memories and avoidance), autoscopic phenomena (e.g., out-of-body experiences), or clinically significant somatoform symptoms. None had auditory verbal hallucinations but four intensely engaged in daydreaming and experienced imagined conversations as very real. All of them had been seeking information about DID in literature and the Internet. For more information about them see Table 2. Their names have been changed to protect their confidentiality. Data Analysis Verbatim transcriptions were made of all video recordings, which were analyzed together with researchers’ notes using qualitative data-analysis software – NVivo11. Consecutive analytical steps recommended for IPA were employed in the study (Pietkiewicz and Smith, 2014). For each interview, researchers watched the recording and carefully read the transcript several times. They individually made notes about body language, facial expressions, the content and language use, and wrote down their interpretative comments using the ‘annotation’ feature in NVivo10. Next, they categorized their notes into emergent themes by allocating descriptive labels (nodes). The team then compared and discussed their coding and interpretations. They analyzed connections between themes in each interview and between cases, and grouped themes according to conceptual similarities into main themes and sub-themes. Credibility Checks During each interview, participants were encouraged to give examples illustrating reported symptoms or experiences. Clarification questions were asked to negotiate the meaning participants wanted to convey. At the end of the interview, they were also asked questions to check that their responses were thorough. The researchers discussed each case thoroughly and also compared their interpretative notes to compare their understanding of the content and its meaning (the second hermeneutics). RESULTS Participants in this study explained how they concluded they were suffering from DID, developed knowledge about the syndrome and an identity of a DID patient, and how this affected their everyday life and relationships. Five salient themes appeared in all interviews, as listed in Table 3. Each theme is discussed and illustrated with verbatim excerpts from the interviews, in accordance with IPA principles. The Researchers Theme 1: Endorsement and Identification With the Diagnosis The principal investigator (IJP) is a psychotherapist, supervisor, and researcher in the field of community health psychology and clinical psychology. The second co-investigator (RT) is a psychiatrist, psychotherapist, and supervisor. The third coinvestigator (SB) is a clinical psychologist, psychotherapist, supervisor, and a consulting expert in forensic psychology, Frontiers in Psychology | www.frontiersin.org All six participants hoped to confirm they had DID. They read books and browsed the Internet seeking information about dissociation, and watched YouTube videos presenting people describing multiple personalities. Dominique, Victoria, Mary, 4 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID TABLE 2 | Study participants. Name Participant’s characteristics Victoria Age 22, single, lives with parents and younger brother. Stopped her studies after 3 years and was hospitalized in a psychiatric facility for a short period due to problems with emotions and relationships. Reports difficulties with recognizing and expressing emotions, emptiness, feels easily hurt and rejected, afraid of abandonment. Perceives herself as unimportant and worthless, sometimes cuts herself for emotional relief. Maintains superficial relationships, does not trust people; in childhood was frequently left alone with grandparents because her parents traveed; described her parents as setting high expectations, mother as getting easily upset and impulsive. No substance use. No history of physical or sexual trauma. Her maternal grandfather abused alcohol but was not violent; no history of suicides in her family. Scored 38 points in SDQ-20 but no significant somatoform symptoms reported during clinical assessment. Karina Age 22, single, secondary education. Enrolled in university programs twice but stopped. Acting is a hobby; recently worked as a waitress or hostess, currently unemployed. Has had psychiatric treatment for 17 years due to anxiety and problems in relationships. Two short hospital admissions; in psychodynamic psychotherapy in last 2 years. Reports emotional instability, feeling depressed, anxious, and lonely; maintains few relationships; experiences conflicts with expressing anger and needs for dependency, no self-harm. She had periods of using alcohol excessively in the past, currently once a month, no drugs. No family members used psychiatric help. Reports abandonment, emotional and physical abuse in childhood and eagerly talks about these experiences. Scored 68 points in SDQ-20 but no significant somatoform symptoms reported during clinical assessment. Dominique Age 33, higher education, married, three children. Works as a playwright, comes from an artistic family. Was given away to her grandparents as a baby and returned to parents and brothers when she was seven; often felt abandoned and neglected. She had learning difficulties and problems in relationships, mood regulation, auto-aggressive behavior, feelings of emptiness and loneliness. Denies using alcohol or drugs; at secondary school abused marihuana. Her paternal grandmother had psychosis, her father abused marihuana and mother was treated for depression. Reports poverty at home. No suicides in family. Often retreated into her fantasy world in which she developed a story about boys kept in a resocialisation center. Has had psychiatric treatment and counseling for 20 years. Scored 52 points in SDQ-20 but no somatoform symptoms confirmed during clinical assessment. Mary Age 34, higher education, married. Works in the creative industry and engaged in proselytic activities as an active Jehovah’s Witness (joined the organization 10 years earlier, encouraged by her mother). Has had EMDR therapy for 2 years due to problems maintaining relationships and managing anger. When her therapist asked if she felt there were different parts inside her, she started exploring information about DID. She denies smoking or using any drugs, alcohol. Mother suffered from mild depression. No suicides in family. Scored 48 points in SDQ-20 but no somatoform symptoms confirmed during clinical assessment. Olga Age 40, higher education, single. Works in social care. Reports depressive mood, low self-esteem, difficulties with concentration, problems with social contacts. Occasionally uses alcohol in small doses, no drugs. Describes her mother as demanding but also distant and negligent because she was busy with her medical practice. Father withdrawn and depressed but never used psychiatric treatment. No other trauma history. No suicides in family. Tried psychotherapy four times but usually terminated treatment after a while. Her psychiatrist referred her for evaluation of memory problems, and confirming DID. Scored 31 points in SDQ-20; confirms a few somatoform symptoms: headaches, symptoms associated with cystitis, detachment from bodily sensations. Katia Age 42, post-graduate education. Unemployed. On social benefits for 15 years due to neurological and pulmonary symptoms, complications after urological surgeries. Reports low self-esteem, self-loathing, problems in establishing or maintaining relationships, feeling lonely, rejected and not understood. Inclinations toward passive-aggressive behavior toward people representing authority, fatigue, insecurity about her financial situation. Reports no alcohol or drug use. Mother treated for depression. No suicides in family. Scored 69 points in SDQ-20; multiple somatic complaints associated with Lyme disease, describes mother as emotionally and physically abusive, and father as abandoning and unprotecting. Has never used psychotherapy; was referred for consultation by a psychiatrist after persuading him that she had DID symptoms. Participants names have been changed to protect their confidentiality. During an argument with my mother I felt as if some incredible force took control and I smashed the glass in the cabinet with my hand. It was like being under control of an alien force. I started reading about borderline and I thought I had it. I found a webpage about that and told my mother I should see a psychiatrist. I went for a consultation and told her my story. This lady said: “Child, you don’t have borderline, but multiple personality.” She wanted to keep me in the psychiatric unit but I did not agree to stay for observation. (Dominique). TABLE 3 | Salient themes identified during the interpretative phenomenological analysis. Theme 1: Endorsement and identification with the diagnosis Theme 2: Using the notion of dissociative parts to justify identity confusion and conflicting ego-states Theme 3: Gaining knowledge about DID affects the clinical presentation Theme 4: Fragmented personality becomes an important discussion topic with others Theme 5: Ruling out DID leads to disappointment or anger. This led Dominique to research the new diagnosis. Karina also said she was encouraged to seek information about DID, when a doctor suggested she might be suffering with it. When I was 11, I had problems at school and home. Other children made fun of me. My mom took me to a doctor and he said I had borderline, but later I was diagnosed with an anxiety disorder. That doctor also suggested I had DID and told me that I should read more about this diagnosis. (Karina). and Karina said that a mental health professional suggested this diagnosis to them. Dominique remembers consulting a psychiatrist when she was 15, because she had problems controlling anger at home or in public places. She initially found descriptions of borderline personality captured her experiences well enough, but a psychiatrist refuted the idea and recommended further diagnostics toward a dissociative disorder. However, the girl refused to go to hospital for observation. Frontiers in Psychology | www.frontiersin.org Victoria and Mary shared similar stories about psychotherapists suggesting the existence of dissociative parts, having readily accepted this new category as a good explanation 5 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID for aggressive impulses or problems with recalling situations evoking guilt or shame. Dominique and Victoria stressed, however, that, apart from feeling emotionally abandoned, they could not trace any significant traumas in their early childhoods, although therapists maintained that such events must be present in dissociative patients. different expectations. Whoever comes up front, then I have these ideas. (Dominique). Dominique neither had amnesia nor found evidence for leading separate lives and engaging herself in activities associated with her characters. She maintained her job as a playwright, and merely imagined alternative scenarios of her life, expressed by her inner heroes. In other parts of the interview, she referred to them as ‘voices inside,’ but admitted she never heard them acoustically. They were her own vivid thoughts representing different, conflicting opinions or impulses. Katia said she felt internally fragmented. There were times when she engaged in certain interests, knowledge and skills, but she later changed her goals. Fifteen years ago she gave up her academic career and went on sickness benefit when she became disabled due to medical problems; she experienced this as a great loss, a failure, which affected her sense of identity and purpose. I have no idea why I have this [DID]. My therapist looked for evidence of childhood trauma, which sounds like the easiest explanation, but I don’t feel I had any horrific memories which I threw out of my consciousness. (Victoria). Katia and Olga had used psychiatric treatment for anxiety and depression for years. After exploring information about different mental disorders they concluded they had DID. They thought there was a similarity between their personal experiences and those of people publishing testimonials about multiple personalities. In recent years I have a growing sense of identity fragmentation. I have problems with defining my identity because it changes. I used to feel more stable in the past. I had these versions of myself which were more dominating, so I had a stronger sense of identity. For example, 20 years ago there was this scientist. I was studying and felt like a scientist, attending conferences. Now I don’t have that and I don’t know who I am. [. . .] I also have changing interests and hobbies because of different personalities. Long ago I liked certain music, played the guitar, sang songs. I don’t do that anymore, I suddenly lost interest in all that. (Katia). I tried to understand this battle inside, leading me to stagnation. I didn’t know how to describe that but I recently bought a book Healing the fragmented selves of trauma survivors, and everything was explained there. Some of these things I have discovered myself and some were new to me. (Olga). Subsequently, Katia presented to her doctor a review of literature about DID, trying to persuade him that she had this disorder. Theme 2: Using the Notion of Dissociative Parts to Justify Identity Confusion and Conflicting Ego-States She described changes in her professional and social lives in terms of switches between dissociative parts. Although she maintained the first person narrative (“I was studying,” “I played,” or “I sang”), indicating some sense of continuity, she thought it proved the existence of two or more distinct personalities. Participants also reported thoughts, temptations, impulses or actions which seemed to evoke conflicting feelings. Attributing them to ‘something inside that is not-me’ could free them from guilt or shame, so they used a metaphor of someone taking over, logging in, or switching. Dominique thought it was inappropriate to express disappointment or anger, but she accepted the thought that her dissociative parts were doing this. Once participants had embraced the idea of having multiple personalities, they seemed to construct inner reality and justify conflicting needs, impulses or behaviors as an expression of dissociative parts. They referred to being uncertain about who they were and having difficulties recognizing personal emotions, needs or interests. Some of them felt it was connected to a negative cognition about themselves as worthless, unimportant, and not deserving to express what they felt or wanted. Victoria said she would rather define herself through the eyes of others: When I’m angry at my therapist, it is not really me but somebody inside who gets angry easily. Greg often switches on in such situations and says: “Tell her this and this”. [. . .] I went to a shop once and discovered that the price on the label was not for a whole package of batteries but a single one. And suddenly Greg switched on and had a row with the cashier. I mean, I did it, but wound up by his anger. This is so weird, I wouldn’t react like that. They just charged incorrectly and I would normally ignore that but Greg said: “I give a shit about their mistakes. I won’t accept that.” What a failure! (Dominique). My therapist asked what I wanted or needed. It turned out that without other people’s expectations or preferences to which I normally adjust, I wouldn’t know who I am or what I want. I usually engage in my friends’ hobbies and do what I think gives them pleasure. Otherwise, I think they will not like me and reject me, because I have nothing to offer. (Victoria). Since a young age, Dominique tended to immerse herself in a fantasy world, developing elaborated scenarios about people living in a youth center administered by a vicious boss. Different characters in her ‘Story’ represented specific features, interests and plans she had. Mary said she had parts that expressed anger, sadness, and needs associated with attachment. She observed them and allowed them to step in, when situations required. Well, there is John who is a teacher and researcher. He teaches mathematics. I have no skills in maths at all. Tim is a philosopher and would like to train philosophers, enroll doctoral studies. He would like me to study philosophy but the rest of the system wants me to be a worrier. Ralf is a caring nurse and would like to become a paramedic. It is difficult to reconcile all these Frontiers in Psychology | www.frontiersin.org There were situations in my life when the teenager must have been active. She protected me. She is ready to fight; I am not like that at all. I hate violence, and that teenager likes using force to protect me. [. . .] My therapist suggested I call her after this interview if I 6 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID but not necessarily related to trauma. Katia said she recently remembered the picture of the house and garden where she played as a child and associated these experiences with moments of joy. Karina also exemplified her flashbacks with ‘intrusions of happy memories’ which belonged to other personalities: do not feel well. I didn’t accept that but the [inner] girls got upset and told me I needed her help. They made me comply, so I agreed to call her if I do not feel well. It has always been like this. (Mary). During assessment, no participant provided evidence for the existence of autonomous dissociative parts. It seems that the inner characters described by them personified unintegrated egostates which used to evoke conflicting feelings. Sometimes I begin to laugh but this is not my laughter, but the laughter of sheer joy. Someone inside me is very happy and wants to talk about happy childhood memories, make jokes. (Karina). Theme 3: Exploring Personal Experiences via the Lens of Dissociation Mary said a child part of her was responsible for flashbacks and making comments about current situations. However, she later denied hearing voices or having any other Schneider’s symptoms. Reading books, websites and watching videos of people who claimed to have DID, encouraged them to compare themselves, talk about and express ‘multiple personalities.’ The participants became familiar with specialist terms and learned about core symptoms mentioned in psychiatric manuals. I can hear her comments, that she does not like something. I can be flooded by emotions and have flashbacks associated with that child. For example, there is a trigger and I can see things that this child has seen. She is showing me what was happening in her life. (Mary). I read First person plural which helped me understand what this is all about. The drama of the gifted child and The body keeps the score. More and more girls started to appear. There is a 6-month old baby which showed up only 2 months ago, a sad 11-year old teenager, and a 16-year old who thinks I am a loser. I was a teenager like that. Now she is having problems and becoming withdrawn there are fewer switches, because she knows we need to help the little one first. (Mary). Participants discussed their dissociative parts, their names and features, exhibiting neither avoidance nor fear or shame. On the contrary, they seemed to draw pleasure by smiling, showing excitement and eagerness to produce more examples of their unusual experiences. At the beginning of the interview, Karina was very enthusiastic and said, “My heart is beating so fast, as if I were in fight-or-flight mode.” Olga was also inspired by books. Not only did she find similarities to trauma survivors but she made new discoveries and thought there were other experiences she had been unaware of earlier. Victoria started using techniques which literature recommended for stabilization in dissociative disorders. She said these books helped her understand intense emotions and improve concentration. Theme 4: Talking About DID Attracts Attention Not only were multiple personalities a helpful metaphor for expressing conflicting feelings or needs (already mentioned in Theme 2), but they also became an important topic of conversations with family or friends. This explains everything that happens to me, why I get so angry. I also found anchors helpful. I focus on certain objects, sounds or smells which remind me where I am, instead of drifting away into my thoughts. (Victoria). My husband says sometimes: “I would like to talk to the little girl.” He then says that I start behaving differently. I also talk to my therapist using different voices. Sometimes, she addresses them asking questions. If questions are asked directly, they respond, but there are times I do not allow them to speak, because the teenager part can be very mean and attacks people. (Mary). It seemed that exploring information about DID encouraged changes in participants’ clinical presentation. At first, they merely struggled with emotional liability or detachment, internal conflicts, and concentration problems. Later, they started reporting intrusions of dissociative parts or using clinical terms (e.g., flashback) for experiences which were not necessarily clinical symptoms. Dominique said that the characters of her story would often ‘log in’ and take control. She demonstrated that during the interview by changing her voice and going into a ‘trance.’ She created her own metaphors, explaining these experiences and comparing them with those described in literature. She stressed that she never had amnesia and remained aware of what was happening during her ‘trance.’ It may have been easier for Mary to express her needs for dependency and care by ascribing them to a little girl and, because she felt awkward about feeling angry with the therapist, attributing hostile impulses to a teenager could give her a sense of control and reduce guilt. Karina decided to create a videoblog for documenting dissociative parts, and shared her videos with people interested in DID. She said she was surprised to find clips in which she looked dreadful, having her make-up smeared all over the face, because she had no memory of doing that. However, she showed no signs that it bothered her. She discussed the videos with her best friend, a DID fan who had encouraged her to enroll in the study in order to confirm her diagnosis. They were collecting evidence to support the idea that she had a dissociative disorder, which she presented one by one, before being asked about details. I think it is a form of dissociation on the emotional level. I read a lot. . . The minds of Billy Milligan or First person plural. For sure, I do not have an alteration of personality. I have co-consciousness. My theory is, we are like a glove, we all stem from one trunk, but we are like separate fingers. (Dominique). Mark [her friend] reads a lot about DID. He says I sometimes talk in a high voice which is not the way I usually talk. He refers to us as plural. [. . .] In some of these videos I do not move or blink While participants maintained they had flashbacks, they understood them as sudden recollections of past memories Frontiers in Psychology | www.frontiersin.org 7 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID for a minute. I look at some point and there is no expression on my face. I can remember things until this moment, and later I discover myself looking like something from Creepypastas. I am so sorry for people who have to see this. . . and I found my diary. I have been writing diaries since I was seven. I sometimes have no memory for having written something. I need to find these notes because I would like to write a book about a fantasy world and inner conflicts. (Karina). another possibility. It is some information but I have not heard anything new. (Karina). Only Victoria seemed relieved that her DID diagnosis was not confirmed. She was happy to discuss how attachment problems or conflicts with expressing emotions and needs affected her social life and career, and receive guidelines for future treatment. She felt liberated from having to uncover childhood traumas that her therapist expected her to have as a dissociative patient. Dominique and Katia also wrote journals to record dissociative experiences. Katia hoped to be recognized as an expert-by-experience and develop her career in relation to that. She brought with her a script of a book she hoped to publish 1 day. I was hoping that you would find another explanation for my problems. . . for what is wrong with me, why I feel so sensitive or spaced out, because it is annoying. I would like to know what is going on. I don’t think I’ve had any severe trauma but everybody wants to talk about trauma all the time. (Victoria). Theme 5: Ruling Out DID Leads to Disappointment or Anger DISCUSSION Four participants were openly disappointed that their DID diagnosis was not confirmed. They doubted if their descriptions were accurate enough, or they challenged the interviewer’s understanding of the symptoms. Katia also suggested that she was incapable of providing appropriate answers supporting her diagnosis due to amnesia and personality alterations. ICD-10 and DSM-5 provide inadequate criteria for diagnosing DID, basically limited to patients having distinct dissociative identities with their own memories, preferences and behavioral patterns, and episodes of amnesia (American Psychiatric Association, 2013; World Health Organization, 1993). Clinicians without experience of DID may therefore expect patients to present disruptions of identity during a consultation and spontaneously report memory problems. However, trauma specialists view DID as a ‘disorder of hiddenness’ because patients often find their dissociative symptoms bizarre and confusing and do not disclose them readily due to their shame and the phobia of inner experiences (Steele et al., 2005, 2016; Van der Hart et al., 2006). Instead, they tend to undermine their significance, hide them and not report them during consultations unless asked about them directly. Dissociative patients can also be unaware of their amnesia and ignore evidence for having done things they cannot remember because realizing that is too upsetting. Contrary to that, this study and the one conducted in 1999 in the Netherlands by Draijer and Boon, show that some people with personality disorders enthusiastically report DID symptoms by the book, and use the notion of multiple personalities to justify problems with emotional regulation, inner conflicts, or to seek attention. As with Dutch patients, Polish participants were preoccupied with their alternate personalities and two tried to present a ‘switch’ between parts. Their presentations were naïve and often mixed with lay information on DID. However, what they reported could be misleading for clinicians inexperienced in the dissociation field or those lacking the appropriate tools to distinguish a genuine dissociative disorder from an imitated one. Therefore, understanding the subtleties about DID clinical presentation, especially those which are not thoroughly described in psychiatric manuals, is important to come up with a correct diagnosis and treatment plan. Various clinicians stress the importance of understanding the quality of symptoms and the mechanisms behind them in order to distinguish on the phenomenological level between borderline and DID patients (Boon and Draijer, 1993; Laddis et al., 2017). Participants in this study reported problems with identity, affect regulation Do you even consider that I might give different answers if you had asked these questions 2 or 5 years ago? I must have erased some examples from my memory and not all experiences belong to me. I know that people can unconsciously modify their narratives and that is why I wanted an objective assessment. [. . .] Nobody believed I was resistant to anesthetics until I was diagnosed with some abnormalities. It was once written in my medical report that I was a hypochondriac. One signature and things become clear to everyone. Sometimes it is better to have the worst diagnosis, but have it. (Katia). She expected that the diagnosis would legitimize her inability to establish satisfactory relationships, work, and become financially independent. For this reason, she also insisted that the final report produced for her should contain information about how she felt maltreated by family or doctors, and revealed her hopes to claim damages for health injury. Mary and Karina were also upset that the interviewers did not believe they had DID. Can you try to imagine how hard it is? I am not making things up? You don’t believe me. I am telling you things and you must be thinking, from the adult perspective: “You are making this up.” Nothing pisses me off more than someone who is trying to prove to others that they have just imagined things. They [dissociative parts] feel neglected again, as always! (Mary). Karina tried to hide her disappointment and claimed she was glad she didn’t have a severe mental illness. However, she thought she would need to build another theory explaining her symptoms. After the interview, she sent more videos trying to prove the assessment results were not accurate. What about my problems then? I am unable to set boundaries, I have anxiety, I fear that a war might break out. If this is not dissociation, then what? I had tests and they ruled out any neurological problems. I came here and ruled out Frontiers in Psychology | www.frontiersin.org 8 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID dissociative parts which are stuck in trauma. In addition to avoidance, this is another characteristic PTSD feature observed in the clinical presentation of DID patients (Van der Hart et al., 2010). Interestingly, participants in this study showed no evidence for intrusions (images, emotions or somatosensory experiences directly related to trauma), but rather problems with emotional regulation (illustrated in sections “Themes 1 and 2”). Asked about intrusive images, emotions or thoughts, some gave examples of distressing thoughts attacking self-image and blaming for their behavior. This, however, was related to attachment problems and difficulties with self-soothing. They also revealed a tendency to indulge themselves in these auto-critical thoughts instead of actively avoiding them, which is often a case in dissociative patients. Some intrusions reported by DID patients are somatoform in nature and connected with dissociative parts stuck in trauma time (Pietkiewicz et al., 2018). Although three participants in this study had very high scores in SDQ-20 indicating that they may have a dissociative disorder (scores of 50–60 are common in DID), further interviews revealed that they aggravated their symptoms and, in fact, had low levels of somatoform dissociation. This shows that tests results should be interpreted with caution and clinicians should always ask patients for specific examples of the symptoms they report. and internal conflicts about expressing their impulses. Some of them also had somatic complaints. These symptoms are common in personality disorders and also in dissociative disorders, which are polysymptomatic by nature. However, the quality of these symptoms and psychological mechanisms behind them may be different. For a differential diagnosis, clinicians need to become familiar with the unique internal dynamics in people who have developed a structural dissociation of personality as a result of trauma. These patients try to cope with everyday life and avoid actively thinking about and discussing traumatic memories, or experiencing symptoms associated with them. Because of that avoidance, they find it challenging to talk about dissociative symptoms with a clinician. Besides experiencing fear of being labeled as insane and sent to hospital, there may be internal conflicts associated with disclosing information. For example, dissociative parts may forbid them to talk about symptoms or past experiences. This conflict can sometimes be indicated by facial expression, involuntary movements, spasms, and also felt by the clinician in his or her countertransference. In other words, it is not only what patients say about their experiences, but how they do this. Therapists’ observations and countertransference may help in assessing the quality of avoidance: How openly or easily do patients report symptoms or adverse life experiences? Is that associated with strong depersonalisation (detachment from feelings and sensations, being absent)? Is there evidence for internal conflicts, shame, fear or feeling blocked when talking about symptoms (often observed in facial expression, tone of voice)? Participants in this study were eager to talk about how others mistreated them and wanted to have that documented on paper. Difficult experiences in the past sometimes triggered intense emotions in them (anger, resentment, and deep sadness) but they did not avoid exploring and communicating these states. On the contrary, they eagerly shared an elaborate narrative of their sorrows and about their inner characters – the multiple personalities they were convinced they had. They became keen on DID and used a variety of resources to familiarize themselves with core symptoms. They also spontaneously reported them, as if they wanted to provide sound evidence about having DID and were ready to defend their diagnosis. Some planned their future based on it (an academic career, writing a book, or a film). During the interviews, it became clear that some perceived having an exotic diagnosis as an opportunity for seeking attention and feeling unique, exhibiting the drama of an ‘unseen child’ (see section “Theme 4”). Understanding a few of the symptoms identified in this study can be useful for differential diagnosis: intrusions, voices, switches, amnesia, use of language, depersonalisation. How they are presented by patients and interpreted by clinicians is important. Voices It is common for DID patients to experience auditory hallucinations (Dorahy et al., 2009; Longden et al., 2019). The voices usually belong to dissociative parts and comment on actions, express needs, likes and dislikes, and encourage self-mutilation. Subsequently, there may be conflicts between ‘voices,’ and the relationship with them is quite complex. Dorahy et al., 2009 observe that auditory hallucinations are more common in DID than in schizophrenia. In dissociative patients they are more complex and responsive, and already appear in childhood. Specifically, child voices are also to be expected in DID (97% in comparison to 6% in psychosis). None of our participants reported auditory hallucinations although one (Dominique) said she had imaginary friends from childhood. While this could sound like a dissociative experience, exploring their experiences showed she had a tendency to absorb herself in her fantasy world and vividly imagine characters in her story (see section “Theme 2”). Switches Literature also shows that it is uncommon for avoidant dissociative patients to present autonomous dissociative parts to a therapist before a good relationship has been established and the phobia for inner experiences reduced (Steele et al., 2005). Sudden switches between dissociative personalities may occur only when the patient is triggered and cannot exercise enough control to hide his or her symptoms. Two participants in this study (Dominique and Karina) tried to present ‘alternate personalities’ and they actually announced this would happen, so that the interviewer did not miss them. Later on, they could Intrusions Triggered by external or internal factors (memories or anything associated with trauma) dissociative patients tend to relive traumatic experiences. In other words, they have intrusive memories, emotions or sensorimotor sensations contained by Frontiers in Psychology | www.frontiersin.org 9 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID attacks to other parts, not-me (see: Dominique in section “Theme 2”). One might suspect it could be evidence for autonomous dissociative parts. However, these participants seem to have had unintegrated, unaccepted self-states and used the concept of DID to make meaning of their internal conflicts. In their narrative they maintained the first-person narrative. None of them provided sound evidence for extreme forms of depersonalisation, such as not feeling the body altogether or out-of-body experiences. There can be many reasons why people develop symptoms which resemble those typical of DID. Suggestions about a dissociative disorder made by healthcare providers can help people justify and explain inner conflicts or interpersonal problems. In this study several clinicians had suggested a dissociative disorder or DID to the patient. Literature on multiple personalities and therapy focused on them, and using expressions such as ‘parts’, ‘dissociating’, ‘switches,’ can also encourage demonstrating such symptoms. There are also secondary gains explained in this study, such as receiving attention and care. Draijer and Boon (1999) observe that people with borderline features justified shameful behavior and avoided responsibility by attributing their actions to ‘alter personalities.’ Such people can declare amnesia for their outbursts of anger, or hitting partners. Others explained their identity confusion and extreme emptiness using the DID model. All their participants reported emotional neglect and felt unseen in their childhood, so they adopted a new DID-patient identity to fill up inner emptiness (Draijer and Boon, 1999). Just like the participants in this study, they were angry when that diagnosis was disconfirmed during the assessment, as if the clinician had taken away something precious from them. This shows that communicating the results should be done with understanding, empathy and care. Patients and clinicians need to understand and discuss reasons for developing a DID-patient identity, its advantages and pitfalls. In countries where clinicians are less familiar with the dissociative pathology, there may be a greater risk for both falsenegative and false-positive DID diagnoses. The latter is caused by the growing popularity of that disorder in media and social networks. People who try to make meaning of their emotional conflicts, attachment problems and difficulties in establishing satisfactory relationships, may find the DID concept attractive. It is important that clinicians who rule out or disconfirm DID, also provide patients with friendly feedback that encourages using treatment for their actual problems. Nevertheless, this may still evoke strong reactions in patients whose feelings and needs have been neglected, rejected or invalidated by significant others. Disconfirming DID may be experienced by them as an attack, taking something away from them, or an indication that they lie. relate to what happened during the alleged switch (no amnesia), maintaining the first-person perspective (I was saying/doing). Contrary to that, dissociative patients experience much shame and fear of disclosing their internal parts (Draijer and Boon, 1999). If they become aware that switches had occurred, they try to make reasonable explanations for the intrusions of parts and unusual behavior (e.g., I must have been very tired and affected by the new medicine I am taking). Amnesia Dell (2006) mentions various indicators of amnesia in patients with DID. However, losing memory for unpleasant experiences may occur in different disorders, usually for behaviors evoking shame or guilt, or for actions under extreme stress (Laddis et al., 2017). All patients in this study had problems with emotional regulation and some said they could not remember what they said or did when they became very upset. With some priming, they could recall and describe events. For this reason, it is recommended to explore evidence for amnesia for pleasant or neutral activities (e.g., doing shopping or cleaning, socializing). According to Laddis et al. (2017) there are different mechanisms underlying memory problems in personality and dissociative disorders. Use of Language Participants in this study often used clinical jargon (e.g., flashbacks, switches, and feeling depersonalized) which indicates they had read about dissociative psychopathology or received psycho-education. However, they often had lay understanding of clinical terms. A good example in this study was having ‘flashbacks’ of neutral or pleasant situations which had once been forgotten. Examples of nightmares did not necessarily indicate reliving traumatic events during sleep (as in PTSD) but expressed conflicts and agitation through symbolic, unrealistic, sometimes upsetting dreams. When talking about behavior of other parts and their preferences, they often maintained a first-person perspective. Requesting patients to provide specific examples is thus crucial. Depersonalisation Detachment from feelings and emotions, bodily sensations and external reality is often present in various disorders (Simeon and Abugel, 2006). While these phenomena have been commonly associated with dissociation, Holmes et al. (2005) stress the differences between detachment (which can be experienced by both dissociative and non-dissociative patients) and compartmentalisation, associated with the existence of dissociative parts. Allen et al. (1999) also stress that extreme absorptive detachment can interfere with noticing feelings and bodily sensations, and also memory. Some participants in this study tended to enter trance-like states or get absorbed in their inner reality, subsequently getting detached from bodily sensations. They also described their feeling of emptiness in terms of detachment from feelings. Nevertheless, none of them disclosed evidence for having distinct dissociative parts. Some of their statements might have been misleading; for example, when they attributed anger Frontiers in Psychology | www.frontiersin.org Limitations and Further Directions Among the 85 people who participated in a thorough diagnostic assessment, there were six false-positive DID cases, and this study focused on their personal experiences and meaning attributed to the diagnosis. Because IPA studies are highly idiographic, 10 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID TABLE 4 | Red flags for identifying false-positive or imitated DID. This table enumerates suggestive features of false positive or imitated DID cases identified in this study, which should be taken into consideration during diagnostic assessment. 1. Directly or indirectly expects to confirm self-diagnosed DID. 2. DID previously suggested by someone (friend, psychologist, and doctor) without thorough clinical assessment. 3. Keen on DID diagnosis and familiarized with symptoms: read books, watched videos, talked to other patients, participated in a support group for dissociative patients. 4. Uses clinical jargon: parts, alters, dissociating, switch, depersonalisation, etc. 5. Reveals little avoidance: eagerly talks about painful experiences and dissociation, no indicators for genuine shame or inner conflicts associated with disclosing symptoms or parts. 6. Readily justifies losing control of emotions and unacceptable or shameful behavior in terms of not being oneself or being influenced by an alternative personality. 7. No evidence for the intrusions of unwanted and avoided traumatic memories or re-experiencing them in the present. 8. Denies having ego-dystonic thoughts or voices, especially starting in early childhood and child-like voices. Note: Dissociative patients may be afraid, ashamed, or feel it is forbidden to talk about the voices. 9. No evidence of amnesia for neutral or pleasant everyday activities, e.g., working, doing shopping, socializing, playing with children. 10. Tries to control the interview and provide evidence for having DID, e.g., eagerly reports dissociative symptoms without being asked about them. 11. Announces and performs a switch between personalities during clinical assessment, especially before a good relationship with the clinician and trust has been established. 12. Finds apparent gains associated with having DID: receives special interest from family and friends with whom symptoms and personalities are eagerly discussed, runs support groups, blogs or video channels for people with dissociative disorders. 13. Gets upset or disappointed when DID is not confirmed, e.g., demands re-evaluation, excuses oneself for not being accurate enough in giving right answers, wants to provide more evidence. which suggested it was probable they had a dissociative disorder. However, during a clinical diagnostic interview they did not report a cluster of somatoform or psychoform dissociative symptoms and did not meet criteria for any dissociative disorder diagnosis. Clinicians also need to go beyond the face value of a patient’s responses, ask for specific examples, and notice one’s own countertransference. Draijer and Boon (1999) observed that DID patients were often experienced by clinicians as very fragile, and exploring symptoms with people with personality disorders (who try to aggravate them and control the interview) can evoke tiredness or even irritability. It is important that clinicians understand their own responses and use them in the diagnostic process. While psycho-education is considered a crucial element in the initial treatment of dissociative disorders (Van der Hart et al., 2006; Howell, 2011; Steele et al., 2016), patients whose diagnosis has not been confirmed by a thorough diagnostic assessment should not be encouraged to develop knowledge about DID symptomatology, because this may affect their clinical presentation and how they make meaning of their problems. Subsequently, this may lead to a wrong diagnosis and treatment, which can become iatrogenic. they are by nature limited to a small number of participants. There were two important limitations in this research. Firstly, information about the level of psychoform symptoms has not been given, because the validation of the Polish instrument used for that purpose is not complete. Secondly, TADS-I used for collecting clinical data about trauma-related symptoms and dissociation has not been validated, either. Because there are no gold standards in Poland for diagnosing dissociative disorders, video-recordings of diagnostic interviews were carefully analyzed and discussed by all authors to agree upon the diagnosis. Taking this into consideration, further qualitative and quantitative research is recommended to formulate and validate more specific diagnostic criteria for DID and guidelines for the differential diagnosis. CONCLUSION Clinicians need to understand the complexity of DID symptoms and psychological mechanisms responsible for them in order to differentiate between genuine and imitated post-traumatic conditions. There are several features identified in this study which may indicate false-positive or imitated DID shown in Table 4, which should be taken into consideration during diagnostic assessment. In Poland, as in many countries, this requires more systematic training in diagnosis for psychiatrists and clinical psychologists in order to prevent under- and over-diagnosis of dissociative disorders, DID in particular. It is not uncommon that patients exaggerate on self-report questionnaires when they are invested in certain symptoms. In this study, all participants had scores above the cut-off score of 28 on the SDQ-20, a measure to assess somatoform dissociation, Frontiers in Psychology | www.frontiersin.org DATA AVAILABILITY STATEMENT The datasets generated for this study are not readily available because data contain highly sensitive clinical material, including medical data which cannot be shared according to local regulations. Requests to access the datasets should be directed to IP, ipietkiewicz@swps.edu.pl. 11 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID interviews and helped in literature review and manuscript preparation. RT performed psychiatric assessment and helped in data analysis and manuscript preparation. SB helped in data analysis and manuscript preparation. All authors contributed to the article and approved the submitted version. ETHICS STATEMENT The studies involving human participants were reviewed and approved by Ethical Review Board at the SWPS University of Social Sciences and Humanities. The patients/participants provided their written informed consent to participate in this study. FUNDING AUTHOR CONTRIBUTIONS Grant number 2016/22/E/HS6/00306 was obtained for the study “Interpretative phenomenological analysis of depersonalization and derealization in clinical and non-clinical groups.” IP collected qualitative data, performed the analysis, and prepared the manuscript. AB-N transcribed and analyzed the REFERENCES Leonard, D., Brann, S., and Tiller, J. (2005). Dissociative disorders: pathways to diagnosis, clinician attitudes and their impact. Aust. N. Z, J. Psychiatry 39, 940–946. doi: 10.1080/j.1440-1614.2005.01700.x Longden, E., Moskowitz, A., Dorahy, M. J., and Perona-Garcelán, S. (2019). Auditory Verbal Hallucinations: Prevalence, Phenomenology, and the Dissociation Hypothesis Psychosis, Trauma and Dissociation: Evolving Perspectives on Severe Psychopathology. (Hoboken, NJ: John Wiley & Sons Ltd.), 207–222. Nijenhuis, E., van der Hart, O., and Kruger, K. (2002). The psychometric characteristics of the traumatic experiences checklist (TEC): first findings among psychiatric outpatients. Clin. Psychol. Psychother. 9, 200–210. doi: 10. 1002/cpp.332 Pietkiewicz, I. J., Hełka, A., and Tomalski, R. (2018). Validity and reliability of the Polish online and pen-and-paper versions of the somatoform dissociation questionnaires (SDQ-20 and PSDQ-5). Eur. J. Trauma Dissociation 3, 23–31. doi: 10.1016/j.ejtd.2018.05.002 Pietkiewicz, I. J., and Smith, J. A. (2014). A practical guide to using interpretative phenomenological analysis in qualitative research psychology. Psychol. J. 20, 7–14. doi: 10.14691/CPPJ.20.1.7 Putnam, F. W., Guroff, J. J., Silberman, E. K., Barban, L., and Post, R. M. (1986). The clinical phenomenology of multiple personality disorder: review of 100 recent cases. J. Clin. Psychiatry 47, 285–293. Ross, C. A., Norton, G. R., and Wozney, K. (1989). Multiple personality disorder: an analysis of 236 cases. Can. J. Psychiatry 34, 413–418. doi: 10.1177/ 070674378903400509 Sar, V. (2011). Epidemiology of dissociative disorders: an overview. Epidemiol. Res. Int. 2011, 404538. doi: 10.1155/2011/404538 Simeon, D., and Abugel, J. (2006). Feeling Unreal. Depersonalization Disorder and the Loss of the Self. New York, NY: Oxford University Press. Smith, J. A., and Osborn, M. (2008). “Interpretative phenomenological analysis,” in Qualitative Psychology: A Practical Guide to Research Methods, ed. J. Smith (London: Sage), 53–80. Steele, K., Boon, S., and Van der Hart, O. (2016). Treating Trauma-Related Dissociation. A Practical, Integrative Approach. New York, NY: W. W. Norton & Company. Steele, K., Van Der Hart, O., and Nijenhuis, E. R. (2005). Phase-oriented treatment of structural dissociation in complex traumatization: overcoming traumarelated phobias. J. Trauma Dissociation 6, 11–53. Thomas, A. (2001). Factitious and malingered dissociative identity disorder: clinical features observed in 18 cases. J. Trauma Dissociation 2, 59–77. doi: 10.1300/J229v02n04_04 Van der Hart, O., Nijenhuis, E., and Steele, K. (2006). The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. London: W.W. Norton & Co. Van der Hart, O., Nijenhuis, E. R., and Solomon, R. (2010). Dissociation of the personality in complex trauma-related disorders and EMDR: theoretical considerations. J. EMDR Pract. Res. 4, 76–92. doi: 10.1891/1933-3196. 4.2.76 Allen, J. G., Console, D. A., and Lewis, L. (1999). Dissociative detachment and memory impairment: reversible amnesia or encoding failure? Compre. Psychiatry 40, 160–171. doi: 10.1016/S0010-440X(99)90121-9 American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth Edn. Arlington, VA: American Psychiatric Publishing. Boon, S., and Draijer, N. (1993). The differentiation of patients with MPD or DDNOS from patients with a cluster B personality disorder. Dissociation 6, 126–135. Boon, S., and Matthess, H. (2017). Trauma and Dissociation Symptoms Interview (TADS-I), version 1.9. Boon, S. A., and Draijer, P. J. (1995). Screening en Diagnostiek van Dissociatieve Stoornissen. Lisse: Swets & Zeitlinger. Boysen, G. A., and VanBergen, A. (2014). Simulation of multiple personalities: a review of research comparing diagnosed and simulated dissociative identity disorder. Clin. Psychol. Rev. 34, 14–28. doi: 10.1016/j.cpr.2013.10.008 Brand, B. L., Webermann, A. R., and Frankel, A. S. (2016). Assessment of complex dissociative disorder patients and simulated dissociation in forensic contexts. Int. J. Law Psychiatry 49, 197–204. doi: 10.1016/j.ijlp.2016.10.006 Coons, P. M., and Milstein, V. (1994). Factitious or malingered multiple personality disorder: eleven cases. Dissociation 7, 81–85. Dell, P. F. (2006). A new model of dissociative identity disorder. Psychiatr. Clin. 29, 1–26. doi: 10.1016/j.psc.2005.10.013 Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., et al. (2014). Dissociative identity disorder: an empirical overview. Aust. N. Z. J. Psychiatry 48, 402–417. doi: 10.1177/0004867414527523 Dorahy, M. J., Shannon, C., Seagar, L., Corr, M., Stewart, K., Hanna, D., et al. (2009). Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history: similarities and differences. J. Nerv. Ment. Dis. 197, 892–898. doi: 10.1097/NMD.0b013e3181c299ea Draijer, N., and Boon, S. (1999). The imitation of dissociative identity disorder: patients at risk, therapists at risk. J. Psychiatry Law 27, 423–458. doi: 10.1177/ 009318539902700304 Friedl, M., Draijer, N., and De Jonge, P. (2000). Prevalence of dissociative disorders in psychiatric in−patients: the impact of study characteristics. Acta Psychiatr. Scand. 102, 423–428. doi: 10.1034/j.1600-0447.2000.102006423.x Holmes, E. A., Brown, R. J., Mansell, W., Fearon, R. P., Hunter, E. C., Frasquilho, F., et al. (2005). Are there two qualitatively distinct forms of dissociation? a review and some clinical implications. Clin. Psychol. Rev. 25, 1–23. Howell, E. F. (2011). Understanding and Treating Dissociative Identity Disorder: A Relational Approach. New York, NY: Routledge. International Society for the Study of Trauma and Dissociation (2011). Guidelines for treating dissociative identity disorder in adults, third revision. J. Trauma Dissociation 12, 115–187. doi: 10.1080/15299732.2011.537247 Laddis, A., Dell, P. F., and Korzekwa, M. (2017). Comparing the symptoms and mechanisms of “dissociation” in dissociative identity disorder and borderline personality disorder. J. Trauma Dissociation 18, 139–173. Frontiers in Psychology | www.frontiersin.org 12 May 2021 | Volume 12 | Article 637929 Pietkiewicz et al. Revisiting False-Positive and Imitated DID World Health Organization (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization. Copyright © 2021 Pietkiewicz, Bańbura-Nowak, Tomalski and Boon. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Conflict of Interest: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Frontiers in Psychology | www.frontiersin.org 13 May 2021 | Volume 12 | Article 637929 ",Medical,Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",My aunt currently lives in Germany. She said they have so many protesters and they always interfere with regular public activities. I heard there was an issue with the German courts and the protestors. Can you tell me more about the situation? Specifically what happened and how the Germany courts responded? I believe it was something along the lines of they got sued. Give me more than 400 words.,"Journalists file complaint with Germany constitutional court over phone wiretappingNewsMartin Kraft, CC BY-SA 3.0, via Wikimedia Commons Journalists file complaint with Germany constitutional court over phone wiretapping Salma Ben Mariem | Faculty of Law and Political Science of Sousse, TN September 12, 2024 01:42:34 pm Three journalist organizations filed a complaint against German authorities with the country’s Federal Constitutional Court, local media reported on Wednesday. The complaint concerns investigators’ wiretapping of phone calls between journalists and climate activists. This constitutional complaint follows two previous verdicts issued by Munich’s District Court and Munich’s Regional Court. The three associations that filed the complaint are the Bavarian Journalists Association (BJV), Reporters Without Borders (RSF) and the Society for Civil Rights (GFF). They claimed that investigators illegally listened to phone conversations between journalists and members of the group the Last Generation (Letzte Generation). They argued that this measure constituted a violation of press freedom and a threat to democracy. The Last Generation is a group of climate activists who use direct action methods such as traffic blockades and vandalism of buildings, private boats and planes to protest against and raise awareness of climate change. According to a press release published by the GFF, the Munich prosecutor’s office surveilled the phone line provided by the Last Generation to receive journalist inquiries. The surveillance lasted for months and affected 171 journalists who were not informed by authorities of this investigative measure. Consequently, the three journalist’s associations filed a first complaint to Munich’s District Court which ruled that the surveillance measure was lawful. The associations filed a second complaint to Munich’s Regional Court which saw the wiretapping of phone calls as “a profound interference with press freedom.” However, the court considered that the surveillance measure was “proportionate” and rejected the complaint because of an ongoing investigation at the time against seven Last Generation activists over suspicion of supporting a criminal organization. This accusation was denied by the environmental group. The Chairman of the BJV Harald Stocker criticized both rulings and stated in a press release that before approving a wiretapping operation, judges needed to weigh up the interference with press freedom. He explained, “If judges authorize the recording of confidential conversations with journalists, they must first exhaust other options and carefully examine and justify the benefits.” He also added, regarding the Regional Court’s verdict, that it wasn’t sufficient to recognize several months later that the wiretapping operation constituted an interference with press freedom and at the same time uphold the measure as lawful. Furthermore, the BJV Managing Director Dennis Amour described the surveillance of journalists’ phone conversations as a “disproportionate” measure that the courts shouldn’t use to circumvent the protection of reporters bound by professional secrecy. By raising this complaint, the concerned journalists want to ensure that in the future, all courts carefully consider the impact on press freedom and provide a documented assessment of alternatives before approving any surveillance measures. As environmental protests escalated in many European countries, a July Human Rights Watch report revealed that governments have also intensified suppressive measures to quell activists’ dissent."," Only use the provided text to answer the question, no outside sources. My aunt currently lives in Germany. She said they have so many protesters and they always interfere with regular public activities. I heard there was an issue with the German courts and the protestors. Can you tell me more about the situation? Specifically what happened and how the Germany courts responded? I believe it was something along the lines of they got sued. Give me more than 400 words. Journalists file complaint with Germany constitutional court over phone wiretappingNewsMartin Kraft, CC BY-SA 3.0, via Wikimedia Commons Journalists file complaint with Germany constitutional court over phone wiretapping Salma Ben Mariem | Faculty of Law and Political Science of Sousse, TN September 12, 2024 01:42:34 pm Three journalist organizations filed a complaint against German authorities with the country’s Federal Constitutional Court, local media reported on Wednesday. The complaint concerns investigators’ wiretapping of phone calls between journalists and climate activists. This constitutional complaint follows two previous verdicts issued by Munich’s District Court and Munich’s Regional Court. The three associations that filed the complaint are the Bavarian Journalists Association (BJV), Reporters Without Borders (RSF) and the Society for Civil Rights (GFF). They claimed that investigators illegally listened to phone conversations between journalists and members of the group the Last Generation (Letzte Generation). They argued that this measure constituted a violation of press freedom and a threat to democracy. The Last Generation is a group of climate activists who use direct action methods such as traffic blockades and vandalism of buildings, private boats and planes to protest against and raise awareness of climate change. According to a press release published by the GFF, the Munich prosecutor’s office surveilled the phone line provided by the Last Generation to receive journalist inquiries. The surveillance lasted for months and affected 171 journalists who were not informed by authorities of this investigative measure. Consequently, the three journalist’s associations filed a first complaint to Munich’s District Court which ruled that the surveillance measure was lawful. The associations filed a second complaint to Munich’s Regional Court which saw the wiretapping of phone calls as “a profound interference with press freedom.” However, the court considered that the surveillance measure was “proportionate” and rejected the complaint because of an ongoing investigation at the time against seven Last Generation activists over suspicion of supporting a criminal organization. This accusation was denied by the environmental group. The Chairman of the BJV Harald Stocker criticized both rulings and stated in a press release that before approving a wiretapping operation, judges needed to weigh up the interference with press freedom. He explained, “If judges authorize the recording of confidential conversations with journalists, they must first exhaust other options and carefully examine and justify the benefits.” He also added, regarding the Regional Court’s verdict, that it wasn’t sufficient to recognize several months later that the wiretapping operation constituted an interference with press freedom and at the same time uphold the measure as lawful. Furthermore, the BJV Managing Director Dennis Amour described the surveillance of journalists’ phone conversations as a “disproportionate” measure that the courts shouldn’t use to circumvent the protection of reporters bound by professional secrecy. By raising this complaint, the concerned journalists want to ensure that in the future, all courts carefully consider the impact on press freedom and provide a documented assessment of alternatives before approving any surveillance measures. As environmental protests escalated in many European countries, a July Human Rights Watch report revealed that governments have also intensified suppressive measures to quell activists’ dissent. https://www.jurist.org/news/2024/09/journalists-file-complaint-with-germany-constitutional-court-over-phone-wiretapping/",Legal,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",My son wants to start playing football but I'm scared he will get a concussion. Can you help me to understand what concussions actually are? How does it affect a growing child?,"According to a recent Harris Poll, football continues its long reign as America’s most popular sport. From pre-game tailgating to the actual event, where any team can win any week, to post-game celebration parties, and of course, the Super Bowl – one of the most-watched television programs in the country – what’s not to love? Yet despite its popularity, there is increasing concern and controversy about the long-term safety of playing football, which has resulted in many parents deciding not to allow their kids to participate in the game. In fact, a recent Bloomberg Politics poll found that half of all Americans say they wouldn’t want their child to play football. The biggest concern? Head injury. According to HealthResearchFunding.org, concussion rates for children under age 19 who play tackle football have doubled over the last decade, most occurring during practices. Concussions can occur with a blow to the head through helmet to helmet contact, and if undiagnosed and left untreated can lead to permanent brain damage. What is more, “subconcussive hits,” or repeated blows to the head that don’t result in concussions can, over a long period of time, have long term health effects, too – primarily chronic traumatic encephalopathy (CTE), a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma. CTE caused by repetitive blows to the head as a result of playing football was brought to light in 2002 by Bennet Omalu, a Nigerian-American physician and forensic pathologist, who discovered the condition during an autopsy of former Pittsburgh Steelers player Mike Webster. This finding, as well as his subsequent reports of CTE in other deceased NFL players, eventually led to the book and later the 2015 film, “Concussion.” It also spurred increasing concern about whether children should be playing football at all. If you were to ask Omalu, the answer would be no. In a 2015 “The New York Times” editorial piece he wrote: “If a child who plays football is subjected to advanced radiological and neurocognitive studies during the season and several months after the season, there can be evidence of brain damage at the cellular level of brain functioning, even if there were no documented concussions or reported symptoms. If that child continues to play over many seasons, these cellular injuries accumulate to cause irreversible brain damage, which we know now by the name chronic traumatic encephalopathy…” But many sports medicine physicians, like Kristin Ernest, MD, who practices at Texas Children’s Hospital the Woodlands, are less adamant about banning youth tackle football. “There is no conclusive evidence that shows us children shouldn’t play football,” she claimed. “But they should be taught proper technique, and they should have proper fitting equipment.” Jonathan Minor, MD, a pediatric sports medicine specialist on the concussion management team at CHOC hospital in California, agreed that we don’t know whether there’s a cumulative effect of head injury in football beginning in childhood. But he does believe that such injuries may be prevented by introducing kids first to non-impact football, allowing them to develop skills before playing the contact game. He also advocates core strengthening exercises as a part of football practice. “There is some research showing that core and neck strengthening can help to prevent traumatic brain injury during football,” he said. And the American Academy of Pediatrics (AAP), while endorsing efforts to limit contact practices in youth football, recently refused to support those calling for an outright ban on tackling in football for athletes below age 18, saying that it is unwilling to recommend such a fundamental change in the way the game is played. The bottom line is that it’s up to parents to decide whether the risks of youth tackle football outweigh the recreational benefit. Some things to consider for kids who do play football: Learn the youth concussion laws in your state. While all states now have laws designed to reduce risk of concussion and other head injuries in youth football, not all state laws are equal, according to USA Football. Fewer than half contain all of the key principles, such as limits on full contact practice, mandatory education about concussion symptoms for coaches, removal of a player from the game if a head injury is suspected, and written medical clearance for return to play. Only a handful of laws specify which ages/grades are covered and whether the law pertains to public and private schools and athletic leagues. Worse yet, almost all lack consequences for schools or leagues that don’t comply with the law. Find your state laws on USAFootball.com and make sure they are being followed. Make sure your child is being taught “heads up” tackle technique, advised Dr. Ernest. This USA-designed program utilizes five fundamentals through a series of drills to reinforce proper tackling mechanics and teaches players to focus on reducing helmet contact. Research presented at the American Academy of Pediatrics’ recent meeting in Washington D.C. showed that limits on full-contact practice as well as teaching Heads Up tackling are working to reduce concussion risk in youth football. Consider a baseline neurocognitive test, such as ImPACT testing, for your child prior to the football season, even if it’s not required by your child’s coach, said Dr. Minor. “A neurocognitive test is a computer-based 20-30 minute test that measures brain functions like visual and verbal memory and reaction time,” he explained. “It’s very helpful to do at the beginning of the season and then repeat if there are signs of concussion. It can help, along with medical evaluation, to make a diagnosis.” Make sure your child is fitted properly with protective equipment and wears it all the time. Know the symptoms of concussion – and make sure your child knows them, too. He should know that it’s important to report any of these symptoms to the coach and to you and that he should be removed from the practice or game immediately. A child who is suspected to have a concussion should see a licensed health professional as soon as possible. Follow the doctor’s orders exactly if your child has a concussion, said Dr. Ernest. Failure to follow orders for physical and cognitive rest can prolong recovery. And know that those who have a first concussion are 3-6 times more likely to suffer another concussion than an athlete who has not had a concussion. So returning to play before the brain has fully healed can put your athlete at higher risk for complications if a second concussion is sustained. WHAT YOU SHOULD KNOW ABOUT CONCUSSIONS WHAT IT IS: According to sports medicine physician Kristin Ernest, MD, a concussion is any force transmitted to the brain itself. While it generally occurs with a blow to the head, any injury that causes the brain to shift rapidly within the skull (such as a whiplash injury) can cause a concussion. SYMPTOMS OF CONCUSSION: While symptoms can vary from child to child, said Dr. Ernest, some of the most common are headache, nausea, dizziness, irritability or crying, trouble concentrating, and sleep disturbance (sleeping more or less than usual). HOW IT’S DIAGNOSED: A concussion will not show up on imaging tests, such as MRI, said Dr. Ernest. It is diagnosed through medical evaluation of symptoms and often, neurocognitive testing. HOW CONCUSSIONS ARE TREATED: Concussions are treated with both physical and cognitive rest, according to Dr. Ernest. This includes rest from all athletic activities, as well as from homework and screen time. In general, recovery takes about 7-10 days, longer for younger children and for those with a history of migraine or ADHD. MS&F"," Only use the provided text to answer the question, no outside sources. My son wants to start playing football but I'm scared he will get a concussion. Can you help me to understand what concussions actually are? How does it affect a growing child? According to a recent Harris Poll, football continues its long reign as America’s most popular sport. From pre-game tailgating to the actual event, where any team can win any week, to post-game celebration parties, and of course, the Super Bowl – one of the most-watched television programs in the country – what’s not to love? Yet despite its popularity, there is increasing concern and controversy about the long-term safety of playing football, which has resulted in many parents deciding not to allow their kids to participate in the game. In fact, a recent Bloomberg Politics poll found that half of all Americans say they wouldn’t want their child to play football. The biggest concern? Head injury. According to HealthResearchFunding.org, concussion rates for children under age 19 who play tackle football have doubled over the last decade, most occurring during practices. Concussions can occur with a blow to the head through helmet to helmet contact, and if undiagnosed and left untreated can lead to permanent brain damage. What is more, “subconcussive hits,” or repeated blows to the head that don’t result in concussions can, over a long period of time, have long term health effects, too – primarily chronic traumatic encephalopathy (CTE), a progressive degenerative disease of the brain found in athletes (and others) with a history of repetitive brain trauma. CTE caused by repetitive blows to the head as a result of playing football was brought to light in 2002 by Bennet Omalu, a Nigerian-American physician and forensic pathologist, who discovered the condition during an autopsy of former Pittsburgh Steelers player Mike Webster. This finding, as well as his subsequent reports of CTE in other deceased NFL players, eventually led to the book and later the 2015 film, “Concussion.” It also spurred increasing concern about whether children should be playing football at all. If you were to ask Omalu, the answer would be no. In a 2015 “The New York Times” editorial piece he wrote: “If a child who plays football is subjected to advanced radiological and neurocognitive studies during the season and several months after the season, there can be evidence of brain damage at the cellular level of brain functioning, even if there were no documented concussions or reported symptoms. If that child continues to play over many seasons, these cellular injuries accumulate to cause irreversible brain damage, which we know now by the name chronic traumatic encephalopathy…” But many sports medicine physicians, like Kristin Ernest, MD, who practices at Texas Children’s Hospital the Woodlands, are less adamant about banning youth tackle football. “There is no conclusive evidence that shows us children shouldn’t play football,” she claimed. “But they should be taught proper technique, and they should have proper fitting equipment.” Jonathan Minor, MD, a pediatric sports medicine specialist on the concussion management team at CHOC hospital in California, agreed that we don’t know whether there’s a cumulative effect of head injury in football beginning in childhood. But he does believe that such injuries may be prevented by introducing kids first to non-impact football, allowing them to develop skills before playing the contact game. He also advocates core strengthening exercises as a part of football practice. “There is some research showing that core and neck strengthening can help to prevent traumatic brain injury during football,” he said. And the American Academy of Pediatrics (AAP), while endorsing efforts to limit contact practices in youth football, recently refused to support those calling for an outright ban on tackling in football for athletes below age 18, saying that it is unwilling to recommend such a fundamental change in the way the game is played. The bottom line is that it’s up to parents to decide whether the risks of youth tackle football outweigh the recreational benefit. Some things to consider for kids who do play football: Learn the youth concussion laws in your state. While all states now have laws designed to reduce risk of concussion and other head injuries in youth football, not all state laws are equal, according to USA Football. Fewer than half contain all of the key principles, such as limits on full contact practice, mandatory education about concussion symptoms for coaches, removal of a player from the game if a head injury is suspected, and written medical clearance for return to play. Only a handful of laws specify which ages/grades are covered and whether the law pertains to public and private schools and athletic leagues. Worse yet, almost all lack consequences for schools or leagues that don’t comply with the law. Find your state laws on USAFootball.com and make sure they are being followed. Make sure your child is being taught “heads up” tackle technique, advised Dr. Ernest. This USA-designed program utilizes five fundamentals through a series of drills to reinforce proper tackling mechanics and teaches players to focus on reducing helmet contact. Research presented at the American Academy of Pediatrics’ recent meeting in Washington D.C. showed that limits on full-contact practice as well as teaching Heads Up tackling are working to reduce concussion risk in youth football. Consider a baseline neurocognitive test, such as ImPACT testing, for your child prior to the football season, even if it’s not required by your child’s coach, said Dr. Minor. “A neurocognitive test is a computer-based 20-30 minute test that measures brain functions like visual and verbal memory and reaction time,” he explained. “It’s very helpful to do at the beginning of the season and then repeat if there are signs of concussion. It can help, along with medical evaluation, to make a diagnosis.” Make sure your child is fitted properly with protective equipment and wears it all the time. Know the symptoms of concussion – and make sure your child knows them, too. He should know that it’s important to report any of these symptoms to the coach and to you and that he should be removed from the practice or game immediately. A child who is suspected to have a concussion should see a licensed health professional as soon as possible. Follow the doctor’s orders exactly if your child has a concussion, said Dr. Ernest. Failure to follow orders for physical and cognitive rest can prolong recovery. And know that those who have a first concussion are 3-6 times more likely to suffer another concussion than an athlete who has not had a concussion. So returning to play before the brain has fully healed can put your athlete at higher risk for complications if a second concussion is sustained. WHAT YOU SHOULD KNOW ABOUT CONCUSSIONS WHAT IT IS: According to sports medicine physician Kristin Ernest, MD, a concussion is any force transmitted to the brain itself. While it generally occurs with a blow to the head, any injury that causes the brain to shift rapidly within the skull (such as a whiplash injury) can cause a concussion. SYMPTOMS OF CONCUSSION: While symptoms can vary from child to child, said Dr. Ernest, some of the most common are headache, nausea, dizziness, irritability or crying, trouble concentrating, and sleep disturbance (sleeping more or less than usual). HOW IT’S DIAGNOSED: A concussion will not show up on imaging tests, such as MRI, said Dr. Ernest. It is diagnosed through medical evaluation of symptoms and often, neurocognitive testing. HOW CONCUSSIONS ARE TREATED: Concussions are treated with both physical and cognitive rest, according to Dr. Ernest. This includes rest from all athletic activities, as well as from homework and screen time. In general, recovery takes about 7-10 days, longer for younger children and for those with a history of migraine or ADHD. MS&F https://choc.org/news/football-concussion-worth-risk/",Medical,Effect Analysis,Q&A "Fulfill user requests utilizing only the information provided in the prompt. If you cannot answer using the context alone, state that you can't determine the answer due to a lack of context information.",What are the important things to know about partial trisomy 18?,"Trisomy 18 Description Trisomy 18, also called Edwards syndrome, is a chromosomal condition associated with abnormalities in many parts of the body. Individuals with trisomy 18 often have slow growth before birth (intrauterine growth retardation) and a low birth weight. Affected individuals may have heart defects and abnormalities of other organs that develop before birth. Other features of trisomy 18 include a small, abnormally shaped head; a small jaw and mouth; and clenched fists with overlapping fingers. Due to the presence of several life-threatening medical problems, many individuals with trisomy 18 die before birth or within their first month. Five to 10 percent of children with this condition live past their first year, and these children often have severe intellectual disability. Frequency Trisomy 18 occurs in about 1 in 5,000 live-born infants; it is more common in pregnancy, but many affected fetuses do not survive to term. Although women of all ages can have a child with trisomy 18, the chance of having a child with this condition increases as a woman gets older. Causes Most cases of trisomy 18 result from having three copies of chromosome 18 in each cell in the body instead of the usual two copies. The extra genetic material disrupts the normal course of development, causing the characteristic features of trisomy 18. Approximately 5 percent of people with trisomy 18 have an extra copy of chromosome 18 in only some of the body's cells. In these people, the condition is called mosaic trisomy 18. The severity of mosaic trisomy 18 depends on the type and number of cells that have the extra chromosome. The development of individuals with this form of trisomy 18 may range from normal to severely affected. Very rarely, part of the long (q) arm of chromosome 18 becomes attached (translocated) to another chromosome during the formation of reproductive cells (eggs and sperm) or very early in embryonic development. Affected individuals have two copies of chromosome 18, plus the extra material from chromosome 18 attached to another chromosome. People with this genetic change are said to have partial trisomy 18. If only part of the q arm is present in three copies, the physical signs of partial trisomy 18 may be less severe than those typically seen in trisomy 18. If the entire q arm is present in three copies, individuals may be as severely affected as if they had three full copies of chromosome 18. Learn more about the chromosome associated with Trisomy 18 • chromosome 18 Inheritance Most cases of trisomy 18 are not inherited, but occur as random events during the formation of eggs and sperm. An error in cell division called nondisjunction results in a reproductive cell with an abnormal number of chromosomes. For example, an egg or sperm cell may gain an extra copy of chromosome 18. If one of these atypical reproductive cells contributes to the genetic makeup of a child, the child will have an extra chromosome 18 in each of the body's cells. Mosaic trisomy 18 is also not inherited. It occurs as a random event during cell division early in embryonic development. As a result, some of the body's cells have the usual two copies of chromosome 18, and other cells have three copies of this chromosome. Partial trisomy 18 can be inherited. An unaffected person can carry a rearrangement of genetic material between chromosome 18 and another chromosome. This rearrangement is called a balanced translocation because there is no extra material from chromosome 18. Although they do not have signs of trisomy 18, people who carry this type of balanced translocation are at an increased risk of having children with the condition. Other Names for This Condition • Complete trisomy 18 syndrome • Edwards syndrome • Trisomy 18 syndrome • Trisomy E syndrome Additional Information & Resources Genetic Testing Information • Genetic Testing Registry: Complete trisomy 18 (https://www.ncbi.nlm.nih.gov/gtr/co nditions/C0152096/) Genetic and Rare Diseases Information Center • Trisomy 18 (https://rarediseases.info.nih.gov/diseases/6321/index) Patient Support and Advocacy Resources • National Organization for Rare Disorders (NORD) (https://rarediseases.org/) Clinical Trials • ClinicalTrials.gov (https://clinicaltrials.gov/search?cond=%22Trisomy 18%22) Scientific Articles on PubMed • PubMed (https://pubmed.ncbi.nlm.nih.gov/?term=%28%28trisomy+18%5BTIAB%5 D%29+OR+%28Edwards+syndrome%5BTIAB%5D%29%29+AND+english%5Bla% 5D+AND+human%5Bmh%5D+AND+%22last+360+days%22%5Bdp%5D) ","System Instructions: Fulfill user requests utilizing only the information provided in the prompt. If you cannot answer using the context alone, state that you can't determine the answer due to a lack of context information. Question: What are the important things to know about partial trisomy 18? Context: Trisomy 18 Description Trisomy 18, also called Edwards syndrome, is a chromosomal condition associated with abnormalities in many parts of the body. Individuals with trisomy 18 often have slow growth before birth (intrauterine growth retardation) and a low birth weight. Affected individuals may have heart defects and abnormalities of other organs that develop before birth. Other features of trisomy 18 include a small, abnormally shaped head; a small jaw and mouth; and clenched fists with overlapping fingers. Due to the presence of several life-threatening medical problems, many individuals with trisomy 18 die before birth or within their first month. Five to 10 percent of children with this condition live past their first year, and these children often have severe intellectual disability. Frequency Trisomy 18 occurs in about 1 in 5,000 live-born infants; it is more common in pregnancy, but many affected fetuses do not survive to term. Although women of all ages can have a child with trisomy 18, the chance of having a child with this condition increases as a woman gets older. Causes Most cases of trisomy 18 result from having three copies of chromosome 18 in each cell in the body instead of the usual two copies. The extra genetic material disrupts the normal course of development, causing the characteristic features of trisomy 18. Approximately 5 percent of people with trisomy 18 have an extra copy of chromosome 18 in only some of the body's cells. In these people, the condition is called mosaic trisomy 18. The severity of mosaic trisomy 18 depends on the type and number of cells that have the extra chromosome. The development of individuals with this form of trisomy 18 may range from normal to severely affected. Very rarely, part of the long (q) arm of chromosome 18 becomes attached (translocated) to another chromosome during the formation of reproductive cells (eggs and sperm) or very early in embryonic development. Affected individuals have two copies of chromosome 18, plus the extra material from chromosome 18 attached to another chromosome. People with this genetic change are said to have partial trisomy 18. If only part of the q arm is present in three copies, the physical signs of partial trisomy 18 may be less severe than those typically seen in trisomy 18. If the entire q arm is present in three copies, individuals may be as severely affected as if they had three full copies of chromosome 18. Learn more about the chromosome associated with Trisomy 18 • chromosome 18 Inheritance Most cases of trisomy 18 are not inherited, but occur as random events during the formation of eggs and sperm. An error in cell division called nondisjunction results in a reproductive cell with an abnormal number of chromosomes. For example, an egg or sperm cell may gain an extra copy of chromosome 18. If one of these atypical reproductive cells contributes to the genetic makeup of a child, the child will have an extra chromosome 18 in each of the body's cells. Mosaic trisomy 18 is also not inherited. It occurs as a random event during cell division early in embryonic development. As a result, some of the body's cells have the usual two copies of chromosome 18, and other cells have three copies of this chromosome. Partial trisomy 18 can be inherited. An unaffected person can carry a rearrangement of genetic material between chromosome 18 and another chromosome. This rearrangement is called a balanced translocation because there is no extra material from chromosome 18. Although they do not have signs of trisomy 18, people who carry this type of balanced translocation are at an increased risk of having children with the condition. Other Names for This Condition • Complete trisomy 18 syndrome • Edwards syndrome • Trisomy 18 syndrome • Trisomy E syndrome Additional Information & Resources Genetic Testing Information • Genetic Testing Registry: Complete trisomy 18 (https://www.ncbi.nlm.nih.gov/gtr/co nditions/C0152096/) Genetic and Rare Diseases Information Center • Trisomy 18 (https://rarediseases.info.nih.gov/diseases/6321/index) Patient Support and Advocacy Resources • National Organization for Rare Disorders (NORD) (https://rarediseases.org/) Clinical Trials • ClinicalTrials.gov (https://clinicaltrials.gov/search?cond=%22Trisomy 18%22) Scientific Articles on PubMed • PubMed (https://pubmed.ncbi.nlm.nih.gov/?term=%28%28trisomy+18%5BTIAB%5 D%29+OR+%28Edwards+syndrome%5BTIAB%5D%29%29+AND+english%5Bla% 5D+AND+human%5Bmh%5D+AND+%22last+360+days%22%5Bdp%5D) ",Medical,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",Can you summarize what happened in the Qualitex Co. v. Jacobson Products Co. decision? What act supported the right to include color to qualify as a trademark? Explain in a minimum of 200 words how the act's language supported Qualitex Co.'s opinion.,"The case before us grows out of petitioner Qualitex Company's use (since the 1950's) of a special shade of green-gold color on the pads that it makes and sells to dry cleaning firms for use on dry cleaning presses. In 1989, respondent J acobson Products (a Qualitex rival) began to sell its own press pads to dry cleaning firms; and it colored those pads a similar green gold. In 1991, Qualitex registered the special greengold color on press pads with the Patent and Trademark Office as a trademark. Registration No. 1,633,711 (Feb. 5, 1991). Qualitex subsequently added a trademark infringement count, 15 U. s. C. § 1114(1), to an unfair competition claim, § 1125(a), in a lawsuit it had already filed challenging Jacobson's use of the green-gold color. Qualitex won the lawsuit in the District Court. 21 U. S. P. Q. 2d 1457 (CD Cal. 1991). But, the Court of Appeals for the Ninth Circuit set aside the judgment in Qualitex's favor on the trademark infringement claim because, in that Circuit's view, the Lanham Act does not permit Qualitex, or anyone else, to register ""color alone"" as a trademark. 13 F.3d 1297, 1300, 1302 (1994). The Courts of Appeals have differed as to whether or not the law recognizes the use of color alone as a trademark. Compare NutraSweet Co. v. Stadt Corp., 917 F.2d 1024, 1028 (CA7 1990) (absolute prohibition against protection of color alone), with In re Owens-Corning Fiberglas Corp., 774 F.2d 1116, 1128 (CA Fed. 1985) (allowing registration of color pink for fiberglass insulation), and Master Distributors, Inc. v. Pako Corp., 986 F.2d 219, 224 (CA8 1993) (declining to establish per se prohibition against protecting color alone as a trademark). Therefore, this Court granted certiorari. 512 162 u. S. 1287 (1994). We now hold that there is no rule absolutely barring the use of color alone, and we reverse the judgment of the Ninth Circuit. II The Lanham Act gives a seller or producer the exclusive right to ""register"" a trademark, 15 U. S. C. § 1052 (1988 ed. and Supp. V), and to prevent his or her competitors from using that trademark, § 1114(1). Both the language of the Act and the basic underlying principles of trademark law would seem to include color within the universe of things that can qualify as a trademark. The language of the Lanham Act describes that universe in the broadest of terms. It says that trademarks ""includ[e] any word, name, symbol, or device, or any combination thereof."" § 1127. Since human beings might use as a ""symbol"" or ""device"" almost anything at all that is capable of carrying meaning, this language, read literally, is not restrictive. The courts and the Patent and Trademark Office have authorized for use as a mark a particular shape (of a Coca-Cola bottle), a particular sound (of NBC's three chimes), and even a particular scent (of plumeria blossoms on sewing thread). See, e. g., Registration No. 696,147 (Apr. 12, 1960); Registration Nos. 523,616 (Apr. 4, 1950) and 916,522 (July 13, 1971); In re Clarke, 17 U. S. P. Q. 2d 1238, 1240 (TTAB 1990). If a shape, a sound, and a fragrance can act as symbols why, one might ask, can a color not do the same? A color is also capable of satisfying the more important part of the statutory definition of a trademark, which requires that a person ""us[e]"" or ""inten[d] to use"" the mark ""to identify and distinguish his or her goods, including a unique product, from those manufactured or sold by others and to indicate the source of the goods, even if that source is unknown."" 15 U. S. C. § 1127. True, a product's color is unlike ""fanciful,"" ""arbitrary,"" or ""suggestive"" words or designs, which almost automatically tell a customer that they refer to a brand. Abercrombie & Fitch Co. v. Hunting World, Inc., 537 F.2d 4, 9-10 (CA2 1976) (Friendly, J.); see Two Pesos, Inc. v. Taco Cabana, Inc., 505 U. S. 763, 768 (1992). The imaginary word ""Suntost,"" or the words ""Suntost Marmalade,"" on a jar of orange jam immediately would signal a brand or a product ""source""; the jam's orange color does not do so. But, over time, customers may come to treat a particular color on a product or its packaging (say, a color that in context seems unusual, such as pink on a firm's insulating material or red on the head of a large industrial bolt) as signifying a brand. And, if so, that color would have come to identify and distinguish the goods-i. e., ""to indicate"" their ""source""-much in the way that descriptive words on a product (say, ""Trim"" on nail clippers or ""Car- Freshner"" on deodorizer) can come to indicate a product's origin. See, e. g., J. Wiss & Sons Co. v. W E. Bassett Co., 59 C. C. P. A. 1269, 1271 (Pat.), 462 F.2d 567, 569 (1972); Car-Freshner Corp. v. Turtle Wax, Inc., 268 F. Supp. 162, 164 (SDNY 1967). In this circumstance, trademark law says that the word (e. g., ""Trim""), although not inherently distinctive, has developed ""secondary meaning."" See Inwood Laboratories, Inc. v. Ives Laboratories, Inc., 456 U. S. 844, 851, n. 11 (1982) (""[S]econdary meaning"" is acquired when ""in the minds of the public, the primary significance of a product feature ... is to identify the source of the product rather than the product itself""). Again, one might ask, if trademark law permits a descriptive word with secondary meaning to act as a mark, why would it not permit a color, under similar circumstances, to do the same? We cannot find in the basic objectives of trademark law any obvious theoretical objection to the use of color alone as a trademark, where that color has attained ""secondary meaning"" and therefore identifies and distinguishes a particular brand (and thus indicates its ""source""). In principle, trademark law, by preventing others from copying a sourceidentifying mark, ""reduce[s] the customer's costs of shopping and making purchasing decisions,"" 1 J. McCarthy, McCarthy on Trademarks and Unfair Competition § 2.01[2], p. 2-3 (3d ed. 1994) (hereinafter McCarthy), for it quickly and easily assures a potential customer that this item-the item with this mark-is made by the same producer as other similarly marked items that he or she liked (or disliked) in the past. At the same time, the law helps assure a producer that it (and not an imitating competitor) will reap the financial, reputation-related rewards associated with a desirable product. The law thereby ""encourage[s] the production of quality products,"" ibid., and simultaneously discourages those who hope to sell inferior products by capitalizing on a consumer's inability quickly to evaluate the quality of an item offered for sale. See, e. g., 3 L. Altman, Callmann on Unfair Competition, Trademarks and Monopolies § 17.03 (4th ed. 1983); Landes & Posner, The Economics of Trademark Law, 78 T. M. Rep. 267, 271-272 (1988); Park 'N Fly, Inc. v. Dollar Park & Fly, Inc., 469 U. S. 189, 198 (1985); S. Rep. No. 100515, p. 4 (1988). It is the source-distinguishing ability of a mark-not its ontological status as color, shape, fragrance, word, or sign-that permits it to serve these basic purposes. See Landes & Posner, Trademark Law: An Economic Perspective, 30 J. Law & Econ. 265, 290 (1987). And, for that reason, it is difficult to find, in basic trademark objectives, a reason to disqualify absolutely the use of a color as a mark.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Can you summarize what happened in the Qualitex Co. v. Jacobson Products Co. decision? What act supported the right to include color to qualify as a trademark? Explain in a minimum of 200 words how the act's language supported Qualitex Co.'s opinion. The case before us grows out of petitioner Qualitex Company's use (since the 1950's) of a special shade of green-gold color on the pads that it makes and sells to dry cleaning firms for use on dry cleaning presses. In 1989, respondent J acobson Products (a Qualitex rival) began to sell its own press pads to dry cleaning firms; and it colored those pads a similar green gold. In 1991, Qualitex registered the special greengold color on press pads with the Patent and Trademark Office as a trademark. Registration No. 1,633,711 (Feb. 5, 1991). Qualitex subsequently added a trademark infringement count, 15 U. s. C. § 1114(1), to an unfair competition claim, § 1125(a), in a lawsuit it had already filed challenging Jacobson's use of the green-gold color. Qualitex won the lawsuit in the District Court. 21 U. S. P. Q. 2d 1457 (CD Cal. 1991). But, the Court of Appeals for the Ninth Circuit set aside the judgment in Qualitex's favor on the trademark infringement claim because, in that Circuit's view, the Lanham Act does not permit Qualitex, or anyone else, to register ""color alone"" as a trademark. 13 F.3d 1297, 1300, 1302 (1994). The Courts of Appeals have differed as to whether or not the law recognizes the use of color alone as a trademark. Compare NutraSweet Co. v. Stadt Corp., 917 F.2d 1024, 1028 (CA7 1990) (absolute prohibition against protection of color alone), with In re Owens-Corning Fiberglas Corp., 774 F.2d 1116, 1128 (CA Fed. 1985) (allowing registration of color pink for fiberglass insulation), and Master Distributors, Inc. v. Pako Corp., 986 F.2d 219, 224 (CA8 1993) (declining to establish per se prohibition against protecting color alone as a trademark). Therefore, this Court granted certiorari. 512 162 u. S. 1287 (1994). We now hold that there is no rule absolutely barring the use of color alone, and we reverse the judgment of the Ninth Circuit. II The Lanham Act gives a seller or producer the exclusive right to ""register"" a trademark, 15 U. S. C. § 1052 (1988 ed. and Supp. V), and to prevent his or her competitors from using that trademark, § 1114(1). Both the language of the Act and the basic underlying principles of trademark law would seem to include color within the universe of things that can qualify as a trademark. The language of the Lanham Act describes that universe in the broadest of terms. It says that trademarks ""includ[e] any word, name, symbol, or device, or any combination thereof."" § 1127. Since human beings might use as a ""symbol"" or ""device"" almost anything at all that is capable of carrying meaning, this language, read literally, is not restrictive. The courts and the Patent and Trademark Office have authorized for use as a mark a particular shape (of a Coca-Cola bottle), a particular sound (of NBC's three chimes), and even a particular scent (of plumeria blossoms on sewing thread). See, e. g., Registration No. 696,147 (Apr. 12, 1960); Registration Nos. 523,616 (Apr. 4, 1950) and 916,522 (July 13, 1971); In re Clarke, 17 U. S. P. Q. 2d 1238, 1240 (TTAB 1990). If a shape, a sound, and a fragrance can act as symbols why, one might ask, can a color not do the same? A color is also capable of satisfying the more important part of the statutory definition of a trademark, which requires that a person ""us[e]"" or ""inten[d] to use"" the mark ""to identify and distinguish his or her goods, including a unique product, from those manufactured or sold by others and to indicate the source of the goods, even if that source is unknown."" 15 U. S. C. § 1127. True, a product's color is unlike ""fanciful,"" ""arbitrary,"" or ""suggestive"" words or designs, which almost automatically tell a customer that they refer to a brand. Abercrombie & Fitch Co. v. Hunting World, Inc., 537 F.2d 4, 9-10 (CA2 1976) (Friendly, J.); see Two Pesos, Inc. v. Taco Cabana, Inc., 505 U. S. 763, 768 (1992). The imaginary word ""Suntost,"" or the words ""Suntost Marmalade,"" on a jar of orange jam immediately would signal a brand or a product ""source""; the jam's orange color does not do so. But, over time, customers may come to treat a particular color on a product or its packaging (say, a color that in context seems unusual, such as pink on a firm's insulating material or red on the head of a large industrial bolt) as signifying a brand. And, if so, that color would have come to identify and distinguish the goods-i. e., ""to indicate"" their ""source""-much in the way that descriptive words on a product (say, ""Trim"" on nail clippers or ""Car- Freshner"" on deodorizer) can come to indicate a product's origin. See, e. g., J. Wiss & Sons Co. v. W E. Bassett Co., 59 C. C. P. A. 1269, 1271 (Pat.), 462 F.2d 567, 569 (1972); Car-Freshner Corp. v. Turtle Wax, Inc., 268 F. Supp. 162, 164 (SDNY 1967). In this circumstance, trademark law says that the word (e. g., ""Trim""), although not inherently distinctive, has developed ""secondary meaning."" See Inwood Laboratories, Inc. v. Ives Laboratories, Inc., 456 U. S. 844, 851, n. 11 (1982) (""[S]econdary meaning"" is acquired when ""in the minds of the public, the primary significance of a product feature ... is to identify the source of the product rather than the product itself""). Again, one might ask, if trademark law permits a descriptive word with secondary meaning to act as a mark, why would it not permit a color, under similar circumstances, to do the same? We cannot find in the basic objectives of trademark law any obvious theoretical objection to the use of color alone as a trademark, where that color has attained ""secondary meaning"" and therefore identifies and distinguishes a particular brand (and thus indicates its ""source""). In principle, trademark law, by preventing others from copying a sourceidentifying mark, ""reduce[s] the customer's costs of shopping and making purchasing decisions,"" 1 J. McCarthy, McCarthy on Trademarks and Unfair Competition § 2.01[2], p. 2-3 (3d ed. 1994) (hereinafter McCarthy), for it quickly and easily assures a potential customer that this item-the item with this mark-is made by the same producer as other similarly marked items that he or she liked (or disliked) in the past. At the same time, the law helps assure a producer that it (and not an imitating competitor) will reap the financial, reputation-related rewards associated with a desirable product. The law thereby ""encourage[s] the production of quality products,"" ibid., and simultaneously discourages those who hope to sell inferior products by capitalizing on a consumer's inability quickly to evaluate the quality of an item offered for sale. See, e. g., 3 L. Altman, Callmann on Unfair Competition, Trademarks and Monopolies § 17.03 (4th ed. 1983); Landes & Posner, The Economics of Trademark Law, 78 T. M. Rep. 267, 271-272 (1988); Park 'N Fly, Inc. v. Dollar Park & Fly, Inc., 469 U. S. 189, 198 (1985); S. Rep. No. 100515, p. 4 (1988). It is the source-distinguishing ability of a mark-not its ontological status as color, shape, fragrance, word, or sign-that permits it to serve these basic purposes. See Landes & Posner, Trademark Law: An Economic Perspective, 30 J. Law & Econ. 265, 290 (1987). And, for that reason, it is difficult to find, in basic trademark objectives, a reason to disqualify absolutely the use of a color as a mark. https://supreme.justia.com/cases/federal/us/514/159/",Legal,Summarize,Text Transformation "In your answer, refer only to the context document. Do not employ any outside knowledge","According to the article, what percentage of your savings is best to put into venture capital?","**How I'd Invest $250,000 Cash Today** Usually, I have between $50,000 – $100,000 in my main bank account. But at one point, I accumulated over $250,000 mainly due to a $122,000 private real estate investment windfall. In addition to accumulating cash, I also dollar-cost averaged in the S&P 500 on the way down in 2022 and way up in 2023. I also dollar-cost averaged in Sunbelt real estate, which struggled in 2023 due to high mortgage rates. These purchases were usually in $1,000 – $5,000 increments. After building a larger-than-normal cash balance, here's how I'd deploy it in today's market. I'm constantly updating this post as conditions change, so book mark it if interested. If you have less than $250,000, that’s fine too. I share the percentages of where I will allocate my money. Background Info To Understand Our Investment Process I'm 46 and my wife is 42. Our kids our 6 and 4. We consider ourselves moderately conservative investors since we haven't had regular day job income since 2012 for me and 2015 for my wife. We fear having to go back to work full-time, not because of work itself but because we fear losing our freedom to spend time with our young children. As a result, we are unwilling to take too much investment risk until both attend school full-time in fall 2024. Although we don't have day jobs, we do generate passive investment income to cover most of our living expenses. This is our definition of financial independence. We also generate online income, which we usually reinvest to generate more passive income. Therefore, our cash pile will continue to build if we don't spend or invest all the money. Our children's educational expenses are on track after we superfunded two 529 plans when they were born. We also have life insurance and estate planning set up. The only foreseeable big ticket item coming up is a car in 2029. Here's how we'd invest $250,000 cash in today's market. This is what we did and are doing with our own cash. This is not investment advice for you as everybody's financial goals, risk tolerance, and situation are different. Please always do your own due diligence before making any investment. Your investment decisions are yours alone. 1) Treasury Bonds (50% Of Cash Holding) Only about 3% of our net worth is in bonds, mostly individual muni bonds we plan to hold until maturity. Our target annual net worth growth rate is between 5% to 10% a year, depending on economic conditions. As a result, being able to earn 5% on a Treasury bond is enticing. The 10-year yield is currently at ~4.2% and Fed Chair Jerome Powell has hinted at Fed rate cuts starting in mid-2024. Investors can get up to around 5% for a one-year Treasury bond. Although locking in a 4% – 5% return won't make us rich, it will provide us peace of mind. We also already feel rich, so making more money won't make us feel richer. Our focus is on optimizing our freedom and time. Below is a recent bond yield table for all the various types of bonds you can buy, by duration. Risk-free Treasury bills and CDs look attractive. If you're in the highest marginal income tax bracket, municipal bonds look good too. Notice how the Treasury bond yield curve is still inverted. Now that we've deployed 50% of our cash in Treasury bonds, the remaining 49.9% of our cash will be invested in risk assets. 2) Stocks (15% Of Cash Holdings) Roughly 15% of our net worth is in stocks after paying cash for a new house in 4Q2023. The range has fluctuated between 20% – 35% since I left work in 2012. Since I started working in equities in 1999, I've done my best to diversify away from stocks and into hard assets. My career and pay were already leveraged to the stock market. And I saw so many great fortunes made and lost during my time in the industry. When I left work, I continued my preference of investing mostly in real estate. We almost always front-loaded our stock purchases for the year through our kids' Roth IRAs, custodial accounts, SEP IRAs, and 529 plans. For over 23 years, we've always front-loaded our tax-advantaged accounts at the beginning of the year to get them out of the way. Most of the time it works out, some of the time it doesn't, like in 2022. That's market timing for you. But we got to front-load our tax-advantaged investments again in 2023, which has worked out great. Keep on investing consistently! In addition to maxing out all our tax-advantaged accounts, we've been regular contributors to our taxable online brokerage accounts. After all, in order to retire early, you need a much larger taxable investment portfolio to live off its income. When it comes to stocks, it's important to invest for specific purposes. If you do, you will be much more motivated to save and invest since stocks provide no utility or joy. Stocks Seem Fully Valued Now Here are the 2024 Wall Street S&P 500 forecasts with an average year-end price target of about 4,850. In other words, there’s now downside at these levels for 2024 if the average prediction comes true. Although, some strategists are forecasting 5,100-5,500 for the year. Given the situation, I'm just buying in $1,000 – $5,000 tranches after every 1% decline. The huge year-end rally in stocks has pulled forward the expected performance in 2024. Here is a post that provides a framework for your stock allocation by bond yield. The higher risk-free bond yields go, the lower your stock allocation is recommended to be and vice versa. If I was in my 20s and 30s, I would allocate 50% of my cash to buying stocks instead. The remaining 20% would go to online real estate as the sector rebounds, 20% to venture capital, and only 10% would go to Treasuries and education. Remember, every investment is based off an individual's personal financial situation and goals. 3) Venture Capital (15% Of Cash Holding) I enjoy investing in private funds because they are long-term investments with no day-to-day price updates. As a result, these investments cause little stress and are easy to forget about. Private investing forces you to invest for the long run. I've already made capital commitments to a couple venture capital funds from Kleiner Perkins, Burst Capital, and Structural Capital (venture debt). As a result, I will just keep contributing to these funds whenever there are capital calls. Venture capital is likely going to roar back in 2024 given private company valuations took a hit since 2022. Capital often rotates toward the biggest underperforming asset classes. Investing In Artificial Intelligence I'm most excited about investing in artificial intelligence, one of the biggest investment opportunities over the next decade. My Kleiner Perkins funds are actively making AI investments. But these funds are invite only with $100,000+ minimums. The Fundrise Innovation Fund, on the other hand, is open to all with a $10 minimum investment. The fund invests in AI companies such as Databricks and Canva. Both are incredible companies and I look forward to the fund getting into more promising AI deals. 20 years from now, I don't want my kids asking me why I didn't invest in AI or work in AI given I had a chance to near the beginning. By investing in funds that invest in AI, at least I'll be able to benefit if I can't get a job in AI. Here's an hour-long discussion I have with Ben Miller, CEO of Fundrise, about AI and investing in growth companies. Roughly 35% of the Innovation Fund is invested in AI companies. 4) Real Estate (20% Of Cash Holding) I’m bullish on real estate in 2024 as the sector plays catch-up to stocks. With mortgage rates coming down, demand is going to rebound. As a result, I’m actively buying real estate funds today. Real estate is my favorite asset class to build wealth. It provides shelter, generates income, and is less volatile. Unlike with some stocks, real estate values just don't decline by massive amounts overnight due to some small earnings miss. Real estate accounts for about 50% of our net worth. No matter what happens to the value of our current forever home we bought in 2020, I'm thankful it has been able to keep my family safe and loved during the pandemic. When it comes to buying a primary residence, it's lifestyle first, investment returns a distant second.","[query] ======= According to the article, what percentage of your savings is best to put into venture capital? ---------- [instruction] ======= In your answer, refer only to the context document. Do not employ any outside knowledge ---------- [article] ======= **How I'd Invest $250,000 Cash Today** Usually, I have between $50,000 – $100,000 in my main bank account. But at one point, I accumulated over $250,000 mainly due to a $122,000 private real estate investment windfall. In addition to accumulating cash, I also dollar-cost averaged in the S&P 500 on the way down in 2022 and way up in 2023. I also dollar-cost averaged in Sunbelt real estate, which struggled in 2023 due to high mortgage rates. These purchases were usually in $1,000 – $5,000 increments. After building a larger-than-normal cash balance, here's how I'd deploy it in today's market. I'm constantly updating this post as conditions change, so book mark it if interested. If you have less than $250,000, that’s fine too. I share the percentages of where I will allocate my money. Background Info To Understand Our Investment Process I'm 46 and my wife is 42. Our kids our 6 and 4. We consider ourselves moderately conservative investors since we haven't had regular day job income since 2012 for me and 2015 for my wife. We fear having to go back to work full-time, not because of work itself but because we fear losing our freedom to spend time with our young children. As a result, we are unwilling to take too much investment risk until both attend school full-time in fall 2024. Although we don't have day jobs, we do generate passive investment income to cover most of our living expenses. This is our definition of financial independence. We also generate online income, which we usually reinvest to generate more passive income. Therefore, our cash pile will continue to build if we don't spend or invest all the money. Our children's educational expenses are on track after we superfunded two 529 plans when they were born. We also have life insurance and estate planning set up. The only foreseeable big ticket item coming up is a car in 2029. Here's how we'd invest $250,000 cash in today's market. This is what we did and are doing with our own cash. This is not investment advice for you as everybody's financial goals, risk tolerance, and situation are different. Please always do your own due diligence before making any investment. Your investment decisions are yours alone. 1) Treasury Bonds (50% Of Cash Holding) Only about 3% of our net worth is in bonds, mostly individual muni bonds we plan to hold until maturity. Our target annual net worth growth rate is between 5% to 10% a year, depending on economic conditions. As a result, being able to earn 5% on a Treasury bond is enticing. The 10-year yield is currently at ~4.2% and Fed Chair Jerome Powell has hinted at Fed rate cuts starting in mid-2024. Investors can get up to around 5% for a one-year Treasury bond. Although locking in a 4% – 5% return won't make us rich, it will provide us peace of mind. We also already feel rich, so making more money won't make us feel richer. Our focus is on optimizing our freedom and time. Below is a recent bond yield table for all the various types of bonds you can buy, by duration. Risk-free Treasury bills and CDs look attractive. If you're in the highest marginal income tax bracket, municipal bonds look good too. Notice how the Treasury bond yield curve is still inverted. Now that we've deployed 50% of our cash in Treasury bonds, the remaining 49.9% of our cash will be invested in risk assets. 2) Stocks (15% Of Cash Holdings) Roughly 15% of our net worth is in stocks after paying cash for a new house in 4Q2023. The range has fluctuated between 20% – 35% since I left work in 2012. Since I started working in equities in 1999, I've done my best to diversify away from stocks and into hard assets. My career and pay were already leveraged to the stock market. And I saw so many great fortunes made and lost during my time in the industry. When I left work, I continued my preference of investing mostly in real estate. We almost always front-loaded our stock purchases for the year through our kids' Roth IRAs, custodial accounts, SEP IRAs, and 529 plans. For over 23 years, we've always front-loaded our tax-advantaged accounts at the beginning of the year to get them out of the way. Most of the time it works out, some of the time it doesn't, like in 2022. That's market timing for you. But we got to front-load our tax-advantaged investments again in 2023, which has worked out great. Keep on investing consistently! In addition to maxing out all our tax-advantaged accounts, we've been regular contributors to our taxable online brokerage accounts. After all, in order to retire early, you need a much larger taxable investment portfolio to live off its income. When it comes to stocks, it's important to invest for specific purposes. If you do, you will be much more motivated to save and invest since stocks provide no utility or joy. Stocks Seem Fully Valued Now Here are the 2024 Wall Street S&P 500 forecasts with an average year-end price target of about 4,850. In other words, there’s now downside at these levels for 2024 if the average prediction comes true. Although, some strategists are forecasting 5,100-5,500 for the year. Given the situation, I'm just buying in $1,000 – $5,000 tranches after every 1% decline. The huge year-end rally in stocks has pulled forward the expected performance in 2024. Here is a post that provides a framework for your stock allocation by bond yield. The higher risk-free bond yields go, the lower your stock allocation is recommended to be and vice versa. If I was in my 20s and 30s, I would allocate 50% of my cash to buying stocks instead. The remaining 20% would go to online real estate as the sector rebounds, 20% to venture capital, and only 10% would go to Treasuries and education. Remember, every investment is based off an individual's personal financial situation and goals. 3) Venture Capital (15% Of Cash Holding) I enjoy investing in private funds because they are long-term investments with no day-to-day price updates. As a result, these investments cause little stress and are easy to forget about. Private investing forces you to invest for the long run. I've already made capital commitments to a couple venture capital funds from Kleiner Perkins, Burst Capital, and Structural Capital (venture debt). As a result, I will just keep contributing to these funds whenever there are capital calls. Venture capital is likely going to roar back in 2024 given private company valuations took a hit since 2022. Capital often rotates toward the biggest underperforming asset classes. Investing In Artificial Intelligence I'm most excited about investing in artificial intelligence, one of the biggest investment opportunities over the next decade. My Kleiner Perkins funds are actively making AI investments. But these funds are invite only with $100,000+ minimums. The Fundrise Innovation Fund, on the other hand, is open to all with a $10 minimum investment. The fund invests in AI companies such as Databricks and Canva. Both are incredible companies and I look forward to the fund getting into more promising AI deals. 20 years from now, I don't want my kids asking me why I didn't invest in AI or work in AI given I had a chance to near the beginning. By investing in funds that invest in AI, at least I'll be able to benefit if I can't get a job in AI. Here's an hour-long discussion I have with Ben Miller, CEO of Fundrise, about AI and investing in growth companies. Roughly 35% of the Innovation Fund is invested in AI companies. 4) Real Estate (20% Of Cash Holding) I’m bullish on real estate in 2024 as the sector plays catch-up to stocks. With mortgage rates coming down, demand is going to rebound. As a result, I’m actively buying real estate funds today. Real estate is my favorite asset class to build wealth. It provides shelter, generates income, and is less volatile. Unlike with some stocks, real estate values just don't decline by massive amounts overnight due to some small earnings miss. Real estate accounts for about 50% of our net worth. No matter what happens to the value of our current forever home we bought in 2020, I'm thankful it has been able to keep my family safe and loved during the pandemic. When it comes to buying a primary residence, it's lifestyle first, investment returns a distant second.",Financial,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","My house recently burned down, and I have decided to stay in a hotel until construction on my new house is completed. What rights do I have as a hotel customer? Please organize the information into a neat bullet-point list and limit your response to 150 words.","Your Rights at a Hotel or Motel in Tennessee If you stay at or live in a hotel or motel, you should know its rights and responsibilities as well as your own rights and responsibilities. Minimum Standards for Hotels and Motels in Tennessee The Tennessee Department of Health, and Department of Environment and Conservation, require minimum standards for all hotels and motels in Tennessee. Those standards cover utilities, maintenance, safety, and basic health, and are available in full online here. Make Sure that You Know Your Rights As a guest at a hotel or motel, you should ask for a copy of all contracts or agreements that you signed for your stay. These papers may set forth the hotel's or motel's requirements during your stay as well as your rights and responsibilities as a guest in the hotel or motel. Hotels and Motels Cannot Discriminate against You Under federal and state laws, hotels and motels are not allowed to discriminate against you (including, refusing or denying services, or kicking you out) because of your race, creed, color, national origin, religion, sex, disability, marital status or age unless it is for a good reason. After staying at a hotel or motel for 30 consistent days, you now have tenant rights. The Legal Aid Society in Tennessee successfully takes the position that once you've been there for 30 days, you're entitled to the same protection against eviction as a conventional tenant. That would mean the right to notice to cure or quit for a violation or unpaid rent, and to have your eviction case heard in court. You'd also have the same protections when it comes to repair issues, and retaliation. Refusal to Provide Services to You Hotels and motels have the right to refuse or deny services to you for the following reasons: -You refuse to pay or are unable to pay for the services offered by the hotel or motel -You are visibly intoxicated or disturbing the public -The hotel or motel reasonably believes that you are seeking services for an illegal reason -The hotel or motel reasonably believes that you are bringing dangerous items or substances onto the property -The hotel or motel is trying to limit the number of people staying at it -These rules must be visibly and clearly posted at the registration desk and in every room. Removing You from Your Room and the Property Hotels and motels have the right to remove you from your room and the property, even if you are living there, for the following reasons: -You refuse to pay and do not pay for the accommodations or services provided to you -You are visibly intoxicated or disturbing the public -The hotel or motel reasonably believes that you are involved in illegal activities during your stay -The hotel or motel reasonably believes that you are bringing dangerous items (such as guns or explosives) onto the property -You have violated a federal, state or local law involving the hotel or motel -You have violated a rule of the hotel or motel Under state law, you have a right to be notified of these six rules. In addition, you have a right to be notified of the rules of the hotel or motel. All of the rules must be visibly and clearly posted at the registration desk and in every room. Can a Hotel or Motel Sue You? Hotels and motels may sue you for any accommodations or services that you received from it without paying for them. In addition, hotels and motels may sue you for any damages that you cause. Those damages may include property damages, lost revenue if it is unable to use the room while it is being repaired, and restitution to any person who is injured due to the damages caused by you. What if Your Property or Luggage is Lost, Stolen or Destroyed? Hotels and motels may allow you to keep your valuable items (such as money or jewelry) in a safe during your stay. The hotel or motel may be liable for losses, up to $800, if your valuable items are lost, stolen or destroyed. Similarly, the hotel or motel may be liable for your lost or stolen luggage, up to $1,500, if it does not provide a place to keep your luggage during your stay. Can a Hotel or Motel Take, Sell or Destroy Your Property? Hotels and motels may place a lien on any property that your brought to your room (such as goods, clothes, baggage or furniture) if you owe any money to the hotel or motel, allowing the hotel to keep your property until you pay. Such liens may be placed on your belongings if you have stayed for one or more nights. In addition, if you owe money to the hotel or motel, it can auction off any and all of the luggage or property that you left there to pay off your debt. The hotel or motel must advertise such auctions at least ten days beforehand.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. My house recently burned down, and I have decided to stay in a hotel until construction on my new house is completed. What rights do I have as a hotel customer? Please organize the information into a neat bullet-point list and limit your response to 150 words. Your Rights at a Hotel or Motel in Tennessee If you stay at or live in a hotel or motel, you should know its rights and responsibilities as well as your own rights and responsibilities. Minimum Standards for Hotels and Motels in Tennessee The Tennessee Department of Health, and Department of Environment and Conservation, require minimum standards for all hotels and motels in Tennessee. Those standards cover utilities, maintenance, safety, and basic health, and are available in full online here. Make Sure that You Know Your Rights As a guest at a hotel or motel, you should ask for a copy of all contracts or agreements that you signed for your stay. These papers may set forth the hotel's or motel's requirements during your stay as well as your rights and responsibilities as a guest in the hotel or motel. Hotels and Motels Cannot Discriminate against You Under federal and state laws, hotels and motels are not allowed to discriminate against you (including, refusing or denying services, or kicking you out) because of your race, creed, color, national origin, religion, sex, disability, marital status or age unless it is for a good reason. After staying at a hotel or motel for 30 consistent days, you now have tenant rights. The Legal Aid Society in Tennessee successfully takes the position that once you've been there for 30 days, you're entitled to the same protection against eviction as a conventional tenant. That would mean the right to notice to cure or quit for a violation or unpaid rent, and to have your eviction case heard in court. You'd also have the same protections when it comes to repair issues, and retaliation. Refusal to Provide Services to You Hotels and motels have the right to refuse or deny services to you for the following reasons: -You refuse to pay or are unable to pay for the services offered by the hotel or motel -You are visibly intoxicated or disturbing the public -The hotel or motel reasonably believes that you are seeking services for an illegal reason -The hotel or motel reasonably believes that you are bringing dangerous items or substances onto the property -The hotel or motel is trying to limit the number of people staying at it -These rules must be visibly and clearly posted at the registration desk and in every room. Removing You from Your Room and the Property Hotels and motels have the right to remove you from your room and the property, even if you are living there, for the following reasons: -You refuse to pay and do not pay for the accommodations or services provided to you -You are visibly intoxicated or disturbing the public -The hotel or motel reasonably believes that you are involved in illegal activities during your stay -The hotel or motel reasonably believes that you are bringing dangerous items (such as guns or explosives) onto the property -You have violated a federal, state or local law involving the hotel or motel -You have violated a rule of the hotel or motel Under state law, you have a right to be notified of these six rules. In addition, you have a right to be notified of the rules of the hotel or motel. All of the rules must be visibly and clearly posted at the registration desk and in every room. Can a Hotel or Motel Sue You? Hotels and motels may sue you for any accommodations or services that you received from it without paying for them. In addition, hotels and motels may sue you for any damages that you cause. Those damages may include property damages, lost revenue if it is unable to use the room while it is being repaired, and restitution to any person who is injured due to the damages caused by you. What if Your Property or Luggage is Lost, Stolen or Destroyed? Hotels and motels may allow you to keep your valuable items (such as money or jewelry) in a safe during your stay. The hotel or motel may be liable for losses, up to $800, if your valuable items are lost, stolen or destroyed. Similarly, the hotel or motel may be liable for your lost or stolen luggage, up to $1,500, if it does not provide a place to keep your luggage during your stay. Can a Hotel or Motel Take, Sell or Destroy Your Property? Hotels and motels may place a lien on any property that your brought to your room (such as goods, clothes, baggage or furniture) if you owe any money to the hotel or motel, allowing the hotel to keep your property until you pay. Such liens may be placed on your belongings if you have stayed for one or more nights. In addition, if you owe money to the hotel or motel, it can auction off any and all of the luggage or property that you left there to pay off your debt. The hotel or motel must advertise such auctions at least ten days beforehand. https://www.help4tn.org/node/1493/your-rights-hotel-or-motel-tennessee-help4tn-blog",Legal,Fact Finding,Q&A "You must generate a response using only this provided document. Do not use any other outside source to support your claims. If you are unable to answer the request using the supporting document only, then you must respond with ""please support more relevant documents so that I may answer your request accurately"".",What do the ratings say that are 2 stars and below?,"Top positive review Positive reviews› Jodi P 5.0 out of 5 stars Is as described Reviewed in the United States on December 14, 2023 Like the balls, good for exercising fingers. A bit small for full hand workout 3 people found this helpful Top critical review Critical reviews› Bonnie Rosenstock 3.0 out of 5 stars Not very substantial Reviewed in the United States on November 23, 2023 Too small. So not very good workout. 2 people found this helpful Search SORT BY Top reviewsMost recent Top reviews FILTER BY All reviewersVerified purchase only All reviewers All stars5 star only4 star only3 star only2 star only1 star onlyPositive reviewsCritical reviews All stars Text, image, videoImage and video reviews only Text, image, video 3,286 total ratings, 194 with reviews From the United States Jodi P 5.0 out of 5 stars Is as described Reviewed in the United States on December 14, 2023 Verified Purchase Like the balls, good for exercising fingers. A bit small for full hand workout 3 people found this helpful Helpful Report Jesse B 5.0 out of 5 stars Great exercise for your hands Reviewed in the United States on January 29, 2024 Verified Purchase Have a little arthritis in both hands, and I use the balls to exercise my grip. Works great. Helpful Report Ronda Sasser 4.0 out of 5 stars Good for PT Reviewed in the United States on September 10, 2023 Verified Purchase Good for strength training your hands after shoulder surgery. Helpful Report Marie Skinner 5.0 out of 5 stars Just what i was looking for. Reviewed in the United States on January 6, 2024 Verified Purchase As a massage therapist, i use my hands a lot. I got these balls to strengthen them. The balls are easy to use. Helpful Report Bonnie Rosenstock 3.0 out of 5 stars Not very substantial Reviewed in the United States on November 23, 2023 Verified Purchase Too small. So not very good workout. 2 people found this helpful Helpful Report Paul Gabriel Wiener 5.0 out of 5 stars They do what they're supposed to do Reviewed in the United States on September 17, 2022 Verified Purchase Set of 3 squeeze balls. Yellow is pretty soft, orange is moderately firm, and blue is kind of tough. They've got a good texture. Just rough enough to have some grip without being irritating to hold. They helped strengthen my arms in preparation for some IV treatment, and they're also just fun to squeeze. They'd make good juggling practice balls, too, if you're into that. 7 people found this helpful Helpful Report E. Nawrocki 5.0 out of 5 stars A little sticky at first Reviewed in the United States on August 30, 2023 Verified Purchase These were a little sticky at first but got better during use. Helped with my hands that had some ligament damage. One person found this helpful Helpful Report DianaQ 5.0 out of 5 stars Great Squishy Balls Reviewed in the United States on August 5, 2022 Verified Purchase Broke my arm in three places and wound up with a big, purple, swollen hand. Surgeon suggested this type of hand exercise to get my hand back to normal. I have poor circulation in the other hand (goes to sleep easily) so now I do two-handed squishy ball squeezes as I watch TV in the evening. It’s clearly benefiting both hands! Good value for the money spent. Zippered case keeps them clean. Don’t know why anyone would need to spend more on exercise balls like these. 3 people found this helpful Helpful Report Richard Lyda 4.0 out of 5 stars Squeeze balls Reviewed in the United States on July 25, 2023 Verified Purchase They are squeeze balls for medical purposes They squeeze what can I say Helpful Report Prairie Gal 3.0 out of 5 stars Just ok Reviewed in the United States on November 2, 2023 Verified Purchase There was no indication of the colors and resistance levels and it is very hard to feel the difference! Ok for the money paid! One person found this helpful From the United States Wesismore 2.0 out of 5 stars Not what I wanted Reviewed in the United States on January 31, 2024 Verified Purchase These feel cheap. They say that there are 3 levels of resistence which is nonsense. Both I and my mother who I bought these for, couldn't tell/feel the differences among them. Also, they say they are 2 inches across, they are not. They measure smaller and feel as such in ones hand. I am returning for a refund. Helpful Report Norine McDonald Tepas 4.0 out of 5 stars PT Reviewed in the United States on July 16, 2023 Verified Purchase Suggested by my Doctor and PT Helpful Report J. Smith 4.0 out of 5 stars Different strengths are great Reviewed in the United States on April 30, 2023 Verified Purchase I like the idea I can have the option of the different strengths. I wish they were a little bit bigger. I have osteoarthritis in my fingers and the stress balls really help. 2 people found this helpful Helpful Report Marie 4.0 out of 5 stars Stress Balls Reviewed in the United States on June 28, 2023 Verified Purchase They are Ok Helpful Report Francisco 4.0 out of 5 stars Quite good Reviewed in the United States on May 13, 2023 Verified Purchase Pretty happy with them. Wish they were bigger, but otherwise got what I wanted 2 people found this helpful Helpful Report Angela C. Adams 5.0 out of 5 stars soft Reviewed in the United States on October 4, 2023 Verified Purchase easy to use One person found this helpful Helpful Report Angela K. 4.0 out of 5 stars Smaller than expected Reviewed in the United States on February 21, 2023 Verified Purchase Like the material. It’s easy to grip and not slippery. Many options for hand and finger strengthening 2 people found this helpful Helpful Report Charles L. 4.0 out of 5 stars A bit small for a woman's hand Reviewed in the United States on February 20, 2023 Verified Purchase A bit small to do physical therapy for an average woman's hand, but otherwise very good. 3 people found this helpful Helpful Report Debora Vardeman 5.0 out of 5 stars Our Grand dogs love them Reviewed in the United States on March 23, 2023 Verified Purchase We buy these for our grand dogs as they are small enough for them to grab by the mouth and bring back to us. Due to what they are made of, the dogs can not tear them apart. We also have a niece dog that visits and she goes nuts over them. Very well made. Helpful Report Maureen 5.0 out of 5 stars 3 firmness levels…works great! Reviewed in the United States on August 20, 2023 Verified Purchase I used this for exercising my hand. Loved that the colors correspond to the firmness levels. 3 people found this helpful From the United States Sharon DeLorenzo 3.0 out of 5 stars Very small Reviewed in the United States on June 6, 2023 Verified Purchase Purchase this as part of OT after shoulder replacement to strengthen my hand grip. I am the petite woman and these are very small did not like at all. Returned 3 people found this helpful Helpful Report dale decarlo 2.0 out of 5 stars Too small Reviewed in the United States on January 10, 2024 Verified Purchase The person in the picture must have tiny little hands. These were very small. Helpful Report Robert 3.0 out of 5 stars excersise ball Reviewed in the United States on July 5, 2023 Verified Purchase Image is mis leading. To small. Dont reccomend to buy. 2 people found this helpful Helpful Report Debby 4.0 out of 5 stars I bought it for me Reviewed in the United States on December 23, 2022 Verified Purchase Broke my wrist and need them for therapy 2 people found this helpful Helpful Report Christy 5.0 out of 5 stars 100% helpful Reviewed in the United States on May 12, 2023 Verified Purchase Love these. I'm trying to build up wrist/finger strength and these are great way to start. I can use at desk during work. One person found this helpful Helpful Report David C. Fischer 2.0 out of 5 stars Too small Reviewed in the United States on December 29, 2023 Verified Purchase Too small to be of much use Helpful Report Kathleen S. Jablonski 4.0 out of 5 stars Smaller than expected, but a good feel in my hand. Reviewed in the United States on August 14, 2022 Verified Purchase Smaller than expected, but a good feel in my hand. I’m not sure I like the sort of sticky feeling to the gel, but on the overall, I think it’s a great value. One person found this helpful Helpful Report Brittany Chavarria 5.0 out of 5 stars Lo recomiendo Reviewed in the United States on May 15, 2023 Verified Purchase Las pelotas son de un buen tamaño, tienen diferentes intensidades y es de muy buen material One person found this helpful Helpful Report Translate review to English Emily 5.0 out of 5 stars Makes hands feel better. Reviewed in the United States on June 18, 2023 Verified Purchase Using them seems to help my arthritis Helpful Report Sara Martin 5.0 out of 5 stars Good Product Reviewed in the United States on June 17, 2023 Verified Purchase Will use this product in physical therapy From the United States Beth 5.0 out of 5 stars Nice Reviewed in the United States on June 18, 2023 Verified Purchase Has improved grip and strength Helpful Report Lee W. 4.0 out of 5 stars For my RA and carpal tunnel hand exercises Reviewed in the United States on January 29, 2020 Verified Purchase What I like: The size is just right for the average women's hands and it has three levels of resistance-yellow/softer resistance, orange/medium resistance, blue/ harder resistance. Just enough resistance so that you can press them but not collapse them. Each came in its own little zip lock bag. What I kinda don't like: Feel weird...They are sticky like those toys my kids use to play with that you throw at the wall and it sticks, then it slowly 'crawls' back down. So I use it inside of its plastic bag. Crinkly but works. 22 people found this helpful Helpful Report D. Lefever 5.0 out of 5 stars Great for weak, elderly hands Reviewed in the United States on January 9, 2023 Verified Purchase My doctor said to buy these, and I use occasionally every night while watching TV. Fingers are stronger and I'm dropping a lot less. Keep away from dogs. 3 people found this helpful Helpful Report Nancy Alameda 5.0 out of 5 stars Too small Reviewed in the United States on April 29, 2021 Verified Purchase I just really like them. I think they’ll be very helpful for my old painful hands. After having used them for several days I’ve come to the conclusion that they are too small. I’m only able to squeeze with my first three fingers. My thumb and pinky finger are uninvolved. I will send them back and have already ordered a different set. I think these would be great for kids, but I don’t know why kids would need them, unless for an injury. 6 people found this helpful Helpful Report Thuong Le 4.0 out of 5 stars Good Reviewed in the United States on April 26, 2022 Verified Purchase I practiced it every night and it worked. My hand feel better and wasn’t numb when I woke up. Helpful Report JONATHAN V. 5.0 out of 5 stars Good to have Reviewed in the United States on May 2, 2023 Verified Purchase Great to have One person found this helpful Helpful Report Samuel Moore II 4.0 out of 5 stars Perfect Reviewed in the United States on February 12, 2022 Verified Purchase My father had a stroke in Dec 2021 He lost a little strength in his left hand, these were perfect for him. One person found this helpful Helpful Report Tikiroom2435 3.0 out of 5 stars No chart or label with firmness of each ball. Sticky to the touch. Okay for the price. Reviewed in the United States on January 8, 2020 Verified Purchase Ordered these balls for therapy after thumb ligament joint reconstruction surgery for osteoarthritis. Great price but you get what you pay for. The balls are good size for my small hands but they are sticky to the touch. The balls have imperfections which i can feel on my skin...weird. Was very disappointed the balls arrived with no chart or instructions stating the firmness of each color. The orange and yellow were so similar in firmness, I couldn’t tell which was which. My memory is not the best but hate I have to keep looking up the chart photo on the Amazon listing to see which is which. For the price, these are ok for me to start with but I think a cloth covered stress ball work better in my situation. 8 people found this helpful Helpful Report Litigator Rater 2.0 out of 5 stars No instructions for use of the product Reviewed in the United States on April 28, 2023 Verified Purchase I received three spheres of varying color and density, in a clear cellophane envelope. There were no instructions for use or maintenance. Inasmuch as these are advertised for exercise, it is unfair that the promotional instructions are not provided to the buyers of the product. I suppose the only way to see the ads on Amazon is through screen captures. Helpful Report Isbel feliz 5.0 out of 5 stars Excelente Reviewed in the United States on April 20, 2023 Verified Purchase Que llegaron intactas From the United States Robert F Anderson 1.0 out of 5 stars sticky lint traps that I dont even want to touch!!! Reviewed in the United States on February 14, 2024 Verified Purchase sticky lint traps that I dont even want to touch let alone exercise!!! Total waste of money. Helpful Report BILL SKEBECK 5.0 out of 5 stars Very nice product! Reviewed in the United States on October 23, 2022 Verified Purchase Satisfied with product. First package came empty but Amazon customer service immediately corrected this and sent the order very quickly and got the right package quickly....all good! One person found this helpful Helpful Report darknology 3.0 out of 5 stars Gummy Balls Reviewed in the United States on November 3, 2022 Verified Purchase They have a gummy/sticky feel, which I find unpleasant. They each have a different consistency - as advertised. I prefer the 2.5-inch ball that I have. Impressive colors, though. 2 people found this helpful Helpful Report G. Boehm 5.0 out of 5 stars Received my order a few days ago Reviewed in the United States on March 14, 2023 Verified Purchase It was what I wanted Helpful Report all way seen 5.0 out of 5 stars 3 different level of softness. perfect for elders Reviewed in the United States on February 10, 2023 Verified Purchase my mother likes these smaller size relief balls. 2 people found this helpful Helpful Report Sharon 3.0 out of 5 stars VERY SMALL Reviewed in the United States on July 22, 2021 Verified Purchase These balls are very small (even for a woman's hands) and they are sticky/slimy at first touch. After a bit of use (reluctantly) they do ""dry up"" somewhat. I needed to try them because I couldn't find ""stress balls"" anywhere locally and I need them for finger stiffness resulting from a broken wrist. I will likely return these when I find larger ones to buy from Amazon. Disappointed. 4 people found this helpful Helpful Report Richard B. 3.0 out of 5 stars Misleading Ad Reviewed in the United States on February 22, 2022 Verified Purchase Misleading, certainly shows what looks like a carry bag in the ad, but you don't get one. But the pic of a carry bag (look alike) swayed the decision to buy it. Why show something that is not included, unless you wanted to sway a person's choice. One person found this helpful Helpful Report SFR 4.0 out of 5 stars Works best for small hands Reviewed in the United States on December 10, 2021 Verified Purchase My hands are not small but the balls work okay. Helpful Report Karin M 4.0 out of 5 stars A decent option Reviewed in the United States on July 1, 2021 Verified Purchase I'm not really able to tell a difference in the strength on these, and they are just a bit too small. Helpful Report Kindle Customer 4.0 out of 5 stars Worth the money Reviewed in the United States on July 11, 2021 Verified Purchase These work well for what I needed them for help with my hands that have tendinitis From the United States Shmuelman 5.0 out of 5 stars I thought they would be too small... Reviewed in the United States on September 1, 2022 Verified Purchase but when I started using them they are just right. Very comfortable and addictive to use. Helpful Report Grace Laine 4.0 out of 5 stars Addictive Therapy Reviewed in the United States on August 24, 2020 Verified Purchase I need these for numbness in my hands and fingers and use them habitually, either squeezing them or rolling them in my palm for dexterity. There's a slight difference in thickness - mostly felt in the blue ball. They're addictive and helpful. One person found this helpful Helpful Report WildWest 5.0 out of 5 stars Do the job Reviewed in the United States on November 27, 2021 Verified Purchase Price point was great; definitely very different firmness. I used these after a bicep tendon reattachment and had the three for only a bit more than the kids tennis ball my physical therapist recommended. Helpful Report ARMANDO BALTAZAR 4.0 out of 5 stars Too small for a mans hand Reviewed in the United States on September 9, 2021 Verified Purchase The balls are too small for a mans hand Helpful Report mnt 5.0 out of 5 stars these are great Reviewed in the United States on April 26, 2021 Verified Purchase Only drawback is they don't come with the instructions for different exercises. Balls are nicely made and a great substance. Just started with the yellow, which is lightest resistance but appreciate having the others to upgrade to appropriately. They feel good to the touch. 2 people found this helpful Helpful Report SILKOAK 5.0 out of 5 stars good prodict Reviewed in the United States on February 15, 2022 Verified Purchase I ordered the balls to exercise my arthritic fingers and i do this numerous times a day. It will take awhile but hope it helps. Helpful Report Rainey 5.0 out of 5 stars Hand therapeutic exercise balls Reviewed in the United States on November 19, 2022 Verified Purchase These are just as good as the Gaiam products. One person found this helpful Helpful Report LZee 5.0 out of 5 stars Awesome Reviewed in the United States on May 30, 2022 Verified Purchase My Mom uses it for her arthritis. Her massage therapist had great comments about it. Mom is happy Helpful Report Vince D 5.0 out of 5 stars Does the job Reviewed in the United States on October 12, 2021 Verified Purchase I see reviews stating that there’s not much of a difference in resistance between the three. There’s a significant difference to someone rehabbing a hand injury. Well worth trying for the price. Helpful Report Mileyka 5.0 out of 5 stars Muy prácticas Reviewed in the United States on February 20, 2022 Verified Purchase Buena inversión porque no son muy grandes. Que se pueden llevar para cualquier lugar y así mantener ejercitadas las manos y dedos. From the United States Sue 4.0 out of 5 stars it works great for my needs Reviewed in the United States on March 25, 2021 Verified Purchase I like that it fits in my hands perfectly. Just firm enough to work my hands. Helpful Report L. Key 5.0 out of 5 stars Exercise for broken wrist Reviewed in the United States on September 14, 2021 Verified Purchase These are great to help a broken wrist heal! My wrist stopped hurting after I started using the ball! I highly recommend these to anyone who has broken their wrist!! Helpful Report Lorie 5.0 out of 5 stars These Reviewed in the United States on September 3, 2021 Verified Purchase These balls are so good to use because I have rheumatoid arthritis and it helps my hands so much. I need to strengthen my hands and this has helped so much. Helpful Report Amazon Customer 5.0 out of 5 stars Love them! Reviewed in the United States on November 11, 2020 Verified Purchase A teacher I work with had one and didn't know where to find it- I lucked up and these are exactly the same. I like this because it doesn't seem like you can break them, without actively using some sharp to do so. The middle schoolers I work with love using these! Helpful Report J G Stamps 5.0 out of 5 stars Great non slippery squeeze balls in bright colors Reviewed in the United States on December 18, 2020 Verified Purchase Bought these for my elderly mom who had a stroke and wanted to re-teach her left hand to grip. These are perfect for her, not slippery, brightly colored, and progressive strengths. Anybody wanting to build up grip and forearms will enjoy. Also stress relieving in 2020. One person found this helpful Helpful Report Betty C. Shaheen 5.0 out of 5 stars Therapy for hand Reviewed in the United States on July 26, 2022 Verified Purchase Good for therapy on hand.. Just right size for my hand. Helpful Report J. Hatch 3.0 out of 5 stars Too small Reviewed in the United States on March 12, 2022 Verified Purchase The balls seem to be good quality but they should be bigger to engage all fingers and thumb Helpful Report Kimmy in MD 5.0 out of 5 stars Great Exercise Tool! Reviewed in the United States on August 27, 2022 Verified Purchase Love these bands for working legs and glutes! Helpful Report May 5.0 out of 5 stars Good therapeutic item Reviewed in the United States on July 6, 2021 Verified Purchase Perfect item for my own home PT therapy . If you have had a broken hand in past or now, get this item to help with the therapy healing process Helpful Report Denise 3.0 out of 5 stars All the same? Reviewed in the United States on September 2, 2021 Verified Purchase Purchased these for a family member in rehab. I could not determine the different resistance levels they all felt the same. In the end he didn't use. Helpful Report From the United States Frank 4.0 out of 5 stars Good product Reviewed in the United States on May 20, 2021 Verified Purchase Good product. Very useful. Helpful Report Alicia G 5.0 out of 5 stars Good Reviewed in the United States on September 10, 2022 Verified Purchase Good exercise motivation Helpful Report DB 4.0 out of 5 stars good Reviewed in the United States on June 12, 2021 Verified Purchase worked well Helpful Report NonnaVO 5.0 out of 5 stars Just what my husband was looking for Reviewed in the United States on March 12, 2022 Verified Purchase Good value for the cost. Helpful with exercise of arthritic hands Helpful Report LW 3.0 out of 5 stars They work price is good. Reviewed in the United States on June 17, 2021 Verified Purchase They aren't marked so you know which size is the easiest to the hardest. Which makes it hard to know if you are using the right one. Helpful Report Barabara Sagraves 5.0 out of 5 stars Great for hand exercise Reviewed in the United States on September 18, 2021 Verified Purchase Husband has had shoulder surgery. These have kept his hand from swelling because he can’t move his shoulder or arm. Helpful Report Cindylou 3.0 out of 5 stars Okay Reviewed in the United States on April 26, 2022 Verified Purchase I was looking for something softer Helpful Report Alan 5.0 out of 5 stars These are just what I was looking for. The size is just right and they are easy to use. Reviewed in the United States on September 13, 2021 Verified Purchase These are just what I was looking for. The size is just right and they are easy to use. Helpful Report Fran 4.0 out of 5 stars Great hand massage Reviewed in the United States on April 10, 2021 Verified Purchase Great for arthritic hands Helpful Report 2004done 2.0 out of 5 stars 3 of the same Reviewed in the United States on January 9, 2021 Verified Purchase Not much difference in the three,, unless you don't like the color. Trying to rehab myself from a broken wrist, so practicing juggling is a fun part of it ( no, I can't juggle any longer, but couldn't before either as the saying goes). I AM able to deflect with fingertips' strength now, so it is working. I use a rolled up towel for flexing (which I thought these would work), but these are only for strength exercise. Can't really recommend them, other than for juggling (they're much better than using eggs). From the United States Karenv 5.0 out of 5 stars Great size and good resistance Reviewed in the United States on August 10, 2020 Verified Purchase These stress balls are smaller than I expected but they are actually perfect for my hand. The increasingly hard resistance is just what I need to strengthen my hand after a fracture. Helpful Report Jose V. 4.0 out of 5 stars good quality product for this price Reviewed in the United States on July 4, 2020 Verified Purchase Nice and easy to use. Good quality to this price Helpful Report Mark Ashworth 3.0 out of 5 stars Too small for my hands Reviewed in the United States on January 31, 2021 Verified Purchase I like the variation in resistance but they are too small for my hands which are not very large. I have to use two balls at a time which is awkward. Helpful Report i m irene 5.0 out of 5 stars Good for rehab in broken arm Reviewed in the United States on November 27, 2021 Verified Purchase Do not let animals get this. It is not a toy Helpful Report Nelson 5.0 out of 5 stars Strength ball Reviewed in the United States on March 16, 2022 Verified Purchase Fix in my plan very easily Helpful Report dave ratalsky 5.0 out of 5 stars Good Reviewed in the United States on August 7, 2021 Verified Purchase They’re round and squeezable. They do what they were made for. Enough said. Helpful Report rochelle conner 5.0 out of 5 stars good fit Reviewed in the United States on April 27, 2022 Verified Purchase none Helpful Report Bob D Weakley 5.0 out of 5 stars They are just I was looking for and I expected Reviewed in the United States on June 9, 2021 Verified Purchase I like the size of them and how easy to always have one on all the time. Helpful Report Drew 4.0 out of 5 stars Good Reviewed in the United States on October 30, 2020 Verified Purchase They do the job Helpful Report GL 5.0 out of 5 stars They do make a difference Reviewed in the United States on March 30, 2021 Verified Purchase When you do the exercises everyday there is a sizable difference. Also, just squeezing the ball is a good stress reliever From the United States Robert E Gauldin 5.0 out of 5 stars Great exercise balls. Reviewed in the United States on August 4, 2020 Verified Purchase I find the useful for hand exercises. They do feel a bit sticky but don't seem to p pick up any dirt. I'm very pleased with them. Helpful Report DebbieA 5.0 out of 5 stars Perfect in every way , and great to get hands strengthened Reviewed in the United States on September 4, 2019 Verified Purchase Perfect size, squeeze resistance, and can use for hours to help add dexterity to weakened hands! I would prefer that they all came in one zip top bag though, but overall these balls rock!! 8 people found this helpful Helpful Report Barbara 5.0 out of 5 stars very effective Reviewed in the United States on July 3, 2021 Verified Purchase The balls are very helpful for an exercise for my arthritic and neuropathy hands. Helpful Report K. Johansen 2.0 out of 5 stars Not recommended Reviewed in the United States on June 22, 2021 Verified Purchase Got these and was surprised at how small they are, so small that I doubt they would even be good for a kid. The difference in tension is also pretty bad, not much difference at all. Of course these are made in china. Will go back to the devices I was using, thought maybe these would be good, but I do not recommend them One person found this helpful Helpful Report James P. Bontrager 3.0 out of 5 stars Way to much wrapping! Reviewed in the United States on December 29, 2021 Verified Purchase Average Helpful Report Anthony 5.0 out of 5 stars Great for rehabilitation of the hand. Reviewed in the United States on October 10, 2020 Verified Purchase I bought these for my mother after she broke her wrist so she could rebuild strength in her hand and she loves them. Helpful Report Jesse 5.0 out of 5 stars Get them Reviewed in the United States on March 17, 2021 Verified Purchase Just had carpal tunnel surgery and this is getting my hand back to strength fast. Helpful Report adonais d. 5.0 out of 5 stars Están muy colada lo recomiendo Reviewed in the United States on August 14, 2021 Verified Purchase Me gusto muy suave para mis mano lo recomiendo Helpful Report Translate review to English stephanie D 5.0 out of 5 stars I haven’t used the balls very long, but they seem to help pain. Reviewed in the United States on April 1, 2020 Verified Purchase I am using the exercise balls to relieve the arthritis in my hands. I have trigger fingers on both hands and the exercise seems to help. One person found this helpful Helpful Report Customer 777 2.0 out of 5 stars Easy to bite in half for child or dementia patient so be careful Reviewed in the United States on November 16, 2022 Verified Purchase Easy to bite Chunks out be careful not for children or confused elderly","You must generate a response using only this provided document. Do not use any other outside source to support your claims. If you are unable to answer the request using the supporting document only, then you must respond with ""please support more relevant documents so that I may answer your request accurately"". What do the ratings say that are 2 stars and below? Top positive review Positive reviews› Jodi P 5.0 out of 5 stars Is as described Reviewed in the United States on December 14, 2023 Like the balls, good for exercising fingers. A bit small for full hand workout 3 people found this helpful Top critical review Critical reviews› Bonnie Rosenstock 3.0 out of 5 stars Not very substantial Reviewed in the United States on November 23, 2023 Too small. So not very good workout. 2 people found this helpful Search SORT BY Top reviewsMost recent Top reviews FILTER BY All reviewersVerified purchase only All reviewers All stars5 star only4 star only3 star only2 star only1 star onlyPositive reviewsCritical reviews All stars Text, image, videoImage and video reviews only Text, image, video 3,286 total ratings, 194 with reviews From the United States Jodi P 5.0 out of 5 stars Is as described Reviewed in the United States on December 14, 2023 Verified Purchase Like the balls, good for exercising fingers. A bit small for full hand workout 3 people found this helpful Helpful Report Jesse B 5.0 out of 5 stars Great exercise for your hands Reviewed in the United States on January 29, 2024 Verified Purchase Have a little arthritis in both hands, and I use the balls to exercise my grip. Works great. Helpful Report Ronda Sasser 4.0 out of 5 stars Good for PT Reviewed in the United States on September 10, 2023 Verified Purchase Good for strength training your hands after shoulder surgery. Helpful Report Marie Skinner 5.0 out of 5 stars Just what i was looking for. Reviewed in the United States on January 6, 2024 Verified Purchase As a massage therapist, i use my hands a lot. I got these balls to strengthen them. The balls are easy to use. Helpful Report Bonnie Rosenstock 3.0 out of 5 stars Not very substantial Reviewed in the United States on November 23, 2023 Verified Purchase Too small. So not very good workout. 2 people found this helpful Helpful Report Paul Gabriel Wiener 5.0 out of 5 stars They do what they're supposed to do Reviewed in the United States on September 17, 2022 Verified Purchase Set of 3 squeeze balls. Yellow is pretty soft, orange is moderately firm, and blue is kind of tough. They've got a good texture. Just rough enough to have some grip without being irritating to hold. They helped strengthen my arms in preparation for some IV treatment, and they're also just fun to squeeze. They'd make good juggling practice balls, too, if you're into that. 7 people found this helpful Helpful Report E. Nawrocki 5.0 out of 5 stars A little sticky at first Reviewed in the United States on August 30, 2023 Verified Purchase These were a little sticky at first but got better during use. Helped with my hands that had some ligament damage. One person found this helpful Helpful Report DianaQ 5.0 out of 5 stars Great Squishy Balls Reviewed in the United States on August 5, 2022 Verified Purchase Broke my arm in three places and wound up with a big, purple, swollen hand. Surgeon suggested this type of hand exercise to get my hand back to normal. I have poor circulation in the other hand (goes to sleep easily) so now I do two-handed squishy ball squeezes as I watch TV in the evening. It’s clearly benefiting both hands! Good value for the money spent. Zippered case keeps them clean. Don’t know why anyone would need to spend more on exercise balls like these. 3 people found this helpful Helpful Report Richard Lyda 4.0 out of 5 stars Squeeze balls Reviewed in the United States on July 25, 2023 Verified Purchase They are squeeze balls for medical purposes They squeeze what can I say Helpful Report Prairie Gal 3.0 out of 5 stars Just ok Reviewed in the United States on November 2, 2023 Verified Purchase There was no indication of the colors and resistance levels and it is very hard to feel the difference! Ok for the money paid! One person found this helpful From the United States Wesismore 2.0 out of 5 stars Not what I wanted Reviewed in the United States on January 31, 2024 Verified Purchase These feel cheap. They say that there are 3 levels of resistence which is nonsense. Both I and my mother who I bought these for, couldn't tell/feel the differences among them. Also, they say they are 2 inches across, they are not. They measure smaller and feel as such in ones hand. I am returning for a refund. Helpful Report Norine McDonald Tepas 4.0 out of 5 stars PT Reviewed in the United States on July 16, 2023 Verified Purchase Suggested by my Doctor and PT Helpful Report J. Smith 4.0 out of 5 stars Different strengths are great Reviewed in the United States on April 30, 2023 Verified Purchase I like the idea I can have the option of the different strengths. I wish they were a little bit bigger. I have osteoarthritis in my fingers and the stress balls really help. 2 people found this helpful Helpful Report Marie 4.0 out of 5 stars Stress Balls Reviewed in the United States on June 28, 2023 Verified Purchase They are Ok Helpful Report Francisco 4.0 out of 5 stars Quite good Reviewed in the United States on May 13, 2023 Verified Purchase Pretty happy with them. Wish they were bigger, but otherwise got what I wanted 2 people found this helpful Helpful Report Angela C. Adams 5.0 out of 5 stars soft Reviewed in the United States on October 4, 2023 Verified Purchase easy to use One person found this helpful Helpful Report Angela K. 4.0 out of 5 stars Smaller than expected Reviewed in the United States on February 21, 2023 Verified Purchase Like the material. It’s easy to grip and not slippery. Many options for hand and finger strengthening 2 people found this helpful Helpful Report Charles L. 4.0 out of 5 stars A bit small for a woman's hand Reviewed in the United States on February 20, 2023 Verified Purchase A bit small to do physical therapy for an average woman's hand, but otherwise very good. 3 people found this helpful Helpful Report Debora Vardeman 5.0 out of 5 stars Our Grand dogs love them Reviewed in the United States on March 23, 2023 Verified Purchase We buy these for our grand dogs as they are small enough for them to grab by the mouth and bring back to us. Due to what they are made of, the dogs can not tear them apart. We also have a niece dog that visits and she goes nuts over them. Very well made. Helpful Report Maureen 5.0 out of 5 stars 3 firmness levels…works great! Reviewed in the United States on August 20, 2023 Verified Purchase I used this for exercising my hand. Loved that the colors correspond to the firmness levels. 3 people found this helpful From the United States Sharon DeLorenzo 3.0 out of 5 stars Very small Reviewed in the United States on June 6, 2023 Verified Purchase Purchase this as part of OT after shoulder replacement to strengthen my hand grip. I am the petite woman and these are very small did not like at all. Returned 3 people found this helpful Helpful Report dale decarlo 2.0 out of 5 stars Too small Reviewed in the United States on January 10, 2024 Verified Purchase The person in the picture must have tiny little hands. These were very small. Helpful Report Robert 3.0 out of 5 stars excersise ball Reviewed in the United States on July 5, 2023 Verified Purchase Image is mis leading. To small. Dont reccomend to buy. 2 people found this helpful Helpful Report Debby 4.0 out of 5 stars I bought it for me Reviewed in the United States on December 23, 2022 Verified Purchase Broke my wrist and need them for therapy 2 people found this helpful Helpful Report Christy 5.0 out of 5 stars 100% helpful Reviewed in the United States on May 12, 2023 Verified Purchase Love these. I'm trying to build up wrist/finger strength and these are great way to start. I can use at desk during work. One person found this helpful Helpful Report David C. Fischer 2.0 out of 5 stars Too small Reviewed in the United States on December 29, 2023 Verified Purchase Too small to be of much use Helpful Report Kathleen S. Jablonski 4.0 out of 5 stars Smaller than expected, but a good feel in my hand. Reviewed in the United States on August 14, 2022 Verified Purchase Smaller than expected, but a good feel in my hand. I’m not sure I like the sort of sticky feeling to the gel, but on the overall, I think it’s a great value. One person found this helpful Helpful Report Brittany Chavarria 5.0 out of 5 stars Lo recomiendo Reviewed in the United States on May 15, 2023 Verified Purchase Las pelotas son de un buen tamaño, tienen diferentes intensidades y es de muy buen material One person found this helpful Helpful Report Translate review to English Emily 5.0 out of 5 stars Makes hands feel better. Reviewed in the United States on June 18, 2023 Verified Purchase Using them seems to help my arthritis Helpful Report Sara Martin 5.0 out of 5 stars Good Product Reviewed in the United States on June 17, 2023 Verified Purchase Will use this product in physical therapy From the United States Beth 5.0 out of 5 stars Nice Reviewed in the United States on June 18, 2023 Verified Purchase Has improved grip and strength Helpful Report Lee W. 4.0 out of 5 stars For my RA and carpal tunnel hand exercises Reviewed in the United States on January 29, 2020 Verified Purchase What I like: The size is just right for the average women's hands and it has three levels of resistance-yellow/softer resistance, orange/medium resistance, blue/ harder resistance. Just enough resistance so that you can press them but not collapse them. Each came in its own little zip lock bag. What I kinda don't like: Feel weird...They are sticky like those toys my kids use to play with that you throw at the wall and it sticks, then it slowly 'crawls' back down. So I use it inside of its plastic bag. Crinkly but works. 22 people found this helpful Helpful Report D. Lefever 5.0 out of 5 stars Great for weak, elderly hands Reviewed in the United States on January 9, 2023 Verified Purchase My doctor said to buy these, and I use occasionally every night while watching TV. Fingers are stronger and I'm dropping a lot less. Keep away from dogs. 3 people found this helpful Helpful Report Nancy Alameda 5.0 out of 5 stars Too small Reviewed in the United States on April 29, 2021 Verified Purchase I just really like them. I think they’ll be very helpful for my old painful hands. After having used them for several days I’ve come to the conclusion that they are too small. I’m only able to squeeze with my first three fingers. My thumb and pinky finger are uninvolved. I will send them back and have already ordered a different set. I think these would be great for kids, but I don’t know why kids would need them, unless for an injury. 6 people found this helpful Helpful Report Thuong Le 4.0 out of 5 stars Good Reviewed in the United States on April 26, 2022 Verified Purchase I practiced it every night and it worked. My hand feel better and wasn’t numb when I woke up. Helpful Report JONATHAN V. 5.0 out of 5 stars Good to have Reviewed in the United States on May 2, 2023 Verified Purchase Great to have One person found this helpful Helpful Report Samuel Moore II 4.0 out of 5 stars Perfect Reviewed in the United States on February 12, 2022 Verified Purchase My father had a stroke in Dec 2021 He lost a little strength in his left hand, these were perfect for him. One person found this helpful Helpful Report Tikiroom2435 3.0 out of 5 stars No chart or label with firmness of each ball. Sticky to the touch. Okay for the price. Reviewed in the United States on January 8, 2020 Verified Purchase Ordered these balls for therapy after thumb ligament joint reconstruction surgery for osteoarthritis. Great price but you get what you pay for. The balls are good size for my small hands but they are sticky to the touch. The balls have imperfections which i can feel on my skin...weird. Was very disappointed the balls arrived with no chart or instructions stating the firmness of each color. The orange and yellow were so similar in firmness, I couldn’t tell which was which. My memory is not the best but hate I have to keep looking up the chart photo on the Amazon listing to see which is which. For the price, these are ok for me to start with but I think a cloth covered stress ball work better in my situation. 8 people found this helpful Helpful Report Litigator Rater 2.0 out of 5 stars No instructions for use of the product Reviewed in the United States on April 28, 2023 Verified Purchase I received three spheres of varying color and density, in a clear cellophane envelope. There were no instructions for use or maintenance. Inasmuch as these are advertised for exercise, it is unfair that the promotional instructions are not provided to the buyers of the product. I suppose the only way to see the ads on Amazon is through screen captures. Helpful Report Isbel feliz 5.0 out of 5 stars Excelente Reviewed in the United States on April 20, 2023 Verified Purchase Que llegaron intactas From the United States Robert F Anderson 1.0 out of 5 stars sticky lint traps that I dont even want to touch!!! Reviewed in the United States on February 14, 2024 Verified Purchase sticky lint traps that I dont even want to touch let alone exercise!!! Total waste of money. Helpful Report BILL SKEBECK 5.0 out of 5 stars Very nice product! Reviewed in the United States on October 23, 2022 Verified Purchase Satisfied with product. First package came empty but Amazon customer service immediately corrected this and sent the order very quickly and got the right package quickly....all good! One person found this helpful Helpful Report darknology 3.0 out of 5 stars Gummy Balls Reviewed in the United States on November 3, 2022 Verified Purchase They have a gummy/sticky feel, which I find unpleasant. They each have a different consistency - as advertised. I prefer the 2.5-inch ball that I have. Impressive colors, though. 2 people found this helpful Helpful Report G. Boehm 5.0 out of 5 stars Received my order a few days ago Reviewed in the United States on March 14, 2023 Verified Purchase It was what I wanted Helpful Report all way seen 5.0 out of 5 stars 3 different level of softness. perfect for elders Reviewed in the United States on February 10, 2023 Verified Purchase my mother likes these smaller size relief balls. 2 people found this helpful Helpful Report Sharon 3.0 out of 5 stars VERY SMALL Reviewed in the United States on July 22, 2021 Verified Purchase These balls are very small (even for a woman's hands) and they are sticky/slimy at first touch. After a bit of use (reluctantly) they do ""dry up"" somewhat. I needed to try them because I couldn't find ""stress balls"" anywhere locally and I need them for finger stiffness resulting from a broken wrist. I will likely return these when I find larger ones to buy from Amazon. Disappointed. 4 people found this helpful Helpful Report Richard B. 3.0 out of 5 stars Misleading Ad Reviewed in the United States on February 22, 2022 Verified Purchase Misleading, certainly shows what looks like a carry bag in the ad, but you don't get one. But the pic of a carry bag (look alike) swayed the decision to buy it. Why show something that is not included, unless you wanted to sway a person's choice. One person found this helpful Helpful Report SFR 4.0 out of 5 stars Works best for small hands Reviewed in the United States on December 10, 2021 Verified Purchase My hands are not small but the balls work okay. Helpful Report Karin M 4.0 out of 5 stars A decent option Reviewed in the United States on July 1, 2021 Verified Purchase I'm not really able to tell a difference in the strength on these, and they are just a bit too small. Helpful Report Kindle Customer 4.0 out of 5 stars Worth the money Reviewed in the United States on July 11, 2021 Verified Purchase These work well for what I needed them for help with my hands that have tendinitis From the United States Shmuelman 5.0 out of 5 stars I thought they would be too small... Reviewed in the United States on September 1, 2022 Verified Purchase but when I started using them they are just right. Very comfortable and addictive to use. Helpful Report Grace Laine 4.0 out of 5 stars Addictive Therapy Reviewed in the United States on August 24, 2020 Verified Purchase I need these for numbness in my hands and fingers and use them habitually, either squeezing them or rolling them in my palm for dexterity. There's a slight difference in thickness - mostly felt in the blue ball. They're addictive and helpful. One person found this helpful Helpful Report WildWest 5.0 out of 5 stars Do the job Reviewed in the United States on November 27, 2021 Verified Purchase Price point was great; definitely very different firmness. I used these after a bicep tendon reattachment and had the three for only a bit more than the kids tennis ball my physical therapist recommended. Helpful Report ARMANDO BALTAZAR 4.0 out of 5 stars Too small for a mans hand Reviewed in the United States on September 9, 2021 Verified Purchase The balls are too small for a mans hand Helpful Report mnt 5.0 out of 5 stars these are great Reviewed in the United States on April 26, 2021 Verified Purchase Only drawback is they don't come with the instructions for different exercises. Balls are nicely made and a great substance. Just started with the yellow, which is lightest resistance but appreciate having the others to upgrade to appropriately. They feel good to the touch. 2 people found this helpful Helpful Report SILKOAK 5.0 out of 5 stars good prodict Reviewed in the United States on February 15, 2022 Verified Purchase I ordered the balls to exercise my arthritic fingers and i do this numerous times a day. It will take awhile but hope it helps. Helpful Report Rainey 5.0 out of 5 stars Hand therapeutic exercise balls Reviewed in the United States on November 19, 2022 Verified Purchase These are just as good as the Gaiam products. One person found this helpful Helpful Report LZee 5.0 out of 5 stars Awesome Reviewed in the United States on May 30, 2022 Verified Purchase My Mom uses it for her arthritis. Her massage therapist had great comments about it. Mom is happy Helpful Report Vince D 5.0 out of 5 stars Does the job Reviewed in the United States on October 12, 2021 Verified Purchase I see reviews stating that there’s not much of a difference in resistance between the three. There’s a significant difference to someone rehabbing a hand injury. Well worth trying for the price. Helpful Report Mileyka 5.0 out of 5 stars Muy prácticas Reviewed in the United States on February 20, 2022 Verified Purchase Buena inversión porque no son muy grandes. Que se pueden llevar para cualquier lugar y así mantener ejercitadas las manos y dedos. From the United States Sue 4.0 out of 5 stars it works great for my needs Reviewed in the United States on March 25, 2021 Verified Purchase I like that it fits in my hands perfectly. Just firm enough to work my hands. Helpful Report L. Key 5.0 out of 5 stars Exercise for broken wrist Reviewed in the United States on September 14, 2021 Verified Purchase These are great to help a broken wrist heal! My wrist stopped hurting after I started using the ball! I highly recommend these to anyone who has broken their wrist!! Helpful Report Lorie 5.0 out of 5 stars These Reviewed in the United States on September 3, 2021 Verified Purchase These balls are so good to use because I have rheumatoid arthritis and it helps my hands so much. I need to strengthen my hands and this has helped so much. Helpful Report Amazon Customer 5.0 out of 5 stars Love them! Reviewed in the United States on November 11, 2020 Verified Purchase A teacher I work with had one and didn't know where to find it- I lucked up and these are exactly the same. I like this because it doesn't seem like you can break them, without actively using some sharp to do so. The middle schoolers I work with love using these! Helpful Report J G Stamps 5.0 out of 5 stars Great non slippery squeeze balls in bright colors Reviewed in the United States on December 18, 2020 Verified Purchase Bought these for my elderly mom who had a stroke and wanted to re-teach her left hand to grip. These are perfect for her, not slippery, brightly colored, and progressive strengths. Anybody wanting to build up grip and forearms will enjoy. Also stress relieving in 2020. One person found this helpful Helpful Report Betty C. Shaheen 5.0 out of 5 stars Therapy for hand Reviewed in the United States on July 26, 2022 Verified Purchase Good for therapy on hand.. Just right size for my hand. Helpful Report J. Hatch 3.0 out of 5 stars Too small Reviewed in the United States on March 12, 2022 Verified Purchase The balls seem to be good quality but they should be bigger to engage all fingers and thumb Helpful Report Kimmy in MD 5.0 out of 5 stars Great Exercise Tool! Reviewed in the United States on August 27, 2022 Verified Purchase Love these bands for working legs and glutes! Helpful Report May 5.0 out of 5 stars Good therapeutic item Reviewed in the United States on July 6, 2021 Verified Purchase Perfect item for my own home PT therapy . If you have had a broken hand in past or now, get this item to help with the therapy healing process Helpful Report Denise 3.0 out of 5 stars All the same? Reviewed in the United States on September 2, 2021 Verified Purchase Purchased these for a family member in rehab. I could not determine the different resistance levels they all felt the same. In the end he didn't use. Helpful Report From the United States Frank 4.0 out of 5 stars Good product Reviewed in the United States on May 20, 2021 Verified Purchase Good product. Very useful. Helpful Report Alicia G 5.0 out of 5 stars Good Reviewed in the United States on September 10, 2022 Verified Purchase Good exercise motivation Helpful Report DB 4.0 out of 5 stars good Reviewed in the United States on June 12, 2021 Verified Purchase worked well Helpful Report NonnaVO 5.0 out of 5 stars Just what my husband was looking for Reviewed in the United States on March 12, 2022 Verified Purchase Good value for the cost. Helpful with exercise of arthritic hands Helpful Report LW 3.0 out of 5 stars They work price is good. Reviewed in the United States on June 17, 2021 Verified Purchase They aren't marked so you know which size is the easiest to the hardest. Which makes it hard to know if you are using the right one. Helpful Report Barabara Sagraves 5.0 out of 5 stars Great for hand exercise Reviewed in the United States on September 18, 2021 Verified Purchase Husband has had shoulder surgery. These have kept his hand from swelling because he can’t move his shoulder or arm. Helpful Report Cindylou 3.0 out of 5 stars Okay Reviewed in the United States on April 26, 2022 Verified Purchase I was looking for something softer Helpful Report Alan 5.0 out of 5 stars These are just what I was looking for. The size is just right and they are easy to use. Reviewed in the United States on September 13, 2021 Verified Purchase These are just what I was looking for. The size is just right and they are easy to use. Helpful Report Fran 4.0 out of 5 stars Great hand massage Reviewed in the United States on April 10, 2021 Verified Purchase Great for arthritic hands Helpful Report 2004done 2.0 out of 5 stars 3 of the same Reviewed in the United States on January 9, 2021 Verified Purchase Not much difference in the three,, unless you don't like the color. Trying to rehab myself from a broken wrist, so practicing juggling is a fun part of it ( no, I can't juggle any longer, but couldn't before either as the saying goes). I AM able to deflect with fingertips' strength now, so it is working. I use a rolled up towel for flexing (which I thought these would work), but these are only for strength exercise. Can't really recommend them, other than for juggling (they're much better than using eggs). From the United States Karenv 5.0 out of 5 stars Great size and good resistance Reviewed in the United States on August 10, 2020 Verified Purchase These stress balls are smaller than I expected but they are actually perfect for my hand. The increasingly hard resistance is just what I need to strengthen my hand after a fracture. Helpful Report Jose V. 4.0 out of 5 stars good quality product for this price Reviewed in the United States on July 4, 2020 Verified Purchase Nice and easy to use. Good quality to this price Helpful Report Mark Ashworth 3.0 out of 5 stars Too small for my hands Reviewed in the United States on January 31, 2021 Verified Purchase I like the variation in resistance but they are too small for my hands which are not very large. I have to use two balls at a time which is awkward. Helpful Report i m irene 5.0 out of 5 stars Good for rehab in broken arm Reviewed in the United States on November 27, 2021 Verified Purchase Do not let animals get this. It is not a toy Helpful Report Nelson 5.0 out of 5 stars Strength ball Reviewed in the United States on March 16, 2022 Verified Purchase Fix in my plan very easily Helpful Report dave ratalsky 5.0 out of 5 stars Good Reviewed in the United States on August 7, 2021 Verified Purchase They’re round and squeezable. They do what they were made for. Enough said. Helpful Report rochelle conner 5.0 out of 5 stars good fit Reviewed in the United States on April 27, 2022 Verified Purchase none Helpful Report Bob D Weakley 5.0 out of 5 stars They are just I was looking for and I expected Reviewed in the United States on June 9, 2021 Verified Purchase I like the size of them and how easy to always have one on all the time. Helpful Report Drew 4.0 out of 5 stars Good Reviewed in the United States on October 30, 2020 Verified Purchase They do the job Helpful Report GL 5.0 out of 5 stars They do make a difference Reviewed in the United States on March 30, 2021 Verified Purchase When you do the exercises everyday there is a sizable difference. Also, just squeezing the ball is a good stress reliever From the United States Robert E Gauldin 5.0 out of 5 stars Great exercise balls. Reviewed in the United States on August 4, 2020 Verified Purchase I find the useful for hand exercises. They do feel a bit sticky but don't seem to p pick up any dirt. I'm very pleased with them. Helpful Report DebbieA 5.0 out of 5 stars Perfect in every way , and great to get hands strengthened Reviewed in the United States on September 4, 2019 Verified Purchase Perfect size, squeeze resistance, and can use for hours to help add dexterity to weakened hands! I would prefer that they all came in one zip top bag though, but overall these balls rock!! 8 people found this helpful Helpful Report Barbara 5.0 out of 5 stars very effective Reviewed in the United States on July 3, 2021 Verified Purchase The balls are very helpful for an exercise for my arthritic and neuropathy hands. Helpful Report K. Johansen 2.0 out of 5 stars Not recommended Reviewed in the United States on June 22, 2021 Verified Purchase Got these and was surprised at how small they are, so small that I doubt they would even be good for a kid. The difference in tension is also pretty bad, not much difference at all. Of course these are made in china. Will go back to the devices I was using, thought maybe these would be good, but I do not recommend them One person found this helpful Helpful Report James P. Bontrager 3.0 out of 5 stars Way to much wrapping! Reviewed in the United States on December 29, 2021 Verified Purchase Average Helpful Report Anthony 5.0 out of 5 stars Great for rehabilitation of the hand. Reviewed in the United States on October 10, 2020 Verified Purchase I bought these for my mother after she broke her wrist so she could rebuild strength in her hand and she loves them. Helpful Report Jesse 5.0 out of 5 stars Get them Reviewed in the United States on March 17, 2021 Verified Purchase Just had carpal tunnel surgery and this is getting my hand back to strength fast. Helpful Report adonais d. 5.0 out of 5 stars Están muy colada lo recomiendo Reviewed in the United States on August 14, 2021 Verified Purchase Me gusto muy suave para mis mano lo recomiendo Helpful Report Translate review to English stephanie D 5.0 out of 5 stars I haven’t used the balls very long, but they seem to help pain. Reviewed in the United States on April 1, 2020 Verified Purchase I am using the exercise balls to relieve the arthritis in my hands. I have trigger fingers on both hands and the exercise seems to help. One person found this helpful Helpful Report Customer 777 2.0 out of 5 stars Easy to bite in half for child or dementia patient so be careful Reviewed in the United States on November 16, 2022 Verified Purchase Easy to bite Chunks out be careful not for children or confused elderly",Retail/Product,Find & Summarize,Text Transformation Please only use information from the provided PDF to answer this prompt. Do not act like you are an expert in legal affairs in any way.,"Using the provided section of text below, please summarize the reasons for concurring and dissenting opinions.","Using the provided section of text below, please summarize the reasons for concurring and dissenting opinions. Concurring and Dissenting Opinions A majority of the Court—six Justices in total—wrote separately to concur or dissent, offering their individual views on how the Second Amendment and the Bruen standard should be properly interpreted both in this case and in future cases. Justice Sotomayor’s concurring opinion, joined by Justice Kagan, expressed her continued view that Bruen was wrongly decided and that a different legal standard should apply to Second Amendment cases.73 She wrote separately to emphasize that when applying the Bruen historical tradition standard, however, the majority’s methodology was the “right one.”74 In Justice Sotomayor’s view, this is an “easy case,” as § 922(g)(8) is “wholly consistent” with historical firearms regulations.75 By contrast, she criticized the dissenting view as too “rigid,” characterizing it as “insist[ing] that the means of addressing that problem cannot be ‘materially different’ from the means that existed in the eighteenth century,” which would unduly hamstring modern policy efforts.76 In his concurring opinion, Justice Gorsuch underscored the difficulty in maintaining a facial challenge to a law, which requires a showing that the law has no constitutional applications.77 He also defended the Bruen historical tradition standard, arguing that the original meaning of the Constitution, while “an imperfect guide,” provides proper constraints on judicial decisionmaking and is better than unbounded alternatives such as an interest-balancing inquiry.78 Justice Gorsuch also cautioned that the Court decided a narrow question—whether § 922(g)(3) “has any lawful scope”—and that future defendants could argue that § 922(g)(3) was unconstitutional under particular facts.79 69 Id. at 1901. 70 Id. at 1902. 71 Id. 72 Id. at 1903. 73 Id. at 1904 (Sotomayor, J., concurring). 74 Id. 75 Id. 76 Id. at 1905. 77 Id. at 1907 (Gorsuch, J., concurring). 78 Id. at 1909. 79 Id. at 1910. Supreme Court Term October 2023: A Review of Selected Major Rulings Congressional Research Service 8 Justice Kavanaugh concurred to expound his view on the roles of text, history, and precedent in constitutional interpretation. He explained that unambiguous text controls and that history, rather than policy, is a more neutral and principled guide for constitutional decisionmaking when the text is unclear.80 Using historical examples, Justice Kavanaugh illustrated his view on how preand post-ratification history may inform the meaning of vague constitutional text.81 Next, he argued that balancing tests in constitutional cases are a relatively recent development, generally depart from tests centered on text and history, are inherently subjective, and should not be extended to the Second Amendment arena.82 Finally, he opined that the majority’s opinion was faithful to his perception of the appropriate roles of text, history, and precedent in constitutional adjudication in this particular case.83 Justice Barrett wrote a concurring opinion to explain her understanding of the relationship between Bruen’s historical tradition test and originalism as a method of constitutional interpretation. In her view, historical tradition is a means to understand original meaning, and, accordingly, historical practice around the time of ratification should be the focus of the legal inquiry.84 In her view, history demonstrates that, “[s]ince the founding, our Nation’s firearm laws have included provisions preventing individuals who threaten physical harm to others from misusing firearms.” Justice Barrett agreed with the majority that § 922(g)(8) “fits well within that principle.”85 Justice Jackson also wrote a concurring opinion, agreeing that the majority fairly applied Bruen as precedent.86 She wrote separately to highlight what she perceived as problems with applying the history-and-tradition standard in a workable manner.87 She argued that Rahimi illustrates the “pitfalls of Bruen’s approach” by demonstrating the difficulty of sifting through the historical record and determining whether historical evidence establishes a tradition of sufficiently analogous regulation.88 The numerous unanswered questions that remain even after Rahimi, in her view, result in “the Rule of Law suffer[ing].”89 Stating that legal standards should “foster stability, facilitate consistency, and promote predictability,” Justice Jackson concluded by arguing that “Bruen’s history-focused test ticks none of those boxes.”90 Justice Thomas was the sole dissenter. In his view, the historical examples cited by the majority were not sufficient to establish a tradition of firearm regulation that justified § 922(g)(8).91 According to Justice Thomas, courts should look to two metrics to evaluate whether historical examples of regulation are analogous to modern enactments: “how and why the regulations burden a law-abiding citizen’s right to armed self-defense.”92 In his view, the two categories of evidence proffered by the government—historical laws disarming “dangerous” individuals and historical characterization of the right to bear arms as belonging only to “peaceable” citizens— 80 Id. at 1912 (Kavanaugh, J., concurring). 81 Id. at 1913–19. 82 Id. at 1921. 83 Id. at 1923. 84 Id. at 1924 (Barrett, J., concurring). 85 Id. at 1926 (quoting Rahimi, 144 S. Ct. at 1896 (majority opinion)). 86 Id. (Jackson, J., concurring). 87 Id. at 1928. 88 Id. 89 Id. at 1929. 90 Id. 91 Id. at 1930 (Thomas, J., dissenting). 92 Id. at 1931–32. Supreme Court Term October 2023: A Review of Selected Major Rulings Congressional Research Service 9 did not impose comparable burdens as § 922(g)(8).93 Justice Thomas argued that § 922(g)(8) was enacted in response to “interpersonal violence,” whereas the historical English laws were concerned with insurrection and rebellion.94 Ultimately, Rahimi could have been disarmed, in Justice Thomas’s view, through criminal conviction but not through a restraining order.95","Concurring and Dissenting Opinions A majority of the Court—six Justices in total—wrote separately to concur or dissent, offering their individual views on how the Second Amendment and the Bruen standard should be properly interpreted both in this case and in future cases. Justice Sotomayor’s concurring opinion, joined by Justice Kagan, expressed her continued view that Bruen was wrongly decided and that a different legal standard should apply to Second Amendment cases.73 She wrote separately to emphasize that when applying the Bruen historical tradition standard, however, the majority’s methodology was the “right one.”74 In Justice Sotomayor’s view, this is an “easy case,” as § 922(g)(8) is “wholly consistent” with historical firearms regulations.75 By contrast, she criticized the dissenting view as too “rigid,” characterizing it as “insist[ing] that the means of addressing that problem cannot be ‘materially different’ from the means that existed in the eighteenth century,” which would unduly hamstring modern policy efforts.76 In his concurring opinion, Justice Gorsuch underscored the difficulty in maintaining a facial challenge to a law, which requires a showing that the law has no constitutional applications.77 He also defended the Bruen historical tradition standard, arguing that the original meaning of the Constitution, while “an imperfect guide,” provides proper constraints on judicial decisionmaking and is better than unbounded alternatives such as an interest-balancing inquiry.78 Justice Gorsuch also cautioned that the Court decided a narrow question—whether § 922(g)(3) “has any lawful scope”—and that future defendants could argue that § 922(g)(3) was unconstitutional under particular facts.79 69 Id. at 1901. 70 Id. at 1902. 71 Id. 72 Id. at 1903. 73 Id. at 1904 (Sotomayor, J., concurring). 74 Id. 75 Id. 76 Id. at 1905. 77 Id. at 1907 (Gorsuch, J., concurring). 78 Id. at 1909. 79 Id. at 1910. Supreme Court Term October 2023: A Review of Selected Major Rulings Congressional Research Service 8 Justice Kavanaugh concurred to expound his view on the roles of text, history, and precedent in constitutional interpretation. He explained that unambiguous text controls and that history, rather than policy, is a more neutral and principled guide for constitutional decisionmaking when the text is unclear.80 Using historical examples, Justice Kavanaugh illustrated his view on how preand post-ratification history may inform the meaning of vague constitutional text.81 Next, he argued that balancing tests in constitutional cases are a relatively recent development, generally depart from tests centered on text and history, are inherently subjective, and should not be extended to the Second Amendment arena.82 Finally, he opined that the majority’s opinion was faithful to his perception of the appropriate roles of text, history, and precedent in constitutional adjudication in this particular case.83 Justice Barrett wrote a concurring opinion to explain her understanding of the relationship between Bruen’s historical tradition test and originalism as a method of constitutional interpretation. In her view, historical tradition is a means to understand original meaning, and, accordingly, historical practice around the time of ratification should be the focus of the legal inquiry.84 In her view, history demonstrates that, “[s]ince the founding, our Nation’s firearm laws have included provisions preventing individuals who threaten physical harm to others from misusing firearms.” Justice Barrett agreed with the majority that § 922(g)(8) “fits well within that principle.”85 Justice Jackson also wrote a concurring opinion, agreeing that the majority fairly applied Bruen as precedent.86 She wrote separately to highlight what she perceived as problems with applying the history-and-tradition standard in a workable manner.87 She argued that Rahimi illustrates the “pitfalls of Bruen’s approach” by demonstrating the difficulty of sifting through the historical record and determining whether historical evidence establishes a tradition of sufficiently analogous regulation.88 The numerous unanswered questions that remain even after Rahimi, in her view, result in “the Rule of Law suffer[ing].”89 Stating that legal standards should “foster stability, facilitate consistency, and promote predictability,” Justice Jackson concluded by arguing that “Bruen’s history-focused test ticks none of those boxes.”90 Justice Thomas was the sole dissenter. In his view, the historical examples cited by the majority were not sufficient to establish a tradition of firearm regulation that justified § 922(g)(8).91 According to Justice Thomas, courts should look to two metrics to evaluate whether historical examples of regulation are analogous to modern enactments: “how and why the regulations burden a law-abiding citizen’s right to armed self-defense.”92 In his view, the two categories of evidence proffered by the government—historical laws disarming “dangerous” individuals and historical characterization of the right to bear arms as belonging only to “peaceable” citizens— 80 Id. at 1912 (Kavanaugh, J., concurring). 81 Id. at 1913–19. 82 Id. at 1921. 83 Id. at 1923. 84 Id. at 1924 (Barrett, J., concurring). 85 Id. at 1926 (quoting Rahimi, 144 S. Ct. at 1896 (majority opinion)). 86 Id. (Jackson, J., concurring). 87 Id. at 1928. 88 Id. 89 Id. at 1929. 90 Id. 91 Id. at 1930 (Thomas, J., dissenting). 92 Id. at 1931–32. Supreme Court Term October 2023: A Review of Selected Major Rulings Congressional Research Service 9 did not impose comparable burdens as § 922(g)(8).93 Justice Thomas argued that § 922(g)(8) was enacted in response to “interpersonal violence,” whereas the historical English laws were concerned with insurrection and rebellion.94 Ultimately, Rahimi could have been disarmed, in Justice Thomas’s view, through criminal conviction but not through a restraining order.95",Legal,Summarize,Text Transformation This task requires that you answer the following question based solely on the information provided in the prompt and context block. You are not allowed to use any external resources or prior knowledge.,How did the introduction of the 16-bit Intel 8088 microprocessor contribute to the rise of personal computers in mainstream business use?,"The microprocessor, or CPU, as some people call it, is the brains of our personal computer. I’m getting into this history lesson not because I’m a history buff (though computers do have a wonderfully interesting past), but to go through the development step-by-step to explain how they work. Well, not everything about how they work, but enough to understand the importance of the latest features and what they do for you. It’s going to take more than one article to dig into the inner secrets of microprocessors. I hope it’s an interesting read for you and helps you recognize computer buzzwords when you’re making your next computer purchase. 1. Where Did CPUs Come From? When the 1970s dawned, computers were still monster machines hidden in air-conditioned rooms and attended to by technicians in white lab coats. One component of a mainframe computer, as they were known, was the CPU, or Central Processing Unit. This was a steel cabinet bigger than a refrigerator full of circuit boards crowded with transistors. Computers had only recently been converted from vacuum tubes to transistors and only the very latest machines used primitive integrated circuits where a few transistors were gathered in one package. That means the CPU was a big pile of equipment. The thought that the CPU could be reduced to a chip of silicon the size of your fingernail was the stuff of science fiction. 2. How Does a CPU Work? In the '40s, mathematicians John Von Neumann, J. Presper Eckert and John Mauchly came up with the concept of the stored instruction digital computer. Before then, computers were programmed by rewiring their circuits to perform a certain calculation over and over. By having a memory and storing a set of instructions that can be performed over and over, as well as logic to vary the path of instruction, execution programmable computers were possible. The component of the computer that fetches the instructions and data from the memory and carries out the instructions in the form of data manipulation and numerical calculations is called the CPU. It’s central because all the memory and the input/output devices must connect to the CPU, so it’s only natural to keep the cables short to put the CPU in the middle. It does all the instruction execution and number calculations so it’s called the Processing Unit. The CPU has a program counter that points to the next instruction to be executed. It goes through a cycle where it retrieves, from memory, the instructions in the program counter. It then retrieves the required data from memory, performs the calculation indicated by the instruction and stores the result. The program counter is incremented to point to the next instruction and the cycle starts all over. 3. The First Microprocessor In 1971 when the heavy iron mainframe computers still ruled, a small Silicon Valley company was contracted to design an integrated circuit for a business calculator for Busicom. Instead of hardwired calculations like other calculator chips of the day, this one was designed as a tiny CPU that could be programmed to perform almost any calculation. The expensive and time-consuming work of designing a custom wired chip was replaced by the flexible 4004 microprocessor and the instructions stored in a separate ROM (Read Only Memory) chip. A new calculator with entirely new features can be created simply by programming a new ROM chip. The company that started this revolution was Intel Corporation. The concept of a general purpose CPU chip grew up to be the microprocessor that is the heart of your powerful PC. 4. 4 Bits Isn’t Enough The original 4004 microprocessor chip handled data in four bit chunks. Four bits gives you sixteen possible numbers, enough to handle standard decimal arithmetic for a calculator. If it were only the size of the numbers we calculate with, we might still be using four bit microprocessors. The problem is that there is another form of calculation a stored instruction computer needs to do. That is it has to figure out where in memory instructions are. In other words, it has to calculate memory locations to process program branch instructions or to index into tables of data. Like I said, four bits only gets you sixteen possibilities and even the 4004 needed to address 640 bytes of memory to handle calculator functions. Modern microprocessor chips like the Intel Pentium 4 can address 18,446,744,073,709,551,616 bytes of memory, though the motherboard is limited to less than this total. This led to the push for more bits in our microprocessors. We are now on the fence between 32 bit microprocessors and 64 bit monsters like the AMD Athlon 64. 5. The First Step Up, 8 Bits With a total memory address space of 640 bytes, the Intel 4004 chip was not the first microprocessor to be the starting point for a personal computer. In 1972, Intel delivered the 8008, a scaled up 4004. The 8008 was the first of many 8- bit microprocessors to fuel the home computer revolution. It was limited to only 16 Kilobytes of address space, but in those days no one could afford that much RAM. Two years later, Intel introduced the 8080 microprocessor with 64 Kilobytes of memory space and increased the rate of execution by a factor of ten over the 8008. About this time, Motorola brought out the 6800 with similar performance. The 8080 became the core of serious microcomputers that led to the Intel 8088 used in the IBM PC, while the 6800 family headed in the direction of the Apple II personal computer. 6. 16 Bits Enables the IBM PC By the late '70s, the personal computer was bursting at the seams of the 8 bit microprocessor performance. In 1979, Intel delivered the 8088 and IBM engineers used it for the first PC. The combination of the new 16 bit microprocessor and the name IBM shifted the personal computer from a techie toy in the garage to a mainstream business tool. The major advantage of the 8086 was up to 1 Megabyte of memory addressing. Now, large spreadsheets or large documents could be read in from the disk and held in RAM memory for fast access and manipulation. These days, it’s not uncommon to have a thousand times more than that in a single 1 Gigabyte RAM Module, but back in that time it put the IBM PC in the same league with minicomputers the size of a refrigerator. 7. Cache RAM, Catching Up With the CPU We’ll have to continue the march through the lineup of microprocessors in the next installment to make way for the first of the enhancements that you should understand. With memory space expanding and the speed of microprocessor cores going ever faster, there was a problem of the memory keeping up. Large low-powered memories cannot go as fast as smaller higher power RAM chips. To keep the fastest CPUs running full speed, microprocessor engineers started inserting a few of the fast and small memories between the main large RAM and the microprocessor. The purpose of this smaller memory is to hold instructions that get repeatedly executed or data that is accessed often. This smaller memory is called cache RAM and allows the microprocessor to execute at full speed. Naturally, the larger the cache RAM the higher percentage of cache hits and the microprocessor can continue running full speed. When the program execution leads to instructions not in the cache, then the instructions need to be fetched from the main memory and the microprocessor has to stop and wait. 8. Cache Grows Up The idea of cache RAM has grown along with the size and complexity of microprocessor chips. A high-end Pentium 4has 2 Megabytes of cache RAM built into the chip. That’s more than twice the entire memory address space of the original 8088 chip used in the first PC and clones. Putting the cache right on the microprocessor itself removes the slowdown of the wires between chips. You know you are going fast when the speed of light for a few inches makes a difference!","System instruction: [This task requires that you answer the following question based solely on the information provided in the prompt and context block. You are not allowed to use any external resources or prior knowledge. ] Question: [How did the introduction of the 16-bit Intel 8088 microprocessor contribute to the rise of personal computers in mainstream business use?] Context: [The microprocessor, or CPU, as some people call it, is the brains of our personal computer. I’m getting into this history lesson not because I’m a history buff (though computers do have a wonderfully interesting past), but to go through the development step-by-step to explain how they work. Well, not everything about how they work, but enough to understand the importance of the latest features and what they do for you. It’s going to take more than one article to dig into the inner secrets of microprocessors. I hope it’s an interesting read for you and helps you recognize computer buzzwords when you’re making your next computer purchase. 1. Where Did CPUs Come From? When the 1970s dawned, computers were still monster machines hidden in air-conditioned rooms and attended to by technicians in white lab coats. One component of a mainframe computer, as they were known, was the CPU, or Central Processing Unit. This was a steel cabinet bigger than a refrigerator full of circuit boards crowded with transistors. Computers had only recently been converted from vacuum tubes to transistors and only the very latest machines used primitive integrated circuits where a few transistors were gathered in one package. That means the CPU was a big pile of equipment. The thought that the CPU could be reduced to a chip of silicon the size of your fingernail was the stuff of science fiction. 2. How Does a CPU Work? In the '40s, mathematicians John Von Neumann, J. Presper Eckert and John Mauchly came up with the concept of the stored instruction digital computer. Before then, computers were programmed by rewiring their circuits to perform a certain calculation over and over. By having a memory and storing a set of instructions that can be performed over and over, as well as logic to vary the path of instruction, execution programmable computers were possible. The component of the computer that fetches the instructions and data from the memory and carries out the instructions in the form of data manipulation and numerical calculations is called the CPU. It’s central because all the memory and the input/output devices must connect to the CPU, so it’s only natural to keep the cables short to put the CPU in the middle. It does all the instruction execution and number calculations so it’s called the Processing Unit. The CPU has a program counter that points to the next instruction to be executed. It goes through a cycle where it retrieves, from memory, the instructions in the program counter. It then retrieves the required data from memory, performs the calculation indicated by the instruction and stores the result. The program counter is incremented to point to the next instruction and the cycle starts all over. 3. The First Microprocessor In 1971 when the heavy iron mainframe computers still ruled, a small Silicon Valley company was contracted to design an integrated circuit for a business calculator for Busicom. Instead of hardwired calculations like other calculator chips of the day, this one was designed as a tiny CPU that could be programmed to perform almost any calculation. The expensive and time-consuming work of designing a custom wired chip was replaced by the flexible 4004 microprocessor and the instructions stored in a separate ROM (Read Only Memory) chip. A new calculator with entirely new features can be created simply by programming a new ROM chip. The company that started this revolution was Intel Corporation. The concept of a general purpose CPU chip grew up to be the microprocessor that is the heart of your powerful PC. 4. 4 Bits Isn’t Enough The original 4004 microprocessor chip handled data in four bit chunks. Four bits gives you sixteen possible numbers, enough to handle standard decimal arithmetic for a calculator. If it were only the size of the numbers we calculate with, we might still be using four bit microprocessors. The problem is that there is another form of calculation a stored instruction computer needs to do. That is it has to figure out where in memory instructions are. In other words, it has to calculate memory locations to process program branch instructions or to index into tables of data. Like I said, four bits only gets you sixteen possibilities and even the 4004 needed to address 640 bytes of memory to handle calculator functions. Modern microprocessor chips like the Intel Pentium 4 can address 18,446,744,073,709,551,616 bytes of memory, though the motherboard is limited to less than this total. This led to the push for more bits in our microprocessors. We are now on the fence between 32 bit microprocessors and 64 bit monsters like the AMD Athlon 64. 5. The First Step Up, 8 Bits With a total memory address space of 640 bytes, the Intel 4004 chip was not the first microprocessor to be the starting point for a personal computer. In 1972, Intel delivered the 8008, a scaled up 4004. The 8008 was the first of many 8- bit microprocessors to fuel the home computer revolution. It was limited to only 16 Kilobytes of address space, but in those days no one could afford that much RAM. Two years later, Intel introduced the 8080 microprocessor with 64 Kilobytes of memory space and increased the rate of execution by a factor of ten over the 8008. About this time, Motorola brought out the 6800 with similar performance. The 8080 became the core of serious microcomputers that led to the Intel 8088 used in the IBM PC, while the 6800 family headed in the direction of the Apple II personal computer. 6. 16 Bits Enables the IBM PC By the late '70s, the personal computer was bursting at the seams of the 8 bit microprocessor performance. In 1979, Intel delivered the 8088 and IBM engineers used it for the first PC. The combination of the new 16 bit microprocessor and the name IBM shifted the personal computer from a techie toy in the garage to a mainstream business tool. The major advantage of the 8086 was up to 1 Megabyte of memory addressing. Now, large spreadsheets or large documents could be read in from the disk and held in RAM memory for fast access and manipulation. These days, it’s not uncommon to have a thousand times more than that in a single 1 Gigabyte RAM Module, but back in that time it put the IBM PC in the same league with minicomputers the size of a refrigerator. 7. Cache RAM, Catching Up With the CPU We’ll have to continue the march through the lineup of microprocessors in the next installment to make way for the first of the enhancements that you should understand. With memory space expanding and the speed of microprocessor cores going ever faster, there was a problem of the memory keeping up. Large low-powered memories cannot go as fast as smaller higher power RAM chips. To keep the fastest CPUs running full speed, microprocessor engineers started inserting a few of the fast and small memories between the main large RAM and the microprocessor. The purpose of this smaller memory is to hold instructions that get repeatedly executed or data that is accessed often. This smaller memory is called cache RAM and allows the microprocessor to execute at full speed. Naturally, the larger the cache RAM the higher percentage of cache hits and the microprocessor can continue running full speed. When the program execution leads to instructions not in the cache, then the instructions need to be fetched from the main memory and the microprocessor has to stop and wait. 8. Cache Grows Up The idea of cache RAM has grown along with the size and complexity of microprocessor chips. A high-end Pentium 4has 2 Megabytes of cache RAM built into the chip. That’s more than twice the entire memory address space of the original 8088 chip used in the first PC and clones. Putting the cache right on the microprocessor itself removes the slowdown of the wires between chips. You know you are going fast when the speed of light for a few inches makes a difference!]",Internet/Technology,Fact Finding,Q&A You can only respond to the prompt using the information in the context block and no other sources.,Write a summary of all of the benefits and concerns of artificial intelligence development and use.,"In recent years, the Administration and Congress have been increasingly engaged in supporting artificial intelligence R&D and working to address policy concerns arising from AI development and use. Congressional activities focused on AI increased substantially in the 116th and 117th Congresses, including multiple committee hearings in the House and Senate, the introduction of numerous AI-focused bills, and the passage of AI provisions in legislation. Enacted legislation has included the National AI Initiative Act of 2020 within the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 (P.L. 116-283); the AI in Government Act of 2020 within the Consolidated Appropriations Act, 2021 (P.L. 116-260); and provisions focused on AI activities at NSF, DOE, and NIST within P.L. 117-167, the CHIPS and Science Act. AI holds potential benefits and opportunities, such as through augmenting human decisionmaking and optimizing performance for complex tasks. It also presents challenges and pitfalls, such as through perpetuating or amplifying bias and failing in unexpected ways. The ready availability in 2022 of software (i.e., ChatGPT) that can intelligently (1) respond to questions, and (2) draft prose documents may represent a sentinel event in popular use of AI. There are several broad concerns related to AI, spanning multiple sectors, that could be considered in the 118th Congress. These include Congressional Research Service 45 Science and Technology Issues for the 118th Congress • the impact of AI and AI-driven automation on the workforce, including potential job losses and the need for worker retraining; • the challenges of educating students in AI, from teaching foundational concepts at the K-12 level to supporting doctoral-level training to meet increasing demand for AI expertise; • the balance of federal and private sector funding for AI; • whether and how to increase access to public datasets to train AI systems for use in the public and private sectors; • the development of standards and testing protocols and algorithmic auditing capabilities for AI systems; • the need for and effectiveness of federal and international coordination efforts in AI, as well as concerns over international competition in AI R&D and deployment; and • the incorporation of ethics, privacy, security, transparency, and accountability considerations in AI systems, including such applications as facial recognition technologies. There are additional national security concerns about the potential use of AI technologies that Congress could address, such as the potential for “deep fakes” to influence elections and erode public trust, the balance of human and automated decisionmaking in military operations, and concerns about the dissemination of U.S.-developed AI technologies and federally funded AI research results to potential competitors or adversaries.","You can only respond to the prompt using the information in the context block and no other sources. Write a summary of all of the benefits and concerns of artificial intelligence development and use. In recent years, the Administration and Congress have been increasingly engaged in supporting artificial intelligence R&D and working to address policy concerns arising from AI development and use. Congressional activities focused on AI increased substantially in the 116th and 117th Congresses, including multiple committee hearings in the House and Senate, the introduction of numerous AI-focused bills, and the passage of AI provisions in legislation. Enacted legislation has included the National AI Initiative Act of 2020 within the William M. (Mac) Thornberry National Defense Authorization Act for Fiscal Year 2021 (P.L. 116-283); the AI in Government Act of 2020 within the Consolidated Appropriations Act, 2021 (P.L. 116-260); and provisions focused on AI activities at NSF, DOE, and NIST within P.L. 117-167, the CHIPS and Science Act. AI holds potential benefits and opportunities, such as through augmenting human decisionmaking and optimizing performance for complex tasks. It also presents challenges and pitfalls, such as through perpetuating or amplifying bias and failing in unexpected ways. The ready availability in 2022 of software (i.e., ChatGPT) that can intelligently (1) respond to questions, and (2) draft prose documents may represent a sentinel event in popular use of AI. There are several broad concerns related to AI, spanning multiple sectors, that could be considered in the 118th Congress. These include Congressional Research Service 45 Science and Technology Issues for the 118th Congress • the impact of AI and AI-driven automation on the workforce, including potential job losses and the need for worker retraining; • the challenges of educating students in AI, from teaching foundational concepts at the K-12 level to supporting doctoral-level training to meet increasing demand for AI expertise; • the balance of federal and private sector funding for AI; • whether and how to increase access to public datasets to train AI systems for use in the public and private sectors; • the development of standards and testing protocols and algorithmic auditing capabilities for AI systems; • the need for and effectiveness of federal and international coordination efforts in AI, as well as concerns over international competition in AI R&D and deployment; and • the incorporation of ethics, privacy, security, transparency, and accountability considerations in AI systems, including such applications as facial recognition technologies. There are additional national security concerns about the potential use of AI technologies that Congress could address, such as the potential for “deep fakes” to influence elections and erode public trust, the balance of human and automated decisionmaking in military operations, and concerns about the dissemination of U.S.-developed AI technologies and federally funded AI research results to potential competitors or adversaries.",Internet/Technology,Pros & Cons,Q&A You must draw your answer from the below text only. You must not use any outside resources or prior knowledge. Limit your answer to 100 words or fewer.,What is the deeming rule?,"Circuit Split over the Food and Drug Administration’s Denial of Applications Seeking to Market Flavored E-Cigarettes, Part 1 of 2 April 5, 2024 Electronic nicotine delivery system (ENDS) products—products that go by many common names, such as e-cigarettes and vape pens—are generally required to receive prior authorization from the Food and Drug Administration (FDA) before they can be lawfully marketed in the United States. Before FDA issued regulations in 2016 to subject these products to the premarket review process, however, many of them were already being sold on the U.S. market and were allowed to remain there while FDA implemented the application and review process. These products come in a variety of forms and flavors, from tobacco and menthol flavors based on the flavors of traditional combustible cigarettes to other flavors based on the flavors of fruit, candy, and other sweets (“flavored ENDS products”). While limited studies of certain ENDS products show that they contain substantially lower levels of toxins than combustible cigarettes, indicating a benefit to current adult smokers who switch completely to using ENDS products, flavored ENDS products have been shown to be particularly attractive to youth. In a 2016-2017 study, for instance, 93.2% of youth ENDS product users reported that their first use was with a flavored product. In 2018, the Surgeon General issued an advisory on the “e-cigarette epidemic among youth.” Since the initial deadline in September 2020 for ENDS product manufacturers to submit their premarket tobacco product applications (PMTAs), FDA has received millions of applications for ENDS products. To date, the agency has authorized 23 tobacco-flavored ENDS products for lawful marketing and has not authorized any flavored ENDS products. Many applicants that have received a marketing denial order (MDO) for their flavored ENDS products have filed petitions in U.S. Courts of Appeals throughout the country to challenge the denial of their PMTAs. Of the courts that have considered these petitions, the Second, Third, Fourth, Sixth, Seventh, Ninth, Tenth, and D.C. Circuits have sided with FDA and denied the petitions or requests to stay the agency’s MDOs. The Eleventh and Fifth Circuits, on the other hand, have sided with the ENDS manufacturers and vacated FDA’s MDOs, remanding the applications to FDA for reconsideration. This circuit split sets the stage for potential Supreme Court review regarding what information FDA may require applicants seeking to market flavored ENDS products to provide as part of Congressional Research Service https://crsreports.congress.gov LSB11141 Congressional Research Service 2 their PMTAs. This two-part Sidebar examines the circuit split. Part I provides an overview of the Family Smoking Prevention and Tobacco Control Act (TCA) regulatory framework, relevant FDA actions related to ENDS products, and the agency’s review and denial of the PMTAs involving flavored ENDS products. Part II provides an overview of the litigation challenging those FDA orders, the court decisions to date, and certain preliminary observations for consideration by Congress. Background on TCA’s Statutory Framework In 2009, Congress enacted the TCA, which established the central federal regulatory regime for the manufacture, marketing, and distribution of tobacco products. Among other things, the TCA required all new tobacco products—that is, those not commercially marketed in the United States prior to February 15, 2007—to receive prior authorization from FDA before they can be marketed to the public. In establishing this regulatory regime, the TCA aims to balance competing interests in protecting the public’s health against the harmful effects of smoking and youth tobacco use, while preserving access to lawfully marketed tobacco products for adult consumers. To further this goal, the TCA grants FDA “primary Federal regulatory authority” over tobacco products and establishes a premarket review process for new tobacco products. Such products generally may not be marketed until the manufacturer submits a PMTA and receives a marketing granted order (MGO) from the Center for Tobacco Products, established within FDA to implement the TCA. The TCA permits FDA to issue an MGO only upon certain findings, including a conclusion that “permitting such tobacco product to be marketed would be appropriate for the protection of the public health,” or APPH. This APPH determination must be made “with respect to the risks and benefits to the population as a whole, including users and nonusers of the tobacco product,” taking into account the likelihood that existing users of tobacco products will stop using such products and the likelihood that those who do not use such products will start using them. The TCA directs FDA, in making this evaluation, to consult a range of evidence, including “information submitted to the Secretary as part of the [PMTA] and any other information before the Secretary with respect to such tobacco product.” Such information may include “when appropriate . . . well-controlled investigations, which may include 1 or more clinical investigations by experts qualified by training and experience to evaluate the tobacco product,” as well as other “valid scientific evidence” determined by the Secretary to be sufficient to evaluate the tobacco product. While the TCA explicitly applies to cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco, the statute also authorizes FDA to deem other tobacco products subject to the law. In 2016, FDA invoked this authority and promulgated what is known as the Deeming Rule, which subjected ENDS products to the TCA’s regulatory regime. ","You must draw your answer from the below text only. You must not use any outside resources or prior knowledge. Limit your answer to 100 words or fewer. Circuit Split over the Food and Drug Administration’s Denial of Applications Seeking to Market Flavored E-Cigarettes, Part 1 of 2 April 5, 2024 Electronic nicotine delivery system (ENDS) products—products that go by many common names, such as e-cigarettes and vape pens—are generally required to receive prior authorization from the Food and Drug Administration (FDA) before they can be lawfully marketed in the United States. Before FDA issued regulations in 2016 to subject these products to the premarket review process, however, many of them were already being sold on the U.S. market and were allowed to remain there while FDA implemented the application and review process. These products come in a variety of forms and flavors, from tobacco and menthol flavors based on the flavors of traditional combustible cigarettes to other flavors based on the flavors of fruit, candy, and other sweets (“flavored ENDS products”). While limited studies of certain ENDS products show that they contain substantially lower levels of toxins than combustible cigarettes, indicating a benefit to current adult smokers who switch completely to using ENDS products, flavored ENDS products have been shown to be particularly attractive to youth. In a 2016-2017 study, for instance, 93.2% of youth ENDS product users reported that their first use was with a flavored product. In 2018, the Surgeon General issued an advisory on the “e-cigarette epidemic among youth.” Since the initial deadline in September 2020 for ENDS product manufacturers to submit their premarket tobacco product applications (PMTAs), FDA has received millions of applications for ENDS products. To date, the agency has authorized 23 tobacco-flavored ENDS products for lawful marketing and has not authorized any flavored ENDS products. Many applicants that have received a marketing denial order (MDO) for their flavored ENDS products have filed petitions in U.S. Courts of Appeals throughout the country to challenge the denial of their PMTAs. Of the courts that have considered these petitions, the Second, Third, Fourth, Sixth, Seventh, Ninth, Tenth, and D.C. Circuits have sided with FDA and denied the petitions or requests to stay the agency’s MDOs. The Eleventh and Fifth Circuits, on the other hand, have sided with the ENDS manufacturers and vacated FDA’s MDOs, remanding the applications to FDA for reconsideration. This circuit split sets the stage for potential Supreme Court review regarding what information FDA may require applicants seeking to market flavored ENDS products to provide as part of Congressional Research Service https://crsreports.congress.gov LSB11141 Congressional Research Service 2 their PMTAs. This two-part Sidebar examines the circuit split. Part I provides an overview of the Family Smoking Prevention and Tobacco Control Act (TCA) regulatory framework, relevant FDA actions related to ENDS products, and the agency’s review and denial of the PMTAs involving flavored ENDS products. Part II provides an overview of the litigation challenging those FDA orders, the court decisions to date, and certain preliminary observations for consideration by Congress. Background on TCA’s Statutory Framework In 2009, Congress enacted the TCA, which established the central federal regulatory regime for the manufacture, marketing, and distribution of tobacco products. Among other things, the TCA required all new tobacco products—that is, those not commercially marketed in the United States prior to February 15, 2007—to receive prior authorization from FDA before they can be marketed to the public. In establishing this regulatory regime, the TCA aims to balance competing interests in protecting the public’s health against the harmful effects of smoking and youth tobacco use, while preserving access to lawfully marketed tobacco products for adult consumers. To further this goal, the TCA grants FDA “primary Federal regulatory authority” over tobacco products and establishes a premarket review process for new tobacco products. Such products generally may not be marketed until the manufacturer submits a PMTA and receives a marketing granted order (MGO) from the Center for Tobacco Products, established within FDA to implement the TCA. The TCA permits FDA to issue an MGO only upon certain findings, including a conclusion that “permitting such tobacco product to be marketed would be appropriate for the protection of the public health,” or APPH. This APPH determination must be made “with respect to the risks and benefits to the population as a whole, including users and nonusers of the tobacco product,” taking into account the likelihood that existing users of tobacco products will stop using such products and the likelihood that those who do not use such products will start using them. The TCA directs FDA, in making this evaluation, to consult a range of evidence, including “information submitted to the Secretary as part of the [PMTA] and any other information before the Secretary with respect to such tobacco product.” Such information may include “when appropriate . . . well-controlled investigations, which may include 1 or more clinical investigations by experts qualified by training and experience to evaluate the tobacco product,” as well as other “valid scientific evidence” determined by the Secretary to be sufficient to evaluate the tobacco product. While the TCA explicitly applies to cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco, the statute also authorizes FDA to deem other tobacco products subject to the law. In 2016, FDA invoked this authority and promulgated what is known as the Deeming Rule, which subjected ENDS products to the TCA’s regulatory regime. QUESTION What is the deeming rule?",Legal,Explanation/Definition,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Currently learning about IoT it implementations, use cases and so on. How it impact our lives and industries. What industries, technologies implement this and what benefits we receive from them? What are some examples where this technology is used? Explain in less than 500 words.","What is the Internet of Things (IoT)? The term IoT, or Internet of Things, refers to the collective network of connected devices and the technology that facilitates communication between devices and the cloud, as well as between the devices themselves. Thanks to the advent of inexpensive computer chips and high bandwidth telecommunication, we now have billions of devices connected to the internet. This means everyday devices like toothbrushes, vacuums, cars, and machines can use sensors to collect data and respond intelligently to users. The Internet of Things integrates everyday “things” with the internet. Computer Engineers have been adding sensors and processors to everyday objects since the 90s. However, progress was initially slow because the chips were big and bulky. Low power computer chips called RFID tags were first used to track expensive equipment. As computing devices shrank in size, these chips also became smaller, faster, and smarter over time. The cost of integrating computing power into small objects has now dropped considerably. For example, you can add connectivity with Alexa voice services capabilities to MCUs with less than 1MB embedded RAM, such as for light switches. A whole industry has sprung up with a focus on filling our homes, businesses, and offices with IoT devices. These smart objects can automatically transmit data to and from the Internet. All these “invisible computing devices” and the technology associated with them are collectively referred to as the Internet of Things. How does IoT work? A typical IoT system works through the real-time collection and exchange of data. An IoT system has three components: Smart devices This is a device, like a television, security camera, or exercise equipment that has been given computing capabilities. It collects data from its environment, user inputs, or usage patterns and communicates data over the internet to and from its IoT application. IoT application An IoT application is a collection of services and software that integrates data received from various IoT devices. It uses machine learning or artificial intelligence (AI) technology to analyze this data and make informed decisions. These decisions are communicated back to the IoT device and the IoT device then responds intelligently to inputs. A graphical user interface The IoT device or fleet of devices can be managed through a graphical user interface. Common examples include a mobile application or website that can be used to register and control smart devices. What are examples of IoT devices? Let’s look at some examples of IoT systems in use today: Connected cars There are many ways vehicles, such as cars, can be connected to the internet. It can be through smart dashcams, infotainment systems, or even the vehicle's connected gateway. They collect data from the accelerator, brakes, speedometer, odometer, wheels, and fuel tanks to monitor both driver performance and vehicle health. Connected cars have a range of uses: Monitoring rental car fleets to increase fuel efficiency and reduce costs. Helping parents track the driving behavior of their children. Notifying friends and family automatically in case of a car crash. Predicting and preventing vehicle maintenance needs. Connected homes Smart home devices are mainly focused on improving the efficiency and safety of the house, as well as improving home networking. Devices like smart outlets monitor electricity usage and smart thermostats provide better temperature control. Hydroponic systems can use IoT sensors to manage the garden while IoT smoke detectors can detect tobacco smoke. Home security systems like door locks, security cameras, and water leak detectors can detect and prevent threats, and send alerts to homeowners. Connected devices for the home can be used for: Automatically turning off devices not being used. Rental property management and maintenance. Finding misplaced items like keys or wallets. Automating daily tasks like vacuuming, making coffee, etc. Smart cities IoT applications have made urban planning and infrastructure maintenance more efficient. Governments are using IoT applications to tackle problems in infrastructure, health, and the environment. IoT applications can be used for: Measuring air quality and radiation levels. Reducing energy bills with smart lighting systems. Detecting maintenance needs for critical infrastructures such as streets, bridges, and pipelines. Increasing profits through efficient parking management. Smart buildings Buildings such as college campuses and commercial buildings use IoT applications to drive greater operational efficiencies. IoT devices can be use in smart buildings for: Reducing energy consumption. Lowering maintenance costs. Utilizing work spaces more efficiently. What is Industrial IoT? Industrial IoT (IIoT) refers to smart devices used in manufacturing, retail, health, and other enterprises to create business efficiencies. Industrial devices, from sensors to equipment, give business owners detailed, real-time data that can be used to improve business processes. They provide insights on supply chain management, logistics, human resource, and production – decreasing costs and increasing revenue streams. Let’s look at existing smart industrial systems in different verticals: Manufacturing Enterprise IoT in manufacturing uses predictive maintenance to reduce unplanned downtime and wearable technology to improve worker safety. IoT applications can predict machine failure before it happens, reducing production downtime. Wearables in helmets and wristbands, as well as computer vision cameras, are used to warn workers about potential hazards. Automobile Sensor-driven analytics and robotics increase efficiency in automobile manufacturing and maintenance. For example, industrial sensors are used to provide 3D real-time images of internal vehicle components. Diagnostics and troubleshooting can be done much faster while the IoT system orders replacement parts automatically. Logistics and transport Commercial and Industrial IoT devices can help with supply chain management, including inventory management, vendor relationships, fleet management, and scheduled maintenance. Shipping companies use Industrial IoT applications to keep track of assets and optimize fuel consumption on shipping routes. The technology is especially useful for tight temperature control in refrigerated containers. Supply chain managers make informed predictions through smart routing and rerouting algorithms. Retail Amazon is driving innovation in automation and human-machine collaboration in retail. Amazon facilities make use of internet-connected robots for tracking, locating, sorting, and moving products. How can IoT improve our lives? The Internet of Things has a wide-ranging impact on human life and work. It allows machines to do more heavy lifting, take over tedious tasks and make life more healthy, productive, and comfortable. For example, connected devices could change your entire morning routine. When you hit the snooze button, your alarm clock would automatically get the coffee machine to turn on and open your window blinds. Your refrigerator would auto-detect finishing groceries and order them for home delivery. Your smart oven would tell you the menu for the day — it might even cook pre-assembled ingredients and make sure your lunch is ready. Your smartwatch will schedule meetings as your connected car automatically sets the GPS to stop for a fuel refill. The opportunities are endless in an IoT world! What are the benefits of IoT for business? Accelerate innovation The Internet of Things gives businesses access to advanced analytics that uncover new opportunities. For example, businesses can create highly targeted advertising campaigns by collecting data on customer behavior. Turn data into insights and actions with AI and ML Collected data and historical trends can be used to predict future outcomes. For example, warranty information can be paired with IoT-collected data to predict maintenance incidents. This can be used to proactively provide customer service and build customer loyalty. Increase security Continuous monitoring of digital and physical infrastructure can optimize performance, improve efficiency and reduce safety risks. For example, data collected from an onsite monitor can be combined with hardware and firmware version data to automatically schedule system updates. Scale differentiated solutions IoT technologies can be deployed in a customer focused way to increase satisfaction. For example, trending products can be restocked promptly to avoid shortages.","[question] Currently learning about IoT it implementations, use cases and so on. How it impact our lives and industries. What industries, technologies implement this and what benefits we receive from them? What are some examples where this technology is used? Explain in less than 500 words. ===================== [text] What is the Internet of Things (IoT)? The term IoT, or Internet of Things, refers to the collective network of connected devices and the technology that facilitates communication between devices and the cloud, as well as between the devices themselves. Thanks to the advent of inexpensive computer chips and high bandwidth telecommunication, we now have billions of devices connected to the internet. This means everyday devices like toothbrushes, vacuums, cars, and machines can use sensors to collect data and respond intelligently to users. The Internet of Things integrates everyday “things” with the internet. Computer Engineers have been adding sensors and processors to everyday objects since the 90s. However, progress was initially slow because the chips were big and bulky. Low power computer chips called RFID tags were first used to track expensive equipment. As computing devices shrank in size, these chips also became smaller, faster, and smarter over time. The cost of integrating computing power into small objects has now dropped considerably. For example, you can add connectivity with Alexa voice services capabilities to MCUs with less than 1MB embedded RAM, such as for light switches. A whole industry has sprung up with a focus on filling our homes, businesses, and offices with IoT devices. These smart objects can automatically transmit data to and from the Internet. All these “invisible computing devices” and the technology associated with them are collectively referred to as the Internet of Things. How does IoT work? A typical IoT system works through the real-time collection and exchange of data. An IoT system has three components: Smart devices This is a device, like a television, security camera, or exercise equipment that has been given computing capabilities. It collects data from its environment, user inputs, or usage patterns and communicates data over the internet to and from its IoT application. IoT application An IoT application is a collection of services and software that integrates data received from various IoT devices. It uses machine learning or artificial intelligence (AI) technology to analyze this data and make informed decisions. These decisions are communicated back to the IoT device and the IoT device then responds intelligently to inputs. A graphical user interface The IoT device or fleet of devices can be managed through a graphical user interface. Common examples include a mobile application or website that can be used to register and control smart devices. What are examples of IoT devices? Let’s look at some examples of IoT systems in use today: Connected cars There are many ways vehicles, such as cars, can be connected to the internet. It can be through smart dashcams, infotainment systems, or even the vehicle's connected gateway. They collect data from the accelerator, brakes, speedometer, odometer, wheels, and fuel tanks to monitor both driver performance and vehicle health. Connected cars have a range of uses: Monitoring rental car fleets to increase fuel efficiency and reduce costs. Helping parents track the driving behavior of their children. Notifying friends and family automatically in case of a car crash. Predicting and preventing vehicle maintenance needs. Connected homes Smart home devices are mainly focused on improving the efficiency and safety of the house, as well as improving home networking. Devices like smart outlets monitor electricity usage and smart thermostats provide better temperature control. Hydroponic systems can use IoT sensors to manage the garden while IoT smoke detectors can detect tobacco smoke. Home security systems like door locks, security cameras, and water leak detectors can detect and prevent threats, and send alerts to homeowners. Connected devices for the home can be used for: Automatically turning off devices not being used. Rental property management and maintenance. Finding misplaced items like keys or wallets. Automating daily tasks like vacuuming, making coffee, etc. Smart cities IoT applications have made urban planning and infrastructure maintenance more efficient. Governments are using IoT applications to tackle problems in infrastructure, health, and the environment. IoT applications can be used for: Measuring air quality and radiation levels. Reducing energy bills with smart lighting systems. Detecting maintenance needs for critical infrastructures such as streets, bridges, and pipelines. Increasing profits through efficient parking management. Smart buildings Buildings such as college campuses and commercial buildings use IoT applications to drive greater operational efficiencies. IoT devices can be use in smart buildings for: Reducing energy consumption. Lowering maintenance costs. Utilizing work spaces more efficiently. What is Industrial IoT? Industrial IoT (IIoT) refers to smart devices used in manufacturing, retail, health, and other enterprises to create business efficiencies. Industrial devices, from sensors to equipment, give business owners detailed, real-time data that can be used to improve business processes. They provide insights on supply chain management, logistics, human resource, and production – decreasing costs and increasing revenue streams. Let’s look at existing smart industrial systems in different verticals: Manufacturing Enterprise IoT in manufacturing uses predictive maintenance to reduce unplanned downtime and wearable technology to improve worker safety. IoT applications can predict machine failure before it happens, reducing production downtime. Wearables in helmets and wristbands, as well as computer vision cameras, are used to warn workers about potential hazards. Automobile Sensor-driven analytics and robotics increase efficiency in automobile manufacturing and maintenance. For example, industrial sensors are used to provide 3D real-time images of internal vehicle components. Diagnostics and troubleshooting can be done much faster while the IoT system orders replacement parts automatically. Logistics and transport Commercial and Industrial IoT devices can help with supply chain management, including inventory management, vendor relationships, fleet management, and scheduled maintenance. Shipping companies use Industrial IoT applications to keep track of assets and optimize fuel consumption on shipping routes. The technology is especially useful for tight temperature control in refrigerated containers. Supply chain managers make informed predictions through smart routing and rerouting algorithms. Retail Amazon is driving innovation in automation and human-machine collaboration in retail. Amazon facilities make use of internet-connected robots for tracking, locating, sorting, and moving products. How can IoT improve our lives? The Internet of Things has a wide-ranging impact on human life and work. It allows machines to do more heavy lifting, take over tedious tasks and make life more healthy, productive, and comfortable. For example, connected devices could change your entire morning routine. When you hit the snooze button, your alarm clock would automatically get the coffee machine to turn on and open your window blinds. Your refrigerator would auto-detect finishing groceries and order them for home delivery. Your smart oven would tell you the menu for the day — it might even cook pre-assembled ingredients and make sure your lunch is ready. Your smartwatch will schedule meetings as your connected car automatically sets the GPS to stop for a fuel refill. The opportunities are endless in an IoT world! What are the benefits of IoT for business? Accelerate innovation The Internet of Things gives businesses access to advanced analytics that uncover new opportunities. For example, businesses can create highly targeted advertising campaigns by collecting data on customer behavior. Turn data into insights and actions with AI and ML Collected data and historical trends can be used to predict future outcomes. For example, warranty information can be paired with IoT-collected data to predict maintenance incidents. This can be used to proactively provide customer service and build customer loyalty. Increase security Continuous monitoring of digital and physical infrastructure can optimize performance, improve efficiency and reduce safety risks. For example, data collected from an onsite monitor can be combined with hardware and firmware version data to automatically schedule system updates. Scale differentiated solutions IoT technologies can be deployed in a customer focused way to increase satisfaction. For example, trending products can be restocked promptly to avoid shortages. https://aws.amazon.com/what-is/iot/#:~:text=The%20term%20IoT%2C%20or%20Internet,as%20between%20the%20devices%20themselves. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Explanation/Definition,Q&A Rely solely on the context provided to you to answer any questions. Never use any external resources or prior knowledge to answer questions. Limit your responses to five paragraphs or less.,Discuss the concept of student loan repayment and forgiveness programs and their relationship to employment choices.,"In assessing the influence of a loan forgiveness or loan repayment program on an individual’s employment choice, one issue to consider is whether, in the absence of such a program, the recipient would have engaged in the qualifying service. Information on the influence of such programs might be gleaned from an examination that compares the career paths of individuals who have access to loan forgiveness or loan repayment benefits with the career paths of otherwise similarly situated individuals without such access. These types of evaluations generally have not been conducted for federal loan forgiveness and loan repayment programs. However, some data from one federal program may be instructive. The National Institutes of Health (NIH) examined the career trajectories of loan repayment recipients in its Intramural Research Program (IRP) and compared them with similar individuals who did not receive loan repayment under the IRP. The purposes of the IRP’s loan repayment component is to encourage individuals to complete medical research at the NIH and to encourage qualified health professionals to continue careers in medical research in general (e.g., at a university). The NIH found that individuals receiving loan repayment benefits were more likely to continue conducting medical research at the NIH than those who did not. Likewise, individuals who received loan repayment benefits but then left the NIH were more likely to continue a career as a medical researcher than those who did not.56 This study suggests that the program may be meeting its stated goals. While the NIH study indicates that its loan repayment program may be meeting its stated goals, the loan repayment program is unlikely the sole reason for at least some of the individuals to remain in the NIH’s targeted positions. Other research has found that some individuals would have entered certain fields or taken certain positions in the absence of loan repayments for a variety of other reasons. If this were true, then the program would not have been necessary and, therefore, might be considered ineffective. For example, a loan repayment program may be an effective incentive when jobs are plentiful for recent graduates who are weighing multiple employment opportunities but may be unnecessary when there are fewer employment opportunities. In relatively recent years, for instance, law school graduates have had fewer employment opportunities57 and may take a public interest or government job because of more limited private sector opportunities. Finally, individuals who accept loan repayment for a specific job might have taken the same job without loan repayment benefits. For example, one study found that healthcare providers who practice in rural areas would have done so without receiving a loan repayment award.58 Although in some cases loan forgiveness or loan repayment programs may appear to be unnecessary, in some instances there is evidence showing that participants would likely not have taken a particular position but for loan repayment. For example, the NIH examined its IRP loan repayment program and found that most loan repayment award recipients had competing job offers and stated that the potential for loan repayment was an attractive benefit that was unique to the NIH employment. This was particularly true for physicians who often had competing job offers at higher salaries. Physicians who received loan repayment benefits were also more likely to remain in research at the NIH, which demonstrates that loan repayment may be an important recruitment and retention tool.59 Other federal agencies have found that loan repayment programs are effective at recruiting and maintaining staff, but there are indications that some aspects of a program’s design may undermine its effectiveness.60 For example, discretionary programs may have their funding reduced or cut altogether, thus making the availability of loan repayment benefits to individuals uncertain. The effectiveness of these programs as a recruitment incentive may be hard to determine because job applicants do not know whether they will receive a loan repayment award until after having accepted a job.61 Additionally, loan repayment award amounts may not be a sufficient incentive for individuals to enter into and remain in certain professions. Some researchers have theorized that loan repayment programs may be more likely to be successful in meeting recruitment and retention needs if the financial benefits are sufficiently meaningful to offset a reasonable share of the costs associated with borrowing to pursue a postsecondary education.62 Similarly, in some circumstances, while the dollar amount of loan repayment benefits may be perceived as sufficient, additional program design elements such as an individual’s responsibility to pay federal income taxes associated with receiving a loan payment may make the benefit less attractive for an individual. Specifically, under the Government Employee Student Loan Repayment Program (GESLRP), participants are responsible for the tax liability, which some agencies estimate can account for 39% of the loan repayment amount.63 Some agencies suggest that this makes the program less attractive to participants than it would be if benefits were excluded from taxation.64 Another consideration is the short-term nature of many of these programs (e.g., providing loan repayment benefits in exchange for a two-year employment commitment), which may contribute to turnover, as individuals may decide to change jobs once they have realized the full benefit of a program. This could possibly lead to a less stable workforce for employers. For example, some researchers have found that individuals who have a service obligation have shorter tenures in a particular position than do individuals who do not have service obligations.65 ","In assessing the influence of a loan forgiveness or loan repayment program on an individual’s employment choice, one issue to consider is whether, in the absence of such a program, the recipient would have engaged in the qualifying service. Information on the influence of such programs might be gleaned from an examination that compares the career paths of individuals who have access to loan forgiveness or loan repayment benefits with the career paths of otherwise similarly situated individuals without such access. These types of evaluations generally have not been conducted for federal loan forgiveness and loan repayment programs. However, some data from one federal program may be instructive. The National Institutes of Health (NIH) examined the career trajectories of loan repayment recipients in its Intramural Research Program (IRP) and compared them with similar individuals who did not receive loan repayment under the IRP. The purposes of the IRP’s loan repayment component is to encourage individuals to complete medical research at the NIH and to encourage qualified health professionals to continue careers in medical research in general (e.g., at a university). The NIH found that individuals receiving loan repayment benefits were more likely to continue conducting medical research at the NIH than those who did not. Likewise, individuals who received loan repayment benefits but then left the NIH were more likely to continue a career as a medical researcher than those who did not.56 This study suggests that the program may be meeting its stated goals. While the NIH study indicates that its loan repayment program may be meeting its stated goals, the loan repayment program is unlikely the sole reason for at least some of the individuals to remain in the NIH’s targeted positions. Other research has found that some individuals would have entered certain fields or taken certain positions in the absence of loan repayments for a variety of other reasons. If this were true, then the program would not have been necessary and, therefore, might be considered ineffective. For example, a loan repayment program may be an effective incentive when jobs are plentiful for recent graduates who are weighing multiple employment opportunities but may be unnecessary when there are fewer employment opportunities. In relatively recent years, for instance, law school graduates have had fewer employment opportunities57 and may take a public interest or government job because of more limited private sector opportunities. Finally, individuals who accept loan repayment for a specific job might have taken the same job without loan repayment benefits. For example, one study found that healthcare providers who practice in rural areas would have done so without receiving a loan repayment award.58 Although in some cases loan forgiveness or loan repayment programs may appear to be unnecessary, in some instances there is evidence showing that participants would likely not have taken a particular position but for loan repayment. For example, the NIH examined its IRP loan repayment program and found that most loan repayment award recipients had competing job offers and stated that the potential for loan repayment was an attractive benefit that was unique to the NIH employment. This was particularly true for physicians who often had competing job offers at higher salaries. Physicians who received loan repayment benefits were also more likely to remain in research at the NIH, which demonstrates that loan repayment may be an important recruitment and retention tool.59 Other federal agencies have found that loan repayment programs are effective at recruiting and maintaining staff, but there are indications that some aspects of a program’s design may undermine its effectiveness.60 For example, discretionary programs may have their funding reduced or cut altogether, thus making the availability of loan repayment benefits to individuals uncertain. The effectiveness of these programs as a recruitment incentive may be hard to determine because job applicants do not know whether they will receive a loan repayment award until after having accepted a job.61 Additionally, loan repayment award amounts may not be a sufficient incentive for individuals to enter into and remain in certain professions. Some researchers have theorized that loan repayment programs may be more likely to be successful in meeting recruitment and retention needs if the financial benefits are sufficiently meaningful to offset a reasonable share of the costs associated with borrowing to pursue a postsecondary education.62 Similarly, in some circumstances, while the dollar amount of loan repayment benefits may be perceived as sufficient, additional program design elements such as an individual’s responsibility to pay federal income taxes associated with receiving a loan payment may make the benefit less attractive for an individual. Specifically, under the Government Employee Student Loan Repayment Program (GESLRP), participants are responsible for the tax liability, which some agencies estimate can account for 39% of the loan repayment amount.63 Some agencies suggest that this makes the program less attractive to participants than it would be if benefits were excluded from taxation.64 Another consideration is the short-term nature of many of these programs (e.g., providing loan repayment benefits in exchange for a two-year employment commitment), which may contribute to turnover, as individuals may decide to change jobs once they have realized the full benefit of a program. This could possibly lead to a less stable workforce for employers. For example, some researchers have found that individuals who have a service obligation have shorter tenures in a particular position than do individuals who do not have service obligations.65 Rely solely on the context provided to you to answer any questions. Never use any external resources or prior knowledge to answer questions. Limit your responses to five paragraphs or less. Discuss the concept of student loan repayment and forgiveness programs and their relationship to employment choices.",Financial,Effect Analysis,Q&A "Only use the information shared in the context to answer the questions. Do not rely on external sources or your inherent knowledge to answer the question. If a meaningful answer cannot be generated from the context, do not hallucinate.",Explain the text in simple terms without leaving out any information,"Section 161. Expansion of Family Caregiver Program of the VA Eligibility This section amends 38 U.S.C. §1720G(a)(2) to expand eligibility for the Comprehensive Caregiver Program to pre-9/11 veterans, beginning on the date when the Secretary submits to Congress the certification that the VA has fully implemented the IT system (described in Section 162), herein referred to as the certification date. Beginning on the certification date, the Comprehensive Caregiver Program is extended over a two-year period to pre-9/11 veterans who have a serious injury incurred or aggravated in the line of duty in the active military, naval, or air service on or before May 7, 1975. Two years after the certification date, the Comprehensive Care Program is extended to all pre-9/11 veterans, covering veterans of all eras. It requires the Secretary, no later than 30 days after the date the Secretary submits to Congress the above certification, to publish the certification date in the Federal Register. It also amends 38 U.S.C. §1720G(a)(2) to expand the eligibility criteria for the Comprehensive Caregiver Program to include those veterans in need of personal care services because of a need for regular or extensive instruction or supervision, without which the ability of the veteran to function in daily life would be seriously impaired, among other existing criteria. Caregiver Assistance This section amends 38 U.S.C. §1720G(a)(3) to expand the types of assistance available to family caregivers under the Comprehensive Care Program to include financial planning services and legal services relating to the needs of injured veterans and their caregivers. It further amends this subsection regarding the monthly stipend determination to specify that in determining the amount and degree of personal care services provided to an eligible veteran whose need is based on a need for supervision or protection, as specified, or regular instruction or supervision, as specified, the determination must take into account (1) the assessment by the family caregiver; (2) the extent to which the veteran can function safely and independently without supervision, protection, or instruction; and (3) the amount of time required for the family caregiver to provide supervision, protection, or instruction. It also adds new language under 38 U.S.C. §1720G(a)(3) that in providing instruction, preparation, and training to each approved family caregiver, the Secretary is required to VA MISSION Act of 2018 (P.L.115-182) Congressional Research Service R45390 · VERSION 2 · UPDATED 30 periodically evaluate the needs of the eligible veteran and the skills of the family caregiver to determine if additional support is necessary. It amends 38 U.S.C. §1720(a)(5) to require the Secretary to evaluate each application submitted jointly by an eligible veteran in collaboration with the primary care team for the eligible veteran to the maximum extent practicable. It further adds a new paragraph under 38 U.S.C. §1720(a) that in providing assistance to family caregivers of eligible veterans, the Secretary may enter into contracts or agreements with specified entities to provide family caregivers such assistance. The Secretary is required to provide such assistance only if it is reasonably accessible to the family caregiver and is substantially equivalent or better in quality to similar services provided by the VA. It authorizes the Secretary to provide fair compensation to federal agencies, states, and other entities that provide such assistance. It amends the definition of personal care services under 38 U.S.C. §1720(d)(4) to include services that provide the veteran with (1) supervision or protection based on symptoms or residuals of neurological or other impairment or injury, and (2) regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired. Section 162. Implementation of Information Technology System of the VA to Assess and Improve the Family Caregiver Program This section requires the Secretary to implement an IT system, no later than October 1, 2018, with certain specified elements that fully supports the Comprehensive Caregiver Program and allows for data assessment and program monitoring. No later than 180 days after implementing the IT system, the Secretary is required, through the Under Secretary for Health, to conduct an assessment of how key aspects of the Comprehensive Caregiver Program are structured and carried out using data from the IT system and any other relevant data. The Secretary is required to use the IT system to monitor and assess program workload, and to implement certain modifications necessary to ensure program functioning and timeliness of services. It also requires the Secretary, no later than 90 days after enactment, to submit an initial report to the SVAC, HVAC, and GAO on the status of the planning, development, and deployment of the IT system. The initial report must include an assessment of the needs of family caregivers of veterans eligible for the Comprehensive Program solely due to a serious injury incurred or aggravated in the line of duty in the active military, naval, or air service before September 11, 2001; the resource needs for including such family caregivers; and any changes necessary to ensure successful program expansion. The GAO is required to review the initial report and notify SVAC and HVAC with respect to the progress of the Secretary in fully implementing the required IT system, as well implementation of a process to monitor, assess, and modify the program as necessary. No later than October 1, 2019, the Secretary is required to submit a final report to SVAC, HVAC, and the GAO on system implementation, including program monitoring, assessment, and modification, as specified.","SYSTEM INSTRUCTIONS: Only use the information shared in the context to answer the questions. Do not rely on external sources or your inherent knowledge to answer the question. If a meaningful answer cannot be generated from the context, do not hallucinate. CONTEXT: Section 161. Expansion of Family Caregiver Program of the VA Eligibility This section amends 38 U.S.C. §1720G(a)(2) to expand eligibility for the Comprehensive Caregiver Program to pre-9/11 veterans, beginning on the date when the Secretary submits to Congress the certification that the VA has fully implemented the IT system (described in Section 162), herein referred to as the certification date. Beginning on the certification date, the Comprehensive Caregiver Program is extended over a two-year period to pre-9/11 veterans who have a serious injury incurred or aggravated in the line of duty in the active military, naval, or air service on or before May 7, 1975. Two years after the certification date, the Comprehensive Care Program is extended to all pre-9/11 veterans, covering veterans of all eras. It requires the Secretary, no later than 30 days after the date the Secretary submits to Congress the above certification, to publish the certification date in the Federal Register. It also amends 38 U.S.C. §1720G(a)(2) to expand the eligibility criteria for the Comprehensive Caregiver Program to include those veterans in need of personal care services because of a need for regular or extensive instruction or supervision, without which the ability of the veteran to function in daily life would be seriously impaired, among other existing criteria. Caregiver Assistance This section amends 38 U.S.C. §1720G(a)(3) to expand the types of assistance available to family caregivers under the Comprehensive Care Program to include financial planning services and legal services relating to the needs of injured veterans and their caregivers. It further amends this subsection regarding the monthly stipend determination to specify that in determining the amount and degree of personal care services provided to an eligible veteran whose need is based on a need for supervision or protection, as specified, or regular instruction or supervision, as specified, the determination must take into account (1) the assessment by the family caregiver; (2) the extent to which the veteran can function safely and independently without supervision, protection, or instruction; and (3) the amount of time required for the family caregiver to provide supervision, protection, or instruction. It also adds new language under 38 U.S.C. §1720G(a)(3) that in providing instruction, preparation, and training to each approved family caregiver, the Secretary is required to VA MISSION Act of 2018 (P.L.115-182) Congressional Research Service R45390 · VERSION 2 · UPDATED 30 periodically evaluate the needs of the eligible veteran and the skills of the family caregiver to determine if additional support is necessary. It amends 38 U.S.C. §1720(a)(5) to require the Secretary to evaluate each application submitted jointly by an eligible veteran in collaboration with the primary care team for the eligible veteran to the maximum extent practicable. It further adds a new paragraph under 38 U.S.C. §1720(a) that in providing assistance to family caregivers of eligible veterans, the Secretary may enter into contracts or agreements with specified entities to provide family caregivers such assistance. The Secretary is required to provide such assistance only if it is reasonably accessible to the family caregiver and is substantially equivalent or better in quality to similar services provided by the VA. It authorizes the Secretary to provide fair compensation to federal agencies, states, and other entities that provide such assistance. It amends the definition of personal care services under 38 U.S.C. §1720(d)(4) to include services that provide the veteran with (1) supervision or protection based on symptoms or residuals of neurological or other impairment or injury, and (2) regular or extensive instruction or supervision without which the ability of the veteran to function in daily life would be seriously impaired. Section 162. Implementation of Information Technology System of the VA to Assess and Improve the Family Caregiver Program This section requires the Secretary to implement an IT system, no later than October 1, 2018, with certain specified elements that fully supports the Comprehensive Caregiver Program and allows for data assessment and program monitoring. No later than 180 days after implementing the IT system, the Secretary is required, through the Under Secretary for Health, to conduct an assessment of how key aspects of the Comprehensive Caregiver Program are structured and carried out using data from the IT system and any other relevant data. The Secretary is required to use the IT system to monitor and assess program workload, and to implement certain modifications necessary to ensure program functioning and timeliness of services. It also requires the Secretary, no later than 90 days after enactment, to submit an initial report to the SVAC, HVAC, and GAO on the status of the planning, development, and deployment of the IT system. The initial report must include an assessment of the needs of family caregivers of veterans eligible for the Comprehensive Program solely due to a serious injury incurred or aggravated in the line of duty in the active military, naval, or air service before September 11, 2001; the resource needs for including such family caregivers; and any changes necessary to ensure successful program expansion. The GAO is required to review the initial report and notify SVAC and HVAC with respect to the progress of the Secretary in fully implementing the required IT system, as well implementation of a process to monitor, assess, and modify the program as necessary. No later than October 1, 2019, the Secretary is required to submit a final report to SVAC, HVAC, and the GAO on system implementation, including program monitoring, assessment, and modification, as specified. QUESTION: Explain the text in simple terms without leaving out any information.",Legal,Summarize & Simplify,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Zero trust eliminates traditional VPNs as a secure solution by not allowing any ransomware in the first place; it requires no extra measures like encryption or network segmentation. Explain how the Zero Trust provide maximum security assurance, and how does it surpass VPNs, rendering them irrelevant for external connections and internal connections?","Introduction In May 2021, a group of hackers attacked a VPN that required only a single authentication password and gained access to the organizational network. They then demanded $4.4 million in ransom to return control of the network. In response, the company shut down its operations, which led to a fuel shortage across the east coast of the United States. The Colonial Pipeline ransomware attack was underway, and the cybersecurity industry would never be the same. Ransomware attacks have grown increasingly common (and expensive) in recent years, but organizations like yours are not doomed to become victims. Zero trust is a modern and innovative security model designed to severely limit the damage that ransomware and other cyberattacks can cause. By never inherently trusting users or devices and instead continuously verifying them before granting access, the zero trust framework: Prevents attackers from gaining easy access to critical applications And severely curtails their ability to cause damage if they do get in. In this white paper, we will examine what zero trust is and outline how to implement zero trust access in order to prevent costly and damaging ransomware attacks. Topics that we'll cover include: Zero Trust and Ransomware The current state of ransomware attacks What is Zero Trust Introducing Zero Trust to the Organization How Zero Trust mitigates ransomware attacks Securing the organization with zero trust ZTNA vs. VPNs Choosing a ZTNA provider Implementing Zero Trust in the Organization A phased approach to Zero Trust adoption Zero Trust and Ransomware Ransomware Attacks: A Costly and Worrying Reality In 2021, the number of ransomware attacks significantly increased compared to 2020, which itself saw a 150% ransomware increase compared to 2019. The number of attacks is expected to grow even more in 2022. Every month, hundreds of thousands of ransomware attacks will take place, targeting enterprises, businesses and people. Between 2019 and 2020, the amount paid by ransomware victims rose by 300%. The actual ransom demands made by attackers have also grown in recent years. Between 2019 and 2020, the amount paid by victims rose by 300%. In the first six months of 2021, ransomware payments reported by banks and other financial institutions totaled $590 million. 2021 also saw the largest ransomware demands ever per attack, with attackers demanding tens of millions of dollars following a single breach. It is clear that existing security controls, designed largely for yesterday’s legacy systems, are no longer sufficient in a world of global networks and complex cloud architectures. To prevent ransomware attacks, a new forward-looking approach is needed: zero trust. It is clear that existing security controls, designed largely for yesterday’s legacy systems, are no longer sufficient in a world of global networks and complex cloud architectures. To prevent ransomware attacks, a new forward-looking approach is needed: Zero trust. What is Zero Trust? Zero trust is a modern security architecture and model that can help mitigate ransomware attacks. Zero trust is based on the premise “Never trust, always verify,” which means that no user or machine is granted access (trust) until they are authorized. The three main principles of Zero Trust are: How Does Zero Trust Work? Zero trust is founded on the principle that no person or device should be granted system access based on inherent trust. Instead, zero trust assumes that the network has already been compromised. Therefore, no user or device can access systems or assets without first being authorized via strong authentication methods like MFA (multi-factor authentication). As an added security measure, users are continuously verified even after their initial authorization. How Zero Trust Helps Mitigate Ransomware Ransomware perpetrators attack networks and critical applications and threaten to leak or destroy valuable data unless a hefty ransom is paid. Zero trust access policies prevent the spread of ransomware. When zero trust is implemented: Ransomware attackers are blocked from accessing critical applications. Ransomware attackers are prevented from moving laterally, mitigating their ability to access and leak data. Ransomware attackers cannot see the different system components, target them and gain a foothold.see Auditing and recording capabilities help detect breaches and prevent further damage. The network is hidden, preventing attack methods like IP scanning. Potentially vulnerable VPNs are enhanced by adding an extra layer of security. Introducing Zero Trust to the Organization Securing the Organization with Zero Trust To operationally execute zero trust, it’s important to implement a technology that can secure the following domains: Data People Devices Networks Workloads The zero trust technology used to secure these domains is called ZTNA (zero trust network access). ZTNA is a software perimeter that applies the zero trust principles when authorizing users and services. ZTNA vs. VPNs Many organizations use VPNs to secure their critical applications, especially when providing access for remote users and third parties like partners and contractors. However, VPNs are not secure. First, VPNs provide external users with too much access. Any authenticated user has access to the entire network, including databases and infrastructure. In addition, VPNs providers often have major security vulnerabilities - as recent security incidents such as the Solar Winds cyberattack have demonstrated. Choosing a ZTNA Provider The zero trust tenet of “never trust, always verify” also relates to the vendors that provide zero trust access solutions. Quite paradoxically, most ZTNA providers actually demand inherent trust from their customers by requiring those customers to place their most sensitive assets, including encrypted content, passwords, and user data, in the provider’s cloud. Think of a parking valet, who holds the keys to all the cars in the lot. Rather than attacking individual car owners, a thief’s best bet would clearly be to attack the valet with his many keys. In this same way, security vendors are a tempting target for cybercriminals. This includes ZTNA providers who have access to the crown jewels of all their customers. In light of this reality, it is recommended to choose a ZTNA vendor whose architecture cannot potentially compromise your organization. Ask these 7 questions when selecting a ZTNA provider to ensure you don’t have to trust anyone – even the provider themselves: Is the users’ data exposed? Who has control of the access rules? Where are our secrets (passwords, tokens, private keys) kept? How is the risk of internal threats mitigated? What is the scope of secure access? Does it include users, networks, apps, etc.? What is the ZTNA provider’s infrastructure? Are the servers located in the cloud or in a data center? Who can access it? What happens if the ZTNA","[question] Zero trust eliminates traditional VPNs as a secure solution by not allowing any ransomware in the first place; it requires no extra measures like encryption or network segmentation. Explain how the Zero Trust provide maximum security assurance, and how does it surpass VPNs, rendering them irrelevant for external connections and internal connections? ===================== [text] Introduction In May 2021, a group of hackers attacked a VPN that required only a single authentication password and gained access to the organizational network. They then demanded $4.4 million in ransom to return control of the network. In response, the company shut down its operations, which led to a fuel shortage across the east coast of the United States. The Colonial Pipeline ransomware attack was underway, and the cybersecurity industry would never be the same. Ransomware attacks have grown increasingly common (and expensive) in recent years, but organizations like yours are not doomed to become victims. Zero trust is a modern and innovative security model designed to severely limit the damage that ransomware and other cyberattacks can cause. By never inherently trusting users or devices and instead continuously verifying them before granting access, the zero trust framework: Prevents attackers from gaining easy access to critical applications And severely curtails their ability to cause damage if they do get in. In this white paper, we will examine what zero trust is and outline how to implement zero trust access in order to prevent costly and damaging ransomware attacks. Topics that we'll cover include: Zero Trust and Ransomware The current state of ransomware attacks What is Zero Trust Introducing Zero Trust to the Organization How Zero Trust mitigates ransomware attacks Securing the organization with zero trust ZTNA vs. VPNs Choosing a ZTNA provider Implementing Zero Trust in the Organization A phased approach to Zero Trust adoption Zero Trust and Ransomware Ransomware Attacks: A Costly and Worrying Reality In 2021, the number of ransomware attacks significantly increased compared to 2020, which itself saw a 150% ransomware increase compared to 2019. The number of attacks is expected to grow even more in 2022. Every month, hundreds of thousands of ransomware attacks will take place, targeting enterprises, businesses and people. Between 2019 and 2020, the amount paid by ransomware victims rose by 300%. The actual ransom demands made by attackers have also grown in recent years. Between 2019 and 2020, the amount paid by victims rose by 300%. In the first six months of 2021, ransomware payments reported by banks and other financial institutions totaled $590 million. 2021 also saw the largest ransomware demands ever per attack, with attackers demanding tens of millions of dollars following a single breach. It is clear that existing security controls, designed largely for yesterday’s legacy systems, are no longer sufficient in a world of global networks and complex cloud architectures. To prevent ransomware attacks, a new forward-looking approach is needed: zero trust. It is clear that existing security controls, designed largely for yesterday’s legacy systems, are no longer sufficient in a world of global networks and complex cloud architectures. To prevent ransomware attacks, a new forward-looking approach is needed: Zero trust. What is Zero Trust? Zero trust is a modern security architecture and model that can help mitigate ransomware attacks. Zero trust is based on the premise “Never trust, always verify,” which means that no user or machine is granted access (trust) until they are authorized. The three main principles of Zero Trust are: How Does Zero Trust Work? Zero trust is founded on the principle that no person or device should be granted system access based on inherent trust. Instead, zero trust assumes that the network has already been compromised. Therefore, no user or device can access systems or assets without first being authorized via strong authentication methods like MFA (multi-factor authentication). As an added security measure, users are continuously verified even after their initial authorization. How Zero Trust Helps Mitigate Ransomware Ransomware perpetrators attack networks and critical applications and threaten to leak or destroy valuable data unless a hefty ransom is paid. Zero trust access policies prevent the spread of ransomware. When zero trust is implemented: Ransomware attackers are blocked from accessing critical applications. Ransomware attackers are prevented from moving laterally, mitigating their ability to access and leak data. Ransomware attackers cannot see the different system components, target them and gain a foothold.see Auditing and recording capabilities help detect breaches and prevent further damage. The network is hidden, preventing attack methods like IP scanning. Potentially vulnerable VPNs are enhanced by adding an extra layer of security. Introducing Zero Trust to the Organization Securing the Organization with Zero Trust To operationally execute zero trust, it’s important to implement a technology that can secure the following domains: Data People Devices Networks Workloads The zero trust technology used to secure these domains is called ZTNA (zero trust network access). ZTNA is a software perimeter that applies the zero trust principles when authorizing users and services. ZTNA vs. VPNs Many organizations use VPNs to secure their critical applications, especially when providing access for remote users and third parties like partners and contractors. However, VPNs are not secure. First, VPNs provide external users with too much access. Any authenticated user has access to the entire network, including databases and infrastructure. In addition, VPNs providers often have major security vulnerabilities - as recent security incidents such as the Solar Winds cyberattack have demonstrated. Choosing a ZTNA Provider The zero trust tenet of “never trust, always verify” also relates to the vendors that provide zero trust access solutions. Quite paradoxically, most ZTNA providers actually demand inherent trust from their customers by requiring those customers to place their most sensitive assets, including encrypted content, passwords, and user data, in the provider’s cloud. Think of a parking valet, who holds the keys to all the cars in the lot. Rather than attacking individual car owners, a thief’s best bet would clearly be to attack the valet with his many keys. In this same way, security vendors are a tempting target for cybercriminals. This includes ZTNA providers who have access to the crown jewels of all their customers. In light of this reality, it is recommended to choose a ZTNA vendor whose architecture cannot potentially compromise your organization. Ask these 7 questions when selecting a ZTNA provider to ensure you don’t have to trust anyone – even the provider themselves: Is the users’ data exposed? Who has control of the access rules? Where are our secrets (passwords, tokens, private keys) kept? How is the risk of internal threats mitigated? What is the scope of secure access? Does it include users, networks, apps, etc.? What is the ZTNA provider’s infrastructure? Are the servers located in the cloud or in a data center? Who can access it? What happens if the ZTNA https://cyolo.io/white-papers/how-to-stop-ransomware-attacks-with-zero-trust#:~:text=Zero%20trust%20access%20policies%20prevent,to%20access%20and%20leak%20data. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Concept Comparison,Q&A "Use only the article provided to answer the question, do not utilize any outside knowledge. Answer in full sentences.",Where did the Elysian speakers' name came from?,"Elysian Speakers: Turning Your Home into a Sonic Heaven The culmination of a special three-year R&D project, Wharfedale’s new flagship speakers are the ultimate expression of pure musical enjoyment embedded at the heart of this famous British brand. Cambridgeshire, England – In Greek mythology, the Elysian Fields are a heavenly place where the heroic and the virtuous are rewarded in the afterlife. Elysian, as an adjective, means blissful – a fitting name for Wharfedale’s new flagship loudspeakers, conceived to deliver blissful sonic reward to music lovers seeking heavenly respite from the rigours of daily life. Two Elysian loudspeakers have been created; a large standmount model called Elysian 2 (£4,500 per pair) and a floorstanding speaker named Elysian 4 (£6,500 per pair). Both speakers were developed concurrently with the EVO4 Series, which launched towards the end of 2019 and sits immediately below Elysian in Wharfedale’s new hierarchy. Elysian and EVO4 share many design elements, having benefitted from the same R&D process as part of a unified project. The core speakers in both ranges are three-way designs, sporting an unusual and sophisticated driver array including an Air Motion Transformer (AMT) high-frequency unit. But with Elysian, each component part is engineered to the very highest standard. The drivers, the crossover, the cabinet – every aspect has been developed in harmony and without cost constraint to push the project to its performance limit. Many of these elements were trickled down, remodelled and engineered in a more affordable form to create the EVO4 Series, enabling the speakers in this range to deliver astounding value for money. With the EVO4 Series already winning major awards, now is the time for Wharfedale to unleash Elysian. Elysian AMT Treble Unit In the 1940s, Wharfedale’s founder, Gilbert Briggs, developed the first two-way speaker for domestic use, radical for its separate treble and bass drivers combined via a crossover. Early treble units, such as Brigg’s famous Super 3, resembled small cones as the necessity for reproducing high frequencies demanded the use of low-mass diaphragms. It was subsequently realized that the dome in the centre of the cone was doing most of the work and this gave rise to the now ubiquitous dome tweeter. Dome treble units have dominated the hi-fi scene for decades, but they are not necessarily the ideal way of reproducing the exact harmonics of the musical waveform. In order to reduce moving mass, the dome has to be small and use ultra-thin materials, both of which counteract its efficiency and accuracy. The AMT is a radically different way of moving air, using a large, pleated, lightweight diaphragm driven across its surface by rows of strategically placed metallic strips immersed in a strong magnetic field. The pleats in the diaphragm contract and expand under the influence of the musical drive, squeezing the air between them to form the desired waveform. Not only is this an efficient way of moving air, it is also highly accurate as the diaphragm is under close control of the motor system at all times. The result is a wide bandwidth transducer that achieves extremely low distortion and wonderful musical detail, with scintillating speed and dynamic ability. The development of this AMT unit was a key part of the Elysian/EVO4 project. The Elysian AMT is larger and of higher specification than the one used in the EVO4 Series, featuring an ultra-lightweight diaphragm material called PET and an acoustically damped rear chamber, delivering even more spellbindingly clear and sweetly extended high frequencies. Elysian Midrange Driver In the spirit of Gilbert Briggs, who was well known for experimenting with new driver materials, Wharfedale investigated a range of options to match the sensitivity and accuracy of the AMT treble unit. The company settled on a proprietary woven glass fibre matrix, formed into a 150mm cone. This provides a superb combination of low mass and high strength, with the addition of a high-plasticity coating to control its acoustic behaviour. With such a low-mass cone, only a low-damping, foamed, rubber-like material would match for the surround – again, coated for durability. A central phase plug is specially shaped to linearise the output across a wide bandwidth, even off-axis, enhancing a natural response to the music that can be heard anywhere the listener wishes to sit. This midrange driver enables the Elysian speakers to deliver voices and instruments with astonishing realism. Vocalists seem to be present in the room with the listener – simply close your eyes and listen to the palpable presence of singers in the acoustic space. Elysian Bass Driver The midrange unit is matched with a glass fibre matrix cone for the bass unit, in this case terminated with a highly flexible rubber surround and driven by a specially developed low-distortion motor system. In order to plumb the depths of the lowest frequencies in recorded music, the 220mm bass units – one in the Elysian 2, two in the Elysian 4 – are capable of reaching down below 28Hz in-room, revealing the full body and impact of percussion, stringed and wind instruments. The bass units are loaded by an advanced version of Wharfedale’s signature slot-loaded port. Christened SLPP (Slot-Loaded Profiled Port), it ensures that the rear output of the bass units is not wasted. Instead, the lowest frequency energy is vented to a slot at the base of the speaker, specially profiled to equalise the high internal pressure to the low pressure in the room. This reduces the distortion that is typical of bass reflex systems and increases the port’s efficiency. In addition, because the air is dispersed uniformly in the room, the speakers are less fussy about siting. Elysian Crossover Network The drivers’ output is combined via a sophisticated crossover network, fine-tuned over hundreds of hours of listening tests to ensure a seamless blend between the drive units. Of particular note is the phase consistency across the driver output, permitting a wide range of seating positions and encouraging the power response to be highly linear throughout the listening room. Only the highest grade, acoustically transparent components are used throughout the crossover network, ensuring all the musical detail is heard with nothing held back. Elysian Cabinet The Elysian speaker cabinets are designed to enhance the acoustic output of the drivers and provide a piece of furniture of which the owner can be justly proud. Handcrafted veneers are enhanced by true piano finish lacquers, hand-polished to six levels of depth to give a truly beautiful finish. Beneath the veneer is a sandwich of woods of differing density, designed to reduce panel resonance to below audibility. Named PROS (Panel Resonance Optimization System), this multi-layer construction also inhibits the leakage of unwanted sound energy from inside the cabinet, which would otherwise interfere with the forward output of the drive units. Both Elysian models have a wide stature that complements the output of the drive units by helping them match to the acoustics of the room – an aspect of home audio reproduction that has been largely overlooked amid the modern trend to design slim, compact loudspeakers. One key aspect is the wide baffle, finished with radiused edges to smooth the flow of sonic energy around the cabinet. Speaking about the development of Elysian, Wharfedale’s Director of Acoustic Design, Peter Comeau, said: “Our aim for the Elysian/EVO4 project was to deliver a new flagship for Wharfedale (Elysian) whilst creating design elements that could be trickled down to a more affordable, mid-range series (EVO4). While we are justly proud of the value for money offered by the EVO4 Series, the two Elysian models represent the pinnacle of our achievements – loudspeakers that deliver an exceptional high-end performance yet still cost much less than many of the models with which they compete.” Comeau added, “The cabinet design, in combination with the drive units, allows the Elysian speakers to convey the full body of instruments like cello and bass guitar, without constraining the dynamics of the musical recital. Whether you’re listening to solo piano, a full orchestra, a jazz trio or a rock band, these speakers bring the thrill and excitement of the performance to your listening room.” The Wharfedale Elysian 2 and Elysian 4 are available in the UK from this month. RRPs are £4,500 per pair (£4,900 with matching stands) and £6,500 per pair respectively. Finish options are walnut, black or white, hand-finished in high-gloss piano lacquer.","[Task Instruction] ================== Use only the article provided to answer the question, do not utilize any outside knowledge. Answer in full sentences. ---------- [Question] ================== Where did the Elysian speakers' name came from? ---------- [Text] ================== Elysian Speakers: Turning Your Home into a Sonic Heaven The culmination of a special three-year R&D project, Wharfedale’s new flagship speakers are the ultimate expression of pure musical enjoyment embedded at the heart of this famous British brand. Cambridgeshire, England – In Greek mythology, the Elysian Fields are a heavenly place where the heroic and the virtuous are rewarded in the afterlife. Elysian, as an adjective, means blissful – a fitting name for Wharfedale’s new flagship loudspeakers, conceived to deliver blissful sonic reward to music lovers seeking heavenly respite from the rigours of daily life. Two Elysian loudspeakers have been created; a large standmount model called Elysian 2 (£4,500 per pair) and a floorstanding speaker named Elysian 4 (£6,500 per pair). Both speakers were developed concurrently with the EVO4 Series, which launched towards the end of 2019 and sits immediately below Elysian in Wharfedale’s new hierarchy. Elysian and EVO4 share many design elements, having benefitted from the same R&D process as part of a unified project. The core speakers in both ranges are three-way designs, sporting an unusual and sophisticated driver array including an Air Motion Transformer (AMT) high-frequency unit. But with Elysian, each component part is engineered to the very highest standard. The drivers, the crossover, the cabinet – every aspect has been developed in harmony and without cost constraint to push the project to its performance limit. Many of these elements were trickled down, remodelled and engineered in a more affordable form to create the EVO4 Series, enabling the speakers in this range to deliver astounding value for money. With the EVO4 Series already winning major awards, now is the time for Wharfedale to unleash Elysian. Elysian AMT Treble Unit In the 1940s, Wharfedale’s founder, Gilbert Briggs, developed the first two-way speaker for domestic use, radical for its separate treble and bass drivers combined via a crossover. Early treble units, such as Brigg’s famous Super 3, resembled small cones as the necessity for reproducing high frequencies demanded the use of low-mass diaphragms. It was subsequently realized that the dome in the centre of the cone was doing most of the work and this gave rise to the now ubiquitous dome tweeter. Dome treble units have dominated the hi-fi scene for decades, but they are not necessarily the ideal way of reproducing the exact harmonics of the musical waveform. In order to reduce moving mass, the dome has to be small and use ultra-thin materials, both of which counteract its efficiency and accuracy. The AMT is a radically different way of moving air, using a large, pleated, lightweight diaphragm driven across its surface by rows of strategically placed metallic strips immersed in a strong magnetic field. The pleats in the diaphragm contract and expand under the influence of the musical drive, squeezing the air between them to form the desired waveform. Not only is this an efficient way of moving air, it is also highly accurate as the diaphragm is under close control of the motor system at all times. The result is a wide bandwidth transducer that achieves extremely low distortion and wonderful musical detail, with scintillating speed and dynamic ability. The development of this AMT unit was a key part of the Elysian/EVO4 project. The Elysian AMT is larger and of higher specification than the one used in the EVO4 Series, featuring an ultra-lightweight diaphragm material called PET and an acoustically damped rear chamber, delivering even more spellbindingly clear and sweetly extended high frequencies. Elysian Midrange Driver In the spirit of Gilbert Briggs, who was well known for experimenting with new driver materials, Wharfedale investigated a range of options to match the sensitivity and accuracy of the AMT treble unit. The company settled on a proprietary woven glass fibre matrix, formed into a 150mm cone. This provides a superb combination of low mass and high strength, with the addition of a high-plasticity coating to control its acoustic behaviour. With such a low-mass cone, only a low-damping, foamed, rubber-like material would match for the surround – again, coated for durability. A central phase plug is specially shaped to linearise the output across a wide bandwidth, even off-axis, enhancing a natural response to the music that can be heard anywhere the listener wishes to sit. This midrange driver enables the Elysian speakers to deliver voices and instruments with astonishing realism. Vocalists seem to be present in the room with the listener – simply close your eyes and listen to the palpable presence of singers in the acoustic space. Elysian Bass Driver The midrange unit is matched with a glass fibre matrix cone for the bass unit, in this case terminated with a highly flexible rubber surround and driven by a specially developed low-distortion motor system. In order to plumb the depths of the lowest frequencies in recorded music, the 220mm bass units – one in the Elysian 2, two in the Elysian 4 – are capable of reaching down below 28Hz in-room, revealing the full body and impact of percussion, stringed and wind instruments. The bass units are loaded by an advanced version of Wharfedale’s signature slot-loaded port. Christened SLPP (Slot-Loaded Profiled Port), it ensures that the rear output of the bass units is not wasted. Instead, the lowest frequency energy is vented to a slot at the base of the speaker, specially profiled to equalise the high internal pressure to the low pressure in the room. This reduces the distortion that is typical of bass reflex systems and increases the port’s efficiency. In addition, because the air is dispersed uniformly in the room, the speakers are less fussy about siting. Elysian Crossover Network The drivers’ output is combined via a sophisticated crossover network, fine-tuned over hundreds of hours of listening tests to ensure a seamless blend between the drive units. Of particular note is the phase consistency across the driver output, permitting a wide range of seating positions and encouraging the power response to be highly linear throughout the listening room. Only the highest grade, acoustically transparent components are used throughout the crossover network, ensuring all the musical detail is heard with nothing held back. Elysian Cabinet The Elysian speaker cabinets are designed to enhance the acoustic output of the drivers and provide a piece of furniture of which the owner can be justly proud. Handcrafted veneers are enhanced by true piano finish lacquers, hand-polished to six levels of depth to give a truly beautiful finish. Beneath the veneer is a sandwich of woods of differing density, designed to reduce panel resonance to below audibility. Named PROS (Panel Resonance Optimization System), this multi-layer construction also inhibits the leakage of unwanted sound energy from inside the cabinet, which would otherwise interfere with the forward output of the drive units. Both Elysian models have a wide stature that complements the output of the drive units by helping them match to the acoustics of the room – an aspect of home audio reproduction that has been largely overlooked amid the modern trend to design slim, compact loudspeakers. One key aspect is the wide baffle, finished with radiused edges to smooth the flow of sonic energy around the cabinet. Speaking about the development of Elysian, Wharfedale’s Director of Acoustic Design, Peter Comeau, said: “Our aim for the Elysian/EVO4 project was to deliver a new flagship for Wharfedale (Elysian) whilst creating design elements that could be trickled down to a more affordable, mid-range series (EVO4). While we are justly proud of the value for money offered by the EVO4 Series, the two Elysian models represent the pinnacle of our achievements – loudspeakers that deliver an exceptional high-end performance yet still cost much less than many of the models with which they compete.” Comeau added, “The cabinet design, in combination with the drive units, allows the Elysian speakers to convey the full body of instruments like cello and bass guitar, without constraining the dynamics of the musical recital. Whether you’re listening to solo piano, a full orchestra, a jazz trio or a rock band, these speakers bring the thrill and excitement of the performance to your listening room.” The Wharfedale Elysian 2 and Elysian 4 are available in the UK from this month. RRPs are £4,500 per pair (£4,900 with matching stands) and £6,500 per pair respectively. Finish options are walnut, black or white, hand-finished in high-gloss piano lacquer.",Retail/Product,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","My spouse is pregnant, and I saw the term ""Apgar"" in a pamphlet at the OB's office at a recent prenatal visit. I looked up the term online and found this article. Please explain Agpar and its significance to health outcomes.","Introduction The Apgar score is based on five components (skin color, heart rate, reflex irritability, muscle tone, and respiration). Each item is scored from 0 to 2 with a total score of 7–10 as normal and the highest score of 10 representing the optimal condition. The Apgar score has been used worldwide as a vitality index for almost every newborn immediately after birth. Methods Study Population We conducted a population-based cohort study using data from Danish national registers. A total of 2,272,473 live singletons were identified during 1978–2015 from the Danish Medical Birth Registry . We excluded 1,001 births with missing information on sex and 41,252 births with no valid information on 5-min Apgar scores (including the score of 0). We further excluded 16,398 infants who died or emigrated from Denmark before the age of 1 year. The final cohort comprised 2,213,822 births. Discussion Main Findings In this large population-based cohort study, during childhood, we found individuals with even clinically “normal” Apgar score range of 7–9 still had higher risks of overall mental disorders and some specific diagnoses: organic disorders and a series of neurodevelopmental disorders (intellectual disability, pervasive developmental disorders, childhood autism, and ADHD). It is also interesting to observe that compromised Apgar scores were at elevated risks of developing organic disorders and neurotic disorders, which were reported for the first time. During early adulthood, compromised 5-min Apgar scores were not found to be associated with mental disorders. Comparisons With Other Studies To our knowledge, this is the first study to examine the association of the full spectrum of mental disorders with the 5-min Apgar score. Our findings indicate the strongest associations for intellectual disability in childhood, which corroborates the results from previous studies. Most previous studies were based on results of different non-standardized intelligence tests, and cross-sectional or descriptive designs, except a recent Swedish study, by virtue of clinically confirmed diagnosis and cohort design, reporting that term infants with low 5-min Apgar score had a higher risk of severe neurologic morbidity, including a 9-fold risk of intellectual disability. However, the Swedish study only captured cases before 14 years of age and only adjusted for year of birth, maternal age, parity, and smoking. Similarly, we observed 3~5-fold risks of intellectual disability in childhood (until 18 years of age), and we were able to adjust for not only the aforementioned confounders but also parental psychiatric history and socioeconomic status, indicating a more robust association. In addition, ADHD and autism were another two widely studied neurodevelopment disorders in relation to Apgar score during childhood, but existing results were inconsistent, which may be due to heterogeneity of methodology, in particular categorizations of Apgar scores and definition of outcomes. For example, some studies used pervasive developmental disorder (ICD-10 codes: F84) as a proxy to define autism, which includes but is not limited to autism. To reduce the possibility of misclassification, we only focused on childhood autism–the typical and most severe type of autism–to explore the association. Our findings further support that compromised 5-min Apgar scores were associated with childhood autism. Furthermore, we observed that individuals with a compromised 5-min Apgar score had higher risks of organic disorder and neurotic disorder during childhood, which have not been reported previously. These findings imply that less-than-optimal Apgar scores at birth may be an indicator for a broad scope of mental disorders in childhood, not merely neurodevelopmental disorders. There have been scarce studies examining the association between low Apgar score and adulthood mental health. We did not find that compromised 5-min Apgar scores were associated with mental disorders during early adulthood, which may be attributed to incomplete records of Apgar scores during the initial establishment of the Danish Medical Birth Register (MBR). We observed that participants with suboptimal Apgar scores at 5 min tended to have higher risks of organic disorders, schizophrenia, neurotic disorders, and personality disorders, and the low statistical precisions may probably be due to limited cases in the low Apgar score groups. Considering that the maximum attained age in our study was only up to 39 years, the follow-up between 19 and 39 years was not long enough to detect some late-onset mental disorders (e.g., dementia), therefore, future studies with extended follow-up to late adulthood are warranted. Current guidelines recommend Apgar scores of 7 or higher to be reassuring, hence, infants with these scores are often assumed to constitute a homogeneous group. Nevertheless, recent studies showed that even reassuring Apgar scores of 7–9 are associated with higher risks of neonatal mortality, neonatal morbidity, and adverse long-term neurological outcomes, compared with an Apgar score of 10. We found a dose-response increasing the overall risk of mental disorders with decreasing Apgar score of 9 toward 7. Furthermore, individuals with “normal” scores of 7–9 carried increased risks of a wide range of neurodevelopmental disorders, such as intellectual disability, pervasive developmental disorders, childhood autism, and ADHD. Similarly, prior studies based on developmental screening scales found children aged 5 years with 5-min Apgar scores of 7–9 were more vulnerable on the emotional or physical health domain of the Early Development Instrument. Recently, a large transnational study also suggested that low Apgar scores of 7–9 were associated with a higher risk of autistic disorder but without controlling for socioeconomic status and paternal psychiatric history. Our findings are in line with those of previous studies by showing that reassuring Apgar scores 7–9 are associated with various neurodevelopmental disorders in childhood. These findings support that 5-min Apgar scores routinely available in contemporary neonatal settings, even within the normal range 7–9, are not totally reassuring. The causes of mental disorders are multifactorial. Adverse prenatal events (e.g., gestational diabetes mellitus, preterm, and restricted fetal growth) are important risk factors and could have a programming effect on fetal brain development, resulting in increased risk for psychopathology later in life. In this study, adjusting for gestational age at birth and fetal growth status did not substantially change the risks, indicating that preterm birth or restricted fetal growth do not strongly modify the relations between low Apgar scores at birth and subsequent mental disorders. Although Apgar scores are not clear on any causal pathway of pathogenesis, less-than-optimal Apgar scores at birth may be a potential sign of the cumulative effect of those adverse prenatal events. Especially, the clinically reassuring but suboptimal score range 7–9 may indicate subtle but still detrimental intrauterine insults which will act negatively on fetal brain development. In clinical settings, a distressed infant will receive resuscitation well before the 5-min Apgar score is assigned, so the score 7–9 could not well reflect severe conditions prior to the assessment. That may be one of the reasons we observed exposure to the scores 7–9 was associated with an increased risk of mental disorders. In this study, a novel finding that a compromised 5-min Apgar score was linked to increased risks of organic disorder and neurotic disorder was reported. Organic disorder comprises a range of mental disorders based on a demonstrable etiology in cerebral disease, brain injury, or other insults leading to cerebral dysfunction. Increased risk of organic disorder with low Apgar score implies adverse prenatal insults (e.g., hypoxia-ischemia, white matter injury, reduced blood flow, malnutrition) exert a long-lasting impact on brain function in later life. With regard to neurotic disorder, its prevalence is relevant to low levels of socioeconomic status (SES). In this study, we found individuals with compromised Apgar scores tended to be born in families with worse SES (e.g., mothers live alone and have a low education level). It is, therefore, possible that SES factors at least partially mediate the observed association between compromised Apgar scores and neurotic disorder.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== My spouse is pregnant, and I saw the term ""Apgar"" in a pamphlet at the OB's office at a recent prenatal visit. I looked up the term online and found this article. Please explain Agpar and its significance to health outcomes. {passage 0} ========== Introduction The Apgar score is based on five components (skin color, heart rate, reflex irritability, muscle tone, and respiration). Each item is scored from 0 to 2 with a total score of 7–10 as normal and the highest score of 10 representing the optimal condition. The Apgar score has been used worldwide as a vitality index for almost every newborn immediately after birth. Methods Study Population We conducted a population-based cohort study using data from Danish national registers. A total of 2,272,473 live singletons were identified during 1978–2015 from the Danish Medical Birth Registry . We excluded 1,001 births with missing information on sex and 41,252 births with no valid information on 5-min Apgar scores (including the score of 0). We further excluded 16,398 infants who died or emigrated from Denmark before the age of 1 year. The final cohort comprised 2,213,822 births. Discussion Main Findings In this large population-based cohort study, during childhood, we found individuals with even clinically “normal” Apgar score range of 7–9 still had higher risks of overall mental disorders and some specific diagnoses: organic disorders and a series of neurodevelopmental disorders (intellectual disability, pervasive developmental disorders, childhood autism, and ADHD). It is also interesting to observe that compromised Apgar scores were at elevated risks of developing organic disorders and neurotic disorders, which were reported for the first time. During early adulthood, compromised 5-min Apgar scores were not found to be associated with mental disorders. Comparisons With Other Studies To our knowledge, this is the first study to examine the association of the full spectrum of mental disorders with the 5-min Apgar score. Our findings indicate the strongest associations for intellectual disability in childhood, which corroborates the results from previous studies. Most previous studies were based on results of different non-standardized intelligence tests, and cross-sectional or descriptive designs, except a recent Swedish study, by virtue of clinically confirmed diagnosis and cohort design, reporting that term infants with low 5-min Apgar score had a higher risk of severe neurologic morbidity, including a 9-fold risk of intellectual disability. However, the Swedish study only captured cases before 14 years of age and only adjusted for year of birth, maternal age, parity, and smoking. Similarly, we observed 3~5-fold risks of intellectual disability in childhood (until 18 years of age), and we were able to adjust for not only the aforementioned confounders but also parental psychiatric history and socioeconomic status, indicating a more robust association. In addition, ADHD and autism were another two widely studied neurodevelopment disorders in relation to Apgar score during childhood, but existing results were inconsistent, which may be due to heterogeneity of methodology, in particular categorizations of Apgar scores and definition of outcomes. For example, some studies used pervasive developmental disorder (ICD-10 codes: F84) as a proxy to define autism, which includes but is not limited to autism. To reduce the possibility of misclassification, we only focused on childhood autism–the typical and most severe type of autism–to explore the association. Our findings further support that compromised 5-min Apgar scores were associated with childhood autism. Furthermore, we observed that individuals with a compromised 5-min Apgar score had higher risks of organic disorder and neurotic disorder during childhood, which have not been reported previously. These findings imply that less-than-optimal Apgar scores at birth may be an indicator for a broad scope of mental disorders in childhood, not merely neurodevelopmental disorders. There have been scarce studies examining the association between low Apgar score and adulthood mental health. We did not find that compromised 5-min Apgar scores were associated with mental disorders during early adulthood, which may be attributed to incomplete records of Apgar scores during the initial establishment of the Danish Medical Birth Register (MBR). We observed that participants with suboptimal Apgar scores at 5 min tended to have higher risks of organic disorders, schizophrenia, neurotic disorders, and personality disorders, and the low statistical precisions may probably be due to limited cases in the low Apgar score groups. Considering that the maximum attained age in our study was only up to 39 years, the follow-up between 19 and 39 years was not long enough to detect some late-onset mental disorders (e.g., dementia), therefore, future studies with extended follow-up to late adulthood are warranted. Current guidelines recommend Apgar scores of 7 or higher to be reassuring, hence, infants with these scores are often assumed to constitute a homogeneous group. Nevertheless, recent studies showed that even reassuring Apgar scores of 7–9 are associated with higher risks of neonatal mortality, neonatal morbidity, and adverse long-term neurological outcomes, compared with an Apgar score of 10. We found a dose-response increasing the overall risk of mental disorders with decreasing Apgar score of 9 toward 7. Furthermore, individuals with “normal” scores of 7–9 carried increased risks of a wide range of neurodevelopmental disorders, such as intellectual disability, pervasive developmental disorders, childhood autism, and ADHD. Similarly, prior studies based on developmental screening scales found children aged 5 years with 5-min Apgar scores of 7–9 were more vulnerable on the emotional or physical health domain of the Early Development Instrument. Recently, a large transnational study also suggested that low Apgar scores of 7–9 were associated with a higher risk of autistic disorder but without controlling for socioeconomic status and paternal psychiatric history. Our findings are in line with those of previous studies by showing that reassuring Apgar scores 7–9 are associated with various neurodevelopmental disorders in childhood. These findings support that 5-min Apgar scores routinely available in contemporary neonatal settings, even within the normal range 7–9, are not totally reassuring. The causes of mental disorders are multifactorial. Adverse prenatal events (e.g., gestational diabetes mellitus, preterm, and restricted fetal growth) are important risk factors and could have a programming effect on fetal brain development, resulting in increased risk for psychopathology later in life. In this study, adjusting for gestational age at birth and fetal growth status did not substantially change the risks, indicating that preterm birth or restricted fetal growth do not strongly modify the relations between low Apgar scores at birth and subsequent mental disorders. Although Apgar scores are not clear on any causal pathway of pathogenesis, less-than-optimal Apgar scores at birth may be a potential sign of the cumulative effect of those adverse prenatal events. Especially, the clinically reassuring but suboptimal score range 7–9 may indicate subtle but still detrimental intrauterine insults which will act negatively on fetal brain development. In clinical settings, a distressed infant will receive resuscitation well before the 5-min Apgar score is assigned, so the score 7–9 could not well reflect severe conditions prior to the assessment. That may be one of the reasons we observed exposure to the scores 7–9 was associated with an increased risk of mental disorders. In this study, a novel finding that a compromised 5-min Apgar score was linked to increased risks of organic disorder and neurotic disorder was reported. Organic disorder comprises a range of mental disorders based on a demonstrable etiology in cerebral disease, brain injury, or other insults leading to cerebral dysfunction. Increased risk of organic disorder with low Apgar score implies adverse prenatal insults (e.g., hypoxia-ischemia, white matter injury, reduced blood flow, malnutrition) exert a long-lasting impact on brain function in later life. With regard to neurotic disorder, its prevalence is relevant to low levels of socioeconomic status (SES). In this study, we found individuals with compromised Apgar scores tended to be born in families with worse SES (e.g., mothers live alone and have a low education level). It is, therefore, possible that SES factors at least partially mediate the observed association between compromised Apgar scores and neurotic disorder. https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.796544/full#F1",Medical,Explanation/Definition,Q&A Use only the information provided in the prompt to answer questions. Do not use any prior knowledge or external sources. List the response without numbers or bullet points. Restate the question as an introductory sentence. No other text in the response.,What are the conditions that have a differential diagnosis of angina pectoris?," Diffuse Esophageal Spasm ■ Essentials of Diagnosis • Dysphagia, noncardiac chest pain, hypersalivation, reflux of recently ingested food • May be precipitated by ingestion of hot or cold foods • Endoscopic, radiographic, and manometric demonstration of nonpropulsive hyperperistalsis; lower esophageal sphincter relaxes normally • “Nutcracker esophagus” variant with prolonged, high-pressure (> 175 mm Hg) propulsive contractions ■ Differential Diagnosis • Angina pectoris • Esophageal or mediastinal tumors • Aperistalsis • Achalasia • Psychiatric disease ■ Treatment • Trial of acid suppression. • Calcium channel blockers such as nifedipine or diltiazem in combination with nitrates often effective. For patient failing to respond, possible role for sildenafil, botulinum toxin. • Trazodone or tricyclic antidepressants for substernal pain ■ Pearl This condition may be indistinguishable from myocardial ischemia; exclude that possibility before investigating the esophagus. Reference Grübel C, Borovicka J, Schwizer W, Fox M, Hebbard G. Diffuse esophageal spasm. Am J Gastroenterol 2008;103:450. [PMID: 18005367] Chapter 3 Gastrointestinal Diseases 77 3 Disaccharidase (Lactase) Deficiency ■ Essentials of Diagnosis • Common in Asians and blacks, in whom lactase enzyme deficiency is nearly ubiquitous and begins in childhood; can also be acquired temporarily after gastroenteritis of other causes • Symptoms vary from abdominal bloating, distention, cramps, and flatulence to explosive diarrhea in response to disaccharide ingestion • Stool pH < 5.5; reducing substances present in stool • Abnormal lactose hydrogen breath test, resolution of symptoms on lactose-free diet, or flat glucose response to disaccharide loading suggests the diagnosis ■ Differential Diagnosis • Chronic mucosal malabsorptive disorders • Irritable bowel syndrome • Celiac sprue • Small intestinal bacterial overgrowth • Inflammatory bowel disease • Pancreatic insufficiency • Giardiasis • Excess artificial sweetener use ■ Treatment • Restriction of dietary lactose; usually happens by experience in affected minorities from early life • Lactase enzyme supplementation • Maintenance of adequate nutritional and calcium intake ■ Pearl Consider this in undiagnosed diarrhea; the patient may not be aware of ingesting lactose-containing foods. Foreign Bodies in the Esophagus ■ Essentials of Diagnosis • Most common in children, edentulous older patients, and the severely mentally impaired • Occurs at physiologic areas of narrowing (upper esophageal sphincter, the level of the aortic arch, or the diaphragmatic hiatus) • Other predisposing factors favoring impaction include Zenker’s diverticulum, webs, achalasia, peptic strictures, or malignancy • Recent ingestion of food or foreign material (coins most commonly in children, meat bolus most common in adults), but the history may be missing • Vague discomfort in chest or neck, dysphagia, inability to handle secretions, odynophagia, hypersalivation, and stridor or dyspnea in children • Radiographic or endoscopic evidence of esophageal obstruction by foreign body ■ Differential Diagnosis • Esophageal stricture • Eosinophilic esophagitis • Esophageal or mediastinal tumor • Angina pectoris ■ Treatment • Endoscopic removal with airway protection as needed and the use of an overtube if sharp objects are present • Emergent endoscopy should be used for sharp objects, disk batteries (secondary to risk of perforation due to their caustic nature), or evidence of the inability to handle secretions; objects retained in the esophagus should be removed within 24 hours of ingestion • Endoscopy is successful in > 90% of cases; avoid barium studies before endoscopy, as they impair visualization ■ Pearl Treatment is ordinarily straightforward; diagnosis may not be, especially in the very young and very old. Reference Eisen GM, Baron TH, Dominitz JA, et al; American Society for Gastrointestinal Endoscopy. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002;55:802. [PMID: 12024131] Gastritis ■ Essentials of Diagnosis • May be acute (erosive) or indolent (atrophic); multiple varied causes • Symptoms often vague and include nausea, vomiting, anorexia, nondescript upper abdominal distress • Mild epigastric tenderness to palpation; in some, physical signs absent • Iron deficiency anemia not unusual • Endoscopy with gastric biopsy for definitive diagnosis • Multiple associations include stress and diminished mucosal blood flow (burns, sepsis, critical illness), drugs (NSAIDs, salicylates), atrophic states (aging, pernicious anemia), previous surgery (gastrectomy, Billroth II), H. pylori infection, acute or chronic alcoholism ■ Differential Diagnosis • Peptic ulcer • Hiatal hernia • Malignancy of stomach or pancreas • Cholecystitis • Ischemic cardiac disease ■ Treatment • Avoidance of alcohol, caffeine, salicylates, tobacco, and NSAIDs • Investigate for presence of H. pylori; eradicate if present • Proton pump inhibitors in patients receiving oral feedings, H2 inhibitors, or sucralfate • Prevention in high-risk patients (eg, intensive care setting) using these same agents ■ Pearl Ninety-five percent of gastroenterologists and a high proportion of other health care workers carry H. pylori. Reference El-Zimaity H. Gastritis and gastric atrophy. Curr Opin Gastroenterol 2008;24:682. [PMID: 19122515] 84 Current Essentials of Medicine 3 Gastroesophageal Reflux Disease (GERD) ■ Essentials of Diagnosis • Substernal burning (pyrosis) or pressure, aggravated by recumbency and relieved with sitting; can cause dysphagia, odynophagia, atypical chest pain; proton pump inhibitor may be diagnostic and therapeutic; further testing when diagnosis unclear, symptoms refractory • Reflux, hiatal hernia may be found at barium study • Incompetent lower esophageal sphincter (LES); endoscopy with biopsy may be necessary to exclude other diagnoses • Esophageal pH helpful during symptoms • Diminished LES tone also seen in obesity, pregnancy, hiatal hernia, nasogastric tube ■ Differential Diagnosis • Peptic ulcer disease • Angina pectoris • Achalasia, esophageal spasm, pill esophagitis ■ Treatment • Weight loss, avoidance of late-night meals, elevation of head of bed • Avoid chocolate, caffeine, tobacco, alcohol • High-dose H2 blockers or proton pump inhibitors • Surgical fundoplication for patients intolerant or allergic to medical therapy or refractory cases with predominantly regurgitation or nonacid reflux; use caution in patients whose primary complaint is heartburn and who are found to have nonerosive GER, as these patients likely have a component of visceral hypersensitivity that may be exacerbated by surgery. ■ Pearl Eradication of H. pylori may actually worsen GERD; the gastric acid secretion increases upon eradication of the bacterium. Reference Fass R. Proton pump inhibitor failure: what are the therapeutic options? Am J Gastroenterol 2009;104(suppl):S33. [PMID: 19262545] Chapter 3 Gastrointestinal Diseases 85 3 Intestinal Tuberculosis ■ Essentials of Diagnosis • Chronic abdominal pain, anorexia, bloating; weight loss, fever, diarrhea, new-onset ascites in many • Mild right lower quadrant tenderness, as ileocecal area is the most commonly involved intestinal site; fistula-in-ano sometimes seen • Barium study may reveal mucosal ulcerations or scarring and fibrosis with narrowing of the small or large intestine • In peritonitis, ascitic fluid has high protein and mononuclear pleocytosis; peritoneal biopsy with granulomas is more sensitive than ascites AFB culture; high adenosine deaminase levels in ascitic fluid may suggest the diagnosis; TB peritonitis more common in those with immune compromise • Complications include intestinal obstruction, hemorrhage, fistula formation, and bacterial overgrowth with malabsorption ■ Differential Diagnosis • Carcinoma of the colon or small bowel • Inflammatory bowel disease: Crohn’s disease • Ameboma or Yersinia infection • Intestinal lymphoma or amyloidosis • Ovarian or peritoneal carcinomatosis • Mycobacterium avium-intracellulare infection ■ Treatment • Standard therapy for tuberculosis; as infection heals, the affected bowel may develop stricture ■ Pearl Seen uncommonly in the developed world, but experienced clinicians have long noted that exploratory laparotomy for suspected small bowel obstruction relieves symptoms without antituberculous therapy. Reference Donoghue HD, Holton J. Intestinal tuberculosis. Curr Opin Infect Dis 2009;22:490. [PMID: 19623062] Carpal Tunnel Syndrome ■ Essentials of Diagnosis • The most common entrapment neuropathy, caused by compression of the median nerve (which innervates the flexor muscles of the wrist and fingers) • Middle-aged women and those with a history of repetitive use of the hands commonly affected • Pain classically worse at night (sleep with hands curled into the body) and exacerbated by hand movement • Initial symptoms of pain or paresthesias in thumb, index, middle, and lateral part of ring finger; progression to thenar eminence wasting • Pain radiation to forearm, shoulder, neck, chest, or other fingers of the hand not uncommon • Positive Tinel’s sign • Usually idiopathic; in bilateral onset consider secondary causes including rheumatoid arthritis, amyloidosis, sarcoidosis, hypothyroidism, diabetes, pregnancy, acromegaly, gout • Diagnosis is primarily clinical; detection of deficits by electrodiagnostic testing (assessing nerve conduction velocity) very helpful to guide referral for surgical release ■ Differential Diagnosis • C6 or C7 cervical radiculopathy • Thoracic outlet syndrome leading to brachial plexus neuropathy • Mononeuritis multiplex • Syringomyelia • Multiple sclerosis • Angina pectoris, especially when left-sided ■ Treatment • Conservative measures initially, including hand rest, nocturnal splinting of wrists, anti-inflammatory medications • Steroid injection into the carpal tunnel occasionally • Surgical decompression in a few who have nerve conduction abnormalities; best done before development of thenar atrophy ■ Pearl Carpal tunnel affects the radial three and one-half fingers, myocardial ischemia the ulnar one and one-half; remember this in evaluating arm pain—and hope it’s the right arm. Reference Dahlin LB, Salö M, Thomsen N, Stütz N. Carpal tunnel syndrome and treatment of recurrent symptoms. Scand J Plast Reconstr Surg Hand Surg 2010;44:4. [PMID: 20136467]","Use only the information provided in the prompt to answer questions. Do not use any prior knowledge or external sources. List the response without numbers or bullet points. Restate the question as an introductory sentence. No other text in the response. What are the conditions that have a differential diagnosis of angina pectoris? Diffuse Esophageal Spasm ■ Essentials of Diagnosis • Dysphagia, noncardiac chest pain, hypersalivation, reflux of recently ingested food • May be precipitated by ingestion of hot or cold foods • Endoscopic, radiographic, and manometric demonstration of nonpropulsive hyperperistalsis; lower esophageal sphincter relaxes normally • “Nutcracker esophagus” variant with prolonged, high-pressure (> 175 mm Hg) propulsive contractions ■ Differential Diagnosis • Angina pectoris • Esophageal or mediastinal tumors • Aperistalsis • Achalasia • Psychiatric disease ■ Treatment • Trial of acid suppression. • Calcium channel blockers such as nifedipine or diltiazem in combination with nitrates often effective. For patient failing to respond, possible role for sildenafil, botulinum toxin. • Trazodone or tricyclic antidepressants for substernal pain ■ Pearl This condition may be indistinguishable from myocardial ischemia; exclude that possibility before investigating the esophagus. Reference Grübel C, Borovicka J, Schwizer W, Fox M, Hebbard G. Diffuse esophageal spasm. Am J Gastroenterol 2008;103:450. [PMID: 18005367] Chapter 3 Gastrointestinal Diseases 77 3 Disaccharidase (Lactase) Deficiency ■ Essentials of Diagnosis • Common in Asians and blacks, in whom lactase enzyme deficiency is nearly ubiquitous and begins in childhood; can also be acquired temporarily after gastroenteritis of other causes • Symptoms vary from abdominal bloating, distention, cramps, and flatulence to explosive diarrhea in response to disaccharide ingestion • Stool pH < 5.5; reducing substances present in stool • Abnormal lactose hydrogen breath test, resolution of symptoms on lactose-free diet, or flat glucose response to disaccharide loading suggests the diagnosis ■ Differential Diagnosis • Chronic mucosal malabsorptive disorders • Irritable bowel syndrome • Celiac sprue • Small intestinal bacterial overgrowth • Inflammatory bowel disease • Pancreatic insufficiency • Giardiasis • Excess artificial sweetener use ■ Treatment • Restriction of dietary lactose; usually happens by experience in affected minorities from early life • Lactase enzyme supplementation • Maintenance of adequate nutritional and calcium intake ■ Pearl Consider this in undiagnosed diarrhea; the patient may not be aware of ingesting lactose-containing foods. Foreign Bodies in the Esophagus ■ Essentials of Diagnosis • Most common in children, edentulous older patients, and the severely mentally impaired • Occurs at physiologic areas of narrowing (upper esophageal sphincter, the level of the aortic arch, or the diaphragmatic hiatus) • Other predisposing factors favoring impaction include Zenker’s diverticulum, webs, achalasia, peptic strictures, or malignancy • Recent ingestion of food or foreign material (coins most commonly in children, meat bolus most common in adults), but the history may be missing • Vague discomfort in chest or neck, dysphagia, inability to handle secretions, odynophagia, hypersalivation, and stridor or dyspnea in children • Radiographic or endoscopic evidence of esophageal obstruction by foreign body ■ Differential Diagnosis • Esophageal stricture • Eosinophilic esophagitis • Esophageal or mediastinal tumor • Angina pectoris ■ Treatment • Endoscopic removal with airway protection as needed and the use of an overtube if sharp objects are present • Emergent endoscopy should be used for sharp objects, disk batteries (secondary to risk of perforation due to their caustic nature), or evidence of the inability to handle secretions; objects retained in the esophagus should be removed within 24 hours of ingestion • Endoscopy is successful in > 90% of cases; avoid barium studies before endoscopy, as they impair visualization ■ Pearl Treatment is ordinarily straightforward; diagnosis may not be, especially in the very young and very old. Reference Eisen GM, Baron TH, Dominitz JA, et al; American Society for Gastrointestinal Endoscopy. Guideline for the management of ingested foreign bodies. Gastrointest Endosc 2002;55:802. [PMID: 12024131] Gastritis ■ Essentials of Diagnosis • May be acute (erosive) or indolent (atrophic); multiple varied causes • Symptoms often vague and include nausea, vomiting, anorexia, nondescript upper abdominal distress • Mild epigastric tenderness to palpation; in some, physical signs absent • Iron deficiency anemia not unusual • Endoscopy with gastric biopsy for definitive diagnosis • Multiple associations include stress and diminished mucosal blood flow (burns, sepsis, critical illness), drugs (NSAIDs, salicylates), atrophic states (aging, pernicious anemia), previous surgery (gastrectomy, Billroth II), H. pylori infection, acute or chronic alcoholism ■ Differential Diagnosis • Peptic ulcer • Hiatal hernia • Malignancy of stomach or pancreas • Cholecystitis • Ischemic cardiac disease ■ Treatment • Avoidance of alcohol, caffeine, salicylates, tobacco, and NSAIDs • Investigate for presence of H. pylori; eradicate if present • Proton pump inhibitors in patients receiving oral feedings, H2 inhibitors, or sucralfate • Prevention in high-risk patients (eg, intensive care setting) using these same agents ■ Pearl Ninety-five percent of gastroenterologists and a high proportion of other health care workers carry H. pylori. Reference El-Zimaity H. Gastritis and gastric atrophy. Curr Opin Gastroenterol 2008;24:682. [PMID: 19122515] 84 Current Essentials of Medicine 3 Gastroesophageal Reflux Disease (GERD) ■ Essentials of Diagnosis • Substernal burning (pyrosis) or pressure, aggravated by recumbency and relieved with sitting; can cause dysphagia, odynophagia, atypical chest pain; proton pump inhibitor may be diagnostic and therapeutic; further testing when diagnosis unclear, symptoms refractory • Reflux, hiatal hernia may be found at barium study • Incompetent lower esophageal sphincter (LES); endoscopy with biopsy may be necessary to exclude other diagnoses • Esophageal pH helpful during symptoms • Diminished LES tone also seen in obesity, pregnancy, hiatal hernia, nasogastric tube ■ Differential Diagnosis • Peptic ulcer disease • Angina pectoris • Achalasia, esophageal spasm, pill esophagitis ■ Treatment • Weight loss, avoidance of late-night meals, elevation of head of bed • Avoid chocolate, caffeine, tobacco, alcohol • High-dose H2 blockers or proton pump inhibitors • Surgical fundoplication for patients intolerant or allergic to medical therapy or refractory cases with predominantly regurgitation or nonacid reflux; use caution in patients whose primary complaint is heartburn and who are found to have nonerosive GER, as these patients likely have a component of visceral hypersensitivity that may be exacerbated by surgery. ■ Pearl Eradication of H. pylori may actually worsen GERD; the gastric acid secretion increases upon eradication of the bacterium. Reference Fass R. Proton pump inhibitor failure: what are the therapeutic options? Am J Gastroenterol 2009;104(suppl):S33. [PMID: 19262545] Chapter 3 Gastrointestinal Diseases 85 3 Intestinal Tuberculosis ■ Essentials of Diagnosis • Chronic abdominal pain, anorexia, bloating; weight loss, fever, diarrhea, new-onset ascites in many • Mild right lower quadrant tenderness, as ileocecal area is the most commonly involved intestinal site; fistula-in-ano sometimes seen • Barium study may reveal mucosal ulcerations or scarring and fibrosis with narrowing of the small or large intestine • In peritonitis, ascitic fluid has high protein and mononuclear pleocytosis; peritoneal biopsy with granulomas is more sensitive than ascites AFB culture; high adenosine deaminase levels in ascitic fluid may suggest the diagnosis; TB peritonitis more common in those with immune compromise • Complications include intestinal obstruction, hemorrhage, fistula formation, and bacterial overgrowth with malabsorption ■ Differential Diagnosis • Carcinoma of the colon or small bowel • Inflammatory bowel disease: Crohn’s disease • Ameboma or Yersinia infection • Intestinal lymphoma or amyloidosis • Ovarian or peritoneal carcinomatosis • Mycobacterium avium-intracellulare infection ■ Treatment • Standard therapy for tuberculosis; as infection heals, the affected bowel may develop stricture Carpal Tunnel Syndrome ■ Essentials of Diagnosis • The most common entrapment neuropathy, caused by compression of the median nerve (which innervates the flexor muscles of the wrist and fingers) • Middle-aged women and those with a history of repetitive use of the hands commonly affected • Pain classically worse at night (sleep with hands curled into the body) and exacerbated by hand movement • Initial symptoms of pain or paresthesias in thumb, index, middle, and lateral part of ring finger; progression to thenar eminence wasting • Pain radiation to forearm, shoulder, neck, chest, or other fingers of the hand not uncommon • Positive Tinel’s sign • Usually idiopathic; in bilateral onset consider secondary causes including rheumatoid arthritis, amyloidosis, sarcoidosis, hypothyroidism, diabetes, pregnancy, acromegaly, gout • Diagnosis is primarily clinical; detection of deficits by electrodiagnostic testing (assessing nerve conduction velocity) very helpful to guide referral for surgical release ■ Differential Diagnosis • C6 or C7 cervical radiculopathy • Thoracic outlet syndrome leading to brachial plexus neuropathy • Mononeuritis multiplex • Syringomyelia • Multiple sclerosis • Angina pectoris, especially when left-sided ■ Treatment • Conservative measures initially, including hand rest, nocturnal splinting of wrists, anti-inflammatory medications • Steroid injection into the carpal tunnel occasionally • Surgical decompression in a few who have nerve conduction abnormalities; best done before development of thenar atrophy ■ Pearl Carpal tunnel affects the radial three and one-half fingers, myocardial ischemia the ulnar one and one-half; remember this in evaluating arm pain—and hope it’s the right arm. Reference Dahlin LB, Salö M, Thomsen N, Stütz N. Carpal tunnel syndrome and treatment of recurrent symptoms. Scand J Plast Reconstr Surg Hand Surg 2010;44:4. [PMID: 20136467]",Medical,Fact Finding,Q&A Use information present in the text to support your response. Do not use outside information.,What does the attached document have to say about the prognosis of someone diagnosed with malignant MS?,"**What is multiple sclerosis?** Multiple sclerosis (MS) is the most common disabling neurological disease of young adults with symptom onset generally occurring between the ages of 20 to 40 years. In MS, the immune system cells that normally protect us from viruses, bacteria, and unhealthy cells mistakenly attack myelin in the central nervous system (brain, optic nerves, and spinal cord). Myelin is a substance that makes up the protective sheath (myelin sheath) that coats nerve fibers (axons). MS is a chronic disease that affects people differently. A small number of people with MS will have a mild course with little to no disability, whereas others will have a steadily worsening disease that leads to increased disability over time. Most people with MS, however, will have short periods of symptoms followed by long stretches of relative quiescence (inactivity or dormancy), with partial or full recovery. The disease is rarely fatal and most people with MS have a normal life expectancy. Myelin and the immune system MS attacks axons in the central nervous system protected by myelin, which are commonly called white matter. MS also damages the nerve cell bodies, which are found in the brain's gray matter, as well as the axons themselves in the brain, spinal cord, and optic nerves that transmit visual information from the eye to the brain. As the disease progresses, the outermost layer of the brain, called the cerebral cortex, shrinks in a process known as cortical atrophy. The term multiple sclerosis refers to the distinctive areas of scar tissue (sclerosis—also called plaques or lesions) that result from the attack on myelin by the immune system. These plaques are visible using magnetic resonance imaging (MRI). Plaques can be as small as a pinhead or as large as a golf ball. The symptoms of MS depend on the severity of the inflammatory reaction as well as the location and extent of the plaques, which primarily appear in the brain stem, cerebellum (involved with balance and coordination of movement, among other functions), spinal cord, optic nerves, and the white matter around the brain ventricles (fluid-filled cavaties). Signs and symptoms of MS The natural course of MS is different for each person, which makes it difficult to predict. The onset and duration of MS symptoms usually depend on the specific type but may begin over a few days and go away quickly or develop more slowly and gradually over many years. There are four main types of MS, named according to the progression of symptoms over time: Relapsing-remitting MS—Symptoms in this type come in the form of attacks. In between attacks, people recover or return to their usual level of disability. When symptoms occur in this form of MS, it is called an attack, a relapse, or exacerbation. The periods of disease inactivity between MS attacks are referred to as remission. Weeks, months, or even years may pass before another attack occurs, followed again by a period of inactivity. Most people with MS are initially diagnosed with this form of the disease. Secondary-progressive MS—People with this form of MS usually have had a previous history of MS attacks but then start to develop gradual and steady symptoms and deterioration in their function over time. Most individuals with severe relapsing-remitting MS may go on to develop secondary progressive MS if they are untreated. Primary-progressive MS—This type of MS is less common and is characterized by progressively worsening symptoms from the beginning with no noticeable relapses or exacerbations of the disease, although there may be temporary or minor relief from symptoms. Progressive-relapsing MS—The rarest form of MS is characterized by a steady worsening of symptoms from the beginning with acute relapses that can occur over time during the disease course. There are some rare and unusual variants of MS, such as: Marburg variant MS (also known as malignant MS) causes swift and relentless symptoms and decline in function, and may result in significant disability or even death shortly after disease onset. Balo's concentric sclerosis causes concentric rings of myelin destruction that can be seen on an MRI and is another variant type of MS that can progress rapidly. Early MS symptoms often include: Vision problems such as blurred or double vision, or optic neuritis, which causes pain with eye movement and rapid vision loss Muscle weakness, often in the hands and legs, and muscle stiffness accompanied by painful muscle spasms Tingling, numbness, or pain in the arms, legs, trunk, or face Clumsiness, especially difficulty staying balanced when walking Bladder control problems Intermittent or constant dizziness MS may also cause later symptoms, such as: Mental or physical fatigue which accompanies the early symptoms during an attack Mood changes such as depression or difficulty with emotional expression or control Cognitive dysfunction—problems concentrating, multitasking, thinking, learning, or difficulties with memory or judgment Muscle weakness, stiffness, and spasms may be severe enough to affect walking or standing. In some cases, MS leads to partial or complete paralysis and the use of a wheelchair is not uncommon, particularly in individuals who are untreated or have advanced disease. Many people with MS find that weakness and fatigue are worse when they have a fever or when they are exposed to heat. MS exacerbations may occur following common infections. Pain is rarely the first sign of MS but pain often occurs with optic neuritis and trigeminal neuralgia, a disorder that affects one of the nerves that provides sensation to different parts of the face. Painful limb spasms and sharp pain shooting down the legs or around the abdomen can also be symptoms of MS. Genetic susceptibility MS itself is not inherited, but susceptibility to MS may be inherited. Studies show that some individuals with MS have one or more family member or relative who also have MS. Current research suggests that dozens of genes and possibly hundreds of variations in the genetic code (gene variants) combine to create vulnerability to MS. Some of these genes have been identified, and most are associated with functions of the immune system. Many of the known genes are similar to those that have been identified in people with other autoimmune diseases as type 1 diabetes, rheumatoid arthritis, or lupus. Infectious factors and viruses Several viruses have been found in people with MS, but the virus most consistently linked to the development of MS is the Epstein-Barr virus (EBV) which causes infectious mononucleosis. Only about five percent of the population has not been infected by EBV. These individuals are at a lower risk for developing MS than those who have been infected. People who were infected with EBV in adolescence or adulthood, and who therefore develop an exaggerated immune response to EBV, are at a significantly higher risk for developing MS than those who were infected in early childhood. This suggests that it may be the type of immune response to EBV that may lead to MS, rather than EBV infection itself. However, there is still no proof that EBV causes MS and the mechanisms that underlie this process are poorly understood. Environmental factors Several studies indicate that people who spend more time in the sun and those with relatively higher levels of vitamin D are less likely to develop MS or have a less severe course of disease and fewer relapses. Bright sunlight helps human skin produce vitamin D. Researchers believe that vitamin D may help regulate the immune system in ways that reduce the risk of MS or autoimmunity in general. People from regions near the equator, where there is a great deal of bright sunlight, generally have a much lower risk of MS than people from temperate areas such as the U.S. and Canada. Studies have found that people who smoke are more likely to develop MS and have a more aggressive disease course. Indeed, people who smoke tend to have more brain lesions and brain shrinkage than non-smokers. How is multiple sclerosis diagnosed and treated? Diagnosing MS There is no single test used to diagnose MS. The disease is confirmed when symptoms and signs develop and are related to different parts of the nervous system at more than one interval and after other alternative diagnoses have been excluded. Doctors use different tests to rule out or confirm the diagnosis. In addition to a complete medical history, physical examination, and a detailed neurological examination, a doctor may recommend: MRI scans of the brain and spinal cord to look for the characteristic lesions of MS. A special dye or contrast agent may be injected into a vein to enhance brain images of the active MS lesions. Lumbar puncture (sometimes called a spinal tap) to obtain a sample of cerebrospinal fluid and examine it for proteins and inflammatory cells associated with the disease. Spinal tap analysis also can rule out diseases that may look like MS. Evoked potential tests, which use electrodes placed on the skin and painless electric signals to measure how quickly and accurately the nervous system responds to stimulation. Treating MS There is no cure for MS, but there are treatments that can reduce the number and severity of relapses and delay the long-term disability progression of the disease. Corticosteroids, such as intravenous (infused into a vein) methylprednisolone, are prescribed over the course of three to five days. Intravenous steroids quickly and potently suppress the immune system and reduce inflammation. They may be followed by a tapered dose of oral corticosteroids. Clinical trials have shown that these drugs hasten recovery from MS attacks, but do not alter the long-term outcome of the disease. Plasma exchange (plasmapheresis) can treat severe flare-ups in people with relapsing forms of MS who do not have a good response to methylprednisolone. Plasma exchange involves taking blood out of the body and removing components in the blood's plasma that are thought to be harmful. The rest of the blood, plus replacement plasma, is then transfused back into the body. This treatment has not been shown to be effective for secondary progressive or chronic progressive MS. Disease-modifying treatments Current therapies approved by the U.S. Food and Drug Administration (FDA) for MS are designed to modulate or suppress the inflammatory reactions of the disease. They are most effective for relapsing-remitting MS at early stages of the disease.","[Article] ========== **What is multiple sclerosis?** Multiple sclerosis (MS) is the most common disabling neurological disease of young adults with symptom onset generally occurring between the ages of 20 to 40 years. In MS, the immune system cells that normally protect us from viruses, bacteria, and unhealthy cells mistakenly attack myelin in the central nervous system (brain, optic nerves, and spinal cord). Myelin is a substance that makes up the protective sheath (myelin sheath) that coats nerve fibers (axons). MS is a chronic disease that affects people differently. A small number of people with MS will have a mild course with little to no disability, whereas others will have a steadily worsening disease that leads to increased disability over time. Most people with MS, however, will have short periods of symptoms followed by long stretches of relative quiescence (inactivity or dormancy), with partial or full recovery. The disease is rarely fatal and most people with MS have a normal life expectancy. Myelin and the immune system MS attacks axons in the central nervous system protected by myelin, which are commonly called white matter. MS also damages the nerve cell bodies, which are found in the brain's gray matter, as well as the axons themselves in the brain, spinal cord, and optic nerves that transmit visual information from the eye to the brain. As the disease progresses, the outermost layer of the brain, called the cerebral cortex, shrinks in a process known as cortical atrophy. The term multiple sclerosis refers to the distinctive areas of scar tissue (sclerosis—also called plaques or lesions) that result from the attack on myelin by the immune system. These plaques are visible using magnetic resonance imaging (MRI). Plaques can be as small as a pinhead or as large as a golf ball. The symptoms of MS depend on the severity of the inflammatory reaction as well as the location and extent of the plaques, which primarily appear in the brain stem, cerebellum (involved with balance and coordination of movement, among other functions), spinal cord, optic nerves, and the white matter around the brain ventricles (fluid-filled cavaties). Signs and symptoms of MS The natural course of MS is different for each person, which makes it difficult to predict. The onset and duration of MS symptoms usually depend on the specific type but may begin over a few days and go away quickly or develop more slowly and gradually over many years. There are four main types of MS, named according to the progression of symptoms over time: Relapsing-remitting MS—Symptoms in this type come in the form of attacks. In between attacks, people recover or return to their usual level of disability. When symptoms occur in this form of MS, it is called an attack, a relapse, or exacerbation. The periods of disease inactivity between MS attacks are referred to as remission. Weeks, months, or even years may pass before another attack occurs, followed again by a period of inactivity. Most people with MS are initially diagnosed with this form of the disease. Secondary-progressive MS—People with this form of MS usually have had a previous history of MS attacks but then start to develop gradual and steady symptoms and deterioration in their function over time. Most individuals with severe relapsing-remitting MS may go on to develop secondary progressive MS if they are untreated. Primary-progressive MS—This type of MS is less common and is characterized by progressively worsening symptoms from the beginning with no noticeable relapses or exacerbations of the disease, although there may be temporary or minor relief from symptoms. Progressive-relapsing MS—The rarest form of MS is characterized by a steady worsening of symptoms from the beginning with acute relapses that can occur over time during the disease course. There are some rare and unusual variants of MS, such as: Marburg variant MS (also known as malignant MS) causes swift and relentless symptoms and decline in function, and may result in significant disability or even death shortly after disease onset. Balo's concentric sclerosis causes concentric rings of myelin destruction that can be seen on an MRI and is another variant type of MS that can progress rapidly. Early MS symptoms often include: Vision problems such as blurred or double vision, or optic neuritis, which causes pain with eye movement and rapid vision loss Muscle weakness, often in the hands and legs, and muscle stiffness accompanied by painful muscle spasms Tingling, numbness, or pain in the arms, legs, trunk, or face Clumsiness, especially difficulty staying balanced when walking Bladder control problems Intermittent or constant dizziness MS may also cause later symptoms, such as: Mental or physical fatigue which accompanies the early symptoms during an attack Mood changes such as depression or difficulty with emotional expression or control Cognitive dysfunction—problems concentrating, multitasking, thinking, learning, or difficulties with memory or judgment Muscle weakness, stiffness, and spasms may be severe enough to affect walking or standing. In some cases, MS leads to partial or complete paralysis and the use of a wheelchair is not uncommon, particularly in individuals who are untreated or have advanced disease. Many people with MS find that weakness and fatigue are worse when they have a fever or when they are exposed to heat. MS exacerbations may occur following common infections. Pain is rarely the first sign of MS but pain often occurs with optic neuritis and trigeminal neuralgia, a disorder that affects one of the nerves that provides sensation to different parts of the face. Painful limb spasms and sharp pain shooting down the legs or around the abdomen can also be symptoms of MS. Genetic susceptibility MS itself is not inherited, but susceptibility to MS may be inherited. Studies show that some individuals with MS have one or more family member or relative who also have MS. Current research suggests that dozens of genes and possibly hundreds of variations in the genetic code (gene variants) combine to create vulnerability to MS. Some of these genes have been identified, and most are associated with functions of the immune system. Many of the known genes are similar to those that have been identified in people with other autoimmune diseases as type 1 diabetes, rheumatoid arthritis, or lupus. Infectious factors and viruses Several viruses have been found in people with MS, but the virus most consistently linked to the development of MS is the Epstein-Barr virus (EBV) which causes infectious mononucleosis. Only about five percent of the population has not been infected by EBV. These individuals are at a lower risk for developing MS than those who have been infected. People who were infected with EBV in adolescence or adulthood, and who therefore develop an exaggerated immune response to EBV, are at a significantly higher risk for developing MS than those who were infected in early childhood. This suggests that it may be the type of immune response to EBV that may lead to MS, rather than EBV infection itself. However, there is still no proof that EBV causes MS and the mechanisms that underlie this process are poorly understood. Environmental factors Several studies indicate that people who spend more time in the sun and those with relatively higher levels of vitamin D are less likely to develop MS or have a less severe course of disease and fewer relapses. Bright sunlight helps human skin produce vitamin D. Researchers believe that vitamin D may help regulate the immune system in ways that reduce the risk of MS or autoimmunity in general. People from regions near the equator, where there is a great deal of bright sunlight, generally have a much lower risk of MS than people from temperate areas such as the U.S. and Canada. Studies have found that people who smoke are more likely to develop MS and have a more aggressive disease course. Indeed, people who smoke tend to have more brain lesions and brain shrinkage than non-smokers. How is multiple sclerosis diagnosed and treated? Diagnosing MS There is no single test used to diagnose MS. The disease is confirmed when symptoms and signs develop and are related to different parts of the nervous system at more than one interval and after other alternative diagnoses have been excluded. Doctors use different tests to rule out or confirm the diagnosis. In addition to a complete medical history, physical examination, and a detailed neurological examination, a doctor may recommend: MRI scans of the brain and spinal cord to look for the characteristic lesions of MS. A special dye or contrast agent may be injected into a vein to enhance brain images of the active MS lesions. Lumbar puncture (sometimes called a spinal tap) to obtain a sample of cerebrospinal fluid and examine it for proteins and inflammatory cells associated with the disease. Spinal tap analysis also can rule out diseases that may look like MS. Evoked potential tests, which use electrodes placed on the skin and painless electric signals to measure how quickly and accurately the nervous system responds to stimulation. Treating MS There is no cure for MS, but there are treatments that can reduce the number and severity of relapses and delay the long-term disability progression of the disease. Corticosteroids, such as intravenous (infused into a vein) methylprednisolone, are prescribed over the course of three to five days. Intravenous steroids quickly and potently suppress the immune system and reduce inflammation. They may be followed by a tapered dose of oral corticosteroids. Clinical trials have shown that these drugs hasten recovery from MS attacks, but do not alter the long-term outcome of the disease. Plasma exchange (plasmapheresis) can treat severe flare-ups in people with relapsing forms of MS who do not have a good response to methylprednisolone. Plasma exchange involves taking blood out of the body and removing components in the blood's plasma that are thought to be harmful. The rest of the blood, plus replacement plasma, is then transfused back into the body. This treatment has not been shown to be effective for secondary progressive or chronic progressive MS. Disease-modifying treatments Current therapies approved by the U.S. Food and Drug Administration (FDA) for MS are designed to modulate or suppress the inflammatory reactions of the disease. They are most effective for relapsing-remitting MS at early stages of the disease. ---------------- [Query] ========== What does the attached document have to say about the prognosis of someone diagnosed with malignant MS? ---------------- [Task Instructions] ========== Use information present in the text to support your response. Do not use outside information.",Medical,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",I am doing some research into my asthma and I want a little help understanding what's happening to me. Can you explain more about the symptoms and causes?,"Asthma is a prevalent chronic inflammatory respiratory condition affecting millions of people worldwide and presents substantial challenges in both diagnosis and management. This respiratory condition is characterized by inflammation of the airways, causing intermittent airflow obstruction and bronchial hyperresponsiveness. The hallmark asthma symptoms include coughing, wheezing, and shortness of breath, which can be frequently exacerbated by triggers ranging from allergens to viral infections. Despite treatment advancements, disparities persist in asthma care, with variations in access to diagnosis, treatment, and patient education across different demographics. Severity varies from intermittent symptoms to life-threatening airway closure. Healthcare professionals establish a definitive diagnosis through patient history, physical examination, pulmonary function testing, and appropriate laboratory testing. Spirometry with a post-bronchodilator response (BDR) is the primary diagnostic test. Treatment focuses on providing continued education, routine symptom assessment, access to fast-acting bronchodilators, and appropriate controller medications tailored to disease severity. Childhood Wheezing caused by viral infections, particularly respiratory syncytial virus and human rhinovirus, may predispose infants and young children to develop asthma later in life. In addition, early-life exposure to air pollution, including combustion by-products from gas-fired appliances and indoor fires, obesity, and early puberty, also increases the risk of asthma. Adulthood The most significant risk factors for adult-onset asthma include tobacco smoke, occupational exposure, and adults with rhinitis or atopy. Studies also suggest a modest increase in asthma incidence among postmenopausal women taking hormone replacement therapy. Furthermore, the following factors can contribute to asthma and airway hyperreactivity: Exposure to environmental allergens such as house dust mites, animal allergens (especially from cats and dogs), cockroach allergens, and fungi Physical activity or exercise Conditions such as hyperventilation, gastroesophageal reflux disease, and chronic sinusitis Hypersensitivity to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), as well as sulfite sensitivity Use of β-adrenergic receptor blockers, including ophthalmic preparations Exposure to irritants such as household sprays and paint fumes Contact with various high- and low-molecular-weight compounds found in insects, plants, latex, gums, diisocyanates, anhydrides, wood dust, and solder fluxes, which are associated with occupational asthma Emotional factors or stress Aspirin-Exacerbated Respiratory Disease Aspirin-exacerbated respiratory disease (AERD) is a condition characterized by a combination of asthma, chronic rhinosinusitis with nasal polyposis, and NSAID intolerance. Patients with AERD present with upper and lower respiratory tract symptoms after ingesting aspirin or NSAIDs that inhibit cyclooxygenase-1 (COX-1). This condition arises from dysregulated arachidonic acid metabolism and the overproduction of leukotrienes involving the 5-lipoxygenase and cyclooxygenase pathways. AERD affects approximately 7% of adults with asthma. Occupational-Induced Asthma Two types of occupational asthma exist based on their appearance after a latency period: Occupational asthma triggered by workplace sensitizers results from an allergic or immunological process associated with a latency period induced by both low- and high-molecular-weight agents. High-molecular-weight substances, such as flour, contain proteins and polysaccharides of plant or animal origin. Low-molecular-weight substances, like formaldehyde, form a sensitizing neoantigen when combined with a human protein. Occupational asthma caused by irritants involves a nonallergic or nonimmunological process induced by gases, fumes, smoke, and aerosols. Asthma prevalence in the United States differs among demographic groups, including age, gender, race, and socioeconomic status. The United States Centers for Disease Control and Prevention (CDC) estimates that around 25 million Americans are currently affected by asthma. Among individuals younger than 18, boys exhibit a higher prevalence compared to girls, while among adults, women are more commonly affected than men. Additionally, asthma prevalence is notably higher among Black individuals, with a prevalence of 10.1%, compared to White individuals at 8.1%. Hispanic Americans generally have a lower prevalence of 6.4%, except for those from Puerto Rico, where the prevalence rises to 12.8%. Moreover, underrepresented minorities and individuals living below the poverty line experience the highest incidence of asthma, along with heightened rates of asthma-related morbidity and mortality. Similar to worldwide data, the mortality rate of asthma in the United States has also undergone a consistent decline. The current mortality rate is 9.86 per million compared to 15.09 per million in 2001. However, mortality rates remain consistently higher for Black patients compared to their White counterparts. According to the CDC, from 1999 to 2016, asthma death rates among adults aged 55 to 64 were 16.32 per 1 million persons, 9.95 per 1 million for females, 9.39 per 1 million for individuals who were not Hispanic or Latino, and notably higher at 25.60 per 1 million for Black patients. Physical Examination During physical examination, widespread, high-pitched wheezes are a characteristic finding associated with asthma. However, wheezing is not specific to asthma and is typically absent between acute exacerbations. Findings suggestive of a severe asthma exacerbation include tachypnea, tachycardia, a prolonged expiratory phase, reduced air movement, difficulty speaking in complete sentences or phrases, discomfort when lying supine due to breathlessness, and adopting a ""tripod position.""[27] The use of the accessory muscles of breathing during inspiration and pulsus paradoxus are additional indicators of a severe asthma attack. Healthcare professionals may identify extrapulmonary findings that support the diagnosis of asthma, such as pale, boggy nasal mucous membranes, posterior pharyngeal cobblestoning, nasal polyps, and atopic dermatitis. Nasal polyps should prompt further inquiry about anosmia, chronic sinusitis, and aspirin sensitivity to evaluate for AERD. Although AERD is uncommon in children or adolescents, the presence of nasal polyps in a child with lower respiratory disease should prompt an evaluation for cystic fibrosis. Clubbing, characterized by bulbous fusiform enlargement of the distal portion of a digit, is not associated with asthma and should prompt evaluation for alternative diagnoses. Please see StatPearls' companion resource, ""Nail Clubbing,"" for further information.","""================ ======= Asthma is a prevalent chronic inflammatory respiratory condition affecting millions of people worldwide and presents substantial challenges in both diagnosis and management. This respiratory condition is characterized by inflammation of the airways, causing intermittent airflow obstruction and bronchial hyperresponsiveness. The hallmark asthma symptoms include coughing, wheezing, and shortness of breath, which can be frequently exacerbated by triggers ranging from allergens to viral infections. Despite treatment advancements, disparities persist in asthma care, with variations in access to diagnosis, treatment, and patient education across different demographics. Severity varies from intermittent symptoms to life-threatening airway closure. Healthcare professionals establish a definitive diagnosis through patient history, physical examination, pulmonary function testing, and appropriate laboratory testing. Spirometry with a post-bronchodilator response (BDR) is the primary diagnostic test. Treatment focuses on providing continued education, routine symptom assessment, access to fast-acting bronchodilators, and appropriate controller medications tailored to disease severity. Childhood Wheezing caused by viral infections, particularly respiratory syncytial virus and human rhinovirus, may predispose infants and young children to develop asthma later in life. In addition, early-life exposure to air pollution, including combustion by-products from gas-fired appliances and indoor fires, obesity, and early puberty, also increases the risk of asthma. Adulthood The most significant risk factors for adult-onset asthma include tobacco smoke, occupational exposure, and adults with rhinitis or atopy. Studies also suggest a modest increase in asthma incidence among postmenopausal women taking hormone replacement therapy. Furthermore, the following factors can contribute to asthma and airway hyperreactivity: Exposure to environmental allergens such as house dust mites, animal allergens (especially from cats and dogs), cockroach allergens, and fungi Physical activity or exercise Conditions such as hyperventilation, gastroesophageal reflux disease, and chronic sinusitis Hypersensitivity to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), as well as sulfite sensitivity Use of β-adrenergic receptor blockers, including ophthalmic preparations Exposure to irritants such as household sprays and paint fumes Contact with various high- and low-molecular-weight compounds found in insects, plants, latex, gums, diisocyanates, anhydrides, wood dust, and solder fluxes, which are associated with occupational asthma Emotional factors or stress Aspirin-Exacerbated Respiratory Disease Aspirin-exacerbated respiratory disease (AERD) is a condition characterized by a combination of asthma, chronic rhinosinusitis with nasal polyposis, and NSAID intolerance. Patients with AERD present with upper and lower respiratory tract symptoms after ingesting aspirin or NSAIDs that inhibit cyclooxygenase-1 (COX-1). This condition arises from dysregulated arachidonic acid metabolism and the overproduction of leukotrienes involving the 5-lipoxygenase and cyclooxygenase pathways. AERD affects approximately 7% of adults with asthma. Occupational-Induced Asthma Two types of occupational asthma exist based on their appearance after a latency period: Occupational asthma triggered by workplace sensitizers results from an allergic or immunological process associated with a latency period induced by both low- and high-molecular-weight agents. High-molecular-weight substances, such as flour, contain proteins and polysaccharides of plant or animal origin. Low-molecular-weight substances, like formaldehyde, form a sensitizing neoantigen when combined with a human protein. Occupational asthma caused by irritants involves a nonallergic or nonimmunological process induced by gases, fumes, smoke, and aerosols. Asthma prevalence in the United States differs among demographic groups, including age, gender, race, and socioeconomic status. The United States Centers for Disease Control and Prevention (CDC) estimates that around 25 million Americans are currently affected by asthma. Among individuals younger than 18, boys exhibit a higher prevalence compared to girls, while among adults, women are more commonly affected than men. Additionally, asthma prevalence is notably higher among Black individuals, with a prevalence of 10.1%, compared to White individuals at 8.1%. Hispanic Americans generally have a lower prevalence of 6.4%, except for those from Puerto Rico, where the prevalence rises to 12.8%. Moreover, underrepresented minorities and individuals living below the poverty line experience the highest incidence of asthma, along with heightened rates of asthma-related morbidity and mortality. Similar to worldwide data, the mortality rate of asthma in the United States has also undergone a consistent decline. The current mortality rate is 9.86 per million compared to 15.09 per million in 2001. However, mortality rates remain consistently higher for Black patients compared to their White counterparts. According to the CDC, from 1999 to 2016, asthma death rates among adults aged 55 to 64 were 16.32 per 1 million persons, 9.95 per 1 million for females, 9.39 per 1 million for individuals who were not Hispanic or Latino, and notably higher at 25.60 per 1 million for Black patients. Physical Examination During physical examination, widespread, high-pitched wheezes are a characteristic finding associated with asthma. However, wheezing is not specific to asthma and is typically absent between acute exacerbations. Findings suggestive of a severe asthma exacerbation include tachypnea, tachycardia, a prolonged expiratory phase, reduced air movement, difficulty speaking in complete sentences or phrases, discomfort when lying supine due to breathlessness, and adopting a ""tripod position.""[27] The use of the accessory muscles of breathing during inspiration and pulsus paradoxus are additional indicators of a severe asthma attack. Healthcare professionals may identify extrapulmonary findings that support the diagnosis of asthma, such as pale, boggy nasal mucous membranes, posterior pharyngeal cobblestoning, nasal polyps, and atopic dermatitis. Nasal polyps should prompt further inquiry about anosmia, chronic sinusitis, and aspirin sensitivity to evaluate for AERD. Although AERD is uncommon in children or adolescents, the presence of nasal polyps in a child with lower respiratory disease should prompt an evaluation for cystic fibrosis. Clubbing, characterized by bulbous fusiform enlargement of the distal portion of a digit, is not associated with asthma and should prompt evaluation for alternative diagnoses. Please see StatPearls' companion resource, ""Nail Clubbing,"" for further information. https://www.ncbi.nlm.nih.gov/books/NBK430901/ ================ ======= I am doing some research into my asthma and I want a little help understanding what's happening to me. Can you explain more about the symptoms and causes? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","With the advancement of technology and no signs of it slowing down, I am worried about career as a filmmaker and content creator. What fields are booming in tech and how will AI affect its productivity when in relation to the human job market? I do not need to know a lot, just the fields to research. I'm specifically interested in what AI tools can do in the content production realm. can you list the fields and give me a rundown on what AI is taking over in the production field?","Four evolving technology trends modernizing the consumer products and retail industry 1. Artificial intelligence/machine learning (AI/ML) and microcomputing to optimize and enhance experience and supply chain Why it’s important: In the CP&R industry, personalized experiences and efficient supply chains are paramount for winning in the market. Artificial intelligence and machine learning (AI/ML) and microcomputing technologies are crucial for achieving these objectives by enabling real-time data ingestion and action across customer interactions. This, in turn, empowers businesses to understand consumer preferences at a granular and even hyper-local level, driving increased sales and profitability, brand engagement and loyalty, and streamlined supply chain efforts. Now and in the future, brands and retailers will implement AI/ML across a host of use cases, such as: 2. Generative AI for content creation and innovation Generative AI holds immense significance in CP&R for its ability to foster innovation in content creation and product development. By harnessing the power of GenAI, businesses can produce fresh and engaging content, get to market with speed and build rapid customer engagement models. GenAI is still in its early stages and so are its applications in CP&R, but it’s already clear that the possibilities are endless. Content generation and customization for marketing Product and promotional development and design Virtual shopping assistants Supplier communication and negotiation Quality control and defect detection CP&R companies should consider integrating GenAI into operations more broadly across the value chain. Organizations that find the most appropriate use cases and implement them at scale will drive the operational agility that industry stakeholders have been expecting for years. It will be critical to rethink how talent and capital allocation can be repositioned to better drive value when content and innovation can be available at the drop of a hat. 3. Digital twin and predictive analytics to drive process controls and decision-making Digital twin technology and predictive analytics play a pivotal role in revolutionizing CP&R operations. They facilitate agility and offer a comprehensive view of product lifecycles, supply chains and manufacturing processes. Digital twin and predictive analytics are not new in CP&R, but applications for their use are becoming more robust Design and development optimization for consumer goods Manufacturing process optimization Inventory management and demand forecasting in retail As the CP&R industry becomes increasingly more digitally connected and complex, driven by software proliferation and the Internet of Things (IoT), companies should expand their use of digital twins to a wider range of interconnected value chain nodes. This approach will enable a more proactive response to disruption and market shifts by transforming these tools into a means for a truly dynamic enterprise, from the front office through to the back office. 4. Cloud and ERP upgrades for efficiency and scalability With enterprise resource planning (ERP) upgrades imminent by 2025, modernization is foundational to integrating evolving technology capabilities. Cloud computing provides on-demand data storage and computing power, which is essential for supporting and scaling these new technologies. CP&R executives should be considering these applications to derive the most value from Cloud and ERP upgrades. Connecting systems from front to back office Real-time analytics and computing power Enhanced data security and compliance Companies must look at their legacy transaction systems and rationalize how to modernize them to create efficiencies, whether by integrating evolving tech that makes their systems more usable or by upgrading legacy transaction systems to keep pace with their front-end infrastructure. Considerations for consumer products and retail leaders to help transform evolving tech trends into ‘force multipliers’ It's imperative to recognize that the true power and value behind an evolving digital landscape lie not just in the technologies themselves but in how companies strategically integrate and orchestrate them into their operations and strategic initiatives. The following considerations serve as a guide to help CP&R leaders start a journey down this transformative path. Data strategy: Establish robust data quality and governance frameworks, as inaccurate or poor-quality data can undermine the success of tech implementations. Zero-party data: Capitalize on data provided directly by consumers to personalize experiences and tailor product offerings to meet individual preferences. How EY can help Read more Evaluating the tech ecosystem: Continuously assess your technology ecosystem by building strategic alliances and leveraging partnerships to gain access to cutting-edge technologies and expertise, further driving innovation, agility and competitive advantage. Collaboration and co-opetition: Encourage data- and tech-enabled collaboration both within your organization and externally, as partnerships with suppliers, distributors and even competitors can foster innovation and create a more agile system. Governance: Establish clear governance policies and ethical guidelines for responsible technology use, particularly in areas like AI and data analytics. Talent agenda: Invest in employee training and upskilling to enable your workforce to effectively utilize technology and adapt to new tools and workflows.","""================ ======= Four evolving technology trends modernizing the consumer products and retail industry 1. Artificial intelligence/machine learning (AI/ML) and microcomputing to optimize and enhance experience and supply chain Why it’s important: In the CP&R industry, personalized experiences and efficient supply chains are paramount for winning in the market. Artificial intelligence and machine learning (AI/ML) and microcomputing technologies are crucial for achieving these objectives by enabling real-time data ingestion and action across customer interactions. This, in turn, empowers businesses to understand consumer preferences at a granular and even hyper-local level, driving increased sales and profitability, brand engagement and loyalty, and streamlined supply chain efforts. Now and in the future, brands and retailers will implement AI/ML across a host of use cases, such as: 2. Generative AI for content creation and innovation Generative AI holds immense significance in CP&R for its ability to foster innovation in content creation and product development. By harnessing the power of GenAI, businesses can produce fresh and engaging content, get to market with speed and build rapid customer engagement models. GenAI is still in its early stages and so are its applications in CP&R, but it’s already clear that the possibilities are endless. Content generation and customization for marketing Product and promotional development and design Virtual shopping assistants Supplier communication and negotiation Quality control and defect detection CP&R companies should consider integrating GenAI into operations more broadly across the value chain. Organizations that find the most appropriate use cases and implement them at scale will drive the operational agility that industry stakeholders have been expecting for years. It will be critical to rethink how talent and capital allocation can be repositioned to better drive value when content and innovation can be available at the drop of a hat. 3. Digital twin and predictive analytics to drive process controls and decision-making Digital twin technology and predictive analytics play a pivotal role in revolutionizing CP&R operations. They facilitate agility and offer a comprehensive view of product lifecycles, supply chains and manufacturing processes. Digital twin and predictive analytics are not new in CP&R, but applications for their use are becoming more robust Design and development optimization for consumer goods Manufacturing process optimization Inventory management and demand forecasting in retail As the CP&R industry becomes increasingly more digitally connected and complex, driven by software proliferation and the Internet of Things (IoT), companies should expand their use of digital twins to a wider range of interconnected value chain nodes. This approach will enable a more proactive response to disruption and market shifts by transforming these tools into a means for a truly dynamic enterprise, from the front office through to the back office. 4. Cloud and ERP upgrades for efficiency and scalability With enterprise resource planning (ERP) upgrades imminent by 2025, modernization is foundational to integrating evolving technology capabilities. Cloud computing provides on-demand data storage and computing power, which is essential for supporting and scaling these new technologies. CP&R executives should be considering these applications to derive the most value from Cloud and ERP upgrades. Connecting systems from front to back office Real-time analytics and computing power Enhanced data security and compliance Companies must look at their legacy transaction systems and rationalize how to modernize them to create efficiencies, whether by integrating evolving tech that makes their systems more usable or by upgrading legacy transaction systems to keep pace with their front-end infrastructure. Considerations for consumer products and retail leaders to help transform evolving tech trends into ‘force multipliers’ It's imperative to recognize that the true power and value behind an evolving digital landscape lie not just in the technologies themselves but in how companies strategically integrate and orchestrate them into their operations and strategic initiatives. The following considerations serve as a guide to help CP&R leaders start a journey down this transformative path. Data strategy: Establish robust data quality and governance frameworks, as inaccurate or poor-quality data can undermine the success of tech implementations. Zero-party data: Capitalize on data provided directly by consumers to personalize experiences and tailor product offerings to meet individual preferences. How EY can help Read more Evaluating the tech ecosystem: Continuously assess your technology ecosystem by building strategic alliances and leveraging partnerships to gain access to cutting-edge technologies and expertise, further driving innovation, agility and competitive advantage. Collaboration and co-opetition: Encourage data- and tech-enabled collaboration both within your organization and externally, as partnerships with suppliers, distributors and even competitors can foster innovation and create a more agile system. Governance: Establish clear governance policies and ethical guidelines for responsible technology use, particularly in areas like AI and data analytics. Talent agenda: Invest in employee training and upskilling to enable your workforce to effectively utilize technology and adapt to new tools and workflows. https://www.ey.com/en_us/insights/consumer-products/how-embracing-technology-trends-can-drive-leadership-in-the-next ================ ======= With the advancement of technology and no signs of it slowing down, I am worried about career as a filmmaker and content creator. What fields are booming in tech and how will AI affect its productivity when in relation to the human job market? I do not need to know a lot, just the fields to research. I'm specifically interested in what AI tools can do in the content production realm. can you list the fields and give me a rundown on what AI is taking over in the production field? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Internet/Technology,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","What are key changes to the Social Security program for 2024, related to the cost-of-living adjustments(COLA), taxable earning limit, and disability benefits, and how do they impact recipients?","7 New Social Security Changes for 2024 The 3.2% COLA for 2024 reflects a drop in inflation—and the 2025 COLA is expected soon By Rebecca Rosenberg Updated September 13, 2024 Reviewed by Charlene Rhinehart Fact checked by Rebecca McClay Part of the Series Understanding Social Security Every October, the U.S. Social Security Administration (SSA) announces its annual changes to the Social Security program for the following year. For 2024, the changes consist of a 3.2% cost-of-living adjustment (COLA) to the monthly benefit amount, an increase in the maximum earnings subject to the Social Security tax, a rise in disability benefits, and more. 1 Key Takeaways Those who are receiving Social Security benefits got a 3.2% raise in 2024. Social Security tax rates for 2024 are 6.2% for employees and 12.4% for the self-employed. In 2024, it takes $1,730 to earn a Social Security credit. The Social Security Administration is expected to release the 2025 COLA soon. 1. COLA Increase While we don't yet know what the cost-of-living adjustment (COLA) will be for 2025, more than 71 million Social Security recipients received a COLA increase to their monthly benefits of 3.2% in 2024. 1 The adjustment helps benefits keep pace with inflation and is based on the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) calculated by the U.S. Bureau of Labor Statistics (BLS). Based on the increase for 2024, the average monthly benefit for all retired workers is $1,907, up from $1,848. 2 2. Higher Maximum Monthly Payout The earliest individuals can claim Social Security retirement benefits is age 62. However, claiming before full retirement age (FRA) will result in a permanently reduced payout. 3 In 1983, Congress passed a law increasing the full retirement age by two months each year from 2000 to 2022, until it hit 67. In 2024, anyone born in 1960 or later will not reach full retirement age until they are 67. 4 3 Those who earn delayed retirement credits—that is, waiting to claim Social Security past full (or normal) retirement age—can collect more than their full, or normal, payout. In 2024, the maximum payout of a worker retiring at full retirement age is $3,822. Retiring at age 70 means a maximum payout of $4,873. 5 Take the Next Step to Invest Advertiser Disclosure Earning retirement income above a certain threshold—$22,320 in 2024—will temporarily reduce your benefits before your full retirement age. Once you reach full retirement age, you can work as much as you want and your benefits won't be reduced. You'll still receive your full Social Security benefits. 6 Individuals can earn an additional 8% of their benefit per year up until age 70 by delaying retirement. 7 Custom illustration shows a woman stands at a table looking at a cake with the number 62 on top A woman stands at a table looking at a cake with the number 62 on it. You can claim Social Security benefits as early as age 62, but you won’t receive your maximum benefit. Xiaojie Liu / Investopedia 3. Earnings Limits Increased For recipients who work while collecting Social Security benefits, all or part of their benefits may be temporarily withheld, depending on how much they earn. Before reaching full retirement age, recipients can earn up to $22,320 in 2024. After that, $1 will be deducted from their payment for every $2 that exceeds the limit. 8 Individuals who reach full retirement age in 2024 can earn $59,520, up $3,000 from the 2023 limit of $56,520. For every $3 you earn over the limit, your Social Security benefits will be reduced by $1 for money earned in the months before full retirement age. Once full retirement age is reached, no benefits will be withheld if recipients continue to work. 2 4. Taxable Earnings Rose Employees paid the 6.2% Social Security tax, with their employer matching that payment, on income of up to $160,200 in 2023. In 2024, the maximum taxable earnings increased to $168,600. The Social Security tax rate remains at 6.2% and 12.4% for the self-employed. 2 5. Disability Benefits and Income Thresholds Increased Social Security Disability Insurance (SSDI) provides income for those who can no longer work due to a disability. More than 8.9 million people in the United States who are receiving Social Security disability benefits received a 3.2% increase in 2024. 1 Disabled workers receive on average $1,537 per month in 2024, up from $1,489 in 2023. Disabled workers with a spouse and one or more children can expect an average of $2,720. 2 Blind workers have a cap of $2,590 per month in 2024. 2 6. Higher Credit Earning Threshold Those born in 1929 or later must earn at least 40 credits (maximum of four per year) over their working life to qualify for Social Security benefits. The amount it takes to earn a single credit goes up each year. 9 For 2024, it will take $1,730 in earnings per credit. 2 The number of credits needed for SSDI depends on the age when the recipient becomes disabled. 7. Increase in Medicare Part B Premiums Premiums for Medicare Part B, determined according to the Social Security Act, rose in 2024. The standard monthly premium for Medicare Part B is $174.70 for 2024, up from $164.90 in 2023. The annual deductible for Medicare Part B is $240 in 2024. 10 Program Funding Through 2035 According to the 2024 Social Security and Medicare Boards of Trustees annual report, Social Security and Medicare programs face future financing issues. The Old-Age and Survivors Insurance (OASI) Trust Fund and the Disability Insurance (DI) Trust Fund are combined to create the OASDI, used to indicate the status of the Social Security program. 11 As of 2024, OASDI is projected to pay 100% of total scheduled benefits until 2035, At that point, the projected fund's reserves will be depleted and the continuing total fund income will pay 83% of expected benefits. 11 The Old-Age and Survivors Insurance (OASI) Trust Fund is projected to pay 100% of scheduled benefits until 2033. The fund's reserves will be depleted and continuing program income will be able to pay 79% of benefits. The Disability Insurance (DI) Trust Fund is projected to support 100% of benefits through 2098. 11 What Is the Highest Social Security Benefit in 2024? The maximum Social Security benefit for a worker retiring at full retirement age in 2024 is $3,822 monthly. Though uncommon, it's possible to be eligible for triple the Social Security benefits: Social Security retirement benefits, Social Security Disability Insurance (SSDI), and Supplemental Security Income (SSI). Individuals can check their full retirement age on the Social Security Administration’s Retirement Age Calculator. 2 12 What Is the Cost-of-Living Adjustment (COLA) for the Military in 2024? Cost-of-living adjustments (COLAs) for pay for retired military members increased to 3.2% in 2024, depending on the time of retirement. 13 Can a Divorced Person Collect Their Ex-Spouse’s Social Security? Individuals who divorced but were married to a spouse for more than 10 years can likely claim some portion of their spouse’s Social Security benefits. They must be unmarried when collecting Social Security benefits. The widow’s benefit is 71% to 100% of what a spouse received before they died. 14 The Bottom Line Social Security benefits increased in 2024 with a COLA based on inflation. The ideal time to take retirement benefits depends on an individual's financial situation and retirement goals.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== What are key changes to the Social Security program for 2024, related to the cost-of-living adjustments(COLA), taxable earning limit, and disability benefits, and how do they impact recipients? {passage 0} ========== 7 New Social Security Changes for 2024 The 3.2% COLA for 2024 reflects a drop in inflation—and the 2025 COLA is expected soon By Rebecca Rosenberg Updated September 13, 2024 Reviewed by Charlene Rhinehart Fact checked by Rebecca McClay Part of the Series Understanding Social Security Every October, the U.S. Social Security Administration (SSA) announces its annual changes to the Social Security program for the following year. For 2024, the changes consist of a 3.2% cost-of-living adjustment (COLA) to the monthly benefit amount, an increase in the maximum earnings subject to the Social Security tax, a rise in disability benefits, and more. 1 Key Takeaways Those who are receiving Social Security benefits got a 3.2% raise in 2024. Social Security tax rates for 2024 are 6.2% for employees and 12.4% for the self-employed. In 2024, it takes $1,730 to earn a Social Security credit. The Social Security Administration is expected to release the 2025 COLA soon. 1. COLA Increase While we don't yet know what the cost-of-living adjustment (COLA) will be for 2025, more than 71 million Social Security recipients received a COLA increase to their monthly benefits of 3.2% in 2024. 1 The adjustment helps benefits keep pace with inflation and is based on the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) calculated by the U.S. Bureau of Labor Statistics (BLS). Based on the increase for 2024, the average monthly benefit for all retired workers is $1,907, up from $1,848. 2 2. Higher Maximum Monthly Payout The earliest individuals can claim Social Security retirement benefits is age 62. However, claiming before full retirement age (FRA) will result in a permanently reduced payout. 3 In 1983, Congress passed a law increasing the full retirement age by two months each year from 2000 to 2022, until it hit 67. In 2024, anyone born in 1960 or later will not reach full retirement age until they are 67. 4 3 Those who earn delayed retirement credits—that is, waiting to claim Social Security past full (or normal) retirement age—can collect more than their full, or normal, payout. In 2024, the maximum payout of a worker retiring at full retirement age is $3,822. Retiring at age 70 means a maximum payout of $4,873. 5 Take the Next Step to Invest Advertiser Disclosure Earning retirement income above a certain threshold—$22,320 in 2024—will temporarily reduce your benefits before your full retirement age. Once you reach full retirement age, you can work as much as you want and your benefits won't be reduced. You'll still receive your full Social Security benefits. 6 Individuals can earn an additional 8% of their benefit per year up until age 70 by delaying retirement. 7 Custom illustration shows a woman stands at a table looking at a cake with the number 62 on top A woman stands at a table looking at a cake with the number 62 on it. You can claim Social Security benefits as early as age 62, but you won’t receive your maximum benefit. Xiaojie Liu / Investopedia 3. Earnings Limits Increased For recipients who work while collecting Social Security benefits, all or part of their benefits may be temporarily withheld, depending on how much they earn. Before reaching full retirement age, recipients can earn up to $22,320 in 2024. After that, $1 will be deducted from their payment for every $2 that exceeds the limit. 8 Individuals who reach full retirement age in 2024 can earn $59,520, up $3,000 from the 2023 limit of $56,520. For every $3 you earn over the limit, your Social Security benefits will be reduced by $1 for money earned in the months before full retirement age. Once full retirement age is reached, no benefits will be withheld if recipients continue to work. 2 4. Taxable Earnings Rose Employees paid the 6.2% Social Security tax, with their employer matching that payment, on income of up to $160,200 in 2023. In 2024, the maximum taxable earnings increased to $168,600. The Social Security tax rate remains at 6.2% and 12.4% for the self-employed. 2 5. Disability Benefits and Income Thresholds Increased Social Security Disability Insurance (SSDI) provides income for those who can no longer work due to a disability. More than 8.9 million people in the United States who are receiving Social Security disability benefits received a 3.2% increase in 2024. 1 Disabled workers receive on average $1,537 per month in 2024, up from $1,489 in 2023. Disabled workers with a spouse and one or more children can expect an average of $2,720. 2 Blind workers have a cap of $2,590 per month in 2024. 2 6. Higher Credit Earning Threshold Those born in 1929 or later must earn at least 40 credits (maximum of four per year) over their working life to qualify for Social Security benefits. The amount it takes to earn a single credit goes up each year. 9 For 2024, it will take $1,730 in earnings per credit. 2 The number of credits needed for SSDI depends on the age when the recipient becomes disabled. 7. Increase in Medicare Part B Premiums Premiums for Medicare Part B, determined according to the Social Security Act, rose in 2024. The standard monthly premium for Medicare Part B is $174.70 for 2024, up from $164.90 in 2023. The annual deductible for Medicare Part B is $240 in 2024. 10 Program Funding Through 2035 According to the 2024 Social Security and Medicare Boards of Trustees annual report, Social Security and Medicare programs face future financing issues. The Old-Age and Survivors Insurance (OASI) Trust Fund and the Disability Insurance (DI) Trust Fund are combined to create the OASDI, used to indicate the status of the Social Security program. 11 As of 2024, OASDI is projected to pay 100% of total scheduled benefits until 2035, At that point, the projected fund's reserves will be depleted and the continuing total fund income will pay 83% of expected benefits. 11 The Old-Age and Survivors Insurance (OASI) Trust Fund is projected to pay 100% of scheduled benefits until 2033. The fund's reserves will be depleted and continuing program income will be able to pay 79% of benefits. The Disability Insurance (DI) Trust Fund is projected to support 100% of benefits through 2098. 11 What Is the Highest Social Security Benefit in 2024? The maximum Social Security benefit for a worker retiring at full retirement age in 2024 is $3,822 monthly. Though uncommon, it's possible to be eligible for triple the Social Security benefits: Social Security retirement benefits, Social Security Disability Insurance (SSDI), and Supplemental Security Income (SSI). Individuals can check their full retirement age on the Social Security Administration’s Retirement Age Calculator. 2 12 What Is the Cost-of-Living Adjustment (COLA) for the Military in 2024? Cost-of-living adjustments (COLAs) for pay for retired military members increased to 3.2% in 2024, depending on the time of retirement. 13 Can a Divorced Person Collect Their Ex-Spouse’s Social Security? Individuals who divorced but were married to a spouse for more than 10 years can likely claim some portion of their spouse’s Social Security benefits. They must be unmarried when collecting Social Security benefits. The widow’s benefit is 71% to 100% of what a spouse received before they died. 14 The Bottom Line Social Security benefits increased in 2024 with a COLA based on inflation. The ideal time to take retirement benefits depends on an individual's financial situation and retirement goals. https://www.investopedia.com/retirement/social-security-changes/",Financial,Fact Finding,Q&A Draw your answer from the text below only.,Summarize the different resources offered and list the pros and cons of each.,"Introduction CHFA’s vision is that everyone will have the opportunity for housing stability and economic prosperity, two things that underserved markets often consider out of reach. To support recent initiatives to reduce the homeownership gap between White homeowners and minority homeowners, CHFA is continuously engaging with community to learn how to provide products and services in a meaningful way. Throughout this engagement, CHFA has heard two consistent requests: to meet homebuyers where they are, and to provide expansive homebuying resources that they can trust to support them on the path to homeownership. Often, community members cite the overabundance of information as being overwhelming and sometimes misleading. As the state housing and finance authority, CHFA is looked to as a trusted resource, so we developed the Homebuyer’s Roadmap to help people access requested information at their own pace. The Homebuyer’s Roadmap is available online and in a printed folder with supplemental inserts so homebuyers can select the option that works best for them. It begins by introducing CHFA and helping the user understand CHFA’s mission and vision, along with how CHFA can help them on their homebuying journey, before breaking the homebuying process into 10 “stops on the homebuying journey.” The interactive online version allows users to “choose their own adventure” by selecting the stop of most interest based on where they are in the homebuying process. They can also dig deeper into topics of interest by using the additional resource links throughout, which open as pop-ups with summary information or in a new tab. For the printed folder, many of these additional resources are provided as inserts. Navigation is intuitive; no matter where the user is within the Roadmap, they can use the navigation ribbon on the right of the screen to visit other stops, or the overarching navigation buttons on the bottom-right to visit the home page or the “stops” page. The Roadmap also encourages continued engagement with CHFA: after the final stop, which shares resources to help people maintain homeownership, users can click to a final screen showing links to newsletters, homebuying classes, and our “Help for Homebuyers” site. The Roadmap has been well received. Since October 2023, it has been viewed by 1,335 users an average of 5.24 times each, showing that people are returning to use it as they progress in their homebuying journey. In addition, 182 people have requested a printed copy. It is innovative and meets a state housing need. Colorado Housing and Finance Authority CHFA Homebuyer’s Roadmap Homeownership – Empowering New Buyers Colorado Housing and Finance Authority CHFA Homebuyer’s Roadmap Homeownership – Empowering New Buyers Based on community feedback, we learned that there was a gap in current homebuying educational offerings. We heard from many potential homebuyers that while they wanted to be as informed as possible about the homebuying process, they felt overwhelmed by the sheer amount of information available. Other “roadmap” communications vacillated between two extremes: having limited space to convey adequate information (such as in a print flyer) or trying to include everything in an effort to educate, which resulted in readers losing focus or not being able to locate the exact information they were looking for (such as on a web page). CHFA’s own products illustrate this gap: we offer a high-level Steps to Homeownership on our site, a one- hour Homebuyer 101 webinar, and an in-depth homebuyer education class for certification (classes last between six to eight hours). The shorter, more high-level options are suited for those just getting started, and the longer class is great for those homebuyers who are moving forward with a purchase, but we were missing the middle piece: a resource that was interactive, allowing homebuyers to navigate at their own pace and quickly find more in-depth information. The design of the Roadmap was instrumental in this delivery. In addition to the intuitive navigation throughout, pop-ups, information buttons, and third-party links kept the screens uncluttered and let each user create their own experience. While there is a wealth of information, it never feels overwhelming. Utilizing movement throughout creates a fresh and engaging experience while highlighting the individual resources. It demonstrates effective use of resources, benefits outweighing costs, and a replicable development process. The Roadmap is an in-house product. Content was developed collaboratively by marketing and home finance team members, the design was completed in Adobe InDesign, and the finished digital product was easily uploaded and integrated into our website functionality. Content updates are easy to implement in the digital version, and we printed a low count of the folder to reduce waste when changes are needed. All the supplements in the folder are those that were already developed prior to the Roadmap launch and are used in other outreach and communication activities. A two-year content review schedule will help to ensure that information is accurate and current. Overall costs were minimal; the development was incorporated into staff project flow, and the only additional costs are for the small-batch folder printing and individual mailings for requests. The accessibility of the product is also a benefit: it is free, print versions are mailed within one business day of request, and no specific software is required for viewing the online version. It effectively employes partnerships with industry professionals. When creating the Roadmap, we wanted to deliver something that lenders, real estate agents, and homebuyer education providers could use with their customers to elevate themselves as a resource. Throughout development, feedback was sought from our Lender Advisory Group and real estate agents regarding content and utilization. Traditionally, our partners value CHFA collateral that they can leverage 2 for homebuyer engagement. In the words of one, “Why would we do it if CHFA already has and much better than we could?” It helps CHFA achieve strategic objectives. One of CHFA’s main goals (and a market differentiator) is that we require homebuyer education course completion to be eligible for our loan products. This is because we know that an informed homebuyer makes a successful homeowner. Many customers cite the course as one of the best values of being a CHFA customer. The Homebuyer’s Roadmap is yet another way for us to help homebuyers feel informed and confident when purchasing a home. As stated at the beginning, it is an accessible resource that helps to “meet people where they are,” be that where they are in the homebuying process, or in which medium they prefer (online or in print). By providing a simple design with interactive topics, the Homebuyer’s Roadmap allows homebuyers to “choose their own adventure” at the pace with which they are comfortable, and further establishes CHFA as a valuable resource for homebuyers and industry professionals.","Summarize the different resources offered and list the pros and cons of each. Draw your answer from the text below only. Introduction CHFA’s vision is that everyone will have the opportunity for housing stability and economic prosperity, two things that underserved markets often consider out of reach. To support recent initiatives to reduce the homeownership gap between White homeowners and minority homeowners, CHFA is continuously engaging with community to learn how to provide products and services in a meaningful way. Throughout this engagement, CHFA has heard two consistent requests: to meet homebuyers where they are, and to provide expansive homebuying resources that they can trust to support them on the path to homeownership. Often, community members cite the overabundance of information as being overwhelming and sometimes misleading. As the state housing and finance authority, CHFA is looked to as a trusted resource, so we developed the Homebuyer’s Roadmap to help people access requested information at their own pace. The Homebuyer’s Roadmap is available online and in a printed folder with supplemental inserts so homebuyers can select the option that works best for them. It begins by introducing CHFA and helping the user understand CHFA’s mission and vision, along with how CHFA can help them on their homebuying journey, before breaking the homebuying process into 10 “stops on the homebuying journey.” The interactive online version allows users to “choose their own adventure” by selecting the stop of most interest based on where they are in the homebuying process. They can also dig deeper into topics of interest by using the additional resource links throughout, which open as pop-ups with summary information or in a new tab. For the printed folder, many of these additional resources are provided as inserts. Navigation is intuitive; no matter where the user is within the Roadmap, they can use the navigation ribbon on the right of the screen to visit other stops, or the overarching navigation buttons on the bottom-right to visit the home page or the “stops” page. The Roadmap also encourages continued engagement with CHFA: after the final stop, which shares resources to help people maintain homeownership, users can click to a final screen showing links to newsletters, homebuying classes, and our “Help for Homebuyers” site. The Roadmap has been well received. Since October 2023, it has been viewed by 1,335 users an average of 5.24 times each, showing that people are returning to use it as they progress in their homebuying journey. In addition, 182 people have requested a printed copy. It is innovative and meets a state housing need. Colorado Housing and Finance Authority CHFA Homebuyer’s Roadmap Homeownership – Empowering New Buyers Colorado Housing and Finance Authority CHFA Homebuyer’s Roadmap Homeownership – Empowering New Buyers Based on community feedback, we learned that there was a gap in current homebuying educational offerings. We heard from many potential homebuyers that while they wanted to be as informed as possible about the homebuying process, they felt overwhelmed by the sheer amount of information available. Other “roadmap” communications vacillated between two extremes: having limited space to convey adequate information (such as in a print flyer) or trying to include everything in an effort to educate, which resulted in readers losing focus or not being able to locate the exact information they were looking for (such as on a web page). CHFA’s own products illustrate this gap: we offer a high-level Steps to Homeownership on our site, a one- hour Homebuyer 101 webinar, and an in-depth homebuyer education class for certification (classes last between six to eight hours). The shorter, more high-level options are suited for those just getting started, and the longer class is great for those homebuyers who are moving forward with a purchase, but we were missing the middle piece: a resource that was interactive, allowing homebuyers to navigate at their own pace and quickly find more in-depth information. The design of the Roadmap was instrumental in this delivery. In addition to the intuitive navigation throughout, pop-ups, information buttons, and third-party links kept the screens uncluttered and let each user create their own experience. While there is a wealth of information, it never feels overwhelming. Utilizing movement throughout creates a fresh and engaging experience while highlighting the individual resources. It demonstrates effective use of resources, benefits outweighing costs, and a replicable development process. The Roadmap is an in-house product. Content was developed collaboratively by marketing and home finance team members, the design was completed in Adobe InDesign, and the finished digital product was easily uploaded and integrated into our website functionality. Content updates are easy to implement in the digital version, and we printed a low count of the folder to reduce waste when changes are needed. All the supplements in the folder are those that were already developed prior to the Roadmap launch and are used in other outreach and communication activities. A two-year content review schedule will help to ensure that information is accurate and current. Overall costs were minimal; the development was incorporated into staff project flow, and the only additional costs are for the small-batch folder printing and individual mailings for requests. The accessibility of the product is also a benefit: it is free, print versions are mailed within one business day of request, and no specific software is required for viewing the online version. It effectively employes partnerships with industry professionals. When creating the Roadmap, we wanted to deliver something that lenders, real estate agents, and homebuyer education providers could use with their customers to elevate themselves as a resource. Throughout development, feedback was sought from our Lender Advisory Group and real estate agents regarding content and utilization. Traditionally, our partners value CHFA collateral that they can leverage 2 for homebuyer engagement. In the words of one, “Why would we do it if CHFA already has and much better than we could?” It helps CHFA achieve strategic objectives. One of CHFA’s main goals (and a market differentiator) is that we require homebuyer education course completion to be eligible for our loan products. This is because we know that an informed homebuyer makes a successful homeowner. Many customers cite the course as one of the best values of being a CHFA customer. The Homebuyer’s Roadmap is yet another way for us to help homebuyers feel informed and confident when purchasing a home. As stated at the beginning, it is an accessible resource that helps to “meet people where they are,” be that where they are in the homebuying process, or in which medium they prefer (online or in print). By providing a simple design with interactive topics, the Homebuyer’s Roadmap allows homebuyers to “choose their own adventure” at the pace with which they are comfortable, and further establishes CHFA as a valuable resource for homebuyers and industry professionals.",Financial,Pros & Cons,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",I would like the numerical information from the text restated in bullet point lists with the relevant textual descriptors. Please retain the section headings to use for organization. You may simplify word choices for the layperson to understand where applicable.,"The increase in real GDP primarily reflected increases in consumer spending, private inventory investment, and nonresidential fixed investment. Imports, which are a subtraction in the calculation of GDP, increased (table 2). Compared to the first quarter, the acceleration in real GDP in the second quarter primarily reflected an upturn in private inventory investment and an acceleration in consumer spending. These movements were partly offset by a downturn in residential fixed investment. Current‑dollar GDP increased 5.5 percent at an annual rate, or $383.2 billion, in the second quarter to a level of $28.65 trillion, an upward revision of $23.2 billion from the previous estimate (tables 1 and 3). More information on the source data that underlie the estimates is available in the ""Key Source Data and Assumptions"" file on BEA's website. The price index for gross domestic purchases increased 2.4 percent in the second quarter, an upward revision of 0.1 percentage point from the previous estimate. The personal consumption expenditures (PCE) price index increased 2.5 percent, a downward revision of 0.1 percentage point. Excluding food and energy prices, the PCE price index increased 2.8 percent, a downward revision of 0.1 percentage point. Personal Income Current-dollar personal income increased $233.6 billion in the second quarter, a downward revision of $4.0 billion from the previous estimate. The increase primarily reflected increases in compensation and personal current transfer receipts (table 8). Disposable personal income increased $183.0 billion, or 3.6 percent, in the second quarter, a downward revision of $3.2 billion from the previous estimate. Real disposable personal income increased 1.0 percent, unrevised from the prior estimate. Personal saving was $686.4 billion in the second quarter, a downward revision of $34.1 billion from the previous estimate. The personal saving rate—personal saving as a percentage of disposable personal income—was 3.3 percent in the second quarter, a downward revision of 0.2 percentage point. Gross Domestic Income and Corporate Profits Real gross domestic income (GDI) increased 1.3 percent in the second quarter, the same as in the first quarter. The average of real GDP and real GDI, a supplemental measure of U.S. economic activity that equally weights GDP and GDI, increased 2.1 percent in the second quarter, compared with an increase of 1.4 percent in the first quarter (table 1). Profits from current production (corporate profits with inventory valuation and capital consumption adjustments) increased $57.6 billion in the second quarter, in contrast to a decrease of $47.1 billion in the first quarter (table 10). Profits of domestic financial corporations increased $46.4 billion in the second quarter, compared with an increase of $65.0 billion in the first quarter. Profits of domestic nonfinancial corporations increased $29.2 billion, in contrast to a decrease of $114.5 billion. Rest-of-the-world profits decreased $18.0 billion, in contrast to an increase of $2.3 billion. In the second quarter, receipts decreased $6.2 billion, and payments increased $11.8 billion. Updates to GDP With the second estimate, an upward revision to consumer spending was partly offset by downward revisions to nonresidential fixed investment, exports, private inventory investment, federal government spending, state and local government spending, and residential fixed investment. Imports were revised up. For more information, refer to the Technical Note. For information on updates to GDP, refer to the ""Additional Information"" section that follows. Advance Estimate Second Estimate (Percent change from preceding quarter) Real GDP 2.8 3.0 Current-dollar GDP 5.2 5.5 Real GDI … 1.3 Average of Real GDP and Real GDI … 2.1 Gross domestic purchases price index 2.3 2.4 PCE price index 2.6 2.5 PCE price index excluding food and energy 2.9 2.8","[question] I would like the numerical information from the text restated in bullet point lists with the relevant textual descriptors. Please retain the section headings to use for organization. You may simplify word choices for the layperson to understand where applicable. ===================== [text] The increase in real GDP primarily reflected increases in consumer spending, private inventory investment, and nonresidential fixed investment. Imports, which are a subtraction in the calculation of GDP, increased (table 2). Compared to the first quarter, the acceleration in real GDP in the second quarter primarily reflected an upturn in private inventory investment and an acceleration in consumer spending. These movements were partly offset by a downturn in residential fixed investment. Current‑dollar GDP increased 5.5 percent at an annual rate, or $383.2 billion, in the second quarter to a level of $28.65 trillion, an upward revision of $23.2 billion from the previous estimate (tables 1 and 3). More information on the source data that underlie the estimates is available in the ""Key Source Data and Assumptions"" file on BEA's website. The price index for gross domestic purchases increased 2.4 percent in the second quarter, an upward revision of 0.1 percentage point from the previous estimate. The personal consumption expenditures (PCE) price index increased 2.5 percent, a downward revision of 0.1 percentage point. Excluding food and energy prices, the PCE price index increased 2.8 percent, a downward revision of 0.1 percentage point. Personal Income Current-dollar personal income increased $233.6 billion in the second quarter, a downward revision of $4.0 billion from the previous estimate. The increase primarily reflected increases in compensation and personal current transfer receipts (table 8). Disposable personal income increased $183.0 billion, or 3.6 percent, in the second quarter, a downward revision of $3.2 billion from the previous estimate. Real disposable personal income increased 1.0 percent, unrevised from the prior estimate. Personal saving was $686.4 billion in the second quarter, a downward revision of $34.1 billion from the previous estimate. The personal saving rate—personal saving as a percentage of disposable personal income—was 3.3 percent in the second quarter, a downward revision of 0.2 percentage point. Gross Domestic Income and Corporate Profits Real gross domestic income (GDI) increased 1.3 percent in the second quarter, the same as in the first quarter. The average of real GDP and real GDI, a supplemental measure of U.S. economic activity that equally weights GDP and GDI, increased 2.1 percent in the second quarter, compared with an increase of 1.4 percent in the first quarter (table 1). Profits from current production (corporate profits with inventory valuation and capital consumption adjustments) increased $57.6 billion in the second quarter, in contrast to a decrease of $47.1 billion in the first quarter (table 10). Profits of domestic financial corporations increased $46.4 billion in the second quarter, compared with an increase of $65.0 billion in the first quarter. Profits of domestic nonfinancial corporations increased $29.2 billion, in contrast to a decrease of $114.5 billion. Rest-of-the-world profits decreased $18.0 billion, in contrast to an increase of $2.3 billion. In the second quarter, receipts decreased $6.2 billion, and payments increased $11.8 billion. Updates to GDP With the second estimate, an upward revision to consumer spending was partly offset by downward revisions to nonresidential fixed investment, exports, private inventory investment, federal government spending, state and local government spending, and residential fixed investment. Imports were revised up. For more information, refer to the Technical Note. For information on updates to GDP, refer to the ""Additional Information"" section that follows. Advance Estimate Second Estimate (Percent change from preceding quarter) Real GDP 2.8 3.0 Current-dollar GDP 5.2 5.5 Real GDI … 1.3 Average of Real GDP and Real GDI … 2.1 Gross domestic purchases price index 2.3 2.4 PCE price index 2.6 2.5 PCE price index excluding food and energy 2.9 2.8 https://www.bea.gov/news/2024/gross-domestic-product-second-estimate-corporate-profits-preliminary-estimate-second ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Financial,Summarize & Format,Text Transformation "Respond using only information from the provided content. Adhere to a 300-word limit. Avoid responding in table format or JSON","According to the above text, what are the benefits of working a job in the tech industry?","**Getting a Job in the Tech Industry** Because of the tech industry's rapid evolution, employees often possess both technical and nontechnical skills. Companies typically seek unique individuals who can strengthen their business as the industry grows, and some may not even require industry experience as a qualifier for candidates. If you're interested in advancing your career path and increasing your earning potential, consider researching tech job openings. In this article, we explain what the tech industry is, what to expect as an employee, some benefits of working in tech and steps and tips to help you get a job in the tech industry. What is the tech industry? The tech industry encompasses several business sectors, like e-commerce, internet software and services, financial technology, consumer electronics and telecommunications. It's constantly evolving through innovation and new creative processes, which regularly create new jobs. Because there are so many job options, you can allow your interests to guide you towards a career you can enjoy, such as software development, programming or digital communications. When you accept a job in the tech industry, there are a few things you can expect. For instance, many entry-level positions are technical support roles, so you may be responsible for answering inbound calls and performing troubleshooting to assist users remotely. Depending on the job requirements, you can perform these tasks either in an office or from home. This may involve collaborating with other IT specialists on projects or for user issue resolution. Tech industry jobs also allow you to make real-world impacts by identifying and evaluating problems and innovating solutions. The tech industry mainly favors meritocracy, which encourages employees to focus on their abilities as opposed to their experience level. This concept can promote a positive and collaborative workplace and show a company's commitment to employee satisfaction. Many tech companies value this kind of work culture, and it often resonates in their brand message and company statements. Benefits of working in tech The tech industry offers a variety of unique benefits to its employees. Some of the most significant perks include: Flexibility: Many tech companies offer their employees flexible hours and working conditions, which can appeal to a variety of individuals. Mobile and remote tasks give employees the ability to work anywhere, and this can be an exciting and refreshing contrast to consistent office work. These unique assignments and nontraditional workspaces can empower you to innovate new solutions and contribute to an overall increase in productivity by exercising your time management and technical skills. Work-life balance: Another advantage of working in the tech industry is the ability to achieve and maintain an effective balance between work and other life activities. Because many technical jobs require remote or mobile tasks, you may be able to manage your time more efficiently by building a schedule that accommodates your personal and professional responsibilities. This can give you the ideal work-life balance, and it could encourage you to lead a successful and productive life. Positive work environment: Many tech companies offer substantial perks in their work environments, like complimentary food, a casual dress code and compatible residence areas. Your company might also provide paid time off, volunteer days and insurance. These perks contribute to an optimistic work environment, which can promote creativity, encourage innovation and support your career development in the tech industry. Career growth and development: Working in tech also offers several opportunities for career growth and skill development. You can refine your skills and improve your workflow with every task by applying your knowledge to practical experiences. The skills you learn and apply are transferrable, and they can increase your marketability and advance your career by appealing to potential employers. You can also consider applying them independently to create your own startup business. How to get a job in the tech industry Getting a job in the tech industry can be a rewarding opportunity and provide you with substantial earning potential. If you're interested in securing a tech job, consider reviewing these steps to help you succeed in your career goals: 1. Develop your technical skills The first step to securing a job in the tech industry is to develop the technical skills necessary to excel in your career. This might include programming, data science, analytics, software engineering and development, digital marketing and project management. You can establish and improve these skills by researching, talking to industry professionals or reading respected tech publications like journals, newsletters or websites. Learning from those who work in the tech industry can help you understand which skills are essential and how they use them in their daily tasks. 2. Seek a mentor Having a mentor can give you a distinct advantage in your career development because they impart their professional skills, provide industry knowledge and give you tips to aid in your success. Many mentors offer support, advice and encouragement to guide you towards a rewarding career in tech, and you can learn valuable techniques from those with years of firsthand experience. When seeking a mentor, consider searching for someone who's open-minded and willing to take suggestions. These qualities create a collaborative learning environment for you and your mentor, which strengthens both your skills and relationship. 3. Build your professional network When you connect with others that share similar interests in the tech industry, you're building your professional network. Attending local conferences, contributing to online tech forums and talking to local professionals are all effective methods to expand your tech industry connections. These introductions can play a vital role in securing a career in technology because they give you opportunities to collaborate with others and gather helpful industry information, such as job listings, resume advice and tips from experienced individuals. 4. Pursue a technical certification While there are several tech jobs available that don't require a bachelor's degree in qualified candidates, earning one in a related field may help you appeal to potential tech industry employers. Many colleges also offer vocational programs that offer certifications for various skills, like data security, engineering and project management. Consider researching different colleges and websites to learn about the certifications, degrees and intensive training courses that best support your career development. 5. Create a strong, customized resume. When you apply for tech industry jobs, review the descriptions of the open positions that interest you. This helps you understand the requirements and important aspects of the role. It also gives you the opportunity to customize your resume to appeal to hiring managers. Each company, job and hiring process is unique, and adjusting your resume for each role can help differentiate you from other candidates. Consider including specific skills, tools and programs on your resume that you're familiar with. If a company uses a resume scanning program, keywords can increase the likelihood of the program selecting your resume for further review. Here are some tips that can help you secure a job in the tech industry: Research active job listings: Consider researching active job listings to discover the positions that are currently available. This can help you find which areas of the tech industry interest you, and it may give you a better understanding of the roles that exist. You can also talk to industry professionals to learn their daily activities and necessary skills to determine if these aspects inspire you to seek a specific position. Take advantage of online courses: There are programs online that can help you learn valuable skills that can help you excel in the tech industry, like programming, coding or software development. These self-paced programs allow you to learn at your own pace and develop skills without committing to a single program or course, and many provide certifications that can help differentiate you from other candidates in the application process. Even if you don't possess industry experience, online courses can provide a valuable advantage by developing the essential skills that many tech jobs require. Identify your outsider advantage: Because the tech industry is constantly changing, many tech companies advertise nontechnical positions from human resources, product marketing or sales development to gain employees with different viewpoints. Candidates without technical experience can provide unique perspectives on how they communicate with technology. Hiring managers often seek candidates with adept communication skills and the ability to relate strongly to others to promote a collaborative work environment and increase project efficiency, so consider including these skills on your resume while applying for jobs. Research tech startup companies: Startup companies often forego traditional job requirements to focus more on training and candidate potential, and they usually seek qualified individuals with marketable skills and excellent communication abilities. With these skills and some technical experience, you can be an ideal candidate for many tech startup companies. Consider accepting an internship or finding a mentor so you can apply your technical skills, gain industry experience and become an appealing candidate to startup hiring managers. Focus on your unique qualities: When you apply for a job in the tech industry, you can differentiate yourself from other candidates by identifying which skills make you unique. Explaining nontechnical qualities like drive, determination and perseverance can enhance your resume and help you appeal to potential employers. You can also include general soft skills like problem solving, adaptability and quick learning to show hiring managers you're skillful in several areas that can benefit their company.","{Question} ======= According to the above text, what are the benefits of working a job in the tech industry? {Instruction} ======= Respond using only information from the provided content. Adhere to a 300-word limit. Avoid responding in table format or JSON {Context} ======= **Getting a Job in the Tech Industry** Because of the tech industry's rapid evolution, employees often possess both technical and nontechnical skills. Companies typically seek unique individuals who can strengthen their business as the industry grows, and some may not even require industry experience as a qualifier for candidates. If you're interested in advancing your career path and increasing your earning potential, consider researching tech job openings. In this article, we explain what the tech industry is, what to expect as an employee, some benefits of working in tech and steps and tips to help you get a job in the tech industry. What is the tech industry? The tech industry encompasses several business sectors, like e-commerce, internet software and services, financial technology, consumer electronics and telecommunications. It's constantly evolving through innovation and new creative processes, which regularly create new jobs. Because there are so many job options, you can allow your interests to guide you towards a career you can enjoy, such as software development, programming or digital communications. When you accept a job in the tech industry, there are a few things you can expect. For instance, many entry-level positions are technical support roles, so you may be responsible for answering inbound calls and performing troubleshooting to assist users remotely. Depending on the job requirements, you can perform these tasks either in an office or from home. This may involve collaborating with other IT specialists on projects or for user issue resolution. Tech industry jobs also allow you to make real-world impacts by identifying and evaluating problems and innovating solutions. The tech industry mainly favors meritocracy, which encourages employees to focus on their abilities as opposed to their experience level. This concept can promote a positive and collaborative workplace and show a company's commitment to employee satisfaction. Many tech companies value this kind of work culture, and it often resonates in their brand message and company statements. Benefits of working in tech The tech industry offers a variety of unique benefits to its employees. Some of the most significant perks include: Flexibility: Many tech companies offer their employees flexible hours and working conditions, which can appeal to a variety of individuals. Mobile and remote tasks give employees the ability to work anywhere, and this can be an exciting and refreshing contrast to consistent office work. These unique assignments and nontraditional workspaces can empower you to innovate new solutions and contribute to an overall increase in productivity by exercising your time management and technical skills. Work-life balance: Another advantage of working in the tech industry is the ability to achieve and maintain an effective balance between work and other life activities. Because many technical jobs require remote or mobile tasks, you may be able to manage your time more efficiently by building a schedule that accommodates your personal and professional responsibilities. This can give you the ideal work-life balance, and it could encourage you to lead a successful and productive life. Positive work environment: Many tech companies offer substantial perks in their work environments, like complimentary food, a casual dress code and compatible residence areas. Your company might also provide paid time off, volunteer days and insurance. These perks contribute to an optimistic work environment, which can promote creativity, encourage innovation and support your career development in the tech industry. Career growth and development: Working in tech also offers several opportunities for career growth and skill development. You can refine your skills and improve your workflow with every task by applying your knowledge to practical experiences. The skills you learn and apply are transferrable, and they can increase your marketability and advance your career by appealing to potential employers. You can also consider applying them independently to create your own startup business. How to get a job in the tech industry Getting a job in the tech industry can be a rewarding opportunity and provide you with substantial earning potential. If you're interested in securing a tech job, consider reviewing these steps to help you succeed in your career goals: 1. Develop your technical skills The first step to securing a job in the tech industry is to develop the technical skills necessary to excel in your career. This might include programming, data science, analytics, software engineering and development, digital marketing and project management. You can establish and improve these skills by researching, talking to industry professionals or reading respected tech publications like journals, newsletters or websites. Learning from those who work in the tech industry can help you understand which skills are essential and how they use them in their daily tasks. 2. Seek a mentor Having a mentor can give you a distinct advantage in your career development because they impart their professional skills, provide industry knowledge and give you tips to aid in your success. Many mentors offer support, advice and encouragement to guide you towards a rewarding career in tech, and you can learn valuable techniques from those with years of firsthand experience. When seeking a mentor, consider searching for someone who's open-minded and willing to take suggestions. These qualities create a collaborative learning environment for you and your mentor, which strengthens both your skills and relationship. 3. Build your professional network When you connect with others that share similar interests in the tech industry, you're building your professional network. Attending local conferences, contributing to online tech forums and talking to local professionals are all effective methods to expand your tech industry connections. These introductions can play a vital role in securing a career in technology because they give you opportunities to collaborate with others and gather helpful industry information, such as job listings, resume advice and tips from experienced individuals. 4. Pursue a technical certification While there are several tech jobs available that don't require a bachelor's degree in qualified candidates, earning one in a related field may help you appeal to potential tech industry employers. Many colleges also offer vocational programs that offer certifications for various skills, like data security, engineering and project management. Consider researching different colleges and websites to learn about the certifications, degrees and intensive training courses that best support your career development. 5. Create a strong, customized resume. When you apply for tech industry jobs, review the descriptions of the open positions that interest you. This helps you understand the requirements and important aspects of the role. It also gives you the opportunity to customize your resume to appeal to hiring managers. Each company, job and hiring process is unique, and adjusting your resume for each role can help differentiate you from other candidates. Consider including specific skills, tools and programs on your resume that you're familiar with. If a company uses a resume scanning program, keywords can increase the likelihood of the program selecting your resume for further review. Here are some tips that can help you secure a job in the tech industry: Research active job listings: Consider researching active job listings to discover the positions that are currently available. This can help you find which areas of the tech industry interest you, and it may give you a better understanding of the roles that exist. You can also talk to industry professionals to learn their daily activities and necessary skills to determine if these aspects inspire you to seek a specific position. Take advantage of online courses: There are programs online that can help you learn valuable skills that can help you excel in the tech industry, like programming, coding or software development. These self-paced programs allow you to learn at your own pace and develop skills without committing to a single program or course, and many provide certifications that can help differentiate you from other candidates in the application process. Even if you don't possess industry experience, online courses can provide a valuable advantage by developing the essential skills that many tech jobs require. Identify your outsider advantage: Because the tech industry is constantly changing, many tech companies advertise nontechnical positions from human resources, product marketing or sales development to gain employees with different viewpoints. Candidates without technical experience can provide unique perspectives on how they communicate with technology. Hiring managers often seek candidates with adept communication skills and the ability to relate strongly to others to promote a collaborative work environment and increase project efficiency, so consider including these skills on your resume while applying for jobs. Research tech startup companies: Startup companies often forego traditional job requirements to focus more on training and candidate potential, and they usually seek qualified individuals with marketable skills and excellent communication abilities. With these skills and some technical experience, you can be an ideal candidate for many tech startup companies. Consider accepting an internship or finding a mentor so you can apply your technical skills, gain industry experience and become an appealing candidate to startup hiring managers. Focus on your unique qualities: When you apply for a job in the tech industry, you can differentiate yourself from other candidates by identifying which skills make you unique. Explaining nontechnical qualities like drive, determination and perseverance can enhance your resume and help you appeal to potential employers. You can also include general soft skills like problem solving, adaptability and quick learning to show hiring managers you're skillful in several areas that can benefit their company.",Internet/Technology,Find & Summarize,Text Transformation "Respond succinctly and directly. Refer only to the provided document. After your answer, provide any relevant quotes from the source document in italics.",What are the 5th gen Standard Series CPUs based on?,"**Microsoft Azure SQL Database pricing** vCore A vCore-based purchase model is best if you are looking for flexibility, control and transparency of individual resource consumption. This model allows you to scale compute, memory and storage based upon your workload needs and provides a straightforward way to translate on-premises workload requirements to the cloud. Serverless compute The SQL Database server-less compute tier optimises price-performance and simplifies performance management for single databases with intermittent, unpredictable usage by auto-scaling compute and billing for compute used per second. For details, see the FAQ section and documentation. Hyperscale Serverless Hyperscale combines the benefits of compute auto-scaling with storage auto-scaling up to 100 TB to help you optimise price-performance of your database resources to meet your workload's needs. If zone redundancy is enabled, the database must have at least one high availability (HA) replica. The pricing below is applicable for both primary and secondary replicas. Standard-series (Gen 5) Standard-series (Gen 5) logical CPUs are based on Intel E5-2673 v4 (Broadwell) 2.3 GHz, Intel SP8160 (Skylake), Intel Xeon Platinum 8272CL 2.5 GHz (Cascade Lake) and Intel(R) Xeon Scalable 2.8 GHz processor (Ice Lake) processors. In the standard-series (Gen 5), 1 vCore = 1 hyper thread. The standard-series (Gen 5) logical CPU is great for most relational database servers. Primary replica pricing Minimum vCores Maximum vCores Minimum Memory (GB) Maximum Memory (GB) Price 0.5 80 2.05 240 $0.0001050/vCore-second ($0.378/vCore-hour) High Availability Replica and Named Replica Pricing Minimum vCores Maximum vCores Minimum Memory (GB) Maximum Memory (GB) Price 0.5 80 2.05 240 $0.0001050/vCore-second ($0.378/vCore-hour) Storage In the Hyperscale tier, you are charged for storage for your database based on actual allocation. Storage is dynamically allocated between 10 GB and 100 TB, in 10 GB increments. Storage Price GB/month $0.25 Back up storage (point-in-time restore) By default, seven days of backups are stored in RA-GRS Standard blob storage. Any corrupted or deleted database can be restored to any point in time within that period. The storage is used by periodic storage blob snapshots and all generated transaction log. The usage of the backup storage depends on the rate of change of the database and the configured retention period. Back up storage consumption will be charged in GB/month. Learn more about automated backups, and how to monitor and manage backup costs. Redundancy Price LRS $0.08/GB/month ZRS $0.10/GB/month RA-GRS $0.20/GB/month Provisioned compute The SQL Database provisioned compute tier provides a fixed amount of compute resource for a fixed price billed hourly. It optimises price-performance for single databases and elastic pools with more regular usage that cannot afford any delay in compute warm-up after idle usage periods. For details, see the FAQ section and documentation. Hyperscale Build new, highly scalable cloud applications on Azure SQL Database Hyperscale. Hyperscale provides rapid, auto-scaling storage up to 100 TB to help you optimise database resources for your workload's needs. To enable zone redundancy, the database must have at least one secondary high availability replica. The pricing below is applicable for both primary and secondary replicas. Standard-series (Gen 5) Standard-series (Gen 5) logical CPUs are based on Intel E5-2673 v4 (Broadwell) 2.3 GHz, Intel SP8160 (Skylake), Intel Xeon Platinum 8272CL 2.5 GHz (Cascade Lake) and Intel(R) Xeon Scalable 2.8 GHz processor (Ice Lake) processors. In the standard-series (Gen 5), 1 vCore = 1 hyper thread. The standard-series (Gen 5) logical CPU is great for most relational database servers. vCORE Memory (GB) Pay as you go 1-year reserved capacity 1 3 year reserved capacity 1 2 10.2 $0.366/hour $0.238/hour ~35% savings $0.165/hour ~55% savings 4 20.4 $0.731/hour $0.475/hour ~35% savings $0.329/hour ~55% savings 6 30.6 $1.096/hour $0.713/hour ~35% savings $0.494/hour ~55% savings 8 40.8 $1.462/hour $0.950/hour ~35% savings $0.658/hour ~55% savings 10 51 $1.827/hour $1.188/hour ~35% savings $0.822/hour ~55% savings 12 61.2 $2.192/hour $1.425/hour ~35% savings $0.987/hour ~55% savings 14 71.4 $2.558/hour $1.663/hour ~35% savings $1.151/hour ~55% savings 16 81.6 $2.923/hour $1.900/hour ~35% savings $1.316/hour ~55% savings 18 91.8 $3.288/hour $2.137/hour ~35% savings $1.480/hour ~55% savings 20 102 $3.654/hour $2.375/hour ~35% savings $1.644/hour ~55% savings 24 122.4 $4.384/hour $2.850/hour ~35% savings $1.973/hour ~55% savings 32 163.2 $5.846/hour $3.800/hour ~35% savings $2.631/hour ~55% savings 40 204 $7.307/hour $4.749/hour ~35% savings $3.288/hour ~55% savings 80 396 $14.613/hour $9.498/hour ~35% savings $6.576/hour ~55% savings 1Learn more about Azure reservations and Azure SQL Database reserved capacity pricing. Compute is provisioned in virtual cores (vCores) with an option to choose between compute generations. DC-series The DC-series logical CPUs are based on Intel XEON E-2288G processors with Software Guard Extensions (Intel SGX) technology. In the DC-series, 1 vCore = 1 physical core. DC-series supports Always Encrypted with secure enclaves and it is designed to for workloads that process sensitive data and demand confidential query processing capabilities. vCORE Memory (GB) Pay as you go 2 9 $0.73/hour 4 18 $1.46/hour 6 27 $2.19/hour 8 36 $2.92/hour 10 45 $3.65/hour 12 54 $4.38/hour 14 63 $5.11/hour 16 72 $5.84/hour 18 81 $6.57/hour 20 90 $7.30/hour 32 144 $11.68/hour 40 180 $14.60/hour This hardware option is subject to regional availability. See our documentation for the latest list of available regions. Compute is provisioned in virtual cores (vCores). A vCore represents a logical CPU offered with an option to choose between compute generations. Premium-series Premium-series logical CPUs are based on the latest Intel(R) Xeon (Ice Lake) and AMD EPYCTM 7763v (Milan) chipsets, 1 vCore = 1 hyper thread. The premium-series logical CPU is a great fit for database workloads that require faster compute and memory performance as well as improved IO and network experience over the standard-series hardware offering. vCORE Memory (GB) Pay as you go 1-year reserved capacity 1 2 10.4 $0.366/hour $0.238/hour ~35% savings 4 20.8 $0.731/hour $0.475/hour ~35% savings 6 31.1 $1.096/hour $0.713/hour ~35% savings 8 41.5 $1.462/hour $0.950/hour ~35% savings 10 51.9 $1.827/hour $1.188/hour ~35% savings 12 62.3 $2.192/hour $1.425/hour ~35% savings 14 72.7 $2.558/hour $1.663/hour ~35% savings 16 83 $2.923/hour $1.900/hour ~35% savings 18 93.4 $3.288/hour $2.137/hour ~35% savings 20 103.8 $3.654/hour $2.375/hour ~35% savings 24 124.6 $4.384/hour $2.850/hour ~35% savings 32 166.1 $5.846/hour $3.800/hour ~35% savings 40 207.6 $7.307/hour $4.749/hour ~35% savings 64 664.4 $11.691/hour $7.599/hour ~35% savings 80 415.2 $14.613/hour $9.498/hour ~35% savings 128 647.8 $23.381/hour $15.197/hour ~35% savings 1Learn more about Azure reservations and Azure SQL Database reserved capacity pricing. Compute is provisioned in virtual cores (vCores). A vCore represents a logical CPU offered with an option to choose between compute generations.","[Task Description] ======= Respond succinctly and directly. Refer only to the provided document. After your answer, provide any relevant quotes from the source document in italics. ---------------- [Text] ======= **Microsoft Azure SQL Database pricing** vCore A vCore-based purchase model is best if you are looking for flexibility, control and transparency of individual resource consumption. This model allows you to scale compute, memory and storage based upon your workload needs and provides a straightforward way to translate on-premises workload requirements to the cloud. Serverless compute The SQL Database server-less compute tier optimises price-performance and simplifies performance management for single databases with intermittent, unpredictable usage by auto-scaling compute and billing for compute used per second. For details, see the FAQ section and documentation. Hyperscale Serverless Hyperscale combines the benefits of compute auto-scaling with storage auto-scaling up to 100 TB to help you optimise price-performance of your database resources to meet your workload's needs. If zone redundancy is enabled, the database must have at least one high availability (HA) replica. The pricing below is applicable for both primary and secondary replicas. Standard-series (Gen 5) Standard-series (Gen 5) logical CPUs are based on Intel E5-2673 v4 (Broadwell) 2.3 GHz, Intel SP8160 (Skylake), Intel Xeon Platinum 8272CL 2.5 GHz (Cascade Lake) and Intel(R) Xeon Scalable 2.8 GHz processor (Ice Lake) processors. In the standard-series (Gen 5), 1 vCore = 1 hyper thread. The standard-series (Gen 5) logical CPU is great for most relational database servers. Primary replica pricing Minimum vCores Maximum vCores Minimum Memory (GB) Maximum Memory (GB) Price 0.5 80 2.05 240 $0.0001050/vCore-second ($0.378/vCore-hour) High Availability Replica and Named Replica Pricing Minimum vCores Maximum vCores Minimum Memory (GB) Maximum Memory (GB) Price 0.5 80 2.05 240 $0.0001050/vCore-second ($0.378/vCore-hour) Storage In the Hyperscale tier, you are charged for storage for your database based on actual allocation. Storage is dynamically allocated between 10 GB and 100 TB, in 10 GB increments. Storage Price GB/month $0.25 Back up storage (point-in-time restore) By default, seven days of backups are stored in RA-GRS Standard blob storage. Any corrupted or deleted database can be restored to any point in time within that period. The storage is used by periodic storage blob snapshots and all generated transaction log. The usage of the backup storage depends on the rate of change of the database and the configured retention period. Back up storage consumption will be charged in GB/month. Learn more about automated backups, and how to monitor and manage backup costs. Redundancy Price LRS $0.08/GB/month ZRS $0.10/GB/month RA-GRS $0.20/GB/month Provisioned compute The SQL Database provisioned compute tier provides a fixed amount of compute resource for a fixed price billed hourly. It optimises price-performance for single databases and elastic pools with more regular usage that cannot afford any delay in compute warm-up after idle usage periods. For details, see the FAQ section and documentation. Hyperscale Build new, highly scalable cloud applications on Azure SQL Database Hyperscale. Hyperscale provides rapid, auto-scaling storage up to 100 TB to help you optimise database resources for your workload's needs. To enable zone redundancy, the database must have at least one secondary high availability replica. The pricing below is applicable for both primary and secondary replicas. Standard-series (Gen 5) Standard-series (Gen 5) logical CPUs are based on Intel E5-2673 v4 (Broadwell) 2.3 GHz, Intel SP8160 (Skylake), Intel Xeon Platinum 8272CL 2.5 GHz (Cascade Lake) and Intel(R) Xeon Scalable 2.8 GHz processor (Ice Lake) processors. In the standard-series (Gen 5), 1 vCore = 1 hyper thread. The standard-series (Gen 5) logical CPU is great for most relational database servers. vCORE Memory (GB) Pay as you go 1-year reserved capacity 1 3 year reserved capacity 1 2 10.2 $0.366/hour $0.238/hour ~35% savings $0.165/hour ~55% savings 4 20.4 $0.731/hour $0.475/hour ~35% savings $0.329/hour ~55% savings 6 30.6 $1.096/hour $0.713/hour ~35% savings $0.494/hour ~55% savings 8 40.8 $1.462/hour $0.950/hour ~35% savings $0.658/hour ~55% savings 10 51 $1.827/hour $1.188/hour ~35% savings $0.822/hour ~55% savings 12 61.2 $2.192/hour $1.425/hour ~35% savings $0.987/hour ~55% savings 14 71.4 $2.558/hour $1.663/hour ~35% savings $1.151/hour ~55% savings 16 81.6 $2.923/hour $1.900/hour ~35% savings $1.316/hour ~55% savings 18 91.8 $3.288/hour $2.137/hour ~35% savings $1.480/hour ~55% savings 20 102 $3.654/hour $2.375/hour ~35% savings $1.644/hour ~55% savings 24 122.4 $4.384/hour $2.850/hour ~35% savings $1.973/hour ~55% savings 32 163.2 $5.846/hour $3.800/hour ~35% savings $2.631/hour ~55% savings 40 204 $7.307/hour $4.749/hour ~35% savings $3.288/hour ~55% savings 80 396 $14.613/hour $9.498/hour ~35% savings $6.576/hour ~55% savings 1Learn more about Azure reservations and Azure SQL Database reserved capacity pricing. Compute is provisioned in virtual cores (vCores) with an option to choose between compute generations. DC-series The DC-series logical CPUs are based on Intel XEON E-2288G processors with Software Guard Extensions (Intel SGX) technology. In the DC-series, 1 vCore = 1 physical core. DC-series supports Always Encrypted with secure enclaves and it is designed to for workloads that process sensitive data and demand confidential query processing capabilities. vCORE Memory (GB) Pay as you go 2 9 $0.73/hour 4 18 $1.46/hour 6 27 $2.19/hour 8 36 $2.92/hour 10 45 $3.65/hour 12 54 $4.38/hour 14 63 $5.11/hour 16 72 $5.84/hour 18 81 $6.57/hour 20 90 $7.30/hour 32 144 $11.68/hour 40 180 $14.60/hour This hardware option is subject to regional availability. See our documentation for the latest list of available regions. Compute is provisioned in virtual cores (vCores). A vCore represents a logical CPU offered with an option to choose between compute generations. Premium-series Premium-series logical CPUs are based on the latest Intel(R) Xeon (Ice Lake) and AMD EPYCTM 7763v (Milan) chipsets, 1 vCore = 1 hyper thread. The premium-series logical CPU is a great fit for database workloads that require faster compute and memory performance as well as improved IO and network experience over the standard-series hardware offering. vCORE Memory (GB) Pay as you go 1-year reserved capacity 1 2 10.4 $0.366/hour $0.238/hour ~35% savings 4 20.8 $0.731/hour $0.475/hour ~35% savings 6 31.1 $1.096/hour $0.713/hour ~35% savings 8 41.5 $1.462/hour $0.950/hour ~35% savings 10 51.9 $1.827/hour $1.188/hour ~35% savings 12 62.3 $2.192/hour $1.425/hour ~35% savings 14 72.7 $2.558/hour $1.663/hour ~35% savings 16 83 $2.923/hour $1.900/hour ~35% savings 18 93.4 $3.288/hour $2.137/hour ~35% savings 20 103.8 $3.654/hour $2.375/hour ~35% savings 24 124.6 $4.384/hour $2.850/hour ~35% savings 32 166.1 $5.846/hour $3.800/hour ~35% savings 40 207.6 $7.307/hour $4.749/hour ~35% savings 64 664.4 $11.691/hour $7.599/hour ~35% savings 80 415.2 $14.613/hour $9.498/hour ~35% savings 128 647.8 $23.381/hour $15.197/hour ~35% savings 1Learn more about Azure reservations and Azure SQL Database reserved capacity pricing. Compute is provisioned in virtual cores (vCores). A vCore represents a logical CPU offered with an option to choose between compute generations. ---------------- [Query] ======= What are the 5th gen Standard Series CPUs based on?",Internet/Technology,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","I am a high school teacher and I've been concerned about my students using generative AI to complete their assignments. I'm afraid that they are finding the easy way to get a passing grade without putting in the effort, and this will result in them not learning anything. To find a way to deal with this, I've been reading some articles and I found one that has several interesting points. What are some ways in which, as a teacher, I can use GenAI to my advantage? What concerns should I be aware of regarding the use of GenAI by students?","Generative AI (GenAI) can be defined as a “technology that (i) leverages deep learning models to (ii) generate human-like content (e.g., images, words) in response to (iii) complex and varied prompts (e.g., languages, instructions, questions)”. As generative Artificial Intelligence (AI) continues to evolve rapidly, in the next few years, it will drive innovation and improvements in higher education, but it will also create a myriad of new challenges. Specifically, ChatGPT (Chat Generative Pre-Trained Transformer), a chatbot driven by GenAI, has been attracting headlines and has become the center of ongoing debate regarding the potential negative effects that it can have on teaching and learning. ChatGPT describes itself as a large language model trained to “generate humanlike text based on a given prompt or context. It can be used for a variety of natural language processing tasks, such as text completion, conversation generation, and language translation”. Given its advanced generative skills, one of the major concerns in higher education is that it can be used to reply to exam questions, write assignments and draft academic essays without being easily detected by current versions of anti-plagiarism software. Responses from higher education institutions (HEIs) to this emerging threat to academic integrity have been varied and fragmented, ranging from those that have rushed to implement full bans on the use of ChatGPT to others who have started to embrace it by publishing student guidance on how to engage with AI effectively and ethically. Nevertheless, most of the information provided by higher education institutions (HEIs) to students so far has been unclear or lacking in detail regarding the specific circumstances in which the use of ChatGPT is allowed or considered acceptable. However, what is evident is that most HEIs are currently in the process of reviewing their policies around the use of ChatGPT and its implications for academic integrity. Meanwhile, a growing body of literature has started to document the potential challenges and opportunities posed by ChatGPT. Among the key issues with the use of ChatGPT in education, accuracy, reliability, and plagiarism are regularly cited. Issues related to accuracy and reliability include relying on biased data (i.e., the limited scope of data used to train ChatGPT), having limited up-to-date knowledge (i.e., training stopped in 2021), and generating incorrect/fake information (e.g., providing fictitious references). It is also argued that the risk of overreliance on ChatGPT could negatively impact students’ critical thinking and problem-solving skills. Regarding plagiarism, evidence suggests that essays generated by ChatGPT can bypass conventional plagiarism detectors. ChatGPT can also successfully pass graduate-level exams, which could potentially make some types of assessments obsolete. ChatGPT can also be used to enhance education, provided that its limitations (as discussed in the previous paragraph) are recognized. For instance, ChatGPT can be used as a tool to generate answers to theory-based questions and generate initial ideas for essays, but students should be mindful of the need to examine the credibility of generated responses. Given its advanced conversational skills, ChatGPT can also provide formative feedback on essays and become a tutoring system by stimulating critical thinking and debates among students. The language editing and translation skills of ChatGPT can also contribute towards increased equity in education by somewhat leveling the playing field for students from non-English speaking backgrounds. ChatGPT can also be a valuable tool for educators as it can help in creating lesson plans for specific courses, developing customized resources and learning activities (i.e., personalized learning support), carrying out assessment and evaluation, and supporting the writing process of research. ChatGPT might also be used to enrich a reflective teaching practice by testing existing assessment methods to validate their scope, design, and capabilities beyond the possible use of GenAI, challenging academics to develop AI-proof assessments as a result and contributing to the authentic assessment of students’ learning achievements. Overall, some early studies have started to shed some light regarding the potential challenges and opportunities of ChatGPT for higher education, but more in-depth discussions are needed. We argue that the current discourse is highly focused on studying ChatGPT as an object rather than a subject. Given the advanced generative capabilities of ChatGPT, we would like to contribute to the ongoing discussion by exploring what ChatGPT has to say about itself regarding the challenges and opportunities that it represents for higher education. By adopting this approach, we hope to contribute to a more balanced discussion that accommodates the AI perspective using a ‘thing ethnography’ methodology. This approach considers things not as objects but as subjects that possess a non-human worldview or perspective that can point to novel insights in research.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I am a high school teacher and I've been concerned about my students using generative AI to complete their assignments. I'm afraid that they are finding the easy way to get a passing grade without putting in the effort, and this will result in them not learning anything. To find a way to deal with this, I've been reading some articles and I found one that has several interesting points. What are some ways in which, as a teacher, I can use GenAI to my advantage? What concerns should I be aware of regarding the use of GenAI by students? {passage 0} ========== Generative AI (GenAI) can be defined as a “technology that (i) leverages deep learning models to (ii) generate human-like content (e.g., images, words) in response to (iii) complex and varied prompts (e.g., languages, instructions, questions)”. As generative Artificial Intelligence (AI) continues to evolve rapidly, in the next few years, it will drive innovation and improvements in higher education, but it will also create a myriad of new challenges. Specifically, ChatGPT (Chat Generative Pre-Trained Transformer), a chatbot driven by GenAI, has been attracting headlines and has become the center of ongoing debate regarding the potential negative effects that it can have on teaching and learning. ChatGPT describes itself as a large language model trained to “generate humanlike text based on a given prompt or context. It can be used for a variety of natural language processing tasks, such as text completion, conversation generation, and language translation”. Given its advanced generative skills, one of the major concerns in higher education is that it can be used to reply to exam questions, write assignments and draft academic essays without being easily detected by current versions of anti-plagiarism software. Responses from higher education institutions (HEIs) to this emerging threat to academic integrity have been varied and fragmented, ranging from those that have rushed to implement full bans on the use of ChatGPT to others who have started to embrace it by publishing student guidance on how to engage with AI effectively and ethically. Nevertheless, most of the information provided by higher education institutions (HEIs) to students so far has been unclear or lacking in detail regarding the specific circumstances in which the use of ChatGPT is allowed or considered acceptable. However, what is evident is that most HEIs are currently in the process of reviewing their policies around the use of ChatGPT and its implications for academic integrity. Meanwhile, a growing body of literature has started to document the potential challenges and opportunities posed by ChatGPT. Among the key issues with the use of ChatGPT in education, accuracy, reliability, and plagiarism are regularly cited. Issues related to accuracy and reliability include relying on biased data (i.e., the limited scope of data used to train ChatGPT), having limited up-to-date knowledge (i.e., training stopped in 2021), and generating incorrect/fake information (e.g., providing fictitious references). It is also argued that the risk of overreliance on ChatGPT could negatively impact students’ critical thinking and problem-solving skills. Regarding plagiarism, evidence suggests that essays generated by ChatGPT can bypass conventional plagiarism detectors. ChatGPT can also successfully pass graduate-level exams, which could potentially make some types of assessments obsolete. ChatGPT can also be used to enhance education, provided that its limitations (as discussed in the previous paragraph) are recognized. For instance, ChatGPT can be used as a tool to generate answers to theory-based questions and generate initial ideas for essays, but students should be mindful of the need to examine the credibility of generated responses. Given its advanced conversational skills, ChatGPT can also provide formative feedback on essays and become a tutoring system by stimulating critical thinking and debates among students. The language editing and translation skills of ChatGPT can also contribute towards increased equity in education by somewhat leveling the playing field for students from non-English speaking backgrounds. ChatGPT can also be a valuable tool for educators as it can help in creating lesson plans for specific courses, developing customized resources and learning activities (i.e., personalized learning support), carrying out assessment and evaluation, and supporting the writing process of research. ChatGPT might also be used to enrich a reflective teaching practice by testing existing assessment methods to validate their scope, design, and capabilities beyond the possible use of GenAI, challenging academics to develop AI-proof assessments as a result and contributing to the authentic assessment of students’ learning achievements. Overall, some early studies have started to shed some light regarding the potential challenges and opportunities of ChatGPT for higher education, but more in-depth discussions are needed. We argue that the current discourse is highly focused on studying ChatGPT as an object rather than a subject. Given the advanced generative capabilities of ChatGPT, we would like to contribute to the ongoing discussion by exploring what ChatGPT has to say about itself regarding the challenges and opportunities that it represents for higher education. By adopting this approach, we hope to contribute to a more balanced discussion that accommodates the AI perspective using a ‘thing ethnography’ methodology. This approach considers things not as objects but as subjects that possess a non-human worldview or perspective that can point to novel insights in research. https://www.mdpi.com/2227-7102/13/9/856",Internet/Technology,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",the first time I had c diff I took vancomycin to treat it but i had an allergic reaction. i have c diff again. what can make it go away? I am retired. please only list affordable options.,"Current Pharmacologic Options There are 3 antibiotics available for treatment of CDI: metronidazole, vancomycin, and fidaxomicin. All have demonstrated efficacy with similar rates of cure in nonsevere disease [18]. However, use of fidaxomicin, with a narrower spectrum of antimicrobial activity, has been shown to result in lower recurrence rates [19]. Based on this benefit, the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Disease Society of America (IDSA) clinical practice guidelines position fidaxomicin above vancomycin for treatment of an initial CDI [20]. The guidelines published by the American College of Gastroenterology (ACG) differ, stating that either vancomycin or fidaxomicin is appropriate to treat an initial CDI [21]. This recommendation was based on comparable efficacy data with far lower costs of vancomycin compared with fidaxomicin. In severe infections, treatment with metronidazole was shown to be associated with increased 30-day mortality [22]. In addition, C. difficile isolates with reduced susceptibility to metronidazole and treatment failures with this agent are increasing [23]. Therefore, use of metronidazole to treat patients with severe disease or those who are older or have comorbidities is not recommended by either practice guideline, though ACG guidelines maintain that metronidazole is appropriate to treat nonsevere infections in younger patients without comorbidities. SHEA/IDSA guidelines discourage its use altogether. Bezolotoxumab is a monoclonal antibody that binds to toxin B and has been shown to reduce CDI recurrence in patients at high risk of recurrence [24]. Neutralization of the toxin while the antibody remains in circulation may prevent symptoms in the event of C. difficile regrowth after completion of antibiotic therapy. There are significant drug and infusion costs to use of this agent, and clinical trials demonstrated a number needed to treat of 10 to prevent 1 recurrent CDI. The Gastroenterology Society treatment guidelines recommend considering use of this agent for patients in whom the observed clinical benefits were greatest, including those aged ≥65 years with at least 1 of the following additional risk factors: experiencing their second episode of CDI within the past 6 months, immunocompromised, or with severe CDI [21]. SHEA/IDSA guidelines similarly recommend use be reserved for patients with risk factors for recurrence. Fecal Microbiota Transplantation: History and Current Status FMT has emerged as a safe and effective therapy for CDI and is now recommended in treatment guidelines after a second recurrence [21]. Initially described by the surgeon Ben Eiseman as a treatment for pseudomembranous enterocolitis in 1958 [25] with several additional successful case reports over the years [26], it was viewed as a treatment of “last resort” until rising numbers of severe and recurrent cases of C. difficile in the early 2000s. A 2004 publication by gastroenterologist Thomas Borody promoted the use of screened donor stool as “bacteriotherapy” for CDI and other gastrointestinal conditions [27]. Interest in the treatment began to gain momentum, yet through 2008, only 100 patients comprised the world's literature of recurrent CDI treated with bacteriotherapy [28]. In 2010, Yoon et al reported 100% success in 12 patients treated with donor stool administered during colonoscopy [29], and this method was rapidly adopted by other gastroenterologists as a well-tolerated and effective method. By 2012, other investigators were reporting similar high rates of cure using the colonoscopic approach in larger case series [30, 31], and the first long-term follow-up study supported the treatment as durable and safe [32]. Mechanisms of effect were also being investigated with 16s rRNA sequencing to characterize recipient's stool before and after the procedure and showed dramatic effects on the composition of the gut microbiome [33]. In the interest of standardizing the approach to donor selection and screening and administration protocols, a multidisciplinary working group was formed. This group, comprised of gastroenterologists and infectious diseases specialists, coined the term “fecal microbiota transplant” and published the first guidance for clinicians [34]. In January 2013, results from the first randomized, controlled trial of FMT for treatment of recurrent CDI were reported [35]. This landmark Dutch study was stopped at the interim analysis after duodenal infusion of a preparation of donor feces was found to be far superior to standard-of-care oral vancomycin in preventing further CDI recurrence. This study was widely publicized, increasing awareness among patients and members of the medical community and reassuring physicians about the efficacy and safety of the procedure (Figure 1). Prompted by growing interest in FMT for CDI and other applications, the US Food and Drug Administration (FDA) convened a public workshop in 2013 titled “Fecal Microbiota for Transplantation” with the purpose of exchanging information with the medical and scientific communities about the regulatory and scientific issues associated FMT. Clinicians, scientists, and patient advocates were invited to speak and present data on the gut microbiome, the epidemiology and treatment of recurrent CDI and its impact on patients, and FMT for CDI. At the meeting’s conclusion, it was announced that the FDA intended to regulate fecal microbiota as a biologic drug. As such, it was unapproved, and an investigational new drug (IND) application would be required to administer or conduct clinical trials on FMT. In subsequent communications, physicians and scientists expressed concern that the IND requirement was burdensome to physicians and would adversely affect the availability of FMT to patients who were suffering with recurrent CDI. In acknowledgment of these concerns, the FDA announced the policy of “enforcement discretion,” which permitted FMT to be done for patients suffering from CDI who had not responded to standard therapies, provided they were given informed consent stating that FMT is investigational and discussing potential risks [36]. Around this time, OpenBiome, a nonprofit stool bank founded by a team of physicians, microbiologists, and public health experts, was established and began to provide screened donor material for FMT. Operating under enforcement discretion, OpenBiome centralized the process of donor testing, stool donation, and processing and shipped preparations of frozen donor material to clinicians for use in FMT. With extensive donor health screenings and serologic and stool testing, infection transmission risk was minimized. With this convenient source of donor stool, FMT was facilitated; by 2018, OpenBiome had shipped 10 000 doses and partnered with investigators to conduct research around FMT and the gut microbiome. The widespread adoption of stool banks was not anticipated by FDA, and members of industry argued that the availability of donor stool under enforcement discretion was impacting enrollment in clinical trials of live biotherapeutic products. In response, the agency issued a draft guidance in 2016 that would require stool banks to adhere to IND requirements in order to distribute FMT products [37]. This would remain in draft form for several years while public comments were elicited and LBPs for treatment of CDI remained in clinical development. Gastroenterologists continued to work with collaborators from other disciplines to contribute to discoveries and innovation in the field, and the years 2013 through 2019 saw great advances in knowledge around FMT. A multicenter, retrospective series on the use of FMT in immunocompromised recipients demonstrated the effective use of FMT for CDI in this population with few serious adverse events and no related infectious complications in these high-risk patients [38]. Additional series showed the effectiveness for CDI in patients with inflammatory bowel disease (IBD) [39–41], solid organ transplant recipients [42], and elderly individuals [43] and examined factors predictive of FMT failure [44]. The first placebo-controlled trial of colonoscopically administered FMT was published in 2016 [45]. This study enrolled 46 patients with multiple recurrent CDI. Patients were randomized after completing a course of oral vancomycin to treat the most recent episode and received FMT using donor stool or autologous FMT (as placebo). In the intention-to-treat analysis, 20 of 22 patients (90.9%) in the donor FMT group achieved clinical cure at 8 weeks compared with 15 of 24 (62.5%) in the autologous FMT group (P = .042).","[question] the first time I had c diff I took vancomycin to treat it but i had an allergic reaction. i have c diff again. what can make it go away? I am retired. please only list affordable options. ===================== [text] Current Pharmacologic Options There are 3 antibiotics available for treatment of CDI: metronidazole, vancomycin, and fidaxomicin. All have demonstrated efficacy with similar rates of cure in nonsevere disease [18]. However, use of fidaxomicin, with a narrower spectrum of antimicrobial activity, has been shown to result in lower recurrence rates [19]. Based on this benefit, the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Disease Society of America (IDSA) clinical practice guidelines position fidaxomicin above vancomycin for treatment of an initial CDI [20]. The guidelines published by the American College of Gastroenterology (ACG) differ, stating that either vancomycin or fidaxomicin is appropriate to treat an initial CDI [21]. This recommendation was based on comparable efficacy data with far lower costs of vancomycin compared with fidaxomicin. In severe infections, treatment with metronidazole was shown to be associated with increased 30-day mortality [22]. In addition, C. difficile isolates with reduced susceptibility to metronidazole and treatment failures with this agent are increasing [23]. Therefore, use of metronidazole to treat patients with severe disease or those who are older or have comorbidities is not recommended by either practice guideline, though ACG guidelines maintain that metronidazole is appropriate to treat nonsevere infections in younger patients without comorbidities. SHEA/IDSA guidelines discourage its use altogether. Bezolotoxumab is a monoclonal antibody that binds to toxin B and has been shown to reduce CDI recurrence in patients at high risk of recurrence [24]. Neutralization of the toxin while the antibody remains in circulation may prevent symptoms in the event of C. difficile regrowth after completion of antibiotic therapy. There are significant drug and infusion costs to use of this agent, and clinical trials demonstrated a number needed to treat of 10 to prevent 1 recurrent CDI. The Gastroenterology Society treatment guidelines recommend considering use of this agent for patients in whom the observed clinical benefits were greatest, including those aged ≥65 years with at least 1 of the following additional risk factors: experiencing their second episode of CDI within the past 6 months, immunocompromised, or with severe CDI [21]. SHEA/IDSA guidelines similarly recommend use be reserved for patients with risk factors for recurrence. Fecal Microbiota Transplantation: History and Current Status FMT has emerged as a safe and effective therapy for CDI and is now recommended in treatment guidelines after a second recurrence [21]. Initially described by the surgeon Ben Eiseman as a treatment for pseudomembranous enterocolitis in 1958 [25] with several additional successful case reports over the years [26], it was viewed as a treatment of “last resort” until rising numbers of severe and recurrent cases of C. difficile in the early 2000s. A 2004 publication by gastroenterologist Thomas Borody promoted the use of screened donor stool as “bacteriotherapy” for CDI and other gastrointestinal conditions [27]. Interest in the treatment began to gain momentum, yet through 2008, only 100 patients comprised the world's literature of recurrent CDI treated with bacteriotherapy [28]. In 2010, Yoon et al reported 100% success in 12 patients treated with donor stool administered during colonoscopy [29], and this method was rapidly adopted by other gastroenterologists as a well-tolerated and effective method. By 2012, other investigators were reporting similar high rates of cure using the colonoscopic approach in larger case series [30, 31], and the first long-term follow-up study supported the treatment as durable and safe [32]. Mechanisms of effect were also being investigated with 16s rRNA sequencing to characterize recipient's stool before and after the procedure and showed dramatic effects on the composition of the gut microbiome [33]. In the interest of standardizing the approach to donor selection and screening and administration protocols, a multidisciplinary working group was formed. This group, comprised of gastroenterologists and infectious diseases specialists, coined the term “fecal microbiota transplant” and published the first guidance for clinicians [34]. In January 2013, results from the first randomized, controlled trial of FMT for treatment of recurrent CDI were reported [35]. This landmark Dutch study was stopped at the interim analysis after duodenal infusion of a preparation of donor feces was found to be far superior to standard-of-care oral vancomycin in preventing further CDI recurrence. This study was widely publicized, increasing awareness among patients and members of the medical community and reassuring physicians about the efficacy and safety of the procedure (Figure 1). Prompted by growing interest in FMT for CDI and other applications, the US Food and Drug Administration (FDA) convened a public workshop in 2013 titled “Fecal Microbiota for Transplantation” with the purpose of exchanging information with the medical and scientific communities about the regulatory and scientific issues associated FMT. Clinicians, scientists, and patient advocates were invited to speak and present data on the gut microbiome, the epidemiology and treatment of recurrent CDI and its impact on patients, and FMT for CDI. At the meeting’s conclusion, it was announced that the FDA intended to regulate fecal microbiota as a biologic drug. As such, it was unapproved, and an investigational new drug (IND) application would be required to administer or conduct clinical trials on FMT. In subsequent communications, physicians and scientists expressed concern that the IND requirement was burdensome to physicians and would adversely affect the availability of FMT to patients who were suffering with recurrent CDI. In acknowledgment of these concerns, the FDA announced the policy of “enforcement discretion,” which permitted FMT to be done for patients suffering from CDI who had not responded to standard therapies, provided they were given informed consent stating that FMT is investigational and discussing potential risks [36]. Around this time, OpenBiome, a nonprofit stool bank founded by a team of physicians, microbiologists, and public health experts, was established and began to provide screened donor material for FMT. Operating under enforcement discretion, OpenBiome centralized the process of donor testing, stool donation, and processing and shipped preparations of frozen donor material to clinicians for use in FMT. With extensive donor health screenings and serologic and stool testing, infection transmission risk was minimized. With this convenient source of donor stool, FMT was facilitated; by 2018, OpenBiome had shipped 10 000 doses and partnered with investigators to conduct research around FMT and the gut microbiome. The widespread adoption of stool banks was not anticipated by FDA, and members of industry argued that the availability of donor stool under enforcement discretion was impacting enrollment in clinical trials of live biotherapeutic products. In response, the agency issued a draft guidance in 2016 that would require stool banks to adhere to IND requirements in order to distribute FMT products [37]. This would remain in draft form for several years while public comments were elicited and LBPs for treatment of CDI remained in clinical development. Gastroenterologists continued to work with collaborators from other disciplines to contribute to discoveries and innovation in the field, and the years 2013 through 2019 saw great advances in knowledge around FMT. A multicenter, retrospective series on the use of FMT in immunocompromised recipients demonstrated the effective use of FMT for CDI in this population with few serious adverse events and no related infectious complications in these high-risk patients [38]. Additional series showed the effectiveness for CDI in patients with inflammatory bowel disease (IBD) [39–41], solid organ transplant recipients [42], and elderly individuals [43] and examined factors predictive of FMT failure [44]. The first placebo-controlled trial of colonoscopically administered FMT was published in 2016 [45]. This study enrolled 46 patients with multiple recurrent CDI. Patients were randomized after completing a course of oral vancomycin to treat the most recent episode and received FMT using donor stool or autologous FMT (as placebo). In the intention-to-treat analysis, 20 of 22 patients (90.9%) in the donor FMT group achieved clinical cure at 8 weeks compared with 15 of 24 (62.5%) in the autologous FMT group (P = .042). https://academic.oup.com/cid/article/77/Supplement_6/S463/7459148 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Fact Finding,Q&A Answer the prompt using only the provide text and nothing else. Your answer must be at least 4 sentences but no more than 6 sentences. Your answer must also be in paragraph format with no lists.,"I have a year and a month left on my lease and my landlord is going to evict me even though I've paid my rent, how long do I have to leave after they actually start the process?","Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 11 a claim of housing discrimination based on a protected category. V. ENDING A LEASE A periodic lease (month-to-month or year-to-year) most often ends in one of three ways: • You move out before the end of the term • You or the landlord gives notice 15 days before the end of the term that the lease will not renew • You or the landlord materially breaches the lease A lease for a fixed period of time most often ends in one of three ways: • You move out before the end of the term • The term of the lease expires and the parties do not agree to renew • You or the landlord materially breaches the lease A. Early Termination There is no stand-alone right to terminate a lease early, and many lease agreements do not allow a tenant to terminate early. If you voluntarily move out before the end of the lease, the lease does not allow for early termination, and the landlord has not breached any of their obligations, then you will likely be responsible for paying rent until the lease expires or until the landlord rents the unit to a new tenant. In Pennsylvania, the landlord has no obligation to locate a new tenant to rent the unit. If you move out early, the landlord may be able to make you pay rent for the rest of the lease term. B. Security Deposit Refund and Deductions To have your security deposit refunded, you must provide the landlord with a forwarding address and return the keys to the property. 68 P.S. § 250.512(e). Before leaving, clean the unit as thoroughly as possible and take photos to document its condition. Within 30 days after you have moved out, the landlord must either return the entire security deposit or send you a list of damages, the cost of repairs, and any money remaining from the security deposit. 68 P.S. § 250.512(a). Permissible deductions include “actual damages” to the rental unit. Id. If the landlord does not provide a written list of damages within 30 days, they may not keep any part of the security deposit. 68 P.S. § 250.512(b). You may then sue to recover double the amount of the deposit minus any actual damages as determined by a court. 68 P.S. § 250.512(c). If, within 30 days, the landlord fails to pay you the difference between the security deposit and the actual damages to the property, the landlord is liable for double the amount by which the Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 12 security deposit exceeds the actual damages to the property. 68 P.S. § 250.512(b)-(c). If you break the lease, the security deposit may be forfeited. 68 P.S. § 250.512(a). C. Eviction A landlord may seek to evict you if you fail to pay rent, fail to move out at the end of the lease, or violate a term of the lease. 68 P.S. § 250.501(a). Landlord “self-help” eviction is prohibited – i.e., landlord may not change your locks or shut off your utility service to initiate an eviction. Instead, the landlord must follow the process below. Some cities in Pennsylvania, such as Philadelphia, may have eviction diversion or mediation programs designed to help you and the landlord come to an agreement without using the court process or creating an eviction record. 1. Notice to Quit To begin eviction, the landlord must first give you a written eviction notice known as a Notice to Quit. • If the eviction is for failure to pay rent or for use of illegal drugs, the Notice to Quit must give the tenant 10 days to leave voluntarily. 68 P.S. §§ 250.501(b), 250.505-A. • If the eviction is for a breach of any other condition of the lease and the lease is for one year or less (or an indeterminate time), the notice to quit must give the tenant 15 days to leave voluntarily. 68 P.S. § 250.501(b). • If the eviction is for a breach any other condition of the lease and the lease is for more than one year, the notice to quit must give the tenant 30 days to leave voluntarily. 68 P.S. § 250.501(b). The landlord must notify you of the notice to quit in one of three ways, 68 P.S. § 250.501(f): • Give you the notice personally • Leave the notice at the main building of the leased property • Post the notice conspicuously on the leased property Notice requirements may be and are often waived in the lease under a Waiver of Notice to Quit provision. If the notice is validly waived, the landlord is permitted to take you to court (see Landlord Tenant Complaint (Part V.C.2) below), without any advance notice. 68 P.S. § 250.501(e). The Office of Attorney General encourages all landlords across the Commonwealth to deal fairly with tenants by not including Waiver of Notice to Quit provisions in lease agreements and by providing tenants with notice before beginning eviction proceedings. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 13 2. Landlord-Tenant Complaint If you do not voluntarily leave the unit within the time period listed in the notice to quit, the landlord still cannot evict you themselves. Instead, the landlord must file a legal action in court often referred to as a Landlord-Tenant Complaint. The complaint will be filed with your county’s Magisterial District Court, or in Philadelphia, the Philadelphia Municipal Court, or in Allegheny County, the Housing Court. The complaint will ask for possession of the unit and may also ask for back rent or damages. 246 Pa. Code § 503. After the complaint is filed, the court will issue a summons to you, which is a copy of the complaint and a notice to appear at a hearing on a specific date and time. 246 Pa. Code § 504. The court will serve the summons by mailing a copy to you at your last known address by First- Class Mail. 246 Pa. Code § 506. A sheriff or certified constable will also serve you with the summons personally or by posting it conspicuously on the leased property. Id. If you have any claims against the landlord for breach of the lease—for example, a breach of the Implied Warranty of Habitability (Part IV.C)—you may file a counterclaim, but you must do so before the date of the hearing. 246 Pa. Code § 508. Each court will have slightly different rules for how it processes landlord-tenant complaints. Make sure to check the local rules (sometimes called local civil rules or rules and procedures) for the court where the complaint was filed to make sure you are aware of how the court operates. For example, the Philadelphia Municipal Court will continue (i.e., postpone) the hearing on a landlord-tenant complaint if the tenant has filed a complaint which has been accepted by the Philadelphia Fair Housing Commission prior to the date the landlord filed the complaint for eviction. 3. Hearing & Judgment At the hearing, you and the landlord will each have an opportunity to present your case. 246 Pa. Code § 512. You may bring a lawyer to help you. You may also bring documents, photos, emails, records, and other evidence to support your case. It is extremely important that you do not miss your hearing date. If you miss or are late to your hearing date, the landlord wins by default. If you cannot attend the hearing, contact the court and ask if the hearing can be rescheduled. At the end of the hearing or within three days, the judge will make a decision, called a Notice of Judgment. 246 Pa. Code § 514(C). • Judgment in favor of the landlord: If the judge rules in favor of the landlord, then the Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 14 landlord will be granted possession of the unit. 246 Pa. Code § 514. The judge may also require you to pay damages and unpaid rent. Id. • Judgment in favor of the tenant: If the judge rules in your favor, then the landlord must do what the judge orders them to do, such as allowing you to remain in the unit or paying you money. 4. Appeal You have 10 days after entry of judgement against you to file an appeal in the court of common pleas. 68 P.S. § 250.513; 246 Pa. Code § 1008. The appeal will block an actual eviction (in legal terminology, operate as a supersedeas) only if you deposit with the court either three months’ rent or the amount the judge ordered you to pay, whichever is less. 246 Pa. Code § 1008(B). If you are low-income, you can file a tenant’s affidavit and deposit one third of your monthly rent. 246 Pa. Code § 1008(C). In both situations, you will also have to deposit rent each month while the appeal is pending. 246 Pa. Code § 1008(B), (C). The money will be held in escrow by the court. 5. Order of Possession Even if judgment is entered in favor of the landlord, the landlord still cannot evict you themselves. Instead, the landlord must wait 10 days after entry of judgment and then ask the court to issue an order of possession. 246 Pa. Code § 515(B). The court will serve the order of possession by mailing a copy to you at your last known address by First-Class Mail. 246 Pa. Code § 517. A sheriff or certified constable will also serve you with the order of possession personally or by posting it conspicuously on the leased property. Id. The order of possession will require you to vacate the residential unit within 10 days after the date of service. 246 Pa. Code § 517(2). If you remain in the rental unit on the 11th day following service of the order of possession, then you can be forcibly evicted. 246 Pa. Code § 519(B). If you are forcibly evicted and leave possessions behind, the landlord must notify you by First- Class Mail of your right to retrieve the property. 68 P.S. § 250.505a(d), (e). You have 10 days from the postmark date of the notice to either retrieve your possessions or ask that your landlord store your possessions for up to 30 days. Id. If you ask your landlord to store your possessions, you will be responsible for any costs. Id. If you do not contact the landlord or retrieve your property, the landlord can dispose of it. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 15 6. Domestic Violence Survivor If you are a victim of domestic violence,13 then you have 30 days to appeal a judgment in favor of the landlord. 68 P.S. § 250.513(b). If the landlord obtains an order of possession before the 30 days have passed, you can file a domestic violence affidavit with the court to stay (i.e., freeze) the order of possession pending an appeal or until the end of the 30 days. 246 Pa. Code § 514.1. 7. Satisfaction of Judgment for Nonpayment of Rent If the eviction is only for failure to pay rent, a tenant can stop the eviction by paying—any point before actual eviction—the full amount of unpaid rent and other fees. 246 Pa. Code § 518. Once that happens, one more step needs to be taken: the landlord should enter with the court that the judgment has been satisfied. 246 Pa. Code § 341. If your landlord does not do so, you should file a written request to have the judgment marked satisfied with the court and serve it on the landlord. 246 Pa. Code § 341. If the landlord does not enter that the judgment has been satisfied within 90 days of a written request without good cause, the landlord will be liable to the tenant for 1% of the judgment amount, at least $250 and up to $2,500, every month the judgment is not marked satisfied. 42 Pa. Cons. Stat. § 8104(b). 8. Eviction Records An “eviction record” is an official record—court filings, transcripts and orders, for example— that contains information about a past or ongoing lawsuit to evict a tenant. There is no uniform requirement across all Pennsylvania courts for what details must be included in an eviction record; there is no guarantee that the information contained in eviction records tells the whole story. An eviction record may also show, incorrectly, that a tenant who was evicted for failure to pay rent has not satisfied the judgment just because the landlord has failed to have the judgment marked satisfied with the court. Pennsylvania does not automatically seal or expunge eviction records, even if the case is withdrawn. Some cities in Pennsylvania, such as Philadelphia, may have eviction diversion or mediation programs designed to help you and the landlord come to an agreement without using the court process or creating an eviction record.","Answer the prompt using only the provide text and nothing else. Your answer must be at least 4 sentences but no more than 6 sentences. Your answer must also be in paragraph format with no lists. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 11 a claim of housing discrimination based on a protected category. V. ENDING A LEASE A periodic lease (month-to-month or year-to-year) most often ends in one of three ways: • You move out before the end of the term • You or the landlord gives notice 15 days before the end of the term that the lease will not renew • You or the landlord materially breaches the lease A lease for a fixed period of time most often ends in one of three ways: • You move out before the end of the term • The term of the lease expires and the parties do not agree to renew • You or the landlord materially breaches the lease A. Early Termination There is no stand-alone right to terminate a lease early, and many lease agreements do not allow a tenant to terminate early. If you voluntarily move out before the end of the lease, the lease does not allow for early termination, and the landlord has not breached any of their obligations, then you will likely be responsible for paying rent until the lease expires or until the landlord rents the unit to a new tenant. In Pennsylvania, the landlord has no obligation to locate a new tenant to rent the unit. If you move out early, the landlord may be able to make you pay rent for the rest of the lease term. B. Security Deposit Refund and Deductions To have your security deposit refunded, you must provide the landlord with a forwarding address and return the keys to the property. 68 P.S. § 250.512(e). Before leaving, clean the unit as thoroughly as possible and take photos to document its condition. Within 30 days after you have moved out, the landlord must either return the entire security deposit or send you a list of damages, the cost of repairs, and any money remaining from the security deposit. 68 P.S. § 250.512(a). Permissible deductions include “actual damages” to the rental unit. Id. If the landlord does not provide a written list of damages within 30 days, they may not keep any part of the security deposit. 68 P.S. § 250.512(b). You may then sue to recover double the amount of the deposit minus any actual damages as determined by a court. 68 P.S. § 250.512(c). If, within 30 days, the landlord fails to pay you the difference between the security deposit and the actual damages to the property, the landlord is liable for double the amount by which the Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 12 security deposit exceeds the actual damages to the property. 68 P.S. § 250.512(b)-(c). If you break the lease, the security deposit may be forfeited. 68 P.S. § 250.512(a). C. Eviction A landlord may seek to evict you if you fail to pay rent, fail to move out at the end of the lease, or violate a term of the lease. 68 P.S. § 250.501(a). Landlord “self-help” eviction is prohibited – i.e., landlord may not change your locks or shut off your utility service to initiate an eviction. Instead, the landlord must follow the process below. Some cities in Pennsylvania, such as Philadelphia, may have eviction diversion or mediation programs designed to help you and the landlord come to an agreement without using the court process or creating an eviction record. 1. Notice to Quit To begin eviction, the landlord must first give you a written eviction notice known as a Notice to Quit. • If the eviction is for failure to pay rent or for use of illegal drugs, the Notice to Quit must give the tenant 10 days to leave voluntarily. 68 P.S. §§ 250.501(b), 250.505-A. • If the eviction is for a breach of any other condition of the lease and the lease is for one year or less (or an indeterminate time), the notice to quit must give the tenant 15 days to leave voluntarily. 68 P.S. § 250.501(b). • If the eviction is for a breach any other condition of the lease and the lease is for more than one year, the notice to quit must give the tenant 30 days to leave voluntarily. 68 P.S. § 250.501(b). The landlord must notify you of the notice to quit in one of three ways, 68 P.S. § 250.501(f): • Give you the notice personally • Leave the notice at the main building of the leased property • Post the notice conspicuously on the leased property Notice requirements may be and are often waived in the lease under a Waiver of Notice to Quit provision. If the notice is validly waived, the landlord is permitted to take you to court (see Landlord Tenant Complaint (Part V.C.2) below), without any advance notice. 68 P.S. § 250.501(e). The Office of Attorney General encourages all landlords across the Commonwealth to deal fairly with tenants by not including Waiver of Notice to Quit provisions in lease agreements and by providing tenants with notice before beginning eviction proceedings. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 13 2. Landlord-Tenant Complaint If you do not voluntarily leave the unit within the time period listed in the notice to quit, the landlord still cannot evict you themselves. Instead, the landlord must file a legal action in court often referred to as a Landlord-Tenant Complaint. The complaint will be filed with your county’s Magisterial District Court, or in Philadelphia, the Philadelphia Municipal Court, or in Allegheny County, the Housing Court. The complaint will ask for possession of the unit and may also ask for back rent or damages. 246 Pa. Code § 503. After the complaint is filed, the court will issue a summons to you, which is a copy of the complaint and a notice to appear at a hearing on a specific date and time. 246 Pa. Code § 504. The court will serve the summons by mailing a copy to you at your last known address by First- Class Mail. 246 Pa. Code § 506. A sheriff or certified constable will also serve you with the summons personally or by posting it conspicuously on the leased property. Id. If you have any claims against the landlord for breach of the lease—for example, a breach of the Implied Warranty of Habitability (Part IV.C)—you may file a counterclaim, but you must do so before the date of the hearing. 246 Pa. Code § 508. Each court will have slightly different rules for how it processes landlord-tenant complaints. Make sure to check the local rules (sometimes called local civil rules or rules and procedures) for the court where the complaint was filed to make sure you are aware of how the court operates. For example, the Philadelphia Municipal Court will continue (i.e., postpone) the hearing on a landlord-tenant complaint if the tenant has filed a complaint which has been accepted by the Philadelphia Fair Housing Commission prior to the date the landlord filed the complaint for eviction. 3. Hearing & Judgment At the hearing, you and the landlord will each have an opportunity to present your case. 246 Pa. Code § 512. You may bring a lawyer to help you. You may also bring documents, photos, emails, records, and other evidence to support your case. It is extremely important that you do not miss your hearing date. If you miss or are late to your hearing date, the landlord wins by default. If you cannot attend the hearing, contact the court and ask if the hearing can be rescheduled. At the end of the hearing or within three days, the judge will make a decision, called a Notice of Judgment. 246 Pa. Code § 514(C). • Judgment in favor of the landlord: If the judge rules in favor of the landlord, then the Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 14 landlord will be granted possession of the unit. 246 Pa. Code § 514. The judge may also require you to pay damages and unpaid rent. Id. • Judgment in favor of the tenant: If the judge rules in your favor, then the landlord must do what the judge orders them to do, such as allowing you to remain in the unit or paying you money. 4. Appeal You have 10 days after entry of judgement against you to file an appeal in the court of common pleas. 68 P.S. § 250.513; 246 Pa. Code § 1008. The appeal will block an actual eviction (in legal terminology, operate as a supersedeas) only if you deposit with the court either three months’ rent or the amount the judge ordered you to pay, whichever is less. 246 Pa. Code § 1008(B). If you are low-income, you can file a tenant’s affidavit and deposit one third of your monthly rent. 246 Pa. Code § 1008(C). In both situations, you will also have to deposit rent each month while the appeal is pending. 246 Pa. Code § 1008(B), (C). The money will be held in escrow by the court. 5. Order of Possession Even if judgment is entered in favor of the landlord, the landlord still cannot evict you themselves. Instead, the landlord must wait 10 days after entry of judgment and then ask the court to issue an order of possession. 246 Pa. Code § 515(B). The court will serve the order of possession by mailing a copy to you at your last known address by First-Class Mail. 246 Pa. Code § 517. A sheriff or certified constable will also serve you with the order of possession personally or by posting it conspicuously on the leased property. Id. The order of possession will require you to vacate the residential unit within 10 days after the date of service. 246 Pa. Code § 517(2). If you remain in the rental unit on the 11th day following service of the order of possession, then you can be forcibly evicted. 246 Pa. Code § 519(B). If you are forcibly evicted and leave possessions behind, the landlord must notify you by First- Class Mail of your right to retrieve the property. 68 P.S. § 250.505a(d), (e). You have 10 days from the postmark date of the notice to either retrieve your possessions or ask that your landlord store your possessions for up to 30 days. Id. If you ask your landlord to store your possessions, you will be responsible for any costs. Id. If you do not contact the landlord or retrieve your property, the landlord can dispose of it. Consumer Guide to Tenant and Landlord Rights Version 1.1. Last updated June 13, 2022. 15 6. Domestic Violence Survivor If you are a victim of domestic violence,13 then you have 30 days to appeal a judgment in favor of the landlord. 68 P.S. § 250.513(b). If the landlord obtains an order of possession before the 30 days have passed, you can file a domestic violence affidavit with the court to stay (i.e., freeze) the order of possession pending an appeal or until the end of the 30 days. 246 Pa. Code § 514.1. 7. Satisfaction of Judgment for Nonpayment of Rent If the eviction is only for failure to pay rent, a tenant can stop the eviction by paying—any point before actual eviction—the full amount of unpaid rent and other fees. 246 Pa. Code § 518. Once that happens, one more step needs to be taken: the landlord should enter with the court that the judgment has been satisfied. 246 Pa. Code § 341. If your landlord does not do so, you should file a written request to have the judgment marked satisfied with the court and serve it on the landlord. 246 Pa. Code § 341. If the landlord does not enter that the judgment has been satisfied within 90 days of a written request without good cause, the landlord will be liable to the tenant for 1% of the judgment amount, at least $250 and up to $2,500, every month the judgment is not marked satisfied. 42 Pa. Cons. Stat. § 8104(b). 8. Eviction Records An “eviction record” is an official record—court filings, transcripts and orders, for example— that contains information about a past or ongoing lawsuit to evict a tenant. There is no uniform requirement across all Pennsylvania courts for what details must be included in an eviction record; there is no guarantee that the information contained in eviction records tells the whole story. An eviction record may also show, incorrectly, that a tenant who was evicted for failure to pay rent has not satisfied the judgment just because the landlord has failed to have the judgment marked satisfied with the court. Pennsylvania does not automatically seal or expunge eviction records, even if the case is withdrawn. Some cities in Pennsylvania, such as Philadelphia, may have eviction diversion or mediation programs designed to help you and the landlord come to an agreement without using the court process or creating an eviction record. I have a year and a month left on my lease and my landlord is going to evict me even though I've paid my rent, how long do I have to leave after they actually start the process?",Legal,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",List and summarize the established exceptions to the general rule that employees are not protected by FECA when injured while traveling between home and work. Answer should not exceed 150 words.,"U.S. Department of Labor Office of Workers’ Compensation Programs Procedure Manual Division of Federal Employees' Compensation (DFEC) FECA Part 2 6. To and From Work. Employees do not generally have the protection of the FECA when injured while en route between work and home. a. Exceptions. There are five well-established exceptions to this general rule. These exceptions are: (1) Where the employment requires the employee to travel; (2) Where the employer contracts for and furnishes transportation to and from work; (3) Where the employee is subject to emergency duty, as in the case of firefighters; (4) Where the employee uses the highway or public transportation to do something incidental to employment with the knowledge and approval of the employer; and (5) Where the employee is required to travel during a curfew established by local, municipal, county or state authorities because of civil disturbances or for other reasons. b. Where the Employment Requires the Employee to Travel. This situation will not occur in the case of an employee having a fixed place of employment unless on an errand or special mission. It usually involves an employee who performs all or most of the work away from the industrial premises, such as a chauffeur, truck driver, or messenger. In cases of this type the official superior should be requested to submit a supplemental statement fully describing the employee's assigned duties and showing how and in what manner the work required the employee to travel, whether on the highway or by public transportation. In injury cases a similar statement should be obtained from the injured employee. c. Where the Employer Contracts for and Furnishes Transportation to and from Work. Where this expectation is claimed, the official superior should be requested to submit a supplemental statement showing, with appropriate explanation, whether the employee's transportation was furnished or otherwise provided by contract by contract by the employer. In injury cases a similar statement should be obtained from the injured employee. Also see Program Memorandum 104 dated October 24, 1969. The Safe, Accountable, Flexible, Efficient Transportation Equity Act of 2005 (Public Law 109-59) amends Title 31, Section 1344 of the U.S. Code to allow Federal agencies in the National Capitol Region to pay for the costs of shuttle buses or other means of transportation between the place of employment and mass transit facilities. The bill statues that for ""purpose of any determination under chapter 81 of title 5 ... an individual shall not be considered to be 'in the performance of duty' or 'acting within the scope of his or her employment' by virtue of the fact that such individual is receiving transportation services"" under this legislation. IF it is determined that a shuttle bus or other means of transportation to and from mass transit is authorized under this statue, then the injury is not considered to have occurred within the performance of duty. When requesting information from the agency about the employer-provided conveyance, the agency should be asked whether the service in question was provided pursuant to the above statutory authority. d. Where the Employee is Subject to Emergency Duty. (1) When it is alleged that the employee was subject to emergency duty, the official superior should be requested to submit: (a) A copy of the injured employee's official position description, or other document showing that as the occasion arose, the duties did in fact require the performance of emergency duty; and (b) A specific statement showing that at the time of the injury the employee was in fact traveling to or from work because of emergency duty. (2) In disability cases, a statement from the injured employee should be requested showing whether at the time of the injury the employee was in fact going to or from work because of emergency duty. e. Where the Employee Uses the Highway or Public Transportation to Perform a Service for the Employer. (1) Where this exception is claimed, the official superior should be requested to submit a statement showing: (a) The precise duty the employee had performed or was expected to perform for the employer during the trip in question; and (b) Whether this was being done upon directions of the employer and, if not, whether the employer had prior knowledge of and had previously approved the employee's activity. (2) In disability cases the injured employee should be requested to submit a similar statement. f. Travel During a Curfew. (1) When it has been determined that the employee was required to travel during a curfew established by local, municipal, county or state authorities because of civil disturbances or for other reasons, the official superior should be requested to submit: (a) The reason the employee was requested to report for duty; (b) Whether other employees were given administrative leave because of the curfew; and (c) Whether the injury resulted from a specific hazard caused by the imposition of the curfew, such as an attack by rioting citizens. (2) In disability cases the injured employee should be requested to submit a similar statement. (3) When all the facts are developed, the case should be referred to the National Office.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== List and summarize the established exceptions to the general rule that employees are not protected by FECA when injured while traveling between home and work. Answer should not exceed 150 words. {passage 0} ========== U.S. Department of Labor Office of Workers’ Compensation Programs Procedure Manual Division of Federal Employees' Compensation (DFEC) FECA Part 2 6. To and From Work. Employees do not generally have the protection of the FECA when injured while en route between work and home. a. Exceptions. There are five well-established exceptions to this general rule. These exceptions are: (1) Where the employment requires the employee to travel; (2) Where the employer contracts for and furnishes transportation to and from work; (3) Where the employee is subject to emergency duty, as in the case of firefighters; (4) Where the employee uses the highway or public transportation to do something incidental to employment with the knowledge and approval of the employer; and (5) Where the employee is required to travel during a curfew established by local, municipal, county or state authorities because of civil disturbances or for other reasons. b. Where the Employment Requires the Employee to Travel. This situation will not occur in the case of an employee having a fixed place of employment unless on an errand or special mission. It usually involves an employee who performs all or most of the work away from the industrial premises, such as a chauffeur, truck driver, or messenger. In cases of this type the official superior should be requested to submit a supplemental statement fully describing the employee's assigned duties and showing how and in what manner the work required the employee to travel, whether on the highway or by public transportation. In injury cases a similar statement should be obtained from the injured employee. c. Where the Employer Contracts for and Furnishes Transportation to and from Work. Where this expectation is claimed, the official superior should be requested to submit a supplemental statement showing, with appropriate explanation, whether the employee's transportation was furnished or otherwise provided by contract by contract by the employer. In injury cases a similar statement should be obtained from the injured employee. Also see Program Memorandum 104 dated October 24, 1969. The Safe, Accountable, Flexible, Efficient Transportation Equity Act of 2005 (Public Law 109-59) amends Title 31, Section 1344 of the U.S. Code to allow Federal agencies in the National Capitol Region to pay for the costs of shuttle buses or other means of transportation between the place of employment and mass transit facilities. The bill statues that for ""purpose of any determination under chapter 81 of title 5 ... an individual shall not be considered to be 'in the performance of duty' or 'acting within the scope of his or her employment' by virtue of the fact that such individual is receiving transportation services"" under this legislation. IF it is determined that a shuttle bus or other means of transportation to and from mass transit is authorized under this statue, then the injury is not considered to have occurred within the performance of duty. When requesting information from the agency about the employer-provided conveyance, the agency should be asked whether the service in question was provided pursuant to the above statutory authority. d. Where the Employee is Subject to Emergency Duty. (1) When it is alleged that the employee was subject to emergency duty, the official superior should be requested to submit: (a) A copy of the injured employee's official position description, or other document showing that as the occasion arose, the duties did in fact require the performance of emergency duty; and (b) A specific statement showing that at the time of the injury the employee was in fact traveling to or from work because of emergency duty. (2) In disability cases, a statement from the injured employee should be requested showing whether at the time of the injury the employee was in fact going to or from work because of emergency duty. e. Where the Employee Uses the Highway or Public Transportation to Perform a Service for the Employer. (1) Where this exception is claimed, the official superior should be requested to submit a statement showing: (a) The precise duty the employee had performed or was expected to perform for the employer during the trip in question; and (b) Whether this was being done upon directions of the employer and, if not, whether the employer had prior knowledge of and had previously approved the employee's activity. (2) In disability cases the injured employee should be requested to submit a similar statement. f. Travel During a Curfew. (1) When it has been determined that the employee was required to travel during a curfew established by local, municipal, county or state authorities because of civil disturbances or for other reasons, the official superior should be requested to submit: (a) The reason the employee was requested to report for duty; (b) Whether other employees were given administrative leave because of the curfew; and (c) Whether the injury resulted from a specific hazard caused by the imposition of the curfew, such as an attack by rioting citizens. (2) In disability cases the injured employee should be requested to submit a similar statement. (3) When all the facts are developed, the case should be referred to the National Office. https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/FECA-PT2/group1#20805",Legal,Find & Summarize,Text Transformation Address the user's request with the information contained within the provided text - Do not draw on external resources or from your base knowledge.,Please present a comprehensive history of polio and its vaccines in bullet-point format.,"1.2 History of poliomyelitis and polio vaccines Poliomyelitis is a disease of great antiquity. Perhaps the earliest description is evident in an Egyptian stele from around 1350 BC depicting a young man with typical asymmetric flaccid paralysis and atrophy of the leg. Several scattered reports of the disease also appear in the literature from the 17th and 18th century. By the mid-19th century, the Industrial Revolution had brought increased urbanization to Europe and North America and, with it, significant changes and improvements in living conditions. Coincident with these massive changes was the advent of larger and more frequent outbreaks of poliomyelitis. From the late 1800s, outbreaks were occurring in several European countries and in the United States, and they remained a dominant public health problem in the developed world for the first half of the 20th century. A major landmark in the study of poliomyelitis was the successful passage of the virus to nonhuman primates by Landsteiner and Popper in 1909. The availability of animal models provided the first opportunity to study the disease outside of human patients and produced important information on the process of infection and the pathophysiology of the disease. Further studies on the infectious agent awaited the crucial development by Enders, Weller, and Robbins in 1949 of tissue culture systems for in vitro propagation of the virus. This advance, and the recognition of three distinct serotypes, opened the way for all subsequent work on vaccines and study of the biochemical and biophysical properties of the polioviruses. By the 1950s, two different approaches to the prevention of poliomyelitis by vaccination were developed. Salk and Younger produced the first successful polio vaccine in 1954 by chemical inactivation of tissue culture-propagated virus using formaldehyde. This vaccine was completely non-infectious, yet, following injection, it elicited an immune response that was protective against paralytic disease. During the same period, many laboratories sought to produce live, attenuated polio vaccines. The OPV strains of Sabin were licensed in 1961 following extensive field trials in the former Soviet Union, Eastern Europe and Latin America. Mass immunization campaigns in many countries began in 1962 and 1963. Both the inactivated polio vaccine (IPV) and OPV contain three components, one for each immunologically distinct serotype of poliovirus. Some countries use enhanced IPV (eIPV) that contains higher D-antigenic units per dose for types 2 and 3 than standard IPV. Widespread immunization with IPV, and since 1963 with OPV, has virtually eliminated poliomyelitis in most developed countries. 1.3 Characterization of the pathogen The polioviruses belong to the genus Enterovirus in the family Picornaviridae. All are small, round 30 nm particles with icosahedral symmetry, and they contain no essential lipid envelope. Polioviruses share most of their biochemical and biophysical characteristics with the other enteroviruses and are different from some of the other picornaviruses. The viral particles have a buoyant density of 1.34 g/ml in caesium chloride and a sedimentation coefficient of approximately 156S. The infectious particles are relatively heat resistant (when stabilized by magnesium cations), resistant to acid pH (pH 3 to 5 for one to three hours), and also resistant to WHO/IVB/04.10 5 many common detergents and disinfectants, including common soap, non-ionic detergents, ether, chloroform, and other lipid solvents. The virus is stable for weeks at 4°C and for days at room temperature. Drying, ultraviolet light, high heat, formaldehyde, and free chlorine, however, readily inactivate the virus. Polioviruses and the enteroviruses are distinguished from the other picornaviruses on the basis of physical properties such as buoyant density in caesium chloride and stability in weak acid. The three poliovirus serotypes are distinguished from the other enteroviruses by neutralization with serotype-specific antisera and the propensity to cause paralytic illness. The Mahoney strain of type 1 poliovirus is the prototype for the polioviruses, the genus enterovirus, and the family Picornaviridae. It is among the most-studied and best-characterized agents of human disease. The poliovirus consists of 60 copies each of four polypeptide chains that form a very highly structured shell. Located inside this shell, the viral genome consists of a single molecule of ribonucleic acid (RNA), which is about 7500 nucleotides long. The four capsid polypeptides are produced by the proteolytic cleavage of a single polyprotein precursor, and are designated VP1 through VP4. Attached covalently to the amino-terminal of the VP4 protein is a single molecule of myristilate. In addition, one small protein, VPg, is covalently attached to the 5'-end of the viral RNA. A major advance in studies on the structure of polioviruses occurred with the solution of the crystal structure to a resolution of 0.29 nm. From the three-dimensional structure of the poliovirus, VP1 contributes the majority of the amino acid residues on the virus surface, VP2 and VP3 are partially exposed on the surface, and VP4 is completely internal. The information concerning the surface of the virus has been particularly useful in understanding the neutralization of poliovirus by antibodies. Studies with monoclonal neutralizing antibodies and mutant viruses resistant to them have revealed four main antigenic sites on the virus. The relative importance of individual sites is different for each of the three serotypes of poliovirus. The X-ray crystal structure has confirmed that the antigenic sites are composed of amino acid residues located on the virus surface and exposed loops of capsid proteins. Adjacent domains of the same and other capsid proteins influence the conformation of the loops. This explains why antigenicity of the virus is destroyed by disruption of the virus structure. In addition, there are other antigenic sites that elicit an immune response that is not neutralizing. The poliovirus-neutralizing antibody response is serotype-specific, with the exception of some minor cross-reaction between poliovirus 1 and 2. Heat-disrupted viruses, particularly those heated in the presence of detergent, induce antibodies that react with many enteroviruses. These broadly reacting antibodies are generally not neutralizing. Antisera raised in animals to each of the viruses are largely type-specific and are used for the determination of serotype in a neutralization assay. Although more than one T-cell epitope has been described in both structural and non-structural viral proteins, the role of cell-mediated immunity in controlling infection has not been determined. 6 Polio laboratory manual Polioviruses are among the simplest viruses in terms of genetic complexity and size. The RNA genomes from all three serotypes of poliovirus have been cloned and sequenced. The genomic RNA is infectious and serves as messenger RNA for viral protein synthesis. The RNA is translated in a single open reading frame into one large polyprotein, which is then processed through proteolytic cleavage by two distinct virus-encoded proteases into the functional viral proteins (Figure 1.2). Despite much research and the simple nature of the virus, several steps of the virus growth cycle have remained elusive, including the site and mode of virus entry and release of the genome into the cytoplasm. Polioviruses initially bind to a specific plasma membrane protein, the poliovirus receptor (PVR; CD155), a member of the immunoglobulin superfamily of proteins. The binding to the receptor triggers conformational changes in the capsid structure that are necessary for the release of the genome into the cytoplasm (uncoating). No other picornaviruses use this protein as their cellular receptor, a fact that has been exploited in the eradication programme by the use of a recombinant murine cell line expressing the human PVR to selectively isolate polioviruses. Once the viral genome has entered the cell, the replication cycle begins when the viral RNA is transcribed by the viral polymerase beginning at the 3'-end of the infecting viral RNA to generate a complementary RNA (cRNA). In the next step, which is dependent on a “host factor”, the progeny viral RNA is synthesized from the cRNA. The newly synthesized viral RNA is covalently linked to the VPg protein at the 5'- end of the RNA, and then only the positive sense strand of RNA is encapsidated in the viral structural proteins to form infectious viral particles. The extensive studies into virus replication and assembly have resulted in the remarkable accomplishment of complete cell-free replication of poliovirus beginning only with the viral RNA.","Address the user's request with the information contained within the provided text - Do not draw on external resources or from your base knowledge. 1.2 History of poliomyelitis and polio vaccines Poliomyelitis is a disease of great antiquity. Perhaps the earliest description is evident in an Egyptian stele from around 1350 BC depicting a young man with typical asymmetric flaccid paralysis and atrophy of the leg. Several scattered reports of the disease also appear in the literature from the 17th and 18th century. By the mid-19th century, the Industrial Revolution had brought increased urbanization to Europe and North America and, with it, significant changes and improvements in living conditions. Coincident with these massive changes was the advent of larger and more frequent outbreaks of poliomyelitis. From the late 1800s, outbreaks were occurring in several European countries and in the United States, and they remained a dominant public health problem in the developed world for the first half of the 20th century. A major landmark in the study of poliomyelitis was the successful passage of the virus to nonhuman primates by Landsteiner and Popper in 1909. The availability of animal models provided the first opportunity to study the disease outside of human patients and produced important information on the process of infection and the pathophysiology of the disease. Further studies on the infectious agent awaited the crucial development by Enders, Weller, and Robbins in 1949 of tissue culture systems for in vitro propagation of the virus. This advance, and the recognition of three distinct serotypes, opened the way for all subsequent work on vaccines and study of the biochemical and biophysical properties of the polioviruses. By the 1950s, two different approaches to the prevention of poliomyelitis by vaccination were developed. Salk and Younger produced the first successful polio vaccine in 1954 by chemical inactivation of tissue culture-propagated virus using formaldehyde. This vaccine was completely non-infectious, yet, following injection, it elicited an immune response that was protective against paralytic disease. During the same period, many laboratories sought to produce live, attenuated polio vaccines. The OPV strains of Sabin were licensed in 1961 following extensive field trials in the former Soviet Union, Eastern Europe and Latin America. Mass immunization campaigns in many countries began in 1962 and 1963. Both the inactivated polio vaccine (IPV) and OPV contain three components, one for each immunologically distinct serotype of poliovirus. Some countries use enhanced IPV (eIPV) that contains higher D-antigenic units per dose for types 2 and 3 than standard IPV. Widespread immunization with IPV, and since 1963 with OPV, has virtually eliminated poliomyelitis in most developed countries. 1.3 Characterization of the pathogen The polioviruses belong to the genus Enterovirus in the family Picornaviridae. All are small, round 30 nm particles with icosahedral symmetry, and they contain no essential lipid envelope. Polioviruses share most of their biochemical and biophysical characteristics with the other enteroviruses and are different from some of the other picornaviruses. The viral particles have a buoyant density of 1.34 g/ml in caesium chloride and a sedimentation coefficient of approximately 156S. The infectious particles are relatively heat resistant (when stabilized by magnesium cations), resistant to acid pH (pH 3 to 5 for one to three hours), and also resistant to WHO/IVB/04.10 5 many common detergents and disinfectants, including common soap, non-ionic detergents, ether, chloroform, and other lipid solvents. The virus is stable for weeks at 4°C and for days at room temperature. Drying, ultraviolet light, high heat, formaldehyde, and free chlorine, however, readily inactivate the virus. Polioviruses and the enteroviruses are distinguished from the other picornaviruses on the basis of physical properties such as buoyant density in caesium chloride and stability in weak acid. The three poliovirus serotypes are distinguished from the other enteroviruses by neutralization with serotype-specific antisera and the propensity to cause paralytic illness. The Mahoney strain of type 1 poliovirus is the prototype for the polioviruses, the genus enterovirus, and the family Picornaviridae. It is among the most-studied and best-characterized agents of human disease. The poliovirus consists of 60 copies each of four polypeptide chains that form a very highly structured shell. Located inside this shell, the viral genome consists of a single molecule of ribonucleic acid (RNA), which is about 7500 nucleotides long. The four capsid polypeptides are produced by the proteolytic cleavage of a single polyprotein precursor, and are designated VP1 through VP4. Attached covalently to the amino-terminal of the VP4 protein is a single molecule of myristilate. In addition, one small protein, VPg, is covalently attached to the 5'-end of the viral RNA. A major advance in studies on the structure of polioviruses occurred with the solution of the crystal structure to a resolution of 0.29 nm. From the three-dimensional structure of the poliovirus, VP1 contributes the majority of the amino acid residues on the virus surface, VP2 and VP3 are partially exposed on the surface, and VP4 is completely internal. The information concerning the surface of the virus has been particularly useful in understanding the neutralization of poliovirus by antibodies. Studies with monoclonal neutralizing antibodies and mutant viruses resistant to them have revealed four main antigenic sites on the virus. The relative importance of individual sites is different for each of the three serotypes of poliovirus. The X-ray crystal structure has confirmed that the antigenic sites are composed of amino acid residues located on the virus surface and exposed loops of capsid proteins. Adjacent domains of the same and other capsid proteins influence the conformation of the loops. This explains why antigenicity of the virus is destroyed by disruption of the virus structure. In addition, there are other antigenic sites that elicit an immune response that is not neutralizing. The poliovirus-neutralizing antibody response is serotype-specific, with the exception of some minor cross-reaction between poliovirus 1 and 2. Heat-disrupted viruses, particularly those heated in the presence of detergent, induce antibodies that react with many enteroviruses. These broadly reacting antibodies are generally not neutralizing. Antisera raised in animals to each of the viruses are largely type-specific and are used for the determination of serotype in a neutralization assay. Although more than one T-cell epitope has been described in both structural and non-structural viral proteins, the role of cell-mediated immunity in controlling infection has not been determined. 6 Polio laboratory manual Polioviruses are among the simplest viruses in terms of genetic complexity and size. The RNA genomes from all three serotypes of poliovirus have been cloned and sequenced. The genomic RNA is infectious and serves as messenger RNA for viral protein synthesis. The RNA is translated in a single open reading frame into one large polyprotein, which is then processed through proteolytic cleavage by two distinct virus-encoded proteases into the functional viral proteins (Figure 1.2). Despite much research and the simple nature of the virus, several steps of the virus growth cycle have remained elusive, including the site and mode of virus entry and release of the genome into the cytoplasm. Polioviruses initially bind to a specific plasma membrane protein, the poliovirus receptor (PVR; CD155), a member of the immunoglobulin superfamily of proteins. The binding to the receptor triggers conformational changes in the capsid structure that are necessary for the release of the genome into the cytoplasm (uncoating). No other picornaviruses use this protein as their cellular receptor, a fact that has been exploited in the eradication programme by the use of a recombinant murine cell line expressing the human PVR to selectively isolate polioviruses. Once the viral genome has entered the cell, the replication cycle begins when the viral RNA is transcribed by the viral polymerase beginning at the 3'-end of the infecting viral RNA to generate a complementary RNA (cRNA). In the next step, which is dependent on a “host factor”, the progeny viral RNA is synthesized from the cRNA. The newly synthesized viral RNA is covalently linked to the VPg protein at the 5'- end of the RNA, and then only the positive sense strand of RNA is encapsidated in the viral structural proteins to form infectious viral particles. The extensive studies into virus replication and assembly have resulted in the remarkable accomplishment of complete cell-free replication of poliovirus beginning only with the viral RNA. Please present a comprehensive history of polio and its vaccines in bullet-point format.",Medical,Summarize & Format,Text Transformation You are an assistant for a marketing team. You analyze articles about companies and products and answer any questions the marketing team may have. Do not use any sources of external information in your answer. Base your answer solely on the article provided.,Is Michael Jordan mentioned in this article?,"Our NIKE Brand product offerings are aligned around our consumer construct focused on Men's, Women's and Kids'. We also design products specifically for the Jordan Brand and Converse. We believe this approach allows us to create products that better meet individual consumer needs while accelerating our largest growth opportunities. NIKE's athletic footwear products are designed primarily for specific athletic use, although a large percentage of the products are worn for casual or leisure purposes. We place considerable emphasis on innovation and high-quality construction in the development and manufacturing of our products. Our Men's, Women's and Jordan Brand footwear products currently lead in footwear sales and we expect them to continue to do so. We also sell sports apparel, which features the same trademarks and are sold predominantly through the same marketing and distribution channels as athletic footwear. Our sports apparel, similar to our athletic footwear products, is designed primarily for athletic use, although many of the products are worn for casual or leisure purposes, and demonstrates our commitment to innovation and high-quality construction. Our Men's and Women's apparel products currently lead in apparel sales and we expect them to continue to do so. We often market footwear, apparel and accessories in ""collections"" of similar use or by category. We also market apparel with licensed college and professional team and league logos. We sell a line of performance equipment and accessories under the NIKE Brand name, including bags, socks, sport balls, eyewear, timepieces, digital devices, bats, gloves, protective equipment and other equipment designed for sports activities. We also sell small amounts of various plastic products to other manufacturers through our wholly-owned subsidiary, NIKE IHM, Inc., doing business as Air Manufacturing Innovation. Our Jordan Brand designs, distributes and licenses athletic and casual footwear, apparel and accessories predominantly focused on basketball performance and culture using the Jumpman trademark. Sales and operating results for Jordan Brand products are reported within the respective NIKE Brand geographic operating segments. Our wholly-owned subsidiary brand, Converse, headquartered in Boston, Massachusetts, designs, distributes and licenses casual sneakers, apparel and accessories under the Converse, Chuck Taylor, All Star, One Star, Star Chevron and Jack Purcell trademarks. Operating results of the Converse brand are reported on a stand-alone basis. In addition to the products we sell to our wholesale customers and directly to consumers through our NIKE Direct operations, we have also entered into license agreements that permit unaffiliated parties to manufacture and sell, using NIKE-owned trademarks, certain apparel, digital devices and applications and other equipment designed for sports activities.","You are an assistant for a marketing team. You analyze articles about companies and products and answer any questions the marketing team may have. Do not use any sources of external information in your answer. Base your answer solely on the article provided. Question: Is Michael Jordan mentioned in this article? Article: ""Our NIKE Brand product offerings are aligned around our consumer construct focused on Men's, Women's and Kids'. We also design products specifically for the Jordan Brand and Converse. We believe this approach allows us to create products that better meet individual consumer needs while accelerating our largest growth opportunities. NIKE's athletic footwear products are designed primarily for specific athletic use, although a large percentage of the products are worn for casual or leisure purposes. We place considerable emphasis on innovation and high-quality construction in the development and manufacturing of our products. Our Men's, Women's and Jordan Brand footwear products currently lead in footwear sales and we expect them to continue to do so. We also sell sports apparel, which features the same trademarks and are sold predominantly through the same marketing and distribution channels as athletic footwear. Our sports apparel, similar to our athletic footwear products, is designed primarily for athletic use, although many of the products are worn for casual or leisure purposes, and demonstrates our commitment to innovation and high-quality construction. Our Men's and Women's apparel products currently lead in apparel sales and we expect them to continue to do so. We often market footwear, apparel and accessories in ""collections"" of similar use or by category. We also market apparel with licensed college and professional team and league logos. We sell a line of performance equipment and accessories under the NIKE Brand name, including bags, socks, sport balls, eyewear, timepieces, digital devices, bats, gloves, protective equipment and other equipment designed for sports activities. We also sell small amounts of various plastic products to other manufacturers through our wholly-owned subsidiary, NIKE IHM, Inc., doing business as Air Manufacturing Innovation. Our Jordan Brand designs, distributes and licenses athletic and casual footwear, apparel and accessories predominantly focused on basketball performance and culture using the Jumpman trademark. Sales and operating results for Jordan Brand products are reported within the respective NIKE Brand geographic operating segments. Our wholly-owned subsidiary brand, Converse, headquartered in Boston, Massachusetts, designs, distributes and licenses casual sneakers, apparel and accessories under the Converse, Chuck Taylor, All Star, One Star, Star Chevron and Jack Purcell trademarks. Operating results of the Converse brand are reported on a stand-alone basis. In addition to the products we sell to our wholesale customers and directly to consumers through our NIKE Direct operations, we have also entered into license agreements that permit unaffiliated parties to manufacture and sell, using NIKE-owned trademarks, certain apparel, digital devices and applications and other equipment designed for sports activities.""",Retail/Product,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","lately I have been trying to learn more about my uncles heart disease issues. Can you tell me what the article says about hypertension? Make it 380-400 words without referencing what it is caused by, or vitamin D","In recent years, researchers and public health programs and practices have focused on preventing, managing, and controlling traditional CVD risk factors by instituting timely intervention programs, identifying social determinants of health (SDOH), examining disparities in CVD risks, assessing the COVID-19 pandemic’s impact on CVD risks, and implementing collective efforts through community-based approaches to achieve population-level improvements in cardiovascular health. This special PCD collection of 20 articles published from January 2020 through November 2022 highlights some of these efforts by using multiple data sources collected before or during the pandemic. For instance, cigarette smoking and risk-enhancing factors related to pregnancy have been shown to increase CVD risks with significant implications (eg, increased infant mortality). Disparities in hypertension, stroke, and stroke mortality exist, exhibiting significant sociodemographic (eg, racial) and geographic (eg, rural–urban, county, zip code) variations. Intervention programs, such as behavioral modifications strengthening chronic disease awareness, use of self-measured blood pressure monitoring, and sodium intake reduction, are evaluated. The impact of COVID-19 on CVD is also explored. Finally, systematic reviews and meta-analyses evaluated the associations of circulating vitamin D levels, vitamin D supplementation, or high-density lipoprotein cholesterol (HDL-C) with blood pressure or stroke. These 20 articles advance our understanding of effective CVD risk management and intervention programs in multiple settings — in the general population and among high-risk groups — with a health equity lens across 3 broad themes further explored in this essay: Examining factors contributing to CVD risk Exploring factors contributing to disparities in CVD Using community-based approaches to decrease CVDExamining the Factors Contributing to CVD Risk The greatest contributors to CVD-related years of life lost globally are tobacco exposure, hypertension, high body mass index (BMI), and high fasting plasma glucose (3). Tobacco exposure, including cigarette smoking, secondhand smoke, and use of smokeless tobacco, contributed to 8.7 million deaths worldwide in 2019, one-third of which were due to CVD (3). Hypertension affects more than 4 billion people worldwide, representing a near doubling in the absolute prevalence of hypertension since 1990 (3). In the US, nearly half of adults (47%) have hypertension, but only about 1 in 4 (24%) have their condition under control (7). Elevated BMI continues to increase globally, with significant effects on death, disability, and quality of life (3). The prevalence of obesity has increased worldwide in the past 50 years, reaching pandemic levels. Obesity represents a major health challenge because it substantially increases the risk of diseases such as hypertension, myocardial infarction, stroke, type 2 diabetes, and dementia, thereby contributing to a decline in both quality of life and life expectancy (8). Furthermore, global increases in high fasting plasma glucose and its sequelae, type 2 diabetes, have mirrored the increases seen in BMI over the past 3 decades (9). Other behavioral risks (eg, unhealthy diet, physical inactivity, inadequate sleep, excessive alcohol use); environmental risks (eg, air pollution, extreme temperatures); and social risks (eg, house and food insecurity) also contribute to increased CVD burden and disparities in cardiovascular morbidity and mortality (10) Several of the contextual risk factors attributed to increased CVD burden are covered in this special collection. Cigarette smoking persists among adults with chronic disease. Using data from the 2019 National Health Interview Survey (NHIS), Loretan and colleagues reported that more than 1 in 4 US adults aged 18 to 64 years with 1 or more chronic diseases associated with smoking were current smokers (11). The current cigarette smoking prevalence in the US reached 51.9% among adults aged 18 to 44 years with 2 or more chronic diseases (11). Furthermore, that study showed that smoking cessation services were not being provided to almost 1 in 3 people who have a chronic disease, leaving important steps to be taken toward successful smoking cessation in this population (11). Also concerning, rates of smoking vary significantly across countries, and approximately 1 billion people smoke globally, with significant negative implications for cardiovascular health (3). Goulding and colleagues used National Health and Nutrition Examination Survey data collected from 2011 through 2018 to provide estimates of the prevalence of high blood pressure among US children aged 8 to 17 years. The authors documented that elevated blood pressure was most prevalent among children who were older, male, or non-Hispanic Black, with factors beyond inequalities in body weight likely contributing to disparities in elevated blood pressure (12). Furthermore, a meta-analysis conducted by Qie and colleagues determined that a high level of HDL-C may provide a protective effect on the risk of total stroke and ischemic stroke but may increase the risk of intracerebral hemorrhage (13). Another meta-analysis by Zhang and colleagues found an L-shaped dose–response relationship between circulating vitamin D levels and the risk of hypertension; however, the pooled results of randomized controlled trials did not show vitamin D supplementation to be effective in preventing hypertension (14). Studies in this collection also identified populations and communities with higher prevalence or at higher risk for CVD. In a cross-sectional study using 2018 NHIS data, Mendez and colleagues documented a higher prevalence of CVD and its risk factors among US adults with vision impairment (15). Salahuddin and colleagues documented zip code variations in infant mortality rates associated with a high prevalence of maternal cardiometabolic high-risk conditions (chronic or gestational diabetes, chronic or gestational hypertension, smoking during pregnancy, and prepregnancy obesity) in 2 counties in Texas (16). Findings from these articles could direct efforts to implement appropriate strategies to prevent, manage, and control CVD in populations at high risk. Top Exploring Factors Contributing to Disparities in CVD CVD and its related risk factors are increasingly recognized as growing indicators of global health disparities (17). Globally, differences in morbidity and mortality from CVD exist among high-, middle-, and low-income countries and across ethnic groups (1,3,5,6,17,18). In the US, disparities in CVD morbidity, mortality, and risk factors have persisted for decades, with concerning stagnation and significant upward trends since the early 2000s (18). Disparities are largely influenced by demographic, socioeconomic, and environmental factors (19,20). For example, African American and American Indian adults experience a higher burden of cardiovascular risk factors and CVD compared with non-Hispanic White adults (18). Unfortunately, structural racism remains a significant cause of poor cardiovascular health, restricting racial and ethnic minority populations from opportunities to live healthier lives, in healthier neighborhoods, and from access to quality education and health care (20).","[question] lately I have been trying to learn more about my uncles heart disease issues. Can you tell me what the article says about hypertension? Make it 380-400 words without referencing what it is caused by, or vitamin D ===================== [text] In recent years, researchers and public health programs and practices have focused on preventing, managing, and controlling traditional CVD risk factors by instituting timely intervention programs, identifying social determinants of health (SDOH), examining disparities in CVD risks, assessing the COVID-19 pandemic’s impact on CVD risks, and implementing collective efforts through community-based approaches to achieve population-level improvements in cardiovascular health. This special PCD collection of 20 articles published from January 2020 through November 2022 highlights some of these efforts by using multiple data sources collected before or during the pandemic. For instance, cigarette smoking and risk-enhancing factors related to pregnancy have been shown to increase CVD risks with significant implications (eg, increased infant mortality). Disparities in hypertension, stroke, and stroke mortality exist, exhibiting significant sociodemographic (eg, racial) and geographic (eg, rural–urban, county, zip code) variations. Intervention programs, such as behavioral modifications strengthening chronic disease awareness, use of self-measured blood pressure monitoring, and sodium intake reduction, are evaluated. The impact of COVID-19 on CVD is also explored. Finally, systematic reviews and meta-analyses evaluated the associations of circulating vitamin D levels, vitamin D supplementation, or high-density lipoprotein cholesterol (HDL-C) with blood pressure or stroke. These 20 articles advance our understanding of effective CVD risk management and intervention programs in multiple settings — in the general population and among high-risk groups — with a health equity lens across 3 broad themes further explored in this essay: Examining factors contributing to CVD risk Exploring factors contributing to disparities in CVD Using community-based approaches to decrease CVDExamining the Factors Contributing to CVD Risk The greatest contributors to CVD-related years of life lost globally are tobacco exposure, hypertension, high body mass index (BMI), and high fasting plasma glucose (3). Tobacco exposure, including cigarette smoking, secondhand smoke, and use of smokeless tobacco, contributed to 8.7 million deaths worldwide in 2019, one-third of which were due to CVD (3). Hypertension affects more than 4 billion people worldwide, representing a near doubling in the absolute prevalence of hypertension since 1990 (3). In the US, nearly half of adults (47%) have hypertension, but only about 1 in 4 (24%) have their condition under control (7). Elevated BMI continues to increase globally, with significant effects on death, disability, and quality of life (3). The prevalence of obesity has increased worldwide in the past 50 years, reaching pandemic levels. Obesity represents a major health challenge because it substantially increases the risk of diseases such as hypertension, myocardial infarction, stroke, type 2 diabetes, and dementia, thereby contributing to a decline in both quality of life and life expectancy (8). Furthermore, global increases in high fasting plasma glucose and its sequelae, type 2 diabetes, have mirrored the increases seen in BMI over the past 3 decades (9). Other behavioral risks (eg, unhealthy diet, physical inactivity, inadequate sleep, excessive alcohol use); environmental risks (eg, air pollution, extreme temperatures); and social risks (eg, house and food insecurity) also contribute to increased CVD burden and disparities in cardiovascular morbidity and mortality (10) Several of the contextual risk factors attributed to increased CVD burden are covered in this special collection. Cigarette smoking persists among adults with chronic disease. Using data from the 2019 National Health Interview Survey (NHIS), Loretan and colleagues reported that more than 1 in 4 US adults aged 18 to 64 years with 1 or more chronic diseases associated with smoking were current smokers (11). The current cigarette smoking prevalence in the US reached 51.9% among adults aged 18 to 44 years with 2 or more chronic diseases (11). Furthermore, that study showed that smoking cessation services were not being provided to almost 1 in 3 people who have a chronic disease, leaving important steps to be taken toward successful smoking cessation in this population (11). Also concerning, rates of smoking vary significantly across countries, and approximately 1 billion people smoke globally, with significant negative implications for cardiovascular health (3). Goulding and colleagues used National Health and Nutrition Examination Survey data collected from 2011 through 2018 to provide estimates of the prevalence of high blood pressure among US children aged 8 to 17 years. The authors documented that elevated blood pressure was most prevalent among children who were older, male, or non-Hispanic Black, with factors beyond inequalities in body weight likely contributing to disparities in elevated blood pressure (12). Furthermore, a meta-analysis conducted by Qie and colleagues determined that a high level of HDL-C may provide a protective effect on the risk of total stroke and ischemic stroke but may increase the risk of intracerebral hemorrhage (13). Another meta-analysis by Zhang and colleagues found an L-shaped dose–response relationship between circulating vitamin D levels and the risk of hypertension; however, the pooled results of randomized controlled trials did not show vitamin D supplementation to be effective in preventing hypertension (14). Studies in this collection also identified populations and communities with higher prevalence or at higher risk for CVD. In a cross-sectional study using 2018 NHIS data, Mendez and colleagues documented a higher prevalence of CVD and its risk factors among US adults with vision impairment (15). Salahuddin and colleagues documented zip code variations in infant mortality rates associated with a high prevalence of maternal cardiometabolic high-risk conditions (chronic or gestational diabetes, chronic or gestational hypertension, smoking during pregnancy, and prepregnancy obesity) in 2 counties in Texas (16). Findings from these articles could direct efforts to implement appropriate strategies to prevent, manage, and control CVD in populations at high risk. Top Exploring Factors Contributing to Disparities in CVD CVD and its related risk factors are increasingly recognized as growing indicators of global health disparities (17). Globally, differences in morbidity and mortality from CVD exist among high-, middle-, and low-income countries and across ethnic groups (1,3,5,6,17,18). In the US, disparities in CVD morbidity, mortality, and risk factors have persisted for decades, with concerning stagnation and significant upward trends since the early 2000s (18). Disparities are largely influenced by demographic, socioeconomic, and environmental factors (19,20). For example, African American and American Indian adults experience a higher burden of cardiovascular risk factors and CVD compared with non-Hispanic White adults (18). Unfortunately, structural racism remains a significant cause of poor cardiovascular health, restricting racial and ethnic minority populations from opportunities to live healthier lives, in healthier neighborhoods, and from access to quality education and health care (20). https://www.cdc.gov/pcd/issues/2022/22_0347.htm ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Find & Summarize,Text Transformation You can only respond with the information in the context block. Please give your response in a simple tone that could be shared with a non-legal audience and easily understood. ,Please summarize the determinations made in the text provided and explain the consequences of the rulings made.,"In the United States Court of Federal Claims No. 13-821 (Filed: 2 January 2024) *************************************** INGHAM REG’L MEDICAL CENTER, * n/k/a MCLAREN GREATER LANSING, * et al., * * Plaintiffs, * * v. * * THE UNITED STATES, * * Defendant. * * Plaintiffs are six hospitals purporting to represent a class of approximately 1,610 hospitals across the United States in a suit requesting, among other things, the Court interpret what the Federal Circuit has deemed an “extremely strange” contract.1 This contract arose when hospitals complained the government underpaid reimbursements for Department of Defense Military Health System, TRICARE, outpatient services rendered between 2003 and 2009. In 2011, after completion of a data analysis, the government voluntarily entered a discretionary payment process contract with plaintiffs and offered net adjusted payments. In November 2022, after nine years of litigation and one Federal Circuit appeal, the Court granted in part and denied in part the government’s Motion for Summary Judgment. As the only surviving breach of contract claims concern the government’s duty to extract, analyze, and adjust line items from its 1 9 June 2022 Oral Arg. Tr. at 161:7–13, ECF No. 259 (“THE COURT: So the Federal Circuit panel, when the case was argued, characterized this agreement as extremely strange. [THE GOVERNMENT]: That is accurate. It is extremely strange. THE COURT: It is extremely strange? [THE GOVERNMENT]: It is.”). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 1 of 23 - 2 - database, the Court required the parties to file a joint status report regarding the effect of summary judgment on plaintiffs’ Renewed Motion to Certify a Class Action. Following a status conference, plaintiffs filed a discovery motion related to class certification. For the following reasons, the Court grants-in-part and denies-in-part plaintiffs’ Motion. I. Background A. Factual and Procedural History2 TRICARE is a “military health care system” which “provides medical and dental care for current and former members of the military and their dependents.” Ingham Reg’l Med. Ctr. v. United States, 874 F.3d 1341, 1342 (Fed. Cir. 2017). TRICARE Management Activity (TMA), a “field office in the Defense Department [(DoD)],” managed the TRICARE system.3 N. Mich. Hosps., Inc. v. Health Net Fed. Servs., LLC, 344 F. App’x 731, 734 (3d Cir. 2009). In 2001, Congress amended the TRICARE statute to require DoD to follow Medicare rules when reimbursing outside healthcare providers. Ingham Reg’l Med. Ctr., 874 F.3d at 1343 (citing 10 U.S.C. § 1079(j)(2) (2002)). To facilitate transition to Medicare rules, in 2005, DoD issued a Final Rule which specified “[f]or most outpatient services, hospitals would receive payments ‘based on the TRICARE-allowable cost method in effect for professional providers or the [Civilian Health and Medical Program of the Uniformed Services] (CHAMPUS) Maximum Allowable Charge (CMAC).’” Id. (quoting TRICARE; Sub-Acute Care Program; Uniform Skilled Nursing Facility Benefit; Home Health Care Benefit; Adopting Medicare Payment Methods for Skilled Nursing Facilities and Home Health Care Providers, 70 Fed. Reg. 61368, 61371 (Oct. 24, 2005) (codified as amended at 32 C.F.R. § 199)). The TRICARE-allowable cost method “applied until 2009, when TRICARE introduced a new payment system for hospital outpatient services that was similar to the Medicare [Outpatient Prospective Payment System (OPPS)].” Id. In response to hospital complaints of payment issues, TRICARE hired Kennell and Associates, a consulting firm, to “undertake a study [(‘Kennell study’)] of the accuracy of its payments to the hospitals.” Ingham Reg’l Med. Ctr., 874 F.3d at 1343–44. The Kennell study “compared CMAC payments to the payments that would have been made using Medicare payment principles, and determined that DoD ‘(1) underpaid hospitals for outpatient radiology but, (2) correctly paid hospitals for all other outpatient services.’” Id. at 1344 (emphasis omitted) (citation omitted). From the Kennell study findings, “DoD created a discretionary payment process [(DPP)],” and, on 25 April 2011, DoD notified hospitals by letter of the process for them to “request a review of their TRICARE reimbursements (the ‘Letter’)” and “published a document titled ‘NOTICE TO HOSPITALS OF POTENTIAL ADJUSTMENT TO PAST PAYMENTS FOR OUTPATIENT RADIOLOGY SERVICES’ (the ‘Notice’)” on the TRICARE website. Id.; App. to Def.’s MSJ at A3–A9, ECF No. 203-1. The Notice described a nine-step methodology to “govern the review of payments for hospital outpatient radiology services and [the] payment 2 The factual and procedural history in this Order contains only those facts pertinent to plaintiffs’ Motion for Discovery, ECF No. 269. 3 The Defense Health Agency now manages activities previously managed by TMA. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 2 of 23 - 3 - of any discretionary net adjustments” by which hospitals could “request an analysis of their claims data for possible discretionary adjustment.” App. to Def.’s MSJ at A7. On 21 October 2013, plaintiffs brought this action claiming the government underpaid them for certain outpatient medical services they provided between 1 August 2003 and 1 May 2009. See Ingham Reg’l Med. Ctr. v United States, 126 Fed. Cl. 1, 9 (2016), aff’d in part, rev’d in part, 874 F.3d 1341 (Fed. Cir. 2017). Plaintiffs allege the approximately six years of underpayment breached two contracts and violated various statutory and regulatory provisions. Id. Plaintiffs estimate several thousand hospitals submitted requests for discretionary payment, including the six named plaintiffs in this case. See id. at 16. Plaintiffs therefore seek to represent a class of as many as 1,610 similarly situated hospitals. See Pls.’ Mem. in Supp. of Mot. to Certify at 1, ECF No. 77; see also Mot. to Certify, ECF No. 76. On 11 February 2020, during the parties’ second discovery period, plaintiffs requested from the government “[a]ny and all data concerning hospital outpatient services claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period . . . .” See App. to Pls.’ Disc. Mot. at 23, ECF No. 269; Gov’t’s Disc. Resp. at 11, ECF No. 270. The government rejected this request for records from “thousands of hospitals . . . that are not [named] plaintiffs” on 16 March 2020 and instead only “produce[d] the data requested for the six plaintiffs in this lawsuit.” App. to Pls.’ Disc. Mot. at 29. Plaintiffs filed a motion to clarify the case schedule or, in the alternative, to compel discovery of “data and documents relating to the [g]overnment’s calculation of payments under the [DPP] for all putative class members, not just the named [p]laintiffs” on 31 July 2020, the last day of discovery. See Pls.’ Mot. to Compel (“Pl.’s MTC”) at 2, ECF No. 161 (emphasis added). In response, the government stated, “[t]here is no basis for the Court to . . . compel extraneous discovery of hospitals that are not now in this lawsuit.” Def.’s Resp. to Pl.’s MTC (“Def.’s MTC Resp.”) at 2, ECF No. 166. During a status conference on 13 October 2020, the parties agreed to table plaintiffs’ discovery request and associated Motion to Compel pending resolution of the government’s then-pending Motion for Reconsideration, ECF No. 150, and any additional potentially dispositive motions. See 13 Oct. 2020 Tr. (“SC Tr.”) at 27:13–28:9, ECF No. 178 (“THE COURT: . . . So to state differently, then, [plaintiffs agree] to stay consideration of this particular [discovery] issue until class certification is decided? [PLAINTIFFS:] Yes, that would be fine. THE COURT: . . . [W]ould the [g]overnment agree with that? [THE GOVERNMENT:] Yes, [y]our [h]onor . . . [but] the [g]overnment still intends to file a motion for summary judgment. . . . THE COURT: Okay. So on the [g]overnment’s motion for summary judgment . . . that should probably not be filed until at least after the motion for reconsideration is resolved? [THE GOVERNMENT:] That’s correct.”). On 5 June 2020, plaintiffs filed a renewed motion to certify a class and appoint class counsel (“Pls.’ Class Cert.”), ECF No. 146, which the parties fully briefed. See Def.’s Class Cert. Resp., ECF No. 207; Pls.’ Class Cert. Reply, EF No. 226. On 26 August 2021, the government filed a motion for summary judgment (“Def.’s MSJ”), ECF No. 203. Plaintiffs filed an opposition to the government’s motion for summary judgment on 4 February 2022 (“Pls.’ MSJ Resp.”), ECF No. 225, and on 11 March 2022, the government filed a reply (“Def.’s MSJ Reply”), ECF No. 234. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 3 of 23 - 4 - “The Court [granted] the government’s [M]otion for [S]ummary [J]udgment as to plaintiffs’ hospital-data duty and mutual mistake of fact claims but [denied] the government’s [M]otion as to plaintiffs’ TMA-data duty and alternate zip code claims[,] . . . [and stayed] the evidentiary motions” on 28 November 2022. Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 428 (2022). The Court, deeming the government’s settlement arrangements with plaintiffs to be contracts (the “DPP Contracts”), specifically found “the DPP Contract[s] only obligated TMA to use its data, not the hospitals’ data,” leaving the government’s data as the only set relevant to this case. Id. at 427. The Court held the government’s (1) “failure to extract thirteen line items [meeting all qualifications for extraction] for Integris Baptist and Integris Bass Baptist”; and (2) failure to adjust “five . . . line items [for Integris Baptist] during the DPP because of an alternate zip code” constituted breach of the DPP Contracts. Id. at 409–10, 412. “Based on the summary judgment holding . . . the Court [found it needed] further information regarding how plaintiffs in this post-summary judgment smaller class would meet the requirements for class certification.” Id. “The Court accordingly decline[d] to rule on plaintiffs’ class certification motion . . . [a]s the only surviving claims are breach of contract for failure to follow the DPP in a few limited circumstances, [and] the parties did not adequately brief the narrower proposed class of plaintiffs arising under the remaining claims.” Id. The Court ordered the parties to file “a joint status report [(JSR)] providing the parties’ views on class certification for the smaller class of plaintiffs affected by the government’s breach of contract for failure to follow the DPP in limited circumstances and on whether further briefing is necessary.” Id. On 28 December 2022, the parties filed a JSR providing their opposing positions on whether plaintiffs can request further discovery related to class certification: “plaintiffs expressly reserve, and do not waive, any rights that they may currently have, or may have in the future, with respect to additional class certification fact or expert discovery”; and “the [g]overnment opposes any further fact or expert discovery in connection with plaintiffs’ amended/supplemental motion for class certification, and, in agreeing to the foregoing briefing schedule, is not agreeing to any further fact or expert discovery in this case.” 28 Dec. 2022 JSR at 2, ECF No. 262. Plaintiffs then filed a motion requesting leave to conduct further discovery and submit a supplemental expert report on 21 March 2023 (“plaintiffs’ Discovery Motion”). Pls.’ Disc. Mot., ECF No. 269. The government filed a response on 21 April 2023. Gov’t’s Disc. Resp. Plaintiffs filed a reply on 9 May 2023. Pls.’ Disc. Reply, ECF No. 271. The Court held oral argument on 19 July 2023. See 5 June 2023 Order, ECF No. 272; 19 July 2023 Oral Arg. Tr. (“Tr.”), ECF No. 276. On 31 August 2023, following oral argument on plaintiffs’ Discovery Motion, the government filed an unopposed motion to stay the case for the government to complete a “second look at the records [analyzed] . . . in the July 2019 expert report of Kennell . . . that were the subject of one of the Court’s liability rulings on summary judgment.” Def.’s Mot. to Stay at 1, ECF No. 277. The Court granted this Motion on the same day. Order, ECF No. 278. On 25 October 2023, the parties filed a JSR, ECF No. 284, in which the government addressed its findings4 and “proposed [a] way forward” in this case. 25 Oct. 2023 JSR at 2. In 4 In the 25 October 2023 JSR, the government explained twelve of the thirteen line items the government failed to extract for Integris Baptist and Integris Bass Baptist, see Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 412 (2022), were missed due to a “now-known” error in which “a very small set of patients comprised of military spouses . . . under age 65” were overlooked because they “receive Medicare Part A” but not Medicare Part B, Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 4 of 23 - 5 - response to the government’s data analysis, plaintiffs noted in the JSR “the [g]overnment’s update makes clear that [additional g]overnment data is required to evaluate which hospitals were affected by the [g]overnment’s breach of the DPP.” Id. at 16. Plaintiffs then likewise “[p]roposed [n]ext [s]teps” in this case, beginning with resolution of their Discovery Motion. Id. at 18. On 19 December 2023, the Court held a telephonic status conference to understand the technical aspects of plaintiffs’ discovery requests as they relate to the DPP process and algorithm. See Scheduling Order, ECF No. 285. B. Discovery Requests at Issue Plaintiffs seek leave to perform additional discovery stemming from the Court’s summary judgment holding “TMA [breached its duty] . . . to extract, analyze, and adjust radiology data from its database” by failing to (1) adjust “five . . . line items [for Integris Baptist] during the DPP because of an alternate zip code” and (2) “extract . . . thirteen line items [meeting the criteria for extraction] for Integris Baptist and Integris Bass Baptist.” Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 409–10, 412. Plaintiffs’ sought-after discovery includes a request for “the same data for the [putative] class hospitals” as plaintiffs currently “have [for the] six named [p]laintiffs,” Tr. at 50:14–19, to assist plaintiffs in identifying “line items in [TMA’s radiology data] . . . that met the [DPP C]ontract criteria but were excluded from the adjustment . . . .” Gov’t’s Disc. Resp. at 15. In all, plaintiffs “seek leave to (1) depose a [g]overnment corporate designee, (2) serve document requests, and (3) thereafter serve a supplemental expert report on the relevant class issues.” Pls.’ Disc. Mot. at 2. Plaintiffs further detail the purpose of each request: First, [p]laintiffs seek leave to depose a [g]overnment corporate designee to identify the various data sources in the [g]overnment’s possession from the relevant time period. Second, [p]laintiffs seek leave to serve . . . document requests to obtain critical data related to each Potential Class member hospital. Third, once the above discovery is completed, [p]laintiffs seek leave to serve a supplemental expert report that applies the DPP methodology to the relevant claims data to identify the Final Class. Id. at 6–7 (footnote omitted) (citations omitted). The second request, mirroring plaintiffs’ February 2020 request for “[a]ny and all data concerning hospital outpatient service claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period,” App. to Pl.’s Disc. Mot. at 23, comprises “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations[;] and (2) all hospital outpatient claims meaning the “outpatient services that these individuals receive are paid for . . . by TRICARE.” 25 Oct. JSR at 4, ECF No. 284. As a result of this Medicare arrangement, line items for this group of patients were not extracted as the individuals were mistakenly deemed Medicare, rather than TRICARE, recipients for procedures within the scope of the DPP. Id. The cause of the thirteenth unextracted line item remains unclear. Id. at 5. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 5 of 23 - 6 - data available for each of the Potential Class member hospitals during the relevant time period.” Pl.’s Disc. Mot. at 8–9. This request includes: (1) CMAC rate files “needed to apply the DPP methodology”; (2) “[d]ata on hospital outpatient radiology services claim line items for each Potential Class member hospital”; (3) “[d]ata concerning hospital outpatient services claim line items for each Potential Class member hospital” to verify the radiology files are complete; and (4) “TRICARE Encounter Data (‘TED’) records and Health Care Service Records (‘HCSR’).” Id. at 9–10. II. Applicable Law This court’s application of the Rules of the United States Court of Federal Claims (“RCFC”) is guided by case law interpreting the Federal Rules of Civil Procedure (FRCP). See RCFC rules committee’s note to 2002 revision (“[I]nterpretation of the court’s rules will be guided by case law and the Advisory Committee Notes that accompany the Federal Rules of Civil Procedure.”). Regarding the scope of discovery, the rules of this court provide: [P]arties may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case, considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to relevant information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the burden or expense of the proposed discovery outweighs its likely benefit. RCFC 26(b)(1). “Questions of the scope and conduct of discovery are . . . committed to the discretion of the trial court.” Florsheim Shoe Co., Div. of Interco, Inc. v. United States, 744 F.2d 787, 797 (Fed. Cir. 1984). The Court of Federal Claims generally “afford[s] a liberal treatment to the rules of discovery.” Securiforce Int’l Am., LLC v. United States, 127 Fed. Cl. 386, 400 (2016), aff’d in part and vacated in part on other grounds, 879 F.3d 1354 (Fed. Cir. 2018), cert. denied, 139 S. Ct. 478 (2018) (mem.). “[T]he [C]ourt must be careful not to deprive a party of discovery that is reasonably necessary to afford a fair opportunity to develop and prepare the case.” Heat & Control, Inc. v. Hester Indus., Inc., 785 F.2d 1017, 1024 (Fed. Cir. 1986) (quoting FED. R. CIV. P. 26(b)(1) advisory committee’s note to 1983 amendment). Further, “[a] trial court ‘has wide discretion in setting the limits of discovery.’” Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)). This court has previously found such “discretion [extends to] . . . deciding whether to grant a motion to . . . reopen discovery.” Croman Corp. v. United States, 94 Fed. Cl. 157, 160 (2010) (citing Te-Moak Bands of W. Shoshone Indians of Nev. v. United States, 948 F.2d 1258, 1260 (Fed. Cir. 1991)); see also Wordtech Sys., Inc. v. Integrated Networks Sols., Inc., 609 F.3d 1308, 1322–23 (Fed. Cir. 2010) (citing Coleman v. Quaker Oats Co., 232 F.3d 1271, 1294 (9th Cir. 2000)) (applying Ninth Circuit law in determining trial court did not abuse its discretion in refusing to reopen discovery). Notwithstanding, modification of a court-imposed schedule, including a discovery schedule, may be done “only for good cause and with the judge’s consent.” RCFC 16(b)(4). In Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 6 of 23 - 7 - High Point Design, the Federal Circuit applied Second Circuit law5 when discussing the good cause standard of FRCP 16(b)(4) for amending a case schedule. “When assessing whether good cause has been shown, ‘the primary consideration is whether the moving party can demonstrate diligence.’” High Point Design LLC v. Buyers Direct, Inc., 730 F.3d 1301, 1319 (Fed. Cir. 2013) (quoting Kassner v. 2nd Ave. Delicatessen, Inc., 496 F.3d 229, 244 (2d Cir. 2007)); see also Adv. Software Design Corp. v. Fiserv, Inc., 641 F.3d 1368, 1381 (Fed. Cir. 2011) (“Under the good cause standard, the threshold inquiry is whether the movant has been diligent.” (citing Sherman v. Winco Fireworks, Inc., 532 F.3d 709, 717 (8th Cir. 2008))). This “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc. v. Metal-Lite, Inc., 304 F.3d 1256, 1270 (Fed. Cir. 2002) (applying Ninth Circuit law in finding defendant’s attempt to amend the pleadings first required modification of the scheduling order under FRCP 16(b)(4)). Trial courts may also consider “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). Prejudice related to the reopening of discovery may involve the delay of proceedings. Wordtech Sys., 609 F.3d at 1322 (“[A] need to reopen discovery and therefore delay the proceedings supports a district court’s finding of prejudice from a delayed motion to amend the complaint.” (quoting Lockheed Martin Corp. v. Network Sols., Inc., 194 F.3d 980, 986 (9th Cir. 1999))). III. Parties’ Arguments Plaintiffs contend “good cause exists for [p]laintiffs to conduct . . . additional limited discovery,” Pls.’ Disc. Mot. at 7–8 (citing Geneva Pharms. Tech. Corp. v. Barr Lab’ys, Inc., Nos. 98 Civ. 861, 99 Civ. 3687, 2005 WL 2132438, at *5 (S.D.N.Y. Sept. 6, 2005)), largely mirroring their “live and pending request for discovery [from February 2020] that[ ha]s been tabled” since October 2020, Tr. at 37:16–17; see SC Tr. at 27:13–23. Specifically, plaintiffs argue, “[t]he Court’s ruling on the [g]overnment’s Summary Judgment Motion is a material event that has fundamentally altered the scope of this case.” Pl.’s Disc. Mot. at 7–8 (citing Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 428 (2022) (“[T]he parties did not adequately brief the narrower proposed class of plaintiffs arising under the remaining claims.”)). Plaintiffs state the requested “discovery will allow them to provide the Court with the information required for the determination of the Final Class, and that this will greatly assist the Court with its ruling on class certification.” Id. at 10. At oral argument, the government acknowledged “[p]laintiffs[’] [2020] request [for] all class hospital data” concerned much of the same information plaintiffs are “asking for now.” Tr. at 103:7–17. The government, however, maintains “plaintiffs’ motion to reopen fact and expert discovery should be denied.” Gov’t’s Disc. Resp. at 17. Specifically, the government argues plaintiffs “filed this case, moved for class certification twice, and proceeded through two full rounds of fact and expert discovery, based upon . . . [p]laintiffs’ view of the law.” Id. at 16. The 5 RCFC 16(b)(4) is identical to the corresponding Rule 16(b)(4) of the Federal Rules of Civil Procedure. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 7 of 23 - 8 - government therefore argues plaintiffs should not be permitted to “reopen fact and expert discovery” simply because “on summary judgment,” the “legal theories that animated plaintiffs’ [previous] discovery and expert reports have been shown . . . to be . . . wrong.” Id. at 16–17. The government argues “[a] party’s realization that it elected to pursue the wrong litigation strategy is not good cause for amending a schedule,” so plaintiffs have failed to show good cause to reopen discovery as they request. Gov’t’s Disc. Resp. at 17 (quoting Sys. Fuels, Inc. v. United States, 111 Fed. Cl. 381, 383 (2013)). Alluding to the standard for reopening discovery, the government argues “no actions by plaintiffs . . . even remotely approximate the showing of diligence required under RCFC 16 . . . .” Id. at 35. The government also argues plaintiffs’ requests “overwhelming[ly] and incurabl[y] prejudice . . . the [g]overnment.” Id. at 38. IV. Whether Good Cause Exists to Reopen Discovery As noted supra Section III, plaintiffs contend “good cause exists for [p]laintiffs to conduct . . . additional limited discovery,” Pls.’ Disc. Mot. at 7–8 (citing Geneva Pharms. Tech. Corp. v. Barr Lab’ys, Inc., Nos. 98 Civ. 861, 99 Civ. 3687, 2005 WL 2132438, at *5 (S.D.N.Y. Sept. 6, 2005)), largely mirroring their “live and pending request for discovery [from February 2020] that[ ha]s been tabled” since October 2020, when the parties agreed to first proceed with the government’s Motion for Reconsideration and Motion for Summary Judgment. Tr. at 37:16– 17; see SC Tr. at 27:13–23. Plaintiffs believe the requested “discovery will allow them to provide the Court with the information required for the determination of the Final Class, and that this will greatly assist the Court with its ruling on class certification.” Pl.’s Disc. Mot. at 10. In contrast, the government asserts plaintiffs have, in two previous rounds of discovery and in their summary judgment briefing, chosen to pursue a litigation strategy based on a class damages model relying on hospital and government data and cannot now justify reopening discovery because they need to change tactics following the Court’s summary judgment ruling limiting the scope of this case to the government’s data. See Gov’t’s Disc. Resp. at 22–23. Specifically, the government contends plaintiffs have neither made the required showing of diligence during past discovery periods to justify modifying the Court’s discovery schedule nor adequately refuted the government’s claim this discovery is prejudicial. See Gov’t’s Disc. Resp. at 28, 35. “A trial court ‘has wide discretion in setting the limits of discovery.’” Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)). This court has previously found such “discretion [is applicable] in deciding whether to grant a motion to . . . reopen discovery.” Croman Corp. v. United States, 94 Fed. Cl. 157, 160 (2010) (citing Te-Moak Bands of W. Shoshone Indians of Nev. v. United States, 948 F.2d 1258, 1260 (Fed. Cir. 1991)). RCFC 16(b)(4) permits modification of a court-imposed schedule, such as to re-open discovery, “only for good cause and with the judge’s consent.”6 Good cause “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc. v. Metal-Lite, Inc., 304 F.3d 1256, 1270 (Fed. Cir. 2002) (applying Ninth Circuit law in finding defendant’s attempt to amend the 6 At oral argument, the parties agreed plaintiffs are requesting the Court reopen discovery, meaning this good cause standard applies. Tr. 99:14–19: “[PLAINTIFFS:] I think, as between [supplementation and reopening], th[ese requests] probably fit[] better in the reopening category as between those two . . . . THE COURT: So . . . the standard for reopening is good cause? [PLAINTIFFS:] Yes. THE COURT: [The government], [do] you agree? [THE GOVERNMENT:] I agree.” Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 8 of 23 - 9 - pleadings first required modification of the scheduling order under FRCP 16(b)(4)). Likewise, in determining whether good cause exists to reopen discovery, a trial court may consider “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design LLC v. Buyers Direct, Inc., 730 F.3d 1301, 1319 (Fed. Cir. 2013) (quoting Kassner v. 2nd Ave. Delicatessen, Inc., 496 F.3d 229, 244 (2d Cir. 2007)). The Court accordingly must determine whether good cause exists to reopen discovery as requested by plaintiffs by analyzing plaintiffs’ diligence and whether the requested discovery prejudices the government. The Court begins with plaintiffs’ document requests. A. Document Requests Plaintiffs request the government turn over “critical data related to each Potential Class member hospital” and argue “denying ‘precertification discovery where it is necessary to determine the existence of a class is an abuse of discretion.’” Pls.’ Disc. Mot. at 6–7; Pls.’ Disc. Reply at 2 (quoting Perez v. Safelite Grp. Inc., 553 F. App’x 667, 669 (9th Cir. 2014)). These document requests specifically target “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations, and (2) all hospital outpatient claims data available for each of the Potential Class member hospitals during the relevant time period.” Pls.’ Disc. Mot. at 8–9. Plaintiffs’ goal is to acquire all “radiology line item[]” data and other information necessary to “apply the DPP methodology” to all of the putative class members’ claims data from the DPP period. Id. at 9. Plaintiffs contend “good cause exists” for the Court to reopen discovery with respect to these documents because the “Court’s ruling on the [g]overnment’s Summary Judgment Motion is a material event that . . . fundamentally altered the scope of this case.” Id. at 8. Namely, plaintiffs’ “damages are now limited to those claims involving errors in the [g]overnment’s data,” so plaintiffs allege this data, which “by its very nature [is] exclusively in [the government’s] possession,” is necessary “to identify the class members.” Pls.’ Disc. Reply at 3; see Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 427–29 (2022). Further, plaintiffs believe reopening discovery for this request is appropriate because in February 2020, during discovery, plaintiffs served a request for production on the government for the same “data concerning hospital outpatient services, claims, and . . . reimbursement for all class hospitals.” Tr. at 41:5–11. Plaintiffs likewise moved to compel this discovery in July 2020. Pls.’ Disc. Reply at 4 (“Plaintiffs also later moved for an order to conduct class discovery or for the [g]overnment to alternatively produce documents for all hospitals.”). Plaintiffs argue tabling this request and motion at the end of October 2020 while the case “proceeded with reconsideration, summary judgment, and other procedural” items did not do away with their “live and pending request for [this] discovery.” Tr. at 41:16–17, 37:14– 25, 128:5–6. With respect to prejudice, plaintiffs clarify their requests “will not prejudice the” government primarily because “the benefit to this case from the discovery would significantly outweigh any burden,” Pls.’ Disc. Reply at 8–9 (first citing Davita HealthCare Partners, Inc. v. United States, 125 Fed. Cl. 394, 402 n.6 (2016); and then citing Kennedy Heights Apartments Ltd. I v. United States, 2005 WL 6112633, at *4 (Fed. Cl. Apr. 26, 2005)), as this discovery will “assist the court with its ruling on class certification.” Pls.’ Disc. Mot. at 9–10. Further, plaintiffs contend any prejudice could be cured at trial by cross-examination of plaintiffs’ expert, who will use this data in a future supplemental report. Pls.’ Disc. Reply at 10 (citing Panasonic Commc’ns Corp. of Am. v. United States, 108 Fed. Cl. 412, 416 (2013)). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 9 of 23 - 10 - The government argues good cause does not exist to reopen discovery as requested by plaintiffs. With respect to diligence, the government first asserts plaintiffs’ 31 July 2020 Motion regarding class discovery was not diligent because it was filed on the last day of the discovery period. Gov’t’s Disc. Resp. at 33–34. Next, the government argues “[p]laintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment . . . the proposed discovery requests . . . because it obviously was not.” Id. at 28 (citation omitted). Rather, per the government, “plaintiffs disregarded, rather than responding to, evidence, analysis, and law that was inconsistent with their theories of the case, even when the [g]overnment brought such issues to the fore.” Id. at 30. The government argues “plaintiffs ignored these issues at their peril throughout the entire second period of fact and expert discovery that followed, and that means that they were not diligent under the law” and are not now entitled to discovery to assist them in changing their theory of the case. Id. at 31–32. Concerning prejudice, the government argues “plaintiffs are proposing fact discovery on a scale never before undertaken in this case, a new expert report for the [g]overnment to then respond to, more expert depositions, and, no doubt, additional Daubert and class-related motions practice, resulting in substantial delay in bringing this matter to resolution.” Id. at 36 (footnote omitted). “Permitting plaintiffs to now evade a long overdue reckoning, and attempt to moot [the government’s motions to exclude plaintiffs’ expert reports], in addition to being completely contrary to law, [according to the government,] deprives the [g]overnment of its day in court for what should be an imminent resolution of this matter.” Id. 1. Diligence A finding of diligence sufficient to modify a case schedule “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc., 304 F.3d at 1270 (applying Ninth Circuit law in finding defendant’s attempt to amend the pleadings first required modification of the scheduling order under FRCP 16(b)(4)). On 11 February 2020, at the very early stages of the “re-opened period of fact discovery,” plaintiffs “served the [g]overnment with additional document requests,” including a request for “[a]ny and all data concerning hospital outpatient services claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period . . . .” Gov’t’s Disc. Resp. at 11 (citations omitted); see also App. to Pls.’ Disc. Mot. at 23. At the time, the government “objected to this request” and only “produce[d] the data requested for the six [named] plaintiffs.” Id. at 11–12 (citations omitted). Over the next several months, the parties continued with fact and expert discovery, during which time the Court “established a schedule for briefing on class certification and summary judgment.” Id. at 13 (citing Order at 2, ECF No. 143). On 31 July 2020, “the date . . . both fact and expert discovery closed, plaintiffs filed a motion . . . [to] compel[] the [g]overnment to produce documents for all hospitals, rather than for just the six representative plaintiffs.” Id. at 14. Plaintiffs therefore requested the data at issue in this document request at least twice before the instant Motion—once on 11 February 2020 and again on 31 July 2020. Tr. at 81:10–11 (“[PLAINTIFFS:] [W]e did ask for all of those things that [the government is] talking about [before we t]abled the issues . . . .”). They thus argue they “meet [the] diligence [standard] here because [they] asked for” this information “a long time ago” and continued to believe it “was a live and open issue.” Tr. at 128:5–6; Tr. at 104:25–105:9 (“[PLAINTIFFS:] We served the discovery request in the discovery period. We got objections from the [g]overnment. We conferred several times with [the government] about this to figure Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 10 of 23 - 11 - out what we are doing here . . . . We then had the conference with the Court because we had filed our motion [to compel] and the [g]overnment fought to arrange things in the way they arranged. So we walked away from that believing this [discovery] was a live and open issue.”); see 28 Dec. 2022 JSR at 2. The government’s first diligence argument, as noted supra Section IV.A, is plaintiffs filed their Motion to Compel on the final day of discovery and thus did not diligently pursue this request. Gov’t’s Disc. Resp. at 33–34; Tr. at 84:21–23 (“[THE GOVERNMENT:] [Plaintiffs] did nothing between March and July. There was no agreement to table during that four-month period. And then in July, they filed a motion [to compel.]”). Despite the already pending 11 February 2020 “request for all class hospital data,” the government contends plaintiffs “should have filed more motions to compel” earlier in the discovery period. Tr. at 85:4–10; Tr. at 107:2– 5 (“[PLAINTIFFS:] [The government is saying] we raised [these discovery issues] too long ago and didn’t come back often enough.”). To the extent the government alleges “filing a motion to compel on the very last day of discovery is . . . untimely, not diligent,” however, the government overlooks the significance of plaintiffs’ timely February 2020 request. See Gov’t’s Disc. Resp. at 34. Plaintiffs did not first make this request the day discovery closed; they asked the government to produce these documents early in the discovery period. Pls.’ Disc. Mot. at 4–5. Plaintiffs then “conferred several times with” the government and waited to see whether the government’s production would be sufficiently responsive to their February 2020 request despite the government’s objection. Tr. at 104:24–105:6 (“[PLAINTIFFS]: We served the discovery request in the discovery period. We got objections from the [g]overnment. We conferred several times with [the government] about this . . . We then . . . filed our motion. . . .”). Thus, only when it became clear the government was not going to produce plaintiffs’ requested information or any comparable data in the final days of the discovery period did plaintiffs file a motion to compel. Id. Further, the government’s cited cases for the proposition motions filed at the end of discovery are untimely are from out-of-circuit district courts and contain factual situations inapposite to this case. See Gov’t’s Disc. Resp. at 34 (first citing Rainbow Energy Mktg. Corp. v. DC Transco, LLC, No. 21-CV-313, 2022 WL 17365260, at *2 (W.D. Tex. Dec. 1, 2022) (denying a renewed motion to compel after: (1) the plaintiff’s initial motion was denied, (2) the plaintiff filed a motion to extend discovery after the period had closed, and (3) the plaintiff filed a renewed motion to compel on the last day of extended discovery); then citing U.S. ex rel. Gohil v. Sanofi U.S. Servs., Inc., No. 02-2964, 2020 WL 1888966, at *4 (E.D. Pa. Apr. 16, 2020) (rejecting a motion to compel in part because the requesting party made a “misrepresentation that it did not know” the importance of the information until just before the close of discovery); then citing Summy-Long v. Pa. State Univ., No. 06–cv–1117, 2015 WL 5924505, at *2, *5 (M.D. Pa. Oct. 9. 2015) (denying the plaintiff’s motion to compel “because [her] request [wa]s overly broad and unduly burdensome and because granting further discovery extensions . . . would strain the bounds of reasonableness and fairness to all litigants”); then citing In re Sulfuric Acid Antitrust Litig., 231 F.R.D. 331, 332–33, 337 (N.D. Ill. 2005) (acknowledging there is “great[] uncertainty” as to whether courts should deny motions to compel filed “very close to the discovery cut-off date” and recognizing “the matter is [generally] left to the broad discretion” of the trial court “to control discovery”); then citing Toone v. Fed. Express Corp., No. Civ. A. 96-2450, 1997 WL 446257, at *8 (D.D.C. July 30, 1997) (denying the plaintiff’s motion to compel filed on the last day of discovery because (1) given the close proximity to the original date for trial, “the defendant could have responded to the request . . . on Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 11 of 23 - 12 - the day of the original trial date,” and (2) it was moot); and then citing Babcock v. CAE-Link Corp., 878 F. Supp. 377, 387 (N.D.N.Y. 1995) (denying a motion to compel regarding discovery requests served on the last day of discovery). The Court therefore is not persuaded plaintiffs’ Motion to Compel was untimely. Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197). The government further contends “[p]laintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment” this “proposed discovery request[].” Def.’s Disc. Resp. at 28. The government argues plaintiffs’ “tunnel vision” with respect to their legal theory caused plaintiffs to ignore “evidence, analysis, and law” not directly consistent with “their theories of the case, even when the [g]overnment brought such issues to the fore.” Id. at 29–30. “Turning a blind eye . . . [due to] legal error is not the same thing as having the inability to meet court deadlines,” according to the government, so “plaintiffs cannot demonstrate the requisite diligence.” Id. at 30. Although plaintiffs did not file “more motions to compel,” plaintiffs timely made their February 2020 request and timely filed their July 2020 Motion to Compel, supra. See Tr. at 85:4–9. To the extent the government alleges plaintiffs are not entitled to reopen discovery to amend their litigation strategy because the government “unmasked on summary judgment” plaintiffs’ “legal errors,” the government overlooks its own admission at oral argument, “[p]laintiffs’ request[s] [for] all class hospital data” in February and July 2020 sought the same data “[plaintiffs a]re asking for now.” Tr. 103:7–17; Def.’s Disc. Resp. at 28. Contrary to the government’s argument, plaintiffs therefore did not have “tunnel vision” causing them to ignore the requested evidence earlier in this litigation. See Def.’s Disc. Resp. at 28–30. Rather, plaintiffs requested this data during the appropriate discovery periods, only to have their request put on hold “because the [g]overnment ha[d] additional motions” it wished the Court to first decide. See Tr. at 85:12–21 (the court); Pls.’ Disc. Mot. at 4; App. to Pl.’s Disc. Mot. at 23; Tr. at 105:5–9; Def.’s Disc. Resp. at 14 (“Ultimately, the issues raised by this motion [to compel] were tabled by agreement of the parties.”); Tr. at 55:5–6 (“[PLAINTIFFS:] [T]he [g]overnment fought tooth and nail [to have the Court] hear [their] summary judgment motion first.”). Plaintiffs have thus considered these requests “a live and open issue” pending resolution of the government’s motions ever since, prompting them to file the instant Motion upon the Court issuing its Summary Judgment Order in November 2022. Tr. at 105:8–9 (“[PLAINTIFFS:] [W]e walked away from that [tabling discussion] believing this [discovery] was a live and open issue.”). Finally, while this “data [may] not [have been] necessary for summary judgment . . . [it is] for class certification.”7 Tr. at 111:10–11 (plaintiffs); Clippinger v. State Farm Mut. Auto. Ins. Co., 2021 WL 1894821, at *2 (“[C]lass certification discovery is not relevant [at the summary judgment stage].”); Tr. at 111:8–11 (“[PLAINTIFFS]: Well, I think like in Clippinger, there is some wisdom to the concept that maybe all of that data is not necessary for summary judgment, but then becomes necessary for class certification.”). To that end, the government 7 To the extent the government relies on plaintiffs’ 13 April 2020 statement plaintiffs “will not need this information [pertaining to hospitals other than the six named plaintiffs] prior to resolving [p]laintiffs’ [M]otion for [C]lass [C]ertification,” the government overlooks the substantial change in circumstances discussed infra Section IV.B.1. See Def.’s Disc. Resp. at 12–13 (quoting 21 May 2020 JSR at 3–4, ECF No. 140). The government likewise ignores plaintiffs’ agreement to table these discovery requests temporarily in October 2020, at which time plaintiffs acknowledged they would eventually re-raise these requests, even if—at the time—the plan was to do so after class certification. See Tr. at 85:12–21, 55:5–6. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 12 of 23 - 13 - cannot “object[] to [plaintiffs’ document] request” in 2020 as “irrelevant and not proportional to the needs of the case insofar as plaintiffs seek . . . [information from] thousands of hospitals” only to now argue it is too late for this discovery and “plaintiffs [have] squandered . . . their allotted discovery periods . . . .” Gov’t’s Disc. Resp. at 11, 28; Tr. at 106:7–14 (“[PLAINTIFFS:] [I]t’s almost like the [g]overnment—they’re playing gotcha here. . . . [T]hey didn’t want to give us the information at the time [of discovery] and then they say, well, here’s summary judgment first and we can defer this until later . . . and now we’ve got a summary judgment opinion and now [they] say gotcha . . . .”). Nor can the government object to turning over the requested data in 2020 and now only to “use [plaintiffs’] lack of this data as a sword” come class certification. Tr. at 126:23–127:2. Indeed, “this has never been a case where” plaintiffs “said we’re not going to look at that [requested] data . . . [or] we’re not eventually going to be coming for that.” Tr. at 126:18–20. To the contrary, plaintiffs “requested this [data] during discovery,” and have long maintained this discovery “is the way to” “figure out . . . what are we dealing with” from a class perspective, including in the JSR filed after the Court’s November 2022 Summary Judgment Order, in which plaintiffs reserved the right to move for “additional class certification fact or expert discovery.” Tr. at 44:10, 56:21–22; 28 Dec. 2022 JSR at 2. By way of the government’s objection to plaintiffs’ February 2020 request and the parties’ tabling this request in October 2020, plaintiffs “even with the exercise of due diligence[,]” could not have obtained the requested information in a way sufficient to “meet the [Court’s discovery] timetable.” Slip Track Sys., Inc., 304 F.3d at 1270. Had they “received the data in 2020,” they “would have . . . run the DPP” for all potential class members as plaintiffs now request the opportunity to. Tr. at 113:12–15. Instead, plaintiffs did not have access to the data so continued to raise this request at all reasonably appropriate times. See Tr. at 112:8–9 (“[PLAINTIFFS:] [I]t was not possible for us to have done this [DPP] calculation without th[is] data.”). The Court accordingly finds plaintiffs were sufficiently diligent to justify a finding of good cause to reopen fact discovery as to plaintiffs’ document request for “critical data related to each Potential Class member hospital,” Pls.’ Disc. Mot. at 6. Slip Track Sys., Inc., 304 F.2d at 1270. 2. Prejudice In considering whether to reopen discovery, a trial court may consider, in addition to the requesting party’s diligence, “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244). Prejudice related to the reopening of discovery may involve the delay of proceedings. Wordtech Sys., Inc. v. Integrated Networks Sols., Inc., 609 F.3d 1308, 1322 (Fed. Cir. 2010) (“[A] need to reopen discovery and therefore delay the proceedings supports a district court’s finding of prejudice from a delayed motion to amend the complaint.” (quoting Lockheed Martin Corp. v. Network Sols., Inc., 194 F.3d 980, 986 (9th Cir. 1999))). Further, RCFC 26(b)(1) provides: [P]arties may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case, considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to relevant information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 13 of 23 - 14 - burden or expense of the proposed discovery outweighs its likely benefit. RCFC 26(b)(1). “Questions of the scope and conduct of discovery are . . . committed to the discretion of the trial court.” Florsheim Shoe Co., Div. of Interco, Inc. v. United States, 744 F.2d 787, 797 (Fed. Cir. 1984). The government contends reopening discovery is prejudicial because “plaintiffs are proposing fact discovery on a scale never before undertaken in this case, a new expert report for the [g]overnment to then respond to, more expert depositions, and, no doubt, additional Daubert and class-related motions practice, resulting in substantial delay in bringing this matter to resolution.” Gov’t’s Disc. Resp. at 35–36 (footnote omitted). Plaintiffs, on the other hand, argue: (1) the sought after data “is . . . exclusively in [the government’s] possession”; and (2) their request will not prejudice the government because it will have an opportunity to oppose plaintiffs’ expert report. Pls.’ Disc. Reply at 3, 8. Even if there is any prejudice to the government, plaintiffs assert “the benefit to this case from the discovery would significantly outweigh any burden to the parties,” id. at 9, because of the assistance the discovery would provide the Court in ruling on class certification of the “narrower proposed class of plaintiffs,” Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428, left after summary judgment. Id. at 5, 9–10 (first citing Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428; and then citing Alta Wind I Owner Lessor C v. United States, 154 Fed. Cl. 204, 217 (2021)). Indeed, plaintiffs argue “produc[ing] the data . . . [now will be] more efficient [than production after certification] [a]s there will be less hypothetical back-and-forth between the parties [during certification briefing]” if the government’s data is available to all sides. Tr. at 118:2–6. Any prejudice could also be cured at trial by cross-examination of plaintiffs’ expert, plaintiffs contend. Pls.’ Disc. Reply at 10. The Court’s Summary Judgment Order indicated “the Court . . . needs further information regarding how plaintiffs in this post-summary judgment smaller class would meet the requirements for class certification” before deciding plaintiffs’ motion for class certification. Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428. To that end, mirroring their requests during the 2020 discovery period, plaintiffs ask the government to provide “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations, and (2) all hospital outpatient claims data available for each of the Potential Class member hospitals during the relevant time period.” Pls.’ Disc. Mot. at 8–9 (emphasis added). Plaintiffs argue this discovery will “benefit . . . this case” by providing the radiology data needed to determine “who is in the [now-narrowed] class.” Pls.’ Disc. Reply at 2, 9 (“Plaintiffs’ damages are now limited to those claims involving errors in the [g]overnment’s data”); Tr. at 57:1. The government has not refuted this claim. Tr. at 132:16–25 (“THE COURT: Just to make sure I understand, can you just quickly articulate the prejudice to the [g]overnment [from the Motion to Compel the data]? . . . [THE GOVERNMENT:] The [prejudice from the] [M]otion to [C]ompel is a significant reasonableness and proportionality concern . . . .”); Tr. at 56:18–57:14 (“[PLAINTIFFS:] [W]e really followed the Court’s lead, looking at the summary judgment opinion saying . . . go back and figure out now what we are dealing with . . . [with respect to] who is in the class . . . only on the [g]overnment’s [data] . . . . [THE GOVERNMENT:] I firmly disagree with that [procedural move]. I think that [p]laintiffs are trying to jump their original expert report . . . [a]nd under the law, [they] can’t.”). Rather, the government’s primary prejudice-related allegation is plaintiffs’ request violates the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 14 of 23 - 15 - “[r]easonableness and proportionality” tenants set forth in RCFC 26(b)(1) because “[t]he [g]overnment has already incurred substantial expense,” Def.’s Disc. Resp. at 36, and plaintiffs have “not established a right to discovery of [non-named plaintiff] hospitals . . . based on what they have shown.” Tr. at 130:10–14. As the Court noted above, the government cannot argue plaintiffs’ document discovery request was too early before summary judgment and too late now that the government has incurred greater expense in litigating this case. See supra Section IV.A.1. Neither party knew the substantial impact summary judgment would have on the trajectory of this case, but the parties agreed to table plaintiffs’ discovery requests until after the Court’s summary judgment decision. See Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 395; SC Tr. at 27:13–23. As evidenced by the recent data analysis performed by the government, after summary judgment, “[g]overnment data is required to evaluate which hospitals were affected by the [g]overnment’s breach of” contract. 25 Oct. 2023 JSR at 16. Plaintiffs cannot be expected to argue, and the Court cannot “rule on[,] numerosity [and related class certification factors] if there[ i]s no evidence regarding the approximate number of hospitals who would fit the . . . requirements allowed in the summary judgment order.” Tr. at 108:6–11. The parties must both have an opportunity to review the relevant data held by the government to determine which hospitals should, or should not, be included in the putative class.8 See id. The requested data, which includes the pertinent “outpatient claims data” and the information “used in the DPP calculations,” Pls.’ Disc. Mot. at 8–9, is therefore highly relevant to the next step in this case— class certification—and, rather than delay this case, having this data will enable the Court to decide plaintiffs’ motion for class certification more efficiently. Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”). To the extent the government argues the scale of the information requested is “grossly disproportionate to the needs of the case,” Tr. at 110:22, the government ignores: (1) plaintiffs’ and the Court’s substantial need to understand “who would be in the class” come time to brief and rule on class certification, Tr. at 55:24–25; and (2) the inability of plaintiffs and the Court to access this data “exclusively in [the government’s] possession” without production by the government, Pls.’ Disc. Reply at 3. See Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399; RCFC 26(b)(1) (“[P]arties may obtain discovery regarding any nonprivileged matter that is relevant . . . and proportional . . . [considering] the parties’ relative access to [the] relevant information . . . .” (emphasis added)). The government likewise overlooks its ability to rebut any arguments plaintiffs make using this data both before and at trial. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The documents plaintiffs request are therefore highly relevant and proportional to the needs of the case as they will provide plaintiffs and the Court 8 This is not a case where, as the government alleges, plaintiffs are “attempt[ing] to use discovery to find new clients upon learning of infirmities in the claims of putative class representatives.” Def.’s Disc. Resp. at 26–27 (first citing In re Williams-Sonoma, Inc., 947 F.3d 533, 540 (9th Cir. 2020); then citing Gawry v. Countrywide Home Loans, Inc., 395 F. App’x 152, 160 (6th Cir. 2010); Douglas v. Talk Am., Inc., 266 F.R.D. 464, 467 (C.D. Cal. 2010); Falcon v. Phillips Elec. N. Am. Corp., 304 F. App’x 896, 898 (2d Cir. 2008)). Rather, plaintiffs are requesting access to information held by the government to adequately brief class certification on behalf of the existing named plaintiffs and the putative class. See Pls.’ Disc. Mot. at 2 (“After completion of this discovery, [p]laintiffs would then file an amended motion for class certification.”). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 15 of 23 - 16 - information necessary for a thorough analysis of class certification. Florsheim Shoe Co., Div. of Interco, Inc., 744 F.2d at 797; Davita HealthCare Partners, 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”); RCFC 26(b)(1). The Court accordingly finds any prejudice to the government caused by the scope of plaintiffs’ document request is mitigated by the benefit of the requested information to the efficient resolution of this case.9 See High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); Tr. at 118:2–6. The government will have ample opportunity to oppose any supplemental expert reports presented by plaintiffs using the requested data, including through cross-examination of plaintiffs’ experts at trial. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The Court therefore finds plaintiffs were diligent in pursuing this document discovery request and the government will not experience prejudice sufficient to warrant denying plaintiffs’ Motion as to the request. The Court accordingly grants plaintiffs’ document discovery request as tailored, infra Section V, to the liability found in the Court’s November 2022 Summary Judgment Order, as there is good cause to do so. See High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”); Pls.’ Disc. Mot. at 8–9. B. Plaintiffs’ Request to Depose a Government Corporate Designee Pursuant to Rule 30(b)(6) Plaintiffs also seek leave to “depose a [g]overnment corporate designee to identify which data sources were . . . available to the [g]overnment from the relevant time period, and where the relevant claims data resides.” Pls.’ Disc. Mot. at 8. Plaintiffs specify they are seeking “an hour . . . of deposition, just getting the [g]overnment to . . . confirm . . . the data sources” they have now and had during the relevant time periods “to make sure . . . there’s been no spoliation . . . .” Tr. at 117:22–25. In response, the government contends it previously identified an agency employee “as an individual with ‘discoverable information concerning TRICARE Encounter Data (TED), the DHA Military Health System Data Repository (MDR), and the creation, content and maintenance of records in both of those databases[,]’. . . [but] plaintiffs expressly declined a deposition during the established periods of fact and expert discovery[] and elected instead to proceed through limited interrogatories.” Defs.’ Disc. Resp. at 33. The government alleges “[p]laintiffs cannot reasonably be said to have been diligent in pursuing the 9 The Court emphasizes the government alone is in possession of the TMA data potentially comprising “tens of millions of records.” Tr. at 134:3. As such, the government is the only party capable of sorting and producing the large volumes of information. See RCFC 26(b)(1) (“[P]arties may obtain discovery regarding any nonprivileged matter that is relevant . . . and proportional . . . [considering] the parties’ relative access to [the] relevant information.”). Indeed, at the 19 December 2023 status conference, the government agreed it is capable of reviewing all data in its possession to identify line items of putative class members missed during DPP extraction due to issues akin to those impacting twelve out of the thirteen unextracted line items for Integris Baptist and Integris Bass Baptist. See 25 Oct. 2023 JSR; see also Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 409, 412 (2022). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 16 of 23 - 17 - deposition that they now request when they intentionally eschewed [an offered deposition] during the established period of fact discovery.” Id. The government also reasserts its prejudice and diligence-related arguments discussed supra Section IV.A.1–2. See, e.g., id. at 28 (“Plaintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment . . . the deposition notice . . . because it obviously was not.”); Tr. at 130:8–10 (“THE COURT: . . . So what’s the prejudice though? [THE GOVERNMENT]: Reasonableness and proportionality.”). 1. Diligence The government’s only novel diligence argument related to plaintiffs’ deposition request is plaintiffs previously declined an opportunity to depose an “an individual with ‘discoverable information concerning [TED and MDR], and the creation, content and maintenance of records in both of those databases.” Defs.’ Disc. Mot. Resp. at 33. The government otherwise broadly asserts plaintiffs were not diligent in pursuing their discovery requests. See, e.g., id. at 28. As determined supra Section IV.A.1, plaintiffs were diligent with respect to pursuing the government’s data and related information at the appropriate time during discovery. See, e.g., App. to Pls.’ Disc. Mot. at 23–24. The Court therefore only addresses the government’s argument related to previous deposition opportunities below. A “trial court ‘has wide discretion in setting the limits of discovery.’” Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197). Notwithstanding, modification of a court-imposed schedule may be done “only for good cause and with the judge’s consent.” RCFC 16(b)(4). “When assessing whether good cause has been shown, ‘the primary consideration is whether the moving party can demonstrate diligence.’” High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244). The government’s primary contention—plaintiffs were not diligent in pursuing the requested deposition because they turned down an offer to depose a government employee in May 2019—assumes a party cannot be diligent if they have, at any time in the past, “eschewed [similar discovery.]” Defs.’ Disc. Mot. Resp. at 33. Over the past four and a half years, however, this case has changed substantially. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 227 (granting additional discovery upon remand and reassignment of the case); see also Geneva Pharms. Tech. Corp., 2005 WL 2132438, at *5 (“[M]aterial events have occurred since the last discovery period, which justice requires that the parties have an opportunity to develop through discovery.”). As noted by plaintiffs, “[t]he Court’s ruling on the [g]overnment’s Summary Judgment Motion . . . fundamentally altered the scope of this case,” Pls.’ Disc. Mot. at 8, by substantially narrowing the potential class members and limiting plaintiffs’ “damages . . . to [two] claims involving errors in the [g]overnment’s data,” Pls.’ Disc. Reply at 3. “[T]o analyze the extent of the . . . error[s]” in the government’s data, 25 Oct. 2023 JSR at 16, and perform “a more accurate damages calculation” for the putative class members, Pls.’ Reply at 7, plaintiffs therefore need to understand the data sources available to the government now and at the time of line item extraction. See 25 Oct. 2023 JSR at 17 (“The only way to evaluate whether Mr. Kennell failed to extract all relevant data . . . for the entire class is for the [g]overnment to produce . . . [the discovery] [p]laintiffs seek.”); Pls.’ Disc. Reply at 7. In 2020, in contrast, at which time plaintiffs “elected . . . to proceed through limited interrogatories” rather than conduct the government’s offered deposition, the Court had not yet narrowed the scope of the case or limited the damages calculations to the government’s data. Defs.’ Disc. Resp. at 33. During the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 17 of 23 - 18 - initial discovery periods, plaintiffs still reasonably believed their own data might be relevant and did not yet understand the importance of the government’s data. See Pls.’ Disc. Reply at 3; see also 25 Oct. 2023 JSR at 16. Plaintiffs therefore did not exhibit a lack of diligence by not accepting the government’s offer to depose an individual whose testimony, at the time, was less relevant to the case. The government has accordingly failed to produce evidence sufficient to show plaintiffs were not diligent in pursuing the requested deposition. Schism, 316 F.3d at 1300; High Point Design LLC, 730 F.3d at 1319; see also Alta Wind I Owner Lessor C, 154 Fed. Cl. at 227. 2. Prejudice As noted supra Section IV.A.2, courts considering requests to reopen discovery may consider whether and to what extent granting the request will prejudice the opposing party, including via delaying the litigation. High Point Design, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); Wordtech Sys., 609 F.3d at 1322 (quoting Lockheed Martin Corp., 194 F.3d at 986). Regarding plaintiffs’ deposition request, the government argues granting plaintiffs’ deposition request will, like plaintiffs’ document requests, result in additional expense and “substantial delay in bringing this matter to resolution.” Def.’s Disc. Resp. at 36. Plaintiffs indicated at oral argument, however, the requested deposition will be “an hour,” with the goal being simply to understand “the data sources” in the government’s possession. Tr. at 117:22. To the extent this short deposition of a government employee, which the government was prepared to allow for several years ago, will allow the case to proceed “more efficient[ly]” to class certification with fewer “hypothetical back-and-forth[s] between the parties” related to considerations like numerosity, see Tr. at 118:2–6, the Court finds the minimal potential prejudice to the government from this deposition is outweighed by the value of this information to the later stages of this litigation. Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”). The Court therefore does not find the government’s argument regarding diligence or prejudice persuasive with respect to plaintiffs’ deposition request. The Court accordingly grants this request as there is good cause to do so.10 High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). C. Supplemental Expert Report Plaintiffs finally request leave to “serve a supplemental expert report on . . . relevant class 10 To the extent the government intended its arguments related to proportionality and relevance to apply to plaintiffs’ deposition request, the Court is unpersuaded. See Def.’s Disc. Resp. at 36. A single deposition lasting approximately one hour on subject matter on which the government previously offered to permit a deposition is not disproportionate to the needs of this case. Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)); RCFC 26(b)(1). Likewise, the subject matter—the sources of the data plaintiffs request access to—is highly relevant in ensuring a complete and accurate data set free of spoliation. Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197); RCFC 26(b)(1); see supra Section IV.A.2. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 18 of 23 - 19 - issues” upon completion of the above-requested discovery. Pls.’ Disc. Mot. at 2. Specifically, plaintiffs wish to “submit a supplemental expert report analyzing the [government’s] data and applying the DPP methodology to the correct universe of outpatient radiology line items . . . .” Id. at 10; see also Pls.’ Disc. Reply at 3 (“Plaintiffs’ supplemental expert report would identify the scope of the class, as requested by the Court.”); Tr. at 73:10–14 (“[PLAINTIFFS:] [I]t is a very complex formula. And I think that it is something that . . . you would want someone with experience with these data line items going through and doing it . . . it’s [objective] math. . . . It’s essentially a claims administrator.”). Plaintiffs make clear their initial expert report was an attempt at extrapolating the named plaintiffs’ data “across the class to come up with . . . estimated number[s],” which they now wish to update with “the exact numbers” once they receive the government’s data. Tr. at 69:4–16. Plaintiffs contend “[r]eopening discovery is warranted where supplemental information from an expert would assist the Court in resolving important issues . . . [s]uch [as] . . . ‘presenting the Court with a more accurate representation of plaintiffs’ damages allegations.’” Pls.’ Disc. Reply at 6 (first citing Kennedy Heights Apartments Ltd. I, 2005 WL 6112633, at *3–4; and then quoting Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217). Likening this case to Alta Wind, plaintiffs argue the Court should conclude here an “expert report will provide the Court with a damages estimate more accurately reflecting plaintiffs’ damages position [in light of the changes to the case rendered by summary judgment] . . . and therefore will likely assist the Court.” Id. at 7 (quoting Alta Wind, 154 Fed. Cl. at 216); Tr. at 68:17–69:16 (“[PLAINTIFFS]: With respect to Ms. Jerzak and the breach of contract, she did two things [in her report.] . . . One, she compared the hospital line items to the government line items for the named [p]laintiffs and did a straight objective calculation of what was the difference. . . . She also took those numbers and extrapolated them across the class to come up with an estimated number. THE COURT: A hypothetical. [PLAINTIFFS]: Yes . . . [r]ecognizing that if the class was certified . . . we’d have to do the exact numbers.”). Plaintiffs conclude this report will “not prejudice the [g]overnment in any way, and would actually benefit the [g]overnment” by providing an “opportunity . . . to oppose” additional contentions appropriate to the posture of the case. Id. at 8 (emphasis omitted) (citing Alta Wind I Owner Lessor C, 154 Fed. Cl. at 216). Plaintiffs note, however, “in [their] mind, this [report] is something that always was going to happen after certification” at the merits stage, Tr. at 73:15– 16 (emphasis added), as they do not “need an expert report for class certification because” the government “admitted breach,” Tr. at 96:3–4; Tr. at 63:22–64:6 (“[PLAINTIFFS:] [L]et’s say the Court certified a class here. The next step . . . is for merits. Someone is going to have to spit out a report saying here are the class members and when I run their . . . data . . . here are the differences and here’s the number that gets spit out.” (emphasis added)). The government reiterates its diligence and prejudice arguments discussed supra Sections IV.A–B with respect to plaintiffs’ request for leave to file a supplemental expert report. The government likewise refutes the notion plaintiffs’ current expert report is a “placeholder . . . that was[] [not] really meant to be real.” Tr. at 70:19–20. In other words, the government contends plaintiffs “meant th[eir earlier] expert report” to apply to “their currently pending motion for class cert[ification],” Tr. at 71:21–23, and now “seek to have the Court rescue them from their own litigation choices,” including the choice to file “expert damages models [that] could never be used to measure class damages.” Def.’s Disc. Resp. at 16–17. Plaintiffs should not be permitted to file a new expert report, according to the government, simply because “they have not . . . marshaled any legally cognizable expert evidence concerning the few claims that remain” Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 19 of 23 - 20 - after summary judgment. Def.’s Disc. Resp. at 17. To the extent plaintiffs concede the requested expert report “is for [the] merits” stage and not necessary for class certification, however, the government believes “a class cannot be certified without a viable expert damages methodology meeting the requirements of Comcast,” meaning plaintiffs’ pending motion for class certification automatically fails because “the only expert evidence in the record that bears on the two types of breaches found by the Court is . . . offered by the [g]overnment.” Id. at 22– 23 (citing Comcast Corp. v. Behrend, 569 U.S. 27, 33–34 (2013)). Indeed, according to the government, “plaintiffs are left with no expert model at all as to the few remaining contract claims,” meaning they cannot adequately allege “damages are capable of measurement on a class[-]wide basis” as required by Comcast. Id. at 24 (quoting Comcast, 569 U.S. at 34). Concerning plaintiffs’ request for leave to file an expert report, the government broadly asserts plaintiffs were not diligent in pursuing their discovery requests. See, e.g., Def.’s Disc. Resp. at 28. As determined supra Section IV.A.1, however, plaintiffs were diligent with respect to pursuing the requested discovery generally. Plaintiffs requested the relevant data in February and July 2020 and planned to replace “the extrapolation” present in their earlier expert reports with analysis “using actual data” upon completion of this requested discovery. See supra Section IV.A.1; Tr. at 136:15–23. The Court’s November 2022 Summary Judgement Order narrowed the scope of this case and further highlighted the need for this additional discovery related to the remaining issues and potential class members. See supra Section IV.A.1, B; Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 427. Further, to the extent the government alleges plaintiffs requested expert report is prejudicial, the government will have sufficient time and opportunity to rebut any supplemental expert report filed by plaintiffs. See supra Section IV.A.2, B.2; Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The contemplated expert report, which will perform the DPP analysis for outpatient radiology claims data within the scope of the Court’s November 2022 liability findings for each putative class member hospital using “only the [government’s] data” as required by the Court’s Summary Judgment Order, could also aid the Court at the merits stage in determining “the amount[] that each hospital is owed.” Tr. at 78:7–15. The requested report therefore would likely not be prejudicial to the government to such an extent as to “warrant the severe sanction of exclusion of [useful] data.” Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399; High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). Plaintiffs acknowledge, however, the updated calculations they plan to include in their requested expert report are not necessary until “after [class] certification”—at the merits stage. Tr. at 73:15–16. At oral argument, plaintiffs clearly stated they do not “need an expert report for class certification,” which is the next step in this litigation. Tr. at 96:3–4. To the extent the government argues plaintiffs’ certification motion will necessarily fail because plaintiffs lack evidence “damages are [measurable] . . . on a class[-]wide basis” in response to this statement by plaintiffs, Def.’s Disc. Rep. at 23 (quoting Comcast, 569 U.S. at 34), plaintiffs respond the DPP Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 20 of 23 - 21 - is the requisite means of “calculat[ing] damages for every single class member,” Tr. at 136:4–5. While the Court reserves judgment as to plaintiffs’ class certification motion, plaintiffs’ argument the DPP provides their model for calculating damages on a class-wide basis because it is a uniform model applicable to all putative class members is sufficient to suggest plaintiffs need not fully calculate alleged damages in a supplemental expert report at this time. Tr. at 54:9–15 (“[PLAINTIFFS:] I think the type of cases that [the government] is talking about [like Comcast] where there’s been [a failure by the plaintiffs to actually address the calculation of class-wide damages, are inapposite because] we haven’t offered a model that is deviating from the contract. What we’re saying . . . the experts are going to . . . essentially crunch[ the] numbers [using the DPP].”). Plaintiffs can do so if and when the merits of this case are argued at trial. This is not a case like Comcast, in which the plaintiffs presented to the court “a methodology that identifies damages that are not the result of the wrong” at issue. Comcast, 569 U.S. at 37. Here, in contrast, the parties indicated at oral argument plaintiffs’ proffered DPP methodology from the parties’ DPP Contracts appears capable of calculating damages for all potential class members. Tr. at 136:1–5 (“[PLAINTIFFS:] But what I will tell you that we’re going to do with the data is we are going to have the auditor [i.e., the expert] plug [the government’s] data into the DPP. That is the model. That is [what] the contract . . . dictates . . . how you calculate damages for every single class member.”); Tr. at 54:12–13 (“[PLAINTIFFS:] [W]e haven’t offered a model that is deviating from the contract.”); Tr. at 93:2–5 (“THE COURT: But the model is just what you said is—if I understood correctly, is that the report is just DPP data discrepancy output. [THE GOVERNMENT]: For each individual [p]laintiff.”); see Tr. 93:2–95:25. The Court accordingly denies plaintiffs’ request for an expert report without prejudice in the interest of the efficient disposition of plaintiffs’ class certification motion. High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). To the extent plaintiffs “would want in [the] merits” stage an expert report from an “auditor to make sure” the parties “all agree on” damages calculated via the DPP, plaintiffs may refile this motion at that time. Tr. at 96:12–13 (plaintiffs). V. Scope of Granted Discovery and Next Steps As discussed supra Section IV: 1. The Court grants plaintiffs’ deposition request. 2. The Court grants plaintiffs’ document requests as follows: Plaintiffs are permitted to serve amended document discovery requests for all putative class member hospitals tailored to seek only those documents required for plaintiffs to identify “breach[es] of TMA’s [contractual] duty” under the DPP Contract akin to either: (1) the government’s failure to extract “thirteen line items for Integris Baptist and Integris Bass Baptist”; or (2) the government’s failure to adjust “five . . . line items” for Integris Baptist “during the DPP because of an alternate zip code.” See Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 409, 412 (2022). This specification ensures plaintiffs’ requests remain within the scope of the Court’s findings of liability in November 2022. Id. The Court notes at the 19 December 2023 status conference the government agreed it is possible to Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 21 of 23 - 22 - execute the same analysis performed on the named plaintiffs’ data in the 25 October 2023 JSR on the government’s data for all putative class members. 11 3. The Court denies plaintiffs’ request to file a supplemental expert report without prejudice. Plaintiffs may move to file an updated expert report later in this litigation as necessary, at which time the government will be permitted to file a response report. Within three weeks of the date this Order is issued, the parties shall file a JSR comprised of the following: 1. Plaintiffs’ discovery requests revised in accordance with the above clarifications; 2. The parties’ proposed schedule for discovery, including a timeline for plaintiffs’ deposition and the exchange of documents between the parties; and 3. The parties’ proposed schedule for re-briefing class certification after all discovery closes, including a proposed timeline for the filing of new expert reports. As noted by the Court at the 19 December status conference, plaintiffs’ next step should be to analyze the government’s data for the six named plaintiffs already in plaintiffs’ possession to assist plaintiffs in tailoring their document requests as discussed above. Further, at the 19 December 2023 status conference, the parties agreed the partial grant of plaintiffs’ Discovery Motion moots plaintiffs’ pending Motion to Certify Class Action and Appoint Class Counsel, ECF No. 146, as the parties will need to re-brief these issues following the narrowing of this case on summary judgment and the upcoming additional discovery. The government agreed its pending Motion to Exclude Inadmissible Evidence Relied Upon in Plaintiffs’ Motion for Class Certification, ECF No. 204, is accordingly moot. The government may refile a similar motion if needed during future class certification briefing. Plaintiffs likewise agreed to withdraw without prejudice their Motion to Exclude the Expert Opinions and Continued Participation of Kennell, ECF No. 251, pending further discovery and briefing. Further, plaintiffs agreed, given the scope of this case after summary judgment, the expert report of Fay is moot. Accordingly, the government’s Motion to Exclude the Expert Opinions of Fay, ECF No. 206, is moot. Finally, plaintiffs stated they plan to file a new expert report replacing that of Jerzak later in this litigation. The government noted at the 19 December status conference plaintiffs’ replacement of Ms. Jerzak’s current report will render the government’s Motion to Exclude the Expert Opinions of Jerzak, ECF No. 205, moot as well. 11 As discussed supra note 4, in the 25 October 2023 JSR, the government explained why twelve of the thirteen line items improperly excluded for Integris Baptist and Integris Bass Baptist were not extracted. At the 19 December 2023 status conference, the government indicated it can now search its database for line items improperly excluded due to this same error for all hospitals that participated in the DPP. The government noted, however, it is not aware of what caused the thirteenth line item to be missed so cannot create search criteria appropriate to identifying other similar misses. Finally, to identify missed alternate zip codes, the government stated it would need zip code information from plaintiffs and the putative class members. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 22 of 23 - 23 - VI. Conclusion For the foregoing reasons, and as specified supra Section V, the Court GRANTS-INPART and DENIES-IN-PART plaintiffs’ Motion for Leave to Conduct Certain Limited Additional Discovery and to Submit Supplemental Expert Report, ECF No. 269, and FINDS as MOOT plaintiffs’ Motion for Clarification or, in the Alternative, to Compel Production, ECF No. 161.12 As noted supra Section V, the Court FINDS as MOOT plaintiffs’ Motion to Certify Class Action and Appoint Class Counsel, ECF No. 146, the government’s Motion to Exclude Inadmissible Evidence Relied Upon in Plaintiffs’ Motion for Class Certification, ECF No. 204, the government’s Motion to Exclude the Expert Opinions of Fay, ECF No. 206, and the government’s Motion to Exclude the Expert Opinions of Jerzak, ECF No. 205. As agreed to at the 19 December 2023 status conference, plaintiffs SHALL WITHDRAW their Motion to Exclude the Expert Opinions and Continued Participation of Kennell, ECF No. 251, without prejudice. Finally, as noted at oral argument, see Tr. at 139:10–140:8, the Court STRIKES the government’s Notice of Additional Authority, ECF No. 273, as deficient and GRANTS the government’s Unopposed Motion for Leave to File Notice of Supplemental Authority, ECF No. 274, for good cause shown. The parties SHALL FILE the joint status report discussed supra Section V on or before 23 January 2024. IT IS SO ORDERED. s/ Holte HOLTE Judge 12 At oral argument, the parties agreed the Court ruling on plaintiffs’ current Discovery Motion is also a “ruling on [plaintiffs’ previous Motion to Compel,] ECF [No.] 161.” Tr. at 139:2–9. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24","You can only respond with the information in the context block. Please give your response in a simple tone that could be shared with a non-legal audience and easily understood. Please summarize the determinations made in the text provided and explain the consequences of the rulings made. In the United States Court of Federal Claims No. 13-821 (Filed: 2 January 2024) *************************************** INGHAM REG’L MEDICAL CENTER, * n/k/a MCLAREN GREATER LANSING, * et al., * * Plaintiffs, * * v. * * THE UNITED STATES, * * Defendant. * * Plaintiffs are six hospitals purporting to represent a class of approximately 1,610 hospitals across the United States in a suit requesting, among other things, the Court interpret what the Federal Circuit has deemed an “extremely strange” contract.1 This contract arose when hospitals complained the government underpaid reimbursements for Department of Defense Military Health System, TRICARE, outpatient services rendered between 2003 and 2009. In 2011, after completion of a data analysis, the government voluntarily entered a discretionary payment process contract with plaintiffs and offered net adjusted payments. In November 2022, after nine years of litigation and one Federal Circuit appeal, the Court granted in part and denied in part the government’s Motion for Summary Judgment. As the only surviving breach of contract claims concern the government’s duty to extract, analyze, and adjust line items from its 1 9 June 2022 Oral Arg. Tr. at 161:7–13, ECF No. 259 (“THE COURT: So the Federal Circuit panel, when the case was argued, characterized this agreement as extremely strange. [THE GOVERNMENT]: That is accurate. It is extremely strange. THE COURT: It is extremely strange? [THE GOVERNMENT]: It is.”). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 1 of 23 - 2 - database, the Court required the parties to file a joint status report regarding the effect of summary judgment on plaintiffs’ Renewed Motion to Certify a Class Action. Following a status conference, plaintiffs filed a discovery motion related to class certification. For the following reasons, the Court grants-in-part and denies-in-part plaintiffs’ Motion. I. Background A. Factual and Procedural History2 TRICARE is a “military health care system” which “provides medical and dental care for current and former members of the military and their dependents.” Ingham Reg’l Med. Ctr. v. United States, 874 F.3d 1341, 1342 (Fed. Cir. 2017). TRICARE Management Activity (TMA), a “field office in the Defense Department [(DoD)],” managed the TRICARE system.3 N. Mich. Hosps., Inc. v. Health Net Fed. Servs., LLC, 344 F. App’x 731, 734 (3d Cir. 2009). In 2001, Congress amended the TRICARE statute to require DoD to follow Medicare rules when reimbursing outside healthcare providers. Ingham Reg’l Med. Ctr., 874 F.3d at 1343 (citing 10 U.S.C. § 1079(j)(2) (2002)). To facilitate transition to Medicare rules, in 2005, DoD issued a Final Rule which specified “[f]or most outpatient services, hospitals would receive payments ‘based on the TRICARE-allowable cost method in effect for professional providers or the [Civilian Health and Medical Program of the Uniformed Services] (CHAMPUS) Maximum Allowable Charge (CMAC).’” Id. (quoting TRICARE; Sub-Acute Care Program; Uniform Skilled Nursing Facility Benefit; Home Health Care Benefit; Adopting Medicare Payment Methods for Skilled Nursing Facilities and Home Health Care Providers, 70 Fed. Reg. 61368, 61371 (Oct. 24, 2005) (codified as amended at 32 C.F.R. § 199)). The TRICARE-allowable cost method “applied until 2009, when TRICARE introduced a new payment system for hospital outpatient services that was similar to the Medicare [Outpatient Prospective Payment System (OPPS)].” Id. In response to hospital complaints of payment issues, TRICARE hired Kennell and Associates, a consulting firm, to “undertake a study [(‘Kennell study’)] of the accuracy of its payments to the hospitals.” Ingham Reg’l Med. Ctr., 874 F.3d at 1343–44. The Kennell study “compared CMAC payments to the payments that would have been made using Medicare payment principles, and determined that DoD ‘(1) underpaid hospitals for outpatient radiology but, (2) correctly paid hospitals for all other outpatient services.’” Id. at 1344 (emphasis omitted) (citation omitted). From the Kennell study findings, “DoD created a discretionary payment process [(DPP)],” and, on 25 April 2011, DoD notified hospitals by letter of the process for them to “request a review of their TRICARE reimbursements (the ‘Letter’)” and “published a document titled ‘NOTICE TO HOSPITALS OF POTENTIAL ADJUSTMENT TO PAST PAYMENTS FOR OUTPATIENT RADIOLOGY SERVICES’ (the ‘Notice’)” on the TRICARE website. Id.; App. to Def.’s MSJ at A3–A9, ECF No. 203-1. The Notice described a nine-step methodology to “govern the review of payments for hospital outpatient radiology services and [the] payment 2 The factual and procedural history in this Order contains only those facts pertinent to plaintiffs’ Motion for Discovery, ECF No. 269. 3 The Defense Health Agency now manages activities previously managed by TMA. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 2 of 23 - 3 - of any discretionary net adjustments” by which hospitals could “request an analysis of their claims data for possible discretionary adjustment.” App. to Def.’s MSJ at A7. On 21 October 2013, plaintiffs brought this action claiming the government underpaid them for certain outpatient medical services they provided between 1 August 2003 and 1 May 2009. See Ingham Reg’l Med. Ctr. v United States, 126 Fed. Cl. 1, 9 (2016), aff’d in part, rev’d in part, 874 F.3d 1341 (Fed. Cir. 2017). Plaintiffs allege the approximately six years of underpayment breached two contracts and violated various statutory and regulatory provisions. Id. Plaintiffs estimate several thousand hospitals submitted requests for discretionary payment, including the six named plaintiffs in this case. See id. at 16. Plaintiffs therefore seek to represent a class of as many as 1,610 similarly situated hospitals. See Pls.’ Mem. in Supp. of Mot. to Certify at 1, ECF No. 77; see also Mot. to Certify, ECF No. 76. On 11 February 2020, during the parties’ second discovery period, plaintiffs requested from the government “[a]ny and all data concerning hospital outpatient services claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period . . . .” See App. to Pls.’ Disc. Mot. at 23, ECF No. 269; Gov’t’s Disc. Resp. at 11, ECF No. 270. The government rejected this request for records from “thousands of hospitals . . . that are not [named] plaintiffs” on 16 March 2020 and instead only “produce[d] the data requested for the six plaintiffs in this lawsuit.” App. to Pls.’ Disc. Mot. at 29. Plaintiffs filed a motion to clarify the case schedule or, in the alternative, to compel discovery of “data and documents relating to the [g]overnment’s calculation of payments under the [DPP] for all putative class members, not just the named [p]laintiffs” on 31 July 2020, the last day of discovery. See Pls.’ Mot. to Compel (“Pl.’s MTC”) at 2, ECF No. 161 (emphasis added). In response, the government stated, “[t]here is no basis for the Court to . . . compel extraneous discovery of hospitals that are not now in this lawsuit.” Def.’s Resp. to Pl.’s MTC (“Def.’s MTC Resp.”) at 2, ECF No. 166. During a status conference on 13 October 2020, the parties agreed to table plaintiffs’ discovery request and associated Motion to Compel pending resolution of the government’s then-pending Motion for Reconsideration, ECF No. 150, and any additional potentially dispositive motions. See 13 Oct. 2020 Tr. (“SC Tr.”) at 27:13–28:9, ECF No. 178 (“THE COURT: . . . So to state differently, then, [plaintiffs agree] to stay consideration of this particular [discovery] issue until class certification is decided? [PLAINTIFFS:] Yes, that would be fine. THE COURT: . . . [W]ould the [g]overnment agree with that? [THE GOVERNMENT:] Yes, [y]our [h]onor . . . [but] the [g]overnment still intends to file a motion for summary judgment. . . . THE COURT: Okay. So on the [g]overnment’s motion for summary judgment . . . that should probably not be filed until at least after the motion for reconsideration is resolved? [THE GOVERNMENT:] That’s correct.”). On 5 June 2020, plaintiffs filed a renewed motion to certify a class and appoint class counsel (“Pls.’ Class Cert.”), ECF No. 146, which the parties fully briefed. See Def.’s Class Cert. Resp., ECF No. 207; Pls.’ Class Cert. Reply, EF No. 226. On 26 August 2021, the government filed a motion for summary judgment (“Def.’s MSJ”), ECF No. 203. Plaintiffs filed an opposition to the government’s motion for summary judgment on 4 February 2022 (“Pls.’ MSJ Resp.”), ECF No. 225, and on 11 March 2022, the government filed a reply (“Def.’s MSJ Reply”), ECF No. 234. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 3 of 23 - 4 - “The Court [granted] the government’s [M]otion for [S]ummary [J]udgment as to plaintiffs’ hospital-data duty and mutual mistake of fact claims but [denied] the government’s [M]otion as to plaintiffs’ TMA-data duty and alternate zip code claims[,] . . . [and stayed] the evidentiary motions” on 28 November 2022. Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 428 (2022). The Court, deeming the government’s settlement arrangements with plaintiffs to be contracts (the “DPP Contracts”), specifically found “the DPP Contract[s] only obligated TMA to use its data, not the hospitals’ data,” leaving the government’s data as the only set relevant to this case. Id. at 427. The Court held the government’s (1) “failure to extract thirteen line items [meeting all qualifications for extraction] for Integris Baptist and Integris Bass Baptist”; and (2) failure to adjust “five . . . line items [for Integris Baptist] during the DPP because of an alternate zip code” constituted breach of the DPP Contracts. Id. at 409–10, 412. “Based on the summary judgment holding . . . the Court [found it needed] further information regarding how plaintiffs in this post-summary judgment smaller class would meet the requirements for class certification.” Id. “The Court accordingly decline[d] to rule on plaintiffs’ class certification motion . . . [a]s the only surviving claims are breach of contract for failure to follow the DPP in a few limited circumstances, [and] the parties did not adequately brief the narrower proposed class of plaintiffs arising under the remaining claims.” Id. The Court ordered the parties to file “a joint status report [(JSR)] providing the parties’ views on class certification for the smaller class of plaintiffs affected by the government’s breach of contract for failure to follow the DPP in limited circumstances and on whether further briefing is necessary.” Id. On 28 December 2022, the parties filed a JSR providing their opposing positions on whether plaintiffs can request further discovery related to class certification: “plaintiffs expressly reserve, and do not waive, any rights that they may currently have, or may have in the future, with respect to additional class certification fact or expert discovery”; and “the [g]overnment opposes any further fact or expert discovery in connection with plaintiffs’ amended/supplemental motion for class certification, and, in agreeing to the foregoing briefing schedule, is not agreeing to any further fact or expert discovery in this case.” 28 Dec. 2022 JSR at 2, ECF No. 262. Plaintiffs then filed a motion requesting leave to conduct further discovery and submit a supplemental expert report on 21 March 2023 (“plaintiffs’ Discovery Motion”). Pls.’ Disc. Mot., ECF No. 269. The government filed a response on 21 April 2023. Gov’t’s Disc. Resp. Plaintiffs filed a reply on 9 May 2023. Pls.’ Disc. Reply, ECF No. 271. The Court held oral argument on 19 July 2023. See 5 June 2023 Order, ECF No. 272; 19 July 2023 Oral Arg. Tr. (“Tr.”), ECF No. 276. On 31 August 2023, following oral argument on plaintiffs’ Discovery Motion, the government filed an unopposed motion to stay the case for the government to complete a “second look at the records [analyzed] . . . in the July 2019 expert report of Kennell . . . that were the subject of one of the Court’s liability rulings on summary judgment.” Def.’s Mot. to Stay at 1, ECF No. 277. The Court granted this Motion on the same day. Order, ECF No. 278. On 25 October 2023, the parties filed a JSR, ECF No. 284, in which the government addressed its findings4 and “proposed [a] way forward” in this case. 25 Oct. 2023 JSR at 2. In 4 In the 25 October 2023 JSR, the government explained twelve of the thirteen line items the government failed to extract for Integris Baptist and Integris Bass Baptist, see Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 412 (2022), were missed due to a “now-known” error in which “a very small set of patients comprised of military spouses . . . under age 65” were overlooked because they “receive Medicare Part A” but not Medicare Part B, Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 4 of 23 - 5 - response to the government’s data analysis, plaintiffs noted in the JSR “the [g]overnment’s update makes clear that [additional g]overnment data is required to evaluate which hospitals were affected by the [g]overnment’s breach of the DPP.” Id. at 16. Plaintiffs then likewise “[p]roposed [n]ext [s]teps” in this case, beginning with resolution of their Discovery Motion. Id. at 18. On 19 December 2023, the Court held a telephonic status conference to understand the technical aspects of plaintiffs’ discovery requests as they relate to the DPP process and algorithm. See Scheduling Order, ECF No. 285. B. Discovery Requests at Issue Plaintiffs seek leave to perform additional discovery stemming from the Court’s summary judgment holding “TMA [breached its duty] . . . to extract, analyze, and adjust radiology data from its database” by failing to (1) adjust “five . . . line items [for Integris Baptist] during the DPP because of an alternate zip code” and (2) “extract . . . thirteen line items [meeting the criteria for extraction] for Integris Baptist and Integris Bass Baptist.” Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 409–10, 412. Plaintiffs’ sought-after discovery includes a request for “the same data for the [putative] class hospitals” as plaintiffs currently “have [for the] six named [p]laintiffs,” Tr. at 50:14–19, to assist plaintiffs in identifying “line items in [TMA’s radiology data] . . . that met the [DPP C]ontract criteria but were excluded from the adjustment . . . .” Gov’t’s Disc. Resp. at 15. In all, plaintiffs “seek leave to (1) depose a [g]overnment corporate designee, (2) serve document requests, and (3) thereafter serve a supplemental expert report on the relevant class issues.” Pls.’ Disc. Mot. at 2. Plaintiffs further detail the purpose of each request: First, [p]laintiffs seek leave to depose a [g]overnment corporate designee to identify the various data sources in the [g]overnment’s possession from the relevant time period. Second, [p]laintiffs seek leave to serve . . . document requests to obtain critical data related to each Potential Class member hospital. Third, once the above discovery is completed, [p]laintiffs seek leave to serve a supplemental expert report that applies the DPP methodology to the relevant claims data to identify the Final Class. Id. at 6–7 (footnote omitted) (citations omitted). The second request, mirroring plaintiffs’ February 2020 request for “[a]ny and all data concerning hospital outpatient service claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period,” App. to Pl.’s Disc. Mot. at 23, comprises “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations[;] and (2) all hospital outpatient claims meaning the “outpatient services that these individuals receive are paid for . . . by TRICARE.” 25 Oct. JSR at 4, ECF No. 284. As a result of this Medicare arrangement, line items for this group of patients were not extracted as the individuals were mistakenly deemed Medicare, rather than TRICARE, recipients for procedures within the scope of the DPP. Id. The cause of the thirteenth unextracted line item remains unclear. Id. at 5. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 5 of 23 - 6 - data available for each of the Potential Class member hospitals during the relevant time period.” Pl.’s Disc. Mot. at 8–9. This request includes: (1) CMAC rate files “needed to apply the DPP methodology”; (2) “[d]ata on hospital outpatient radiology services claim line items for each Potential Class member hospital”; (3) “[d]ata concerning hospital outpatient services claim line items for each Potential Class member hospital” to verify the radiology files are complete; and (4) “TRICARE Encounter Data (‘TED’) records and Health Care Service Records (‘HCSR’).” Id. at 9–10. II. Applicable Law This court’s application of the Rules of the United States Court of Federal Claims (“RCFC”) is guided by case law interpreting the Federal Rules of Civil Procedure (FRCP). See RCFC rules committee’s note to 2002 revision (“[I]nterpretation of the court’s rules will be guided by case law and the Advisory Committee Notes that accompany the Federal Rules of Civil Procedure.”). Regarding the scope of discovery, the rules of this court provide: [P]arties may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case, considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to relevant information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the burden or expense of the proposed discovery outweighs its likely benefit. RCFC 26(b)(1). “Questions of the scope and conduct of discovery are . . . committed to the discretion of the trial court.” Florsheim Shoe Co., Div. of Interco, Inc. v. United States, 744 F.2d 787, 797 (Fed. Cir. 1984). The Court of Federal Claims generally “afford[s] a liberal treatment to the rules of discovery.” Securiforce Int’l Am., LLC v. United States, 127 Fed. Cl. 386, 400 (2016), aff’d in part and vacated in part on other grounds, 879 F.3d 1354 (Fed. Cir. 2018), cert. denied, 139 S. Ct. 478 (2018) (mem.). “[T]he [C]ourt must be careful not to deprive a party of discovery that is reasonably necessary to afford a fair opportunity to develop and prepare the case.” Heat & Control, Inc. v. Hester Indus., Inc., 785 F.2d 1017, 1024 (Fed. Cir. 1986) (quoting FED. R. CIV. P. 26(b)(1) advisory committee’s note to 1983 amendment). Further, “[a] trial court ‘has wide discretion in setting the limits of discovery.’” Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)). This court has previously found such “discretion [extends to] . . . deciding whether to grant a motion to . . . reopen discovery.” Croman Corp. v. United States, 94 Fed. Cl. 157, 160 (2010) (citing Te-Moak Bands of W. Shoshone Indians of Nev. v. United States, 948 F.2d 1258, 1260 (Fed. Cir. 1991)); see also Wordtech Sys., Inc. v. Integrated Networks Sols., Inc., 609 F.3d 1308, 1322–23 (Fed. Cir. 2010) (citing Coleman v. Quaker Oats Co., 232 F.3d 1271, 1294 (9th Cir. 2000)) (applying Ninth Circuit law in determining trial court did not abuse its discretion in refusing to reopen discovery). Notwithstanding, modification of a court-imposed schedule, including a discovery schedule, may be done “only for good cause and with the judge’s consent.” RCFC 16(b)(4). In Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 6 of 23 - 7 - High Point Design, the Federal Circuit applied Second Circuit law5 when discussing the good cause standard of FRCP 16(b)(4) for amending a case schedule. “When assessing whether good cause has been shown, ‘the primary consideration is whether the moving party can demonstrate diligence.’” High Point Design LLC v. Buyers Direct, Inc., 730 F.3d 1301, 1319 (Fed. Cir. 2013) (quoting Kassner v. 2nd Ave. Delicatessen, Inc., 496 F.3d 229, 244 (2d Cir. 2007)); see also Adv. Software Design Corp. v. Fiserv, Inc., 641 F.3d 1368, 1381 (Fed. Cir. 2011) (“Under the good cause standard, the threshold inquiry is whether the movant has been diligent.” (citing Sherman v. Winco Fireworks, Inc., 532 F.3d 709, 717 (8th Cir. 2008))). This “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc. v. Metal-Lite, Inc., 304 F.3d 1256, 1270 (Fed. Cir. 2002) (applying Ninth Circuit law in finding defendant’s attempt to amend the pleadings first required modification of the scheduling order under FRCP 16(b)(4)). Trial courts may also consider “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). Prejudice related to the reopening of discovery may involve the delay of proceedings. Wordtech Sys., 609 F.3d at 1322 (“[A] need to reopen discovery and therefore delay the proceedings supports a district court’s finding of prejudice from a delayed motion to amend the complaint.” (quoting Lockheed Martin Corp. v. Network Sols., Inc., 194 F.3d 980, 986 (9th Cir. 1999))). III. Parties’ Arguments Plaintiffs contend “good cause exists for [p]laintiffs to conduct . . . additional limited discovery,” Pls.’ Disc. Mot. at 7–8 (citing Geneva Pharms. Tech. Corp. v. Barr Lab’ys, Inc., Nos. 98 Civ. 861, 99 Civ. 3687, 2005 WL 2132438, at *5 (S.D.N.Y. Sept. 6, 2005)), largely mirroring their “live and pending request for discovery [from February 2020] that[ ha]s been tabled” since October 2020, Tr. at 37:16–17; see SC Tr. at 27:13–23. Specifically, plaintiffs argue, “[t]he Court’s ruling on the [g]overnment’s Summary Judgment Motion is a material event that has fundamentally altered the scope of this case.” Pl.’s Disc. Mot. at 7–8 (citing Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 428 (2022) (“[T]he parties did not adequately brief the narrower proposed class of plaintiffs arising under the remaining claims.”)). Plaintiffs state the requested “discovery will allow them to provide the Court with the information required for the determination of the Final Class, and that this will greatly assist the Court with its ruling on class certification.” Id. at 10. At oral argument, the government acknowledged “[p]laintiffs[’] [2020] request [for] all class hospital data” concerned much of the same information plaintiffs are “asking for now.” Tr. at 103:7–17. The government, however, maintains “plaintiffs’ motion to reopen fact and expert discovery should be denied.” Gov’t’s Disc. Resp. at 17. Specifically, the government argues plaintiffs “filed this case, moved for class certification twice, and proceeded through two full rounds of fact and expert discovery, based upon . . . [p]laintiffs’ view of the law.” Id. at 16. The 5 RCFC 16(b)(4) is identical to the corresponding Rule 16(b)(4) of the Federal Rules of Civil Procedure. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 7 of 23 - 8 - government therefore argues plaintiffs should not be permitted to “reopen fact and expert discovery” simply because “on summary judgment,” the “legal theories that animated plaintiffs’ [previous] discovery and expert reports have been shown . . . to be . . . wrong.” Id. at 16–17. The government argues “[a] party’s realization that it elected to pursue the wrong litigation strategy is not good cause for amending a schedule,” so plaintiffs have failed to show good cause to reopen discovery as they request. Gov’t’s Disc. Resp. at 17 (quoting Sys. Fuels, Inc. v. United States, 111 Fed. Cl. 381, 383 (2013)). Alluding to the standard for reopening discovery, the government argues “no actions by plaintiffs . . . even remotely approximate the showing of diligence required under RCFC 16 . . . .” Id. at 35. The government also argues plaintiffs’ requests “overwhelming[ly] and incurabl[y] prejudice . . . the [g]overnment.” Id. at 38. IV. Whether Good Cause Exists to Reopen Discovery As noted supra Section III, plaintiffs contend “good cause exists for [p]laintiffs to conduct . . . additional limited discovery,” Pls.’ Disc. Mot. at 7–8 (citing Geneva Pharms. Tech. Corp. v. Barr Lab’ys, Inc., Nos. 98 Civ. 861, 99 Civ. 3687, 2005 WL 2132438, at *5 (S.D.N.Y. Sept. 6, 2005)), largely mirroring their “live and pending request for discovery [from February 2020] that[ ha]s been tabled” since October 2020, when the parties agreed to first proceed with the government’s Motion for Reconsideration and Motion for Summary Judgment. Tr. at 37:16– 17; see SC Tr. at 27:13–23. Plaintiffs believe the requested “discovery will allow them to provide the Court with the information required for the determination of the Final Class, and that this will greatly assist the Court with its ruling on class certification.” Pl.’s Disc. Mot. at 10. In contrast, the government asserts plaintiffs have, in two previous rounds of discovery and in their summary judgment briefing, chosen to pursue a litigation strategy based on a class damages model relying on hospital and government data and cannot now justify reopening discovery because they need to change tactics following the Court’s summary judgment ruling limiting the scope of this case to the government’s data. See Gov’t’s Disc. Resp. at 22–23. Specifically, the government contends plaintiffs have neither made the required showing of diligence during past discovery periods to justify modifying the Court’s discovery schedule nor adequately refuted the government’s claim this discovery is prejudicial. See Gov’t’s Disc. Resp. at 28, 35. “A trial court ‘has wide discretion in setting the limits of discovery.’” Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)). This court has previously found such “discretion [is applicable] in deciding whether to grant a motion to . . . reopen discovery.” Croman Corp. v. United States, 94 Fed. Cl. 157, 160 (2010) (citing Te-Moak Bands of W. Shoshone Indians of Nev. v. United States, 948 F.2d 1258, 1260 (Fed. Cir. 1991)). RCFC 16(b)(4) permits modification of a court-imposed schedule, such as to re-open discovery, “only for good cause and with the judge’s consent.”6 Good cause “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc. v. Metal-Lite, Inc., 304 F.3d 1256, 1270 (Fed. Cir. 2002) (applying Ninth Circuit law in finding defendant’s attempt to amend the 6 At oral argument, the parties agreed plaintiffs are requesting the Court reopen discovery, meaning this good cause standard applies. Tr. 99:14–19: “[PLAINTIFFS:] I think, as between [supplementation and reopening], th[ese requests] probably fit[] better in the reopening category as between those two . . . . THE COURT: So . . . the standard for reopening is good cause? [PLAINTIFFS:] Yes. THE COURT: [The government], [do] you agree? [THE GOVERNMENT:] I agree.” Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 8 of 23 - 9 - pleadings first required modification of the scheduling order under FRCP 16(b)(4)). Likewise, in determining whether good cause exists to reopen discovery, a trial court may consider “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design LLC v. Buyers Direct, Inc., 730 F.3d 1301, 1319 (Fed. Cir. 2013) (quoting Kassner v. 2nd Ave. Delicatessen, Inc., 496 F.3d 229, 244 (2d Cir. 2007)). The Court accordingly must determine whether good cause exists to reopen discovery as requested by plaintiffs by analyzing plaintiffs’ diligence and whether the requested discovery prejudices the government. The Court begins with plaintiffs’ document requests. A. Document Requests Plaintiffs request the government turn over “critical data related to each Potential Class member hospital” and argue “denying ‘precertification discovery where it is necessary to determine the existence of a class is an abuse of discretion.’” Pls.’ Disc. Mot. at 6–7; Pls.’ Disc. Reply at 2 (quoting Perez v. Safelite Grp. Inc., 553 F. App’x 667, 669 (9th Cir. 2014)). These document requests specifically target “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations, and (2) all hospital outpatient claims data available for each of the Potential Class member hospitals during the relevant time period.” Pls.’ Disc. Mot. at 8–9. Plaintiffs’ goal is to acquire all “radiology line item[]” data and other information necessary to “apply the DPP methodology” to all of the putative class members’ claims data from the DPP period. Id. at 9. Plaintiffs contend “good cause exists” for the Court to reopen discovery with respect to these documents because the “Court’s ruling on the [g]overnment’s Summary Judgment Motion is a material event that . . . fundamentally altered the scope of this case.” Id. at 8. Namely, plaintiffs’ “damages are now limited to those claims involving errors in the [g]overnment’s data,” so plaintiffs allege this data, which “by its very nature [is] exclusively in [the government’s] possession,” is necessary “to identify the class members.” Pls.’ Disc. Reply at 3; see Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 427–29 (2022). Further, plaintiffs believe reopening discovery for this request is appropriate because in February 2020, during discovery, plaintiffs served a request for production on the government for the same “data concerning hospital outpatient services, claims, and . . . reimbursement for all class hospitals.” Tr. at 41:5–11. Plaintiffs likewise moved to compel this discovery in July 2020. Pls.’ Disc. Reply at 4 (“Plaintiffs also later moved for an order to conduct class discovery or for the [g]overnment to alternatively produce documents for all hospitals.”). Plaintiffs argue tabling this request and motion at the end of October 2020 while the case “proceeded with reconsideration, summary judgment, and other procedural” items did not do away with their “live and pending request for [this] discovery.” Tr. at 41:16–17, 37:14– 25, 128:5–6. With respect to prejudice, plaintiffs clarify their requests “will not prejudice the” government primarily because “the benefit to this case from the discovery would significantly outweigh any burden,” Pls.’ Disc. Reply at 8–9 (first citing Davita HealthCare Partners, Inc. v. United States, 125 Fed. Cl. 394, 402 n.6 (2016); and then citing Kennedy Heights Apartments Ltd. I v. United States, 2005 WL 6112633, at *4 (Fed. Cl. Apr. 26, 2005)), as this discovery will “assist the court with its ruling on class certification.” Pls.’ Disc. Mot. at 9–10. Further, plaintiffs contend any prejudice could be cured at trial by cross-examination of plaintiffs’ expert, who will use this data in a future supplemental report. Pls.’ Disc. Reply at 10 (citing Panasonic Commc’ns Corp. of Am. v. United States, 108 Fed. Cl. 412, 416 (2013)). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 9 of 23 - 10 - The government argues good cause does not exist to reopen discovery as requested by plaintiffs. With respect to diligence, the government first asserts plaintiffs’ 31 July 2020 Motion regarding class discovery was not diligent because it was filed on the last day of the discovery period. Gov’t’s Disc. Resp. at 33–34. Next, the government argues “[p]laintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment . . . the proposed discovery requests . . . because it obviously was not.” Id. at 28 (citation omitted). Rather, per the government, “plaintiffs disregarded, rather than responding to, evidence, analysis, and law that was inconsistent with their theories of the case, even when the [g]overnment brought such issues to the fore.” Id. at 30. The government argues “plaintiffs ignored these issues at their peril throughout the entire second period of fact and expert discovery that followed, and that means that they were not diligent under the law” and are not now entitled to discovery to assist them in changing their theory of the case. Id. at 31–32. Concerning prejudice, the government argues “plaintiffs are proposing fact discovery on a scale never before undertaken in this case, a new expert report for the [g]overnment to then respond to, more expert depositions, and, no doubt, additional Daubert and class-related motions practice, resulting in substantial delay in bringing this matter to resolution.” Id. at 36 (footnote omitted). “Permitting plaintiffs to now evade a long overdue reckoning, and attempt to moot [the government’s motions to exclude plaintiffs’ expert reports], in addition to being completely contrary to law, [according to the government,] deprives the [g]overnment of its day in court for what should be an imminent resolution of this matter.” Id. 1. Diligence A finding of diligence sufficient to modify a case schedule “requires a showing that even with the exercise of due diligence the moving party could not meet the order’s timetable.” Slip Track Sys., Inc., 304 F.3d at 1270 (applying Ninth Circuit law in finding defendant’s attempt to amend the pleadings first required modification of the scheduling order under FRCP 16(b)(4)). On 11 February 2020, at the very early stages of the “re-opened period of fact discovery,” plaintiffs “served the [g]overnment with additional document requests,” including a request for “[a]ny and all data concerning hospital outpatient services claims and TRICARE reimbursement for hospital outpatient services claims during the relevant time period . . . .” Gov’t’s Disc. Resp. at 11 (citations omitted); see also App. to Pls.’ Disc. Mot. at 23. At the time, the government “objected to this request” and only “produce[d] the data requested for the six [named] plaintiffs.” Id. at 11–12 (citations omitted). Over the next several months, the parties continued with fact and expert discovery, during which time the Court “established a schedule for briefing on class certification and summary judgment.” Id. at 13 (citing Order at 2, ECF No. 143). On 31 July 2020, “the date . . . both fact and expert discovery closed, plaintiffs filed a motion . . . [to] compel[] the [g]overnment to produce documents for all hospitals, rather than for just the six representative plaintiffs.” Id. at 14. Plaintiffs therefore requested the data at issue in this document request at least twice before the instant Motion—once on 11 February 2020 and again on 31 July 2020. Tr. at 81:10–11 (“[PLAINTIFFS:] [W]e did ask for all of those things that [the government is] talking about [before we t]abled the issues . . . .”). They thus argue they “meet [the] diligence [standard] here because [they] asked for” this information “a long time ago” and continued to believe it “was a live and open issue.” Tr. at 128:5–6; Tr. at 104:25–105:9 (“[PLAINTIFFS:] We served the discovery request in the discovery period. We got objections from the [g]overnment. We conferred several times with [the government] about this to figure Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 10 of 23 - 11 - out what we are doing here . . . . We then had the conference with the Court because we had filed our motion [to compel] and the [g]overnment fought to arrange things in the way they arranged. So we walked away from that believing this [discovery] was a live and open issue.”); see 28 Dec. 2022 JSR at 2. The government’s first diligence argument, as noted supra Section IV.A, is plaintiffs filed their Motion to Compel on the final day of discovery and thus did not diligently pursue this request. Gov’t’s Disc. Resp. at 33–34; Tr. at 84:21–23 (“[THE GOVERNMENT:] [Plaintiffs] did nothing between March and July. There was no agreement to table during that four-month period. And then in July, they filed a motion [to compel.]”). Despite the already pending 11 February 2020 “request for all class hospital data,” the government contends plaintiffs “should have filed more motions to compel” earlier in the discovery period. Tr. at 85:4–10; Tr. at 107:2– 5 (“[PLAINTIFFS:] [The government is saying] we raised [these discovery issues] too long ago and didn’t come back often enough.”). To the extent the government alleges “filing a motion to compel on the very last day of discovery is . . . untimely, not diligent,” however, the government overlooks the significance of plaintiffs’ timely February 2020 request. See Gov’t’s Disc. Resp. at 34. Plaintiffs did not first make this request the day discovery closed; they asked the government to produce these documents early in the discovery period. Pls.’ Disc. Mot. at 4–5. Plaintiffs then “conferred several times with” the government and waited to see whether the government’s production would be sufficiently responsive to their February 2020 request despite the government’s objection. Tr. at 104:24–105:6 (“[PLAINTIFFS]: We served the discovery request in the discovery period. We got objections from the [g]overnment. We conferred several times with [the government] about this . . . We then . . . filed our motion. . . .”). Thus, only when it became clear the government was not going to produce plaintiffs’ requested information or any comparable data in the final days of the discovery period did plaintiffs file a motion to compel. Id. Further, the government’s cited cases for the proposition motions filed at the end of discovery are untimely are from out-of-circuit district courts and contain factual situations inapposite to this case. See Gov’t’s Disc. Resp. at 34 (first citing Rainbow Energy Mktg. Corp. v. DC Transco, LLC, No. 21-CV-313, 2022 WL 17365260, at *2 (W.D. Tex. Dec. 1, 2022) (denying a renewed motion to compel after: (1) the plaintiff’s initial motion was denied, (2) the plaintiff filed a motion to extend discovery after the period had closed, and (3) the plaintiff filed a renewed motion to compel on the last day of extended discovery); then citing U.S. ex rel. Gohil v. Sanofi U.S. Servs., Inc., No. 02-2964, 2020 WL 1888966, at *4 (E.D. Pa. Apr. 16, 2020) (rejecting a motion to compel in part because the requesting party made a “misrepresentation that it did not know” the importance of the information until just before the close of discovery); then citing Summy-Long v. Pa. State Univ., No. 06–cv–1117, 2015 WL 5924505, at *2, *5 (M.D. Pa. Oct. 9. 2015) (denying the plaintiff’s motion to compel “because [her] request [wa]s overly broad and unduly burdensome and because granting further discovery extensions . . . would strain the bounds of reasonableness and fairness to all litigants”); then citing In re Sulfuric Acid Antitrust Litig., 231 F.R.D. 331, 332–33, 337 (N.D. Ill. 2005) (acknowledging there is “great[] uncertainty” as to whether courts should deny motions to compel filed “very close to the discovery cut-off date” and recognizing “the matter is [generally] left to the broad discretion” of the trial court “to control discovery”); then citing Toone v. Fed. Express Corp., No. Civ. A. 96-2450, 1997 WL 446257, at *8 (D.D.C. July 30, 1997) (denying the plaintiff’s motion to compel filed on the last day of discovery because (1) given the close proximity to the original date for trial, “the defendant could have responded to the request . . . on Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 11 of 23 - 12 - the day of the original trial date,” and (2) it was moot); and then citing Babcock v. CAE-Link Corp., 878 F. Supp. 377, 387 (N.D.N.Y. 1995) (denying a motion to compel regarding discovery requests served on the last day of discovery). The Court therefore is not persuaded plaintiffs’ Motion to Compel was untimely. Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197). The government further contends “[p]laintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment” this “proposed discovery request[].” Def.’s Disc. Resp. at 28. The government argues plaintiffs’ “tunnel vision” with respect to their legal theory caused plaintiffs to ignore “evidence, analysis, and law” not directly consistent with “their theories of the case, even when the [g]overnment brought such issues to the fore.” Id. at 29–30. “Turning a blind eye . . . [due to] legal error is not the same thing as having the inability to meet court deadlines,” according to the government, so “plaintiffs cannot demonstrate the requisite diligence.” Id. at 30. Although plaintiffs did not file “more motions to compel,” plaintiffs timely made their February 2020 request and timely filed their July 2020 Motion to Compel, supra. See Tr. at 85:4–9. To the extent the government alleges plaintiffs are not entitled to reopen discovery to amend their litigation strategy because the government “unmasked on summary judgment” plaintiffs’ “legal errors,” the government overlooks its own admission at oral argument, “[p]laintiffs’ request[s] [for] all class hospital data” in February and July 2020 sought the same data “[plaintiffs a]re asking for now.” Tr. 103:7–17; Def.’s Disc. Resp. at 28. Contrary to the government’s argument, plaintiffs therefore did not have “tunnel vision” causing them to ignore the requested evidence earlier in this litigation. See Def.’s Disc. Resp. at 28–30. Rather, plaintiffs requested this data during the appropriate discovery periods, only to have their request put on hold “because the [g]overnment ha[d] additional motions” it wished the Court to first decide. See Tr. at 85:12–21 (the court); Pls.’ Disc. Mot. at 4; App. to Pl.’s Disc. Mot. at 23; Tr. at 105:5–9; Def.’s Disc. Resp. at 14 (“Ultimately, the issues raised by this motion [to compel] were tabled by agreement of the parties.”); Tr. at 55:5–6 (“[PLAINTIFFS:] [T]he [g]overnment fought tooth and nail [to have the Court] hear [their] summary judgment motion first.”). Plaintiffs have thus considered these requests “a live and open issue” pending resolution of the government’s motions ever since, prompting them to file the instant Motion upon the Court issuing its Summary Judgment Order in November 2022. Tr. at 105:8–9 (“[PLAINTIFFS:] [W]e walked away from that [tabling discussion] believing this [discovery] was a live and open issue.”). Finally, while this “data [may] not [have been] necessary for summary judgment . . . [it is] for class certification.”7 Tr. at 111:10–11 (plaintiffs); Clippinger v. State Farm Mut. Auto. Ins. Co., 2021 WL 1894821, at *2 (“[C]lass certification discovery is not relevant [at the summary judgment stage].”); Tr. at 111:8–11 (“[PLAINTIFFS]: Well, I think like in Clippinger, there is some wisdom to the concept that maybe all of that data is not necessary for summary judgment, but then becomes necessary for class certification.”). To that end, the government 7 To the extent the government relies on plaintiffs’ 13 April 2020 statement plaintiffs “will not need this information [pertaining to hospitals other than the six named plaintiffs] prior to resolving [p]laintiffs’ [M]otion for [C]lass [C]ertification,” the government overlooks the substantial change in circumstances discussed infra Section IV.B.1. See Def.’s Disc. Resp. at 12–13 (quoting 21 May 2020 JSR at 3–4, ECF No. 140). The government likewise ignores plaintiffs’ agreement to table these discovery requests temporarily in October 2020, at which time plaintiffs acknowledged they would eventually re-raise these requests, even if—at the time—the plan was to do so after class certification. See Tr. at 85:12–21, 55:5–6. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 12 of 23 - 13 - cannot “object[] to [plaintiffs’ document] request” in 2020 as “irrelevant and not proportional to the needs of the case insofar as plaintiffs seek . . . [information from] thousands of hospitals” only to now argue it is too late for this discovery and “plaintiffs [have] squandered . . . their allotted discovery periods . . . .” Gov’t’s Disc. Resp. at 11, 28; Tr. at 106:7–14 (“[PLAINTIFFS:] [I]t’s almost like the [g]overnment—they’re playing gotcha here. . . . [T]hey didn’t want to give us the information at the time [of discovery] and then they say, well, here’s summary judgment first and we can defer this until later . . . and now we’ve got a summary judgment opinion and now [they] say gotcha . . . .”). Nor can the government object to turning over the requested data in 2020 and now only to “use [plaintiffs’] lack of this data as a sword” come class certification. Tr. at 126:23–127:2. Indeed, “this has never been a case where” plaintiffs “said we’re not going to look at that [requested] data . . . [or] we’re not eventually going to be coming for that.” Tr. at 126:18–20. To the contrary, plaintiffs “requested this [data] during discovery,” and have long maintained this discovery “is the way to” “figure out . . . what are we dealing with” from a class perspective, including in the JSR filed after the Court’s November 2022 Summary Judgment Order, in which plaintiffs reserved the right to move for “additional class certification fact or expert discovery.” Tr. at 44:10, 56:21–22; 28 Dec. 2022 JSR at 2. By way of the government’s objection to plaintiffs’ February 2020 request and the parties’ tabling this request in October 2020, plaintiffs “even with the exercise of due diligence[,]” could not have obtained the requested information in a way sufficient to “meet the [Court’s discovery] timetable.” Slip Track Sys., Inc., 304 F.3d at 1270. Had they “received the data in 2020,” they “would have . . . run the DPP” for all potential class members as plaintiffs now request the opportunity to. Tr. at 113:12–15. Instead, plaintiffs did not have access to the data so continued to raise this request at all reasonably appropriate times. See Tr. at 112:8–9 (“[PLAINTIFFS:] [I]t was not possible for us to have done this [DPP] calculation without th[is] data.”). The Court accordingly finds plaintiffs were sufficiently diligent to justify a finding of good cause to reopen fact discovery as to plaintiffs’ document request for “critical data related to each Potential Class member hospital,” Pls.’ Disc. Mot. at 6. Slip Track Sys., Inc., 304 F.2d at 1270. 2. Prejudice In considering whether to reopen discovery, a trial court may consider, in addition to the requesting party’s diligence, “other relevant factors including, in particular, whether allowing the amendment . . . will prejudice [the opposing party].” High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244). Prejudice related to the reopening of discovery may involve the delay of proceedings. Wordtech Sys., Inc. v. Integrated Networks Sols., Inc., 609 F.3d 1308, 1322 (Fed. Cir. 2010) (“[A] need to reopen discovery and therefore delay the proceedings supports a district court’s finding of prejudice from a delayed motion to amend the complaint.” (quoting Lockheed Martin Corp. v. Network Sols., Inc., 194 F.3d 980, 986 (9th Cir. 1999))). Further, RCFC 26(b)(1) provides: [P]arties may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case, considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to relevant information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 13 of 23 - 14 - burden or expense of the proposed discovery outweighs its likely benefit. RCFC 26(b)(1). “Questions of the scope and conduct of discovery are . . . committed to the discretion of the trial court.” Florsheim Shoe Co., Div. of Interco, Inc. v. United States, 744 F.2d 787, 797 (Fed. Cir. 1984). The government contends reopening discovery is prejudicial because “plaintiffs are proposing fact discovery on a scale never before undertaken in this case, a new expert report for the [g]overnment to then respond to, more expert depositions, and, no doubt, additional Daubert and class-related motions practice, resulting in substantial delay in bringing this matter to resolution.” Gov’t’s Disc. Resp. at 35–36 (footnote omitted). Plaintiffs, on the other hand, argue: (1) the sought after data “is . . . exclusively in [the government’s] possession”; and (2) their request will not prejudice the government because it will have an opportunity to oppose plaintiffs’ expert report. Pls.’ Disc. Reply at 3, 8. Even if there is any prejudice to the government, plaintiffs assert “the benefit to this case from the discovery would significantly outweigh any burden to the parties,” id. at 9, because of the assistance the discovery would provide the Court in ruling on class certification of the “narrower proposed class of plaintiffs,” Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428, left after summary judgment. Id. at 5, 9–10 (first citing Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428; and then citing Alta Wind I Owner Lessor C v. United States, 154 Fed. Cl. 204, 217 (2021)). Indeed, plaintiffs argue “produc[ing] the data . . . [now will be] more efficient [than production after certification] [a]s there will be less hypothetical back-and-forth between the parties [during certification briefing]” if the government’s data is available to all sides. Tr. at 118:2–6. Any prejudice could also be cured at trial by cross-examination of plaintiffs’ expert, plaintiffs contend. Pls.’ Disc. Reply at 10. The Court’s Summary Judgment Order indicated “the Court . . . needs further information regarding how plaintiffs in this post-summary judgment smaller class would meet the requirements for class certification” before deciding plaintiffs’ motion for class certification. Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 428. To that end, mirroring their requests during the 2020 discovery period, plaintiffs ask the government to provide “(1) all information Kennell used in the DPP calculations for each Potential Class member hospital, as well as the underlying calculations, and (2) all hospital outpatient claims data available for each of the Potential Class member hospitals during the relevant time period.” Pls.’ Disc. Mot. at 8–9 (emphasis added). Plaintiffs argue this discovery will “benefit . . . this case” by providing the radiology data needed to determine “who is in the [now-narrowed] class.” Pls.’ Disc. Reply at 2, 9 (“Plaintiffs’ damages are now limited to those claims involving errors in the [g]overnment’s data”); Tr. at 57:1. The government has not refuted this claim. Tr. at 132:16–25 (“THE COURT: Just to make sure I understand, can you just quickly articulate the prejudice to the [g]overnment [from the Motion to Compel the data]? . . . [THE GOVERNMENT:] The [prejudice from the] [M]otion to [C]ompel is a significant reasonableness and proportionality concern . . . .”); Tr. at 56:18–57:14 (“[PLAINTIFFS:] [W]e really followed the Court’s lead, looking at the summary judgment opinion saying . . . go back and figure out now what we are dealing with . . . [with respect to] who is in the class . . . only on the [g]overnment’s [data] . . . . [THE GOVERNMENT:] I firmly disagree with that [procedural move]. I think that [p]laintiffs are trying to jump their original expert report . . . [a]nd under the law, [they] can’t.”). Rather, the government’s primary prejudice-related allegation is plaintiffs’ request violates the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 14 of 23 - 15 - “[r]easonableness and proportionality” tenants set forth in RCFC 26(b)(1) because “[t]he [g]overnment has already incurred substantial expense,” Def.’s Disc. Resp. at 36, and plaintiffs have “not established a right to discovery of [non-named plaintiff] hospitals . . . based on what they have shown.” Tr. at 130:10–14. As the Court noted above, the government cannot argue plaintiffs’ document discovery request was too early before summary judgment and too late now that the government has incurred greater expense in litigating this case. See supra Section IV.A.1. Neither party knew the substantial impact summary judgment would have on the trajectory of this case, but the parties agreed to table plaintiffs’ discovery requests until after the Court’s summary judgment decision. See Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 395; SC Tr. at 27:13–23. As evidenced by the recent data analysis performed by the government, after summary judgment, “[g]overnment data is required to evaluate which hospitals were affected by the [g]overnment’s breach of” contract. 25 Oct. 2023 JSR at 16. Plaintiffs cannot be expected to argue, and the Court cannot “rule on[,] numerosity [and related class certification factors] if there[ i]s no evidence regarding the approximate number of hospitals who would fit the . . . requirements allowed in the summary judgment order.” Tr. at 108:6–11. The parties must both have an opportunity to review the relevant data held by the government to determine which hospitals should, or should not, be included in the putative class.8 See id. The requested data, which includes the pertinent “outpatient claims data” and the information “used in the DPP calculations,” Pls.’ Disc. Mot. at 8–9, is therefore highly relevant to the next step in this case— class certification—and, rather than delay this case, having this data will enable the Court to decide plaintiffs’ motion for class certification more efficiently. Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”). To the extent the government argues the scale of the information requested is “grossly disproportionate to the needs of the case,” Tr. at 110:22, the government ignores: (1) plaintiffs’ and the Court’s substantial need to understand “who would be in the class” come time to brief and rule on class certification, Tr. at 55:24–25; and (2) the inability of plaintiffs and the Court to access this data “exclusively in [the government’s] possession” without production by the government, Pls.’ Disc. Reply at 3. See Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399; RCFC 26(b)(1) (“[P]arties may obtain discovery regarding any nonprivileged matter that is relevant . . . and proportional . . . [considering] the parties’ relative access to [the] relevant information . . . .” (emphasis added)). The government likewise overlooks its ability to rebut any arguments plaintiffs make using this data both before and at trial. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The documents plaintiffs request are therefore highly relevant and proportional to the needs of the case as they will provide plaintiffs and the Court 8 This is not a case where, as the government alleges, plaintiffs are “attempt[ing] to use discovery to find new clients upon learning of infirmities in the claims of putative class representatives.” Def.’s Disc. Resp. at 26–27 (first citing In re Williams-Sonoma, Inc., 947 F.3d 533, 540 (9th Cir. 2020); then citing Gawry v. Countrywide Home Loans, Inc., 395 F. App’x 152, 160 (6th Cir. 2010); Douglas v. Talk Am., Inc., 266 F.R.D. 464, 467 (C.D. Cal. 2010); Falcon v. Phillips Elec. N. Am. Corp., 304 F. App’x 896, 898 (2d Cir. 2008)). Rather, plaintiffs are requesting access to information held by the government to adequately brief class certification on behalf of the existing named plaintiffs and the putative class. See Pls.’ Disc. Mot. at 2 (“After completion of this discovery, [p]laintiffs would then file an amended motion for class certification.”). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 15 of 23 - 16 - information necessary for a thorough analysis of class certification. Florsheim Shoe Co., Div. of Interco, Inc., 744 F.2d at 797; Davita HealthCare Partners, 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”); RCFC 26(b)(1). The Court accordingly finds any prejudice to the government caused by the scope of plaintiffs’ document request is mitigated by the benefit of the requested information to the efficient resolution of this case.9 See High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); Tr. at 118:2–6. The government will have ample opportunity to oppose any supplemental expert reports presented by plaintiffs using the requested data, including through cross-examination of plaintiffs’ experts at trial. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The Court therefore finds plaintiffs were diligent in pursuing this document discovery request and the government will not experience prejudice sufficient to warrant denying plaintiffs’ Motion as to the request. The Court accordingly grants plaintiffs’ document discovery request as tailored, infra Section V, to the liability found in the Court’s November 2022 Summary Judgment Order, as there is good cause to do so. See High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”); Pls.’ Disc. Mot. at 8–9. B. Plaintiffs’ Request to Depose a Government Corporate Designee Pursuant to Rule 30(b)(6) Plaintiffs also seek leave to “depose a [g]overnment corporate designee to identify which data sources were . . . available to the [g]overnment from the relevant time period, and where the relevant claims data resides.” Pls.’ Disc. Mot. at 8. Plaintiffs specify they are seeking “an hour . . . of deposition, just getting the [g]overnment to . . . confirm . . . the data sources” they have now and had during the relevant time periods “to make sure . . . there’s been no spoliation . . . .” Tr. at 117:22–25. In response, the government contends it previously identified an agency employee “as an individual with ‘discoverable information concerning TRICARE Encounter Data (TED), the DHA Military Health System Data Repository (MDR), and the creation, content and maintenance of records in both of those databases[,]’. . . [but] plaintiffs expressly declined a deposition during the established periods of fact and expert discovery[] and elected instead to proceed through limited interrogatories.” Defs.’ Disc. Resp. at 33. The government alleges “[p]laintiffs cannot reasonably be said to have been diligent in pursuing the 9 The Court emphasizes the government alone is in possession of the TMA data potentially comprising “tens of millions of records.” Tr. at 134:3. As such, the government is the only party capable of sorting and producing the large volumes of information. See RCFC 26(b)(1) (“[P]arties may obtain discovery regarding any nonprivileged matter that is relevant . . . and proportional . . . [considering] the parties’ relative access to [the] relevant information.”). Indeed, at the 19 December 2023 status conference, the government agreed it is capable of reviewing all data in its possession to identify line items of putative class members missed during DPP extraction due to issues akin to those impacting twelve out of the thirteen unextracted line items for Integris Baptist and Integris Bass Baptist. See 25 Oct. 2023 JSR; see also Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 409, 412 (2022). Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 16 of 23 - 17 - deposition that they now request when they intentionally eschewed [an offered deposition] during the established period of fact discovery.” Id. The government also reasserts its prejudice and diligence-related arguments discussed supra Section IV.A.1–2. See, e.g., id. at 28 (“Plaintiffs make no claim that it was impossible during two separate discovery periods for them to have served on the [g]overnment . . . the deposition notice . . . because it obviously was not.”); Tr. at 130:8–10 (“THE COURT: . . . So what’s the prejudice though? [THE GOVERNMENT]: Reasonableness and proportionality.”). 1. Diligence The government’s only novel diligence argument related to plaintiffs’ deposition request is plaintiffs previously declined an opportunity to depose an “an individual with ‘discoverable information concerning [TED and MDR], and the creation, content and maintenance of records in both of those databases.” Defs.’ Disc. Mot. Resp. at 33. The government otherwise broadly asserts plaintiffs were not diligent in pursuing their discovery requests. See, e.g., id. at 28. As determined supra Section IV.A.1, plaintiffs were diligent with respect to pursuing the government’s data and related information at the appropriate time during discovery. See, e.g., App. to Pls.’ Disc. Mot. at 23–24. The Court therefore only addresses the government’s argument related to previous deposition opportunities below. A “trial court ‘has wide discretion in setting the limits of discovery.’” Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197). Notwithstanding, modification of a court-imposed schedule may be done “only for good cause and with the judge’s consent.” RCFC 16(b)(4). “When assessing whether good cause has been shown, ‘the primary consideration is whether the moving party can demonstrate diligence.’” High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244). The government’s primary contention—plaintiffs were not diligent in pursuing the requested deposition because they turned down an offer to depose a government employee in May 2019—assumes a party cannot be diligent if they have, at any time in the past, “eschewed [similar discovery.]” Defs.’ Disc. Mot. Resp. at 33. Over the past four and a half years, however, this case has changed substantially. See Alta Wind I Owner Lessor C, 154 Fed. Cl. at 227 (granting additional discovery upon remand and reassignment of the case); see also Geneva Pharms. Tech. Corp., 2005 WL 2132438, at *5 (“[M]aterial events have occurred since the last discovery period, which justice requires that the parties have an opportunity to develop through discovery.”). As noted by plaintiffs, “[t]he Court’s ruling on the [g]overnment’s Summary Judgment Motion . . . fundamentally altered the scope of this case,” Pls.’ Disc. Mot. at 8, by substantially narrowing the potential class members and limiting plaintiffs’ “damages . . . to [two] claims involving errors in the [g]overnment’s data,” Pls.’ Disc. Reply at 3. “[T]o analyze the extent of the . . . error[s]” in the government’s data, 25 Oct. 2023 JSR at 16, and perform “a more accurate damages calculation” for the putative class members, Pls.’ Reply at 7, plaintiffs therefore need to understand the data sources available to the government now and at the time of line item extraction. See 25 Oct. 2023 JSR at 17 (“The only way to evaluate whether Mr. Kennell failed to extract all relevant data . . . for the entire class is for the [g]overnment to produce . . . [the discovery] [p]laintiffs seek.”); Pls.’ Disc. Reply at 7. In 2020, in contrast, at which time plaintiffs “elected . . . to proceed through limited interrogatories” rather than conduct the government’s offered deposition, the Court had not yet narrowed the scope of the case or limited the damages calculations to the government’s data. Defs.’ Disc. Resp. at 33. During the Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 17 of 23 - 18 - initial discovery periods, plaintiffs still reasonably believed their own data might be relevant and did not yet understand the importance of the government’s data. See Pls.’ Disc. Reply at 3; see also 25 Oct. 2023 JSR at 16. Plaintiffs therefore did not exhibit a lack of diligence by not accepting the government’s offer to depose an individual whose testimony, at the time, was less relevant to the case. The government has accordingly failed to produce evidence sufficient to show plaintiffs were not diligent in pursuing the requested deposition. Schism, 316 F.3d at 1300; High Point Design LLC, 730 F.3d at 1319; see also Alta Wind I Owner Lessor C, 154 Fed. Cl. at 227. 2. Prejudice As noted supra Section IV.A.2, courts considering requests to reopen discovery may consider whether and to what extent granting the request will prejudice the opposing party, including via delaying the litigation. High Point Design, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); Wordtech Sys., 609 F.3d at 1322 (quoting Lockheed Martin Corp., 194 F.3d at 986). Regarding plaintiffs’ deposition request, the government argues granting plaintiffs’ deposition request will, like plaintiffs’ document requests, result in additional expense and “substantial delay in bringing this matter to resolution.” Def.’s Disc. Resp. at 36. Plaintiffs indicated at oral argument, however, the requested deposition will be “an hour,” with the goal being simply to understand “the data sources” in the government’s possession. Tr. at 117:22. To the extent this short deposition of a government employee, which the government was prepared to allow for several years ago, will allow the case to proceed “more efficient[ly]” to class certification with fewer “hypothetical back-and-forth[s] between the parties” related to considerations like numerosity, see Tr. at 118:2–6, the Court finds the minimal potential prejudice to the government from this deposition is outweighed by the value of this information to the later stages of this litigation. Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399 (“[T]he additional time . . . does not warrant the severe sanction of exclusion of data helpful to both parties in this litigation.”). The Court therefore does not find the government’s argument regarding diligence or prejudice persuasive with respect to plaintiffs’ deposition request. The Court accordingly grants this request as there is good cause to do so.10 High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). C. Supplemental Expert Report Plaintiffs finally request leave to “serve a supplemental expert report on . . . relevant class 10 To the extent the government intended its arguments related to proportionality and relevance to apply to plaintiffs’ deposition request, the Court is unpersuaded. See Def.’s Disc. Resp. at 36. A single deposition lasting approximately one hour on subject matter on which the government previously offered to permit a deposition is not disproportionate to the needs of this case. Schism v. United States, 316 F.3d 1259, 1300 (Fed. Cir. 2002) (quoting Moore v. Armour Pharm. Co., 927 F.2d 1194, 1197 (11th Cir. 1991)); RCFC 26(b)(1). Likewise, the subject matter—the sources of the data plaintiffs request access to—is highly relevant in ensuring a complete and accurate data set free of spoliation. Schism, 316 F.3d at 1300 (quoting Moore, 927 F.2d at 1197); RCFC 26(b)(1); see supra Section IV.A.2. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 18 of 23 - 19 - issues” upon completion of the above-requested discovery. Pls.’ Disc. Mot. at 2. Specifically, plaintiffs wish to “submit a supplemental expert report analyzing the [government’s] data and applying the DPP methodology to the correct universe of outpatient radiology line items . . . .” Id. at 10; see also Pls.’ Disc. Reply at 3 (“Plaintiffs’ supplemental expert report would identify the scope of the class, as requested by the Court.”); Tr. at 73:10–14 (“[PLAINTIFFS:] [I]t is a very complex formula. And I think that it is something that . . . you would want someone with experience with these data line items going through and doing it . . . it’s [objective] math. . . . It’s essentially a claims administrator.”). Plaintiffs make clear their initial expert report was an attempt at extrapolating the named plaintiffs’ data “across the class to come up with . . . estimated number[s],” which they now wish to update with “the exact numbers” once they receive the government’s data. Tr. at 69:4–16. Plaintiffs contend “[r]eopening discovery is warranted where supplemental information from an expert would assist the Court in resolving important issues . . . [s]uch [as] . . . ‘presenting the Court with a more accurate representation of plaintiffs’ damages allegations.’” Pls.’ Disc. Reply at 6 (first citing Kennedy Heights Apartments Ltd. I, 2005 WL 6112633, at *3–4; and then quoting Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217). Likening this case to Alta Wind, plaintiffs argue the Court should conclude here an “expert report will provide the Court with a damages estimate more accurately reflecting plaintiffs’ damages position [in light of the changes to the case rendered by summary judgment] . . . and therefore will likely assist the Court.” Id. at 7 (quoting Alta Wind, 154 Fed. Cl. at 216); Tr. at 68:17–69:16 (“[PLAINTIFFS]: With respect to Ms. Jerzak and the breach of contract, she did two things [in her report.] . . . One, she compared the hospital line items to the government line items for the named [p]laintiffs and did a straight objective calculation of what was the difference. . . . She also took those numbers and extrapolated them across the class to come up with an estimated number. THE COURT: A hypothetical. [PLAINTIFFS]: Yes . . . [r]ecognizing that if the class was certified . . . we’d have to do the exact numbers.”). Plaintiffs conclude this report will “not prejudice the [g]overnment in any way, and would actually benefit the [g]overnment” by providing an “opportunity . . . to oppose” additional contentions appropriate to the posture of the case. Id. at 8 (emphasis omitted) (citing Alta Wind I Owner Lessor C, 154 Fed. Cl. at 216). Plaintiffs note, however, “in [their] mind, this [report] is something that always was going to happen after certification” at the merits stage, Tr. at 73:15– 16 (emphasis added), as they do not “need an expert report for class certification because” the government “admitted breach,” Tr. at 96:3–4; Tr. at 63:22–64:6 (“[PLAINTIFFS:] [L]et’s say the Court certified a class here. The next step . . . is for merits. Someone is going to have to spit out a report saying here are the class members and when I run their . . . data . . . here are the differences and here’s the number that gets spit out.” (emphasis added)). The government reiterates its diligence and prejudice arguments discussed supra Sections IV.A–B with respect to plaintiffs’ request for leave to file a supplemental expert report. The government likewise refutes the notion plaintiffs’ current expert report is a “placeholder . . . that was[] [not] really meant to be real.” Tr. at 70:19–20. In other words, the government contends plaintiffs “meant th[eir earlier] expert report” to apply to “their currently pending motion for class cert[ification],” Tr. at 71:21–23, and now “seek to have the Court rescue them from their own litigation choices,” including the choice to file “expert damages models [that] could never be used to measure class damages.” Def.’s Disc. Resp. at 16–17. Plaintiffs should not be permitted to file a new expert report, according to the government, simply because “they have not . . . marshaled any legally cognizable expert evidence concerning the few claims that remain” Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 19 of 23 - 20 - after summary judgment. Def.’s Disc. Resp. at 17. To the extent plaintiffs concede the requested expert report “is for [the] merits” stage and not necessary for class certification, however, the government believes “a class cannot be certified without a viable expert damages methodology meeting the requirements of Comcast,” meaning plaintiffs’ pending motion for class certification automatically fails because “the only expert evidence in the record that bears on the two types of breaches found by the Court is . . . offered by the [g]overnment.” Id. at 22– 23 (citing Comcast Corp. v. Behrend, 569 U.S. 27, 33–34 (2013)). Indeed, according to the government, “plaintiffs are left with no expert model at all as to the few remaining contract claims,” meaning they cannot adequately allege “damages are capable of measurement on a class[-]wide basis” as required by Comcast. Id. at 24 (quoting Comcast, 569 U.S. at 34). Concerning plaintiffs’ request for leave to file an expert report, the government broadly asserts plaintiffs were not diligent in pursuing their discovery requests. See, e.g., Def.’s Disc. Resp. at 28. As determined supra Section IV.A.1, however, plaintiffs were diligent with respect to pursuing the requested discovery generally. Plaintiffs requested the relevant data in February and July 2020 and planned to replace “the extrapolation” present in their earlier expert reports with analysis “using actual data” upon completion of this requested discovery. See supra Section IV.A.1; Tr. at 136:15–23. The Court’s November 2022 Summary Judgement Order narrowed the scope of this case and further highlighted the need for this additional discovery related to the remaining issues and potential class members. See supra Section IV.A.1, B; Ingham Reg’l Med. Ctr., 163 Fed. Cl. at 427. Further, to the extent the government alleges plaintiffs requested expert report is prejudicial, the government will have sufficient time and opportunity to rebut any supplemental expert report filed by plaintiffs. See supra Section IV.A.2, B.2; Alta Wind I Owner Lessor C, 154 Fed. Cl. at 217 (“Other Court of Federal Claims judges have noted that providing the government an opportunity to file a rebuttal mitigates any prejudice that may have otherwise existed in providing plaintiff the opportunity to reopen the record.”). The contemplated expert report, which will perform the DPP analysis for outpatient radiology claims data within the scope of the Court’s November 2022 liability findings for each putative class member hospital using “only the [government’s] data” as required by the Court’s Summary Judgment Order, could also aid the Court at the merits stage in determining “the amount[] that each hospital is owed.” Tr. at 78:7–15. The requested report therefore would likely not be prejudicial to the government to such an extent as to “warrant the severe sanction of exclusion of [useful] data.” Davita HealthCare Partners, Inc., 125 Fed. Cl. at 399; High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). Plaintiffs acknowledge, however, the updated calculations they plan to include in their requested expert report are not necessary until “after [class] certification”—at the merits stage. Tr. at 73:15–16. At oral argument, plaintiffs clearly stated they do not “need an expert report for class certification,” which is the next step in this litigation. Tr. at 96:3–4. To the extent the government argues plaintiffs’ certification motion will necessarily fail because plaintiffs lack evidence “damages are [measurable] . . . on a class[-]wide basis” in response to this statement by plaintiffs, Def.’s Disc. Rep. at 23 (quoting Comcast, 569 U.S. at 34), plaintiffs respond the DPP Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 20 of 23 - 21 - is the requisite means of “calculat[ing] damages for every single class member,” Tr. at 136:4–5. While the Court reserves judgment as to plaintiffs’ class certification motion, plaintiffs’ argument the DPP provides their model for calculating damages on a class-wide basis because it is a uniform model applicable to all putative class members is sufficient to suggest plaintiffs need not fully calculate alleged damages in a supplemental expert report at this time. Tr. at 54:9–15 (“[PLAINTIFFS:] I think the type of cases that [the government] is talking about [like Comcast] where there’s been [a failure by the plaintiffs to actually address the calculation of class-wide damages, are inapposite because] we haven’t offered a model that is deviating from the contract. What we’re saying . . . the experts are going to . . . essentially crunch[ the] numbers [using the DPP].”). Plaintiffs can do so if and when the merits of this case are argued at trial. This is not a case like Comcast, in which the plaintiffs presented to the court “a methodology that identifies damages that are not the result of the wrong” at issue. Comcast, 569 U.S. at 37. Here, in contrast, the parties indicated at oral argument plaintiffs’ proffered DPP methodology from the parties’ DPP Contracts appears capable of calculating damages for all potential class members. Tr. at 136:1–5 (“[PLAINTIFFS:] But what I will tell you that we’re going to do with the data is we are going to have the auditor [i.e., the expert] plug [the government’s] data into the DPP. That is the model. That is [what] the contract . . . dictates . . . how you calculate damages for every single class member.”); Tr. at 54:12–13 (“[PLAINTIFFS:] [W]e haven’t offered a model that is deviating from the contract.”); Tr. at 93:2–5 (“THE COURT: But the model is just what you said is—if I understood correctly, is that the report is just DPP data discrepancy output. [THE GOVERNMENT]: For each individual [p]laintiff.”); see Tr. 93:2–95:25. The Court accordingly denies plaintiffs’ request for an expert report without prejudice in the interest of the efficient disposition of plaintiffs’ class certification motion. High Point Design LLC, 730 F.3d at 1319 (quoting Kassner, 496 F.3d at 244); 6A CHARLES A. WRIGHT ET AL., FEDERAL PRACTICE AND PROCEDURE § 1522.2 (3d ed. 1998) (“What constitutes good cause sufficient to justify the modification of a scheduling order necessarily varies with the circumstances of each case.”). To the extent plaintiffs “would want in [the] merits” stage an expert report from an “auditor to make sure” the parties “all agree on” damages calculated via the DPP, plaintiffs may refile this motion at that time. Tr. at 96:12–13 (plaintiffs). V. Scope of Granted Discovery and Next Steps As discussed supra Section IV: 1. The Court grants plaintiffs’ deposition request. 2. The Court grants plaintiffs’ document requests as follows: Plaintiffs are permitted to serve amended document discovery requests for all putative class member hospitals tailored to seek only those documents required for plaintiffs to identify “breach[es] of TMA’s [contractual] duty” under the DPP Contract akin to either: (1) the government’s failure to extract “thirteen line items for Integris Baptist and Integris Bass Baptist”; or (2) the government’s failure to adjust “five . . . line items” for Integris Baptist “during the DPP because of an alternate zip code.” See Ingham Reg’l Med. Ctr. v. United States, 163 Fed. Cl. 384, 409, 412 (2022). This specification ensures plaintiffs’ requests remain within the scope of the Court’s findings of liability in November 2022. Id. The Court notes at the 19 December 2023 status conference the government agreed it is possible to Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 21 of 23 - 22 - execute the same analysis performed on the named plaintiffs’ data in the 25 October 2023 JSR on the government’s data for all putative class members. 11 3. The Court denies plaintiffs’ request to file a supplemental expert report without prejudice. Plaintiffs may move to file an updated expert report later in this litigation as necessary, at which time the government will be permitted to file a response report. Within three weeks of the date this Order is issued, the parties shall file a JSR comprised of the following: 1. Plaintiffs’ discovery requests revised in accordance with the above clarifications; 2. The parties’ proposed schedule for discovery, including a timeline for plaintiffs’ deposition and the exchange of documents between the parties; and 3. The parties’ proposed schedule for re-briefing class certification after all discovery closes, including a proposed timeline for the filing of new expert reports. As noted by the Court at the 19 December status conference, plaintiffs’ next step should be to analyze the government’s data for the six named plaintiffs already in plaintiffs’ possession to assist plaintiffs in tailoring their document requests as discussed above. Further, at the 19 December 2023 status conference, the parties agreed the partial grant of plaintiffs’ Discovery Motion moots plaintiffs’ pending Motion to Certify Class Action and Appoint Class Counsel, ECF No. 146, as the parties will need to re-brief these issues following the narrowing of this case on summary judgment and the upcoming additional discovery. The government agreed its pending Motion to Exclude Inadmissible Evidence Relied Upon in Plaintiffs’ Motion for Class Certification, ECF No. 204, is accordingly moot. The government may refile a similar motion if needed during future class certification briefing. Plaintiffs likewise agreed to withdraw without prejudice their Motion to Exclude the Expert Opinions and Continued Participation of Kennell, ECF No. 251, pending further discovery and briefing. Further, plaintiffs agreed, given the scope of this case after summary judgment, the expert report of Fay is moot. Accordingly, the government’s Motion to Exclude the Expert Opinions of Fay, ECF No. 206, is moot. Finally, plaintiffs stated they plan to file a new expert report replacing that of Jerzak later in this litigation. The government noted at the 19 December status conference plaintiffs’ replacement of Ms. Jerzak’s current report will render the government’s Motion to Exclude the Expert Opinions of Jerzak, ECF No. 205, moot as well. 11 As discussed supra note 4, in the 25 October 2023 JSR, the government explained why twelve of the thirteen line items improperly excluded for Integris Baptist and Integris Bass Baptist were not extracted. At the 19 December 2023 status conference, the government indicated it can now search its database for line items improperly excluded due to this same error for all hospitals that participated in the DPP. The government noted, however, it is not aware of what caused the thirteenth line item to be missed so cannot create search criteria appropriate to identifying other similar misses. Finally, to identify missed alternate zip codes, the government stated it would need zip code information from plaintiffs and the putative class members. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24 Page 22 of 23 - 23 - VI. Conclusion For the foregoing reasons, and as specified supra Section V, the Court GRANTS-INPART and DENIES-IN-PART plaintiffs’ Motion for Leave to Conduct Certain Limited Additional Discovery and to Submit Supplemental Expert Report, ECF No. 269, and FINDS as MOOT plaintiffs’ Motion for Clarification or, in the Alternative, to Compel Production, ECF No. 161.12 As noted supra Section V, the Court FINDS as MOOT plaintiffs’ Motion to Certify Class Action and Appoint Class Counsel, ECF No. 146, the government’s Motion to Exclude Inadmissible Evidence Relied Upon in Plaintiffs’ Motion for Class Certification, ECF No. 204, the government’s Motion to Exclude the Expert Opinions of Fay, ECF No. 206, and the government’s Motion to Exclude the Expert Opinions of Jerzak, ECF No. 205. As agreed to at the 19 December 2023 status conference, plaintiffs SHALL WITHDRAW their Motion to Exclude the Expert Opinions and Continued Participation of Kennell, ECF No. 251, without prejudice. Finally, as noted at oral argument, see Tr. at 139:10–140:8, the Court STRIKES the government’s Notice of Additional Authority, ECF No. 273, as deficient and GRANTS the government’s Unopposed Motion for Leave to File Notice of Supplemental Authority, ECF No. 274, for good cause shown. The parties SHALL FILE the joint status report discussed supra Section V on or before 23 January 2024. IT IS SO ORDERED. s/ Holte HOLTE Judge 12 At oral argument, the parties agreed the Court ruling on plaintiffs’ current Discovery Motion is also a “ruling on [plaintiffs’ previous Motion to Compel,] ECF [No.] 161.” Tr. at 139:2–9. Case 1:13-cv-00821-RTH Document 286 Filed 01/02/24",Legal,Find & Summarize,Text Transformation Only use the provided context to create your answers. Be concise and limit your response to 250 words or less.,"What are the areas of competency required for digital transformation? Give an example of each, if available.","What does it take? A digital transformation requires five areas of competency: Adopting new technology A definitive feature of a digital transformation is that it involves the adoption of new software-based digital capabilities or technology infrastructure. It’s not necessary that these use emergent technologies such as Machine Learning, Augmented Reality, or Blockchain, so long as they support innovation, the creation of new value to customers, or operational efficiencies. Using data With digital transformation comes an explosion in the data available about your products and target markets. That means that collecting, analyzing, and using data to make good decisions is key. Being good at it can give you a competitive advantage. Being bad is just the opposite. In an increasingly data-led competitive environment, new strategies must be based on objective information where possible. As put in a 2017 article by The Economist [2], “The world’s most valuable resource is no longer oil, but data.” Customer focus Understanding your customers is critical for any business and even more so when trying new ways of working in new markets or business areas. These insights help you understand what can potentially increase customer satisfaction and, ultimately, sales. As a business, it means having the capability to get deep customer insights, experiment with ideas, and adapt and evolve your offering or business model in response. The mantra ‘constant change’ applies to your markets, competitors and customers, and your business. Continually learning what your customers care about (i.e., value) and where the market is heading must be embedded within your organization. Cross-functional collaboration and processes Today’s digital products are highly complex and involve many specialists to bring them to market, from skilled software developers and designers to User eXperience (UX) experts, DevOps, and Product Managers. No one individual has all the insights or skills necessary for success - a team of specialists working closely together is needed. In many companies, you see organizational silos, which can make cross-functional teamwork hard. Empire building and old-fashioned power hierarchies (founded on the human tendency for large egos to dominate) are often the reason. In these silos, top-down decision making, known as command-and-control, is often the result. However, this can exclude vital insights from other functions. Building software products is a creative process, and diverse skills and viewpoints in the team drive better results. Organization structures and processes that promote cross-functional working can bring out the best from all the different specialisms and maximize the odds of success. Having everyone’s primary home as an autonomous team (or squad) focused on a specific product/element is often held up as the ideal example of how to do this. However, more often we see a product management department with Product Managers leading virtual teams who are working on their product(s). Capacity to change and adopt a digital mindset Digital transformation requires fundamental changes within an organization, which go to the heart of its business model, culture, and operations. Companies must be willing to take a risk by experimenting with new business models and new ways of doing things. For example, incentivizing Sales to sell software rather than hardware or changing the business case approach to see software products as an ongoing development rather than a one-off project. A good example is the car industry in Europe. Over the last couple of years, it has been trying to adopt this digital mindset and move from the paradigm of a hardware-centric product (a one-off sale of a car) to a more softwarecentric approach. With continuous updates to the car’s software this opens up the potential for new additional and ongoing revenue. This is possible only if the leadership and people in a company adopt a digital mindset. It’s about thinking about digital as the default approach rather than a series of one-off transformation projects.","What are the areas of competency required for digital transformation? Give an example of each, if available. Only use the provided context to create your answers. Be concise and limit your response to 250 words or less. What does it take? A digital transformation requires five areas of competency: Adopting new technology A definitive feature of a digital transformation is that it involves the adoption of new software-based digital capabilities or technology infrastructure. It’s not necessary that these use emergent technologies such as Machine Learning, Augmented Reality, or Blockchain, so long as they support innovation, the creation of new value to customers, or operational efficiencies. Using data With digital transformation comes an explosion in the data available about your products and target markets. That means that collecting, analyzing, and using data to make good decisions is key. Being good at it can give you a competitive advantage. Being bad is just the opposite. In an increasingly data-led competitive environment, new strategies must be based on objective information where possible. As put in a 2017 article by The Economist [2], “The world’s most valuable resource is no longer oil, but data.” Customer focus Understanding your customers is critical for any business and even more so when trying new ways of working in new markets or business areas. These insights help you understand what can potentially increase customer satisfaction and, ultimately, sales. As a business, it means having the capability to get deep customer insights, experiment with ideas, and adapt and evolve your offering or business model in response. The mantra ‘constant change’ applies to your markets, competitors and customers, and your business. Continually learning what your customers care about (i.e., value) and where the market is heading must be embedded within your organization. Cross-functional collaboration and processes Today’s digital products are highly complex and involve many specialists to bring them to market, from skilled software developers and designers to User eXperience (UX) experts, DevOps, and Product Managers. No one individual has all the insights or skills necessary for success - a team of specialists working closely together is needed. In many companies, you see organizational silos, which can make cross-functional teamwork hard. Empire building and old-fashioned power hierarchies (founded on the human tendency for large egos to dominate) are often the reason. In these silos, top-down decision making, known as command-and-control, is often the result. However, this can exclude vital insights from other functions. Building software products is a creative process, and diverse skills and viewpoints in the team drive better results. Organization structures and processes that promote cross-functional working can bring out the best from all the different specialisms and maximize the odds of success. Having everyone’s primary home as an autonomous team (or squad) focused on a specific product/element is often held up as the ideal example of how to do this. However, more often we see a product management department with Product Managers leading virtual teams who are working on their product(s). Capacity to change and adopt a digital mindset Digital transformation requires fundamental changes within an organization, which go to the heart of its business model, culture, and operations. Companies must be willing to take a risk by experimenting with new business models and new ways of doing things. For example, incentivizing Sales to sell software rather than hardware or changing the business case approach to see software products as an ongoing development rather than a one-off project. A good example is the car industry in Europe. Over the last couple of years, it has been trying to adopt this digital mindset and move from the paradigm of a hardware-centric product (a one-off sale of a car) to a more softwarecentric approach. With continuous updates to the car’s software this opens up the potential for new additional and ongoing revenue. This is possible only if the leadership and people in a company adopt a digital mindset. It’s about thinking about digital as the default approach rather than a series of one-off transformation projects.",Internet/Technology,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","Summarize the text in 5 sentences with 20 words. Then provide a two-sentence example of an important quantitative finding. Finally, list the 5 limitations of the study.","Discussion Our most important finding is the inverse correlation between the presence of a chronic disease and the likelihood of treatment of an unrelated disorder. In no case did the presence of the chronic disease justify withholding an effective medical treatment. The results are compatible with the theory that one disease provides protection against other diseases, but this theory is unlikely to be correct, given medical pathophysiology and shared underlying predisposing factors.19–22 Instead, our findings suggest a shortfall in health care — specifically, that unrelated disorders are relatively neglected in patients with chronic medical diseases. Our work has several limitations, of which three merit emphasis. First, the study was not a randomized trial: it is not possible to assign patients randomly to have or not to have a chronic disease. Subtle confounding could contribute to and possibly justify the observed differences. However, imbalances related to age, sex, insurance status or carrier, ability to pay, or random chance would not explain the findings. Second, optimal rates of secondary treatments are controversial. In theory, our findings could be explained by postulating the overtreatment of patients who do not have chronic diseases. If true, this postulate could represent a potentially more common failure in medical decision making. Finally, the mechanism underlying the results remains a topic for future research — in particular, the question of whether the second disease is not detected in the presence of the first or whether it is detected but not treated. The observed results might arise from several sources. Patients with chronic diseases may be exhausted and reluctant to accept multiple interventions. Clinicians are often busy and may strive to keep care simple, particularly if they do not have relatively more time for the patients with relatively more complicated conditions. A chronic disease — particularly chronic psychosis — may also limit communication between patient and doctor. Universal insurance coverage could also contribute if the implicit goal of equity is achieved by doing something for all but a lot for none. The results, however, cannot be attributed either to a tendency toward prescribing multiple medications for the elderly or to barriers in access to medical care, both of which work against finding any negative associations.23–25 Similarly, the results cannot be attributed to fraud in which more than one person uses the same health insurance card.26,27 Unrelated treatments are not always indicated for patients who have chronic diseases. Chronic diseases are sometimes associated with reduced life expectancy, making long-term preventive therapy unrewarding. Adding supplementary medications often increases the risk of unwanted drug interactions and the potential for an adverse event. Prescribing additional medications for an unrelated disorder might also alter a patient's compliance with essential medications and indirectly cause harm. Time constraints, communication problems, the patient's preferences, and the priorities of the specialist involved sometimes make it difficult to address more than one problem effectively in any one patient. Finally, it is often sensible to postpone minor treatments until major problems are resolved. The unrelated treatments we chose had important implications for each selected chronic disease. Patients with diabetes mellitus are at increased risk for atherosclerosis and may be particularly likely to benefit from estrogen-replacement therapy.28,29 The reserve capacity of patients with pulmonary emphysema is seriously compromised, and they may be unable to tolerate even a small cardiovascular event.30,31 Patients with psychotic syndromes are often sensitive to discomfort and theoretically might have further worsening of their mental status as a result of joint pain.32,33 In all three examples, inadvertent undertreatment may have consequences. Furthermore, these examples are similar to other reported cases of mistakes in the care of patients who have more than one illness.34–36","""================ ======= Discussion Our most important finding is the inverse correlation between the presence of a chronic disease and the likelihood of treatment of an unrelated disorder. In no case did the presence of the chronic disease justify withholding an effective medical treatment. The results are compatible with the theory that one disease provides protection against other diseases, but this theory is unlikely to be correct, given medical pathophysiology and shared underlying predisposing factors.19–22 Instead, our findings suggest a shortfall in health care — specifically, that unrelated disorders are relatively neglected in patients with chronic medical diseases. Our work has several limitations, of which three merit emphasis. First, the study was not a randomized trial: it is not possible to assign patients randomly to have or not to have a chronic disease. Subtle confounding could contribute to and possibly justify the observed differences. However, imbalances related to age, sex, insurance status or carrier, ability to pay, or random chance would not explain the findings. Second, optimal rates of secondary treatments are controversial. In theory, our findings could be explained by postulating the overtreatment of patients who do not have chronic diseases. If true, this postulate could represent a potentially more common failure in medical decision making. Finally, the mechanism underlying the results remains a topic for future research — in particular, the question of whether the second disease is not detected in the presence of the first or whether it is detected but not treated. The observed results might arise from several sources. Patients with chronic diseases may be exhausted and reluctant to accept multiple interventions. Clinicians are often busy and may strive to keep care simple, particularly if they do not have relatively more time for the patients with relatively more complicated conditions. A chronic disease — particularly chronic psychosis — may also limit communication between patient and doctor. Universal insurance coverage could also contribute if the implicit goal of equity is achieved by doing something for all but a lot for none. The results, however, cannot be attributed either to a tendency toward prescribing multiple medications for the elderly or to barriers in access to medical care, both of which work against finding any negative associations.23–25 Similarly, the results cannot be attributed to fraud in which more than one person uses the same health insurance card.26,27 Unrelated treatments are not always indicated for patients who have chronic diseases. Chronic diseases are sometimes associated with reduced life expectancy, making long-term preventive therapy unrewarding. Adding supplementary medications often increases the risk of unwanted drug interactions and the potential for an adverse event. Prescribing additional medications for an unrelated disorder might also alter a patient's compliance with essential medications and indirectly cause harm. Time constraints, communication problems, the patient's preferences, and the priorities of the specialist involved sometimes make it difficult to address more than one problem effectively in any one patient. Finally, it is often sensible to postpone minor treatments until major problems are resolved. The unrelated treatments we chose had important implications for each selected chronic disease. Patients with diabetes mellitus are at increased risk for atherosclerosis and may be particularly likely to benefit from estrogen-replacement therapy.28,29 The reserve capacity of patients with pulmonary emphysema is seriously compromised, and they may be unable to tolerate even a small cardiovascular event.30,31 Patients with psychotic syndromes are often sensitive to discomfort and theoretically might have further worsening of their mental status as a result of joint pain.32,33 In all three examples, inadvertent undertreatment may have consequences. Furthermore, these examples are similar to other reported cases of mistakes in the care of patients who have more than one illness.34–36 https://www.nejm.org/doi/full/10.1056/NEJM199805213382106 ================ ======= Summarize the text in 5 sentences with 20 words. Then provide a two-sentence example of an important quantitative finding. Finally, list the 5 limitations of the study. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Find & Summarize,Text Transformation You are given a reference document. You must only use information found in the reference document to answer the question asked.,"In what ways do companies within the sharing economy (Uber, Airbnb) evade governmental regulations but remain in business?","Case Studies in Ethics: Teaching Caselettes dukeethics.org This work is licensed under the Creative Commons Attribution - Noncommercial - No Derivative Works 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0/. You may reproduce this work for non-commercial use if you use the entire document and attribute the source: The Kenan Institute for Ethics at Duke University. The term “Sharing Economy” refers to individuals directly interacting with each other online to exchange goods and services, which is also known as collaborative consumption. Individuals connect to each other through websites or phone applications, like Airbnb or Uber, which create the market space for peer-to-peer interactions. Through these sites and apps, people rent out their extra rooms on Airbnb, or rent the empty backseats of their car for travellers on Uber. However, Uber and Airbnb are beginning to face regulation concerns, which introduces the questions of what, why and how to regulate these companies. This case study will use the ethical frameworks of utilitarianism and Rawlsianism to address the regulatory issues of collaborative consumption, specifically the companies Airbnb and Uber. This case study was completed under the direction of Dr. Amber Díaz Pearson, The Kenan Institute for Ethics. THE ETHICS OF REGULATING THE SHARING ECONOMY Teaching Caselette Alexandra Zrenner Case Studies in Ethics 2 dukeethics.org Background Collaborative consumption has many economic benefits: the decline of transaction costs, increased efficiency and thus increased profits. The Internet, namely websites and phone applications, minimizes the transaction costs – the cost to the producer and consumer to conduct business – by directly connecting suppliers and consumers. Collaborative consumption companies also enable individuals to sell the unused potential of an owned good for another’s temporary use, which further increases efficiency. Owners profit from the unused potential, and consumers save from renting rather than owning. The result of the growing collaborative economy and its efficiency is a peerto-peer rental market worth $26 billion.1 Airbnb and Uber are two popular examples of collaborative consumption companies. Airbnb is a website on which Hosts offer their homes, or rooms in their homes, to Guests for visits. Uber is an application for smartphones that connects Riders to pay Drivers for a ride. The companies’ Terms of Service, which users agree to upon using Airbnb or Uber, define the companies as the platforms that facilitate the transactions between all users and the company. Given these Terms of Service, Airbnb and Uber are not held to full legal responsibility for the actions of the site or application users. Regulations The practices of Airbnb and Uber create regulatory concerns related to market competition, consumer protections, and the legality of the companies’ practices. Regulators must balance protecting established industries and assisting developing industries; decide to what standards of consumer safety the companies should be held; and determine the legality of the new companies’ practices. Competition The expectation in a capitalist and competitive economy is that innovation encourages competition and vice versa, which further increases efficiency. Airbnb and Uber use innovative online technologies to offer consumers new ways to find a place to stay or a ride. For example, consumers can choose to pay an Airbnb Host or a range of hotels for similar services, so Airbnb and hotels must compete for the consumer. Airbnb can offer lower prices to a consumer due to the company’s use of innovative online technology that minimizes production and transaction costs. The hotel industry has higher costs that must cover workers’ wages and property maintenance. Stephen Dubner, writer of Freakonomics: The Hidden Side of Everything and host of the podcast by the same name, discussed how the innovations of Airbnb and Uber might fit the “creative destruction” model in economics.2 The term “creative destruction” was first presented in 1942 by Austrian economist Joseph Schumpeter to describe how new innovations or companies compete with the established technologies or companies, and the success of the new means the disappearance of the established.3Within this model, the prediction is that, more consumers would choose Airbnb and Uber, increasing Airbnb’s and Uber’s profits. Simultaneously, the profits of the hotel and taxi companies would fall until every hotel and taxi company leaves the industry, leading to the disappearance of those industries. 1 “The Rise of the Sharing Economy.” The Economist. The Economist Newspaper, 09 Mar. 2013. Web. 27 Mar. 2015. 2 Dubner, Stephen. “Re: Regulate This!” Audio blog comment. Freakonomics: The Hidden Side of Everything. Freakonomics, LLC, 4 Sept. 2014. Web. 1 Apr. 2015. 3 W. Michael Cox and Richard Alm, “Creative Destruction.” The Concise Encyclopedia of Economics. 2008. Library of Economics and Liberty. 27 March 2015. . Case Studies in Ethics 3 dukeethics.org Airbnb, Uber, hotels and taxi companies, and regulators are aware of the creative destruction model’s prediction. In this model, Airbnb and Uber would be “winners”: the competition between Airbnb and Uber and hotels and taxi companies should increase the overall welfare of those within the room- and ride-providing markets. On the other hand, local, state and federal policymakers aiming to protect careers in the hotel and taxi industries argue that the disappearance of these industries would cause greater harm to society than the improvements that would result from the newer companies. Consumer Protections Many established regulations for the hotel and taxi industry exist for consumer protection: safety standards, antidiscrimination laws, etc. However, Airbnb and Uber are not a hotel or taxi service; they are platforms that are not directly legally responsible for the same standards a hotel or taxi may be responsible to. Airbnb and Uber argue that they developed methods to be regulated by themselves and their users. Competitive economic theory holds that producer- or consumer-based methods of regulation will provide the most efficient outcome, and that government regulations are comparatively inefficient. Producer-based regulation is called “delegated regulation”: the local government sets standards and allows Airbnb and Uber to determine whether or not they met these standards themselves. The consumer-based method of regulation is reviews: users write reviews of Airbnb Hosts and Uber Drivers, incentivizing positive Host and Driver behavior, and regulating the quality and standards of the Hosts and Drivers. Regulators concerned with consumer safety do not consider delegated regulation and consumer reviews adequate substitutes for government standards of consumer protection. Consumer reviews may not address fire standards of the apartment or emissions standards of a car. In addition, producer-based delegated regulation lacks accountability measures to ensure the companies protect the consumers. While the government can set the standards, the companies must hold themselves accountable, which worries regulators. Consumer-safety regulators and sometimes even Uber customers criticize Uber’s practice of surge pricing as a violation of consumer protections. Uber uses an algorithm to surge prices – an increase of prices resulting from an increase in demand (as economic theory would predict). The increase in price should signal more drivers to offer rides. This in turn should increase consumers’ welfare since they have more access to the service, and the drivers’ welfare should increase from receiving higher profits. Although Uber references this economic theory to explain the use of surge pricing, some critics have questioned the wisdom of allowing an algorithm in all situations and scenarios. For example, Uber’s algorithm surged prices during the Sydney, Australia shooting and during natural disasters like Northeastern winter storms. Consumers do not know the algorithm, and question if Uber is abusing the consumer’s safety during natural disasters or perilous situations. Taxes & Legality of Practice Airbnb and Uber have been criticized for their Hosts and Drivers not complying with city, state or federal law. In cities where Airbnb and Uber operate, the legality of renting out your empty rooms or backseats varies and may be ambiguous depending on the location.4 New York and California have existing laws on zoning, home rentals, and taxi regulations that address the legality of ride-sharing or charging guests for temporary home or room rentals. In many cities, temporary home or room rentals or charging individuals for rides require city permission. However, 4 Streitfeld, David. “Airbnb Listings Mostly Illegal, New York State Contends.” The New York Times. The New York Times, 15 Oct. 2014. Web. 27 Mar. 2015. Case Studies in Ethics 4 dukeethics.org the average Host or Driver does not seek out city operating permits because the Hosts and Drivers don’t know how to obtain the permits, or don’t think they would need a permit for their primary residence or car. Governments, mainly at the local and state levels, are concerned about the questionable legality of Airbnb and Uber transactions, and the lack of taxes collected from these transactions. To address these concerns, Airbnb is reaching out to cities and states to help legislators draft or adjust legislation. In addition, on the “Frequently Asked Questions” page, Airbnb informs and requires Hosts to be aware of and comply with local laws and their landlord’s rental policies, both of which may prohibit short-term rentals. Airbnb has worked with San Francisco, Portland, New York and the District of Columbia to address the concerns of the city and to help legislatures draft new laws to ensure that Airbnb users do not violate city laws. For example, Airbnb recently started to collect hotel taxes from Washington, D.C. Hosts and to send the collected funds directly to the city. 5 In doing so, Airbnb protects the information of its Hosts so that the city could not punish the Hosts for the ambiguous legality of their actions, and ensures the city does not financially suffer from loss of tax revenue. Airbnb’s active efforts to work with governments to address regulatory concerns are an example of self-regulation happening within the market. As such, some supporters of Airbnb argue that the company does not need any additional outside governmental regulations. Uber, in contrast, has not reached out to address legislative or tax concerns, and its main concern is regulatory. Uber’s interactions with governments have resulted in government delegating regulatory responsibilities to Uber rather than the typical arrangement of the government regulating the company.6 Some advocates argue that this delegated regulation is efficient, so any further government regulation would be inefficient and unnecessary. Nonetheless, regulators may be concerned that these Airbnb and Uber-created regulations are still insufficient to meet government standards. 5 Badger, Emily. “Airbnb Is about to Start Collecting Hotel Taxes in More Major Cities, including Washington.” Washington Post. The Washington Post, 29 Jan. 2015. Web. 27 Mar. 2015. 6 Uber argues that its methods regulating Drivers with background checks are sufficient if not better than government background checks. Uber is pushing and lobbying against regulations that are similar to taxi regulations that may hinder Uber growth. Regulators, however, question Uber’s concern of legality and consumer safety. Isaac, Mike. “Uber’s System for Screening Drivers Draws Scrutiny.” The New York Times. The New York Times, 09 Dec. 2014. Web. 07 Apr. 2015. ","You are given a reference document. You must only use information found in the reference document to answer the question asked. In what ways do companies within the sharing economy (Uber, Airbnb) evade governmental regulations but remain in business? Case Studies in Ethics: Teaching Caselettes dukeethics.org This work is licensed under the Creative Commons Attribution - Noncommercial - No Derivative Works 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0/. You may reproduce this work for non-commercial use if you use the entire document and attribute the source: The Kenan Institute for Ethics at Duke University. The term “Sharing Economy” refers to individuals directly interacting with each other online to exchange goods and services, which is also known as collaborative consumption. Individuals connect to each other through websites or phone applications, like Airbnb or Uber, which create the market space for peer-to-peer interactions. Through these sites and apps, people rent out their extra rooms on Airbnb, or rent the empty backseats of their car for travellers on Uber. However, Uber and Airbnb are beginning to face regulation concerns, which introduces the questions of what, why and how to regulate these companies. This case study will use the ethical frameworks of utilitarianism and Rawlsianism to address the regulatory issues of collaborative consumption, specifically the companies Airbnb and Uber. This case study was completed under the direction of Dr. Amber Díaz Pearson, The Kenan Institute for Ethics. THE ETHICS OF REGULATING THE SHARING ECONOMY Teaching Caselette Alexandra Zrenner Case Studies in Ethics 2 dukeethics.org Background Collaborative consumption has many economic benefits: the decline of transaction costs, increased efficiency and thus increased profits. The Internet, namely websites and phone applications, minimizes the transaction costs – the cost to the producer and consumer to conduct business – by directly connecting suppliers and consumers. Collaborative consumption companies also enable individuals to sell the unused potential of an owned good for another’s temporary use, which further increases efficiency. Owners profit from the unused potential, and consumers save from renting rather than owning. The result of the growing collaborative economy and its efficiency is a peerto-peer rental market worth $26 billion.1 Airbnb and Uber are two popular examples of collaborative consumption companies. Airbnb is a website on which Hosts offer their homes, or rooms in their homes, to Guests for visits. Uber is an application for smartphones that connects Riders to pay Drivers for a ride. The companies’ Terms of Service, which users agree to upon using Airbnb or Uber, define the companies as the platforms that facilitate the transactions between all users and the company. Given these Terms of Service, Airbnb and Uber are not held to full legal responsibility for the actions of the site or application users. Regulations The practices of Airbnb and Uber create regulatory concerns related to market competition, consumer protections, and the legality of the companies’ practices. Regulators must balance protecting established industries and assisting developing industries; decide to what standards of consumer safety the companies should be held; and determine the legality of the new companies’ practices. Competition The expectation in a capitalist and competitive economy is that innovation encourages competition and vice versa, which further increases efficiency. Airbnb and Uber use innovative online technologies to offer consumers new ways to find a place to stay or a ride. For example, consumers can choose to pay an Airbnb Host or a range of hotels for similar services, so Airbnb and hotels must compete for the consumer. Airbnb can offer lower prices to a consumer due to the company’s use of innovative online technology that minimizes production and transaction costs. The hotel industry has higher costs that must cover workers’ wages and property maintenance. Stephen Dubner, writer of Freakonomics: The Hidden Side of Everything and host of the podcast by the same name, discussed how the innovations of Airbnb and Uber might fit the “creative destruction” model in economics.2 The term “creative destruction” was first presented in 1942 by Austrian economist Joseph Schumpeter to describe how new innovations or companies compete with the established technologies or companies, and the success of the new means the disappearance of the established.3Within this model, the prediction is that, more consumers would choose Airbnb and Uber, increasing Airbnb’s and Uber’s profits. Simultaneously, the profits of the hotel and taxi companies would fall until every hotel and taxi company leaves the industry, leading to the disappearance of those industries. 1 “The Rise of the Sharing Economy.” The Economist. The Economist Newspaper, 09 Mar. 2013. Web. 27 Mar. 2015. 2 Dubner, Stephen. “Re: Regulate This!” Audio blog comment. Freakonomics: The Hidden Side of Everything. Freakonomics, LLC, 4 Sept. 2014. Web. 1 Apr. 2015. 3 W. Michael Cox and Richard Alm, “Creative Destruction.” The Concise Encyclopedia of Economics. 2008. Library of Economics and Liberty. 27 March 2015. . Case Studies in Ethics 3 dukeethics.org Airbnb, Uber, hotels and taxi companies, and regulators are aware of the creative destruction model’s prediction. In this model, Airbnb and Uber would be “winners”: the competition between Airbnb and Uber and hotels and taxi companies should increase the overall welfare of those within the room- and ride-providing markets. On the other hand, local, state and federal policymakers aiming to protect careers in the hotel and taxi industries argue that the disappearance of these industries would cause greater harm to society than the improvements that would result from the newer companies. Consumer Protections Many established regulations for the hotel and taxi industry exist for consumer protection: safety standards, antidiscrimination laws, etc. However, Airbnb and Uber are not a hotel or taxi service; they are platforms that are not directly legally responsible for the same standards a hotel or taxi may be responsible to. Airbnb and Uber argue that they developed methods to be regulated by themselves and their users. Competitive economic theory holds that producer- or consumer-based methods of regulation will provide the most efficient outcome, and that government regulations are comparatively inefficient. Producer-based regulation is called “delegated regulation”: the local government sets standards and allows Airbnb and Uber to determine whether or not they met these standards themselves. The consumer-based method of regulation is reviews: users write reviews of Airbnb Hosts and Uber Drivers, incentivizing positive Host and Driver behavior, and regulating the quality and standards of the Hosts and Drivers. Regulators concerned with consumer safety do not consider delegated regulation and consumer reviews adequate substitutes for government standards of consumer protection. Consumer reviews may not address fire standards of the apartment or emissions standards of a car. In addition, producer-based delegated regulation lacks accountability measures to ensure the companies protect the consumers. While the government can set the standards, the companies must hold themselves accountable, which worries regulators. Consumer-safety regulators and sometimes even Uber customers criticize Uber’s practice of surge pricing as a violation of consumer protections. Uber uses an algorithm to surge prices – an increase of prices resulting from an increase in demand (as economic theory would predict). The increase in price should signal more drivers to offer rides. This in turn should increase consumers’ welfare since they have more access to the service, and the drivers’ welfare should increase from receiving higher profits. Although Uber references this economic theory to explain the use of surge pricing, some critics have questioned the wisdom of allowing an algorithm in all situations and scenarios. For example, Uber’s algorithm surged prices during the Sydney, Australia shooting and during natural disasters like Northeastern winter storms. Consumers do not know the algorithm, and question if Uber is abusing the consumer’s safety during natural disasters or perilous situations. Taxes & Legality of Practice Airbnb and Uber have been criticized for their Hosts and Drivers not complying with city, state or federal law. In cities where Airbnb and Uber operate, the legality of renting out your empty rooms or backseats varies and may be ambiguous depending on the location.4 New York and California have existing laws on zoning, home rentals, and taxi regulations that address the legality of ride-sharing or charging guests for temporary home or room rentals. In many cities, temporary home or room rentals or charging individuals for rides require city permission. However, 4 Streitfeld, David. “Airbnb Listings Mostly Illegal, New York State Contends.” The New York Times. The New York Times, 15 Oct. 2014. Web. 27 Mar. 2015. Case Studies in Ethics 4 dukeethics.org the average Host or Driver does not seek out city operating permits because the Hosts and Drivers don’t know how to obtain the permits, or don’t think they would need a permit for their primary residence or car. Governments, mainly at the local and state levels, are concerned about the questionable legality of Airbnb and Uber transactions, and the lack of taxes collected from these transactions. To address these concerns, Airbnb is reaching out to cities and states to help legislators draft or adjust legislation. In addition, on the “Frequently Asked Questions” page, Airbnb informs and requires Hosts to be aware of and comply with local laws and their landlord’s rental policies, both of which may prohibit short-term rentals. Airbnb has worked with San Francisco, Portland, New York and the District of Columbia to address the concerns of the city and to help legislatures draft new laws to ensure that Airbnb users do not violate city laws. For example, Airbnb recently started to collect hotel taxes from Washington, D.C. Hosts and to send the collected funds directly to the city. 5 In doing so, Airbnb protects the information of its Hosts so that the city could not punish the Hosts for the ambiguous legality of their actions, and ensures the city does not financially suffer from loss of tax revenue. Airbnb’s active efforts to work with governments to address regulatory concerns are an example of self-regulation happening within the market. As such, some supporters of Airbnb argue that the company does not need any additional outside governmental regulations. Uber, in contrast, has not reached out to address legislative or tax concerns, and its main concern is regulatory. Uber’s interactions with governments have resulted in government delegating regulatory responsibilities to Uber rather than the typical arrangement of the government regulating the company.6 Some advocates argue that this delegated regulation is efficient, so any further government regulation would be inefficient and unnecessary. Nonetheless, regulators may be concerned that these Airbnb and Uber-created regulations are still insufficient to meet government standards. 5 Badger, Emily. “Airbnb Is about to Start Collecting Hotel Taxes in More Major Cities, including Washington.” Washington Post. The Washington Post, 29 Jan. 2015. Web. 27 Mar. 2015. 6 Uber argues that its methods regulating Drivers with background checks are sufficient if not better than government background checks. Uber is pushing and lobbying against regulations that are similar to taxi regulations that may hinder Uber growth. Regulators, however, question Uber’s concern of legality and consumer safety. Isaac, Mike. “Uber’s System for Screening Drivers Draws Scrutiny.” The New York Times. The New York Times, 09 Dec. 2014. Web. 07 Apr. 2015. ",Legal,Effect Analysis,Q&A Using only the information in the provided context give your answer in bullet points.,What were all of the findings on the non-human test subjects?,"Because the brain is particularly vulnerable to oxidative stress, and anxiety disorders are characterized by a decrease in protective antioxidants as well as an increase in oxidative damage, treatments that protect against oxidative stress are desirable (54, 55). Multiple suggested mechanisms have been suggested to explain how oxidative stress plays a role in brain disorders. Oxidative stress can act as a trigger for these disorders and can also be a result of neuroinflammation, which has also been linked to brain-related disorders (56). Figure 3 shows how the components of ashwagandha can affect cell signaling pathways and the production of inflammatory mediators. Inflammation in peripheral tissues may directly play a role in increasing neuroinflammation and oxidative stress in the brain (56). Although there is evidence linking both oxidative stress and inflammation to brain-related disorders, it has not been conclusively proven which one causes the other or vice versa (57). Studies on animals exploring the effects of WS on anxiety have revealed a strong link between improvements in anxiety-related behavior and the amelioration of oxidative stress and inflammatory indicators. The root extract and leaf extract of WS, although not clearly described, were able to increase the levels of catalase activity and reduced glutathione (GSH) in the brain, and also lower the levels of lipid peroxidation in a mouse model of sleep deprivation and a zebrafish model of neurotoxicity induced by benzo[a]pyrene (58, 59). Furthermore, WS demonstrated the ability to decrease nitrite levels in the mouse model and also lower protein carbonylation in the zebrafish model (58, 59). In an experiment using rats to simulate an ischemic stroke, a uniform hydroalcoholic extract derived from WS roots effectively decreased the levels of lipid peroxidation and enhanced antioxidant function in the brain (60). ASH-WEX, an aqueous leaf extract, was shown to decrease pro-inflammatory cytokines, specifically TNFα and IL-6, both in the peripheral and central nervous systems, in animal models of neuroinflammation and sleep deprivation (61). ASH-WEX produced a significant reduction in indicators of reactive gliosis, such as GFAP, as well as neuroinflammation, such as NOX2, iNOS, and COX2. Furthermore, it successfully regulated various inflammatory pathways and reduced cellular death in the brain (62). In a rat experiment examining the effects of a high fat diet on obesity, the use of WS dry leaf powder significantly lessened the expression of pro-inflammatory cytokines both in the body and brain, decreased indicators of reactive gliosis and neuroinflammation, modulated the nuclear factor NF-kappa-B (NF-κB) pathway, and lowered cell death (63). Supplementation with ashwagandha has been shown to lower C-reactive protein (CRP) activity (64), one of the most important indicators of inflammation. Furthermore, other studies have shown that ashwagandha exerts a number of anti-inflammatory effects on chronic inflammation-mediated diseases (65), particularly rheumatoid arthritis (66), inflammatory bowel disorder (67), and systemic lupus erythematosus (68). These studies suggest that ashwagandha may be a useful tool for reducing the cytokine storm. Withanolides, particularly Withaferin A, are responsible for the majority of ashwagandha’s anti-inflammatory effects, according to several reports (69, 70). Ashwagandha may work by interacting with components of the proinflammatory cell signaling pathway, such as NF-κB, signaling kinases, HSP90, Nrf2, and the inflammasome complex, even though the mechanisms behind the anti-inflammatory effect of withanolides are not fully understood (71). Since the NF-κB transcription factor family is implicated in a number of chronic disorders caused by inflammation, individuals with high NF-κB levels may benefit from therapeutic targeting of NF-κB. In this situation, ashwagandha has the ability to inhibit and mediate the activity of the NF-κB pathway (72). It is thought that strong protein kinase inhibitor activity is necessary for ashwagandha to function. Ashwagandha has the ability to inhibit the signaling cascades of protein kinases, which are essential in inflammatory pathways (72). Furthermore, it appears that kinase inhibition takes place when nitric oxide synthesis is inhibited, which also benefits the inflammatory process. Another possible explanation for ashwagandha’s anti-inflammatory properties is the downregulation or destabilization of HSP activity, which is implicated in regulatory kinase pathways. As previously mentioned, ashwagandha regulates Nrf2 to moderate oxidative stress (34, 73). Nrf2 activation may account for ashwagandha’s anti-inflammatory properties, as oxidative stress frequently takes place in sites of inflammation and is thought to be one cause of chronic inflammation (74). Finally, by blocking inflammasomes, cytokines, and other multiprotein pro-inflammatory complexes, ashwagandha may lessen inflammation (7 According to some reports, ashwagandha is an adaptogen that, due to its antioxidant properties, boosts immunity, helps the body respond to stress more effectively, increases resilience, and fights oxidative stress and cellular damage (76, 77). It has been demonstrated that the bioactive C28-steroidal lactones present in WS leaves possess neuroprotective, anxiolytic, antioxidant, and anti-inflammatory properties. Moreover, Withanoside IV and its metabolite sominone, found in WS roots, have been shown to promote synaptogenesis and neuronal outgrowth. Furthermore, it has been demonstrated that the herb inhibits acetylcholinesterase and protects rats from cognitive decline (78). One study evaluated the effects of ashwagandha root extract 300 mg twice a day in humans with moderate cognitive impairment (79). After 8 weeks, the treatment group outperformed the placebo group in tests measuring immediate and general memory, information-processing speed, executive function, and attention. However, the benefits on working memory and visuospatial processing were not definitive because there was little difference between the two groups’ performance on these tasks. Another study examined the effect of ashwagandha extract on cognitive impairment in individuals with bipolar disorder (80). Tests were conducted at baseline and after the intervention, with rats randomly allocated to receive 500 mg/day of ashwagandha or a placebo for 8 weeks. When compared to the placebo, subjects in the treatment group showed significantly better results on the Flanker Test (neutral mean reaction time), the Penn Emotional Acuity Test (mean social cognition response rating), and the Auditory Digit Span (mean digit span backward). These findings suggested that ashwagandha extract may safely enhance cognitive function in bipolar disorder patients, including verbal working memory, response time, and social cognition response. Another study was carried out using ashwagandha root extract on a group of horses. The animals were subjected to a variety of stressors, including loud noises, prolonged physical activity, and separation. Following a 21-day period, the treated group showed a statistically significant reduction in cortisol, glucose, adrenaline, IL-6, lipids, creatinine, aspartate aminotransferase, and alanine aminotransferase (81).","system instruction: [Using only the information in the provided context give your answer in bullet points.] question: [What were all of the findings on the non-human test subjects?] context block: [Because the brain is particularly vulnerable to oxidative stress, and anxiety disorders are characterized by a decrease in protective antioxidants as well as an increase in oxidative damage, treatments that protect against oxidative stress are desirable (54, 55). Multiple suggested mechanisms have been suggested to explain how oxidative stress plays a role in brain disorders. Oxidative stress can act as a trigger for these disorders and can also be a result of neuroinflammation, which has also been linked to brain-related disorders (56). Figure 3 shows how the components of ashwagandha can affect cell signaling pathways and the production of inflammatory mediators. Inflammation in peripheral tissues may directly play a role in increasing neuroinflammation and oxidative stress in the brain (56). Although there is evidence linking both oxidative stress and inflammation to brain-related disorders, it has not been conclusively proven which one causes the other or vice versa (57). Studies on animals exploring the effects of WS on anxiety have revealed a strong link between improvements in anxiety-related behavior and the amelioration of oxidative stress and inflammatory indicators. The root extract and leaf extract of WS, although not clearly described, were able to increase the levels of catalase activity and reduced glutathione (GSH) in the brain, and also lower the levels of lipid peroxidation in a mouse model of sleep deprivation and a zebrafish model of neurotoxicity induced by benzo[a]pyrene (58, 59). Furthermore, WS demonstrated the ability to decrease nitrite levels in the mouse model and also lower protein carbonylation in the zebrafish model (58, 59). In an experiment using rats to simulate an ischemic stroke, a uniform hydroalcoholic extract derived from WS roots effectively decreased the levels of lipid peroxidation and enhanced antioxidant function in the brain (60). ASH-WEX, an aqueous leaf extract, was shown to decrease pro-inflammatory cytokines, specifically TNFα and IL-6, both in the peripheral and central nervous systems, in animal models of neuroinflammation and sleep deprivation (61). ASH-WEX produced a significant reduction in indicators of reactive gliosis, such as GFAP, as well as neuroinflammation, such as NOX2, iNOS, and COX2. Furthermore, it successfully regulated various inflammatory pathways and reduced cellular death in the brain (62). In a rat experiment examining the effects of a high fat diet on obesity, the use of WS dry leaf powder significantly lessened the expression of pro-inflammatory cytokines both in the body and brain, decreased indicators of reactive gliosis and neuroinflammation, modulated the nuclear factor NF-kappa-B (NF-κB) pathway, and lowered cell death (63). Supplementation with ashwagandha has been shown to lower C-reactive protein (CRP) activity (64), one of the most important indicators of inflammation. Furthermore, other studies have shown that ashwagandha exerts a number of anti-inflammatory effects on chronic inflammation-mediated diseases (65), particularly rheumatoid arthritis (66), inflammatory bowel disorder (67), and systemic lupus erythematosus (68). These studies suggest that ashwagandha may be a useful tool for reducing the cytokine storm. Withanolides, particularly Withaferin A, are responsible for the majority of ashwagandha’s anti-inflammatory effects, according to several reports (69, 70). Ashwagandha may work by interacting with components of the proinflammatory cell signaling pathway, such as NF-κB, signaling kinases, HSP90, Nrf2, and the inflammasome complex, even though the mechanisms behind the anti-inflammatory effect of withanolides are not fully understood (71). Since the NF-κB transcription factor family is implicated in a number of chronic disorders caused by inflammation, individuals with high NF-κB levels may benefit from therapeutic targeting of NF-κB. In this situation, ashwagandha has the ability to inhibit and mediate the activity of the NF-κB pathway (72). It is thought that strong protein kinase inhibitor activity is necessary for ashwagandha to function. Ashwagandha has the ability to inhibit the signaling cascades of protein kinases, which are essential in inflammatory pathways (72). Furthermore, it appears that kinase inhibition takes place when nitric oxide synthesis is inhibited, which also benefits the inflammatory process. Another possible explanation for ashwagandha’s anti-inflammatory properties is the downregulation or destabilization of HSP activity, which is implicated in regulatory kinase pathways. As previously mentioned, ashwagandha regulates Nrf2 to moderate oxidative stress (34, 73). Nrf2 activation may account for ashwagandha’s anti-inflammatory properties, as oxidative stress frequently takes place in sites of inflammation and is thought to be one cause of chronic inflammation (74). Finally, by blocking inflammasomes, cytokines, and other multiprotein pro-inflammatory complexes, ashwagandha may lessen inflammation (7 According to some reports, ashwagandha is an adaptogen that, due to its antioxidant properties, boosts immunity, helps the body respond to stress more effectively, increases resilience, and fights oxidative stress and cellular damage (76, 77). It has been demonstrated that the bioactive C28-steroidal lactones present in WS leaves possess neuroprotective, anxiolytic, antioxidant, and anti-inflammatory properties. Moreover, Withanoside IV and its metabolite sominone, found in WS roots, have been shown to promote synaptogenesis and neuronal outgrowth. Furthermore, it has been demonstrated that the herb inhibits acetylcholinesterase and protects rats from cognitive decline (78). One study evaluated the effects of ashwagandha root extract 300 mg twice a day in humans with moderate cognitive impairment (79). After 8 weeks, the treatment group outperformed the placebo group in tests measuring immediate and general memory, information-processing speed, executive function, and attention. However, the benefits on working memory and visuospatial processing were not definitive because there was little difference between the two groups’ performance on these tasks. Another study examined the effect of ashwagandha extract on cognitive impairment in individuals with bipolar disorder (80). Tests were conducted at baseline and after the intervention, with rats randomly allocated to receive 500 mg/day of ashwagandha or a placebo for 8 weeks. When compared to the placebo, subjects in the treatment group showed significantly better results on the Flanker Test (neutral mean reaction time), the Penn Emotional Acuity Test (mean social cognition response rating), and the Auditory Digit Span (mean digit span backward). These findings suggested that ashwagandha extract may safely enhance cognitive function in bipolar disorder patients, including verbal working memory, response time, and social cognition response. Another study was carried out using ashwagandha root extract on a group of horses. The animals were subjected to a variety of stressors, including loud noises, prolonged physical activity, and separation. Following a 21-day period, the treated group showed a statistically significant reduction in cortisol, glucose, adrenaline, IL-6, lipids, creatinine, aspartate aminotransferase, and alanine aminotransferase (81).]",Medical,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]",What are the requirements for providing expert evidence? Provide a step by step process of how an expert would present evidence in a court without referencing any specifics such as the type of expert or their specific field of expertise.,"Obligations of experts in New Zealand An “expert” is anyone with specialised knowledge or skill based on training, study or experience – it is not necessary for an expert to have formal qualifications (though, they often do).[1] In New Zealand, expert witnesses are not advocates — they have an overriding duty of impartiality to assist the Court.[2] The duty of impartiality is a fundamental tenet of giving expert evidence in New Zealand, in direct contrast to jurisdictions such as the United States, where experts are specifically selected as part of the advocacy team. The requirements of expert evidence in New Zealand are set out in the Evidence Act 2006 and the High Court Rules 2016, which sets out the prescribed Code of Conduct (the Code).[3] Expert evidence is only admissible if it is of “substantial help” to the judge,[4] and the expert’s conduct complies with the prescriptive requirements of the Code:[5] experts must read and agree to comply with the Code; experts must state their qualifications and confirm that the specific issues they address are properly within their expertise; experts must state all relevant facts, assumptions, reasoning, literature (or other material), testing or investigations relied on in reaching their opinion; and experts must appropriately qualify their opinions as necessary. In common law jurisdictions such as New Zealand, independent experts are engaged by the parties to the dispute. The Court may appoint its own independent expert, but this person must be agreed upon by the parties (if possible), or otherwise selected from experts named by the parties.[6] Once appointed, experts present evidence to the Court and are then examined by legal counsel, reflecting the adversarial nature of the common law system used in New Zealand. The adversarial court system will be immediately unfamiliar territory for European experts. For example, it is far more common in Germany for experts to be appointed by and primarily examined by the presiding judge.[7] Experts engaged by the parties are considered advocates, and their opinion will be considered as submissions (rather than evidence) by the Court.[8] In New Zealand, it is not a requirement that experts will disclose the scope of their engagements or the questions that have been put to them in their evidence. Nevertheless, we generally encourage this, as the nature of the questions put to an expert can be used as a measure of the expert’s independence (by checking if that the questions put to the witness are impartial and do not lead the witness to a particular answer). This is a mandatory requirement in England, Wales and Australia. If both parties have engaged experts to address the same issue of fact, the Court may direct that the witnesses confer and attempt to reach agreement on matters within their field of expertise.[9] This narrows the scope of the disputed issues, allowing for more efficient use of Court time. Consistent with their overriding duty to assist the Court, expert witnesses are obligated to comply with these directions. It is common practice for these obligations to be applied to arbitration proceedings based in New Zealand. In adjudication proceedings, where only a written “witness statement” is required, it is typical for experts to refer to the Code when providing evidence."," Only use the provided text to answer the question, no outside sources. What are the requirements for providing expert evidence? Provide a step by step process of how an expert would present evidence in a court without referencing any specifics such as the type of expert or their specific field of expertise. Obligations of experts in New Zealand An “expert” is anyone with specialised knowledge or skill based on training, study or experience – it is not necessary for an expert to have formal qualifications (though, they often do).[1] In New Zealand, expert witnesses are not advocates — they have an overriding duty of impartiality to assist the Court.[2] The duty of impartiality is a fundamental tenet of giving expert evidence in New Zealand, in direct contrast to jurisdictions such as the United States, where experts are specifically selected as part of the advocacy team. The requirements of expert evidence in New Zealand are set out in the Evidence Act 2006 and the High Court Rules 2016, which sets out the prescribed Code of Conduct (the Code).[3] Expert evidence is only admissible if it is of “substantial help” to the judge,[4] and the expert’s conduct complies with the prescriptive requirements of the Code:[5] experts must read and agree to comply with the Code; experts must state their qualifications and confirm that the specific issues they address are properly within their expertise; experts must state all relevant facts, assumptions, reasoning, literature (or other material), testing or investigations relied on in reaching their opinion; and experts must appropriately qualify their opinions as necessary. In common law jurisdictions such as New Zealand, independent experts are engaged by the parties to the dispute. The Court may appoint its own independent expert, but this person must be agreed upon by the parties (if possible), or otherwise selected from experts named by the parties.[6] Once appointed, experts present evidence to the Court and are then examined by legal counsel, reflecting the adversarial nature of the common law system used in New Zealand. The adversarial court system will be immediately unfamiliar territory for European experts. For example, it is far more common in Germany for experts to be appointed by and primarily examined by the presiding judge.[7] Experts engaged by the parties are considered advocates, and their opinion will be considered as submissions (rather than evidence) by the Court.[8] In New Zealand, it is not a requirement that experts will disclose the scope of their engagements or the questions that have been put to them in their evidence. Nevertheless, we generally encourage this, as the nature of the questions put to an expert can be used as a measure of the expert’s independence (by checking if that the questions put to the witness are impartial and do not lead the witness to a particular answer). This is a mandatory requirement in England, Wales and Australia. If both parties have engaged experts to address the same issue of fact, the Court may direct that the witnesses confer and attempt to reach agreement on matters within their field of expertise.[9] This narrows the scope of the disputed issues, allowing for more efficient use of Court time. Consistent with their overriding duty to assist the Court, expert witnesses are obligated to comply with these directions. It is common practice for these obligations to be applied to arbitration proceedings based in New Zealand. In adjudication proceedings, where only a written “witness statement” is required, it is typical for experts to refer to the Code when providing evidence. https://www.minterellison.co.nz/insights/calling-international-experts-an-introduction-to-giving-expert-evidence-in-new-zealand",Legal,Summarize & Format,Text Transformation You base all answers on the provided context block. Use only the information in the context block to answer the user's question.,How do the two parts of the nest interface?,"Abstract The Nest Thermostat is a smart home automation device that aims to learn a user’s heating and cooling habits to help optimize scheduling and power usage. With its debut in 2011, Nest has proven to be such a success that Google spent $3.2B to acquire the company. However, the complexity of the infrastructure in the Nest Thermostat provides a breeding ground for security vulnerabilities similar to those found in other computer systems. To mitigate this issue, Nest signs firmware updates sent to the device, but the hardware infrastructure lacks proper protection, allowing attackers to install malicious software into the unit. Through a USB connection, we demonstrate how the firmware verification done by the Nest software stack can be bypassed, providing the means to completely alter the behavior of the unit. The compromised Nest Thermostat will then act as a beachhead to attack other nodes within the local network. Also, any information stored within the unit is now available to the attacker, who no longer has to have physical access to the device. Finally, we present a solution to smart device architects and manufacturers aiding the development and deployment of a secure hardware platform. 1 Introduction The concept of Internet of Things (IoT) and wearable devices has been widely accepted in the last few years with an increasing amount of smart devices being designed, fabricated, and deployed. It is estimated that there will be more than 50 billion network connected devices by 2020, the majority of which will be IoT and wearable devices1 . The once science fiction scenes that showed our refrigerators ordering us milk and our washing machines messaging us when laundry needs to be done are now reality. The convenience provided by networked smart devices also breeds security and privacy concerns. Nest founder Tony Fadell claimed in an interview, “We have bank-level security, we encrypt updates, and we have an internal hacker team testing the security ... [the Nest Thermostat] will never take off if people don’t trust it.” However, a deep look into the current IoT and wearable device design flow revealed to us that most of the current security considerations, if any, are put on the application and network level. That is, designers often treat IoT and wearable devices as standard networked devices and try to apply the security protections developed for regular, everyday use computing devices. It is rare to find any work done beyond firmware authentication or encryption. Most IoT and wearable devices collect usage information and other data and send it to a service provider, leading to privacy concerns. Full disclosure of the what is collected is rare, and anything that is actually published is often hidden in the legalese that is the privacy policies and terms of services of the unit In the rest of the paper, we will introduce our work identifying a security vulnerability in the Nest Thermostat, targeting the hardware infrastructure and the hardware-software boundary. We will demonstrate that attackers who understand the hardware can change the boot process of the device in order to upload malicious firmware, effectively bypassing the firmware update verification done by the software. From a positive angle, however, we argue that this same vulnerability offers legitimate users a way to defend themselves against the collection of data thus protecting their privacy and to extend the functionality of the device. 2 The Nest Thermostat The Nest Thermostat is a smart device designed to control a central air conditioning unit based on heuristics and learned behavior. Coupled with a WiFi module, the Nest Thermostat is able connect to the user’s home or office network and interface with the Nest Cloud, thereby allowing for remote control of the unit. It also exhibits a ZigBee module for communication with other Nest devices, but has remained dormant for firmware versions up to the now current 4.2.x series. The Nest Thermostat runs a Linux kernel, coupled with some GNU userland tools, Busybox, other miscellaneous utilities supporting a proprietary stack by Nest Labs. To remain GPL compliant, the modified source code used within the device has been published and is available for download from Nest Lab’s Open Source Compliance page at https://nest.com/legal/compliance, with the notable exception of the C library. A toolchain to build these sources is not provided either. 2.1 User Privacy The Nest Thermostat will collect usage statistics of the device and environmental data and thus “learn” the user’s behavior. This is stored within the unit and also uploaded to the Nest Cloud once the thermostat connects to a network. Not only usage statistics are uploaded, but also system logs and Nest software logs, which contains information such as the user’s Zip Code, device settings, HVAC settings, and wiring configuration. Forensic analysis of the device also yields that the Nest Thermostat has code to prompt the user for information about their place of residence or office. Reports indicate that Nest plans to share this information with energy providers in order to generate energy more efficiently. 2.2 Architecture Overview As a device itself, the Nest Thermostat is divided into two components, a backplate which directly interfaces with the air conditioning unit and a front panel with a screen, a button, a rotary dial and a motion sensor. The operating system runs on the front plate. The backplate contains a STMicroelectronics low power ARM Cortex-M3 microcontroller with 128KiB of flash storage and 16KiB of RAM, coupled with a few driver circuits and an SHT20 temperature and humidity sensor. The backplate communicates with the front plate using a UART. The front panel offers a Texas Instruments (TI) Sitara AM3703 microprocessor, 64MiB of SDRAM, 2Gibit (256MiB) of ECC NAND flash, a ZigBee module and a WiFi module supporting 802.11 b/g/n. The board for this device also offers a Texas Instruments TPS65921B power management module with HS USB capabilities. This part of the Nest has been the target of our research so far, as it contains the most hardware and handles all user data and input. 2.3 Boot Process Upon normal power on conditions, the Sitara AM3703 starts to execute the code in its internal ROM. This code initializes the most basic peripherals, including the General Purpose Memory Controller (GPMC). It then looks for the first stage bootloader, x-loader, and places it into SRAM. Once this operation finishes, the ROM code jumps into x-loader, which proceeds to initialize other peripherals and SDRAM. Afterwards, it copies the second stage bootloader, u-boot, into SDRAM and proceeds to execute it. At this point, u-boot proceeds to initialize the remaining subsystems and executes the uImage in NAND with the configured environment. The system finishes booting from NAND as initialization scripts are executed, services are run, culminating with the loading of the Nest Thermostat proprietary software stack.","You base all answers on the provided context block. Use only the information in the context block to answer the user's question. How do the two parts of the nest interface? Abstract The Nest Thermostat is a smart home automation device that aims to learn a user’s heating and cooling habits to help optimize scheduling and power usage. With its debut in 2011, Nest has proven to be such a success that Google spent $3.2B to acquire the company. However, the complexity of the infrastructure in the Nest Thermostat provides a breeding ground for security vulnerabilities similar to those found in other computer systems. To mitigate this issue, Nest signs firmware updates sent to the device, but the hardware infrastructure lacks proper protection, allowing attackers to install malicious software into the unit. Through a USB connection, we demonstrate how the firmware verification done by the Nest software stack can be bypassed, providing the means to completely alter the behavior of the unit. The compromised Nest Thermostat will then act as a beachhead to attack other nodes within the local network. Also, any information stored within the unit is now available to the attacker, who no longer has to have physical access to the device. Finally, we present a solution to smart device architects and manufacturers aiding the development and deployment of a secure hardware platform. 1 Introduction The concept of Internet of Things (IoT) and wearable devices has been widely accepted in the last few years with an increasing amount of smart devices being designed, fabricated, and deployed. It is estimated that there will be more than 50 billion network connected devices by 2020, the majority of which will be IoT and wearable devices1 . The once science fiction scenes that showed our refrigerators ordering us milk and our washing machines messaging us when laundry needs to be done are now reality. The convenience provided by networked smart devices also breeds security and privacy concerns. Nest founder Tony Fadell claimed in an interview, “We have bank-level security, we encrypt updates, and we have an internal hacker team testing the security ... [the Nest Thermostat] will never take off if people don’t trust it.” However, a deep look into the current IoT and wearable device design flow revealed to us that most of the current security considerations, if any, are put on the application and network level. That is, designers often treat IoT and wearable devices as standard networked devices and try to apply the security protections developed for regular, everyday use computing devices. It is rare to find any work done beyond firmware authentication or encryption. Most IoT and wearable devices collect usage information and other data and send it to a service provider, leading to privacy concerns. Full disclosure of the what is collected is rare, and anything that is actually published is often hidden in the legalese that is the privacy policies and terms of services of the unit In the rest of the paper, we will introduce our work identifying a security vulnerability in the Nest Thermostat, targeting the hardware infrastructure and the hardware-software boundary. We will demonstrate that attackers who understand the hardware can change the boot process of the device in order to upload malicious firmware, effectively bypassing the firmware update verification done by the software. From a positive angle, however, we argue that this same vulnerability offers legitimate users a way to defend themselves against the collection of data thus protecting their privacy and to extend the functionality of the device. 2 The Nest Thermostat The Nest Thermostat is a smart device designed to control a central air conditioning unit based on heuristics and learned behavior. Coupled with a WiFi module, the Nest Thermostat is able connect to the user’s home or office network and interface with the Nest Cloud, thereby allowing for remote control of the unit. It also exhibits a ZigBee module for communication with other Nest devices, but has remained dormant for firmware versions up to the now current 4.2.x series. The Nest Thermostat runs a Linux kernel, coupled with some GNU userland tools, Busybox, other miscellaneous utilities supporting a proprietary stack by Nest Labs. To remain GPL compliant, the modified source code used within the device has been published and is available for download from Nest Lab’s Open Source Compliance page at https://nest.com/legal/compliance, with the notable exception of the C library. A toolchain to build these sources is not provided either. 2.1 User Privacy The Nest Thermostat will collect usage statistics of the device and environmental data and thus “learn” the user’s behavior. This is stored within the unit and also uploaded to the Nest Cloud once the thermostat connects to a network. Not only usage statistics are uploaded, but also system logs and Nest software logs, which contains information such as the user’s Zip Code, device settings, HVAC settings, and wiring configuration. Forensic analysis of the device also yields that the Nest Thermostat has code to prompt the user for information about their place of residence or office. Reports indicate that Nest plans to share this information with energy providers in order to generate energy more efficiently. 2.2 Architecture Overview As a device itself, the Nest Thermostat is divided into two components, a backplate which directly interfaces with the air conditioning unit and a front panel with a screen, a button, a rotary dial and a motion sensor. The operating system runs on the front plate. The backplate contains a STMicroelectronics low power ARM Cortex-M3 microcontroller with 128KiB of flash storage and 16KiB of RAM, coupled with a few driver circuits and an SHT20 temperature and humidity sensor. The backplate communicates with the front plate using a UART. The front panel offers a Texas Instruments (TI) Sitara AM3703 microprocessor, 64MiB of SDRAM, 2Gibit (256MiB) of ECC NAND flash, a ZigBee module and a WiFi module supporting 802.11 b/g/n. The board for this device also offers a Texas Instruments TPS65921B power management module with HS USB capabilities. This part of the Nest has been the target of our research so far, as it contains the most hardware and handles all user data and input. 2.3 Boot Process Upon normal power on conditions, the Sitara AM3703 starts to execute the code in its internal ROM. This code initializes the most basic peripherals, including the General Purpose Memory Controller (GPMC). It then looks for the first stage bootloader, x-loader, and places it into SRAM. Once this operation finishes, the ROM code jumps into x-loader, which proceeds to initialize other peripherals and SDRAM. Afterwards, it copies the second stage bootloader, u-boot, into SDRAM and proceeds to execute it. At this point, u-boot proceeds to initialize the remaining subsystems and executes the uImage in NAND with the configured environment. The system finishes booting from NAND as initialization scripts are executed, services are run, culminating with the loading of the Nest Thermostat proprietary software stack.",Internet/Technology,Fact Finding,Q&A You can only respond using information from the prompt. Do not rely on any internal information. Give your answer in the form of a bullet point list. List at least 3 bullet points.,Summarize the contents of each US code described in the text.,"The Supreme Court has held that “officers of the State ... performing official duties,” including public safety officials, act “under color of ... law” for purposes of Section 242. As DOJ has explained, law enforcement officers may violate Section 242 through “excessive force, sexual assault, intentional false arrests, theft, or the intentional fabrication of evidence resulting in a loss of liberty to another.” DOJ enforces Sections 241 and 242 by bringing criminal charges against officers accused of violating those statutes. People who believe their rights have been infringed may report such violations to DOJ, but Sections 241 and 242 do not authorize suits by individuals. If DOJ elects to pursue criminal charges under Section 241 or 242, it faces a high standard of proof. Under the cases Screws v. United States and United States v. Guest, the prosecution must prove the defendant had “a specific intent to deprive a person of a federal right made definite by decision or other rule of law.” Specific intent means that the defendant must not intend only to, for example, assault a victim but must also intend to violate a federal right by doing so. This results in what some view as a significant hurdle to bringing Section 241 and 242 claims. DOJ brought charges under Section 242 against the officers involved in the deaths of George Floyd and Breonna Taylor. The officers involved in Mr. Floyd’s killing pled guilty or were convicted by a jury. As of February 2023, charges against the officers involved in Ms. Taylor’s death remain pending. DOJ Civil Enforcement Another section of the U.S. Code, 34 U.S.C. § 12601 (Section 12601, formerly codified at 42 U.S.C. § 14141) renders it “unlawful for any governmental authority, or any agent thereof, ... to engage in a pattern or practice of conduct by law enforcement officers or by officials ... that deprives persons of rights, privileges, or immunities secured or protected by the Constitution or laws of the United States.” Another CRS Legal Sidebar discusses this statute in more detail. According to DOJ, potential violations of the provision include “excessive force, discriminatory harassment, false arrests, coercive sexual conduct, and unlawful stops, searches or arrests.” DOJ enforces the provision by filing civil complaints against allegedly offending law enforcement agencies. The statute does not create a private right for individuals harmed by violations to sue. Moreover, because the law applies only to a “pattern or practice of conduct,” it cannot remedy isolated instances of misconduct. Finally, the statute does not provide for monetary penalties. If DOJ successfully sues under the provision, it may “obtain appropriate equitable and declaratory relief to eliminate the pattern or practice.” Private Civil Rights Litigation Federal law also allows individuals to seek civil redress for violations of their legal rights. The applicable statute, 42 U.S.C. § 1983 (Section 1983), provides in relevant part: Every person who, under color of any statute, ordinance, regulation, custom, or usage, of any State . . . subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws, shall be liable to the party injured[.] Unlike the other statutory provisions discussed above, Section 1983 creates a private right of action, meaning that anyone suffering a covered deprivation of rights may sue the persons responsible. Moreover, unlike Sections 241 and 242, courts have interpreted Section 1983 not to contain a specific intent requirement, making it easier for plaintiffs to prove violations of the statute.","The Supreme Court has held that “officers of the State ... performing official duties,” including public safety officials, act “under color of ... law” for purposes of Section 242. As DOJ has explained, law enforcement officers may violate Section 242 through “excessive force, sexual assault, intentional false arrests, theft, or the intentional fabrication of evidence resulting in a loss of liberty to another.” DOJ enforces Sections 241 and 242 by bringing criminal charges against officers accused of violating those statutes. People who believe their rights have been infringed may report such violations to DOJ, but Sections 241 and 242 do not authorize suits by individuals. If DOJ elects to pursue criminal charges under Section 241 or 242, it faces a high standard of proof. Under the cases Screws v. United States and United States v. Guest, the prosecution must prove the defendant had “a specific intent to deprive a person of a federal right made definite by decision or other rule of law.” Specific intent means that the defendant must not intend only to, for example, assault a victim but must also intend to violate a federal right by doing so. This results in what some view as a significant hurdle to bringing Section 241 and 242 claims. DOJ brought charges under Section 242 against the officers involved in the deaths of George Floyd and Breonna Taylor. The officers involved in Mr. Floyd’s killing pled guilty or were convicted by a jury. As of February 2023, charges against the officers involved in Ms. Taylor’s death remain pending. DOJ Civil Enforcement Another section of the U.S. Code, 34 U.S.C. § 12601 (Section 12601, formerly codified at 42 U.S.C. § 14141) renders it “unlawful for any governmental authority, or any agent thereof, ... to engage in a pattern or practice of conduct by law enforcement officers or by officials ... that deprives persons of rights, privileges, or immunities secured or protected by the Constitution or laws of the United States.” Another CRS Legal Sidebar discusses this statute in more detail. According to DOJ, potential violations of the provision include “excessive force, discriminatory harassment, false arrests, coercive sexual conduct, and unlawful stops, searches or arrests.” DOJ enforces the provision by filing civil complaints against allegedly offending law enforcement agencies. The statute does not create a private right for individuals harmed by violations to sue. Moreover, because the law applies only to a “pattern or practice of conduct,” it cannot remedy isolated instances of misconduct. Finally, the statute does not provide for monetary penalties. If DOJ successfully sues under the provision, it may “obtain appropriate equitable and declaratory relief to eliminate the pattern or practice.” Private Civil Rights Litigation Federal law also allows individuals to seek civil redress for violations of their legal rights. The applicable statute, 42 U.S.C. § 1983 (Section 1983), provides in relevant part: Every person who, under color of any statute, ordinance, regulation, custom, or usage, of any State . . . subjects, or causes to be subjected, any citizen of the United States or other person within the jurisdiction thereof to the deprivation of any rights, privileges, or immunities secured by the Constitution and laws, shall be liable to the party injured[.] Unlike the other statutory provisions discussed above, Section 1983 creates a private right of action, meaning that anyone suffering a covered deprivation of rights may sue the persons responsible. Moreover, unlike Sections 241 and 242, courts have interpreted Section 1983 not to contain a specific intent requirement, making it easier for plaintiffs to prove violations of the statute. Summarize the contents of each US code described in the text. You can only respond using information from the prompt. Do not rely on any internal information. Give your answer in the form of a bullet point list. List at least 3 bullet points.",Legal,Find & Summarize,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","I just had a baby and he was diagnosed with a VSD and I am freaking out. What is the cause of this and how common is it? Can the hole close it on its own? What symptoms should I look for in my baby? If the hole is too large or doesn't close, what is the next step?","About Ventricular Septal Defect Key points A ventricular septal defect (pronounced ven·tric·u·lar sep·tal de·fect) is atype of congenital heart defect. Congenital means present at birth. A ventricular septal defect is a hole in the wall (septum) that separates the two lower chambers (ventricles) of the heart. Doctor listening to baby's heart What it is A ventricular septal defect (VSD) happens during pregnancy if the wall that forms between the two ventricles does not fully develop. This leaves a hole. In babies without a heart defect, the right side of the heart pumps oxygen-poor blood from the heart to the lungs. The left side of the heart pumps oxygen-rich blood to the rest of the body. In babies with a VSD, blood flows from the left ventricle through the VSD to the right ventricle and into the lungs. Keep Reading: How the Heart Works Occurrence About 42 of every 10,000 babies in the United States are born with a VSD.1 This means that about 16,800 babies are born with a VSD each year. Types An infant with a VSD can have one or more holes in different places of the septum. There are several names for these holes. Some common locations and names are listed below: Conoventricular Ventricular Septal Defect. In general, this is a hole where portions of the ventricular septum should meet just below the pulmonary and aortic valves. Perimembranous Ventricular Septal Defect. This is a hole in the upper section of the ventricular septum. Inlet Ventricular Septal Defect. This is a hole in the septum near to where the blood enters the ventricles through the tricuspid and mitral valves. This type of ventricular septal defect also might be part of another heart defect called an atrioventricular septal defect (AVSD). Muscular Ventricular Septal Defect. This is a hole in the lower, muscular part of the ventricular septum. This is the most common type of ventricular septal defect. View LargerDownload Normal heart compared with a heart with VSD A VSD is one or more holes in the wall between the ventricles. Signs and symptoms The size of the ventricular septal defect will influence what symptoms, if any, are present. Signs of a ventricular septal defect might be present at birth or might not appear until well after birth. If the hole is small, it could close on its own. The baby might not show any signs of the defect. However, if the hole is large, the baby might have symptoms, including Shortness of breath Fast or heavy breathing Sweating Tiredness while feeding Poor weight gain Complications A ventricular septal defect increases the amount of blood that flows through the lungs. This forces the heart and lungs to work harder. Overtime, if not repaired, a ventricular septal defect can increase the risk for other complications, including Heart failure High blood pressure in the lungs (called pulmonary hypertension) Irregular heart rhythms (called arrhythmia) Stroke Risk factors The causes of ventricular septal defects among most babies are unknown. Some babies have heart defects because of changes in their genes or chromosomes. A combination of genes and other risk factors may increase the risk for ventricular septal defects. These factors can include things in a mother's environment, what she eats or drinks, or the medicines she uses. Diagnosis A VSD is usually diagnosed after a baby is born. During a physical exam, a healthcare provider might hear a distinct whooshing sound, called a heart murmur. The size of the VSD will influence whether a healthcare provider hears a heart murmur during a physical exam. If signs or symptoms are present, the healthcare provider might request one or more tests to confirm the diagnosis. The most common test is an echocardiogram, which is an ultrasound of the heart. An echocardiogram can show how large the hole is and how much blood is flowing through the hole. A doctor has a stethoscope on a babies chest A VSD is usually diagnosed after a baby is born. Treatments Treatments for a VSD depend on the size of the hole and the problems it might cause. Many VSDs are small and close on their own. If the hole is small and causing no symptoms, the doctor will check the infant regularly. This is to ensure there are no signs of heart failure and that the hole closes. If the hole doesn't close on its own or if it's large, further action might needed. Depending on the size of the hole, symptoms, and general health of the child, the doctor might recommend either cardiac catheterization or open-heart surgery. These procedures will close the hole and restore normal blood flow. After surgery, the doctor will set up regular follow-up visits to make sure that the VSD remains closed. Medicines Some children will need medicines to help strengthen the heart muscle, lower their blood pressure, and help the body get rid of extra fluid. Nutrition Some babies with a ventricular septal defect become tired while feeding and do not eat enough to gain weight. To make sure babies have a healthy weight gain, a special high-calorie formula might be prescribed. Some babies become extremely tired while feeding and might need to be fed through a feeding tube. What to expect long-term Most children who have a VSD that closes (either on its own or with surgery) live healthy lives.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I just had a baby and he was diagnosed with a VSD and I am freaking out. What is the cause of this and how common is it? Can the hole close it on its own? What symptoms should I look for in my baby? If the hole is too large or doesn't close, what is the next step? About Ventricular Septal Defect Key points A ventricular septal defect (pronounced ven·tric·u·lar sep·tal de·fect) is atype of congenital heart defect. Congenital means present at birth. A ventricular septal defect is a hole in the wall (septum) that separates the two lower chambers (ventricles) of the heart. Doctor listening to baby's heart What it is A ventricular septal defect (VSD) happens during pregnancy if the wall that forms between the two ventricles does not fully develop. This leaves a hole. In babies without a heart defect, the right side of the heart pumps oxygen-poor blood from the heart to the lungs. The left side of the heart pumps oxygen-rich blood to the rest of the body. In babies with a VSD, blood flows from the left ventricle through the VSD to the right ventricle and into the lungs. Keep Reading: How the Heart Works Occurrence About 42 of every 10,000 babies in the United States are born with a VSD.1 This means that about 16,800 babies are born with a VSD each year. Types An infant with a VSD can have one or more holes in different places of the septum. There are several names for these holes. Some common locations and names are listed below: Conoventricular Ventricular Septal Defect. In general, this is a hole where portions of the ventricular septum should meet just below the pulmonary and aortic valves. Perimembranous Ventricular Septal Defect. This is a hole in the upper section of the ventricular septum. Inlet Ventricular Septal Defect. This is a hole in the septum near to where the blood enters the ventricles through the tricuspid and mitral valves. This type of ventricular septal defect also might be part of another heart defect called an atrioventricular septal defect (AVSD). Muscular Ventricular Septal Defect. This is a hole in the lower, muscular part of the ventricular septum. This is the most common type of ventricular septal defect. View LargerDownload Normal heart compared with a heart with VSD A VSD is one or more holes in the wall between the ventricles. Signs and symptoms The size of the ventricular septal defect will influence what symptoms, if any, are present. Signs of a ventricular septal defect might be present at birth or might not appear until well after birth. If the hole is small, it could close on its own. The baby might not show any signs of the defect. However, if the hole is large, the baby might have symptoms, including Shortness of breath Fast or heavy breathing Sweating Tiredness while feeding Poor weight gain Complications A ventricular septal defect increases the amount of blood that flows through the lungs. This forces the heart and lungs to work harder. Overtime, if not repaired, a ventricular septal defect can increase the risk for other complications, including Heart failure High blood pressure in the lungs (called pulmonary hypertension) Irregular heart rhythms (called arrhythmia) Stroke Risk factors The causes of ventricular septal defects among most babies are unknown. Some babies have heart defects because of changes in their genes or chromosomes. A combination of genes and other risk factors may increase the risk for ventricular septal defects. These factors can include things in a mother's environment, what she eats or drinks, or the medicines she uses. Diagnosis A VSD is usually diagnosed after a baby is born. During a physical exam, a healthcare provider might hear a distinct whooshing sound, called a heart murmur. The size of the VSD will influence whether a healthcare provider hears a heart murmur during a physical exam. If signs or symptoms are present, the healthcare provider might request one or more tests to confirm the diagnosis. The most common test is an echocardiogram, which is an ultrasound of the heart. An echocardiogram can show how large the hole is and how much blood is flowing through the hole. A doctor has a stethoscope on a babies chest A VSD is usually diagnosed after a baby is born. Treatments Treatments for a VSD depend on the size of the hole and the problems it might cause. Many VSDs are small and close on their own. If the hole is small and causing no symptoms, the doctor will check the infant regularly. This is to ensure there are no signs of heart failure and that the hole closes. If the hole doesn't close on its own or if it's large, further action might needed. Depending on the size of the hole, symptoms, and general health of the child, the doctor might recommend either cardiac catheterization or open-heart surgery. These procedures will close the hole and restore normal blood flow. After surgery, the doctor will set up regular follow-up visits to make sure that the VSD remains closed. Medicines Some children will need medicines to help strengthen the heart muscle, lower their blood pressure, and help the body get rid of extra fluid. Nutrition Some babies with a ventricular septal defect become tired while feeding and do not eat enough to gain weight. To make sure babies have a healthy weight gain, a special high-calorie formula might be prescribed. Some babies become extremely tired while feeding and might need to be fed through a feeding tube. What to expect long-term Most children who have a VSD that closes (either on its own or with surgery) live healthy lives. https://www.cdc.gov/heart-defects/about/ventricular-septal-defect.html",Medical,Fact Finding,Q&A You can only respond using the information in the context block. Do not list any similarities between the two fields.,What are the differences between public accounting and private/corporate?,"University of Nebraska at Omaha School of Accounting THE ACCOUNTING PROFESSION The accounting profession has been around for hundreds of years and is incorrectly perceived as nerdy, shy, quiet people who sit and “crunch” numbers. While accounting, by nature, does require a basic understanding of math, there is so much more to an accounting career than just numbers. A career in accounting is challenging, but with challenge comes rewards and opportunities. This profession can provide an exciting path to meet and work with people from different backgrounds as well as opportunities to travel the world. Because accountants offer a specific skill-set they are typically highly compensated through competitive salaries and, in a growing number of instances, allowed flexible work schedules. The demand for talented, knowledgeable accountants has historically been high and is projected to increase over the next few years. The Bureau of Labor Statistics estimates that the accounting job field will grow an additional 139,900 jobs through the year 20261. The U.S. News and World Report ranks “Accountant” #3 on the list of “Best Business Jobs” because of the substantial salary amounts and the job security the profession provides. 2 Every business needs at least one accountant if not several accountants to help track and manage costs, assist with reporting, calculate federal, state and local tax liabilities, along with many other tasks. Also many individuals rely on accountants to help with tax planning, personal finance and wealth building. Because of this there are several different types of accountants that expand beyond the standard bookkeeper or tax preparer that most people associate with the term “accountant”. AREAS OF ACCOUNTING The accounting profession can be broken between public accountants and private accountants. Regardless if someone goes into public or private accounting, each professional must have certain skills above and beyond the education requirements. Most accountants must be detailed oriented, have the ability to organize and manage time effectively. Those that work in accounting, contrary to the typical accountant stereotype, must also have outstanding people skills and be able to communicate effectively. Additionally, each business and public accounting firm use different software when performing different job duties; therefore, accountants must be knowledgeable and comfortable with computers and have the capability to learn new systems quickly. All accountants are expected to be proficient in Microsoft Office especially Microsoft Excel. Also, successful accountants are analytical. They can think beyond the numbers and assist with making businesses more efficient. Below highlights the differences, lists the potential career paths and salary information for public vs. private accountants. Public Accounting: - Definition: accountants that serve businesses, governments, non-profits, and individuals by providing various accounting services. Those services include tax return preparation, financial statement preparation, financial statement audit or review, and various consulting related to business transactions. - Requirements: These accountants typically have a bachelor’s degree in accounting. Most individuals that work in public accounting must be a Certified Public Accountant (CPA) and be licensed with the state. - Why choose public accounting? It’s called public accounting because these accountants work with the public and must be able to communicate effortlessly. Public accountants work continuously with colleagues to complete projects as well as with clients to meet their specific needs. Those that choose public accounting are typically outgoing personalities that are also highly driven, goal oriented, and have a passion for serving others. It should be noted that usually it is easier for an accounting career to move from public accounting to private accounting (it’s challenging to go from private accounting to public without having to start over again in lower entry level positions). - Public accounting has various options in-and-of itself. While public accounting firms offer a variety of services, the main services provided fall under tax preparation and audits of financial statements. These are very different and require different skill sets. o Tax preparers must be knowledgeable in local, state and federal tax laws. However, they do more than just tax return preparation. Tax professionals work with businesses as well as individuals assisting with tax planning, financial planning, estate planning, and tax research. Tax preparers have steady work all through-out the year but work through a “busy season” from January through April 15th. These individuals mostly work out of the firm’s office but must be willing to do some travel to visit clients. o Auditors must be knowledgeable in Generally Accepted Accounting Principles (GAAP). These auditors provide an opinion on whether or not a business’s financial statements have been prepared according to GAAP. Auditors typically must gather information and complete their audits on location in the client’s office which could take days, weeks or months depending on the size of the client and the service being provided. Therefore, an auditor must be willing to travel and work in close proximity with others. Auditors also have steady work through-out the year but have periodic busy seasons depending on the type of clients they have. Private/Corporate Accounting: - Definition: accountants that work inside a business, governmental entity or a non-profit that use financial accounting and/or managerial accounting knowledge to build financial statements and other reports to assist in evaluating various business decisions. -Requirements: These accountants typically have a bachelor’s degree in accounting. Those that want to separate themselves from the rest will go on and receive a master’s degree and/or a professional accounting license. - Below are some (not all) typical job titles that fall in the area of private/corporate accounting: o Bookkeeper o Billing Clerk o Payroll Clerk o Inventory Analyst o Purchasing Manager o Collections Clerk o General Accountant o Cost Accountant o Tax Accountant o Internal Auditor o IT Auditor o Controller o Treasurer o Chief Financial Officer - Why choose private/corporate accounting? From the small sample of job titles above it can be noted that corporate accounting provides a vast amount of options for those that want to work inside a business or other organization. Many people are drawn to corporate accounting because they have more flexibility to design a career path that truly incorporates their interests whether it be cost management, tax compliance, account receivable management, etc. These accountants must still be able to work with others but in some positions, corporate accounting does provide a quieter, more secluded work space compared to public accounting. Additionally, many corporate accounting positions do not require a CPA license or a master’s degree making it easier to enter an accounting career (However, the CPA license, other professional accounting licenses and/or a Master’s degree will make it easier to move up in an accounting career.) ","Question: What are the differences between public accounting and private/corporate? System Instructions: You can only respond using the information in the context block. Do not list any similarities between the two fields. Context: University of Nebraska at Omaha School of Accounting THE ACCOUNTING PROFESSION The accounting profession has been around for hundreds of years and is incorrectly perceived as nerdy, shy, quiet people who sit and “crunch” numbers. While accounting, by nature, does require a basic understanding of math, there is so much more to an accounting career than just numbers. A career in accounting is challenging, but with challenge comes rewards and opportunities. This profession can provide an exciting path to meet and work with people from different backgrounds as well as opportunities to travel the world. Because accountants offer a specific skill-set they are typically highly compensated through competitive salaries and, in a growing number of instances, allowed flexible work schedules. The demand for talented, knowledgeable accountants has historically been high and is projected to increase over the next few years. The Bureau of Labor Statistics estimates that the accounting job field will grow an additional 139,900 jobs through the year 20261. The U.S. News and World Report ranks “Accountant” #3 on the list of “Best Business Jobs” because of the substantial salary amounts and the job security the profession provides. 2 Every business needs at least one accountant if not several accountants to help track and manage costs, assist with reporting, calculate federal, state and local tax liabilities, along with many other tasks. Also many individuals rely on accountants to help with tax planning, personal finance and wealth building. Because of this there are several different types of accountants that expand beyond the standard bookkeeper or tax preparer that most people associate with the term “accountant”. AREAS OF ACCOUNTING The accounting profession can be broken between public accountants and private accountants. Regardless if someone goes into public or private accounting, each professional must have certain skills above and beyond the education requirements. Most accountants must be detailed oriented, have the ability to organize and manage time effectively. Those that work in accounting, contrary to the typical accountant stereotype, must also have outstanding people skills and be able to communicate effectively. Additionally, each business and public accounting firm use different software when performing different job duties; therefore, accountants must be knowledgeable and comfortable with computers and have the capability to learn new systems quickly. All accountants are expected to be proficient in Microsoft Office especially Microsoft Excel. Also, successful accountants are analytical. They can think beyond the numbers and assist with making businesses more efficient. Below highlights the differences, lists the potential career paths and salary information for public vs. private accountants. Public Accounting: - Definition: accountants that serve businesses, governments, non-profits, and individuals by providing various accounting services. Those services include tax return preparation, financial statement preparation, financial statement audit or review, and various consulting related to business transactions. - Requirements: These accountants typically have a bachelor’s degree in accounting. Most individuals that work in public accounting must be a Certified Public Accountant (CPA) and be licensed with the state. - Why choose public accounting? It’s called public accounting because these accountants work with the public and must be able to communicate effortlessly. Public accountants work continuously with colleagues to complete projects as well as with clients to meet their specific needs. Those that choose public accounting are typically outgoing personalities that are also highly driven, goal oriented, and have a passion for serving others. It should be noted that usually it is easier for an accounting career to move from public accounting to private accounting (it’s challenging to go from private accounting to public without having to start over again in lower entry level positions). - Public accounting has various options in-and-of itself. While public accounting firms offer a variety of services, the main services provided fall under tax preparation and audits of financial statements. These are very different and require different skill sets. o Tax preparers must be knowledgeable in local, state and federal tax laws. However, they do more than just tax return preparation. Tax professionals work with businesses as well as individuals assisting with tax planning, financial planning, estate planning, and tax research. Tax preparers have steady work all through-out the year but work through a “busy season” from January through April 15th. These individuals mostly work out of the firm’s office but must be willing to do some travel to visit clients. o Auditors must be knowledgeable in Generally Accepted Accounting Principles (GAAP). These auditors provide an opinion on whether or not a business’s financial statements have been prepared according to GAAP. Auditors typically must gather information and complete their audits on location in the client’s office which could take days, weeks or months depending on the size of the client and the service being provided. Therefore, an auditor must be willing to travel and work in close proximity with others. Auditors also have steady work through-out the year but have periodic busy seasons depending on the type of clients they have. Private/Corporate Accounting: - Definition: accountants that work inside a business, governmental entity or a non-profit that use financial accounting and/or managerial accounting knowledge to build financial statements and other reports to assist in evaluating various business decisions. -Requirements: These accountants typically have a bachelor’s degree in accounting. Those that want to separate themselves from the rest will go on and receive a master’s degree and/or a professional accounting license. - Below are some (not all) typical job titles that fall in the area of private/corporate accounting: o Bookkeeper o Billing Clerk o Payroll Clerk o Inventory Analyst o Purchasing Manager o Collections Clerk o General Accountant o Cost Accountant o Tax Accountant o Internal Auditor o IT Auditor o Controller o Treasurer o Chief Financial Officer - Why choose private/corporate accounting? From the small sample of job titles above it can be noted that corporate accounting provides a vast amount of options for those that want to work inside a business or other organization. Many people are drawn to corporate accounting because they have more flexibility to design a career path that truly incorporates their interests whether it be cost management, tax compliance, account receivable management, etc. These accountants must still be able to work with others but in some positions, corporate accounting does provide a quieter, more secluded work space compared to public accounting. Additionally, many corporate accounting positions do not require a CPA license or a master’s degree making it easier to enter an accounting career (However, the CPA license, other professional accounting licenses and/or a Master’s degree will make it easier to move up in an accounting career.) ",Financial,Concept Comparison,Q&A "Using ONLY the context block/prompt to guide your answer, provide a comprehensive comparison of the subjects mentioned in the question. Do not use any previous knowledge or outside sources to inform your answer. ",How e-sports broadcasts compare with traditional sports broadcasts?,"E-Sports Broadcasting 8 Introduction Sportscasters on a Digital Field Sitting at a desk underbright lights, two announcerstalk at afast clip. After a weekend full of commentating, theirvoices are scratchyandfading, yet theirexcitement never wanes. No one watchingcan see the two men, though a camerasitsjust afew feet infront ofthem. Instead, the live audience andhome viewers see the Europeanchampions, Fnatic,going head to head with SK Gaming on a virtualbattlefield. They're 55 minutes into an absoluteslugfest, the two announcers'voices rise andfallwith the action ofthe game. Over the PA, the audience hears that this game is mere seconds awayfrom ending. The SK team has Fnaticon the ropes after brilliantlydefending their base. Fnatic'sstarplayer, Xpeke stays, attempting to win the game singlehandedly. The casters initiallydismiss the lastditch effort while the bulk of SK's team move to end thegameontheothersideofthemap.However,thecamerastaysonXpeke whoisina showdown with one memberofSK. NanosecondsawayfromdefeatXpeke dodgesa deadly ability. The casters erupt in nearly unintelligible,frantic excitement as the 25,000 live attendees atSpodek Arena in Katowice, Polandcheerat the sudden Fnaticvictory. Back in the realworld, theentireFnaticteamjumpsawayfrom theircomputersandpileontoXpeke whilewe hear, ""I do not believe it! Xpeke's done it!"" Over 643,000 online viewers around the world watch the camerapan acrossthe SK team, stunnedin theirdefeat. From theirhome computers, these viewers have just witnessed e-sports history. E-Sports Broadcasting 9 The above scene unfolded at the 2014 Intel Extreme Masters World Championships in League of Legends, a popular e-sports title. The solo maneuver that Xpeke performed on that stage has since made its way into common LeagueofLegends vernacular, being invoked in any match, casual or professional, where a player deftly ends a game singlehandedly. E-sports, which encompasses many more titles than League of Legends, has become a cultural phenomenon of sorts. People may wonder whether the whole scene is just a flash in the pan or something more significant. I begin this thesis in much the same way that I have begun many conversations over the past two years: defining e-sports. In most of those conversations, I simply say ""professional video-gaming"" and move on to other topics. Here, though, I fully elaborate on what e-sports means. More than just professional gaming, e-sports is an entire industry created around competitive gaming at all levels of play. An e-sport is not a just a sports video game like the title might suggest, though some e-sports titles are sports video games. Instead, e-sports titles are meticulously balanced, competitive, multiplayer games. Many games would fall into this category, but it takes a community of people to take an e-sport to the level of the classics like Counter Strike and Starcraft. Such communities are core to the identity of e-sports. Indeed, this identity itself is an oxymoronic collision of geek and jock culture; a mixture that media would have us believe acts like oil and water. Even within e-sports communities lines are hazy and misdrawn. As Taylor and Witkowski (2010) show in their study of a mega-LAN event, the e-sports scene is fraught with identity issues not only from outside, but within as well. The jock-like first-person-shooter (FPS) players competing at the same event as the nerdy, enigmatic World of Warcraft players E-Sports Broadcasting 10 shows the conflicting, lived masculinities in e-sports. Players are unsure whether to act like superstar athletes or tech-geeks. Can you be both? The word e-sports alone evokes such a conflicting image. Electronic sports seems almost paradoxical in nature. Have we moved beyond a physical match of skill and extended our contests to avatars in a digital world? How can two players sitting at a desk be sporting? As e- sports continue to grow not only as a segment of the gaming industry, but as a spectator affair, we begin to see the 'sports' side of e-sports both challenged and invoked more frequently. In a telling case, Twitter erupted after a Dota 2 tournament made an appearance on ESPN 2 in 2014. With $10 million at stake, many e-sports fans thought the event warranted the attention of the all-sports network. Plenty of viewers took to social media to praise the move made by ESPN. Others were shocked: ""Espn2 is seriously airing an online gaming championship? Wtf man. This is our society now. That is not a sport"" (Hernandez 2014). The sports status of e-sports has been both defended and attacked by journalists, academics, and fans alike. The debate about the status of e-sports has been raging for many years. Witkowski's piece, ""Probing the Sportiness of E-Sports"", presents both sides of the argument pulling from games studies scholars and assessing e-sports on their terms. Ultimately though, I believe she shelves the debate deftly when she states, ""sport is a personal experience... as many a sporting scholar has written before - if an individual considers the sporting activity they are engaged in to be a sport... then it is a sport"" (2009, 56). I do not wish to rehash this debate. I have no stake in it. As Witkowski asserts, the attempt would be futile. Instead, I accept the role traditional sports have played in the shaping of e-sports. In fact, exploring the relationship between e-sports and their traditional counterpart drives this work. In what follows, I argue that the sports media industrial complex has fundamentally E-Sports Broadcasting 11 shaped the current e-sports industry. Beyond this grounding, e-sports broadcasters constantly borrow from traditional televisual broadcasts, using models that they feel to be appropriate for their medium. Regardless of whether e-sports qualify as sports or not, they are constantly informed by sports broadcasting and follow a trajectory set out by traditional sports models. This work comes about at in an interesting moment in e-sports history. E-sports audiences have never been larger, Riot games boasted an impressive 27 million viewers for the League ofLegends World Championship in 2014 while the 2015 Intel Extreme Masters world championship saw over 1 million concurrent viewers across multiple live-streaming platforms (Riot Games 2014; ESL 2014). An old classic, CounterStrike, has re-emerged, albeit in a new package. The audience it continues to draw proves that some titles have staying power in this fickle industry. At the same time, a new title, League ofLegends, consistently pulls in over 100,000 concurrent viewers for its weekly shows in the U.S. and E.U. As the League ofLegends Championship Series moves into its fifth season, it has come to resemble a traditional sports broadcast more than it does its fellow e-sports shows. A new addition in Season 5, a segment called Prime Time League (PTL) is nearly indistinguishable from ESPN's Pardon the Interruption (PTI) at a glance. Figure 1-Left Image: Prime Time League; Right Image: Pardon the Interruption E-Sports Broadcasting 12 Comparing these two images reveals the level of sports emulation found in e-sports broadcasting today. From the stats and schedule ticker at the bottom of the screen to the show rundown along the edge of the screen, an uninitiated viewer would have difficulty distinguishing between the e- sports show and the traditional sports show. A steady influx of television producers and directors are starting to shape an industry that already has an identity crisis while still investigating how best to harness the new medium of live-streaming. These assertions are not meant to give the impression that we stand on the edge of wholly untouched land as pioneers in a new frontier. As shown in the e-sports literature review to follow, the e-sports industry has a history of evoking the feeling of standing on a precipice. Organization In the introduction, I first provide a brief history of e-sports and take note of the directions e-sports scholarship has pursued. Following this review, I introduce the sports media industrial complex to better situate e-sports broadcasting within the larger media landscape of sports broadcasting: the focus of chapter 1. The first chapter begins by looking at the long history of sports and media. By introducing the full gamut of sports media, I am better able to investigate how e-sports broadcasting stays in conversation with each of its predecessors. As evidenced in the reshuffling of sports media through history, we can see that e-sports make use of all of these forms of media while creating something new. During this chapter, I look to the transition moments in traditional sports broadcasting as the foundation ofthe e-sports industry. Moments of tension and doubt within the sports media industry as it shifted from one medium to another provide perfect lessons E-Sports Broadcasting 13 to be learned by the e-sports industry as they struggle with some of the same issues found in the reshuffling of media history. Indeed, while making use of the same media through journalism, public relations, and audiovisual broadcasts, the e-sports industry constantly wrangles with the use of the newly emerged medium of live-streaming. Television especially influences live- streamed broadcasts, which e-sports broadcasts tend to approach with the same framework as television. Chapter two focuses on e-sportscasters, also known as shoutcasters. I begin the chapter with a brief look at the history of shoutcasting. Considering that many of the early shoutcasters pull solely from traditional sportscasters, understanding their influences is crucial in understanding how e-sports has evolved in the way it has. As, I argue, the single most pointed signaling of the sportiness in e-sports, these individuals have pushed the e-sports industry towards a sports model. When first time viewers or listeners leave an e-sports broadcast with the distinct feeling of a sports broadcast in their mind, it is the shoutcasters doing their job. They rely heavily on conventions set by traditional sportscasters. Much like their predecessors when faced with something new, shoutcasters borrowed what they could and innovated when there was nothing to borrow. Chapter two also focuses on shoutcasters' formulation of their identity within the e-sports industry as personalities, professionals, and record-keepers. Shoutcasters are just now creating an identity separate from traditional sportscasting. Where veteran shoutcasters relied primarily on traditional sports broadcasts, newer casters look instead to other shoutcasters. These shoutcasters are reshaping their identity while attempting to fully embrace the new medium of live-streaming. The third and final chapter tackles the topic of economics in e-sports. As the history and trajectory of sports broadcasting has profoundly affected the e-sports industry, many of the E-Sports Broadcasting 14 economic models present in traditional sports bled into the e-sports industry as well. The e-sports industry in the US and Europe has yet to be analyzed as such. Some work (Taylor 2012) has focused on e-sports revenue streams including sponsorships, company models, and team ownership, but overall, the subject remains underexplored. Dal Yong Jin's (2010) analysis of the political economy of e-sports in South Korea offers a tool set for this chapter. While the South Korean e-sports model spawned out of an extremely particular set of circumstances that cannot be readily applied to the U.S. or E.U. e-sports scenes, Jin's investigation of the surrounding economic systems surrounding e-sports translates well to my own investigation of the U.S. and E.U. industries. As staggering prize pools continue to make headlines, it is easy to lose sight of the economic system working behind the scenes to keep e-sports financially salable, or in some cases not. The third chapter delves into traditional sports economics and their influence on the e- sports industry. In some areas, the models translate perfectly. In others, e-sports has been unable to tap into the same revenue generators as traditional sports. Unless some developments significantly alter the e-sports industry, it may be more tenable to pursue other models instead of the sports industry. Methods This thesis makes use of many qualitative methods including historical analysis, interviews, and fieldwork. To grasp the significance and situation of e-sports broadcasting in its current state fully, one must analyze the same developments in traditional sports broadcasting. As one takes a deeper look into the past of the professional sporting industry, its influences on e- sports become clear. A feedback loop has been created between the two. Historical analysis offers a glimpse at key moments which defined the incredibly successful global sports industry. E-Sports Broadcasting 15 Not only are similar situations appearing in e-sports, but e-sports pushes back into each of the investigated forms of media. A few of the issues currently facing e-sports could be resolved through following the path established by traditional sports, while other issues have been caused because so much has been borrowed. I also had the pleasure of conducting seven interviews with professional shoutcasters. I limited the selection of shoutcasters to full-time professionals, rather than amateurs, to get an insight into how these new professionals view their role within the industry. Roughly half the participants are veteran shoutcasters of five or more years. The other half have joined the scene more recently with one in particular having shoutcasted professionally for less than one year. As these informants are a few of only dozens of professional shoutcasters in the world, I have attempted to keep their identities anonymous. As professional personas, some of these casters may benefit from being associated with this work, but I do not want to run the risk of potentially linking these shoutcasters with their statements in the event that this information could somehow affect the community's perception of the individual or potentially harm their prospects within the e-sports industry. The conversations were all positive, but one can never truly assure their informants that information they have provided in confidence will have no repercussion in any foreseeable future. With these considerations in mind I decided before conducting the interviews that the informants would remain anonymous. Finally, I was also able to spend time working within the e-sports industry. My time spent working for a prominent e-sports company profoundly shaped this thesis. Working alongside industry professionals sparked countless conversations about the current climate of the e-sports industry and possible futures. These conversations have both helped and challenged my thinking about the e-sports industry. While I often refer to the e-sports industry or community as a E-Sports Broadcasting 16 homogenous whole, the professionals who live within the space are not all of one mind and it would be a mistake to present them that way. Within e-sports, there are many different games and communities vying for viewers, players, and attention. What follows is my best attempt at wrangling the many paths e-sports has started to follow. E-sports Literature Review E-sports is still a young industry and an even younger subject of critical inquiry. Most entries into e-sports scholarship have emerged within the last five years. E-sports literature tends to come from the much older tradition of games studies, but ties into many other fields including the social sciences, cultural studies, economics, and law. Professional-gaming literature is a veritable hotbed of potential research topics with more articles, theses, and dissertations appearing every year. Much of the growing body of e-sports literature focuses on the professionalization of gaming (Jin 2010; Mora and Heas 2005; Swalwell 2009; Taylor, Nicholas 2009; Taylor, T.L. 2012; Witkowski 2012). These histories offer much more than a rundown of the events that created the e-sports industry. They also offer insight into our contemporary social moment. The arrival of a professionalization of video gaming signals many significant developments within both western and non-western culture. The global nature of e-sports and its meshing together of complex and often conflicting identities continues to beg investigation. E-sports literature primarily resides within the social sciences. Many cultural analyses in e-sports (Chee and Smith 2005; Harper 2010 and 2014; Hinnant 2013; Swalwell 2009; Taylor 2011) have focused on the communities growing within different scenes. Todd Harper, for instance, investigates the culture of competitive fighting games, a fascinating community which stands both within and at odds with the rest of competitive gaming. Gender studies are also E-Sports Broadcasting 17 becoming increasingly common within e-sports literature (Chen 2006; Crawford 2005; Leonard 2008; Taylor 2009 and 2011; Taylor and Witkowski 2010; Witkowski 2013). With the fascinating and fraught formulation of masculinity within these spaces as well as the perceived absence of femininity, gender studies are incredibly important within e-sports literature. Nicholas Taylor (2011) offers insight into the ability of e-sports to create embodied performances of masculinity at live events which spread through communities specific to certain titles or genres. Taylor and Witkowski (2010) also show the conflicting versions of masculinity that appear in different e-sports genres. There has also been an increasing focus on e-sports as a spectator activity. Jeff Huang and Gifford Cheung (2012) found in a study that many of the e-sports fans they investigated prefer watching high-level play rather than playing a match themselves. Kaytou and Raissi (2012) also investigate spectatorship in e-sports with a focus on how best to measure live- streaming audiences. Others (Bowman 2013; Gommesen 2012; Kow and Young 2013) show that the audience in e-sports has a profound effect on performance for the players, akin to a traditional sports audience. These scholars also investigate the expertise apparent in e-sports players that is passed on through spectating as often as practicing. As the professional play of video games fascinates so many, e-sports literature has understandably focused primarily on professional players. Notable exceptions include Jin (2012) and Taylor (2012) who, while still heeding players, also investigate the surrounding factors which allow for play at a professional level. Without these other factors, professional players would not exist. It is from the tradition of these two authors, among others, that I base this work. This thesis, like many of the works listed above seeks to better understand the phenomenon of e- sports while analyzing a particular segment of the scene. With few investigations into the E-Sports Broadcasting 18 broadcasting of e-sports, I hope to contribute to e-sports literature in a way that is both unique and replicable to other systems found within the larger e-sports framework. Sports Media Industrial Complex As sport and media become increasingly intertwined, it becomes difficult to analyze one without at least acknowledging the impact of the other. Pointing to the inextricable link between sports and media, sports media scholar K. Lefever (2012) argues, ""while sport provides valuable content and audiences for media operators, the media is a revenue source and promotional tool for sport."" As such, the steady professionalization and, in turn, commercialization of sport relies heavily on its media counterpart. The subsequent interdependence between media outlets, sponsors, and sports leagues creates what is often referred to as the sports/media complex or sports media industrial complex (Jhally 1989, Rowe 1999, Maguire 1991). Wenner (1989) coined the neologism, MediaSport, to define the deeply rooted relationship between sports and media. The two can hardly be considered separate anymore. Stein (2013), a Comparative Media Studies alumni, building on the work of these earlier scholars created a model which could be applied to new arrivals in the sports media landscape. Thankfully, Stein provides a fairly replicable analysis of sports video games within the broader sports media landscape. His investigation of the relationship between televisual sports video games and sports media largely informs my own work. He notes an almost relentless stream of advertising and commercialization rhetoric appearing in sports video games. Building on the work of Wenner, Rowe, and Jhally, he argues that the commodification and capitalist trends found in traditional sports broadcasting bleed into newer media such as video games. This steady influx of advertising and commercialization can be found in e-sports as well. E-Sports Broadcasting 19 As e-sports broadcasters gain more experience and access to more robust technology, they have started to incorporate many of the same commercial opportunities Stein noticed in sports video games. Segments of the broadcast are occasionally sponsored, or one might see a sponsor make an appearance in an event's title such as the Intel Extreme Masters tournament. Where Stein argues that sports video games incorporate these advertisements as a signifier of their televisual legitimacy, I argue that e-sports broadcasters make use of the same strategies because they are informed by earlier forms of sports media. The steady commercialization found in e-sports reveals the influence that the sports media industrial complex has had on the e-sports industry. In documenting the dynamics of the sports media industrial complex, Jhally (1989) argues that sports are best viewed as commodities. Jhally's model focuses on the sporting industry in the US prior to the emergence of new media. More readily applicable to e-sports, Lefever's (2012) analysis of the sports media complex within new media details a phenomenon which has upended the former relationships between stakeholders in the sports media industrial complex. She claims that, ""the sports/media complex has somehow changed, allowing the different stakeholders to take up new roles"" (Lefever 2012, 13). The stakeholders, including sports franchises, sponsors, and media outlets, have had to adapt to a new media landscape with new roles. These new roles are more transient within the high-demand world of new media. Sports organizations and franchises have taken a more active role in connecting with fans, media outlets have taken a larger interest in sports franchises (often buying sports franchises if it is less expensive than purchasing media rights), and sponsors have taken advantage of new, innovative ways to reach consumers (Lefever 2012, 21). According to sports scholars Haynes and Boyle (2003), television sports viewers are no longer expected to just sit back and relax. Instead they are expected to follow their sport through E-Sports Broadcasting 20 social media, forums, blogs, and other digital outlets. This new, active fan fits well within the e- sports industry and live-streaming, but has changed the traditional sports media industrial complex. Before delving too far into the role of traditional sports economic models on e-sports, however, I will first situate live-streaming and e-sports within the larger sports media industrial complex. E-Sports Broadcasting 21 Chapter 1 Sports Media in Transition From Print to Live-Streaming Every day, millions of Americans are catching up with the latest sports news through print, radio, television, and online. Sports have saturated the entire spectrum of mass media in the US. With the emergence of each form of mass media, sports coverage has been at the forefront of adoption and innovation (Bryant and Holt 2006, 22). Each major medium shift in the US has been accompanied by a massive reshuffling of the sports media landscape. Often, this reshuffling opens a space for a particular sport to take up the new medium, create conventions, and carve a path for others to follow. These sports were not spawned by mass media, but their spike in popularity around the emergence of a new medium indicates very specific social moments in the US. Early sports magazines and print coverage of sports focused primarily on prize-fighting, radio ushered in the golden era of baseball, and television transformed football into a titanic entertainment industry. The rise and stabilization of sports media are as much a product of available technology as they are indicative of societal preoccupations of the time. If sports and sports media are indicative of our social moment, then what can we glean from the arrival of live-streaming and e-sports? The co-evolution of sports and media is the coalescence of many factors including changes in power structures, modes of production, and available technology. As Bryant and Holt argue in their investigation of the history of sports and media, ""[e]ach epoch of social evolution has witnessed important sports-media developments that were affected by the evolving socio- cultural environment"" (2006, 22). In what follows, I trace the co-evolution of sports and media with particular focus on the relationship between emerging mass media and the media ecology E-Sports Broadcasting 22 surrounding that emergence. By documenting these moments of turbulence, I establish the framework necessary to analyze live-streaming as a new medium with which e-sports has emerged as an early adopter and convention creator. Live-streaming did not emerge independently from its predecessors, but rather delivers on the preoccupations of our current social moment. It has once again started a reshuffling of the roles of media within the sports media complex. E-sports, while primarily viewed through live-streaming, relies on all of the previous forms of media to varying degrees. With this framework in mind, I argue that the feedback between live-streaming, e-sports, and traditional sports has spawned an industry which roots itself in traditional sports media while still investigating the full potential of live-streaming. I begin by briefly discussing sports media in antiquity with Thomas Scanlon's (2006) piece on ancient Mediterranean sports and media. After this introduction to sports media, I move to the US in the late eighteenth century with the emergence of the first sports-only publication, the sports magazine, as well as early print news coverage of prize fighting during the rise of industrialization and nationalism. The next section maps the push towards immediacy in sports coverage and the rise of radio. On the heels of radio and the golden age of baseball, I discuss the early issues with televised sport before the post-war era. Moving into the 1950s and 1960s, I detail the transformation of football into a televisual sport accompanied by a very specific social contingency. I then transition into an investigation of live-streaming and e-sports, particularly how both are in conversation with sports media history. Origins of Sports Media As classicist Thomas Scanlon (2006) posits, there is no history of sports without its media counterpart. Media in antiquity, he argues, ""are a tool of society, a means of transmitting a message, primarily one from the rulers to the ruled"" (Scanlon 2006, 17). While his definition is E-Sports Broadcasting 23 quite limited, Scanlon is correct in noting that media are inflected with the power structures of a society. Sports as media were classically used by those with power to reinforce the hierarchy. Sports events were ""represented as a benevolent benefaction from the rich, noble, and empowered to those marginalized"" (Scanlon 2006, 18). This reinforcement of power structures comes through not only in the production of sporting events, but also in the medium itself. Scanlon suggests that the most powerful sports 'medium' in classical times was Roman architecture. The massive circuses and arenas were meant to ""provoke awe, admiration, and obedience in the citizens"" (Scanlon 2006, 18). Scanlon establishes that the predominant sports medium in a given society correlates directly with their notions of power. Within the realm of more dispersed authority such as the Ancient Greeks, sports media reflected the high value of an individual and his merits. Depictions of athletics in Ancient Greek poetry and pottery, made by and for the common people, focus on a particular athlete's prowess more than the event itself. On the other hand, societies with incredibly rigid hierarchies and god-kings such as the Ancient Egyptians and Persians, tend to represent sports as a demonstration of the ruler's power over their people. Ancient Rome, with its centrally focused authority, used architecture to demonstrate the power of the nobility as both benefactors and arbiters, diminishing the role of the athlete to that of an entertainer. Moving into more recent history with media such as newspapers and radio, Scanlon concludes that sports media became an amalgamation of both the Roman and Greek styles: large spectacles with massive personalities. E-Sports Broadcasting 24 Establishing a Media Landscape: Early Sports Media in America The importance of the printing press on modem society cannot be overstated. While its precise effects are still being debated', the affordances of the printing press allowed individuals to produce and disseminate a massive amount of information far more efficiently than ever before. With a massive rise in literacy rates and increased access to print brought about by the printing press, the reading population of the world shifted (Eisenstein 1983). While early readership was restricted to a very small subset of society, the printing press paved the way for the coverage of more mundane topics such as sports. In their analysis of sports media in pre- industrial America, sports media scholars Jennings Bryant and Andrea Holt point to two major developments: first, the appearance of sports in newspapers as 'general news' and second the creation of a completely sports-centered publication: the sports magazine (2006, 22). The advent and success of sports magazines in the early nineteenth century stands as a marker for some of the intellectual shifts of the industrial era. During this time we see a professionalization of sport in the form of prize fighters. We also see a shift from sports as a local leisure activity to something that one follows from a distance. Sports contests began to take on implications beyond a mere matching of athletes. Many sports magazines started out as independent, one-person operations that began circulation in the 1820s and 1830s (Bryant and Holt 2006, 22). The Spiritof the Times, one of the earliest iterations of the sports magazine, actually reached a circulation of over 100,000 readers by the 1840s. The success of this initial sports-focused publication displays the roots of the American sports media tradition. While they note the significance of sports magazines in the overall climate of sports media in America, Bryant and Holt trace the advent of modem sports 1See Elizabeth Eisenstein. 1983. The Printing Revolution in Early Modern Europe. New York: Cambridge University Press. E-Sports Broadcasting 25 media to recaps of prize fighting in the Penny Press age of the 1830s. With increased circulation to the middle and lower classes, sports coverage increased substantially in the mid-nineteenth century. Sports coverage in the Penny Press era focused on creating spectacular depictions of sporting events. As McChesney, a media historian points out, James Gordon Bennett, owner of the New York Herald,was ""one of the first exponents of 'sensationalism' as a means of generating circulation, and sport fit comfortably within this rubric"" (1989, 51) Out of the sensationalism present in these early newspapers, sports began to take on more significant cultural meaning. There was particular focus on regionalism and nationalism. Sports media scholar J. Enriquez explains that sporting events were far more likely to be covered if they featured a contest which reflected the social preoccupations of the day such as a northern horse racing against a southern horse, or an American boxer fighting a European (2002, 201). Through these mediated depictions, sporting events were encoded with much more meaning than a simple contest. They reflected the contemporary hopes and anxieties of the people. Sports media built up athletes as representatives. Newspaper recaps did much more than simply describe the actions; they created dramas (McChesney 1989, 51). The hyped up imagery of athletes and their contests created through the Penny Press and sports magazines became the paradigm for sports coverage for decades while a new sport caught America's attention. Newspaper Sports Writing and the Rise of Team Sports The rise of baseball as a national pastime coincide with the period of time just after the American Civil War. McChesney explains, ""The Civil War introduced baseball to an entire generation of Americans, as the troops on both sides played the game when time permitted. Indeed, baseball emerged as the preeminent national team sport during this period"" (1989, 52). E-Sports Broadcasting 26 After the Civil War, baseball helped mediate conflict by providing common ground for northerners and southerners. This moment was one in which the country was seeking to heal its rift, looking for neutral things that could bind the nation together. Baseball filled a political agenda by giving people something to focus on without opening old wounds. Sports writing changed drastically in the years following baseball's spike in popularity. Sports coverage began to receive regular columns and increased coverage throughout the late nineteenth century, leading to a new kind of journalistic specialization: the sports-writer (Enriquez 2002, 202). This fixation on sport was a result of new socio-cultural environments. Mandelbaum (2004), a sports media scholar and historian, argues that the industrial revolution created a new sports landscape through several major developments. First, the notion of childhood had expanded. In the nineteenth century, the period between birth and entering the workforce increased substantially. The new notion of childhood permitted more people to engage with baseball, football, and basketball. This increased interest in team sports continued into adulthood. Watching and reading about sports in the newspaper or sports magazines became an acceptable way to recapture the ""carefree years of their lives"" (Mandelbaum 2004, 2). Mandelbaum also argues that baseball offered a renewed connection to pastoral America, creating a feeling of nostalgia for the new city dwellers and factory workers who desperately missed the pace and beauty of rural America. Baseball coverage created the first major feedback loop between sports and media in America. Bryant and Holt claim that the importance of sport was downplayed significantly in the puritan era, but, ""regular, routine reporting of sports in newspapers and specialized magazines helped shift the cultural attitude towards sports in general"" (Bryant and Holt 2006, 25). They argue that in the late 1870s through the 1890s, Americans adopted a new stance on sports as important for the development of mind, body, and society. This new cultural stance on sports E-Sports Broadcasting 27 was shaped and fostered by an increased media coverage of sports. As baseball and its media coverage became more professionalized, Americans began to consume sports media in completely different methods. Sports spectatorship became a regular and acceptable pastime for the industrial worker. The industrial revolution created the first opportunity in America for sports production and spectatorship to be commercially successful endeavors. The growth of cities and the massive developments in individual mobility allowed for sporting events to take on new significance (Mandelbaum 2004, 3). Cities provided large numbers of sports players as well as spectators to fill newly built stadiums and watch newly formed teams. Sports fandom in the U.S. fit neatly into the predominant forms of labor and leisure. Zillmann and Paulus (1993), two psychologists who wrote on sports spectatorship, explain, ""spectatorship, as a significant form of recreation, is an outgrowth of the monotony of machine-dictated labor, sports events became the weekend love affair of all those whose workday was strictly regulated by production schedules"" (601). Zillmann and Paulus' article further supports the feedback between sports media consumption and societal structures. Live spectatorship in America had previously been seen as a luxury for the rich and powerful, but with the increased circulation of newspapers, and in particular sports coverage, to the middle and lower classes, sports spectatorship became accessible to an entirely new sector of the population (Bryant and Holt 2006, 21). Architecture once again emerged as an important medium. Large concrete and steel stadiums were created, replacing the more organically created playing fields of the late nineteenth century (Mandelbaum 2004, 52). We see here an important transition into the production of sport as a money making opportunity. As I discuss in the third chapter, the introduction of investors and producers fundamentally alters sports and their media counterparts. E-Sports Broadcasting 28 The available media shaped the portrayal and perception of athletics in the industrial era as well. The idea may sound a bit romantic, but Benjamin Rader (1984), a sports scholar focused on the transformation of sports media in America, labels the period of sports media prior to television as an era of heroes. Whether speaking of prize-fighters or the Mighty Casey of folklore, sports media in the industrial era painted athletes as larger-than-life characters. Rader claims, ""[t]hose standing on the assembly lines and those sitting at their desks in the bureaucracies increasingly found their greatest satisfaction in the athletic hero, who presented an image of all-conquering power"" (1989, 16). To Rader, sports media before television presented the American ideal. Athletes were meritocratic role-models playing for the love of the game. Rader's analysis places the impetus on newspapers to depict dramatic stories with characters akin to David and Goliath. In addition to individual mobility, urbanization, and industrial work, Enriquez attributes the rise and legitimacy of sports journalism as the catalyst for the nationalization of sports in America (2002, 201). As all forms of communication and nationalization were transforming, sports coverage lead the charge. In the early twentieth century, most newspapers had dedicated sports writers on staff. These sports writers became famous through their innovative and entrancing writing. Writers like W. 0. McGeehan, who worked for many San Francisco papers, described athletes as sorrowful sages and their contests as the clashing of titans on a battlefield (Nyhistory.org 2015). In this period however, it is difficult to judge the difference between journalism and public relations (Bryant and Holt 2006, 30). In fact, the issue of PR penetrating journalism in the late nineteenth to early twentieth century is explicitly laid out in Michael Schudson's (1981) chapter, ""Stories and Information: Two Journalisms in the 1890s"". At the turn of the century, there existed a dichotomy between news as entertainment and news as E-Sports Broadcasting 29 information. As papers around the country struggled to define themselves, sports media also went through a defining period. Legitimate sports writing became known for its higher literary quality, but read more like advertisements with its exaggerated, often hyperbolic, language. Public relations soon became as much a part of sports journalism as describing the events themselves. Team owners understood the media's role in keeping attendance at sporting events up and began catering to sports journalists for coverage (Enriquez 2002, 206). The team owners expected sports journalists to act as publicists for their events. The gambit paid off as sports writing filled more and more of the daily papers and attendance at live events continued to rise. The sports writers added significance to the experience of watching a sporting event. Between the shifts in the American middle class, leisure activities, and the flowery language of sports journalism, watching a sporting event began to take on the significance of watching history unfold. We will see these same issues appear again in e-sports coverage as journalism becomes a legitimizing force within the e-sports landscape, torn between deep analysis and hyped-up depictions for the sake of generating publicity. Liveness continued to assert its role in sports media as new technologies emerged. The telegraph especially placed the impetus on news sources to provide timely information. In a fascinating illustration of the desire for timely sports news, the ChicagoTribuneran the following note on March 17, 1897, the day of the legendary boxing match between Jim Corbett and Rob Fitzsimmons: ""The Tribune will display bulletins today on the prize fight. It has secured a telegraph wire to the ring in Carson City and a competent man will describe the progress of the fight, blow by blow, until the test is decided. The bulletins will be posted thirty seconds after they are written in the far Western city"" (Bryant and Holt 2006, 29). This fixation on live updates for sporting events across the nation is another example of how sports media has shaped the E-Sports Broadcasting 30 media landscape of America. Information began traveling faster than ever via wireless transmissions, but it was actually a yacht race which saw one of the very first implementations of wireless for live information transmission. Sporting events saw some of the earliest uses of the telegraph for news reporting as well (Mott 1950, 597). As the telegraph allowed for a sense of liveness even for remote events, it paved the way for the most significant development in sports media prior to television: radio. A Fixation on Liveness: Radio and Sports Consumption Radio delivered on the push towards liveness established by the telegraph. The first broadcast of a Major League Baseball game occurred within a year of the commercial release of radio (Enriquez 2002, 206). Rader remarks, ""Now the fan did not have to await his morning newspaper; he instantly shared the drama transpiring on the playing field"" (Rader 1984, 23). For the first time, sports were perceived as home entertainment. Broadcasters as well as businesses capitalized on the shift. Sports coverage was integral to the rise in popularity of radio in the interwar period. In Rader's words, In the pre-television era, the heroes of sports assisted the public in coping with a rapidly changing society. The sports world made it possible for Americans to continue to believe in the traditional gospel of success: that hard work, frugality, and loyalty paid dividends; that the individual was potent and could play a large role in shaping his own destiny (1984, 15). By Rader's account, sports programming on radio delivered a much needed revitalization of the American ideals through the transient industrial period and The Great Depression. The rise of radio coincides with the golden age of baseball, but there was an awkward transitional phase into the new medium while newspapers and radio both tried to define their new boundaries. While consumers clearly desired liveness, initial radio broadcasts felt flat and emotionless (Bryant and Holt 2006, 27). Some of the greatest blow-by-blow sports writers were E-Sports Broadcasting 31 terrible at delivering a compelling radio broadcast. Sports writers were extremely adept at creating dramas through print, but they failed to capture audiences in the early days of radio. Oddly enough, their sports knowledge undermined their sports coverage in the new medium. Instead, a new role emerged: the sportscaster. In the era of radio, the performance of live sports broadcasts came with significant stakes. Adept sportscasters were cherished more for their voices than their sports knowledge. Delivering play-by-play depictions of sporting events takes little technical knowledge, instead the entertainment comes from the delivery. Mandelbaum writes of early radio sportscasters, ""the broadcasters were akin to poets and troubadours who preserved and handed down the great tales oftheir cultures by committing them to memory and reciting them publicly"" (2004, 80). Delivery was actually so important that sometimes sportscasters such as Graham McNamee, known especially for his baseball broadcasts, were not even present at the event but instead handed written play-by-play depictions of the game so that they could add their own dramatic and authorial tone to the live event (Mandelbaum 2004). Another issue during the emergence of radio was redefining the role of newspaper sports coverage. Radio could deliver the liveness desired by sports fans and was incredibly well suited for play-by-play commentary. Newspapers had traditionally covered the blow-by-blow report of an event, capturing the drama through flowery language and hyperbole. With radio, the sportscaster captured the audience's attention through the same means, bringing in even more emotion as his voice rose and fell with the action of the contest (Enriquez 2002, 202). Sports writers instead decided to focus on an area that radio broadcasters could not: strategy. Early sportscasters had to focus so much on the delivery of the action that they could not elaborate on the reasons behind certain maneuvers. Sports writers took advantage of this deficiency and began E-Sports Broadcasting 32 writing articles which focused on everything around the action. From in-depth analysis of strategy to the creation of larger than life athlete personalities, newspaper coverage of sports in the era of radio completely changed to remain relevant. Sports magazines also had to find a new space to occupy during radio's reign. Completely unable to keep up with the live coverage by radio and the strategic coverage of America's favorite sport, baseball, sports magazines instead began to focus on niche sports such as yacht racing. The other innovation of sports magazines in the early 1930s was their addition of full page color photographs of athletes, something that neither radio nor newspapers could offer (Enriquez 2002, 202). They remained as an important sports medium but had been supplanted by both radio and newspapers. Baseball's hold on the American public was so strong that the niche sports, which were typically covered in sports magazines, hardly seemed relevant. Football in particular rarely saw coverage anywhere other than sports magazines (Bryant and Holt 2006, 32). Football had traditionally been seen as a college sport reserved for the wealthy, but with an increasing number of college graduates in the U.S. and the rise of a new medium, its niche status was about to change (Oriard 2014, vii). The Televisual Transformation of Sport Television's initial debut into the sports world was a colossal failure. Reaching only a few hundred people, the first American televisual sports broadcast was a Columbia-Princeton baseball game on May 17, 1939. Just a few years after the commercial release of the television in the U.S., RCA's first foray into televised sport flopped. The New York Times' Orrin E. Dunlap Jr. recounted on the following Sunday, ""The televiewer lacks freedom; seeing baseball on television is too confining, for the novelty would not hold up for more than an hour if it were not for the commentator"" (Rader 1984, 17). He goes on to say, ""To see the fresh green of the field as The E-Sports Broadcasting 33 Mighty Casey advances to the bat, and the dust fly as he defiantly digs in, is a thrill to the eye that cannot be electrified and flashed through space on a May day, no matter how clear the air."" Bryant, Holt, Enriquez, and Rader attribute the failure of early televisual sports to several factors. First, television camera technology was rudimentary and receivers were even worse (Bryant and Holt 2006, 31; Rader 1984, 18). Viewers could hardly see the player, much less follow the ball or action on the field. Second, television was not a commercial success upon its release. Sets were expensive and did not offer nearly enough programming to warrant their price: an issue that created a sort of negative loop as the television industry needed more viewers to warrant more content yet could not supply enough content to attract more viewers. The third factor, described by Enriquez, is the failure for broadcasters to adapt to the new medium. Sportscasters could not actually see the video feed and casted the game as if they were still on radio; recounting every single action that occurred on the field despite what was on viewers' screens at home. Inexperienced camera operators had difficulty following the action and the image rarely matched what the sportscaster was describing. Radio sportscasters also had difficulty transitioning into the new visual medium because they could no longer provide the same level of drama through exaggeration and hyperbole. Where short infield ground balls could previously be described as laser-fast bullets, the viewers at home now saw that the play was just another ordinary event. Situated somewhere in between watching the game live at a stadium yet still sounding like radio, televisual sport had a difficult time defining itself in the late 1930s and early 1940s. According to Rader, televisual sport experimentation stopped completely during the Second World War (1984, 23). With the well-established roles of radio, newspapers, and sports magazines, the revival of televisual sport seemed to be impossible. The utter failure of televised sports in the late 1930s E-Sports Broadcasting 34 into the Second World War left televisual sport in a difficult position. Sports radio's popularity was at an all-time high in the 1940s. Baseball had captured the hearts and minds of the American people, and famous radio broadcasters such as Bill Stern and Jack Armstrong kept them listening with bated breath (Rader 1984, 30-3 1). Baseball and more generally live event sports spectatorship, however, could not keep the nation content for too long. In what has been dubbed the Sports Slump of the 1950s by Rader and others (Bryant and Holt 2006, McChesney 1989), spectatorship had finally started to dwindle. Television sets were making their way into homes in record numbers after World War 11. In the post-World War 11 era, pastimes shifted from inner-city, public forms of recreation to private, home-centered forms of recreation. Sports revenue was down and change was in the air. People could watch baseball on their television sets at home, but not many people wanted to. As shown by the earlier quote from The New York Times, television had difficulty containing the magic that baseball once held. Football, however, was poised to rise with the new medium. It had been long overlooked, but football was incredibly well suited for television broadcasts. The large, visually distinct ball and typically slow moving action provided an acceptable subject for contemporary television camera technology (Grano 2014, 13). College football had seen a bit of success in newspapers, but professional football had a negative reputation as a ""perversion ofthe college game played for alma mater rather than a lousy paycheck"" (Oriard 2014, vii). Radio broadcasts of football had never reached the same level of success as baseball. Professional football seemed to be a sport without a suitable medium. As sports media scholar Michael Oriard explains, ""[o]nly television could give the professional game a national audience, and Pete Rozelle's defining act as the commissioner who ushered in the modem NFL was to market the league through a single television contract, rather than leaving clubs to work E-Sports Broadcasting 35 out their own deals"" (2014, vii). This deal with broadcasting giant, NBC, led to the NFL's great breakout story and what would soon become the model for televised sports (Rader 1984, 85). With the NBC still losing money on a dwindling sports fanbase, they were ready to pull the plug on their deal with the budding NFL until the championship match between the Baltimore Colts and the New York Giants of 1958 (Grano 2014, 13). This match, still hailed as the 'Greatest Game Ever Played', would become the longstanding origin story of televised football. The game went into a second overtime, pushing the broadcast into prime time on the East Coast, a slot in which NBC never dared to place professional football. As millions of Americans tuned in for their regularly scheduled programming, they instead found John Unitas and his Baltimore Colts scoring the game winning touchdown after a long, hard-fought battle. Oriard, Rader, Grano, Oates, and Furness all trace the NFL's commercial success to this one defining moment. As compelling as origin stories often are, the truth is that many other factors lead to the success of football in the new mass medium. New technologies such as video tape were integral to the rise of football in America. Hitchcock argues that instant replay in particular helped with the rebranding of professional football: ""The use of video-tape gave the game of football a whole new image... The instant replay changed football from brutal, quick collisions into graceful leaps, tumbles and falls. It gave football an aura of art in movement. It made football attractive to entirely new segments of the audience"" (1989, 2). Where football players had once been seen as lethargic brutes, instant replay allowed broadcasters to slow down images, dissect plays, and highlight the athleticism of players (Rader 1984, 83-84). Sports, with football leading the charge, were once again on the cutting edge of media adoption. According to Dylan Mulvin, the first documented use of instant replay for review and training purposes was in 1957 during a game between the Los Angeles Rams and the San E-Sports Broadcasting 36 Francisco 49ers (2014, 49). By 1964, instant replay was a standard broadcasting technique across all sports. The NFL's willingness to adapt to the new medium set it apart from other sports at the time. In addition to these technological and legal advances, Bryant and Holt as well as McChesney argue that one particularly innovative producer reinvented sports broadcasting for television: Roone Arledge. With ABC's full support, Arledge established television broadcasting conventions still present today. After the 1958 Championship game between the Colts and the Giants, ABC was scrambling to catch up to the NBC's success in televised sports broadcasting. As Enriquez describes, ""Television broadcasting affected different sports in different ways. It devastated boxing, had mixed effects on baseball, and proved a boon to college and professional football"" (2002, 202). As NBC began to ride the wave created by the NFL, ABC looked to get in on the action. Arledge was given free rein to perform a complete overhaul of ABC Sports. Bryant and Holt argue that the single most important innovation Arledge brought was the notion that a televisual broadcast should be presented ""from the perspective of what the typical fan would see if he or she attended the game live"" (Bryant and Holt 2006, 33). Arledge (2003) believed that the broadcast should capture the essence of attending a game, not just the play on the field, but the roar of the crowd, the cheerleaders, the marching bands, and the coaches on the sidelines. As Enriquez describes, ""under Arledge, television assumed every role previously played by print media; it served as the primary medium for experiencing events, it provided detailed analysis, and it gave human faces to the participants"" (2002, 205). Through football, televised sports were able to set conventions which separated them from earlier forms of media. This transition lives E-Sports Broadcasting 37 on in live-streaming today as we will see later with live-streaming's adaptation rather than transformation of televised sport. The arrival of television meant that sports radio and print media had to redefine their role in sports coverage. Television could deliver the liveness of radio and, with the help of commentators and technology like instant replay, the drama and dissection of strategy found in print media. Newspaper coverage of sports was now relegated to simple recaps. Sports magazines on the other hand rode the success of television. As Bryant and Holt assert, ""Sports Illustratedoffers a classic example of an old medium responding to a new one"" (2006, 36). Rather than seeking out an area left uncovered by television, Sports Illustratedsupported televised sports by providing innovative action photography and updates on the most popular athletes and teams at the time. Sports broadcasts of the 1960s were infused with the hopes and fears of the Cold War era. R. Powers, a television sports scholar, suggests that sports filled a void in the American public, ""shrugging off the darker morbidities of the Cold War and McCarthyism"" (1984, 118). The re-found focus on sports as spectacle established by ""the youthful theme of ABC, echoed the Kennedy idealism of the new frontier, the sporting emphasis echoed Kennedy's image of muscular athleticism..."" (Whannel 2002, 34). Entertainment sports media, with its art-in-motion presentation, delivered a message of newness and regeneration to American. Through broadcasting and advertising deals, sports helped build and perpetuate the growing conspicuous consumption movement and the capitalist ideals of post-war America. Athletes resumed their star status. Sports stars began appearing in advertising everywhere. Merchandising became a key part of sports promotion. Anything from replica jerseys of sports stars to blankets and flags with team branding can be found almost anywhere in the U.S. E-Sports Broadcasting 38 Contemporary Sports fandom has come to mean much more than simply following a team. It means buying a team's products, playing sports video games, joining fantasy leagues, and watching sports entertainment television. Oates, a sports media scholar focused on the NFL, writes that fandom has been transformed by the presentation of athletes as commodities to be consumed selectively and self-consciously by sports fans (2014, 80). The previously subcultural hyper-fandom activities such as fantasy football and sports video games, Oates argues, have moved into mainstream prominence and profitability. Fans are invited to interact with athletes as vicarious managers in fantasy sports, offering a completely new, personally tailored form of interaction with sports organizations. This new drive for constant connection and feedback within the sports industry culminates with live-streaming. Live-Streaming: Constant Connection As Oates suggests, sports fandom has fundamentally changed to reflect an increased involvement on the part of the spectator. Athletes and personalities have become commodities for fans to interact with. Social media, fantasy sports, and video games have created a connection to sports stars that was never before available in other media. At any moment, a spectator can catch highlights on ESPN, head over to forums to discuss major sporting events, or load a stream of a match on their phone, all while tweeting at their favorite athletes with the expectation that their words will be received on the other end. Recent trends show a change in the sports media landscape as new platforms begin to vie for control over sports broadcasting in the US. The NFL has recently signed a deal with Google allowing for the streaming of games over the internet after their current contract with DirecTV ends in 2015. This deal reflects the changing media landscape in the internet era. The rise of new streaming platforms poses an interesting dilemma to the current media titans and new E-Sports Broadcasting 39 opportunities for new forms of media sports. Thus far, using the tradition established by McChesney, Bryant, Holt, and Rader among others, I have used sports media as a lens through which to view particular socio-cultural moments in America. I now turn that lens towards the contemporary sports media landscape. What can we learn about our own social moment by looking at the use of streaming platforms for traditional sports or the arrival of e-sports as an entirely new form of professional competition that makes use of older forms of media, but thrives in live-streams and video on demand? The MLB offers an early case study into the use of live-streaming for major league sports broadcasting. The regular season in the MLB consists of 2,430 games, a staggering number compared to the NFL's 256. The sheer number of regular season games held each year causes a problem with over-saturation. This inundation of content lowers the value of each individual game in the eyes of the major networks (Mondelo 2006, 283). The games that these networks choose not to air due to scheduling conflicts previously caused many games to go unseen by fans outside of the local media market for the two competing teams. To remedy the situation, the MLB streamed over 1,000 regular season games online starting in 2003. The launch of MLB.tv in 2002 allowed engaged MLB fans to continue watching content even when they did not have access to the games through the major networks. While not initially a huge commercial success, MLB.tv still runs today, over a decade later at a monthly subscription of $19.99 and as of 2014 incorporated both post-season games and the World Series as part of the package (MLB.tv 2015). While the MLB has not released the official revenue totals for its live-streaming service, with 3.7 million subscribers the platform generates well over $400 million per year (MLB.tv 2013). This little-known use of live-streaming shows a hunger for immediate interaction with sports media regardless of the available medium. E-Sports Broadcasting 40 Early live-streaming fundamentally looks and feels like television, but it filled a role which network television could not: all access and constant connection to media. It took form on a new platform, but did not truly differ from television. Early live-streaming is more like an adaptation of television than a new medium. Rather than creating something new, the early foray into live-streaming by the MLB simply adapted the already present broadcasting infrastructure and applied it through a different avenue. Television is often invoked in live-streaming. If we look at MLB.tv, the .tv signifies its connection to television, but that domain is actually the official domain for the country of Tuvalu. Other streaming platforms like ustream.tv, twitch.tv, MLG.tv, all based outside of Tuvalu, use the same domain to signal their televisual connection. Live-streaming emerged at a very particular moment in the evolution of sports media. With air-time limited on the major networks, the internet allows a near infinite amount of content to reach sports fans. As Oates would argue, from fantasy sports, to blogs, to live-streaming, the internet is, for many, the new space of the sports fan. Live-streaming goes beyond the ability of other media to reach viewers wherever and whenever, whether from a home computer or a mobile device. Live-streaming delivers on the constant connectedness expected by consumers today. At its roots, live-streaming is a televisual medium. So what separates it from television? Live-streaming today has created its own niche by blending other forms of media. Most live-streams host an internet relay chat (IRC) in addition to the audiovisual component of the broadcast. This IRC allows viewers to chat with other audience members and often the broadcaster, a functionality not currently available in television. This live audience connection in live-streaming is unparalleled in television. Hamilton et al., in their investigation of the significance of live-streaming for community creation, situate Twitch streams as an important 'third place' for community. Building on the work of both Oldenberg and McLuhan, Hamilton et E-Sports Broadcasting 41 al. (2014) suggest that ""By combining hot and cool media, streams enable the sharing of rich ephemeral experiences in tandem with open participation through informal social interaction, the ingredients for a third place."" The third place that the authors point to creates a rich connection akin to interpersonal interaction. The ephemeral nature of these interactions creates a deep sense of community even in streams with hundreds of thousands of viewers. Live-streaming and in turn, the IRC associated with streams creates a shared experience tantamount to the ""roar of a stadium"" (Hamilton et al. 2014). These streams also pull in a global audience, connecting isolated audiences into one hyper-connected community. Live-streaming draws on television for its look and feel, but delivers not only on the desire for liveness perpetuated in sports media but also the hyper-connectivity present in today's globalized world. E-sports, Live-streaming, and Sports Media Many factors contributed to the success of live-streaming for e-sports. It arrived at a moment when television seemed closed to e-sports, it was much less expensive to produce, and much easier to cultivate. Television broadcasts are prohibitively expensive to produce. Early attempts at airing e-sports on television have typically flopped, rarely surviving past a second season. E-sports are difficult to film when compared to traditional sports and conventions had not yet been set for the televisual presentation of e-sports (Taylor 2012). The action in traditional sports can typically be captured by one shot. E-sports broadcasts, in contrast, must synthesize one cohesive narrative out many different player viewpoints with varying levels of information. In a game like CounterStrike, broadcasters must wrangle with a large map with ten players in first-person perspective. The resulting audiovisual feed is a frantic attempt to capture the most relevant information from the players with an outside 'observer' controlling another viewpoint E-Sports Broadcasting 42 removed from the players' point of view. The observer functionality in the early days of e-sports broadcasting created a difficult barrier to overcome for commercial success on television. Observer functionality had not yet become a focus for game developers and commentary had not reached the level of competency it has in more contemporary broadcasts. Instead of finding success on television, e-sports pulls in millions of concurrent viewers on live-streaming sites such as Twitch.tv. With television seemingly out of reach and streaming requiring significant investment per event in the early 2000's, e-sports broadcasting remained relatively stagnant until the arrival of a reliable, and cheap, live-streaming platform. Justin.tv (and other similar sites like UStream and Stickam), which launched in 2007, delivered exactly what e-sports broadcasters needed to grow. The site allowed users to quickly and easily stream content online with the use of some relatively simple software. Both broadband internet reach and streaming technology had developed to a point that lowered the barrier of entry for broadcasters. Players from around the world streamed games from their bedrooms. E-sports broadcasters reached new, massive audiences. The success of gaming content on Justin.tv spurred a new streaming site dedicated solely to gaming. The games-centered streaming site, Twitch.tv, launched in 2011. Twitch.tv revolutionized the e-sports industry. Each of the casters I interviewed spent time detailing the importance of Twitch.tv without being prompted. As one explained, Twitch.tv is ""the clearest driving factor that's grown e-sports over the past 2-3 years."" As mentioned in the introduction, e- sports audiences have reached previously unheard of levels. Large scale e-sports events regularly see concurrent viewer numbers in the hundreds of thousands. These broadcasts still largely resemble televised sports however, rarely, if ever, making use of the IRC. E-Sports Broadcasting 43 Live-streaming is just one of the forms of media the e-sports industry makes use of. In fact, e-sports interacts with most media in the same ways that traditional sports have. The e- sports industry pushes back into almost all of the earlier forms of media discussed in this chapter. Print and radio typically fill a PR role in e-sports coverage. Large events or developments often make their way into publications like The New York Times. Local radio segments will occasionally feature summaries of e-sports events occurring nearby. Internet versions of both of print and radio sports coverage are fundamental segments of the e-sports media ecosystem. Podcasts, digital audio files available on the internet through downloads or streaming, vlogs, and video diaries fill essentially the same role for e-sports that radio currently plays for traditional sports. Experts weigh in on recent developments and players breakdown certain aspects of a game. E-sports journalism has also immerged as a legitimizing force within the industry. Sites like ongamers.com and esportsheaven.com keep fans abreast of any new developments in the professional scene for all of the major e-sports titles. Journalists like Richard Lewis add legitimacy to e-sports through their coverage of current events. Their recaps of developments as well as summaries of various tournaments and leagues closely resemble their print counterparts in sports coverage. It is clear that the e-sports industry is in conversation with many forms of media. Many of the forms and techniques are borrowed directly from sports coverage. These forms of media did not appear instantly however, they are the result of years of push and pull with the larger sports media landscape. Nowhere is this more apparent than in the commentating of e-sports live-streams. E-Sports Broadcasting 44 Chapter 2 Shoutcasters Collecting Conventions E-sportscasters, often referred to as shoutcasters, both look and sound like professional sportscasters. Their attire and cadence both create an instant connection to televisual sports. Having never seen a game of Starcraft 2 before, you may watch the flashing lights and explosions with a perplexed look on your face. As you continue to watch, you hear two commentators provide a narrative, stats fly across the screen, and you start to piece together the game in front of you. After a few minutes, you know the two players who are facing off against one another, you feel the excitement as they engage each other's armies, and a slight sting as the player you were rooting for concedes the match with a polite ""GG."" The whole presentation feels like a variant of Monday Night Football with virtual armies instead of football teams. From the stat-tickers to the sound of the commentator's voice, you can almost imagine the ESPN or CBS logo gracing the bottom corner of the screen. Shoutcasters have become a staple in e-sports. One of the main signifiers of the 'sports' moniker professional gaming has taken on, shoutcasters lend an air of professionalism to a scene which often struggles to define itself. By adopting the 'sport' title, a precedent has been set for e-sports broadcasters which informs their style and conventions. Shoutcasters are important to investigate because they form a fundamental grounding for e-sports which helps it to create its identity in the face of blistering turnover rates and constant field shifts. E-sports stand in a unique position compared to traditional sports. Where players and coaches in traditional sports often have careers that last for several years, e-sports personalities E-Sports Broadcasting 45 suffer from intense turnover rates where professional careers can end within a year. E-sports players burn out quickly and coaches rarely make a lasting name in the industry. The recognizable personalities in e-sports are the few innovators and commentators who turned their passion into a career. In this chapter, I analyze the role of shoutcasters within the larger framework of the e-sports industry. I build much of this analysis on the foundation that Taylor (2012) established in her investigation of the rise of e-sports. Much of Taylor's analysis still holds true today, but some other developments in the field have created new dynamics within shoutcasting that were not present during her initial encounters with shoutcasters. Understanding how shoutcasters borrow from earlier forms of media, the issues they perceive within the industry, and how they cultivate their own identity as shoutcasters while grappling with the hyper-connection found in live-streaming as a medium allows us to grasp the relationship e- sports broadcasting has with earlier forms of media while still creating its own identity. I begin with a very brief look at the history of shoutcasting. Shoutcasting History One can see that even early attempts at broadcasting competitive gaming borrowed heavily from its media contemporaries. Starcade,a 1982 show that ran for two years, marks one of the first forays into e-sports broadcasting. Though the term e-sports had not yet emerged, the show featured two opponents attempting to outscore each other on various arcade machines. If we look to Starcade as an early example of e-sports, then the origins of e-sports commentating resemble game show commentary found in Jeapordy! or The Price is Right. Watching Starcade for the hosting alone reveals many similarities to other game shows: the host wears typical game- show host garb, pleasantly explains every aspect of the competition, and speaks with the E-Sports Broadcasting 46 broadcast voice we all recognize. Starcadealso shows the constant evolution of competitive gaming coverage as it continued to refine its camera angles, presentation, and format over its two year run. The model which more closely resembles our modern vision of shoutcasting gained momentum at the turn of the twenty-first century. The title shoutcaster comes from the early streaming software used for e-sports broadcasting, SHOUTcast. While many people familiar with e-sports may have no idea where the term comes from, a prominent shoutcaster, djWHEAT (2012), claims that the title remains due to its signaling of the history of e-sports. SHOUTcast, a media streaming program, arrived in 1998, allowing interested parties to broadcast audio recordings to various 'radio' channels for free. SHOUTcast allowed for video streaming, but as one early shoutcaster I interviewed lamented, the bandwidth and equipment required for video streaming was prohibitively expensive. Instead of the audiovisual broadcast we regularly associate with e-sports live-streams today, early shoutcasters relied on audio recordings akin to early radio coverage of traditional sports. These early broadcasts only streamed audio to a few hundred dedicated fans on internet radio. Early shoutcasts follow the form of traditional play-by-play radio broadcasts, focused primarily on presenting every development in the game. In interviews, veteran shoutcasters were not shy about admitting the influence radio sportscasters had on their own style. One mentioned that he spent hours listening to live sports radio to hone his own skills. Early shoutcasters also performed many aspects of the production that they are no longer required to perform in the more mature e-sports industry. They would attend events, set up their own station, typically with their own laptop and microphone. It was a very grassroots affair. E-Sports Broadcasting 47 With little experience in the technical aspects of broadcasting, the productions emulated as much as they could from sports broadcasting to lend an air of professionalism. With the arrival of Twitch.tv, and other reliable streaming platforms, much of the onus of production was taken off of shoutcasters. Instead of acting as producers, directors, editors, and on-air talent all at once as they had in the early audio-only streams, shoutcasters are now more able to focus on the portion of their work from which they get their name. Shoutcasting after the early days of internet radio has come to not only sound like traditional sportscasting, but also look like traditional sportscasting. Something Borrowed: Influences from Sportscasting Wardrobe Many ofthe shoutcasters I interviewed talked about wardrobe as a huge change within shoutcasting, one that was spurred entirely by looking at traditional sportscasting. Most shoutcasters got their start wearing t-shirts and jeans at various e-sports events. Today, you will rarely find a shoutcaster not wearing a shirt with a blazer. Looking at the image below shows the incredible shift in shoutcasting just within the last six years. Both images feature the same Figure 2-Left: Joe Miller at 2009 Intel Friday Game London; Right: Joe Miller at 2015 Intel Extreme Masters World Championship in Katowice Poland. Image credit: ESL, Philip Soedler and Helena Kristiansson. Flickr.com/eslphotos E-Sports Broadcasting 48 shoutcaster: Joe Miller. The left-hand image comes from the 2009 Intel Friday Game London while the right-hand image comes from the 2015 Intel Extreme Masters World Championship. While the images are quite similar, the professionalism apparent in the right-hand image resembles a professional sportscaster. The gamer/geek vibe found in the left-hand image has been removed from the shoutcasting image. As a few of the shoutcasters I spoke with admitted, the drive to rework the shoutcaster wardrobe came purely from traditional sports. On top of that, they pointed to a desire to shed the gamer/geek stereotypes that e-sports had come to inhabit. By adopting professional attire, they felt that they could get rid of the old image and emulate the professionalism of a sports broadcast. Wardrobe is not the only aspect of traditional sportscasting that has made its way into shoutcasting. Style One of the more elusive aspects borrowed from traditional sports is the actual commentary style. I use the term elusive here to signal the difficulty in pinning down exactly why shoutcasters remind us so vividly of traditional sportscasters. Early shoutcasters had no models outside of traditional sportscasting so they took as much as they could: ""So as a broadcaster we look at traditional sportscasting. We pull from that and then make sure it fits in game casting."" As it turns out, many sports commentary conventions translate well into game casting. As such, the first generation of casters share many similarities with television sportscasters. Most of these early shoutcasters admit to being influenced almost entirely by traditional sportscasters. One caster explains, ""Television is where we grew up, it's what we watched. So clearly that's where we're going to pull from."" E-Sports Broadcasting 49 Shoutcasters typically have no media training, instead relying on mimicry of earlier conventions to get by. As with most positions in e-sports, and similar to early sports writers and radio casters, shoutcasters are just passionate fans turned professional. In conversations, they each revealed a bit of their own personal history that pushed them towards broadcasting, but only one ever mentioned having received any sort of formal training. Years into his shoutcasting career, he ""went back and did a journalism and broadcasting course for 6-9 months."" Of particular note, he mentions, ""they did one really good project which was 'how to be a news presenter'. They taught me the basics of that."" The rest, he says, he learned on-air through experience. The other shoutcasters I interviewed echoed this story. Most of the shoutcasters I interviewed fell into shoutcasting through happenstance and had to learn their craft on-air. Shoutcasters are akin to the very early television sportscasters who had to reinvent their style during broadcasts like Bob Stanton, a radio sportscaster turned television sportscaster who would send his friends to sports bars to gather feedback and suggestions from audience members (Rader 1984). Echoing this inexperience and improvisation, one shoutcaster I interviewed confided, ""the first time I had ever been on camera, I sat down and I was like, 'I have no idea how to do this.' I had done two and a half years of audio casting, but I had never done video."" Another caster recalls of his first show, ""All I knew going into my first broadcast was that I know this game. I know how it works, I know these players, and I play against these kinds of players. I don't know how commentary works, but I can do this."" After these first, trial broadcasts, both of the above-mentioned shoutcasters admitted to going back and watching traditional sportscasters to learn more about their craft. Other broadcasting style conventions such as how to handle dead-air, how to end a segment, or how to transition into gameplay were lifted directly from sportscasting. Paul E-Sports Broadcasting 50 ""ReDeYe"" Chaloner, a prominent personality within the e-sports industry, addresses each of these techniques in his primer on becoming a professional shoutcaster, constantly pointing to various examples from traditional sports broadcasting to illustrate his points. In his section on dead-air, Chaloner writes, ""[o]ne of the best pieces of advice I had for TV was from legendary sports producer Mike Burks (11 time Emmy award winner for sports production) who told me 'A great commentator knows when to shut up and say nothing""' (2009, 9). Chaloner uses traditional sports broadcasting as a way to explain shoutcasting, a clear indication of its influence on e- sports broadcasting. Content Analysis: Play-by-play and Color Commentary in the NFL andLCS Another convention lifted directly from traditional sports broadcasts is the arrangement of the casting team. Traditional television sportscasters fall into one of two roles: play-by-play or color commentary. Shoutcasters use these same two roles. Both sports broadcasts and e-sports broadcasts feature one of each type. The play-by-play commentator narrates the action, putting together the complicated and unconnected segments of the game into a cohesive narrative. The color commentator provides their in-depth analysis of the game, typically from the stance of a professional player. Shoutcasters have adopted the two-person team directly from traditional sports broadcasts. The path to each role follows the same pattern as well. An ex-professional player almost always fills the role of color commentary in both traditional sports and e-sports. Their insight is unparalleled. Color commentators attempt to breakdown complex series of events or highly technical maneuvers as if they were still a professional player. In the words of one e- sports color commentator, ""I'm not pretending to be a professional player, but I'm doing my best E-Sports Broadcasting 51 to emulate them."" He goes on to say, ""You can read up on it and study it as much as you like, but unless you've lived it, you can't really comment on it."" In comparison, a play-by-play commentator does not need to have the technical depth, but relies more on presentation. Even though a play-by-play commentator has most likely played hundreds of hours of whichever game they cast, they cannot fill the role of the color commentator. This dynamic allows for play-by- play commentators to switch games with relative ease whereas color commentators, both in traditional sports and e-sports, are locked into one game. To illustrate the emulation of sports broadcasting found in e-sports, I now turn to a brief content analysis of the commentary found in a regular season NFL game and a regular season League of Legends Championship Series game. I start with the commentary from one play in an NFL game. After presenting the traditional model, I move to the commentary from one team fight in League of Legends to demonstrate how the convention has been adapted for e-sports commentary. In both cases, I have removed the names of players, commentators, and teams to cut down on jargon and clutter. Each case exhibits the dynamic present in the two man commentary team. NFL With both teams lined up, the play begins and the play-by-play commentator comes in immediately. Play-by-play: Here's [player 1] out to midfield, a yard shy of a first down. [player 2] on the tackle. After the play has ended, the color commentator takes over. Color: It's been [team 1] on both sides of the ball. Whether it be defense and the way that they dominated this ball game and then offensively, the early going had the interception, didn't get much going over the next couple of possessions offensively but since that time, [player 3] has been very precise in how he has thrown the football and they just attacked this defense every which way. E-Sports Broadcasting 52 LCS Three members ofthe Red Team engage Blue Team atRed Team's turret Play-by-play: This is going to be dangerous. Doing what he can to hold out. They're going to grab the turret, the fight will continue after the shield onto [player 1] is already broken. He gets hit, the ignite is completely killing the ultimate! He gets hit by [player 2] who turns around again and heads back to [player 3]. With the action overfor the moment, the colorcommentatorbegins to speak Color: I thought he finished a camp here too... The color commentatoris cut off as two more members ofBlue Team attempt to attack. Play-by-Play Heyo, as the top side comes in here too. [player 1], will he hit a good ultimate!? Oh! They were staring right at him but now he's just left to get shredded apart here. They couldn't have thought that this was going to go well for them. With thefightconcluded, thecolorcommentatorcontinuesagain. Color: Is this just the week of chaos? Because that was a really really uncharacteristic lapse in judgement from [Blue Team]: Not calling everybody into position at the right time, and [Red Team] with the advantage make them pay for it. They didn't expect the ignite from Nautilus. I think they expected Nautilus to have exhaust instead, but [player 1] pops the ignite, and as we said there is no armor so [player 2] just... and it continues! The color commentator is cut off once again as the two teams engage one another for a third time. If we look at these examples for their content rather than the specific moment in the game we can catch a full illustration of the two-caster dynamic. As we can see by the NFL example, the play- by-play commentator provides a running narration of the action in the game. When the action ends, the color commentator provides the meta-level analysis of the unfolding events. In the LCS example, we see that the same dynamic is present, however, due to the continuous action in the game, the transition into color commentary becomes difficult. In the first lull, the LCS color E-Sports Broadcasting 53 commentator tries to insert his analysis, but he is cut off by a second engagement. The color commentator stops talking immediately and allows the play-by-play commentator to continue describing the action. After the engagement ends, we hear the color commentator pick up again, explaining why the fight developed the way it did as well as his insight into why the teams played the way they did. Entertainment and Narrative Entertainment value was a repeated concept in my interviews with shoutcasters. Some went so far as to claim that their role was only to entertain. One stated, ""I want to get you excited. I want to get you to watch the game as if it was a show on television."" Many would point to good sportscasters as an example to follow. If we recall the example of the early days of radio sportscasting, casters had a difficult time making the transition to the new medium. Their broadcasts felt flat when compared with their print counterparts (Bryant and Holt 2006, 27). Early sportscasters got locked into the idea that their responsibility was to provide the basic play- by-play depiction of a match. The golden age of sports radio was brought in by popular sportscasters, such as Graham McNamee, who were so popular that they'd be asked to cast games remotely. McNamee, like a live version of his print counterparts, was famous for creating florid depictions of the game, athletes became heroes and their play became combat as told by McNamee. While the presentation of live and accurate information was still essential, popular radio sportscasters shifted sports media from news reports to entertainment. Sportscasters are responsible for this shift. Without their expert embellishment, play-by-play depictions lack entertainment value. E-Sports Broadcasting 54 Even non-sports fans can feel the excitement from a particularly good sportscaster. The game they portray is far more intriguing than any actual events happening on the field (Bryant, Brown, Comisky, and Zillmann 1982). This disconnect forms one of the primary reasons that the transition to casting televised sport was so difficult. The small liberties that sportscasters took were no longer acceptable in the visual medium. Once the home viewer could see the game, commentary had to shift to accommodate more scrutiny. Radio sportscasters were notorious for their embellishment. As Bryant, Comisky, and Zillman note from one of their several investigations of sportscasting, roughly forty percent of commentary is dramatic embellishment (1977). In 1977, the authors tracked the amount of hyperbole and exaggeration in sports broadcasting and found that over half of the speech was dedicated to drama. E-sports shoutcasters, by comparison, rarely use dramatic embellishment of action. A few of the informants noted that they feel that embellishing actions is not possible due to their audience. The e-sports audience as pictured by shoutcasters, includes mostly dedicated players. While many sports fans may play their sport casually, e-sports fans engage with the games they watch regularly. As one shoutcaster explains, ""we've only ever gone out to a hardcore audience."" He acknowledges that the current audience is in flux, but the primary base of e-sports fans are intensely dedicated viewers and players. Because of this dynamic, shoutcasters feel that embellishment of the actions on screen would be difficult to slip past a discerning eye. Their belief that dramatic embellishment isn't possible may say more about their understanding of traditional sports fans than it does about their formulation of their role as commentators. While unacknowledged in interviews, the possibility for shoutcasters to add embellishment exists. Their choice not to use embellishment speaks more to their formulation of the e-sports audience than it E-Sports Broadcasting 55 does to their casting quality. Instead of embellishment of action, shoutscasters rely on another convention found in traditional sportscasting: narrative. Studies that focus on the media effects of sportscasting suggest that sportscasters fundamentally alter the audience perception of the telecast through story-telling and narrative (Krein and Martin 2006). Sportscasters take many liberties in their descriptions of the game to add a dramatic flair. In several empirical studies, Bryant, Brown, Comisky, and Zillman (1979) found that when sportscasters created a narrative of animosity between players, viewers felt an increased amount of tension and engagement. They conclude that the narrative scope of the sportscaster is critical in the perception of sports broadcasting. This narrative creation has bled into shoutcasting as many shoutcasters attempt to amplify the emotional content of their games by highlighting underdog stories or hyping up animosity between players. One caster I interviewed connected his work to the narrative creation in sports commentary by stating, ""Emotion is one of the key words in commentary. You need to be able to connect a certain emotion to the words you're saying. You need to be able to make someone scared for their favorite player or overjoyed when they win. Create greatest enemies. You need to be able to make these feelings through what you say or how you say it. Emotion is everything."" This caster goes to great lengths to dig up statistics from previous matchups to provide a narrative for the match he casts. Through this investigation, the shoutcaster is able to contextualize a match with a rich history. Perhaps two players have met three times before and each time the result has been the same. Will viewers be able to share in the momentous victory of the underdog? As part of their preparation, shoutcasters will research all of the previous meetings between two players to create a history between them, a tactic which they acknowledge has been used in traditional sports for decades. E-Sports Broadcasting 56 Production Stream production is another realm where e-sports have started to borrow heavily. While e-sports producers may have gotten a head start on streaming live events, they often rely on the expertise of television producers to put a show together. Multiple shoutcasters pointed to a steady influx of television producers making their way into e-sports, ""the way we approach a production is very much like television. A lot of the production guys that are getting into it are from television."" In fact, the executive producer of the League of Legends Championship Series, an immensely popular e-sports program, is former emmy-winner Ariel Horn. Horn won his Emmy as an associate producer of the 2004 Olympics for NBC. Likewise, Mike Burks, executive producer for the Championship Gaming Series mentioned in the above quote from Paul Chaloner, had an immense amount of experience in televised sports before migrating to e- sports. These are just two of the many experienced television producers making their way into e- sports. Their style is beginning to show as e-sports events become more polished every year. If we recall the image of Prime Time League in the introduction to this thesis, we can see the influx of television conventions in e-sports from the production side. The shoutcasters benefit from the experience of working with television producers to refine their style. As the field has grown, however, we begin to see minor tweaks in style and delivery. Spending a significant time with e- sports casting, in comparison with sportscasting, reveals several distinctions. Much of this difference comes with the age of the field, but just as Starcadeevolved over its short lifespan, shoutcasters have found ways to make themselves unique. Their understanding of their role within the overall e-sports industry informs us of some of the key differences here. E-Sports Broadcasting 57 Something New: Shoutcaster Identity Shoutcasters are situated somewhere between fan and professional. As evidenced by the above investigation of how shoutcasters are informed by their traditional predecessors, the role of shoutcasters is still very much in flux. Shoutcasters are just recently creating their own identity separate from their sportscasting roots. In particular, the less experienced shoutcasters I spoke with use markedly different models to inform their own casting. The Second Generation of Professional Shoutcasters A second generation of casters is just now coming into the scene. Instead of looking to traditional sportscasters as their models, they emulate veteran shoutcasters: ""my influences are the streamers that I watched. I watched everyone who casts and commentates...my commentary style comes from those guys. I don't know how much is conscious or just mimicry."" This new caster has been on the scene for only a fraction of the time that the veterans have. In that time he has honed his shoutcasting skills not by finding sports commentary and seeing which aspects apply to shoutcasting, but by absorbing as much information as he could from other shoutcasters. Another fresh shoutcaster offers a fascinating disconnect from the older casters: ""I definitely bounce off more e-sportscasters than sports. I just watch more e-sports than sports. Sports are so different than e-sports, there's so little that I can actually use from them."" Where his predecessors admit to borrowing primarily from traditional sportscasters, this new generation has left the realm of traditional sportscasting behind. The professional casters provide material for an amateur level of shoutcasters to pull from. The shoutcasters I interviewed were all professionals who typically work on major events with massive support and budgets. With a robust network of shoutcasters to pull from, however, E-Sports Broadcasting 58 we may see much more support for the grassroots level of e-sports that many early fans are accustomed to. Current shoutcasters also provide a model for potential careers. Through the hard-fought struggle of years-worth of unpaid events, the shoutcasters I spoke with have created a legitimate profession worth pursuing. Most warned me that the path is no longer as easy as they once had it. Most of them pursued shoutcasting for the love of e-sports. They had years to fumble through persona creation, broadcast techniques, and conventions. New, potential shoutcasters are automatically held to a higher standard. A senior caster offered the following advice, ""With how casting has changed, you need to be open to casting multiple games. You have to be willing to learn. There is a lot we can teach a caster, but you have to have some skills within you alone. You have to have some camera presence."" The mention of camera presence signals a significant jump from early shoutcasting. Just a few years ago, the shoutcasters I interviewed sat down in front of a camera for the first time armed with nothing but game knowledge; camera presence was a foreign word to them. Perhaps the most significant change to casters is their overall level of experience. Some of the shoutcasters I spoke with have been broadcasting for over a decade. Time has allowed these casters to experiment and find their own style. As mentioned earlier, many of the minutia involved in running a show take time to learn. Most casters got their start casually. They may have been passionate about e-sports and created a role for themselves within the industry. Some are former players who made the hard decision to give up on their hopes of winning big to instead cultivate a community. As new professionals, shoutcasters are just now coming together with the support of e- sports companies under legitimate full-time contracts. The professional casters I spoke with all acknowledged a significant change in their commentary since making the transition into full-time E-Sports Broadcasting 59 casting with other casters around for feedback and training. One explained that he had never been sure how to handle dead-air, moments when both casters are silent and there is little action in the game. Through feedback sessions with other casters, he learned that there are some appropriate times to let the viewer formulate their own opinions on the match. Heeding the advice of veteran casters like Paul Chaloner, he went on to explain that one of the problems he sees in shoutcasting more generally is that shoutcasters are afraid to just be quiet during a stream. Part of the emotional build-up of a game, he explains, is letting the natural flow of a game take its course without any input from the casters. It will be fascinating to watch as these expert networks inform e-sports broadcasts across the world. One informant remarked, ""Now that we're all working together, we're learning a lot off of one another, which hasn't happened in commentary before."" Beyond allowing veteran shoutcasters to compare notes, the professional status of shoutcasting provides training to new shoutcasters. One veteran claimed, ""All the junior people are learning so much faster than we ever did. They're taking everything we learned over 5-10 years and doing it in months."" These veteran casters can now pass on their experience and their style. Techniques like hand-offs at the end of a segment or transitions from the desk to gameplay often came up in my interviews as issues which take years to learn, but newer shoutcasters are able to pick these cues up from earlier shoutcasters instead of taking what they can from a sports show and hoping that everything translates well. Beyond the expected roles that shoutcasters fill, they also perform many secondary tasks which don't typically fall to traditional sportscasters. In the very early days of live-streaming, shoutcasters were often responsible for every aspect of the broadcast from set-up to teardown. Some shoutcasters still regularly assist on production aspects of the broadcast such as graphics E-Sports Broadcasting 60 packages, camera set-up, and audio checks, but others leave the production aspects of the stream to more experienced hands while focusing instead on updating websites, answering tweets, creating content, or streaming their own play sessionss. No two casters seem to fill exactly the same role within the broadcast team. They do, however, share some similarities which seem to form the shoutcaster identity. Record-keepers and Community Managers All of the casters pointed to stats-tracking as part of their roles outside of their air-time responsibilities. Most of them keep highly detailed databases full of every possible stat they can get a hold of from game clients and public databases. These stats can be as simple as wins and losses from remote regions or LAN tournaments that do not post their results online. The stats can also get as minute as the number of units a particular Starcraft 2 player built in one particular match. When the data isn't readily available, shoutcasters go out of their way to curate the database themselves. While some keep their database secret to provide a personal flair to their casting, others find it important to share this information with their e-sports communities. One shoutcaster recalled his surprise when he first worked with a major South Korean e-sports company with its own dedicated stats team. He expressed that he had never realized how much he needed a dedicated stats team like you find in traditional sports until that moment. It was then that he realized how much of his daily routine stats curation filled. While he was grateful for the help, he also felt personally responsible for stats collection and did not entirely trust the figures from the professional statisticians. This example shows the difficult position e-sports fills, constantly stuck between borrowing from traditional sports while not fully able to cope with the maturity of the sports media industry. E-Sports Broadcasting 61 Another role which tends to fill a shoutcaster's daily routine is community maintenance. Whether the caster creates their own content on gaming sites, responds to fans on social media, or spends their time streaming and interacting with the community, they all mentioned some form of community maintenance as part of their duties as a shoutcaster. This particular focus on community maintenance most likely results from the grassroots origins of shoutcasters. These casters were a part of an e-sports community long before they became shoutcasters. Whether they view it as their professional responsibility or a social responsibility remains unclear. They all admit to some level of e-sports advocacy, however. They view PR, and the proliferation of e- sports as part of their responsibilities. The most effective way to tackle this issue, many of them have decided, is through community engagement. The community aspect of shoutcasting identity leads me to a discussion of the affordances of the hyper-connectivity in live-streaming. Grappling with the Hyper-Connectivity in Live-streaming and E-sports Shoutcaster Connection I have yet to meet anyone in the e-sports industry who has not remarked on the unique level of connection present in e-sports. Shoutcasters especially, tap into the network created in these online communities. In a representative summary of my conversations, one shoutcaster explained, ""the connectedness is so unique in e-sports. The way that we can interact with fans instantly. The players at the end of the day are gamers, they know exactly where to look. They've got Twitter, they go on Facebook, they post on Reddit."" Audience members connect ephemerally in the IRC of a Twitch stream, but they constantly scour the social media outlets of their favorite stars, e-sports companies, and shoutcasters, creating a deeply connected community. Professional shoutcasters understand that the e-sports communities operate in a E-Sports Broadcasting 62 unique way when compared to traditional sports fandom. E-sports fans have an odd connection to franchises or teams within their chosen e-sport. As mentioned before, turnover rates and general industry growth force entire communities to radically reform from one season to another. Where traditional sports fans often follow a team based on geographic loyalty, or familial connections, e-sports fans do not have that option. While you will often hear of fans cheering for teams in their geographic region (North America, Europe, South-East Asia, etc) if they make it to the last few rounds of an international tournament, they may also base their fandom off of a team logo, or a particular player instead. Shoutcasters recognize this dynamic and use it to cultivate the community. Communication, they claim, separates them from traditional sports broadcasts or even news anchors: ""We communicate more with our audience than you'll see TV news anchors or celebrities, but it's part of our job to get more information out there."" The focus on communication seems to be unique to shoutcasters as the majority of it happens outside of their broadcasts. While many shoutcasters define their role on-screen as an educator of sorts, the notion of spreading information about e-sports falls outside of their screen time. This double role of broadcaster and community manager extends what media scholars have dubbed the broadcasting persona beyond the point typically associated with sportscasters or news anchors. Shoutcasters and Persona Horton and Wohl (1956), two social scientists who study mass media, make the assertion that mass media performers make a conscious decision to create and maintain parasocial interactions through the creation of a persona. Social scientists have coined the term parasocial interaction for the intangible connection which most of us feel to some form of media or another. E-Sports Broadcasting 63 Standing in contrast to interpersonal interaction, a person to person exchange between two real and cognizant human beings, parasocial interaction is instead a unidirectional relationship (Miller and Steinberg 1970). The feeling of connection we create with fictional characters, news anchors, or sports stars does not fall within the definition of an interpersonal interaction. Whether mediated through a screen or the pages of a book, a parasocial interaction does not manifest in an exchange of thoughts or words between individuals. Rather, it is embodied and lived through one individual. Schiappa et al. (2007) conducted a meta-analysis of parasocial interaction literature to better understand how broadcasters 'hook' viewers to a certain show. They concluded that parasocial interactions can create and prolong connection to television programming. While Schiappa et al. concede that there are a few opportunities for a parasocial interaction to result in interpersonal relationships in the physical world, the compelling issue is the establishment of intimacy mediated through means well outside of a person to person context. Horton and Wohl set out with the goal of creating a term for the relationship between performers and their audience in mass media. The authors suggest that the emergence of mass media created an illusion of connection to performers which was previously unavailable. They argue that the connection people feel to mass media stars is analogous to primary social engagement. If this type of engagement takes place in radio and television, where users have no opportunity to interact with audience members who are not co-present, it follows that the interaction between broadcasters, their audience, and one another in a Twitch stream is a particularly deep connection even beyond the level noticed by Horton and Wohl. Shoutcasters create a familiar face and personality for audience members to connect with. Mark Levy (1979), another proponent of parasocial interaction who focused his work on news anchors, suggests that both news anchors and sportscasters help to create and maintain E-Sports Broadcasting 64 communities through regular scheduling, conversational tones, and the creation of a broadcasting persona. Shoutcasters perform this same role to even greater effect due to the constant changes surrounding the e-sports industry. The regularity and consistency of shoutcasters' broadcasts helps to foster a feeling of genuine connectedness within the community. Although difficult to quantify, many conversations with shoutcasters turned to the odd feeling of connection that e-sports fans feel towards one another. One shoutcaster attempted to explain this connection by stating, ""[w]henever I go to an event, I realize that fans are just friends I haven't met yet."" I found this statement to be particularly poignant. It hints to the sort of intangible connection e-sports industry personalities and fans feel to one another through live- streams. Anecdotally, this air of friendship permeated e-sports events that I have attended and went well beyond what I have felt at traditional sporting events or concerts. Previously, persona creation and maintenance occurred on-screen or at events only. Social media has forced many media personalities to extend their personas beyond the long-held notions of broadcaster-fan interaction. In many ways, shoutcasters must go beyond even these extended boundaries into a near constant persona maintenance because of their roles in live- streaming and community maintenance. Many shoutcasters give up their personal, off-air time to stream their own gameplay or to create video content which necessarily prolongs the amount of time they embody their broadcast persona. I found that shoutcasters create a variation on the broadcast persona. Rather than a full- blown broadcasting personality which they inhabit while on-air, most shoutcasters have found that between community management, social media interactions, and broadcasts, they almost never get an opportunity to step out of their role as a shoutcaster. Due to this near constant connection, most shoutcasters acknowledge that they act differently on air, but they tend to E-Sports Broadcasting 65 simply invoke a more upbeat and charismatic version of themselves. Echoed in each of the interviews, the casters point to the idea of excitement, ""you have to get excited for the person out there watching."" Even if they are not in the mood to shoutcast, or they have had a bad day, shoutcasters must leave their personal issues out of the broadcast. This aspect of the shoutcaster's personality comes out in all of their interactions on social media as well. Most of the shoutcasters I interviewed situated their role in e-sports as somewhere between Public Relations, Marketing, and Community Management. One of the casters explained the importance of invoking the broadcast persona when speaking about sponsor expectations: ""We're working in an industry with companies behind us, we can't always say exactly what we want to say."" Shoutcasters' acknowledgement of their involvement in securing sponsorships signals an interesting shift in the e-sports industry: the focus of the broadcast team on potential revenue generation. I turn now to an analysis of the revenue streams found in both traditional sports and e-sports broadcasting. E-Sports Broadcasting 66 Chapter 3 Revenue Funding Professional Play After situating e-sports broadcasting within the greater sports media landscape, particularly in conventions, casting, and use of medium, it is important to analyze the portions of sports media production that have made their way into e-sports broadcasting. If we acknowledge the influence that traditional sports broadcasting has had on e-sports broadcasting in the realms of conventions and casting, we must also understand the importance of this relationship at the production and economic levels. In this chapter I discuss how the history and development of the sports media industrial complex in the U.S. has bled into the economics of the e-sports industry. In particular, I focus on how sports media models inform the e-sports industry while portions of the sports industry's revenue streams remain out of reach for e-sports broadcasters. Despite the reshuffling of the sports media industrial complex mentioned in the introduction to this thesis, traditional sports broadcasting still relies on the same revenue streams that it had in the past. Traditional sports producers have fully capitalized on the commodification of their content. E- sports producers, in contrast, are still shaping their revenue streams within live-streaming. The commercialization found in the sports media industrial complex has taken hold of the e-sports industry in several notable ways. Following in the example set by Stein's thesis work, it is not enough to just acknowledge the relationship between e-sports and traditional sports media, we must also understand the path which brought e-sports broadcasting to its current state.","E-Sports Broadcasting 8 Introduction Sportscasters on a Digital Field Sitting at a desk underbright lights, two announcerstalk at afast clip. After a weekend full of commentating, theirvoices are scratchyandfading, yet theirexcitement never wanes. No one watchingcan see the two men, though a camerasitsjust afew feet infront ofthem. Instead, the live audience andhome viewers see the Europeanchampions, Fnatic,going head to head with SK Gaming on a virtualbattlefield. They're 55 minutes into an absoluteslugfest, the two announcers'voices rise andfallwith the action ofthe game. Over the PA, the audience hears that this game is mere seconds awayfrom ending. The SK team has Fnaticon the ropes after brilliantlydefending their base. Fnatic'sstarplayer, Xpeke stays, attempting to win the game singlehandedly. The casters initiallydismiss the lastditch effort while the bulk of SK's team move to end thegameontheothersideofthemap.However,thecamerastaysonXpeke whoisina showdown with one memberofSK. NanosecondsawayfromdefeatXpeke dodgesa deadly ability. The casters erupt in nearly unintelligible,frantic excitement as the 25,000 live attendees atSpodek Arena in Katowice, Polandcheerat the sudden Fnaticvictory. Back in the realworld, theentireFnaticteamjumpsawayfrom theircomputersandpileontoXpeke whilewe hear, ""I do not believe it! Xpeke's done it!"" Over 643,000 online viewers around the world watch the camerapan acrossthe SK team, stunnedin theirdefeat. From theirhome computers, these viewers have just witnessed e-sports history. E-Sports Broadcasting 9 The above scene unfolded at the 2014 Intel Extreme Masters World Championships in League of Legends, a popular e-sports title. The solo maneuver that Xpeke performed on that stage has since made its way into common LeagueofLegends vernacular, being invoked in any match, casual or professional, where a player deftly ends a game singlehandedly. E-sports, which encompasses many more titles than League of Legends, has become a cultural phenomenon of sorts. People may wonder whether the whole scene is just a flash in the pan or something more significant. I begin this thesis in much the same way that I have begun many conversations over the past two years: defining e-sports. In most of those conversations, I simply say ""professional video-gaming"" and move on to other topics. Here, though, I fully elaborate on what e-sports means. More than just professional gaming, e-sports is an entire industry created around competitive gaming at all levels of play. An e-sport is not a just a sports video game like the title might suggest, though some e-sports titles are sports video games. Instead, e-sports titles are meticulously balanced, competitive, multiplayer games. Many games would fall into this category, but it takes a community of people to take an e-sport to the level of the classics like Counter Strike and Starcraft. Such communities are core to the identity of e-sports. Indeed, this identity itself is an oxymoronic collision of geek and jock culture; a mixture that media would have us believe acts like oil and water. Even within e-sports communities lines are hazy and misdrawn. As Taylor and Witkowski (2010) show in their study of a mega-LAN event, the e-sports scene is fraught with identity issues not only from outside, but within as well. The jock-like first-person-shooter (FPS) players competing at the same event as the nerdy, enigmatic World of Warcraft players E-Sports Broadcasting 10 shows the conflicting, lived masculinities in e-sports. Players are unsure whether to act like superstar athletes or tech-geeks. Can you be both? The word e-sports alone evokes such a conflicting image. Electronic sports seems almost paradoxical in nature. Have we moved beyond a physical match of skill and extended our contests to avatars in a digital world? How can two players sitting at a desk be sporting? As e- sports continue to grow not only as a segment of the gaming industry, but as a spectator affair, we begin to see the 'sports' side of e-sports both challenged and invoked more frequently. In a telling case, Twitter erupted after a Dota 2 tournament made an appearance on ESPN 2 in 2014. With $10 million at stake, many e-sports fans thought the event warranted the attention of the all-sports network. Plenty of viewers took to social media to praise the move made by ESPN. Others were shocked: ""Espn2 is seriously airing an online gaming championship? Wtf man. This is our society now. That is not a sport"" (Hernandez 2014). The sports status of e-sports has been both defended and attacked by journalists, academics, and fans alike. The debate about the status of e-sports has been raging for many years. Witkowski's piece, ""Probing the Sportiness of E-Sports"", presents both sides of the argument pulling from games studies scholars and assessing e-sports on their terms. Ultimately though, I believe she shelves the debate deftly when she states, ""sport is a personal experience... as many a sporting scholar has written before - if an individual considers the sporting activity they are engaged in to be a sport... then it is a sport"" (2009, 56). I do not wish to rehash this debate. I have no stake in it. As Witkowski asserts, the attempt would be futile. Instead, I accept the role traditional sports have played in the shaping of e-sports. In fact, exploring the relationship between e-sports and their traditional counterpart drives this work. In what follows, I argue that the sports media industrial complex has fundamentally E-Sports Broadcasting 11 shaped the current e-sports industry. Beyond this grounding, e-sports broadcasters constantly borrow from traditional televisual broadcasts, using models that they feel to be appropriate for their medium. Regardless of whether e-sports qualify as sports or not, they are constantly informed by sports broadcasting and follow a trajectory set out by traditional sports models. This work comes about at in an interesting moment in e-sports history. E-sports audiences have never been larger, Riot games boasted an impressive 27 million viewers for the League ofLegends World Championship in 2014 while the 2015 Intel Extreme Masters world championship saw over 1 million concurrent viewers across multiple live-streaming platforms (Riot Games 2014; ESL 2014). An old classic, CounterStrike, has re-emerged, albeit in a new package. The audience it continues to draw proves that some titles have staying power in this fickle industry. At the same time, a new title, League ofLegends, consistently pulls in over 100,000 concurrent viewers for its weekly shows in the U.S. and E.U. As the League ofLegends Championship Series moves into its fifth season, it has come to resemble a traditional sports broadcast more than it does its fellow e-sports shows. A new addition in Season 5, a segment called Prime Time League (PTL) is nearly indistinguishable from ESPN's Pardon the Interruption (PTI) at a glance. Figure 1-Left Image: Prime Time League; Right Image: Pardon the Interruption E-Sports Broadcasting 12 Comparing these two images reveals the level of sports emulation found in e-sports broadcasting today. From the stats and schedule ticker at the bottom of the screen to the show rundown along the edge of the screen, an uninitiated viewer would have difficulty distinguishing between the e- sports show and the traditional sports show. A steady influx of television producers and directors are starting to shape an industry that already has an identity crisis while still investigating how best to harness the new medium of live-streaming. These assertions are not meant to give the impression that we stand on the edge of wholly untouched land as pioneers in a new frontier. As shown in the e-sports literature review to follow, the e-sports industry has a history of evoking the feeling of standing on a precipice. Organization In the introduction, I first provide a brief history of e-sports and take note of the directions e-sports scholarship has pursued. Following this review, I introduce the sports media industrial complex to better situate e-sports broadcasting within the larger media landscape of sports broadcasting: the focus of chapter 1. The first chapter begins by looking at the long history of sports and media. By introducing the full gamut of sports media, I am better able to investigate how e-sports broadcasting stays in conversation with each of its predecessors. As evidenced in the reshuffling of sports media through history, we can see that e-sports make use of all of these forms of media while creating something new. During this chapter, I look to the transition moments in traditional sports broadcasting as the foundation ofthe e-sports industry. Moments of tension and doubt within the sports media industry as it shifted from one medium to another provide perfect lessons E-Sports Broadcasting 13 to be learned by the e-sports industry as they struggle with some of the same issues found in the reshuffling of media history. Indeed, while making use of the same media through journalism, public relations, and audiovisual broadcasts, the e-sports industry constantly wrangles with the use of the newly emerged medium of live-streaming. Television especially influences live- streamed broadcasts, which e-sports broadcasts tend to approach with the same framework as television. Chapter two focuses on e-sportscasters, also known as shoutcasters. I begin the chapter with a brief look at the history of shoutcasting. Considering that many of the early shoutcasters pull solely from traditional sportscasters, understanding their influences is crucial in understanding how e-sports has evolved in the way it has. As, I argue, the single most pointed signaling of the sportiness in e-sports, these individuals have pushed the e-sports industry towards a sports model. When first time viewers or listeners leave an e-sports broadcast with the distinct feeling of a sports broadcast in their mind, it is the shoutcasters doing their job. They rely heavily on conventions set by traditional sportscasters. Much like their predecessors when faced with something new, shoutcasters borrowed what they could and innovated when there was nothing to borrow. Chapter two also focuses on shoutcasters' formulation of their identity within the e-sports industry as personalities, professionals, and record-keepers. Shoutcasters are just now creating an identity separate from traditional sportscasting. Where veteran shoutcasters relied primarily on traditional sports broadcasts, newer casters look instead to other shoutcasters. These shoutcasters are reshaping their identity while attempting to fully embrace the new medium of live-streaming. The third and final chapter tackles the topic of economics in e-sports. As the history and trajectory of sports broadcasting has profoundly affected the e-sports industry, many of the E-Sports Broadcasting 14 economic models present in traditional sports bled into the e-sports industry as well. The e-sports industry in the US and Europe has yet to be analyzed as such. Some work (Taylor 2012) has focused on e-sports revenue streams including sponsorships, company models, and team ownership, but overall, the subject remains underexplored. Dal Yong Jin's (2010) analysis of the political economy of e-sports in South Korea offers a tool set for this chapter. While the South Korean e-sports model spawned out of an extremely particular set of circumstances that cannot be readily applied to the U.S. or E.U. e-sports scenes, Jin's investigation of the surrounding economic systems surrounding e-sports translates well to my own investigation of the U.S. and E.U. industries. As staggering prize pools continue to make headlines, it is easy to lose sight of the economic system working behind the scenes to keep e-sports financially salable, or in some cases not. The third chapter delves into traditional sports economics and their influence on the e- sports industry. In some areas, the models translate perfectly. In others, e-sports has been unable to tap into the same revenue generators as traditional sports. Unless some developments significantly alter the e-sports industry, it may be more tenable to pursue other models instead of the sports industry. Methods This thesis makes use of many qualitative methods including historical analysis, interviews, and fieldwork. To grasp the significance and situation of e-sports broadcasting in its current state fully, one must analyze the same developments in traditional sports broadcasting. As one takes a deeper look into the past of the professional sporting industry, its influences on e- sports become clear. A feedback loop has been created between the two. Historical analysis offers a glimpse at key moments which defined the incredibly successful global sports industry. E-Sports Broadcasting 15 Not only are similar situations appearing in e-sports, but e-sports pushes back into each of the investigated forms of media. A few of the issues currently facing e-sports could be resolved through following the path established by traditional sports, while other issues have been caused because so much has been borrowed. I also had the pleasure of conducting seven interviews with professional shoutcasters. I limited the selection of shoutcasters to full-time professionals, rather than amateurs, to get an insight into how these new professionals view their role within the industry. Roughly half the participants are veteran shoutcasters of five or more years. The other half have joined the scene more recently with one in particular having shoutcasted professionally for less than one year. As these informants are a few of only dozens of professional shoutcasters in the world, I have attempted to keep their identities anonymous. As professional personas, some of these casters may benefit from being associated with this work, but I do not want to run the risk of potentially linking these shoutcasters with their statements in the event that this information could somehow affect the community's perception of the individual or potentially harm their prospects within the e-sports industry. The conversations were all positive, but one can never truly assure their informants that information they have provided in confidence will have no repercussion in any foreseeable future. With these considerations in mind I decided before conducting the interviews that the informants would remain anonymous. Finally, I was also able to spend time working within the e-sports industry. My time spent working for a prominent e-sports company profoundly shaped this thesis. Working alongside industry professionals sparked countless conversations about the current climate of the e-sports industry and possible futures. These conversations have both helped and challenged my thinking about the e-sports industry. While I often refer to the e-sports industry or community as a E-Sports Broadcasting 16 homogenous whole, the professionals who live within the space are not all of one mind and it would be a mistake to present them that way. Within e-sports, there are many different games and communities vying for viewers, players, and attention. What follows is my best attempt at wrangling the many paths e-sports has started to follow. E-sports Literature Review E-sports is still a young industry and an even younger subject of critical inquiry. Most entries into e-sports scholarship have emerged within the last five years. E-sports literature tends to come from the much older tradition of games studies, but ties into many other fields including the social sciences, cultural studies, economics, and law. Professional-gaming literature is a veritable hotbed of potential research topics with more articles, theses, and dissertations appearing every year. Much of the growing body of e-sports literature focuses on the professionalization of gaming (Jin 2010; Mora and Heas 2005; Swalwell 2009; Taylor, Nicholas 2009; Taylor, T.L. 2012; Witkowski 2012). These histories offer much more than a rundown of the events that created the e-sports industry. They also offer insight into our contemporary social moment. The arrival of a professionalization of video gaming signals many significant developments within both western and non-western culture. The global nature of e-sports and its meshing together of complex and often conflicting identities continues to beg investigation. E-sports literature primarily resides within the social sciences. Many cultural analyses in e-sports (Chee and Smith 2005; Harper 2010 and 2014; Hinnant 2013; Swalwell 2009; Taylor 2011) have focused on the communities growing within different scenes. Todd Harper, for instance, investigates the culture of competitive fighting games, a fascinating community which stands both within and at odds with the rest of competitive gaming. Gender studies are also E-Sports Broadcasting 17 becoming increasingly common within e-sports literature (Chen 2006; Crawford 2005; Leonard 2008; Taylor 2009 and 2011; Taylor and Witkowski 2010; Witkowski 2013). With the fascinating and fraught formulation of masculinity within these spaces as well as the perceived absence of femininity, gender studies are incredibly important within e-sports literature. Nicholas Taylor (2011) offers insight into the ability of e-sports to create embodied performances of masculinity at live events which spread through communities specific to certain titles or genres. Taylor and Witkowski (2010) also show the conflicting versions of masculinity that appear in different e-sports genres. There has also been an increasing focus on e-sports as a spectator activity. Jeff Huang and Gifford Cheung (2012) found in a study that many of the e-sports fans they investigated prefer watching high-level play rather than playing a match themselves. Kaytou and Raissi (2012) also investigate spectatorship in e-sports with a focus on how best to measure live- streaming audiences. Others (Bowman 2013; Gommesen 2012; Kow and Young 2013) show that the audience in e-sports has a profound effect on performance for the players, akin to a traditional sports audience. These scholars also investigate the expertise apparent in e-sports players that is passed on through spectating as often as practicing. As the professional play of video games fascinates so many, e-sports literature has understandably focused primarily on professional players. Notable exceptions include Jin (2012) and Taylor (2012) who, while still heeding players, also investigate the surrounding factors which allow for play at a professional level. Without these other factors, professional players would not exist. It is from the tradition of these two authors, among others, that I base this work. This thesis, like many of the works listed above seeks to better understand the phenomenon of e- sports while analyzing a particular segment of the scene. With few investigations into the E-Sports Broadcasting 18 broadcasting of e-sports, I hope to contribute to e-sports literature in a way that is both unique and replicable to other systems found within the larger e-sports framework. Sports Media Industrial Complex As sport and media become increasingly intertwined, it becomes difficult to analyze one without at least acknowledging the impact of the other. Pointing to the inextricable link between sports and media, sports media scholar K. Lefever (2012) argues, ""while sport provides valuable content and audiences for media operators, the media is a revenue source and promotional tool for sport."" As such, the steady professionalization and, in turn, commercialization of sport relies heavily on its media counterpart. The subsequent interdependence between media outlets, sponsors, and sports leagues creates what is often referred to as the sports/media complex or sports media industrial complex (Jhally 1989, Rowe 1999, Maguire 1991). Wenner (1989) coined the neologism, MediaSport, to define the deeply rooted relationship between sports and media. The two can hardly be considered separate anymore. Stein (2013), a Comparative Media Studies alumni, building on the work of these earlier scholars created a model which could be applied to new arrivals in the sports media landscape. Thankfully, Stein provides a fairly replicable analysis of sports video games within the broader sports media landscape. His investigation of the relationship between televisual sports video games and sports media largely informs my own work. He notes an almost relentless stream of advertising and commercialization rhetoric appearing in sports video games. Building on the work of Wenner, Rowe, and Jhally, he argues that the commodification and capitalist trends found in traditional sports broadcasting bleed into newer media such as video games. This steady influx of advertising and commercialization can be found in e-sports as well. E-Sports Broadcasting 19 As e-sports broadcasters gain more experience and access to more robust technology, they have started to incorporate many of the same commercial opportunities Stein noticed in sports video games. Segments of the broadcast are occasionally sponsored, or one might see a sponsor make an appearance in an event's title such as the Intel Extreme Masters tournament. Where Stein argues that sports video games incorporate these advertisements as a signifier of their televisual legitimacy, I argue that e-sports broadcasters make use of the same strategies because they are informed by earlier forms of sports media. The steady commercialization found in e-sports reveals the influence that the sports media industrial complex has had on the e-sports industry. In documenting the dynamics of the sports media industrial complex, Jhally (1989) argues that sports are best viewed as commodities. Jhally's model focuses on the sporting industry in the US prior to the emergence of new media. More readily applicable to e-sports, Lefever's (2012) analysis of the sports media complex within new media details a phenomenon which has upended the former relationships between stakeholders in the sports media industrial complex. She claims that, ""the sports/media complex has somehow changed, allowing the different stakeholders to take up new roles"" (Lefever 2012, 13). The stakeholders, including sports franchises, sponsors, and media outlets, have had to adapt to a new media landscape with new roles. These new roles are more transient within the high-demand world of new media. Sports organizations and franchises have taken a more active role in connecting with fans, media outlets have taken a larger interest in sports franchises (often buying sports franchises if it is less expensive than purchasing media rights), and sponsors have taken advantage of new, innovative ways to reach consumers (Lefever 2012, 21). According to sports scholars Haynes and Boyle (2003), television sports viewers are no longer expected to just sit back and relax. Instead they are expected to follow their sport through E-Sports Broadcasting 20 social media, forums, blogs, and other digital outlets. This new, active fan fits well within the e- sports industry and live-streaming, but has changed the traditional sports media industrial complex. Before delving too far into the role of traditional sports economic models on e-sports, however, I will first situate live-streaming and e-sports within the larger sports media industrial complex. E-Sports Broadcasting 21 Chapter 1 Sports Media in Transition From Print to Live-Streaming Every day, millions of Americans are catching up with the latest sports news through print, radio, television, and online. Sports have saturated the entire spectrum of mass media in the US. With the emergence of each form of mass media, sports coverage has been at the forefront of adoption and innovation (Bryant and Holt 2006, 22). Each major medium shift in the US has been accompanied by a massive reshuffling of the sports media landscape. Often, this reshuffling opens a space for a particular sport to take up the new medium, create conventions, and carve a path for others to follow. These sports were not spawned by mass media, but their spike in popularity around the emergence of a new medium indicates very specific social moments in the US. Early sports magazines and print coverage of sports focused primarily on prize-fighting, radio ushered in the golden era of baseball, and television transformed football into a titanic entertainment industry. The rise and stabilization of sports media are as much a product of available technology as they are indicative of societal preoccupations of the time. If sports and sports media are indicative of our social moment, then what can we glean from the arrival of live-streaming and e-sports? The co-evolution of sports and media is the coalescence of many factors including changes in power structures, modes of production, and available technology. As Bryant and Holt argue in their investigation of the history of sports and media, ""[e]ach epoch of social evolution has witnessed important sports-media developments that were affected by the evolving socio- cultural environment"" (2006, 22). In what follows, I trace the co-evolution of sports and media with particular focus on the relationship between emerging mass media and the media ecology E-Sports Broadcasting 22 surrounding that emergence. By documenting these moments of turbulence, I establish the framework necessary to analyze live-streaming as a new medium with which e-sports has emerged as an early adopter and convention creator. Live-streaming did not emerge independently from its predecessors, but rather delivers on the preoccupations of our current social moment. It has once again started a reshuffling of the roles of media within the sports media complex. E-sports, while primarily viewed through live-streaming, relies on all of the previous forms of media to varying degrees. With this framework in mind, I argue that the feedback between live-streaming, e-sports, and traditional sports has spawned an industry which roots itself in traditional sports media while still investigating the full potential of live-streaming. I begin by briefly discussing sports media in antiquity with Thomas Scanlon's (2006) piece on ancient Mediterranean sports and media. After this introduction to sports media, I move to the US in the late eighteenth century with the emergence of the first sports-only publication, the sports magazine, as well as early print news coverage of prize fighting during the rise of industrialization and nationalism. The next section maps the push towards immediacy in sports coverage and the rise of radio. On the heels of radio and the golden age of baseball, I discuss the early issues with televised sport before the post-war era. Moving into the 1950s and 1960s, I detail the transformation of football into a televisual sport accompanied by a very specific social contingency. I then transition into an investigation of live-streaming and e-sports, particularly how both are in conversation with sports media history. Origins of Sports Media As classicist Thomas Scanlon (2006) posits, there is no history of sports without its media counterpart. Media in antiquity, he argues, ""are a tool of society, a means of transmitting a message, primarily one from the rulers to the ruled"" (Scanlon 2006, 17). While his definition is E-Sports Broadcasting 23 quite limited, Scanlon is correct in noting that media are inflected with the power structures of a society. Sports as media were classically used by those with power to reinforce the hierarchy. Sports events were ""represented as a benevolent benefaction from the rich, noble, and empowered to those marginalized"" (Scanlon 2006, 18). This reinforcement of power structures comes through not only in the production of sporting events, but also in the medium itself. Scanlon suggests that the most powerful sports 'medium' in classical times was Roman architecture. The massive circuses and arenas were meant to ""provoke awe, admiration, and obedience in the citizens"" (Scanlon 2006, 18). Scanlon establishes that the predominant sports medium in a given society correlates directly with their notions of power. Within the realm of more dispersed authority such as the Ancient Greeks, sports media reflected the high value of an individual and his merits. Depictions of athletics in Ancient Greek poetry and pottery, made by and for the common people, focus on a particular athlete's prowess more than the event itself. On the other hand, societies with incredibly rigid hierarchies and god-kings such as the Ancient Egyptians and Persians, tend to represent sports as a demonstration of the ruler's power over their people. Ancient Rome, with its centrally focused authority, used architecture to demonstrate the power of the nobility as both benefactors and arbiters, diminishing the role of the athlete to that of an entertainer. Moving into more recent history with media such as newspapers and radio, Scanlon concludes that sports media became an amalgamation of both the Roman and Greek styles: large spectacles with massive personalities. E-Sports Broadcasting 24 Establishing a Media Landscape: Early Sports Media in America The importance of the printing press on modem society cannot be overstated. While its precise effects are still being debated', the affordances of the printing press allowed individuals to produce and disseminate a massive amount of information far more efficiently than ever before. With a massive rise in literacy rates and increased access to print brought about by the printing press, the reading population of the world shifted (Eisenstein 1983). While early readership was restricted to a very small subset of society, the printing press paved the way for the coverage of more mundane topics such as sports. In their analysis of sports media in pre- industrial America, sports media scholars Jennings Bryant and Andrea Holt point to two major developments: first, the appearance of sports in newspapers as 'general news' and second the creation of a completely sports-centered publication: the sports magazine (2006, 22). The advent and success of sports magazines in the early nineteenth century stands as a marker for some of the intellectual shifts of the industrial era. During this time we see a professionalization of sport in the form of prize fighters. We also see a shift from sports as a local leisure activity to something that one follows from a distance. Sports contests began to take on implications beyond a mere matching of athletes. Many sports magazines started out as independent, one-person operations that began circulation in the 1820s and 1830s (Bryant and Holt 2006, 22). The Spiritof the Times, one of the earliest iterations of the sports magazine, actually reached a circulation of over 100,000 readers by the 1840s. The success of this initial sports-focused publication displays the roots of the American sports media tradition. While they note the significance of sports magazines in the overall climate of sports media in America, Bryant and Holt trace the advent of modem sports 1See Elizabeth Eisenstein. 1983. The Printing Revolution in Early Modern Europe. New York: Cambridge University Press. E-Sports Broadcasting 25 media to recaps of prize fighting in the Penny Press age of the 1830s. With increased circulation to the middle and lower classes, sports coverage increased substantially in the mid-nineteenth century. Sports coverage in the Penny Press era focused on creating spectacular depictions of sporting events. As McChesney, a media historian points out, James Gordon Bennett, owner of the New York Herald,was ""one of the first exponents of 'sensationalism' as a means of generating circulation, and sport fit comfortably within this rubric"" (1989, 51) Out of the sensationalism present in these early newspapers, sports began to take on more significant cultural meaning. There was particular focus on regionalism and nationalism. Sports media scholar J. Enriquez explains that sporting events were far more likely to be covered if they featured a contest which reflected the social preoccupations of the day such as a northern horse racing against a southern horse, or an American boxer fighting a European (2002, 201). Through these mediated depictions, sporting events were encoded with much more meaning than a simple contest. They reflected the contemporary hopes and anxieties of the people. Sports media built up athletes as representatives. Newspaper recaps did much more than simply describe the actions; they created dramas (McChesney 1989, 51). The hyped up imagery of athletes and their contests created through the Penny Press and sports magazines became the paradigm for sports coverage for decades while a new sport caught America's attention. Newspaper Sports Writing and the Rise of Team Sports The rise of baseball as a national pastime coincide with the period of time just after the American Civil War. McChesney explains, ""The Civil War introduced baseball to an entire generation of Americans, as the troops on both sides played the game when time permitted. Indeed, baseball emerged as the preeminent national team sport during this period"" (1989, 52). E-Sports Broadcasting 26 After the Civil War, baseball helped mediate conflict by providing common ground for northerners and southerners. This moment was one in which the country was seeking to heal its rift, looking for neutral things that could bind the nation together. Baseball filled a political agenda by giving people something to focus on without opening old wounds. Sports writing changed drastically in the years following baseball's spike in popularity. Sports coverage began to receive regular columns and increased coverage throughout the late nineteenth century, leading to a new kind of journalistic specialization: the sports-writer (Enriquez 2002, 202). This fixation on sport was a result of new socio-cultural environments. Mandelbaum (2004), a sports media scholar and historian, argues that the industrial revolution created a new sports landscape through several major developments. First, the notion of childhood had expanded. In the nineteenth century, the period between birth and entering the workforce increased substantially. The new notion of childhood permitted more people to engage with baseball, football, and basketball. This increased interest in team sports continued into adulthood. Watching and reading about sports in the newspaper or sports magazines became an acceptable way to recapture the ""carefree years of their lives"" (Mandelbaum 2004, 2). Mandelbaum also argues that baseball offered a renewed connection to pastoral America, creating a feeling of nostalgia for the new city dwellers and factory workers who desperately missed the pace and beauty of rural America. Baseball coverage created the first major feedback loop between sports and media in America. Bryant and Holt claim that the importance of sport was downplayed significantly in the puritan era, but, ""regular, routine reporting of sports in newspapers and specialized magazines helped shift the cultural attitude towards sports in general"" (Bryant and Holt 2006, 25). They argue that in the late 1870s through the 1890s, Americans adopted a new stance on sports as important for the development of mind, body, and society. This new cultural stance on sports E-Sports Broadcasting 27 was shaped and fostered by an increased media coverage of sports. As baseball and its media coverage became more professionalized, Americans began to consume sports media in completely different methods. Sports spectatorship became a regular and acceptable pastime for the industrial worker. The industrial revolution created the first opportunity in America for sports production and spectatorship to be commercially successful endeavors. The growth of cities and the massive developments in individual mobility allowed for sporting events to take on new significance (Mandelbaum 2004, 3). Cities provided large numbers of sports players as well as spectators to fill newly built stadiums and watch newly formed teams. Sports fandom in the U.S. fit neatly into the predominant forms of labor and leisure. Zillmann and Paulus (1993), two psychologists who wrote on sports spectatorship, explain, ""spectatorship, as a significant form of recreation, is an outgrowth of the monotony of machine-dictated labor, sports events became the weekend love affair of all those whose workday was strictly regulated by production schedules"" (601). Zillmann and Paulus' article further supports the feedback between sports media consumption and societal structures. Live spectatorship in America had previously been seen as a luxury for the rich and powerful, but with the increased circulation of newspapers, and in particular sports coverage, to the middle and lower classes, sports spectatorship became accessible to an entirely new sector of the population (Bryant and Holt 2006, 21). Architecture once again emerged as an important medium. Large concrete and steel stadiums were created, replacing the more organically created playing fields of the late nineteenth century (Mandelbaum 2004, 52). We see here an important transition into the production of sport as a money making opportunity. As I discuss in the third chapter, the introduction of investors and producers fundamentally alters sports and their media counterparts. E-Sports Broadcasting 28 The available media shaped the portrayal and perception of athletics in the industrial era as well. The idea may sound a bit romantic, but Benjamin Rader (1984), a sports scholar focused on the transformation of sports media in America, labels the period of sports media prior to television as an era of heroes. Whether speaking of prize-fighters or the Mighty Casey of folklore, sports media in the industrial era painted athletes as larger-than-life characters. Rader claims, ""[t]hose standing on the assembly lines and those sitting at their desks in the bureaucracies increasingly found their greatest satisfaction in the athletic hero, who presented an image of all-conquering power"" (1989, 16). To Rader, sports media before television presented the American ideal. Athletes were meritocratic role-models playing for the love of the game. Rader's analysis places the impetus on newspapers to depict dramatic stories with characters akin to David and Goliath. In addition to individual mobility, urbanization, and industrial work, Enriquez attributes the rise and legitimacy of sports journalism as the catalyst for the nationalization of sports in America (2002, 201). As all forms of communication and nationalization were transforming, sports coverage lead the charge. In the early twentieth century, most newspapers had dedicated sports writers on staff. These sports writers became famous through their innovative and entrancing writing. Writers like W. 0. McGeehan, who worked for many San Francisco papers, described athletes as sorrowful sages and their contests as the clashing of titans on a battlefield (Nyhistory.org 2015). In this period however, it is difficult to judge the difference between journalism and public relations (Bryant and Holt 2006, 30). In fact, the issue of PR penetrating journalism in the late nineteenth to early twentieth century is explicitly laid out in Michael Schudson's (1981) chapter, ""Stories and Information: Two Journalisms in the 1890s"". At the turn of the century, there existed a dichotomy between news as entertainment and news as E-Sports Broadcasting 29 information. As papers around the country struggled to define themselves, sports media also went through a defining period. Legitimate sports writing became known for its higher literary quality, but read more like advertisements with its exaggerated, often hyperbolic, language. Public relations soon became as much a part of sports journalism as describing the events themselves. Team owners understood the media's role in keeping attendance at sporting events up and began catering to sports journalists for coverage (Enriquez 2002, 206). The team owners expected sports journalists to act as publicists for their events. The gambit paid off as sports writing filled more and more of the daily papers and attendance at live events continued to rise. The sports writers added significance to the experience of watching a sporting event. Between the shifts in the American middle class, leisure activities, and the flowery language of sports journalism, watching a sporting event began to take on the significance of watching history unfold. We will see these same issues appear again in e-sports coverage as journalism becomes a legitimizing force within the e-sports landscape, torn between deep analysis and hyped-up depictions for the sake of generating publicity. Liveness continued to assert its role in sports media as new technologies emerged. The telegraph especially placed the impetus on news sources to provide timely information. In a fascinating illustration of the desire for timely sports news, the ChicagoTribuneran the following note on March 17, 1897, the day of the legendary boxing match between Jim Corbett and Rob Fitzsimmons: ""The Tribune will display bulletins today on the prize fight. It has secured a telegraph wire to the ring in Carson City and a competent man will describe the progress of the fight, blow by blow, until the test is decided. The bulletins will be posted thirty seconds after they are written in the far Western city"" (Bryant and Holt 2006, 29). This fixation on live updates for sporting events across the nation is another example of how sports media has shaped the E-Sports Broadcasting 30 media landscape of America. Information began traveling faster than ever via wireless transmissions, but it was actually a yacht race which saw one of the very first implementations of wireless for live information transmission. Sporting events saw some of the earliest uses of the telegraph for news reporting as well (Mott 1950, 597). As the telegraph allowed for a sense of liveness even for remote events, it paved the way for the most significant development in sports media prior to television: radio. A Fixation on Liveness: Radio and Sports Consumption Radio delivered on the push towards liveness established by the telegraph. The first broadcast of a Major League Baseball game occurred within a year of the commercial release of radio (Enriquez 2002, 206). Rader remarks, ""Now the fan did not have to await his morning newspaper; he instantly shared the drama transpiring on the playing field"" (Rader 1984, 23). For the first time, sports were perceived as home entertainment. Broadcasters as well as businesses capitalized on the shift. Sports coverage was integral to the rise in popularity of radio in the interwar period. In Rader's words, In the pre-television era, the heroes of sports assisted the public in coping with a rapidly changing society. The sports world made it possible for Americans to continue to believe in the traditional gospel of success: that hard work, frugality, and loyalty paid dividends; that the individual was potent and could play a large role in shaping his own destiny (1984, 15). By Rader's account, sports programming on radio delivered a much needed revitalization of the American ideals through the transient industrial period and The Great Depression. The rise of radio coincides with the golden age of baseball, but there was an awkward transitional phase into the new medium while newspapers and radio both tried to define their new boundaries. While consumers clearly desired liveness, initial radio broadcasts felt flat and emotionless (Bryant and Holt 2006, 27). Some of the greatest blow-by-blow sports writers were E-Sports Broadcasting 31 terrible at delivering a compelling radio broadcast. Sports writers were extremely adept at creating dramas through print, but they failed to capture audiences in the early days of radio. Oddly enough, their sports knowledge undermined their sports coverage in the new medium. Instead, a new role emerged: the sportscaster. In the era of radio, the performance of live sports broadcasts came with significant stakes. Adept sportscasters were cherished more for their voices than their sports knowledge. Delivering play-by-play depictions of sporting events takes little technical knowledge, instead the entertainment comes from the delivery. Mandelbaum writes of early radio sportscasters, ""the broadcasters were akin to poets and troubadours who preserved and handed down the great tales oftheir cultures by committing them to memory and reciting them publicly"" (2004, 80). Delivery was actually so important that sometimes sportscasters such as Graham McNamee, known especially for his baseball broadcasts, were not even present at the event but instead handed written play-by-play depictions of the game so that they could add their own dramatic and authorial tone to the live event (Mandelbaum 2004). Another issue during the emergence of radio was redefining the role of newspaper sports coverage. Radio could deliver the liveness desired by sports fans and was incredibly well suited for play-by-play commentary. Newspapers had traditionally covered the blow-by-blow report of an event, capturing the drama through flowery language and hyperbole. With radio, the sportscaster captured the audience's attention through the same means, bringing in even more emotion as his voice rose and fell with the action of the contest (Enriquez 2002, 202). Sports writers instead decided to focus on an area that radio broadcasters could not: strategy. Early sportscasters had to focus so much on the delivery of the action that they could not elaborate on the reasons behind certain maneuvers. Sports writers took advantage of this deficiency and began E-Sports Broadcasting 32 writing articles which focused on everything around the action. From in-depth analysis of strategy to the creation of larger than life athlete personalities, newspaper coverage of sports in the era of radio completely changed to remain relevant. Sports magazines also had to find a new space to occupy during radio's reign. Completely unable to keep up with the live coverage by radio and the strategic coverage of America's favorite sport, baseball, sports magazines instead began to focus on niche sports such as yacht racing. The other innovation of sports magazines in the early 1930s was their addition of full page color photographs of athletes, something that neither radio nor newspapers could offer (Enriquez 2002, 202). They remained as an important sports medium but had been supplanted by both radio and newspapers. Baseball's hold on the American public was so strong that the niche sports, which were typically covered in sports magazines, hardly seemed relevant. Football in particular rarely saw coverage anywhere other than sports magazines (Bryant and Holt 2006, 32). Football had traditionally been seen as a college sport reserved for the wealthy, but with an increasing number of college graduates in the U.S. and the rise of a new medium, its niche status was about to change (Oriard 2014, vii). The Televisual Transformation of Sport Television's initial debut into the sports world was a colossal failure. Reaching only a few hundred people, the first American televisual sports broadcast was a Columbia-Princeton baseball game on May 17, 1939. Just a few years after the commercial release of the television in the U.S., RCA's first foray into televised sport flopped. The New York Times' Orrin E. Dunlap Jr. recounted on the following Sunday, ""The televiewer lacks freedom; seeing baseball on television is too confining, for the novelty would not hold up for more than an hour if it were not for the commentator"" (Rader 1984, 17). He goes on to say, ""To see the fresh green of the field as The E-Sports Broadcasting 33 Mighty Casey advances to the bat, and the dust fly as he defiantly digs in, is a thrill to the eye that cannot be electrified and flashed through space on a May day, no matter how clear the air."" Bryant, Holt, Enriquez, and Rader attribute the failure of early televisual sports to several factors. First, television camera technology was rudimentary and receivers were even worse (Bryant and Holt 2006, 31; Rader 1984, 18). Viewers could hardly see the player, much less follow the ball or action on the field. Second, television was not a commercial success upon its release. Sets were expensive and did not offer nearly enough programming to warrant their price: an issue that created a sort of negative loop as the television industry needed more viewers to warrant more content yet could not supply enough content to attract more viewers. The third factor, described by Enriquez, is the failure for broadcasters to adapt to the new medium. Sportscasters could not actually see the video feed and casted the game as if they were still on radio; recounting every single action that occurred on the field despite what was on viewers' screens at home. Inexperienced camera operators had difficulty following the action and the image rarely matched what the sportscaster was describing. Radio sportscasters also had difficulty transitioning into the new visual medium because they could no longer provide the same level of drama through exaggeration and hyperbole. Where short infield ground balls could previously be described as laser-fast bullets, the viewers at home now saw that the play was just another ordinary event. Situated somewhere in between watching the game live at a stadium yet still sounding like radio, televisual sport had a difficult time defining itself in the late 1930s and early 1940s. According to Rader, televisual sport experimentation stopped completely during the Second World War (1984, 23). With the well-established roles of radio, newspapers, and sports magazines, the revival of televisual sport seemed to be impossible. The utter failure of televised sports in the late 1930s E-Sports Broadcasting 34 into the Second World War left televisual sport in a difficult position. Sports radio's popularity was at an all-time high in the 1940s. Baseball had captured the hearts and minds of the American people, and famous radio broadcasters such as Bill Stern and Jack Armstrong kept them listening with bated breath (Rader 1984, 30-3 1). Baseball and more generally live event sports spectatorship, however, could not keep the nation content for too long. In what has been dubbed the Sports Slump of the 1950s by Rader and others (Bryant and Holt 2006, McChesney 1989), spectatorship had finally started to dwindle. Television sets were making their way into homes in record numbers after World War 11. In the post-World War 11 era, pastimes shifted from inner-city, public forms of recreation to private, home-centered forms of recreation. Sports revenue was down and change was in the air. People could watch baseball on their television sets at home, but not many people wanted to. As shown by the earlier quote from The New York Times, television had difficulty containing the magic that baseball once held. Football, however, was poised to rise with the new medium. It had been long overlooked, but football was incredibly well suited for television broadcasts. The large, visually distinct ball and typically slow moving action provided an acceptable subject for contemporary television camera technology (Grano 2014, 13). College football had seen a bit of success in newspapers, but professional football had a negative reputation as a ""perversion ofthe college game played for alma mater rather than a lousy paycheck"" (Oriard 2014, vii). Radio broadcasts of football had never reached the same level of success as baseball. Professional football seemed to be a sport without a suitable medium. As sports media scholar Michael Oriard explains, ""[o]nly television could give the professional game a national audience, and Pete Rozelle's defining act as the commissioner who ushered in the modem NFL was to market the league through a single television contract, rather than leaving clubs to work E-Sports Broadcasting 35 out their own deals"" (2014, vii). This deal with broadcasting giant, NBC, led to the NFL's great breakout story and what would soon become the model for televised sports (Rader 1984, 85). With the NBC still losing money on a dwindling sports fanbase, they were ready to pull the plug on their deal with the budding NFL until the championship match between the Baltimore Colts and the New York Giants of 1958 (Grano 2014, 13). This match, still hailed as the 'Greatest Game Ever Played', would become the longstanding origin story of televised football. The game went into a second overtime, pushing the broadcast into prime time on the East Coast, a slot in which NBC never dared to place professional football. As millions of Americans tuned in for their regularly scheduled programming, they instead found John Unitas and his Baltimore Colts scoring the game winning touchdown after a long, hard-fought battle. Oriard, Rader, Grano, Oates, and Furness all trace the NFL's commercial success to this one defining moment. As compelling as origin stories often are, the truth is that many other factors lead to the success of football in the new mass medium. New technologies such as video tape were integral to the rise of football in America. Hitchcock argues that instant replay in particular helped with the rebranding of professional football: ""The use of video-tape gave the game of football a whole new image... The instant replay changed football from brutal, quick collisions into graceful leaps, tumbles and falls. It gave football an aura of art in movement. It made football attractive to entirely new segments of the audience"" (1989, 2). Where football players had once been seen as lethargic brutes, instant replay allowed broadcasters to slow down images, dissect plays, and highlight the athleticism of players (Rader 1984, 83-84). Sports, with football leading the charge, were once again on the cutting edge of media adoption. According to Dylan Mulvin, the first documented use of instant replay for review and training purposes was in 1957 during a game between the Los Angeles Rams and the San E-Sports Broadcasting 36 Francisco 49ers (2014, 49). By 1964, instant replay was a standard broadcasting technique across all sports. The NFL's willingness to adapt to the new medium set it apart from other sports at the time. In addition to these technological and legal advances, Bryant and Holt as well as McChesney argue that one particularly innovative producer reinvented sports broadcasting for television: Roone Arledge. With ABC's full support, Arledge established television broadcasting conventions still present today. After the 1958 Championship game between the Colts and the Giants, ABC was scrambling to catch up to the NBC's success in televised sports broadcasting. As Enriquez describes, ""Television broadcasting affected different sports in different ways. It devastated boxing, had mixed effects on baseball, and proved a boon to college and professional football"" (2002, 202). As NBC began to ride the wave created by the NFL, ABC looked to get in on the action. Arledge was given free rein to perform a complete overhaul of ABC Sports. Bryant and Holt argue that the single most important innovation Arledge brought was the notion that a televisual broadcast should be presented ""from the perspective of what the typical fan would see if he or she attended the game live"" (Bryant and Holt 2006, 33). Arledge (2003) believed that the broadcast should capture the essence of attending a game, not just the play on the field, but the roar of the crowd, the cheerleaders, the marching bands, and the coaches on the sidelines. As Enriquez describes, ""under Arledge, television assumed every role previously played by print media; it served as the primary medium for experiencing events, it provided detailed analysis, and it gave human faces to the participants"" (2002, 205). Through football, televised sports were able to set conventions which separated them from earlier forms of media. This transition lives E-Sports Broadcasting 37 on in live-streaming today as we will see later with live-streaming's adaptation rather than transformation of televised sport. The arrival of television meant that sports radio and print media had to redefine their role in sports coverage. Television could deliver the liveness of radio and, with the help of commentators and technology like instant replay, the drama and dissection of strategy found in print media. Newspaper coverage of sports was now relegated to simple recaps. Sports magazines on the other hand rode the success of television. As Bryant and Holt assert, ""Sports Illustratedoffers a classic example of an old medium responding to a new one"" (2006, 36). Rather than seeking out an area left uncovered by television, Sports Illustratedsupported televised sports by providing innovative action photography and updates on the most popular athletes and teams at the time. Sports broadcasts of the 1960s were infused with the hopes and fears of the Cold War era. R. Powers, a television sports scholar, suggests that sports filled a void in the American public, ""shrugging off the darker morbidities of the Cold War and McCarthyism"" (1984, 118). The re-found focus on sports as spectacle established by ""the youthful theme of ABC, echoed the Kennedy idealism of the new frontier, the sporting emphasis echoed Kennedy's image of muscular athleticism..."" (Whannel 2002, 34). Entertainment sports media, with its art-in-motion presentation, delivered a message of newness and regeneration to American. Through broadcasting and advertising deals, sports helped build and perpetuate the growing conspicuous consumption movement and the capitalist ideals of post-war America. Athletes resumed their star status. Sports stars began appearing in advertising everywhere. Merchandising became a key part of sports promotion. Anything from replica jerseys of sports stars to blankets and flags with team branding can be found almost anywhere in the U.S. E-Sports Broadcasting 38 Contemporary Sports fandom has come to mean much more than simply following a team. It means buying a team's products, playing sports video games, joining fantasy leagues, and watching sports entertainment television. Oates, a sports media scholar focused on the NFL, writes that fandom has been transformed by the presentation of athletes as commodities to be consumed selectively and self-consciously by sports fans (2014, 80). The previously subcultural hyper-fandom activities such as fantasy football and sports video games, Oates argues, have moved into mainstream prominence and profitability. Fans are invited to interact with athletes as vicarious managers in fantasy sports, offering a completely new, personally tailored form of interaction with sports organizations. This new drive for constant connection and feedback within the sports industry culminates with live-streaming. Live-Streaming: Constant Connection As Oates suggests, sports fandom has fundamentally changed to reflect an increased involvement on the part of the spectator. Athletes and personalities have become commodities for fans to interact with. Social media, fantasy sports, and video games have created a connection to sports stars that was never before available in other media. At any moment, a spectator can catch highlights on ESPN, head over to forums to discuss major sporting events, or load a stream of a match on their phone, all while tweeting at their favorite athletes with the expectation that their words will be received on the other end. Recent trends show a change in the sports media landscape as new platforms begin to vie for control over sports broadcasting in the US. The NFL has recently signed a deal with Google allowing for the streaming of games over the internet after their current contract with DirecTV ends in 2015. This deal reflects the changing media landscape in the internet era. The rise of new streaming platforms poses an interesting dilemma to the current media titans and new E-Sports Broadcasting 39 opportunities for new forms of media sports. Thus far, using the tradition established by McChesney, Bryant, Holt, and Rader among others, I have used sports media as a lens through which to view particular socio-cultural moments in America. I now turn that lens towards the contemporary sports media landscape. What can we learn about our own social moment by looking at the use of streaming platforms for traditional sports or the arrival of e-sports as an entirely new form of professional competition that makes use of older forms of media, but thrives in live-streams and video on demand? The MLB offers an early case study into the use of live-streaming for major league sports broadcasting. The regular season in the MLB consists of 2,430 games, a staggering number compared to the NFL's 256. The sheer number of regular season games held each year causes a problem with over-saturation. This inundation of content lowers the value of each individual game in the eyes of the major networks (Mondelo 2006, 283). The games that these networks choose not to air due to scheduling conflicts previously caused many games to go unseen by fans outside of the local media market for the two competing teams. To remedy the situation, the MLB streamed over 1,000 regular season games online starting in 2003. The launch of MLB.tv in 2002 allowed engaged MLB fans to continue watching content even when they did not have access to the games through the major networks. While not initially a huge commercial success, MLB.tv still runs today, over a decade later at a monthly subscription of $19.99 and as of 2014 incorporated both post-season games and the World Series as part of the package (MLB.tv 2015). While the MLB has not released the official revenue totals for its live-streaming service, with 3.7 million subscribers the platform generates well over $400 million per year (MLB.tv 2013). This little-known use of live-streaming shows a hunger for immediate interaction with sports media regardless of the available medium. E-Sports Broadcasting 40 Early live-streaming fundamentally looks and feels like television, but it filled a role which network television could not: all access and constant connection to media. It took form on a new platform, but did not truly differ from television. Early live-streaming is more like an adaptation of television than a new medium. Rather than creating something new, the early foray into live-streaming by the MLB simply adapted the already present broadcasting infrastructure and applied it through a different avenue. Television is often invoked in live-streaming. If we look at MLB.tv, the .tv signifies its connection to television, but that domain is actually the official domain for the country of Tuvalu. Other streaming platforms like ustream.tv, twitch.tv, MLG.tv, all based outside of Tuvalu, use the same domain to signal their televisual connection. Live-streaming emerged at a very particular moment in the evolution of sports media. With air-time limited on the major networks, the internet allows a near infinite amount of content to reach sports fans. As Oates would argue, from fantasy sports, to blogs, to live-streaming, the internet is, for many, the new space of the sports fan. Live-streaming goes beyond the ability of other media to reach viewers wherever and whenever, whether from a home computer or a mobile device. Live-streaming delivers on the constant connectedness expected by consumers today. At its roots, live-streaming is a televisual medium. So what separates it from television? Live-streaming today has created its own niche by blending other forms of media. Most live-streams host an internet relay chat (IRC) in addition to the audiovisual component of the broadcast. This IRC allows viewers to chat with other audience members and often the broadcaster, a functionality not currently available in television. This live audience connection in live-streaming is unparalleled in television. Hamilton et al., in their investigation of the significance of live-streaming for community creation, situate Twitch streams as an important 'third place' for community. Building on the work of both Oldenberg and McLuhan, Hamilton et E-Sports Broadcasting 41 al. (2014) suggest that ""By combining hot and cool media, streams enable the sharing of rich ephemeral experiences in tandem with open participation through informal social interaction, the ingredients for a third place."" The third place that the authors point to creates a rich connection akin to interpersonal interaction. The ephemeral nature of these interactions creates a deep sense of community even in streams with hundreds of thousands of viewers. Live-streaming and in turn, the IRC associated with streams creates a shared experience tantamount to the ""roar of a stadium"" (Hamilton et al. 2014). These streams also pull in a global audience, connecting isolated audiences into one hyper-connected community. Live-streaming draws on television for its look and feel, but delivers not only on the desire for liveness perpetuated in sports media but also the hyper-connectivity present in today's globalized world. E-sports, Live-streaming, and Sports Media Many factors contributed to the success of live-streaming for e-sports. It arrived at a moment when television seemed closed to e-sports, it was much less expensive to produce, and much easier to cultivate. Television broadcasts are prohibitively expensive to produce. Early attempts at airing e-sports on television have typically flopped, rarely surviving past a second season. E-sports are difficult to film when compared to traditional sports and conventions had not yet been set for the televisual presentation of e-sports (Taylor 2012). The action in traditional sports can typically be captured by one shot. E-sports broadcasts, in contrast, must synthesize one cohesive narrative out many different player viewpoints with varying levels of information. In a game like CounterStrike, broadcasters must wrangle with a large map with ten players in first-person perspective. The resulting audiovisual feed is a frantic attempt to capture the most relevant information from the players with an outside 'observer' controlling another viewpoint E-Sports Broadcasting 42 removed from the players' point of view. The observer functionality in the early days of e-sports broadcasting created a difficult barrier to overcome for commercial success on television. Observer functionality had not yet become a focus for game developers and commentary had not reached the level of competency it has in more contemporary broadcasts. Instead of finding success on television, e-sports pulls in millions of concurrent viewers on live-streaming sites such as Twitch.tv. With television seemingly out of reach and streaming requiring significant investment per event in the early 2000's, e-sports broadcasting remained relatively stagnant until the arrival of a reliable, and cheap, live-streaming platform. Justin.tv (and other similar sites like UStream and Stickam), which launched in 2007, delivered exactly what e-sports broadcasters needed to grow. The site allowed users to quickly and easily stream content online with the use of some relatively simple software. Both broadband internet reach and streaming technology had developed to a point that lowered the barrier of entry for broadcasters. Players from around the world streamed games from their bedrooms. E-sports broadcasters reached new, massive audiences. The success of gaming content on Justin.tv spurred a new streaming site dedicated solely to gaming. The games-centered streaming site, Twitch.tv, launched in 2011. Twitch.tv revolutionized the e-sports industry. Each of the casters I interviewed spent time detailing the importance of Twitch.tv without being prompted. As one explained, Twitch.tv is ""the clearest driving factor that's grown e-sports over the past 2-3 years."" As mentioned in the introduction, e- sports audiences have reached previously unheard of levels. Large scale e-sports events regularly see concurrent viewer numbers in the hundreds of thousands. These broadcasts still largely resemble televised sports however, rarely, if ever, making use of the IRC. E-Sports Broadcasting 43 Live-streaming is just one of the forms of media the e-sports industry makes use of. In fact, e-sports interacts with most media in the same ways that traditional sports have. The e- sports industry pushes back into almost all of the earlier forms of media discussed in this chapter. Print and radio typically fill a PR role in e-sports coverage. Large events or developments often make their way into publications like The New York Times. Local radio segments will occasionally feature summaries of e-sports events occurring nearby. Internet versions of both of print and radio sports coverage are fundamental segments of the e-sports media ecosystem. Podcasts, digital audio files available on the internet through downloads or streaming, vlogs, and video diaries fill essentially the same role for e-sports that radio currently plays for traditional sports. Experts weigh in on recent developments and players breakdown certain aspects of a game. E-sports journalism has also immerged as a legitimizing force within the industry. Sites like ongamers.com and esportsheaven.com keep fans abreast of any new developments in the professional scene for all of the major e-sports titles. Journalists like Richard Lewis add legitimacy to e-sports through their coverage of current events. Their recaps of developments as well as summaries of various tournaments and leagues closely resemble their print counterparts in sports coverage. It is clear that the e-sports industry is in conversation with many forms of media. Many of the forms and techniques are borrowed directly from sports coverage. These forms of media did not appear instantly however, they are the result of years of push and pull with the larger sports media landscape. Nowhere is this more apparent than in the commentating of e-sports live-streams. E-Sports Broadcasting 44 Chapter 2 Shoutcasters Collecting Conventions E-sportscasters, often referred to as shoutcasters, both look and sound like professional sportscasters. Their attire and cadence both create an instant connection to televisual sports. Having never seen a game of Starcraft 2 before, you may watch the flashing lights and explosions with a perplexed look on your face. As you continue to watch, you hear two commentators provide a narrative, stats fly across the screen, and you start to piece together the game in front of you. After a few minutes, you know the two players who are facing off against one another, you feel the excitement as they engage each other's armies, and a slight sting as the player you were rooting for concedes the match with a polite ""GG."" The whole presentation feels like a variant of Monday Night Football with virtual armies instead of football teams. From the stat-tickers to the sound of the commentator's voice, you can almost imagine the ESPN or CBS logo gracing the bottom corner of the screen. Shoutcasters have become a staple in e-sports. One of the main signifiers of the 'sports' moniker professional gaming has taken on, shoutcasters lend an air of professionalism to a scene which often struggles to define itself. By adopting the 'sport' title, a precedent has been set for e-sports broadcasters which informs their style and conventions. Shoutcasters are important to investigate because they form a fundamental grounding for e-sports which helps it to create its identity in the face of blistering turnover rates and constant field shifts. E-sports stand in a unique position compared to traditional sports. Where players and coaches in traditional sports often have careers that last for several years, e-sports personalities E-Sports Broadcasting 45 suffer from intense turnover rates where professional careers can end within a year. E-sports players burn out quickly and coaches rarely make a lasting name in the industry. The recognizable personalities in e-sports are the few innovators and commentators who turned their passion into a career. In this chapter, I analyze the role of shoutcasters within the larger framework of the e-sports industry. I build much of this analysis on the foundation that Taylor (2012) established in her investigation of the rise of e-sports. Much of Taylor's analysis still holds true today, but some other developments in the field have created new dynamics within shoutcasting that were not present during her initial encounters with shoutcasters. Understanding how shoutcasters borrow from earlier forms of media, the issues they perceive within the industry, and how they cultivate their own identity as shoutcasters while grappling with the hyper-connection found in live-streaming as a medium allows us to grasp the relationship e- sports broadcasting has with earlier forms of media while still creating its own identity. I begin with a very brief look at the history of shoutcasting. Shoutcasting History One can see that even early attempts at broadcasting competitive gaming borrowed heavily from its media contemporaries. Starcade,a 1982 show that ran for two years, marks one of the first forays into e-sports broadcasting. Though the term e-sports had not yet emerged, the show featured two opponents attempting to outscore each other on various arcade machines. If we look to Starcade as an early example of e-sports, then the origins of e-sports commentating resemble game show commentary found in Jeapordy! or The Price is Right. Watching Starcade for the hosting alone reveals many similarities to other game shows: the host wears typical game- show host garb, pleasantly explains every aspect of the competition, and speaks with the E-Sports Broadcasting 46 broadcast voice we all recognize. Starcadealso shows the constant evolution of competitive gaming coverage as it continued to refine its camera angles, presentation, and format over its two year run. The model which more closely resembles our modern vision of shoutcasting gained momentum at the turn of the twenty-first century. The title shoutcaster comes from the early streaming software used for e-sports broadcasting, SHOUTcast. While many people familiar with e-sports may have no idea where the term comes from, a prominent shoutcaster, djWHEAT (2012), claims that the title remains due to its signaling of the history of e-sports. SHOUTcast, a media streaming program, arrived in 1998, allowing interested parties to broadcast audio recordings to various 'radio' channels for free. SHOUTcast allowed for video streaming, but as one early shoutcaster I interviewed lamented, the bandwidth and equipment required for video streaming was prohibitively expensive. Instead of the audiovisual broadcast we regularly associate with e-sports live-streams today, early shoutcasters relied on audio recordings akin to early radio coverage of traditional sports. These early broadcasts only streamed audio to a few hundred dedicated fans on internet radio. Early shoutcasts follow the form of traditional play-by-play radio broadcasts, focused primarily on presenting every development in the game. In interviews, veteran shoutcasters were not shy about admitting the influence radio sportscasters had on their own style. One mentioned that he spent hours listening to live sports radio to hone his own skills. Early shoutcasters also performed many aspects of the production that they are no longer required to perform in the more mature e-sports industry. They would attend events, set up their own station, typically with their own laptop and microphone. It was a very grassroots affair. E-Sports Broadcasting 47 With little experience in the technical aspects of broadcasting, the productions emulated as much as they could from sports broadcasting to lend an air of professionalism. With the arrival of Twitch.tv, and other reliable streaming platforms, much of the onus of production was taken off of shoutcasters. Instead of acting as producers, directors, editors, and on-air talent all at once as they had in the early audio-only streams, shoutcasters are now more able to focus on the portion of their work from which they get their name. Shoutcasting after the early days of internet radio has come to not only sound like traditional sportscasting, but also look like traditional sportscasting. Something Borrowed: Influences from Sportscasting Wardrobe Many ofthe shoutcasters I interviewed talked about wardrobe as a huge change within shoutcasting, one that was spurred entirely by looking at traditional sportscasting. Most shoutcasters got their start wearing t-shirts and jeans at various e-sports events. Today, you will rarely find a shoutcaster not wearing a shirt with a blazer. Looking at the image below shows the incredible shift in shoutcasting just within the last six years. Both images feature the same Figure 2-Left: Joe Miller at 2009 Intel Friday Game London; Right: Joe Miller at 2015 Intel Extreme Masters World Championship in Katowice Poland. Image credit: ESL, Philip Soedler and Helena Kristiansson. Flickr.com/eslphotos E-Sports Broadcasting 48 shoutcaster: Joe Miller. The left-hand image comes from the 2009 Intel Friday Game London while the right-hand image comes from the 2015 Intel Extreme Masters World Championship. While the images are quite similar, the professionalism apparent in the right-hand image resembles a professional sportscaster. The gamer/geek vibe found in the left-hand image has been removed from the shoutcasting image. As a few of the shoutcasters I spoke with admitted, the drive to rework the shoutcaster wardrobe came purely from traditional sports. On top of that, they pointed to a desire to shed the gamer/geek stereotypes that e-sports had come to inhabit. By adopting professional attire, they felt that they could get rid of the old image and emulate the professionalism of a sports broadcast. Wardrobe is not the only aspect of traditional sportscasting that has made its way into shoutcasting. Style One of the more elusive aspects borrowed from traditional sports is the actual commentary style. I use the term elusive here to signal the difficulty in pinning down exactly why shoutcasters remind us so vividly of traditional sportscasters. Early shoutcasters had no models outside of traditional sportscasting so they took as much as they could: ""So as a broadcaster we look at traditional sportscasting. We pull from that and then make sure it fits in game casting."" As it turns out, many sports commentary conventions translate well into game casting. As such, the first generation of casters share many similarities with television sportscasters. Most of these early shoutcasters admit to being influenced almost entirely by traditional sportscasters. One caster explains, ""Television is where we grew up, it's what we watched. So clearly that's where we're going to pull from."" E-Sports Broadcasting 49 Shoutcasters typically have no media training, instead relying on mimicry of earlier conventions to get by. As with most positions in e-sports, and similar to early sports writers and radio casters, shoutcasters are just passionate fans turned professional. In conversations, they each revealed a bit of their own personal history that pushed them towards broadcasting, but only one ever mentioned having received any sort of formal training. Years into his shoutcasting career, he ""went back and did a journalism and broadcasting course for 6-9 months."" Of particular note, he mentions, ""they did one really good project which was 'how to be a news presenter'. They taught me the basics of that."" The rest, he says, he learned on-air through experience. The other shoutcasters I interviewed echoed this story. Most of the shoutcasters I interviewed fell into shoutcasting through happenstance and had to learn their craft on-air. Shoutcasters are akin to the very early television sportscasters who had to reinvent their style during broadcasts like Bob Stanton, a radio sportscaster turned television sportscaster who would send his friends to sports bars to gather feedback and suggestions from audience members (Rader 1984). Echoing this inexperience and improvisation, one shoutcaster I interviewed confided, ""the first time I had ever been on camera, I sat down and I was like, 'I have no idea how to do this.' I had done two and a half years of audio casting, but I had never done video."" Another caster recalls of his first show, ""All I knew going into my first broadcast was that I know this game. I know how it works, I know these players, and I play against these kinds of players. I don't know how commentary works, but I can do this."" After these first, trial broadcasts, both of the above-mentioned shoutcasters admitted to going back and watching traditional sportscasters to learn more about their craft. Other broadcasting style conventions such as how to handle dead-air, how to end a segment, or how to transition into gameplay were lifted directly from sportscasting. Paul E-Sports Broadcasting 50 ""ReDeYe"" Chaloner, a prominent personality within the e-sports industry, addresses each of these techniques in his primer on becoming a professional shoutcaster, constantly pointing to various examples from traditional sports broadcasting to illustrate his points. In his section on dead-air, Chaloner writes, ""[o]ne of the best pieces of advice I had for TV was from legendary sports producer Mike Burks (11 time Emmy award winner for sports production) who told me 'A great commentator knows when to shut up and say nothing""' (2009, 9). Chaloner uses traditional sports broadcasting as a way to explain shoutcasting, a clear indication of its influence on e- sports broadcasting. Content Analysis: Play-by-play and Color Commentary in the NFL andLCS Another convention lifted directly from traditional sports broadcasts is the arrangement of the casting team. Traditional television sportscasters fall into one of two roles: play-by-play or color commentary. Shoutcasters use these same two roles. Both sports broadcasts and e-sports broadcasts feature one of each type. The play-by-play commentator narrates the action, putting together the complicated and unconnected segments of the game into a cohesive narrative. The color commentator provides their in-depth analysis of the game, typically from the stance of a professional player. Shoutcasters have adopted the two-person team directly from traditional sports broadcasts. The path to each role follows the same pattern as well. An ex-professional player almost always fills the role of color commentary in both traditional sports and e-sports. Their insight is unparalleled. Color commentators attempt to breakdown complex series of events or highly technical maneuvers as if they were still a professional player. In the words of one e- sports color commentator, ""I'm not pretending to be a professional player, but I'm doing my best E-Sports Broadcasting 51 to emulate them."" He goes on to say, ""You can read up on it and study it as much as you like, but unless you've lived it, you can't really comment on it."" In comparison, a play-by-play commentator does not need to have the technical depth, but relies more on presentation. Even though a play-by-play commentator has most likely played hundreds of hours of whichever game they cast, they cannot fill the role of the color commentator. This dynamic allows for play-by- play commentators to switch games with relative ease whereas color commentators, both in traditional sports and e-sports, are locked into one game. To illustrate the emulation of sports broadcasting found in e-sports, I now turn to a brief content analysis of the commentary found in a regular season NFL game and a regular season League of Legends Championship Series game. I start with the commentary from one play in an NFL game. After presenting the traditional model, I move to the commentary from one team fight in League of Legends to demonstrate how the convention has been adapted for e-sports commentary. In both cases, I have removed the names of players, commentators, and teams to cut down on jargon and clutter. Each case exhibits the dynamic present in the two man commentary team. NFL With both teams lined up, the play begins and the play-by-play commentator comes in immediately. Play-by-play: Here's [player 1] out to midfield, a yard shy of a first down. [player 2] on the tackle. After the play has ended, the color commentator takes over. Color: It's been [team 1] on both sides of the ball. Whether it be defense and the way that they dominated this ball game and then offensively, the early going had the interception, didn't get much going over the next couple of possessions offensively but since that time, [player 3] has been very precise in how he has thrown the football and they just attacked this defense every which way. E-Sports Broadcasting 52 LCS Three members ofthe Red Team engage Blue Team atRed Team's turret Play-by-play: This is going to be dangerous. Doing what he can to hold out. They're going to grab the turret, the fight will continue after the shield onto [player 1] is already broken. He gets hit, the ignite is completely killing the ultimate! He gets hit by [player 2] who turns around again and heads back to [player 3]. With the action overfor the moment, the colorcommentatorbegins to speak Color: I thought he finished a camp here too... The color commentatoris cut off as two more members ofBlue Team attempt to attack. Play-by-Play Heyo, as the top side comes in here too. [player 1], will he hit a good ultimate!? Oh! They were staring right at him but now he's just left to get shredded apart here. They couldn't have thought that this was going to go well for them. With thefightconcluded, thecolorcommentatorcontinuesagain. Color: Is this just the week of chaos? Because that was a really really uncharacteristic lapse in judgement from [Blue Team]: Not calling everybody into position at the right time, and [Red Team] with the advantage make them pay for it. They didn't expect the ignite from Nautilus. I think they expected Nautilus to have exhaust instead, but [player 1] pops the ignite, and as we said there is no armor so [player 2] just... and it continues! The color commentator is cut off once again as the two teams engage one another for a third time. If we look at these examples for their content rather than the specific moment in the game we can catch a full illustration of the two-caster dynamic. As we can see by the NFL example, the play- by-play commentator provides a running narration of the action in the game. When the action ends, the color commentator provides the meta-level analysis of the unfolding events. In the LCS example, we see that the same dynamic is present, however, due to the continuous action in the game, the transition into color commentary becomes difficult. In the first lull, the LCS color E-Sports Broadcasting 53 commentator tries to insert his analysis, but he is cut off by a second engagement. The color commentator stops talking immediately and allows the play-by-play commentator to continue describing the action. After the engagement ends, we hear the color commentator pick up again, explaining why the fight developed the way it did as well as his insight into why the teams played the way they did. Entertainment and Narrative Entertainment value was a repeated concept in my interviews with shoutcasters. Some went so far as to claim that their role was only to entertain. One stated, ""I want to get you excited. I want to get you to watch the game as if it was a show on television."" Many would point to good sportscasters as an example to follow. If we recall the example of the early days of radio sportscasting, casters had a difficult time making the transition to the new medium. Their broadcasts felt flat when compared with their print counterparts (Bryant and Holt 2006, 27). Early sportscasters got locked into the idea that their responsibility was to provide the basic play- by-play depiction of a match. The golden age of sports radio was brought in by popular sportscasters, such as Graham McNamee, who were so popular that they'd be asked to cast games remotely. McNamee, like a live version of his print counterparts, was famous for creating florid depictions of the game, athletes became heroes and their play became combat as told by McNamee. While the presentation of live and accurate information was still essential, popular radio sportscasters shifted sports media from news reports to entertainment. Sportscasters are responsible for this shift. Without their expert embellishment, play-by-play depictions lack entertainment value. E-Sports Broadcasting 54 Even non-sports fans can feel the excitement from a particularly good sportscaster. The game they portray is far more intriguing than any actual events happening on the field (Bryant, Brown, Comisky, and Zillmann 1982). This disconnect forms one of the primary reasons that the transition to casting televised sport was so difficult. The small liberties that sportscasters took were no longer acceptable in the visual medium. Once the home viewer could see the game, commentary had to shift to accommodate more scrutiny. Radio sportscasters were notorious for their embellishment. As Bryant, Comisky, and Zillman note from one of their several investigations of sportscasting, roughly forty percent of commentary is dramatic embellishment (1977). In 1977, the authors tracked the amount of hyperbole and exaggeration in sports broadcasting and found that over half of the speech was dedicated to drama. E-sports shoutcasters, by comparison, rarely use dramatic embellishment of action. A few of the informants noted that they feel that embellishing actions is not possible due to their audience. The e-sports audience as pictured by shoutcasters, includes mostly dedicated players. While many sports fans may play their sport casually, e-sports fans engage with the games they watch regularly. As one shoutcaster explains, ""we've only ever gone out to a hardcore audience."" He acknowledges that the current audience is in flux, but the primary base of e-sports fans are intensely dedicated viewers and players. Because of this dynamic, shoutcasters feel that embellishment of the actions on screen would be difficult to slip past a discerning eye. Their belief that dramatic embellishment isn't possible may say more about their understanding of traditional sports fans than it does about their formulation of their role as commentators. While unacknowledged in interviews, the possibility for shoutcasters to add embellishment exists. Their choice not to use embellishment speaks more to their formulation of the e-sports audience than it E-Sports Broadcasting 55 does to their casting quality. Instead of embellishment of action, shoutscasters rely on another convention found in traditional sportscasting: narrative. Studies that focus on the media effects of sportscasting suggest that sportscasters fundamentally alter the audience perception of the telecast through story-telling and narrative (Krein and Martin 2006). Sportscasters take many liberties in their descriptions of the game to add a dramatic flair. In several empirical studies, Bryant, Brown, Comisky, and Zillman (1979) found that when sportscasters created a narrative of animosity between players, viewers felt an increased amount of tension and engagement. They conclude that the narrative scope of the sportscaster is critical in the perception of sports broadcasting. This narrative creation has bled into shoutcasting as many shoutcasters attempt to amplify the emotional content of their games by highlighting underdog stories or hyping up animosity between players. One caster I interviewed connected his work to the narrative creation in sports commentary by stating, ""Emotion is one of the key words in commentary. You need to be able to connect a certain emotion to the words you're saying. You need to be able to make someone scared for their favorite player or overjoyed when they win. Create greatest enemies. You need to be able to make these feelings through what you say or how you say it. Emotion is everything."" This caster goes to great lengths to dig up statistics from previous matchups to provide a narrative for the match he casts. Through this investigation, the shoutcaster is able to contextualize a match with a rich history. Perhaps two players have met three times before and each time the result has been the same. Will viewers be able to share in the momentous victory of the underdog? As part of their preparation, shoutcasters will research all of the previous meetings between two players to create a history between them, a tactic which they acknowledge has been used in traditional sports for decades. E-Sports Broadcasting 56 Production Stream production is another realm where e-sports have started to borrow heavily. While e-sports producers may have gotten a head start on streaming live events, they often rely on the expertise of television producers to put a show together. Multiple shoutcasters pointed to a steady influx of television producers making their way into e-sports, ""the way we approach a production is very much like television. A lot of the production guys that are getting into it are from television."" In fact, the executive producer of the League of Legends Championship Series, an immensely popular e-sports program, is former emmy-winner Ariel Horn. Horn won his Emmy as an associate producer of the 2004 Olympics for NBC. Likewise, Mike Burks, executive producer for the Championship Gaming Series mentioned in the above quote from Paul Chaloner, had an immense amount of experience in televised sports before migrating to e- sports. These are just two of the many experienced television producers making their way into e- sports. Their style is beginning to show as e-sports events become more polished every year. If we recall the image of Prime Time League in the introduction to this thesis, we can see the influx of television conventions in e-sports from the production side. The shoutcasters benefit from the experience of working with television producers to refine their style. As the field has grown, however, we begin to see minor tweaks in style and delivery. Spending a significant time with e- sports casting, in comparison with sportscasting, reveals several distinctions. Much of this difference comes with the age of the field, but just as Starcadeevolved over its short lifespan, shoutcasters have found ways to make themselves unique. Their understanding of their role within the overall e-sports industry informs us of some of the key differences here. E-Sports Broadcasting 57 Something New: Shoutcaster Identity Shoutcasters are situated somewhere between fan and professional. As evidenced by the above investigation of how shoutcasters are informed by their traditional predecessors, the role of shoutcasters is still very much in flux. Shoutcasters are just recently creating their own identity separate from their sportscasting roots. In particular, the less experienced shoutcasters I spoke with use markedly different models to inform their own casting. The Second Generation of Professional Shoutcasters A second generation of casters is just now coming into the scene. Instead of looking to traditional sportscasters as their models, they emulate veteran shoutcasters: ""my influences are the streamers that I watched. I watched everyone who casts and commentates...my commentary style comes from those guys. I don't know how much is conscious or just mimicry."" This new caster has been on the scene for only a fraction of the time that the veterans have. In that time he has honed his shoutcasting skills not by finding sports commentary and seeing which aspects apply to shoutcasting, but by absorbing as much information as he could from other shoutcasters. Another fresh shoutcaster offers a fascinating disconnect from the older casters: ""I definitely bounce off more e-sportscasters than sports. I just watch more e-sports than sports. Sports are so different than e-sports, there's so little that I can actually use from them."" Where his predecessors admit to borrowing primarily from traditional sportscasters, this new generation has left the realm of traditional sportscasting behind. The professional casters provide material for an amateur level of shoutcasters to pull from. The shoutcasters I interviewed were all professionals who typically work on major events with massive support and budgets. With a robust network of shoutcasters to pull from, however, E-Sports Broadcasting 58 we may see much more support for the grassroots level of e-sports that many early fans are accustomed to. Current shoutcasters also provide a model for potential careers. Through the hard-fought struggle of years-worth of unpaid events, the shoutcasters I spoke with have created a legitimate profession worth pursuing. Most warned me that the path is no longer as easy as they once had it. Most of them pursued shoutcasting for the love of e-sports. They had years to fumble through persona creation, broadcast techniques, and conventions. New, potential shoutcasters are automatically held to a higher standard. A senior caster offered the following advice, ""With how casting has changed, you need to be open to casting multiple games. You have to be willing to learn. There is a lot we can teach a caster, but you have to have some skills within you alone. You have to have some camera presence."" The mention of camera presence signals a significant jump from early shoutcasting. Just a few years ago, the shoutcasters I interviewed sat down in front of a camera for the first time armed with nothing but game knowledge; camera presence was a foreign word to them. Perhaps the most significant change to casters is their overall level of experience. Some of the shoutcasters I spoke with have been broadcasting for over a decade. Time has allowed these casters to experiment and find their own style. As mentioned earlier, many of the minutia involved in running a show take time to learn. Most casters got their start casually. They may have been passionate about e-sports and created a role for themselves within the industry. Some are former players who made the hard decision to give up on their hopes of winning big to instead cultivate a community. As new professionals, shoutcasters are just now coming together with the support of e- sports companies under legitimate full-time contracts. The professional casters I spoke with all acknowledged a significant change in their commentary since making the transition into full-time E-Sports Broadcasting 59 casting with other casters around for feedback and training. One explained that he had never been sure how to handle dead-air, moments when both casters are silent and there is little action in the game. Through feedback sessions with other casters, he learned that there are some appropriate times to let the viewer formulate their own opinions on the match. Heeding the advice of veteran casters like Paul Chaloner, he went on to explain that one of the problems he sees in shoutcasting more generally is that shoutcasters are afraid to just be quiet during a stream. Part of the emotional build-up of a game, he explains, is letting the natural flow of a game take its course without any input from the casters. It will be fascinating to watch as these expert networks inform e-sports broadcasts across the world. One informant remarked, ""Now that we're all working together, we're learning a lot off of one another, which hasn't happened in commentary before."" Beyond allowing veteran shoutcasters to compare notes, the professional status of shoutcasting provides training to new shoutcasters. One veteran claimed, ""All the junior people are learning so much faster than we ever did. They're taking everything we learned over 5-10 years and doing it in months."" These veteran casters can now pass on their experience and their style. Techniques like hand-offs at the end of a segment or transitions from the desk to gameplay often came up in my interviews as issues which take years to learn, but newer shoutcasters are able to pick these cues up from earlier shoutcasters instead of taking what they can from a sports show and hoping that everything translates well. Beyond the expected roles that shoutcasters fill, they also perform many secondary tasks which don't typically fall to traditional sportscasters. In the very early days of live-streaming, shoutcasters were often responsible for every aspect of the broadcast from set-up to teardown. Some shoutcasters still regularly assist on production aspects of the broadcast such as graphics E-Sports Broadcasting 60 packages, camera set-up, and audio checks, but others leave the production aspects of the stream to more experienced hands while focusing instead on updating websites, answering tweets, creating content, or streaming their own play sessionss. No two casters seem to fill exactly the same role within the broadcast team. They do, however, share some similarities which seem to form the shoutcaster identity. Record-keepers and Community Managers All of the casters pointed to stats-tracking as part of their roles outside of their air-time responsibilities. Most of them keep highly detailed databases full of every possible stat they can get a hold of from game clients and public databases. These stats can be as simple as wins and losses from remote regions or LAN tournaments that do not post their results online. The stats can also get as minute as the number of units a particular Starcraft 2 player built in one particular match. When the data isn't readily available, shoutcasters go out of their way to curate the database themselves. While some keep their database secret to provide a personal flair to their casting, others find it important to share this information with their e-sports communities. One shoutcaster recalled his surprise when he first worked with a major South Korean e-sports company with its own dedicated stats team. He expressed that he had never realized how much he needed a dedicated stats team like you find in traditional sports until that moment. It was then that he realized how much of his daily routine stats curation filled. While he was grateful for the help, he also felt personally responsible for stats collection and did not entirely trust the figures from the professional statisticians. This example shows the difficult position e-sports fills, constantly stuck between borrowing from traditional sports while not fully able to cope with the maturity of the sports media industry. E-Sports Broadcasting 61 Another role which tends to fill a shoutcaster's daily routine is community maintenance. Whether the caster creates their own content on gaming sites, responds to fans on social media, or spends their time streaming and interacting with the community, they all mentioned some form of community maintenance as part of their duties as a shoutcaster. This particular focus on community maintenance most likely results from the grassroots origins of shoutcasters. These casters were a part of an e-sports community long before they became shoutcasters. Whether they view it as their professional responsibility or a social responsibility remains unclear. They all admit to some level of e-sports advocacy, however. They view PR, and the proliferation of e- sports as part of their responsibilities. The most effective way to tackle this issue, many of them have decided, is through community engagement. The community aspect of shoutcasting identity leads me to a discussion of the affordances of the hyper-connectivity in live-streaming. Grappling with the Hyper-Connectivity in Live-streaming and E-sports Shoutcaster Connection I have yet to meet anyone in the e-sports industry who has not remarked on the unique level of connection present in e-sports. Shoutcasters especially, tap into the network created in these online communities. In a representative summary of my conversations, one shoutcaster explained, ""the connectedness is so unique in e-sports. The way that we can interact with fans instantly. The players at the end of the day are gamers, they know exactly where to look. They've got Twitter, they go on Facebook, they post on Reddit."" Audience members connect ephemerally in the IRC of a Twitch stream, but they constantly scour the social media outlets of their favorite stars, e-sports companies, and shoutcasters, creating a deeply connected community. Professional shoutcasters understand that the e-sports communities operate in a E-Sports Broadcasting 62 unique way when compared to traditional sports fandom. E-sports fans have an odd connection to franchises or teams within their chosen e-sport. As mentioned before, turnover rates and general industry growth force entire communities to radically reform from one season to another. Where traditional sports fans often follow a team based on geographic loyalty, or familial connections, e-sports fans do not have that option. While you will often hear of fans cheering for teams in their geographic region (North America, Europe, South-East Asia, etc) if they make it to the last few rounds of an international tournament, they may also base their fandom off of a team logo, or a particular player instead. Shoutcasters recognize this dynamic and use it to cultivate the community. Communication, they claim, separates them from traditional sports broadcasts or even news anchors: ""We communicate more with our audience than you'll see TV news anchors or celebrities, but it's part of our job to get more information out there."" The focus on communication seems to be unique to shoutcasters as the majority of it happens outside of their broadcasts. While many shoutcasters define their role on-screen as an educator of sorts, the notion of spreading information about e-sports falls outside of their screen time. This double role of broadcaster and community manager extends what media scholars have dubbed the broadcasting persona beyond the point typically associated with sportscasters or news anchors. Shoutcasters and Persona Horton and Wohl (1956), two social scientists who study mass media, make the assertion that mass media performers make a conscious decision to create and maintain parasocial interactions through the creation of a persona. Social scientists have coined the term parasocial interaction for the intangible connection which most of us feel to some form of media or another. E-Sports Broadcasting 63 Standing in contrast to interpersonal interaction, a person to person exchange between two real and cognizant human beings, parasocial interaction is instead a unidirectional relationship (Miller and Steinberg 1970). The feeling of connection we create with fictional characters, news anchors, or sports stars does not fall within the definition of an interpersonal interaction. Whether mediated through a screen or the pages of a book, a parasocial interaction does not manifest in an exchange of thoughts or words between individuals. Rather, it is embodied and lived through one individual. Schiappa et al. (2007) conducted a meta-analysis of parasocial interaction literature to better understand how broadcasters 'hook' viewers to a certain show. They concluded that parasocial interactions can create and prolong connection to television programming. While Schiappa et al. concede that there are a few opportunities for a parasocial interaction to result in interpersonal relationships in the physical world, the compelling issue is the establishment of intimacy mediated through means well outside of a person to person context. Horton and Wohl set out with the goal of creating a term for the relationship between performers and their audience in mass media. The authors suggest that the emergence of mass media created an illusion of connection to performers which was previously unavailable. They argue that the connection people feel to mass media stars is analogous to primary social engagement. If this type of engagement takes place in radio and television, where users have no opportunity to interact with audience members who are not co-present, it follows that the interaction between broadcasters, their audience, and one another in a Twitch stream is a particularly deep connection even beyond the level noticed by Horton and Wohl. Shoutcasters create a familiar face and personality for audience members to connect with. Mark Levy (1979), another proponent of parasocial interaction who focused his work on news anchors, suggests that both news anchors and sportscasters help to create and maintain E-Sports Broadcasting 64 communities through regular scheduling, conversational tones, and the creation of a broadcasting persona. Shoutcasters perform this same role to even greater effect due to the constant changes surrounding the e-sports industry. The regularity and consistency of shoutcasters' broadcasts helps to foster a feeling of genuine connectedness within the community. Although difficult to quantify, many conversations with shoutcasters turned to the odd feeling of connection that e-sports fans feel towards one another. One shoutcaster attempted to explain this connection by stating, ""[w]henever I go to an event, I realize that fans are just friends I haven't met yet."" I found this statement to be particularly poignant. It hints to the sort of intangible connection e-sports industry personalities and fans feel to one another through live- streams. Anecdotally, this air of friendship permeated e-sports events that I have attended and went well beyond what I have felt at traditional sporting events or concerts. Previously, persona creation and maintenance occurred on-screen or at events only. Social media has forced many media personalities to extend their personas beyond the long-held notions of broadcaster-fan interaction. In many ways, shoutcasters must go beyond even these extended boundaries into a near constant persona maintenance because of their roles in live- streaming and community maintenance. Many shoutcasters give up their personal, off-air time to stream their own gameplay or to create video content which necessarily prolongs the amount of time they embody their broadcast persona. I found that shoutcasters create a variation on the broadcast persona. Rather than a full- blown broadcasting personality which they inhabit while on-air, most shoutcasters have found that between community management, social media interactions, and broadcasts, they almost never get an opportunity to step out of their role as a shoutcaster. Due to this near constant connection, most shoutcasters acknowledge that they act differently on air, but they tend to E-Sports Broadcasting 65 simply invoke a more upbeat and charismatic version of themselves. Echoed in each of the interviews, the casters point to the idea of excitement, ""you have to get excited for the person out there watching."" Even if they are not in the mood to shoutcast, or they have had a bad day, shoutcasters must leave their personal issues out of the broadcast. This aspect of the shoutcaster's personality comes out in all of their interactions on social media as well. Most of the shoutcasters I interviewed situated their role in e-sports as somewhere between Public Relations, Marketing, and Community Management. One of the casters explained the importance of invoking the broadcast persona when speaking about sponsor expectations: ""We're working in an industry with companies behind us, we can't always say exactly what we want to say."" Shoutcasters' acknowledgement of their involvement in securing sponsorships signals an interesting shift in the e-sports industry: the focus of the broadcast team on potential revenue generation. I turn now to an analysis of the revenue streams found in both traditional sports and e-sports broadcasting. E-Sports Broadcasting 66 Chapter 3 Revenue Funding Professional Play After situating e-sports broadcasting within the greater sports media landscape, particularly in conventions, casting, and use of medium, it is important to analyze the portions of sports media production that have made their way into e-sports broadcasting. If we acknowledge the influence that traditional sports broadcasting has had on e-sports broadcasting in the realms of conventions and casting, we must also understand the importance of this relationship at the production and economic levels. In this chapter I discuss how the history and development of the sports media industrial complex in the U.S. has bled into the economics of the e-sports industry. In particular, I focus on how sports media models inform the e-sports industry while portions of the sports industry's revenue streams remain out of reach for e-sports broadcasters. Despite the reshuffling of the sports media industrial complex mentioned in the introduction to this thesis, traditional sports broadcasting still relies on the same revenue streams that it had in the past. Traditional sports producers have fully capitalized on the commodification of their content. E- sports producers, in contrast, are still shaping their revenue streams within live-streaming. The commercialization found in the sports media industrial complex has taken hold of the e-sports industry in several notable ways. Following in the example set by Stein's thesis work, it is not enough to just acknowledge the relationship between e-sports and traditional sports media, we must also understand the path which brought e-sports broadcasting to its current state. Using ONLY the context block/prompt to guide your answer, provide a comprehensive comparison of the subjects mentioned in the question. Do not use any previous knowledge or outside sources to inform your answer. How e-sports broadcasts compare with traditional sports broadcasts?",Internet/Technology,Concept Comparison,Q&A "Only use the information shared in the context to answer the questions. Do not rely on external sources or your inherent knowledge to answer the question. If a meaningful answer cannot be generated from the context, acknowledge that and ask for a related document or offer to help answer something else; do not hallucinate.",Explain all the eligibility processes from the context in detail.,"Direct Certification Direct certification is a process through which state agencies and school districts automatically certify children for free meals based on documentation of the child’s status in a program or category without the need for a household application.74 States are required to conduct direct certification with SNAP and have the option of conducting direct certification with the other programs and categories that convey categorical eligibility. For SNAP and other federal programs, the direct certification process typically involves state agencies (e.g., state SNAP and state educational agencies) cross-checking program rolls.75 A list of matched children is sent to the school district, which certifies children for free meals without the need for a household application.76 For foster, homeless, migrant, and runaway children, direct certification typically involves school district communication with a local or state official who can provide documentation of the child’s status in one of these categories.77 The 2004 child nutrition reauthorization act (P.L. 108-265) required states to conduct direct certification with SNAP, with nationwide implementation taking effect in school year 2008-2009. As of school year 2018-2019 (the most recent data available), USDA reported that 98% of children in SNAP households were directly certified for free school meals.78 The HHFKA made further policy changes to expand direct certification. One of those changes was the initiation of a demonstration project to test direct certification with Medicaid (see the text box below). The law also funded performance incentive grants for high-performing states and authorized corrective action plans for low-performing states in direct certification activities.79 Direct Certification with Medicaid Demonstration The HHFKA initiated a demonstration project to conduct direct certification of children individually participating in Medicaid and children in Medicaid households. Unlike the other programs used to directly certify children for school meals, Medicaid does not convey categorical eligibility for free school meals, but rather identifies children in households that would meet the income eligibility thresholds for either free or reduced-price school meals.80 Following the demonstration authority in the HHFKA as well as pilot authority in the Richard B. Russell National School Lunch Act, some states are currently directly certifying children based on Medicaid data.81 As of school year 2023-2024, there were 38 states operating direct certification with Medicaid. Two states used Medicaid to directly certify children for free meals only (130% of the poverty level or below).82 Thirty-six states were operating under an expanded direct certification demonstration project to test direct certification with Medicaid for free and reduced-price meals (up to 185% of the poverty level).83 Verification of Eligibility Each fall, districts are required to verify a sample of approved household applications on file, with a focus on applications close to the eligibility threshold (“error-prone” applications).86 School districts may also conduct verification of questionable applications. Verification is not required for children who are directly certified for free or reduced-price meals. (Note that districts participating in Provisions 1, 2, and 3 must meet verification requirements for the years in which they administer household applications.) Many districts employ direct verification (matching data from other low-income programs) to conduct their verification activities, but if data cannot be verified in this way, schools must contact households to verify the information provided on the application. A child’s eligibility status may stay the same or change (e.g., from free meals to reduced-price meals or loss of eligibility) as a result of verification of household income, or if the household does not respond to verification outreach (in which case eligibility would be lost, though that decision can be appealed). Reimbursement School food authorities must keep track of the daily number of meals they serve in each category (free, reduced-price, and paid) that meet federal nutrition requirements. School food authorities then submit claims for reimbursement to the state agency, which submits the claims to FNS. Approved reimbursements are distributed to school food authorities by the state agency, usually on a monthly basis. Per statute, reimbursement rates are adjusted for inflation annually.87 Table 4 shows NSLP and SBP reimbursement rates for school year 2023-2024. (Note that school food authorities also receive a per-lunch commodity reimbursement, discussed previously under “Commodity Assistance”.) The law provides a higher reimbursement rate for meals meeting certain criteria. For example, school food authorities that are compliant with the updated federal nutrition standards for school meals receive an additional 8 cents per lunch. 88 School food authorities also receive an additional 2 cents per lunch if they serve 60% or more of their lunches at a free or reduced price. For breakfasts, school food authorities receive higher reimbursements if they serve 40% or more lunches at a free or reduced price (referred to as severe need schools). Once school food authorities receive the cash reimbursements, they can use the funds to support almost any aspect of the school food service operation. However, federal cash reimbursements must go into a nonprofit school food service account that is subject to federal regulations.89 Payments for non-program foods (e.g., vending machine sales) must also accrue to the nonprofit school food service account.90 FNS periodically studies the costs of producing a reimbursable meal. In April 2019, FNS released a School Nutrition and Meal Cost Study, which found that the average reported cost of producing a reimbursable lunch was $3.81 in school year 2014-2015 (reported costs were defined as those charged to the school food service account).91 This exceeded the average federal cash reimbursement ($3.32) for lunches in school year 2014-2015. When unreported costs were included (costs outside of the food service account; for example, labor costs associated with processing applications), the cost of producing the average reimbursable lunch was $6.02. As noted previously, children’s payments and state and local funds may also cover meal costs.","#SYSTEM INSTRUCTIONS Only use the information shared in the context to answer the questions. Do not rely on external sources or your inherent knowledge to answer the question. If a meaningful answer cannot be generated from the context, acknowledge that and ask for a related document or offer to help answer something else; do not hallucinate. #CONTEXT Direct Certification Direct certification is a process through which state agencies and school districts automatically certify children for free meals based on documentation of the child’s status in a program or category without the need for a household application.74 States are required to conduct direct certification with SNAP and have the option of conducting direct certification with the other programs and categories that convey categorical eligibility. For SNAP and other federal programs, the direct certification process typically involves state agencies (e.g., state SNAP and state educational agencies) cross-checking program rolls.75 A list of matched children is sent to the school district, which certifies children for free meals without the need for a household application.76 For foster, homeless, migrant, and runaway children, direct certification typically involves school district communication with a local or state official who can provide documentation of the child’s status in one of these categories.77 The 2004 child nutrition reauthorization act (P.L. 108-265) required states to conduct direct certification with SNAP, with nationwide implementation taking effect in school year 2008-2009. As of school year 2018-2019 (the most recent data available), USDA reported that 98% of children in SNAP households were directly certified for free school meals.78 The HHFKA made further policy changes to expand direct certification. One of those changes was the initiation of a demonstration project to test direct certification with Medicaid (see the text box below). The law also funded performance incentive grants for high-performing states and authorized corrective action plans for low-performing states in direct certification activities.79 Direct Certification with Medicaid Demonstration The HHFKA initiated a demonstration project to conduct direct certification of children individually participating in Medicaid and children in Medicaid households. Unlike the other programs used to directly certify children for school meals, Medicaid does not convey categorical eligibility for free school meals, but rather identifies children in households that would meet the income eligibility thresholds for either free or reduced-price school meals.80 Following the demonstration authority in the HHFKA as well as pilot authority in the Richard B. Russell National School Lunch Act, some states are currently directly certifying children based on Medicaid data.81 As of school year 2023-2024, there were 38 states operating direct certification with Medicaid. Two states used Medicaid to directly certify children for free meals only (130% of the poverty level or below).82 Thirty-six states were operating under an expanded direct certification demonstration project to test direct certification with Medicaid for free and reduced-price meals (up to 185% of the poverty level).83 Verification of Eligibility Each fall, districts are required to verify a sample of approved household applications on file, with a focus on applications close to the eligibility threshold (“error-prone” applications).86 School districts may also conduct verification of questionable applications. Verification is not required for children who are directly certified for free or reduced-price meals. (Note that districts participating in Provisions 1, 2, and 3 must meet verification requirements for the years in which they administer household applications.) Many districts employ direct verification (matching data from other low-income programs) to conduct their verification activities, but if data cannot be verified in this way, schools must contact households to verify the information provided on the application. A child’s eligibility status may stay the same or change (e.g., from free meals to reduced-price meals or loss of eligibility) as a result of verification of household income, or if the household does not respond to verification outreach (in which case eligibility would be lost, though that decision can be appealed). Reimbursement School food authorities must keep track of the daily number of meals they serve in each category (free, reduced-price, and paid) that meet federal nutrition requirements. School food authorities then submit claims for reimbursement to the state agency, which submits the claims to FNS. Approved reimbursements are distributed to school food authorities by the state agency, usually on a monthly basis. Per statute, reimbursement rates are adjusted for inflation annually.87 Table 4 shows NSLP and SBP reimbursement rates for school year 2023-2024. (Note that school food authorities also receive a per-lunch commodity reimbursement, discussed previously under “Commodity Assistance”.) The law provides a higher reimbursement rate for meals meeting certain criteria. For example, school food authorities that are compliant with the updated federal nutrition standards for school meals receive an additional 8 cents per lunch. 88 School food authorities also receive an additional 2 cents per lunch if they serve 60% or more of their lunches at a free or reduced price. For breakfasts, school food authorities receive higher reimbursements if they serve 40% or more lunches at a free or reduced price (referred to as severe need schools). Once school food authorities receive the cash reimbursements, they can use the funds to support almost any aspect of the school food service operation. However, federal cash reimbursements must go into a nonprofit school food service account that is subject to federal regulations.89 Payments for non-program foods (e.g., vending machine sales) must also accrue to the nonprofit school food service account.90 FNS periodically studies the costs of producing a reimbursable meal. In April 2019, FNS released a School Nutrition and Meal Cost Study, which found that the average reported cost of producing a reimbursable lunch was $3.81 in school year 2014-2015 (reported costs were defined as those charged to the school food service account).91 This exceeded the average federal cash reimbursement ($3.32) for lunches in school year 2014-2015. When unreported costs were included (costs outside of the food service account; for example, labor costs associated with processing applications), the cost of producing the average reimbursable lunch was $6.02. As noted previously, children’s payments and state and local funds may also cover meal costs. #QUESTION Explain all the eligibility processes from the context in detail.",Legal,Fact Finding,Q&A "Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.",What are the negative and positive aspects of virtual teaching for the instructors?,"See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/377123871 More I-talk in student teachers’ written reflections indicates higher stress during VR teaching Article in Computers & Education · April 2024 DOI: 10.1016/j.compedu.2024.104987 CITATIONS 0 READS 70 4 authors: Andrea Westphal University of Greifswald 53 PUBLICATIONS 305 CITATIONS SEE PROFILE Eric Richter Universität Potsdam 45 PUBLICATIONS 495 CITATIONS SEE PROFILE Rebecca Lazarides Universität Potsdam 145 PUBLICATIONS 1,980 CITATIONS SEE PROFILE Yizhen Huang Universität Potsdam 19 PUBLICATIONS 208 CITATIONS SEE PROFILE All content following this page was uploaded by Eric Richter on 12 January 2024. The user has requested enhancement of the downloaded file. Computers & Education 212 (2024) 104987 Available online 3 January 2024 0360-1315/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). More I-talk in student teachers’ written reflections indicates higher stress during VR teaching Andrea Westphal a,* , Eric Richter b , Rebecca Lazarides b , Yizhen Huang b a University of Greifswald, Department of Education, Steinbeckerstr. 15, 17487, Greifswald, Germany b University of Potsdam, Department of Education, Karl-Liebknecht-Straße 24-25, 14476, Potsdam, Germany ARTICLE INFO Keywords: Augmented and virtual reality Improving classroom teaching Teacher professional development ABSTRACT Video-based reflection on one’s own teaching represents a crucial tool in teacher education. When student teachers reflect on negative classroom events, it elicits “self-focused attention,” which has been associated with more intense negative emotionality. Self-focused attention can be quantitatively captured using first-person singular pronouns (“I,” “me,” “my”) in written reflections by, for instance, student teachers. What is unclear is whether student teachers’ use of these firstperson singular pronouns in their written reflections is linked to and predicts their negative affective experiences during teaching. For the present study, a fully immersive virtual reality (VR) classroom was implemented in which student teachers taught a lesson, provided written reflections on their teaching, and then taught a second lesson. We measured N = 59 student teachers’ self-reported stress and heartrate responses while teaching in the VR classroom and determined the percentage of first-person singular pronouns in their written reflections. Firstly, our results showed that the use of first-person singular pronouns provides incremental information on manual ratings of student teachers’ foci in their written reflections. Secondly, student teachers’ heartrates during instruction—a measure of physiological stress—were associated with the use of first-person singular pronouns in subsequent written reflections. Thirdly, the use of first-person singular pronouns predicted the increase in physiological stress from the first to the second round of VR teaching. We discuss implications for automated feedback and for designing reflective tasks. 1. Introduction Teaching is often seen as a challenging profession (Chang, 2009; Westphal et al., 2022; . The transition to school practice, at least when it takes place in real school classrooms, is especially demanding for student teachers1 (Goddard et al., 2006; Hultell et al., 2013; Voss & Kunter, 2020). Fully immersive virtual reality (VR) classrooms provide a safe environment for student teachers to gain hands-on teaching experience (Gold & Windscheid, 2020 ; Lin, 2023; Lugrin et al., 2016; Pendergast et al., 2022; Remacle et al., 2023; Richter et al., 2022; Seufert et al., 2022). Ke and Xu (2020) suggested that active learning processes (“diving in”) and reflective * Corresponding author. E-mail addresses: andrea.westphal@uni-greifswald.de (A. Westphal), eric.richter@uni-potsdam.de (E. Richter), rebecca.lazarides@uni-potsdam. de (R. Lazarides), yihuang@uni-potsdam.de (Y. Huang). 1 In our study, the term “student teachers” refers to those prospective teachers who have not yet begun the supervised teaching portion of their teacher education program. Contents lists available at ScienceDirect Computers & Education journal homepage: www.elsevier.com/locate/compedu https://doi.org/10.1016/j.compedu.2024.104987 Received 21 November 2022; Received in revised form 11 November 2023; Accepted 2 January 2024 Computers & Education 212 (2024) 104987 2 learning processes (“stepping out”) can be easily combined in VR classrooms. Thus, it may be useful to practice reflecting on classroom situations from a more distanced perspective using VR classrooms early on in teacher education to help student teachers make a smooth transition into the classroom. Because the setting is standardized and similar for all student teachers, VR classrooms allow us to more accurately research the contributing factors and consequences of student teachers’ self-reflection; the highly controllable setting increases the internal validity of research findings (Huang et al., 2021; Richter et al., 2022). This is of particular interest for research looking at the interrelationships between student teachers’ affects in relation to their classroom experiences and their reflections upon those experiences. VR classrooms allow us, for instance, to apply a finding from experimental psychology to the field of teacher education. Research in the fields of experimental psychology and clinical psychology has shown that self-focus after negative events is accompanied by greater negative affect (e.g., Mor & Winquist, 2002). This finding has been explained by dysfunctional emotion-regulation strategies (e.g., Nook et al., 2017). Applied to the context of teacher education, these findings may imply that student teachers who are less skilled at transitioning between a more immersed perspective and a more distanced perspective on challenging classroom events may experience more negative affect. The degree of a person’s self-focus can be determined based on the frequency with which they use first-person singular pronouns (e.g., “I,” “me,” “my”); this has also been called “I-talk” (Tackman et al., 2019). It would be highly relevant to examine this link between self-focused attention in written reflections—as reflected by more frequent I-talk—and negative affect during instruction in the field of teacher education, because knowledge about the link between the use of first-person singular pronouns and negative affect could be implemented in automated feedback systems to help identify student teachers at risk of intense stress and burnout, allowing them to be offered personalized feedback and support. To date, however, these questions have not been explored. To examine whether student teachers’ use of first-person singular pronouns is an indicator of the stress level they experience in the classroom, and whether it can predict changes in a student teachers’ stress, a highly standardized teaching situation is preferable, because it ensures that all student teachers under study are reflecting on the same learning environment and on similar classroom events at all measurement occasions. A VR classroom creates just such a setting. In the present study, class size in the VR classroom was manipulated to induce higher levels of stress (large-class-size condition with a higher number of student avatars) and lower levels of stress (small-class-size condition with a lower number of student avatars). Initially, we checked whether the use of first-person pronouns in written reflections provides incremental information about subsequent manual ratings of student-teachers’ foci (whether on their own actions vs. student actions vs. the learning environment) in these reflections. In addition, we examine whether student teachers who experience more self-reported stress and physiological stress (as measured by heartrate response) while teaching in a VR classroom use more first-person singular pronouns in written reflections on their teaching. We also explore whether student teachers’ use of first-person singular pronouns in written reflections predicts the increase in stress in a subsequent VR lesson. 1.1. Reflection in teacher education: Technological advances “Reflection” has been defined as “deliberate, purposeful, metacognitive thinking and/or action” (Koˇsir et al., 2015, p. 113) that is believed to enhance instructional quality (Chernikova et al., 2020) by improving student teachers’ “noticing” and “knowledge-based reasoning” (Stürmer et al., 2013; van Es & Sherin, 2008). Noticing is understood as a teachers’ ability to focus their attention on relevant classroom events (van Es & Sherin, 2002). Knowledge-based reasoning is defined as teachers’ ability to apply their professional knowledge in order to interpret these classroom events (Borko, 2004; van Es & Sherin, 2002). In teacher education programs, reflection is implemented in different ways, with student teachers reflecting on classroom videos of other teachers or on video recordings of their own teaching (Kleinknecht & Schneider, 2013). Technological advances have made it possible to design VR classrooms that student teachers experience as realistic and authentic classroom settings (Huang et al., 2021; Wiepke et al., 2019, allowing them to practice and subsequently reflect on video recordings of their own teaching. Beyond the practical advantages for student teacher education (e.g., the approval of students, parents, educators, and administrators is not required), an important benefit of VR classrooms is the standardized classroom setting in which all student teachers experience similar classroom events for which they can be prepared in advance. This enables teacher educators to more easily provide relevant professional knowledge tailored to managing critical classroom events in the VR classroom; when reflecting on video recordings of their own teaching in the VR setting, student teachers may thus be more able to apply relevant professional knowledge. Video-based reflection generally involves written or oral reflections after viewing classroom videos; it is recommended that these reflections follow a three-step process (e.g., Prilop et al., 2021). Firstly, student teachers are instructed to describe the relevant classroom events; secondly, they are asked to evaluate and interpret these events; and, thirdly, they are required to identify alternative classroom behaviors (e.g., Prilop et al., 2021). When describing relevant classroom events, student teachers may focus either on their own actions, students’ actions, or on the learning environment as a whole (Kleinknecht & Schneider, 2013; Lohse-Bossenz et al., 2019). Previous research has been resoundingly positive on the benefits of video-based reflection for student teachers’ professional vision (e. g., Stürmer et al., 2013; Weber et al., 2020). Very few studies shed light on the affective experiences associated with video-based reflection (Kleinknecht, 2021). Although Kleinknecht and Schneider (2013) suggested that reflecting on other teachers’ videos can induce more negative affect than reflecting on one’s own teaching videos, several studies have shown that reflecting on one’s own videos elicits intense emotional involvement (Borko et al., 2008; Seidel et al., 2011; Zhang et al., 2011). What is unclear, however, is to what extent student teachers’ attentional focus (i.e., focusing on own thoughts, actions, or emotions) in the video-based reflection of their own videos relates to their experiences of negative affect or stress. A. Westphal et al. Computers & Education 212 (2024) 104987 3 1.2. “I-talk” as a linguistic marker of self-focused attention and negative affect In the fields of experimental psychology and clinical psychology, there is increasing empirical evidence indicating that there is a relationship between self-focused attention and greater negative affect (e.g., Mor & Winquist, 2002; Nook et al., 2017). For instance, studies using correlational designs showed that self-report measures of self-focus—such as the Public and Private Self-Consciousness Scale (Fenigstein et al., 1975), but also sentence completion tasks (Exner, 1973; Wegner & Giuliano, 1980)—are associated with self-report measures of state or trait negative affect in non-clinical and clinical samples (for an overview, see the meta-analysis by Mor & Winquist, 2002). Other studies showed that self-referential language (so-called “I-talk”)—as a linguistic marker of an individual’s self-focus—is associated with more intense negative emotionality in non-clinical samples (Kern et al., 2014; Mehl et al., 2006; Yarkoni, 2010; Yee et al., 2011; see also meta-analysis by Edwards & Holtzman, 2017) and is a marker of depression (Dunnack & Park, 2009; Rude et al., 2004; Zimmermann et al., 2016). An extensive multi-lab multi-language study with data from more than 4700 participants recently confirmed that the use of first-person singular pronouns is linked to more intense negative emotionality and depression (Tackman et al., 2019). The association between I-talk and depression has been explained to some extent by negative emotionality (Tackman et al., 2019). This indicates that “I-talk” might reflect a broader dispositional tendency towards feelings of distress, but “[t] his possibility is a topic of ongoing research” (Berry-Blunt et al., 2021, p. 5). Although frequent I-talk is seen as maladaptive, it may be a way of processing negative affect (e.g., after receiving deprecatory information about oneself), as a recent literature review concluded (Berry-Blunt et al., 2021). This would suggest that greater negative affect provokes I-talk. Experimental research did not find any evidence that inducing negative affect by showing participants negative pictures led to more I-talk (e.g., Bernard, Baddeley, Rodriguez, & Burke, 2016). In line with Bernard, Baddeley, Rodriguez, and Burke (2016) suggestion, it may be the case that negative affect only leads to more I-talk when elicited by self-deprecating information. This proposition is consistent with research on the negative affective experiences of teasing and ostracism, which do lead to more frequent I-talk (Klauke et al., 2020; Kowalski, 2000). The reverse may also be true, however. Taking a more distanced perspective—as indicated by less I-talk—may over time change an individual’s dispositional negative emotionality (Berry-Blunt et al., 2021). Distancing, i.e., shifting one’s perspective to be more “distant” from or less immersed in a negative event, is an adaptive emotion-regulation strategy that is characterized by a lower level of self-focused attention and can help reduce negative affect (Kross & Ayduk, 2008). The suggestion that repeated distancing may reduce an individual’s tendency to experience negative affect (Berry-Blunt et al., 2021) would explain why I-talk predicts future depressive symptoms in patients (Dunnack & Park, 2009; Zimmermann et al., 2016). Even in the short term, less I-talk may lead to less negative affect: Experimental research confirmed that distancing—i.e., using no I-talk when talking about one’s own emotions while preparing a stressful speech—can lessen negative affect after having given the speech (Kross et al., 2014, Study 3). Thus, the causal direction of the link between I-talk and negative emotionality is less clear, but there may be a bidirectional relationship. 1.3. Gender differences in the association between self-focus and negative affect Based on meta-analytical findings that women exhibit a greater tendency to ruminatively self-focus than men when experiencing depression (Johnson & Whisman, 2013), it has been suggested that the positive association between negative emotionality and the use of first-person singular pronouns is larger for women than it is for men (e.g., Tackman et al., 2019). When examining these gender differences, Tackman et al. (2019) underlined that the use of first-person singular pronouns seems to be driven by low-arousal negative distress in women. In contrast, it appears that men’s use of first-person singular pronouns is driven by high-arousal negative distress (Tackman et al., 2019). Thus, the use of first-person singular pronouns may be an indicator of different affective experiences in women and men (Fast & Funder, 2010) and, thus, gender should be taken into account when studying the relationship between self-focus and negative affect. 1.4. Distinguishing different forms of self-focus in written reflections Different strands of research differ in their operationalization of self-focus. In research on reflection in teacher training, manual ratings indicate the extent to which student teachers focus on their own actions and thoughts, on students’ actions, or on the learning environment (e.g., Kleinknecht & Schneider, 2013). In experimental psychology, self-focus is often operationalized via the use of first-person singular pronouns (Berry-Blunt et al., 2021; Mor & Winquist, 2002). This strand of research has argued that individuals can take a more or less immersed or distanced perspective on their own actions and thoughts by using more or fewer first-person singular pronouns (Kross & Ayduk, 2008; Kross et al., 2014). When reflecting on their own teaching, some student teachers may distance themselves from the experience and therefore rarely use first-person singular pronouns, while others may immerse themselves in the experience and use first-person singular pronouns more frequently. As such, both indicators of self-focus (qualitative ratings vs. first-person singular pronouns) should provide incremental information about student teachers’ self-focus in their written reflections. For student teachers taking a more immersive perspective on their own teaching, objective first-person singular pronouns (i.e., “me,” “myself”) may reflect a more dysfunctional form of self-focus than subjective first-person singular pronouns (i.e., “I”) (Zimmermann et al., 2016). While subjective pronouns reflect an “active or self-as-actor form of self-focus,” objective pronouns reflect a “passive or self-as-target form of self-focus” (James, 1890; Tackman et al., 2019, p. 819) that may indicate an even more detrimental style of processing self-relevant information (Zimmermann et al., 2016; see also more and less dysfunctional questions in Ehring, 2020). This poses the question of whether the relationship between the use of first-person pronouns and negative affect is driven mainly by objective first-person pronouns (Zimmermann et al., 2016). As such, “it is important to evaluate whether and how the A. Westphal et al. Computers & Education 212 (2024) 104987 4 association between depression and I-talk varies as a function of first-person singular pronoun type” (Tackman et al., 2019, p. 819). Previous evidence on whether subjective and objective first-person pronouns differentially relate to negative affect is mixed (there is support in the study by Zimmermann et al., 2016; but no or inconsistent differences in the studies by Dunnack & Park, 2009; Tackman et al., 2019). But the distinction between subjective and objective first-person singular pronouns appears to be essential in our study, in which the relationship between the use of first-person pronouns and negative affect is examined for the first time in the context of teacher training. 1.5. Present study Negative emotionality may be critical for student teachers when they reflect on their own teaching, yet research has rarely concentrated on the role of negative emotionality for reflective processes (Kleinknecht, 2021). Meanwhile, research in the field of experimental psychology indicates that negative affect may provoke self-focused attention as indicated by the use of first-person singular pronouns (Berry-Blunt et al., 2021). Moreover, self-focused attention may also increase the tendency towards experiencing negative affect (Berry-Blunt et al., 2021). What we do not know is whether this applies to the context of teacher education where student teachers reflect on their own teaching. Studying this link between self-focus and negative affect in the context of student teachers’ written reflections can provide valuable cues for diagnostic tools, automated feedback systems, and the improvement of student teachers’ professional self-regulation. We used a VR classroom setting, and thus a highly standardized teaching situation, to ensure that student teachers were reflecting on similar classroom events as we examined the following research questions: (1) Do student teachers who exhibit a greater focus on their own actions (instead of students’ actions or the classroom environment) use more subjective and objective first-person singular pronouns in written reflections on their teaching? Here, the assumption could be that those student teachers who use subjective and objective first-person singular pronouns more frequently also tend to focus on themselves rather than on the students in class or on the classroom environment. However, there is no previous research combining manual ratings of student teachers’ foci (whether on their own actions vs. student actions vs. the learning environment) with student teachers’ subjective and objective use of first-person singular pronouns when reflecting on their own teaching. Thus, it is unclear to what extent manual ratings of student teachers’ foci correspond to the subjective and objective use of first-person pronouns in written reflections on their teaching. We seek to address this research gap as an exploratory question. (2) Do student teachers who experience more self-reported stress and physiological stress (as measured by heartrate response) while teaching in a VR classroom use more subjective and objective first-person singular pronouns in written reflections of their teaching? Building on empirical evidence showing that negative affect may provoke self-focused attention, we analyze whether student teachers who experience higher levels of negative affect when teaching in the VR classroom more frequently use subjective and objective first-person singular pronouns in their written reflections. The class size in the VR classroom, i.e., the number of student avatars, was manipulated to evoke higher levels (large-class-size condition) and lower levels of negative affect (small-class-size condition(Huang et al., 2022). We hypothesize that student teachers who experience more negative affect—operationalized via self-reported and physiological stress—when teaching in the VR classroom for the first time will use more subjective and objective first-person singular pronouns in their written reflections. (3) Does student teachers’ use of subjective and objective first-person singular pronouns in written reflections of their teaching predict their increase in stress in a subsequent VR lesson? We postulate that student teachers who use more subjective and objective first-person singular pronouns in their written reflections will experience a greater increase in self-reported and physiological stress in the second VR classroom (as compared to the stress levels experienced when teaching in the VR classroom for the first time). 2. Material and methods 2.1. Sample and procedure Participants were N = 65 student teachers enrolled at the University of (anonymized for review) in Germany. Four of the participating students did not hand in their written reflection and two additional students did not participate in the second VR practice session, limiting our analyses to n = 59 students. Student teachers were on average 24 years old (SD = 4.57) and 49% identified as female, 51% as male, none as diverse. Most students were third-year bachelor students (58%; second-year: 27%; fourth-year: 14%). These student teachers participated in a weekly seminar on classroom management. The seminar included two 10-min practice sessions in a VR classroom that took place two weeks apart. Both VR practice sessions followed a standardized procedure. Participants were first given a brief standardized audio introduction on how to interact with the VR environment. Participants were then given a brief lecture about an a priori determined topic in the VR classroom to deliver to avatar students. During the first VR teaching experience, participants taught about the US electoral system and the 2020 US election. For the second VR teaching experience, A. Westphal et al. Computers & Education 212 (2024) 104987 5 participants taught about sustainability. All the instructional materials that participants needed to accomplish the teaching task were prepared and provided by the course instructor one week before the teaching exercise. During their VR teaching session, participants were exposed to various on-task and off-task behaviors from the avatar students, such as asking topic-related questions, chatting, or throwing paper balls. All avatar student actions were prescribed and therefore the same for all participants in both the class with 10 student avatars and the class with 30 student avatars. Immediately after their teaching experience in the VR classroom, the student teachers reported on their stress levels in an online questionnaire. In addition, the student teachers handed in a written reflection on their VR teaching session in the week following the first VR practice session.2 Prior to writing their reflections, the student teachers received guidance on the three-step reflection process. In this process, they were instructed to describe three relevant classroom situations (Step 1), evaluate and interpret these situations based on their professional knowledge (Step 2), and outline alternatives for classroom situations that they evaluated negatively (Step 3). Before writing their reflections, student teachers were given time to repeatedly watch the video of the VR classroom situation in which they had taught. 2.2. Design of the VR classroom The VR classroom was designed to resemble an upper secondary school classroom in Germany (e.g., (Wiepke et al., 2021)). It was set up with five rows and three columns of school desks and chairs with avatar students (see Appendix). Avatar students’ names were displayed on name tags placed on their desks and had a wide range of physical characteristics, such as skin tone, hairstyle, and clothing. Student teachers were randomly assigned to teach a class of either 10 or 30 student avatars when teaching the VR classroom for the first time and again when teaching it for the second time. The avatar students engaged in a range of behaviors that included both ontask and off-task actions. These actions ranged from constructive activities, such as writing in a notebook, to less productive actions, such as throwing a paper ball. The avatar students maintained a natural seated posture and a neutral demeanour, occasionally redirecting their attention by shifting their gaze or adjusting their body orientation in response to the participants’ movements. The selection of off-task behaviors was based on a compilation of common disruptive behaviors documented in the academic literature (Borko, 2016; Wolff et al., 2016). All parameters governing the avatar students’ behaviors, including initiation time, duration, spatial location, and behavior type, were carefully scripted to maintain uniformity across experimental conditions. This ensured that the behaviors enacted by the avatar students remained consistent between the scenarios with 10 avatar students and those with 30 avatar students in the classroom. We were using the HTC VIVE headset which has a resolution of 1080 x 1200 pixels per eye with a 108◦ field of view and a refresh rate of 90 Hz. The headset was connected to a laptop (Alienware) with a 2.2-GHz Intel Core i7-8750H processor, with 16 GB of RAM, and a NVIDIA GeForce RTX 2060 with 6 GB of VRAM graphic card, where the VR classroom software was operated. Essentially, participants could move around in reality while experiencing multisensory feedback in the VR classroom. Previous studies have confirmed that the technical setup in our VR classroom created an immersive soundscape which student teachers experienced as realistic and authentic (Wiepke et al., 2019, 2021). Student teachers were equally distributed across the four conditions (small class size VR1, small class size VR2: 21%; small class size VR1, large class size VR2: 23%; large class size VR1, small class size VR2: 25%; large class size VR1, large class size VR2: 28%).3 Thus, some teachers taught under the same conditions twice, while other teachers taught one VR session in the small class size condition and the other VR session in the large class size condition. Student teachers teaching in the VR classroom were instructed to teach their lesson as they would in a real classroom i.e., walking around the room and using similar observational and nonverbal behavior when interacting with the avatar students as they would with non-virtual students. 2.3. Measures 2.3.1. Self-reported stress in the VR classroom We measured the stress that student teachers experienced during the VR scenario using two items (“How tense did you feel in the VR classroom?” and “How did you feel emotionally during the VR classroom?”; e.g., Delaney & Brodie, 2000). Items were answered on a 9-point Likert-type scale ranging from 1 (calm, relaxed, composed) to 9 (tense). The internal consistency was good (αT1 = 0.83; αT2 = 0.85). 2.3.2. Physiological indicator of stress in the VR classroom We operationalized student teachers’ physiological stress reactions based on their heartrate (beats per minute, BPM). Student teachers’ BPM was measured using an armband optical HR sensor (Polar OH1) at 0.3s intervals when teaching in the VR classroom. Prior to starting the VR scenarios, each student teachers’ baseline heartrate was measured at 0.3s intervals while student teachers were asked to sit quietly and stay still. These baseline measures were used to control for individual differences in cardiovascular activity. We then aggregated both heartrate measurements during the baseline phase and heartrate measurements during the VR teaching. The differences between student teachers’ heartrate during teaching and student teachers’ baseline heartrate was used as a physiological 2 Students also reflected on the second VR classroom three months afterwards based on a video recording. Given the time span between this VR classroom and the written reflection, we didn’t include these written reflections in our analyses. 3 Percentages do not total 100 because of rounding. A. Westphal et al. Computers & Education 212 (2024) 104987 6 indicator of student teachers’ stress response. 2.3.3. Self-referential language We used the R package stringr (Wickham, 2019) to estimate the frequency of subjective and objective first-person singular pronouns. For each written reflection, we computed the percentage of subjective first-person singular pronouns (German: “ich”; English: “I”) and the percentage of objective first-person singular pronouns (German: “mich,” “mir”; English: “me,” “myself”).4 2.3.4. Manual ratings of focus and depth in written reflections Two independent raters manually rated the focus (as either student teachers’ own actions, student avatars’ actions, learning environment, or no focus) and depth (description, evaluating/explaining, or reflecting on alternatives) in student teachers’ written reflections using the software MAXQDA and following the procedure of Lohse-Bossenz et al. (2019; Kleinknecht & Groschner, ¨ 2016). Interrater agreement was good (κ = 0.75). For our analyses, we used the coverage percentage, i.e., the number of characters in the coded segment in relation to the total number of characters in the text. 2.4. Statistical analyses To test the hypotheses, we conducted regression analyses using the R package MplusAutomation (Hallquist & Wiley, 2018) and MLR as the estimation method. A manipulation check on our data was conducted by Huang et al. (2022) who probed whether student teachers experienced more self-reported and physiological stress when teaching a VR classroom in the large-size condition than in the small-size condition. We initially examined whether student teachers who used more subjective and objective first-person singular pronouns focused more frequently on themselves rather than on the avatar students in class or on the classroom environment (RQ1). To do so, we distinguished between student teachers who used subjective first-person singular pronouns with low frequency (i.e., ≤0.5 SD below M), average frequency (≥0.5 SD below M and ≤0.5 SD above M), and high frequency (≥0.5 SD above M). A multivariate analysis of variance was conducted with the subjective use of first-person singular pronouns (low, average, or high) as the between-person factor and the relative frequency of the student teachers’ reflection focus (the student teacher, student avatars, or learning environment) as the dependent variable. The analysis was then repeated for the objective use of first-person singular pronouns. To examine our second research question, we then regressed subjective and objective first-person singular pronoun use in the written reflections of the first VR classroom on self-reported stress in these VR sessions (RQ2). We controlled for gender.5 Within this model, we allowed the use of subjective and objective first-person singular pronouns to correlate. We specified an analogous model with physiological stress as the predictor. In a second step, we regressed self-reported stress during the second VR classroom teaching session on the subjective and objective use of first-person singular pronouns while controlling for self-reported stress during the first VR classroom teaching session (RQ3). Gender and class size in the second VR classroom teaching session were used as covariates. Thus, regression coefficients of pronoun use and gender indicate whether these variables explain changes in self-reported stress in the second, as compared to the first, VR classroom teaching session. Analyses were conducted separately for the use of subjective and objective first-person singular pronouns to probe whether subjective and objective first-person pronouns differentially relate to negative affect (instead of examining incremental effects). Analogous models were computed for physiological stress. Due to technical difficulties when transferring the heartrate data onto the storage device, heartrate while teaching in the VR classroom was only available for 40 students. There were only 29 students for whom heartrate responses were present in both VR classrooms. We examined whether values were missing completely at random using the MCAR-Test (Little, 1988) implemented in the R package naniar (Tierney et al., 2021). The test yielded non-significant results (χ2 = 17.5, df = 25, p = 0.864) indicating that the values were missing completely at random. We applied the full-information maximum-likelihood approach (FIML; Enders, 2001) to obtain appropriate estimates and standard errors. 3. Results A manipulation check on our data Huang et al., 2022)showed that student teachers experienced more self-reported and physiological stress when teaching a VR class in the large-size condition than in the small-size condition. Descriptive results (Table 1) and a dependent t-test showed that self-reported stress was greater in the first VR session than in the second VR session, t(54) = 4.89, p < 0.001. In contrast, physiological stress did not differ statistically significantly between the two VR sessions, t(28) = 0.68, p = 0.503. 3.1. Subjective and objective first-person singular pronouns and manual ratings of focus in written reflections Pertaining to our first research question, we checked whether student teachers with a more frequent use of subjective and objective first-person singular pronouns focused more often on themselves rather than on the avatar students in class or on the classroom environment (Fig. 1a and b). A multivariate analysis of variance with the subjective use of first-person singular pronouns (low, average, or high) as a between-person factor and relative frequency of student teachers’ focus of reflection on their own actions (as opposed to focus on student avatars or the learning environment) as a dependent variable showed no statistically significant effect, F(6, 4 The objective first-person singular pronoun “meiner” is rarely used and was not considered here—following the suggestion by Tackman et al. (2019)—because it overlaps with the more frequently used possessive pronoun “meiner”. 5 We did not look for interaction effects between the use of first-person singular pronouns and gender as our sample was small. A. Westphal et al. Computers & Education 212 (2024) 104987 7 108) = 0.59, p = 0.74. Similarly, we found no statistically significant difference between students with low, average, or high frequency of the objective use of first-person singular pronouns on the relative frequency of student teachers’ reflection being focused on their own actions, F(6, 108) = 1.18, p = 0.32. Thus, high subjective or objective first-person singular pronoun use was not reflected in a greater focus on student teachers’ own actions in written reflections (as indicated by manual ratings). 3.2. Do student teachers who experience more stress in the VR session use more subjective and objective first-person singular pronouns in their written reflections? To answer our second research question regarding the relationship between student teachers’ stress in the VR session and the use of subjective and objective first-person singular pronouns, we conducted cross-sectional regression analyses. Our results showed that selfreported stress experienced during the first VR teaching session was not statistically significantly associated with the use of subjective and objective first-person singular pronouns (Table 2). Gender showed a statistically significant association with subjective and objective pronoun use, indicating that student teachers who identified as male used subjective and objective first-person singular pronouns more frequently than student teachers who identified as female. In contrast, physiological stress experienced during the first VR teaching session was statistically and positively associated with both the use of subjective and the use of objective first-person singular pronouns. Thus, student teachers who experienced greater physiological stress when teaching in the VR classroom used more subjective or objective first-person singular pronouns in their written reflections. Beyond physiological stress, associations between gender and the use of subjective or objective first-person pronouns were not statistically significant. 3.3. Do student teachers who use more subjective and objective first-person singular pronouns in their written reflections experience a greater increase in stress in the second VR session? Concerning our third research question, we examined whether student teachers who used more subjective and objective firstperson singular pronouns in their written reflection experienced a greater increase in stress in the second VR session. When regressing the self-reported stress that participants experienced during the second VR teaching session, the use of subjective firstperson singular pronouns was not a statistically significant predictor when controlling for self-reported stress in the first VR teaching session, gender and class size during the second VR teaching session (Table 3, Model 3a). The use of objective first-person singular pronouns emerged as a statistically significant predictor of self-reported stress during the second VR teaching session (Table 3, Model 3b). This was not in line with our cross-sectional findings and we therefore conducted additional analyses, which revealed that the association between the use of objective first-person singular pronouns and self-reported stress was explained by the level of physiological stress in the first VR teaching session (Table A2 in Appendix). Concerning the covariates, gender and class size were not statistically significant predictors of self-reported stress in both models (Models 3a-b, Table 3). Associations between self-reported stress experienced in the first and in the second VR teaching session were statistically significant, indicating that student teachers who experienced more self-reported stress in the first VR teaching session reported more self-reported stress in the second VR teaching session. Associations between physiological stress during the second VR teaching session and the use of subjective first-person singular pronouns were statistically significant when controlling for physiological stress experienced during the first VR teaching session and class size in the second VR session (Table 3, Model 4a). Thus, student teachers who used more subjective first-person singular pronouns in their written reflections of the first VR teaching session experienced a stronger increase in physiological stress during the second VR teaching session. We found no association between physiological stress during the second VR teaching session and the use of objective first-person singular pronouns (Table 3, Model 4b). Regarding the covariates, gender was not a statistically significant predictor of physiological stress in either model, while a greater class size for the second VR classroom was associated with greater physiological stress (Models 4a-b, Table 3). Student teachers who experienced greater physiological stress in the first VR teaching session exhibited more intense physiological stress in the second VR teaching session. 4. Discussion Negative affect can play a crucial role in student teachers’ reflection, but it has barely been studied (Kleinknecht, 2021). The Table 1 Descriptive statistics. N M SD Min Max Psychological stress VR1 58 5.22 1.70 2.00 9.00 Psychological stress VR2 55 3.97 1.78 1.50 9.00 Physiological stress VR1 40 60.36 22.25 21.56 108.38 Physiological stress VR2 46 56.88 24.40 7.86 97.90 Subjective pronouns VR1 59 3.61 2.16 0.00 9.18 Objective pronouns VR1 59 1.13 1.12 0.00 5.10 Note. Physiological stress = difference between heartrate (BPM) while teaching and baseline heartrate (BPM). Subjective pronouns = relative frequency of subjective first-person singular pronouns in written reflection. Objective pronouns = relative frequency of objective first-person singular pronouns in written reflection. Gender: 0 = female. A. Westphal et al. Computers & Education 212 (2024) 104987 8 (caption on next page) A. Westphal et al. Computers & Education 212 (2024) 104987 9 present study applied psychological research on the relationship between negative affect and self-focus—which would potentially be valuable for diagnostic tools, automated feedback systems, and the improvement of emotion regulation—to the context of student teachers’ reflections. Initially, we looked at whether student teachers who used more subjective and objective first-person singular pronouns focused more frequently on themselves rather than on the avatar students in the VR class or on the classroom environment as a whole. In addition, we examined whether student teachers’ negative affect while teaching in a VR classroom—in terms of higher self-reported stress and heartrate—affected their self-focus in written reflections operationalized via the subjective and objective use of first-person singular pronouns. We also explored whether the use of subjective and objective first-person singular pronouns relates to stress in a subsequent teaching session in a VR classroom. Initially, we found that there were no differences in manual ratings of focus between student teachers with a low, average, or high subjective or objective use of first-person singular pronouns. This is in line with findings illustrating that individuals can regard their own actions and thoughts from a more or less immersed or distanced standpoint, which is reflected in their more or less frequent use of subjective and objective first-person singular pronouns (Kross & Ayduk, 2008; Kross et al., 2014). While one student teacher, for instance, described classroom disruptions during his lesson from a more immersed perspective, pointing out how it made him feel (“Some classroom disturbances made me upset […]. The interruptions kept me from getting back to where I started and from finishing properly.”), another student started his reflection by taking a more distanced perspective, describing his own actions from a third-person perspective (“There is a recurring loss of the common thread due to class disruptions and the teacher trying to address every minor disruption.”). Thus, the use of subjective and objective first-person singular pronouns provides incremental information to manual ratings of focus in written reflections. Future research examining student teachers’ focus when reflecting on their own teaching could therefore benefit from incorporating different measures of self-focus. Fig. 1. a Focus in written reflections from content analysis by use of subjective first-person singular pronouns Note. Low use of subjective firstperson singular pronouns ≤0.5 SD below M. Average use of subjective first-person singular pronouns ≥0.5 SD below M and ≤0.5 SD above M. High use of subjective first-person singular pronouns ≥0.5 SD above M. 1b Focus in written reflections from content analysis by use of objective firstperson singular pronouns. Table 2 Predicting first-person singular pronoun use in written reflection by self-reported and physiological stress in first VR teaching session. Subjective pronouns Objective pronouns β p 95% CI β p 95% CI Model 1 Intercept 0.74 0.110 [-0.16, 1.65] 0.17 0.700 [-0.68, 1.02] Self-reported stress 0.21 0.100 [-0.04, 0.45] 0.20 0.160 [-0.08, 0.47] Gender 0.28* 0.020 [ 0.05, 0.51] 0.23* 0.040 [ 0.01, 0.45] R2 0.12 0.09 Model 2 Intercept 0.47 0.240 [-0.31, 1.24] − 0.06 0.850 [-0.66, 0.54] Physiological stress 0.35*** 0.000 [ 0.13, 0.57] 0.32* 0.010 [ 0.09, 0.55] Gender 0.24 0.030 [0.02, 0.47] 0.20 0.110 [-0.04, 0.44] R2 0.18 0.14 Note. Coefficients are standardized. Gender: 0 = female. Table 3 Predicting self-reported and physiological stress in subsequent VR teaching session by use of first-person singular pronouns in written reflection of previous VR teaching session. β p 95% CI β p 95% CI Self-reported stress VR2 Model 3a Model 3b Intercept 1.38* 0.020 [ 0.24, 2.52] 1.20* 0.040 [ 0.05, 2.34] Self-rep. stress VR1 0.37*** <0.001 [ 0.12, 0.61] 0.33* 0.010 [ 0.10, 0.57] Class size in VR2 − 0.16 0.190 [-0.39, 0.08] − 0.10 0.410 [-0.35, 0.14] Subj. pronouns VR1 0.06 0.650 [-0.22, 0.35] Obj. pronouns VR1 0.29* 0.030 [ 0.02, 0.55] Gender 0.07 0.590 [-0.19, 0.34] 0.04 0.770 [-0.20, 0.27] R2 0.18 0.23 Physiological stress VR2 Model 4a Model 4b Intercept − 1.29*** <0.001 [-1.89, − 0.69] − 1.17*** <0.001 [-1.74, − 0.60] Phys. stress VR1 0.26*** <0.001 [ 0.09, 0.42] 0.25*** <0.001 [ 0.09, 0.41] Class size in VR2 0.83*** <0.001 [ 0.75, 0.92] 0.84*** <0.001 [ 0.75, 0.93] Subj. pronouns VR1 0.18* 0.040 [0.01, 0.35] Obj. pronouns VR1 0.17 0.060 [-0.01, 0.35] Gender 0.05 0.560 [-0.12, 0.22] 0.05 0.510 [-0.11, 0.21] R2 0.72 0.71 Note. Coefficients are standardized. Gender: 0 = female. Class size: 0 = small. A. Westphal et al. Computers & Education 212 (2024) 104987 10 Our results also indicate that student teachers who experienced more physiological stress when teaching in the VR classroom used more subjective and objective first-person singular pronouns in their written reflections. This finding is consistent with research showing that negative affective experiences may provoke the use of subjective and objective first-person singular pronouns as a way to process negative self-relevant information (Berry-Blunt et al., 2021; Klauke et al., 2020; Kowalski, 2000). However, given their cross-sectional nature, our results could also indicate that student teachers who use less linguistic distancing—i.e., who are more immersed into a situation, indicated by a greater use of subjective and objective first-person singular pronouns—experience higher levels of negative affect, which is also in line with previous findings (Shahane et al., 2023). Our study is the first to confirm that this association can be replicated in the context of student teachers’ reflections on their own teaching. Our results further amplify existing research by revealing that this relationship generalizes to a physiological indicator of negative affect, namely to individuals’ heartrates. In terms of gender differences, our results suggested that student teachers who identified as male used more subjective and objective first-person singular pronouns than student teachers who identified as female. These gender differences disappeared when controlling for physiological stress experienced during the VR teaching session. The finding that men used subjective and objective first-person singular pronouns more frequently than women is not in line with related research that shows a greater tendency in women to ruminatively self-focus when depressed, and thus experiencing high levels of negative affect (Johnson & Whisman, 2013). It has, however, been suggested that men’s use of subjective and objective first-person singular pronouns is an indicator of high-arousal negative distress, while women’s use of first-person singular pronouns is driven by low-arousal negative distress (Tackman et al., 2019). In our study, student teachers were reflecting on a teaching situation that had the potential to elicit high-arousal negative distress. Indeed, we found that, when controlling for physiological stress experienced during the VR session, gender differences in the use of subjective and objective first-person singular pronouns disappeared. These results further support the notion that the use of first-person singular pronouns may be an indicator of different affective experiences in women and men (Fast & Funder, 2010). In addition, we found that greater use of subjective first-person singular pronouns led to higher physiological stress in the subsequent VR session. Thus, we found some indication that student teachers who took a more distanced perspective experienced reduced future stress (as suggested by Berry-Blunt et al., 2021; Zimmermann et al., 2016). This is in line with research showing that individuals who spontaneously use more linguistic distancing when reflecting on negative and positive events report lower levels of stress in these and in subsequent situations, and overall greater well-being (Shahane et al., 2023). Despite the fact that the use of subjective and objective first-person singular pronouns may be a strategy that student teachers use to process negative teaching experiences, this strategy—referred to as rumination—is considered maladaptive (e.g., Mor & Winquist, 2002). Rumination—i.e., the strategy of regulating negative mood by repeatedly focusing one’s attention on one’s own negative experiences, and the causes and effects (Nolen-Hoksema, 1991)—has been associated with depression (Hong, 2007), inefficient problem-solving, and lower self-efficacy (Lyubomirsky et al., 2003; Reindl et al., 2020). Teachers who ruminate more experience higher levels of stress in the classroom and are more susceptible to burnout (Koˇsir et al., 2015). We assessed naturally occurring differences in the use of subjective and objective first-person singular pronouns and may therefore have underestimated the benefits of taking a more distanced perspective. Future studies with greater sample sizes and power should aim to explore whether a similar effect might emerge for objective first-person pronouns, for which we found a marginally significant p-value. In contrast, our data did not support the association between self-reported negative affect and the use of subjective and objective first-person singular pronouns. Berry-Blunt et al. (2021) proposed that some psychometric units, i.e., “facets, nuances, and items” (p. 8) might capture I-talk better than others; our self-report measure of stress may not have been ideal in this respect. Moreover, the self-report was assessed after the VR session, which potentially led to lower congruence between physiological and self-reported stress responses than when self-report is assessed continuously during the stressful situation (Campbell & Ehlert, 2012). 4.1. Pedagogical implications While reflection can improve student teachers’ professional vision, and is therefore seen as an important tool in teacher education (e.g., Stürmer et al., 2013; Weber et al., 2020), less is known about its potential to assist adaptive emotion regulation strategies that teachers need in order to be able to cope with challenging classroom events (Chang, 2009). Reappraising a challenging situation is seen as an effective strategy (Gross, 2002) by which teachers change how they think about an event and thereby decrease its emotional impact (Chang, 2009; Gross, 2022). When engaging in reappraisal, teachers may reduce their use of first-person singular pronouns, indicating their greater psychological distance to a challenging situation (Nook et al., 2020). Our findings indicate that an increased self-focus in student teachers’ written reflections—as indicated by a more frequent use of subjective first-person singular pronouns—is associated with greater physiological stress. Automated feedback systems could build on this finding by identifying student teachers who repeatedly experience elevated stress and are thus at risk for depression and burnout. This could complement feedback on the quality of their written reflections (Wulff et al., 2022, 2023). We found some indication that taking a more distanced perspective—as indicated by less frequent use of subjective first-person pronouns—reduces future stress (as suggested by Berry-Blunt et al., 2021; Shahane et al., 2023; Zimmermann et al., 2016). Practicing taking a more distanced perspective on negative events is not only seen as an adaptive emotion-regulation strategy (Kross & Ayduk, 2008), it may over time change a student teacher’s tendency to experience stress (for a similar suggestion outside the context of teacher education, see Berry-Blunt et al., 2021). A structured practice of reappraisal can facilitate adaptive emotion regulation (Christou-Champi et al., 2015). Thus, training student teachers to use more reappraisal and put more distance between themselves and challenging classroom situations when reflecting on their teaching could be a viable strategy to help them cope with stress. In addition, Ehring (2020) suggests that ruminative thinking, i.e., focusing one’s attention on one’s own negative experiences, can be transformed into more adaptive information processing by focusing attention on A. Westphal et al. Computers & Education 212 (2024) 104987 11 physical reactions and emotions in a specific situation and fostering self-compassion, which has been shown to be incompatible with ruminative thinking (Watkins, 2016). Combining video-based reflection on one’s own teaching with reappraisal and mindfulness-based strategies could be a promising way to foster student teachers’ professional vision, as well as their well-being and stress-resistance. 4.2. Limitations and future research The current study has some limitations. The sample size of the study was small. Our results should therefore be replicated using a larger sample, which could more effectively detect small effects. By providing a highly standardized setting, the VR classroom increases the internal validity of our research findings, which may come at the cost of ecological validity. It has been argued that VR creates a perceptual illusion and “the real power of VR […] [is that] even though you know it is an illusion, this does not change your perception or your response to it” (Slater, 2018, p. 2). Some features of the VR environment, such as a realistic display of the environment, a smooth display of motion and view changes, and control of behaviors, are seen as essential to increase the likelihood of optimal learning in VR (Dalgarno & Lee, 2010; Delamarre et al., 2021). Prior studies showed that student teachers perceived our VR classroom as realistic and authentic Wiepke et al., 2019, 2021. Student teachers trained in our VR classroom showed similar reflection processes compared to students reflecting on real classroom videos and showed a substantial increase in reflection-related self-efficacy over time (Richter et al., 2022). Nevertheless, more validation studies are needed to evaluate the transferability of the positive results of the participation in a VR learning setting to authentic classrooms. Moreover, future studies should investigate whether our findings are generalizable to non-virtual classroom environments and to in-service teachers. Studies should also incorporate further self-report measures of negative affect to “identify […] the smaller psychometric units (e.g., trait facets, nuances, and items) that best capture I-talk” (Berry-Blunt et al., 2021, p. 8). To better understand the temporal dynamics between negative affect and self-focused attention, a longitudinal study with multiple measurements is necessary. Such a study design could help explain the extent to which situation-specific and personal characteristics play a role in the interplay between the use of subjective and objective first-person singular pronouns and negative affect. The extent to which student teachers can be trained to more professionally process negative events could be explored by experimentally manipulating the ways in which student teachers describe and evaluate negative classroom events—taking either a distanced or a self-immersed perspective—by prompting student teachers to use distanced vs. self-referential language or by instructing them to reframe negative events vs. self-immerse in their emotions (see also Nook et al., 2017). Intervention studies could be a promising approach to help identify how reflection could be implemented in a way that is beneficial for student teachers’ professional vision and their emotion regulation, without overwhelming them. 5. Conclusions Thanks to a standardized VR classroom environment, our study is the first to provide evidence that student teachers’ self-focus in their written reflections is linked to the stress they experience while teaching. Our multimodal assessment of stress—based on student teachers’ self-reports and heartrate responses—allowed for a differentiated approach to studying emotions in the VR learning environment. Not only can we show that the association between negative affect and self-focus—measured via I-talk—holds in student teachers’ written reflections on their own teaching, but our study also adds to previous findings by showing that this link can be generalized to individuals’ heartrates, representing a physiological indicator of negative affect. These results point to the potential that reflecting on one’s own teaching may have for practicing adaptive emotion regulation strategies in teacher education programs. Credit author statement AW: Conceptualization. Formal analysis. Writing – original draft, Reviewing and Editing, ER: Conceptualization. Investigation. Data curation. Project administration. Writing- Reviewing and Editing, RL: Writing- Reviewing and Editing, YH: Investigation, Project administration. Declaration of competing interest None. Data availability The authors do not have permission to share data. A. Westphal et al. Computers & Education 212 (2024) 104987 12 APPENDIX Table A.1 Descriptive statistics for baseline heartrate and heartrate in VR teaching session N M SD Min Max Baseline BPM T1 42 96.92 30.88 44.41 173.62 Baseline BPM T2 50 102.37 30.03 40.34 175.88 BPM in VR session T1 57 161.14 20.44 125.02 196.45 BPM in VR session T2 55 160.65 20.00 115.57 196.59 Note. Measures used to compute physiological stress, i.e., difference in heartrate between baseline and VR session. Table A.2 Predicting self-reported stress in subsequent VR teaching session by physiological stress and use of firstperson singular pronouns in written reflection of previous VR teaching session β p 95% CI Self-reported stress VR2 Model 5a Intercept 0.39 0.560 [-0.93, 1.71] Self-reported stress VR1 0.31* 0.010 [ 0.06, 0.55] Physiological stress VR1 0.29* 0.040 [ 0.01, 0.57] Class size in VR2 − 0.06 0.640 [-0.31, 0.19] Objective pronouns VR1 0.24 0.110 [-0.05, 0.54] Gender 0.06 0.620 [-0.18, 0.30] R2 0.28 Note. Coefficients are standardized. Gender: 0 = female. Class size: 0 = small. Fig. A1. VR Classroom from the perspective of student teachers. A. Westphal et al. Computers & Education 212 (2024) 104987 13 Fig. A.2. Student teacher teaching in VR Classroom. References Bernard, J. D., Baddeley, J. L., Rodriguez, B. F., & Burke, P. A. (2016). Depression, language, and affect: An examination of the influence of baseline depression and affect induction on language. Journal of Language and Social Psychology, 35(3), 317–326. https://doi.org/10.1177/0261927X15589186 Berry-Blunt, A. K., Holtzman, S. H., Donnellan, M. B., & Mehl, M. R. (2021). The story of “I” tracking: Psychological implications of self-referential language use. Social and Personality Psychology Compass, 15(2), Article e12647. https://doi.org/10.1111/spc3.12647 Borko, H. (2004). Professional development and teacher learning: Mapping the terrain. Educational Researcher, 33(8), 3–15, 10.3102%2F0013189X033008003. Borko, H. (2016). Methodological contributions to video-based studies of classroom teaching and learning: A commentary. ZDM, 48(1), 213–218, 10/gfs2vk. Borko, H., Jacobs, J., Eiteljorg, E., & Pittman, M. E. (2008). Video as a tool for fostering productive discussions in mathematics professional development. Teaching and Teacher Education, 24(2), 417–436. https://doi.org/10.1016/j.tate.2006.11.012 Campbell, J., & Ehlert, U. (2012). Acute psychosocial stress: Does the emotional stress response correspond with physiological responses? Psychoneuroendocrinology, 37(8), 1111–1134. https://doi.org/10.1016/j.psyneuen.2011.12.010 Chang, M. L. (2009). An appraisal perspective of teacher burnout: Examining the emotional work of teachers. Educational Psychology Review, 21, 193–218. https://doi. org/10.1007/s10648-009-9106-y Chernikova, O., Heitzmann, N., Fink, M. C., Timothy, V., Seidel, T., Fischer, F., & DFG Research group COSIMA.. (2020). Facilitating diagnostic competences in higher education - a meta-analysis in medical and teacher education. Educational Psychology Review, 32, 157–196. https://doi.org/10.1007/s10648-019-09492-2 Christou-Champi, S., Farrow, T. F., & Webb, T. L. (2015). Automatic control of negative emotions: Evidence that structured practice increases the efficiency of emotion regulation. Cognition & Emotion, 29(2), 319–331. https://doi.org/10.1080/02699931.2014.901213 Dalgarno, B., & Lee, M. J. (2010). What are the learning affordances of 3-D virtual environments? British Journal of Educational Technology, 41(1), 10–32. https://doi. org/10.14221/ajte.2016v41n1.8 Delamarre, A., Shernoff, E., Buche, C., Frazier, S., Gabbard, J., & Lisetti, C. (2021). The interactive virtual training for teachers (IVT-T) to practice classroom behavior management. International Journal of Human-Computer Studies, 152, Article 102646. https://doi.org/10.1016/j.ijhcs.2021.102646 Delaney, J. P. A., & Brodie, D. A. (2000). Effects of short-term psychological stress on the time and frequency domains of heart-rate variability. Perceptual and Motor Skills, 91(2), 515–524. https://doi.org/10.2466/pms.2000.91.2.515 Dunnack, E. S., & Park, C. L. (2009). The effect of an expressive writing intervention on pronouns: The surprising case of I. Journal of Loss & Trauma, 14(6), 436–446. https://doi.org/10.1080/15325020902925084 Edwards, T., & Holtzman, N. S. (2017). A meta-analysis of correlations between depression and first singular pronoun use. Journal of Research in Personality, 68, 63–68. https://doi.org/10.1016/j.jrp.2017.02.005 Ehring, T. (2020). Die ruminationsfokussierte Kognitive Verhaltenstherapie [Rumination-focused cognitive-Behavioral Therapy]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 68(3), 150–159. https://doi.org/10.1024/1661-4747/a000414 Enders, C. K. (2001). The impact of nonnormality on full information maximum-likelihood estimation for structural equation models with missing data. Psychological Methods, 6, 352–370. https://doi.org/10.1037/1082-989X.6.4.352 Exner, J. E., Jr. (1973). The self focus sentence completion: A study of egocentricity. Journal of Personality Assessment, 37(5), 437–455. https://doi.org/10.1080/ 00223891.1973.10119902 Fast, L. A., & Funder, D. C. (2010). Gender differences in the correlates of self-referent word use: Authority, entitlement, and depressive symptoms. Journal of Personality, 78, 313–338. https://doi.org/10.1111/j.1467-6494.2009.00617.x Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self-consciousness: Assessment and theory. Journal of Consulting and Clinical Psychology, 43(4), 522–527. https://doi.org/10.1037/h0076760 Goddard, R., O’brien, P., & Goddard, M. (2006). Work environment predictors of beginning teacher burnout. British Educational Research Journal, 32(6), 857–874. https://doi.org/10.1080/01411920600989511Gold,B.,&Windscheid. J. (2020). Observing 360-degree classroom videos – Effects of video type on presence, emotions, workload, classroom observations, and ratings of teaching quality. Computers & Education, 156, 103960. Gold, B., & Windscheid, J. (2020). Observing 360-degree classroom videos–Effects of video type on presence, emotions, workload, classroom observations, and ratings of teaching quality. Computers & Education, 156, 103960. https://doi.org/10.1016/j.compedu.2020.103960. Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281–291, 10.1017.S0048577201393198. Hallquist, M. N., & Wiley, J. F. (2018). MplusAutomation: An R package for facilitating large-scale latent variable analyses in Mplus. Structural Equation Modeling: A Multidisciplinary Journal, 25(4), 621–638. https://doi.org/10.1080/10705511.2017.1402334 Hong, R. Y. (2007). Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behavior Research and Therapy, 45 (2), 277–290. https://doi.org/10.1016/j.brat.2006.03.006 Huang, Y., Richter, E., Kleickmann, T., & Richter, D. (2022). Class size affects preservice teachers’ physiological and psychological stress reactions: An experiment in a virtual reality classroom. Computers & Education, 184, 104503. https://doi.org/10.1016/j.compedu.2022.104503. Huang, Y., Richter, E., Kleickmann, T., Wiepke, A., & Richter, D. (2021). Classroom complexity affects student teachers’ behavior in a VR classroom. Computers & Education, 163, 104100. https://doi.org/10.1016/j.compedu.2020.104100. Hultell, D., Melin, B., & Gustavsson, J. P. (2013). Getting personal with teacher burnout: A longitudinal study on the development of burnout using a person-based approach. Teaching and Teacher Education, 32, 75–86. https://doi.org/10.1016/j.tate.2013.01.007 James, W. (1890). The principles of psychology. New York, NY: Holt & Co. Johnson, D. P., & Whisman, M. A. (2013). Gender differences in rumination: A meta-analysis. Personality and Individual Differences, 55, 367–374. https://doi.org/ 10.1016/j.paid.2013.03.019 Ke, F., & Xu, X. (2020). Virtual reality simulation-based learning of teaching with alternative perspectives taking. British Journal of Educational Technology, 51(6), 2544–2557. https://doi.org/10.1111/bjet.12936 A. Westphal et al. Computers & Education 212 (2024) 104987 14 Kern, M. L., Eichstaedt, J. C., Schwartz, H. A., Dziurzynski, L., Ungar, L. H., Stillwell, D. J., Kosinski, M., Ramones, S. M., & Seligman, M. E. P. (2014). The online social self: An open vocabulary approach to personality. Assessment, 21(2), 158–169. https://doi.org/10.1177/1073191113514104 Klauke, F., Müller-Frommeyer, L. C., & Kauffeld, S. (2020). Writing about the silence: Identifying the language of ostracism. Journal of Language and Social Psychology, 39(5–6), 751–763. https://doi.org/10.1177/0261927X19884599 Kleinknecht, M. (2021). Emotionen von Lehrkraften ¨ in unterrichtsvideobasierten Fortbildungen [Teachers’ emotions in video-based training]. In M. Gl¨ aser-Zikuda, F. Hofmann, & V. Frederking (Eds.), Emotionen im Unterricht: Psychologische, padagogische ¨ und fachdidaktische Perspektiven [Emotions in the classroom: Psychological, pedagogical and didactical perspectives] (pp. 231–243). Stuttgart, Germany: Kohlhammer Verlag, 2021. Kleinknecht, M., & Groschner, ¨ A. (2016). Fostering preservice teachers’ noticing with structured video feedback: Results of an online- and video-based intervention study. Teaching and Teacher Education, 59, 45–56. https://doi.org/10.1016/j.tate.2016.05.020 Kleinknecht, M., & Schneider, J. (2013). What do teachers think and feel when analyzing videos of themselves and other teachers teaching? Teaching and Teacher Education, 33, 13–23. https://doi.org/10.1016/j.tate.2013.02.002 Koˇsir, K., Tement, S., Licardo, M., & Habe, K. (2015). Two sides of the same coin? The role of rumination and reflection in elementary school teachers’ classroom stress and burnout. Teaching and Teacher Education, 47, 131–141. Kowalski, R. M. (2000). “I was only kidding!” Victims’ and perpetrators’ perceptions of teasing. Personality and Social Psychology Bulletin, 26, 231–241. https://doi. org/10.1177/0146167200264009 Kross, E., & Ayduk, O. (2008). Facilitating adaptive emotional analysis: Distinguishing distanced-analysis of depressive experiences from immersed-analysis and distraction. Personality and Social Psychology Bulletin, 34(7), 924–938, 10.1177%2F0146167208315938. Kross, E., Bruehlman-Senecal, E., Park, J., Burson, A., Dougherty, A., Shablack, H., Bremner, R., Moser, J., & Ayduk, O. (2014). Self-talk as a regulatory mechanism: How you do it matters. Journal of Personality and Social Psychology, 106(2), 304–324. https://doi.org/10.1037/a0035173 Lin, Y. C. (2023). Using virtual classroom simulations in a mathematics methods course to develop pre-service primary mathematics teachers’ noticing skills. British Journal of Educational Technology, 54(3), 734–753. https://doi.org/10.1111/bjet.13291 Little, R. J. A. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202. https://doi.org/10.2307/2290157 Lohse-Bossenz, H., Schonknecht, ¨ L., & Brandtner, M. (2019). Entwicklung und Validierung eines Fragebogens zur Erfassung Reflexionsbezogener Selbstwirksamkeit von Lehrkraften ¨ im Vorbereitungsdienst [Development and validation of a questionnaire assessing pre-service teachers’ self-efficacy in reflection]. Empirische Padagogik, ¨ 33(2), 164–179. Lugrin, J.-L., Latoschik, M. E., Habel, M., Roth, D., Seufert, C., & Grafe, S. (2016). Breaking bad behaviors: A new tool for learning classroom management using virtual reality. Frontiers in ICT, 3(26). https://doi.org/10.3389/fict.2016.00026 Lyubomirsky, S., Kasri, F., & Zehm, K. (2003). Dysphoric rumination impairs concentration on academic tasks. Cognitive Therapy and Research, 27(3), 309–330. https://doi.org/10.1023/A:1023918517378 Mehl, M. R., Gosling, S. D., & Pennebaker, J. W. (2006). Personality in its natural habitat: Manifestations and implicit folk theories of personality in daily life. Journal of Personality and Social Psychology, 90(5), 862–877. https://doi.org/10.1037/0022-3514.90.5.862 Mor, N., & Winquist, J. (2002). Self-focused attention and negative affect: A meta-analysis. Psychological Bulletin, 128(4), 638–662. https://doi.org/10.1037/0033- 2909.128.4.638 Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582. https://doi.org/10.1037/0021-843X.100.4.569 Nook, E. C., Schleider, J. L., & Somerville, L. H. (2017). A linguistic signature of psychological distancing in emotion regulation. Journal of Experimental Psychology: General, 146(3), 337–346. https://doi.org/10.1037/xge0000263 Nook, E. C., Vidal Bustamante, C. M., Cho, H. Y., & Somerville, L. H. (2020). Use of linguistic distancing and cognitive reappraisal strategies during emotion regulation in children, adolescents, and young adults. Emotion, 20(4), 525. https://doi.org/10.1037/emo0000570 Pendergast, D., O’Brien, M., Prestridge, S., & Exley, B. (2022). Self-efficacy in a 3-dimensional virtual reality classroom—initial teacher education students’ experiences. Education Sciences, 12(6), 368. https://doi.org/10.3390/educsci12060368 Prilop, C. N., Weber, K. E., & Kleinknecht, M. (2021). The role of expert feedback in the development of pre-service teachers’ professional vision of classroom management in an online blended learning environment. Teaching and Teacher Education, 99, Article 103276. https://doi.org/10.1016/j.tate.2020.103276 Reindl, M., Tulis, M., & Dresel, M. (2020). Profiles of emotional and motivational self-regulation following errors: Associations with learning. Learning and Individual Differences, 77, Article 101806. https://doi.org/10.1016/j.lindif.2019.101806 Remacle, A., Bouchard, S., & Morsomme, D. (2023). Can teaching simulations in a virtual classroom help trainee teachers to develop oral communication skills and self-efficacy? A randomized controlled trial. Computers & Education, 200, Article 104808. https://doi.org/10.1016/j.compedu.2023.104808 Richter, E., Hußner, I., Huang, Y., Richter, D., & Lazarides, R. (2022). Video-based reflection in teacher education: Comparing virtual reality and real classroom videos. Computers & Education, 24(3), Article 104601. https://doi.org/10.1016/j.compedu.2022.104601 Rude, S., Gortner, E.-M., & Pennebaker, J. W. (2004). Language use of depressed and depression-vulnerable college students. Cognition & Emotion, 18(8), 1121–1133. https://doi.org/10.1080/02699930441000030 Seidel, T., Stürmer, K., Blomberg, G., Kobarg, M., & Schwindt, K. (2011). Teacher learning from analysis of videotaped classroom situations: Does it make a difference whether teachers observe their own teaching or that of others? Teaching and Teacher Education, 27(2), 259–267. https://doi.org/10.1016/j.tate.2010.08.009 Seufert, C., Oberdorfer, ¨ S., Roth, A., Grafe, S., Lugrin, J. L., & Latoschik, M. E. (2022). Classroom management competency enhancement for student teachers using a fully immersive virtual classroom. Computers & Education, 179, Article 104410. https://doi.org/10.1016/j.compedu.2021.104410 Shahane, A. D., Godfrey, D. A., & Denny, B. T. (2023). Predicting real-world emotion and health from spontaneously assessed linguistic distancing using novel scalable technology. Emotion. Advance online publication. https://doi.org/10.1037/emo0001211 Stürmer, K., Konings, ¨ K. D., & Seidel, T. (2013). Declarative knowledge and professional vision in teacher education: Effect of courses in teaching and learning. British Journal of Educational Psychology, 83(3), 467–483. https://doi.org/10.1111/j.2044-8279.2012.02075.x Tackman, A. M., Sbarra, D. A., Carey, A. L., Donnellan, M. B., Horn, A. B., Holtzman, N. S., Edwards, T. S., Pennebaker, J. W., & Mehl, M. R. (2019). Depression, negative emotionality, and self-referential language: A multi-lab, multi-measure, and multi-language-task research synthesis. Journal of Personality and Social Psychology, 116(5), 817–834. https://doi.org/10.1037/pspp0000187 Tierney, N., Cook, D., McBain, M., & Fay, C. (2021). naniar: Data structures, summaries, and visualisations for missing data. R package version 0.6.1 https://CRAN.Rproject.org/package=naniarv. van Es, E. A., & Sherin, M. G. (2002). Learning to notice: Scaffolding new teachers’ interpretations of classroom interactions. Journal of Technology and Teacher Education, 10(4), 571–596. https://www.learntechlib.org/primary/p/9171/. van Es, E. A., & Sherin, M. G. (2008). Mathematics teachers’ “learning to notice” in the context of a video club. Teaching and Teacher Education, 24(2), 244–276. https://doi.org/10.1016/j.tate.2006.11.005 Voss, T., & Kunter, M. (2020). “Reality shock” of beginning teachers? Changes in teacher candidates’ emotional exhaustion and constructivist-oriented beliefs. Journal of Teacher Education, 71(3), 292–306. https://doi.org/10.1177/0022487119839700 Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. New York: Guilford. Weber, K. E., Prilop, C. N., Viehoff, S., Gold, B., & Kleinknecht, M. (2020). Fordert ¨ eine videobasierte intervention im praktikum die professionelle wahrnehmung von Klassenführung?—eine quantitativ-inhaltsanalytische messung von Subprozessen professioneller wahrnehmung [does a video-based practicum intervention provide a realistic picture of classroom management? A quantitative content analysis of the subprocesses of professional awareness]. Zeitschrift für Erziehungswissenschaft, 23, 343–365. https://doi.org/10.1007/s11618-020-00939-9 Wegner, D. M., & Giuliano, T. (1980). Arousal-induced attention to self. Journal of Personality and Social Psychology, 38(5), 719–726. https://doi.org/10.1037/0022- 3514.38.5.719 A. Westphal et al. Computers & Education 212 (2024) 104987 15 Westphal, A., Kalinowski, E., Hoferichter, C. J., & Vock, M. (2022). K− 12 teachers’ stress and burnout during the COVID-19 pandemic: A systematic review. Frontiers in psychology, 13, 920326. https://doi.org/10.3389/fpsyg.2022.920326. Wickham, H. (2019). stringr: Simple, consistent wrappers for common string operations. R package version 1.4.0. https://CRAN.R-project.org/package=stringr. Wiepke, A., Heinemann, B., Lucke, U., & Schroeder, U. (2021). Jenseits des eigenen Klassenzimmers: Perspektiven & Weiterentwicklungen des VR-Klassenzimmers [Beyond the own classroom: Perspectives & further developments of the VR classroom.]. DELFI 2021 - Die 19. Fachtagung Bildungstechnologien [Educational technologies symposium], 331–336. http://dl.gi.de/handle/20.500.12116/37031. Wolff, C. E., Jarodzka, H., van den Bogert, N., & Boshuizen, H. P. A. (2016). Teacher vision: Expert and novice teachers’ perception of problematic classroom management scenes. Instructional Science, 44(3), 243–265, 10/f8tcpm. Wulff, P., Westphal, A., Mientus, L., Nowak, A., & Borowski, A. (2023, January). Enhancing writing analytics in science education research with machine learning and natural language processing—Formative assessment of science and non-science preservice teachers’ written reflections. In Frontiers in Education, 7, Article 1061461. https://doi.org/10.3389/feduc.2022.1061461. Frontiers. Wulff, P., Buschhüter, D., Westphal, A., Mientus, L., Nowak, A., & Borowski, A. (2022). Bridging the gap between qualitative and quantitative assessment in science education research with machine learning—A case for pretrained language models-based clustering. Journal of Science Education and Technology, 31(4), 490–513. https://doi.org/10.1007/s10956-022-09969-w. Yarkoni, T. (2010). Personality in 100,000 words: A large-scale analysis of personality and word use among bloggers. Journal of Research in Personality, 44(3), 363–373. https://doi.org/10.1016/j.jrp.2010.04.001 Yee, N., Harris, H., Jabon, M., & Bailenson, J. N. (2011). The expression of personality in virtual worlds. Social Psychological and Personality Science, 2(1), 5–12. https://doi.org/10.1177/1948550610379056 Zhang, M., Lundeberg, M., Koehler, M. J., & Eberhardt, J. (2011). Understanding affordances and challenges of three types of video for teacher professional development. Teaching and Teacher Education, 27(2), 454–462. https://doi.org/10.1016/j.tate.2010.09.015 Zimmermann, J., Brockmeyer, T., Hunn, M., Schauenburg, H., & Wolf, M. (2016). First-person pronoun use in spoken language as a predictor of future depressive symptoms: Preliminary evidence from a clinical sample of depressed patients. Clinical Psychology & Psychotherapy, 24(2), 384–391. https://doi.org/10.1002/ cpp.2006 Wiepke, A., Richter, E., Zender, R., & Richter, D. (2019). Einsatz von Virtual Reality zum Aufbau von Klassenmanagement-Kompetenzen im Lehramtsstudium [Use of virtual reality for training student teachers’ classroom management competencies]. DELFI, 2019. https://doi.org/10.18420/delfi2019_319 A. Westphal et al. View publication stats","Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand. What are the negative and positive aspects of virtual teaching for the instructors? See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/377123871 More I-talk in student teachers’ written reflections indicates higher stress during VR teaching Article in Computers & Education · April 2024 DOI: 10.1016/j.compedu.2024.104987 CITATIONS 0 READS 70 4 authors: Andrea Westphal University of Greifswald 53 PUBLICATIONS 305 CITATIONS SEE PROFILE Eric Richter Universität Potsdam 45 PUBLICATIONS 495 CITATIONS SEE PROFILE Rebecca Lazarides Universität Potsdam 145 PUBLICATIONS 1,980 CITATIONS SEE PROFILE Yizhen Huang Universität Potsdam 19 PUBLICATIONS 208 CITATIONS SEE PROFILE All content following this page was uploaded by Eric Richter on 12 January 2024. The user has requested enhancement of the downloaded file. Computers & Education 212 (2024) 104987 Available online 3 January 2024 0360-1315/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). More I-talk in student teachers’ written reflections indicates higher stress during VR teaching Andrea Westphal a,* , Eric Richter b , Rebecca Lazarides b , Yizhen Huang b a University of Greifswald, Department of Education, Steinbeckerstr. 15, 17487, Greifswald, Germany b University of Potsdam, Department of Education, Karl-Liebknecht-Straße 24-25, 14476, Potsdam, Germany ARTICLE INFO Keywords: Augmented and virtual reality Improving classroom teaching Teacher professional development ABSTRACT Video-based reflection on one’s own teaching represents a crucial tool in teacher education. When student teachers reflect on negative classroom events, it elicits “self-focused attention,” which has been associated with more intense negative emotionality. Self-focused attention can be quantitatively captured using first-person singular pronouns (“I,” “me,” “my”) in written reflections by, for instance, student teachers. What is unclear is whether student teachers’ use of these firstperson singular pronouns in their written reflections is linked to and predicts their negative affective experiences during teaching. For the present study, a fully immersive virtual reality (VR) classroom was implemented in which student teachers taught a lesson, provided written reflections on their teaching, and then taught a second lesson. We measured N = 59 student teachers’ self-reported stress and heartrate responses while teaching in the VR classroom and determined the percentage of first-person singular pronouns in their written reflections. Firstly, our results showed that the use of first-person singular pronouns provides incremental information on manual ratings of student teachers’ foci in their written reflections. Secondly, student teachers’ heartrates during instruction—a measure of physiological stress—were associated with the use of first-person singular pronouns in subsequent written reflections. Thirdly, the use of first-person singular pronouns predicted the increase in physiological stress from the first to the second round of VR teaching. We discuss implications for automated feedback and for designing reflective tasks. 1. Introduction Teaching is often seen as a challenging profession (Chang, 2009; Westphal et al., 2022; . The transition to school practice, at least when it takes place in real school classrooms, is especially demanding for student teachers1 (Goddard et al., 2006; Hultell et al., 2013; Voss & Kunter, 2020). Fully immersive virtual reality (VR) classrooms provide a safe environment for student teachers to gain hands-on teaching experience (Gold & Windscheid, 2020 ; Lin, 2023; Lugrin et al., 2016; Pendergast et al., 2022; Remacle et al., 2023; Richter et al., 2022; Seufert et al., 2022). Ke and Xu (2020) suggested that active learning processes (“diving in”) and reflective * Corresponding author. E-mail addresses: andrea.westphal@uni-greifswald.de (A. Westphal), eric.richter@uni-potsdam.de (E. Richter), rebecca.lazarides@uni-potsdam. de (R. Lazarides), yihuang@uni-potsdam.de (Y. Huang). 1 In our study, the term “student teachers” refers to those prospective teachers who have not yet begun the supervised teaching portion of their teacher education program. Contents lists available at ScienceDirect Computers & Education journal homepage: www.elsevier.com/locate/compedu https://doi.org/10.1016/j.compedu.2024.104987 Received 21 November 2022; Received in revised form 11 November 2023; Accepted 2 January 2024 Computers & Education 212 (2024) 104987 2 learning processes (“stepping out”) can be easily combined in VR classrooms. Thus, it may be useful to practice reflecting on classroom situations from a more distanced perspective using VR classrooms early on in teacher education to help student teachers make a smooth transition into the classroom. Because the setting is standardized and similar for all student teachers, VR classrooms allow us to more accurately research the contributing factors and consequences of student teachers’ self-reflection; the highly controllable setting increases the internal validity of research findings (Huang et al., 2021; Richter et al., 2022). This is of particular interest for research looking at the interrelationships between student teachers’ affects in relation to their classroom experiences and their reflections upon those experiences. VR classrooms allow us, for instance, to apply a finding from experimental psychology to the field of teacher education. Research in the fields of experimental psychology and clinical psychology has shown that self-focus after negative events is accompanied by greater negative affect (e.g., Mor & Winquist, 2002). This finding has been explained by dysfunctional emotion-regulation strategies (e.g., Nook et al., 2017). Applied to the context of teacher education, these findings may imply that student teachers who are less skilled at transitioning between a more immersed perspective and a more distanced perspective on challenging classroom events may experience more negative affect. The degree of a person’s self-focus can be determined based on the frequency with which they use first-person singular pronouns (e.g., “I,” “me,” “my”); this has also been called “I-talk” (Tackman et al., 2019). It would be highly relevant to examine this link between self-focused attention in written reflections—as reflected by more frequent I-talk—and negative affect during instruction in the field of teacher education, because knowledge about the link between the use of first-person singular pronouns and negative affect could be implemented in automated feedback systems to help identify student teachers at risk of intense stress and burnout, allowing them to be offered personalized feedback and support. To date, however, these questions have not been explored. To examine whether student teachers’ use of first-person singular pronouns is an indicator of the stress level they experience in the classroom, and whether it can predict changes in a student teachers’ stress, a highly standardized teaching situation is preferable, because it ensures that all student teachers under study are reflecting on the same learning environment and on similar classroom events at all measurement occasions. A VR classroom creates just such a setting. In the present study, class size in the VR classroom was manipulated to induce higher levels of stress (large-class-size condition with a higher number of student avatars) and lower levels of stress (small-class-size condition with a lower number of student avatars). Initially, we checked whether the use of first-person pronouns in written reflections provides incremental information about subsequent manual ratings of student-teachers’ foci (whether on their own actions vs. student actions vs. the learning environment) in these reflections. In addition, we examine whether student teachers who experience more self-reported stress and physiological stress (as measured by heartrate response) while teaching in a VR classroom use more first-person singular pronouns in written reflections on their teaching. We also explore whether student teachers’ use of first-person singular pronouns in written reflections predicts the increase in stress in a subsequent VR lesson. 1.1. Reflection in teacher education: Technological advances “Reflection” has been defined as “deliberate, purposeful, metacognitive thinking and/or action” (Koˇsir et al., 2015, p. 113) that is believed to enhance instructional quality (Chernikova et al., 2020) by improving student teachers’ “noticing” and “knowledge-based reasoning” (Stürmer et al., 2013; van Es & Sherin, 2008). Noticing is understood as a teachers’ ability to focus their attention on relevant classroom events (van Es & Sherin, 2002). Knowledge-based reasoning is defined as teachers’ ability to apply their professional knowledge in order to interpret these classroom events (Borko, 2004; van Es & Sherin, 2002). In teacher education programs, reflection is implemented in different ways, with student teachers reflecting on classroom videos of other teachers or on video recordings of their own teaching (Kleinknecht & Schneider, 2013). Technological advances have made it possible to design VR classrooms that student teachers experience as realistic and authentic classroom settings (Huang et al., 2021; Wiepke et al., 2019, allowing them to practice and subsequently reflect on video recordings of their own teaching. Beyond the practical advantages for student teacher education (e.g., the approval of students, parents, educators, and administrators is not required), an important benefit of VR classrooms is the standardized classroom setting in which all student teachers experience similar classroom events for which they can be prepared in advance. This enables teacher educators to more easily provide relevant professional knowledge tailored to managing critical classroom events in the VR classroom; when reflecting on video recordings of their own teaching in the VR setting, student teachers may thus be more able to apply relevant professional knowledge. Video-based reflection generally involves written or oral reflections after viewing classroom videos; it is recommended that these reflections follow a three-step process (e.g., Prilop et al., 2021). Firstly, student teachers are instructed to describe the relevant classroom events; secondly, they are asked to evaluate and interpret these events; and, thirdly, they are required to identify alternative classroom behaviors (e.g., Prilop et al., 2021). When describing relevant classroom events, student teachers may focus either on their own actions, students’ actions, or on the learning environment as a whole (Kleinknecht & Schneider, 2013; Lohse-Bossenz et al., 2019). Previous research has been resoundingly positive on the benefits of video-based reflection for student teachers’ professional vision (e. g., Stürmer et al., 2013; Weber et al., 2020). Very few studies shed light on the affective experiences associated with video-based reflection (Kleinknecht, 2021). Although Kleinknecht and Schneider (2013) suggested that reflecting on other teachers’ videos can induce more negative affect than reflecting on one’s own teaching videos, several studies have shown that reflecting on one’s own videos elicits intense emotional involvement (Borko et al., 2008; Seidel et al., 2011; Zhang et al., 2011). What is unclear, however, is to what extent student teachers’ attentional focus (i.e., focusing on own thoughts, actions, or emotions) in the video-based reflection of their own videos relates to their experiences of negative affect or stress. A. Westphal et al. Computers & Education 212 (2024) 104987 3 1.2. “I-talk” as a linguistic marker of self-focused attention and negative affect In the fields of experimental psychology and clinical psychology, there is increasing empirical evidence indicating that there is a relationship between self-focused attention and greater negative affect (e.g., Mor & Winquist, 2002; Nook et al., 2017). For instance, studies using correlational designs showed that self-report measures of self-focus—such as the Public and Private Self-Consciousness Scale (Fenigstein et al., 1975), but also sentence completion tasks (Exner, 1973; Wegner & Giuliano, 1980)—are associated with self-report measures of state or trait negative affect in non-clinical and clinical samples (for an overview, see the meta-analysis by Mor & Winquist, 2002). Other studies showed that self-referential language (so-called “I-talk”)—as a linguistic marker of an individual’s self-focus—is associated with more intense negative emotionality in non-clinical samples (Kern et al., 2014; Mehl et al., 2006; Yarkoni, 2010; Yee et al., 2011; see also meta-analysis by Edwards & Holtzman, 2017) and is a marker of depression (Dunnack & Park, 2009; Rude et al., 2004; Zimmermann et al., 2016). An extensive multi-lab multi-language study with data from more than 4700 participants recently confirmed that the use of first-person singular pronouns is linked to more intense negative emotionality and depression (Tackman et al., 2019). The association between I-talk and depression has been explained to some extent by negative emotionality (Tackman et al., 2019). This indicates that “I-talk” might reflect a broader dispositional tendency towards feelings of distress, but “[t] his possibility is a topic of ongoing research” (Berry-Blunt et al., 2021, p. 5). Although frequent I-talk is seen as maladaptive, it may be a way of processing negative affect (e.g., after receiving deprecatory information about oneself), as a recent literature review concluded (Berry-Blunt et al., 2021). This would suggest that greater negative affect provokes I-talk. Experimental research did not find any evidence that inducing negative affect by showing participants negative pictures led to more I-talk (e.g., Bernard, Baddeley, Rodriguez, & Burke, 2016). In line with Bernard, Baddeley, Rodriguez, and Burke (2016) suggestion, it may be the case that negative affect only leads to more I-talk when elicited by self-deprecating information. This proposition is consistent with research on the negative affective experiences of teasing and ostracism, which do lead to more frequent I-talk (Klauke et al., 2020; Kowalski, 2000). The reverse may also be true, however. Taking a more distanced perspective—as indicated by less I-talk—may over time change an individual’s dispositional negative emotionality (Berry-Blunt et al., 2021). Distancing, i.e., shifting one’s perspective to be more “distant” from or less immersed in a negative event, is an adaptive emotion-regulation strategy that is characterized by a lower level of self-focused attention and can help reduce negative affect (Kross & Ayduk, 2008). The suggestion that repeated distancing may reduce an individual’s tendency to experience negative affect (Berry-Blunt et al., 2021) would explain why I-talk predicts future depressive symptoms in patients (Dunnack & Park, 2009; Zimmermann et al., 2016). Even in the short term, less I-talk may lead to less negative affect: Experimental research confirmed that distancing—i.e., using no I-talk when talking about one’s own emotions while preparing a stressful speech—can lessen negative affect after having given the speech (Kross et al., 2014, Study 3). Thus, the causal direction of the link between I-talk and negative emotionality is less clear, but there may be a bidirectional relationship. 1.3. Gender differences in the association between self-focus and negative affect Based on meta-analytical findings that women exhibit a greater tendency to ruminatively self-focus than men when experiencing depression (Johnson & Whisman, 2013), it has been suggested that the positive association between negative emotionality and the use of first-person singular pronouns is larger for women than it is for men (e.g., Tackman et al., 2019). When examining these gender differences, Tackman et al. (2019) underlined that the use of first-person singular pronouns seems to be driven by low-arousal negative distress in women. In contrast, it appears that men’s use of first-person singular pronouns is driven by high-arousal negative distress (Tackman et al., 2019). Thus, the use of first-person singular pronouns may be an indicator of different affective experiences in women and men (Fast & Funder, 2010) and, thus, gender should be taken into account when studying the relationship between self-focus and negative affect. 1.4. Distinguishing different forms of self-focus in written reflections Different strands of research differ in their operationalization of self-focus. In research on reflection in teacher training, manual ratings indicate the extent to which student teachers focus on their own actions and thoughts, on students’ actions, or on the learning environment (e.g., Kleinknecht & Schneider, 2013). In experimental psychology, self-focus is often operationalized via the use of first-person singular pronouns (Berry-Blunt et al., 2021; Mor & Winquist, 2002). This strand of research has argued that individuals can take a more or less immersed or distanced perspective on their own actions and thoughts by using more or fewer first-person singular pronouns (Kross & Ayduk, 2008; Kross et al., 2014). When reflecting on their own teaching, some student teachers may distance themselves from the experience and therefore rarely use first-person singular pronouns, while others may immerse themselves in the experience and use first-person singular pronouns more frequently. As such, both indicators of self-focus (qualitative ratings vs. first-person singular pronouns) should provide incremental information about student teachers’ self-focus in their written reflections. For student teachers taking a more immersive perspective on their own teaching, objective first-person singular pronouns (i.e., “me,” “myself”) may reflect a more dysfunctional form of self-focus than subjective first-person singular pronouns (i.e., “I”) (Zimmermann et al., 2016). While subjective pronouns reflect an “active or self-as-actor form of self-focus,” objective pronouns reflect a “passive or self-as-target form of self-focus” (James, 1890; Tackman et al., 2019, p. 819) that may indicate an even more detrimental style of processing self-relevant information (Zimmermann et al., 2016; see also more and less dysfunctional questions in Ehring, 2020). This poses the question of whether the relationship between the use of first-person pronouns and negative affect is driven mainly by objective first-person pronouns (Zimmermann et al., 2016). As such, “it is important to evaluate whether and how the A. Westphal et al. Computers & Education 212 (2024) 104987 4 association between depression and I-talk varies as a function of first-person singular pronoun type” (Tackman et al., 2019, p. 819). Previous evidence on whether subjective and objective first-person pronouns differentially relate to negative affect is mixed (there is support in the study by Zimmermann et al., 2016; but no or inconsistent differences in the studies by Dunnack & Park, 2009; Tackman et al., 2019). But the distinction between subjective and objective first-person singular pronouns appears to be essential in our study, in which the relationship between the use of first-person pronouns and negative affect is examined for the first time in the context of teacher training. 1.5. Present study Negative emotionality may be critical for student teachers when they reflect on their own teaching, yet research has rarely concentrated on the role of negative emotionality for reflective processes (Kleinknecht, 2021). Meanwhile, research in the field of experimental psychology indicates that negative affect may provoke self-focused attention as indicated by the use of first-person singular pronouns (Berry-Blunt et al., 2021). Moreover, self-focused attention may also increase the tendency towards experiencing negative affect (Berry-Blunt et al., 2021). What we do not know is whether this applies to the context of teacher education where student teachers reflect on their own teaching. Studying this link between self-focus and negative affect in the context of student teachers’ written reflections can provide valuable cues for diagnostic tools, automated feedback systems, and the improvement of student teachers’ professional self-regulation. We used a VR classroom setting, and thus a highly standardized teaching situation, to ensure that student teachers were reflecting on similar classroom events as we examined the following research questions: (1) Do student teachers who exhibit a greater focus on their own actions (instead of students’ actions or the classroom environment) use more subjective and objective first-person singular pronouns in written reflections on their teaching? Here, the assumption could be that those student teachers who use subjective and objective first-person singular pronouns more frequently also tend to focus on themselves rather than on the students in class or on the classroom environment. However, there is no previous research combining manual ratings of student teachers’ foci (whether on their own actions vs. student actions vs. the learning environment) with student teachers’ subjective and objective use of first-person singular pronouns when reflecting on their own teaching. Thus, it is unclear to what extent manual ratings of student teachers’ foci correspond to the subjective and objective use of first-person pronouns in written reflections on their teaching. We seek to address this research gap as an exploratory question. (2) Do student teachers who experience more self-reported stress and physiological stress (as measured by heartrate response) while teaching in a VR classroom use more subjective and objective first-person singular pronouns in written reflections of their teaching? Building on empirical evidence showing that negative affect may provoke self-focused attention, we analyze whether student teachers who experience higher levels of negative affect when teaching in the VR classroom more frequently use subjective and objective first-person singular pronouns in their written reflections. The class size in the VR classroom, i.e., the number of student avatars, was manipulated to evoke higher levels (large-class-size condition) and lower levels of negative affect (small-class-size condition(Huang et al., 2022). We hypothesize that student teachers who experience more negative affect—operationalized via self-reported and physiological stress—when teaching in the VR classroom for the first time will use more subjective and objective first-person singular pronouns in their written reflections. (3) Does student teachers’ use of subjective and objective first-person singular pronouns in written reflections of their teaching predict their increase in stress in a subsequent VR lesson? We postulate that student teachers who use more subjective and objective first-person singular pronouns in their written reflections will experience a greater increase in self-reported and physiological stress in the second VR classroom (as compared to the stress levels experienced when teaching in the VR classroom for the first time). 2. Material and methods 2.1. Sample and procedure Participants were N = 65 student teachers enrolled at the University of (anonymized for review) in Germany. Four of the participating students did not hand in their written reflection and two additional students did not participate in the second VR practice session, limiting our analyses to n = 59 students. Student teachers were on average 24 years old (SD = 4.57) and 49% identified as female, 51% as male, none as diverse. Most students were third-year bachelor students (58%; second-year: 27%; fourth-year: 14%). These student teachers participated in a weekly seminar on classroom management. The seminar included two 10-min practice sessions in a VR classroom that took place two weeks apart. Both VR practice sessions followed a standardized procedure. Participants were first given a brief standardized audio introduction on how to interact with the VR environment. Participants were then given a brief lecture about an a priori determined topic in the VR classroom to deliver to avatar students. During the first VR teaching experience, participants taught about the US electoral system and the 2020 US election. For the second VR teaching experience, A. Westphal et al. Computers & Education 212 (2024) 104987 5 participants taught about sustainability. All the instructional materials that participants needed to accomplish the teaching task were prepared and provided by the course instructor one week before the teaching exercise. During their VR teaching session, participants were exposed to various on-task and off-task behaviors from the avatar students, such as asking topic-related questions, chatting, or throwing paper balls. All avatar student actions were prescribed and therefore the same for all participants in both the class with 10 student avatars and the class with 30 student avatars. Immediately after their teaching experience in the VR classroom, the student teachers reported on their stress levels in an online questionnaire. In addition, the student teachers handed in a written reflection on their VR teaching session in the week following the first VR practice session.2 Prior to writing their reflections, the student teachers received guidance on the three-step reflection process. In this process, they were instructed to describe three relevant classroom situations (Step 1), evaluate and interpret these situations based on their professional knowledge (Step 2), and outline alternatives for classroom situations that they evaluated negatively (Step 3). Before writing their reflections, student teachers were given time to repeatedly watch the video of the VR classroom situation in which they had taught. 2.2. Design of the VR classroom The VR classroom was designed to resemble an upper secondary school classroom in Germany (e.g., (Wiepke et al., 2021)). It was set up with five rows and three columns of school desks and chairs with avatar students (see Appendix). Avatar students’ names were displayed on name tags placed on their desks and had a wide range of physical characteristics, such as skin tone, hairstyle, and clothing. Student teachers were randomly assigned to teach a class of either 10 or 30 student avatars when teaching the VR classroom for the first time and again when teaching it for the second time. The avatar students engaged in a range of behaviors that included both ontask and off-task actions. These actions ranged from constructive activities, such as writing in a notebook, to less productive actions, such as throwing a paper ball. The avatar students maintained a natural seated posture and a neutral demeanour, occasionally redirecting their attention by shifting their gaze or adjusting their body orientation in response to the participants’ movements. The selection of off-task behaviors was based on a compilation of common disruptive behaviors documented in the academic literature (Borko, 2016; Wolff et al., 2016). All parameters governing the avatar students’ behaviors, including initiation time, duration, spatial location, and behavior type, were carefully scripted to maintain uniformity across experimental conditions. This ensured that the behaviors enacted by the avatar students remained consistent between the scenarios with 10 avatar students and those with 30 avatar students in the classroom. We were using the HTC VIVE headset which has a resolution of 1080 x 1200 pixels per eye with a 108◦ field of view and a refresh rate of 90 Hz. The headset was connected to a laptop (Alienware) with a 2.2-GHz Intel Core i7-8750H processor, with 16 GB of RAM, and a NVIDIA GeForce RTX 2060 with 6 GB of VRAM graphic card, where the VR classroom software was operated. Essentially, participants could move around in reality while experiencing multisensory feedback in the VR classroom. Previous studies have confirmed that the technical setup in our VR classroom created an immersive soundscape which student teachers experienced as realistic and authentic (Wiepke et al., 2019, 2021). Student teachers were equally distributed across the four conditions (small class size VR1, small class size VR2: 21%; small class size VR1, large class size VR2: 23%; large class size VR1, small class size VR2: 25%; large class size VR1, large class size VR2: 28%).3 Thus, some teachers taught under the same conditions twice, while other teachers taught one VR session in the small class size condition and the other VR session in the large class size condition. Student teachers teaching in the VR classroom were instructed to teach their lesson as they would in a real classroom i.e., walking around the room and using similar observational and nonverbal behavior when interacting with the avatar students as they would with non-virtual students. 2.3. Measures 2.3.1. Self-reported stress in the VR classroom We measured the stress that student teachers experienced during the VR scenario using two items (“How tense did you feel in the VR classroom?” and “How did you feel emotionally during the VR classroom?”; e.g., Delaney & Brodie, 2000). Items were answered on a 9-point Likert-type scale ranging from 1 (calm, relaxed, composed) to 9 (tense). The internal consistency was good (αT1 = 0.83; αT2 = 0.85). 2.3.2. Physiological indicator of stress in the VR classroom We operationalized student teachers’ physiological stress reactions based on their heartrate (beats per minute, BPM). Student teachers’ BPM was measured using an armband optical HR sensor (Polar OH1) at 0.3s intervals when teaching in the VR classroom. Prior to starting the VR scenarios, each student teachers’ baseline heartrate was measured at 0.3s intervals while student teachers were asked to sit quietly and stay still. These baseline measures were used to control for individual differences in cardiovascular activity. We then aggregated both heartrate measurements during the baseline phase and heartrate measurements during the VR teaching. The differences between student teachers’ heartrate during teaching and student teachers’ baseline heartrate was used as a physiological 2 Students also reflected on the second VR classroom three months afterwards based on a video recording. Given the time span between this VR classroom and the written reflection, we didn’t include these written reflections in our analyses. 3 Percentages do not total 100 because of rounding. A. Westphal et al. Computers & Education 212 (2024) 104987 6 indicator of student teachers’ stress response. 2.3.3. Self-referential language We used the R package stringr (Wickham, 2019) to estimate the frequency of subjective and objective first-person singular pronouns. For each written reflection, we computed the percentage of subjective first-person singular pronouns (German: “ich”; English: “I”) and the percentage of objective first-person singular pronouns (German: “mich,” “mir”; English: “me,” “myself”).4 2.3.4. Manual ratings of focus and depth in written reflections Two independent raters manually rated the focus (as either student teachers’ own actions, student avatars’ actions, learning environment, or no focus) and depth (description, evaluating/explaining, or reflecting on alternatives) in student teachers’ written reflections using the software MAXQDA and following the procedure of Lohse-Bossenz et al. (2019; Kleinknecht & Groschner, ¨ 2016). Interrater agreement was good (κ = 0.75). For our analyses, we used the coverage percentage, i.e., the number of characters in the coded segment in relation to the total number of characters in the text. 2.4. Statistical analyses To test the hypotheses, we conducted regression analyses using the R package MplusAutomation (Hallquist & Wiley, 2018) and MLR as the estimation method. A manipulation check on our data was conducted by Huang et al. (2022) who probed whether student teachers experienced more self-reported and physiological stress when teaching a VR classroom in the large-size condition than in the small-size condition. We initially examined whether student teachers who used more subjective and objective first-person singular pronouns focused more frequently on themselves rather than on the avatar students in class or on the classroom environment (RQ1). To do so, we distinguished between student teachers who used subjective first-person singular pronouns with low frequency (i.e., ≤0.5 SD below M), average frequency (≥0.5 SD below M and ≤0.5 SD above M), and high frequency (≥0.5 SD above M). A multivariate analysis of variance was conducted with the subjective use of first-person singular pronouns (low, average, or high) as the between-person factor and the relative frequency of the student teachers’ reflection focus (the student teacher, student avatars, or learning environment) as the dependent variable. The analysis was then repeated for the objective use of first-person singular pronouns. To examine our second research question, we then regressed subjective and objective first-person singular pronoun use in the written reflections of the first VR classroom on self-reported stress in these VR sessions (RQ2). We controlled for gender.5 Within this model, we allowed the use of subjective and objective first-person singular pronouns to correlate. We specified an analogous model with physiological stress as the predictor. In a second step, we regressed self-reported stress during the second VR classroom teaching session on the subjective and objective use of first-person singular pronouns while controlling for self-reported stress during the first VR classroom teaching session (RQ3). Gender and class size in the second VR classroom teaching session were used as covariates. Thus, regression coefficients of pronoun use and gender indicate whether these variables explain changes in self-reported stress in the second, as compared to the first, VR classroom teaching session. Analyses were conducted separately for the use of subjective and objective first-person singular pronouns to probe whether subjective and objective first-person pronouns differentially relate to negative affect (instead of examining incremental effects). Analogous models were computed for physiological stress. Due to technical difficulties when transferring the heartrate data onto the storage device, heartrate while teaching in the VR classroom was only available for 40 students. There were only 29 students for whom heartrate responses were present in both VR classrooms. We examined whether values were missing completely at random using the MCAR-Test (Little, 1988) implemented in the R package naniar (Tierney et al., 2021). The test yielded non-significant results (χ2 = 17.5, df = 25, p = 0.864) indicating that the values were missing completely at random. We applied the full-information maximum-likelihood approach (FIML; Enders, 2001) to obtain appropriate estimates and standard errors. 3. Results A manipulation check on our data Huang et al., 2022)showed that student teachers experienced more self-reported and physiological stress when teaching a VR class in the large-size condition than in the small-size condition. Descriptive results (Table 1) and a dependent t-test showed that self-reported stress was greater in the first VR session than in the second VR session, t(54) = 4.89, p < 0.001. In contrast, physiological stress did not differ statistically significantly between the two VR sessions, t(28) = 0.68, p = 0.503. 3.1. Subjective and objective first-person singular pronouns and manual ratings of focus in written reflections Pertaining to our first research question, we checked whether student teachers with a more frequent use of subjective and objective first-person singular pronouns focused more often on themselves rather than on the avatar students in class or on the classroom environment (Fig. 1a and b). A multivariate analysis of variance with the subjective use of first-person singular pronouns (low, average, or high) as a between-person factor and relative frequency of student teachers’ focus of reflection on their own actions (as opposed to focus on student avatars or the learning environment) as a dependent variable showed no statistically significant effect, F(6, 4 The objective first-person singular pronoun “meiner” is rarely used and was not considered here—following the suggestion by Tackman et al. (2019)—because it overlaps with the more frequently used possessive pronoun “meiner”. 5 We did not look for interaction effects between the use of first-person singular pronouns and gender as our sample was small. A. Westphal et al. Computers & Education 212 (2024) 104987 7 108) = 0.59, p = 0.74. Similarly, we found no statistically significant difference between students with low, average, or high frequency of the objective use of first-person singular pronouns on the relative frequency of student teachers’ reflection being focused on their own actions, F(6, 108) = 1.18, p = 0.32. Thus, high subjective or objective first-person singular pronoun use was not reflected in a greater focus on student teachers’ own actions in written reflections (as indicated by manual ratings). 3.2. Do student teachers who experience more stress in the VR session use more subjective and objective first-person singular pronouns in their written reflections? To answer our second research question regarding the relationship between student teachers’ stress in the VR session and the use of subjective and objective first-person singular pronouns, we conducted cross-sectional regression analyses. Our results showed that selfreported stress experienced during the first VR teaching session was not statistically significantly associated with the use of subjective and objective first-person singular pronouns (Table 2). Gender showed a statistically significant association with subjective and objective pronoun use, indicating that student teachers who identified as male used subjective and objective first-person singular pronouns more frequently than student teachers who identified as female. In contrast, physiological stress experienced during the first VR teaching session was statistically and positively associated with both the use of subjective and the use of objective first-person singular pronouns. Thus, student teachers who experienced greater physiological stress when teaching in the VR classroom used more subjective or objective first-person singular pronouns in their written reflections. Beyond physiological stress, associations between gender and the use of subjective or objective first-person pronouns were not statistically significant. 3.3. Do student teachers who use more subjective and objective first-person singular pronouns in their written reflections experience a greater increase in stress in the second VR session? Concerning our third research question, we examined whether student teachers who used more subjective and objective firstperson singular pronouns in their written reflection experienced a greater increase in stress in the second VR session. When regressing the self-reported stress that participants experienced during the second VR teaching session, the use of subjective firstperson singular pronouns was not a statistically significant predictor when controlling for self-reported stress in the first VR teaching session, gender and class size during the second VR teaching session (Table 3, Model 3a). The use of objective first-person singular pronouns emerged as a statistically significant predictor of self-reported stress during the second VR teaching session (Table 3, Model 3b). This was not in line with our cross-sectional findings and we therefore conducted additional analyses, which revealed that the association between the use of objective first-person singular pronouns and self-reported stress was explained by the level of physiological stress in the first VR teaching session (Table A2 in Appendix). Concerning the covariates, gender and class size were not statistically significant predictors of self-reported stress in both models (Models 3a-b, Table 3). Associations between self-reported stress experienced in the first and in the second VR teaching session were statistically significant, indicating that student teachers who experienced more self-reported stress in the first VR teaching session reported more self-reported stress in the second VR teaching session. Associations between physiological stress during the second VR teaching session and the use of subjective first-person singular pronouns were statistically significant when controlling for physiological stress experienced during the first VR teaching session and class size in the second VR session (Table 3, Model 4a). Thus, student teachers who used more subjective first-person singular pronouns in their written reflections of the first VR teaching session experienced a stronger increase in physiological stress during the second VR teaching session. We found no association between physiological stress during the second VR teaching session and the use of objective first-person singular pronouns (Table 3, Model 4b). Regarding the covariates, gender was not a statistically significant predictor of physiological stress in either model, while a greater class size for the second VR classroom was associated with greater physiological stress (Models 4a-b, Table 3). Student teachers who experienced greater physiological stress in the first VR teaching session exhibited more intense physiological stress in the second VR teaching session. 4. Discussion Negative affect can play a crucial role in student teachers’ reflection, but it has barely been studied (Kleinknecht, 2021). The Table 1 Descriptive statistics. N M SD Min Max Psychological stress VR1 58 5.22 1.70 2.00 9.00 Psychological stress VR2 55 3.97 1.78 1.50 9.00 Physiological stress VR1 40 60.36 22.25 21.56 108.38 Physiological stress VR2 46 56.88 24.40 7.86 97.90 Subjective pronouns VR1 59 3.61 2.16 0.00 9.18 Objective pronouns VR1 59 1.13 1.12 0.00 5.10 Note. Physiological stress = difference between heartrate (BPM) while teaching and baseline heartrate (BPM). Subjective pronouns = relative frequency of subjective first-person singular pronouns in written reflection. Objective pronouns = relative frequency of objective first-person singular pronouns in written reflection. Gender: 0 = female. A. Westphal et al. Computers & Education 212 (2024) 104987 8 (caption on next page) A. Westphal et al. Computers & Education 212 (2024) 104987 9 present study applied psychological research on the relationship between negative affect and self-focus—which would potentially be valuable for diagnostic tools, automated feedback systems, and the improvement of emotion regulation—to the context of student teachers’ reflections. Initially, we looked at whether student teachers who used more subjective and objective first-person singular pronouns focused more frequently on themselves rather than on the avatar students in the VR class or on the classroom environment as a whole. In addition, we examined whether student teachers’ negative affect while teaching in a VR classroom—in terms of higher self-reported stress and heartrate—affected their self-focus in written reflections operationalized via the subjective and objective use of first-person singular pronouns. We also explored whether the use of subjective and objective first-person singular pronouns relates to stress in a subsequent teaching session in a VR classroom. Initially, we found that there were no differences in manual ratings of focus between student teachers with a low, average, or high subjective or objective use of first-person singular pronouns. This is in line with findings illustrating that individuals can regard their own actions and thoughts from a more or less immersed or distanced standpoint, which is reflected in their more or less frequent use of subjective and objective first-person singular pronouns (Kross & Ayduk, 2008; Kross et al., 2014). While one student teacher, for instance, described classroom disruptions during his lesson from a more immersed perspective, pointing out how it made him feel (“Some classroom disturbances made me upset […]. The interruptions kept me from getting back to where I started and from finishing properly.”), another student started his reflection by taking a more distanced perspective, describing his own actions from a third-person perspective (“There is a recurring loss of the common thread due to class disruptions and the teacher trying to address every minor disruption.”). Thus, the use of subjective and objective first-person singular pronouns provides incremental information to manual ratings of focus in written reflections. Future research examining student teachers’ focus when reflecting on their own teaching could therefore benefit from incorporating different measures of self-focus. Fig. 1. a Focus in written reflections from content analysis by use of subjective first-person singular pronouns Note. Low use of subjective firstperson singular pronouns ≤0.5 SD below M. Average use of subjective first-person singular pronouns ≥0.5 SD below M and ≤0.5 SD above M. High use of subjective first-person singular pronouns ≥0.5 SD above M. 1b Focus in written reflections from content analysis by use of objective firstperson singular pronouns. Table 2 Predicting first-person singular pronoun use in written reflection by self-reported and physiological stress in first VR teaching session. Subjective pronouns Objective pronouns β p 95% CI β p 95% CI Model 1 Intercept 0.74 0.110 [-0.16, 1.65] 0.17 0.700 [-0.68, 1.02] Self-reported stress 0.21 0.100 [-0.04, 0.45] 0.20 0.160 [-0.08, 0.47] Gender 0.28* 0.020 [ 0.05, 0.51] 0.23* 0.040 [ 0.01, 0.45] R2 0.12 0.09 Model 2 Intercept 0.47 0.240 [-0.31, 1.24] − 0.06 0.850 [-0.66, 0.54] Physiological stress 0.35*** 0.000 [ 0.13, 0.57] 0.32* 0.010 [ 0.09, 0.55] Gender 0.24 0.030 [0.02, 0.47] 0.20 0.110 [-0.04, 0.44] R2 0.18 0.14 Note. Coefficients are standardized. Gender: 0 = female. Table 3 Predicting self-reported and physiological stress in subsequent VR teaching session by use of first-person singular pronouns in written reflection of previous VR teaching session. β p 95% CI β p 95% CI Self-reported stress VR2 Model 3a Model 3b Intercept 1.38* 0.020 [ 0.24, 2.52] 1.20* 0.040 [ 0.05, 2.34] Self-rep. stress VR1 0.37*** <0.001 [ 0.12, 0.61] 0.33* 0.010 [ 0.10, 0.57] Class size in VR2 − 0.16 0.190 [-0.39, 0.08] − 0.10 0.410 [-0.35, 0.14] Subj. pronouns VR1 0.06 0.650 [-0.22, 0.35] Obj. pronouns VR1 0.29* 0.030 [ 0.02, 0.55] Gender 0.07 0.590 [-0.19, 0.34] 0.04 0.770 [-0.20, 0.27] R2 0.18 0.23 Physiological stress VR2 Model 4a Model 4b Intercept − 1.29*** <0.001 [-1.89, − 0.69] − 1.17*** <0.001 [-1.74, − 0.60] Phys. stress VR1 0.26*** <0.001 [ 0.09, 0.42] 0.25*** <0.001 [ 0.09, 0.41] Class size in VR2 0.83*** <0.001 [ 0.75, 0.92] 0.84*** <0.001 [ 0.75, 0.93] Subj. pronouns VR1 0.18* 0.040 [0.01, 0.35] Obj. pronouns VR1 0.17 0.060 [-0.01, 0.35] Gender 0.05 0.560 [-0.12, 0.22] 0.05 0.510 [-0.11, 0.21] R2 0.72 0.71 Note. Coefficients are standardized. Gender: 0 = female. Class size: 0 = small. A. Westphal et al. Computers & Education 212 (2024) 104987 10 Our results also indicate that student teachers who experienced more physiological stress when teaching in the VR classroom used more subjective and objective first-person singular pronouns in their written reflections. This finding is consistent with research showing that negative affective experiences may provoke the use of subjective and objective first-person singular pronouns as a way to process negative self-relevant information (Berry-Blunt et al., 2021; Klauke et al., 2020; Kowalski, 2000). However, given their cross-sectional nature, our results could also indicate that student teachers who use less linguistic distancing—i.e., who are more immersed into a situation, indicated by a greater use of subjective and objective first-person singular pronouns—experience higher levels of negative affect, which is also in line with previous findings (Shahane et al., 2023). Our study is the first to confirm that this association can be replicated in the context of student teachers’ reflections on their own teaching. Our results further amplify existing research by revealing that this relationship generalizes to a physiological indicator of negative affect, namely to individuals’ heartrates. In terms of gender differences, our results suggested that student teachers who identified as male used more subjective and objective first-person singular pronouns than student teachers who identified as female. These gender differences disappeared when controlling for physiological stress experienced during the VR teaching session. The finding that men used subjective and objective first-person singular pronouns more frequently than women is not in line with related research that shows a greater tendency in women to ruminatively self-focus when depressed, and thus experiencing high levels of negative affect (Johnson & Whisman, 2013). It has, however, been suggested that men’s use of subjective and objective first-person singular pronouns is an indicator of high-arousal negative distress, while women’s use of first-person singular pronouns is driven by low-arousal negative distress (Tackman et al., 2019). In our study, student teachers were reflecting on a teaching situation that had the potential to elicit high-arousal negative distress. Indeed, we found that, when controlling for physiological stress experienced during the VR session, gender differences in the use of subjective and objective first-person singular pronouns disappeared. These results further support the notion that the use of first-person singular pronouns may be an indicator of different affective experiences in women and men (Fast & Funder, 2010). In addition, we found that greater use of subjective first-person singular pronouns led to higher physiological stress in the subsequent VR session. Thus, we found some indication that student teachers who took a more distanced perspective experienced reduced future stress (as suggested by Berry-Blunt et al., 2021; Zimmermann et al., 2016). This is in line with research showing that individuals who spontaneously use more linguistic distancing when reflecting on negative and positive events report lower levels of stress in these and in subsequent situations, and overall greater well-being (Shahane et al., 2023). Despite the fact that the use of subjective and objective first-person singular pronouns may be a strategy that student teachers use to process negative teaching experiences, this strategy—referred to as rumination—is considered maladaptive (e.g., Mor & Winquist, 2002). Rumination—i.e., the strategy of regulating negative mood by repeatedly focusing one’s attention on one’s own negative experiences, and the causes and effects (Nolen-Hoksema, 1991)—has been associated with depression (Hong, 2007), inefficient problem-solving, and lower self-efficacy (Lyubomirsky et al., 2003; Reindl et al., 2020). Teachers who ruminate more experience higher levels of stress in the classroom and are more susceptible to burnout (Koˇsir et al., 2015). We assessed naturally occurring differences in the use of subjective and objective first-person singular pronouns and may therefore have underestimated the benefits of taking a more distanced perspective. Future studies with greater sample sizes and power should aim to explore whether a similar effect might emerge for objective first-person pronouns, for which we found a marginally significant p-value. In contrast, our data did not support the association between self-reported negative affect and the use of subjective and objective first-person singular pronouns. Berry-Blunt et al. (2021) proposed that some psychometric units, i.e., “facets, nuances, and items” (p. 8) might capture I-talk better than others; our self-report measure of stress may not have been ideal in this respect. Moreover, the self-report was assessed after the VR session, which potentially led to lower congruence between physiological and self-reported stress responses than when self-report is assessed continuously during the stressful situation (Campbell & Ehlert, 2012). 4.1. Pedagogical implications While reflection can improve student teachers’ professional vision, and is therefore seen as an important tool in teacher education (e.g., Stürmer et al., 2013; Weber et al., 2020), less is known about its potential to assist adaptive emotion regulation strategies that teachers need in order to be able to cope with challenging classroom events (Chang, 2009). Reappraising a challenging situation is seen as an effective strategy (Gross, 2002) by which teachers change how they think about an event and thereby decrease its emotional impact (Chang, 2009; Gross, 2022). When engaging in reappraisal, teachers may reduce their use of first-person singular pronouns, indicating their greater psychological distance to a challenging situation (Nook et al., 2020). Our findings indicate that an increased self-focus in student teachers’ written reflections—as indicated by a more frequent use of subjective first-person singular pronouns—is associated with greater physiological stress. Automated feedback systems could build on this finding by identifying student teachers who repeatedly experience elevated stress and are thus at risk for depression and burnout. This could complement feedback on the quality of their written reflections (Wulff et al., 2022, 2023). We found some indication that taking a more distanced perspective—as indicated by less frequent use of subjective first-person pronouns—reduces future stress (as suggested by Berry-Blunt et al., 2021; Shahane et al., 2023; Zimmermann et al., 2016). Practicing taking a more distanced perspective on negative events is not only seen as an adaptive emotion-regulation strategy (Kross & Ayduk, 2008), it may over time change a student teacher’s tendency to experience stress (for a similar suggestion outside the context of teacher education, see Berry-Blunt et al., 2021). A structured practice of reappraisal can facilitate adaptive emotion regulation (Christou-Champi et al., 2015). Thus, training student teachers to use more reappraisal and put more distance between themselves and challenging classroom situations when reflecting on their teaching could be a viable strategy to help them cope with stress. In addition, Ehring (2020) suggests that ruminative thinking, i.e., focusing one’s attention on one’s own negative experiences, can be transformed into more adaptive information processing by focusing attention on A. Westphal et al. Computers & Education 212 (2024) 104987 11 physical reactions and emotions in a specific situation and fostering self-compassion, which has been shown to be incompatible with ruminative thinking (Watkins, 2016). Combining video-based reflection on one’s own teaching with reappraisal and mindfulness-based strategies could be a promising way to foster student teachers’ professional vision, as well as their well-being and stress-resistance. 4.2. Limitations and future research The current study has some limitations. The sample size of the study was small. Our results should therefore be replicated using a larger sample, which could more effectively detect small effects. By providing a highly standardized setting, the VR classroom increases the internal validity of our research findings, which may come at the cost of ecological validity. It has been argued that VR creates a perceptual illusion and “the real power of VR […] [is that] even though you know it is an illusion, this does not change your perception or your response to it” (Slater, 2018, p. 2). Some features of the VR environment, such as a realistic display of the environment, a smooth display of motion and view changes, and control of behaviors, are seen as essential to increase the likelihood of optimal learning in VR (Dalgarno & Lee, 2010; Delamarre et al., 2021). Prior studies showed that student teachers perceived our VR classroom as realistic and authentic Wiepke et al., 2019, 2021. Student teachers trained in our VR classroom showed similar reflection processes compared to students reflecting on real classroom videos and showed a substantial increase in reflection-related self-efficacy over time (Richter et al., 2022). Nevertheless, more validation studies are needed to evaluate the transferability of the positive results of the participation in a VR learning setting to authentic classrooms. Moreover, future studies should investigate whether our findings are generalizable to non-virtual classroom environments and to in-service teachers. Studies should also incorporate further self-report measures of negative affect to “identify […] the smaller psychometric units (e.g., trait facets, nuances, and items) that best capture I-talk” (Berry-Blunt et al., 2021, p. 8). To better understand the temporal dynamics between negative affect and self-focused attention, a longitudinal study with multiple measurements is necessary. Such a study design could help explain the extent to which situation-specific and personal characteristics play a role in the interplay between the use of subjective and objective first-person singular pronouns and negative affect. The extent to which student teachers can be trained to more professionally process negative events could be explored by experimentally manipulating the ways in which student teachers describe and evaluate negative classroom events—taking either a distanced or a self-immersed perspective—by prompting student teachers to use distanced vs. self-referential language or by instructing them to reframe negative events vs. self-immerse in their emotions (see also Nook et al., 2017). Intervention studies could be a promising approach to help identify how reflection could be implemented in a way that is beneficial for student teachers’ professional vision and their emotion regulation, without overwhelming them. 5. Conclusions Thanks to a standardized VR classroom environment, our study is the first to provide evidence that student teachers’ self-focus in their written reflections is linked to the stress they experience while teaching. Our multimodal assessment of stress—based on student teachers’ self-reports and heartrate responses—allowed for a differentiated approach to studying emotions in the VR learning environment. Not only can we show that the association between negative affect and self-focus—measured via I-talk—holds in student teachers’ written reflections on their own teaching, but our study also adds to previous findings by showing that this link can be generalized to individuals’ heartrates, representing a physiological indicator of negative affect. These results point to the potential that reflecting on one’s own teaching may have for practicing adaptive emotion regulation strategies in teacher education programs. Credit author statement AW: Conceptualization. Formal analysis. Writing – original draft, Reviewing and Editing, ER: Conceptualization. Investigation. Data curation. Project administration. Writing- Reviewing and Editing, RL: Writing- Reviewing and Editing, YH: Investigation, Project administration. Declaration of competing interest None. Data availability The authors do not have permission to share data. A. Westphal et al. Computers & Education 212 (2024) 104987 12 APPENDIX Table A.1 Descriptive statistics for baseline heartrate and heartrate in VR teaching session N M SD Min Max Baseline BPM T1 42 96.92 30.88 44.41 173.62 Baseline BPM T2 50 102.37 30.03 40.34 175.88 BPM in VR session T1 57 161.14 20.44 125.02 196.45 BPM in VR session T2 55 160.65 20.00 115.57 196.59 Note. Measures used to compute physiological stress, i.e., difference in heartrate between baseline and VR session. Table A.2 Predicting self-reported stress in subsequent VR teaching session by physiological stress and use of firstperson singular pronouns in written reflection of previous VR teaching session β p 95% CI Self-reported stress VR2 Model 5a Intercept 0.39 0.560 [-0.93, 1.71] Self-reported stress VR1 0.31* 0.010 [ 0.06, 0.55] Physiological stress VR1 0.29* 0.040 [ 0.01, 0.57] Class size in VR2 − 0.06 0.640 [-0.31, 0.19] Objective pronouns VR1 0.24 0.110 [-0.05, 0.54] Gender 0.06 0.620 [-0.18, 0.30] R2 0.28 Note. Coefficients are standardized. Gender: 0 = female. Class size: 0 = small. Fig. A1. VR Classroom from the perspective of student teachers. A. Westphal et al. Computers & Education 212 (2024) 104987 13 Fig. A.2. Student teacher teaching in VR Classroom. References Bernard, J. D., Baddeley, J. L., Rodriguez, B. F., & Burke, P. A. (2016). Depression, language, and affect: An examination of the influence of baseline depression and affect induction on language. Journal of Language and Social Psychology, 35(3), 317–326. https://doi.org/10.1177/0261927X15589186 Berry-Blunt, A. K., Holtzman, S. H., Donnellan, M. B., & Mehl, M. R. (2021). The story of “I” tracking: Psychological implications of self-referential language use. Social and Personality Psychology Compass, 15(2), Article e12647. https://doi.org/10.1111/spc3.12647 Borko, H. (2004). Professional development and teacher learning: Mapping the terrain. Educational Researcher, 33(8), 3–15, 10.3102%2F0013189X033008003. Borko, H. (2016). Methodological contributions to video-based studies of classroom teaching and learning: A commentary. ZDM, 48(1), 213–218, 10/gfs2vk. Borko, H., Jacobs, J., Eiteljorg, E., & Pittman, M. E. (2008). Video as a tool for fostering productive discussions in mathematics professional development. Teaching and Teacher Education, 24(2), 417–436. https://doi.org/10.1016/j.tate.2006.11.012 Campbell, J., & Ehlert, U. (2012). Acute psychosocial stress: Does the emotional stress response correspond with physiological responses? Psychoneuroendocrinology, 37(8), 1111–1134. https://doi.org/10.1016/j.psyneuen.2011.12.010 Chang, M. L. (2009). An appraisal perspective of teacher burnout: Examining the emotional work of teachers. Educational Psychology Review, 21, 193–218. https://doi. org/10.1007/s10648-009-9106-y Chernikova, O., Heitzmann, N., Fink, M. C., Timothy, V., Seidel, T., Fischer, F., & DFG Research group COSIMA.. (2020). Facilitating diagnostic competences in higher education - a meta-analysis in medical and teacher education. Educational Psychology Review, 32, 157–196. https://doi.org/10.1007/s10648-019-09492-2 Christou-Champi, S., Farrow, T. F., & Webb, T. L. (2015). Automatic control of negative emotions: Evidence that structured practice increases the efficiency of emotion regulation. Cognition & Emotion, 29(2), 319–331. https://doi.org/10.1080/02699931.2014.901213 Dalgarno, B., & Lee, M. J. (2010). What are the learning affordances of 3-D virtual environments? British Journal of Educational Technology, 41(1), 10–32. https://doi. org/10.14221/ajte.2016v41n1.8 Delamarre, A., Shernoff, E., Buche, C., Frazier, S., Gabbard, J., & Lisetti, C. (2021). The interactive virtual training for teachers (IVT-T) to practice classroom behavior management. International Journal of Human-Computer Studies, 152, Article 102646. https://doi.org/10.1016/j.ijhcs.2021.102646 Delaney, J. P. A., & Brodie, D. A. (2000). Effects of short-term psychological stress on the time and frequency domains of heart-rate variability. Perceptual and Motor Skills, 91(2), 515–524. https://doi.org/10.2466/pms.2000.91.2.515 Dunnack, E. S., & Park, C. L. (2009). The effect of an expressive writing intervention on pronouns: The surprising case of I. Journal of Loss & Trauma, 14(6), 436–446. https://doi.org/10.1080/15325020902925084 Edwards, T., & Holtzman, N. S. (2017). A meta-analysis of correlations between depression and first singular pronoun use. Journal of Research in Personality, 68, 63–68. https://doi.org/10.1016/j.jrp.2017.02.005 Ehring, T. (2020). Die ruminationsfokussierte Kognitive Verhaltenstherapie [Rumination-focused cognitive-Behavioral Therapy]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 68(3), 150–159. https://doi.org/10.1024/1661-4747/a000414 Enders, C. K. (2001). The impact of nonnormality on full information maximum-likelihood estimation for structural equation models with missing data. Psychological Methods, 6, 352–370. https://doi.org/10.1037/1082-989X.6.4.352 Exner, J. E., Jr. (1973). The self focus sentence completion: A study of egocentricity. Journal of Personality Assessment, 37(5), 437–455. https://doi.org/10.1080/ 00223891.1973.10119902 Fast, L. A., & Funder, D. C. (2010). Gender differences in the correlates of self-referent word use: Authority, entitlement, and depressive symptoms. Journal of Personality, 78, 313–338. https://doi.org/10.1111/j.1467-6494.2009.00617.x Fenigstein, A., Scheier, M. F., & Buss, A. H. (1975). Public and private self-consciousness: Assessment and theory. Journal of Consulting and Clinical Psychology, 43(4), 522–527. https://doi.org/10.1037/h0076760 Goddard, R., O’brien, P., & Goddard, M. (2006). Work environment predictors of beginning teacher burnout. British Educational Research Journal, 32(6), 857–874. https://doi.org/10.1080/01411920600989511Gold,B.,&Windscheid. J. (2020). Observing 360-degree classroom videos – Effects of video type on presence, emotions, workload, classroom observations, and ratings of teaching quality. Computers & Education, 156, 103960. Gold, B., & Windscheid, J. (2020). Observing 360-degree classroom videos–Effects of video type on presence, emotions, workload, classroom observations, and ratings of teaching quality. Computers & Education, 156, 103960. https://doi.org/10.1016/j.compedu.2020.103960. Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281–291, 10.1017.S0048577201393198. Hallquist, M. N., & Wiley, J. F. (2018). MplusAutomation: An R package for facilitating large-scale latent variable analyses in Mplus. Structural Equation Modeling: A Multidisciplinary Journal, 25(4), 621–638. https://doi.org/10.1080/10705511.2017.1402334 Hong, R. Y. (2007). Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behavior Research and Therapy, 45 (2), 277–290. https://doi.org/10.1016/j.brat.2006.03.006 Huang, Y., Richter, E., Kleickmann, T., & Richter, D. (2022). Class size affects preservice teachers’ physiological and psychological stress reactions: An experiment in a virtual reality classroom. Computers & Education, 184, 104503. https://doi.org/10.1016/j.compedu.2022.104503. Huang, Y., Richter, E., Kleickmann, T., Wiepke, A., & Richter, D. (2021). Classroom complexity affects student teachers’ behavior in a VR classroom. Computers & Education, 163, 104100. https://doi.org/10.1016/j.compedu.2020.104100. Hultell, D., Melin, B., & Gustavsson, J. P. (2013). Getting personal with teacher burnout: A longitudinal study on the development of burnout using a person-based approach. Teaching and Teacher Education, 32, 75–86. https://doi.org/10.1016/j.tate.2013.01.007 James, W. (1890). The principles of psychology. New York, NY: Holt & Co. Johnson, D. P., & Whisman, M. A. (2013). Gender differences in rumination: A meta-analysis. Personality and Individual Differences, 55, 367–374. https://doi.org/ 10.1016/j.paid.2013.03.019 Ke, F., & Xu, X. (2020). Virtual reality simulation-based learning of teaching with alternative perspectives taking. British Journal of Educational Technology, 51(6), 2544–2557. https://doi.org/10.1111/bjet.12936 A. Westphal et al. Computers & Education 212 (2024) 104987 14 Kern, M. L., Eichstaedt, J. C., Schwartz, H. A., Dziurzynski, L., Ungar, L. H., Stillwell, D. J., Kosinski, M., Ramones, S. M., & Seligman, M. E. P. (2014). The online social self: An open vocabulary approach to personality. Assessment, 21(2), 158–169. https://doi.org/10.1177/1073191113514104 Klauke, F., Müller-Frommeyer, L. C., & Kauffeld, S. (2020). Writing about the silence: Identifying the language of ostracism. Journal of Language and Social Psychology, 39(5–6), 751–763. https://doi.org/10.1177/0261927X19884599 Kleinknecht, M. (2021). Emotionen von Lehrkraften ¨ in unterrichtsvideobasierten Fortbildungen [Teachers’ emotions in video-based training]. In M. Gl¨ aser-Zikuda, F. Hofmann, & V. Frederking (Eds.), Emotionen im Unterricht: Psychologische, padagogische ¨ und fachdidaktische Perspektiven [Emotions in the classroom: Psychological, pedagogical and didactical perspectives] (pp. 231–243). Stuttgart, Germany: Kohlhammer Verlag, 2021. Kleinknecht, M., & Groschner, ¨ A. (2016). Fostering preservice teachers’ noticing with structured video feedback: Results of an online- and video-based intervention study. Teaching and Teacher Education, 59, 45–56. https://doi.org/10.1016/j.tate.2016.05.020 Kleinknecht, M., & Schneider, J. (2013). What do teachers think and feel when analyzing videos of themselves and other teachers teaching? Teaching and Teacher Education, 33, 13–23. https://doi.org/10.1016/j.tate.2013.02.002 Koˇsir, K., Tement, S., Licardo, M., & Habe, K. (2015). Two sides of the same coin? The role of rumination and reflection in elementary school teachers’ classroom stress and burnout. Teaching and Teacher Education, 47, 131–141. Kowalski, R. M. (2000). “I was only kidding!” Victims’ and perpetrators’ perceptions of teasing. Personality and Social Psychology Bulletin, 26, 231–241. https://doi. org/10.1177/0146167200264009 Kross, E., & Ayduk, O. (2008). Facilitating adaptive emotional analysis: Distinguishing distanced-analysis of depressive experiences from immersed-analysis and distraction. Personality and Social Psychology Bulletin, 34(7), 924–938, 10.1177%2F0146167208315938. Kross, E., Bruehlman-Senecal, E., Park, J., Burson, A., Dougherty, A., Shablack, H., Bremner, R., Moser, J., & Ayduk, O. (2014). Self-talk as a regulatory mechanism: How you do it matters. Journal of Personality and Social Psychology, 106(2), 304–324. https://doi.org/10.1037/a0035173 Lin, Y. C. (2023). Using virtual classroom simulations in a mathematics methods course to develop pre-service primary mathematics teachers’ noticing skills. British Journal of Educational Technology, 54(3), 734–753. https://doi.org/10.1111/bjet.13291 Little, R. J. A. (1988). A test of missing completely at random for multivariate data with missing values. Journal of the American Statistical Association, 83(404), 1198–1202. https://doi.org/10.2307/2290157 Lohse-Bossenz, H., Schonknecht, ¨ L., & Brandtner, M. (2019). Entwicklung und Validierung eines Fragebogens zur Erfassung Reflexionsbezogener Selbstwirksamkeit von Lehrkraften ¨ im Vorbereitungsdienst [Development and validation of a questionnaire assessing pre-service teachers’ self-efficacy in reflection]. Empirische Padagogik, ¨ 33(2), 164–179. Lugrin, J.-L., Latoschik, M. E., Habel, M., Roth, D., Seufert, C., & Grafe, S. (2016). Breaking bad behaviors: A new tool for learning classroom management using virtual reality. Frontiers in ICT, 3(26). https://doi.org/10.3389/fict.2016.00026 Lyubomirsky, S., Kasri, F., & Zehm, K. (2003). Dysphoric rumination impairs concentration on academic tasks. Cognitive Therapy and Research, 27(3), 309–330. https://doi.org/10.1023/A:1023918517378 Mehl, M. R., Gosling, S. D., & Pennebaker, J. W. (2006). Personality in its natural habitat: Manifestations and implicit folk theories of personality in daily life. Journal of Personality and Social Psychology, 90(5), 862–877. https://doi.org/10.1037/0022-3514.90.5.862 Mor, N., & Winquist, J. (2002). Self-focused attention and negative affect: A meta-analysis. Psychological Bulletin, 128(4), 638–662. https://doi.org/10.1037/0033- 2909.128.4.638 Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582. https://doi.org/10.1037/0021-843X.100.4.569 Nook, E. C., Schleider, J. L., & Somerville, L. H. (2017). A linguistic signature of psychological distancing in emotion regulation. Journal of Experimental Psychology: General, 146(3), 337–346. https://doi.org/10.1037/xge0000263 Nook, E. C., Vidal Bustamante, C. M., Cho, H. Y., & Somerville, L. H. (2020). Use of linguistic distancing and cognitive reappraisal strategies during emotion regulation in children, adolescents, and young adults. Emotion, 20(4), 525. https://doi.org/10.1037/emo0000570 Pendergast, D., O’Brien, M., Prestridge, S., & Exley, B. (2022). Self-efficacy in a 3-dimensional virtual reality classroom—initial teacher education students’ experiences. Education Sciences, 12(6), 368. https://doi.org/10.3390/educsci12060368 Prilop, C. N., Weber, K. E., & Kleinknecht, M. (2021). The role of expert feedback in the development of pre-service teachers’ professional vision of classroom management in an online blended learning environment. Teaching and Teacher Education, 99, Article 103276. https://doi.org/10.1016/j.tate.2020.103276 Reindl, M., Tulis, M., & Dresel, M. (2020). Profiles of emotional and motivational self-regulation following errors: Associations with learning. Learning and Individual Differences, 77, Article 101806. https://doi.org/10.1016/j.lindif.2019.101806 Remacle, A., Bouchard, S., & Morsomme, D. (2023). Can teaching simulations in a virtual classroom help trainee teachers to develop oral communication skills and self-efficacy? A randomized controlled trial. Computers & Education, 200, Article 104808. https://doi.org/10.1016/j.compedu.2023.104808 Richter, E., Hußner, I., Huang, Y., Richter, D., & Lazarides, R. (2022). Video-based reflection in teacher education: Comparing virtual reality and real classroom videos. Computers & Education, 24(3), Article 104601. https://doi.org/10.1016/j.compedu.2022.104601 Rude, S., Gortner, E.-M., & Pennebaker, J. W. (2004). Language use of depressed and depression-vulnerable college students. Cognition & Emotion, 18(8), 1121–1133. https://doi.org/10.1080/02699930441000030 Seidel, T., Stürmer, K., Blomberg, G., Kobarg, M., & Schwindt, K. (2011). Teacher learning from analysis of videotaped classroom situations: Does it make a difference whether teachers observe their own teaching or that of others? Teaching and Teacher Education, 27(2), 259–267. https://doi.org/10.1016/j.tate.2010.08.009 Seufert, C., Oberdorfer, ¨ S., Roth, A., Grafe, S., Lugrin, J. L., & Latoschik, M. E. (2022). Classroom management competency enhancement for student teachers using a fully immersive virtual classroom. Computers & Education, 179, Article 104410. https://doi.org/10.1016/j.compedu.2021.104410 Shahane, A. D., Godfrey, D. A., & Denny, B. T. (2023). Predicting real-world emotion and health from spontaneously assessed linguistic distancing using novel scalable technology. Emotion. Advance online publication. https://doi.org/10.1037/emo0001211 Stürmer, K., Konings, ¨ K. D., & Seidel, T. (2013). Declarative knowledge and professional vision in teacher education: Effect of courses in teaching and learning. British Journal of Educational Psychology, 83(3), 467–483. https://doi.org/10.1111/j.2044-8279.2012.02075.x Tackman, A. M., Sbarra, D. A., Carey, A. L., Donnellan, M. B., Horn, A. B., Holtzman, N. S., Edwards, T. S., Pennebaker, J. W., & Mehl, M. R. (2019). Depression, negative emotionality, and self-referential language: A multi-lab, multi-measure, and multi-language-task research synthesis. Journal of Personality and Social Psychology, 116(5), 817–834. https://doi.org/10.1037/pspp0000187 Tierney, N., Cook, D., McBain, M., & Fay, C. (2021). naniar: Data structures, summaries, and visualisations for missing data. R package version 0.6.1 https://CRAN.Rproject.org/package=naniarv. van Es, E. A., & Sherin, M. G. (2002). Learning to notice: Scaffolding new teachers’ interpretations of classroom interactions. Journal of Technology and Teacher Education, 10(4), 571–596. https://www.learntechlib.org/primary/p/9171/. van Es, E. A., & Sherin, M. G. (2008). Mathematics teachers’ “learning to notice” in the context of a video club. Teaching and Teacher Education, 24(2), 244–276. https://doi.org/10.1016/j.tate.2006.11.005 Voss, T., & Kunter, M. (2020). “Reality shock” of beginning teachers? Changes in teacher candidates’ emotional exhaustion and constructivist-oriented beliefs. Journal of Teacher Education, 71(3), 292–306. https://doi.org/10.1177/0022487119839700 Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. New York: Guilford. Weber, K. E., Prilop, C. N., Viehoff, S., Gold, B., & Kleinknecht, M. (2020). Fordert ¨ eine videobasierte intervention im praktikum die professionelle wahrnehmung von Klassenführung?—eine quantitativ-inhaltsanalytische messung von Subprozessen professioneller wahrnehmung [does a video-based practicum intervention provide a realistic picture of classroom management? A quantitative content analysis of the subprocesses of professional awareness]. Zeitschrift für Erziehungswissenschaft, 23, 343–365. https://doi.org/10.1007/s11618-020-00939-9 Wegner, D. M., & Giuliano, T. (1980). Arousal-induced attention to self. Journal of Personality and Social Psychology, 38(5), 719–726. https://doi.org/10.1037/0022- 3514.38.5.719 A. Westphal et al. Computers & Education 212 (2024) 104987 15 Westphal, A., Kalinowski, E., Hoferichter, C. J., & Vock, M. (2022). K− 12 teachers’ stress and burnout during the COVID-19 pandemic: A systematic review. Frontiers in psychology, 13, 920326. https://doi.org/10.3389/fpsyg.2022.920326. Wickham, H. (2019). stringr: Simple, consistent wrappers for common string operations. R package version 1.4.0. https://CRAN.R-project.org/package=stringr. Wiepke, A., Heinemann, B., Lucke, U., & Schroeder, U. (2021). Jenseits des eigenen Klassenzimmers: Perspektiven & Weiterentwicklungen des VR-Klassenzimmers [Beyond the own classroom: Perspectives & further developments of the VR classroom.]. DELFI 2021 - Die 19. Fachtagung Bildungstechnologien [Educational technologies symposium], 331–336. http://dl.gi.de/handle/20.500.12116/37031. Wolff, C. E., Jarodzka, H., van den Bogert, N., & Boshuizen, H. P. A. (2016). Teacher vision: Expert and novice teachers’ perception of problematic classroom management scenes. Instructional Science, 44(3), 243–265, 10/f8tcpm. Wulff, P., Westphal, A., Mientus, L., Nowak, A., & Borowski, A. (2023, January). Enhancing writing analytics in science education research with machine learning and natural language processing—Formative assessment of science and non-science preservice teachers’ written reflections. In Frontiers in Education, 7, Article 1061461. https://doi.org/10.3389/feduc.2022.1061461. Frontiers. Wulff, P., Buschhüter, D., Westphal, A., Mientus, L., Nowak, A., & Borowski, A. (2022). Bridging the gap between qualitative and quantitative assessment in science education research with machine learning—A case for pretrained language models-based clustering. Journal of Science Education and Technology, 31(4), 490–513. https://doi.org/10.1007/s10956-022-09969-w. Yarkoni, T. (2010). Personality in 100,000 words: A large-scale analysis of personality and word use among bloggers. Journal of Research in Personality, 44(3), 363–373. https://doi.org/10.1016/j.jrp.2010.04.001 Yee, N., Harris, H., Jabon, M., & Bailenson, J. N. (2011). The expression of personality in virtual worlds. Social Psychological and Personality Science, 2(1), 5–12. https://doi.org/10.1177/1948550610379056 Zhang, M., Lundeberg, M., Koehler, M. J., & Eberhardt, J. (2011). Understanding affordances and challenges of three types of video for teacher professional development. Teaching and Teacher Education, 27(2), 454–462. https://doi.org/10.1016/j.tate.2010.09.015 Zimmermann, J., Brockmeyer, T., Hunn, M., Schauenburg, H., & Wolf, M. (2016). First-person pronoun use in spoken language as a predictor of future depressive symptoms: Preliminary evidence from a clinical sample of depressed patients. Clinical Psychology & Psychotherapy, 24(2), 384–391. https://doi.org/10.1002/ cpp.2006 Wiepke, A., Richter, E., Zender, R., & Richter, D. (2019). Einsatz von Virtual Reality zum Aufbau von Klassenmanagement-Kompetenzen im Lehramtsstudium [Use of virtual reality for training student teachers’ classroom management competencies]. DELFI, 2019. https://doi.org/10.18420/delfi2019_319 A. Westphal et al. View publication stats",Internet/Technology,Pros & Cons,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",I'm making a presentation to first-year biology students based on this article. Please summarize this excerpt. Be sure to use language that an 11th grader can understand (but define jargon so that students learn some relevant terminology).,"1 Introduction Cervical squamous intraepithelial lesion (SIL) is a condition characterized by abnormal changes in cervical squamous cells. Although most low-grade squamous intraepithelial lesions (LSILs) can regress naturally within 1–2 years, while high-grade squamous intraepithelial lesions (HSILs) have a higher potential for malignant transformation. Current treatment methods for SIL comprise ablative treatments (such as cryotherapy, radiofrequency, and focused ultrasound treatments) and excision procedures (including cold knife conization, cervical loop electrosurgical excision procedure, and laser conization). In the past few years, there has been an increase in the occurrence of SIL among younger woman. As a result, clinicians and patients are not only concerned about lesion clearance, but also paying attention to cervical wound healing, which has emerged as a new area of interest. SARS-CoV-2, a novel coronavirus, emerged in 2019 and caused a global pandemic of acute respiratory illness named SARS-CoV-2. With the deepening of research, it has been found that SARS-CoV-2 not only affects the respiratory system, but also the digestive system, nervous system, cardiovascular system, endocrine system, reproductive system, and can cause a decrease in the body’s immunity, leading to secondary bacterial infections. However, little is known about the impact of SARS-CoV-2 infection on cervical wound healing after treatment. In this study, we investigated the wound healing status of patients who were infected with SARS-CoV-2 within one month after cervical treatment and compared them with a control group of patients who underwent cervical treatment after the disappearance of infection symptoms. 2 Materials and methods 2.1 Study population A total of 60 patients, aged 19 to 53 years old, who underwent cervical treatment for SILs at the gynecology cervical clinic of the People’s Hospital of Guangxi Zhuang Autonomous Region from November 2022 to February 2023 were recruited as the study population. Informed consent was obtained from all subjects involved in the study. The inclusion criteria for patients were a diagnosis of SIL using the three-step method of cervical cytology, which including HPV test, colposcopy, and cervical biopsy. The exclusion criteria included: patients with acute or subacute genital infections, genital malignancy, a history of hysterectomy or pelvic radiotherapy, a history of cervical excision, cervical ablation, or medication treatment, pregnant or lactating women, uncontrolled diabetes, hyperthyroidism or hypothyroidism, severe cardiovascular, cerebral, pulmonary, hepatic, or renal dysfunction, or comorbidities of immunological disorders or immunosuppressive drug use. The experimental group consisted of 29 patients who exhibited symptoms (such as fever, sore throat, and cough) and were confirmed to have SARS-CoV-2 infection through antigen testing within one month of receiving cervical treatment. The control group comprised t31 patients who underwent cervical treatment at least one week after their SARS-CoV-2 symptoms had resolved. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Guangxi Zhuang Autonomous Region People’s Hospital (no. KY-KJT02023-10) on August 01, 2022. 2.2 Treatment methods All cervical treatments were performed 3–7 days after the end of menstruation, excluding patients who have reached menopause. To assess the extent of the cervical lesion, acetic acid and iodine are applied to stain the junction of the cervical squamous epithelium and columnar epithelium. Local anesthesia with 1% lidocaine is administered at the 4 quadrants of the cervix. The cervical SILs are treated using either loop electrosurgical excision procedure (LEEP) or ablative treatment such as focused ultrasound or radiofrequency ablation. Details regarding the indications for patients undergoing LEEP excision or ablative treatment can be found in the Supplementary materials. The (LEEP) is performed using a triangular-shaped electrosurgical knife with a length of 15–20 mm, The treatment area is set to approximately 5 mm from the outer edge of the lesion, utilizing a cutting-coagulation mode with a power setting of 40 W. Depending on the type of transformation zone, different lengths of lesion tissue are removed (7–10 mm for type 1, 10–15 mm for type 2, and 15–25 mm for type 3). Following excision, a ball-shaped electrode is used to perform electrocoagulation for hemostasis at the surgical site. The power setting for focused ultrasound therapy is between 3.5 and 4.5 W. Treatment is performed in a circular scanning pattern from the lesion area toward the normal area. During the treatment, the focused ultrasound probe is kept in close contact with the treatment area. The treatment should be stopped when local tissues become concave or hardened. The treatment range should extend beyond the edge of the cervical lesion by approximately 2–5 mm. The power for radiofrequency ablation is set to 30 W. The treatment area extends beyond the area that tests positive in acetic acid and iodine tests by 2–5 mm. An auto-coagulator knife is used to ablate the cervical epithelium from the inside out, until the epithelium is thermocoagulated to a light yellow color and the wound has formed a shallow cone shape. 2.3 Cervical wound healing evaluation after treatment Assessing the rate of wound healing is a key factor in evaluating the progress of wound recovery. A comprehensive evaluation of the healing process includes recording the cervical wound condition immediately after treatment and at a specified time-point after treatment. The wound area is measured using Imagine J software (National Institutes of Health, Bethesda, MD). To calculate the wound healing rate, the formula [(treatment wound area - remaining wound area)/treatment wound area] × 100% is applied. This approach enables clinicians to quantitatively assess the healing process and monitor the progress of wound closure over time. Specifically, the calculation is performed on the 30th day after treatment, providing a comprehensive evaluation of healing rate. 2.4 Vaginal discharge test before and one month after treatment Before undergoing cervical treatment, each patient underwent a vaginal discharge examination to rule out vaginal inflammation. During the one-month follow-up vaginal colposcopy after receiving cervical treatment, another examination of vaginal discharge was conducted to assess the vaginal microbiota and inflammatory condition. 4 Results There were no significant differences between the two groups in terms of age, disease severity, treatment methods, or treatment duration. The mean time of SARS-CoV-2 infection in post-treatment infection group is 15.83 ± 9.74 days after cervical treatment, and the mean time of SARS-CoV-2 infection in treatment after infection recovered group is 39.13 ± 9.80 days before cervical treatment. Compared with the control group, the experimental group had a lower wound healing rate 83.77 (62.04, 97.09) % vs. 98.64(97.10, 99.46)%, p < 0.001. The Box and whisker plot of the wound healing rate for the two group was shown in Supplementary Figure 1. Also the experimental group had a higher scab non-shedding rate 24.14% (7/29) on the 30th day after treatment when compared with control group (24.14% vs. 3.22%, p = 0.024). We conducted further analysis to explore the potential correlation between delayed wound healing and the timing of SARS-CoV-2 infection in the experimental group. Out of the 7 patients who experienced delayed wound healing, 5 patients (71.43%) contracted SARS-CoV-2 within 2 weeks after undergoing cervical treatment, only 2 (2/7 or 28.57%) patients infected with delayed wound healing infected SARS-CoV-2 2 weeks after cervical treatment. It is worth noting that in the control group, there was only 1 patient who experienced poor wound healing, and the cervical treatment of this patient was conducted 45 days after SARS-CoV-2 infection. Pre-treatment vaginal discharge tests for all patients exhibited normal levels of white blood cell counts and leukocyte esterase, with no detection of trichomonas vaginalis, pseudohyphae, or budding spores in both pre and post-treatment assessments. We compared the correlation between white blood cell count and leukocyte esterase in vaginal discharge with cervical healing. The results of the chi-square test for contingency table revealed no significant correlation between white blood cell count or leukocyte esterase in vaginal discharge and delayed wound healing of the cervix (defined as the non-shedding of scabs after 1 month of treatment) (p = 0.947 and 0.970, respectively).","[question] I'm making a presentation to first-year biology students based on this article. Please summarize this excerpt. Be sure to use language that an 11th grader can understand (but define jargon so that students learn some relevant terminology). ===================== [text] 1 Introduction Cervical squamous intraepithelial lesion (SIL) is a condition characterized by abnormal changes in cervical squamous cells. Although most low-grade squamous intraepithelial lesions (LSILs) can regress naturally within 1–2 years, while high-grade squamous intraepithelial lesions (HSILs) have a higher potential for malignant transformation. Current treatment methods for SIL comprise ablative treatments (such as cryotherapy, radiofrequency, and focused ultrasound treatments) and excision procedures (including cold knife conization, cervical loop electrosurgical excision procedure, and laser conization). In the past few years, there has been an increase in the occurrence of SIL among younger woman. As a result, clinicians and patients are not only concerned about lesion clearance, but also paying attention to cervical wound healing, which has emerged as a new area of interest. SARS-CoV-2, a novel coronavirus, emerged in 2019 and caused a global pandemic of acute respiratory illness named SARS-CoV-2. With the deepening of research, it has been found that SARS-CoV-2 not only affects the respiratory system, but also the digestive system, nervous system, cardiovascular system, endocrine system, reproductive system, and can cause a decrease in the body’s immunity, leading to secondary bacterial infections. However, little is known about the impact of SARS-CoV-2 infection on cervical wound healing after treatment. In this study, we investigated the wound healing status of patients who were infected with SARS-CoV-2 within one month after cervical treatment and compared them with a control group of patients who underwent cervical treatment after the disappearance of infection symptoms. 2 Materials and methods 2.1 Study population A total of 60 patients, aged 19 to 53 years old, who underwent cervical treatment for SILs at the gynecology cervical clinic of the People’s Hospital of Guangxi Zhuang Autonomous Region from November 2022 to February 2023 were recruited as the study population. Informed consent was obtained from all subjects involved in the study. The inclusion criteria for patients were a diagnosis of SIL using the three-step method of cervical cytology, which including HPV test, colposcopy, and cervical biopsy. The exclusion criteria included: patients with acute or subacute genital infections, genital malignancy, a history of hysterectomy or pelvic radiotherapy, a history of cervical excision, cervical ablation, or medication treatment, pregnant or lactating women, uncontrolled diabetes, hyperthyroidism or hypothyroidism, severe cardiovascular, cerebral, pulmonary, hepatic, or renal dysfunction, or comorbidities of immunological disorders or immunosuppressive drug use. The experimental group consisted of 29 patients who exhibited symptoms (such as fever, sore throat, and cough) and were confirmed to have SARS-CoV-2 infection through antigen testing within one month of receiving cervical treatment. The control group comprised t31 patients who underwent cervical treatment at least one week after their SARS-CoV-2 symptoms had resolved. The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Guangxi Zhuang Autonomous Region People’s Hospital (no. KY-KJT02023-10) on August 01, 2022. 2.2 Treatment methods All cervical treatments were performed 3–7 days after the end of menstruation, excluding patients who have reached menopause. To assess the extent of the cervical lesion, acetic acid and iodine are applied to stain the junction of the cervical squamous epithelium and columnar epithelium. Local anesthesia with 1% lidocaine is administered at the 4 quadrants of the cervix. The cervical SILs are treated using either loop electrosurgical excision procedure (LEEP) or ablative treatment such as focused ultrasound or radiofrequency ablation. Details regarding the indications for patients undergoing LEEP excision or ablative treatment can be found in the Supplementary materials. The (LEEP) is performed using a triangular-shaped electrosurgical knife with a length of 15–20 mm, The treatment area is set to approximately 5 mm from the outer edge of the lesion, utilizing a cutting-coagulation mode with a power setting of 40 W. Depending on the type of transformation zone, different lengths of lesion tissue are removed (7–10 mm for type 1, 10–15 mm for type 2, and 15–25 mm for type 3). Following excision, a ball-shaped electrode is used to perform electrocoagulation for hemostasis at the surgical site. The power setting for focused ultrasound therapy is between 3.5 and 4.5 W. Treatment is performed in a circular scanning pattern from the lesion area toward the normal area. During the treatment, the focused ultrasound probe is kept in close contact with the treatment area. The treatment should be stopped when local tissues become concave or hardened. The treatment range should extend beyond the edge of the cervical lesion by approximately 2–5 mm. The power for radiofrequency ablation is set to 30 W. The treatment area extends beyond the area that tests positive in acetic acid and iodine tests by 2–5 mm. An auto-coagulator knife is used to ablate the cervical epithelium from the inside out, until the epithelium is thermocoagulated to a light yellow color and the wound has formed a shallow cone shape. 2.3 Cervical wound healing evaluation after treatment Assessing the rate of wound healing is a key factor in evaluating the progress of wound recovery. A comprehensive evaluation of the healing process includes recording the cervical wound condition immediately after treatment and at a specified time-point after treatment. The wound area is measured using Imagine J software (National Institutes of Health, Bethesda, MD). To calculate the wound healing rate, the formula [(treatment wound area - remaining wound area)/treatment wound area] × 100% is applied. This approach enables clinicians to quantitatively assess the healing process and monitor the progress of wound closure over time. Specifically, the calculation is performed on the 30th day after treatment, providing a comprehensive evaluation of healing rate. 2.4 Vaginal discharge test before and one month after treatment Before undergoing cervical treatment, each patient underwent a vaginal discharge examination to rule out vaginal inflammation. During the one-month follow-up vaginal colposcopy after receiving cervical treatment, another examination of vaginal discharge was conducted to assess the vaginal microbiota and inflammatory condition. 4 Results There were no significant differences between the two groups in terms of age, disease severity, treatment methods, or treatment duration. The mean time of SARS-CoV-2 infection in post-treatment infection group is 15.83 ± 9.74 days after cervical treatment, and the mean time of SARS-CoV-2 infection in treatment after infection recovered group is 39.13 ± 9.80 days before cervical treatment. Compared with the control group, the experimental group had a lower wound healing rate 83.77 (62.04, 97.09) % vs. 98.64(97.10, 99.46)%, p < 0.001. The Box and whisker plot of the wound healing rate for the two group was shown in Supplementary Figure 1. Also the experimental group had a higher scab non-shedding rate 24.14% (7/29) on the 30th day after treatment when compared with control group (24.14% vs. 3.22%, p = 0.024). We conducted further analysis to explore the potential correlation between delayed wound healing and the timing of SARS-CoV-2 infection in the experimental group. Out of the 7 patients who experienced delayed wound healing, 5 patients (71.43%) contracted SARS-CoV-2 within 2 weeks after undergoing cervical treatment, only 2 (2/7 or 28.57%) patients infected with delayed wound healing infected SARS-CoV-2 2 weeks after cervical treatment. It is worth noting that in the control group, there was only 1 patient who experienced poor wound healing, and the cervical treatment of this patient was conducted 45 days after SARS-CoV-2 infection. Pre-treatment vaginal discharge tests for all patients exhibited normal levels of white blood cell counts and leukocyte esterase, with no detection of trichomonas vaginalis, pseudohyphae, or budding spores in both pre and post-treatment assessments. We compared the correlation between white blood cell count and leukocyte esterase in vaginal discharge with cervical healing. The results of the chi-square test for contingency table revealed no significant correlation between white blood cell count or leukocyte esterase in vaginal discharge and delayed wound healing of the cervix (defined as the non-shedding of scabs after 1 month of treatment) (p = 0.947 and 0.970, respectively). https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2023.1222767/full ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Summarize & Simplify,Text Transformation You must only respond with information found in the text block. You must begin with an introduction paragraph and finish with a concluding paragraph. The body must only be bullet points.,"Can you provide a summary of the text, focusing on Lawrence G. Roberts' and Leonard Kleinrock's contributions to the origin of the internet?","The first recorded description of the social interactions that could be enabled through networking was a series of memos written by J.C.R. Licklider of MIT in August 1962 discussing his “Galactic Network” concept. He envisioned a globally interconnected set of computers through which everyone could quickly access data and programs from any site. In spirit, the concept was very much like the Internet of today. Licklider was the first head of the computer research program at DARPA,4 starting in October 1962. While at DARPA he convinced his successors at DARPA, Ivan Sutherland, Bob Taylor, and MIT researcher Lawrence G. Roberts, of the importance of this networking concept. Leonard Kleinrock at MIT published the first paper on packet switching theory in July 1961 and the first book on the subject in 1964. Kleinrock convinced Roberts of the theoretical feasibility of communications using packets rather than circuits, which was a major step along the path towards computer networking. The other key step was to make the computers talk together. To explore this, in 1965 working with Thomas Merrill, Roberts connected the TX-2 computer in Mass. to the Q-32 in California with a low speed dial-up telephone line creating the first (however small) wide-area computer network ever built. The result of this experiment was the realization that the time-shared computers could work well together, running programs and retrieving data as necessary on the remote machine, but that the circuit switched telephone system was totally inadequate for the job. Kleinrock’s conviction of the need for packet switching was confirmed. In late 1966 Roberts went to DARPA to develop the computer network concept and quickly put together his plan for the “ARPANET”, publishing it in 1967. At the conference where he presented the paper, there was also a paper on a packet network concept from the UK by Donald Davies and Roger Scantlebury of NPL. Scantlebury told Roberts about the NPL work as well as that of Paul Baran and others at RAND. The RAND group had written a paper on packet switching networks for secure voice in the military in 1964. It happened that the work at MIT (1961-1967), at RAND (1962-1965), and at NPL (1964-1967) had all proceeded in parallel without any of the researchers knowing about the other work. The word “packet” was adopted from the work at NPL and the proposed line speed to be used in the ARPANET design was upgraded from 2.4 kbps to 50 kbps.5 In August 1968, after Roberts and the DARPA funded community had refined the overall structure and specifications for the ARPANET, an RFQ was released by DARPA for the development of one of the key components, the packet switches called Interface Message Processors (IMP’s). The RFQ was won in December 1968 by a group headed by Frank Heart at Bolt Beranek and Newman (BBN). As the BBN team worked on the IMP’s with Bob Kahn playing a major role in the overall ARPANET architectural design, the network topology and economics were designed and optimized by Roberts working with Howard Frank and his team at Network Analysis Corporation, and the network measurement system was prepared by Kleinrock’s team at UCLA.6 Due to Kleinrock’s early development of packet switching theory and his focus on analysis, design and measurement, his Network Measurement Center at UCLA was selected to be the first node on the ARPANET. All this came together in September 1969 when BBN installed the first IMP at UCLA and the first host computer was connected. Doug Engelbart’s project on “Augmentation of Human Intellect” (which included NLS, an early hypertext system) at Stanford Research Institute (SRI) provided a second node. SRI supported the Network Information Center, led by Elizabeth (Jake) Feinler and including functions such as maintaining tables of host name to address mapping as well as a directory of the RFC’s. One month later, when SRI was connected to the ARPANET, the first host-to-host message was sent from Kleinrock’s laboratory to SRI. Two more nodes were added at UC Santa Barbara and University of Utah. These last two nodes incorporated application visualization projects, with Glen Culler and Burton Fried at UCSB investigating methods for display of mathematical functions using storage displays to deal with the problem of refresh over the net, and Robert Taylor and Ivan Sutherland at Utah investigating methods of 3-D representations over the net. Thus, by the end of 1969, four host computers were connected together into the initial ARPANET, and the budding Internet was off the ground. Even at this early stage, it should be noted that the networking research incorporated both work on the underlying network and work on how to utilize the network. This tradition continues to this day. Computers were added quickly to the ARPANET during the following years, and work proceeded on completing a functionally complete Host-to-Host protocol and other network software. In December 1970 the Network Working Group (NWG) working under S. Crocker finished the initial ARPANET Host-to-Host protocol, called the Network Control Protocol (NCP). As the ARPANET sites completed implementing NCP during the period 1971-1972, the network users finally could begin to develop applications. In October 1972, Kahn organized a large, very successful demonstration of the ARPANET at the International Computer Communication Conference (ICCC). This was the first public demonstration of this new network technology to the public. It was also in 1972 that the initial “hot” application, electronic mail, was introduced. In March Ray Tomlinson at BBN wrote the basic email message send and read software, motivated by the need of the ARPANET developers for an easy coordination mechanism. In July, Roberts expanded its utility by writing the first email utility program to list, selectively read, file, forward, and respond to messages. From there email took off as the largest network application for over a decade. This was a harbinger of the kind of activity we see on the World Wide Web today, namely, the enormous growth of all kinds of “people-to-people” traffic. ","You must only respond with information found in the text block. You must begin with an introduction paragraph and finish with a concluding paragraph. The body must only be bullet points. Can you provide a summary of the text, focusing on Lawrence G. Roberts' and Leonard Kleinrock's contributions to the origin of the internet? The first recorded description of the social interactions that could be enabled through networking was a series of memos written by J.C.R. Licklider of MIT in August 1962 discussing his “Galactic Network” concept. He envisioned a globally interconnected set of computers through which everyone could quickly access data and programs from any site. In spirit, the concept was very much like the Internet of today. Licklider was the first head of the computer research program at DARPA,4 starting in October 1962. While at DARPA he convinced his successors at DARPA, Ivan Sutherland, Bob Taylor, and MIT researcher Lawrence G. Roberts, of the importance of this networking concept. Leonard Kleinrock at MIT published the first paper on packet switching theory in July 1961 and the first book on the subject in 1964. Kleinrock convinced Roberts of the theoretical feasibility of communications using packets rather than circuits, which was a major step along the path towards computer networking. The other key step was to make the computers talk together. To explore this, in 1965 working with Thomas Merrill, Roberts connected the TX-2 computer in Mass. to the Q-32 in California with a low speed dial-up telephone line creating the first (however small) wide-area computer network ever built. The result of this experiment was the realization that the time-shared computers could work well together, running programs and retrieving data as necessary on the remote machine, but that the circuit switched telephone system was totally inadequate for the job. Kleinrock’s conviction of the need for packet switching was confirmed. In late 1966 Roberts went to DARPA to develop the computer network concept and quickly put together his plan for the “ARPANET”, publishing it in 1967. At the conference where he presented the paper, there was also a paper on a packet network concept from the UK by Donald Davies and Roger Scantlebury of NPL. Scantlebury told Roberts about the NPL work as well as that of Paul Baran and others at RAND. The RAND group had written a paper on packet switching networks for secure voice in the military in 1964. It happened that the work at MIT (1961-1967), at RAND (1962-1965), and at NPL (1964-1967) had all proceeded in parallel without any of the researchers knowing about the other work. The word “packet” was adopted from the work at NPL and the proposed line speed to be used in the ARPANET design was upgraded from 2.4 kbps to 50 kbps.5 In August 1968, after Roberts and the DARPA funded community had refined the overall structure and specifications for the ARPANET, an RFQ was released by DARPA for the development of one of the key components, the packet switches called Interface Message Processors (IMP’s). The RFQ was won in December 1968 by a group headed by Frank Heart at Bolt Beranek and Newman (BBN). As the BBN team worked on the IMP’s with Bob Kahn playing a major role in the overall ARPANET architectural design, the network topology and economics were designed and optimized by Roberts working with Howard Frank and his team at Network Analysis Corporation, and the network measurement system was prepared by Kleinrock’s team at UCLA.6 Due to Kleinrock’s early development of packet switching theory and his focus on analysis, design and measurement, his Network Measurement Center at UCLA was selected to be the first node on the ARPANET. All this came together in September 1969 when BBN installed the first IMP at UCLA and the first host computer was connected. Doug Engelbart’s project on “Augmentation of Human Intellect” (which included NLS, an early hypertext system) at Stanford Research Institute (SRI) provided a second node. SRI supported the Network Information Center, led by Elizabeth (Jake) Feinler and including functions such as maintaining tables of host name to address mapping as well as a directory of the RFC’s. One month later, when SRI was connected to the ARPANET, the first host-to-host message was sent from Kleinrock’s laboratory to SRI. Two more nodes were added at UC Santa Barbara and University of Utah. These last two nodes incorporated application visualization projects, with Glen Culler and Burton Fried at UCSB investigating methods for display of mathematical functions using storage displays to deal with the problem of refresh over the net, and Robert Taylor and Ivan Sutherland at Utah investigating methods of 3-D representations over the net. Thus, by the end of 1969, four host computers were connected together into the initial ARPANET, and the budding Internet was off the ground. Even at this early stage, it should be noted that the networking research incorporated both work on the underlying network and work on how to utilize the network. This tradition continues to this day. Computers were added quickly to the ARPANET during the following years, and work proceeded on completing a functionally complete Host-to-Host protocol and other network software. In December 1970 the Network Working Group (NWG) working under S. Crocker finished the initial ARPANET Host-to-Host protocol, called the Network Control Protocol (NCP). As the ARPANET sites completed implementing NCP during the period 1971-1972, the network users finally could begin to develop applications. In October 1972, Kahn organized a large, very successful demonstration of the ARPANET at the International Computer Communication Conference (ICCC). This was the first public demonstration of this new network technology to the public. It was also in 1972 that the initial “hot” application, electronic mail, was introduced. In March Ray Tomlinson at BBN wrote the basic email message send and read software, motivated by the need of the ARPANET developers for an easy coordination mechanism. In July, Roberts expanded its utility by writing the first email utility program to list, selectively read, file, forward, and respond to messages. From there email took off as the largest network application for over a decade. This was a harbinger of the kind of activity we see on the World Wide Web today, namely, the enormous growth of all kinds of “people-to-people” traffic. ",Internet/Technology,Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","What are the core differences between fundamental analysis and technical analysis, in what they measure and how they are used? Include criticisms or downsides of each analysis to explain the differences in practice.","What Is Fundamental Analysis? Fundamental analysis is used in finance to evaluate the intrinsic value—the real worth—of a security, sector, or economy. It's used when scrutinizing income statements, balance sheets, and cash flow statements for a company's stock. Fundamental analysis is generally for those looking for long-term value. As such, those performing this kind of analysis are trying to calculate how much the company will make in the future against its present net value. A stock trading below the company's intrinsic value is seen as promising, while the opposite is true for those priced below it. The outcome of the analysis can lead to buying, holding, or selling a security. The Main Tools of Fundamental Analysis This approach seeks to uncover the intrinsic value of a security, such as a stock or currency, using these main tools: Financial statements: These include a company's income statement, balance sheet, and cash flow statement, which provide an economic snapshot and help assess its profitability, liquidity, and solvency. Analysts use these to determine financial ratios, multiples, and other mathematical representations of a firm's financial health. Economic indicators: Macroeconomic indicators like gross domestic product growth, inflation, and unemployment rates are used to understand the economic environment in which a company operates. These indicators can affect consumer behavior and, therefore, a company's performance. Interest rates: Central bank interest rates can significantly affect an investment's value. Higher interest rates generally lead to lower stock prices, while lower rates boost stock prices. News and events: Company news, such as earnings reports, new contracts, and regulatory changes, affect stock prices. Qualitative information: This includes details about management quality, industry cycles, competitive advantage, and other nonquantifiable factors that affect a company's stock. 1 Investors use these tools to see whether a security is undervalued or overvalued. Criticisms of Fundamental Analysis Here are some of the main criticisms of fundamental analysis: Time-consuming: Fundamental analysis requires extensive research and data collection, which can be very time-intensive. Subjectivity: As with technical analysis, different analysts may interpret the same data differently, leading to the claim that the results end up subjective. Information lag: Financial reports and economic data are often released with a delay, potentially making the analysis outdated. Difficulty quantifying qualitative factors: Aspects like management quality or brand value are hard to objectively measure. Assumption of market efficiency: Fundamental analysis very often assumes that markets are efficient. Hence, long-term value (the prices on the stock market) will eventually match the stock's underlying reality or intrinsic value. However, the long-term may never come, and in the meantime, what's the best approach to obtain the gains from price changes? Long-term focus: It may not be as useful for short-term trading decisions. Overlooking market sentiment: Fundamental analysis may not adequately account for investor psychology and market trends. It may miss important price trends and patterns that technical analysis might catch. Vulnerability to unexpected events: Sudden geopolitical or economic events can quickly render fundamental analysis irrelevant. 2 These criticisms highlight why some investors prefer technical analysis or combine both approaches. What Is Technical Analysis? Technical analysis evaluates financial assets, such as stocks, currencies, or commodities, by reviewing the historical price and volume data. Unlike fundamental analysis, which focuses on the intrinsic value of an asset, technical analysis examines the volume and price of shares over time. 2 Simplifying more than a little, where those using fundamental analysis portray themselves as the sober-minded investigators uncovering real value in the economy, those who use technical analysis start from the perspective that markets are inefficient and price patterns and trends in market data can be exploited for potential profit. Fundamental and technical analyses are the major schools of thought for approaching the markets. The Main Tools of Technical Analysis Here are the tools most often used in technical analyses: Technical analysis indicators: These are mathematical calculations based on price, volume, or open interest to predict future prices. The indicators are generally based on momentum or mean reversion. Volume analysis: This studies the number of shares, lots, or contracts traded in a security or market during a certain period. Relative strength: This metric compares the performance of an asset to a benchmark to gauge its momentum. 2 Chart pattern analysis: The study of price movements in a market pinpoints patterns that can suggest future activity. 3 Candlestick pattern analysis: This kind of financial chart used for price movements could indicate investor sentiment, market trends, or reversals of those trends. 4 Example candlestick pattern A candlestick pattern on charts consists of rectangular ""bodies"" that show the opening and closing prices, with thin vertical lines called ""wicks"" or ""shadows"" extending above and below to indicate the high and low prices for the period. The body is typically colored differently (often green/white for up moves and red/black for down moves) to quickly convey whether the price closed higher or lower than it opened during that time frame. Investopedia / Sabrina Jiang Support and resistance: These are horizontal lines drawn on a price chart to indicate where a security's price will be unlikely to move beyond. 5 Trend analysis: This is interpreting past and present moves in the market to predict future asset prices. Historical prices and trading volume are the most often used. 6 Each element allows investors to analyze a share or market's behavior. Criticisms of Technical Analysis Trying to predict stock prices based on past trading data has long been a topic of heated discussion, with many academics and professional investors being skeptical about its effectiveness. Imagine trying to predict tomorrow's weather just by looking at past weather patterns. That's somewhat akin to what technical analysts do with stock prices. Skepticism of the Efficiency of Markets One of the main criticisms of technical analysis is that it goes against the efficient market hypothesis. 7 This economic theory suggests that stock prices already reflect all available information, making it impossible to consistently beat the market using any predefined strategy. Critics argue that even if technical analysis really worked, everyone would use it, and its advantages would quickly disappear. However, proponents of technical analysis counter that markets aren't always perfectly efficient, and that there's value in analyzing price trends and trading patterns. Supposed Non-Objectivity of Technical Analysis Another point of contention is the often subjective nature of technical analysis. Much like seeing shapes in clouds, different analysts might interpret the same chart patterns differently, leading to inconsistent predictions. Moreover, with so much financial data available today, there's a risk of ""overfitting,"" or finding patterns that seem meaningful but are actually just coincidences --similar to how you might flip a coin 10 times, get heads each time, and mistakenly conclude the coin is rigged. This has led to concerns about data mining, where patterns that seem to have worked in the past have no real predictive power for the future. Despite these criticisms, technical analysis remains popular among many traders and investors. Some argue that technical analysis may appear to work in some cases due to a self-fulfilling prophecy: if enough traders follow the same technical signals, their collective actions could actually move the market in the predicted direction, at least in the short term. Others point out that technical analysis can be a useful tool for understanding market psychology and sentiment. By studying price movements and trading volumes, analysts might gain insights into the emotions driving buying and selling pressure, which can be valuable for identifying resistance and support levels, and timing entry and exit points in trades.","[question] What are the core differences between fundamental analysis and technical analysis, in what they measure and how they are used? Include criticisms or downsides of each analysis to explain the differences in practice. ===================== [text] What Is Fundamental Analysis? Fundamental analysis is used in finance to evaluate the intrinsic value—the real worth—of a security, sector, or economy. It's used when scrutinizing income statements, balance sheets, and cash flow statements for a company's stock. Fundamental analysis is generally for those looking for long-term value. As such, those performing this kind of analysis are trying to calculate how much the company will make in the future against its present net value. A stock trading below the company's intrinsic value is seen as promising, while the opposite is true for those priced below it. The outcome of the analysis can lead to buying, holding, or selling a security. The Main Tools of Fundamental Analysis This approach seeks to uncover the intrinsic value of a security, such as a stock or currency, using these main tools: Financial statements: These include a company's income statement, balance sheet, and cash flow statement, which provide an economic snapshot and help assess its profitability, liquidity, and solvency. Analysts use these to determine financial ratios, multiples, and other mathematical representations of a firm's financial health. Economic indicators: Macroeconomic indicators like gross domestic product growth, inflation, and unemployment rates are used to understand the economic environment in which a company operates. These indicators can affect consumer behavior and, therefore, a company's performance. Interest rates: Central bank interest rates can significantly affect an investment's value. Higher interest rates generally lead to lower stock prices, while lower rates boost stock prices. News and events: Company news, such as earnings reports, new contracts, and regulatory changes, affect stock prices. Qualitative information: This includes details about management quality, industry cycles, competitive advantage, and other nonquantifiable factors that affect a company's stock. 1 Investors use these tools to see whether a security is undervalued or overvalued. Criticisms of Fundamental Analysis Here are some of the main criticisms of fundamental analysis: Time-consuming: Fundamental analysis requires extensive research and data collection, which can be very time-intensive. Subjectivity: As with technical analysis, different analysts may interpret the same data differently, leading to the claim that the results end up subjective. Information lag: Financial reports and economic data are often released with a delay, potentially making the analysis outdated. Difficulty quantifying qualitative factors: Aspects like management quality or brand value are hard to objectively measure. Assumption of market efficiency: Fundamental analysis very often assumes that markets are efficient. Hence, long-term value (the prices on the stock market) will eventually match the stock's underlying reality or intrinsic value. However, the long-term may never come, and in the meantime, what's the best approach to obtain the gains from price changes? Long-term focus: It may not be as useful for short-term trading decisions. Overlooking market sentiment: Fundamental analysis may not adequately account for investor psychology and market trends. It may miss important price trends and patterns that technical analysis might catch. Vulnerability to unexpected events: Sudden geopolitical or economic events can quickly render fundamental analysis irrelevant. 2 These criticisms highlight why some investors prefer technical analysis or combine both approaches. What Is Technical Analysis? Technical analysis evaluates financial assets, such as stocks, currencies, or commodities, by reviewing the historical price and volume data. Unlike fundamental analysis, which focuses on the intrinsic value of an asset, technical analysis examines the volume and price of shares over time. 2 Simplifying more than a little, where those using fundamental analysis portray themselves as the sober-minded investigators uncovering real value in the economy, those who use technical analysis start from the perspective that markets are inefficient and price patterns and trends in market data can be exploited for potential profit. Fundamental and technical analyses are the major schools of thought for approaching the markets. The Main Tools of Technical Analysis Here are the tools most often used in technical analyses: Technical analysis indicators: These are mathematical calculations based on price, volume, or open interest to predict future prices. The indicators are generally based on momentum or mean reversion. Volume analysis: This studies the number of shares, lots, or contracts traded in a security or market during a certain period. Relative strength: This metric compares the performance of an asset to a benchmark to gauge its momentum. 2 Chart pattern analysis: The study of price movements in a market pinpoints patterns that can suggest future activity. 3 Candlestick pattern analysis: This kind of financial chart used for price movements could indicate investor sentiment, market trends, or reversals of those trends. 4 Example candlestick pattern A candlestick pattern on charts consists of rectangular ""bodies"" that show the opening and closing prices, with thin vertical lines called ""wicks"" or ""shadows"" extending above and below to indicate the high and low prices for the period. The body is typically colored differently (often green/white for up moves and red/black for down moves) to quickly convey whether the price closed higher or lower than it opened during that time frame. Investopedia / Sabrina Jiang Support and resistance: These are horizontal lines drawn on a price chart to indicate where a security's price will be unlikely to move beyond. 5 Trend analysis: This is interpreting past and present moves in the market to predict future asset prices. Historical prices and trading volume are the most often used. 6 Each element allows investors to analyze a share or market's behavior. Criticisms of Technical Analysis Trying to predict stock prices based on past trading data has long been a topic of heated discussion, with many academics and professional investors being skeptical about its effectiveness. Imagine trying to predict tomorrow's weather just by looking at past weather patterns. That's somewhat akin to what technical analysts do with stock prices. Skepticism of the Efficiency of Markets One of the main criticisms of technical analysis is that it goes against the efficient market hypothesis. 7 This economic theory suggests that stock prices already reflect all available information, making it impossible to consistently beat the market using any predefined strategy. Critics argue that even if technical analysis really worked, everyone would use it, and its advantages would quickly disappear. However, proponents of technical analysis counter that markets aren't always perfectly efficient, and that there's value in analyzing price trends and trading patterns. Supposed Non-Objectivity of Technical Analysis Another point of contention is the often subjective nature of technical analysis. Much like seeing shapes in clouds, different analysts might interpret the same chart patterns differently, leading to inconsistent predictions. Moreover, with so much financial data available today, there's a risk of ""overfitting,"" or finding patterns that seem meaningful but are actually just coincidences --similar to how you might flip a coin 10 times, get heads each time, and mistakenly conclude the coin is rigged. This has led to concerns about data mining, where patterns that seem to have worked in the past have no real predictive power for the future. Despite these criticisms, technical analysis remains popular among many traders and investors. Some argue that technical analysis may appear to work in some cases due to a self-fulfilling prophecy: if enough traders follow the same technical signals, their collective actions could actually move the market in the predicted direction, at least in the short term. Others point out that technical analysis can be a useful tool for understanding market psychology and sentiment. By studying price movements and trading volumes, analysts might gain insights into the emotions driving buying and selling pressure, which can be valuable for identifying resistance and support levels, and timing entry and exit points in trades. https://www.investopedia.com/ask/answers/difference-between-fundamental-and-technical-analysis/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Financial,Concept Comparison,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",I learned that Pokemon GO uses augmented reality technology. Discuss which aspects of augmented reality in Pokemon GO contribute to the health and wellness of its players.,"The promise of an augmented reality game—Pokémon GO Recent advances in technology facilitate the promoting of physical activity (1-8). This is important due to the health effect of physical activity and the reach and disseminability of technology based programs/interventions. Specifically, Pokémon GO (released in 2016) may promote a higher degree of activity than many previous exergames such as Nintendo Wii Fit (released in 2007). Pokémon GO uses augmented reality (AR), which is similar to virtual reality but the key concept for it is ‘utility’ instead of ‘presence’. Pokémon GO encourages players to walk around, to socialize, and even to make friends. AR is a promising concept in that it allows for another type of tailoring of interventions, namely geographic tailoring to an individual’s environment. According to recent studies, Pokémon GO increased physical activity and decreased sedentary behaviors (1-3); however, its long-term effect is unknown at this point. In one of the studies, players had gone back to their baseline physical activity levels within six weeks of their first installing the game (2). The real test of the technology based AR game for promoting physical activity is whether participants continue to engage in the game over longer periods of time. It only took 19 days to reach 50 million downloads and in September, 2016 Pokémon GO reached 500 million downloads. However, since September, 2016 player numbers are on the decline which raises the question if this game is following the trajectory of most technology games and only be maintained by those who are hard core gamers. Data show that respondents were somewhat more likely to be younger, white, and female; however, there were no significant demographic interactions for any behavioral indicator (1-3). At least one study indicated that Pokémon GO may be more beneficial for more obese individuals (3). It was noted that if Pokémon GO players would increase 1,000 steps daily, and this behavior change would be sustained, about 41 days of additional life expectancy would be assumed (1). So the public health impact potential is substantial. It is recommended that researchers apply theoretical constructs of health behavior theory (HBT) for behavior change to promote physical activity (6,7). For example, SuperBetter includes tailored educational elements based on HBT, such as individualized assistance and feedback on each player’s achievement/improvement. Systematic reviews report that the most prevalent theoretical constructs of health intervention games were self-monitoring, goal setting, and self-reward (6,9). Health interventions, which are designed based on theoretical frameworks, are likely to lead to longer behavior change (7). Therefore, there is a need for researchers to assess theoretical contents and gamification elements of Pokémon GO (4,5). T h e r e a r e m a n y g a m e s d e v e l o p e d i n a c a d e m i a incorporating theoretical constructs for health behavior change interventions; however, very few become popular. Limited funding for development budgets and speed of implementation including testing, publishing, and implementing in a real-world make it challenging (10). Therefore, it is worth while studying which, either entertainment-based games or educational elements- based games, is more popular, engages long-term behavior change, and elevates player’s motivation (7). In addition, in order to increase the level of scientific evidence for the interventions, it is important to develop and adopt standardized protocols in terms of interventions, populations, and outcomes. This effort eventually will allow further comparison between differently designed experimental studies to translate evidence- based interventions to gaming-based approaches (10). Collaborations between game developers, app designers, and content experts in behavior health are necessary (7). It is also recommended that researchers explore the potential benefits of applying Pokémon GO to other areas such as depression, heart disease, type 2 diabetes, etc. and to diverse study subjects such as children, elders, and people with disabilities (1,2,8,10). It has been reported that older adult players have an awareness in playing games for favorable health outcomes (8). Further research, therefore, should be conducted to identify end user’s needs assessment and specific GUI (graphical user interface) elements, develop human-centered gaming design guidelines, and evaluate usability issues. Considering the characters (the Pokémons) of Pokémon GO appear to be “on top of” the real world, not “in” the real world, players may expect another stage of mixed reality (combining AR and virtual reality) with the concept of ‘flexibility’ where their illusion is not easily broken. In other words, when we lean in close the Pokémons get larger, and when we walk around the virtual landscape changes with respect to the position in the way a real object would (like Minecraft—latest update released in 2016—as an example of an interactive virtual world). This natural and intuitive way of interaction simplifies the communication between players and Pokémon GO, especially for players who have no previous experience. Therefore, with a mixed reality interface, it is expected that Pokémon GO would have the potential to be more sustainable and effective. Even though larger robust longitudinal studies employing rigorous methodologies and further research on negative effects such as injuries, road traffic incidents, game addiction, etc. are still needed (1-3,10,11), Pokémon GO is emerging as a potentially useful tool for motivational and behavioral impacts on physical activity.","""================ ======= The promise of an augmented reality game—Pokémon GO Recent advances in technology facilitate the promoting of physical activity (1-8). This is important due to the health effect of physical activity and the reach and disseminability of technology based programs/interventions. Specifically, Pokémon GO (released in 2016) may promote a higher degree of activity than many previous exergames such as Nintendo Wii Fit (released in 2007). Pokémon GO uses augmented reality (AR), which is similar to virtual reality but the key concept for it is ‘utility’ instead of ‘presence’. Pokémon GO encourages players to walk around, to socialize, and even to make friends. AR is a promising concept in that it allows for another type of tailoring of interventions, namely geographic tailoring to an individual’s environment. According to recent studies, Pokémon GO increased physical activity and decreased sedentary behaviors (1-3); however, its long-term effect is unknown at this point. In one of the studies, players had gone back to their baseline physical activity levels within six weeks of their first installing the game (2). The real test of the technology based AR game for promoting physical activity is whether participants continue to engage in the game over longer periods of time. It only took 19 days to reach 50 million downloads and in September, 2016 Pokémon GO reached 500 million downloads. However, since September, 2016 player numbers are on the decline which raises the question if this game is following the trajectory of most technology games and only be maintained by those who are hard core gamers. Data show that respondents were somewhat more likely to be younger, white, and female; however, there were no significant demographic interactions for any behavioral indicator (1-3). At least one study indicated that Pokémon GO may be more beneficial for more obese individuals (3). It was noted that if Pokémon GO players would increase 1,000 steps daily, and this behavior change would be sustained, about 41 days of additional life expectancy would be assumed (1). So the public health impact potential is substantial. It is recommended that researchers apply theoretical constructs of health behavior theory (HBT) for behavior change to promote physical activity (6,7). For example, SuperBetter includes tailored educational elements based on HBT, such as individualized assistance and feedback on each player’s achievement/improvement. Systematic reviews report that the most prevalent theoretical constructs of health intervention games were self-monitoring, goal setting, and self-reward (6,9). Health interventions, which are designed based on theoretical frameworks, are likely to lead to longer behavior change (7). Therefore, there is a need for researchers to assess theoretical contents and gamification elements of Pokémon GO (4,5). T h e r e a r e m a n y g a m e s d e v e l o p e d i n a c a d e m i a incorporating theoretical constructs for health behavior change interventions; however, very few become popular. Limited funding for development budgets and speed of implementation including testing, publishing, and implementing in a real-world make it challenging (10). Therefore, it is worth while studying which, either entertainment-based games or educational elements- based games, is more popular, engages long-term behavior change, and elevates player’s motivation (7). In addition, in order to increase the level of scientific evidence for the interventions, it is important to develop and adopt standardized protocols in terms of interventions, populations, and outcomes. This effort eventually will allow further comparison between differently designed experimental studies to translate evidence- based interventions to gaming-based approaches (10). Collaborations between game developers, app designers, and content experts in behavior health are necessary (7). It is also recommended that researchers explore the potential benefits of applying Pokémon GO to other areas such as depression, heart disease, type 2 diabetes, etc. and to diverse study subjects such as children, elders, and people with disabilities (1,2,8,10). It has been reported that older adult players have an awareness in playing games for favorable health outcomes (8). Further research, therefore, should be conducted to identify end user’s needs assessment and specific GUI (graphical user interface) elements, develop human-centered gaming design guidelines, and evaluate usability issues. Considering the characters (the Pokémons) of Pokémon GO appear to be “on top of” the real world, not “in” the real world, players may expect another stage of mixed reality (combining AR and virtual reality) with the concept of ‘flexibility’ where their illusion is not easily broken. In other words, when we lean in close the Pokémons get larger, and when we walk around the virtual landscape changes with respect to the position in the way a real object would (like Minecraft—latest update released in 2016—as an example of an interactive virtual world). This natural and intuitive way of interaction simplifies the communication between players and Pokémon GO, especially for players who have no previous experience. Therefore, with a mixed reality interface, it is expected that Pokémon GO would have the potential to be more sustainable and effective. Even though larger robust longitudinal studies employing rigorous methodologies and further research on negative effects such as injuries, road traffic incidents, game addiction, etc. are still needed (1-3,10,11), Pokémon GO is emerging as a potentially useful tool for motivational and behavioral impacts on physical activity. https://atm.amegroups.org/article/view/14051/pdf ================ ======= I learned that Pokemon GO uses augmented reality technology. Discuss which aspects of augmented reality in Pokemon GO contribute to the health and wellness of its players. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Internet/Technology,Effect Analysis,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Could you provide three of the fastest growing chain restaurants in the United States, and tell me what has allowed them to be successful? They should have recent sales growth of at least 20%.","When people think of restaurant chains, they think of the most popular ones; McDonald's, KFC, Pizza Hut, and so on. However, the fastest-growing restaurant chains in the U.S. are names that might not be common to most eaters. On top of that, the rise of the health-conscious consumer has made an impact on what is most popular these days. The time of people not caring about what they eat is over. The following list of restaurants is ranked by sales growth. You might be surprised by what company proudly owns that coveted top spot. You might also find some investing opportunities along the way. All numbers below as of May 21, 2019. 1. Mod Pizza Sales Growth: 44.7% Total Unit Growth: 33% Estimated Sales Per Unit (ESPU) Growth: 1.2% You can guess the specialty served at this restaurant, which is the fastest-growing chain in the U.S. for the second consecutive year. Mod Pizza falls into the fast-casual food category, with the owners focused on a socially conscious platform. Mod pays above the minimum wage, donates significantly to charity, and hires people from all walks of life, including those who have spent time in rehab or prison. Mod Pizza grew 44.7% in the previous year with sales of $390.7 million. Mod Pizza opened in 2008, has over 400 locations, and is targeting total locations of 1,000 by 2024. 2. First Watch Sales Growth: 33% Total Unit Growth: 23% Estimated Sales Per Unit (ESPU) Growth: 8.8% First Watch focuses on breakfast food and caters to families. It's the fastest growing food chain in the family dining sector. The restaurant serves food that is health conscious, in tune with what customers are looking for in their dietary intake. In 2018, it was also voted one of the best places to work by the Business Intelligence Group. The company saw sales growth of 33% from the previous year and currently has over 350 locations and is targeting a total number of locations to be around 600. 3. Shake Shack Sales Growth: 27.3% Total Unit Growth: 36% Estimated Sales Per Unit (ESPU) Growth: -7.8% Shake Shack needs no introduction. It is one of the most popular burger chains in the world, with locations in many countries, and it all started from a stand in New York City. The company is a pioneer in how it attracts employees, such as testing a four-day workweek. Shake Shack saw sales growth of 27.3% from the previous year. The company is a powerhouse with over 250 locations worldwide, including 10 Shake Shacks in airports around the world. 4. Lazy Dog Sales Growth: 27.1% Total Unit Growth: 20% Estimated Sales Per Unit (ESPU) Growth: 6.3% Lazy Dog is about the atmosphere. They've created a restaurant that takes people to the Rockies with their cabin-like decor. The food focuses on popular American staples, such as burgers and ribs, and they've also tapped into the popular craft beer trend, offering plenty of craft beers to wash down all that food with. The company saw sales growth of 27.1% and operates a little over 30 restaurants in a handful of states with plans to open further across the country. 5. The Habit Burger Grill Sales Growth: 22.9% Total Unit Growth: 18% Estimated Sales Per Unit (ESPU) Growth: 2.9% The Habit Burger Grill is a fast-casual restaurant whose specialty is charbroiled burgers. They saw sales growth of 22.9% and have approximately 250 locations. In March 2020, Habit Burger Grill was bought by Yum! Brands, the same company that owns Taco Bell and KFC. 6. Raising Cane's Chicken Fingers Sales Growth: 22.5% Total Unit Growth: 13.6% Estimated Sales Per Unit (ESPU) Growth: 6.5% First opened in 1996 in Baton Rouge, La., Raising Cane's Chicken Fingers offers— you guessed it—chicken fingers (never frozen) and its own dipping sauce that employees have to swear to never reveal its components. It's the fastest growing chain focused on chicken, with sales growth of 22.5% with almost 500 locations. 7. True Food Kitchen Sales Growth: 22.2% Total Unit Growth: 19% Estimated Sales Per Unit (ESPU) Growth: -1.7% True Food Kitchen is a health-focused brand that has grown rapidly and continues to do so. Its introduced delivery, added a loyalty program, and received an infusion of capital from Oprah Winfrey. The company saw sales grow by 22.2% and has 33 locations nationwide. 8. Tropical Smoothie Cafe Sales Growth: 20.3% Total Unit Growth: 14.5% Estimated Sales Per Unit (ESPU) Growth: 4.3% As the name would note, this restaurant chain specializes in smoothies. However, as part of its growth strategy, the company has focused on food offerings that have helped spur growth. 60% of sales come from smoothies and the rest from food. The company saw sales growth of 20.3% and has 836 locations. 9. Jersey Mike's Subs Sales Growth: 17.8% Total Unit Growth: 11.2% Estimated Sales Per Unit (ESPU) Growth: 5.1% Jersey Mike’s Subs focuses on sandwiches, has grown rapidly, and has now started to work with Uber Eats and to offer drive-thru options. The company saw sales growth of 17.8% and has an astonishing 1,600 locations nationwide. 10. Blaze Fast-Fire'd Pizza Sales Growth: 17.1% Total Unit Growth: 24.9% Estimated Sales Per Unit (ESPU) Growth: -10% Blaze Fast-Fire'd Pizza focuses on pizzas and is known for its 11-inch pizza pie and has been testing a 14-inch pizza pie as well. The company is a leader in the fast-casual sector, with sales growth of 17.1% and 300 locations. The Bottom Line You might find some investment opportunities on this list, but it is also important to recognize what types of restaurant chains are growing the quickest and where food trends are moving, before making any decisions.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Could you provide three of the fastest growing chain restaurants in the United States, and tell me what has allowed them to be successful? They should have recent sales growth of at least 20%. {passage 0} ========== When people think of restaurant chains, they think of the most popular ones; McDonald's, KFC, Pizza Hut, and so on. However, the fastest-growing restaurant chains in the U.S. are names that might not be common to most eaters. On top of that, the rise of the health-conscious consumer has made an impact on what is most popular these days. The time of people not caring about what they eat is over. The following list of restaurants is ranked by sales growth. You might be surprised by what company proudly owns that coveted top spot. You might also find some investing opportunities along the way. All numbers below as of May 21, 2019. 1. Mod Pizza Sales Growth: 44.7% Total Unit Growth: 33% Estimated Sales Per Unit (ESPU) Growth: 1.2% You can guess the specialty served at this restaurant, which is the fastest-growing chain in the U.S. for the second consecutive year. Mod Pizza falls into the fast-casual food category, with the owners focused on a socially conscious platform. Mod pays above the minimum wage, donates significantly to charity, and hires people from all walks of life, including those who have spent time in rehab or prison. Mod Pizza grew 44.7% in the previous year with sales of $390.7 million. Mod Pizza opened in 2008, has over 400 locations, and is targeting total locations of 1,000 by 2024. 2. First Watch Sales Growth: 33% Total Unit Growth: 23% Estimated Sales Per Unit (ESPU) Growth: 8.8% First Watch focuses on breakfast food and caters to families. It's the fastest growing food chain in the family dining sector. The restaurant serves food that is health conscious, in tune with what customers are looking for in their dietary intake. In 2018, it was also voted one of the best places to work by the Business Intelligence Group. The company saw sales growth of 33% from the previous year and currently has over 350 locations and is targeting a total number of locations to be around 600. 3. Shake Shack Sales Growth: 27.3% Total Unit Growth: 36% Estimated Sales Per Unit (ESPU) Growth: -7.8% Shake Shack needs no introduction. It is one of the most popular burger chains in the world, with locations in many countries, and it all started from a stand in New York City. The company is a pioneer in how it attracts employees, such as testing a four-day workweek. Shake Shack saw sales growth of 27.3% from the previous year. The company is a powerhouse with over 250 locations worldwide, including 10 Shake Shacks in airports around the world. 4. Lazy Dog Sales Growth: 27.1% Total Unit Growth: 20% Estimated Sales Per Unit (ESPU) Growth: 6.3% Lazy Dog is about the atmosphere. They've created a restaurant that takes people to the Rockies with their cabin-like decor. The food focuses on popular American staples, such as burgers and ribs, and they've also tapped into the popular craft beer trend, offering plenty of craft beers to wash down all that food with. The company saw sales growth of 27.1% and operates a little over 30 restaurants in a handful of states with plans to open further across the country. 5. The Habit Burger Grill Sales Growth: 22.9% Total Unit Growth: 18% Estimated Sales Per Unit (ESPU) Growth: 2.9% The Habit Burger Grill is a fast-casual restaurant whose specialty is charbroiled burgers. They saw sales growth of 22.9% and have approximately 250 locations. In March 2020, Habit Burger Grill was bought by Yum! Brands, the same company that owns Taco Bell and KFC. 6. Raising Cane's Chicken Fingers Sales Growth: 22.5% Total Unit Growth: 13.6% Estimated Sales Per Unit (ESPU) Growth: 6.5% First opened in 1996 in Baton Rouge, La., Raising Cane's Chicken Fingers offers— you guessed it—chicken fingers (never frozen) and its own dipping sauce that employees have to swear to never reveal its components. It's the fastest growing chain focused on chicken, with sales growth of 22.5% with almost 500 locations. 7. True Food Kitchen Sales Growth: 22.2% Total Unit Growth: 19% Estimated Sales Per Unit (ESPU) Growth: -1.7% True Food Kitchen is a health-focused brand that has grown rapidly and continues to do so. Its introduced delivery, added a loyalty program, and received an infusion of capital from Oprah Winfrey. The company saw sales grow by 22.2% and has 33 locations nationwide. 8. Tropical Smoothie Cafe Sales Growth: 20.3% Total Unit Growth: 14.5% Estimated Sales Per Unit (ESPU) Growth: 4.3% As the name would note, this restaurant chain specializes in smoothies. However, as part of its growth strategy, the company has focused on food offerings that have helped spur growth. 60% of sales come from smoothies and the rest from food. The company saw sales growth of 20.3% and has 836 locations. 9. Jersey Mike's Subs Sales Growth: 17.8% Total Unit Growth: 11.2% Estimated Sales Per Unit (ESPU) Growth: 5.1% Jersey Mike’s Subs focuses on sandwiches, has grown rapidly, and has now started to work with Uber Eats and to offer drive-thru options. The company saw sales growth of 17.8% and has an astonishing 1,600 locations nationwide. 10. Blaze Fast-Fire'd Pizza Sales Growth: 17.1% Total Unit Growth: 24.9% Estimated Sales Per Unit (ESPU) Growth: -10% Blaze Fast-Fire'd Pizza focuses on pizzas and is known for its 11-inch pizza pie and has been testing a 14-inch pizza pie as well. The company is a leader in the fast-casual sector, with sales growth of 17.1% and 300 locations. The Bottom Line You might find some investment opportunities on this list, but it is also important to recognize what types of restaurant chains are growing the quickest and where food trends are moving, before making any decisions. https://www.investopedia.com/articles/markets/062615/americas-10-fastestgrowing-restaurant-chains.asp",Retail/Product,Find & Summarize,Text Transformation Draw your answer from the above text only. Do not use any external information or prior knowledge. Limit your answer to 75 words or fewer.,Why didn't The Copyright Office recommend amending copyright laws?,"Stop the Presses? Newspapers in the Digital Age During the past 20 years, more than 200 local daily newspapers have either reduced their publication frequency or ceased publishing altogether. Among those that survived, many employ a fraction of the journalists that they did at the turn of the 21st century, and many publish far fewer original, local, and investigative news stories than they did previously. As a result, in order to get local news, thousands of U.S. communities rely on “ghost newspapers” that are shells of their former selves and may rarely employ full-time professional local journalists. Researchers report that, among other societal effects, the lack of a daily newspaper to monitor local governments and publicly traded companies can lead to increased financing costs to make up for investors’ lack of trust. In 2000, daily newspaper industry revenue peaked at $89 billion, adjusted for inflation in 2020 dollars. Twenty years later, the revenue had fallen by 80%. Although some large, national newspapers continue to thrive, the newspaper industry as a whole has contracted. Websites and mobile apps enabling individuals to access news without a subscription have increased competition for readers and advertising. Between that 20-year period, revenue gains from online newspaper advertisements (from $0 to $3.1 billion) have not replaced revenue losses from print newspaper advertisements. Some technology companies both compete and collaborate with newspaper publishers for online advertising revenue. For example, in addition to competing with newspapers’ websites for display advertising revenue, Google sells ad spaces (i.e., areas on websites/mobile apps set aside for online advertisements) on behalf of online publishers. Likewise, Google buys ad spaces on behalf of companies seeking to market goods or services to consumers with advertising (i.e., advertisers). For each step of the process—known as the ad tech stack—Google earns commissions from both buyers and sellers. In January 2023, the U.S. Department of Justice joined eight states in filing a lawsuit against Google, alleging that the company is violating antitrust laws by engaging in unlawful conduct to monopolize the ad tech stack. An additional 16 states and the Commonwealth of Puerto Rico filed a similar suit in 2021. In January 2021, a judicial panel combined this suit with multiple suits filed by newspaper publishers, advertisers, and others. Google claims these allegations mischaracterize its business and the degree of competition within the ad tech stack. In addition, some online platforms—such as news aggregators (e.g., Apple News and Google News) and social media (e.g., Facebook)—can both enhance and diminish the ability of newspaper publishers to reach viewers. By acting as intermediaries between newspapers and their readers, these online platforms may increase consumers’ awareness of newspapers’ websites and prompt consumers to visit them. Alternatively, the headlines, snippets (small portions) of articles, and photographs displayed by these online platforms may dissuade consumers from visiting newspaper publishers’ own websites. This may impede the newspapers’ ability to collect data about their readers and generate revenues from their websites/mobile apps via subscriptions and advertising. The Copyright Act generally prohibits online platforms from distributing full articles from newspaper publishers without their express consent. Courts determine whether a third party’s use of copyright material violates this law on a case-by-case basis. In June 2022, the U.S. Copyright Office published a report titled Copyright Protections for Publishers at the request of several members from the U.S. Senate Committee on the Judiciary. The report assessed the viability of establishing “ancillary copyright” protections for press publishers that would require online news aggregators to pay publishers for using excerpts of their content. The Copyright Office did not recommend amending copyright laws for this purpose, noting that stakeholders who filed comments with the office emphasized that the publishers’ challenges were due more to competition issues rather than copyright issues. Some Members of 118th Congress have introduced bills that may help newspaper publishers. For example, the Advertising Middlemen Endangering Rigorous Internet Competition Accountability Act (S. 1073) would impose certain restrictions related to the ad tech stack. Online advertising revenues that would otherwise accrue to advertising technology firms could flow to the newspaper publishers who sell advertising on their papers’ websites. The Journalism Competition and Preservation Act of 2023 (S. 1094) would potentially increase the relative bargaining power of newspaper publishers. ","Stop the Presses? Newspapers in the Digital Age During the past 20 years, more than 200 local daily newspapers have either reduced their publication frequency or ceased publishing altogether. Among those that survived, many employ a fraction of the journalists that they did at the turn of the 21st century, and many publish far fewer original, local, and investigative news stories than they did previously. As a result, in order to get local news, thousands of U.S. communities rely on “ghost newspapers” that are shells of their former selves and may rarely employ full-time professional local journalists. Researchers report that, among other societal effects, the lack of a daily newspaper to monitor local governments and publicly traded companies can lead to increased financing costs to make up for investors’ lack of trust. In 2000, daily newspaper industry revenue peaked at $89 billion, adjusted for inflation in 2020 dollars. Twenty years later, the revenue had fallen by 80%. Although some large, national newspapers continue to thrive, the newspaper industry as a whole has contracted. Websites and mobile apps enabling individuals to access news without a subscription have increased competition for readers and advertising. Between that 20-year period, revenue gains from online newspaper advertisements (from $0 to $3.1 billion) have not replaced revenue losses from print newspaper advertisements. Some technology companies both compete and collaborate with newspaper publishers for online advertising revenue. For example, in addition to competing with newspapers’ websites for display advertising revenue, Google sells ad spaces (i.e., areas on websites/mobile apps set aside for online advertisements) on behalf of online publishers. Likewise, Google buys ad spaces on behalf of companies seeking to market goods or services to consumers with advertising (i.e., advertisers). For each step of the process—known as the ad tech stack—Google earns commissions from both buyers and sellers. In January 2023, the U.S. Department of Justice joined eight states in filing a lawsuit against Google, alleging that the company is violating antitrust laws by engaging in unlawful conduct to monopolize the ad tech stack. An additional 16 states and the Commonwealth of Puerto Rico filed a similar suit in 2021. In January 2021, a judicial panel combined this suit with multiple suits filed by newspaper publishers, advertisers, and others. Google claims these allegations mischaracterize its business and the degree of competition within the ad tech stack. In addition, some online platforms—such as news aggregators (e.g., Apple News and Google News) and social media (e.g., Facebook)—can both enhance and diminish the ability of newspaper publishers to reach viewers. By acting as intermediaries between newspapers and their readers, these online platforms may increase consumers’ awareness of newspapers’ websites and prompt consumers to visit them. Alternatively, the headlines, snippets (small portions) of articles, and photographs displayed by these online platforms may dissuade consumers from visiting newspaper publishers’ own websites. This may impede the newspapers’ ability to collect data about their readers and generate revenues from their websites/mobile apps via subscriptions and advertising. The Copyright Act generally prohibits online platforms from distributing full articles from newspaper publishers without their express consent. Courts determine whether a third party’s use of copyright material violates this law on a case-by-case basis. In June 2022, the U.S. Copyright Office published a report titled Copyright Protections for Publishers at the request of several members from the U.S. Senate Committee on the Judiciary. The report assessed the viability of establishing “ancillary copyright” protections for press publishers that would require online news aggregators to pay publishers for using excerpts of their content. The Copyright Office did not recommend amending copyright laws for this purpose, noting that stakeholders who filed comments with the office emphasized that the publishers’ challenges were due more to competition issues rather than copyright issues. Some Members of 118th Congress have introduced bills that may help newspaper publishers. For example, the Advertising Middlemen Endangering Rigorous Internet Competition Accountability Act (S. 1073) would impose certain restrictions related to the ad tech stack. Online advertising revenues that would otherwise accrue to advertising technology firms could flow to the newspaper publishers who sell advertising on their papers’ websites. The Journalism Competition and Preservation Act of 2023 (S. 1094) would potentially increase the relative bargaining power of newspaper publishers. Instructions: Draw your answer from the above text only. Do not use any external information or prior knowledge. Limit your answer to 75 words or fewer. Question: Why didn't The Copyright Office recommend amending copyright laws?",Legal,Fact Finding,Q&A Your answer must solely be derived from the information in the prompt itself. No outside sources or prior knowledge can be used.,Could you give me a summary of the history of sports betting from 1992 through 2011?,"Financing Uncertainty As is the case with commercial casinos, some tribal operations that expanded in recent years have had difficulty meeting or restructuring debt obligations. The Mashantucket Pequot Nation, which operates the Foxwoods casino, defaulted in 2009 and completed the restructuring of its debt of $2 billion on July 1, 2013.81 According to recent news reports, Foxwoods remains in a precarious financial position, with outstanding loans of around $1.7 billion.82 The Mohegan Tribal Gaming Authority, which refinanced $1.64 billion of long term debt in March 2012, announced layoffs involving hundreds of employees at the Mohegan Sun in several years since then.83 Because tribes are sovereign nations, there are emerging complications for lenders. For example, the Mohegan tribe’s constitution gives its Gaming Disputes Court, made up of a trial court and an appeals court, exclusive jurisdiction over disputes involving gambling. The Mohegan Sun 2015 Annual Report spelled out some of the potential legal issues: We, the Tribe and our wholly-owned subsidiaries may not be subject to, or permitted to seek protection under, the federal bankruptcy laws since an Indian tribe and we, as an instrumentality of the Tribe, may not be a “person” eligible to be a debtor under the U.S. Bankruptcy Code. Therefore, our creditors may not be able to seek liquidation of our assets or other action under federal bankruptcy laws. Also, the Gaming Disputes Court may lack powers typically associated with a federal bankruptcy court, such as the power to non-consensually alter liabilities, direct the priority of creditors’ payments and liquidate certain assets. The Gaming Disputes Court is a court of limited jurisdiction and may not have jurisdiction over all creditors of ours or our subsidiaries or over all of the territory in which we and our subsidiaries carry on business.84 An ongoing dispute between Wells Fargo Bank and Saybrook Investors LLC, and Wisconsin’s Lac du Flambeau Band of Lake Superior Chippewa Indians could affect gaming financing. Wells Fargo has sued the tribe over its failure to make monthly payments on a $50 million tribal bond to consolidate debt and invest in a riverboat casino operation in Mississippi. The U.S. District Court for the Western District of Wisconsin in 2010 found that the bond deal was invalid because it had not been reviewed by the National Indian Gaming Commission, as the court said was required under IGRA.85 The complicated and long running dispute has continued after a remand in September 2011 by the Seventh Circuit Court of Appeals.86 It may take more years and possibly afew more appeals for a ruling on the validity of the bond documents other than the bond indenture.87 Pari Mutuel Betting Legal in 43 states,88 pari mutuel betting is defined as “player banked betting with all the bets pooled and prizes awarded from the pool.”89 The most common examples in the United States are dog and horse racing and jai alai (a game played on a court with a ball and wicker racket), and other sporting events in which participants finish in ranked order. In recent years, the industry has developed an extensive system of Internet and off track wagering. In 2000, Congress approved legislation to amend the definition of “interstate off track wager” in the Interstate Horseracing Act (15 U.S.C. §§3001 3007). Proponents claim the amendment permits tracks to accept bets online from individuals located in states where pari mutuel betting is legal (although not necessarily where either off track or online betting is legal); the Department of Justice disagrees.90 A bill introduced in the 114th Congress, H.R. 707, would have clarified that the Wire Act and other laws do not apply to the Interstate Horseracing Act. Despite the legal uncertainty, interstate pari mutuel betting with remote devices is growing through the use of advance deposit wagering (ADW). Players first set up accounts with companies such as Twinspires (owned by the Churchill Downs racetrack), Xpressbet, or TV Games Network. They then use the accounts to place bets on races over the phone, on a computer, with mobile devices, or with set top remote control devices linked to television channels that broadcast horse racing. The Oregon Racing Commission, which licenses and audits many of the largest firms taking advance deposit wagers, reports that online wagering via its licensed companies rose to $2.9 billion in 2015, from $962 million in 2005.91 Sports Betting Congress in 1992 passed the Professional and Amateur Sports Protection Act (PASPA; P.L. 102 559) with strong support from the National Basketball Association, the National Football League (NFL), Major League Baseball, the National Hockey League, and the National Collegiate Athletic Association, among others. The law generally barred state governments from licensing, sponsoring, operating, advertising, promoting, or engaging in sports gambling.92 It contained exceptions for Nevada, Oregon, Delaware, and Montana, each of which allowed certain types ofsports betting at the time of passage.93 New Jersey failed to pass legislation in time to qualify for the PASPA exemption. Currently, Nevada is the only state to permit wagers on a full complement of sporting events and leagues.94 According to the University of Nevada, Las Vegas Center for Gaming Research, casino goers in Nevada wagered about $4.2 billion on sporting events in 2015, a rise from $3.4 billion in 2012.95 Delaware, which allowed only limited multigame or parlay betting96 on NFL contests at the time the 1992 law was passed, enacted a law in 2009 to create a state sports lottery. The NFL and other sports leagues challenged the law, and the U.S. Third Circuit Court of Appeals ruled that the state was limited to offering narrow betting, similar to what existed in 1992. The U.S. Supreme Court in May 2010 declined to hear an appeal, effectively ending Delaware’s effort to expand sports betting.97 After its voters authorized sports betting at casinos and racetracks in 2011, New Jersey mounted other court challenges to the constitutionality of PASPA.98 In February 2016, the U.S. Third Circuit Court of Appeals ruled that New Jersey’s sports wagering law conflicts with PASPA and could not be implemented.99 The Supreme Court may consider whether to hear New Jersey’s appeal of the lower court ruling.100 According to an estimate by AGA, Americans spent around $150 billion on illegal sports betting in 2015.101 Two bills have been introduced in the 114th Congress related to sports gambling. The New Jersey Betting and Equal Treatment Act of 2015 (H.R. 457) would expressly exempt New Jersey from PASPA. The Sports Gaming Opportunity Act (H.R. 416) would create an exemption from the PASPA prohibitions for any state that establishes sports gambling through laws enacted on or after January 1, 2015, and that go into effect no later than January 1, 2019. Regulation of Internet Gambling Federal Internet gambling legislation could benefit some sectors of the gambling industry more than others, depending on how it is crafted. State lottery officials, for example, have expressed concern that proposals that would give existing gambling establishments preference for online poker licenses could give those businesses an advantage in the market.102 By the same token, commercial casinos are worried that under the existing legal framework, online state lottery promotions, such as keno type games, could encroach on their turf. If the United States passes federal online gambling legislation and all states opt in during the next 12 months, H2 Gambling Capital predicts a U.S. online gambling market of $15 billion to $16 billion by 2021.103 Interest groups and gambling companies are at odds over remote gambling. One of the strongest proponents of legalized online poker is the Poker Players Alliance.104 Caesars Entertainment and MGM are among the large casino operators that have urged Congress to adopt federal legislation to regulate Internet gambling to avoid a patchwork of state regulations and different tax rates. These interests formed the Coalition for Consumer and Online Protection in 2014.105 Aligned against them are others, including most prominently the Coalition to Stop Internet Gambling.106 The North American Association of State and Provincial Lotteries (NASPL)107 and the National Conference of State Legislatures (NCSL)108 want individual states to have the right to legalize, license, and tax Internet gambling.109 In 2015, the National Council of Legislators from Gaming States (NCLGS) adopted a list of 10 policy standards for Internet gambling legislation addressing topics such as player protections, taxation, licensing, enforcement, payment processing, and geolocation standards.110 The National Governors Association largely echoes this view, and it has called on lawmakers to include state input before acting on any online gambling legislation.111 Many Indian tribes have declared their opposition to any federal gambling regime, although some of the larger tribes are now beginning to reverse their previous positions, viewing online gambling as a possible business opportunity.","System instruction: [Your answer must solely be derived from the information in the prompt itself. No outside sources or prior knowledge can be used.] question: [Could you give me a summary of the history of sports betting from 1992 through 2011?] context: [Financing Uncertainty As is the case with commercial casinos, some tribal operations that expanded in recent years have had difficulty meeting or restructuring debt obligations. The Mashantucket Pequot Nation, which operates the Foxwoods casino, defaulted in 2009 and completed the restructuring of its debt of $2 billion on July 1, 2013.81 According to recent news reports, Foxwoods remains in a precarious financial position, with outstanding loans of around $1.7 billion.82 The Mohegan Tribal Gaming Authority, which refinanced $1.64 billion of long term debt in March 2012, announced layoffs involving hundreds of employees at the Mohegan Sun in several years since then.83 Because tribes are sovereign nations, there are emerging complications for lenders. For example, the Mohegan tribe’s constitution gives its Gaming Disputes Court, made up of a trial court and an appeals court, exclusive jurisdiction over disputes involving gambling. The Mohegan Sun 2015 Annual Report spelled out some of the potential legal issues: We, the Tribe and our wholly-owned subsidiaries may not be subject to, or permitted to seek protection under, the federal bankruptcy laws since an Indian tribe and we, as an instrumentality of the Tribe, may not be a “person” eligible to be a debtor under the U.S. Bankruptcy Code. Therefore, our creditors may not be able to seek liquidation of our assets or other action under federal bankruptcy laws. Also, the Gaming Disputes Court may lack powers typically associated with a federal bankruptcy court, such as the power to non-consensually alter liabilities, direct the priority of creditors’ payments and liquidate certain assets. The Gaming Disputes Court is a court of limited jurisdiction and may not have jurisdiction over all creditors of ours or our subsidiaries or over all of the territory in which we and our subsidiaries carry on business.84 An ongoing dispute between Wells Fargo Bank and Saybrook Investors LLC, and Wisconsin’s Lac du Flambeau Band of Lake Superior Chippewa Indians could affect gaming financing. Wells Fargo has sued the tribe over its failure to make monthly payments on a $50 million tribal bond to consolidate debt and invest in a riverboat casino operation in Mississippi. The U.S. District Court for the Western District of Wisconsin in 2010 found that the bond deal was invalid because it had not been reviewed by the National Indian Gaming Commission, as the court said was required under IGRA.85 The complicated and long running dispute has continued after a remand in September 2011 by the Seventh Circuit Court of Appeals.86 It may take more years and possibly afew more appeals for a ruling on the validity of the bond documents other than the bond indenture.87 Pari Mutuel Betting Legal in 43 states,88 pari mutuel betting is defined as “player banked betting with all the bets pooled and prizes awarded from the pool.”89 The most common examples in the United States are dog and horse racing and jai alai (a game played on a court with a ball and wicker racket), and other sporting events in which participants finish in ranked order. In recent years, the industry has developed an extensive system of Internet and off track wagering. In 2000, Congress approved legislation to amend the definition of “interstate off track wager” in the Interstate Horseracing Act (15 U.S.C. §§3001 3007). Proponents claim the amendment permits tracks to accept bets online from individuals located in states where pari mutuel betting is legal (although not necessarily where either off track or online betting is legal); the Department of Justice disagrees.90 A bill introduced in the 114th Congress, H.R. 707, would have clarified that the Wire Act and other laws do not apply to the Interstate Horseracing Act. Despite the legal uncertainty, interstate pari mutuel betting with remote devices is growing through the use of advance deposit wagering (ADW). Players first set up accounts with companies such as Twinspires (owned by the Churchill Downs racetrack), Xpressbet, or TV Games Network. They then use the accounts to place bets on races over the phone, on a computer, with mobile devices, or with set top remote control devices linked to television channels that broadcast horse racing. The Oregon Racing Commission, which licenses and audits many of the largest firms taking advance deposit wagers, reports that online wagering via its licensed companies rose to $2.9 billion in 2015, from $962 million in 2005.91 Sports Betting Congress in 1992 passed the Professional and Amateur Sports Protection Act (PASPA; P.L. 102 559) with strong support from the National Basketball Association, the National Football League (NFL), Major League Baseball, the National Hockey League, and the National Collegiate Athletic Association, among others. The law generally barred state governments from licensing, sponsoring, operating, advertising, promoting, or engaging in sports gambling.92 It contained exceptions for Nevada, Oregon, Delaware, and Montana, each of which allowed certain types ofsports betting at the time of passage.93 New Jersey failed to pass legislation in time to qualify for the PASPA exemption. Currently, Nevada is the only state to permit wagers on a full complement of sporting events and leagues.94 According to the University of Nevada, Las Vegas Center for Gaming Research, casino goers in Nevada wagered about $4.2 billion on sporting events in 2015, a rise from $3.4 billion in 2012.95 Delaware, which allowed only limited multigame or parlay betting96 on NFL contests at the time the 1992 law was passed, enacted a law in 2009 to create a state sports lottery. The NFL and other sports leagues challenged the law, and the U.S. Third Circuit Court of Appeals ruled that the state was limited to offering narrow betting, similar to what existed in 1992. The U.S. Supreme Court in May 2010 declined to hear an appeal, effectively ending Delaware’s effort to expand sports betting.97 After its voters authorized sports betting at casinos and racetracks in 2011, New Jersey mounted other court challenges to the constitutionality of PASPA.98 In February 2016, the U.S. Third Circuit Court of Appeals ruled that New Jersey’s sports wagering law conflicts with PASPA and could not be implemented.99 The Supreme Court may consider whether to hear New Jersey’s appeal of the lower court ruling.100 According to an estimate by AGA, Americans spent around $150 billion on illegal sports betting in 2015.101 Two bills have been introduced in the 114th Congress related to sports gambling. The New Jersey Betting and Equal Treatment Act of 2015 (H.R. 457) would expressly exempt New Jersey from PASPA. The Sports Gaming Opportunity Act (H.R. 416) would create an exemption from the PASPA prohibitions for any state that establishes sports gambling through laws enacted on or after January 1, 2015, and that go into effect no later than January 1, 2019. Regulation of Internet Gambling Federal Internet gambling legislation could benefit some sectors of the gambling industry more than others, depending on how it is crafted. State lottery officials, for example, have expressed concern that proposals that would give existing gambling establishments preference for online poker licenses could give those businesses an advantage in the market.102 By the same token, commercial casinos are worried that under the existing legal framework, online state lottery promotions, such as keno type games, could encroach on their turf. If the United States passes federal online gambling legislation and all states opt in during the next 12 months, H2 Gambling Capital predicts a U.S. online gambling market of $15 billion to $16 billion by 2021.103 Interest groups and gambling companies are at odds over remote gambling. One of the strongest proponents of legalized online poker is the Poker Players Alliance.104 Caesars Entertainment and MGM are among the large casino operators that have urged Congress to adopt federal legislation to regulate Internet gambling to avoid a patchwork of state regulations and different tax rates. These interests formed the Coalition for Consumer and Online Protection in 2014.105 Aligned against them are others, including most prominently the Coalition to Stop Internet Gambling.106 The North American Association of State and Provincial Lotteries (NASPL)107 and the National Conference of State Legislatures (NCSL)108 want individual states to have the right to legalize, license, and tax Internet gambling.109 In 2015, the National Council of Legislators from Gaming States (NCLGS) adopted a list of 10 policy standards for Internet gambling legislation addressing topics such as player protections, taxation, licensing, enforcement, payment processing, and geolocation standards.110 The National Governors Association largely echoes this view, and it has called on lawmakers to include state input before acting on any online gambling legislation.111 Many Indian tribes have declared their opposition to any federal gambling regime, although some of the larger tribes are now beginning to reverse their previous positions, viewing online gambling as a possible business opportunity.]",Internet/Technology,Explanation/Definition,Q&A "This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Use complete sentences. Do not use bullet points. Do not use the words ""pros"" and ""cons"" in your response. Draw your answer from the below text only",Is increasing pay for IMA work by up to 15% a good idea? Respond in under 100 words.,"Chapter 3: Remuneration of IMA Work Question 1: Do you agree with our proposal to pay higher fees for IMB Work? Please state yes/no/maybe and provide reasons. Question 2: We are evaluating the possibility of increasing fees for IMB Work by up to 15% compared to the current immigration legal aid fees. Within the range of up to 15%, what percentage increase do you believe would be appropriate? Consultation summary 31. In total there were 38 responses to both Question 1 and Question 2. Of the 38 responses to Question 1, 17 agreed with the proposal to pay higher fees for IMA work (45%), 11 disagreed with the proposal (29%) and 10 responded with ‘maybe’ (26%). Of these, 34 respondents went on to provide reasons for their answer. 32. Most respondents agreed with the Government’s proposal to pay higher fees for IMA Work but disagreed with the ‘up to 15%’ fee level and the focus on IMA Work. Upon analysis, the overall sentiment of responses was negative (36 respondents, 95%). Of the remaining responses (two respondents, 5%), one gave a neutral response and another respondent gave a positive response – however no additional comments were given. 33. There were many reasons given for why respondents either disagreed with the proposal or agreed with the proposal overall but had a negative sentiment. These have been summarised below. Fee level 34. Most respondents agreed with the Government’s proposal to pay higher fees for IMA Work but disagreed with the ‘up to 15%’ fee level, with only two respondents (5%) agreeing with the ‘up to’ 15% rise. A reason given by one of these respondents was that ‘lawyers/barristers do very hard important work and should be paid more to reflect huge responsibility that comes with doing [IMA] work’. 35. There were varying views about what fee level should be required, but over half of respondents stated that 15% is either insufficient or inappropriate, should be the minimum increase and/or that the fee level should be higher than 15%. Many Legal Aid Fees in the Illegal Migration Act: The Government’s response to the consultation on fees in relation to the Illegal Migration Act 12 respondents did not provide an alternative rate, but of those that did, increases ranged from 50% to 150% – these included that fees should be: • 50% (six respondents); • raised in line with inflation (three respondents); • 50% for regular work carried out under the IMA; but raised to 100% for any work that progresses to the High Court or beyond (three respondents); and • 100–150%: reflective of inflation, and the lack of increases and subsequent cuts to fees over the years (three respondents). 36. Of those who said 15% was insufficient or inappropriate, or that a higher rate should be pursued, there were a multitude of reasons that formed the basis of this response. For example, respondents stated that 15% would not incentivise capacity and that increasing legal aid fees by ‘up to 15%’ was insufficient to reflect increased caseload, and its subsequent impact on capacity within an already ‘overstretched’ sector. Views were also raised that the proposed increase would not be sufficient to ‘address the challenges the consultation identified’, especially considering the short timeframe for making a suspensive claim (eight days). Another view was raised by respondents around the expected complexity of the work. 37. Respondents also stated that 15% higher fees for IMA Work was insufficient because legal aid rates have not increased, nor been augmented in line with inflation, since 1996 and furthermore were cut by 10% in 2011. One provider noted that 15% ‘does little more than address inflationary increases in costs that providers have had to absorb over the last two years’. Some also noted the depreciation of legal aid fees over time. Respondents also remarked on a difference in levels of legal aid capacity across different areas of the UK as an increasing challenge. 38. However, two respondents stated that an increase less than 15% should be pursued. One stated that it should be 0% as the Government should move to ‘fixed competitive fees’ acquired by chambers bidding. The other stated it should be 3% on the basis that legal aid should be a fixed amount no matter the demand. Scope of fee proposal 39. Some respondents suggested that the proposal should not be restricted to work done under the IMA. Eight respondents said that the fee increase should be expanded to all immigration legal aid (21%), two suggested that it should be expanded to all civil legal aid (5%), and one suggested it should be expanded to all legal aid (3%). Three other respondents raised the restrictive nature of the proposal but did not provide further detail. Legal Aid Fees in the Illegal Migration Act: The Government’s response to the consultation on fees in relation to the Illegal Migration Act 13 40. Views included that a raise in fees for IMA Work only could ‘encourage a shift to this work by providers, away from other essential work that needs to be done’ and could lead to ‘perverse’ incentives to undertake this work, to the detriment of other immigration work. Additional measures 41. Across Questions 1 and 2, respondents stated that additional measures would be required to improve the effectiveness of the 15% increase. The further measures mentioned included: accreditation, interpreter fees and disbursements. Some also stated that additional measures were needed but did not specify further. Those responses have been summarised in Chapter 4. Wider stakeholder feedback 42. At the stakeholder engagement events, on costs and fees many stakeholders noted that the fees uplift should be expanded beyond IMA Work. They also shared the view that limiting the uplift to IMA Work could risk shifting capacity away from other policy priority areas and aggravate access to legal aid for other migrants. Several stakeholders also noted that the 15% uplift is not high enough to increase capacity and suggested increasing fees in line with inflation (which amounts to a 100% uplift.) Other proposals included paying between £150–250 per hour as the adequate compensation level that could incentivise providers and help build capacity. 43. In addition to the roundtable sessions, we also received an open letter from 66 providers who shared their views about the civil legal aid sector and provided various capacity building measures, such as increasing hourly rates for all legal aid Controlled Work in line with inflation since 1996 (based on the Bank of England inflation calculator, this comes to around £100 an hour). They further called for a 50% uplift on work undertaken under the IMA, on top of inflationary increases set out above, to enable providers to train new staff and take on this work at pace.","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Use complete sentences. Do not use bullet points. Do not use the words ""pros"" and ""cons"" in your response. Draw your answer from the below text only Chapter 3: Remuneration of IMA Work Question 1: Do you agree with our proposal to pay higher fees for IMB Work? Please state yes/no/maybe and provide reasons. Question 2: We are evaluating the possibility of increasing fees for IMB Work by up to 15% compared to the current immigration legal aid fees. Within the range of up to 15%, what percentage increase do you believe would be appropriate? Consultation summary 31. In total there were 38 responses to both Question 1 and Question 2. Of the 38 responses to Question 1, 17 agreed with the proposal to pay higher fees for IMA work (45%), 11 disagreed with the proposal (29%) and 10 responded with ‘maybe’ (26%). Of these, 34 respondents went on to provide reasons for their answer. 32. Most respondents agreed with the Government’s proposal to pay higher fees for IMA Work but disagreed with the ‘up to 15%’ fee level and the focus on IMA Work. Upon analysis, the overall sentiment of responses was negative (36 respondents, 95%). Of the remaining responses (two respondents, 5%), one gave a neutral response and another respondent gave a positive response – however no additional comments were given. 33. There were many reasons given for why respondents either disagreed with the proposal or agreed with the proposal overall but had a negative sentiment. These have been summarised below. Fee level 34. Most respondents agreed with the Government’s proposal to pay higher fees for IMA Work but disagreed with the ‘up to 15%’ fee level, with only two respondents (5%) agreeing with the ‘up to’ 15% rise. A reason given by one of these respondents was that ‘lawyers/barristers do very hard important work and should be paid more to reflect huge responsibility that comes with doing [IMA] work’. 35. There were varying views about what fee level should be required, but over half of respondents stated that 15% is either insufficient or inappropriate, should be the minimum increase and/or that the fee level should be higher than 15%. Many Legal Aid Fees in the Illegal Migration Act: The Government’s response to the consultation on fees in relation to the Illegal Migration Act 12 respondents did not provide an alternative rate, but of those that did, increases ranged from 50% to 150% – these included that fees should be: • 50% (six respondents); • raised in line with inflation (three respondents); • 50% for regular work carried out under the IMA; but raised to 100% for any work that progresses to the High Court or beyond (three respondents); and • 100–150%: reflective of inflation, and the lack of increases and subsequent cuts to fees over the years (three respondents). 36. Of those who said 15% was insufficient or inappropriate, or that a higher rate should be pursued, there were a multitude of reasons that formed the basis of this response. For example, respondents stated that 15% would not incentivise capacity and that increasing legal aid fees by ‘up to 15%’ was insufficient to reflect increased caseload, and its subsequent impact on capacity within an already ‘overstretched’ sector. Views were also raised that the proposed increase would not be sufficient to ‘address the challenges the consultation identified’, especially considering the short timeframe for making a suspensive claim (eight days). Another view was raised by respondents around the expected complexity of the work. 37. Respondents also stated that 15% higher fees for IMA Work was insufficient because legal aid rates have not increased, nor been augmented in line with inflation, since 1996 and furthermore were cut by 10% in 2011. One provider noted that 15% ‘does little more than address inflationary increases in costs that providers have had to absorb over the last two years’. Some also noted the depreciation of legal aid fees over time. Respondents also remarked on a difference in levels of legal aid capacity across different areas of the UK as an increasing challenge. 38. However, two respondents stated that an increase less than 15% should be pursued. One stated that it should be 0% as the Government should move to ‘fixed competitive fees’ acquired by chambers bidding. The other stated it should be 3% on the basis that legal aid should be a fixed amount no matter the demand. Scope of fee proposal 39. Some respondents suggested that the proposal should not be restricted to work done under the IMA. Eight respondents said that the fee increase should be expanded to all immigration legal aid (21%), two suggested that it should be expanded to all civil legal aid (5%), and one suggested it should be expanded to all legal aid (3%). Three other respondents raised the restrictive nature of the proposal but did not provide further detail. Legal Aid Fees in the Illegal Migration Act: The Government’s response to the consultation on fees in relation to the Illegal Migration Act 13 40. Views included that a raise in fees for IMA Work only could ‘encourage a shift to this work by providers, away from other essential work that needs to be done’ and could lead to ‘perverse’ incentives to undertake this work, to the detriment of other immigration work. Additional measures 41. Across Questions 1 and 2, respondents stated that additional measures would be required to improve the effectiveness of the 15% increase. The further measures mentioned included: accreditation, interpreter fees and disbursements. Some also stated that additional measures were needed but did not specify further. Those responses have been summarised in Chapter 4. Wider stakeholder feedback 42. At the stakeholder engagement events, on costs and fees many stakeholders noted that the fees uplift should be expanded beyond IMA Work. They also shared the view that limiting the uplift to IMA Work could risk shifting capacity away from other policy priority areas and aggravate access to legal aid for other migrants. Several stakeholders also noted that the 15% uplift is not high enough to increase capacity and suggested increasing fees in line with inflation (which amounts to a 100% uplift.) Other proposals included paying between £150–250 per hour as the adequate compensation level that could incentivise providers and help build capacity. 43. In addition to the roundtable sessions, we also received an open letter from 66 providers who shared their views about the civil legal aid sector and provided various capacity building measures, such as increasing hourly rates for all legal aid Controlled Work in line with inflation since 1996 (based on the Bank of England inflation calculator, this comes to around £100 an hour). They further called for a 50% uplift on work undertaken under the IMA, on top of inflationary increases set out above, to enable providers to train new staff and take on this work at pace. Is increasing pay for IMA work by up to 15% a good idea? Respond in under 100 words.",Legal,Pros & Cons,Q&A "The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, ""The information is not available at this time.""",What impact does the FDA expect the nonprescription availability of Opill to have on unintended pregnancies?,"3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA FDA NEWS RELEASE FDA Approves First Nonprescription Daily Oral Contraceptive For Immediate Release: July 13, 2023 Espanol (https:/Awww.fda.gov/news-events/press-announcements/la-fda-aprueba-el-primer-anticonceptivo-oral-diario-sin-receta) Today, the U.S. Food and Drug Administration approved Opill (norgestrel) tablet for nonprescription use to prevent pregnancy— the first daily oral contraceptive approved for use in the U.S. without a prescription. Approval of this progestin-only oral contraceptive pill provides an option for consumers to purchase oral contraceptive medicine without a prescription at drug stores, convenience stores and grocery stores, as well as online. The timeline for availability and price of this nonprescription product is determined by the manufacturer. Other approved formulations and dosages of other oral contraceptives will remain available by prescription only. “Today’s approval marks the first time a nonprescription daily oral contraceptive will be an available option for millions of people in the United States,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research. “When used as directed, daily oral contraception is safe and is expected to be more effective than currently available nonprescription contraceptive methods in preventing unintended pregnancy.” Nonprescription availability of Opill may reduce barriers to access by allowing individuals to obtain an oral contraceptive without the need to first see a health care provider. Almost half of the 6.1 million pregnancies in the U.S. each year are unintended. Unintended pregnancies have been linked to negative maternal and perinatal outcomes, including reduced likelihood of receiving early prenatal care and increased risk of preterm delivery, with associated adverse neonatal, developmental and child health outcomes. Availability of nonprescription Opill may help reduce the number of unintended pregnancies and their potential negative impacts. The contraceptive efficacy of norgestrel was established with the original approval for prescription use in 1973. ription-nonprescription-rx-ote-switches) to switch norgestrel from a prescription to an over-the- counter product. For approval of a product for use in the nonprescription setting, the FDA requires that the applicant demonstrate (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/0170310rigisogiSumR.pdf) that the product can be used by consumers safely and effectively, relying only on the nonprescription drug labeling without any assistance from a health care professional. Studies showed that consumer understanding of information on the Opill Drug Facts label was high overall and that a high proportion of consumers understood the label instructions, supporting their ability to properly use the drug when it is available as an over-the-counter product. When properly used, Opill is safe and effective. https:/Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA Opill should be taken at the same time every day; adherence to daily use at the same time of day is important for the effectiveness of Opill. Using medications that interact with Opill can result in decreased efficacy of Opill or the other medication, or both, potentially resulting in unintended pregnancy. The most common side effects of Opill include irregular bleeding, headaches, dizziness, nausea, increased appetite, abdominal pain, cramps or bloating. Opill should not be used by those who have or have ever had breast cancer. Consumers who have any other form of cancer should ask a doctor before use. Opill also should not be used together with another hormonal birth control product such as another oral contraceptive tablet, a vaginal ring, a contraceptive patch, a contraceptive implant, a contraceptive injection or an IUD (intra-uterine device). Use of Opill may be associated with changes in vaginal bleeding patterns, such as irregular spotting and prolonged bleeding. Consumers should inform a health care provider if they develop repeated vaginal bleeding after sex, or prolonged episodes of bleeding or amenorrhea (absence of menstrual period). Individuals who miss two periods (or have missed a single period and have missed doses of Opill) or suspect they may be pregnant should take a pregnancy test. Consumers should discontinue Opill if pregnancy is confirmed. Opill is not for use as emergency contraception and does not prevent pregnancy after unprotected sex. Oral contraceptives do not protect against transmission of HIV, AIDS and other sexually transmitted diseases such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B and syphilis. Condoms should be used to prevent sexually transmitted diseases. The FDA granted the approval to Laboratoire HRA Pharma, recently acquired by Perrigo Company ple. Related Information * Drugs@FDA: Opill (http://www.accessdata.fda.gov/scripts/cder/daf/index.cfm? event=overview.process&varAppINo=017031), * Decisional Memo (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/0170310rigisog1SumR.pdf) © Opill (0.075mg Oral Norgestrel Tablet) Information (http://www.fda.gov/drugs/postmarket-drug-safety- information-patients-and-providers/opill-oo75mg-oral-norgestrel-tablet-information), HEF The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products. Inquiries Media: Jeremy Kahn (mailto: Jeremy. kahn@fda.hhs.gov) & (301) 796-8671 https:/Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA Consumer: &. 888-INFO-FDA Was this helpful? @ More Press Announcements (/news-events/newsroom/press-announcements) https://Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/3","The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, ""The information is not available at this time."" What impact does the FDA expect the nonprescription availability of Opill to have on unintended pregnancies? 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA FDA NEWS RELEASE FDA Approves First Nonprescription Daily Oral Contraceptive For Immediate Release: July 13, 2023 Espanol (https:/Awww.fda.gov/news-events/press-announcements/la-fda-aprueba-el-primer-anticonceptivo-oral-diario-sin-receta) Today, the U.S. Food and Drug Administration approved Opill (norgestrel) tablet for nonprescription use to prevent pregnancy— the first daily oral contraceptive approved for use in the U.S. without a prescription. Approval of this progestin-only oral contraceptive pill provides an option for consumers to purchase oral contraceptive medicine without a prescription at drug stores, convenience stores and grocery stores, as well as online. The timeline for availability and price of this nonprescription product is determined by the manufacturer. Other approved formulations and dosages of other oral contraceptives will remain available by prescription only. “Today’s approval marks the first time a nonprescription daily oral contraceptive will be an available option for millions of people in the United States,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research. “When used as directed, daily oral contraception is safe and is expected to be more effective than currently available nonprescription contraceptive methods in preventing unintended pregnancy.” Nonprescription availability of Opill may reduce barriers to access by allowing individuals to obtain an oral contraceptive without the need to first see a health care provider. Almost half of the 6.1 million pregnancies in the U.S. each year are unintended. Unintended pregnancies have been linked to negative maternal and perinatal outcomes, including reduced likelihood of receiving early prenatal care and increased risk of preterm delivery, with associated adverse neonatal, developmental and child health outcomes. Availability of nonprescription Opill may help reduce the number of unintended pregnancies and their potential negative impacts. The contraceptive efficacy of norgestrel was established with the original approval for prescription use in 1973. ription-nonprescription-rx-ote-switches) to switch norgestrel from a prescription to an over-the- counter product. For approval of a product for use in the nonprescription setting, the FDA requires that the applicant demonstrate (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/0170310rigisogiSumR.pdf) that the product can be used by consumers safely and effectively, relying only on the nonprescription drug labeling without any assistance from a health care professional. Studies showed that consumer understanding of information on the Opill Drug Facts label was high overall and that a high proportion of consumers understood the label instructions, supporting their ability to properly use the drug when it is available as an over-the-counter product. When properly used, Opill is safe and effective. https:/Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA Opill should be taken at the same time every day; adherence to daily use at the same time of day is important for the effectiveness of Opill. Using medications that interact with Opill can result in decreased efficacy of Opill or the other medication, or both, potentially resulting in unintended pregnancy. The most common side effects of Opill include irregular bleeding, headaches, dizziness, nausea, increased appetite, abdominal pain, cramps or bloating. Opill should not be used by those who have or have ever had breast cancer. Consumers who have any other form of cancer should ask a doctor before use. Opill also should not be used together with another hormonal birth control product such as another oral contraceptive tablet, a vaginal ring, a contraceptive patch, a contraceptive implant, a contraceptive injection or an IUD (intra-uterine device). Use of Opill may be associated with changes in vaginal bleeding patterns, such as irregular spotting and prolonged bleeding. Consumers should inform a health care provider if they develop repeated vaginal bleeding after sex, or prolonged episodes of bleeding or amenorrhea (absence of menstrual period). Individuals who miss two periods (or have missed a single period and have missed doses of Opill) or suspect they may be pregnant should take a pregnancy test. Consumers should discontinue Opill if pregnancy is confirmed. Opill is not for use as emergency contraception and does not prevent pregnancy after unprotected sex. Oral contraceptives do not protect against transmission of HIV, AIDS and other sexually transmitted diseases such as chlamydia, genital herpes, genital warts, gonorrhea, hepatitis B and syphilis. Condoms should be used to prevent sexually transmitted diseases. The FDA granted the approval to Laboratoire HRA Pharma, recently acquired by Perrigo Company ple. Related Information * Drugs@FDA: Opill (http://www.accessdata.fda.gov/scripts/cder/daf/index.cfm? event=overview.process&varAppINo=017031), * Decisional Memo (https://www.accessdata.fda.gov/drugsatfda_docs/nda/2023/0170310rigisog1SumR.pdf) © Opill (0.075mg Oral Norgestrel Tablet) Information (http://www.fda.gov/drugs/postmarket-drug-safety- information-patients-and-providers/opill-oo75mg-oral-norgestrel-tablet-information), HEF The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products. Inquiries Media: Jeremy Kahn (mailto: Jeremy. kahn@fda.hhs.gov) & (301) 796-8671 https:/Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/10/24, 10:58 AM FDA Approves First Nonprescription Daily Oral Contraceptive | FDA Consumer: &. 888-INFO-FDA Was this helpful? @ More Press Announcements (/news-events/newsroom/press-announcements) https://Awww.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive 3/3",Medical,Effect Analysis,Q&A Please limit your knowledge to the document. Avoid generalizations and ensure accuracy by directly referencing the document's arguments and examples.,What optional mitigations does the NSA recommend for Windows infrastructures against BlackLotus?,"National Security Agency | Cybersecurity Information BlackLotus Mitigation Guide Executive summary BlackLotus is a recently publicized malware product garnering significant attention within tech media. Similar to 2020’s BootHole (CVE-2020-10713), BlackLotus takes advantage of a boot loader flaw—specifically CVE-2022-21894 Secure Boot bypass known as “Baton Drop”—to take control of an endpoint from the earliest phase of software boot. Microsoft ® issued patches for supported versions of Windows to correct boot loader logic. However, patches were not issued to revoke trust in unpatched boot loaders via the Secure Boot Deny List Database (DBX). Administrators should not consider the threat fully remediated as boot loaders vulnerable to Baton Drop are still trusted by Secure Boot. As described in this Cybersecurity Information Sheet (CSI), NSA recommends infrastructure owners take action by hardening user executable policies and monitoring the integrity of the boot partition. An optional advanced mitigation is to customize Secure Boot policy by adding DBX records to Windows® endpoints or removing the Windows Production CA certificate from Linux® endpoints. BlackLotus boot security threat NSA recognizes significant confusion regarding the threat posed by BlackLotus. Some organizations use terms like “unstoppable,” “unkillable,” and “unpatchable” to describe the threat. Other organizations believe there is no threat due to patches that Microsoft released in January 2022 and early 2023 for supported versions of Windows. [1] The risk exists somewhere between both extremes. BlackLotus shares some characteristics with Boot Hole (CVE-2020-10713). [2] Instead of breaking the Linux boot security chain, BlackLotus targets Windows boot by exploiting a flaw in older boot loaders—also called boot managers—to set off a chain of malicious actions that compromise endpoint security. Exploitation of Baton Drop (CVE-2022-21894) allows BlackLotus to strip the Secure Boot policy and prevent its enforcement. Unlike Boot Hole, the vulnerable boot loaders have not been added to the Secure Boot DBX revocation list. Because the vulnerable boot loaders are not listed within the DBX, attackers can substitute fully patched boot loaders with vulnerable versions to execute BlackLotus. NSA recommends system administrators within DoD and other networks take action. BlackLotus is not a firmware threat, but instead targets the earliest software stage of boot. U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 1 NSA | BlackLotus Mitigation Guide Defensive software solutions can be configured to detect and prevent the installation of the BlackLotus payload or the reboot event that starts its execution and implantation. NSA believes that currently published patches could provide a false sense of security for some infrastructures. Because BlackLotus integrates Shim and GRUB into its implantation routine, Linux administrators should also be vigilant for variants affecting popular Linux distributions. Mitigation recommendations Action 1: Update recovery media and activate optional mitigations Recommended for all Windows infrastructures. Not applicable to Linux infrastructures. NSA recommends Windows administrators install the latest security patches for their endpoints. Microsoft patches from May 2023 contain optional software mitigations to prevent rollback of the boot manager and kernel to versions vulnerable to Baton Drop and BlackLotus. The optional mitigations – including a Code Integrity Boot Policy – should be enabled after the organization has updated its Windows installation, recovery, and diagnostic software to the latest available versions. [3] Infrastructure administrators should note that Windows 10 and 11 have applicable security updates and ongoing mitigation deployments for BlackLotus. Older, unsupported Windows versions will not receive the full complement of BlackLotus mitigation measures. Windows infrastructures should migrate to supported versions of Windows if running an unsupported release. [3] Action 2: Harden defensive policies Recommended for all infrastructures. The malware install process for BlackLotus places an older Windows boot loader Extensible Firmware Interface (EFI) binary into the boot partition, disables Memory Integrity, disables BitLocker, and reboots the device. Many endpoint security products (e.g., Endpoint Detection and Response, host-based security suites, user-monitoring packages) can be configured to block one or more of these events outside of a legitimate, scheduled update. Configure defensive software to scrutinize changes to the EFI boot partition in particular. Alternatively, leverage application allow lists to permit only known and trusted executables. Action 3: Monitor device integrity measurements and boot configuration Recommended for most infrastructures. Many endpoint security products and firmware monitoring tools provide integrity-scanning features. Configure these products and tools to monitor the composition of the EFI boot partition. Leverage these tools to look for unexpected U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 2 NSA | BlackLotus Mitigation Guide changes in bootmgfw.efi, bootmgr.efi, or the introduction of additional unexpected EFI binaries (e.g., shimx64.efi or grubx64.efi). Changes to the boot partition are infrequent and warrant additional scrutiny. If unexpected changes are detected within the EFI boot partition, prevent the device from rebooting. Endpoint and host defensive suites may allow creating rules or triggers that can be paired with group policies to temporarily restrict reboot. Remediate the boot partition to a known good state before permitting reboot. A reboot will execute EFI binaries and can implant BlackLotus. Microsoft has published specific information regarding the staging of BlackLotus components, alterations to Windows registry values, and network indicators. Full specifics can be found at the Microsoft Incident Response blog. [4] Action 4: Customize UEFI Secure Boot 4.A. Instructions for Windows infrastructures. Expertly administered and exposed infrastructures only. Not recommended due to limited long-term effectiveness. BlackLotus relies upon older (pre-January 2022), signed Windows boot loader images to implant a system. Secure Boot can be updated with DBX deny list hashes that prevent executing older and vulnerable boot loaders. Public reporting [5] provides indications as to which boot managers are observed exploited in the wild. In 2020, NSA published ""UEFI Secure Boot Customization"" to provide guidance on modifying Secure Boot. Adding DBX hashes qualifies as a partial customization action covered in section 4 ""Customization,"" starting on page 7, and continuing through section 4.4.3 “Update the DB or DBX.” [6] Additionally, a GitHub.com repository has been set up with some helpful scripts and guides to accomplish customization. [7] Note: Adding boot loader hashes to the DBX may render many Windows install and recovery images, discs, and removable media drives unbootable. Microsoft provides updated install and recovery images for Windows 11 and 10. Only update the DBX after acquiring install and recovery media with the January 2022 or later patch assortment applied (e.g., version 22H1 or newer). Warning: The following DBX hashes may be combined with the Secure Boot Customization steps to revoke trust in select boot loaders vulnerable to Baton Drop. [6] However, more vulnerable boot loaders exist than the DBX can contain. BlackLotus developers can rapidly switch to alternate vulnerable boot loaders to evade DBX customization. Mitigating BlackLotus U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 3 NSA | BlackLotus Mitigation Guide via DBX updates is not recommended. Action 1’s patches and optional mitigations are recommended instead. Table: DBX hashes # UEFI Secure Boot DBX Hashes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nstructions for Linux infrastructures. Expertly administered and exposed infrastructures only. Linux system administrators may forego adding DBX hashes in favor of removing the Microsoft Windows Production CA 2011 certificate from Secure Boot’s DB. The total number of Baton Drop-vulnerable boot loaders signed by the key associated with the Production CA’s certificate is thought to exceed the available DBX memory. Removing the certificate negates the need to add DBX entries related to Baton Drop and BlackLotus. Linux administrators will still need the Microsoft Unified Extensible Firmware Interface (UEFI) Third Party Marketplace CA 2011 certificate to utilize Secure Boot with leading Linux distributions. [6] Do not place the Windows Production CA 2011 certificate in the Machine Owner Key Exclusion (MOKX) list in lieu of removing it from the DB. Utilizing MOKX in this way will cause the revoked certificate to still be trusted between firmware initialization and the initialization of Shim’s Secure Boot extensions. The Windows Production CA 2011 certificate must be restored if converting the device from Linux to Windows. Microsoft provides the certificate for download via their resources for system manufacturers. [9] U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 4 NSA | BlackLotus Mitigation Guide Frequently asked questions 1. Is BlackLotus a firmware implant? No. BlackLotus is boot software. The UEFI boot process involves several phases. Execution control flow transitions from firmware to software following the Boot Device Select phase. [8] 2. Can BlackLotus be removed or quarantined? Yes, prior to execution. Devices that boot to a BlackLotus EFI binary will need to be completely reimaged. Attempts to remove BlackLotus following installation result in kernel errors. 3. Does BlackLotus bypass Secure Boot? An initial bypass is followed by poisoning that configures Secure Boot to trust the malware. An older, vulnerable boot loader that is trusted by Secure Boot is necessary to strip the Secure Boot policy from being enforced so that BlackLotus can implant its entire software stack. Subsequent boots extend the Microsoft UEFI signing ecosystem with a malicious BlackLotus certificate. Thus, Secure Boot will trust the malware. 4. Which version of Windows is affected? BlackLotus targets Windows 11 and 10. Variants may exist to target older, UEFI-booting versions of Windows. Patches are available for Windows 8.1, 10, and 11. 5. Is Linux affected? Is there a version of BlackLotus that targets Linux? No, not that has been identified at this time. BlackLotus does incorporate some Linux boot binaries, but the malware targets Windows OS software. No Linux-targeting variant has been observed. 6. Is BlackLotus really unstoppable? No – BlackLotus is very stoppable on fully updated Windows endpoints, Secure Bootcustomized devices, or Linux endpoints. Microsoft has released patches and continues to harden mitigations against BlackLotus and Baton Drop. [1], [3], [4] The Linux community may remove the Microsoft Windows Production CA 2011 certificate on devices that exclusively boot Linux. Mitigation options available today will be reinforced by changes to vendor Secure Boot certificates in the future (some certificates are expiring starting in 2026). 7. Where can I find more public information? NSA is aware of several technically deep analysis reports posted online from security researchers and vendors. One thorough source of public information is ESET Security’s blog U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 5 NSA | BlackLotus Mitigation Guide referenced as [5] in this report. Another source of information is the Microsoft Security Response Center. [3], [4] 8. Should I reconfigure Secure Boot? No. Secure Boot is best left enabled in standard mode. Only advanced infrastructures and expert administrators should engage the custom/user-defined mode. Some security software may require additional certificates or hashes to be added to the DB allow list or DBX deny list. No one should disable Secure Boot on an endpoint built within the past 5 years. 9. Can a Trusted Platform Module (TPM) stop BlackLotus? No. A TPM can only detect BlackLotus. Implant boot binaries are delivered to the EFI boot partition after the TPM has recorded boot time measurements. Upon the next reboot, the TPM captures measurements showing a BlackLotus infection. However, a TPM can only detect – not prevent – implantation as the TPM is an observer and container of integrity indicator data. A TPM does not have an active enforcement capability. In a Network Access Control (NAC) infrastructure based on TPM attestation, NAC would prevent infected machines from accessing protected resources by indicating changes in Platform Configuration Registers (PCRs) 4-7. NAC also provides an opportunity to remediate affected endpoints prior to connecting to a protected resource. 10. Can TPM-extended Shim / TrustedShim (T-Shim) stop BlackLotus? No. T-Shim checks TPM measurements recorded prior to the main boot loader. Secure Boot is responsible for enforcement following T-Shim. 11. What is Secure Boot customization? Customization involves one of the following:   Partial customization – augmenting the Microsoft and system vendor Secure Boot ecosystem with additional DB and DBX entries as necessary to enable signature and hash checks on unsupported/custom software or block unwanted software. Full customization – replacing all vendor and Microsoft certificates and hashes with those generated and selected by the infrastructure owner (requires specialized knowledge of hardware values). U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 6 NSA | BlackLotus Mitigation Guide 12. How does BlackLotus compare to Boot Hole? Boot Hole involved flaws in Secure Boot-signed GRUB boot loaders. A configuration file could be created to cause buffer overflows and arbitrary code execution at boot time. Secure Boot could be ignored and completely bypassed. BlackLotus is sophisticated malware observed in the wild. It exploits a flaw (known as Baton Drop) in Secure Boot-signed copies of the Windows Boot Manager to truncate the Secure Boot policy values. Instead of stopping due to the lack DB and DBX values, the vulnerable boot manager allows boot to continue. BlackLotus injects a version of Shim utilizing its own Machine Owner Key (MOK) – similar to the allow list DB – to vouch for signatures on its own malicious binaries. The result is Secure Boot remains enforcing while silently poisoned and permitting malware to execute. 13. Why doesn’t NSA recommend setting up a custom Secure Boot ecosystem as a mitigation? NSA has internally piloted efforts to exclusively rely on custom certificates and hashes to define Secure Boot policy. Pilot efforts have proven effective at preventing threats like BlackLotus, Baton Drop, BootHole, and similar prior to discovery. However, the administrative overhead and vendor collaboration necessary represent a resource investment not appropriate for most enterprise infrastructures. The process of fully customizing Secure Boot is also not capable of being automated outside of a narrow selection of workstation and server products. 14. Can Trusted eXecution Technology (TXT) stop BlackLotus? Yes, if and only if the TPM non-volatile memory (NVRAM) policy is set to boot a specific boot loader. In practice, setting a specific boot loader has caused administrative challenges when handling updates that affect the EFI boot partition. TXT is not a recommended mitigation given the likelihood to render endpoints temporarily unbootable. 15. Are virtual machines affected? Yes. VMs boot into a virtual UEFI environment. BlackLotus targets the OS software boot loaders that execute following the virtual firmware initialization. Works cited [1] Microsoft Security Response Center (2022), January 2022 Security Updates. https://msrc.microsoft.com/update-guide/releaseNote/2022-Jan [2] Eclypsium (2020), There’s a Hole in the Boot. https://eclypsium.com/2020/07/29/theres-a-hole-in-the-boot [3] Microsoft Security Response Center (2023), KB5025885: How to manage the Windows Boot Manager revocations for Secure Boot changes associated with CVE-2023-24932. https://support.microsoft.com/help/5025885 U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 7 NSA | BlackLotus Mitigation Guide [4] Microsoft Incident Response (2023), Guidance for investigating attacks using CVE-2022-21894: The BlackLotus campaign. https://www.microsoft.com/en-us/blog/2023/04/11/guidance-for-investigatingattacks-using-cve-2022-21894-the-blacklotus-campaign [5] Smolar, Martin (2023), BlackLotus UEFI Bootkit: Myth Confirmed. https://www.welivesecurity.com/2023/03/01/blacklotus-uefi-bootkit-myth-confirmed [6] National Security Agency (2020), UEFI Secure Boot Customization [S/N: U/OO/168873-20]. https://media.defense.gov/2020/Sep/15/2002497594/-1/-1/0/CTR-UEFI-SECURE-BOOTCUSTOMIZATION-20200915.PDF/CTR-UEFI-SECURE-BOOT-CUSTOMIZATION-20200915.PDF [7] National Security Agency (2020), UEFI Secure Boot Customization. https://github.com/nsacyber/Hardware-and-Firmware-Security-Guidance/tree/master/secureboot [8] Carnegie Mellon University (2022), UEFI – Terra Firma for Attackers. https://insights.sei.cmu.edu/blog/uefi-terra-firma-for-attackers/ [9] Microsoft (2022), Windows Secure Boot Key Creation and Management Guidance. https://learn.microsoft.com/en-us/windows-hardware/manufacture/desktop/windows-secure-boot-keycreation-and-management-guidance Disclaimer of endorsement The information and opinions contained in this document are provided ""as is"" and without any warranties or guarantees. Reference herein to any specific commercial products, process, or service by trade name, trademark, manufacturer, or otherwise, does not constitute or imply its endorsement, recommendation, or favoring by the United States Government. This guidance shall not be used for advertising or product endorsement purposes. Purpose This document was developed in furtherance of NSA’s cybersecurity missions, including its responsibilities to identify and disseminate threats to National Security Systems, Department of Defense, and Defense Industrial Base information systems, and to develop and issue cybersecurity specifications and mitigations. This information may be shared broadly to reach all appropriate stakeholders. Contact Cybersecurity Report Questions and Feedback: CybersecurityReports@nsa.gov Defense Industrial Base Inquiries and Cybersecurity Services: DIB_Defense@cyber.nsa.gov Media Inquiries / Press Desk: 443-634-0721, MediaRelations@nsa.gov U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 8 ","Please limit your knowledge to the document. Avoid generalizations and ensure accuracy by directly referencing the document's arguments and examples. What optional mitigations does the NSA recommend for Windows infrastructures against BlackLotus? National Security Agency | Cybersecurity Information BlackLotus Mitigation Guide Executive summary BlackLotus is a recently publicized malware product garnering significant attention within tech media. Similar to 2020’s BootHole (CVE-2020-10713), BlackLotus takes advantage of a boot loader flaw—specifically CVE-2022-21894 Secure Boot bypass known as “Baton Drop”—to take control of an endpoint from the earliest phase of software boot. Microsoft ® issued patches for supported versions of Windows to correct boot loader logic. However, patches were not issued to revoke trust in unpatched boot loaders via the Secure Boot Deny List Database (DBX). Administrators should not consider the threat fully remediated as boot loaders vulnerable to Baton Drop are still trusted by Secure Boot. As described in this Cybersecurity Information Sheet (CSI), NSA recommends infrastructure owners take action by hardening user executable policies and monitoring the integrity of the boot partition. An optional advanced mitigation is to customize Secure Boot policy by adding DBX records to Windows® endpoints or removing the Windows Production CA certificate from Linux® endpoints. BlackLotus boot security threat NSA recognizes significant confusion regarding the threat posed by BlackLotus. Some organizations use terms like “unstoppable,” “unkillable,” and “unpatchable” to describe the threat. Other organizations believe there is no threat due to patches that Microsoft released in January 2022 and early 2023 for supported versions of Windows. [1] The risk exists somewhere between both extremes. BlackLotus shares some characteristics with Boot Hole (CVE-2020-10713). [2] Instead of breaking the Linux boot security chain, BlackLotus targets Windows boot by exploiting a flaw in older boot loaders—also called boot managers—to set off a chain of malicious actions that compromise endpoint security. Exploitation of Baton Drop (CVE-2022-21894) allows BlackLotus to strip the Secure Boot policy and prevent its enforcement. Unlike Boot Hole, the vulnerable boot loaders have not been added to the Secure Boot DBX revocation list. Because the vulnerable boot loaders are not listed within the DBX, attackers can substitute fully patched boot loaders with vulnerable versions to execute BlackLotus. NSA recommends system administrators within DoD and other networks take action. BlackLotus is not a firmware threat, but instead targets the earliest software stage of boot. U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 1 NSA | BlackLotus Mitigation Guide Defensive software solutions can be configured to detect and prevent the installation of the BlackLotus payload or the reboot event that starts its execution and implantation. NSA believes that currently published patches could provide a false sense of security for some infrastructures. Because BlackLotus integrates Shim and GRUB into its implantation routine, Linux administrators should also be vigilant for variants affecting popular Linux distributions. Mitigation recommendations Action 1: Update recovery media and activate optional mitigations Recommended for all Windows infrastructures. Not applicable to Linux infrastructures. NSA recommends Windows administrators install the latest security patches for their endpoints. Microsoft patches from May 2023 contain optional software mitigations to prevent rollback of the boot manager and kernel to versions vulnerable to Baton Drop and BlackLotus. The optional mitigations – including a Code Integrity Boot Policy – should be enabled after the organization has updated its Windows installation, recovery, and diagnostic software to the latest available versions. [3] Infrastructure administrators should note that Windows 10 and 11 have applicable security updates and ongoing mitigation deployments for BlackLotus. Older, unsupported Windows versions will not receive the full complement of BlackLotus mitigation measures. Windows infrastructures should migrate to supported versions of Windows if running an unsupported release. [3] Action 2: Harden defensive policies Recommended for all infrastructures. The malware install process for BlackLotus places an older Windows boot loader Extensible Firmware Interface (EFI) binary into the boot partition, disables Memory Integrity, disables BitLocker, and reboots the device. Many endpoint security products (e.g., Endpoint Detection and Response, host-based security suites, user-monitoring packages) can be configured to block one or more of these events outside of a legitimate, scheduled update. Configure defensive software to scrutinize changes to the EFI boot partition in particular. Alternatively, leverage application allow lists to permit only known and trusted executables. Action 3: Monitor device integrity measurements and boot configuration Recommended for most infrastructures. Many endpoint security products and firmware monitoring tools provide integrity-scanning features. Configure these products and tools to monitor the composition of the EFI boot partition. Leverage these tools to look for unexpected U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 2 NSA | BlackLotus Mitigation Guide changes in bootmgfw.efi, bootmgr.efi, or the introduction of additional unexpected EFI binaries (e.g., shimx64.efi or grubx64.efi). Changes to the boot partition are infrequent and warrant additional scrutiny. If unexpected changes are detected within the EFI boot partition, prevent the device from rebooting. Endpoint and host defensive suites may allow creating rules or triggers that can be paired with group policies to temporarily restrict reboot. Remediate the boot partition to a known good state before permitting reboot. A reboot will execute EFI binaries and can implant BlackLotus. Microsoft has published specific information regarding the staging of BlackLotus components, alterations to Windows registry values, and network indicators. Full specifics can be found at the Microsoft Incident Response blog. [4] Action 4: Customize UEFI Secure Boot 4.A. Instructions for Windows infrastructures. Expertly administered and exposed infrastructures only. Not recommended due to limited long-term effectiveness. BlackLotus relies upon older (pre-January 2022), signed Windows boot loader images to implant a system. Secure Boot can be updated with DBX deny list hashes that prevent executing older and vulnerable boot loaders. Public reporting [5] provides indications as to which boot managers are observed exploited in the wild. In 2020, NSA published ""UEFI Secure Boot Customization"" to provide guidance on modifying Secure Boot. Adding DBX hashes qualifies as a partial customization action covered in section 4 ""Customization,"" starting on page 7, and continuing through section 4.4.3 “Update the DB or DBX.” [6] Additionally, a GitHub.com repository has been set up with some helpful scripts and guides to accomplish customization. [7] Note: Adding boot loader hashes to the DBX may render many Windows install and recovery images, discs, and removable media drives unbootable. Microsoft provides updated install and recovery images for Windows 11 and 10. Only update the DBX after acquiring install and recovery media with the January 2022 or later patch assortment applied (e.g., version 22H1 or newer). Warning: The following DBX hashes may be combined with the Secure Boot Customization steps to revoke trust in select boot loaders vulnerable to Baton Drop. [6] However, more vulnerable boot loaders exist than the DBX can contain. BlackLotus developers can rapidly switch to alternate vulnerable boot loaders to evade DBX customization. Mitigating BlackLotus U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 3 NSA | BlackLotus Mitigation Guide via DBX updates is not recommended. Action 1’s patches and optional mitigations are recommended instead. Table: DBX hashes # UEFI Secure Boot DBX Hashes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nstructions for Linux infrastructures. Expertly administered and exposed infrastructures only. Linux system administrators may forego adding DBX hashes in favor of removing the Microsoft Windows Production CA 2011 certificate from Secure Boot’s DB. The total number of Baton Drop-vulnerable boot loaders signed by the key associated with the Production CA’s certificate is thought to exceed the available DBX memory. Removing the certificate negates the need to add DBX entries related to Baton Drop and BlackLotus. Linux administrators will still need the Microsoft Unified Extensible Firmware Interface (UEFI) Third Party Marketplace CA 2011 certificate to utilize Secure Boot with leading Linux distributions. [6] Do not place the Windows Production CA 2011 certificate in the Machine Owner Key Exclusion (MOKX) list in lieu of removing it from the DB. Utilizing MOKX in this way will cause the revoked certificate to still be trusted between firmware initialization and the initialization of Shim’s Secure Boot extensions. The Windows Production CA 2011 certificate must be restored if converting the device from Linux to Windows. Microsoft provides the certificate for download via their resources for system manufacturers. [9] U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 4 NSA | BlackLotus Mitigation Guide Frequently asked questions 1. Is BlackLotus a firmware implant? No. BlackLotus is boot software. The UEFI boot process involves several phases. Execution control flow transitions from firmware to software following the Boot Device Select phase. [8] 2. Can BlackLotus be removed or quarantined? Yes, prior to execution. Devices that boot to a BlackLotus EFI binary will need to be completely reimaged. Attempts to remove BlackLotus following installation result in kernel errors. 3. Does BlackLotus bypass Secure Boot? An initial bypass is followed by poisoning that configures Secure Boot to trust the malware. An older, vulnerable boot loader that is trusted by Secure Boot is necessary to strip the Secure Boot policy from being enforced so that BlackLotus can implant its entire software stack. Subsequent boots extend the Microsoft UEFI signing ecosystem with a malicious BlackLotus certificate. Thus, Secure Boot will trust the malware. 4. Which version of Windows is affected? BlackLotus targets Windows 11 and 10. Variants may exist to target older, UEFI-booting versions of Windows. Patches are available for Windows 8.1, 10, and 11. 5. Is Linux affected? Is there a version of BlackLotus that targets Linux? No, not that has been identified at this time. BlackLotus does incorporate some Linux boot binaries, but the malware targets Windows OS software. No Linux-targeting variant has been observed. 6. Is BlackLotus really unstoppable? No – BlackLotus is very stoppable on fully updated Windows endpoints, Secure Bootcustomized devices, or Linux endpoints. Microsoft has released patches and continues to harden mitigations against BlackLotus and Baton Drop. [1], [3], [4] The Linux community may remove the Microsoft Windows Production CA 2011 certificate on devices that exclusively boot Linux. Mitigation options available today will be reinforced by changes to vendor Secure Boot certificates in the future (some certificates are expiring starting in 2026). 7. Where can I find more public information? NSA is aware of several technically deep analysis reports posted online from security researchers and vendors. One thorough source of public information is ESET Security’s blog U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 5 NSA | BlackLotus Mitigation Guide referenced as [5] in this report. Another source of information is the Microsoft Security Response Center. [3], [4] 8. Should I reconfigure Secure Boot? No. Secure Boot is best left enabled in standard mode. Only advanced infrastructures and expert administrators should engage the custom/user-defined mode. Some security software may require additional certificates or hashes to be added to the DB allow list or DBX deny list. No one should disable Secure Boot on an endpoint built within the past 5 years. 9. Can a Trusted Platform Module (TPM) stop BlackLotus? No. A TPM can only detect BlackLotus. Implant boot binaries are delivered to the EFI boot partition after the TPM has recorded boot time measurements. Upon the next reboot, the TPM captures measurements showing a BlackLotus infection. However, a TPM can only detect – not prevent – implantation as the TPM is an observer and container of integrity indicator data. A TPM does not have an active enforcement capability. In a Network Access Control (NAC) infrastructure based on TPM attestation, NAC would prevent infected machines from accessing protected resources by indicating changes in Platform Configuration Registers (PCRs) 4-7. NAC also provides an opportunity to remediate affected endpoints prior to connecting to a protected resource. 10. Can TPM-extended Shim / TrustedShim (T-Shim) stop BlackLotus? No. T-Shim checks TPM measurements recorded prior to the main boot loader. Secure Boot is responsible for enforcement following T-Shim. 11. What is Secure Boot customization? Customization involves one of the following:   Partial customization – augmenting the Microsoft and system vendor Secure Boot ecosystem with additional DB and DBX entries as necessary to enable signature and hash checks on unsupported/custom software or block unwanted software. Full customization – replacing all vendor and Microsoft certificates and hashes with those generated and selected by the infrastructure owner (requires specialized knowledge of hardware values). U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 6 NSA | BlackLotus Mitigation Guide 12. How does BlackLotus compare to Boot Hole? Boot Hole involved flaws in Secure Boot-signed GRUB boot loaders. A configuration file could be created to cause buffer overflows and arbitrary code execution at boot time. Secure Boot could be ignored and completely bypassed. BlackLotus is sophisticated malware observed in the wild. It exploits a flaw (known as Baton Drop) in Secure Boot-signed copies of the Windows Boot Manager to truncate the Secure Boot policy values. Instead of stopping due to the lack DB and DBX values, the vulnerable boot manager allows boot to continue. BlackLotus injects a version of Shim utilizing its own Machine Owner Key (MOK) – similar to the allow list DB – to vouch for signatures on its own malicious binaries. The result is Secure Boot remains enforcing while silently poisoned and permitting malware to execute. 13. Why doesn’t NSA recommend setting up a custom Secure Boot ecosystem as a mitigation? NSA has internally piloted efforts to exclusively rely on custom certificates and hashes to define Secure Boot policy. Pilot efforts have proven effective at preventing threats like BlackLotus, Baton Drop, BootHole, and similar prior to discovery. However, the administrative overhead and vendor collaboration necessary represent a resource investment not appropriate for most enterprise infrastructures. The process of fully customizing Secure Boot is also not capable of being automated outside of a narrow selection of workstation and server products. 14. Can Trusted eXecution Technology (TXT) stop BlackLotus? Yes, if and only if the TPM non-volatile memory (NVRAM) policy is set to boot a specific boot loader. In practice, setting a specific boot loader has caused administrative challenges when handling updates that affect the EFI boot partition. TXT is not a recommended mitigation given the likelihood to render endpoints temporarily unbootable. 15. Are virtual machines affected? Yes. VMs boot into a virtual UEFI environment. BlackLotus targets the OS software boot loaders that execute following the virtual firmware initialization. Works cited [1] Microsoft Security Response Center (2022), January 2022 Security Updates. https://msrc.microsoft.com/update-guide/releaseNote/2022-Jan [2] Eclypsium (2020), There’s a Hole in the Boot. https://eclypsium.com/2020/07/29/theres-a-hole-in-the-boot [3] Microsoft Security Response Center (2023), KB5025885: How to manage the Windows Boot Manager revocations for Secure Boot changes associated with CVE-2023-24932. https://support.microsoft.com/help/5025885 U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 7 NSA | BlackLotus Mitigation Guide [4] Microsoft Incident Response (2023), Guidance for investigating attacks using CVE-2022-21894: The BlackLotus campaign. https://www.microsoft.com/en-us/blog/2023/04/11/guidance-for-investigatingattacks-using-cve-2022-21894-the-blacklotus-campaign [5] Smolar, Martin (2023), BlackLotus UEFI Bootkit: Myth Confirmed. https://www.welivesecurity.com/2023/03/01/blacklotus-uefi-bootkit-myth-confirmed [6] National Security Agency (2020), UEFI Secure Boot Customization [S/N: U/OO/168873-20]. https://media.defense.gov/2020/Sep/15/2002497594/-1/-1/0/CTR-UEFI-SECURE-BOOTCUSTOMIZATION-20200915.PDF/CTR-UEFI-SECURE-BOOT-CUSTOMIZATION-20200915.PDF [7] National Security Agency (2020), UEFI Secure Boot Customization. https://github.com/nsacyber/Hardware-and-Firmware-Security-Guidance/tree/master/secureboot [8] Carnegie Mellon University (2022), UEFI – Terra Firma for Attackers. https://insights.sei.cmu.edu/blog/uefi-terra-firma-for-attackers/ [9] Microsoft (2022), Windows Secure Boot Key Creation and Management Guidance. https://learn.microsoft.com/en-us/windows-hardware/manufacture/desktop/windows-secure-boot-keycreation-and-management-guidance Disclaimer of endorsement The information and opinions contained in this document are provided ""as is"" and without any warranties or guarantees. Reference herein to any specific commercial products, process, or service by trade name, trademark, manufacturer, or otherwise, does not constitute or imply its endorsement, recommendation, or favoring by the United States Government. This guidance shall not be used for advertising or product endorsement purposes. Purpose This document was developed in furtherance of NSA’s cybersecurity missions, including its responsibilities to identify and disseminate threats to National Security Systems, Department of Defense, and Defense Industrial Base information systems, and to develop and issue cybersecurity specifications and mitigations. This information may be shared broadly to reach all appropriate stakeholders. Contact Cybersecurity Report Questions and Feedback: CybersecurityReports@nsa.gov Defense Industrial Base Inquiries and Cybersecurity Services: DIB_Defense@cyber.nsa.gov Media Inquiries / Press Desk: 443-634-0721, MediaRelations@nsa.gov U/OO/167397-23 | PP-23-1628 | JUN 2023 Ver. 1.0 8 ",Internet/Technology,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","Hello, I am looking to organize this article so that I can write a report on it later. To start, I would like you to list out in point form all the activities that Charlie was involved in.","Story image # Advanced Persistent Threat Protection # Cybersecurity # EDR Sophos unveils Chinese cyber espionage tactics in new report Sophos has unveiled the latest developments in a Chinese cyber espionage campaign in Southeast Asia, as detailed in its report titled “Crimson Palace: New Tools, Tactics, Targets.” The research conducted by Sophos X-Ops reveals three clusters of nation-state activity - named Cluster Alpha, Cluster Bravo, and Cluster Charlie - inside a high-profile government organisation. These clusters have continued their activities over the nearly two-year-long campaign. The report notes a renewed presence of both Cluster Bravo and Cluster Charlie, not only within the initial targeted organisation but also across multiple other entities in the region. An important discovery made during this process is a novel keylogger dubbed “Tattletale.” According to the report, this keylogger impersonates users, collecting information related to password policies, security settings, cached passwords, browser information, and storage data. Paul Jaramillo, director of threat hunting and threat intelligence at Sophos, commented on the adaptive capabilities of these threat actors. “We’ve been in an ongoing chess match with these adversaries. During the initial phases of the operation, Cluster Charlie was deploying various bespoke tools and malware,” he explained. “However, we were able to ‘burn’ much of their previous infrastructure, blocking their Command and Control (C2) tools and forcing them to pivot. This is good; however, their switch to open-source tools demonstrates just how quickly these attacker groups can adapt and remain persistent.” During its initial activity phase from March to August 2023, Cluster Charlie operated within a high-level government organisation. After a brief hiatus, the cluster re-emerged in September 2023 and continued its operations until at least May 2024. In this second phase, the group aimed to evade endpoint detection and response (EDR) tools while gathering more intelligence. The report suggests that the overarching organisation directing these clusters has shifted tactics, increasingly using open-source tools instead of custom-developed malware. Sophos X-Ops has tracked ongoing Cluster Charlie activities across multiple organisations in Southeast Asia. Cluster Bravo, originally active for three weeks in March 2023, reappeared in January 2024 and targeted at least 11 other organisations in the region. Both Cluster Bravo and Cluster Charlie share tactics, techniques, and procedures (TTPs) with known Chinese threat groups Earth Longzhi and Unfading Sea Haze, respectively, indicating coordination among these clusters. Jaramillo noted the increasing coordination and expansion of operations among the clusters. “Not only are we seeing all three of the ‘Crimson Palace’ clusters refine and coordinate their tactics, but they’re also expanding their operations, attempting to infiltrate other targets in Southeast Asia. Given how frequently Chinese nation-state groups share infrastructure and tools, and the fact that Cluster Bravo and Cluster Charlie are moving beyond the original target, we will likely continue to see this campaign evolve - and potentially new locations. We will be monitoring it closely,” he said. Operation Crimson Palace highlights the ongoing threat posed by sophisticated cyber espionage activities targeting critical sectors. Sophos' continuous monitoring and research efforts serve to identify and mitigate these threats, providing early detection and bolstering the security infrastructure of its partners and clients.","""================ ======= Story image # Advanced Persistent Threat Protection # Cybersecurity # EDR Sophos unveils Chinese cyber espionage tactics in new report Sophos has unveiled the latest developments in a Chinese cyber espionage campaign in Southeast Asia, as detailed in its report titled “Crimson Palace: New Tools, Tactics, Targets.” The research conducted by Sophos X-Ops reveals three clusters of nation-state activity - named Cluster Alpha, Cluster Bravo, and Cluster Charlie - inside a high-profile government organisation. These clusters have continued their activities over the nearly two-year-long campaign. The report notes a renewed presence of both Cluster Bravo and Cluster Charlie, not only within the initial targeted organisation but also across multiple other entities in the region. An important discovery made during this process is a novel keylogger dubbed “Tattletale.” According to the report, this keylogger impersonates users, collecting information related to password policies, security settings, cached passwords, browser information, and storage data. Paul Jaramillo, director of threat hunting and threat intelligence at Sophos, commented on the adaptive capabilities of these threat actors. “We’ve been in an ongoing chess match with these adversaries. During the initial phases of the operation, Cluster Charlie was deploying various bespoke tools and malware,” he explained. “However, we were able to ‘burn’ much of their previous infrastructure, blocking their Command and Control (C2) tools and forcing them to pivot. This is good; however, their switch to open-source tools demonstrates just how quickly these attacker groups can adapt and remain persistent.” During its initial activity phase from March to August 2023, Cluster Charlie operated within a high-level government organisation. After a brief hiatus, the cluster re-emerged in September 2023 and continued its operations until at least May 2024. In this second phase, the group aimed to evade endpoint detection and response (EDR) tools while gathering more intelligence. The report suggests that the overarching organisation directing these clusters has shifted tactics, increasingly using open-source tools instead of custom-developed malware. Sophos X-Ops has tracked ongoing Cluster Charlie activities across multiple organisations in Southeast Asia. Cluster Bravo, originally active for three weeks in March 2023, reappeared in January 2024 and targeted at least 11 other organisations in the region. Both Cluster Bravo and Cluster Charlie share tactics, techniques, and procedures (TTPs) with known Chinese threat groups Earth Longzhi and Unfading Sea Haze, respectively, indicating coordination among these clusters. Jaramillo noted the increasing coordination and expansion of operations among the clusters. “Not only are we seeing all three of the ‘Crimson Palace’ clusters refine and coordinate their tactics, but they’re also expanding their operations, attempting to infiltrate other targets in Southeast Asia. Given how frequently Chinese nation-state groups share infrastructure and tools, and the fact that Cluster Bravo and Cluster Charlie are moving beyond the original target, we will likely continue to see this campaign evolve - and potentially new locations. We will be monitoring it closely,” he said. Operation Crimson Palace highlights the ongoing threat posed by sophisticated cyber espionage activities targeting critical sectors. Sophos' continuous monitoring and research efforts serve to identify and mitigate these threats, providing early detection and bolstering the security infrastructure of its partners and clients. https://securitybrief.asia/story/sophos-unveils-chinese-cyber-espionage-tactics-in-new-report ================ ======= Hello, I am looking to organize this article so that I can write a report on it later. To start, I would like you to list out in point form all the activities that Charlie was involved in. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Internet/Technology,Summarize & Format,Text Transformation Your response to the prompt shall consist exclusively of information contained within the context block with no use of external sources. Your responses shall be between 150 and 200 words and shall not be presented in a list format of any sort.,Please give a short summary of the battery systems of the Mars Helicopter.,"F. Telecommunication System Once separated from the host spacecraft (lander or rover), the Mars Helicopter can only communicate to or be commanded from Earth via radio link. This link is implemented using a COTS 802.15.4 (Zig-Bee) standard 900 MHz chipset, SiFlex 02, originally manufactured by LS Research. Two identical SiFlex parts are used, one of which is an integral part of a base station mounted on the host spacecraft, the other being included in the helicopter electronics. These radios are mounted on identical, custom PC boards which provide mechanical support, power, heat distribution, and other necessary infrastructure. The boards on each side of the link are connected to their respective custom antennas. The helicopter antenna is a loaded quarter wave monopole positioned near the center of the solar panel (which also serves as ground plane) at the top of the entire helicopter assembly and is fed through a miniature coaxial cable routed through the mast to the electronics below. The radio is configured and exchanges data with the helicopter and base station system computers via UART. One challenge in using off-the-shelf assemblies for electronics systems to be used on Mars is the low temperatures expected on the surface. At night, the antenna and cable assemblies will see temperatures as low as −140 C. Electronics assemblies on both base station and helicopter will be kept “warm” (not below −15 C) by heaters as required. Another challenge is antenna placement and accommodation on the larger host spacecraft. Each radio emits approximately 0.75 W power at 900 MHz with the board consuming up to 3 W supply power when transmitting and approximately 0.15 W while receiving. The link is designed to relay data at over-the-air rates of 20 kbps or 250 kbps over distances of up to 1000 m. A one-way data transmission mode is used to recover data from the helicopter in real time during its brief sorties. When landed, a secure two-way mode is used. Due to protocol overhead and channel management, a maximum return throughput in flight of 200 kbps is expected while two-way throughputs as low as 10 kbps are supported if required by marginal, landed circumstances. G. Power & Energy System The helicopter is powered by a Li-Ion battery system that is recharged daily by a solar panel. The energy in the battery is used for operating heaters to survive the cold Martian nights as well as operate the helicopter actuators and avionics during short flights lasting from 90 seconds to a few minutes. Depending on the latitude of operations and the Martian season, recharging of this battery through the solar panel could occur over one to multiple sols (Martian days). The helicopter battery shown in Fig. 12 consists of 6 Sony SE US1865o VTC4 Li-ion cells with a nameplate capacity of 2 Ah. The maximum discharge rate is greater than 25 A amd the maximum cell voltage specified by the manufacturer is 4.25 V. The continuous tested power load capability of this batterry is 480 W with a peak power capability of 510 W. Battery voltage is in the range of 15–25.2 V and the total mass of the 6 cells is 273 g. A cell balancing charge management system controlled by the FPGA ensures that the all the individual cells are at a uniform voltage. A de-rated end-of-life battery capacity of 35.75 Wh is available for use. Of this capacity, 10.73 Wh (30%) is kept as reserve, night-time survival energy usage is estimated at 21 Wh for typical operation in the northern latitudes in the spring season, and approximatley 10 Wh is available for flight. Assuming that 20% of the power is at the peak load of 510 W and 80% is at a continuous load of 360 W, approximately 90 sec of flight is possible. These energy projections represent conservative worst-case end-of-mision battery performance at 0 C initial temperature. More moderate power loads will extend the flight time. The solar panel is made from Inverted Metamorphic (IMM4J) cells from SolAero Technologies. The cells are optimized for the Mars solar spectrum and occupy a rectangular area with 680 cm2 of substrate (544 cm2 active cell area) in a region centered and immediately above the co-axial rotors. This region minimally interferes with the flow through the rotor. H. Thermal System The helicopter must survive the cold of the night on Mars where temperatures can drop to -100 C or lower. The most critical component is the battery which is kept above -15 C through the night as it powers Kapton film heaters attached to the battery cells. The avionics boards in the ECM surround the battery and are also kept at an elevated temperature by virtue of their proximity to the warm battery assembly. Insulation around the avionics boards is provided by a carbon-dioxide gap of 3 cm width. Additional insulation can be provided by replacing the carbon-dioxide gas with an Aerogel formulation. The outermost fuselage thermal coating is from Sheldahl with Solar absorptivity α = 0.8 and infra-red (IR) emissivity  = 0.1. In addition to thermal losses through the gas gap (or aerogel), additional losses occur due to conduction in the mast as well as through the copper wiring that penetrate the ECM from the mast. To minimize the latter, the wire gauges are selected to be of the thinnest gauges that can still support the current draw during operations without overheating. Prior to flight, under the control of the FPGA, the thermal system powers on heaters in the motor control boards that have been exposed to the ambient temperatures. The internal battery temperature is brought up to 5 C to allow hi-power energy extraction from the cells. During operation the ECM and battery warm up as a result of avionics operations and battery self-heating. However, the thermal inertia of the elements is such that for the short flights of the helicopter, there is no overheating.","Your response to the prompt shall consist exclusively of information contained within the context block with no use of external sources. Your responses shall be between 150 and 200 words and shall not be presented in a list format of any sort. F. Telecommunication System Once separated from the host spacecraft (lander or rover), the Mars Helicopter can only communicate to or be commanded from Earth via radio link. This link is implemented using a COTS 802.15.4 (Zig-Bee) standard 900 MHz chipset, SiFlex 02, originally manufactured by LS Research. Two identical SiFlex parts are used, one of which is an integral part of a base station mounted on the host spacecraft, the other being included in the helicopter electronics. These radios are mounted on identical, custom PC boards which provide mechanical support, power, heat distribution, and other necessary infrastructure. The boards on each side of the link are connected to their respective custom antennas. The helicopter antenna is a loaded quarter wave monopole positioned near the center of the solar panel (which also serves as ground plane) at the top of the entire helicopter assembly and is fed through a miniature coaxial cable routed through the mast to the electronics below. The radio is configured and exchanges data with the helicopter and base station system computers via UART. One challenge in using off-the-shelf assemblies for electronics systems to be used on Mars is the low temperatures expected on the surface. At night, the antenna and cable assemblies will see temperatures as low as −140 C. Electronics assemblies on both base station and helicopter will be kept “warm” (not below −15 C) by heaters as required. Another challenge is antenna placement and accommodation on the larger host spacecraft. Each radio emits approximately 0.75 W power at 900 MHz with the board consuming up to 3 W supply power when transmitting and approximately 0.15 W while receiving. The link is designed to relay data at over-the-air rates of 20 kbps or 250 kbps over distances of up to 1000 m. A one-way data transmission mode is used to recover data from the helicopter in real time during its brief sorties. When landed, a secure two-way mode is used. Due to protocol overhead and channel management, a maximum return throughput in flight of 200 kbps is expected while two-way throughputs as low as 10 kbps are supported if required by marginal, landed circumstances. G. Power & Energy System The helicopter is powered by a Li-Ion battery system that is recharged daily by a solar panel. The energy in the battery is used for operating heaters to survive the cold Martian nights as well as operate the helicopter actuators and avionics during short flights lasting from 90 seconds to a few minutes. Depending on the latitude of operations and the Martian season, recharging of this battery through the solar panel could occur over one to multiple sols (Martian days). The helicopter battery shown in Fig. 12 consists of 6 Sony SE US1865o VTC4 Li-ion cells with a nameplate capacity of 2 Ah. The maximum discharge rate is greater than 25 A amd the maximum cell voltage specified by the manufacturer is 4.25 V. The continuous tested power load capability of this batterry is 480 W with a peak power capability of 510 W. Battery voltage is in the range of 15–25.2 V and the total mass of the 6 cells is 273 g. A cell balancing charge management system controlled by the FPGA ensures that the all the individual cells are at a uniform voltage. A de-rated end-of-life battery capacity of 35.75 Wh is available for use. Of this capacity, 10.73 Wh (30%) is kept as reserve, night-time survival energy usage is estimated at 21 Wh for typical operation in the northern latitudes in the spring season, and approximatley 10 Wh is available for flight. Assuming that 20% of the power is at the peak load of 510 W and 80% is at a continuous load of 360 W, approximately 90 sec of flight is possible. These energy projections represent conservative worst-case end-of-mision battery performance at 0 C initial temperature. More moderate power loads will extend the flight time. The solar panel is made from Inverted Metamorphic (IMM4J) cells from SolAero Technologies. The cells are optimized for the Mars solar spectrum and occupy a rectangular area with 680 cm2 of substrate (544 cm2 active cell area) in a region centered and immediately above the co-axial rotors. This region minimally interferes with the flow through the rotor. H. Thermal System The helicopter must survive the cold of the night on Mars where temperatures can drop to -100 C or lower. The most critical component is the battery which is kept above -15 C through the night as it powers Kapton film heaters attached to the battery cells. The avionics boards in the ECM surround the battery and are also kept at an elevated temperature by virtue of their proximity to the warm battery assembly. Insulation around the avionics boards is provided by a carbon-dioxide gap of 3 cm width. Additional insulation can be provided by replacing the carbon-dioxide gas with an Aerogel formulation. The outermost fuselage thermal coating is from Sheldahl with Solar absorptivity α = 0.8 and infra-red (IR) emissivity  = 0.1. In addition to thermal losses through the gas gap (or aerogel), additional losses occur due to conduction in the mast as well as through the copper wiring that penetrate the ECM from the mast. To minimize the latter, the wire gauges are selected to be of the thinnest gauges that can still support the current draw during operations without overheating. Prior to flight, under the control of the FPGA, the thermal system powers on heaters in the motor control boards that have been exposed to the ambient temperatures. The internal battery temperature is brought up to 5 C to allow hi-power energy extraction from the cells. During operation the ECM and battery warm up as a result of avionics operations and battery self-heating. However, the thermal inertia of the elements is such that for the short flights of the helicopter, there is no overheating. Please give a short summary of the battery systems of the Mars Helicopter.",Internet/Technology,Find & Summarize,Text Transformation Draw your answer only from information within the text provided. Ensure that the response explains any terms that may be industry or product-specific.,Paraphrase this article.,"Fiber-optic communications was born at a time whenthe telecommunications industry had grown cautious and conservative after making telephone service ubiquitous in the United States and widely available in other developed countries. The backbones of the long distance telephone network were chains of microwave relay towers, which engineers had planned to replace by buried pipelines carrying millimeter waves in the 60-GHz range, starting in the 1970s. Bell Telephone Laboratories were quick to begin research on optical communications after the invention of the laser, but they spent the 1960s studying beam transmission through buried hollow confocal waveguides, expecting laser communications to be the next generation after the millimeter waveguide, on a technology timetable spanning decades. Corning’s invention of the low-loss fiber in 1970 changed all that. Bell abandoned the hollow optical guide in 1972 and never put any millimeter waveguide into commercial service after completing a field test in the mid-1970s. But telephone engineers remained wary of installing fiber without exhaustive tests and field trials. Bell engineers developed and exhaustively tested the first generation of fiber-optic systems, based on multimode graded-index fibers transmitting 45 Mb/s at 850 nm over spans of 10 km, connecting local telephone central offices. Deployment began slowly in the late 1970s, and soon a second fiber window opened at 1300nm, allowing a doubling of speed and transmission distance. In 1980, AT&T announced plans to extend multimode fiber into its long-haul network, by laying a 144-fiber cable between Boston and Washington with repeaters spaced every 7 km along an existing right of way. Yet by then change was accelerating in the no-longer stodgy telecommunications industry. Two crucial choices in system design and the breakup of AT&T were about to launch the modern fiber-optic communications industry. In 1980, Bell Labs announced that the next generation of transoceanic telephone cables would use single-mode fiber instead of the copper coaxial cables used since the first transatlantic phone cable in 1956. In 1982, the upstart MCI Communications picked single-mode fiber as the backbone of its new North American longdistance phone network, replacing the microwave towers that gave the company its original name, Microwave Communications Inc. That same year, AT&T agreed to divest its seven regional telephone companies to focus on long-distance service, computing, and communications hardware. The submarine fiber decision was a bold bet on a new technology based on desperation. Regulators had barred AT&T from operating communication satellites since the mid-1960s. Coax had reached its practical limit for intercontinental cables. Only single-mode fiber transmitting at 1310 nm could transmit 280 Mb/s through 50-km spans stretching more than 6000 km across the Atlantic. AT&T and its partners British Telecom and France Telecom set a target of 1988 for installing TAT-8, the first transatlantic fiber cable. More submarine fiber cables would follow. In 1982, MCI went looking for new technology to upgrade its long-distance phone network. Visits to British Telecom Research Labs and Japanese equipment makers convinced them that single-mode fiber transmitting 400 Mb/s at 1310 nm was ready for installation. AT&T and Sprint soon followed, with Sprint ads promoting the new fiber technology by claiming that callers could hear a pin drop over it. Fueled by the breakup of AT&T and intense competition for long-distance telephone service, fiber sales boomed as new long-haul networks were installed, then slumped briefly after their completion. The switch to single-mode fiber opened the room to further system improvements. By 1987, terrestrial long-distance backbone systems were carrying 800 Mb/s, and systems able to transmit 1.7 Gb/s were in development. Long-distance traffic increased as competition reduced long-distance rates, and developers pushed for the next transmission milestone of 2.5 Gb/s. Telecommunications was becoming an important part of the laser and optics market, pushing development of products including diode lasers, receivers, and optical connectors. Fiber optics had shifted the telephone industry into overdrive. Two more technological revolutions in their early stages in the late 1980s would soon shift telecommunications to warp speed. One came from the optical world, the fiber amplifier. The other came from telecommunications—the Internet. Even inthe late 1980s, the bulk of telecommunications traffic consisted of telephone conversations. (Cable television networks carried analog signals and were separate from the usual world of telecommunications.) Telephony was a mature industry, with traffic volume growing about 10% a year. Fiber traffic was increasing faster than that because fiber was displacing older technologies including microwave relays and geosynchronous communication satellites. Telecommunications networks also carried some digital data, but the overall volume was small. The ideas that laid the groundwork for the Internet date back to the late 1960s. Universities began installing terminals so students and faculty could access mainframe computers, ARPANET began operations to connect universities, and telephone companies envisioned linking home users to mainframes through telephone wiring. Special terminals were hooked to television screens for early home information services called videotex. But those data services attracted few customers, and data traffic remained limited until the spread of personal computers in the 1980s. The first personal computer modems sent 300 bits/s through phone lines, a number that soon rose to 1200 bits/s. Initially the Internet was limited to academic and government users, so other PC users accessed private networks such as CompuServe and America Online, but private Internet accounts became available by 1990. The World Wide Web was launched in 1991 at the European Center for Nuclear Research (CERN)and initially grew slowly. Butin 1994the numberofserverssoaredfrom500 to 10,000, and the data floodgates were loosed. Digital traffic soared. By good fortune, the global fiber-optic backbone network was already in place as data traffic started to soar. Construction expenses are a major part of network costs, so multi-fiber cables were laid that in the mid-1980s were thought to be adequate to support many years of normal traffic growth. That kept the “Information Superhighway” from becoming a global traffic jam as data traffic took off. The impact of fiber is evident in Fig. 1, a chart presented by Donald Keck during his 2011 CLEO plenary talk. Diverse new technologies had increased data transmission rates since 1850. Fiber optics became the dominant technology after 1980 and is responsible for the change in slope of the data-rate growth. Even morefortunately, Internet traffic was growing in phase with the development of a vital new optical technology, the optical fiber amplifier. Early efforts to develop all-optical amplifiers focused on semiconductor sources, because they could be easily matched to signal wavelengths, but experiments in the middle to late 1980s found high noise levels. Attention turned to fiber amplifiers after David Payne demonstrated the first erbium-doped fiber amplifier in 1987. (See Digonnet’s chapter on p. 195.) Elias Snitzer had demonstrated a neodymium-doped optical amplifier at American Optical in 1964, but it had not caught on because it required flashlamp pumping. Erbium was the right material at the right time. Its gain band fell in the 1550-nm window where optical fibers have minimum attenuation. Within a couple of years, British Telecom Labs had identified a diode-laser pump band at 980 nm and Snitzer, then at Polaroid, had found another at 1480 nm. By 1989, diode-pumped fiber amplifiers looked like good replacements for cumbersome electro-optic repeaters. What launched the bandwidth revolution was the ability of fiber amplifiers to handle wavelength division multiplexed signals. The first tests started with only a few wavelengths and a single amplifier; then developers added more wavelengths and additional amplifiers. The good news was that wavelength-division multiplexing (WDM) multiplied capacity by the number of channels that could be squeezed into the transmission band. The bad news was that WDM also multiplied the number of potential complications.","System Instructions: Draw your answer only from information within the text provided. Ensure that the response explains any terms that may be industry or product-specific. Question: Paraphrase this article. Context: Fiber-optic communications was born at a time whenthe telecommunications industry had grown cautious and conservative after making telephone service ubiquitous in the United States and widely available in other developed countries. The backbones of the long distance telephone network were chains of microwave relay towers, which engineers had planned to replace by buried pipelines carrying millimeter waves in the 60-GHz range, starting in the 1970s. Bell Telephone Laboratories were quick to begin research on optical communications after the invention of the laser, but they spent the 1960s studying beam transmission through buried hollow confocal waveguides, expecting laser communications to be the next generation after the millimeter waveguide, on a technology timetable spanning decades. Corning’s invention of the low-loss fiber in 1970 changed all that. Bell abandoned the hollow optical guide in 1972 and never put any millimeter waveguide into commercial service after completing a field test in the mid-1970s. But telephone engineers remained wary of installing fiber without exhaustive tests and field trials. Bell engineers developed and exhaustively tested the first generation of fiber-optic systems, based on multimode graded-index fibers transmitting 45 Mb/s at 850 nm over spans of 10 km, connecting local telephone central offices. Deployment began slowly in the late 1970s, and soon a second fiber window opened at 1300nm, allowing a doubling of speed and transmission distance. In 1980, AT&T announced plans to extend multimode fiber into its long-haul network, by laying a 144-fiber cable between Boston and Washington with repeaters spaced every 7 km along an existing right of way. Yet by then change was accelerating in the no-longer stodgy telecommunications industry. Two crucial choices in system design and the breakup of AT&T were about to launch the modern fiber-optic communications industry. In 1980, Bell Labs announced that the next generation of transoceanic telephone cables would use single-mode fiber instead of the copper coaxial cables used since the first transatlantic phone cable in 1956. In 1982, the upstart MCI Communications picked single-mode fiber as the backbone of its new North American longdistance phone network, replacing the microwave towers that gave the company its original name, Microwave Communications Inc. That same year, AT&T agreed to divest its seven regional telephone companies to focus on long-distance service, computing, and communications hardware. The submarine fiber decision was a bold bet on a new technology based on desperation. Regulators had barred AT&T from operating communication satellites since the mid-1960s. Coax had reached its practical limit for intercontinental cables. Only single-mode fiber transmitting at 1310 nm could transmit 280 Mb/s through 50-km spans stretching more than 6000 km across the Atlantic. AT&T and its partners British Telecom and France Telecom set a target of 1988 for installing TAT-8, the first transatlantic fiber cable. More submarine fiber cables would follow. In 1982, MCI went looking for new technology to upgrade its long-distance phone network. Visits to British Telecom Research Labs and Japanese equipment makers convinced them that single-mode fiber transmitting 400 Mb/s at 1310 nm was ready for installation. AT&T and Sprint soon followed, with Sprint ads promoting the new fiber technology by claiming that callers could hear a pin drop over it. Fueled by the breakup of AT&T and intense competition for long-distance telephone service, fiber sales boomed as new long-haul networks were installed, then slumped briefly after their completion. The switch to single-mode fiber opened the room to further system improvements. By 1987, terrestrial long-distance backbone systems were carrying 800 Mb/s, and systems able to transmit 1.7 Gb/s were in development. Long-distance traffic increased as competition reduced long-distance rates, and developers pushed for the next transmission milestone of 2.5 Gb/s. Telecommunications was becoming an important part of the laser and optics market, pushing development of products including diode lasers, receivers, and optical connectors. Fiber optics had shifted the telephone industry into overdrive. Two more technological revolutions in their early stages in the late 1980s would soon shift telecommunications to warp speed. One came from the optical world, the fiber amplifier. The other came from telecommunications—the Internet. Even inthe late 1980s, the bulk of telecommunications traffic consisted of telephone conversations. (Cable television networks carried analog signals and were separate from the usual world of telecommunications.) Telephony was a mature industry, with traffic volume growing about 10% a year. Fiber traffic was increasing faster than that because fiber was displacing older technologies including microwave relays and geosynchronous communication satellites. Telecommunications networks also carried some digital data, but the overall volume was small. The ideas that laid the groundwork for the Internet date back to the late 1960s. Universities began installing terminals so students and faculty could access mainframe computers, ARPANET began operations to connect universities, and telephone companies envisioned linking home users to mainframes through telephone wiring. Special terminals were hooked to television screens for early home information services called videotex. But those data services attracted few customers, and data traffic remained limited until the spread of personal computers in the 1980s. The first personal computer modems sent 300 bits/s through phone lines, a number that soon rose to 1200 bits/s. Initially the Internet was limited to academic and government users, so other PC users accessed private networks such as CompuServe and America Online, but private Internet accounts became available by 1990. The World Wide Web was launched in 1991 at the European Center for Nuclear Research (CERN)and initially grew slowly. Butin 1994the numberofserverssoaredfrom500 to 10,000, and the data floodgates were loosed. Digital traffic soared. By good fortune, the global fiber-optic backbone network was already in place as data traffic started to soar. Construction expenses are a major part of network costs, so multi-fiber cables were laid that in the mid-1980s were thought to be adequate to support many years of normal traffic growth. That kept the “Information Superhighway” from becoming a global traffic jam as data traffic took off. The impact of fiber is evident in Fig. 1, a chart presented by Donald Keck during his 2011 CLEO plenary talk. Diverse new technologies had increased data transmission rates since 1850. Fiber optics became the dominant technology after 1980 and is responsible for the change in slope of the data-rate growth. Even morefortunately, Internet traffic was growing in phase with the development of a vital new optical technology, the optical fiber amplifier. Early efforts to develop all-optical amplifiers focused on semiconductor sources, because they could be easily matched to signal wavelengths, but experiments in the middle to late 1980s found high noise levels. Attention turned to fiber amplifiers after David Payne demonstrated the first erbium-doped fiber amplifier in 1987. (See Digonnet’s chapter on p. 195.) Elias Snitzer had demonstrated a neodymium-doped optical amplifier at American Optical in 1964, but it had not caught on because it required flashlamp pumping. Erbium was the right material at the right time. Its gain band fell in the 1550-nm window where optical fibers have minimum attenuation. Within a couple of years, British Telecom Labs had identified a diode-laser pump band at 980 nm and Snitzer, then at Polaroid, had found another at 1480 nm. By 1989, diode-pumped fiber amplifiers looked like good replacements for cumbersome electro-optic repeaters. What launched the bandwidth revolution was the ability of fiber amplifiers to handle wavelength division multiplexed signals. The first tests started with only a few wavelengths and a single amplifier; then developers added more wavelengths and additional amplifiers. The good news was that wavelength-division multiplexing (WDM) multiplied capacity by the number of channels that could be squeezed into the transmission band. The bad news was that WDM also multiplied the number of potential complications.",Internet/Technology,Paraphrase,Text Transformation You may only respond using the information provided in the context block. Bold any statute numbers.,Explain how 17 U.S.C. Section 112 affects radio stations in layman's terms,"Who pays whom, as well as who can sue whom for copyright infringement, depends in part on the mode of listening to music. Rights owners of sound recordings (e.g., record labels) pay music publishers for the right to record and distribute the publishers’ musical works in a physical format.27 Retail outlets that sell digital files or physical reproductions of sound recordings pay the distribution subsidiaries of major record labels, which act as wholesalers.28 Purchasers of a lawfully made reproduction, such as a compact disc or a digital file, may listen to that song as often as they wish in a private setting. Radio listeners have less control over when and where they listen to a song than they would if they purchased the song outright. The Copyright Act does not require broadcast radio stations to pay public performance royalties to record labels and artists, but it does require them to pay public performance royalties to music publishers and songwriters for the use of notes and lyrics in broadcast music. In addition to mechanical rights, digital services must pay both record labels and music publishers for public performance rights. Both traditional broadcast radio stations and music streaming services that limit the ability of users to choose which songs they hear next (noninteractive services) may make temporary reproductions of songs in the normal course of transmitting music to listeners.29 The rights to make these temporary reproductions, known as “ephemeral reproductions,” fall under 17 U.S.C. Section 112 (see “Ephemeral Reproductions”). Users of an “on demand” or “interactive” music streaming service can listen to songs upon request, an experience similar in some ways to playing a compact disc and in other ways to listening to a radio broadcast. To enable multiple listeners to select songs, the services download digital files to consumers’ devices. These digital reproductions are known as “conditional” or “tethered” downloads, because consumers’ ability to listen to them upon request is conditioned upon remaining subscribers to the interactive services.30 The services pay royalties to music publishers or songwriters for the right to reproduce and distribute the musical works, and pay royalties to record labels or artists for the right to reproduce and distribute sound recordings.31 Thus, while record labels reproduce and distribute their own sound recordings in physical form, they license such rights to interactive digital streaming services when the music is in digital form.","System instructions: [You may only respond using the information provided in the context block. Bold any statute numbers. ] Content block: [Who pays whom, as well as who can sue whom for copyright infringement, depends in part on the mode of listening to music. Rights owners of sound recordings (e.g., record labels) pay music publishers for the right to record and distribute the publishers’ musical works in a physical format.27 Retail outlets that sell digital files or physical reproductions of sound recordings pay the distribution subsidiaries of major record labels, which act as wholesalers.28 Purchasers of a lawfully made reproduction, such as a compact disc or a digital file, may listen to that song as often as they wish in a private setting. Radio listeners have less control over when and where they listen to a song than they would if they purchased the song outright. The Copyright Act does not require broadcast radio stations to pay public performance royalties to record labels and artists, but it does require them to pay public performance royalties to music publishers and songwriters for the use of notes and lyrics in broadcast music. In addition to mechanical rights, digital services must pay both record labels and music publishers for public performance rights. Both traditional broadcast radio stations and music streaming services that limit the ability of users to choose which songs they hear next (noninteractive services) may make temporary reproductions of songs in the normal course of transmitting music to listeners.29 The rights to make these temporary reproductions, known as “ephemeral reproductions,” fall under 17 U.S.C. Section 112 (see “Ephemeral Reproductions”). Users of an “on demand” or “interactive” music streaming service can listen to songs upon request, an experience similar in some ways to playing a compact disc and in other ways to listening to a radio broadcast. To enable multiple listeners to select songs, the services download digital files to consumers’ devices. These digital reproductions are known as “conditional” or “tethered” downloads, because consumers’ ability to listen to them upon request is conditioned upon remaining subscribers to the interactive services.30 The services pay royalties to music publishers or songwriters for the right to reproduce and distribute the musical works, and pay royalties to record labels or artists for the right to reproduce and distribute sound recordings.31 Thus, while record labels reproduce and distribute their own sound recordings in physical form, they license such rights to interactive digital streaming services when the music is in digital form.] Question: [Explain how 17 U.S.C. Section 112 affects radio stations in layman's terms]",Legal,Summarize & Format,Text Transformation "Find the correct answer from the context, and respond in two sentences. Omit any filler. Respond only using information from the provided context. ",Can you explain CAUTION?,"Representative Michael McCaul introduced the Deterring America’s Technological Adversaries (DATA) Act (H.R. 1153, H.Rept. 118-63) on February 24, 2023. Among other provisions, the bill would require federal actions to protect the sensitive personal data of U.S. persons, with a particular focus on prohibiting the transfer of such data to foreign persons influenced by China. It would also require the Department of the Treasury to issue a directive prohibiting U.S. persons from engaging in any transaction with any person who knowingly provides or may transfer sensitive personal data subject to U.S. jurisdiction to any foreign person subject to Chinese influence. The bill was reported by the Committee on Foreign Affairs on May 16, 2023, and placed on the Union Calendar, Calendar No. 43, the same day. Representative Kat Cammack introduced the Chinese-owned Applications Using the Information of Our Nation (CAUTION) Act of 2023 (H.R. 750) on February 2, 2023. The bill would require any person who sells or distributes the social media application TikTok (or any service developed or provided by ByteDance Ltd.) to disclose, prior to download, that the use of the application is prohibited on government-owned devices. The bill was ordered to be reported, amended, on March 9, 2023, by the House Committee on Energy and Commerce. Representative Ken Buck introduced the No TikTok on United States Devices Act (H.R. 503) on January 25, 2023. Among other provisions, the bill would impose sanctions on the parent company of the TikTok social media service, ByteDance Ltd., as long as it is involved with TikTok. Specifically, the President would be required to impose property-blocking sanctions on ByteDance or any successor entity or subsidiary if it is involved in matters relating to (1) TikTok or any successor service; or (2) information, video, or data associated with such a service. Additionally, the bill would require the Office of the Director of National Intelligence (ODNI) to report to Congress on any national security threats posed by TikTok, including the ability of China’s government to access or use the data of U.S. users of TikTok. Within 180 days of the bill’s enactment, ODNI would be required to brief Congress on the implementation of the bill. On February 27, 2023, the bill was referred to the Subcommittee on the National Intelligence Enterprise. Senator Josh Hawley introduced the No TikTok on United States Devices Act (S. 85) on January 25, 2023. The bill is substantially similar to H.R. 503. On January 25, 2023, the bill was referred to the Committee on Banking, Housing, and Urban Affairs.","Can you explain CAUTION? Find the correct answer from the context, and respond in two sentences. Omit any filler. Respond only using information from the provided context. Representative Michael McCaul introduced the Deterring America’s Technological Adversaries (DATA) Act (H.R. 1153, H.Rept. 118-63) on February 24, 2023. Among other provisions, the bill would require federal actions to protect the sensitive personal data of U.S. persons, with a particular focus on prohibiting the transfer of such data to foreign persons influenced by China. It would also require the Department of the Treasury to issue a directive prohibiting U.S. persons from engaging in any transaction with any person who knowingly provides or may transfer sensitive personal data subject to U.S. jurisdiction to any foreign person subject to Chinese influence. The bill was reported by the Committee on Foreign Affairs on May 16, 2023, and placed on the Union Calendar, Calendar No. 43, the same day. Representative Kat Cammack introduced the Chinese-owned Applications Using the Information of Our Nation (CAUTION) Act of 2023 (H.R. 750) on February 2, 2023. The bill would require any person who sells or distributes the social media application TikTok (or any service developed or provided by ByteDance Ltd.) to disclose, prior to download, that the use of the application is prohibited on government-owned devices. The bill was ordered to be reported, amended, on March 9, 2023, by the House Committee on Energy and Commerce. Representative Ken Buck introduced the No TikTok on United States Devices Act (H.R. 503) on January 25, 2023. Among other provisions, the bill would impose sanctions on the parent company of the TikTok social media service, ByteDance Ltd., as long as it is involved with TikTok. Specifically, the President would be required to impose property-blocking sanctions on ByteDance or any successor entity or subsidiary if it is involved in matters relating to (1) TikTok or any successor service; or (2) information, video, or data associated with such a service. Additionally, the bill would require the Office of the Director of National Intelligence (ODNI) to report to Congress on any national security threats posed by TikTok, including the ability of China’s government to access or use the data of U.S. users of TikTok. Within 180 days of the bill’s enactment, ODNI would be required to brief Congress on the implementation of the bill. On February 27, 2023, the bill was referred to the Subcommittee on the National Intelligence Enterprise. Senator Josh Hawley introduced the No TikTok on United States Devices Act (S. 85) on January 25, 2023. The bill is substantially similar to H.R. 503. On January 25, 2023, the bill was referred to the Committee on Banking, Housing, and Urban Affairs.",Internet/Technology,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]",what is monkeypox and is it currently spreading? what is the direct effects of monkeypox and how dangerous is it? are there ways to prevent monkey pox?,"Mpox (formerly known as monkeypox) is a disease caused by infection with a virus, known as Monkeypox virus. This virus is part of the same family as the virus that causes smallpox. People with mpox often get a rash, along with other symptoms. The rash will go through several stages, including scabs, before healing. Mpox is not related to chickenpox. Mpox is a zoonotic disease, meaning it can be spread between animals and people. It is endemic, or found regularly, in parts of Central and West Africa. The virus that causes mpox has been found in small rodents, monkeys, and other mammals that live in these areas. Discovery and History The virus that causes mpox was discovered in 1958, when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. Despite being named “monkeypox” originally, the source of the disease remains unknown. Scientists suspect African rodents and non-human primates (like monkeys) might harbor the virus and infect people. The first human case of mpox was recorded in 1970, in what is now the Democratic Republic of the Congo. In 2022, mpox spread around the world. Before that, cases of mpox in other places were rare and usually linked to travel or to animals being imported from regions where mpox is endemic. The World Health Organization renamed the disease in 2022 to follow modern guidelines for naming illnesses. Those guidelines recommend that disease names should avoid offending cultural, social, national, regional, professional or ethnic groups and minimize unnecessary negative effects on trade, travel, tourism or animal welfare. The virus that causes it still has its historic name, however. Virus Types Map of countries known to be endemic for clade I & 2 Mpox View Larger There are two types of the virus that causes mpox: clade I and clade II. Clade I is responsible for the current rise of cases in Central and Eastern Africa. Historically, clade I caused higher numbers of severe illnesses than clade II, with up to 10% of people dying from it. Recent outbreaks have seen much lower death rates of about 1-3.3%. Clade II is the type that caused the global outbreak that began in 2022. Infections from clade II mpox are generally less severe. More than 99.9% of people survive. Clade II is endemic to West Africa. Both types of the virus can spread through: Close contact (including intimate contact) with a person with mpox Direct contact with contaminated materials Direct contact with infected animals Risk of Severe Disease Although cases of mpox are not life-threatening, some people may be more likely to get severely ill, including People with severely weakened immune systems Children younger than 1 People with a history of eczema People who are pregnant Preventing Mpox There are several ways you can protect yourself and others from mpox: Getting vaccinated. Check with your healthcare provider to find out if the mpox vaccine is recommended for you. Avoiding close, skin-to-skin contact with people who have a rash that looks like mpox. Avoiding contact with materials that a person with mpox has used, including sharing eating utensils and cups, and handling their bedding or clothing. If you do get mpox, isolate at home, and cover lesions and wear a mask if you must be around others. If you are in an area of Western or Central Africa where mpox occurs regularly, avoid contact with live or dead wild animals."," Only use the provided text to answer the question, no outside sources. what is monkeypox and is it currently spreading? what is the direct effects of monkeypox and how dangerous is it? are there ways to prevent monkey pox? Mpox (formerly known as monkeypox) is a disease caused by infection with a virus, known as Monkeypox virus. This virus is part of the same family as the virus that causes smallpox. People with mpox often get a rash, along with other symptoms. The rash will go through several stages, including scabs, before healing. Mpox is not related to chickenpox. Mpox is a zoonotic disease, meaning it can be spread between animals and people. It is endemic, or found regularly, in parts of Central and West Africa. The virus that causes mpox has been found in small rodents, monkeys, and other mammals that live in these areas. Discovery and History The virus that causes mpox was discovered in 1958, when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research. Despite being named “monkeypox” originally, the source of the disease remains unknown. Scientists suspect African rodents and non-human primates (like monkeys) might harbor the virus and infect people. The first human case of mpox was recorded in 1970, in what is now the Democratic Republic of the Congo. In 2022, mpox spread around the world. Before that, cases of mpox in other places were rare and usually linked to travel or to animals being imported from regions where mpox is endemic. The World Health Organization renamed the disease in 2022 to follow modern guidelines for naming illnesses. Those guidelines recommend that disease names should avoid offending cultural, social, national, regional, professional or ethnic groups and minimize unnecessary negative effects on trade, travel, tourism or animal welfare. The virus that causes it still has its historic name, however. Virus Types Map of countries known to be endemic for clade I & 2 Mpox View Larger There are two types of the virus that causes mpox: clade I and clade II. Clade I is responsible for the current rise of cases in Central and Eastern Africa. Historically, clade I caused higher numbers of severe illnesses than clade II, with up to 10% of people dying from it. Recent outbreaks have seen much lower death rates of about 1-3.3%. Clade II is the type that caused the global outbreak that began in 2022. Infections from clade II mpox are generally less severe. More than 99.9% of people survive. Clade II is endemic to West Africa. Both types of the virus can spread through: Close contact (including intimate contact) with a person with mpox Direct contact with contaminated materials Direct contact with infected animals Risk of Severe Disease Although cases of mpox are not life-threatening, some people may be more likely to get severely ill, including People with severely weakened immune systems Children younger than 1 People with a history of eczema People who are pregnant Preventing Mpox There are several ways you can protect yourself and others from mpox: Getting vaccinated. Check with your healthcare provider to find out if the mpox vaccine is recommended for you. Avoiding close, skin-to-skin contact with people who have a rash that looks like mpox. Avoiding contact with materials that a person with mpox has used, including sharing eating utensils and cups, and handling their bedding or clothing. If you do get mpox, isolate at home, and cover lesions and wear a mask if you must be around others. If you are in an area of Western or Central Africa where mpox occurs regularly, avoid contact with live or dead wild animals. https://www.cdc.gov/poxvirus/mpox/about/index.html",Medical,Find & Summarize,Text Transformation "ONLY USE THE DATA I PROVIDE Limit your response to 250 words If you cannot answer using the contexts alone, say ""I cannot determine the answer to that due to lack of context""",What does it mean when a nail polish is 10-free?,"What is 7 Free Nail Polish? And Why is 10 Free Even Better! September 27, 2021 By Mary Lennon Did you know that the nail polish you are currently using could be affecting your health in ways you may have never even thought?  Mainstream nail polishes contain several chemicals and other harsh ingredients that have the ability to cause severe adverse reactions alongside damaging health concerns.  As a result of this, you may have come across nail polish brands that claim to be 3-free, 5-free, or even 7-free, and it is likely that you have wondered what exactly is meant by those confusing phrases.   In this blog post, we will be covering everything that you need to know about non-toxic nail polish, as well as offer an explanation as to why the nail polish you are using right now could be bad for your health.     **The Importance Of Non-Toxic Nail Polish** First off, to truly understand the importance of non-toxic nail polish, it is fundamental that one knows the negative health connotations associated with regular nail polish. A 2015 study found that certain chemicals that are used in most bottles of nail polish, can be absorbed into the body via the nails and cause several damaging health effects to the user.  These damaged health effects vary greatly from person to person, but they can cause quite a devastating impact. Regular types of nail polish contain cancer-causing chemicals, can cause hormone imbalances, alongside thyroid issues, and increase the risk of diabetes should you be overexposing yourself to the product.  Though you may assume that you are not going to be affected by these chemicals, just think of how much you breathe in the scent of nail lacquer while painting your nails and how often the paint touches your skin, as well as the amount of contact your nails have with your mouth directly, or when preparing food for both you and your loved ones.    Fortunately, enough research has been established so that while regular nail polish used at your nail salon is sadly still able to promote itself, innovative and safe nail products have been developed with the health of the customer in mind. Non- toxic nail polish comes in several variants, with each type excluding certain chemicals, ingredients, and products that may have highly damaging effects on the user. These types of non toxic nail polishes are often referred to as 3-free, 5-free, 7-free, or 10-free.  Here at Côte Nail Polish, all of our vegan nail polishes are cruelty-free, and most importantly, non-toxic. Our customers can be assured that their health is our optimal concern and that we will always endeavor to use the best and highest quality ingredients for our nail polish and accessories.    **What Is 7-Free Nail Polish?** 7-free nail polish is free of 7 toxic chemicals that are common in most regular nail polish formulas. The chemicals this nail lacquer is free from are as follows: dibutyl phthalate, formaldehyde, toluene, formaldehyde resin, camphor, ethyl tosylamide, and xylene. Each of these chemicals can have a negative impact on the user’s health, and therefore, substituting them out of the polish formula will help to lessen the toxic effect of nail varnish.  There are also other variants of the free toxin nail polish, each omitting a specific number of chemicals: 3-Free: This formula is void of the “Toxic Trio”: Dibutyl Phthalate (DPB), Formaldehyde, and Toluene. These three chemicals are by far the most harmful, as they are associated with some of the most harmful and debilitating diseases, including cancer and diabetes.  5-Free:  The chemicals excluded in 5- free include the above-mentioned “Toxic Trio” as well as formaldehyde resin, and camphor.  10-Free:  This type of formula omits dibutyl phthalate, TPHP, toluene, xylene, ethyl tosylamide, camphor, formaldehyde, formaldehyde resin, parabens, and gluten. Therefore, this formula of nail polish is considered to be one of the safest types of nail polish due to its substitution of toxic chemicals.    **Chemicals Excluded in 7-Free Polish** Simply providing the names of the seven harmful chemicals left out of these 7- free polishes will not accurately represent the harm that these toxins can cause. In this section, we have outlined the chemicals that are excluded from seven free nail polishes, explaining the health issues that these can cause.  Dibutyl Phthalate (DPB):  DPB is a harsh chemical that affects the endocrine system, which controls hormone regulation. Too much DPB can cause issues with your thyroid, causing mental health issues as well as physical problems like fatigue. It can also hamper developmental growth and potentially affect reproductive health. Formaldehyde: This commonly used chemical is a known human carcinogen, meaning it has been known to increase the risk of cancer. It can also cause severe dermatitis, skin irritation, and eye irritation.  Toluene: Toluene can cause birth defects in the children of pregnant women who are overly exposed to the chemical. It can also affect the nervous system, causing nausea, lightheadedness, and fatigue.   Formaldehyde Resin:  This chemical is a common allergen causing skin irritation, redness, and itching. It is used in nail lacquers to help solidify the liquid into a thicker texture.  Camphor:  Camphor can lead to poor nail health, which is the opposite of what you want when caring for and painting your nails. This is because the harsh toxins strip your nails of their essential nutrients, starving them of what they need to maintain their strength. This chemical can also cause disorientation, and more alarmingly, seizures.  Ethyl Tosylamide: This chemical is banned in Europe due to potentially causing severe allergic reactions in users. The role of Ethyl Tosylamide is to help the polish to stick to the surface of the nail, though non-toxic nail polish also has great durability without the associated health risks.  Xylene: This chemical is what gives your nail polish that distinct smell that often causes headaches or lightheadedness. It is used in nail polish to avoid clumpiness by thinning out the solution, but it is an incredibly toxic chemical that can cause immense reactions and irritation.    **Why 10-Free Nail Polish Is Even Better** 10-free nail polish is better than 7-free as it excludes some additional chemicals and products that are not only toxic but also environmentally damaging, and even unethical to be using.  
 Parabens:  Parabens are a group of preservatives that are used in polishes to aid longevity. Not only do parabens interfere with the hormonal system, but they're also a factor directly involved with well-researched carcinogens that can cause skin and breast cancer.   Triphenyl Phosphate: Triphenyl phosphate is another harmful toxin often included in traditional nail polish to aid the malleability of the varnish. Ongoing or frequent or extended exposure to Triphenyl phosphate can cause changes in hormone regulation, affecting reproductive systems, as well as metabolism. Consequently, it is best to avoid this harmful chemical, especially in your nail polish. Gluten:  Gluten may seem surprising, but for those with a gluten allergy or intolerance, the inclusion of gluten in their nail polish can lead to severe adverse reactions. For those with celiac disease, topical exposure to wheat products can cause irritation. 
  **Conclusion** In summary, regular nail polishes can be extremely harmful to not only the health of your nails but to your body as a whole! We believe that educating people on the toxic ingredients in nail polish can help customers to make more informed decisions regarding their health. At Côte, we are dedicated to sharing our belief in beautiful, clean, and safe nontoxic nail polishes, and that is why all our products are 10- free, cruelty free, with a non-toxic formula and amazing vibrant colors. Additionally, all of our products are vegan and free of studies involving lab animals.  ","[System Instruction] ================== ONLY USE THE DATA I PROVIDE Limit your response to 250 words If you cannot answer using the contexts alone, say ""I cannot determine the answer to that due to lack of context"" ---------------- [Passage] ================== What is 7 Free Nail Polish? And Why is 10 Free Even Better! September 27, 2021 By Mary Lennon Did you know that the nail polish you are currently using could be affecting your health in ways you may have never even thought?  Mainstream nail polishes contain several chemicals and other harsh ingredients that have the ability to cause severe adverse reactions alongside damaging health concerns.  As a result of this, you may have come across nail polish brands that claim to be 3-free, 5-free, or even 7-free, and it is likely that you have wondered what exactly is meant by those confusing phrases.   In this blog post, we will be covering everything that you need to know about non-toxic nail polish, as well as offer an explanation as to why the nail polish you are using right now could be bad for your health.     **The Importance Of Non-Toxic Nail Polish** First off, to truly understand the importance of non-toxic nail polish, it is fundamental that one knows the negative health connotations associated with regular nail polish. A 2015 study found that certain chemicals that are used in most bottles of nail polish, can be absorbed into the body via the nails and cause several damaging health effects to the user.  These damaged health effects vary greatly from person to person, but they can cause quite a devastating impact. Regular types of nail polish contain cancer-causing chemicals, can cause hormone imbalances, alongside thyroid issues, and increase the risk of diabetes should you be overexposing yourself to the product.  Though you may assume that you are not going to be affected by these chemicals, just think of how much you breathe in the scent of nail lacquer while painting your nails and how often the paint touches your skin, as well as the amount of contact your nails have with your mouth directly, or when preparing food for both you and your loved ones.    Fortunately, enough research has been established so that while regular nail polish used at your nail salon is sadly still able to promote itself, innovative and safe nail products have been developed with the health of the customer in mind. Non- toxic nail polish comes in several variants, with each type excluding certain chemicals, ingredients, and products that may have highly damaging effects on the user. These types of non toxic nail polishes are often referred to as 3-free, 5-free, 7-free, or 10-free.  Here at Côte Nail Polish, all of our vegan nail polishes are cruelty-free, and most importantly, non-toxic. Our customers can be assured that their health is our optimal concern and that we will always endeavor to use the best and highest quality ingredients for our nail polish and accessories.    **What Is 7-Free Nail Polish?** 7-free nail polish is free of 7 toxic chemicals that are common in most regular nail polish formulas. The chemicals this nail lacquer is free from are as follows: dibutyl phthalate, formaldehyde, toluene, formaldehyde resin, camphor, ethyl tosylamide, and xylene. Each of these chemicals can have a negative impact on the user’s health, and therefore, substituting them out of the polish formula will help to lessen the toxic effect of nail varnish.  There are also other variants of the free toxin nail polish, each omitting a specific number of chemicals: 3-Free: This formula is void of the “Toxic Trio”: Dibutyl Phthalate (DPB), Formaldehyde, and Toluene. These three chemicals are by far the most harmful, as they are associated with some of the most harmful and debilitating diseases, including cancer and diabetes.  5-Free:  The chemicals excluded in 5- free include the above-mentioned “Toxic Trio” as well as formaldehyde resin, and camphor.  10-Free:  This type of formula omits dibutyl phthalate, TPHP, toluene, xylene, ethyl tosylamide, camphor, formaldehyde, formaldehyde resin, parabens, and gluten. Therefore, this formula of nail polish is considered to be one of the safest types of nail polish due to its substitution of toxic chemicals.    **Chemicals Excluded in 7-Free Polish** Simply providing the names of the seven harmful chemicals left out of these 7- free polishes will not accurately represent the harm that these toxins can cause. In this section, we have outlined the chemicals that are excluded from seven free nail polishes, explaining the health issues that these can cause.  Dibutyl Phthalate (DPB):  DPB is a harsh chemical that affects the endocrine system, which controls hormone regulation. Too much DPB can cause issues with your thyroid, causing mental health issues as well as physical problems like fatigue. It can also hamper developmental growth and potentially affect reproductive health. Formaldehyde: This commonly used chemical is a known human carcinogen, meaning it has been known to increase the risk of cancer. It can also cause severe dermatitis, skin irritation, and eye irritation.  Toluene: Toluene can cause birth defects in the children of pregnant women who are overly exposed to the chemical. It can also affect the nervous system, causing nausea, lightheadedness, and fatigue.   Formaldehyde Resin:  This chemical is a common allergen causing skin irritation, redness, and itching. It is used in nail lacquers to help solidify the liquid into a thicker texture.  Camphor:  Camphor can lead to poor nail health, which is the opposite of what you want when caring for and painting your nails. This is because the harsh toxins strip your nails of their essential nutrients, starving them of what they need to maintain their strength. This chemical can also cause disorientation, and more alarmingly, seizures.  Ethyl Tosylamide: This chemical is banned in Europe due to potentially causing severe allergic reactions in users. The role of Ethyl Tosylamide is to help the polish to stick to the surface of the nail, though non-toxic nail polish also has great durability without the associated health risks.  Xylene: This chemical is what gives your nail polish that distinct smell that often causes headaches or lightheadedness. It is used in nail polish to avoid clumpiness by thinning out the solution, but it is an incredibly toxic chemical that can cause immense reactions and irritation.    **Why 10-Free Nail Polish Is Even Better** 10-free nail polish is better than 7-free as it excludes some additional chemicals and products that are not only toxic but also environmentally damaging, and even unethical to be using.  
 Parabens:  Parabens are a group of preservatives that are used in polishes to aid longevity. Not only do parabens interfere with the hormonal system, but they're also a factor directly involved with well-researched carcinogens that can cause skin and breast cancer.   Triphenyl Phosphate: Triphenyl phosphate is another harmful toxin often included in traditional nail polish to aid the malleability of the varnish. Ongoing or frequent or extended exposure to Triphenyl phosphate can cause changes in hormone regulation, affecting reproductive systems, as well as metabolism. Consequently, it is best to avoid this harmful chemical, especially in your nail polish. Gluten:  Gluten may seem surprising, but for those with a gluten allergy or intolerance, the inclusion of gluten in their nail polish can lead to severe adverse reactions. For those with celiac disease, topical exposure to wheat products can cause irritation. 
  **Conclusion** In summary, regular nail polishes can be extremely harmful to not only the health of your nails but to your body as a whole! We believe that educating people on the toxic ingredients in nail polish can help customers to make more informed decisions regarding their health. At Côte, we are dedicated to sharing our belief in beautiful, clean, and safe nontoxic nail polishes, and that is why all our products are 10- free, cruelty free, with a non-toxic formula and amazing vibrant colors. Additionally, all of our products are vegan and free of studies involving lab animals.  ---------------- [Question] ================== What does it mean when a nail polish is 10-free?",Retail/Product,Explanation/Definition,Q&A "Use only the document provided. If the question can not be answered then respond with 'I am unable to answer this request'",What are some ICT advances in the field of social touch?,"REVIEW published: 27 May 2015 doi: 10.3389/fdigh.2015.00002 Social touch in human–computer interaction Jan B. F. van Erp 1,2 * and Alexander Toet 1 1 Perceptual and Cognitive Systems, TNO, Soesterberg, Netherlands, 2 Human Media Interaction, University of Twente, Enschede, Netherlands Edited by: Yoram Chisik, University of Madeira, Portugal Reviewed by: Mohamed Chetouani, Université Pierre et Marie Curie, France Gualtiero Volpe, Università degli Studi di Genova, Italy Hongying Meng, Brunel University London, UK *Correspondence: Jan B. F. van Erp, TNO Human Factors, Kampweg 5, Soesterberg 3769DE, Netherlands jan.vanerp@tno.nl Specialty section: This article was submitted to Human-Media Interaction, a section of the journal Frontiers in Digital Humanities Received: 06 February 2015 Paper pending published: 19 March 2015 Accepted: 08 May 2015 Published: 27 May 2015 Citation: van Erp JBF and Toet A (2015) Social touch in human–computer interaction. Front. Digit. Humanit. 2:2. doi: 10.3389/fdigh.2015.00002 Touch is our primary non-verbal communication channel for conveying intimate emotions and as such essential for our physical and emotional wellbeing. In our digital age, human social interaction is often mediated. However, even though there is increasing evidence that mediated touch affords affective communication, current communication systems (such as videoconferencing) still do not support communication through the sense of touch. As a result, mediated communication does not provide the intense affective experience of co-located communication. The need for ICT mediated or generated touch as an intuitive way of social communication is even further emphasized by the growing interest in the use of touch-enabled agents and robots for healthcare, teaching, and telepresence applications. Here, we review the important role of social touch in our daily life and the available evidence that affective touch can be mediated reliably between humans and between humans and digital agents. We base our observations on evidence from psychology, computer science, sociology, and neuroscience with focus on the first two. Our review shows that mediated affective touch can modulate physiological responses, increase trust and affection, help to establish bonds between humans and avatars or robots, and initiate pro-social behavior. We argue that ICT mediated or generated social touch can (a) intensify the perceived social presence of remote communication partners and (b) enable computer systems to more effectively convey affective information. However, this research field on the crossroads of ICT and psychology is still embryonic and we identify several topics that can help to mature the field in the following areas: establishing an overarching theoretical framework, employing better research methodologies, developing basic social touch building blocks, and solving specific ICT challenges. Keywords: affective touch, mediated touch, social touch, interpersonal touch, human–computer interaction, human–robot interaction, haptic, tactile Introduction Affective Touch in Interpersonal Communication The sense of touch is the earliest sense to develop in a human embryo (Gottlieb 1971) and is critical for mammals’ early social development and to grow up healthily (Harlow and Zimmermann 1959; Montagu 1972). The sense of touch is one of the first mediums of communication between newborns and parents. Interpersonal communication is to a large extent non-verbal and one of the primary purposes of non-verbal behavior is to communicate emotional states. Non-verbal communication includes facial expressions, prosody, gesture, and touch Frontiers in Digital Humanities | www.frontiersin.org 1 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI (Argyle 1975; Knapp and Hall 2010) of which touch is the primary modality for conveying intimate emotions (Field 2010; Morrison et al. 2010; App et al. 2011), for instance, in greetings, in corrections, and in (sexual) relationships. As touch implies direct physical interaction and co-location, it inherently has the potential to elicit feelings of social presence. The importance of touch as a modality in social communication is highlighted by the fact that the human skin has specific receptors to process affective touch (“the skin as a social organ”: Morrison et al. 2010) in addition to those for discriminative touch (Löken et al. 2009; Morrison et al. 2011; Gordon et al. 2013; McGlone et al. 2014), presumably like all mammals (Vrontou et al. 2013). ICT systems can employ human touch for information processing (discriminative touch) and communication (social touch) as well. Field (2010) and Gallace and Spence (2010)]. For these reasons, mediated interpersonal touch is our first topic of interest. Human–computer interaction applications increasingly deploy intelligent agents to support the social aspects of the interaction. Social agents (either embodied or virtual) already employ vision and audition to communicate social signals but generally lack touch capabilities. If we look at applications in robots and avatars, the first applications including touch facilitated information from user to system only, e.g., in the form of a touch screen or through specific touch sensors in a tangible interface. Social agents that can touch the user are of much more recent date. We believe that social agents could benefit from generating and perceiving social touch cues (van Erp 2012). Based on studies reviewed in this paper, we expect that people will feel a closer bond with agents or robots that use and respond to affective touch since they appear more human than machine-like and more trustworthy. Touch-enabled social agents are therefore our second topic of interest. Discriminative Touch in ICT Systems Conventional systems for human–computer interaction only occasionally employ the sense of touch and mainly provide information through vision and audition. One of the first large-scale applications of a tactile display was the vibration function on mobile phones, communicating the 1-bit message of an incoming call, and the number of systems that include the sense of touch has steadily increased over the past two decades. An important reason for the sparse use of touch is the supposed low bandwidth of the touch channel (Gallace et al. 2012). Although often underestimated, our touch sense is very well able to process large amounts of abstract information. For instance, blind people who are trained in Braille reading can actually read with their fingertips. This information processing capability is increasingly applied in our interaction with systems, and more complex information is being displayed, e.g., to reduce the risk of visual and auditory overload in car driving, to make us feel more immersed in virtual environments, or to realistically train and execute certain medical skills (van Erp and van Veen 2004; Self et al. 2008). Touch in Social Communication Social touch can take many forms in our daily lifes such as greetings (shaking hands, embracing, kissing, backslapping, and cheektweaking), in intimate communication (holding hands, cuddling, stroking, back scratching, massaging), and in corrections (punishment, spank on the bottom). Effects of social touch are apparent at many levels ranging from physiology to social behavior as we will discuss in the following sections. Social touches can elicit a range of strong experiences between pleasant and unpleasant, depending on among others the stimulus [e.g., unpleasant pinches evoking pain (nociception)] and location on the body (e.g., pleasant strokes in erogenous zones). In addition to touch in communication, touch can also be employed in psychotherapy (Phelan 2009) and nursing (Gleeson and Timmins 2005). Examples range from basic comforting touches and massaging to alternative therapies such as acu-pressure, Reiki, vibroacoustic therapy, and low-frequency vibration (Wigram 1996; Kvam 1997; Patrick 1999; Puhan et al. 2006; Prisby et al. 2008). See Dijk et al. (2013) for more examples on mental, healthrelated, and bodily effects of touch. In this paper, we focus on ICT mediated and generated social touch (the areas where psychology and computer science meet), meaning that areas of, for instance, Reiki and low-frequency vibration fall outside the scope of this paper. We first discuss the many roles of social touch in our daily life before continuing with ICT mediated inter-human touch and ICT generated and interpreted touch in human–agent interaction. In 1990s (Vallbo et al. 1993), the first reports on so-called C tactile afferents in human hairy skin were published. This neurophysiological channel in the skin reacts to soft, stroking touches, and its activity strongly depends on stroking speed (with an optimum in the speed range 3–10 cm/s) and has a high correlation with subjective ratings of the pleasantness of the touch. Research over the past decades has shown that this system is not involved in discriminative touch (Olausson et al. 2008) but underlies the emotional aspects of touch and the development and function of the social brain (McGlone et al. 2014). Social touches may activate both this pleasurable touch system and the discriminative touch Affective Touch in ICT Systems Incorporating the sense of touch in ICT systems started with discriminative touch as an information channel, often in addition to vision and audition (touch for information processing). We believe that we are on the averge of a second transition: adding social or affective touch to ICT systems (touch for social communication). In our digital era, an increasing amount of our social interactions is mediated, for example, through (cell) phones, video conferencing, text messaging, chat, or e-mail. Substituting direct contact, these modern technologies make it easy to stay in contact with distant friends and relatives, and they afford some degree of affective communication. For instance, an audio channel can transmit affective information through phonetic features like amplitude variation, pitch inflections, tempo, duration, filtration, tonality, or rhythm, while a video channel supports nonverbal information such as facial expressions and body gestures. However, current communication devices do not allow people to express their emotions through touch and may therefore lack a convincing experience of actual togetherness (social presence). This technology-induced touch deprivation may even degrade the potential beneficial effects of mediated social interaction [for reviews of the negative side effects of touch deprivation see Frontiers in Digital Humanities | www.frontiersin.org 2 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI system (reacting to, for instance, pressure, vibration, and skin stretch). caring, agreement, gratitude, and moral support. Cold feedback was consistently associated with negative issues. Touch, Physiological Functioning, and Wellbeing Touch to Communicate Emotions Hertenstein et al. (2006, 2009) showed that touch alone can effectively be used to convey distinct emotions such as anger, fear, and disgust. In addition, touch plays a role in communicating more complex social messages like trust, receptivity, affection (Mehrabian 1972; Burgoon 1991) and nurture, dependence, and affiliation (Argyle 1975). Touch can also enhance the meaning of other forms of verbal and non-verbal communication, e.g., touch amplifies the intensity of emotional displays from our face and voice (Knapp and Hall 2010). Examples of touches used to communicate emotions are shaking, pushing, and squeezing to communicate anger, hugging, patting, and stroking to communicate love (Gallace and Spence 2010). Jones and Yarbrough (1985) stated that a handshake, an encouraging pat on the back, a sensual caress, a nudge for attention, a tender kiss, or a gentle brush of the shoulder can all convey a vitality and immediacy that is at times far more powerful than language. According to App et al. (2011), touch is the preferred non-verbal communication channel for conveying intimate emotions like love and sympathy, confirmed by, for instance, Debrot et al. (2013) who showed that responsive touch between romantic partners enhances their affective state. McCance and Otley (1951) showed that licking and stroking of the mother animal is critical to start certain physiological processes in a new-born mammal. This indicates the direct link between skin stimulation and physiological processes, a link that is preserved later in life. For instance, gentle stroking touch can lower heart rate and blood pressure (Grewen et al. 2003), increase transient sympathetic reflexes and increase pain thresholds (Drescher et al. 1980; Uvnäs-Moberg 1997), and affect the secretion of stress hormones (Whitcher and Fisher 1979; Shermer 2004; Ditzen et al. 2007). Women holding their partner’s hand showed attenuated threat-related brain activity in response to mild electric shocks (Coan et al. 2006) and reported less pain in a cold pressor task (Master et al. 2009). Touch can also result in coupling or syncing of electrodermal activity of interacting (romantic) couples (ChatelGoldman et al. 2014). Interpersonal touch is the most commonly used method of comforting (Dolin and Booth-Butterfield 1993) and an instrument in nursing care (Bush 2001, Chang 2001, Henricson et al. 2008). For example, patients who were touched by a nurse during preoperative instructions experienced lower subjective and objective stress levels (Whitcher and Fisher 1979), than people who were not. In addition to touch affecting hormone levels, hormones (i.e., oxytocin) also affect the perception of interpersonal touch. Scheele et al. (2014) investigated the effect of oxytocin on the perception of a presumed male or female touch on male participants and found that oxytocin increased the rated pleasantness and brain activity of presumed female touches but not of male touches (all touches were delivered by the same female experimenter). Ellingsen et al. (2014) reported that after oxytocin submission, the effect of touch on the evaluation of facial expression increased. In addition, touch (handshaking in particular) can also play a role in social chemo-signaling. Handshaking can lead to the exchange of chemicals in sweat and behavioral data indicates that people more often sniff their hands after a greeting with a handshake than without a handshake (Frumin et al. 2015). Many social touches are reciprocal in nature (like cuddling and holding hands) and their dynamics rely on different mechanisms all having their own time scale: milliseconds for the detection of a touch (discriminative touch), hundreds of milliseconds and up for the experience of pleasurable touch, and seconds and up for physiological responses (including changes in hormone levels). How these processes interact and possibly reinforce each other is still terra incognita. Physiological responses can also be indirect, i.e., the result of social or empathetic mechanisms. Cooper et al. (2014) recently showed that the body temperature of people decreased when looking at a video of other people putting their hands in cold water. Another recent paradigm is to use thermal and haptically enhanced interpersonal speech communication. This showed that warm and cold signals were used to communicate the valence of messages (IJzerman and Semin 2009; Suhonen et al. 2012a). Warm messages were used to emphasize positive feelings and pleasant experiences, and to express empathy, comfort, closeness, Frontiers in Digital Humanities | www.frontiersin.org Touch to Elicit Emotions Not only can the sense of touch be used to communicate distinct emotions but also to elicit (Suk et al. 2009) and modulate human emotion. Please note that interpreting communicated emotions differs from eliciting emotions as the former may be considered as a cognitive task not resulting in physiological responses, e.g., one can perceive a touch as communicating anger without feeling angry. Starting with the James–Lange theory (James 1884; Cannon 1927; Damasio 1999), the conscious experience of emotion is the brain’s interpretation of physiological states. The existence of specific neurophysiological channels for affective touch and pain and the direct physiological reactions to touch indicate that there may be a direct link between tactile stimulation, physiological responses, and emotional experiences. Together with the distinct somatotopic mapping between bodily tactile sensations and different emotional feelings as found by Nummenmaa et al. (2013), one may assume that tactile stimulation of different bodily regions can elicit a wide range of emotions. Touch as a Behavior Modulator In addition to communicating and eliciting emotions, touch provides an effective means of influencing people’s attitudes toward persons, places, or services, their tendency to create bonds and their (pro-)social behaviors [see Gallace and Spence (2010) for an excellent overview]. This effect is referred to as the Midas touch: a brief, casual touch (often at the hand or arm) that is not necessarily consciously perceived named after king Midas from Greek mythology who had the ability to turn everything he touched into gold. For example, a half-second of hand-to-hand touch from a librarian fostered more favorable impressions of the library (Fisher et al. 1976), touching by a salesperson increased positive evaluations of the store (Hornik 1992), and touch can 3 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI also boost the attractiveness ratings of the toucher (Burgoon et al. 1992). Recipients of such “simple” Midas touches are also more likely to be more compliant or unselfish: willing to participate in a survey (Guéguen 2002) or to adhere to medication (Guéguen et al. 2010), volunteering for demonstrating in a course (Guéguen 2004), returning money left in a public phone (Kleinke 1977), spending more money in a shop (Hornik 1992), tipping more in a restaurant (Crusco and Wetzel 1984), helping with picking-up dropped items (Guéguen and Fischer-Lokou 2003), or giving away a cigarette (Joule and Guéguen 2007). In addition to these oneon-one examples, touch also plays a role in teams. For instance, physical touch enhances team performance of basketball players through building cooperation (Kraus et al. 2010). In clinical and professional situations, interpersonal touch can increase information flow and causes people to evaluate communication partners more favorably (Fisher et al. 1976). and Watts 2010; Tsetserukou 2010), pokes (Park et al. 2011), handholding (Gooch and Watts 2012; Toet et al. 2013), handshakes (Bailenson et al. 2007), strokes on the hand (Eichhorn et al. 2008), arm (Huisman et al. 2013) and cheek (Park et al. 2012), pinches, tickles (Furukawa et al. 2012), pats (Bonanni et al. 2006), squeezes (Rantala et al. 2013), thermal signals (Gooch and Watts 2010; Suhonen et al. 2012a,b), massages (Chung et al. 2009), and intimate sexual touches (Solon 2015). In addition to direct mediation, there is also an option to use indirect ways, for instance, through avatars in a virtual world. Devices like a haptic-jacket system can enhance the communication between users of virtual worlds such as Second Life by enabling the exchange of touch cues resembling encouraging pats and comforting hugs between users and their respective avatars (Hossain et al. 2011). The Huggable is a semi-autonomous robotic teddy bear equipped with somatic sensors, intended to facilitate affective haptic communication between two people (Lee et al. 2009) through a tangible rather than a virtual interface. Using these systems, people can not only exchange messages but also emotionally and physically feel the social presence of the communication partner (Tsetserukou and Neviarouskaya 2010). The above examples can be considered demonstrations of the potential devices and applications and the richness of social touch. Although it appears that virtual interfaces can effectively transmit emotion even with touch cues that are extremely degraded (e.g., a handshake that is lacking grip, temperature, dryness, and texture: Bailenson et al. 2007), the field lacks rigorous validation and systematic exploration of the critical parameters. The few exceptions are the work by Smith and MacLean (2007) and by Salminen et al. (2008). Smith and MacLean performed an extensive study into the possibilities and the design space of an interpersonal haptic link and concluded that emotion can indeed be communicated through this medium. Salminen et al. (2008) developed a friction-based horizontally rotating fingertip stimulator to investigate emotional experiences and behavioral responses to haptic stimulation and showed that people can rate these kind of stimuli as less or more unpleasant, arousing, avoidable, and dominating. Mediated Social Touch In the previous section, we showed that people communicate emotions through touch, and that inter-human touch can enhance wellbeing and modulate behavior. In interpersonal communication, we may use touch more frequently than we are aware of. Currently, interpersonal communication is often mediated and given the inherent human need for affective communication, mediated social interaction should preferably afford the same affective characteristics as face-to-face communication. However, despite the social richness of touch and its vital role in human social interaction, existing communication media still rely on vision and audition and do not support haptic interaction. For a more in-depth reflection on the general effects of mediated interpersonal communication, we refer to Konijn et al. (2008) and Ledbetter (2014). Tactile or kinesthetic interfaces in principle enable haptic communication between people who are physically apart, and may thus provide mediated social touch, with all the physical, emotional, and intellectual feedback it supplies (Cranny-Francis 2011). Recent experiments show that even simple forms of mediated touch have the ability to elicit a wide range of distinct affective feelings (Tsalamlal et al. 2014). This finding has stimulated the study and design of devices and systems that can communicate, elicit, enhance, or influence the emotional state of a human by means of mediated touch. Remote Collaboration Between Groups Collaborative virtual environments are increasingly used for distance education [e.g., Mikropoulos and Natsis (2011)], training simulations [e.g., Dev et al. (2007) and Flowers and Aggarwal (2014)], therapy treatments (Bohil et al. 2011), and for social interaction venues (McCall and Blascovich 2009). It has been shown that adding haptic feedback to the interaction between users of these environments significantly increases their perceived social presence (Basdogan et al. 2000; Sallnäs 2010). Another recent development is telepresence robots that enable users to physically interact with geographically remote persons and environments. Their ultimate goal is to provide users with the illusion of a physical presence in remote places. Telepresence robots combine physical and remote presence and have a wide range of potential social applications like remote embodied teleconferencing and teaching, visiting or monitoring elderly in care centers, and making patient rounds in medical facilities (Kristoffersson et al. 2013). To achieve an illusion of telepresence, the robot should be able to reciprocate the user’s behavior and to Remote Communication Between Partners Intimacy is of central importance in creating and maintaining strong emotional bonds. Humans have an important social and personal need to feel connected in order to maintain their interpersonal relationships (Kjeldskov et al. 2004). A large part of their interpersonal communication is emotional rather than factual (Kjeldskov et al. 2004). The vibration function on a mobile phone has been used to render emotional information for blind users (Réhman and Liu 2010) and a similar interface can convey emotional content in instant messaging (Shin et al. 2007). Also, a wide range of systems have been developed for the mediated representation of specific touch events between dyads such as kisses (Saadatian et al. 2014), hugs (Mueller et al. 2005; Cha et al. 2008; Teh et al. 2008; Gooch Frontiers in Digital Humanities | www.frontiersin.org 4 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI provide the user with real-time multisensory feedback. As far as we are aware of, systems including the sense of touch have not been described yet. provided by the user to the system, and closing the loop between these signals. Generating Social Touch Signals Lemmens et al. (2009) tested tactile jackets (and later blankets) to increase emotional experiences while watching movies and reported quite strong effects of well-designed vibration patterns. Dijk et al. (2013) developed a dance vest for deaf teenagers. This vest included an algorithm that translated music into vibration patterns presented through the vest. Although not generated by a social entity, experiencing music has a substantial emotional part as did the automatically generated vibration patterns. Beyond the scripted and one-way social touch cues employed in the examples above, human–computer interaction applications increasingly deploy intelligent agents to support the social aspects of the interaction (Nijholt 2014). Social agents are used to communicate, express, and perceive emotions, maintain social relationships, interpret natural cues, and develop social competencies (Fong et al. 2003; Li et al. 2011). Empathic communication in general may serve to establish and improve affective relations with social agents (Bickmore and Picard 2005), and may be considered as a fundamental requirement for social agents that are designed to function as social companions and therapists (Breazeal 2011). Initial studies have shown that human interaction with social robots can indeed have therapeutic value (Kanamori et al. 2003; Wada and Shibata 2007; Robinson et al. 2013). These agents typically use facial expressions, gesture, and speech to convey affective cues to the user. Social agents (either physically embodied as, e.g., robots or represented as on-screen virtual agents) may also use (mediated) touch technology to communicate with humans (Huisman et al. 2014a). In this case, the touch cue is not only mediated but also generated and interpreted by an electronic system instead of a human. The physical embodiment of robots gives them a direct capability to touch users, while avatars may use the technology designed for other HCI or mediated social touch applications to virtually touch their user. Several devices have been proposed that enable haptic interaction with virtual characters (Hossain et al. 2011; Rahman and El Saddik 2011; Huisman et al. 2014a). Only few studies investigated autonomous systems that touch users for affective or therapeutic purposes (Chen et al. 2011), or that use touch to communicate the affective state of artificial creatures to their users (Yohanan and MacLean 2012). Reactions to Mediated Touch at a Physiological, Behavioral, and Social Level Although the field generally lacks serious validation studies, there is mounting evidence that people use, experience, and react to direct and mediated social touch in similar ways Bailenson and Yee (2007), at the physiological, psychological, behavioral, and social level. At a physiological and psychological level, mediated affective touch on the forearm can reduce heart rate of participants that experienced a sad event (Cabibihan et al. 2012). Mediated touch affects the quality of a shared experience and increases the intimacy felt toward the other person (Takahashi et al. 2011). Stimulation of someone’s hand through mediated touch can modulate the quality of a remotely shared experience (e.g., the hilariousness of a movie) and increase sympathy for the communication partner (Takahashi et al. 2011). In a storytelling paradigm, participants experienced a significantly higher degree of connectedness with the storyteller when the speech was accompanied by remotely administered squeezes in the upper arm (Wang et al. 2012). Additional evidence for the potential effects of mediated touch are found in the fact that hugging a robot medium while talking increases affective feelings and attraction toward a conversation partner (Kuwamura et al. 2013; Nakanishi et al. 2013). Participants receiving tactile facial stimulation experienced a stranger receiving similar stimulation to be closer, more positive and more similar to themselves when they were provided with synchronous visual feedback (Paladino et al. 2010). At a behavioral level, the most important observation is that the effect of a mediated touch on people’s pro-social behavior is similar to that of a real touch. According to Haans and IJsselsteijn (2009a), a virtual Midas touch has effects in the same order of magnitude as a real Midas touch. At the social level, the use of mediated touch is only considered appropriate as a means of communication between people in close personal relationships (Rantala et al. 2013), and the mere fact that two people are willing to touch implies an element of trust and mutual understanding (Collier 1985). The interpretation of mediated touch depends on the type of interrelationship between sender and receiver (Rantala et al. 2013), similar to direct touch (Coan et al. 2006; Thompson and Hampton 2011) and like direct touch, mediated touch communication between strangers can cause discomfort (Smith and MacLean 2007). Recognizing and Interpreting Social Touch Signals Communication implies a two-way interaction and social robots and avatars should therefore not only be able to generate but also to recognize affectionate touches. For instance, robotic affective responses to touch may contribute to people’s quality of life (Cooney et al. 2014). Touch capability is not only “nice to have” but may even be a necessity: people expect social interaction with embodied social agents to the extent that physical embodiment without tactile interaction results in a negative appraisal of the robot (Lee et al. 2006). In a recent study on the suitability of social robots for the wellbeing of the elderly, all participants expressed their wish for the robot to feel pleasant to hold or stroke and to Social Touch Generated by ICT Systems The previous chapter dealt with devices that enable interpersonal social touch communication, i.e., a situation in which the touch signals are generated and interpreted by human users and only mediated through information and communication technology. One step beyond this is to include social touch in the communication between a user and a virtual entity. This implies three additional challenges: the generation of social touch signals from system to user, the interpretation of social touch signals Frontiers in Digital Humanities | www.frontiersin.org 5 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI respond to touch (Hutson et al. 2011). The well-known example of the pet seal Paro (Wada et al. 2010) shows how powerful a simple device can be in evoking social touches. Paro responds sec to being touched but does neither interpret social touch nor produce touch. Similar effects are reported for touching a humanoid robot on the shoulder: just being able to touch already significantly increases trust toward the robot (Dougherty and Scharfe 2011). Automatic recognition and interpretation of the affective content of human originated social touch is essential to support this interaction (Argall and Billard 2010). Different approaches to equipping robots with a sense of touch include covering them with an artificial skin that simulates the human somatosensory systems (Dahiya et al. 2010) or the use of fully embodied robots covered with a range of different (e.g., temperature, proximity, pressure) sensors (Stiehl et al. 2005). To fully capture a social touch requires sensors that go beyond those used in the more advanced area of haptics and that primarily involve discriminative touch (e.g., contact, pressure, resistance). At least sensors for temperature and soft, stroking touch should be included to capture important parameters of social touch. However, just equipping a system (robot, avatar, or interface) with touch sensors is not sufficient to enable affective haptic interaction. A system can only appreciate and respond to affective touch in a natural way when it is able (a) to determine where the touch was applied, (b) to assess what kind of tactile stimulation was applied, and (c) to appraise the affective quality of the touch (Nguyen et al. 2007). While video- and audio-based affect recognition have been widely investigated (Calvo and D’Mello 2010), there have only been a few studies on touch-based affect recognition. The results of these preliminary studies indicate that affect recognition based on tactile interaction between humans and robots is comparable to that between humans (Naya et al. 1999; Cooney et al. 2012; Altun and MacLean 2014; Jung et al. 2014; van Wingerden et al. 2014). Research on capturing emotions from touch input to a computer system (i.e., not in a social context) confirms the potential of the touch modality (Zacharatos et al. 2014). Several research groups worked on capturing emotions from traditional computer input devices like mouse and keyboard based on the assumption that a user’s emotional state affects the motor output system. A general finding is that typing speed correlates to valence with a decrease in typing speed for negative valence and increased speed for positive valence compared to typing speed in neutral emotional state (Tsihrintzis et al. 2008; Khanna and Sasikumar 2010). A more informative system includes the force pattern of the key strokes. Using this information, very high-accuracy rates (>90%) are reported (Lv et al. 2008) for categorizing six emotional states (neutral, anger, fear, happiness, sadness, and surprise). This technique requires force sensitive keyboards, which are not widely available. Touch screens are used by an increasing number of people and offer much richer interaction parameters than keystrokes such as scrolling, tapping, or stroking. Recent work by Gao et al. (2012) showed that in a particular game played on the iPod, touch inputs like stroke length, pressure, and speed were important features related to a participant’s verbal description of the emotional experience during the game. Using a linear SVM, classification performance reached 77% for four emotional classes Frontiers in Digital Humanities | www.frontiersin.org (excited, relaxed, frustrated, and bored), close to 90% for two levels of arousal, and close to 85% for two levels of valence. Closing the Loop A robot that has the ability to “feel,” “understand,” and “respond” to touch in a human-like way will be capable of more intuitive and meaningful interaction with humans. Currently, artificial entities that include touch capabilities either produce or interpret social touch, but not both. However, both are required to close the loop and come to real, bidirectional interaction. The latter may require strict adherence to, for instance, timing and immediacy; a handshake in which the partners are out-of-phase can be very awkward. And as Cranny-Francis (2011) states, violating the tactile regime may result in being rejected as alien and may seriously offend others. Reactions to Touching Robots and Avatars at a Physiological, Behavioral, and Social Level Although there are still very few studies in this field, and there has been hardly any real formal evaluation, the first results of touch interactions with artificial entities appear promising. For instance, people experience robots that interact by touch as less machinelike (Cramer et al. 2009). Yohanan and colleagues (Yohanan et al. 2005; Yohanan and MacLean 2012) designed several haptic creatures to study a robot’s communication of emotional state and concluded that participants experienced a broader range of affect when haptic renderings were applied. Basori et al. (2009) showed the feasibility of using vibration in combination with sound and facial expression in avatars to communicate emotion strength. Touch also assists in building a relationship with social actors: hand squeezes (delivered through an airbladder) can improve the relation with a virtual agent (Bickmore et al. 2010). Artificial hands equipped with synthetic skins can potentially replicate not only the biomechanical behavior but also the warmth (the “feel”) of the human hand (Cabibihan et al. 2009, 2010, 2011). Users perceived a higher degree of friendship and social presence when interacting with a zoomorphic social robot with a warmer skin (Park and Lee 2014). Recent experiments indicate that the warmth of a robotic hand mediating social touch contributed significantly to the feeling of social presence (Nakanishi et al. 2014) and holding a warm robot hand increased feelings of friendship and trust toward a robot (Nie et al. 2012). Kotranza and colleagues (Kotranza and Lok 2008; Kotranza et al. 2009) describe a virtual patient as a medical student’s training tool that is able to be touched and to touch back. These touchenabled virtual patients were treated more like real humans than virtual patients without touch capabilities (students expressed more empathy and used touch more frequently to comfort and reassure the virtual patient).The authors concluded that by adding haptic interaction to the virtual patient, the bandwidth of the student-virtual patient communication increases and approaches that of human–human communication. In a study on the interaction between toddlers and a small humanoid robot, Tanaka et al. (2007) found that social connectedness correlated with the amount of touch between the child and robot. In a study where participants were asked to brush off “dirt” from either virtual objects or virtual humans, they touched virtual humans with 6 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI less force than non-human objects, and they touched the face of a virtual human with less force than the torso, while male virtual humans were touched with more force than female virtual humans (Bailenson and Yee 2008). Huisman et al. (2014b) performed a study in which participants played a collaborative augmented reality game together with two virtual agents, visible in the same augmented reality space. During interaction, one of the virtual agents touched the user on the arm by means of a vibrotactile display. They found that the touching virtual agent was rated higher on affective adjectives than the non-touching agent. Finally, Nakagawa et al. (2011) created a situation in which a robot requested participants to perform a repetitive monotonous task. This request was accompanied by an active touch, a passive touch, or no touch. The result showed that the active touch increased people’s motivation to continue performing the monotonous task. This confirms the earlier finding of Haans and IJsselsteijn (2009a) that the effect of the virtual Midas touch is in the same order of magnitude as the real Midas touch effect. may stimulate the further development of mediated social touch devices. Another research topic is the presumed close link between social touch and emotions and the potential underlying neurophysiological mechanisms, i.e., the connection between social touch and the emotional brain. Multisensory and Contextual Cues The meaning and appreciation of touch critically depend on its context (Collier 1985; Camps et al. 2012), such as the relation between conversation partners (Burgoon et al. 1992; Thompson and Hampton 2011), the body location of the touch (Nguyen et al. 1975), and the communication partner’s culture (McDaniel and Andersen 1998). There is no one-to-one correspondence between a touch and its meaning (Jones and Yarbrough 1985). Hence, the touch channel should be coupled with other sensory channels to clarify its meaning (Wang and Quek 2010). An important research question is which multisensory and contextual cues are critical. Direct (i.e., unmediated) touch is usually a multisensory experience: during interpersonal touch, we typically experience not only tactile stimulation but also changes in warmth along with verbal and non-verbal visual, auditory, and olfactory signals. Nonverbal cues (when people both see, hear, feel, and possibly smell their interaction partner performing the touching) may render mediated haptic technology more transparent, thereby increasing perceived social presence and enhancing the convincingness or immediacy of social touch (Haans and IJsselsteijn 2009b, 2010). Also, since the sight of touch activates brain regions involved in somatosensory processing [Rolls (2010); even watching a videotaped version: Walker and McGlone (2015)], the addition of visual feedback may enhance the associated haptic experience. Another strong cue for physical presence is body warmth. In human social interaction, physical temperature also plays an important role in sending interpersonal warmth (trust) information. Thermal stimuli may therefore serve as a proxy for social presence and stimulate the establishment of social relationships (IJzerman and Semin 2010). In addition to these bottom-up, stimulus driven aspects, topdown factors like expectations/beliefs of the receiver should be accounted for (e.g., beliefs about the intent of the interaction partner, familiarity with the partner, affordances of a physically embodied agent, etc.) since they shape the perceived meaning of touch (Burgoon and Walther 1990; Gallace and Spence 2010; Suhonen et al. 2012b). Research Topics Mediated social touch is a relatively young field of research that has the potential to substantially enrich human–human and human–system interaction. Although it is still not clear to what extent mediated touch can reproduce real touch, converging evidence seems to show that mediated touch shares important effects with real touch. However, many studies have an anecdotal character without solid and/or generalizable conclusions and the key studies in this field have not been replicated yet. This does not necessarily mean that the results are erroneous but it indicates that the field has not matured enough and may suffer from a publication bias. We believe that we need advancements in the following four areas for the field to mature: building an overarching framework, developing social touch basic building blocks, improving current research methodologies, and solving specific ICT challenges. Framework The human skin in itself is a complex organ able to process many different stimulus dimensions such as pressure, vibration, stretch, and temperature (van Erp 2007). “Social touch” is what the brain makes of these stimulus characteristics (sensations) taking into account personality, previous experiences, social conventions, the context, the object or person providing the touch, and probably many more factors. The scientific domains involved in social touch each have interesting research questions and answering them helps the understanding of (real life or mediated) social touch. In addition, we need an overarching framework to link the results across disciplines, to foster multidisciplinary research, and to encourage the transition from exploratory research to hypothesis driven research. Social and Cultural Social touch has a strong (unwritten) etiquette (Cranny-Francis 2011). Important questions are how to develop a touch etiquette for mediated touch and for social agents that can touch (van Erp and Toet 2013), and how to incorporate social, cultural, and individual differences with respect to acceptance and meaning of a mediated or social agent’s touch. Individual differences may include gender, attitude toward robots, and technology and touch receptivity [the (dis-)liking of being touched, Bickmore et al. 2010]. An initial set of guidelines for this etiquette is given by van Erp and Toet (2013). In addition, we should consider possible ethical implications of the technology, ranging from affecting people’s behavior without them being aware of it to the threat of physical abuse “at a distance.” Neuroscience The recent finding that there exists a distinct somatotopic mapping between tactile sensations and different emotional feelings (Nummenmaa et al. 2013; Walker and McGlone 2015) suggests that it may also be of interest to determine a map of our responsiveness to interpersonal (mediated) touch across the skin surface (Gallace and Spence 2010). The availability of such a map Frontiers in Digital Humanities | www.frontiersin.org 7 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Social Touch Building Blocks Effect Measures Gallace and Spence (2010) noted that even the most advanced devices will not be able to deliver something that can approximate realistic interpersonal touch if we do not know exactly what needs to be communicated and how to communicate it. Our touch capabilities are very complex, and like mediated vision and audition, mediated touch will always be degraded compared to real touch. The question is how this degradation affects the effects aimed for. A priori, mediated haptic communication should closely resemble non-mediated communication in order to be intuitively processed without introducing ambiguity or increasing the cognitive load (Rantala et al. 2011). However, the results discussed in this paper [e.g., Bailenson et al. (2007), Smith and MacLean (2007), Haans and IJsselsteijn (2009a), Giannopoulos et al. (2011), and Rantala et al. (2013)] indicate that social touch is quite robust to degradations and it may not be necessary to mediate all physical parameters accurately or at all. However, it is currently not even clear how we can haptically represent valence and arousal, let alone that we have robust knowledge on which parameters of the rich and complex touch characteristics are crucial in relation to the intended effects. Ideally, we have a set of building blocks of social touch that can be applied and combined depending on the situation. Social touch can evoke effects at many different levels in the receiver: physiological, psychological, behavioral, and social, and it is likely that effects at these different levels also interact. For instance, (social) presence and emotions can reciprocally reinforce each other. Currently, a broad range of effect measures is applied, which makes it difficult to compare results, assess interactions between levels, and combine experimental results into an integrated perspective. This pleads for setting a uniform set of validated and standardized measures that covers the different levels and that is robust and sensitive to the hypothesized effects of social touch. This set could include basic physiological measures known to vary with emotional experience [e.g., heart rate variability and skin conductance; Hogervorst et al. 2014]; psychological and social measures reflecting trust, proximity, togetherness, and social presence (IJsselsteijn et al. 2003; Van Bel et al. 2008; van Bel et al. 2009), and behavioral measures, e.g., quantifying compliance and performance. Please note though that each set of measures will have its own pitfalls. For instance, see Brouwer et al. (2015) for a critical reflection on the use of neurophysiological measures to assess cognitive or mental state, and Bailenson and Yee (2008) on the use of self-report questionnaires. Specific ICT Challenges Enabling ICT mediated, generated, and/or interpreted social touch requires specific ICT knowledge and technology. We consider the following issues as most prominent. Methodology Not uncommon for research in the embryonic stage, mediated social touch research is going through a phase of haphazard, anecdotal studies demonstrating the concept and its’ potential. To mature, the field needs rigorous replication and methodological well-designed studies and protocols. The multidisciplinary nature of the field adds to the diversity in research approaches. Understanding Social Touches With a few exceptions, mediated social touch studies are restricted to producing a social touch and investigate its effects on a user. To use social touch in interaction means that the system should not only be able to generate social touches but also to receive and understand social touches provided by human users. Taken the richness of human touch into account, this is not trivial. We may currently not even have the necessary sensor suite to capture a social touch adequately, including parameters like sheer and tangential forces, compliance, temperature, skin stretch, etc. After adequate capturing, algorithms should determine the social appraisal of the touch. Currently, the first attempts to capture social touches with different emotional values on a single body location (e.g., the arm) and to use computer algorithms to classify them are undertaken (van Wingerden et al. 2014). Controlled Studies Only few studies have actually investigated mediated affect conveyance, and compared mediated with unmediated touch. Although it appears that mediated social touch can indeed to some extent convey emotions (Bailenson et al. 2007) and induce pro-social behavior [e.g., the Midas effect; Haans and IJsselsteijn (2009a)], it is still not known to what extent it can also elicit strong affective experiences (Haans and IJsselsteijn 2006) and how this all compares to real touch or other control conditions. Context Aware Computing and Social Signal Processing Protocols Previous studies on mediated haptic interpersonal communication mainly investigated the communication of deliberately performed (instructed) rather than naturally occurring emotions (Bailenson et al. 2007; Smith and MacLean 2007; Rantala et al. 2013). Although this protocol is very time efficient, it relies heavily on participants’ ability to spontaneously generate social touches with, for instance, a specific emotional value. This is comparable to the research domain of facial expression where often trained actors are used to produce expressions on demand. One may consider training people in producing social touches on demand or employ a protocol (scenario) that naturally evokes specific social signals rather than instruct naïve participants to produce them. Frontiers in Digital Humanities | www.frontiersin.org The meaning of a social touch is highly dependent on the accompanying verbal and non-verbal signals of the sender and the context in which the touch is applied. An ICT system involved in social touch interaction should take the relevant parameters into account, both in generating touch and in interpreting touch. To understand and manage social signals of a person, the system is communicating with is the main challenge in the – in itself relatively young – field of social signal processing (Vinciarelli et al. 2008). Context aware (Schilit et al. 1994) implies that the system can sense its environment and reason about it in the context of social touch. 8 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Current ICT advances like the embodiment of artificial entities, the development of advanced haptic and tactile display technologies and standards (van Erp et al. 2010, including initial guidelines for mediated social touch: van Erp and Toet 2013) enable the exploration of new ICT systems that employ this powerful communication option, for instance, to enhance communication between physically separated partners and increase trust in and compliance with artificial entities. There are two prerequisites to make these applications viable. First, inter-human social touch can be ICT mediated, and second, social touch can be ICT generated and understood, all without loss of effectiveness, efficiency, and user satisfaction. In this paper, we show that there is converging evidence that both prerequisites can be met. Mediated social touch shows effects at aforementioned levels, and these effects resemble those of a real touch, even if the mediated touch is severely degraded. We also report the first indications that a social touch can be generated by an artificial entity, although the evidence base is still small. Moreover, the first steps are taken to develop algorithms to automatically classify social touches produced by the user. Our review also shows that (mediated) social touch is an embryonic field relying for a large part on technology demonstrations with only a few systematic investigations. To advance the field, we believe the focus should be on the following four activities: developing an overarching framework (integrating neuroscience, computer science, and social and behavioral science), developing basic social touch building blocks (based on the critical social touch parameters), applying stricter research methodologies (use controlled studies, validated protocols, and standard effect measures), and realizing breakthroughs in ICT (classifying social touches, context aware computing, social signal processing, congruence, and enhancing touch cues). When we are successful in managing these challenges at the crossroads of ICT and psychology, we believe that (mediated) social touch can improve our wellbeing and quality of life, can bridge the gap between real and virtual (social) worlds, and can make artificial entities more human-like. Congruency in Time, Space, and Semantics As with most multimodal interactions, congruency of the signals in space, time, and meaning is of eminent importance. For instance, touches should be congruent with other (mediated) display modalities (visual, auditory, olfactory) to communicate the intended meaning. In addition, congruence in time and space between, for instance, a seen gesture and a resulting haptic sensation is required to support a common interaction metaphor based on real touch. It has been shown that combining mediated social touch with morphologically congruent imagery enhances perceived social presence, whereas incongruent imagery results in lower degrees of social presence (Haans and IJsselsteijn 2010). Especially in closed-loop interaction (e.g., when holding or shaking hands), signals that are out of sync may severely degrade the interaction, thus requiring (near) real-time processing of touch and other social signals and generation of adequate social touches in reaction. Enhancing Touch Cues Social touch seems robust to degradations and mediated touch does not need to replicate all physical parameters accurately. The flipside of degradation is enhancement. Future research should investigate to what extent the affective quality of the mediated touch signals can be enhanced by the addition of other communication channels or by controlling specific touch parameters. Touch parameters do not necessarily have to be mediated one-to-one, but, for instance, temperature and force profiles may be either amplified or attenuated. The additional options mediation can provide to social touch have not been explored yet. Conclusion Social touch is of eminent importance in inter-human social communication and grounded in specific neurophysiological processing channels. Social touch can have effects at many levels including physiological (heart rate and hormone levels), psychological (trust in others), and sociological (pro-social behavior toward others). In Proceedings of the International Conference on Computer Technology and Development (ICCTD ‘09), 416–420. Piscataway, NJ: IEEE Press. Bickmore, T.W., Fernando, R., Ring, L., and Schulman, D. 2010. Empathic touch by relational agents. IEEE Trans. Affect. Comput. 1: 60–71. doi:10.1109/T-AFFC. 2010.4 Bickmore, T.W., and Picard, R.W. 2005. Establishing and maintaining longterm human-computer relationships. ACM Trans. Comput. Hum. Interact. 12: 293–327. doi:10.1145/1067860.1067867 Bohil, C.J., Alicea, B., and Biocca, F.A. 2011. Virtual reality in neuroscience research and therapy. Nat. Rev. Neurosci. 12: 752–62. doi:10.1038/nrn3122 Bonanni, L., Vaucelle, C., Lieberman, J., and Zuckerman, O. 2006. TapTap: a haptic wearable for asynchronous distributed touch therapy. In Proceedings of the ACM Conference on Human Factors in Computing Systems CHI ‘06, 580–585. New York, NY: ACM. Breazeal, C. 2011. Social robots for health applications. In Proceedings of the IEEE 2011 Annual International Conference on Engineering in Medicine and Biology (EMBC), 5368–5371. Piscataway, NJ: IEEE. Brouwer, A.-M., Zander, T.O., van Erp, J.B.F., Korteling, J.E., and Bronkhorst, A.W. 2015. Using neurophysiological signals that reflect cognitive or affective state: six recommendations to avoid common pitfalls. Front. Neurosci. 9:136. doi:10.3389/fnins.2015.00136 Burgoon, J.K. 1991. Relational message interpretations of touch, conversational distance, and posture. J. Nonverbal Behav. 15:233–59. doi:10.1007/BF00986924 References Altun, K., and MacLean, K.E. 2014. Recognizing affect in human touch of a robot. Pattern Recognit. Lett. doi:10.1016/j.patrec.2014.10.016 App, B., McIntosh, D.N., Reed, C.L., and Hertenstein, M.J. 2011. Nonverbal channel use in communication of emotion: how may depend on why. Emotion 11: 603–17. doi:10.1037/a0023164 Argall, B.D., and Billard, A.G. 2010. A survey of tactile human-robot interactions. Rob. Auton. Syst. 58: 1159–76. doi:10.1016/j.robot.2010.07.002 Argyle, M. 1975. Bodily Communication. 2nd ed. London, UK: Methuen. Bailenson, J.N., and Yee, N. 2007. Virtual interpersonal touch and digital chameleons. J. Nonverbal Behav. 31: 225–42. doi:10.1007/s10919-007-0034-6 Bailenson, J.N., and Yee, N. 2008. Virtual interpersonal touch: haptic interaction and copresence in collaborative virtual environments. Multimed. Tools Appl. 37: 5–14. doi:10.1007/s11042-007-0171-2 Bailenson, J.N., Yee, N., Brave, S., Merget, D., and Koslow, D. 2007. Virtual interpersonal touch: expressing and recognizing emotions through haptic devices. Hum. Comput. Interact. 22: 325–53. doi:10.1080/07370020701493509 Basdogan, C., Ho, C.-H., Srinivasan, M.A., and Slater, M. 2000. An experimental study on the role of touch in shared virtual environments. ACM Trans. Comput. Hum. Interact. 7: 443–60. doi:10.1145/365058.365082 Basori, A.H., Bade, A., Sunar, M.S., Daman, D., and Saari, N. 2009. Haptic vibration for emotional expression of avatar to enhance the realism of virtual reality. Frontiers in Digital Humanities | www.frontiersin.org 9 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Burgoon, J.K., and Walther, J.B. 1990. Nonverbal expectancies and the evaluative consequences of violations. Hum. Comm. Res. 17: 232–65. doi:10.1111/j. 1468-2958.1990.tb00232.x Burgoon, J.K., Walther, J.B., and Baesler, E.J. 1992. Interpretations, evaluations, and consequences of interpersonal touch. Hum. Comm. Res. 19: 237–63. doi:10.1111/ j.1468-2958.1992.tb00301.x Bush, E. 2001. The use of human touch to improve the well-being of older adults: A holistic nursing intervention. J. Holist. Nurs. 19(3):256–270. doi:10.1177/ 089801010101900306 Cabibihan, J.-J., Ahmed, I., and Ge, S.S. 2011. Force and motion analyses of the human patting gesture for robotic social touching. In Proceedings of the 2011 IEEE 5th International Conference on Cybernetics and Intelligent Systems (CIS), 165–169. Piscataway, NJ: IEEE. Cabibihan, J.-J., Jegadeesan, R., Salehi, S., and Ge, S.S. 2010. Synthetic skins with humanlike warmth. In Social Robotics, Edited by S. Ge, H. Li, J.J. Cabibihan, and Y. Tan, 362–371. Berlin: Springer. Cabibihan, J.-J., Pradipta, R., Chew, Y., and Ge, S. 2009. Towards humanlike social touch for prosthetics and sociable robotics: Handshake experiments and finger phalange indentations. In Advances in Robotics, Edited by J.H. Kim, S. Ge, P. Vadakkepat, N. Jesse, A. Al Manum, K. Puthusserypady, et al., 73–79 Berlin: Springer. doi:10.1007/978-3-642-03983-6_11 Cabibihan, J.-J., Zheng, L., and Cher, C.K.T. 2012. Affective tele-touch. In Social Robotics, Edited by S. Ge, O. Khatib, J.J. Cabibihan, R. Simmons, and M.A. Williams, 348–356. Berlin: Springer. Calvo, R.A., and D’Mello, S. 2010. Affect detection: an interdisciplinary review of models, methods, and their applications. IEEE Trans. Affect. Comput. 1: 18–37. doi:10.1109/T-AFFC.2010.1 Camps, J., Tuteleers, C., Stouten, J., and Nelissen, J. 2012. A situational touch: how touch affects people’s decision behavior. Social Influence 8: 237–50. doi:10.1080/ 15534510.2012.719479 Cannon, W.B. 1927. The James-Lange theory of emotions: a critical examination and an alternative theory. Am. J. Psychol. 39: 106–24. doi:10.2307/1415404 Cha, J., Eid, M., Barghout, A., and Rahman, A.M. 2008. HugMe: an interpersonal haptic communication system. In IEEE International Workshop on Haptic Audio visual Environments and Games (HAVE 2008), 99–102. Piscataway, NJ: IEEE. Chang, S.O. 2001. The conceptual structure of physical touch in caring. J. Adv. Nurs. 33(6): 820–827. doi:10.1046/j.1365-2648.2001.01721.x Chatel-Goldman, J., Congedo, M., Jutten, C., and Schwartz, J.L. 2014. Touch increases autonomic coupling between romantic partners. Front. Behav. Neurosci. 8:95. doi:10.3389/fnbeh.2014.00095 Chen, T.L., King, C.-H., Thomaz, A.L., and Kemp, C.C. 2011. Touched by a robot: an investigation of subjective responses to robot-initiated touch. In Proceedings of the 6th International Conference on Human-Robot Interaction HRI ‘11, 457–464. New York, NY: ACM. Chung, K., Chiu, C., Xiao, X., and Chi, P.Y.P. 2009. Stress outsourced: a haptic social network via crowdsourcing. In CHI ‘09 Extended Abstracts on Human Factors in Computing Systems, Edited by D.R. Olsen, K. Hinckley, M. Ringel-Morris, S. Hudson and S. Greenberg, 2439–2448. New York, NY: ACM. doi:10.1145/ 1520340.1520346 Coan, J.A., Schaefer, H.S., and Davidson, R.J. 2006. Lending a hand: social regulation of the neural response to threat. Psychol. Sci. 17: 1032–9. doi:10.1111/j. 1467-9280.2006.01832.x Collier, G. 1985. Emotional Expression. Hillsdale, NJ: Lawrence Erlbaum Associates Inc. Cooney, M.D., Nishio, S., and Ishiguro, H. 2012. Recognizing affection for a touchbased interaction with a humanoid robot. In IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), 1420–1427. Piscataway, NJ: IEEE. Cooney, M.D., Nishio, S., and Ishiguro, H. 2014. Importance of touch for conveying affection in a multimodal interaction with a small humanoid robot. Int. J. Hum. Rob. 12(1): 1550002. doi:10.1142/S0219843615500024 Cooper, E.A., Garlick, J., Featherstone, E., Voon, V., Singer, T., Critchley, H.D., et al. 2014. You turn me cold: evidence for temperature contagion. PLoS One 9:e116126. doi:10.1371/journal.pone.0116126 Cramer, H., Kemper, N., Amin, A., Wielinga, B., and Evers, V. 2009. “Give me a hug”: the effects of touch and autonomy on people’s responses to embodied social agents. Comput. Anim. Virtual Worlds 20: 437–45. doi:10.1002/cav.317 Cranny-Francis, A. 2011. Semefulness: a social semiotics of touch. Soc. Semiotics 21: 463–81. doi:10.1080/10350330.2011.591993 Frontiers in Digital Humanities | www.frontiersin.org Crusco, A.H., and Wetzel, C.G. 1984. The midas touch: the effects of interpersonal touch on restaurant tipping. Pers. Soc. Psychol. B 10: 512–7. doi:10.1177/ 0146167284104003 Dahiya, R.S., Metta, G., Valle, M., and Sandini, G. 2010. Tactile sensing – from humans to humanoids. IEEE Trans. Rob. 26: 1–20. doi:10.1109/TRO.2009. 2033627 Damasio, A. 1999. The Feeling of What Happens: Body and Emotion in the Making of Consciousness. London, UK: Heinemann. Debrot, A., Schoebi, D., Perrez, M., and Horn, A.B. 2013. Touch as an interpersonal emotion regulation process in couples’ daily lives: the mediating role of psychological intimacy. Pers. Soc. Psychol. B 39: 1373–85. doi:10.1177/ 0146167213497592 Dev, P., Youngblood, P., Heinrichs, W.L., and Kusumoto, L. 2007. Virtual worlds and team training. Anesthesiol. Clin. 25: 321–36. doi:10.1016/j.anclin.2007.03. 001 Dijk, E.O., Nijholt, A., van Erp, J.B.F., Wolferen, G.V., and Kuyper, E. 2013. Audiotactile stimulation: a tool to improve health and well-being? Int. J. Auton. Adapt. Commun. Syst. 6: 305–23. doi:10.1504/IJAACS.2013.056818 Ditzen, B., Neumann, I.D., Bodenmann, G., von Dawans, B., Turner, R.A., Ehlert, U., et al. 2007. Effects of different kinds of couple interaction on cortisol and heart rate responses to stress in women. Psychoneuroendocrinology 32: 565–74. doi:10.1016/j.psyneuen.2007.03.011 Dolin, D.J., and Booth-Butterfield, M. 1993. Reach out and touch someone: analysis of nonverbal comforting responses. Commun. Q. 41: 383–93. doi:10.1080/ 01463379309369899 Dougherty, E., and Scharfe, H. 2011. Initial formation of trust: designing an interaction with geminoid-DK to promote a positive attitude for cooperation. In Social Robotics, Edited by B. Mutlu, C. Bartneck, J. Ham, V. Evers, and T. Kanda, 95–103. Berlin: Springer. Drescher, V.M., Gantt, W.H., and Whitehead, W.E. 1980. Heart rate response to touch. Psychosom. Med. 42: 559–65. doi:10.1097/00006842-198011000-00004 Eichhorn, E., Wettach, R., and Hornecker, E. 2008. A stroking device for spatially separated couples. In Proceedings of the 10th International Conference on Human Computer Interaction with Mobile Devices and Services Mobile HCI ‘08, 303–306. New York, NY: ACM. Ellingsen, D.M., Wessberg, J., Chelnokova, O., Olausson, H., Aeng, B., and Eknes, S. 2014. In touch with your emotions: oxytocin and touch change social impressions while others’ facial expressions can alter touch. Psychoneuroendocrinology 39: 11–20. doi:10.1016/j.psyneuen.2013.09.017 Field, T. 2010. Touch for socioemotional and physical well-being: a review. Dev. Rev. 30: 367–83. doi:10.1016/j.dr.2011.01.001 Fisher, J.D., Rytting, M., and Heslin, R. 1976. Hands touching hands: affective and evaluative effects of an interpersonal touch. Sociometry 39: 416–21. doi:10.2307/ 3033506 Flowers, M.G., and Aggarwal, R. 2014. Second LifeTM : a novel simulation platform for the training of surgical residents. Expert Rev. Med. Devices 11: 101–3. doi:10. 1586/17434440.2014.863706 Fong, T., Nourbakhsh, I., and Dautenhahn, K. 2003. A survey of socially interactive robots. Rob. Auton. Syst. 42: 143–66. doi:10.1016/S0921-8890(02) 00372-X Frumin, I., Perl, O., Endevelt-Shapira, Y., Eisen, A., Eshel, N., Heller, I., et al. 2015. A social chemosignaling function for human handshaking. Elife 4: e05154. doi:10.7554/eLife.05154 Furukawa, M., Kajimoto, H., and Tachi, S. 2012. KUSUGURI: a shared tactile interface for bidirectional tickling. In Proceedings of the 3rd Augmented Human International Conference AH ‘12, 1–8. New York, NY: ACM. Gallace, A., Ngo, M.K., Sulaitis, J., and Spence, C. 2012. Multisensory presence in virtual reality: possibilities & limitations. In Multiple Sensorial Media Advances and Applications: New Developments in MulSeMedia, Edited by G. Ghinea, F. Andres and S.R. Gulliver, 1–40. Vancouver, BC: IGI Global. Gallace, A., and Spence, C. 2010. The science of interpersonal touch: an overview. Neurosci. Biobehav. Rev. 34: 246–59. doi:10.1016/j.neubiorev.2008.10.004 Gao, Y., Bianchi-Berthouze, N., and Meng, H. 2012. What does touch tell us about emotions in touchscreen-based gameplay? ACM Trans. Comput. Hum. Interact. 19: 1–30. doi:10.1145/2395131.2395138 Giannopoulos, E., Wang, Z., Peer, A., Buss, M., and Slater, M. 2011. Comparison of people’s responses to real and virtual handshakes within a virtual environment. Brain Res. Bull. 85: 276–82. doi:10.1016/j.brainresbull.2010.11.012 10 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Gleeson, M., and Timmins, F. 2005. A review of the use and clinical effectiveness of touch as a nursing intervention. Clin. Effect. Nurs. 9: 69–77. doi:10.1016/j.cein. 2004.12.002 Gooch, D., and Watts, L. 2010. Communicating social presence through thermal hugs. In Proceedings of First Workshop on Social Interaction in Spatially Separated Environments (SISSI2010), Edited by F. Schmid, T. Hesselmann, S. Boll, K. Cheverst, and L. Kulik, 11–19. Copenhagen: International Society for Presence Research. Gooch, D., and Watts, L. 2012. Yourgloves, hothands and hotmits: devices to hold hands at a distance. In Proceedings of the 25th Annual ACM Symposium on User Interface Software and Technology UIST ‘12, 157–166. New York, NY: ACM. Gordon, I., Voos, A.C., Bennett, R.H., Bolling, D.Z., Pelphrey, K.A. and Kaiser, M.D. 2013. Brain mechanisms for processing affective touch. Hum. Brain Mapp. 34(4):914–922. doi:10.1002/hbm.21480 Gottlieb, G. 1971. Ontogenesis of sensory function in birds and mammals. In The Biopsychology of Development, Edited by E. Tobach, L.R. Aronson, and E. Shaw, 67–128. New York, NY: Academic Press. Grewen, K.M., Anderson, B.J., Girdler, S.S., and Light, K.C. 2003. Warm partner contact is related to lower cardiovascular reactivity. Behav. Med. 29: 123–30. doi:10.1080/08964280309596065 Guéguen, N. 2002. Touch, awraness of touch, and compliance with a request. Percept. Mot. Skills 95: 355–60. doi:10.2466/pms.2002.95.2.355 Guéguen, N. 2004. Nonverbal encouragement of participation in a course: the effect of touching. Soc. Psychol. Educ. 7: 89–98. doi:10.1023/B:SPOE.0000010691. 30834.14 Guéguen, N., and Fischer-Lokou, J. 2003. Tactile contact and spontaneous help: an evaluation in a natural setting. J. Soc. Psychol. 143: 785–7. doi:10.1080/ 00224540309600431 Guéguen, N., Meineri, S., and Charles-Sire, V. 2010. Improving medication adherence by using practitioner nonverbal techniques: a field experiment on the effect of touch. J. Behav. Med. 33: 466–73. doi:10.1007/s10865-010-9277-5 Haans, A., and IJsselsteijn, W.A. 2006. Mediated social touch: a review of current research and future directions. Virtual Reality 9: 149–59. doi:10.1007/ s10055-005-0014-2 Haans, A., and IJsselsteijn, W.A. (2009a). The virtual Midas Touch: helping behavior after a mediated social touch. IEEE Trans. Haptics 2: 136–40. doi:10.1109/TOH. 2009.20 Haans, A., and IJsselsteijn, W.A. (2009b). I’m always touched by your presence, dear: combining mediated social touch with morphologically correct visual feedback. In Proceedings of Presence 2009, 1–6. Los Angeles, CA: International Society for Presence Research. Haans, A., and IJsselsteijn, W.A. 2010. Combining mediated social touch with vision: from self-attribution to telepresence? In Proceedings of Special Symposium at EuroHaptics 2010: Haptic and Audio-Visual Stimuli: Enhancing Experiences and Interaction, Edited by A. Nijholt, E.O. Dijk, and P.M.C. Lemmens, 35–46 Enschede:University of Twente. Henricson, M., Ersson, A., Määttä, S., Segesten, K., and Berglund, A.L. 2008. The outcome of tactile touch on stress parameters in intensive care: A randomized controlled trial. Complement. Ther. Clin. Prac. 14(4): 244–254. Harlow, H.F., and Zimmermann, R.R. 1959. Affectional responses in the infant monkey; orphaned baby monkeys develop a strong and persistent attachment to inanimate surrogate mothers. Science 130: 421–32. doi:10.1126/science.130. 3373.421 Hertenstein, M.J., Holmes, R., McCullough, M., and Keltner, D. 2009. The communication of emotion via touch. Emotion 9: 566–73. doi:10.1037/a0016108 Hertenstein, M.J., Keltner, D., App, B., Bulleit, B.A., and Jaskolka, A.R. 2006. Touch communicates distinct emotions. Emotion 6: 528–33. doi:10.1037/1528-3542.6. 3.528 Hogervorst, M.A., Brouwer, A.-M., and van Erp, J.B.F. 2014. Combining and comparing EEG, peripheral physiology and eye-related measures for the assessment of mental workload. Front. Neurosci. 8:322. doi:10.3389/fnins.2014.00322 Hornik, J. 1992. Tactile stimulation and consumer response. J. Consum. Res. 19: 449–58. doi:10.1086/209314 Hossain, S.K.A., Rahman, A.S.M.M., and El Saddik, A. 2011. Measurements of multimodal approach to haptic interaction in second life interpersonal communication system. IEEE Trans. Instrum. Meas. 60: 3547–58. doi:10.1109/TIM. 2011.2161148 Huisman, G., Bruijnes, M., Kolkmeier, J., Jung, M.M., Darriba Frederiks, A., and Rybarczyk, Y. (2014a). Touching virtual agents: embodiment and mind. In Innovative and Creative Developments in Multimodal Interaction Systems, Edited Frontiers in Digital Humanities | www.frontiersin.org by Y. Rybarczyk, T. Cardoso, J. Rosas, and L. Camarinha-Matos, 114–138. Berlin: Springer. Huisman, G., Kolkmeier, J., and Heylen, D. (2014b). Simulated social touch in a collaborative game. In Haptics: Neuroscience, Devices, Modeling, and Applications, Edited by M. Auvray and C. Duriez, 248–256. Berlin: Springer. Huisman, G., Darriba Frederiks, A., Van Dijk, E.M.A.G., Kröse, B.J.A., and Heylen, D.K.J. 2013. Self touch to touch others: designing the tactile sleeve for social touch. In Online Proceedings of TEI’13. Available at: http://www.tei-conf.org/13/ sites/default/files/page-files/Huisman.pdf Hutson, S., Lim, S., Bentley, P.J., Bianchi-Berthouze, N., and Bowling, A. 2011. Investigating the suitability of social robots for the wellbeing of the elderly. In Affective Computing and Intelligent Interaction, Edited by S. D’Mello, A. Graesser, B. Schuller, and J.C. Martin, 578–587. Berlin: Springer. IJsselsteijn, W.A., van Baren, J., and van Lanen, F. 2003. Staying in touch: social presence and connectedness through synchronous and asynchronous communication media (Part III). In Human-Computer Interaction: Theory and Practice, Edited by C. Stephanidis and J. Jacko, 924–928. Boca Raton, FL: CRC Press. IJzerman, H., and Semin, G.R. 2009. The thermometer of social relations: mapping social proximity on temperature. Psychol. Sci. 20: 1214–20. doi:10.1111/j. 1467-9280.2009.02434.x IJzerman, H., and Semin, G.R. 2010. Temperature perceptions as a ground for social proximity. J. Exp. Soc. Psychol. 46: 867–73. doi:10.1016/j.jesp.2010.07.015 James, W. 1884. What is an emotion? Mind 9: 188–205. doi:10.1093/mind/os-IX. 34.188 Jones, S.E., and Yarbrough, A.E. 1985. A naturalistic study of the meanings of touch. Comm. Monogr. 52: 19–56. doi:10.1080/03637758509376094 Joule, R.V., and Guéguen, N. 2007. Touch, compliance, and awareness of tactile contact. Percept. Mot. Skills 104: 581–8. doi:10.2466/pms.104.2.581-588 Jung, M.M., Poppe, R., Poel, M., and Heylen, D.K.J. 2014. Touching the VOID – introducing CoST: corpus of social touch. In Proceedings of the 16th International Conference on Multimodal Interaction (ICMI ‘14), 120–127. New York, NY: ACM. Kanamori, M., Suzuki, M., Oshiro, H., Tanaka, M., Inoguchi, T., Takasugi, H., et al. 2003. Pilot study on improvement of quality of life among elderly using a pet-type robot. In Proceedings of the IEEE International Symposium on Computational Intelligence in Robotics and Automation, 107–112. Piscataway, NJ: IEEE. Khanna, P., and Sasikumar, M. 2010. Recognising emotions from keyboard stroke pattern. Int. J. Comput. Appl. 11: 1–5. doi:10.5120/1614-2170 Kjeldskov, J., Gibbs, M., Vetere, F., Howard, S., Pedell, S., Mecoles, K., et al. 2004. Using cultural probes to explore mediated intimacy. Australas J. Inf. Syst. 11. Available at: http://journal.acs.org.au/index.php/ajis/article/view/128 Kleinke, C.L. 1977. Compliance to requests made by gazing and touching experimenters in field settings. J. Exp. Soc. Psychol. 13: 218–23. doi:10.1016/ 0022-1031(77)90044-0 Knapp, M.L., and Hall, J.A. 2010. Nonverbal Communication in Human Interaction (7th ed.). Boston, MA: Wadsworth, CENGAGE Learning. Konijn, E.A., Utz, S., Tanis, M., and Barnes, S.B. 2008. Mediated Interpersonal Communication. New York, NY: Routledge. Kotranza, A., and Lok, B. 2008. Virtual human + tangible interface = mixed reality human: an initial exploration with a virtual breast exam patient. In Proceedings of the IEEE Virtual Reality Conference 2008 (VR ‘08), 99–106. Piscataway, NJ: IEEE. Kotranza, A., Lok, B., Deladisma, A., Pugh, C.M., and Lind, D.S. 2009. Mixed reality humans: evaluating behavior, usability, and acceptability. IEEE Trans. Vis. Comput. Graph. 15: 369–82. doi:10.1109/TVCG.2008.195 Kraus, M.W., Huang, C., and Keltner, D. 2010. Tactile communication, cooperation, and performance: an ethological study of the NBA. Emotion 10: 745–9. doi:10. 1037/a0019382 Kristoffersson, A., Coradeschi, S., and Loutfi, A. 2013. A review of mobile robotic telepresence. Adv. Hum. Comput. Int. 2013: 1–17. doi:10.1155/2013/ 902316 Kuwamura, K., Sakai, K., Minato, T., Nishio, S., and Ishiguro, H. 2013. Hugvie: a medium that fosters love. In The 22nd IEEE International Symposium on Robot and Human Interactive Communication, 70–75. Gyeongju: IEEE. Kvam, M.H. 1997. The effect of vibroacoustic therapy. Physiotherapy 83: 290–5. doi:10.1016/S0031-9406(05)66176-7 Ledbetter, A.M. 2014. The past and future of technology in interpersonal communication theory and research. Commun. Stud. 65: 456–9. doi:10.1080/10510974. 2014.927298 11 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Lee, J.K., Stiehl, W.D., Toscano, R.L., and Breazeal, C. 2009. Semi-autonomous robot avatar as a medium for family communication and education. Adv. Rob. 23: 1925–49. doi:10.1163/016918609X12518783330324 Lee, K.M., Jung, Y., Kim, J., and Kim, S.R. 2006. Are physically embodied social agents better than disembodied social agents? The effects of physical embodiment, tactile interaction, and people’s loneliness in human-robot interaction. Int. J. Hum. Comput. Stud. 64: 962–73. doi:10.1016/j.ijhcs.2006.05.002 Lemmens, P., Crompvoets, F., Brokken, D., van den Eerenbeemd, J., and de Vries, G.J. 2009. A body-conforming tactile jacket to enrich movie viewing. In EuroHaptics Conference, 2009 and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems. World Haptics 2009. Third Joint, 7–12. Piscataway, NJ: IEEE Press. Li, H., Cabibihan, J.-J., and Tan, Y. 2011. Towards an effective design of social robots. Int. J. Soc. Rob. 3: 333–5. doi:10.1007/s12369-011-0121-z Löken, L.S., Wessberg, J., Morrison, I., McGlone, F., and Olausson, H. 2009. Coding of pleasant touch by unmyelinated afferents in humans. Nat. Neurosci. 12(5): 547–548. doi:10.1038/nn.2312 Lv, H.-R., Lin, Z.-L., Yin, W.-J., and Dong, J. 2008. Emotion recognition based on pressure sensor keyboards. In IEEE International Conference on Multimedia and Expo 2008, 1089–1092. Piscataway, NJ: IEEE. Master, S.L., Eisenberger, N.I., Taylor, S.E., Naliboff, B.D., Shirinyan, D., and Lieberman, M.D. 2009. A picture’s worth: partner photographs reduce experimentally induced pain. Psychol. Sci. 20: 1316–8. doi:10.1111/j.1467-9280.2009.02444.x McCall, C., and Blascovich, J. 2009. How, when, and why to use digital experimental virtual environments to study social behavior. Soc. Pers. Psychol. Compass 3: 744–58. doi:10.1111/j.1751-9004.2009.00195.x McCance, R.A., and Otley, M. 1951. Course of the blood urea in newborn rats, pigs and kittens. J. Physiol. 113: 18–22. doi:10.1113/jphysiol.1951.sp004552 McDaniel, E., and Andersen, P.A. 1998. International patterns of interpersonal tactile communication: a field study. J. Nonverbal Behav. 22: 59–75. doi:10.1023/ A:1022952509743 McGlone, F., Wessberg, J., and Olausson, H. 2014. Discriminative and affective touch: sensing and feeling. Neuron 82: 737–55. doi:10.1016/j.neuron.2014. 05.001 Mehrabian, A. 1972. Nonverbal Communication. Chicago, IL: Aldine-Atherton. Mikropoulos, T.A., and Natsis, A. 2011. Educational virtual environments: a tenyear review of empirical research (1999-2009). Comput. Educ. 56: 769–80. doi:10. 1016/j.compedu.2010.10.020 Montagu, A. 1972. Touching: The Human Significance of the Skin. New York, NY: Harper & Row Publishers. Morrison, I., Löken, L., and Olausson, H. 2010. The skin as a social organ. Exp. Brain Res. 204: 305–14. doi:10.1007/s00221-009-2007-y Morrison, I., Björnsdotter, M., and Olausson, H. 2011. Vicarious responses to social touch in posterior insular cortex are tuned to pleasant caressing speeds. J. Neurosci. 31(26):9554–9562. Mueller, F., Vetere, F., Gibbs, M.R., Kjeldskov, J., Pedell, S., and Howard, S. 2005. Hug over a distance. In CHI ‘05 Extended Abstracts on Human Factors in Computing Systems, Edited by G. van der Veer and C. Gale, 1673–1676. New York, NY: ACM. doi:10.1145/1056808.1056994 Nakagawa, K., Shiomi, M., Shinozawa, K., Matsumura, R., Ishiguro, H., and Hagita, N. 2011. Effect of robot’s active touch on people’s motivation. In Proceedings of the 6th International Conference on Human-Robot Interaction HRI ‘11, 465–472. New York, NY: ACM. Nakanishi, H., Tanaka, K., and Wada, Y. 2014. Remote handshaking: touch enhances video-mediated social telepresence. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems CHI’14, 2143–2152. New York, NY: ACM. Nakanishi, J., Kuwamura, K., Minato, T., Nishio, S., and Ishiguro, H. 2013. Evoking affection for a communication partner by a robotic communication medium. In The First International Conference on Human-Agent Interaction (iHAI 2013), 1–8. Available at: http://hai-conference.net/ihai2013/proceedings/pdf/III-1-4.pdf Naya, F., Yamato, J., and Shinozawa, K. 1999. Recognizing human touching behaviors using a haptic interface for a pet-robot. In Conference Proceedings of the IEEE International Conference on Systems, Man, and Cybernetics (IEEE SMC ‘99), 1030–1034. Piscataway, NJ: IEEE. Nguyen, N., Wachsmuth, I., and Kopp, S. 2007. Touch perception and emotional appraisal for a virtual agent. In Proceedings of the 2nd Workshop Emotion and Computing-Current Research and Future Impact, Edited by D. Reichardt and P. Levi, 17–22. Stuttgart: Berufsakademie Stuttgart. Frontiers in Digital Humanities | www.frontiersin.org Nguyen, T., Heslin, R., and Nguyen, M.L. 1975. The meanings of touch: sex differences. J. Commun. 25: 92–103. doi:10.1111/j.1460-2466. 1975.tb00610.x Nie, J., Park, M., Marin, A.L., and Sundar, S.S. 2012. Can you hold my hand? Physical warmth in human-robot interaction. In Proceeedings of the 7th ACM/IEEE International Conference on Human-Robot Interaction (HRI), 201–202. Piscataway, NJ: IEEE. Nijholt, A. 2014. Breaking fresh ground in human-media interaction research. Front. ICT 1:4. doi:10.3389/fict.2014.00004 Nummenmaa, L., Glerean, E., Hari, R., and Hietanen, J.K. 2013. Bodily maps of emotions. Proc. Natl. Acad. Sci. U.S.A. 111: 646–51. doi:10.1073/pnas. 1321664111 Olausson, H.W., Cole, J., Vallbo, Å, McGlone, F., Elam, M., Krämer, H.H., et al. 2008. Unmyelinated tactile afferents have opposite effects on insular and somatosensory cortical processing. Neurosci. Lett. 436: 128–32. doi:10.1016/j.neulet.2008. 03.015 Paladino, M.P., Mazzurega, M., Pavani, F., and Schubert, T.W. 2010. Synchronous multisensory stimulation blurs self-other boundaries. Psychol. Sci. 21: 1202–7. doi:10.1177/0956797610379234 Park, E., and Lee, J. 2014. I am a warm robot: the effects of temperature in physical human – robot interaction. Robotica 32: 133–42. doi:10.1017/ S026357471300074X Park, Y.W., Bae, S.H., and Nam, T.J. 2012. How do Couples Use CheekTouch Over Phone Calls? New York, NY: ACM. 763–6. Park, Y.W., Hwang, S., and Nam, T.J. 2011. Poke: emotional touch delivery through an inflatable surface over interpersonal mobile communications. In Adjunct Proceedings of the 24th Annual ACM Symposium Adjunct on User Interface Software and Technology UIST ‘11, 61–62. New York, NY: ACM. Patrick, G. 1999. The effects of vibroacoustic music on symptom reduction. IEEE Eng. Med. Biol. Mag. 18: 97–100. doi:10.1109/51.752987 Phelan, J.E. 2009. Exploring the use of touch in the psychotherapeutic setting: a phenomenological review. Psychotherapy (Chic) 46: 97–111. doi:10.1037/a0014751 Prisby, R.D., Lafage-Proust, M.-H., Malaval, L., Belli, A., and Vico, L. 2008. Effects of whole body vibration on the skeleton and other organ systems in man and animal models: what we know and what we need to know. Ageing Res. Rev. 7: 319–29. doi:10.1016/j.arr.2008.07.004 Puhan, M.A., Suarez, A., Cascio, C.L., Zahn, A., Heitz, M., and Braendli, O. 2006. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ 332: 266–70. doi:10.1136/bmj.38705. 470590.55 Rahman, A.S.M.M., and El Saddik, A. 2011. HKiss: real world based haptic interaction with virtual 3D avatars. In Proceedings of the 2011 IEEE International Conference on Multimedia and Expo (ICME), 1–6. Piscataway, NJ: IEEE. Rantala, J., Raisamo, R., Lylykangas, J., Ahmaniemi, T., Raisamo, J., Rantala, J., et al. 2011. The role of gesture types and spatial feedback in haptic communication. IEEE Trans. Haptics 4: 295–306. doi:10.1109/TOH.2011.4 Rantala, J., Salminen, K., Raisamo, R., and Surakka, V. 2013. Touch gestures in communicating emotional intention via vibrotactile stimulation. Int. J. Hum. Comput. Stud. 7: 679–90. doi:10.1016/j.ijhcs.2013.02.004 Réhman, S., and Liu, L. 2010. iFeeling: vibrotactile rendering of human emotions on mobile phones. In Mobile Multimedia Processing, Edited by X. Jiang, M.Y. Ma, and C. Chen, 1–20. Berlin: Springer. Robinson, H., MacDonald, B., Kerse, N., and Broadbent, E. 2013. The psychosocial effects of a companion robot: a randomized controlled trial. J. Am. Med. Dir. Assoc. 14: 661–7. doi:10.1016/j.jamda.2013.02.007 Rolls, E.T. 2010. The affective and cognitive processing of touch, oral texture, and temperature in the brain. Neurosci. Biobehav. Rev. 34: 237–45. doi:10.1016/j. neubiorev.2008.03.010 Saadatian, E., Samani, H., Parsani, R., Pandey, A.V., Li, J., Tejada, L., et al. 2014. Mediating intimacy in long-distance relationships using kiss messaging. Int. J. Hum. Comput. Stud. 72: 736–46. doi:10.1016/j.ijhcs.2014.05.004 Sallnäs, E.L. 2010. Haptic feedback increases perceived social presence. In Haptics: Generating and Perceiving Tangible Sensations, Part II, Edited by A.M. Kappers, J.B. Erp, W.M. Bergmann Tiest, and F.C. Helm, 178–185. Berlin: Springer. Salminen, K., Surakka, V., Lylykangas, J., Raisamo, R., Saarinen, R., Raisamo, R., et al. 2008. Emotional and behavioral responses to haptic stimulation. In Proceeding of the Twenty-Sixth Annual SIGCHI Conference on Human Factors in Computing Systems, 1555–1562. New York, NY: ACM Press. 12 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Scheele, D., Kendrick, K.M., Khouri, C., Kretzer, E., Schläpfer, T.E., StoffelWagner, B., et al. 2014. An oxytocin-induced facilitation of neural and emotional responses to social touch correlates inversely with autism traits. Neuropsychopharmacology 39: 2078–85. doi:10.1038/npp.2014.78 Schilit, B., Adams, N., and Want, R. 1994. Context-aware computing applications. In First Workshop on Mobile Computing Systems and Applications (WMCSA 1994), 85–90. Piscataway, NJ: IEEE. Self, B.P., van Erp, J.B.F., Eriksson, L., and Elliott, L.R. 2008. Human factors issues of tactile displays for military environments. In Tactile Displays for Navigation, Orientation and Communication in Military Environments, Edited by J.B.F. van Erp and B.P. Self, 3. Neuillu-sur-Seine: NATO RTO. Shermer, M. 2004. A bounty of science. Sci. Am. 290: 33. doi:10.1038/ scientificamerican0204-33 Shin, H., Lee, J., Park, J., Kim, Y., Oh, H., and Lee, T. 2007. A tactile emotional interface for instant messenger chat. In Proceedings of the 2007 Conference on Human Interface, Edited by M.J. Smith and G. Salvendy, 166–175. Berlin: Springer. Smith, J., and MacLean, K. 2007. Communicating emotion through a haptic link: design space and methodology. Int. J. Hum. Comput. Stud. 65: 376–87. doi:10. 1016/j.ijhcs.2006.11.006 Solon, O. 2015. These sex tech toys will blow your mind. WIRED. Available at: http://www.wired.co.uk/news/archive/2014-06/27/sex-tech Stiehl, W.D., Lieberman, J., Breazeal, C., Basel, L., Lalla, L., and Wolf, M. 2005. Design of a therapeutic robotic companion for relational, affective touch. In IEEE International Workshop on Robot and Human Interactive Communication (ROMAN 2005), 408–415. Piscataway, NJ: IEEE. Suhonen, K., Müller, S., Rantala, J., Väänänen-Vainio-Mattila, K., Raisamo, R., and Lantz, V. (2012a). Haptically augmented remote speech communication: a study of user practices and experiences. In Proceedings of the 7th Nordic Conference on Human-Computer Interaction: Making Sense Through Design NordiCHI ‘12, 361–369. New York, NY: ACM. Suhonen, K., Väänänen-Vainio-Mattila, K., and Mäkelä, K. (2012b). User experiences and expectations of vibrotactile, thermal and squeeze feedback in interpersonal communication. In Proceedings of the 26th Annual BCS Interaction Specialist Group Conference on People and Computers BCS-HCI ‘12, 205–214. New York, NY: ACM. Suk, H.-J., Jeong, S.-H., Hang, T.-H., and Kwon, D.-S. 2009. Tactile sensation as emotion elicitor. Kansei Eng. Int. 8(2): 147–52. Takahashi, K., Mitsuhashi, H., Murata, K., Norieda, S., and Watanabe, K. 2011. Improving shared experiences by haptic telecommunication. In 2011 International Conference on Biometrics and Kansei Engineering (ICBAKE), 210–215. Los Alamitos, CA: IEEE. doi:10.1109/ICBAKE.2011.19 Tanaka, F., Cicourel, A., and Movellan, J.R. 2007. Socialization between toddlers and robots at an early childhood education center. Proc. Natl. Acad. Sci. U.S.A. 104: 17954–8. doi:10.1073/pnas.0707769104 Teh, J.K.S., Cheok, A.D., Peiris, R.L., Choi, Y., Thuong, V., and Lai, S. 2008. Huggy pajama: a mobile parent and child hugging communication system. In Proceedings of the 7th International Conference on Interaction Design and Children IDC ‘08, 250–257. New York, NY: ACM. Thompson, E.H., and Hampton, J.A. 2011. The effect of relationship status on communicating emotions through touch. Cognit. Emot. 25: 295–306. doi:10. 1080/02699931.2010.492957 Toet, A., van Erp, J.B.F., Petrignani, F.F., Dufrasnes, M.H., Sadhashivan, A., van Alphen, D., et al. 2013. Reach out and touch somebody’s virtual hand. Affectively connected through mediated touch. In Proceedings of the 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction, 786–791. Piscataway, NJ: IEEE Computer Society. Tsalamlal, M.Y., Ouarti, N., Martin, J.C., and Ammi, M. 2014. Haptic communication of dimensions of emotions using air jet based tactile stimulation. J. Multimodal User Interfaces 9(1): 69–77. doi:10.1007/s12193-014 -0162-3 Tsetserukou, D. 2010. HaptiHug: a novel haptic display for communication of hug over a distance. In Haptics: Generating and Perceiving Tangible Sensations, Edited by A.M. Kappers, J.B. Erp, W.M. Bergmann Tiest, and F.C. Helm, 340–347. Berlin: Springer. Tsetserukou, D., and Neviarouskaya, A. 2010. Innovative real-time communication system with rich emotional and haptic channels. In Haptics: Generating and Frontiers in Digital Humanities | www.frontiersin.org Perceiving Tangible Sensations, Edited by A.M. Kappers, J.B. van Erp, W.M. Bergmann Tiest, and F.C. Helm, 306–313. Berlin: Springer. Tsihrintzis, G.A., Virvou, M., Alepis, E., and Stathopoulou, I.O. 2008. Towards improving visual-facial emotion recognition through use of complementary keyboard-stroke pattern information. In Fifth International Conference on Information Technology: New Generations (ITNG 2008), 32–37. Piscataway, NJ: IEEE. Uvnäs-Moberg, K. 1997. Physiological and endocrine effects of social contact. Ann. N. Y. Acad. Sci. 807: 146–63. doi:10.1111/j.1749-6632.1997.tb51917.x Vallbo, A., Olausson, H., Wessberg, J., and Norrsell, U. 1993. A system of unmyelinated afferents for innocuous mechanoreception in the human skin. Brain Res. 628: 301–4. doi:10.1016/0006-8993(93)90968-S Van Bel, D.T., IJsselsteijn, W.A., and de Kort, Y.A.W. 2008. Interpersonal connectedness: conceptualization and directions for a measurement instrument. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI’08), 3129–3134. New York, NY: ACM. van Bel, D.T., Smolders, K.C.H.J., IJsselsteijn, W.A., and de Kort, Y.A.W. 2009. Social connectedness: concept and measurement. In Proceedings of the 5th International Conference on Intelligent Environments, Edited by V. Callaghan, A. Kameas, A. Reyes, D. Royo, and M. Weber, 67–74. Amsterdam: IOS Press. van Erp, J.B.F. 2007. Tactile Displays for Navigation and Orientation: Perception and Behaviour. Utrecht: Utrecht University. van Erp, J.B.F. 2012. The ten rules of touch: guidelines for social agents and robots that can touch. In Proceedings of the 25th Annual Conference on Computer Animation and Social Agents (CASA 2012), Singapore: Nanayang Technological University. van Erp, J.B.F., Kyung, K.-U., Kassner, S., Carter, J., Brewster, S., Weber, G., et al. 2010. Setting the standards for haptic and tactile interactions: ISO’s work. In Haptics: Generating and Perceiving Tangible Sensations. Proceedings of Eurohaptics 2010, Edited by A.M.L. Kappers, J.B.F. van Erp, W.M. Bergmann Tiest, and F.C.T. van der Helm, 353–358. Heidelberg: Springer. van Erp, J.B.F., and Toet, A. 2013. How to touch humans. Guidelines for social agents and robots that can touch. In Proceedings of the 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction, 780–785. Geneva:IEEE Computer Society. doi:10.1109/ACII.2013.77145 van Erp, J.B.F., and van Veen, H.A.H.C. 2004. Vibrotactile in-vehicle navigation system. Transp. Res. Part F Traffic Psychol. Behav. 7: 247–56. doi:10.1016/j.trf. 2004.09.003 van Wingerden, S., Uebbing, T.J., Jung, M.M., and Poel, M. 2014. A neural network based approach to social touch classification. In Proceedings of the 2014 Workshop on Emotion Representation and Modelling in Human-Computer-InteractionSystems (ERM4HCI ‘14), 7–12. New York, NY: ACM. Vinciarelli, A., Pantic, M., Bourlard, H., and Pentland, A. 2008. Social signal processing: state-of-the-art and future perspectives of an emerging domain. In Proceedings of the 16th ACM International Conference on Multimedia, 1061–1070. New York, NY: ACM. Vrontou, S., Wong, A.M., Rau, K.K., Koerber, H.R., and Anderson, D.J. 2013. Genetic identification of C fibres that detect massage-like stroking of hairy skin in vivo. Nature 493: 669–73. doi:10.1038/nature11810 Wada, K., Ikeda, Y., Inoue, K., and Uehara, R. 2010. Development and preliminary evaluation of a caregiver’s manual for robot therapy using the therapeutic seal robot Paro. In Proceedings of the IEEE International Workshop on Robot and Human Interactive Communication (RO-MAN 2010), 533–538. Piscataway, NJ: IEEE. Wada, K., and Shibata, T. 2007. Living with seal robots – its sociopsychological and physiological influences on the elderly at a care house. IEEE Trans. Rob. 23: 972–80. doi:10.1109/TRO.2007.906261 Walker, S.C., and McGlone, F.P. 2015. Perceived pleasantness of social touch reflects the anatomical distribution and velocity tuning of C-tactile afferents: an affective homunculus. In Program No. 339.14/HH22. 2014 Neuroscience Meeting Planner, Washington, DC: Society for Neuroscience. Wang, R., and Quek, F. 2010. Touch & talk: contextualizing remote touch for affective interaction. In Proceedings of the 4th International Conference on Tangible, Embedded, and Embodied Interaction (TEI ‘10), 13–20. New York, NY: ACM. Wang, R., Quek, F., Tatar, D., Teh, K.S., and Cheok, A.D. 2012. Keep in touch: channel, expectation and experience. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems CHI ‘12, 139–148. New York, NY: ACM. 13 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Whitcher, S.J., and Fisher, J.D. 1979. Multidimensional reaction to therapeutic touch in a hospital setting. J. Pers. Soc. Psychol. 37: 87–96. doi:10.1037/0022-3514.37. 1.87 Wigram, A.L. 1996. The Effects of Vibroacoustic Therapy on Clinical and NonClinical Populations. Ph.D. thesis, St. George’s Hospital Medical School, London University, London. Yohanan, S., Chan, M., Hopkins, J., Sun, H., and MacLean, K. 2005. Hapticat: exploration of affective touch. In Proceedings of the 7th International Conference on Multimodal Interfaces (ICMI ‘05), 222–229. New York, NY: ACM. Yohanan, S., and MacLean, K. 2012. The role of affective touch in human-robot interaction: human intent and expectations in touching the haptic creature. Int. J. Soc. Rob. 4: 163–80. doi:10.1007/s12369-011-0126-7 Frontiers in Digital Humanities | www.frontiersin.org Zacharatos, H., Gatzoulis, C., and Chrysanthou, Y.L. 2014. Automatic emotion recognition based on body movement analysis: a survey. IEEE CGA 34: 35–45. doi:10.1109/MCG.2014.106 Conflict of Interest Statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Copyright © 2015 van Erp and Toet. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. 14 May 2015 | Volume 2 | Article 2 ","Use only the document provided. If the question can not be answered then respond with 'I am unable to answer this request' What are some ICT advances in the field of social touch? REVIEW published: 27 May 2015 doi: 10.3389/fdigh.2015.00002 Social touch in human–computer interaction Jan B. F. van Erp 1,2 * and Alexander Toet 1 1 Perceptual and Cognitive Systems, TNO, Soesterberg, Netherlands, 2 Human Media Interaction, University of Twente, Enschede, Netherlands Edited by: Yoram Chisik, University of Madeira, Portugal Reviewed by: Mohamed Chetouani, Université Pierre et Marie Curie, France Gualtiero Volpe, Università degli Studi di Genova, Italy Hongying Meng, Brunel University London, UK *Correspondence: Jan B. F. van Erp, TNO Human Factors, Kampweg 5, Soesterberg 3769DE, Netherlands jan.vanerp@tno.nl Specialty section: This article was submitted to Human-Media Interaction, a section of the journal Frontiers in Digital Humanities Received: 06 February 2015 Paper pending published: 19 March 2015 Accepted: 08 May 2015 Published: 27 May 2015 Citation: van Erp JBF and Toet A (2015) Social touch in human–computer interaction. Front. Digit. Humanit. 2:2. doi: 10.3389/fdigh.2015.00002 Touch is our primary non-verbal communication channel for conveying intimate emotions and as such essential for our physical and emotional wellbeing. In our digital age, human social interaction is often mediated. However, even though there is increasing evidence that mediated touch affords affective communication, current communication systems (such as videoconferencing) still do not support communication through the sense of touch. As a result, mediated communication does not provide the intense affective experience of co-located communication. The need for ICT mediated or generated touch as an intuitive way of social communication is even further emphasized by the growing interest in the use of touch-enabled agents and robots for healthcare, teaching, and telepresence applications. Here, we review the important role of social touch in our daily life and the available evidence that affective touch can be mediated reliably between humans and between humans and digital agents. We base our observations on evidence from psychology, computer science, sociology, and neuroscience with focus on the first two. Our review shows that mediated affective touch can modulate physiological responses, increase trust and affection, help to establish bonds between humans and avatars or robots, and initiate pro-social behavior. We argue that ICT mediated or generated social touch can (a) intensify the perceived social presence of remote communication partners and (b) enable computer systems to more effectively convey affective information. However, this research field on the crossroads of ICT and psychology is still embryonic and we identify several topics that can help to mature the field in the following areas: establishing an overarching theoretical framework, employing better research methodologies, developing basic social touch building blocks, and solving specific ICT challenges. Keywords: affective touch, mediated touch, social touch, interpersonal touch, human–computer interaction, human–robot interaction, haptic, tactile Introduction Affective Touch in Interpersonal Communication The sense of touch is the earliest sense to develop in a human embryo (Gottlieb 1971) and is critical for mammals’ early social development and to grow up healthily (Harlow and Zimmermann 1959; Montagu 1972). The sense of touch is one of the first mediums of communication between newborns and parents. Interpersonal communication is to a large extent non-verbal and one of the primary purposes of non-verbal behavior is to communicate emotional states. Non-verbal communication includes facial expressions, prosody, gesture, and touch Frontiers in Digital Humanities | www.frontiersin.org 1 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI (Argyle 1975; Knapp and Hall 2010) of which touch is the primary modality for conveying intimate emotions (Field 2010; Morrison et al. 2010; App et al. 2011), for instance, in greetings, in corrections, and in (sexual) relationships. As touch implies direct physical interaction and co-location, it inherently has the potential to elicit feelings of social presence. The importance of touch as a modality in social communication is highlighted by the fact that the human skin has specific receptors to process affective touch (“the skin as a social organ”: Morrison et al. 2010) in addition to those for discriminative touch (Löken et al. 2009; Morrison et al. 2011; Gordon et al. 2013; McGlone et al. 2014), presumably like all mammals (Vrontou et al. 2013). ICT systems can employ human touch for information processing (discriminative touch) and communication (social touch) as well. Field (2010) and Gallace and Spence (2010)]. For these reasons, mediated interpersonal touch is our first topic of interest. Human–computer interaction applications increasingly deploy intelligent agents to support the social aspects of the interaction. Social agents (either embodied or virtual) already employ vision and audition to communicate social signals but generally lack touch capabilities. If we look at applications in robots and avatars, the first applications including touch facilitated information from user to system only, e.g., in the form of a touch screen or through specific touch sensors in a tangible interface. Social agents that can touch the user are of much more recent date. We believe that social agents could benefit from generating and perceiving social touch cues (van Erp 2012). Based on studies reviewed in this paper, we expect that people will feel a closer bond with agents or robots that use and respond to affective touch since they appear more human than machine-like and more trustworthy. Touch-enabled social agents are therefore our second topic of interest. Discriminative Touch in ICT Systems Conventional systems for human–computer interaction only occasionally employ the sense of touch and mainly provide information through vision and audition. One of the first large-scale applications of a tactile display was the vibration function on mobile phones, communicating the 1-bit message of an incoming call, and the number of systems that include the sense of touch has steadily increased over the past two decades. An important reason for the sparse use of touch is the supposed low bandwidth of the touch channel (Gallace et al. 2012). Although often underestimated, our touch sense is very well able to process large amounts of abstract information. For instance, blind people who are trained in Braille reading can actually read with their fingertips. This information processing capability is increasingly applied in our interaction with systems, and more complex information is being displayed, e.g., to reduce the risk of visual and auditory overload in car driving, to make us feel more immersed in virtual environments, or to realistically train and execute certain medical skills (van Erp and van Veen 2004; Self et al. 2008). Touch in Social Communication Social touch can take many forms in our daily lifes such as greetings (shaking hands, embracing, kissing, backslapping, and cheektweaking), in intimate communication (holding hands, cuddling, stroking, back scratching, massaging), and in corrections (punishment, spank on the bottom). Effects of social touch are apparent at many levels ranging from physiology to social behavior as we will discuss in the following sections. Social touches can elicit a range of strong experiences between pleasant and unpleasant, depending on among others the stimulus [e.g., unpleasant pinches evoking pain (nociception)] and location on the body (e.g., pleasant strokes in erogenous zones). In addition to touch in communication, touch can also be employed in psychotherapy (Phelan 2009) and nursing (Gleeson and Timmins 2005). Examples range from basic comforting touches and massaging to alternative therapies such as acu-pressure, Reiki, vibroacoustic therapy, and low-frequency vibration (Wigram 1996; Kvam 1997; Patrick 1999; Puhan et al. 2006; Prisby et al. 2008). See Dijk et al. (2013) for more examples on mental, healthrelated, and bodily effects of touch. In this paper, we focus on ICT mediated and generated social touch (the areas where psychology and computer science meet), meaning that areas of, for instance, Reiki and low-frequency vibration fall outside the scope of this paper. We first discuss the many roles of social touch in our daily life before continuing with ICT mediated inter-human touch and ICT generated and interpreted touch in human–agent interaction. In 1990s (Vallbo et al. 1993), the first reports on so-called C tactile afferents in human hairy skin were published. This neurophysiological channel in the skin reacts to soft, stroking touches, and its activity strongly depends on stroking speed (with an optimum in the speed range 3–10 cm/s) and has a high correlation with subjective ratings of the pleasantness of the touch. Research over the past decades has shown that this system is not involved in discriminative touch (Olausson et al. 2008) but underlies the emotional aspects of touch and the development and function of the social brain (McGlone et al. 2014). Social touches may activate both this pleasurable touch system and the discriminative touch Affective Touch in ICT Systems Incorporating the sense of touch in ICT systems started with discriminative touch as an information channel, often in addition to vision and audition (touch for information processing). We believe that we are on the averge of a second transition: adding social or affective touch to ICT systems (touch for social communication). In our digital era, an increasing amount of our social interactions is mediated, for example, through (cell) phones, video conferencing, text messaging, chat, or e-mail. Substituting direct contact, these modern technologies make it easy to stay in contact with distant friends and relatives, and they afford some degree of affective communication. For instance, an audio channel can transmit affective information through phonetic features like amplitude variation, pitch inflections, tempo, duration, filtration, tonality, or rhythm, while a video channel supports nonverbal information such as facial expressions and body gestures. However, current communication devices do not allow people to express their emotions through touch and may therefore lack a convincing experience of actual togetherness (social presence). This technology-induced touch deprivation may even degrade the potential beneficial effects of mediated social interaction [for reviews of the negative side effects of touch deprivation see Frontiers in Digital Humanities | www.frontiersin.org 2 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI system (reacting to, for instance, pressure, vibration, and skin stretch). caring, agreement, gratitude, and moral support. Cold feedback was consistently associated with negative issues. Touch, Physiological Functioning, and Wellbeing Touch to Communicate Emotions Hertenstein et al. (2006, 2009) showed that touch alone can effectively be used to convey distinct emotions such as anger, fear, and disgust. In addition, touch plays a role in communicating more complex social messages like trust, receptivity, affection (Mehrabian 1972; Burgoon 1991) and nurture, dependence, and affiliation (Argyle 1975). Touch can also enhance the meaning of other forms of verbal and non-verbal communication, e.g., touch amplifies the intensity of emotional displays from our face and voice (Knapp and Hall 2010). Examples of touches used to communicate emotions are shaking, pushing, and squeezing to communicate anger, hugging, patting, and stroking to communicate love (Gallace and Spence 2010). Jones and Yarbrough (1985) stated that a handshake, an encouraging pat on the back, a sensual caress, a nudge for attention, a tender kiss, or a gentle brush of the shoulder can all convey a vitality and immediacy that is at times far more powerful than language. According to App et al. (2011), touch is the preferred non-verbal communication channel for conveying intimate emotions like love and sympathy, confirmed by, for instance, Debrot et al. (2013) who showed that responsive touch between romantic partners enhances their affective state. McCance and Otley (1951) showed that licking and stroking of the mother animal is critical to start certain physiological processes in a new-born mammal. This indicates the direct link between skin stimulation and physiological processes, a link that is preserved later in life. For instance, gentle stroking touch can lower heart rate and blood pressure (Grewen et al. 2003), increase transient sympathetic reflexes and increase pain thresholds (Drescher et al. 1980; Uvnäs-Moberg 1997), and affect the secretion of stress hormones (Whitcher and Fisher 1979; Shermer 2004; Ditzen et al. 2007). Women holding their partner’s hand showed attenuated threat-related brain activity in response to mild electric shocks (Coan et al. 2006) and reported less pain in a cold pressor task (Master et al. 2009). Touch can also result in coupling or syncing of electrodermal activity of interacting (romantic) couples (ChatelGoldman et al. 2014). Interpersonal touch is the most commonly used method of comforting (Dolin and Booth-Butterfield 1993) and an instrument in nursing care (Bush 2001, Chang 2001, Henricson et al. 2008). For example, patients who were touched by a nurse during preoperative instructions experienced lower subjective and objective stress levels (Whitcher and Fisher 1979), than people who were not. In addition to touch affecting hormone levels, hormones (i.e., oxytocin) also affect the perception of interpersonal touch. Scheele et al. (2014) investigated the effect of oxytocin on the perception of a presumed male or female touch on male participants and found that oxytocin increased the rated pleasantness and brain activity of presumed female touches but not of male touches (all touches were delivered by the same female experimenter). Ellingsen et al. (2014) reported that after oxytocin submission, the effect of touch on the evaluation of facial expression increased. In addition, touch (handshaking in particular) can also play a role in social chemo-signaling. Handshaking can lead to the exchange of chemicals in sweat and behavioral data indicates that people more often sniff their hands after a greeting with a handshake than without a handshake (Frumin et al. 2015). Many social touches are reciprocal in nature (like cuddling and holding hands) and their dynamics rely on different mechanisms all having their own time scale: milliseconds for the detection of a touch (discriminative touch), hundreds of milliseconds and up for the experience of pleasurable touch, and seconds and up for physiological responses (including changes in hormone levels). How these processes interact and possibly reinforce each other is still terra incognita. Physiological responses can also be indirect, i.e., the result of social or empathetic mechanisms. Cooper et al. (2014) recently showed that the body temperature of people decreased when looking at a video of other people putting their hands in cold water. Another recent paradigm is to use thermal and haptically enhanced interpersonal speech communication. This showed that warm and cold signals were used to communicate the valence of messages (IJzerman and Semin 2009; Suhonen et al. 2012a). Warm messages were used to emphasize positive feelings and pleasant experiences, and to express empathy, comfort, closeness, Frontiers in Digital Humanities | www.frontiersin.org Touch to Elicit Emotions Not only can the sense of touch be used to communicate distinct emotions but also to elicit (Suk et al. 2009) and modulate human emotion. Please note that interpreting communicated emotions differs from eliciting emotions as the former may be considered as a cognitive task not resulting in physiological responses, e.g., one can perceive a touch as communicating anger without feeling angry. Starting with the James–Lange theory (James 1884; Cannon 1927; Damasio 1999), the conscious experience of emotion is the brain’s interpretation of physiological states. The existence of specific neurophysiological channels for affective touch and pain and the direct physiological reactions to touch indicate that there may be a direct link between tactile stimulation, physiological responses, and emotional experiences. Together with the distinct somatotopic mapping between bodily tactile sensations and different emotional feelings as found by Nummenmaa et al. (2013), one may assume that tactile stimulation of different bodily regions can elicit a wide range of emotions. Touch as a Behavior Modulator In addition to communicating and eliciting emotions, touch provides an effective means of influencing people’s attitudes toward persons, places, or services, their tendency to create bonds and their (pro-)social behaviors [see Gallace and Spence (2010) for an excellent overview]. This effect is referred to as the Midas touch: a brief, casual touch (often at the hand or arm) that is not necessarily consciously perceived named after king Midas from Greek mythology who had the ability to turn everything he touched into gold. For example, a half-second of hand-to-hand touch from a librarian fostered more favorable impressions of the library (Fisher et al. 1976), touching by a salesperson increased positive evaluations of the store (Hornik 1992), and touch can 3 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI also boost the attractiveness ratings of the toucher (Burgoon et al. 1992). Recipients of such “simple” Midas touches are also more likely to be more compliant or unselfish: willing to participate in a survey (Guéguen 2002) or to adhere to medication (Guéguen et al. 2010), volunteering for demonstrating in a course (Guéguen 2004), returning money left in a public phone (Kleinke 1977), spending more money in a shop (Hornik 1992), tipping more in a restaurant (Crusco and Wetzel 1984), helping with picking-up dropped items (Guéguen and Fischer-Lokou 2003), or giving away a cigarette (Joule and Guéguen 2007). In addition to these oneon-one examples, touch also plays a role in teams. For instance, physical touch enhances team performance of basketball players through building cooperation (Kraus et al. 2010). In clinical and professional situations, interpersonal touch can increase information flow and causes people to evaluate communication partners more favorably (Fisher et al. 1976). and Watts 2010; Tsetserukou 2010), pokes (Park et al. 2011), handholding (Gooch and Watts 2012; Toet et al. 2013), handshakes (Bailenson et al. 2007), strokes on the hand (Eichhorn et al. 2008), arm (Huisman et al. 2013) and cheek (Park et al. 2012), pinches, tickles (Furukawa et al. 2012), pats (Bonanni et al. 2006), squeezes (Rantala et al. 2013), thermal signals (Gooch and Watts 2010; Suhonen et al. 2012a,b), massages (Chung et al. 2009), and intimate sexual touches (Solon 2015). In addition to direct mediation, there is also an option to use indirect ways, for instance, through avatars in a virtual world. Devices like a haptic-jacket system can enhance the communication between users of virtual worlds such as Second Life by enabling the exchange of touch cues resembling encouraging pats and comforting hugs between users and their respective avatars (Hossain et al. 2011). The Huggable is a semi-autonomous robotic teddy bear equipped with somatic sensors, intended to facilitate affective haptic communication between two people (Lee et al. 2009) through a tangible rather than a virtual interface. Using these systems, people can not only exchange messages but also emotionally and physically feel the social presence of the communication partner (Tsetserukou and Neviarouskaya 2010). The above examples can be considered demonstrations of the potential devices and applications and the richness of social touch. Although it appears that virtual interfaces can effectively transmit emotion even with touch cues that are extremely degraded (e.g., a handshake that is lacking grip, temperature, dryness, and texture: Bailenson et al. 2007), the field lacks rigorous validation and systematic exploration of the critical parameters. The few exceptions are the work by Smith and MacLean (2007) and by Salminen et al. (2008). Smith and MacLean performed an extensive study into the possibilities and the design space of an interpersonal haptic link and concluded that emotion can indeed be communicated through this medium. Salminen et al. (2008) developed a friction-based horizontally rotating fingertip stimulator to investigate emotional experiences and behavioral responses to haptic stimulation and showed that people can rate these kind of stimuli as less or more unpleasant, arousing, avoidable, and dominating. Mediated Social Touch In the previous section, we showed that people communicate emotions through touch, and that inter-human touch can enhance wellbeing and modulate behavior. In interpersonal communication, we may use touch more frequently than we are aware of. Currently, interpersonal communication is often mediated and given the inherent human need for affective communication, mediated social interaction should preferably afford the same affective characteristics as face-to-face communication. However, despite the social richness of touch and its vital role in human social interaction, existing communication media still rely on vision and audition and do not support haptic interaction. For a more in-depth reflection on the general effects of mediated interpersonal communication, we refer to Konijn et al. (2008) and Ledbetter (2014). Tactile or kinesthetic interfaces in principle enable haptic communication between people who are physically apart, and may thus provide mediated social touch, with all the physical, emotional, and intellectual feedback it supplies (Cranny-Francis 2011). Recent experiments show that even simple forms of mediated touch have the ability to elicit a wide range of distinct affective feelings (Tsalamlal et al. 2014). This finding has stimulated the study and design of devices and systems that can communicate, elicit, enhance, or influence the emotional state of a human by means of mediated touch. Remote Collaboration Between Groups Collaborative virtual environments are increasingly used for distance education [e.g., Mikropoulos and Natsis (2011)], training simulations [e.g., Dev et al. (2007) and Flowers and Aggarwal (2014)], therapy treatments (Bohil et al. 2011), and for social interaction venues (McCall and Blascovich 2009). It has been shown that adding haptic feedback to the interaction between users of these environments significantly increases their perceived social presence (Basdogan et al. 2000; Sallnäs 2010). Another recent development is telepresence robots that enable users to physically interact with geographically remote persons and environments. Their ultimate goal is to provide users with the illusion of a physical presence in remote places. Telepresence robots combine physical and remote presence and have a wide range of potential social applications like remote embodied teleconferencing and teaching, visiting or monitoring elderly in care centers, and making patient rounds in medical facilities (Kristoffersson et al. 2013). To achieve an illusion of telepresence, the robot should be able to reciprocate the user’s behavior and to Remote Communication Between Partners Intimacy is of central importance in creating and maintaining strong emotional bonds. Humans have an important social and personal need to feel connected in order to maintain their interpersonal relationships (Kjeldskov et al. 2004). A large part of their interpersonal communication is emotional rather than factual (Kjeldskov et al. 2004). The vibration function on a mobile phone has been used to render emotional information for blind users (Réhman and Liu 2010) and a similar interface can convey emotional content in instant messaging (Shin et al. 2007). Also, a wide range of systems have been developed for the mediated representation of specific touch events between dyads such as kisses (Saadatian et al. 2014), hugs (Mueller et al. 2005; Cha et al. 2008; Teh et al. 2008; Gooch Frontiers in Digital Humanities | www.frontiersin.org 4 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI provide the user with real-time multisensory feedback. As far as we are aware of, systems including the sense of touch have not been described yet. provided by the user to the system, and closing the loop between these signals. Generating Social Touch Signals Lemmens et al. (2009) tested tactile jackets (and later blankets) to increase emotional experiences while watching movies and reported quite strong effects of well-designed vibration patterns. Dijk et al. (2013) developed a dance vest for deaf teenagers. This vest included an algorithm that translated music into vibration patterns presented through the vest. Although not generated by a social entity, experiencing music has a substantial emotional part as did the automatically generated vibration patterns. Beyond the scripted and one-way social touch cues employed in the examples above, human–computer interaction applications increasingly deploy intelligent agents to support the social aspects of the interaction (Nijholt 2014). Social agents are used to communicate, express, and perceive emotions, maintain social relationships, interpret natural cues, and develop social competencies (Fong et al. 2003; Li et al. 2011). Empathic communication in general may serve to establish and improve affective relations with social agents (Bickmore and Picard 2005), and may be considered as a fundamental requirement for social agents that are designed to function as social companions and therapists (Breazeal 2011). Initial studies have shown that human interaction with social robots can indeed have therapeutic value (Kanamori et al. 2003; Wada and Shibata 2007; Robinson et al. 2013). These agents typically use facial expressions, gesture, and speech to convey affective cues to the user. Social agents (either physically embodied as, e.g., robots or represented as on-screen virtual agents) may also use (mediated) touch technology to communicate with humans (Huisman et al. 2014a). In this case, the touch cue is not only mediated but also generated and interpreted by an electronic system instead of a human. The physical embodiment of robots gives them a direct capability to touch users, while avatars may use the technology designed for other HCI or mediated social touch applications to virtually touch their user. Several devices have been proposed that enable haptic interaction with virtual characters (Hossain et al. 2011; Rahman and El Saddik 2011; Huisman et al. 2014a). Only few studies investigated autonomous systems that touch users for affective or therapeutic purposes (Chen et al. 2011), or that use touch to communicate the affective state of artificial creatures to their users (Yohanan and MacLean 2012). Reactions to Mediated Touch at a Physiological, Behavioral, and Social Level Although the field generally lacks serious validation studies, there is mounting evidence that people use, experience, and react to direct and mediated social touch in similar ways Bailenson and Yee (2007), at the physiological, psychological, behavioral, and social level. At a physiological and psychological level, mediated affective touch on the forearm can reduce heart rate of participants that experienced a sad event (Cabibihan et al. 2012). Mediated touch affects the quality of a shared experience and increases the intimacy felt toward the other person (Takahashi et al. 2011). Stimulation of someone’s hand through mediated touch can modulate the quality of a remotely shared experience (e.g., the hilariousness of a movie) and increase sympathy for the communication partner (Takahashi et al. 2011). In a storytelling paradigm, participants experienced a significantly higher degree of connectedness with the storyteller when the speech was accompanied by remotely administered squeezes in the upper arm (Wang et al. 2012). Additional evidence for the potential effects of mediated touch are found in the fact that hugging a robot medium while talking increases affective feelings and attraction toward a conversation partner (Kuwamura et al. 2013; Nakanishi et al. 2013). Participants receiving tactile facial stimulation experienced a stranger receiving similar stimulation to be closer, more positive and more similar to themselves when they were provided with synchronous visual feedback (Paladino et al. 2010). At a behavioral level, the most important observation is that the effect of a mediated touch on people’s pro-social behavior is similar to that of a real touch. According to Haans and IJsselsteijn (2009a), a virtual Midas touch has effects in the same order of magnitude as a real Midas touch. At the social level, the use of mediated touch is only considered appropriate as a means of communication between people in close personal relationships (Rantala et al. 2013), and the mere fact that two people are willing to touch implies an element of trust and mutual understanding (Collier 1985). The interpretation of mediated touch depends on the type of interrelationship between sender and receiver (Rantala et al. 2013), similar to direct touch (Coan et al. 2006; Thompson and Hampton 2011) and like direct touch, mediated touch communication between strangers can cause discomfort (Smith and MacLean 2007). Recognizing and Interpreting Social Touch Signals Communication implies a two-way interaction and social robots and avatars should therefore not only be able to generate but also to recognize affectionate touches. For instance, robotic affective responses to touch may contribute to people’s quality of life (Cooney et al. 2014). Touch capability is not only “nice to have” but may even be a necessity: people expect social interaction with embodied social agents to the extent that physical embodiment without tactile interaction results in a negative appraisal of the robot (Lee et al. 2006). In a recent study on the suitability of social robots for the wellbeing of the elderly, all participants expressed their wish for the robot to feel pleasant to hold or stroke and to Social Touch Generated by ICT Systems The previous chapter dealt with devices that enable interpersonal social touch communication, i.e., a situation in which the touch signals are generated and interpreted by human users and only mediated through information and communication technology. One step beyond this is to include social touch in the communication between a user and a virtual entity. This implies three additional challenges: the generation of social touch signals from system to user, the interpretation of social touch signals Frontiers in Digital Humanities | www.frontiersin.org 5 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI respond to touch (Hutson et al. 2011). The well-known example of the pet seal Paro (Wada et al. 2010) shows how powerful a simple device can be in evoking social touches. Paro responds sec to being touched but does neither interpret social touch nor produce touch. Similar effects are reported for touching a humanoid robot on the shoulder: just being able to touch already significantly increases trust toward the robot (Dougherty and Scharfe 2011). Automatic recognition and interpretation of the affective content of human originated social touch is essential to support this interaction (Argall and Billard 2010). Different approaches to equipping robots with a sense of touch include covering them with an artificial skin that simulates the human somatosensory systems (Dahiya et al. 2010) or the use of fully embodied robots covered with a range of different (e.g., temperature, proximity, pressure) sensors (Stiehl et al. 2005). To fully capture a social touch requires sensors that go beyond those used in the more advanced area of haptics and that primarily involve discriminative touch (e.g., contact, pressure, resistance). At least sensors for temperature and soft, stroking touch should be included to capture important parameters of social touch. However, just equipping a system (robot, avatar, or interface) with touch sensors is not sufficient to enable affective haptic interaction. A system can only appreciate and respond to affective touch in a natural way when it is able (a) to determine where the touch was applied, (b) to assess what kind of tactile stimulation was applied, and (c) to appraise the affective quality of the touch (Nguyen et al. 2007). While video- and audio-based affect recognition have been widely investigated (Calvo and D’Mello 2010), there have only been a few studies on touch-based affect recognition. The results of these preliminary studies indicate that affect recognition based on tactile interaction between humans and robots is comparable to that between humans (Naya et al. 1999; Cooney et al. 2012; Altun and MacLean 2014; Jung et al. 2014; van Wingerden et al. 2014). Research on capturing emotions from touch input to a computer system (i.e., not in a social context) confirms the potential of the touch modality (Zacharatos et al. 2014). Several research groups worked on capturing emotions from traditional computer input devices like mouse and keyboard based on the assumption that a user’s emotional state affects the motor output system. A general finding is that typing speed correlates to valence with a decrease in typing speed for negative valence and increased speed for positive valence compared to typing speed in neutral emotional state (Tsihrintzis et al. 2008; Khanna and Sasikumar 2010). A more informative system includes the force pattern of the key strokes. Using this information, very high-accuracy rates (>90%) are reported (Lv et al. 2008) for categorizing six emotional states (neutral, anger, fear, happiness, sadness, and surprise). This technique requires force sensitive keyboards, which are not widely available. Touch screens are used by an increasing number of people and offer much richer interaction parameters than keystrokes such as scrolling, tapping, or stroking. Recent work by Gao et al. (2012) showed that in a particular game played on the iPod, touch inputs like stroke length, pressure, and speed were important features related to a participant’s verbal description of the emotional experience during the game. Using a linear SVM, classification performance reached 77% for four emotional classes Frontiers in Digital Humanities | www.frontiersin.org (excited, relaxed, frustrated, and bored), close to 90% for two levels of arousal, and close to 85% for two levels of valence. Closing the Loop A robot that has the ability to “feel,” “understand,” and “respond” to touch in a human-like way will be capable of more intuitive and meaningful interaction with humans. Currently, artificial entities that include touch capabilities either produce or interpret social touch, but not both. However, both are required to close the loop and come to real, bidirectional interaction. The latter may require strict adherence to, for instance, timing and immediacy; a handshake in which the partners are out-of-phase can be very awkward. And as Cranny-Francis (2011) states, violating the tactile regime may result in being rejected as alien and may seriously offend others. Reactions to Touching Robots and Avatars at a Physiological, Behavioral, and Social Level Although there are still very few studies in this field, and there has been hardly any real formal evaluation, the first results of touch interactions with artificial entities appear promising. For instance, people experience robots that interact by touch as less machinelike (Cramer et al. 2009). Yohanan and colleagues (Yohanan et al. 2005; Yohanan and MacLean 2012) designed several haptic creatures to study a robot’s communication of emotional state and concluded that participants experienced a broader range of affect when haptic renderings were applied. Basori et al. (2009) showed the feasibility of using vibration in combination with sound and facial expression in avatars to communicate emotion strength. Touch also assists in building a relationship with social actors: hand squeezes (delivered through an airbladder) can improve the relation with a virtual agent (Bickmore et al. 2010). Artificial hands equipped with synthetic skins can potentially replicate not only the biomechanical behavior but also the warmth (the “feel”) of the human hand (Cabibihan et al. 2009, 2010, 2011). Users perceived a higher degree of friendship and social presence when interacting with a zoomorphic social robot with a warmer skin (Park and Lee 2014). Recent experiments indicate that the warmth of a robotic hand mediating social touch contributed significantly to the feeling of social presence (Nakanishi et al. 2014) and holding a warm robot hand increased feelings of friendship and trust toward a robot (Nie et al. 2012). Kotranza and colleagues (Kotranza and Lok 2008; Kotranza et al. 2009) describe a virtual patient as a medical student’s training tool that is able to be touched and to touch back. These touchenabled virtual patients were treated more like real humans than virtual patients without touch capabilities (students expressed more empathy and used touch more frequently to comfort and reassure the virtual patient).The authors concluded that by adding haptic interaction to the virtual patient, the bandwidth of the student-virtual patient communication increases and approaches that of human–human communication. In a study on the interaction between toddlers and a small humanoid robot, Tanaka et al. (2007) found that social connectedness correlated with the amount of touch between the child and robot. In a study where participants were asked to brush off “dirt” from either virtual objects or virtual humans, they touched virtual humans with 6 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI less force than non-human objects, and they touched the face of a virtual human with less force than the torso, while male virtual humans were touched with more force than female virtual humans (Bailenson and Yee 2008). Huisman et al. (2014b) performed a study in which participants played a collaborative augmented reality game together with two virtual agents, visible in the same augmented reality space. During interaction, one of the virtual agents touched the user on the arm by means of a vibrotactile display. They found that the touching virtual agent was rated higher on affective adjectives than the non-touching agent. Finally, Nakagawa et al. (2011) created a situation in which a robot requested participants to perform a repetitive monotonous task. This request was accompanied by an active touch, a passive touch, or no touch. The result showed that the active touch increased people’s motivation to continue performing the monotonous task. This confirms the earlier finding of Haans and IJsselsteijn (2009a) that the effect of the virtual Midas touch is in the same order of magnitude as the real Midas touch effect. may stimulate the further development of mediated social touch devices. Another research topic is the presumed close link between social touch and emotions and the potential underlying neurophysiological mechanisms, i.e., the connection between social touch and the emotional brain. Multisensory and Contextual Cues The meaning and appreciation of touch critically depend on its context (Collier 1985; Camps et al. 2012), such as the relation between conversation partners (Burgoon et al. 1992; Thompson and Hampton 2011), the body location of the touch (Nguyen et al. 1975), and the communication partner’s culture (McDaniel and Andersen 1998). There is no one-to-one correspondence between a touch and its meaning (Jones and Yarbrough 1985). Hence, the touch channel should be coupled with other sensory channels to clarify its meaning (Wang and Quek 2010). An important research question is which multisensory and contextual cues are critical. Direct (i.e., unmediated) touch is usually a multisensory experience: during interpersonal touch, we typically experience not only tactile stimulation but also changes in warmth along with verbal and non-verbal visual, auditory, and olfactory signals. Nonverbal cues (when people both see, hear, feel, and possibly smell their interaction partner performing the touching) may render mediated haptic technology more transparent, thereby increasing perceived social presence and enhancing the convincingness or immediacy of social touch (Haans and IJsselsteijn 2009b, 2010). Also, since the sight of touch activates brain regions involved in somatosensory processing [Rolls (2010); even watching a videotaped version: Walker and McGlone (2015)], the addition of visual feedback may enhance the associated haptic experience. Another strong cue for physical presence is body warmth. In human social interaction, physical temperature also plays an important role in sending interpersonal warmth (trust) information. Thermal stimuli may therefore serve as a proxy for social presence and stimulate the establishment of social relationships (IJzerman and Semin 2010). In addition to these bottom-up, stimulus driven aspects, topdown factors like expectations/beliefs of the receiver should be accounted for (e.g., beliefs about the intent of the interaction partner, familiarity with the partner, affordances of a physically embodied agent, etc.) since they shape the perceived meaning of touch (Burgoon and Walther 1990; Gallace and Spence 2010; Suhonen et al. 2012b). Research Topics Mediated social touch is a relatively young field of research that has the potential to substantially enrich human–human and human–system interaction. Although it is still not clear to what extent mediated touch can reproduce real touch, converging evidence seems to show that mediated touch shares important effects with real touch. However, many studies have an anecdotal character without solid and/or generalizable conclusions and the key studies in this field have not been replicated yet. This does not necessarily mean that the results are erroneous but it indicates that the field has not matured enough and may suffer from a publication bias. We believe that we need advancements in the following four areas for the field to mature: building an overarching framework, developing social touch basic building blocks, improving current research methodologies, and solving specific ICT challenges. Framework The human skin in itself is a complex organ able to process many different stimulus dimensions such as pressure, vibration, stretch, and temperature (van Erp 2007). “Social touch” is what the brain makes of these stimulus characteristics (sensations) taking into account personality, previous experiences, social conventions, the context, the object or person providing the touch, and probably many more factors. The scientific domains involved in social touch each have interesting research questions and answering them helps the understanding of (real life or mediated) social touch. In addition, we need an overarching framework to link the results across disciplines, to foster multidisciplinary research, and to encourage the transition from exploratory research to hypothesis driven research. Social and Cultural Social touch has a strong (unwritten) etiquette (Cranny-Francis 2011). Important questions are how to develop a touch etiquette for mediated touch and for social agents that can touch (van Erp and Toet 2013), and how to incorporate social, cultural, and individual differences with respect to acceptance and meaning of a mediated or social agent’s touch. Individual differences may include gender, attitude toward robots, and technology and touch receptivity [the (dis-)liking of being touched, Bickmore et al. 2010]. An initial set of guidelines for this etiquette is given by van Erp and Toet (2013). In addition, we should consider possible ethical implications of the technology, ranging from affecting people’s behavior without them being aware of it to the threat of physical abuse “at a distance.” Neuroscience The recent finding that there exists a distinct somatotopic mapping between tactile sensations and different emotional feelings (Nummenmaa et al. 2013; Walker and McGlone 2015) suggests that it may also be of interest to determine a map of our responsiveness to interpersonal (mediated) touch across the skin surface (Gallace and Spence 2010). The availability of such a map Frontiers in Digital Humanities | www.frontiersin.org 7 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Social Touch Building Blocks Effect Measures Gallace and Spence (2010) noted that even the most advanced devices will not be able to deliver something that can approximate realistic interpersonal touch if we do not know exactly what needs to be communicated and how to communicate it. Our touch capabilities are very complex, and like mediated vision and audition, mediated touch will always be degraded compared to real touch. The question is how this degradation affects the effects aimed for. A priori, mediated haptic communication should closely resemble non-mediated communication in order to be intuitively processed without introducing ambiguity or increasing the cognitive load (Rantala et al. 2011). However, the results discussed in this paper [e.g., Bailenson et al. (2007), Smith and MacLean (2007), Haans and IJsselsteijn (2009a), Giannopoulos et al. (2011), and Rantala et al. (2013)] indicate that social touch is quite robust to degradations and it may not be necessary to mediate all physical parameters accurately or at all. However, it is currently not even clear how we can haptically represent valence and arousal, let alone that we have robust knowledge on which parameters of the rich and complex touch characteristics are crucial in relation to the intended effects. Ideally, we have a set of building blocks of social touch that can be applied and combined depending on the situation. Social touch can evoke effects at many different levels in the receiver: physiological, psychological, behavioral, and social, and it is likely that effects at these different levels also interact. For instance, (social) presence and emotions can reciprocally reinforce each other. Currently, a broad range of effect measures is applied, which makes it difficult to compare results, assess interactions between levels, and combine experimental results into an integrated perspective. This pleads for setting a uniform set of validated and standardized measures that covers the different levels and that is robust and sensitive to the hypothesized effects of social touch. This set could include basic physiological measures known to vary with emotional experience [e.g., heart rate variability and skin conductance; Hogervorst et al. 2014]; psychological and social measures reflecting trust, proximity, togetherness, and social presence (IJsselsteijn et al. 2003; Van Bel et al. 2008; van Bel et al. 2009), and behavioral measures, e.g., quantifying compliance and performance. Please note though that each set of measures will have its own pitfalls. For instance, see Brouwer et al. (2015) for a critical reflection on the use of neurophysiological measures to assess cognitive or mental state, and Bailenson and Yee (2008) on the use of self-report questionnaires. Specific ICT Challenges Enabling ICT mediated, generated, and/or interpreted social touch requires specific ICT knowledge and technology. We consider the following issues as most prominent. Methodology Not uncommon for research in the embryonic stage, mediated social touch research is going through a phase of haphazard, anecdotal studies demonstrating the concept and its’ potential. To mature, the field needs rigorous replication and methodological well-designed studies and protocols. The multidisciplinary nature of the field adds to the diversity in research approaches. Understanding Social Touches With a few exceptions, mediated social touch studies are restricted to producing a social touch and investigate its effects on a user. To use social touch in interaction means that the system should not only be able to generate social touches but also to receive and understand social touches provided by human users. Taken the richness of human touch into account, this is not trivial. We may currently not even have the necessary sensor suite to capture a social touch adequately, including parameters like sheer and tangential forces, compliance, temperature, skin stretch, etc. After adequate capturing, algorithms should determine the social appraisal of the touch. Currently, the first attempts to capture social touches with different emotional values on a single body location (e.g., the arm) and to use computer algorithms to classify them are undertaken (van Wingerden et al. 2014). Controlled Studies Only few studies have actually investigated mediated affect conveyance, and compared mediated with unmediated touch. Although it appears that mediated social touch can indeed to some extent convey emotions (Bailenson et al. 2007) and induce pro-social behavior [e.g., the Midas effect; Haans and IJsselsteijn (2009a)], it is still not known to what extent it can also elicit strong affective experiences (Haans and IJsselsteijn 2006) and how this all compares to real touch or other control conditions. Context Aware Computing and Social Signal Processing Protocols Previous studies on mediated haptic interpersonal communication mainly investigated the communication of deliberately performed (instructed) rather than naturally occurring emotions (Bailenson et al. 2007; Smith and MacLean 2007; Rantala et al. 2013). Although this protocol is very time efficient, it relies heavily on participants’ ability to spontaneously generate social touches with, for instance, a specific emotional value. This is comparable to the research domain of facial expression where often trained actors are used to produce expressions on demand. One may consider training people in producing social touches on demand or employ a protocol (scenario) that naturally evokes specific social signals rather than instruct naïve participants to produce them. Frontiers in Digital Humanities | www.frontiersin.org The meaning of a social touch is highly dependent on the accompanying verbal and non-verbal signals of the sender and the context in which the touch is applied. An ICT system involved in social touch interaction should take the relevant parameters into account, both in generating touch and in interpreting touch. To understand and manage social signals of a person, the system is communicating with is the main challenge in the – in itself relatively young – field of social signal processing (Vinciarelli et al. 2008). Context aware (Schilit et al. 1994) implies that the system can sense its environment and reason about it in the context of social touch. 8 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Current ICT advances like the embodiment of artificial entities, the development of advanced haptic and tactile display technologies and standards (van Erp et al. 2010, including initial guidelines for mediated social touch: van Erp and Toet 2013) enable the exploration of new ICT systems that employ this powerful communication option, for instance, to enhance communication between physically separated partners and increase trust in and compliance with artificial entities. There are two prerequisites to make these applications viable. First, inter-human social touch can be ICT mediated, and second, social touch can be ICT generated and understood, all without loss of effectiveness, efficiency, and user satisfaction. In this paper, we show that there is converging evidence that both prerequisites can be met. Mediated social touch shows effects at aforementioned levels, and these effects resemble those of a real touch, even if the mediated touch is severely degraded. We also report the first indications that a social touch can be generated by an artificial entity, although the evidence base is still small. Moreover, the first steps are taken to develop algorithms to automatically classify social touches produced by the user. Our review also shows that (mediated) social touch is an embryonic field relying for a large part on technology demonstrations with only a few systematic investigations. To advance the field, we believe the focus should be on the following four activities: developing an overarching framework (integrating neuroscience, computer science, and social and behavioral science), developing basic social touch building blocks (based on the critical social touch parameters), applying stricter research methodologies (use controlled studies, validated protocols, and standard effect measures), and realizing breakthroughs in ICT (classifying social touches, context aware computing, social signal processing, congruence, and enhancing touch cues). When we are successful in managing these challenges at the crossroads of ICT and psychology, we believe that (mediated) social touch can improve our wellbeing and quality of life, can bridge the gap between real and virtual (social) worlds, and can make artificial entities more human-like. Congruency in Time, Space, and Semantics As with most multimodal interactions, congruency of the signals in space, time, and meaning is of eminent importance. For instance, touches should be congruent with other (mediated) display modalities (visual, auditory, olfactory) to communicate the intended meaning. In addition, congruence in time and space between, for instance, a seen gesture and a resulting haptic sensation is required to support a common interaction metaphor based on real touch. It has been shown that combining mediated social touch with morphologically congruent imagery enhances perceived social presence, whereas incongruent imagery results in lower degrees of social presence (Haans and IJsselsteijn 2010). Especially in closed-loop interaction (e.g., when holding or shaking hands), signals that are out of sync may severely degrade the interaction, thus requiring (near) real-time processing of touch and other social signals and generation of adequate social touches in reaction. Enhancing Touch Cues Social touch seems robust to degradations and mediated touch does not need to replicate all physical parameters accurately. The flipside of degradation is enhancement. Future research should investigate to what extent the affective quality of the mediated touch signals can be enhanced by the addition of other communication channels or by controlling specific touch parameters. Touch parameters do not necessarily have to be mediated one-to-one, but, for instance, temperature and force profiles may be either amplified or attenuated. The additional options mediation can provide to social touch have not been explored yet. Conclusion Social touch is of eminent importance in inter-human social communication and grounded in specific neurophysiological processing channels. Social touch can have effects at many levels including physiological (heart rate and hormone levels), psychological (trust in others), and sociological (pro-social behavior toward others). In Proceedings of the International Conference on Computer Technology and Development (ICCTD ‘09), 416–420. Piscataway, NJ: IEEE Press. Bickmore, T.W., Fernando, R., Ring, L., and Schulman, D. 2010. Empathic touch by relational agents. IEEE Trans. Affect. Comput. 1: 60–71. doi:10.1109/T-AFFC. 2010.4 Bickmore, T.W., and Picard, R.W. 2005. Establishing and maintaining longterm human-computer relationships. ACM Trans. Comput. Hum. Interact. 12: 293–327. doi:10.1145/1067860.1067867 Bohil, C.J., Alicea, B., and Biocca, F.A. 2011. Virtual reality in neuroscience research and therapy. Nat. Rev. Neurosci. 12: 752–62. doi:10.1038/nrn3122 Bonanni, L., Vaucelle, C., Lieberman, J., and Zuckerman, O. 2006. TapTap: a haptic wearable for asynchronous distributed touch therapy. In Proceedings of the ACM Conference on Human Factors in Computing Systems CHI ‘06, 580–585. New York, NY: ACM. Breazeal, C. 2011. Social robots for health applications. In Proceedings of the IEEE 2011 Annual International Conference on Engineering in Medicine and Biology (EMBC), 5368–5371. Piscataway, NJ: IEEE. Brouwer, A.-M., Zander, T.O., van Erp, J.B.F., Korteling, J.E., and Bronkhorst, A.W. 2015. Using neurophysiological signals that reflect cognitive or affective state: six recommendations to avoid common pitfalls. Front. Neurosci. 9:136. doi:10.3389/fnins.2015.00136 Burgoon, J.K. 1991. Relational message interpretations of touch, conversational distance, and posture. J. Nonverbal Behav. 15:233–59. doi:10.1007/BF00986924 References Altun, K., and MacLean, K.E. 2014. Recognizing affect in human touch of a robot. Pattern Recognit. Lett. doi:10.1016/j.patrec.2014.10.016 App, B., McIntosh, D.N., Reed, C.L., and Hertenstein, M.J. 2011. Nonverbal channel use in communication of emotion: how may depend on why. Emotion 11: 603–17. doi:10.1037/a0023164 Argall, B.D., and Billard, A.G. 2010. A survey of tactile human-robot interactions. Rob. Auton. Syst. 58: 1159–76. doi:10.1016/j.robot.2010.07.002 Argyle, M. 1975. Bodily Communication. 2nd ed. London, UK: Methuen. Bailenson, J.N., and Yee, N. 2007. Virtual interpersonal touch and digital chameleons. J. Nonverbal Behav. 31: 225–42. doi:10.1007/s10919-007-0034-6 Bailenson, J.N., and Yee, N. 2008. Virtual interpersonal touch: haptic interaction and copresence in collaborative virtual environments. Multimed. Tools Appl. 37: 5–14. doi:10.1007/s11042-007-0171-2 Bailenson, J.N., Yee, N., Brave, S., Merget, D., and Koslow, D. 2007. Virtual interpersonal touch: expressing and recognizing emotions through haptic devices. Hum. Comput. Interact. 22: 325–53. doi:10.1080/07370020701493509 Basdogan, C., Ho, C.-H., Srinivasan, M.A., and Slater, M. 2000. An experimental study on the role of touch in shared virtual environments. ACM Trans. Comput. Hum. Interact. 7: 443–60. doi:10.1145/365058.365082 Basori, A.H., Bade, A., Sunar, M.S., Daman, D., and Saari, N. 2009. Haptic vibration for emotional expression of avatar to enhance the realism of virtual reality. Frontiers in Digital Humanities | www.frontiersin.org 9 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Burgoon, J.K., and Walther, J.B. 1990. Nonverbal expectancies and the evaluative consequences of violations. Hum. Comm. Res. 17: 232–65. doi:10.1111/j. 1468-2958.1990.tb00232.x Burgoon, J.K., Walther, J.B., and Baesler, E.J. 1992. Interpretations, evaluations, and consequences of interpersonal touch. Hum. Comm. Res. 19: 237–63. doi:10.1111/ j.1468-2958.1992.tb00301.x Bush, E. 2001. The use of human touch to improve the well-being of older adults: A holistic nursing intervention. J. Holist. Nurs. 19(3):256–270. doi:10.1177/ 089801010101900306 Cabibihan, J.-J., Ahmed, I., and Ge, S.S. 2011. Force and motion analyses of the human patting gesture for robotic social touching. In Proceedings of the 2011 IEEE 5th International Conference on Cybernetics and Intelligent Systems (CIS), 165–169. Piscataway, NJ: IEEE. Cabibihan, J.-J., Jegadeesan, R., Salehi, S., and Ge, S.S. 2010. Synthetic skins with humanlike warmth. In Social Robotics, Edited by S. Ge, H. Li, J.J. Cabibihan, and Y. Tan, 362–371. Berlin: Springer. Cabibihan, J.-J., Pradipta, R., Chew, Y., and Ge, S. 2009. Towards humanlike social touch for prosthetics and sociable robotics: Handshake experiments and finger phalange indentations. In Advances in Robotics, Edited by J.H. Kim, S. Ge, P. Vadakkepat, N. Jesse, A. Al Manum, K. Puthusserypady, et al., 73–79 Berlin: Springer. doi:10.1007/978-3-642-03983-6_11 Cabibihan, J.-J., Zheng, L., and Cher, C.K.T. 2012. Affective tele-touch. In Social Robotics, Edited by S. Ge, O. Khatib, J.J. Cabibihan, R. Simmons, and M.A. Williams, 348–356. Berlin: Springer. Calvo, R.A., and D’Mello, S. 2010. Affect detection: an interdisciplinary review of models, methods, and their applications. IEEE Trans. Affect. Comput. 1: 18–37. doi:10.1109/T-AFFC.2010.1 Camps, J., Tuteleers, C., Stouten, J., and Nelissen, J. 2012. A situational touch: how touch affects people’s decision behavior. Social Influence 8: 237–50. doi:10.1080/ 15534510.2012.719479 Cannon, W.B. 1927. The James-Lange theory of emotions: a critical examination and an alternative theory. Am. J. Psychol. 39: 106–24. doi:10.2307/1415404 Cha, J., Eid, M., Barghout, A., and Rahman, A.M. 2008. HugMe: an interpersonal haptic communication system. In IEEE International Workshop on Haptic Audio visual Environments and Games (HAVE 2008), 99–102. Piscataway, NJ: IEEE. Chang, S.O. 2001. The conceptual structure of physical touch in caring. J. Adv. Nurs. 33(6): 820–827. doi:10.1046/j.1365-2648.2001.01721.x Chatel-Goldman, J., Congedo, M., Jutten, C., and Schwartz, J.L. 2014. Touch increases autonomic coupling between romantic partners. Front. Behav. Neurosci. 8:95. doi:10.3389/fnbeh.2014.00095 Chen, T.L., King, C.-H., Thomaz, A.L., and Kemp, C.C. 2011. Touched by a robot: an investigation of subjective responses to robot-initiated touch. In Proceedings of the 6th International Conference on Human-Robot Interaction HRI ‘11, 457–464. New York, NY: ACM. Chung, K., Chiu, C., Xiao, X., and Chi, P.Y.P. 2009. Stress outsourced: a haptic social network via crowdsourcing. In CHI ‘09 Extended Abstracts on Human Factors in Computing Systems, Edited by D.R. Olsen, K. Hinckley, M. Ringel-Morris, S. Hudson and S. Greenberg, 2439–2448. New York, NY: ACM. doi:10.1145/ 1520340.1520346 Coan, J.A., Schaefer, H.S., and Davidson, R.J. 2006. Lending a hand: social regulation of the neural response to threat. Psychol. Sci. 17: 1032–9. doi:10.1111/j. 1467-9280.2006.01832.x Collier, G. 1985. Emotional Expression. Hillsdale, NJ: Lawrence Erlbaum Associates Inc. Cooney, M.D., Nishio, S., and Ishiguro, H. 2012. Recognizing affection for a touchbased interaction with a humanoid robot. In IEEE/RSJ International Conference on Intelligent Robots and Systems (IROS), 1420–1427. Piscataway, NJ: IEEE. Cooney, M.D., Nishio, S., and Ishiguro, H. 2014. Importance of touch for conveying affection in a multimodal interaction with a small humanoid robot. Int. J. Hum. Rob. 12(1): 1550002. doi:10.1142/S0219843615500024 Cooper, E.A., Garlick, J., Featherstone, E., Voon, V., Singer, T., Critchley, H.D., et al. 2014. You turn me cold: evidence for temperature contagion. PLoS One 9:e116126. doi:10.1371/journal.pone.0116126 Cramer, H., Kemper, N., Amin, A., Wielinga, B., and Evers, V. 2009. “Give me a hug”: the effects of touch and autonomy on people’s responses to embodied social agents. Comput. Anim. Virtual Worlds 20: 437–45. doi:10.1002/cav.317 Cranny-Francis, A. 2011. Semefulness: a social semiotics of touch. Soc. Semiotics 21: 463–81. doi:10.1080/10350330.2011.591993 Frontiers in Digital Humanities | www.frontiersin.org Crusco, A.H., and Wetzel, C.G. 1984. The midas touch: the effects of interpersonal touch on restaurant tipping. Pers. Soc. Psychol. B 10: 512–7. doi:10.1177/ 0146167284104003 Dahiya, R.S., Metta, G., Valle, M., and Sandini, G. 2010. Tactile sensing – from humans to humanoids. IEEE Trans. Rob. 26: 1–20. doi:10.1109/TRO.2009. 2033627 Damasio, A. 1999. The Feeling of What Happens: Body and Emotion in the Making of Consciousness. London, UK: Heinemann. Debrot, A., Schoebi, D., Perrez, M., and Horn, A.B. 2013. Touch as an interpersonal emotion regulation process in couples’ daily lives: the mediating role of psychological intimacy. Pers. Soc. Psychol. B 39: 1373–85. doi:10.1177/ 0146167213497592 Dev, P., Youngblood, P., Heinrichs, W.L., and Kusumoto, L. 2007. Virtual worlds and team training. Anesthesiol. Clin. 25: 321–36. doi:10.1016/j.anclin.2007.03. 001 Dijk, E.O., Nijholt, A., van Erp, J.B.F., Wolferen, G.V., and Kuyper, E. 2013. Audiotactile stimulation: a tool to improve health and well-being? Int. J. Auton. Adapt. Commun. Syst. 6: 305–23. doi:10.1504/IJAACS.2013.056818 Ditzen, B., Neumann, I.D., Bodenmann, G., von Dawans, B., Turner, R.A., Ehlert, U., et al. 2007. Effects of different kinds of couple interaction on cortisol and heart rate responses to stress in women. Psychoneuroendocrinology 32: 565–74. doi:10.1016/j.psyneuen.2007.03.011 Dolin, D.J., and Booth-Butterfield, M. 1993. Reach out and touch someone: analysis of nonverbal comforting responses. Commun. Q. 41: 383–93. doi:10.1080/ 01463379309369899 Dougherty, E., and Scharfe, H. 2011. Initial formation of trust: designing an interaction with geminoid-DK to promote a positive attitude for cooperation. In Social Robotics, Edited by B. Mutlu, C. Bartneck, J. Ham, V. Evers, and T. Kanda, 95–103. Berlin: Springer. Drescher, V.M., Gantt, W.H., and Whitehead, W.E. 1980. Heart rate response to touch. Psychosom. Med. 42: 559–65. doi:10.1097/00006842-198011000-00004 Eichhorn, E., Wettach, R., and Hornecker, E. 2008. A stroking device for spatially separated couples. In Proceedings of the 10th International Conference on Human Computer Interaction with Mobile Devices and Services Mobile HCI ‘08, 303–306. New York, NY: ACM. Ellingsen, D.M., Wessberg, J., Chelnokova, O., Olausson, H., Aeng, B., and Eknes, S. 2014. In touch with your emotions: oxytocin and touch change social impressions while others’ facial expressions can alter touch. Psychoneuroendocrinology 39: 11–20. doi:10.1016/j.psyneuen.2013.09.017 Field, T. 2010. Touch for socioemotional and physical well-being: a review. Dev. Rev. 30: 367–83. doi:10.1016/j.dr.2011.01.001 Fisher, J.D., Rytting, M., and Heslin, R. 1976. Hands touching hands: affective and evaluative effects of an interpersonal touch. Sociometry 39: 416–21. doi:10.2307/ 3033506 Flowers, M.G., and Aggarwal, R. 2014. Second LifeTM : a novel simulation platform for the training of surgical residents. Expert Rev. Med. Devices 11: 101–3. doi:10. 1586/17434440.2014.863706 Fong, T., Nourbakhsh, I., and Dautenhahn, K. 2003. A survey of socially interactive robots. Rob. Auton. Syst. 42: 143–66. doi:10.1016/S0921-8890(02) 00372-X Frumin, I., Perl, O., Endevelt-Shapira, Y., Eisen, A., Eshel, N., Heller, I., et al. 2015. A social chemosignaling function for human handshaking. Elife 4: e05154. doi:10.7554/eLife.05154 Furukawa, M., Kajimoto, H., and Tachi, S. 2012. KUSUGURI: a shared tactile interface for bidirectional tickling. In Proceedings of the 3rd Augmented Human International Conference AH ‘12, 1–8. New York, NY: ACM. Gallace, A., Ngo, M.K., Sulaitis, J., and Spence, C. 2012. Multisensory presence in virtual reality: possibilities & limitations. In Multiple Sensorial Media Advances and Applications: New Developments in MulSeMedia, Edited by G. Ghinea, F. Andres and S.R. Gulliver, 1–40. Vancouver, BC: IGI Global. Gallace, A., and Spence, C. 2010. The science of interpersonal touch: an overview. Neurosci. Biobehav. Rev. 34: 246–59. doi:10.1016/j.neubiorev.2008.10.004 Gao, Y., Bianchi-Berthouze, N., and Meng, H. 2012. What does touch tell us about emotions in touchscreen-based gameplay? ACM Trans. Comput. Hum. Interact. 19: 1–30. doi:10.1145/2395131.2395138 Giannopoulos, E., Wang, Z., Peer, A., Buss, M., and Slater, M. 2011. Comparison of people’s responses to real and virtual handshakes within a virtual environment. Brain Res. Bull. 85: 276–82. doi:10.1016/j.brainresbull.2010.11.012 10 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Gleeson, M., and Timmins, F. 2005. A review of the use and clinical effectiveness of touch as a nursing intervention. Clin. Effect. Nurs. 9: 69–77. doi:10.1016/j.cein. 2004.12.002 Gooch, D., and Watts, L. 2010. Communicating social presence through thermal hugs. In Proceedings of First Workshop on Social Interaction in Spatially Separated Environments (SISSI2010), Edited by F. Schmid, T. Hesselmann, S. Boll, K. Cheverst, and L. Kulik, 11–19. Copenhagen: International Society for Presence Research. Gooch, D., and Watts, L. 2012. Yourgloves, hothands and hotmits: devices to hold hands at a distance. In Proceedings of the 25th Annual ACM Symposium on User Interface Software and Technology UIST ‘12, 157–166. New York, NY: ACM. Gordon, I., Voos, A.C., Bennett, R.H., Bolling, D.Z., Pelphrey, K.A. and Kaiser, M.D. 2013. Brain mechanisms for processing affective touch. Hum. Brain Mapp. 34(4):914–922. doi:10.1002/hbm.21480 Gottlieb, G. 1971. Ontogenesis of sensory function in birds and mammals. In The Biopsychology of Development, Edited by E. Tobach, L.R. Aronson, and E. Shaw, 67–128. New York, NY: Academic Press. Grewen, K.M., Anderson, B.J., Girdler, S.S., and Light, K.C. 2003. Warm partner contact is related to lower cardiovascular reactivity. Behav. Med. 29: 123–30. doi:10.1080/08964280309596065 Guéguen, N. 2002. Touch, awraness of touch, and compliance with a request. Percept. Mot. Skills 95: 355–60. doi:10.2466/pms.2002.95.2.355 Guéguen, N. 2004. Nonverbal encouragement of participation in a course: the effect of touching. Soc. Psychol. Educ. 7: 89–98. doi:10.1023/B:SPOE.0000010691. 30834.14 Guéguen, N., and Fischer-Lokou, J. 2003. Tactile contact and spontaneous help: an evaluation in a natural setting. J. Soc. Psychol. 143: 785–7. doi:10.1080/ 00224540309600431 Guéguen, N., Meineri, S., and Charles-Sire, V. 2010. Improving medication adherence by using practitioner nonverbal techniques: a field experiment on the effect of touch. J. Behav. Med. 33: 466–73. doi:10.1007/s10865-010-9277-5 Haans, A., and IJsselsteijn, W.A. 2006. Mediated social touch: a review of current research and future directions. Virtual Reality 9: 149–59. doi:10.1007/ s10055-005-0014-2 Haans, A., and IJsselsteijn, W.A. (2009a). The virtual Midas Touch: helping behavior after a mediated social touch. IEEE Trans. Haptics 2: 136–40. doi:10.1109/TOH. 2009.20 Haans, A., and IJsselsteijn, W.A. (2009b). I’m always touched by your presence, dear: combining mediated social touch with morphologically correct visual feedback. In Proceedings of Presence 2009, 1–6. Los Angeles, CA: International Society for Presence Research. Haans, A., and IJsselsteijn, W.A. 2010. Combining mediated social touch with vision: from self-attribution to telepresence? In Proceedings of Special Symposium at EuroHaptics 2010: Haptic and Audio-Visual Stimuli: Enhancing Experiences and Interaction, Edited by A. Nijholt, E.O. Dijk, and P.M.C. Lemmens, 35–46 Enschede:University of Twente. Henricson, M., Ersson, A., Määttä, S., Segesten, K., and Berglund, A.L. 2008. The outcome of tactile touch on stress parameters in intensive care: A randomized controlled trial. Complement. Ther. Clin. Prac. 14(4): 244–254. Harlow, H.F., and Zimmermann, R.R. 1959. Affectional responses in the infant monkey; orphaned baby monkeys develop a strong and persistent attachment to inanimate surrogate mothers. Science 130: 421–32. doi:10.1126/science.130. 3373.421 Hertenstein, M.J., Holmes, R., McCullough, M., and Keltner, D. 2009. The communication of emotion via touch. Emotion 9: 566–73. doi:10.1037/a0016108 Hertenstein, M.J., Keltner, D., App, B., Bulleit, B.A., and Jaskolka, A.R. 2006. Touch communicates distinct emotions. Emotion 6: 528–33. doi:10.1037/1528-3542.6. 3.528 Hogervorst, M.A., Brouwer, A.-M., and van Erp, J.B.F. 2014. Combining and comparing EEG, peripheral physiology and eye-related measures for the assessment of mental workload. Front. Neurosci. 8:322. doi:10.3389/fnins.2014.00322 Hornik, J. 1992. Tactile stimulation and consumer response. J. Consum. Res. 19: 449–58. doi:10.1086/209314 Hossain, S.K.A., Rahman, A.S.M.M., and El Saddik, A. 2011. Measurements of multimodal approach to haptic interaction in second life interpersonal communication system. IEEE Trans. Instrum. Meas. 60: 3547–58. doi:10.1109/TIM. 2011.2161148 Huisman, G., Bruijnes, M., Kolkmeier, J., Jung, M.M., Darriba Frederiks, A., and Rybarczyk, Y. (2014a). Touching virtual agents: embodiment and mind. In Innovative and Creative Developments in Multimodal Interaction Systems, Edited Frontiers in Digital Humanities | www.frontiersin.org by Y. Rybarczyk, T. Cardoso, J. Rosas, and L. Camarinha-Matos, 114–138. Berlin: Springer. Huisman, G., Kolkmeier, J., and Heylen, D. (2014b). Simulated social touch in a collaborative game. In Haptics: Neuroscience, Devices, Modeling, and Applications, Edited by M. Auvray and C. Duriez, 248–256. Berlin: Springer. Huisman, G., Darriba Frederiks, A., Van Dijk, E.M.A.G., Kröse, B.J.A., and Heylen, D.K.J. 2013. Self touch to touch others: designing the tactile sleeve for social touch. In Online Proceedings of TEI’13. Available at: http://www.tei-conf.org/13/ sites/default/files/page-files/Huisman.pdf Hutson, S., Lim, S., Bentley, P.J., Bianchi-Berthouze, N., and Bowling, A. 2011. Investigating the suitability of social robots for the wellbeing of the elderly. In Affective Computing and Intelligent Interaction, Edited by S. D’Mello, A. Graesser, B. Schuller, and J.C. Martin, 578–587. Berlin: Springer. IJsselsteijn, W.A., van Baren, J., and van Lanen, F. 2003. Staying in touch: social presence and connectedness through synchronous and asynchronous communication media (Part III). In Human-Computer Interaction: Theory and Practice, Edited by C. Stephanidis and J. Jacko, 924–928. Boca Raton, FL: CRC Press. IJzerman, H., and Semin, G.R. 2009. The thermometer of social relations: mapping social proximity on temperature. Psychol. Sci. 20: 1214–20. doi:10.1111/j. 1467-9280.2009.02434.x IJzerman, H., and Semin, G.R. 2010. Temperature perceptions as a ground for social proximity. J. Exp. Soc. Psychol. 46: 867–73. doi:10.1016/j.jesp.2010.07.015 James, W. 1884. What is an emotion? Mind 9: 188–205. doi:10.1093/mind/os-IX. 34.188 Jones, S.E., and Yarbrough, A.E. 1985. A naturalistic study of the meanings of touch. Comm. Monogr. 52: 19–56. doi:10.1080/03637758509376094 Joule, R.V., and Guéguen, N. 2007. Touch, compliance, and awareness of tactile contact. Percept. Mot. Skills 104: 581–8. doi:10.2466/pms.104.2.581-588 Jung, M.M., Poppe, R., Poel, M., and Heylen, D.K.J. 2014. Touching the VOID – introducing CoST: corpus of social touch. In Proceedings of the 16th International Conference on Multimodal Interaction (ICMI ‘14), 120–127. New York, NY: ACM. Kanamori, M., Suzuki, M., Oshiro, H., Tanaka, M., Inoguchi, T., Takasugi, H., et al. 2003. Pilot study on improvement of quality of life among elderly using a pet-type robot. In Proceedings of the IEEE International Symposium on Computational Intelligence in Robotics and Automation, 107–112. Piscataway, NJ: IEEE. Khanna, P., and Sasikumar, M. 2010. Recognising emotions from keyboard stroke pattern. Int. J. Comput. Appl. 11: 1–5. doi:10.5120/1614-2170 Kjeldskov, J., Gibbs, M., Vetere, F., Howard, S., Pedell, S., Mecoles, K., et al. 2004. Using cultural probes to explore mediated intimacy. Australas J. Inf. Syst. 11. Available at: http://journal.acs.org.au/index.php/ajis/article/view/128 Kleinke, C.L. 1977. Compliance to requests made by gazing and touching experimenters in field settings. J. Exp. Soc. Psychol. 13: 218–23. doi:10.1016/ 0022-1031(77)90044-0 Knapp, M.L., and Hall, J.A. 2010. Nonverbal Communication in Human Interaction (7th ed.). Boston, MA: Wadsworth, CENGAGE Learning. Konijn, E.A., Utz, S., Tanis, M., and Barnes, S.B. 2008. Mediated Interpersonal Communication. New York, NY: Routledge. Kotranza, A., and Lok, B. 2008. Virtual human + tangible interface = mixed reality human: an initial exploration with a virtual breast exam patient. In Proceedings of the IEEE Virtual Reality Conference 2008 (VR ‘08), 99–106. Piscataway, NJ: IEEE. Kotranza, A., Lok, B., Deladisma, A., Pugh, C.M., and Lind, D.S. 2009. Mixed reality humans: evaluating behavior, usability, and acceptability. IEEE Trans. Vis. Comput. Graph. 15: 369–82. doi:10.1109/TVCG.2008.195 Kraus, M.W., Huang, C., and Keltner, D. 2010. Tactile communication, cooperation, and performance: an ethological study of the NBA. Emotion 10: 745–9. doi:10. 1037/a0019382 Kristoffersson, A., Coradeschi, S., and Loutfi, A. 2013. A review of mobile robotic telepresence. Adv. Hum. Comput. Int. 2013: 1–17. doi:10.1155/2013/ 902316 Kuwamura, K., Sakai, K., Minato, T., Nishio, S., and Ishiguro, H. 2013. Hugvie: a medium that fosters love. In The 22nd IEEE International Symposium on Robot and Human Interactive Communication, 70–75. Gyeongju: IEEE. Kvam, M.H. 1997. The effect of vibroacoustic therapy. Physiotherapy 83: 290–5. doi:10.1016/S0031-9406(05)66176-7 Ledbetter, A.M. 2014. The past and future of technology in interpersonal communication theory and research. Commun. Stud. 65: 456–9. doi:10.1080/10510974. 2014.927298 11 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Lee, J.K., Stiehl, W.D., Toscano, R.L., and Breazeal, C. 2009. Semi-autonomous robot avatar as a medium for family communication and education. Adv. Rob. 23: 1925–49. doi:10.1163/016918609X12518783330324 Lee, K.M., Jung, Y., Kim, J., and Kim, S.R. 2006. Are physically embodied social agents better than disembodied social agents? The effects of physical embodiment, tactile interaction, and people’s loneliness in human-robot interaction. Int. J. Hum. Comput. Stud. 64: 962–73. doi:10.1016/j.ijhcs.2006.05.002 Lemmens, P., Crompvoets, F., Brokken, D., van den Eerenbeemd, J., and de Vries, G.J. 2009. A body-conforming tactile jacket to enrich movie viewing. In EuroHaptics Conference, 2009 and Symposium on Haptic Interfaces for Virtual Environment and Teleoperator Systems. World Haptics 2009. Third Joint, 7–12. Piscataway, NJ: IEEE Press. Li, H., Cabibihan, J.-J., and Tan, Y. 2011. Towards an effective design of social robots. Int. J. Soc. Rob. 3: 333–5. doi:10.1007/s12369-011-0121-z Löken, L.S., Wessberg, J., Morrison, I., McGlone, F., and Olausson, H. 2009. Coding of pleasant touch by unmyelinated afferents in humans. Nat. Neurosci. 12(5): 547–548. doi:10.1038/nn.2312 Lv, H.-R., Lin, Z.-L., Yin, W.-J., and Dong, J. 2008. Emotion recognition based on pressure sensor keyboards. In IEEE International Conference on Multimedia and Expo 2008, 1089–1092. Piscataway, NJ: IEEE. Master, S.L., Eisenberger, N.I., Taylor, S.E., Naliboff, B.D., Shirinyan, D., and Lieberman, M.D. 2009. A picture’s worth: partner photographs reduce experimentally induced pain. Psychol. Sci. 20: 1316–8. doi:10.1111/j.1467-9280.2009.02444.x McCall, C., and Blascovich, J. 2009. How, when, and why to use digital experimental virtual environments to study social behavior. Soc. Pers. Psychol. Compass 3: 744–58. doi:10.1111/j.1751-9004.2009.00195.x McCance, R.A., and Otley, M. 1951. Course of the blood urea in newborn rats, pigs and kittens. J. Physiol. 113: 18–22. doi:10.1113/jphysiol.1951.sp004552 McDaniel, E., and Andersen, P.A. 1998. International patterns of interpersonal tactile communication: a field study. J. Nonverbal Behav. 22: 59–75. doi:10.1023/ A:1022952509743 McGlone, F., Wessberg, J., and Olausson, H. 2014. Discriminative and affective touch: sensing and feeling. Neuron 82: 737–55. doi:10.1016/j.neuron.2014. 05.001 Mehrabian, A. 1972. Nonverbal Communication. Chicago, IL: Aldine-Atherton. Mikropoulos, T.A., and Natsis, A. 2011. Educational virtual environments: a tenyear review of empirical research (1999-2009). Comput. Educ. 56: 769–80. doi:10. 1016/j.compedu.2010.10.020 Montagu, A. 1972. Touching: The Human Significance of the Skin. New York, NY: Harper & Row Publishers. Morrison, I., Löken, L., and Olausson, H. 2010. The skin as a social organ. Exp. Brain Res. 204: 305–14. doi:10.1007/s00221-009-2007-y Morrison, I., Björnsdotter, M., and Olausson, H. 2011. Vicarious responses to social touch in posterior insular cortex are tuned to pleasant caressing speeds. J. Neurosci. 31(26):9554–9562. Mueller, F., Vetere, F., Gibbs, M.R., Kjeldskov, J., Pedell, S., and Howard, S. 2005. Hug over a distance. In CHI ‘05 Extended Abstracts on Human Factors in Computing Systems, Edited by G. van der Veer and C. Gale, 1673–1676. New York, NY: ACM. doi:10.1145/1056808.1056994 Nakagawa, K., Shiomi, M., Shinozawa, K., Matsumura, R., Ishiguro, H., and Hagita, N. 2011. Effect of robot’s active touch on people’s motivation. In Proceedings of the 6th International Conference on Human-Robot Interaction HRI ‘11, 465–472. New York, NY: ACM. Nakanishi, H., Tanaka, K., and Wada, Y. 2014. Remote handshaking: touch enhances video-mediated social telepresence. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems CHI’14, 2143–2152. New York, NY: ACM. Nakanishi, J., Kuwamura, K., Minato, T., Nishio, S., and Ishiguro, H. 2013. Evoking affection for a communication partner by a robotic communication medium. In The First International Conference on Human-Agent Interaction (iHAI 2013), 1–8. Available at: http://hai-conference.net/ihai2013/proceedings/pdf/III-1-4.pdf Naya, F., Yamato, J., and Shinozawa, K. 1999. Recognizing human touching behaviors using a haptic interface for a pet-robot. In Conference Proceedings of the IEEE International Conference on Systems, Man, and Cybernetics (IEEE SMC ‘99), 1030–1034. Piscataway, NJ: IEEE. Nguyen, N., Wachsmuth, I., and Kopp, S. 2007. Touch perception and emotional appraisal for a virtual agent. In Proceedings of the 2nd Workshop Emotion and Computing-Current Research and Future Impact, Edited by D. Reichardt and P. Levi, 17–22. Stuttgart: Berufsakademie Stuttgart. Frontiers in Digital Humanities | www.frontiersin.org Nguyen, T., Heslin, R., and Nguyen, M.L. 1975. The meanings of touch: sex differences. J. Commun. 25: 92–103. doi:10.1111/j.1460-2466. 1975.tb00610.x Nie, J., Park, M., Marin, A.L., and Sundar, S.S. 2012. Can you hold my hand? Physical warmth in human-robot interaction. In Proceeedings of the 7th ACM/IEEE International Conference on Human-Robot Interaction (HRI), 201–202. Piscataway, NJ: IEEE. Nijholt, A. 2014. Breaking fresh ground in human-media interaction research. Front. ICT 1:4. doi:10.3389/fict.2014.00004 Nummenmaa, L., Glerean, E., Hari, R., and Hietanen, J.K. 2013. Bodily maps of emotions. Proc. Natl. Acad. Sci. U.S.A. 111: 646–51. doi:10.1073/pnas. 1321664111 Olausson, H.W., Cole, J., Vallbo, Å, McGlone, F., Elam, M., Krämer, H.H., et al. 2008. Unmyelinated tactile afferents have opposite effects on insular and somatosensory cortical processing. Neurosci. Lett. 436: 128–32. doi:10.1016/j.neulet.2008. 03.015 Paladino, M.P., Mazzurega, M., Pavani, F., and Schubert, T.W. 2010. Synchronous multisensory stimulation blurs self-other boundaries. Psychol. Sci. 21: 1202–7. doi:10.1177/0956797610379234 Park, E., and Lee, J. 2014. I am a warm robot: the effects of temperature in physical human – robot interaction. Robotica 32: 133–42. doi:10.1017/ S026357471300074X Park, Y.W., Bae, S.H., and Nam, T.J. 2012. How do Couples Use CheekTouch Over Phone Calls? New York, NY: ACM. 763–6. Park, Y.W., Hwang, S., and Nam, T.J. 2011. Poke: emotional touch delivery through an inflatable surface over interpersonal mobile communications. In Adjunct Proceedings of the 24th Annual ACM Symposium Adjunct on User Interface Software and Technology UIST ‘11, 61–62. New York, NY: ACM. Patrick, G. 1999. The effects of vibroacoustic music on symptom reduction. IEEE Eng. Med. Biol. Mag. 18: 97–100. doi:10.1109/51.752987 Phelan, J.E. 2009. Exploring the use of touch in the psychotherapeutic setting: a phenomenological review. Psychotherapy (Chic) 46: 97–111. doi:10.1037/a0014751 Prisby, R.D., Lafage-Proust, M.-H., Malaval, L., Belli, A., and Vico, L. 2008. Effects of whole body vibration on the skeleton and other organ systems in man and animal models: what we know and what we need to know. Ageing Res. Rev. 7: 319–29. doi:10.1016/j.arr.2008.07.004 Puhan, M.A., Suarez, A., Cascio, C.L., Zahn, A., Heitz, M., and Braendli, O. 2006. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ 332: 266–70. doi:10.1136/bmj.38705. 470590.55 Rahman, A.S.M.M., and El Saddik, A. 2011. HKiss: real world based haptic interaction with virtual 3D avatars. In Proceedings of the 2011 IEEE International Conference on Multimedia and Expo (ICME), 1–6. Piscataway, NJ: IEEE. Rantala, J., Raisamo, R., Lylykangas, J., Ahmaniemi, T., Raisamo, J., Rantala, J., et al. 2011. The role of gesture types and spatial feedback in haptic communication. IEEE Trans. Haptics 4: 295–306. doi:10.1109/TOH.2011.4 Rantala, J., Salminen, K., Raisamo, R., and Surakka, V. 2013. Touch gestures in communicating emotional intention via vibrotactile stimulation. Int. J. Hum. Comput. Stud. 7: 679–90. doi:10.1016/j.ijhcs.2013.02.004 Réhman, S., and Liu, L. 2010. iFeeling: vibrotactile rendering of human emotions on mobile phones. In Mobile Multimedia Processing, Edited by X. Jiang, M.Y. Ma, and C. Chen, 1–20. Berlin: Springer. Robinson, H., MacDonald, B., Kerse, N., and Broadbent, E. 2013. The psychosocial effects of a companion robot: a randomized controlled trial. J. Am. Med. Dir. Assoc. 14: 661–7. doi:10.1016/j.jamda.2013.02.007 Rolls, E.T. 2010. The affective and cognitive processing of touch, oral texture, and temperature in the brain. Neurosci. Biobehav. Rev. 34: 237–45. doi:10.1016/j. neubiorev.2008.03.010 Saadatian, E., Samani, H., Parsani, R., Pandey, A.V., Li, J., Tejada, L., et al. 2014. Mediating intimacy in long-distance relationships using kiss messaging. Int. J. Hum. Comput. Stud. 72: 736–46. doi:10.1016/j.ijhcs.2014.05.004 Sallnäs, E.L. 2010. Haptic feedback increases perceived social presence. In Haptics: Generating and Perceiving Tangible Sensations, Part II, Edited by A.M. Kappers, J.B. Erp, W.M. Bergmann Tiest, and F.C. Helm, 178–185. Berlin: Springer. Salminen, K., Surakka, V., Lylykangas, J., Raisamo, R., Saarinen, R., Raisamo, R., et al. 2008. Emotional and behavioral responses to haptic stimulation. In Proceeding of the Twenty-Sixth Annual SIGCHI Conference on Human Factors in Computing Systems, 1555–1562. New York, NY: ACM Press. 12 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Scheele, D., Kendrick, K.M., Khouri, C., Kretzer, E., Schläpfer, T.E., StoffelWagner, B., et al. 2014. An oxytocin-induced facilitation of neural and emotional responses to social touch correlates inversely with autism traits. Neuropsychopharmacology 39: 2078–85. doi:10.1038/npp.2014.78 Schilit, B., Adams, N., and Want, R. 1994. Context-aware computing applications. In First Workshop on Mobile Computing Systems and Applications (WMCSA 1994), 85–90. Piscataway, NJ: IEEE. Self, B.P., van Erp, J.B.F., Eriksson, L., and Elliott, L.R. 2008. Human factors issues of tactile displays for military environments. In Tactile Displays for Navigation, Orientation and Communication in Military Environments, Edited by J.B.F. van Erp and B.P. Self, 3. Neuillu-sur-Seine: NATO RTO. Shermer, M. 2004. A bounty of science. Sci. Am. 290: 33. doi:10.1038/ scientificamerican0204-33 Shin, H., Lee, J., Park, J., Kim, Y., Oh, H., and Lee, T. 2007. A tactile emotional interface for instant messenger chat. In Proceedings of the 2007 Conference on Human Interface, Edited by M.J. Smith and G. Salvendy, 166–175. Berlin: Springer. Smith, J., and MacLean, K. 2007. Communicating emotion through a haptic link: design space and methodology. Int. J. Hum. Comput. Stud. 65: 376–87. doi:10. 1016/j.ijhcs.2006.11.006 Solon, O. 2015. These sex tech toys will blow your mind. WIRED. Available at: http://www.wired.co.uk/news/archive/2014-06/27/sex-tech Stiehl, W.D., Lieberman, J., Breazeal, C., Basel, L., Lalla, L., and Wolf, M. 2005. Design of a therapeutic robotic companion for relational, affective touch. In IEEE International Workshop on Robot and Human Interactive Communication (ROMAN 2005), 408–415. Piscataway, NJ: IEEE. Suhonen, K., Müller, S., Rantala, J., Väänänen-Vainio-Mattila, K., Raisamo, R., and Lantz, V. (2012a). Haptically augmented remote speech communication: a study of user practices and experiences. In Proceedings of the 7th Nordic Conference on Human-Computer Interaction: Making Sense Through Design NordiCHI ‘12, 361–369. New York, NY: ACM. Suhonen, K., Väänänen-Vainio-Mattila, K., and Mäkelä, K. (2012b). User experiences and expectations of vibrotactile, thermal and squeeze feedback in interpersonal communication. In Proceedings of the 26th Annual BCS Interaction Specialist Group Conference on People and Computers BCS-HCI ‘12, 205–214. New York, NY: ACM. Suk, H.-J., Jeong, S.-H., Hang, T.-H., and Kwon, D.-S. 2009. Tactile sensation as emotion elicitor. Kansei Eng. Int. 8(2): 147–52. Takahashi, K., Mitsuhashi, H., Murata, K., Norieda, S., and Watanabe, K. 2011. Improving shared experiences by haptic telecommunication. In 2011 International Conference on Biometrics and Kansei Engineering (ICBAKE), 210–215. Los Alamitos, CA: IEEE. doi:10.1109/ICBAKE.2011.19 Tanaka, F., Cicourel, A., and Movellan, J.R. 2007. Socialization between toddlers and robots at an early childhood education center. Proc. Natl. Acad. Sci. U.S.A. 104: 17954–8. doi:10.1073/pnas.0707769104 Teh, J.K.S., Cheok, A.D., Peiris, R.L., Choi, Y., Thuong, V., and Lai, S. 2008. Huggy pajama: a mobile parent and child hugging communication system. In Proceedings of the 7th International Conference on Interaction Design and Children IDC ‘08, 250–257. New York, NY: ACM. Thompson, E.H., and Hampton, J.A. 2011. The effect of relationship status on communicating emotions through touch. Cognit. Emot. 25: 295–306. doi:10. 1080/02699931.2010.492957 Toet, A., van Erp, J.B.F., Petrignani, F.F., Dufrasnes, M.H., Sadhashivan, A., van Alphen, D., et al. 2013. Reach out and touch somebody’s virtual hand. Affectively connected through mediated touch. In Proceedings of the 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction, 786–791. Piscataway, NJ: IEEE Computer Society. Tsalamlal, M.Y., Ouarti, N., Martin, J.C., and Ammi, M. 2014. Haptic communication of dimensions of emotions using air jet based tactile stimulation. J. Multimodal User Interfaces 9(1): 69–77. doi:10.1007/s12193-014 -0162-3 Tsetserukou, D. 2010. HaptiHug: a novel haptic display for communication of hug over a distance. In Haptics: Generating and Perceiving Tangible Sensations, Edited by A.M. Kappers, J.B. Erp, W.M. Bergmann Tiest, and F.C. Helm, 340–347. Berlin: Springer. Tsetserukou, D., and Neviarouskaya, A. 2010. Innovative real-time communication system with rich emotional and haptic channels. In Haptics: Generating and Frontiers in Digital Humanities | www.frontiersin.org Perceiving Tangible Sensations, Edited by A.M. Kappers, J.B. van Erp, W.M. Bergmann Tiest, and F.C. Helm, 306–313. Berlin: Springer. Tsihrintzis, G.A., Virvou, M., Alepis, E., and Stathopoulou, I.O. 2008. Towards improving visual-facial emotion recognition through use of complementary keyboard-stroke pattern information. In Fifth International Conference on Information Technology: New Generations (ITNG 2008), 32–37. Piscataway, NJ: IEEE. Uvnäs-Moberg, K. 1997. Physiological and endocrine effects of social contact. Ann. N. Y. Acad. Sci. 807: 146–63. doi:10.1111/j.1749-6632.1997.tb51917.x Vallbo, A., Olausson, H., Wessberg, J., and Norrsell, U. 1993. A system of unmyelinated afferents for innocuous mechanoreception in the human skin. Brain Res. 628: 301–4. doi:10.1016/0006-8993(93)90968-S Van Bel, D.T., IJsselsteijn, W.A., and de Kort, Y.A.W. 2008. Interpersonal connectedness: conceptualization and directions for a measurement instrument. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems (CHI’08), 3129–3134. New York, NY: ACM. van Bel, D.T., Smolders, K.C.H.J., IJsselsteijn, W.A., and de Kort, Y.A.W. 2009. Social connectedness: concept and measurement. In Proceedings of the 5th International Conference on Intelligent Environments, Edited by V. Callaghan, A. Kameas, A. Reyes, D. Royo, and M. Weber, 67–74. Amsterdam: IOS Press. van Erp, J.B.F. 2007. Tactile Displays for Navigation and Orientation: Perception and Behaviour. Utrecht: Utrecht University. van Erp, J.B.F. 2012. The ten rules of touch: guidelines for social agents and robots that can touch. In Proceedings of the 25th Annual Conference on Computer Animation and Social Agents (CASA 2012), Singapore: Nanayang Technological University. van Erp, J.B.F., Kyung, K.-U., Kassner, S., Carter, J., Brewster, S., Weber, G., et al. 2010. Setting the standards for haptic and tactile interactions: ISO’s work. In Haptics: Generating and Perceiving Tangible Sensations. Proceedings of Eurohaptics 2010, Edited by A.M.L. Kappers, J.B.F. van Erp, W.M. Bergmann Tiest, and F.C.T. van der Helm, 353–358. Heidelberg: Springer. van Erp, J.B.F., and Toet, A. 2013. How to touch humans. Guidelines for social agents and robots that can touch. In Proceedings of the 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction, 780–785. Geneva:IEEE Computer Society. doi:10.1109/ACII.2013.77145 van Erp, J.B.F., and van Veen, H.A.H.C. 2004. Vibrotactile in-vehicle navigation system. Transp. Res. Part F Traffic Psychol. Behav. 7: 247–56. doi:10.1016/j.trf. 2004.09.003 van Wingerden, S., Uebbing, T.J., Jung, M.M., and Poel, M. 2014. A neural network based approach to social touch classification. In Proceedings of the 2014 Workshop on Emotion Representation and Modelling in Human-Computer-InteractionSystems (ERM4HCI ‘14), 7–12. New York, NY: ACM. Vinciarelli, A., Pantic, M., Bourlard, H., and Pentland, A. 2008. Social signal processing: state-of-the-art and future perspectives of an emerging domain. In Proceedings of the 16th ACM International Conference on Multimedia, 1061–1070. New York, NY: ACM. Vrontou, S., Wong, A.M., Rau, K.K., Koerber, H.R., and Anderson, D.J. 2013. Genetic identification of C fibres that detect massage-like stroking of hairy skin in vivo. Nature 493: 669–73. doi:10.1038/nature11810 Wada, K., Ikeda, Y., Inoue, K., and Uehara, R. 2010. Development and preliminary evaluation of a caregiver’s manual for robot therapy using the therapeutic seal robot Paro. In Proceedings of the IEEE International Workshop on Robot and Human Interactive Communication (RO-MAN 2010), 533–538. Piscataway, NJ: IEEE. Wada, K., and Shibata, T. 2007. Living with seal robots – its sociopsychological and physiological influences on the elderly at a care house. IEEE Trans. Rob. 23: 972–80. doi:10.1109/TRO.2007.906261 Walker, S.C., and McGlone, F.P. 2015. Perceived pleasantness of social touch reflects the anatomical distribution and velocity tuning of C-tactile afferents: an affective homunculus. In Program No. 339.14/HH22. 2014 Neuroscience Meeting Planner, Washington, DC: Society for Neuroscience. Wang, R., and Quek, F. 2010. Touch & talk: contextualizing remote touch for affective interaction. In Proceedings of the 4th International Conference on Tangible, Embedded, and Embodied Interaction (TEI ‘10), 13–20. New York, NY: ACM. Wang, R., Quek, F., Tatar, D., Teh, K.S., and Cheok, A.D. 2012. Keep in touch: channel, expectation and experience. In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems CHI ‘12, 139–148. New York, NY: ACM. 13 May 2015 | Volume 2 | Article 2 van Erp and Toet Social touch in HCI Whitcher, S.J., and Fisher, J.D. 1979. Multidimensional reaction to therapeutic touch in a hospital setting. J. Pers. Soc. Psychol. 37: 87–96. doi:10.1037/0022-3514.37. 1.87 Wigram, A.L. 1996. The Effects of Vibroacoustic Therapy on Clinical and NonClinical Populations. Ph.D. thesis, St. George’s Hospital Medical School, London University, London. Yohanan, S., Chan, M., Hopkins, J., Sun, H., and MacLean, K. 2005. Hapticat: exploration of affective touch. In Proceedings of the 7th International Conference on Multimodal Interfaces (ICMI ‘05), 222–229. New York, NY: ACM. Yohanan, S., and MacLean, K. 2012. The role of affective touch in human-robot interaction: human intent and expectations in touching the haptic creature. Int. J. Soc. Rob. 4: 163–80. doi:10.1007/s12369-011-0126-7 Frontiers in Digital Humanities | www.frontiersin.org Zacharatos, H., Gatzoulis, C., and Chrysanthou, Y.L. 2014. Automatic emotion recognition based on body movement analysis: a survey. IEEE CGA 34: 35–45. doi:10.1109/MCG.2014.106 Conflict of Interest Statement: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Copyright © 2015 van Erp and Toet. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. 14 May 2015 | Volume 2 | Article 2 ",Internet/Technology,Find & Summarize,Text Transformation Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document.,What are the pros and cons?,"Michael M. 1.0 out of 5 stars Don't spend your hard on money on this garbage, you will regret it when it breaks within the year. Reviewed in the United States on February 8, 2024 If you want a TV that last and is user friendly DO NOT BUY Hisense. The of the HDMI ports failed for no reason. The TV sat securely with a PC and a PS5 connected and both ports broke. Hisense deemed it non-warranty because of a microscopic pinhole in the screen, which they also refused to cover. The user interface if non-nonsensical, clunky, and awkward. At night I like to turn on the auto-volume leveling (which isn't even very good, it's still fluctuates wildly in volume compared to Visio) you will have to navigate through a maze of sub-menu'. During the day I would reverse the process, it's not a user friendly TV, the menu's don't make sense, most of the settings don't have any detail description just a cryptic one-word setting. Bunny S. 1.0 out of 5 stars Worst customer service ever!! Purchased an 85 inch from Best Buy. Worked fine for a month or two then the sound started going out I would have to literally turn the TV off and back on to get the sound they’ve been out twice and they were a no-show on one appointment finally here it is December and I’ve gotten them to, tell me the TV cannot be repaired. Still waiting for my money to be returned/refunded. The only person that was nice was one of the repairman. You call the repair line and it was always a major ordeal. You cannot speak to a supervisor, the worst experience I’ve ever had , I will never purchase another one of their products ever again. JP 1.0 out of 5 stars Do not buy a TV from Hisense!! I've had my TV for 2 years. I keep all documents when I buy large appliances because I know that if I don't and they break I'd be SOL. Called Hisense the day my TV just stopped turning on and although I sent them pictures of all my documents they said they needed a manager to review my case. Two days later they texted me saying that my warranty was for the wrong TV and sent me a link to a web page for a warranty they said was the right one. I texted back asking for someone to call and explain. No one did. I called several days later and was hung up on, left on hold, and eventually told they would not honor my warranty. Do not buy this TV. There was no reason for my TV to stop working. Now I have a 70 inch wall weight. Tracy L. 2.0 out of 5 stars Good for a few The TV works fine for a year or do then it won't work like it should. The apps won't work right or not at all. The apps that are permanently on the TV you can't uninstall so you can reset the app. It won't update at all. Over all it's a throw away TV good just to get by for a better one. Tammy B. 1.0 out of 5 stars Sucks There is not one thing that I liked about that TV I thought the price was good but they could give me another one for free and I wouldn't take it. The worst TV to try and figure out how to navigate I've ever had and you couldn't get Alexa or The voice Assistant to work on it ever. Tania A. 5.0 out of 5 stars works excellent just to need linking. i love it Ernie 5.0 out of 5 stars working great make sure you set up everything with the same google account or alexa account if you dint you wont see it on ur device Jared B. 5.0 out of 5 stars Easy to setup and works great I setup my Hisense U75H Google TV to work with Alexa. Turned on and off TV, changed volume, muted, unmuted. They all worked on the first command. I'm surprised so many people are having so many issues. Cole 5.0 out of 5 stars It does work after setup. sign out of hisense account then sign back in. it will prompt you to ebavke the tv and it works great. Eileen G. 5.0 out of 5 stars Works, first attempt This works for the Hisense 55U7G. Not sure about all of the negative reviews without model numbers. l assume that many are working with models before Alexa enabling. I'm sure that it would do more with a Fire TV. I'm working with Android TV in my model. John S. 3.0 out of 5 stars Log out and then enable skill again the review below works. have to enable askoll, create hisense accout, then log out of Hisense, go back to alexa enable akill, and the linking then works when gou log back in. Stupid it cant just work the first time. Ricardo 3.0 out of 5 stars Works Great The app works 100% with Alexa, I’m able to tell Alexa pretty much a lot of commands from turning the tv on and off, control volume, etc. Amazon Customer 3.0 out of 5 stars More commands added but still lacking When I first got this skill, it had zero functionality, but over time commands to turn the TV on and off as well as adjust volume and change both the channel and the various inputs have come into play. Still missing commands to open up specific apps, which would definitely make this app a must-have for anyone with a Hisense. Matt 3.0 out of 5 stars Missing a major feature it's a pain to setup, but it works. So before you lose your mind, Go into network settings and change the ""Wake-on-Lan/Wifi"" to ON. (Depends on how it's connected to the internet) and you'll be able to turn it on and off. Unfortunately it doesn't start any apps. it's just on and off, change input, and control volume. Juanito D. 3.0 out of 5 stars It work.. barely halfway It a little hard to set up, but in the same time is easy, just be ready in the time to setup with you smarthphone and email ready to follow step by step. I saw many reviews saying the only thing do is turn off the TV, no turn on, that's not a problem of the skill is just the tv setting. At least in my Hisense Android TV at factory settings comes with the Wake on Wireless Network off, just turned on in Network setting and can turn on the TV with Alexa commands. The only thing I can't do is change the input with commands, in the skill setting tell I can do it but Alexa tell me: Can find any devices who can do that. But the commands if tell the skill we can do work; can Turn on/off, modify Vol. and activate apps. ","Only respond with the most direct answer possible. Do not discuss anything else. Use only information from the provided document. What are the pros and cons? Michael M. 1.0 out of 5 stars Don't spend your hard on money on this garbage, you will regret it when it breaks within the year. Reviewed in the United States on February 8, 2024 If you want a TV that last and is user friendly DO NOT BUY Hisense. The of the HDMI ports failed for no reason. The TV sat securely with a PC and a PS5 connected and both ports broke. Hisense deemed it non-warranty because of a microscopic pinhole in the screen, which they also refused to cover. The user interface if non-nonsensical, clunky, and awkward. At night I like to turn on the auto-volume leveling (which isn't even very good, it's still fluctuates wildly in volume compared to Visio) you will have to navigate through a maze of sub-menu'. During the day I would reverse the process, it's not a user friendly TV, the menu's don't make sense, most of the settings don't have any detail description just a cryptic one-word setting. Bunny S. 1.0 out of 5 stars Worst customer service ever!! Purchased an 85 inch from Best Buy. Worked fine for a month or two then the sound started going out I would have to literally turn the TV off and back on to get the sound they’ve been out twice and they were a no-show on one appointment finally here it is December and I’ve gotten them to, tell me the TV cannot be repaired. Still waiting for my money to be returned/refunded. The only person that was nice was one of the repairman. You call the repair line and it was always a major ordeal. You cannot speak to a supervisor, the worst experience I’ve ever had , I will never purchase another one of their products ever again. JP 1.0 out of 5 stars Do not buy a TV from Hisense!! I've had my TV for 2 years. I keep all documents when I buy large appliances because I know that if I don't and they break I'd be SOL. Called Hisense the day my TV just stopped turning on and although I sent them pictures of all my documents they said they needed a manager to review my case. Two days later they texted me saying that my warranty was for the wrong TV and sent me a link to a web page for a warranty they said was the right one. I texted back asking for someone to call and explain. No one did. I called several days later and was hung up on, left on hold, and eventually told they would not honor my warranty. Do not buy this TV. There was no reason for my TV to stop working. Now I have a 70 inch wall weight. Tracy L. 2.0 out of 5 stars Good for a few The TV works fine for a year or do then it won't work like it should. The apps won't work right or not at all. The apps that are permanently on the TV you can't uninstall so you can reset the app. It won't update at all. Over all it's a throw away TV good just to get by for a better one. Tammy B. 1.0 out of 5 stars Sucks There is not one thing that I liked about that TV I thought the price was good but they could give me another one for free and I wouldn't take it. The worst TV to try and figure out how to navigate I've ever had and you couldn't get Alexa or The voice Assistant to work on it ever. Tania A. 5.0 out of 5 stars works excellent just to need linking. i love it Ernie 5.0 out of 5 stars working great make sure you set up everything with the same google account or alexa account if you dint you wont see it on ur device Jared B. 5.0 out of 5 stars Easy to setup and works great I setup my Hisense U75H Google TV to work with Alexa. Turned on and off TV, changed volume, muted, unmuted. They all worked on the first command. I'm surprised so many people are having so many issues. Cole 5.0 out of 5 stars It does work after setup. sign out of hisense account then sign back in. it will prompt you to ebavke the tv and it works great. Eileen G. 5.0 out of 5 stars Works, first attempt This works for the Hisense 55U7G. Not sure about all of the negative reviews without model numbers. l assume that many are working with models before Alexa enabling. I'm sure that it would do more with a Fire TV. I'm working with Android TV in my model. John S. 3.0 out of 5 stars Log out and then enable skill again the review below works. have to enable askoll, create hisense accout, then log out of Hisense, go back to alexa enable akill, and the linking then works when gou log back in. Stupid it cant just work the first time. Ricardo 3.0 out of 5 stars Works Great The app works 100% with Alexa, I’m able to tell Alexa pretty much a lot of commands from turning the tv on and off, control volume, etc. Amazon Customer 3.0 out of 5 stars More commands added but still lacking When I first got this skill, it had zero functionality, but over time commands to turn the TV on and off as well as adjust volume and change both the channel and the various inputs have come into play. Still missing commands to open up specific apps, which would definitely make this app a must-have for anyone with a Hisense. Matt 3.0 out of 5 stars Missing a major feature it's a pain to setup, but it works. So before you lose your mind, Go into network settings and change the ""Wake-on-Lan/Wifi"" to ON. (Depends on how it's connected to the internet) and you'll be able to turn it on and off. Unfortunately it doesn't start any apps. it's just on and off, change input, and control volume. Juanito D. 3.0 out of 5 stars It work.. barely halfway It a little hard to set up, but in the same time is easy, just be ready in the time to setup with you smarthphone and email ready to follow step by step. I saw many reviews saying the only thing do is turn off the TV, no turn on, that's not a problem of the skill is just the tv setting. At least in my Hisense Android TV at factory settings comes with the Wake on Wireless Network off, just turned on in Network setting and can turn on the TV with Alexa commands. The only thing I can't do is change the input with commands, in the skill setting tell I can do it but Alexa tell me: Can find any devices who can do that. But the commands if tell the skill we can do work; can Turn on/off, modify Vol. and activate apps. ",Retail/Product,Pros & Cons,Q&A Present your answer without any extraneous information.,What is the general customer feedback?,"8 A day age Failure atter failure. Switching to mint took ages. You failed to enable one of us to connect at all. Her money is going to another provider. Texting rarely works or can lake hours to deliver. Now, my phone has stopped working af all, Wi-Fi works. Wi-Fi calling doesn't. The other two phones on the plan work. | just gal an email telling me my next 6 months are free. That would mean something if | actually had service. After all, zero service is enly werk zero dollars. Asoon to be @x-customer. Date of experience: March 7, 2024 pf Usetul = oF Share i= ‘ss Paeply trom Mint Mobile 21 hours aga Hi, Thank you for contacting Mint Mobile. We're soery for any inconvenience you may have capenenood with the serviog. This is definitely not the experionce we want you 1b have when using our service. Since we aro unadle to provide you with assistance ‘through this channel, plaase contact us through our cusbomer support channels at 8O0- 683-7452 or our live chat plationn, 7 days a week from 5am to 7 pm PST, bo tatoo a look at your case and find the best solution. (Christy Unruh irview @ US 2 days age Hassle free service The company never bothers me with upsells & my better hall will change service once his contract is wp. He has had the same number since the earhy 90s. Anything they might want to tell me abaut is done by my email, which is awesarnell (Date of eaperonoe: February 06, 2024 eo Useful = of Share i=4 Grace Fong lroview @ US BREE 18 hours ago A Canadian snowbird who wants to use the same phone number again next year. Jam a Canadian whe just began to “snewbird” in Hawaii this year - it means | came hare in the winter for a few mente to agcape the deep frees. Having the Mint mabile account has been very convenient for doing all kinds of business and shopping. This lire | gulbseribed for three monihs a¢ | return to Canada April 23.1 will come back to my apartment in Katbua, Hl again im Jan. 2025. It would be wonderful if | could use the game phone nurnber nest year Would thal be posgible? Thank you. (Date of experienom March 07, 2024 pf UWeetul = of Share - BBE Updated 2 days ago Had for almost 2 years and for the most... Had fer almost 2 years and for the mest parl been happy until | go aver data limits. I'm ok with 4 $0 called “SLOW DOWN"" speed when over erry limit, but when it is se slow info times out it is a totally useless service. Will be switehing te anether service 4% anether data level with Mint Mobile gives me more options with their competition. ","Present your answer without any extraneous information. What is the general customer feedback? 8 A day age Failure atter failure. Switching to mint took ages. You failed to enable one of us to connect at all. Her money is going to another provider. Texting rarely works or can lake hours to deliver. Now, my phone has stopped working af all, Wi-Fi works. Wi-Fi calling doesn't. The other two phones on the plan work. | just gal an email telling me my next 6 months are free. That would mean something if | actually had service. After all, zero service is enly werk zero dollars. Asoon to be @x-customer. Date of experience: March 7, 2024 pf Usetul = oF Share i= ‘ss Paeply trom Mint Mobile 21 hours aga Hi, Thank you for contacting Mint Mobile. We're soery for any inconvenience you may have capenenood with the serviog. This is definitely not the experionce we want you 1b have when using our service. Since we aro unadle to provide you with assistance ‘through this channel, plaase contact us through our cusbomer support channels at 8O0- 683-7452 or our live chat plationn, 7 days a week from 5am to 7 pm PST, bo tatoo a look at your case and find the best solution. (Christy Unruh irview @ US 2 days age Hassle free service The company never bothers me with upsells & my better hall will change service once his contract is wp. He has had the same number since the earhy 90s. Anything they might want to tell me abaut is done by my email, which is awesarnell (Date of eaperonoe: February 06, 2024 eo Useful = of Share i=4 Grace Fong lroview @ US BREE 18 hours ago A Canadian snowbird who wants to use the same phone number again next year. Jam a Canadian whe just began to “snewbird” in Hawaii this year - it means | came hare in the winter for a few mente to agcape the deep frees. Having the Mint mabile account has been very convenient for doing all kinds of business and shopping. This lire | gulbseribed for three monihs a¢ | return to Canada April 23.1 will come back to my apartment in Katbua, Hl again im Jan. 2025. It would be wonderful if | could use the game phone nurnber nest year Would thal be posgible? Thank you. (Date of experienom March 07, 2024 pf UWeetul = of Share - BBE Updated 2 days ago Had for almost 2 years and for the most... Had fer almost 2 years and for the mest parl been happy until | go aver data limits. I'm ok with 4 $0 called “SLOW DOWN"" speed when over erry limit, but when it is se slow info times out it is a totally useless service. Will be switehing te anether service 4% anether data level with Mint Mobile gives me more options with their competition. ",Internet/Technology,Summarize & Format,Text Transformation the model should only respond using information presented in the prompt/context block. the model response should contain at least three bullet points.,Please summarize the three articles mentioned,"Legislative History Congress enacted the UCMJ in 1950, and it entered into force in 1951. At the time of enactment, Article 43 provided that there was no statute of limitations for “desertion or absence without leave in time of war, or with aiding the enemy, mutiny, or murder” and set a three-year statute of limitations for most other offenses, including rape. Article 120 provided that a person guilty of rape “shall be punished by death or such other punishment as a court-martial may direct.” Article 55, then as now, prohibits “[p]unishment by flogging, or by branding, marking, or tattooing on the body, or any other cruel or unusual punishment.” Amendments to Article 43 As relevant to Briggs and Collins, Congress has amended Article 43 three times. In 1986, Congress provided that there was no statute of limitations for “any offense punishable by death” and set a five-year statute of limitations for most other offenses. These statutes of limitations mirrored their civilian counterparts, which are codified at 18 U.S.C. § 3281 for offenses punishable by death, and § 3282 for other offenses. Congress again amended Article 43 in 2003, setting a twenty-five-year statute of limitations for child abuse offenses, including rape of a child under Article 120. Most recently, Congress amended Article 43 in the National Defense Authorization Act for Fiscal Year 2006 (2006 NDAA) in a section titled “Extension of Statute of Limitations for Murder, Rape, and Child Abuse Offenses under the [UCMJ].” The 2006 amendments provided that there is no statute of limitations for “murder or rape, or [for] any other offenses punishable by death” and modified the twenty-five-year statute of limitations for child abuse offenses other than rape. In an accompanying report, the Senate Committee on Armed Services described the amendments as “clarify[ing] that all murders are included in the class of offenses that has an unlimited statute of limitations . . . [and] includ[ing] rape in that class of offenses.” Amendments to Article 120 As with Article 43, Congress has amended Article 120 several times since its enactment. Of note, in the 2006 NDAA, Congress amended Article 120 to specify that a person guilty of rape “shall be punished as a court-martial may direct,” removing the statutory authority to punish rape by death. Judicial Interpretations Before Briggs and Collins, the Supreme Court had not interpreted Articles 43, 55, or 120, but several lower courts, including the U.S. Court of Appeals for the Armed Forces (CAAF), had done so. Three cases are particularly relevant to Briggs and Collins. First, in the 1983 case United States v. Matthews, the CAAF (then known as the U.S. Court of Military Appeals) addressed whether Article 55 protected servicemembers from cruel and unusual punishment in the same manner as the Eighth Amendment to the U.S. Constitution. Specifically, the court considered whether the Eighth Amendment’s prohibition on cruel and unusual punishment barred the imposition of the death penalty on a servicemember found guilty of rape and murder. The court held that “a servicemember is entitled both by statute [under Article 55] and under the Eighth Amendment to protection against ‘cruel and unusual punishments.’” It recognized, however, that, “since in many ways the military community is unique, . . . there may be circumstances under which the rules governing capital punishment of servicemembers will be different from those applicable to civilians.” Congressional Research Service 3 In dicta, the Matthews court further observed that, while “Congress obviously intended that in cases where an accused servicemember is convicted of . . . rape, the court-martial members should have the option to adjudge a death sentence,” this intent “[p]robably . . . cannot be constitutionally effectuated in a case where the rape of an adult female is involved, . . . at least, where there is no purpose unique to the military mission that would be served by allowing the death penalty for this offense.” The court based its reasoning on the Supreme Court’s 1977 holding in Coker v. Georgia that “a sentence of death is grossly disproportionate and excessive punishment for the crime of rape and is therefore forbidden by the Eighth Amendment as cruel and unusual punishment.” Second, in the 1998 case Willenbring v. Neurauter, the CAAF held there was no statute of limitations for rape, relying on the contemporaneous language of Articles 43(a) (“A person charged . . . with any offense punishable by death, may be tried and punished at any time without limitation”) and 120(a) (any person “guilty of rape . . . shall be punished by death or such other punishment as a court-martial may direct”). The CAAF considered its decision in Matthews and the Supreme Court’s decision in Coker but held that the 1986 amendment to Article 43 “was meant to apply to the most serious offenses without listing each one in the statute.” The CAAF concluded that rape under Article 120 was an offense that Congress deemed punishable by death, regardless of whether such a sentence constitutionally could be imposed. Third, and most recently, in the 2018 case United States v. Mangahas, the CAAF overruled Willenbring. Relying on Coker, the CAAF reasoned that where “there is no set of circumstances under which the death penalty could constitutionally be imposed for the rape of an adult woman, that offense is simply not ‘punishable by death.’” Recognizing that “Willenbring gave short shrift to this highly salient point,” the court overruled its prior decision. The CAAF concluded that because rape was not constitutionally punishable by death, rapes committed between 1986 and 2006 are subject to a five-year statute of limitations under Article 43 ","System instruction: the model should only respond using information presented in the prompt/context block. the model response should contain at least three bullet points. context: Legislative History Congress enacted the UCMJ in 1950, and it entered into force in 1951. At the time of enactment, Article 43 provided that there was no statute of limitations for “desertion or absence without leave in time of war, or with aiding the enemy, mutiny, or murder” and set a three-year statute of limitations for most other offenses, including rape. Article 120 provided that a person guilty of rape “shall be punished by death or such other punishment as a court-martial may direct.” Article 55, then as now, prohibits “[p]unishment by flogging, or by branding, marking, or tattooing on the body, or any other cruel or unusual punishment.” Amendments to Article 43 As relevant to Briggs and Collins, Congress has amended Article 43 three times. In 1986, Congress provided that there was no statute of limitations for “any offense punishable by death” and set a five-year statute of limitations for most other offenses. These statutes of limitations mirrored their civilian counterparts, which are codified at 18 U.S.C. § 3281 for offenses punishable by death, and § 3282 for other offenses. Congress again amended Article 43 in 2003, setting a twenty-five-year statute of limitations for child abuse offenses, including rape of a child under Article 120. Most recently, Congress amended Article 43 in the National Defense Authorization Act for Fiscal Year 2006 (2006 NDAA) in a section titled “Extension of Statute of Limitations for Murder, Rape, and Child Abuse Offenses under the [UCMJ].” The 2006 amendments provided that there is no statute of limitations for “murder or rape, or [for] any other offenses punishable by death” and modified the twenty-five-year statute of limitations for child abuse offenses other than rape. In an accompanying report, the Senate Committee on Armed Services described the amendments as “clarify[ing] that all murders are included in the class of offenses that has an unlimited statute of limitations . . . [and] includ[ing] rape in that class of offenses.” Amendments to Article 120 As with Article 43, Congress has amended Article 120 several times since its enactment. Of note, in the 2006 NDAA, Congress amended Article 120 to specify that a person guilty of rape “shall be punished as a court-martial may direct,” removing the statutory authority to punish rape by death. Judicial Interpretations Before Briggs and Collins, the Supreme Court had not interpreted Articles 43, 55, or 120, but several lower courts, including the U.S. Court of Appeals for the Armed Forces (CAAF), had done so. Three cases are particularly relevant to Briggs and Collins. First, in the 1983 case United States v. Matthews, the CAAF (then known as the U.S. Court of Military Appeals) addressed whether Article 55 protected servicemembers from cruel and unusual punishment in the same manner as the Eighth Amendment to the U.S. Constitution. Specifically, the court considered whether the Eighth Amendment’s prohibition on cruel and unusual punishment barred the imposition of the death penalty on a servicemember found guilty of rape and murder. The court held that “a servicemember is entitled both by statute [under Article 55] and under the Eighth Amendment to protection against ‘cruel and unusual punishments.’” It recognized, however, that, “since in many ways the military community is unique, . . . there may be circumstances under which the rules governing capital punishment of servicemembers will be different from those applicable to civilians.” Congressional Research Service 3 In dicta, the Matthews court further observed that, while “Congress obviously intended that in cases where an accused servicemember is convicted of . . . rape, the court-martial members should have the option to adjudge a death sentence,” this intent “[p]robably . . . cannot be constitutionally effectuated in a case where the rape of an adult female is involved, . . . at least, where there is no purpose unique to the military mission that would be served by allowing the death penalty for this offense.” The court based its reasoning on the Supreme Court’s 1977 holding in Coker v. Georgia that “a sentence of death is grossly disproportionate and excessive punishment for the crime of rape and is therefore forbidden by the Eighth Amendment as cruel and unusual punishment.” Second, in the 1998 case Willenbring v. Neurauter, the CAAF held there was no statute of limitations for rape, relying on the contemporaneous language of Articles 43(a) (“A person charged . . . with any offense punishable by death, may be tried and punished at any time without limitation”) and 120(a) (any person “guilty of rape . . . shall be punished by death or such other punishment as a court-martial may direct”). The CAAF considered its decision in Matthews and the Supreme Court’s decision in Coker but held that the 1986 amendment to Article 43 “was meant to apply to the most serious offenses without listing each one in the statute.” The CAAF concluded that rape under Article 120 was an offense that Congress deemed punishable by death, regardless of whether such a sentence constitutionally could be imposed. Third, and most recently, in the 2018 case United States v. Mangahas, the CAAF overruled Willenbring. Relying on Coker, the CAAF reasoned that where “there is no set of circumstances under which the death penalty could constitutionally be imposed for the rape of an adult woman, that offense is simply not ‘punishable by death.’” Recognizing that “Willenbring gave short shrift to this highly salient point,” the court overruled its prior decision. The CAAF concluded that because rape was not constitutionally punishable by death, rapes committed between 1986 and 2006 are subject to a five-year statute of limitations under Article 43 question: please summarize the three articles mentioned",Legal,Find & Summarize,Text Transformation "Use only information from the following context to answer the eventual question; do not use any information that isn't in the context. Bold any words that both: 1. Are specifically what's being asked about, and 2. Explicitly exist, verbatim, in both the context and the user's question. For example, if I asked: ""What is a hotdog?,"" then the thing I'm asking about would be a ""hotdog,"" so if the text also explicitly said the word ""hotdog,"" you would bold any instance of the word ""hotdog"" in your response.",Summarize what this text is saying about machines.,"Ambiguity is celebrated in human language. It is a central feature of literature, poetry, and humor. Ambiguity is anathema to computer language. An ambiguous computer language is a nonsensical concept because the predictability of computers is what gives part of their value; imagine a computer that was asked, “what is 1 and 1” it randomly returned either “two” or “11”. Although it is debatable whether every contract can be translated into machine language, many of them can be.73 When lawyers or the programmers they hire write contracts in code, there is less of a chance for ambiguity than in natural language if only for the simple fact that artificial language must be complete and predefined, whereas natural language is infinite.74 That is to say a person can walk around and verbally recite lines of code and people can at least understand what he is saying; a machine cannot understand human language that it is not programmed to understand. All of this is simply to say that the problem of ambiguity is reduced in the smart contract context. Finally, all of the usual defenses to formation of a contract also apply in the realm of smart contracts, although as will be seen later, enforcing the remedy against a strong smart contract may prove problematic to a court. Take unconscionability and illegality, for instance. If a vending machine were to sell alcohol to minors or sell alcohol in a dry jurisdiction, then the contract could be voided as illegal.75 As will be discussed, the remedies will be either ex post through legal action or ex ante through regulation. In this instance, the illegal contract can either be policed through a prohibition on alcoholic vending machines76 or a system of preclearance where a driver’s license scanner or some mechanism are required to ensure compliance with age requirements. Similarly, suppose the vending machine charged $1,000 for a can of Coke and a court were to find this to be substantively unconscionable. The remedies would again either be in damages or in policing the use of such vending machines before the contract could be formed.","Use only information from the following context to answer the eventual question; do not use any information that isn't in the context. Bold any words that both: 1. Are specifically what's being asked about, and 2. Explicitly exist, verbatim, in both the context and the user's question. For example, if I asked: ""What is a hotdog?,"" then the thing I'm asking about would be a ""hotdog,"" so if the text also explicitly said the word ""hotdog,"" you would bold any instance of the word ""hotdog"" in your response. Ambiguity is celebrated in human language. It is a central feature of literature, poetry, and humor. Ambiguity is anathema to computer language. An ambiguous computer language is a nonsensical concept because the predictability of computers is what gives part of their value; imagine a computer that was asked, “what is 1 and 1” it randomly returned either “two” or “11”. Although it is debatable whether every contract can be translated into machine language, many of them can be.73 When lawyers or the programmers they hire write contracts in code, there is less of a chance for ambiguity than in natural language if only for the simple fact that artificial language must be complete and predefined, whereas natural language is infinite.74 That is to say a person can walk around and verbally recite lines of code and people can at least understand what he is saying; a machine cannot understand human language that it is not programmed to understand. All of this is simply to say that the problem of ambiguity is reduced in the smart contract context. Finally, all of the usual defenses to formation of a contract also apply in the realm of smart contracts, although as will be seen later, enforcing the remedy against a strong smart contract may prove problematic to a court. Take unconscionability and illegality, for instance. If a vending machine were to sell alcohol to minors or sell alcohol in a dry jurisdiction, then the contract could be voided as illegal.75 As will be discussed, the remedies will be either ex post through legal action or ex ante through regulation. In this instance, the illegal contract can either be policed through a prohibition on alcoholic vending machines76 or a system of preclearance where a driver’s license scanner or some mechanism are required to ensure compliance with age requirements. Similarly, suppose the vending machine charged $1,000 for a can of Coke and a court were to find this to be substantively unconscionable. The remedies would again either be in damages or in policing the use of such vending machines before the contract could be formed. Summarize what this text is saying about machines.",Legal,Find & Summarize,Text Transformation "Only use the information from the document within the context block when developing your answer. You mustn't use sources from outside of the context block or previous knowledge. Include three bullet point lists in your response. Respond in between 250-500 words.",Please describe one finding for each of the studies mentioned in the document text.,"Video Game Play and Real-World Violence We must stop the glorification of violence in our society. This includes the gruesome and grisly video games that are now commonplace. It is too easy today for troubled youth to surround themselves with a culture that celebrates violence. —Donald Trump, U.S. President (2019) The tendency to link violent crimes to the playing of violent video games is so prevalent that a term exists to describe it: “the Grand Theft Fallacy.” As one might guess from the word fallacy, this tendency is not only flawed, it gets matters entirely backward. Countries that consume more video games have lower levels of violent crime than those devoid of this media (Markey and Ferguson 2017). Months when people play violent video games the most tend to be safer than months they play them less (Markey, Markey, and French 2015). Even when violent video games, like Grand Theft Auto, were first released, there tends to be a decrease in violent crimes (Beerthuizen, Weijters, and van der Laan 2017). These findings have been replicated by psychologists, economists, and sociologists at various universities considering numerous other variables (cf. Cunningham, Engelstätter, and Ward 2016; Ward 2011). Most strikingly, these findings are not unique to violent video game play— other forms of violent media have also been linked to decreases in violent crime. Contrary to the fear that violent television poses a threat to our society, violent assaults, rapes, and murders all decrease when people are watching extremely violent television shows (Messner 1986). Even violent movies have been linked to declines in real-world violence. As with violent video games, years in which the most violent films were released saw decreases in violent crime, and crime consistently decreases in the days following the release of popular violent movies (Dahl and DellaVigna 2009; Markey, French, and Markey 2015). Regardless of the type of violent media—games, movies, or television shows—the research is consistent. When society is exposed to violent media, there is a reliable reduction in real-world violence. The reason why violent video game play (and other violent media) seems to reduce crime can be traced back to what criminologists call “routine activity theory” (Felson 1994). The simple notion behind this theory is this: For a violent crime to occur, a perpetrator must be in the same location as the victim, and this location tends to be free of those who would likely prevent the crime. Now, consider how playing many hours of video games may keep these potential criminals and victims entertained and off the streets. Male gamers in the United States spend a total of 468 million hours each month playing video games (Snider 2014). These hours constitute time during which at-risk individuals remain inside their homes, instead of being out on the streets. In this manner, video game play could serve as an effective crime-reduction strategy. No taxpayer money is needed. It naturally targets those individuals who are at the highest risk for committing violence or being victims of violence, and it appears to be working. Video Game Play and Aggression If you shoot somebody in one of these games, you don’t go to jail, you don’t get penalized in some way—you get extra points! This doesn’t mean that your child will go out into the world and shoot someone. But they do use more aggressive language, they do use more aggressive images, they have less ability to control their anger, and they externalize things in these violent ways. It’s absolutely not good. —“Dr. Phil” McGraw, television personality (2005) As illustrated by Dr. Phil’s quote, although some might not think video games cause violent homicides, they are still willing to believe that video game play, especially violent video game play, causes aggressive behaviors like punching others, fighting, or bullying. In this context, aggressive behaviors are actions committed by an individual intending to harm another individual. Although similar to violent behaviors like homicides, aggressive acts tend not to cause such extreme physical harm (Bushman et al. 2016). Much of the research purporting to support the claim that video games cause more minor forms of aggression has done little more than establish associations between self-reports of video game play and self-reports of feelings. Figure 2 provides some examples researchers have used to examine whether video games cause aggression. As we can see from these items, these studies do not examine real acts of aggression. Instead, these questionnaires attempt to measure aggression by using items that assess whether an individual might be “jerky” (that is, believing that to say something nasty about an individual behind his or her back is acceptable), antisocial, (as in, “I feel unsociable”), gossipy (as in “I have spread gossip about people I do not like”), or—oddly enough—conservative (like someone who might say, “Any nation should be ready with a strong military at all times”) (Krahé and Möller 2004; Anderson and Dill 2000; Greitemeyer 2019; Anderson et al. 2004). Thus, the meaning and importance one can draw from such studies are extremely suspect. When video game researchers have conducted experiments, these studies have typically involved one group of participants who play a violent video game and another group who plays a nonviolent video game. After a short play session, participants’ aggressive thoughts or behaviors are assessed. Some researchers who have used this methodology found that individuals who play violent video games are more likely to expose others to loud irritating noises (Bushman and Gibson 2011), report feeling more hostile on a questionnaire (Anderson and Dill 2000), give longer prison sentences to hypothetical criminals (Deselms and Altman 2003), and even give hot sauce to people who do not like spicy food (Yang, Huesmann, and Bushman 2014). Importantly, many other researchers cannot replicate these effects (Kühn et al. 2019). So, even if these various experimental outcomes might be related to disagreeable thoughts, it is extremely questionable how well these responses translate to real-world aggressive behavior such as fighting, hitting, and bullying. Other scholars have raised both methodological and measurement concerns with studies examining aggression. For instance, one popular method, the competitive reaction time task (CRTT), measures how aggressive a person becomes after playing a violent video game by giving the player a chance to “blast” another person with an irritating noise. Specifically, participants are allowed to select both the duration and the intensity level (on a scale of zero to ten) of a white noise burst administered to another person. Unfortunately, no standardized scoring method exists for this measurement of aggression. Some researchers have scored aggression as the sum of the intensity and duration (Bushman and Gibson 2011), the product of the intensity and duration (Bartholow, Sestir, and Davis 2005), the log-transformation of duration, ignoring the intensity (Anderson and Dill 2000), and even the square root of the duration score multiplied by the intensity score (Carnagey and Anderson 2005). Collectively, there are at least 147 different ways researchers have scored this measurement. Given all these permutations, one can make it appear as if video games increase aggression, decrease aggression, or have no effect on aggression even within the same sample (Elson et al. 2014). Looking past such methodical problems, numerous scholars have conducted meta-analyses to try to understand better how big an effect video games have on these mundane aggressive outcomes. On average, only 0.4 percent to 4 percent of the variance in minor forms of aggression can be explained by violent video games (Ferguson 2015b; Hilgard, Engelhardt, and Rouder 2017). Keep in mind that this small effect is in reference to the effect of video game play on aggressive outcomes with minimal repercussions (e.g., giving hot sauce to another person who does not like spicy foods) that often have methodical issues (e.g., the CRTT) and are not direct measurements of real-world aggressive acts. Thus, the extremely small effect sizes linking violent video games to questionable proxy measurements of aggression found in many studies likely constitute an overestimate of any true effect video game play has on real-world aggressive behaviors.","Context: Video Game Play and Real-World Violence We must stop the glorification of violence in our society. This includes the gruesome and grisly video games that are now commonplace. It is too easy today for troubled youth to surround themselves with a culture that celebrates violence. —Donald Trump, U.S. President (2019) The tendency to link violent crimes to the playing of violent video games is so prevalent that a term exists to describe it: “the Grand Theft Fallacy.” As one might guess from the word fallacy, this tendency is not only flawed, it gets matters entirely backward. Countries that consume more video games have lower levels of violent crime than those devoid of this media (Markey and Ferguson 2017). Months when people play violent video games the most tend to be safer than months they play them less (Markey, Markey, and French 2015). Even when violent video games, like Grand Theft Auto, were first released, there tends to be a decrease in violent crimes (Beerthuizen, Weijters, and van der Laan 2017). These findings have been replicated by psychologists, economists, and sociologists at various universities considering numerous other variables (cf. Cunningham, Engelstätter, and Ward 2016; Ward 2011). Most strikingly, these findings are not unique to violent video game play— other forms of violent media have also been linked to decreases in violent crime. Contrary to the fear that violent television poses a threat to our society, violent assaults, rapes, and murders all decrease when people are watching extremely violent television shows (Messner 1986). Even violent movies have been linked to declines in real-world violence. As with violent video games, years in which the most violent films were released saw decreases in violent crime, and crime consistently decreases in the days following the release of popular violent movies (Dahl and DellaVigna 2009; Markey, French, and Markey 2015). Regardless of the type of violent media—games, movies, or television shows—the research is consistent. When society is exposed to violent media, there is a reliable reduction in real-world violence. The reason why violent video game play (and other violent media) seems to reduce crime can be traced back to what criminologists call “routine activity theory” (Felson 1994). The simple notion behind this theory is this: For a violent crime to occur, a perpetrator must be in the same location as the victim, and this location tends to be free of those who would likely prevent the crime. Now, consider how playing many hours of video games may keep these potential criminals and victims entertained and off the streets. Male gamers in the United States spend a total of 468 million hours each month playing video games (Snider 2014). These hours constitute time during which at-risk individuals remain inside their homes, instead of being out on the streets. In this manner, video game play could serve as an effective crime-reduction strategy. No taxpayer money is needed. It naturally targets those individuals who are at the highest risk for committing violence or being victims of violence, and it appears to be working. Video Game Play and Aggression If you shoot somebody in one of these games, you don’t go to jail, you don’t get penalized in some way—you get extra points! This doesn’t mean that your child will go out into the world and shoot someone. But they do use more aggressive language, they do use more aggressive images, they have less ability to control their anger, and they externalize things in these violent ways. It’s absolutely not good. —“Dr. Phil” McGraw, television personality (2005) As illustrated by Dr. Phil’s quote, although some might not think video games cause violent homicides, they are still willing to believe that video game play, especially violent video game play, causes aggressive behaviors like punching others, fighting, or bullying. In this context, aggressive behaviors are actions committed by an individual intending to harm another individual. Although similar to violent behaviors like homicides, aggressive acts tend not to cause such extreme physical harm (Bushman et al. 2016). Much of the research purporting to support the claim that video games cause more minor forms of aggression has done little more than establish associations between self-reports of video game play and self-reports of feelings. Figure 2 provides some examples researchers have used to examine whether video games cause aggression. As we can see from these items, these studies do not examine real acts of aggression. Instead, these questionnaires attempt to measure aggression by using items that assess whether an individual might be “jerky” (that is, believing that to say something nasty about an individual behind his or her back is acceptable), antisocial, (as in, “I feel unsociable”), gossipy (as in “I have spread gossip about people I do not like”), or—oddly enough—conservative (like someone who might say, “Any nation should be ready with a strong military at all times”) (Krahé and Möller 2004; Anderson and Dill 2000; Greitemeyer 2019; Anderson et al. 2004). Thus, the meaning and importance one can draw from such studies are extremely suspect. When video game researchers have conducted experiments, these studies have typically involved one group of participants who play a violent video game and another group who plays a nonviolent video game. After a short play session, participants’ aggressive thoughts or behaviors are assessed. Some researchers who have used this methodology found that individuals who play violent video games are more likely to expose others to loud irritating noises (Bushman and Gibson 2011), report feeling more hostile on a questionnaire (Anderson and Dill 2000), give longer prison sentences to hypothetical criminals (Deselms and Altman 2003), and even give hot sauce to people who do not like spicy food (Yang, Huesmann, and Bushman 2014). Importantly, many other researchers cannot replicate these effects (Kühn et al. 2019). So, even if these various experimental outcomes might be related to disagreeable thoughts, it is extremely questionable how well these responses translate to real-world aggressive behavior such as fighting, hitting, and bullying. Other scholars have raised both methodological and measurement concerns with studies examining aggression. For instance, one popular method, the competitive reaction time task (CRTT), measures how aggressive a person becomes after playing a violent video game by giving the player a chance to “blast” another person with an irritating noise. Specifically, participants are allowed to select both the duration and the intensity level (on a scale of zero to ten) of a white noise burst administered to another person. Unfortunately, no standardized scoring method exists for this measurement of aggression. Some researchers have scored aggression as the sum of the intensity and duration (Bushman and Gibson 2011), the product of the intensity and duration (Bartholow, Sestir, and Davis 2005), the log-transformation of duration, ignoring the intensity (Anderson and Dill 2000), and even the square root of the duration score multiplied by the intensity score (Carnagey and Anderson 2005). Collectively, there are at least 147 different ways researchers have scored this measurement. Given all these permutations, one can make it appear as if video games increase aggression, decrease aggression, or have no effect on aggression even within the same sample (Elson et al. 2014). Looking past such methodical problems, numerous scholars have conducted meta-analyses to try to understand better how big an effect video games have on these mundane aggressive outcomes. On average, only 0.4 percent to 4 percent of the variance in minor forms of aggression can be explained by violent video games (Ferguson 2015b; Hilgard, Engelhardt, and Rouder 2017). Keep in mind that this small effect is in reference to the effect of video game play on aggressive outcomes with minimal repercussions (e.g., giving hot sauce to another person who does not like spicy foods) that often have methodical issues (e.g., the CRTT) and are not direct measurements of real-world aggressive acts. Thus, the extremely small effect sizes linking violent video games to questionable proxy measurements of aggression found in many studies likely constitute an overestimate of any true effect video game play has on real-world aggressive behaviors. Question: Please describe one finding for each of the studies mentioned in the document text. System Instructions: Only use the information from the document within the context block when developing your answer. You mustn't use sources from outside of the context block or previous knowledge. Include three bullet point lists in your response. Respond in between 250-500 words.",Internet/Technology,Find & Summarize,Text Transformation "Your response must only present information that is present in the context block. Ensure that your response is clear and presents all information in an unbiased manner. You may use bulleted lists for organizing your response, but avoid all other markdown formatting.",Discuss the differing perspectives on whether or not the output of AI models should be afforded copyright protection.,"Do AI Outputs Enjoy Copyright Protection? The question of whether or not copyright protection may be afforded to AI outputs—such as images created by DALL-E or texts created by ChatGPT—likely hinges at least partly on the concept of “authorship.” The U.S. Constitution authorizes Congress to “secur[e] for limited Times to Authors . . . the exclusive Right to their . . . Writings.” Based on this authority, the Copyright Act affords copyright protection to “original works of authorship.” Although the Constitution and Copyright Act do not explicitly define who (or what) may be an “author,” the U.S. Copyright Office recognizes copyright only in works “created by a human being.” Courts have likewise declined to extend copyright protection to nonhuman authors, holding that a monkey who took a series of photos lacked standing to sue under the Copyright Act; that some human creativity was required to copyright a book purportedly inspired by celestial beings; and that a living garden could not be copyrighted as it lacked a human author. A recent lawsuit challenged the human-authorship requirement in the context of works purportedly “authored” by AI. In June 2022, Stephen Thaler sued the Copyright Office for denying his application to register a visual artwork that he claims was authored “autonomously” by an AI program called the Creativity Machine. Dr. Thaler argued that human authorship is not required by the Copyright Act. On August 18, 2023, a federal district court granted summary judgment in favor of the Copyright Office. The court held that “human authorship is an essential part of a valid copyright claim,” reasoning that only human authors need copyright as an incentive to create works. Dr. Thaler has stated that he plans to appeal the decision. Assuming that a copyrightable work requires a human author, works created by humans using generative AI could still be entitled to copyright protection, depending on the nature of human involvement in the creative process. However, a recent copyright proceeding and subsequent Copyright Registration Guidance indicate that the Copyright Office is unlikely to find the requisite human authorship where an AI program generates works in response to text prompts. In September 2022, Kris Kashtanova registered a copyright for a graphic novel illustrated with images that Midjourney generated in response to text inputs. In October 2022, the Copyright Office initiated cancellation proceedings, noting that Kashtanova had not disclosed the use of AI. Kashtanova responded by arguing that the images were made via “a creative, iterative process.” On February 21, 2023, the Copyright Office determined that the images were not copyrightable, deciding that Midjourney, rather than Kashtanova, authored the “visual material.” In March 2023, the Copyright Office released guidance stating that, when AI “determines the expressive elements of its output, the generated material is not the product of human authorship.” Some commentators assert that some AI-generated works should receive copyright protection, arguing that AI programs are like other tools that human beings have used to create copyrighted works. For example, the Supreme Court has held since the 1884 case Burrow-Giles Lithographic Co. v. Sarony that photographs can be entitled to copyright protection where the photographer makes decisions regarding creative elements such as composition, arrangement, and lighting. Generative AI programs might be seen as a new tool analogous to the camera, as Kashtanova argued. Other commentators and the Copyright Office dispute the photography analogy and question whether AI users exercise sufficient creative control for AI to be considered merely a tool. In Kashtanova’s case, the Copyright Office reasoned that Midjourney was not “a tool that [] Kashtanova controlled and guided to reach [their] desired image” because it “generates images in an unpredictable way.” The Copyright Office instead compared the AI user to “a client who hires an artist” and gives that artist only “general directions.” The office’s March 2023 guidance similarly claims that “users do not exercise ultimate creative control over how [generative AI] systems interpret prompts and generate materials.” One of Kashtanova’s lawyers, on the other hand, argues that the Copyright Act does not require such exacting creative control, noting that certain photographs and modern art incorporate a degree of happenstance. Some commentators argue that the Copyright Act’s distinction between copyrightable “works” and noncopyrightable “ideas” supplies another reason that copyright should not protect AI-generated works. One law professor has suggested that the human user who enters a text prompt into an AI program—for instance, asking DALL-E “to produce a painting of hedgehogs having a tea party on the beach”—has “contributed nothing more than an idea” to the finished work. According to this argument, the output image lacks a human author and cannot be copyrighted. While the Copyright Office’s actions indicate that it may be challenging to obtain copyright protection for AI-generated works, the issue remains unsettled. Applicants may file suit in U.S. district court to challenge the Copyright Office’s final decisions to refuse to register a copyright (as Dr. Thaler did), and it remains to be seen whether federal courts will agree with all of the office’s decisions. While the Copyright Office notes that courts sometimes give weight to the office’s experience and expertise in this field, courts will not necessarily adopt the office’s interpretations of the Copyright Act. In addition, the Copyright Office’s guidance accepts that works “containing” AI-generated material may be copyrighted under some circumstances, such as “sufficiently creative” human arrangements or modifications of AI-generated material or works that combine AI-generated and human-authored material. The office states that the author may only claim copyright protection “for their own contributions” to such works, and they must identify and disclaim AI-generated parts of the work if they apply to register their copyright. In September 2023, for instance, the Copyright Office Review Board affirmed the office’s refusal to register a copyright for an artwork that was generated by Midjourney and then modified in various ways by the applicant, since the applicant did not disclaim the AI-generated material.","Your response must only present information that is present in the context block. Ensure that your response is clear and presents all information in an unbiased manner. You may use bulleted lists for organizing your response, but avoid all other markdown formatting. Your response shall address the following user request: Discuss the differing perspectives on whether or not the output of AI models should be afforded copyright protection. Do AI Outputs Enjoy Copyright Protection? The question of whether or not copyright protection may be afforded to AI outputs—such as images created by DALL-E or texts created by ChatGPT—likely hinges at least partly on the concept of “authorship.” The U.S. Constitution authorizes Congress to “secur[e] for limited Times to Authors . . . the exclusive Right to their . . . Writings.” Based on this authority, the Copyright Act affords copyright protection to “original works of authorship.” Although the Constitution and Copyright Act do not explicitly define who (or what) may be an “author,” the U.S. Copyright Office recognizes copyright only in works “created by a human being.” Courts have likewise declined to extend copyright protection to nonhuman authors, holding that a monkey who took a series of photos lacked standing to sue under the Copyright Act; that some human creativity was required to copyright a book purportedly inspired by celestial beings; and that a living garden could not be copyrighted as it lacked a human author. A recent lawsuit challenged the human-authorship requirement in the context of works purportedly “authored” by AI. In June 2022, Stephen Thaler sued the Copyright Office for denying his application to register a visual artwork that he claims was authored “autonomously” by an AI program called the Creativity Machine. Dr. Thaler argued that human authorship is not required by the Copyright Act. On August 18, 2023, a federal district court granted summary judgment in favor of the Copyright Office. The court held that “human authorship is an essential part of a valid copyright claim,” reasoning that only human authors need copyright as an incentive to create works. Dr. Thaler has stated that he plans to appeal the decision. Assuming that a copyrightable work requires a human author, works created by humans using generative AI could still be entitled to copyright protection, depending on the nature of human involvement in the creative process. However, a recent copyright proceeding and subsequent Copyright Registration Guidance indicate that the Copyright Office is unlikely to find the requisite human authorship where an AI program generates works in response to text prompts. In September 2022, Kris Kashtanova registered a copyright for a graphic novel illustrated with images that Midjourney generated in response to text inputs. In October 2022, the Copyright Office initiated cancellation proceedings, noting that Kashtanova had not disclosed the use of AI. Kashtanova responded by arguing that the images were made via “a creative, iterative process.” On February 21, 2023, the Copyright Office determined that the images were not copyrightable, deciding that Midjourney, rather than Kashtanova, authored the “visual material.” In March 2023, the Copyright Office released guidance stating that, when AI “determines the expressive elements of its output, the generated material is not the product of human authorship.” Some commentators assert that some AI-generated works should receive copyright protection, arguing that AI programs are like other tools that human beings have used to create copyrighted works. For example, the Supreme Court has held since the 1884 case Burrow-Giles Lithographic Co. v. Sarony that photographs can be entitled to copyright protection where the photographer makes decisions regarding creative elements such as composition, arrangement, and lighting. Generative AI programs might be seen as a new tool analogous to the camera, as Kashtanova argued. Other commentators and the Copyright Office dispute the photography analogy and question whether AI users exercise sufficient creative control for AI to be considered merely a tool. In Kashtanova’s case, the Copyright Office reasoned that Midjourney was not “a tool that [] Kashtanova controlled and guided to reach [their] desired image” because it “generates images in an unpredictable way.” The Copyright Office instead compared the AI user to “a client who hires an artist” and gives that artist only “general directions.” The office’s March 2023 guidance similarly claims that “users do not exercise ultimate creative control over how [generative AI] systems interpret prompts and generate materials.” One of Kashtanova’s lawyers, on the other hand, argues that the Copyright Act does not require such exacting creative control, noting that certain photographs and modern art incorporate a degree of happenstance. Some commentators argue that the Copyright Act’s distinction between copyrightable “works” and noncopyrightable “ideas” supplies another reason that copyright should not protect AI-generated works. One law professor has suggested that the human user who enters a text prompt into an AI program—for instance, asking DALL-E “to produce a painting of hedgehogs having a tea party on the beach”—has “contributed nothing more than an idea” to the finished work. According to this argument, the output image lacks a human author and cannot be copyrighted. While the Copyright Office’s actions indicate that it may be challenging to obtain copyright protection for AI-generated works, the issue remains unsettled. Applicants may file suit in U.S. district court to challenge the Copyright Office’s final decisions to refuse to register a copyright (as Dr. Thaler did), and it remains to be seen whether federal courts will agree with all of the office’s decisions. While the Copyright Office notes that courts sometimes give weight to the office’s experience and expertise in this field, courts will not necessarily adopt the office’s interpretations of the Copyright Act. In addition, the Copyright Office’s guidance accepts that works “containing” AI-generated material may be copyrighted under some circumstances, such as “sufficiently creative” human arrangements or modifications of AI-generated material or works that combine AI-generated and human-authored material. The office states that the author may only claim copyright protection “for their own contributions” to such works, and they must identify and disclaim AI-generated parts of the work if they apply to register their copyright. In September 2023, for instance, the Copyright Office Review Board affirmed the office’s refusal to register a copyright for an artwork that was generated by Midjourney and then modified in various ways by the applicant, since the applicant did not disclaim the AI-generated material.",Legal,Pros & Cons,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]",Explain the negative effects of salary arbitration in baseball from the point of view of the players. Why might a baseball player be opposed to salary arbitration?,"IV. PROBLEMS WITH SALARY ARBITRATION The requirements laid out by the collective bargaining agreement still leave much room for problems between the players and the teams. The first problem stems from the final offer or high/low format of arbitration procedure. In requiring the arbitrator to chose one amount or the other makes the final offer format unique. The arbitrator cannot reach a compromise between the two parties' offers. Since the arbitrator can only choose one side, many owners feel that this may be the root cause of the increasing salaries in baseball. The owners feel that abolition of salary arbitration is proper because it becomes a ""win-win"" situation for the players. After salary arbitration, ""the players will always come out better than they were before."" [EN 24] The issue for the owners is that if they present an amount that is significantly low, the arbitrator will tend to favor the player and choose the higher amount. [EN 25] In order to prevent this from happening, many teams tend to keep their amount submitted higher than they would like to prevent the arbitrator from choosing the higher amount given by players. However, the counter argument is that the final offer format forces both sides to give a reasonable offer. During the arbitration process, the parties will be more concerned with how much the other side will offer. The parties will also concentrate on making their own offer fairer, so that the arbitrator will select it. The second issue with salary arbitration is whether the evidence introduced between the two sides can affect the ongoing relationship between the team and the player after the arbitration hearings. According to the CBA criteria for salary arbitration, a team can essentially introduce evidence that may degrade a player and his accomplishments in the arbitration hearings. However, since the player will likely be returning to the same team the following year, the team may tend to hold back sensitive information which may offend the player. An arbitrator from a prominent New York law firm that handles some of the arbitration proceedings for the New York Yankees stated in a phone conversation on March 4, 2002, that most teams tend to hold back degrading and malicious information about some of their players because they are afraid of the repercussions in the following year. For example, many teams will not disclose information in an arbitration hearing about how the team manager, teammates, or members of the organization feel about a certain player. If this information is negative, it will not be a comfortable situation for that player if he remains with the team during the following season. Some teams are afraid of introducing the degrading and detrimental evidence of a player and his conduct to prevent the player from being offended and taking those feelings of betrayal with him to the field the following season. The arbitrator gave an example of a player being affected by an arbitration hearing in the National Hockey League (""NHL""). The case involved the owner of the New York Islanders who went into a salary arbitration hearing with their then goalie. The owner introduced humiliating evidence into the arbitration hearing about that goalie. The goalie felt so betrayed by his team and the whole process, he refused to return to the Islanders the following season. Thus, the goalie was traded because of his refusal to play directly due to the arbitration hearings. To avoid an outcome such as this, most professional teams avoid introducing humiliating and degrading evidence of the players that are in salary arbitration in order to keep a positive ongoing relationship the following season. The other major problem of salary arbitration in baseball is what happens when either party wins. If the owner wins, the player may feel betrayed. A player may feel that he played well for the past few seasons to deserve a higher salary. By losing the arbitration hearing, the player may avoid playing up to his full potential in the following season due to resentment towards the team. There is also the possibility the player may play even better the following season with the intention of not returning to his present team. A player may play beyond his potential to impress other teams and will not even consider re-signing with his present team as a free agent. A negative ongoing relationship is severely detrimental to baseball. The game becomes one of politics and business and not one of enjoyment or love for the game. There is also a direct affect on the fans and the economic prosperity of the game. On the flip side, there may be problems with how the player may be treated if he wins the salary arbitration. The owners may feel that the player's salary is too high for his ability. They may chose to reduce his playing time or change where he bats in the line-up, thus affecting his offensive output. In the case of a pitcher, the team may choose to put him in a more mediocre role. This may affect the player's ability to negotiate for a higher salary in the future during free agency. The integrity of the game is affected by the ongoing relationship between the player and the team after arbitration."," Only use the provided text to answer the question, no outside sources. Explain the negative effects of salary arbitration in baseball from the point of view of the players. Why might a baseball player be opposed to salary arbitration? IV. PROBLEMS WITH SALARY ARBITRATION The requirements laid out by the collective bargaining agreement still leave much room for problems between the players and the teams. The first problem stems from the final offer or high/low format of arbitration procedure. In requiring the arbitrator to chose one amount or the other makes the final offer format unique. The arbitrator cannot reach a compromise between the two parties' offers. Since the arbitrator can only choose one side, many owners feel that this may be the root cause of the increasing salaries in baseball. The owners feel that abolition of salary arbitration is proper because it becomes a ""win-win"" situation for the players. After salary arbitration, ""the players will always come out better than they were before."" [EN 24] The issue for the owners is that if they present an amount that is significantly low, the arbitrator will tend to favor the player and choose the higher amount. [EN 25] In order to prevent this from happening, many teams tend to keep their amount submitted higher than they would like to prevent the arbitrator from choosing the higher amount given by players. However, the counter argument is that the final offer format forces both sides to give a reasonable offer. During the arbitration process, the parties will be more concerned with how much the other side will offer. The parties will also concentrate on making their own offer fairer, so that the arbitrator will select it. The second issue with salary arbitration is whether the evidence introduced between the two sides can affect the ongoing relationship between the team and the player after the arbitration hearings. According to the CBA criteria for salary arbitration, a team can essentially introduce evidence that may degrade a player and his accomplishments in the arbitration hearings. However, since the player will likely be returning to the same team the following year, the team may tend to hold back sensitive information which may offend the player. An arbitrator from a prominent New York law firm that handles some of the arbitration proceedings for the New York Yankees stated in a phone conversation on March 4, 2002, that most teams tend to hold back degrading and malicious information about some of their players because they are afraid of the repercussions in the following year. For example, many teams will not disclose information in an arbitration hearing about how the team manager, teammates, or members of the organization feel about a certain player. If this information is negative, it will not be a comfortable situation for that player if he remains with the team during the following season. Some teams are afraid of introducing the degrading and detrimental evidence of a player and his conduct to prevent the player from being offended and taking those feelings of betrayal with him to the field the following season. The arbitrator gave an example of a player being affected by an arbitration hearing in the National Hockey League (""NHL""). The case involved the owner of the New York Islanders who went into a salary arbitration hearing with their then goalie. The owner introduced humiliating evidence into the arbitration hearing about that goalie. The goalie felt so betrayed by his team and the whole process, he refused to return to the Islanders the following season. Thus, the goalie was traded because of his refusal to play directly due to the arbitration hearings. To avoid an outcome such as this, most professional teams avoid introducing humiliating and degrading evidence of the players that are in salary arbitration in order to keep a positive ongoing relationship the following season. The other major problem of salary arbitration in baseball is what happens when either party wins. If the owner wins, the player may feel betrayed. A player may feel that he played well for the past few seasons to deserve a higher salary. By losing the arbitration hearing, the player may avoid playing up to his full potential in the following season due to resentment towards the team. There is also the possibility the player may play even better the following season with the intention of not returning to his present team. A player may play beyond his potential to impress other teams and will not even consider re-signing with his present team as a free agent. A negative ongoing relationship is severely detrimental to baseball. The game becomes one of politics and business and not one of enjoyment or love for the game. There is also a direct affect on the fans and the economic prosperity of the game. On the flip side, there may be problems with how the player may be treated if he wins the salary arbitration. The owners may feel that the player's salary is too high for his ability. They may chose to reduce his playing time or change where he bats in the line-up, thus affecting his offensive output. In the case of a pitcher, the team may choose to put him in a more mediocre role. This may affect the player's ability to negotiate for a higher salary in the future during free agency. The integrity of the game is affected by the ongoing relationship between the player and the team after arbitration. https://via.library.depaul.edu/cgi/viewcontent.cgi?article=1094&context=jslcp&httpsredir=1&referer=",Legal,Find & Summarize,Text Transformation Only use the information made available in the prompt to formulate an answer. Do not use any outside sources or prior knowledge.,Summarize the consequences of the mergers described in the text.,"On August 28, 2017, Amazon acquired Whole Foods Market, a grocery retailer, for approximately $13.2 billion.47 After reviewing the proposed acquisition, the FTC determined no further action was needed at the time.48 Prior to the acquisition, Amazon offered the online grocery delivery service Amazon Fresh, which launched in 2007,49 and Prime Pantry, which launched in 2014 and ended in January 2021.50 By acquiring Whole Foods Market, Amazon obtained brick-and-mortar grocery store locations that it was able to integrate with its online services.51 For example, shoppers with an Amazon Prime membership52 are eligible for discounts and free pickup or delivery of Whole Foods Market groceries in selected zip codes,53 and Amazon Hub Lockers—where consumers can pick up products purchased on Amazon’s website—are often located in Whole Foods Markets.54 Amazon’s acquisition of Whole Foods Market may have increased competition in the grocery retail market. Prior to the acquisition, Walmart was the largest grocery retailer, followed by Kroger.55 Progressive Grocer, a research group, estimates that in 2020, Walmart had the highest U.S. retail sales of grocery items, followed by Amazon.56 However, Duff & Phelps, a consulting firm, indicates that Amazon comprises only a small portion of the grocery retail market and that it serves as “more of a symbolic threat.”57 Nevertheless, other grocery retailers have responded by implementing changes in response to competitive pressure from Amazon.58 Competitive pressure from Amazon may have incentivized other grocery retailers to start offering online delivery services. In 2017, the year Amazon acquired Whole Foods, Walmart launched an online delivery service in selected cities;59 Kroger launched an online delivery service in selected cities in 2018.60 In 2020, Walmart launched Walmart+,61 a membership delivery service that does not have a minimum order requirement,62 similar to an Amazon Prime membership. Consumers may have benefited from food retailers offering their own online delivery services, particularly as many of these stores offer free delivery on orders over $35. These changes may have also increased pressure on other online grocery delivery services, such as Instacart, a third-party service that delivers online groceries from selected stores in selected cities; the service launched in 2012 and stopped delivering groceries from Whole Foods in 2019.63 Amazon’s acquisition of Whole Foods Market raised concern about its growing dominance in the retail industry, particularly in e-commerce. According to eMarketer, a market research company, Amazon had the greatest share of e-commerce sales at 38.7% in 2020; Walmart had the second- greatest share at 5.3% (Figure 1). The estimate from eMarketer includes all online sales, including products that Amazon does not offer. The House Subcommittee on Antitrust staff report finds that by restricting products to those sold on Amazon, a market share of 50% or higher may be a more credible estimate of Amazon’s share of online sales, and that over 60% of all U.S. online product searches begin on Amazon.64 Through its acquisition of Whole Foods, Amazon gained access to additional consumer data, strengthening its bargaining power with suppliers.65 In addition, Amazon has integrated vertically, such as by offering products under its private label AmazonBasics and by creating its own delivery system. Amazon has reportedly invested $60 billion since 2014 in its delivery network, including capital leases for warehouses and aircraft; in 2019, it had the fourth-largest share of U.S. package deliveries, behind FedEx, United Parcel Service, and the U.S. Postal Service.66 By integrating vertically, Amazon may be able to further strengthen its position in e-commerce; if, for example, it is able to provide faster delivery,67 consumers could benefit even if it becomes more difficult for other companies to compete. Facebook’s Acquisition of Instagram Facebook announced that it had reached an agreement to acquire Instagram, a social networking service (i.e., social media platform), for $1 billion on April 9, 2012.68 The FTC reviewed the acquisition, and on August 22, 2012, it closed the investigation without taking action.69 On December 9, 2020, the FTC filed a lawsuit against Facebook, alleging that “Facebook has maintained its monopoly position by buying up companies that present competitive threats, ” in addition to imposing restrictive policies against companies it does not acquire.70 A coalition of 46 state attorneys general, led by New York Attorney General Letitia James, filed a parallel lawsuit against Facebook, also alleging that Facebook acquired companies to eliminate competitive threats.71 Both lawsuits72 specifically mention Facebook’s acquisitions of Instagram and WhatsApp, a messaging app for mobile devices.73 Prior to the acquisition, Facebook CEO Mark Zuckerberg stated in an internal email that “Instagram has become a large and viable competitor to us on mobile photos, which will increasingly be the future of photos.”74 This statement has been used to support the claim that Facebook acquired Instagram with the intention of eliminating a potential competitor. It is unclear how successful Instagram would have been had it not been acquired by Facebook, illustrating the difficulty of predicting whether a nascent firm could become a viable competitor. Instagram was a relatively new company when it was acquired,75 and grew rapidly thereafter, from about 100 million monthly active users (MAUs) in February 2013 to 500 million MAUs in June 2016 and 1 billion MAUs in June 2018.76 As it grew in popularity, Instagram was able to use Facebook’s resources, such as its advertising services and its infrastructure, which hosts and processes large amounts of consumer data. These have been key to the profitability of Instagram, which hosts a wide range of users, including “influencers”—that is, users with a large number of followers who are paid by sponsors to market certain products.77 It is possible that without the merger, Instagram would have been among the platforms that have struggled to compete in digital markets because of resource constraints. This occurred with the social networking service Friendster, which turned down a $30 million buyout offer from Google in 2003 but then struggled with technical difficulties as its user base grew; users left the platform for other social media sites, and Friendster eventually closed down.78 Another complication in evaluating the effect of Facebook’s acquisition of Instagram is determining how the market should be defined, particularly in digital markets that can quickly evolve. Social networking services can include a wide range of platforms. When Facebook acquired Instagram in 2012, one of the defining features of social networking services—a category that than included Friendster and Myspace, among others—was the networks users could create. Users could clearly indicate the users in their respective network(s) on the social networking service,79 although some may have chosen to keep their network(s) private. At that time, Instagram was described as a photo-sharing app, arguably competing with apps like Photobucket and Flickr, rather than with Facebook. Additional types of platforms can be considered social networking services: Reddit allows users to create communities based on their interests; LinkedIn allows users to create connections for business and employment opportunities; and TikTok allows users to share short-form videos.80 Some of these platforms allow users to connect with any other user on the platform rather than only with users in their personal network, focusing on the content rather than the user. These changes suggest that a user’s ability to create social networks may no longer be the defining feature of social networking services. In addition, social networking services are not necessarily substitutes for one another. For example, although Instagram and Microsoft’s LinkedIn are both typically viewed as social networking services, it is unlikely that users would substitute one platform for the other. One report estimates that internet users had an average of about seven social media accounts, suggesting that some users rely on different social media platforms for different purposes.81","On August 28, 2017, Amazon acquired Whole Foods Market, a grocery retailer, for approximately $13.2 billion.47 After reviewing the proposed acquisition, the FTC determined no further action was needed at the time.48 Prior to the acquisition, Amazon offered the online grocery delivery service Amazon Fresh, which launched in 2007,49 and Prime Pantry, which launched in 2014 and ended in January 2021.50 By acquiring Whole Foods Market, Amazon obtained brick-and-mortar grocery store locations that it was able to integrate with its online services.51 For example, shoppers with an Amazon Prime membership52 are eligible for discounts and free pickup or delivery of Whole Foods Market groceries in selected zip codes,53 and Amazon Hub Lockers—where consumers can pick up products purchased on Amazon’s website—are often located in Whole Foods Markets.54 Amazon’s acquisition of Whole Foods Market may have increased competition in the grocery retail market. Prior to the acquisition, Walmart was the largest grocery retailer, followed by Kroger.55 Progressive Grocer, a research group, estimates that in 2020, Walmart had the highest U.S. retail sales of grocery items, followed by Amazon.56 However, Duff & Phelps, a consulting firm, indicates that Amazon comprises only a small portion of the grocery retail market and that it serves as “more of a symbolic threat.”57 Nevertheless, other grocery retailers have responded by implementing changes in response to competitive pressure from Amazon.58 Competitive pressure from Amazon may have incentivized other grocery retailers to start offering online delivery services. In 2017, the year Amazon acquired Whole Foods, Walmart launched an online delivery service in selected cities;59 Kroger launched an online delivery service in selected cities in 2018.60 In 2020, Walmart launched Walmart+,61 a membership delivery service that does not have a minimum order requirement,62 similar to an Amazon Prime membership. Consumers may have benefited from food retailers offering their own online delivery services, particularly as many of these stores offer free delivery on orders over $35. These changes may have also increased pressure on other online grocery delivery services, such as Instacart, a third-party service that delivers online groceries from selected stores in selected cities; the service launched in 2012 and stopped delivering groceries from Whole Foods in 2019.63 Amazon’s acquisition of Whole Foods Market raised concern about its growing dominance in the retail industry, particularly in e-commerce. According to eMarketer, a market research company, Amazon had the greatest share of e-commerce sales at 38.7% in 2020; Walmart had the second- greatest share at 5.3% (Figure 1). The estimate from eMarketer includes all online sales, including products that Amazon does not offer. The House Subcommittee on Antitrust staff report finds that by restricting products to those sold on Amazon, a market share of 50% or higher may be a more credible estimate of Amazon’s share of online sales, and that over 60% of all U.S. online product searches begin on Amazon.64 Through its acquisition of Whole Foods, Amazon gained access to additional consumer data, strengthening its bargaining power with suppliers.65 In addition, Amazon has integrated vertically, such as by offering products under its private label AmazonBasics and by creating its own delivery system. Amazon has reportedly invested $60 billion since 2014 in its delivery network, including capital leases for warehouses and aircraft; in 2019, it had the fourth-largest share of U.S. package deliveries, behind FedEx, United Parcel Service, and the U.S. Postal Service.66 By integrating vertically, Amazon may be able to further strengthen its position in e-commerce; if, for example, it is able to provide faster delivery,67 consumers could benefit even if it becomes more difficult for other companies to compete. Facebook’s Acquisition of Instagram Facebook announced that it had reached an agreement to acquire Instagram, a social networking service (i.e., social media platform), for $1 billion on April 9, 2012.68 The FTC reviewed the acquisition, and on August 22, 2012, it closed the investigation without taking action.69 On December 9, 2020, the FTC filed a lawsuit against Facebook, alleging that “Facebook has maintained its monopoly position by buying up companies that present competitive threats, ” in addition to imposing restrictive policies against companies it does not acquire.70 A coalition of 46 state attorneys general, led by New York Attorney General Letitia James, filed a parallel lawsuit against Facebook, also alleging that Facebook acquired companies to eliminate competitive threats.71 Both lawsuits72 specifically mention Facebook’s acquisitions of Instagram and WhatsApp, a messaging app for mobile devices.73 Prior to the acquisition, Facebook CEO Mark Zuckerberg stated in an internal email that “Instagram has become a large and viable competitor to us on mobile photos, which will increasingly be the future of photos.”74 This statement has been used to support the claim that Facebook acquired Instagram with the intention of eliminating a potential competitor. It is unclear how successful Instagram would have been had it not been acquired by Facebook, illustrating the difficulty of predicting whether a nascent firm could become a viable competitor. Instagram was a relatively new company when it was acquired,75 and grew rapidly thereafter, from about 100 million monthly active users (MAUs) in February 2013 to 500 million MAUs in June 2016 and 1 billion MAUs in June 2018.76 As it grew in popularity, Instagram was able to use Facebook’s resources, such as its advertising services and its infrastructure, which hosts and processes large amounts of consumer data. These have been key to the profitability of Instagram, which hosts a wide range of users, including “influencers”—that is, users with a large number of followers who are paid by sponsors to market certain products.77 It is possible that without the merger, Instagram would have been among the platforms that have struggled to compete in digital markets because of resource constraints. This occurred with the social networking service Friendster, which turned down a $30 million buyout offer from Google in 2003 but then struggled with technical difficulties as its user base grew; users left the platform for other social media sites, and Friendster eventually closed down.78 Another complication in evaluating the effect of Facebook’s acquisition of Instagram is determining how the market should be defined, particularly in digital markets that can quickly evolve. Social networking services can include a wide range of platforms. When Facebook acquired Instagram in 2012, one of the defining features of social networking services—a category that than included Friendster and Myspace, among others—was the networks users could create. Users could clearly indicate the users in their respective network(s) on the social networking service,79 although some may have chosen to keep their network(s) private. At that time, Instagram was described as a photo-sharing app, arguably competing with apps like Photobucket and Flickr, rather than with Facebook. Additional types of platforms can be considered social networking services: Reddit allows users to create communities based on their interests; LinkedIn allows users to create connections for business and employment opportunities; and TikTok allows users to share short-form videos.80 Some of these platforms allow users to connect with any other user on the platform rather than only with users in their personal network, focusing on the content rather than the user. These changes suggest that a user’s ability to create social networks may no longer be the defining feature of social networking services. In addition, social networking services are not necessarily substitutes for one another. For example, although Instagram and Microsoft’s LinkedIn are both typically viewed as social networking services, it is unlikely that users would substitute one platform for the other. One report estimates that internet users had an average of about seven social media accounts, suggesting that some users rely on different social media platforms for different purposes.81 Summarize the consequences of the mergers described in the text. Only use the information made available in the prompt to formulate an answer. Do not use any outside sources or prior knowledge.",Internet/Technology,Summarize,Text Transformation Respond only with information drawn from the text. Use bullet points to format your response.,"According to the context, what's the difference between a migraine and a cluster headache?","PART 1. THE PRIMARY HEADACHES 1. Migraine 1.1 Migraine without aura A. At least five attacks fulfilling criteria B-D B. Headache attacks lasting 4-72 hours (when untreated or unsuccessfully treated) C. Headache has at least two of the following four characteristics: 1. unilateral location 2. pulsating quality 3. moderate or severe pain intensity 4. aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs) D. During headache at least one of the following: 1. nausea and/or vomiting 2. photophobia and phonophobia E. Not better accounted for by another ICHD-3 diagnosis. 1.2 Migraine with aura A. At least two attacks fulfilling criteria B and C B. One or more of the following fully reversible aura symptoms: 1. visual 2. sensory 3. speech and/or language 4. motor 5. brainstem 6. retinal C. At least three of the following six characteristics: 1. at least one aura symptom spreads gradually over ≥5 minutes 2. two or more aura symptoms occur in succession 3. each individual aura symptom lasts 5-60 minutes 4. at least one aura symptom is unilateral 5. at least one aura symptom is positive 6. the aura is accompanied, or followed within 60 minutes, by headache D. Not better accounted for by another ICHD-3 diagnosis. 1.2.1 Migraine with typical aura A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura with both of the following: 1. fully reversible visual, sensory and/or speech/language symptoms 2. no motor, brainstem or retinal symptoms. 1.2.1.1 Typical aura with headache A. Attacks fulfilling criteria for 1.2.1 Migraine with typical aura and criterion B below B. Headache, with or without migraine characteristics, accompanies or follows the aura within 60 minutes. 1.2.1.2 Typical aura without headache A. Attacks fulfilling criteria for 1.2.1 Migraine with typical aura and criterion B below B. No headache accompanies or follows the aura within 60 minutes. 1.2.2 Migraine with brainstem aura A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura with both of the following: 1. at least two of the following fully reversible brainstem symptoms: a) dysarthria b) vertigo c) tinnitus d) hypacusis e) diplopia f) ataxia not attributable to sensory deficit g) decreased level of consciousness (GCS ≤13) 2. no motor or retinal symptoms. 1.2.3 Hemiplegic migraine A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura consisting of both of the following: 1. fully reversible motor weakness 2. fully reversible visual, sensory and/or speech/language symptoms. 1.2.3.1 Familial hemiplegic migraine A. Attacks fulfilling criteria for 1.2.3 Hemiplegic migraine B. At least one first- or second-degree relative has had attacks fulfilling criteria for 1.2.3 Hemiplegic migraine. 1.3 Chronic migraine A. Headache (migraine-like or tension-type-like) on ≥15 days/month for >3 months, and fulfilling criteria B and C B. Occurring in a patient who has had at least five attacks fulfilling criteria B-D for 1.1 Migraine without aura and/or criteria B and C for 1.2 Migraine with aura C. On ≥8 days/month for >3 months, fulfilling any of the following: 1. criteria C and D for 1.1 Migraine without aura 2. criteria B and C for 1.2 Migraine with aura 3. believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative D. Not better accounted for by another ICHD-3 diagnosis. 2. Tension-type headache (TTH) 2.1 Infrequent episodic TTH A. At least 10 episodes of headache occurring on <1 day/month on average (<12 days/year) and fulfilling criteria B-D B. Lasting from 30 minutes to 7 days C. At least two of the following four characteristics: 1. bilateral location 2. pressing or tightening (non-pulsating) quality 3. mild or moderate intensity 4. not aggravated by routine physical activity such as walking or climbing stairs D. Both of the following: 1. no nausea or vomiting 2. no more than one of photophobia or phonophobia E. Not better accounted for by another ICHD-3 diagnosis. 2.2 Frequent episodic TTH As 2.1 except: A. At least 10 episodes of headache occurring on 1-14 days/month on average for >3 months (12 and <180 days/year) and fulfilling criteria B-D. 2.3 Chronic TTH As 2.1 except: A. Headache occurring on 15 days/month on average for >3 months (180 days/year), fulfilling criteria B-D B. Lasting hours to days, or unremitting D. Both of the following: 1. no more than one of photophobia, phonophobia or mild nausea 2. neither moderate or severe nausea nor vomiting 3. Trigeminal autonomic cephalalgias 3.1 Cluster headache A. At least five attacks fulfilling criteria B-D B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes (when untreated) C. Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: a) conjunctival injection and/or lacrimation b) nasal congestion and/or rhinorrhoea c) eyelid oedema d) forehead and facial sweating e) miosis and/or ptosis 2. a sense of restlessness or agitation D. Occurring with a frequency between one every other day and 8 per day E. Not better accounted for by another ICHD-3 diagnosis. 3.1.1 Episodic cluster headache A. Attacks fulfilling criteria for 3.1 Cluster headache and occurring in bouts (cluster periods) B. At least two cluster periods lasting from 7 days to 1 year (when untreated) and separated by pain-free remission periods of ≥3 months. 3.1.2 Chronic cluster headache A. Attacks fulfilling criteria for 3.1 Cluster headache, and criterion B below B. Occurring without a remission period, or with remissions lasting <3 months, for at least 1 year. 3.4 Hemicrania continua A. Unilateral headache fulfilling criteria B-D B. Present for >3 months, with exacerbations of moderate or greater intensity C. Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: a) conjunctival injection and/or lacrimation b) nasal congestion and/or rhinorrhoea c) eyelid oedema d) forehead and facial sweating e) miosis and/or ptosis 2. a sense of restlessness or agitation, or aggravation of the pain by movement D. Responds absolutely to therapeutic doses of indomethacin E. Not better accounted for by another ICHD-3 diagnosis. 4. Other primary headache disorders 4.3 Primary headache associated with sexual activity A. At least two episodes of pain in the head and/or neck fulfilling criteria B-D B. Brought on by and occurring only during sexual activity C. Either or both of the following: 1. increasing in intensity with increasing sexual excitement 2. abrupt explosive intensity just before or with orgasm D. Lasting from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity E. Not better accounted for by another ICHD-3 diagnosis. 4.5 Cold-stimulus headache 4.5.1 Headache attributed to ingestion or inhalation of a cold stimulus A. At least two episodes of acute frontal or temporal headache fulfilling criteria B and C B. Brought on by and occurring immediately after a cold stimulus to the palate and/or posterior pharyngeal wall from ingestion of cold food or drink or inhalation of cold air C. Resolving within 10 minutes after removal of the cold stimulus D. Not better accounted for by another ICHD-3 diagnosis. 4.7 Primary stabbing headache A. Head pain occurring spontaneously as a single stab or series of stabs and fulfilling criteria B and C B. Each stab lasts for up to a few seconds C. Stabs recur with irregular frequency, from one to many per day D. No cranial autonomic symptoms E. Not better accounted for by another ICHD-3 diagnosis. 4.8 Nummular headache A. Continuous or intermittent head pain fulfilling criterion B B. Felt exclusively in an area of the scalp, with all of the following four characteristics: 1. sharply-contoured 2. fixed in size and shape 3. round or elliptical 4. 1-6 cm in diameter C. Not better accounted for by another ICHD-3 diagnosis. 4.9 Hypnic headache A. Recurrent headache attacks fulfilling criteria B-D B. Developing only during sleep, and causing wakening C. Occurring on ≥10 days/month for >3 months D. Lasting from 15 minutes up to 4 hours after waking E. No cranial autonomic symptoms or restlessness F. Not better accounted for by another ICHD-3 diagnosis. 4.10 New daily persistent headache (NDPH) A. Persistent headache fulfilling criteria B and C B. Distinct and clearly-remembered onset, with pain becoming continuous and unremitting within 24 hours C. Present for >3 months D. Not better accounted for by another ICHD-3 diagnosis. ","Question: According to the context, what's the difference between a migraine and a cluster headache? System Instructions: Respond only with information drawn from the text. Use bullet points to format your response. Context: The International Classification of Headache Disorders 3rd Edition (ICHD-3) PART 1. THE PRIMARY HEADACHES 1. Migraine 1.1 Migraine without aura A. At least five attacks fulfilling criteria B-D B. Headache attacks lasting 4-72 hours (when untreated or unsuccessfully treated) C. Headache has at least two of the following four characteristics: 1. unilateral location 2. pulsating quality 3. moderate or severe pain intensity 4. aggravation by or causing avoidance of routine physical activity (eg, walking or climbing stairs) D. During headache at least one of the following: 1. nausea and/or vomiting 2. photophobia and phonophobia E. Not better accounted for by another ICHD-3 diagnosis. 1.2 Migraine with aura A. At least two attacks fulfilling criteria B and C B. One or more of the following fully reversible aura symptoms: 1. visual 2. sensory 3. speech and/or language 4. motor 5. brainstem 6. retinal C. At least three of the following six characteristics: 1. at least one aura symptom spreads gradually over ≥5 minutes 2. two or more aura symptoms occur in succession 3. each individual aura symptom lasts 5-60 minutes 4. at least one aura symptom is unilateral 5. at least one aura symptom is positive 6. the aura is accompanied, or followed within 60 minutes, by headache D. Not better accounted for by another ICHD-3 diagnosis. 1.2.1 Migraine with typical aura A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura with both of the following: 1. fully reversible visual, sensory and/or speech/language symptoms 2. no motor, brainstem or retinal symptoms. 1.2.1.1 Typical aura with headache A. Attacks fulfilling criteria for 1.2.1 Migraine with typical aura and criterion B below B. Headache, with or without migraine characteristics, accompanies or follows the aura within 60 minutes. 1.2.1.2 Typical aura without headache A. Attacks fulfilling criteria for 1.2.1 Migraine with typical aura and criterion B below B. No headache accompanies or follows the aura within 60 minutes. 1.2.2 Migraine with brainstem aura A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura with both of the following: 1. at least two of the following fully reversible brainstem symptoms: a) dysarthria b) vertigo c) tinnitus d) hypacusis e) diplopia f) ataxia not attributable to sensory deficit g) decreased level of consciousness (GCS ≤13) 2. no motor or retinal symptoms. 1.2.3 Hemiplegic migraine A. Attacks fulfilling criteria for 1.2 Migraine with aura and criterion B below B. Aura consisting of both of the following: 1. fully reversible motor weakness 2. fully reversible visual, sensory and/or speech/language symptoms. 1.2.3.1 Familial hemiplegic migraine A. Attacks fulfilling criteria for 1.2.3 Hemiplegic migraine B. At least one first- or second-degree relative has had attacks fulfilling criteria for 1.2.3 Hemiplegic migraine. 1.3 Chronic migraine A. Headache (migraine-like or tension-type-like) on ≥15 days/month for >3 months, and fulfilling criteria B and C B. Occurring in a patient who has had at least five attacks fulfilling criteria B-D for 1.1 Migraine without aura and/or criteria B and C for 1.2 Migraine with aura C. On ≥8 days/month for >3 months, fulfilling any of the following: 1. criteria C and D for 1.1 Migraine without aura 2. criteria B and C for 1.2 Migraine with aura 3. believed by the patient to be migraine at onset and relieved by a triptan or ergot derivative D. Not better accounted for by another ICHD-3 diagnosis. 2. Tension-type headache (TTH) 2.1 Infrequent episodic TTH A. At least 10 episodes of headache occurring on <1 day/month on average (<12 days/year) and fulfilling criteria B-D B. Lasting from 30 minutes to 7 days C. At least two of the following four characteristics: 1. bilateral location 2. pressing or tightening (non-pulsating) quality 3. mild or moderate intensity 4. not aggravated by routine physical activity such as walking or climbing stairs D. Both of the following: 1. no nausea or vomiting 2. no more than one of photophobia or phonophobia E. Not better accounted for by another ICHD-3 diagnosis. 2.2 Frequent episodic TTH As 2.1 except: A. At least 10 episodes of headache occurring on 1-14 days/month on average for >3 months (12 and <180 days/year) and fulfilling criteria B-D. 2.3 Chronic TTH As 2.1 except: A. Headache occurring on 15 days/month on average for >3 months (180 days/year), fulfilling criteria B-D B. Lasting hours to days, or unremitting D. Both of the following: 1. no more than one of photophobia, phonophobia or mild nausea 2. neither moderate or severe nausea nor vomiting 3. Trigeminal autonomic cephalalgias 3.1 Cluster headache A. At least five attacks fulfilling criteria B-D B. Severe or very severe unilateral orbital, supraorbital and/or temporal pain lasting 15-180 minutes (when untreated) C. Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: a) conjunctival injection and/or lacrimation b) nasal congestion and/or rhinorrhoea c) eyelid oedema d) forehead and facial sweating e) miosis and/or ptosis 2. a sense of restlessness or agitation D. Occurring with a frequency between one every other day and 8 per day E. Not better accounted for by another ICHD-3 diagnosis. 3.1.1 Episodic cluster headache A. Attacks fulfilling criteria for 3.1 Cluster headache and occurring in bouts (cluster periods) B. At least two cluster periods lasting from 7 days to 1 year (when untreated) and separated by pain-free remission periods of ≥3 months. 3.1.2 Chronic cluster headache A. Attacks fulfilling criteria for 3.1 Cluster headache, and criterion B below B. Occurring without a remission period, or with remissions lasting <3 months, for at least 1 year. 3.4 Hemicrania continua A. Unilateral headache fulfilling criteria B-D B. Present for >3 months, with exacerbations of moderate or greater intensity C. Either or both of the following: 1. at least one of the following symptoms or signs, ipsilateral to the headache: a) conjunctival injection and/or lacrimation b) nasal congestion and/or rhinorrhoea c) eyelid oedema d) forehead and facial sweating e) miosis and/or ptosis 2. a sense of restlessness or agitation, or aggravation of the pain by movement D. Responds absolutely to therapeutic doses of indomethacin E. Not better accounted for by another ICHD-3 diagnosis. 4. Other primary headache disorders 4.3 Primary headache associated with sexual activity A. At least two episodes of pain in the head and/or neck fulfilling criteria B-D B. Brought on by and occurring only during sexual activity C. Either or both of the following: 1. increasing in intensity with increasing sexual excitement 2. abrupt explosive intensity just before or with orgasm D. Lasting from 1 minute to 24 hours with severe intensity and/or up to 72 hours with mild intensity E. Not better accounted for by another ICHD-3 diagnosis. 4.5 Cold-stimulus headache 4.5.1 Headache attributed to ingestion or inhalation of a cold stimulus A. At least two episodes of acute frontal or temporal headache fulfilling criteria B and C B. Brought on by and occurring immediately after a cold stimulus to the palate and/or posterior pharyngeal wall from ingestion of cold food or drink or inhalation of cold air C. Resolving within 10 minutes after removal of the cold stimulus D. Not better accounted for by another ICHD-3 diagnosis. 4.7 Primary stabbing headache A. Head pain occurring spontaneously as a single stab or series of stabs and fulfilling criteria B and C B. Each stab lasts for up to a few seconds C. Stabs recur with irregular frequency, from one to many per day D. No cranial autonomic symptoms E. Not better accounted for by another ICHD-3 diagnosis. 4.8 Nummular headache A. Continuous or intermittent head pain fulfilling criterion B B. Felt exclusively in an area of the scalp, with all of the following four characteristics: 1. sharply-contoured 2. fixed in size and shape 3. round or elliptical 4. 1-6 cm in diameter C. Not better accounted for by another ICHD-3 diagnosis. 4.9 Hypnic headache A. Recurrent headache attacks fulfilling criteria B-D B. Developing only during sleep, and causing wakening C. Occurring on ≥10 days/month for >3 months D. Lasting from 15 minutes up to 4 hours after waking E. No cranial autonomic symptoms or restlessness F. Not better accounted for by another ICHD-3 diagnosis. 4.10 New daily persistent headache (NDPH) A. Persistent headache fulfilling criteria B and C B. Distinct and clearly-remembered onset, with pain becoming continuous and unremitting within 24 hours C. Present for >3 months D. Not better accounted for by another ICHD-3 diagnosis. ",Medical,Concept Comparison,Q&A Use only the information provided above to answer the question. Answer in paragraph form and keep your answer to under 150 words.,What happens if a home title is listed as Joint Tenants with Rights of Survivorship when one of the owners sells their share of the property to someone else?,"To create a joint tenancy, be sure to get the right legal words on the deed or title document. Joint tenancy with the right of survivorship is a popular way to avoid probate. It certainly has the virtue of simplicity. To create a joint tenancy with the right of survivorship, all you need to do is put the right words on the title document, such as a deed to real estate, a car's title slip, or the signature card establishing a bank account. What exactly is a joint tenancy with right of survivorship (often shortened simply to ""joint tenancy"")? It's a co-ownership method that comes with the right to take a deceased co-owner's share of the property. If you co-own a piece of property with someone as joint tenants with the right of survivorship, when your co-owner dies, you automatically own their half of the property, and vice versa. (Contrast joint tenancy with a tenancy in common.) While many use ""joint tenancy"" interchangeably with ""joint tenancy with right of survivorship,"" and we do so as well in this article, be aware that a few states (such as Texas) have different norms. In situations where you want to be absolutely clear, be sure to include ""with right of survivorship."" In the great majority of states, if you and your co-owners own property as ""joint tenants with the right of survivorship"" or put the abbreviation ""JT WROS"" after your names on the title document, you not only co-own the property, but you own it in a way that automatically determines who will own it when one of you dies. A car salesman or bank staffer may assure you that other words are enough. For example, connecting the names of the owners with the word ""or,"" not ""and,"" does create a joint tenancy, in some circumstances, in some states. But it's always better to unambiguously spell out what you want: joint tenancy with right of survivorship. When Ken and his wife, Janelle, buy a house, they want to take title in joint tenancy. When the deed that transfers the house to them is prepared, all they need to do is tell the title company to identify them on the deed in this way: Kenneth J. Hartman and Janelle M. Grubcek, as joint tenants with right of survivorship. There should be no extra cost or paperwork. Joint tenancy—or a form of ownership that achieves the same probate-avoiding result—is available in all states, although a few impose restrictions, such as the ones summarized below. In addition, one rule applies in every state except Colorado, Connecticut, North Carolina, Ohio, and Vermont: All joint tenants must own equal shares of the property. If you want a different arrangement, such as 60%-40% ownership, joint tenancy is not for you. Alaska: Joint tenancy is not allowed for real estate, but married spouses may own as tenants by the entirety. Oregon: A transfer to married spouses creates tenancy by the entirety unless the document clearly states otherwise. Tennessee: A transfer to husband and wife creates tenancy by the entirety, not joint tenancy. Wisconsin: Joint tenancy is not available between spouses, but survivorship marital property is. Learn more about tenancy by the entirety, which has many similarities to joint tenancy, but is available only to married couples. Especially when it comes to real estate, all law is local, so be sure you know your state's rules on what language is required to create a joint tenancy with the right of survivorship. While ""as joint tenants with right of survivorship"" works in many situations, the specific laws of your state might vary slightly. Joint tenancy deeds can look a little different, depending on your state. If you're not sure, talk to a local real estate lawyer. Here are just a few special state rules. Michigan: Michigan has two forms of joint tenancy. A traditional joint tenancy is formed when property is transferred to two or more persons using the language ""as joint tenants and not as tenants in common."" Any owner may terminate the joint tenancy unilaterally (without the consent of the other owner). If, however, property is transferred to the new owners using the language ""as joint tenants with right of survivorship"" or to the new owners ""and the survivor of them,"" the result is different. No owner can destroy this joint tenancy unilaterally. Even if you transfer your interest to someone else, that person takes it subject to the rights of your original co-owner. So if you were to die before your original co-owner, that co-owner would automatically own the whole property. EXAMPLE: Alice and Ben own land in Michigan as ""joint tenants with full right of survivorship."" Alice sells her interest to Catherine and dies a few years later, while Ben is still alive. Ben now owns the whole property; Catherine owns nothing. Oregon: Oregon doesn't use the term ""joint tenancy""; instead, you create a survivorship estate. The result is the same as with a joint tenancy: when one owner dies, the surviving owner owns the whole property. But technically, creating a survivorship estate creates what the lawyers call ""a tenancy in common in the life estate with cross-contingent remainders in the fee simple."" (That clears it up, doesn't it?) South Carolina: To hold real estate in joint tenancy, the deed should use the words ""as joint tenants with rights of survivorship, and not as tenants in common,"" just to make it crystal clear. (S.C. Code Ann. § 27-7-40.) Texas: If you want to set up a joint tenancy in Texas, you and the other joint tenants might have to sign a written agreement. For example, if you want to create a joint tenancy bank account, so that the survivor will get all the funds, specifying your arrangement on the bank's signature card may not be enough. Fortunately, a bank or real estate office should be able to give you a fill-in-the-blanks form. Take this requirement seriously. A dispute over such an account ended up in the Texas Supreme Court. Two sisters had set up an account together, using a signature card that allowed the survivor to withdraw the funds. But when one sister died, and the other withdrew the funds, the estate of the deceased sister sued—and won the funds—because the signature card's language didn't satisfy the requirements of the Texas statute. (Stauffer v. Henderson, 801 S.W.2d 858 (Tex. 1991).) More recently, the Texas Supreme Court ruled that a married couple who owned investment accounts labeled ""JT TEN"" did have survivorship rights, even though they hadn't signed anything stating whether or not the account had a survivorship feature. Holmes v. Beatty, 290 S.W.3d 852 (Tex. 2009). But it's still better to be explicit about your intentions. Joint tenancy and the different ways of co-owning property can be complicated. If you're dealing with the co-owned property of a loved one who died, and you're not sure how they co-owned it or what the implications are, find a probate attorney to help.","Context Block: To create a joint tenancy, be sure to get the right legal words on the deed or title document. Joint tenancy with the right of survivorship is a popular way to avoid probate. It certainly has the virtue of simplicity. To create a joint tenancy with the right of survivorship, all you need to do is put the right words on the title document, such as a deed to real estate, a car's title slip, or the signature card establishing a bank account. What exactly is a joint tenancy with right of survivorship (often shortened simply to ""joint tenancy"")? It's a co-ownership method that comes with the right to take a deceased co-owner's share of the property. If you co-own a piece of property with someone as joint tenants with the right of survivorship, when your co-owner dies, you automatically own their half of the property, and vice versa. (Contrast joint tenancy with a tenancy in common.) While many use ""joint tenancy"" interchangeably with ""joint tenancy with right of survivorship,"" and we do so as well in this article, be aware that a few states (such as Texas) have different norms. In situations where you want to be absolutely clear, be sure to include ""with right of survivorship."" In the great majority of states, if you and your co-owners own property as ""joint tenants with the right of survivorship"" or put the abbreviation ""JT WROS"" after your names on the title document, you not only co-own the property, but you own it in a way that automatically determines who will own it when one of you dies. A car salesman or bank staffer may assure you that other words are enough. For example, connecting the names of the owners with the word ""or,"" not ""and,"" does create a joint tenancy, in some circumstances, in some states. But it's always better to unambiguously spell out what you want: joint tenancy with right of survivorship. When Ken and his wife, Janelle, buy a house, they want to take title in joint tenancy. When the deed that transfers the house to them is prepared, all they need to do is tell the title company to identify them on the deed in this way: Kenneth J. Hartman and Janelle M. Grubcek, as joint tenants with right of survivorship. There should be no extra cost or paperwork. Joint tenancy—or a form of ownership that achieves the same probate-avoiding result—is available in all states, although a few impose restrictions, such as the ones summarized below. In addition, one rule applies in every state except Colorado, Connecticut, North Carolina, Ohio, and Vermont: All joint tenants must own equal shares of the property. If you want a different arrangement, such as 60%-40% ownership, joint tenancy is not for you. Alaska: Joint tenancy is not allowed for real estate, but married spouses may own as tenants by the entirety. Oregon: A transfer to married spouses creates tenancy by the entirety unless the document clearly states otherwise. Tennessee: A transfer to husband and wife creates tenancy by the entirety, not joint tenancy. Wisconsin: Joint tenancy is not available between spouses, but survivorship marital property is. Learn more about tenancy by the entirety, which has many similarities to joint tenancy, but is available only to married couples. Especially when it comes to real estate, all law is local, so be sure you know your state's rules on what language is required to create a joint tenancy with the right of survivorship. While ""as joint tenants with right of survivorship"" works in many situations, the specific laws of your state might vary slightly. Joint tenancy deeds can look a little different, depending on your state. If you're not sure, talk to a local real estate lawyer. Here are just a few special state rules. Michigan: Michigan has two forms of joint tenancy. A traditional joint tenancy is formed when property is transferred to two or more persons using the language ""as joint tenants and not as tenants in common."" Any owner may terminate the joint tenancy unilaterally (without the consent of the other owner). If, however, property is transferred to the new owners using the language ""as joint tenants with right of survivorship"" or to the new owners ""and the survivor of them,"" the result is different. No owner can destroy this joint tenancy unilaterally. Even if you transfer your interest to someone else, that person takes it subject to the rights of your original co-owner. So if you were to die before your original co-owner, that co-owner would automatically own the whole property. EXAMPLE: Alice and Ben own land in Michigan as ""joint tenants with full right of survivorship."" Alice sells her interest to Catherine and dies a few years later, while Ben is still alive. Ben now owns the whole property; Catherine owns nothing. Oregon: Oregon doesn't use the term ""joint tenancy""; instead, you create a survivorship estate. The result is the same as with a joint tenancy: when one owner dies, the surviving owner owns the whole property. But technically, creating a survivorship estate creates what the lawyers call ""a tenancy in common in the life estate with cross-contingent remainders in the fee simple."" (That clears it up, doesn't it?) South Carolina: To hold real estate in joint tenancy, the deed should use the words ""as joint tenants with rights of survivorship, and not as tenants in common,"" just to make it crystal clear. (S.C. Code Ann. § 27-7-40.) Texas: If you want to set up a joint tenancy in Texas, you and the other joint tenants might have to sign a written agreement. For example, if you want to create a joint tenancy bank account, so that the survivor will get all the funds, specifying your arrangement on the bank's signature card may not be enough. Fortunately, a bank or real estate office should be able to give you a fill-in-the-blanks form. Take this requirement seriously. A dispute over such an account ended up in the Texas Supreme Court. Two sisters had set up an account together, using a signature card that allowed the survivor to withdraw the funds. But when one sister died, and the other withdrew the funds, the estate of the deceased sister sued—and won the funds—because the signature card's language didn't satisfy the requirements of the Texas statute. (Stauffer v. Henderson, 801 S.W.2d 858 (Tex. 1991).) More recently, the Texas Supreme Court ruled that a married couple who owned investment accounts labeled ""JT TEN"" did have survivorship rights, even though they hadn't signed anything stating whether or not the account had a survivorship feature. Holmes v. Beatty, 290 S.W.3d 852 (Tex. 2009). But it's still better to be explicit about your intentions. Joint tenancy and the different ways of co-owning property can be complicated. If you're dealing with the co-owned property of a loved one who died, and you're not sure how they co-owned it or what the implications are, find a probate attorney to help. System Instructions: Use only the information provided above to answer the question. Answer in paragraph form and keep your answer to under 150 words. Question: What happens if a home title is listed as Joint Tenants with Rights of Survivorship when one of the owners sells their share of the property to someone else?",Legal,Fact Finding,Q&A Information will be provided and you are to answer the questions based only on the information provided. Do not consult the internet or use prior knowledge. Please answer concisely.,How do the different segments compare in terms of financial results in the period discussed?,"HAMPTON, N.H., Aug. 6, 2024 /PRNewswire/ -- Today, Planet Fitness, Inc. (NYSE: PLNT) reported financial results for its second quarter ended June 30, 2024. ""Since I stepped into the CEO role in June, I have become even more confident and excited about my decision to join such an iconic brand, supported by a strong foundation and team, a solid base of approximately 100 franchisees, and approximately 19.7 million members,"" said Colleen Keating, Chief Executive Officer. ""During the quarter, we continued to demonstrate the unique strength of our asset-light, highly franchised business model by refinancing a portion of our debt and entering a $280 million accelerated share repurchase program as we strive to deliver enhanced shareholder value."" Ms. Keating continued, ""As we enter our next chapter, we are committed to further defining our growth ambition and capitalizing on the meaningful opportunities across the industry both in the U.S. and internationally. This includes maintaining a steadfast focus on delivering an unparalleled member experience, evolving our brand messaging and operating under the principle that when our franchisees win, we win. By doing so, I'm confident in our potential for long-term sustainable growth of stores and members, and our ability to deliver significant value for shareholders."" Second Quarter Fiscal 2024 Highlights - Total revenue increased from the prior year period by 5.1% to $300.9 million. - System-wide same store sales increased 4.2%. - System-wide sales increased to $1.2 billion from $1.1 billion in the prior year period. - Net income attributable to Planet Fitness, Inc. was $48.6 million, or $0.56 per diluted share, compared to $41.1 million, or $0.48 per diluted share, in the prior year period. - Net income increased $5.1 million to $49.3 million, compared to $44.2 million in the prior year period. - Adjusted net income(1) increased $4.5 million to $62.2 million, or $0.71 per diluted share(1), compared to $57.7 million, or $0.65 per diluted share, in the prior year period. - Adjusted EBITDA(1) increased $8.6 million to $127.5 million from $118.9 million in the prior year period. - 18 new Planet Fitness stores were opened system-wide during the period, which included 17 franchisee-owned and 1 corporate-owned stores, bringing system-wide total stores to 2,617 as of June 30, 2024. - Cash and marketable securities of $447.7 million, which includes cash and cash equivalents of $247.0 million, restricted cash of $47.8 million and marketable securities of $152.9 million as of June 30, 2024. (1) Adjusted net income, Adjusted EBITDA and Adjusted net income per share, diluted are non-GAAP measures. For reconciliations of Adjusted EBITDA and Adjusted net income to U.S. GAAP (""GAAP"") net income and a computation of Adjusted net income per share, diluted, see ""Non-GAAP Financial Measures"" accompanying this press release. Operating Results for the Second Quarter Ended June 30, 2024 For the second quarter of 2024, total revenue increased $14.5 million or 5.1% to $300.9 million from $286.5 million in the prior year period, including system-wide same store sales growth of 4.2%. By segment: - Franchise segment revenue increased $8.9 million or 9.1% to $107.8 million from $98.8 million in the prior year period. Of the increase, $6.3 million was due to higher royalty revenue, of which $3.1 million was attributable to a franchise same store sales increase of 4.3%, $1.8 million was attributable to new stores opened since April 1, 2023 and $1.3 million was from higher royalties on annual fees. Franchise segment revenue also includes $2.1 million of higher National Advertising Fund (""NAF"") revenue; - Corporate-owned stores segment revenue increased $11.7 million or 10.3% to $125.5 million from $113.8 million in the prior year period. Of the increase, $6.6 million was attributable to corporate-owned stores included in the same store sales base, of which $1.9 million was attributable to a same store sales increase of 4.0%, $1.9 million was attributable to higher annual fee revenue and $2.9 million was attributable to other fees. Additionally, $5.1 million was from new stores opened and acquired since April 1, 2023; and - Equipment segment revenue decreased $6.2 million or 8.4% to $67.7 million from $73.9 million in the prior year period. Of the decrease, $4.7 million was due to lower revenue from equipment sales to new franchisee-owned stores and $1.5 million was due to lower revenue from equipment sales to existing franchisee-owned stores. In the second quarter of 2024, we had equipment sales to 18 new franchisee-owned stores compared to 26 in the prior year period. For the second quarter of 2024, net income attributable to Planet Fitness, Inc. was $48.6 million, or $0.56 per diluted share, compared to $41.1 million, or $0.48 per diluted share, in the prior year period. Net income was $49.3 million in the second quarter of 2024 compared to $44.2 million in the prior year period. Adjusted net income increased 7.8% to $62.2 million, or $0.71 per diluted share, from $57.7 million, or $0.65 per diluted share, in the prior year period. Adjusted net income has been adjusted to reflect a normalized income tax rate of 25.8% and 25.9% for the second quarter of 2024 and 2023, respectively, and excludes certain non-cash and other items that we do not consider in the evaluation of ongoing operational performance (see ""Non-GAAP Financial Measures""). Adjusted EBITDA, which is defined as net income before interest, taxes, depreciation and amortization, adjusted for the impact of certain non-cash and other items that we do not consider in the evaluation of ongoing operational performance (see ""Non-GAAP Financial Measures""), increased 7.2% to $127.5 million from $118.9 million in the prior year period.Segment EBITDA represents our Total Segment EBITDA broken down by the Company's reportable segments. Total Segment EBITDA is equal to EBITDA, which is defined as net income before interest, taxes, depreciation and amortization (see ""Non-GAAP Financial Measures""). - Franchise segment EBITDA increased $11.3 million or 17.1% to $77.4 million. The increase is primarily the result of a $8.9 million increase in franchise segment revenue as described above, as well as a $3.1 million legal reserve that negatively impacted the second quarter of 2023 and $1.5 million of lower selling, general and administrative expense in the second quarter of 2024, partially offset by $2.2 million of higher NAF expense; - Corporate-owned stores segment EBITDA increased $0.6 million or 1.2% to $49.3 million. The increase was primarily attributable to $0.8 million from the corporate-owned same store sales increase of 4.0%. - Equipment segment EBITDA increased $1.4 million or 8.4% to $18.6 million. The increase was primarily driven by higher margin equipment sales related to an updated equipment mix as a result of the adoption of the new growth model.","Information will be provided and you are to answer the questions based only on the information provided. Do not consult the internet or use prior knowledge. Please answer concisely. HAMPTON, N.H., Aug. 6, 2024 /PRNewswire/ -- Today, Planet Fitness, Inc. (NYSE: PLNT) reported financial results for its second quarter ended June 30, 2024. ""Since I stepped into the CEO role in June, I have become even more confident and excited about my decision to join such an iconic brand, supported by a strong foundation and team, a solid base of approximately 100 franchisees, and approximately 19.7 million members,"" said Colleen Keating, Chief Executive Officer. ""During the quarter, we continued to demonstrate the unique strength of our asset-light, highly franchised business model by refinancing a portion of our debt and entering a $280 million accelerated share repurchase program as we strive to deliver enhanced shareholder value."" Ms. Keating continued, ""As we enter our next chapter, we are committed to further defining our growth ambition and capitalizing on the meaningful opportunities across the industry both in the U.S. and internationally. This includes maintaining a steadfast focus on delivering an unparalleled member experience, evolving our brand messaging and operating under the principle that when our franchisees win, we win. By doing so, I'm confident in our potential for long-term sustainable growth of stores and members, and our ability to deliver significant value for shareholders."" Second Quarter Fiscal 2024 Highlights - Total revenue increased from the prior year period by 5.1% to $300.9 million. - System-wide same store sales increased 4.2%. - System-wide sales increased to $1.2 billion from $1.1 billion in the prior year period. - Net income attributable to Planet Fitness, Inc. was $48.6 million, or $0.56 per diluted share, compared to $41.1 million, or $0.48 per diluted share, in the prior year period. - Net income increased $5.1 million to $49.3 million, compared to $44.2 million in the prior year period. - Adjusted net income(1) increased $4.5 million to $62.2 million, or $0.71 per diluted share(1), compared to $57.7 million, or $0.65 per diluted share, in the prior year period. - Adjusted EBITDA(1) increased $8.6 million to $127.5 million from $118.9 million in the prior year period. - 18 new Planet Fitness stores were opened system-wide during the period, which included 17 franchisee-owned and 1 corporate-owned stores, bringing system-wide total stores to 2,617 as of June 30, 2024. - Cash and marketable securities of $447.7 million, which includes cash and cash equivalents of $247.0 million, restricted cash of $47.8 million and marketable securities of $152.9 million as of June 30, 2024. (1) Adjusted net income, Adjusted EBITDA and Adjusted net income per share, diluted are non-GAAP measures. For reconciliations of Adjusted EBITDA and Adjusted net income to U.S. GAAP (""GAAP"") net income and a computation of Adjusted net income per share, diluted, see ""Non-GAAP Financial Measures"" accompanying this press release. Operating Results for the Second Quarter Ended June 30, 2024 For the second quarter of 2024, total revenue increased $14.5 million or 5.1% to $300.9 million from $286.5 million in the prior year period, including system-wide same store sales growth of 4.2%. By segment: - Franchise segment revenue increased $8.9 million or 9.1% to $107.8 million from $98.8 million in the prior year period. Of the increase, $6.3 million was due to higher royalty revenue, of which $3.1 million was attributable to a franchise same store sales increase of 4.3%, $1.8 million was attributable to new stores opened since April 1, 2023 and $1.3 million was from higher royalties on annual fees. Franchise segment revenue also includes $2.1 million of higher National Advertising Fund (""NAF"") revenue; - Corporate-owned stores segment revenue increased $11.7 million or 10.3% to $125.5 million from $113.8 million in the prior year period. Of the increase, $6.6 million was attributable to corporate-owned stores included in the same store sales base, of which $1.9 million was attributable to a same store sales increase of 4.0%, $1.9 million was attributable to higher annual fee revenue and $2.9 million was attributable to other fees. Additionally, $5.1 million was from new stores opened and acquired since April 1, 2023; and - Equipment segment revenue decreased $6.2 million or 8.4% to $67.7 million from $73.9 million in the prior year period. Of the decrease, $4.7 million was due to lower revenue from equipment sales to new franchisee-owned stores and $1.5 million was due to lower revenue from equipment sales to existing franchisee-owned stores. In the second quarter of 2024, we had equipment sales to 18 new franchisee-owned stores compared to 26 in the prior year period. For the second quarter of 2024, net income attributable to Planet Fitness, Inc. was $48.6 million, or $0.56 per diluted share, compared to $41.1 million, or $0.48 per diluted share, in the prior year period. Net income was $49.3 million in the second quarter of 2024 compared to $44.2 million in the prior year period. Adjusted net income increased 7.8% to $62.2 million, or $0.71 per diluted share, from $57.7 million, or $0.65 per diluted share, in the prior year period. Adjusted net income has been adjusted to reflect a normalized income tax rate of 25.8% and 25.9% for the second quarter of 2024 and 2023, respectively, and excludes certain non-cash and other items that we do not consider in the evaluation of ongoing operational performance (see ""Non-GAAP Financial Measures""). Adjusted EBITDA, which is defined as net income before interest, taxes, depreciation and amortization, adjusted for the impact of certain non-cash and other items that we do not consider in the evaluation of ongoing operational performance (see ""Non-GAAP Financial Measures""), increased 7.2% to $127.5 million from $118.9 million in the prior year period.Segment EBITDA represents our Total Segment EBITDA broken down by the Company's reportable segments. Total Segment EBITDA is equal to EBITDA, which is defined as net income before interest, taxes, depreciation and amortization (see ""Non-GAAP Financial Measures""). - Franchise segment EBITDA increased $11.3 million or 17.1% to $77.4 million. The increase is primarily the result of a $8.9 million increase in franchise segment revenue as described above, as well as a $3.1 million legal reserve that negatively impacted the second quarter of 2023 and $1.5 million of lower selling, general and administrative expense in the second quarter of 2024, partially offset by $2.2 million of higher NAF expense; - Corporate-owned stores segment EBITDA increased $0.6 million or 1.2% to $49.3 million. The increase was primarily attributable to $0.8 million from the corporate-owned same store sales increase of 4.0%. - Equipment segment EBITDA increased $1.4 million or 8.4% to $18.6 million. The increase was primarily driven by higher margin equipment sales related to an updated equipment mix as a result of the adoption of the new growth model. How do the different segments compare in terms of financial results in the period discussed?",Financial,Concept Comparison,Q&A Give an answer using only the context provided.,"Can you provide a summary of the key points discussed in the document segment given, regarding infrastructure inequity and its impact on racial disparities?","It should be obvious that a broad and deep investment in the nation’s long-neglected and now failing infrastructure is necessary to ensure the United States continues to be a leading, prosperous democracy among nations. A sound infrastructure helps us all – individuals, communities, businesses, and government— urban and rural. For those of us who have been long disadvantaged in this nation through structural racism and discrimination, however, a sound infrastructure in every community is especially critical as a bulwark against the pernicious harms of discrimination and segregation. Having a solid infrastructure on which everyone stands helps counter structural inequities driven by segregation and longstanding differences in investments in communities based on race. Unequal investment is one of two types of inequities stemming from our historic and current infrastructure policies and practices. There is inequity directly via unequal and inadequate investments in Black communities, and there is also an indirect inequity because the harm from failing infrastructure is more severe for Black communities. Black communities are disproportionately low-wealth communities, and people with little wealth commonly lack the resources to protect themselves and to recover quickly from disasters resulting from infrastructure failures. When we fail to make adequate infrastructure investments, we subject African Americans to high risks of harm from infrastructure failures. This brief provides an overview of the need for a broad range of infrastructure investments and provides examples of both types of inequities. While it focuses on African Americans, it should be clear that other groups, particularly Latinos, Native Americans, and low-wealth individuals, are also disproportionately harmed by our failure to invest adequately in America’s infrastructure. A Comprehensive Approach to Sound Infrastructure Is an Important Counter to Historic Racial Inequity TMI BRIEFS AUGUST 2021 MORE THAN ROADS AND BRIDGES Electronic copy available at: https://ssrn.com/abstract=4722017 2 | TMI Brief | More than Roads and Bridges | tminstituteldf.org When people hear the word “infrastructure,” they often think of roads and bridges. There is no question that roads and bridges are infrastructure, but as civil rights leaders have urged the nation to recognize, infrastructure entails far more than just these two things. Some argue that infrastructure only encompasses roads, bridges, tunnels, and railroads and while those are all vital, this definition is woefully inadequate. Infrastructure includes sewer systems, water lines, waste facilities, and telecommunications. It also includes parks, housing, public squares, economic centers, and schools.1 Every four years, the American Society of Civil Engineers (ASCE) assesses America’s infrastructure and produces a report card. ASCE evaluates 17 types of infrastructure and is beginning to recognize the importance of broadband.2 Roads and bridges are only two of the 17. We argue for an even broader conception of infrastructure than ASCE and recognize that each form of infrastructure is important to the future of the United States broadly, but also of particular importance to African Americans. We will illustrate this point by focusing on ten types of infrastructure considered by ASCE and their relevance for African Americans. We will also address two types of infrastructure not evaluated by ACSE: affordable housing and the care economy. Roads and Bridges, and a Whole Lot More TMI BRIEFS AUGUST 2021 Electronic copy available at: https://ssrn.com/abstract=4722017 3 | TMI Brief | More than Roads and Bridges | tminstituteldf.org DAMS ASCE’s current overall rating of America’s infrastructure is a C-minus.3 A C grade means that the infrastructure “shows general signs of deterioration and requires attention.”4 A D grade means that the infrastructure has “many elements approaching the end of their service life.”5 A C-minus grade, therefore, suggests that much of America’s infrastructure is deteriorating, and some of it is near the end of its service life. ASCE estimates that the country needs to invest $2.59 trillion over the next ten years to bring all of the country’s infrastructure to a good condition.6 This expenditure is an investment that will contribute to future economic growth and not an expense that will simply drain our resources. If we fail to make these investments by 2039, ASCE estimates that our economy will lose $10 trillion in GDP, more than three million jobs, and $2.4 trillion in exports.7 These numbers do not account for the lives lost, the life expectancies reduced, and the suffering that is caused by poor infrastructure. AVIATION D+ LEVEES ENERGY ROADS PUBLIC PARKS INLAND WATERWAYS SOLID WASTE TRANSIT BRIDGES PORTS HAZARDOUS WASTE SCHOOLS DRINKING WATER RAIL DRINKING WATER STORMWATER WASTEWATER C D CD+ D D+ D C+ DCD+ D BB D+ D D+ SOURCE: ASCE 2021 Report Card for America's Infrastructure Electronic copy available at: https://ssrn.com/abstract=4722017 4 | TMI Brief | More than Roads and Bridges | tminstituteldf.org To appreciate the importance of roads and bridges for African Americans, it is useful to look at Mississippi, which is the state with the largest share of African American residents,8 at nearly 40%.9 ASCE gives the nation’s roads a D grade and the nation’s bridges a C grade.10 Mississippi’s roads and bridges are considerably worse than the national average, with both rated D-minus.11 ASCE finds that only 24% of Mississippi’s major roads and highways are in good condition. Forty-three percent are in poor condition, and the remaining 33% are in mediocre or fair condition.12 Bad roads impose costs on motorists. For example, in Southaven, Mississippi, ASCE estimates that damage from bad roads costs the average driver $1,870 a year.13 This amounts to 6% of the median household income for Black Mississippians, and 3% for White residents of the state.14 ASCE values the lost time due to drivers being stuck in traffic in Southaven at an additional $1,080 per driver.15 Many Americans would struggle to pay for a vehicle repair bill of $1,870—or even half as much.16 For Black Mississippians, who have lower incomes than both average Americans and White Mississippians 17 the struggle is likely to be considerably harder.18 These repair bills could easily cause lasting damage to Black households in the state. When people are unable to use their vehicles, there is considerable hardship because, for much of America, Mississippi included, many day-to-day activities Roads and Bridges: Costly and Unsafe MISSISSIPPI’S MAJOR ROADS AND HIGHWAYS CONDITION 24% 43% 33% GOOD POOR FAIR TMI BRIEFS AUGUST 2021 Electronic copy available at: https://ssrn.com/abstract=4722017 5 | TMI Brief | More than Roads and Bridges | tminstituteldf.org condition, and 9% of them need substantial repairs.20 Over 400 Mississippi bridges have been closed because they are unsafe. There are many weight-restricted bridges that cannot support a load heavier than a pickup truck.21 As illustrated, roads and bridges are important to African Americans, but these are not their only important infrastructure needs. require access to a private vehicle. The loss of access to a vehicle could lead to the loss of a job, the inability to access health care, or the inability to vote. Individuals might need to turn to high-interest loans to pay for repairs, leading to substantial debt. Alternatively, individuals might be forced to drive an unsafe vehicle and put their health and the health of others at risk. There is another health risk from Mississippi’s bad roads. Mississippi has one of the highest automotive fatality rates in the country. The state’s bad roads are implicated in about a third of the deaths.19 As mentioned above, Mississippi’s bridges also received a D-minus grade. Among the reasons Mississippi’s bridges earn such a poor grade is because only 63% of them are in good condition. More than a quarter of them (28%) are in fair MISSISSIPPI’S BRIDGES HAVE BEEN CLOSED BECAUSE THEY ARE UNSAFE Lawrence Sawyer/Getty Images Electronic copy available at: https://ssrn.com/abstract=4722017 6 | TMI Brief | More than Roads and Bridges | tminstituteldf.org While Black people do not comprise a large percentage of the population of Texas, by the numbers, more Black people live in Texas than in any other state.22 This year, a severe winter storm shut down the electrical grid in Texas, causing many people to go without heat and water for several days.23 This caused a severe crisis, resulting in almost 200 deaths, including people freezing to death, dying from carbon monoxide poisoning when they were forced to rely on dangerous sources of heat, and people dying when their medical devices failed, or they were unable to get life-saving medical treatment.24 The Houston Chronicle reported that [t]he deaths come from 57 counties in all regions of the state but are disproportionately centered on the Houston area, which at times during the crisis accounted for nearly half of all power outages. Of the known ages, races and ethnicities of the victims, 74 percent were people of color. Half were at least 65. Six were children.25 Energy: The Need to Move Away from Fossil Fuels TMI BRIEFS AUGUST 2021 HOUSTON, Feb. 15, 2021 -- A highway is closed due to snow and ice in Houston, Texas, the United States, on Feb. 15, 2021. Up to 2.5 million customers were without power in the U.S. state of Texas Monday morning as the state's power generation capacity is impacted by an ongoing winter storm brought by Arctic blast. Photo by Chengyue Lao/Xinhua via Getty Images Electronic copy available at: https://ssrn.com/abstract=4722017 7 | TMI Brief | More than Roads and Bridges | tminstituteldf.org The Texas blackout during a severe winter storm is a foreshadowing of future catastrophes, as climate change will bring more extreme weather.26 Power failures have increased by more than 60% across the nation since 2015.27 A sustained power failure during a heatwave could be more deadly than one during extremely cold weather.28 Already, in early June 2021, the Electric Reliability Council of Texas urged Texans “to turn down thermostats and cut back electricity use” after the reserve of available electricity had shrunk to near critical levels.29 Our energy systems—our engines and our power plants—mainly rely on fossil fuels that produce greenhouse gases that lead to climate change. Climate change causes extreme weather events that are expected to exceed the capacity of our infrastructure.30 To address this problem, we need to move away from fossils fuels to help limit the damage from climate change,31 and we need to design our infrastructure with the awareness that weather that used to be seen as extreme will be increasingly normal. 32 Climate change will be more harmful to African Americans. The negative economic impact from climate change is expected to be most severe in the Southern United States, where the Black population is concentrated.33 Additionally, White Americans have greater wealth to endure natural disasters stemming from climate change,34 and the requirements for receiving government aid in disaster areas are structured in ways to disproportionately benefit wealthy White homeowners.35 Consequently, researchers are finding that natural disasters widen existing inequalities.36 While there is much damage from climate change expected in the future, African Americans have been living with the harm from the pollution and toxins from burning fossil fuels for generations. African Americans are more likely to live near fossil-fuel power plants, and they are “exposed to 1.5 times as much of the sooty pollution that comes from burning fossil fuels as the population at large.”37 Exposure to fossil-fuel pollutants increases the risk of preterm births, asthma, cancer, and other ailments.38 Moving to clean renewable energy will bring significant health benefits to African Americans.39 TMI BRIEFS AUGUST 2021 Climate change will be more harmful to African Americans. ","Give an answer using only the context provided. Can you provide a summary of the key points discussed in the document segment given, regarding infrastructure inequity and its impact on racial disparities? It should be obvious that a broad and deep investment in the nation’s long-neglected and now failing infrastructure is necessary to ensure the United States continues to be a leading, prosperous democracy among nations. A sound infrastructure helps us all – individuals, communities, businesses, and government— urban and rural. For those of us who have been long disadvantaged in this nation through structural racism and discrimination, however, a sound infrastructure in every community is especially critical as a bulwark against the pernicious harms of discrimination and segregation. Having a solid infrastructure on which everyone stands helps counter structural inequities driven by segregation and longstanding differences in investments in communities based on race. Unequal investment is one of two types of inequities stemming from our historic and current infrastructure policies and practices. There is inequity directly via unequal and inadequate investments in Black communities, and there is also an indirect inequity because the harm from failing infrastructure is more severe for Black communities. Black communities are disproportionately low-wealth communities, and people with little wealth commonly lack the resources to protect themselves and to recover quickly from disasters resulting from infrastructure failures. When we fail to make adequate infrastructure investments, we subject African Americans to high risks of harm from infrastructure failures. This brief provides an overview of the need for a broad range of infrastructure investments and provides examples of both types of inequities. While it focuses on African Americans, it should be clear that other groups, particularly Latinos, Native Americans, and low-wealth individuals, are also disproportionately harmed by our failure to invest adequately in America’s infrastructure. A Comprehensive Approach to Sound Infrastructure Is an Important Counter to Historic Racial Inequity TMI BRIEFS AUGUST 2021 MORE THAN ROADS AND BRIDGES Electronic copy available at: https://ssrn.com/abstract=4722017 2 | TMI Brief | More than Roads and Bridges | tminstituteldf.org When people hear the word “infrastructure,” they often think of roads and bridges. There is no question that roads and bridges are infrastructure, but as civil rights leaders have urged the nation to recognize, infrastructure entails far more than just these two things. Some argue that infrastructure only encompasses roads, bridges, tunnels, and railroads and while those are all vital, this definition is woefully inadequate. Infrastructure includes sewer systems, water lines, waste facilities, and telecommunications. It also includes parks, housing, public squares, economic centers, and schools.1 Every four years, the American Society of Civil Engineers (ASCE) assesses America’s infrastructure and produces a report card. ASCE evaluates 17 types of infrastructure and is beginning to recognize the importance of broadband.2 Roads and bridges are only two of the 17. We argue for an even broader conception of infrastructure than ASCE and recognize that each form of infrastructure is important to the future of the United States broadly, but also of particular importance to African Americans. We will illustrate this point by focusing on ten types of infrastructure considered by ASCE and their relevance for African Americans. We will also address two types of infrastructure not evaluated by ACSE: affordable housing and the care economy. Roads and Bridges, and a Whole Lot More TMI BRIEFS AUGUST 2021 Electronic copy available at: https://ssrn.com/abstract=4722017 3 | TMI Brief | More than Roads and Bridges | tminstituteldf.org DAMS ASCE’s current overall rating of America’s infrastructure is a C-minus.3 A C grade means that the infrastructure “shows general signs of deterioration and requires attention.”4 A D grade means that the infrastructure has “many elements approaching the end of their service life.”5 A C-minus grade, therefore, suggests that much of America’s infrastructure is deteriorating, and some of it is near the end of its service life. ASCE estimates that the country needs to invest $2.59 trillion over the next ten years to bring all of the country’s infrastructure to a good condition.6 This expenditure is an investment that will contribute to future economic growth and not an expense that will simply drain our resources. If we fail to make these investments by 2039, ASCE estimates that our economy will lose $10 trillion in GDP, more than three million jobs, and $2.4 trillion in exports.7 These numbers do not account for the lives lost, the life expectancies reduced, and the suffering that is caused by poor infrastructure. AVIATION D+ LEVEES ENERGY ROADS PUBLIC PARKS INLAND WATERWAYS SOLID WASTE TRANSIT BRIDGES PORTS HAZARDOUS WASTE SCHOOLS DRINKING WATER RAIL DRINKING WATER STORMWATER WASTEWATER C D CD+ D D+ D C+ DCD+ D BB D+ D D+ SOURCE: ASCE 2021 Report Card for America's Infrastructure Electronic copy available at: https://ssrn.com/abstract=4722017 4 | TMI Brief | More than Roads and Bridges | tminstituteldf.org To appreciate the importance of roads and bridges for African Americans, it is useful to look at Mississippi, which is the state with the largest share of African American residents,8 at nearly 40%.9 ASCE gives the nation’s roads a D grade and the nation’s bridges a C grade.10 Mississippi’s roads and bridges are considerably worse than the national average, with both rated D-minus.11 ASCE finds that only 24% of Mississippi’s major roads and highways are in good condition. Forty-three percent are in poor condition, and the remaining 33% are in mediocre or fair condition.12 Bad roads impose costs on motorists. For example, in Southaven, Mississippi, ASCE estimates that damage from bad roads costs the average driver $1,870 a year.13 This amounts to 6% of the median household income for Black Mississippians, and 3% for White residents of the state.14 ASCE values the lost time due to drivers being stuck in traffic in Southaven at an additional $1,080 per driver.15 Many Americans would struggle to pay for a vehicle repair bill of $1,870—or even half as much.16 For Black Mississippians, who have lower incomes than both average Americans and White Mississippians 17 the struggle is likely to be considerably harder.18 These repair bills could easily cause lasting damage to Black households in the state. When people are unable to use their vehicles, there is considerable hardship because, for much of America, Mississippi included, many day-to-day activities Roads and Bridges: Costly and Unsafe MISSISSIPPI’S MAJOR ROADS AND HIGHWAYS CONDITION 24% 43% 33% GOOD POOR FAIR TMI BRIEFS AUGUST 2021 Electronic copy available at: https://ssrn.com/abstract=4722017 5 | TMI Brief | More than Roads and Bridges | tminstituteldf.org condition, and 9% of them need substantial repairs.20 Over 400 Mississippi bridges have been closed because they are unsafe. There are many weight-restricted bridges that cannot support a load heavier than a pickup truck.21 As illustrated, roads and bridges are important to African Americans, but these are not their only important infrastructure needs. require access to a private vehicle. The loss of access to a vehicle could lead to the loss of a job, the inability to access health care, or the inability to vote. Individuals might need to turn to high-interest loans to pay for repairs, leading to substantial debt. Alternatively, individuals might be forced to drive an unsafe vehicle and put their health and the health of others at risk. There is another health risk from Mississippi’s bad roads. Mississippi has one of the highest automotive fatality rates in the country. The state’s bad roads are implicated in about a third of the deaths.19 As mentioned above, Mississippi’s bridges also received a D-minus grade. Among the reasons Mississippi’s bridges earn such a poor grade is because only 63% of them are in good condition. More than a quarter of them (28%) are in fair MISSISSIPPI’S BRIDGES HAVE BEEN CLOSED BECAUSE THEY ARE UNSAFE Lawrence Sawyer/Getty Images Electronic copy available at: https://ssrn.com/abstract=4722017 6 | TMI Brief | More than Roads and Bridges | tminstituteldf.org While Black people do not comprise a large percentage of the population of Texas, by the numbers, more Black people live in Texas than in any other state.22 This year, a severe winter storm shut down the electrical grid in Texas, causing many people to go without heat and water for several days.23 This caused a severe crisis, resulting in almost 200 deaths, including people freezing to death, dying from carbon monoxide poisoning when they were forced to rely on dangerous sources of heat, and people dying when their medical devices failed, or they were unable to get life-saving medical treatment.24 The Houston Chronicle reported that [t]he deaths come from 57 counties in all regions of the state but are disproportionately centered on the Houston area, which at times during the crisis accounted for nearly half of all power outages. Of the known ages, races and ethnicities of the victims, 74 percent were people of color. Half were at least 65. Six were children.25 Energy: The Need to Move Away from Fossil Fuels TMI BRIEFS AUGUST 2021 HOUSTON, Feb. 15, 2021 -- A highway is closed due to snow and ice in Houston, Texas, the United States, on Feb. 15, 2021. Up to 2.5 million customers were without power in the U.S. state of Texas Monday morning as the state's power generation capacity is impacted by an ongoing winter storm brought by Arctic blast. Photo by Chengyue Lao/Xinhua via Getty Images Electronic copy available at: https://ssrn.com/abstract=4722017 7 | TMI Brief | More than Roads and Bridges | tminstituteldf.org The Texas blackout during a severe winter storm is a foreshadowing of future catastrophes, as climate change will bring more extreme weather.26 Power failures have increased by more than 60% across the nation since 2015.27 A sustained power failure during a heatwave could be more deadly than one during extremely cold weather.28 Already, in early June 2021, the Electric Reliability Council of Texas urged Texans “to turn down thermostats and cut back electricity use” after the reserve of available electricity had shrunk to near critical levels.29 Our energy systems—our engines and our power plants—mainly rely on fossil fuels that produce greenhouse gases that lead to climate change. Climate change causes extreme weather events that are expected to exceed the capacity of our infrastructure.30 To address this problem, we need to move away from fossils fuels to help limit the damage from climate change,31 and we need to design our infrastructure with the awareness that weather that used to be seen as extreme will be increasingly normal. 32 Climate change will be more harmful to African Americans. The negative economic impact from climate change is expected to be most severe in the Southern United States, where the Black population is concentrated.33 Additionally, White Americans have greater wealth to endure natural disasters stemming from climate change,34 and the requirements for receiving government aid in disaster areas are structured in ways to disproportionately benefit wealthy White homeowners.35 Consequently, researchers are finding that natural disasters widen existing inequalities.36 While there is much damage from climate change expected in the future, African Americans have been living with the harm from the pollution and toxins from burning fossil fuels for generations. African Americans are more likely to live near fossil-fuel power plants, and they are “exposed to 1.5 times as much of the sooty pollution that comes from burning fossil fuels as the population at large.”37 Exposure to fossil-fuel pollutants increases the risk of preterm births, asthma, cancer, and other ailments.38 Moving to clean renewable energy will bring significant health benefits to African Americans.39 TMI BRIEFS AUGUST 2021 Climate change will be more harmful to African Americans. ",Unknown,Find & Summarize,Text Transformation Draw your answer based solely on the text provided in the prompt.,Summarize this text about Vietnam's nonmarket economy status.,"Shortly after extending normal trade relations (NTR) status to Vietnam in 2001, the United States designated Vietnam as a “nonmarket economy” (NME) for the purposes of antidumping (AD) and countervailing duty (CVD) investigations. The government of Vietnam has long sought to remove the designation, arguing it may hinder closer bilateral ties. During President Joseph Biden’s September 2023 visit to Hanoi, where he and then-Communist Party of Vietnam (CPV) Secretary-General Nguyen Phu Trong elevated the U.S.-Vietnam relationship to a “comprehensive strategic partnership,” Biden agreed to review Vietnam’s request to review its NME status. The following month, the Department of Commerce initiated an official review. During the review period, some Members of Congress raised concerns over whether Vietnam meets the conditions to be designated as a market economy. On August 2, 2024, Commerce announced its decision to sustain Vietnam’s NME designation, citing the Vietnamese government’s involvement in the economy, despite “substantive reforms,” as a factor for not lifting the designation. U.S.-Vietnam Relations Since 2010, the United States and Vietnam have forged a strategic partnership on many regional security and economic issues, prompted in part by shared concerns about China’s increased assertiveness in the region, and by burgeoning economic links. Over the last decade, Vietnam has become a major manufacturing center and one of the United States’ top ten trading partners. Top U.S. imports from Vietnam include consumer electronics, furniture, semiconductors and parts, apparel, and footwear. Vietnam is the second-largest source of U.S. apparel imports, after China. The September 2023 upgrade in relations was accompanied by several initiatives, including U.S. pledges to support Vietnam's development of its semiconductor industry (including with $2 million in U.S. government funds) and digital infrastructure ($12 million). Additionally, agreements under the U.S.-led, 14-country Indo-Pacific Economic Framework for Prosperity (IPEF) negotiations, which includes Vietnam, may further deepen U.S.-Vietnam economic ties. Under the doi moi (renovation) economic reforms that began in 1986, the Vietnamese government abandoned many aspects of central state planning, cut subsidies to state enterprises, reformed the price system, and opened the country to foreign direct investment (FDI). In a 2022 report, the Organisation for Economic Cooperation and Development (OECD) noted that the number of state-owned enterprises (SOEs) has decreased significantly, but SOEs still account for roughly 30% of the GDP. The U.S. government also actively monitors Vietnam’s currency practices, which were subject to U.S. Congressional Research Service https://crsreports.congress.gov IN12326 CRS INSIGHT Prepared for Members and Committees of Congress Congressional Research Service 2 investigations before the countries reached a bilateral agreement in July 2021. Vietnamese authorities limit daily fluctuations in the Vietnamese dong to 5% against the dollar, adjusted from 3% in 2022. Nonmarket Economy Status under U.S. Trade Laws The Commerce Department has the authority to designate countries as NMEs for the purpose of U.S. AD/CVD laws. An NME is a country that Commerce determines “does not operate on market principles of cost or pricing structures, so that sales of merchandise in such country do not reflect the fair value of merchandise.” In designating a country as an NME, Commerce considers the extent to which (1) the country’s currency is convertible; (2) its wage rates result from free bargaining between labor and management; (3) joint ventures or other foreign investment are permitted; (4) the government owns or controls the means of production; and (5) the government controls the allocation of resources and price and output decisions. Commerce may also consider other factors that it considers appropriate. An NME designation remains in effect until revoked by Commerce. There are currently 12 countries, including Vietnam, designated as NMEs. While considering whether an NME is engaged in dumping, Commerce uses factors of production from a comparable market economy country to calculate the normal value for merchandise alleged to have been dumped in the United States. An affirmative NME designation may lead to higher tariffs. These methods have raised concerns at the WTO that a subsidy may be offset twice when both antidumping and countervailing duties are applied to NME products. After Commerce published the notice initiating the review of Vietnam’s NME status, interested parties submitted comments to Regulations.gov and Commerce held a public hearing on May 8, 2024. Some U.S. manufacturing groups urged Commerce to maintain Vietnam’s NME status, arguing that Vietnam has not met the statutory conditions (above) to lift the NME designation. Others promoted removal of the designation, citing the country’s overall reforms, including openness to foreign investment, free bargaining of wages, and currency convertibility. Considerations for Congress In conducting oversight, Congress may consider the potential implications of an NME designation on U.S.-Vietnam trade, and overall bilateral relations. According to press accounts, Vietnamese government officials have expressed regret over Commerce’s decision to sustain Vietnam’s NME status and some analysts have stated that the decision might hinder bilateral relations. Congress may consider the extent to which Vietnam’s economic reforms might be sufficient to satisfy the statutory conditions should Vietnam submit future requests for review. During the review period, some Members of Congress argued that Vietnam does not meet the conditions, including the prominence of state-owned enterprises (SOE) in Vietnam’s economy, “severe deficiencies” in Vietnam’s labor laws, and potential harm to U.S. industries and workers. The Commerce Department stated in its decision that despite Vietnam’s market-oriented reforms, the government “remains entrenched in many aspects of the Vietnamese economy,” including foreign exchange intervention, control of labor unions, and “significant state ownership and control over the means of production.” Other options for Congress might include linking the decision to other policy areas, such as Vietnam’s human rights records, which some observers say is poor and worsening, and/or foreign assistance. The Vietnam Human Rights Act (H.R. 3172), which would prohibit U.S. assistance to Vietnam's Ministry of Public Security and require the executive branch to put more emphasis on ensuring internet freedom in Vietnam, could be a potential vehicle for Members of Congress who would like to maintain the NME status irrespective of economic policy changes.","system instruction: Draw your answer based solely on the text provided in the prompt. question: Summarize this text about Vietnam's nonmarket economy status. context block: Shortly after extending normal trade relations (NTR) status to Vietnam in 2001, the United States designated Vietnam as a “nonmarket economy” (NME) for the purposes of antidumping (AD) and countervailing duty (CVD) investigations. The government of Vietnam has long sought to remove the designation, arguing it may hinder closer bilateral ties. During President Joseph Biden’s September 2023 visit to Hanoi, where he and then-Communist Party of Vietnam (CPV) Secretary-General Nguyen Phu Trong elevated the U.S.-Vietnam relationship to a “comprehensive strategic partnership,” Biden agreed to review Vietnam’s request to review its NME status. The following month, the Department of Commerce initiated an official review. During the review period, some Members of Congress raised concerns over whether Vietnam meets the conditions to be designated as a market economy. On August 2, 2024, Commerce announced its decision to sustain Vietnam’s NME designation, citing the Vietnamese government’s involvement in the economy, despite “substantive reforms,” as a factor for not lifting the designation. U.S.-Vietnam Relations Since 2010, the United States and Vietnam have forged a strategic partnership on many regional security and economic issues, prompted in part by shared concerns about China’s increased assertiveness in the region, and by burgeoning economic links. Over the last decade, Vietnam has become a major manufacturing center and one of the United States’ top ten trading partners. Top U.S. imports from Vietnam include consumer electronics, furniture, semiconductors and parts, apparel, and footwear. Vietnam is the second-largest source of U.S. apparel imports, after China. The September 2023 upgrade in relations was accompanied by several initiatives, including U.S. pledges to support Vietnam's development of its semiconductor industry (including with $2 million in U.S. government funds) and digital infrastructure ($12 million). Additionally, agreements under the U.S.-led, 14-country Indo-Pacific Economic Framework for Prosperity (IPEF) negotiations, which includes Vietnam, may further deepen U.S.-Vietnam economic ties. Under the doi moi (renovation) economic reforms that began in 1986, the Vietnamese government abandoned many aspects of central state planning, cut subsidies to state enterprises, reformed the price system, and opened the country to foreign direct investment (FDI). In a 2022 report, the Organisation for Economic Cooperation and Development (OECD) noted that the number of state-owned enterprises (SOEs) has decreased significantly, but SOEs still account for roughly 30% of the GDP. The U.S. government also actively monitors Vietnam’s currency practices, which were subject to U.S. Congressional Research Service https://crsreports.congress.gov IN12326 CRS INSIGHT Prepared for Members and Committees of Congress Congressional Research Service 2 investigations before the countries reached a bilateral agreement in July 2021. Vietnamese authorities limit daily fluctuations in the Vietnamese dong to 5% against the dollar, adjusted from 3% in 2022. Nonmarket Economy Status under U.S. Trade Laws The Commerce Department has the authority to designate countries as NMEs for the purpose of U.S. AD/CVD laws. An NME is a country that Commerce determines “does not operate on market principles of cost or pricing structures, so that sales of merchandise in such country do not reflect the fair value of merchandise.” In designating a country as an NME, Commerce considers the extent to which (1) the country’s currency is convertible; (2) its wage rates result from free bargaining between labor and management; (3) joint ventures or other foreign investment are permitted; (4) the government owns or controls the means of production; and (5) the government controls the allocation of resources and price and output decisions. Commerce may also consider other factors that it considers appropriate. An NME designation remains in effect until revoked by Commerce. There are currently 12 countries, including Vietnam, designated as NMEs. While considering whether an NME is engaged in dumping, Commerce uses factors of production from a comparable market economy country to calculate the normal value for merchandise alleged to have been dumped in the United States. An affirmative NME designation may lead to higher tariffs. These methods have raised concerns at the WTO that a subsidy may be offset twice when both antidumping and countervailing duties are applied to NME products. After Commerce published the notice initiating the review of Vietnam’s NME status, interested parties submitted comments to Regulations.gov and Commerce held a public hearing on May 8, 2024. Some U.S. manufacturing groups urged Commerce to maintain Vietnam’s NME status, arguing that Vietnam has not met the statutory conditions (above) to lift the NME designation. Others promoted removal of the designation, citing the country’s overall reforms, including openness to foreign investment, free bargaining of wages, and currency convertibility. Considerations for Congress In conducting oversight, Congress may consider the potential implications of an NME designation on U.S.-Vietnam trade, and overall bilateral relations. According to press accounts, Vietnamese government officials have expressed regret over Commerce’s decision to sustain Vietnam’s NME status and some analysts have stated that the decision might hinder bilateral relations. Congress may consider the extent to which Vietnam’s economic reforms might be sufficient to satisfy the statutory conditions should Vietnam submit future requests for review. During the review period, some Members of Congress argued that Vietnam does not meet the conditions, including the prominence of state-owned enterprises (SOE) in Vietnam’s economy, “severe deficiencies” in Vietnam’s labor laws, and potential harm to U.S. industries and workers. The Commerce Department stated in its decision that despite Vietnam’s market-oriented reforms, the government “remains entrenched in many aspects of the Vietnamese economy,” including foreign exchange intervention, control of labor unions, and “significant state ownership and control over the means of production.” Other options for Congress might include linking the decision to other policy areas, such as Vietnam’s human rights records, which some observers say is poor and worsening, and/or foreign assistance. The Vietnam Human Rights Act (H.R. 3172), which would prohibit U.S. assistance to Vietnam's Ministry of Public Security and require the executive branch to put more emphasis on ensuring internet freedom in Vietnam, could be a potential vehicle for Members of Congress who would like to maintain the NME status irrespective of economic policy changes.",Legal,Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",How are big pharmaceutical companies doing revenue-wise this year? I'm particularly interested in how this relates to their profits. Please keep your response under 200 words.,"Key takeaways Macro worries meet AI wonderwall. Stocks have managed to climb a wall of macro worries, thanks to largely solid earnings that we believe can expand beyond AI beneficiaries and continue to support prices. As Q3 begins, we look for: Greater dispersion as earnings growth broadens Alpha capacity in stocks chosen ― and avoided Fresh reason for an active bent in U.S. large caps U.S. stocks held onto gains in the second quarter, even as concerns over stubborn inflation, strong economic data and reduced expectations for Fed rate cuts sprinkled cold water on the Q1 hot streak. Markets found support in relatively strong Q1 earnings, led primarily by a small group of high-flying mega-cap stocks. We see the earnings-growth gap between these leaders and the rest closing later this year, as shown below. This presents a compelling opportunity for stock selection, as earnings feed valuations. While the “Magnificent 7” mega-caps were priced at roughly 34x earnings as of late May, the other 493 stocks in the S&P 500 traded at a much less demanding 17x. Yet a still-strong earnings profile means many of the top stocks aren’t necessarily expensive relative to their growth prospects. In all cases, individual analysis is key to ensuring share prices are well aligned to company fundamentals. A narrowing gap and widening opportunity set Consensus analyst expectations for year-over-year earnings growth, 2023-2024 Taking stock equity market outlook: Chart showing S&P 500 earnings estimates for 2024. Source: BlackRock Fundamental Equities, with data from FactSet as of May 30, 2024. Chart shows consensus analyst estimates for year-over-year earnings per share (EPS) growth of the “Magnificent 7” mega-cap stocks in the S&P 500 Index and the remaining constituents. Past performance is not indicative of current or future results. Indexes are unmanaged. It is not possible to invest directly in an index. Parsing a ‘stock picker’s paradise’ Macro factors (inflation, interest rates, etc.) still hold sway over daily moves at the broad index level, but we see company earnings growth as the catalyst for increased stock-level dispersion that could create mean reversion between the market’s leaders and laggards. Notably, while we see the broad S&P 500 catching up to the Mag 7 toward the fourth quarter of this year, earnings growth looks particularly interesting for value stocks once you remove the index’s AI-supercharged top stock, which has heavily skewed the averages. Under this analysis, earnings growth for the Russell 1000 Value Index takes the lead by the third quarter. This is not to suggest an outright preference for value stocks, though the valuation gap between value and growth is quite wide today. It does, however, indicate there is some stored upside in value stocks that investors can look to exploit. Doing so may require looking to a style-pure value manager given that the indexes today are growth dominated. As shown below, the broad market is comprised of only 21% value names. The Russell 1000 Value Index belies its label at 57% core and growth, having experienced a 36% decline in value exposure over the past 25 years. True value is hard to find U.S. stock market style exposures, 2024 Taking stock equity market outlook: Chart showing the style exposures of three major U.S. market indexes. Source: BlackRock Fundamental Equities, with data Morningstar as of April 30, 2024. Chart shows the composition, by style, of three major U.S. stock indices. Indexes are unmanaged. It is not possible to invest directly in an index. “ A market in which earnings growth broadens beyond the prevailing leaders ― creating dispersion in the process ― is a stock picker’s paradise. ” Alpha potential in opting out … We often note the merits of skilled stock selection in the pursuit of alpha. And avoiding underperformers can be as important as choosing outperformers in this pursuit of benchmark-beating returns. What are we avoiding today? Despite an overall preference for healthcare, we are skirting the big U.S. drug makers. Large-cap pharmaceutical companies face an inherent dilemma ― in other industries, products are evergreen once deployed, but pharmaceuticals have the life of a patent cycle. When those patents expire and cheaper generics come to market, revenues inevitably decline. We see several major U.S. pharma companies losing patent protection on up to 70% of their revenue by 2030. Estimates suggest the industry could face a $100 billion drop in revenue as a result. Profits are also at risk of disproportionate decline, as it’s typically the oldest and highest-margin products that are losing patent protection. At the same time, U.S. pharma is confronted with price pressure related to the Inflation Reduction Act (IRA), which gives Medicare the authority to begin negotiating prices on select drugs. That process is underway, with results (and potential price reductions) due in September. The notable exception to our U.S. pharma aversion is the manufacturers of the newer GLP-1 “diabesity” drugs, which we believe are just beginning their success journey. Several of our teams within BlackRock Fundamental Equities are also trimming positions in financials, as interest rate cuts tend to affect bank margins, and parts of the consumer sectors, where the end of pandemic-era excess savings and high inflation are beginning to show up in greater spending discipline. Credit card data reveals an uptick in delinquency rates at lower income levels, increasing loss rates for financials. In technology, we see reductions in software and services offset by buying in semiconductors, where generative AI needs are crowding out other technology spending. … and leaning in Beyond the buying in semiconductors, we see a platform-level bullishness around AI that is manifesting in new ways to tap into the megatrend. Our investors are finding opportunities outside of the accepted AI winners. Examples include companies that own data and those that provide memory for storing it; power companies and industrials that supply into AI infrastructure needs, including those that equip data center cooling systems; and, more recently, opportunities in AI-ready PCs that are set to be introduced this year. Several of our active stock pickers are adding to positions in healthcare, with a preference for healthcare equipment and services. We have also been adding to communication services, including media and entertainment. Others are eyeing value in defensive areas of the market that were left behind in the cyclical rally since 2023. Utilities is one of these sectors. It is priced at a discount to the broad market and, we believe, poised for re-rating. The transition to renewable forms of energy will compel upgrades to existing power grids and push up private market electricity rates in the process, while the power required by a growing field of AI data centers is set to fuel a meaningful spike in energy demand. Underappreciated alpha potential in U.S. large caps In our full quarterly outlook, we challenge a long-held portfolio construction “truism” that asserts exposure to large-cap U.S. stocks is best achieved via passive index-tracking products. The argument suggests the U.S. stock market is so efficient and transparent that there is little alpha to be captured via active stock selection. We disagree and offer analysis showing that a combination of decent excess returns from top managers plus a large U.S. representation in global indexes makes the total alpha opportunity in U.S. large caps the greatest on the global stage. And even as median managers may underperform, we see growing opportunity for skilled managers to add alpha given our outlook for greater earnings and valuation dispersion in what we have described as a new era for equity investing.","""================ ======= Key takeaways Macro worries meet AI wonderwall. Stocks have managed to climb a wall of macro worries, thanks to largely solid earnings that we believe can expand beyond AI beneficiaries and continue to support prices. As Q3 begins, we look for: Greater dispersion as earnings growth broadens Alpha capacity in stocks chosen ― and avoided Fresh reason for an active bent in U.S. large caps U.S. stocks held onto gains in the second quarter, even as concerns over stubborn inflation, strong economic data and reduced expectations for Fed rate cuts sprinkled cold water on the Q1 hot streak. Markets found support in relatively strong Q1 earnings, led primarily by a small group of high-flying mega-cap stocks. We see the earnings-growth gap between these leaders and the rest closing later this year, as shown below. This presents a compelling opportunity for stock selection, as earnings feed valuations. While the “Magnificent 7” mega-caps were priced at roughly 34x earnings as of late May, the other 493 stocks in the S&P 500 traded at a much less demanding 17x. Yet a still-strong earnings profile means many of the top stocks aren’t necessarily expensive relative to their growth prospects. In all cases, individual analysis is key to ensuring share prices are well aligned to company fundamentals. A narrowing gap and widening opportunity set Consensus analyst expectations for year-over-year earnings growth, 2023-2024 Taking stock equity market outlook: Chart showing S&P 500 earnings estimates for 2024. Source: BlackRock Fundamental Equities, with data from FactSet as of May 30, 2024. Chart shows consensus analyst estimates for year-over-year earnings per share (EPS) growth of the “Magnificent 7” mega-cap stocks in the S&P 500 Index and the remaining constituents. Past performance is not indicative of current or future results. Indexes are unmanaged. It is not possible to invest directly in an index. Parsing a ‘stock picker’s paradise’ Macro factors (inflation, interest rates, etc.) still hold sway over daily moves at the broad index level, but we see company earnings growth as the catalyst for increased stock-level dispersion that could create mean reversion between the market’s leaders and laggards. Notably, while we see the broad S&P 500 catching up to the Mag 7 toward the fourth quarter of this year, earnings growth looks particularly interesting for value stocks once you remove the index’s AI-supercharged top stock, which has heavily skewed the averages. Under this analysis, earnings growth for the Russell 1000 Value Index takes the lead by the third quarter. This is not to suggest an outright preference for value stocks, though the valuation gap between value and growth is quite wide today. It does, however, indicate there is some stored upside in value stocks that investors can look to exploit. Doing so may require looking to a style-pure value manager given that the indexes today are growth dominated. As shown below, the broad market is comprised of only 21% value names. The Russell 1000 Value Index belies its label at 57% core and growth, having experienced a 36% decline in value exposure over the past 25 years. True value is hard to find U.S. stock market style exposures, 2024 Taking stock equity market outlook: Chart showing the style exposures of three major U.S. market indexes. Source: BlackRock Fundamental Equities, with data Morningstar as of April 30, 2024. Chart shows the composition, by style, of three major U.S. stock indices. Indexes are unmanaged. It is not possible to invest directly in an index. “ A market in which earnings growth broadens beyond the prevailing leaders ― creating dispersion in the process ― is a stock picker’s paradise. ” Alpha potential in opting out … We often note the merits of skilled stock selection in the pursuit of alpha. And avoiding underperformers can be as important as choosing outperformers in this pursuit of benchmark-beating returns. What are we avoiding today? Despite an overall preference for healthcare, we are skirting the big U.S. drug makers. Large-cap pharmaceutical companies face an inherent dilemma ― in other industries, products are evergreen once deployed, but pharmaceuticals have the life of a patent cycle. When those patents expire and cheaper generics come to market, revenues inevitably decline. We see several major U.S. pharma companies losing patent protection on up to 70% of their revenue by 2030. Estimates suggest the industry could face a $100 billion drop in revenue as a result. Profits are also at risk of disproportionate decline, as it’s typically the oldest and highest-margin products that are losing patent protection. At the same time, U.S. pharma is confronted with price pressure related to the Inflation Reduction Act (IRA), which gives Medicare the authority to begin negotiating prices on select drugs. That process is underway, with results (and potential price reductions) due in September. The notable exception to our U.S. pharma aversion is the manufacturers of the newer GLP-1 “diabesity” drugs, which we believe are just beginning their success journey. Several of our teams within BlackRock Fundamental Equities are also trimming positions in financials, as interest rate cuts tend to affect bank margins, and parts of the consumer sectors, where the end of pandemic-era excess savings and high inflation are beginning to show up in greater spending discipline. Credit card data reveals an uptick in delinquency rates at lower income levels, increasing loss rates for financials. In technology, we see reductions in software and services offset by buying in semiconductors, where generative AI needs are crowding out other technology spending. … and leaning in Beyond the buying in semiconductors, we see a platform-level bullishness around AI that is manifesting in new ways to tap into the megatrend. Our investors are finding opportunities outside of the accepted AI winners. Examples include companies that own data and those that provide memory for storing it; power companies and industrials that supply into AI infrastructure needs, including those that equip data center cooling systems; and, more recently, opportunities in AI-ready PCs that are set to be introduced this year. Several of our active stock pickers are adding to positions in healthcare, with a preference for healthcare equipment and services. We have also been adding to communication services, including media and entertainment. Others are eyeing value in defensive areas of the market that were left behind in the cyclical rally since 2023. Utilities is one of these sectors. It is priced at a discount to the broad market and, we believe, poised for re-rating. The transition to renewable forms of energy will compel upgrades to existing power grids and push up private market electricity rates in the process, while the power required by a growing field of AI data centers is set to fuel a meaningful spike in energy demand. Underappreciated alpha potential in U.S. large caps In our full quarterly outlook, we challenge a long-held portfolio construction “truism” that asserts exposure to large-cap U.S. stocks is best achieved via passive index-tracking products. The argument suggests the U.S. stock market is so efficient and transparent that there is little alpha to be captured via active stock selection. We disagree and offer analysis showing that a combination of decent excess returns from top managers plus a large U.S. representation in global indexes makes the total alpha opportunity in U.S. large caps the greatest on the global stage. And even as median managers may underperform, we see growing opportunity for skilled managers to add alpha given our outlook for greater earnings and valuation dispersion in what we have described as a new era for equity investing. https://www.blackrock.com/us/individual/insights/taking-stock-quarterly-outlook ================ ======= How are big pharmaceutical companies doing revenue-wise this year? I'm particularly interested in how this relates to their profits. Please keep your response under 200 words. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Financial,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",Assess how quantum computing will impact existing cryptographic protocols as well as recommend ways the effectiveness of the blockchain system can be guaranteed in the post-quantum world? Analyze the prospects of the new quantum-resistant algorithms; Review the scalability challenges of QKD and explain the policy implications on natural security,"The Challenges of Quantum Computing in Cryptography While quantum computing offers many benefits, it also presents several challenges. One of the most significant challenges is the threat of quantum attacks on current encryption algorithms. As mentioned earlier, Shor's algorithm can break RSA encryption, which is widely used to secure data. Any data encrypted using RSA encryption is vulnerable to quantum attacks [9]. 1. Error Correction: The effects of noise and decoherence on quantum computers make them extremely prone to mistakes. Implementing trustworthy quantum cryptography systems to overcome these mistakes can be extremely difficult. 2. Scalability: Because quantum computing is still in its infancy, the number of qubits that present quantum computing systems can support is constrained. Due to this, scaling quantum cryptography systems to handle bigger data volumes and applications is challenging. Another challenge is developing new encryption algorithms resistant to quantum attacks. This is because current encryption algorithms that are secure against classical attacks may not be secure against quantum attacks. Therefore, researchers are actively developing new quantum-resistant encryption algorithms that can be used in the post-quantum era. D. Policy Implications of Quantum Computing in Cryptography As quantum computing advances, policymakers must carefully consider the national security and critical infrastructure implications. Encryption algorithms are essential for securing military communications, financial transactions, and government data, making it crucial to assess the impact of quantum computing on current encryption standards and develop strategies to address any vulnerabilities. The National Institute of Standards and Technology (NIST) has initiated a standardization process for post- quantum cryptography to address this issue. The goal is to create a portfolio of quantum-resistant algorithms that can be widely implemented in the coming years. This process involves a public competition in which researchers submit their proposed encryption algorithms and undergo a rigorous evaluation. NIST will then select the most promising algorithms for standardization. In addition to the need for quantum-resistant encryption, policymakers must also consider the potential for quantum computing to be used for offensive purposes. A quantum computer could break into secure systems and access sensitive data, which could be detrimental to national security. Therefore, governments must establish policies and regulations to prevent the misuse of quantum computing technology and safeguard against potential threats. E. Social Implications of Quantum Computing in Cryptography The impact of quantum computing on cryptography goes beyond policy and security concerns. It also has social implications that must be considered. For example, if quantum computing can break current encryption algorithms, it could significantly impact individual privacy. Personal information such as medical records, financial data, and online communications could be compromised. Furthermore, developing new quantum-resistant encryption algorithms will require significant investment and research, which could limit access to these technologies. This could widen the digital divide and create disparities in access to secure communication channels, particularly for marginalized communities. In conclusion, quantum computing has the potential to revolutionize cryptography, but it also presents significant challenges. While new cryptographic techniques such as QKD and quantum signature schemes can enhance security, quantum computing can also be used for offensive purposes. Therefore, policymakers and researchers must collaborate to address these challenges and ensure critical infrastructure security and individual privacy in the post-quantum era. III. CRYPTOGRAPHY AND QUANTUM COMPUTING A. Quantum Key Distribution QKD is a method of securely sharing keys between two parties based on the principles of quantum mechanics. This approach takes advantage of the fact that any attempt to intercept the keys will introduce detectable errors. QKD is considered an unconditionally secure key distribution method, making it ideal for sensitive applications. Although QKD is still in the experimental stage, it has shown promising results and is being studied extensively by researchers worldwide. One of the challenges in implementing QKD is the issue of scalability. Current QKD systems are limited regarding the distance they can distribute keys and the number of users they can support [11]. Researchers are exploring new technologies such as quantum repeaters, quantum memories, and quantum routers to overcome this challenge. These technologies will enable the distribution of keys over longer distances and the support of more users, making QKD a viable option for a wide range of applications. B. Quantum-Resistant Cryptography Quantum-resistant cryptography refers to cryptographic techniques designed to be secure against attacks by quantum computers. Quantum computers pose a threat to current cryptographic algorithms like RSA and Elliptic Curve 3 Cryptography (ECC). Hence, new cryptographic techniques that can resist quantum attacks are necessary. Lattice-based cryptography is one of the most promising candidates for post-quantum cryptography and is under extensive research [11]. Code-based cryptography is another well-established approach that has been around for a while. These approaches are believed to provide high security against quantum attacks. However, one of the challenges in developing post- quantum cryptographic algorithms is ensuring that they are efficient and practical for real-world applications. Many of the current post-quantum cryptographic algorithms are computationally intensive, which could make them impractical for use in resource-constrained environments like mobile devices and the Internet of Things (IoT) [13]. To address this challenge, researchers are exploring new approaches to post-quantum cryptography that are efficient and practical while maintaining the security of sensitive information. C. Cryptographic Protocols for Quantum Computing Cryptographic protocols use cryptographic techniques to secure quantum computing systems. These protocols are designed to protect quantum computers from attacks, prevent the tampering of quantum information, and ensure the integrity of quantum cryptographic keys [2]. Examples of cryptographic protocols for quantum computing include quantum secret sharing [12], quantum oblivious transfer, and quantum homomorphic encryption. These protocols are essential for the secure operation of quantum computing systems, and they are being studied extensively by researchers worldwide. Another challenge in developing cryptographic protocols for quantum computing is ensuring they resist attacks by quantum computers. Many current cryptographic protocols are vulnerable to attacks by quantum computers, which could compromise the security of quantum information [2]. To address this issue, researchers are developing new cryptographic protocols resistant to attacks by quantum computers, ensuring that quantum computing systems remain secure. These new cryptographic protocols are being studied extensively by researchers worldwide and can potentially revolutionize how we secure information in the quantum computing era. D. Quantum Cryptography Standards Quantum cryptography standards refer to guidelines defining the requirements for implementing quantum cryptography. These standards ensure that quantum cryptography is implemented securely, reliably, and efficiently [6]. There are several standards for quantum cryptography, including the European Telecommunications Standards Institute (ETSI) and the National Institute of Standards and Technology (NIST) [7]. The previous two organizations work consistently on quantum cryptography standards, as they are developing guidelines and recommendations for implementing quantum cryptography, including post-quantum cryptographic algorithms [8]. Developing quantum cryptography standards will facilitate the adoption of quantum cryptography and ensure that it is implemented securely and efficiently [6]. The development of quantum cryptography standards is essential for the widespread adoption of quantum cryptographic systems. It will ensure that these systems are interoperable and compatible with existing cryptographic protocols. Measures will also help establish trust in quantum cryptographic systems by providing a framework for evaluating and certifying these systems. However, developing standards for quantum cryptography is a complex and challenging task. It requires the collaboration of experts from various fields, including quantum physics, computer science, cryptography and standards development. As quantum cryptographic systems continue to evolve and become more sophisticated, the development of standards will become increasingly important to ensure their security and reliability. E. Quantum Computing and Blockchain Quantum computing has the potential to disrupt the security of blockchain systems. Blockchain is a decentralized, tamper-proof database that records transactions securely and transparently. However, the security of blockchain systems depends on the underlying cryptographic algorithms, which are vulnerable to attacks by quantum computers. To address this issue, researchers are developing post-quantum cryptographic algorithms that can be used to secure blockchain systems.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Assess how quantum computing will impact existing cryptographic protocols as well as recommend ways the effectiveness of the blockchain system can be guaranteed in the post-quantum world? Analyze the prospects of the new quantum-resistant algorithms; Review the scalability challenges of QKD and explain the policy implications on natural security The Challenges of Quantum Computing in Cryptography While quantum computing offers many benefits, it also presents several challenges. One of the most significant challenges is the threat of quantum attacks on current encryption algorithms. As mentioned earlier, Shor's algorithm can break RSA encryption, which is widely used to secure data. Any data encrypted using RSA encryption is vulnerable to quantum attacks [9]. 1. Error Correction: The effects of noise and decoherence on quantum computers make them extremely prone to mistakes. Implementing trustworthy quantum cryptography systems to overcome these mistakes can be extremely difficult. 2. Scalability: Because quantum computing is still in its infancy, the number of qubits that present quantum computing systems can support is constrained. Due to this, scaling quantum cryptography systems to handle bigger data volumes and applications is challenging. Another challenge is developing new encryption algorithms resistant to quantum attacks. This is because current encryption algorithms that are secure against classical attacks may not be secure against quantum attacks. Therefore, researchers are actively developing new quantum-resistant encryption algorithms that can be used in the post-quantum era. D. Policy Implications of Quantum Computing in Cryptography As quantum computing advances, policymakers must carefully consider the national security and critical infrastructure implications. Encryption algorithms are essential for securing military communications, financial transactions, and government data, making it crucial to assess the impact of quantum computing on current encryption standards and develop strategies to address any vulnerabilities. The National Institute of Standards and Technology (NIST) has initiated a standardization process for post- quantum cryptography to address this issue. The goal is to create a portfolio of quantum-resistant algorithms that can be widely implemented in the coming years. This process involves a public competition in which researchers submit their proposed encryption algorithms and undergo a rigorous evaluation. NIST will then select the most promising algorithms for standardization. In addition to the need for quantum-resistant encryption, policymakers must also consider the potential for quantum computing to be used for offensive purposes. A quantum computer could break into secure systems and access sensitive data, which could be detrimental to national security. Therefore, governments must establish policies and regulations to prevent the misuse of quantum computing technology and safeguard against potential threats. E. Social Implications of Quantum Computing in Cryptography The impact of quantum computing on cryptography goes beyond policy and security concerns. It also has social implications that must be considered. For example, if quantum computing can break current encryption algorithms, it could significantly impact individual privacy. Personal information such as medical records, financial data, and online communications could be compromised. Furthermore, developing new quantum-resistant encryption algorithms will require significant investment and research, which could limit access to these technologies. This could widen the digital divide and create disparities in access to secure communication channels, particularly for marginalized communities. In conclusion, quantum computing has the potential to revolutionize cryptography, but it also presents significant challenges. While new cryptographic techniques such as QKD and quantum signature schemes can enhance security, quantum computing can also be used for offensive purposes. Therefore, policymakers and researchers must collaborate to address these challenges and ensure critical infrastructure security and individual privacy in the post-quantum era. III. CRYPTOGRAPHY AND QUANTUM COMPUTING A. Quantum Key Distribution QKD is a method of securely sharing keys between two parties based on the principles of quantum mechanics. This approach takes advantage of the fact that any attempt to intercept the keys will introduce detectable errors. QKD is considered an unconditionally secure key distribution method, making it ideal for sensitive applications. Although QKD is still in the experimental stage, it has shown promising results and is being studied extensively by researchers worldwide. One of the challenges in implementing QKD is the issue of scalability. Current QKD systems are limited regarding the distance they can distribute keys and the number of users they can support [11]. Researchers are exploring new technologies such as quantum repeaters, quantum memories, and quantum routers to overcome this challenge. These technologies will enable the distribution of keys over longer distances and the support of more users, making QKD a viable option for a wide range of applications. B. Quantum-Resistant Cryptography Quantum-resistant cryptography refers to cryptographic techniques designed to be secure against attacks by quantum computers. Quantum computers pose a threat to current cryptographic algorithms like RSA and Elliptic Curve 3 Cryptography (ECC). Hence, new cryptographic techniques that can resist quantum attacks are necessary. Lattice-based cryptography is one of the most promising candidates for post-quantum cryptography and is under extensive research [11]. Code-based cryptography is another well-established approach that has been around for a while. These approaches are believed to provide high security against quantum attacks. However, one of the challenges in developing post- quantum cryptographic algorithms is ensuring that they are efficient and practical for real-world applications. Many of the current post-quantum cryptographic algorithms are computationally intensive, which could make them impractical for use in resource-constrained environments like mobile devices and the Internet of Things (IoT) [13]. To address this challenge, researchers are exploring new approaches to post-quantum cryptography that are efficient and practical while maintaining the security of sensitive information. C. Cryptographic Protocols for Quantum Computing Cryptographic protocols use cryptographic techniques to secure quantum computing systems. These protocols are designed to protect quantum computers from attacks, prevent the tampering of quantum information, and ensure the integrity of quantum cryptographic keys [2]. Examples of cryptographic protocols for quantum computing include quantum secret sharing [12], quantum oblivious transfer, and quantum homomorphic encryption. These protocols are essential for the secure operation of quantum computing systems, and they are being studied extensively by researchers worldwide. Another challenge in developing cryptographic protocols for quantum computing is ensuring they resist attacks by quantum computers. Many current cryptographic protocols are vulnerable to attacks by quantum computers, which could compromise the security of quantum information [2]. To address this issue, researchers are developing new cryptographic protocols resistant to attacks by quantum computers, ensuring that quantum computing systems remain secure. These new cryptographic protocols are being studied extensively by researchers worldwide and can potentially revolutionize how we secure information in the quantum computing era. D. Quantum Cryptography Standards Quantum cryptography standards refer to guidelines defining the requirements for implementing quantum cryptography. These standards ensure that quantum cryptography is implemented securely, reliably, and efficiently [6]. There are several standards for quantum cryptography, including the European Telecommunications Standards Institute (ETSI) and the National Institute of Standards and Technology (NIST) [7]. The previous two organizations work consistently on quantum cryptography standards, as they are developing guidelines and recommendations for implementing quantum cryptography, including post-quantum cryptographic algorithms [8]. Developing quantum cryptography standards will facilitate the adoption of quantum cryptography and ensure that it is implemented securely and efficiently [6]. The development of quantum cryptography standards is essential for the widespread adoption of quantum cryptographic systems. It will ensure that these systems are interoperable and compatible with existing cryptographic protocols. Measures will also help establish trust in quantum cryptographic systems by providing a framework for evaluating and certifying these systems. However, developing standards for quantum cryptography is a complex and challenging task. It requires the collaboration of experts from various fields, including quantum physics, computer science, cryptography and standards development. As quantum cryptographic systems continue to evolve and become more sophisticated, the development of standards will become increasingly important to ensure their security and reliability. E. Quantum Computing and Blockchain Quantum computing has the potential to disrupt the security of blockchain systems. Blockchain is a decentralized, tamper-proof database that records transactions securely and transparently. However, the security of blockchain systems depends on the underlying cryptographic algorithms, which are vulnerable to attacks by quantum computers. To address this issue, researchers are developing post-quantum cryptographic algorithms that can be used to secure blockchain systems. https://american-cse.org/csci2023-ieee/pdfs/CSCI2023-47UoKEqjHou6fHnm3C9aVb/615100a490/615100a490.pdf",Internet/Technology,Effect Analysis,Q&A "Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand.",what are the pros of plastic and plastic bottle use?,"We have all seen the photos: birds nesting in piles of garbage along the shore, fish fatally caught in discarded netting, and huge mosaics of debris floating in the ocean. Even more alarmingly, what we see in these poignant images is only a portion of the problem. Approximately half of all plastic pollution is submerged below the ocean surface, much of it in the form of microplastics so small that we may never be able to clean them up completely. To cut through the enormity of the ocean pollution crisis, one approach is to focus on something recognizable within these images of debris. Identify something you personally have used that may have ended up in the ocean—a water bottle perhaps. Find one in an image and ask yourself, how did it get there? Plastic is a human-made, synthetic material that was first discovered more than one hundred years ago but did not broadly enter the public sphere until the 1950s. While currently a major culprit in ocean pollution, plastics are not inherently bad for humans or the environment. In fact, in a United Nations (UN) report on combatting the negative effects of plastics, the head of the UN Environment Programme Erik Solheim made a point to acknowledge that plastic is in fact a “miracle material.” “Thanks to plastics, countless lives have been saved in the health sector, the growth of clean energy from wind turbines and solar panels has been greatly facilitated, and safe food storage has been revolutionized,” Solheim wrote in his introduction. Yet plastic bottles are one of the most common items within marine debris. So how did such a promising material become a symbol of human environmental desecration? Plastic bottles are a single-use plastic, a product designed to be used only once and then discarded. Single-use plastics also include plastic packaging, for example of meats and fresh produce, which accounts for almost half of all plastic pollution. This type of plastic product is distinct from multi-use plastics, which can also pollute the ocean, but tend to amass less frequently due to their multi-use nature. For example, refillable bottles can store water in a way that does not produce the repeated waste of a single-use plastic water bottle. Refillable bottles can be made of many materials, including plastic, but last much longer than a single-use bottle and can be recycled when they become old or damaged. For both types of bottles, how they are discarded determines their ultimate resting place and whether they become pollutants of the ocean. A single-use plastic water bottle was manufactured, filled with water, and likely transported to a store, where it sat on a shelf waiting for a thirsty purchaser. Many of us drink out of plastic bottles several times during an average day, week, or month. Once we are finished with it, we have a choice where we leave that bottle: Recycling bin: Bottles destined for recycling are unlikely to end up in the ocean, in their current form, unless they are mismanaged or lost in transit to a processing facility. However, due to recent limitations in how recyclables are internationally transferred and accepted for processing, many of these bottles will unfortunately end up in landfills rather than recycling facilities. Trash can: These bottles also will not likely end up, in their current form, in the ocean. However, in areas across the globe with poor waste management or a lack of properly sealed landfills, as a bottle breaks down into microplastic particles over time, some particles may seep into the soil and eventually make their way into our waterways, ultimately entering and polluting the ocean. Litter: These bottles may very well be carried by wind, storm water, or other processes to sewers, rivers, lakes, and other waterways that may ultimately deposit the bottle in the ocean. Multi-use plastic bottles face these same pathways at end of their life—but of course this happens much less frequently since they can be used many times. National Geographic Explorer Heather J. Koldewey works to empower communities around the world to participate in solving the ocean pollution crisis from single-use plastics via incremental individual actions—including a campaign called One Less, which encourages people to stop using single-use plastic water bottles altogether. One Less is currently based in and focused on London, England and its inhabitants, but anyone can make the choice to use one less single-use bottle.","Write the answer in one paragraph, using full sentences. Use only the document provided. Use language that is easy to understand. what are the pros of plastic and plastic bottle use? We have all seen the photos: birds nesting in piles of garbage along the shore, fish fatally caught in discarded netting, and huge mosaics of debris floating in the ocean. Even more alarmingly, what we see in these poignant images is only a portion of the problem. Approximately half of all plastic pollution is submerged below the ocean surface, much of it in the form of microplastics so small that we may never be able to clean them up completely. To cut through the enormity of the ocean pollution crisis, one approach is to focus on something recognizable within these images of debris. Identify something you personally have used that may have ended up in the ocean—a water bottle perhaps. Find one in an image and ask yourself, how did it get there? Plastic is a human-made, synthetic material that was first discovered more than one hundred years ago but did not broadly enter the public sphere until the 1950s. While currently a major culprit in ocean pollution, plastics are not inherently bad for humans or the environment. In fact, in a United Nations (UN) report on combatting the negative effects of plastics, the head of the UN Environment Programme Erik Solheim made a point to acknowledge that plastic is in fact a “miracle material.” “Thanks to plastics, countless lives have been saved in the health sector, the growth of clean energy from wind turbines and solar panels has been greatly facilitated, and safe food storage has been revolutionized,” Solheim wrote in his introduction. Yet plastic bottles are one of the most common items within marine debris. So how did such a promising material become a symbol of human environmental desecration? Plastic bottles are a single-use plastic, a product designed to be used only once and then discarded. Single-use plastics also include plastic packaging, for example of meats and fresh produce, which accounts for almost half of all plastic pollution. This type of plastic product is distinct from multi-use plastics, which can also pollute the ocean, but tend to amass less frequently due to their multi-use nature. For example, refillable bottles can store water in a way that does not produce the repeated waste of a single-use plastic water bottle. Refillable bottles can be made of many materials, including plastic, but last much longer than a single-use bottle and can be recycled when they become old or damaged. For both types of bottles, how they are discarded determines their ultimate resting place and whether they become pollutants of the ocean. A single-use plastic water bottle was manufactured, filled with water, and likely transported to a store, where it sat on a shelf waiting for a thirsty purchaser. Many of us drink out of plastic bottles several times during an average day, week, or month. Once we are finished with it, we have a choice where we leave that bottle: Recycling bin: Bottles destined for recycling are unlikely to end up in the ocean, in their current form, unless they are mismanaged or lost in transit to a processing facility. However, due to recent limitations in how recyclables are internationally transferred and accepted for processing, many of these bottles will unfortunately end up in landfills rather than recycling facilities. Trash can: These bottles also will not likely end up, in their current form, in the ocean. However, in areas across the globe with poor waste management or a lack of properly sealed landfills, as a bottle breaks down into microplastic particles over time, some particles may seep into the soil and eventually make their way into our waterways, ultimately entering and polluting the ocean. Litter: These bottles may very well be carried by wind, storm water, or other processes to sewers, rivers, lakes, and other waterways that may ultimately deposit the bottle in the ocean. Multi-use plastic bottles face these same pathways at end of their life—but of course this happens much less frequently since they can be used many times. National Geographic Explorer Heather J. Koldewey works to empower communities around the world to participate in solving the ocean pollution crisis from single-use plastics via incremental individual actions—including a campaign called One Less, which encourages people to stop using single-use plastic water bottles altogether. One Less is currently based in and focused on London, England and its inhabitants, but anyone can make the choice to use one less single-use bottle.",Unknown,Pros & Cons,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Given the inherent instability of qubits and the challenges in maintaining quantum coherence, what theoretical advancements or technological breakthroughs would be necessary to achieve fault-tolerant quantum computing on a large scale?","Quantum Computing: What It Is, Why We Want It, and How We're Trying to Get It Quantum mechanics emerged as a branch of physics in the early 1900s to explain nature on the scale of atoms and led to advances such as transistors, lasers, and magnetic resonance imaging. The idea to merge quantum mechanics and information theory arose in the 1970s but garnered little attention until 1982, when physicist Richard Feynman gave a talk in which he reasoned that computing based on classical logic could not tractably process calculations describing quantum phenomena. Computing based on quantum phenomena configured to simulate other quantum phenomena, however, would not be subject to the same bottlenecks. Although this application eventually became the field of quantum simulation, it didn't spark much research activity at the time. In 1994, however, interest in quantum computing rose dramatically when mathematician Peter Shor developed a quantum algorithm, which could find the prime factors of large numbers efficiently. Here, “efficiently” means in a time of practical relevance, which is beyond the capability of state-of-the-art classical algorithms. Although this may seem simply like an oddity, it is impossible to overstate the importance of Shor's insight. The security of nearly every online transaction today relies on an RSA cryptosystem that hinges on the intractability of the factoring problem to classical algorithms. WHAT IS QUANTUM COMPUTING? Quantum and classical computers both try to solve problems, but the way they manipulate data to get answers is fundamentally different. This section provides an explanation of what makes quantum computers unique by introducing two principles of quantum mechanics crucial for their operation, superposition and entanglement. Superposition is the counterintuitive ability of a quantum object, like an electron, to simultaneously exist in multiple “states.” With an electron, one of these states may be the lowest energy level in an atom while another may be the first excited level. If an electron is prepared in a superposition of these two states it has some probability of being in the lower state and some probability of being in the upper. A measurement will destroy this superposition, and only then can it be said that it is in the lower or upper state. Understanding superposition makes it possible to understand the basic component of information in quantum computing, the qubit. In classical computing, bits are transistors that can be off or on, corresponding to the states 0 and 1. In qubits such as electrons, 0 and 1 simply correspond to states like the lower and upper energy levels discussed above. Qubits are distinguished from classical bits, which must always be in the 0 or 1 state, by their ability to be in superpositions with varying probabilities that can be manipulated by quantum operations during computations. Entanglement is a phenomenon in which quantum entities are created and/or manipulated such that none of them can be described without referencing the others. Individual identities are lost. This concept is exceedingly difficult to conceptualize when one considers how entanglement can persist over long distances. A measurement on one member of an entangled pair will immediately determine measurements on its partner, making it appear as if information can travel faster than the speed of light. This apparent action at a distance was so disturbing that even Einstein dubbed it “spooky” (Born 1971, p. 158). The popular press often writes that quantum computers obtain their speedup by trying every possible answer to a problem in parallel. In reality a quantum computer leverages entanglement between qubits and the probabilities associated with superpositions to carry out a series of operations (a quantum algorithm) such that certain probabilities are enhanced (i.e., those of the right answers) and others depressed, even to zero (i.e., those of the wrong answers). When a measurement is made at the end of a computation, the probability of measuring the correct answer should be maximized. The way quantum computers leverage probabilities and entanglement is what makes them so different from classical computers. WHY DO WE WANT IT? The promise of developing a quantum computer sophisticated enough to execute Shor's algorithm for large numbers has been a primary motivator for advancing the field of quantum computation. To develop a broader view of quantum computers, however, it is important to understand that they will likely deliver tremendous speed-ups for only specific types of problems. Researchers are working to both understand which problems are suited for quantum speed-ups and develop algorithms to demonstrate them. In general, it is believed that quantum computers will help immensely with problems related to optimization, which play key roles in everything from defense to financial trading. Multiple additional applications for qubit systems that are not related to computing or simulation also exist and are active areas of research, but they are beyond the scope of this overview. Two of the most prominent areas are (1) quantum sensing and metrology, which leverage the extreme sensitivity of qubits to the environment to realize sensing beyond the classical shot noise limit, and (2) quantum networks and communications, which may lead to revolutionary ways to share information. HOW ARE WE TRYING TO GET IT? Building quantum computers is incredibly difficult. Many candidate qubit systems exist on the scale of single atoms, and the physicists, engineers, and materials scientists who are trying to execute quantum operations on these systems constantly deal with two competing requirements. First, qubits need to be protected from the environment because it can destroy the delicate quantum states needed for computation. The longer a qubit survives in its desired state the longer its “coherence time.” From this perspective, isolation is prized. Second, however, for algorithm execution qubits need to be entangled, shuffled around physical architectures, and controllable on demand. The better these operations can be carried out the higher their “fidelity.” Balancing the required isolation and interaction is difficult, but after decades of research a few systems are emerging as top candidates for large-scale quantum information processing. Superconducting systems, trapped atomic ions, and semiconductors are some of the leading platforms for building a quantum computer. Each has advantages and disadvantages related to coherence, fidelity, and ultimate scalability to large systems. It is clear, however, that all of these platforms will need some type of error correction protocols to be robust enough to carry out meaningful calculations, and how to design and implement these protocols is itself a large area of research. For an overview of quantum computing, with more detail regarding experimental implementations, see Ladd et al. (2010). In this article, “quantum computing” has so far been used as a blanket term describing all computations that utilize quantum phenomena. There are actually multiple types of operational frameworks. Logical, gate-based quantum computing is probably the best recognized. In it, qubits are prepared in initial states and then subject to a series of “gate operations,” like current or laser pulses depending on qubit type. Through these gates the qubits are put in superpositions, entangled, and subjected to logic operations like the AND, OR, and NOT gates of traditional computation. The qubits are then measured and a result obtained. Another framework is measurement-based computation, in which highly entangled qubits serve as the starting point. Then, instead of performing manipulation operations on qubits, single qubit measurements are performed, leaving the targeted single qubit in a definitive state. Based on the result, further measurements are carried out on other qubits and eventually an answer is reached. A third framework is topological computation, in which qubits and operations are based on quasiparticles and their braiding operations. While nascent implementations of the components of topological quantum computers have yet to be demonstrated, the approach is attractive because these systems are theoretically protected against noise, which destroys the coherence of other qubits."," Only use the provided text to answer the question, no outside sources. Given the inherent instability of qubits and the challenges in maintaining quantum coherence, what theoretical advancements or technological breakthroughs would be necessary to achieve fault-tolerant quantum computing on a large scale? Quantum Computing: What It Is, Why We Want It, and How We're Trying to Get It Quantum mechanics emerged as a branch of physics in the early 1900s to explain nature on the scale of atoms and led to advances such as transistors, lasers, and magnetic resonance imaging. The idea to merge quantum mechanics and information theory arose in the 1970s but garnered little attention until 1982, when physicist Richard Feynman gave a talk in which he reasoned that computing based on classical logic could not tractably process calculations describing quantum phenomena. Computing based on quantum phenomena configured to simulate other quantum phenomena, however, would not be subject to the same bottlenecks. Although this application eventually became the field of quantum simulation, it didn't spark much research activity at the time. In 1994, however, interest in quantum computing rose dramatically when mathematician Peter Shor developed a quantum algorithm, which could find the prime factors of large numbers efficiently. Here, “efficiently” means in a time of practical relevance, which is beyond the capability of state-of-the-art classical algorithms. Although this may seem simply like an oddity, it is impossible to overstate the importance of Shor's insight. The security of nearly every online transaction today relies on an RSA cryptosystem that hinges on the intractability of the factoring problem to classical algorithms. WHAT IS QUANTUM COMPUTING? Quantum and classical computers both try to solve problems, but the way they manipulate data to get answers is fundamentally different. This section provides an explanation of what makes quantum computers unique by introducing two principles of quantum mechanics crucial for their operation, superposition and entanglement. Superposition is the counterintuitive ability of a quantum object, like an electron, to simultaneously exist in multiple “states.” With an electron, one of these states may be the lowest energy level in an atom while another may be the first excited level. If an electron is prepared in a superposition of these two states it has some probability of being in the lower state and some probability of being in the upper. A measurement will destroy this superposition, and only then can it be said that it is in the lower or upper state. Understanding superposition makes it possible to understand the basic component of information in quantum computing, the qubit. In classical computing, bits are transistors that can be off or on, corresponding to the states 0 and 1. In qubits such as electrons, 0 and 1 simply correspond to states like the lower and upper energy levels discussed above. Qubits are distinguished from classical bits, which must always be in the 0 or 1 state, by their ability to be in superpositions with varying probabilities that can be manipulated by quantum operations during computations. Entanglement is a phenomenon in which quantum entities are created and/or manipulated such that none of them can be described without referencing the others. Individual identities are lost. This concept is exceedingly difficult to conceptualize when one considers how entanglement can persist over long distances. A measurement on one member of an entangled pair will immediately determine measurements on its partner, making it appear as if information can travel faster than the speed of light. This apparent action at a distance was so disturbing that even Einstein dubbed it “spooky” (Born 1971, p. 158). The popular press often writes that quantum computers obtain their speedup by trying every possible answer to a problem in parallel. In reality a quantum computer leverages entanglement between qubits and the probabilities associated with superpositions to carry out a series of operations (a quantum algorithm) such that certain probabilities are enhanced (i.e., those of the right answers) and others depressed, even to zero (i.e., those of the wrong answers). When a measurement is made at the end of a computation, the probability of measuring the correct answer should be maximized. The way quantum computers leverage probabilities and entanglement is what makes them so different from classical computers. WHY DO WE WANT IT? The promise of developing a quantum computer sophisticated enough to execute Shor's algorithm for large numbers has been a primary motivator for advancing the field of quantum computation. To develop a broader view of quantum computers, however, it is important to understand that they will likely deliver tremendous speed-ups for only specific types of problems. Researchers are working to both understand which problems are suited for quantum speed-ups and develop algorithms to demonstrate them. In general, it is believed that quantum computers will help immensely with problems related to optimization, which play key roles in everything from defense to financial trading. Multiple additional applications for qubit systems that are not related to computing or simulation also exist and are active areas of research, but they are beyond the scope of this overview. Two of the most prominent areas are (1) quantum sensing and metrology, which leverage the extreme sensitivity of qubits to the environment to realize sensing beyond the classical shot noise limit, and (2) quantum networks and communications, which may lead to revolutionary ways to share information. HOW ARE WE TRYING TO GET IT? Building quantum computers is incredibly difficult. Many candidate qubit systems exist on the scale of single atoms, and the physicists, engineers, and materials scientists who are trying to execute quantum operations on these systems constantly deal with two competing requirements. First, qubits need to be protected from the environment because it can destroy the delicate quantum states needed for computation. The longer a qubit survives in its desired state the longer its “coherence time.” From this perspective, isolation is prized. Second, however, for algorithm execution qubits need to be entangled, shuffled around physical architectures, and controllable on demand. The better these operations can be carried out the higher their “fidelity.” Balancing the required isolation and interaction is difficult, but after decades of research a few systems are emerging as top candidates for large-scale quantum information processing. Superconducting systems, trapped atomic ions, and semiconductors are some of the leading platforms for building a quantum computer. Each has advantages and disadvantages related to coherence, fidelity, and ultimate scalability to large systems. It is clear, however, that all of these platforms will need some type of error correction protocols to be robust enough to carry out meaningful calculations, and how to design and implement these protocols is itself a large area of research. For an overview of quantum computing, with more detail regarding experimental implementations, see Ladd et al. (2010). In this article, “quantum computing” has so far been used as a blanket term describing all computations that utilize quantum phenomena. There are actually multiple types of operational frameworks. Logical, gate-based quantum computing is probably the best recognized. In it, qubits are prepared in initial states and then subject to a series of “gate operations,” like current or laser pulses depending on qubit type. Through these gates the qubits are put in superpositions, entangled, and subjected to logic operations like the AND, OR, and NOT gates of traditional computation. The qubits are then measured and a result obtained. Another framework is measurement-based computation, in which highly entangled qubits serve as the starting point. Then, instead of performing manipulation operations on qubits, single qubit measurements are performed, leaving the targeted single qubit in a definitive state. Based on the result, further measurements are carried out on other qubits and eventually an answer is reached. A third framework is topological computation, in which qubits and operations are based on quasiparticles and their braiding operations. While nascent implementations of the components of topological quantum computers have yet to be demonstrated, the approach is attractive because these systems are theoretically protected against noise, which destroys the coherence of other qubits. https://www.ncbi.nlm.nih.gov/books/NBK538701/",Internet/Technology,Find & Summarize,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]","I'm starting up a business and need to decide very soon if I should have a brick-and-mortar or an online business, or if it's worth it to have both. Summarize key points in this article regarding the shift to online shopping and what I need to consider if I choose to operate solely online. Please make sure its 400 words or less.","Just as hybrid office-remote work arrangements have become more common, retail is becoming increasingly hybrid. The line between brick and mortar and e-commerce is now blurry, and in this evolving retail environment, many entrepreneurs are wondering the best way to position their small businesses for a prosperous year. Industry experts offered their predictions for the retail trends to watch this year. Tech will continue to shape retail Technology is always remaking the retail environment, from creating self-service kiosks in stores to supporting the e-commerce boom. However, with the rapid evolution of digital technology, artificial intelligence and machine learning — and the need for retailers to stand out from the e-commerce crowd — tech adoption has become more pressing. The rate at which business owners opened e-commerce shops and consumers shopped online increased dramatically during the COVID-19 pandemic, and the trend has continued into the post-pandemic era. “Companies that put e-commerce at the heart of their business strategies are prepared for the post-COVID-19 era,” said Yomi Kastro, founder and CEO of e-commerce platform Inveon. “There is an enormous opportunity for industries that are still more used to physical shopping, such as fast-moving consumer goods and pharmaceuticals.” Even brick-and-mortar retailers should have some semblance of an e-commerce presence. Many consumers prefer to shop from the comfort of their own homes or at the spur of the moment. Consider offering your bestselling items in an e-commerce store to give your customers the option of purchasing your most popular products without visiting your physical location. Retailers are reducing packaging waste. As consumers become more environmentally conscious, look for retailers and brands to reduce their packaging waste, said Anthony Martin, CEO of Choice Mutual Insurance Agency. “Organizations will be more conscious about using recyclable or biodegradable packaging materials, which can be easily recycled or break down naturally in the environment,” he said. The movement toward more sustainable packaging can be seen in the emergence of companies developing new packaging materials out of plant-derived materials. Furniture giant IKEA, for example, said it plans to eliminate plastic packaging for new products by 2025 and all products by 2028. Many other large brands are moving in the same direction. Technology will shape retail workforce management. Hiring and retaining quality workers will likely remain a challenge for retailers. One way businesses can adapt is by offering hybrid roles in which salespeople interact with customers online, thereby increasing their talent pool and reducing geographical limitations on the workers they can recruit. “An hourly workforce has unique pay rules, labor regulations, compliance obligations and scheduling needs,” he said. “Companies need technology that can support their growing requirements and evolve with their business. The pandemic [accelerated] the adoption of new digital technologies, which can save organizations money by increasing efficiencies and improving the experience of their employees.” Did You Know? Consumers are increasingly comfortable shopping online, which means retailers will need to have an e-commerce presence to see success in [year]. To get your online shop started the right way, check out our article on overcoming common e-commerce challenges. U.S. retailers need to protect consumer data Consumer data protection will continue to be a major concern for U.S. retailers. High-profile data breaches not only cost retailers money but also damage their brands. And the stakes have only been heightened since the adoption of consumer data privacy laws such as the European Union’s General Data Protection Regulation (GDPR) and the California Consumer Privacy Act (CCPA). “With the landscape of Google getting rid of third-party cookies and Apple accelerating its privacy-first approach, businesses of all sizes will become under greater scrutiny for how they protect customer data,” said Steffen Schebesta, CEO of global digital marketing platform Sendinblue. “My sense is that the learning curve will be steep for American companies, and if penalties apply, the lessons will be expensive. It will get especially messy if the regulations are not enacted on a federal level. This would force businesses to deal with state-by-state regulations.” While retail businesses collect consumer data for valid purposes, they need to ensure that information is highly protected from cyberattacks. Failure to defend sensitive customer data, such as financial information, could lead to massive lawsuits and fines, not to mention serious damage to brand reputation and lost opportunities for future business. Micro fulfillment centers bring merchandise closer to buyers With the e-commerce boom of recent years, massive fulfillment centers became a symbol of commerce. Jonathan Morav, head of product strategy at retail fulfillment company Fabric, said companies are now looking more to micro fulfillment centers, far smaller facilities that can be located closer to the residential areas where their customers live. They also enable businesses to take advantage of falling commercial real estate prices in downtown cities. Underutilized space in malls and parking lots can hold micro fulfillment centers. While an average Amazon fulfillment center is around 800,000 square feet, a micro fulfillment center typically takes up less than 50,000 square feet and is often as small as 10,000 square feet, while still fulfilling the expectations of fast, free shipping, Morav said. Brick-and-mortar retailers will create special customer experiences Brick-and-mortar retailers have faced significant challenges as the industry has evolved. Retailers have a better chance of being successful if they create unique and memorable customer experiences by personalizing the shopping journey and making it fun. Personal shopping services will increase. Personal shopping services include online preorder and pickup, personal shoppers who walk customers through the showroom floor and much more. Personal shopping services create an extra layer of customer service that can enhance the overall experience and is difficult for e-commerce stores to replicate. Did You Know? Personalized shopping services don’t just enhance the customer experience; they create opportunities to cross-sell and upsell customers to drive more revenue. Automation in pricing will continue to rise In recent years, more and more companies have relied on automated technology to ensure their prices are properly set. Expect automated pricing tech to become even more commonplace, helping retailers reduce the amount of labor required by their staff. Omri Traub, an executive at restaurant point-of-sale software company Toast, expects automation to play an even bigger part in this arena going forward. He pointed to “a new wave of companies” that provide such automation solutions as a service. Once implemented, he said, the tech will provide “low implementation costs and [reductions in] operating costs.” Marketing and customer engagement will see changes. Customers now primarily engage with small retail stores in an online, mobile-friendly model. That’s shifted the paradigm for marketers and customer engagement specialists, and the trend will continue this year. Social media will continue to introduce customers to brands. Social media is a major driver of the customer journey and online sales for many companies. Going forward, experts expect that hashtags and meme culture will play as large a role as traditional advertising methods for successful small businesses and their younger customers. One way that will happen, Gabor said, is through “creative social commerce,” in which platforms such as TikTok and Instagram fuel online shopping. This includes experiential marketing, such as live events that are streamed over social media platforms. Whether people engage with the brand in person or online, these types of events offer widespread exposure. Influencers will keep playing a big role. Love them or hate them, influencers will remain relevant for nearly every retail brand. With companies highlighting authentic voices, Gabor said, consumers will be able to look for leadership among those individuals. Key Takeaway Consumers expect to be able to interact with your brand from their mobile devices, and they will continue looking to influencers for brand and product recommendations."," Only use the provided text to answer the question, no outside sources. I'm starting up a business and need to decide very soon if I should have a brick-and-mortar or an online business, or if it's worth it to have both. Summarize key points in this article regarding the shift to online shopping and what I need to consider if I choose to operate solely online. Please make sure its 400 words or less. Just as hybrid office-remote work arrangements have become more common, retail is becoming increasingly hybrid. The line between brick and mortar and e-commerce is now blurry, and in this evolving retail environment, many entrepreneurs are wondering the best way to position their small businesses for a prosperous year. Industry experts offered their predictions for the retail trends to watch this year. Tech will continue to shape retail Technology is always remaking the retail environment, from creating self-service kiosks in stores to supporting the e-commerce boom. However, with the rapid evolution of digital technology, artificial intelligence and machine learning — and the need for retailers to stand out from the e-commerce crowd — tech adoption has become more pressing. The rate at which business owners opened e-commerce shops and consumers shopped online increased dramatically during the COVID-19 pandemic, and the trend has continued into the post-pandemic era. “Companies that put e-commerce at the heart of their business strategies are prepared for the post-COVID-19 era,” said Yomi Kastro, founder and CEO of e-commerce platform Inveon. “There is an enormous opportunity for industries that are still more used to physical shopping, such as fast-moving consumer goods and pharmaceuticals.” Even brick-and-mortar retailers should have some semblance of an e-commerce presence. Many consumers prefer to shop from the comfort of their own homes or at the spur of the moment. Consider offering your bestselling items in an e-commerce store to give your customers the option of purchasing your most popular products without visiting your physical location. Retailers are reducing packaging waste. As consumers become more environmentally conscious, look for retailers and brands to reduce their packaging waste, said Anthony Martin, CEO of Choice Mutual Insurance Agency. “Organizations will be more conscious about using recyclable or biodegradable packaging materials, which can be easily recycled or break down naturally in the environment,” he said. The movement toward more sustainable packaging can be seen in the emergence of companies developing new packaging materials out of plant-derived materials. Furniture giant IKEA, for example, said it plans to eliminate plastic packaging for new products by 2025 and all products by 2028. Many other large brands are moving in the same direction. Technology will shape retail workforce management. Hiring and retaining quality workers will likely remain a challenge for retailers. One way businesses can adapt is by offering hybrid roles in which salespeople interact with customers online, thereby increasing their talent pool and reducing geographical limitations on the workers they can recruit. “An hourly workforce has unique pay rules, labor regulations, compliance obligations and scheduling needs,” he said. “Companies need technology that can support their growing requirements and evolve with their business. The pandemic [accelerated] the adoption of new digital technologies, which can save organizations money by increasing efficiencies and improving the experience of their employees.” Did You Know? Consumers are increasingly comfortable shopping online, which means retailers will need to have an e-commerce presence to see success in [year]. To get your online shop started the right way, check out our article on overcoming common e-commerce challenges. U.S. retailers need to protect consumer data Consumer data protection will continue to be a major concern for U.S. retailers. High-profile data breaches not only cost retailers money but also damage their brands. And the stakes have only been heightened since the adoption of consumer data privacy laws such as the European Union’s General Data Protection Regulation (GDPR) and the California Consumer Privacy Act (CCPA). “With the landscape of Google getting rid of third-party cookies and Apple accelerating its privacy-first approach, businesses of all sizes will become under greater scrutiny for how they protect customer data,” said Steffen Schebesta, CEO of global digital marketing platform Sendinblue. “My sense is that the learning curve will be steep for American companies, and if penalties apply, the lessons will be expensive. It will get especially messy if the regulations are not enacted on a federal level. This would force businesses to deal with state-by-state regulations.” While retail businesses collect consumer data for valid purposes, they need to ensure that information is highly protected from cyberattacks. Failure to defend sensitive customer data, such as financial information, could lead to massive lawsuits and fines, not to mention serious damage to brand reputation and lost opportunities for future business. Micro fulfillment centers bring merchandise closer to buyers With the e-commerce boom of recent years, massive fulfillment centers became a symbol of commerce. Jonathan Morav, head of product strategy at retail fulfillment company Fabric, said companies are now looking more to micro fulfillment centers, far smaller facilities that can be located closer to the residential areas where their customers live. They also enable businesses to take advantage of falling commercial real estate prices in downtown cities. Underutilized space in malls and parking lots can hold micro fulfillment centers. While an average Amazon fulfillment center is around 800,000 square feet, a micro fulfillment center typically takes up less than 50,000 square feet and is often as small as 10,000 square feet, while still fulfilling the expectations of fast, free shipping, Morav said. Brick-and-mortar retailers will create special customer experiences Brick-and-mortar retailers have faced significant challenges as the industry has evolved. Retailers have a better chance of being successful if they create unique and memorable customer experiences by personalizing the shopping journey and making it fun. Personal shopping services will increase. Personal shopping services include online preorder and pickup, personal shoppers who walk customers through the showroom floor and much more. Personal shopping services create an extra layer of customer service that can enhance the overall experience and is difficult for e-commerce stores to replicate. Did You Know? Personalized shopping services don’t just enhance the customer experience; they create opportunities to cross-sell and upsell customers to drive more revenue. Automation in pricing will continue to rise In recent years, more and more companies have relied on automated technology to ensure their prices are properly set. Expect automated pricing tech to become even more commonplace, helping retailers reduce the amount of labor required by their staff. Omri Traub, an executive at restaurant point-of-sale software company Toast, expects automation to play an even bigger part in this arena going forward. He pointed to “a new wave of companies” that provide such automation solutions as a service. Once implemented, he said, the tech will provide “low implementation costs and [reductions in] operating costs.” Marketing and customer engagement will see changes. Customers now primarily engage with small retail stores in an online, mobile-friendly model. That’s shifted the paradigm for marketers and customer engagement specialists, and the trend will continue this year. Social media will continue to introduce customers to brands. Social media is a major driver of the customer journey and online sales for many companies. Going forward, experts expect that hashtags and meme culture will play as large a role as traditional advertising methods for successful small businesses and their younger customers. One way that will happen, Gabor said, is through “creative social commerce,” in which platforms such as TikTok and Instagram fuel online shopping. This includes experiential marketing, such as live events that are streamed over social media platforms. Whether people engage with the brand in person or online, these types of events offer widespread exposure. Influencers will keep playing a big role. Love them or hate them, influencers will remain relevant for nearly every retail brand. With companies highlighting authentic voices, Gabor said, consumers will be able to look for leadership among those individuals. Key Takeaway Consumers expect to be able to interact with your brand from their mobile devices, and they will continue looking to influencers for brand and product recommendations. https://www.businessnewsdaily.com/9836-future-of-retail.html",Retail/Product,Find & Summarize,Text Transformation Use only the information provided in the text above. Do not use any external resources or prior knowledge.,Summarize the proposed changes to Dodd-Frank 1. Explain it in easy to understand language in a numbered list.,"18 While commentators generally agree that maturity transformation is socially valuable,19 the process makes financial nstitutions vulnerable to liquidity “runs.” 20 That is, when a financial institution’s short-term creditors become concerned about its solvency or liquidity, they have incentives to demand immediate conversion of their claims into cash,21 or to reduce their exposure in other ways that force the institution to sell its illiquid assets at significantly discounted prices.22 A “run” on one financial institution can spread to other institutions that do business with it.23 Small banks typically hold deposit balances at larger banks, and large banks, securities firms, and insurance companies often face significant exposure to one another through their over-the-counter derivatives portfolios.24 Accordingly, troubles at one financial institution can spread to others, resulting in additional “runs” and a “contagious panic throughout the financial system that causes otherwise solvent financial institutions to become insolvent.” 25 This type of financial “contagion” can cause asset price implosions as institutions liquidate assets in order to meet creditor demands, further impairing their ability to lend and the ability of businesses to raise capital.26 Faced with a choice between bailouts and economic collapse, policymakers have generally opted for bailouts,27 70 Among other things, Dodd-Frank reformed certain aspects of securities and derivatives markets,71 imposed a variety of requirements related to mortgage standards, 72 and created a new federal agency tasked with consumer financial protection (the Consumer Financial Protection Bureau).73 Other portions of Dodd-Frank are specifically directed at the systemic risk created by TBTF financial institutions. In order to minimize the risks that large financial institutions like Lehman and AIG fail, Title I of Dodd-Frank establishes an enhanced prudential regulatory regime for certain large bank holding companies and non-bank financial companies.74 And in order to resolve systemically important financial institutions in the event that they nevertheless experience financial distress, Title II establishes a new resolution regime available for such institutions outside of the Bankruptcy Code.75 The remaining sections of this report discuss the legal issues raised by Titles I and II, their implementation by federal regulatory agencies, and proposals to reform them. Regulators have traditionally relied upon a variety of tools to minimize the risks of financial institution failures. In order to reduce the risk of insolvency, regulators have imposed capital requirements on commercial and investment banks.76 In order to reduce depositors’ incentives to “run,” regulators require all commercial banks to obtain minimum levels of deposit insurance from the Federal Deposit Insurance Corporation (FDIC).77 In order to address liquidity problems, the Federal Reserve has the authority to serve as a “lender of last resort” by making “discount window” loans to commercial banks.78 Moreover, the Federal Reserve can lend to non-banks in “unusual and exigent circumstances” pursuant to its authority under Section 13(3) of the Federal Reserve Act.79 However, as the 2007-2009 financial crisis arguably demonstrated, sometimes these measures have proven insufficient to prevent financial institution failures. In response to these concerns, Title I of Dodd-Frank establishes an enhanced prudential regulatory regime for certain large financial institutions.80 Specifically, the Title I regime applies to (1) all bank holding companies with total consolidated assets of $50 billion or more, and (2) any non-bank financial companies81 that the Financial Stability Oversight Council (FSOC)82 designates as systemically important.83 Section 165 of Dodd-Frank directs the Federal Reserve to impose prudential standards on these institutions that “are more stringent than” those applicable to other bank holding companies and non-bank financial companies, and that “increase in stringency” based on certain statutorily-prescribed considerations.84 These enhanced standards include 1. risk-based capital requirements and leverage limits; 85 2. liquidity requirements; 86 3. overall risk management requirements; 87 4. a requirement that the relevant companies develop resolution plans (so-called “living wills”) describing how they can be rapidly resolved in the event of material distress or failure; 88 and 5. credit exposure reporting requirements.89 Congress is currently considering whether to change the first basis for imposition of enhanced prudential regulations on financial institutions—the automatic $50 billion threshold for bank holding companies.90 That policy question is addressed in another recent Congressional Research Service report.91 This section of the report accordingly provides a legal overview of (1) FSOC’s process for designating non-banks as systemically important and FSOC’s designations to date, (2) criticisms of FSOC’s designation process and responses, and (3) proposals to reform FSOC’s designation process. Proposed Legislation A number of bills that would alter FSOC’s authority to designate non-banks for enhanced regulation have been introduced in the 115th Congress. The Financial CHOICE Act of 2017, as passed by the House of Representatives in June 2017, would repeal FSOC’s authority to designate non-banks for enhanced regulation altogether.167 H.R. 4061, the Financial Stability Oversight Council Improvement Act of 2017, which was reported out of the House Committee on Financial Services in March 2018, proposes more limited changes to FSOC’s authority.168 Specifically, H.R. 4061 would require FSOC to consider “the appropriateness of the imposition of prudential standards as opposed to other forms of regulation to mitigate the identified risks” in determining whether to designate a non-bank as systemically important.169 The bill would further require that FSOC provide designated companies with the opportunity to submit written materials contesting their designation during FSOC’s annual reevaluation process.170 If FSOC determines during a re-evaluation that a designation should not be rescinded, the bill would require it to provide notice to the designated company “address[ing] with specificity” how it assessed the relevant statutory factors in light of the company’s written submissions.171 The Trump Administration’s Views In November 2017, the Trump Administration’s Treasury Department released a report outlining four general recommendations for reforming FSOC’s process for designating non-banks as systemically important.172 First, the report recommended that FSOC adopt an “activities-based” or “industry-wide” approach to assessing potential risks posed by non-banks.173 Under this approach, FSOC would prioritize identifying specific financial activities and products that could pose risks to financial stability, work with the primary financial regulatory agencies to address those specific risks, and consider individual firms for designation as systemically important only as a matter of last resort if more limited actions aimed at mitigating discrete risks are insufficient to safeguard financial stability.174 Second, the Treasury Department recommended that FSOC “increas[e] the analytical rigor” of its designation analyses.175 Specifically, the Report recommended that FSOC: (1) consider any factors that might mitigate the exposure of a firm’s creditors and counterparties to its financial distress; (2) focus on “plausible” (and not merely “possible”) asset liquidation risks; (3) evaluate the likelihood that a firm will experience financial distress before evaluating how that distress could be transmitted to other firms; (4) consider the benefits and costs of designations; and (5) collapse its three-stage review process into two steps, notifying companies that they are under active review during Stage 1 and voting on proposed designations after the completion of Stage 2.176 Third, the Treasury Department recommended enhancing engagement between FSOC and companies under review, and improving the designation process’s transparency.177 Specifically, the report recommended that FSOC: (1) engage earlier with companies under review and “explain ... the key risks” that FSOC has identified, (2) “undertake greater engagement” with companies’ primary financial regulators, and (3) publicly release explanations of its designation decisions.178 Fourth, the Treasury Department recommended that FSOC provide “a clear off-ramp” for nonbanks designated as systemically important.179 The report recommended that FSOC: (1) highlight the key risks that led to a company’s designation, (2) “adopt a more robust and transparent process for its annual reevaluations” that “make[s] clear how companies can engage with FSOC ... and what information companies should submit during a reevaluation,” (3) “develop a process to enable a designated company to discuss potential changes it could make to address the risks it could pose to financial stability,” and (4) “make clear that the standard it applies in its annual reevaluations is the same as the standard for an initial designation of a nonbank financial company.”","Summarize the proposed changes to Dodd-Frank 1. Explain it in easy to understand language in a numbered list. 18 While commentators generally agree that maturity transformation is socially valuable,19 the process makes financial nstitutions vulnerable to liquidity “runs.” 20 That is, when a financial institution’s short-term creditors become concerned about its solvency or liquidity, they have incentives to demand immediate conversion of their claims into cash,21 or to reduce their exposure in other ways that force the institution to sell its illiquid assets at significantly discounted prices.22 A “run” on one financial institution can spread to other institutions that do business with it.23 Small banks typically hold deposit balances at larger banks, and large banks, securities firms, and insurance companies often face significant exposure to one another through their over-the-counter derivatives portfolios.24 Accordingly, troubles at one financial institution can spread to others, resulting in additional “runs” and a “contagious panic throughout the financial system that causes otherwise solvent financial institutions to become insolvent.” 25 This type of financial “contagion” can cause asset price implosions as institutions liquidate assets in order to meet creditor demands, further impairing their ability to lend and the ability of businesses to raise capital.26 Faced with a choice between bailouts and economic collapse, policymakers have generally opted for bailouts,27 70 Among other things, Dodd-Frank reformed certain aspects of securities and derivatives markets,71 imposed a variety of requirements related to mortgage standards, 72 and created a new federal agency tasked with consumer financial protection (the Consumer Financial Protection Bureau).73 Other portions of Dodd-Frank are specifically directed at the systemic risk created by TBTF financial institutions. In order to minimize the risks that large financial institutions like Lehman and AIG fail, Title I of Dodd-Frank establishes an enhanced prudential regulatory regime for certain large bank holding companies and non-bank financial companies.74 And in order to resolve systemically important financial institutions in the event that they nevertheless experience financial distress, Title II establishes a new resolution regime available for such institutions outside of the Bankruptcy Code.75 The remaining sections of this report discuss the legal issues raised by Titles I and II, their implementation by federal regulatory agencies, and proposals to reform them. Regulators have traditionally relied upon a variety of tools to minimize the risks of financial institution failures. In order to reduce the risk of insolvency, regulators have imposed capital requirements on commercial and investment banks.76 In order to reduce depositors’ incentives to “run,” regulators require all commercial banks to obtain minimum levels of deposit insurance from the Federal Deposit Insurance Corporation (FDIC).77 In order to address liquidity problems, the Federal Reserve has the authority to serve as a “lender of last resort” by making “discount window” loans to commercial banks.78 Moreover, the Federal Reserve can lend to non-banks in “unusual and exigent circumstances” pursuant to its authority under Section 13(3) of the Federal Reserve Act.79 However, as the 2007-2009 financial crisis arguably demonstrated, sometimes these measures have proven insufficient to prevent financial institution failures. In response to these concerns, Title I of Dodd-Frank establishes an enhanced prudential regulatory regime for certain large financial institutions.80 Specifically, the Title I regime applies to (1) all bank holding companies with total consolidated assets of $50 billion or more, and (2) any non-bank financial companies81 that the Financial Stability Oversight Council (FSOC)82 designates as systemically important.83 Section 165 of Dodd-Frank directs the Federal Reserve to impose prudential standards on these institutions that “are more stringent than” those applicable to other bank holding companies and non-bank financial companies, and that “increase in stringency” based on certain statutorily-prescribed considerations.84 These enhanced standards include 1. risk-based capital requirements and leverage limits; 85 2. liquidity requirements; 86 3. overall risk management requirements; 87 4. a requirement that the relevant companies develop resolution plans (so-called “living wills”) describing how they can be rapidly resolved in the event of material distress or failure; 88 and 5. credit exposure reporting requirements.89 Congress is currently considering whether to change the first basis for imposition of enhanced prudential regulations on financial institutions—the automatic $50 billion threshold for bank holding companies.90 That policy question is addressed in another recent Congressional Research Service report.91 This section of the report accordingly provides a legal overview of (1) FSOC’s process for designating non-banks as systemically important and FSOC’s designations to date, (2) criticisms of FSOC’s designation process and responses, and (3) proposals to reform FSOC’s designation process. Proposed Legislation A number of bills that would alter FSOC’s authority to designate non-banks for enhanced regulation have been introduced in the 115th Congress. The Financial CHOICE Act of 2017, as passed by the House of Representatives in June 2017, would repeal FSOC’s authority to designate non-banks for enhanced regulation altogether.167 H.R. 4061, the Financial Stability Oversight Council Improvement Act of 2017, which was reported out of the House Committee on Financial Services in March 2018, proposes more limited changes to FSOC’s authority.168 Specifically, H.R. 4061 would require FSOC to consider “the appropriateness of the imposition of prudential standards as opposed to other forms of regulation to mitigate the identified risks” in determining whether to designate a non-bank as systemically important.169 The bill would further require that FSOC provide designated companies with the opportunity to submit written materials contesting their designation during FSOC’s annual reevaluation process.170 If FSOC determines during a re-evaluation that a designation should not be rescinded, the bill would require it to provide notice to the designated company “address[ing] with specificity” how it assessed the relevant statutory factors in light of the company’s written submissions.171 The Trump Administration’s Views In November 2017, the Trump Administration’s Treasury Department released a report outlining four general recommendations for reforming FSOC’s process for designating non-banks as systemically important.172 First, the report recommended that FSOC adopt an “activities-based” or “industry-wide” approach to assessing potential risks posed by non-banks.173 Under this approach, FSOC would prioritize identifying specific financial activities and products that could pose risks to financial stability, work with the primary financial regulatory agencies to address those specific risks, and consider individual firms for designation as systemically important only as a matter of last resort if more limited actions aimed at mitigating discrete risks are insufficient to safeguard financial stability.174 Second, the Treasury Department recommended that FSOC “increas[e] the analytical rigor” of its designation analyses.175 Specifically, the Report recommended that FSOC: (1) consider any factors that might mitigate the exposure of a firm’s creditors and counterparties to its financial distress; (2) focus on “plausible” (and not merely “possible”) asset liquidation risks; (3) evaluate the likelihood that a firm will experience financial distress before evaluating how that distress could be transmitted to other firms; (4) consider the benefits and costs of designations; and (5) collapse its three-stage review process into two steps, notifying companies that they are under active review during Stage 1 and voting on proposed designations after the completion of Stage 2.176 Third, the Treasury Department recommended enhancing engagement between FSOC and companies under review, and improving the designation process’s transparency.177 Specifically, the report recommended that FSOC: (1) engage earlier with companies under review and “explain ... the key risks” that FSOC has identified, (2) “undertake greater engagement” with companies’ primary financial regulators, and (3) publicly release explanations of its designation decisions.178 Fourth, the Treasury Department recommended that FSOC provide “a clear off-ramp” for nonbanks designated as systemically important.179 The report recommended that FSOC: (1) highlight the key risks that led to a company’s designation, (2) “adopt a more robust and transparent process for its annual reevaluations” that “make[s] clear how companies can engage with FSOC ... and what information companies should submit during a reevaluation,” (3) “develop a process to enable a designated company to discuss potential changes it could make to address the risks it could pose to financial stability,” and (4) “make clear that the standard it applies in its annual reevaluations is the same as the standard for an initial designation of a nonbank financial company.” Use only the information provided in the text above. Do not use any external resources or prior knowledge.",Legal,Summarize & Format,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","Should someone be worried about acquiring an infection in the hospital? Why? Why is this a bad thing on a governmental level? What is the difference between an uncomplicated UTI and a complicated UTI? Why is a polymicrobial bacteraemic UTIs particularly serious? How do these cases occur?","Healthcare-associated infections (HAIs) represent a significant public health burden, where an estimated 1 in 31 patients that enter a hospital will go on to develop an HAI, resulting in an additional $28.4 billion in healthcare-related expenses and 100,000 deaths1,2. Among HAIs, urinary tract infections (UTIs) are the most common, affecting over 400 million people worldwide in 2019 alone3. UTIs can be distinguished as complicated or uncomplicated. Up to 75–85% of uncomplicated UTIs are caused by uropathogenic Escherichia coli (UPEC)4,5,6. Unlike uncomplicated UTIs, catheter-associated UTI (CAUTI) is caused by a diverse range of pathogens, including UPEC (23.9%), fungal Candida spp. (17.8%), Enterococcus spp. (13.8%), P. aeruginosa (10.3%), and Klebsiella sp. (10.1%)7,8. Uncomplicated UTIs (uUTIs) predominantly affect pre-menopausal and non-pregnant women and occur in otherwise healthy individuals with no functional or structural abnormalities of the kidneys or urinary tract4. Complicated UTIs (cUTIs) occur in individuals with additional risk factors, including underlying health conditions and abnormalities or obstructions in the kidneys and urinary tract, pregnancy, and intermittent or long-term catheterization4. It is estimated that 15-25% of hospitalized patients will receive a urinary catheter and that 75% of healthcare-acquired UTIs are associated with catheterization9. Furthermore, the risk of bacterial colonization of a catheter increases 3–7% per day upon placement, with the risk of catheter colonization and associated complications near 100% in long-term catheterized patients10,11. The treatment of UTIs has been complicated by the rise of antimicrobial-resistant (AMR) uropathogens, many of which were cited as urgent or serious threats in the CDC’s 2019 Antibiotic Threats Report. These AMR pathogens were classified as: (i) urgent, carbapenem-resistant Acinetobacter and carbapenem-resistant Enterobacterales; and (ii) serious, drug-resistant Candida, ESBL- Enterobacterales, vancomycin-resistant enterococci (VRE), multidrug-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA)12. Indeed, a 2019 report listed UTIs as one of the leading global causes of AMR-associated deaths13. As these uropathogens become increasingly antibiotic-resistant, new treatment strategies are necessary to combat the rise of antibiotic-resistant UTIs. Another factor complicating the treatment of CAUTIs is the high prevalence of polymicrobial catheter colonization, with 31–87% of catheters and urine from catheterized patients colonized by two or more species, depending on the study14,15,16. Polymicrobial bacteraemic UTIs are associated with increased mortality relative to bacteraemic UTIs caused by a single uropathogen17. The relationships between the bacteria in these polymicrobial communities is still poorly understood, including the mechanistic drivers of the positive species interactions that promote species co-occurrence and the negative species interactions that prevent co-occurrence in the same microenvironment. During urinary catheterization, the host wounding response results in the deposition of host proteins, including fibrinogen, onto the catheter that can be used by several bacterial species as a food source and as a means to adhere to and form biofilms on the catheter18,19,20. Positive co-occurrences between species may thus result from pioneer species that are able to colonize the catheter and then recruit other microbial species, forming polymicrobial communities. While this has been demonstrated to occur in the polymicrobial communities of oral biofilms, wherein certain groups of bacteria, including streptococci and Actinomyces species, serve as the pioneering species that can adhere to enamel pellicle and facilitate the colonization of other microbial species, the establishment of pioneer species and the subsequent effects on colonization in CAUTI has yet to be fully elucidated21,22. Within these communities, “cross-feeding” or “cross-signaling” may occur to augment the growth and/or biofilm formation of one or more of the species. Further, it has been shown that E. faecalis can suppress the host innate immune response, allowing for augmented growth of E. coli in a co-infection model of CAUTI23. Negative co-occurrences may be due to competition for nutrients or alterations in host response. For instance, MRSA elicits a robust host response which may result in decreased co-colonization by other bacterial species that are unable to withstand this response24. Understanding the mechanisms that drive the formation and persistence of these communities is essential to designing new therapeutics that target the bacterial interactions that promote CAUTI.","[question] Should someone be worried about acquiring an infection in the hospital? Why? Why is this a bad thing on a governmental level? What is the difference between an uncomplicated UTI and a complicated UTI? Why is a polymicrobial bacteraemic UTIs particularly serious? How do these cases occur? ===================== [text] Healthcare-associated infections (HAIs) represent a significant public health burden, where an estimated 1 in 31 patients that enter a hospital will go on to develop an HAI, resulting in an additional $28.4 billion in healthcare-related expenses and 100,000 deaths1,2. Among HAIs, urinary tract infections (UTIs) are the most common, affecting over 400 million people worldwide in 2019 alone3. UTIs can be distinguished as complicated or uncomplicated. Up to 75–85% of uncomplicated UTIs are caused by uropathogenic Escherichia coli (UPEC)4,5,6. Unlike uncomplicated UTIs, catheter-associated UTI (CAUTI) is caused by a diverse range of pathogens, including UPEC (23.9%), fungal Candida spp. (17.8%), Enterococcus spp. (13.8%), P. aeruginosa (10.3%), and Klebsiella sp. (10.1%)7,8. Uncomplicated UTIs (uUTIs) predominantly affect pre-menopausal and non-pregnant women and occur in otherwise healthy individuals with no functional or structural abnormalities of the kidneys or urinary tract4. Complicated UTIs (cUTIs) occur in individuals with additional risk factors, including underlying health conditions and abnormalities or obstructions in the kidneys and urinary tract, pregnancy, and intermittent or long-term catheterization4. It is estimated that 15-25% of hospitalized patients will receive a urinary catheter and that 75% of healthcare-acquired UTIs are associated with catheterization9. Furthermore, the risk of bacterial colonization of a catheter increases 3–7% per day upon placement, with the risk of catheter colonization and associated complications near 100% in long-term catheterized patients10,11. The treatment of UTIs has been complicated by the rise of antimicrobial-resistant (AMR) uropathogens, many of which were cited as urgent or serious threats in the CDC’s 2019 Antibiotic Threats Report. These AMR pathogens were classified as: (i) urgent, carbapenem-resistant Acinetobacter and carbapenem-resistant Enterobacterales; and (ii) serious, drug-resistant Candida, ESBL- Enterobacterales, vancomycin-resistant enterococci (VRE), multidrug-resistant Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus (MRSA)12. Indeed, a 2019 report listed UTIs as one of the leading global causes of AMR-associated deaths13. As these uropathogens become increasingly antibiotic-resistant, new treatment strategies are necessary to combat the rise of antibiotic-resistant UTIs. Another factor complicating the treatment of CAUTIs is the high prevalence of polymicrobial catheter colonization, with 31–87% of catheters and urine from catheterized patients colonized by two or more species, depending on the study14,15,16. Polymicrobial bacteraemic UTIs are associated with increased mortality relative to bacteraemic UTIs caused by a single uropathogen17. The relationships between the bacteria in these polymicrobial communities is still poorly understood, including the mechanistic drivers of the positive species interactions that promote species co-occurrence and the negative species interactions that prevent co-occurrence in the same microenvironment. During urinary catheterization, the host wounding response results in the deposition of host proteins, including fibrinogen, onto the catheter that can be used by several bacterial species as a food source and as a means to adhere to and form biofilms on the catheter18,19,20. Positive co-occurrences between species may thus result from pioneer species that are able to colonize the catheter and then recruit other microbial species, forming polymicrobial communities. While this has been demonstrated to occur in the polymicrobial communities of oral biofilms, wherein certain groups of bacteria, including streptococci and Actinomyces species, serve as the pioneering species that can adhere to enamel pellicle and facilitate the colonization of other microbial species, the establishment of pioneer species and the subsequent effects on colonization in CAUTI has yet to be fully elucidated21,22. Within these communities, “cross-feeding” or “cross-signaling” may occur to augment the growth and/or biofilm formation of one or more of the species. Further, it has been shown that E. faecalis can suppress the host innate immune response, allowing for augmented growth of E. coli in a co-infection model of CAUTI23. Negative co-occurrences may be due to competition for nutrients or alterations in host response. For instance, MRSA elicits a robust host response which may result in decreased co-colonization by other bacterial species that are unable to withstand this response24. Understanding the mechanisms that drive the formation and persistence of these communities is essential to designing new therapeutics that target the bacterial interactions that promote CAUTI. https://www.nature.com/articles/s41467-023-44095-0 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Concept Comparison,Q&A Pull your answer from the text below only.,How dangerous is meningitis?,"Bacterial meningitis is a rare but potentially fatal disease. Several types of bacteria can first cause an upper respiratory tract infection and then travel through the bloodstream to the brain. The disease also can occur when certain bacteria invade the meninges directly. Bacterial meningitis can cause stroke, hearing loss, and permanent brain damage. Pneumococcal meningitis is the most common form of meningitis and is the most serious form of bacterial meningitis. Some 6,000 cases of pneumococcal meningitis are reported in the United States each year. The disease is caused by the bacterium Streptococcus pneumoniae, which also causes pneumonia, blood poisoning (septicemia), and ear and sinus infections. At particular risk are children under age 12 and adults with a weakened immune system. People who have had pneumococcal meningitis often suffer neurological damage ranging from deafness to severe brain damage. Meningococcal meningitis is caused by the bacterium Neisseria meningitudes. Each year in the United States about 2,600 people get this highly contagious disease. High-risk groups include infants under the age of 1 year, people with suppressed immune systems, travelers to foreign countries where the disease is endemic, and military recruits and others who reside in dormitories. Between 10-15 percent of cases are fatal, with another 10-15 percent causing brain damage and other serious side effects. 5 Haemophilus influenzae meningitis was at one time the most common form of bacterial meningitis. Fortunately, the Haemophilus influenzae b vaccine has greatly reduced the number of cases in the United States (see Treatment section). Those most at risk of getting this disease are children in child-care settings and children who do not have access to this vaccine. Other forms of bacterial meningitis include Listeria monocytogenes meningitis (in which certain foods such as unpasteurized dairy or deli meats are sometimes implicated); Escherichia coli meningitis, which is most common in elderly adults and newborns and may be transmitted to a baby through the birth canal; and Mycobacterium tuberculosis meningitis, a rare disease that occurs when the bacterium that causes tuberculosis attacks the meninges. Viral, or aseptic, meningitis is usually caused by enteroviruses—common viruses that enter the body through the mouth and travel to the brain and surrounding tissues where they multiply. Enteroviruses are present in mucus, saliva, and feces, and can be transmitted through direct contact with an infected person or an infected object or surface. Other viruses that cause meningitis include Varicella zoster (the virus that causes chicken pox and can appear decades later as shingles), influenza, mumps, HIV, and Herpes simplex type 2 (genital herpes). Fungal infections can affect the brain. The most common form of fungal meningitis is caused by the fungus Cryptococcus neoformans (found mainly in dirt and bird droppings). 6 It can be slow to develop and smolder for weeks. Although treatable, fungal meningitis often recurs in nearly half of affected persons. Parasitic causes include cysticercosis (a tapeworm infection in the brain), which is common in other parts of the world, as well as cerebral malaria. There are rare cases of amoebic meningitis, sometimes related to fresh water swimming, which can be rapidly fatal. People who are suspected of having meningitis or encephalitis should receive immediate, aggressive medical treatment. Both diseases can progress quickly and have the potential to cause severe, irreversible neurological damage. Effective vaccines are available to prevent Haemophilus influenzae, pneumococcal and meningococcal meningitis. Two types of vaccines are available in the United States to help prevent meningococcal meningitis. The Centers for Disease Control and Prevention recommends vaccination with a meningococcal conjugate vaccine for all preteens and teens ages 11 to 12 years, with a booster dose at 16 years old. Teens and young adults (ages 16 through 23) also may be vaccinated with a serogroup B meningococcal vaccine. If meningococcal meningitis is diagnosed, people in close contact with an infected individual should be given preventative antibiotics. Early treatment of bacterial meningitis involves antibiotics that can cross the bloodbrain barrier (a lining of cells that keeps harmful micro-organisms and chemicals from entering the brain). Appropriate antibiotic treatment for most types of meningitis can greatly reduce the risk of dying from the disease. Anticonvulsants to prevent seizures and corticosteroids to reduce brain inflammation may be prescribed. Infected sinuses may need to be drained. Corticosteroids such as prednisone may be ordered to relieve brain pressure and swelling and to prevent hearing loss that is common in some forms of meningitis. Lyme disease, a bacterial infection, is treated with antibiotics. meningitis is rarely life threatening and no specific treatment is needed. Fungal meningitis is treated with intravenous antifungal medications. Antiviral drugs used to treat viral encephalitis include acyclovir and ganciclovir. For most encephalitis-causing viruses, no specific treatment is available. Autoimmune causes of encephalitis are treated with additional immunosuppressant drugs and screening for underlying tumors when appropriate. Acute disseminated encephalomyelitis, a non-infectious inflammatory brain disease mostly seen in children, is treated with steroids. Anticonvulsants may be prescribed to stop or prevent seizures. Corticosteroids can reduce brain swelling. Affected individuals with breathing difficulties may require artificial respiration. Once the acute illness is under control, comprehensive rehabilitation should include cognitive rehabilitation and physical, speech, and occupational therapy. Can meningitis and encephalitis be prevented? Effective vaccines are available to prevent some forms of meningitis. People should avoid sharing food, utensils, glasses, and other objects with someone who may be exposed to or have the infection. People should wash their hands often with soap and rinse under running water. People who live, work, or go to school with someone who has been diagnosed with bacterial meningitis may be asked to take antibiotics for a few days as a preventive measure. Also, people should limit outdoor activities at night, wear long-sleeved clothing when outdoors, use insect repellents that are most effective for that particular region of the country, and rid lawn and outdoor areas of free-standing pools of water, in which mosquitoes breed. What is the prognosis for these infections? Outcome generally depends on the particular infectious agent involved, the severity of the illness, and how quickly treatment is given. In most cases, people with very mild encephalitis or meningitis can make a full recovery, although the process may be slow. Individuals who experience only headache, fever, and stiff neck may recover in 2-4 weeks. Individuals with bacterial meningitis typically show some relief 48-72 hours following initial treatment but are more likely to experience complications caused by the disease. In more serious cases, these diseases can cause hearing and/or speech loss, blindness, permanent brain and nerve damage, behavioral changes, cognitive disabilities, lack of muscle control, seizures, and memory loss. These individuals may need long-term therapy, medication, and supportive care. The recovery from encephalitis is variable depending on the cause of the disease and extent of brain inflammation. ","How dangerous is meningitis? Pull your answer from the text below only. Bacterial meningitis is a rare but potentially fatal disease. Several types of bacteria can first cause an upper respiratory tract infection and then travel through the bloodstream to the brain. The disease also can occur when certain bacteria invade the meninges directly. Bacterial meningitis can cause stroke, hearing loss, and permanent brain damage. Pneumococcal meningitis is the most common form of meningitis and is the most serious form of bacterial meningitis. Some 6,000 cases of pneumococcal meningitis are reported in the United States each year. The disease is caused by the bacterium Streptococcus pneumoniae, which also causes pneumonia, blood poisoning (septicemia), and ear and sinus infections. At particular risk are children under age 12 and adults with a weakened immune system. People who have had pneumococcal meningitis often suffer neurological damage ranging from deafness to severe brain damage. Meningococcal meningitis is caused by the bacterium Neisseria meningitudes. Each year in the United States about 2,600 people get this highly contagious disease. High-risk groups include infants under the age of 1 year, people with suppressed immune systems, travelers to foreign countries where the disease is endemic, and military recruits and others who reside in dormitories. Between 10-15 percent of cases are fatal, with another 10-15 percent causing brain damage and other serious side effects. 5 Haemophilus influenzae meningitis was at one time the most common form of bacterial meningitis. Fortunately, the Haemophilus influenzae b vaccine has greatly reduced the number of cases in the United States (see Treatment section). Those most at risk of getting this disease are children in child-care settings and children who do not have access to this vaccine. Other forms of bacterial meningitis include Listeria monocytogenes meningitis (in which certain foods such as unpasteurized dairy or deli meats are sometimes implicated); Escherichia coli meningitis, which is most common in elderly adults and newborns and may be transmitted to a baby through the birth canal; and Mycobacterium tuberculosis meningitis, a rare disease that occurs when the bacterium that causes tuberculosis attacks the meninges. Viral, or aseptic, meningitis is usually caused by enteroviruses—common viruses that enter the body through the mouth and travel to the brain and surrounding tissues where they multiply. Enteroviruses are present in mucus, saliva, and feces, and can be transmitted through direct contact with an infected person or an infected object or surface. Other viruses that cause meningitis include Varicella zoster (the virus that causes chicken pox and can appear decades later as shingles), influenza, mumps, HIV, and Herpes simplex type 2 (genital herpes). Fungal infections can affect the brain. The most common form of fungal meningitis is caused by the fungus Cryptococcus neoformans (found mainly in dirt and bird droppings). 6 It can be slow to develop and smolder for weeks. Although treatable, fungal meningitis often recurs in nearly half of affected persons. Parasitic causes include cysticercosis (a tapeworm infection in the brain), which is common in other parts of the world, as well as cerebral malaria. There are rare cases of amoebic meningitis, sometimes related to fresh water swimming, which can be rapidly fatal. People who are suspected of having meningitis or encephalitis should receive immediate, aggressive medical treatment. Both diseases can progress quickly and have the potential to cause severe, irreversible neurological damage. Effective vaccines are available to prevent Haemophilus influenzae, pneumococcal and meningococcal meningitis. Two types of vaccines are available in the United States to help prevent meningococcal meningitis. The Centers for Disease Control and Prevention recommends vaccination with a meningococcal conjugate vaccine for all preteens and teens ages 11 to 12 years, with a booster dose at 16 years old. Teens and young adults (ages 16 through 23) also may be vaccinated with a serogroup B meningococcal vaccine. If meningococcal meningitis is diagnosed, people in close contact with an infected individual should be given preventative antibiotics. Early treatment of bacterial meningitis involves antibiotics that can cross the bloodbrain barrier (a lining of cells that keeps harmful micro-organisms and chemicals from entering the brain). Appropriate antibiotic treatment for most types of meningitis can greatly reduce the risk of dying from the disease. Anticonvulsants to prevent seizures and corticosteroids to reduce brain inflammation may be prescribed. Infected sinuses may need to be drained. Corticosteroids such as prednisone may be ordered to relieve brain pressure and swelling and to prevent hearing loss that is common in some forms of meningitis. Lyme disease, a bacterial infection, is treated with antibiotics. meningitis is rarely life threatening and no specific treatment is needed. Fungal meningitis is treated with intravenous antifungal medications. Antiviral drugs used to treat viral encephalitis include acyclovir and ganciclovir. For most encephalitis-causing viruses, no specific treatment is available. Autoimmune causes of encephalitis are treated with additional immunosuppressant drugs and screening for underlying tumors when appropriate. Acute disseminated encephalomyelitis, a non-infectious inflammatory brain disease mostly seen in children, is treated with steroids. Anticonvulsants may be prescribed to stop or prevent seizures. Corticosteroids can reduce brain swelling. Affected individuals with breathing difficulties may require artificial respiration. Once the acute illness is under control, comprehensive rehabilitation should include cognitive rehabilitation and physical, speech, and occupational therapy. Can meningitis and encephalitis be prevented? Effective vaccines are available to prevent some forms of meningitis. People should avoid sharing food, utensils, glasses, and other objects with someone who may be exposed to or have the infection. People should wash their hands often with soap and rinse under running water. People who live, work, or go to school with someone who has been diagnosed with bacterial meningitis may be asked to take antibiotics for a few days as a preventive measure. Also, people should limit outdoor activities at night, wear long-sleeved clothing when outdoors, use insect repellents that are most effective for that particular region of the country, and rid lawn and outdoor areas of free-standing pools of water, in which mosquitoes breed. What is the prognosis for these infections? Outcome generally depends on the particular infectious agent involved, the severity of the illness, and how quickly treatment is given. In most cases, people with very mild encephalitis or meningitis can make a full recovery, although the process may be slow. Individuals who experience only headache, fever, and stiff neck may recover in 2-4 weeks. Individuals with bacterial meningitis typically show some relief 48-72 hours following initial treatment but are more likely to experience complications caused by the disease. In more serious cases, these diseases can cause hearing and/or speech loss, blindness, permanent brain and nerve damage, behavioral changes, cognitive disabilities, lack of muscle control, seizures, and memory loss. These individuals may need long-term therapy, medication, and supportive care. The recovery from encephalitis is variable depending on the cause of the disease and extent of brain inflammation. ",Medical,Fact Finding,Q&A The response should only contain info from this text.,what are the cases where a it comes out the mouth?,"WHILE the occipital and sincipital cerebral hernias form external visible tumors in the occipital and naso-frontal regions respectively, we find no external visible tumors in the basal hernias. As the sincipital hernias, however, leave the cranium in close proximity to the place of exit of the basal hernias, let us first review briefly the various forms of sincipital hernias: 1. The naso-frontal hernias leave the cranium between the frontal and nasal bones and form a tumor in the median line in the region of the glabella. 2. The naso-ethmoidal hernias leave the cranium between the frontal and nasal bones on the one side and the lateral mass or labyrinth on the other, which is forced or displaced downward toward the nasal cavity. The tumor appears externally in the region of the border between the osseous and cartilaginous portions of the nose, hanging down toward the tip or the wing of the nose. 3. The naso-orbital hernias leave the cranium between the frontal, ethmoid and lachrymal bones. In the region of the latter they enter the orbit and present at or near the inner canthus of the eye. All the above-named varieties present external visible tumors. The naso-ethmoidal and naso-orbital varieties are probably not distinguish- able from each other, as they leave the cranium at the same place ; namely, the nasal notch of the frontal and the cribriform plate of the ethmoid bone. Furthermore, the same hernia may divide into two branches, of which the anterior passes downward and forward behind the nasal bone, to protrude in the face at the border of the osseous and cartilaginous part of the nose, and the posterior branch descends into the anterior and medial portion of the orbit between the frontal, eth- moid and lachrymal bones. There is always some defect of the bones in question at the point where the encephalocele leaves the cranium. 4. Basal hernias are, as already stated, distinguished from the other sincipital hernias by not causing a protruding tumor in the face. Heinecke* distinguishes between three forms of these hernias : I. Cephalocele spheno-pharyngea is the most common variety, and leaves the cranium through an opening between the body of the sphenoid bone and the ethmoid bone, or through one of these bones, to come down in the nasal or naso-pharyngeal cavity. Extending from this point they may present in one of the nostrils, as in Czerny’s case; in the naso- pharyngeal cavity as in the cases of Giraldés, Otto, and Klimentowsky, cited from Larger,” and in my case, or come down into the mouth through a cleft palate, as in the cases reported by Virchow, Lichten- berg, Klintosch and Serres, also cited from Larger. II. Cephalocele spheno-orbitalis, which leaves the cranium through the superior orbital fissure to enter the orbit behind the globe of the eye. III. Cephalocele spheno-maxillaris, which, like the second form, leaves the cranium through the superior orbital fissure, but instead of remain- ing in the posterior part of the orbit, descends through the inferior orbital fissure into the spheno-maxillary fossa. The tumor presents, and can be felt in the mouth on the medial side of the ascending ramus of the inferior maxilla, and is visible on the outside of the face, on the cheek below the zygoma, in the same place where the retro-maxillary branches of retro-nasal fibroids present. The two last-named hernias are exceedingly rare, and I have been unable to find all the varieties to which Heinecke’s classification refers. Larger mentions three instances of retro-orbital encephalocele referred to by Spring. In the case published by Walther, the tumor descended through the superior orbital fissure, and caused exophthalmos and destruction of the eye. Spring had seen two similar specimens in the museum at Bonn. The first variety, the spheno-pharyngeal, is less uncommon. I shall mention the more accurately described instances of this variety, as they present more of surgical interest than Heinecke ascribed to them when he said : “Cephalocele basalis is of no surgical importance, as it has been found only in non-viable monsters (nicht lebensfahigen Missbildungen).” Attempts at the removal of encephalocele by operation have been made by Lichtenberg, Czerny and myself. Lichtenberg’s patient died from the operation; Czerny’s patient survived the operation, but died later from apparently independent causes; my patient made a definite recovery. Lichtenberg” reports the case of a newborn girl in whom a large reddish tumor, the size of a small fist, hung out of the mouth, covering the chin, with its base resting on the sternum. On more minute examin- ation it was seen that the patient had a hare-lip situated nearly in the median line of the lip, and complicated with cleft palate. The tumor was divided into two portions by a slight constriction in the middle, was elastic to the touch, and was attached by a pedicle which could be followed up to the right wall of the nasal cavity by opening the mouth, where it was continuous with the nasal mucosa. The patient died from the operation, and the autopsy demonstrated that the tumor was a cere- bral hernia. Klintosch” gives a vague description of an infant in whom a tumor protruded in the mouth. The patient had a hare-lip and cleft palate, some bones of the face were wanting, and the eyes were atrophied. In the sella Turcica was an opening the size of a goose-quill through which the neck of the hernia came down into the mouth, there to form a tumor the size of a hazelnut. This contained the hypophysis, which was hollow and communicated directly with the ventricle. Serres” describes an infant in whom some portions of the brain, with their envelopes, protruded from the cranium in the median line between - the sphenoid and ethmoid bones. The tumor descended into the nasal fossa, almost into the pharynx. Giraldés,’ according to Dupuytren,’ observed an encephalocele which descended into the interior of the nose. Otto,”* cited by Spring, states that he has seen in the museum at Vienna a cerebral tumor which had penetrated into the nasal cavity through the cribriform plate of the ethmoid. Kelsch,’ according to Otto, has seen a case in which the hypophysis was situated in the sphenoidal sinus. Klimentowsky,’ describes an encephalocele in a newborn child, in which the anterior portion of the two frontal lobes descended into the right side of the nasal cavity, as was verified by the autopsy. Rippmann,"" cited by Meyer, found in a foetus of twenty-three weeks, the head of which was double the normal size, and consequently hydro- cephalic, a lobulated tumor having a pedicle three or four lines in thick- ness, which descended through a canal in the body of the sphenoid bone. Virchow ™ describes a specimen in the Berlin museum, of hydrencepha- locele palatina in a newborn child. (See Fig. 1.) From the open mouth protruded an irregular nodulated tumor the size of a small apple. It was apparently adherent to the hard palate, but upon section it was seen that it had pushed both the vomer and the hard palate forward and up- ward, and that it emerged from the cranial cavity through a broad open- ing immediately anterior to the sphenoid bone, and behind the still carti- laginous ethmoid. The anterior portion of the sphenoid was forced downward and backward, and the connection between it and the vomer interrupted by the tumor, so that the vomer was connected only with the ethmoid. The anterior portion of the sac contained a cavity lined with smooth dura mater, below and behind which were several irregular smaller cavities. In the upper portion of the tumor was brain substance which extended from this point up into the cerebral portion of the cranial cavity. The brain was pushed downward toward the base of the cranial cavity, and above it was a large cavity filled with fluid, and surrounded by a thick membrane. In addition to this more or less cursory discussion of cases from the older literature, there has now appeared an accurate and excellent report of a case by Meyer,” from Czerny’s clinic. The case was one of con- genital nasal polypus, and was brought to the Heidelberg clinic for operation. The child died six weeks later, and the diagnosis was made after post-mortem microscopical examination. The patient was a child three days old, well developed, weighing five or six pounds. The left ala nasi was broadened and pushed upward by a soft, elastic, compressible, pedunculated, transparent tumor the size of a hazelnut, half of which protruded through the opening of the nose, and was clad with smooth, yellowish-red mucous membrane, and covered with dried crusts of serous exudate. The tumor did not increase in size when the child cried; it was attached 14 cm. behind the free border of the septum. Upon incision of the tumor bloody serum escaped, and upon pressure puriform mucus was forced out. ","WHILE the occipital and sincipital cerebral hernias form external visible tumors in the occipital and naso-frontal regions respectively, we find no external visible tumors in the basal hernias. As the sincipital hernias, however, leave the cranium in close proximity to the place of exit of the basal hernias, let us first review briefly the various forms of sincipital hernias: 1. The naso-frontal hernias leave the cranium between the frontal and nasal bones and form a tumor in the median line in the region of the glabella. 2. The naso-ethmoidal hernias leave the cranium between the frontal and nasal bones on the one side and the lateral mass or labyrinth on the other, which is forced or displaced downward toward the nasal cavity. The tumor appears externally in the region of the border between the osseous and cartilaginous portions of the nose, hanging down toward the tip or the wing of the nose. 3. The naso-orbital hernias leave the cranium between the frontal, ethmoid and lachrymal bones. In the region of the latter they enter the orbit and present at or near the inner canthus of the eye. All the above-named varieties present external visible tumors. The naso-ethmoidal and naso-orbital varieties are probably not distinguish- able from each other, as they leave the cranium at the same place ; namely, the nasal notch of the frontal and the cribriform plate of the ethmoid bone. Furthermore, the same hernia may divide into two branches, of which the anterior passes downward and forward behind the nasal bone, to protrude in the face at the border of the osseous and cartilaginous part of the nose, and the posterior branch descends into the anterior and medial portion of the orbit between the frontal, eth- moid and lachrymal bones. There is always some defect of the bones in question at the point where the encephalocele leaves the cranium. 4. Basal hernias are, as already stated, distinguished from the other sincipital hernias by not causing a protruding tumor in the face. Heinecke* distinguishes between three forms of these hernias : I. Cephalocele spheno-pharyngea is the most common variety, and leaves the cranium through an opening between the body of the sphenoid bone and the ethmoid bone, or through one of these bones, to come down in the nasal or naso-pharyngeal cavity. Extending from this point they may present in one of the nostrils, as in Czerny’s case; in the naso- pharyngeal cavity as in the cases of Giraldés, Otto, and Klimentowsky, cited from Larger,” and in my case, or come down into the mouth through a cleft palate, as in the cases reported by Virchow, Lichten- berg, Klintosch and Serres, also cited from Larger. II. Cephalocele spheno-orbitalis, which leaves the cranium through the superior orbital fissure to enter the orbit behind the globe of the eye. III. Cephalocele spheno-maxillaris, which, like the second form, leaves the cranium through the superior orbital fissure, but instead of remain- ing in the posterior part of the orbit, descends through the inferior orbital fissure into the spheno-maxillary fossa. The tumor presents, and can be felt in the mouth on the medial side of the ascending ramus of the inferior maxilla, and is visible on the outside of the face, on the cheek below the zygoma, in the same place where the retro-maxillary branches of retro-nasal fibroids present. The two last-named hernias are exceedingly rare, and I have been unable to find all the varieties to which Heinecke’s classification refers. Larger mentions three instances of retro-orbital encephalocele referred to by Spring. In the case published by Walther, the tumor descended through the superior orbital fissure, and caused exophthalmos and destruction of the eye. Spring had seen two similar specimens in the museum at Bonn. The first variety, the spheno-pharyngeal, is less uncommon. I shall mention the more accurately described instances of this variety, as they present more of surgical interest than Heinecke ascribed to them when he said : “Cephalocele basalis is of no surgical importance, as it has been found only in non-viable monsters (nicht lebensfahigen Missbildungen).” Attempts at the removal of encephalocele by operation have been made by Lichtenberg, Czerny and myself. Lichtenberg’s patient died from the operation; Czerny’s patient survived the operation, but died later from apparently independent causes; my patient made a definite recovery. Lichtenberg” reports the case of a newborn girl in whom a large reddish tumor, the size of a small fist, hung out of the mouth, covering the chin, with its base resting on the sternum. On more minute examin- ation it was seen that the patient had a hare-lip situated nearly in the median line of the lip, and complicated with cleft palate. The tumor was divided into two portions by a slight constriction in the middle, was elastic to the touch, and was attached by a pedicle which could be followed up to the right wall of the nasal cavity by opening the mouth, where it was continuous with the nasal mucosa. The patient died from the operation, and the autopsy demonstrated that the tumor was a cere- bral hernia. Klintosch” gives a vague description of an infant in whom a tumor protruded in the mouth. The patient had a hare-lip and cleft palate, some bones of the face were wanting, and the eyes were atrophied. In the sella Turcica was an opening the size of a goose-quill through which the neck of the hernia came down into the mouth, there to form a tumor the size of a hazelnut. This contained the hypophysis, which was hollow and communicated directly with the ventricle. Serres” describes an infant in whom some portions of the brain, with their envelopes, protruded from the cranium in the median line between - the sphenoid and ethmoid bones. The tumor descended into the nasal fossa, almost into the pharynx. Giraldés,’ according to Dupuytren,’ observed an encephalocele which descended into the interior of the nose. Otto,”* cited by Spring, states that he has seen in the museum at Vienna a cerebral tumor which had penetrated into the nasal cavity through the cribriform plate of the ethmoid. Kelsch,’ according to Otto, has seen a case in which the hypophysis was situated in the sphenoidal sinus. Klimentowsky,’ describes an encephalocele in a newborn child, in which the anterior portion of the two frontal lobes descended into the right side of the nasal cavity, as was verified by the autopsy. Rippmann,"" cited by Meyer, found in a foetus of twenty-three weeks, the head of which was double the normal size, and consequently hydro- cephalic, a lobulated tumor having a pedicle three or four lines in thick- ness, which descended through a canal in the body of the sphenoid bone. Virchow ™ describes a specimen in the Berlin museum, of hydrencepha- locele palatina in a newborn child. (See Fig. 1.) From the open mouth protruded an irregular nodulated tumor the size of a small apple. It was apparently adherent to the hard palate, but upon section it was seen that it had pushed both the vomer and the hard palate forward and up- ward, and that it emerged from the cranial cavity through a broad open- ing immediately anterior to the sphenoid bone, and behind the still carti- laginous ethmoid. The anterior portion of the sphenoid was forced downward and backward, and the connection between it and the vomer interrupted by the tumor, so that the vomer was connected only with the ethmoid. The anterior portion of the sac contained a cavity lined with smooth dura mater, below and behind which were several irregular smaller cavities. In the upper portion of the tumor was brain substance which extended from this point up into the cerebral portion of the cranial cavity. The brain was pushed downward toward the base of the cranial cavity, and above it was a large cavity filled with fluid, and surrounded by a thick membrane. In addition to this more or less cursory discussion of cases from the older literature, there has now appeared an accurate and excellent report of a case by Meyer,” from Czerny’s clinic. The case was one of con- genital nasal polypus, and was brought to the Heidelberg clinic for operation. The child died six weeks later, and the diagnosis was made after post-mortem microscopical examination. The patient was a child three days old, well developed, weighing five or six pounds. The left ala nasi was broadened and pushed upward by a soft, elastic, compressible, pedunculated, transparent tumor the size of a hazelnut, half of which protruded through the opening of the nose, and was clad with smooth, yellowish-red mucous membrane, and covered with dried crusts of serous exudate. The tumor did not increase in size when the child cried; it was attached 14 cm. behind the free border of the septum. Upon incision of the tumor bloody serum escaped, and upon pressure puriform mucus was forced out. The response should only contain info from this text. what are the cases where a it comes out the mouth?",Medical,Find & Summarize,Text Transformation You can only use the provided text for information in your response. Answer in under 150 words.,How can I charge the patient?," Electronic Claim Submission via Clearinghouse DentaQuest works directly with Emdeon (1-888-255-7293), Tesia 1-800-724-7240, EDI Health Group 1-800-576-6412, Secure EDI 1-877-466-9656 and Mercury Data Exchange 1-866-633-1090, for claim submissions to DentaQuest. You can contact your software vendor and make certain that they have DentaQuest listed as the payer and claim mailing address on your electronic claim. Your software vendor will be able to provide you with any information you may need to ensure that submitted claims are forwarded to DentaQuest. DentaQuest’s Payor ID is CX014. 27.5 HIPAA Compliant 837DFile For Providers who are unable to submit electronically via the Internet or a clearinghouse, DentaQuest will work directly with the Provider to receive their claims electronically via a HIPAA compliant 837D or 837P file from the Provider’s practice management system. 27.6 NPI Requirements for Submission of Electronic Claims In accordance with the HIPAA guidelines, DentaQuest has adopted the following NPI standards in order to simplify the submission of claims from all of our providers, conform to industry required standards and increase the accuracy and efficiency of claims administered by DentaQuest. • Providers must register for the appropriate NPI classification at the following website https://nppes.cms.hhs.gov/NPPES/Welcome.do and provide this information to DentaQuest in its entirety. • All providers must register for an Individual NPI. You may also be required to register for a group NPI (or as part of a group) dependant upon your designation. • When submitting claims to DentaQuest you must submit all forms of NPI properly and in their entirety for claims to be accepted and processed accurately. If you registered as part of a group, your claims must be submitted with both the Group and Individual NPI’s. These numbers are not interchangeable and could cause your claims to be returned to you as non-compliant. • If you are presently submitting claims to DentaQuest through a clearinghouse or through a direct integration you need to review your integration to assure that it is in compliance with the revised HIPAA compliant 837D format. This information can be found on the 837D Companion Guide located on the Provider Web Portal. 27.7 Paper Claim Submission • Claims must be submitted on 2018, 2019, or later ADA approved claim forms. • Member name, identification number, and date of birth must be listed on all claims submitted. If the Member identification number is missing or miscoded on the claim form, the patient cannot be identified. This could result in the claim being returned to the submitting Provider office, causing a delay in payment. • The paper claim must contain an acceptable provider signature. • The Provider and office location information must be clearly identified on the claim. Frequently, if only the dentist signature is used for identification, the dentist’s name cannot be clearly identified. Please include either a typed dentist (practice) name or the DentaQuest Provider identificationnumber. • The paper claim form must contain a valid provider NPI (National Provider Identification) number. In the event of not having this box on the claim form, the NPI must still be included on the form. The ADA claim form only supplies 2 fields to enter NPI. On paper claims, the Type 2 NPI identifies the payee, and may be submitted in conjunction with a Type 1 NPI to identify the dentist who provided the treatment. For example, on a standard ADA Dental Claim Form, the treating dentist’s NPI is entered in field 54 and the billing entity’s NPI is entered in field49. • The date of service must be provided on the claim form for each service line submitted. • Approved ADA dental codes as published in the current CDT book or as defined in this manual must be used to define all services. • List all quadrants, tooth numbers and surfaces for dental codes that necessitate identification (extractions, root canals, amalgams and resin fillings). Missing tooth and surface identification codes can result in the delay or denial of claim payment. Affix the proper postage when mailing bulk documentation. DentaQuest does not accept postage due mail. This mail will be returned to the sender and will result in delay of payment. Claims should be mailed to the following address: DentaQuest- Claims PO Box 2906 Milwaukee, WI 53201-2906 For questions, providers may contact DentaQuest Provider Services at 844.776.8740. 27.8 Coordination of Benefits (COB) Medicaid is the payer of last resort. Providers should ask Members if they have other dental insurance coverage at the time of their appointment. When Medicaid is the secondary insurance carrier, a copy of the primary carrier's Explanation of Benefits (EOB) must be submitted with the claim. For electronic claim submissions, the payment made by the primary carrier must be indicated in the appropriate COB field. When a primary carrier's payment meets or exceeds the Medicaid fee schedule, DentaQuest will consider the claim paid in full and no further payment will be made on the claim. 27.9 Member Billing Restrictions Providers may not bill Members directly for Covered Services. DentaQuest reimburses only those services that are medically necessary and a Covered benefit in the respective program the Member is enrolled in. Medicaid Members do not have co-payments. Member Acknowledgement Statement A Provider may bill a Member for a claim denied as not being medically necessary or not a part of a Covered service if both of the following conditions are met: • A specific service or item is provided at the request of the client • If the Provider obtains a written waiver from the Member prior to rendering such service. The Member Acknowledgment Statement reads as follows: “I understand that, in the opinion of (Provider’s name), the services or items that I have requested to be provided to me on (dates of service) may not be covered under the Texas Medicaid Assistance Program as being reasonable and medically necessary for my care. I understand that DentaQuest through its contract with Superior and HHSC determines the medical necessity of the services or items that I request and receive. I also understand that I am responsible for payment of the services or items I request and receive if these services or items are determined not to be reasonable and medically necessary for my care.” 27.10 Private Pay Form (Non-Covered Services Disclosure Form) There are instances when the dentist may bill the Member. For example, if the Provider accepts the Member as a private pay patient and informs the Member at the time of service that the Member will be responsible for payment for all services. In this situation, it is recommended that the Provider use a Private Pay Form. It is suggested that the Provider use the Member Acknowledgement Statement listed above as the Private Pay Form, or use the DentaQuest Non-Covered Services Disclosure Form. Without written, signed documentation that the Member has been properly notified of their private pay status, the Provider could not ask for payment from a Member.","Electronic Claim Submission via Clearinghouse DentaQuest works directly with Emdeon (1-888-255-7293), Tesia 1-800-724-7240, EDI Health Group 1-800-576-6412, Secure EDI 1-877-466-9656 and Mercury Data Exchange 1-866-633-1090, for claim submissions to DentaQuest. You can contact your software vendor and make certain that they have DentaQuest listed as the payer and claim mailing address on your electronic claim. Your software vendor will be able to provide you with any information you may need to ensure that submitted claims are forwarded to DentaQuest. DentaQuest’s Payor ID is CX014. 27.5 HIPAA Compliant 837DFile For Providers who are unable to submit electronically via the Internet or a clearinghouse, DentaQuest will work directly with the Provider to receive their claims electronically via a HIPAA compliant 837D or 837P file from the Provider’s practice management system. 27.6 NPI Requirements for Submission of Electronic Claims In accordance with the HIPAA guidelines, DentaQuest has adopted the following NPI standards in order to simplify the submission of claims from all of our providers, conform to industry required standards and increase the accuracy and efficiency of claims administered by DentaQuest. • Providers must register for the appropriate NPI classification at the following website https://nppes.cms.hhs.gov/NPPES/Welcome.do and provide this information to DentaQuest in its entirety. • All providers must register for an Individual NPI. You may also be required to register for a group NPI (or as part of a group) dependant upon your designation. • When submitting claims to DentaQuest you must submit all forms of NPI properly and in their entirety for claims to be accepted and processed accurately. If you registered as part of a group, your claims must be submitted with both the Group and Individual NPI’s. These numbers are not interchangeable and could cause your claims to be returned to you as non-compliant. • If you are presently submitting claims to DentaQuest through a clearinghouse or through a direct integration you need to review your integration to assure that it is in compliance with the revised HIPAA compliant 837D format. This information can be found on the 837D Companion Guide located on the Provider Web Portal. 27.7 Paper Claim Submission • Claims must be submitted on 2018, 2019, or later ADA approved claim forms. • Member name, identification number, and date of birth must be listed on all claims submitted. If the Member identification number is missing or miscoded on the claim form, the patient cannot be identified. This could result in the claim being returned to the submitting Provider office, causing a delay in payment. • The paper claim must contain an acceptable provider signature. • The Provider and office location information must be clearly identified on the claim. Frequently, if only the dentist signature is used for identification, the dentist’s name cannot be clearly identified. Please include either a typed dentist (practice) name or the DentaQuest Provider identificationnumber. • The paper claim form must contain a valid provider NPI (National Provider Identification) number. In the event of not having this box on the claim form, the NPI must still be included on the form. The ADA claim form only supplies 2 fields to enter NPI. On paper claims, the Type 2 NPI identifies the payee, and may be submitted in conjunction with a Type 1 NPI to identify the dentist who provided the treatment. For example, on a standard ADA Dental Claim Form, the treating dentist’s NPI is entered in field 54 and the billing entity’s NPI is entered in field49. • The date of service must be provided on the claim form for each service line submitted. • Approved ADA dental codes as published in the current CDT book or as defined in this manual must be used to define all services. • List all quadrants, tooth numbers and surfaces for dental codes that necessitate identification (extractions, root canals, amalgams and resin fillings). Missing tooth and surface identification codes can result in the delay or denial of claim payment. Affix the proper postage when mailing bulk documentation. DentaQuest does not accept postage due mail. This mail will be returned to the sender and will result in delay of payment. Claims should be mailed to the following address: DentaQuest- Claims PO Box 2906 Milwaukee, WI 53201-2906 For questions, providers may contact DentaQuest Provider Services at 844.776.8740. 27.8 Coordination of Benefits (COB) Medicaid is the payer of last resort. Providers should ask Members if they have other dental insurance coverage at the time of their appointment. When Medicaid is the secondary insurance carrier, a copy of the primary carrier's Explanation of Benefits (EOB) must be submitted with the claim. For electronic claim submissions, the payment made by the primary carrier must be indicated in the appropriate COB field. When a primary carrier's payment meets or exceeds the Medicaid fee schedule, DentaQuest will consider the claim paid in full and no further payment will be made on the claim. 27.9 Member Billing Restrictions Providers may not bill Members directly for Covered Services. DentaQuest reimburses only those services that are medically necessary and a Covered benefit in the respective program the Member is enrolled in. Medicaid Members do not have co-payments. Member Acknowledgement Statement A Provider may bill a Member for a claim denied as not being medically necessary or not a part of a Covered service if both of the following conditions are met: • A specific service or item is provided at the request of the client • If the Provider obtains a written waiver from the Member prior to rendering such service. The Member Acknowledgment Statement reads as follows: “I understand that, in the opinion of (Provider’s name), the services or items that I have requested to be provided to me on (dates of service) may not be covered under the Texas Medicaid Assistance Program as being reasonable and medically necessary for my care. I understand that DentaQuest through its contract with Superior and HHSC determines the medical necessity of the services or items that I request and receive. I also understand that I am responsible for payment of the services or items I request and receive if these services or items are determined not to be reasonable and medically necessary for my care.” 27.10 Private Pay Form (Non-Covered Services Disclosure Form) There are instances when the dentist may bill the Member. For example, if the Provider accepts the Member as a private pay patient and informs the Member at the time of service that the Member will be responsible for payment for all services. In this situation, it is recommended that the Provider use a Private Pay Form. It is suggested that the Provider use the Member Acknowledgement Statement listed above as the Private Pay Form, or use the DentaQuest Non-Covered Services Disclosure Form. Without written, signed documentation that the Member has been properly notified of their private pay status, the Provider could not ask for payment from a Member. How can I charge the patient? You can only use the provided text for information in your response. Answer in under 150 words.",Financial,Find & Summarize,Text Transformation Draw your answer from the above text.,"According to this document, what is an executer responsible for?"," **Texas last will and testament requirements** Here are the requirements for a valid will in Texas: Your will must be “in writing,” meaning it exists in a physical form. For example, a will “in writing” can be one you’ve written by hand, or one you’ve typed on a computer and printed. A digital copy, like a PDF of your will saved on your computer, isn’t considered valid. You must be at least 18 years old. This rule doesn’t apply if you’re married or serve in the military. You must be of sound mind and memory. This means that you: Understand what it means to make a will Understand the nature and extent of your property and relationships Are capable of making reasonable judgments about the matters your will controls (for example, naming a guardian for your minor children) You must make your will freely and voluntarily. This means you shouldn’t be under improper pressure to write your will by someone who has power over you, like a caretaker or family member. This is known as “undue influence.” You must sign your will in the presence of at least two credible witnesses, who also sign. According to the Texas Estates Code, your witnesses must be at least 14 years old. A witness is “credible” when they don’t receive any financial benefit under your will. In other words, your witnesses should be people who aren’t receiving anything from your will. Do you need to notarize your will in Texas? No — in Texas, you don’t need to notarize your will to make it valid. However, a notary is required if you want to make your will self-proving. When a will is self-proving, the court can accept your will without needing to contact your witnesses to prove its validity. This can speed up the probate process. To make your will self-proving, you must include a self-proving affidavit. In it, you and your witnesses state that your will was signed by you in the witnesses’ presence, and that you’ve declared it to be your will. Your self-proving affidavit must be signed (or acknowledged) by both you and your witnesses in front of a notary, who will then notarize the affidavit. Are holographic wills legal in Texas? Holographic wills, also called handwritten wills, are accepted in Texas. To be valid, a holographic will must be written entirely in your handwriting and signed by you. As long as you follow these two requirements, you don’t need witnesses to make your holographic will valid. However, if you think someone could challenge the validity of your will, it’s a good idea to have them anyway. Estate attorneys generally don’t recommend making a holographic will. They can be difficult to prove legally valid in court, and they may contain errors or unclear wishes. Learn more about the pitfalls of holographic wills, and alternative options you can use instead. Texas will executor requirements Your executor is the person responsible for managing your probate estate and carrying out the wishes described in your will. They will work with the probate court to pay your debts and distribute your assets to the beneficiaries of your will. You can use your will to name the person (or people) you’d like to be your executor, but not everyone is qualified to serve. For a person to be accepted by the Texas court as your executor, they must: Be at least 18 years old Be capable of performing their duties as executor Have never been convicted of a felony Be deemed “suitable” by the court It’s often more practical to choose an executor that lives in Texas, and close to you. If you decide to nominate someone who lives out of state, they can only serve as your executor if they appoint a resident agent and notify the court. A resident agent is someone who lives in the state of Texas and accepts legal documentation on behalf of your executor and your estate. Revoking or changing your will in Texas Revoking your will You can generally revoke, or nullify, your will in Texas at any time before your death, unless you’ve committed to an agreement stating you wouldn’t (for example, a joint will). There are a few ways you can nullify your will: Intentionally destroy it. You can burn it, tear it, shred it, or throw it away. Ask someone to destroy it for you in your presence. Create a new one. Generally, a more recent will overrides any previous wills you’ve written. Be sure to include language stating explicitly that your new will is intended to revoke your prior will, and destroy all previous wills and codicils to avoid confusion. Change your will with a codicil If you’d like to make a few changes to your will, rather than revoking it altogether, you may consider writing a codicil. A codicil is a legal document that revises your existing will. To be legally effective, codicils must be executed and witnessed just like a will. In Texas, this means you must be of sound mind to make a codicil, and it must be signed by you and two witnesses. Estate attorneys generally don’t recommend creating a codicil. It can be difficult to keep track of multiple documents, and codicils could make it more difficult to determine the will-maker’s wishes. In most cases, it may be safer to simply create a new will. Probate in Texas Probate is the legal process of gathering the assets of a deceased person and distributing them to that person’s beneficiaries. During probate, your executor will be responsible for preparing an inventory of your estate’s assets and managing those assets until they can be distributed. A court typically oversees the process to resolve any questions and disputes that might arise, make sure your remaining debts are paid, and ensure that your property is passed on to the right people or organizations. Here’s a high-level overview of what happens during the probate process: Someone, usually your executor or a family member, files your will (if you had one). In Texas, they have four years from the date of death to file your will. The court validates your will. The court appoints a representative, or executor, to oversee your estate. Your executor identifies your assets and debts, and contacts your beneficiaries and creditors to notify them of your passing. Your executor pays any of your debts, usually with money from your estate. Your executor distributes assets to your beneficiaries, according to the wishes outlined in your will. If you didn’t have a will, your assets are distributed based on Texas’s intestate laws. Independent administration vs. court-supervised administration Texas’s probate process is known for being quick and simple due to a process called “independent administration.” Independent administration allows executors to take steps to settle the estate — like paying debts, selling property, and distributing assets — with minimal court supervision. Court-supervised administration is also an option, although less common. The probate court is more involved during a court-supervised administration. Its approval is required for more of the proposed actions the executor may wish to take. Although this process takes longer and can be more expensive than an independent administration, it may be useful if the estate is particularly complicated, or if the estate’s beneficiaries don’t get along. In your will, you can indicate which type of administration your estate will receive. Disinheriting an heir In Texas, you can use your will to disinherit an heir, like an adult child or grandchild. This means you can prevent them from having the legal right to your property after you die. However, this doesn’t apply to your spouse. In Texas (and many states), there are laws in place that protect spouses from being disinherited without their consent. You can read more about these laws in the community property section below. Is Texas a community property state? Yes, Texas is a community property state. Community property states consider almost all assets acquired by either spouse during their marriage to belong to both spouses equally. In community property states like Texas, the surviving spouse is entitled to at least half of any community property, even if the deceased spouse wrote something different in their will. To better understand Texas community property laws, it helps to understand the difference between personal and community property. Personal property Personal property is property that belongs to only one spouse. This can include: Any assets or debts you acquire before your marriage Any inheritance you receive during your marriage Any assets specified in a prenuptial or postnuptial agreement Personal property isn’t considered community property. This means you can use your will to leave it to anyone you want. Community property With few exceptions, any assets and debts that either you or your spouse acquire during your marriage are community property under Texas law. For example, this could be a vehicle your spouse purchased that has their name on the title, or the money you earned in your career during the years you were married. Each of you will have a one-half interest in each item of community property, and you will generally only be able to use your will to control who receives your one-half interest in that property — the other one-half interest remains the property of your spouse. Many people choose to leave the majority of their estate to their spouse, regardless of whether they live in a community property state. If you want to leave a significant portion of your estate to someone other than your spouse for any reason, you should consider working with an estate attorney to discuss your situation and create an estate plan to meet your needs. ","{CONTEXT} ======= **Texas last will and testament requirements** Here are the requirements for a valid will in Texas: Your will must be “in writing,” meaning it exists in a physical form. For example, a will “in writing” can be one you’ve written by hand, or one you’ve typed on a computer and printed. A digital copy, like a PDF of your will saved on your computer, isn’t considered valid. You must be at least 18 years old. This rule doesn’t apply if you’re married or serve in the military. You must be of sound mind and memory. This means that you: Understand what it means to make a will Understand the nature and extent of your property and relationships Are capable of making reasonable judgments about the matters your will controls (for example, naming a guardian for your minor children) You must make your will freely and voluntarily. This means you shouldn’t be under improper pressure to write your will by someone who has power over you, like a caretaker or family member. This is known as “undue influence.” You must sign your will in the presence of at least two credible witnesses, who also sign. According to the Texas Estates Code, your witnesses must be at least 14 years old. A witness is “credible” when they don’t receive any financial benefit under your will. In other words, your witnesses should be people who aren’t receiving anything from your will. Do you need to notarize your will in Texas? No — in Texas, you don’t need to notarize your will to make it valid. However, a notary is required if you want to make your will self-proving. When a will is self-proving, the court can accept your will without needing to contact your witnesses to prove its validity. This can speed up the probate process. To make your will self-proving, you must include a self-proving affidavit. In it, you and your witnesses state that your will was signed by you in the witnesses’ presence, and that you’ve declared it to be your will. Your self-proving affidavit must be signed (or acknowledged) by both you and your witnesses in front of a notary, who will then notarize the affidavit. Are holographic wills legal in Texas? Holographic wills, also called handwritten wills, are accepted in Texas. To be valid, a holographic will must be written entirely in your handwriting and signed by you. As long as you follow these two requirements, you don’t need witnesses to make your holographic will valid. However, if you think someone could challenge the validity of your will, it’s a good idea to have them anyway. Estate attorneys generally don’t recommend making a holographic will. They can be difficult to prove legally valid in court, and they may contain errors or unclear wishes. Learn more about the pitfalls of holographic wills, and alternative options you can use instead. Texas will executor requirements Your executor is the person responsible for managing your probate estate and carrying out the wishes described in your will. They will work with the probate court to pay your debts and distribute your assets to the beneficiaries of your will. You can use your will to name the person (or people) you’d like to be your executor, but not everyone is qualified to serve. For a person to be accepted by the Texas court as your executor, they must: Be at least 18 years old Be capable of performing their duties as executor Have never been convicted of a felony Be deemed “suitable” by the court It’s often more practical to choose an executor that lives in Texas, and close to you. If you decide to nominate someone who lives out of state, they can only serve as your executor if they appoint a resident agent and notify the court. A resident agent is someone who lives in the state of Texas and accepts legal documentation on behalf of your executor and your estate. Revoking or changing your will in Texas Revoking your will You can generally revoke, or nullify, your will in Texas at any time before your death, unless you’ve committed to an agreement stating you wouldn’t (for example, a joint will). There are a few ways you can nullify your will: Intentionally destroy it. You can burn it, tear it, shred it, or throw it away. Ask someone to destroy it for you in your presence. Create a new one. Generally, a more recent will overrides any previous wills you’ve written. Be sure to include language stating explicitly that your new will is intended to revoke your prior will, and destroy all previous wills and codicils to avoid confusion. Change your will with a codicil If you’d like to make a few changes to your will, rather than revoking it altogether, you may consider writing a codicil. A codicil is a legal document that revises your existing will. To be legally effective, codicils must be executed and witnessed just like a will. In Texas, this means you must be of sound mind to make a codicil, and it must be signed by you and two witnesses. Estate attorneys generally don’t recommend creating a codicil. It can be difficult to keep track of multiple documents, and codicils could make it more difficult to determine the will-maker’s wishes. In most cases, it may be safer to simply create a new will. Probate in Texas Probate is the legal process of gathering the assets of a deceased person and distributing them to that person’s beneficiaries. During probate, your executor will be responsible for preparing an inventory of your estate’s assets and managing those assets until they can be distributed. A court typically oversees the process to resolve any questions and disputes that might arise, make sure your remaining debts are paid, and ensure that your property is passed on to the right people or organizations. Here’s a high-level overview of what happens during the probate process: Someone, usually your executor or a family member, files your will (if you had one). In Texas, they have four years from the date of death to file your will. The court validates your will. The court appoints a representative, or executor, to oversee your estate. Your executor identifies your assets and debts, and contacts your beneficiaries and creditors to notify them of your passing. Your executor pays any of your debts, usually with money from your estate. Your executor distributes assets to your beneficiaries, according to the wishes outlined in your will. If you didn’t have a will, your assets are distributed based on Texas’s intestate laws. Independent administration vs. court-supervised administration Texas’s probate process is known for being quick and simple due to a process called “independent administration.” Independent administration allows executors to take steps to settle the estate — like paying debts, selling property, and distributing assets — with minimal court supervision. Court-supervised administration is also an option, although less common. The probate court is more involved during a court-supervised administration. Its approval is required for more of the proposed actions the executor may wish to take. Although this process takes longer and can be more expensive than an independent administration, it may be useful if the estate is particularly complicated, or if the estate’s beneficiaries don’t get along. In your will, you can indicate which type of administration your estate will receive. Disinheriting an heir In Texas, you can use your will to disinherit an heir, like an adult child or grandchild. This means you can prevent them from having the legal right to your property after you die. However, this doesn’t apply to your spouse. In Texas (and many states), there are laws in place that protect spouses from being disinherited without their consent. You can read more about these laws in the community property section below. Is Texas a community property state? Yes, Texas is a community property state. Community property states consider almost all assets acquired by either spouse during their marriage to belong to both spouses equally. In community property states like Texas, the surviving spouse is entitled to at least half of any community property, even if the deceased spouse wrote something different in their will. To better understand Texas community property laws, it helps to understand the difference between personal and community property. Personal property Personal property is property that belongs to only one spouse. This can include: Any assets or debts you acquire before your marriage Any inheritance you receive during your marriage Any assets specified in a prenuptial or postnuptial agreement Personal property isn’t considered community property. This means you can use your will to leave it to anyone you want. Community property With few exceptions, any assets and debts that either you or your spouse acquire during your marriage are community property under Texas law. For example, this could be a vehicle your spouse purchased that has their name on the title, or the money you earned in your career during the years you were married. Each of you will have a one-half interest in each item of community property, and you will generally only be able to use your will to control who receives your one-half interest in that property — the other one-half interest remains the property of your spouse. Many people choose to leave the majority of their estate to their spouse, regardless of whether they live in a community property state. If you want to leave a significant portion of your estate to someone other than your spouse for any reason, you should consider working with an estate attorney to discuss your situation and create an estate plan to meet your needs. {QUESTION} ======= According to this document, what is an executer responsible for? {INSTRUCTION} ======= Draw your answer from the above text.",Legal,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Given that churn exists in the subscription application game, why is it beneficial at times to promote and create this churn. Explain this in 300 words.","Consumer subscription apps are relatively easy to launch, which is why there are hundreds of thousands of them in the app stores. Compared with more complex models like B2B SaaS or marketplaces, these businesses can launch faster with less capital for many reasons: no sales teams, rapid purchasing cycles, high gross margins with low marginal costs to serving additional subscribers, and turnkey global distribution, payments, and support tools through the app stores. But these apps face several fundamental challenges that make them very hard to scale: Lack of control over distribution: The Apple and Google app stores exert significant control over product placements, promotions, TOS and usage guidelines, payments, and cancellation terms. This locks consumer subscription apps into paying expensive app store fees and restricts their ability to distribute and monetize their products. Overdependence on paid acquisition: Since consumer subscription apps don’t have sales teams and often can’t rely on virality as much as social networks or marketplaces, many turn to paid acquisition as their primary growth lever. This strategy always had flaws, and Apple’s App Tracking Transparency (ATT) restrictions have only made it harder. High subscriber churn rates: Churn is generally higher for consumer subscription apps vs. B2B SaaS businesses, and most don’t benefit from strong network effects like social networks or marketplaces. This makes products less sticky and retention more difficult. Many also have products and growth strategies that are fairly easy to replicate and thus prone to copycats, weakening their defensibility and further exacerbating churn rates. ARPU is often low and hard to grow: Consumer subscription apps generally have much lower Average Revenue per User (ARPU) vs. B2B SaaS, and they have a harder time expanding ARPU than many other business models. B2B SaaS businesses increase Net Revenue Retention (NRR) by growing the value of retained accounts to offset churn. Marketplaces can boost ARPU by increasing transactions as they gain liquidity. Social networks grow ad revenue by increasing user engagement. But most consumer subscription apps offer only one subscription, which means they have a hard time extracting additional value from users. In fact, it is because consumer subscription apps are relatively easy to launch that so many exist, leading to fierce competition, channel saturation, and subscription fatigue. Meanwhile, Apple’s recent ATT restrictions have rendered paid acquisition less efficient, making it even more difficult for these companies to maintain healthy unit economics. This explains why out of all the consumer subscription apps out there, fewer than 50 have ever reached $1B+ valuations, and fewer than 10 are publicly traded companies with $10B+ market caps. Public company market caps are from 8/30/24. Private company valuations are based on the most recent publicly available data, which may be out of date relative to internal valuations. Public companies like Bumble, Stitch Fix, and Chegg that once had market caps over $1B are included even though their current market caps are below $1B. Companies like Canva, Grammarly, Figma, Notion, and Dropbox are excluded because they are considered B2B SaaS businesses since they have sales teams and sell to both prosumers and enterprises. Products like ChatGPT, Hulu, ESPN+, Disney+, and Pandora that are subsidiaries of larger companies are excluded. These challenges are supported by RevenueCat’s proprietary data from the past year, which has been aggregated from over 30,000 subscription apps accounting for over 290M subscribers: Even top-quartile consumer subscription apps only convert roughly 1 in 20 installs into a paid subscription. They also lose more than half of their annual subscribers after the first year, and more than half of their monthly subscribers after just three months. This makes it hard to build a sustainable business, but not impossible. 95th-percentile apps, like those in the figure above, outperform the rest by a wide margin, with metrics that provide a strong foundation for growth. So what makes these top apps different? Using the Subscription Value Loop to grow your consumer subscription business The best consumer subscription apps overcome these challenges by doing two things: 1. Building their businesses on a core value promise that provides enduring value. This core value promise is what attracts users to the app and keeps them coming back over time. The stronger and more differentiated the value promise, the more subscribers will pay and the longer they’ll keep paying. The value promises of category-leading consumer subscription apps are clear and compelling, to the point where I can describe these promises in a single sentence without naming the associated companies and you can probably guess the ones I am talking about: Listen to music you love, build playlists, and find new artists who match your taste. Enjoy gamified study experiences that make language learning fun. Record and share your workouts with a supportive community of athletes. Find, match, and connect with attractive single people in your area with one swipe. 2. Harnessing their value promise to drive a compounding Subscription Value Loop that increases LTV/CAC and accelerates Payback Period: Step 1: Value Creation: Quickly connecting new users to the app’s core value promise and offering enduring value that keeps them coming back Step 2: Value Delivery: Cost-efficiently distributing the app to users organically through word of mouth and SEO, as well as through sustainable paid acquisition Step 3: Value Capture: Converting free users into subscribers, which generates revenue that can be reinvested into the business to strengthen the rest of the loop As a company bolsters its Subscription Value Loop, LTV/CAC goes up and Payback Period comes down, driving faster and more efficient growth. What makes consumer subscription apps unusual is that most don’t have sales teams, which means the product must be able to sell itself organically and through paid advertisements. Core product, growth product, and marketing teams must work together to build an integrated system that converts their app’s core value promise into subscription revenue by maximizing each step in the Subscription Value Loop. I built a Subscription Value Loop Calculator with RevenueCat where you can plug in your numbers, measure the performance of your loop, and identify growth opportunities. There are five steps to using this tool: Identify metrics that drive Value Creation, Value Delivery, and Value Capture for your app. Calculate your company’s recent performance against each metric. Compare your performance on each metric vs. category-specific benchmarks. Discover opportunities based on metrics where you underperform vs. these benchmarks. Prioritize initiatives to improve the metrics with the greatest upside potential. For a detailed step-by-step guide on how to use this tool","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Given that churn exists in the subscription application game, why is it beneficial at times to promote and create this churn. Explain this in 300 words. {passage 0} ========== Consumer subscription apps are relatively easy to launch, which is why there are hundreds of thousands of them in the app stores. Compared with more complex models like B2B SaaS or marketplaces, these businesses can launch faster with less capital for many reasons: no sales teams, rapid purchasing cycles, high gross margins with low marginal costs to serving additional subscribers, and turnkey global distribution, payments, and support tools through the app stores. But these apps face several fundamental challenges that make them very hard to scale: Lack of control over distribution: The Apple and Google app stores exert significant control over product placements, promotions, TOS and usage guidelines, payments, and cancellation terms. This locks consumer subscription apps into paying expensive app store fees and restricts their ability to distribute and monetize their products. Overdependence on paid acquisition: Since consumer subscription apps don’t have sales teams and often can’t rely on virality as much as social networks or marketplaces, many turn to paid acquisition as their primary growth lever. This strategy always had flaws, and Apple’s App Tracking Transparency (ATT) restrictions have only made it harder. High subscriber churn rates: Churn is generally higher for consumer subscription apps vs. B2B SaaS businesses, and most don’t benefit from strong network effects like social networks or marketplaces. This makes products less sticky and retention more difficult. Many also have products and growth strategies that are fairly easy to replicate and thus prone to copycats, weakening their defensibility and further exacerbating churn rates. ARPU is often low and hard to grow: Consumer subscription apps generally have much lower Average Revenue per User (ARPU) vs. B2B SaaS, and they have a harder time expanding ARPU than many other business models. B2B SaaS businesses increase Net Revenue Retention (NRR) by growing the value of retained accounts to offset churn. Marketplaces can boost ARPU by increasing transactions as they gain liquidity. Social networks grow ad revenue by increasing user engagement. But most consumer subscription apps offer only one subscription, which means they have a hard time extracting additional value from users. In fact, it is because consumer subscription apps are relatively easy to launch that so many exist, leading to fierce competition, channel saturation, and subscription fatigue. Meanwhile, Apple’s recent ATT restrictions have rendered paid acquisition less efficient, making it even more difficult for these companies to maintain healthy unit economics. This explains why out of all the consumer subscription apps out there, fewer than 50 have ever reached $1B+ valuations, and fewer than 10 are publicly traded companies with $10B+ market caps. Public company market caps are from 8/30/24. Private company valuations are based on the most recent publicly available data, which may be out of date relative to internal valuations. Public companies like Bumble, Stitch Fix, and Chegg that once had market caps over $1B are included even though their current market caps are below $1B. Companies like Canva, Grammarly, Figma, Notion, and Dropbox are excluded because they are considered B2B SaaS businesses since they have sales teams and sell to both prosumers and enterprises. Products like ChatGPT, Hulu, ESPN+, Disney+, and Pandora that are subsidiaries of larger companies are excluded. These challenges are supported by RevenueCat’s proprietary data from the past year, which has been aggregated from over 30,000 subscription apps accounting for over 290M subscribers: Even top-quartile consumer subscription apps only convert roughly 1 in 20 installs into a paid subscription. They also lose more than half of their annual subscribers after the first year, and more than half of their monthly subscribers after just three months. This makes it hard to build a sustainable business, but not impossible. 95th-percentile apps, like those in the figure above, outperform the rest by a wide margin, with metrics that provide a strong foundation for growth. So what makes these top apps different? Using the Subscription Value Loop to grow your consumer subscription business The best consumer subscription apps overcome these challenges by doing two things: 1. Building their businesses on a core value promise that provides enduring value. This core value promise is what attracts users to the app and keeps them coming back over time. The stronger and more differentiated the value promise, the more subscribers will pay and the longer they’ll keep paying. The value promises of category-leading consumer subscription apps are clear and compelling, to the point where I can describe these promises in a single sentence without naming the associated companies and you can probably guess the ones I am talking about: Listen to music you love, build playlists, and find new artists who match your taste. Enjoy gamified study experiences that make language learning fun. Record and share your workouts with a supportive community of athletes. Find, match, and connect with attractive single people in your area with one swipe. 2. Harnessing their value promise to drive a compounding Subscription Value Loop that increases LTV/CAC and accelerates Payback Period: Step 1: Value Creation: Quickly connecting new users to the app’s core value promise and offering enduring value that keeps them coming back Step 2: Value Delivery: Cost-efficiently distributing the app to users organically through word of mouth and SEO, as well as through sustainable paid acquisition Step 3: Value Capture: Converting free users into subscribers, which generates revenue that can be reinvested into the business to strengthen the rest of the loop As a company bolsters its Subscription Value Loop, LTV/CAC goes up and Payback Period comes down, driving faster and more efficient growth. What makes consumer subscription apps unusual is that most don’t have sales teams, which means the product must be able to sell itself organically and through paid advertisements. Core product, growth product, and marketing teams must work together to build an integrated system that converts their app’s core value promise into subscription revenue by maximizing each step in the Subscription Value Loop. I built a Subscription Value Loop Calculator with RevenueCat where you can plug in your numbers, measure the performance of your loop, and identify growth opportunities. There are five steps to using this tool: Identify metrics that drive Value Creation, Value Delivery, and Value Capture for your app. Calculate your company’s recent performance against each metric. Compare your performance on each metric vs. category-specific benchmarks. Discover opportunities based on metrics where you underperform vs. these benchmarks. Prioritize initiatives to improve the metrics with the greatest upside potential. For a detailed step-by-step guide on how to use this tool https://www.lennysnewsletter.com/p/the-subscription-value-loop-a-framework",Retail/Product,Explanation/Definition,Q&A You can only respond using information in the context block. List 5 bullet points.,What are the main points of this passage?,"States and local governments traditionally lead U.S. economic development efforts, with the federal government selectively intervening to address significant need. However, the 2019 Coronavirus Disease (COVID-19) pandemic has caused pervasive social and economic dislocation and extreme subnational fiscal stress, straining existing federal economic development structures. This Insight examines current federal economic development policy and outlines various options for addressing a potentially lengthy pandemic recovery, or future such long-term challenges. Federal Economic Development and COVID-19 The nationwide scope and protracted time horizon of the COVID-19 pandemic has challenged the existing economic development infrastructure at all levels of government. This system is not designed or arguably equipped to address scenarios in which otherwise unusual distress is endemic, and state and local governments are acutely constrained by both the scale of the crisis as well as fiscal limitations. The Federal Approach: Distress-Based Interventions In the United States’ federal system, economic development activities are primarily the responsibility of state and local governments, which fund various programs that may include business relocation and retention incentives, workforce development, and other policies that stimulate growth and job creation. State and local governments are also the primary agents (sometimes with the support of federal funding) in other economic development-related activities—such as improvements to general infrastructure, housing, community facilities, land use, education, and public safety. Those unmet needs not fully addressed at the state and local levels, particularly in economically distressed or disadvantaged communities, are targeted through federal economic development interventions. Most funding programs provided by the principal federal economic development agencies—the Department of Housing and Urban Development (HUD), the Economic Development Administration (EDA), the Department of Agriculture (USDA), and the federal regional commissions and authorities— prioritize economic development resources for communities exhibiting acute socioeconomic distress. For Congressional Research Service https://crsreports.congress.gov IN11587 Congressional Research Service 2 example, HUD’s flagship Community Development Block Grant (CDBG) program is targeted at low- and moderate-income individuals in predominantly urban places. The EDA utilizes distress criteria, and has historically focused on rural and other non-urban places alongside USDA’s rural development programs. The federal regional commissions and authorities employ taxonomies of distress in delineated geographic service areas to prioritize their economic development activities. In addition, federal tax incentives for economic development—such as the New Markets Tax Credit and Opportunity Zones—prioritize areas shown to demonstrate high levels of economic distress. Economic Development in a Time of COVID The efficacy of the federal distress-based approach to economic development is broadly conditioned on state and local governments’ ability to conduct more general economic development. In situations of acute short-term disruption, such as a localized natural disaster or emergency, the federal government can utilize its economic development and emergency management toolkit to support state and local governments, organizations and businesses, and individuals with recovery. However, the pandemic’s scale and longevity has challenged the existing federal economic development and emergency management apparatus. In response, Congress has provided emergency supplemental appropriations to increase the capacity of existing federal economic development infrastructure and support temporary capabilities—such as the Federal Reserve’s direct lending programs, supplemental unemployment insurance, stimulus cash payments, and the extended deployment of various short-term emergency management authorities and countermeasures. Despite congressional action, the pandemic has contributed to surges in poverty, food and housing insecurity, waves of business closures, and a sharp annual decline in growth, indicating the limits of federal economic development approaches. Policy Options for Congress Congress may consider policy options for adapting federal economic development tools to address highimpact events with extended or indefinite time horizons (e.g., pandemics, climate/weather-related disasters, or manmade emergencies), such as:  Increasing funding for HUD’s CDBG program, and providing additional grantee discretion for addressing distress not necessarily captured in CDBG’s current national objectives—such as fiscal and public health;  Permanently authorizing broad-based relief tools like CDBG authorities for disaster recovery (CDBG-DR), or a CARES Act Coronavirus Relief Fund-type analogue, that could draw from a “no-year” strategic account similar to the Disaster Relief Fund;  Developing a standing fiscal support function for states as well as localities, potentially based on an expanded Community Disaster Loan-type program;  Building on the federal regional commissions model, providing a framework for establishing and resourcing intergovernmental federal-state regional commissions throughout the United States as the principal loci of regional economic development, like once provided under Title V of the Public Works and Economic Development Act of 1965 (“Title V” commissions);  Developing authorities for targeted basic income and “job corps” workforce programs, which could be rapidly activated and expanded during emergencies to provide cash relief to affected individuals and fill urgent labor needs (such as contact tracers and medical auxiliaries during the pandemic); and Congressional Research Service 3 IN11587 · VERSION 3 · NEW   Establishing a permanent interagency infrastructure to plan and coordinate industrial mobilization and support, using the Defense Production Act (DPA) and other emergency authorities, to respond to future social and economic dislocations. Congress may also consider policies to strengthen and revise the national approach to economic development generally, including:  An integrated, intergovernmental economic development framework where federal, state, and local governments coordinate on planning, priorities, and funding;  A greater emphasis on cultivating business development and job growth regionally (“economic gardening”), and shifting from incentive-driven regional competition to regional clusters of comparative advantage in a global economy; and  Developing industrial policies that promote the development of strategic industries and supply chains—beyond the defense industrial base—and drive investments in domestic (and certain allied) supply chains anticipating various possible contingency scenarios. Congress may also take steps to broaden the impacts of these reforms, such as by utilizing reinsurance markets for a permanent CDBG-DR-type program; authorizing federal regional commissions to issue bonds for strategic projects; broader adoption of federal loan and loan guarantee mechanisms in lieu of some grants; and taking equity positions as part of direct investments, including potentially in DPA Title III projects.","What are the main points of this passage? You can only respond using information in the passage. List your answers in 5 bullet points with short explanations after. These explanations cannot be longer than 30 words. States and local governments traditionally lead U.S. economic development efforts, with the federal government selectively intervening to address significant need. However, the 2019 Coronavirus Disease (COVID-19) pandemic has caused pervasive social and economic dislocation and extreme subnational fiscal stress, straining existing federal economic development structures. This Insight examines current federal economic development policy and outlines various options for addressing a potentially lengthy pandemic recovery, or future such long-term challenges. Federal Economic Development and COVID-19 The nationwide scope and protracted time horizon of the COVID-19 pandemic has challenged the existing economic development infrastructure at all levels of government. This system is not designed or arguably equipped to address scenarios in which otherwise unusual distress is endemic, and state and local governments are acutely constrained by both the scale of the crisis as well as fiscal limitations. The Federal Approach: Distress-Based Interventions In the United States’ federal system, economic development activities are primarily the responsibility of state and local governments, which fund various programs that may include business relocation and retention incentives, workforce development, and other policies that stimulate growth and job creation. State and local governments are also the primary agents (sometimes with the support of federal funding) in other economic development-related activities—such as improvements to general infrastructure, housing, community facilities, land use, education, and public safety. Those unmet needs not fully addressed at the state and local levels, particularly in economically distressed or disadvantaged communities, are targeted through federal economic development interventions. Most funding programs provided by the principal federal economic development agencies—the Department of Housing and Urban Development (HUD), the Economic Development Administration (EDA), the Department of Agriculture (USDA), and the federal regional commissions and authorities— prioritize economic development resources for communities exhibiting acute socioeconomic distress. For Congressional Research Service https://crsreports.congress.gov IN11587 Congressional Research Service 2 example, HUD’s flagship Community Development Block Grant (CDBG) program is targeted at low- and moderate-income individuals in predominantly urban places. The EDA utilizes distress criteria, and has historically focused on rural and other non-urban places alongside USDA’s rural development programs. The federal regional commissions and authorities employ taxonomies of distress in delineated geographic service areas to prioritize their economic development activities. In addition, federal tax incentives for economic development—such as the New Markets Tax Credit and Opportunity Zones—prioritize areas shown to demonstrate high levels of economic distress. Economic Development in a Time of COVID The efficacy of the federal distress-based approach to economic development is broadly conditioned on state and local governments’ ability to conduct more general economic development. In situations of acute short-term disruption, such as a localized natural disaster or emergency, the federal government can utilize its economic development and emergency management toolkit to support state and local governments, organizations and businesses, and individuals with recovery. However, the pandemic’s scale and longevity has challenged the existing federal economic development and emergency management apparatus. In response, Congress has provided emergency supplemental appropriations to increase the capacity of existing federal economic development infrastructure and support temporary capabilities—such as the Federal Reserve’s direct lending programs, supplemental unemployment insurance, stimulus cash payments, and the extended deployment of various short-term emergency management authorities and countermeasures. Despite congressional action, the pandemic has contributed to surges in poverty, food and housing insecurity, waves of business closures, and a sharp annual decline in growth, indicating the limits of federal economic development approaches. Policy Options for Congress Congress may consider policy options for adapting federal economic development tools to address highimpact events with extended or indefinite time horizons (e.g., pandemics, climate/weather-related disasters, or manmade emergencies), such as:  Increasing funding for HUD’s CDBG program, and providing additional grantee discretion for addressing distress not necessarily captured in CDBG’s current national objectives—such as fiscal and public health;  Permanently authorizing broad-based relief tools like CDBG authorities for disaster recovery (CDBG-DR), or a CARES Act Coronavirus Relief Fund-type analogue, that could draw from a “no-year” strategic account similar to the Disaster Relief Fund;  Developing a standing fiscal support function for states as well as localities, potentially based on an expanded Community Disaster Loan-type program;  Building on the federal regional commissions model, providing a framework for establishing and resourcing intergovernmental federal-state regional commissions throughout the United States as the principal loci of regional economic development, like once provided under Title V of the Public Works and Economic Development Act of 1965 (“Title V” commissions);  Developing authorities for targeted basic income and “job corps” workforce programs, which could be rapidly activated and expanded during emergencies to provide cash relief to affected individuals and fill urgent labor needs (such as contact tracers and medical auxiliaries during the pandemic); and Congressional Research Service 3 IN11587 · VERSION 3 · NEW   Establishing a permanent interagency infrastructure to plan and coordinate industrial mobilization and support, using the Defense Production Act (DPA) and other emergency authorities, to respond to future social and economic dislocations. Congress may also consider policies to strengthen and revise the national approach to economic development generally, including:  An integrated, intergovernmental economic development framework where federal, state, and local governments coordinate on planning, priorities, and funding;  A greater emphasis on cultivating business development and job growth regionally (“economic gardening”), and shifting from incentive-driven regional competition to regional clusters of comparative advantage in a global economy; and  Developing industrial policies that promote the development of strategic industries and supply chains—beyond the defense industrial base—and drive investments in domestic (and certain allied) supply chains anticipating various possible contingency scenarios. Congress may also take steps to broaden the impacts of these reforms, such as by utilizing reinsurance markets for a permanent CDBG-DR-type program; authorizing federal regional commissions to issue bonds for strategic projects; broader adoption of federal loan and loan guarantee mechanisms in lieu of some grants; and taking equity positions as part of direct investments, including potentially in DPA Title III projects.",Financial,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","What about composites, like what the Titan was made of, make them unsafe in deep water, and why do they design subs with new advanced materials and composites when we already know steel works fine? Also what are some of the actual materials they use?","Several new technologies have been introduced in the submersibles developed during this period compared to the submersibles developed during the first period. The technical characteristics of these submersibles can be summarized as follows: (a) Use of a solid buoyancy material. This change allows for a more compact design and eliminates the need for large gasoline tanks, contributing significantly to the miniaturization of submersibles. (b) Use of ultra-high-strength steel and lightweight metals such as maraging steel, aluminum, and titanium. These materials offer a combination of strength and lightness, enabling the construction of smaller and more maneuverable submersibles and reducing manufacturing and operating costs. As a result of these advancements, submersible technology has been significantly improved in terms of miniaturization, cost reduction, and increased production. This has led to a larger number of submersibles being built in many countries, reflecting the widespread adoption and utilization of this technology. Pressure hull The primary design objective of the pressure hull in submersibles is to achieve a balance between reducing the hull weight and increasing the internal volume while ensuring structural strength and stability [19]. This balance is crucial because it directly affects the payload capacity of submersible. The weight displacement ratio is a key factor influenced by the shape and materials used in constructing the pressure hull. The weight displacement ratio refers to the ratio of the weight of the submersible (including its equipment, payload, and crew) to the volume of water displaced by the submersible hull [8]. To maximize the payload capacity, submersible designers aim to minimize the weight displacement ratio. This can be achieved through careful consideration of the shape and materials used in the construction of the pressure hull. The shape of the hull should be optimized to reduce drag and improve hydrodynamics, while the materials used should be strong and lightweight. By reducing the weight displacement ratio, submersibles can provide a greater payload capacity, allowing for the inclusion of more equipment, sensors, and scientific instruments. This, in turn, enhances the submersible’s capabilities for various applications, such as scientific research, underwater exploration, and deep-sea operations. Regarding the shape, pressure hulls in submersibles often take on conventional forms such as spherical, cylindrical, or a combination of these shapes. Spherical pressure hulls are commonly used in large depth manned submersibles such as New Alvin, Nautile, MIR I, MIR II, Shinkai 6500, Jiaolong, Shenhaiyongshi, Fendouzhe, and Limiting Factor. The spherical shape provides structural strength and evenly distributes external pressure, making it suitable for withstanding extreme depths. Additionally, some small manned submersibles used for scientific research, such as Triton, c-explorer3, and Deep Flight Dragon, are also spherically shaped for similar reasons. Cylindrical pressure hulls are relatively easy to process and manufacture, and they offer high utilization of internal space. This shape is commonly adopted by large sightseeing submersibles and small private submersibles such as Atlantis, MarkII, Aurora-5, and C-Explorer5. The cylindrical shape allows for the efficient use of space for passengers or equipment while maintaining structural integrity. The lotus-root shape represents a novel pressure hull structure consisting of a series of intersecting spherical shells [20]. This shape can consist of double, triple, quadruple, or multiple intersecting spherical shells. The AURORA-6 submersible is based on this innovative lotus-root shape, which provides increased strength and stability while maximizing the internal volume. Selecting a suitable pressure hull shape depends on various factors, including the intended purpose, depth requirements, structural considerations, and design objectives of the submersible. Each shape offers unique advantages and considerations in terms of structural strength, internal space utilization, and overall performance. In terms of materials, special marine environments impose greater requirements on the pressure hull materials of submersibles. The materials used in submersibles can be categorized into two types: metallic and nonmetallic materials [21]. Metallic materials commonly include ultra-high strength steel, aluminum alloys, and titanium alloys [8]. For instance, the Mir1 and Mir2 submersibles were built with pressure hulls made from ultra-high strengh steel. On the other hand, underwater gliders such as Spray Glider, Seaglider, Slocum, and PETREL were built with pressure hulls made from aluminum alloys. Notable submersibles such as Nautile, Shinakai, Alvin, New Alvin, Limiting Factor, Jiaolong, Fendouzhe, and Shenhaiyongshi were all built with pressured hulls made from titanium alloys. Nonmetallic materials mainly consist of structural ceramics, advanced polymer matrix composites [22], and organic glass. In the Nereus submersible, structural ceramics were utilized as the buoyancy material. Submersibles such as AUSSMOD2, Deep Glider, Cyclops1, and Haiyi were developed with pressure hulls made from advanced polymer matrix composites. Additionally, organic glass is used in Huandao Jiaolong as its pressure hull material. The weaknesses of composites have been revealed in several manned submersibles, such as the Deepflight Challenger and Titan. The recent tragedy involving Titan serves as a reminder that the use of inhomogeneous materials in a manned cabin must be approached with great caution, considering the homogeneity of deep-water pressure. The utilization of advanced materials has facilitated the construction of stronger and lighter pressure hulls, providing increased interior space for submersible operators. These innovative materials enable the pressure hulls to withstand higher underwater pressures, allowing for deeper diving depths. This advancement in materials not only enables deeper exploration but also enables the miniaturization of submersibles. Regarding the design of manned cabins, designing the viewport is technically difficult. Presently, most people apply the American Society of Mechanical Engineers (ASME) PVHO-1 rule [23]. In cooperative studies of full ocean depth manned submersibles [5], Sauli Ruohonen, the chief designer of the MIR submersible, Anatoly Sagalevitch, the chief pilot of the MIR submersible, and Weicheng Cui, the chief designer of the Rainbowfish full ocean depth manned submersible, all agreed that the ASME rule is too conservative and that its thickness can be reduced. After a series of 13 models tested by Cui’s team, they found that the thickness can be reduced from 403 mm for the rule requirement to 240 mm for a full ocean depth manned cabin with a diameter of 2.1 m [24]. This approach can significantly reduce the total weight of the manned cabin.","[question] What about composites, like what the Titan was made of, make them unsafe in deep water, and why do they design subs with new advanced materials and composites when we already know steel works fine? Also what are some of the actual materials they use? ===================== [text] Several new technologies have been introduced in the submersibles developed during this period compared to the submersibles developed during the first period. The technical characteristics of these submersibles can be summarized as follows: (a) Use of a solid buoyancy material. This change allows for a more compact design and eliminates the need for large gasoline tanks, contributing significantly to the miniaturization of submersibles. (b) Use of ultra-high-strength steel and lightweight metals such as maraging steel, aluminum, and titanium. These materials offer a combination of strength and lightness, enabling the construction of smaller and more maneuverable submersibles and reducing manufacturing and operating costs. As a result of these advancements, submersible technology has been significantly improved in terms of miniaturization, cost reduction, and increased production. This has led to a larger number of submersibles being built in many countries, reflecting the widespread adoption and utilization of this technology. Pressure hull The primary design objective of the pressure hull in submersibles is to achieve a balance between reducing the hull weight and increasing the internal volume while ensuring structural strength and stability [19]. This balance is crucial because it directly affects the payload capacity of submersible. The weight displacement ratio is a key factor influenced by the shape and materials used in constructing the pressure hull. The weight displacement ratio refers to the ratio of the weight of the submersible (including its equipment, payload, and crew) to the volume of water displaced by the submersible hull [8]. To maximize the payload capacity, submersible designers aim to minimize the weight displacement ratio. This can be achieved through careful consideration of the shape and materials used in the construction of the pressure hull. The shape of the hull should be optimized to reduce drag and improve hydrodynamics, while the materials used should be strong and lightweight. By reducing the weight displacement ratio, submersibles can provide a greater payload capacity, allowing for the inclusion of more equipment, sensors, and scientific instruments. This, in turn, enhances the submersible’s capabilities for various applications, such as scientific research, underwater exploration, and deep-sea operations. Regarding the shape, pressure hulls in submersibles often take on conventional forms such as spherical, cylindrical, or a combination of these shapes. Spherical pressure hulls are commonly used in large depth manned submersibles such as New Alvin, Nautile, MIR I, MIR II, Shinkai 6500, Jiaolong, Shenhaiyongshi, Fendouzhe, and Limiting Factor. The spherical shape provides structural strength and evenly distributes external pressure, making it suitable for withstanding extreme depths. Additionally, some small manned submersibles used for scientific research, such as Triton, c-explorer3, and Deep Flight Dragon, are also spherically shaped for similar reasons. Cylindrical pressure hulls are relatively easy to process and manufacture, and they offer high utilization of internal space. This shape is commonly adopted by large sightseeing submersibles and small private submersibles such as Atlantis, MarkII, Aurora-5, and C-Explorer5. The cylindrical shape allows for the efficient use of space for passengers or equipment while maintaining structural integrity. The lotus-root shape represents a novel pressure hull structure consisting of a series of intersecting spherical shells [20]. This shape can consist of double, triple, quadruple, or multiple intersecting spherical shells. The AURORA-6 submersible is based on this innovative lotus-root shape, which provides increased strength and stability while maximizing the internal volume. Selecting a suitable pressure hull shape depends on various factors, including the intended purpose, depth requirements, structural considerations, and design objectives of the submersible. Each shape offers unique advantages and considerations in terms of structural strength, internal space utilization, and overall performance. In terms of materials, special marine environments impose greater requirements on the pressure hull materials of submersibles. The materials used in submersibles can be categorized into two types: metallic and nonmetallic materials [21]. Metallic materials commonly include ultra-high strength steel, aluminum alloys, and titanium alloys [8]. For instance, the Mir1 and Mir2 submersibles were built with pressure hulls made from ultra-high strengh steel. On the other hand, underwater gliders such as Spray Glider, Seaglider, Slocum, and PETREL were built with pressure hulls made from aluminum alloys. Notable submersibles such as Nautile, Shinakai, Alvin, New Alvin, Limiting Factor, Jiaolong, Fendouzhe, and Shenhaiyongshi were all built with pressured hulls made from titanium alloys. Nonmetallic materials mainly consist of structural ceramics, advanced polymer matrix composites [22], and organic glass. In the Nereus submersible, structural ceramics were utilized as the buoyancy material. Submersibles such as AUSSMOD2, Deep Glider, Cyclops1, and Haiyi were developed with pressure hulls made from advanced polymer matrix composites. Additionally, organic glass is used in Huandao Jiaolong as its pressure hull material. The weaknesses of composites have been revealed in several manned submersibles, such as the Deepflight Challenger and Titan. The recent tragedy involving Titan serves as a reminder that the use of inhomogeneous materials in a manned cabin must be approached with great caution, considering the homogeneity of deep-water pressure. The utilization of advanced materials has facilitated the construction of stronger and lighter pressure hulls, providing increased interior space for submersible operators. These innovative materials enable the pressure hulls to withstand higher underwater pressures, allowing for deeper diving depths. This advancement in materials not only enables deeper exploration but also enables the miniaturization of submersibles. Regarding the design of manned cabins, designing the viewport is technically difficult. Presently, most people apply the American Society of Mechanical Engineers (ASME) PVHO-1 rule [23]. In cooperative studies of full ocean depth manned submersibles [5], Sauli Ruohonen, the chief designer of the MIR submersible, Anatoly Sagalevitch, the chief pilot of the MIR submersible, and Weicheng Cui, the chief designer of the Rainbowfish full ocean depth manned submersible, all agreed that the ASME rule is too conservative and that its thickness can be reduced. After a series of 13 models tested by Cui’s team, they found that the thickness can be reduced from 403 mm for the rule requirement to 240 mm for a full ocean depth manned cabin with a diameter of 2.1 m [24]. This approach can significantly reduce the total weight of the manned cabin. https://spj.science.org/doi/10.34133/olar.0036 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Fact Finding,Q&A Use information from the article only to explain your answer. Do not rely on outside knowledge.,What does it mean that the Dept of Labor is hiring for an intermittent employment position?,"EMPLOYEE HANDBOOK Table of Contents Welcome................................................................................................................................................... 5 About the Agency .................................................................................................................................... 6 Mission Statement ................................................................................................................................... 6 Supersedence ........................................................................................................................................... 6 General Highlights .................................................................................................................................. 7 Access Card ............................................................................................................................................. 7 Affirmative Action/Equal Employment Opportunity Employer ....................................................... 7 Americans with Disabilities Act ............................................................................................................ 7 Appearance & Dress Code ..................................................................................................................... 7 Building Security .................................................................................................................................... 7 Code of Ethics ......................................................................................................................................... 7 Collective Bargaining ............................................................................................................................. 7 Email & Internet Use.............................................................................................................................. 8 Employee Assistance Program .............................................................................................................. 8 Employee Background Check ............................................................................................................... 8 Employment Applications ...................................................................................................................... 8 Equal Employment Opportunity........................................................................................................... 8 Immigration Law Compliance............................................................................................................... 8 On-the-Job Accident/Illness ................................................................................................................... 9 Photo Identification ................................................................................................................................ 9 Political Activity ...................................................................................................................................... 9 Rideshare ................................................................................................................................................. 9 Safety ........................................................................................................................................................ 9 Sexual Harassment ................................................................................................................................. 9 Smoking ................................................................................................................................................. 10 Standards of Conduct ........................................................................................................................... 10 Telephones - Cellular Telephones ....................................................................................................... 10 Travel ..................................................................................................................................................... 10 Uniformed Services Employment & Reemployment......................................................................... 10 Violence in the Workplace ................................................................................................................... 10 Visitors ................................................................................................................................................... 11 Weather & Emergency Closings ......................................................................................................... 11 Collective Bargaining ........................................................................................................................... 12 Bargaining Unit Representation .......................................................................................................... 12 Union Contracts .................................................................................................................................... 12 2 Grievance Procedure ............................................................................................................................ 12 Appointment and Promotion ............................................................................................................... 14 Merit System ......................................................................................................................................... 14 Job Classification .................................................................................................................................. 14 Classified & Unclassified Positions ..................................................................................................... 14 Competitive & Non-Competitive Positions ........................................................................................ 14 Scheduled & Continuous Recruitment Job Announcements ........................................................... 14 Job Announcements.............................................................................................................................. 14 Employment Opportunities ................................................................................................................. 15 Application Accommodations for People with Disabilities ............................................................... 15 Rejection from State Application ........................................................................................................ 15 Appointment Types .............................................................................................................................. 15 Working Test Period ............................................................................................................................ 16 Service Ratings ...................................................................................................................................... 17 Promotion & Reclassification .............................................................................................................. 17 Temporary Service in a Higher Class ................................................................................................. 17 Transfers ................................................................................................................................................ 18 Dual Employment ................................................................................................................................. 18 Personnel Records ................................................................................................................................ 19 Personnel Files ...................................................................................................................................... 19 Change of Personal Data ...................................................................................................................... 19 Working Hours ..................................................................................................................................... 19 Meal & Break Periods .......................................................................................................................... 20 Overtime & Compensatory Time ........................................................................................................ 20 Shift Assignments.................................................................................................................................. 20 Attendance ............................................................................................................................................. 20 Paid Leave Time ................................................................................................................................... 21 Holidays ................................................................................................................................................. 21 Sick Leave .............................................................................................................................................. 21 Vacation Leave ...................................................................................................................................... 22 Personal Leave ...................................................................................................................................... 23 Jury Duty ............................................................................................................................................... 23 Military Leave ....................................................................................................................................... 24 Leave Without Pay ............................................................................................................................... 25 Leave of Absence Without Pay (LAW) ............................................................................................... 25 Maternity Leave .................................................................................................................................... 25 3 Medical Leave ....................................................................................................................................... 25 Family Leave ......................................................................................................................................... 26 Salary ..................................................................................................................................................... 27 Payment ................................................................................................................................................. 27 Payday .................................................................................................................................................... 27 Annual Increments ............................................................................................................................... 27 Collective Bargaining & Cost-of-Living Increases ............................................................................ 27 Longevity Pay ........................................................................................................................................ 27 Deductions ............................................................................................................................................. 29 Federal Income Tax & Social Security Tax ....................................................................................... 29 Connecticut Income Tax ...................................................................................................................... 29 Health Insurance ................................................................................................................................... 29 Group Life Insurance ........................................................................................................................... 29 Supplemental Benefits .......................................................................................................................... 29 Direct Deposit ........................................................................................................................................ 30 Deferred Compensation ....................................................................................................................... 30 State Employees Campaign ................................................................................................................. 30 Union Dues ............................................................................................................................................ 30 Credit Unions ........................................................................................................................................ 30 Retirement Tiers ................................................................................................................................... 31 Separation .............................................................................................................................................. 36 Resignation ............................................................................................................................................ 33 Layoff ..................................................................................................................................................... 33 Reemployment Rights .......................................................................................................................... 33 Rescind of Resignation or Retirement ................................................................................................ 33 Exit Interview ........................................................................................................................................ 33 Retirement ............................................................................................................................................. 33 Retirement Types .................................................................................................................................. 36 Pension Payment Options .................................................................................................................... 36 Insurance Benefits ................................................................................................................................ 36 Training and Development .................................................................................................................. 38 In-Service Training ............................................................................................................................... 38 Management Development Courses .................................................................................................... 38 Tuition Reimbursement ....................................................................................................................... 38 Conferences, Workshops & Seminars ................................................................................................ 38 EMPLOYMENT POLICIES ............................................................................................................... 39 4 Welcome Whether you have just joined the agency or have been with us for a while, we are confident that you will or have found our organization to be a dynamic and rewarding place in which to work. We consider the employees of the Department of Labor to be our most valuable resource and we look forward to a productive and successful partnership. This handbook has been prepared for you to serve as a guide for the employer-employee relationship. The topics covered in this handbook apply to all employees of the Department of Labor. It is important to keep the following things in mind about this handbook. First, it contains general information and guidelines. It is not intended to be comprehensive or to address all the possible applications of, or exceptions to, the general policies and procedures described. It is not intended to replace or supersede collective bargaining agreements that may cover many of your terms and conditions of employment. Employees covered by a collective bargaining agreement will receive a copy of their contract at orientation. You should read and become familiar with your collective bargaining agreement, this employee handbook and the agency’s employment policies. If you have any questions concerning eligibility for a particular benefit, or the applicability of a policy or practice, you should address your specific questions to your supervisor or contact your HR Generalist for clarification. Second, neither this handbook nor any other agency document confers any contractual right, either expressed or implied, to remain in the agency’s employ or guarantee any fixed terms and conditions of your employment. Third, the policies, procedures, and benefits described here may be modified or discontinued from time to time. We will try to inform employees of any changes as they occur but cannot guarantee immediate advance notice of changes. Finally, some of the subjects described here are covered in detail elsewhere. The terms of written insurance policies and/or plan documents are controlling for health, life, retirement and deferred or reduced income benefits. You should refer to those documents for specific information since this handbook is only designed as a brief guide and summary of policies and benefits. We are pleased to have you as a member of the Department of Labor and look forward to a successful and beneficial association. 5 About the Agency The Department of Labor handles far more than unemployment insurance benefits. Helping employers and jobseekers with their workforce needs is our goal. An overview of the many programs and public services the agency offers is available on the website (www.ct.gov/dol), which also contains information ranging from upcoming job fairs to wage and workplace guidelines. Mission Statement The Department of Labor is committed to protecting and promoting the interests of Connecticut workers. In order to accomplish this in an ever-changing environment, we assist workers and employers to become competitive in the global economy. We take a comprehensive approach to meeting the needs of workers and employers, and the other agencies that serve them. We ensure the supply of high-quality integrated services that serve the needs of our customer. Supersedence This revised version of the Employee Handbook supersedes all prior versions that have been issued by the Department of Labor and will be effective April 2023. 6 General Highlights Access Card Central Office and Annex employees are issued an access card to enter the building. Should your card be lost, stolen or destroyed, contact Facilities Operations so the card can be deactivated and a replacement issued. Affirmative Action/Equal Employment Opportunity Employer The Department of Labor is committed to affirmative action/equal employment that will build on the strengths of our current workforce and continually enhance the diversity of our organization. The department opposes all forms of discrimination and has developed a set of anti-discriminatory policies. Please direct your questions about affirmative action issues to the AA/EEO Manager at Central Office, 200 Folly Brook Boulevard, Wethersfield, CT 06109; telephone (860) 263-6520. To file a complaint, please click on the link to access the form: Internal Discrimination Complaint Americans with Disabilities Act The Department of Labor complies with all relevant and applicable provisions of the Americans with Disabilities Act (ADA). The agency will not discriminate against any qualified employee or job applicant with respect to any terms, privileges, or conditions of employment because of a person’s physical or mental disability. See the Americans with Disabilities Act Reasonable Accommodation Policy Appearance & Dress Code It is the policy of the agency to project a business-like image to clients, visitors and co-workers. In line with this, you are required to dress appropriately in clothing which is suitable for your job responsibilities and work environment, meets the requirements established for safety reasons, and complies with the agency’s dress code requirements. See Professional Image Policy. Building Security Each and every employee must follow the building security rules and regulations. Employees are not allowed on the property after hours without prior authorization from their supervisor. Code of Ethics The department’s standards of ethical conduct, which all employees are expected to be familiar with and observe, are outlined in the Code of Ethics for Public Officials & State Employees and the Ethical Conduct Policy . Collective Bargaining Your assignment to a collective bargaining unit (union) is based on your job classification. As a bargaining unit member, you will have union dues deducted from your bi-weekly paycheck. You may elect not to join a union. Your union contract governs salary, benefits and hours of work, and other terms and conditions of employment. Collective bargaining agreements are negotiated periodically. 7 Exempt employees are excluded from the collective bargaining process and are not required to pay union dues. Email & Internet Use It is the policy of the agency to provide electronic mail (email) and internet access for work-related purposes. You are required to adhere to this and related policies to ensure proper, legal and effective use of these electronic tools and resources. See Acceptable Use of State Systems Policy. Employee Assistance Program The Employee Assistance Program (EAP) is designed to offer consultation and counseling services for employees and their dependents who are experiencing problems which may be impacting their life at work and/or at home. Some of these problems may include family, marital, alcohol/drugs, emotional distress, and job-related, legal, or financial difficulties. Participation is voluntary and confidential. EAP services are provided by Wheeler EAP. To schedule an appointment or obtain more information, call 1800-252-4555 or 1-800-225-2527, or log on to their website at Wheeler EAP. Employee Background Check Prior to making an offer of employment, Human Resources may conduct a job-related background check. A comprehensive background check may consist of prior employment verification, professional reference check, education confirmation and fingerprinting. Employment Applications We rely upon the accuracy of information contained in an employment application and the accuracy of other data presented throughout the hiring process and employment. Any misrepresentation, falsification or material omission of information or data may result in exclusion of the individual from consideration for employment or, if the person has been hired, termination of employment. Equal Employment Opportunity The Department of Labor is an equal employment opportunity employer. Employment decisions are based on merit and business needs. The Department of Labor does not discriminate on the basis of race, color, citizenship status, national origin, ancestry, gender, sexual orientation, age, religion, creed, physical or mental disability, marital status, veterans’ status, political affiliation, or any other factor protected by law. To file a complaint, please click on the link to access the form: Internal Discrimination Complaint. Immigration Law Compliance All offers of employment are contingent on verification of the candidate’s right to work in the United States. On the first day of work, every new employee will be asked to provide original documents verifying his or her right to work and, as required by federal law, to complete and sign an Employment Eligibility Verification Form I-9. 8 On-the-Job Accident/Illness The agency promotes safety in the workplace. The State of Connecticut also has implemented a Managed Care Program for Workers’ Compensation, administered by Gallagher Bassett Services, Inc. You must report a work-related accident or illness to your supervisor, who is required to call a 24-hour hotline (1-800-828-2717) to report your accident or illness and initiate a claim. If your supervisor is unavailable, you may call or have someone call for you. Your supervisor must also complete the First Report of Injury (Form WC-207) and submit it to DAS_RfaxWCHE@ct.gov or by fax to 959-200-4841, whether or not you seek treatment or lose time from work. To become eligible for workers’ compensation benefits, you must seek treatment from a network physician or medical facility. Forms can be obtained at Workers' Compensation Rights, Responsibilities, and Claims--Documents (ct.gov). In cases of a medical emergency call 911 to seek immediate medical attention. Contact the DAS Workers' Compensation Division at (860) 713-5002 with any questions regarding access. Photo Identification You are required to wear and visibly display a photo identification badge during working hours. If your identification badge is lost, stolen, or destroyed, or you have transferred to a different unit, you must request a replacement through Facilities Operations. Political Activity As a state employee, state statutes govern your involvement in various political activities such as campaigning and running for elective office. Also, if you are working on programs financed in whole or in part by federal funds, you are subject to the provisions of the federal Hatch Act, which is generally more restrictive than state statue. The purpose of these laws is to avoid a conflict of interest between your state job and political activities. Information regarding political activity may be found in DAS General Letter 214D, link to document General Letter 214D – Political Activity. The Ethical Conduct Policy also addressed these issues and you are advised to contact the agency’s Ethics Liaison regarding any political activity. See Ethical Conduct Policy. Rideshare The department promotes the statewide Rideshare Program, an opportunity to reduce your transportation expenses to work. Consider using a ride-sharing mode (carpool, vanpool or bus) as an alternative to driving alone. Ride sharing saves you money, energy and preserves the environment. For information call 800-972-EASY (800-972-3279) or visit the website at www.rideshare.com. Safety The safety and health of employees is our top priority. The agency makes every effort to comply with all federal and state workplace safety requirements. Each employee is expected to obey safety rules and exercise caution and common sense in all work activities. Promptly report safety concerns to your supervisor. Sexual Harassment The Department of Labor does not tolerate sexual harassment. Sexual harassment may include unwelcome sexual advances, requests for sexual favors, or other unwelcome verbal or physical contact 9 of a sexual nature when such conduct creates an offensive, hostile and intimidating work environment and prevents an individual from effectively performing the duties of their position. See Sexual Harassment Policy. Smoking Smoking is prohibited throughout agency buildings and offices, including in rest rooms, private offices, lounges and similar areas. Smoking is permitted only in designated areas outside office buildings and other work locations. The use of smokeless tobacco and e-cigarettes are also prohibited and subject to the same restrictions. Standards of Conduct The work rules and standards of conduct for employees are important and the agency regards them seriously. All employees are urged to become familiar with and must follow these rules and standards. See Employee Conduct Policy. Telephones - Cellular Telephones The agency recognizes that occasionally it is necessary for employees to make or receive personal telephone calls during working hours. You are expected to restrict your personal telephone usage, both on state-owned phones and personally owned cellular phones, to reasonable, incidental calls that do not interfere with your work schedule or the performance of your duties. To avoid being disruptive to others in the workplace, please make certain audible alerts are disabled. Travel Your position may require travel to conduct state business. If you are required to travel for work, you may obtain a state-owned vehicle from a central carpool with a valid driver’s license. Use of your personal vehicle in the performance of Agency duties is allowable only when the use of a State-owned vehicle is not reasonably available for use and request mileage reimbursement. You must present proof of automobile insurance with the minimum coverage requirements. Contact your supervisor or Business Management if you have any questions. Uniformed Services Employment & Reemployment As an equal opportunity employer, the Department of Labor is committed to providing employment and reemployment services and support as set forth in the Uniformed Services and Reemployment Rights Act of 1994 (USERRA). Violence in the Workplace The Department of Labor has a policy prohibiting workplace violence. Consistent with this policy, acts or threats of physical violence, including intimidation, harassment and/or coercion, which involve or affect the organization and its employees will not be tolerated. See Violence in the Workplace Prevention Policy. 10 Visitors To provide for safety and security, only authorized visitors are allowed in the workplace. All visitors must enter through the main reception area, sign-in and sign-out at the front desk and receive a visitor identification to wear while on the premises. Authorized visitors will be escorted to their destination and must be accompanied by an employee at all times. Weather & Emergency Closings At times, emergencies such as severe weather or power failures can disrupt business operations. Everbridge, is a system that the state utilizes to notify enrolled individuals on safety and weather concerns. You can determine by which methods you want to be notified. Sign-up is free. Any personal information provided (such as cell number) will be used for important employee notifications purposes only directed by DAS. Everbridge will never give or sell contact or location information to any vendor or other organization. The Department of Emergency Service & Public Protection website is the official source of information for state employees. Use this page to find any official announcements about closures or delayed openings that have been declared by the Governor. Everbridge system can send alerts to your work phone and email as well as your home phone, cell phone, and home email. The Statewide CT Alert system can also keep you informed of state emergencies and send you emails and text alerts. FEMA’s Ready.gov preparedness site has information on how to keep safe during the winter. 11 Collective Bargaining Bargaining Unit Representation Labor unions and management at times negotiate collective bargaining agreements (union contracts). The contracts govern such areas as salary, benefits, hours of work, and the terms and conditions of employment. Most state job classifications have been assigned to particular bargaining units (unions) and state employees have voted to have unions represent them in the negotiation process. If you are a nonexempt employee, you have been assigned to a bargaining unit based on your job classification and will be represented by that specific union. If you are an exempt employee, you have been excluded from the collective bargaining process. The terms and conditions of your employment will be governed by state statutes, rules and regulations. Union Contracts Union contracts, established through the formal negotiation process, outline the terms and conditions of your employment. You should familiarize yourself with your contract. Benefits and provisions vary between bargaining units. Contract language has been crafted to avoid disputes and eliminate misunderstandings. Contract provisions, however, may be open to interpretation and subject to the grievance and arbitration process. Direct your questions about your union contract to your supervisor, union representative or Human Resources Generalist. Grievance Procedure Your problems or complaints should be resolved quickly and fairly. First, discuss the issue with your supervisor, who may help you find a solution. If your supervisor or another employee in the chain of command cannot resolve your problem or complaint, or if you feel that you have been treated unjustly, contact your union steward or Agency Labor Relations Specialist. If an issue cannot be resolved informally, you may follow the grievance procedure outlined in your union contract. This procedure helps resolve disputes concerning the interpretation and application of a contract. You should, however, make every effort to resolve an issue before filing a grievance. Though specific procedures may vary, your union contract establishes time limits for initiating grievances and obtaining responses. The first steps of the grievance process are informal to encourage quick resolution. If an issue still cannot be resolved, more formal meetings are conducted until the grievance reaches the highest level of the process. Most grievance procedures permit arbitration when an issue cannot be resolved at the highest level. An arbitrator, an impartial party chosen by the union and management, will hear both sides of an issue and render a binding decision. A union normally requests arbitration, but you as an employee may also request it in certain circumstances. Arbitration is permitted only if negotiated as a step in the grievance procedure. You or a group of employees may present a grievance to management for resolution without your union’s participation. However, the resolution must be consistent with your union contract and your union must be given the opportunity to attend all meetings. 12 If you are an exempt classified employee, you may appeal certain actions through the grievance procedure as outlined in Sec. 5-202 of the Connecticut General Statutes. 13 Appointment and Promotion Merit System The appointment and promotion of state employees is based on the merit principles in the State Personnel Act. As with other federal, state and municipal merit systems, this system was established to minimize the influence of electoral politics on the employment and retention of state employees. The system strives to place the best qualified people in state service and to ensure that they are fairly treated in the appointment and promotion process. The merit system is not subject to collective bargaining. Job Classification The state, as an employer of thousands of people, must systematically describe and group jobs to ensure consistent and fair treatment when assigning, compensating and promoting employees. Consequently, it has established a classification plan for all jobs in the executive branch of state service. Individual positions are grouped into job classes, with each class consisting of positions with similar duties, responsibilities and required qualifications. Your job classification is the foundation for the employment process. Classified & Unclassified Positions Most positions in the executive branch of state government are classified. Unclassified positions may be exempt from job announcements. The State Personnel Act lists a number of unclassified categories: agency heads, members of boards and commissions, officers appointed by the governor, deputies and executive assistants to the head of departments, executive secretaries, employees in the Senior Executive Service and professional specialists. Competitive & Non-Competitive Positions Most classified positions are competitive and require an application. The type of experience required depends on the job classification. Applicants must meet minimum general experience and training requirements, however, to be eligible for appointment if a position requires a professional license or degree, there may be no additional requirements beyond possession of the professional license or degree. Scheduled & Continuous Recruitment Job Announcements Most state job opportunities are announced to the general public with a specific closing date. If you apply for a job opening, you will be notified if you are selected for an interview by the hiring agency. When the state considers continuous recruiting necessary, it may postpone the closing date for filing applications until it receives a suitable number of candidates. A job posting will indicate when recruiting is continuous and that applications may be filed until further notice. Job Announcements To meet merit system objectives, the state has developed competitive job classifications to fill many of its positions. They are not used to fill unclassified positions or those in classes designated as noncompetitive. State job announcements fall into the following categories: 14 Open to the Public. If you meet the minimum experience and training qualifications for a position, you may participate in this type of recruitment. Open-competitive job announcements are administered periodically usually when a state agency is recruiting for a vacant position. Statewide & Agency Promotion. If you are a state employee who meets the minimum experience and training qualifications for a position and has completed six months continuous service in a state agency, you may participate in a statewide recruitment. Agency promotional announcements will have the additional requirements that you must be a current agency employee. Employment Opportunities Agency job announcements are posted on the DAS Online Employment Center. You should check regularly for the most up to date information. To apply for employment, you must complete a Master Application on the DAS Website. Check the state employment pages on the Department of Administrative Services website (Job Openings Department of Administrative Services (jobapscloud.com) for information about completing the application form, job opportunities, and to sign up for e-mail notification of current job openings. Application Accommodations for People with Disabilities The state may conduct recruitments in various ways. If you need special accommodations for a particular recruitment, you or someone on your behalf should immediately notify the DAS at (860) 713-7463. You must supply the application title and job number, and a description of your special needs and documentation of the disability. Rejection from State Application Your application for a state job opening may be rejected if (1) your application was received after the closing date, (2) you did not meet the minimum requirements, (3) your years of experience did not match the requirements, (4) specific information was missing from your application, (5) you failed to meet the special requirements for the position, or (6) your years of experience did not match the special requirements. Appointment Types Durational. An employee hired for a specific term, for a reason not provided above, including a grant or specially funded program, not to exceed one year. A durational employee shall become permanent after six months, or the length of the working test period, whichever is longer. Emergency. The state may appoint you to an emergency position to meet short-term agency needs. The appointment may extend for as long as two months but may not be renewed in a fiscal year. Intermittent. Intermittent employment is also work on an ""as needed"" basis. The agency may use intermittent interviewers to supplement permanent staff in times of high unemployment. They are paid an hourly rate for time worked and may receive benefits. They are eligible to apply for agency promotional postings following the completion of 1044 hours of intermittent service. 15 Permanent. The state may appoint you to a permanent competitive position from a certification list. You must successfully complete the working test period to gain permanent status. Provisional. The state may provisionally appoint you to a position that must be filled immediately if no active certification list exists, or an insufficient number of candidates are listed. The appointment may extend for as long as six months or until a job announcement for the position has been held and a certification list promulgated. You may not receive more than one provisional appointment in a fiscal year or serve more than six months as a provisional appointee. Your job performance while a provisional must be satisfactory. To receive a permanent appointment, you must be appointed from a competitive process for the position. If you are not appointed from a competitive process and do not have a permanent position to which you may return, you must be separated from state service. If the competitive process is not completed for a position within six months, an additional temporary or emergency appointment may be authorized. Seasonal. Seasonal employment for a position established for a specific period, usually during summer months. Individuals employed are paid an hourly rate and are not entitled to any fringe benefits. Temporary. Position filled for a short term, seasonal, or an emergency situation, including to cover for a permanent position when the incumbent is on workers’ compensation or other extended leave, not to exceed 6 months. May be extended up to one year. If a temporary employee is retained greater than 12 months, said employee shall be considered durational. Working Test Period The working test period, or probationary period, for a state employee is an extension of the state recruitment process. You must serve this period to gain permanent status following initial appointment or promotion. Your initial test period is generally six months, depending on the applicable contract or state regulation. Your promotional test period is generally four to six months, again depending on the applicable contract or regulation. Exceptions may occur in the length of the trial period for trainee positions. Questions about your working test period may be directed to your supervisor or Human Resources Generalist. During an initial working test period, you are considered a probationary employee and will work closely with supervisors and colleagues to learn your duties. This period also gives your supervisor the opportunity to evaluate your response to training and job requirements. If you demonstrate acceptable performance during your initial test period, you will be given a satisfactory service rating and gain permanent status as a state employee. Your working test period may be extended in certain circumstances. If you do not meet acceptable performance standards during the initial working test period, you will be separated from state service. You may not appeal a dismissal during your initial test period through the contractual grievance procedure, but you may request an administrative review. If you fail to meet acceptable performance standards during a promotional working test period, you will revert to your previous classification. 16 Service Ratings You will receive a service rating for your initial working test period or promotional test period, and at least three months before your annual increase date. Depending on your union contract or state statutes, you may receive a service rating at any time, particularly when your job performance has changed significantly. Service ratings record your progress and performance as training and job experience increase. The state recognizes satisfactory performance by awarding annual salary increases (as negotiated) until reaching the maximum step in a salary group. For employees at the maximum step, some bargaining units award a lump sum payment in lieu of an annual increment. A “less than good” rating may prevent you from receiving an increase. An “unsatisfactory” during the working test period signifies failure. After attaining permanent status, two successive “unsatisfactory” ratings may result in your dismissal. Managers are evaluated in accordance with the provisions of the Performance Assessment and Recognition System (PARS) Program. Promotion & Reclassification Generally, there are two ways in which you may receive an appointment to a higher-level job classification. First, you may compete for a new position or an opening that arises when another employee leaves an existing position. The agency may use a formal state employment application process to obtain a list of candidates to be considered for an opening or it may use a less formal recruitment and selection process. In either event, in order to be considered you must meet the minimum qualifications for the higher classification and comply with the application procedures. Recruitment notices are posted internally on the agency intranet, and at times externally on the Department of Administrative Services website. It is your responsibility to monitor them and respond according to the instructions on the job posting. Additionally, you may progress to a higher level through reclassification. After working for the agency for some time, you may find that your duties have expanded and are more consistent with a higher-level job classification. In such cases, your supervisor will ask you to complete a job duties questionnaire, which will be evaluated by Human Resources. If you are found to be working “out of class,” the agency has the option of either removing the higher-level duties or reclassifying your position to the higher level. Certain conditions must be met for reclassification. You must be in your current position for at least six months, have a rating of “good” or better on your last two performance evaluations and meet the minimum experience and training requirements for the higher class. If you have applied for a job opening and did not qualify for the classification, this is evidence that you do not meet the qualifications for the higher-level class and cannot be considered for reclassification. Temporary Service in a Higher Class When a temporary vacancy occurs in a non-entry level classification, such as the result of an employee being on an extended leave of absence, the agency may fill the opening by temporarily assigning you to a higher level as long as the assignment lasts for more than 30 days and meets any other relevant union contract provisions. You must meet the minimum qualifications of the class. While serving in this type 17 of service, you are paid at the higher level, but you retain status in your permanent (lower) classification. Benefits such as longevity and vacation accrual are based on the permanent class. Transfers You may voluntarily transfer within the agency or to another state agency. To place your name on a Statewide Transfer list, for your current job class in which you hold permanent status, please visit the DAS Website, Freenames - Department of Administrative Services (jobapscloud.com), scroll down and follow the process of Statewide Transfers. If your job classification is unique to the agency, your transfer options will be limited to those classes deemed comparable to the one in which you have permanent status. Consult your union contract for more information. If you are interested in transferring to another work location within the agency and meet the eligibility of the job requirements, Human Resources will send emails periodically with transfer opportunities, to be considered you must follow the procedures noted on the email. The agency may involuntarily transfer you under certain circumstances, generally defined in your union contract or state personnel regulations. Transfers occur for a variety of reasons: when the agency seeks to better use its resources, to avoid layoffs, to meet emergency or seasonal conditions, or to accommodate you. If you are an exempt employee, your transfer is subject to state regulations and the State Personnel Act. Dual Employment You may be authorized to work at a secondary agency subject to the dual employment provisions of the regulations for state agencies. For this to occur, the secondary agency must initiate and complete the appropriate paperwork. The secondary agency will forward a copy of the dual employment request form to the primary agency for completion and return. If all provisions are met, subject to any fair labor standards considerations and the operating needs of the department, you may be eligible for secondary employment. Secondary employment may not pose a conflict of interest or interfere with the performance of your job duties and your approved work schedule for the Department of Labor. 18 Personnel Records Personnel Files The agency maintains a digital personnel file containing information about your employment: service ratings; personnel processing forms; appointment, promotion, and disciplinary letters. The agency also maintains a separate, confidential file that contains your medical documents, including doctor’s notes and medical certificates. You may review your digital personnel file by contacting Human Resources. You may sign a waiver to allow another person, such as a union official, to review your files. The agency must comply with written requests for information about its employees under the state freedom-of-information law. If the agency considers an information request to be a possible invasion of your privacy, you will be notified. Change of Personal Data Whenever you change your name, address, number of dependents, telephone number, or marital status, you must promptly notify Payroll so that agency records and files may be updated. You may also need to complete a new federal or state withholding allowance certificate (W-4 or CT W-4), or various health insurance forms. Working Hours The negotiated workweek for most staff members currently averages 40 hours per week. Some union contracts provide for a 35 or 37.5-hour workweek. Many employees work a standard schedule of 8:00 a.m. to 4:30 p.m. The agency has also established nonstandard work schedules, which are approved in advance by the appointing authority in consultation with the Director of Human Resources. Provision for flex time has been included in some contracts. If your position is covered by flex time or other nonstandard workweek, your supervisor will explain its operation. The Payroll Unit will maintain your attendance record. From time to time and consistent with the terms of the applicable collective bargaining agreement, it may be necessary to temporarily or permanently change your work schedule to meet operational needs. In such a situation you will be given as much notice as possible, at a minimum that is required by your union contract. Regardless of your work schedule, you are expected to arrive at work on time, return from lunch and breaks on time, and not leave your job prior to quitting time. 19 Meal & Break Periods Full-time employees are permitted two 15-minute breaks and a 30-minute unpaid meal period. Longer unpaid meal periods are allowed with supervisory approval. The schedule for all meal and break periods is determined by your supervisor based on business operations and staffing needs. Your supervisor will inform you of your schedule and any required changes. Employees are not permitted to work through lunch to leave early. Breaks do not accumulate, nor may they be used to start late or leave early. Overtime & Compensatory Time Overtime occurs when you work in excess of your regular established weekly schedule. Overtime assignments must be approved in advance, except in extreme emergencies. The Fair Labor Standards Act (FLSA), state statutes and regulations, and your union contract govern your eligibility for overtime and the rate of compensation. Compensatory time is a form of accrued leave time that may be used later; it does not constitute a basis for additional compensation. Compensatory time must be taken in accordance with the provisions of your contract and agency policy. The FLSA may conflict with your union contract regarding compensation for overtime. Generally, you will be paid by the method that provides the greater benefit. Hours worked in excess of 40 in one week are generally compensated at the rate of time-and-one half. The time-and-one-half rate is derived from your basic hourly wage rate. Some employees may be ineligible for the overtime provisions of FLSA. Questions may be directed to Payroll. Shift Assignments Some areas engage in multi-shift operations. Depending on the starting and ending times of your shift and union contract, you may be eligible for shift-differential payments. These usually take the form of additional pay for the hours worked on your assigned shift. Generally, any shift that begins before 6:00 a.m. or after 2:00 p.m. is subject to shift-differential payments. Some employees may not be eligible for these payments, even when assigned to such a shift. Consult your union contract for information regarding eligibility for the shift and weekend differentials, and the applicable pay rate. Attendance You are responsible for maintaining a good attendance record. Frequent absenteeism reduces the level of your service to the agency and the public, increases operational costs, and places a burden on your co-workers. Use your accrued leave in accordance with agency policies and procedures and ensure that you comply with Employee Dependability Policy requirements. You should request leave time as far in advance as possible. Refer to your union contract for additional guidelines. Agency operating needs, the reasonableness of the request, and the specific language contained in the union contract govern the approval or denial of your leave request. Whenever possible, avoid unscheduled leave. 20 Paid Leave Time Holidays The state grants 13 paid holidays per year to permanent, full-time employees: New Year’s Day, Martin Luther King’s Birthday, Lincoln’s Birthday, Washington’s Birthday, Good Friday, Memorial Day, Juneteenth Day, Independence Day, Labor Day, Columbus Day, Veterans’ Day, Thanksgiving Day and Christmas Day. Intermittent and durational employees must work the equivalent of six months (1044 hours) to be eligible for holiday pay. If a holiday falls on a Saturday or Sunday, the state generally designates the Friday preceding or the Monday following as the day it will be observed. A calendar detailing the exact day of holiday observance appears on the Human Resources intranet site. You will be paid for a holiday if you are on the payroll on or immediately before or after the day it is celebrated; you normally will not receive holiday pay if on a leave of absence without pay before and after a scheduled holiday. Consult your union contract for information about compensation for work performed on a state holiday. Sick Leave As a permanent employee, you accrue sick leave from your date of employment for each fully completed calendar month of service, except as otherwise provided in the statutes. You must use sick leave when incapacitated or in the special cases described in your union contract. Upon exhaustion of sick leave, you must use other accrued leave in lieu of sick leave unless FMLA rules dictate otherwise. If an employee is sick while on annual vacation leave, the time will be charged against accrued sick leave if supported by a properly completed medical certificate. Sick leave is not an extension of vacation or personal leave. You should maintain a sick leave balance as a form of insurance in the event of a long-term illness. Accrual. Full-time employees accrue paid sick leave at the rate of 1¼ days per completed month of service or 15 days per year. If you are absent without pay for more than forty hours in any month, you do not accrue sick leave in that month. If you are an eligible part-time employee, you accrue paid sick leave on a pro-rated basis or on the amount of your scheduled hours as a percentage of a full-time schedule. Balances. Payroll records your sick leave balance (time accrued but not used) in hours and minutes. When you retire, the state will compensate you for 25 percent of your accrued sick leave balance (to a maximum of 60 days). Call-In Procedure. If you are unexpectedly absent as a result of injury or illness, you must notify your supervisor or designee as early as possible, but no later than one-half hour before your scheduled reporting time. If your absence is continuous or lengthy and you have not been granted a medical leave 21 of absence, you must notify your supervisor on a daily basis. If you fail to call in, you may be placed on unauthorized leave without pay and subject to corrective action. Medical Documentation. Your physician must complete a medical certificate if you are absent as the result of injury or illness for more than five working days or as otherwise outlined in your union contract or state personnel regulations. If you fail to provide the required medical documentation, you may be placed on unauthorized leave, which can lead to loss of pay and disciplinary action. Medical certification forms should be emailed directly to DAS.BenefitsandLeavesPod4@ct.gov. Any questions must be sent directly to DAS.BenefitsandLeavesPod4@ct.gov. Additional Use of Sick Leave. You may use sick leave for situations other than your own injury or illness (a medical certificate or written statement supporting a request may be required): • • • • • Medical, dental or optical examination or treatment when arrangements cannot be made outside working hours. Death in your immediate family. Illness or injury to a member of your immediate family. Funeral for a person other than an immediate family member. Birth, adoption or taking custody of a child. To determine the exact number of days allowed, refer to your union contract. Extended Illness or Recuperation. If you exhaust your accrued sick leave during a prolonged illness or injury, you may be permitted to use other accrued time. You must obtain approval from your immediate supervisor for use of other accrued leave to cover the remainder of the absence. In certain circumstances, you may be granted an advance of sick leave if you have at least five years of full-time state service. Consult your union contract for information regarding the sick leave bank or donation of leave time. If an employee has no accrued leave time available, a written request for a medical leave without pay must be submitted to DAS.BenefitsandLeavesPod4@ct.gov, and the request must be followed up in writing upon return to work. Failure to do so will result in charging the absence to Sick Leave Without Pay. Illness or Injury While on Vacation. If you become ill or injured while on vacation, you may request that the recovery time be charged to your sick leave rather than to your vacation leave. A medical certificate or documentation support your request will be required. Vacation Leave Usage. As a full-time employee, you may begin taking paid vacation leave after six months of continuous service. Unless otherwise stated in a union contract, a part-time employee may begin taking paid vacation after completing the equivalent of six months of full-time service (1044 hours). Requests for vacation leave are subject to the approval of your supervisor, based on the operating needs of the unit and the seniority provisions of your contract. 22 Accrual. You accrue vacation leave at the end of each full calendar month of service. Absence without pay for more than five days (equivalent to 40 hours) in a month result in the loss of accrual for that month. You accrue vacation leave at the following rate for each completed month of service (prorated, if part-time): • • • 0-5 years of service: 1 day per month (12 days per year). 5-20 years: 1-1/4 days per month (15 days per year). 20 or more years: 1-2/3 days per month (20 days per year) As a manager and confidential employees excluded from collective bargaining, you accrue vacation leave at the rate of 1-1/4 days per completed month of service or 15 days per year. After completing 10 years of service, on January 1 of each subsequent year you will receive the following number of days in addition to the normal accrual: • • • • • 11 years of service: 1 additional day 12 years: 2 additional days 13 years: 3 additional days 14 years: 4 additional days 15 or more years: 5 additional days Balances. Payroll will record your vacation leave balance in hours and minutes. Without agency permission, you cannot carry more than 10 days of accrued vacation leave from one year to the next if you are a nonexempt employee. If you are a nonexempt employee, refer to your bargaining union contract regarding your maximum accrual. If you are a nonexempt employee or a manager, you may accumulate as many as 120 days of vacation time. When separated from state service, if a permanent employee, you will receive a lump-sum payment for your vacation leave balance. Personal Leave As a full-time employee who has attained permanent status, you are credited with three days of personal leave to conduct private affairs, including the observance of religious holidays. On January 1 of each year thereafter, three days of personal leave will be credited to your leave balance. You must request authorization in advance from your supervisor to use personal leave. Personal leave must be used prior to the end of the calendar year or it will be forfeited. You are responsible for monitoring your time charges to ensure that your personal leave is used within the calendar year. Part-time employees generally are entitled to prorated personal leave; consult your union contract for the specifics. Payroll will maintain your balance. Jury Duty If you are summoned for jury duty, you will not lose your regular salary or benefits. You must notify your supervisor immediately and supply the jury notice; your supervisor will forward it along with the reason for your absence to the Payroll Unit. The court will supply you with verification of your attendance; which is then submitted through your supervisor to Payroll. You must return to work 23 whenever not actively serving on jury duty. With the exception of travel allowances, you must return the money received for jury duty to Payroll. Military Leave If you are a member of the National Guard or a reserve component of the U.S. armed forces and a permanent employee, you may apply for leave to attend required training. To verify the leave, you must submit a copy of your military orders to DAS.BenefitsandLeavesPod5@ct.gov or fax to 860-622-4928. The state permits as many as three weeks in a calendar year for field training. Paid leave for military call-ups other than annual training is limited to unscheduled emergencies, subject to the provisions of your union contract. Notify your supervisor as soon as you become aware of your military leave schedule. 24 Leave Without Pay Leave of Absence Without Pay (LAW) Depending on the terms of your union contract, you may be granted a LAW without endangering your status as a state employee. Your benefits, however, may be affected. You will not accrue vacation or sick leave in any month on a LAW for more than five working days (hourly equivalent of) without pay, and service credit toward retirement, seniority and longevity may be suspended. If you are on a LAW for pregnancy, illness, injury, or an FMLA-qualifying reason, the state will continue to pay the same portion of your health insurance as while you were working. You will, however, be billed directly for the amount that you previously paid through payroll deduction. If on a LAW for another reason, you will be billed for the full cost of medical coverage. If possible, submit your LAW request to DAS.BenefitsandLeavesPod4@ct.gov in advance and in writing with appropriate documentation. Your manager may grant a LAW for as many as five consecutive days. A LAW of longer than five days must be authorized by the Benefits and Leaves Pod before the leave, except in extraordinary situations such as emergency medical leave. You may be granted a LAW for a variety of purposes on a position-held or not-held basis. Your LAW must be consistent with the requirements in your union contract or state regulations if you are an exempt employee. If your position is held, you may resume employment on the expiration of the LAW. You must be cleared by a physician to return to normal duties if you are on a medical LAW. This needs to be done before you return to work. If your position is not held, your return to active service depends on the availability of a position. The agency will consider the reason for your request, your work record and agency operating needs when deciding whether to grant you a LAW and to hold your position. Maternity Leave If pregnant, you must use accrued sick leave to cover time before, during or after your delivery when a physician certifies you as “unable to perform the requirements of your job.” You must send a Medical Certificate - P33A to DAS.BenefitsandLeavesPod4@ct.gov to substantiate your disability. When your disability period ends or you have exhausted your sick leave balance prior to the end of your disability period, you may request to use accrued vacation and personal leave. When all your paid leave has been used, you may request a LAW with your position held. Refer to your union contract and the FMLA Policy for further information. Medical Leave You must use accrued sick leave to cover the time which you are unable to work because of illness. If that period extends beyond five days, you will need to supply a Medical Certificate - P33A to DAS.BenefitsandLeavesPod4@ct.gov to substantiate your use of sick time to. When your sick leave balance is exhausted, you must apply vacation or personal leave to cover your absence unless FMLA rules dictate otherwise. Your union contract may contain provisions for advance of sick leave, a sick leave bank, and donation of leave time in cases of prolonged illness. You may also request a leave of absence without pay. Details on the requirements and provisions of such leaves are in your union contract and the FMLA policy. 25 Family Leave You may request a LAW for the birth or adoption of a child; the serious illness or health condition of a child, spouse or parent; your own serious health condition; the placement of a foster child in your care and certain other conditions. A medical certificate must be submitted by email to DAS.BenefitsandLeavesPod4@ct.gov to substantiate a request for leave under the Family and Medical Leave Act (FMLA). You must request forms by sending an email to DAS.BenefitsandLeavesPod4@ct.gov. 26 SALARY Payment Your job classification determines your salary grade. Classifications are assigned to a salary group based on the amount and type of required experience and training, technical complexity, difficulty and level of responsibility. The state establishes a number of steps for salary groups other than managerial and confidential classes. As a new employee, you will generally start at the salary range minimum for your job classification. Payday The state issues salary payments bi-weekly through a checkless system called e-pay. You will receive payment for the work you performed during the previous two weeks. The delay allows for processing. If you are a new employee, you should receive your first salary payment four weeks after your first workday. If you separate from state service, you will receive your last salary payment two weeks following the end of the last pay period worked. Earnings, itemized deductions and leave accruals are viewable online. Questions should be directed to Payroll. Annual Increments Annual increments are based on the terms of your union contract. You may be raised to the next higher step in a salary group on your anniversary date. Consult your union contract for details. If an appointed official or manager, you may be awarded an increase by the governor, usually effective on January 1. The amount of the increase will be based on your goal attainment and performance under PARS, the Performance Appraisal and Recognition System for managers. Collective Bargaining & Cost-of-Living Increases If you are a union member, your increase will result from the collective bargaining process. An increase generally will be calculated as an across-the-board percentage within a negotiated salary structure and payable in July. If you are an appointed official or a manager, the governor may award you a cost-ofliving increase, usually a percentage of your annual salary, also payable in July. When promoted, you will normally receive a salary increase of at least one full step in the salary group, unless you are placed at the maximum step. If promoted to a managerial position, you will receive an increase of five percent or the minimum of the new salary range, whichever is greater. Longevity Pay Employees hired on or after July 1, 2011, shall not be entitled to a longevity payment however, any individual hired on or after said date who shall have military service which would count toward longevity under current rules shall be entitled to longevity if they obtain the requisite service in the future. Employees hired prior to July 1, 2011, are eligible for longevity. For those eligible employees, when you complete the equivalent of 10 years of full-time state service (generally continuous) you will receive a longevity payment. The amount of longevity payment increases when you complete 15, 20, and 25 year years of service. Longevity schedules appear in your union contract and other pay plans. To qualify, you must attain the required years of service by April1 or October 1. Longevity payment are also paid 27 in these months. Employees not included in any collective bargaining unit are no longer eligible for longevity payments. 28 DEDUCTIONS Federal Income Tax & Social Security Tax Federal income and Social Security taxes will be deducted from your paycheck in accordance with federal law. Connecticut Income Tax State income tax will be deducted from your paycheck in accordance with state law. Health Insurance Health insurance coverage for eligible employees who choose to enroll in the state’s health benefit plan will be effective the first of the month immediately following the employee’s hire date or date of eligibility. For example, if you were hired on November 9, you must submit your application within thirty days; your effective date of coverage would be December 1. You may extend health and dental coverage to cover your spouse, dependent children under age 26, and/or disabled children over age 26. Please contact Payroll for enrollment eligibility. Refer to the Office of State Comptroller’s website for a summary of health insurance options and rates. You must remain with your insurance carrier until the next open enrollment period, the one time a year when you can change carriers. You may add a dependent newborn or spouse within one month of the birth or marriage (please note if adding a new spouse, a marriage certificate is required); other dependent changes generally are restricted to the open enrollment period. If your spouse’s insurance was terminated through his/her employer, you may be eligible to add them as a special exception. A letter from the employer stating insurance has been cancelled will be required. All additions, deletions, or other changes must be processed through the Payroll Unit. You must provide documentation of each dependent’s eligibility status at the time of enrollment. It is your responsibility to notify the Payroll Unit when any dependent is no longer eligible for coverage. Group Life Insurance You may purchase term life insurance at group rates. The state pays a portion of this coverage. You may authorize payroll deductions for this insurance after six months of employment. If you waive coverage and later decide to enroll, you must apply with medical evidence of insurability and wait for approval. The amount of life insurance coverage is based on your annual salary and is automatically adjusted on April 1 and October 1 as your salary increases. Contact the Payroll Unit to obtain forms or arrange for beneficiary changes. You may visit the Office of State Comptroller’s website (https://carecompass.ct.gov/supplementalbenefits/) for more information. Supplemental Benefits The state offers various supplemental benefits to qualified employees and retirees, which are designed to complement the benefits provided by the state. These benefits are on a voluntary basis and are paid entirely by the employee through the convenience of payroll deduction. Available supplemental benefits 29 are listed on the OSC website Supplemental Benefits - Care Compass (ct.gov). Contact the authorized vendors for information and assistance with the enrollment process. Direct Deposit You may deposit your paycheck in a checking or savings account in a financial institution that is a member of the automated clearinghouse. Your funds will be electronically transmitted and available to you after 9:00 a.m. on the date of the check. You must complete an authorization form to adjust or cancel direct deposit. Authorization forms can be obtained from Payroll. Deferred Compensation Permanent employees who work more than 20 hours a week are eligible for the state’s deferred compensation plan. Through payroll deduction, you may set aside a portion of your taxable wages (prior to tax deferrals). The minimum contribution is $20 per pay period. Obtain details by contacting the plan administrator. State Employees Campaign Through the state employee campaign, you may contribute to your choice of a range of service organizations via payroll deduction. Union Dues As a member of a collective bargaining unit, you may elect to join the union and have union dues deducted from your check. Your union determines the amount by using a set-rate or sliding-scale formula based on the amount of your salary. Credit Unions As an agency employee, you may join the, CT Labor Department Federal Credit Union, 200 Folly Brook Blvd., Wethersfield, CT 06109 (telephone 860-263-6500). As a State of Connecticut employee, you may also join the CT State Employees Credit Union. Offices are as follow: 84 Wadsworth Street Hartford, CT 06106 860-522-5388 1244 Storrs Road Storrs, CT 06268 860-429-9306 2434 Berlin Turnpike Newington, CT 06111 860-667-7668 401 West Thames Street Southbury Training School Norwich, CT 06360 Southbury, CT 06488 860-889-7378 203-267-7610 1666 Litchfield Turnpike Woodbridge, CT 06525 203-397-2949 Silver & Holmes Street Middletown, CT 06457 860-347-0479 30 Retirement Tiers The state and collective bargaining units negotiate the pension agreement. The retirement system includes five plans: Tier I, II, IIA, III and IV. For details, contact Office of the State Comptroller’s at osc.crsp@ct.gov or consult the specific retirement booklet for which you are a member. Online copies are available at the OSC website Retiree Resources (ct.gov). Tier I. Usually, you are member of this retirement plan if you were hired on or before July 1, 1984 and contribute by payroll deduction to your pension. You may retire at age 55 with 25 years of service, or at age 65 with 10 years of service, or retire early at age 55 with 10 years of service – at a reduced rate. This tier is divided into three plans. Members of Plans A and C contribute five percent of salary toward retirement. Members of Plan A have chosen not to participate in the Social Security plan; Plan C members pay Social Security taxes and are eligible for Social Security benefits. Plan B members contribute two percent of salary toward retirement until they reach the Social Security maximum, and five percent of salary above the maximum; they will receive reduced pensions when Social Security payments begin. You also may purchase periods of service for which you have not made contributions: war service, prior state service, and leaves of absence for medical reasons. Tier II. If you were hired into state service from July 2, 1984 to June 30, 1997, you are automatically covered under this noncontributing plan. If you were employed by the state on or before July 1, 1984, and were not a member of any other state retirement plan, the Tier II plan also covers you. You contribute two percent of your salary towards retirement. You are eligible for normal retirement benefits after you attain: (1) age 60 with at least 25 years of vesting service; (2) age 62 with at least 10, but less than 25 years of vesting service; or (3) age 62 with at least five years of actual state service. If you have at least 10 years of service, you can receive retirement benefits – at a reduced rate – if you retire on the first day of any month following your 55th birthday. Retirements on or after July 1, 2022 are subject to the age and years of service specified in the SEBAC 2011 agreement. Tier IIA. If you entered state service from July 1, 1997 to June 30, 2011, you are covered under this plan as of the date of your employment. You contribute two percent of your salary towards retirement have the same options and benefits as a Tier II employee. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. You also may purchase periods of service for which you have not made contributions: war service and leaves of absence for medical reasons. Tier III. This plan covers employees hired on or after July 1, 2011 to July 30, 2017. As a Tier III member, you contribute two percent of your total annual salary. Your normal retirement date is the first of any month on or after you reach age 63 if you have at least 25 years of service, or age 65 with at least 10, but less than 25 years of service. If you have 10 years of vesting service, you can receive early retirement benefits on the first of any month following your 58th birthday. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. 31 Tier IV. This plan covers employees hired on or after July 31, 2017. The Tier IV retirement plan provides elements of both a defined benefit and defined contribution plan. Defined Benefits – Participants that satisfy the minimum eligibility criteria will qualify for a pre-defined monthly retirement income for life, with the amount being determined by years of service, retirement age and Final Average Earnings. You contribute 7% of your annual salary (this rate is for fiscal year July 2023 through June 2024). Defined Contribution – You contribute 1% to a defined contribution plan with a 1% employer match. This plan also has a risk sharing component wherein for any given year the employee contribution can be up to 2% higher depending on the plan’s performance for the previous year. This contribution will be computed by the plan’s actuaries. (You may also contribute to a 457 plan). For additional information please see the State Comptroller’s Retirement Resources website . Please note: If you were a former state employee who contributed to a different state retirement plan, please contact Payroll 860-263-6195 or dol.payroll@ct.gov to see if you qualify to be placed into a different retirement plan. 32 Separation Resignation The personnel regulation on resignation reads: “An employee in the classified service who wishes to voluntarily separate from state service in good standing shall give the appointing authority at least two working weeks written notice of resignation, except that the appointing authority may require as much notification as four weeks if the employee occupies a professional or supervisory position.” If you resign, your written notice must include your last day of work and be submitted to your supervisor at least two weeks before you leave. You will receive a lump-sum payment for unused vacation time if you are a permanent employee. You may arrange to continue your health insurance benefits at the COBRA rate for a specific period of time. Contact Payroll for details on the length of coverage and payment amount. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. If you do not return to state service within five years and have not withdrawn your contributions, the Retirement Division will send you a refund application. After you complete the form and return it, you will receive your contributions plus interest. If the Retirement Division cannot locate you within 10 years after your employment ends, your contributions will become part of the retirement fund. If you submit your resignation less than two weeks before leaving, your separation may be regarded as not in good standing and may affect your re-employment rights. An unauthorized absence of five or more working days also will be considered as a resignation not in good standing. You will be notified if your resignation is considered as not in good standing and you may file an appeal with the Commissioner of the Department of Administrative Services. Layoff The state defines a layoff as an involuntary, non-disciplinary separation from state service resulting from a lack of work, program cutback or other economic necessity. Consult your union contract for particulars. If you are an exempt employee, consult Sec. 5-241 of the Connecticut General Statutes. Reemployment Rights In an effort to deliver services in a contemporary and cost effective fashion, the State of Connecticut uses a module called Freenames through the Online Employment Center (JobAps) as a platform for processing the following: • • • Mandatory rights for eligible individuals (reemployment/SEBAC/other mandatory rights) Statewide Transfer requests (non-mandatory transfers) Rescind of Resignation or Retirement requests This section applies to: Current or former State Employees who have been affected by the following: • • • Layoffs Noticed for layoff Accepted a demotion in lieu of layoff 33 • • • • • • Notified of eligibility for mandatory rights Recently failed a working test period and has permanent classified status Exercising rights to return to the classified service from the unclassified service Recently separated NP-2 employee with Article 39 Rights Current employees who request to place their names on a Statewide Transfer list Former employees who request to rescind their resignation in good standing or voluntary retirement. If you retire from state service, you are eligible for temporary employment in any class in which you had permanent status. As a re-employed retiree, you may work as many as 120 days per calendar year (bases on 40 hours per week prior to retirement) without adversely affecting your pension. Such appointments are totally at the discretion of the agency. Rescind of Resignation or Retirement If you have permanent status and resign in good standing, you may, within one year of the date of your separation, request to rescind your resignation by completing the Rescind Resignation request via the JobAps, Freenames Application within one year from date of resignation. This will enable you to be considered for any classes in which you had permanent status. Reinstatement is strictly voluntary on the part of the Agency and may occur at any time up to two years from the date of your separation. Former employees shall be fully independent in and responsible for conducting their own search for reinstatement by requesting rescind privileges via the JobAps, Freenames Application. Use the rescind of resignation or retirement option to request to rescind a resignation in good standing, or a retirement from state service in accordance with DAS General Letter 177. Note: There are no reemployment rights associated with a rescind of resignation. The State of Connecticut is not required to rehire individuals who rescind resignation. Rather, certain privileges may be granted depending on the job class and effective date of rehire. Requirements A former State employee must meet the following conditions: • Attained permanent status as a State employee • Separated from state service in good standing from a position in the Classified service or a bargaining unit position in the Unclassified service • You must know the job class you resigned or retired from. To locate this information, contact your former Human Resources Representative or refer to your last paycheck as an active employee. • You must include each job code matching your last held title including different hourly equivalent. For example: 7603EU= Information Technology Analyst 1 (35 hours) 7603FD= Information Technology Analyst 1 (40 hours) DAS will conduct a review and approve or deny all rescind requests for any or all job classes identified. Applicants will be notified of the status of their requests via email. Please be sure to keep your contact information updated and check your email and spam folders often as most communication will occur via email. 34 For detailed instructions to request to rescind a resignation in good standing or retirement, refer to Instructions Rescind Resignation or Retirement. Exit Interview Below you will find the link and QR code to access a confidential exit interview survey. Thank you for taking the time to engage in the exit interview process. This survey will only take approximately three minutes to complete. The information collected will help us evaluate factors like pay, benefits, work environment, and your overall work experience. All your answers are confidential, so please be candid with your responses. The information collected will help us to identify any potential areas where we can implement new strategies to increase the satisfaction of our workforce. Thank you again for your time and atention. Link to survey: Confidential Exit Survey State of Connecticut - DAS (office.com) QR code: 35 Retirement Retirement Types State employees are members of one of several retirement programs. Once an employee has completed the required actual or vesting service required by the retirement system, he/she is eligible for a pension. Retirements are effective on the first of the month following the last working day of the previous month. For retirement purposes, an employee who is on prolonged sick leave will retire the first of the month following the last working day that sick leave was used in the previous month (a medical certificate is required) and may qualify for a disability retirement. Types of retirement include, Normal, Early, Hazardous Duty or Disability. If you plan to retire you must send your Notice of Intent to Retire and Retirement Information Form via fax to 860-622-4928 or via email to DAS.BenefitsandLeavesPod5@ct.gov. Please refer to the Plan Summary which can be found on the Office of the State Comptroller’s website at Retiree Resources (ct.gov). Regardless of the type of separation from service; on the last day of work, the terminating employee must return State property to her or his supervisor. Pension Payment Options Option A - 50% Spouse: This option will pay you a reduced benefit for your lifetime in exchange for the protection that, should you pre-decease your spouse, the state will continue to pay 50% of your reduced benefit for your spouse's lifetime. Option B - 50% or 100% Contingent Annuitant: This option provides you a reduced monthly benefit for your life and allows you to guarantee lifetime payments after your death to a selected beneficiary. After your death, a percentage of your reduced benefit, either 50% or 100%, whichever you choose, will continue for your beneficiary’s life. Option C - 10 Year or 20 Year Period Certain: This option provides you a reduced monthly benefit for your lifetime in exchange for the guarantee that monthly benefits will be paid for at least 10 or 20 years from your retirement date (whichever you choose). Option D - Straight Life Annuity: This option pays you the maximum monthly benefit for your lifetime only. All benefits will end upon your death, including state-sponsored health insurance for any surviving eligible dependents. Insurance Benefits You must meet age and minimum service requirements to be eligible for retiree health coverage. Service requirements vary. For more about eligibility for retiree health benefits, contact the Retiree Health Insurance Unit at 860-702-3533. Regardless of the retirement option you choose, you will receive a monthly pension for the rest of your life, and, if you qualify for health insurance benefits, coverage will extend to your eligible dependents. Once you or your dependents become eligible for Medicare, this is your primary medical plan provider and the state plan is supplementary. 36 If you retire with at least 25 years of service and have state-sponsored life insurance, the state will pay for 50 percent of the amount of coverage (at least $7,500) as when employed. If you retire with less than 25 years of service, the state will pay a prorated amount. The Group Life Insurance Section of the Retirement Division will contact you following your retirement concerning conversion options. Disability retirement and pre-retirement death benefits are a part of your pension agreement. Pensions also are subject to cost-of-living increases as outlined in the agreement. For further information regarding retirement benefits call or email: Office of the State Comptroller Retirement Division 165 Capitol Avenue Hartford, CT 06106 Telephone: (860) 702-3490 Email: osc.rsd@ct.gov 37 TRAINING & DEVELOPMENT In-Service Training You may apply for Department of Administrative Services in-service training courses. Courses should be relevant to your position or career mobility, or to your unit’s operational needs. They are generally held during regular work hours in the spring and fall. Supervisor approval is required. For information, contact Employee and Organizational Development. Management Development Courses A calendar of courses focusing on leadership, supervisory and management development, strategic planning, customer service skills and total quality management techniques is distributed twice a year. Contact Employee and Organizational Development for particulars. Tuition Reimbursement You may seek tuition reimbursement from the state for courses taken during non-working hours at colleges, universities, technical schools or other accredited educational institutions. You do not need supervisory approval. Eligibility and funding provisions are outlined in your union contract if you are a bargaining unit employee. As a non-exempt employee, you may be reimbursed for a non-credited course through your union. Convert course hours to credits. For example, 6-14 hours equal one credit for tuition reimbursement; 15-29 hours, two credits; and 30-44, three credits. As a manager, you are eligible for tuition reimbursement from the State Management Advisory Council or agency funds. As a non-managerial confidential employee, you may apply for reimbursement in accordance with the union contract that would have included your job classification had your class not been excluded. For a fall semester class, you must document by Feb. 1 that you paid for a course and passed it, and by June 1 for a spring semester class. Forms and assistance are available through Employee and Organizational Development. You must submit your application to that unit at Central Office, 200 Folly Brook Blvd., Wethersfield, CT 061091114, at least two weeks before the start of a class. Conferences, Workshops & Seminars Your union contract may pay costs associated with conferences, workshops or seminars such as registration fees, travel expenses and meals. You must receive supervisory approval before processing a payment request. Consult you union contract for details. 38 EMPLOYMENT POLICIES (Ctrl + Click to follow links below) Acceptable Use of State Systems Policy - Statewide (2019) ADA Reasonable Accommodation Policy Affirmative Action Policy Statement – DOL (2023) AIDS Policy – DOL (7/16/2012) Background Check Policy and Procedures – DOL (10/31/2022) Disposition of Public Records Policy – DOL (11/28/2011) Discrimination and Illegal Harassment Prevention Policy – DOL (April 2023) Drug Free Workplace State Policy – DOL (7/16/2012) Employee Conduct Policy – DOL (8/3/2018) Employee Dependability Policy – DOL (7/16/2012) Employee Discipline Policy – DOL (7/16/2012) Ethical Conduct Policy – DOL (8/2013) Family Violence Leave Policy – Statewide GL 34 (1/2022) Federal Family & Medical Leave Act – DOL (7/16/2012) Health and Safety Policy – DOL (7/16/2012) Internal Discrimination Complaint Procedure – DOL (4/18/2023) Internal Security Standards - DOL Office Automation Policy, Standards and Guidelines – DOL (7/16/2012) Personal Wireless Device Policy (Rev. 9/9/2020) Phone Use Policy (Rev. 4/23/2023) Policy for DOL Facility Occupancy – DOL (7/9/2020) Professional Image Policy – DOL (3/1/2023) Prohibition of Weapons in DOL Worksites Policy – DOL (8/10/16) Public Officials and State Employees Guide to the Code of Ethics - Statewide 07/16/2012 Software Anti-Piracy Policy – DOL (7/16/2012) Vehicle-Use-for-State-Business-Policy--DAS-General-Letter-115--April-1-2012.pdf (ct.gov) Violence in the Workplace Prevention – DOL (4/2012) Workers Compensation Rights Responsibilities and Claims (ct.gov) Workplace Incident Report and Footprints Instructions – DOL (2015) **Please refer to online Employee Handbook for link activation. 39 ","Use information from the article only to explain your answer. Do not rely on outside knowledge. What does it mean that the Dept of Labor is hiring for an intermittent employment position? EMPLOYEE HANDBOOK Table of Contents Welcome................................................................................................................................................... 5 About the Agency .................................................................................................................................... 6 Mission Statement ................................................................................................................................... 6 Supersedence ........................................................................................................................................... 6 General Highlights .................................................................................................................................. 7 Access Card ............................................................................................................................................. 7 Affirmative Action/Equal Employment Opportunity Employer ....................................................... 7 Americans with Disabilities Act ............................................................................................................ 7 Appearance & Dress Code ..................................................................................................................... 7 Building Security .................................................................................................................................... 7 Code of Ethics ......................................................................................................................................... 7 Collective Bargaining ............................................................................................................................. 7 Email & Internet Use.............................................................................................................................. 8 Employee Assistance Program .............................................................................................................. 8 Employee Background Check ............................................................................................................... 8 Employment Applications ...................................................................................................................... 8 Equal Employment Opportunity........................................................................................................... 8 Immigration Law Compliance............................................................................................................... 8 On-the-Job Accident/Illness ................................................................................................................... 9 Photo Identification ................................................................................................................................ 9 Political Activity ...................................................................................................................................... 9 Rideshare ................................................................................................................................................. 9 Safety ........................................................................................................................................................ 9 Sexual Harassment ................................................................................................................................. 9 Smoking ................................................................................................................................................. 10 Standards of Conduct ........................................................................................................................... 10 Telephones - Cellular Telephones ....................................................................................................... 10 Travel ..................................................................................................................................................... 10 Uniformed Services Employment & Reemployment......................................................................... 10 Violence in the Workplace ................................................................................................................... 10 Visitors ................................................................................................................................................... 11 Weather & Emergency Closings ......................................................................................................... 11 Collective Bargaining ........................................................................................................................... 12 Bargaining Unit Representation .......................................................................................................... 12 Union Contracts .................................................................................................................................... 12 2 Grievance Procedure ............................................................................................................................ 12 Appointment and Promotion ............................................................................................................... 14 Merit System ......................................................................................................................................... 14 Job Classification .................................................................................................................................. 14 Classified & Unclassified Positions ..................................................................................................... 14 Competitive & Non-Competitive Positions ........................................................................................ 14 Scheduled & Continuous Recruitment Job Announcements ........................................................... 14 Job Announcements.............................................................................................................................. 14 Employment Opportunities ................................................................................................................. 15 Application Accommodations for People with Disabilities ............................................................... 15 Rejection from State Application ........................................................................................................ 15 Appointment Types .............................................................................................................................. 15 Working Test Period ............................................................................................................................ 16 Service Ratings ...................................................................................................................................... 17 Promotion & Reclassification .............................................................................................................. 17 Temporary Service in a Higher Class ................................................................................................. 17 Transfers ................................................................................................................................................ 18 Dual Employment ................................................................................................................................. 18 Personnel Records ................................................................................................................................ 19 Personnel Files ...................................................................................................................................... 19 Change of Personal Data ...................................................................................................................... 19 Working Hours ..................................................................................................................................... 19 Meal & Break Periods .......................................................................................................................... 20 Overtime & Compensatory Time ........................................................................................................ 20 Shift Assignments.................................................................................................................................. 20 Attendance ............................................................................................................................................. 20 Paid Leave Time ................................................................................................................................... 21 Holidays ................................................................................................................................................. 21 Sick Leave .............................................................................................................................................. 21 Vacation Leave ...................................................................................................................................... 22 Personal Leave ...................................................................................................................................... 23 Jury Duty ............................................................................................................................................... 23 Military Leave ....................................................................................................................................... 24 Leave Without Pay ............................................................................................................................... 25 Leave of Absence Without Pay (LAW) ............................................................................................... 25 Maternity Leave .................................................................................................................................... 25 3 Medical Leave ....................................................................................................................................... 25 Family Leave ......................................................................................................................................... 26 Salary ..................................................................................................................................................... 27 Payment ................................................................................................................................................. 27 Payday .................................................................................................................................................... 27 Annual Increments ............................................................................................................................... 27 Collective Bargaining & Cost-of-Living Increases ............................................................................ 27 Longevity Pay ........................................................................................................................................ 27 Deductions ............................................................................................................................................. 29 Federal Income Tax & Social Security Tax ....................................................................................... 29 Connecticut Income Tax ...................................................................................................................... 29 Health Insurance ................................................................................................................................... 29 Group Life Insurance ........................................................................................................................... 29 Supplemental Benefits .......................................................................................................................... 29 Direct Deposit ........................................................................................................................................ 30 Deferred Compensation ....................................................................................................................... 30 State Employees Campaign ................................................................................................................. 30 Union Dues ............................................................................................................................................ 30 Credit Unions ........................................................................................................................................ 30 Retirement Tiers ................................................................................................................................... 31 Separation .............................................................................................................................................. 36 Resignation ............................................................................................................................................ 33 Layoff ..................................................................................................................................................... 33 Reemployment Rights .......................................................................................................................... 33 Rescind of Resignation or Retirement ................................................................................................ 33 Exit Interview ........................................................................................................................................ 33 Retirement ............................................................................................................................................. 33 Retirement Types .................................................................................................................................. 36 Pension Payment Options .................................................................................................................... 36 Insurance Benefits ................................................................................................................................ 36 Training and Development .................................................................................................................. 38 In-Service Training ............................................................................................................................... 38 Management Development Courses .................................................................................................... 38 Tuition Reimbursement ....................................................................................................................... 38 Conferences, Workshops & Seminars ................................................................................................ 38 EMPLOYMENT POLICIES ............................................................................................................... 39 4 Welcome Whether you have just joined the agency or have been with us for a while, we are confident that you will or have found our organization to be a dynamic and rewarding place in which to work. We consider the employees of the Department of Labor to be our most valuable resource and we look forward to a productive and successful partnership. This handbook has been prepared for you to serve as a guide for the employer-employee relationship. The topics covered in this handbook apply to all employees of the Department of Labor. It is important to keep the following things in mind about this handbook. First, it contains general information and guidelines. It is not intended to be comprehensive or to address all the possible applications of, or exceptions to, the general policies and procedures described. It is not intended to replace or supersede collective bargaining agreements that may cover many of your terms and conditions of employment. Employees covered by a collective bargaining agreement will receive a copy of their contract at orientation. You should read and become familiar with your collective bargaining agreement, this employee handbook and the agency’s employment policies. If you have any questions concerning eligibility for a particular benefit, or the applicability of a policy or practice, you should address your specific questions to your supervisor or contact your HR Generalist for clarification. Second, neither this handbook nor any other agency document confers any contractual right, either expressed or implied, to remain in the agency’s employ or guarantee any fixed terms and conditions of your employment. Third, the policies, procedures, and benefits described here may be modified or discontinued from time to time. We will try to inform employees of any changes as they occur but cannot guarantee immediate advance notice of changes. Finally, some of the subjects described here are covered in detail elsewhere. The terms of written insurance policies and/or plan documents are controlling for health, life, retirement and deferred or reduced income benefits. You should refer to those documents for specific information since this handbook is only designed as a brief guide and summary of policies and benefits. We are pleased to have you as a member of the Department of Labor and look forward to a successful and beneficial association. 5 About the Agency The Department of Labor handles far more than unemployment insurance benefits. Helping employers and jobseekers with their workforce needs is our goal. An overview of the many programs and public services the agency offers is available on the website (www.ct.gov/dol), which also contains information ranging from upcoming job fairs to wage and workplace guidelines. Mission Statement The Department of Labor is committed to protecting and promoting the interests of Connecticut workers. In order to accomplish this in an ever-changing environment, we assist workers and employers to become competitive in the global economy. We take a comprehensive approach to meeting the needs of workers and employers, and the other agencies that serve them. We ensure the supply of high-quality integrated services that serve the needs of our customer. Supersedence This revised version of the Employee Handbook supersedes all prior versions that have been issued by the Department of Labor and will be effective April 2023. 6 General Highlights Access Card Central Office and Annex employees are issued an access card to enter the building. Should your card be lost, stolen or destroyed, contact Facilities Operations so the card can be deactivated and a replacement issued. Affirmative Action/Equal Employment Opportunity Employer The Department of Labor is committed to affirmative action/equal employment that will build on the strengths of our current workforce and continually enhance the diversity of our organization. The department opposes all forms of discrimination and has developed a set of anti-discriminatory policies. Please direct your questions about affirmative action issues to the AA/EEO Manager at Central Office, 200 Folly Brook Boulevard, Wethersfield, CT 06109; telephone (860) 263-6520. To file a complaint, please click on the link to access the form: Internal Discrimination Complaint Americans with Disabilities Act The Department of Labor complies with all relevant and applicable provisions of the Americans with Disabilities Act (ADA). The agency will not discriminate against any qualified employee or job applicant with respect to any terms, privileges, or conditions of employment because of a person’s physical or mental disability. See the Americans with Disabilities Act Reasonable Accommodation Policy Appearance & Dress Code It is the policy of the agency to project a business-like image to clients, visitors and co-workers. In line with this, you are required to dress appropriately in clothing which is suitable for your job responsibilities and work environment, meets the requirements established for safety reasons, and complies with the agency’s dress code requirements. See Professional Image Policy. Building Security Each and every employee must follow the building security rules and regulations. Employees are not allowed on the property after hours without prior authorization from their supervisor. Code of Ethics The department’s standards of ethical conduct, which all employees are expected to be familiar with and observe, are outlined in the Code of Ethics for Public Officials & State Employees and the Ethical Conduct Policy . Collective Bargaining Your assignment to a collective bargaining unit (union) is based on your job classification. As a bargaining unit member, you will have union dues deducted from your bi-weekly paycheck. You may elect not to join a union. Your union contract governs salary, benefits and hours of work, and other terms and conditions of employment. Collective bargaining agreements are negotiated periodically. 7 Exempt employees are excluded from the collective bargaining process and are not required to pay union dues. Email & Internet Use It is the policy of the agency to provide electronic mail (email) and internet access for work-related purposes. You are required to adhere to this and related policies to ensure proper, legal and effective use of these electronic tools and resources. See Acceptable Use of State Systems Policy. Employee Assistance Program The Employee Assistance Program (EAP) is designed to offer consultation and counseling services for employees and their dependents who are experiencing problems which may be impacting their life at work and/or at home. Some of these problems may include family, marital, alcohol/drugs, emotional distress, and job-related, legal, or financial difficulties. Participation is voluntary and confidential. EAP services are provided by Wheeler EAP. To schedule an appointment or obtain more information, call 1800-252-4555 or 1-800-225-2527, or log on to their website at Wheeler EAP. Employee Background Check Prior to making an offer of employment, Human Resources may conduct a job-related background check. A comprehensive background check may consist of prior employment verification, professional reference check, education confirmation and fingerprinting. Employment Applications We rely upon the accuracy of information contained in an employment application and the accuracy of other data presented throughout the hiring process and employment. Any misrepresentation, falsification or material omission of information or data may result in exclusion of the individual from consideration for employment or, if the person has been hired, termination of employment. Equal Employment Opportunity The Department of Labor is an equal employment opportunity employer. Employment decisions are based on merit and business needs. The Department of Labor does not discriminate on the basis of race, color, citizenship status, national origin, ancestry, gender, sexual orientation, age, religion, creed, physical or mental disability, marital status, veterans’ status, political affiliation, or any other factor protected by law. To file a complaint, please click on the link to access the form: Internal Discrimination Complaint. Immigration Law Compliance All offers of employment are contingent on verification of the candidate’s right to work in the United States. On the first day of work, every new employee will be asked to provide original documents verifying his or her right to work and, as required by federal law, to complete and sign an Employment Eligibility Verification Form I-9. 8 On-the-Job Accident/Illness The agency promotes safety in the workplace. The State of Connecticut also has implemented a Managed Care Program for Workers’ Compensation, administered by Gallagher Bassett Services, Inc. You must report a work-related accident or illness to your supervisor, who is required to call a 24-hour hotline (1-800-828-2717) to report your accident or illness and initiate a claim. If your supervisor is unavailable, you may call or have someone call for you. Your supervisor must also complete the First Report of Injury (Form WC-207) and submit it to DAS_RfaxWCHE@ct.gov or by fax to 959-200-4841, whether or not you seek treatment or lose time from work. To become eligible for workers’ compensation benefits, you must seek treatment from a network physician or medical facility. Forms can be obtained at Workers' Compensation Rights, Responsibilities, and Claims--Documents (ct.gov). In cases of a medical emergency call 911 to seek immediate medical attention. Contact the DAS Workers' Compensation Division at (860) 713-5002 with any questions regarding access. Photo Identification You are required to wear and visibly display a photo identification badge during working hours. If your identification badge is lost, stolen, or destroyed, or you have transferred to a different unit, you must request a replacement through Facilities Operations. Political Activity As a state employee, state statutes govern your involvement in various political activities such as campaigning and running for elective office. Also, if you are working on programs financed in whole or in part by federal funds, you are subject to the provisions of the federal Hatch Act, which is generally more restrictive than state statue. The purpose of these laws is to avoid a conflict of interest between your state job and political activities. Information regarding political activity may be found in DAS General Letter 214D, link to document General Letter 214D – Political Activity. The Ethical Conduct Policy also addressed these issues and you are advised to contact the agency’s Ethics Liaison regarding any political activity. See Ethical Conduct Policy. Rideshare The department promotes the statewide Rideshare Program, an opportunity to reduce your transportation expenses to work. Consider using a ride-sharing mode (carpool, vanpool or bus) as an alternative to driving alone. Ride sharing saves you money, energy and preserves the environment. For information call 800-972-EASY (800-972-3279) or visit the website at www.rideshare.com. Safety The safety and health of employees is our top priority. The agency makes every effort to comply with all federal and state workplace safety requirements. Each employee is expected to obey safety rules and exercise caution and common sense in all work activities. Promptly report safety concerns to your supervisor. Sexual Harassment The Department of Labor does not tolerate sexual harassment. Sexual harassment may include unwelcome sexual advances, requests for sexual favors, or other unwelcome verbal or physical contact 9 of a sexual nature when such conduct creates an offensive, hostile and intimidating work environment and prevents an individual from effectively performing the duties of their position. See Sexual Harassment Policy. Smoking Smoking is prohibited throughout agency buildings and offices, including in rest rooms, private offices, lounges and similar areas. Smoking is permitted only in designated areas outside office buildings and other work locations. The use of smokeless tobacco and e-cigarettes are also prohibited and subject to the same restrictions. Standards of Conduct The work rules and standards of conduct for employees are important and the agency regards them seriously. All employees are urged to become familiar with and must follow these rules and standards. See Employee Conduct Policy. Telephones - Cellular Telephones The agency recognizes that occasionally it is necessary for employees to make or receive personal telephone calls during working hours. You are expected to restrict your personal telephone usage, both on state-owned phones and personally owned cellular phones, to reasonable, incidental calls that do not interfere with your work schedule or the performance of your duties. To avoid being disruptive to others in the workplace, please make certain audible alerts are disabled. Travel Your position may require travel to conduct state business. If you are required to travel for work, you may obtain a state-owned vehicle from a central carpool with a valid driver’s license. Use of your personal vehicle in the performance of Agency duties is allowable only when the use of a State-owned vehicle is not reasonably available for use and request mileage reimbursement. You must present proof of automobile insurance with the minimum coverage requirements. Contact your supervisor or Business Management if you have any questions. Uniformed Services Employment & Reemployment As an equal opportunity employer, the Department of Labor is committed to providing employment and reemployment services and support as set forth in the Uniformed Services and Reemployment Rights Act of 1994 (USERRA). Violence in the Workplace The Department of Labor has a policy prohibiting workplace violence. Consistent with this policy, acts or threats of physical violence, including intimidation, harassment and/or coercion, which involve or affect the organization and its employees will not be tolerated. See Violence in the Workplace Prevention Policy. 10 Visitors To provide for safety and security, only authorized visitors are allowed in the workplace. All visitors must enter through the main reception area, sign-in and sign-out at the front desk and receive a visitor identification to wear while on the premises. Authorized visitors will be escorted to their destination and must be accompanied by an employee at all times. Weather & Emergency Closings At times, emergencies such as severe weather or power failures can disrupt business operations. Everbridge, is a system that the state utilizes to notify enrolled individuals on safety and weather concerns. You can determine by which methods you want to be notified. Sign-up is free. Any personal information provided (such as cell number) will be used for important employee notifications purposes only directed by DAS. Everbridge will never give or sell contact or location information to any vendor or other organization. The Department of Emergency Service & Public Protection website is the official source of information for state employees. Use this page to find any official announcements about closures or delayed openings that have been declared by the Governor. Everbridge system can send alerts to your work phone and email as well as your home phone, cell phone, and home email. The Statewide CT Alert system can also keep you informed of state emergencies and send you emails and text alerts. FEMA’s Ready.gov preparedness site has information on how to keep safe during the winter. 11 Collective Bargaining Bargaining Unit Representation Labor unions and management at times negotiate collective bargaining agreements (union contracts). The contracts govern such areas as salary, benefits, hours of work, and the terms and conditions of employment. Most state job classifications have been assigned to particular bargaining units (unions) and state employees have voted to have unions represent them in the negotiation process. If you are a nonexempt employee, you have been assigned to a bargaining unit based on your job classification and will be represented by that specific union. If you are an exempt employee, you have been excluded from the collective bargaining process. The terms and conditions of your employment will be governed by state statutes, rules and regulations. Union Contracts Union contracts, established through the formal negotiation process, outline the terms and conditions of your employment. You should familiarize yourself with your contract. Benefits and provisions vary between bargaining units. Contract language has been crafted to avoid disputes and eliminate misunderstandings. Contract provisions, however, may be open to interpretation and subject to the grievance and arbitration process. Direct your questions about your union contract to your supervisor, union representative or Human Resources Generalist. Grievance Procedure Your problems or complaints should be resolved quickly and fairly. First, discuss the issue with your supervisor, who may help you find a solution. If your supervisor or another employee in the chain of command cannot resolve your problem or complaint, or if you feel that you have been treated unjustly, contact your union steward or Agency Labor Relations Specialist. If an issue cannot be resolved informally, you may follow the grievance procedure outlined in your union contract. This procedure helps resolve disputes concerning the interpretation and application of a contract. You should, however, make every effort to resolve an issue before filing a grievance. Though specific procedures may vary, your union contract establishes time limits for initiating grievances and obtaining responses. The first steps of the grievance process are informal to encourage quick resolution. If an issue still cannot be resolved, more formal meetings are conducted until the grievance reaches the highest level of the process. Most grievance procedures permit arbitration when an issue cannot be resolved at the highest level. An arbitrator, an impartial party chosen by the union and management, will hear both sides of an issue and render a binding decision. A union normally requests arbitration, but you as an employee may also request it in certain circumstances. Arbitration is permitted only if negotiated as a step in the grievance procedure. You or a group of employees may present a grievance to management for resolution without your union’s participation. However, the resolution must be consistent with your union contract and your union must be given the opportunity to attend all meetings. 12 If you are an exempt classified employee, you may appeal certain actions through the grievance procedure as outlined in Sec. 5-202 of the Connecticut General Statutes. 13 Appointment and Promotion Merit System The appointment and promotion of state employees is based on the merit principles in the State Personnel Act. As with other federal, state and municipal merit systems, this system was established to minimize the influence of electoral politics on the employment and retention of state employees. The system strives to place the best qualified people in state service and to ensure that they are fairly treated in the appointment and promotion process. The merit system is not subject to collective bargaining. Job Classification The state, as an employer of thousands of people, must systematically describe and group jobs to ensure consistent and fair treatment when assigning, compensating and promoting employees. Consequently, it has established a classification plan for all jobs in the executive branch of state service. Individual positions are grouped into job classes, with each class consisting of positions with similar duties, responsibilities and required qualifications. Your job classification is the foundation for the employment process. Classified & Unclassified Positions Most positions in the executive branch of state government are classified. Unclassified positions may be exempt from job announcements. The State Personnel Act lists a number of unclassified categories: agency heads, members of boards and commissions, officers appointed by the governor, deputies and executive assistants to the head of departments, executive secretaries, employees in the Senior Executive Service and professional specialists. Competitive & Non-Competitive Positions Most classified positions are competitive and require an application. The type of experience required depends on the job classification. Applicants must meet minimum general experience and training requirements, however, to be eligible for appointment if a position requires a professional license or degree, there may be no additional requirements beyond possession of the professional license or degree. Scheduled & Continuous Recruitment Job Announcements Most state job opportunities are announced to the general public with a specific closing date. If you apply for a job opening, you will be notified if you are selected for an interview by the hiring agency. When the state considers continuous recruiting necessary, it may postpone the closing date for filing applications until it receives a suitable number of candidates. A job posting will indicate when recruiting is continuous and that applications may be filed until further notice. Job Announcements To meet merit system objectives, the state has developed competitive job classifications to fill many of its positions. They are not used to fill unclassified positions or those in classes designated as noncompetitive. State job announcements fall into the following categories: 14 Open to the Public. If you meet the minimum experience and training qualifications for a position, you may participate in this type of recruitment. Open-competitive job announcements are administered periodically usually when a state agency is recruiting for a vacant position. Statewide & Agency Promotion. If you are a state employee who meets the minimum experience and training qualifications for a position and has completed six months continuous service in a state agency, you may participate in a statewide recruitment. Agency promotional announcements will have the additional requirements that you must be a current agency employee. Employment Opportunities Agency job announcements are posted on the DAS Online Employment Center. You should check regularly for the most up to date information. To apply for employment, you must complete a Master Application on the DAS Website. Check the state employment pages on the Department of Administrative Services website (Job Openings Department of Administrative Services (jobapscloud.com) for information about completing the application form, job opportunities, and to sign up for e-mail notification of current job openings. Application Accommodations for People with Disabilities The state may conduct recruitments in various ways. If you need special accommodations for a particular recruitment, you or someone on your behalf should immediately notify the DAS at (860) 713-7463. You must supply the application title and job number, and a description of your special needs and documentation of the disability. Rejection from State Application Your application for a state job opening may be rejected if (1) your application was received after the closing date, (2) you did not meet the minimum requirements, (3) your years of experience did not match the requirements, (4) specific information was missing from your application, (5) you failed to meet the special requirements for the position, or (6) your years of experience did not match the special requirements. Appointment Types Durational. An employee hired for a specific term, for a reason not provided above, including a grant or specially funded program, not to exceed one year. A durational employee shall become permanent after six months, or the length of the working test period, whichever is longer. Emergency. The state may appoint you to an emergency position to meet short-term agency needs. The appointment may extend for as long as two months but may not be renewed in a fiscal year. Intermittent. Intermittent employment is also work on an ""as needed"" basis. The agency may use intermittent interviewers to supplement permanent staff in times of high unemployment. They are paid an hourly rate for time worked and may receive benefits. They are eligible to apply for agency promotional postings following the completion of 1044 hours of intermittent service. 15 Permanent. The state may appoint you to a permanent competitive position from a certification list. You must successfully complete the working test period to gain permanent status. Provisional. The state may provisionally appoint you to a position that must be filled immediately if no active certification list exists, or an insufficient number of candidates are listed. The appointment may extend for as long as six months or until a job announcement for the position has been held and a certification list promulgated. You may not receive more than one provisional appointment in a fiscal year or serve more than six months as a provisional appointee. Your job performance while a provisional must be satisfactory. To receive a permanent appointment, you must be appointed from a competitive process for the position. If you are not appointed from a competitive process and do not have a permanent position to which you may return, you must be separated from state service. If the competitive process is not completed for a position within six months, an additional temporary or emergency appointment may be authorized. Seasonal. Seasonal employment for a position established for a specific period, usually during summer months. Individuals employed are paid an hourly rate and are not entitled to any fringe benefits. Temporary. Position filled for a short term, seasonal, or an emergency situation, including to cover for a permanent position when the incumbent is on workers’ compensation or other extended leave, not to exceed 6 months. May be extended up to one year. If a temporary employee is retained greater than 12 months, said employee shall be considered durational. Working Test Period The working test period, or probationary period, for a state employee is an extension of the state recruitment process. You must serve this period to gain permanent status following initial appointment or promotion. Your initial test period is generally six months, depending on the applicable contract or state regulation. Your promotional test period is generally four to six months, again depending on the applicable contract or regulation. Exceptions may occur in the length of the trial period for trainee positions. Questions about your working test period may be directed to your supervisor or Human Resources Generalist. During an initial working test period, you are considered a probationary employee and will work closely with supervisors and colleagues to learn your duties. This period also gives your supervisor the opportunity to evaluate your response to training and job requirements. If you demonstrate acceptable performance during your initial test period, you will be given a satisfactory service rating and gain permanent status as a state employee. Your working test period may be extended in certain circumstances. If you do not meet acceptable performance standards during the initial working test period, you will be separated from state service. You may not appeal a dismissal during your initial test period through the contractual grievance procedure, but you may request an administrative review. If you fail to meet acceptable performance standards during a promotional working test period, you will revert to your previous classification. 16 Service Ratings You will receive a service rating for your initial working test period or promotional test period, and at least three months before your annual increase date. Depending on your union contract or state statutes, you may receive a service rating at any time, particularly when your job performance has changed significantly. Service ratings record your progress and performance as training and job experience increase. The state recognizes satisfactory performance by awarding annual salary increases (as negotiated) until reaching the maximum step in a salary group. For employees at the maximum step, some bargaining units award a lump sum payment in lieu of an annual increment. A “less than good” rating may prevent you from receiving an increase. An “unsatisfactory” during the working test period signifies failure. After attaining permanent status, two successive “unsatisfactory” ratings may result in your dismissal. Managers are evaluated in accordance with the provisions of the Performance Assessment and Recognition System (PARS) Program. Promotion & Reclassification Generally, there are two ways in which you may receive an appointment to a higher-level job classification. First, you may compete for a new position or an opening that arises when another employee leaves an existing position. The agency may use a formal state employment application process to obtain a list of candidates to be considered for an opening or it may use a less formal recruitment and selection process. In either event, in order to be considered you must meet the minimum qualifications for the higher classification and comply with the application procedures. Recruitment notices are posted internally on the agency intranet, and at times externally on the Department of Administrative Services website. It is your responsibility to monitor them and respond according to the instructions on the job posting. Additionally, you may progress to a higher level through reclassification. After working for the agency for some time, you may find that your duties have expanded and are more consistent with a higher-level job classification. In such cases, your supervisor will ask you to complete a job duties questionnaire, which will be evaluated by Human Resources. If you are found to be working “out of class,” the agency has the option of either removing the higher-level duties or reclassifying your position to the higher level. Certain conditions must be met for reclassification. You must be in your current position for at least six months, have a rating of “good” or better on your last two performance evaluations and meet the minimum experience and training requirements for the higher class. If you have applied for a job opening and did not qualify for the classification, this is evidence that you do not meet the qualifications for the higher-level class and cannot be considered for reclassification. Temporary Service in a Higher Class When a temporary vacancy occurs in a non-entry level classification, such as the result of an employee being on an extended leave of absence, the agency may fill the opening by temporarily assigning you to a higher level as long as the assignment lasts for more than 30 days and meets any other relevant union contract provisions. You must meet the minimum qualifications of the class. While serving in this type 17 of service, you are paid at the higher level, but you retain status in your permanent (lower) classification. Benefits such as longevity and vacation accrual are based on the permanent class. Transfers You may voluntarily transfer within the agency or to another state agency. To place your name on a Statewide Transfer list, for your current job class in which you hold permanent status, please visit the DAS Website, Freenames - Department of Administrative Services (jobapscloud.com), scroll down and follow the process of Statewide Transfers. If your job classification is unique to the agency, your transfer options will be limited to those classes deemed comparable to the one in which you have permanent status. Consult your union contract for more information. If you are interested in transferring to another work location within the agency and meet the eligibility of the job requirements, Human Resources will send emails periodically with transfer opportunities, to be considered you must follow the procedures noted on the email. The agency may involuntarily transfer you under certain circumstances, generally defined in your union contract or state personnel regulations. Transfers occur for a variety of reasons: when the agency seeks to better use its resources, to avoid layoffs, to meet emergency or seasonal conditions, or to accommodate you. If you are an exempt employee, your transfer is subject to state regulations and the State Personnel Act. Dual Employment You may be authorized to work at a secondary agency subject to the dual employment provisions of the regulations for state agencies. For this to occur, the secondary agency must initiate and complete the appropriate paperwork. The secondary agency will forward a copy of the dual employment request form to the primary agency for completion and return. If all provisions are met, subject to any fair labor standards considerations and the operating needs of the department, you may be eligible for secondary employment. Secondary employment may not pose a conflict of interest or interfere with the performance of your job duties and your approved work schedule for the Department of Labor. 18 Personnel Records Personnel Files The agency maintains a digital personnel file containing information about your employment: service ratings; personnel processing forms; appointment, promotion, and disciplinary letters. The agency also maintains a separate, confidential file that contains your medical documents, including doctor’s notes and medical certificates. You may review your digital personnel file by contacting Human Resources. You may sign a waiver to allow another person, such as a union official, to review your files. The agency must comply with written requests for information about its employees under the state freedom-of-information law. If the agency considers an information request to be a possible invasion of your privacy, you will be notified. Change of Personal Data Whenever you change your name, address, number of dependents, telephone number, or marital status, you must promptly notify Payroll so that agency records and files may be updated. You may also need to complete a new federal or state withholding allowance certificate (W-4 or CT W-4), or various health insurance forms. Working Hours The negotiated workweek for most staff members currently averages 40 hours per week. Some union contracts provide for a 35 or 37.5-hour workweek. Many employees work a standard schedule of 8:00 a.m. to 4:30 p.m. The agency has also established nonstandard work schedules, which are approved in advance by the appointing authority in consultation with the Director of Human Resources. Provision for flex time has been included in some contracts. If your position is covered by flex time or other nonstandard workweek, your supervisor will explain its operation. The Payroll Unit will maintain your attendance record. From time to time and consistent with the terms of the applicable collective bargaining agreement, it may be necessary to temporarily or permanently change your work schedule to meet operational needs. In such a situation you will be given as much notice as possible, at a minimum that is required by your union contract. Regardless of your work schedule, you are expected to arrive at work on time, return from lunch and breaks on time, and not leave your job prior to quitting time. 19 Meal & Break Periods Full-time employees are permitted two 15-minute breaks and a 30-minute unpaid meal period. Longer unpaid meal periods are allowed with supervisory approval. The schedule for all meal and break periods is determined by your supervisor based on business operations and staffing needs. Your supervisor will inform you of your schedule and any required changes. Employees are not permitted to work through lunch to leave early. Breaks do not accumulate, nor may they be used to start late or leave early. Overtime & Compensatory Time Overtime occurs when you work in excess of your regular established weekly schedule. Overtime assignments must be approved in advance, except in extreme emergencies. The Fair Labor Standards Act (FLSA), state statutes and regulations, and your union contract govern your eligibility for overtime and the rate of compensation. Compensatory time is a form of accrued leave time that may be used later; it does not constitute a basis for additional compensation. Compensatory time must be taken in accordance with the provisions of your contract and agency policy. The FLSA may conflict with your union contract regarding compensation for overtime. Generally, you will be paid by the method that provides the greater benefit. Hours worked in excess of 40 in one week are generally compensated at the rate of time-and-one half. The time-and-one-half rate is derived from your basic hourly wage rate. Some employees may be ineligible for the overtime provisions of FLSA. Questions may be directed to Payroll. Shift Assignments Some areas engage in multi-shift operations. Depending on the starting and ending times of your shift and union contract, you may be eligible for shift-differential payments. These usually take the form of additional pay for the hours worked on your assigned shift. Generally, any shift that begins before 6:00 a.m. or after 2:00 p.m. is subject to shift-differential payments. Some employees may not be eligible for these payments, even when assigned to such a shift. Consult your union contract for information regarding eligibility for the shift and weekend differentials, and the applicable pay rate. Attendance You are responsible for maintaining a good attendance record. Frequent absenteeism reduces the level of your service to the agency and the public, increases operational costs, and places a burden on your co-workers. Use your accrued leave in accordance with agency policies and procedures and ensure that you comply with Employee Dependability Policy requirements. You should request leave time as far in advance as possible. Refer to your union contract for additional guidelines. Agency operating needs, the reasonableness of the request, and the specific language contained in the union contract govern the approval or denial of your leave request. Whenever possible, avoid unscheduled leave. 20 Paid Leave Time Holidays The state grants 13 paid holidays per year to permanent, full-time employees: New Year’s Day, Martin Luther King’s Birthday, Lincoln’s Birthday, Washington’s Birthday, Good Friday, Memorial Day, Juneteenth Day, Independence Day, Labor Day, Columbus Day, Veterans’ Day, Thanksgiving Day and Christmas Day. Intermittent and durational employees must work the equivalent of six months (1044 hours) to be eligible for holiday pay. If a holiday falls on a Saturday or Sunday, the state generally designates the Friday preceding or the Monday following as the day it will be observed. A calendar detailing the exact day of holiday observance appears on the Human Resources intranet site. You will be paid for a holiday if you are on the payroll on or immediately before or after the day it is celebrated; you normally will not receive holiday pay if on a leave of absence without pay before and after a scheduled holiday. Consult your union contract for information about compensation for work performed on a state holiday. Sick Leave As a permanent employee, you accrue sick leave from your date of employment for each fully completed calendar month of service, except as otherwise provided in the statutes. You must use sick leave when incapacitated or in the special cases described in your union contract. Upon exhaustion of sick leave, you must use other accrued leave in lieu of sick leave unless FMLA rules dictate otherwise. If an employee is sick while on annual vacation leave, the time will be charged against accrued sick leave if supported by a properly completed medical certificate. Sick leave is not an extension of vacation or personal leave. You should maintain a sick leave balance as a form of insurance in the event of a long-term illness. Accrual. Full-time employees accrue paid sick leave at the rate of 1¼ days per completed month of service or 15 days per year. If you are absent without pay for more than forty hours in any month, you do not accrue sick leave in that month. If you are an eligible part-time employee, you accrue paid sick leave on a pro-rated basis or on the amount of your scheduled hours as a percentage of a full-time schedule. Balances. Payroll records your sick leave balance (time accrued but not used) in hours and minutes. When you retire, the state will compensate you for 25 percent of your accrued sick leave balance (to a maximum of 60 days). Call-In Procedure. If you are unexpectedly absent as a result of injury or illness, you must notify your supervisor or designee as early as possible, but no later than one-half hour before your scheduled reporting time. If your absence is continuous or lengthy and you have not been granted a medical leave 21 of absence, you must notify your supervisor on a daily basis. If you fail to call in, you may be placed on unauthorized leave without pay and subject to corrective action. Medical Documentation. Your physician must complete a medical certificate if you are absent as the result of injury or illness for more than five working days or as otherwise outlined in your union contract or state personnel regulations. If you fail to provide the required medical documentation, you may be placed on unauthorized leave, which can lead to loss of pay and disciplinary action. Medical certification forms should be emailed directly to DAS.BenefitsandLeavesPod4@ct.gov. Any questions must be sent directly to DAS.BenefitsandLeavesPod4@ct.gov. Additional Use of Sick Leave. You may use sick leave for situations other than your own injury or illness (a medical certificate or written statement supporting a request may be required): • • • • • Medical, dental or optical examination or treatment when arrangements cannot be made outside working hours. Death in your immediate family. Illness or injury to a member of your immediate family. Funeral for a person other than an immediate family member. Birth, adoption or taking custody of a child. To determine the exact number of days allowed, refer to your union contract. Extended Illness or Recuperation. If you exhaust your accrued sick leave during a prolonged illness or injury, you may be permitted to use other accrued time. You must obtain approval from your immediate supervisor for use of other accrued leave to cover the remainder of the absence. In certain circumstances, you may be granted an advance of sick leave if you have at least five years of full-time state service. Consult your union contract for information regarding the sick leave bank or donation of leave time. If an employee has no accrued leave time available, a written request for a medical leave without pay must be submitted to DAS.BenefitsandLeavesPod4@ct.gov, and the request must be followed up in writing upon return to work. Failure to do so will result in charging the absence to Sick Leave Without Pay. Illness or Injury While on Vacation. If you become ill or injured while on vacation, you may request that the recovery time be charged to your sick leave rather than to your vacation leave. A medical certificate or documentation support your request will be required. Vacation Leave Usage. As a full-time employee, you may begin taking paid vacation leave after six months of continuous service. Unless otherwise stated in a union contract, a part-time employee may begin taking paid vacation after completing the equivalent of six months of full-time service (1044 hours). Requests for vacation leave are subject to the approval of your supervisor, based on the operating needs of the unit and the seniority provisions of your contract. 22 Accrual. You accrue vacation leave at the end of each full calendar month of service. Absence without pay for more than five days (equivalent to 40 hours) in a month result in the loss of accrual for that month. You accrue vacation leave at the following rate for each completed month of service (prorated, if part-time): • • • 0-5 years of service: 1 day per month (12 days per year). 5-20 years: 1-1/4 days per month (15 days per year). 20 or more years: 1-2/3 days per month (20 days per year) As a manager and confidential employees excluded from collective bargaining, you accrue vacation leave at the rate of 1-1/4 days per completed month of service or 15 days per year. After completing 10 years of service, on January 1 of each subsequent year you will receive the following number of days in addition to the normal accrual: • • • • • 11 years of service: 1 additional day 12 years: 2 additional days 13 years: 3 additional days 14 years: 4 additional days 15 or more years: 5 additional days Balances. Payroll will record your vacation leave balance in hours and minutes. Without agency permission, you cannot carry more than 10 days of accrued vacation leave from one year to the next if you are a nonexempt employee. If you are a nonexempt employee, refer to your bargaining union contract regarding your maximum accrual. If you are a nonexempt employee or a manager, you may accumulate as many as 120 days of vacation time. When separated from state service, if a permanent employee, you will receive a lump-sum payment for your vacation leave balance. Personal Leave As a full-time employee who has attained permanent status, you are credited with three days of personal leave to conduct private affairs, including the observance of religious holidays. On January 1 of each year thereafter, three days of personal leave will be credited to your leave balance. You must request authorization in advance from your supervisor to use personal leave. Personal leave must be used prior to the end of the calendar year or it will be forfeited. You are responsible for monitoring your time charges to ensure that your personal leave is used within the calendar year. Part-time employees generally are entitled to prorated personal leave; consult your union contract for the specifics. Payroll will maintain your balance. Jury Duty If you are summoned for jury duty, you will not lose your regular salary or benefits. You must notify your supervisor immediately and supply the jury notice; your supervisor will forward it along with the reason for your absence to the Payroll Unit. The court will supply you with verification of your attendance; which is then submitted through your supervisor to Payroll. You must return to work 23 whenever not actively serving on jury duty. With the exception of travel allowances, you must return the money received for jury duty to Payroll. Military Leave If you are a member of the National Guard or a reserve component of the U.S. armed forces and a permanent employee, you may apply for leave to attend required training. To verify the leave, you must submit a copy of your military orders to DAS.BenefitsandLeavesPod5@ct.gov or fax to 860-622-4928. The state permits as many as three weeks in a calendar year for field training. Paid leave for military call-ups other than annual training is limited to unscheduled emergencies, subject to the provisions of your union contract. Notify your supervisor as soon as you become aware of your military leave schedule. 24 Leave Without Pay Leave of Absence Without Pay (LAW) Depending on the terms of your union contract, you may be granted a LAW without endangering your status as a state employee. Your benefits, however, may be affected. You will not accrue vacation or sick leave in any month on a LAW for more than five working days (hourly equivalent of) without pay, and service credit toward retirement, seniority and longevity may be suspended. If you are on a LAW for pregnancy, illness, injury, or an FMLA-qualifying reason, the state will continue to pay the same portion of your health insurance as while you were working. You will, however, be billed directly for the amount that you previously paid through payroll deduction. If on a LAW for another reason, you will be billed for the full cost of medical coverage. If possible, submit your LAW request to DAS.BenefitsandLeavesPod4@ct.gov in advance and in writing with appropriate documentation. Your manager may grant a LAW for as many as five consecutive days. A LAW of longer than five days must be authorized by the Benefits and Leaves Pod before the leave, except in extraordinary situations such as emergency medical leave. You may be granted a LAW for a variety of purposes on a position-held or not-held basis. Your LAW must be consistent with the requirements in your union contract or state regulations if you are an exempt employee. If your position is held, you may resume employment on the expiration of the LAW. You must be cleared by a physician to return to normal duties if you are on a medical LAW. This needs to be done before you return to work. If your position is not held, your return to active service depends on the availability of a position. The agency will consider the reason for your request, your work record and agency operating needs when deciding whether to grant you a LAW and to hold your position. Maternity Leave If pregnant, you must use accrued sick leave to cover time before, during or after your delivery when a physician certifies you as “unable to perform the requirements of your job.” You must send a Medical Certificate - P33A to DAS.BenefitsandLeavesPod4@ct.gov to substantiate your disability. When your disability period ends or you have exhausted your sick leave balance prior to the end of your disability period, you may request to use accrued vacation and personal leave. When all your paid leave has been used, you may request a LAW with your position held. Refer to your union contract and the FMLA Policy for further information. Medical Leave You must use accrued sick leave to cover the time which you are unable to work because of illness. If that period extends beyond five days, you will need to supply a Medical Certificate - P33A to DAS.BenefitsandLeavesPod4@ct.gov to substantiate your use of sick time to. When your sick leave balance is exhausted, you must apply vacation or personal leave to cover your absence unless FMLA rules dictate otherwise. Your union contract may contain provisions for advance of sick leave, a sick leave bank, and donation of leave time in cases of prolonged illness. You may also request a leave of absence without pay. Details on the requirements and provisions of such leaves are in your union contract and the FMLA policy. 25 Family Leave You may request a LAW for the birth or adoption of a child; the serious illness or health condition of a child, spouse or parent; your own serious health condition; the placement of a foster child in your care and certain other conditions. A medical certificate must be submitted by email to DAS.BenefitsandLeavesPod4@ct.gov to substantiate a request for leave under the Family and Medical Leave Act (FMLA). You must request forms by sending an email to DAS.BenefitsandLeavesPod4@ct.gov. 26 SALARY Payment Your job classification determines your salary grade. Classifications are assigned to a salary group based on the amount and type of required experience and training, technical complexity, difficulty and level of responsibility. The state establishes a number of steps for salary groups other than managerial and confidential classes. As a new employee, you will generally start at the salary range minimum for your job classification. Payday The state issues salary payments bi-weekly through a checkless system called e-pay. You will receive payment for the work you performed during the previous two weeks. The delay allows for processing. If you are a new employee, you should receive your first salary payment four weeks after your first workday. If you separate from state service, you will receive your last salary payment two weeks following the end of the last pay period worked. Earnings, itemized deductions and leave accruals are viewable online. Questions should be directed to Payroll. Annual Increments Annual increments are based on the terms of your union contract. You may be raised to the next higher step in a salary group on your anniversary date. Consult your union contract for details. If an appointed official or manager, you may be awarded an increase by the governor, usually effective on January 1. The amount of the increase will be based on your goal attainment and performance under PARS, the Performance Appraisal and Recognition System for managers. Collective Bargaining & Cost-of-Living Increases If you are a union member, your increase will result from the collective bargaining process. An increase generally will be calculated as an across-the-board percentage within a negotiated salary structure and payable in July. If you are an appointed official or a manager, the governor may award you a cost-ofliving increase, usually a percentage of your annual salary, also payable in July. When promoted, you will normally receive a salary increase of at least one full step in the salary group, unless you are placed at the maximum step. If promoted to a managerial position, you will receive an increase of five percent or the minimum of the new salary range, whichever is greater. Longevity Pay Employees hired on or after July 1, 2011, shall not be entitled to a longevity payment however, any individual hired on or after said date who shall have military service which would count toward longevity under current rules shall be entitled to longevity if they obtain the requisite service in the future. Employees hired prior to July 1, 2011, are eligible for longevity. For those eligible employees, when you complete the equivalent of 10 years of full-time state service (generally continuous) you will receive a longevity payment. The amount of longevity payment increases when you complete 15, 20, and 25 year years of service. Longevity schedules appear in your union contract and other pay plans. To qualify, you must attain the required years of service by April1 or October 1. Longevity payment are also paid 27 in these months. Employees not included in any collective bargaining unit are no longer eligible for longevity payments. 28 DEDUCTIONS Federal Income Tax & Social Security Tax Federal income and Social Security taxes will be deducted from your paycheck in accordance with federal law. Connecticut Income Tax State income tax will be deducted from your paycheck in accordance with state law. Health Insurance Health insurance coverage for eligible employees who choose to enroll in the state’s health benefit plan will be effective the first of the month immediately following the employee’s hire date or date of eligibility. For example, if you were hired on November 9, you must submit your application within thirty days; your effective date of coverage would be December 1. You may extend health and dental coverage to cover your spouse, dependent children under age 26, and/or disabled children over age 26. Please contact Payroll for enrollment eligibility. Refer to the Office of State Comptroller’s website for a summary of health insurance options and rates. You must remain with your insurance carrier until the next open enrollment period, the one time a year when you can change carriers. You may add a dependent newborn or spouse within one month of the birth or marriage (please note if adding a new spouse, a marriage certificate is required); other dependent changes generally are restricted to the open enrollment period. If your spouse’s insurance was terminated through his/her employer, you may be eligible to add them as a special exception. A letter from the employer stating insurance has been cancelled will be required. All additions, deletions, or other changes must be processed through the Payroll Unit. You must provide documentation of each dependent’s eligibility status at the time of enrollment. It is your responsibility to notify the Payroll Unit when any dependent is no longer eligible for coverage. Group Life Insurance You may purchase term life insurance at group rates. The state pays a portion of this coverage. You may authorize payroll deductions for this insurance after six months of employment. If you waive coverage and later decide to enroll, you must apply with medical evidence of insurability and wait for approval. The amount of life insurance coverage is based on your annual salary and is automatically adjusted on April 1 and October 1 as your salary increases. Contact the Payroll Unit to obtain forms or arrange for beneficiary changes. You may visit the Office of State Comptroller’s website (https://carecompass.ct.gov/supplementalbenefits/) for more information. Supplemental Benefits The state offers various supplemental benefits to qualified employees and retirees, which are designed to complement the benefits provided by the state. These benefits are on a voluntary basis and are paid entirely by the employee through the convenience of payroll deduction. Available supplemental benefits 29 are listed on the OSC website Supplemental Benefits - Care Compass (ct.gov). Contact the authorized vendors for information and assistance with the enrollment process. Direct Deposit You may deposit your paycheck in a checking or savings account in a financial institution that is a member of the automated clearinghouse. Your funds will be electronically transmitted and available to you after 9:00 a.m. on the date of the check. You must complete an authorization form to adjust or cancel direct deposit. Authorization forms can be obtained from Payroll. Deferred Compensation Permanent employees who work more than 20 hours a week are eligible for the state’s deferred compensation plan. Through payroll deduction, you may set aside a portion of your taxable wages (prior to tax deferrals). The minimum contribution is $20 per pay period. Obtain details by contacting the plan administrator. State Employees Campaign Through the state employee campaign, you may contribute to your choice of a range of service organizations via payroll deduction. Union Dues As a member of a collective bargaining unit, you may elect to join the union and have union dues deducted from your check. Your union determines the amount by using a set-rate or sliding-scale formula based on the amount of your salary. Credit Unions As an agency employee, you may join the, CT Labor Department Federal Credit Union, 200 Folly Brook Blvd., Wethersfield, CT 06109 (telephone 860-263-6500). As a State of Connecticut employee, you may also join the CT State Employees Credit Union. Offices are as follow: 84 Wadsworth Street Hartford, CT 06106 860-522-5388 1244 Storrs Road Storrs, CT 06268 860-429-9306 2434 Berlin Turnpike Newington, CT 06111 860-667-7668 401 West Thames Street Southbury Training School Norwich, CT 06360 Southbury, CT 06488 860-889-7378 203-267-7610 1666 Litchfield Turnpike Woodbridge, CT 06525 203-397-2949 Silver & Holmes Street Middletown, CT 06457 860-347-0479 30 Retirement Tiers The state and collective bargaining units negotiate the pension agreement. The retirement system includes five plans: Tier I, II, IIA, III and IV. For details, contact Office of the State Comptroller’s at osc.crsp@ct.gov or consult the specific retirement booklet for which you are a member. Online copies are available at the OSC website Retiree Resources (ct.gov). Tier I. Usually, you are member of this retirement plan if you were hired on or before July 1, 1984 and contribute by payroll deduction to your pension. You may retire at age 55 with 25 years of service, or at age 65 with 10 years of service, or retire early at age 55 with 10 years of service – at a reduced rate. This tier is divided into three plans. Members of Plans A and C contribute five percent of salary toward retirement. Members of Plan A have chosen not to participate in the Social Security plan; Plan C members pay Social Security taxes and are eligible for Social Security benefits. Plan B members contribute two percent of salary toward retirement until they reach the Social Security maximum, and five percent of salary above the maximum; they will receive reduced pensions when Social Security payments begin. You also may purchase periods of service for which you have not made contributions: war service, prior state service, and leaves of absence for medical reasons. Tier II. If you were hired into state service from July 2, 1984 to June 30, 1997, you are automatically covered under this noncontributing plan. If you were employed by the state on or before July 1, 1984, and were not a member of any other state retirement plan, the Tier II plan also covers you. You contribute two percent of your salary towards retirement. You are eligible for normal retirement benefits after you attain: (1) age 60 with at least 25 years of vesting service; (2) age 62 with at least 10, but less than 25 years of vesting service; or (3) age 62 with at least five years of actual state service. If you have at least 10 years of service, you can receive retirement benefits – at a reduced rate – if you retire on the first day of any month following your 55th birthday. Retirements on or after July 1, 2022 are subject to the age and years of service specified in the SEBAC 2011 agreement. Tier IIA. If you entered state service from July 1, 1997 to June 30, 2011, you are covered under this plan as of the date of your employment. You contribute two percent of your salary towards retirement have the same options and benefits as a Tier II employee. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. You also may purchase periods of service for which you have not made contributions: war service and leaves of absence for medical reasons. Tier III. This plan covers employees hired on or after July 1, 2011 to July 30, 2017. As a Tier III member, you contribute two percent of your total annual salary. Your normal retirement date is the first of any month on or after you reach age 63 if you have at least 25 years of service, or age 65 with at least 10, but less than 25 years of service. If you have 10 years of vesting service, you can receive early retirement benefits on the first of any month following your 58th birthday. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. 31 Tier IV. This plan covers employees hired on or after July 31, 2017. The Tier IV retirement plan provides elements of both a defined benefit and defined contribution plan. Defined Benefits – Participants that satisfy the minimum eligibility criteria will qualify for a pre-defined monthly retirement income for life, with the amount being determined by years of service, retirement age and Final Average Earnings. You contribute 7% of your annual salary (this rate is for fiscal year July 2023 through June 2024). Defined Contribution – You contribute 1% to a defined contribution plan with a 1% employer match. This plan also has a risk sharing component wherein for any given year the employee contribution can be up to 2% higher depending on the plan’s performance for the previous year. This contribution will be computed by the plan’s actuaries. (You may also contribute to a 457 plan). For additional information please see the State Comptroller’s Retirement Resources website . Please note: If you were a former state employee who contributed to a different state retirement plan, please contact Payroll 860-263-6195 or dol.payroll@ct.gov to see if you qualify to be placed into a different retirement plan. 32 Separation Resignation The personnel regulation on resignation reads: “An employee in the classified service who wishes to voluntarily separate from state service in good standing shall give the appointing authority at least two working weeks written notice of resignation, except that the appointing authority may require as much notification as four weeks if the employee occupies a professional or supervisory position.” If you resign, your written notice must include your last day of work and be submitted to your supervisor at least two weeks before you leave. You will receive a lump-sum payment for unused vacation time if you are a permanent employee. You may arrange to continue your health insurance benefits at the COBRA rate for a specific period of time. Contact Payroll for details on the length of coverage and payment amount. If you are not eligible for any retirement benefits when you leave state service, you may withdraw your retirement contributions. If you do not return to state service within five years and have not withdrawn your contributions, the Retirement Division will send you a refund application. After you complete the form and return it, you will receive your contributions plus interest. If the Retirement Division cannot locate you within 10 years after your employment ends, your contributions will become part of the retirement fund. If you submit your resignation less than two weeks before leaving, your separation may be regarded as not in good standing and may affect your re-employment rights. An unauthorized absence of five or more working days also will be considered as a resignation not in good standing. You will be notified if your resignation is considered as not in good standing and you may file an appeal with the Commissioner of the Department of Administrative Services. Layoff The state defines a layoff as an involuntary, non-disciplinary separation from state service resulting from a lack of work, program cutback or other economic necessity. Consult your union contract for particulars. If you are an exempt employee, consult Sec. 5-241 of the Connecticut General Statutes. Reemployment Rights In an effort to deliver services in a contemporary and cost effective fashion, the State of Connecticut uses a module called Freenames through the Online Employment Center (JobAps) as a platform for processing the following: • • • Mandatory rights for eligible individuals (reemployment/SEBAC/other mandatory rights) Statewide Transfer requests (non-mandatory transfers) Rescind of Resignation or Retirement requests This section applies to: Current or former State Employees who have been affected by the following: • • • Layoffs Noticed for layoff Accepted a demotion in lieu of layoff 33 • • • • • • Notified of eligibility for mandatory rights Recently failed a working test period and has permanent classified status Exercising rights to return to the classified service from the unclassified service Recently separated NP-2 employee with Article 39 Rights Current employees who request to place their names on a Statewide Transfer list Former employees who request to rescind their resignation in good standing or voluntary retirement. If you retire from state service, you are eligible for temporary employment in any class in which you had permanent status. As a re-employed retiree, you may work as many as 120 days per calendar year (bases on 40 hours per week prior to retirement) without adversely affecting your pension. Such appointments are totally at the discretion of the agency. Rescind of Resignation or Retirement If you have permanent status and resign in good standing, you may, within one year of the date of your separation, request to rescind your resignation by completing the Rescind Resignation request via the JobAps, Freenames Application within one year from date of resignation. This will enable you to be considered for any classes in which you had permanent status. Reinstatement is strictly voluntary on the part of the Agency and may occur at any time up to two years from the date of your separation. Former employees shall be fully independent in and responsible for conducting their own search for reinstatement by requesting rescind privileges via the JobAps, Freenames Application. Use the rescind of resignation or retirement option to request to rescind a resignation in good standing, or a retirement from state service in accordance with DAS General Letter 177. Note: There are no reemployment rights associated with a rescind of resignation. The State of Connecticut is not required to rehire individuals who rescind resignation. Rather, certain privileges may be granted depending on the job class and effective date of rehire. Requirements A former State employee must meet the following conditions: • Attained permanent status as a State employee • Separated from state service in good standing from a position in the Classified service or a bargaining unit position in the Unclassified service • You must know the job class you resigned or retired from. To locate this information, contact your former Human Resources Representative or refer to your last paycheck as an active employee. • You must include each job code matching your last held title including different hourly equivalent. For example: 7603EU= Information Technology Analyst 1 (35 hours) 7603FD= Information Technology Analyst 1 (40 hours) DAS will conduct a review and approve or deny all rescind requests for any or all job classes identified. Applicants will be notified of the status of their requests via email. Please be sure to keep your contact information updated and check your email and spam folders often as most communication will occur via email. 34 For detailed instructions to request to rescind a resignation in good standing or retirement, refer to Instructions Rescind Resignation or Retirement. Exit Interview Below you will find the link and QR code to access a confidential exit interview survey. Thank you for taking the time to engage in the exit interview process. This survey will only take approximately three minutes to complete. The information collected will help us evaluate factors like pay, benefits, work environment, and your overall work experience. All your answers are confidential, so please be candid with your responses. The information collected will help us to identify any potential areas where we can implement new strategies to increase the satisfaction of our workforce. Thank you again for your time and atention. Link to survey: Confidential Exit Survey State of Connecticut - DAS (office.com) QR code: 35 Retirement Retirement Types State employees are members of one of several retirement programs. Once an employee has completed the required actual or vesting service required by the retirement system, he/she is eligible for a pension. Retirements are effective on the first of the month following the last working day of the previous month. For retirement purposes, an employee who is on prolonged sick leave will retire the first of the month following the last working day that sick leave was used in the previous month (a medical certificate is required) and may qualify for a disability retirement. Types of retirement include, Normal, Early, Hazardous Duty or Disability. If you plan to retire you must send your Notice of Intent to Retire and Retirement Information Form via fax to 860-622-4928 or via email to DAS.BenefitsandLeavesPod5@ct.gov. Please refer to the Plan Summary which can be found on the Office of the State Comptroller’s website at Retiree Resources (ct.gov). Regardless of the type of separation from service; on the last day of work, the terminating employee must return State property to her or his supervisor. Pension Payment Options Option A - 50% Spouse: This option will pay you a reduced benefit for your lifetime in exchange for the protection that, should you pre-decease your spouse, the state will continue to pay 50% of your reduced benefit for your spouse's lifetime. Option B - 50% or 100% Contingent Annuitant: This option provides you a reduced monthly benefit for your life and allows you to guarantee lifetime payments after your death to a selected beneficiary. After your death, a percentage of your reduced benefit, either 50% or 100%, whichever you choose, will continue for your beneficiary’s life. Option C - 10 Year or 20 Year Period Certain: This option provides you a reduced monthly benefit for your lifetime in exchange for the guarantee that monthly benefits will be paid for at least 10 or 20 years from your retirement date (whichever you choose). Option D - Straight Life Annuity: This option pays you the maximum monthly benefit for your lifetime only. All benefits will end upon your death, including state-sponsored health insurance for any surviving eligible dependents. Insurance Benefits You must meet age and minimum service requirements to be eligible for retiree health coverage. Service requirements vary. For more about eligibility for retiree health benefits, contact the Retiree Health Insurance Unit at 860-702-3533. Regardless of the retirement option you choose, you will receive a monthly pension for the rest of your life, and, if you qualify for health insurance benefits, coverage will extend to your eligible dependents. Once you or your dependents become eligible for Medicare, this is your primary medical plan provider and the state plan is supplementary. 36 If you retire with at least 25 years of service and have state-sponsored life insurance, the state will pay for 50 percent of the amount of coverage (at least $7,500) as when employed. If you retire with less than 25 years of service, the state will pay a prorated amount. The Group Life Insurance Section of the Retirement Division will contact you following your retirement concerning conversion options. Disability retirement and pre-retirement death benefits are a part of your pension agreement. Pensions also are subject to cost-of-living increases as outlined in the agreement. For further information regarding retirement benefits call or email: Office of the State Comptroller Retirement Division 165 Capitol Avenue Hartford, CT 06106 Telephone: (860) 702-3490 Email: osc.rsd@ct.gov 37 TRAINING & DEVELOPMENT In-Service Training You may apply for Department of Administrative Services in-service training courses. Courses should be relevant to your position or career mobility, or to your unit’s operational needs. They are generally held during regular work hours in the spring and fall. Supervisor approval is required. For information, contact Employee and Organizational Development. Management Development Courses A calendar of courses focusing on leadership, supervisory and management development, strategic planning, customer service skills and total quality management techniques is distributed twice a year. Contact Employee and Organizational Development for particulars. Tuition Reimbursement You may seek tuition reimbursement from the state for courses taken during non-working hours at colleges, universities, technical schools or other accredited educational institutions. You do not need supervisory approval. Eligibility and funding provisions are outlined in your union contract if you are a bargaining unit employee. As a non-exempt employee, you may be reimbursed for a non-credited course through your union. Convert course hours to credits. For example, 6-14 hours equal one credit for tuition reimbursement; 15-29 hours, two credits; and 30-44, three credits. As a manager, you are eligible for tuition reimbursement from the State Management Advisory Council or agency funds. As a non-managerial confidential employee, you may apply for reimbursement in accordance with the union contract that would have included your job classification had your class not been excluded. For a fall semester class, you must document by Feb. 1 that you paid for a course and passed it, and by June 1 for a spring semester class. Forms and assistance are available through Employee and Organizational Development. You must submit your application to that unit at Central Office, 200 Folly Brook Blvd., Wethersfield, CT 061091114, at least two weeks before the start of a class. Conferences, Workshops & Seminars Your union contract may pay costs associated with conferences, workshops or seminars such as registration fees, travel expenses and meals. You must receive supervisory approval before processing a payment request. Consult you union contract for details. 38 EMPLOYMENT POLICIES (Ctrl + Click to follow links below) Acceptable Use of State Systems Policy - Statewide (2019) ADA Reasonable Accommodation Policy Affirmative Action Policy Statement – DOL (2023) AIDS Policy – DOL (7/16/2012) Background Check Policy and Procedures – DOL (10/31/2022) Disposition of Public Records Policy – DOL (11/28/2011) Discrimination and Illegal Harassment Prevention Policy – DOL (April 2023) Drug Free Workplace State Policy – DOL (7/16/2012) Employee Conduct Policy – DOL (8/3/2018) Employee Dependability Policy – DOL (7/16/2012) Employee Discipline Policy – DOL (7/16/2012) Ethical Conduct Policy – DOL (8/2013) Family Violence Leave Policy – Statewide GL 34 (1/2022) Federal Family & Medical Leave Act – DOL (7/16/2012) Health and Safety Policy – DOL (7/16/2012) Internal Discrimination Complaint Procedure – DOL (4/18/2023) Internal Security Standards - DOL Office Automation Policy, Standards and Guidelines – DOL (7/16/2012) Personal Wireless Device Policy (Rev. 9/9/2020) Phone Use Policy (Rev. 4/23/2023) Policy for DOL Facility Occupancy – DOL (7/9/2020) Professional Image Policy – DOL (3/1/2023) Prohibition of Weapons in DOL Worksites Policy – DOL (8/10/16) Public Officials and State Employees Guide to the Code of Ethics - Statewide 07/16/2012 Software Anti-Piracy Policy – DOL (7/16/2012) Vehicle-Use-for-State-Business-Policy--DAS-General-Letter-115--April-1-2012.pdf (ct.gov) Violence in the Workplace Prevention – DOL (4/2012) Workers Compensation Rights Responsibilities and Claims (ct.gov) Workplace Incident Report and Footprints Instructions – DOL (2015) **Please refer to online Employee Handbook for link activation. 39 ",Unknown,Explanation/Definition,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","My daughter was recently diagnosed with hyperhidrosis. What are the signs and symptoms of this? I'm also looking to know what causes this, including any underlying medical conditions. Are there any medications that can help with the excessive sweating? Her doctor wants to run some tests and I was wondering what some of those might be. Is this a common ailment?","Hyperhidrosis is excessive sweating. This condition happens when you sweat more than what your body needs to regulate your temperature. You may experience sweating when you’re at rest, in cold temperatures or randomly at times when you wouldn’t expect to sweat. There are two types of hyperhidrosis: Primary focal hyperhidrosis: Focal hyperhidrosis is a chronic skin condition. A genetic change (mutation) causes this condition. You can inherit it from your biological family. This is the most common type of hyperhidrosis. It usually affects your armpits, hands, feet and face. It tends to start before age 25. Secondary generalized hyperhidrosis: Generalized hyperhidrosis is excessive sweating caused by an underlying medical condition or it’s a side effect of a medication. Some examples include diabetes and Parkinson’s disease and medications, such as naproxen (Aleve®). Generalized hyperhidrosis may cause you to sweat while sleeping. How common is hyperhidrosis? Hyperhidrosis is common. Research suggests that an estimated 3% of adults in the United States between ages 20 and 60 have hyperhidrosis. What are the symptoms of hyperhidrosis? The main symptom of hyperhidrosis is sweating. When you sweat, you may feel: Wetness on your skin. Damp clothing. Beads of fluid dripping from your cheeks or forehead. Over time, hyperhidrosis can lead to the following symptoms: Itching and inflammation when sweat irritates your skin. Body odor, which occurs when bacteria on your skin mixes with sweat particles. Cracked or peeling skin on your feet. Hyperhidrosis symptoms can range in severity. You may have minor symptoms that come and go or you may have constant symptoms that have an impact on your day-to-day activities. Sweat comes from eccrine glands, which exist in the skin throughout your body. You have the most eccrine glands in your: Armpits or underarms (axillary hyperhidrosis). Soles of your feet (plantar hyperhidrosis). Palms of your hands (palmar hyperhidrosis). Forehead and cheeks (craniofacial hyperhidrosis). Genitals. Lower back. The most common location on your body to experience excessive sweating is the palms of your hands. What causes hyperhidrosis? Overactive sweat glands cause hyperhidrosis. Your eccrine glands (sweat glands) create sweat to cool down your body when you get hot. This process activates when you exercise or if you’re nervous. If you have hyperhidrosis, your eccrine glands activate and produce sweat more often than when your body is too hot. You may experience sweating at random times of the day when there isn’t something like an activity or emotion causing your glands to produce sweat. Research is ongoing to learn more about why your glands make too much sweat. Your body produces sweat to cool it down and prevent overheating. There may be certain triggers in your environment that can cause your sweat glands to produce more sweat including: Certain emotions like stress, anxiety, fear or nervousness. Warm temperatures or humidity. Exercise or physical activity. Certain foods and beverages, like spicy foods, fatty foods, sugary and salty foods, and foods with high levels of protein. Beverage examples include caffeinated beverages (coffee) and alcohol. Medications that cause sweating Certain medications can cause sweating as a side effect, including but not limited to: Albuterol (Proventil®). Bupropion (Wellbutrin®). Hydrocodone. Insulin (Humulin® R, Novolin® R). Levothyroxine. Lisinopril. Naproxen (Aleve®). Omeprazole (Prilosec®). Sertraline (Zoloft®). Hyperhidrosis (generalized) could be a sign of an underlying medical condition including but not limited to: Acromegaly. An infection (tuberculosis). Anxiety. Cancer. Diabetes. Heart disease or heart failure. Hyperthyroidism. Menopause. Obesity. Parkinson’s disease. Does hyperhidrosis run in families? Yes, you may be more at risk of hyperhidrosis, specifically focal hyperhidrosis, if someone in your biological family has the condition. Research indicates that a hereditary genetic mutation or change to your DNA could cause hyperhidrosis. Hyperhidrosis can cause complications that include: A skin infection. Skin changes, such as paleness, discoloration, cracks or wrinkles. Maceration, or unusually soft, moist skin. Hyperhidrosis can also impact your mental health. You may find yourself changing your routine to hide your symptoms from others. Constant sweating may be so severe that you avoid common actions, such as lifting your arms or shaking hands. You may even give up activities you enjoy to avoid problems or embarrassment from excessive sweating. Contact a healthcare provider if hyperhidrosis affects your mental health and social well-being. Diagnosis and Tests How is hyperhidrosis diagnosed? A healthcare provider will diagnose hyperhidrosis after a physical exam and learning more about your symptoms and medical history. They’ll evaluate your symptoms using diagnostic criteria. If you experienced excessive sweating for at least six months and answered yes to at least two of the following questions, it may lead to a hyperhidrosis diagnosis: Sweating occurs on your underarms, palms, soles or face. You sweat the same on both sides of your body. You don’t sweat at night or sweat less at night. An episode of sweating lasts for at least one week. You have a history of hyperhidrosis in your biological family. Sweating interferes with your ability to do certain activities. You’re younger than 25 years old. What tests diagnose hyperhidrosis? A healthcare provider may use one of the following tests to determine the cause of hyperhidrosis: Starch-iodine test: Your provider applies an iodine solution to the sweaty area and sprinkles starch over the iodine solution. In places where you have excess sweating, the solution turns dark blue. Paper test: Your provider places special paper on the affected area to absorb sweat. Later, your provider weighs the paper to determine how much sweat you have. Blood or imaging tests: These tests can take a sample of your blood or take pictures underneath your skin to help your healthcare provider learn more about what causes your symptoms. Management and Treatment You can manage your symptoms of hyperhidrosis at home by: Using antiperspirants and deodorants. Antiperspirants work by sealing up sweat glands so your body stops producing sweat. A provider may recommend certain over-the-counter (OTC) or prescription-strength varieties. The best deodorant for hyperhidrosis is an aluminum-based product. Showering or bathing more often. Changing your routine, such as showering more often, may improve mild symptoms. Wearing breathable clothing. Choosing clothing that’s breathable and more absorbent, like cotton, can help you feel more comfortable if you sweat. Avoid blended fabrics and polyester, which can trap heat and make you sweat more. Hyperhidrosis medications A healthcare provider or dermatologist may recommend taking medications to reduce your symptoms of hyperhidrosis, including: Anticholinergic agents (glycopyrrolate and oxybutynin). Antidepressants. Beta-blockers. Medicated wipes (glycopyrronium tosylate, Qbrexza®). Aluminum chloride gel. Hyperhidrosis treatment therapies If your symptoms don’t improve with at-home treatment and/or medications, your healthcare provider may recommend more specialized therapies: Iontophoresis: You place your hands or feet in a shallow tub of tap water. A special device emits a low electrical current through the water, blocking sweat glands over time. Each treatment takes 10 to 20 minutes. You may need repeated treatments. Insurance may cover the equipment, enabling you to do the therapy at home. Botulinum toxin (Botox®) injections: Injecting botulinum toxin into an overactive nerve can stop sweat production for months at a time. Repeat treatments are necessary. Microwave therapy: Your provider places a high-tech device (miraDry®) against the affected area of your skin. The device emits thermal energy (heat), which destroys sweat glands permanently. This is an hour-long procedure that takes place in a healthcare provider’s office. Hyperhidrosis surgery Endoscopic thoracic sympathectomy: ETS is a minimally invasive type of surgery where a surgeon will cut a nerve in your body to turn off the signal that tells your glands to produce sweat. Sweat gland removal: A surgeon will remove your sweat glands using a laser, scraping (curettage), cutting (excision) or liposuction. Surgery has the potential to offer lasting benefits for persistent sweating that doesn’t respond to other therapies."," Only use the provided text to answer the question, no outside sources. My daughter was recently diagnosed with hyperhidrosis. What are the signs and symptoms of this? I'm also looking to know what causes this, including any underlying medical conditions. Are there any medications that can help with the excessive sweating? Her doctor wants to run some tests and I was wondering what some of those might be. Is this a common ailment? Hyperhidrosis is excessive sweating. This condition happens when you sweat more than what your body needs to regulate your temperature. You may experience sweating when you’re at rest, in cold temperatures or randomly at times when you wouldn’t expect to sweat. There are two types of hyperhidrosis: Primary focal hyperhidrosis: Focal hyperhidrosis is a chronic skin condition. A genetic change (mutation) causes this condition. You can inherit it from your biological family. This is the most common type of hyperhidrosis. It usually affects your armpits, hands, feet and face. It tends to start before age 25. Secondary generalized hyperhidrosis: Generalized hyperhidrosis is excessive sweating caused by an underlying medical condition or it’s a side effect of a medication. Some examples include diabetes and Parkinson’s disease and medications, such as naproxen (Aleve®). Generalized hyperhidrosis may cause you to sweat while sleeping. How common is hyperhidrosis? Hyperhidrosis is common. Research suggests that an estimated 3% of adults in the United States between ages 20 and 60 have hyperhidrosis. What are the symptoms of hyperhidrosis? The main symptom of hyperhidrosis is sweating. When you sweat, you may feel: Wetness on your skin. Damp clothing. Beads of fluid dripping from your cheeks or forehead. Over time, hyperhidrosis can lead to the following symptoms: Itching and inflammation when sweat irritates your skin. Body odor, which occurs when bacteria on your skin mixes with sweat particles. Cracked or peeling skin on your feet. Hyperhidrosis symptoms can range in severity. You may have minor symptoms that come and go or you may have constant symptoms that have an impact on your day-to-day activities. Sweat comes from eccrine glands, which exist in the skin throughout your body. You have the most eccrine glands in your: Armpits or underarms (axillary hyperhidrosis). Soles of your feet (plantar hyperhidrosis). Palms of your hands (palmar hyperhidrosis). Forehead and cheeks (craniofacial hyperhidrosis). Genitals. Lower back. The most common location on your body to experience excessive sweating is the palms of your hands. What causes hyperhidrosis? Overactive sweat glands cause hyperhidrosis. Your eccrine glands (sweat glands) create sweat to cool down your body when you get hot. This process activates when you exercise or if you’re nervous. If you have hyperhidrosis, your eccrine glands activate and produce sweat more often than when your body is too hot. You may experience sweating at random times of the day when there isn’t something like an activity or emotion causing your glands to produce sweat. Research is ongoing to learn more about why your glands make too much sweat. Your body produces sweat to cool it down and prevent overheating. There may be certain triggers in your environment that can cause your sweat glands to produce more sweat including: Certain emotions like stress, anxiety, fear or nervousness. Warm temperatures or humidity. Exercise or physical activity. Certain foods and beverages, like spicy foods, fatty foods, sugary and salty foods, and foods with high levels of protein. Beverage examples include caffeinated beverages (coffee) and alcohol. Medications that cause sweating Certain medications can cause sweating as a side effect, including but not limited to: Albuterol (Proventil®). Bupropion (Wellbutrin®). Hydrocodone. Insulin (Humulin® R, Novolin® R). Levothyroxine. Lisinopril. Naproxen (Aleve®). Omeprazole (Prilosec®). Sertraline (Zoloft®). Hyperhidrosis (generalized) could be a sign of an underlying medical condition including but not limited to: Acromegaly. An infection (tuberculosis). Anxiety. Cancer. Diabetes. Heart disease or heart failure. Hyperthyroidism. Menopause. Obesity. Parkinson’s disease. Does hyperhidrosis run in families? Yes, you may be more at risk of hyperhidrosis, specifically focal hyperhidrosis, if someone in your biological family has the condition. Research indicates that a hereditary genetic mutation or change to your DNA could cause hyperhidrosis. Hyperhidrosis can cause complications that include: A skin infection. Skin changes, such as paleness, discoloration, cracks or wrinkles. Maceration, or unusually soft, moist skin. Hyperhidrosis can also impact your mental health. You may find yourself changing your routine to hide your symptoms from others. Constant sweating may be so severe that you avoid common actions, such as lifting your arms or shaking hands. You may even give up activities you enjoy to avoid problems or embarrassment from excessive sweating. Contact a healthcare provider if hyperhidrosis affects your mental health and social well-being. Diagnosis and Tests How is hyperhidrosis diagnosed? A healthcare provider will diagnose hyperhidrosis after a physical exam and learning more about your symptoms and medical history. They’ll evaluate your symptoms using diagnostic criteria. If you experienced excessive sweating for at least six months and answered yes to at least two of the following questions, it may lead to a hyperhidrosis diagnosis: Sweating occurs on your underarms, palms, soles or face. You sweat the same on both sides of your body. You don’t sweat at night or sweat less at night. An episode of sweating lasts for at least one week. You have a history of hyperhidrosis in your biological family. Sweating interferes with your ability to do certain activities. You’re younger than 25 years old. What tests diagnose hyperhidrosis? A healthcare provider may use one of the following tests to determine the cause of hyperhidrosis: Starch-iodine test: Your provider applies an iodine solution to the sweaty area and sprinkles starch over the iodine solution. In places where you have excess sweating, the solution turns dark blue. Paper test: Your provider places special paper on the affected area to absorb sweat. Later, your provider weighs the paper to determine how much sweat you have. Blood or imaging tests: These tests can take a sample of your blood or take pictures underneath your skin to help your healthcare provider learn more about what causes your symptoms. Management and Treatment You can manage your symptoms of hyperhidrosis at home by: Using antiperspirants and deodorants. Antiperspirants work by sealing up sweat glands so your body stops producing sweat. A provider may recommend certain over-the-counter (OTC) or prescription-strength varieties. The best deodorant for hyperhidrosis is an aluminum-based product. Showering or bathing more often. Changing your routine, such as showering more often, may improve mild symptoms. Wearing breathable clothing. Choosing clothing that’s breathable and more absorbent, like cotton, can help you feel more comfortable if you sweat. Avoid blended fabrics and polyester, which can trap heat and make you sweat more. Hyperhidrosis medications A healthcare provider or dermatologist may recommend taking medications to reduce your symptoms of hyperhidrosis, including: Anticholinergic agents (glycopyrrolate and oxybutynin). Antidepressants. Beta-blockers. Medicated wipes (glycopyrronium tosylate, Qbrexza®). Aluminum chloride gel. Hyperhidrosis treatment therapies If your symptoms don’t improve with at-home treatment and/or medications, your healthcare provider may recommend more specialized therapies: Iontophoresis: You place your hands or feet in a shallow tub of tap water. A special device emits a low electrical current through the water, blocking sweat glands over time. Each treatment takes 10 to 20 minutes. You may need repeated treatments. Insurance may cover the equipment, enabling you to do the therapy at home. Botulinum toxin (Botox®) injections: Injecting botulinum toxin into an overactive nerve can stop sweat production for months at a time. Repeat treatments are necessary. Microwave therapy: Your provider places a high-tech device (miraDry®) against the affected area of your skin. The device emits thermal energy (heat), which destroys sweat glands permanently. This is an hour-long procedure that takes place in a healthcare provider’s office. Hyperhidrosis surgery Endoscopic thoracic sympathectomy: ETS is a minimally invasive type of surgery where a surgeon will cut a nerve in your body to turn off the signal that tells your glands to produce sweat. Sweat gland removal: A surgeon will remove your sweat glands using a laser, scraping (curettage), cutting (excision) or liposuction. Surgery has the potential to offer lasting benefits for persistent sweating that doesn’t respond to other therapies. https://my.clevelandclinic.org/health/diseases/17113-hyperhidrosis",Medical,Fact Finding,Q&A Using only this document provide the answer in a single sentence. It should be between 15 to 30 words.,Are there treatments for EDS?,"Ehlers-Danlos syndromes Ehlers-Danlos syndromes (EDS) are a group of rare inherited conditions that affect connective tissue. Connective tissues provide support in skin, tendons, ligaments, blood vessels, internal organs and bones. Symptoms of Ehlers-Danlos syndromes (EDS) There are several types of EDS that may share some symptoms. These include: an increased range of joint movement (joint hypermobility) stretchy skin fragile skin that breaks or bruises easily EDS can affect people in different ways. For some, the condition is relatively mild, while for others their symptoms can be disabling. The different types of EDS are caused by faults in certain genes that make connective tissue weaker. Depending on the type of EDS, the faulty gene may have been inherited from 1 parent or both parents. Sometimes the faulty gene is not inherited, but occurs in the person for the first time. Some of the rare, severe types can be life threatening. Main types of Ehlers-Danlos syndromes (EDS) There are 13 types of EDS, most of which are rare. Hypermobile EDS (hEDS) is the most common type. Other types of EDS include classical EDS, vascular EDS and kyphoscoliotic EDS. The EDS Support UK website has more information about the different types of EDS Hypermobile EDS People with hEDS may have: joint hypermobility loose, unstable joints that dislocate easily joint pain and clicking joints extreme tiredness (fatigue) skin that bruises easily digestive problems, such as heartburn and constipation dizziness and an increased heart rate after standing up problems with internal organs, such as mitral valve problems or organ prolapse problems with bladder control (urinary incontinence) Currently, there are no tests to confirm whether someone has hEDS. The diagnosis is made based on a person's medical history and a physical examination. Classical EDS Classical EDS (cEDS) is less common than hypermobile EDS and tends to affect the skin more. People with cEDS may have: joint hypermobility loose, unstable joints that dislocate easily stretchy skin fragile skin that can split easily, especially over the forehead, knees, shins and elbows smooth, velvety skin that bruises easily wounds that are slow to heal and leave wide scars hernias and organ prolapse Vascular EDS Vascular EDS (vEDS) is a rare type of EDS and is often considered to be the most serious. It affects the blood vessels and internal organs, which can cause them to split open and lead to life-threatening bleeding. People with vEDS may have: skin that bruises very easily thin skin with visible small blood vessels, particularly on the upper chest and legs fragile blood vessels that can bulge or tear, resulting in serious internal bleeding a risk of organ problems, such as the bowel tearing, the womb tearing (in late pregnancy) and partial collapse of the lung hypermobile fingers and toes, unusual facial features (such as a thin nose and lips, large eyes and small earlobes), varicose veins and delayed wound healing Kyphoscoliotic EDS Kyphoscoliotic EDS (kEDS) is rare. People with kEDS may have: curvature of the spine – this starts in early childhood and often gets worse in the teenage years joint hypermobility loose, unstable joints that dislocate easily weak muscle tone from childhood (hypotonia) – this may cause a delay in sitting and walking, or difficulty walking if symptoms get worse fragile eyes that can easily be damaged soft, velvety skin that is stretchy, bruises easily and scars Hypermobility spectrum disorder (HSD) Some people have problems caused by hypermobility, but do not have any of the specific EDS conditions. They may be diagnosed with hypermobility spectrum disorder (HSD), which is treated in the same way as hEDS. Getting medical advice See a GP if you have several troublesome symptoms of EDS. You do not usually need to worry if you only have a few symptoms and they're not causing any problems. Joint hypermobility, for example, is relatively common, affecting around 1 in 30 people. It's unlikely to be caused by EDS if you do not have any other symptoms. The GP may refer you to a joint specialist (rheumatologist) if you have problems with your joints and they suspect EDS. If there's a possibility you may have 1 of the rare types of EDS, the GP can refer you to your local genetics service for an assessment. The genetics specialist will ask about your medical history, family history, assess your symptoms and may carry out a genetic blood test to confirm the diagnosis. If further investigation is needed, your hospital doctor can refer you to a specialist EDS diagnostic service based in Sheffield or London – see the Annabelle's Challenge website for more information. Treatment for Ehlers-Danlos syndromes (EDS) There's no specific treatment for EDS, but it's possible to manage many of the symptoms with support and advice. People with EDS may also benefit from support from a number of different healthcare professionals. For example: a physiotherapist can teach you exercises to help strengthen your joints, avoid injuries and manage pain an occupational therapist can help you manage daily activities and give advice on equipment that may help you counselling and cognitive behavioural therapy (CBT) may be useful if you're struggling to cope with long-term pain for certain types of EDS, regular scans carried out in hospital can detect problems with internal organs genetic counselling can help you learn more about the cause of your condition, how it's inherited, and what the chances are of passing it on to your children Your GP or consultant can refer you to these services. Information: Self-refer for treatment If you have Ehlers-Danlos syndromes, you might be able to refer yourself directly to services for help with your condition without seeing a GP. To find out if there are any services in your area: ask the reception staff at your GP surgery check your GP surgery's website contact your integrated care board (ICB) – find your local ICB search online for NHS treatment for Ehlers-Danlos syndromes near you Living with Ehlers-Danlos syndromes (EDS) It's important to be careful about activities that put a lot of strain on your joints or put you at risk of injury. But it's also important not to be overprotective and avoid living an otherwise normal life. Advice will depend on which type of EDS you have and how it affects you: you may be advised to avoid some activities entirely, such as heavy lifting and contact sports for some activities you may need to wear appropriate protection and be taught how to reduce the strain on your joints lower-risk activities, such as swimming or pilates, may be recommended to help you stay fit and healthy if fatigue is a problem, you can be taught ways to conserve your energy and pace your activities How Ehlers-Danlos syndromes (EDS) are inherited EDS can be inherited, but it happen by chance in someone without a family history of the condition. The 2 main ways EDS is inherited are: autosomal dominant inheritance (hypermobile, classical and vascular EDS) – the faulty gene that causes EDS is passed on by 1 parent and there's a 1 in 2 chance of each of their children developing the condition autosomal recessive inheritance (kyphoscoliotic EDS) – the faulty gene is inherited from both parents and there's a 1 in 4 chance of each of their children developing the condition A person with EDS can only pass on the same type of EDS to their children. For example, the children of someone with hypermobile EDS cannot inherit vascular EDS. The severity of the condition can vary within the same family. More information The following websites provide more information, advice and support for people with EDS and their families: Ehlers-Danlos Support UK – you can also call their free helpline on 0800 907 8518 or find local support groups Hypermobility Syndromes Association (HMSA) – you can also call their helpline on 0333 011 6388 or find local support groups Information about you If you have EDS, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service. This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Page last reviewed: 04 October 2022 Next review due: 04 October 2025 ","question: Are there treatments for EDS? ---------- context: Ehlers-Danlos syndromes Ehlers-Danlos syndromes (EDS) are a group of rare inherited conditions that affect connective tissue. Connective tissues provide support in skin, tendons, ligaments, blood vessels, internal organs and bones. Symptoms of Ehlers-Danlos syndromes (EDS) There are several types of EDS that may share some symptoms. These include: an increased range of joint movement (joint hypermobility) stretchy skin fragile skin that breaks or bruises easily EDS can affect people in different ways. For some, the condition is relatively mild, while for others their symptoms can be disabling. The different types of EDS are caused by faults in certain genes that make connective tissue weaker. Depending on the type of EDS, the faulty gene may have been inherited from 1 parent or both parents. Sometimes the faulty gene is not inherited, but occurs in the person for the first time. Some of the rare, severe types can be life threatening. Main types of Ehlers-Danlos syndromes (EDS) There are 13 types of EDS, most of which are rare. Hypermobile EDS (hEDS) is the most common type. Other types of EDS include classical EDS, vascular EDS and kyphoscoliotic EDS. The EDS Support UK website has more information about the different types of EDS Hypermobile EDS People with hEDS may have: joint hypermobility loose, unstable joints that dislocate easily joint pain and clicking joints extreme tiredness (fatigue) skin that bruises easily digestive problems, such as heartburn and constipation dizziness and an increased heart rate after standing up problems with internal organs, such as mitral valve problems or organ prolapse problems with bladder control (urinary incontinence) Currently, there are no tests to confirm whether someone has hEDS. The diagnosis is made based on a person's medical history and a physical examination. Classical EDS Classical EDS (cEDS) is less common than hypermobile EDS and tends to affect the skin more. People with cEDS may have: joint hypermobility loose, unstable joints that dislocate easily stretchy skin fragile skin that can split easily, especially over the forehead, knees, shins and elbows smooth, velvety skin that bruises easily wounds that are slow to heal and leave wide scars hernias and organ prolapse Vascular EDS Vascular EDS (vEDS) is a rare type of EDS and is often considered to be the most serious. It affects the blood vessels and internal organs, which can cause them to split open and lead to life-threatening bleeding. People with vEDS may have: skin that bruises very easily thin skin with visible small blood vessels, particularly on the upper chest and legs fragile blood vessels that can bulge or tear, resulting in serious internal bleeding a risk of organ problems, such as the bowel tearing, the womb tearing (in late pregnancy) and partial collapse of the lung hypermobile fingers and toes, unusual facial features (such as a thin nose and lips, large eyes and small earlobes), varicose veins and delayed wound healing Kyphoscoliotic EDS Kyphoscoliotic EDS (kEDS) is rare. People with kEDS may have: curvature of the spine – this starts in early childhood and often gets worse in the teenage years joint hypermobility loose, unstable joints that dislocate easily weak muscle tone from childhood (hypotonia) – this may cause a delay in sitting and walking, or difficulty walking if symptoms get worse fragile eyes that can easily be damaged soft, velvety skin that is stretchy, bruises easily and scars Hypermobility spectrum disorder (HSD) Some people have problems caused by hypermobility, but do not have any of the specific EDS conditions. They may be diagnosed with hypermobility spectrum disorder (HSD), which is treated in the same way as hEDS. Getting medical advice See a GP if you have several troublesome symptoms of EDS. You do not usually need to worry if you only have a few symptoms and they're not causing any problems. Joint hypermobility, for example, is relatively common, affecting around 1 in 30 people. It's unlikely to be caused by EDS if you do not have any other symptoms. The GP may refer you to a joint specialist (rheumatologist) if you have problems with your joints and they suspect EDS. If there's a possibility you may have 1 of the rare types of EDS, the GP can refer you to your local genetics service for an assessment. The genetics specialist will ask about your medical history, family history, assess your symptoms and may carry out a genetic blood test to confirm the diagnosis. If further investigation is needed, your hospital doctor can refer you to a specialist EDS diagnostic service based in Sheffield or London – see the Annabelle's Challenge website for more information. Treatment for Ehlers-Danlos syndromes (EDS) There's no specific treatment for EDS, but it's possible to manage many of the symptoms with support and advice. People with EDS may also benefit from support from a number of different healthcare professionals. For example: a physiotherapist can teach you exercises to help strengthen your joints, avoid injuries and manage pain an occupational therapist can help you manage daily activities and give advice on equipment that may help you counselling and cognitive behavioural therapy (CBT) may be useful if you're struggling to cope with long-term pain for certain types of EDS, regular scans carried out in hospital can detect problems with internal organs genetic counselling can help you learn more about the cause of your condition, how it's inherited, and what the chances are of passing it on to your children Your GP or consultant can refer you to these services. Information: Self-refer for treatment If you have Ehlers-Danlos syndromes, you might be able to refer yourself directly to services for help with your condition without seeing a GP. To find out if there are any services in your area: ask the reception staff at your GP surgery check your GP surgery's website contact your integrated care board (ICB) – find your local ICB search online for NHS treatment for Ehlers-Danlos syndromes near you Living with Ehlers-Danlos syndromes (EDS) It's important to be careful about activities that put a lot of strain on your joints or put you at risk of injury. But it's also important not to be overprotective and avoid living an otherwise normal life. Advice will depend on which type of EDS you have and how it affects you: you may be advised to avoid some activities entirely, such as heavy lifting and contact sports for some activities you may need to wear appropriate protection and be taught how to reduce the strain on your joints lower-risk activities, such as swimming or pilates, may be recommended to help you stay fit and healthy if fatigue is a problem, you can be taught ways to conserve your energy and pace your activities How Ehlers-Danlos syndromes (EDS) are inherited EDS can be inherited, but it happen by chance in someone without a family history of the condition. The 2 main ways EDS is inherited are: autosomal dominant inheritance (hypermobile, classical and vascular EDS) – the faulty gene that causes EDS is passed on by 1 parent and there's a 1 in 2 chance of each of their children developing the condition autosomal recessive inheritance (kyphoscoliotic EDS) – the faulty gene is inherited from both parents and there's a 1 in 4 chance of each of their children developing the condition A person with EDS can only pass on the same type of EDS to their children. For example, the children of someone with hypermobile EDS cannot inherit vascular EDS. The severity of the condition can vary within the same family. More information The following websites provide more information, advice and support for people with EDS and their families: Ehlers-Danlos Support UK – you can also call their free helpline on 0800 907 8518 or find local support groups Hypermobility Syndromes Association (HMSA) – you can also call their helpline on 0333 011 6388 or find local support groups Information about you If you have EDS, your clinical team will pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service. This helps scientists look for better ways to prevent and treat this condition. You can opt out of the register at any time. Page last reviewed: 04 October 2022 Next review due: 04 October 2025 ---------- instructions: Using only this document provide the answer in a single sentence. It should be between 15 to 30 words.",Medical,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","In the context of Large Language Models(LLMs) like ChatGPT, how can ethical concerns be effectively integrated into their development and deployment? Also, explain the importance of applying multiple ethical perspectives.","The development of Large Language Models (LLMs) has been an incremental process, but particularly the public release of ChatGPT, an LLM-based conversational agent, in November 2022, sparked a worldwide hype and even speculation about impeding Artificial General Intelligence (AGI). Articles in both popular and academic publications have discussed diverse opportunities, challenges, and implications of conversational agents (e.g., Dwivedi et al. 2023). The field is developing so fast, that there is hardly time to properly assess what is going on. For many organizations, governments, companies, and citizens, key questions are: What can it do exactly? Is it hype or real? What are the various ethical issues? It is this last question that we aim to (partially) address in this paper. Below, we will discuss several ethical issues aspects of one LLM-based conversational agent: ChatGPT. The authors have worked in multiple applied research and innovation projects, with numerous clients and partners, on the development and evaluation of AI systems, and aiming to integrate concerns for ethical aspects in these projects. It is from this vantage point that we are interested in the ethical aspects of conversational agents. We have observed that ethical concerns often remain implicit; the people involved rarely explicitly discuss ethical perspectives and aspects. Conversely, we propose that making such perspectives and aspects more explicit, and organizing reflection and deliberation, is necessary, if we want to move ‘from principles to practices’ (Morley et al. 2020). Such ethical reflection and deliberation are urgent when AI systems are deployed in practice; especially if people’s safety and fundamental rights are at stake. In this article we discuss an approach to organize ethical reflection and deliberation, around the seven key requirements of the European Commission’s High-Level Expert Group on AI (HLEG) (2019). There are diverse approaches to integrate ethical aspects in the development and deployment of technologies; methods can be used at the start of development, during development, or after development (Reijers et al. 2018). We propose that integrating ethical aspects during development and deployment would be most useful, especially when this is part of an iterative development process, like CRISP-DM (Martínez-Plumed et al. 2021; Shearer 2000). Furthermore, we propose to use different ethical perspectives more explicitly. Notably, we propose to use consequentialism, duty ethics, relational ethics, and virtue ethics (Van de Poel and Royakkers 2011), and to use them in parallel, as complimentary perspectives. Moreover, we understand ethics as an iterative and participatory process of ethical reflection, inquiry, and deliberation (REF removed for review). The task for the people involved is then to make room for such a process and to facilitate relevant people to participate. Such a process can have three (iterative) steps: Identify issues that are (potentially) at play in the project and reflect on these. A handful of issues works best (if there are more, one can cluster; if there are less, one can explore more.) Organize dialogues with relevant people, both inside and outside the organization, for example, stakeholders, to inquire into these issues from diverse perspectives and to hear diverse voices. Make decisions, for example, between different design options and test these in experiments; this promotes transparency and accountability. The key is to steer the project more consciously, explicitly, and carefully. Our focus is on the first step (identify issues); below, we identify and discuss a range of ethical aspects of one specific LLM-based conversational agent: ChatGPT. The second step (organize dialogues) and the third step (make decisions) are outside the current article’s scope. Below, we will introduce the ingredients of our approach: a modest form of systems thinking; four complementary ethical perspectives; and the HLEG’s seven key requirements. Then we illustrate our approach with a case study of ChatGPT. This case study is also meant to explore how different ethical perspectives are relevant to different key requirements. We close the paper with a discussion of our approach. Human agency and oversight, including fundamental rights; the HLEG proposes the principle of respect for human autonomy (2019, p. 12), which they describe as follows: ‘Humans interacting with AI systems must be able to keep full and effective self-determination over themselves […]. AI systems […] should be designed to augment, complement and empower human cognitive, social and cultural skills.’ Human oversight refers to measures that help ‘ensuring that an AI system does not undermine human autonomy’ (HLEG, 2019, p. 16). Technical robustness and safety; this requirement refers to resilience to attacks and other security risks; to having effective fallback plans to promote safety; and to accuracy, reliability, and reproducibility. The evaluation of many of these aspects would require technical tests or experiments. In this article, however, we will only identify and discuss these aspects, and not actually conduct tests or experiments. Privacy and data governance; various concerns are at play, notably: that privacy sensitive information has probably been part of the training corpus many LLMs; and that users can submit privacy sensitive data through their prompts, thus submitting these data to the organizations that owns these LLMs and the conversational agents built on them. This information can also be used for subsequent finetuning of the model. Transparency; the HLEG argues (2019, p. 12) that ‘[e]xplicability is crucial for building and maintaining users’ trust in AI systems. This means that processes need to be transparent, the capabilities and purpose of AI systems openly communicated, and decisions—to the extent possible—explainable to those directly and indirectly affected. […] The degree to which explicability is needed is highly dependent on the context and the severity of the consequences if that output is erroneous or otherwise inaccurate.’ It also includes traceability, explainability, and communication. Moreover, it refers not only to the explicability of the AI system itself, but also to the processes in which this AI system is used, the capabilities and purposes of this system, and to communication about these processes, capabilities, and purposes. Diversity, non-discrimination and fairness; the HLEG (2019, p. 12) describes fairness as having ‘both a substantive and a procedural dimension. The substantive dimension implies a commitment to: ensuring equal and just distribution of both benefits and costs, and ensuring that individuals and groups are free from unfair bias, discrimination and stigmatisation. […] The procedural dimension […] entails the ability to contest and seek effective redress against decisions made by AI systems and by the humans operating them.’ Fairness not only refers narrowly to an application, but also to the processes and organizations in which this application is used (REF removed). Related aspects are: accessibility and universal design, and involving stakeholders in design and deployment. Societal and environmental well-being; the HLEG proposes the principle of prevention of harm (2019, p. 12): ‘AI systems should neither cause nor exacerbate harm or otherwise adversely affect human beings’; they draw attention to ‘situations where AI systems can cause or exacerbate adverse impacts due to asymmetries of power or information, such as between employers and employees, businesses and consumers or governments and citizens’ and to harms to ‘the natural environment and all living beings.’ Accountability; the HLEG describes this as ‘the assessment of algorithms, data and design processes’, through either internal or external audits; especially of applications that may affect fundamental rights or safety-critical applications (2019, pp. 19–20). It includes concerns for the auditability of systems and the ability to obtain redress for users; the HLEG recommends ‘accessible mechanisms… that ensure adequate redress’ (2019, p. 20).","""================ ======= The development of Large Language Models (LLMs) has been an incremental process, but particularly the public release of ChatGPT, an LLM-based conversational agent, in November 2022, sparked a worldwide hype and even speculation about impeding Artificial General Intelligence (AGI). Articles in both popular and academic publications have discussed diverse opportunities, challenges, and implications of conversational agents (e.g., Dwivedi et al. 2023). The field is developing so fast, that there is hardly time to properly assess what is going on. For many organizations, governments, companies, and citizens, key questions are: What can it do exactly? Is it hype or real? What are the various ethical issues? It is this last question that we aim to (partially) address in this paper. Below, we will discuss several ethical issues aspects of one LLM-based conversational agent: ChatGPT. The authors have worked in multiple applied research and innovation projects, with numerous clients and partners, on the development and evaluation of AI systems, and aiming to integrate concerns for ethical aspects in these projects. It is from this vantage point that we are interested in the ethical aspects of conversational agents. We have observed that ethical concerns often remain implicit; the people involved rarely explicitly discuss ethical perspectives and aspects. Conversely, we propose that making such perspectives and aspects more explicit, and organizing reflection and deliberation, is necessary, if we want to move ‘from principles to practices’ (Morley et al. 2020). Such ethical reflection and deliberation are urgent when AI systems are deployed in practice; especially if people’s safety and fundamental rights are at stake. In this article we discuss an approach to organize ethical reflection and deliberation, around the seven key requirements of the European Commission’s High-Level Expert Group on AI (HLEG) (2019). There are diverse approaches to integrate ethical aspects in the development and deployment of technologies; methods can be used at the start of development, during development, or after development (Reijers et al. 2018). We propose that integrating ethical aspects during development and deployment would be most useful, especially when this is part of an iterative development process, like CRISP-DM (Martínez-Plumed et al. 2021; Shearer 2000). Furthermore, we propose to use different ethical perspectives more explicitly. Notably, we propose to use consequentialism, duty ethics, relational ethics, and virtue ethics (Van de Poel and Royakkers 2011), and to use them in parallel, as complimentary perspectives. Moreover, we understand ethics as an iterative and participatory process of ethical reflection, inquiry, and deliberation (REF removed for review). The task for the people involved is then to make room for such a process and to facilitate relevant people to participate. Such a process can have three (iterative) steps: Identify issues that are (potentially) at play in the project and reflect on these. A handful of issues works best (if there are more, one can cluster; if there are less, one can explore more.) Organize dialogues with relevant people, both inside and outside the organization, for example, stakeholders, to inquire into these issues from diverse perspectives and to hear diverse voices. Make decisions, for example, between different design options and test these in experiments; this promotes transparency and accountability. The key is to steer the project more consciously, explicitly, and carefully. Our focus is on the first step (identify issues); below, we identify and discuss a range of ethical aspects of one specific LLM-based conversational agent: ChatGPT. The second step (organize dialogues) and the third step (make decisions) are outside the current article’s scope. Below, we will introduce the ingredients of our approach: a modest form of systems thinking; four complementary ethical perspectives; and the HLEG’s seven key requirements. Then we illustrate our approach with a case study of ChatGPT. This case study is also meant to explore how different ethical perspectives are relevant to different key requirements. We close the paper with a discussion of our approach. Human agency and oversight, including fundamental rights; the HLEG proposes the principle of respect for human autonomy (2019, p. 12), which they describe as follows: ‘Humans interacting with AI systems must be able to keep full and effective self-determination over themselves […]. AI systems […] should be designed to augment, complement and empower human cognitive, social and cultural skills.’ Human oversight refers to measures that help ‘ensuring that an AI system does not undermine human autonomy’ (HLEG, 2019, p. 16). Technical robustness and safety; this requirement refers to resilience to attacks and other security risks; to having effective fallback plans to promote safety; and to accuracy, reliability, and reproducibility. The evaluation of many of these aspects would require technical tests or experiments. In this article, however, we will only identify and discuss these aspects, and not actually conduct tests or experiments. Privacy and data governance; various concerns are at play, notably: that privacy sensitive information has probably been part of the training corpus many LLMs; and that users can submit privacy sensitive data through their prompts, thus submitting these data to the organizations that owns these LLMs and the conversational agents built on them. This information can also be used for subsequent finetuning of the model. Transparency; the HLEG argues (2019, p. 12) that ‘[e]xplicability is crucial for building and maintaining users’ trust in AI systems. This means that processes need to be transparent, the capabilities and purpose of AI systems openly communicated, and decisions—to the extent possible—explainable to those directly and indirectly affected. […] The degree to which explicability is needed is highly dependent on the context and the severity of the consequences if that output is erroneous or otherwise inaccurate.’ It also includes traceability, explainability, and communication. Moreover, it refers not only to the explicability of the AI system itself, but also to the processes in which this AI system is used, the capabilities and purposes of this system, and to communication about these processes, capabilities, and purposes. Diversity, non-discrimination and fairness; the HLEG (2019, p. 12) describes fairness as having ‘both a substantive and a procedural dimension. The substantive dimension implies a commitment to: ensuring equal and just distribution of both benefits and costs, and ensuring that individuals and groups are free from unfair bias, discrimination and stigmatisation. […] The procedural dimension […] entails the ability to contest and seek effective redress against decisions made by AI systems and by the humans operating them.’ Fairness not only refers narrowly to an application, but also to the processes and organizations in which this application is used (REF removed). Related aspects are: accessibility and universal design, and involving stakeholders in design and deployment. Societal and environmental well-being; the HLEG proposes the principle of prevention of harm (2019, p. 12): ‘AI systems should neither cause nor exacerbate harm or otherwise adversely affect human beings’; they draw attention to ‘situations where AI systems can cause or exacerbate adverse impacts due to asymmetries of power or information, such as between employers and employees, businesses and consumers or governments and citizens’ and to harms to ‘the natural environment and all living beings.’ Accountability; the HLEG describes this as ‘the assessment of algorithms, data and design processes’, through either internal or external audits; especially of applications that may affect fundamental rights or safety-critical applications (2019, pp. 19–20). It includes concerns for the auditability of systems and the ability to obtain redress for users; the HLEG recommends ‘accessible mechanisms… that ensure adequate redress’ (2019, p. 20). https://link.springer.com/article/10.1007/s43681-024-00571-x ================ ======= In the context of Large Language Models(LLMs) like ChatGPT, how can ethical concerns be effectively integrated into their development and deployment? Also, explain the importance of applying multiple ethical perspectives. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Internet/Technology,Fact Finding,Q&A [Use only the provided text to answer any questions. Do not include information from the internet or your data storage.],How does production relate to the definition of a farm for tax purposes?,"Meeting the qualifications of farming and being a farmer under the Internal Revenue Code (IRC) allows for special benefits; however, not all agricultural producers meet these qualifications even if they are producing agricultural products, which is why it is vitally important for operators of farms and their tax professionals to understand the IRS tax definitions of farm, farming, and farmer. For example, one of the benefits of being classified as a farmer is the exclusion of certain receipts from income as in the case of conservation payments as allowed under IRC Section 175. Brief examples of farmers/ranchers are: • Bob raises wheat and sells his wheat to the local elevator. • Rosa has a flock of milking goats and sells the milk to a local organic foods co-op. • Amal grows cut flowers which she sells weekly at the local farmer’s market. • Ricardo raises lettuce and cabbage which he sells to a salad processing company. • Louisa operates a cattle ranch; she sells weaned calves to a feedlot investor. These examples show a producer raising or growing a product and selling that product. They have not further processed or modified the product. These are farming activities and hence would all qualify as farm income. The following discussion looks at the definition of a farmer from an income tax perspective, including the definitions of farm, farming and farmers as found in the Internal Revenue Code (IRC) and Treasury Regulations. Defining “Farm” Farm is commonly defined in the tax code in numerous places with nearly the same words. One such definition is found in IRC Section 2032A(e)(4) relative to estate tax valuation; it reads as follows: The term “farm” includes stock, dairy, poultry, fruit, furbearing animal, and truck farms, plantations, ranches, nurseries, ranges, greenhouses or other similar structures used primarily for the raising of agricultural or horticultural commodities, and orchards and woodlands. Examples of other locations in the Internal Revenue Code (IRC) and Treasury Regulations (TR) where this language with minor variation is used to define farm are: • TR Section 1.61-4(d) (gross income of farmers) • TR Section 1.175-3 (soil and water conservation expenses) • TR Section 1.6073-1(b)(2) (estimated taxes) • IRC Section 6420(c)(2) (excise tax on gasoline) • TR Section 48.6420-4(c) (meaning of terms; excise tax on gasoline) In the definition above the word orchard is included, however, vineyard or grove is not. Yet, operators of a grape vineyard will fall under the definition of farm when using the inclusive wording “agricultural and horticultural commodities”. Grapes are the product of the vineyard and an agricultural commodity; therefore, the vineyard is a farm. Other rural operations producing products which can be defined as agricultural or horticultural, for example, a rural business producing goat’s milk will be defined for income tax purposes as a farm. A vineyard selling grapes is a farm. A winery that produces and sells wine would not be a farm. For operations with a combination, they would need to work with their tax preparer to separate the farming activities from non-farm business activity. The definition of a farm describes farming activities. These activities produce farm income which is recorded on a Form 1040 Schedule F: Profit or Loss From Farming. Someone may have a farm and produce farm income, but not qualify as a farmer under a specific tax provision. Estimated Tax Payments [IRC § 6654(i)(2)] If a taxpayer qualifies as a farmer by having more than two-thirds of his/her gross income being derived from farming; they may make a single estimated tax payment by the 15th of the month that follows the close of their tax year or make payment in full of their income tax liability by the first of the third month following the close of their tax year. (Calendar-year taxpayers: 15th of January or 1st of March). Example 1: Jose raises sheep full-time in the alpine meadows of Colorado. Jose sells market lambs and wool shorn from the flock. This is Jose’s primary source of income with over two-thirds of his income coming from this. He has a profit motive relative to his business activities. Wooly is a farmer for income tax purposes and would qualify for the estimated tax payments provisions. Example 2: Susie grows herbs for sale at her local farmer’s market on the weekends. Susie’s main source of income is her work as a computer engineer for a software company. Her herb sales are a small part of her total income. Even though she has a horticultural activity, less than 2/3s of her income is from farming. So, she would not qualify for the special benefits for estimated tax payments. If Susie can show she has a profit motive, her herb production would qualify as a farm activity and any income and expenses would be recorded on an IRS Form 1040 Schedule F. Installment Sale of Farm Products (IRC § 453) Cash-basis farmers are permitted to report income from the sale of farm products when the product is sold. They are not required to maintain inventories. If the farmer enters a forward sales contract to deliver the farm product in a subsequent year after production the income is reported in the year of payment not production. The contract must specify that the farmer can only receive the payment in the subsequent year to production, even if the delivery of the production occurred in the year of production. This is available for all farming income. The activities must fall within the definition of a farm in the previous section. Defining Agritourism as a Contrast to Farming Determining whether or not a business is a farming business is a confusing issue for operators of agritourism businesses using farmland and farm production as part of that business model which may be educational in nature or focuses on the sale of value-added products (Isn’t it really the “farming of people”?). In recent years agritourism businesses have a goal of connecting the non-farming population with production agriculture through experiences in a rural and farm setting. Agritourism is defined by Merriam-Webster as, “the practice of touring agricultural areas to see farms and often to participate in farm activities”. Merriam-Webster also indicates that the word agritourism entered the English language as a new word in 1979. Agritourism is also defined in other sources to include cooking cleaning and handicrafts or in contrast only when staying at the farm1. 1 The unabridged Dictionary.com (based on Random House Dictionary © 2009) defines agritourism as a noun with the following meaning: Tourism in which tourists take part in farm or village activities, as animal and crop care, cooking and cleaning, handicrafts, and entertainments. Agritourism is also defined by The American Heritage® Dictionary of the English Language, Fourth Edition © 2009 by Houghton Mifflin Company, with the following meaning: Tourism in which tourists board at farms or in rural villages and experience farming at close hand. Agritourism is not defined in the Internal Revenue Code or Treasury Regulations for income tax purposes. Definitions from dictionaries provide similarities within the meaning of agritourism ranging from simply touring agricultural areas to see farms to boarding on those farms and engaging in various activities for education or entertainment. When the definition of farming is contrasted with these definitions of agritourism it becomes clear that farming taxpayers who expand into agritourism activities and their practitioners should be diligent in determining extent of the non-farming business. Example 3: Friendly Farmer uses the six- bedroom antebellum farm house as a Bed & Breakfast. He has developed walking and horseback riding trails over the 600 acre farm that has been in his family for six generations. He is quite successful as a spinner of tall tales and is a gregarious host, so much so, that he now generates 70 percent of his gross income from guest services. Friendly is in the agritourism business even though he uses the family farm as the venue for these activities, he is more of an entertainer than farmer. While the income from the farm part of the operation would still be considered Farm Income and reported on IRS 1040 Schedule F, since less than two-thirds of his income is from farming, he would not be eligible for the estimated tax payments provisions.","[Use only the provided text to answer any questions. Do not include information from the internet or your data storage.] Meeting the qualifications of farming and being a farmer under the Internal Revenue Code (IRC) allows for special benefits; however, not all agricultural producers meet these qualifications even if they are producing agricultural products, which is why it is vitally important for operators of farms and their tax professionals to understand the IRS tax definitions of farm, farming, and farmer. For example, one of the benefits of being classified as a farmer is the exclusion of certain receipts from income as in the case of conservation payments as allowed under IRC Section 175. Brief examples of farmers/ranchers are: • Bob raises wheat and sells his wheat to the local elevator. • Rosa has a flock of milking goats and sells the milk to a local organic foods co-op. • Amal grows cut flowers which she sells weekly at the local farmer’s market. • Ricardo raises lettuce and cabbage which he sells to a salad processing company. • Louisa operates a cattle ranch; she sells weaned calves to a feedlot investor. These examples show a producer raising or growing a product and selling that product. They have not further processed or modified the product. These are farming activities and hence would all qualify as farm income. The following discussion looks at the definition of a farmer from an income tax perspective, including the definitions of farm, farming and farmers as found in the Internal Revenue Code (IRC) and Treasury Regulations. Defining “Farm” Farm is commonly defined in the tax code in numerous places with nearly the same words. One such definition is found in IRC Section 2032A(e)(4) relative to estate tax valuation; it reads as follows: The term “farm” includes stock, dairy, poultry, fruit, furbearing animal, and truck farms, plantations, ranches, nurseries, ranges, greenhouses or other similar structures used primarily for the raising of agricultural or horticultural commodities, and orchards and woodlands. Examples of other locations in the Internal Revenue Code (IRC) and Treasury Regulations (TR) where this language with minor variation is used to define farm are: • TR Section 1.61-4(d) (gross income of farmers) • TR Section 1.175-3 (soil and water conservation expenses) • TR Section 1.6073-1(b)(2) (estimated taxes) • IRC Section 6420(c)(2) (excise tax on gasoline) • TR Section 48.6420-4(c) (meaning of terms; excise tax on gasoline) In the definition above the word orchard is included, however, vineyard or grove is not. Yet, operators of a grape vineyard will fall under the definition of farm when using the inclusive wording “agricultural and horticultural commodities”. Grapes are the product of the vineyard and an agricultural commodity; therefore, the vineyard is a farm. Other rural operations producing products which can be defined as agricultural or horticultural, for example, a rural business producing goat’s milk will be defined for income tax purposes as a farm. A vineyard selling grapes is a farm. A winery that produces and sells wine would not be a farm. For operations with a combination, they would need to work with their tax preparer to separate the farming activities from non-farm business activity. The definition of a farm describes farming activities. These activities produce farm income which is recorded on a Form 1040 Schedule F: Profit or Loss From Farming. Someone may have a farm and produce farm income, but not qualify as a farmer under a specific tax provision. Estimated Tax Payments [IRC § 6654(i)(2)] If a taxpayer qualifies as a farmer by having more than two-thirds of his/her gross income being derived from farming; they may make a single estimated tax payment by the 15th of the month that follows the close of their tax year or make payment in full of their income tax liability by the first of the third month following the close of their tax year. (Calendar-year taxpayers: 15th of January or 1st of March). Example 1: Jose raises sheep full-time in the alpine meadows of Colorado. Jose sells market lambs and wool shorn from the flock. This is Jose’s primary source of income with over two-thirds of his income coming from this. He has a profit motive relative to his business activities. Wooly is a farmer for income tax purposes and would qualify for the estimated tax payments provisions. Example 2: Susie grows herbs for sale at her local farmer’s market on the weekends. Susie’s main source of income is her work as a computer engineer for a software company. Her herb sales are a small part of her total income. Even though she has a horticultural activity, less than 2/3s of her income is from farming. So, she would not qualify for the special benefits for estimated tax payments. If Susie can show she has a profit motive, her herb production would qualify as a farm activity and any income and expenses would be recorded on an IRS Form 1040 Schedule F. Installment Sale of Farm Products (IRC § 453) Cash-basis farmers are permitted to report income from the sale of farm products when the product is sold. They are not required to maintain inventories. If the farmer enters a forward sales contract to deliver the farm product in a subsequent year after production the income is reported in the year of payment not production. The contract must specify that the farmer can only receive the payment in the subsequent year to production, even if the delivery of the production occurred in the year of production. This is available for all farming income. The activities must fall within the definition of a farm in the previous section. Defining Agritourism as a Contrast to Farming Determining whether or not a business is a farming business is a confusing issue for operators of agritourism businesses using farmland and farm production as part of that business model which may be educational in nature or focuses on the sale of value-added products (Isn’t it really the “farming of people”?). In recent years agritourism businesses have a goal of connecting the non-farming population with production agriculture through experiences in a rural and farm setting. Agritourism is defined by Merriam-Webster as, “the practice of touring agricultural areas to see farms and often to participate in farm activities”. Merriam-Webster also indicates that the word agritourism entered the English language as a new word in 1979. Agritourism is also defined in other sources to include cooking cleaning and handicrafts or in contrast only when staying at the farm1. 1 The unabridged Dictionary.com (based on Random House Dictionary © 2009) defines agritourism as a noun with the following meaning: Tourism in which tourists take part in farm or village activities, as animal and crop care, cooking and cleaning, handicrafts, and entertainments. Agritourism is also defined by The American Heritage® Dictionary of the English Language, Fourth Edition © 2009 by Houghton Mifflin Company, with the following meaning: Tourism in which tourists board at farms or in rural villages and experience farming at close hand. Agritourism is not defined in the Internal Revenue Code or Treasury Regulations for income tax purposes. Definitions from dictionaries provide similarities within the meaning of agritourism ranging from simply touring agricultural areas to see farms to boarding on those farms and engaging in various activities for education or entertainment. When the definition of farming is contrasted with these definitions of agritourism it becomes clear that farming taxpayers who expand into agritourism activities and their practitioners should be diligent in determining extent of the non-farming business. Example 3: Friendly Farmer uses the six- bedroom antebellum farm house as a Bed & Breakfast. He has developed walking and horseback riding trails over the 600 acre farm that has been in his family for six generations. He is quite successful as a spinner of tall tales and is a gregarious host, so much so, that he now generates 70 percent of his gross income from guest services. Friendly is in the agritourism business even though he uses the family farm as the venue for these activities, he is more of an entertainer than farmer. While the income from the farm part of the operation would still be considered Farm Income and reported on IRS 1040 Schedule F, since less than two-thirds of his income is from farming, he would not be eligible for the estimated tax payments provisions. How does production relate to the definition of a farm for tax purposes?",Financial,Effect Analysis,Q&A Please answer from the text only and do not extrapolate from the source material.,What are the different ways to induce labor for an expectant mother?,"Department of Obstetrics and Gynecology - 1 - Induction of Labor What is induction of labor? Induction of labor is a medical procedure that softens the cervix (the opening to the womb or uterus) and starts contractions (muscle movements that help push the baby out of the uterus). This procedure is a way to plan when your labor (childbirth) will start, instead of waiting until labor starts on its own. The goal of an induction is to have a safe vaginal birth within 24 hours. What happens during an induction procedure? We use standard medications and techniques to soften and dilate (widen) the cervix so it can reach 10 centimeters (cm) wide. A safe and effective induction procedure includes the following: Misoprostol (Cytotec®) • This is a small pill that your provider will place in the vagina every 3 hours at the start of your induction until the cervix is 3-4 cm dilated. • Misoprostol causes your cervix to soften and open and starts your contractions. Balloon • When your cervix is between 1-3 cm dilated, your provider will place a soft balloon at the top of the cervix. This causes your cervix to soften and dilate. • This balloon can also be placed in the OB Triage or in the clinic before your scheduled induction. Then you will be admitted to the hospital later in the day. Department of Obstetrics and Gynecology Induction of Labor - 2 - • Misoprostol is used in combination with the balloon. Amniotomy • When your cervix is around 3-4 cm dilated, your provider will remove the balloon. Then they will use a device to break the bag of water around your baby. This procedure is called an amniotomy. • The amniotomy causes more contractions to help labor progress. Oxytocin (Pitocin®) • Starting around when your cervix is 3-4 cm dilated, your provider will give you oxytocin through an IV (a needle inserted into your vein). • This medication causes contractions, and it can be easily increased or decreased to avoid having too many contractions. Sometimes oxytocin is also used instead of misoprostol earlier in the induction process. Other steps throughout your induction procedure: • We will do cervical exams every 2-4 hours to confirm that the induction process is going well. • We will do continuous fetal monitoring (medical checks on the baby) to make sure that the baby is doing well throughout the process. • We will place an IV at the start of your induction. Department of Obstetrics and Gynecology Induction of Labor - 3 - Timeline (by centimeters dilated) of the induction procedures and medications: What are the benefits of induction? Induction for a medical reason For some medical conditions, induction of labor is recommended to reduce the risk of complications (medical problems) for both the pregnant person and the baby. Timing your birth instead of waiting for spontaneous labor (whenever labor naturally starts on its own) decreases the chance that your medical conditions will get worse. It also decreases the risk of stillbirth (when a baby dies during pregnancy or birth). Some of these medical conditions include: • Pre-eclampsia and high blood pressure • Diabetes • Low amniotic fluid (oligohydramnios) • When the baby is much smaller than expected Ask your doctor, nurse, or midwife if you have a condition where early birth is recommended. Induction after 39 weeks of pregnancy Induction of labor can be done safely after 39 weeks for pregnant people who do not have a medical reason for early birth. Potential benefits include: • Reduced risk of developing high blood pressure or pre-eclampsia later in pregnancy Department of Obstetrics and Gynecology Induction of Labor - 4 - • Decreased risk of stillbirth (if induced before 42 weeks) • Possibly making it less likely that you will need a Cesarean birth (a surgery to deliver a baby through a cut made through the belly, also called a C-section) What are the risks of induction? • We monitor the baby’s heartbeat continuously because sometimes labor can be harmful to babies. If this is the case, you might need urgent or emergency interventions (including Cesarean birth). • An induction of labor can fail if your cervix does not dilate to 10 cm, despite all efforts to help labor progress. If this happens, you will need a Cesarean birth. Your doctor, midwife and nurse will regularly keep you updated on next steps for care. • If an induction takes too long (more than 24 hours), there is a higher risk of bleeding, infection, and Cesarean birth. • Patients who are induced have a longer hospital stay before birth compared to patients who have spontaneous labor. • It may be harder for you to rest during the early parts of your labor. What are alternatives to induction? • Waiting for spontaneous labor • Cesarean birth How can I help my induction go well? • During the early part of the induction, try to rest as much as possible, drink fluids, and snack lightly. • When your contractions get stronger, rock on a birth ball or use the shower to make yourself more comfortable. Being upright (instead of lying down) and active helps your labor move forward. Department of Obstetrics and Gynecology Induction of Labor - 5 - Disclaimer: This document contains information and/or instructional materials developed by University of Michigan (U-M) Health for the typical patient with your condition. It may include links to online content that was not created by U-M Health and for which U-M Health does not assume responsibility. It does not replace medical advice from your health care provider because your experience may differ from that of the typical patient. Talk to your health care provider if you have any questions about this document, your condition, or your treatment plan. Authors: Joanne Bailey, CNM PhD, Jourdan Triebwasser, MD Edited by: Brittany Batell, MPH MSW Patient Education by U-M Health is licensed under a Creative Commons AttributionNonCommercial-ShareAlike 4.0 International Public License. Last revised 02/2024 • Change positions often, especially if you have an epidural (an injection of medication that blocks pain during labor). • Plan to have a support team (your partner, family member, doula, friend) with you. Having ongoing labor support after your contractions get stronger decreases the possibility of a Cesarean birth and improves your labor and birth experience. • Before you come to the hospital for your induction, learn about ways to push effectively after the cervix is 10 cm dilated. What can I eat and drink during an induction? During an induction, you can eat food without animal protein or fat. Once you get an epidural or once you’re in active labor, you can have clear liquids (like water, apple or grape juice, gelatin, popsicles). What does a scheduled induction look like? On the day that your induction is scheduled, you should arrive at the Birth Center at the time you are scheduled (unless you are contacted that day with different instructions). Please note that we may have to delay your induction 1 day or more, depending on how busy it is in the Birth Center. We try to give you as much advance notice as possible about delays.","Please answer from the text only and do not extrapolate from the source material. What are the different ways to induce labor for an expectant mother? Department of Obstetrics and Gynecology - 1 - Induction of Labor What is induction of labor? Induction of labor is a medical procedure that softens the cervix (the opening to the womb or uterus) and starts contractions (muscle movements that help push the baby out of the uterus). This procedure is a way to plan when your labor (childbirth) will start, instead of waiting until labor starts on its own. The goal of an induction is to have a safe vaginal birth within 24 hours. What happens during an induction procedure? We use standard medications and techniques to soften and dilate (widen) the cervix so it can reach 10 centimeters (cm) wide. A safe and effective induction procedure includes the following: Misoprostol (Cytotec®) • This is a small pill that your provider will place in the vagina every 3 hours at the start of your induction until the cervix is 3-4 cm dilated. • Misoprostol causes your cervix to soften and open and starts your contractions. Balloon • When your cervix is between 1-3 cm dilated, your provider will place a soft balloon at the top of the cervix. This causes your cervix to soften and dilate. • This balloon can also be placed in the OB Triage or in the clinic before your scheduled induction. Then you will be admitted to the hospital later in the day. Department of Obstetrics and Gynecology Induction of Labor - 2 - • Misoprostol is used in combination with the balloon. Amniotomy • When your cervix is around 3-4 cm dilated, your provider will remove the balloon. Then they will use a device to break the bag of water around your baby. This procedure is called an amniotomy. • The amniotomy causes more contractions to help labor progress. Oxytocin (Pitocin®) • Starting around when your cervix is 3-4 cm dilated, your provider will give you oxytocin through an IV (a needle inserted into your vein). • This medication causes contractions, and it can be easily increased or decreased to avoid having too many contractions. Sometimes oxytocin is also used instead of misoprostol earlier in the induction process. Other steps throughout your induction procedure: • We will do cervical exams every 2-4 hours to confirm that the induction process is going well. • We will do continuous fetal monitoring (medical checks on the baby) to make sure that the baby is doing well throughout the process. • We will place an IV at the start of your induction. Department of Obstetrics and Gynecology Induction of Labor - 3 - Timeline (by centimeters dilated) of the induction procedures and medications: What are the benefits of induction? Induction for a medical reason For some medical conditions, induction of labor is recommended to reduce the risk of complications (medical problems) for both the pregnant person and the baby. Timing your birth instead of waiting for spontaneous labor (whenever labor naturally starts on its own) decreases the chance that your medical conditions will get worse. It also decreases the risk of stillbirth (when a baby dies during pregnancy or birth). Some of these medical conditions include: • Pre-eclampsia and high blood pressure • Diabetes • Low amniotic fluid (oligohydramnios) • When the baby is much smaller than expected Ask your doctor, nurse, or midwife if you have a condition where early birth is recommended. Induction after 39 weeks of pregnancy Induction of labor can be done safely after 39 weeks for pregnant people who do not have a medical reason for early birth. Potential benefits include: • Reduced risk of developing high blood pressure or pre-eclampsia later in pregnancy Department of Obstetrics and Gynecology Induction of Labor - 4 - • Decreased risk of stillbirth (if induced before 42 weeks) • Possibly making it less likely that you will need a Cesarean birth (a surgery to deliver a baby through a cut made through the belly, also called a C-section) What are the risks of induction? • We monitor the baby’s heartbeat continuously because sometimes labor can be harmful to babies. If this is the case, you might need urgent or emergency interventions (including Cesarean birth). • An induction of labor can fail if your cervix does not dilate to 10 cm, despite all efforts to help labor progress. If this happens, you will need a Cesarean birth. Your doctor, midwife and nurse will regularly keep you updated on next steps for care. • If an induction takes too long (more than 24 hours), there is a higher risk of bleeding, infection, and Cesarean birth. • Patients who are induced have a longer hospital stay before birth compared to patients who have spontaneous labor. • It may be harder for you to rest during the early parts of your labor. What are alternatives to induction? • Waiting for spontaneous labor • Cesarean birth How can I help my induction go well? • During the early part of the induction, try to rest as much as possible, drink fluids, and snack lightly. • When your contractions get stronger, rock on a birth ball or use the shower to make yourself more comfortable. Being upright (instead of lying down) and active helps your labor move forward. Department of Obstetrics and Gynecology Induction of Labor - 5 - Disclaimer: This document contains information and/or instructional materials developed by University of Michigan (U-M) Health for the typical patient with your condition. It may include links to online content that was not created by U-M Health and for which U-M Health does not assume responsibility. It does not replace medical advice from your health care provider because your experience may differ from that of the typical patient. Talk to your health care provider if you have any questions about this document, your condition, or your treatment plan. Authors: Joanne Bailey, CNM PhD, Jourdan Triebwasser, MD Edited by: Brittany Batell, MPH MSW Patient Education by U-M Health is licensed under a Creative Commons AttributionNonCommercial-ShareAlike 4.0 International Public License. Last revised 02/2024 • Change positions often, especially if you have an epidural (an injection of medication that blocks pain during labor). • Plan to have a support team (your partner, family member, doula, friend) with you. Having ongoing labor support after your contractions get stronger decreases the possibility of a Cesarean birth and improves your labor and birth experience. • Before you come to the hospital for your induction, learn about ways to push effectively after the cervix is 10 cm dilated. What can I eat and drink during an induction? During an induction, you can eat food without animal protein or fat. Once you get an epidural or once you’re in active labor, you can have clear liquids (like water, apple or grape juice, gelatin, popsicles). What does a scheduled induction look like? On the day that your induction is scheduled, you should arrive at the Birth Center at the time you are scheduled (unless you are contacted that day with different instructions). Please note that we may have to delay your induction 1 day or more, depending on how busy it is in the Birth Center. We try to give you as much advance notice as possible about delays.",Medical,Fact Finding,Q&A Only use the information provided in the document to give your answer. Keep it to less than 50 words.,"In the context of the provided document, what is the definition of ""nonexpendable equipment""?","**Creating a budget for a grant** Although the degree of specificity of any budget will vary depending on the nature of the project and OJP agency requirements, a complete, well-thought-out budget serves to reinforce your credibility and increase the likelihood of your proposal being funded. Keep in mind the following— A well-prepared budget should be reasonable and demonstrate that the funds being asked for will be used wisely. The budget should be as concrete and specific as possible in its estimates. Make every effort to be realistic, to estimate costs accurately. The budget format should be as clear as possible. It should begin with a budget narrative, which you should write after the entire budget has been prepared. Each section of the budget should be in outline form, listing line items under major headings and subheadings. Each of the major components should be subtotaled with a grand total at the end. Your budget should justify all expenses and be consistent with the program narrative: Salaries should be comparable to those within the applicant organization. If new staff is being hired, additional space and equipment are considered, as necessary. If the budget lists an equipment purchase, it is the type allowed by the agency. If additional space is rented, the increase in insurance is supported. If an indirect cost rate applies to the proposal, the division between direct and indirect costs is not in conflict, and the aggregate budget totals refer directly to the approved formula. Indirect costs are costs that are not readily assignable to a particular project, but are necessary to the operation of the organization and the performance of the project (like the cost of operating and maintaining facilities, depreciation, and administrative salaries). If matching funds are required, the contributions to the matching fund are taken out of the budget unless otherwise specified in the application instructions. While budget adjustments are sometimes made after the grant award, this can be a lengthy process. It’s best to be certain that implementation, continuation, and phase-down costs can be met with the budget you submit with the proposal. Consider costs associated with leases, evaluation systems, hard/soft match requirements, audits, development, implementing and maintaining information and accounting systems, and other long-term financial commitments. Use OJP’s Budget Detail Worksheet as a guide when preparing your budget and budget narrative. You may submit this worksheet or your own version, but it must address all of the categories in the sample budget detail worksheet. (See a sample budget summary and narrative.) Whatever format you submit, however, must include all of the information asked for on the budget detail worksheet in the solicitation for your grant application, in addition to the budget narrative: Personnel—List each position by title and employee name, if available. Show the annual salary rate and the percentage of time to be devoted to the project. Compensation paid for employees engaged in grant activities must be consistent with that paid for similar work within your organization. List only the employees of the applicant organization; all other grant-funded positions should be listed under the consultants/contracts category. Fringe Benefits—Base fringe benefits on actual known costs or an established formula. Fringe benefits are for listed personnel and only for the percentage of time devoted to the project. Fringe benefits on overtime hours are limited to FICA, workers’ compensation, and unemployment compensation. Travel—Itemize travel expenses for project personnel by purpose (e.g., staff to training, field interviews, advisory group meetings). Show how you calculated these costs (e.g., six people to 3-day training at $X airfare, $X lodging, $X meals). In training projects, list travel and meals for trainees separately. Show the number of trainees and the unit costs involved. Identify the location of travel, if known. Indicate the source of any travel policies you have applied, and if applicant or federal travel regulations apply. The use of use federal grant funds to travel to non-DOJ-sponsored training events requires prior approval from the funding agency. Equipment—List nonexpendable items that are to be purchased. Nonexpendable equipment is tangible property having a useful life of more than 2 years and an acquisition cost of $5,000 or more per unit. (Note: An organization’s own capitalization policy may be used for items costing less than $5,000.) Include expendable items either in the ""supplies"" category or in the ""other"" category. Analyze the cost benefits of purchasing versus leasing equipment, particularly high-cost items and those subject to rapid technical advances. List rented or leased equipment costs in the ""contractual"" category. Explain why the equipment is needed for the project to succeed. Attach a narrative describing the method that will be used to procure the equipment. Supplies—List items by type (office supplies, postage, training materials, copying paper, and expendable equipment items costing less than $5,000, such as books and handheld tape recorders) and show how you calculated these costs. (Note: An organization’s own capitalization policy may be used for items costing less than $5,000.) Generally, supplies include any materials that are expendable or consumed during the course of the project. Construction—As a rule, construction costs are not allowable. In some cases, minor repairs or renovations may be allowable. Check the solicitation and with the program office before budgeting funds in this category. Consultants/Contracts—Indicate whether you will follow your organization’s formal, written procurement policy or the Federal Acquisition Regulations. Consultant Fees: For each consultant, enter the name, if known, service to be provided, hourly or daily fee (8-hour day), and estimated time on the project. Consultant fees in excess of $450 per day require additional justification and prior approval from OJP. Consultant Expenses: List all expenses to be paid from the grant to the individual consultants in addition to their fees (e.g., travel, meals, lodging). Contracts: Describe the product or service to be procured by contract and provide an estimate of the cost. Promote free and open competition in awarding contracts. You must provide a separate justification for sole-source contracts of $100,000 or more. Other Costs—List items (e.g., rent, reproduction, telephone, janitorial or security services, investigative or confidential funds) by major type and show how you calculated the costs. For example, for rent, provide the square footage and the cost per square foot or a monthly rental cost and how many months of rent are proposed. Indirect Costs—Indirect costs are allowed only if you have a federally approved indirect cost rate and you attach a copy of the rate approval (a fully executed, negotiated agreement). If you don’t have an approved rate, you can request one by contacting your cognizant federal agency, which will review all documentation and approve a rate. Or, if your accounting system permits, you may allocate costs in the direct costs categories. Remember to include computations that clearly show how the costs were derived, as well as documentation that explains the cost or line item. Sustaining the Project Do not anticipate that the grant income will be the sole support for your project. Consider this when developing your overall budget requirements and, in particular, when developing budget line items most subject to inflation. Exercise restraint when determining inflationary cost projections (avoid padding budget line items), but try to anticipate possible future increases. Federal funds must be used to supplement existing funds for program activities and must not replace (supplant) those funds that have been appropriated for the same purpose. SUPPLANTING IS PROHIBITED Definition: To deliberately reduce state or local funds because of the existence of federal funds. Prohibition: Federal funds must be used to supplement existing funds for program activities and must not replace those funds that have been appropriated for the same purpose. Example: When state funds are appropriated for a stated purpose and federal funds are awarded for that same purpose, the state replaces its state funds with federal funds, thereby reducing the total amount available for the stated purpose. Monitoring: Supplanting will be the subject of application review, preaward review, postaward monitoring, and audit. Most grant programs require applicants to include information that explains how they will fund and sustain the project once the grant funds have been expended. Describe a plan for continuing your project beyond the grant period, and outline all other fundraising efforts you are considering and any plans to apply for additional grants in the future. Please note that it is prohibited to use grant funds or grant-funded positions for your fundraising efforts. Also, provide projections for operating and maintaining facilities and equipment. Discuss maintenance and future program funding if program funds are for construction activity. Account for other needed expenditures if the program includes purchasing equipment."," ========== **Creating a budget for a grant** Although the degree of specificity of any budget will vary depending on the nature of the project and OJP agency requirements, a complete, well-thought-out budget serves to reinforce your credibility and increase the likelihood of your proposal being funded. Keep in mind the following— A well-prepared budget should be reasonable and demonstrate that the funds being asked for will be used wisely. The budget should be as concrete and specific as possible in its estimates. Make every effort to be realistic, to estimate costs accurately. The budget format should be as clear as possible. It should begin with a budget narrative, which you should write after the entire budget has been prepared. Each section of the budget should be in outline form, listing line items under major headings and subheadings. Each of the major components should be subtotaled with a grand total at the end. Your budget should justify all expenses and be consistent with the program narrative: Salaries should be comparable to those within the applicant organization. If new staff is being hired, additional space and equipment are considered, as necessary. If the budget lists an equipment purchase, it is the type allowed by the agency. If additional space is rented, the increase in insurance is supported. If an indirect cost rate applies to the proposal, the division between direct and indirect costs is not in conflict, and the aggregate budget totals refer directly to the approved formula. Indirect costs are costs that are not readily assignable to a particular project, but are necessary to the operation of the organization and the performance of the project (like the cost of operating and maintaining facilities, depreciation, and administrative salaries). If matching funds are required, the contributions to the matching fund are taken out of the budget unless otherwise specified in the application instructions. While budget adjustments are sometimes made after the grant award, this can be a lengthy process. It’s best to be certain that implementation, continuation, and phase-down costs can be met with the budget you submit with the proposal. Consider costs associated with leases, evaluation systems, hard/soft match requirements, audits, development, implementing and maintaining information and accounting systems, and other long-term financial commitments. Use OJP’s Budget Detail Worksheet as a guide when preparing your budget and budget narrative. You may submit this worksheet or your own version, but it must address all of the categories in the sample budget detail worksheet. (See a sample budget summary and narrative.) Whatever format you submit, however, must include all of the information asked for on the budget detail worksheet in the solicitation for your grant application, in addition to the budget narrative: Personnel—List each position by title and employee name, if available. Show the annual salary rate and the percentage of time to be devoted to the project. Compensation paid for employees engaged in grant activities must be consistent with that paid for similar work within your organization. List only the employees of the applicant organization; all other grant-funded positions should be listed under the consultants/contracts category. Fringe Benefits—Base fringe benefits on actual known costs or an established formula. Fringe benefits are for listed personnel and only for the percentage of time devoted to the project. Fringe benefits on overtime hours are limited to FICA, workers’ compensation, and unemployment compensation. Travel—Itemize travel expenses for project personnel by purpose (e.g., staff to training, field interviews, advisory group meetings). Show how you calculated these costs (e.g., six people to 3-day training at $X airfare, $X lodging, $X meals). In training projects, list travel and meals for trainees separately. Show the number of trainees and the unit costs involved. Identify the location of travel, if known. Indicate the source of any travel policies you have applied, and if applicant or federal travel regulations apply. The use of use federal grant funds to travel to non-DOJ-sponsored training events requires prior approval from the funding agency. Equipment—List nonexpendable items that are to be purchased. Nonexpendable equipment is tangible property having a useful life of more than 2 years and an acquisition cost of $5,000 or more per unit. (Note: An organization’s own capitalization policy may be used for items costing less than $5,000.) Include expendable items either in the ""supplies"" category or in the ""other"" category. Analyze the cost benefits of purchasing versus leasing equipment, particularly high-cost items and those subject to rapid technical advances. List rented or leased equipment costs in the ""contractual"" category. Explain why the equipment is needed for the project to succeed. Attach a narrative describing the method that will be used to procure the equipment. Supplies—List items by type (office supplies, postage, training materials, copying paper, and expendable equipment items costing less than $5,000, such as books and handheld tape recorders) and show how you calculated these costs. (Note: An organization’s own capitalization policy may be used for items costing less than $5,000.) Generally, supplies include any materials that are expendable or consumed during the course of the project. Construction—As a rule, construction costs are not allowable. In some cases, minor repairs or renovations may be allowable. Check the solicitation and with the program office before budgeting funds in this category. Consultants/Contracts—Indicate whether you will follow your organization’s formal, written procurement policy or the Federal Acquisition Regulations. Consultant Fees: For each consultant, enter the name, if known, service to be provided, hourly or daily fee (8-hour day), and estimated time on the project. Consultant fees in excess of $450 per day require additional justification and prior approval from OJP. Consultant Expenses: List all expenses to be paid from the grant to the individual consultants in addition to their fees (e.g., travel, meals, lodging). Contracts: Describe the product or service to be procured by contract and provide an estimate of the cost. Promote free and open competition in awarding contracts. You must provide a separate justification for sole-source contracts of $100,000 or more. Other Costs—List items (e.g., rent, reproduction, telephone, janitorial or security services, investigative or confidential funds) by major type and show how you calculated the costs. For example, for rent, provide the square footage and the cost per square foot or a monthly rental cost and how many months of rent are proposed. Indirect Costs—Indirect costs are allowed only if you have a federally approved indirect cost rate and you attach a copy of the rate approval (a fully executed, negotiated agreement). If you don’t have an approved rate, you can request one by contacting your cognizant federal agency, which will review all documentation and approve a rate. Or, if your accounting system permits, you may allocate costs in the direct costs categories. Remember to include computations that clearly show how the costs were derived, as well as documentation that explains the cost or line item. Sustaining the Project Do not anticipate that the grant income will be the sole support for your project. Consider this when developing your overall budget requirements and, in particular, when developing budget line items most subject to inflation. Exercise restraint when determining inflationary cost projections (avoid padding budget line items), but try to anticipate possible future increases. Federal funds must be used to supplement existing funds for program activities and must not replace (supplant) those funds that have been appropriated for the same purpose. SUPPLANTING IS PROHIBITED Definition: To deliberately reduce state or local funds because of the existence of federal funds. Prohibition: Federal funds must be used to supplement existing funds for program activities and must not replace those funds that have been appropriated for the same purpose. Example: When state funds are appropriated for a stated purpose and federal funds are awarded for that same purpose, the state replaces its state funds with federal funds, thereby reducing the total amount available for the stated purpose. Monitoring: Supplanting will be the subject of application review, preaward review, postaward monitoring, and audit. Most grant programs require applicants to include information that explains how they will fund and sustain the project once the grant funds have been expended. Describe a plan for continuing your project beyond the grant period, and outline all other fundraising efforts you are considering and any plans to apply for additional grants in the future. Please note that it is prohibited to use grant funds or grant-funded positions for your fundraising efforts. Also, provide projections for operating and maintaining facilities and equipment. Discuss maintenance and future program funding if program funds are for construction activity. Account for other needed expenditures if the program includes purchasing equipment. ========== In the context of the provided document, what is the definition of ""nonexpendable equipment""? ========== Only use the information provided in the document to give your answer. Keep it to less than 50 words.",Financial,Explanation/Definition,Q&A Only answer by using the information in the context block below. Do not use external sources for your answer.,How does 10% of calories from fat benefit us?,"The rationale for the Nutrition Spectrum Reversal Program guidelines can be stated briefly: 10% OF TOTAL CALORIES FROM FAT. The guideline of 10% of calories from fat provides sufficient nutrition, supports heart disease regression, and weight loss. It can be accomplished by eating a wide range of satisfying and pleasurable foods. Limiting dietary fat to 10% of total calories reduces consumption of all fats, which decreases blood cholesterol levels. It also typically reduces total calorie intake, because fat contains 9 calories per gram compared to 4 calories per gram in carbohydrates and protein. Reducing body weight reduces risk because obesity adds to the risk of heart disease. A nutrition program without added fats and high-fat foods (i.e. meat, fish, poultry, milk fat, oils, and high-fat plant foods) still contains about 10% of calories from fat. This comes from the naturally occurring fat in grain products and some vegetables and beans. Excessive food restrictions would be required for the nutrition program to go lower than 10% fat. The human body needs about 5% of calories from fat to obtain the essential fats for good health. Plus, there are no research studies that have evaluated or supported a fat intake below 10% fat. Diets with higher amounts of fat (20-30% fat) have not been associated with heart disease reversal. In addition, high-fat diets have been associated with an increased risk of some cancers, such as breast, colon, and prostate. All fats and oils contain three kinds of fat: saturated fat, monounsaturated fat, and polyunsaturated fat. These kinds of fats are present in different proportions in fats and oils, and they affect blood cholesterol levels differently. Typically, foods that are very high in saturated fat are solid at room temperature, and foods that are very low in saturated fat are liquid at room temperature.","Only answer by using the information in the context block below. Do not use external sources for your answer. How does 10% of calories from fat benefit us? [The rationale for the Nutrition Spectrum Reversal Program guidelines can be stated briefly: 10% OF TOTAL CALORIES FROM FAT. The guideline of 10% of calories from fat provides sufficient nutrition, supports heart disease regression, and weight loss. It can be accomplished by eating a wide range of satisfying and pleasurable foods. Limiting dietary fat to 10% of total calories reduces consumption of all fats, which decreases blood cholesterol levels. It also typically reduces total calorie intake, because fat contains 9 calories per gram compared to 4 calories per gram in carbohydrates and protein. Reducing body weight reduces risk because obesity adds to the risk of heart disease. A nutrition program without added fats and high-fat foods (i.e. meat, fish, poultry, milk fat, oils, and high-fat plant foods) still contains about 10% of calories from fat. This comes from the naturally occurring fat in grain products and some vegetables and beans. Excessive food restrictions would be required for the nutrition program to go lower than 10% fat. The human body needs about 5% of calories from fat to obtain the essential fats for good health. Plus, there are no research studies that have evaluated or supported a fat intake below 10% fat. Diets with higher amounts of fat (20-30% fat) have not been associated with heart disease reversal. In addition, high-fat diets have been associated with an increased risk of some cancers, such as breast, colon, and prostate. All fats and oils contain three kinds of fat: saturated fat, monounsaturated fat, and polyunsaturated fat. These kinds of fats are present in different proportions in fats and oils, and they affect blood cholesterol levels differently. Typically, foods that are very high in saturated fat are solid at room temperature, and foods that are very low in saturated fat are liquid at room temperature.]",Medical,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","My doctor said he can't use Nexobrid to remove an eschar on my arm because of my papaya allergy. Can you explain why this allergy prevents me from using this treatment, even though papayas aren't an ingredient? Explain in 50 words or less.","2.2 Recommended Dosage Recommended Dosage in Adults Apply a 3 mm thick layer (approximate thickness of a tongue depressor) of NEXOBRID to a burn wound area of up to 15% body surface area (BSA) in one application in adult patients. Remove NEXOBRID after 4 hours [see Dosage and Administration (2.5)]. A second application of NEXOBRID may be applied 24 hours following the first application to either the same area previously treated with NEXOBRID or to a new area in adult patients. Apply a second application if: • The wound area is more than 15% BSA, or • Multiple wound areas on different body surfaces require two treatments for logistical reasons such as body position, or • The first application’s eschar removal was not complete. For both applications, the total treated area must not exceed 20% BSA. Recommended Dosage in Pediatric Patients Pediatric Patients 6 Years of Age and Older Apply a 3 mm thick layer (approximate thickness of a tongue depressor) of NEXOBRID to a burn wound area of up to 15% BSA in one application in pediatric patients 6 years of age and older. Remove NEXOBRID after 4 hours [see Dosage and Administration (2.5)]. A second application of NEXOBRID is not recommended. Pediatric Patients Less Than 6 Years of Age Apply a 3 mm thick layer (approximate thickness of a tongue depressor) of NEXOBRID to a burn wound area of up to 10% BSA in one application in pediatric patients less than 6 years of age. Remove NEXOBRID after 4 hours [see Dosage and Administration (2.5)]. A second application of NEXOBRID is not recommended. 2.3 Preparation of Patient and Burn Wound Treatment Area Prepare the wound area as follows: 1. Thoroughly clean the wound to remove any charred tissue, blisters, and any topical products. 2. Apply a dressing soaked with an antibacterial solution to the treatment area for at least 2 hours. 3. Ensure the wound bed is clear of any remnants of topical agents (e.g., silver sulfadiazine, povidone iodine). 4 4. Apply an ointment skin protectant (e.g., petrolatum) 2 to 3 cm outside of the treatment area to create an ointment barrier. Avoid applying the protectant ointment to the treatment area itself, as this would impede direct contact of NEXOBRID with the eschar. 5. Protect any other open wounds (e.g., laceration, abraded skin, escharotomy incision) with skin protectant ointments or ointment gauze to prevent possible exposure to NEXOBRID. 2.4 Preparation and Application of NEXOBRID Gather the following sterile supplies prior to NEXOBRID preparation and application: • Instrument for mixing (e.g., spatula or tongue depressor) • Tongue depressor for NEXOBRID application • 0.9% Sodium Chloride Irrigation • Occlusive film dressing • Loose, thick fluffy dressing and bandage Preparation Prepare NEXOBRID at the patient’s bedside within 15 minutes of the intended application. Using aseptic technique, mix NEXOBRID lyophilized powder and gel vehicle as follows: 1. Pour the NEXOBRID lyophilized powder into the gel vehicle jar. 2. Thoroughly mix the NEXOBRID lyophilized powder and gel vehicle using a sterile instrument (e.g., tongue depressor or spatula) until the mixture is uniform. The mixed lyophilized powder and gel vehicle produce NEXOBRID in a final concentration of 8.8% w/w. DISCARD NEXOBRID IF NOT USED WITHIN 15 MINUTES OF PREPARATION, as the enzymatic activity of NEXOBRID decreases progressively following mixing. Application Apply NEXOBRID within 15 minutes of preparation as follows: 1. Moisten the treatment area by sprinkling sterile 0.9% Sodium Chloride Irrigation onto the burn wound. 2. Using a sterile tongue depressor, completely cover the moistened burn wound treatment area with the mixed NEXOBRID in a 3 mm thick layer (approximate thickness of a tongue depressor). Ensure NEXOBRID covers the entire target treatment area. 3. Cover the treated wound with a sterile occlusive film dressing. 4. Gently press the occlusive film dressing at the area of contact with the ointment barrier to ensure adherence between the occlusive film dressing and the ointment barrier and to achieve complete containment of NEXOBRID on the treatment area. There should be no visible air under the occlusive film dressing. 5. Cover the occlusive film dressing with a sterile loose, thick, fluffy dressing and secure with a sterile bandage. 6. Discard any unused portions of NEXOBRID. 5 2.5 Removal of NEXOBRID Remove NEXOBRID after 4 hours. Gather the following sterile supplies prior to NEXOBRID removal: • Blunt-edged instruments (e.g., tongue depressor) • Large dry gauze • Gauze soaked with 0.9% Sodium Chloride Irrigation • Dressing soaked with an antibacterial solution 1. Remove the occlusive film dressing using aseptic technique. 2. Remove the ointment barrier using a sterile blunt-edged instrument. 3. Remove the dissolved eschar from the wound by scraping it away with a sterile blunt-edged instrument. 4. Wipe the wound thoroughly with a large sterile dry gauze, then wipe with a sterile gauze that has been soaked with sterile 0.9% Sodium Chloride Irrigation. Rub the treated area until the appearance of a clean dermis or subcutaneous tissues with pinpoint bleeding. 5. To remove remnants of dissolved eschar, apply a dressing soaked with an antibacterial solution for at least 2 hours. 5 WARNINGS AND PRECAUTIONS 5.1 Hypersensitivity Reactions NEXOBRID-Treated Patients Serious hypersensitivity reactions, including anaphylaxis, have been reported with postmarketing use of NEXOBRID. If a hypersensitivity reaction occurs, remove NEXOBRID (if applicable) and initiate appropriate therapy. NEXOBRID is contraindicated in patients with a known hypersensitivity to anacaulase- bcdb, bromelain, pineapples or to any other component of NEXOBRID. NEXOBRID is also contraindicated in patients with known hypersensitivity to papayas or papain because of the risk of cross-sensitivity. Healthcare Providers Preparing and Applying NEXOBRID Healthcare personnel should take appropriate precautions to avoid exposure when preparing and handling NEXOBRID (e.g., gloves, surgical masks, other protective coverings, as needed). In the event of inadvertent skin exposure, rinse NEXOBRID off with water to reduce the likelihood of skin sensitization. 5.2 Coagulopathy A reduction of platelet aggregation and plasma fibrinogen levels and a moderate increase in partial thromboplastin and prothrombin times have been reported in the literature as possible effects following oral administration of bromelain, a component of NEXOBRID. In vitro and animal data suggest that bromelain can also promote fibrinolysis. Avoid use of NEXOBRID in patients with uncontrolled disorders of coagulation. Use NEXOBRID with caution in patients on anticoagulant therapy or other drugs affecting coagulation, and in patients with low platelet counts and increased risk of bleeding from other causes (e.g., peptic ulcers and sepsis). Monitor patients for possible signs of coagulation abnormalities and signs of bleeding.","""================ ======= 2.2 Recommended Dosage Recommended Dosage in Adults Apply a 3 mm thick layer (approximate thickness of a tongue depressor) of NEXOBRID to a burn wound area of up to 15% body surface area (BSA) in one application in adult patients. Remove NEXOBRID after 4 hours [see Dosage and Administration (2.5)]. A second application of NEXOBRID may be applied 24 hours following the first application to either the same area previously treated with NEXOBRID or to a new area in adult patients. Apply a second application if: • The wound area is more than 15% BSA, or • Multiple wound areas on different body surfaces require two treatments for logistical reasons such as body position, or • The first application’s eschar removal was not complete. For both applications, the total treated area must not exceed 20% BSA. Recommended Dosage in Pediatric Patients Pediatric Patients 6 Years of Age and Older Apply a 3 mm thick layer (approximate thickness of a tongue depressor) of NEXOBRID to a burn wound area of up to 15% BSA in one application in pediatric patients 6 years of age and older. Remove NEXOBRID after 4 hours [see Dosage and Administration (2.5)]. A second application of NEXOBRID is not recommended. Pediatric Patients Less Than 6 Years of Age Apply a 3 mm thick layer (approximate thickness of a tongue depressor) of NEXOBRID to a burn wound area of up to 10% BSA in one application in pediatric patients less than 6 years of age. Remove NEXOBRID after 4 hours [see Dosage and Administration (2.5)]. A second application of NEXOBRID is not recommended. 2.3 Preparation of Patient and Burn Wound Treatment Area Prepare the wound area as follows: 1. Thoroughly clean the wound to remove any charred tissue, blisters, and any topical products. 2. Apply a dressing soaked with an antibacterial solution to the treatment area for at least 2 hours. 3. Ensure the wound bed is clear of any remnants of topical agents (e.g., silver sulfadiazine, povidone iodine). 4 4. Apply an ointment skin protectant (e.g., petrolatum) 2 to 3 cm outside of the treatment area to create an ointment barrier. Avoid applying the protectant ointment to the treatment area itself, as this would impede direct contact of NEXOBRID with the eschar. 5. Protect any other open wounds (e.g., laceration, abraded skin, escharotomy incision) with skin protectant ointments or ointment gauze to prevent possible exposure to NEXOBRID. 2.4 Preparation and Application of NEXOBRID Gather the following sterile supplies prior to NEXOBRID preparation and application: • Instrument for mixing (e.g., spatula or tongue depressor) • Tongue depressor for NEXOBRID application • 0.9% Sodium Chloride Irrigation • Occlusive film dressing • Loose, thick fluffy dressing and bandage Preparation Prepare NEXOBRID at the patient’s bedside within 15 minutes of the intended application. Using aseptic technique, mix NEXOBRID lyophilized powder and gel vehicle as follows: 1. Pour the NEXOBRID lyophilized powder into the gel vehicle jar. 2. Thoroughly mix the NEXOBRID lyophilized powder and gel vehicle using a sterile instrument (e.g., tongue depressor or spatula) until the mixture is uniform. The mixed lyophilized powder and gel vehicle produce NEXOBRID in a final concentration of 8.8% w/w. DISCARD NEXOBRID IF NOT USED WITHIN 15 MINUTES OF PREPARATION, as the enzymatic activity of NEXOBRID decreases progressively following mixing. Application Apply NEXOBRID within 15 minutes of preparation as follows: 1. Moisten the treatment area by sprinkling sterile 0.9% Sodium Chloride Irrigation onto the burn wound. 2. Using a sterile tongue depressor, completely cover the moistened burn wound treatment area with the mixed NEXOBRID in a 3 mm thick layer (approximate thickness of a tongue depressor). Ensure NEXOBRID covers the entire target treatment area. 3. Cover the treated wound with a sterile occlusive film dressing. 4. Gently press the occlusive film dressing at the area of contact with the ointment barrier to ensure adherence between the occlusive film dressing and the ointment barrier and to achieve complete containment of NEXOBRID on the treatment area. There should be no visible air under the occlusive film dressing. 5. Cover the occlusive film dressing with a sterile loose, thick, fluffy dressing and secure with a sterile bandage. 6. Discard any unused portions of NEXOBRID. 5 2.5 Removal of NEXOBRID Remove NEXOBRID after 4 hours. Gather the following sterile supplies prior to NEXOBRID removal: • Blunt-edged instruments (e.g., tongue depressor) • Large dry gauze • Gauze soaked with 0.9% Sodium Chloride Irrigation • Dressing soaked with an antibacterial solution 1. Remove the occlusive film dressing using aseptic technique. 2. Remove the ointment barrier using a sterile blunt-edged instrument. 3. Remove the dissolved eschar from the wound by scraping it away with a sterile blunt-edged instrument. 4. Wipe the wound thoroughly with a large sterile dry gauze, then wipe with a sterile gauze that has been soaked with sterile 0.9% Sodium Chloride Irrigation. Rub the treated area until the appearance of a clean dermis or subcutaneous tissues with pinpoint bleeding. 5. To remove remnants of dissolved eschar, apply a dressing soaked with an antibacterial solution for at least 2 hours. 5 WARNINGS AND PRECAUTIONS 5.1 Hypersensitivity Reactions NEXOBRID-Treated Patients Serious hypersensitivity reactions, including anaphylaxis, have been reported with postmarketing use of NEXOBRID. If a hypersensitivity reaction occurs, remove NEXOBRID (if applicable) and initiate appropriate therapy. NEXOBRID is contraindicated in patients with a known hypersensitivity to anacaulase- bcdb, bromelain, pineapples or to any other component of NEXOBRID. NEXOBRID is also contraindicated in patients with known hypersensitivity to papayas or papain because of the risk of cross-sensitivity. Healthcare Providers Preparing and Applying NEXOBRID Healthcare personnel should take appropriate precautions to avoid exposure when preparing and handling NEXOBRID (e.g., gloves, surgical masks, other protective coverings, as needed). In the event of inadvertent skin exposure, rinse NEXOBRID off with water to reduce the likelihood of skin sensitization. 5.2 Coagulopathy A reduction of platelet aggregation and plasma fibrinogen levels and a moderate increase in partial thromboplastin and prothrombin times have been reported in the literature as possible effects following oral administration of bromelain, a component of NEXOBRID. In vitro and animal data suggest that bromelain can also promote fibrinolysis. Avoid use of NEXOBRID in patients with uncontrolled disorders of coagulation. Use NEXOBRID with caution in patients on anticoagulant therapy or other drugs affecting coagulation, and in patients with low platelet counts and increased risk of bleeding from other causes (e.g., peptic ulcers and sepsis). Monitor patients for possible signs of coagulation abnormalities and signs of bleeding. https://www.nexobrid-us.com/pdf/nexobrid-full-prescribing-information.pdf ================ ======= My doctor said he can't use Nexobrid to remove an eschar on my arm because of my papaya allergy. Can you explain why this allergy prevents me from using this treatment, even though papayas aren't an ingredient? Explain in 50 words or less. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Fact Finding,Q&A "Draw your answer only from the provided text. Give your answer in bullet points. If you cannot fully answer the question with only the provided information, say “I’m sorry, I cannot answer that question due to a lack of context”.","Find and summarize how nanotechnology is being used to treat cancer and influenza, highlighting the different methods, each in three to five sentences. ","What Is Nanotechnology? Most current applications of nanotechnology are evolutionary in nature, offering incremental improvements to existing products and generally modest economic and societal benefits. For example, nanotechnology has been used in display screens to improve picture quality, color, and brightness, provide wider viewing angles, reduce power consumption and extend product lives; in automobile bumpers, cargo beds, and step-assists to reduce weight, increase resistance to dents and scratches, and eliminate rust; in clothes to increase resistance to staining, wrinkling, and bacterial growth and to provide lighter-weight body armor; and in sporting goods, such as baseball bats and golf clubs, to improve performance.4 Nanotechnology plays a central role in some current applications with substantial economic value. For example, nanotechnology is a fundamental enabling technology in nearly all microchips and is fundamental to improvements in chip speed, size, weight, and energy use. Similarly, nanotechnology has substantially increased the storage density of non-volatile flash memory and computer hard drives. In the longer term, proponents of nanotechnology believe it may deliver revolutionary advances with profound economic and societal implications. The applications they discuss involve various degrees of speculation and varying time-frames. The examples below suggest a few of the areas where revolutionary advances may emerge, and for which early R&D efforts may provide insights into how such advances might be achieved. Detection and treatment of diseases. A wide range of nanotechnology applications are being developed to detect and treat diseases: *Cancer. Current nanotechnology disease detection efforts include the development of sensors that can identify biomarkers—such as altered genes,5 receptor proteins that are indicative of newly-developing blood vessels associated with early tumor development, 6 and prostate specific antigens (PSA)7—that may provide an early indicator of cancer.8 Some of these approaches are currently in clinical trials or have been approved for use by the Food and Drug Administration.9 One approach uses carbon nanotubes and nanowires to identify the unique molecular signals of cancer biomarkers. Another approach uses nanoscale cantilevers—resembling a row of diving boards—treated with molecules that bind only with cancer biomarkers. When these molecules bind, the additional weight alters the resonant frequency of the cantilevers indicating the presence and concentration of these biomarkers. Nanotechnology also holds promise for showing the presence, location, and/or contours of cancer, cardiovascular disease, or neurological disease. Current R&D efforts employ metallic, magnetic, and polymeric nanoparticles with strong imaging characteristics attached to an antibody or other agent that binds selectively with targeted cells. The imaging results can be used to guide surgical procedures and to monitor the effectiveness of non-surgical therapies in killing the disease or slowing its growth. Nanotechnology may also offer new cancer treatment approaches. For example, researchers have developed a chemically engineered adenovirus nanoparticle to deliver a molecule that stimulates the immune system10 and a nanoparticle that safely shuts down a key enzyme in cancer cells. 11 Another approach employs nanoshells with a core of silica and an outer metallic shell that can be engineered to concentrate at cancer lesion sites. Once at the sites, a harmless energy source (such as near-infrared light) can be used to cause the nanoshells to heat, killing the cancer cells they are attached to.12 Yet another treatment uses a dual cancer-killing approach. A gold nanoshell containing a chemotherapy drug attaches itself to a cancer cell. The shell is then heated using a near-infrared light source, killing the cancer cells in the vicinity while also rupturing the shell, releasing the chemotherapy drug inside the tumor. 13 Another approach would employ a nanoparticle to carry three or more different drugs and release them “in response to three distinct triggering mechanisms.”14 * Ebola. In February 2015, amid the Ebola outbreak in West Africa that began in 2014, the Food and Drug Administration provided emergency authorization of a nanotechnology-enabled antigen test for the detection of Ebola viruses. * Influenza. Medical researchers at the National Institutes for Health are using nanotechnology in the development of a molecule they intend to serve as a universal influenza vaccine that “stimulates the production of antibodies to fight against the ever-changing flu virus.” 15 * Diabetes. Diabetes is the target of a nano-enabled skin patch that painlessly delivers insulin using an array of microneedles, each of which contains more than 100 million vesicles that release insulin in response to the detection of high glucose levels.1","Find and summarize how nanotechnology is being used to treat cancer and influenza, highlighting the different methods, each in three to five sentences. Draw your answer only from the provided text. Give your answer in bullet points. If you cannot fully answer the question with only the provided information, say “I’m sorry, I cannot answer that question due to a lack of context”. Context: What Is Nanotechnology? Most current applications of nanotechnology are evolutionary in nature, offering incremental improvements to existing products and generally modest economic and societal benefits. For example, nanotechnology has been used in display screens to improve picture quality, color, and brightness, provide wider viewing angles, reduce power consumption and extend product lives; in automobile bumpers, cargo beds, and step-assists to reduce weight, increase resistance to dents and scratches, and eliminate rust; in clothes to increase resistance to staining, wrinkling, and bacterial growth and to provide lighter-weight body armor; and in sporting goods, such as baseball bats and golf clubs, to improve performance.4 Nanotechnology plays a central role in some current applications with substantial economic value. For example, nanotechnology is a fundamental enabling technology in nearly all microchips and is fundamental to improvements in chip speed, size, weight, and energy use. Similarly, nanotechnology has substantially increased the storage density of non-volatile flash memory and computer hard drives. In the longer term, proponents of nanotechnology believe it may deliver revolutionary advances with profound economic and societal implications. The applications they discuss involve various degrees of speculation and varying time-frames. The examples below suggest a few of the areas where revolutionary advances may emerge, and for which early R&D efforts may provide insights into how such advances might be achieved. Detection and treatment of diseases. A wide range of nanotechnology applications are being developed to detect and treat diseases: *Cancer. Current nanotechnology disease detection efforts include the development of sensors that can identify biomarkers—such as altered genes,5 receptor proteins that are indicative of newly-developing blood vessels associated with early tumor development, 6 and prostate specific antigens (PSA)7—that may provide an early indicator of cancer.8 Some of these approaches are currently in clinical trials or have been approved for use by the Food and Drug Administration.9 One approach uses carbon nanotubes and nanowires to identify the unique molecular signals of cancer biomarkers. Another approach uses nanoscale cantilevers—resembling a row of diving boards—treated with molecules that bind only with cancer biomarkers. When these molecules bind, the additional weight alters the resonant frequency of the cantilevers indicating the presence and concentration of these biomarkers. Nanotechnology also holds promise for showing the presence, location, and/or contours of cancer, cardiovascular disease, or neurological disease. Current R&D efforts employ metallic, magnetic, and polymeric nanoparticles with strong imaging characteristics attached to an antibody or other agent that binds selectively with targeted cells. The imaging results can be used to guide surgical procedures and to monitor the effectiveness of non-surgical therapies in killing the disease or slowing its growth. Nanotechnology may also offer new cancer treatment approaches. For example, researchers have developed a chemically engineered adenovirus nanoparticle to deliver a molecule that stimulates the immune system10 and a nanoparticle that safely shuts down a key enzyme in cancer cells. 11 Another approach employs nanoshells with a core of silica and an outer metallic shell that can be engineered to concentrate at cancer lesion sites. Once at the sites, a harmless energy source (such as near-infrared light) can be used to cause the nanoshells to heat, killing the cancer cells they are attached to.12 Yet another treatment uses a dual cancer-killing approach. A gold nanoshell containing a chemotherapy drug attaches itself to a cancer cell. The shell is then heated using a near-infrared light source, killing the cancer cells in the vicinity while also rupturing the shell, releasing the chemotherapy drug inside the tumor. 13 Another approach would employ a nanoparticle to carry three or more different drugs and release them “in response to three distinct triggering mechanisms.”14 * Ebola. In February 2015, amid the Ebola outbreak in West Africa that began in 2014, the Food and Drug Administration provided emergency authorization of a nanotechnology-enabled antigen test for the detection of Ebola viruses. * Influenza. Medical researchers at the National Institutes for Health are using nanotechnology in the development of a molecule they intend to serve as a universal influenza vaccine that “stimulates the production of antibodies to fight against the ever-changing flu virus.” 15 * Diabetes. Diabetes is the target of a nano-enabled skin patch that painlessly delivers insulin using an array of microneedles, each of which contains more than 100 million vesicles that release insulin in response to the detection of high glucose levels.1",Medical,Find & Summarize,Text Transformation "Answer the question in the prompt fully, in the format requested by the prompt, using only information in the prompt and context block.","According to the following text, how should I process the snare during the mixing phase of audio production? Please provide your response in bullet points, outlining the main processes I should apply to the snare drum.","Mixing The Drums Now that you have recorded your best drum tracks, it’s time to process and mix the audio to really bring the drums to life. By mixing the raw drum stems you can focus and balance each individual part of the drum set. There are a wide range of valuable production tools and effects that are used to enhance sound recordings. I will provide an overview and instructions to some of the most important tools used in sound recording. When mixing audio you will need to use a high quality pair of headphones or a pair of studio reference monitors. This is by no means a list of ALL of the sound recording tools available, but these are the most essential tools to enable the drums sit well in a mix, whilst adding clarity and punch. The following will all be available as plugins within your digital audio workstation. Panning Panning is a tool that spreads a signal in a multi-channel sound field. It’s crucial for making up a complete stereo image and creates the impression of space within a mix. Panning is important for mixing drums, because it mimics the realistic effect of a drum set stage sound. Using panning creates a wide sounding drum set that can be heard from all sides. The best way to pan drums is to pan the separate parts of the drum set how they appear before you as if you are playing the drums. This is called “Drummers Perspective”. •Set the kick drum and snare drum panned dead centre. •Pan the overheads fully left and right respectively. •Don’t pan the toms as extreme as the overheads. I pan the high tom to the left, middle tom slightly right and floor tom to the right. EQ EQ is a corrective and creative tool used within sound recording and reproduction to correct frequency responses using linear filters. EQ is used to strengthen or weaken frequency bands to alter a signal’s sound. What this means is that EQ allows you to adjust frequencies of a signal to improve how it sounds. EQ is your best friend in recording. It is incredibly important for balancing sounds to create a mix that allows a listener to hear all the individual parts of a drum set with clarity. Use your ears when using EQ for your drums – they are the most valuable tools at your disposal. To get your drum sounds in the right ballpark, here are some engineer approved tips for drums: •Kick EQ – Adding a bump at 60Hz will give you some thick low-end. Add 3-5kHz for some ‘knock’ and some 10kHz for some click. Try cutting around 400-500Hz, this will stop your bass drum from sounding like a cardboard box. •Snare EQ – If you want your snare to hit you in the chest, add a bump at 150-200Hz. For more body to your snare add the frequencies around 500Hz. And for more attack, add 5kHz. •Toms EQ – For toms you want to reduce boxiness and increase thump and attack. Add 100Hz for some thump and 3-5kHz for clarity. Cut the mid frequencies for toms to remove the boxy sound, but be sure to leave some left so the toms don’t sound hollow. •Overheads EQ – With the overheads your aim is to increase presence in the upper mids and high frequencies whilst reducing overall boxiness in some of the lower frequencies. If the close-mics are all sounding great you can use a high-pass filter to cut out everything below 500Hz. Compression Compression is the process of lessening the dynamic range between the loudest and quietest parts of an audio signal. The goal of compression is to even out unwanted level variations of a signal. For drums, this means turning down louder hits to match softer hits in order to make the drum sounds more balanced overall. Compression is a fairly complex tool, and there is no ‘one-size fits all’ compression setting. But proper use of compression will help smoothen out the shape of the drums and keep dynamics under control. •Threshold – When compressing drums, we generally want the entire drum signal to be compressed. You’ll want to set your threshold low enough that any drum signal can trigger it. •Attack – Nearly all the drum’s punch is found in the initial milliseconds of the drum sound. This is the “attack”. A good starting point is to set an attack of 30ms and to adjust from there. •Release – The release determines how soon the compressor stops working after its initial activation. You ideally want to set the release to be fast enough so the compression switches off before the next hit. A good starting point is around 200ms. •Ratio – The ratio determines how much the output signal increases based on the input signal. Lower ratios will provide more punch, and I would try a ratio of 3:1 or 4:1 to start with. Reverb Reverb is another essential tool in modern recording. Reverb exists all around us, and within music production the aim is to emulate a natural acoustic environment for your sounds. Digital reverb plugins mimic the way a real acoustic space works. They are designed to simulate reflections, and the echoes and the decay of high versus low frequencies. Reverb is important for bringing life to drums, and to make them sound punchy, lifelike and full within a mix. Use your ears to achieve an optimal balance for reverb. Even if you want explosive drum sounds, don’t go overboard. The choice of reverb will need to fit with the emotional quality of a song and its mix. There are five main categories of reverb. Use your ears and experiment with the different types of reverb and see what works best with your drum sounds: •Room •Hall •Chamber •Spring •Plate","According to the following text, how should I process the snare during the mixing phase of audio production? Please provide your response in bullet points, outlining the main processes I should apply to the snare drum. Mixing The Drums Now that you have recorded your best drum tracks, it’s time to process and mix the audio to really bring the drums to life. By mixing the raw drum stems you can focus and balance each individual part of the drum set. There are a wide range of valuable production tools and effects that are used to enhance sound recordings. I will provide an overview and instructions to some of the most important tools used in sound recording. When mixing audio you will need to use a high quality pair of headphones or a pair of studio reference monitors. This is by no means a list of ALL of the sound recording tools available, but these are the most essential tools to enable the drums sit well in a mix, whilst adding clarity and punch. The following will all be available as plugins within your digital audio workstation. Panning Panning is a tool that spreads a signal in a multi-channel sound field. It’s crucial for making up a complete stereo image and creates the impression of space within a mix. Panning is important for mixing drums, because it mimics the realistic effect of a drum set stage sound. Using panning creates a wide sounding drum set that can be heard from all sides. The best way to pan drums is to pan the separate parts of the drum set how they appear before you as if you are playing the drums. This is called “Drummers Perspective”. •Set the kick drum and snare drum panned dead centre. •Pan the overheads fully left and right respectively. •Don’t pan the toms as extreme as the overheads. I pan the high tom to the left, middle tom slightly right and floor tom to the right. EQ EQ is a corrective and creative tool used within sound recording and reproduction to correct frequency responses using linear filters. EQ is used to strengthen or weaken frequency bands to alter a signal’s sound. What this means is that EQ allows you to adjust frequencies of a signal to improve how it sounds. EQ is your best friend in recording. It is incredibly important for balancing sounds to create a mix that allows a listener to hear all the individual parts of a drum set with clarity. Use your ears when using EQ for your drums – they are the most valuable tools at your disposal. To get your drum sounds in the right ballpark, here are some engineer approved tips for drums: •Kick EQ – Adding a bump at 60Hz will give you some thick low-end. Add 3-5kHz for some ‘knock’ and some 10kHz for some click. Try cutting around 400-500Hz, this will stop your bass drum from sounding like a cardboard box. •Snare EQ – If you want your snare to hit you in the chest, add a bump at 150-200Hz. For more body to your snare add the frequencies around 500Hz. And for more attack, add 5kHz. •Toms EQ – For toms you want to reduce boxiness and increase thump and attack. Add 100Hz for some thump and 3-5kHz for clarity. Cut the mid frequencies for toms to remove the boxy sound, but be sure to leave some left so the toms don’t sound hollow. •Overheads EQ – With the overheads your aim is to increase presence in the upper mids and high frequencies whilst reducing overall boxiness in some of the lower frequencies. If the close-mics are all sounding great you can use a high-pass filter to cut out everything below 500Hz. Compression Compression is the process of lessening the dynamic range between the loudest and quietest parts of an audio signal. The goal of compression is to even out unwanted level variations of a signal. For drums, this means turning down louder hits to match softer hits in order to make the drum sounds more balanced overall. Compression is a fairly complex tool, and there is no ‘one-size fits all’ compression setting. But proper use of compression will help smoothen out the shape of the drums and keep dynamics under control. •Threshold – When compressing drums, we generally want the entire drum signal to be compressed. You’ll want to set your threshold low enough that any drum signal can trigger it. •Attack – Nearly all the drum’s punch is found in the initial milliseconds of the drum sound. This is the “attack”. A good starting point is to set an attack of 30ms and to adjust from there. •Release – The release determines how soon the compressor stops working after its initial activation. You ideally want to set the release to be fast enough so the compression switches off before the next hit. A good starting point is around 200ms. •Ratio – The ratio determines how much the output signal increases based on the input signal. Lower ratios will provide more punch, and I would try a ratio of 3:1 or 4:1 to start with. Reverb Reverb is another essential tool in modern recording. Reverb exists all around us, and within music production the aim is to emulate a natural acoustic environment for your sounds. Digital reverb plugins mimic the way a real acoustic space works. They are designed to simulate reflections, and the echoes and the decay of high versus low frequencies. Reverb is important for bringing life to drums, and to make them sound punchy, lifelike and full within a mix. Use your ears to achieve an optimal balance for reverb. Even if you want explosive drum sounds, don’t go overboard. The choice of reverb will need to fit with the emotional quality of a song and its mix. There are five main categories of reverb. Use your ears and experiment with the different types of reverb and see what works best with your drum sounds: •Room •Hall •Chamber •Spring •Plate",Internet/Technology,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","I'm writing a blog post, can you please make it at least 400 words? In what ways can the use of social media foster positive psychological outcomes, such as enhanced social support, improved self-expression, and access to mental health resources, particularly when considering the role of online communities, peer feedback, and the balance between virtual and real-world interactions?","What is healthy vs. potentially problematic social media use? Our study has brought preliminary evidence to answer this question. Using a nationally representative sample, we assessed the association of two dimensions of social media use—how much it’s routinely used and how emotionally connected users are to the platforms—with three health-related outcomes: social well-being, positive mental health, and self-rated health. We found that routine social media use—for example, using social media as part of everyday routine and responding to content that others share—is positively associated with all three health outcomes. Emotional connection to social media—for example, checking apps excessively out of fear of missing out, being disappointed about or feeling disconnected from friends when not logged into social media—is negatively associated with all three outcomes. In more general terms, these findings suggest that as long as we are mindful users, routine use may not in itself be a problem. Indeed, it could be beneficial. For those with unhealthy social media use, behavioral interventions may help. For example, programs that develop “effortful control” skills—the ability to self-regulate behavior—have been widely shown to be useful in dealing with problematic Internet and social media use. We’re used to hearing that social media use is harmful to mental health and well-being, particularly for young people. Did it surprise you to find that it can have positive effects? The findings go against what some might expect, which is intriguing. We know that having a strong social network is associated with positive mental health and well-being. Routine social media use may compensate for diminishing face-to-face social interactions in people’s busy lives. Social media may provide individuals with a platform that overcomes barriers of distance and time, allowing them to connect and reconnect with others and thereby expand and strengthen their in-person networks and interactions. Indeed, there is some empirical evidence supporting this. On the other hand, a growing body of research has demonstrated that social media use is negatively associated with mental health and well-being, particularly among young people—for example, it may contribute to increased risk of depression and anxiety symptoms. Our findings suggest that the ways that people are using social media may have more of an impact on their mental health and well-being than just the frequency and duration of their use. What disparities did you find in the ways that social media use benefits and harms certain populations? What concerns does this raise? My co-authors Rachel McCloud, Vish Viswanath, and I found that the benefits and harms associated with social media use varied across demographic, socioeconomic, and racial population sub-groups. Specifically, while the benefits were generally associated with younger age, better education, and being white, the harms were associated with older age, less education, and being a racial minority. Indeed, these findings are consistent with the body of work on communication inequalities and health disparities that our lab, the Viswanath lab, has documented over the past 15 or so years. We know that education, income, race, and ethnicity influence people’s access to, and ability to act on, health information from media, including the Internet. The concern is that social media may perpetuate those differences. — Amy Roeder","[question] I'm writing a blog post, can you please make it at least 400 words? In what ways can the use of social media foster positive psychological outcomes, such as enhanced social support, improved self-expression, and access to mental health resources, particularly when considering the role of online communities, peer feedback, and the balance between virtual and real-world interactions? ===================== [text] What is healthy vs. potentially problematic social media use? Our study has brought preliminary evidence to answer this question. Using a nationally representative sample, we assessed the association of two dimensions of social media use—how much it’s routinely used and how emotionally connected users are to the platforms—with three health-related outcomes: social well-being, positive mental health, and self-rated health. We found that routine social media use—for example, using social media as part of everyday routine and responding to content that others share—is positively associated with all three health outcomes. Emotional connection to social media—for example, checking apps excessively out of fear of missing out, being disappointed about or feeling disconnected from friends when not logged into social media—is negatively associated with all three outcomes. In more general terms, these findings suggest that as long as we are mindful users, routine use may not in itself be a problem. Indeed, it could be beneficial. For those with unhealthy social media use, behavioral interventions may help. For example, programs that develop “effortful control” skills—the ability to self-regulate behavior—have been widely shown to be useful in dealing with problematic Internet and social media use. We’re used to hearing that social media use is harmful to mental health and well-being, particularly for young people. Did it surprise you to find that it can have positive effects? The findings go against what some might expect, which is intriguing. We know that having a strong social network is associated with positive mental health and well-being. Routine social media use may compensate for diminishing face-to-face social interactions in people’s busy lives. Social media may provide individuals with a platform that overcomes barriers of distance and time, allowing them to connect and reconnect with others and thereby expand and strengthen their in-person networks and interactions. Indeed, there is some empirical evidence supporting this. On the other hand, a growing body of research has demonstrated that social media use is negatively associated with mental health and well-being, particularly among young people—for example, it may contribute to increased risk of depression and anxiety symptoms. Our findings suggest that the ways that people are using social media may have more of an impact on their mental health and well-being than just the frequency and duration of their use. What disparities did you find in the ways that social media use benefits and harms certain populations? What concerns does this raise? My co-authors Rachel McCloud, Vish Viswanath, and I found that the benefits and harms associated with social media use varied across demographic, socioeconomic, and racial population sub-groups. Specifically, while the benefits were generally associated with younger age, better education, and being white, the harms were associated with older age, less education, and being a racial minority. Indeed, these findings are consistent with the body of work on communication inequalities and health disparities that our lab, the Viswanath lab, has documented over the past 15 or so years. We know that education, income, race, and ethnicity influence people’s access to, and ability to act on, health information from media, including the Internet. The concern is that social media may perpetuate those differences. — Amy Roeder https://www.hsph.harvard.edu/news/features/social-media-positive-mental-health/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Concept Comparison,Q&A "Only refer to the document to answer the question. Only answer the question, do not add extra chatter or descriptions. Your answer should not be in bullet point format.","According to this document, can chats on a discussion board be cited for cyber bullying?","UNIVERSITY ANTI-HARASSMENT POLICY The University strictly prohibits harassment in any form, including sexual harassment, in accordance with all five pillars: love (Mathew 22:37, 39), integrity (Proverbs 11:3), discipleship (Matthew 28:19), wisdom (Proverbs 9:10) and unity (Ephesians 4:3). Harassment is serious misconduct. It subverts the mission of the University and threatens the careers, educational experience, and well-being of students, faculty and staff. In addition, harassment is contrary to the biblical principles upon which this University is founded and operates. No one has the authority to engage in this behavior, and the University does not tolerate harassment by, or directed toward, any student, employee or other persons on campus. To promote a pleasant work and educational environment free of harassment and to avoid the risk of damaging the reputation and resources of the University, all employees, students and other persons on campus are expected to refrain from any behavior that could be viewed as harassing, including immoral or unprofessional conduct. In addition, it is the duty of all employees of the University to prevent harassment by others. THREATS Proverbs 21:21 Whoever pursues righteousness and kindness will find life, righteousness and honor. 31 BULLYING/CYBER-BULLYING stopbullying.gov Bullying will not be tolerated, and students will be subject to discipline if found to have been a part of bullying in accordance with all five pillars: love (Mathew 22:37, 39), integrity (Proverbs 11:3), discipleship (Matthew 28:19), wisdom (Proverbs 9:10) and unity (Ephesians 4:3). Bullying is described as follows: Bullying is a form of aggressive behavior manifested by the use of force or coercion to affect others, particularly when the behavior is habitual and involves an imbalance of power. It can include verbal harassment, physical assault or coercion and may be directed repeatedly towards particular victims, perhaps on grounds of race, religion, gender, sexuality or ability. Bullying consists of three basic types of abuse: emotional, verbal and physical. Cyber-Bullying will not be tolerated and students will be subject to discipline if found to have been part of cyber-bullying. Cyber-bullying is described as follows: • actions that use information and communication technologies to support deliberate, repeated and hostile behavior by an individual or group that is intended to harm another or others • use of communication technologies for the intention of harming another person • use of internet service and mobile technologies such as web pages and discussion groups as well as instant messaging or text messaging with the intention of harming another person Sexual harassment is a unique form of harassment in several respects. Traditionally, a sexual harassment claim has been based on the premise that an individual with power over an employee’s employment or a student’s academic standing required sexual favors in return for job or academic rewards. Such a claim has usually involved conduct between a supervisor and subordinate or a faculty member and student. However, the legal definition of sexual harassment is much broader. For example, harassment may exist where the University tolerates an intimidating, hostile or offensive atmosphere, even if the conduct was initially welcomed or even initiated by the “victim.” Liability may also exist between co-workers at the same job level, between fellow students or between other persons of the same University status. Bullying/Cyber-Bullying Policy: fhu.edu/campuslife/studentservices HAZING In recent years, hazing has come under a lot of bad press nationally. Some states have passed legislation against the practice, including Tennessee. National fraternities are working hard to eliminate the practice. Freed-Hardeman students may seek to rationalize and say that nothing 32 FHU HAZING RESPONSE How is an incident reported? Students who feel that they have been the victim of a hazing incident can contact the Office of Student Life or the Office of Student Services directly or they may fill out a confidential hazing report form. The hazing report form may be picked up in the Office of Student Life or the Office of Student Services. Does the student who is hazed have to file a report? Anyone who witnesses hazing may report the incident in the same manner described above. What happens when a hazing incident is reported? • Once the Office of Student Life or the Office of Student Services is notified officially (see above) of a potential hazing incident, the Student Life and Student Services Offices will meet immediately to review the incident report. • The student reporting the hazing incident will be summoned to make a statement. • The students accused of hazing will be summoned to make a statement. • Other witnesses may be called for clarification. • If the hazing report proves to be valid after these meeting have occurred, all club sponsors will be notified of the allegation of hazing against their club and asked to meet with the Student Life and Student Services Office. • After club sponsors have been notified the social club officers will be called for a mandatory meeting with the Office of Student Life and the Dean of Students and sponsors to present the allegation of hazing (no student names are to be used). What is FHU’s response to hazing? In the event that hazing has occurred, students involved in the incident will forfeit their membership in their social club. They will also lose membership in the following groups if a member (UPC, Interface, Makin’ Music Director). The loss of membership will prevent them from participating in intramurals, fundraising opportunities for the club, banquets, club meetings or any other club related activities. Students will also be subject to discipline by the Office of Student Services. we do can be termed as hazing. There is a clear legal concern for any club that fails to follow the guidelines established by the University. The purpose of the guidelines is not to make the induction of new members harder for the clubs, but to protect the club and prospective members from irrational acts that may not be well thought out. Therefore, any club or individual who persists in engaging in activities that have danger of physical discomfort, pain or harm, or that subjects the student to humiliation and degradation should be aware that the club and/or the individual may become legally liable for such acts. Hazing Policy: fhu.edu/campuslife/studentservices TENNESSEE HAZING LAW Tennessee Code: 49-7-123. Hazing prohibited: stophazing.org/policy/state-laws/tennessee/ FHU HAZING RESPONSE How is an incident reported? Students who feel that they have been the victim of a hazing incident can contact the Office of Student Life or the Office of Student Services directly or they may fill out a confidential hazing report form. The hazing report form may be picked up in the Office of Student Life or the Office of Student Services. Does the student who is hazed have to file a report? Anyone who witnesses hazing may report the incident in the same manner described above. What happens when a hazing incident is reported? • Once the Office of Student Life or the Office of Student Services is notified officially (see above) of a potential hazing incident, the Student Life and Student Services Offices will meet immediately to review the incident report. • The student reporting the hazing incident will be summoned to make a statement. • The students accused of hazing will be summoned to make a statement. • Other witnesses may be called for clarification. • If the hazing report proves to be valid after these meeting have occurred, all club sponsors will be notified of the allegation of hazing against their club and asked to meet with the Student Life and Student Services Office. • After club sponsors have been notified the social club officers will be called for a mandatory meeting with the Office of Student Life and the Dean of Students and sponsors to present the allegation of hazing (no student names are to be used). What is FHU’s response to hazing? In the event that hazing has occurred, students involved in the incident will forfeit their membership in their social club. They will also lose membership in the following groups if a member (UPC, Interface, Makin’ Music Director). The loss of membership will prevent them from participating in intramurals, fundraising opportunities for the club, banquets, club meetings or any other club related activities. Students will also be subject to discipline by the Office of Student Services. we do can be termed as hazing. There is a clear legal concern for any club that fails to follow the guidelines established by the University. The purpose of the guidelines is not to make the induction of new members harder for the clubs, but to protect the club and prospective members from irrational acts that may not be well thought out. Therefore, any club or individual who persists in engaging in activities that have danger of physical discomfort, pain or harm, or that subjects the student to humiliation and degradation should be aware that the club and/or the individual may become legally liable for such acts. Hazing Policy: fhu.edu/campuslife/studentservices TENNESSEE HAZING LAW Tennessee Code: 49-7-123. Hazing prohibited: stophazing.org/policy/state-laws/tennessee/","
================== UNIVERSITY ANTI-HARASSMENT POLICY The University strictly prohibits harassment in any form, including sexual harassment, in accordance with all five pillars: love (Mathew 22:37, 39), integrity (Proverbs 11:3), discipleship (Matthew 28:19), wisdom (Proverbs 9:10) and unity (Ephesians 4:3). Harassment is serious misconduct. It subverts the mission of the University and threatens the careers, educational experience, and well-being of students, faculty and staff. In addition, harassment is contrary to the biblical principles upon which this University is founded and operates. No one has the authority to engage in this behavior, and the University does not tolerate harassment by, or directed toward, any student, employee or other persons on campus. To promote a pleasant work and educational environment free of harassment and to avoid the risk of damaging the reputation and resources of the University, all employees, students and other persons on campus are expected to refrain from any behavior that could be viewed as harassing, including immoral or unprofessional conduct. In addition, it is the duty of all employees of the University to prevent harassment by others. THREATS Proverbs 21:21 Whoever pursues righteousness and kindness will find life, righteousness and honor. 31 BULLYING/CYBER-BULLYING stopbullying.gov Bullying will not be tolerated, and students will be subject to discipline if found to have been a part of bullying in accordance with all five pillars: love (Mathew 22:37, 39), integrity (Proverbs 11:3), discipleship (Matthew 28:19), wisdom (Proverbs 9:10) and unity (Ephesians 4:3). Bullying is described as follows: Bullying is a form of aggressive behavior manifested by the use of force or coercion to affect others, particularly when the behavior is habitual and involves an imbalance of power. It can include verbal harassment, physical assault or coercion and may be directed repeatedly towards particular victims, perhaps on grounds of race, religion, gender, sexuality or ability. Bullying consists of three basic types of abuse: emotional, verbal and physical. Cyber-Bullying will not be tolerated and students will be subject to discipline if found to have been part of cyber-bullying. Cyber-bullying is described as follows: • actions that use information and communication technologies to support deliberate, repeated and hostile behavior by an individual or group that is intended to harm another or others • use of communication technologies for the intention of harming another person • use of internet service and mobile technologies such as web pages and discussion groups as well as instant messaging or text messaging with the intention of harming another person Sexual harassment is a unique form of harassment in several respects. Traditionally, a sexual harassment claim has been based on the premise that an individual with power over an employee’s employment or a student’s academic standing required sexual favors in return for job or academic rewards. Such a claim has usually involved conduct between a supervisor and subordinate or a faculty member and student. However, the legal definition of sexual harassment is much broader. For example, harassment may exist where the University tolerates an intimidating, hostile or offensive atmosphere, even if the conduct was initially welcomed or even initiated by the “victim.” Liability may also exist between co-workers at the same job level, between fellow students or between other persons of the same University status. Bullying/Cyber-Bullying Policy: fhu.edu/campuslife/studentservices HAZING In recent years, hazing has come under a lot of bad press nationally. Some states have passed legislation against the practice, including Tennessee. National fraternities are working hard to eliminate the practice. Freed-Hardeman students may seek to rationalize and say that nothing 32 FHU HAZING RESPONSE How is an incident reported? Students who feel that they have been the victim of a hazing incident can contact the Office of Student Life or the Office of Student Services directly or they may fill out a confidential hazing report form. The hazing report form may be picked up in the Office of Student Life or the Office of Student Services. Does the student who is hazed have to file a report? Anyone who witnesses hazing may report the incident in the same manner described above. What happens when a hazing incident is reported? • Once the Office of Student Life or the Office of Student Services is notified officially (see above) of a potential hazing incident, the Student Life and Student Services Offices will meet immediately to review the incident report. • The student reporting the hazing incident will be summoned to make a statement. • The students accused of hazing will be summoned to make a statement. • Other witnesses may be called for clarification. • If the hazing report proves to be valid after these meeting have occurred, all club sponsors will be notified of the allegation of hazing against their club and asked to meet with the Student Life and Student Services Office. • After club sponsors have been notified the social club officers will be called for a mandatory meeting with the Office of Student Life and the Dean of Students and sponsors to present the allegation of hazing (no student names are to be used). What is FHU’s response to hazing? In the event that hazing has occurred, students involved in the incident will forfeit their membership in their social club. They will also lose membership in the following groups if a member (UPC, Interface, Makin’ Music Director). The loss of membership will prevent them from participating in intramurals, fundraising opportunities for the club, banquets, club meetings or any other club related activities. Students will also be subject to discipline by the Office of Student Services. we do can be termed as hazing. There is a clear legal concern for any club that fails to follow the guidelines established by the University. The purpose of the guidelines is not to make the induction of new members harder for the clubs, but to protect the club and prospective members from irrational acts that may not be well thought out. Therefore, any club or individual who persists in engaging in activities that have danger of physical discomfort, pain or harm, or that subjects the student to humiliation and degradation should be aware that the club and/or the individual may become legally liable for such acts. Hazing Policy: fhu.edu/campuslife/studentservices TENNESSEE HAZING LAW Tennessee Code: 49-7-123. Hazing prohibited: stophazing.org/policy/state-laws/tennessee/ FHU HAZING RESPONSE How is an incident reported? Students who feel that they have been the victim of a hazing incident can contact the Office of Student Life or the Office of Student Services directly or they may fill out a confidential hazing report form. The hazing report form may be picked up in the Office of Student Life or the Office of Student Services. Does the student who is hazed have to file a report? Anyone who witnesses hazing may report the incident in the same manner described above. What happens when a hazing incident is reported? • Once the Office of Student Life or the Office of Student Services is notified officially (see above) of a potential hazing incident, the Student Life and Student Services Offices will meet immediately to review the incident report. • The student reporting the hazing incident will be summoned to make a statement. • The students accused of hazing will be summoned to make a statement. • Other witnesses may be called for clarification. • If the hazing report proves to be valid after these meeting have occurred, all club sponsors will be notified of the allegation of hazing against their club and asked to meet with the Student Life and Student Services Office. • After club sponsors have been notified the social club officers will be called for a mandatory meeting with the Office of Student Life and the Dean of Students and sponsors to present the allegation of hazing (no student names are to be used). What is FHU’s response to hazing? In the event that hazing has occurred, students involved in the incident will forfeit their membership in their social club. They will also lose membership in the following groups if a member (UPC, Interface, Makin’ Music Director). The loss of membership will prevent them from participating in intramurals, fundraising opportunities for the club, banquets, club meetings or any other club related activities. Students will also be subject to discipline by the Office of Student Services. we do can be termed as hazing. There is a clear legal concern for any club that fails to follow the guidelines established by the University. The purpose of the guidelines is not to make the induction of new members harder for the clubs, but to protect the club and prospective members from irrational acts that may not be well thought out. Therefore, any club or individual who persists in engaging in activities that have danger of physical discomfort, pain or harm, or that subjects the student to humiliation and degradation should be aware that the club and/or the individual may become legally liable for such acts. Hazing Policy: fhu.edu/campuslife/studentservices TENNESSEE HAZING LAW Tennessee Code: 49-7-123. Hazing prohibited: stophazing.org/policy/state-laws/tennessee/ ================== Only refer to the document to answer the question. Only answer the question, do not add extra chatter or descriptions. Your answer should not be in bullet point format. ================== According to this document, can chats on a discussion board be cited for cyber bullying?",Unknown,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",Farmer Old MacDonald operates a large and very efficient farm in Iowa. Is it likely that Old MacDonald's farm is also very profitable if he owns his land? Use the relevant financial measures in answering the question.,"Financial Performance Measures for Iowa Farms Farmers who have a large investment in land, machinery, livestock, and equipment need to keep informed about the financial condition of their operations. Some useful measures of financial performance can be calculated from information found in most farm record books and accounting programs. These measures can help farmers assess the profitability, debt capacity, and financial risk currently faced by their businesses. The measures presented in this publication are based on guidelines of the Farm Financial Standards Council, ffsc.org/, and are used by most agricultural lenders and farm accountants. Types of Measures Five different areas of financial condition are measured. Liquidity refers to the degree to which debt obligations coming due can be paid from cash or assets that soon will be turned into cash. This is measured by the current ratio, the amount of working capital, and the amount of working capital per dollar of gross revenue. A more thorough analysis of liquidity can be made with a cash flow budget. FM1792, AgDM File C3-15: Twelve Steps to Cash Flow Budgeting, store. extension.iastate.edu/Product/1815.pdf, explains this tool in detail. Solvency refers to the degree to which all debts are secured and the relative mix of equity and debt capital used by the farm. The total debt-to-asset ratio is one of several ratios used to measure solvency, all of which are based on the same relationship of assets, liabilities, and net worth. Profitability refers to the difference between income and expenses. One important measure of profitability is net farm income. Annual rates of return on both equity capital and total assets also can be calculated and compared to interest rates for loans or rates of return from alternative investments. Financial efficiency ratios show what percent of gross farm revenue went to pay interest, operating expenses, and depreciation, and how much was left for net farm income. The asset turnover ratio measures how much gross income was generated for each dollar invested in land, livestock, equipment, and other assets. Repayment capacity measures show the degree to which cash generated from the farm and other sources will be sufficient to pay principal and interest payments as they come due. Using Performance Measures Values for the farm financial measures should be calculated for several years to observe trends and to avoid making judgments based on an unusual year. Typical historical values for most of these measures can be found in the tables at the end of this publication. They are based on data obtained from the Iowa Farm Business Association (IFBA). Values will vary according to the major enterprises carried out, farm size, location, and the type of land tenure. Other comparable data can be found in the annual publication FM1789, AgDM File C1-10: Iowa Farm Costs and Returns, store.extension.iastate.edu/ Product/1812.pdf. Liquidity Farms with good liquidity typically have current ratios of at least 3.0 or higher. Dairy farms or other farms that have continuous sales throughout the year can safely operate with a current ratio as low as 2.0, however. Conversely, operations that concentrate sales during several periods each year, such as cash grain farms, need to strive for a current ratio higher than 3.0, especially near the beginning of the year. The amount of working capital needed depends on the size of the operation. Records show that working capital measured at the beginning of the year is typically equal to about 50-70% of the farm’s annual gross revenue. For dairy farms, working capital can be as low as 30% of gross revenue, but cash grain farms may need as much as 50%. Solvency Total debt-to-asset ratios tend to be higher for larger farms and for farms that specialize in livestock feeding. Ratios of 10-30% are common among Iowa farms, although many operate with little or no debt. A high debt load does not make farms less efficient, but principal and interest payments eat into cash flow. High-efficiency farms are able to service a higher debt load safely. Two other ratios are commonly used to measure solvency. The equity-to-asset ratio shows how many dollars of net worth a farm has for every dollar of assets. It is equal to 100% minus the debt-to-asset ratio. Higher equity-to-asset ratios indicate a less risky financial situation. Some lenders prefer to use the debt-to-equity ratio to measure solvency. Higher ratios indicate more risk. Another useful measure is how much net worth the farm has for each crop acre farmed, especially for cash grain farms. The IFBA average is nearly $2,500. Profitability Net farm income from operations is what is left from all income received from the farm business in the past year, minus all the operating expenses used to generate this income. Note that operating expenses do not include the cost of financing the business, which is interest expense. Net farm income, or what is left after subtracting interest, is highly variable from year to year and is closely tied to the size and efficiency of the operation. It also depends on the amount of debt the farm is carrying. The rate of return on farm assets is quite variable, too, but average long-term rates of 6-10% have been common in Iowa. High-profit farms may average more than 12%, while low-profit farms often realize a return of only 2% or less. The average rate of return on farm equity measures how fast farm net worth is growing. Highly leveraged farms may earn little or no return on equity when interest rates are high. On the other hand, if the farm’s overall return on assets is higher than the cost of borrowed money, the return on equity may be quite high and net worth will grow rapidly. Operating profit margin is equal to the dollar return to capital divided by the value of farm production each year. Ratios have averaged about 6-10% in recent years, and 25-30% in the 2000s. High-profit farms have had ratios of 30% or more, while low-profit farms have had ratios of less than 10%. Farms that hire or rent assets such as labor, land, or machinery usually will have a lower operating profit margin because operating costs are higher. However, they will also generate a larger gross and net income. Farms with owned or crop share rented land will have a higher operating profit margin because they have lower operating expenses. Another common measure of profitability is Earnings Before Interest, Taxes, Depreciation, and Amortization, abbreviated as EBITDA. It shows how many dollars are available for debt repayment. Financial Efficiency Asset turnover ratios for typical farms are about 20-30%, but they can range from 10-20% for lowprofit farms and up to 30-50% for high-profit farms. The asset turnover ratio measures the efficient use of investment capital to generate revenue while the operating profit margin ratio measures the efficient use of operating capital. Because they are substitutes for each other (owned and rented land, for example), farms that are high in one measure may be low in the other. Farms with mostly rented land should have higher asset turnover ratios than farms with mostly owned land, generally around 50%. Rented farms also will have higher operating expense ratios because rent paid is included in operating expenses. Likewise, rented farms will tend to have lower depreciation and interest expense ratios than owned farms. Typically, about 60-70% of gross revenue goes for operating expenses, 5-10% goes for depreciation, and under 5% goes for interest. The average net farm income ratio for Iowa farms has been in the 5-15% range in recent years but used to be in the 20-30% range in the 2000s. High-profit farms have averaged 20% over the past decade, while lowprofit farms averaged less than 5%.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. Farmer Old MacDonald operates a large and very efficient farm in Iowa. Is it likely that Old MacDonald's farm is also very profitable if he owns his land? Use the relevant financial measures in answering the question. Financial Performance Measures for Iowa Farms Farmers who have a large investment in land, machinery, livestock, and equipment need to keep informed about the financial condition of their operations. Some useful measures of financial performance can be calculated from information found in most farm record books and accounting programs. These measures can help farmers assess the profitability, debt capacity, and financial risk currently faced by their businesses. The measures presented in this publication are based on guidelines of the Farm Financial Standards Council, ffsc.org/, and are used by most agricultural lenders and farm accountants. Types of Measures Five different areas of financial condition are measured. Liquidity refers to the degree to which debt obligations coming due can be paid from cash or assets that soon will be turned into cash. This is measured by the current ratio, the amount of working capital, and the amount of working capital per dollar of gross revenue. A more thorough analysis of liquidity can be made with a cash flow budget. FM1792, AgDM File C3-15: Twelve Steps to Cash Flow Budgeting, store. extension.iastate.edu/Product/1815.pdf, explains this tool in detail. Solvency refers to the degree to which all debts are secured and the relative mix of equity and debt capital used by the farm. The total debt-to-asset ratio is one of several ratios used to measure solvency, all of which are based on the same relationship of assets, liabilities, and net worth. Profitability refers to the difference between income and expenses. One important measure of profitability is net farm income. Annual rates of return on both equity capital and total assets also can be calculated and compared to interest rates for loans or rates of return from alternative investments. Financial efficiency ratios show what percent of gross farm revenue went to pay interest, operating expenses, and depreciation, and how much was left for net farm income. The asset turnover ratio measures how much gross income was generated for each dollar invested in land, livestock, equipment, and other assets. Repayment capacity measures show the degree to which cash generated from the farm and other sources will be sufficient to pay principal and interest payments as they come due. Using Performance Measures Values for the farm financial measures should be calculated for several years to observe trends and to avoid making judgments based on an unusual year. Typical historical values for most of these measures can be found in the tables at the end of this publication. They are based on data obtained from the Iowa Farm Business Association (IFBA). Values will vary according to the major enterprises carried out, farm size, location, and the type of land tenure. Other comparable data can be found in the annual publication FM1789, AgDM File C1-10: Iowa Farm Costs and Returns, store.extension.iastate.edu/ Product/1812.pdf. Liquidity Farms with good liquidity typically have current ratios of at least 3.0 or higher. Dairy farms or other farms that have continuous sales throughout the year can safely operate with a current ratio as low as 2.0, however. Conversely, operations that concentrate sales during several periods each year, such as cash grain farms, need to strive for a current ratio higher than 3.0, especially near the beginning of the year. The amount of working capital needed depends on the size of the operation. Records show that working capital measured at the beginning of the year is typically equal to about 50-70% of the farm’s annual gross revenue. For dairy farms, working capital can be as low as 30% of gross revenue, but cash grain farms may need as much as 50%. Solvency Total debt-to-asset ratios tend to be higher for larger farms and for farms that specialize in livestock feeding. Ratios of 10-30% are common among Iowa farms, although many operate with little or no debt. A high debt load does not make farms less efficient, but principal and interest payments eat into cash flow. High-efficiency farms are able to service a higher debt load safely. Two other ratios are commonly used to measure solvency. The equity-to-asset ratio shows how many dollars of net worth a farm has for every dollar of assets. It is equal to 100% minus the debt-to-asset ratio. Higher equity-to-asset ratios indicate a less risky financial situation. Some lenders prefer to use the debt-to-equity ratio to measure solvency. Higher ratios indicate more risk. Another useful measure is how much net worth the farm has for each crop acre farmed, especially for cash grain farms. The IFBA average is nearly $2,500. Profitability Net farm income from operations is what is left from all income received from the farm business in the past year, minus all the operating expenses used to generate this income. Note that operating expenses do not include the cost of financing the business, which is interest expense. Net farm income, or what is left after subtracting interest, is highly variable from year to year and is closely tied to the size and efficiency of the operation. It also depends on the amount of debt the farm is carrying. The rate of return on farm assets is quite variable, too, but average long-term rates of 6-10% have been common in Iowa. High-profit farms may average more than 12%, while low-profit farms often realize a return of only 2% or less. The average rate of return on farm equity measures how fast farm net worth is growing. Highly leveraged farms may earn little or no return on equity when interest rates are high. On the other hand, if the farm’s overall return on assets is higher than the cost of borrowed money, the return on equity may be quite high and net worth will grow rapidly. Operating profit margin is equal to the dollar return to capital divided by the value of farm production each year. Ratios have averaged about 6-10% in recent years, and 25-30% in the 2000s. High-profit farms have had ratios of 30% or more, while low-profit farms have had ratios of less than 10%. Farms that hire or rent assets such as labor, land, or machinery usually will have a lower operating profit margin because operating costs are higher. However, they will also generate a larger gross and net income. Farms with owned or crop share rented land will have a higher operating profit margin because they have lower operating expenses. Another common measure of profitability is Earnings Before Interest, Taxes, Depreciation, and Amortization, abbreviated as EBITDA. It shows how many dollars are available for debt repayment. Financial Efficiency Asset turnover ratios for typical farms are about 20-30%, but they can range from 10-20% for lowprofit farms and up to 30-50% for high-profit farms. The asset turnover ratio measures the efficient use of investment capital to generate revenue while the operating profit margin ratio measures the efficient use of operating capital. Because they are substitutes for each other (owned and rented land, for example), farms that are high in one measure may be low in the other. Farms with mostly rented land should have higher asset turnover ratios than farms with mostly owned land, generally around 50%. Rented farms also will have higher operating expense ratios because rent paid is included in operating expenses. Likewise, rented farms will tend to have lower depreciation and interest expense ratios than owned farms. Typically, about 60-70% of gross revenue goes for operating expenses, 5-10% goes for depreciation, and under 5% goes for interest. The average net farm income ratio for Iowa farms has been in the 5-15% range in recent years but used to be in the 20-30% range in the 2000s. High-profit farms have averaged 20% over the past decade, while lowprofit farms averaged less than 5%. https://www.extension.iastate.edu/agdm/wholefarm/pdf/c3-55.pdf",Financial,Effect Analysis,Q&A Respond only based on the information provided in the prompt. You cannot use any external resources or prior knowledge to answer questions. Format your response using markdown where appropriate.,Create a list of the key information about where New Zealanders are currently spending money on gambling,"A new Strategy to Prevent and Minimise Gambling Harm The Government has set a clear direction for mental health and addiction in New Zealand with a priority focus on: • increasing access to mental health and addiction support • growing the mental health and addiction workforce • strengthening the focus on the prevention of and early intervention • improving the effectiveness of mental health and addiction support. This direction, supported by available data, research and evidence of what works, has driven the development of this new draft Strategy to Prevent and Minimise Gambling Harm 2025/26 to 2027/28 (the Strategy). This document seeks your comment on the proposed direction and content of the draft Strategy. It provides the full proposed Strategy for public consultation, and includes: • the problem definition and needs assessment, which informs the proposed Strategy as required under the Gambling Act 2003 (the Act)1 • the strategic plan, including the strategic framework that sets out the goal, outcomes, priorities and actions for the Strategy • the service plan for the three years from 2025/26 to 2027/28, including the amount of funding required for the Ministry of Health | Manatū Hauora (the Ministry) and Health New Zealand | Te Whatu Ora (Health New Zealand) to deliver the gambling harm prevention and minimisation activities described in the Strategy • the problem gambling levy rates and weighting options per sector for the next three years. Problem definition: Gambling harm is wide-reaching and services are under pressure to respond to a changing gambling environment About one in five people in New Zealand experience harm as a result of their own or someone else’s gambling. Harm is not experienced evenly across our communities, and Māori, Pacific, Asian and young people are at greater risk. Department of Internal Affairs data show that in 2022/23, New Zealanders lost $2.76 billion gambling on the four regulated gambling sectors (Lotto New Zealand, TAB NZ, casinos and non-casino gambling machines or class 4 gambling). Most money spent on gambling comes from the relatively small number of people (around 11% of adults in 2020) who play electronic gaming machines (“pokies”). For the first time in 2022/23, New Zealanders lost over $1 billion on these machines, which are disproportionately located in higher deprivation areas. In addition, online gambling, which has the potential to cause significant harm, is expanding into New Zealand. The unregulated offshore online gambling market has grown significantly in recent years, with higher participation, higher spend, and greater harm being reported by New Zealanders. The Government has agreed to regulate online casinos through a licensing system, which will be designed to minimise harm, support tax collection, and provide consumer protections to New Zealanders. This regime is expected to come into effect in 2026. Whether an individual experiences harm from their own or someone else’s gambling, and how this harm is experienced at a whānau and community level, results from many factors. This includes the wider determinants of health and wellbeing and the nature of the gambling environment. The Gambling Act 2003 and associated regulations, as administered by the Dept of Internal Affairs, set the framework for legal gambling in New Zealand. The Act requires a needs assessment be undertaken to inform each iteration of the Strategy. The 2024 needs assessment highlights a changing environment and gambling 2 harm services under pressure . Key findings include: • Gambling activity has remained relatively constant in New Zealand, with data indicating that most adults engage in gambling at some stage in their lives. • While there has been a reduction in the number of pokies the distribution and availability of these machines remains disproportionately high in areas of high- deprivation. Expenditure on pokies has continued to increase. • Online gambling, particularly with unregulated providers based overseas, continues to grow. This is revealing inconsistencies with the current levy funding regime and service provisions. • The gambling harm minimisation sector is under pressure and has found the health reforms challenging. It seeks stronger government leadership and coordination.","Respond only based on the information provided in the prompt. You cannot use any external resources or prior knowledge to answer questions. Format your response using markdown where appropriate. Create a list of the key information about where New Zealanders are currently spending money on gambling A new Strategy to Prevent and Minimise Gambling Harm The Government has set a clear direction for mental health and addiction in New Zealand with a priority focus on: • increasing access to mental health and addiction support • growing the mental health and addiction workforce • strengthening the focus on the prevention of and early intervention • improving the effectiveness of mental health and addiction support. This direction, supported by available data, research and evidence of what works, has driven the development of this new draft Strategy to Prevent and Minimise Gambling Harm 2025/26 to 2027/28 (the Strategy). This document seeks your comment on the proposed direction and content of the draft Strategy. It provides the full proposed Strategy for public consultation, and includes: • the problem definition and needs assessment, which informs the proposed Strategy as required under the Gambling Act 2003 (the Act)1 • the strategic plan, including the strategic framework that sets out the goal, outcomes, priorities and actions for the Strategy • the service plan for the three years from 2025/26 to 2027/28, including the amount of funding required for the Ministry of Health | Manatū Hauora (the Ministry) and Health New Zealand | Te Whatu Ora (Health New Zealand) to deliver the gambling harm prevention and minimisation activities described in the Strategy • the problem gambling levy rates and weighting options per sector for the next three years. Problem definition: Gambling harm is wide-reaching and services are under pressure to respond to a changing gambling environment About one in five people in New Zealand experience harm as a result of their own or someone else’s gambling. Harm is not experienced evenly across our communities, and Māori, Pacific, Asian and young people are at greater risk. Department of Internal Affairs data show that in 2022/23, New Zealanders lost $2.76 billion gambling on the four regulated gambling sectors (Lotto New Zealand, TAB NZ, casinos and non-casino gambling machines or class 4 gambling). Most money spent on gambling comes from the relatively small number of people (around 11% of adults in 2020) who play electronic gaming machines (“pokies”). For the first time in 2022/23, New Zealanders lost over $1 billion on these machines, which are disproportionately located in higher deprivation areas. In addition, online gambling, which has the potential to cause significant harm, is expanding into New Zealand. The unregulated offshore online gambling market has grown significantly in recent years, with higher participation, higher spend, and greater harm being reported by New Zealanders. The Government has agreed to regulate online casinos through a licensing system, which will be designed to minimise harm, support tax collection, and provide consumer protections to New Zealanders. This regime is expected to come into effect in 2026. Whether an individual experiences harm from their own or someone else’s gambling, and how this harm is experienced at a whānau and community level, results from many factors. This includes the wider determinants of health and wellbeing and the nature of the gambling environment. The Gambling Act 2003 and associated regulations, as administered by the Dept of Internal Affairs, set the framework for legal gambling in New Zealand. The Act requires a needs assessment be undertaken to inform each iteration of the Strategy. The 2024 needs assessment highlights a changing environment and gambling 2 harm services under pressure . Key findings include: • Gambling activity has remained relatively constant in New Zealand, with data indicating that most adults engage in gambling at some stage in their lives. • While there has been a reduction in the number of pokies the distribution and availability of these machines remains disproportionately high in areas of high- deprivation. Expenditure on pokies has continued to increase. • Online gambling, particularly with unregulated providers based overseas, continues to grow. This is revealing inconsistencies with the current levy funding regime and service provisions. • The gambling harm minimisation sector is under pressure and has found the health reforms challenging. It seeks stronger government leadership and coordination.",Medical,Summarize & Format,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","My daughter is 11 months old, and I'm trying to decide what type of sippy cup to buy. Explain the different types of sippy cups. Then, tell me the best options, including pros and cons for each. My biggest concerns are durability, and being able to travel without spils. Don't include soft spout cups, she already has those and we want to try a different type.","Types of sippy cups You can choose from a few different types of sippy cups: Soft spout. These are the closest to a bottle, containing a nipple spout that still allows for sucking. They can be used to transition your baby to latched tops or open tops by allowing them to first get used to holding and gripping the cup and its handles. Hard spout. Hard-spout sippy cups encourage your child to transition from sucking to tilting and sipping. It’s often best to introduce it after they’ve mastered the soft spout. Straw. Straw sippy cups, as you may have guessed, employ a straw rather than a spout. Some feel that a straw is preferable for speech development over a spout. They can also help your child get used to drinking from a straw and using a cup. No spout or flat lid. These sippy cups are spoutless with a flat top (sometimes referred to as 360 cups). They allow for water to flow from all edges of the cup opening to resemble the action of a real cup while still using a lid. They typically lack any no-spill valves, and that’s a good thing. Sippy cups can be a good option for bridging the gap between a bottle and an open cup. They prevent spilling while still giving your child more independence. Your child may not take to the first option you present to them, but keep trying! The key to success is choosing cups that are appropriate for your child’s age and stage of development. 6 to 12 months old As your baby continues transitioning to cup use, the options get more varied and include: spout cups spoutless cups straw cups The variety you choose is up to you and your baby. Since the cup may be too heavy for your little one to hold with just one hand, cups with handles are helpful at this stage. And even if a cup has a larger capacity, resist filling it to the top so your baby can maneuver it. Continue to supervise your baby using a cup until they are at least 1 year old. Best soft-spout cup NUK Learner Cup Price: $$ Pros: Options for both 5- and 10-ounce cup sizes; removable handles for when your little one is ready to transition to more of a cup; includes a plastic lid to help prevent spills when traveling Cons: Spout can be slow and require hard sucking The NUK Learner Cup comes in 5- or 10-ounce sizes and features removable handles for your growing baby. It’s appropriate for babies 6 months old or over, and it’s made from BPA-free plastic. The cup has a soft silicone spout that has a special vent to prevent baby from swallowing too much air. Parents share that this cup is easy to handwash and that the travel piece that comes with the cup prevents leaks when it’s tossed in a diaper bag. Others say their babies had trouble getting milk out of the cup, even when sucking very hard. Shop now at Amazon Best straw sippy cup ZoLi BOT Straw Sippy Cup Price: $$$ Pros: Weighted straw makes it easier to get the last of the liquid out; dishwasher safe Cons: One of the more expensive cup options; not the thickest of straws and can be bitten through The ZoLi BOT Straw Sippy Cup is suitable for babies 9 months old or over. It features a weighted straw, so your little one can get liquid no matter how the cup is oriented. The plastic is BPA-free and can be hand washed or run through your dishwasher for cleaning. You can also purchase replacement straws. Parents who like this cup say that it’s simple to assemble and that the handles are easy for babies to hold. On the downside, it can also be difficult to screw the top on correctly, making it prone to leaks. The cup can also leak if the straw becomes damaged from biting or normal wear and tear. Shop now at Amazon Best spoutless sippy cup Munchkin Miracle 360 Trainer Cup Price: $ Pros: Budget-friendly option; dishwasher safe; comes in a variety of sizes and colors Cons: The top’s design can allow for big spills; the design can be hard for some children to figure out how to drink from The Munchkin Miracle 360 Trainer Cup is an affordable option. The unique spoutless construction allows babies 6 months old and over to simulate drinking from an open cup without the spills. It’s also streamlined with only three main pieces and top-rack dishwasher safe. Some parents complain that, while the cup is spill-proof, their smart babies figured out they can pour the liquid by simply pressing on the center of the top. Shop now on Amazon 12 to 18 months old Toddlers have mastered more dexterity with their hands, so many may graduate from handles at this age. Cups with a curved or hourglass shape can help little hands grip and hold. Best for toddlers First Essentials by NUK Fun Grips Hard Spout Sippy Cup Price: $ Pros: Made in the United States; dishwasher safe; hourglass shape is easier to hold without needing handles Cons: The cup’s wide base won’t fit in standard cup holders The economical First Essentials by NUK Fun Grips Sippy Cup (previously sold as Gerber Graduates) is made in the United States from BPA-free plastic. The two-part design is simple and the hourglass shape is easy for toddlers ages 12 months and older to grab. This cup features a 100 percent spill-proof, leak-proof, break-proof guarantee. You may wash this sippy cup either by hand or in the dishwasher. On the negative side, some reviewers say the cup’s base is too wide and that it doesn’t fit easily into standard cup holders or diaper bag pockets. Shop now at Amazon Best straw sippy cup Nuby No-Spill Cup with Flex Straw Price: $ Pros: Budget-friendly option; contoured design offers secure grip without handles; thicker straw Cons:10-ounce size might be larger than some children can easily handle; valve in the straw requires a “squeeze and suck” action Nuby’s No-Spill Flex Straw Cup is a popular choice for toddlers who prefer straws to spouts. The silicone straw has a built-in valve to prevent spills and leaks, and it’s sturdy enough to stand up to occasional biting. While this 10-ounce cup doesn’t have handles, it does feature a contoured design for little hands to grip and is made from BPA-free plastic. The straw does require a “squeeze and suck” action to get liquid through the valve, and some tots find this difficult to master. That said, many parents share that the protection the valve provides is worth the extra effort. Shop now on Amazon","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== My daughter is 11 months old, and I'm trying to decide what type of sippy cup to buy. Explain the different types of sippy cups. Then, tell me the best options, including pros and cons for each. My biggest concerns are durability, and being able to travel without spils. Don't include soft spout cups, she already has those and we want to try a different type. {passage 0} ========== Types of sippy cups You can choose from a few different types of sippy cups: Soft spout. These are the closest to a bottle, containing a nipple spout that still allows for sucking. They can be used to transition your baby to latched tops or open tops by allowing them to first get used to holding and gripping the cup and its handles. Hard spout. Hard-spout sippy cups encourage your child to transition from sucking to tilting and sipping. It’s often best to introduce it after they’ve mastered the soft spout. Straw. Straw sippy cups, as you may have guessed, employ a straw rather than a spout. Some feel that a straw is preferable for speech development over a spout. They can also help your child get used to drinking from a straw and using a cup. No spout or flat lid. These sippy cups are spoutless with a flat top (sometimes referred to as 360 cups). They allow for water to flow from all edges of the cup opening to resemble the action of a real cup while still using a lid. They typically lack any no-spill valves, and that’s a good thing. Sippy cups can be a good option for bridging the gap between a bottle and an open cup. They prevent spilling while still giving your child more independence. Your child may not take to the first option you present to them, but keep trying! The key to success is choosing cups that are appropriate for your child’s age and stage of development. 6 to 12 months old As your baby continues transitioning to cup use, the options get more varied and include: spout cups spoutless cups straw cups The variety you choose is up to you and your baby. Since the cup may be too heavy for your little one to hold with just one hand, cups with handles are helpful at this stage. And even if a cup has a larger capacity, resist filling it to the top so your baby can maneuver it. Continue to supervise your baby using a cup until they are at least 1 year old. Best soft-spout cup NUK Learner Cup Price: $$ Pros: Options for both 5- and 10-ounce cup sizes; removable handles for when your little one is ready to transition to more of a cup; includes a plastic lid to help prevent spills when traveling Cons: Spout can be slow and require hard sucking The NUK Learner Cup comes in 5- or 10-ounce sizes and features removable handles for your growing baby. It’s appropriate for babies 6 months old or over, and it’s made from BPA-free plastic. The cup has a soft silicone spout that has a special vent to prevent baby from swallowing too much air. Parents share that this cup is easy to handwash and that the travel piece that comes with the cup prevents leaks when it’s tossed in a diaper bag. Others say their babies had trouble getting milk out of the cup, even when sucking very hard. Shop now at Amazon Best straw sippy cup ZoLi BOT Straw Sippy Cup Price: $$$ Pros: Weighted straw makes it easier to get the last of the liquid out; dishwasher safe Cons: One of the more expensive cup options; not the thickest of straws and can be bitten through The ZoLi BOT Straw Sippy Cup is suitable for babies 9 months old or over. It features a weighted straw, so your little one can get liquid no matter how the cup is oriented. The plastic is BPA-free and can be hand washed or run through your dishwasher for cleaning. You can also purchase replacement straws. Parents who like this cup say that it’s simple to assemble and that the handles are easy for babies to hold. On the downside, it can also be difficult to screw the top on correctly, making it prone to leaks. The cup can also leak if the straw becomes damaged from biting or normal wear and tear. Shop now at Amazon Best spoutless sippy cup Munchkin Miracle 360 Trainer Cup Price: $ Pros: Budget-friendly option; dishwasher safe; comes in a variety of sizes and colors Cons: The top’s design can allow for big spills; the design can be hard for some children to figure out how to drink from The Munchkin Miracle 360 Trainer Cup is an affordable option. The unique spoutless construction allows babies 6 months old and over to simulate drinking from an open cup without the spills. It’s also streamlined with only three main pieces and top-rack dishwasher safe. Some parents complain that, while the cup is spill-proof, their smart babies figured out they can pour the liquid by simply pressing on the center of the top. Shop now on Amazon 12 to 18 months old Toddlers have mastered more dexterity with their hands, so many may graduate from handles at this age. Cups with a curved or hourglass shape can help little hands grip and hold. Best for toddlers First Essentials by NUK Fun Grips Hard Spout Sippy Cup Price: $ Pros: Made in the United States; dishwasher safe; hourglass shape is easier to hold without needing handles Cons: The cup’s wide base won’t fit in standard cup holders The economical First Essentials by NUK Fun Grips Sippy Cup (previously sold as Gerber Graduates) is made in the United States from BPA-free plastic. The two-part design is simple and the hourglass shape is easy for toddlers ages 12 months and older to grab. This cup features a 100 percent spill-proof, leak-proof, break-proof guarantee. You may wash this sippy cup either by hand or in the dishwasher. On the negative side, some reviewers say the cup’s base is too wide and that it doesn’t fit easily into standard cup holders or diaper bag pockets. Shop now at Amazon Best straw sippy cup Nuby No-Spill Cup with Flex Straw Price: $ Pros: Budget-friendly option; contoured design offers secure grip without handles; thicker straw Cons:10-ounce size might be larger than some children can easily handle; valve in the straw requires a “squeeze and suck” action Nuby’s No-Spill Flex Straw Cup is a popular choice for toddlers who prefer straws to spouts. The silicone straw has a built-in valve to prevent spills and leaks, and it’s sturdy enough to stand up to occasional biting. While this 10-ounce cup doesn’t have handles, it does feature a contoured design for little hands to grip and is made from BPA-free plastic. The straw does require a “squeeze and suck” action to get liquid through the valve, and some tots find this difficult to master. That said, many parents share that the protection the valve provides is worth the extra effort. Shop now on Amazon https://www.healthline.com/health/parenting/best-sippy-cups#6-to-12-months",Retail/Product,Pros & Cons,Q&A "Use only the provided text to answer the question. Don't use numbered or bulleted lists. Instead, your response should be in paragraph form.",What is the market breakdown of 100+ seat commercial aircraft as reported in this article?,"Industry Analysis Overview of the Industry The Aerospace and Defense industry has seen accelerated growth in the past couple of years. The rising demand in today’s environment for military equipment has added to this huge success. The rapid growth rate of nations like China and India has contributed to the rising demand for passenger aircrafts for travel. The increase in the world’s growth rate also helps benefit the Boeing Co. The Aerospace industry has recorded annual sales growth of 8.2% for the five years through 2005, and 10.4% for the past three years. Net income rose by 12.4% annually over the five year period, and 20.8% annually over the past three years. For the five year period ending in September of 2006, the S&P 500 Aerospace and Defense industry index had outperformed the S&P 500 by 71%. The result for the three year period was the same. The industry returned 87%, while the S&P 500 returned 42%. The Aerospace industry has been revitalized and has been booming due to a strong wave of global economic growth and the emergence of countries such as China and India as economic powers. The rise of wealth in the Middle East has also added to the booming success. This massive growth throughout the world has spurred huge gains in business travel, as well as in air cargo traffic. Boeing saw its orders from China jump to 143 commercial jets in 2005, and 114 for the nine months through September 2006. India ordered 98 planes from Boeing in 2005. Middle East orders also rose to 44 in 2005. Also, rising income levels, in some countries, have added to the company’s success, due to the greater mobility amongst people in such regions. The defense market has experienced massive growth since the terrorist attacks of 2001, as a result of the U.S. government funding the wars in Afghanistan and Iraq. Since the wars have begun, the U.S. government and the governments of other nations have splurged and put a lot of money into defense. Safety and national security has become a huge profit gainer for the Aerospace and Defense industry. Also, it is believed that the United States and its allies are locked in a struggle for control that will continue in years to come. This will increase the need for expenditures in the future for military equipment. One issue that has risen is that while defense is benefiting from the current environment in which we live, air travel is not, as a result of the attacks in 2001. This could very well decrease commercial air travel. Commercial Aircraft Based on total unit orders of 100-plus seat jetliners in 2005 (latest available), Boeing and Airbus control about 49% and 51%, respectively, of the global commercial jetliner market. Demand for jetliners is driven primarily by growth in the global 100-plus seat commercial aircraft fleet. Independent research firm Avitas Inc., projects that the global fleet of 100- plus seat jetliners will grow at a 4.3% compound annual rate over the next 20 years, due to its projection of a 5.9% compound annual growth in passenger traffic over the same period. We believe that, given the economic development of many former third-world countries in Asia, Eastern Europe, the Middle East, etc., fleet growth should continue at an above- average rate for the foreseeable future. One of the things that helps Boeing in this segment of their business is their Six Sigma methodology. Six Sigma aids manufacturers in their quest to design, build and deliver near- perfect products by reducing defects and variation, and improving quality, resulting in substantial cost savings. Six Sigma refers to manufacturing processes that produce a level of quality at 3.4 defects per million opportunities. Most U.S. companies operate at a rate of 66,807 defects per million, or ""3.0 Sigma."" Boeings’ current main plant location is in Seattle, Washington. Although Boeing mostly outsourcers many of its business products and flies them in, they still remain to have a presence in the States. Military Segment Examining Boeings’ military weapons segment, demand for IDS's equipment and systems is primarily driven by growth in the procurement and Research and Development sectors of the U.S. defense budget, which accounts for about 40% of global military weapons spending. Based on U.S. Department of Defense statistics, from fiscal year 1995 through fiscal year 2005, the procurement and Research and Development sectors of the total U.S. defense budget grew at 8.0% and 5.1% average annual rates, respectively. It is believed that two factors contributed to this strong growth: cuts to the defense budget that occurred during the Clinton presidential administration, which resulted in the need for increased defense spending in later years, and the wars in Iraq and Afghanistan. We expect defense budgets to continue to grow, but at much slower rates, going forward. This will be especially evident as the U.S. decreases its presence in Iraq in the near future. Outlook on Aerospace and Defense The fundamental outlook for the Aerospace & Defense industry is positive. We believe many companies in the Aerospace & Defense area will record solid earnings per share gains in the near term, due to our nation's current military action, plus the high growth in nations such as China and India. The outlook for the defense segment is strongly positive. We believe that the ongoing military actions in Iraq and Afghanistan, potential threats from Islamic terrorists, North Korea and Iran, as well as a military buildup in China, will make it necessary to continue funding the defense segment. At the same time, we believe that a number of defense contractors have become more efficient, have shown strong cash flow, and have engaged in significant share repurchases and dividend increases. However, there is also the potential likelihood of the risk of declining defense spending following the recent Democratic win of Congress. The outlook for the commercial aircraft segment is especially positive. In looking at the 100- plus-seat commercial aircraft-making sector, we expect that the global airline industry, the largest customer of passenger jets, will continue to have strong passenger traffic growth, which the International Air Transport Associations projects at over 4.5% in 2007. Following the 9/11 attacks, global airlines were hit by large declines in air traffic. However, passenger traffic has picked up significantly in recent years, boosted by global economic growth and attractive fares. Boeing currently has a higher price-to-earnings ratio than typically desired for a value investor. However, this high ratio is due to Boeings’ very high growth potential. Boeing currently receives the most contracts in their industry, whether it is in the commercial aircraft segment of their business, or the military segment of their business. Furthermore, Boeing has surpassed its earnings estimates for the most recent quarter (ending March 31, 2007) by a whopping 27%. Orders are pouring into the company on an almost daily basis. This is for a hundred million dollar product! The price for a 787 Dreamliner ranges from $138 million to $188 million per plane. Customers include: Air New Zealand (787-9, eight), Blue Panorama (four), First Choice Airways (eight), Continental (20), Japan Airlines (30 + 20 options), Vietnam Airlines (four), Chinese Airlines (60), Icelandair (four), Ethiopian Airlines (ten), Korean Airlines (ten + ten options), Northwest Airlines (18 + 50 options), Air Canada (14 + 46 options), Air India (27), Royal Air Maroc (four), LOT (seven), China Southern (ten), ILFC (20), Qantas (45 + 20 options), Kenya Airways (six), Singapore Airlines (787-9, 20 + 20 options), Air Pacific (787-9, five + three options), Monarch Airlines (787-8, six + four options). DJ US Aerospace & Defense Index vs. Boeing: 5 Year Trend DJ US Aerospa ce & Defense Index VS Boeing, Lockheed Martin, and Northrop Grumman: 5 Year Trend ","Use only the provided text to answer the question. Don't use numbered or bulleted lists. Instead, your response should be in paragraph form. What is the market breakdown of 100+ seat commercial aircraft as reported in this article? Industry Analysis Overview of the Industry The Aerospace and Defense industry has seen accelerated growth in the past couple of years. The rising demand in today’s environment for military equipment has added to this huge success. The rapid growth rate of nations like China and India has contributed to the rising demand for passenger aircrafts for travel. The increase in the world’s growth rate also helps benefit the Boeing Co. The Aerospace industry has recorded annual sales growth of 8.2% for the five years through 2005, and 10.4% for the past three years. Net income rose by 12.4% annually over the five year period, and 20.8% annually over the past three years. For the five year period ending in September of 2006, the S&P 500 Aerospace and Defense industry index had outperformed the S&P 500 by 71%. The result for the three year period was the same. The industry returned 87%, while the S&P 500 returned 42%. The Aerospace industry has been revitalized and has been booming due to a strong wave of global economic growth and the emergence of countries such as China and India as economic powers. The rise of wealth in the Middle East has also added to the booming success. This massive growth throughout the world has spurred huge gains in business travel, as well as in air cargo traffic. Boeing saw its orders from China jump to 143 commercial jets in 2005, and 114 for the nine months through September 2006. India ordered 98 planes from Boeing in 2005. Middle East orders also rose to 44 in 2005. Also, rising income levels, in some countries, have added to the company’s success, due to the greater mobility amongst people in such regions. The defense market has experienced massive growth since the terrorist attacks of 2001, as a result of the U.S. government funding the wars in Afghanistan and Iraq. Since the wars have begun, the U.S. government and the governments of other nations have splurged and put a lot of money into defense. Safety and national security has become a huge profit gainer for the Aerospace and Defense industry. Also, it is believed that the United States and its allies are locked in a struggle for control that will continue in years to come. This will increase the need for expenditures in the future for military equipment. One issue that has risen is that while defense is benefiting from the current environment in which we live, air travel is not, as a result of the attacks in 2001. This could very well decrease commercial air travel. Commercial Aircraft Based on total unit orders of 100-plus seat jetliners in 2005 (latest available), Boeing and Airbus control about 49% and 51%, respectively, of the global commercial jetliner market. Demand for jetliners is driven primarily by growth in the global 100-plus seat commercial aircraft fleet. Independent research firm Avitas Inc., projects that the global fleet of 100- plus seat jetliners will grow at a 4.3% compound annual rate over the next 20 years, due to its projection of a 5.9% compound annual growth in passenger traffic over the same period. We believe that, given the economic development of many former third-world countries in Asia, Eastern Europe, the Middle East, etc., fleet growth should continue at an above- average rate for the foreseeable future. One of the things that helps Boeing in this segment of their business is their Six Sigma methodology. Six Sigma aids manufacturers in their quest to design, build and deliver near- perfect products by reducing defects and variation, and improving quality, resulting in substantial cost savings. Six Sigma refers to manufacturing processes that produce a level of quality at 3.4 defects per million opportunities. Most U.S. companies operate at a rate of 66,807 defects per million, or ""3.0 Sigma."" Boeings’ current main plant location is in Seattle, Washington. Although Boeing mostly outsourcers many of its business products and flies them in, they still remain to have a presence in the States. Military Segment Examining Boeings’ military weapons segment, demand for IDS's equipment and systems is primarily driven by growth in the procurement and Research and Development sectors of the U.S. defense budget, which accounts for about 40% of global military weapons spending. Based on U.S. Department of Defense statistics, from fiscal year 1995 through fiscal year 2005, the procurement and Research and Development sectors of the total U.S. defense budget grew at 8.0% and 5.1% average annual rates, respectively. It is believed that two factors contributed to this strong growth: cuts to the defense budget that occurred during the Clinton presidential administration, which resulted in the need for increased defense spending in later years, and the wars in Iraq and Afghanistan. We expect defense budgets to continue to grow, but at much slower rates, going forward. This will be especially evident as the U.S. decreases its presence in Iraq in the near future. Outlook on Aerospace and Defense The fundamental outlook for the Aerospace & Defense industry is positive. We believe many companies in the Aerospace & Defense area will record solid earnings per share gains in the near term, due to our nation's current military action, plus the high growth in nations such as China and India. The outlook for the defense segment is strongly positive. We believe that the ongoing military actions in Iraq and Afghanistan, potential threats from Islamic terrorists, North Korea and Iran, as well as a military buildup in China, will make it necessary to continue funding the defense segment. At the same time, we believe that a number of defense contractors have become more efficient, have shown strong cash flow, and have engaged in significant share repurchases and dividend increases. However, there is also the potential likelihood of the risk of declining defense spending following the recent Democratic win of Congress. The outlook for the commercial aircraft segment is especially positive. In looking at the 100- plus-seat commercial aircraft-making sector, we expect that the global airline industry, the largest customer of passenger jets, will continue to have strong passenger traffic growth, which the International Air Transport Associations projects at over 4.5% in 2007. Following the 9/11 attacks, global airlines were hit by large declines in air traffic. However, passenger traffic has picked up significantly in recent years, boosted by global economic growth and attractive fares. Boeing currently has a higher price-to-earnings ratio than typically desired for a value investor. However, this high ratio is due to Boeings’ very high growth potential. Boeing currently receives the most contracts in their industry, whether it is in the commercial aircraft segment of their business, or the military segment of their business. Furthermore, Boeing has surpassed its earnings estimates for the most recent quarter (ending March 31, 2007) by a whopping 27%. Orders are pouring into the company on an almost daily basis. This is for a hundred million dollar product! The price for a 787 Dreamliner ranges from $138 million to $188 million per plane. Customers include: Air New Zealand (787-9, eight), Blue Panorama (four), First Choice Airways (eight), Continental (20), Japan Airlines (30 + 20 options), Vietnam Airlines (four), Chinese Airlines (60), Icelandair (four), Ethiopian Airlines (ten), Korean Airlines (ten + ten options), Northwest Airlines (18 + 50 options), Air Canada (14 + 46 options), Air India (27), Royal Air Maroc (four), LOT (seven), China Southern (ten), ILFC (20), Qantas (45 + 20 options), Kenya Airways (six), Singapore Airlines (787-9, 20 + 20 options), Air Pacific (787-9, five + three options), Monarch Airlines (787-8, six + four options). DJ US Aerospace & Defense Index vs. Boeing: 5 Year Trend DJ US Aerospa ce & Defense Index VS Boeing, Lockheed Martin, and Northrop Grumman: 5 Year Trend ",Internet/Technology,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","Im trying to do research on fine ceramics from Japan, but why am I getting so much info about electronics? Why would they use clay in advanced technology when we have metal? Is it just because it's cheap?","Advanced ceramics are an integral part ofmodern technology. Most of these productsplay crucial functions ‘behind the scenes’ in anumber of applications in everyday life. Theyusually offer superior performance that cannotbe replicated easily by other materials (Riedel,2013). Advanced ceramics today play a keyrole in technologies such as energy and theenvironment, transport, the life sciences, andcommunication and information technology(Greil, 2002). The terminology for defining this type ofceramics differs from continent to continent(Kulik, 1999). In the Japanese literature it’snormally referred to as ‘fine’ ceramics, and inAmerican literature as ‘advanced’ or‘technical’ ceramics (Kulik, 1999). In theEuropean context the term ‘technical’ ceramicsis more frequently used (Kulik, 1999). Afurther classification, depending on the use, iscommon in the UK, where the term ‘technicalceramics’ is further subdivided into functionalceramics to refer to electronic applications andstructural ceramics to refer mostly tomechanically loaded components (Kulik,1999).Advanced ceramics possess uniqueproperties that cannot be obtained inconventional materials, such as highrefractoriness and hardness, low density, lowcoefficient of thermal expansion (CTE), andhigher working temperatures (can maintaingood mechanical properties at hightemperatures). Moreover, there are reportswhich have proven that the cost of producingceramic materials is lower compared to metallicmaterials, and raw material reserves forceramics are abundant (Kulik, 1999).Resources for the production of metals andtheir alloys are dwindling, and thecontinuously increasing demand forengineering products requires alternativematerials to be identified. Over the past fewdecades advanced ceramics have made inroadsin a number of critical applications in everydaylife. It is noteworthy to mention here thatwithout sparkplugs made of alumina (Al2O3)ceramic, vehicle technology would not be soadvanced, moreover metallurgy would not beso reliable without refractories (Kulik, 1999).These are the hard facts behind commonplaceproducts that we normally take for granted.Although ceramics play a crucial role in anumber of technologies due to their uniquecombination of properties, it must be notedthat as structural materials they still face stiffcompetition from cheap metals, alloys, andcomposites (Kulik, 1999). Thus the majorbarriers to the broad application of advancedceramic materials include the lack ofspecifications and databases, high scale-upcosts, and lack of repair methods (Freitag andRicherson, 1998). However, over the years alot of progress has been made to alleviatethese deficiencies through new materialdiscoveries, improvements in properties, andimproved design methods (Freitag andRicherson, 1998). The term ’advanced ceramics’ was coined in the 1970s todesignate a new category of engineering materials that wereto drive new technologies into the 21st century (Charreyron,2013). Since then there has been phenomenal growth in thetechnological advancement of these materials. A report fromResearch and Markets projected the advanced ceramicsmarket to reach US$10.4 billion by 2021, growing at acompounded annual growth rate (CAGR) of 6.5%(Charreyron, 2013). This growth is attributed to theincreasing use of advanced ceramic materials as alternativesto metals and plastics, with key drivers being the medical,electronics, and transport industries. The analog-to-digitalshift in consumer products has seen massive growth inelectronic device content in a number of applications. Forinstance, liquid crystal displays (LCDs) replaced cathode raytubes and DVDs replaced VHS tapes and players. Thisbasically points to significant growth for ceramic capacitorsand other ceramic electronic components. The largest share ofthe market has always been in the electronics industry,representing approximately more than 70% of production,but positive and negative shifts are expected according tochanges in demand (Kulik, 1999). Advanced ceramics are produced from three main classesof materials, namely oxides, carbides, and nitrides, with asmall quantity accounting for mixed compounds (WorldAdvanced Ceramics, 1966). Japan has been at the forefrontfor a number of years, owing partly to the high degree ofcooperation between companies in investigations anddevelopments (dynamic partnership) and high exportvolumes (Kulik, 1999; Charreyron, 2013). The major volumeof production in Japan is represented by electronic ceramics,accounting for up to 80% of total production (Kulik, 1999).The second largest producer of advanced ceramics is NorthAmerica, where the industry has been driven by massivegovernment financing of research and design development.The main difference between the two approaches is thatNorth America plays a leading role in technology andJapanese companies lead in the applications of advancedceramics. Such approaches have been successfully adopted bya number of European countries that now contributeextensively to the advanced technology market. One suchcountry is Germany, which is home to a number ofcompanies that compete for advanced technology projectsthroughout the world. One of the most significant advances in ceramics research inthe past two decades has been improvements in fracturetoughness, especially for structural ceramics. On acomparative basis, glass has a fracture toughness of 1MPa.m0.5 and most conventional ceramics range from about2–3 MPa.m0.5; steel is about 40 MPa.m0.5 (Freitag andRicherson, 1998). Some advanced ceramics such astransformation toughened zirconia-ZrO2have toughness ofabout 15 MPa.m0.5, which is higher than that of tungsten-carbide cobalt (WC-Co) cermet and cast iron (Freitag andRicherson, 1998). This has dramatically improved theresistance to contact stress and handling damage, thusimparting high reliability and durability comparable to that ofmetals and WC-Co cermets (Freitag and Richerson, 1998).Prior to 1970, most ceramic materials had strengths wellbelow 345 MPa, but nowadays advanced ceramics such assilicon nitride (Si3N4) and toughened zirconia (ZrO2) arecommercially available with strengths above 690 MPa(Freitag and Richerson, 1998).The detailed mechanism of transformation tougheningcan be found elsewhere (Matizamhuka, 2016). However,what is important to note is that fracture toughness values 3–6 times higher than monolithic ZrO2ceramics have beenachieved by transformation toughening. Several othertechniques have been developed over the years to improvefracture toughness of advanced ceramics, such as the use ofmore ductile binders and reinforcement with fibres, whiskers,or second-phase particles. Details of such techniques can befound in the open literature (Matizamhuka, 2016).On the other hand, the high cost of ceramic componentshas been attributed to the lack of large-scale production withminimum losses in the production line. Ceramic-basedmaterials often compete against engineering materials withlower upfront costs, and it is often difficult to convincecustomers to pay a premium in exchange for performancebenefits (Charreyron, 2013). Design, process technology, andmachining technology still need to develop significantly toachieve cost-effective levels of high-volume production,consequently reducing the cost of components. A strategyused by previous market pioneers is that of forward pricingand continued government subsidies in anticipation of futuremarket growth. The recent phenomenal growth in theadvanced ceramics industry could easily translate into agreater market share in future, but this can happen only ifmajor breakthroughs are achieved in fundamental andapplied research (Liang and Dutta, 2001).","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Im trying to do research on fine ceramics from Japan, but why am I getting so much info about electronics? Why would they use clay in advanced technology when we have metal? Is it just because it's cheap? {passage 0} ========== Advanced ceramics are an integral part ofmodern technology. Most of these productsplay crucial functions ‘behind the scenes’ in anumber of applications in everyday life. Theyusually offer superior performance that cannotbe replicated easily by other materials (Riedel,2013). Advanced ceramics today play a keyrole in technologies such as energy and theenvironment, transport, the life sciences, andcommunication and information technology(Greil, 2002). The terminology for defining this type ofceramics differs from continent to continent(Kulik, 1999). In the Japanese literature it’snormally referred to as ‘fine’ ceramics, and inAmerican literature as ‘advanced’ or‘technical’ ceramics (Kulik, 1999). In theEuropean context the term ‘technical’ ceramicsis more frequently used (Kulik, 1999). Afurther classification, depending on the use, iscommon in the UK, where the term ‘technicalceramics’ is further subdivided into functionalceramics to refer to electronic applications andstructural ceramics to refer mostly tomechanically loaded components (Kulik,1999).Advanced ceramics possess uniqueproperties that cannot be obtained inconventional materials, such as highrefractoriness and hardness, low density, lowcoefficient of thermal expansion (CTE), andhigher working temperatures (can maintaingood mechanical properties at hightemperatures). Moreover, there are reportswhich have proven that the cost of producingceramic materials is lower compared to metallicmaterials, and raw material reserves forceramics are abundant (Kulik, 1999).Resources for the production of metals andtheir alloys are dwindling, and thecontinuously increasing demand forengineering products requires alternativematerials to be identified. Over the past fewdecades advanced ceramics have made inroadsin a number of critical applications in everydaylife. It is noteworthy to mention here thatwithout sparkplugs made of alumina (Al2O3)ceramic, vehicle technology would not be soadvanced, moreover metallurgy would not beso reliable without refractories (Kulik, 1999).These are the hard facts behind commonplaceproducts that we normally take for granted.Although ceramics play a crucial role in anumber of technologies due to their uniquecombination of properties, it must be notedthat as structural materials they still face stiffcompetition from cheap metals, alloys, andcomposites (Kulik, 1999). Thus the majorbarriers to the broad application of advancedceramic materials include the lack ofspecifications and databases, high scale-upcosts, and lack of repair methods (Freitag andRicherson, 1998). However, over the years alot of progress has been made to alleviatethese deficiencies through new materialdiscoveries, improvements in properties, andimproved design methods (Freitag andRicherson, 1998). The term ’advanced ceramics’ was coined in the 1970s todesignate a new category of engineering materials that wereto drive new technologies into the 21st century (Charreyron,2013). Since then there has been phenomenal growth in thetechnological advancement of these materials. A report fromResearch and Markets projected the advanced ceramicsmarket to reach US$10.4 billion by 2021, growing at acompounded annual growth rate (CAGR) of 6.5%(Charreyron, 2013). This growth is attributed to theincreasing use of advanced ceramic materials as alternativesto metals and plastics, with key drivers being the medical,electronics, and transport industries. The analog-to-digitalshift in consumer products has seen massive growth inelectronic device content in a number of applications. Forinstance, liquid crystal displays (LCDs) replaced cathode raytubes and DVDs replaced VHS tapes and players. Thisbasically points to significant growth for ceramic capacitorsand other ceramic electronic components. The largest share ofthe market has always been in the electronics industry,representing approximately more than 70% of production,but positive and negative shifts are expected according tochanges in demand (Kulik, 1999). Advanced ceramics are produced from three main classesof materials, namely oxides, carbides, and nitrides, with asmall quantity accounting for mixed compounds (WorldAdvanced Ceramics, 1966). Japan has been at the forefrontfor a number of years, owing partly to the high degree ofcooperation between companies in investigations anddevelopments (dynamic partnership) and high exportvolumes (Kulik, 1999; Charreyron, 2013). The major volumeof production in Japan is represented by electronic ceramics,accounting for up to 80% of total production (Kulik, 1999).The second largest producer of advanced ceramics is NorthAmerica, where the industry has been driven by massivegovernment financing of research and design development.The main difference between the two approaches is thatNorth America plays a leading role in technology andJapanese companies lead in the applications of advancedceramics. Such approaches have been successfully adopted bya number of European countries that now contributeextensively to the advanced technology market. One suchcountry is Germany, which is home to a number ofcompanies that compete for advanced technology projectsthroughout the world. One of the most significant advances in ceramics research inthe past two decades has been improvements in fracturetoughness, especially for structural ceramics. On acomparative basis, glass has a fracture toughness of 1MPa.m0.5 and most conventional ceramics range from about2–3 MPa.m0.5; steel is about 40 MPa.m0.5 (Freitag andRicherson, 1998). Some advanced ceramics such astransformation toughened zirconia-ZrO2have toughness ofabout 15 MPa.m0.5, which is higher than that of tungsten-carbide cobalt (WC-Co) cermet and cast iron (Freitag andRicherson, 1998). This has dramatically improved theresistance to contact stress and handling damage, thusimparting high reliability and durability comparable to that ofmetals and WC-Co cermets (Freitag and Richerson, 1998).Prior to 1970, most ceramic materials had strengths wellbelow 345 MPa, but nowadays advanced ceramics such assilicon nitride (Si3N4) and toughened zirconia (ZrO2) arecommercially available with strengths above 690 MPa(Freitag and Richerson, 1998).The detailed mechanism of transformation tougheningcan be found elsewhere (Matizamhuka, 2016). However,what is important to note is that fracture toughness values 3–6 times higher than monolithic ZrO2ceramics have beenachieved by transformation toughening. Several othertechniques have been developed over the years to improvefracture toughness of advanced ceramics, such as the use ofmore ductile binders and reinforcement with fibres, whiskers,or second-phase particles. Details of such techniques can befound in the open literature (Matizamhuka, 2016).On the other hand, the high cost of ceramic componentshas been attributed to the lack of large-scale production withminimum losses in the production line. Ceramic-basedmaterials often compete against engineering materials withlower upfront costs, and it is often difficult to convincecustomers to pay a premium in exchange for performancebenefits (Charreyron, 2013). Design, process technology, andmachining technology still need to develop significantly toachieve cost-effective levels of high-volume production,consequently reducing the cost of components. A strategyused by previous market pioneers is that of forward pricingand continued government subsidies in anticipation of futuremarket growth. The recent phenomenal growth in theadvanced ceramics industry could easily translate into agreater market share in future, but this can happen only ifmajor breakthroughs are achieved in fundamental andapplied research (Liang and Dutta, 2001). https://www.researchgate.net/publication/327770223_Advanced_ceramics_-_The_new_frontier_in_modern-day_technology_Part_I",Internet/Technology,Explanation/Definition,Q&A Only use information from the text provided. Do not use any external resources or prior knowledge to answer questions.,List the things people thought would happen in the future according to this article from 1995.," The Internet? Bah! Hype alert: Why cyberspace isn't, and will never be, nirvana By NEWSWEEK From the magazine issue dated Feb 27, 1995 After two decades online, I'm perplexed. It's not that I haven't had a gas of a good time on the Internet. I've met great people and even caught a hacker or two. But today, I'm uneasy about this most trendy and oversold community. Visionaries see a future of telecommuting workers, interactive libraries and multimedia classrooms. They speak of electronic town meetings and virtual communities. Commerce and business will shift from offices and malls to networks and modems. And the freedom of digital networks will make government more democratic. Baloney. Do our computer pundits lack all common sense? The truth in no online database will replace your daily newspaper, no CD-ROM can take the place of a competent teacher and no computer network will change the way government works. Consider today's online world. The Usenet, a worldwide bulletin board, allows anyone to post messages across the nation. Your word gets out, leapfrogging editors and publishers. Every voice can be heard cheaply and instantly. The result? Every voice is heard. The cacophany more closely resembles citizens band radio, complete with handles, harrasment, and anonymous threats. When most everyone shouts, few listen. How about electronic publishing? Try reading a book on disc. At best, it's an unpleasant chore: the myopic glow of a clunky computer replaces the friendly pages of a book. And you can't tote that laptop to the beach. Yet Nicholas Negroponte, director of the MIT Media Lab, predicts that we'll soon buy books and newspapers straight over the Intenet. Uh, sure. What the Internet hucksters won't tell you is tht the Internet is one big ocean of unedited data, without any pretense of completeness. Lacking editors, reviewers or critics, the Internet has become a wasteland of unfiltered data. You don't know what to ignore and what's worth reading. Logged onto the World Wide Web, I hunt for the date of the Battle of Trafalgar. Hundreds of files show up, and it takes 15 minutes to unravel them—one's a biography written by an eighth grader, the second is a computer game that doesn't work and the third is an image of a London monument. None answers my question, and my search is periodically interrupted by messages like, ""Too many connectios, try again later."" Won't the Internet be useful in governing? Internet addicts clamor for government reports. But when Andy Spano ran for county executive in Westchester County, N.Y., he put every press release and position paper onto a bulletin board. In that affluent county, with plenty of computer companies, how many voters logged in? Fewer than 30. Not a good omen. Point and click: Then there are those pushing computers into schools. We're told that multimedia will make schoolwork easy and fun. Students will happily learn from animated characters while taught by expertly tailored software.Who needs teachers when you've got computer-aided education? Bah. These expensive toys are difficult to use in classrooms and require extensive teacher training. Sure, kids love videogames—but think of your own experience: can you recall even one educational filmstrip of decades past? I'll bet you remember the two or three great teachers who made a difference in your life. Then there's cyberbusiness. We're promised instant catalog shopping—just point and click for great deals. We'll order airline tickets over the network, make restaurant reservations and negotiate sales contracts. Stores will become obselete. So how come my local mall does more business in an afternoon than the entire Internet handles in a month? Even if there were a trustworthy way to send money over the Internet—which there isn't—the network is missing a most essential ingredient of capitalism: salespeople. What's missing from this electronic wonderland? Human contact. Discount the fawning techno-burble about virtual communities. Computers and networks isolate us from one another. A network chat line is a limp substitute for meeting friends over coffee. No interactive multimedia display comes close to the excitement of a live concert. And who'd prefer cybersex to the real thing? While the Internet beckons brightly, seductively flashing an icon of knowledge-as-power, this nonplace lures us to surrender our time on earth. A poor substitute it is, this virtual reality where frustration is legion and where—in the holy names of Education and Progress—important aspects of human interactions are relentlessly devalued.","Context Block: The Internet? Bah! Hype alert: Why cyberspace isn't, and will never be, nirvana By NEWSWEEK From the magazine issue dated Feb 27, 1995 After two decades online, I'm perplexed. It's not that I haven't had a gas of a good time on the Internet. I've met great people and even caught a hacker or two. But today, I'm uneasy about this most trendy and oversold community. Visionaries see a future of telecommuting workers, interactive libraries and multimedia classrooms. They speak of electronic town meetings and virtual communities. Commerce and business will shift from offices and malls to networks and modems. And the freedom of digital networks will make government more democratic. Baloney. Do our computer pundits lack all common sense? The truth in no online database will replace your daily newspaper, no CD-ROM can take the place of a competent teacher and no computer network will change the way government works. Consider today's online world. The Usenet, a worldwide bulletin board, allows anyone to post messages across the nation. Your word gets out, leapfrogging editors and publishers. Every voice can be heard cheaply and instantly. The result? Every voice is heard. The cacophany more closely resembles citizens band radio, complete with handles, harrasment, and anonymous threats. When most everyone shouts, few listen. How about electronic publishing? Try reading a book on disc. At best, it's an unpleasant chore: the myopic glow of a clunky computer replaces the friendly pages of a book. And you can't tote that laptop to the beach. Yet Nicholas Negroponte, director of the MIT Media Lab, predicts that we'll soon buy books and newspapers straight over the Intenet. Uh, sure. What the Internet hucksters won't tell you is tht the Internet is one big ocean of unedited data, without any pretense of completeness. Lacking editors, reviewers or critics, the Internet has become a wasteland of unfiltered data. You don't know what to ignore and what's worth reading. Logged onto the World Wide Web, I hunt for the date of the Battle of Trafalgar. Hundreds of files show up, and it takes 15 minutes to unravel them—one's a biography written by an eighth grader, the second is a computer game that doesn't work and the third is an image of a London monument. None answers my question, and my search is periodically interrupted by messages like, ""Too many connectios, try again later."" Won't the Internet be useful in governing? Internet addicts clamor for government reports. But when Andy Spano ran for county executive in Westchester County, N.Y., he put every press release and position paper onto a bulletin board. In that affluent county, with plenty of computer companies, how many voters logged in? Fewer than 30. Not a good omen. Point and click: Then there are those pushing computers into schools. We're told that multimedia will make schoolwork easy and fun. Students will happily learn from animated characters while taught by expertly tailored software.Who needs teachers when you've got computer-aided education? Bah. These expensive toys are difficult to use in classrooms and require extensive teacher training. Sure, kids love videogames—but think of your own experience: can you recall even one educational filmstrip of decades past? I'll bet you remember the two or three great teachers who made a difference in your life. Then there's cyberbusiness. We're promised instant catalog shopping—just point and click for great deals. We'll order airline tickets over the network, make restaurant reservations and negotiate sales contracts. Stores will become obselete. So how come my local mall does more business in an afternoon than the entire Internet handles in a month? Even if there were a trustworthy way to send money over the Internet—which there isn't—the network is missing a most essential ingredient of capitalism: salespeople. What's missing from this electronic wonderland? Human contact. Discount the fawning techno-burble about virtual communities. Computers and networks isolate us from one another. A network chat line is a limp substitute for meeting friends over coffee. No interactive multimedia display comes close to the excitement of a live concert. And who'd prefer cybersex to the real thing? While the Internet beckons brightly, seductively flashing an icon of knowledge-as-power, this nonplace lures us to surrender our time on earth. A poor substitute it is, this virtual reality where frustration is legion and where—in the holy names of Education and Progress—important aspects of human interactions are relentlessly devalued. Question: List the things people thought would happen in the future according to this article from 1995. System Instruction: Only use information from the text provided. Do not use any external resources or prior knowledge to answer questions. ",Internet/Technology,Fact Finding,Q&A Do not use any outside resources or knowledge. Only use the information provided in the prompt to answer. Answer in 5 sentences.,How does Alzheimer's treatment work?,"Treatments Progress in Alzheimer’s and dementia research is creating promising treatments for people living with the disease. The U.S. Food and Drug Administration (FDA) has approved medications that fall into two categories: drugs that change disease progression in people living with Alzheimer’s, and drugs that may temporarily mitigate some of the symptoms of the disease. When considering any treatment, it is important to have a conversation with a health care professional to determine whether it is appropriate. A physician who is experienced in using these types of medications should monitor people who are taking them and ensure that the recommended guidelines are strictly observed. Drugs That Change Disease Progression Drugs in this category slow disease progression. They slow the decline of memory and thinking, as well as function, in people living with Alzheimer’s disease. The treatment landscape is rapidly changing. Amyloid-targeting approaches Anti-amyloid treatments work by removing beta-amyloid, a protein that accumulates into plaques, from the brain. Each works differently and targets beta-amyloid at a different stage of plaque formation. These treatments change the course of the disease in a meaningful way for people in the early stages, giving them more time to participate in daily life and live independently. Clinical trial participants who received anti-amyloid treatments experienced reduction in cognitive decline observed through measures of cognition and function. Examples of cognition measures include: ● Memory. ● Orientation. Examples of functional measures include: ● Conducting personal finances. ● Performing household chores such as cleaning. Anti-amyloid treatments do have side effects. These treatments can cause serious allergic reactions. Side effects can also include amyloid-related imaging abnormalities (ARIA), infusion-related reactions, headaches and falls. ARIA is a common side effect that does not usually cause symptoms but can be serious. It is typically a temporary swelling in areas of the brain that usually resolves over time. Some people may also have small spots of bleeding in or on the surface of the brain with the swelling, although most people with swelling in areas of the brain do not have symptoms. Some may have symptoms of ARIA such as headache, dizziness, nausea, confusion and vision changes. Some people have a genetic risk factor (ApoE ε4 gene carriers) that may cause an increased risk for ARIA. The FDA encourages that testing for ApoE ε4 status should be performed prior to initiation of treatment to inform the risk of developing ARIA. Prior to testing, doctors should discuss with patients the risk of ARIA and the implications of genetic testing results. These are not all the possible side effects, and individuals should talk with their doctors to develop a treatment plan that is right for them, including weighing the benefits and risks of all approved therapies. Aducanumab (Aduhelm® ) Aducanumab (Aduhelm) is an anti-amyloid antibody intravenous (IV) infusion therapy that is delivered every four weeks. It has received accelerated approval from the FDA to treat early Alzheimer's disease, including people living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease who have confirmation of elevated beta-amyloid in the brain. Aducanumab was the first therapy to demonstrate that removing beta-amyloid from the brain reduces cognitive and functional decline in people living with early Alzheimer’s. Aducanumab is being discontinued by its manufacturer, Biogen. The company stated that people who are now receiving the drug as part of a clinical trial will continue to have access to it until May 1, 2024, and that people who are now receiving it by prescription will have it available to them until Nov. 1, 2024. Donanemab (Kisunla™) Donanemab (Kisunla) is an anti-amyloid antibody intravenous (IV) infusion therapy delivered every four weeks. It has received traditional approval from the FDA to treat early Alzheimer's disease, including people living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease who have confirmation of elevated beta-amyloid in the brain. There is no safety or effectiveness data on initiating treatment at earlier or later stages of the disease than were studied. Donanemab was the third therapy to demonstrate that removing beta-amyloid from the brain reduces cognitive and functional decline in people living with early Alzheimer's. The drugs currently approved to treat cognitive symptoms are cholinesterase inhibitors and glutamate regulators. Cholinesterase inhibitors Cholinesterase (KOH-luh-NES-ter-ays) inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment and other thought processes. These medications prevent the breakdown of acetylcholine (a-SEA-til-KOHlean), a chemical messenger important for memory and learning. These drugs support communication between nerve cells. The cholinesterase inhibitors most commonly prescribed are: Donepezil (Aricept® ): approved to treat all stages of Alzheimer’s disease. Galantamine (Razadyne® ): approved for mild-to-moderate stages of Alzheimer’s disease. Rivastigmine (Exelon® ): approved for mild-to-moderate Alzheimer’s as well as mild-to-moderate dementia associated with Parkinson’s disease. Though generally well-tolerated, if side effects occur, they commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements. Glutamate regulators Glutamate regulators are prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. This type of drug works by regulating the activity of glutamate, a different chemical messenger that helps the brain process information. This drug is known as: Memantine (Namenda® ): approved for moderate-to-severe Alzheimer’s disease. Can cause side effects, including headache, constipation, confusion and dizziness. Cholinesterase inhibitor + glutamate regulator This type of drug is a combination of a cholinesterase inhibitor and a glutamate regulator. Donepezil and memantine (Namzaric® ): approved for moderate-to-severe Alzheimer’s disease. Possible side effects include nausea, vomiting, loss of appetite, increased frequency of bowel movements, headache, constipation, confusion and dizziness. Noncognitive symptoms (behavioral and psychological symptoms) Alzheimer’s affects more than just memory and thinking. A person’s quality of life may be impacted by a variety of behavioral and psychological symptoms that accompany dementia, such as sleep disturbances, agitation, hallucinations and delusions. Some medications focus on treating these noncognitive symptoms for a time, though it is important to try non-drug strategies to manage behaviors before adding medications. The FDA has approved one drug to address symptoms of insomnia that has been tested in people living with dementia and one that treats agitation. Orexin receptor antagonist Prescribed to treat insomnia, this drug inhibits the activity of orexin, a type of neurotransmitter involved in the sleep-wake cycle: Suvorexant (Belsomra® ): approved for treatment of insomnia and has been shown in clinical trials to be effective for people living with mild to moderate Alzheimer’s disease. Possible side effects include, but are not limited to: risk of impaired alertness and motor coordination (including impaired driving), worsening of depression or suicidal thinking, complex sleep behaviors (such as sleep-walking and sleep-driving), sleep paralysis and compromised respiratory function. Atypical antipsychotics are a group of antipsychotic drugs that target the serotonin and dopamine chemical pathways in the brain. These drugs are largely used to treat schizophrenia and bipolar disorder and as add-on therapies for major depressive disorder. The FDA requires that all atypical antipsychotics carry a safety warning that the medication has been associated with an increased risk of death in older patients with dementia-related psychosis. Many atypical antipsychotic medications are used ""off-label"" to treat dementia-related behaviors, and there is currently only one FDA-approved atypical antipsychotic to treat agitation associated with dementia due to Alzheimer's. It is important to try non-drug strategies to manage non-cognitive symptoms — like agitation — before adding medications. ","Do not use any outside resources or knowledge. Only use the information provided in the prompt to answer. Answer in 5 sentences. How does Alzheimer's treatment work? Treatments Progress in Alzheimer’s and dementia research is creating promising treatments for people living with the disease. The U.S. Food and Drug Administration (FDA) has approved medications that fall into two categories: drugs that change disease progression in people living with Alzheimer’s, and drugs that may temporarily mitigate some of the symptoms of the disease. When considering any treatment, it is important to have a conversation with a health care professional to determine whether it is appropriate. A physician who is experienced in using these types of medications should monitor people who are taking them and ensure that the recommended guidelines are strictly observed. Drugs That Change Disease Progression Drugs in this category slow disease progression. They slow the decline of memory and thinking, as well as function, in people living with Alzheimer’s disease. The treatment landscape is rapidly changing. Amyloid-targeting approaches Anti-amyloid treatments work by removing beta-amyloid, a protein that accumulates into plaques, from the brain. Each works differently and targets beta-amyloid at a different stage of plaque formation. These treatments change the course of the disease in a meaningful way for people in the early stages, giving them more time to participate in daily life and live independently. Clinical trial participants who received anti-amyloid treatments experienced reduction in cognitive decline observed through measures of cognition and function. Examples of cognition measures include: ● Memory. ● Orientation. Examples of functional measures include: ● Conducting personal finances. ● Performing household chores such as cleaning. Anti-amyloid treatments do have side effects. These treatments can cause serious allergic reactions. Side effects can also include amyloid-related imaging abnormalities (ARIA), infusion-related reactions, headaches and falls. ARIA is a common side effect that does not usually cause symptoms but can be serious. It is typically a temporary swelling in areas of the brain that usually resolves over time. Some people may also have small spots of bleeding in or on the surface of the brain with the swelling, although most people with swelling in areas of the brain do not have symptoms. Some may have symptoms of ARIA such as headache, dizziness, nausea, confusion and vision changes. Some people have a genetic risk factor (ApoE ε4 gene carriers) that may cause an increased risk for ARIA. The FDA encourages that testing for ApoE ε4 status should be performed prior to initiation of treatment to inform the risk of developing ARIA. Prior to testing, doctors should discuss with patients the risk of ARIA and the implications of genetic testing results. These are not all the possible side effects, and individuals should talk with their doctors to develop a treatment plan that is right for them, including weighing the benefits and risks of all approved therapies. Aducanumab (Aduhelm® ) Aducanumab (Aduhelm) is an anti-amyloid antibody intravenous (IV) infusion therapy that is delivered every four weeks. It has received accelerated approval from the FDA to treat early Alzheimer's disease, including people living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease who have confirmation of elevated beta-amyloid in the brain. Aducanumab was the first therapy to demonstrate that removing beta-amyloid from the brain reduces cognitive and functional decline in people living with early Alzheimer’s. Aducanumab is being discontinued by its manufacturer, Biogen. The company stated that people who are now receiving the drug as part of a clinical trial will continue to have access to it until May 1, 2024, and that people who are now receiving it by prescription will have it available to them until Nov. 1, 2024. Donanemab (Kisunla™) Donanemab (Kisunla) is an anti-amyloid antibody intravenous (IV) infusion therapy delivered every four weeks. It has received traditional approval from the FDA to treat early Alzheimer's disease, including people living with mild cognitive impairment (MCI) or mild dementia due to Alzheimer's disease who have confirmation of elevated beta-amyloid in the brain. There is no safety or effectiveness data on initiating treatment at earlier or later stages of the disease than were studied. Donanemab was the third therapy to demonstrate that removing beta-amyloid from the brain reduces cognitive and functional decline in people living with early Alzheimer's. The drugs currently approved to treat cognitive symptoms are cholinesterase inhibitors and glutamate regulators. Cholinesterase inhibitors Cholinesterase (KOH-luh-NES-ter-ays) inhibitors are prescribed to treat symptoms related to memory, thinking, language, judgment and other thought processes. These medications prevent the breakdown of acetylcholine (a-SEA-til-KOHlean), a chemical messenger important for memory and learning. These drugs support communication between nerve cells. The cholinesterase inhibitors most commonly prescribed are: Donepezil (Aricept® ): approved to treat all stages of Alzheimer’s disease. Galantamine (Razadyne® ): approved for mild-to-moderate stages of Alzheimer’s disease. Rivastigmine (Exelon® ): approved for mild-to-moderate Alzheimer’s as well as mild-to-moderate dementia associated with Parkinson’s disease. Though generally well-tolerated, if side effects occur, they commonly include nausea, vomiting, loss of appetite and increased frequency of bowel movements. Glutamate regulators Glutamate regulators are prescribed to improve memory, attention, reason, language and the ability to perform simple tasks. This type of drug works by regulating the activity of glutamate, a different chemical messenger that helps the brain process information. This drug is known as: Memantine (Namenda® ): approved for moderate-to-severe Alzheimer’s disease. Can cause side effects, including headache, constipation, confusion and dizziness. Cholinesterase inhibitor + glutamate regulator This type of drug is a combination of a cholinesterase inhibitor and a glutamate regulator. Donepezil and memantine (Namzaric® ): approved for moderate-to-severe Alzheimer’s disease. Possible side effects include nausea, vomiting, loss of appetite, increased frequency of bowel movements, headache, constipation, confusion and dizziness. Noncognitive symptoms (behavioral and psychological symptoms) Alzheimer’s affects more than just memory and thinking. A person’s quality of life may be impacted by a variety of behavioral and psychological symptoms that accompany dementia, such as sleep disturbances, agitation, hallucinations and delusions. Some medications focus on treating these noncognitive symptoms for a time, though it is important to try non-drug strategies to manage behaviors before adding medications. The FDA has approved one drug to address symptoms of insomnia that has been tested in people living with dementia and one that treats agitation. Orexin receptor antagonist Prescribed to treat insomnia, this drug inhibits the activity of orexin, a type of neurotransmitter involved in the sleep-wake cycle: Suvorexant (Belsomra® ): approved for treatment of insomnia and has been shown in clinical trials to be effective for people living with mild to moderate Alzheimer’s disease. Possible side effects include, but are not limited to: risk of impaired alertness and motor coordination (including impaired driving), worsening of depression or suicidal thinking, complex sleep behaviors (such as sleep-walking and sleep-driving), sleep paralysis and compromised respiratory function. Atypical antipsychotics are a group of antipsychotic drugs that target the serotonin and dopamine chemical pathways in the brain. These drugs are largely used to treat schizophrenia and bipolar disorder and as add-on therapies for major depressive disorder. The FDA requires that all atypical antipsychotics carry a safety warning that the medication has been associated with an increased risk of death in older patients with dementia-related psychosis. Many atypical antipsychotic medications are used ""off-label"" to treat dementia-related behaviors, and there is currently only one FDA-approved atypical antipsychotic to treat agitation associated with dementia due to Alzheimer's. It is important to try non-drug strategies to manage non-cognitive symptoms — like agitation — before adding medications. ",Medical,Concept Comparison,Q&A "This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Answer in twenty words or less, do not use bullet points or lists in your answer. ",What legal basis is being used to analyze the merger between Microsoft and Activision Blizzard?,"On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 Microsoft and Activision Blizzard in the Video Game Industry Microsoft distributes video games using Microsoft Store, its subscription service Game Pass,24 and its cloud gaming service Xbox Cloud Gaming (Beta);25 publishes games, including the franchises Halo and Minecraft; 26 and owns 23 gaming studios.27 In 2021, Microsoft had the second-highest share in the U.S. market for game consoles at 34.8%, according to a report from MarketLine, an industry research firm; estimates for Sony and Nintendo were 40.7% and 24.5%, respectively.28 In January 2022, Microsoft stated that it had more than 25 million Game Pass subscribers.29 In April 2022, Microsoft reported that more than 10 million people have streamed games over Xbox Cloud Gaming,30 although it is unclear how long or how many times users accessed the service. Estimates from Ampere Analysis reportedly indicate that Game Pass makes up about 60% of the video game subscription market.31 Among video game publishers in the United States, Microsoft had the highest market share at 23.9%, according to IBISWorld.32 Activision Blizzard is a video game publisher and developer primarily known for its franchise games, which include World of Warcraft, Call of Duty, Diablo, and Candy Crush. 33 The company can be separated into three segments—Activision, Blizzard, and King—that each contain their own gaming studios. Among video game publishers in the United States, Activision Blizzard had the second highest market share at 10%, according to IBISWorld.34 Activision also distributes video games for PCs through its digital store—Battle.net.35 ","What legal basis is being used to analyze the merger between Microsoft and Activision Blizzard? This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Answer in twenty words or less, do not use bullet points or lists in your answer. On January 18, 2022, Microsoft Corp. announced plans to acquire Activision Blizzard Inc., a video game company, for $68.7 billion.1 The Federal Trade Commission (FTC) is reviewing the acquisition,2 as provided under the Hart-Scott-Rodino Act (HSR),3 to determine whether its effect might be “substantially to lessen competition”—a violation of Section 7 of the Clayton Act. 4 Competition authorities in other countries are reviewing Microsoft’s proposed acquisition as well.5 The companies have said they expect to complete the acquisition before June 30, 2023.6 In recent decades, enforcement of antitrust laws has typically focused on how a proposed merger or acquisition might affect consumers, such as by reducing price competition in relevant product markets. Some of the FTC’s actions and statements over the last two years suggest that in its review of Microsoft’s proposed acquisition, the FTC may be considering other factors that are discussed in this report.7 This report discusses Microsoft’s proposed acquisition of Activision Blizzard, including some of the potential effects on existing product markets, labor markets, and on product markets that do not currently exist but may develop in the future. The report also provides some considerations for Congress, discussing some bills that may affect Microsoft’s proposed acquisition or Microsoft’s future behavior if the acquisition is completed. The video game industry can be separated into three components: developers or gaming studios that create and design video games; publishers who market and monetize the video games; and distributors who provide the video games to consumers.8 Video games are most commonly played on game consoles, personal computers (PCs), and mobile devices (Figure 1). Although some retailers sell physical copies of video games for consoles and PCs, the majority of video games are sold in digital format;9 games for mobile devices are sold only in digital format The extent of competition among distributors depends on the format and device used to play the game. The digital format of video games played on a console generally can only be downloaded from a digital store operated by the producer of the console. Games for PCs can be purchased from a selection of digital stores that are operated by various firms,10 including publishers and developers.11 Some of these firms also provide their games as apps on certain mobile devices;12 these are distributed through app stores, such as Google Play and Apple’s App Store. Consoles are typically sold at a loss; the manufacturers then profit from sales of games and subscription services.13 This can incentivize console producers to acquire developers and publishers and offer exclusive content.14 Technological developments have allowed some PCs and other devices, depending on their hardware capabilities, to compete with game consoles.15 For example, early in 2022, Valve Corp. released a handheld PC—Steam Deck—that resembles the Nintendo Switch console but provides features that are typically available on PCs, such as a web browser, and allows users to download third-party software, including other operating systems.16 Some firms have started offering video game subscription services that provide access to multiple games for a monthly fee, meaning users do not need to purchase each individual game.17 Some firms offer cloud gaming, which allows users to play video games using remote servers in data centers, reducing the hardware requirements needed to play the games and expanding the variety of devices that can be used.18 Cloud gaming, however, requires a high-speed internet connection and is not feasible for potential users who do not have access to sufficiently high broadband speeds.19 Subscription services reportedly provide 4% of total revenue in the North American and European video game markets.20 Some firms backed by venture capitalists and large firms that are primarily known for providing other online services have shown interest in entering the video game industry.21 For example, Netflix started offering games on mobile devices on November 2, 2021, and has acquired video game developers.22 These firms may be able to further expand the selection of distributors available for certain devices and potentially increase competition in the industry.23 Microsoft and Activision Blizzard in the Video Game Industry Microsoft distributes video games using Microsoft Store, its subscription service Game Pass,24 and its cloud gaming service Xbox Cloud Gaming (Beta);25 publishes games, including the franchises Halo and Minecraft; 26 and owns 23 gaming studios.27 In 2021, Microsoft had the second-highest share in the U.S. market for game consoles at 34.8%, according to a report from MarketLine, an industry research firm; estimates for Sony and Nintendo were 40.7% and 24.5%, respectively.28 In January 2022, Microsoft stated that it had more than 25 million Game Pass subscribers.29 In April 2022, Microsoft reported that more than 10 million people have streamed games over Xbox Cloud Gaming,30 although it is unclear how long or how many times users accessed the service. Estimates from Ampere Analysis reportedly indicate that Game Pass makes up about 60% of the video game subscription market.31 Among video game publishers in the United States, Microsoft had the highest market share at 23.9%, according to IBISWorld.32 Activision Blizzard is a video game publisher and developer primarily known for its franchise games, which include World of Warcraft, Call of Duty, Diablo, and Candy Crush. 33 The company can be separated into three segments—Activision, Blizzard, and King—that each contain their own gaming studios. Among video game publishers in the United States, Activision Blizzard had the second highest market share at 10%, according to IBISWorld.34 Activision also distributes video games for PCs through its digital store—Battle.net.35 ",Legal,Fact Finding,Q&A "The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, ""The information is not available at this time.""","If a pimple is ready to be popped, should I go ahead and pop it?","Although rare, popping acne in the ""danger triangle""—previously known as the ""triangle of death""— may cause an infection of the face or head. The ""danger triangle"" consists of the area from the corners of your mouth to the bridge of your nose.1 An infection of that area can lead to cavernous sinus thrombosis (CST), or a rare blood clot in your cavernous sinuses. A blood clot in your cavernous sinuses can delay blood flow from your brain.2 Due to the risk of life-threatening infection, you may wonder if and how it's OK to pop pimples on your face. According to dermatologists, here's what you need to know about the ""danger triangle"" and when (if at all) you can pop pimples on your face safely. popping pimple on the the triangle of death (the nose) ZORANM / GETTY IMAGES What Is the 'Triangle of Death'? The ""triangle of death"" is an old term for what many experts now call the ""danger triangle.""1 Visualizing the region on your face may take a bit of imagination. ""The area of the face connecting the nose to the corners of the mouth is thought to be a particularly dangerous area of the face because of their close connection to the brain,"" Joshua Zeichner, MD, an associate professor of dermatology at Mount Sinai Hospital in New York, told Health. The best way to see the triangle is to form one with your fingers—connecting the tips of your thumbs, then the tips of your pointer fingers. On your face, the top of your triangle is on the bridge of your nose. The base starts at either corner of your mouth and extends across the bottom of your upper lip. Acne Face Mapping: How to Determine the Cause of Your Breakouts Risks of Popping Pimples in the ‘Danger Triangle' The phrase ""danger triangle"" might sound slightly extreme when talking about pimple popping. Still, practicing care near that area of your face is critical. Picking at or scratching pimples on that area is not wise since it can allow bacteria to enter and cause infection. In general, the American Academy of Dermatology Association (AAD) does not advise that you pop your pimples. You may push the contents of the pimple deeper into the skin, leading to complications like permanent scarring and more painful and noticeable acne.3 Infection Popping a pimple in the ""danger triangle"" runs the risk of a potentially life-threatening infection. As a result, CST may develop, in which a blood clot forms in your cavernous sinuses and blocks blood flow from your brain.2 ""The cavernous sinus is the name of a large vein that drains blood to the brain, creating a connection from our outside to our inside,"" said Dr. Zeichner. In other words, the infection in a pimple on your nose has a somewhat clear path to your brain. For that reason, ""any infection in that area is a little bit higher risk,"" Alok Vij, MD, a dermatologist at the Cleveland Clinic, told Health. ""In the event that you pick a pimple, and an infection develops, the worst-case scenario is that the infection spreads from the skin through this sinus,"" explained Dr. Zeichner. CST is a dangerous disorder, but recognizing the symptoms right away minimizes the risk of death and complications. CST symptoms include:2 Fever Headache Paralysis of the muscles that control eye movements Swelling around the eyes More Noticeable and Painful Acne Frequently touching your face increases the risk of more acne.4 When you pop pimples, bacteria, dead skin cells, and oil push further into your skin. As a result, more swelling and redness occur, making acne appear more noticeable and painful.5 Scarring Another reason to keep your hands off the ""danger triangle"" is that you may cause scarring in the area, added Dr. Vij. In general, popping pimples may cause scabs to form.6 As the skin heals, you may notice scarring or dark spots on your face. Those dark spots, or post-inflammatory hyperpigmentation, may fade over long periods. Some dark spots take as long as 12 months to return to your natural skin color, while others may be permanent.4 How Do You Treat Pimples? Keeping your hands away from your face is essential to get rid of acne in the ""danger triangle."" Instead of popping pimples in that area, try practicing general self-care tips for treating acne. Acne Medicines You can treat your acne with over-the-counter medicines, such as:7 Adapalene Azelaic acid Benzoyl peroxide Glycolic acid Salicylic acid Sulfur Products with those ingredients help eliminate bacteria, dry oil, or peel the top layer of your skin. By doing so, those products may cause some redness. You may avoid irritating your skin by using a pea-sized amount of product every other or third day. Ensure you use a water-based face moisturizer to prevent dryness and peeling.7 Avoid Foods That Worsen Acne Experts do not conclusively know what foods cause or worsen acne. Still, you may find that some foods, like dairy, high-fat foods, or sweet treats (aka sugar) trigger your acne. Try limiting or cutting out any foods that may cause your acne to flare.7 Daily Skincare Routine A daily skincare routine is essential to treating and preventing acne. For example, try incorporating the following into your routine:7 Clean your face with a gentle, non-drying cleanser to remove dirt and makeup. Repeat once or twice daily and after exercise. Do not use rubbing alcohol or toner on the skin. Those products can dry the skin out. Keep long hair out of your face when you sleep by pulling it back. Only use products that are ""non-comedogenic,"" meaning they do not clog your pores. Shampoo your hair when it's oily. Is There a Way to Safely Pop Pimples? Treating acne may be easier said than done. Sometimes, flattening a pimple on your chin is all too rewarding. While popping your pimples is not advised, there are a few ways to make the process less high-risk. First, stay away from pimples in the ""danger triangle"" region. Anytime you reach for acne on your nose, remember the risk of infection. In contrast, consider the timing if you are determined to pop a pimple on other regions, like your chin. ""If you are going to pop your pimples, do not do it right before bed when you are tired. Think of it like a sterile surgical procedure,"" said Dr. Zeichner. Before popping, thoroughly wash your hands, said Dr. Vij. Ensure the spaces underneath your fingernails are clean since bacteria are good at hiding there. Better yet, cut your nails before popping a pimple, added Dr. Zeichner. Next, clean the skin on your face. Apply a warm compress to your face before you begin the picking process, noted Dr. Vij. Do not pick the top of a zit off with your nails. Instead, ""apply even, downward pressure around the pimples,"" said Dr. Zeichner. It would help if you did this with one of two instruments: a cotton swab or the soft part of your fingertip. Of the utmost importance is realizing when to stop: ""If the blockage does not come out easily, abort the mission,"" noted Dr. Zeichner. Then, remember to practice after-care. ""After picking, apply a topical antibiotic ointment like bacitracin to any open skin."" When To See a Healthcare Provider At-home treatments can help get rid of and prevent acne. Still, some people may have more stubborn acne than others. Consult a dermatologist if you notice:7 At-home treatments do not get rid of or prevent acne within several months Cysts Emotional distress or social anxiety about acne Redness around pimples Scars form as acne clears Worsening acne What Is Stress Acne—And How Do You Get Rid of It? A Quick Review Popping your pimples anywhere on your face is not advised, especially in the area on your face known as the ""danger triangle."" You risk an infection that could travel to your brain and bloodstream if you pop a pimple in that region. While popping pimples is tempting, it is not worth the risk of complications. Instead, avoid touching your face, try at-home treatments, or consult a dermatologist if your acne is not clearing up.","The response should be accurate and concise, with little added conversational elements or tone. If you cannot provide the answer to the request based on the context given, make sure to simply state, ""The information is not available at this time."" If a pimple is ready to be popped, should I go ahead and pop it? Although rare, popping acne in the ""danger triangle""—previously known as the ""triangle of death""— may cause an infection of the face or head. The ""danger triangle"" consists of the area from the corners of your mouth to the bridge of your nose.1 An infection of that area can lead to cavernous sinus thrombosis (CST), or a rare blood clot in your cavernous sinuses. A blood clot in your cavernous sinuses can delay blood flow from your brain.2 Due to the risk of life-threatening infection, you may wonder if and how it's OK to pop pimples on your face. According to dermatologists, here's what you need to know about the ""danger triangle"" and when (if at all) you can pop pimples on your face safely. popping pimple on the the triangle of death (the nose) ZORANM / GETTY IMAGES What Is the 'Triangle of Death'? The ""triangle of death"" is an old term for what many experts now call the ""danger triangle.""1 Visualizing the region on your face may take a bit of imagination. ""The area of the face connecting the nose to the corners of the mouth is thought to be a particularly dangerous area of the face because of their close connection to the brain,"" Joshua Zeichner, MD, an associate professor of dermatology at Mount Sinai Hospital in New York, told Health. The best way to see the triangle is to form one with your fingers—connecting the tips of your thumbs, then the tips of your pointer fingers. On your face, the top of your triangle is on the bridge of your nose. The base starts at either corner of your mouth and extends across the bottom of your upper lip. Acne Face Mapping: How to Determine the Cause of Your Breakouts Risks of Popping Pimples in the ‘Danger Triangle' The phrase ""danger triangle"" might sound slightly extreme when talking about pimple popping. Still, practicing care near that area of your face is critical. Picking at or scratching pimples on that area is not wise since it can allow bacteria to enter and cause infection. In general, the American Academy of Dermatology Association (AAD) does not advise that you pop your pimples. You may push the contents of the pimple deeper into the skin, leading to complications like permanent scarring and more painful and noticeable acne.3 Infection Popping a pimple in the ""danger triangle"" runs the risk of a potentially life-threatening infection. As a result, CST may develop, in which a blood clot forms in your cavernous sinuses and blocks blood flow from your brain.2 ""The cavernous sinus is the name of a large vein that drains blood to the brain, creating a connection from our outside to our inside,"" said Dr. Zeichner. In other words, the infection in a pimple on your nose has a somewhat clear path to your brain. For that reason, ""any infection in that area is a little bit higher risk,"" Alok Vij, MD, a dermatologist at the Cleveland Clinic, told Health. ""In the event that you pick a pimple, and an infection develops, the worst-case scenario is that the infection spreads from the skin through this sinus,"" explained Dr. Zeichner. CST is a dangerous disorder, but recognizing the symptoms right away minimizes the risk of death and complications. CST symptoms include:2 Fever Headache Paralysis of the muscles that control eye movements Swelling around the eyes More Noticeable and Painful Acne Frequently touching your face increases the risk of more acne.4 When you pop pimples, bacteria, dead skin cells, and oil push further into your skin. As a result, more swelling and redness occur, making acne appear more noticeable and painful.5 Scarring Another reason to keep your hands off the ""danger triangle"" is that you may cause scarring in the area, added Dr. Vij. In general, popping pimples may cause scabs to form.6 As the skin heals, you may notice scarring or dark spots on your face. Those dark spots, or post-inflammatory hyperpigmentation, may fade over long periods. Some dark spots take as long as 12 months to return to your natural skin color, while others may be permanent.4 How Do You Treat Pimples? Keeping your hands away from your face is essential to get rid of acne in the ""danger triangle."" Instead of popping pimples in that area, try practicing general self-care tips for treating acne. Acne Medicines You can treat your acne with over-the-counter medicines, such as:7 Adapalene Azelaic acid Benzoyl peroxide Glycolic acid Salicylic acid Sulfur Products with those ingredients help eliminate bacteria, dry oil, or peel the top layer of your skin. By doing so, those products may cause some redness. You may avoid irritating your skin by using a pea-sized amount of product every other or third day. Ensure you use a water-based face moisturizer to prevent dryness and peeling.7 Avoid Foods That Worsen Acne Experts do not conclusively know what foods cause or worsen acne. Still, you may find that some foods, like dairy, high-fat foods, or sweet treats (aka sugar) trigger your acne. Try limiting or cutting out any foods that may cause your acne to flare.7 Daily Skincare Routine A daily skincare routine is essential to treating and preventing acne. For example, try incorporating the following into your routine:7 Clean your face with a gentle, non-drying cleanser to remove dirt and makeup. Repeat once or twice daily and after exercise. Do not use rubbing alcohol or toner on the skin. Those products can dry the skin out. Keep long hair out of your face when you sleep by pulling it back. Only use products that are ""non-comedogenic,"" meaning they do not clog your pores. Shampoo your hair when it's oily. Is There a Way to Safely Pop Pimples? Treating acne may be easier said than done. Sometimes, flattening a pimple on your chin is all too rewarding. While popping your pimples is not advised, there are a few ways to make the process less high-risk. First, stay away from pimples in the ""danger triangle"" region. Anytime you reach for acne on your nose, remember the risk of infection. In contrast, consider the timing if you are determined to pop a pimple on other regions, like your chin. ""If you are going to pop your pimples, do not do it right before bed when you are tired. Think of it like a sterile surgical procedure,"" said Dr. Zeichner. Before popping, thoroughly wash your hands, said Dr. Vij. Ensure the spaces underneath your fingernails are clean since bacteria are good at hiding there. Better yet, cut your nails before popping a pimple, added Dr. Zeichner. Next, clean the skin on your face. Apply a warm compress to your face before you begin the picking process, noted Dr. Vij. Do not pick the top of a zit off with your nails. Instead, ""apply even, downward pressure around the pimples,"" said Dr. Zeichner. It would help if you did this with one of two instruments: a cotton swab or the soft part of your fingertip. Of the utmost importance is realizing when to stop: ""If the blockage does not come out easily, abort the mission,"" noted Dr. Zeichner. Then, remember to practice after-care. ""After picking, apply a topical antibiotic ointment like bacitracin to any open skin."" When To See a Healthcare Provider At-home treatments can help get rid of and prevent acne. Still, some people may have more stubborn acne than others. Consult a dermatologist if you notice:7 At-home treatments do not get rid of or prevent acne within several months Cysts Emotional distress or social anxiety about acne Redness around pimples Scars form as acne clears Worsening acne What Is Stress Acne—And How Do You Get Rid of It? A Quick Review Popping your pimples anywhere on your face is not advised, especially in the area on your face known as the ""danger triangle."" You risk an infection that could travel to your brain and bloodstream if you pop a pimple in that region. While popping pimples is tempting, it is not worth the risk of complications. Instead, avoid touching your face, try at-home treatments, or consult a dermatologist if your acne is not clearing up.",Medical,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Hey, I'm working on a paper about the use of low-dose aspirin during pregnancy, and I'm trying to clarify something. In the leaflet, it says aspirin reduces the risk of pre-eclampsia and smaller babies, but I'm confused about how it affects placental blood flow versus its impact on potential bleeding during labor. Wouldn't increased blood flow increase bleeding risks? Also, how does aspirin interact with indigestion remedies, and does that complicate its safety for someone with both pregnancy and digestive issues?","You have been given this information leaflet as you have been advised to take low dose aspirin, 150mg once a day from 12 to 36 weeks of your pregnancy. What is aspirin? Aspirin is known as an NSAID (a non-steroidal anti-inflammatory drug). Aspirin is often used to treat pain, fever, inflammation or prevent clot formation. There is evidence that taking low dose aspirin once a day can help increase the function and blood flow of your placenta (afterbirth) which provides your baby with oxygen and nutrients during your pregnancy to help them grow. Why have I been advised to take aspirin? Not everyone is recommended to take aspirin in pregnancy. You have been advised to take a low dose of aspirin during your pregnancy to reduce the risk of: • developing hypertension (high blood pressure) and pre-eclampsia (high blood pressure and protein in your urine) • giving birth to your baby prematurely (before 37 weeks) • your baby being smaller than expected Your midwife or obstetrician (a doctor who specialises in the care of pregnant women) may recommend that you take low dose aspirin to reduce the risk of hypertension (high blood pressure) if one of the following apply to you: • you had hypertension (high blood pressure) during a previous pregnancy • you have chronic kidney disease • you have an auto-immune disease (for example, lupus or antiphospholipid syndrome) • you have Type 1 or 2 diabetes • you have chronic hypertension (high blood pressure before pregnancy) • you have previously given birth to a baby who was smaller than expected • you have low Pregnancy Associated Plasma Protein (PAPP-A) screening blood test • you are aged 40 years or older Low dose aspirin may also be recommended if two or more of the following apply to you: • this is your first pregnancy • there are more than 10 years between this pregnancy and the birth of your last baby • your BMI is 35 or more at your booking appointment • there is a family history of pre-eclampsia in a first degree relative • this is a multiple pregnancy (for example, twins or triplets) You may also be advised to take low dose aspirin if you have a slightly higher chance of having a baby which may be smaller than expected. Or there were any concerns about how your placenta was working in a previous pregnancy; this will be discussed with you. Page 2 of 3 How and when do I take aspirin? You should take 150mg (2 x75mg tablets) once a day from 12 weeks until 36 weeks of your pregnancy. It is best to take in the evening either with or just after food. Please do not worry if you forget to take a tablet, just take one when you remember, however make sure you only take 150mg once a day. If you think you may be in labour, you can stop taking your aspirin until this is confirmed. It will not increase your risk of bleeding during your labour. Is low dose aspirin safe to take in pregnancy? Low dose aspirin is not known to be harmful to you or your baby during pregnancy. In fact it is known to reduce the risk of harm by reducing the risk of high blood pressure, pre-eclampsia, smaller babies and stillbirth. However, aspirin can affect (and be affected by) other medications, including ‘over the Counter’ medicines and herbal remedies. Please discuss any other medications you are taking with your midwife, GP or obstetrician. Side effects Taking low dose aspirin can cause mild indigestion. If you take your aspirin either with or just after food, it will be less likely to upset your stomach. Avoid taking aspirin on an empty stomach. If you also take indigestion remedies, take them at least two hours before or after you take your aspirin. There is no evidence to suggest low dose aspirin causes any increase in bleeding during pregnancy or at the time of birth. If you have any questions or concerns about taking low dose aspirin please speak to your obstetrician, GP or midwife. Allergies Please tell your obstetrician, midwife or GP if you are allergic to aspirin (or other NSAIDS), or you have severe asthma, chronic kidney problems, stomach ulcers or have been previously advised not to take aspirin or other NSAIDs. As with any medicine, you should seek urgent medical assistance if you experience serious side effects such as wheezing, swelling of the lips, face or body, rashes or other indications of an allergic reaction. What can I do to help? If you smoke it is very important that you stop as it can affect placental (afterbirth) function and your baby’s growth. Please contact your community or continuity team midwife who can refer you to smoking cessation; you can also self-refer at One You East Sussex Sources of information If you would like more information about taking low dose aspirin in pregnancy, your midwife or obstetrician will be happy to answer your questions and advise you"," Only use the provided text to answer the question, no outside sources. Hey, I'm working on a paper about the use of low-dose aspirin during pregnancy, and I'm trying to clarify something. In the leaflet, it says aspirin reduces the risk of pre-eclampsia and smaller babies, but I'm confused about how it affects placental blood flow versus its impact on potential bleeding during labor. Wouldn't increased blood flow increase bleeding risks? Also, how does aspirin interact with indigestion remedies, and does that complicate its safety for someone with both pregnancy and digestive issues? You have been given this information leaflet as you have been advised to take low dose aspirin, 150mg once a day from 12 to 36 weeks of your pregnancy. What is aspirin? Aspirin is known as an NSAID (a non-steroidal anti-inflammatory drug). Aspirin is often used to treat pain, fever, inflammation or prevent clot formation. There is evidence that taking low dose aspirin once a day can help increase the function and blood flow of your placenta (afterbirth) which provides your baby with oxygen and nutrients during your pregnancy to help them grow. Why have I been advised to take aspirin? Not everyone is recommended to take aspirin in pregnancy. You have been advised to take a low dose of aspirin during your pregnancy to reduce the risk of: • developing hypertension (high blood pressure) and pre-eclampsia (high blood pressure and protein in your urine) • giving birth to your baby prematurely (before 37 weeks) • your baby being smaller than expected Your midwife or obstetrician (a doctor who specialises in the care of pregnant women) may recommend that you take low dose aspirin to reduce the risk of hypertension (high blood pressure) if one of the following apply to you: • you had hypertension (high blood pressure) during a previous pregnancy • you have chronic kidney disease • you have an auto-immune disease (for example, lupus or antiphospholipid syndrome) • you have Type 1 or 2 diabetes • you have chronic hypertension (high blood pressure before pregnancy) • you have previously given birth to a baby who was smaller than expected • you have low Pregnancy Associated Plasma Protein (PAPP-A) screening blood test • you are aged 40 years or older Low dose aspirin may also be recommended if two or more of the following apply to you: • this is your first pregnancy • there are more than 10 years between this pregnancy and the birth of your last baby • your BMI is 35 or more at your booking appointment • there is a family history of pre-eclampsia in a first degree relative • this is a multiple pregnancy (for example, twins or triplets) You may also be advised to take low dose aspirin if you have a slightly higher chance of having a baby which may be smaller than expected. Or there were any concerns about how your placenta was working in a previous pregnancy; this will be discussed with you. Page 2 of 3 How and when do I take aspirin? You should take 150mg (2 x75mg tablets) once a day from 12 weeks until 36 weeks of your pregnancy. It is best to take in the evening either with or just after food. Please do not worry if you forget to take a tablet, just take one when you remember, however make sure you only take 150mg once a day. If you think you may be in labour, you can stop taking your aspirin until this is confirmed. It will not increase your risk of bleeding during your labour. Is low dose aspirin safe to take in pregnancy? Low dose aspirin is not known to be harmful to you or your baby during pregnancy. In fact it is known to reduce the risk of harm by reducing the risk of high blood pressure, pre-eclampsia, smaller babies and stillbirth. However, aspirin can affect (and be affected by) other medications, including ‘over the Counter’ medicines and herbal remedies. Please discuss any other medications you are taking with your midwife, GP or obstetrician. Side effects Taking low dose aspirin can cause mild indigestion. If you take your aspirin either with or just after food, it will be less likely to upset your stomach. Avoid taking aspirin on an empty stomach. If you also take indigestion remedies, take them at least two hours before or after you take your aspirin. There is no evidence to suggest low dose aspirin causes any increase in bleeding during pregnancy or at the time of birth. If you have any questions or concerns about taking low dose aspirin please speak to your obstetrician, GP or midwife. Allergies Please tell your obstetrician, midwife or GP if you are allergic to aspirin (or other NSAIDS), or you have severe asthma, chronic kidney problems, stomach ulcers or have been previously advised not to take aspirin or other NSAIDs. As with any medicine, you should seek urgent medical assistance if you experience serious side effects such as wheezing, swelling of the lips, face or body, rashes or other indications of an allergic reaction. What can I do to help? If you smoke it is very important that you stop as it can affect placental (afterbirth) function and your baby’s growth. Please contact your community or continuity team midwife who can refer you to smoking cessation; you can also self-refer at One You East Sussex Sources of information If you would like more information about taking low dose aspirin in pregnancy, your midwife or obstetrician will be happy to answer your questions and advise you https://www.esht.nhs.uk/wp-content/uploads/2021/06/0925.pdf",Medical,Effect Analysis,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","I am going to have surgery next week and my doctor sent a form home with me with a questionnaire to fill out before I go in for the surgery. Using this article for reference, can you tell me what medications may interfere with anesthesia and why? Use at least 500 words.","4 types of medications that can interfere with anesthesia BY Molly Adams Patients with cancer may take all kinds of medications – whether they’re used to treat cancer, its side effects, or other conditions that have nothing to do with a cancer diagnosis. While medications are a part of daily life for many of us, there are times when you should adjust your dose or even stop taking certain medicines. “Before you undergo anesthesia for any reason, you want to be sure you’re not taking any medicines that may cause a problem with anesthesia or your procedure,” says Shannon Popovich, M.D., medical director of MD Anderson’s Perioperative Evaluation and Management Center. Here, Popovich shares four types of medication to be mindful of before anesthesia. 1. Blood pressure and heart failure medications Patients may take these to help treat high blood pressure or heart failure. These drugs include beta-blockers, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors or diuretics. When a patient is under anesthesia, we monitor their blood pressure very closely, and some of these medications can lower your blood pressure more when combined with anesthesia. If you’re taking any medication to lower your blood pressure, that can really complicate our efforts to maintain your blood pressure during surgery or any other treatment performed under anesthesia. We generally suggest patients stop taking ACE inhibitors, angiotensin receptor blockers or direct renin inhibitors 24 hours before undergoing anesthesia to reduce the risk of your blood pressure falling too low when combined with anesthesia. Beta-blockers, calcium channel blockers and medications for heart failure should be taken as usual. They’re not as likely to complicate your blood pressure during anesthesia. 2. Type 2 diabetes medications Certain drugs used to help regulate blood sugars for patients with diabetes and pre-diabetes should be discussed with your physician before receiving anesthesia. Two specific classes of drugs are particularly concerning: GLP-1 agonists and SGLT-2 inhibitors. Medications called GLP-1 agonists (Semaglutide) before anesthesia can increase the risk of vomiting and aspiration because they slow the time it takes for food to leave your stomach. Even when patients stop eating for the advised period before anesthesia, these drugs may still cause them to have a full stomach. We generally ask patients to temporarily stop taking these medications based on how often they take them. For example, if you take the drug once a week, stop taking it a week before anesthesia. If you take it once a day, hold it the day of surgery, and consider holding it the day before to reduce your risk of a full stomach. SGLT-2 inhibitors are known to place patients at risk for euglycemic ketoacidosis when the body is under stress or they are fasting. This is a dangerous condition, and these medications should be held 3 to 4 days before anesthesia, depending on which drug you’re taking. Talk to your prescribing doctor to learn what they recommend for you. If you’re concerned about how holding your diabetes medication may affect your blood glucose levels, talk to your endocrinologist or prescribing doctor to see what they recommend. If you take insulin to help manage Type 1 diabetes, continue taking it as you normally do. MD Anderson patients will discuss specific recommendations with the Perioperative Evaluation and Management team or Endocrinology teams before anesthesia. Insulin taken for Type 2 diabetes may be adjusted in the 24 hours before anesthesia as instructed by your doctor. But be sure to tell your care team about your medication and dosage. 3. Weight loss medications Although some diabetes medications, like GLP-1 agonists, may help patients with weight loss, there’s another class of drugs solely aimed at weight loss. These are stimulants and work by decreasing appetite and increasing your heart rate. That stimulation can have an unwanted effect when combined with anesthesia. Drugs that contain phentermine need to be held for 4 days before anesthesia, but when combined with another medication (like topiramate) may need to be slowly tapered off over time. Be sure to talk to your care team about your dose and type of medication so we can wean you off safely. 4. Blood thinners and blood clotting drugs If you’re undergoing anesthesia before surgery, you might need to stop blood thinning medications – even over-the-counter ones like ibuprofen or Advil – to avoid the risk of excessive bleeding. Talk with your surgeon or proceduralist about any blood thinners you’re taking. For less-invasive procedures like MRI, you should be able to keep taking blood thinners as normal. Some medications are important to keep taking Most patients will be able to start taking their regular medications again soon after waking up from anesthesia. In many cases, you may be able to start taking your medications again after you’ve had something to eat and are cleared after surgery. Although there are several medications to avoid before anesthesia, there are many you can – and should keep taking. Patients who take birth control should continue doing so to avoid the risk of becoming pregnant. This is especially important for patients undergoing chemotherapy or radiation therapy, which can be dangerous to unborn babies. Antidepressants, anxiety medication and most medicines used to treat ADHD are also safe to continue. If you use sleep aids to help ease insomnia, you can also keep taking them as directed. The most important thing is to be honest about any drugs you’re taking – prescription or not – so your care team can give you the best advice for your unique needs.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I am going to have surgery next week and my doctor sent a form home with me with a questionnaire to fill out before I go in for the surgery. Using this article for reference, can you tell me what medications may interfere with anesthesia and why? Use at least 500 words. {passage 0} ========== 4 types of medications that can interfere with anesthesia BY Molly Adams Patients with cancer may take all kinds of medications – whether they’re used to treat cancer, its side effects, or other conditions that have nothing to do with a cancer diagnosis. While medications are a part of daily life for many of us, there are times when you should adjust your dose or even stop taking certain medicines. “Before you undergo anesthesia for any reason, you want to be sure you’re not taking any medicines that may cause a problem with anesthesia or your procedure,” says Shannon Popovich, M.D., medical director of MD Anderson’s Perioperative Evaluation and Management Center. Here, Popovich shares four types of medication to be mindful of before anesthesia. 1. Blood pressure and heart failure medications Patients may take these to help treat high blood pressure or heart failure. These drugs include beta-blockers, ACE inhibitors, angiotensin receptor blockers, direct renin inhibitors or diuretics. When a patient is under anesthesia, we monitor their blood pressure very closely, and some of these medications can lower your blood pressure more when combined with anesthesia. If you’re taking any medication to lower your blood pressure, that can really complicate our efforts to maintain your blood pressure during surgery or any other treatment performed under anesthesia. We generally suggest patients stop taking ACE inhibitors, angiotensin receptor blockers or direct renin inhibitors 24 hours before undergoing anesthesia to reduce the risk of your blood pressure falling too low when combined with anesthesia. Beta-blockers, calcium channel blockers and medications for heart failure should be taken as usual. They’re not as likely to complicate your blood pressure during anesthesia. 2. Type 2 diabetes medications Certain drugs used to help regulate blood sugars for patients with diabetes and pre-diabetes should be discussed with your physician before receiving anesthesia. Two specific classes of drugs are particularly concerning: GLP-1 agonists and SGLT-2 inhibitors. Medications called GLP-1 agonists (Semaglutide) before anesthesia can increase the risk of vomiting and aspiration because they slow the time it takes for food to leave your stomach. Even when patients stop eating for the advised period before anesthesia, these drugs may still cause them to have a full stomach. We generally ask patients to temporarily stop taking these medications based on how often they take them. For example, if you take the drug once a week, stop taking it a week before anesthesia. If you take it once a day, hold it the day of surgery, and consider holding it the day before to reduce your risk of a full stomach. SGLT-2 inhibitors are known to place patients at risk for euglycemic ketoacidosis when the body is under stress or they are fasting. This is a dangerous condition, and these medications should be held 3 to 4 days before anesthesia, depending on which drug you’re taking. Talk to your prescribing doctor to learn what they recommend for you. If you’re concerned about how holding your diabetes medication may affect your blood glucose levels, talk to your endocrinologist or prescribing doctor to see what they recommend. If you take insulin to help manage Type 1 diabetes, continue taking it as you normally do. MD Anderson patients will discuss specific recommendations with the Perioperative Evaluation and Management team or Endocrinology teams before anesthesia. Insulin taken for Type 2 diabetes may be adjusted in the 24 hours before anesthesia as instructed by your doctor. But be sure to tell your care team about your medication and dosage. 3. Weight loss medications Although some diabetes medications, like GLP-1 agonists, may help patients with weight loss, there’s another class of drugs solely aimed at weight loss. These are stimulants and work by decreasing appetite and increasing your heart rate. That stimulation can have an unwanted effect when combined with anesthesia. Drugs that contain phentermine need to be held for 4 days before anesthesia, but when combined with another medication (like topiramate) may need to be slowly tapered off over time. Be sure to talk to your care team about your dose and type of medication so we can wean you off safely. 4. Blood thinners and blood clotting drugs If you’re undergoing anesthesia before surgery, you might need to stop blood thinning medications – even over-the-counter ones like ibuprofen or Advil – to avoid the risk of excessive bleeding. Talk with your surgeon or proceduralist about any blood thinners you’re taking. For less-invasive procedures like MRI, you should be able to keep taking blood thinners as normal. Some medications are important to keep taking Most patients will be able to start taking their regular medications again soon after waking up from anesthesia. In many cases, you may be able to start taking your medications again after you’ve had something to eat and are cleared after surgery. Although there are several medications to avoid before anesthesia, there are many you can – and should keep taking. Patients who take birth control should continue doing so to avoid the risk of becoming pregnant. This is especially important for patients undergoing chemotherapy or radiation therapy, which can be dangerous to unborn babies. Antidepressants, anxiety medication and most medicines used to treat ADHD are also safe to continue. If you use sleep aids to help ease insomnia, you can also keep taking them as directed. The most important thing is to be honest about any drugs you’re taking – prescription or not – so your care team can give you the best advice for your unique needs. https://www.mdanderson.org/cancerwise/4-types-of-medications-that-can-interfere-with-anesthesia.h00-159623379.html",Medical,Fact Finding,Q&A Base your response on the given text. Limit your response to 300 words. Give your answer in paragraphs.,Give me some examples of software.,"What is technology?1 In the narrowest sense, technology consists of manufactured objects like tools (axes, arrowheads, and their modern equivalents) and containers (pots, water reservoirs, buildings). Their purpose is either to enhance human capabilities (e.g., with a hammer you can apply a stronger force to an object) or to enable humans to perform tasks they could not perform otherwise (with a pot you can transport larger amounts of water; with your hands you cannot). Engineers call such objects “hardware”. Anthropologists speak of “artifacts”. But technology does not end there. Artifacts have to be produced. They have to be invented, designed, and manufactured. This requires a larger system including hardware (such as machinery or a manufacturing plant), factor inputs (labor, energy, raw materials, capital), and finally “software” (know-how, human knowledge and skills). The latter, for which the French use the term technique, represents the disembodied nature of technology, its knowledge base. Thus, technology includes both what things are made and how things are made. Finally, knowledge, or technique, is required not only for the production of artifacts, but also for their use. Knowledge is needed to drive a car or use a bank account. Knowledge is needed both at the level of the individual, in complex organizations, and at the level of society. A typewriter, without a user who knows how to type, let alone how to read, is simply a useless, heavy piece of equipment. Technological hardware varies in size and complexity, as does the “software” required to produce and use hardware. The two are interrelated and require both tangible and intangible settings in the form of spatial structures and social organizations. Institutions, including governments, firms, and markets, and social norms and attitudes, are especially important in determining how systems for producing and using artifacts emerge and function. They determine how particular artifacts and combinations of artifacts originate, which ones are rejected or which ones become successful, and, if successful, how quickly they are incorporated in the economy and the society. The latter step is referred to as technology diffusion.","Base your response on the given text. Limit your response to 300 words. Give your answer in paragraphs. What is technology?1 In the narrowest sense, technology consists of manufactured objects like tools (axes, arrowheads, and their modern equivalents) and containers (pots, water reservoirs, buildings). Their purpose is either to enhance human capabilities (e.g., with a hammer you can apply a stronger force to an object) or to enable humans to perform tasks they could not perform otherwise (with a pot you can transport larger amounts of water; with your hands you cannot). Engineers call such objects “hardware”. Anthropologists speak of “artifacts”. But technology does not end there. Artifacts have to be produced. They have to be invented, designed, and manufactured. This requires a larger system including hardware (such as machinery or a manufacturing plant), factor inputs (labor, energy, raw materials, capital), and finally “software” (know-how, human knowledge and skills). The latter, for which the French use the term technique, represents the disembodied nature of technology, its knowledge base. Thus, technology includes both what things are made and how things are made. Finally, knowledge, or technique, is required not only for the production of artifacts, but also for their use. Knowledge is needed to drive a car or use a bank account. Knowledge is needed both at the level of the individual, in complex organizations, and at the level of society. A typewriter, without a user who knows how to type, let alone how to read, is simply a useless, heavy piece of equipment. Technological hardware varies in size and complexity, as does the “software” required to produce and use hardware. The two are interrelated and require both tangible and intangible settings in the form of spatial structures and social organizations. Institutions, including governments, firms, and markets, and social norms and attitudes, are especially important in determining how systems for producing and using artifacts emerge and function. They determine how particular artifacts and combinations of artifacts originate, which ones are rejected or which ones become successful, and, if successful, how quickly they are incorporated in the economy and the society. The latter step is referred to as technology diffusion. Give me some examples of software.",Internet/Technology,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","I got a mail order bride, she cheated on me.... a lot. what is her scenario going to be now that i want to divorce her and have nothing to do with her. We don't have a kid, she's never had a real job, she doesn't have a bank account, pretty much has nothing going for herself. it's only been 10 months since we got her conditional green card. what happens to her?","Green Card Types When you obtain a green card through marriage, it will either be a permanent renewable green card that is valid for ten years or a conditional two-year green card. The conditional green card is issued to applicants that have been married for less than two years at the time the green card is issued. You can apply to have these conditions lifted two years after arriving in the United States. Divorce and a Permanent Green Card If you divorce and you have a permanent green card, there is typically no impact to the renewal process. When it comes time to renew your green card, you simply file Form I-90 (officially called “Application to Replace Permanent Resident Card”). There are no questions about your marital or relationship status for a green card renewal. If you legally changed your name after your divorce, you can also update your green card at that time by submitting a legal record with your new name. Divorce and a Conditional Green Card In order to lift the conditions after two years, you need to prove that you and your partner are still married. Therefore, divorce when you hold a conditional green card can cause issues. A waiver is available when you file Form I-751 to remove the conditions on your green card, but you will have to prove that your marriage prior to the divorce was genuine and not the result of immigration fraud. Typically, U.S. Citizenship and Immigration Services (USCIS) closely examines applications with waivers and you might be asked to provide additional evidence to prove you entered the marriage in good faith. To prove your marriage was real, you can include joint financial records, proof that you lived together, evidence that you have children together, or that you sought marriage counseling. You will also need to include a detailed written statement explaining why your marriage ended. If you and your partner separated because of irreconcilable differences, explain what those differences were. For example, perhaps one partner wanted to have children but the other didn’t. Sometimes, a marriage ends because of the actions of a spouse, such as domestic abuse or adultery. In these cases, you would submit copies of your divorce papers and if available, court records detailing these claims. If the divorce was as a result of your actions, it is best that you consult with an experienced immigration attorney about your case. Removing conditions when the divorce is not final If your divorce has not yet been finalized, you will need to include evidence that you or your partner have initiated divorce proceedings. In this case, USCIS will typically send you a notice in the mail extending your conditional residence status for one more year. At a later date, you will also likely receive a Request For Evidence (RFE) for the final decree of divorce. Removing conditions when you are separated but not divorced In rare cases, you can apply to remove conditions when you and your spouse are separated but you aren’t divorced, or your spouse refuses to grant you a divorce. If you are able to prove “extreme hardship,” then you may still be eligible for a permanent green card. USCIS provides detailed examples of what constitutes “extreme hardship,” Divorcing During the Green Card Application Process If you divorce during the application process for a marriage green card, then the application will stop and no longer progress. This is the case whether you are applying for a marriage green card or you are married to someone being sponsored for a green card through their U.S. employer. It’s also important to be aware that USCIS is very vigilant about immigration fraud and that pretending to be married or not disclosing a divorce when applying for a green card could be viewed as immigration fraud.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I got a mail order bride, she cheated on me.... a lot. what is her scenario going to be now that i want to divorce her and have nothing to do with her. We don't have a kid, she's never had a real job, she doesn't have a bank account, pretty much has nothing going for herself. it's only been 10 months since we got her conditional green card. what happens to her? Green Card Types When you obtain a green card through marriage, it will either be a permanent renewable green card that is valid for ten years or a conditional two-year green card. The conditional green card is issued to applicants that have been married for less than two years at the time the green card is issued. You can apply to have these conditions lifted two years after arriving in the United States. Divorce and a Permanent Green Card If you divorce and you have a permanent green card, there is typically no impact to the renewal process. When it comes time to renew your green card, you simply file Form I-90 (officially called “Application to Replace Permanent Resident Card”). There are no questions about your marital or relationship status for a green card renewal. If you legally changed your name after your divorce, you can also update your green card at that time by submitting a legal record with your new name. Divorce and a Conditional Green Card In order to lift the conditions after two years, you need to prove that you and your partner are still married. Therefore, divorce when you hold a conditional green card can cause issues. A waiver is available when you file Form I-751 to remove the conditions on your green card, but you will have to prove that your marriage prior to the divorce was genuine and not the result of immigration fraud. Typically, U.S. Citizenship and Immigration Services (USCIS) closely examines applications with waivers and you might be asked to provide additional evidence to prove you entered the marriage in good faith. To prove your marriage was real, you can include joint financial records, proof that you lived together, evidence that you have children together, or that you sought marriage counseling. You will also need to include a detailed written statement explaining why your marriage ended. If you and your partner separated because of irreconcilable differences, explain what those differences were. For example, perhaps one partner wanted to have children but the other didn’t. Sometimes, a marriage ends because of the actions of a spouse, such as domestic abuse or adultery. In these cases, you would submit copies of your divorce papers and if available, court records detailing these claims. If the divorce was as a result of your actions, it is best that you consult with an experienced immigration attorney about your case. Removing conditions when the divorce is not final If your divorce has not yet been finalized, you will need to include evidence that you or your partner have initiated divorce proceedings. In this case, USCIS will typically send you a notice in the mail extending your conditional residence status for one more year. At a later date, you will also likely receive a Request For Evidence (RFE) for the final decree of divorce. Removing conditions when you are separated but not divorced In rare cases, you can apply to remove conditions when you and your spouse are separated but you aren’t divorced, or your spouse refuses to grant you a divorce. If you are able to prove “extreme hardship,” then you may still be eligible for a permanent green card. USCIS provides detailed examples of what constitutes “extreme hardship,” Divorcing During the Green Card Application Process If you divorce during the application process for a marriage green card, then the application will stop and no longer progress. This is the case whether you are applying for a marriage green card or you are married to someone being sponsored for a green card through their U.S. employer. It’s also important to be aware that USCIS is very vigilant about immigration fraud and that pretending to be married or not disclosing a divorce when applying for a green card could be viewed as immigration fraud. https://www.boundless.com/immigration-resources/marriage-green-card-divorce/",Legal,Find & Summarize,Text Transformation This task requires you to answer questions based solely on the information provided in the prompt.,"According to this document, how did Youtube advertising revenue perform in Q1 2023?","Ruth Porat, President and Chief Investment Officer; CFO, Alphabet and Google: Thank you, Philipp. We are very pleased with our financial results for the first quarter, driven in particular by strength in Search and Cloud, as well as the ongoing efforts to durably re-engineer our cost base. My comments will be on year-over-year comparisons for the first quarter, unless I state otherwise. I will start with results at the Alphabet level, followed by segment results, and conclude with our outlook. For the first quarter, our consolidated revenues were $80.5 billion, up 15% or up 16% in constant currency. Search remained the largest contributor to revenue growth. In terms of total expenses, the year-on-year comparisons reflect the impact of the restructuring charges we took in the first quarter of 2023, of $2.6 billion, as well as the $716 million in employee severance and related charges in the first quarter of 2024. As you can see in our earnings release, these charges were allocated across the expense lines in Other Cost of Revenues and OpEx based on associated headcount. To help with year-on-year comparisons, we included a table in our earnings release to adjust Other Cost of Revenues, operating expenses, operating income and operating margin to exclude the impact of severance and related office space charges in the first quarter of 2023 versus 2024. In terms of expenses, total Cost of Revenues was $33.7 billion, up 10%. Other Cost of Revenues was $20.8 billion, up 10% on a reported basis, with the increase driven primarily by content acquisition costs associated with YouTube, given the very strong revenue growth in both subscription offerings and ad-supported content. On an adjusted basis, Other Cost of Revenues were up 13% year-on-year. Operating expenses were $21.4 billion, down 2% on a reported basis, primarily reflecting expense decreases in sales and marketing and G&A, offset by an increase in R&D. The largest 10 single factor in the year-on-year decline in G&A expenses was lower charges related to legal matters. On an adjusted basis, operating expenses were up 5%, reflecting; first, in R&D, an increase in compensation expense, primarily for Google DeepMind and Cloud; and second, in Sales and Marketing a slight increase year-on-year, reflecting increases in compensation expense, primarily for Cloud sales. Operating income was $25.5 billion, up 46% on a reported basis, and our operating margin was 32%. On an adjusted basis, operating income was up 31%, and our operating margin was 33%. Net income was $23.7 billion, and EPS was $1.89. We delivered free cash flow of $16.8 billion in the first quarter and $69.1 billion for the trailing 12 months. We ended the quarter with $108 billion in cash and marketable securities. Turning to segment results, within Google Services, revenues were $70.4 billion, up 14%. Google Search & Other advertising revenues of $46.2 billion in the quarter were up 14%, led again by growth in retail. YouTube advertising revenues of $8.1 billion, were up 21%, driven by both direct response and brand advertising. Network advertising revenues of $7.4 billion were down 1%. Subscriptions, Platforms and Devices revenues were $8.7 billion, up 18%, primarily reflecting growth in YouTube subscription revenues. TAC was $12.9 billion, up 10%. Google Services Operating Income was $27.9 billion, up 28%, and the operating margin was 40%. Turning to the Google Cloud segment, revenues were $9.6 billion for the quarter, up 28%, reflecting significant growth in GCP, with an increasing contribution from AI and strong Google Workspace growth, primarily driven by increases in average revenue per seat. Google Cloud delivered Operating Income of $900 million and an operating margin of 9%. As to our Other Bets, for the first quarter, revenues were $495 million, benefiting from a milestone payment in one of the Other Bets. The operating loss was $1 billion. 11 Turning to our outlook for the business, with respect to Google Services. First, within Advertising, we are very pleased with the momentum of our Ads businesses. Search had broad-based strength across verticals. In YouTube, we had acceleration in revenue growth driven by brand and direct response. Looking ahead, two points to call out. First, results in our advertising business in Q1 continued to reflect strength in spend from APAC-based retailers, a trend that began in the second quarter of 2023 and continued through Q1, which means we will begin lapping that impact in the second quarter. Second, the YouTube acceleration in revenue growth in Q1 reflects, in part, lapping the negative year-on-year growth we experienced in the first quarter of 2023. Turning to Subscriptions, Platforms and Devices. We continue to deliver significant growth in our subscriptions business, which drives the majority of revenue growth in this line. The sequential quarterly decline in year-on-year revenue growth for the line in Q1, versus Q4, reflects, in part, the fact that we had only one week of Sunday Ticket subscription revenue in Q1 versus fourteen weeks in Q4. Looking forward, we will anniversary last year's price increase in YouTube TV starting in May. With regard to Platforms, we are pleased with the performance in Play driven by an increase in buyers. With respect to Google Cloud, performance in Q1 reflects strong demand for our GCP infrastructure and solutions, as well as the contribution from our Workspace productivity tools. The growth we are seeing across Cloud is underpinned by the benefit AI provides for our customers. We continue to invest aggressively, while remaining focused on profitable growth. As we look ahead, two points that will affect sequential year-on-year revenue growth comparisons across Alphabet. First, Q1 results reflect the benefit of Leap Year, which contributed slightly more than one point to our revenue growth rate at the consolidated level in the first quarter. Second, at current spot rates, we expect a larger headwind from foreign exchange in Q2 versus Q1. Turning to margins, our efforts to durably re-engineer our cost base are reflected in a 400 basis point expansion of our Alphabet operating margin year-on-year, excluding the impact of restructuring and severance charges in both periods. You can also see the impact in the quarter-on-quarter decline in headcount in Q1, which reflects 12 both actions we have taken over the past few months and a much slower pace of hiring. As we have discussed previously, we are continuing to invest in top engineering and technical talent, particularly in Cloud, Google DeepMind and Technical Infrastructure. Looking ahead, we remain focused on our efforts to moderate the pace of expense growth in order to create capacity for the increases in depreciation and expenses associated with the higher levels of investment in our technical infrastructure. We believe these efforts will enable us to deliver full-year 2024 Alphabet operating margin expansion relative to 2023. With respect to CapEx, our reported CapEx in the first quarter was $12 billion, once again driven overwhelmingly by investment in our technical infrastructure, with the largest component for servers, followed by data centers. The significant year-on-year growth in CapEx in recent quarters reflects our confidence in the opportunities offered by AI across our business. Looking ahead, we expect quarterly CapEx throughout the year to be roughly at or above the Q1 level, keeping in mind that the timing of cash payments can cause variability in quarterly reported CapEx. With regard to Other Bets, we similarly have workstreams under way to enhance overall returns. Finally, as I trust you saw in the press release, we are very pleased to be adding a quarterly dividend of $.20 per share to our capital return program, as well as a new $70 billion authorization in share repurchases. The core of our capital allocation framework remains the same, beginning with investing aggressively in our business as you have heard us talk about today, given the extraordinary opportunities ahead. We view the introduction of the dividend as further strengthening our overall capital return program. Thank you. Sundar, Philipp and I will now take your questions.","System instruction: This task requires you to answer questions based solely on the information provided in the prompt. question: According to this document, how did Youtube advertising revenue perform in Q1 2023? context: Ruth Porat, President and Chief Investment Officer; CFO, Alphabet and Google: Thank you, Philipp. We are very pleased with our financial results for the first quarter, driven in particular by strength in Search and Cloud, as well as the ongoing efforts to durably re-engineer our cost base. My comments will be on year-over-year comparisons for the first quarter, unless I state otherwise. I will start with results at the Alphabet level, followed by segment results, and conclude with our outlook. For the first quarter, our consolidated revenues were $80.5 billion, up 15% or up 16% in constant currency. Search remained the largest contributor to revenue growth. In terms of total expenses, the year-on-year comparisons reflect the impact of the restructuring charges we took in the first quarter of 2023, of $2.6 billion, as well as the $716 million in employee severance and related charges in the first quarter of 2024. As you can see in our earnings release, these charges were allocated across the expense lines in Other Cost of Revenues and OpEx based on associated headcount. To help with year-on-year comparisons, we included a table in our earnings release to adjust Other Cost of Revenues, operating expenses, operating income and operating margin to exclude the impact of severance and related office space charges in the first quarter of 2023 versus 2024. In terms of expenses, total Cost of Revenues was $33.7 billion, up 10%. Other Cost of Revenues was $20.8 billion, up 10% on a reported basis, with the increase driven primarily by content acquisition costs associated with YouTube, given the very strong revenue growth in both subscription offerings and ad-supported content. On an adjusted basis, Other Cost of Revenues were up 13% year-on-year. Operating expenses were $21.4 billion, down 2% on a reported basis, primarily reflecting expense decreases in sales and marketing and G&A, offset by an increase in R&D. The largest 10 single factor in the year-on-year decline in G&A expenses was lower charges related to legal matters. On an adjusted basis, operating expenses were up 5%, reflecting; first, in R&D, an increase in compensation expense, primarily for Google DeepMind and Cloud; and second, in Sales and Marketing a slight increase year-on-year, reflecting increases in compensation expense, primarily for Cloud sales. Operating income was $25.5 billion, up 46% on a reported basis, and our operating margin was 32%. On an adjusted basis, operating income was up 31%, and our operating margin was 33%. Net income was $23.7 billion, and EPS was $1.89. We delivered free cash flow of $16.8 billion in the first quarter and $69.1 billion for the trailing 12 months. We ended the quarter with $108 billion in cash and marketable securities. Turning to segment results, within Google Services, revenues were $70.4 billion, up 14%. Google Search & Other advertising revenues of $46.2 billion in the quarter were up 14%, led again by growth in retail. YouTube advertising revenues of $8.1 billion, were up 21%, driven by both direct response and brand advertising. Network advertising revenues of $7.4 billion were down 1%. Subscriptions, Platforms and Devices revenues were $8.7 billion, up 18%, primarily reflecting growth in YouTube subscription revenues. TAC was $12.9 billion, up 10%. Google Services Operating Income was $27.9 billion, up 28%, and the operating margin was 40%. Turning to the Google Cloud segment, revenues were $9.6 billion for the quarter, up 28%, reflecting significant growth in GCP, with an increasing contribution from AI and strong Google Workspace growth, primarily driven by increases in average revenue per seat. Google Cloud delivered Operating Income of $900 million and an operating margin of 9%. As to our Other Bets, for the first quarter, revenues were $495 million, benefiting from a milestone payment in one of the Other Bets. The operating loss was $1 billion. 11 Turning to our outlook for the business, with respect to Google Services. First, within Advertising, we are very pleased with the momentum of our Ads businesses. Search had broad-based strength across verticals. In YouTube, we had acceleration in revenue growth driven by brand and direct response. Looking ahead, two points to call out. First, results in our advertising business in Q1 continued to reflect strength in spend from APAC-based retailers, a trend that began in the second quarter of 2023 and continued through Q1, which means we will begin lapping that impact in the second quarter. Second, the YouTube acceleration in revenue growth in Q1 reflects, in part, lapping the negative year-on-year growth we experienced in the first quarter of 2023. Turning to Subscriptions, Platforms and Devices. We continue to deliver significant growth in our subscriptions business, which drives the majority of revenue growth in this line. The sequential quarterly decline in year-on-year revenue growth for the line in Q1, versus Q4, reflects, in part, the fact that we had only one week of Sunday Ticket subscription revenue in Q1 versus fourteen weeks in Q4. Looking forward, we will anniversary last year's price increase in YouTube TV starting in May. With regard to Platforms, we are pleased with the performance in Play driven by an increase in buyers. With respect to Google Cloud, performance in Q1 reflects strong demand for our GCP infrastructure and solutions, as well as the contribution from our Workspace productivity tools. The growth we are seeing across Cloud is underpinned by the benefit AI provides for our customers. We continue to invest aggressively, while remaining focused on profitable growth. As we look ahead, two points that will affect sequential year-on-year revenue growth comparisons across Alphabet. First, Q1 results reflect the benefit of Leap Year, which contributed slightly more than one point to our revenue growth rate at the consolidated level in the first quarter. Second, at current spot rates, we expect a larger headwind from foreign exchange in Q2 versus Q1. Turning to margins, our efforts to durably re-engineer our cost base are reflected in a 400 basis point expansion of our Alphabet operating margin year-on-year, excluding the impact of restructuring and severance charges in both periods. You can also see the impact in the quarter-on-quarter decline in headcount in Q1, which reflects 12 both actions we have taken over the past few months and a much slower pace of hiring. As we have discussed previously, we are continuing to invest in top engineering and technical talent, particularly in Cloud, Google DeepMind and Technical Infrastructure. Looking ahead, we remain focused on our efforts to moderate the pace of expense growth in order to create capacity for the increases in depreciation and expenses associated with the higher levels of investment in our technical infrastructure. We believe these efforts will enable us to deliver full-year 2024 Alphabet operating margin expansion relative to 2023. With respect to CapEx, our reported CapEx in the first quarter was $12 billion, once again driven overwhelmingly by investment in our technical infrastructure, with the largest component for servers, followed by data centers. The significant year-on-year growth in CapEx in recent quarters reflects our confidence in the opportunities offered by AI across our business. Looking ahead, we expect quarterly CapEx throughout the year to be roughly at or above the Q1 level, keeping in mind that the timing of cash payments can cause variability in quarterly reported CapEx. With regard to Other Bets, we similarly have workstreams under way to enhance overall returns. Finally, as I trust you saw in the press release, we are very pleased to be adding a quarterly dividend of $.20 per share to our capital return program, as well as a new $70 billion authorization in share repurchases. The core of our capital allocation framework remains the same, beginning with investing aggressively in our business as you have heard us talk about today, given the extraordinary opportunities ahead. We view the introduction of the dividend as further strengthening our overall capital return program. Thank you. Sundar, Philipp and I will now take your questions.",Financial,Fact Finding,Q&A You are to answer based solely on the provided text. You are not allowed to use any external resources or prior knowledge.,When can someone with BMI of 29 kg/m2 be recommended for bariatric surgery?,"A broad range of drugs are under investigation, but there are currently no drugs approved by regulatory agencies for the treatment of NAFLD. This is a field of very active research. As an increasing number of clinical studies are running and results are reported, recommendations may rapidly change. Information on which clinical trials are ongoing can be found on www.clinicaltrials.gov and you should ask your physician for newest updates. Some drugs that are used to treat other conditions have also been tested for NASH. Based on their effects demonstrated by liver biopsy, the following drugs seem to have some efficacy. – Vitamin E showed promise, but only in patients without cirrhosis and without T2D. Given long-term and at high doses, however, vitamin E potentially had negative effects and some data indicate that it could increase the risk of early death and certain cancers. – Pioglitazone, which is approved for the treatment of diabetes, showed promise for NASH in patients with diabetes and pre-diabetes. Side effects such as weight gain and bone fractures should be considered. – Liraglutide and semaglutide are approved for the treatment of obesity and for diabetes. They have also shown promise in reducing liver fat and inflammation in NASH and will be evaluated further. Important: all these drugs must be discussed with your doctor and can harm when self-administered. Future available drugs will be an add-on therapy because lifestyle changes are essential as NAFLD is mainly a lifestyle-related disease. Bariatric surgery very effectively achieves weight loss and weight loss maintenance in patients with obesity. The agreed criteria for the surgical management of obesity and metabolic disorders (BMI ≥40kg/m2 or BMI ≥35kg/m2 with complicating disorders, no resolution after medical treatment) are also applicable for NAFLD. Patients with a BMI of 30–35 kg/m2 who also have T2D that is not adequately controlled by medical therapy may also be candidates for surgery. It is important to know that the change in the anatomy by bariatric surgery can lead to the need of lifelong follow up and this should be considered in discussing this option for patients. If you wonder whether vitamin E, the above-mentioned drugs or bariatric surgery could be helpful for you, please consult your doctor and discuss the potential risks and benefits. Any treatment decision should be based on your individual situation and medical history","You are to answer based solely on the provided text. You are not allowed to use any external resources or prior knowledge. When can someone with BMI of 29 kg/m2 be recommended for bariatric surgery? A broad range of drugs are under investigation, but there are currently no drugs approved by regulatory agencies for the treatment of NAFLD. This is a field of very active research. As an increasing number of clinical studies are running and results are reported, recommendations may rapidly change. Information on which clinical trials are ongoing can be found on www.clinicaltrials.gov and you should ask your physician for newest updates. Some drugs that are used to treat other conditions have also been tested for NASH. Based on their effects demonstrated by liver biopsy, the following drugs seem to have some efficacy. – Vitamin E showed promise, but only in patients without cirrhosis and without T2D. Given long-term and at high doses, however, vitamin E potentially had negative effects and some data indicate that it could increase the risk of early death and certain cancers. – Pioglitazone, which is approved for the treatment of diabetes, showed promise for NASH in patients with diabetes and pre-diabetes. Side effects such as weight gain and bone fractures should be considered. – Liraglutide and semaglutide are approved for the treatment of obesity and for diabetes. They have also shown promise in reducing liver fat and inflammation in NASH and will be evaluated further. Important: all these drugs must be discussed with your doctor and can harm when self-administered. Future available drugs will be an add-on therapy because lifestyle changes are essential as NAFLD is mainly a lifestyle-related disease. Bariatric surgery very effectively achieves weight loss and weight loss maintenance in patients with obesity. The agreed criteria for the surgical management of obesity and metabolic disorders (BMI ≥40kg/m2 or BMI ≥35kg/m2 with complicating disorders, no resolution after medical treatment) are also applicable for NAFLD. Patients with a BMI of 30–35 kg/m2 who also have T2D that is not adequately controlled by medical therapy may also be candidates for surgery. It is important to know that the change in the anatomy by bariatric surgery can lead to the need of lifelong follow up and this should be considered in discussing this option for patients. If you wonder whether vitamin E, the above-mentioned drugs or bariatric surgery could be helpful for you, please consult your doctor and discuss the potential risks and benefits. Any treatment decision should be based on your individual situation and medical history",Medical,Fact Finding,Q&A You can only produce an answer using the context provided to you.,"Which batteries are in the early stages of commercialisation? ","Chapter 4: Batteries for Grid Applications Overview Batteries are devices that store energy chemically. This report focuses on “secondary” batteries, which must be charged before use and which can be discharged and recharged (cycled) many times before the end of their useful life. For electric power grid applications, there are four main battery types of interest:  Lead-acid  High temperature “sodium-beta”  Liquid electrolyte “flow” batteries  Other emerging chemistries84 Lead-acid batteries have been used for more than a century in grid applications and in conventional vehicles for starting, lighting, and ignition (SLI). They continue to be the technology of choice for vehicle SLI applications due to their low cost. Consequently, they are manufactured on a mass scale. In 2010, approximately 120 million lead-acid batteries were shipped in North America alone.85 Lead-acid batteries are commonly used by utilities to serve as uninterruptible power supplies in substations, and have been used at utility scale in several demonstration projects to provide grid support.86 Use of lead acid batteries for grid applications is limited by relatively short cycle life. R&D efforts are focused on improved cycle-life, which could result in greater use in utility-scale applications. Sodium-beta batteries include sodium-sulfur (NaS) units, first developed in the 1960s,87 and commercially available from a single vendor (NGK Insulators, Ltd.) in Japan with over 270 MW deployed worldwide.88 A NaS battery was first deployed in the United States in 2002. 89 There are now a number of U.S. demonstration projects, including several listed in Table 3. The focus of NaS deployments in the United States has been in electric distribution deferral projects, acting to reduce peak demand on distribution systems, but they also can serve multiple grid support services. An alternative high-temperature battery, sodium-nickel-chloride, is in the early stages of commercialization. “Flow” batteries, in which a liquid electrolyte flows through a chemical cell to produce electricity, are in the early stages of commercialization. In grid applications there has been some deployment of two types of flow battery: vanadium redox and zinc-bromide. There are a number of international installations of vanadium redox units, including a 250 kW installation in the United States to relieve a congested transmission line. 91 There are also a number of zinc-bromine demonstration projects.92 Several other flow battery chemistries have been pursued or are under development, but are less mature. In addition to the three battery types discussed above, there are several emerging technologies based on new battery chemistries which may also have potential in grid applications. Several of these emerging technologies are being supported by DOE efforts such as ARPA-E and are discussed briefly in the R&D section of this chapter. Technology Description and Performance Lead-Acid The lead-acid battery consists of a lead dioxide positive electrode (cathode), a lead negative electrode (anode), and an aqueous sulfuric acid electrolyte which carries the charge between the two. During discharge, each electrode is converted to lead sulfate, consuming sulfuric acid from the electrolyte. When recharging, the lead sulfate is converted back to sulfuric acid, leaving a layer of lead dioxide on the cathode and pure lead on the anode. In such conventional “wet” (flooded) cells, water in the electrolyte is broken down to hydrogen and oxygen during the charging process. In a vented wet cell design, these gases escape into the atmosphere, requiring the occasional addition of water to the system. In sealed wet cell designs, the loss of these gases is prevented and their conversion back to water is possible, reducing maintenance requirements. However, if the battery is overcharged or charged too quickly, the rate of gas generation can surpass that of water recombination, which can cause an explosion. In “valve regulated gel” designs, silica is added to the electrolyte to cause it to gel. In “absorbed glass mat” designs, the electrolyte is suspended in a fiberglass mat. The latter are sometimes referred to as “dry” because the fiberglass mat is not completely saturated with acid and there is no excess liquid. Both designs operate under slight constant pressure. Both also eliminate the risk of electrolyte leakage and offer improved safety by using valves to regulate internal pressure due to gas build up, but at significantly higher cost than wet cells described above.93 Lead-acid is currently the lowest-cost battery chemistry on a dollar-per-kWh basis. However, it also has relatively low specific energy (energy per unit mass) on the order of 35 Wh/kg and relatively poor “cycle life,” which is the number of charge-discharge cycles it can provide before its capacity falls too far below a certain percentage (e.g., 80%) of its initial capacity. While the low energy density of lead-acid will likely limit its use in transportation applications, increase in cycle life could make lead-acid cost-effective in grid applications. The cycle life of lead-acid batteries is highly dependent on both the rate and depth of discharge due to corrosion and material shedding off of electrode plates inside the battery. High depth of discharge (DoD) operation intensifies both issues. At 100% DoD (discharging the battery completely) cycle life can be less than 100 full cycles for some lead-acid technologies. During high rate, partial state-of-charge operation, lead sulfate accumulation on the anode can be the primary cause of degradation. These processes are also sensitive to high temperature, where the rule of thumb is to reduce battery life by half for every 8°C (14°F) increase in temperature above ambient. 94 Manufacturers’ warrantees provide some indication of minimum performance expectations, with service life of three to five years for deep cycle batteries, designed to be mostly discharged time after time. SLI batteries in cars have expected service lives of five to seven years, with up to 30 discharges per year depending on the rate of discharge. Temperature also affects capacity, with a battery at -4°C (25°F) having between roughly 70% and 80% of the capacity of a battery at 24°C (75°F).95 For many applications of lead-acid batteries, including SLI and uninterruptible power supply (UPS), efficiency of the batteries is relatively unimportant. One estimate for the DC-DC (direct current) efficiency of utility-scale lead acid battery is 81%, and AC-AC (alternating current) efficiency of 70%-72%.9 High Temperature Sodium-Beta Sodium-beta batteries use molten (liquid) sodium for the anode, with sodium ions transporting the electric charge. The two main types of sodium-beta batteries are distinguished by the type of cathode they use. The sodium-sulfur (Na-S) type employs a liquid sulfur cathode, while the sodium-nickel chloride (Na-NiCl2) type employs a solid metal chloride cathode. Both types include a beta-alumina solid electrolyte material separating the cathode and anode. This ceramic material offers ionic conductivity similar to that of typical aqueous electrolytes, but only at high temperature. Consequently, sodium-beta batteries ordinarily must operate at temperatures around 300°C (572°F). 97 The impermeability of the solid electrolyte to liquid electrodes and its minimal electrical conductivity eliminates self discharge and allows high efficiency.98 Technical challenges associated with sodium-beta battery chemistry generally stem from the high temperature requirements. To maintain a 300°C operating point the battery must have insulation and active heating. If it is not maintained at such a temperature, the resulting freeze-thaw cycles and thermal expansion can lead to mechanical stresses, damaging seals and other cell components, including the electrolyte. 99 The fragile nature of the electrolyte is also a concern, particularly for Na-S cells. In the event of damage to the solid electrolyte, a breach could allow the two liquid electrodes to mix, possibly causing an explosion and fire. 100 Na-S batteries are manufactured commercially for a variety of grid services ranging from shortterm rapid discharge services to long-term energy management services.101 The DC-DC efficiency is about 85%. Calculation of the AC-AC efficiency is complicated by the need for additional heating. The standby heat loss for each 50 kW module is between 2.2 and 3.4 kW. As a result of this heat loss, plus losses in the power conversion equipment, the AC-AC efficiency for loadleveling services is estimated in the range of 75%-80%.102 Expected service life is 15 years at 90% DoD and 4500 cycles.103 The primary sodium-beta alternative to the Na-S chemistry, the Na-NiCl2 cell (typically called the ZEBRA cell).104 Although ZEBRA batteries have been under development for over 20 years, they are only in the early stages of commercialization. 105 Nickel chloride cathodes offer several potential advantages including higher operating voltage, increased operational temperature range (due in part to the lower melting point of the secondary electrolyte), a slightly less corrosive cathode, and somewhat safer cell construction, since handling of metallic sodium—which is potentially explosive—can be avoided. 106 They are likely to offer a slightly reduced energy density.107 ","Context: Chapter 4: Batteries for Grid Applications Overview Batteries are devices that store energy chemically. This report focuses on “secondary” batteries, which must be charged before use and which can be discharged and recharged (cycled) many times before the end of their useful life. For electric power grid applications, there are four main battery types of interest:  Lead-acid  High temperature “sodium-beta”  Liquid electrolyte “flow” batteries  Other emerging chemistries84 Lead-acid batteries have been used for more than a century in grid applications and in conventional vehicles for starting, lighting, and ignition (SLI). They continue to be the technology of choice for vehicle SLI applications due to their low cost. Consequently, they are manufactured on a mass scale. In 2010, approximately 120 million lead-acid batteries were shipped in North America alone.85 Lead-acid batteries are commonly used by utilities to serve as uninterruptible power supplies in substations, and have been used at utility scale in several demonstration projects to provide grid support.86 Use of lead acid batteries for grid applications is limited by relatively short cycle life. R&D efforts are focused on improved cycle-life, which could result in greater use in utility-scale applications. Sodium-beta batteries include sodium-sulfur (NaS) units, first developed in the 1960s,87 and commercially available from a single vendor (NGK Insulators, Ltd.) in Japan with over 270 MW deployed worldwide.88 A NaS battery was first deployed in the United States in 2002. 89 There are now a number of U.S. demonstration projects, including several listed in Table 3. The focus of NaS deployments in the United States has been in electric distribution deferral projects, acting to reduce peak demand on distribution systems, but they also can serve multiple grid support services. An alternative high-temperature battery, sodium-nickel-chloride, is in the early stages of commercialization. “Flow” batteries, in which a liquid electrolyte flows through a chemical cell to produce electricity, are in the early stages of commercialization. In grid applications there has been some deployment of two types of flow battery: vanadium redox and zinc-bromide. There are a number of international installations of vanadium redox units, including a 250 kW installation in the United States to relieve a congested transmission line. 91 There are also a number of zinc-bromine demonstration projects.92 Several other flow battery chemistries have been pursued or are under development, but are less mature. In addition to the three battery types discussed above, there are several emerging technologies based on new battery chemistries which may also have potential in grid applications. Several of these emerging technologies are being supported by DOE efforts such as ARPA-E and are discussed briefly in the R&D section of this chapter. Technology Description and Performance Lead-Acid The lead-acid battery consists of a lead dioxide positive electrode (cathode), a lead negative electrode (anode), and an aqueous sulfuric acid electrolyte which carries the charge between the two. During discharge, each electrode is converted to lead sulfate, consuming sulfuric acid from the electrolyte. When recharging, the lead sulfate is converted back to sulfuric acid, leaving a layer of lead dioxide on the cathode and pure lead on the anode. In such conventional “wet” (flooded) cells, water in the electrolyte is broken down to hydrogen and oxygen during the charging process. In a vented wet cell design, these gases escape into the atmosphere, requiring the occasional addition of water to the system. In sealed wet cell designs, the loss of these gases is prevented and their conversion back to water is possible, reducing maintenance requirements. However, if the battery is overcharged or charged too quickly, the rate of gas generation can surpass that of water recombination, which can cause an explosion. In “valve regulated gel” designs, silica is added to the electrolyte to cause it to gel. In “absorbed glass mat” designs, the electrolyte is suspended in a fiberglass mat. The latter are sometimes referred to as “dry” because the fiberglass mat is not completely saturated with acid and there is no excess liquid. Both designs operate under slight constant pressure. Both also eliminate the risk of electrolyte leakage and offer improved safety by using valves to regulate internal pressure due to gas build up, but at significantly higher cost than wet cells described above.93 Lead-acid is currently the lowest-cost battery chemistry on a dollar-per-kWh basis. However, it also has relatively low specific energy (energy per unit mass) on the order of 35 Wh/kg and relatively poor “cycle life,” which is the number of charge-discharge cycles it can provide before its capacity falls too far below a certain percentage (e.g., 80%) of its initial capacity. While the low energy density of lead-acid will likely limit its use in transportation applications, increase in cycle life could make lead-acid cost-effective in grid applications. The cycle life of lead-acid batteries is highly dependent on both the rate and depth of discharge due to corrosion and material shedding off of electrode plates inside the battery. High depth of discharge (DoD) operation intensifies both issues. At 100% DoD (discharging the battery completely) cycle life can be less than 100 full cycles for some lead-acid technologies. During high rate, partial state-of-charge operation, lead sulfate accumulation on the anode can be the primary cause of degradation. These processes are also sensitive to high temperature, where the rule of thumb is to reduce battery life by half for every 8°C (14°F) increase in temperature above ambient. 94 Manufacturers’ warrantees provide some indication of minimum performance expectations, with service life of three to five years for deep cycle batteries, designed to be mostly discharged time after time. SLI batteries in cars have expected service lives of five to seven years, with up to 30 discharges per year depending on the rate of discharge. Temperature also affects capacity, with a battery at -4°C (25°F) having between roughly 70% and 80% of the capacity of a battery at 24°C (75°F).95 For many applications of lead-acid batteries, including SLI and uninterruptible power supply (UPS), efficiency of the batteries is relatively unimportant. One estimate for the DC-DC (direct current) efficiency of utility-scale lead acid battery is 81%, and AC-AC (alternating current) efficiency of 70%-72%.9 High Temperature Sodium-Beta Sodium-beta batteries use molten (liquid) sodium for the anode, with sodium ions transporting the electric charge. The two main types of sodium-beta batteries are distinguished by the type of cathode they use. The sodium-sulfur (Na-S) type employs a liquid sulfur cathode, while the sodium-nickel chloride (Na-NiCl2) type employs a solid metal chloride cathode. Both types include a beta-alumina solid electrolyte material separating the cathode and anode. This ceramic material offers ionic conductivity similar to that of typical aqueous electrolytes, but only at high temperature. Consequently, sodium-beta batteries ordinarily must operate at temperatures around 300°C (572°F). 97 The impermeability of the solid electrolyte to liquid electrodes and its minimal electrical conductivity eliminates self discharge and allows high efficiency.98 Technical challenges associated with sodium-beta battery chemistry generally stem from the high temperature requirements. To maintain a 300°C operating point the battery must have insulation and active heating. If it is not maintained at such a temperature, the resulting freeze-thaw cycles and thermal expansion can lead to mechanical stresses, damaging seals and other cell components, including the electrolyte. 99 The fragile nature of the electrolyte is also a concern, particularly for Na-S cells. In the event of damage to the solid electrolyte, a breach could allow the two liquid electrodes to mix, possibly causing an explosion and fire. 100 Na-S batteries are manufactured commercially for a variety of grid services ranging from shortterm rapid discharge services to long-term energy management services.101 The DC-DC efficiency is about 85%. Calculation of the AC-AC efficiency is complicated by the need for additional heating. The standby heat loss for each 50 kW module is between 2.2 and 3.4 kW. As a result of this heat loss, plus losses in the power conversion equipment, the AC-AC efficiency for loadleveling services is estimated in the range of 75%-80%.102 Expected service life is 15 years at 90% DoD and 4500 cycles.103 The primary sodium-beta alternative to the Na-S chemistry, the Na-NiCl2 cell (typically called the ZEBRA cell).104 Although ZEBRA batteries have been under development for over 20 years, they are only in the early stages of commercialization. 105 Nickel chloride cathodes offer several potential advantages including higher operating voltage, increased operational temperature range (due in part to the lower melting point of the secondary electrolyte), a slightly less corrosive cathode, and somewhat safer cell construction, since handling of metallic sodium—which is potentially explosive—can be avoided. 106 They are likely to offer a slightly reduced energy density.107 Question: Which batteries are in the early stages of commercialisation? System instruction: You can only produce an answer using the context provided to you.",Internet/Technology,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","How does interleaving improve sensitivity when compared to A/B tests? What does interleaving do better? Please explain in 4 sentences or less, and make sure there's no jargon.","Handles dilution from competitive pairs Interleaved designs also drive up sensitivity by showing if the experience exposed to the user is truly different between treatment and control. An interleaved design generates final output from two lists, allowing us to identify immediately whether those lists are too similar, as shown in Figure 4 below. In most machine learning applications, different modeling approaches are improvings things on the margin. In many cases, the search results returned by two rankers will largely overlap. An interleaved design lets us measure this overlap and analyze the data for competitive pairs — where rankers disagree on the recommendation — which leads to a signal boost. Figure 4: The original lists used here in interleaving are essentially identical except for the last elements. This means that if a user clicks on any of the top four choices, they are not actually contributing to signaling which ranker is preferred. Handles dilution from non-engagement An interesting observation we made when looking at interleaved experiments – as well as search and ranking experiments in general – is that many user actions make it look as if the user is not paying attention or making any choices on the presented content. For instance, although we would generate a carousel with interleaved options, the user would not actively engage with the content and make a decision. As a result, including this data in interleaved analyses dilutes the signal. Here is another way to understand non-engagement. Let's say we present a user with two drinks – Coke and Pepsi – and ask them which they like more. If the user does not engage or refuses to try any options, it might indicate: The user is not interested in the presented results. The user is not in a decision-making mindset at the moment. While these are important insights, examining data from this undifferentiated feedback does not help to determine user preference or understand which drink is preferred. Attention and non-engagement is a fascinating research subject; many folks approach it by looking at additional metrics such as dwell time or how often a user backtracks as per Chucklin and Rijke, 2016. Fortunately, interleaving allows us to identify non-engagement more effectively so that we may remove impressions that are not meaningful. If a user does not take an action, we simply remove the exposure rather than marking the performance of the interleaved ranker as a tie.ctively so that we may remove impressions that are not meaningful. If a user does not take an action, we simply remove the exposure rather than marking the performance of the interleaved ranker as a tie. A/B tests can't effectively address non-engagement because they treat all data equally, including non-engaged interactions, which dilutes the signal and obscures true user preferences. Results Table 2 shows results across five online experiments in which we provide the average relative sensitivity improvement across different methods relative to an A/B setup. Across several experiments, we found that removing dilution helped boost interleaving sensitivity even more, which leads to much smaller required sample sizes. These results were so surprising even to us that we had to stop several times to conduct additional A/A tests to validate that we had not introduced a bug in our SDK, analysis pipeline, or metrics computation. Experiment Vanilla Interleaving Vanilla Interleaving + Removing Dilution % Traffic Used Exp 1 34x 282x <5% Exp 2 67x 482x <5% Exp 3 68x 312x <5% Exp 4 109x 545x <5% Exp 5 60x 301x <5% Avg Improvement ~67x ~384x Table 2: We observed very large sensitivity gains across several experiments. Overall, removing dilution helped improve sensitivity even more. Note that we observed these results while interleaving traffic was getting 1/20th of the A/B traffic. It’s important to highlight that the sensitivity improvement depends on the metric. For clickthrough rate, we have observed half of the sensitivity boost observed in the checkout-conversion metric. Nonetheless, across all use cases we found that removing dilutive exposures drives very large gains in sensitivity.","""================ ======= Handles dilution from competitive pairs Interleaved designs also drive up sensitivity by showing if the experience exposed to the user is truly different between treatment and control. An interleaved design generates final output from two lists, allowing us to identify immediately whether those lists are too similar, as shown in Figure 4 below. In most machine learning applications, different modeling approaches are improvings things on the margin. In many cases, the search results returned by two rankers will largely overlap. An interleaved design lets us measure this overlap and analyze the data for competitive pairs — where rankers disagree on the recommendation — which leads to a signal boost. Figure 4: The original lists used here in interleaving are essentially identical except for the last elements. This means that if a user clicks on any of the top four choices, they are not actually contributing to signaling which ranker is preferred. Handles dilution from non-engagement An interesting observation we made when looking at interleaved experiments – as well as search and ranking experiments in general – is that many user actions make it look as if the user is not paying attention or making any choices on the presented content. For instance, although we would generate a carousel with interleaved options, the user would not actively engage with the content and make a decision. As a result, including this data in interleaved analyses dilutes the signal. Here is another way to understand non-engagement. Let's say we present a user with two drinks – Coke and Pepsi – and ask them which they like more. If the user does not engage or refuses to try any options, it might indicate: The user is not interested in the presented results. The user is not in a decision-making mindset at the moment. While these are important insights, examining data from this undifferentiated feedback does not help to determine user preference or understand which drink is preferred. Attention and non-engagement is a fascinating research subject; many folks approach it by looking at additional metrics such as dwell time or how often a user backtracks as per Chucklin and Rijke, 2016. Fortunately, interleaving allows us to identify non-engagement more effectively so that we may remove impressions that are not meaningful. If a user does not take an action, we simply remove the exposure rather than marking the performance of the interleaved ranker as a tie.ctively so that we may remove impressions that are not meaningful. If a user does not take an action, we simply remove the exposure rather than marking the performance of the interleaved ranker as a tie. A/B tests can't effectively address non-engagement because they treat all data equally, including non-engaged interactions, which dilutes the signal and obscures true user preferences. Results Table 2 shows results across five online experiments in which we provide the average relative sensitivity improvement across different methods relative to an A/B setup. Across several experiments, we found that removing dilution helped boost interleaving sensitivity even more, which leads to much smaller required sample sizes. These results were so surprising even to us that we had to stop several times to conduct additional A/A tests to validate that we had not introduced a bug in our SDK, analysis pipeline, or metrics computation. Experiment Vanilla Interleaving Vanilla Interleaving + Removing Dilution % Traffic Used Exp 1 34x 282x <5% Exp 2 67x 482x <5% Exp 3 68x 312x <5% Exp 4 109x 545x <5% Exp 5 60x 301x <5% Avg Improvement ~67x ~384x Table 2: We observed very large sensitivity gains across several experiments. Overall, removing dilution helped improve sensitivity even more. Note that we observed these results while interleaving traffic was getting 1/20th of the A/B traffic. It’s important to highlight that the sensitivity improvement depends on the metric. For clickthrough rate, we have observed half of the sensitivity boost observed in the checkout-conversion metric. Nonetheless, across all use cases we found that removing dilutive exposures drives very large gains in sensitivity. https://careers.doordash.com/blog/doordash-experimentation-with-interleaving-designs/ ================ ======= How does interleaving improve sensitivity when compared to A/B tests? What does interleaving do better? Please explain in 4 sentences or less, and make sure there's no jargon. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Internet/Technology,Find & Summarize,Text Transformation "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","My husband is applying for an FHA mortgage loan. We don't have any creditor accounts together. He has a good job, but doesn't have a credit score. He pays the rent that includes our water bill. I pay the electric bill and our cell phones in my name. He pays day care every month in cash and has an agreement to pay my brother-in-law for a buy-here-pay-here car note every month with a money order. Neither of us have bank accounts. Is there anything we can use as credit for him since none of this shows on his credit report?","Credit Requirements (A) General Credit Requirements FHA’s general credit policy requires Lenders to analyze the Borrower’s credit history, liabilities, and debts to determine creditworthiness. The Lender must obtain a merged credit report from an independent consumer reporting agency. The Lender must obtain a credit report for each Borrower who will be obligated on the loan Note. The Lender may obtain a joint report for individuals with joint accounts. Before making a determination on the creditworthiness of an applicant, a Lender must conduct an interview to resolve any material discrepancies between the information on the loan application and information on the credit report to determine accurate and complete information. The Lender is not required to obtain a credit report for non-credit qualifying Streamline Refinance transactions. (B) Types of Credit History (1) Traditional Credit Lenders must pull a credit report that draws and merges information from three national credit bureaus. Lenders are prohibited from developing non-traditional credit history to use in place of a traditional credit report. If the credit report generates a credit score, the Lender must utilize traditional credit history. (a) Requirements for the Credit Report Credit reports must obtain all information from three credit repositories pertaining to credit, residence history, and public records information; be in an easy to read and understandable format; and not require code translations. The credit report may not contain whiteouts, erasures, or alterations. The Lender must retain copies of all credit reports. The credit report must include: the name of the Lender ordering the report; the name, address, and telephone number of the consumer reporting agency; the name and SSN of each Borrower; and the primary repository from which any particular information was pulled, for each account listed. A truncated SSN is acceptable for FHA loan insurance purposes provided that the loan application captures the full nine-digit SSN. The credit report must also include: all inquiries made within the last 90 Days; all credit and legal information not considered obsolete under the FCRA, including information for the last seven years regarding: bankruptcies; Judgments; lawsuits; foreclosures; and tax liens; and for each Borrower debt listed: the date the account was opened; high credit amount; required monthly payment amount; unpaid balance; and payment history. (b) Updated Credit Report or Supplement to the Credit Report The Lender must obtain an updated credit report or supplement if the underwriter identifies material inconsistencies between any information in the case binder and the original credit report. (2) Non-traditional Credit For Borrowers without a credit score, the Lender must independently develop the Borrower’s credit history using the requirements outlined below. (a) Independent Verification of Non-traditional Credit Providers The Lender may independently verify the Borrower’s credit references by documenting the existence of the credit provider and that the provider extended credit to the Borrower. To verify the existence of each credit provider, the Lender must review public records from the state, county, or city or other documents providing a similar level of objective information. To verify credit information, the Lender must: use a published address or telephone number for the credit provider and not rely solely on information provided by the applicant; and obtain the most recent 12 months of canceled checks, or equivalent proof of payment, demonstrating the timing of payment to the credit provider. To verify the Borrower’s rental payment history, the Lender must obtain a rental reference from the appropriate rental management company or landlord, demonstrating the timing of payment for the most recent 12 months in lieu of 12 months of canceled checks or equivalent proof of payment. (b) Sufficiency of Non-traditional Credit References To be sufficient to establish the Borrower’s credit, the non-traditional credit history must include three credit references, including at least one of the following: rental housing payments (subject to independent verification if the Borrower is a renter); telephone service; or utility company reference (if not included in the rental housing payment), including: gas; electricity; water; television service; or Internet service. If the Lender cannot obtain all three credit references from the list above, the Lender may use the following sources of unreported recurring debt: insurance premiums not payroll deducted (e.g., medical, auto, life, renter’s insurance); payment to child care providers made to businesses that provide such services; school tuition; retail store credit cards (e.g., from department, furniture, or appliance stores, or specialty stores); rent-to-own (e.g., furniture, appliances); payment of that part of medical bills not covered by insurance; a documented 12-month history of savings evidenced by regular deposits resulting in an increased balance to the account that: were made at least quarterly; were not payroll deducted; and caused no Insufficient Funds (NSF) checks; an automobile lease; a personal loan from an individual with repayment terms in writing and supported by canceled checks to document the payments; or a documented 12-month history of payment by the Borrower on an account for which the Borrower is an authorized user.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. My husband is applying for an FHA mortgage loan. We don't have any creditor accounts together. He has a good job, but doesn't have a credit score. He pays the rent that includes our water bill. I pay the electric bill and our cell phones in my name. He pays day care every month in cash and has an agreement to pay my brother-in-law for a buy-here-pay-here car note every month with a money order. Neither of us have bank accounts. Is there anything we can use as credit for him since none of this shows on his credit report? Credit Requirements (A) General Credit Requirements FHA’s general credit policy requires Lenders to analyze the Borrower’s credit history, liabilities, and debts to determine creditworthiness. The Lender must obtain a merged credit report from an independent consumer reporting agency. The Lender must obtain a credit report for each Borrower who will be obligated on the loan Note. The Lender may obtain a joint report for individuals with joint accounts. Before making a determination on the creditworthiness of an applicant, a Lender must conduct an interview to resolve any material discrepancies between the information on the loan application and information on the credit report to determine accurate and complete information. The Lender is not required to obtain a credit report for non-credit qualifying Streamline Refinance transactions. (B) Types of Credit History (1) Traditional Credit Lenders must pull a credit report that draws and merges information from three national credit bureaus. Lenders are prohibited from developing non-traditional credit history to use in place of a traditional credit report. If the credit report generates a credit score, the Lender must utilize traditional credit history. (a) Requirements for the Credit Report Credit reports must obtain all information from three credit repositories pertaining to credit, residence history, and public records information; be in an easy to read and understandable format; and not require code translations. The credit report may not contain whiteouts, erasures, or alterations. The Lender must retain copies of all credit reports. The credit report must include: the name of the Lender ordering the report; the name, address, and telephone number of the consumer reporting agency; the name and SSN of each Borrower; and the primary repository from which any particular information was pulled, for each account listed. A truncated SSN is acceptable for FHA loan insurance purposes provided that the loan application captures the full nine-digit SSN. The credit report must also include: all inquiries made within the last 90 Days; all credit and legal information not considered obsolete under the FCRA, including information for the last seven years regarding: bankruptcies; Judgments; lawsuits; foreclosures; and tax liens; and for each Borrower debt listed: the date the account was opened; high credit amount; required monthly payment amount; unpaid balance; and payment history. (b) Updated Credit Report or Supplement to the Credit Report The Lender must obtain an updated credit report or supplement if the underwriter identifies material inconsistencies between any information in the case binder and the original credit report. (2) Non-traditional Credit For Borrowers without a credit score, the Lender must independently develop the Borrower’s credit history using the requirements outlined below. (a) Independent Verification of Non-traditional Credit Providers The Lender may independently verify the Borrower’s credit references by documenting the existence of the credit provider and that the provider extended credit to the Borrower. To verify the existence of each credit provider, the Lender must review public records from the state, county, or city or other documents providing a similar level of objective information. To verify credit information, the Lender must: use a published address or telephone number for the credit provider and not rely solely on information provided by the applicant; and obtain the most recent 12 months of canceled checks, or equivalent proof of payment, demonstrating the timing of payment to the credit provider. To verify the Borrower’s rental payment history, the Lender must obtain a rental reference from the appropriate rental management company or landlord, demonstrating the timing of payment for the most recent 12 months in lieu of 12 months of canceled checks or equivalent proof of payment. (b) Sufficiency of Non-traditional Credit References To be sufficient to establish the Borrower’s credit, the non-traditional credit history must include three credit references, including at least one of the following: rental housing payments (subject to independent verification if the Borrower is a renter); telephone service; or utility company reference (if not included in the rental housing payment), including: gas; electricity; water; television service; or Internet service. If the Lender cannot obtain all three credit references from the list above, the Lender may use the following sources of unreported recurring debt: insurance premiums not payroll deducted (e.g., medical, auto, life, renter’s insurance); payment to child care providers made to businesses that provide such services; school tuition; retail store credit cards (e.g., from department, furniture, or appliance stores, or specialty stores); rent-to-own (e.g., furniture, appliances); payment of that part of medical bills not covered by insurance; a documented 12-month history of savings evidenced by regular deposits resulting in an increased balance to the account that: were made at least quarterly; were not payroll deducted; and caused no Insufficient Funds (NSF) checks; an automobile lease; a personal loan from an individual with repayment terms in writing and supported by canceled checks to document the payments; or a documented 12-month history of payment by the Borrower on an account for which the Borrower is an authorized user. https://www.hud.gov/sites/dfiles/OCHCO/documents/40001-hsgh-update15-052024.pdf",Financial,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",What is compound interest savings? Can i get rich with this? explain the formula and use it to figure out how much I can save by putting away 5000 a year.,"Compound interest is a powerful force for consumers looking to build their savings. It creates a multiplier effect on your money that can help it grow more over time. Knowing how it works and how often your bank compounds interest can help you make smarter decisions about where to put your money. The definition of compound interest In simple terms, the compound interest definition is the interest you earn on interest. With a savings account, money market account or CD that earns compound interest, you earn interest on the principal (the initial amount deposited) plus on the interest that accumulates over time. That’s much more valuable than simple interest, which only pays interest on the deposit. How does compound interest work? Many savings accounts and money market accounts, as well as investments, pay compound interest. As a saver or investor, you receive the interest payments on a set schedule: daily, monthly, quarterly or annually. A basic savings account, for example, might compound interest daily, weekly or monthly. When you add money to a savings account or a similar account, you receive interest based on the amount that you deposited. For example, if you deposit $1,000 in an account that pays 1 percent annual interest, you’d earn $10 in interest after a year. Thanks to compound interest, in the second year you’d earn 1 percent on $1,010 — the principal plus the interest, or $10.10 in interest payouts for the year. Compound interest accelerates your interest earnings, helping your savings grow more quickly. Over time, you’ll earn interest on ever-larger account balances that have grown with the help of interest earned in prior years, and therefore steadily increase earnings. To get a deeper understanding of how compounding impacts your savings, the formula for compound interest is: Initial balance × ( 1 + ( interest rate / number of compoundings per period )number of compoundings per period multiplied by number of periods To see how the formula works, consider this example: You have $100,000 in two savings accounts, each paying 2 percent interest. One account compounds interest annually while the other compounds the interest daily. You wait one year and withdraw your money from both accounts. From the first account, which compounds interest just once a year, you’ll receive: $100,000 × ( 1 + ( .02 / 1 )1 × 1 = $102,000 From the second account, which compounds interest each day, you’ll receive: $100,000 × ( 1 + ( .02 / 365 )365 × 1 = $102,020.08 Because the interest you earn each day in the second example also earns interest on the days that follow, you earn an extra $20.08 compared with the account that compounds interest annually. Over the long term, the impacts of compound interest become greater because you’re earning interest on larger account balances that resulted from years of earning interest on previous interest earnings. If you left your money in the account for 30 years, for example, the ending balances would look like this. For annual compounding: $100,000 × ( 1 + ( .02 / 1 )1 × 30 = $181,136.16 For daily compounding: $100,000 × ( 1 + ( .02 / 365 )365 × 30 = $182,208.88 Over the 30-year period, compound interest did all the work for you. That initial $100,000 deposit nearly doubled. Depending on how frequently your money was compounding, your account balance grew to more than $181,000 or $182,000. And daily compounding earned you an extra $1,072.72, or more than $35 a year. The interest rate you earn on your money also has a major impact on the power of compounding. If the savings account paid 5 percent annually instead of 2 percent, the ending balances would look like: 1 year 30 years Annual compounding $105,000.00 $432,194.24 Daily compounding $105,126.75 $448,122.87 The higher the interest rate, the greater the difference between ending balances based on the frequency of compounding. Bankrate’s compound interest calculator can help you calculate how much interest you’ll earn from different accounts. How to take advantage of compound interest There are two simple ways that consumers can take advantage of compound interest. 1. Save early The power of compounding interest comes from time. The longer you leave your money in a savings account or invested in the market, the more interest it can accrue. The more time your money stays in the account, the more compounding can occur, meaning you get to earn additional interest on the earned interest. Consider an example of someone who saves $10,000 a year for 10 years, and then stops saving, compared to someone who saves $2,500 a year for 40 years. Assuming both savers earn 7 percent annual returns, compounded daily, here’s how much they will have at the end of 40 years. Saves $10,000 a year for 10 years, then nothing for 30 years Saves $2,500 a year for 40 years $1,388,623 $612,116 Both people put away the same $100,000 overall amount, but the person who saved more earlier winds up with far more at the end of the 40 years. Even someone who saves $200,000, or twice as much over the full 40 years, winds up with less — $1,224,232 — because a smaller amount was saved initially. 2. Check the APY When you’re shopping around for places to save, focus on looking at the APY. APY shows the effective interest rate of an account, including all of the compounding. If you put $1,000 in an account that pays 1 percent interest a year, you might wind up with more than $1,010 in the account after a year if the interest compounds more frequently than annually. Comparing the APY rather than the interest rate of two accounts will show which truly pays more interest. Some banks may offer only 0.01 percent compared to others that can offer 5 percent or more. This would be a significant difference in earnings over time. 3. Check the frequency of compounding When comparing accounts, don’t just look at APY. Also consider how frequently each compounds interest. The more often interest is compounded, the better. When comparing two accounts with the same interest rate, the one with more frequent compounding may have a higher yield, meaning it can pay more interest on the same account balance. Bottom line The advantage of compound interest lies in its ability to supplement savings over time. By understanding how it operates and considering factors like the interest rate, frequency of compounding and timeline of investments, savers can make the most of compound interest and look for the highest-earning accounts.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. What is compound interest savings? Can i get rich with this? explain the formula and use it to figure out how much I can save by putting away 5000 a year. Compound interest is a powerful force for consumers looking to build their savings. It creates a multiplier effect on your money that can help it grow more over time. Knowing how it works and how often your bank compounds interest can help you make smarter decisions about where to put your money. The definition of compound interest In simple terms, the compound interest definition is the interest you earn on interest. With a savings account, money market account or CD that earns compound interest, you earn interest on the principal (the initial amount deposited) plus on the interest that accumulates over time. That’s much more valuable than simple interest, which only pays interest on the deposit. How does compound interest work? Many savings accounts and money market accounts, as well as investments, pay compound interest. As a saver or investor, you receive the interest payments on a set schedule: daily, monthly, quarterly or annually. A basic savings account, for example, might compound interest daily, weekly or monthly. When you add money to a savings account or a similar account, you receive interest based on the amount that you deposited. For example, if you deposit $1,000 in an account that pays 1 percent annual interest, you’d earn $10 in interest after a year. Thanks to compound interest, in the second year you’d earn 1 percent on $1,010 — the principal plus the interest, or $10.10 in interest payouts for the year. Compound interest accelerates your interest earnings, helping your savings grow more quickly. Over time, you’ll earn interest on ever-larger account balances that have grown with the help of interest earned in prior years, and therefore steadily increase earnings. To get a deeper understanding of how compounding impacts your savings, the formula for compound interest is: Initial balance × ( 1 + ( interest rate / number of compoundings per period )number of compoundings per period multiplied by number of periods To see how the formula works, consider this example: You have $100,000 in two savings accounts, each paying 2 percent interest. One account compounds interest annually while the other compounds the interest daily. You wait one year and withdraw your money from both accounts. From the first account, which compounds interest just once a year, you’ll receive: $100,000 × ( 1 + ( .02 / 1 )1 × 1 = $102,000 From the second account, which compounds interest each day, you’ll receive: $100,000 × ( 1 + ( .02 / 365 )365 × 1 = $102,020.08 Because the interest you earn each day in the second example also earns interest on the days that follow, you earn an extra $20.08 compared with the account that compounds interest annually. Over the long term, the impacts of compound interest become greater because you’re earning interest on larger account balances that resulted from years of earning interest on previous interest earnings. If you left your money in the account for 30 years, for example, the ending balances would look like this. For annual compounding: $100,000 × ( 1 + ( .02 / 1 )1 × 30 = $181,136.16 For daily compounding: $100,000 × ( 1 + ( .02 / 365 )365 × 30 = $182,208.88 Over the 30-year period, compound interest did all the work for you. That initial $100,000 deposit nearly doubled. Depending on how frequently your money was compounding, your account balance grew to more than $181,000 or $182,000. And daily compounding earned you an extra $1,072.72, or more than $35 a year. The interest rate you earn on your money also has a major impact on the power of compounding. If the savings account paid 5 percent annually instead of 2 percent, the ending balances would look like: 1 year 30 years Annual compounding $105,000.00 $432,194.24 Daily compounding $105,126.75 $448,122.87 The higher the interest rate, the greater the difference between ending balances based on the frequency of compounding. Bankrate’s compound interest calculator can help you calculate how much interest you’ll earn from different accounts. How to take advantage of compound interest There are two simple ways that consumers can take advantage of compound interest. 1. Save early The power of compounding interest comes from time. The longer you leave your money in a savings account or invested in the market, the more interest it can accrue. The more time your money stays in the account, the more compounding can occur, meaning you get to earn additional interest on the earned interest. Consider an example of someone who saves $10,000 a year for 10 years, and then stops saving, compared to someone who saves $2,500 a year for 40 years. Assuming both savers earn 7 percent annual returns, compounded daily, here’s how much they will have at the end of 40 years. Saves $10,000 a year for 10 years, then nothing for 30 years Saves $2,500 a year for 40 years $1,388,623 $612,116 Both people put away the same $100,000 overall amount, but the person who saved more earlier winds up with far more at the end of the 40 years. Even someone who saves $200,000, or twice as much over the full 40 years, winds up with less — $1,224,232 — because a smaller amount was saved initially. 2. Check the APY When you’re shopping around for places to save, focus on looking at the APY. APY shows the effective interest rate of an account, including all of the compounding. If you put $1,000 in an account that pays 1 percent interest a year, you might wind up with more than $1,010 in the account after a year if the interest compounds more frequently than annually. Comparing the APY rather than the interest rate of two accounts will show which truly pays more interest. Some banks may offer only 0.01 percent compared to others that can offer 5 percent or more. This would be a significant difference in earnings over time. 3. Check the frequency of compounding When comparing accounts, don’t just look at APY. Also consider how frequently each compounds interest. The more often interest is compounded, the better. When comparing two accounts with the same interest rate, the one with more frequent compounding may have a higher yield, meaning it can pay more interest on the same account balance. Bottom line The advantage of compound interest lies in its ability to supplement savings over time. By understanding how it operates and considering factors like the interest rate, frequency of compounding and timeline of investments, savers can make the most of compound interest and look for the highest-earning accounts. https://www.bankrate.com/banking/what-is-compound-interest/#how-to-take-advantage-of-compound-interest",Financial,Fact Finding,Q&A "You may use no source of information other than what is present in the ""Source Text."" This means you may NOT use any internal or external source of information; you may only use what is provided to answer questions and inform your responses.",Can you summerize what might interfere with a wifi signal?," PSCR UAS 1.0: Unmanned Aerial Systems Flight and Payload Challenge The inaugural UAS challenge took place in 2018 in Fredericksburg, Virginia. In this challenge, PSCR examined how engineering design tradeoffs for flight time and endurance capabilities affect the UAS while carrying a communications payload. This use case examined how a UAS could extend cellular network coverage to “boots on the ground” first responders in a communications-denied location. The challenge was to incorporate a payload that would mimic the weight of a small cellular system on a deployable UAS. UAS were required to achieve 90 minutes of hovering flight endurance while carrying defined payloads of 10, 15, and 20 lb (4.5, 6.8, and 9.1 kg), the typical weights for a small communications system. The total weight of the flight vehicle at liftoff had to be less than 55 lb (24.9 kg) to ensure portability and compliance with FAA regulations. The UAS also had to complete maneuvering and positioning tests as required in the NIST Open Test Lanes and Scenarios test methods with the various attached payloads. [10] The Open Test Lanes methodologies helped simulate and evaluate flight maneuvers, such as position-hold and yaw movements, that a UAS pilot may observe in a responder event. Evaluators used 2D and 3D fiducials as reference points and ground truths to assess each UAS with repeatable and measurable results. By performing these test procedures in an outdoor venue, PSCR could closely replicate the environment that a UAS may encounter while carrying essential communications equipment. In the UAS 1.0 challenge, PSCR found that hybrid fuel solutions, such as a battery and gasoline combination, performed the best. Multi-rotor and aircraft frames supportive of Vertical Takeoff and Landing (VTOL) greatly influenced the performance and accuracy of the aircraft's flight. Deficiencies that PSCR observed were mainly in the form of aircraft control and the need for further tuning of flight software to maintain and hold position. Essential loiter functions and automated flight mechanisms were challenging to maintain, possibly due to the developing UAS marketplace, the device’s prototype nature, and the design of the payload transport functionality. PSCR UAS 2.0: First Responder UAS Endurance Challenge The UAS 2.0 challenge continued the objectives of UAS 1.0 but focused more on endurance. Weight limitations were increased to include larger UAS with the expectation of better control, longer endurance, and innovative ideas. The use case for UAS 2.0 closely matched the communications functions presented in UAS 1.0 but contained an additional use case for longduration search and rescue scenarios. 13 NIST TN 2295 July 2024 The key design requirements in UAS 2.0 included a single payload weight of 10 lb (4.5 kg), which simulated the smallest available cellular network device. The final event took place between 2020 and 2021. Due to the global COVID-19 pandemic, each contestant performed the final event tasks and measurements within their team locality. The NIST-designed payload provided to the contestants for their final flights comprised an independent position data capture and dissemination system for test measurement and validation. As in UAS 1.0, contestants performed a hover endurance test and used the NIST Open Test Lanes as a ground truth measurement system as evaluation methodologies. Larger UAS sizes, up to 100 lb (45.3 kg), were permitted with the expectation of greater endurance, longer flight times over 90 minutes, and increased aircraft stability. Contestants had to provide evidence of airspace authorizations for aircraft weight and height operation exceptions from their respective governing authorities, e.g., FAA Certificate of Authorization. Mirroring the results of the first challenge, UAS with propulsion systems and multi-rotor hybrid battery-gasoline solutions performed the best. Novel propulsion systems, such as hydrogen fuel cells, were also demonstrated in the final event. Some contestants proposed fixed-wing VTOL UAS in the early competition stages, but these ideas failed to progress past theoretical design due to engineering complexity. Flight control and stability functions were also improved with a standard payload, providing more aircraft design flexibility. PSCR found that contestants who started with existing designs early in the competition or those who tested early and frequently had better success in later stages. The winning UAS solution consisted of a hex-rotor design with a hybrid electric-gasoline engine propulsion system. The maximum flight time of this solution in the final test event was approximately 112 minutes, with a total takeoff weight of 54.9 lb (24.9 kg.) PSCR UAS 3.0: First Responder UAS Triple Challenge The UAS 3.0 challenge aimed to create a multi-use, multi-payload UAS platform for first responder search and rescue use cases. The challenge comprised three distinct research challenges that ran concurrently. The final stage of these competitions took place concurrently in June of 2022 in Starkville, Mississippi. 4.3.1. PSCR UAS 3.1: First Responder UAS Triple Challenge: FastFind The design goals of UAS 3.1 focused on the use case of finding missing persons quickly in heavily forested areas. In this challenge, UAS required optical systems that could penetrate thick forest canopies and withstand environmental conditions and hazards. The UAS had to be rapidly deployable and endure the mission's duration. In the UAS 3.1 challenge, flight vehicles had to meet a weight requirement of 55 lb (24.9 kg) or less, including attachments or payloads. A five-point scale evaluated the flight autonomy of the aircraft, with each level describing a range of independence that required less pilot intervention. Additionally, real-time video had to be transmitted to the pilot's ground control station, while onboard recording was mandatory on the aircraft. The vehicles had to demonstrate the capability for degraded takeoff and landing while operating in environments not typically suited for 14 NIST TN 2295 July 2024 standard flight operations, such as areas with uneven surfaces, dirt, or gravel. The final scenario required all competitors to find multiple designated targets within a 60-minute timeframe. In the final event, contestants used adaptive search technologies, including real-time computer vision, machine learning, and human verification, to assist in finding targets. Competitors used one or multiple camera technologies, including infrared, thermal, and neutral-density optical filters, digital filters, and telephoto optical systems, to help expedite recovery time. One contestant utilized a novel technique called Airborne Optical Sectioning, which incorporates a form of synthetic aperture imaging to integrate multiple camera technologies to suppress occlusions computationally. [11] Environmental factors at the test location, including high heat and humidity, negatively affected the contestant’s aircraft performance and the optical systems' efficiency. These conditions also generated false positive matches by computer vision algorithms used in the search. 4.3.2. PSCR UAS 3.2: First Responder UAS Triple Challenge: LifeLink UAS 3.2 LifeLink evaluated techniques using a UAS to provide continuous broadband communications in a service-denied area. The UAS carried a communication relay system to extend communications with first responder stations on the ground. UAS 3.2 contained identical UAS requirements for weight, autonomy, takeoff, and landing conditions as UAS 3.1. Specific to the LifeLink challenge, each UAS was required to have a wireless Wi-Fi transceiver to transmit internet protocol data to responders on the ground and to a NISTprovided bandwidth measurement server. A Wi-Fi antenna or array attached to the UAS could enhance coverage by optimizing signal power and direction. Each contestant’s UAS was not limited beyond FAA Part 107 requirements; contestants could choose the optimal testing height for their solution. UAS designs in UAS 3.2 contained Wi-Fi configurations that could transmit simulated voice and data streams up to 800 ft (244 m) from the aircraft. Omnidirectional antennas provided optimal coverage and higher bandwidth speeds for areas with more first responders in a small, circular geographic area. Directional antenna configurations offered the best coverage for distancefocused applications when correctly oriented. When combined with repeater technology, the WiFi signal could transmit further, but each added repeater would diminish the bandwidth speeds. High heat, humid weather conditions, and forest foliage negatively impacted coverage, distance, and bandwidth speeds. ","System Instructions: You may use no source of information other than what is present in the ""Source Text."" This means you may NOT use any internal or external source of information; you may only use what is provided to answer questions and inform your responses. --- User Query: Can you summerize what might interfere with a wifi signal? --- Source Text: PSCR UAS 1.0: Unmanned Aerial Systems Flight and Payload Challenge The inaugural UAS challenge took place in 2018 in Fredericksburg, Virginia. In this challenge, PSCR examined how engineering design tradeoffs for flight time and endurance capabilities affect the UAS while carrying a communications payload. This use case examined how a UAS could extend cellular network coverage to “boots on the ground” first responders in a communications-denied location. The challenge was to incorporate a payload that would mimic the weight of a small cellular system on a deployable UAS. UAS were required to achieve 90 minutes of hovering flight endurance while carrying defined payloads of 10, 15, and 20 lb (4.5, 6.8, and 9.1 kg), the typical weights for a small communications system. The total weight of the flight vehicle at liftoff had to be less than 55 lb (24.9 kg) to ensure portability and compliance with FAA regulations. The UAS also had to complete maneuvering and positioning tests as required in the NIST Open Test Lanes and Scenarios test methods with the various attached payloads. [10] The Open Test Lanes methodologies helped simulate and evaluate flight maneuvers, such as position-hold and yaw movements, that a UAS pilot may observe in a responder event. Evaluators used 2D and 3D fiducials as reference points and ground truths to assess each UAS with repeatable and measurable results. By performing these test procedures in an outdoor venue, PSCR could closely replicate the environment that a UAS may encounter while carrying essential communications equipment. In the UAS 1.0 challenge, PSCR found that hybrid fuel solutions, such as a battery and gasoline combination, performed the best. Multi-rotor and aircraft frames supportive of Vertical Takeoff and Landing (VTOL) greatly influenced the performance and accuracy of the aircraft's flight. Deficiencies that PSCR observed were mainly in the form of aircraft control and the need for further tuning of flight software to maintain and hold position. Essential loiter functions and automated flight mechanisms were challenging to maintain, possibly due to the developing UAS marketplace, the device’s prototype nature, and the design of the payload transport functionality. PSCR UAS 2.0: First Responder UAS Endurance Challenge The UAS 2.0 challenge continued the objectives of UAS 1.0 but focused more on endurance. Weight limitations were increased to include larger UAS with the expectation of better control, longer endurance, and innovative ideas. The use case for UAS 2.0 closely matched the communications functions presented in UAS 1.0 but contained an additional use case for longduration search and rescue scenarios. 13 NIST TN 2295 July 2024 The key design requirements in UAS 2.0 included a single payload weight of 10 lb (4.5 kg), which simulated the smallest available cellular network device. The final event took place between 2020 and 2021. Due to the global COVID-19 pandemic, each contestant performed the final event tasks and measurements within their team locality. The NIST-designed payload provided to the contestants for their final flights comprised an independent position data capture and dissemination system for test measurement and validation. As in UAS 1.0, contestants performed a hover endurance test and used the NIST Open Test Lanes as a ground truth measurement system as evaluation methodologies. Larger UAS sizes, up to 100 lb (45.3 kg), were permitted with the expectation of greater endurance, longer flight times over 90 minutes, and increased aircraft stability. Contestants had to provide evidence of airspace authorizations for aircraft weight and height operation exceptions from their respective governing authorities, e.g., FAA Certificate of Authorization. Mirroring the results of the first challenge, UAS with propulsion systems and multi-rotor hybrid battery-gasoline solutions performed the best. Novel propulsion systems, such as hydrogen fuel cells, were also demonstrated in the final event. Some contestants proposed fixed-wing VTOL UAS in the early competition stages, but these ideas failed to progress past theoretical design due to engineering complexity. Flight control and stability functions were also improved with a standard payload, providing more aircraft design flexibility. PSCR found that contestants who started with existing designs early in the competition or those who tested early and frequently had better success in later stages. The winning UAS solution consisted of a hex-rotor design with a hybrid electric-gasoline engine propulsion system. The maximum flight time of this solution in the final test event was approximately 112 minutes, with a total takeoff weight of 54.9 lb (24.9 kg.) PSCR UAS 3.0: First Responder UAS Triple Challenge The UAS 3.0 challenge aimed to create a multi-use, multi-payload UAS platform for first responder search and rescue use cases. The challenge comprised three distinct research challenges that ran concurrently. The final stage of these competitions took place concurrently in June of 2022 in Starkville, Mississippi. 4.3.1. PSCR UAS 3.1: First Responder UAS Triple Challenge: FastFind The design goals of UAS 3.1 focused on the use case of finding missing persons quickly in heavily forested areas. In this challenge, UAS required optical systems that could penetrate thick forest canopies and withstand environmental conditions and hazards. The UAS had to be rapidly deployable and endure the mission's duration. In the UAS 3.1 challenge, flight vehicles had to meet a weight requirement of 55 lb (24.9 kg) or less, including attachments or payloads. A five-point scale evaluated the flight autonomy of the aircraft, with each level describing a range of independence that required less pilot intervention. Additionally, real-time video had to be transmitted to the pilot's ground control station, while onboard recording was mandatory on the aircraft. The vehicles had to demonstrate the capability for degraded takeoff and landing while operating in environments not typically suited for 14 NIST TN 2295 July 2024 standard flight operations, such as areas with uneven surfaces, dirt, or gravel. The final scenario required all competitors to find multiple designated targets within a 60-minute timeframe. In the final event, contestants used adaptive search technologies, including real-time computer vision, machine learning, and human verification, to assist in finding targets. Competitors used one or multiple camera technologies, including infrared, thermal, and neutral-density optical filters, digital filters, and telephoto optical systems, to help expedite recovery time. One contestant utilized a novel technique called Airborne Optical Sectioning, which incorporates a form of synthetic aperture imaging to integrate multiple camera technologies to suppress occlusions computationally. [11] Environmental factors at the test location, including high heat and humidity, negatively affected the contestant’s aircraft performance and the optical systems' efficiency. These conditions also generated false positive matches by computer vision algorithms used in the search. 4.3.2. PSCR UAS 3.2: First Responder UAS Triple Challenge: LifeLink UAS 3.2 LifeLink evaluated techniques using a UAS to provide continuous broadband communications in a service-denied area. The UAS carried a communication relay system to extend communications with first responder stations on the ground. UAS 3.2 contained identical UAS requirements for weight, autonomy, takeoff, and landing conditions as UAS 3.1. Specific to the LifeLink challenge, each UAS was required to have a wireless Wi-Fi transceiver to transmit internet protocol data to responders on the ground and to a NISTprovided bandwidth measurement server. A Wi-Fi antenna or array attached to the UAS could enhance coverage by optimizing signal power and direction. Each contestant’s UAS was not limited beyond FAA Part 107 requirements; contestants could choose the optimal testing height for their solution. UAS designs in UAS 3.2 contained Wi-Fi configurations that could transmit simulated voice and data streams up to 800 ft (244 m) from the aircraft. Omnidirectional antennas provided optimal coverage and higher bandwidth speeds for areas with more first responders in a small, circular geographic area. Directional antenna configurations offered the best coverage for distancefocused applications when correctly oriented. When combined with repeater technology, the WiFi signal could transmit further, but each added repeater would diminish the bandwidth speeds. High heat, humid weather conditions, and forest foliage negatively impacted coverage, distance, and bandwidth speeds. ",Internet/Technology,Find & Summarize,Text Transformation "You must only provide your answer using the information I give to you. If you're unable to, you should respond by telling me ""I can't do that.""",Why is a gait analysis important when buying shoes?,"Footwear is an important item of equipment to prevent injury and provide comfort while walking. The most suitable footwear for this exercise program is within the “running” category. Cross trainers, court, training or walking shoes are not as good a choice for many reasons. To best meet your personal requirements and to address the heel-toe motion of walking or running, choose shoes in the “running” category of footwear only. An experienced professional can provide a general gait (walking stride) analysis to determine your personal footwear needs. The best merchants with the most expertise are specialty running shops, where staff is generally trained to assess feet for everyone from walkers to long distance runners. Features of the Running Shoe The uppers of most running shoes today are seamless (no stitching or rough spots that can cause irritation or blistering) and made of durable lightweight, breathable materials. This is important for fit, breathability and flexibility. The midsole will look (and feel) different, depending on the degree of support systems present. Different feet require different footwear.  At one extreme is the low arch, “flat” or highly flexible foot. This foot may require heightened guidance that is often achieved through having two or more different densities of material in the midsole with typically more medial (inside of the foot) density or firmness. This firmness helps to provide the structure and support needed by this foot type.  At the opposite end of the spectrum is the rigid, high instep, inflexible foot. This foot has very different needs compared to low arched feet. Flexibility and shock absorption are the focus for this type of foot. Often the midsoles of this subcategory are of a single density and generally softer in feel. Shoes in the running category should come with removable insoles. If they don’t come with removable insoles, they are likely unsuitable. Removable insoles allow for the use of orthotics and also the occasional washing. Insoles are made of light weight foam that will shrink if you wash them in hot water or put them in the dryer. Wash them in cold water by hand and air dry only. If you wear orthotics, be sure to have them with you when purchasing footwear and always remove the manufacture’s insole when using an orthotic. What to Keep in Mind When Purchasing Footwear A general gait analysis is necessary to determine your foot type and ultimately the best shoes to match them. Have your feet and gait (walking stride) observed by a qualified salesperson. This will determine the subcategory best suited for your personal needs. Call ahead of time and ask if there is someone that can “check my gait.” If they do not offer this service, call another place. Be sure the salesperson watches you walk or run in the shoes you are testing. This will determine if a shoe is over-correcting or under-correcting your gait. Without a gait analysis during the fitting process, it’s just guesswork. Do not be fooled by a really soft, cushy feel. A softer midsole has less structure. This means that your feet will have to work harder to stabilize your body while walking. Walking for longer periods of time in an extremely soft shoe will inevitably tire you quickly and heighten your susceptibility to injury. Although some feet do require high shock absorption (high arched, rigid foot types), it’s important to make the distinction between cushion and shock absorbency. How a shoe fits is important. Do not settle for a shoe that is too roomy or too tight fitting. Shoes are readily available in a variety of widths to meet the needs of the widest or narrowest of feet. An ideal fit will be roomy in the toe box. This will allow your toes to spread comfortably when you are in the ‘toe off’ phase of your stride. If a shoe is too snug around your toes, you run the risk of blistering or bruising. Aim for approximately .8 cm or 1/4 inch of space between your longest toe and the end of the shoe. This extra space will also allow for swelling as you exercise, especially on those warmer days. Shoes will last 6 to 12 months or 800 to 1200km. This will vary according to your foot strike and the conditions they are worn in. For people with limited mobility If you have recently experienced a stroke and/or are limited in your mobility, it is important to choose footwear that will not inhibit your rehab. Safety comes first. In this case, walking stride is less important than preventing falls. Where mobility is low and walking aids are used, it’s best to choose footwear that is lightweight, highly flexible and low profile (thin midsole or low to the ground). Tripping hazards will be diminished and your rehab will be less restricted. As you progress in your rehab, become more mobile, walk longer distances or for longer periods of time, you will then want to have a reanalysis of your gait and choose footwear emphasizing those needs as described above. ","You must only provide your answer using the information I give to you. If you're unable to, you should respond by telling me ""I can't do that."" Footwear is an important item of equipment to prevent injury and provide comfort while walking. The most suitable footwear for this exercise program is within the “running” category. Cross trainers, court, training or walking shoes are not as good a choice for many reasons. To best meet your personal requirements and to address the heel-toe motion of walking or running, choose shoes in the “running” category of footwear only. An experienced professional can provide a general gait (walking stride) analysis to determine your personal footwear needs. The best merchants with the most expertise are specialty running shops, where staff is generally trained to assess feet for everyone from walkers to long distance runners. Features of the Running Shoe The uppers of most running shoes today are seamless (no stitching or rough spots that can cause irritation or blistering) and made of durable lightweight, breathable materials. This is important for fit, breathability and flexibility. The midsole will look (and feel) different, depending on the degree of support systems present. Different feet require different footwear.  At one extreme is the low arch, “flat” or highly flexible foot. This foot may require heightened guidance that is often achieved through having two or more different densities of material in the midsole with typically more medial (inside of the foot) density or firmness. This firmness helps to provide the structure and support needed by this foot type.  At the opposite end of the spectrum is the rigid, high instep, inflexible foot. This foot has very different needs compared to low arched feet. Flexibility and shock absorption are the focus for this type of foot. Often the midsoles of this subcategory are of a single density and generally softer in feel. Shoes in the running category should come with removable insoles. If they don’t come with removable insoles, they are likely unsuitable. Removable insoles allow for the use of orthotics and also the occasional washing. Insoles are made of light weight foam that will shrink if you wash them in hot water or put them in the dryer. Wash them in cold water by hand and air dry only. If you wear orthotics, be sure to have them with you when purchasing footwear and always remove the manufacture’s insole when using an orthotic. What to Keep in Mind When Purchasing Footwear A general gait analysis is necessary to determine your foot type and ultimately the best shoes to match them. Have your feet and gait (walking stride) observed by a qualified salesperson. This will determine the subcategory best suited for your personal needs. Call ahead of time and ask if there is someone that can “check my gait.” If they do not offer this service, call another place. Be sure the salesperson watches you walk or run in the shoes you are testing. This will determine if a shoe is over-correcting or under-correcting your gait. Without a gait analysis during the fitting process, it’s just guesswork. Do not be fooled by a really soft, cushy feel. A softer midsole has less structure. This means that your feet will have to work harder to stabilize your body while walking. Walking for longer periods of time in an extremely soft shoe will inevitably tire you quickly and heighten your susceptibility to injury. Although some feet do require high shock absorption (high arched, rigid foot types), it’s important to make the distinction between cushion and shock absorbency. How a shoe fits is important. Do not settle for a shoe that is too roomy or too tight fitting. Shoes are readily available in a variety of widths to meet the needs of the widest or narrowest of feet. An ideal fit will be roomy in the toe box. This will allow your toes to spread comfortably when you are in the ‘toe off’ phase of your stride. If a shoe is too snug around your toes, you run the risk of blistering or bruising. Aim for approximately .8 cm or 1/4 inch of space between your longest toe and the end of the shoe. This extra space will also allow for swelling as you exercise, especially on those warmer days. Shoes will last 6 to 12 months or 800 to 1200km. This will vary according to your foot strike and the conditions they are worn in. For people with limited mobility If you have recently experienced a stroke and/or are limited in your mobility, it is important to choose footwear that will not inhibit your rehab. Safety comes first. In this case, walking stride is less important than preventing falls. Where mobility is low and walking aids are used, it’s best to choose footwear that is lightweight, highly flexible and low profile (thin midsole or low to the ground). Tripping hazards will be diminished and your rehab will be less restricted. As you progress in your rehab, become more mobile, walk longer distances or for longer periods of time, you will then want to have a reanalysis of your gait and choose footwear emphasizing those needs as described above. Why is a gait analysis important when buying shoes?",Retail/Product,Explanation/Definition,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]",I plan to do an Azure certification to enhance my skillset in cloud development. Can you list down all the Azure services along with their working?,"Today, cloud computing applications and platforms are rapidly growing across all industries, serving as the IT infrastructure that drives new digital businesses. These platforms and applications have revolutionized the ways in which businesses function, and have made processes easier. In fact, more than 77 percent of businesses today have at least some portion of their computing infrastructure in the cloud. While there are many cloud computing platforms available, two platforms dominate the cloud computing industry. Amazon Web Services (AWS) and Microsoft Azure are the two giants in the world of cloud computing. While AWS is the largest cloud computing platform, Microsoft Azure is the fastest-growing and second-largest. This article focuses on Microsoft Azure and what is Azure—its services and uses. Before diving into what is Azure, you should first know what cloud computing is. Want a Job at AWS? Find Out What It Takes Cloud Architect Master's ProgramExplore ProgramWant a Job at AWS? Find Out What It Takes What is Cloud Computing? Cloud computing is a technology that provides access to various computing resources over the internet. All you need to do is use your computer or mobile device to connect to your cloud service provider through the internet. Once connected, you get access to computing resources, which may include serverless computing, virtual machines, storage, and various other things. Basically, cloud service providers have massive data centers that contain hundreds of servers, storage systems and components that are crucial for many kinds of organizations. These data centers are in secure locations and store a large amount of data. The users connect to these data centers to collect data or use it when required. Users can take advantage of various services; for example, if you want a notification every time someone sends you a text or an email, cloud services can help you. The best part about cloud platforms is that you pay only for the services you use, and there are no charges upfront. Cloud computing can be used for various purposes: machine learning, data analysis, storage and backup, streaming media content and so much more. Here’s an interesting fact about the cloud: all the shows and movies that you see on Netflix are actually stored in the cloud. Also, the cloud can be beneficial for creating and testing applications, automating software delivery, and hosting blogs. Why is Cloud Computing Important? Let’s assume that you have an idea for a revolutionary application that can provide great user experience and can become highly profitable. For the application to become successful, you will need to release it on the internet for people to find it, use it, and spread the word about its advantages. However, releasing an application on the internet is not as easy as it seems. To do so, you will need various components, like servers, storage devices, developers, dedicated networks, and application security to ensure that your solution works the way it is intended to. These are a lot of components, which can be problematic. Buying each of these components individually is very expensive and risky. You would need a huge amount of capital to ensure that your application works properly. And if the application doesn’t become popular, you would lose your investment. On the flip side, if the application becomes immensely popular, you will have to buy more servers and storage to cater to more users, which can again increase your costs. This is where cloud computing can come to the rescue. It has many benefits, including offering safe storage and scalability all at once. Get Certified and Future-Proof Your Career Microsoft Certified: Azure Administrator AssociateENROLL NOWGet Certified and Future-Proof Your Career What is Microsoft Azure? Azure is a cloud computing platform and an online portal that allows you to access and manage cloud services and resources provided by Microsoft. These services and resources include storing your data and transforming it, depending on your requirements. To get access to these resources and services, all you need to have is an active internet connection and the ability to connect to the Azure portal. Things that you should know about Azure: It was launched on February 1, 2010, significantly later than its main competitor, AWS. It’s free to start and follows a pay-per-use model, which means you pay only for the services you opt for. Interestingly, 80 percent of the Fortune 500 companies use Azure services for their cloud computing needs. Azure supports multiple programming languages, including Java, Node Js, and C#. Another benefit of Azure is the number of data centers it has around the world. There are 42 Azure data centers spread around the globe, which is the highest number of data centers for any cloud platform. Also, Azure is planning to get 12 more data centers, which will increase the number of data centers to 54, shortly. Azure provides more than 200 services, are divided into 18 categories. These categories include computing, networking, storage, IoT, migration, mobile, analytics, containers, artificial intelligence, and other machine learning, integration, management tools, developer tools, security, databases, DevOps, media identity, and web services. Let’s take a look at some of the major Azure services by category: Compute Services Virtual Machine This service enables you to create a virtual machine in Windows, Linux or any other configuration in seconds. Cloud Service This service lets you create scalable applications within the cloud. Once the application is deployed, everything, including provisioning, load balancing, and health monitoring, is taken care of by Azure. Service Fabric With service fabric, the process of developing a microservice is immensely simplified. Microservice is an application that contains other bundled smaller applications. Functions With functions, you can create applications in any programming language. The best part about this service is that you need not worry about hardware requirements while developing applications because Azure takes care of that. All you need to do is provide the code. Build and Deploy Azure Applications Like a Pro! Azure Cloud ArchitectExplore ProgramBuild and Deploy Azure Applications Like a Pro! Networking Azure CDN Azure CDN (Content Delivery Network) is for delivering content to users. It uses a high bandwidth, and content can be transferred to any person around the globe. The CDN service uses a network of servers placed strategically around the globe so that the users can access the data as soon as possible. Express Route This service lets you connect your on-premise network to the Microsoft cloud or any other services that you want, through a private connection. So, the only communications that will happen here will be between the enterprise network and the service that you want. Virtual network The virtual network allows you to have any of the Azure services communicate with one another privately and securely. Azure DNS This service allows you to host your DNS domains or system domains on Azure. Storage Disk Storage This service allows you to choose from either HDD (Hard Disk Drive) or SSD (Solid State Drive) as your storage option along with your virtual machine. Blob Storage This service is optimized to store a massive amount of unstructured data, including text and even binary data. File Storage This is a managed file storage service that can be accessed via industry SMB (server message block) protocol. Queue Storage With queue storage, you can provide stable message queuing for a large workload. This service can be accessed from anywhere in this world. Next in this what is Azure article, let’s look at what are the uses of Azure."," Only use the provided text to answer the question, no outside sources. I plan to do an Azure certification to enhance my skillset in cloud development. Can you list down all the Azure services along with their working? Today, cloud computing applications and platforms are rapidly growing across all industries, serving as the IT infrastructure that drives new digital businesses. These platforms and applications have revolutionized the ways in which businesses function, and have made processes easier. In fact, more than 77 percent of businesses today have at least some portion of their computing infrastructure in the cloud. While there are many cloud computing platforms available, two platforms dominate the cloud computing industry. Amazon Web Services (AWS) and Microsoft Azure are the two giants in the world of cloud computing. While AWS is the largest cloud computing platform, Microsoft Azure is the fastest-growing and second-largest. This article focuses on Microsoft Azure and what is Azure—its services and uses. Before diving into what is Azure, you should first know what cloud computing is. Want a Job at AWS? Find Out What It Takes Cloud Architect Master's ProgramExplore ProgramWant a Job at AWS? Find Out What It Takes What is Cloud Computing? Cloud computing is a technology that provides access to various computing resources over the internet. All you need to do is use your computer or mobile device to connect to your cloud service provider through the internet. Once connected, you get access to computing resources, which may include serverless computing, virtual machines, storage, and various other things. Basically, cloud service providers have massive data centers that contain hundreds of servers, storage systems and components that are crucial for many kinds of organizations. These data centers are in secure locations and store a large amount of data. The users connect to these data centers to collect data or use it when required. Users can take advantage of various services; for example, if you want a notification every time someone sends you a text or an email, cloud services can help you. The best part about cloud platforms is that you pay only for the services you use, and there are no charges upfront. Cloud computing can be used for various purposes: machine learning, data analysis, storage and backup, streaming media content and so much more. Here’s an interesting fact about the cloud: all the shows and movies that you see on Netflix are actually stored in the cloud. Also, the cloud can be beneficial for creating and testing applications, automating software delivery, and hosting blogs. Why is Cloud Computing Important? Let’s assume that you have an idea for a revolutionary application that can provide great user experience and can become highly profitable. For the application to become successful, you will need to release it on the internet for people to find it, use it, and spread the word about its advantages. However, releasing an application on the internet is not as easy as it seems. To do so, you will need various components, like servers, storage devices, developers, dedicated networks, and application security to ensure that your solution works the way it is intended to. These are a lot of components, which can be problematic. Buying each of these components individually is very expensive and risky. You would need a huge amount of capital to ensure that your application works properly. And if the application doesn’t become popular, you would lose your investment. On the flip side, if the application becomes immensely popular, you will have to buy more servers and storage to cater to more users, which can again increase your costs. This is where cloud computing can come to the rescue. It has many benefits, including offering safe storage and scalability all at once. Get Certified and Future-Proof Your Career Microsoft Certified: Azure Administrator AssociateENROLL NOWGet Certified and Future-Proof Your Career What is Microsoft Azure? Azure is a cloud computing platform and an online portal that allows you to access and manage cloud services and resources provided by Microsoft. These services and resources include storing your data and transforming it, depending on your requirements. To get access to these resources and services, all you need to have is an active internet connection and the ability to connect to the Azure portal. Things that you should know about Azure: It was launched on February 1, 2010, significantly later than its main competitor, AWS. It’s free to start and follows a pay-per-use model, which means you pay only for the services you opt for. Interestingly, 80 percent of the Fortune 500 companies use Azure services for their cloud computing needs. Azure supports multiple programming languages, including Java, Node Js, and C#. Another benefit of Azure is the number of data centers it has around the world. There are 42 Azure data centers spread around the globe, which is the highest number of data centers for any cloud platform. Also, Azure is planning to get 12 more data centers, which will increase the number of data centers to 54, shortly. Azure provides more than 200 services, are divided into 18 categories. These categories include computing, networking, storage, IoT, migration, mobile, analytics, containers, artificial intelligence, and other machine learning, integration, management tools, developer tools, security, databases, DevOps, media identity, and web services. Let’s take a look at some of the major Azure services by category: Compute Services Virtual Machine This service enables you to create a virtual machine in Windows, Linux or any other configuration in seconds. Cloud Service This service lets you create scalable applications within the cloud. Once the application is deployed, everything, including provisioning, load balancing, and health monitoring, is taken care of by Azure. Service Fabric With service fabric, the process of developing a microservice is immensely simplified. Microservice is an application that contains other bundled smaller applications. Functions With functions, you can create applications in any programming language. The best part about this service is that you need not worry about hardware requirements while developing applications because Azure takes care of that. All you need to do is provide the code. Build and Deploy Azure Applications Like a Pro! Azure Cloud ArchitectExplore ProgramBuild and Deploy Azure Applications Like a Pro! Networking Azure CDN Azure CDN (Content Delivery Network) is for delivering content to users. It uses a high bandwidth, and content can be transferred to any person around the globe. The CDN service uses a network of servers placed strategically around the globe so that the users can access the data as soon as possible. Express Route This service lets you connect your on-premise network to the Microsoft cloud or any other services that you want, through a private connection. So, the only communications that will happen here will be between the enterprise network and the service that you want. Virtual network The virtual network allows you to have any of the Azure services communicate with one another privately and securely. Azure DNS This service allows you to host your DNS domains or system domains on Azure. Storage Disk Storage This service allows you to choose from either HDD (Hard Disk Drive) or SSD (Solid State Drive) as your storage option along with your virtual machine. Blob Storage This service is optimized to store a massive amount of unstructured data, including text and even binary data. File Storage This is a managed file storage service that can be accessed via industry SMB (server message block) protocol. Queue Storage With queue storage, you can provide stable message queuing for a large workload. This service can be accessed from anywhere in this world. Next in this what is Azure article, let’s look at what are the uses of Azure. https://www.simplilearn.com/tutorials/azure-tutorial/what-is-azure",Internet/Technology,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Explain the specific new legal standard the Supreme Court established in Kennedy v. Bremerton for determining violations of the Establishment Clause, and detail how this new standard will affect future cases.","The Supreme Court on Monday ruled in favor of a high school football coach who lost his job because of his post-game prayers at the 50-yard line. By a vote of 6-3, the justices ruled that Joseph Kennedy’s conduct was protected by the First Amendment. The court rejected the public school district’s argument that allowing Kennedy’s prayers to continue would have violated the Constitution’s establishment clause, which bars the government from both establishing an official religion and preferring one religion over another. And it pushed back against the argument that students might have felt obligated to join Kennedy’s prayers, stressing that “learning how to tolerate speech or prayer of all kinds is ‘part of learning how to live in a pluralistic society,’ a trait of character essential to ‘a tolerant citizenry.’” The decision by Justice Neil Gorsuch was joined in full by Chief Justice John Roberts and Justices Clarence Thomas, Samuel Alito, and Amy Coney Barrett. Justice Brett Kavanaugh joined most of Gorsuch’s opinion. The three liberal justices dissented. It was the second major ruling on religion and schools in less than a week. On June 21, along the same 6-3 ideological lines, the court struck down a Maine law that banned the use of public funds for students to use at private schools that provide religious instruction. In 2015, Kennedy had been a part-time coach at Bremerton High School, a public school in Washington state, for seven years. During that time, he prayed at midfield after each game – first alone, but later with players and even some members of the opposing team joining him. When the school district learned about Kennedy’s prayers in September 2015, it expressed disapproval, and Kennedy briefly stopped his prayers. On Oct. 14, 2015, Kennedy notified the school district that he intended to resume his prayers at the next game. After a scene that the school district describes as chaotic, with spectators and reporters knocking down members of the band in an effort to join Kennedy at midfield, the school district told him that his prayers violated the district’s policy, and it offered him other options to pray – for example, after the crowd had left. But Kennedy continued to pray at the next two games, prompting the district to place him on administrative leave and, eventually, decline to renew his contract for the following season. Kennedy went to federal district court, where he argued that the school district’s actions had violated his rights under the free speech and free exercise clauses of the Constitution. The U.S. Court of Appeals for the 9th Circuit ruled for the school district, but on Monday the justices reversed that ruling. In a 32-page decision, Gorsuch agreed that Kennedy had met his part of the test for showing that the decision not to renew his contract ran afoul of both clauses. For his free exercise claim, Gorsuch explained, there was no dispute that Kennedy’s desire to pray was sincere, and the district’s prohibition on prayer targeted Kennedy’s religious conduct, rather than applying a neutral rule. And for his free speech claim, Gorsuch continued, Kennedy’s prayers were not part of his duties as a coach. Rather, Gorsuch observed, Kennedy’s prayers occurred “during a period in which the District has acknowledged that its coaching staff was free to engage in all manner of private speech.” By contrast, Gorsuch wrote, the school district’s only real justification for its decision to fire Kennedy was that allowing the prayers to continue would have violated the establishment clause. But that argument, Gorsuch said, rested on a 1971 case, Lemon v. Kurtzman, that outlined a test for courts to use to determine whether a government law or practice violates the establishment clause. Under the Lemon test, the law or practice will pass constitutional muster if it has a secular purpose, its principal effect does not advance or inhibit religion, and it does not create an “excessive entanglement with religion.” Members of the court have long criticized Lemon, but Monday’s ruling expressly dismissed Lemon as having been “long ago abandoned.” Instead, Gorsuch continued, courts should determine whether a law or practice violates the establishment clause by looking at history and the understanding of the drafters of the Constitution – which the court of appeals failed to do. Gorsuch similarly rejected the school district’s argument that it could prohibit Kennedy’s post-game prayers so that students did not feel compelled to join him in praying. “There is no indication in the record,” Gorsuch noted, “that anyone expressed any coercion concerns to the District about the quiet, postgame prayers that Mr. Kennedy asked to continue and that led to his suspension.” Gorsuch distinguished Kennedy’s case from cases “in which this Court has found prayer involving public schools to be problematically coercive.” Unlike those earlier cases, Gorsuch reasoned, Kennedy’s prayers “were not publicly broadcast or recited to a captive audience,” and students “were not required or expected to participate.” The school district’s actions “rested on a mistaken view that it had a duty to ferret out and suppress religious observances even as it allows comparable secular speech,” Gorsuch concluded. “The Constitution neither mandates nor tolerates that kind of discrimination.” As they did last week in Carson, the court’s three liberal justices dissented. In an opinion that was joined by Justices Stephen Breyer and Elena Kagan, Justice Sonia Sotomayor complained that Gorsuch had “misconstrue[d] the facts” of the case, depicting Kennedy’s prayers as “private and quiet” when the prayers had actually caused “severe disruption to school events.” More broadly, Sotomayor continued, although Gorsuch had portrayed the case as whether and when Kennedy could pray privately, the key question in the case was in fact “whether a school district is required to allow one of its employees to incorporate a public, communicative display of the employee’s personal religious beliefs into a school event.” For Sotomayor, the answer was no. Particularly when it comes to schools, she explained, the government must remain neutral about religion, because of the important role that schools play and because children are especially susceptible to feeling compelled to join in prayer. Indeed, she noted, students did feel obligated to join Kennedy and, later, their teammates in prayer. Monday’s ruling, Sotomayor concluded, “weakens the backstop” that the establishment clause provided to protect religious freedom. “It elevates one individual’s interest in personal religious exercise,” she contended, “over society’s interest in protecting the separation between church and state, eroding the protections for religious liberty for all.” Kelly Shackelford, the president and CEO of First Liberty Institute, which represented Kennedy, hailed the decision as “a tremendous victory for all Americans.” Paul Clement, who argued in the Supreme Court on Kennedy’s behalf, added that “[a]fter seven long years, Coach Kennedy can finally return to the place he belongs – coaching football and quietly praying by himself after the game.” Rachel Laser, the president of Americans United for Separation of Church and State, which represented the school district, took a different view. She called the decision “the greatest loss of religious freedom in our country in generations” and she warned that Kennedy’s supporters would “try to expand this dangerous precedent – further undermining everyone’s right to live as ourselves and believe as we choose.”"," Only use the provided text to answer the question, no outside sources. Explain the specific new legal standard the Supreme Court established in Kennedy v. Bremerton for determining violations of the Establishment Clause, and detail how this new standard will affect future cases. The Supreme Court on Monday ruled in favor of a high school football coach who lost his job because of his post-game prayers at the 50-yard line. By a vote of 6-3, the justices ruled that Joseph Kennedy’s conduct was protected by the First Amendment. The court rejected the public school district’s argument that allowing Kennedy’s prayers to continue would have violated the Constitution’s establishment clause, which bars the government from both establishing an official religion and preferring one religion over another. And it pushed back against the argument that students might have felt obligated to join Kennedy’s prayers, stressing that “learning how to tolerate speech or prayer of all kinds is ‘part of learning how to live in a pluralistic society,’ a trait of character essential to ‘a tolerant citizenry.’” The decision by Justice Neil Gorsuch was joined in full by Chief Justice John Roberts and Justices Clarence Thomas, Samuel Alito, and Amy Coney Barrett. Justice Brett Kavanaugh joined most of Gorsuch’s opinion. The three liberal justices dissented. It was the second major ruling on religion and schools in less than a week. On June 21, along the same 6-3 ideological lines, the court struck down a Maine law that banned the use of public funds for students to use at private schools that provide religious instruction. In 2015, Kennedy had been a part-time coach at Bremerton High School, a public school in Washington state, for seven years. During that time, he prayed at midfield after each game – first alone, but later with players and even some members of the opposing team joining him. When the school district learned about Kennedy’s prayers in September 2015, it expressed disapproval, and Kennedy briefly stopped his prayers. On Oct. 14, 2015, Kennedy notified the school district that he intended to resume his prayers at the next game. After a scene that the school district describes as chaotic, with spectators and reporters knocking down members of the band in an effort to join Kennedy at midfield, the school district told him that his prayers violated the district’s policy, and it offered him other options to pray – for example, after the crowd had left. But Kennedy continued to pray at the next two games, prompting the district to place him on administrative leave and, eventually, decline to renew his contract for the following season. Kennedy went to federal district court, where he argued that the school district’s actions had violated his rights under the free speech and free exercise clauses of the Constitution. The U.S. Court of Appeals for the 9th Circuit ruled for the school district, but on Monday the justices reversed that ruling. In a 32-page decision, Gorsuch agreed that Kennedy had met his part of the test for showing that the decision not to renew his contract ran afoul of both clauses. For his free exercise claim, Gorsuch explained, there was no dispute that Kennedy’s desire to pray was sincere, and the district’s prohibition on prayer targeted Kennedy’s religious conduct, rather than applying a neutral rule. And for his free speech claim, Gorsuch continued, Kennedy’s prayers were not part of his duties as a coach. Rather, Gorsuch observed, Kennedy’s prayers occurred “during a period in which the District has acknowledged that its coaching staff was free to engage in all manner of private speech.” By contrast, Gorsuch wrote, the school district’s only real justification for its decision to fire Kennedy was that allowing the prayers to continue would have violated the establishment clause. But that argument, Gorsuch said, rested on a 1971 case, Lemon v. Kurtzman, that outlined a test for courts to use to determine whether a government law or practice violates the establishment clause. Under the Lemon test, the law or practice will pass constitutional muster if it has a secular purpose, its principal effect does not advance or inhibit religion, and it does not create an “excessive entanglement with religion.” Members of the court have long criticized Lemon, but Monday’s ruling expressly dismissed Lemon as having been “long ago abandoned.” Instead, Gorsuch continued, courts should determine whether a law or practice violates the establishment clause by looking at history and the understanding of the drafters of the Constitution – which the court of appeals failed to do. Gorsuch similarly rejected the school district’s argument that it could prohibit Kennedy’s post-game prayers so that students did not feel compelled to join him in praying. “There is no indication in the record,” Gorsuch noted, “that anyone expressed any coercion concerns to the District about the quiet, postgame prayers that Mr. Kennedy asked to continue and that led to his suspension.” Gorsuch distinguished Kennedy’s case from cases “in which this Court has found prayer involving public schools to be problematically coercive.” Unlike those earlier cases, Gorsuch reasoned, Kennedy’s prayers “were not publicly broadcast or recited to a captive audience,” and students “were not required or expected to participate.” The school district’s actions “rested on a mistaken view that it had a duty to ferret out and suppress religious observances even as it allows comparable secular speech,” Gorsuch concluded. “The Constitution neither mandates nor tolerates that kind of discrimination.” As they did last week in Carson, the court’s three liberal justices dissented. In an opinion that was joined by Justices Stephen Breyer and Elena Kagan, Justice Sonia Sotomayor complained that Gorsuch had “misconstrue[d] the facts” of the case, depicting Kennedy’s prayers as “private and quiet” when the prayers had actually caused “severe disruption to school events.” More broadly, Sotomayor continued, although Gorsuch had portrayed the case as whether and when Kennedy could pray privately, the key question in the case was in fact “whether a school district is required to allow one of its employees to incorporate a public, communicative display of the employee’s personal religious beliefs into a school event.” For Sotomayor, the answer was no. Particularly when it comes to schools, she explained, the government must remain neutral about religion, because of the important role that schools play and because children are especially susceptible to feeling compelled to join in prayer. Indeed, she noted, students did feel obligated to join Kennedy and, later, their teammates in prayer. Monday’s ruling, Sotomayor concluded, “weakens the backstop” that the establishment clause provided to protect religious freedom. “It elevates one individual’s interest in personal religious exercise,” she contended, “over society’s interest in protecting the separation between church and state, eroding the protections for religious liberty for all.” Kelly Shackelford, the president and CEO of First Liberty Institute, which represented Kennedy, hailed the decision as “a tremendous victory for all Americans.” Paul Clement, who argued in the Supreme Court on Kennedy’s behalf, added that “[a]fter seven long years, Coach Kennedy can finally return to the place he belongs – coaching football and quietly praying by himself after the game.” Rachel Laser, the president of Americans United for Separation of Church and State, which represented the school district, took a different view. She called the decision “the greatest loss of religious freedom in our country in generations” and she warned that Kennedy’s supporters would “try to expand this dangerous precedent – further undermining everyone’s right to live as ourselves and believe as we choose.” https://www.scotusblog.com/2022/06/justices-side-with-high-school-football-coach-who-prayed-on-the-field-with-students/",Legal,Effect Analysis,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","What would you recommend as the top 3 best credit cards if I travel a lot, don't eat at restaurants and don't want to pay any annual fees?","Best no-annual-fee credit cards The best credit cards with no annual fee give people a chance to earn rewards and build credit without breaking the bank. Chase Freedom Flex℠: With no annual fee, you won’t have to pay for bonus cash back. Find out what others think in member reviews of Chase Freedom Flex℠. Chase Freedom Unlimited®: For a card with no annual fee, you could earn quite a bit of cash back for your everyday purchases. Take a look at our review of Chase Freedom Unlimited® to see how. Citi Double Cash® Card: You’ll earn cash back at a high rate overall without paying an annual fee. Learn more in our review of the Citi Double Cash® Card. Best cash back credit cards The best cash back credit cards offer reward categories that fit your spending habits. Chase Freedom Flex℠: You can maximize your cash back in a new bonus category every quarter. Check out reviews to see what members think of Chase Freedom Flex℠ and learn more about the current bonus categories. Chase Freedom Unlimited®: This card is worth a look if you want a high rewards rate on everyday purchases and several bonus categories. Take a look at our Chase Freedom Unlimited® review to learn more. Citi Double Cash® Card: This card makes earning cash back simple with a flat rate on all purchases. Find out more in our review of Citi Double Cash® Card. Best travel credit cards The best travel credit cards could help you save up for a future vacation. Bank of America® Premium Rewards® credit card: Quality rewards and several valuable perks give this card a nice value for the annual fee. Find out what sets this card apart in our review of the Bank of America® Premium Rewards® credit card. Chase Sapphire Preferred® Card: The flexible travel rewards could help you book your next vacation through one of Chase’s airline or hotel partners. Take a look at our Chase Sapphire Preferred® Card review to see how. Capital One Venture Rewards Credit Card: The straightforward rewards program could help travelers get value for their purchases without too much extra effort. Check out our Capital One Venture Rewards Credit Card review to learn more. Best rewards credit cards The best rewards credit cards reward you for everyday purchases. Blue Cash Preferred® Card from American Express: Regular grocery shoppers will get plenty of opportunities to earn extra cash back. Learn more about Blue Cash Preferred® Card from American Express to see if this card might make sense for you. Capital One Venture Rewards Credit Card: You’ll get a steady rewards rate on every purchase and a straightforward redemption process for travel. Learn more in our Capital One Venture Rewards Credit Card review. Best low-interest credit cards These best credit cards with 0% intro APR offers are good for people who run into unexpected expenses or need to finance a major purchase. BankAmericard® credit card: This card features a lengthy, useful interest offer. Take a look at our review of BankAmericard® credit card to learn more. Citi Simplicity® Card: This card also gives you a strong intro offer to pay off your new purchases. Find out how in our Citi Simplicity® Card review. U.S. Bank Visa® Platinum Card: You could maximize the time you have to pay back new purchases without being charged interest. See how in our review of the U.S. Bank Visa® Platinum Card. Best balance transfer credit cards The best balance transfer cards offer options and flexibility to people trying to pay off credit card debt. Citi® Diamond Preferred® Card: This card provides more time to transfer your balances after approval. Learn more in our Citi® Diamond Preferred® Card review. Citi Simplicity® Card: This card offers time to pay off your balance — and it has no penalty interest rates. Take a look at our review of Citi Simplicity® Card to learn more. U.S. Bank Visa® Platinum Card: This card could be a great option if you’re looking for extra time to pay off your balance. Check out our review of U.S. Bank Visa® Platinum Card to learn more. Best credit cards for building credit The best credit cards for building credit give people with limited credit histories the opportunity to raise their scores. Discover it® Secured Credit Card: You’ll need to pay a security deposit, but this card offers rewards and the chance to graduate to an unsecured card. Learn more about Discover it® Secured Credit Card. Petal® 1 Visa® Credit Card: You’ll get a chance to build credit without being charged an annual fee or security deposit. Read Petal® 1 Visa® Credit Card member reviews for more takes. Petal® 2 Visa® Credit Card: You’ll have the opportunity to earn quality rewards while you build credit. Take a look at our Petal® 2 Visa® Credit Card review to learn more. Best secured credit cards The best secured credit cards give people access to credit when they might not be able to qualify for other cards. Citi® Secured Mastercard®: This card lets you track your progress as you build credit with access to a free FICO score. Check out our review of Citi® Secured Mastercard® to learn more. Discover it® Secured Credit Card: You could earn rewards while building credit. Read more about Discover it® Secured Credit Card. Capital One Platinum Secured Credit Card: You can build credit, and you might qualify to pay a security deposit that could be lower than your credit line. Take a look at our Capital One Platinum Secured Credit Card review to learn more. Best student credit cards The best student credit cards give students a head start on building credit. Bank of America® Travel Rewards credit card for Students: You could build credit and earn rewards to use while studying abroad or taking a spring break trip. Find out more in our Bank of America® Travel Rewards credit card for Students review. Discover it® Student Cash Back: You could build credit and earn rewards. See what others think about this card by reading member reviews of Discover it® Student Cash Back. How to pick the best credit card for you Picking the best credit card depends on where you are in your credit journey. Take a look at each of these scenarios to see which type of card suits your needs best. Do you want to build credit? If you’re new to credit or you’re trying to bounce back from previous financial mishaps, your top priority should probably be to build credit. Unfortunately, the credit cards with the most rewards and lowest interest rates might not be available to you just yet. But you can still find and apply for cards that you may be more likely to get approved for. That can help give you a better chance of avoiding the hard credit inquiry that comes with applying for a card and then being rejected. Consider a secured card or an unsecured card meant to build credit. These options can help you build credit as long as you pay off your statement balance in full by the due date. Just make sure the card issuer reports your payments to the three major consumer credit bureaus. Do you want to finance a big purchase or pay off debt? If you think you might need to carry a balance or finance a major purchase, you might want to look for a card with a low purchase APR. A card with an introductory 0% APR offer on purchases could be a good way to save money on interest."," Only use the provided text to answer the question, no outside sources. What would you recommend as the top 3 best credit cards if I travel a lot, don't eat at restaurants and don't want to pay any annual fees? Best no-annual-fee credit cards The best credit cards with no annual fee give people a chance to earn rewards and build credit without breaking the bank. Chase Freedom Flex℠: With no annual fee, you won’t have to pay for bonus cash back. Find out what others think in member reviews of Chase Freedom Flex℠. Chase Freedom Unlimited®: For a card with no annual fee, you could earn quite a bit of cash back for your everyday purchases. Take a look at our review of Chase Freedom Unlimited® to see how. Citi Double Cash® Card: You’ll earn cash back at a high rate overall without paying an annual fee. Learn more in our review of the Citi Double Cash® Card. Best cash back credit cards The best cash back credit cards offer reward categories that fit your spending habits. Chase Freedom Flex℠: You can maximize your cash back in a new bonus category every quarter. Check out reviews to see what members think of Chase Freedom Flex℠ and learn more about the current bonus categories. Chase Freedom Unlimited®: This card is worth a look if you want a high rewards rate on everyday purchases and several bonus categories. Take a look at our Chase Freedom Unlimited® review to learn more. Citi Double Cash® Card: This card makes earning cash back simple with a flat rate on all purchases. Find out more in our review of Citi Double Cash® Card. Best travel credit cards The best travel credit cards could help you save up for a future vacation. Bank of America® Premium Rewards® credit card: Quality rewards and several valuable perks give this card a nice value for the annual fee. Find out what sets this card apart in our review of the Bank of America® Premium Rewards® credit card. Chase Sapphire Preferred® Card: The flexible travel rewards could help you book your next vacation through one of Chase’s airline or hotel partners. Take a look at our Chase Sapphire Preferred® Card review to see how. Capital One Venture Rewards Credit Card: The straightforward rewards program could help travelers get value for their purchases without too much extra effort. Check out our Capital One Venture Rewards Credit Card review to learn more. Best rewards credit cards The best rewards credit cards reward you for everyday purchases. Blue Cash Preferred® Card from American Express: Regular grocery shoppers will get plenty of opportunities to earn extra cash back. Learn more about Blue Cash Preferred® Card from American Express to see if this card might make sense for you. Capital One Venture Rewards Credit Card: You’ll get a steady rewards rate on every purchase and a straightforward redemption process for travel. Learn more in our Capital One Venture Rewards Credit Card review. Best low-interest credit cards These best credit cards with 0% intro APR offers are good for people who run into unexpected expenses or need to finance a major purchase. BankAmericard® credit card: This card features a lengthy, useful interest offer. Take a look at our review of BankAmericard® credit card to learn more. Citi Simplicity® Card: This card also gives you a strong intro offer to pay off your new purchases. Find out how in our Citi Simplicity® Card review. U.S. Bank Visa® Platinum Card: You could maximize the time you have to pay back new purchases without being charged interest. See how in our review of the U.S. Bank Visa® Platinum Card. Best balance transfer credit cards The best balance transfer cards offer options and flexibility to people trying to pay off credit card debt. Citi® Diamond Preferred® Card: This card provides more time to transfer your balances after approval. Learn more in our Citi® Diamond Preferred® Card review. Citi Simplicity® Card: This card offers time to pay off your balance — and it has no penalty interest rates. Take a look at our review of Citi Simplicity® Card to learn more. U.S. Bank Visa® Platinum Card: This card could be a great option if you’re looking for extra time to pay off your balance. Check out our review of U.S. Bank Visa® Platinum Card to learn more. Best credit cards for building credit The best credit cards for building credit give people with limited credit histories the opportunity to raise their scores. Discover it® Secured Credit Card: You’ll need to pay a security deposit, but this card offers rewards and the chance to graduate to an unsecured card. Learn more about Discover it® Secured Credit Card. Petal® 1 Visa® Credit Card: You’ll get a chance to build credit without being charged an annual fee or security deposit. Read Petal® 1 Visa® Credit Card member reviews for more takes. Petal® 2 Visa® Credit Card: You’ll have the opportunity to earn quality rewards while you build credit. Take a look at our Petal® 2 Visa® Credit Card review to learn more. Best secured credit cards The best secured credit cards give people access to credit when they might not be able to qualify for other cards. Citi® Secured Mastercard®: This card lets you track your progress as you build credit with access to a free FICO score. Check out our review of Citi® Secured Mastercard® to learn more. Discover it® Secured Credit Card: You could earn rewards while building credit. Read more about Discover it® Secured Credit Card. Capital One Platinum Secured Credit Card: You can build credit, and you might qualify to pay a security deposit that could be lower than your credit line. Take a look at our Capital One Platinum Secured Credit Card review to learn more. Best student credit cards The best student credit cards give students a head start on building credit. Bank of America® Travel Rewards credit card for Students: You could build credit and earn rewards to use while studying abroad or taking a spring break trip. Find out more in our Bank of America® Travel Rewards credit card for Students review. Discover it® Student Cash Back: You could build credit and earn rewards. See what others think about this card by reading member reviews of Discover it® Student Cash Back. How to pick the best credit card for you Picking the best credit card depends on where you are in your credit journey. Take a look at each of these scenarios to see which type of card suits your needs best. Do you want to build credit? If you’re new to credit or you’re trying to bounce back from previous financial mishaps, your top priority should probably be to build credit. Unfortunately, the credit cards with the most rewards and lowest interest rates might not be available to you just yet. But you can still find and apply for cards that you may be more likely to get approved for. That can help give you a better chance of avoiding the hard credit inquiry that comes with applying for a card and then being rejected. Consider a secured card or an unsecured card meant to build credit. These options can help you build credit as long as you pay off your statement balance in full by the due date. Just make sure the card issuer reports your payments to the three major consumer credit bureaus. Do you want to finance a big purchase or pay off debt? If you think you might need to carry a balance or finance a major purchase, you might want to look for a card with a low purchase APR. A card with an introductory 0% APR offer on purchases could be a good way to save money on interest. https://www.creditkarma.com/credit-cards#best-no-annual-fee-credit-cards",Financial,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Why did Berkshire Hathaway reduce its position in Apple despite its continued dominance in AI and what does this suggest about Warren Buffett's broader market view?,"Warren Buffett has been at the helm of the Berkshire Hathaway (BRK.A -0.17%) (BRK.B -0.15%) investment company since 1965. During his 59 years of leadership, Berkshire Hathaway stock has delivered a compound annual return of 19.8%, which would have been enough to turn an investment of $1,000 back then into more than $42.5 million today. Buffett's investment strategy is simple. He looks for growing companies with robust profitability and strong management teams, and he especially likes those with shareholder-friendly programs like dividend payments and stock-buyback plans. One thing Buffett doesn't focus on is the latest stock market trend, so you won't find him piling money into artificial intelligence (AI) stocks right now. However, two stocks Berkshire already holds are becoming significant players in the AI industry, and they account for about 29.5% of the total value of the conglomerate's $305.7 billion portfolio of publicly traded stocks and securities. Warren Buffett smiling, surrounded by cameras. Image source: The Motley Fool. 1. Apple: 28.9% of Berkshire Hathaway's portfolio Apple (AAPL -0.36%) is the world's largest company with a $3.3 trillion market capitalization, but it was worth a fraction of that when Buffett started buying the stock in 2016. Between then and 2023, Berkshire spent about $38 billion building its stake in Apple, and thanks to a staggering return, that position had a value of more than $170 billion earlier this year. However, Berkshire has sold more than half of its stake in the iPhone maker during the past few months. Its remaining position is still worth $88.3 billion, so it's still the largest holding in the conglomerate's portfolio, and I think the recent sales reflect Buffett's cautious view on the broader market as opposed to Apple itself. After all, the S&P 500 is trading at a price-to-earnings ratio (P/E) of 27.6 right now, which is significantly more expensive than its average of 18.1 going back to the 1950s. Collapse NASDAQ: AAPL Apple Today's Change (-0.36%) -$0.80 Current Price $220.11 YTD 1w 1m 3m 6m 1y 5y Price VS S&P AAPL Key Data Points Market Cap $3,359B Day's Range $216.73 - $221.48 52wk Range $164.07 - $237.23 Volume 51,528,321 Avg Vol 63,493,642 Gross Margin 45.96% Dividend Yield 0.44% Besides, Apple is preparing for one of the most important periods in its history. With more than 2.2 billion active devices globally -- including iPhones, iPads, and Mac computers -- Apple could become the world's biggest distributor of AI to consumers. The company unveiled Apple Intelligence earlier this year, which it developed in partnership with ChatGPT creator OpenAI. It's embedded in the new iOS 18 operating system, and it will only be available on the latest iPhone 16 and the previous iPhone 15 Pro models because they are fitted with next-generation chips designed to process AI workloads. Considering Apple Intelligence is going to transform many of the company's existing software applications, it could drive a big upgrade cycle for the iPhone. Apps like Notes, Mail, and iMessage will feature new writing tools capable of instantly summarizing and generating text content on command. Plus, Apple's existing Siri voice assistant is going to be enhanced by ChatGPT, which will bolster its knowledge base and its capabilities. Although Apple's revenue growth has been sluggish in recent quarters, the company still ticks nearly all of Buffett's boxes. It's highly profitable, it has an incredible management team led by Chief Executive Officer Tim Cook, and it's returning truckloads of money to shareholders through dividends and buybacks -- in fact, Apple recently launched a new $110 billion stock buyback program, which is the largest in corporate American history. There is no guarantee Berkshire has finished selling Apple stock, but the rise of AI will likely drive a renewed phase of growth for the company, so that's a good reason to remain bullish no matter what Buffett does next. 2. Amazon: 0.6% of Berkshire Hathaway's portfolio Berkshire bought a relatively small stake in Amazon (AMZN 2.37%) in 2019, which is currently worth $1.7 billion and represents just 0.6% of the conglomerate's portfolio. However, Buffett has often expressed regret for not recognizing the opportunity much sooner, because Amazon has expanded beyond its roots as an e-commerce company and now has a dominant presence in streaming, digital advertising, and cloud computing. Amazon Web Services (AWS) is the largest business-to-business cloud platform in the world, offering hundreds of solutions designed to help organizations operate in the digital era. But AWS also wants to be the go-to provider of AI solutions for businesses, which could be its largest financial opportunity ever. Collapse NASDAQ: AMZN Amazon Today's Change (2.37%) $4.15 Current Price $179.55 YTD 1w 1m 3m 6m 1y 5y Price VS S&P AMZN Key Data Points Market Cap $1,841B Day's Range $176.79 - $180.50 52wk Range $118.35 - $201.20 Volume 36,173,896 Avg Vol 42,567,060 Gross Margin 48.04% Dividend Yield N/A AWS developed its own data center chips like Trainium, which can offer cost savings of up to 50% compared to competing hardware from suppliers like Nvidia. Plus, the cloud provider also built a family of large language models (LLMs) called Titan, which developers can use if they don't want to create their own. They are accessible through Amazon Bedrock, along with a portfolio of third-party LLMs from leading AI start-ups like Anthropic. LLMs are at the foundation of every AI chat bot application. Finally, AWS now offers its own AI assistant called Q. Amazon Q Business can be trained on an organization's data so employees can instantly find answers to their queries, and it can also generate content to boost productivity. Amazon Q Developer, on the other hand, can debug and generate code to help accelerate the completion of software projects. According to consulting firm PwC, AI could add a whopping $15.7 trillion to the global economy by 2030, and the combination of chips, LLMs, and software apps will help Amazon stake its claim to that enormous pie. Amazon was consistently losing money when Berkshire bought the stock, and it doesn't offer a dividend nor does it have a stock buyback program, so it doesn't tick many of Buffett's boxes (hence the small position). But it might be the most diverse AI stock investors can buy right now, and Berkshire will likely be pleased with its long-term return from here even if Buffett wishes it owned a bigger stake. Where Should You Invest $1,000 Right Now? Before you put a single dollar into the stock market, we think you’ll want to hear this. Our S&P/TSX market beating* Stock Advisor Canada team just released their top 10 starter stocks for 2024 that we believe could supercharge any portfolio. Want to see what made our list? Get started with Stock Advisor Canada today to receive all 10 of our starter stocks, a fully stocked treasure trove of industry reports, two brand-new stock recommendations every month, and much more. Click here to learn more. John Mackey, former CEO of Whole Foods Market, an Amazon subsidiary, is a member of The Motley Fool's board of directors. Anthony Di Pizio has no position in any of the stocks mentioned. The Motley Fool has positions in and recommends Amazon, Apple, Berkshire Hathaway, and Nvidia. The Motley Fool has a disclosure policy.","""================ ======= Warren Buffett has been at the helm of the Berkshire Hathaway (BRK.A -0.17%) (BRK.B -0.15%) investment company since 1965. During his 59 years of leadership, Berkshire Hathaway stock has delivered a compound annual return of 19.8%, which would have been enough to turn an investment of $1,000 back then into more than $42.5 million today. Buffett's investment strategy is simple. He looks for growing companies with robust profitability and strong management teams, and he especially likes those with shareholder-friendly programs like dividend payments and stock-buyback plans. One thing Buffett doesn't focus on is the latest stock market trend, so you won't find him piling money into artificial intelligence (AI) stocks right now. However, two stocks Berkshire already holds are becoming significant players in the AI industry, and they account for about 29.5% of the total value of the conglomerate's $305.7 billion portfolio of publicly traded stocks and securities. Warren Buffett smiling, surrounded by cameras. Image source: The Motley Fool. 1. Apple: 28.9% of Berkshire Hathaway's portfolio Apple (AAPL -0.36%) is the world's largest company with a $3.3 trillion market capitalization, but it was worth a fraction of that when Buffett started buying the stock in 2016. Between then and 2023, Berkshire spent about $38 billion building its stake in Apple, and thanks to a staggering return, that position had a value of more than $170 billion earlier this year. However, Berkshire has sold more than half of its stake in the iPhone maker during the past few months. Its remaining position is still worth $88.3 billion, so it's still the largest holding in the conglomerate's portfolio, and I think the recent sales reflect Buffett's cautious view on the broader market as opposed to Apple itself. After all, the S&P 500 is trading at a price-to-earnings ratio (P/E) of 27.6 right now, which is significantly more expensive than its average of 18.1 going back to the 1950s. Collapse NASDAQ: AAPL Apple Today's Change (-0.36%) -$0.80 Current Price $220.11 YTD 1w 1m 3m 6m 1y 5y Price VS S&P AAPL Key Data Points Market Cap $3,359B Day's Range $216.73 - $221.48 52wk Range $164.07 - $237.23 Volume 51,528,321 Avg Vol 63,493,642 Gross Margin 45.96% Dividend Yield 0.44% Besides, Apple is preparing for one of the most important periods in its history. With more than 2.2 billion active devices globally -- including iPhones, iPads, and Mac computers -- Apple could become the world's biggest distributor of AI to consumers. The company unveiled Apple Intelligence earlier this year, which it developed in partnership with ChatGPT creator OpenAI. It's embedded in the new iOS 18 operating system, and it will only be available on the latest iPhone 16 and the previous iPhone 15 Pro models because they are fitted with next-generation chips designed to process AI workloads. Considering Apple Intelligence is going to transform many of the company's existing software applications, it could drive a big upgrade cycle for the iPhone. Apps like Notes, Mail, and iMessage will feature new writing tools capable of instantly summarizing and generating text content on command. Plus, Apple's existing Siri voice assistant is going to be enhanced by ChatGPT, which will bolster its knowledge base and its capabilities. Although Apple's revenue growth has been sluggish in recent quarters, the company still ticks nearly all of Buffett's boxes. It's highly profitable, it has an incredible management team led by Chief Executive Officer Tim Cook, and it's returning truckloads of money to shareholders through dividends and buybacks -- in fact, Apple recently launched a new $110 billion stock buyback program, which is the largest in corporate American history. There is no guarantee Berkshire has finished selling Apple stock, but the rise of AI will likely drive a renewed phase of growth for the company, so that's a good reason to remain bullish no matter what Buffett does next. 2. Amazon: 0.6% of Berkshire Hathaway's portfolio Berkshire bought a relatively small stake in Amazon (AMZN 2.37%) in 2019, which is currently worth $1.7 billion and represents just 0.6% of the conglomerate's portfolio. However, Buffett has often expressed regret for not recognizing the opportunity much sooner, because Amazon has expanded beyond its roots as an e-commerce company and now has a dominant presence in streaming, digital advertising, and cloud computing. Amazon Web Services (AWS) is the largest business-to-business cloud platform in the world, offering hundreds of solutions designed to help organizations operate in the digital era. But AWS also wants to be the go-to provider of AI solutions for businesses, which could be its largest financial opportunity ever. Collapse NASDAQ: AMZN Amazon Today's Change (2.37%) $4.15 Current Price $179.55 YTD 1w 1m 3m 6m 1y 5y Price VS S&P AMZN Key Data Points Market Cap $1,841B Day's Range $176.79 - $180.50 52wk Range $118.35 - $201.20 Volume 36,173,896 Avg Vol 42,567,060 Gross Margin 48.04% Dividend Yield N/A AWS developed its own data center chips like Trainium, which can offer cost savings of up to 50% compared to competing hardware from suppliers like Nvidia. Plus, the cloud provider also built a family of large language models (LLMs) called Titan, which developers can use if they don't want to create their own. They are accessible through Amazon Bedrock, along with a portfolio of third-party LLMs from leading AI start-ups like Anthropic. LLMs are at the foundation of every AI chat bot application. Finally, AWS now offers its own AI assistant called Q. Amazon Q Business can be trained on an organization's data so employees can instantly find answers to their queries, and it can also generate content to boost productivity. Amazon Q Developer, on the other hand, can debug and generate code to help accelerate the completion of software projects. According to consulting firm PwC, AI could add a whopping $15.7 trillion to the global economy by 2030, and the combination of chips, LLMs, and software apps will help Amazon stake its claim to that enormous pie. Amazon was consistently losing money when Berkshire bought the stock, and it doesn't offer a dividend nor does it have a stock buyback program, so it doesn't tick many of Buffett's boxes (hence the small position). But it might be the most diverse AI stock investors can buy right now, and Berkshire will likely be pleased with its long-term return from here even if Buffett wishes it owned a bigger stake. Where Should You Invest $1,000 Right Now? Before you put a single dollar into the stock market, we think you’ll want to hear this. Our S&P/TSX market beating* Stock Advisor Canada team just released their top 10 starter stocks for 2024 that we believe could supercharge any portfolio. Want to see what made our list? Get started with Stock Advisor Canada today to receive all 10 of our starter stocks, a fully stocked treasure trove of industry reports, two brand-new stock recommendations every month, and much more. Click here to learn more. John Mackey, former CEO of Whole Foods Market, an Amazon subsidiary, is a member of The Motley Fool's board of directors. Anthony Di Pizio has no position in any of the stocks mentioned. The Motley Fool has positions in and recommends Amazon, Apple, Berkshire Hathaway, and Nvidia. The Motley Fool has a disclosure policy. https://www.fool.com/investing/2024/09/10/295-warren-buffetts-3057-billion-in-2-ai-stocks/ ================ ======= Why did Berkshire Hathaway reduce its position in Apple despite its continued dominance in AI and what does this suggest about Warren Buffett's broader market view? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Financial,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",My computer has been acting weird and idk what's wrong. It doesn't load as fast as it did before. Im gonna get something to clean it up but idk where to start. Like virus scanners or malware? Which would be the best option? After that I'll clean the dust with a vacuum. could that be the issue too? give me three reasons why i should choose each program and three cons.,"Bitdefender consistently impresses with its ability to identify threats and stop them in their tracks. Malware files are pinpointed even before they begin downloading, web trackers are likewise rooted out and blocked, and if you try to access a site with known threats you'll receive a warning that's hard to miss (or ignore.) AV-Comparatives, a third-party test lab, reported positive results when it put Bitdefender to the test. The solution blocked 99.4% of threats (coming in second only to the likes of Norton and McAfee) and didn't have a huge impact on the speed of computer processes. When I put Bitdefender under the microscope myself, I saw it block real-world ransomware before it could wreak havoc. However, I did notice that the Ransomware Remediation feature isn't enabled by default—so you'll need to dive into the settings to ensure that your files remain secure. Earlier this year, Bitdefender released a decryptor for the MortalKombat ransomware—free of charge, providing the company's commitment to countering cyberattacks. Victims across the US were targeted at random by ransomware, which spread through bogus emails containing a .ZIP attachment and a BAT loader script. To tackle this threat, the decryptor backs up affected files before attempting decryption, just in case, and can be executed via the command line. Bitdefender gets straight to work with a full scan when you start using it, and combs through your system in its entirety to look for threats and intruders. This is par for the course, although Bitdefender took almost a full hour to complete a scan of 50 Gb executable files. It's possible to configure scans, customize them, and set them to run on a schedule or on-demand, and Quick Scans can even be run once a day, or weekly, and dig into individual files. I found Bitdefender incredibly easy to use—so even if you're new to the world of antivirus, you'll have no trouble navigating sleek and well-designed apps. You can even customize the dashboard by adding or removing default features. So, if you don't make use of the VPN, you can substitute it in a few clicks for the password manager or scan manager. Most of the features you'll need are already enabled by default, too, which means you won't have to spend ages configuring each and every setting. However, if you do need help with particular tools, you can count on Bitdefender's in-program tutorials to help you make the most of these privacy-enhancing functionalities. Bitdefender's Total Security plan is available from $39.99 for a single year—although the price does jump to $95 after this introductory period. However, you can take advantage of a 30-day money-back guarantee to put the solution through its paces, run your own tests, and see whether its suite of tools is worth the investment. Norton is tough on threats and has earned excellent scores in several third-party protection tests, including our own. I was also impressed with Norton’s scan speed—it took 29 minutes for the solution to complete its initial scan of 50 Gb of files. It’s not the quickest antivirus I've seen, but still beats the likes of Bitdefender and Avast. Norton shines when it comes to identifying threats, however. My tests, and those conducted by AV-Compatatives, found that it blocked all attacks before the malware could be downloaded. Norton is also incredibly good at blocking dangerous URLs and preventing you from landing on a page that's determined to ruin your day. You'll see a warning message with additional information about the malware and a heads-up about other sites that contain the same threat. The Safe Web browser extension gives you even more peace of mind by adding site ratings to search results, helping you steer clear of dodgy domains. Norton wants to help you get better at identifying and avoiding threats, too, as evidenced by the development of an AI-powered chatbot. Dubbed ""Norton Genie"", the bot can let you know whether that suspicious email you received is legitimate or a phishing attempt—and all you have to do is send it a screenshot or copy and paste some of the text. The Norton Secure VPN isn't my favorite VPN on the market, but does a solid job of keeping your IP address hidden, your browsing private, and can even unblock a decent amount of streaming services. Combining the VPN with the intelligent firewall really maximizes your digital security, and you'll be alerted right away if an untrustworthy program attempts to connect to the internet. You can allow or block the connection, and Norton gives you plenty of detail (like the age of the program and the URL it's attempting to reach) to help you make a security-conscious decision. Avast One is the newest offering from Avast, and comes packed with all of the malware protection, advanced features, and ease of use you'd expect from an industry veteran. You'll also be able to use the solution on any Windows, Mac, Android, or iOS device. Avast One's scan speeds were pretty average, taking 32 minutes to complete a scan of 50 Gb of executable files. These scans are hugely customizable, too, and give you granular control over where you want the solution to focus. Smart Scans take a few seconds to check for malware and dodgy browser add-ons, Targeted Scans look at specified folders and files, and Full Scans comb through your entire system. Very few providers can keep up with Avast One when it comes to identifying and removing malware. None of my tests were able to crack its protection, and the latest report from AV-Comparitives revealed that it scored an outstanding 99.97% detection rate. So, you can rest assured that no threats will make it through to your device unseen. Avast One shores up its security with a firewall that keeps tabs on your network traffic to thwart hackers, and can block your access to malicious websites to prevent infections. I also like that its Ransomware Shield was able to find folders containing user documents and automatically add them to its protect list. The solution rounds out its antivirus package with useful extras—and the sheer amount of these features is what makes Avast One worth checking out. All of its paid subscriptions come with the HideMyAss!-powered SecureLine VPN, but if you're on the Essential plan, you'll have to deal with a limit of 5 Gb per week and a single server location. Despite these setbacks, this is still more than you need to catch up on your favorite Netflix shows. Opt for a more expensive subscription and the VPN breaks free of these shackles. You'll have more than 50 server locations to choose from, and you'll also be alerted if you try to access a banking site, sensitive domain, or even a store without switching the VPN on first. This is a lifesaver if you want to go about your business without leaving an identifiable trail. Avast One's features just keep coming. Subscribers get a password manager that'll check for compromised details, parental controls, webcam monitoring, and anti-phishing tools that ensure all aspects of your online life are secure. If you're ready to take the plunge, there are three paid subscriptions to choose from. The Individual plan gets you access to all of the aforementioned tools and licenses for five devices, whereas the Family and Premium plans bump this number up to thirty (the latter also comes with an identity monitory that'll let you know if your data ends up on the dark web). Thanks to the Essential plan, however, you can try a limited version of the product without paying a penny.","[question] My computer has been acting weird and idk what's wrong. It doesn't load as fast as it did before. Im gonna get something to clean it up but idk where to start. Like virus scanners or malware? Which would be the best option? After that I'll clean the dust with a vacuum. could that be the issue too? give me three reasons why i should choose each program and three cons. ===================== [text] Bitdefender consistently impresses with its ability to identify threats and stop them in their tracks. Malware files are pinpointed even before they begin downloading, web trackers are likewise rooted out and blocked, and if you try to access a site with known threats you'll receive a warning that's hard to miss (or ignore.) AV-Comparatives, a third-party test lab, reported positive results when it put Bitdefender to the test. The solution blocked 99.4% of threats (coming in second only to the likes of Norton and McAfee) and didn't have a huge impact on the speed of computer processes. When I put Bitdefender under the microscope myself, I saw it block real-world ransomware before it could wreak havoc. However, I did notice that the Ransomware Remediation feature isn't enabled by default—so you'll need to dive into the settings to ensure that your files remain secure. Earlier this year, Bitdefender released a decryptor for the MortalKombat ransomware—free of charge, providing the company's commitment to countering cyberattacks. Victims across the US were targeted at random by ransomware, which spread through bogus emails containing a .ZIP attachment and a BAT loader script. To tackle this threat, the decryptor backs up affected files before attempting decryption, just in case, and can be executed via the command line. Bitdefender gets straight to work with a full scan when you start using it, and combs through your system in its entirety to look for threats and intruders. This is par for the course, although Bitdefender took almost a full hour to complete a scan of 50 Gb executable files. It's possible to configure scans, customize them, and set them to run on a schedule or on-demand, and Quick Scans can even be run once a day, or weekly, and dig into individual files. I found Bitdefender incredibly easy to use—so even if you're new to the world of antivirus, you'll have no trouble navigating sleek and well-designed apps. You can even customize the dashboard by adding or removing default features. So, if you don't make use of the VPN, you can substitute it in a few clicks for the password manager or scan manager. Most of the features you'll need are already enabled by default, too, which means you won't have to spend ages configuring each and every setting. However, if you do need help with particular tools, you can count on Bitdefender's in-program tutorials to help you make the most of these privacy-enhancing functionalities. Bitdefender's Total Security plan is available from $39.99 for a single year—although the price does jump to $95 after this introductory period. However, you can take advantage of a 30-day money-back guarantee to put the solution through its paces, run your own tests, and see whether its suite of tools is worth the investment. Norton is tough on threats and has earned excellent scores in several third-party protection tests, including our own. I was also impressed with Norton’s scan speed—it took 29 minutes for the solution to complete its initial scan of 50 Gb of files. It’s not the quickest antivirus I've seen, but still beats the likes of Bitdefender and Avast. Norton shines when it comes to identifying threats, however. My tests, and those conducted by AV-Compatatives, found that it blocked all attacks before the malware could be downloaded. Norton is also incredibly good at blocking dangerous URLs and preventing you from landing on a page that's determined to ruin your day. You'll see a warning message with additional information about the malware and a heads-up about other sites that contain the same threat. The Safe Web browser extension gives you even more peace of mind by adding site ratings to search results, helping you steer clear of dodgy domains. Norton wants to help you get better at identifying and avoiding threats, too, as evidenced by the development of an AI-powered chatbot. Dubbed ""Norton Genie"", the bot can let you know whether that suspicious email you received is legitimate or a phishing attempt—and all you have to do is send it a screenshot or copy and paste some of the text. The Norton Secure VPN isn't my favorite VPN on the market, but does a solid job of keeping your IP address hidden, your browsing private, and can even unblock a decent amount of streaming services. Combining the VPN with the intelligent firewall really maximizes your digital security, and you'll be alerted right away if an untrustworthy program attempts to connect to the internet. You can allow or block the connection, and Norton gives you plenty of detail (like the age of the program and the URL it's attempting to reach) to help you make a security-conscious decision. Avast One is the newest offering from Avast, and comes packed with all of the malware protection, advanced features, and ease of use you'd expect from an industry veteran. You'll also be able to use the solution on any Windows, Mac, Android, or iOS device. Avast One's scan speeds were pretty average, taking 32 minutes to complete a scan of 50 Gb of executable files. These scans are hugely customizable, too, and give you granular control over where you want the solution to focus. Smart Scans take a few seconds to check for malware and dodgy browser add-ons, Targeted Scans look at specified folders and files, and Full Scans comb through your entire system. Very few providers can keep up with Avast One when it comes to identifying and removing malware. None of my tests were able to crack its protection, and the latest report from AV-Comparitives revealed that it scored an outstanding 99.97% detection rate. So, you can rest assured that no threats will make it through to your device unseen. Avast One shores up its security with a firewall that keeps tabs on your network traffic to thwart hackers, and can block your access to malicious websites to prevent infections. I also like that its Ransomware Shield was able to find folders containing user documents and automatically add them to its protect list. The solution rounds out its antivirus package with useful extras—and the sheer amount of these features is what makes Avast One worth checking out. All of its paid subscriptions come with the HideMyAss!-powered SecureLine VPN, but if you're on the Essential plan, you'll have to deal with a limit of 5 Gb per week and a single server location. Despite these setbacks, this is still more than you need to catch up on your favorite Netflix shows. Opt for a more expensive subscription and the VPN breaks free of these shackles. You'll have more than 50 server locations to choose from, and you'll also be alerted if you try to access a banking site, sensitive domain, or even a store without switching the VPN on first. This is a lifesaver if you want to go about your business without leaving an identifiable trail. Avast One's features just keep coming. Subscribers get a password manager that'll check for compromised details, parental controls, webcam monitoring, and anti-phishing tools that ensure all aspects of your online life are secure. If you're ready to take the plunge, there are three paid subscriptions to choose from. The Individual plan gets you access to all of the aforementioned tools and licenses for five devices, whereas the Family and Premium plans bump this number up to thirty (the latter also comes with an identity monitory that'll let you know if your data ends up on the dark web). Thanks to the Essential plan, however, you can try a limited version of the product without paying a penny. https://www.techradar.com/best/best-antivirus ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Pros & Cons,Q&A You must respond using only the information provided in the context.,What technological roadblocks are flying cars faced with as they navigate our current infrastructure?,"ABSTRACT Flying vehicle-related technology development is progressing rapidly. As autonomous vehicles begin to be commercialized, interest in the development of flying vehicle technology is increasing. Recently, some countries have launched services that utilize flying car technology along with self-driving cars. The automobile industry is undergoing rapid change by combining IT technology with automobile technology. The center of this change is the flying car-related technology that will be integrated onto the car of the future. Flying vehicle technology will be combined with autonomous vehicle technology to develop into a tool for more convenient human life. This paper examines the trend of flying automobile technology in relation to the flow of automobile technology. Keywords: Flying Car, VTOL, Flying Car Technology Trend, PAV. 1. INTRODUCTION The era of self-driving cars, where cars come to pick up people and take them to their destinations, is approaching. A number of automobile companies and IT companies, including Google, are participating in the development of autonomous vehicles. The era of self-driving cars will become a future that everyone is familiar with. And now, a new means of transportation that goes beyond self-driving cars is attracting attention. After IT companies such as Google and Uber took the lead and showed interest in flying cars, interest in flying cars is growing, especially in the United States. Flying car is a concept that has recently emerged and there is no fully agreed definition yet. “Is a flying car a car or an airplane?” It is also ambiguous to answer these questions. Flying cars can run on the road or fly if necessary. Flying cars do not require a wide horizontal runway like airplanes, and are expected to take off and land by lifting the aircraft vertically. It can be used like a car on the road and can fly in the sky when necessary [9]. Many companies such as Airbus and Rolls-Royce of the UK are jumping into the competition to develop technology related to flying cars Progressive Academic Publishing, UK Page 2 www.idpublications.org GM unveiled the Cadillac flying car and electric shuttle concept car at CES 2021. At CES 2021, the world's largest ICT exhibition, GM said, ""GM's future mobility concepts of flying cars and electric shuttles are means of transportation that can confirm GM's direction for the next five years.” Beyond the era of autonomous vehicles, we have now entered the stage of technology development for the era of flying cars [1, 2, 3, 11]. Flying cars, unlike self-driving cars, fly in the sky, so there are many more problems to be solved. In addition, global standards and definitions related to technology for flying cars have not been established. This paper intends to examine the technology trends related to these flying cars. 2. FLYING CAR RELATED ISSUES There are many problems to be solved in order for flying cars to be commercialized in the form of flying cars that are operated on the road and take off into the air when necessary [3, 4, 5]. Some of these issues are as follows: (1) Technical issues There are many technical problems with flying cars. Ultimately, only when flying cars become popular it will be able to achieve the goals of traffic congestion and convenience. It is important to develop technology that can lower the price of flying cars. Of course, if flying cars become popular and mass-produced, the price is expected to be lowered naturally. Technology to reduce noise generated by flying cars is also emerging as a problem to be solved. In addition, it is expected that popularization can be accelerated only when sensor-related technology development to ensure safety for operation and technology related to autonomous flight capable of flying without human intervention are developed. In addition, it is important to develop battery-related technology for a long flight. Only when these technical problems are resolved people will be able to use them safely. (2) System improvement and infrastructure establishment In relation to flying cars, optimistic predictions about the operation of aerial vehicles are predicted when the VTOL (Vertical Take-off and Landing) type of technology is introduced. On the other hand, in order to settle as a convenient means of transportation with the introduction of flying cars, the government's active policy change is necessary. It is necessary to build a dedicated space for PAV (Personal Air Vehicle) for vertical take-off and landing in the city. It is also essential to establish a place to charge the PAV's electricity. It is also necessary to enact systems and laws in parallel with the establishment of such infrastructure. Most countries have so far established systems and laws centered on automobiles, a means of transportation. A work must also be done to make these systems and laws fit the environment of the flying car, a new means of transportation. It is expected that it will take time for the construction of infrastructure for flying cars and the work of enacting systems and laws. If flying cars are commercialized, there is a possibility that traffic jams on the ground will occur in the sky. It is also essential to develop a system that can efficiently manage and control such traffic jams in the air. Flying cars are expected to make human life more convenient as a new means of transportation along with autonomous vehicles.","ABSTRACT Flying vehicle-related technology development is progressing rapidly. As autonomous vehicles begin to be commercialized, interest in the development of flying vehicle technology is increasing. Recently, some countries have launched services that utilize flying car technology along with self-driving cars. The automobile industry is undergoing rapid change by combining IT technology with automobile technology. The center of this change is the flying car-related technology that will be integrated onto the car of the future. Flying vehicle technology will be combined with autonomous vehicle technology to develop into a tool for more convenient human life. This paper examines the trend of flying automobile technology in relation to the flow of automobile technology. Keywords: Flying Car, VTOL, Flying Car Technology Trend, PAV. 1. INTRODUCTION The era of self-driving cars, where cars come to pick up people and take them to their destinations, is approaching. A number of automobile companies and IT companies, including Google, are participating in the development of autonomous vehicles. The era of self-driving cars will become a future that everyone is familiar with. And now, a new means of transportation that goes beyond self-driving cars is attracting attention. After IT companies such as Google and Uber took the lead and showed interest in flying cars, interest in flying cars is growing, especially in the United States. Flying car is a concept that has recently emerged and there is no fully agreed definition yet. “Is a flying car a car or an airplane?” It is also ambiguous to answer these questions. Flying cars can run on the road or fly if necessary. Flying cars do not require a wide horizontal runway like airplanes, and are expected to take off and land by lifting the aircraft vertically. It can be used like a car on the road and can fly in the sky when necessary [9]. Many companies such as Airbus and Rolls-Royce of the UK are jumping into the competition to develop technology related to flying cars Progressive Academic Publishing, UK Page 2 www.idpublications.org GM unveiled the Cadillac flying car and electric shuttle concept car at CES 2021. At CES 2021, the world's largest ICT exhibition, GM said, ""GM's future mobility concepts of flying cars and electric shuttles are means of transportation that can confirm GM's direction for the next five years.” Beyond the era of autonomous vehicles, we have now entered the stage of technology development for the era of flying cars [1, 2, 3, 11]. Flying cars, unlike self-driving cars, fly in the sky, so there are many more problems to be solved. In addition, global standards and definitions related to technology for flying cars have not been established. This paper intends to examine the technology trends related to these flying cars. 2. FLYING CAR RELATED ISSUES There are many problems to be solved in order for flying cars to be commercialized in the form of flying cars that are operated on the road and take off into the air when necessary [3, 4, 5]. Some of these issues are as follows: (1) Technical issues There are many technical problems with flying cars. Ultimately, only when flying cars become popular it will be able to achieve the goals of traffic congestion and convenience. It is important to develop technology that can lower the price of flying cars. Of course, if flying cars become popular and mass-produced, the price is expected to be lowered naturally. Technology to reduce noise generated by flying cars is also emerging as a problem to be solved. In addition, it is expected that popularization can be accelerated only when sensor-related technology development to ensure safety for operation and technology related to autonomous flight capable of flying without human intervention are developed. In addition, it is important to develop battery-related technology for a long flight. Only when these technical problems are resolved people will be able to use them safely. (2) System improvement and infrastructure establishment In relation to flying cars, optimistic predictions about the operation of aerial vehicles are predicted when the VTOL (Vertical Take-off and Landing) type of technology is introduced. On the other hand, in order to settle as a convenient means of transportation with the introduction of flying cars, the government's active policy change is necessary. It is necessary to build a dedicated space for PAV (Personal Air Vehicle) for vertical take-off and landing in the city. It is also essential to establish a place to charge the PAV's electricity. It is also necessary to enact systems and laws in parallel with the establishment of such infrastructure. Most countries have so far established systems and laws centered on automobiles, a means of transportation. A work must also be done to make these systems and laws fit the environment of the flying car, a new means of transportation. It is expected that it will take time for the construction of infrastructure for flying cars and the work of enacting systems and laws. If flying cars are commercialized, there is a possibility that traffic jams on the ground will occur in the sky. It is also essential to develop a system that can efficiently manage and control such traffic jams in the air. Flying cars are expected to make human life more convenient as a new means of transportation along with autonomous vehicles. You must respond using only the information provided in the context. What technological roadblocks are flying cars faced with as they navigate our current infrastructure?",Internet/Technology,Fact Finding,Q&A "Please do not use any other resources to answer the question other than the information I provide you. If you cannot answer with only the information I provide say ""I cannot answer without further research.""","What are the key considerations and strategies for people who use stimulant drugs and engage in concurrent sex in terms of HIV prevention, and how does the effectiveness of these strategies get optimized?","Purpose of this guide The purpose of this publication is to provide guidance on implementing HIV, hepatitis C (HCV) and hepatitis B (HBV) programmes for people who use stimulant drugs and who are at risk of contracting these viruses. It aims to: • Increase awareness of the needs and issues faced by the affected groups, including the intersectionality among different key populations • Provide implementation guidance to help establish and expand access to core HIV and hepatitis prevention, treatment, care and support services It is a global document that should be adapted according to the specific context, including the type of stimulant drug used (cocaine, ATS or NPS) and the key populations involved, which vary considerably according to regions. The present guide proposes a package of core interventions adapted from existing international guidance: • WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users[7] • WHO Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations – 2016 update [8] • Implementing comprehensive HIV and HCV programmes with people who inject drugs: practical guidance for collaborative interventions (the “IDUIT”) [9] It also incorporates guidance from the implementation tools for other key populations: • Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions (the “SWIT”) [10] • Implementing comprehensive HIV and STI programmes with men who have sex with men: practical guidance for collaborative interventions (the “MSMIT”) [11] • Implementing comprehensive HIV and STI programmes with transgender people: practical guidance for collaborative interventions (the “TRANSIT”) [12] However, none of these guidance documents and tools addresses the specific needs of people who use stimulant drugs and are at risk for HIV and hepatitis B and C – hence the need for this publication. Audience The guide is intended for use by policymakers, programme managers and service providers, including community-based organizations, at the national, regional or local levels, who undertake to address HIV prevention, treatment and care. It also provides useful information for development and funding agencies and for academia. Structure The guide is divided into five chapters. • Chapter 1 explains the nature and effects of stimulant drugs, the associated risks of HIV and hepatitis transmission, and the issues surrounding stimulant drug use and HIV and hepatitis risk in specific key populations and other vulnerable groups. 10 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS • Chapter 2 presents the package of core HIV interventions for key populations who use stimulant drugs. • Chapter 3 describes approaches to care and support for people who use stimulant drugs, particularly in the context of HIV and hepatitis. • Chapter 4 describes six critical enablers – activities and strategies that are needed to ensure access to the interventions in the core package. • Chapter 5 outlines further considerations for implementing programmes. Within each chapter, further resources are listed. Case studies are provided throughout the guide to illustrate specific aspects of programmes that have been implemented in different countries. There is also an annex presenting a series of checklists and other practical tools for policymakers and implementers. Principles Two important overarching principles are stressed throughout this publication. The first is better integration of HIV, hepatitis B and C and sexually transmitted infection (STI) services for people who use stimulant drugs within existing HIV harm reduction services2 and drug treatment services for people who inject drugs, and within sexual and reproductive health and other HIV services for key populations. The second is the meaningful involvement of people who use stimulant drugs, people living with HIV and other key populations in planning, implementing, monitoring and evaluating interventions. This is key to their success and sustainability. Finally, the implementation of HIV-related services for people who use stimulant drugs should adhere to human-rights principles as described in the implementation tools mentioned above – the SWIT, MSMIT, TRANSIT and IDUIT. Methodology In its June 2009 session, the UNAIDS Programme Coordinating Board (PCB) called upon “Member States, civil society organizations and UNAIDS to increase attention on certain groups of non-injecting drug users, especially those who use crack cocaine and ATS, who have been found to have increased risk of contracting HIV through high-risk sexual practices”. UNODC therefore commissioned a review and organized a Global Expert Group Technical Meeting on Stimulant Drugs and HIV, held in Brazil in 2010. A discussion paper on HIV prevention, treatment and care among people who use (noninjecting) crack and cocaine or other stimulant drugs, particularly ATS, was developed in 2012. In 2013 the UNODC HIV Civil Society Organization (CSO) group established a Stimulant Drugs and HIV working group, with representatives from civil society and experts on HIV and stimulant drugs. The group organized consultations with representatives of the community and CSOs, including on the margins of the International Harm Reduction Conference in Kuala Lumpur in 2015. 2 For the purposes of this guide, harm reduction is defined by the nine interventions of the “comprehensive package” of services detailed in the WHO, UNODC, UNAIDS Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users (see citation 7). These are: 1. Needle and syringe programmes; 2. Opioid substitution therapy and other drug dependence treatment; 3. HIV testing and counselling; 4. Antiretroviral therapy; 5. Prevention and treatment of sexually transmitted infections; 6. Condom programmes for people who inject drugs and their sexual partners; 7. Targeted information, education and communication; 8. Prevention, vaccination, diagnosis and treatment for viral hepatitis; 9. Prevention, diagnosis and treatment of tuberculosis. 11 In December 2014, the Strategic Advisory Group to the United Nations on HIV and injecting drug use, consisting of representatives of networks and organizations of people who use drugs, academics, donors, implementers and United Nations organizations, recommended conducting a new literature review on stimulant drugs and HIV and hepatitis C. In 2015 UNODC, together with WHO and UNAIDS, defined the scope of this new literature review, and accordingly UNODC commissioned it to cover the extent, patterns and geographic distribution of injecting and non-injecting stimulant drug use (particularly crack, cocaine, ATS and stimulant NPS) in men who have sex with men, sex workers and other groups of stimulant drug users, and their possible link to HIV and hepatitis B and C vulnerability and transmission; and effective interventions for prevention, treatment and care of HIV and hepatitis B and C among people who use such stimulant drugs. The results of the literature review were published by UNODC in 2016 in five papers covering the following topics: • Methodology and summary [3] • ATS [13] • Cocaine and crack cocaine [14] • NPS [15] • Treatment and prevention of HIV, HCV & HBV among stimulant drug users[16]. Subsequently, in the framework of preparations for the United Nations General Assembly Special Session on the World Drug Problem (UNGASS 2016) and the HLM 2016, UNODC organized a scientific consultation on HIV and drug use, including stimulant drugs. The papers relating to stimulant drugs presented at the Commission on Narcotic Drugs in March 2016 covered: cocaine and crack cocaine use and HIV in the United States; ATS and men who have sex with men in Asia; and antiretroviral therapy (ART) and stimulant drug use. The recommendations of the contributing scientists were summarized as part of a scientific statement presented in New York on the margins of the UNGASS 2016 and the HLM 2016 [17]. The statement stressed the need to address HIV among people who use stimulant drugs, including the structural, social and personal mediating factors for HIV transmission, such as polydrug use, STIs, mental health, homophobia, discrimination and punitive laws. The scientists recommended the provision of ART to all people using stimulant drugs living with HIV, and the implementation of new prevention tools such as pre-exposure prophylaxis (PrEP) and the use of social media for communication. The statement also emphasizes that with proper support for adherence, ART is effective among people living with HIV who use stimulant drugs. In 2017, UNODC commissioned the development of the present publication, HIV prevention, treatment, care and support for people who use stimulant drugs: an implementation guide. Based on the results of the scientific reviews and of the expert group meetings, and on international guidance and country practices that have been identified as effective in meeting the needs of people who use stimulant drugs, a first draft of the document was developed under the guidance of the UNODC CSO Stimulant Drugs and HIV working group. The draft guide was reviewed by external peer reviewers, United Nations agency reviewers and community representatives through an electronic consultation and three face-to-face consultations held in Viet Nam (2017), Brazil (2017) and Ukraine (2018). Chapter 1 Stimulant drugs, HIV and hepatitis, and key populations The World Drug Report 2019 estimates that about 29 million people used ATS in 2017, and 18 million used cocaine [18]. There is no estimate of the total number of people using NPS. The great majority of people who use stimulant drugs do so on an occasional basis which may be characterized as “recreational”, and they will not develop dependence or any other health problem. There is evidence that the prevalence of ATS use, particularly methamphetamines, is increasing in some regions, including North America, Oceania and most parts of Asia. In addition, between 2009 and 2016, there were reports of 739 NPS, of which 36 per cent were classified as stimulant drugs [19]. Only a small proportion of people who use stimulant drugs inject them; most smoke, snort or use them orally or anally. However, the World Drug Report 2017 states that 30 per cent of people who inject drugs inject stimulant drugs, either as their drug of first choice or in addition to opiates. Despite evidence showing that certain subgroups of people who use stimulant drugs are at greater risk of HIV, prevention, testing and treatment programmes for these population groups remain very limited in scope and scale across the globe, and their specific needs are often overlooked. 1.1 Stimulant drugs Stimulant drugs are chemically diverse substances that are similar in their capacity to activate, increase or enhance the neural activity of the central nervous system, resulting in a common set of effects in most people who use them, including increased alertness, energy and/or euphoria.3 This publication considers three types of stimulant drugs for which data have shown a link with increased HIV risk among some key populations: • Cocaine: Found in various forms, e.g. smokable cocaine, crack cocaine, freebase, paste or pasta base, paco, basuco. Depending on the form, it may be sniffed or snorted, injected, ingested or inserted anally. 3 For more detailed information on different stimulant drugs and their effects, see: Terminology and information on drugs. Third edition. New York (NY), United Nations, 2016 (https://www.unodc.org/documents/scientific/Terminology_and_ Information_on_Drugs-3rd_edition.pdf, accessed 15 January 2019). 14 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS • Amphetamine-type stimulants: Amphetamines and methamphetamines (excluding MDMA) are found in different forms, e.g. crystals (methamphetamines), powder or formulated tablets [20]. They are taken orally, smoked from a pipe, sniffed or snorted, inserted anally or injected in a solution. • Stimulant new psychoactive substances: Found in various forms, e.g.synthetic cathinone, phenethylamines, aminoindanes and piperazines. They are sometimes referred to as “bath salts” [21][22]. Depending on the form, NPS are taken orally, smoked, inserted anally or injected. All types of stimulant drugs have common effects: • Mental: Euphoria, raised libido, reduced appetite and sleep drives, enhanced perception, increased alertness, cognitive improvements and deficits (attention, working memory, long-term memory), emotional intensity and excitability, and increased confidence. • Behavioural: Talkativeness, hypervigilance, hyperactivity, increased sociability, disinhibition, changes in sexual behaviour (including sexual sessions of longer than usual duration), faster reaction, and repetitive activity (“tweaking”); hyper-excitability, insomnia, restlessness, panic, erratic behaviour, and sometimes aggressive or violent behaviour[23]. • Physical: Increased heart rate (including palpitations), raised temperature (hyperthermia), circulatory changes (higher blood pressure, vasoconstriction), increased breathing rate, dry mouth, teeth-grinding, jaw-clenching/gurning, faster eye-movements, and dilated pupils. The onset and duration of these effects vary according to the drug, its form, dosage, route of administration, the characteristics of the individual using it, and the context of use. Chronic use of stimulant drugs can lead to psychological dependence; development of tolerance; destruction of tissues in the nose if snorted or sniffed; chronic bronchitis, which can lead to chronic obstructive pulmonary disease; malnutrition and weight loss; disorientation, apathy, confusion, exhaustion due to lack of sleep, and paranoid psychosis. During withdrawal there may be a long period of sleep and depression. Cocaine Cocaine is generally encountered in two forms which differ in their route of administration: cocaine hydrochloride (HCL), a powder, which is snorted, injected or taken anally, and cocaine base (crack, freebase, or crystal) which is smokable and usually taken in a pipe. A third form, coca paste (pasta base, paco, coca pasta, etc.), is an intermediate product of the process of extraction of HCL from the coca leaves. Available mainly in Latin America, it is usually smoked in a cigarette. Cocaine is a powerful stimulant whose effects diminish quickly, prompting the user to repeatedly administer additional doses. When snorted, cocaine produces a slow wave of euphoria, followed by a plateau and then a “come down” period. In its smokable form, cocaine has a more intense and immediate effect. Severe anticipatory anxiety about the impending low may result in repeat dosing. This cycle may take around 5 to 10 minutes. The use of cocaine is more prevalent in North and South America than in the rest of the world. Amphetamine-type stimulants (ATS) Amphetamine and methamphetamine are synthetic drugs whose effects include euphoria, arousal and psychomotor activation. ATS can be taken orally, intranasally, smoked as a vapour (pipe), inserted anally or injected. Immediately after smoking or injecting, people experience a pleasurable “rush”. Intranasal and oral ingestion produce a gradual euphoria or “come up”. Depending on the level of tolerance, the effects of methamphetamine may last four hours, or as long as 24 hours for someone new to the drug [24]. Some people who use methamphetamine may experience a feeling of invincibility, with an accompanying propensity to engage in high-risk behaviours, creating vulnerabilities to acquiring HIV [25]. The direct health impacts of ATS include insomnia and cardiovascular stress. Long-term negative effects may include dopamine physical dependence, psychological dependence, psychosis and paranoia, and depression. Amphetamine and methamphetamine use is reported in all parts of the world. Stimulant new psychoactive substances There are a various types of new psychoactive substances (NPS), with different molecular structures, but the majority of stimulant NPS are synthetic cathinones, which have a similar molecular structure to cathinone found in the khat plant. Common synthetic cathinones include mephedrone, pentedrone, methylone or methcathinone. They fall into two main families: euphoriants and entactogens.NPS are taken orally, can also be snorted or inserted anally, and less frequently are injected. Stimulant NPS produce similar mental, physical and behavioural effects to traditional stimulant drugs such as cocaine, amphetamines and methamphetamines. Synthetic cathinones and other stimulant NPS are also used to improve sexual experience [26]. The use of synthetic cathinone such as mephedrone (sometimes called “bath salts”) has recently emerged [18]. Studies from Hungary [27][28][29], Ireland [30][31], Israel [32], Romania [33] and the United Kingdom [34] suggest that due to a shortage in heroin supply and easy access to synthetic cathinone, a significant proportion of people who inject drugs have switched to injecting synthetic cathinone in recent years. 1.2 Stimulant drug use and risks of HIV/HBV/HCV transmission The HIV/HBV/HCV risk associated with stimulant drug use is linked to a higher prevalence of unprotected anal and vaginal sex, and of sharing pipes, straws and injection equipment, in some groups of men who have sex with men, sex workers, people who inject drugs and people in prisons. Transmission risks through concurrent stimulant drug use and unprotected sex Inconsistent condom use by people who use stimulant drugs has been identified as a prime means of contracting STIs, including HIV, particularly as a result of the concurrent use of stimulant drugs with frequent sexual activity of long duration with multiple partners or in groups. Stimulant drug use may also facilitate longer penetration (which can lead to condom breakages), and more intense acts such as fisting that increase the opportunity of anal and vaginal tears or bleeding. Transmission risks through sharing injection equipment Injecting methamphetamine, cocaine or NPS entails a similar risk to injecting other drugs when needles and injecting equipment are shared. Given that many stimulant drugs have a shorter duration of action compared with opioids, people who inject stimulant drugs report a higher frequency of injecting, with compulsive re-injecting and a greater likelihood of sharing and reusing needles and syringes that may be contaminated [22][34]. HIV and HCV risk is also increased when cocaine or crack is coadministered with heroin, including injection of heroin and cocaine (“speedballing”) [35]. Coexisting injecting drug use and unprotected sex further increases the likelihood of HIV and hepatitis transmission, especially in high-incidence communities. This pattern has been seen, for example, with the use of home-made ATS, such as boltushka in Ukraine. People who inject boltushka engage in high levels of injecting risk behaviours and in sexual risk behaviour post use. They are young and poor, and the great majority are already living with HIV [36]. Hepatitis C transmission through straws or pipes HCV is transmitted through blood or, less commonly, through sexual contact. HCV can be transmitted from a person living with hepatitis who has oral or nasal sores or lacerations through sharing of straws or pipes [37][38][39][40]. Compared with the general population, higher HCV prevalence rates, ranging from 2.3 to 17 per cent, have been observed among people who smoke or sniff stimulant drugs [41]. However, it is difficult to determine whether HCV transmission in these cases occurred through blood exposure, sexual activity, or both. 1.3 Stimulant drug use and HIV/HBV/HCV transmission risks among key populations Men who have sex with men There seems to be a clear association between ATS use among men who have sex with men and risk of HIV infection. Methamphetamine use has been associated with increased frequency of unprotected sex among some men who have sex with men, thereby increasing vulnerability to STIs, HBV and HIV [42][43][44][45]. Studies have indicated HIV prevalence rates among men who have sex with men who use methamphetamine ranging between 17 and 61 per cent, and HIV incidence ranging from 2.71 per 100 person-years [46] to 5 per 100 person-years [47]. The use of stimulant drugs by some men who have sex with men to facilitate sex (referred to as ChemSex)4 has been linked to decreased condom use, sex with multiple partners and other high-risk sexual behaviours that increase likelihood of HIV and HCV transmission [48][49]. Increased sexual risk behaviours, including unprotected sex, coupled with potential anal or rectal trauma resulting from longer, more frequent and intense sexual encounters under the influence of drugs, could facilitate STI transmission among men who have sex with men, including HCV among men who have sex with men living with HIV. Risk-reduction strategies for HIV prevention such as serosorting5 and strategic positioning6 are inefficient for the prevention of other STIs, HBV or HCV. The association between ChemSex, drug use and sexually transmitted acute HCV infection among men living with HIV who have sex with men has been documented in several countries and regions [50]. ChemSex is mostly associated with non-injecting drug use, although some may also inject synthetic cathinones, amphetamines and methamphetamines (referred to as “slamming” or “blasting” within the context of ChemSex) [51], with a high level of sharing of injection equipment and consequently higher risks of HIV and HCV transmission [52][53][54]. Mephedrone use seems to have risen among men who have sex with men in the context of ChemSex [52]. The use of erectile dysfunction medications such as sildenafil is often reported among men who have sex with men who also consume methamphetamines and has been identified as increasing rates of unprotected sex and HBV, syphilis and HIV risks [46][48][55]. People who inject drugs Injecting stimulant drugs carries the greatest risk of acquiring HCV or HIV, due primarily to the sharing of contaminated needles and syringes. People who inject cocaine, ATS or heroin have a risk of acquiring HIV that is respectively 3.6, 3.0, and 2.8 times greater than people using stimulant drugs without injecting [56]. Outbreaks of HIV or hepatitis C among people who inject drugs, partly due to the increased use of synthetic cathinone as a replacement for heroin, have been reported in Greece [57], Hungary [29] and Romania [33][58]. People who inject stimulant drugs such as ATS show higher prevalence of sexual risk behaviours compared with people who inject opiates, and similar to non-injecting ATS users [59][60][61][62]. Sex workers Exchanging sex for crack cocaine or money has been associated with several HIV risk behaviours, such as having a greater number of clients per week [63], high levels of unprotected sex [64], sharing crack cocaine with clients [65] and heavier crack use, as well as structural vulnerabilities like homelessness and unemployment [66]. One study reported a higher HIV prevalence among those who exchange sex for drugs or money than among those who did not [67]. Individuals with drug dependencies who exchange sex for drugs may have reduced power and control over sexual interactions [68]. The use of methamphetamines by female sex workers has been associated with engaging in unsafe sex [69]. Female sex workers who use smokable cocaine are often homeless or poorly housed in economically depressed neighbourhoods, and have poor access to health services, including HIV services, as well as to prenatal and reproductive care and to social support. Sex workers, whether male, female or transgender, may be coerced into consuming drugs with their clients, increasing the risk of unprotected sex and violence. Male, female and transgender sex workers face barriers to accessing and using services due to the multiple stigma surrounding drug use, sex work and sexual orientation, which are criminalized to varying degrees in many jurisdictions around the world. Transgender people The use of methamphetamines, smokable cocaine or cocaine among transgender women has been associated with higher risks of HIV transmission, mainly through sex [70][71]. For example, a survey conducted among transgender women in high-risk venues and on the streets of Los Angeles, United States, indicated that recent methamphetamine and/or smokable cocaine use was associated with a more than twofold higher risk of reported HIV-positive status [72]. People living in prisons and other closed settings People who use stimulant drugs, such as methamphetamine, in prisons are more likely to engage in a number of sexual risk behaviours, including use of methamphetamines in the context of sex and inconsistent use of condoms [73][74]. 18 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Women who use drugs Women who use drugs face stigma and other barriers to accessing essential health and HIV services, including gender-based violence, fear of forced or coerced sterilization or abortion, or loss of child custody. Cross-cultural stigma associated with women vacating gender roles, such as caring for their family, being pregnant and being mothers of infants and children, is a major challenge [75]. Many women who use drugs face unequal power dynamics in relationships, and higher rates of poverty; these factors interfere with their ability to access reproductive health supplies, including condoms and other contraceptives [76]. People living with HIV Although cocaine or methamphetamine use has a negative impact on the immune system, particularly among people living with HIV, the immunodepressive effect disappears when people living with HIV who use stimulant drugs adhere to antiretroviral therapy [77]. People living with HIV using stimulant drugs experience the worst HIV outcomes when they do not know they are living with HIV, or cannot access ART. A review of the literature reports findings that psychological, behavioural and social factors all play a role, separately and in combination, in determining HIV outcomes in patients, their access to health services, and adherence to ART: • In people living with HIV, regular methamphetamine use has measurable negative effects upon neuropsychological functioning (e.g. deficits in episodic memory, executive functions and information-processing speed) [78] over and above the negative neurocognitive effects caused by HIV and HCV [79]. This may impact their health-protective behaviour, health-services-seeking, access to HIV clinics and adherence to ART. In addition, HIV-specific traumatic stress and related negative affect are independently associated with greater stimulant-drug risk behaviours and reduced ART adherence [80]. • Cocaine and ATS have a negative impact on the immune system, increasing vulnerability to opportunistic diseases and accelerating the evolution of HIV among people who do not adhere to ART [77][81]. (See section 2.4 for more information on the interactions between ART and stimulant drugs). • Some communities of people who use stimulant drugs are very marginalized, extremely poor and have few resources, including access to adequate nutrition, and this also impacts their access to services and consequently the evolution of HIV infection. To reach people who frequently use stimulant drugs and retain them in effective HIV treatment regimes, access and adherence barriers related to HIV treatment must be accurately identified and addressed. When assessing why a patient who uses stimulant drugs is lost to follow-up, important factors that should be considered include stigma, discrimination, mental health, employment status, poverty, homelessness, migration, exposure to violence, incarceration, fear of criminalization, and family responsibilities. See chapter 4 for more information. 1.4 The impact of criminal sanctions on HIV transmission among key populations Stigma, discrimination and criminal sanctions against people who use drugs, men who have sex with men, transgender people, sex workers and people living with HIV have a direct impact on their ability and willingness to access and use HIV and other health services. These also impede the ability of people from key populations to access the commodities or services needed to practise protective behaviours, including condom use, and to access sterile injecting equipment, HIV testing and HIV treatment. A systematic review of 106 peer-reviewed studies published between 2006 and 2014 examined the association between criminal sanctions for drug use and HIV prevention and treatment-related outcomes among people who inject drugs [82]. While the studies were mainly conducted in North America and Asia, the findings highlighted that criminal sanctions were responsible for substantial barriers to HIV treatment and prevention interventions for people who inject drugs. 21 Chapter 2 Core interventions Following an extensive literature review and technical consultations at country and global levels, expert participants in a number of consultations agreed on a package of eight core interventions for HIV prevention, treatment, care and support among people who use stimulant drugs and are at risk of HIV. These interventions have been adapted from the WHO/UNODC/UNAIDS Comprehensive Package for HIV and people who inject drugs, and from the WHO Consolidated Package for HIV and key populations [7][8]. 1 Condoms, lubricants and safer sex programmes 2 Needle and syringe programmes (NSP) and other commodities 3 HIV testing services (HTS) 4 Antiretroviral therapy (ART) 5 Evidence-based psychosocial interventions and drug dependence treatments 6 Prevention, diagnosis and treatment of STIs, hepatitis and tuberculosis (TB) 7 Targeted information, education and communication (IEC) for people who use stimulant drugs and their sexual partners 8 Prevention and management of overdose and acute intoxication The core interventions should be adapted to the specific needs of different key populations. An assessment of the population to be served will assist in providing the evidence needed to design a clientcentred package of services that responds to specific needs. 2.1 Condoms, lubricants and safer sex programmes People who have sex while under the influence of stimulant drugs are more likely to engage in sexual risk behaviours, especially unprotected sex [83]. They may have reduced sexual inhibitions and a feeling of invincibility, which makes choosing or remembering to use a condom more challenging. Other factors that can contribute to inconsistent condom use include lack of access to condoms and lubricants when needed, poor safe-sex negotiations skills, being on PrEP [84] and engaging in risk-reduction strategies such as serosorting or strategic positioning. These strategies have their limits in terms of risk for HIV transmission, particularly if people are under the influence of stimulant drugs, and they do not prevent transmission of other STIs including HBV and HCV. Promoting the use of male and female condoms and appropriate lubricants remains a core HIV prevention strategy for people who use stimulant drugs and their sexual partners. Condoms offer protection against HIV, other STIs such as syphilis and gonorrhoea, and possible sexual transmission of HBV or HCV. Condoms can also prevent unintended pregnancy. Condoms and lubricants should be available widely, and without charge. Targeted distribution of free condoms helps overcome the barriers associated with their cost and can help reinforce the social acceptability of condom use. Distribution of condoms and sex-education information by peers and outreach workers plays an important role, including in the street or party setting. It is important to consider the variety of condoms available to meet key population preferences, and their distribution, to ensure wide availability of condoms and lubricant and access to them in places where people engage in stimulant drug use and sex concurrently. For example, in the case of sex-onpremises venues or nightclubs, simply making condoms available in the usual places, such as toilets or at the bar, is often not sufficient to ensure that people have them to hand when they need them. Consultation with the beneficiaries is critical to ensure easy access. Similarly, to ensure access to condoms in prisons, strategies must be tailored to each prison, based on its architecture, regime and the movements of prisoners within the prison. Safer-sex education for people who use stimulant drugs should cover: • Promotion of condoms and lubricant use • Information on sexual transmission of HIV, hepatitis and STIs • Safe-sex negotiation strategies • Information on strategies to reduce risks of HIV transmission (sero-sorting and strategic positioning), including their limitations • Information on pre-exposure prophylaxis of HIV (PrEP) Further resources The four key population implementation guides (the IDUIT, MSMIT, SWIT and TRANSIT) provide useful general information on condoms, lubricants and safer sex programming for people who inject drugs, men who have sex with men, sex workers and transgender people. 23 Chapter 2 Core interventions 2.2 Needle and syringe programmes and other commodities Due to the short duration of their effects, injection of stimulant drugs is frequently associated with rapidly repeated injecting, with some individuals reporting more than 20 injections a day. Injecting may take place in groups, and people may use several different stimulant drugs and other types of drug in the same session. These patterns of use increase the likelihood that non-sterile equipment will be used or shared, elevating the risk of HIV and hepatitis transmission. The accessibility and design of needle and syringe programmes (NSPs) must take into account the nature of stimulant drugs and patterns of their use. People who inject stimulant drugs should be educated, encouraged and supported to acquire sufficient sterile syringes. NSP policies and protocols should allow people who inject stimulant drugs access to enough injecting equipment for themselves and their peers. One-for-one exchange or other forms of restricted access to needles and syringes are not recommended in any situation and are particularly unhelpful with people who inject stimulant drugs [85][86]. In the party and club scene, injecting stimulant drugs is more likely to take place outside the normal operating hours of HIV harm reduction services. NSPs and other community drug services do not always engage with the party and club scene, compounding the lack of service availability or HIV prevention messaging. This lack of access is particularly problematic for people who inject stimulant drugs, who would benefit from access to an NSP and other services. Creative strategies can be used to make sterile needles and syringes available to people who inject stimulant drugs, particularly outside operating hours, and in the places where stimulant drugs are purchased or used. These may include satellite NSPs in projects or clinics for key populations, needle and syringe dispensing machines, secondary NSP, outreach programmes, safer clubbing initiatives, outreach at sex-on-premises venues (bars, saunas, clubs, etc.), outreach programmes at festivals, and community mobilization initiatives. NSPs designed to address the needs of people who use stimulant drugs, including all key populations, are well positioned to provide an entry point to a coordinated cascade of services, starting with voluntary HTS. They can also offer information on how to reduce risks related to the use of drugs, distribute female and male condoms and lubricant, and provide route transition interventions (see below). Efforts to understand the context of an individual’s drug use, their injecting equipment needs, and their concurrent sexual behaviours will help ensure that appropriate messaging is used. NSPs should also provide education, advice and equipment to support safer injecting practices, including on the importance of hand hygiene, avoiding sharing any paraphernalia (filters, water) associated with injecting, and keeping even the smallest amounts of blood out of the space where drugs are prepared for injection. It is also important to provide syringe disposal bins or plastic bins or containers for the safe disposal of used injecting equipment, which is key to preventing needle-stick injuries and reducing risk or inconvenience to the wider community associated with illicit drug injection. Syringes with colour-coded barrels provide an example of a promising practice that supports people who inject stimulant drugs in group settings. Each participant is assigned a different colour and provided with syringes of that colour which he or she alone is to use. This can help reduce the accidental sharing of injecting equipment, particularly if it is reused. Route transition interventions Route transition interventions support people who use drugs to avoid initiation into injecting, or to encourage people who are injecting to transition to non-injecting routes of administration. Behavioural interventions, peer education interventions and the provision of commodities that support alternatives to injecting, such as pipes, mouthguards and aluminium foil, can be used to engage with people who inject heroin and/or stimulant drugs. Box 3. A harm reduction programme for people who smoke cocaine or methamphetamines in the Pacific North-West United States The People’s Harm Reduction Alliance (PHRA) is a peer-based harm reduction programme for people who use drugs in the Pacific North-West of the United States, established in 2007. In its first year, PHRA provided syringes and sterile injection equipment; however, the need to expand services to include people who smoke drugs became quickly apparent via the peer-based framework and feedback from clients. In 2008, PHRA launched a crack pipe programme to reach a different group of people who use drugs. The programme has become a point of contact for them to access additional services. In 2015, the programme was expanded to include methamphetamine pipes because participants informed PHRA that lack of access to pipes led them to inject more frequently than they would otherwise do. Both pipe programmes have increased the inclusion of people who smoke crack and methamphetamine at PHRA and linked them to other essential health services. In 2016, PHRA expanded services for non-injectors further with a snorting programme. HIV and HCV prevention opportunities for people who smoke stimulant drugs Crack cocaine, cocaine base and methamphetamine can be smoked in a pipe, offering access to the high-dose surging effect. The repeated use of heated crack pipes can cause blisters, cracking and sores on the tongue, lips, face, nostrils and fingers. It has been suggested that this may facilitate HCV transmission via unsterile paraphernalia (although this has not been clearly established). People smoking stimulant drugs in pipes do not require single-use equipment but will benefit from having personal (individual) smoking equipment, and messaging that pipes should not be shared. The same principle applies for straws used to inhale cocaine. The distribution of pipes, mouthguards and other piping paraphernalia provides practical strategies for engaging stimulant drug smokers and reinforces the “Don’t share pipes” message. The principles of distributing paraphernalia and engaging people who smoke stimulant drugs with messages about HIV and hepatitis prevention remain the same. 25 Chapter 2 Core interventions Box 4. Example of content of kits for safer smoking • Pipes • Mouth- or lip guards – a rubber band, rubber tubing, or sometimes specially produced • Stainless steel wool, used as gauze to suspend the crack cocaine inside the pipe • Alcohol wipes to clean the pipe and reduce risks associated with sharing • Lip balm containing vitamin E, to help protect and heal chapped or injured lips • Sterile dressing to cover wounds or burns arising from smoking crack • Sugar-free chewing gum which can help stimulate saliva production to protect teeth and reduce dental damage • Condoms and lubricants to support safer sex practices • Health promotion leaflets Safe tattooing In some population groups who use stimulant drugs, unsafe tattooing is frequent and constitutes a risk for transmission of HCV. This is a particular issue in prisons where tattooing is prohibited and hidden and unhygienic tattooing is common. NSPs and other low-threshold services can offer safe tattooing information, training and safe equipment. 2.3 HIV testing services HIV testing provides an opportunity to deliver HIV prevention messages and to link people to HIVprevention and other relevant health and support services. HIV testing services (HTS) are also the critical entry point to ART (see section 2.4). Given the evidence that individuals who are ARTadherent and have achieved viral suppression do not transmit HIV, HTS is a crucial component of HIV prevention programmes. It is important to increase the opportunities for people who use stimulant drugs to access and use confidential, easy and convenient HIV testing that is linked to the provision of ART for those who test positive. Community-based rapid HIV testing provides an opportunity to deliver results immediately. This can be of particular importance with street- or venue-based people who use stimulant drugs, where the primary source of engagement may be outreach programmes brought to where they are, rather than waiting for them to present at a specific testing location. Other outreach opportunities may also be used to distribute HIV self-test kits. Regardless of the testing modality, it is important to have a protocol to assist people to get a confirmatory test if they test positive, and to access and successfully use HIV care and treatment services if needed, including immediate access to ART, post-exposure prophylaxis (PEP) or PrEP, as appropriate. On-site HIV testing can pose challenges, including the possible lack of confidentiality that comes especially with small, closed communities. Outreach workers and service providers need to ensure that HIV testing is always voluntary and that coercive use of self-test kits by third parties such as law enforcement or employers to test any individual (e.g., sex workers) is unacceptable. 2.4 Antiretroviral therapy Antiretroviral therapy (ART) is the treatment of people living with HIV with medications that suppress the replication of the virus. Currently the standard treatment consists of a combination of antiretroviral drugs (ARVs), and it is indicated for all people living with HIV, irrespective of their CD4 count. ART reduces morbidity and mortality rates among people living with HIV, improves their quality of life and reduces risks of transmission of HIV. ARVs are also administered to some groups of people at risk for HIV acquisition either before exposure (PrEP) or after (PEP). ART is also needed for prevention of mother-to-child transmission of HIV. Cocaine and ATS have been associated with faster disease progression in people living with HIV, due to weakening of the immune system by the drugs. However, if adherence is maintained, the effectiveness of ART is not reduced in people who use stimulant drugs: ART reduces viral load and improves immune function, just as it does for other people living with HIV [77]. Strategies to support adherence to ART, including peer and outreach support, are described in section 3.1. Side-effects of antiretroviral drugs and interactions with stimulant drugs As with many medications, ARVs have been associated with various side-effects, including acute or chronic alterations of the renal function, or hepatic dysfunction. Some medications can cause sideeffects in the central nervous system, such as depression. Liver toxicity is one of the most commonly reported adverse consequences associated with ARVs. This can range from asymptomatic elevation of the liver enzymes to a hepatic failure. Risks for ARVrelated adverse consequences for the liver are higher in cases of cocaine use, excessive alcohol use, coinfection with HBV or HCV, fibrosis of the liver, concomitant treatment for TB and advanced age. Impact of stimulant drugs on antiretroviral drug serum level Cocaine, mephedrone and methamphetamines interact with several ARVs, influencing the serum level of the medications and the risk of side-effects. As scientific knowledge progresses, new ARV regimens may be proposed, with the potential for interactions with the NPS that are frequently appearing on the market. The University of Liverpool provides a regularly updated website on HIV medication interactions, including the interaction of ARVs with stimulant drugs: https://www.hiv-druginteractions.org/treatment_selectors. Impact of antiretroviral drugs on serum level of stimulant drugs Serum levels of methamphetamines may increase up to three times when used by someone who is also taking protease inhibitors, especially ritonavir. Fatal cases attributed to inhibition of the metabolism of MDMA and amphetamines by ritonavir have been reported. Oral pre-exposure prophylaxis Oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral medications to prevent the acquisition of HIV infection by uninfected persons. WHO recommends daily oral PrEP as a prevention choice for people at substantial risk of HIV [91]; it can be stopped during periods of low or no risk. Taken as prescribed, PrEP can reduce the risk of getting HIV from sex with an HIV-positive person by more than 90 per cent [92]. PrEP has been effective in communities where the primary vector for transmission is sexual, such as men who have sex with men, and is therefore appropriate for people who use stimulant drugs. PrEP does not replace HIV prevention interventions, such as comprehensive condom programming for sex workers and men who have sex with men. It does not prevent transmission of hepatitis and other STIs. Services for people who inject stimulant drugs should prioritize evidence-based comprehensive HIV prevention interventions, including NSP, condoms and lubricants. For men who have sex with men who use stimulant drugs and engage in high-risk sex, PrEP should always be proposed, whether or not the individual injects drugs. Adherence to PrEP is essential, and it may be challenging for people using stimulant drugs for several days in a row. People who use stimulant drugs and engage in concurrent sex should be encouraged and supported to plan ahead to use condoms, lubricants and PrEP in combination, to ensure better protection against HIV and to prevent other STIs, including hepatitis C and B. As with other prevention tools, the effectiveness of PrEP is optimized when interventions are implemented by, and in close consultation with, prospective beneficiary communities. Further resources Implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection (WHO, 2017) [93] Post-exposure prophylaxis Post-exposure prophylaxis (PEP) is the administration of ARVs for a short term (one month) to prevent HIV infection after exposure to HIV through unprotected sex or contact with blood. PEP should be offered to all individuals who have potentially been exposed to HIV, whether through unprotected sex (including sexual assault), needle-stick injury or sharing drug injection equipment. It should be initiated as early as possible, ideally within 72 hours. People who use stimulant drugs and engage in sex concurrently are known to often have multiple sexual partners. The chances of unprotected sex or condom failure are increased with stimulant drug use or with the increase in the number of partners. A participative stakeholder process should lead to the development of protocols for community access to PEP, from local to national levels, to ensure that the required medications are promptly accessible and are used by those who need them. People who use stimulant drugs and who access PEP regularly should be assessed as likely candidates for PrEP. Further resources Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach - Second edition (WHO, 2016) [162] 2.5 Evidence-based psychosocial interventions and drug dependence treatments The impact of a drug is determined by the complex interactions between the substance, set (the mindset of the individual) and setting (the context), which mediate the drug’s effect and its associated impact on the individual, including the move towards dependent or high-risk drug use [94]. The great majority of people who use stimulant drugs do so on an occasional basis that may be characterized as “recreational”, and they will not develop dependence. This group has little need for high-intensity interventions. This section provides an overview of possible interventions, mainly psychosocial ones, that show effectiveness specifically for reducing risk behaviours and provide support for people who regularly use stimulant drugs, including people living with HIV. 29 Chapter 2 Core interventions The treatment of cocaine or ATS drug dependence requires time-intensive approaches that are not addressed here. Unlike the treatment of opioid dependence, there are currently no substitution medications available to treat dependence on cocaine or ATS [95][96]. Some emerging practices around dispensing dexamphetamine as a substitute for cocaine or methamphetamine dependence have shown early promise, but further research is needed. Behavioural interventions, self-regulation coaching and psychosocial counselling can support HIV/HCV prevention and treatment objectives for people who use stimulant drugs, while also contributing to longer-term and broader health and wellness goals. There is evidence that brief interventions that concentrate on providing information about safe behaviours and harm mitigation are effective in moderating drug-related harms [97] and maintaining ART adherence for those who are living with HIV [98]. Addressing the potential risks associated with the nexus of drug use and HIV requires individual, structural and combination approaches [99]. Psychosocial services such as motivational interviewing, brief interventions, contingency management and cognitive behavioural therapy are critical to effectively support HIV prevention and treatment among people who use stimulant drugs. Some of these approaches are described below. A 2016 review of psychosocial interventions for stimulant drug-use disorders found that all showed improved retention in ART compared with no intervention, although no single intervention showed a sustained benefit over the others [100]. Psychosocial services should be based on principles of community inclusion and participation, peer support and the needs of the individual. When developing HIV prevention interventions, it is important that sexual partners of people who use stimulant drugs be included in the process, focusing on the HIV risks that are associated with drug use and concurrent sexual behaviours. Motivational interviewing Motivational interviewing is a person-centred, semi-directive approach for exploring motivation and ambivalence in order to facilitate self-motivational statements and behavioural changes. It consists in establishing a partnership between the provider and the individual and enabling the individual to become aware of the discrepancy between their present situation and their own values. The technique relies on four principles: express empathy, develop discrepancy, roll with resistance and support selfefficacy. These can easily be used by trained non-specialist staff, including outreach workers, in formal or informal counselling, IEC and other conversations. Motivational interviewing generally requires just one or two sessions. The success of motivational interviewing has led to its implementation as a “catch-all” approach to eliciting change in areas such as medication compliance, smoking cessation and diet and exercise [101]. A 2012 Cochrane review suggested that motivational interviewing could reduce risky sexual behaviour, and in the short term lead to a reduction of viral load in young people living with HIV [102]. Research has shown that motivational interviewing can reduce the incidence of unprotected anal intercourse among men who have sex with men [103], as well as levels of drug use [104]. Brief interventions Brief interventions are short, often opportunistic interactions in which a health worker provides targeted information and advice to individuals during other activities such as distributing sterile injecting equipment or conducting an HIV test. Brief interventions have been shown to reduce drug use as well as associated risks and sexual risk behaviours. Meta-analyses suggest that there is little difference in the outcomes between longer, more intensive interventions and brief interventions, and the latter are likely to be more practical and cost-effective options, with few barriers to implementation [105]. Motivational interviewing, contingency management and brief interventions for dependence to stimulant drugs can reduce drug-related high-risk sexual behaviours and increase adherence to ART and PrEP. 30 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Contingency management Contingency management is an approach that incentivizes people with rewards such as cash that are contingent on achieving a set of pre-defined outcomes. Contingency management has been shown to have a moderate yet consistent effect on drug use across different classes of drugs [106]. The effectiveness of contingency management supports the idea that small, regular rewards motivate people to modify behaviours that could be considered harmful. Positive regard, and the client’s own expressed belief in their ability to achieve goals, are a critical factor in improving agreed-upon outcomes. Cognitive behavioural therapy Cognitive behavioural therapy (CBT) is a structured approach to counselling that assumes that behaviours are learned and reinforced as a result of cognitive constructs and deficits in coping. The aim of CBT is to “unlearn” behaviours considered unhelpful, such as HIV risk behaviour or certain patterns of drug-taking. While results appear to be sustained over a period, CBT is intensive and time-consuming, and demands specialist practitioners and individual treatment [107]. Mindfulness Mindfulness can be defined as the ability to focus open, non-judgemental attention on the full experience of internal and external phenomena, moment by moment. Positive outcomes – including reducing drug use and risk behaviours, and in relapse prevention – have been documented from mindfulness training as part of approaches to reduce harm, including for people who use stimulant drugs [108][109][110]. Opioid substitution therapy and stimulant drug use People receiving opioid substitution therapy (OST) for heroin or other opioid dependence may use stimulant drugs because of OST-triggered fatigue, inability to experience pleasure, or the desire to remain connected to the community of people who use drugs. OST is not designed to counter stimulant drug use, and the concurrent use of stimulant drugs while on OST should not be viewed as a breach, nor should it lead to the reduction or discontinuation of OST. The benefits of OST are independent of stimulant drug use [111]. Existing OST providers should be sensitized to this and trained to use the opportunities afforded by regular OST and client engagement to support the delivery of interventions included in this guidance. Further resources mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings (WHO, 2010) [112] Therapeutic interventions for users of amphetamine-type stimulants (WHO, 2011) [113] Harm reduction and brief interventions for ATS users (WHO, 2011) [114] Guidelines for the management of methamphetamine use disorders in Myanmar (Ministry of Health and Sports, Myanmar, 2017) [115] Guidance for working with cocaine and crack users in primary care (Royal College of General Practitioners, 2004) [116] Principles of drug dependence treatment (UNODC, WHO, 2008) [117] Drug abuse treatment and rehabilitation: a practical planning and implementation guide (UNODC, 2003) [118] TREATNET quality standards for drug dependence treatment and care services (UNODC, 2012) [111] Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence (WHO, 2009)[163] Treatment of stimulant use disorders: current practices and promising perspectives. Discussion paper (UNODC, 2019)[164] 31 Chapter 2 Core interventions 2.6 Prevention, diagnosis and treatment of sexually transmitted infections, hepatitis and tuberculosis Screening people who use stimulant drugs for infectious diseases, such as sexually transmitted infections (STIs), HBV, HCV and TB, is a crucial part of a comprehensive approach. Along with HIV, these infections are often associated with the use of illicit substances, and they may co-occur with stimulant drug use. Prevention, diagnosis and treatment of sexually transmitted infections Unsafe sex can lead to acute STIs, which can cause infertility and severe illness. Several STIs, particularly those involving genital or perianal ulcers, may facilitate the sexual transmission of HIV infection. Sex workers, transgender people and men who have sex with men are often at increased risk of STIs such as syphilis, gonorrhoea, chlamydia and herpes. It is therefore important to offer information, male and female condoms and lubricant, and screening, diagnosis and treatment of STIs and possibly HPV vaccine to people using stimulant drugs who are vulnerable to STIs and HIV. Further resources Resources on sexually transmitted and reproductive tract infections (WHO webpage providing clinical, policy and programmatic, monitoring and evaluation and advocacy guides) [119] Prevention, vaccination, diagnosis and treatment of hepatitis B and C People who inject stimulant drugs are at heightened risk of acquiring HBV and HCV because of frequent injecting and sharing of injection equipment. The risk of sharing equipment is higher when injecting happens in communal settings. HCV is much more virulent than HIV and can survive outside the body at room temperature, on environmental surfaces, for up to three weeks [120], making it more easily transmitted through the sharing of syringes and other injecting paraphernalia. Key populations who use stimulant drugs should be offered hepatitis B or hepatitis A-B vaccination, access to prevention commodities, and voluntary screening and treatment of HBV and HCV. Prevention NSPs and community mobilization initiatives should distribute relevant equipment, including low dead-space syringes, for injecting, smoking and snorting (see section 2.2). Male and female condom programming is also part of hepatitis B and C prevention interventions as well as sexual and reproductive health services. Education should include messages on the risks of serosorting, and of intense sexual practices involving potential trauma of the mucosa for HCV acquisition and transmission among people living with HIV [50]. Hepatitis A and B vaccination Key populations should be offered the series of HBV immunizations. WHO recommends: • Offering people the rapid hepatitis B vaccination regimen (days 0, 7 and 21-30). • Providing people who inject drugs with incentives in order to increase hepatitis B vaccination adherence, at least for the second dose. Even partial immunization confers some immunoprotection. [87] Hepatitis A (HAV) immunization or combined HAV-HBV immunization should be offered to men who have sex with men and people using stimulant drugs [121]. 32 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Immunization should be easily accessible and offered at locations and venues frequented by people who use stimulant drugs, such as drop-in centres, NSPs and other community service outlets. Screening for HBV and HCV Voluntary screening for HBV and/or HCV should be offered to people who use stimulant drugs at risk of these infections. Testing and diagnosis of HBV and HCV infection is an entry point for accessing both prevention and treatment services. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay the progression of liver disease. Rapid tests for hepatitis C allow for better access to diagnosis, including communitybased testing. Treatment of chronic hepatitis C or B All people with chronic hepatitis C should receive treatment. With an 8- to 12-week course, directacting antivirals (DAAs) cure more than 95 per cent of persons with HCV infection, reducing the risk of death from liver cancer and cirrhosis. For chronic hepatitis B, antiviral treatment can slow down the progression of cirrhosis and reduces the risk of liver cancer [162]. People who are actively injecting drugs have been shown to adhere to HCV treatment regimens as well as any other population, particularly when social, emotional and practical support are provided [122]. All people who use stimulant drugs living with HCV should therefore be offered access to direct-acting antivirals without discrimination. Further resources Guidance on prevention of viral hepatitis B and C among people who inject drugs (WHO, 2012) [87] Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection (WHO, 2016) [123] Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach - Second edition (WHO, 2016) [162] Prevention, diagnosis and treatment of tuberculosis In 2016, 10.4 million people fell ill with TB. It is a leading killer of people living with HIV: in 2016, 40 per cent of HIV deaths were due to TB [124]. Transmission of TB is easily facilitated through airborne particulates, such as by kissing, coughing, sneezing or shouting. TB is easily spread in prisons and other closed settings, and in crowded and poorly ventilated spaces, such as are often found in poor communities or among homeless people. People who inject drugs are at increased risk of TB, irrespective of their HIV status, and TB is a leading cause of mortality among people who inject drugs who also have HIV infection [125]. People who use drugs who do not inject have also been found to have increased rates of TB. Certain subgroups of stimulant drug users, such as those who use stimulant drugs regularly for days at a time, may be immuno-deficient from lack of sleep and food, facilitating TB transmission. It is therefore important to include TB prevention, screening and treatment in communities and services. Further resources Integrating collaborative TB and HIV services within a comprehensive package of care for people who inject drugs: consolidated guidelines (WHO, 2016) [125] 33 Chapter 2 Core interventions 2.7 Targeted information, education and communication To reduce the risk of acquiring STIs or HIV, people who use stimulant drugs need knowledge and support. Information, education and communication (IEC) provides information, motivation, education and skills-building to help individuals adopt behaviours that will protect their health. Effective communication for health targeting people who use stimulant drugs requires addressing two challenges: • Crafting messages that can overcome long-standing distrust and fear. • Finding effective means of reaching people who use stimulant drugs with life-saving messages and materials. Key to meeting these challenges is meaningful engagement with the target audience of people who use stimulant drugs. Communities should be represented at every stage of IEC development, including the overall strategy and concept, and the development, testing, dissemination and evaluation of messages. Working with the community will help ensure that tools and materials are accurate and will be trusted and used. Recipients of IEC who have invested their own ideas and time in it will be more likely to stand behind the results and be active participants, not only in their own health but in health promotion in their community. Materials must be easily understandable and to the point. Interactive materials on a digital platform can tailor messaging to the specific situation of the service user and are often helpful in maintaining attention. On the other hand, traditional printed materials have the advantage of not requiring computer, phone or Internet access. They also provide an opportunity for outreach workers or other programme staff distributing the materials to interact with the service users, and a means for service users to easily share information with others. Using information technology to support behavioural interventions Online and social media can be a cost-effective manner of reaching targeted audiences. A local assessment can show where using these technologies will be advantageous and appropriate. Free WiFi at drop-in centres and other community points of congregation provides opportunities for access and use. Where people who use stimulant drugs have smartphones, websites and apps can be deployed just as they have been to reach other key populations. The use of technology has shown promising results in promoting sexual health or adherence to ART in different settings, including resource-limited settings [126][127]. Web-based applications provide an opportunity to reach a large audience at any time and provide information on health and available services. They also allow for online outreach and interactions with people who wish to discuss problems or have questions. However, when the information relates to drug use, or other criminalized behaviours, the use of some digital media raises concerns about the anonymity of the contacts, and possible risks related to law enforcement must be addressed. Working with communities and low-threshold service providers will help inform the local potential for digital materials and campaigns and help ensure the security of people accessing information. Given the variety that exists among people who use stimulant drugs, messaging should take into account the sex, gender, sexual orientation, age and setting of recipients of IEC. Literacy levels, social and community inclusion or exclusion, and other cultural and societal variables must also be considered. 34 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Further resources The European Centre for Disease Prevention and Control (ECDC) has developed guidance documents for the effective use of social media. While the tools were developed for Europe, and specifically for reaching men who have sex with men, they provide guidance on the relative advantages of different media, such as Facebook, online outreach, Google Ads, SMS and YouTube, that may be useful in other contexts. Effective use of digital platforms for HIV prevention among men who have sex with men in the European Union/European Economic Area: an introduction to the ECDC guides (ECDC, 2017) [128] 2.8 Overdose and acute intoxication prevention and management Very high doses of stimulant drugs consumed in a short amount of time can trigger acute respiratory distress, chest pain, palpitations or myocardial infarctions [112]. In extreme cases this can result in cardiac arrest. The first signs of stimulant drugs intoxication are hyperactivity, rapid speech and dilated pupils. In the case of polydrug use, overdose can be the result of the combination of stimulants with other drugs including opioid or sedative drugs. The treatment of stimulant drugs intoxication is symptomatic and requires regular monitoring of blood pressure, pulse rate, respiratory rate and temperature (figure I.). Serotonergic syndrome is caused by an excess of serotonin in the central nervous system associated with the use of ATS. It can result in uncontrollable muscle spasms, tremor, seizures, psychosis, high blood pressure, high body temperature >400 C (hyperthermia) and release of myoglobin from muscles and blood clotting in vessels (disseminated intravascular coagulation), which may lead to severe diseases and potentially death. People who use stimulant drugs need to be informed on how to reduce the risks of acute intoxications (see the Information checklist for self-care and stimulant drugs in the annex). For people on PrEP, ART or hepatitis treatment, information should be provided on the interactions and possible risks of cocaine and ATS use to serum levels (see section 2.4). People who use stimulant drugs should be trained to recognize overdoses, provide first aid, including cardiopulmonary resuscitation (CPR) and call immediately for emergency professional assistance if they witness an overdose. ","Purpose of this guide The purpose of this publication is to provide guidance on implementing HIV, hepatitis C (HCV) and hepatitis B (HBV) programmes for people who use stimulant drugs and who are at risk of contracting these viruses. It aims to: • Increase awareness of the needs and issues faced by the affected groups, including the intersectionality among different key populations • Provide implementation guidance to help establish and expand access to core HIV and hepatitis prevention, treatment, care and support services It is a global document that should be adapted according to the specific context, including the type of stimulant drug used (cocaine, ATS or NPS) and the key populations involved, which vary considerably according to regions. The present guide proposes a package of core interventions adapted from existing international guidance: • WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users[7] • WHO Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations – 2016 update [8] • Implementing comprehensive HIV and HCV programmes with people who inject drugs: practical guidance for collaborative interventions (the “IDUIT”) [9] It also incorporates guidance from the implementation tools for other key populations: • Implementing comprehensive HIV/STI programmes with sex workers: practical approaches from collaborative interventions (the “SWIT”) [10] • Implementing comprehensive HIV and STI programmes with men who have sex with men: practical guidance for collaborative interventions (the “MSMIT”) [11] • Implementing comprehensive HIV and STI programmes with transgender people: practical guidance for collaborative interventions (the “TRANSIT”) [12] However, none of these guidance documents and tools addresses the specific needs of people who use stimulant drugs and are at risk for HIV and hepatitis B and C – hence the need for this publication. Audience The guide is intended for use by policymakers, programme managers and service providers, including community-based organizations, at the national, regional or local levels, who undertake to address HIV prevention, treatment and care. It also provides useful information for development and funding agencies and for academia. Structure The guide is divided into five chapters. • Chapter 1 explains the nature and effects of stimulant drugs, the associated risks of HIV and hepatitis transmission, and the issues surrounding stimulant drug use and HIV and hepatitis risk in specific key populations and other vulnerable groups. 10 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS • Chapter 2 presents the package of core HIV interventions for key populations who use stimulant drugs. • Chapter 3 describes approaches to care and support for people who use stimulant drugs, particularly in the context of HIV and hepatitis. • Chapter 4 describes six critical enablers – activities and strategies that are needed to ensure access to the interventions in the core package. • Chapter 5 outlines further considerations for implementing programmes. Within each chapter, further resources are listed. Case studies are provided throughout the guide to illustrate specific aspects of programmes that have been implemented in different countries. There is also an annex presenting a series of checklists and other practical tools for policymakers and implementers. Principles Two important overarching principles are stressed throughout this publication. The first is better integration of HIV, hepatitis B and C and sexually transmitted infection (STI) services for people who use stimulant drugs within existing HIV harm reduction services2 and drug treatment services for people who inject drugs, and within sexual and reproductive health and other HIV services for key populations. The second is the meaningful involvement of people who use stimulant drugs, people living with HIV and other key populations in planning, implementing, monitoring and evaluating interventions. This is key to their success and sustainability. Finally, the implementation of HIV-related services for people who use stimulant drugs should adhere to human-rights principles as described in the implementation tools mentioned above – the SWIT, MSMIT, TRANSIT and IDUIT. Methodology In its June 2009 session, the UNAIDS Programme Coordinating Board (PCB) called upon “Member States, civil society organizations and UNAIDS to increase attention on certain groups of non-injecting drug users, especially those who use crack cocaine and ATS, who have been found to have increased risk of contracting HIV through high-risk sexual practices”. UNODC therefore commissioned a review and organized a Global Expert Group Technical Meeting on Stimulant Drugs and HIV, held in Brazil in 2010. A discussion paper on HIV prevention, treatment and care among people who use (noninjecting) crack and cocaine or other stimulant drugs, particularly ATS, was developed in 2012. In 2013 the UNODC HIV Civil Society Organization (CSO) group established a Stimulant Drugs and HIV working group, with representatives from civil society and experts on HIV and stimulant drugs. The group organized consultations with representatives of the community and CSOs, including on the margins of the International Harm Reduction Conference in Kuala Lumpur in 2015. 2 For the purposes of this guide, harm reduction is defined by the nine interventions of the “comprehensive package” of services detailed in the WHO, UNODC, UNAIDS Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users (see citation 7). These are: 1. Needle and syringe programmes; 2. Opioid substitution therapy and other drug dependence treatment; 3. HIV testing and counselling; 4. Antiretroviral therapy; 5. Prevention and treatment of sexually transmitted infections; 6. Condom programmes for people who inject drugs and their sexual partners; 7. Targeted information, education and communication; 8. Prevention, vaccination, diagnosis and treatment for viral hepatitis; 9. Prevention, diagnosis and treatment of tuberculosis. 11 In December 2014, the Strategic Advisory Group to the United Nations on HIV and injecting drug use, consisting of representatives of networks and organizations of people who use drugs, academics, donors, implementers and United Nations organizations, recommended conducting a new literature review on stimulant drugs and HIV and hepatitis C. In 2015 UNODC, together with WHO and UNAIDS, defined the scope of this new literature review, and accordingly UNODC commissioned it to cover the extent, patterns and geographic distribution of injecting and non-injecting stimulant drug use (particularly crack, cocaine, ATS and stimulant NPS) in men who have sex with men, sex workers and other groups of stimulant drug users, and their possible link to HIV and hepatitis B and C vulnerability and transmission; and effective interventions for prevention, treatment and care of HIV and hepatitis B and C among people who use such stimulant drugs. The results of the literature review were published by UNODC in 2016 in five papers covering the following topics: • Methodology and summary [3] • ATS [13] • Cocaine and crack cocaine [14] • NPS [15] • Treatment and prevention of HIV, HCV & HBV among stimulant drug users[16]. Subsequently, in the framework of preparations for the United Nations General Assembly Special Session on the World Drug Problem (UNGASS 2016) and the HLM 2016, UNODC organized a scientific consultation on HIV and drug use, including stimulant drugs. The papers relating to stimulant drugs presented at the Commission on Narcotic Drugs in March 2016 covered: cocaine and crack cocaine use and HIV in the United States; ATS and men who have sex with men in Asia; and antiretroviral therapy (ART) and stimulant drug use. The recommendations of the contributing scientists were summarized as part of a scientific statement presented in New York on the margins of the UNGASS 2016 and the HLM 2016 [17]. The statement stressed the need to address HIV among people who use stimulant drugs, including the structural, social and personal mediating factors for HIV transmission, such as polydrug use, STIs, mental health, homophobia, discrimination and punitive laws. The scientists recommended the provision of ART to all people using stimulant drugs living with HIV, and the implementation of new prevention tools such as pre-exposure prophylaxis (PrEP) and the use of social media for communication. The statement also emphasizes that with proper support for adherence, ART is effective among people living with HIV who use stimulant drugs. In 2017, UNODC commissioned the development of the present publication, HIV prevention, treatment, care and support for people who use stimulant drugs: an implementation guide. Based on the results of the scientific reviews and of the expert group meetings, and on international guidance and country practices that have been identified as effective in meeting the needs of people who use stimulant drugs, a first draft of the document was developed under the guidance of the UNODC CSO Stimulant Drugs and HIV working group. The draft guide was reviewed by external peer reviewers, United Nations agency reviewers and community representatives through an electronic consultation and three face-to-face consultations held in Viet Nam (2017), Brazil (2017) and Ukraine (2018). Chapter 1 Stimulant drugs, HIV and hepatitis, and key populations The World Drug Report 2019 estimates that about 29 million people used ATS in 2017, and 18 million used cocaine [18]. There is no estimate of the total number of people using NPS. The great majority of people who use stimulant drugs do so on an occasional basis which may be characterized as “recreational”, and they will not develop dependence or any other health problem. There is evidence that the prevalence of ATS use, particularly methamphetamines, is increasing in some regions, including North America, Oceania and most parts of Asia. In addition, between 2009 and 2016, there were reports of 739 NPS, of which 36 per cent were classified as stimulant drugs [19]. Only a small proportion of people who use stimulant drugs inject them; most smoke, snort or use them orally or anally. However, the World Drug Report 2017 states that 30 per cent of people who inject drugs inject stimulant drugs, either as their drug of first choice or in addition to opiates. Despite evidence showing that certain subgroups of people who use stimulant drugs are at greater risk of HIV, prevention, testing and treatment programmes for these population groups remain very limited in scope and scale across the globe, and their specific needs are often overlooked. 1.1 Stimulant drugs Stimulant drugs are chemically diverse substances that are similar in their capacity to activate, increase or enhance the neural activity of the central nervous system, resulting in a common set of effects in most people who use them, including increased alertness, energy and/or euphoria.3 This publication considers three types of stimulant drugs for which data have shown a link with increased HIV risk among some key populations: • Cocaine: Found in various forms, e.g. smokable cocaine, crack cocaine, freebase, paste or pasta base, paco, basuco. Depending on the form, it may be sniffed or snorted, injected, ingested or inserted anally. 3 For more detailed information on different stimulant drugs and their effects, see: Terminology and information on drugs. Third edition. New York (NY), United Nations, 2016 (https://www.unodc.org/documents/scientific/Terminology_and_ Information_on_Drugs-3rd_edition.pdf, accessed 15 January 2019). 14 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS • Amphetamine-type stimulants: Amphetamines and methamphetamines (excluding MDMA) are found in different forms, e.g. crystals (methamphetamines), powder or formulated tablets [20]. They are taken orally, smoked from a pipe, sniffed or snorted, inserted anally or injected in a solution. • Stimulant new psychoactive substances: Found in various forms, e.g.synthetic cathinone, phenethylamines, aminoindanes and piperazines. They are sometimes referred to as “bath salts” [21][22]. Depending on the form, NPS are taken orally, smoked, inserted anally or injected. All types of stimulant drugs have common effects: • Mental: Euphoria, raised libido, reduced appetite and sleep drives, enhanced perception, increased alertness, cognitive improvements and deficits (attention, working memory, long-term memory), emotional intensity and excitability, and increased confidence. • Behavioural: Talkativeness, hypervigilance, hyperactivity, increased sociability, disinhibition, changes in sexual behaviour (including sexual sessions of longer than usual duration), faster reaction, and repetitive activity (“tweaking”); hyper-excitability, insomnia, restlessness, panic, erratic behaviour, and sometimes aggressive or violent behaviour[23]. • Physical: Increased heart rate (including palpitations), raised temperature (hyperthermia), circulatory changes (higher blood pressure, vasoconstriction), increased breathing rate, dry mouth, teeth-grinding, jaw-clenching/gurning, faster eye-movements, and dilated pupils. The onset and duration of these effects vary according to the drug, its form, dosage, route of administration, the characteristics of the individual using it, and the context of use. Chronic use of stimulant drugs can lead to psychological dependence; development of tolerance; destruction of tissues in the nose if snorted or sniffed; chronic bronchitis, which can lead to chronic obstructive pulmonary disease; malnutrition and weight loss; disorientation, apathy, confusion, exhaustion due to lack of sleep, and paranoid psychosis. During withdrawal there may be a long period of sleep and depression. Cocaine Cocaine is generally encountered in two forms which differ in their route of administration: cocaine hydrochloride (HCL), a powder, which is snorted, injected or taken anally, and cocaine base (crack, freebase, or crystal) which is smokable and usually taken in a pipe. A third form, coca paste (pasta base, paco, coca pasta, etc.), is an intermediate product of the process of extraction of HCL from the coca leaves. Available mainly in Latin America, it is usually smoked in a cigarette. Cocaine is a powerful stimulant whose effects diminish quickly, prompting the user to repeatedly administer additional doses. When snorted, cocaine produces a slow wave of euphoria, followed by a plateau and then a “come down” period. In its smokable form, cocaine has a more intense and immediate effect. Severe anticipatory anxiety about the impending low may result in repeat dosing. This cycle may take around 5 to 10 minutes. The use of cocaine is more prevalent in North and South America than in the rest of the world. Amphetamine-type stimulants (ATS) Amphetamine and methamphetamine are synthetic drugs whose effects include euphoria, arousal and psychomotor activation. ATS can be taken orally, intranasally, smoked as a vapour (pipe), inserted anally or injected. Immediately after smoking or injecting, people experience a pleasurable “rush”. Intranasal and oral ingestion produce a gradual euphoria or “come up”. Depending on the level of tolerance, the effects of methamphetamine may last four hours, or as long as 24 hours for someone new to the drug [24]. Some people who use methamphetamine may experience a feeling of invincibility, with an accompanying propensity to engage in high-risk behaviours, creating vulnerabilities to acquiring HIV [25]. The direct health impacts of ATS include insomnia and cardiovascular stress. Long-term negative effects may include dopamine physical dependence, psychological dependence, psychosis and paranoia, and depression. Amphetamine and methamphetamine use is reported in all parts of the world. Stimulant new psychoactive substances There are a various types of new psychoactive substances (NPS), with different molecular structures, but the majority of stimulant NPS are synthetic cathinones, which have a similar molecular structure to cathinone found in the khat plant. Common synthetic cathinones include mephedrone, pentedrone, methylone or methcathinone. They fall into two main families: euphoriants and entactogens.NPS are taken orally, can also be snorted or inserted anally, and less frequently are injected. Stimulant NPS produce similar mental, physical and behavioural effects to traditional stimulant drugs such as cocaine, amphetamines and methamphetamines. Synthetic cathinones and other stimulant NPS are also used to improve sexual experience [26]. The use of synthetic cathinone such as mephedrone (sometimes called “bath salts”) has recently emerged [18]. Studies from Hungary [27][28][29], Ireland [30][31], Israel [32], Romania [33] and the United Kingdom [34] suggest that due to a shortage in heroin supply and easy access to synthetic cathinone, a significant proportion of people who inject drugs have switched to injecting synthetic cathinone in recent years. 1.2 Stimulant drug use and risks of HIV/HBV/HCV transmission The HIV/HBV/HCV risk associated with stimulant drug use is linked to a higher prevalence of unprotected anal and vaginal sex, and of sharing pipes, straws and injection equipment, in some groups of men who have sex with men, sex workers, people who inject drugs and people in prisons. Transmission risks through concurrent stimulant drug use and unprotected sex Inconsistent condom use by people who use stimulant drugs has been identified as a prime means of contracting STIs, including HIV, particularly as a result of the concurrent use of stimulant drugs with frequent sexual activity of long duration with multiple partners or in groups. Stimulant drug use may also facilitate longer penetration (which can lead to condom breakages), and more intense acts such as fisting that increase the opportunity of anal and vaginal tears or bleeding. Transmission risks through sharing injection equipment Injecting methamphetamine, cocaine or NPS entails a similar risk to injecting other drugs when needles and injecting equipment are shared. Given that many stimulant drugs have a shorter duration of action compared with opioids, people who inject stimulant drugs report a higher frequency of injecting, with compulsive re-injecting and a greater likelihood of sharing and reusing needles and syringes that may be contaminated [22][34]. HIV and HCV risk is also increased when cocaine or crack is coadministered with heroin, including injection of heroin and cocaine (“speedballing”) [35]. Coexisting injecting drug use and unprotected sex further increases the likelihood of HIV and hepatitis transmission, especially in high-incidence communities. This pattern has been seen, for example, with the use of home-made ATS, such as boltushka in Ukraine. People who inject boltushka engage in high levels of injecting risk behaviours and in sexual risk behaviour post use. They are young and poor, and the great majority are already living with HIV [36]. Hepatitis C transmission through straws or pipes HCV is transmitted through blood or, less commonly, through sexual contact. HCV can be transmitted from a person living with hepatitis who has oral or nasal sores or lacerations through sharing of straws or pipes [37][38][39][40]. Compared with the general population, higher HCV prevalence rates, ranging from 2.3 to 17 per cent, have been observed among people who smoke or sniff stimulant drugs [41]. However, it is difficult to determine whether HCV transmission in these cases occurred through blood exposure, sexual activity, or both. 1.3 Stimulant drug use and HIV/HBV/HCV transmission risks among key populations Men who have sex with men There seems to be a clear association between ATS use among men who have sex with men and risk of HIV infection. Methamphetamine use has been associated with increased frequency of unprotected sex among some men who have sex with men, thereby increasing vulnerability to STIs, HBV and HIV [42][43][44][45]. Studies have indicated HIV prevalence rates among men who have sex with men who use methamphetamine ranging between 17 and 61 per cent, and HIV incidence ranging from 2.71 per 100 person-years [46] to 5 per 100 person-years [47]. The use of stimulant drugs by some men who have sex with men to facilitate sex (referred to as ChemSex)4 has been linked to decreased condom use, sex with multiple partners and other high-risk sexual behaviours that increase likelihood of HIV and HCV transmission [48][49]. Increased sexual risk behaviours, including unprotected sex, coupled with potential anal or rectal trauma resulting from longer, more frequent and intense sexual encounters under the influence of drugs, could facilitate STI transmission among men who have sex with men, including HCV among men who have sex with men living with HIV. Risk-reduction strategies for HIV prevention such as serosorting5 and strategic positioning6 are inefficient for the prevention of other STIs, HBV or HCV. The association between ChemSex, drug use and sexually transmitted acute HCV infection among men living with HIV who have sex with men has been documented in several countries and regions [50]. ChemSex is mostly associated with non-injecting drug use, although some may also inject synthetic cathinones, amphetamines and methamphetamines (referred to as “slamming” or “blasting” within the context of ChemSex) [51], with a high level of sharing of injection equipment and consequently higher risks of HIV and HCV transmission [52][53][54]. Mephedrone use seems to have risen among men who have sex with men in the context of ChemSex [52]. The use of erectile dysfunction medications such as sildenafil is often reported among men who have sex with men who also consume methamphetamines and has been identified as increasing rates of unprotected sex and HBV, syphilis and HIV risks [46][48][55]. People who inject drugs Injecting stimulant drugs carries the greatest risk of acquiring HCV or HIV, due primarily to the sharing of contaminated needles and syringes. People who inject cocaine, ATS or heroin have a risk of acquiring HIV that is respectively 3.6, 3.0, and 2.8 times greater than people using stimulant drugs without injecting [56]. Outbreaks of HIV or hepatitis C among people who inject drugs, partly due to the increased use of synthetic cathinone as a replacement for heroin, have been reported in Greece [57], Hungary [29] and Romania [33][58]. People who inject stimulant drugs such as ATS show higher prevalence of sexual risk behaviours compared with people who inject opiates, and similar to non-injecting ATS users [59][60][61][62]. Sex workers Exchanging sex for crack cocaine or money has been associated with several HIV risk behaviours, such as having a greater number of clients per week [63], high levels of unprotected sex [64], sharing crack cocaine with clients [65] and heavier crack use, as well as structural vulnerabilities like homelessness and unemployment [66]. One study reported a higher HIV prevalence among those who exchange sex for drugs or money than among those who did not [67]. Individuals with drug dependencies who exchange sex for drugs may have reduced power and control over sexual interactions [68]. The use of methamphetamines by female sex workers has been associated with engaging in unsafe sex [69]. Female sex workers who use smokable cocaine are often homeless or poorly housed in economically depressed neighbourhoods, and have poor access to health services, including HIV services, as well as to prenatal and reproductive care and to social support. Sex workers, whether male, female or transgender, may be coerced into consuming drugs with their clients, increasing the risk of unprotected sex and violence. Male, female and transgender sex workers face barriers to accessing and using services due to the multiple stigma surrounding drug use, sex work and sexual orientation, which are criminalized to varying degrees in many jurisdictions around the world. Transgender people The use of methamphetamines, smokable cocaine or cocaine among transgender women has been associated with higher risks of HIV transmission, mainly through sex [70][71]. For example, a survey conducted among transgender women in high-risk venues and on the streets of Los Angeles, United States, indicated that recent methamphetamine and/or smokable cocaine use was associated with a more than twofold higher risk of reported HIV-positive status [72]. People living in prisons and other closed settings People who use stimulant drugs, such as methamphetamine, in prisons are more likely to engage in a number of sexual risk behaviours, including use of methamphetamines in the context of sex and inconsistent use of condoms [73][74]. 18 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Women who use drugs Women who use drugs face stigma and other barriers to accessing essential health and HIV services, including gender-based violence, fear of forced or coerced sterilization or abortion, or loss of child custody. Cross-cultural stigma associated with women vacating gender roles, such as caring for their family, being pregnant and being mothers of infants and children, is a major challenge [75]. Many women who use drugs face unequal power dynamics in relationships, and higher rates of poverty; these factors interfere with their ability to access reproductive health supplies, including condoms and other contraceptives [76]. People living with HIV Although cocaine or methamphetamine use has a negative impact on the immune system, particularly among people living with HIV, the immunodepressive effect disappears when people living with HIV who use stimulant drugs adhere to antiretroviral therapy [77]. People living with HIV using stimulant drugs experience the worst HIV outcomes when they do not know they are living with HIV, or cannot access ART. A review of the literature reports findings that psychological, behavioural and social factors all play a role, separately and in combination, in determining HIV outcomes in patients, their access to health services, and adherence to ART: • In people living with HIV, regular methamphetamine use has measurable negative effects upon neuropsychological functioning (e.g. deficits in episodic memory, executive functions and information-processing speed) [78] over and above the negative neurocognitive effects caused by HIV and HCV [79]. This may impact their health-protective behaviour, health-services-seeking, access to HIV clinics and adherence to ART. In addition, HIV-specific traumatic stress and related negative affect are independently associated with greater stimulant-drug risk behaviours and reduced ART adherence [80]. • Cocaine and ATS have a negative impact on the immune system, increasing vulnerability to opportunistic diseases and accelerating the evolution of HIV among people who do not adhere to ART [77][81]. (See section 2.4 for more information on the interactions between ART and stimulant drugs). • Some communities of people who use stimulant drugs are very marginalized, extremely poor and have few resources, including access to adequate nutrition, and this also impacts their access to services and consequently the evolution of HIV infection. To reach people who frequently use stimulant drugs and retain them in effective HIV treatment regimes, access and adherence barriers related to HIV treatment must be accurately identified and addressed. When assessing why a patient who uses stimulant drugs is lost to follow-up, important factors that should be considered include stigma, discrimination, mental health, employment status, poverty, homelessness, migration, exposure to violence, incarceration, fear of criminalization, and family responsibilities. See chapter 4 for more information. 1.4 The impact of criminal sanctions on HIV transmission among key populations Stigma, discrimination and criminal sanctions against people who use drugs, men who have sex with men, transgender people, sex workers and people living with HIV have a direct impact on their ability and willingness to access and use HIV and other health services. These also impede the ability of people from key populations to access the commodities or services needed to practise protective behaviours, including condom use, and to access sterile injecting equipment, HIV testing and HIV treatment. A systematic review of 106 peer-reviewed studies published between 2006 and 2014 examined the association between criminal sanctions for drug use and HIV prevention and treatment-related outcomes among people who inject drugs [82]. While the studies were mainly conducted in North America and Asia, the findings highlighted that criminal sanctions were responsible for substantial barriers to HIV treatment and prevention interventions for people who inject drugs. 21 Chapter 2 Core interventions Following an extensive literature review and technical consultations at country and global levels, expert participants in a number of consultations agreed on a package of eight core interventions for HIV prevention, treatment, care and support among people who use stimulant drugs and are at risk of HIV. These interventions have been adapted from the WHO/UNODC/UNAIDS Comprehensive Package for HIV and people who inject drugs, and from the WHO Consolidated Package for HIV and key populations [7][8]. 1 Condoms, lubricants and safer sex programmes 2 Needle and syringe programmes (NSP) and other commodities 3 HIV testing services (HTS) 4 Antiretroviral therapy (ART) 5 Evidence-based psychosocial interventions and drug dependence treatments 6 Prevention, diagnosis and treatment of STIs, hepatitis and tuberculosis (TB) 7 Targeted information, education and communication (IEC) for people who use stimulant drugs and their sexual partners 8 Prevention and management of overdose and acute intoxication The core interventions should be adapted to the specific needs of different key populations. An assessment of the population to be served will assist in providing the evidence needed to design a clientcentred package of services that responds to specific needs. 2.1 Condoms, lubricants and safer sex programmes People who have sex while under the influence of stimulant drugs are more likely to engage in sexual risk behaviours, especially unprotected sex [83]. They may have reduced sexual inhibitions and a feeling of invincibility, which makes choosing or remembering to use a condom more challenging. Other factors that can contribute to inconsistent condom use include lack of access to condoms and lubricants when needed, poor safe-sex negotiations skills, being on PrEP [84] and engaging in risk-reduction strategies such as serosorting or strategic positioning. These strategies have their limits in terms of risk for HIV transmission, particularly if people are under the influence of stimulant drugs, and they do not prevent transmission of other STIs including HBV and HCV. Promoting the use of male and female condoms and appropriate lubricants remains a core HIV prevention strategy for people who use stimulant drugs and their sexual partners. Condoms offer protection against HIV, other STIs such as syphilis and gonorrhoea, and possible sexual transmission of HBV or HCV. Condoms can also prevent unintended pregnancy. Condoms and lubricants should be available widely, and without charge. Targeted distribution of free condoms helps overcome the barriers associated with their cost and can help reinforce the social acceptability of condom use. Distribution of condoms and sex-education information by peers and outreach workers plays an important role, including in the street or party setting. It is important to consider the variety of condoms available to meet key population preferences, and their distribution, to ensure wide availability of condoms and lubricant and access to them in places where people engage in stimulant drug use and sex concurrently. For example, in the case of sex-onpremises venues or nightclubs, simply making condoms available in the usual places, such as toilets or at the bar, is often not sufficient to ensure that people have them to hand when they need them. Consultation with the beneficiaries is critical to ensure easy access. Similarly, to ensure access to condoms in prisons, strategies must be tailored to each prison, based on its architecture, regime and the movements of prisoners within the prison. Safer-sex education for people who use stimulant drugs should cover: • Promotion of condoms and lubricant use • Information on sexual transmission of HIV, hepatitis and STIs • Safe-sex negotiation strategies • Information on strategies to reduce risks of HIV transmission (sero-sorting and strategic positioning), including their limitations • Information on pre-exposure prophylaxis of HIV (PrEP) Further resources The four key population implementation guides (the IDUIT, MSMIT, SWIT and TRANSIT) provide useful general information on condoms, lubricants and safer sex programming for people who inject drugs, men who have sex with men, sex workers and transgender people. 23 Chapter 2 Core interventions 2.2 Needle and syringe programmes and other commodities Due to the short duration of their effects, injection of stimulant drugs is frequently associated with rapidly repeated injecting, with some individuals reporting more than 20 injections a day. Injecting may take place in groups, and people may use several different stimulant drugs and other types of drug in the same session. These patterns of use increase the likelihood that non-sterile equipment will be used or shared, elevating the risk of HIV and hepatitis transmission. The accessibility and design of needle and syringe programmes (NSPs) must take into account the nature of stimulant drugs and patterns of their use. People who inject stimulant drugs should be educated, encouraged and supported to acquire sufficient sterile syringes. NSP policies and protocols should allow people who inject stimulant drugs access to enough injecting equipment for themselves and their peers. One-for-one exchange or other forms of restricted access to needles and syringes are not recommended in any situation and are particularly unhelpful with people who inject stimulant drugs [85][86]. In the party and club scene, injecting stimulant drugs is more likely to take place outside the normal operating hours of HIV harm reduction services. NSPs and other community drug services do not always engage with the party and club scene, compounding the lack of service availability or HIV prevention messaging. This lack of access is particularly problematic for people who inject stimulant drugs, who would benefit from access to an NSP and other services. Creative strategies can be used to make sterile needles and syringes available to people who inject stimulant drugs, particularly outside operating hours, and in the places where stimulant drugs are purchased or used. These may include satellite NSPs in projects or clinics for key populations, needle and syringe dispensing machines, secondary NSP, outreach programmes, safer clubbing initiatives, outreach at sex-on-premises venues (bars, saunas, clubs, etc.), outreach programmes at festivals, and community mobilization initiatives. NSPs designed to address the needs of people who use stimulant drugs, including all key populations, are well positioned to provide an entry point to a coordinated cascade of services, starting with voluntary HTS. They can also offer information on how to reduce risks related to the use of drugs, distribute female and male condoms and lubricant, and provide route transition interventions (see below). Efforts to understand the context of an individual’s drug use, their injecting equipment needs, and their concurrent sexual behaviours will help ensure that appropriate messaging is used. NSPs should also provide education, advice and equipment to support safer injecting practices, including on the importance of hand hygiene, avoiding sharing any paraphernalia (filters, water) associated with injecting, and keeping even the smallest amounts of blood out of the space where drugs are prepared for injection. It is also important to provide syringe disposal bins or plastic bins or containers for the safe disposal of used injecting equipment, which is key to preventing needle-stick injuries and reducing risk or inconvenience to the wider community associated with illicit drug injection. Syringes with colour-coded barrels provide an example of a promising practice that supports people who inject stimulant drugs in group settings. Each participant is assigned a different colour and provided with syringes of that colour which he or she alone is to use. This can help reduce the accidental sharing of injecting equipment, particularly if it is reused. Route transition interventions Route transition interventions support people who use drugs to avoid initiation into injecting, or to encourage people who are injecting to transition to non-injecting routes of administration. Behavioural interventions, peer education interventions and the provision of commodities that support alternatives to injecting, such as pipes, mouthguards and aluminium foil, can be used to engage with people who inject heroin and/or stimulant drugs. Box 3. A harm reduction programme for people who smoke cocaine or methamphetamines in the Pacific North-West United States The People’s Harm Reduction Alliance (PHRA) is a peer-based harm reduction programme for people who use drugs in the Pacific North-West of the United States, established in 2007. In its first year, PHRA provided syringes and sterile injection equipment; however, the need to expand services to include people who smoke drugs became quickly apparent via the peer-based framework and feedback from clients. In 2008, PHRA launched a crack pipe programme to reach a different group of people who use drugs. The programme has become a point of contact for them to access additional services. In 2015, the programme was expanded to include methamphetamine pipes because participants informed PHRA that lack of access to pipes led them to inject more frequently than they would otherwise do. Both pipe programmes have increased the inclusion of people who smoke crack and methamphetamine at PHRA and linked them to other essential health services. In 2016, PHRA expanded services for non-injectors further with a snorting programme. HIV and HCV prevention opportunities for people who smoke stimulant drugs Crack cocaine, cocaine base and methamphetamine can be smoked in a pipe, offering access to the high-dose surging effect. The repeated use of heated crack pipes can cause blisters, cracking and sores on the tongue, lips, face, nostrils and fingers. It has been suggested that this may facilitate HCV transmission via unsterile paraphernalia (although this has not been clearly established). People smoking stimulant drugs in pipes do not require single-use equipment but will benefit from having personal (individual) smoking equipment, and messaging that pipes should not be shared. The same principle applies for straws used to inhale cocaine. The distribution of pipes, mouthguards and other piping paraphernalia provides practical strategies for engaging stimulant drug smokers and reinforces the “Don’t share pipes” message. The principles of distributing paraphernalia and engaging people who smoke stimulant drugs with messages about HIV and hepatitis prevention remain the same. 25 Chapter 2 Core interventions Box 4. Example of content of kits for safer smoking • Pipes • Mouth- or lip guards – a rubber band, rubber tubing, or sometimes specially produced • Stainless steel wool, used as gauze to suspend the crack cocaine inside the pipe • Alcohol wipes to clean the pipe and reduce risks associated with sharing • Lip balm containing vitamin E, to help protect and heal chapped or injured lips • Sterile dressing to cover wounds or burns arising from smoking crack • Sugar-free chewing gum which can help stimulate saliva production to protect teeth and reduce dental damage • Condoms and lubricants to support safer sex practices • Health promotion leaflets Safe tattooing In some population groups who use stimulant drugs, unsafe tattooing is frequent and constitutes a risk for transmission of HCV. This is a particular issue in prisons where tattooing is prohibited and hidden and unhygienic tattooing is common. NSPs and other low-threshold services can offer safe tattooing information, training and safe equipment. 2.3 HIV testing services HIV testing provides an opportunity to deliver HIV prevention messages and to link people to HIVprevention and other relevant health and support services. HIV testing services (HTS) are also the critical entry point to ART (see section 2.4). Given the evidence that individuals who are ARTadherent and have achieved viral suppression do not transmit HIV, HTS is a crucial component of HIV prevention programmes. It is important to increase the opportunities for people who use stimulant drugs to access and use confidential, easy and convenient HIV testing that is linked to the provision of ART for those who test positive. Community-based rapid HIV testing provides an opportunity to deliver results immediately. This can be of particular importance with street- or venue-based people who use stimulant drugs, where the primary source of engagement may be outreach programmes brought to where they are, rather than waiting for them to present at a specific testing location. Other outreach opportunities may also be used to distribute HIV self-test kits. Regardless of the testing modality, it is important to have a protocol to assist people to get a confirmatory test if they test positive, and to access and successfully use HIV care and treatment services if needed, including immediate access to ART, post-exposure prophylaxis (PEP) or PrEP, as appropriate. On-site HIV testing can pose challenges, including the possible lack of confidentiality that comes especially with small, closed communities. Outreach workers and service providers need to ensure that HIV testing is always voluntary and that coercive use of self-test kits by third parties such as law enforcement or employers to test any individual (e.g., sex workers) is unacceptable. 2.4 Antiretroviral therapy Antiretroviral therapy (ART) is the treatment of people living with HIV with medications that suppress the replication of the virus. Currently the standard treatment consists of a combination of antiretroviral drugs (ARVs), and it is indicated for all people living with HIV, irrespective of their CD4 count. ART reduces morbidity and mortality rates among people living with HIV, improves their quality of life and reduces risks of transmission of HIV. ARVs are also administered to some groups of people at risk for HIV acquisition either before exposure (PrEP) or after (PEP). ART is also needed for prevention of mother-to-child transmission of HIV. Cocaine and ATS have been associated with faster disease progression in people living with HIV, due to weakening of the immune system by the drugs. However, if adherence is maintained, the effectiveness of ART is not reduced in people who use stimulant drugs: ART reduces viral load and improves immune function, just as it does for other people living with HIV [77]. Strategies to support adherence to ART, including peer and outreach support, are described in section 3.1. Side-effects of antiretroviral drugs and interactions with stimulant drugs As with many medications, ARVs have been associated with various side-effects, including acute or chronic alterations of the renal function, or hepatic dysfunction. Some medications can cause sideeffects in the central nervous system, such as depression. Liver toxicity is one of the most commonly reported adverse consequences associated with ARVs. This can range from asymptomatic elevation of the liver enzymes to a hepatic failure. Risks for ARVrelated adverse consequences for the liver are higher in cases of cocaine use, excessive alcohol use, coinfection with HBV or HCV, fibrosis of the liver, concomitant treatment for TB and advanced age. Impact of stimulant drugs on antiretroviral drug serum level Cocaine, mephedrone and methamphetamines interact with several ARVs, influencing the serum level of the medications and the risk of side-effects. As scientific knowledge progresses, new ARV regimens may be proposed, with the potential for interactions with the NPS that are frequently appearing on the market. The University of Liverpool provides a regularly updated website on HIV medication interactions, including the interaction of ARVs with stimulant drugs: https://www.hiv-druginteractions.org/treatment_selectors. Impact of antiretroviral drugs on serum level of stimulant drugs Serum levels of methamphetamines may increase up to three times when used by someone who is also taking protease inhibitors, especially ritonavir. Fatal cases attributed to inhibition of the metabolism of MDMA and amphetamines by ritonavir have been reported. Oral pre-exposure prophylaxis Oral pre-exposure prophylaxis (PrEP) is the use of antiretroviral medications to prevent the acquisition of HIV infection by uninfected persons. WHO recommends daily oral PrEP as a prevention choice for people at substantial risk of HIV [91]; it can be stopped during periods of low or no risk. Taken as prescribed, PrEP can reduce the risk of getting HIV from sex with an HIV-positive person by more than 90 per cent [92]. PrEP has been effective in communities where the primary vector for transmission is sexual, such as men who have sex with men, and is therefore appropriate for people who use stimulant drugs. PrEP does not replace HIV prevention interventions, such as comprehensive condom programming for sex workers and men who have sex with men. It does not prevent transmission of hepatitis and other STIs. Services for people who inject stimulant drugs should prioritize evidence-based comprehensive HIV prevention interventions, including NSP, condoms and lubricants. For men who have sex with men who use stimulant drugs and engage in high-risk sex, PrEP should always be proposed, whether or not the individual injects drugs. Adherence to PrEP is essential, and it may be challenging for people using stimulant drugs for several days in a row. People who use stimulant drugs and engage in concurrent sex should be encouraged and supported to plan ahead to use condoms, lubricants and PrEP in combination, to ensure better protection against HIV and to prevent other STIs, including hepatitis C and B. As with other prevention tools, the effectiveness of PrEP is optimized when interventions are implemented by, and in close consultation with, prospective beneficiary communities. Further resources Implementation tool for pre-exposure prophylaxis (PrEP) of HIV infection (WHO, 2017) [93] Post-exposure prophylaxis Post-exposure prophylaxis (PEP) is the administration of ARVs for a short term (one month) to prevent HIV infection after exposure to HIV through unprotected sex or contact with blood. PEP should be offered to all individuals who have potentially been exposed to HIV, whether through unprotected sex (including sexual assault), needle-stick injury or sharing drug injection equipment. It should be initiated as early as possible, ideally within 72 hours. People who use stimulant drugs and engage in sex concurrently are known to often have multiple sexual partners. The chances of unprotected sex or condom failure are increased with stimulant drug use or with the increase in the number of partners. A participative stakeholder process should lead to the development of protocols for community access to PEP, from local to national levels, to ensure that the required medications are promptly accessible and are used by those who need them. People who use stimulant drugs and who access PEP regularly should be assessed as likely candidates for PrEP. Further resources Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach - Second edition (WHO, 2016) [162] 2.5 Evidence-based psychosocial interventions and drug dependence treatments The impact of a drug is determined by the complex interactions between the substance, set (the mindset of the individual) and setting (the context), which mediate the drug’s effect and its associated impact on the individual, including the move towards dependent or high-risk drug use [94]. The great majority of people who use stimulant drugs do so on an occasional basis that may be characterized as “recreational”, and they will not develop dependence. This group has little need for high-intensity interventions. This section provides an overview of possible interventions, mainly psychosocial ones, that show effectiveness specifically for reducing risk behaviours and provide support for people who regularly use stimulant drugs, including people living with HIV. 29 Chapter 2 Core interventions The treatment of cocaine or ATS drug dependence requires time-intensive approaches that are not addressed here. Unlike the treatment of opioid dependence, there are currently no substitution medications available to treat dependence on cocaine or ATS [95][96]. Some emerging practices around dispensing dexamphetamine as a substitute for cocaine or methamphetamine dependence have shown early promise, but further research is needed. Behavioural interventions, self-regulation coaching and psychosocial counselling can support HIV/HCV prevention and treatment objectives for people who use stimulant drugs, while also contributing to longer-term and broader health and wellness goals. There is evidence that brief interventions that concentrate on providing information about safe behaviours and harm mitigation are effective in moderating drug-related harms [97] and maintaining ART adherence for those who are living with HIV [98]. Addressing the potential risks associated with the nexus of drug use and HIV requires individual, structural and combination approaches [99]. Psychosocial services such as motivational interviewing, brief interventions, contingency management and cognitive behavioural therapy are critical to effectively support HIV prevention and treatment among people who use stimulant drugs. Some of these approaches are described below. A 2016 review of psychosocial interventions for stimulant drug-use disorders found that all showed improved retention in ART compared with no intervention, although no single intervention showed a sustained benefit over the others [100]. Psychosocial services should be based on principles of community inclusion and participation, peer support and the needs of the individual. When developing HIV prevention interventions, it is important that sexual partners of people who use stimulant drugs be included in the process, focusing on the HIV risks that are associated with drug use and concurrent sexual behaviours. Motivational interviewing Motivational interviewing is a person-centred, semi-directive approach for exploring motivation and ambivalence in order to facilitate self-motivational statements and behavioural changes. It consists in establishing a partnership between the provider and the individual and enabling the individual to become aware of the discrepancy between their present situation and their own values. The technique relies on four principles: express empathy, develop discrepancy, roll with resistance and support selfefficacy. These can easily be used by trained non-specialist staff, including outreach workers, in formal or informal counselling, IEC and other conversations. Motivational interviewing generally requires just one or two sessions. The success of motivational interviewing has led to its implementation as a “catch-all” approach to eliciting change in areas such as medication compliance, smoking cessation and diet and exercise [101]. A 2012 Cochrane review suggested that motivational interviewing could reduce risky sexual behaviour, and in the short term lead to a reduction of viral load in young people living with HIV [102]. Research has shown that motivational interviewing can reduce the incidence of unprotected anal intercourse among men who have sex with men [103], as well as levels of drug use [104]. Brief interventions Brief interventions are short, often opportunistic interactions in which a health worker provides targeted information and advice to individuals during other activities such as distributing sterile injecting equipment or conducting an HIV test. Brief interventions have been shown to reduce drug use as well as associated risks and sexual risk behaviours. Meta-analyses suggest that there is little difference in the outcomes between longer, more intensive interventions and brief interventions, and the latter are likely to be more practical and cost-effective options, with few barriers to implementation [105]. Motivational interviewing, contingency management and brief interventions for dependence to stimulant drugs can reduce drug-related high-risk sexual behaviours and increase adherence to ART and PrEP. 30 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Contingency management Contingency management is an approach that incentivizes people with rewards such as cash that are contingent on achieving a set of pre-defined outcomes. Contingency management has been shown to have a moderate yet consistent effect on drug use across different classes of drugs [106]. The effectiveness of contingency management supports the idea that small, regular rewards motivate people to modify behaviours that could be considered harmful. Positive regard, and the client’s own expressed belief in their ability to achieve goals, are a critical factor in improving agreed-upon outcomes. Cognitive behavioural therapy Cognitive behavioural therapy (CBT) is a structured approach to counselling that assumes that behaviours are learned and reinforced as a result of cognitive constructs and deficits in coping. The aim of CBT is to “unlearn” behaviours considered unhelpful, such as HIV risk behaviour or certain patterns of drug-taking. While results appear to be sustained over a period, CBT is intensive and time-consuming, and demands specialist practitioners and individual treatment [107]. Mindfulness Mindfulness can be defined as the ability to focus open, non-judgemental attention on the full experience of internal and external phenomena, moment by moment. Positive outcomes – including reducing drug use and risk behaviours, and in relapse prevention – have been documented from mindfulness training as part of approaches to reduce harm, including for people who use stimulant drugs [108][109][110]. Opioid substitution therapy and stimulant drug use People receiving opioid substitution therapy (OST) for heroin or other opioid dependence may use stimulant drugs because of OST-triggered fatigue, inability to experience pleasure, or the desire to remain connected to the community of people who use drugs. OST is not designed to counter stimulant drug use, and the concurrent use of stimulant drugs while on OST should not be viewed as a breach, nor should it lead to the reduction or discontinuation of OST. The benefits of OST are independent of stimulant drug use [111]. Existing OST providers should be sensitized to this and trained to use the opportunities afforded by regular OST and client engagement to support the delivery of interventions included in this guidance. Further resources mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings (WHO, 2010) [112] Therapeutic interventions for users of amphetamine-type stimulants (WHO, 2011) [113] Harm reduction and brief interventions for ATS users (WHO, 2011) [114] Guidelines for the management of methamphetamine use disorders in Myanmar (Ministry of Health and Sports, Myanmar, 2017) [115] Guidance for working with cocaine and crack users in primary care (Royal College of General Practitioners, 2004) [116] Principles of drug dependence treatment (UNODC, WHO, 2008) [117] Drug abuse treatment and rehabilitation: a practical planning and implementation guide (UNODC, 2003) [118] TREATNET quality standards for drug dependence treatment and care services (UNODC, 2012) [111] Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence (WHO, 2009)[163] Treatment of stimulant use disorders: current practices and promising perspectives. Discussion paper (UNODC, 2019)[164] 31 Chapter 2 Core interventions 2.6 Prevention, diagnosis and treatment of sexually transmitted infections, hepatitis and tuberculosis Screening people who use stimulant drugs for infectious diseases, such as sexually transmitted infections (STIs), HBV, HCV and TB, is a crucial part of a comprehensive approach. Along with HIV, these infections are often associated with the use of illicit substances, and they may co-occur with stimulant drug use. Prevention, diagnosis and treatment of sexually transmitted infections Unsafe sex can lead to acute STIs, which can cause infertility and severe illness. Several STIs, particularly those involving genital or perianal ulcers, may facilitate the sexual transmission of HIV infection. Sex workers, transgender people and men who have sex with men are often at increased risk of STIs such as syphilis, gonorrhoea, chlamydia and herpes. It is therefore important to offer information, male and female condoms and lubricant, and screening, diagnosis and treatment of STIs and possibly HPV vaccine to people using stimulant drugs who are vulnerable to STIs and HIV. Further resources Resources on sexually transmitted and reproductive tract infections (WHO webpage providing clinical, policy and programmatic, monitoring and evaluation and advocacy guides) [119] Prevention, vaccination, diagnosis and treatment of hepatitis B and C People who inject stimulant drugs are at heightened risk of acquiring HBV and HCV because of frequent injecting and sharing of injection equipment. The risk of sharing equipment is higher when injecting happens in communal settings. HCV is much more virulent than HIV and can survive outside the body at room temperature, on environmental surfaces, for up to three weeks [120], making it more easily transmitted through the sharing of syringes and other injecting paraphernalia. Key populations who use stimulant drugs should be offered hepatitis B or hepatitis A-B vaccination, access to prevention commodities, and voluntary screening and treatment of HBV and HCV. Prevention NSPs and community mobilization initiatives should distribute relevant equipment, including low dead-space syringes, for injecting, smoking and snorting (see section 2.2). Male and female condom programming is also part of hepatitis B and C prevention interventions as well as sexual and reproductive health services. Education should include messages on the risks of serosorting, and of intense sexual practices involving potential trauma of the mucosa for HCV acquisition and transmission among people living with HIV [50]. Hepatitis A and B vaccination Key populations should be offered the series of HBV immunizations. WHO recommends: • Offering people the rapid hepatitis B vaccination regimen (days 0, 7 and 21-30). • Providing people who inject drugs with incentives in order to increase hepatitis B vaccination adherence, at least for the second dose. Even partial immunization confers some immunoprotection. [87] Hepatitis A (HAV) immunization or combined HAV-HBV immunization should be offered to men who have sex with men and people using stimulant drugs [121]. 32 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Immunization should be easily accessible and offered at locations and venues frequented by people who use stimulant drugs, such as drop-in centres, NSPs and other community service outlets. Screening for HBV and HCV Voluntary screening for HBV and/or HCV should be offered to people who use stimulant drugs at risk of these infections. Testing and diagnosis of HBV and HCV infection is an entry point for accessing both prevention and treatment services. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay the progression of liver disease. Rapid tests for hepatitis C allow for better access to diagnosis, including communitybased testing. Treatment of chronic hepatitis C or B All people with chronic hepatitis C should receive treatment. With an 8- to 12-week course, directacting antivirals (DAAs) cure more than 95 per cent of persons with HCV infection, reducing the risk of death from liver cancer and cirrhosis. For chronic hepatitis B, antiviral treatment can slow down the progression of cirrhosis and reduces the risk of liver cancer [162]. People who are actively injecting drugs have been shown to adhere to HCV treatment regimens as well as any other population, particularly when social, emotional and practical support are provided [122]. All people who use stimulant drugs living with HCV should therefore be offered access to direct-acting antivirals without discrimination. Further resources Guidance on prevention of viral hepatitis B and C among people who inject drugs (WHO, 2012) [87] Guidelines for the screening, care and treatment of persons with chronic hepatitis C infection (WHO, 2016) [123] Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach - Second edition (WHO, 2016) [162] Prevention, diagnosis and treatment of tuberculosis In 2016, 10.4 million people fell ill with TB. It is a leading killer of people living with HIV: in 2016, 40 per cent of HIV deaths were due to TB [124]. Transmission of TB is easily facilitated through airborne particulates, such as by kissing, coughing, sneezing or shouting. TB is easily spread in prisons and other closed settings, and in crowded and poorly ventilated spaces, such as are often found in poor communities or among homeless people. People who inject drugs are at increased risk of TB, irrespective of their HIV status, and TB is a leading cause of mortality among people who inject drugs who also have HIV infection [125]. People who use drugs who do not inject have also been found to have increased rates of TB. Certain subgroups of stimulant drug users, such as those who use stimulant drugs regularly for days at a time, may be immuno-deficient from lack of sleep and food, facilitating TB transmission. It is therefore important to include TB prevention, screening and treatment in communities and services. Further resources Integrating collaborative TB and HIV services within a comprehensive package of care for people who inject drugs: consolidated guidelines (WHO, 2016) [125] 33 Chapter 2 Core interventions 2.7 Targeted information, education and communication To reduce the risk of acquiring STIs or HIV, people who use stimulant drugs need knowledge and support. Information, education and communication (IEC) provides information, motivation, education and skills-building to help individuals adopt behaviours that will protect their health. Effective communication for health targeting people who use stimulant drugs requires addressing two challenges: • Crafting messages that can overcome long-standing distrust and fear. • Finding effective means of reaching people who use stimulant drugs with life-saving messages and materials. Key to meeting these challenges is meaningful engagement with the target audience of people who use stimulant drugs. Communities should be represented at every stage of IEC development, including the overall strategy and concept, and the development, testing, dissemination and evaluation of messages. Working with the community will help ensure that tools and materials are accurate and will be trusted and used. Recipients of IEC who have invested their own ideas and time in it will be more likely to stand behind the results and be active participants, not only in their own health but in health promotion in their community. Materials must be easily understandable and to the point. Interactive materials on a digital platform can tailor messaging to the specific situation of the service user and are often helpful in maintaining attention. On the other hand, traditional printed materials have the advantage of not requiring computer, phone or Internet access. They also provide an opportunity for outreach workers or other programme staff distributing the materials to interact with the service users, and a means for service users to easily share information with others. Using information technology to support behavioural interventions Online and social media can be a cost-effective manner of reaching targeted audiences. A local assessment can show where using these technologies will be advantageous and appropriate. Free WiFi at drop-in centres and other community points of congregation provides opportunities for access and use. Where people who use stimulant drugs have smartphones, websites and apps can be deployed just as they have been to reach other key populations. The use of technology has shown promising results in promoting sexual health or adherence to ART in different settings, including resource-limited settings [126][127]. Web-based applications provide an opportunity to reach a large audience at any time and provide information on health and available services. They also allow for online outreach and interactions with people who wish to discuss problems or have questions. However, when the information relates to drug use, or other criminalized behaviours, the use of some digital media raises concerns about the anonymity of the contacts, and possible risks related to law enforcement must be addressed. Working with communities and low-threshold service providers will help inform the local potential for digital materials and campaigns and help ensure the security of people accessing information. Given the variety that exists among people who use stimulant drugs, messaging should take into account the sex, gender, sexual orientation, age and setting of recipients of IEC. Literacy levels, social and community inclusion or exclusion, and other cultural and societal variables must also be considered. 34 HIV PREVENTION, TREATMENT, CARE AND SUPPORT FOR PEOPLE WHO USE STIMULANT DRUGS Further resources The European Centre for Disease Prevention and Control (ECDC) has developed guidance documents for the effective use of social media. While the tools were developed for Europe, and specifically for reaching men who have sex with men, they provide guidance on the relative advantages of different media, such as Facebook, online outreach, Google Ads, SMS and YouTube, that may be useful in other contexts. Effective use of digital platforms for HIV prevention among men who have sex with men in the European Union/European Economic Area: an introduction to the ECDC guides (ECDC, 2017) [128] 2.8 Overdose and acute intoxication prevention and management Very high doses of stimulant drugs consumed in a short amount of time can trigger acute respiratory distress, chest pain, palpitations or myocardial infarctions [112]. In extreme cases this can result in cardiac arrest. The first signs of stimulant drugs intoxication are hyperactivity, rapid speech and dilated pupils. In the case of polydrug use, overdose can be the result of the combination of stimulants with other drugs including opioid or sedative drugs. The treatment of stimulant drugs intoxication is symptomatic and requires regular monitoring of blood pressure, pulse rate, respiratory rate and temperature (figure I.). Serotonergic syndrome is caused by an excess of serotonin in the central nervous system associated with the use of ATS. It can result in uncontrollable muscle spasms, tremor, seizures, psychosis, high blood pressure, high body temperature >400 C (hyperthermia) and release of myoglobin from muscles and blood clotting in vessels (disseminated intravascular coagulation), which may lead to severe diseases and potentially death. People who use stimulant drugs need to be informed on how to reduce the risks of acute intoxications (see the Information checklist for self-care and stimulant drugs in the annex). For people on PrEP, ART or hepatitis treatment, information should be provided on the interactions and possible risks of cocaine and ATS use to serum levels (see section 2.4). People who use stimulant drugs should be trained to recognize overdoses, provide first aid, including cardiopulmonary resuscitation (CPR) and call immediately for emergency professional assistance if they witness an overdose. Please do not use any other resources to answer the question other than the information I provide you. If you cannot answer with only the information I provide say ""I cannot answer without further research."" What are the key considerations and strategies for people who use stimulant drugs and engage in concurrent sex in terms of HIV prevention, and how does the effectiveness of these strategies get optimized?",Medical,Effect Analysis,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","How do companies in the context of multi-cloud initiatives strike a balance between the demands of improved data security and cost minimization and the difficulties of handling growing complexity and possible interoperability issues? Talk about how these approaches help IT infrastructure be innovative and flexible, while also meeting the increasing needs for sustainability and integrating new technologies like edge computing, AI, and the IoT.","Multi-cloud strategies are becoming popular as businesses look to improve data management, cost efficiency, and operational flexibility. This approach involves using cloud services from different providers to meet various needs, avoiding reliance on a single vendor. As more organizations undergo digital transformation, understanding the benefits and challenges of multi-cloud strategies becomes crucial for making informed decisions. The multi-cloud approach offers many advantages, such as improved resilience, cost optimization, and enhanced data security. However, it also presents challenges, including management complexity and potential interoperability issues. This blog explores the rise of multi-cloud strategies, highlighting the benefits and challenges they bring to businesses. What Makes Multi-Cloud Unique Multi-cloud strategies are unique because they leverage the strengths of various cloud providers. Is superior to single-cloud or hybrid cloud. It allows businesses to select the top services from various vendors. This ensures they receive the most suitable solutions for their requirements. This flexibility leads to improved performance and cost savings, as companies can optimize their resources more effectively. Another unique aspect of multi-cloud strategies is the enhanced resilience they offer. By spreading workloads across multiple cloud environments, businesses can minimize the risk of downtime and data loss. This distribution of resources ensures that if one cloud provider experiences an outage, the impact on overall operations is minimal, thus maintaining business continuity. Additionally, multi-cloud strategies provide greater freedom in vendor choice and negotiation power. Companies can switch vendors or services easily without causing major disruptions. This is because they are not limited to just one provider. This flexibility fosters innovation and adaptability, essential for staying competitive in today's fast-paced business environment. Essential Market for Business Businesses need to use multi-cloud strategies to stay competitive in the IT infrastructure market. One primary reason is the ability to manage large volumes of data more efficiently. With the rise of big data and analytics, businesses require robust and scalable solutions to handle their data needs. Multi-cloud strategies enable organizations to distribute data across different platforms, ensuring optimal performance and storage efficiency. Cost implications also play a significant role in the growing popularity of multi-cloud strategies. Businesses can save money and customize their cloud usage by using multiple cloud providers. This approach allows companies to avoid vendor lock-in and negotiate better deals, ultimately reducing overall IT costs. Flexibility is another critical factor driving the adoption of multi-cloud strategies. Businesses have many options for services and technologies to quickly adjust to market changes. Being adaptable is important for companies to innovate and grow. It allows them to try out different tools and solutions without being limited to just one vendor. Benefits of Multi-Cloud Strategies One of the most significant benefits of multi-cloud strategies is improved data management. By utilizing multiple cloud providers, businesses can distribute their data more efficiently, ensuring better performance and availability. This method helps with better disaster recovery and backup options by copying data to various cloud platforms. Cost savings are another major advantage of multi-cloud strategies. Companies can optimize their spending by selecting the most cost-effective services from various providers. This method helps businesses save money on cloud services and make sure they get the most out of their investment. Enhanced security is also a key benefit of multi-cloud strategies. With data spread across multiple cloud environments, businesses can implement robust security measures tailored to each platform. This multi-layered approach reduces the risk of data breaches and ensures protection of sensitive information. Challenges of Adopting Multi-Cloud Strategies Despite the numerous benefits, adopting a multi-cloud strategy comes with its challenges. One primary concern is the complexity of managing multiple cloud environments. Businesses need to invest in tools and expertise to ensure seamless integration and operation of various cloud services. This complexity can lead to increased operational costs and require specialized skills to manage effectively. Interoperability issues are another challenge associated with multi-cloud strategies. Cloud providers use various technologies and standards. This can make it difficult to integrate and manage workloads across different platforms. Businesses need to carefully plan their multi-cloud architecture to ensure compatibility and avoid potential conflicts. Additionally, data governance and compliance can become more challenging in a multi-cloud environment. Businesses need to make sure they follow rules and keep control of their data when using multiple cloud providers. This often involves implementing robust monitoring and auditing processes to ensure compliance. Strategic Advantages of Multi-Cloud Adopting a multi-cloud strategy provides businesses with several strategic advantages. One of the most notable is the ability to avoid vendor lock-in. Companies can use more than one cloud provider to switch services and providers easily when necessary. This allows them to avoid being limited to just one vendor. This flexibility enables companies to adapt to changing needs and take advantage of the best services available. This flexibility allows businesses to adapt quickly to market changes and take advantage of new technologies. Another strategic advantage is the ability to optimize performance. Multi-cloud strategies enable businesses to choose the best services for specific workloads, ensuring optimal performance and efficiency. This tailored approach helps companies meet their performance goals and deliver better customer experiences. Furthermore, multi-cloud strategies support innovation by providing access to a wide range of technologies and services. Businesses can experiment with new tools and solutions without being constrained by a single vendor's offerings. This freedom fosters creativity and innovation, helping companies stay competitive and drive growth. Current Trends and Industry Developments The rise of multi-cloud strategies is driven by several current trends and industry developments. One significant trend is the increasing demand for cloud-native applications. These applications are designed to run on multiple cloud environments, making them ideal for multi-cloud strategies. Businesses are adopting cloud-native technologies to improve scalability, performance, and resilience. Another trend is the growing importance of edge computing. With data being generated closer to the source, businesses need to process and analyze data at the edge of the network. Multi-cloud strategies enable organizations to leverage edge computing capabilities from different providers, ensuring they can meet the demands of real-time data processing. The adoption of artificial intelligence (AI) and machine learning (ML) is also driving the rise of multi-cloud strategies. These technologies require significant computing power and data storage, which can be efficiently managed using multiple cloud environments. Businesses are leveraging AI and ML to gain insights, automate processes, and improve decision-making. Future Developments and Opportunities As multi-cloud strategies continue to evolve, several future developments and opportunities are emerging. One area of growth is the development of advanced management tools. These tools will help businesses manage their multi-cloud environments more effectively, providing better visibility, control, and automation. Another area of opportunity is the integration of multi-cloud strategies with emerging technologies such as the Internet of Things (IoT) and 5G. These technologies will generate vast amounts of data that need to be processed and analyzed in real-time. Multi-cloud strategies will enable businesses to leverage the capabilities of different cloud providers to meet these demands. Additionally, the focus on sustainability is driving the adoption of multi-cloud strategies. Businesses are seeking to reduce their environmental impact by optimizing their cloud usage. Multi-cloud strategies allow organizations to choose eco-friendly cloud providers and implement energy-efficient practices, contributing to sustainability goals. The rise of multi-cloud strategies represents a significant shift in how businesses approach their IT infrastructure. By leveraging the strengths of multiple cloud providers, companies can improve data management, optimize costs, and enhance flexibility. However, adopting a multi-cloud approach also presents challenges, such as increased complexity and potential interoperability issues. As businesses continue to embrace digital transformation, understanding the benefits and challenges of multi-cloud strategies is crucial. By carefully planning and managing their multi-cloud environments, organizations can unlock new opportunities for innovation, growth, and sustainability. The future of multi-cloud strategies looks promising, with ongoing developments and emerging technologies set to drive further advancements in this dynamic field.","[question] How do companies in the context of multi-cloud initiatives strike a balance between the demands of improved data security and cost minimization and the difficulties of handling growing complexity and possible interoperability issues? Talk about how these approaches help IT infrastructure be innovative and flexible, while also meeting the increasing needs for sustainability and integrating new technologies like edge computing, AI, and the IoT. ===================== [text] Multi-cloud strategies are becoming popular as businesses look to improve data management, cost efficiency, and operational flexibility. This approach involves using cloud services from different providers to meet various needs, avoiding reliance on a single vendor. As more organizations undergo digital transformation, understanding the benefits and challenges of multi-cloud strategies becomes crucial for making informed decisions. The multi-cloud approach offers many advantages, such as improved resilience, cost optimization, and enhanced data security. However, it also presents challenges, including management complexity and potential interoperability issues. This blog explores the rise of multi-cloud strategies, highlighting the benefits and challenges they bring to businesses. What Makes Multi-Cloud Unique Multi-cloud strategies are unique because they leverage the strengths of various cloud providers. Is superior to single-cloud or hybrid cloud. It allows businesses to select the top services from various vendors. This ensures they receive the most suitable solutions for their requirements. This flexibility leads to improved performance and cost savings, as companies can optimize their resources more effectively. Another unique aspect of multi-cloud strategies is the enhanced resilience they offer. By spreading workloads across multiple cloud environments, businesses can minimize the risk of downtime and data loss. This distribution of resources ensures that if one cloud provider experiences an outage, the impact on overall operations is minimal, thus maintaining business continuity. Additionally, multi-cloud strategies provide greater freedom in vendor choice and negotiation power. Companies can switch vendors or services easily without causing major disruptions. This is because they are not limited to just one provider. This flexibility fosters innovation and adaptability, essential for staying competitive in today's fast-paced business environment. Essential Market for Business Businesses need to use multi-cloud strategies to stay competitive in the IT infrastructure market. One primary reason is the ability to manage large volumes of data more efficiently. With the rise of big data and analytics, businesses require robust and scalable solutions to handle their data needs. Multi-cloud strategies enable organizations to distribute data across different platforms, ensuring optimal performance and storage efficiency. Cost implications also play a significant role in the growing popularity of multi-cloud strategies. Businesses can save money and customize their cloud usage by using multiple cloud providers. This approach allows companies to avoid vendor lock-in and negotiate better deals, ultimately reducing overall IT costs. Flexibility is another critical factor driving the adoption of multi-cloud strategies. Businesses have many options for services and technologies to quickly adjust to market changes. Being adaptable is important for companies to innovate and grow. It allows them to try out different tools and solutions without being limited to just one vendor. Benefits of Multi-Cloud Strategies One of the most significant benefits of multi-cloud strategies is improved data management. By utilizing multiple cloud providers, businesses can distribute their data more efficiently, ensuring better performance and availability. This method helps with better disaster recovery and backup options by copying data to various cloud platforms. Cost savings are another major advantage of multi-cloud strategies. Companies can optimize their spending by selecting the most cost-effective services from various providers. This method helps businesses save money on cloud services and make sure they get the most out of their investment. Enhanced security is also a key benefit of multi-cloud strategies. With data spread across multiple cloud environments, businesses can implement robust security measures tailored to each platform. This multi-layered approach reduces the risk of data breaches and ensures protection of sensitive information. Challenges of Adopting Multi-Cloud Strategies Despite the numerous benefits, adopting a multi-cloud strategy comes with its challenges. One primary concern is the complexity of managing multiple cloud environments. Businesses need to invest in tools and expertise to ensure seamless integration and operation of various cloud services. This complexity can lead to increased operational costs and require specialized skills to manage effectively. Interoperability issues are another challenge associated with multi-cloud strategies. Cloud providers use various technologies and standards. This can make it difficult to integrate and manage workloads across different platforms. Businesses need to carefully plan their multi-cloud architecture to ensure compatibility and avoid potential conflicts. Additionally, data governance and compliance can become more challenging in a multi-cloud environment. Businesses need to make sure they follow rules and keep control of their data when using multiple cloud providers. This often involves implementing robust monitoring and auditing processes to ensure compliance. Strategic Advantages of Multi-Cloud Adopting a multi-cloud strategy provides businesses with several strategic advantages. One of the most notable is the ability to avoid vendor lock-in. Companies can use more than one cloud provider to switch services and providers easily when necessary. This allows them to avoid being limited to just one vendor. This flexibility enables companies to adapt to changing needs and take advantage of the best services available. This flexibility allows businesses to adapt quickly to market changes and take advantage of new technologies. Another strategic advantage is the ability to optimize performance. Multi-cloud strategies enable businesses to choose the best services for specific workloads, ensuring optimal performance and efficiency. This tailored approach helps companies meet their performance goals and deliver better customer experiences. Furthermore, multi-cloud strategies support innovation by providing access to a wide range of technologies and services. Businesses can experiment with new tools and solutions without being constrained by a single vendor's offerings. This freedom fosters creativity and innovation, helping companies stay competitive and drive growth. Current Trends and Industry Developments The rise of multi-cloud strategies is driven by several current trends and industry developments. One significant trend is the increasing demand for cloud-native applications. These applications are designed to run on multiple cloud environments, making them ideal for multi-cloud strategies. Businesses are adopting cloud-native technologies to improve scalability, performance, and resilience. Another trend is the growing importance of edge computing. With data being generated closer to the source, businesses need to process and analyze data at the edge of the network. Multi-cloud strategies enable organizations to leverage edge computing capabilities from different providers, ensuring they can meet the demands of real-time data processing. The adoption of artificial intelligence (AI) and machine learning (ML) is also driving the rise of multi-cloud strategies. These technologies require significant computing power and data storage, which can be efficiently managed using multiple cloud environments. Businesses are leveraging AI and ML to gain insights, automate processes, and improve decision-making. Future Developments and Opportunities As multi-cloud strategies continue to evolve, several future developments and opportunities are emerging. One area of growth is the development of advanced management tools. These tools will help businesses manage their multi-cloud environments more effectively, providing better visibility, control, and automation. Another area of opportunity is the integration of multi-cloud strategies with emerging technologies such as the Internet of Things (IoT) and 5G. These technologies will generate vast amounts of data that need to be processed and analyzed in real-time. Multi-cloud strategies will enable businesses to leverage the capabilities of different cloud providers to meet these demands. Additionally, the focus on sustainability is driving the adoption of multi-cloud strategies. Businesses are seeking to reduce their environmental impact by optimizing their cloud usage. Multi-cloud strategies allow organizations to choose eco-friendly cloud providers and implement energy-efficient practices, contributing to sustainability goals. The rise of multi-cloud strategies represents a significant shift in how businesses approach their IT infrastructure. By leveraging the strengths of multiple cloud providers, companies can improve data management, optimize costs, and enhance flexibility. However, adopting a multi-cloud approach also presents challenges, such as increased complexity and potential interoperability issues. As businesses continue to embrace digital transformation, understanding the benefits and challenges of multi-cloud strategies is crucial. By carefully planning and managing their multi-cloud environments, organizations can unlock new opportunities for innovation, growth, and sustainability. The future of multi-cloud strategies looks promising, with ongoing developments and emerging technologies set to drive further advancements in this dynamic field. https://www.datacenters.com/news/the-rise-of-multi-cloud-strategies-exploring-the-benefits-and-challenges#:~:text=Multi%2Dcloud%20strategies%20are%20becoming,reliance%20on%20a%20single%20vendor. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Effect Analysis,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Is it possible to have a reaction to ibuprofen? I've lately started getting flushed and have trouble breathing every time I take it. If it is the ibuprofen what's happening? Is there a test I can take for this? Please explain simply and keep the response to under 500 words.,"Nonsteroidal antiinflammatory drug (NSAID)-exacerbated respiratory disease (NERD) is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis/nasal polyps, but is a highly heterogeneous disorder with various clinical manifestations. Two major pathogenic mechanisms are: (1) overproduction of cysteinyl leukotrienes with dysregulation of arachidonic acid metabolism and (2) increased type 2 eosinophilic inflammation affected by genetic mechanisms. Aspirin challenge is the gold standard to diagnose NERD, whereas reliable in vitro biomarkers have yet not been identified. Therapeutic approaches have been done on the basis of disease severity with the avoidance of culprit and cross-reacting NSAIDs, and when indicated, aspirin desensitization is an effective treatment option. Biologic approaches targeting Type 2 cytokines are emerging as potential therapeutic options. Here, we summarize the up-to-date evidence of pathophysiologic mechanisms and diagnosis/management approaches to the patients with NERD with its phenotypic classification. Introduction Aspirin (acetylsalicylic acid, ASA) and nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly prescribed drugs in the world (Doña et al., 2012); however, they are considered the most common causes of hypersensitivity reactions to drugs (Blanca-Lopez et al., 2018). Hypersensitivity reactions to NSAIDs have recently been classified by the European Academy of Allergy and Clinical Immunology (EAACI) and European Network of Drug Allergy (ENDA): 1) pharmacologic reactions (mediated by cyclooxygenase [COX]-1 inhibitions) include NSAID-exacerbated respiratory disease (NERD), NSAID-exacerbated cutaneous disease (NECD) and NSAID-induced urticarial/angioedema (NIUA), and present cross-intolerance to various COX-1 inhibitors; 2) selective responses (mediated by immunologic mechanisms) include single NSAIDs-induced urticaria, angioedema and/or anaphylaxis (SNIUAA) and single NSAIDs-induced delayed hypersensitivity reactions (SNIDHR) (Kowalski and Stevenson, 2013). NERD is a major phenotype among cross-intolerant categories of NSAID hypersensitivity and had been called ASA-induced asthma, ASA-intolerant asthma, ASA-sensitive asthma; however, NERD and ASA-exacerbated respiratory disease (AERD) are commonly used (Sánchez-Borges, 2019). The prevalence of NERD is reported to be 5.5% to 12.4% in the general population (Lee et al., 2018a; Chu et al., 2019; Taniguchi et al., 2019), 7.1% among adult asthmatics and 14.9% among severe asthmatics (Rajan et al., 2015), while it rarely occurs in children (Taniguchi et al., 2019). No relationships were found with family history or NSAID administration history (Kowalski et al., 2011; Taniguchi et al., 2019). NERD is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis (CRS) nasal polyps (NPs) with persistent eosinophilic inflammation in the upper and lower airways (Taniguchi et al., 2019) as well as NSAID hypersensitivity where cysteinyl leukotrienes (CysLTs) over-production and chronic type 2 airway inflammation are key findings (Taniguchi et al., 2019). The diagnosis of NERD is confirmed by ASA challenge (via orally, bronchially or nasally route) and supported by potential biomarkers (Pham et al., 2017; Cingi and Bayar Muluk, 2020). In addition, in vitro cell activation tests and radiological imaging with nasal endoscopy can aid in NERD diagnosis (Taniguchi et al., 2019). This review updates the current knowledge on pathophysiologic mechanisms including molecular genetic mechanisms as well as the diagnosis and treatment of NERD. Clinical Features NERD is characterized by chronic type 2 inflammation in the upper and lower airways; therefore, patients suffer from chronic persistent asthmatic symptoms and CRS with/without NPs, which are exacerbated by ASA/NSAID exposure and refractory to conventional medical or surgical treatment. Some patients are accompanied by cutaneous symptoms such as urticaria, angioedema, flushing or gastrointestinal symptoms (Buchheit and Laidlaw, 2016). Previous studies suggested that NERD is more common in females (middle-age onset) and non-atopics (Choi et al., 2015; Trinh et al., 2018). It was reported that rhinitis symptoms appear and then evolve into CRS which worsens asthmatic symptoms, subsequently followed by ASA intolerance (Szczeklik et al., 2000). However, their clinical presentations and courses have been found to be heterogeneous. It has been increasingly required to classify the subphenotypes of NERD according to its clinical features. One study demonstrated 4 subphenotypes by applying a latent class analysis in a Polish cohort: class 1 patients showing moderate asthma with upper airway symptoms and blood eosinophilia; class 2 patients showing mild asthma with low healthcare use; class 3 patients showing severe asthma with severe exacerbation and airway obstruction; and class 4 patients showing poorly controlled asthma with frequent and severe exacerbation (Bochenek et al., 2014). Another study showed 4 subtypes presenting distinct clinical/biochemical findings in a Korean cohort using a 2-step cluster analysis based on 3 clinical phenotypes (urticaria, CRS and atopy status): subtype 1 (NERD with CRS/atopy and no urticaria), subtype 2 (NERD with CRS and no urticaria/atopy), subtype 3 (NERD without CRS/urticaria), and subtype 4 (NERD with acute/chronic urticaria exacerbated by NSAID exposure) (Lee et al., 2017). Each subtype had distinct features in the aspect of female proportion, the degree of eosinophilia, leukotriene (LT) E4 metabolite levels, the frequency of asthma exacerbation, medication requirements (high-dose ICS-LABA or systemic corticosteroids) and asthma severity, suggesting that stratified strategies according to subtype classification may help achieve better clinical outcomes in the management of NERD.","""================ ======= Nonsteroidal antiinflammatory drug (NSAID)-exacerbated respiratory disease (NERD) is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis/nasal polyps, but is a highly heterogeneous disorder with various clinical manifestations. Two major pathogenic mechanisms are: (1) overproduction of cysteinyl leukotrienes with dysregulation of arachidonic acid metabolism and (2) increased type 2 eosinophilic inflammation affected by genetic mechanisms. Aspirin challenge is the gold standard to diagnose NERD, whereas reliable in vitro biomarkers have yet not been identified. Therapeutic approaches have been done on the basis of disease severity with the avoidance of culprit and cross-reacting NSAIDs, and when indicated, aspirin desensitization is an effective treatment option. Biologic approaches targeting Type 2 cytokines are emerging as potential therapeutic options. Here, we summarize the up-to-date evidence of pathophysiologic mechanisms and diagnosis/management approaches to the patients with NERD with its phenotypic classification. Introduction Aspirin (acetylsalicylic acid, ASA) and nonsteroidal antiinflammatory drugs (NSAIDs) are the most commonly prescribed drugs in the world (Doña et al., 2012); however, they are considered the most common causes of hypersensitivity reactions to drugs (Blanca-Lopez et al., 2018). Hypersensitivity reactions to NSAIDs have recently been classified by the European Academy of Allergy and Clinical Immunology (EAACI) and European Network of Drug Allergy (ENDA): 1) pharmacologic reactions (mediated by cyclooxygenase [COX]-1 inhibitions) include NSAID-exacerbated respiratory disease (NERD), NSAID-exacerbated cutaneous disease (NECD) and NSAID-induced urticarial/angioedema (NIUA), and present cross-intolerance to various COX-1 inhibitors; 2) selective responses (mediated by immunologic mechanisms) include single NSAIDs-induced urticaria, angioedema and/or anaphylaxis (SNIUAA) and single NSAIDs-induced delayed hypersensitivity reactions (SNIDHR) (Kowalski and Stevenson, 2013). NERD is a major phenotype among cross-intolerant categories of NSAID hypersensitivity and had been called ASA-induced asthma, ASA-intolerant asthma, ASA-sensitive asthma; however, NERD and ASA-exacerbated respiratory disease (AERD) are commonly used (Sánchez-Borges, 2019). The prevalence of NERD is reported to be 5.5% to 12.4% in the general population (Lee et al., 2018a; Chu et al., 2019; Taniguchi et al., 2019), 7.1% among adult asthmatics and 14.9% among severe asthmatics (Rajan et al., 2015), while it rarely occurs in children (Taniguchi et al., 2019). No relationships were found with family history or NSAID administration history (Kowalski et al., 2011; Taniguchi et al., 2019). NERD is characterized by moderate-to-severe asthma and a higher prevalence of chronic rhinosinusitis (CRS) nasal polyps (NPs) with persistent eosinophilic inflammation in the upper and lower airways (Taniguchi et al., 2019) as well as NSAID hypersensitivity where cysteinyl leukotrienes (CysLTs) over-production and chronic type 2 airway inflammation are key findings (Taniguchi et al., 2019). The diagnosis of NERD is confirmed by ASA challenge (via orally, bronchially or nasally route) and supported by potential biomarkers (Pham et al., 2017; Cingi and Bayar Muluk, 2020). In addition, in vitro cell activation tests and radiological imaging with nasal endoscopy can aid in NERD diagnosis (Taniguchi et al., 2019). This review updates the current knowledge on pathophysiologic mechanisms including molecular genetic mechanisms as well as the diagnosis and treatment of NERD. Clinical Features NERD is characterized by chronic type 2 inflammation in the upper and lower airways; therefore, patients suffer from chronic persistent asthmatic symptoms and CRS with/without NPs, which are exacerbated by ASA/NSAID exposure and refractory to conventional medical or surgical treatment. Some patients are accompanied by cutaneous symptoms such as urticaria, angioedema, flushing or gastrointestinal symptoms (Buchheit and Laidlaw, 2016). Previous studies suggested that NERD is more common in females (middle-age onset) and non-atopics (Choi et al., 2015; Trinh et al., 2018). It was reported that rhinitis symptoms appear and then evolve into CRS which worsens asthmatic symptoms, subsequently followed by ASA intolerance (Szczeklik et al., 2000). However, their clinical presentations and courses have been found to be heterogeneous. It has been increasingly required to classify the subphenotypes of NERD according to its clinical features. One study demonstrated 4 subphenotypes by applying a latent class analysis in a Polish cohort: class 1 patients showing moderate asthma with upper airway symptoms and blood eosinophilia; class 2 patients showing mild asthma with low healthcare use; class 3 patients showing severe asthma with severe exacerbation and airway obstruction; and class 4 patients showing poorly controlled asthma with frequent and severe exacerbation (Bochenek et al., 2014). Another study showed 4 subtypes presenting distinct clinical/biochemical findings in a Korean cohort using a 2-step cluster analysis based on 3 clinical phenotypes (urticaria, CRS and atopy status): subtype 1 (NERD with CRS/atopy and no urticaria), subtype 2 (NERD with CRS and no urticaria/atopy), subtype 3 (NERD without CRS/urticaria), and subtype 4 (NERD with acute/chronic urticaria exacerbated by NSAID exposure) (Lee et al., 2017). Each subtype had distinct features in the aspect of female proportion, the degree of eosinophilia, leukotriene (LT) E4 metabolite levels, the frequency of asthma exacerbation, medication requirements (high-dose ICS-LABA or systemic corticosteroids) and asthma severity, suggesting that stratified strategies according to subtype classification may help achieve better clinical outcomes in the management of NERD. https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2020.01147/full ================ ======= Is it possible to have a reaction to ibuprofen? I've lately started getting flushed and have trouble breathing every time I take it. If it is the ibuprofen what's happening? Is there a test I can take for this? Please explain simply and keep the response to under 500 words. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Summarize & Simplify,Text Transformation I'm providing you with your source material. You will not be using any outside material. Your job is to answer questions about the material.,"What are the details of the transition regulations of Relief for Renters Act, 2024.","1ST SESSION, 43RD LEGISLATURE, ONTARIO 2 CHARLES III, 2024 Bill 163 An Act to amend the Residential Tenancies Act, 2006 MPP A. Hazell Private Member’s Bill 1st Reading February 20, 2024 2nd Reading 3rd Reading Royal Assent EXPLANATORY NOTE The Bill amends the Residential Tenancies Act, 2006 to provide for a residential rent freeze for the calendar year 2025, subject to specified exceptions, and to provide that no landlord shall terminate a tenancy under section 48 or 49 of the Act during the same period, subject to specified exceptions. Bill 163 2024 An Act to amend the Residential Tenancies Act, 2006 His Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows: 1 The Residential Tenancies Act, 2006 is amended by adding the following section: No eviction under ss. 48 and 49 during non-enforcement period Definition 49.1.1 (1) In this section, “non-enforcement period” means the period that begins on January 1, 2025 and ends on December 31, 2025. No termination of tenancy (2) No landlord shall, during the non-enforcement period, terminate a tenancy in accordance with section 48 or 49. Exception (3) Subsection (2) does not apply if the landlord is terminating a tenancy for the purpose of occupation by a person who provides or will provide care services, as described in clause 48 (1) (d), 49 (1) (d) or 49 (2) (d). 2 (1) Subsection 120 (3.1) of the Act is amended by striking out “2021” wherever it appears and substituting in each case “2025”. (2) Subsection 120 (3.2) of the Act is amended by striking out “2021” and substituting “2025”. 3 (1) The definition of “rent freeze period” in subsection 136.1 (1) of the Act is amended by striking out “January 1, 2021 and ends on December 31, 2021” at the end and substituting “January 1, 2025 and ends on December 31, 2025”. (2) Subclause 136.1 (2) (c) (i) of the Act is amended by striking out “Helping Tenants and Small Businesses Act, 2020” and substituting “Relief for Renters Act, 2024”. (3) Subsection 136.1 (3) of the Act is amended by striking out “Helping Tenants and Small Businesses Act, 2020” and substituting “Relief for Renters Act, 2024”. 4 The Act is amended by adding the following section: Transition regulations, Relief for Renters Act, 2024 241.5 (1) The Lieutenant Governor in Council may make regulations governing transitional matters that, in the opinion of the Lieutenant Governor in Council, are necessary or advisable to deal with issues arising out of the amendments to this Act made by the Relief for Renters Act, 2024. Same (2) A regulation made under subsection (1) may govern the application of provisions of this Act to proceedings before a court or the Board in which a claim is made relating to amendments to this Act made by the Relief for Renters Act, 2024 and which were commenced before the commencement date of the amendment. Commencement 5 This Act comes into force on the day it receives Royal Assent. Short title 6 The short title of this Act is the Relief for Renters Act, 2024. ","I'm providing you with your source material. You will not be using any outside material. Your job is to answer questions about the material. What are the details of the transition regulations of Relief for Renters Act, 2024. 1ST SESSION, 43RD LEGISLATURE, ONTARIO 2 CHARLES III, 2024 Bill 163 An Act to amend the Residential Tenancies Act, 2006 MPP A. Hazell Private Member’s Bill 1st Reading February 20, 2024 2nd Reading 3rd Reading Royal Assent EXPLANATORY NOTE The Bill amends the Residential Tenancies Act, 2006 to provide for a residential rent freeze for the calendar year 2025, subject to specified exceptions, and to provide that no landlord shall terminate a tenancy under section 48 or 49 of the Act during the same period, subject to specified exceptions. Bill 163 2024 An Act to amend the Residential Tenancies Act, 2006 His Majesty, by and with the advice and consent of the Legislative Assembly of the Province of Ontario, enacts as follows: 1 The Residential Tenancies Act, 2006 is amended by adding the following section: No eviction under ss. 48 and 49 during non-enforcement period Definition 49.1.1 (1) In this section, “non-enforcement period” means the period that begins on January 1, 2025 and ends on December 31, 2025. No termination of tenancy (2) No landlord shall, during the non-enforcement period, terminate a tenancy in accordance with section 48 or 49. Exception (3) Subsection (2) does not apply if the landlord is terminating a tenancy for the purpose of occupation by a person who provides or will provide care services, as described in clause 48 (1) (d), 49 (1) (d) or 49 (2) (d). 2 (1) Subsection 120 (3.1) of the Act is amended by striking out “2021” wherever it appears and substituting in each case “2025”. (2) Subsection 120 (3.2) of the Act is amended by striking out “2021” and substituting “2025”. 3 (1) The definition of “rent freeze period” in subsection 136.1 (1) of the Act is amended by striking out “January 1, 2021 and ends on December 31, 2021” at the end and substituting “January 1, 2025 and ends on December 31, 2025”. (2) Subclause 136.1 (2) (c) (i) of the Act is amended by striking out “Helping Tenants and Small Businesses Act, 2020” and substituting “Relief for Renters Act, 2024”. (3) Subsection 136.1 (3) of the Act is amended by striking out “Helping Tenants and Small Businesses Act, 2020” and substituting “Relief for Renters Act, 2024”. 4 The Act is amended by adding the following section: Transition regulations, Relief for Renters Act, 2024 241.5 (1) The Lieutenant Governor in Council may make regulations governing transitional matters that, in the opinion of the Lieutenant Governor in Council, are necessary or advisable to deal with issues arising out of the amendments to this Act made by the Relief for Renters Act, 2024. Same (2) A regulation made under subsection (1) may govern the application of provisions of this Act to proceedings before a court or the Board in which a claim is made relating to amendments to this Act made by the Relief for Renters Act, 2024 and which were commenced before the commencement date of the amendment. Commencement 5 This Act comes into force on the day it receives Royal Assent. Short title 6 The short title of this Act is the Relief for Renters Act, 2024. ",Legal,Find & Summarize,Text Transformation "You must answer all user questions using information provided in the prompt. No other sources of information, including your stored data may be used. Format your answer in bullet points and use bold for any key terminology or jargon. ",How can bad actors use Artificial Intelligence to breach existing cybersecurity defenses?,"AI for Cybersecurity Many attacks target relatively simple errors, such as misconfigurations of systems, that are hidden in a vast amount of correct data. Logic-based AI systems are exceptionally good at noticing these kinds of inconsistencies and knowing how to repair them. Other attacks may show up as departures from standard usage patterns. These patterns may not be obviously anomalous, can be hidden deep within data streams, and are unlikely to be visible to humans. Though often indescribable by humans, these patterns can be learned by machines and noticed at scale. It is understood that significant leverage is gained from having a small team of highly skilled cyber defenders protecting networks used by thousands. Using AI could enable similar levels of protection to become ubiquitous while providing the domain experience necessary to address other aspects, such as quality-of-service constraints and degradation-of-system behaviors. AI can also play a role in securely deploying and operating software systems. Once code is developed, AI techniques can automatically explore for low-level attack vectors, or where appropriate, domain and application configuration or logic errors. Similarly, AI can also advise IT professionals on best practices for the secure operation and monitoring of critical systems. Automated configuration advice can secure systems against unsophisticated adversaries, whereas AI-based network monitoring can detect patterns of attack that are associated with more sophisticated nation-state adversaries. Open-source software development offers a unique setting to apply these AI-based software assurance techniques. With its widespread use by commercial and government organizations, open-source security improvements would be extremely high impact (e.g., an automated system that continually proposes security patches for open source software). At the same time, the public nature of open source development adds new challenges concerning the malicious introduction of functionality and corruption of data by an AI-based agent. This requires further exploration. AI for Identity Management Identity management and access control are central to securing modern communication systems and data stores. However, an adversary can compromise many of these systems by stealing relatively small authorization tokens. AI-based identity management can make access-control decisions based on a history of interactions, and it is difficult to circumvent. By characterizing expected behavior, AI techniques can provide protection with more lightweight and transparent mechanisms than current approaches (e.g., two-person authorization requirements for certain actions). AI also can enhance accuracy and reduce threats against biometric authentication systems. However, there is a downside to using AI for identify management. AI monitoring of behavioral patterns to provide authorization and detect insider threats could enable ongoing privacy violations in the system. Research is needed to push monitoring and decision-making procedures closer to where they are needed, and to use techniques such as differential privacy to limit the scope of privacy violations. These efforts should include both the ethical and technical aspects of identity management and examine the potential for abuse. AI techniques are likely to be used by attackers as well as defenders. Traditional defensive strategy sought to eliminate vulnerabilities or to increase the costs of an attack. The use of AI could dramatically alter the attack risk and cost equations. Automated systems will need to plan for worst cases and anticipate, respond, and analyze potential and actual threat occurrences. Research is needed to understand how AI changes the attacker and defender balance of capabilities, and how it alters attack economics. There are multiple stakeholders involved in cyber defensive scenarios, including data owners, service providers, system operators, and those affected by AI-based decisions. How stakeholders are consulted and informed about autonomous operations and how decision-making is delegated and constrained are important considerations. Two areas of specific interest are autonomous attacks and mission-specific resilience. Autonomous Attacks Cyber defenders will face attacks created and orchestrated by AI systems. At the most basic level, where there is a stable cyber environment, attacks could be constructed using classic deterministic planning. At the next level, where the environment is uncertain, attacks may involve planning under uncertainty. In the extreme case where minimal information about the environment and defenses is available, the attacker could use autonomous techniques to discover information and learn how to attack and execute plans for cyber reconnaissance. The attacker’s challenges include the need to remain stealthy and avoid any deception mechanisms. The attacker may use AI to develop strategies that include building a model of the victim network or system (i.e., AI-enabled program synthesis). An adversary can systematically generate programs that have a fixed behavior to learn about a cybersecurity product—using it as an oracle. At a high level, the attacker can generate code examples and predict whether the defense technology would detect the attacker’s presence as malicious. Using the answers, the attacker can build a model of the cybersecurity product. Methods and techniques are needed to make deployed systems resistant to automated analysis and attack, by either increasing the cost or continuing to close system loopholes. One promising technique is automated isolation (e.g., behavioral restrictions). Attacks can exploit the universality of program execution because most software components are designed to have limited behavior. Sandboxes have proven effective in protecting software from memory corruption attacks, but more precise methods are needed. There is value in exploring AI systems that learn the scope of valid behaviors and limit components to those behaviors. Another method is to strategically study defensive agility. How and when should plans and systems be updated? Can results from simulation environments be applied to real systems? What are the principles behind simulating? What is possible, and what is useful? Mission-Specific Resilience Many cybersecurity techniques are designed to be broadly applicable. While often beneficial, applying techniques without accounting for the objectives of the enterprise can lead to problems, including failure to meet the mission (whether social, industrial, or military). Domain experts must team with the AI experts to categorize system attacks and model responses in the context of the primary mission of the organization. Conflict between security measures designed for distinct computing resources, whether they are run concurrently or in sequence, is a challenge. For example, one autonomous agent may be working to lay a cyber deception trail to confuse a cyber attacker while another agent may be trying to simplify the network structure to reduce the attack surface. Autonomous Cyber Defense As adversaries use AI to identify vulnerable systems, amplify points of attack, coordinate resources, and stage attacks at scale, defenders need to respond accordingly. Current practice is often focused on the detection of individual exploits, but sophisticated attacks can involve multiple stages—including penetration, lateral motion, privilege escalation, malware staging, and/or persistence establishment—before the ultimate target is compromised. Although modern ML techniques can detect the individual events that constitute this “cyber kill chain,” a bottom-up approach that sequentially addresses the various stages of attack is inadequate. Progress requires integration activity at the tactical level into a top-down strategic view that reveals the attacker’s goals and current status, and helps coordinate, focus, and manage available defensive resources. Consider the scenario of an attack on a power distribution system. Initial penetration is accomplished through a phishing email and the initial foothold is on a normal workstation. A larger malware package is downloaded that includes a key logger and a “kill disk” that consumes all the space on the workstation disk. The credentials of a system administrator who logs in to repair the workstation are exfiltrated to the attacker, and the attacker moves to the power grid’s operator console, able then to disable the entire distribution network. ","System instruction: You must answer all user questions using information provided in the prompt. No other sources of information, including your stored data may be used. Format your answer in bullet points and use bold for any key terminology or jargon. Context block: AI for Cybersecurity Many attacks target relatively simple errors, such as misconfigurations of systems, that are hidden in a vast amount of correct data. Logic-based AI systems are exceptionally good at noticing these kinds of inconsistencies and knowing how to repair them. Other attacks may show up as departures from standard usage patterns. These patterns may not be obviously anomalous, can be hidden deep within data streams, and are unlikely to be visible to humans. Though often indescribable by humans, these patterns can be learned by machines and noticed at scale. It is understood that significant leverage is gained from having a small team of highly skilled cyber defenders protecting networks used by thousands. Using AI could enable similar levels of protection to become ubiquitous while providing the domain experience necessary to address other aspects, such as quality-of-service constraints and degradation-of-system behaviors. AI can also play a role in securely deploying and operating software systems. Once code is developed, AI techniques can automatically explore for low-level attack vectors, or where appropriate, domain and application configuration or logic errors. Similarly, AI can also advise IT professionals on best practices for the secure operation and monitoring of critical systems. Automated configuration advice can secure systems against unsophisticated adversaries, whereas AI-based network monitoring can detect patterns of attack that are associated with more sophisticated nation-state adversaries. Open-source software development offers a unique setting to apply these AI-based software assurance techniques. With its widespread use by commercial and government organizations, open-source security improvements would be extremely high impact (e.g., an automated system that continually proposes security patches for open source software). At the same time, the public nature of open source development adds new challenges concerning the malicious introduction of functionality and corruption of data by an AI-based agent. This requires further exploration. AI for Identity Management Identity management and access control are central to securing modern communication systems and data stores. However, an adversary can compromise many of these systems by stealing relatively small authorization tokens. AI-based identity management can make access-control decisions based on a history of interactions, and it is difficult to circumvent. By characterizing expected behavior, AI techniques can provide protection with more lightweight and transparent mechanisms than current approaches (e.g., two-person authorization requirements for certain actions). AI also can enhance accuracy and reduce threats against biometric authentication systems. However, there is a downside to using AI for identify management. AI monitoring of behavioral patterns to provide authorization and detect insider threats could enable ongoing privacy violations in the system. Research is needed to push monitoring and decision-making procedures closer to where they are needed, and to use techniques such as differential privacy to limit the scope of privacy violations. These efforts should include both the ethical and technical aspects of identity management and examine the potential for abuse. AI techniques are likely to be used by attackers as well as defenders. Traditional defensive strategy sought to eliminate vulnerabilities or to increase the costs of an attack. The use of AI could dramatically alter the attack risk and cost equations. Automated systems will need to plan for worst cases and anticipate, respond, and analyze potential and actual threat occurrences. Research is needed to understand how AI changes the attacker and defender balance of capabilities, and how it alters attack economics. There are multiple stakeholders involved in cyber defensive scenarios, including data owners, service providers, system operators, and those affected by AI-based decisions. How stakeholders are consulted and informed about autonomous operations and how decision-making is delegated and constrained are important considerations. Two areas of specific interest are autonomous attacks and mission-specific resilience. Autonomous Attacks Cyber defenders will face attacks created and orchestrated by AI systems. At the most basic level, where there is a stable cyber environment, attacks could be constructed using classic deterministic planning. At the next level, where the environment is uncertain, attacks may involve planning under uncertainty. In the extreme case where minimal information about the environment and defenses is available, the attacker could use autonomous techniques to discover information and learn how to attack and execute plans for cyber reconnaissance. The attacker’s challenges include the need to remain stealthy and avoid any deception mechanisms. The attacker may use AI to develop strategies that include building a model of the victim network or system (i.e., AI-enabled program synthesis). An adversary can systematically generate programs that have a fixed behavior to learn about a cybersecurity product—using it as an oracle. At a high level, the attacker can generate code examples and predict whether the defense technology would detect the attacker’s presence as malicious. Using the answers, the attacker can build a model of the cybersecurity product. Methods and techniques are needed to make deployed systems resistant to automated analysis and attack, by either increasing the cost or continuing to close system loopholes. One promising technique is automated isolation (e.g., behavioral restrictions). Attacks can exploit the universality of program execution because most software components are designed to have limited behavior. Sandboxes have proven effective in protecting software from memory corruption attacks, but more precise methods are needed. There is value in exploring AI systems that learn the scope of valid behaviors and limit components to those behaviors. Another method is to strategically study defensive agility. How and when should plans and systems be updated? Can results from simulation environments be applied to real systems? What are the principles behind simulating? What is possible, and what is useful? Mission-Specific Resilience Many cybersecurity techniques are designed to be broadly applicable. While often beneficial, applying techniques without accounting for the objectives of the enterprise can lead to problems, including failure to meet the mission (whether social, industrial, or military). Domain experts must team with the AI experts to categorize system attacks and model responses in the context of the primary mission of the organization. Conflict between security measures designed for distinct computing resources, whether they are run concurrently or in sequence, is a challenge. For example, one autonomous agent may be working to lay a cyber deception trail to confuse a cyber attacker while another agent may be trying to simplify the network structure to reduce the attack surface. Autonomous Cyber Defense As adversaries use AI to identify vulnerable systems, amplify points of attack, coordinate resources, and stage attacks at scale, defenders need to respond accordingly. Current practice is often focused on the detection of individual exploits, but sophisticated attacks can involve multiple stages—including penetration, lateral motion, privilege escalation, malware staging, and/or persistence establishment—before the ultimate target is compromised. Although modern ML techniques can detect the individual events that constitute this “cyber kill chain,” a bottom-up approach that sequentially addresses the various stages of attack is inadequate. Progress requires integration activity at the tactical level into a top-down strategic view that reveals the attacker’s goals and current status, and helps coordinate, focus, and manage available defensive resources. Consider the scenario of an attack on a power distribution system. Initial penetration is accomplished through a phishing email and the initial foothold is on a normal workstation. A larger malware package is downloaded that includes a key logger and a “kill disk” that consumes all the space on the workstation disk. The credentials of a system administrator who logs in to repair the workstation are exfiltrated to the attacker, and the attacker moves to the power grid’s operator console, able then to disable the entire distribution network. Question: How can bad actors use Artificial Intelligence to breach existing cybersecurity defenses?",Internet/Technology,Find & Summarize,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","I am looking into getting Lasik surgery. However, I'd like to know more about the history of how it came to be. Using the article provided, please explain the accident that caused Lasik to be discovered. Use at least 400 words.","A laboratory accident with a laser more than 30 years ago served as the unlikely first step in the development of an entire industry that has helped more than 30 million people overcome vision problems. In 1993, a graduate student at the University of Michigan's Center for Ultrafast Optical Science (CUOS) suffered an accidental laser injury to his eye. The femtosecond laser, which emits pulses of light with a duration of one-quadrillionth of a second (equivalent to one-millionth of one-billionth of a second), left a series of pinpoint laser burns in the center of the retina without damaging any adjacent tissue. The incident instead sparked a collaboration that would result in a revolutionary approach to corrective eye surgery, commonly known as LASIK. Bladeless LASIK, or laser in situ keratomileusis, uses a femtosecond laser rather than a scalpel to cut into the cornea before it is reshaped to improve the patient's vision. Juhasz with deviceJuhasz, a professor of ophthalmology and biomedical engineering at UC Irvine, won a 2022 Golden Goose Award for helping to develop the widely used LASIK surgery device. Credit: Steve Zylius, UC Irvine The laser technology and surgical procedures were developed by a team of scientists at CUOS, a Science and Technology Center funded by the U.S. National Science Foundation from 1990 to 2001. The path from lab to global use, which included additional support from NSF as well as the Department of Energy, the National Institutes of Health and other agencies, is an example of how federal support for basic and translational research produces new technologies with broad societal benefit. Development and commercialization Tibor Juhasz, then a research associate professor in ophthalmology and biomedical engineering at the university, began working with the research team — led by French physicist Gerard Mourou — to see if the laser, which employs ultrashort pulses, could be used for medical purposes. In 1997, Juhasz and Ron Kurtz, then an assistant professor of ophthalmology, founded IntraLase Corp. to commercialize their approach. At IntraLase, Juhasz and Kurtz developed a shoebox-sized instrument to perform bladeless LASIK cornea surgery. The company also received critical support from NSF's Small Business Innovation Research (SBIR) program, which invests in startups to help them develop their ideas and bring them to the market. Compared to bladed surgery, the laser procedure was painless and reduced recovery time for patients, but it took several years to catch on. Military lasix surgeryIn 2007, an ophthalmology surgeon at National Naval Medical Center Bethesda performs LASIK IntraLase surgery. Credit: U.S. Navy Juhasz, now a biomedical engineering and ophthalmology professor at the University of California, Irvine, described the early stages of commercializing the technology as difficult and highlighted the NSF support as crucial: ""There were some bad examples in ophthalmology of laser companies. There were some failures, and that kind of scared away venture capitalists from the industry. But our center was funded by NSF, and that was a big endorsement."" In 2006, a U.S. Navy study concluded that military pilots who underwent the procedure recovered faster and had better vision than those who had conventional operations, giving the procedure a commercial boost. In 2007, IntraLase was acquired for $808 million. ""The story is that an entire industry developed out of those basic laser-tissue interaction experiments. I think that the initial success of IntraLase created followers, therefore lots of new jobs. I believe that a lot of highly trained scientists are working in these companies as we speak,"" Juhasz said. ""I remember the first steps,"" said Denise Caldwell, acting assistant director of NSF's Directorate for Mathematical and Physical Sciences. In the 1990s, Caldwell was the NSF program director managing the research grants that supported the femtosecond laser research at the University of Michigan. ""One of the things we did in talking with the researchers at Michigan was tell them 'if you think there is promise here, you should follow it. Use the resources you have to pursue it.' Having a creative group of individuals and giving that group the flexibility to pursue new directions as they identify them is very important."" NSF support and global recognition In 2022, Juhasz, Kurtz, Mourou, Strickland and Detao Du — the researcher who had the incident with the laser — received the Golden Goose Award for scientific breakthroughs that led to the development of bladeless LASIK. This award, presented by the American Association for the Advancement of Science, honors scientists whose federally funded research has unexpectedly benefited society. In 2018, Mourou and Donna Strickland were awarded the Nobel Prize in Physics for a ""method of generating high-intensity, ultra-short optical pulses."" Ron Kurtz and Tibor Juhasz with the 1000th LensX FS Laser during the build process. Credit: Tibor Juhasz, UC Irvine Beginning in 1980, NSF supported Mourou with several awards for cross-disciplinary work in physics, materials, electrical engineering and biology. NSF funding helped Mourou establish a biological physics facility at the University of Rochester, and CUOS at the University of Michigan now bears his name. NSF support also helped transition technology developed in Mourou's labs to commercial applications. ""It's fully demonstrated here the importance, particularly for the biomedical area, of bringing the physicists and the engineers together to work with clinicians,"" Caldwell said. ""It's really a joint effort between scientists, engineers and companies to make the necessary fundamental discoveries and early prototypes that can eventually become mature technologies that broadly benefit people and communities."" The future Work based on the initial research continues today as many scientists explore other potential applications of the femtosecond laser. In 2008, Juhasz and Kurtz developed femtosecond laser cataract surgery, and a startup led by Juhasz, ViaLase Inc., is currently conducting clinical trials on new methods to treat glaucoma with femtosecond lasers. Clerio Vision, another small business founded based on NSF-funded basic research and which received SBIR funding from NSF at its inception, is also working on a different approach, based on femtosecond laser pulses, to correct various vision impairments. ViaLase LaserThe ViaLase Laser combines femtosecond laser technology and micron-level image guidance to deliver a noninvasive glaucoma treatment called femtosecond laser image-guided high-precision trabeculotomy (FLigHT). Credit: ViaLase ""We can really say that femtosecond laser technology changed how ophthalmic surgery is done today, and I really need to thank NSF for the initial funding and creating this great journey,"" Juhasz said. ""This story illustrates the importance of foundational science to our society and economy, and also equally importantly, the investments that we make in aiding the translation of research from the lab to the market,"" said Erwin Gianchandani, NSF assistant director for Technology, Innovation and Partnerships. ""That's why NSF established a new directorate for Technology, Innovation and Partnerships in March 2022 — our first new directorate in more than 30 years — to specifically accelerate use-inspired and translational research across all areas of science and engineering.""","""================ ======= A laboratory accident with a laser more than 30 years ago served as the unlikely first step in the development of an entire industry that has helped more than 30 million people overcome vision problems. In 1993, a graduate student at the University of Michigan's Center for Ultrafast Optical Science (CUOS) suffered an accidental laser injury to his eye. The femtosecond laser, which emits pulses of light with a duration of one-quadrillionth of a second (equivalent to one-millionth of one-billionth of a second), left a series of pinpoint laser burns in the center of the retina without damaging any adjacent tissue. The incident instead sparked a collaboration that would result in a revolutionary approach to corrective eye surgery, commonly known as LASIK. Bladeless LASIK, or laser in situ keratomileusis, uses a femtosecond laser rather than a scalpel to cut into the cornea before it is reshaped to improve the patient's vision. Juhasz with deviceJuhasz, a professor of ophthalmology and biomedical engineering at UC Irvine, won a 2022 Golden Goose Award for helping to develop the widely used LASIK surgery device. Credit: Steve Zylius, UC Irvine The laser technology and surgical procedures were developed by a team of scientists at CUOS, a Science and Technology Center funded by the U.S. National Science Foundation from 1990 to 2001. The path from lab to global use, which included additional support from NSF as well as the Department of Energy, the National Institutes of Health and other agencies, is an example of how federal support for basic and translational research produces new technologies with broad societal benefit. Development and commercialization Tibor Juhasz, then a research associate professor in ophthalmology and biomedical engineering at the university, began working with the research team — led by French physicist Gerard Mourou — to see if the laser, which employs ultrashort pulses, could be used for medical purposes. In 1997, Juhasz and Ron Kurtz, then an assistant professor of ophthalmology, founded IntraLase Corp. to commercialize their approach. At IntraLase, Juhasz and Kurtz developed a shoebox-sized instrument to perform bladeless LASIK cornea surgery. The company also received critical support from NSF's Small Business Innovation Research (SBIR) program, which invests in startups to help them develop their ideas and bring them to the market. Compared to bladed surgery, the laser procedure was painless and reduced recovery time for patients, but it took several years to catch on. Military lasix surgeryIn 2007, an ophthalmology surgeon at National Naval Medical Center Bethesda performs LASIK IntraLase surgery. Credit: U.S. Navy Juhasz, now a biomedical engineering and ophthalmology professor at the University of California, Irvine, described the early stages of commercializing the technology as difficult and highlighted the NSF support as crucial: ""There were some bad examples in ophthalmology of laser companies. There were some failures, and that kind of scared away venture capitalists from the industry. But our center was funded by NSF, and that was a big endorsement."" In 2006, a U.S. Navy study concluded that military pilots who underwent the procedure recovered faster and had better vision than those who had conventional operations, giving the procedure a commercial boost. In 2007, IntraLase was acquired for $808 million. ""The story is that an entire industry developed out of those basic laser-tissue interaction experiments. I think that the initial success of IntraLase created followers, therefore lots of new jobs. I believe that a lot of highly trained scientists are working in these companies as we speak,"" Juhasz said. ""I remember the first steps,"" said Denise Caldwell, acting assistant director of NSF's Directorate for Mathematical and Physical Sciences. In the 1990s, Caldwell was the NSF program director managing the research grants that supported the femtosecond laser research at the University of Michigan. ""One of the things we did in talking with the researchers at Michigan was tell them 'if you think there is promise here, you should follow it. Use the resources you have to pursue it.' Having a creative group of individuals and giving that group the flexibility to pursue new directions as they identify them is very important."" NSF support and global recognition In 2022, Juhasz, Kurtz, Mourou, Strickland and Detao Du — the researcher who had the incident with the laser — received the Golden Goose Award for scientific breakthroughs that led to the development of bladeless LASIK. This award, presented by the American Association for the Advancement of Science, honors scientists whose federally funded research has unexpectedly benefited society. In 2018, Mourou and Donna Strickland were awarded the Nobel Prize in Physics for a ""method of generating high-intensity, ultra-short optical pulses."" Ron Kurtz and Tibor Juhasz with the 1000th LensX FS Laser during the build process. Credit: Tibor Juhasz, UC Irvine Beginning in 1980, NSF supported Mourou with several awards for cross-disciplinary work in physics, materials, electrical engineering and biology. NSF funding helped Mourou establish a biological physics facility at the University of Rochester, and CUOS at the University of Michigan now bears his name. NSF support also helped transition technology developed in Mourou's labs to commercial applications. ""It's fully demonstrated here the importance, particularly for the biomedical area, of bringing the physicists and the engineers together to work with clinicians,"" Caldwell said. ""It's really a joint effort between scientists, engineers and companies to make the necessary fundamental discoveries and early prototypes that can eventually become mature technologies that broadly benefit people and communities."" The future Work based on the initial research continues today as many scientists explore other potential applications of the femtosecond laser. In 2008, Juhasz and Kurtz developed femtosecond laser cataract surgery, and a startup led by Juhasz, ViaLase Inc., is currently conducting clinical trials on new methods to treat glaucoma with femtosecond lasers. Clerio Vision, another small business founded based on NSF-funded basic research and which received SBIR funding from NSF at its inception, is also working on a different approach, based on femtosecond laser pulses, to correct various vision impairments. ViaLase LaserThe ViaLase Laser combines femtosecond laser technology and micron-level image guidance to deliver a noninvasive glaucoma treatment called femtosecond laser image-guided high-precision trabeculotomy (FLigHT). Credit: ViaLase ""We can really say that femtosecond laser technology changed how ophthalmic surgery is done today, and I really need to thank NSF for the initial funding and creating this great journey,"" Juhasz said. ""This story illustrates the importance of foundational science to our society and economy, and also equally importantly, the investments that we make in aiding the translation of research from the lab to the market,"" said Erwin Gianchandani, NSF assistant director for Technology, Innovation and Partnerships. ""That's why NSF established a new directorate for Technology, Innovation and Partnerships in March 2022 — our first new directorate in more than 30 years — to specifically accelerate use-inspired and translational research across all areas of science and engineering."" https://new.nsf.gov/science-matters/invention-impact-story-lasik-eye-surgery ================ ======= I am looking into getting Lasik surgery. However, I'd like to know more about the history of how it came to be. Using the article provided, please explain the accident that caused Lasik to be discovered. Use at least 400 words. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Effect Analysis,Q&A "Draw your answer only from the provided text. If you cannot answer using the provided text alone, respond with ""I cannot determine an answer due to insufficient context."". Make sure to provide your answer solely in a bulleted list, and be concise.",How does a theoretical world without crisis differ from the real word in terms of intra and intertemporal trade?,"In theory, countries exchange assets with different risk profiles to smooth consumption fluctuations across future random states of nature. This intratemporal trade, an exchange of consumption across different states of nature that occur on the same date, may be contrasted with intertemporal trade, in which consumption on one date is traded for an asset entitling the buyer to consumption on a future date. Cross-border purchases of assets with other assets are intratemporal trades, purchases of goods or services with assets are intertemporal trades. A country’s intertemporal budget constraint limits the present value of its (state-contingent) expenditure (on consumption and investment) to the present value of its (state-contingent) output plus the market value of its net financial claims on the outside world (the net international investment position, or NIIP). Thus, a country’s ultimate consumption possibilities depend not only on the NIIP, but on the prices a country faces in world markets and its (stochastic) output and investment levels. Ideally, if a country has maximally hedged its idiosyncratic risk in world asset markets, its NIIP will respond to shocks (including shocks to current and future world prices) in ways that cushion domestic consumption possibilities. Furthermore, if markets are complete in the sense of Arrow and Debreu, asset trades between individuals will indeed represent Pareto improvements in resource allocation, so that it makes sense to speak of countries as if they consisted of representative individuals. But this type of world – a world without crises – is not the world we inhabit. In the real world, financial trades that one agent makes, viewing them as personally advantageous, canwork to the detriment of others. The implication is that the sheer volume of financial trade can be positively correlated with financial instability risks. It is in the realm of intratemporal asset trade that international trading volume has expanded most in recent years. Fig. 1 illustrates the process. The upper horizontal arrows represent (intratemporal) trade of presently available goods for other present goods between a home and a foreign country, with arrow lengths proportional to the value of the items exchanged. In the figure, Home ships a higher value of goods to Foreign than Foreign ships to Home, so the net difference (Home’s current account surplus)must be paid for by assets that Foreign pays to Home in settlement of the Foreign current account deficit. The implied intertemporal trade – of present consumption for claims on future consumption– is shown in the figure by the diagonal arrows, with lengths equal to the current account imbalance between Home and Foreign. The lower horizontal arrows in Fig. 1 represent intratemporal trade of assets for other assets by the two countries. Home buys more assets from Foreign than it sells – financing the difference through its current export surplus – but while the difference in the two arrows’ lengths is fixed by the size of the current account imbalance, the arrow lengths themselves can be arbitrarily big. At any point in time, the size of the current account imbalance is limited by output sizes and the sizes of predetermined international assets and liabilities – but there is no limit to the number of times funds can be recycled in different forms between Home and Foreign. In that process, the gross external assets and liabilities of the two countries can expand explosively.","System Instructions: Draw your answer only from the provided text. If you cannot answer using the provided text alone, respond with ""I cannot determine an answer due to insufficient context."". Make sure to provide your answer solely in a bulleted list, and be concise. Question: How does a theoretical world without crisis differ from the real word in terms of intra and intertemporal trade? Context Block: In theory, countries exchange assets with different risk profiles to smooth consumption fluctuations across future random states of nature. This intratemporal trade, an exchange of consumption across different states of nature that occur on the same date, may be contrasted with intertemporal trade, in which consumption on one date is traded for an asset entitling the buyer to consumption on a future date. Cross-border purchases of assets with other assets are intratemporal trades, purchases of goods or services with assets are intertemporal trades. A country’s intertemporal budget constraint limits the present value of its (state-contingent) expenditure (on consumption and investment) to the present value of its (state-contingent) output plus the market value of its net financial claims on the outside world (the net international investment position, or NIIP). Thus, a country’s ultimate consumption possibilities depend not only on the NIIP, but on the prices a country faces in world markets and its (stochastic) output and investment levels. Ideally, if a country has maximally hedged its idiosyncratic risk in world asset markets, its NIIP will respond to shocks (including shocks to current and future world prices) in ways that cushion domestic consumption possibilities. Furthermore, if markets are complete in the sense of Arrow and Debreu, asset trades between individuals will indeed represent Pareto improvements in resource allocation, so that it makes sense to speak of countries as if they consisted of representative individuals. But this type of world – a world without crises – is not the world we inhabit. In the real world, financial trades that one agent makes, viewing them as personally advantageous, canwork to the detriment of others. The implication is that the sheer volume of financial trade can be positively correlated with financial instability risks. It is in the realm of intratemporal asset trade that international trading volume has expanded most in recent years. Fig. 1 illustrates the process. The upper horizontal arrows represent (intratemporal) trade of presently available goods for other present goods between a home and a foreign country, with arrow lengths proportional to the value of the items exchanged. In the figure, Home ships a higher value of goods to Foreign than Foreign ships to Home, so the net difference (Home’s current account surplus)must be paid for by assets that Foreign pays to Home in settlement of the Foreign current account deficit. The implied intertemporal trade – of present consumption for claims on future consumption– is shown in the figure by the diagonal arrows, with lengths equal to the current account imbalance between Home and Foreign. The lower horizontal arrows in Fig. 1 represent intratemporal trade of assets for other assets by the two countries. Home buys more assets from Foreign than it sells – financing the difference through its current export surplus – but while the difference in the two arrows’ lengths is fixed by the size of the current account imbalance, the arrow lengths themselves can be arbitrarily big. At any point in time, the size of the current account imbalance is limited by output sizes and the sizes of predetermined international assets and liabilities – but there is no limit to the number of times funds can be recycled in different forms between Home and Foreign. In that process, the gross external assets and liabilities of the two countries can expand explosively.",Financial,Concept Comparison,Q&A This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. The response should be no more than 500 words and exactly 3 paragraphs.,Paraphrase the text.,"Status Offenses Status offenses comprise one category that may pose a particular issue with respect to the act requirement. As one legal scholar has explained, status offenses are crimes such as vagrancy, which are “often defined in such a way as to punish status (e.g., being a vagrant) rather than to punish specific action or omission to act.”205 On a number of occasions, examples of which follow, the Supreme Court has invalidated laws establishing status offenses. In its 1957 opinion in Lambert v. California, 206 the Court reversed a conviction under an ordinance that made it “unlawful for ‘any convicted person’ to be or remain in Los Angeles for a period of more than five days without registering” and required “any person having a place of abode outside the city to register if he comes into the city on five occasions or more during a 30- day period.”207 The Court explained that the law criminalized “conduct that is wholly passive— mere failure to register,” which it viewed as “unlike the commission of acts, or the failure to act under circumstances that should alert the doer to the consequences of his deed.”208 As a result, the Court held that the ordinance violated the defendant’s due process right to notice.209 Following Lambert, however, a number of mandatory registration laws have survived constitutional challenges.210 For instance, in examining an indictment for a violation of the federal Sex Offender Registration and Notification Act (SORNA), the Ninth Circuit agreed with the government that “Lambert is inapplicable because convicted sex offenders are generally subject to registration requirements in all fifty states, and [the defendant] was aware that he was obligated to register as a sex offender.” 211 In a 1962 opinion in Robinson v. California, 212 the Court reversed a conviction under a state law that criminalized addiction to narcotics without requiring any additional act by the defendant. According to the Court, the statute was distinguishable from “one which punishes a person for the use of narcotics, for their purchase, sale or possession, or for antisocial or disorderly behavior resulting from their administration,” since it instead made “the ‘status’ of narcotic addiction a criminal offense, for which the offender may be prosecuted ‘at any time before he reforms.’” 213 The Court held that the law, “which imprisons a person . . . afflicted [by narcotics addiction] as a criminal, even though he has never touched any narcotic drug within the State or been guilty of any irregular behavior there, inflicts a cruel and unusual punishment” in violation of the Eighth Amendment, as incorporated against the states through the Fourteenth Amendment.214 Status offenses can often be “reformulated and redrafted to conform to basic principles of criminal justice.”215 For instance, if a “statute that penalizes being an alcoholic or drug addict is impermissible,” a “statute that penalizes appearing in public in an intoxicated state” may be permissible. 216 The Supreme Court’s 1968 opinion in Powell v. Texas217 illustrates this distinction. Powell stemmed from the conviction of a defendant under a state law making it a crime to “get drunk or be found in a state of intoxication in any public place, or at any private house except [a person’s] own.”218 The defendant argued that he had a compulsion to drink and that the law amounted to cruel and unusual punishment pursuant to Robinson. 219 A four-Justice plurality of the Court disagreed and explained that the defendant was convicted “not for being a chronic alcoholic, but for being in public while drunk on a particular occasion.”220 In other words, the plurality concluded that the law did not seek “to punish a mere status” as the law at issue in Robinson did, but instead punished a voluntary act, being in public while intoxicated.221 In a concurring opinion, Justice White said that the result would have been different if the public intoxication were an unavoidable result of chronic alcoholism.222 For example, according to Justice White, the Eighth Amendment would prohibit criminalizing public intoxication for chronic alcoholics who are homeless because “they have no place else to go and no place else to be when they are drinking.” 223 Four dissenting Justices would have agreed with that conclusion.224 The primary point of departure between Justice White and the dissenting Justices was over the record in Powell—Justice White agreed with the ultimate result in Powell because “nothing in the record indicates that [the defendant] could not have done his drinking in private or that he was so inebriated at the time that he had lost control of his movements and wandered into the public street.”225 The dissenting Justices concluded, however, that the “appellant is a ‘chronic alcoholic’ who, according to the trier of fact, cannot resist the ‘constant excessive consumption of alcohol’ and does not appear in public by his own volition but under a compulsion’ which is part of his condition.” 226Another example of the distinction between an impermissible status offense and a seemingly permissible conduct-based offense may be found in 8 U.S.C. § 1326, which in relevant part provides that “any alien who (1) has been arrested and deported or excluded and deported, and thereafter (2) enters, attempts to enter, or is at any time found in, the United States . . . [without the consent of the Attorney General] shall be fined . . . or imprisoned . . . or both.”227 Some federal appellate courts have rejected the argument that “the ‘found in’ provision of § 1326 impermissibly punishes aliens for their ‘status’ of being found in the United States.”228 In United States v. Ayala, the Ninth Circuit distinguished § 1326 from the law at issue in Robinson, explaining that “[a] conviction under § 1326 for being ‘found in’ the United States necessarily requires that a defendant commit an act: he must re-enter the United States without permission within five years after being deported.”229 Federal appellate courts had split on the issue of whether the Robinson and Powell distinction between impermissible status offenses and permissible conduct-based offenses allowed “criminalizing conduct that is an unavoidable consequence of one’s status.”230 In the 2024 opinion City of Grants Pass v. Johnson, the Supreme Court examined this issue in the context of a municipal ordinance criminalizing sleeping or camping in public.231 In a divided opinion, the Ninth Circuit concluded that the ordinance constituted cruel and unusual punishment, citing to Powell’s concurrence and dissent for the proposition that “a person cannot be prosecuted for involuntary conduct if it is an unavoidable consequence of one’s status.” 232 The Ninth Circuit observed that this would be the inevitable outcome for some of the involuntary homeless population in Grants Pass, which exceeded the available shelter space in the jurisdiction.233 The Supreme Court disagreed, concluding that the camping ordinance was not a status offense of the type barred in Robinson (which lacked a mental state or act requirement), because the ordinance in Grants Pass required “actions like ‘occupy[ing] a campsite’ on public property ‘for the purpose of maintaining a temporary place to live.’” 234 The Court likened the facts of Grants Pass to those of Powell and relied on the Powell plurality’s distinction between laws criminalizing status and those criminalizing acts, even if on some level those acts may be an involuntary result of the underlying status.235 Although the Court did not reconsider Robinson, it reiterated that the Cruel and Unusual Punishments Clause of the Eighth Amendment focuses on the method or kind of punishment a government may impose, rather than on the question of what a government may criminalize. 236 Additional analysis of Grants Pass and its broader implications for status offenses and homelessness laws may be found in other CRS products.23","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. The response should be no more than 500 words and exactly 3 paragraphs. Status Offenses Status offenses comprise one category that may pose a particular issue with respect to the act requirement. As one legal scholar has explained, status offenses are crimes such as vagrancy, which are “often defined in such a way as to punish status (e.g., being a vagrant) rather than to punish specific action or omission to act.”205 On a number of occasions, examples of which follow, the Supreme Court has invalidated laws establishing status offenses. In its 1957 opinion in Lambert v. California, 206 the Court reversed a conviction under an ordinance that made it “unlawful for ‘any convicted person’ to be or remain in Los Angeles for a period of more than five days without registering” and required “any person having a place of abode outside the city to register if he comes into the city on five occasions or more during a 30- day period.”207 The Court explained that the law criminalized “conduct that is wholly passive— mere failure to register,” which it viewed as “unlike the commission of acts, or the failure to act under circumstances that should alert the doer to the consequences of his deed.”208 As a result, the Court held that the ordinance violated the defendant’s due process right to notice.209 Following Lambert, however, a number of mandatory registration laws have survived constitutional challenges.210 For instance, in examining an indictment for a violation of the federal Sex Offender Registration and Notification Act (SORNA), the Ninth Circuit agreed with the government that “Lambert is inapplicable because convicted sex offenders are generally subject to registration requirements in all fifty states, and [the defendant] was aware that he was obligated to register as a sex offender.” 211 In a 1962 opinion in Robinson v. California, 212 the Court reversed a conviction under a state law that criminalized addiction to narcotics without requiring any additional act by the defendant. According to the Court, the statute was distinguishable from “one which punishes a person for the use of narcotics, for their purchase, sale or possession, or for antisocial or disorderly behavior resulting from their administration,” since it instead made “the ‘status’ of narcotic addiction a criminal offense, for which the offender may be prosecuted ‘at any time before he reforms.’” 213 The Court held that the law, “which imprisons a person . . . afflicted [by narcotics addiction] as a criminal, even though he has never touched any narcotic drug within the State or been guilty of any irregular behavior there, inflicts a cruel and unusual punishment” in violation of the Eighth Amendment, as incorporated against the states through the Fourteenth Amendment.214 Status offenses can often be “reformulated and redrafted to conform to basic principles of criminal justice.”215 For instance, if a “statute that penalizes being an alcoholic or drug addict is impermissible,” a “statute that penalizes appearing in public in an intoxicated state” may be permissible. 216 The Supreme Court’s 1968 opinion in Powell v. Texas217 illustrates this distinction. Powell stemmed from the conviction of a defendant under a state law making it a crime to “get drunk or be found in a state of intoxication in any public place, or at any private house except [a person’s] own.”218 The defendant argued that he had a compulsion to drink and that the law amounted to cruel and unusual punishment pursuant to Robinson. 219 A four-Justice plurality of the Court disagreed and explained that the defendant was convicted “not for being a chronic alcoholic, but for being in public while drunk on a particular occasion.”220 In other words, the plurality concluded that the law did not seek “to punish a mere status” as the law at issue in Robinson did, but instead punished a voluntary act, being in public while intoxicated.221 In a concurring opinion, Justice White said that the result would have been different if the public intoxication were an unavoidable result of chronic alcoholism.222 For example, according to Justice White, the Eighth Amendment would prohibit criminalizing public intoxication for chronic alcoholics who are homeless because “they have no place else to go and no place else to be when they are drinking.” 223 Four dissenting Justices would have agreed with that conclusion.224 The primary point of departure between Justice White and the dissenting Justices was over the record in Powell—Justice White agreed with the ultimate result in Powell because “nothing in the record indicates that [the defendant] could not have done his drinking in private or that he was so inebriated at the time that he had lost control of his movements and wandered into the public street.”225 The dissenting Justices concluded, however, that the “appellant is a ‘chronic alcoholic’ who, according to the trier of fact, cannot resist the ‘constant excessive consumption of alcohol’ and does not appear in public by his own volition but under a compulsion’ which is part of his condition.” 226Another example of the distinction between an impermissible status offense and a seemingly permissible conduct-based offense may be found in 8 U.S.C. § 1326, which in relevant part provides that “any alien who (1) has been arrested and deported or excluded and deported, and thereafter (2) enters, attempts to enter, or is at any time found in, the United States . . . [without the consent of the Attorney General] shall be fined . . . or imprisoned . . . or both.”227 Some federal appellate courts have rejected the argument that “the ‘found in’ provision of § 1326 impermissibly punishes aliens for their ‘status’ of being found in the United States.”228 In United States v. Ayala, the Ninth Circuit distinguished § 1326 from the law at issue in Robinson, explaining that “[a] conviction under § 1326 for being ‘found in’ the United States necessarily requires that a defendant commit an act: he must re-enter the United States without permission within five years after being deported.”229 Federal appellate courts had split on the issue of whether the Robinson and Powell distinction between impermissible status offenses and permissible conduct-based offenses allowed “criminalizing conduct that is an unavoidable consequence of one’s status.”230 In the 2024 opinion City of Grants Pass v. Johnson, the Supreme Court examined this issue in the context of a municipal ordinance criminalizing sleeping or camping in public.231 In a divided opinion, the Ninth Circuit concluded that the ordinance constituted cruel and unusual punishment, citing to Powell’s concurrence and dissent for the proposition that “a person cannot be prosecuted for involuntary conduct if it is an unavoidable consequence of one’s status.” 232 The Ninth Circuit observed that this would be the inevitable outcome for some of the involuntary homeless population in Grants Pass, which exceeded the available shelter space in the jurisdiction.233 The Supreme Court disagreed, concluding that the camping ordinance was not a status offense of the type barred in Robinson (which lacked a mental state or act requirement), because the ordinance in Grants Pass required “actions like ‘occupy[ing] a campsite’ on public property ‘for the purpose of maintaining a temporary place to live.’” 234 The Court likened the facts of Grants Pass to those of Powell and relied on the Powell plurality’s distinction between laws criminalizing status and those criminalizing acts, even if on some level those acts may be an involuntary result of the underlying status.235 Although the Court did not reconsider Robinson, it reiterated that the Cruel and Unusual Punishments Clause of the Eighth Amendment focuses on the method or kind of punishment a government may impose, rather than on the question of what a government may criminalize. 236 Additional analysis of Grants Pass and its broader implications for status offenses and homelessness laws may be found in other CRS products.23 Paraphrase the text..",Legal,Summarize & Simplify,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",I am an investor in Coca-Cola but I am curious about some of the companies challenges right now. Give me a bullet list of raw product materials the company uses in making products are at risk of price volatility. Then explain what causes of that volatility could be. I'm not concerned about the concerns about sweeteners so I don't need to know about that. But tell me can social media have a negative impact on the company?,"Raw material costs, including the costs for plastic bottles, aluminum cans, PET resin, carbon dioxide and high fructose corn syrup, are subject to significant price volatility, which may be worsened by periods of increased demand, supply constraints or high inflation. International or domestic geopolitical or other events, including pandemics, armed conflict or the imposition of tariffs and/or quotas by the U.S. government on any of these raw materials, could adversely impact the supply and cost of these raw materials to the Company or render them unavailable at commercially favorable terms or at all. In addition, there are no limits on the prices The Coca-Cola Company and other beverage companies can charge for concentrate. If the Company cannot offset higher raw material costs with higher selling prices, effective commodity price hedging, increased sales volume or reductions in other costs, the Company’s results of operations and profitability could be adversely affected. The Company uses significant amounts of fuel for its delivery fleet and other vehicles used in the distribution of its products. International or domestic geopolitical or other events could impact the supply and cost of fuel and the timely delivery of the Company’s products to its customers. Although the Company strives to reduce fuel consumption and uses commodity hedges to manage the Company’s fuel costs, there can be no assurance the Company will succeed in limiting the impact of fuel price increases or price volatility on the Company’s business or future cost increases, which could reduce the profitability of the Company’s operations. The Company uses a combination of internal and external freight shipping and transportation services to transport and deliver products. The Company’s freight cost and the timely delivery of its products may be adversely impacted by a number of factors that could reduce the profitability of the Company’s operations, including driver shortages, reduced availability of independent contractor drivers, higher fuel costs, weather conditions, traffic congestion, increased government regulation and other matters. The Company continues to make significant reinvestments in its business in order to evolve its operating model and to accommodate future growth and portfolio expansion, including supply chain optimization. The increased costs associated with these reinvestments, the potential for disruption in manufacturing and distribution and the risk the Company may not realize a satisfactory return on its investments could adversely affect the Company’s business, financial condition or results of operations. The reliance on purchased finished products from external sources could have an adverse impact on the Company’s profitability. The Company does not, and does not plan to, manufacture all of the products it distributes and, therefore, remains reliant on purchased finished products from external sources to meet customer demand. As a result, the Company is subject to incremental risk, including, but not limited to, product quality and availability, price variability and production capacity shortfalls for externally purchased finished products, which could have an impact on the Company’s profitability and customer relationships. Particularly, the Company is subject to the risk of unavailability of still products that it acquires from other manufacturers, leading to an inability to meet consumer demand for these products. In most instances, the Company’s ability to negotiate the prices at which it purchases finished products from other U.S. Coca-Cola bottlers is limited pursuant to The Coca-Cola Company’s right to unilaterally establish the prices, or certain elements of the formulas used to determine the prices, for such finished products under the RMA, which could have an adverse impact on the Company’s profitability. Changes in public and consumer perception and preferences, including concerns related to product safety and sustainability, artificial ingredients, brand reputation and obesity, could reduce demand for the Company’s products and reduce profitability. Concerns about perceived negative safety and quality consequences of certain ingredients in the Company’s products, such as nonnutritive sweeteners or ingredients in energy drinks, may erode consumers’ confidence in the safety and quality of the Company’s products, whether or not justified. The Company’s business is also impacted by changes in consumer concerns or perceptions surrounding the product manufacturing processes and packaging materials, including single-use and other plastic packaging, and the environmental and sustainability impact of such manufacturing processes and packaging materials. Any of these factors may reduce consumers’ willingness to purchase the Company’s products and any inability on the part of the Company to anticipate or react to such changes could result in reduced demand for the Company’s products or erode the Company’s competitive and financial position and could adversely affect the Company’s business, reputation, financial condition or results of operations. The Company’s success depends on its ability to maintain consumer confidence in the safety and quality of all of its products. The Company has rigorous product safety and quality standards. However, if beverage products taken to market are or become contaminated or adulterated, the Company may be required to conduct costly product recalls and may become subject to product liability claims and negative publicity, which could cause its business and reputation to suffer. 9 The Company’s success also depends in large part on its ability and the ability of The Coca-Cola Company and other beverage companies it works with to maintain the brand image of existing products, build up brand image for new products and brand extensions and maintain its corporate reputation and social license to operate. Engagements by the Company’s executives in social and public policy debates may occasionally be the subject of criticism from advocacy groups that have differing points of view and could result in adverse media and consumer reaction, including product boycotts. Similarly, the Company’s sponsorship relationships and charitable giving program could subject the Company to negative publicity as a result of actual or perceived views of organizations the Company sponsors or supports financially. Likewise, negative postings or comments on social media or networking websites about the Company, The Coca-Cola Company or one of the products the Company carries, even if inaccurate or malicious, could generate adverse publicity that could damage the reputation of the Company’s brands or the Company. The Company’s business depends substantially on consumer tastes, preferences and shopping habits that change in often unpredictable ways. As a result of certain health and wellness trends, including concern over the public health consequences associated with obesity, consumer preferences over the past several years have shifted from sugar-sweetened sparkling beverages to diet sparkling beverages, tea, sports drinks, enhanced water and bottled water. As the Company distributes, markets and manufactures beverage brands owned by others, the success of the Company’s business depends in large measure on the ability of The Coca-Cola Company and other beverage companies to develop and introduce product innovations to meet the changing preferences of the broad consumer market, and failure to satisfy these consumer preferences could adversely affect the Company’s profitability","""================ ======= Raw material costs, including the costs for plastic bottles, aluminum cans, PET resin, carbon dioxide and high fructose corn syrup, are subject to significant price volatility, which may be worsened by periods of increased demand, supply constraints or high inflation. International or domestic geopolitical or other events, including pandemics, armed conflict or the imposition of tariffs and/or quotas by the U.S. government on any of these raw materials, could adversely impact the supply and cost of these raw materials to the Company or render them unavailable at commercially favorable terms or at all. In addition, there are no limits on the prices The Coca-Cola Company and other beverage companies can charge for concentrate. If the Company cannot offset higher raw material costs with higher selling prices, effective commodity price hedging, increased sales volume or reductions in other costs, the Company’s results of operations and profitability could be adversely affected. The Company uses significant amounts of fuel for its delivery fleet and other vehicles used in the distribution of its products. International or domestic geopolitical or other events could impact the supply and cost of fuel and the timely delivery of the Company’s products to its customers. Although the Company strives to reduce fuel consumption and uses commodity hedges to manage the Company’s fuel costs, there can be no assurance the Company will succeed in limiting the impact of fuel price increases or price volatility on the Company’s business or future cost increases, which could reduce the profitability of the Company’s operations. The Company uses a combination of internal and external freight shipping and transportation services to transport and deliver products. The Company’s freight cost and the timely delivery of its products may be adversely impacted by a number of factors that could reduce the profitability of the Company’s operations, including driver shortages, reduced availability of independent contractor drivers, higher fuel costs, weather conditions, traffic congestion, increased government regulation and other matters. The Company continues to make significant reinvestments in its business in order to evolve its operating model and to accommodate future growth and portfolio expansion, including supply chain optimization. The increased costs associated with these reinvestments, the potential for disruption in manufacturing and distribution and the risk the Company may not realize a satisfactory return on its investments could adversely affect the Company’s business, financial condition or results of operations. The reliance on purchased finished products from external sources could have an adverse impact on the Company’s profitability. The Company does not, and does not plan to, manufacture all of the products it distributes and, therefore, remains reliant on purchased finished products from external sources to meet customer demand. As a result, the Company is subject to incremental risk, including, but not limited to, product quality and availability, price variability and production capacity shortfalls for externally purchased finished products, which could have an impact on the Company’s profitability and customer relationships. Particularly, the Company is subject to the risk of unavailability of still products that it acquires from other manufacturers, leading to an inability to meet consumer demand for these products. In most instances, the Company’s ability to negotiate the prices at which it purchases finished products from other U.S. Coca-Cola bottlers is limited pursuant to The Coca-Cola Company’s right to unilaterally establish the prices, or certain elements of the formulas used to determine the prices, for such finished products under the RMA, which could have an adverse impact on the Company’s profitability. Changes in public and consumer perception and preferences, including concerns related to product safety and sustainability, artificial ingredients, brand reputation and obesity, could reduce demand for the Company’s products and reduce profitability. Concerns about perceived negative safety and quality consequences of certain ingredients in the Company’s products, such as nonnutritive sweeteners or ingredients in energy drinks, may erode consumers’ confidence in the safety and quality of the Company’s products, whether or not justified. The Company’s business is also impacted by changes in consumer concerns or perceptions surrounding the product manufacturing processes and packaging materials, including single-use and other plastic packaging, and the environmental and sustainability impact of such manufacturing processes and packaging materials. Any of these factors may reduce consumers’ willingness to purchase the Company’s products and any inability on the part of the Company to anticipate or react to such changes could result in reduced demand for the Company’s products or erode the Company’s competitive and financial position and could adversely affect the Company’s business, reputation, financial condition or results of operations. The Company’s success depends on its ability to maintain consumer confidence in the safety and quality of all of its products. The Company has rigorous product safety and quality standards. However, if beverage products taken to market are or become contaminated or adulterated, the Company may be required to conduct costly product recalls and may become subject to product liability claims and negative publicity, which could cause its business and reputation to suffer. 9 The Company’s success also depends in large part on its ability and the ability of The Coca-Cola Company and other beverage companies it works with to maintain the brand image of existing products, build up brand image for new products and brand extensions and maintain its corporate reputation and social license to operate. Engagements by the Company’s executives in social and public policy debates may occasionally be the subject of criticism from advocacy groups that have differing points of view and could result in adverse media and consumer reaction, including product boycotts. Similarly, the Company’s sponsorship relationships and charitable giving program could subject the Company to negative publicity as a result of actual or perceived views of organizations the Company sponsors or supports financially. Likewise, negative postings or comments on social media or networking websites about the Company, The Coca-Cola Company or one of the products the Company carries, even if inaccurate or malicious, could generate adverse publicity that could damage the reputation of the Company’s brands or the Company. The Company’s business depends substantially on consumer tastes, preferences and shopping habits that change in often unpredictable ways. As a result of certain health and wellness trends, including concern over the public health consequences associated with obesity, consumer preferences over the past several years have shifted from sugar-sweetened sparkling beverages to diet sparkling beverages, tea, sports drinks, enhanced water and bottled water. As the Company distributes, markets and manufactures beverage brands owned by others, the success of the Company’s business depends in large measure on the ability of The Coca-Cola Company and other beverage companies to develop and introduce product innovations to meet the changing preferences of the broad consumer market, and failure to satisfy these consumer preferences could adversely affect the Company’s profitability https://investor.cokeconsolidated.com/static-files/198305e2-2559-4acc-954c-4123760b0f61 ================ ======= I am an investor in Coca-Cola but I am curious about some of the companies challenges right now. Give me a bullet list of raw product materials the company uses in making products are at risk of price volatility. Then explain what causes of that volatility could be. I'm not concerned about the concerns about sweeteners so I don't need to know about that. But tell me can social media have a negative impact on the company? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Retail/Product,Summarize & Format,Text Transformation " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Growing up with social media, I have always wondered how it has affected my education. How can social media influence students' learning experience both positively and negatively? List one reason for each.","The use of social media is incomparably on the rise among students, influenced by the globalized forms of communication and the post-pandemic rush to use multiple social media platforms for education in different fields of study. Though social media has created tremendous chances for sharing ideas and emotions, the kind of social support it provides might fail to meet students’ emotional needs, or the alleged positive effects might be short-lasting. In recent years, several studies have been conducted to explore the potential effects of social media on students’ affective traits, such as stress, anxiety, depression, and so on. The present paper reviews the findings of the exemplary published works of research to shed light on the positive and negative potential effects of the massive use of social media on students’ emotional well-being. This review can be insightful for teachers who tend to take the potential psychological effects of social media for granted. They may want to know more about the actual effects of the over-reliance on and the excessive (and actually obsessive) use of social media on students’ developing certain images of self and certain emotions which are not necessarily positive. There will be implications for pre- and in-service teacher training and professional development programs and all those involved in student affairs. Social media has turned into an essential element of individuals’ lives including students in today’s world of communication. Its use is growing significantly more than ever before especially in the post-pandemic era, marked by a great revolution happening to the educational systems. Recent investigations of using social media show that approximately 3 billion individuals worldwide are now communicating via social media (Iwamoto and Chun, 2020). This growing population of social media users is spending more and more time on social network groupings, as facts and figures show that individuals spend 2 h a day, on average, on a variety of social media applications, exchanging pictures and messages, updating status, tweeting, favoring, and commenting on many updated socially shared information (Abbott, 2017). Researchers have begun to investigate the psychological effects of using social media on students’ lives. Chukwuere and Chukwuere (2017) maintained that social media platforms can be considered the most important source of changing individuals’ mood, because when someone is passively using a social media platform seemingly with no special purpose, s/he can finally feel that his/her mood has changed as a function of the nature of content overviewed. Therefore, positive and negative moods can easily be transferred among the population using social media networks (Chukwuere and Chukwuere, 2017). This may become increasingly important as students are seen to be using social media platforms more than before and social networking is becoming an integral aspect of their lives. As described by Iwamoto and Chun (2020), when students are affected by social media posts, especially due to the increasing reliance on social media use in life, they may be encouraged to begin comparing themselves to others or develop great unrealistic expectations of themselves or others, which can have several affective consequences. Considering the increasing influence of social media on education, the present paper aims to focus on the affective variables such as depression, stress, and anxiety, and how social media can possibly increase or decrease these emotions in student life. The exemplary works of research on this topic in recent years will be reviewed here, hoping to shed light on the positive and negative effects of these ever-growing influential platforms on the psychology of students. The body of research on the effect of social media on students’ affective and emotional states has led to mixed results. The existing literature shows that there are some positive and some negative affective impacts. Yet, it seems that the latter is pre-dominant. Mathewson (2020) attributed these divergent positive and negative effects to the different theoretical frameworks adopted in different studies and also the different contexts (different countries with whole different educational systems). According to Fredrickson’s broaden-and-build theory of positive emotions (Fredrickson, 2001), the mental repertoires of learners can be built and broadened by how they feel. For instance, some external stimuli might provoke negative emotions such as anxiety and depression in learners. Having experienced these negative emotions, students might repeatedly check their messages on social media or get addicted to them. As a result, their cognitive repertoire and mental capacity might become limited and they might lose their concentration during their learning process. On the other hand, it should be noted that by feeling positive, learners might take full advantage of the affordances of the social media and; thus, be able to follow their learning goals strategically. This point should be highlighted that the link between the use of social media and affective states is bi-directional. Therefore, strategic use of social media or its addictive use by students can direct them toward either positive experiences like enjoyment or negative ones such as anxiety and depression. Also, these mixed positive and negative effects are similar to the findings of several other relevant studies on general populations’ psychological and emotional health. A number of studies (with general research populations not necessarily students) showed that social networks have facilitated the way of staying in touch with family and friends living far away as well as an increased social support (Zhang, 2017). Given the positive and negative emotional effects of social media, social media can either scaffold the emotional repertoire of students, which can develop positive emotions in learners, or induce negative provokers in them, based on which learners might feel negative emotions such as anxiety and depression. However, admittedly, social media has also generated a domain that encourages the act of comparing lives, and striving for approval; therefore, it establishes and internalizes unrealistic perceptions (Virden et al., 2014; Radovic et al., 2017). It should be mentioned that the susceptibility of affective variables to social media should be interpreted from a dynamic lens. This means that the ecology of the social media can make changes in the emotional experiences of learners. More specifically, students’ affective variables might self-organize into different states under the influence of social media. As for the positive correlation found in many studies between the use of social media and such negative effects as anxiety, depression, and stress, it can be hypothesized that this correlation is induced by the continuous comparison the individual makes and the perception that others are doing better than him/her influenced by the posts that appear on social media. Using social media can play a major role in university students’ psychological well-being than expected. Though most of these studies were correlational, and correlation is not the same as causation, as the studies show that the number of participants experiencing these negative emotions under the influence of social media is significantly high, more extensive research is highly suggested to explore causal effects (Mathewson, 2020). As the review of exemplary studies showed, some believed that social media increased comparisons that students made between themselves and others. This finding ratifies the relevance of the Interpretation Comparison Model (Stapel and Koomen, 2000; Stapel, 2007) and Festinger’s (1954) Social Comparison Theory. Concerning the negative effects of social media on students’ psychology, it can be argued that individuals may fail to understand that the content presented in social media is usually changed to only represent the attractive aspects of people’s lives, showing an unrealistic image of things. We can add that this argument also supports the relevance of the Social Comparison Theory and the Interpretation Comparison Model (Stapel and Koomen, 2000; Stapel, 2007), because social media sets standards that students think they should compare themselves with. A constant observation of how other students or peers are showing their instances of achievement leads to higher self-evaluation (Stapel and Koomen, 2000)."," Only use the provided text to answer the question, no outside sources. Growing up with social media, I have always wondered how it has affected my education. How can social media influence students' learning experience both positively and negatively? List one reason for each. The use of social media is incomparably on the rise among students, influenced by the globalized forms of communication and the post-pandemic rush to use multiple social media platforms for education in different fields of study. Though social media has created tremendous chances for sharing ideas and emotions, the kind of social support it provides might fail to meet students’ emotional needs, or the alleged positive effects might be short-lasting. In recent years, several studies have been conducted to explore the potential effects of social media on students’ affective traits, such as stress, anxiety, depression, and so on. The present paper reviews the findings of the exemplary published works of research to shed light on the positive and negative potential effects of the massive use of social media on students’ emotional well-being. This review can be insightful for teachers who tend to take the potential psychological effects of social media for granted. They may want to know more about the actual effects of the over-reliance on and the excessive (and actually obsessive) use of social media on students’ developing certain images of self and certain emotions which are not necessarily positive. There will be implications for pre- and in-service teacher training and professional development programs and all those involved in student affairs. Social media has turned into an essential element of individuals’ lives including students in today’s world of communication. Its use is growing significantly more than ever before especially in the post-pandemic era, marked by a great revolution happening to the educational systems. Recent investigations of using social media show that approximately 3 billion individuals worldwide are now communicating via social media (Iwamoto and Chun, 2020). This growing population of social media users is spending more and more time on social network groupings, as facts and figures show that individuals spend 2 h a day, on average, on a variety of social media applications, exchanging pictures and messages, updating status, tweeting, favoring, and commenting on many updated socially shared information (Abbott, 2017). Researchers have begun to investigate the psychological effects of using social media on students’ lives. Chukwuere and Chukwuere (2017) maintained that social media platforms can be considered the most important source of changing individuals’ mood, because when someone is passively using a social media platform seemingly with no special purpose, s/he can finally feel that his/her mood has changed as a function of the nature of content overviewed. Therefore, positive and negative moods can easily be transferred among the population using social media networks (Chukwuere and Chukwuere, 2017). This may become increasingly important as students are seen to be using social media platforms more than before and social networking is becoming an integral aspect of their lives. As described by Iwamoto and Chun (2020), when students are affected by social media posts, especially due to the increasing reliance on social media use in life, they may be encouraged to begin comparing themselves to others or develop great unrealistic expectations of themselves or others, which can have several affective consequences. Considering the increasing influence of social media on education, the present paper aims to focus on the affective variables such as depression, stress, and anxiety, and how social media can possibly increase or decrease these emotions in student life. The exemplary works of research on this topic in recent years will be reviewed here, hoping to shed light on the positive and negative effects of these ever-growing influential platforms on the psychology of students. The body of research on the effect of social media on students’ affective and emotional states has led to mixed results. The existing literature shows that there are some positive and some negative affective impacts. Yet, it seems that the latter is pre-dominant. Mathewson (2020) attributed these divergent positive and negative effects to the different theoretical frameworks adopted in different studies and also the different contexts (different countries with whole different educational systems). According to Fredrickson’s broaden-and-build theory of positive emotions (Fredrickson, 2001), the mental repertoires of learners can be built and broadened by how they feel. For instance, some external stimuli might provoke negative emotions such as anxiety and depression in learners. Having experienced these negative emotions, students might repeatedly check their messages on social media or get addicted to them. As a result, their cognitive repertoire and mental capacity might become limited and they might lose their concentration during their learning process. On the other hand, it should be noted that by feeling positive, learners might take full advantage of the affordances of the social media and; thus, be able to follow their learning goals strategically. This point should be highlighted that the link between the use of social media and affective states is bi-directional. Therefore, strategic use of social media or its addictive use by students can direct them toward either positive experiences like enjoyment or negative ones such as anxiety and depression. Also, these mixed positive and negative effects are similar to the findings of several other relevant studies on general populations’ psychological and emotional health. A number of studies (with general research populations not necessarily students) showed that social networks have facilitated the way of staying in touch with family and friends living far away as well as an increased social support (Zhang, 2017). Given the positive and negative emotional effects of social media, social media can either scaffold the emotional repertoire of students, which can develop positive emotions in learners, or induce negative provokers in them, based on which learners might feel negative emotions such as anxiety and depression. However, admittedly, social media has also generated a domain that encourages the act of comparing lives, and striving for approval; therefore, it establishes and internalizes unrealistic perceptions (Virden et al., 2014; Radovic et al., 2017). It should be mentioned that the susceptibility of affective variables to social media should be interpreted from a dynamic lens. This means that the ecology of the social media can make changes in the emotional experiences of learners. More specifically, students’ affective variables might self-organize into different states under the influence of social media. As for the positive correlation found in many studies between the use of social media and such negative effects as anxiety, depression, and stress, it can be hypothesized that this correlation is induced by the continuous comparison the individual makes and the perception that others are doing better than him/her influenced by the posts that appear on social media. Using social media can play a major role in university students’ psychological well-being than expected. Though most of these studies were correlational, and correlation is not the same as causation, as the studies show that the number of participants experiencing these negative emotions under the influence of social media is significantly high, more extensive research is highly suggested to explore causal effects (Mathewson, 2020). As the review of exemplary studies showed, some believed that social media increased comparisons that students made between themselves and others. This finding ratifies the relevance of the Interpretation Comparison Model (Stapel and Koomen, 2000; Stapel, 2007) and Festinger’s (1954) Social Comparison Theory. Concerning the negative effects of social media on students’ psychology, it can be argued that individuals may fail to understand that the content presented in social media is usually changed to only represent the attractive aspects of people’s lives, showing an unrealistic image of things. We can add that this argument also supports the relevance of the Social Comparison Theory and the Interpretation Comparison Model (Stapel and Koomen, 2000; Stapel, 2007), because social media sets standards that students think they should compare themselves with. A constant observation of how other students or peers are showing their instances of achievement leads to higher self-evaluation (Stapel and Koomen, 2000). https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2022.1010766/full",Internet/Technology,Find & Summarize,Text Transformation Base your response strictly on the provided document only. Answer in less than 5 words. Do not include numbers.,What date did this executive order go into effect?,"**AN ORDER TEMPORARILY MODIFYING CERTAIN IN-PERSON NOTARIZATION AND ACKNOWLEDGEMENT REQUIREMENTS** WHEREAS, I proclaimed a state of emergency on March 15, 2020 to authorize the use of emergency powers in order to expand and expedite the State's response to the many different effects ofCOVID-19; and WHEREAS, the in-person services of notaries public and witnesses are required to complete and validate a wide variety of important personal and commercial transactions; and WHEREAS, it is now necessary for those services to be provided remotely to ensure the social distancing recommended by the United States and Maine Centers for Disease Control and Prevention; and WHEREAS, a governor's emergency powers pursuant to 37-B M.R.S. §742(l)(C)(l) and §834 expressly include the authority to suspend the enforcement of statutes, orders or rules where strict compliance therewith would in any way prevent, hinder or delay necessary action in coping with the emergency; and WHEREAS, this Order will enable citizens, especially those who are elderly or have serious underlying health conditions, to continue to seek and obtain critical estate planning instruments, such as Last Will and Testaments, Financial Powers of Attorney, Healthcare Powers of Attorney, and for all persons to conduct other important business that requires sworn statements or affidavits, in a manner that reduces in-person contact and promotes social distancing; and WHEREAS, the requirements of this Order are designed to protect the reliability of in-person notary acknowledgments, sworn statements and affidavits; NOW, THEREFORE, I, Janet T. Mills, Governor of the State of Maine, pursuant to 37-B M.R.S. Ch. 13, including but not limited to the provisions cited above, do hereby Order as follows: I. APPLICATION This Order applies to all provisions of Maine law that require a signature to be acknowledged, witnessed or notarized in person, with the exceptions of: (a) solemnizing marriages, (b) administering oaths to circulators of state or local direct initiative or referendum petitions and nomination petitions of candidates for electoral office, and ( c) absentee ballots in state and local elections. This Order authorizes remote, not electronic, notarization. All requirements under Maine law pertaining to the taking of sworn statements and acknowledgments by notaries and those authorized to perform notarial acts, other than the requirement to appear in person, remain in effect during the effective period of this Order. II. ORDERS While this Order is in effect, with the exceptions noted in Part I of this Order, the enforcement of those provisions of Maine law that require the physical presence of the person whose oath is being taken (""the Signatory"") at the same location as the Notary Public or other person authorized to perform a notarial act (""the Notary"") and any witness to the signing are hereby suspended provided the conditions set forth in paragraphs A-G of this Section are met. A. The Notary must be physically within the State while performing the notarial act and must follow any additional guidance for remote notarization issued by the Maine Secretary of State. B. The act of notarization or witnessing required by Maine law may be completed remotely via two-way audio-video communication technology, provided that: I. The two-way audio-video communication technology must allow direct contemporaneous interaction between the individual signing the document (""the Signatory""), the Notary and any witness by sight and sound in real time ( e.g. with no pre-recordings); 2. The Signatory must be reasonably identified by the Notary by one or more of the following: (a) is personally !mown to the Notary; (b) presented a valid photo identification to the Notary during the video conference; ( c) the oath or affirmation of a witness who: (i) is in the physical presence of either the Notary or the Signatory; or (ii) is able to communicate with the Notary and the Signatory simultaneously by sight and sound through an electronic device or process at the time of the notarization, if the witness has personal knowledge of the individual and has been reasonably identified by the Notary under clauses (a) or (b) herein. 3. The Signatory must attest to being physically located in Maine and affirmatively state the name of the county in which the Signatory is located at the time of execution during the two-way audio-video communication; 4. The Notary and any witness must attest to being physically located in Maine during the two-way audio-video communication; 5. For Wills and Powers of Attorney, the Notary or at least one witness must be an attorney licensed to practice law in the State of Maine; 6. Before any documents are signed, the Notary must be able to view by camera the entire space in which the Signatory and any witness is located, and any person who is present in those spaces must state their name while on video and in clear view of the Notary; 7. The Signatory must affirmatively state on the two-way audio-video communication what document the Signatory is signing and the Notary must be provided with a copy of the document prior to the signing; 8. Each page of the document being witnessed must be shown to the Notary and any witness on the two-way audio-video communication in a means clearly legible to the Notary and initialed by the Signatory in the presence of the Notary and any witness; 9. The act of signing and initialing must be captured sufficiently up close on the two-way audio-video communication for the Notary to observe; 10. Any witness or witnesses required or permitted to properly execute any original document or documents according to Maine Law may similarly witness the signing of the document by the Signatory utilizing two-way audio-video communication described in paragraph 1 and may sign as a witness to the document upon receipt of the original document; 11. The Signatory must transmit by fax or electronic means (which may include transmitting a photograph of every page by cellphone) a legible copy of the entire signed document directly to the Notary and any witness, immediately after signing the document, or, if that is not possible, no later than 24 hours after the Signatory's execution of the document; 12. The Signatory must send the original signed document directly to the witness within 48 hours ( or 2 days) after the Signatory's execution of the document, or to the Notary if no witness is involved; 13. Within 48 hours after receiving the original document from the Signatory, the witness must sign it and sent to the second witness, if any, or to the Notary if no other witness is involved. The official date and time of each witness's signature shall be the date and time when the witness witnesses the Signatory's signature via the two-way audio-video communication technology described in paragraph 1; 14. Upon review of the original document and satisfactory comparison with the faxed or electronic document provided on the date of signing, the Notary shall notarize the original document within 48 hours of receipt thereof, and the official date and time of the notarization shall be the date and time when the Notary witnessed the signature via the two-way audio-video technology and shall add the following language below the Notary and or Witness signature lines: ""Notarized (and/or Witnessed) remotely, in accordance with Executive Order 37 FY 19/20""; and 15. A recording of the two-way audio-video communication must be made and preserved by the Notary for a period of at least 5 years from the date of the notarial act. The Notary shall provide a copy of the recording to the Signatory and the Secretary of State upon request. C. Any document that is required under any law of the State of Maine to be notarized ""in the presence and hearing"" or similar language of a Signatory, and that is signed, notarized or witnessed in accordance with the terms of this Executive Order shall be deemed to have been signed and/or notarized in the presence and hearing of the Signatory. D. Nothing in this Order shall require a Notary to perform remote notarization. E. The validity and recognition of a notarization or witness under this Order shall not prevent an aggrieved person from seeking to invalidate a record or transaction that is the subject of a notarization or from seeking other remedies based on State or Federal law other than this Order for any reason not addressed in this Order, such as incapacity, absence of authority or undue influence. F. The failure of a Notary or a witness to meet a requirement specified in this Order shall not invalidate or impair the recognition of a notarization performed by the Notary if it was performed in substantial compliance with this Order. G. The Secretary of State is authorized to issue guidance consistent with this Order to protect the integrity of the remote notarization process. III. INTEGRITY A primary and essential purpose of this Order is to safeguard the integrity of transactions and the important personal interests served by those transactions. Persons who violate the rights of others during a remote notarization are subject to all pertinent civil remedies and criminal penalties. IV. JUDICIAL NOTICE A copy of this Order shall for notice be provided to the Chief Justice of the Maine Supreme Judicial Court. I intend further that the acts, records and proceedings under this Order receive full faith and credit in the courts of the United States and other states. V. EFFECTIVE DATE This Order shall take effect on April 8, 2020 and, unless sooner amended or rescinded, terminates 30 days after the termination of the COVID-19 state of emergency. "," ======= What date did this executive order go into effect? ======= **AN ORDER TEMPORARILY MODIFYING CERTAIN IN-PERSON NOTARIZATION AND ACKNOWLEDGEMENT REQUIREMENTS** WHEREAS, I proclaimed a state of emergency on March 15, 2020 to authorize the use of emergency powers in order to expand and expedite the State's response to the many different effects ofCOVID-19; and WHEREAS, the in-person services of notaries public and witnesses are required to complete and validate a wide variety of important personal and commercial transactions; and WHEREAS, it is now necessary for those services to be provided remotely to ensure the social distancing recommended by the United States and Maine Centers for Disease Control and Prevention; and WHEREAS, a governor's emergency powers pursuant to 37-B M.R.S. §742(l)(C)(l) and §834 expressly include the authority to suspend the enforcement of statutes, orders or rules where strict compliance therewith would in any way prevent, hinder or delay necessary action in coping with the emergency; and WHEREAS, this Order will enable citizens, especially those who are elderly or have serious underlying health conditions, to continue to seek and obtain critical estate planning instruments, such as Last Will and Testaments, Financial Powers of Attorney, Healthcare Powers of Attorney, and for all persons to conduct other important business that requires sworn statements or affidavits, in a manner that reduces in-person contact and promotes social distancing; and WHEREAS, the requirements of this Order are designed to protect the reliability of in-person notary acknowledgments, sworn statements and affidavits; NOW, THEREFORE, I, Janet T. Mills, Governor of the State of Maine, pursuant to 37-B M.R.S. Ch. 13, including but not limited to the provisions cited above, do hereby Order as follows: I. APPLICATION This Order applies to all provisions of Maine law that require a signature to be acknowledged, witnessed or notarized in person, with the exceptions of: (a) solemnizing marriages, (b) administering oaths to circulators of state or local direct initiative or referendum petitions and nomination petitions of candidates for electoral office, and ( c) absentee ballots in state and local elections. This Order authorizes remote, not electronic, notarization. All requirements under Maine law pertaining to the taking of sworn statements and acknowledgments by notaries and those authorized to perform notarial acts, other than the requirement to appear in person, remain in effect during the effective period of this Order. II. ORDERS While this Order is in effect, with the exceptions noted in Part I of this Order, the enforcement of those provisions of Maine law that require the physical presence of the person whose oath is being taken (""the Signatory"") at the same location as the Notary Public or other person authorized to perform a notarial act (""the Notary"") and any witness to the signing are hereby suspended provided the conditions set forth in paragraphs A-G of this Section are met. A. The Notary must be physically within the State while performing the notarial act and must follow any additional guidance for remote notarization issued by the Maine Secretary of State. B. The act of notarization or witnessing required by Maine law may be completed remotely via two-way audio-video communication technology, provided that: I. The two-way audio-video communication technology must allow direct contemporaneous interaction between the individual signing the document (""the Signatory""), the Notary and any witness by sight and sound in real time ( e.g. with no pre-recordings); 2. The Signatory must be reasonably identified by the Notary by one or more of the following: (a) is personally !mown to the Notary; (b) presented a valid photo identification to the Notary during the video conference; ( c) the oath or affirmation of a witness who: (i) is in the physical presence of either the Notary or the Signatory; or (ii) is able to communicate with the Notary and the Signatory simultaneously by sight and sound through an electronic device or process at the time of the notarization, if the witness has personal knowledge of the individual and has been reasonably identified by the Notary under clauses (a) or (b) herein. 3. The Signatory must attest to being physically located in Maine and affirmatively state the name of the county in which the Signatory is located at the time of execution during the two-way audio-video communication; 4. The Notary and any witness must attest to being physically located in Maine during the two-way audio-video communication; 5. For Wills and Powers of Attorney, the Notary or at least one witness must be an attorney licensed to practice law in the State of Maine; 6. Before any documents are signed, the Notary must be able to view by camera the entire space in which the Signatory and any witness is located, and any person who is present in those spaces must state their name while on video and in clear view of the Notary; 7. The Signatory must affirmatively state on the two-way audio-video communication what document the Signatory is signing and the Notary must be provided with a copy of the document prior to the signing; 8. Each page of the document being witnessed must be shown to the Notary and any witness on the two-way audio-video communication in a means clearly legible to the Notary and initialed by the Signatory in the presence of the Notary and any witness; 9. The act of signing and initialing must be captured sufficiently up close on the two-way audio-video communication for the Notary to observe; 10. Any witness or witnesses required or permitted to properly execute any original document or documents according to Maine Law may similarly witness the signing of the document by the Signatory utilizing two-way audio-video communication described in paragraph 1 and may sign as a witness to the document upon receipt of the original document; 11. The Signatory must transmit by fax or electronic means (which may include transmitting a photograph of every page by cellphone) a legible copy of the entire signed document directly to the Notary and any witness, immediately after signing the document, or, if that is not possible, no later than 24 hours after the Signatory's execution of the document; 12. The Signatory must send the original signed document directly to the witness within 48 hours ( or 2 days) after the Signatory's execution of the document, or to the Notary if no witness is involved; 13. Within 48 hours after receiving the original document from the Signatory, the witness must sign it and sent to the second witness, if any, or to the Notary if no other witness is involved. The official date and time of each witness's signature shall be the date and time when the witness witnesses the Signatory's signature via the two-way audio-video communication technology described in paragraph 1; 14. Upon review of the original document and satisfactory comparison with the faxed or electronic document provided on the date of signing, the Notary shall notarize the original document within 48 hours of receipt thereof, and the official date and time of the notarization shall be the date and time when the Notary witnessed the signature via the two-way audio-video technology and shall add the following language below the Notary and or Witness signature lines: ""Notarized (and/or Witnessed) remotely, in accordance with Executive Order 37 FY 19/20""; and 15. A recording of the two-way audio-video communication must be made and preserved by the Notary for a period of at least 5 years from the date of the notarial act. The Notary shall provide a copy of the recording to the Signatory and the Secretary of State upon request. C. Any document that is required under any law of the State of Maine to be notarized ""in the presence and hearing"" or similar language of a Signatory, and that is signed, notarized or witnessed in accordance with the terms of this Executive Order shall be deemed to have been signed and/or notarized in the presence and hearing of the Signatory. D. Nothing in this Order shall require a Notary to perform remote notarization. E. The validity and recognition of a notarization or witness under this Order shall not prevent an aggrieved person from seeking to invalidate a record or transaction that is the subject of a notarization or from seeking other remedies based on State or Federal law other than this Order for any reason not addressed in this Order, such as incapacity, absence of authority or undue influence. F. The failure of a Notary or a witness to meet a requirement specified in this Order shall not invalidate or impair the recognition of a notarization performed by the Notary if it was performed in substantial compliance with this Order. G. The Secretary of State is authorized to issue guidance consistent with this Order to protect the integrity of the remote notarization process. III. INTEGRITY A primary and essential purpose of this Order is to safeguard the integrity of transactions and the important personal interests served by those transactions. Persons who violate the rights of others during a remote notarization are subject to all pertinent civil remedies and criminal penalties. IV. JUDICIAL NOTICE A copy of this Order shall for notice be provided to the Chief Justice of the Maine Supreme Judicial Court. I intend further that the acts, records and proceedings under this Order receive full faith and credit in the courts of the United States and other states. V. EFFECTIVE DATE This Order shall take effect on April 8, 2020 and, unless sooner amended or rescinded, terminates 30 days after the termination of the COVID-19 state of emergency. ======= Base your response strictly on the provided document only. Answer in less than 5 words. Do not include numbers.",Legal,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","In my economics class today, we read this article about the Laffer Curve. I'm rereading it at home and would like to gain a better understanding of how to apply it in practice. Would it be fair to say that lowering prohibitively low taxes will usually lead to increased tax revenue and how the Laffer curved is used? Please explain the reasoning, outlined in this reference text, that supports your answer in two to seven sentences.","Tax Revenue versus Tax Rates: A Discussion of the Laffer Curve Named for economist Arthur Laffer, the Laffer curve is one of the few macroeconomic concepts with which the general public has at least a passing familiarity. However, it also is not well understood even by many who reference it. Economist Hal Varian once noted, “It has been said that the popularity of the Laffer curve is due to the fact that you can explain it to a Congressman in six minutes and he can talk about it for six months.” 1 This brief explains what the Laffer curve is and its implications for economic policy. In its most general form, the Laffer curve depicts the relationship between tax rates and the revenue the government receives–that is, a single tax rate exists that maximizes the amount of revenue the government obtains from taxation. Figure 1 below represents a graphical depiction of a Laffer curve. Figure 1. General form of a Laffer curve. The vertical axis of Figure 1 depicts the tax rate as a percentage, while the horizontal axis depicts revenues received in dollars. At both a tax rate of 0 percent and 100 percent total tax revenues equal zero. Point E represents the tax rate at which total revenues are maximized.2 The horizontal line through point E that bisects the curve represents two ranges of tax rates in terms of their relationship to revenues. Tax rates below this line indicate the normal range of rates, in which an increase in the tax rate corresponds to an increase in total revenues. Tax rates above this line correspond to the prohibitive range, in which an increase in tax rates results in a decrease in total revenues. Thus, any tax rate other than the rate corresponding to point E results in less revenue collected from the tax. Point E, notably, only represents the rate at which total tax revenues are maximized, not the optimal tax rate in terms of the rate that 1 Varian, H.R. (1989) “What Use is Economic Theory?” Available online at http://people.ischool.berkeley.edu/~hal/Papers/theory.pdf. Accessed 1 May 2017. 2 While point E in Figure 1 may appear to represent the midpoint between tax rates of 0 and 100 percent, it does not necessarily indicate a tax rate of 50 percent maximizes total revenues. [2] creates the fewest distortions in the economy. The vertical line through the curve marked by points A and B demonstrates how, because of the symmetric nature of the curve, two different tax rates can result in the same amount of total revenue. Point A represents a relatively high tax rate, slightly below 100 percent. Point B, conversely, represents a relatively low tax rate, slightly above 0 percent. Yet as the vertical line indicates the total tax revenue collected under these two rates is the same according to the Laffer curve. Points A and B, respectively, indicate that in theory, a high rate on a relatively small tax base generates the same revenue as a low tax rate on a relatively large tax base. The general form of the Laffer curve in Figure 1 does not specify the type of tax rates the government levies. While economists have studied numerous applications, the Laffer curve is usually used to describe the behavior of individual income tax rates levied either by the federal or a state government. In many analyses, economists use the Laffer curve to specifically refer to marginal income tax rates–the rate of tax paid on an additional dollar of income. Laffer describes the curve as illustrating two effects of tax rates on tax revenues.3 The first effect is the arithmetic effect, the increase (decrease) in tax revenues that results from an increase (decrease) in the tax rate. The second–and much more controversial–effect is the economic effect, the increase (decrease) in tax revenues resulting from a decrease (increase) in tax rates because of the incentives (disincentives) created to increase (decrease) work, output, and employment. Essentially the economic effect of the Laffer curve holds that reducing tax rates will motivate people to work more and produce more, leading to more revenue; raising tax rates produces the opposite effect. Laffer notes that the two effects are always in the opposite direction, so that the impact of a change in tax rates on revenues is not necessarily immediately clear. In order for a decrease in tax rates to increase revenues, for example, the rate must lie within the prohibitive range of tax rates as illustrated in Figure 1. In this range the economic effect is positive and larger than the arithmetic effect. Significantly, Laffer states that the curve “. . . does not say whether a tax cut will raise or lower revenues.” He maintains that what happens to revenues as a result of a tax rate change depends on a number of factors, such as “. . . the tax system in place, the time period being considered, the ease of movement into underground activities, the level of tax rates already in place,” and “the prevalence of legal and accounting-driven tax loopholes. . .” Thus, individuals who argue the Laffer curve always holds that a tax cut leads to an increase in tax revenues– whether for good or for ill–misrepresent what it hypothesizes. The Laffer curve has been controversial throughout its forty-year-plus history. One of the chief criticisms inflicted against it is determining where a current tax system lies on the curve; i.e., where the tax rate is in relation to point E in Figure 1. Some economists developed a formula that uses income elasticities and other parameters to determine the rate at which point E occurs. This formula finds that the rate equals around 70 percent.4 Other economists also 3 Laffer, A.B. (2004) “The Laffer Curve: Past, Present, and Future.” Executive Summary Backgrounder No. 1765. The Heritage Foundation. 4 Matthews, D. (2010) “Where does the Laffer curve bend?” The Washington Post. 9 August. Available online at http://voices.washingtonpost.com/ezra-klein/2010/08/where_does_the_laffer_curve_be.html. Accessed 2 May 2017. [3] venture the rate corresponding to point E lies in the range of 70 percent; however, other economists contend the rate is considerably lower. Another criticism of the Laffer curve is a lack of empirical evidence. Arthur Laffer cites several instances in U.S. history and in other countries as examples of “Laffer curve effects.” However, the inherent complexities of most systems of taxation as well as other complicating factors make isolating the impacts of specific rate changes difficult in practice. This situation leads to another criticism of the Laffer curve, which is because it focuses on a single rate, it oversimplifies the analysis of tax rate changes. In conclusion, the Laffer curve continues to influence policymakers at the state and national level both in and outside of the U.S. It is an economic concept with ardent defenders and equally ardent detractors. However, the Laffer curve’s most significant contribution may be how it serves as a jumping off point for serious economic policy discussions involving the structure of income tax systems and how individuals respond to these different structures.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. In my economics class today, we read this article about the Laffer Curve. I'm rereading it at home and would like to gain a better understanding of how to apply it in practice. Would it be fair to say that lowering prohibitively low taxes will usually lead to increased tax revenue and how the Laffer curved is used? Please explain the reasoning, outlined in this reference text, that supports your answer in two to seven sentences. Tax Revenue versus Tax Rates: A Discussion of the Laffer Curve Named for economist Arthur Laffer, the Laffer curve is one of the few macroeconomic concepts with which the general public has at least a passing familiarity. However, it also is not well understood even by many who reference it. Economist Hal Varian once noted, “It has been said that the popularity of the Laffer curve is due to the fact that you can explain it to a Congressman in six minutes and he can talk about it for six months.” 1 This brief explains what the Laffer curve is and its implications for economic policy. In its most general form, the Laffer curve depicts the relationship between tax rates and the revenue the government receives–that is, a single tax rate exists that maximizes the amount of revenue the government obtains from taxation. Figure 1 below represents a graphical depiction of a Laffer curve. Figure 1. General form of a Laffer curve. The vertical axis of Figure 1 depicts the tax rate as a percentage, while the horizontal axis depicts revenues received in dollars. At both a tax rate of 0 percent and 100 percent total tax revenues equal zero. Point E represents the tax rate at which total revenues are maximized.2 The horizontal line through point E that bisects the curve represents two ranges of tax rates in terms of their relationship to revenues. Tax rates below this line indicate the normal range of rates, in which an increase in the tax rate corresponds to an increase in total revenues. Tax rates above this line correspond to the prohibitive range, in which an increase in tax rates results in a decrease in total revenues. Thus, any tax rate other than the rate corresponding to point E results in less revenue collected from the tax. Point E, notably, only represents the rate at which total tax revenues are maximized, not the optimal tax rate in terms of the rate that 1 Varian, H.R. (1989) “What Use is Economic Theory?” Available online at http://people.ischool.berkeley.edu/~hal/Papers/theory.pdf. Accessed 1 May 2017. 2 While point E in Figure 1 may appear to represent the midpoint between tax rates of 0 and 100 percent, it does not necessarily indicate a tax rate of 50 percent maximizes total revenues. [2] creates the fewest distortions in the economy. The vertical line through the curve marked by points A and B demonstrates how, because of the symmetric nature of the curve, two different tax rates can result in the same amount of total revenue. Point A represents a relatively high tax rate, slightly below 100 percent. Point B, conversely, represents a relatively low tax rate, slightly above 0 percent. Yet as the vertical line indicates the total tax revenue collected under these two rates is the same according to the Laffer curve. Points A and B, respectively, indicate that in theory, a high rate on a relatively small tax base generates the same revenue as a low tax rate on a relatively large tax base. The general form of the Laffer curve in Figure 1 does not specify the type of tax rates the government levies. While economists have studied numerous applications, the Laffer curve is usually used to describe the behavior of individual income tax rates levied either by the federal or a state government. In many analyses, economists use the Laffer curve to specifically refer to marginal income tax rates–the rate of tax paid on an additional dollar of income. Laffer describes the curve as illustrating two effects of tax rates on tax revenues.3 The first effect is the arithmetic effect, the increase (decrease) in tax revenues that results from an increase (decrease) in the tax rate. The second–and much more controversial–effect is the economic effect, the increase (decrease) in tax revenues resulting from a decrease (increase) in tax rates because of the incentives (disincentives) created to increase (decrease) work, output, and employment. Essentially the economic effect of the Laffer curve holds that reducing tax rates will motivate people to work more and produce more, leading to more revenue; raising tax rates produces the opposite effect. Laffer notes that the two effects are always in the opposite direction, so that the impact of a change in tax rates on revenues is not necessarily immediately clear. In order for a decrease in tax rates to increase revenues, for example, the rate must lie within the prohibitive range of tax rates as illustrated in Figure 1. In this range the economic effect is positive and larger than the arithmetic effect. Significantly, Laffer states that the curve “. . . does not say whether a tax cut will raise or lower revenues.” He maintains that what happens to revenues as a result of a tax rate change depends on a number of factors, such as “. . . the tax system in place, the time period being considered, the ease of movement into underground activities, the level of tax rates already in place,” and “the prevalence of legal and accounting-driven tax loopholes. . .” Thus, individuals who argue the Laffer curve always holds that a tax cut leads to an increase in tax revenues– whether for good or for ill–misrepresent what it hypothesizes. The Laffer curve has been controversial throughout its forty-year-plus history. One of the chief criticisms inflicted against it is determining where a current tax system lies on the curve; i.e., where the tax rate is in relation to point E in Figure 1. Some economists developed a formula that uses income elasticities and other parameters to determine the rate at which point E occurs. This formula finds that the rate equals around 70 percent.4 Other economists also 3 Laffer, A.B. (2004) “The Laffer Curve: Past, Present, and Future.” Executive Summary Backgrounder No. 1765. The Heritage Foundation. 4 Matthews, D. (2010) “Where does the Laffer curve bend?” The Washington Post. 9 August. Available online at http://voices.washingtonpost.com/ezra-klein/2010/08/where_does_the_laffer_curve_be.html. Accessed 2 May 2017. [3] venture the rate corresponding to point E lies in the range of 70 percent; however, other economists contend the rate is considerably lower. Another criticism of the Laffer curve is a lack of empirical evidence. Arthur Laffer cites several instances in U.S. history and in other countries as examples of “Laffer curve effects.” However, the inherent complexities of most systems of taxation as well as other complicating factors make isolating the impacts of specific rate changes difficult in practice. This situation leads to another criticism of the Laffer curve, which is because it focuses on a single rate, it oversimplifies the analysis of tax rate changes. In conclusion, the Laffer curve continues to influence policymakers at the state and national level both in and outside of the U.S. It is an economic concept with ardent defenders and equally ardent detractors. However, the Laffer curve’s most significant contribution may be how it serves as a jumping off point for serious economic policy discussions involving the structure of income tax systems and how individuals respond to these different structures. http://www.mississippi.edu/urc/downloads/laffer_curve.pdf",Financial,Find & Summarize,Text Transformation Answer the prompt only using the provided text as your source of information. Do not use any external sources or prior knowledge.,List every strange law pertaining to an animal.,"Alabama: • Anniston: You may not wear blue jeans down Noble Street. • Bear wrestling matches are prohibited. • Dominoes may not be played on Sunday. • It is illegal for a driver to be blindfolded while operating a vehicle. • It is illegal to wear a fake moustache that causes laughter in church. • It is legal to drive the wrong way down a one-way street if you have a lantern attached to the front of your automobile. • Montgomery: It is considered an offense to open an umbrella on a street, for fear of it spooking horses. • You cannot chain your alligator to a fire hydrant. • You may not drive barefooted. • You may not have an ice cream cone in your back pocket at any time. Alaska: • Even though it is legal to hunt a bear, it is illegal to wake a bear and take a picture for photo opportunities. • In Alaska it is illegal to whisper in someone's ear while they are moose hunting. • It is considered an offense to push a live moose out of a moving airplane. • Kangaroos are not allowed in barber shops at any time. • Moose may not be viewed from an airplane. Arizona: • Donkeys cannot sleep in bathtubs. • Glendale: Cars may not be driven in reverse. • Hunting camels is prohibited. • It is illegal for men and women over the age of 18 to have less than one missing tooth visible when smiling. • It is unlawful to refuse a person a glass of water. • Mohave County: A decree declares that anyone caught stealing soap must wash with it until it is all used up. Arkansas: • A law provides that school teachers who bob their hair will not get a raise. • Alligators may not be kept in bathtubs. • Arkansas must be pronounced ""Arkansaw"" • In Arkansas it is illegal to buy or sell blue light bulbs. California: • Baldwin Park: Nobody is allowed to ride a bicycle in a swimming pool. • Blythe: You are not permitted to wear cowboy boots unless you already own at least two cows. • Burlingame: It is illegal to spit, except on baseball diamonds; Carmel Ice cream may not be eaten while standing on the sidewalk. (Repealed when Clint Eastwood was mayor); Women may not wear high heels while in the city limits. • Community leaders passed an ordinance that makes it illegal for anyone to try and stop a child from playfully jumping over puddles of water. • Hollywood: It is illegal to drive more than two thousand sheep down Hollywood Boulevard at one time. • In California it is illegal to have caller ID • In California it's against regulations to let phones ring more than nine times in state offices. • It is illegal to cry on the witness stand. • Lodi: It is illegal to own or sell ""Silly String"". • It is illegal to set a mouse trap without a hunting license. • Women may not drive in a house coat. Colorado: • Car dealers may not show cars on a Sunday. • Cripple Creek: It is illegal to bring your horse or pack mule above the ground floor of any building. • Denver: The dog catcher must notify dogs of impounding by posting, for three consecutive days, a notice on a tree in the city park and along a public road running through said park; it is unlawful to lend your vacuum cleaner to your next-door neighbor; it is illegal to mistreat rats; you may not drive a black car on Sundays. • In Colorado it's now legal to remove the furniture tags that say, ""Do Not Remove Under Penalty of Law."" • It is illegal to mistreat rats in Denver. • In Colorado it's now legal to remove the furniture tags that say, ""Do Not Remove Under Penalty of Law."" • Pueblo: It is illegal to let a dandelion grow within the city limits. • Sterling: Cats may not run loose without having been fit with a taillight. Connecticut: • A local ordinance in Atwoodville, Connecticut prohibits people from playing Scrabble while waiting for a politician to speak. • A pickle is not officially a pickle unless it bounces • Balloons with advertising on them are illegal in Hartford, Conn. • Bloomfield, Conn: It's against the law to eat in your car. • Devon: It is unlawful to walk backwards after sunset. • Guilford: Only white Christmas lights are allowed for display. • Hartford: You aren't allowed to cross a street while walking on your hands. • You may not educate dogs","System instruction: Answer the prompt only using the provided text as your source of information. Do not use any external sources or prior knowledge. User question: List every strange law pertaining to an animal. Context block: Alabama: • Anniston: You may not wear blue jeans down Noble Street. • Bear wrestling matches are prohibited. • Dominoes may not be played on Sunday. • It is illegal for a driver to be blindfolded while operating a vehicle. • It is illegal to wear a fake moustache that causes laughter in church. • It is legal to drive the wrong way down a one-way street if you have a lantern attached to the front of your automobile. • Montgomery: It is considered an offense to open an umbrella on a street, for fear of it spooking horses. • You cannot chain your alligator to a fire hydrant. • You may not drive barefooted. • You may not have an ice cream cone in your back pocket at any time. Alaska: • Even though it is legal to hunt a bear, it is illegal to wake a bear and take a picture for photo opportunities. • In Alaska it is illegal to whisper in someone's ear while they are moose hunting. • It is considered an offense to push a live moose out of a moving airplane. • Kangaroos are not allowed in barber shops at any time. • Moose may not be viewed from an airplane. Arizona: • Donkeys cannot sleep in bathtubs. • Glendale: Cars may not be driven in reverse. • Hunting camels is prohibited. • It is illegal for men and women over the age of 18 to have less than one missing tooth visible when smiling. • It is unlawful to refuse a person a glass of water. • Mohave County: A decree declares that anyone caught stealing soap must wash with it until it is all used up. Arkansas: • A law provides that school teachers who bob their hair will not get a raise. • Alligators may not be kept in bathtubs. • Arkansas must be pronounced ""Arkansaw"" • In Arkansas it is illegal to buy or sell blue light bulbs. California: • Baldwin Park: Nobody is allowed to ride a bicycle in a swimming pool. • Blythe: You are not permitted to wear cowboy boots unless you already own at least two cows. • Burlingame: It is illegal to spit, except on baseball diamonds; Carmel Ice cream may not be eaten while standing on the sidewalk. (Repealed when Clint Eastwood was mayor); Women may not wear high heels while in the city limits. • Community leaders passed an ordinance that makes it illegal for anyone to try and stop a child from playfully jumping over puddles of water. • Hollywood: It is illegal to drive more than two thousand sheep down Hollywood Boulevard at one time. • In California it is illegal to have caller ID • In California it's against regulations to let phones ring more than nine times in state offices. • It is illegal to cry on the witness stand. • Lodi: It is illegal to own or sell ""Silly String"". • It is illegal to set a mouse trap without a hunting license. • Women may not drive in a house coat. Colorado: • Car dealers may not show cars on a Sunday. • Cripple Creek: It is illegal to bring your horse or pack mule above the ground floor of any building. • Denver: The dog catcher must notify dogs of impounding by posting, for three consecutive days, a notice on a tree in the city park and along a public road running through said park; it is unlawful to lend your vacuum cleaner to your next-door neighbor; it is illegal to mistreat rats; you may not drive a black car on Sundays. • In Colorado it's now legal to remove the furniture tags that say, ""Do Not Remove Under Penalty of Law."" • It is illegal to mistreat rats in Denver. • In Colorado it's now legal to remove the furniture tags that say, ""Do Not Remove Under Penalty of Law."" • Pueblo: It is illegal to let a dandelion grow within the city limits. • Sterling: Cats may not run loose without having been fit with a taillight. Connecticut: • A local ordinance in Atwoodville, Connecticut prohibits people from playing Scrabble while waiting for a politician to speak. • A pickle is not officially a pickle unless it bounces • Balloons with advertising on them are illegal in Hartford, Conn. • Bloomfield, Conn: It's against the law to eat in your car. • Devon: It is unlawful to walk backwards after sunset. • Guilford: Only white Christmas lights are allowed for display. • Hartford: You aren't allowed to cross a street while walking on your hands. • You may not educate dogs",Legal,Find & Summarize,Text Transformation This task requires you to answer a question based only on the information provided in the prompt. You should not use external resources or prior knowledge to answer it. Please answer using language that is sophisticated and would be understood by someone who is familiar with the topic but not an expert.,"Please define Common Law Offenses, Surety Statues, and Statutory Prohibitions as they relate to gun laws.","(2) The burden then falls on respondents to show that New York’s proper-cause requirement is consistent with this Nation’s historical tradition of firearm regulation. To do so, respondents appeal to a variety of historical sources from the late 1200s to the early 1900s. But when it comes to interpreting the Constitution, not all history is created equal. “Constitutional rights are enshrined with the scope they were understood to have when the people adopted them.” Heller, 554 U. S., at 634–635. The Second Amendment was adopted in 1791; the Fourteenth in 1868. Historical evidence that long predates or postdates either time may not illuminate the scope of the right. With these principles in mind, the Court concludes that respondents have failed to meet their burden to identify an American tradition justifying New York’s proper-cause requirement. Pp. 24–62. (i) Respondents’ substantial reliance on English history and custom before the founding makes some sense given Heller’s statement that the Second Amendment “codified a right ‘inherited from our English ancestors.’ ” 554 U. S., at 599. But the Court finds that history ambiguous at best and sees little reason to think that the Framers would have thought it applicable in the New World. The Court cannot conclude from this historical record that, by the time of the founding, English law would have justified restricting the right to publicly bear arms suited for self-defense only to those who demonstrate some special need for self-protection. Pp. 30–37. (ii) Respondents next direct the Court to the history of the Colonies and early Republic, but they identify only three restrictions on public carry from that time. While the Court doubts that just three colonial regulations could suffice to show a tradition of public-carry regulation, even looking at these laws on their own terms, the Court is not convinced that they regulated public carry akin to the New York law at issue. The statutes essentially prohibited bearing arms in a way that spread “fear” or “terror” among the people, including by carrying of “dangerous and unusual weapons.” See 554 U. S., at 627. Whatever the likelihood that handguns were considered “dangerous and unusual” during the colonial period, they are today “the quintessential self-defense weapon.” Id., at 629. Thus, these colonial laws provide no justification for laws restricting the public carry of weapons that are unquestionably in common use today. Pp. 37–42. (iii) Only after the ratification of the Second Amendment in 1791 did public-carry restrictions proliferate. Respondents rely heavily on these restrictions, which generally fell into three categories: common-law offenses, statutory prohibitions, and “surety” statutes. None of these restrictions imposed a substantial burden on public carry analogous to that imposed by New York’s restrictive licensing regime. Common-Law Offenses. As during the colonial and founding periods, the common-law offenses of “affray” or going armed “to the terror of the people” continued to impose some limits on firearm carry in the antebellum period. But there is no evidence indicating that these common-law limitations impaired the right of the general population to peaceable public carry. Statutory Prohibitions. In the early to mid-19th century, some States began enacting laws that proscribed the concealed carry of pistols and other small weapons. But the antebellum state-court decisions upholding them evince a consensus view that States could not altogether prohibit the public carry of arms protected by the Second Amendment or state analogues. Surety Statutes. In the mid-19th century, many jurisdictions began adopting laws that required certain individuals to post bond before carrying weapons in public. Contrary to respondents’ position, these surety statutes in no way represented direct precursors to New York’s proper-cause requirement. While New York presumes that individuals have no public carry right without a showing of heightened need, the surety statutes presumed that individuals had a right to public carry that could be burdened only if another could make out a specific showing of “reasonable cause to fear an injury, or breach of the peace.” Mass. Rev. Stat., ch. 134, §16 (1836). Thus, unlike New York’s regime, a showing of special need was required only after an individual was reasonably accused of intending to injure another or breach the peace. And, even then, proving special need simply avoided a fee. In sum, the historical evidence from antebellum America does demonstrate that the manner of public carry was subject to reasonable regulation, but none of these limitations on the right to bear arms operated to prevent law-abiding citizens with ordinary self-defense needs from carrying arms in public for that purpose. Pp. 42–51. (iv) Evidence from around the adoption of the Fourteenth Amendment also does not support respondents’ position. The “discussion of the [right to keep and bear arms] in Congress and in public discourse, as people debated whether and how to secure constitutional rights for newly free slaves,” Heller, 554 U. S., at 614, generally demonstrates that during Reconstruction the right to keep and bear arms had limits that were consistent with a right of the public to peaceably carry handguns for self-defense. The Court acknowledges two Texas cases—English v. State, 35 Tex. 473 and State v. Duke, 42 Tex. 455—that approved a statutory “reasonable grounds” standard for public carry analogous to New York’s proper-cause requirement. But these decisions were outliers and therefore provide little insight into how postbellum courts viewed the right to carry protected arms in public. See Heller, 554 U. S., at 632. Pp. 52–58.","system instruction: [This task requires you to answer a question based only on the information provided in the prompt. You should not use external resources or prior knowledge to answer it. Please answer using language that is sophisticated and would be understood by someone who is familiar with the topic but not an expert.] question: [Please define Common Law Offenses, Surety Statues, and Statutory Prohibitions as they relate to gun laws.] context block: [(2) The burden then falls on respondents to show that New York’s proper-cause requirement is consistent with this Nation’s historical tradition of firearm regulation. To do so, respondents appeal to a variety of historical sources from the late 1200s to the early 1900s. But when it comes to interpreting the Constitution, not all history is created equal. “Constitutional rights are enshrined with the scope they were understood to have when the people adopted them.” Heller, 554 U. S., at 634–635. The Second Amendment was adopted in 1791; the Fourteenth in 1868. Historical evidence that long predates or postdates either time may not illuminate the scope of the right. With these principles in mind, the Court concludes that respondents have failed to meet their burden to identify an American tradition justifying New York’s proper-cause requirement. Pp. 24–62. (i) Respondents’ substantial reliance on English history and custom before the founding makes some sense given Heller’s statement that the Second Amendment “codified a right ‘inherited from our English ancestors.’ ” 554 U. S., at 599. But the Court finds that history ambiguous at best and sees little reason to think that the Framers would have thought it applicable in the New World. The Court cannot conclude from this historical record that, by the time of the founding, English law would have justified restricting the right to publicly bear arms suited for self-defense only to those who demonstrate some special need for self-protection. Pp. 30–37. (ii) Respondents next direct the Court to the history of the Colonies and early Republic, but they identify only three restrictions on public carry from that time. While the Court doubts that just three colonial regulations could suffice to show a tradition of public-carry regulation, even looking at these laws on their own terms, the Court is not convinced that they regulated public carry akin to the New York law at issue. The statutes essentially prohibited bearing arms in a way that spread “fear” or “terror” among the people, including by carrying of “dangerous and unusual weapons.” See 554 U. S., at 627. Whatever the likelihood that handguns were considered “dangerous and unusual” during the colonial period, they are today “the quintessential self-defense weapon.” Id., at 629. Thus, these colonial laws provide no justification for laws restricting the public carry of weapons that are unquestionably in common use today. Pp. 37–42. (iii) Only after the ratification of the Second Amendment in 1791 did public-carry restrictions proliferate. Respondents rely heavily on these restrictions, which generally fell into three categories: common-law offenses, statutory prohibitions, and “surety” statutes. None of these restrictions imposed a substantial burden on public carry analogous to that imposed by New York’s restrictive licensing regime. Common-Law Offenses. As during the colonial and founding periods, the common-law offenses of “affray” or going armed “to the terror of the people” continued to impose some limits on firearm carry in the antebellum period. But there is no evidence indicating that these common-law limitations impaired the right of the general population to peaceable public carry. Statutory Prohibitions. In the early to mid-19th century, some States began enacting laws that proscribed the concealed carry of pistols and other small weapons. But the antebellum state-court decisions upholding them evince a consensus view that States could not altogether prohibit the public carry of arms protected by the Second Amendment or state analogues. Surety Statutes. In the mid-19th century, many jurisdictions began adopting laws that required certain individuals to post bond before carrying weapons in public. Contrary to respondents’ position, these surety statutes in no way represented direct precursors to New York’s proper-cause requirement. While New York presumes that individuals have no public carry right without a showing of heightened need, the surety statutes presumed that individuals had a right to public carry that could be burdened only if another could make out a specific showing of “reasonable cause to fear an injury, or breach of the peace.” Mass. Rev. Stat., ch. 134, §16 (1836). Thus, unlike New York’s regime, a showing of special need was required only after an individual was reasonably accused of intending to injure another or breach the peace. And, even then, proving special need simply avoided a fee. In sum, the historical evidence from antebellum America does demonstrate that the manner of public carry was subject to reasonable regulation, but none of these limitations on the right to bear arms operated to prevent law-abiding citizens with ordinary self-defense needs from carrying arms in public for that purpose. Pp. 42–51. (iv) Evidence from around the adoption of the Fourteenth Amendment also does not support respondents’ position. The “discussion of the [right to keep and bear arms] in Congress and in public discourse, as people debated whether and how to secure constitutional rights for newly free slaves,” Heller, 554 U. S., at 614, generally demonstrates that during Reconstruction the right to keep and bear arms had limits that were consistent with a right of the public to peaceably carry handguns for self-defense. The Court acknowledges two Texas cases—English v. State, 35 Tex. 473 and State v. Duke, 42 Tex. 455—that approved a statutory “reasonable grounds” standard for public carry analogous to New York’s proper-cause requirement. But these decisions were outliers and therefore provide little insight into how postbellum courts viewed the right to carry protected arms in public. See Heller, 554 U. S., at 632. Pp. 52–58.]",Legal,Explanation/Definition,Q&A "Answer in complete sentences, only use the context document, no outside knowledge.","According to the document, can a city make it illegal to be homeless?","**Homelessness laws in Texas** When is an individual considered homeless? The United State Department of Housing and Urban Development (HUD) provides four broad categories of homelessness:  Individuals and families who lack a fixed, regular, and adequate nighttime residence, which includes a subset for an individual who is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or a place not meant for human habitation immediately before entering that institution;  Individuals and families who will imminently lose their primary nighttime residence;  Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition; or  Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member. What negative effects can a large homeless population have on a city? A large homeless population can be draining on a community. Homeless individuals that lack access to proper medical care may choose an emergency room at a hospital for medical services rather than a primary care medical office. This option is significantly more expensive and typically the homeless individual is unable to pay the bill, so the cost is passed on to insurance companies and the average customer in a community. Homeless individuals spend more time in local jails than the housed population for petty offenses, which increases the costs to run the facility. Additionally, a large homeless population can affect a city’s ability to attract tourists. What is affordable housing? Affordable housing is housing for which the occupant pays less than 30 percent of their income. Housing that is considered to be “affordable” will differ between communities, depending on the median family income of the area. What is Section 8 housing? “Section 8” refers to Section 8 of the federal Housing Act of 1937. This section authorizes project-based rental assistance programs under which a participating owner, or landlord, is required to reserve units in a building for low-income tenants, in return for a federal government guarantee to make up the difference between the tenant's contribution and the rent in the owner's contract with the government. What is a Section 8 voucher? Section 8 of the federal Housing Act also authorizes vouchers for low-income individuals. HUD manages the Housing Choice Voucher Program, which provides financial assistance directly to the landlord for a family that qualifies. The Housing Choice Voucher Program is the federal government's major program for assisting very low-income families, the elderly, and the disabled to afford decent, safe, and sanitary housing in the private market. Since housing assistance is provided on behalf of the family or individual, participants are able to find their own housing, including single-family homes, townhouses and apartments, and are free to choose any housing option that meets the requirements of the program. Housing choice vouchers are administered locally by public housing agencies (PHAs). The PHAs receive federal funds from HUD to administer the voucher program. A list of public housing authorities in Texas can be found at http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/pha/contacts/ tx A housing subsidy is paid to the landlord directly by the PHA on behalf of the participating family. The family then pays the difference between the actual rent charged by the landlord and the amount subsidized by the program. Can a city make being homeless illegal? No. Laws that punish status or condition rather than criminal conduct have been struck down by courts as constituting cruel and unusual punishment. These types of laws fail to give fair notice of prohibited conduct and encourage arbitrary arrests and convictions. Additionally, courts have overturned vagrancy laws, or laws that criminalize being homeless, as impermissible restrictions on an individual’s right to travel. See Papachristou v. City of Jacksonville, 45 U.S. 156, 162(1972); Handler v. Denver, 77 P.2d 132, 135 (Colo. 1938); Pottinger v. City of Miami, 810 F. Supp. 1551, 1578 (S.D. Fla. 1992). Can the city enact a loitering prohibition? Maybe. In a 1983 decision in Kolender v. Lawson, the United State Supreme Court invalidated a California loitering statute requiring street wanderers to present valid identification when stopped by police officers. The Court held that the statute was too vague to satisfy due process requirements. The Court followed this decision with its decision in Chicago v. Morales, which struck down a Chicago ordinance preventing loitering by gang members on due process grounds. An ordinance that is general in nature that criminalizes loitering on a public street would most likely be struck down by a court for vagueness. However, if the wording of the ordinance is sufficient to set forth guidelines for law enforcement officers narrowly tailoring the restriction to those who loiter with a specific illegal purpose, then a loitering ordinance may pass constitutional muster. City officials will want to work closely with their local legal counsel if they desire to adopt such an ordinance. Can a city prevent homeless people from panhandling in all public places? No. Litigation related to bans on panhandling has centered on First Amendment free speech claims. Courts have ruled that outlawing panhandling in all public places was unconstitutional. See generally Young v. New York City Transit Auth., 903 F.2d 146 (2d Cir. 1990); Speet v. Schuette, 889 F. Supp. 2d 969 (W.D. Mich. 2012). Instead, any limits on panhandling on public sidewalks trigger strict scrutiny, meaning the regulations must be narrowly tailored to serve a significant governmental interest and must be the least restrictive means for achieving that interest. Courts have found that safety and traffic congestion may be significant interests but “mere annoyance” is not a sufficiently compelling reason to absolutely deprive an individual of his or her First Amendment rights. What strategies have cities used to reduce homelessness?  Participating in the “Mayors Challenge to End Veteran Homelessness,” a program designed to equip city leaders with tools to combat veteran homelessness. For more information on how to participate, you can visit the Department of Housing and Urban Development’s Mayors Challenge page at http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/veteran_info rmation/mayors_challenge/mayors_and_staff;  Seeking state grants awarded by the Texas Department of Housing and Community Affairs or federal grants awarded by HUD;  Educating law enforcement officers on alternatives to issuing citations and supporting police department partnerships with mental health partners;  Recruiting landlords in the city to assist in providing housing opportunities for individuals and families experiencing homelessness;  Educating municipal court personnel on providing referrals to municipal court defendants to non-profit groups in the city that provide housing and other services;  Issuing general obligation bonds for the purpose of expanding affordable housing in the city;  Creating a housing authority to assist with providing affordable housing within the city. What is a housing authority? A housing authority is a public body that is created for clearance, replanning, and reconstruction of areas in which unsanitary or unsafe housing exists and for providing safe and sanitary housing for persons of low income. The housing authority may provide for the construction, improvement, alteration, or repair of a housing project, or part of a housing project, in its area of operation. A housing authority may also lease or rent housing, land, buildings, structures, or facilities included in a housing project. A housing authority is able to borrow money or accept grants or other financial assistance from the federal government for a housing project in the authority's area of operation, or form a partnership or another entity to raise capital for a housing project to be owned by the partnership or other entity. How does our city create a housing authority? The city council may declare by resolution that there is a need for a housing authority in the city if it finds that there is: (1) unsanitary or unsafe inhabited housing in the city; or (2) a shortage of safe or sanitary housing in the city available to persons of low income at rentals that they can afford. TEX. LOC. GOV’T CODE § 392.011. The council may determine on its own motion if there is a need for a housing authority but must determine there is a need upon receiving a petition signed by at least 100 qualified voters of the city. Who appoints members of a housing authority? Each municipal housing authority is governed by either five, seven, nine, or 11 commissioners. The mayor of the city appoints the commissioners of the authority, and an appointed commissioner of the authority may not be an officer or employee of the city. TEX. LOC. GOV’T CODE § 392.031. After the appointment, a certificate of the appointment of a commissioner must be filed with the city secretary. A city with a municipal housing authority composed of five commissioners must appoint at least one commissioner to the authority who is a tenant of a public housing project over which the authority has jurisdiction. TEX. LOC. GOV’T CODE § 392.0331. A city with a municipality with a municipal housing authority composed of seven or more commissioners must appoint at least two commissioners to the authority who are tenants of a public housing project over which the authority has jurisdiction. What is the term of office for a housing authority commissioner? Initially, a housing authority with five commissioners must have two designated to serve oneyear terms and three designated to serve two-year terms. A housing authority with seven commissioners must have three designated to serve one-year terms and four designated to serve two-year terms. A housing authority with nine commissioners must have four designated to serve one-year terms and five designated to serve two-year terms. Finally, a housing authority with 11 commissioners must have five designated to serve one-year terms and six designated to serve two-year terms. Subsequent municipal housing commissioners are appointed for two-year terms. If there is a vacancy on the housing authority board, the mayor appoints someone to fill the unexpired term. TEX. LOC. GOV’T CODE § 392.034. ","[question] ================== According to the document, can a city make it illegal to be homeless? ================ [passage] ================== **Homelessness laws in Texas** When is an individual considered homeless? The United State Department of Housing and Urban Development (HUD) provides four broad categories of homelessness:  Individuals and families who lack a fixed, regular, and adequate nighttime residence, which includes a subset for an individual who is exiting an institution where he or she resided for 90 days or less and who resided in an emergency shelter or a place not meant for human habitation immediately before entering that institution;  Individuals and families who will imminently lose their primary nighttime residence;  Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition; or  Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member. What negative effects can a large homeless population have on a city? A large homeless population can be draining on a community. Homeless individuals that lack access to proper medical care may choose an emergency room at a hospital for medical services rather than a primary care medical office. This option is significantly more expensive and typically the homeless individual is unable to pay the bill, so the cost is passed on to insurance companies and the average customer in a community. Homeless individuals spend more time in local jails than the housed population for petty offenses, which increases the costs to run the facility. Additionally, a large homeless population can affect a city’s ability to attract tourists. What is affordable housing? Affordable housing is housing for which the occupant pays less than 30 percent of their income. Housing that is considered to be “affordable” will differ between communities, depending on the median family income of the area. What is Section 8 housing? “Section 8” refers to Section 8 of the federal Housing Act of 1937. This section authorizes project-based rental assistance programs under which a participating owner, or landlord, is required to reserve units in a building for low-income tenants, in return for a federal government guarantee to make up the difference between the tenant's contribution and the rent in the owner's contract with the government. What is a Section 8 voucher? Section 8 of the federal Housing Act also authorizes vouchers for low-income individuals. HUD manages the Housing Choice Voucher Program, which provides financial assistance directly to the landlord for a family that qualifies. The Housing Choice Voucher Program is the federal government's major program for assisting very low-income families, the elderly, and the disabled to afford decent, safe, and sanitary housing in the private market. Since housing assistance is provided on behalf of the family or individual, participants are able to find their own housing, including single-family homes, townhouses and apartments, and are free to choose any housing option that meets the requirements of the program. Housing choice vouchers are administered locally by public housing agencies (PHAs). The PHAs receive federal funds from HUD to administer the voucher program. A list of public housing authorities in Texas can be found at http://portal.hud.gov/hudportal/HUD?src=/program_offices/public_indian_housing/pha/contacts/ tx A housing subsidy is paid to the landlord directly by the PHA on behalf of the participating family. The family then pays the difference between the actual rent charged by the landlord and the amount subsidized by the program. Can a city make being homeless illegal? No. Laws that punish status or condition rather than criminal conduct have been struck down by courts as constituting cruel and unusual punishment. These types of laws fail to give fair notice of prohibited conduct and encourage arbitrary arrests and convictions. Additionally, courts have overturned vagrancy laws, or laws that criminalize being homeless, as impermissible restrictions on an individual’s right to travel. See Papachristou v. City of Jacksonville, 45 U.S. 156, 162(1972); Handler v. Denver, 77 P.2d 132, 135 (Colo. 1938); Pottinger v. City of Miami, 810 F. Supp. 1551, 1578 (S.D. Fla. 1992). Can the city enact a loitering prohibition? Maybe. In a 1983 decision in Kolender v. Lawson, the United State Supreme Court invalidated a California loitering statute requiring street wanderers to present valid identification when stopped by police officers. The Court held that the statute was too vague to satisfy due process requirements. The Court followed this decision with its decision in Chicago v. Morales, which struck down a Chicago ordinance preventing loitering by gang members on due process grounds. An ordinance that is general in nature that criminalizes loitering on a public street would most likely be struck down by a court for vagueness. However, if the wording of the ordinance is sufficient to set forth guidelines for law enforcement officers narrowly tailoring the restriction to those who loiter with a specific illegal purpose, then a loitering ordinance may pass constitutional muster. City officials will want to work closely with their local legal counsel if they desire to adopt such an ordinance. Can a city prevent homeless people from panhandling in all public places? No. Litigation related to bans on panhandling has centered on First Amendment free speech claims. Courts have ruled that outlawing panhandling in all public places was unconstitutional. See generally Young v. New York City Transit Auth., 903 F.2d 146 (2d Cir. 1990); Speet v. Schuette, 889 F. Supp. 2d 969 (W.D. Mich. 2012). Instead, any limits on panhandling on public sidewalks trigger strict scrutiny, meaning the regulations must be narrowly tailored to serve a significant governmental interest and must be the least restrictive means for achieving that interest. Courts have found that safety and traffic congestion may be significant interests but “mere annoyance” is not a sufficiently compelling reason to absolutely deprive an individual of his or her First Amendment rights. What strategies have cities used to reduce homelessness?  Participating in the “Mayors Challenge to End Veteran Homelessness,” a program designed to equip city leaders with tools to combat veteran homelessness. For more information on how to participate, you can visit the Department of Housing and Urban Development’s Mayors Challenge page at http://portal.hud.gov/hudportal/HUD?src=/program_offices/comm_planning/veteran_info rmation/mayors_challenge/mayors_and_staff;  Seeking state grants awarded by the Texas Department of Housing and Community Affairs or federal grants awarded by HUD;  Educating law enforcement officers on alternatives to issuing citations and supporting police department partnerships with mental health partners;  Recruiting landlords in the city to assist in providing housing opportunities for individuals and families experiencing homelessness;  Educating municipal court personnel on providing referrals to municipal court defendants to non-profit groups in the city that provide housing and other services;  Issuing general obligation bonds for the purpose of expanding affordable housing in the city;  Creating a housing authority to assist with providing affordable housing within the city. What is a housing authority? A housing authority is a public body that is created for clearance, replanning, and reconstruction of areas in which unsanitary or unsafe housing exists and for providing safe and sanitary housing for persons of low income. The housing authority may provide for the construction, improvement, alteration, or repair of a housing project, or part of a housing project, in its area of operation. A housing authority may also lease or rent housing, land, buildings, structures, or facilities included in a housing project. A housing authority is able to borrow money or accept grants or other financial assistance from the federal government for a housing project in the authority's area of operation, or form a partnership or another entity to raise capital for a housing project to be owned by the partnership or other entity. How does our city create a housing authority? The city council may declare by resolution that there is a need for a housing authority in the city if it finds that there is: (1) unsanitary or unsafe inhabited housing in the city; or (2) a shortage of safe or sanitary housing in the city available to persons of low income at rentals that they can afford. TEX. LOC. GOV’T CODE § 392.011. The council may determine on its own motion if there is a need for a housing authority but must determine there is a need upon receiving a petition signed by at least 100 qualified voters of the city. Who appoints members of a housing authority? Each municipal housing authority is governed by either five, seven, nine, or 11 commissioners. The mayor of the city appoints the commissioners of the authority, and an appointed commissioner of the authority may not be an officer or employee of the city. TEX. LOC. GOV’T CODE § 392.031. After the appointment, a certificate of the appointment of a commissioner must be filed with the city secretary. A city with a municipal housing authority composed of five commissioners must appoint at least one commissioner to the authority who is a tenant of a public housing project over which the authority has jurisdiction. TEX. LOC. GOV’T CODE § 392.0331. A city with a municipality with a municipal housing authority composed of seven or more commissioners must appoint at least two commissioners to the authority who are tenants of a public housing project over which the authority has jurisdiction. What is the term of office for a housing authority commissioner? Initially, a housing authority with five commissioners must have two designated to serve oneyear terms and three designated to serve two-year terms. A housing authority with seven commissioners must have three designated to serve one-year terms and four designated to serve two-year terms. A housing authority with nine commissioners must have four designated to serve one-year terms and five designated to serve two-year terms. Finally, a housing authority with 11 commissioners must have five designated to serve one-year terms and six designated to serve two-year terms. Subsequent municipal housing commissioners are appointed for two-year terms. If there is a vacancy on the housing authority board, the mayor appoints someone to fill the unexpired term. TEX. LOC. GOV’T CODE § 392.034. ================ [task] ================== Answer in complete sentences, only use the context document, no outside knowledge.",Legal,Fact Finding,Q&A Answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points.,Summarize why pain control is important.,"Vital Signs The surgeon, anesthesiologist, physician’s assistant, or nurse practitioner will write an order that specifies how often the vital signs should be checked. Measuring the pulse and blood pressure every 15 minutes in the first hour after the operation is not unusual. The CNA should always let the supervising nurse or physician know about a fever or an abnormal pulse or blood pressure. This is especially important when caring for a post-operative patient. Slight deviations of pulse and blood pressure may be normal after surgery, but these should still be reported. It should not be assumed that a pulse greater than 100, or a systolic blood pressure that is low, are of no concern. Mental Status Drowsiness is expected after surgery. This can be minimal or it may be significant. However, excessive drowsiness or drowsiness that is not improving is not normal. A nurse or physician should be informed if a patient’s mental status appears abnormal. Pain Pain is inevitable following surgery. An incision has been made through the skin, and the swelling and bleeding at the incision increase pressure on nerve endings, contributing to the pain. Some patients will inform the CNA or nurse about their pain and request medications, but others will not. The CNA should always ask the post-operative patient if pain is occurring, but should also be observant to recognize the nonverbal signs of pain. A patient may decide to endure the pain without taking pain medication because of feeling wary about accepting medication. Aside from specifically asking the patient about pain, the CNA should look for objective information and nonverbal cues that indicate the presence of pain. Does the patient grimace when asked to move? Is the patient hesitant about performing coughing and deep breathing exercises? Is the patient’s blood pressure and heart rate elevated? If the patient is showing evidence of any of the above, the CNA may reasonably assume that a significant level of pain is occurring. Pain control is important as it increases patient compliance with post-operative movement and surgical wound healing measures, and the speed of recovery. It is also important to address physical suffering in the post-operative phase to improve standard quality measures of patient comfort during hospital care. The level of pain a patient has will depend in part on what operation was performed. The pain associated with a minor procedure should be mild, but if the patient has had a major orthopedic surgery, such as hip surgery, the pain can be severe. There is no “normal” level of pain and each person has an individual level of tolerance. If the procedure was a simple one, and the patient is significantly uncomfortable, this may indicate a problem. If the CNA notices the patient is uncomfortable, a nurse or physician should always be informed. If the patient is requesting pain medication more frequently than it has been prescribed, this is a warning sign. Many healthcare facilities use pain scales to assess a patient’s level of pain. A typical pain scale is the 1-10 scale. The patient is asked to remember the worst pain ever experienced and consider that a level 10. The patient is then asked to remember a painful experience that was very minor and consider that a level 1. After that, the patient is asked to assign the current level of pain a number on the 1-10 pain scale. The CNA would ask the patient, for example, “If the worst pain you have ever felt was a 10 and a very minor pain you’ve experienced was a 1, what would you consider your current level of pain to be?” Surgical Dressing A surgical dressing is a sterile cover applied over the incision. A dressing can be a small bandage, or it may be a large, complicated affair with gauze pads and tape. The surgeon will write orders that specify how to care for the dressing. It is very important to follow these orders exactly. The CNA should not change or adjust the dressing in any way that has not been ordered. The dressing should be checked frequently to make sure it is intact and that there are no loose edges. Any bleeding or unusual drainage should be noted, and if the CNA notices either one, a supervising nurse or physician needs to be notified.","Answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points. Summarize why pain control is important. Vital Signs The surgeon, anesthesiologist, physician’s assistant, or nurse practitioner will write an order that specifies how often the vital signs should be checked. Measuring the pulse and blood pressure every 15 minutes in the first hour after the operation is not unusual. The CNA should always let the supervising nurse or physician know about a fever or an abnormal pulse or blood pressure. This is especially important when caring for a post-operative patient. Slight deviations of pulse and blood pressure may be normal after surgery, but these should still be reported. It should not be assumed that a pulse greater than 100, or a systolic blood pressure that is low, are of no concern. Mental Status Drowsiness is expected after surgery. This can be minimal or it may be significant. However, excessive drowsiness or drowsiness that is not improving is not normal. A nurse or physician should be informed if a patient’s mental status appears abnormal. Pain Pain is inevitable following surgery. An incision has been made through the skin, and the swelling and bleeding at the incision increase pressure on nerve endings, contributing to the pain. Some patients will inform the CNA or nurse about their pain and request medications, but others will not. The CNA should always ask the post-operative patient if pain is occurring, but should also be observant to recognize the nonverbal signs of pain. A patient may decide to endure the pain without taking pain medication because of feeling wary about accepting medication. Aside from specifically asking the patient about pain, the CNA should look for objective information and nonverbal cues that indicate the presence of pain. Does the patient grimace when asked to move? Is the patient hesitant about performing coughing and deep breathing exercises? Is the patient’s blood pressure and heart rate elevated? If the patient is showing evidence of any of the above, the CNA may reasonably assume that a significant level of pain is occurring. Pain control is important as it increases patient compliance with post-operative movement and surgical wound healing measures, and the speed of recovery. It is also important to address physical suffering in the post-operative phase to improve standard quality measures of patient comfort during hospital care. The level of pain a patient has will depend in part on what operation was performed. The pain associated with a minor procedure should be mild, but if the patient has had a major orthopedic surgery, such as hip surgery, the pain can be severe. There is no “normal” level of pain and each person has an individual level of tolerance. If the procedure was a simple one, and the patient is significantly uncomfortable, this may indicate a problem. If the CNA notices the patient is uncomfortable, a nurse or physician should always be informed. If the patient is requesting pain medication more frequently than it has been prescribed, this is a warning sign. Many healthcare facilities use pain scales to assess a patient’s level of pain. A typical pain scale is the 1-10 scale. The patient is asked to remember the worst pain ever experienced and consider that a level 10. The patient is then asked to remember a painful experience that was very minor and consider that a level 1. After that, the patient is asked to assign the current level of pain a number on the 1-10 pain scale. The CNA would ask the patient, for example, “If the worst pain you have ever felt was a 10 and a very minor pain you’ve experienced was a 1, what would you consider your current level of pain to be?” Surgical Dressing A surgical dressing is a sterile cover applied over the incision. A dressing can be a small bandage, or it may be a large, complicated affair with gauze pads and tape. The surgeon will write orders that specify how to care for the dressing. It is very important to follow these orders exactly. The CNA should not change or adjust the dressing in any way that has not been ordered. The dressing should be checked frequently to make sure it is intact and that there are no loose edges. Any bleeding or unusual drainage should be noted, and if the CNA notices either one, a supervising nurse or physician needs to be notified.",Medical,Summarize,Text Transformation "Only using the below text to draw your answer from,",what factors in the cypto market create uncertainty in terms of government oversight and enforcement?,"SEC Jurisdiction and Perceived Crypto-Asset Regulatory Gap: An FTX Case Study November 29, 2022 FTX Trading, a crypto company once valued at $32 billion, filed for Chapter 11 bankruptcy proceedings in November 2022. Some of FTX’s largest investors immediately wrote their FTX investments down to $0. More than a million creditors (including individuals and institutions) are caught up in this FTX insolvency. This Insight uses the FTX event as a case study to illustrate the Securities and Exchange Commission’s (SEC’s) regulatory jurisdiction, how it applies to crypto-assets, and perceived weaknesses in the application of the current regulatory framework. SEC Investigation of FTX The SEC and dozens of other federal, state, and international regulatory agencies and prosecutors have engaged with FTX to obtain more information. The SEC generally does not publicly disclose information regarding ongoing investigations. But multiple news sources have reported that the SEC has been investigating FTX.US, FTX’s U.S. subsidiary, for months. While FTX is based overseas and reportedly seeks to block U.S. customers to potentially avoid U.S. jurisdiction, FTX.US provides narrower product offers and is tailored for the U.S. market, and it maintains several U.S. regulatory licenses. Since the FTX crash, the SEC has reportedly expanded its investigation toward FTX and Alameda Research, an FTX-affiliated investment management firm. At issue is whether FTX and its affiliates are involved in certain securities-related activities, which should have been registered with the SEC (or received an exemption) before being sold to investors. To the extent that these are securities transactions that implicate U.S. jurisdiction, a crypto exchange may be subject to the SEC’s regulation, including the Customer Protection Rule, which requires securities broker-dealers to segregate client assets from their proprietary business activities. That rule may have mitigated some of the issues that reportedly led to FTX’s bankruptcy, as the firm is alleged to have loaned client funds to Alameda Research. More importantly, even if the SEC could prove that FTX and its affiliates violated securities regulations, the SEC’s capability to go after FTX is limited to securities activities, which generally do not include commodities and other non-securities instruments that make up the bulk (or even all, depending on whom you ask) of FTX’s business. Some observers believe that the SEC may face difficulty pursuing FTX mainly because of the firm’s offshore status and how existing regulatory frameworks are currently applied Congressional Research Service https://crsreports.congress.gov IN12052 Congressional Research Service 2 to crypto-assets—certain crypto-asset market segments are generally not subject to federal securities marketplace regulation commonly seen in traditional investments. SEC Jurisdiction The current regulatory landscape for crypto-assets is fragmented. Multiple agencies apply different regulatory approaches to crypto-assets at the federal and state levels. The SEC is the primary regulator overseeing securities offers, sales, and investment activities, including those involving crypto-assets. In general, a security is “the investment of money in a common enterprise with a reasonable expectation of profits to be derived from the efforts of others.” When a crypto-asset meets this criterion, it is subject to the SEC’s jurisdiction. SEC Chair Gensler has repeatedly stated that he believes the vast majority of crypto tokens are securities (while recognizing some crypto-assets are not). Other stakeholders, including the crypto industry, disagree with that assertion. In cases where they are not securities, crypto-assets may be commodities under the Commodity Exchange Act (CEA). In such cases, they would be subject to the Commodity Futures Trading Commission’s (CFTC’s) jurisdiction, which generally extends to commodities and derivatives. For example, under this framework as currently applied, most initial coin offerings are considered securities, but Bitcoin is considered a commodity, not a security. Securities regulations could also apply if the crypto market intermediaries (e.g., investment advisers, trading platforms, and custodians) are directly engaged in the security-based crypto-asset transactions. In cases where the crypto-assets are securities, the SEC has both (1) enforcement authority that allows the SEC to bring civil enforcement actions, such as anti-fraud and anti-manipulation actions, for securities laws violations after the fact and (2) regulatory authority, including over digital asset securities, which could include registration requirements, oversight, and principles-based regulation. Also, the CEA provides the CFTC with certain enforcement and regulatory authority when it comes to digital asset derivatives. However, the CFTC has enforcement authority, but not regulatory authority, over the spot market of digital asset commodities. Perceived Crypto-Asset Regulatory Gap Because crypto-asset commodities spot market activities receive CFTC oversight that generally pertains to enforcement (but not regulatory) authority, activities in these non-security crypto-asset markets are not subject to the same safeguards as those established in securities markets. Examples of such safeguards include certain rules and regulations that encourage market transparency, conflict-of-interest mitigation, investor protection, and orderly market operations. In the case of FTX, if FTX and its affiliates are involved in the crypto commodities spot market (e.g., the trading of Bitcoin), neither the SEC nor the CFTC would normally regulate these activities. Certain observers, including the Financial Stability Oversight Council (FSOC), characterize this framework as having a regulatory gap. FSOC has encouraged Congress to provide explicit rulemaking regulatory authority for federal financial regulators over the spot market for crypto-assets that are not securities. FSOC states that this new rulemaking authority “should not interfere with or weaken market regulators’ current jurisdictional remits.” Policy Questions Some Members of Congress have proposed to redesign SEC and CFTC jurisdiction, and Congress will likely continue to propose changes and explore alternatives. When designing a new regulatory landscape, Congressional Research Service 3 IN12052 · VERSION 1 · NEW policymakers face challenging questions about how (or if) to make crypto-asset securities and commodities regulation more alike. Financial regulators have traditionally followed the “same activity, same risk, same regulation” principle to mitigate the potential risks of regulatory arbitrage. Related questions include: To what extent should the design of the crypto-asset regulation framework align with the existing securities trading and investment regulation? Should different sets of rules be based on the regulatory jurisdiction or the nature of risk exposure and risk mitigation needs? What are the operational costs to the platforms under different alternatives? Should Congress appoint a primary regulator for crypto-asset markets, or should actions such as rulemaking be evenly coordinated across financial agencies that are governing the same or similar entities? ","Only using the below text to draw your answer from, what factors in the cypto market create uncertainty in terms of government oversight and enforcement? SEC Jurisdiction and Perceived Crypto-Asset Regulatory Gap: An FTX Case Study November 29, 2022 FTX Trading, a crypto company once valued at $32 billion, filed for Chapter 11 bankruptcy proceedings in November 2022. Some of FTX’s largest investors immediately wrote their FTX investments down to $0. More than a million creditors (including individuals and institutions) are caught up in this FTX insolvency. This Insight uses the FTX event as a case study to illustrate the Securities and Exchange Commission’s (SEC’s) regulatory jurisdiction, how it applies to crypto-assets, and perceived weaknesses in the application of the current regulatory framework. SEC Investigation of FTX The SEC and dozens of other federal, state, and international regulatory agencies and prosecutors have engaged with FTX to obtain more information. The SEC generally does not publicly disclose information regarding ongoing investigations. But multiple news sources have reported that the SEC has been investigating FTX.US, FTX’s U.S. subsidiary, for months. While FTX is based overseas and reportedly seeks to block U.S. customers to potentially avoid U.S. jurisdiction, FTX.US provides narrower product offers and is tailored for the U.S. market, and it maintains several U.S. regulatory licenses. Since the FTX crash, the SEC has reportedly expanded its investigation toward FTX and Alameda Research, an FTX-affiliated investment management firm. At issue is whether FTX and its affiliates are involved in certain securities-related activities, which should have been registered with the SEC (or received an exemption) before being sold to investors. To the extent that these are securities transactions that implicate U.S. jurisdiction, a crypto exchange may be subject to the SEC’s regulation, including the Customer Protection Rule, which requires securities broker-dealers to segregate client assets from their proprietary business activities. That rule may have mitigated some of the issues that reportedly led to FTX’s bankruptcy, as the firm is alleged to have loaned client funds to Alameda Research. More importantly, even if the SEC could prove that FTX and its affiliates violated securities regulations, the SEC’s capability to go after FTX is limited to securities activities, which generally do not include commodities and other non-securities instruments that make up the bulk (or even all, depending on whom you ask) of FTX’s business. Some observers believe that the SEC may face difficulty pursuing FTX mainly because of the firm’s offshore status and how existing regulatory frameworks are currently applied Congressional Research Service https://crsreports.congress.gov IN12052 Congressional Research Service 2 to crypto-assets—certain crypto-asset market segments are generally not subject to federal securities marketplace regulation commonly seen in traditional investments. SEC Jurisdiction The current regulatory landscape for crypto-assets is fragmented. Multiple agencies apply different regulatory approaches to crypto-assets at the federal and state levels. The SEC is the primary regulator overseeing securities offers, sales, and investment activities, including those involving crypto-assets. In general, a security is “the investment of money in a common enterprise with a reasonable expectation of profits to be derived from the efforts of others.” When a crypto-asset meets this criterion, it is subject to the SEC’s jurisdiction. SEC Chair Gensler has repeatedly stated that he believes the vast majority of crypto tokens are securities (while recognizing some crypto-assets are not). Other stakeholders, including the crypto industry, disagree with that assertion. In cases where they are not securities, crypto-assets may be commodities under the Commodity Exchange Act (CEA). In such cases, they would be subject to the Commodity Futures Trading Commission’s (CFTC’s) jurisdiction, which generally extends to commodities and derivatives. For example, under this framework as currently applied, most initial coin offerings are considered securities, but Bitcoin is considered a commodity, not a security. Securities regulations could also apply if the crypto market intermediaries (e.g., investment advisers, trading platforms, and custodians) are directly engaged in the security-based crypto-asset transactions. In cases where the crypto-assets are securities, the SEC has both (1) enforcement authority that allows the SEC to bring civil enforcement actions, such as anti-fraud and anti-manipulation actions, for securities laws violations after the fact and (2) regulatory authority, including over digital asset securities, which could include registration requirements, oversight, and principles-based regulation. Also, the CEA provides the CFTC with certain enforcement and regulatory authority when it comes to digital asset derivatives. However, the CFTC has enforcement authority, but not regulatory authority, over the spot market of digital asset commodities. Perceived Crypto-Asset Regulatory Gap Because crypto-asset commodities spot market activities receive CFTC oversight that generally pertains to enforcement (but not regulatory) authority, activities in these non-security crypto-asset markets are not subject to the same safeguards as those established in securities markets. Examples of such safeguards include certain rules and regulations that encourage market transparency, conflict-of-interest mitigation, investor protection, and orderly market operations. In the case of FTX, if FTX and its affiliates are involved in the crypto commodities spot market (e.g., the trading of Bitcoin), neither the SEC nor the CFTC would normally regulate these activities. Certain observers, including the Financial Stability Oversight Council (FSOC), characterize this framework as having a regulatory gap. FSOC has encouraged Congress to provide explicit rulemaking regulatory authority for federal financial regulators over the spot market for crypto-assets that are not securities. FSOC states that this new rulemaking authority “should not interfere with or weaken market regulators’ current jurisdictional remits.” Policy Questions Some Members of Congress have proposed to redesign SEC and CFTC jurisdiction, and Congress will likely continue to propose changes and explore alternatives. When designing a new regulatory landscape, Congressional Research Service 3 IN12052 · VERSION 1 · NEW policymakers face challenging questions about how (or if) to make crypto-asset securities and commodities regulation more alike. Financial regulators have traditionally followed the “same activity, same risk, same regulation” principle to mitigate the potential risks of regulatory arbitrage. Related questions include: To what extent should the design of the crypto-asset regulation framework align with the existing securities trading and investment regulation? Should different sets of rules be based on the regulatory jurisdiction or the nature of risk exposure and risk mitigation needs? What are the operational costs to the platforms under different alternatives? Should Congress appoint a primary regulator for crypto-asset markets, or should actions such as rulemaking be evenly coordinated across financial agencies that are governing the same or similar entities? ",Internet/Technology,Find & Summarize,Text Transformation "Respond to the following question with only the information I provide within this prompt, your answer should be two paragraphs long.",Why is Mr Lloyd's strategy unusual?,"A. INTRODUCTION 1. Mr Richard Lloyd - with financial backing from Therium Litigation Funding IC, a commercial litigation funder - has issued a claim against Google LLC, alleging breach of its duties as a data controller under section 4(4) of the Data Protection Act 1998 (“the DPA 1998”). The claim alleges that, for several months in late 2011 and early 2012, Google secretly tracked the internet activity of millions of Apple iPhone users and used the data collected in this way for commercial purposes without the users’ knowledge or consent. 2. The factual allegation is not new. In August 2012, Google agreed to pay a civil penalty of US$22.5m to settle charges brought by the United States Federal Trade Commission based upon the allegation. In November 2013, Google agreed to pay US$17m to settle consumer-based actions brought against it in the United States. In England and Wales, three individuals sued Google in June 2013 making the same allegation and claiming compensation under the DPA 1998 and at common law for misuse of private information: see Vidal-Hall v Google Inc (Information Comr intervening) [2015] EWCA Civ 311; [2016] QB 1003. Following a dispute over jurisdiction, their claims were settled before Google had served a defence. What is new about the present action is that Mr Lloyd is not just claiming damages in his own right, as the three claimants did in Vidal-Hall. He claims to represent everyone resident in England and Wales who owned an Apple iPhone at the relevant time and whose data were obtained by Google without their consent, and to be entitled to recover damages on behalf of all these people. It is estimated that they number more than 4m. 3. Class actions, in which a single person is permitted to bring a claim and obtain redress on behalf of a class of people who have been affected in a similar way by alleged wrongdoing, have long been possible in the United States and, more recently, in Canada and Australia. Whether legislation to establish a class action regime should be enacted in the UK has been much discussed. In 2009, the Government rejected a recommendation from the Civil Justice Council to introduce a generic class action regime applicable to all types of claim, preferring a “sector based approach”. This was for two reasons: “Firstly, there are potential structural differences between the sectors which will require different consideration. … Secondly, it will be necessary to undertake a full assessment Page 3 of the likely economic and other impacts before implementing any reform.” See the Government’s Response to the Civil Justice Council’s Report: “Improving Access to Justice through Collective Actions” (2008), paras 12-13. 4. Since then, the only sector for which such a regime has so far been enacted is that of competition law. Parliament has not legislated to establish a class action regime in the field of data protection. 5. Mr Lloyd has sought to overcome this difficulty by what the Court of Appeal in this case described as “an unusual and innovative use of the representative procedure” in rule 19.6 of the Civil Procedure Rules: see [2019] EWCA Civ 1599; [2020] QB 747, para 7. This is a procedure of very long standing in England and Wales whereby a claim can be brought by (or against) one or more persons as representatives of others who have “the same interest” in the claim. Mr Lloyd accepts that he could not use this procedure to claim compensation on behalf of other iPhone users if the compensation recoverable by each user would have to be individually assessed. But he contends that such individual assessment is unnecessary. He argues that, as a matter of law, compensation can be awarded under the DPA 1998 for “loss of control” of personal data without the need to prove that the claimant suffered any financial loss or mental distress as a result of the breach. Mr Lloyd further argues that a “uniform sum” of damages can properly be awarded in relation to each person whose data protection rights have been infringed without the need to investigate any circumstances particular to their individual case. The amount of damages recoverable per person would be a matter for argument, but a figure of £750 was advanced in a letter of claim. Multiplied by the number of people whom Mr Lloyd claims to represent, this would produce an award of damages of the order of £3 billion. 6. Because Google is a Delaware corporation, the claimant needs the court’s permission to serve the claim form on Google outside the jurisdiction. The application for permission has been contested by Google on the grounds that the claim has no real prospect of success as: (1) damages cannot be awarded under the DPA 1998 for “loss of control” of data without proof that it caused financial damage or distress; and (2) the claim in any event is not suitable to proceed as a representative action. In the High Court Warby J decided both issues in Google’s favour and therefore refused permission to serve the proceedings on Google: see [2018] EWHC 2599 (QB); [2019] 1 WLR 1265. The Court of Appeal reversed that decision, for reasons given in a judgment of the Chancellor, Sir Geoffrey Vos, with which Davis LJ and Dame Victoria Sharp agreed: [2019] EWCA Civ 1599; [2020] QB 747. Page 4 7. On this further appeal, because of the potential ramifications of the issues raised, as well as hearing the claimant and Google, the court has received written and oral submissions from the Information Commissioner and written submissions from five further interested parties. 8. In this judgment I will first summarise the facts alleged and the relevant legal framework for data protection before considering the different methods currently available in English procedural law for claiming collective redress and, in particular, the representative procedure which the claimant is seeking to use. Whether that procedure is capable of being used in this case critically depends, as the claimant accepts, on whether compensation for the alleged breaches of data protection law would need to be individually assessed. I will then consider the claimant’s arguments that individual assessment is unnecessary. For the reasons given in detail below, those arguments cannot in my view withstand scrutiny. In order to recover compensation under the DPA 1998 for any given individual, it would be necessary to show both that Google made some unlawful use of personal data relating to that individual and that the individual suffered some damage as a result. The claimant’s attempt to recover compensation under the Act without proving either matter in any individual case is therefore doomed to fail. B. FACTUAL BACKGROUND 9. The relevant events took place between 9 August 2011 and 15 February 2012 and involved the alleged use by Google of what has been called the “Safari workaround” to bypass privacy settings on Apple iPhones. 10. Safari is an internet browser developed by Apple and installed on its iPhones. At the relevant time, unlike most other internet browsers, all relevant versions of Safari were set by default to block third party cookies. A “cookie” is a small block of data that is placed on a device when the user visits a website. A “third party cookie” is a cookie placed on the device not by the website visited by the user but by a third party whose content is included on that website. Third party cookies are often used to gather information about internet use, and in particular web pages visited over time, to enable the delivery to the user of advertisements tailored to interests inferred from the user’s browsing history. 11. Google had a cookie known as the “DoubleClick Ad cookie” which could operate as a third party cookie. It would be placed on a device if the user visited a website that included DoubleClick Ad content. The DoubleClick Ad cookie enabled Google to identify visits by the device to any website displaying an advertisement from its vast Page 5 advertising network and to collect considerable amounts of information. It could tell the date and time of any visit to a given website, how long the user spent there, which pages were visited for how long, and what advertisements were viewed for how long. In some cases, by means of the IP address of the browser, the user’s approximate geographical location could be identified. 12. Although the default settings for Safari blocked all third party cookies, a blanket application of these settings would have prevented the use of certain popular web functions; so Apple devised some exceptions to them. These exceptions were in place until March 2012, when the system was changed. But in the meantime the exceptions made it possible for Google to devise and implement the Safari workaround. Its effect was to place the DoubleClick Ad cookie on an Apple device, without the user’s knowledge or consent, immediately, whenever the user visited a website that contained DoubleClick Ad content. 13. It is alleged that, in this way, Google was able to collect or infer information relating not only to users’ internet surfing habits and location, but also about such diverse factors as their interests and pastimes, race or ethnicity, social class, political or religious beliefs or affiliations, health, sexual interests, age, gender and financial situation. 14. Further, it is said that Google aggregated browser generated information from users displaying similar patterns, creating groups with labels such as “football lovers”, or “current affairs enthusiasts”. Google’s DoubleClick service then offered these group labels to subscribing advertisers to choose from when selecting the type of people at whom they wanted to target their advertisements","Respond to the following question with only the information I provide within this prompt, your answer should be two paragraphs long. Why is Mr Lloyd's strategy unusual? A. INTRODUCTION 1. Mr Richard Lloyd - with financial backing from Therium Litigation Funding IC, a commercial litigation funder - has issued a claim against Google LLC, alleging breach of its duties as a data controller under section 4(4) of the Data Protection Act 1998 (“the DPA 1998”). The claim alleges that, for several months in late 2011 and early 2012, Google secretly tracked the internet activity of millions of Apple iPhone users and used the data collected in this way for commercial purposes without the users’ knowledge or consent. 2. The factual allegation is not new. In August 2012, Google agreed to pay a civil penalty of US$22.5m to settle charges brought by the United States Federal Trade Commission based upon the allegation. In November 2013, Google agreed to pay US$17m to settle consumer-based actions brought against it in the United States. In England and Wales, three individuals sued Google in June 2013 making the same allegation and claiming compensation under the DPA 1998 and at common law for misuse of private information: see Vidal-Hall v Google Inc (Information Comr intervening) [2015] EWCA Civ 311; [2016] QB 1003. Following a dispute over jurisdiction, their claims were settled before Google had served a defence. What is new about the present action is that Mr Lloyd is not just claiming damages in his own right, as the three claimants did in Vidal-Hall. He claims to represent everyone resident in England and Wales who owned an Apple iPhone at the relevant time and whose data were obtained by Google without their consent, and to be entitled to recover damages on behalf of all these people. It is estimated that they number more than 4m. 3. Class actions, in which a single person is permitted to bring a claim and obtain redress on behalf of a class of people who have been affected in a similar way by alleged wrongdoing, have long been possible in the United States and, more recently, in Canada and Australia. Whether legislation to establish a class action regime should be enacted in the UK has been much discussed. In 2009, the Government rejected a recommendation from the Civil Justice Council to introduce a generic class action regime applicable to all types of claim, preferring a “sector based approach”. This was for two reasons: “Firstly, there are potential structural differences between the sectors which will require different consideration. … Secondly, it will be necessary to undertake a full assessment Page 3 of the likely economic and other impacts before implementing any reform.” See the Government’s Response to the Civil Justice Council’s Report: “Improving Access to Justice through Collective Actions” (2008), paras 12-13. 4. Since then, the only sector for which such a regime has so far been enacted is that of competition law. Parliament has not legislated to establish a class action regime in the field of data protection. 5. Mr Lloyd has sought to overcome this difficulty by what the Court of Appeal in this case described as “an unusual and innovative use of the representative procedure” in rule 19.6 of the Civil Procedure Rules: see [2019] EWCA Civ 1599; [2020] QB 747, para 7. This is a procedure of very long standing in England and Wales whereby a claim can be brought by (or against) one or more persons as representatives of others who have “the same interest” in the claim. Mr Lloyd accepts that he could not use this procedure to claim compensation on behalf of other iPhone users if the compensation recoverable by each user would have to be individually assessed. But he contends that such individual assessment is unnecessary. He argues that, as a matter of law, compensation can be awarded under the DPA 1998 for “loss of control” of personal data without the need to prove that the claimant suffered any financial loss or mental distress as a result of the breach. Mr Lloyd further argues that a “uniform sum” of damages can properly be awarded in relation to each person whose data protection rights have been infringed without the need to investigate any circumstances particular to their individual case. The amount of damages recoverable per person would be a matter for argument, but a figure of £750 was advanced in a letter of claim. Multiplied by the number of people whom Mr Lloyd claims to represent, this would produce an award of damages of the order of £3 billion. 6. Because Google is a Delaware corporation, the claimant needs the court’s permission to serve the claim form on Google outside the jurisdiction. The application for permission has been contested by Google on the grounds that the claim has no real prospect of success as: (1) damages cannot be awarded under the DPA 1998 for “loss of control” of data without proof that it caused financial damage or distress; and (2) the claim in any event is not suitable to proceed as a representative action. In the High Court Warby J decided both issues in Google’s favour and therefore refused permission to serve the proceedings on Google: see [2018] EWHC 2599 (QB); [2019] 1 WLR 1265. The Court of Appeal reversed that decision, for reasons given in a judgment of the Chancellor, Sir Geoffrey Vos, with which Davis LJ and Dame Victoria Sharp agreed: [2019] EWCA Civ 1599; [2020] QB 747. Page 4 7. On this further appeal, because of the potential ramifications of the issues raised, as well as hearing the claimant and Google, the court has received written and oral submissions from the Information Commissioner and written submissions from five further interested parties. 8. In this judgment I will first summarise the facts alleged and the relevant legal framework for data protection before considering the different methods currently available in English procedural law for claiming collective redress and, in particular, the representative procedure which the claimant is seeking to use. Whether that procedure is capable of being used in this case critically depends, as the claimant accepts, on whether compensation for the alleged breaches of data protection law would need to be individually assessed. I will then consider the claimant’s arguments that individual assessment is unnecessary. For the reasons given in detail below, those arguments cannot in my view withstand scrutiny. In order to recover compensation under the DPA 1998 for any given individual, it would be necessary to show both that Google made some unlawful use of personal data relating to that individual and that the individual suffered some damage as a result. The claimant’s attempt to recover compensation under the Act without proving either matter in any individual case is therefore doomed to fail. B. FACTUAL BACKGROUND 9. The relevant events took place between 9 August 2011 and 15 February 2012 and involved the alleged use by Google of what has been called the “Safari workaround” to bypass privacy settings on Apple iPhones. 10. Safari is an internet browser developed by Apple and installed on its iPhones. At the relevant time, unlike most other internet browsers, all relevant versions of Safari were set by default to block third party cookies. A “cookie” is a small block of data that is placed on a device when the user visits a website. A “third party cookie” is a cookie placed on the device not by the website visited by the user but by a third party whose content is included on that website. Third party cookies are often used to gather information about internet use, and in particular web pages visited over time, to enable the delivery to the user of advertisements tailored to interests inferred from the user’s browsing history. 11. Google had a cookie known as the “DoubleClick Ad cookie” which could operate as a third party cookie. It would be placed on a device if the user visited a website that included DoubleClick Ad content. The DoubleClick Ad cookie enabled Google to identify visits by the device to any website displaying an advertisement from its vast Page 5 advertising network and to collect considerable amounts of information. It could tell the date and time of any visit to a given website, how long the user spent there, which pages were visited for how long, and what advertisements were viewed for how long. In some cases, by means of the IP address of the browser, the user’s approximate geographical location could be identified. 12. Although the default settings for Safari blocked all third party cookies, a blanket application of these settings would have prevented the use of certain popular web functions; so Apple devised some exceptions to them. These exceptions were in place until March 2012, when the system was changed. But in the meantime the exceptions made it possible for Google to devise and implement the Safari workaround. Its effect was to place the DoubleClick Ad cookie on an Apple device, without the user’s knowledge or consent, immediately, whenever the user visited a website that contained DoubleClick Ad content. 13. It is alleged that, in this way, Google was able to collect or infer information relating not only to users’ internet surfing habits and location, but also about such diverse factors as their interests and pastimes, race or ethnicity, social class, political or religious beliefs or affiliations, health, sexual interests, age, gender and financial situation. 14. Further, it is said that Google aggregated browser generated information from users displaying similar patterns, creating groups with labels such as “football lovers”, or “current affairs enthusiasts”. Google’s DoubleClick service then offered these group labels to subscribing advertisers to choose from when selecting the type of people at whom they wanted to target their advertisements",Legal,Effect Analysis,Q&A You must respond to the prompt using only the information provided in the context block.Here is the question you are to answer:,How does the Government of Alberta's Ministry of Health plan to meet the three outcomes identified in their 2022-2023 Annual Health Report?,"Outcome One: An effective, accessible and coordinated health care system built around the needs of individuals, families, caregivers and communities, and supported by competent, accountable health professionals and secure digital information systems Key Objectives 1.1 Increase health system capacity and reduce wait times, particularly for publicly funded surgical procedures and diagnostic MRI and CT scans, emergency medical services, and intensive care units. As the province emerges from the pandemic, Alberta Health continues to prioritize health system capacity, including building surgical and Intensive Care Unit (ICU) capacity, as well as the health workforce. Several initiatives are underway to minimize disruptions to patient care and expand the capacity of Alberta’s publicly funded health care system permanently. This also includes preparing to respond more effectively to any future health crises and reducing wait times across the health care system. A resilient, sustainable health system will allow the system to operate at full capacity for longer periods before needing to adjust health care resources. The policy has overall goals of improving access to scheduled health services, improving wait time measurement and reporting, and ensuring timely communication for patients. In November 2022, Alberta released the Health Care Action Plan (HCAP). The HCAP identifies immediate government actions to build a better health care system for Albertans. In order to meet the growing demands of Alberta’s health care system, an Official Administrator was appointed to Alberta Health Services (AHS) to provide leadership to address the four goals of the HCAP: • decrease emergency department wait times; • improve emergency medical services response times; • reduce wait times for surgeries; and, • empower frontline workers to deliver health care. Since 2019, government has been committed to increasing surgical capacity to keep pace with demand and reduce the length of time Albertans are waiting for scheduled surgeries. Efforts are geared towards improving patient navigation of the health care system through enhanced care coordination and surgical pathways and resources; improving specialist advice and collaboration with family physicians before consultation; and, centralizing referrals for distribution to the most appropriate surgeon with a shorter wait list. Through the Alberta Surgical Initiative (ASI), Alberta Health continues to work with AHS to improve and standardize the entire surgical journey through: • prioritizing surgeries and allocating operating room time according to the greatest need; • streamlining referrals from primary care to specialists; • increasing surgeries at underutilized operating rooms, mainly in rural areas; and, • providing less complex surgeries through accredited chartered surgical facilities (CSFs) to provide publicly funded insured services and extend existing capacity in hospitals. Through these dedicated efforts, the total number of surgeries completed in 2022-23 was 292,500, which is over 13,900 more surgeries than the year before. Further, approximately 22,100 cancer surgeries were completed in 2022-23, which represents a 10 per cent increase compared to the pre-pandemic amount. Nearly 65 per cent of the cancer surgeries were completed within clinically recommended wait times. By the end of 2022-23, AHS had cleared all postponed surgeries due to COVID-19, and continues to work on reducing wait times. The main focus remains on those patients that are waiting the longest out of clinically recommended targets, and the most acute cases. As of March 31, 2023, AHS reduced the adult surgical waitlist by more than 7,000 patients, and the total number of cases on the adult surgical waitlist is 67,186 which is less than before the pandemic. In 2022-23, there were 38 existing CSFs and three new CSF contracts were implemented to expand publicly funded surgical capacity in these facilities. CSFs are an extension of existing capacity in hospitals and used in many other Canadian health systems. Under the Health Facilities Act, CSFs providing publicly funded insured services must be accredited by the College of Physicians and Surgeons of Alberta, and have a signed service contract with AHS. In 2022-23, accredited CSFs in Alberta provided approximately 47,400 surgeries, which is equivalent to 16.2 per cent of publicly funded scheduled surgeries. In Alberta and other provinces, wait times for three common surgical procedures (hip replacement, knee replacement and cataract surgeries) continue to be impacted by delays due to the COVID-19 pandemic and workforce shortages. The 2022-23 results for hip, knee and cataract surgical procedures showed a decline, meaning that fewer Albertans received these surgical procedures within national benchmark wait times when compared to 2021-22 results. The chart below shows quarterly trends for the three common surgical procedures completed within national benchmarks in 2022-23. There were improvements in the number of cases completed for hip and knee replacements over the course of 2022-23, showing increases of 13 per cent and 15 per cent (respectively), and demonstrating significant improvements with the appointment of the Official Administrator and the implementation of the HCAP in November 2022. While the quarterly results for cataract surgery declined in the second quarter, the number has stabilized in the third quarter since the implementation of HCAP and is beginning an upward trend in the fourth quarter, although it is slightly below the first quarter result. Since 2019-20, there has been a 20 per cent improvement in cases completed within national benchmarks for cataract surgeries, ranking Alberta as a top performer nationally. As part of ASI, Alberta Health has worked with AHS to implement additional measures aimed at improving access and wait times for surgery. Work is ongoing to increase the use of Rapid Access Clinics to reduce wait times for the assessment of orthopedic issues, reducing unnecessary consultations and decreasing wait times for consultations. The Facilitated Access to Specialized Treatment (FAST) program accelerates implementation of central intake for orthopedic and urology surgery to allow patients to see the first available surgeon. Work has begun on the implementation of the Electronic Referral System (ERS), which will expedite referrals for Albertans requiring assessment by surgical specialists. In addition, consultants have been contracted to enhance surgical capacity by improving inpatient surgeries scheduling, monitoring operating room capacity, and reducing patient flow variation. With the added capacity of additional CSFs offering surgeries and implementation of FAST and ERS, Albertans will experience a streamlined surgical journey from referral to consultation to surgery. More Albertans will get their surgery within the clinically recommended wait time targets, thereby reducing the amount of time they must live with pain and other inconveniences. Reducing wait times for medically necessary diagnostic tests is also a top priority for government. Each year, Alberta spends about $1 billion on diagnostic imaging, which includes ultrasounds, Xrays, mammography, MRI and CT scans. About 46 per cent of the $1 billion is allocated to AHS, while 54 per cent is allocated to community diagnostic imaging providers. Approximately one-third of all CT and MRI scans are emergency scans and are completed within clinically appropriate timelines (under 24 hours). In 2022-23, a total of 520,504 CT scans and 231,030 MRI scans were completed across the province. The wait time for both types of scans increased due to a sharp increase in demand and staffing issues. Alberta Health and AHS continue to implement the Diagnostic Imaging Action Plan developed in 2019 to facilitate timely access to CT and MRI scans. As part of the plan, there is a significant focus on triaging patients to ensure that those who need urgent scans can get one as soon as possible. In addition, the Clinical Decision Support (CDS) within Connect Care aims to improve appropriateness of referrals and triage decisions. AHS has reached a five-year agreement with radiologist groups in Edmonton and Calgary to reduce wait times, and signed a memorandum of understanding with the remaining three largest radiology providers in Alberta North, Central, and South Zones. In total, 83 per cent of provincial radiologists have signed agreements with AHS. As part of the HCAP, the Government of Alberta is working with AHS to improve emergency medical services (EMS) response times. Improved ambulance times means that Albertans are receiving the urgent care they need from highly skilled paramedics more quickly. The Alberta Emergency Medical Services Provincial Advisory Committee (AEPAC) was established and tasked with providing immediate and long-term recommendations that will better support staff and ensure a strengthened and sustainable EMS system for Albertans needing services now and into the future. AEPAC focused on the issues facing EMS, such as system pressures that may cause service gaps, staffing issues, and hours of work. This included issues related to ground ambulance, air ambulance, and dispatch. Furthermore, Alberta conducted an independent review of EMS dispatch (the Dispatch Review) to inform improvements that can be made to dispatch services overall. The Dispatch Review and full report from AEPAC were submitted to the Minister of Health in the fall of 2022 and released to the public in January 2023. The Government of Alberta accepted the final AEPAC report and Dispatch Review recommendations in full. The recommendations were focused on accountability, capacity, efficiencies, operations, performance, and workforce support. Adjustments are being made to improve EMS response times and get paramedics out of hospital waiting rooms and back into their communities. Implementation of recommendations on a priority basis has supported ongoing reduction in EMS response times and red alerts, and improvements in community coverage. In 2022-23, Alberta Health initiated several actions to address these recommendations and strengthen the EMS system across the province. Examples of projects include: • Implemented measures to improve the central dispatch system to better deal with lowacuity calls and prioritize emergent/urgent 911 calls for EMS and made workforcescheduling changes as part of the Fatigue Management Strategy. • Initiated pilot projects using an integrated Fire-EMS model to maximize the use of paramedics and increase ambulance capacity to the health care system. Examples of the projects included: using inbound EMS resources only when they are clinically required; staffing spare ambulances to support the EMS system during times of stress; and, expanding single member advanced care paramedic response units that provide immediate advanced life support care in anticipation of, or in the absence of, an available ambulance. • Introduced new provincial guidelines, including a 45-minute EMS emergency department (ED) wait time target for 911, to get ambulances back on the road more quickly. The new provincial guidelines enable fast-tracking ambulance transfers at EDs by moving less urgent patients to hospital waiting areas. • Put procedures in place to contract appropriately trained resources for non-emergency transfers between facilities in Calgary and Edmonton, freeing up paramedics. Instead of using highly trained paramedics for non-medical patient transfers to patients’ homes from a facility or acute care, alternative resources are now arranged by hospitals, also freeing up paramedics. • Granted an exemption to the minimum staffing requirements defined in the Ground Ambulance Regulation, significantly expanding the instances where an emergency medical responder can meet the staffing requirements for all classes of ambulance, to alleviate staffing challenges across the province. • Empowered paramedics to assess a patient's condition at the scene to decide if they need ambulance transport to the hospital. In 2022-23, a total of $590 million was spent on EMS. Capacity increases were laid out in the AHS’ EMS 10-Point Plan and recommendations by AEPAC, including increases in paramedic workforce and adding ambulances to the system. As of March 31, 2023, there are 8,417 regulated members in the province registered with the Alberta College of Paramedics, including 1,383 emergency medical responders, 4,050 primary care paramedics, and 2,984 advanced care paramedics. AHS added 19 new ambulances in Calgary and Edmonton and more ambulance coverage in Chestermere and Okotoks, and hired 457 new staff members, including 341 paramedics. Increased capacity helps reduce EMS response times and red alerts and improves working conditions for frontline practitioners and community coverage, especially for life-threatening conditions. Measures to address staffing issues include AHS’ Fatigue Management Strategy, a recruitment campaign aimed at other provinces and Australia, development of a Provincial Service Plan, and interim AEPAC recommendations brought forward in June 2022, granting an exemption to expand use of emergency medical responders and pilot projects to give greater autonomy to ambulance operators using an integrated fire-EMS model. In addition, keeping paramedics out of hospital waiting rooms and in communities has contributed to decreased EMS response times and red alerts, improved community coverage, and quicker access to EMS. The HCAP 90-day Report released in February 2023 (https://www.albertahealthservices.ca/assets/about/aop/ahs-aop-90-report.pdf ) shows an early reduction in response times and red alerts, and greater focus on urgent/emergent 911 calls through low-acuity diversion measures and non-clinical patient transport programs across Alberta, particularly in Calgary and Edmonton. Comparing November 2022 to March 2023, EMS response time for the most urgent calls in metro and urban areas was reduced from 21.8 minutes to 15 minutes. Improving access to EMS enables timely patient care and entry into the health care system. The government also launched the EMS/811 Shared Response program to ensure patients receive the level of care they need and reduce unnecessary ambulance responses. Calls that have been assessed as not experiencing a medical emergency that requires an ambulance are transferred to Health Link 811, where registered nurses provide further triage, assessment and care. Since the launch in January 2023, more than 2000 911-callers with non-urgent conditions were transferred and helped by Health Link 811, keeping more ambulances available for emergency calls. In October 2022, government appointed a Parliamentary Secretary of EMS Reform to work with health partners to set priorities for service improvement based on AEPAC and Dispatch Review report recommendations. Remaining AEPAC and Dispatch Review recommendations have been incorporated into the AHS Operations Plan and are being prioritized and monitored by the EMS Reform Parliamentary Secretary. There are almost two million visits to Alberta EDs every year. Alberta Health together with AHS is working to improve patient flow within the health system, in particular to reduce ED wait times. AHS is committed to improving the experience of patients and families from the time they seek emergency care until the time the patient is discharged or admitted. There are 780 more staff in EDs today than in December 2018. AHS is working diligently on several initiatives to improve access to emergency care including improving access to continuing care living options, expanding hospital capacity, and implementing initiatives in hospitals to streamline patient treatment and discharge. In 2022-23, alternate level of care days were reduced by enhancing social work supports in acute care to address barriers for discharge. This included adding a fast-track area at the Alberta Children’s Hospital in Calgary, and deploying additional units of EMS mobile Integrated Health Units in Calgary and Edmonton to provide care for unscheduled needs within the community (i.e., IV antibiotics, rehydration, and transfusions at home). In January 2023, the Bridge Healing Transitional Accommodation Program was launched in Edmonton to support transitioning of patients experiencing homelessness as they are discharged from emergency departments. The initiative aims to reduce hospital readmission rates for Albertans experiencing homelessness by providing wrap-around health and social services. This program provides 36 beds to support this vulnerable population. Over the next three years, $305 million will be provided for additional health care capacity on a permanent basis under the HCAP. This includes approximately $268.6 million in operating funds and $36.4 million for capital projects to increase ICU capacity on a permanent basis. Approximately $61 million was spent in 2022-23 to create 50 permanent new fully equipped and staffed adult ICU beds across the province, which brings the number of ICU beds up to 223 from 173 before the pandemic. The pandemic has shown that more permanent capacity and staff are needed, particularly in rural and remote areas. The ministry continues to address ICU staffing shortages across health care facilities in Alberta. As vacancies are filled, ICU beds are reopened. Temporary bed closures are implemented only as a last resort, and patients continue to receive safe, high-quality care. AHS filled 392 positions, as of the end of fiscal year 2022-23, to support the new beds. These positions included nurses, allied health professionals, pharmacists, and clinical support service positions for diagnostic imaging and service workers. The latest data available at the end of fiscal year 2022-23 indicated that the provincial ICU baseline occupancy rate was 82 per cent, a 29 per cent improvement from being at over capacity (115 per cent) in 2021-22. Increasing ICU capacity ensures that Albertans receive care when they need it most. However, unplanned temporary service disruptions, including bed reductions, are not unusual in any health system, as services and beds are managed based on patient need, staffing levels, acuity of patient health, and other factors. Government works to ensure patients continue to receive safe, high-quality care. Occasionally, however, temporary bed closures are implemented as a last resort. Government is committed to ensuring that any Albertan who needs acute care will receive it. Workforce challenges remain a significant barrier to improving wait times for surgery given the high demand for anesthesiologists in Canada and international jurisdictions. Alberta Health is reviewing and developing options to support continued implementation of the Anesthesia Care Team Model in AHS and CSFs. The implementation of the Anesthesia Care Team Model aims to use anesthesiologists more resourcefully for some ophthalmology and orthopedic surgeries by employing a multidisciplinary team that works under supervision of the anesthesiologist to support anesthesia services in the operating room. Recruitment efforts are underway through AHS to attract more anesthesiologists to Alberta, including in rural areas. In March 2023, government released MAPS Strategy, which sets out a framework for supporting the province’s current health care workers and building the future workforce that can support Albertans getting the health care they need when and where they need it. Alberta has various initiatives underway to attract and retain nurses and increase system capacity. Alberta Health worked with the College of Registered Nurses of Alberta to streamline registration processes for Internationally Educated Nurses (IEN) and developed a grant agreement with the Alberta Association of Nurses for nurse navigators to support IENs going through the assessment, education, and registration processes. Announced in September 2022, the Modernizing Alberta’s Primary Health Care System (MAPS) initiative formed three panels to provide advice to the Minister on ways to improve the primary health care system, thereby improving the overall efficiency of the health care system. On February 21, 2023, the Minister announced an investment into primary health care of $243 million over three years; of this, $125 million is allocated for MAPS recommendations. In addition, the Minister accepted, in principle, early opportunities for investment that could be implemented to enhance Albertans’ access to primary health care immediately. On March 31, 2023, the MAPS Strategic Advisory Panel and Indigenous Primary Health Care Advisory Panel submitted parallel final reports to the Minister, outlining transformative strategic roadmaps for the next 10 years of primary health care in Alberta. These reports address both Indigenous access to primary health care and advice on improving primary health care for all Albertans. The intent of the MAPS initiative will be to reorient the health system around primary health care, thereby improving patient outcomes and reducing costs and decreasing pressures on the acute care system in the long-term. Partnerships and collaboration between primary care providers and specialists will improve patient wait times and health outcomes. The ASI Care Pathways and Specialty Advice, which includes the Provincial Pathways Unit and provincially aligned non-urgent telephone advice service programs, support consistency and quality to ensure continuity of care across the patient journey. The Provincial Primary Care Network provided these projects with conditional endorsement to begin transition to operational shared service programs. Primary Care Networks (PCNs) are also working with other stakeholders on the ASI to improve primary care and specialist linkages and patient navigation of the health care system by building and leveraging PCN specialist linkage programs. Some initiatives include Strong Partnerships and Transitions of Care for the Central Zone; Patient’s Medical Home, including referral navigators; Specialist LINK Tool for the Calgary Zone; Connect MD for the Edmonton and North Zones; FAST General Surgery for the Edmonton Zone; and, Specialist Integration Task Group for the Calgary Zone. Modernize Alberta’s continuing care system, based on Alberta’s facility‐based continuing care and palliative and end‐of‐life care reviews, to improve continuing care services for Albertans living with disabilities and chronic conditions (including people living with dementia). Government continues to be committed to addressing gaps in the continuing care system, and meeting the needs of Albertans by implementing transformative changes within the system. Alberta Health worked with partners to develop a new legislative framework for the continuing care system. The Continuing Care Act (Act), which received Royal Assent on May 31, 2022, will increase clarity regarding services, address gaps and inconsistencies across services and settings, enable improved service delivery for Albertans, and support health system accountability and sustainability. Multiple pieces of legislation will be consolidated into the Act, which establishes clear and consistent oversight and authority over the delivery of continuing care services and settings. The new legislation was proclaimed to be in effect April 1, 2024, except for sections regarding administrative penalties, which will be proclaimed on April 1, 2025. Implementation of the legislative framework will better support Albertans transitioning between care types and settings, including home and community care, supportive living accommodations, and continuing care homes. The continuing care system in Alberta provides a range of services for health, personal care, and housing to ensure the safety, independence, and quality of life for people in Alberta, regardless of age, based on their evaluated need for continuing care assistance. Publicly funded care options include home and community care; continuing care homes, which includes Designated Supportive Living and Long-Term Care; and, Palliative and End-of-Life Care services (PEOLC). In addition, Albertans have the option to access housing support in supportive living settings, such as lodges, group homes, and seniors' complexes. In 2022-23, 871 new continuing care beds/spaces were created at AHS-operated or contracted facilities to meet Albertans’ needs. The government continues to be committed to expanding the number of available continuing care spaces throughout the province and enhancing the continuing care system to effectively meet the needs of Albertans by incorporating recommendations from the Facility-Based Continuing Care (FBCC) Review Final Report, which was released on May 31, 2021. Alberta Health has acted on several recommendations from the FBCC review, including the introduction of self-managed care as a way to provide greater choice regarding locations, types and providers of services. Further, Alberta Health has enhanced client choice by supporting more continuing care clients in the community rather than at FBCC sites. Alberta Health worked with Alberta Blue Cross and AHS to successfully implement the ClientDirected Home Care Invoicing model. This model was implemented in the Edmonton Zone in April 2022, and in the Calgary Zone in the fall of 2022. Expansion to rural areas of the province will move forward over the course of 2023 to provide Albertans with increased choice and flexibility in selecting their home care service provider and the ability to better direct how their care is provided. In June 2022, Alberta Health worked with AHS to initiate a Request for Expression of Interest and Qualification (RFEOIQ) procurement process to explore opportunities to optimize the provision of home care services in Alberta, as well as identify innovative service delivery solutions to support specialized needs and populations. Albertans will begin to see the outcomes and impacts of the RFEOIQ process during fiscal year 2023-24, as the successful proposals are implemented. Another recommendation from the FBCC report was to streamline inspections. Transition of continuing care facility audits from AHS to Alberta Health began in March 2022. A coordinated monitoring approach has reduced duplications of both reviews and site visits. In 2022-23, over 1,100 inspections were completed on accommodation and care in continuing care facilities across the province. Alberta Health also followed up on over 940 reportable incidents of resident safety or care concerns and conducted 103 complaint investigations. These activities continue to provide assurance that residents and clients are receiving safe and quality care and services. Budget 2022 allocated $204 million in capital grant funding over three years to expand capacity for continuing care. The inaugural Indigenous Stream was launched in 2021 to support continuing care facilities on and off reserves/settlements. As of June 2022, seven projects were approved for $67 million to develop 147 continuing care spaces. The inaugural Modernization Stream was launched on September 20, 2022, and concluded on January 6, 2023. This stream focused on refurbishing and/or replacing existing aging continuing care infrastructure at non-AHS owned facilities. The Government of Alberta continues to prioritize quality PEOLC by investing $20 million in over 30 projects since 2019. Progress to date on projects commenced in 2020 include: • Covenant Health continued to work to increase general awareness of PEOLC, increase uptake of advance care planning and develop standardized, competency-based education to support the provision of high-quality PEOLC. • In October 2022, Covenant Health’s Palliative Institute launched the Compassionate Alberta website, (compassionatealberta.ca) which is a resource aimed at increasing awareness around palliative care and to help Albertans have open and honest conversations about death. • Between April 2022 and March 2023, the Alberta Hospice Palliative Care Association successfully launched two programs that addresses the needs of caregivers and those with a life-limiting illness (the Living Every Season Program) as well as grief and bereavement needs for Albertans (the You’re Not Alone Grief Connection Program). In November 2021, Alberta Health released the PEOLC call for grant proposals. The grant program focused on projects that address the four PEOLC priority areas identified in the Advancing Palliative and End‐of‐Life Care in Alberta Report. As a result of this grant call, a total of 25 new PEOLC grants were initiated in April 2022, totaling $11.3 million. The funding and project breakdown is as follows: • Nearly $4.2 million for eight projects to expand community supports and services. • More than $4.1 million for 10 projects to improve health-care provider and caregiver education and training. • More than $1.9 million to support four projects that advance earlier access to palliative and end-of-life care. • More than $1.1 million for three projects for research and innovation. In June 2022, the Pilgrims Hospice Society completed a one-year, grant-funded project that supported care navigation services, which provided Albertans with information on residential support programming and provided staff training on hospice care. Pilgrims Hospice Society also received $2.5 million in October 2022 to support residential hospice care at the Roozen Family Hospice Centre in Edmonton. This demonstration project will provide important information on the standalone hospice model used at the centre, including usage data and service quality, to identify longer-term options for funding and expanding residential hospice services in Alberta. Government continued to invest in supporting the nearly one million Albertans who are caregivers for family and friends. This included approximately $2 million in grant funding since 2022 to Caregivers Alberta to enhance their programs and services; to Norquest College for the Skills Training for caregivers with a focus on rural areas; to the University of Alberta to reduce caregiver distress and support family and friend caregivers to maintain their health and well-being; and, to the Alzheimer Society of Alberta and the Northwest Territories to focus on delivering communitybased programming for persons living with dementia and their caregivers. In 2022-23, the Government of Alberta continued to support innovations in dementia care through the Community-based Innovations for Dementia Care initiative, which supported 15 communitylevel projects, and through multiple projects delivered by the Alzheimer Society of Alberta and the Northwest Territories: • The Alberta Employers Dementia Awareness Project identified the needs of employers to develop best practices to create inclusive workplaces. This included piloting and launch of the Dementia Alberta website (https://www.dementiaalberta.ca) to ensure dementia in the workplace awareness materials are available to Alberta employers. The project also helps to ensure that employers have access to materials describing the importance of brain health and dementia risk reductions, and that employers have access to sample guidance, facts, tips and scenarios applicable to Alberta employers and employees. • The expansion of the First Link® early intervention program by enhancing outreach to and in rural communities. During the project, 113 rural communities received outreach and 91 small cities, specialized municipalities, municipal districts, towns, villages or summer villages received outreach services. • The Community Dementia Ambassador Project, which created a program delivered by volunteers (Ambassadors) who live in or are familiar with the cultural and social values of Alberta communities. This project identified 22 Ambassadors from 16 communities, including Cardston, St. Paul and Peace River. Ambassadors reached more than 1,325 Albertans. To support the continuing care sector and its staffing needs, the government is exploring ways to increase the number of students enrolled in Health Care Aide (HCA) programs at various postsecondary institutions. Government is funding an additional 1,090 seats in HCA programs over three years, and invested $12.8 million to provide bursaries for HCA students to assist with education costs and encourage them to become HCAs. The HCA bursary program, administered by NorQuest College, went live July 1, 2022, and included three streams of funding: the Financial Incentive program, the HCA Tuition Bursary program, and the Workplace Tutor program. Under the Financial Incentive program, students who were enrolled in a licensed HCA program between January 1 and June 30, 2022, are eligible for up to $4,000 if they agree to work a minimum of 1,000 hours with an identified continuing care operator within one year of starting employment. Eligible HCA students may receive up to $9,000 through the HCA Tuition Bursary program. The Workplace Tutor program provides funding for identified continuing care operators to educate and train HCAs at their workplace. Demand for the bursaries is steady with over 600 students applying for the regular bursary and approximately 350 HCA students approved to receive the bursary. These bursaries will remove barriers for students, and pay for schooling and other expenses while they are completing their program. From July 2022 to March 31, 2023, government provided $20.6 million to continuing care operators to partially offset inflationary increases to accommodation charges for continuing care residents. This support made accommodation charges more affordable for residents and shielded them from the full cost of living pressures associated with higher-than-average inflation. The government provided $1 million to improve access to non-medical supports in the community. This included initiatives with United Way Calgary and the Edmonton Seniors Coordinating Council to provide more community supports and navigation assistance for clients seeking this help, expanding caregiver supports. In 2022-23, the percentage of medical patients with an unplanned hospital readmission within 30 days of discharge from hospital was 12.8 per cent. This was one per cent lower compared to last year (2021-22). A lower percentage means fewer patients have been readmitted to hospital within one month of discharge. A high rate of readmissions increases costs and may mean the health system is not performing as well as it could be. Although readmission may involve many factors, lower readmission rates show that Albertans are supported by discharge planning and continuity of services after discharge. Rates may also be impacted by the nature of the population served by a hospital facility, such as elderly patients or patients with complex health needs, or by the accessibility of post-discharge health care services in the community. Coordination of care is also improving with increased access to virtual care services and supports as well as recent enhancements to health information systems that enable electronic notification of primary care doctors when their patient is admitted or discharged from hospital. 1.3 Use digital technology to enable new models of care and reduce manual and paperbased processes. Government continues to enhance the digital health environment to provide Albertans with digital access to their health information and give health care providers more complete digital patient information at the point of care to enhance quality of care for Albertans. Collecting health system data helps support evidence-informed decisions to address changing circumstances and to keep Albertans informed. The digital modernization of the health care system involves several key elements. The MyHealth Records (MHR) portal allows Albertans to access their health information. In 2022-23, over $7.9 million was spent on MHR. Alberta Netcare, the province's Electronic Health Record, is available to health care professionals in the community and AHS. In addition, Connect Care, an integrated system with Alberta Netcare, serves as a common platform for clinical information and stores all medical records, prescriptions, and care history collected from AHS facilities, including doctor's notes. Giving Albertans digital access to their health information via the MHR portal reduces the need for them to manually request that information separately from each health provider. Albertans registered on MHR has grown from 1.25 million users in March of 2022 to just under 1.5 million users at the end of March 2023. MHR portal capabilities have been expanded with the addition of immediate release diagnostic imaging reports including CT and MRI scans. The Apple MHR App is now integrated with Apple Health Kit, allowing Albertans to connect health information from their Apple Health App account to MHR. These information technology components facilitate the shift from paper-based processes to digital processes and support the expansion of virtual care options. In 2022-23, new services to support electronic referral as part of the ASI were planned and developed. A data feed is being tested, paving the way for future referral notifications in MHR and in the Electronic Medical Records (EMR) systems of referring providers. Other improvements also included continuity of care services: • Patient data from the Central Patient Attachment Registry is now integrated with Alberta Netcare, enabling health care providers across Alberta to access information on the patient’s medical home, and who their primary provider is. Design work on Alberta’s version of the International Patient Summary is nearing completion and development work will begin shortly with EMR vendors. A patient summary is a collection of clinical and contextual information about a patient’s health details. The Alberta version of the national standard is being coordinated with Ontario and Canada Health Infoway (a not-for profit funded by the Government of Canada) and includes necessary minimum amount of information to inform patient treatment at point of care. Alberta is hoping to have at least one EMR vendor conformed to Alberta’s Patient Summary in 2023, with additional vendors onboarded in 2024. • The Community Information Integration (CII) project improves Albertans’ access to primary care and community health information by collecting patient data from physician offices and other community-based clinics and making it available to other health care providers through Alberta Netcare. Over $6.5 million was spent on CII in 2022-23. In January 2023, there were 1,764 providers live on CII, taken from 430 clinics across 40 PCNs, and nearly 1.2 million Albertans in the Central Patient Attachment Registry database. More than seven million patient encounters and over 500,000 consult reports have been submitted to Netcare as of March 31, 2023. As the province emerges from the pandemic, the expectations of Albertans have shifted and there is a greater reliance on accessing on-demand virtual government services. In alignment with the Government of Alberta Digital Strategy and Alberta Health’s eHealth Strategy, developed in 202122, Alberta Health will modernize digital service delivery, increase productivity, save tax dollars, and improve user experience by better integrating technologies into the delivery of government services. In 2022-23, $5.7 million was spent through the Health Canada Bilateral Agreement for PanCanadian Virtual Care to address secure messaging, secure video-conferencing technology, remote patient monitoring technologies, patient access to COVID-19 and other lab results, and back-end supports for integration of new platforms. This investment supported Alberta Health’s ongoing initiatives foundational to expanding the virtual health care system. Alberta Health has identified four strategic priorities for virtual care delivery in the province, which are reflected in Alberta’s Virtual Care Action Plan: • establishment of an eHealth Strategy that includes a strategy for virtual care; • expansion of the MyHealth Records patient portal capabilities, including expansion of lab results and addition of diagnostic imaging results; • development of secure messaging services for Alberta, including advanced services for twoway integration between community EMRs and Alberta Netcare; and, • development of a privacy and security framework for virtual care. Access to the MHR portal is free at https://myhealth.alberta.ca/myhealthrecords. Currently, Albertans can view parts of their Netcare record, including their medications dispensed through community pharmacies, lab results and immunization history through MHR. In 2022-23, discussions and approval processes for MHR and Alberta Netcare were underway for implementation. This enables Albertans to be active participants in their own health management. The ministry continues to make progress on a phased roll out of Connect Care within all AHS facilities to support digital modernization of the health system. In 2022-23, five of the nine planned launches for this multi-year project had been completed. Connect Care provides a single source of information in AHS to support team-based, integrated care with a focus on the patient and the efficient and effective provision of services. In 2022-23, over $260 million was spent on Connect Care. The total cost of Connect Care when completed is expected to be $1.45 billion. Although progress was slowed by the pandemic, work continues on the remaining four launches of deployment. All launches are expected to be completed by fall 2024 and approximately 145,400 users are expected with full roll out of the program. The application of modern technologies will support the delivery of innovative care models that empower patients, families and their health care teams to improve quality of care. In 2022-23, eight digital health projects were funded at the Universities of Alberta and Calgary for a total investment of $9.6 million from AHS and Alberta Innovates. These academic-clinical collaborations will help AHS identify and advance solutions that improve health care quality, health outcomes, and overall value for Albertans. Projects include the integration of prevention into Connect Care to improve the health of Albertans; digital tools such as clinical decision support and remote monitoring for people with kidney issues to reduce acute care use; tele monitoring to reduce adverse events for hospitalized patients; and, an integrated digital health approach to diabetes with First Nations in Alberta. Digital technology is also being leveraged to modernize critical capabilities to administer the Alberta Health Care Insurance Plan (AHCIP) and support core business, such as claims processing and payment to health care providers. To better meet the needs of Albertans and care providers, work continued on future models of care and emerging digital technology to replace and redesign mainframe systems to increase functionality and reduce maintenance costs. In 2022-23, over $6.5 million was spent on this initiative and the work towards the replacement and redesign of nine applications used to administer the AHCIP is ongoing. 1.4 Ensure processes for resolving patient concerns are effective, streamlined, and consistent across the province. It is important that Albertans are aware of what resources are available to help them resolve patient concerns, and how their valuable feedback can help improve the quality and safety of health services. The Office of the Alberta Health Advocates empowers Albertans to advocate for their health needs; resolves their concerns and refers individuals to programs and services to address their complaints; educates Albertans about the province’s Health Charter; and, provides health selfadvocacy skills and health literacy education to promote early resolution of issues and remove barriers and gaps in care. In February 2023, government appointed a new Health and Mental Health Advocate to be a strong voice for Albertans when it comes to their health care and to ensure the health system operates effectively for all Albertans. From April 1, 2022, to March 31, 2023, there were 2,589 Albertans served by the Office of the Alberta Health Advocates. More specifically, there were 1,565 under the Health Advocate’s jurisdiction, 742 under the Mental Health Advocate’s jurisdiction, and 175 files that were under both jurisdictions. The Office of the Alberta Health Advocates hears the patient perspective on care experiences and provides feedback to entities in the health system through effective partnership and collaboration to encourage system improvement/change and effective legislative development. The ministry is committed to ensuring the patient complaints process is fair, responsive, and accessible and has processes in place to review and respond to feedback from patients and families. Recommendations to improve the current processes for resolving patient concerns and complaints have been developed, informed by consultation and research led by the Health Quality Council of Alberta. These recommendations were approved by government in the summer of 2022; Alberta Health is working on their implementation which is to expand the role and mandate of the Health Advocate; centralize intake, triage, navigation and standardize follow up with Albertans for all patient complaints; and, require mandatory information exchange between stakeholders to support improved public reporting for health care complaints. Once the recommendations are fully implemented, Albertans will have a simplified process to raise concerns and complaints about health care, and the Health Advocate will help them find the appropriate body to review and investigate the complaints. The Health Advocate will help improve accountability by monitoring the status of the resolution processes for completion and closure. Concerns and complaints will continue to be reviewed and investigated by AHS, health professions and other bodies created under statute to hear concerns. Alberta Health continues working with First Nations and Métis health leaders to better understand their experiences with the current complaints management systems in Alberta, involve them in identifying ways to build Indigenous patient trust in the health care they receive, and to ensure their concerns are addressed appropriately. The outcome of this work will improve the current complaints management system by removing existing red tape and making the system easier to navigate for patients and families. Outcome Two: A modernized, safe, person-centred, high quality and resilient health system that provides the most effective care now and in the future for each tax dollar spent Key Objectives 2.1 Continue to implement strategies to bring Alberta’s health spending and health outcomes more in line with comparator provinces and national norms, including implementation of AHS review recommendations and working with the Alberta Medical Association to reach a fiscally sustainable agreement. Albertans want and deserve a health care system that meets their needs, while also understanding the system needs to be sustainable. Government’s focus on ensuring value for money spent on health care supports this vision through actions and initiatives that make the most of taxpayer dollars. Budget 2022 invested $22.5 billion in Health’s operating budget to keep Albertans safe and healthy. In 2022-23, Alberta received $5.8 billion in Government of Canada transfers, of which $5.5 billion was the Canada Health Transfer (CHT). The CHT included a $232 million one-time funding to address surgery backlog resulting from the COVID-19 pandemic. In February 2023, Alberta reached an agreement with the Government of Canada to invest more than $24 billion in Alberta's health care system over the next 10 years through the CHT. This funding aims to respond to the immediate needs of Albertans under the Health Care Action Plan, as well as improve access to family health services, including in rural and remote areas and in underserved communities; foster a resilient and supported health workforce; improve mental health care and addictions services; and, allow Albertans access to their own electronic health information. The ministry continues to closely monitor provincial per capita spending on health care to quantify progress on government’s broader commitment to get the most value for each dollar and improve access, and make the health system work better for Albertans, while managing cost growth in health care. The Government of Alberta continues to collaborate with health system partners to manage the biggest cost drivers in the health system – namely hospital services, labour and physician compensation, and publicly funded drug benefit programs. In 2022-23, the Government of Alberta spent $4.3 billion on hospital services (i.e., acute care), $6.0 billion on physician compensation and development, and $2.5 billion on drugs and supplemental health benefits. The pandemic caused per capita health care spending for all provinces to increase significantly. The national average increased from $4,835 in 2019-20 to $5,628 in 2021-22. The Alberta provincial per capita spending on health care in 2021-22 is estimated to be $5,384, on par with the Canadian average. Improving efficiency and ensuring more value for tax dollars will improve health outcomes and support fiscal sustainability of the health system. The Alberta Health Services (AHS) Performance Review identified opportunities for AHS to reduce costs and improve health outcomes by using resources more efficiently. The ministry will continue to pursue opportunities to align spending with British Columbia, Ontario and Quebec by implementing efficiencies and reducing drug costs through the work of the pan-Canadian Pharmaceutical Alliance. AHS continues to find ways to improve the health system and access to services to Albertans. Actions implemented as a result of the 2019 AHS Performance Review have had substantial impacts on the health care system and savings have been used to improve front-line care and system sustainability (https://open.alberta.ca/publications/alberta-health-services-performance-reviewsummary-report). Implementation of the AHS Review initiatives was concurrent with a global pandemic, labour negotiations and development of a new agreement between the government and the Alberta Medical Association (AMA). Operating expenditures (excluding COVID-19 costs) increased by 6.1 per cent in 2022-23 when compared to 2021-22. Alberta’s population growth and aging population has resulted in increased demand for healthcare services. The overall increase also reflected implementation of the new agreement with the AMA and recent settlements with various health labour unions. Despite these cost pressures, health spending growth is lower than the combined population growth and inflation increase. Protecting and improving the quality of health care in Alberta also requires capital investments. In 2022-23, a total of $841 million was invested in health-related capital projects across the province, including technology and information systems maintenance and renewal of existing facilities. Alberta continues to expand and modernize hospitals and other facilities to protect quality health care and grow system capacity. Investments in health system infrastructure is fundamental to improving efficiency in the health care system, reducing wait-times, providing additional surgical capacity, and to generally improve patient outcomes. Budget 2022 invested $193 million over three years for the redevelopment and expansion of the Red Deer Regional Hospital Centre to increase critical services and add capacity to one of the busiest hospitals in the province. The Red Deer Regional Hospital Centre redevelopment project functional program was completed in late April. The functional program develops and validates the scope of services and projected workload, staffing, and space to meet current and emerging acute health care needs of all residents of the Red Deer Regional Hospital’s catchment area. The functional program also addresses capacity and quality of space to improve patient and staff safety, support quality of care, manage utilization efficiently and sustainably, and ensure timely access to care. When completed this project will expand inpatient capacity from 370 beds to 570 beds and add three surgical suites, plus space to add three more suites when required in the future. There will be a new cardiac catheterization laboratory, a new medical device reprocessing space, expanded ambulatory care capacity, and expansion of many other clinical programs throughout the hospital. In 2022-23, over $133 million was allocated over three years for Alberta Surgical Initiative capital projects at AHS-owned facilities. This includes the renovation of the Medicine Hat Regional Hospital, the Edson Health Centre, and the Royal Alexandra Hospital in Edmonton. Construction also progressed on the University of Alberta Hospital in Edmonton, which will include a postanesthetic recovery unit and medical device reprocessing area when completed, and the Rocky Mountain House Health Centre, which is undergoing renovations for a new procedure room and the development of a new medical device reprocessing area. Design was completed for redevelopment at the Chinook Regional Hospital that will modernize and increase surgical procedure capacity. Other work also included designing 11 operating suites at the Calgary Foothills Medical Centre. As part of Budget 2022, $2.2 billion was allocated over three years to move forward with a number of capital projects, for example: • The University of Alberta Hospital Brain Centre received $50 million over three years for a Neurosciences Intensive Care Unit. The design development report is nearing completion. • Provincial Pharmacy Central Drug Production and Distribution Centre ($49 million over three years). The design development report is complete. • The Norwood Tower at the Gene Zwozdesky Centre ($142 million over two years) received an occupancy permit in March 2023 and was turned over to AHS for operational commissioning. In 2022-23, $116 million was spent to complete the Calgary Cancer Centre. The Calgary Cancer Centre Construction is complete and AHS is preparing the hospital to open in 2024. The hospital will have 160 new inpatient cancer beds, 100 patient exam rooms, 100 chemotherapy chairs, increased space for clinical trials, 12 radiation vaults, outpatient cancer clinics, and designated areas for clinical and operational support services and research laboratories. The completed project will increase cancer care capacity in Calgary by consolidating and expanding existing services to support integrated and comprehensive cancer care. On October 6, 2022, the government executed a four-year agreement with the AMA to address common interests such as quality of care, health care system sustainability, and stability of physician practices. Implementation of the AMA Agreement is underway and includes over $250 million in new spending over four years on initiatives targeted at communities and physician specialties facing recruitment and retention issues. The agreement included concrete solutions and the financial resources to support Albertans’ health care needs by promoting system stability through competitive compensation and providing targeted funding to address pressures that require immediate and longer-term stabilization. The agreement also allows physicians to provide greater input into longer-term approaches on improving patient care and physician compensation reform initiatives. Physicians received a one per cent lump sum COVID-19 recognition payment in 2022-23. Alberta physicians were at the forefront of the pandemic and the one-time payment for eligible practicing physicians is in recognition of that work during the 2021-22 fiscal year. The lump sum payment is approximately $45 million and was provided to the AMA in December 2022 to distribute to their members. Physicians will receive an average one per cent rate increase to compensation for each of the next three years. As part of implementation of the AMA Agreement, the Business Costs Program premium rate was increased by about 22 per cent. This increase will help physicians deal with inflation and keep practices open. The increase is estimated to cost $20 million annually, providing on average an extra $2,300 annually for each physician. This is in addition to about $80 million the government currently invests in the program each year. Following the ratification of the AMA Agreement, a commitment for collaboration between Alberta Health and the AMA regarding primary health care, including one-time investments of $20 million in Primary Care Networks (PCNs) for two fiscal years, was established. The Provincial PCN Committee provided significant contributions to the work of the Modernizing Alberta’s Primary Health Care System (MAPS) initiative to improve access and quality of primary and community health services. The MAPS initiative goal is to provide recommendations on ways to strengthen primary health care and achieve a primary health care-oriented health system. MAPS is engaging leaders and experts with hands-on experience in primary health care and health systems improvement to examine the current landscape and propose improvements. By March 31, 2023, a final report was delivered proposing a strategic direction for primary health care over the next 10 years, with a parallel report providing strategic directions to improve the delivery of primary health care for Indigenous peoples in Alberta. The $20 million investment in primary health care provides significant relief across the primary health care system, particularly for PCNs that have experienced a decline in their per capita payments from declining numbers of patients. This funding provides stabilization while work is undertaken to review and improve the overall funding model for PCNs, which will consider recommendations from the MAPS initiative. For many Albertans, prescription drugs have tremendous benefits in terms of improving quality of life, managing illnesses, and in some cases, precluding the need for more extensive treatments. Alberta continued to work with the pan-Canadian Pharmaceutical Alliance (pCPA) to reduce prescription drug costs and increase access to clinically effective and cost-effective drug treatment options, including cell and gene therapy. All new drugs and/or new indications for use undergo price negotiations between the pCPA and drug manufacturers. In 2022-23, rebates have increased to an estimated $327 million from $275 million in 2021-22. This is a successful trend that shows the importance of the pCPA and Alberta’s involvement as a member to push health jurisdictions for more value and budgetary protection. In 2022-23, the province spent $2.5 billion on drugs and supplemental health benefits and continued to improve existing drug benefit programs and add innovative and effective therapies through the addition of 320 new products in 2022-23. Of the 320 products added, 48 were brand name drug products and 272 were generic products. Alberta’s Biosimilars Initiative will expand the use of biosimilars by replacing the use of biologic drugs with their biosimilar versions whenever possible. This means patients will continue receiving safe and effective treatment, but at a lower cost. In 2022-23, savings from this initiative increased to an estimated $65.7 million from $48.9 million in 2021-22. 2.2 Increase regulations and oversight to improve safety, while reducing red tape within the health system by restructuring and modernizing health legislation, streamlining processes, and reducing duplication. As of March 31, 2023, the ministry, including AHS, achieved a 36.1 per cent reduction of its regulatory and administrative requirements, exceeding the government target of 33 per cent. AHS will continue to see reductions with the ongoing launches of Connect Care across the organization, continuing through 2024. Connect Care supports digital modernization of more complete central access to patient information related to AHS services. It provides resources, including medication alerts; evidencebased order sets; test and treatment suggestions; and, care paths and best practice advisories, which result in fewer repeated tests and consistent information across the province wherever care is being provided at AHS facilities. This system also reduces the number of forms used by AHS and helps to eliminate data entry duplication. Connect Care also facilitates direct communication between patients and providers through a patient portal, MyAHS Connect, which helps patients better manage their health with online access to their health information, including reports and test results. It also allows for online interaction with their care team, an ability to review and manage appointments and after visit care summaries, and less repeating of their health histories or need to remember complex histories or medication lists. The ministry continues to monitor Alberta’s health system to ensure standards are maintained and to improve safety and quality of health care. As of March 31, 2023, amendments to the Health Professions Act have been proclaimed into force that modernize Alberta’s professional regulatory structure. This included changes to 29 regulatory college regulations and one regulation that enhance professional regulation by health profession regulatory bodies and will make it easier for regulatory colleges to be more agile and adapt faster to changing best practices. The PCN Nurse Practitioner (NP) Support Program was created to enable NPs to work to the full scope of their skills. In 2022-23, $7.6 million was provided and the program facilitated the incorporation of NPs working more than 57 full-time equivalent positions as of March 2023. The program increases access to primary health care, including after hours, weekends, and in rural and remote areas and underserved populations; supports chronic disease management; and, helps meet unmet demand for primary health care services. Challenges for the program include NP compensation, recruitment and retention, and the desire of NPs for an independent practice model. Alberta Health is currently consulting with key stakeholders on a draft NP Compensation Model to address the challenges of the program. Amendments to the Pharmacy and Drug Act and the Pharmacy and Drug Regulation came into effect June 1, 2022. These amendments allow the Alberta College of Pharmacy and pharmacies to better respond to changes in the provision of pharmacy services to Albertans and reduce significant government red tape faced by pharmacy operators. To address the current challenges in continuing care legislation and help to initiate transformative change within continuing care, Alberta Health worked with partners to develop a new legislative framework for the continuing care system to increase clarity regarding services, address gaps and inconsistencies across settings, enable improved service delivery for Albertans, and support health system accountability and sustainability. On May 31, 2022, the Continuing Care Act (Act) received Royal Assent. The Act will come into force on April 1, 2024, after the development and approval of regulations and standards. The ministry is currently working with partners on the development of those regulations and standards. When proclaimed, the Act will regulate the full spectrum of continuing care services and settings in Alberta, including continuing care homes, supportive living accommodations, and home and community care. Consequential amendments to the Act are included in The Red Tape Reduction Statutes Amendment Act, 2023. These amendments ensure alignment of terminology in existing legislation with the Act while maintaining the policies and intent of the current legislation. In May 2022, the Food Regulation under the Public Health Act was amended to eliminate the requirement for food establishments to request an approval from a public health inspector to allow dogs into outdoor eating areas. The amendment reduced red tape for operators and provided them greater flexibility in meeting the needs of their customers. The Food Regulation provides clear requirements to support the change so dogs can stay with their owners on outdoor patios, while maintaining a high degree of food safety. 2.3 Improve measuring, monitoring and reporting of health system performance to drive health care improvements. Measuring performance is the clearest way to show investments in the health care system are leading to better outcomes for Albertans. Alberta Health worked with the Health Quality Council of Alberta (HQCA) to ensure alignment of their plans and priorities with government key priorities and achieve improvements through various initiatives. On July 26, 2022, Alberta Health executed a $23 million operating grant agreement with the HQCA over three years (April 1, 2022 to March 31, 2025) to keep the organization working with patients, families, and partners from across health care and academia to inspire improvement in patient safety, person-centred care, and health service quality. As an example, Alberta Health worked with the HQCA to develop a Primary Care Patient Experience survey to engage Albertans on their experiences within the health care system. Work continued towards transitioning manual surveys to a digital, computer-adaptive testing methodologies format to use digital technology to enable new models of care and reduce manual and paper-based processes. Digital formats for surveys and reports across primary and continuing care increased Albertans’ engagement within the health system and allowed more timely feedback to service providers about care concerns, including patients’ opinions. Alberta Health worked with HQCA to create primary health care panel reports to support planning, quality improvement, health system management for overall purpose of improving primary health care delivery. The panel reports provide family physicians with information on their patients’ continuity, as well as valuable data on screening and vaccination rates, chronic conditions, pharmaceutical use, and emergency and hospital visits. Alberta Health worked with AHS and the HQCA to develop a value-based assessment tool for objectively assessing value from the Government of Alberta annual investment into health outcomes of Albertans and benchmark against other jurisdictions, particularly the comparator provinces of British Columbia, Ontario and Quebec. Alberta Health also worked with the HQCA to complete priority work on identifying emergency medical services key performance indicators. Performance measures were developed and are under ministry review, with a shift in focus to reducing response times measured at the 90th percentile, rather than the 50th percentile. Releasing the results and performance information improves quality and patient safety and assures Albertans of the government’s commitment to increase accountability and transparency in Alberta’s health care system. The adoption of best practices and monitoring of performance measures help to improve health outcomes. Work continued with the HQCA on developing the Patient Experience Awards and Quality Exchange to support excellence in care and sharing of best practices. This included continuing to develop resources and information to support and inform program planning, panel management, quality improvement and policy development in primary health care, as well as patient experience information for designated supportive living and continuing care. Information is published for Albertans in FOCUS, a dynamic online reporting tool which collects information about what patients experience in the provincial health care system, including: emergency departments, primary health care, long-term care, designated supportive living and home care. Outcome Three: The health and well-being of all Albertans is protected, supported and improved, and health inequities among population groups are reduced Key Objectives 3.1 Ensure a continued, effective response to the COVID‐19 pandemic by optimizing access to treatments and vaccine, and reducing vaccine hesitancy. The Government of Alberta remains committed to supporting Albertans as we shift to managing COVID-19 similar to how other endemic respiratory viruses are managed. Alberta’s capacity to treat and clinically manage cases of COVID-19 continues to improve. Immunization, including receiving a booster dose of COVID-19 vaccine, is one of the best choices Albertans can make to protect themselves from severe illness due to COVID-19 infection. In 2022-23, $1.2 billion was spent on COVID-19 response to ensure the health care system had the resources required to address health care pressures resulting from the pandemic. By the end of June 2022, all mandatory public health measures related to COVID-19 were lifted. This was due to increased immunization coverage, attenuation of severity of new circulating variants, and the ability to treat and clinically manage cases of COVID-19. This signaled the beginning of a shift in Alberta’s handling of COVID-19 from an emergency pandemic response to an endemic state. Government supported this transition by working across multiple facets of health care (e.g., primary care, continuing care, workplace health and safety, public health, provincial laboratory, etc.) to align public health recommendations, such as testing and isolation, across all common respiratory viral illnesses. The ministry continued to monitor the impacts and transmission of COVID-19 and other respiratory viruses in the community by working with partners on the implementation of ongoing and new COVID-19 immunization programs, including the introduction of bivalent booster vaccines, and implementing treatment protocols for COVID-19. Alberta Health and the Health Quality Council of Alberta established a COVID-19 Data Task Force, comprised of health professionals, to conduct a data review of the last several years of health information with a view to offering recommendations to the Government of Alberta on how to better manage a future pandemic. The purpose of the review is an opportunity to reflect on Alberta’s pandemic response from a data quality and validity lens to identify opportunities for improvements to manage future pandemics. To minimize the impact of COVID-19 and protect public health, COVID-19 Rapid Antigen Tests were made available across the province to all Albertans free of charge through participating community pharmacies. Initially, supply was limited and this distribution model enabled an equitable distribution of tests across the province. Between March 2021 to March 31, 2023, Alberta distributed 48.5 million rapid antigen tests to acute and continuing care sites, primary care clinics, businesses, K-12 schools, municipalities, First Nations and Métis communities, and the general public. Government developed COVID-19 vaccine strategies to help reduce the spread, minimize severe outcomes and protect vulnerable Albertans. Work continued to support the review of ongoing evidence and recommendations for immunization against COVID-19, including guidance for immunization post-infection (or hybrid immunity), as well as for fall/spring booster programs. In 2022, Alberta continuously achieved key milestones on COVID-19 vaccine administration and roll out for different age groups and populations. In April 2022, 40 per cent of Albertans 12 and older had received their third vaccine dose. In June 2022, 35 per cent of Albertans aged five to 11 had received two doses of COVID-19 vaccine. On November 14, 2022, the Pfizer vaccine was made available for individuals six months to four years of age, and on March 20, 2023, a second bivalent vaccine (spring booster) was made available for residents living in senior congregate living settings. In 2022-23, 1.4 million COVID-19 vaccine doses were administered to Albertans and 26 per cent of the population 12 years of age and older had received a booster dose. While the federal government continued to cover the costs of the vaccines, Alberta Health spent $53 million in 2022-23 to distribute the vaccines to Albertans. The Alberta Vaccine Booking System (AVBS), launched in summer of 2021, continues to provide Albertans with access to book both COVID-19 and influenza vaccine appointments at participating Alberta Health Services (AHS) or pharmacy locations by providing a centralized, province-wide online appointment booking platform. The centralization of all vaccine booking appointments, including from AHS, Public Health, and Community Pharmacy helps Alberta Health forecast vaccine demand and strategically distribute vaccine supply. Vaccine eligibility criteria and system functionality continue to be updated based on direction from provincial immunization programs. In 2022-23, more than 575,000 appointments for COVID-19 and influenza immunization were scheduled using the AVBS. Updates continue to be released to support dynamic vaccine eligibility changes and to continually improve the user experience. Previously, Albertans had to call multiple pharmacies and Health Link in an attempt to find available vaccine supply. The Health Link 811 call centre continues to support Albertans who do not or cannot use the AVBS. To ensure a continued response to COVID-19, Alberta Health together with AHS extended the provision of free personal protective equipment (PPE) to primary care physicians, pediatricians, and their staff to support their operations and enhance safety to May 31, 2022. In 2022-23, inventory consumption expense associated with the COVID-19 response was $365 million; this includes PPE, testing supplies and $88.6 million for rapid test kits. In addition, the government worked with continuing care partners to protect residents of congregate care facilities and home care clients. A total of $286 million was provided in 2022-23 for additional staffing costs and cleaning supplies, PPE and screening of visitors to protect the health and safety of residents. In 2022-23, AHS, in collaboration with the Zone PCN Committees, worked towards the administration of an oral antiviral COVID-19 treatment in respective AHS geographical zones, enhancing capacity for testing and swabbing for respiratory illnesses. In 2021-22, intravenous Sotrovimab was made available on an outpatient basis to Albertans at higher risk of severe illness or death, followed by availability of Paxlovid, the first COVID-19 treatment approved by Health Canada that can be taken orally at home. Efforts were made to recruit sentinels (primary care physicians/nurse volunteers) to increase the effectiveness of the TARRANT Viral Watch Program, which monitors respiratory infections circulating in the community. 3.2 Safeguard Albertans from communicable diseases that can cause severe illness, permanent disability, or death. The ministry works to protect Albertans from a number of communicable diseases, such as influenza, measles, and sexually transmitted and blood borne infections. Over the past year, immunization programs for vaccine-preventable diseases continued to be a primary strategy in preventing disease, disease transmission and severe health outcomes. They are key to the health of a population and to decreasing the strain on the acute care system. Through promoting initiatives that aim to increase childhood and adult immunization rates, Alberta continued to offer immunizations programs, including influenza vaccine, to Albertans six months of age and older, free of charge in collaboration with many partners. Alberta’s 2022-23 influenza season started earlier with a surge of influenza A cases in early October. The highest positivity for influenza A was 31.9 per cent in the week of November 20, 2022, and cases and outbreaks decreased significantly by the end of December 2022. Alberta had sufficient supply of influenza vaccines to immunize 38 per cent of the population. Alberta Health worked with AHS to ensure respiratory outbreak definitions and management guidelines were in place for high-risk settings, including continuing care and acute care facilities, to minimize severe health outcomes and protect the most vulnerable Albertans in these settings. Despite the challenges of fatigued providers and a generally vaccine fatigued population, the overall influenza immunization rate is one per cent higher than in 2021-22. As of March 31, 2023, approximately 28 per cent of Albertans received an influenza vaccine. Budget 2022 included an increase of $14.3 million related to the approval of the high-dose influenza vaccine for Albertans 65 years of age or older. As of March 31, 2023, approximately 64 per cent of Albertans 65 years of age and older, and 75 per cent of Albertans 90 years of age and older received a high-dose influenza vaccine. The Alberta Outreach Program started the week of October 3, 2022, to immunize those at highest risk of severe outcomes from influenza. The 2022-23 Influenza Immunization Program for the general public began on October 17, 2022, and ended on March 31, 2023. Influenza vaccine was available at over 2,500 immunizing sites, including AHS clinics, Indigenous Services Canada clinics, community pharmacies, community medical clinics, and post-secondary institutions. Immunization programs save millions of dollars, helping people of all ages live longer, healthier lives, and decreasing the burden on the health care system. The pandemic did result in some disruptions to the routine school immunization program and overall infant and preschool immunization rates have decreased. However, AHS has hired additional staff to support addressing the school immunization backlog and in-school catch-up programs, and immunization rates for school-aged children are nearing pre-pandemic coverage levels. In 2022, by age two, 71 per cent of Albertans had received immunization with diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine and 82 per cent had received immunization with measles, mumps, rubella (MMR) vaccine. These immunization rates are both lower than the national target of 95 per cent for these vaccines. As a result of the COVID-19 response, childhood immunization rates dropped between 2021 and 2022. AHS has a catch-up program to increase childhood immunization rates to help reach the national target of 95 per cent. This includes actions such as reminder calls for booked appointments, monitoring wait times and adding appointments as needed, and following up using a recall process for children with delayed immunizations. Work is underway with service providers to enhance testing, treatment and prevention strategies, including working with community-based organizations, to improve women’s health, reduce barriers to sexually transmitted and blood borne infections (STBBI) testing and treatment, and increase access to prenatal syphilis screening. Over $8 million annually is provided to organizations to prevent STBBIs and provide wrap-around supports for people living with those infections, including $1.2 million specifically for syphilis outbreak response. In September 2022, Alberta experienced a shigella outbreak in Edmonton, which ended in February 2023 after two weeks without new cases. However, the outbreak was re-opened in March 2023, when seven additional cases were reported and some patients hospitalized. As of March 31, 2023, 214 cases were reported since the outbreak initially started; no deaths were reported. In October 2022, the Shigella Task Force brought together cross-sector partners, including representatives from Alberta Health, AHS, shelters, inner-city agencies, the City of Edmonton, local family physicians, and Alberta Precision Labs to coordinate resources and discuss options for limiting spread. Syphilis has made a drastic resurgence in Alberta since 2019, with rates being the highest in more than 70 years. Alberta Health has resumed a leadership role in the provincial syphilis response, after an interruption due to COVID-19, through work with frontline service providers to support testing, treatment, and prevention strategies. By increasing access to syphilis testing and treatment services in a variety of novel health settings, the Government of Alberta will help create awareness and normalize sexually transmitted infections testing and treatment for all Albertans. The ministry is also leading and supporting a number of provincial outbreak responses and preparedness activities including: • leading the human health response to highly pathogenic avian influenza, including supporting the update of public health disease management guidelines and communication pieces for government websites; • supporting the coordinated provincial response to the international mpox (formally known as monkey pox) outbreak, including guidelines for contact management and guidance on pre and post-exposure vaccine use; and, • working with AHS public health in preparation for response to international communicable disease outbreaks, including Ebola and Polio. In early May 2022, cases of mpox began to occur in countries where mpox was not previously detected. Canada’s first case was reported on May 19, 2022, and Alberta reported its first case on June 2, 2022. By July 2022, mpox was declared a public health emergency of international concern by the World Health Organization. Alberta Health worked in collaboration with public health partners to develop testing criteria, case definitions and public health management guidelines. The Alberta Mpox Public Health Notifiable Disease Guideline was published in June 2022. Alberta began offering post-exposure vaccine on June 7, 2022, and the targeted pre-exposure vaccine campaign began at the end of June. As of March 31, 2023, Alberta recorded 45 cases of mpox. Alberta has administered 2,183 first doses and 1,715 second doses of the vaccine. 3.3 Expand access to a range of in‐person and virtual recovery‐oriented addiction and mental health services. Reporting responsibility for this objective has transferred to the Ministry of Mental Health and Addiction. Performance Measure 3.a Percentage of mental health and addiction‐related emergency department visits with no mental health service in previous two years Reporting responsibility for this performance measure has transferred to the Ministry of Mental Health and Addiction. 3.4 Prevent injuries and chronic diseases and conditions through health and wellness promotion, and environmental and individual initiatives. In 2022-23, $646 million was expensed to support population and public health initiatives to maintain and improve the health of Albertans through services promoting and protecting health and preventing injury and disease. Government provides leadership and support to protect the health and safety of Albertans and improve their health and well-being by setting public policy in a number of areas, such as maternal, infant and early child development; injury prevention; public health matters related to cannabis use; tobacco and vaping control; and, promotion of population wellness and health equity. Government recognizes that Albertans living with diabetes want to access health programs and services that will more effectively support their needs. On July 21, 2022, the Minister announced the establishment of the Diabetes Working Group (DWG) to review Alberta’s entire diabetes care pathway, identify gaps in care, and provide recommendations to improve diabetes prevention, diagnosis, treatment, and management. In addition, Alberta Health expanded the Insulin Pump Therapy Program to include newer pumps and supplies. Albertans enrolled in the pump program now have access to the newest technologies for management of diabetes. Improved access to the newer diabetes management technologies, and the work of the DWG will improve outcomes and quality of life for Albertans living with diabetes. Nearly $7 million was provided to AHS for cancer prevention initiatives supporting comprehensive projects that are reducing the risk of cancer across the province. These projects address healthy lifestyles, smoking cessation, workplace wellness, and partnerships with Indigenous communities. In 2022-23, the Cancer Prevention Screening and Innovation initiative worked with organizations such as Promoting Health, Chronic Disease Prevention and Oral Health, AHS Provincial Population and Public Health, the Alberta First Nations Information Governance Centre, the Métis Nation of Alberta, and the new AHS Indigenous Wellness Core to: • adopt the Alberta Healthy Communities Approach to focus on scaling and spreading successful interventions provincewide; • create a working partnership with the Human Papilloma Virus community innovation for sub-populations and the Provincial Population and Public Health Screening Programs and Communicable Disease Control divisions; • improve the Healthier Together Workplace program and recognition strategy; and, • strengthen work with Indigenous communities to facilitate community action to reduce modifiable factors, raise cancer awareness and improve cancer screening. A community support model was created, and tools were adapted to support the three initial Metis Settlements to create, implement and evaluate cancer prevention action plans. Alberta Health currently funds several health promotion-based initiatives to improve individual and community health and well-being: • Alberta Health continues to support the Injury Prevention Centre to provide unintentional injury prevention programs, research, and education. Through the Injury Prevention Centre, Albertans have access to programs and education that reduce the risk of injury and make communities safer. Injury prevention is a public health priority that directly reduces costs to the health care system. Injury bears an estimated financial cost of $7.1 billion annually in Alberta, $4.6 billion of which is direct health care costs. • Physician prescription to Get Active supports individuals to become more active through physical activity. Prescriptions can be filled at participating recreation facilities for free visits, free one month facility passes and/or free fitness classes. • The Communities ChooseWell program advances healthy eating and active living by supporting communities to create local conditions and environments that enable Albertans to eat well and be active. The program provides resources, education and support to community groups as well as offering small grants for implementing local healthy eating and active living initiatives. Alberta Health provides approximately $2 million in grants annually to five programs that support vulnerable mothers and their babies. From April 2022 to September 2022, programs provided intensive supports to 287 vulnerable women who were pregnant or of child-bearing age, and more vulnerable women were provided outreach supports to address gaps in support specific to the COVID-19 pandemic. Alberta Health and AHS also provided funding to support the University of Alberta’s ENRICH Maskwacîs Kokums and Mosoms Elders Mentoring Program, which creates enhanced support networks for parents-to-be. In addition, elder support helps address a gap in service within the prenatal clinical setting by connecting parents to traditional knowledge and culture. Budget 2021 provided a total of $6.75 million over three years, including $2.25 million in Budget 2022, to establish and operate the AHS Tobacco and Vaping Reduction Act Enforcement Team. As of March 31, 2023, over $2.4 million has been spent, and the team has conducted retail inspections, established a secret shopper program and a public complaint line, and created retailer resources (handbook and signage) that will improve compliance with the Act and regulation. The most current data (from the 2021-22 fiscal year) shows the enforcement team conducted 2,400 retail inspections and provided over 4,000 copies of the retailer handbook and signs to retailers. In 2022-23, Alberta Health established the Alberta Ukrainian Evacuees Health Benefit Program. The total cost of the program was $9.5 million, including physician services. As of March 31, 2023, 24,000 Ukrainians have applied for health coverage in Alberta. In addition, the ministry established a health benefit program that provided Ukrainian evacuees with access to supplemental coverage for prescription and non-prescription drugs, nutritional products, diabetic supplies, and dental, optical and emergency ambulance services. Work continues in partnership with the ministries of Agriculture and Irrigation and Environment and Protected Areas on a One Health approach to antimicrobial resistance (AMR) in the province. This work is critical to address the emerging threat of treatment-resistant microbes in human and animal populations and in the environment. An Antimicrobial Strategic Framework for Action and Implementation plan continues to be developed to help guide collective efforts to address the growing threat of AMR in Alberta. Stakeholders and partners were consulted and supported development of the framework. In 2022-23, the Office of One Health at the University of Calgary was contracted at a cost of $200,000 to support implementation of AMR priority areas for action. As part of the contract, an advisory group on stewardship was created to provide guidance on specific activities, measures, targets, and costs for implementation. Alberta Health worked with AHS, Alberta Environment and Protected Areas, and the Alberta Lake Management Society to quickly set up a water quality (fecal contamination and cyanobacterial blooms) monitoring program for four sites on Lac Ste. Anne to support the 2022 papal visit and annual Lac Ste. Anne pilgrimage. Data from this monitoring program provided the basis for issuance of a cyanobacterial bloom public health advisory for Lac Ste. Anne shortly before the event. Alberta Health regularly assesses the evidence on water fluoridation to help support municipal councils to make evidence-informed decisions regarding community water fluoridation. The ministry worked on updating community water fluoridation position statement with new relevant research, including new local data from Calgary. Alberta Health continues to provide transparent information about environmental public health data, while simultaneously providing risk communication materials to influence modifiable risk factors within the Alberta population. Examples of public health data and information available through the Open Government Portal include: • Routine chemistry and trace element data from domestic well water samples analyzed in 2016–17 and 2017–18 are available. Alberta Health funded routine chemistry and trace elements analysis of 4,842 samples of drinking water from private water wells and 307 samples from small, public, non-municipal drinking water systems. As well, data related to the study of two stormwater ponds in Lacombe, Alberta were released to the open government portal at https://open.alberta.ca/opendata/lacombe-stormwater-ponddataset. This data includes the analysis of contaminants (e.g., mercury, polycyclic aromatic hydrocarbons, trace metals, pesticides and volatile organic compounds) in fish, sediments, and water. • The Alberta Environmental Public Health Information Network, accessible at http://aephin.alberta.ca, supports awareness and provides opportunities for Albertans, academics, and cross-government partners to learn more about environmental hazards and public health in the province. In 2022-23, new visualizations were published for “Human Biomonitoring of Environmental Chemicals in Canada and the Prairies” and a “Search Interface for Environmental Site Assessment Repository”, along with enhancements including the incorporation of new, yearly data on the recreational water bodies and the impacts of poor air quality and heat. In addition, Alberta Health developed the Extreme Heat website and notification protocol at https://www.alberta.ca/extreme-heat.aspx. • Alberta Health continued to provide real-time information to Albertans about hazards and risks associated with recreational water quality at Alberta beaches and waterbodies. In 2022, over 2,300 samples were collected from 85 recreational sites to identify fecal contamination and 436 samples were collected from 50 lakes, reservoirs, and rivers to be assessed for cyanobacterial (blue green algal) blooms and microcystin toxin. This monitoring resulted in the issuing of 47 cyanobacterial bloom advisories and nine fecal contamination advisories to protect the health of Albertans and visitors to the province. Additionally, in May 2022, Alberta Health updated the Alberta Safe Beach Protocol available at https://open.alberta.ca/publications/9781460145395 to reflect new Health Canada Guidelines for cyanobacterial blooms in recreational water. In February 2023, Alberta Health released a position statement around use of stormwater ponds at https://open.alberta.ca/publications/stormwater-ponds-in-alberta-health-guidanceinformation-sheet. • Alberta Health, as part of the Scientific Working Group on Contaminated Sites in Alberta, has published a Site-Specific Risk Assessment guidance document to clarify the specific requirements of conducting a site-specific risk assessment in Alberta, available at: https://open.alberta.ca/publications/supplemental-guidance-on-site-specific-riskassessments-in-alberta. Alberta Health and the Alberta Centre for Toxicology at the University of Calgary have published the report and dataset of “Post-Horse River Wildfire Surface Water Quality Monitoring Using the Water Cytotoxicity Test” available at https://prism.ucalgary.ca/handle/1880/115412. 3.5 Improve access for underserved populations and for First Nations, Métis, and Inuit peoples to quality health services that support improved health outcomes. The most current result available from Statistics Canada’s Canadian Community Health Survey shows that in 2021, 87.3 per cent of Albertans had access to a regular health provider, an improvement from 85.3 per cent in 2020. Having a regular health care provider is important for early screening, prevention through health and wellness advice, diagnosis, and treatment of a health issue, as well as ensuring good continuity of care and connections to other health and social services. The desired result is to increase the percentage of Albertans who have access to a regular health care provider. Increasing access to a regular health care provider is consistent with progress towards the following provincial primary health care goals: • timely access to appropriate primary care services delivered by a regular health care provider or team; • coordinated, seamless delivery of primary care services through a patient’s ‘medical home’ and integration of primary care with other levels of the health care system; • efficient delivery of high-quality, evidence-informed primary care services; and, • involvement of Albertans as active partners in their own health and wellness. Alberta’s Primary Care Networks are involved in a variety of initiatives that support provincial and health zone primary care goals, including adopting a ‘medical home’ approach in their practices. This approach strengthens the connection between a patient and regular health care provider to improve access to care, chronic disease prevention and management, continuity of care, and innovations in primary health care including telemedicine and virtual care. The Government of Alberta is committed to addressing the health needs of First Nations, Métis and Inuit peoples residing in Alberta, including working with First Nations and Métis leaders, the Government of Canada and other partners to streamline how Indigenous peoples access health services, and ensuring that health services are more culturally appropriate. There is a significant gap in equitable access to primary health care for Indigenous peoples. This is evidenced by noting that in Alberta, Indigenous peoples’ life expectancy is 16.4 years below that of all other Albertans, falling below 64 years of age. An Indigenous Primary Health Care Advisory Panel was established in the fall of 2022 under MAPS to provide advice to the Minister on how the existing primary health care system could be improved to ensure First Nation, Métis, and Inuit peoples have access to high-quality, culturally safe primary health care no matter where they live. As part of their work, the Indigenous Panel convened an Indigenous Youth Innovation Forum, Indigenous Primary Health Care Innovation Forum, and participated in the MAPS Forum and Community Care Innovation Forum. These forums, along with engagements with First Nations, the Metis Settlements General Council, the Métis Nation of Alberta, and others ensured that a broad range of perspectives informed the Indigenous Panel’s work. As part of their deliberations, the Indigenous Panel submitted recommendations to the Minister in December 2022 for early opportunities for investment in enhancing Indigenous primary health care. These recommendations were approved in principle by the Minister as a first step to improving access to more culturally safe and integrated care. In 2022-23, Alberta Health provided $8.8 million to the Indigenous Wellness Program Alternative Relationship Plan to support 24 full-time equivalent physician positions to provide care in over 20 Indigenous health care centres throughout Alberta, including the Alberta Indigenous Virtual Care Clinic. Alberta Health has a separate Alternative Relationship Plan arrangement with Siksika Nation, and provides up to $1.1 million to support three full-time equivalent physician positions to provide care in the community. Alberta Health continues to engage Indigenous health care experts through the First Nations Health Advisory Panel and a Metis Settlements Health Advisory Panel. Panel members include Health Directors from across the province, as well as other associated stakeholders. The Panels inform health priorities and strategies and assist in identifying issues or gaps in programs and services, as well as working to identify potential solutions and areas of future collaboration. Alberta Health also continued work on Alberta’s Protocol Agreement Health Sub-Tables to collaborate on addressing the health gaps identified by the members of the Blackfoot Confederacy and the Stoney Nakoda Tsuut’ina Tribal Council. Alberta Health similarly worked with the Métis Nation of Alberta under their Framework Agreement with the Government of Alberta. Alberta upholds the Jordan’s Principle commitments by working with the Government of Canada and the First Nations Health Consortium, an Alberta-wide organization developed to improve access to health, social, and education services and supports to First Nations and Inuit children throughout the province, living both on and off reserve. To ensure compliance, Alberta Health established an Executive Leadership Group (including the ministries of Children’s Services, Seniors, Community and Social Services, Alberta Education, Indigenous Relations, and Alberta Health) to implement Jordan’s Principle in Alberta and to ensure that First Nations children have access to health, social, and educational resources when required, without denial or delay related to jurisdictional dispute over payment. Alberta Health has also established a Technical Cross-Jurisdictional Working Group to address barriers impacting access to programs and services. The working group includes the First Nations Health Consortium, the First Nations Inuit Health Branch, and the Ministries of Children Services, Seniors, Community and Social Services, Education, and Indigenous Relations. On October 24, 2022, government appointed a Parliamentary Secretary for Rural Health, to work with Alberta Health to address rural health challenges, such as access and health care professionals. Budget 2022 introduced a new Rural Capacity Investment Fund, as part of the provincial agreement that impacted more than 30,000 registered nurses and registered psychiatric nurses across the province. The fund supports recruitment and retention strategies in rural and remote areas of the province, including relocation assistance. Almost $4.4 million was spent in 2022-23 to assist nearly 200 employees who chose to relocate to rural Alberta and pay out retention payments to over 8,200 rural health professionals. The benefit to rural Albertans will be realized by improved staff retention rates and fewer vacancies. The Government of Alberta recognizes the importance of rural health facilities and that these health centres provide an essential role for local residents. AHS and Alberta Health have established Zone Health Care Plans based on a framework that guides the development of comprehensive, zone-wide strategic health service plans, including services for Indigenous peoples. These long-range plans address the needs of rural communities with a continued focus on appropriate quality of care, patient safety, and access to services. Conditional approval was provided to seven proponents under the Continuing Care Capital Program–Indigenous Stream in June 2022. The Modernization Stream was launched in September 2022. In 2022-23, the Government of Alberta provided approximately $7 million to the Rural Health Professions Action Plan to attract and retain rural physicians with the appropriate skills to meet the needs of rural Albertans. The program supported physician locums to maintain services when rural physicians need time away from their practice; offered continuing medical education; provided accommodations for 785 rural learners for rural placements so that they can train and choose to practice in rural communities; and, created welcoming environments though 50 attraction and retention committees so that rural communities can attract and retain health professionals. In 2022, the Government of Alberta announced the Rural Education Supplement and Integrated Doctor Experience (RESIDE) program, which allocated $8 million over three years to provide incentives to new family physicians who agree to practice in rural and remote communities in exchange for a multi-year service agreement. The program will help address challenges in patient access to health services in rural and remote areas. Since the start of the program, Alberta Health has approved several changes to the RESIDE program to better meet the needs of physicians and communities and help ensure the program successfully incentivizes more physicians to move to communities of need. As of March 31, 2023, seven physicians had signed return of service agreements in rural communities. The Provincial Primary Care Network Committee provided the Minister with a recommendations report on supporting recruitment and retention of primary care physicians, nurse practitioners, and physician assistants in rural communities. In May 2022, the Minister accepted the seven recommendations that address broader systemic aspects of rural health service challenges, and this report will inform further work within Alberta Health. In July 2022, government announced new funding of $45 million over three years to increase access to pediatric rehabilitation services and programs such as speech-language, as well as occupational and physical therapy for children and youth. A community pediatric services model was developed by AHS to address gaps with implementation of enhanced pediatric rehabilitation supports, including universal and targeted resources and programs and expanded eligibility for specified services. Service delivery is enhanced with clear intake, access and triage to services and strengthened teams to support care. Pediatric rehabilitation professionals work with families and alongside other health care professionals to help children and youth live well, build resiliency and take part in activities meaningful to them and their families. A multi-pronged workforce recruitment, retention, and optimization approach is enabling implementation despite the ongoing challenges with recruitment of health professionals across programs and jurisdictions. Alberta Health Services Provincial Rural Palliative Care In-Home Funding Program provides special, funding that can be accessed by rural palliative clients and families when they require additional support beyond existing services at end-of-life to remain at home instead of being admitted to hospital. Between April 1, 2022 and March 31, 2023, a total of 143 clients were served by the program. Of the clients who have died while accessing the program, 80 per cent were able to pass away in the comfort of their own home. ","You must respond to the prompt using only the information provided in the context block.Here is the question you are to answer: How does the Government of Alberta's Ministry of Health plan to meet the three outcomes identified in their 2022-2023 Annual Health Report? Outcome One: An effective, accessible and coordinated health care system built around the needs of individuals, families, caregivers and communities, and supported by competent, accountable health professionals and secure digital information systems Key Objectives 1.1 Increase health system capacity and reduce wait times, particularly for publicly funded surgical procedures and diagnostic MRI and CT scans, emergency medical services, and intensive care units. As the province emerges from the pandemic, Alberta Health continues to prioritize health system capacity, including building surgical and Intensive Care Unit (ICU) capacity, as well as the health workforce. Several initiatives are underway to minimize disruptions to patient care and expand the capacity of Alberta’s publicly funded health care system permanently. This also includes preparing to respond more effectively to any future health crises and reducing wait times across the health care system. A resilient, sustainable health system will allow the system to operate at full capacity for longer periods before needing to adjust health care resources. The policy has overall goals of improving access to scheduled health services, improving wait time measurement and reporting, and ensuring timely communication for patients. In November 2022, Alberta released the Health Care Action Plan (HCAP). The HCAP identifies immediate government actions to build a better health care system for Albertans. In order to meet the growing demands of Alberta’s health care system, an Official Administrator was appointed to Alberta Health Services (AHS) to provide leadership to address the four goals of the HCAP: • decrease emergency department wait times; • improve emergency medical services response times; • reduce wait times for surgeries; and, • empower frontline workers to deliver health care. Since 2019, government has been committed to increasing surgical capacity to keep pace with demand and reduce the length of time Albertans are waiting for scheduled surgeries. Efforts are geared towards improving patient navigation of the health care system through enhanced care coordination and surgical pathways and resources; improving specialist advice and collaboration with family physicians before consultation; and, centralizing referrals for distribution to the most appropriate surgeon with a shorter wait list. Through the Alberta Surgical Initiative (ASI), Alberta Health continues to work with AHS to improve and standardize the entire surgical journey through: • prioritizing surgeries and allocating operating room time according to the greatest need; • streamlining referrals from primary care to specialists; • increasing surgeries at underutilized operating rooms, mainly in rural areas; and, • providing less complex surgeries through accredited chartered surgical facilities (CSFs) to provide publicly funded insured services and extend existing capacity in hospitals. Through these dedicated efforts, the total number of surgeries completed in 2022-23 was 292,500, which is over 13,900 more surgeries than the year before. Further, approximately 22,100 cancer surgeries were completed in 2022-23, which represents a 10 per cent increase compared to the pre-pandemic amount. Nearly 65 per cent of the cancer surgeries were completed within clinically recommended wait times. By the end of 2022-23, AHS had cleared all postponed surgeries due to COVID-19, and continues to work on reducing wait times. The main focus remains on those patients that are waiting the longest out of clinically recommended targets, and the most acute cases. As of March 31, 2023, AHS reduced the adult surgical waitlist by more than 7,000 patients, and the total number of cases on the adult surgical waitlist is 67,186 which is less than before the pandemic. In 2022-23, there were 38 existing CSFs and three new CSF contracts were implemented to expand publicly funded surgical capacity in these facilities. CSFs are an extension of existing capacity in hospitals and used in many other Canadian health systems. Under the Health Facilities Act, CSFs providing publicly funded insured services must be accredited by the College of Physicians and Surgeons of Alberta, and have a signed service contract with AHS. In 2022-23, accredited CSFs in Alberta provided approximately 47,400 surgeries, which is equivalent to 16.2 per cent of publicly funded scheduled surgeries. In Alberta and other provinces, wait times for three common surgical procedures (hip replacement, knee replacement and cataract surgeries) continue to be impacted by delays due to the COVID-19 pandemic and workforce shortages. The 2022-23 results for hip, knee and cataract surgical procedures showed a decline, meaning that fewer Albertans received these surgical procedures within national benchmark wait times when compared to 2021-22 results. The chart below shows quarterly trends for the three common surgical procedures completed within national benchmarks in 2022-23. There were improvements in the number of cases completed for hip and knee replacements over the course of 2022-23, showing increases of 13 per cent and 15 per cent (respectively), and demonstrating significant improvements with the appointment of the Official Administrator and the implementation of the HCAP in November 2022. While the quarterly results for cataract surgery declined in the second quarter, the number has stabilized in the third quarter since the implementation of HCAP and is beginning an upward trend in the fourth quarter, although it is slightly below the first quarter result. Since 2019-20, there has been a 20 per cent improvement in cases completed within national benchmarks for cataract surgeries, ranking Alberta as a top performer nationally. As part of ASI, Alberta Health has worked with AHS to implement additional measures aimed at improving access and wait times for surgery. Work is ongoing to increase the use of Rapid Access Clinics to reduce wait times for the assessment of orthopedic issues, reducing unnecessary consultations and decreasing wait times for consultations. The Facilitated Access to Specialized Treatment (FAST) program accelerates implementation of central intake for orthopedic and urology surgery to allow patients to see the first available surgeon. Work has begun on the implementation of the Electronic Referral System (ERS), which will expedite referrals for Albertans requiring assessment by surgical specialists. In addition, consultants have been contracted to enhance surgical capacity by improving inpatient surgeries scheduling, monitoring operating room capacity, and reducing patient flow variation. With the added capacity of additional CSFs offering surgeries and implementation of FAST and ERS, Albertans will experience a streamlined surgical journey from referral to consultation to surgery. More Albertans will get their surgery within the clinically recommended wait time targets, thereby reducing the amount of time they must live with pain and other inconveniences. Reducing wait times for medically necessary diagnostic tests is also a top priority for government. Each year, Alberta spends about $1 billion on diagnostic imaging, which includes ultrasounds, Xrays, mammography, MRI and CT scans. About 46 per cent of the $1 billion is allocated to AHS, while 54 per cent is allocated to community diagnostic imaging providers. Approximately one-third of all CT and MRI scans are emergency scans and are completed within clinically appropriate timelines (under 24 hours). In 2022-23, a total of 520,504 CT scans and 231,030 MRI scans were completed across the province. The wait time for both types of scans increased due to a sharp increase in demand and staffing issues. Alberta Health and AHS continue to implement the Diagnostic Imaging Action Plan developed in 2019 to facilitate timely access to CT and MRI scans. As part of the plan, there is a significant focus on triaging patients to ensure that those who need urgent scans can get one as soon as possible. In addition, the Clinical Decision Support (CDS) within Connect Care aims to improve appropriateness of referrals and triage decisions. AHS has reached a five-year agreement with radiologist groups in Edmonton and Calgary to reduce wait times, and signed a memorandum of understanding with the remaining three largest radiology providers in Alberta North, Central, and South Zones. In total, 83 per cent of provincial radiologists have signed agreements with AHS. As part of the HCAP, the Government of Alberta is working with AHS to improve emergency medical services (EMS) response times. Improved ambulance times means that Albertans are receiving the urgent care they need from highly skilled paramedics more quickly. The Alberta Emergency Medical Services Provincial Advisory Committee (AEPAC) was established and tasked with providing immediate and long-term recommendations that will better support staff and ensure a strengthened and sustainable EMS system for Albertans needing services now and into the future. AEPAC focused on the issues facing EMS, such as system pressures that may cause service gaps, staffing issues, and hours of work. This included issues related to ground ambulance, air ambulance, and dispatch. Furthermore, Alberta conducted an independent review of EMS dispatch (the Dispatch Review) to inform improvements that can be made to dispatch services overall. The Dispatch Review and full report from AEPAC were submitted to the Minister of Health in the fall of 2022 and released to the public in January 2023. The Government of Alberta accepted the final AEPAC report and Dispatch Review recommendations in full. The recommendations were focused on accountability, capacity, efficiencies, operations, performance, and workforce support. Adjustments are being made to improve EMS response times and get paramedics out of hospital waiting rooms and back into their communities. Implementation of recommendations on a priority basis has supported ongoing reduction in EMS response times and red alerts, and improvements in community coverage. In 2022-23, Alberta Health initiated several actions to address these recommendations and strengthen the EMS system across the province. Examples of projects include: • Implemented measures to improve the central dispatch system to better deal with lowacuity calls and prioritize emergent/urgent 911 calls for EMS and made workforcescheduling changes as part of the Fatigue Management Strategy. • Initiated pilot projects using an integrated Fire-EMS model to maximize the use of paramedics and increase ambulance capacity to the health care system. Examples of the projects included: using inbound EMS resources only when they are clinically required; staffing spare ambulances to support the EMS system during times of stress; and, expanding single member advanced care paramedic response units that provide immediate advanced life support care in anticipation of, or in the absence of, an available ambulance. • Introduced new provincial guidelines, including a 45-minute EMS emergency department (ED) wait time target for 911, to get ambulances back on the road more quickly. The new provincial guidelines enable fast-tracking ambulance transfers at EDs by moving less urgent patients to hospital waiting areas. • Put procedures in place to contract appropriately trained resources for non-emergency transfers between facilities in Calgary and Edmonton, freeing up paramedics. Instead of using highly trained paramedics for non-medical patient transfers to patients’ homes from a facility or acute care, alternative resources are now arranged by hospitals, also freeing up paramedics. • Granted an exemption to the minimum staffing requirements defined in the Ground Ambulance Regulation, significantly expanding the instances where an emergency medical responder can meet the staffing requirements for all classes of ambulance, to alleviate staffing challenges across the province. • Empowered paramedics to assess a patient's condition at the scene to decide if they need ambulance transport to the hospital. In 2022-23, a total of $590 million was spent on EMS. Capacity increases were laid out in the AHS’ EMS 10-Point Plan and recommendations by AEPAC, including increases in paramedic workforce and adding ambulances to the system. As of March 31, 2023, there are 8,417 regulated members in the province registered with the Alberta College of Paramedics, including 1,383 emergency medical responders, 4,050 primary care paramedics, and 2,984 advanced care paramedics. AHS added 19 new ambulances in Calgary and Edmonton and more ambulance coverage in Chestermere and Okotoks, and hired 457 new staff members, including 341 paramedics. Increased capacity helps reduce EMS response times and red alerts and improves working conditions for frontline practitioners and community coverage, especially for life-threatening conditions. Measures to address staffing issues include AHS’ Fatigue Management Strategy, a recruitment campaign aimed at other provinces and Australia, development of a Provincial Service Plan, and interim AEPAC recommendations brought forward in June 2022, granting an exemption to expand use of emergency medical responders and pilot projects to give greater autonomy to ambulance operators using an integrated fire-EMS model. In addition, keeping paramedics out of hospital waiting rooms and in communities has contributed to decreased EMS response times and red alerts, improved community coverage, and quicker access to EMS. The HCAP 90-day Report released in February 2023 (https://www.albertahealthservices.ca/assets/about/aop/ahs-aop-90-report.pdf ) shows an early reduction in response times and red alerts, and greater focus on urgent/emergent 911 calls through low-acuity diversion measures and non-clinical patient transport programs across Alberta, particularly in Calgary and Edmonton. Comparing November 2022 to March 2023, EMS response time for the most urgent calls in metro and urban areas was reduced from 21.8 minutes to 15 minutes. Improving access to EMS enables timely patient care and entry into the health care system. The government also launched the EMS/811 Shared Response program to ensure patients receive the level of care they need and reduce unnecessary ambulance responses. Calls that have been assessed as not experiencing a medical emergency that requires an ambulance are transferred to Health Link 811, where registered nurses provide further triage, assessment and care. Since the launch in January 2023, more than 2000 911-callers with non-urgent conditions were transferred and helped by Health Link 811, keeping more ambulances available for emergency calls. In October 2022, government appointed a Parliamentary Secretary of EMS Reform to work with health partners to set priorities for service improvement based on AEPAC and Dispatch Review report recommendations. Remaining AEPAC and Dispatch Review recommendations have been incorporated into the AHS Operations Plan and are being prioritized and monitored by the EMS Reform Parliamentary Secretary. There are almost two million visits to Alberta EDs every year. Alberta Health together with AHS is working to improve patient flow within the health system, in particular to reduce ED wait times. AHS is committed to improving the experience of patients and families from the time they seek emergency care until the time the patient is discharged or admitted. There are 780 more staff in EDs today than in December 2018. AHS is working diligently on several initiatives to improve access to emergency care including improving access to continuing care living options, expanding hospital capacity, and implementing initiatives in hospitals to streamline patient treatment and discharge. In 2022-23, alternate level of care days were reduced by enhancing social work supports in acute care to address barriers for discharge. This included adding a fast-track area at the Alberta Children’s Hospital in Calgary, and deploying additional units of EMS mobile Integrated Health Units in Calgary and Edmonton to provide care for unscheduled needs within the community (i.e., IV antibiotics, rehydration, and transfusions at home). In January 2023, the Bridge Healing Transitional Accommodation Program was launched in Edmonton to support transitioning of patients experiencing homelessness as they are discharged from emergency departments. The initiative aims to reduce hospital readmission rates for Albertans experiencing homelessness by providing wrap-around health and social services. This program provides 36 beds to support this vulnerable population. Over the next three years, $305 million will be provided for additional health care capacity on a permanent basis under the HCAP. This includes approximately $268.6 million in operating funds and $36.4 million for capital projects to increase ICU capacity on a permanent basis. Approximately $61 million was spent in 2022-23 to create 50 permanent new fully equipped and staffed adult ICU beds across the province, which brings the number of ICU beds up to 223 from 173 before the pandemic. The pandemic has shown that more permanent capacity and staff are needed, particularly in rural and remote areas. The ministry continues to address ICU staffing shortages across health care facilities in Alberta. As vacancies are filled, ICU beds are reopened. Temporary bed closures are implemented only as a last resort, and patients continue to receive safe, high-quality care. AHS filled 392 positions, as of the end of fiscal year 2022-23, to support the new beds. These positions included nurses, allied health professionals, pharmacists, and clinical support service positions for diagnostic imaging and service workers. The latest data available at the end of fiscal year 2022-23 indicated that the provincial ICU baseline occupancy rate was 82 per cent, a 29 per cent improvement from being at over capacity (115 per cent) in 2021-22. Increasing ICU capacity ensures that Albertans receive care when they need it most. However, unplanned temporary service disruptions, including bed reductions, are not unusual in any health system, as services and beds are managed based on patient need, staffing levels, acuity of patient health, and other factors. Government works to ensure patients continue to receive safe, high-quality care. Occasionally, however, temporary bed closures are implemented as a last resort. Government is committed to ensuring that any Albertan who needs acute care will receive it. Workforce challenges remain a significant barrier to improving wait times for surgery given the high demand for anesthesiologists in Canada and international jurisdictions. Alberta Health is reviewing and developing options to support continued implementation of the Anesthesia Care Team Model in AHS and CSFs. The implementation of the Anesthesia Care Team Model aims to use anesthesiologists more resourcefully for some ophthalmology and orthopedic surgeries by employing a multidisciplinary team that works under supervision of the anesthesiologist to support anesthesia services in the operating room. Recruitment efforts are underway through AHS to attract more anesthesiologists to Alberta, including in rural areas. In March 2023, government released MAPS Strategy, which sets out a framework for supporting the province’s current health care workers and building the future workforce that can support Albertans getting the health care they need when and where they need it. Alberta has various initiatives underway to attract and retain nurses and increase system capacity. Alberta Health worked with the College of Registered Nurses of Alberta to streamline registration processes for Internationally Educated Nurses (IEN) and developed a grant agreement with the Alberta Association of Nurses for nurse navigators to support IENs going through the assessment, education, and registration processes. Announced in September 2022, the Modernizing Alberta’s Primary Health Care System (MAPS) initiative formed three panels to provide advice to the Minister on ways to improve the primary health care system, thereby improving the overall efficiency of the health care system. On February 21, 2023, the Minister announced an investment into primary health care of $243 million over three years; of this, $125 million is allocated for MAPS recommendations. In addition, the Minister accepted, in principle, early opportunities for investment that could be implemented to enhance Albertans’ access to primary health care immediately. On March 31, 2023, the MAPS Strategic Advisory Panel and Indigenous Primary Health Care Advisory Panel submitted parallel final reports to the Minister, outlining transformative strategic roadmaps for the next 10 years of primary health care in Alberta. These reports address both Indigenous access to primary health care and advice on improving primary health care for all Albertans. The intent of the MAPS initiative will be to reorient the health system around primary health care, thereby improving patient outcomes and reducing costs and decreasing pressures on the acute care system in the long-term. Partnerships and collaboration between primary care providers and specialists will improve patient wait times and health outcomes. The ASI Care Pathways and Specialty Advice, which includes the Provincial Pathways Unit and provincially aligned non-urgent telephone advice service programs, support consistency and quality to ensure continuity of care across the patient journey. The Provincial Primary Care Network provided these projects with conditional endorsement to begin transition to operational shared service programs. Primary Care Networks (PCNs) are also working with other stakeholders on the ASI to improve primary care and specialist linkages and patient navigation of the health care system by building and leveraging PCN specialist linkage programs. Some initiatives include Strong Partnerships and Transitions of Care for the Central Zone; Patient’s Medical Home, including referral navigators; Specialist LINK Tool for the Calgary Zone; Connect MD for the Edmonton and North Zones; FAST General Surgery for the Edmonton Zone; and, Specialist Integration Task Group for the Calgary Zone. Modernize Alberta’s continuing care system, based on Alberta’s facility‐based continuing care and palliative and end‐of‐life care reviews, to improve continuing care services for Albertans living with disabilities and chronic conditions (including people living with dementia). Government continues to be committed to addressing gaps in the continuing care system, and meeting the needs of Albertans by implementing transformative changes within the system. Alberta Health worked with partners to develop a new legislative framework for the continuing care system. The Continuing Care Act (Act), which received Royal Assent on May 31, 2022, will increase clarity regarding services, address gaps and inconsistencies across services and settings, enable improved service delivery for Albertans, and support health system accountability and sustainability. Multiple pieces of legislation will be consolidated into the Act, which establishes clear and consistent oversight and authority over the delivery of continuing care services and settings. The new legislation was proclaimed to be in effect April 1, 2024, except for sections regarding administrative penalties, which will be proclaimed on April 1, 2025. Implementation of the legislative framework will better support Albertans transitioning between care types and settings, including home and community care, supportive living accommodations, and continuing care homes. The continuing care system in Alberta provides a range of services for health, personal care, and housing to ensure the safety, independence, and quality of life for people in Alberta, regardless of age, based on their evaluated need for continuing care assistance. Publicly funded care options include home and community care; continuing care homes, which includes Designated Supportive Living and Long-Term Care; and, Palliative and End-of-Life Care services (PEOLC). In addition, Albertans have the option to access housing support in supportive living settings, such as lodges, group homes, and seniors' complexes. In 2022-23, 871 new continuing care beds/spaces were created at AHS-operated or contracted facilities to meet Albertans’ needs. The government continues to be committed to expanding the number of available continuing care spaces throughout the province and enhancing the continuing care system to effectively meet the needs of Albertans by incorporating recommendations from the Facility-Based Continuing Care (FBCC) Review Final Report, which was released on May 31, 2021. Alberta Health has acted on several recommendations from the FBCC review, including the introduction of self-managed care as a way to provide greater choice regarding locations, types and providers of services. Further, Alberta Health has enhanced client choice by supporting more continuing care clients in the community rather than at FBCC sites. Alberta Health worked with Alberta Blue Cross and AHS to successfully implement the ClientDirected Home Care Invoicing model. This model was implemented in the Edmonton Zone in April 2022, and in the Calgary Zone in the fall of 2022. Expansion to rural areas of the province will move forward over the course of 2023 to provide Albertans with increased choice and flexibility in selecting their home care service provider and the ability to better direct how their care is provided. In June 2022, Alberta Health worked with AHS to initiate a Request for Expression of Interest and Qualification (RFEOIQ) procurement process to explore opportunities to optimize the provision of home care services in Alberta, as well as identify innovative service delivery solutions to support specialized needs and populations. Albertans will begin to see the outcomes and impacts of the RFEOIQ process during fiscal year 2023-24, as the successful proposals are implemented. Another recommendation from the FBCC report was to streamline inspections. Transition of continuing care facility audits from AHS to Alberta Health began in March 2022. A coordinated monitoring approach has reduced duplications of both reviews and site visits. In 2022-23, over 1,100 inspections were completed on accommodation and care in continuing care facilities across the province. Alberta Health also followed up on over 940 reportable incidents of resident safety or care concerns and conducted 103 complaint investigations. These activities continue to provide assurance that residents and clients are receiving safe and quality care and services. Budget 2022 allocated $204 million in capital grant funding over three years to expand capacity for continuing care. The inaugural Indigenous Stream was launched in 2021 to support continuing care facilities on and off reserves/settlements. As of June 2022, seven projects were approved for $67 million to develop 147 continuing care spaces. The inaugural Modernization Stream was launched on September 20, 2022, and concluded on January 6, 2023. This stream focused on refurbishing and/or replacing existing aging continuing care infrastructure at non-AHS owned facilities. The Government of Alberta continues to prioritize quality PEOLC by investing $20 million in over 30 projects since 2019. Progress to date on projects commenced in 2020 include: • Covenant Health continued to work to increase general awareness of PEOLC, increase uptake of advance care planning and develop standardized, competency-based education to support the provision of high-quality PEOLC. • In October 2022, Covenant Health’s Palliative Institute launched the Compassionate Alberta website, (compassionatealberta.ca) which is a resource aimed at increasing awareness around palliative care and to help Albertans have open and honest conversations about death. • Between April 2022 and March 2023, the Alberta Hospice Palliative Care Association successfully launched two programs that addresses the needs of caregivers and those with a life-limiting illness (the Living Every Season Program) as well as grief and bereavement needs for Albertans (the You’re Not Alone Grief Connection Program). In November 2021, Alberta Health released the PEOLC call for grant proposals. The grant program focused on projects that address the four PEOLC priority areas identified in the Advancing Palliative and End‐of‐Life Care in Alberta Report. As a result of this grant call, a total of 25 new PEOLC grants were initiated in April 2022, totaling $11.3 million. The funding and project breakdown is as follows: • Nearly $4.2 million for eight projects to expand community supports and services. • More than $4.1 million for 10 projects to improve health-care provider and caregiver education and training. • More than $1.9 million to support four projects that advance earlier access to palliative and end-of-life care. • More than $1.1 million for three projects for research and innovation. In June 2022, the Pilgrims Hospice Society completed a one-year, grant-funded project that supported care navigation services, which provided Albertans with information on residential support programming and provided staff training on hospice care. Pilgrims Hospice Society also received $2.5 million in October 2022 to support residential hospice care at the Roozen Family Hospice Centre in Edmonton. This demonstration project will provide important information on the standalone hospice model used at the centre, including usage data and service quality, to identify longer-term options for funding and expanding residential hospice services in Alberta. Government continued to invest in supporting the nearly one million Albertans who are caregivers for family and friends. This included approximately $2 million in grant funding since 2022 to Caregivers Alberta to enhance their programs and services; to Norquest College for the Skills Training for caregivers with a focus on rural areas; to the University of Alberta to reduce caregiver distress and support family and friend caregivers to maintain their health and well-being; and, to the Alzheimer Society of Alberta and the Northwest Territories to focus on delivering communitybased programming for persons living with dementia and their caregivers. In 2022-23, the Government of Alberta continued to support innovations in dementia care through the Community-based Innovations for Dementia Care initiative, which supported 15 communitylevel projects, and through multiple projects delivered by the Alzheimer Society of Alberta and the Northwest Territories: • The Alberta Employers Dementia Awareness Project identified the needs of employers to develop best practices to create inclusive workplaces. This included piloting and launch of the Dementia Alberta website (https://www.dementiaalberta.ca) to ensure dementia in the workplace awareness materials are available to Alberta employers. The project also helps to ensure that employers have access to materials describing the importance of brain health and dementia risk reductions, and that employers have access to sample guidance, facts, tips and scenarios applicable to Alberta employers and employees. • The expansion of the First Link® early intervention program by enhancing outreach to and in rural communities. During the project, 113 rural communities received outreach and 91 small cities, specialized municipalities, municipal districts, towns, villages or summer villages received outreach services. • The Community Dementia Ambassador Project, which created a program delivered by volunteers (Ambassadors) who live in or are familiar with the cultural and social values of Alberta communities. This project identified 22 Ambassadors from 16 communities, including Cardston, St. Paul and Peace River. Ambassadors reached more than 1,325 Albertans. To support the continuing care sector and its staffing needs, the government is exploring ways to increase the number of students enrolled in Health Care Aide (HCA) programs at various postsecondary institutions. Government is funding an additional 1,090 seats in HCA programs over three years, and invested $12.8 million to provide bursaries for HCA students to assist with education costs and encourage them to become HCAs. The HCA bursary program, administered by NorQuest College, went live July 1, 2022, and included three streams of funding: the Financial Incentive program, the HCA Tuition Bursary program, and the Workplace Tutor program. Under the Financial Incentive program, students who were enrolled in a licensed HCA program between January 1 and June 30, 2022, are eligible for up to $4,000 if they agree to work a minimum of 1,000 hours with an identified continuing care operator within one year of starting employment. Eligible HCA students may receive up to $9,000 through the HCA Tuition Bursary program. The Workplace Tutor program provides funding for identified continuing care operators to educate and train HCAs at their workplace. Demand for the bursaries is steady with over 600 students applying for the regular bursary and approximately 350 HCA students approved to receive the bursary. These bursaries will remove barriers for students, and pay for schooling and other expenses while they are completing their program. From July 2022 to March 31, 2023, government provided $20.6 million to continuing care operators to partially offset inflationary increases to accommodation charges for continuing care residents. This support made accommodation charges more affordable for residents and shielded them from the full cost of living pressures associated with higher-than-average inflation. The government provided $1 million to improve access to non-medical supports in the community. This included initiatives with United Way Calgary and the Edmonton Seniors Coordinating Council to provide more community supports and navigation assistance for clients seeking this help, expanding caregiver supports. In 2022-23, the percentage of medical patients with an unplanned hospital readmission within 30 days of discharge from hospital was 12.8 per cent. This was one per cent lower compared to last year (2021-22). A lower percentage means fewer patients have been readmitted to hospital within one month of discharge. A high rate of readmissions increases costs and may mean the health system is not performing as well as it could be. Although readmission may involve many factors, lower readmission rates show that Albertans are supported by discharge planning and continuity of services after discharge. Rates may also be impacted by the nature of the population served by a hospital facility, such as elderly patients or patients with complex health needs, or by the accessibility of post-discharge health care services in the community. Coordination of care is also improving with increased access to virtual care services and supports as well as recent enhancements to health information systems that enable electronic notification of primary care doctors when their patient is admitted or discharged from hospital. 1.3 Use digital technology to enable new models of care and reduce manual and paperbased processes. Government continues to enhance the digital health environment to provide Albertans with digital access to their health information and give health care providers more complete digital patient information at the point of care to enhance quality of care for Albertans. Collecting health system data helps support evidence-informed decisions to address changing circumstances and to keep Albertans informed. The digital modernization of the health care system involves several key elements. The MyHealth Records (MHR) portal allows Albertans to access their health information. In 2022-23, over $7.9 million was spent on MHR. Alberta Netcare, the province's Electronic Health Record, is available to health care professionals in the community and AHS. In addition, Connect Care, an integrated system with Alberta Netcare, serves as a common platform for clinical information and stores all medical records, prescriptions, and care history collected from AHS facilities, including doctor's notes. Giving Albertans digital access to their health information via the MHR portal reduces the need for them to manually request that information separately from each health provider. Albertans registered on MHR has grown from 1.25 million users in March of 2022 to just under 1.5 million users at the end of March 2023. MHR portal capabilities have been expanded with the addition of immediate release diagnostic imaging reports including CT and MRI scans. The Apple MHR App is now integrated with Apple Health Kit, allowing Albertans to connect health information from their Apple Health App account to MHR. These information technology components facilitate the shift from paper-based processes to digital processes and support the expansion of virtual care options. In 2022-23, new services to support electronic referral as part of the ASI were planned and developed. A data feed is being tested, paving the way for future referral notifications in MHR and in the Electronic Medical Records (EMR) systems of referring providers. Other improvements also included continuity of care services: • Patient data from the Central Patient Attachment Registry is now integrated with Alberta Netcare, enabling health care providers across Alberta to access information on the patient’s medical home, and who their primary provider is. Design work on Alberta’s version of the International Patient Summary is nearing completion and development work will begin shortly with EMR vendors. A patient summary is a collection of clinical and contextual information about a patient’s health details. The Alberta version of the national standard is being coordinated with Ontario and Canada Health Infoway (a not-for profit funded by the Government of Canada) and includes necessary minimum amount of information to inform patient treatment at point of care. Alberta is hoping to have at least one EMR vendor conformed to Alberta’s Patient Summary in 2023, with additional vendors onboarded in 2024. • The Community Information Integration (CII) project improves Albertans’ access to primary care and community health information by collecting patient data from physician offices and other community-based clinics and making it available to other health care providers through Alberta Netcare. Over $6.5 million was spent on CII in 2022-23. In January 2023, there were 1,764 providers live on CII, taken from 430 clinics across 40 PCNs, and nearly 1.2 million Albertans in the Central Patient Attachment Registry database. More than seven million patient encounters and over 500,000 consult reports have been submitted to Netcare as of March 31, 2023. As the province emerges from the pandemic, the expectations of Albertans have shifted and there is a greater reliance on accessing on-demand virtual government services. In alignment with the Government of Alberta Digital Strategy and Alberta Health’s eHealth Strategy, developed in 202122, Alberta Health will modernize digital service delivery, increase productivity, save tax dollars, and improve user experience by better integrating technologies into the delivery of government services. In 2022-23, $5.7 million was spent through the Health Canada Bilateral Agreement for PanCanadian Virtual Care to address secure messaging, secure video-conferencing technology, remote patient monitoring technologies, patient access to COVID-19 and other lab results, and back-end supports for integration of new platforms. This investment supported Alberta Health’s ongoing initiatives foundational to expanding the virtual health care system. Alberta Health has identified four strategic priorities for virtual care delivery in the province, which are reflected in Alberta’s Virtual Care Action Plan: • establishment of an eHealth Strategy that includes a strategy for virtual care; • expansion of the MyHealth Records patient portal capabilities, including expansion of lab results and addition of diagnostic imaging results; • development of secure messaging services for Alberta, including advanced services for twoway integration between community EMRs and Alberta Netcare; and, • development of a privacy and security framework for virtual care. Access to the MHR portal is free at https://myhealth.alberta.ca/myhealthrecords. Currently, Albertans can view parts of their Netcare record, including their medications dispensed through community pharmacies, lab results and immunization history through MHR. In 2022-23, discussions and approval processes for MHR and Alberta Netcare were underway for implementation. This enables Albertans to be active participants in their own health management. The ministry continues to make progress on a phased roll out of Connect Care within all AHS facilities to support digital modernization of the health system. In 2022-23, five of the nine planned launches for this multi-year project had been completed. Connect Care provides a single source of information in AHS to support team-based, integrated care with a focus on the patient and the efficient and effective provision of services. In 2022-23, over $260 million was spent on Connect Care. The total cost of Connect Care when completed is expected to be $1.45 billion. Although progress was slowed by the pandemic, work continues on the remaining four launches of deployment. All launches are expected to be completed by fall 2024 and approximately 145,400 users are expected with full roll out of the program. The application of modern technologies will support the delivery of innovative care models that empower patients, families and their health care teams to improve quality of care. In 2022-23, eight digital health projects were funded at the Universities of Alberta and Calgary for a total investment of $9.6 million from AHS and Alberta Innovates. These academic-clinical collaborations will help AHS identify and advance solutions that improve health care quality, health outcomes, and overall value for Albertans. Projects include the integration of prevention into Connect Care to improve the health of Albertans; digital tools such as clinical decision support and remote monitoring for people with kidney issues to reduce acute care use; tele monitoring to reduce adverse events for hospitalized patients; and, an integrated digital health approach to diabetes with First Nations in Alberta. Digital technology is also being leveraged to modernize critical capabilities to administer the Alberta Health Care Insurance Plan (AHCIP) and support core business, such as claims processing and payment to health care providers. To better meet the needs of Albertans and care providers, work continued on future models of care and emerging digital technology to replace and redesign mainframe systems to increase functionality and reduce maintenance costs. In 2022-23, over $6.5 million was spent on this initiative and the work towards the replacement and redesign of nine applications used to administer the AHCIP is ongoing. 1.4 Ensure processes for resolving patient concerns are effective, streamlined, and consistent across the province. It is important that Albertans are aware of what resources are available to help them resolve patient concerns, and how their valuable feedback can help improve the quality and safety of health services. The Office of the Alberta Health Advocates empowers Albertans to advocate for their health needs; resolves their concerns and refers individuals to programs and services to address their complaints; educates Albertans about the province’s Health Charter; and, provides health selfadvocacy skills and health literacy education to promote early resolution of issues and remove barriers and gaps in care. In February 2023, government appointed a new Health and Mental Health Advocate to be a strong voice for Albertans when it comes to their health care and to ensure the health system operates effectively for all Albertans. From April 1, 2022, to March 31, 2023, there were 2,589 Albertans served by the Office of the Alberta Health Advocates. More specifically, there were 1,565 under the Health Advocate’s jurisdiction, 742 under the Mental Health Advocate’s jurisdiction, and 175 files that were under both jurisdictions. The Office of the Alberta Health Advocates hears the patient perspective on care experiences and provides feedback to entities in the health system through effective partnership and collaboration to encourage system improvement/change and effective legislative development. The ministry is committed to ensuring the patient complaints process is fair, responsive, and accessible and has processes in place to review and respond to feedback from patients and families. Recommendations to improve the current processes for resolving patient concerns and complaints have been developed, informed by consultation and research led by the Health Quality Council of Alberta. These recommendations were approved by government in the summer of 2022; Alberta Health is working on their implementation which is to expand the role and mandate of the Health Advocate; centralize intake, triage, navigation and standardize follow up with Albertans for all patient complaints; and, require mandatory information exchange between stakeholders to support improved public reporting for health care complaints. Once the recommendations are fully implemented, Albertans will have a simplified process to raise concerns and complaints about health care, and the Health Advocate will help them find the appropriate body to review and investigate the complaints. The Health Advocate will help improve accountability by monitoring the status of the resolution processes for completion and closure. Concerns and complaints will continue to be reviewed and investigated by AHS, health professions and other bodies created under statute to hear concerns. Alberta Health continues working with First Nations and Métis health leaders to better understand their experiences with the current complaints management systems in Alberta, involve them in identifying ways to build Indigenous patient trust in the health care they receive, and to ensure their concerns are addressed appropriately. The outcome of this work will improve the current complaints management system by removing existing red tape and making the system easier to navigate for patients and families. Outcome Two: A modernized, safe, person-centred, high quality and resilient health system that provides the most effective care now and in the future for each tax dollar spent Key Objectives 2.1 Continue to implement strategies to bring Alberta’s health spending and health outcomes more in line with comparator provinces and national norms, including implementation of AHS review recommendations and working with the Alberta Medical Association to reach a fiscally sustainable agreement. Albertans want and deserve a health care system that meets their needs, while also understanding the system needs to be sustainable. Government’s focus on ensuring value for money spent on health care supports this vision through actions and initiatives that make the most of taxpayer dollars. Budget 2022 invested $22.5 billion in Health’s operating budget to keep Albertans safe and healthy. In 2022-23, Alberta received $5.8 billion in Government of Canada transfers, of which $5.5 billion was the Canada Health Transfer (CHT). The CHT included a $232 million one-time funding to address surgery backlog resulting from the COVID-19 pandemic. In February 2023, Alberta reached an agreement with the Government of Canada to invest more than $24 billion in Alberta's health care system over the next 10 years through the CHT. This funding aims to respond to the immediate needs of Albertans under the Health Care Action Plan, as well as improve access to family health services, including in rural and remote areas and in underserved communities; foster a resilient and supported health workforce; improve mental health care and addictions services; and, allow Albertans access to their own electronic health information. The ministry continues to closely monitor provincial per capita spending on health care to quantify progress on government’s broader commitment to get the most value for each dollar and improve access, and make the health system work better for Albertans, while managing cost growth in health care. The Government of Alberta continues to collaborate with health system partners to manage the biggest cost drivers in the health system – namely hospital services, labour and physician compensation, and publicly funded drug benefit programs. In 2022-23, the Government of Alberta spent $4.3 billion on hospital services (i.e., acute care), $6.0 billion on physician compensation and development, and $2.5 billion on drugs and supplemental health benefits. The pandemic caused per capita health care spending for all provinces to increase significantly. The national average increased from $4,835 in 2019-20 to $5,628 in 2021-22. The Alberta provincial per capita spending on health care in 2021-22 is estimated to be $5,384, on par with the Canadian average. Improving efficiency and ensuring more value for tax dollars will improve health outcomes and support fiscal sustainability of the health system. The Alberta Health Services (AHS) Performance Review identified opportunities for AHS to reduce costs and improve health outcomes by using resources more efficiently. The ministry will continue to pursue opportunities to align spending with British Columbia, Ontario and Quebec by implementing efficiencies and reducing drug costs through the work of the pan-Canadian Pharmaceutical Alliance. AHS continues to find ways to improve the health system and access to services to Albertans. Actions implemented as a result of the 2019 AHS Performance Review have had substantial impacts on the health care system and savings have been used to improve front-line care and system sustainability (https://open.alberta.ca/publications/alberta-health-services-performance-reviewsummary-report). Implementation of the AHS Review initiatives was concurrent with a global pandemic, labour negotiations and development of a new agreement between the government and the Alberta Medical Association (AMA). Operating expenditures (excluding COVID-19 costs) increased by 6.1 per cent in 2022-23 when compared to 2021-22. Alberta’s population growth and aging population has resulted in increased demand for healthcare services. The overall increase also reflected implementation of the new agreement with the AMA and recent settlements with various health labour unions. Despite these cost pressures, health spending growth is lower than the combined population growth and inflation increase. Protecting and improving the quality of health care in Alberta also requires capital investments. In 2022-23, a total of $841 million was invested in health-related capital projects across the province, including technology and information systems maintenance and renewal of existing facilities. Alberta continues to expand and modernize hospitals and other facilities to protect quality health care and grow system capacity. Investments in health system infrastructure is fundamental to improving efficiency in the health care system, reducing wait-times, providing additional surgical capacity, and to generally improve patient outcomes. Budget 2022 invested $193 million over three years for the redevelopment and expansion of the Red Deer Regional Hospital Centre to increase critical services and add capacity to one of the busiest hospitals in the province. The Red Deer Regional Hospital Centre redevelopment project functional program was completed in late April. The functional program develops and validates the scope of services and projected workload, staffing, and space to meet current and emerging acute health care needs of all residents of the Red Deer Regional Hospital’s catchment area. The functional program also addresses capacity and quality of space to improve patient and staff safety, support quality of care, manage utilization efficiently and sustainably, and ensure timely access to care. When completed this project will expand inpatient capacity from 370 beds to 570 beds and add three surgical suites, plus space to add three more suites when required in the future. There will be a new cardiac catheterization laboratory, a new medical device reprocessing space, expanded ambulatory care capacity, and expansion of many other clinical programs throughout the hospital. In 2022-23, over $133 million was allocated over three years for Alberta Surgical Initiative capital projects at AHS-owned facilities. This includes the renovation of the Medicine Hat Regional Hospital, the Edson Health Centre, and the Royal Alexandra Hospital in Edmonton. Construction also progressed on the University of Alberta Hospital in Edmonton, which will include a postanesthetic recovery unit and medical device reprocessing area when completed, and the Rocky Mountain House Health Centre, which is undergoing renovations for a new procedure room and the development of a new medical device reprocessing area. Design was completed for redevelopment at the Chinook Regional Hospital that will modernize and increase surgical procedure capacity. Other work also included designing 11 operating suites at the Calgary Foothills Medical Centre. As part of Budget 2022, $2.2 billion was allocated over three years to move forward with a number of capital projects, for example: • The University of Alberta Hospital Brain Centre received $50 million over three years for a Neurosciences Intensive Care Unit. The design development report is nearing completion. • Provincial Pharmacy Central Drug Production and Distribution Centre ($49 million over three years). The design development report is complete. • The Norwood Tower at the Gene Zwozdesky Centre ($142 million over two years) received an occupancy permit in March 2023 and was turned over to AHS for operational commissioning. In 2022-23, $116 million was spent to complete the Calgary Cancer Centre. The Calgary Cancer Centre Construction is complete and AHS is preparing the hospital to open in 2024. The hospital will have 160 new inpatient cancer beds, 100 patient exam rooms, 100 chemotherapy chairs, increased space for clinical trials, 12 radiation vaults, outpatient cancer clinics, and designated areas for clinical and operational support services and research laboratories. The completed project will increase cancer care capacity in Calgary by consolidating and expanding existing services to support integrated and comprehensive cancer care. On October 6, 2022, the government executed a four-year agreement with the AMA to address common interests such as quality of care, health care system sustainability, and stability of physician practices. Implementation of the AMA Agreement is underway and includes over $250 million in new spending over four years on initiatives targeted at communities and physician specialties facing recruitment and retention issues. The agreement included concrete solutions and the financial resources to support Albertans’ health care needs by promoting system stability through competitive compensation and providing targeted funding to address pressures that require immediate and longer-term stabilization. The agreement also allows physicians to provide greater input into longer-term approaches on improving patient care and physician compensation reform initiatives. Physicians received a one per cent lump sum COVID-19 recognition payment in 2022-23. Alberta physicians were at the forefront of the pandemic and the one-time payment for eligible practicing physicians is in recognition of that work during the 2021-22 fiscal year. The lump sum payment is approximately $45 million and was provided to the AMA in December 2022 to distribute to their members. Physicians will receive an average one per cent rate increase to compensation for each of the next three years. As part of implementation of the AMA Agreement, the Business Costs Program premium rate was increased by about 22 per cent. This increase will help physicians deal with inflation and keep practices open. The increase is estimated to cost $20 million annually, providing on average an extra $2,300 annually for each physician. This is in addition to about $80 million the government currently invests in the program each year. Following the ratification of the AMA Agreement, a commitment for collaboration between Alberta Health and the AMA regarding primary health care, including one-time investments of $20 million in Primary Care Networks (PCNs) for two fiscal years, was established. The Provincial PCN Committee provided significant contributions to the work of the Modernizing Alberta’s Primary Health Care System (MAPS) initiative to improve access and quality of primary and community health services. The MAPS initiative goal is to provide recommendations on ways to strengthen primary health care and achieve a primary health care-oriented health system. MAPS is engaging leaders and experts with hands-on experience in primary health care and health systems improvement to examine the current landscape and propose improvements. By March 31, 2023, a final report was delivered proposing a strategic direction for primary health care over the next 10 years, with a parallel report providing strategic directions to improve the delivery of primary health care for Indigenous peoples in Alberta. The $20 million investment in primary health care provides significant relief across the primary health care system, particularly for PCNs that have experienced a decline in their per capita payments from declining numbers of patients. This funding provides stabilization while work is undertaken to review and improve the overall funding model for PCNs, which will consider recommendations from the MAPS initiative. For many Albertans, prescription drugs have tremendous benefits in terms of improving quality of life, managing illnesses, and in some cases, precluding the need for more extensive treatments. Alberta continued to work with the pan-Canadian Pharmaceutical Alliance (pCPA) to reduce prescription drug costs and increase access to clinically effective and cost-effective drug treatment options, including cell and gene therapy. All new drugs and/or new indications for use undergo price negotiations between the pCPA and drug manufacturers. In 2022-23, rebates have increased to an estimated $327 million from $275 million in 2021-22. This is a successful trend that shows the importance of the pCPA and Alberta’s involvement as a member to push health jurisdictions for more value and budgetary protection. In 2022-23, the province spent $2.5 billion on drugs and supplemental health benefits and continued to improve existing drug benefit programs and add innovative and effective therapies through the addition of 320 new products in 2022-23. Of the 320 products added, 48 were brand name drug products and 272 were generic products. Alberta’s Biosimilars Initiative will expand the use of biosimilars by replacing the use of biologic drugs with their biosimilar versions whenever possible. This means patients will continue receiving safe and effective treatment, but at a lower cost. In 2022-23, savings from this initiative increased to an estimated $65.7 million from $48.9 million in 2021-22. 2.2 Increase regulations and oversight to improve safety, while reducing red tape within the health system by restructuring and modernizing health legislation, streamlining processes, and reducing duplication. As of March 31, 2023, the ministry, including AHS, achieved a 36.1 per cent reduction of its regulatory and administrative requirements, exceeding the government target of 33 per cent. AHS will continue to see reductions with the ongoing launches of Connect Care across the organization, continuing through 2024. Connect Care supports digital modernization of more complete central access to patient information related to AHS services. It provides resources, including medication alerts; evidencebased order sets; test and treatment suggestions; and, care paths and best practice advisories, which result in fewer repeated tests and consistent information across the province wherever care is being provided at AHS facilities. This system also reduces the number of forms used by AHS and helps to eliminate data entry duplication. Connect Care also facilitates direct communication between patients and providers through a patient portal, MyAHS Connect, which helps patients better manage their health with online access to their health information, including reports and test results. It also allows for online interaction with their care team, an ability to review and manage appointments and after visit care summaries, and less repeating of their health histories or need to remember complex histories or medication lists. The ministry continues to monitor Alberta’s health system to ensure standards are maintained and to improve safety and quality of health care. As of March 31, 2023, amendments to the Health Professions Act have been proclaimed into force that modernize Alberta’s professional regulatory structure. This included changes to 29 regulatory college regulations and one regulation that enhance professional regulation by health profession regulatory bodies and will make it easier for regulatory colleges to be more agile and adapt faster to changing best practices. The PCN Nurse Practitioner (NP) Support Program was created to enable NPs to work to the full scope of their skills. In 2022-23, $7.6 million was provided and the program facilitated the incorporation of NPs working more than 57 full-time equivalent positions as of March 2023. The program increases access to primary health care, including after hours, weekends, and in rural and remote areas and underserved populations; supports chronic disease management; and, helps meet unmet demand for primary health care services. Challenges for the program include NP compensation, recruitment and retention, and the desire of NPs for an independent practice model. Alberta Health is currently consulting with key stakeholders on a draft NP Compensation Model to address the challenges of the program. Amendments to the Pharmacy and Drug Act and the Pharmacy and Drug Regulation came into effect June 1, 2022. These amendments allow the Alberta College of Pharmacy and pharmacies to better respond to changes in the provision of pharmacy services to Albertans and reduce significant government red tape faced by pharmacy operators. To address the current challenges in continuing care legislation and help to initiate transformative change within continuing care, Alberta Health worked with partners to develop a new legislative framework for the continuing care system to increase clarity regarding services, address gaps and inconsistencies across settings, enable improved service delivery for Albertans, and support health system accountability and sustainability. On May 31, 2022, the Continuing Care Act (Act) received Royal Assent. The Act will come into force on April 1, 2024, after the development and approval of regulations and standards. The ministry is currently working with partners on the development of those regulations and standards. When proclaimed, the Act will regulate the full spectrum of continuing care services and settings in Alberta, including continuing care homes, supportive living accommodations, and home and community care. Consequential amendments to the Act are included in The Red Tape Reduction Statutes Amendment Act, 2023. These amendments ensure alignment of terminology in existing legislation with the Act while maintaining the policies and intent of the current legislation. In May 2022, the Food Regulation under the Public Health Act was amended to eliminate the requirement for food establishments to request an approval from a public health inspector to allow dogs into outdoor eating areas. The amendment reduced red tape for operators and provided them greater flexibility in meeting the needs of their customers. The Food Regulation provides clear requirements to support the change so dogs can stay with their owners on outdoor patios, while maintaining a high degree of food safety. 2.3 Improve measuring, monitoring and reporting of health system performance to drive health care improvements. Measuring performance is the clearest way to show investments in the health care system are leading to better outcomes for Albertans. Alberta Health worked with the Health Quality Council of Alberta (HQCA) to ensure alignment of their plans and priorities with government key priorities and achieve improvements through various initiatives. On July 26, 2022, Alberta Health executed a $23 million operating grant agreement with the HQCA over three years (April 1, 2022 to March 31, 2025) to keep the organization working with patients, families, and partners from across health care and academia to inspire improvement in patient safety, person-centred care, and health service quality. As an example, Alberta Health worked with the HQCA to develop a Primary Care Patient Experience survey to engage Albertans on their experiences within the health care system. Work continued towards transitioning manual surveys to a digital, computer-adaptive testing methodologies format to use digital technology to enable new models of care and reduce manual and paper-based processes. Digital formats for surveys and reports across primary and continuing care increased Albertans’ engagement within the health system and allowed more timely feedback to service providers about care concerns, including patients’ opinions. Alberta Health worked with HQCA to create primary health care panel reports to support planning, quality improvement, health system management for overall purpose of improving primary health care delivery. The panel reports provide family physicians with information on their patients’ continuity, as well as valuable data on screening and vaccination rates, chronic conditions, pharmaceutical use, and emergency and hospital visits. Alberta Health worked with AHS and the HQCA to develop a value-based assessment tool for objectively assessing value from the Government of Alberta annual investment into health outcomes of Albertans and benchmark against other jurisdictions, particularly the comparator provinces of British Columbia, Ontario and Quebec. Alberta Health also worked with the HQCA to complete priority work on identifying emergency medical services key performance indicators. Performance measures were developed and are under ministry review, with a shift in focus to reducing response times measured at the 90th percentile, rather than the 50th percentile. Releasing the results and performance information improves quality and patient safety and assures Albertans of the government’s commitment to increase accountability and transparency in Alberta’s health care system. The adoption of best practices and monitoring of performance measures help to improve health outcomes. Work continued with the HQCA on developing the Patient Experience Awards and Quality Exchange to support excellence in care and sharing of best practices. This included continuing to develop resources and information to support and inform program planning, panel management, quality improvement and policy development in primary health care, as well as patient experience information for designated supportive living and continuing care. Information is published for Albertans in FOCUS, a dynamic online reporting tool which collects information about what patients experience in the provincial health care system, including: emergency departments, primary health care, long-term care, designated supportive living and home care. Outcome Three: The health and well-being of all Albertans is protected, supported and improved, and health inequities among population groups are reduced Key Objectives 3.1 Ensure a continued, effective response to the COVID‐19 pandemic by optimizing access to treatments and vaccine, and reducing vaccine hesitancy. The Government of Alberta remains committed to supporting Albertans as we shift to managing COVID-19 similar to how other endemic respiratory viruses are managed. Alberta’s capacity to treat and clinically manage cases of COVID-19 continues to improve. Immunization, including receiving a booster dose of COVID-19 vaccine, is one of the best choices Albertans can make to protect themselves from severe illness due to COVID-19 infection. In 2022-23, $1.2 billion was spent on COVID-19 response to ensure the health care system had the resources required to address health care pressures resulting from the pandemic. By the end of June 2022, all mandatory public health measures related to COVID-19 were lifted. This was due to increased immunization coverage, attenuation of severity of new circulating variants, and the ability to treat and clinically manage cases of COVID-19. This signaled the beginning of a shift in Alberta’s handling of COVID-19 from an emergency pandemic response to an endemic state. Government supported this transition by working across multiple facets of health care (e.g., primary care, continuing care, workplace health and safety, public health, provincial laboratory, etc.) to align public health recommendations, such as testing and isolation, across all common respiratory viral illnesses. The ministry continued to monitor the impacts and transmission of COVID-19 and other respiratory viruses in the community by working with partners on the implementation of ongoing and new COVID-19 immunization programs, including the introduction of bivalent booster vaccines, and implementing treatment protocols for COVID-19. Alberta Health and the Health Quality Council of Alberta established a COVID-19 Data Task Force, comprised of health professionals, to conduct a data review of the last several years of health information with a view to offering recommendations to the Government of Alberta on how to better manage a future pandemic. The purpose of the review is an opportunity to reflect on Alberta’s pandemic response from a data quality and validity lens to identify opportunities for improvements to manage future pandemics. To minimize the impact of COVID-19 and protect public health, COVID-19 Rapid Antigen Tests were made available across the province to all Albertans free of charge through participating community pharmacies. Initially, supply was limited and this distribution model enabled an equitable distribution of tests across the province. Between March 2021 to March 31, 2023, Alberta distributed 48.5 million rapid antigen tests to acute and continuing care sites, primary care clinics, businesses, K-12 schools, municipalities, First Nations and Métis communities, and the general public. Government developed COVID-19 vaccine strategies to help reduce the spread, minimize severe outcomes and protect vulnerable Albertans. Work continued to support the review of ongoing evidence and recommendations for immunization against COVID-19, including guidance for immunization post-infection (or hybrid immunity), as well as for fall/spring booster programs. In 2022, Alberta continuously achieved key milestones on COVID-19 vaccine administration and roll out for different age groups and populations. In April 2022, 40 per cent of Albertans 12 and older had received their third vaccine dose. In June 2022, 35 per cent of Albertans aged five to 11 had received two doses of COVID-19 vaccine. On November 14, 2022, the Pfizer vaccine was made available for individuals six months to four years of age, and on March 20, 2023, a second bivalent vaccine (spring booster) was made available for residents living in senior congregate living settings. In 2022-23, 1.4 million COVID-19 vaccine doses were administered to Albertans and 26 per cent of the population 12 years of age and older had received a booster dose. While the federal government continued to cover the costs of the vaccines, Alberta Health spent $53 million in 2022-23 to distribute the vaccines to Albertans. The Alberta Vaccine Booking System (AVBS), launched in summer of 2021, continues to provide Albertans with access to book both COVID-19 and influenza vaccine appointments at participating Alberta Health Services (AHS) or pharmacy locations by providing a centralized, province-wide online appointment booking platform. The centralization of all vaccine booking appointments, including from AHS, Public Health, and Community Pharmacy helps Alberta Health forecast vaccine demand and strategically distribute vaccine supply. Vaccine eligibility criteria and system functionality continue to be updated based on direction from provincial immunization programs. In 2022-23, more than 575,000 appointments for COVID-19 and influenza immunization were scheduled using the AVBS. Updates continue to be released to support dynamic vaccine eligibility changes and to continually improve the user experience. Previously, Albertans had to call multiple pharmacies and Health Link in an attempt to find available vaccine supply. The Health Link 811 call centre continues to support Albertans who do not or cannot use the AVBS. To ensure a continued response to COVID-19, Alberta Health together with AHS extended the provision of free personal protective equipment (PPE) to primary care physicians, pediatricians, and their staff to support their operations and enhance safety to May 31, 2022. In 2022-23, inventory consumption expense associated with the COVID-19 response was $365 million; this includes PPE, testing supplies and $88.6 million for rapid test kits. In addition, the government worked with continuing care partners to protect residents of congregate care facilities and home care clients. A total of $286 million was provided in 2022-23 for additional staffing costs and cleaning supplies, PPE and screening of visitors to protect the health and safety of residents. In 2022-23, AHS, in collaboration with the Zone PCN Committees, worked towards the administration of an oral antiviral COVID-19 treatment in respective AHS geographical zones, enhancing capacity for testing and swabbing for respiratory illnesses. In 2021-22, intravenous Sotrovimab was made available on an outpatient basis to Albertans at higher risk of severe illness or death, followed by availability of Paxlovid, the first COVID-19 treatment approved by Health Canada that can be taken orally at home. Efforts were made to recruit sentinels (primary care physicians/nurse volunteers) to increase the effectiveness of the TARRANT Viral Watch Program, which monitors respiratory infections circulating in the community. 3.2 Safeguard Albertans from communicable diseases that can cause severe illness, permanent disability, or death. The ministry works to protect Albertans from a number of communicable diseases, such as influenza, measles, and sexually transmitted and blood borne infections. Over the past year, immunization programs for vaccine-preventable diseases continued to be a primary strategy in preventing disease, disease transmission and severe health outcomes. They are key to the health of a population and to decreasing the strain on the acute care system. Through promoting initiatives that aim to increase childhood and adult immunization rates, Alberta continued to offer immunizations programs, including influenza vaccine, to Albertans six months of age and older, free of charge in collaboration with many partners. Alberta’s 2022-23 influenza season started earlier with a surge of influenza A cases in early October. The highest positivity for influenza A was 31.9 per cent in the week of November 20, 2022, and cases and outbreaks decreased significantly by the end of December 2022. Alberta had sufficient supply of influenza vaccines to immunize 38 per cent of the population. Alberta Health worked with AHS to ensure respiratory outbreak definitions and management guidelines were in place for high-risk settings, including continuing care and acute care facilities, to minimize severe health outcomes and protect the most vulnerable Albertans in these settings. Despite the challenges of fatigued providers and a generally vaccine fatigued population, the overall influenza immunization rate is one per cent higher than in 2021-22. As of March 31, 2023, approximately 28 per cent of Albertans received an influenza vaccine. Budget 2022 included an increase of $14.3 million related to the approval of the high-dose influenza vaccine for Albertans 65 years of age or older. As of March 31, 2023, approximately 64 per cent of Albertans 65 years of age and older, and 75 per cent of Albertans 90 years of age and older received a high-dose influenza vaccine. The Alberta Outreach Program started the week of October 3, 2022, to immunize those at highest risk of severe outcomes from influenza. The 2022-23 Influenza Immunization Program for the general public began on October 17, 2022, and ended on March 31, 2023. Influenza vaccine was available at over 2,500 immunizing sites, including AHS clinics, Indigenous Services Canada clinics, community pharmacies, community medical clinics, and post-secondary institutions. Immunization programs save millions of dollars, helping people of all ages live longer, healthier lives, and decreasing the burden on the health care system. The pandemic did result in some disruptions to the routine school immunization program and overall infant and preschool immunization rates have decreased. However, AHS has hired additional staff to support addressing the school immunization backlog and in-school catch-up programs, and immunization rates for school-aged children are nearing pre-pandemic coverage levels. In 2022, by age two, 71 per cent of Albertans had received immunization with diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b (DTaP-IPV-Hib) vaccine and 82 per cent had received immunization with measles, mumps, rubella (MMR) vaccine. These immunization rates are both lower than the national target of 95 per cent for these vaccines. As a result of the COVID-19 response, childhood immunization rates dropped between 2021 and 2022. AHS has a catch-up program to increase childhood immunization rates to help reach the national target of 95 per cent. This includes actions such as reminder calls for booked appointments, monitoring wait times and adding appointments as needed, and following up using a recall process for children with delayed immunizations. Work is underway with service providers to enhance testing, treatment and prevention strategies, including working with community-based organizations, to improve women’s health, reduce barriers to sexually transmitted and blood borne infections (STBBI) testing and treatment, and increase access to prenatal syphilis screening. Over $8 million annually is provided to organizations to prevent STBBIs and provide wrap-around supports for people living with those infections, including $1.2 million specifically for syphilis outbreak response. In September 2022, Alberta experienced a shigella outbreak in Edmonton, which ended in February 2023 after two weeks without new cases. However, the outbreak was re-opened in March 2023, when seven additional cases were reported and some patients hospitalized. As of March 31, 2023, 214 cases were reported since the outbreak initially started; no deaths were reported. In October 2022, the Shigella Task Force brought together cross-sector partners, including representatives from Alberta Health, AHS, shelters, inner-city agencies, the City of Edmonton, local family physicians, and Alberta Precision Labs to coordinate resources and discuss options for limiting spread. Syphilis has made a drastic resurgence in Alberta since 2019, with rates being the highest in more than 70 years. Alberta Health has resumed a leadership role in the provincial syphilis response, after an interruption due to COVID-19, through work with frontline service providers to support testing, treatment, and prevention strategies. By increasing access to syphilis testing and treatment services in a variety of novel health settings, the Government of Alberta will help create awareness and normalize sexually transmitted infections testing and treatment for all Albertans. The ministry is also leading and supporting a number of provincial outbreak responses and preparedness activities including: • leading the human health response to highly pathogenic avian influenza, including supporting the update of public health disease management guidelines and communication pieces for government websites; • supporting the coordinated provincial response to the international mpox (formally known as monkey pox) outbreak, including guidelines for contact management and guidance on pre and post-exposure vaccine use; and, • working with AHS public health in preparation for response to international communicable disease outbreaks, including Ebola and Polio. In early May 2022, cases of mpox began to occur in countries where mpox was not previously detected. Canada’s first case was reported on May 19, 2022, and Alberta reported its first case on June 2, 2022. By July 2022, mpox was declared a public health emergency of international concern by the World Health Organization. Alberta Health worked in collaboration with public health partners to develop testing criteria, case definitions and public health management guidelines. The Alberta Mpox Public Health Notifiable Disease Guideline was published in June 2022. Alberta began offering post-exposure vaccine on June 7, 2022, and the targeted pre-exposure vaccine campaign began at the end of June. As of March 31, 2023, Alberta recorded 45 cases of mpox. Alberta has administered 2,183 first doses and 1,715 second doses of the vaccine. 3.3 Expand access to a range of in‐person and virtual recovery‐oriented addiction and mental health services. Reporting responsibility for this objective has transferred to the Ministry of Mental Health and Addiction. Performance Measure 3.a Percentage of mental health and addiction‐related emergency department visits with no mental health service in previous two years Reporting responsibility for this performance measure has transferred to the Ministry of Mental Health and Addiction. 3.4 Prevent injuries and chronic diseases and conditions through health and wellness promotion, and environmental and individual initiatives. In 2022-23, $646 million was expensed to support population and public health initiatives to maintain and improve the health of Albertans through services promoting and protecting health and preventing injury and disease. Government provides leadership and support to protect the health and safety of Albertans and improve their health and well-being by setting public policy in a number of areas, such as maternal, infant and early child development; injury prevention; public health matters related to cannabis use; tobacco and vaping control; and, promotion of population wellness and health equity. Government recognizes that Albertans living with diabetes want to access health programs and services that will more effectively support their needs. On July 21, 2022, the Minister announced the establishment of the Diabetes Working Group (DWG) to review Alberta’s entire diabetes care pathway, identify gaps in care, and provide recommendations to improve diabetes prevention, diagnosis, treatment, and management. In addition, Alberta Health expanded the Insulin Pump Therapy Program to include newer pumps and supplies. Albertans enrolled in the pump program now have access to the newest technologies for management of diabetes. Improved access to the newer diabetes management technologies, and the work of the DWG will improve outcomes and quality of life for Albertans living with diabetes. Nearly $7 million was provided to AHS for cancer prevention initiatives supporting comprehensive projects that are reducing the risk of cancer across the province. These projects address healthy lifestyles, smoking cessation, workplace wellness, and partnerships with Indigenous communities. In 2022-23, the Cancer Prevention Screening and Innovation initiative worked with organizations such as Promoting Health, Chronic Disease Prevention and Oral Health, AHS Provincial Population and Public Health, the Alberta First Nations Information Governance Centre, the Métis Nation of Alberta, and the new AHS Indigenous Wellness Core to: • adopt the Alberta Healthy Communities Approach to focus on scaling and spreading successful interventions provincewide; • create a working partnership with the Human Papilloma Virus community innovation for sub-populations and the Provincial Population and Public Health Screening Programs and Communicable Disease Control divisions; • improve the Healthier Together Workplace program and recognition strategy; and, • strengthen work with Indigenous communities to facilitate community action to reduce modifiable factors, raise cancer awareness and improve cancer screening. A community support model was created, and tools were adapted to support the three initial Metis Settlements to create, implement and evaluate cancer prevention action plans. Alberta Health currently funds several health promotion-based initiatives to improve individual and community health and well-being: • Alberta Health continues to support the Injury Prevention Centre to provide unintentional injury prevention programs, research, and education. Through the Injury Prevention Centre, Albertans have access to programs and education that reduce the risk of injury and make communities safer. Injury prevention is a public health priority that directly reduces costs to the health care system. Injury bears an estimated financial cost of $7.1 billion annually in Alberta, $4.6 billion of which is direct health care costs. • Physician prescription to Get Active supports individuals to become more active through physical activity. Prescriptions can be filled at participating recreation facilities for free visits, free one month facility passes and/or free fitness classes. • The Communities ChooseWell program advances healthy eating and active living by supporting communities to create local conditions and environments that enable Albertans to eat well and be active. The program provides resources, education and support to community groups as well as offering small grants for implementing local healthy eating and active living initiatives. Alberta Health provides approximately $2 million in grants annually to five programs that support vulnerable mothers and their babies. From April 2022 to September 2022, programs provided intensive supports to 287 vulnerable women who were pregnant or of child-bearing age, and more vulnerable women were provided outreach supports to address gaps in support specific to the COVID-19 pandemic. Alberta Health and AHS also provided funding to support the University of Alberta’s ENRICH Maskwacîs Kokums and Mosoms Elders Mentoring Program, which creates enhanced support networks for parents-to-be. In addition, elder support helps address a gap in service within the prenatal clinical setting by connecting parents to traditional knowledge and culture. Budget 2021 provided a total of $6.75 million over three years, including $2.25 million in Budget 2022, to establish and operate the AHS Tobacco and Vaping Reduction Act Enforcement Team. As of March 31, 2023, over $2.4 million has been spent, and the team has conducted retail inspections, established a secret shopper program and a public complaint line, and created retailer resources (handbook and signage) that will improve compliance with the Act and regulation. The most current data (from the 2021-22 fiscal year) shows the enforcement team conducted 2,400 retail inspections and provided over 4,000 copies of the retailer handbook and signs to retailers. In 2022-23, Alberta Health established the Alberta Ukrainian Evacuees Health Benefit Program. The total cost of the program was $9.5 million, including physician services. As of March 31, 2023, 24,000 Ukrainians have applied for health coverage in Alberta. In addition, the ministry established a health benefit program that provided Ukrainian evacuees with access to supplemental coverage for prescription and non-prescription drugs, nutritional products, diabetic supplies, and dental, optical and emergency ambulance services. Work continues in partnership with the ministries of Agriculture and Irrigation and Environment and Protected Areas on a One Health approach to antimicrobial resistance (AMR) in the province. This work is critical to address the emerging threat of treatment-resistant microbes in human and animal populations and in the environment. An Antimicrobial Strategic Framework for Action and Implementation plan continues to be developed to help guide collective efforts to address the growing threat of AMR in Alberta. Stakeholders and partners were consulted and supported development of the framework. In 2022-23, the Office of One Health at the University of Calgary was contracted at a cost of $200,000 to support implementation of AMR priority areas for action. As part of the contract, an advisory group on stewardship was created to provide guidance on specific activities, measures, targets, and costs for implementation. Alberta Health worked with AHS, Alberta Environment and Protected Areas, and the Alberta Lake Management Society to quickly set up a water quality (fecal contamination and cyanobacterial blooms) monitoring program for four sites on Lac Ste. Anne to support the 2022 papal visit and annual Lac Ste. Anne pilgrimage. Data from this monitoring program provided the basis for issuance of a cyanobacterial bloom public health advisory for Lac Ste. Anne shortly before the event. Alberta Health regularly assesses the evidence on water fluoridation to help support municipal councils to make evidence-informed decisions regarding community water fluoridation. The ministry worked on updating community water fluoridation position statement with new relevant research, including new local data from Calgary. Alberta Health continues to provide transparent information about environmental public health data, while simultaneously providing risk communication materials to influence modifiable risk factors within the Alberta population. Examples of public health data and information available through the Open Government Portal include: • Routine chemistry and trace element data from domestic well water samples analyzed in 2016–17 and 2017–18 are available. Alberta Health funded routine chemistry and trace elements analysis of 4,842 samples of drinking water from private water wells and 307 samples from small, public, non-municipal drinking water systems. As well, data related to the study of two stormwater ponds in Lacombe, Alberta were released to the open government portal at https://open.alberta.ca/opendata/lacombe-stormwater-ponddataset. This data includes the analysis of contaminants (e.g., mercury, polycyclic aromatic hydrocarbons, trace metals, pesticides and volatile organic compounds) in fish, sediments, and water. • The Alberta Environmental Public Health Information Network, accessible at http://aephin.alberta.ca, supports awareness and provides opportunities for Albertans, academics, and cross-government partners to learn more about environmental hazards and public health in the province. In 2022-23, new visualizations were published for “Human Biomonitoring of Environmental Chemicals in Canada and the Prairies” and a “Search Interface for Environmental Site Assessment Repository”, along with enhancements including the incorporation of new, yearly data on the recreational water bodies and the impacts of poor air quality and heat. In addition, Alberta Health developed the Extreme Heat website and notification protocol at https://www.alberta.ca/extreme-heat.aspx. • Alberta Health continued to provide real-time information to Albertans about hazards and risks associated with recreational water quality at Alberta beaches and waterbodies. In 2022, over 2,300 samples were collected from 85 recreational sites to identify fecal contamination and 436 samples were collected from 50 lakes, reservoirs, and rivers to be assessed for cyanobacterial (blue green algal) blooms and microcystin toxin. This monitoring resulted in the issuing of 47 cyanobacterial bloom advisories and nine fecal contamination advisories to protect the health of Albertans and visitors to the province. Additionally, in May 2022, Alberta Health updated the Alberta Safe Beach Protocol available at https://open.alberta.ca/publications/9781460145395 to reflect new Health Canada Guidelines for cyanobacterial blooms in recreational water. In February 2023, Alberta Health released a position statement around use of stormwater ponds at https://open.alberta.ca/publications/stormwater-ponds-in-alberta-health-guidanceinformation-sheet. • Alberta Health, as part of the Scientific Working Group on Contaminated Sites in Alberta, has published a Site-Specific Risk Assessment guidance document to clarify the specific requirements of conducting a site-specific risk assessment in Alberta, available at: https://open.alberta.ca/publications/supplemental-guidance-on-site-specific-riskassessments-in-alberta. Alberta Health and the Alberta Centre for Toxicology at the University of Calgary have published the report and dataset of “Post-Horse River Wildfire Surface Water Quality Monitoring Using the Water Cytotoxicity Test” available at https://prism.ucalgary.ca/handle/1880/115412. 3.5 Improve access for underserved populations and for First Nations, Métis, and Inuit peoples to quality health services that support improved health outcomes. The most current result available from Statistics Canada’s Canadian Community Health Survey shows that in 2021, 87.3 per cent of Albertans had access to a regular health provider, an improvement from 85.3 per cent in 2020. Having a regular health care provider is important for early screening, prevention through health and wellness advice, diagnosis, and treatment of a health issue, as well as ensuring good continuity of care and connections to other health and social services. The desired result is to increase the percentage of Albertans who have access to a regular health care provider. Increasing access to a regular health care provider is consistent with progress towards the following provincial primary health care goals: • timely access to appropriate primary care services delivered by a regular health care provider or team; • coordinated, seamless delivery of primary care services through a patient’s ‘medical home’ and integration of primary care with other levels of the health care system; • efficient delivery of high-quality, evidence-informed primary care services; and, • involvement of Albertans as active partners in their own health and wellness. Alberta’s Primary Care Networks are involved in a variety of initiatives that support provincial and health zone primary care goals, including adopting a ‘medical home’ approach in their practices. This approach strengthens the connection between a patient and regular health care provider to improve access to care, chronic disease prevention and management, continuity of care, and innovations in primary health care including telemedicine and virtual care. The Government of Alberta is committed to addressing the health needs of First Nations, Métis and Inuit peoples residing in Alberta, including working with First Nations and Métis leaders, the Government of Canada and other partners to streamline how Indigenous peoples access health services, and ensuring that health services are more culturally appropriate. There is a significant gap in equitable access to primary health care for Indigenous peoples. This is evidenced by noting that in Alberta, Indigenous peoples’ life expectancy is 16.4 years below that of all other Albertans, falling below 64 years of age. An Indigenous Primary Health Care Advisory Panel was established in the fall of 2022 under MAPS to provide advice to the Minister on how the existing primary health care system could be improved to ensure First Nation, Métis, and Inuit peoples have access to high-quality, culturally safe primary health care no matter where they live. As part of their work, the Indigenous Panel convened an Indigenous Youth Innovation Forum, Indigenous Primary Health Care Innovation Forum, and participated in the MAPS Forum and Community Care Innovation Forum. These forums, along with engagements with First Nations, the Metis Settlements General Council, the Métis Nation of Alberta, and others ensured that a broad range of perspectives informed the Indigenous Panel’s work. As part of their deliberations, the Indigenous Panel submitted recommendations to the Minister in December 2022 for early opportunities for investment in enhancing Indigenous primary health care. These recommendations were approved in principle by the Minister as a first step to improving access to more culturally safe and integrated care. In 2022-23, Alberta Health provided $8.8 million to the Indigenous Wellness Program Alternative Relationship Plan to support 24 full-time equivalent physician positions to provide care in over 20 Indigenous health care centres throughout Alberta, including the Alberta Indigenous Virtual Care Clinic. Alberta Health has a separate Alternative Relationship Plan arrangement with Siksika Nation, and provides up to $1.1 million to support three full-time equivalent physician positions to provide care in the community. Alberta Health continues to engage Indigenous health care experts through the First Nations Health Advisory Panel and a Metis Settlements Health Advisory Panel. Panel members include Health Directors from across the province, as well as other associated stakeholders. The Panels inform health priorities and strategies and assist in identifying issues or gaps in programs and services, as well as working to identify potential solutions and areas of future collaboration. Alberta Health also continued work on Alberta’s Protocol Agreement Health Sub-Tables to collaborate on addressing the health gaps identified by the members of the Blackfoot Confederacy and the Stoney Nakoda Tsuut’ina Tribal Council. Alberta Health similarly worked with the Métis Nation of Alberta under their Framework Agreement with the Government of Alberta. Alberta upholds the Jordan’s Principle commitments by working with the Government of Canada and the First Nations Health Consortium, an Alberta-wide organization developed to improve access to health, social, and education services and supports to First Nations and Inuit children throughout the province, living both on and off reserve. To ensure compliance, Alberta Health established an Executive Leadership Group (including the ministries of Children’s Services, Seniors, Community and Social Services, Alberta Education, Indigenous Relations, and Alberta Health) to implement Jordan’s Principle in Alberta and to ensure that First Nations children have access to health, social, and educational resources when required, without denial or delay related to jurisdictional dispute over payment. Alberta Health has also established a Technical Cross-Jurisdictional Working Group to address barriers impacting access to programs and services. The working group includes the First Nations Health Consortium, the First Nations Inuit Health Branch, and the Ministries of Children Services, Seniors, Community and Social Services, Education, and Indigenous Relations. On October 24, 2022, government appointed a Parliamentary Secretary for Rural Health, to work with Alberta Health to address rural health challenges, such as access and health care professionals. Budget 2022 introduced a new Rural Capacity Investment Fund, as part of the provincial agreement that impacted more than 30,000 registered nurses and registered psychiatric nurses across the province. The fund supports recruitment and retention strategies in rural and remote areas of the province, including relocation assistance. Almost $4.4 million was spent in 2022-23 to assist nearly 200 employees who chose to relocate to rural Alberta and pay out retention payments to over 8,200 rural health professionals. The benefit to rural Albertans will be realized by improved staff retention rates and fewer vacancies. The Government of Alberta recognizes the importance of rural health facilities and that these health centres provide an essential role for local residents. AHS and Alberta Health have established Zone Health Care Plans based on a framework that guides the development of comprehensive, zone-wide strategic health service plans, including services for Indigenous peoples. These long-range plans address the needs of rural communities with a continued focus on appropriate quality of care, patient safety, and access to services. Conditional approval was provided to seven proponents under the Continuing Care Capital Program–Indigenous Stream in June 2022. The Modernization Stream was launched in September 2022. In 2022-23, the Government of Alberta provided approximately $7 million to the Rural Health Professions Action Plan to attract and retain rural physicians with the appropriate skills to meet the needs of rural Albertans. The program supported physician locums to maintain services when rural physicians need time away from their practice; offered continuing medical education; provided accommodations for 785 rural learners for rural placements so that they can train and choose to practice in rural communities; and, created welcoming environments though 50 attraction and retention committees so that rural communities can attract and retain health professionals. In 2022, the Government of Alberta announced the Rural Education Supplement and Integrated Doctor Experience (RESIDE) program, which allocated $8 million over three years to provide incentives to new family physicians who agree to practice in rural and remote communities in exchange for a multi-year service agreement. The program will help address challenges in patient access to health services in rural and remote areas. Since the start of the program, Alberta Health has approved several changes to the RESIDE program to better meet the needs of physicians and communities and help ensure the program successfully incentivizes more physicians to move to communities of need. As of March 31, 2023, seven physicians had signed return of service agreements in rural communities. The Provincial Primary Care Network Committee provided the Minister with a recommendations report on supporting recruitment and retention of primary care physicians, nurse practitioners, and physician assistants in rural communities. In May 2022, the Minister accepted the seven recommendations that address broader systemic aspects of rural health service challenges, and this report will inform further work within Alberta Health. In July 2022, government announced new funding of $45 million over three years to increase access to pediatric rehabilitation services and programs such as speech-language, as well as occupational and physical therapy for children and youth. A community pediatric services model was developed by AHS to address gaps with implementation of enhanced pediatric rehabilitation supports, including universal and targeted resources and programs and expanded eligibility for specified services. Service delivery is enhanced with clear intake, access and triage to services and strengthened teams to support care. Pediatric rehabilitation professionals work with families and alongside other health care professionals to help children and youth live well, build resiliency and take part in activities meaningful to them and their families. A multi-pronged workforce recruitment, retention, and optimization approach is enabling implementation despite the ongoing challenges with recruitment of health professionals across programs and jurisdictions. Alberta Health Services Provincial Rural Palliative Care In-Home Funding Program provides special, funding that can be accessed by rural palliative clients and families when they require additional support beyond existing services at end-of-life to remain at home instead of being admitted to hospital. Between April 1, 2022 and March 31, 2023, a total of 143 clients were served by the program. Of the clients who have died while accessing the program, 80 per cent were able to pass away in the comfort of their own home. ",Medical,Fact Finding,Q&A "Answer questions using the information provided in the prompt. Attempt to keep answers concise, while also avoiding or explaining jargon that the masses wouldn't understand.",What does the article suggest General Motors Company has an advantage in?,"GENERAL MOTORS COMPANY Item 1A. Risk Factors We have listed below the most material risk factors applicable to us. These risk factors are not necessarily in the order of importance or probability of occurrence: Risks related to our competition and strategy If we do not deliver new products, services, technologies and customer experiences in response to increased competition and changing consumer needs and preferences, our business could suffer. We believe that the automotive industry will continue to experience significant change in the coming years, particularly as traditional automotive original equipment manufacturers (OEMs) continue to shift resources to the development of EVs. In addition to our traditional competitors, we must also be responsive to the entrance of start-ups and other non-traditional competitors in the automotive industry, such as software and ridesharing services supported by large technology companies. These new competitors, as well as established industry participants, are disrupting the historic business model of our industry through the introduction of new technologies, products, services, direct-to-consumer sales channels, methods of transportation and vehicle ownership. To successfully execute our long-term strategy, we must continue to develop and commercialize new products and services, including products and services that are outside of our historically core ICE business, such as EVs and AVs, software-enabled connected services and other new businesses. There can be no assurance that advances in technology will occur in a timely or feasible way, if at all, that others will not acquire similar or superior technologies sooner than we do, or that we will acquire technologies on an exclusive basis or at a significant price advantage. The process of designing and developing new technology, products and services is costly and uncertain and requires extensive capital investment. If our access to capital were to become significantly constrained, if costs of capital increased significantly, or if our ability to raise capital is challenged relative to our peers, our ability to execute on our strategic plans could be adversely affected. Further, if we are unable to prevent or effectively remedy errors, bugs, vulnerabilities or defects in our software and hardware, or fail to deploy updates to our software properly, or if we do not adequately prepare for and respond to new kinds of technological innovations, market developments and changing customer needs and preferences, our sales, profitability and long-term competitiveness may be materially harmed. Our ability to attract and retain talented, diverse and highly skilled employees is critical to our success and competitiveness. Our success depends on our ability to recruit and retain talented and diverse employees who are highly skilled in their areas. In particular, our vehicles and connected services increasingly rely on software and hardware that is highly technical and complex and our success in this area is dependent upon our ability to retain and recruit the best talent. The market for highly skilled workers and leaders in our industry is extremely competitive. In addition to compensation considerations, current and potential employees are increasingly placing a premium on culture and other various intangibles, such as working for companies with a clear purpose and strong brand reputation, flexible work arrangements, and other considerations, such as embracing sustainability and diversity, equity and inclusion initiatives. Failure to attract, hire, develop, motivate and retain highly qualified and diverse employees could disrupt our operations and adversely affect our strategic plans. Our ability to maintain profitability is dependent upon our ability to timely fund and introduce new and improved vehicle models, including EVs, that are able to attract a sufficient number of consumers. We operate in a very competitive industry with market participants routinely introducing new and improved vehicle models and features, at decreasing price points, designed to meet rapidly evolving consumer expectations. Producing new and improved vehicle models, including EVs, that preserve our reputation for designing, building and selling safe, high-quality cars, crossovers, trucks and SUVs is critical to our long-term profitability. Successful launches of our new vehicles are critical to our short-term profitability. The new vehicle development process can take two years or more, and a number of factors may lengthen that time period. Because of this product development cycle and the various elements that may contribute to consumers’ acceptance of new vehicle designs, including competitors’ product introductions, technological innovations, fuel prices, general economic conditions, regulatory developments, including tax credits or other government policies in various countries, transportation infrastructure and changes in quality, safety, reliability and styling demands and preferences, an initial product concept or design may not result in a saleable vehicle or a vehicle that generates sales in sufficient quantities and at high enough prices to be profitable. Our high proportion of fixed costs, both due to our significant investment in property, plant and equipment as well as other requirements of our collective bargaining agreements, which limit our flexibility to adjust personnel costs to changes in demands for our products, may further exacerbate the risks associated with incorrectly assessing demand for our vehicles. Our long-term strategy is dependent upon our ability to profitably deliver a strategic portfolio of EVs. The production and profitable sale of EVs has become increasingly important to our long-term business as we continue our transition to an allelectric future. Our EV strategy is dependent on our ability to deliver a strategic portfolio of high-quality EVs that are competitive and meet consumer demands; scale our EV manufacturing capabilities; reduce the costs associated with the manufacture of EVs, particularly with respect to battery cells and packs; increase vehicle range and the energy density of our batteries; efficiently source sufficient materials for the manufacture of battery cells; license and monetize our proprietary platforms and related innovations; successfully invest in new technologies relative to our peers; develop new software and services; and leverage our scale, manufacturing capabilities and synergies with existing ICE vehicles. Our progress towards these objectives has impacted, and may continue to impact, the need to record losses on our EV-related inventory, including battery cells.In addition, the success of our long-term strategy is dependent on consumer adoption of EVs. Consumer adoption of EVs could be impacted by numerous factors, including the breadth of the portfolio of EVs available; perceptions about EV features, quality, safety, performance and cost relative to ICE vehicles; the range over which EVs may be driven on a given battery charge; the proliferation and speed of charging infrastructure, in particular with respect to public EV charging stations, and the success of the Company's charging infrastructure programs and strategic joint ventures and other relationships; cost and availability of high fuel-economy ICE vehicles; volatility, or a sustained decrease, in the cost of petroleum-based fuel; failure by governments and other third parties to make the investments necessary to make infrastructure improvements, such as greater availability of cleaner energy grids and EV charging stations, and to provide meaningful and fully utilizable economic incentives promoting the adoption of EVs, including production and consumer credits contemplated by the Inflation Reduction Act (IRA); and negative feedback from stakeholders impacting investor and consumer confidence in our company or industry. If we are unable to successfully deliver on our EV strategy, it could materially and adversely affect our results of operations, financial condition and growth prospects, and could negatively impact our brand and reputation. Our near-term profitability is dependent upon the success of our current line of ICE vehicles, particularly our full-size ICE SUVs and full-size ICE pickup trucks. While we offer a broad portfolio of cars, crossovers, SUVs and trucks, and we have announced significant plans to design, build and sell a strategic portfolio of EVs, we currently recognize the highest profit margins on our full-size ICE SUVs and full-size ICE pickup trucks. As a result, our near-term success is dependent upon our ability to sell higher margin vehicles in sufficient volumes. We are also using the cash generated by our ICE vehicles to fund our growth strategy, including with respect to EVs and AVs. Any near-term shift in consumer preferences toward smaller, more fuel-efficient vehicles, whether as a result of increases in the price of oil or any sustained shortage of oil, including as a result of global political instability (such as related to the ongoing conflicts in Ukraine and Gaza), concerns about fuel consumption or GHG emissions, or other reasons, could weaken the demand for our higher margin vehicles. More stringent fuel economy regulations could also impact our ability to sell these vehicles or could result in additional costs associated with these vehicles, which could be material. See “Our operations and products are subject to extensive laws, regulations and policies, including those related to vehicle emissions and fuel economy standards, which can significantly increase our costs and affect how we do business.”","System Instructions: Answer questions using the information provided in the prompt. Attempt to keep answers concise, while also avoiding or explaining jargon that the masses wouldn't understand. Question: What does the article suggest General Motors Company has an advantage in? Context Block: GENERAL MOTORS COMPANY Item 1A. Risk Factors We have listed below the most material risk factors applicable to us. These risk factors are not necessarily in the order of importance or probability of occurrence: Risks related to our competition and strategy If we do not deliver new products, services, technologies and customer experiences in response to increased competition and changing consumer needs and preferences, our business could suffer. We believe that the automotive industry will continue to experience significant change in the coming years, particularly as traditional automotive original equipment manufacturers (OEMs) continue to shift resources to the development of EVs. In addition to our traditional competitors, we must also be responsive to the entrance of start-ups and other non-traditional competitors in the automotive industry, such as software and ridesharing services supported by large technology companies. These new competitors, as well as established industry participants, are disrupting the historic business model of our industry through the introduction of new technologies, products, services, direct-to-consumer sales channels, methods of transportation and vehicle ownership. To successfully execute our long-term strategy, we must continue to develop and commercialize new products and services, including products and services that are outside of our historically core ICE business, such as EVs and AVs, software-enabled connected services and other new businesses. There can be no assurance that advances in technology will occur in a timely or feasible way, if at all, that others will not acquire similar or superior technologies sooner than we do, or that we will acquire technologies on an exclusive basis or at a significant price advantage. The process of designing and developing new technology, products and services is costly and uncertain and requires extensive capital investment. If our access to capital were to become significantly constrained, if costs of capital increased significantly, or if our ability to raise capital is challenged relative to our peers, our ability to execute on our strategic plans could be adversely affected. Further, if we are unable to prevent or effectively remedy errors, bugs, vulnerabilities or defects in our software and hardware, or fail to deploy updates to our software properly, or if we do not adequately prepare for and respond to new kinds of technological innovations, market developments and changing customer needs and preferences, our sales, profitability and long-term competitiveness may be materially harmed. Our ability to attract and retain talented, diverse and highly skilled employees is critical to our success and competitiveness. Our success depends on our ability to recruit and retain talented and diverse employees who are highly skilled in their areas. In particular, our vehicles and connected services increasingly rely on software and hardware that is highly technical and complex and our success in this area is dependent upon our ability to retain and recruit the best talent. The market for highly skilled workers and leaders in our industry is extremely competitive. In addition to compensation considerations, current and potential employees are increasingly placing a premium on culture and other various intangibles, such as working for companies with a clear purpose and strong brand reputation, flexible work arrangements, and other considerations, such as embracing sustainability and diversity, equity and inclusion initiatives. Failure to attract, hire, develop, motivate and retain highly qualified and diverse employees could disrupt our operations and adversely affect our strategic plans. Our ability to maintain profitability is dependent upon our ability to timely fund and introduce new and improved vehicle models, including EVs, that are able to attract a sufficient number of consumers. We operate in a very competitive industry with market participants routinely introducing new and improved vehicle models and features, at decreasing price points, designed to meet rapidly evolving consumer expectations. Producing new and improved vehicle models, including EVs, that preserve our reputation for designing, building and selling safe, high-quality cars, crossovers, trucks and SUVs is critical to our long-term profitability. Successful launches of our new vehicles are critical to our short-term profitability. The new vehicle development process can take two years or more, and a number of factors may lengthen that time period. Because of this product development cycle and the various elements that may contribute to consumers’ acceptance of new vehicle designs, including competitors’ product introductions, technological innovations, fuel prices, general economic conditions, regulatory developments, including tax credits or other government policies in various countries, transportation infrastructure and changes in quality, safety, reliability and styling demands and preferences, an initial product concept or design may not result in a saleable vehicle or a vehicle that generates sales in sufficient quantities and at high enough prices to be profitable. Our high proportion of fixed costs, both due to our significant investment in property, plant and equipment as well as other requirements of our collective bargaining agreements, which limit our flexibility to adjust personnel costs to changes in demands for our products, may further exacerbate the risks associated with incorrectly assessing demand for our vehicles. Our long-term strategy is dependent upon our ability to profitably deliver a strategic portfolio of EVs. The production and profitable sale of EVs has become increasingly important to our long-term business as we continue our transition to an allelectric future. Our EV strategy is dependent on our ability to deliver a strategic portfolio of high-quality EVs that are competitive and meet consumer demands; scale our EV manufacturing capabilities; reduce the costs associated with the manufacture of EVs, particularly with respect to battery cells and packs; increase vehicle range and the energy density of our batteries; efficiently source sufficient materials for the manufacture of battery cells; license and monetize our proprietary platforms and related innovations; successfully invest in new technologies relative to our peers; develop new software and services; and leverage our scale, manufacturing capabilities and synergies with existing ICE vehicles. Our progress towards these objectives has impacted, and may continue to impact, the need to record losses on our EV-related inventory, including battery cells.In addition, the success of our long-term strategy is dependent on consumer adoption of EVs. Consumer adoption of EVs could be impacted by numerous factors, including the breadth of the portfolio of EVs available; perceptions about EV features, quality, safety, performance and cost relative to ICE vehicles; the range over which EVs may be driven on a given battery charge; the proliferation and speed of charging infrastructure, in particular with respect to public EV charging stations, and the success of the Company's charging infrastructure programs and strategic joint ventures and other relationships; cost and availability of high fuel-economy ICE vehicles; volatility, or a sustained decrease, in the cost of petroleum-based fuel; failure by governments and other third parties to make the investments necessary to make infrastructure improvements, such as greater availability of cleaner energy grids and EV charging stations, and to provide meaningful and fully utilizable economic incentives promoting the adoption of EVs, including production and consumer credits contemplated by the Inflation Reduction Act (IRA); and negative feedback from stakeholders impacting investor and consumer confidence in our company or industry. If we are unable to successfully deliver on our EV strategy, it could materially and adversely affect our results of operations, financial condition and growth prospects, and could negatively impact our brand and reputation. Our near-term profitability is dependent upon the success of our current line of ICE vehicles, particularly our full-size ICE SUVs and full-size ICE pickup trucks. While we offer a broad portfolio of cars, crossovers, SUVs and trucks, and we have announced significant plans to design, build and sell a strategic portfolio of EVs, we currently recognize the highest profit margins on our full-size ICE SUVs and full-size ICE pickup trucks. As a result, our near-term success is dependent upon our ability to sell higher margin vehicles in sufficient volumes. We are also using the cash generated by our ICE vehicles to fund our growth strategy, including with respect to EVs and AVs. Any near-term shift in consumer preferences toward smaller, more fuel-efficient vehicles, whether as a result of increases in the price of oil or any sustained shortage of oil, including as a result of global political instability (such as related to the ongoing conflicts in Ukraine and Gaza), concerns about fuel consumption or GHG emissions, or other reasons, could weaken the demand for our higher margin vehicles. More stringent fuel economy regulations could also impact our ability to sell these vehicles or could result in additional costs associated with these vehicles, which could be material. See “Our operations and products are subject to extensive laws, regulations and policies, including those related to vehicle emissions and fuel economy standards, which can significantly increase our costs and affect how we do business.”",Financial,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",I've heard some people talk about the constitution and how it has racist traits. What is the three fifths part about in regard to black men and what does it mean? How is this legal and what does it mean to primarily prisons and people in jail through the legal system. I hate reading so can ou limit this to 200 words.,"the 13th Amendment officially was ratified, and with it, slavery finally was abolished in America. The New York World hailed it as “one of the most important reforms ever accomplished by voluntary human agency.” The newspaper said the amendment “takes out of politics, and consigns to history, an institution incongruous to our political system, inconsistent with justice and repugnant to the humane sentiments fostered by Christian civilization.” With the passage of the 13th Amendment—which states that “[n]either slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction”—the central contradiction at the heart of the Founding was resolved. Eighty-nine years after the Declaration of Independence had proclaimed all men to be free and equal, race-based chattel slavery would be no more in the United States. While all today recognize this momentous accomplishment, many remain confused about the status of slavery under the original Constitution. Textbooks and history books routinely dismiss the Constitution as racist and pro-slavery. The New York Times, among others, continues to casually assert that the Constitution affirmed African-Americans to be worth only three-fifths of a human being. Ironically, many Americans who are resolutely opposed to racism unwittingly agree with Chief Justice Roger Taney’s claim in Dred Scott v. Sandford (1857) that the Founders’ Constitution regarded blacks as “so far inferior that they had no rights which the white man was bound to respect, and that the negro might justly and lawfully be reduced to slavery for his benefit.” In this view, the worst Supreme Court case decision in American history was actually correctly decided. The argument that the Constitution is racist suffers from one fatal flaw: the concept of race does not exist in the Constitution. Such arguments have unsettling implications for the health of our republic. They teach citizens to despise their founding charter and to be ashamed of their country’s origins. They make the Constitution an object of contempt rather than reverence. And they foster alienation and resentment among African-American citizens by excluding them from our Constitution. The received wisdom in this case is wrong. If we turn to the actual text of the Constitution and the debates that gave rise to it, a different picture emerges. The case for a racist, pro-slavery Constitution collapses under closer scrutiny. Race and the Constitution The argument that the Constitution is racist suffers from one fatal flaw: the concept of race does not exist in the Constitution. Nowhere in the Constitution—or in the Declaration of Independence, for that matter—are human beings classified according to race, skin color, or ethnicity (nor, one should add, sex, religion, or any other of the left’s favored groupings). Our founding principles are colorblind (although our history, regrettably, has not been). The Constitution speaks of people, citizens, persons, other persons (a euphemism for slaves) and Indians not taxed (in which case, it is their tax-exempt status, and not their skin color, that matters). The first references to “race” and “color” occur in the 15th Amendment’s guarantee of the right to vote, ratified in 1870. The infamous three-fifths clause, which more nonsense has been written than any other clause, does not declare that a black person is worth 60 percent of a white person. It says that for purposes of determining the number of representatives for each state in the House (and direct taxes), the government would count only three-fifths of the slaves, and not all of them, as the Southern states, who wanted to gain more seats, had insisted. The 60,000 or so free blacks in the North and the South were counted on par with whites. Contrary to a popular misconception, the Constitution also does not say that only white males who owned property could vote. The Constitution defers to the states to determine who shall be eligible to vote (Article I, Section 2, Clause 1). It is a little known fact of American history that black citizens were voting in perhaps as many as 10 states at the time of the founding (the precise number is unclear, but only Georgia, South Carolina, and Virginia explicitly restricted suffrage to whites). Slavery and the Constitution Not only does the Constitution not mention blacks or whites, but it also doesn’t mention slaves or slavery. Throughout the document, slaves are referred to as persons to underscore their humanity. As James Madison remarked during the constitutional convention, it was “wrong to admit in the Constitution the idea that there could be property in men.” The Constitution refers to slaves using three different formulations: “other persons” (Article I, Section 2, Clause 3), “such persons as any of the states now existing shall think proper to admit” (Article I, Section 9, Clause 1), and a “person held to service or labor in one state, under the laws thereof” (Article IV, Section 2, Clause 3). Although these circumlocutions may not have done much to improve the lot of slaves, they are important, as they denied constitutional legitimacy to the institution of slavery. The practice remained legal, but slaveholders could not invoke the supreme law of the land to defend its legitimacy. These formulations make clear that slavery is a state institution that is tolerated—but not sanctioned—by the national government and the Constitution. Reading the original Constitution, a visitor from a foreign land would simply have no way of knowing that race-based slavery existed in America. As Abraham Lincoln would later explain: Thus, the thing is hid away, in the Constitution, just as an afflicted man hides away a wen or a cancer, which he dares not cut out at once, lest he bleed to death.","""================ ======= the 13th Amendment officially was ratified, and with it, slavery finally was abolished in America. The New York World hailed it as “one of the most important reforms ever accomplished by voluntary human agency.” The newspaper said the amendment “takes out of politics, and consigns to history, an institution incongruous to our political system, inconsistent with justice and repugnant to the humane sentiments fostered by Christian civilization.” With the passage of the 13th Amendment—which states that “[n]either slavery nor involuntary servitude, except as a punishment for crime whereof the party shall have been duly convicted, shall exist within the United States, or any place subject to their jurisdiction”—the central contradiction at the heart of the Founding was resolved. Eighty-nine years after the Declaration of Independence had proclaimed all men to be free and equal, race-based chattel slavery would be no more in the United States. While all today recognize this momentous accomplishment, many remain confused about the status of slavery under the original Constitution. Textbooks and history books routinely dismiss the Constitution as racist and pro-slavery. The New York Times, among others, continues to casually assert that the Constitution affirmed African-Americans to be worth only three-fifths of a human being. Ironically, many Americans who are resolutely opposed to racism unwittingly agree with Chief Justice Roger Taney’s claim in Dred Scott v. Sandford (1857) that the Founders’ Constitution regarded blacks as “so far inferior that they had no rights which the white man was bound to respect, and that the negro might justly and lawfully be reduced to slavery for his benefit.” In this view, the worst Supreme Court case decision in American history was actually correctly decided. The argument that the Constitution is racist suffers from one fatal flaw: the concept of race does not exist in the Constitution. Such arguments have unsettling implications for the health of our republic. They teach citizens to despise their founding charter and to be ashamed of their country’s origins. They make the Constitution an object of contempt rather than reverence. And they foster alienation and resentment among African-American citizens by excluding them from our Constitution. The received wisdom in this case is wrong. If we turn to the actual text of the Constitution and the debates that gave rise to it, a different picture emerges. The case for a racist, pro-slavery Constitution collapses under closer scrutiny. Race and the Constitution The argument that the Constitution is racist suffers from one fatal flaw: the concept of race does not exist in the Constitution. Nowhere in the Constitution—or in the Declaration of Independence, for that matter—are human beings classified according to race, skin color, or ethnicity (nor, one should add, sex, religion, or any other of the left’s favored groupings). Our founding principles are colorblind (although our history, regrettably, has not been). The Constitution speaks of people, citizens, persons, other persons (a euphemism for slaves) and Indians not taxed (in which case, it is their tax-exempt status, and not their skin color, that matters). The first references to “race” and “color” occur in the 15th Amendment’s guarantee of the right to vote, ratified in 1870. The infamous three-fifths clause, which more nonsense has been written than any other clause, does not declare that a black person is worth 60 percent of a white person. It says that for purposes of determining the number of representatives for each state in the House (and direct taxes), the government would count only three-fifths of the slaves, and not all of them, as the Southern states, who wanted to gain more seats, had insisted. The 60,000 or so free blacks in the North and the South were counted on par with whites. Contrary to a popular misconception, the Constitution also does not say that only white males who owned property could vote. The Constitution defers to the states to determine who shall be eligible to vote (Article I, Section 2, Clause 1). It is a little known fact of American history that black citizens were voting in perhaps as many as 10 states at the time of the founding (the precise number is unclear, but only Georgia, South Carolina, and Virginia explicitly restricted suffrage to whites). Slavery and the Constitution Not only does the Constitution not mention blacks or whites, but it also doesn’t mention slaves or slavery. Throughout the document, slaves are referred to as persons to underscore their humanity. As James Madison remarked during the constitutional convention, it was “wrong to admit in the Constitution the idea that there could be property in men.” The Constitution refers to slaves using three different formulations: “other persons” (Article I, Section 2, Clause 3), “such persons as any of the states now existing shall think proper to admit” (Article I, Section 9, Clause 1), and a “person held to service or labor in one state, under the laws thereof” (Article IV, Section 2, Clause 3). Although these circumlocutions may not have done much to improve the lot of slaves, they are important, as they denied constitutional legitimacy to the institution of slavery. The practice remained legal, but slaveholders could not invoke the supreme law of the land to defend its legitimacy. These formulations make clear that slavery is a state institution that is tolerated—but not sanctioned—by the national government and the Constitution. Reading the original Constitution, a visitor from a foreign land would simply have no way of knowing that race-based slavery existed in America. As Abraham Lincoln would later explain: Thus, the thing is hid away, in the Constitution, just as an afflicted man hides away a wen or a cancer, which he dares not cut out at once, lest he bleed to death. https://www.heritage.org/the-constitution/commentary/what-the-constitution-really-says-about-race-and-slavery ================ ======= I've heard some people talk about the constitution and how it has racist traits. What is the three fifths part about in regard to black men and what does it mean? How is this legal and what does it mean to primarily prisons and people in jail through the legal system. I hate reading so can ou limit this to 200 words. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Legal,Summarize,Text Transformation You will use only the information presented by the user when answering the user's questions. You will not use external sources or your own stored data to answer these questions.,What are the mentioned pros and cons of using historical precedent to decide the case in the context block?,"The Supreme Court’s Opinion The Court, in an opinion by Chief Justice Roberts, held that § 922(g)(8) is consistent with the Second Amendment, reversing the Fifth Circuit and rejecting Rahimi’s challenge to the law.64 The Court emphasized that the scope of the Second Amendment is not limited to those laws that “precisely match . . . historical precursors” or that are “identical” to laws from 1791, as if the Second Amendment were “trapped in amber.”65 Instead, the Court explained that, under Bruen, a court is required to assess whether a challenged law is “relevantly similar” to laws from the country’s regulatory tradition, with “why and how” the challenged law burdens the Second Amendment right being the “central” considerations in this inquiry.66 In the context of § 922(g)(8), the Court determined that sufficient historical support existed for the principle that, “[w]hen an individual poses a clear threat of physical violence to another, the threatening individual may be disarmed.”67 The Court found that surety laws, which were designed to prevent firearm violence by requiring an individual who posed a credible threat of violence to another to post a surety, and “going armed” laws, which punished individuals who had menaced others or disturbed the public order with firearms through imprisonment or disarmament, established a historical tradition of similar firearm regulation.68 In the Court’s view, 57 Id. at 456. “Going armed” laws refer to the ancient criminal offense of “going armed to terrify the King’s subjects.” Id. at 457. Surety laws were common law allowing an individual who could show “just cause to fear” injury from another to “demand surety of the peace against such person.” Id. at 459. The individual causing fear would then be required to post monetary surety or be forbidden from carrying arms. Id. 58 Id. at 460. 59 Id. at 461. 60 Petition for Writ of Certiorari, United States v. Rahimi, No. 22-915 (U.S. Mar. 17, 2023). 61 Rahimi, 143 S. Ct. at 2688–89. 62 Petition for Writ of Certiorari, supra note footnote 60, at I. 63 Rahimi, 61 F.4th at 449 n.2. 64 United States v. Rahimi, 144 S. Ct. 1889, 1898 (2024). 65 Id. at 1897–98. 66 Id. at 1898. 67 Id. at 1901. 68 Id. at 1901–02. Congressional Research Service 6 Supreme Court Term October 2023: A Review of Selected Major Rulings § 922(g)(8), which disarms an individual found by a judge to threaten the physical safety of another, “fits neatly” within this tradition.69 The Court emphasized that § 922(g)(8) is of “limited duration,” prohibiting firearm possession for only as long as the individual is subject to the restraining order, and Rahimi himself was subject to the order for up to two years after his release from prison.70 The Court also explained that, historically, individuals could be imprisoned for threatening others with firearms, so the regulatory burden imposed by § 922(g)(8) was less than the more severe penalty of imprisonment.71 Finally, the Court rejected the government’s argument that Rahimi may be disarmed simply because he is not “responsible,” clarifying that, although the Court’s precedents describe “responsible” individuals as those who enjoy the Second Amendment right, this wording was a vague description rather than a legal line being drawn.72 Concurring and Dissenting Opinions A majority of the Court—six Justices in total—wrote separately to concur or dissent, offering their individual views on how the Second Amendment and the Bruen standard should be properly interpreted both in this case and in future cases. Justice Sotomayor’s concurring opinion, joined by Justice Kagan, expressed her continued view that Bruen was wrongly decided and that a different legal standard should apply to Second Amendment cases.73 She wrote separately to emphasize that when applying the Bruen historical tradition standard, however, the majority’s methodology was the “right one.”74 In Justice Sotomayor’s view, this is an “easy case,” as § 922(g)(8) is “wholly consistent” with historical firearms regulations.75 By contrast, she criticized the dissenting view as too “rigid,” characterizing it as “insist[ing] that the means of addressing that problem cannot be ‘materially different’ from the means that existed in the eighteenth century,” which would unduly hamstring modern policy efforts.76 In his concurring opinion, Justice Gorsuch underscored the difficulty in maintaining a facial challenge to a law, which requires a showing that the law has no constitutional applications.77 He also defended the Bruen historical tradition standard, arguing that the original meaning of the Constitution, while “an imperfect guide,” provides proper constraints on judicial decisionmaking and is better than unbounded alternatives such as an interest-balancing inquiry.78 Justice Gorsuch also cautioned that the Court decided a narrow question—whether § 922(g)(3) “has any lawful scope”—and that future defendants could argue that § 922(g)(3) was unconstitutional under particular facts.79 69 Id. at 1901. 70 Id. at 1902. 71 Id. 72 Id. at 1903. 73 Id. at 1904 (Sotomayor, J., concurring). 74 Id. 75 Id. 76 Id. at 1905. 77 Id. at 1907 (Gorsuch, J., concurring). 78 Id. at 1909. 79 Id. at 1910. Congressional Research Service 7 Supreme Court Term October 2023: A Review of Selected Major Rulings Justice Kavanaugh concurred to expound his view on the roles of text, history, and precedent in constitutional interpretation. He explained that unambiguous text controls and that history, rather than policy, is a more neutral and principled guide for constitutional decisionmaking when the text is unclear.80 Using historical examples, Justice Kavanaugh illustrated his view on how pre- and post-ratification history may inform the meaning of vague constitutional text.81 Next, he argued that balancing tests in constitutional cases are a relatively recent development, generally depart from tests centered on text and history, are inherently subjective, and should not be extended to the Second Amendment arena.82 Finally, he opined that the majority’s opinion was faithful to his perception of the appropriate roles of text, history, and precedent in constitutional adjudication in this particular case.83 Justice Barrett wrote a concurring opinion to explain her understanding of the relationship between Bruen’s historical tradition test and originalism as a method of constitutional interpretation. In her view, historical tradition is a means to understand original meaning, and, accordingly, historical practice around the time of ratification should be the focus of the legal inquiry.84 In her view, history demonstrates that, “[s]ince the founding, our Nation’s firearm laws have included provisions preventing individuals who threaten physical harm to others from misusing firearms.” Justice Barrett agreed with the majority that § 922(g)(8) “fits well within that principle.”85 Justice Jackson also wrote a concurring opinion, agreeing that the majority fairly applied Bruen as precedent.86 She wrote separately to highlight what she perceived as problems with applying the history-and-tradition standard in a workable manner.87 She argued that Rahimi illustrates the “pitfalls of Bruen’s approach” by demonstrating the difficulty of sifting through the historical record and determining whether historical evidence establishes a tradition of sufficiently analogous regulation.88 The numerous unanswered questions that remain even after Rahimi, in her view, result in “the Rule of Law suffer[ing].”89 Stating that legal standards should “foster stability, facilitate consistency, and promote predictability,” Justice Jackson concluded by arguing that “Bruen’s history-focused test ticks none of those boxes.”90 Justice Thomas was the sole dissenter. In his view, the historical examples cited by the majority were not sufficient to establish a tradition of firearm regulation that justified § 922(g)(8).91 According to Justice Thomas, courts should look to two metrics to evaluate whether historical examples of regulation are analogous to modern enactments: “how and why the regulations burden a law-abiding citizen’s right to armed self-defense.”92 In his view, the two categories of evidence proffered by the government—historical laws disarming “dangerous” individuals and historical characterization of the right to bear arms as belonging only to “peaceable” citizens— 80 Id. at 1912 (Kavanaugh, J., concurring). 81 Id. at 1913–19. 82 Id. at 1921. 83 Id. at 1923. 84 Id. at 1924 (Barrett, J., concurring). 85 Id. at 1926 (quoting Rahimi, 144 S. Ct. at 1896 (majority opinion)). 86 Id. (Jackson, J., concurring). 87 Id. at 1928. 88 Id. 89 Id. at 1929. 90 Id. 91 Id. at 1930 (Thomas, J., dissenting). 92 Id. at 1931–32. Congressional Research Service 8 Supreme Court Term October 2023: A Review of Selected Major Rulings did not impose comparable burdens as § 922(g)(8).93 Justice Thomas argued that § 922(g)(8) was enacted in response to “interpersonal violence,” whereas the historical English laws were concerned with insurrection and rebellion.94 Ultimately, Rahimi could have been disarmed, in Justice Thomas’s view, through criminal conviction but not through a restraining order.95 ","You will use only the information presented by the user when answering the user's questions. You will not use external sources or your own stored data to answer these questions. What are the mentioned pros and cons of using historical precedent to decide the case in the context block? The Supreme Court’s Opinion The Court, in an opinion by Chief Justice Roberts, held that § 922(g)(8) is consistent with the Second Amendment, reversing the Fifth Circuit and rejecting Rahimi’s challenge to the law.64 The Court emphasized that the scope of the Second Amendment is not limited to those laws that “precisely match . . . historical precursors” or that are “identical” to laws from 1791, as if the Second Amendment were “trapped in amber.”65 Instead, the Court explained that, under Bruen, a court is required to assess whether a challenged law is “relevantly similar” to laws from the country’s regulatory tradition, with “why and how” the challenged law burdens the Second Amendment right being the “central” considerations in this inquiry.66 In the context of § 922(g)(8), the Court determined that sufficient historical support existed for the principle that, “[w]hen an individual poses a clear threat of physical violence to another, the threatening individual may be disarmed.”67 The Court found that surety laws, which were designed to prevent firearm violence by requiring an individual who posed a credible threat of violence to another to post a surety, and “going armed” laws, which punished individuals who had menaced others or disturbed the public order with firearms through imprisonment or disarmament, established a historical tradition of similar firearm regulation.68 In the Court’s view, 57 Id. at 456. “Going armed” laws refer to the ancient criminal offense of “going armed to terrify the King’s subjects.” Id. at 457. Surety laws were common law allowing an individual who could show “just cause to fear” injury from another to “demand surety of the peace against such person.” Id. at 459. The individual causing fear would then be required to post monetary surety or be forbidden from carrying arms. Id. 58 Id. at 460. 59 Id. at 461. 60 Petition for Writ of Certiorari, United States v. Rahimi, No. 22-915 (U.S. Mar. 17, 2023). 61 Rahimi, 143 S. Ct. at 2688–89. 62 Petition for Writ of Certiorari, supra note footnote 60, at I. 63 Rahimi, 61 F.4th at 449 n.2. 64 United States v. Rahimi, 144 S. Ct. 1889, 1898 (2024). 65 Id. at 1897–98. 66 Id. at 1898. 67 Id. at 1901. 68 Id. at 1901–02. Congressional Research Service 6 Supreme Court Term October 2023: A Review of Selected Major Rulings § 922(g)(8), which disarms an individual found by a judge to threaten the physical safety of another, “fits neatly” within this tradition.69 The Court emphasized that § 922(g)(8) is of “limited duration,” prohibiting firearm possession for only as long as the individual is subject to the restraining order, and Rahimi himself was subject to the order for up to two years after his release from prison.70 The Court also explained that, historically, individuals could be imprisoned for threatening others with firearms, so the regulatory burden imposed by § 922(g)(8) was less than the more severe penalty of imprisonment.71 Finally, the Court rejected the government’s argument that Rahimi may be disarmed simply because he is not “responsible,” clarifying that, although the Court’s precedents describe “responsible” individuals as those who enjoy the Second Amendment right, this wording was a vague description rather than a legal line being drawn.72 Concurring and Dissenting Opinions A majority of the Court—six Justices in total—wrote separately to concur or dissent, offering their individual views on how the Second Amendment and the Bruen standard should be properly interpreted both in this case and in future cases. Justice Sotomayor’s concurring opinion, joined by Justice Kagan, expressed her continued view that Bruen was wrongly decided and that a different legal standard should apply to Second Amendment cases.73 She wrote separately to emphasize that when applying the Bruen historical tradition standard, however, the majority’s methodology was the “right one.”74 In Justice Sotomayor’s view, this is an “easy case,” as § 922(g)(8) is “wholly consistent” with historical firearms regulations.75 By contrast, she criticized the dissenting view as too “rigid,” characterizing it as “insist[ing] that the means of addressing that problem cannot be ‘materially different’ from the means that existed in the eighteenth century,” which would unduly hamstring modern policy efforts.76 In his concurring opinion, Justice Gorsuch underscored the difficulty in maintaining a facial challenge to a law, which requires a showing that the law has no constitutional applications.77 He also defended the Bruen historical tradition standard, arguing that the original meaning of the Constitution, while “an imperfect guide,” provides proper constraints on judicial decisionmaking and is better than unbounded alternatives such as an interest-balancing inquiry.78 Justice Gorsuch also cautioned that the Court decided a narrow question—whether § 922(g)(3) “has any lawful scope”—and that future defendants could argue that § 922(g)(3) was unconstitutional under particular facts.79 69 Id. at 1901. 70 Id. at 1902. 71 Id. 72 Id. at 1903. 73 Id. at 1904 (Sotomayor, J., concurring). 74 Id. 75 Id. 76 Id. at 1905. 77 Id. at 1907 (Gorsuch, J., concurring). 78 Id. at 1909. 79 Id. at 1910. Congressional Research Service 7 Supreme Court Term October 2023: A Review of Selected Major Rulings Justice Kavanaugh concurred to expound his view on the roles of text, history, and precedent in constitutional interpretation. He explained that unambiguous text controls and that history, rather than policy, is a more neutral and principled guide for constitutional decisionmaking when the text is unclear.80 Using historical examples, Justice Kavanaugh illustrated his view on how pre- and post-ratification history may inform the meaning of vague constitutional text.81 Next, he argued that balancing tests in constitutional cases are a relatively recent development, generally depart from tests centered on text and history, are inherently subjective, and should not be extended to the Second Amendment arena.82 Finally, he opined that the majority’s opinion was faithful to his perception of the appropriate roles of text, history, and precedent in constitutional adjudication in this particular case.83 Justice Barrett wrote a concurring opinion to explain her understanding of the relationship between Bruen’s historical tradition test and originalism as a method of constitutional interpretation. In her view, historical tradition is a means to understand original meaning, and, accordingly, historical practice around the time of ratification should be the focus of the legal inquiry.84 In her view, history demonstrates that, “[s]ince the founding, our Nation’s firearm laws have included provisions preventing individuals who threaten physical harm to others from misusing firearms.” Justice Barrett agreed with the majority that § 922(g)(8) “fits well within that principle.”85 Justice Jackson also wrote a concurring opinion, agreeing that the majority fairly applied Bruen as precedent.86 She wrote separately to highlight what she perceived as problems with applying the history-and-tradition standard in a workable manner.87 She argued that Rahimi illustrates the “pitfalls of Bruen’s approach” by demonstrating the difficulty of sifting through the historical record and determining whether historical evidence establishes a tradition of sufficiently analogous regulation.88 The numerous unanswered questions that remain even after Rahimi, in her view, result in “the Rule of Law suffer[ing].”89 Stating that legal standards should “foster stability, facilitate consistency, and promote predictability,” Justice Jackson concluded by arguing that “Bruen’s history-focused test ticks none of those boxes.”90 Justice Thomas was the sole dissenter. In his view, the historical examples cited by the majority were not sufficient to establish a tradition of firearm regulation that justified § 922(g)(8).91 According to Justice Thomas, courts should look to two metrics to evaluate whether historical examples of regulation are analogous to modern enactments: “how and why the regulations burden a law-abiding citizen’s right to armed self-defense.”92 In his view, the two categories of evidence proffered by the government—historical laws disarming “dangerous” individuals and historical characterization of the right to bear arms as belonging only to “peaceable” citizens— 80 Id. at 1912 (Kavanaugh, J., concurring). 81 Id. at 1913–19. 82 Id. at 1921. 83 Id. at 1923. 84 Id. at 1924 (Barrett, J., concurring). 85 Id. at 1926 (quoting Rahimi, 144 S. Ct. at 1896 (majority opinion)). 86 Id. (Jackson, J., concurring). 87 Id. at 1928. 88 Id. 89 Id. at 1929. 90 Id. 91 Id. at 1930 (Thomas, J., dissenting). 92 Id. at 1931–32. Congressional Research Service 8 Supreme Court Term October 2023: A Review of Selected Major Rulings did not impose comparable burdens as § 922(g)(8).93 Justice Thomas argued that § 922(g)(8) was enacted in response to “interpersonal violence,” whereas the historical English laws were concerned with insurrection and rebellion.94 Ultimately, Rahimi could have been disarmed, in Justice Thomas’s view, through criminal conviction but not through a restraining order.95 ",Legal,Pros & Cons,Q&A Respond using only the information contained within this prompt.,"According to this report, can someone vote in the Annual Meeting if they bought shares in Tripadvisor for the first time 3 months before the meeting date?","The 2024 Annual Meeting of Stockholders of Tripadvisor, Inc., a Delaware corporation, will be held on Tuesday, June 11, 2024, at 11:00 a.m. Eastern Time. The Annual Meeting will be held via the Internet and will be a completely virtual meeting. You may attend the Annual Meeting, submit questions, and vote your shares electronically during the meeting via the Internet by visiting www.virtualshareholdermeeting.com/TRIP2024. To enter the Annual Meeting, you will need the 16-digit control number that is printed in the box marked by the arrow on your proxy card. We recommend logging in at least fifteen minutes before the meeting to ensure that you are correctly logged in when the Annual Meeting begins. The online check-in will start shortly before the Annual Meeting on June 11, 2024. At the Annual Meeting, stockholders will be asked to consider and vote on the following proposals: 1. To elect the ten directors named in this Proxy Statement, each to serve for a one-year term from the date of his or her election and until such director’s successor is elected or until such director’s earlier resignation or removal; 2. To ratify the appointment of KPMG LLP as our independent registered public accounting firm for the fiscal year ending December 31, 2024; 3. To approve, on a non-binding advisory basis, the compensation of our named executive officers; 4. To vote, on a non-binding advisory basis, on the frequency of future advisory resolutions to approve the compensation of our named executive officers; 5. To vote on the stockholder proposal requesting a report on implementation of the Global Human Rights Policy concerning operations in CAHRAs; and 6. To consider and act upon any other business that may properly come before the Annual Meeting and any adjournments or postponements thereof. Only holders of record of outstanding shares of Tripadvisor capital stock at the close of business on April 15, 2024 are entitled to notice of and to vote at the Annual Meeting and at any adjournments or postponements thereof. We will furnish the Notice of Annual Meeting of Stockholders, Proxy Statement and Annual Report on Form 10-K for the fiscal year ended December 31, 2023 over the Internet. Whether or not you plan to attend the Annual Meeting, we encourage you to access and read the accompanying Proxy Statement. We will send to our stockholders a Notice of Internet Availability of Proxy Materials on or about April 26, 2024, and provide access to our proxy materials over the Internet to our holders of record and beneficial owners of our capital stock as of the close of business on the record date. You may request paper copies by following the instructions on the Notice of Internet Availability of Proxy Materials.","System instruction: Respond using only the information contained within this prompt. context: The 2024 Annual Meeting of Stockholders of Tripadvisor, Inc., a Delaware corporation, will be held on Tuesday, June 11, 2024, at 11:00 a.m. Eastern Time. The Annual Meeting will be held via the Internet and will be a completely virtual meeting. You may attend the Annual Meeting, submit questions, and vote your shares electronically during the meeting via the Internet by visiting www.virtualshareholdermeeting.com/TRIP2024. To enter the Annual Meeting, you will need the 16-digit control number that is printed in the box marked by the arrow on your proxy card. We recommend logging in at least fifteen minutes before the meeting to ensure that you are correctly logged in when the Annual Meeting begins. The online check-in will start shortly before the Annual Meeting on June 11, 2024. At the Annual Meeting, stockholders will be asked to consider and vote on the following proposals: 1. To elect the ten directors named in this Proxy Statement, each to serve for a one-year term from the date of his or her election and until such director’s successor is elected or until such director’s earlier resignation or removal; 2. To ratify the appointment of KPMG LLP as our independent registered public accounting firm for the fiscal year ending December 31, 2024; 3. To approve, on a non-binding advisory basis, the compensation of our named executive officers; 4. To vote, on a non-binding advisory basis, on the frequency of future advisory resolutions to approve the compensation of our named executive officers; 5. To vote on the stockholder proposal requesting a report on implementation of the Global Human Rights Policy concerning operations in CAHRAs; and 6. To consider and act upon any other business that may properly come before the Annual Meeting and any adjournments or postponements thereof. Only holders of record of outstanding shares of Tripadvisor capital stock at the close of business on April 15, 2024 are entitled to notice of and to vote at the Annual Meeting and at any adjournments or postponements thereof. We will furnish the Notice of Annual Meeting of Stockholders, Proxy Statement and Annual Report on Form 10-K for the fiscal year ended December 31, 2023 over the Internet. Whether or not you plan to attend the Annual Meeting, we encourage you to access and read the accompanying Proxy Statement. We will send to our stockholders a Notice of Internet Availability of Proxy Materials on or about April 26, 2024, and provide access to our proxy materials over the Internet to our holders of record and beneficial owners of our capital stock as of the close of business on the record date. You may request paper copies by following the instructions on the Notice of Internet Availability of Proxy Materials. question: According to this report, can someone vote in the Annual Meeting if they bought shares in Tripadvisor for the first time 3 months before the meeting date?",Financial,Fact Finding,Q&A "You will be provided with a user prompt and a context block. Only respond to prompts using information that has been provided in the context block. Do not use any outside knowledge to answer prompts. If you cannot answer a prompt based on the information in the context block alone, please state ""I unable to determine that without additional context"" and do not add anything further.","According to the author of the preface, who cannot accept that value investing works?","Preface to the Sixth Edition THE TIMELESS WISDOM OF GRAHAM AND DODD BY SETH A. KLARMAN Seventy-five years after Benjamin Graham and David Dodd wrote Security Analysis, a growing coterie of modern-day value investors remain deeply indebted to them. Graham and David were two assiduous and unusually insightful thinkers seeking to give order to the mostly uncharted financial wilderness of their era. They kindled a flame that has illuminated the way for value investors ever since. Today, Security Analysis remains an invaluable roadmap for investors as they navigate through unpredictable, often volatile, and sometimes treacherous finan- cial markets. Frequently referred to as the “bible of value investing,” Secu- rity Analysis is extremely thorough and detailed, teeming with wisdom for the ages. Although many of the examples are obviously dated, their les- sons are timeless. And while the prose may sometimes seem dry, readers can yet discover valuable ideas on nearly every page. The financial mar- kets have morphed since 1934 in almost unimaginable ways, but Graham and Dodd’s approach to investing remains remarkably applicable today. Value investing, today as in the era of Graham and Dodd, is the prac- tice of purchasing securities or assets for less than they are worth—the proverbial dollar for 50 cents. Investing in bargain-priced securities pro- vides a “margin of safety”—room for error, imprecision, bad luck, or the vicissitudes of the economy and stock market. While some might mistak- enly consider value investing a mechanical tool for identifying bargains, it is actually a comprehensive investment philosophy that emphasizes the need to perform in-depth fundamental analysis, pursue long-term investment results, limit risk, and resist crowd psychology. Far too many people approach the stock market with a focus on mak- ing money quickly. Such an orientation involves speculation rather than investment and is based on the hope that share prices will rise irrespec- tive of valuation. Speculators generally regard stocks as pieces of paper to be quickly traded back and forth, foolishly decoupling them from business reality and valuation criteria. Speculative approaches—which pay little or no attention to downside risk—are especially popular in ris- ing markets. In heady times, few are sufficiently disciplined to maintain strict standards of valuation and risk aversion, especially when most of those abandoning such standards are quickly getting rich. After all, it is easy to confuse genius with a bull market. In recent years, some people have attempted to expand the defini- tion of an investment to include any asset that has recently—or might soon—appreciate in price: art, rare stamps, or a wine collection. Because these items have no ascertainable fundamental value, generate no pres- ent or future cash flow, and depend for their value entirely on buyer whim, they clearly constitute speculations rather than investments. In contrast to the speculator’s preoccupation with rapid gain, value investors demonstrate their risk aversion by striving to avoid loss. A risk- averse investor is one for whom the perceived benefit of any gain is out- weighed by the perceived cost of an equivalent loss. Once any of us has accumulated a modicum of capital, the incremental benefit of gaining more is typically eclipsed by the pain of having less.1 Imagine how you would respond to the proposition of a coin flip that would either double your net worth or extinguish it. Being risk averse, nearly all people would respectfully decline such a gamble. Such risk aversion is deeply ingrained in human nature. Yet many unwittingly set aside their risk aversion when the sirens of market speculation call. Value investors regard securities not as speculative instruments but as fractional ownership in, or debt claims on, the underlying businesses. This orientation is key to value investing. When a small slice of a business is offered at a bargain price, it is helpful to evaluate it as if the whole business were offered for sale there. This analytical anchor helps value investors remain focused on the pursuit of long-term results rather than the profitability of their daily trading ledger. At the root of Graham and Dodd’s philosophy is the principle that the financial markets are the ultimate creators of opportunity. Sometimes the markets price securities correctly, other times not. Indeed, in the short run, the market can be quite inefficient, with great deviations between price and underlying value. Unexpected developments, increased uncer- tainty, and capital flows can boost short-term market volatility, with prices overshooting in either direction.2 In the words of Graham and Dodd, “The price [of a security] is frequently an essential element, so that a stock . . . may have investment merit at one price level but not at another.” (p. 106) As Graham has instructed, those who view the market as a weighing machine—a precise and efficient assessor of value—are part of the emo- tionally driven herd. Those who regard the market as a voting machine—a sentiment-driven popularity contest—will be well positioned to take proper advantage of the extremes of market sentiment. While it might seem that anyone can be a value investor, the essential characteristics of this type of investor—patience, discipline, and risk aver- sion—may well be genetically determined. When you first learn of the value approach, it either resonates with you or it doesn’t. Either you are able to remain disciplined and patient, or you aren’t. As Warren Buffett said in his famous article, “The Superinvestors of Graham-and-Doddsville,” “It is extraordinary to me that the idea of buying dollar bills for 40 cents takes immediately with people or it doesn’t take at all. It’s like an inocula- tion. If it doesn’t grab a person right away, I find you can talk to him for years and show him records, and it doesn’t make any difference.” 3,4 If Security Analysis resonates with you—if you can resist speculating and sometimes sit on your hands—perhaps you have a predisposition toward value investing. If not, at least the book will help you understand where you fit into the investing landscape and give you an appreciation for what the value-investing community may be thinking. Just as Relevant Now Perhaps the most exceptional achievement of Security Analysis, first pub- lished in 1934 and revised in the acclaimed 1940 edition, is that its les- sons are timeless. Generations of value investors have adopted the teachings of Graham and Dodd and successfully implemented them across highly varied market environments, countries, and asset classes. 3 “The Superinvestors of Graham-and-Doddsville,” Hermes, the Columbia Business School magazine, 1984. 4 My own experience has been exactly the one that Buffett describes. My 1978 summer job at Mutual Shares, a no-load value-based mutual fund, set the course for my professional career. The planned liquidation of Telecor and spin-off of its Electro Rent subsidiary in 1980 forever imprinted in my mind the merit of fundamental investment analysis. A buyer of Telecor stock was effectively creating an investment in the shares of Electro Rent, a fast-growing equipment rental company, at the giveaway valuation of approximately 1 times the cash flow. You always remember your first value investment.This would delight the authors, who hoped to set forth principles that would “stand the test of the ever enigmatic future.” (p. xliv) In 1992, Tweedy, Browne Company LLC, a well-known value invest- ment firm, published a compilation of 44 research studies entitled, “What Has Worked in Investing.” The study found that what has worked is fairly simple: cheap stocks (measured by price-to-book values, price- to-earnings ratios, or dividend yields) reliably outperform expensive ones, and stocks that have underperformed (over three- and five-year periods) subsequently beat those that have lately performed well. In other words, value investing works! I know of no long-time practitioner who regrets adhering to a value philosophy; few investors who embrace the fundamental principles ever abandon this investment approach for another. Today, when you read Graham and Dodd’s description of how they navigated through the financial markets of the 1930s, it seems as if they were detailing a strange, foreign, and antiquated era of economic depression, extreme risk aversion, and obscure and obsolete businesses. But such an exploration is considerably more valuable than it superfi- cially appears. After all, each new day has the potential to bring with it a strange and foreign environment. Investors tend to assume that tomor- row’s markets will look very much like today’s, and, most of the time, they will. But every once in a while,5 conventional wisdom is turned on its head, circular reasoning is unraveled, prices revert to the mean, and speculative behavior is exposed as such. At those times, when today fails to resemble yesterday, most investors will be paralyzed. In the words of Graham and Dodd, “We have striven throughout to guard the student against overemphasis upon the superficial and the temporary,” which is “at once the delusion and the nemesis of the world of finance.” (p. xliv) It is during periods of tumult that a value-investing philosophy is particu- larly beneficial. In 1934, Graham and Dodd had witnessed over a five-year span the best and the worst of times in the markets—the run-up to the 1929 peak, the October 1929 crash, and the relentless grind of the Great Depression. They laid out a plan for how investors in any environment might sort through hundreds or even thousands of common stocks, pre- ferred shares, and bonds to identify those worthy of investment. Remark- ably, their approach is essentially the same one that value investors employ today. The same principles they applied to the U.S. stock and bond markets of the 1920s and 1930s apply to the global capital markets of the early twenty-first century, to less liquid asset classes like real estate and private equity, and even to derivative instruments that hardly existed when Security Analysis was written. While formulas such as the classic “net working capital” test are nec- essary to support an investment analysis, value investing is not a paint- by-numbers exercise.6 Skepticism and judgment are always required. For one thing, not all elements affecting value are captured in a company’s financial statements—inventories can grow obsolete and receivables uncollectible; liabilities are sometimes unrecorded and property values over- or understated. Second, valuation is an art, not a science. Because the value of a business depends on numerous variables, it can typically be assessed only within a range. Third, the outcomes of all investments depend to some extent on the future, which cannot be predicted with certainty; for this reason, even some carefully analyzed investments fail to achieve profitable outcomes. Sometimes a stock becomes cheap for good reason: a broken business model, hidden liabilities, protracted litigation, or incompetent or corrupt management. Investors must always act with caution and humility, relentlessly searching for additional infor- mation while realizing that they will never know everything about a company. In the end, the most successful value investors combine detailed business research and valuation work with endless discipline and patience, a well-considered sensitivity analysis, intellectual honesty, and years of analytical and investment experience. Interestingly, Graham and Dodd’s value-investing principles apply beyond the financial markets—including, for example, to the market for baseball talent, as eloquently captured in Moneyball, Michael Lewis’s 2003 bestseller. The market for baseball players, like the market for stocks and bonds, is inefficient—and for many of the same reasons. In both investing and baseball, there is no single way to ascertain value, no one metric that tells the whole story. In both, there are mountains of information and no broad consensus on how to assess it. Decision makers in both arenas mis- interpret available data, misdirect their analyses, and reach inaccurate conclusions. In baseball, as in securities, many overpay because they fear standing apart from the crowd and being criticized. They often make decisions for emotional, not rational, reasons. They become exuberant; they panic. Their orientation sometimes becomes overly short term. They fail to understand what is mean reverting and what isn’t. Baseball’s value investors, like financial market value investors, have achieved significant outperformance over time. While Graham and Dodd didn’t apply value principles to baseball, the applicability of their insights to the market for athletic talent attests to the universality and timelessness of this approach. Value Investing Today Amidst the Great Depression, the stock market and the national econ- omy were exceedingly risky. Downward movements in share prices and business activity came suddenly and could be severe and protracted. Optimists were regularly rebuffed by circumstances. Winning, in a sense, was accomplished by not losing. Investors could achieve a margin of safety by buying shares in businesses at a large discount to their under- lying value, and they needed a margin of safety because of all the things that could—and often did—go wrong. Even in the worst of markets, Graham and Dodd remained faithful to their principles, including their view that the economy and markets sometimes go through painful cycles, which must simply be endured. They expressed confidence, in those dark days, that the economy and stock market would eventually rebound: “While we were writing, we had to combat a widespread conviction that financial debacle was to be the permanent order.” (p. xliv) Of course, just as investors must deal with down cycles when busi- ness results deteriorate and cheap stocks become cheaper, they must also endure up cycles when bargains are scarce and investment capital is plentiful. In recent years, the financial markets have performed exceed- ingly well by historic standards, attracting substantial fresh capital in need of managers. Today, a meaningful portion of that capital—likely totaling in the trillions of dollars globally—invests with a value approach. This includes numerous value-based asset management firms and mutual funds, a number of today’s roughly 9,000 hedge funds, and some of the largest and most successful university endowments and family investment offices. It is important to note that not all value investors are alike. In the aforementioned “Superinvestors of Graham-and-Doddsville,” Buffett describes numerous successful value investors who have little portfolio overlap. Some value investors hold obscure, “pink-sheet shares” while others focus on the large-cap universe. Some have gone global, while others focus on a single market sector such as real estate or energy. Some run computer screens to identify statistically inexpensive compa- nies, while others assess “private market value”—the value an industry buyer would pay for the entire company. Some are activists who aggres- sively fight for corporate change, while others seek out undervalued securities with a catalyst already in place—such as a spin-off, asset sale, major share repurchase plan, or new management team—for the partial or full realization of the underlying value. And, of course, as in any pro- fession, some value investors are simply more talented than others. In the aggregate, the value-investing community is no longer the very small group of adherents that it was several decades ago. Competition can have a powerful corrective effect on market inefficiencies and mis- pricings. With today’s many amply capitalized and skilled investors, what are the prospects for a value practitioner? Better than you might expect, for several reasons. First, even with a growing value community, there are far more market participants with little or no value orientation. Most man- agers, including growth and momentum investors and market indexers, pay little or no attention to value criteria. Instead, they concentrate almost single-mindedly on the growth rate of a company’s earnings, the momentum of its share price, or simply its inclusion in a market index. Second, nearly all money managers today, including some hapless value managers, are forced by the (real or imagined) performance pres- sures of the investment business to have an absurdly short investment horizon, sometimes as brief as a calendar quarter, month, or less. A value strategy is of little use to the impatient investor since it usually takes time to pay off. Finally, human nature never changes. Capital market manias regularly occur on a grand scale: Japanese stocks in the late 1980s, Internet and technology stocks in 1999 and 2000, subprime mortgage lending in 2006 and 2007, and alternative investments currently. It is always difficult to take a contrarian approach. Even highly capable investors can wither under the relentless message from the market that they are wrong. The pressures to succumb are enormous; many investment managers fear they’ll lose business if they stand too far apart from the crowd. Some also fail to pursue value because they’ve handcuffed themselves (or been saddled by clients) with constraints preventing them from buying stocks selling at low dollar prices, small-cap stocks, stocks of companies that don’t pay dividends or are losing money, or debt instruments with below investment-grade ratings.7 Many also engage in career manage- ment techniques like “window dressing” their portfolios at the end of cal- endar quarters or selling off losers (even if they are undervalued) while buying more of the winners (even if overvalued). Of course, for those value investors who are truly long term oriented, it is a wonderful thing that many potential competitors are thrown off course by constraints that render them unable or unwilling to effectively compete. Another reason that greater competition may not hinder today’s value investors is the broader and more diverse investment landscape in which they operate. Graham faced a limited lineup of publicly traded U.S. equity and debt securities. Today, there are many thousands of publicly traded stocks in the United States alone, and many tens of thousands worldwide, plus thousands of corporate bonds and asset-backed debt securities. Previously illiquid assets, such as bank loans, now trade regu- larly. Investors may also choose from an almost limitless number of derivative instruments, including customized contracts designed to meet any need or hunch. Nevertheless, 25 years of historically strong stock market perform- ance have left the market far from bargain-priced. High valuations and intensified competition raise the specter of lower returns for value investors generally. Also, some value investment firms have become extremely large, and size can be the enemy of investment performance because decision making is slowed by bureaucracy and smaller opportu- nities cease to move the needle. In addition, because growing numbers of competent buy-side and sell-side analysts are plying their trade with the assistance of sophisti- cated information technology, far fewer securities seem likely to fall through the cracks to become extremely undervalued.8 Today’s value investors are unlikely to find opportunity armed only with a Value Line guide or by thumbing through stock tables. While bargains still occasion- ally hide in plain sight, securities today are most likely to become mis- priced when they are either accidentally overlooked or deliberately avoided. Consequently, value investors have had to become thoughtful about where to focus their analysis. In the early 2000s, for example, investors became so disillusioned with the capital allocation procedures of many South Korean companies that few considered them candidates for worthwhile investment. As a result, the shares of numerous South Korean companies traded at great discounts from prevailing international valuations: at two or three times the cash flow, less than half the underly- ing business value, and, in several cases, less than the cash (net of debt) held on their balance sheets. Bargain issues, such as Posco and SK Tele- com, ultimately attracted many value seekers; Warren Buffett reportedly profited handsomely from a number of South Korean holdings. Today’s value investors also find opportunity in the stocks and bonds of companies stigmatized on Wall Street because of involvement in pro-tracted litigation, scandal, accounting fraud, or financial distress. The securities of such companies sometimes trade down to bargain levels, where they become good investments for those who are able to remain stalwart in the face of bad news. For example, the debt of Enron, per- haps the world’s most stigmatized company after an accounting scandal forced it into bankruptcy in 2001, traded as low as 10 cents on the dollar of claim; ultimate recoveries are expected to be six times that amount. Similarly, companies with tobacco or asbestos exposure have in recent years periodically come under severe selling pressure due to the uncer- tainties surrounding litigation and the resultant risk of corporate finan- cial distress. More generally, companies that disappoint or surprise investors with lower-than-expected results, sudden management changes, accounting problems, or ratings downgrades are more likely than consistently strong performers to be sources of opportunity. When bargains are scarce, value investors must be patient; compro- mising standards is a slippery slope to disaster. New opportunities will emerge, even if we don’t know when or where. In the absence of com- pelling opportunity, holding at least a portion of one’s portfolio in cash equivalents (for example, U.S. Treasury bills) awaiting future deployment will sometimes be the most sensible option. Recently, Warren Buffett stated that he has more cash to invest than he has good investments. As all value investors must do from time to time, Buffett is waiting patiently. Still, value investors are bottom-up analysts, good at assessing securi- ties one at a time based on the fundamentals. They don’t need the entire market to be bargain priced, just 20 or 25 unrelated securities—a num- ber sufficient for diversification of risk. Even in an expensive market, value investors must keep analyzing securities and assessing businesses, gaining knowledge and experience that will be useful in the future. Value investors, therefore, should not try to time the market or guess whether it will rise or fall in the near term. Rather, they should rely on a bottom-up approach, sifting the financial markets for bargains and then buying them, regardless of the level or recent direction of the market or economy. Only when they cannot find bargains should they default to holding cash. A Flexible Approach Because our nation’s founders could not foresee—and knew they could not foresee—technological, social, cultural, and economic changes that the future would bring, they wrote a flexible constitution that still guides us over two centuries later. Similarly, Benjamin Graham and David Dodd acknowledged that they could not anticipate the business, economic, technological, and competitive changes that would sweep through the investment world over the ensuing years. But they, too, wrote a flexible treatise that provides us with the tools to function in an investment landscape that was destined—and remains destined—to undergo pro- found and unpredictable change. For example, companies today sell products that Graham and Dodd could not have imagined. Indeed, there are companies and entire indus- tries that they could not have envisioned. Security Analysis offers no examples of how to value cellular phone carriers, software companies, satellite television providers, or Internet search engines. But the book provides the analytical tools to evaluate almost any company, to assess the value of its marketable securities, and to determine the existence of a margin of safety. Questions of solvency, liquidity, predictability, busi- ness strategy, and risk cut across businesses, nations, and time. Graham and Dodd did not specifically address how to value private businesses or how to determine the value of an entire company rather than the value of a fractional interest through ownership of its shares.9 9 They did consider the relative merits of corporate control enjoyed by a private business owner ver- sus the value of marketability for a listed stock (p. 372). But their analytical principles apply equally well to these different issues. Investors still need to ask, how stable is the enterprise, and what are its future prospects? What are its earnings and cash flow? What is the downside risk of owning it? What is its liquidation value? How capable and honest is its management? What would you pay for the stock of this company if it were public? What factors might cause the owner of this business to sell control at a bargain price? Similarly, the pair never addressed how to analyze the purchase of an office building or apartment complex. Real estate bargains come about for the same reasons as securities bargains—an urgent need for cash, inability to perform proper analysis, a bearish macro view, or investor disfavor or neglect. In a bad real estate climate, tighter lending standards can cause even healthy properties to sell at distressed prices. Graham and Dodd’s principles—such as the stability of cash flow, sufficiency of return, and analysis of downside risk—allow us to identify real estate investments with a margin of safety in any market environment. Even complex derivatives not imagined in an earlier era can be scruti- nized with the value investor’s eye. While traders today typically price put and call options via the Black-Scholes model, one can instead use value-investing precepts—upside potential, downside risk, and the likeli- hood that each of various possible scenarios will occur—to analyze these instruments. An inexpensive option may, in effect, have the favorable risk-return characteristics of a value investment—regardless of what the Black-Scholes model dictates. Institutional Investing Perhaps the most important change in the investment landscape over the past 75 years is the ascendancy of institutional investing. In the 1930s, individual investors dominated the stock market. Today, by contrast, most market activity is driven by institutional investors—large pools of pension, endowment, and aggregated individual capital. While the advent of these large, quasi-permanent capital pools might have resulted in the wide-scale adoption of a long-term value-oriented approach, in fact this has not occurred. Instead, institutional investing has evolved into a short-term performance derby, which makes it diffi- cult for institutional managers to take contrarian or long-term positions. Indeed, rather than standing apart from the crowd and possibly suffering disappointing short-term results that could cause clients to withdraw capital, institutional investors often prefer the safe haven of assured mediocre performance that can be achieved only by closely following the herd. Alternative investments—a catch-all category that includes venture capital, leveraged buyouts, private equity, and hedge funds—are the cur- rent institutional rage. No investment treatise written today could fail to comment on this development. Fueled by performance pressures and a growing expectation of low (and inadequate) returns from traditional equity and debt investments, institutional investors have sought high returns and diversification by allocating a growing portion of their endowments and pension funds to alternatives. Pioneering Portfolio Management, written in 2000 by David Swensen, the groundbreaking head of Yale’s Investment Office, makes a strong case for alternative investments. In it, Swensen points to the historically inefficient pricing of many asset classes,10 the historically high risk-adjusted returns of many alternative managers, and the limited 10 Many investors make the mistake of thinking about returns to asset classes as if they were perma- nent. Returns are not inherent to an asset class; they result from the fundamentals of the underlying businesses and the price paid by investors for the related securities. Capital flowing into an asset class can, reflexively, impair the ability of those investing in that asset class to continue to generate the anticipated, historically attractive returns. He highlights the importance of alternative manager selection by noting the large dispersion of returns achieved between top-quartile and third- quartile performers. A great many endowment managers have emulated Swensen, following him into a large commitment to alternative investments, almost certainly on worse terms and amidst a more competitive environment than when he entered the area. Graham and Dodd would be greatly concerned by the commitment of virtually all major university endowments to one type of alternative investment: venture capital. The authors of the margin-of-safety approach to investing would not find one in the entire venture capital universe.11 While there is often the prospect of substantial upside in ven- ture capital, there is also very high risk of failure. Even with the diversifi- cation provided by a venture fund, it is not clear how to analyze the underlying investments to determine whether the potential return justi- fies the risk. Venture capital investment would, therefore, have to be characterized as pure speculation, with no margin of safety whatsoever. Hedge funds—a burgeoning area of institutional interest with nearly $2 trillion of assets under management—are pools of capital that vary widely in their tactics but have a common fee structure that typically pays the manager 1% to 2% annually of assets under management and 20% (and sometimes more) of any profits generated. They had their start in the 1920s, when Ben Graham himself ran one of the first hedge funds. What would Graham and Dodd say about the hedge funds operating in today’s markets? They would likely disapprove of hedge funds that make investments based on macroeconomic assessments or that pursue 11 Nor would they find one in leveraged buyouts, through which businesses are purchased at lofty prices using mostly debt financing and a thin layer of equity capital. The only value-investing ration- ale for venture capital or leveraged buyouts might be if they were regarded as mispriced call options. Even so, it is not clear that these areas constitute good value. Such funds, by avoiding or even sell- ing undervalued securities to participate in one or another folly, inadver- tently create opportunities for value investors. The illiquidity, lack of transparency, gargantuan size, embedded leverage, and hefty fees of some hedge funds would no doubt raise red flags. But Graham and Dodd would probably approve of hedge funds that practice value-ori- ented investment selection. Importantly, while Graham and Dodd emphasized limiting risk on an investment-by-investment basis, they also believed that diversification and hedging could protect the downside for an entire portfolio. (p. 106) This is what most hedge funds attempt to do. While they hold individual securities that, considered alone, may involve an uncomfortable degree of risk, they attempt to offset the risks for the entire portfolio through the short sale of similar but more highly valued securities, through the purchase of put options on individual securities or market indexes, and through adequate diversification (although many are guilty of overdiver- sification, holding too little of their truly good ideas and too much of their mediocre ones). In this way, a hedge fund portfolio could (in theory, anyway) have characteristics of good potential return with limited risk that its individual components may not have. Modern-day Developments As mentioned, the analysis of businesses and securities has become increasingly sophisticated over the years. Spreadsheet technology, for example, allows for vastly more sophisticated modeling than was possible even one generation ago. Benjamin Graham’s pencil, clearly one of the sharpest of his era, might not be sharp enough today. On the other hand, technology can easily be misused; computer modeling requires making a series of assumptions about the future that can lead to a spurious preci- sion of which Graham would have been quite dubious. While Graham was interested in companies that produced consistent earnings, analysis in his day was less sophisticated regarding why some company’s earnings might be more consistent than others. Analysts today examine businesses but also business models; the bottom-line impact of changes in revenues, profit margins, product mix, and other variables is carefully studied by managements and financial analysts alike. Investors know that businesses do not exist in a vacuum; the actions of competitors, suppliers, and cus- tomers can greatly impact corporate profitability and must be considered.12 Another important change in focus over time is that while Graham looked at corporate earnings and dividend payments as barometers of a company’s health, most value investors today analyze free cash flow. This is the cash generated annually from the operations of a business after all capital expenditures are made and changes in working capital are con- sidered. Investors have increasingly turned to this metric because reported earnings can be an accounting fiction, masking the cash gener- ated by a business or implying positive cash generation when there is none. Today’s investors have rightly concluded that following the cash— as the manager of a business must do—is the most reliable and reveal- ing means of assessing a company. In addition, many value investors today consider balance sheet analy- sis less important than was generally thought a few generations ago. With returns on capital much higher at present than in the past, most stocks trade far above book value; balance sheet analysis is less helpful in understanding upside potential or downside risk of stocks priced at 12 Professor Michael Porter of Harvard Business School, in his seminal book Competitive Strategy (Free Press, 1980), lays out the groundwork for a more intensive, thorough, and dynamic analysis of busi- nesses and industries in the modern economy. A broad industry analysis has become particularly necessary as a result of the passage in 2000 of Regulation FD (Fair Disclosure), which regulates and restricts the communications between a company and its actual or potential shareholders. Wall Street analysts, facing a dearth of information from the companies they cover, have been forced to expand their areas of inquiry. The effects of sustained inflation over time have also wreaked havoc with the accuracy of assets accounted for using historic cost; this means that two companies owning identical assets could report very different book values. Of course, balance sheets must still be carefully scrutinized. Astute observers of corporate balance sheets are often the first to see business deterioration or vulnerability as inventories and receivables build, debt grows, and cash evaporates. And for investors in the equity and debt of underperforming companies, balance sheet analysis remains one generally reliable way of assessing downside protection. Globalization has increasingly affected the investment landscape, with most investors looking beyond their home countries for opportunity and diversification. Graham and Dodd’s principles fully apply to international markets, which are, if anything, even more subject to the vicissitudes of investor sentiment—and thus more inefficiently priced—than the U.S. market is today. Investors must be cognizant of the risks of international investing, including exposure to foreign currencies and the need to consider hedging them. Among the other risks are political instability, different (or absent) securities laws and investor protections, varying accounting standards, and limited availability of information. Oddly enough, despite 75 years of success achieved by value investors, one group of observers largely ignores or dismisses this disci- pline: academics. Academics tend to create elegant theories that purport to explain the real world but in fact oversimplify it. One such theory, the Efficient Market Hypothesis (EMH), holds that security prices always and immediately reflect all available information, an idea deeply at odds with Graham and Dodd’s notion that there is great value to fundamental security analysis. The Capital Asset Pricing Model (CAPM) relates risk to return but always mistakes volatility, or beta, for risk. Modern Portfolio Theory (MPT) applauds the benefits of diversification in constructing an optimal portfolio. But by insisting that higher expected return comes only with greater risk, MPT effectively repudiates the entire value-invest- ing philosophy and its long-term record of risk-adjusted investment out- performance. Value investors have no time for these theories and generally ignore them. The assumptions made by these theories—including continuous markets, perfect information, and low or no transaction costs—are unre- alistic. Academics, broadly speaking, are so entrenched in their theories that they cannot accept that value investing works. Instead of launching a series of studies to understand the remarkable 50-year investment record of Warren Buffett, academics instead explain him away as an aber- ration. Greater attention has been paid recently to behavioral economics, a field recognizing that individuals do not always act rationally and have systematic cognitive biases that contribute to market inefficiencies and security mispricings. These teachings—which would not seem alien to Graham—have not yet entered the academic mainstream, but they are building some momentum. Academics have espoused nuanced permutations of their flawed the- ories for several decades. Countless thousands of their students have been taught that security analysis is worthless, that risk is the same as volatility, and that investors must avoid overconcentration in good ideas (because in efficient markets there can be no good ideas) and thus diver- sify into mediocre or bad ones. Of course, for value investors, the propa- gation of these academic theories has been deeply gratifying: the brainwashing of generations of young investors produces the very ineffi- ciencies that savvy stock pickers can exploit. Another important factor for value investors to take into account is the growing propensity of the Federal Reserve to intervene in financial markets at the first sign of trouble. Amidst severe turbulence, the Fed frequently lowers interest rates to prop up securities prices and restore investor confidence. While the intention of Fed officials is to maintain orderly capital markets, some money managers view Fed intervention as a virtual license to speculate. Aggressive Fed tactics, sometimes referred to as the “Greenspan put” (now the “Bernanke put”), create a moral haz- ard that encourages speculation while prolonging overvaluation. So long as value investors aren’t lured into a false sense of security, so long as they can maintain a long-term horizon and ensure their staying power, market dislocations caused by Fed action (or investor anticipation of it) may ultimately be a source of opportunity. Another modern development of relevance is the ubiquitous cable television coverage of the stock market. This frenetic lunacy exacerbates the already short-term orientation of most investors. It foments the view that it is possible—or even necessary—to have an opinion on everything pertinent to the financial markets, as opposed to the patient and highly selective approach endorsed by Graham and Dodd. This sound-bite cul- ture reinforces the popular impression that investing is easy, not rigorous and painstaking. The daily cheerleading pundits exult at rallies and record highs and commiserate over market reversals; viewers get the impression that up is the only rational market direction and that selling or sitting on the sidelines is almost unpatriotic. The hysterical tenor is exacerbated at every turn. For example, CNBC frequently uses a format- ted screen that constantly updates the level of the major market indexes against a digital clock. Not only is the time displayed in hours, minutes, and seconds but in completely useless hundredths of seconds, the num- bers flashing by so rapidly (like tenths of a cent on the gas pump) as to be completely unreadable. The only conceivable purpose is to grab the viewers’ attention and ratchet their adrenaline to full throttle. Cable business channels bring the herdlike mentality of the crowd into everyone’s living room, thus making it much harder for viewers to stand apart from the masses. Only on financial cable TV would a commentator with a crazed persona become a celebrity whose pronouncements regularly move markets. In a world in which the differences between investing and speculating are frequently blurred, the nonsense on financial cable channels only compounds the problem. Graham would have been appalled. The only saving grace is that value investors prosper at the expense of those who fall under the spell of the cable pundits. Meanwhile, human nature virtually ensures that there will never be a Graham and Dodd channel. Unanswered Questions Today’s investors still wrestle, as Graham and Dodd did in their day, with a number of important investment questions. One is whether to focus on relative or absolute value. Relative value involves the assessment that one security is cheaper than another, that Microsoft is a better bargain than IBM. Relative value is easier to determine than absolute value, the two-dimensional assessment of whether a security is cheaper than other securities and cheap enough to be worth purchasing. The most intrepid investors in relative value manage hedge funds where they purchase the relatively less expensive securities and sell short the relatively more expensive ones. This enables them potentially to profit on both sides of the ledger, long and short. Of course, it also exposes them to double- barreled losses if they are wrong.13 It is harder to think about absolute value than relative value. When is a stock cheap enough to buy and hold without a short sale as a hedge? One standard is to buy when a security trades at an appreciable—say, 30%, 40%, or greater—discount from its underlying value, calculated either as its liquidation value, going-concern value, or private-market 13 Many hedge funds also use significant leverage to goose their returns further, which backfires when analysis is faulty or judgment is flawed. Another standard is to invest when a security offers an acceptably attractive return to a long-term holder, such as a low-risk bond priced to yield 10% or more, or a stock with an 8% to 10% or higher free cash flow yield at a time when “risk-free” U.S. government bonds deliver 4% to 5% nominal and 2% to 3% real returns. Such demanding standards virtually ensure that absolute value will be quite scarce. Another area where investors struggle is trying to define what consti- tutes a good business. Someone once defined the best possible business as a post office box to which people send money. That idea has certainly been eclipsed by the creation of subscription Web sites that accept credit cards. Today’s most profitable businesses are those in which you sell a fixed amount of work product—say, a piece of software or a hit recording—millions and millions of times at very low marginal cost. Good businesses are generally considered those with strong barriers to entry, limited capital requirements, reliable customers, low risk of tech- nological obsolescence, abundant growth possibilities, and thus signifi- cant and growing free cash flow. Businesses are also subject to changes in the technological and com- petitive landscape. Because of the Internet, the competitive moat sur- rounding the newspaper business—which was considered a very good business only a decade ago—has eroded faster than almost anyone anticipated. In an era of rapid technological change, investors must be ever vigilant, even with regard to companies that are not involved in technology but are simply affected by it. In short, today’s good busi- nesses may not be tomorrow’s. Investors also expend considerable effort attempting to assess the quality of a company’s management. Some managers are more capable or scrupulous than others, and some may be able to manage certain businesses and environments better than others. Yet, as Graham and Dodd noted, “Objective tests of managerial ability are few and far from scientific.” (p. 84) Make no mistake about it: a management’s acumen, foresight, integrity, and motivation all make a huge difference in share- holder returns. In the present era of aggressive corporate financial engi- neering, managers have many levers at their disposal to positively impact returns, including share repurchases, prudent use of leverage, and a valuation-based approach to acquisitions. Managers who are unwilling to make shareholder-friendly decisions risk their companies becoming perceived as “value traps”: inexpensively valued, but ulti- mately poor investments, because the assets are underutilized. Such companies often attract activist investors seeking to unlock this trapped value. Even more difficult, investors must decide whether to take the risk of investing—at any price—with management teams that have not always done right by shareholders. Shares of such companies may sell at steeply discounted levels, but perhaps the discount is warranted; value that today belongs to the equity holders may tomorrow have been spir- ited away or squandered. An age-old difficulty for investors is ascertaining the value of future growth. In the preface to the first edition of Security Analysis, the authors said as much: “Some matters of vital significance, e.g., the determination of the future prospects of an enterprise, have received little space, because little of definite value can be said on the subject.” (p. xliii) Clearly, a company that will earn (or have free cash flow of) $1 per share today and $2 per share in five years is worth considerably more than a company with identical current per share earnings and no growth. This is especially true if the growth of the first company is likely to continue and is not subject to great variability. Another complication is that companies can grow in many different ways—for example, selling the same number of units at higher prices; selling more units at the same (or even lower) prices; changing the product mix (selling proportionately more of the higher-profit-margin products); or developing an entirely new product line. Obviously, some forms of growth are worth more than others. There is a significant downside to paying up for growth or, worse, to obsessing over it. Graham and Dodd astutely observed that “analysis is concerned primarily with values which are supported by the facts and not with those which depend largely upon expectations.” (p. 86) Strongly preferring the actual to the possible, they regarded the “future as a haz- ard which his [the analyst’s] conclusions must encounter rather than as the source of his vindication.” (p. 86) Investors should be especially vigi- lant against focusing on growth to the exclusion of all else, including the risk of overpaying. Again, Graham and Dodd were spot on, warning that “carried to its logical extreme, . . . [there is no price] too high for a good stock, and that such an issue was equally ‘safe’ after it had advanced to 200 as it had been at 25.” (p. 105) Precisely this mistake was made when stock prices surged skyward during the Nifty Fifty era of the early 1970s and the dot-com bubble of 1999 to 2000. The flaw in such a growth-at-any-price approach becomes obvious when the anticipated growth fails to materialize. When the future disap- points, what should investors do? Hope growth resumes? Or give up and sell? Indeed, failed growth stocks are often so aggressively dumped by disappointed holders that their price falls to levels at which value investors, who stubbornly pay little or nothing for growth characteristics, become major holders. This was the case with many technology stocks that suffered huge declines after the dot-com bubble burst in the spring of 2000. By 2002, hundreds of fallen tech stocks traded for less than the cash on their balance sheets, a value investor’s dream. One such com- pany was Radvision, an Israeli provider of voice, video, and data products whose stock subsequently rose from under $5 to the mid-$20s after the urgent selling abated and investors refocused on fundamentals. Another conundrum for value investors is knowing when to sell. Buy- ing bargains is the sweet spot of value investors, although how small a discount one might accept can be subject to debate. Selling is more dif- ficult because it involves securities that are closer to fully priced. As with buying, investors need a discipline for selling. First, sell targets, once set, should be regularly adjusted to reflect all currently available information. Second, individual investors must consider tax consequences. Third, whether or not an investor is fully invested may influence the urgency of raising cash from a stockholding as it approaches full valuation. The availability of better bargains might also make one a more eager seller. Finally, value investors should completely exit a security by the time it reaches full value; owning overvalued securities is the realm of specula- tors. Value investors typically begin selling at a 10% to 20% discount to their assessment of underlying value—based on the liquidity of the security, the possible presence of a catalyst for value realization, the quality of management, the riskiness and leverage of the underlying business, and the investors’ confidence level regarding the assumptions underlying the investment. Finally, investors need to deal with the complex subject of risk. As mentioned earlier, academics and many professional investors have come to define risk in terms of the Greek letter beta, which they use as a measure of past share price volatility: a historically more volatile stock is seen as riskier. But value investors, who are inclined to think about risk as the probability and amount of potential loss, find such reasoning absurd. In fact, a volatile stock may become deeply undervalued, rendering it a very low risk investment. One of the most difficult questions for value investors is how much risk to incur. One facet of this question involves position size and its impact on portfolio diversification. How much can you comfortably own of even the most attractive opportunities? Naturally, investors desire to profit fully from their good ideas. Yet this tendency is tempered by the fear of being unlucky or wrong. Nonetheless, value investors should concentrate their holdings in their best ideas; if you can tell a good investment from a bad one, you can also distinguish a great one from a good one. Investors must also ponder the risks of investing in politically unsta- ble countries, as well as the uncertainties involving currency, interest rate, and economic fluctuations. How much of your capital do you want tied up in Argentina or Thailand, or even France or Australia, no matter how undervalued the stocks may be in those markets? Another risk consideration for value investors, as with all investors, is whether or not to use leverage. While some value-oriented hedge funds and even endowments use leverage to enhance their returns, I side with those who are unwilling to incur the added risks that come with margin debt. Just as leverage enhances the return of successful investments, it magnifies the losses from unsuccessful ones. More importantly, nonre- course (margin) debt raises risk to unacceptable levels because it places one’s staying power in jeopardy. One risk-related consideration should be paramount above all others: the ability to sleep well at night, confi- dent that your financial position is secure whatever the future may bring. Final Thoughts In a rising market, everyone makes money and a value philosophy is unnecessary. But because there is no certain way to predict what the market will do, one must follow a value philosophy at all times. By con- trolling risk and limiting loss through extensive fundamental analysis, strict discipline, and endless patience, value investors can expect good results with limited downside. You may not get rich quick, but you will keep what you have, and if the future of value investing resembles its past, you are likely to get rich slowly. As investment strategies go, this is the most that any reasonable investor can hope for. The real secret to investing is that there is no secret to investing. Every important aspect of value investing has been made available to the public many times over, beginning in 1934 with the first edition of Security Analysis. That so many people fail to follow this timeless and almost foolproof approach enables those who adopt it to remain suc- cessful. The foibles of human nature that result in the mass pursuit of instant wealth and effortless gain seem certain to be with us forever. So long as people succumb to this aspect of their natures, value investing will remain, as it has been for 75 years, a sound and low-risk approach to successful long-term investing. SETH A. KLARMAN Boston, Massachusetts, May, 2008 Introduction to the Sixth Edition It was a distracted world before which McGraw-Hill set, with a thud, the first edition of Security Analysis in July 1934. From Berlin dribbled reports of a shake-up at the top of the German government. “It will simplify the Führer’s whole work immensely if he need not first ask some- body if he may do this or that,” the Associated Press quoted an informant on August 1 as saying of Hitler’s ascension from chancellor to dictator. Set against such epochal proceedings, a 727-page textbook on the fine points of value investing must have seemed an unlikely candidate for bestsellerdom, then or later. In his posthumously published autobiography, The Memoirs of the Dean of Wall Street, Graham (1894–1976) thanked his lucky stars that he had entered the investment business when he did. The timing seemed not so propitious in the year of the first edition of Security Analysis, or, indeed, that of the second edition—expanded and revised—six years later. From its 1929 peak to its 1932 trough, the Dow Jones Industrial Average had lost 87% of its value. At cyclical low ebb, in 1933, the national unemployment rate topped 25%. That the Great Depression ended in 1933 was the considered judgment of the timekeepers of the National Bureau of Economic Research. Millions of Americans, however— not least, the relatively few who tried to squeeze a living out of a profit- less Wall Street—had reason to doubt it. The bear market and credit liquidation of the early 1930s gave the institutions of American finance a top-to-bottom scouring. What was left of them presently came in for a rough handling by the first Roosevelt administration. Graham had learned his trade in the Wall Street of the mid–nineteen teens, an era of lightly regulated markets. He began work on Security Analysis as the administration of Herbert Hoover was giving the country its first taste of thoroughgoing federal intervention in a peacetime economy. He was correcting page proofs as the Roosevelt administration was implementing its first radical forays into macroeco- nomic management. By 1934, there were laws to institute federal regula- tion of the securities markets, federal insurance of bank deposits, and federal price controls (not to put a cap on prices, as in later, inflationary times, but rather to put a floor under them). To try to prop up prices, the administration devalued the dollar. It is a testament to the enduring quality of Graham’s thought, not to mention the resiliency of America’s financial markets, that Security Analysis lost none of its relevance even as the economy was being turned upside down and inside out. Five full months elapsed following publication of the first edition before Louis Rich got around to reviewing it in the New York Times. Who knows? Maybe the conscientious critic read every page. In any case, Rich gave the book a rave, albeit a slightly rueful one. “On the assumption,” he wrote, on December 2, 1934, “that despite the debacle of recent history there are still people left whose money burns a hole in their pockets, it is hoped that they will read this book. It is a full-bodied, mature, meticu- lous and wholly meritorious outgrowth of scholarly probing and practi- cal sagacity. Although cast in the form and spirit of a textbook, the presentation is endowed with all the qualities likely to engage the liveli- est interest of the layman.”1 How few laymen seemed to care about investing was brought home to Wall Street more forcefully with every passing year of the unprosperous postcrash era. Just when it seemed that trading volume could get no smaller, or New York Stock Exchange seat prices no lower, or equity valu- ations more absurdly cheap, a new, dispiriting record was set. It required every effort of the editors of the Big Board’s house organ, the Exchange magazine, to keep up a brave face. “Must There Be an End to Progress?” was the inquiring headline over an essay by the Swedish economist Gus- tav Cassel published around the time of the release of Graham and Dodd’s second edition (the professor thought not).2 “Why Do Securities Brokers Stay in Business?” the editors posed and helpfully answered, “Despite wearying lethargy over long periods, confidence abounds that when the public recognizes fully the value of protective measures which lately have been ranged about market procedure, investment interest in securities will increase.” It did not amuse the Exchange that a New York City magistrate, sarcastically addressing in his court a collection of defen- dants hauled in by the police for shooting craps on the sidewalk, had derided the financial profession. “The first thing you know,” the judge had upbraided the suspects, “you’ll wind up as stock brokers in Wall Street with yachts and country homes on Long Island.”3 In ways now difficult to imagine, Murphy’s Law was the order of the day; what could go wrong, did. “Depression” was more than a long-lin- gering state of economic affairs. It had become a worldview. The aca- demic exponents of “secular stagnation,” notably Alvin Hansen and Joseph Schumpeter, each a Harvard economics professor, predicted a long decline in American population growth. This deceleration, Hansen contended in his 1939 essay, “together with the failure of any really important innovations of a magnitude to absorb large capital outlays, weighs very heavily as an explanation for the failure of the recent recov- ery to reach full employment.”4 Neither Hansen nor his readers had any way of knowing that a baby boom was around the corner. Nothing could have seemed more unlikely to a world preoccupied with a new war in Europe and the evident decline and fall of capitalism. Certainly, Hansen’s ideas must have struck a chord with the chronically underemployed brokers and traders in lower Manhat- tan. As a business, the New York Stock Exchange was running at a steady loss. From 1933, the year in which it began to report its financial results, through 1940, the Big Board recorded a profit in only one year, 1935 (and a nominal one, at that). And when, in 1937, Chelcie C. Bosland, an assis- tant professor of economics at Brown University, brought forth a book entitled The Common Stock Theory of Investment, he remarked as if he were repeating a commonplace that the American economy had peaked two decades earlier at about the time of what was not yet called World War I. The professor added, quoting unnamed authorities, that American population growth could be expected to stop in its tracks by 1975.5 Small wonder that Graham was to write that the acid test of a bond issuer was its capacity to meet its obligations not in a time of middling prosperity (which modest test today’s residential mortgage–backed securities strug- gle to meet) but in a depression. Altogether, an investor in those days was well advised to keep up his guard. “The combination of a record high level for bonds,” writes Graham in the 1940 edition, “with a history of two catastrophic price collapses in the preceding 20 years and a major war in progress is not one to justify airy confidence in the future.” (p. 142) Wall Street, not such a big place even during the 1920s’ boom, got considerably smaller in the subsequent bust. Ben Graham, in conjunction with his partner Jerry Newman, made a very small cog of this low-horse- power machine. The two of them conducted a specialty investment busi- ness at 52 Wall Street. Their strong suits were arbitrage, reorganizations, bankruptcies, and other complex matters. A schematic drawing of the financial district published by Fortune in 1937 made no reference to the Graham-Newman offices. Then again, the partnerships and corporate headquarters that did rate a spot on the Wall Street map were them- selves—by the standards of twenty-first-century finance—remarkably compact. One floor at 40 Wall Street was enough to contain the entire office of Merrill Lynch & Co. And a single floor at 2 Wall Street was all the space required to house Morgan Stanley, the hands-down leader in 1936 corporate securities underwriting, with originations of all of $195 million. Compensation was in keeping with the slow pace of business, especially at the bottom of the corporate ladder.6 After a 20% rise in the new fed- eral minimum wage, effective October 1939, brokerage employees could earn no less than 30 cents an hour.7 In March 1940, the Exchange documented in all the detail its readers could want (and possibly then some) the collapse of public participation in the stock market. In the first three decades of the twentieth century, the annual volume of trading had almost invariably exceeded the quantity of listed shares outstanding, sometimes by a wide margin. And in only one year between 1900 and 1930 had annual volume amounted to less than 50% of listed shares—the exception being 1914, the year in which the exchange was closed for 41/2 months to allow for the shock of the out- break of World War I to sink in. Then came the 1930s, and the annual turnover as a percentage of listed shares struggled to reach as high as 50%. In 1939, despite a short-lived surge of trading on the outbreak of World War II in Europe, the turnover ratio had fallen to a shockingly low 18.4%. (For comparison, in 2007, the ratio of trading volume to listed shares amounted to 123%.) “Perhaps,” sighed the author of the study, “it is a fair statement that if the farming industry showed a similar record, government subsidies would have been voted long ago. Unfortunately for Wall Street, it seems to have too little sponsorship in officialdom.”8 If a reader took hope from the idea that things were so bad that they could hardly get worse, he or she was in for yet another disappointment. The second edition of Security Analysis had been published only months earlier when, on August 19, 1940, the stock exchange volume totaled just 129,650 shares. It was one of the sleepiest sessions since the 49,000- share mark set on August 5, 1916. For the entire 1940 calendar year, vol- ume totaled 207,599,749 shares—a not very busy two hours’ turnover at this writing and 18.5% of the turnover of 1929, that year of seemingly irrecoverable prosperity. The cost of a membership, or seat, on the stock exchange sank along with turnover and with the major price indexes. At the nadir in 1942, a seat fetched just $17,000. It was the lowest price since 1897 and 97% below the record high price of $625,000, set—natu- rally—in 1929. “‘The Cleaners,’” quipped Fred Schwed, Jr., in his funny and wise book Where Are the Customers’ Yachts? (which, like Graham’s second edition, appeared in 1940), “was not one of those exclusive clubs; by 1932, every- body who had ever tried speculation had been admitted to membership.”9 And if an investor did, somehow, manage to avoid the cleaner’s during the formally designated Great Depression, he or she was by no means home free. In August 1937, the market began a violent sell-off that would carry the averages down by 50% by March 1938. The nonfinancial portion of the economy fared little better than the financial side. In just nine months, industrial production fell by 34.5%, a sharper contraction even than that in the depression of 1920 to 1921, a slump that, for Graham’s generation, had seemed to set the standard for the most economic damage in the shortest elapsed time.10 The Roosevelt administration insisted that the slump of 1937 to 1938 was no depression but rather a “recession.” The national unemployment rate in 1938 was, on average, 18.8%. In April 1937, four months before the bottom fell out of the stock mar- ket for the second time in 10 years, Robert Lovett, a partner at the invest- ment firm of Brown Brothers Harriman & Co., served warning to the American public in the pages of the weekly Saturday Evening Post. Lovett, a member of the innermost circle of the Wall Street establishment, set out to demonstrate that there is no such thing as financial security—none, at least, to be had in stocks and bonds. The gist of Lovett’s argument was that, in capitalism, capital is consumed and that businesses are just as fragile, and mortal, as the people who own them. He invited his millions of readers to examine the record, as he had done: “If an investor had pur- chased 100 shares of the 20 most popular dividend-paying stocks on December 31, 1901, and held them through 1936, adding, in the mean- time, all the melons in the form of stock dividends, and all the plums in the form of stock split-ups, and had exercised all the valuable rights to subscribe to additional stock, the aggregate market value of his total holdings on December 31, 1936, would have shown a shrinkage of 39% as compared with the cost of his original investment. In plain English, the average investor paid $294,911.90 for things worth $180,072.06 on December 31, 1936. That’s a big disappearance of dollar value in any lan- guage.” In the innocent days before the crash, people had blithely spoken of “permanent investments.” “For our part,” wrote this partner of an emi- nent Wall Street private bank, “we are convinced that the only permanent investment is one which has become a total and irretrievable loss.”11 Lovett turned out to be a prophet. At the nadir of the 1937 to 1938 bear market, one in five NYSE-listed industrial companies was valued in the market for less than its net current assets. Subtract from cash and quick assets all liabilities and the remainder was greater than the company’s market value. That is, business value was negative. The Great Atlantic & Pacific Tea Company (A&P), the Wal-Mart of its day, was one of these corporate castoffs. At the 1938 lows, the market value of the com- mon and preferred shares of A&P at $126 million was less than the value of its cash, inventories, and receivables, conservatively valued at $134 million. In the words of Graham and Dodd, the still-profitable company was selling for “scrap.” (p. 673) A Different Wall Street Few institutional traces of that Wall Street remain. Nowadays, the big broker-dealers keep as much as $1 trillion in securities in inventory; in Graham’s day, they customarily held none. Nowadays, the big broker- dealers are in a perpetual competitive lather to see which can bring the greatest number of initial public offerings (IPOs) to the public market. In Graham’s day, no frontline member firm would stoop to placing an IPO in public hands, the risks and rewards for this kind of offering being reserved for professionals. Federal securities regulation was a new thing in the 1930s. What had preceded the Securities and Exchange Commis- sion (SEC) was a regime of tribal sanction. Some things were simply beyond the pale. Both during and immediately after World War I, no self- respecting NYSE member firm facilitated a client’s switch from Liberty bonds into potentially more lucrative, if less patriotic, alternatives. There was no law against such a business development overture. Rather, according to Graham, it just wasn’t done. A great many things weren’t done in the Wall Street of the 1930s. Newly empowered regulators were resistant to financial innovation, trans- action costs were high, technology was (at least by today’s digital stan- dards) primitive, and investors were demoralized. After the vicious bear market of 1937 to 1938, not a few decided they’d had enough. What was the point of it all? “In June 1939,” writes Graham in a note to a discussion about corporate finance in the second edition, “the S.E.C. set a salutary precedent by refusing to authorize the issuance of ‘Capital Income Debentures’ in the reorganization of the Griess-Pfleger Tanning Company, on the ground that the devising of new types of hybrid issues had gone far enough.” (p. 115, fn. 4) In the same conservative vein, he expresses his approval of the institution of the “legal list,” a document compiled by state banking departments to stipulate which bonds the regulated sav- ings banks could safely own. The very idea of such a list flies in the face of nearly every millennial notion about good regulatory practice. But Gra- ham defends it thus: “Since the selection of high-grade bonds has been shown to be in good part a process of exclusion, it lends itself reasonably well to the application of definite rules and standards designed to dis- qualify unsuitable issues.” (p. 169) No collateralized debt obligations stocked with subprime mortgages for the father of value investing! The 1930s ushered in a revolution in financial disclosure. The new federal securities acts directed investor-owned companies to brief their stockholders once a quarter as well as at year-end. But the new stan- dards were not immediately applicable to all public companies, and more than a few continued doing business the old-fashioned way, with their cards to their chests. One of these informational holdouts was none other than Dun & Bradstreet (D&B), the financial information company. Graham seemed to relish the irony of D&B not revealing “its own earn- ings to its own stockholders.” (p. 92, fn. 4) On the whole, by twenty-first- century standards, information in Graham’s time was as slow moving as it was sparse. There were no conference calls, no automated spread- sheets, and no nonstop news from distant markets—indeed, not much truck with the world outside the 48 states. Security Analysis barely acknowledges the existence of foreign markets. Such an institutional setting was hardly conducive to the develop- ment of “efficient markets,” as the economists today call them—markets in which information is disseminated rapidly, human beings process it flawlessly, and prices incorporate it instantaneously. Graham would have scoffed at such an idea. Equally, he would have smiled at the discovery— so late in the evolution of the human species—that there was a place in economics for a subdiscipline called “behavioral finance.” Reading Security Analysis, one is led to wonder what facet of investing is not behavioral. The stock market, Graham saw, is a source of entertainment value as well as investment value: “Even when the underlying motive of purchase is mere speculative greed, human nature desires to conceal this unlovely impulse behind a screen of apparent logic and good sense. To adapt the aphorism of Voltaire, it may be said that if there were no such thing as common-stock analysis, it would be necessary to counterfeit it.” (p. 348) Anomalies of undervaluation and overvaluation—of underdoing it and overdoing it—fill these pages. It bemused Graham, but did not shock him, that so many businesses could be valued in the stock market for less than their net current assets, even during the late 1920s’ boom, or that, in the dislocations to the bond market immediately following World War I, investors became disoriented enough to assign a higher price and a lower yield to the Union Pacific First Mortgage 4s than they did to the U.S. Treasury’s own Fourth Liberty 41⁄4s. Graham writes of the “inveterate tendency of the stock market to exaggerate.” (p. 679) He would not have exaggerated much if he had written, instead, “all markets.” Though he did not dwell long on the cycles in finance, Graham was certainly aware of them. He could see that ideas, no less than prices and categories of investment assets, had their seasons. The discussion in Security Analysis of the flame-out of the mortgage guarantee business in the early 1930s is a perfect miniature of the often-ruinous competition in which financial institutions periodically engage. “The rise of the newer and more aggressive real estate bond organizations had a most unfortu- nate effect upon the policies of the older concerns,” Graham writes of his time and also of ours. “By force of competition they were led to relax their standards of making loans. New mortgages were granted on an increasingly liberal basis, and when old mortgages matured, they were frequently renewed in a larger sum. Furthermore, the face amount of the mortgages guaranteed rose to so high a multiple of the capital of the guarantor companies that it should have been obvious that the guaranty would afford only the flimsiest of protection in the event of a general decline in values.” (p. 217) Security analysis itself is a cyclical phenomenon; it, too, goes in and out of fashion, Graham observed. It holds a strong, intuitive appeal for the kind of businessperson who thinks about stocks the way he or she thinks about his or her own family business. What would such a fount of com- mon sense care about earnings momentum or Wall Street’s pseudo-scien- tific guesses about the economic future? Such an investor, appraising a common stock, would much rather know what the company behind it is worth. That is, he or she would want to study its balance sheet. Well, Gra- ham relates here, that kind of analysis went out of style when stocks started levitating without reference to anything except hope and prophecy. So, by about 1927, fortune-telling and chart-reading had dis- placed the value discipline by which he and his partner were earning a very good living. It is characteristic of Graham that his critique of the “new era” method of investing is measured and not derisory. The old, conserva- tive approach—his own—had been rather backward looking, Graham admits. It had laid more emphasis on the past than on the future, on sta- ble earning power rather than tomorrow’s earnings prospects. But new technologies, new methods, and new forms of corporate organization had introduced new risks into the post–World War I economy. This fact— “the increasing instability of the typical business”—had blown a small hole in the older analytical approach that emphasized stable earnings power over forecast earnings growth. Beyond that mitigating considera- tion, however, Graham does not go. The new era approach, “which turned upon the earnings trend as the sole criterion of value, . . . was certain to end in an appalling debacle.” (p. 366) Which, of course, it did, and—in the CNBC-driven markets of the twenty-first century—continues to do at intervals today. A Man of Many Talents Benjamin Graham was born Benjamin Grossbaum on May 9, 1894, in London, and sailed to New York with his family before he was two. Young Benjamin was a prodigy in mathematics, classical languages, modern languages, expository writing (as readers of this volume will see for themselves), and anything else that the public schools had to offer. He had a tenacious memory and a love of reading—a certain ticket to aca- demic success, then or later. His father’s death at the age of 35 left him, his two brothers, and their mother in the social and financial lurch. Ben- jamin early learned to work and to do without. No need here for a biographical profile of the principal author of Security Analysis: Graham’s own memoir delightfully covers that ground. Suffice it to say that the high school brainiac entered Columbia College as an Alumni Scholar in September 1911 at the age of 17. So much material had he already absorbed that he began with a semester’s head start, “the highest possible advanced standing.”12 He mixed his academic studies with a grab bag of jobs, part-time and full-time alike. Upon his graduation in 1914, he started work as a runner and board-boy at the New York Stock Exchange member firm of Newberger, Henderson & Loeb. Within a year, the board-boy was playing the liquidation of the Guggenheim Exploration Company by astutely going long the shares of Guggenheim and short the stocks of the companies in which Guggen- heim had made a minority investment, as his no-doubt bemused elders looked on: “The profit was realized exactly as calculated; and everyone was happy, not least myself.”13 Security Analysis did not come out of the blue. Graham had supple- mented his modest salary by contributing articles to the Magazine of Wall Street. His productions are unmistakably those of a self-assured and superbly educated Wall Street moneymaker. There was no need to quote expert opinion. He and the documents he interpreted were all the authority he needed. His favorite topics were the ones that he subse- quently developed in the book you hold in your hands. He was partial to the special situations in which Graham-Newman was to become so suc- cessful. Thus, when a high-flying, and highly complex, American Interna- tional Corp. fell from the sky in 1920, Graham was able to show that the stock was cheap in relation to the evident value of its portfolio of miscel- laneous (and not especially well disclosed) investment assets.14 The shocking insolvency of Goodyear Tire and Rubber attracted his attention in 1921. “The downfall of Goodyear is a remarkable incident even in the present plenitude of business disasters,” he wrote, in a characteristic Gra- ham sentence (how many financial journalists, then or later, had “pleni- tude” on the tips of their tongues?). He shrewdly judged that Goodyear would be a survivor.15 In the summer of 1924, he hit on a theme that would echo through Security Analysis: it was the evident non sequitor of stocks valued in the market at less than the liquidating value of the com- panies that issued them. “Eight Stock Bargains Off the Beaten Track,” said the headline over the Benjamin Graham byline: “Stocks that Are Covered Chiefly by Cash or the Equivalent—No Bonds or Preferred Stock Ahead of These Issues—An Unusually Interesting Group of Securities.” In one case, that of Tonopah Mining, liquid assets of $4.31 per share towered over a market price of just $1.38 a share.16 For Graham, an era of sweet reasonableness in investment thinking seemed to end around 1914. Before that time, the typical investor was a businessman who analyzed a stock or a bond much as he might a claim on a private business. He—it was usually a he—would naturally try to determine what the security-issuing company owned, free and clear of any encumbrances. If the prospective investment was a bond—and it usually was—the businessman-investor would seek assurances that the borrowing company had the financial strength to weather a depression. “It’s not undue modesty,” Graham wrote in his memoir, “to say that I had become something of a smart cookie in my particular field.” His spe- cialty was the carefully analyzed out-of-the-way investment: castaway stocks or bonds, liquidations, bankruptcies, arbitrage. Since at least the early 1920s, Graham had preached the sermon of the “margin of safety.” As the future is a closed book, he urged in his writings, an investor, as a matter of self-defense against the unknown, should contrive to pay less than “intrinsic” value. Intrinsic value, as defined in Security Analysis, is “that value which is justified by the facts, e.g., the assets, earnings, divi- dends, definite prospects, as distinct, let us say, from market quotations established by artificial manipulation or distorted by psychological excesses.” (p. 64) He himself had gone from the ridiculous to the sublime (and some- times back again) in the conduct of his own investment career. His quick and easy grasp of mathematics made him a natural arbitrageur. He would sell one stock and simultaneously buy another. Or he would buy or sell shares of stock against the convertible bonds of the identical issu- ing company. So doing, he would lock in a profit that, if not certain, was as close to guaranteed as the vicissitudes of finance allowed. In one instance, in the early 1920s, he exploited an inefficiency in the relation- ship between DuPont and the then red-hot General Motors (GM). DuPont held a sizable stake in GM. And it was for that interest alone which the market valued the big chemical company. By implication, the rest of the business was worth nothing. To exploit this anomaly, Graham bought shares in DuPont and sold short the hedge-appropriate number of shares in GM. And when the market came to its senses, and the price gap between DuPont and GM widened in the expected direction, Gra- ham took his profit.17 However, Graham, like many another value investors after him, some- times veered from the austere precepts of safe-and-cheap investing. A Graham only slightly younger than the master who sold GM and bought DuPont allowed himself to be hoodwinked by a crooked promoter of a company that seems not actually to have existed—at least, in anything like the state of glowing prosperity described by the manager of the pool to which Graham entrusted his money. An electric sign in Colum- bus Circle, on the upper West Side of Manhattan, did bear the name of the object of Graham’s misplaced confidence, Savold Tire. But, as the author of Security Analysis confessed in his memoir, that could have been the only tangible marker of the company’s existence. “Also, as far as I knew,” Graham added, “nobody complained to the district attorney’s office about the promoter’s bare-faced theft of the public’s money.” Cer- tainly, by his own telling, Graham didn’t.18 By 1929, when he was 35, Graham was well on his way to fame and fortune. His wife and he kept a squadron of servants, including—for the first and only time in his life—a manservant for himself. With JerryNewman, Graham had compiled an investment record so enviable that the great Bernard M. Baruch sought him out. Would Graham wind up his busi- ness to manage Baruch’s money? “I replied,” Graham writes, “that I was highly flattered—flabbergasted, in fact—by his proposal, but I could not end so abruptly the close and highly satisfactory relations I had with my friends and clients.”19 Those relations soon became much less satisfactory. Graham relates that, though he was worried at the top of the market, he failed to act on his bearish hunch. The Graham-Newman partnership went into the 1929 break with $2.5 million of capital. And they con- trolled about $2.5 million in hedged positions—stocks owned long offset by stocks sold short. They had, besides, about $4.5 million in outright long positions. It was bad enough that they were leveraged, as Graham later came to realize. Compounding that tactical error was a deeply rooted conviction that the stocks they owned were cheap enough to withstand any imaginable blow. They came through the crash creditably: down by only 20% was, for the final quarter of 1929, almost heroic. But they gave up 50% in 1930, 16% in 1931, and 3% in 1932 (another relatively excellent showing), for a cumulative loss of 70%.20 “I blamed myself not so much for my failure to protect myself against the disaster I had been predicting,” Graham writes, “as for having slipped into an extravagant way of life which I hadn’t the temperament or capacity to enjoy. I quickly convinced myself that the true key to material happiness lay in a modest standard of living which could be achieved with little difficulty under almost all economic condi- tions”—the margin-of-safety idea applied to personal finance.21 It can’t be said that the academic world immediately clasped Security Analysis to its breast as the definitive elucidation of value investing, or of anything else. The aforementioned survey of the field in which Graham and Dodd made their signal contribution, The Common Stock Theory of Investment, by Chelcie C. Bosland, published three years after the appear- ance of the first edition of Security Analysis, cited 53 different sources and 43 different authors. Not one of them was named Graham or Dodd. Edgar Lawrence Smith, however, did receive Bosland’s full and respectful attention. Smith’s Common Stocks as Long Term Investments, published in 1924, had challenged the long-held view that bonds were innately superior to equities. For one thing, Smith argued, the dollar (even the gold-backed 1924 edition) was inflation-prone, which meant that creditors were inherently disadvantaged. Not so the owners of com- mon stock. If the companies in which they invested earned a profit, and if the managements of those companies retained a portion of that profit in the business, and if those retained earnings, in turn, produced future earnings, the principal value of an investor’s portfolio would tend “to increase in accordance with the operation of compound interest.”22 Smith’s timing was impeccable. Not a year after he published, the great Coolidge bull market erupted. Common Stocks as Long Term Investments, only 129 pages long, provided a handy rationale for chasing the market higher. That stocks do, in fact, tend to excel in the long run has entered the canon of American investment thought as a revealed truth (it looked any- thing but obvious in the 1930s). For his part, Graham entered a strong dis- sent to Smith’s thesis, or, more exactly, its uncritical bullish application. It was one thing to pay 10 times earnings for an equity investment, he notes, quite another to pay 20 to 40 times earnings. Besides, the Smith analysis skirted the important question of what asset values lay behind the stock certificates that people so feverishly and uncritically traded back and forth. Finally, embedded in Smith’s argument was the assumption that common stocks could be counted on to deliver in the future what they had done in the past. Graham was not a believer. (pp. 362–363) If Graham was a hard critic, however, he was also a generous one. In 1939 he was given John Burr Williams’s The Theory of Investment Value to review for the Journal of Political Economy (no small honor for a Wall Street author-practitioner). Williams’s thesis was as important as it was concise. The investment value of a common stock is the present value of all future dividends, he proposed. Williams did not underestimate the significance of these loaded words. Armed with that critical knowledge, the author ventured to hope, investors might restrain themselves from bidding stocks back up to the moon again. Graham, in whose capacious brain dwelled the talents both of the quant and behavioral financier, voiced his doubts about that forecast. The rub, as he pointed out, was that, in order to apply Williams’s method, one needed to make some very large assumptions about the future course of interest rates, the growth of profit, and the terminal value of the shares when growth stops. “One wonders,” Graham mused, “whether there may not be too great a discrepancy between the necessarily hit-or-miss character of these assumptions and the highly refined mathematical treatment to which they are subjected.” Graham closed his essay on a characteristi- cally generous and witty note, commending Williams for the refreshing level-headedness of his approach and adding: “This conservatism is not really implicit in the author’s formulas; but if the investor can be per- suaded by higher algebra to take a sane attitude toward common-stock prices, the reviewer will cast a loud vote for higher algebra.”23 Graham’s technical accomplishments in securities analysis, by them- selves, could hardly have carried Security Analysis through its five edi- tions. It’s the book’s humanity and good humor that, to me, explain its long life and the adoring loyalty of a certain remnant of Graham readers, myself included. Was there ever a Wall Street moneymaker better steeped than Graham in classical languages and literature and in the financial history of his own time? I would bet “no” with all the confidence of a value investor laying down money to buy an especially cheap stock. Yet this great investment philosopher was, to a degree, a prisoner of his own times. He could see that the experiences through which he lived were unique, that the Great Depression was, in fact, a great anomaly. If anyone understood the folly of projecting current experience into the unpredictable future, it was Graham. Yet this investment-philosopher king, having spent 727 pages (not including the gold mine of an appendix) describing how a careful and risk-averse investor could prosper in every kind of macroeconomic conditions, arrives at a remarkable conclusion. What of the institutional investor, he asks. How should he invest? At first, Graham diffidently ducks the question—who is he to prescribe for the experienced financiers at the head of America’s philanthropic and educational institutions? But then he takes the astonishing plunge. “An institution,” he writes, “that can manage to get along on the low income provided by high-grade fixed-value issues should, in our opinion, confine its holdings to this field. We doubt if the better performance of common- stock indexes over past periods will, in itself, warrant the heavy responsi- bilities and the recurring uncertainties that are inseparable from a common-stock investment program.” (pp. 709–710) Could the greatest value investor have meant that? Did the man who stuck it out through ruinous losses in the Depression years and went on to compile a remarkable long-term investment record really mean that common stocks were not worth the bother? In 1940, with a new world war fanning the Roosevelt administration’s fiscal and monetary policies, high-grade corporate bonds yielded just 2.75%, while blue-chip equities yielded 5.1%. Did Graham mean to say that bonds were a safer proposi- tion than stocks? Well, he did say it. If Homer could nod, so could Gra- ham—and so can the rest of us, whoever we are. Let it be a lesson. ","You will be provided with a user prompt and a context block. Only respond to prompts using information that has been provided in the context block. Do not use any outside knowledge to answer prompts. If you cannot answer a prompt based on the information in the context block alone, please state ""I unable to determine that without additional context"" and do not add anything further. According to the author of the preface, who cannot accept that value investing works? Preface to the Sixth Edition THE TIMELESS WISDOM OF GRAHAM AND DODD BY SETH A. KLARMAN Seventy-five years after Benjamin Graham and David Dodd wrote Security Analysis, a growing coterie of modern-day value investors remain deeply indebted to them. Graham and David were two assiduous and unusually insightful thinkers seeking to give order to the mostly uncharted financial wilderness of their era. They kindled a flame that has illuminated the way for value investors ever since. Today, Security Analysis remains an invaluable roadmap for investors as they navigate through unpredictable, often volatile, and sometimes treacherous finan- cial markets. Frequently referred to as the “bible of value investing,” Secu- rity Analysis is extremely thorough and detailed, teeming with wisdom for the ages. Although many of the examples are obviously dated, their les- sons are timeless. And while the prose may sometimes seem dry, readers can yet discover valuable ideas on nearly every page. The financial mar- kets have morphed since 1934 in almost unimaginable ways, but Graham and Dodd’s approach to investing remains remarkably applicable today. Value investing, today as in the era of Graham and Dodd, is the prac- tice of purchasing securities or assets for less than they are worth—the proverbial dollar for 50 cents. Investing in bargain-priced securities pro- vides a “margin of safety”—room for error, imprecision, bad luck, or the vicissitudes of the economy and stock market. While some might mistak- enly consider value investing a mechanical tool for identifying bargains, it is actually a comprehensive investment philosophy that emphasizes the need to perform in-depth fundamental analysis, pursue long-term investment results, limit risk, and resist crowd psychology. Far too many people approach the stock market with a focus on mak- ing money quickly. Such an orientation involves speculation rather than investment and is based on the hope that share prices will rise irrespec- tive of valuation. Speculators generally regard stocks as pieces of paper to be quickly traded back and forth, foolishly decoupling them from business reality and valuation criteria. Speculative approaches—which pay little or no attention to downside risk—are especially popular in ris- ing markets. In heady times, few are sufficiently disciplined to maintain strict standards of valuation and risk aversion, especially when most of those abandoning such standards are quickly getting rich. After all, it is easy to confuse genius with a bull market. In recent years, some people have attempted to expand the defini- tion of an investment to include any asset that has recently—or might soon—appreciate in price: art, rare stamps, or a wine collection. Because these items have no ascertainable fundamental value, generate no pres- ent or future cash flow, and depend for their value entirely on buyer whim, they clearly constitute speculations rather than investments. In contrast to the speculator’s preoccupation with rapid gain, value investors demonstrate their risk aversion by striving to avoid loss. A risk- averse investor is one for whom the perceived benefit of any gain is out- weighed by the perceived cost of an equivalent loss. Once any of us has accumulated a modicum of capital, the incremental benefit of gaining more is typically eclipsed by the pain of having less.1 Imagine how you would respond to the proposition of a coin flip that would either double your net worth or extinguish it. Being risk averse, nearly all people would respectfully decline such a gamble. Such risk aversion is deeply ingrained in human nature. Yet many unwittingly set aside their risk aversion when the sirens of market speculation call. Value investors regard securities not as speculative instruments but as fractional ownership in, or debt claims on, the underlying businesses. This orientation is key to value investing. When a small slice of a business is offered at a bargain price, it is helpful to evaluate it as if the whole business were offered for sale there. This analytical anchor helps value investors remain focused on the pursuit of long-term results rather than the profitability of their daily trading ledger. At the root of Graham and Dodd’s philosophy is the principle that the financial markets are the ultimate creators of opportunity. Sometimes the markets price securities correctly, other times not. Indeed, in the short run, the market can be quite inefficient, with great deviations between price and underlying value. Unexpected developments, increased uncer- tainty, and capital flows can boost short-term market volatility, with prices overshooting in either direction.2 In the words of Graham and Dodd, “The price [of a security] is frequently an essential element, so that a stock . . . may have investment merit at one price level but not at another.” (p. 106) As Graham has instructed, those who view the market as a weighing machine—a precise and efficient assessor of value—are part of the emo- tionally driven herd. Those who regard the market as a voting machine—a sentiment-driven popularity contest—will be well positioned to take proper advantage of the extremes of market sentiment. While it might seem that anyone can be a value investor, the essential characteristics of this type of investor—patience, discipline, and risk aver- sion—may well be genetically determined. When you first learn of the value approach, it either resonates with you or it doesn’t. Either you are able to remain disciplined and patient, or you aren’t. As Warren Buffett said in his famous article, “The Superinvestors of Graham-and-Doddsville,” “It is extraordinary to me that the idea of buying dollar bills for 40 cents takes immediately with people or it doesn’t take at all. It’s like an inocula- tion. If it doesn’t grab a person right away, I find you can talk to him for years and show him records, and it doesn’t make any difference.” 3,4 If Security Analysis resonates with you—if you can resist speculating and sometimes sit on your hands—perhaps you have a predisposition toward value investing. If not, at least the book will help you understand where you fit into the investing landscape and give you an appreciation for what the value-investing community may be thinking. Just as Relevant Now Perhaps the most exceptional achievement of Security Analysis, first pub- lished in 1934 and revised in the acclaimed 1940 edition, is that its les- sons are timeless. Generations of value investors have adopted the teachings of Graham and Dodd and successfully implemented them across highly varied market environments, countries, and asset classes. 3 “The Superinvestors of Graham-and-Doddsville,” Hermes, the Columbia Business School magazine, 1984. 4 My own experience has been exactly the one that Buffett describes. My 1978 summer job at Mutual Shares, a no-load value-based mutual fund, set the course for my professional career. The planned liquidation of Telecor and spin-off of its Electro Rent subsidiary in 1980 forever imprinted in my mind the merit of fundamental investment analysis. A buyer of Telecor stock was effectively creating an investment in the shares of Electro Rent, a fast-growing equipment rental company, at the giveaway valuation of approximately 1 times the cash flow. You always remember your first value investment.This would delight the authors, who hoped to set forth principles that would “stand the test of the ever enigmatic future.” (p. xliv) In 1992, Tweedy, Browne Company LLC, a well-known value invest- ment firm, published a compilation of 44 research studies entitled, “What Has Worked in Investing.” The study found that what has worked is fairly simple: cheap stocks (measured by price-to-book values, price- to-earnings ratios, or dividend yields) reliably outperform expensive ones, and stocks that have underperformed (over three- and five-year periods) subsequently beat those that have lately performed well. In other words, value investing works! I know of no long-time practitioner who regrets adhering to a value philosophy; few investors who embrace the fundamental principles ever abandon this investment approach for another. Today, when you read Graham and Dodd’s description of how they navigated through the financial markets of the 1930s, it seems as if they were detailing a strange, foreign, and antiquated era of economic depression, extreme risk aversion, and obscure and obsolete businesses. But such an exploration is considerably more valuable than it superfi- cially appears. After all, each new day has the potential to bring with it a strange and foreign environment. Investors tend to assume that tomor- row’s markets will look very much like today’s, and, most of the time, they will. But every once in a while,5 conventional wisdom is turned on its head, circular reasoning is unraveled, prices revert to the mean, and speculative behavior is exposed as such. At those times, when today fails to resemble yesterday, most investors will be paralyzed. In the words of Graham and Dodd, “We have striven throughout to guard the student against overemphasis upon the superficial and the temporary,” which is “at once the delusion and the nemesis of the world of finance.” (p. xliv) It is during periods of tumult that a value-investing philosophy is particu- larly beneficial. In 1934, Graham and Dodd had witnessed over a five-year span the best and the worst of times in the markets—the run-up to the 1929 peak, the October 1929 crash, and the relentless grind of the Great Depression. They laid out a plan for how investors in any environment might sort through hundreds or even thousands of common stocks, pre- ferred shares, and bonds to identify those worthy of investment. Remark- ably, their approach is essentially the same one that value investors employ today. The same principles they applied to the U.S. stock and bond markets of the 1920s and 1930s apply to the global capital markets of the early twenty-first century, to less liquid asset classes like real estate and private equity, and even to derivative instruments that hardly existed when Security Analysis was written. While formulas such as the classic “net working capital” test are nec- essary to support an investment analysis, value investing is not a paint- by-numbers exercise.6 Skepticism and judgment are always required. For one thing, not all elements affecting value are captured in a company’s financial statements—inventories can grow obsolete and receivables uncollectible; liabilities are sometimes unrecorded and property values over- or understated. Second, valuation is an art, not a science. Because the value of a business depends on numerous variables, it can typically be assessed only within a range. Third, the outcomes of all investments depend to some extent on the future, which cannot be predicted with certainty; for this reason, even some carefully analyzed investments fail to achieve profitable outcomes. Sometimes a stock becomes cheap for good reason: a broken business model, hidden liabilities, protracted litigation, or incompetent or corrupt management. Investors must always act with caution and humility, relentlessly searching for additional infor- mation while realizing that they will never know everything about a company. In the end, the most successful value investors combine detailed business research and valuation work with endless discipline and patience, a well-considered sensitivity analysis, intellectual honesty, and years of analytical and investment experience. Interestingly, Graham and Dodd’s value-investing principles apply beyond the financial markets—including, for example, to the market for baseball talent, as eloquently captured in Moneyball, Michael Lewis’s 2003 bestseller. The market for baseball players, like the market for stocks and bonds, is inefficient—and for many of the same reasons. In both investing and baseball, there is no single way to ascertain value, no one metric that tells the whole story. In both, there are mountains of information and no broad consensus on how to assess it. Decision makers in both arenas mis- interpret available data, misdirect their analyses, and reach inaccurate conclusions. In baseball, as in securities, many overpay because they fear standing apart from the crowd and being criticized. They often make decisions for emotional, not rational, reasons. They become exuberant; they panic. Their orientation sometimes becomes overly short term. They fail to understand what is mean reverting and what isn’t. Baseball’s value investors, like financial market value investors, have achieved significant outperformance over time. While Graham and Dodd didn’t apply value principles to baseball, the applicability of their insights to the market for athletic talent attests to the universality and timelessness of this approach. Value Investing Today Amidst the Great Depression, the stock market and the national econ- omy were exceedingly risky. Downward movements in share prices and business activity came suddenly and could be severe and protracted. Optimists were regularly rebuffed by circumstances. Winning, in a sense, was accomplished by not losing. Investors could achieve a margin of safety by buying shares in businesses at a large discount to their under- lying value, and they needed a margin of safety because of all the things that could—and often did—go wrong. Even in the worst of markets, Graham and Dodd remained faithful to their principles, including their view that the economy and markets sometimes go through painful cycles, which must simply be endured. They expressed confidence, in those dark days, that the economy and stock market would eventually rebound: “While we were writing, we had to combat a widespread conviction that financial debacle was to be the permanent order.” (p. xliv) Of course, just as investors must deal with down cycles when busi- ness results deteriorate and cheap stocks become cheaper, they must also endure up cycles when bargains are scarce and investment capital is plentiful. In recent years, the financial markets have performed exceed- ingly well by historic standards, attracting substantial fresh capital in need of managers. Today, a meaningful portion of that capital—likely totaling in the trillions of dollars globally—invests with a value approach. This includes numerous value-based asset management firms and mutual funds, a number of today’s roughly 9,000 hedge funds, and some of the largest and most successful university endowments and family investment offices. It is important to note that not all value investors are alike. In the aforementioned “Superinvestors of Graham-and-Doddsville,” Buffett describes numerous successful value investors who have little portfolio overlap. Some value investors hold obscure, “pink-sheet shares” while others focus on the large-cap universe. Some have gone global, while others focus on a single market sector such as real estate or energy. Some run computer screens to identify statistically inexpensive compa- nies, while others assess “private market value”—the value an industry buyer would pay for the entire company. Some are activists who aggres- sively fight for corporate change, while others seek out undervalued securities with a catalyst already in place—such as a spin-off, asset sale, major share repurchase plan, or new management team—for the partial or full realization of the underlying value. And, of course, as in any pro- fession, some value investors are simply more talented than others. In the aggregate, the value-investing community is no longer the very small group of adherents that it was several decades ago. Competition can have a powerful corrective effect on market inefficiencies and mis- pricings. With today’s many amply capitalized and skilled investors, what are the prospects for a value practitioner? Better than you might expect, for several reasons. First, even with a growing value community, there are far more market participants with little or no value orientation. Most man- agers, including growth and momentum investors and market indexers, pay little or no attention to value criteria. Instead, they concentrate almost single-mindedly on the growth rate of a company’s earnings, the momentum of its share price, or simply its inclusion in a market index. Second, nearly all money managers today, including some hapless value managers, are forced by the (real or imagined) performance pres- sures of the investment business to have an absurdly short investment horizon, sometimes as brief as a calendar quarter, month, or less. A value strategy is of little use to the impatient investor since it usually takes time to pay off. Finally, human nature never changes. Capital market manias regularly occur on a grand scale: Japanese stocks in the late 1980s, Internet and technology stocks in 1999 and 2000, subprime mortgage lending in 2006 and 2007, and alternative investments currently. It is always difficult to take a contrarian approach. Even highly capable investors can wither under the relentless message from the market that they are wrong. The pressures to succumb are enormous; many investment managers fear they’ll lose business if they stand too far apart from the crowd. Some also fail to pursue value because they’ve handcuffed themselves (or been saddled by clients) with constraints preventing them from buying stocks selling at low dollar prices, small-cap stocks, stocks of companies that don’t pay dividends or are losing money, or debt instruments with below investment-grade ratings.7 Many also engage in career manage- ment techniques like “window dressing” their portfolios at the end of cal- endar quarters or selling off losers (even if they are undervalued) while buying more of the winners (even if overvalued). Of course, for those value investors who are truly long term oriented, it is a wonderful thing that many potential competitors are thrown off course by constraints that render them unable or unwilling to effectively compete. Another reason that greater competition may not hinder today’s value investors is the broader and more diverse investment landscape in which they operate. Graham faced a limited lineup of publicly traded U.S. equity and debt securities. Today, there are many thousands of publicly traded stocks in the United States alone, and many tens of thousands worldwide, plus thousands of corporate bonds and asset-backed debt securities. Previously illiquid assets, such as bank loans, now trade regu- larly. Investors may also choose from an almost limitless number of derivative instruments, including customized contracts designed to meet any need or hunch. Nevertheless, 25 years of historically strong stock market perform- ance have left the market far from bargain-priced. High valuations and intensified competition raise the specter of lower returns for value investors generally. Also, some value investment firms have become extremely large, and size can be the enemy of investment performance because decision making is slowed by bureaucracy and smaller opportu- nities cease to move the needle. In addition, because growing numbers of competent buy-side and sell-side analysts are plying their trade with the assistance of sophisti- cated information technology, far fewer securities seem likely to fall through the cracks to become extremely undervalued.8 Today’s value investors are unlikely to find opportunity armed only with a Value Line guide or by thumbing through stock tables. While bargains still occasion- ally hide in plain sight, securities today are most likely to become mis- priced when they are either accidentally overlooked or deliberately avoided. Consequently, value investors have had to become thoughtful about where to focus their analysis. In the early 2000s, for example, investors became so disillusioned with the capital allocation procedures of many South Korean companies that few considered them candidates for worthwhile investment. As a result, the shares of numerous South Korean companies traded at great discounts from prevailing international valuations: at two or three times the cash flow, less than half the underly- ing business value, and, in several cases, less than the cash (net of debt) held on their balance sheets. Bargain issues, such as Posco and SK Tele- com, ultimately attracted many value seekers; Warren Buffett reportedly profited handsomely from a number of South Korean holdings. Today’s value investors also find opportunity in the stocks and bonds of companies stigmatized on Wall Street because of involvement in pro-tracted litigation, scandal, accounting fraud, or financial distress. The securities of such companies sometimes trade down to bargain levels, where they become good investments for those who are able to remain stalwart in the face of bad news. For example, the debt of Enron, per- haps the world’s most stigmatized company after an accounting scandal forced it into bankruptcy in 2001, traded as low as 10 cents on the dollar of claim; ultimate recoveries are expected to be six times that amount. Similarly, companies with tobacco or asbestos exposure have in recent years periodically come under severe selling pressure due to the uncer- tainties surrounding litigation and the resultant risk of corporate finan- cial distress. More generally, companies that disappoint or surprise investors with lower-than-expected results, sudden management changes, accounting problems, or ratings downgrades are more likely than consistently strong performers to be sources of opportunity. When bargains are scarce, value investors must be patient; compro- mising standards is a slippery slope to disaster. New opportunities will emerge, even if we don’t know when or where. In the absence of com- pelling opportunity, holding at least a portion of one’s portfolio in cash equivalents (for example, U.S. Treasury bills) awaiting future deployment will sometimes be the most sensible option. Recently, Warren Buffett stated that he has more cash to invest than he has good investments. As all value investors must do from time to time, Buffett is waiting patiently. Still, value investors are bottom-up analysts, good at assessing securi- ties one at a time based on the fundamentals. They don’t need the entire market to be bargain priced, just 20 or 25 unrelated securities—a num- ber sufficient for diversification of risk. Even in an expensive market, value investors must keep analyzing securities and assessing businesses, gaining knowledge and experience that will be useful in the future. Value investors, therefore, should not try to time the market or guess whether it will rise or fall in the near term. Rather, they should rely on a bottom-up approach, sifting the financial markets for bargains and then buying them, regardless of the level or recent direction of the market or economy. Only when they cannot find bargains should they default to holding cash. A Flexible Approach Because our nation’s founders could not foresee—and knew they could not foresee—technological, social, cultural, and economic changes that the future would bring, they wrote a flexible constitution that still guides us over two centuries later. Similarly, Benjamin Graham and David Dodd acknowledged that they could not anticipate the business, economic, technological, and competitive changes that would sweep through the investment world over the ensuing years. But they, too, wrote a flexible treatise that provides us with the tools to function in an investment landscape that was destined—and remains destined—to undergo pro- found and unpredictable change. For example, companies today sell products that Graham and Dodd could not have imagined. Indeed, there are companies and entire indus- tries that they could not have envisioned. Security Analysis offers no examples of how to value cellular phone carriers, software companies, satellite television providers, or Internet search engines. But the book provides the analytical tools to evaluate almost any company, to assess the value of its marketable securities, and to determine the existence of a margin of safety. Questions of solvency, liquidity, predictability, busi- ness strategy, and risk cut across businesses, nations, and time. Graham and Dodd did not specifically address how to value private businesses or how to determine the value of an entire company rather than the value of a fractional interest through ownership of its shares.9 9 They did consider the relative merits of corporate control enjoyed by a private business owner ver- sus the value of marketability for a listed stock (p. 372). But their analytical principles apply equally well to these different issues. Investors still need to ask, how stable is the enterprise, and what are its future prospects? What are its earnings and cash flow? What is the downside risk of owning it? What is its liquidation value? How capable and honest is its management? What would you pay for the stock of this company if it were public? What factors might cause the owner of this business to sell control at a bargain price? Similarly, the pair never addressed how to analyze the purchase of an office building or apartment complex. Real estate bargains come about for the same reasons as securities bargains—an urgent need for cash, inability to perform proper analysis, a bearish macro view, or investor disfavor or neglect. In a bad real estate climate, tighter lending standards can cause even healthy properties to sell at distressed prices. Graham and Dodd’s principles—such as the stability of cash flow, sufficiency of return, and analysis of downside risk—allow us to identify real estate investments with a margin of safety in any market environment. Even complex derivatives not imagined in an earlier era can be scruti- nized with the value investor’s eye. While traders today typically price put and call options via the Black-Scholes model, one can instead use value-investing precepts—upside potential, downside risk, and the likeli- hood that each of various possible scenarios will occur—to analyze these instruments. An inexpensive option may, in effect, have the favorable risk-return characteristics of a value investment—regardless of what the Black-Scholes model dictates. Institutional Investing Perhaps the most important change in the investment landscape over the past 75 years is the ascendancy of institutional investing. In the 1930s, individual investors dominated the stock market. Today, by contrast, most market activity is driven by institutional investors—large pools of pension, endowment, and aggregated individual capital. While the advent of these large, quasi-permanent capital pools might have resulted in the wide-scale adoption of a long-term value-oriented approach, in fact this has not occurred. Instead, institutional investing has evolved into a short-term performance derby, which makes it diffi- cult for institutional managers to take contrarian or long-term positions. Indeed, rather than standing apart from the crowd and possibly suffering disappointing short-term results that could cause clients to withdraw capital, institutional investors often prefer the safe haven of assured mediocre performance that can be achieved only by closely following the herd. Alternative investments—a catch-all category that includes venture capital, leveraged buyouts, private equity, and hedge funds—are the cur- rent institutional rage. No investment treatise written today could fail to comment on this development. Fueled by performance pressures and a growing expectation of low (and inadequate) returns from traditional equity and debt investments, institutional investors have sought high returns and diversification by allocating a growing portion of their endowments and pension funds to alternatives. Pioneering Portfolio Management, written in 2000 by David Swensen, the groundbreaking head of Yale’s Investment Office, makes a strong case for alternative investments. In it, Swensen points to the historically inefficient pricing of many asset classes,10 the historically high risk-adjusted returns of many alternative managers, and the limited 10 Many investors make the mistake of thinking about returns to asset classes as if they were perma- nent. Returns are not inherent to an asset class; they result from the fundamentals of the underlying businesses and the price paid by investors for the related securities. Capital flowing into an asset class can, reflexively, impair the ability of those investing in that asset class to continue to generate the anticipated, historically attractive returns. He highlights the importance of alternative manager selection by noting the large dispersion of returns achieved between top-quartile and third- quartile performers. A great many endowment managers have emulated Swensen, following him into a large commitment to alternative investments, almost certainly on worse terms and amidst a more competitive environment than when he entered the area. Graham and Dodd would be greatly concerned by the commitment of virtually all major university endowments to one type of alternative investment: venture capital. The authors of the margin-of-safety approach to investing would not find one in the entire venture capital universe.11 While there is often the prospect of substantial upside in ven- ture capital, there is also very high risk of failure. Even with the diversifi- cation provided by a venture fund, it is not clear how to analyze the underlying investments to determine whether the potential return justi- fies the risk. Venture capital investment would, therefore, have to be characterized as pure speculation, with no margin of safety whatsoever. Hedge funds—a burgeoning area of institutional interest with nearly $2 trillion of assets under management—are pools of capital that vary widely in their tactics but have a common fee structure that typically pays the manager 1% to 2% annually of assets under management and 20% (and sometimes more) of any profits generated. They had their start in the 1920s, when Ben Graham himself ran one of the first hedge funds. What would Graham and Dodd say about the hedge funds operating in today’s markets? They would likely disapprove of hedge funds that make investments based on macroeconomic assessments or that pursue 11 Nor would they find one in leveraged buyouts, through which businesses are purchased at lofty prices using mostly debt financing and a thin layer of equity capital. The only value-investing ration- ale for venture capital or leveraged buyouts might be if they were regarded as mispriced call options. Even so, it is not clear that these areas constitute good value. Such funds, by avoiding or even sell- ing undervalued securities to participate in one or another folly, inadver- tently create opportunities for value investors. The illiquidity, lack of transparency, gargantuan size, embedded leverage, and hefty fees of some hedge funds would no doubt raise red flags. But Graham and Dodd would probably approve of hedge funds that practice value-ori- ented investment selection. Importantly, while Graham and Dodd emphasized limiting risk on an investment-by-investment basis, they also believed that diversification and hedging could protect the downside for an entire portfolio. (p. 106) This is what most hedge funds attempt to do. While they hold individual securities that, considered alone, may involve an uncomfortable degree of risk, they attempt to offset the risks for the entire portfolio through the short sale of similar but more highly valued securities, through the purchase of put options on individual securities or market indexes, and through adequate diversification (although many are guilty of overdiver- sification, holding too little of their truly good ideas and too much of their mediocre ones). In this way, a hedge fund portfolio could (in theory, anyway) have characteristics of good potential return with limited risk that its individual components may not have. Modern-day Developments As mentioned, the analysis of businesses and securities has become increasingly sophisticated over the years. Spreadsheet technology, for example, allows for vastly more sophisticated modeling than was possible even one generation ago. Benjamin Graham’s pencil, clearly one of the sharpest of his era, might not be sharp enough today. On the other hand, technology can easily be misused; computer modeling requires making a series of assumptions about the future that can lead to a spurious preci- sion of which Graham would have been quite dubious. While Graham was interested in companies that produced consistent earnings, analysis in his day was less sophisticated regarding why some company’s earnings might be more consistent than others. Analysts today examine businesses but also business models; the bottom-line impact of changes in revenues, profit margins, product mix, and other variables is carefully studied by managements and financial analysts alike. Investors know that businesses do not exist in a vacuum; the actions of competitors, suppliers, and cus- tomers can greatly impact corporate profitability and must be considered.12 Another important change in focus over time is that while Graham looked at corporate earnings and dividend payments as barometers of a company’s health, most value investors today analyze free cash flow. This is the cash generated annually from the operations of a business after all capital expenditures are made and changes in working capital are con- sidered. Investors have increasingly turned to this metric because reported earnings can be an accounting fiction, masking the cash gener- ated by a business or implying positive cash generation when there is none. Today’s investors have rightly concluded that following the cash— as the manager of a business must do—is the most reliable and reveal- ing means of assessing a company. In addition, many value investors today consider balance sheet analy- sis less important than was generally thought a few generations ago. With returns on capital much higher at present than in the past, most stocks trade far above book value; balance sheet analysis is less helpful in understanding upside potential or downside risk of stocks priced at 12 Professor Michael Porter of Harvard Business School, in his seminal book Competitive Strategy (Free Press, 1980), lays out the groundwork for a more intensive, thorough, and dynamic analysis of busi- nesses and industries in the modern economy. A broad industry analysis has become particularly necessary as a result of the passage in 2000 of Regulation FD (Fair Disclosure), which regulates and restricts the communications between a company and its actual or potential shareholders. Wall Street analysts, facing a dearth of information from the companies they cover, have been forced to expand their areas of inquiry. The effects of sustained inflation over time have also wreaked havoc with the accuracy of assets accounted for using historic cost; this means that two companies owning identical assets could report very different book values. Of course, balance sheets must still be carefully scrutinized. Astute observers of corporate balance sheets are often the first to see business deterioration or vulnerability as inventories and receivables build, debt grows, and cash evaporates. And for investors in the equity and debt of underperforming companies, balance sheet analysis remains one generally reliable way of assessing downside protection. Globalization has increasingly affected the investment landscape, with most investors looking beyond their home countries for opportunity and diversification. Graham and Dodd’s principles fully apply to international markets, which are, if anything, even more subject to the vicissitudes of investor sentiment—and thus more inefficiently priced—than the U.S. market is today. Investors must be cognizant of the risks of international investing, including exposure to foreign currencies and the need to consider hedging them. Among the other risks are political instability, different (or absent) securities laws and investor protections, varying accounting standards, and limited availability of information. Oddly enough, despite 75 years of success achieved by value investors, one group of observers largely ignores or dismisses this disci- pline: academics. Academics tend to create elegant theories that purport to explain the real world but in fact oversimplify it. One such theory, the Efficient Market Hypothesis (EMH), holds that security prices always and immediately reflect all available information, an idea deeply at odds with Graham and Dodd’s notion that there is great value to fundamental security analysis. The Capital Asset Pricing Model (CAPM) relates risk to return but always mistakes volatility, or beta, for risk. Modern Portfolio Theory (MPT) applauds the benefits of diversification in constructing an optimal portfolio. But by insisting that higher expected return comes only with greater risk, MPT effectively repudiates the entire value-invest- ing philosophy and its long-term record of risk-adjusted investment out- performance. Value investors have no time for these theories and generally ignore them. The assumptions made by these theories—including continuous markets, perfect information, and low or no transaction costs—are unre- alistic. Academics, broadly speaking, are so entrenched in their theories that they cannot accept that value investing works. Instead of launching a series of studies to understand the remarkable 50-year investment record of Warren Buffett, academics instead explain him away as an aber- ration. Greater attention has been paid recently to behavioral economics, a field recognizing that individuals do not always act rationally and have systematic cognitive biases that contribute to market inefficiencies and security mispricings. These teachings—which would not seem alien to Graham—have not yet entered the academic mainstream, but they are building some momentum. Academics have espoused nuanced permutations of their flawed the- ories for several decades. Countless thousands of their students have been taught that security analysis is worthless, that risk is the same as volatility, and that investors must avoid overconcentration in good ideas (because in efficient markets there can be no good ideas) and thus diver- sify into mediocre or bad ones. Of course, for value investors, the propa- gation of these academic theories has been deeply gratifying: the brainwashing of generations of young investors produces the very ineffi- ciencies that savvy stock pickers can exploit. Another important factor for value investors to take into account is the growing propensity of the Federal Reserve to intervene in financial markets at the first sign of trouble. Amidst severe turbulence, the Fed frequently lowers interest rates to prop up securities prices and restore investor confidence. While the intention of Fed officials is to maintain orderly capital markets, some money managers view Fed intervention as a virtual license to speculate. Aggressive Fed tactics, sometimes referred to as the “Greenspan put” (now the “Bernanke put”), create a moral haz- ard that encourages speculation while prolonging overvaluation. So long as value investors aren’t lured into a false sense of security, so long as they can maintain a long-term horizon and ensure their staying power, market dislocations caused by Fed action (or investor anticipation of it) may ultimately be a source of opportunity. Another modern development of relevance is the ubiquitous cable television coverage of the stock market. This frenetic lunacy exacerbates the already short-term orientation of most investors. It foments the view that it is possible—or even necessary—to have an opinion on everything pertinent to the financial markets, as opposed to the patient and highly selective approach endorsed by Graham and Dodd. This sound-bite cul- ture reinforces the popular impression that investing is easy, not rigorous and painstaking. The daily cheerleading pundits exult at rallies and record highs and commiserate over market reversals; viewers get the impression that up is the only rational market direction and that selling or sitting on the sidelines is almost unpatriotic. The hysterical tenor is exacerbated at every turn. For example, CNBC frequently uses a format- ted screen that constantly updates the level of the major market indexes against a digital clock. Not only is the time displayed in hours, minutes, and seconds but in completely useless hundredths of seconds, the num- bers flashing by so rapidly (like tenths of a cent on the gas pump) as to be completely unreadable. The only conceivable purpose is to grab the viewers’ attention and ratchet their adrenaline to full throttle. Cable business channels bring the herdlike mentality of the crowd into everyone’s living room, thus making it much harder for viewers to stand apart from the masses. Only on financial cable TV would a commentator with a crazed persona become a celebrity whose pronouncements regularly move markets. In a world in which the differences between investing and speculating are frequently blurred, the nonsense on financial cable channels only compounds the problem. Graham would have been appalled. The only saving grace is that value investors prosper at the expense of those who fall under the spell of the cable pundits. Meanwhile, human nature virtually ensures that there will never be a Graham and Dodd channel. Unanswered Questions Today’s investors still wrestle, as Graham and Dodd did in their day, with a number of important investment questions. One is whether to focus on relative or absolute value. Relative value involves the assessment that one security is cheaper than another, that Microsoft is a better bargain than IBM. Relative value is easier to determine than absolute value, the two-dimensional assessment of whether a security is cheaper than other securities and cheap enough to be worth purchasing. The most intrepid investors in relative value manage hedge funds where they purchase the relatively less expensive securities and sell short the relatively more expensive ones. This enables them potentially to profit on both sides of the ledger, long and short. Of course, it also exposes them to double- barreled losses if they are wrong.13 It is harder to think about absolute value than relative value. When is a stock cheap enough to buy and hold without a short sale as a hedge? One standard is to buy when a security trades at an appreciable—say, 30%, 40%, or greater—discount from its underlying value, calculated either as its liquidation value, going-concern value, or private-market 13 Many hedge funds also use significant leverage to goose their returns further, which backfires when analysis is faulty or judgment is flawed. Another standard is to invest when a security offers an acceptably attractive return to a long-term holder, such as a low-risk bond priced to yield 10% or more, or a stock with an 8% to 10% or higher free cash flow yield at a time when “risk-free” U.S. government bonds deliver 4% to 5% nominal and 2% to 3% real returns. Such demanding standards virtually ensure that absolute value will be quite scarce. Another area where investors struggle is trying to define what consti- tutes a good business. Someone once defined the best possible business as a post office box to which people send money. That idea has certainly been eclipsed by the creation of subscription Web sites that accept credit cards. Today’s most profitable businesses are those in which you sell a fixed amount of work product—say, a piece of software or a hit recording—millions and millions of times at very low marginal cost. Good businesses are generally considered those with strong barriers to entry, limited capital requirements, reliable customers, low risk of tech- nological obsolescence, abundant growth possibilities, and thus signifi- cant and growing free cash flow. Businesses are also subject to changes in the technological and com- petitive landscape. Because of the Internet, the competitive moat sur- rounding the newspaper business—which was considered a very good business only a decade ago—has eroded faster than almost anyone anticipated. In an era of rapid technological change, investors must be ever vigilant, even with regard to companies that are not involved in technology but are simply affected by it. In short, today’s good busi- nesses may not be tomorrow’s. Investors also expend considerable effort attempting to assess the quality of a company’s management. Some managers are more capable or scrupulous than others, and some may be able to manage certain businesses and environments better than others. Yet, as Graham and Dodd noted, “Objective tests of managerial ability are few and far from scientific.” (p. 84) Make no mistake about it: a management’s acumen, foresight, integrity, and motivation all make a huge difference in share- holder returns. In the present era of aggressive corporate financial engi- neering, managers have many levers at their disposal to positively impact returns, including share repurchases, prudent use of leverage, and a valuation-based approach to acquisitions. Managers who are unwilling to make shareholder-friendly decisions risk their companies becoming perceived as “value traps”: inexpensively valued, but ulti- mately poor investments, because the assets are underutilized. Such companies often attract activist investors seeking to unlock this trapped value. Even more difficult, investors must decide whether to take the risk of investing—at any price—with management teams that have not always done right by shareholders. Shares of such companies may sell at steeply discounted levels, but perhaps the discount is warranted; value that today belongs to the equity holders may tomorrow have been spir- ited away or squandered. An age-old difficulty for investors is ascertaining the value of future growth. In the preface to the first edition of Security Analysis, the authors said as much: “Some matters of vital significance, e.g., the determination of the future prospects of an enterprise, have received little space, because little of definite value can be said on the subject.” (p. xliii) Clearly, a company that will earn (or have free cash flow of) $1 per share today and $2 per share in five years is worth considerably more than a company with identical current per share earnings and no growth. This is especially true if the growth of the first company is likely to continue and is not subject to great variability. Another complication is that companies can grow in many different ways—for example, selling the same number of units at higher prices; selling more units at the same (or even lower) prices; changing the product mix (selling proportionately more of the higher-profit-margin products); or developing an entirely new product line. Obviously, some forms of growth are worth more than others. There is a significant downside to paying up for growth or, worse, to obsessing over it. Graham and Dodd astutely observed that “analysis is concerned primarily with values which are supported by the facts and not with those which depend largely upon expectations.” (p. 86) Strongly preferring the actual to the possible, they regarded the “future as a haz- ard which his [the analyst’s] conclusions must encounter rather than as the source of his vindication.” (p. 86) Investors should be especially vigi- lant against focusing on growth to the exclusion of all else, including the risk of overpaying. Again, Graham and Dodd were spot on, warning that “carried to its logical extreme, . . . [there is no price] too high for a good stock, and that such an issue was equally ‘safe’ after it had advanced to 200 as it had been at 25.” (p. 105) Precisely this mistake was made when stock prices surged skyward during the Nifty Fifty era of the early 1970s and the dot-com bubble of 1999 to 2000. The flaw in such a growth-at-any-price approach becomes obvious when the anticipated growth fails to materialize. When the future disap- points, what should investors do? Hope growth resumes? Or give up and sell? Indeed, failed growth stocks are often so aggressively dumped by disappointed holders that their price falls to levels at which value investors, who stubbornly pay little or nothing for growth characteristics, become major holders. This was the case with many technology stocks that suffered huge declines after the dot-com bubble burst in the spring of 2000. By 2002, hundreds of fallen tech stocks traded for less than the cash on their balance sheets, a value investor’s dream. One such com- pany was Radvision, an Israeli provider of voice, video, and data products whose stock subsequently rose from under $5 to the mid-$20s after the urgent selling abated and investors refocused on fundamentals. Another conundrum for value investors is knowing when to sell. Buy- ing bargains is the sweet spot of value investors, although how small a discount one might accept can be subject to debate. Selling is more dif- ficult because it involves securities that are closer to fully priced. As with buying, investors need a discipline for selling. First, sell targets, once set, should be regularly adjusted to reflect all currently available information. Second, individual investors must consider tax consequences. Third, whether or not an investor is fully invested may influence the urgency of raising cash from a stockholding as it approaches full valuation. The availability of better bargains might also make one a more eager seller. Finally, value investors should completely exit a security by the time it reaches full value; owning overvalued securities is the realm of specula- tors. Value investors typically begin selling at a 10% to 20% discount to their assessment of underlying value—based on the liquidity of the security, the possible presence of a catalyst for value realization, the quality of management, the riskiness and leverage of the underlying business, and the investors’ confidence level regarding the assumptions underlying the investment. Finally, investors need to deal with the complex subject of risk. As mentioned earlier, academics and many professional investors have come to define risk in terms of the Greek letter beta, which they use as a measure of past share price volatility: a historically more volatile stock is seen as riskier. But value investors, who are inclined to think about risk as the probability and amount of potential loss, find such reasoning absurd. In fact, a volatile stock may become deeply undervalued, rendering it a very low risk investment. One of the most difficult questions for value investors is how much risk to incur. One facet of this question involves position size and its impact on portfolio diversification. How much can you comfortably own of even the most attractive opportunities? Naturally, investors desire to profit fully from their good ideas. Yet this tendency is tempered by the fear of being unlucky or wrong. Nonetheless, value investors should concentrate their holdings in their best ideas; if you can tell a good investment from a bad one, you can also distinguish a great one from a good one. Investors must also ponder the risks of investing in politically unsta- ble countries, as well as the uncertainties involving currency, interest rate, and economic fluctuations. How much of your capital do you want tied up in Argentina or Thailand, or even France or Australia, no matter how undervalued the stocks may be in those markets? Another risk consideration for value investors, as with all investors, is whether or not to use leverage. While some value-oriented hedge funds and even endowments use leverage to enhance their returns, I side with those who are unwilling to incur the added risks that come with margin debt. Just as leverage enhances the return of successful investments, it magnifies the losses from unsuccessful ones. More importantly, nonre- course (margin) debt raises risk to unacceptable levels because it places one’s staying power in jeopardy. One risk-related consideration should be paramount above all others: the ability to sleep well at night, confi- dent that your financial position is secure whatever the future may bring. Final Thoughts In a rising market, everyone makes money and a value philosophy is unnecessary. But because there is no certain way to predict what the market will do, one must follow a value philosophy at all times. By con- trolling risk and limiting loss through extensive fundamental analysis, strict discipline, and endless patience, value investors can expect good results with limited downside. You may not get rich quick, but you will keep what you have, and if the future of value investing resembles its past, you are likely to get rich slowly. As investment strategies go, this is the most that any reasonable investor can hope for. The real secret to investing is that there is no secret to investing. Every important aspect of value investing has been made available to the public many times over, beginning in 1934 with the first edition of Security Analysis. That so many people fail to follow this timeless and almost foolproof approach enables those who adopt it to remain suc- cessful. The foibles of human nature that result in the mass pursuit of instant wealth and effortless gain seem certain to be with us forever. So long as people succumb to this aspect of their natures, value investing will remain, as it has been for 75 years, a sound and low-risk approach to successful long-term investing. SETH A. KLARMAN Boston, Massachusetts, May, 2008 Introduction to the Sixth Edition It was a distracted world before which McGraw-Hill set, with a thud, the first edition of Security Analysis in July 1934. From Berlin dribbled reports of a shake-up at the top of the German government. “It will simplify the Führer’s whole work immensely if he need not first ask some- body if he may do this or that,” the Associated Press quoted an informant on August 1 as saying of Hitler’s ascension from chancellor to dictator. Set against such epochal proceedings, a 727-page textbook on the fine points of value investing must have seemed an unlikely candidate for bestsellerdom, then or later. In his posthumously published autobiography, The Memoirs of the Dean of Wall Street, Graham (1894–1976) thanked his lucky stars that he had entered the investment business when he did. The timing seemed not so propitious in the year of the first edition of Security Analysis, or, indeed, that of the second edition—expanded and revised—six years later. From its 1929 peak to its 1932 trough, the Dow Jones Industrial Average had lost 87% of its value. At cyclical low ebb, in 1933, the national unemployment rate topped 25%. That the Great Depression ended in 1933 was the considered judgment of the timekeepers of the National Bureau of Economic Research. Millions of Americans, however— not least, the relatively few who tried to squeeze a living out of a profit- less Wall Street—had reason to doubt it. The bear market and credit liquidation of the early 1930s gave the institutions of American finance a top-to-bottom scouring. What was left of them presently came in for a rough handling by the first Roosevelt administration. Graham had learned his trade in the Wall Street of the mid–nineteen teens, an era of lightly regulated markets. He began work on Security Analysis as the administration of Herbert Hoover was giving the country its first taste of thoroughgoing federal intervention in a peacetime economy. He was correcting page proofs as the Roosevelt administration was implementing its first radical forays into macroeco- nomic management. By 1934, there were laws to institute federal regula- tion of the securities markets, federal insurance of bank deposits, and federal price controls (not to put a cap on prices, as in later, inflationary times, but rather to put a floor under them). To try to prop up prices, the administration devalued the dollar. It is a testament to the enduring quality of Graham’s thought, not to mention the resiliency of America’s financial markets, that Security Analysis lost none of its relevance even as the economy was being turned upside down and inside out. Five full months elapsed following publication of the first edition before Louis Rich got around to reviewing it in the New York Times. Who knows? Maybe the conscientious critic read every page. In any case, Rich gave the book a rave, albeit a slightly rueful one. “On the assumption,” he wrote, on December 2, 1934, “that despite the debacle of recent history there are still people left whose money burns a hole in their pockets, it is hoped that they will read this book. It is a full-bodied, mature, meticu- lous and wholly meritorious outgrowth of scholarly probing and practi- cal sagacity. Although cast in the form and spirit of a textbook, the presentation is endowed with all the qualities likely to engage the liveli- est interest of the layman.”1 How few laymen seemed to care about investing was brought home to Wall Street more forcefully with every passing year of the unprosperous postcrash era. Just when it seemed that trading volume could get no smaller, or New York Stock Exchange seat prices no lower, or equity valu- ations more absurdly cheap, a new, dispiriting record was set. It required every effort of the editors of the Big Board’s house organ, the Exchange magazine, to keep up a brave face. “Must There Be an End to Progress?” was the inquiring headline over an essay by the Swedish economist Gus- tav Cassel published around the time of the release of Graham and Dodd’s second edition (the professor thought not).2 “Why Do Securities Brokers Stay in Business?” the editors posed and helpfully answered, “Despite wearying lethargy over long periods, confidence abounds that when the public recognizes fully the value of protective measures which lately have been ranged about market procedure, investment interest in securities will increase.” It did not amuse the Exchange that a New York City magistrate, sarcastically addressing in his court a collection of defen- dants hauled in by the police for shooting craps on the sidewalk, had derided the financial profession. “The first thing you know,” the judge had upbraided the suspects, “you’ll wind up as stock brokers in Wall Street with yachts and country homes on Long Island.”3 In ways now difficult to imagine, Murphy’s Law was the order of the day; what could go wrong, did. “Depression” was more than a long-lin- gering state of economic affairs. It had become a worldview. The aca- demic exponents of “secular stagnation,” notably Alvin Hansen and Joseph Schumpeter, each a Harvard economics professor, predicted a long decline in American population growth. This deceleration, Hansen contended in his 1939 essay, “together with the failure of any really important innovations of a magnitude to absorb large capital outlays, weighs very heavily as an explanation for the failure of the recent recov- ery to reach full employment.”4 Neither Hansen nor his readers had any way of knowing that a baby boom was around the corner. Nothing could have seemed more unlikely to a world preoccupied with a new war in Europe and the evident decline and fall of capitalism. Certainly, Hansen’s ideas must have struck a chord with the chronically underemployed brokers and traders in lower Manhat- tan. As a business, the New York Stock Exchange was running at a steady loss. From 1933, the year in which it began to report its financial results, through 1940, the Big Board recorded a profit in only one year, 1935 (and a nominal one, at that). And when, in 1937, Chelcie C. Bosland, an assis- tant professor of economics at Brown University, brought forth a book entitled The Common Stock Theory of Investment, he remarked as if he were repeating a commonplace that the American economy had peaked two decades earlier at about the time of what was not yet called World War I. The professor added, quoting unnamed authorities, that American population growth could be expected to stop in its tracks by 1975.5 Small wonder that Graham was to write that the acid test of a bond issuer was its capacity to meet its obligations not in a time of middling prosperity (which modest test today’s residential mortgage–backed securities strug- gle to meet) but in a depression. Altogether, an investor in those days was well advised to keep up his guard. “The combination of a record high level for bonds,” writes Graham in the 1940 edition, “with a history of two catastrophic price collapses in the preceding 20 years and a major war in progress is not one to justify airy confidence in the future.” (p. 142) Wall Street, not such a big place even during the 1920s’ boom, got considerably smaller in the subsequent bust. Ben Graham, in conjunction with his partner Jerry Newman, made a very small cog of this low-horse- power machine. The two of them conducted a specialty investment busi- ness at 52 Wall Street. Their strong suits were arbitrage, reorganizations, bankruptcies, and other complex matters. A schematic drawing of the financial district published by Fortune in 1937 made no reference to the Graham-Newman offices. Then again, the partnerships and corporate headquarters that did rate a spot on the Wall Street map were them- selves—by the standards of twenty-first-century finance—remarkably compact. One floor at 40 Wall Street was enough to contain the entire office of Merrill Lynch & Co. And a single floor at 2 Wall Street was all the space required to house Morgan Stanley, the hands-down leader in 1936 corporate securities underwriting, with originations of all of $195 million. Compensation was in keeping with the slow pace of business, especially at the bottom of the corporate ladder.6 After a 20% rise in the new fed- eral minimum wage, effective October 1939, brokerage employees could earn no less than 30 cents an hour.7 In March 1940, the Exchange documented in all the detail its readers could want (and possibly then some) the collapse of public participation in the stock market. In the first three decades of the twentieth century, the annual volume of trading had almost invariably exceeded the quantity of listed shares outstanding, sometimes by a wide margin. And in only one year between 1900 and 1930 had annual volume amounted to less than 50% of listed shares—the exception being 1914, the year in which the exchange was closed for 41/2 months to allow for the shock of the out- break of World War I to sink in. Then came the 1930s, and the annual turnover as a percentage of listed shares struggled to reach as high as 50%. In 1939, despite a short-lived surge of trading on the outbreak of World War II in Europe, the turnover ratio had fallen to a shockingly low 18.4%. (For comparison, in 2007, the ratio of trading volume to listed shares amounted to 123%.) “Perhaps,” sighed the author of the study, “it is a fair statement that if the farming industry showed a similar record, government subsidies would have been voted long ago. Unfortunately for Wall Street, it seems to have too little sponsorship in officialdom.”8 If a reader took hope from the idea that things were so bad that they could hardly get worse, he or she was in for yet another disappointment. The second edition of Security Analysis had been published only months earlier when, on August 19, 1940, the stock exchange volume totaled just 129,650 shares. It was one of the sleepiest sessions since the 49,000- share mark set on August 5, 1916. For the entire 1940 calendar year, vol- ume totaled 207,599,749 shares—a not very busy two hours’ turnover at this writing and 18.5% of the turnover of 1929, that year of seemingly irrecoverable prosperity. The cost of a membership, or seat, on the stock exchange sank along with turnover and with the major price indexes. At the nadir in 1942, a seat fetched just $17,000. It was the lowest price since 1897 and 97% below the record high price of $625,000, set—natu- rally—in 1929. “‘The Cleaners,’” quipped Fred Schwed, Jr., in his funny and wise book Where Are the Customers’ Yachts? (which, like Graham’s second edition, appeared in 1940), “was not one of those exclusive clubs; by 1932, every- body who had ever tried speculation had been admitted to membership.”9 And if an investor did, somehow, manage to avoid the cleaner’s during the formally designated Great Depression, he or she was by no means home free. In August 1937, the market began a violent sell-off that would carry the averages down by 50% by March 1938. The nonfinancial portion of the economy fared little better than the financial side. In just nine months, industrial production fell by 34.5%, a sharper contraction even than that in the depression of 1920 to 1921, a slump that, for Graham’s generation, had seemed to set the standard for the most economic damage in the shortest elapsed time.10 The Roosevelt administration insisted that the slump of 1937 to 1938 was no depression but rather a “recession.” The national unemployment rate in 1938 was, on average, 18.8%. In April 1937, four months before the bottom fell out of the stock mar- ket for the second time in 10 years, Robert Lovett, a partner at the invest- ment firm of Brown Brothers Harriman & Co., served warning to the American public in the pages of the weekly Saturday Evening Post. Lovett, a member of the innermost circle of the Wall Street establishment, set out to demonstrate that there is no such thing as financial security—none, at least, to be had in stocks and bonds. The gist of Lovett’s argument was that, in capitalism, capital is consumed and that businesses are just as fragile, and mortal, as the people who own them. He invited his millions of readers to examine the record, as he had done: “If an investor had pur- chased 100 shares of the 20 most popular dividend-paying stocks on December 31, 1901, and held them through 1936, adding, in the mean- time, all the melons in the form of stock dividends, and all the plums in the form of stock split-ups, and had exercised all the valuable rights to subscribe to additional stock, the aggregate market value of his total holdings on December 31, 1936, would have shown a shrinkage of 39% as compared with the cost of his original investment. In plain English, the average investor paid $294,911.90 for things worth $180,072.06 on December 31, 1936. That’s a big disappearance of dollar value in any lan- guage.” In the innocent days before the crash, people had blithely spoken of “permanent investments.” “For our part,” wrote this partner of an emi- nent Wall Street private bank, “we are convinced that the only permanent investment is one which has become a total and irretrievable loss.”11 Lovett turned out to be a prophet. At the nadir of the 1937 to 1938 bear market, one in five NYSE-listed industrial companies was valued in the market for less than its net current assets. Subtract from cash and quick assets all liabilities and the remainder was greater than the company’s market value. That is, business value was negative. The Great Atlantic & Pacific Tea Company (A&P), the Wal-Mart of its day, was one of these corporate castoffs. At the 1938 lows, the market value of the com- mon and preferred shares of A&P at $126 million was less than the value of its cash, inventories, and receivables, conservatively valued at $134 million. In the words of Graham and Dodd, the still-profitable company was selling for “scrap.” (p. 673) A Different Wall Street Few institutional traces of that Wall Street remain. Nowadays, the big broker-dealers keep as much as $1 trillion in securities in inventory; in Graham’s day, they customarily held none. Nowadays, the big broker- dealers are in a perpetual competitive lather to see which can bring the greatest number of initial public offerings (IPOs) to the public market. In Graham’s day, no frontline member firm would stoop to placing an IPO in public hands, the risks and rewards for this kind of offering being reserved for professionals. Federal securities regulation was a new thing in the 1930s. What had preceded the Securities and Exchange Commis- sion (SEC) was a regime of tribal sanction. Some things were simply beyond the pale. Both during and immediately after World War I, no self- respecting NYSE member firm facilitated a client’s switch from Liberty bonds into potentially more lucrative, if less patriotic, alternatives. There was no law against such a business development overture. Rather, according to Graham, it just wasn’t done. A great many things weren’t done in the Wall Street of the 1930s. Newly empowered regulators were resistant to financial innovation, trans- action costs were high, technology was (at least by today’s digital stan- dards) primitive, and investors were demoralized. After the vicious bear market of 1937 to 1938, not a few decided they’d had enough. What was the point of it all? “In June 1939,” writes Graham in a note to a discussion about corporate finance in the second edition, “the S.E.C. set a salutary precedent by refusing to authorize the issuance of ‘Capital Income Debentures’ in the reorganization of the Griess-Pfleger Tanning Company, on the ground that the devising of new types of hybrid issues had gone far enough.” (p. 115, fn. 4) In the same conservative vein, he expresses his approval of the institution of the “legal list,” a document compiled by state banking departments to stipulate which bonds the regulated sav- ings banks could safely own. The very idea of such a list flies in the face of nearly every millennial notion about good regulatory practice. But Gra- ham defends it thus: “Since the selection of high-grade bonds has been shown to be in good part a process of exclusion, it lends itself reasonably well to the application of definite rules and standards designed to dis- qualify unsuitable issues.” (p. 169) No collateralized debt obligations stocked with subprime mortgages for the father of value investing! The 1930s ushered in a revolution in financial disclosure. The new federal securities acts directed investor-owned companies to brief their stockholders once a quarter as well as at year-end. But the new stan- dards were not immediately applicable to all public companies, and more than a few continued doing business the old-fashioned way, with their cards to their chests. One of these informational holdouts was none other than Dun & Bradstreet (D&B), the financial information company. Graham seemed to relish the irony of D&B not revealing “its own earn- ings to its own stockholders.” (p. 92, fn. 4) On the whole, by twenty-first- century standards, information in Graham’s time was as slow moving as it was sparse. There were no conference calls, no automated spread- sheets, and no nonstop news from distant markets—indeed, not much truck with the world outside the 48 states. Security Analysis barely acknowledges the existence of foreign markets. Such an institutional setting was hardly conducive to the develop- ment of “efficient markets,” as the economists today call them—markets in which information is disseminated rapidly, human beings process it flawlessly, and prices incorporate it instantaneously. Graham would have scoffed at such an idea. Equally, he would have smiled at the discovery— so late in the evolution of the human species—that there was a place in economics for a subdiscipline called “behavioral finance.” Reading Security Analysis, one is led to wonder what facet of investing is not behavioral. The stock market, Graham saw, is a source of entertainment value as well as investment value: “Even when the underlying motive of purchase is mere speculative greed, human nature desires to conceal this unlovely impulse behind a screen of apparent logic and good sense. To adapt the aphorism of Voltaire, it may be said that if there were no such thing as common-stock analysis, it would be necessary to counterfeit it.” (p. 348) Anomalies of undervaluation and overvaluation—of underdoing it and overdoing it—fill these pages. It bemused Graham, but did not shock him, that so many businesses could be valued in the stock market for less than their net current assets, even during the late 1920s’ boom, or that, in the dislocations to the bond market immediately following World War I, investors became disoriented enough to assign a higher price and a lower yield to the Union Pacific First Mortgage 4s than they did to the U.S. Treasury’s own Fourth Liberty 41⁄4s. Graham writes of the “inveterate tendency of the stock market to exaggerate.” (p. 679) He would not have exaggerated much if he had written, instead, “all markets.” Though he did not dwell long on the cycles in finance, Graham was certainly aware of them. He could see that ideas, no less than prices and categories of investment assets, had their seasons. The discussion in Security Analysis of the flame-out of the mortgage guarantee business in the early 1930s is a perfect miniature of the often-ruinous competition in which financial institutions periodically engage. “The rise of the newer and more aggressive real estate bond organizations had a most unfortu- nate effect upon the policies of the older concerns,” Graham writes of his time and also of ours. “By force of competition they were led to relax their standards of making loans. New mortgages were granted on an increasingly liberal basis, and when old mortgages matured, they were frequently renewed in a larger sum. Furthermore, the face amount of the mortgages guaranteed rose to so high a multiple of the capital of the guarantor companies that it should have been obvious that the guaranty would afford only the flimsiest of protection in the event of a general decline in values.” (p. 217) Security analysis itself is a cyclical phenomenon; it, too, goes in and out of fashion, Graham observed. It holds a strong, intuitive appeal for the kind of businessperson who thinks about stocks the way he or she thinks about his or her own family business. What would such a fount of com- mon sense care about earnings momentum or Wall Street’s pseudo-scien- tific guesses about the economic future? Such an investor, appraising a common stock, would much rather know what the company behind it is worth. That is, he or she would want to study its balance sheet. Well, Gra- ham relates here, that kind of analysis went out of style when stocks started levitating without reference to anything except hope and prophecy. So, by about 1927, fortune-telling and chart-reading had dis- placed the value discipline by which he and his partner were earning a very good living. It is characteristic of Graham that his critique of the “new era” method of investing is measured and not derisory. The old, conserva- tive approach—his own—had been rather backward looking, Graham admits. It had laid more emphasis on the past than on the future, on sta- ble earning power rather than tomorrow’s earnings prospects. But new technologies, new methods, and new forms of corporate organization had introduced new risks into the post–World War I economy. This fact— “the increasing instability of the typical business”—had blown a small hole in the older analytical approach that emphasized stable earnings power over forecast earnings growth. Beyond that mitigating considera- tion, however, Graham does not go. The new era approach, “which turned upon the earnings trend as the sole criterion of value, . . . was certain to end in an appalling debacle.” (p. 366) Which, of course, it did, and—in the CNBC-driven markets of the twenty-first century—continues to do at intervals today. A Man of Many Talents Benjamin Graham was born Benjamin Grossbaum on May 9, 1894, in London, and sailed to New York with his family before he was two. Young Benjamin was a prodigy in mathematics, classical languages, modern languages, expository writing (as readers of this volume will see for themselves), and anything else that the public schools had to offer. He had a tenacious memory and a love of reading—a certain ticket to aca- demic success, then or later. His father’s death at the age of 35 left him, his two brothers, and their mother in the social and financial lurch. Ben- jamin early learned to work and to do without. No need here for a biographical profile of the principal author of Security Analysis: Graham’s own memoir delightfully covers that ground. Suffice it to say that the high school brainiac entered Columbia College as an Alumni Scholar in September 1911 at the age of 17. So much material had he already absorbed that he began with a semester’s head start, “the highest possible advanced standing.”12 He mixed his academic studies with a grab bag of jobs, part-time and full-time alike. Upon his graduation in 1914, he started work as a runner and board-boy at the New York Stock Exchange member firm of Newberger, Henderson & Loeb. Within a year, the board-boy was playing the liquidation of the Guggenheim Exploration Company by astutely going long the shares of Guggenheim and short the stocks of the companies in which Guggen- heim had made a minority investment, as his no-doubt bemused elders looked on: “The profit was realized exactly as calculated; and everyone was happy, not least myself.”13 Security Analysis did not come out of the blue. Graham had supple- mented his modest salary by contributing articles to the Magazine of Wall Street. His productions are unmistakably those of a self-assured and superbly educated Wall Street moneymaker. There was no need to quote expert opinion. He and the documents he interpreted were all the authority he needed. His favorite topics were the ones that he subse- quently developed in the book you hold in your hands. He was partial to the special situations in which Graham-Newman was to become so suc- cessful. Thus, when a high-flying, and highly complex, American Interna- tional Corp. fell from the sky in 1920, Graham was able to show that the stock was cheap in relation to the evident value of its portfolio of miscel- laneous (and not especially well disclosed) investment assets.14 The shocking insolvency of Goodyear Tire and Rubber attracted his attention in 1921. “The downfall of Goodyear is a remarkable incident even in the present plenitude of business disasters,” he wrote, in a characteristic Gra- ham sentence (how many financial journalists, then or later, had “pleni- tude” on the tips of their tongues?). He shrewdly judged that Goodyear would be a survivor.15 In the summer of 1924, he hit on a theme that would echo through Security Analysis: it was the evident non sequitor of stocks valued in the market at less than the liquidating value of the com- panies that issued them. “Eight Stock Bargains Off the Beaten Track,” said the headline over the Benjamin Graham byline: “Stocks that Are Covered Chiefly by Cash or the Equivalent—No Bonds or Preferred Stock Ahead of These Issues—An Unusually Interesting Group of Securities.” In one case, that of Tonopah Mining, liquid assets of $4.31 per share towered over a market price of just $1.38 a share.16 For Graham, an era of sweet reasonableness in investment thinking seemed to end around 1914. Before that time, the typical investor was a businessman who analyzed a stock or a bond much as he might a claim on a private business. He—it was usually a he—would naturally try to determine what the security-issuing company owned, free and clear of any encumbrances. If the prospective investment was a bond—and it usually was—the businessman-investor would seek assurances that the borrowing company had the financial strength to weather a depression. “It’s not undue modesty,” Graham wrote in his memoir, “to say that I had become something of a smart cookie in my particular field.” His spe- cialty was the carefully analyzed out-of-the-way investment: castaway stocks or bonds, liquidations, bankruptcies, arbitrage. Since at least the early 1920s, Graham had preached the sermon of the “margin of safety.” As the future is a closed book, he urged in his writings, an investor, as a matter of self-defense against the unknown, should contrive to pay less than “intrinsic” value. Intrinsic value, as defined in Security Analysis, is “that value which is justified by the facts, e.g., the assets, earnings, divi- dends, definite prospects, as distinct, let us say, from market quotations established by artificial manipulation or distorted by psychological excesses.” (p. 64) He himself had gone from the ridiculous to the sublime (and some- times back again) in the conduct of his own investment career. His quick and easy grasp of mathematics made him a natural arbitrageur. He would sell one stock and simultaneously buy another. Or he would buy or sell shares of stock against the convertible bonds of the identical issu- ing company. So doing, he would lock in a profit that, if not certain, was as close to guaranteed as the vicissitudes of finance allowed. In one instance, in the early 1920s, he exploited an inefficiency in the relation- ship between DuPont and the then red-hot General Motors (GM). DuPont held a sizable stake in GM. And it was for that interest alone which the market valued the big chemical company. By implication, the rest of the business was worth nothing. To exploit this anomaly, Graham bought shares in DuPont and sold short the hedge-appropriate number of shares in GM. And when the market came to its senses, and the price gap between DuPont and GM widened in the expected direction, Gra- ham took his profit.17 However, Graham, like many another value investors after him, some- times veered from the austere precepts of safe-and-cheap investing. A Graham only slightly younger than the master who sold GM and bought DuPont allowed himself to be hoodwinked by a crooked promoter of a company that seems not actually to have existed—at least, in anything like the state of glowing prosperity described by the manager of the pool to which Graham entrusted his money. An electric sign in Colum- bus Circle, on the upper West Side of Manhattan, did bear the name of the object of Graham’s misplaced confidence, Savold Tire. But, as the author of Security Analysis confessed in his memoir, that could have been the only tangible marker of the company’s existence. “Also, as far as I knew,” Graham added, “nobody complained to the district attorney’s office about the promoter’s bare-faced theft of the public’s money.” Cer- tainly, by his own telling, Graham didn’t.18 By 1929, when he was 35, Graham was well on his way to fame and fortune. His wife and he kept a squadron of servants, including—for the first and only time in his life—a manservant for himself. With JerryNewman, Graham had compiled an investment record so enviable that the great Bernard M. Baruch sought him out. Would Graham wind up his busi- ness to manage Baruch’s money? “I replied,” Graham writes, “that I was highly flattered—flabbergasted, in fact—by his proposal, but I could not end so abruptly the close and highly satisfactory relations I had with my friends and clients.”19 Those relations soon became much less satisfactory. Graham relates that, though he was worried at the top of the market, he failed to act on his bearish hunch. The Graham-Newman partnership went into the 1929 break with $2.5 million of capital. And they con- trolled about $2.5 million in hedged positions—stocks owned long offset by stocks sold short. They had, besides, about $4.5 million in outright long positions. It was bad enough that they were leveraged, as Graham later came to realize. Compounding that tactical error was a deeply rooted conviction that the stocks they owned were cheap enough to withstand any imaginable blow. They came through the crash creditably: down by only 20% was, for the final quarter of 1929, almost heroic. But they gave up 50% in 1930, 16% in 1931, and 3% in 1932 (another relatively excellent showing), for a cumulative loss of 70%.20 “I blamed myself not so much for my failure to protect myself against the disaster I had been predicting,” Graham writes, “as for having slipped into an extravagant way of life which I hadn’t the temperament or capacity to enjoy. I quickly convinced myself that the true key to material happiness lay in a modest standard of living which could be achieved with little difficulty under almost all economic condi- tions”—the margin-of-safety idea applied to personal finance.21 It can’t be said that the academic world immediately clasped Security Analysis to its breast as the definitive elucidation of value investing, or of anything else. The aforementioned survey of the field in which Graham and Dodd made their signal contribution, The Common Stock Theory of Investment, by Chelcie C. Bosland, published three years after the appear- ance of the first edition of Security Analysis, cited 53 different sources and 43 different authors. Not one of them was named Graham or Dodd. Edgar Lawrence Smith, however, did receive Bosland’s full and respectful attention. Smith’s Common Stocks as Long Term Investments, published in 1924, had challenged the long-held view that bonds were innately superior to equities. For one thing, Smith argued, the dollar (even the gold-backed 1924 edition) was inflation-prone, which meant that creditors were inherently disadvantaged. Not so the owners of com- mon stock. If the companies in which they invested earned a profit, and if the managements of those companies retained a portion of that profit in the business, and if those retained earnings, in turn, produced future earnings, the principal value of an investor’s portfolio would tend “to increase in accordance with the operation of compound interest.”22 Smith’s timing was impeccable. Not a year after he published, the great Coolidge bull market erupted. Common Stocks as Long Term Investments, only 129 pages long, provided a handy rationale for chasing the market higher. That stocks do, in fact, tend to excel in the long run has entered the canon of American investment thought as a revealed truth (it looked any- thing but obvious in the 1930s). For his part, Graham entered a strong dis- sent to Smith’s thesis, or, more exactly, its uncritical bullish application. It was one thing to pay 10 times earnings for an equity investment, he notes, quite another to pay 20 to 40 times earnings. Besides, the Smith analysis skirted the important question of what asset values lay behind the stock certificates that people so feverishly and uncritically traded back and forth. Finally, embedded in Smith’s argument was the assumption that common stocks could be counted on to deliver in the future what they had done in the past. Graham was not a believer. (pp. 362–363) If Graham was a hard critic, however, he was also a generous one. In 1939 he was given John Burr Williams’s The Theory of Investment Value to review for the Journal of Political Economy (no small honor for a Wall Street author-practitioner). Williams’s thesis was as important as it was concise. The investment value of a common stock is the present value of all future dividends, he proposed. Williams did not underestimate the significance of these loaded words. Armed with that critical knowledge, the author ventured to hope, investors might restrain themselves from bidding stocks back up to the moon again. Graham, in whose capacious brain dwelled the talents both of the quant and behavioral financier, voiced his doubts about that forecast. The rub, as he pointed out, was that, in order to apply Williams’s method, one needed to make some very large assumptions about the future course of interest rates, the growth of profit, and the terminal value of the shares when growth stops. “One wonders,” Graham mused, “whether there may not be too great a discrepancy between the necessarily hit-or-miss character of these assumptions and the highly refined mathematical treatment to which they are subjected.” Graham closed his essay on a characteristi- cally generous and witty note, commending Williams for the refreshing level-headedness of his approach and adding: “This conservatism is not really implicit in the author’s formulas; but if the investor can be per- suaded by higher algebra to take a sane attitude toward common-stock prices, the reviewer will cast a loud vote for higher algebra.”23 Graham’s technical accomplishments in securities analysis, by them- selves, could hardly have carried Security Analysis through its five edi- tions. It’s the book’s humanity and good humor that, to me, explain its long life and the adoring loyalty of a certain remnant of Graham readers, myself included. Was there ever a Wall Street moneymaker better steeped than Graham in classical languages and literature and in the financial history of his own time? I would bet “no” with all the confidence of a value investor laying down money to buy an especially cheap stock. Yet this great investment philosopher was, to a degree, a prisoner of his own times. He could see that the experiences through which he lived were unique, that the Great Depression was, in fact, a great anomaly. If anyone understood the folly of projecting current experience into the unpredictable future, it was Graham. Yet this investment-philosopher king, having spent 727 pages (not including the gold mine of an appendix) describing how a careful and risk-averse investor could prosper in every kind of macroeconomic conditions, arrives at a remarkable conclusion. What of the institutional investor, he asks. How should he invest? At first, Graham diffidently ducks the question—who is he to prescribe for the experienced financiers at the head of America’s philanthropic and educational institutions? But then he takes the astonishing plunge. “An institution,” he writes, “that can manage to get along on the low income provided by high-grade fixed-value issues should, in our opinion, confine its holdings to this field. We doubt if the better performance of common- stock indexes over past periods will, in itself, warrant the heavy responsi- bilities and the recurring uncertainties that are inseparable from a common-stock investment program.” (pp. 709–710) Could the greatest value investor have meant that? Did the man who stuck it out through ruinous losses in the Depression years and went on to compile a remarkable long-term investment record really mean that common stocks were not worth the bother? In 1940, with a new world war fanning the Roosevelt administration’s fiscal and monetary policies, high-grade corporate bonds yielded just 2.75%, while blue-chip equities yielded 5.1%. Did Graham mean to say that bonds were a safer proposi- tion than stocks? Well, he did say it. If Homer could nod, so could Gra- ham—and so can the rest of us, whoever we are. Let it be a lesson. ",Financial,Fact Finding,Q&A "Answer questions based only on information provided in the context block. Do not use external resources or any prior knowledge. Give your answer in bullet points, with a brief explanation following each one.",What do I need to be on the lookout for if I'm worried about pre-eclampsia?,"1 Preeclampsia - Topic of the Month J U LY 6 , 2022 What is preeclampsia? Preeclampsia is a life-threatening disorder that most often occurs during pregnancy, although ten percent of cases occur in the postpartum period. The disorder is defined by two major symptoms found after 20 weeks of pregnancy, the most significant is a rapid rise in blood pressure (hypertension) combined with the presence of protein in the urine (proteinuria). For some women, proteinuria does not occur; for these women, preeclampsia is diagnosed as hypertension with thrombocytopenia (low platelet count), impaired liver function, renal insufficiency (poor kidney function), pulmonary edema (excess fluid in the lungs), and/or cerebral or visual disturbances (brain and vision problems). Preeclampsia is just one of the hypertensive disorders that may occur during pregnancy, others include chronic hypertension, gestational hypertension, HELLP syndrome, and eclampsia. Hypertensive disorders during pregnancy result in one of the leading causes of maternal and perinatal mortality worldwide.4 Historically, women and infants of color and American Indian women and their infants are disproportionately affected.3 Shocking statistics3: ▪ Hypertensive disorders affect 4-10% of pregnancies in the US. ▪ Severe hypertension contributes to 9% of maternal deaths in the US. ▪ One-third of severe childbirth complications result from preeclampsia/eclampsia. What are the maternal risks? PREECLAMPSIA - TO PIC O F THE MONTH 2 Preeclampsia puts great stress on the heart and can impair liver and kidney function. There is also a risk of suffering a stroke, seizures, hemorrhaging, multiple organ failure, placenta abruption (placenta separates from wall of uterus), and even maternal and/or infant death. What are the risks to the infant? Preeclampsia may restrict the flow of blood to the placenta, decreasing the oxygen and nutrients the fetus needs to thrive. Lack of these essential components can contribute to low infant birth weight, preterm delivery, and a chance of experiencing a stillbirth. Prematurity is the second leading cause of infant death in Minnesota.3 Infants that are born premature have a higher risk of long-term health and development difficulties. The prevention of preterm birth is critical to supporting infant health, promoting health equity, and controlling healthcare costs.3 WIC Pregnancy Related Risk Codes – refer to Implications for WIC Services 304 History of Preeclampsia 345 Hypertension and Prehypertension What are the warning signs? Preeclampsia typically occurs during the third trimester of pregnancy (after 28 weeks). For the postpartum parent, preeclampsia can occur within 48 hours of delivery or up to six weeks later. Parents who recognize any of these symptoms below should immediately contact their healthcare provider. Common warning signs of preeclampsia: ▪ Persistent headache that gets worse overtime ▪ Any changes in vision such as seeing spots or blurred vision ▪ Sudden and severe swelling in hands or face ▪ Sudden weight gain ▪ Nausea and vomiting in second half of pregnancy ▪ Pain in right upper abdomen or shoulder ▪ Shortness of breath or heavy chest Is preeclampsia preventable? It is not widely understood what causes preeclampsia. For this reason, doctors recommend parents maintain regular prenatal and postnatal visits with their healthcare providers and be vigilant of the signs and symptoms of the condition. Preventative care is the best defense against any pregnancy related hypertensive disorders. Preventative tips: PREECLAMPSIA - TO PIC O F THE MONTH 3 ▪ Attend regular healthcare visits and all prenatal visits ▪ Follow a healthy dietary pattern with regular daily meals and snacks ▪ Aim for an adequate calcium intake. While it is not yet conclusive, when dietary calcium is inadequate, research suggests that adequate calcium intake may help prevent preeclampsia. ▪ Maintain a healthy pre-pregnancy weight and gain appropriately during pregnancy ▪ Stay active with 150 minutes of moderate activity each week ▪ Reduce intake of tobacco products or consider smoking cessation A history of preeclampsia increases the risk of future hypertension, cardiovascular disease, and stroke. The above healthy lifestyle habits can help reduce the risk. Postpartum nutrition education contacts can provide an opportune time to follow up on this. For more information about Hypertensive Disorders of pregnancy: Blood Pressure During Pregnancy- December 14, 2021, Bay State Health Training Opportunity Section 5.3: Nutrition Risk Assessment policy explains the importance for WIC staff to obtain and synthesize information about a participant medical/health/nutrition status to most appropriately individualize WIC services. This includes asking questions that allow for education based on the participant’s concerns and offering referrals when necessary. Using the Pregnant Woman complete question format during the assessment may help you to most accurately determine if there are concerns the participant or their healthcare provider have regarding their medical, health, and/or nutrition. Exercise: 1. Read through the Pregnant Woman complete question format alone or as a group. 2. Discuss with a co-worker or as a group what questions would help identify some of the risk factors for preeclampsia. (HINT: Read through the risk factors above.) 3. What education can you offer to support the health of the at-risk participant? (HINT: Read through the preventative tips above.) Resources 1. Preeclampsia Foundation 2. HEAR HER Campaign -Centerfor Disease Control and Prevention (CDC) 3. Hypertension in Pregnancy -Minnesota Perinatal Quality Collaborative (MNPQC) 4. Hypertension and Preeclampsia in Pregnancy -The American College of Obstetricians and Gynecologists (ACOG) Topic ideas? Share yourfuture topic suggestion with carole.Kelnhofer@state.mn.us. PREECLAMPSIA - TO PIC O F THE MONTH 4 Reference – Complete Listing of Hyperlinks 304 History of Preeclampsia (https://www.health.state.mn.us/docs/people/wic/localagency/nutrition/riskcodes/bioclinmed /304mn.pdf) 345 Hypertension and Prehypertension (https://www.health.state.mn.us/docs/people/wic/localagency/nutrition/riskcodes/bioclinmed /345mn.pdf) Blood Pressure During Pregnancy (https://www.youtube.com/watch?v=Ff061nIXPx0&t=537s) Preeclampsia Foundation (https://www.preeclampsia.org/) HEAR HER Campaign (https://www.cdc.gov/hearher/index.html) Hypertension in Pregnancy (https://minnesotaperinatal.org/hypertension-in-pregnancy/) Hypertension and Preeclampsia in Pregnancy (https://www.acog.org/topics/hypertension-andpreeclampsia-in-pregnancy) Minnesota Department of Health - WIC Program, 85 E 7th Place, PO BOX 64882, ST PAUL MN 55164-0882; 1-800-657-3942, health.wic@state.mn.us, www.health.state.mn.us; to obtain this information in a different format, call: 1-800-657-3942.","System instruction: [Answer questions based only on information provided in the context block. Do not use external resources or any prior knowledge. Give your answer in bullet points, with a brief explanation following each one.] Question: [What do I need to be on the lookout for if I'm worried about pre-eclampsia?] Context block: [1 Preeclampsia - Topic of the Month J U LY 6 , 2022 What is preeclampsia? Preeclampsia is a life-threatening disorder that most often occurs during pregnancy, although ten percent of cases occur in the postpartum period. The disorder is defined by two major symptoms found after 20 weeks of pregnancy, the most significant is a rapid rise in blood pressure (hypertension) combined with the presence of protein in the urine (proteinuria). For some women, proteinuria does not occur; for these women, preeclampsia is diagnosed as hypertension with thrombocytopenia (low platelet count), impaired liver function, renal insufficiency (poor kidney function), pulmonary edema (excess fluid in the lungs), and/or cerebral or visual disturbances (brain and vision problems). Preeclampsia is just one of the hypertensive disorders that may occur during pregnancy, others include chronic hypertension, gestational hypertension, HELLP syndrome, and eclampsia. Hypertensive disorders during pregnancy result in one of the leading causes of maternal and perinatal mortality worldwide.4 Historically, women and infants of color and American Indian women and their infants are disproportionately affected.3 Shocking statistics3: ▪ Hypertensive disorders affect 4-10% of pregnancies in the US. ▪ Severe hypertension contributes to 9% of maternal deaths in the US. ▪ One-third of severe childbirth complications result from preeclampsia/eclampsia. What are the maternal risks? PREECLAMPSIA - TO PIC O F THE MONTH 2 Preeclampsia puts great stress on the heart and can impair liver and kidney function. There is also a risk of suffering a stroke, seizures, hemorrhaging, multiple organ failure, placenta abruption (placenta separates from wall of uterus), and even maternal and/or infant death. What are the risks to the infant? Preeclampsia may restrict the flow of blood to the placenta, decreasing the oxygen and nutrients the fetus needs to thrive. Lack of these essential components can contribute to low infant birth weight, preterm delivery, and a chance of experiencing a stillbirth. Prematurity is the second leading cause of infant death in Minnesota.3 Infants that are born premature have a higher risk of long-term health and development difficulties. The prevention of preterm birth is critical to supporting infant health, promoting health equity, and controlling healthcare costs.3 WIC Pregnancy Related Risk Codes – refer to Implications for WIC Services 304 History of Preeclampsia 345 Hypertension and Prehypertension What are the warning signs? Preeclampsia typically occurs during the third trimester of pregnancy (after 28 weeks). For the postpartum parent, preeclampsia can occur within 48 hours of delivery or up to six weeks later. Parents who recognize any of these symptoms below should immediately contact their healthcare provider. Common warning signs of preeclampsia: ▪ Persistent headache that gets worse overtime ▪ Any changes in vision such as seeing spots or blurred vision ▪ Sudden and severe swelling in hands or face ▪ Sudden weight gain ▪ Nausea and vomiting in second half of pregnancy ▪ Pain in right upper abdomen or shoulder ▪ Shortness of breath or heavy chest Is preeclampsia preventable? It is not widely understood what causes preeclampsia. For this reason, doctors recommend parents maintain regular prenatal and postnatal visits with their healthcare providers and be vigilant of the signs and symptoms of the condition. Preventative care is the best defense against any pregnancy related hypertensive disorders. Preventative tips: PREECLAMPSIA - TO PIC O F THE MONTH 3 ▪ Attend regular healthcare visits and all prenatal visits ▪ Follow a healthy dietary pattern with regular daily meals and snacks ▪ Aim for an adequate calcium intake. While it is not yet conclusive, when dietary calcium is inadequate, research suggests that adequate calcium intake may help prevent preeclampsia. ▪ Maintain a healthy pre-pregnancy weight and gain appropriately during pregnancy ▪ Stay active with 150 minutes of moderate activity each week ▪ Reduce intake of tobacco products or consider smoking cessation A history of preeclampsia increases the risk of future hypertension, cardiovascular disease, and stroke. The above healthy lifestyle habits can help reduce the risk. Postpartum nutrition education contacts can provide an opportune time to follow up on this. For more information about Hypertensive Disorders of pregnancy: Blood Pressure During Pregnancy- December 14, 2021, Bay State Health Training Opportunity Section 5.3: Nutrition Risk Assessment policy explains the importance for WIC staff to obtain and synthesize information about a participant medical/health/nutrition status to most appropriately individualize WIC services. This includes asking questions that allow for education based on the participant’s concerns and offering referrals when necessary. Using the Pregnant Woman complete question format during the assessment may help you to most accurately determine if there are concerns the participant or their healthcare provider have regarding their medical, health, and/or nutrition. Exercise: 1. Read through the Pregnant Woman complete question format alone or as a group. 2. Discuss with a co-worker or as a group what questions would help identify some of the risk factors for preeclampsia. (HINT: Read through the risk factors above.) 3. What education can you offer to support the health of the at-risk participant? (HINT: Read through the preventative tips above.) Resources 1. Preeclampsia Foundation 2. HEAR HER Campaign -Centerfor Disease Control and Prevention (CDC) 3. Hypertension in Pregnancy -Minnesota Perinatal Quality Collaborative (MNPQC) 4. Hypertension and Preeclampsia in Pregnancy -The American College of Obstetricians and Gynecologists (ACOG) Topic ideas? Share yourfuture topic suggestion with carole.Kelnhofer@state.mn.us. PREECLAMPSIA - TO PIC O F THE MONTH 4 Reference – Complete Listing of Hyperlinks 304 History of Preeclampsia (https://www.health.state.mn.us/docs/people/wic/localagency/nutrition/riskcodes/bioclinmed /304mn.pdf) 345 Hypertension and Prehypertension (https://www.health.state.mn.us/docs/people/wic/localagency/nutrition/riskcodes/bioclinmed /345mn.pdf) Blood Pressure During Pregnancy (https://www.youtube.com/watch?v=Ff061nIXPx0&t=537s) Preeclampsia Foundation (https://www.preeclampsia.org/) HEAR HER Campaign (https://www.cdc.gov/hearher/index.html) Hypertension in Pregnancy (https://minnesotaperinatal.org/hypertension-in-pregnancy/) Hypertension and Preeclampsia in Pregnancy (https://www.acog.org/topics/hypertension-andpreeclampsia-in-pregnancy) Minnesota Department of Health - WIC Program, 85 E 7th Place, PO BOX 64882, ST PAUL MN 55164-0882; 1-800-657-3942, health.wic@state.mn.us, www.health.state.mn.us; to obtain this information in a different format, call: 1-800-657-3942.]",Medical,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","I am 50 years old, I live in Louisiana, I am married, and I have a 700 credit score. I am applying for an FHA mortgage loan on a house in a flood zone in Louisiana. I want to apply without my husband since his credit isn't good, he owes a lot debts from before we were married and he doesn't have much of a work history. The loan officer says he has to run a credit report on my husband even if he isn't on the loan. Do we have to have his credit checked too?","II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT A. Title II Insured Housing Programs Forward Mortgages 4. Underwriting the Borrower Using the TOTAL Mortgage Scorecard (TOTAL) Handbook 4000.1 215 Last Revised: 05/20/2024 (2) Standard The Mortgagee must include the debt. The amount of the required payment must be included in the calculation of the Borrower’s total debt to income. (3) Required Documentation The Mortgagee must include documentation from the federal agency evidencing the repayment agreement and verification of payments made, if applicable. (E) Alimony, Child Support, and Maintenance (TOTAL) (1) Definition Alimony, Child Support, and Maintenance are court-ordered or otherwise agreed upon payments. (2) Standard For Alimony, if the Borrower’s income was not reduced by the amount of the monthly alimony obligation in the Mortgagee’s calculation of the Borrower’s gross income, the Mortgagee must include the monthly obligation in the calculation of the Borrower’s debt. Child Support and Maintenance are to be treated as a recurring liability and the Mortgagee must include the monthly obligation in the Borrower’s liabilities and debt. (3) Required Documentation The Mortgagee must verify and document the monthly obligation by obtaining the official signed divorce decree, separation agreement, maintenance agreement, or other legal order. The Mortgagee must also obtain the Borrower’s pay stubs covering no less than 28 consecutive Days to verify whether the Borrower is subject to any order of garnishment relating to the Alimony, Child Support, and Maintenance. (4) Calculation of Monthly Obligation The Mortgagee must calculate the Borrower’s monthly obligation from the greater of: • the amount shown on the most recent decree or agreement establishing the Borrower’s payment obligation; or • the monthly amount of the garnishment. II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT A. Title II Insured Housing Programs Forward Mortgages 4. Underwriting the Borrower Using the TOTAL Mortgage Scorecard (TOTAL) Handbook 4000.1 216 Last Revised: 05/20/2024 (F) Non-Borrowing Spouse Debt in Community Property States (TOTAL) (1) Definition Non-Borrowing Spouse Debt refers to debts owed by a spouse that are not owed by, or in the name of the Borrower. (2) Standard If the Borrower resides in a community property state or the Property being insured is located in a community property state, debts of the non-borrowing spouse must be included in the Borrower’s qualifying ratios, except for obligations specifically excluded by state law. The non-borrowing spouse’s credit history is not considered a reason to deny a mortgage application. (3) Required Documentation The Mortgagee must verify and document the debt of the non-borrowing spouse. The Mortgagee must make a note in the file referencing the specific state law that justifies the exclusion of any debt from consideration. The Mortgagee must obtain a credit report for the non-borrowing spouse in order to determine the debts that must be included in the liabilities. The credit report for the non-borrowing spouse is for the purpose of establishing debt only, and is not submitted to TOTAL Mortgage Scorecard for the purpose of credit evaluation. The credit report for the non-borrowing spouse may be traditional or non- traditional. (G) Deferred Obligations (TOTAL) (1) Definition Deferred Obligations (excluding Student Loans) refer to liabilities that have been incurred but where payment is deferred or has not yet commenced, including accounts in forbearance. (2) Standard The Mortgagee must include deferred obligations in the Borrower’s liabilities. (3) Required Documentation The Mortgagee must obtain written documentation of the deferral of the liability from the creditor and evidence of the outstanding balance and terms of the II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT A. Title II Insured Housing Programs Forward Mortgages 4. Underwriting the Borrower Using the TOTAL Mortgage Scorecard (TOTAL) Handbook 4000.1 217 Last Revised: 05/20/2024 deferred liability. The Mortgagee must obtain evidence of the actual monthly payment obligation, if available. (4) Calculation of Monthly Obligation The Mortgagee must use the actual monthly payment to be paid on a deferred liability, whenever available. If the actual monthly payment is not available for installment debt, the Mortgagee must utilize the terms of the debt or 5 percent of the outstanding balance to establish the monthly payment. (H) Student Loans (TOTAL) (1) Definition Student Loan refers to liabilities incurred for educational purposes. (2) Standard The Mortgagee must include all Student Loans in the Borrower’s liabilities, regardless of the payment type or status of payments. (3) Required Documentation If the payment used for the monthly obligation is less than the monthly payment reported on the Borrower’s credit report, the Mortgagee must obtain written documentation of the actual monthly payment, the payment status, and evidence of the outstanding balance and terms from the creditor or student loan servicer. The Mortgagee may exclude the payment from the Borrower’s monthly debt calculation where written documentation from the student loan program, creditor, or student loan servicer indicates that the loan balance has been forgi","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I am 50 years old, I live in Louisiana, I am married, and I have a 700 credit score. I am applying for an FHA mortgage loan on a house in a flood zone in Louisiana. I want to apply without my husband since his credit isn't good, he owes a lot debts from before we were married and he doesn't have much of a work history. The loan officer says he has to run a credit report on my husband even if he isn't on the loan. Do we have to have his credit checked too? II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT A. Title II Insured Housing Programs Forward Mortgages 4. Underwriting the Borrower Using the TOTAL Mortgage Scorecard (TOTAL) Handbook 4000.1 215 Last Revised: 05/20/2024 (2) Standard The Mortgagee must include the debt. The amount of the required payment must be included in the calculation of the Borrower’s total debt to income. (3) Required Documentation The Mortgagee must include documentation from the federal agency evidencing the repayment agreement and verification of payments made, if applicable. (E) Alimony, Child Support, and Maintenance (TOTAL) (1) Definition Alimony, Child Support, and Maintenance are court-ordered or otherwise agreed upon payments. (2) Standard For Alimony, if the Borrower’s income was not reduced by the amount of the monthly alimony obligation in the Mortgagee’s calculation of the Borrower’s gross income, the Mortgagee must include the monthly obligation in the calculation of the Borrower’s debt. Child Support and Maintenance are to be treated as a recurring liability and the Mortgagee must include the monthly obligation in the Borrower’s liabilities and debt. (3) Required Documentation The Mortgagee must verify and document the monthly obligation by obtaining the official signed divorce decree, separation agreement, maintenance agreement, or other legal order. The Mortgagee must also obtain the Borrower’s pay stubs covering no less than 28 consecutive Days to verify whether the Borrower is subject to any order of garnishment relating to the Alimony, Child Support, and Maintenance. (4) Calculation of Monthly Obligation The Mortgagee must calculate the Borrower’s monthly obligation from the greater of: • the amount shown on the most recent decree or agreement establishing the Borrower’s payment obligation; or • the monthly amount of the garnishment. II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT A. Title II Insured Housing Programs Forward Mortgages 4. Underwriting the Borrower Using the TOTAL Mortgage Scorecard (TOTAL) Handbook 4000.1 216 Last Revised: 05/20/2024 (F) Non-Borrowing Spouse Debt in Community Property States (TOTAL) (1) Definition Non-Borrowing Spouse Debt refers to debts owed by a spouse that are not owed by, or in the name of the Borrower. (2) Standard If the Borrower resides in a community property state or the Property being insured is located in a community property state, debts of the non-borrowing spouse must be included in the Borrower’s qualifying ratios, except for obligations specifically excluded by state law. The non-borrowing spouse’s credit history is not considered a reason to deny a mortgage application. (3) Required Documentation The Mortgagee must verify and document the debt of the non-borrowing spouse. The Mortgagee must make a note in the file referencing the specific state law that justifies the exclusion of any debt from consideration. The Mortgagee must obtain a credit report for the non-borrowing spouse in order to determine the debts that must be included in the liabilities. The credit report for the non-borrowing spouse is for the purpose of establishing debt only, and is not submitted to TOTAL Mortgage Scorecard for the purpose of credit evaluation. The credit report for the non-borrowing spouse may be traditional or non- traditional. (G) Deferred Obligations (TOTAL) (1) Definition Deferred Obligations (excluding Student Loans) refer to liabilities that have been incurred but where payment is deferred or has not yet commenced, including accounts in forbearance. (2) Standard The Mortgagee must include deferred obligations in the Borrower’s liabilities. (3) Required Documentation The Mortgagee must obtain written documentation of the deferral of the liability from the creditor and evidence of the outstanding balance and terms of the II. ORIGINATION THROUGH POST-CLOSING/ENDORSEMENT A. Title II Insured Housing Programs Forward Mortgages 4. Underwriting the Borrower Using the TOTAL Mortgage Scorecard (TOTAL) Handbook 4000.1 217 Last Revised: 05/20/2024 deferred liability. The Mortgagee must obtain evidence of the actual monthly payment obligation, if available. (4) Calculation of Monthly Obligation The Mortgagee must use the actual monthly payment to be paid on a deferred liability, whenever available. If the actual monthly payment is not available for installment debt, the Mortgagee must utilize the terms of the debt or 5 percent of the outstanding balance to establish the monthly payment. (H) Student Loans (TOTAL) (1) Definition Student Loan refers to liabilities incurred for educational purposes. (2) Standard The Mortgagee must include all Student Loans in the Borrower’s liabilities, regardless of the payment type or status of payments. (3) Required Documentation If the payment used for the monthly obligation is less than the monthly payment reported on the Borrower’s credit report, the Mortgagee must obtain written documentation of the actual monthly payment, the payment status, and evidence of the outstanding balance and terms from the creditor or student loan servicer. The Mortgagee may exclude the payment from the Borrower’s monthly debt calculation where written documentation from the student loan program, creditor, or student loan servicer indicates that the loan balance has been forgi https://www.hud.gov/sites/dfiles/OCHCO/documents/40001-hsgh-update15-052024.pdf",Financial,Fact Finding,Q&A Use only context block information. write the answer in bullet points only. Less than 100 words.,Write a cost-benefit analysis of 1983 Act.,"After the 1973 Act, in fulfilling the objective of controlling pollution, each Water Authority had created a water quality advisory panel to monitor its performance in meeting water quality requirements. The objective of the advisory panels was to achieve some independence between the water authority’s functions of public supply, pollution control and monitoring of environmental performance. In a move to address the problem of poor surface water quality, the National Water Council published a classification of river quality objectives in 1977. The classification system related to the purposes for which water was to be used based on five basic classes of river waters: 1A High quality waters suitable for all abstraction purposes with only modest treatment. Capable of supporting high class fisheries. High amenity value. 1B Good quality waters usable for substantially the same purposes as 1A though not as high quality. 2 Fair quality waters viable as coarse (freshwater) fisheries and capable of use for drinking water provided advanced treatment is given. Moderate amenity value. 3 Poor waters polluted to the extent that fish were absent or only sporadically present. Suitable only for low grade industrial abstractions. 4 Bad quality waters which were grossly polluted and likely to cause a nuisance. This classification was adopted by each water authority in setting informal river quality objectives and to define the permits for treated sewage discharges. The suitability of this classification system was later questioned as it introduced the concept of high river quality being a lower priority unless specific uses compel it. With significant scope for discretion in the setting of standards by the water authorities and no imposed national standards, it ultimately led to a review of the number of discharge permits, which led to a relaxation of their requirements36. It further masked the problems of declining water quality and was clearly insufficient to satisfy EC law. With little political acceptance of the dramatic increases required to customer bills to address the problems of under-investment and declining infrastructure, the government continued to delay implementation of the condition from the 1974 Act that required the water authorities to publish pollution registers against the performance of discharge permits. This was contrary to the openness required once the authorities were given the conflicting roles of sewage works operators and river quality regulators37, conflicted with the water authorities’ role to prevent pollution and led the water quality advisory panels to be largely ineffective. With the water authorities unwilling to selfregulate and self-prosecute there was a sharp increase in the number of incidents of river pollution38. Lack of public access to information on discharge permits and pollution incidents further compounded the problem. 3.4 WATER ACT 1983 In response to the problems created by the increasing capital investment requirements of the water authorities and the requirement to address the problems of environmental pollution, the government introduced the Water Act 1983. The assumption underlying the 1983 Act was that water customers were best served by an efficiently run water utility providing prescribed service standards at least cost. The 1983 Act changed the organisational structure of the water authorities, reduced the role of local government, and, by allowing companies to operate in a more commercial manner, paved the way for privatisation. 3.4.1 Constitutional changes Until 1983, the water authorities were run by large boards with a majority of local authority representatives (see section 3.1.4). The 1983 Act reduced the size of the board structures with the intention of making these smaller and more business like by reducing the number of representatives from local authorities. Although all members continued to be appointed by central government, a series of chairmen vacancies were filled by people with experience in the industry rather than experience of public affairs. The 1983 Act provided for Consumer Consultative Committees to represent the interests of customers following the abolishment of locally elected councillors as water authority members, and as a result of restrictions in public access to management meetings of the authorities.","Write a cost-benefit analysis of 1983 Act. Use only context block information. write the answer in bullet points only. Less than 100 words. After the 1973 Act, in fulfilling the objective of controlling pollution, each Water Authority had created a water quality advisory panel to monitor its performance in meeting water quality requirements. The objective of the advisory panels was to achieve some independence between the water authority’s functions of public supply, pollution control and monitoring of environmental performance. In a move to address the problem of poor surface water quality, the National Water Council published a classification of river quality objectives in 1977. The classification system related to the purposes for which water was to be used based on five basic classes of river waters: 1A High quality waters suitable for all abstraction purposes with only modest treatment. Capable of supporting high class fisheries. High amenity value. 1B Good quality waters usable for substantially the same purposes as 1A though not as high quality. 2 Fair quality waters viable as coarse (freshwater) fisheries and capable of use for drinking water provided advanced treatment is given. Moderate amenity value. 3 Poor waters polluted to the extent that fish were absent or only sporadically present. Suitable only for low grade industrial abstractions. 4 Bad quality waters which were grossly polluted and likely to cause a nuisance. This classification was adopted by each water authority in setting informal river quality objectives and to define the permits for treated sewage discharges. The suitability of this classification system was later questioned as it introduced the concept of high river quality being a lower priority unless specific uses compel it. With significant scope for discretion in the setting of standards by the water authorities and no imposed national standards, it ultimately led to a review of the number of discharge permits, which led to a relaxation of their requirements36. It further masked the problems of declining water quality and was clearly insufficient to satisfy EC law. With little political acceptance of the dramatic increases required to customer bills to address the problems of under-investment and declining infrastructure, the government continued to delay implementation of the condition from the 1974 Act that required the water authorities to publish pollution registers against the performance of discharge permits. This was contrary to the openness required once the authorities were given the conflicting roles of sewage works operators and river quality regulators37, conflicted with the water authorities’ role to prevent pollution and led the water quality advisory panels to be largely ineffective. With the water authorities unwilling to selfregulate and self-prosecute there was a sharp increase in the number of incidents of river pollution38. Lack of public access to information on discharge permits and pollution incidents further compounded the problem. 3.4 WATER ACT 1983 In response to the problems created by the increasing capital investment requirements of the water authorities and the requirement to address the problems of environmental pollution, the government introduced the Water Act 1983. The assumption underlying the 1983 Act was that water customers were best served by an efficiently run water utility providing prescribed service standards at least cost. The 1983 Act changed the organisational structure of the water authorities, reduced the role of local government, and, by allowing companies to operate in a more commercial manner, paved the way for privatisation. 3.4.1 Constitutional changes Until 1983, the water authorities were run by large boards with a majority of local authority representatives (see section 3.1.4). The 1983 Act reduced the size of the board structures with the intention of making these smaller and more business like by reducing the number of representatives from local authorities. Although all members continued to be appointed by central government, a series of chairmen vacancies were filled by people with experience in the industry rather than experience of public affairs. The 1983 Act provided for Consumer Consultative Committees to represent the interests of customers following the abolishment of locally elected councillors as water authority members, and as a result of restrictions in public access to management meetings of the authorities. Local authorities were left to propose how the committees were set up, but the government published guidelines indicating how this should be done. The guidelines were criticised for a number of reasons including (i) the committees had wide terms of reference that covered national issues, but were intended to be set up on a regional basis and deal with regional issues, and (ii) they had little independence from the water authorities. In addition, the 1983 Act abolished the National Water Council which had done little to promote the views of the water industry to central government since its implementation40. 3.4.2 Financial changes The 1983 Act initiated many of the financing changes that were ultimately required at privatisation and started the process of transforming the water industry from a public service to a business organisation. The 1983 Act made express provision for water authorities to borrow directly from the private capital markets rather than solely from central government. However, in practice central government continued to exercise control over the authorities’ borrowing and this acted to prevent the authorities from private borrowing. The 1983 Act introduced the principle of cost-benefit to the industry for assessing capital investment requirements and attempts were made to introduce long-run marginal cost pricing for determination of water tariffs41. THE NEED FOR CHANGE Section II of the Control of Pollution Act 1974 (COPA II), finally became effective from 1985 and required publication of discharge permit standards. However, in practice, the changes brought about by COPA II or the 1983 Act did little to improve the environmental performance of the water authorities, measured by improvements in river water quality. Despite the above inflation price rises from the early 1980’s onwards (Figure 3.3.1b), the 1985 River Quality Survey showed, for the first time since surveys were undertaken in 1958, that the length of river quality deterioration had overtaken that of river water quality improvement. In total, 903km out of 40,000km rivers surveyed showed a net deterioration over the period42. And in 1988, for example, 742 out of 6407 sewage treatment works failed their discharge permit requirements. The continued lack of investment meant that a significant number of incidents of pollution continued to occur and the United Kingdom continued to be in breach of a number of EC Directives. The decision by the EC to start prosecution proceedings against the government for non-compliance with two EC Directives in the mid-1980’s was a major factor in the government recognising the requirement for further significant capital investment and control of pollution. With government unwilling to fund the increased investment requirements either from increases in taxes or increasing borrowing and with its broader programme of privatisation of utilities underway, the government started to consider the privatisation of the industry. The next section describes the process of privatisation. 4. PRIVATISATION 4.1 INTRODUCTION The proposals for privatisation of the water industry were in response to the need for more investment in the industry than the government was prepared to fund from public finance. There was also a prevailing policy which favoured privatisation as a means of securing efficiency; British Telecom and British Gas had been privatised in 1984 and 1986 respectively. The government first published its proposals in a discussion paper on water privatisation in 198643. 4.2 INITIAL PROPOSALS The 1986 discussion paper proposed privatisation of the water authorities as they existed. This would have simply transferred the water authorities to private ownership, without changes to their powers or responsibilities. It would have required the authorities, as private companies, to have responsibility for providing water and sewerage services and to have responsibility for flood control, river water quality and control of abstraction. The 1986 discussion paper included the concept of comparative competition, such that the privatised undertakers would be competing in the financial markets for access to finance and the performance of each company could be compared. The government considered profit would be a more effective incentive for improved management performance than government controls. However, to protect customers’ interests, a system of regulatory controls would be required to prevent privatised water authorities from overcharging customers or providing poor standards of service. The paper proposed that a Director General of Water Services would set price limits and performance standards for each licensed company.44 4.2.1 Economic Regulation The proposals for privatisation of the water industry differed in three fundamental respects from those of the gas and telecoms industries:  privatisation would involve not one (as in gas and telecoms), but ten Water Authorities;  the water and sewerage industries are distinctive in that they have duties concerning the protection of the environment; and  natural monopoly conditions were more prevalent in the water and sewerage industry because it consisted of local and regional monopolies with no national distribution network. Alongside its plans for sale and restructuring of the water and sewerage services, the government commissioned a report to discuss the proposals for economic regulation of the industry45. ",Financial,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","The state is trying to introduce some study about how sex offenders keep reoffending, but it has ot been properly peer reviewed., According tho this article, will it be admissible or what should i do to get it thrown out of evidence? I need to know the reasoning behind why eividence gets thrown out.","2. The Frye ruling refers only to the character of the “scientific principle” proffered as evidence. Frye makes no mention of subject-matter expertise (27), except in the sense implied by the “general acceptance” clause, which refers to the consensual expertise held by the scientific community. This concept of consensual expertise as the basis for establishing trustworthiness became eroded through establishment of the Federal Rules of Evidence, which turned the focus toward opinions of individual experts. Rule 702: Testimony by Experts By the 1970s, a sense had emerged that the inflexible Frye requirement for general acceptance was difficult to establish and perhaps insufficient, in that it was mainly relevant to criminal cases in which an invented instrument was proposed to establish fact.# Partly in response to this concern, standards for admissibility of scientific evidence began to change. They did so initially, at least in a formal sense, following recommendations of a federal advisory committee of the United States Judicial Conference, which was established for the broader purpose of normalizing and codifying rules for the use of evidence in US Courts. The Federal Rules of Evidence became law in 1975 by act of Congress. The particular rule that bears on admissibility of expert testimony is known as Rule 702 (28). While Frye selectively targets the use of scientific evidence, Rule 702 applies more generally to expert testimony on “scientific, technical, or other specialized knowledge,” meaning that the same standards apply to evidence drawn from the well of scientific knowledge and to subject-matter experts in nonscience knowledge domains, such as tugboat captaining. In its original form, Rule 702–1975 merely formalized and made into law standards for “helpfulness” and “expert” qualifications, both of which had been less formally applied since the 19th century: “If scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise.” As a notably limp standard for judging the evidentiary nuances of modern science, Rule 702-1975 was subsequently interpreted and clarified by the Supreme Court’s transformative 1993 ruling on scientific evidence in Daubert v. Merrell Dow Pharmaceuticals, Inc. (8). The Daubert Standard Unlike the forensic instrument that motivated the Frye standard, in which the question before the court concerned the scientific validity of measured quantities, the Daubert ruling emerged from a toxic tort case, in which scientific evidence attempted to establish cause and effect. Daubert’s civil action was filed against the drug company Merrell Dow Pharmaceuticals in 1984, on behalf of two children born with serious birth defects. The mothers had taken the drug Bendectin [doxylamine succinate and pyridoxine hydrochloride (vitamin B6)], which was manufactured by Merrell Dow and widely used for decades to quell nausea and vomiting during first-trimester pregnancy. The plaintiff alleged that Bendectin had caused deformities during gestation. Merrell Dow maintained that there was no scientific evidence of a link between their drug and birth defects, but Daubert recruited an expert in the form of obstetrician William McBride, who was prepared to testify on the teratogenic effects of Bendectin. Noting that McBride’s assertions failed to meet the Frye standard of general acceptance by the scientific community, the District Court for the Southern District of California issued summary judgement in favor of Merrell Dow (29). Daubert appealed to the Ninth Circuit, which upheld the lower court’s ruling (30). In response, Daubert went on to argue before the Supreme Court that the common law Frye standard for admissibility of scientific evidence was inapplicable in their case, because it had been replaced in 1975 by the legislatively enacted Rule 702. The Court agreed and upheld Rule 702–1975 as the modern legal standard for admissibility in federal court, superseding the Frye standard.‖ In its ruling (8), the Court provided an interpretation of Rule 702–1975, which is known today as the Daubert standard. This standard consists of a set of clear and useful criteria for assessing the trustworthiness of scientific evidence: • whether the theory or technique in question can be (and has been) tested, • whether it has been subjected to peer review and publication, • its known or potential error rate, and • the existence and maintenance of standards controlling its operation, and • whether it has attracted widespread acceptance within a relevant scientific community Unlike the uncompromising Frye standard, these criteria are intended to be flexibly applied at the discretion of the trial judge. With these brief considerations, Daubert strengthened the application of evidence law in several ways that conform to the nature of scientific investigation. Perhaps most importantly, Daubert returned the focus to the body of scientific knowledge (27), highlighting the importance of empirically demonstrating [“can be (and has been) tested”] that a scientific instrument or principle is a valid predictor of the probability that a courtroom hypothesis is correct (“known or potential error rate”). To that end, the focus on widespread or general acceptance of scientific evidence – consistent with Frye but absent from Rule 702 – is notable here, as the scientific consensus at any moment is the rational basis for decision under the unyielding demands of courtroom litigation. Also consistent with Frye and contrary to the letter of Rule 702, Daubert emphasizes the need for evidence to reflect the consensus of the “relevant scientific community.” As highlighted below, the definition of relevance has become a battleground in efforts to reform the use of forensic evidence. Rule 702 Evolves Rule 702 was substantially amended in 2000 to conform with Daubert and to promote a “more rigorous and structured approach” (31), in which the gatekeeping role was formally handed to judges. The Rule’s emphasis on the expert remained, but three “reliability” requirements were included in Rule 702–2000 (provisions b-d), which place constraints on the data, methods, principles, and their application by the expert: A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if: the expert’s scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue; the testimony is based on sufficient facts or data; (c) the testimony is the product of reliable principles and methods; and (d) the expert has reliably applied the principles and methods to the facts of the case. Rule 702 was revised again in 2022 (to take effect December 2023) through amendments proposed by the Advisory Committee on Evidence Rules and subsequently approved by the US Judicial Conference and the Supreme Court (32). For these efforts, Rule 702–2022 differs from the previous by two small text additions. One defines a preponderance of evidence (“more likely than not”) standard for demonstrating that the four provisions [702(a-d)] have been satisfied, which offers the gatekeeping judge a quantitative criterion for decisions about admissibility. The other clarifies that it is not the expert’s reliable application that matters, but rather that “the expert’s opinion reflects a reliable application,” which grants the trial judge the ability to bar opinions that exceed what can be reasonably concluded from the methods and principles applied.","[question] The state is trying to introduce some study about how sex offenders keep reoffending, but it has ot been properly peer reviewed., According tho this article, will it be admissible or what should i do to get it thrown out of evidence? I need to know the reasoning behind why eividence gets thrown out. ===================== [text] 2. The Frye ruling refers only to the character of the “scientific principle” proffered as evidence. Frye makes no mention of subject-matter expertise (27), except in the sense implied by the “general acceptance” clause, which refers to the consensual expertise held by the scientific community. This concept of consensual expertise as the basis for establishing trustworthiness became eroded through establishment of the Federal Rules of Evidence, which turned the focus toward opinions of individual experts. Rule 702: Testimony by Experts By the 1970s, a sense had emerged that the inflexible Frye requirement for general acceptance was difficult to establish and perhaps insufficient, in that it was mainly relevant to criminal cases in which an invented instrument was proposed to establish fact.# Partly in response to this concern, standards for admissibility of scientific evidence began to change. They did so initially, at least in a formal sense, following recommendations of a federal advisory committee of the United States Judicial Conference, which was established for the broader purpose of normalizing and codifying rules for the use of evidence in US Courts. The Federal Rules of Evidence became law in 1975 by act of Congress. The particular rule that bears on admissibility of expert testimony is known as Rule 702 (28). While Frye selectively targets the use of scientific evidence, Rule 702 applies more generally to expert testimony on “scientific, technical, or other specialized knowledge,” meaning that the same standards apply to evidence drawn from the well of scientific knowledge and to subject-matter experts in nonscience knowledge domains, such as tugboat captaining. In its original form, Rule 702–1975 merely formalized and made into law standards for “helpfulness” and “expert” qualifications, both of which had been less formally applied since the 19th century: “If scientific, technical, or other specialized knowledge will assist the trier of fact to understand the evidence or to determine a fact in issue, a witness qualified as an expert by knowledge, skill, experience, training, or education, may testify thereto in the form of an opinion or otherwise.” As a notably limp standard for judging the evidentiary nuances of modern science, Rule 702-1975 was subsequently interpreted and clarified by the Supreme Court’s transformative 1993 ruling on scientific evidence in Daubert v. Merrell Dow Pharmaceuticals, Inc. (8). The Daubert Standard Unlike the forensic instrument that motivated the Frye standard, in which the question before the court concerned the scientific validity of measured quantities, the Daubert ruling emerged from a toxic tort case, in which scientific evidence attempted to establish cause and effect. Daubert’s civil action was filed against the drug company Merrell Dow Pharmaceuticals in 1984, on behalf of two children born with serious birth defects. The mothers had taken the drug Bendectin [doxylamine succinate and pyridoxine hydrochloride (vitamin B6)], which was manufactured by Merrell Dow and widely used for decades to quell nausea and vomiting during first-trimester pregnancy. The plaintiff alleged that Bendectin had caused deformities during gestation. Merrell Dow maintained that there was no scientific evidence of a link between their drug and birth defects, but Daubert recruited an expert in the form of obstetrician William McBride, who was prepared to testify on the teratogenic effects of Bendectin. Noting that McBride’s assertions failed to meet the Frye standard of general acceptance by the scientific community, the District Court for the Southern District of California issued summary judgement in favor of Merrell Dow (29). Daubert appealed to the Ninth Circuit, which upheld the lower court’s ruling (30). In response, Daubert went on to argue before the Supreme Court that the common law Frye standard for admissibility of scientific evidence was inapplicable in their case, because it had been replaced in 1975 by the legislatively enacted Rule 702. The Court agreed and upheld Rule 702–1975 as the modern legal standard for admissibility in federal court, superseding the Frye standard.‖ In its ruling (8), the Court provided an interpretation of Rule 702–1975, which is known today as the Daubert standard. This standard consists of a set of clear and useful criteria for assessing the trustworthiness of scientific evidence: • whether the theory or technique in question can be (and has been) tested, • whether it has been subjected to peer review and publication, • its known or potential error rate, and • the existence and maintenance of standards controlling its operation, and • whether it has attracted widespread acceptance within a relevant scientific community Unlike the uncompromising Frye standard, these criteria are intended to be flexibly applied at the discretion of the trial judge. With these brief considerations, Daubert strengthened the application of evidence law in several ways that conform to the nature of scientific investigation. Perhaps most importantly, Daubert returned the focus to the body of scientific knowledge (27), highlighting the importance of empirically demonstrating [“can be (and has been) tested”] that a scientific instrument or principle is a valid predictor of the probability that a courtroom hypothesis is correct (“known or potential error rate”). To that end, the focus on widespread or general acceptance of scientific evidence – consistent with Frye but absent from Rule 702 – is notable here, as the scientific consensus at any moment is the rational basis for decision under the unyielding demands of courtroom litigation. Also consistent with Frye and contrary to the letter of Rule 702, Daubert emphasizes the need for evidence to reflect the consensus of the “relevant scientific community.” As highlighted below, the definition of relevance has become a battleground in efforts to reform the use of forensic evidence. Rule 702 Evolves Rule 702 was substantially amended in 2000 to conform with Daubert and to promote a “more rigorous and structured approach” (31), in which the gatekeeping role was formally handed to judges. The Rule’s emphasis on the expert remained, but three “reliability” requirements were included in Rule 702–2000 (provisions b-d), which place constraints on the data, methods, principles, and their application by the expert: A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if: the expert’s scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue; the testimony is based on sufficient facts or data; (c) the testimony is the product of reliable principles and methods; and (d) the expert has reliably applied the principles and methods to the facts of the case. Rule 702 was revised again in 2022 (to take effect December 2023) through amendments proposed by the Advisory Committee on Evidence Rules and subsequently approved by the US Judicial Conference and the Supreme Court (32). For these efforts, Rule 702–2022 differs from the previous by two small text additions. One defines a preponderance of evidence (“more likely than not”) standard for demonstrating that the four provisions [702(a-d)] have been satisfied, which offers the gatekeeping judge a quantitative criterion for decisions about admissibility. The other clarifies that it is not the expert’s reliable application that matters, but rather that “the expert’s opinion reflects a reliable application,” which grants the trial judge the ability to bar opinions that exceed what can be reasonably concluded from the methods and principles applied. https://www.pnas.org/doi/full/10.1073/pnas.2301839120 ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Effect Analysis,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",What are V2G batteries and how do they work in Oakland Unified School District's new bussing system? What are the pros and are there any cons?,"The wheels on this bus do indeed go round and round. Its wipers swish. And its horn beeps. Hidden in its innards, though, is something special — a motor that doesn’t vroom but pairs with a burgeoning technology that could help the grid proliferate with renewable energy. These new buses, developed by a company called Zum, ride clean and quiet because they’re fully electric. With them, California’s Oakland Unified School District just became the first major district in the United States to transition to 100 percent electrified buses. The vehicles are now transporting 1,300 students to and from school, replacing diesel-chugging buses that pollute the kids’ lungs and the neighborhoods with particulate matter. Like in other American cities, Oakland’s underserved areas tend to be closer to freeways and industrial activity, so air quality in those areas is already terrible compared to the city’s richer parts. Pollution from buses and other vehicles contributes to chronic asthma among students, which leads to chronic absenteeism. Since Oakland Unified only provides bus services for its special-need students, the problem of missing school for preventable health issues is particularly acute for them. “We have already seen the data — more kids riding the buses, that means more of our most vulnerable who are not missing school,” said Kyla Johnson-Trammell, superintendent of Oakland Unified School District, during a press conference Tuesday. “That, over time, means they’re having more learning and achievement goes up.” What’s more, a core challenge of weaning our society off fossil fuels is that utilities will need to produce more electricity, not less of it. “In some places, you’re talking about doubling the amount of energy needed,” said Kevin Schneider, an expert in power systems at Pacific Northwest National Laboratory, who isn’t involved in the Oakland project. Counterintuitively enough, the buses’ massive batteries aren’t straining the grid; they’re benefiting it. Like a growing number of consumer EV models, the buses are equipped with vehicle-to-grid technology, or V2G. That allows them to charge their batteries by plugging into the grid, but also send energy back to the grid if the electrical utility needs extra power. “School buses play a very important role in the community as a transportation provider, but now also as an energy provider,” said Vivek Garg, co-founder and chief operating officer of Zum. And provide the buses must. Demand on the grid tends to spike in the late afternoon, when everyone’s returning home and switching on appliances like air conditioners. Historically, utilities could just spin up more generation at a fossil fuel power plant to meet that demand. But as the grid is loaded with more renewable energy sources, intermittency becomes a challenge: You can’t crank up power in the system if the sun isn’t shining or the wind isn’t blowing. If every EV has V2G capability, that creates a distributed network of batteries for a utility to draw on when demand spikes. The nature of the school bus suits it perfectly for this, because it’s on a fixed schedule, making it a predictable resource for the utility. In the afternoon, Zum’s buses take kids home, then plug back into the grid. “They have more energy in each bus than they need to do their route, so there’s always an ample amount left over,” said Rudi Halbright, product manager of V2G integration at Pacific Gas and Electric Company, the utility that’s partnered with Zum and Oakland Unified for the new system. As the night goes on and demand wanes, the buses charge again to be ready for their morning routes. Then during the day, they charge again, when there’s plentiful solar power on the grid. On weekends or holidays, the buses would be available all day as backup power for the grid. “Sure, they’re going to take a very large amount of charge,” said Kevin Schneider, an expert in power systems at Pacific Northwest National Laboratory, who isn’t involved in the Oakland project. “But things like school buses don’t run that often, so they have a great potential to be a resource.” That resource ain’t free: Utilities pay owners of V2G vehicles to provide power to the grid. (Because V2G is so new, utilities are still experimenting with what this rate structure looks like.) Zum says that that revenue helps bring down the transportation costs of its buses to be on par with cheaper diesel-powered buses. Oakland Unified and other districts can get still more money from the EPA’s Clean School Bus Program, which is handing out $5 billion between 2022 and 2026 to make the switch. The potential of V2G is that there are so many different kinds of electric vehicles (or vehicle types left to electrify). Garbage trucks run early in the day, while delivery trucks and city vehicles do more of a nine-to-five. Passenger vehicles are kind of all over the place, with some people taking them to work, while others sit in garages all day. Basically, lots of batteries — big and small — parked idle at different times to send power back to the grid. All the while, fiercer heat waves will require more energy-hungry air conditioning to keep people healthy. (Though ideally, everyone would get a heat pump instead.) “We’re still going to need more generation, more power lines, but energy storage is going to give us the flexibility so we can deploy it quicker,” Schneider said. In the near future, you may get home on a sweltering day and still be able to switch on your AC — thanks to an electric school bus sitting in a lot.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. What are V2G batteries and how do they work in Oakland Unified School District's new bussing system? What are the pros and are there any cons? The wheels on this bus do indeed go round and round. Its wipers swish. And its horn beeps. Hidden in its innards, though, is something special — a motor that doesn’t vroom but pairs with a burgeoning technology that could help the grid proliferate with renewable energy. These new buses, developed by a company called Zum, ride clean and quiet because they’re fully electric. With them, California’s Oakland Unified School District just became the first major district in the United States to transition to 100 percent electrified buses. The vehicles are now transporting 1,300 students to and from school, replacing diesel-chugging buses that pollute the kids’ lungs and the neighborhoods with particulate matter. Like in other American cities, Oakland’s underserved areas tend to be closer to freeways and industrial activity, so air quality in those areas is already terrible compared to the city’s richer parts. Pollution from buses and other vehicles contributes to chronic asthma among students, which leads to chronic absenteeism. Since Oakland Unified only provides bus services for its special-need students, the problem of missing school for preventable health issues is particularly acute for them. “We have already seen the data — more kids riding the buses, that means more of our most vulnerable who are not missing school,” said Kyla Johnson-Trammell, superintendent of Oakland Unified School District, during a press conference Tuesday. “That, over time, means they’re having more learning and achievement goes up.” What’s more, a core challenge of weaning our society off fossil fuels is that utilities will need to produce more electricity, not less of it. “In some places, you’re talking about doubling the amount of energy needed,” said Kevin Schneider, an expert in power systems at Pacific Northwest National Laboratory, who isn’t involved in the Oakland project. Counterintuitively enough, the buses’ massive batteries aren’t straining the grid; they’re benefiting it. Like a growing number of consumer EV models, the buses are equipped with vehicle-to-grid technology, or V2G. That allows them to charge their batteries by plugging into the grid, but also send energy back to the grid if the electrical utility needs extra power. “School buses play a very important role in the community as a transportation provider, but now also as an energy provider,” said Vivek Garg, co-founder and chief operating officer of Zum. And provide the buses must. Demand on the grid tends to spike in the late afternoon, when everyone’s returning home and switching on appliances like air conditioners. Historically, utilities could just spin up more generation at a fossil fuel power plant to meet that demand. But as the grid is loaded with more renewable energy sources, intermittency becomes a challenge: You can’t crank up power in the system if the sun isn’t shining or the wind isn’t blowing. If every EV has V2G capability, that creates a distributed network of batteries for a utility to draw on when demand spikes. The nature of the school bus suits it perfectly for this, because it’s on a fixed schedule, making it a predictable resource for the utility. In the afternoon, Zum’s buses take kids home, then plug back into the grid. “They have more energy in each bus than they need to do their route, so there’s always an ample amount left over,” said Rudi Halbright, product manager of V2G integration at Pacific Gas and Electric Company, the utility that’s partnered with Zum and Oakland Unified for the new system. As the night goes on and demand wanes, the buses charge again to be ready for their morning routes. Then during the day, they charge again, when there’s plentiful solar power on the grid. On weekends or holidays, the buses would be available all day as backup power for the grid. “Sure, they’re going to take a very large amount of charge,” said Kevin Schneider, an expert in power systems at Pacific Northwest National Laboratory, who isn’t involved in the Oakland project. “But things like school buses don’t run that often, so they have a great potential to be a resource.” That resource ain’t free: Utilities pay owners of V2G vehicles to provide power to the grid. (Because V2G is so new, utilities are still experimenting with what this rate structure looks like.) Zum says that that revenue helps bring down the transportation costs of its buses to be on par with cheaper diesel-powered buses. Oakland Unified and other districts can get still more money from the EPA’s Clean School Bus Program, which is handing out $5 billion between 2022 and 2026 to make the switch. The potential of V2G is that there are so many different kinds of electric vehicles (or vehicle types left to electrify). Garbage trucks run early in the day, while delivery trucks and city vehicles do more of a nine-to-five. Passenger vehicles are kind of all over the place, with some people taking them to work, while others sit in garages all day. Basically, lots of batteries — big and small — parked idle at different times to send power back to the grid. All the while, fiercer heat waves will require more energy-hungry air conditioning to keep people healthy. (Though ideally, everyone would get a heat pump instead.) “We’re still going to need more generation, more power lines, but energy storage is going to give us the flexibility so we can deploy it quicker,” Schneider said. In the near future, you may get home on a sweltering day and still be able to switch on your AC — thanks to an electric school bus sitting in a lot. https://grist.org/transportation/oakland-electric-school-buses-battery-storage/",Internet/Technology,Pros & Cons,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","In what ways does the implementation of Zero-Trust architecture transform an organization's cybersecurity strategy, specifically with regard to tackling the obstacles presented by antiquated technologies, societal opposition, and the requirement for expandability? Talk about how the fundamental elements of Zero-Trust, such network segmentation, device security, and identity verification, improve security resilience while taking into account how difficult it is to apply this paradigm in contemporary digital contexts.","Globally, today’s organizations are increasingly vulnerable to a wide array of cybersecurity threats. These range from sophisticated phishing schemes to aggressive ransomware attacks, underscoring the urgent need for more effective security frameworks. Among the most promising of these frameworks is Zero-Trust Architecture (ZTA), a cybersecurity strategy that fundamentally abandons the traditional assumption that everything inside an organization’s network should be trusted. Instead, Zero-Trust operates on a foundational principle of “never trust, always verify,” applying strict access controls and continuous verification to every access request, regardless of origin. This approach challenges the conventional perimeter-centric model of security, which relies on defending the boundary between ‘safe’ internal networks and ‘unsafe’ external ones. In the Zero-Trust model, trust is neither location-dependent nor static; it is contingent on dynamic, context-based policies that evaluate each request for network access on its own merits, incorporating user identity, device security posture, and other behavioral analytics. The importance of Zero-Trust Architecture in modern cybersecurity cannot be overstated. As digital transformation accelerates and organizations adopt cloud technologies and mobile workforces, the traditional security perimeter has dissolved, creating new vulnerabilities and attack surfaces. Zero-Trust addresses these challenges by securing an environment where users, devices, applications, and data are distributed globally, thus necessitating robust mechanisms for protecting data not just at the perimeter, but at every point of digital interaction. By verifying all entities and enforcing strict access controls, Zero-Trust helps prevent unauthorized access and contains lateral movement within the network, significantly enhancing the organization’s overall security posture and resilience against cyber threats. Core Components of Zero-Trust Architecture Zero-Trust Architecture dismantles the old network security model that relies on a secure perimeter and instead uses several core components that enforce its strict security protocols. These components work in unison to ensure that security is maintained not just at the edges, but throughout the network by continuously verifying and limiting access. Identity Verification: At the heart of Zero-Trust is robust identity and access management (IAM), which ensures that only verified users and devices can access network resources. IAM systems utilize advanced authentication methods, such as multi-factor authentication (MFA), to verify identities reliably before granting access. Device Security: Each device attempting to access the network must be secured and compliant with the organization’s security policies. Zero-Trust frameworks often employ device security enforcement mechanisms like endpoint security solutions, which assess devices for compliance before allowing connection to the network. Network Segmentation: This involves dividing the network into smaller, manageable segments, each with its own strict access controls. Network segmentation limits the potential damage in case of a breach by isolating segments from one another, thereby preventing an attacker from moving laterally across the network. Least Privilege Access: This principle ensures that users and devices are granted the minimum level of access necessary to perform their functions. Access rights are strictly controlled and regularly reviewed to ensure they are appropriate, reducing the risk of insider threats and data breaches. Real-Time Threat Detection and Response: Zero-Trust architectures utilize advanced monitoring tools to detect and respond to threats in real-time. These systems analyze network traffic and user behavior to identify suspicious activities, enabling immediate response to potential security incidents. Implementation Strategy Implementing Zero-Trust Architecture requires a strategic approach that encompasses assessing existing infrastructures, designing appropriate security frameworks, and integrating advanced technologies. This section outlines a clear path for organizations to follow, ensuring a comprehensive and secure transition to a Zero-Trust environment. Assessing Current Security Posture and Infrastructure: Begin by conducting a thorough audit of your current security measures and network architecture. This assessment should identify vulnerabilities, outdated systems, and areas lacking sufficient protection, providing a baseline for the Zero-Trust implementation. Identifying Sensitive Data and Systems: Determine which data and systems are critical to the organization’s operations and require higher levels of security. This step involves mapping out data flows and understanding where sensitive information resides and how it is accessed. Designing a Zero-Trust Network Architecture: Based on the assessments, design a network architecture that incorporates Zero-Trust principles such as micro-segmentation and least privilege. This design should ensure that security is enforceable and effective at every layer of the network. Deploying Zero-Trust Policies and Controls: Implement policies that enforce strict identity verification, device compliance, and access controls based on the least privilege principle. These policies should be dynamically applied and capable of adapting to changes in the threat landscape and organizational needs. Continuous Evaluation and Adaptation of Security Measures: Zero-Trust is not a set-and-forget solution; it requires ongoing evaluation and adaptation. Regularly review and update security policies, controls, and system configurations to keep up with evolving security threats and technological advances. Challenges in Adopting Zero-Trust Architecture Adopting Zero-Trust Architecture presents several challenges that organizations must navigate to ensure a successful transition. One of the primary hurdles is cultural resistance within the organization. Zero-Trust necessitates a shift from the traditional security mindset, which can be substantial as it changes fundamental aspects of how employees access systems and data. Employees and management alike may be wary of the increased security measures, viewing them as obstacles to productivity rather than enhancements to security. Overcoming this cultural barrier requires thorough training and clear communication to demonstrate the benefits and necessity of a Zero-Trust approach, emphasizing its role in safeguarding both personal and organizational data. Another significant challenge is the complexity and cost associated with implementing a Zero-Trust model, particularly when integrating with legacy systems. Many organizations operate on outdated infrastructure that is not readily compatible with Zero-Trust principles, making the transition technically challenging and financially demanding. Upgrading these systems or finding workarounds often involves substantial time and resource investment. Additionally, scalability can pose difficulties as organizations grow and their network environments become more complex. Ensuring that the Zero-Trust architecture can scale effectively without compromising security or performance requires continuous adaptation and possibly significant changes to the network and security infrastructure. These challenges demand a committed, strategic approach to ensure that the security architecture can evolve in tandem with the organization. ​​Zero-Trust Architecture stands as a transformative approach in the realm of cybersecurity, shifting the traditional security paradigm to effectively combat the increasing frequency and sophistication of cyber threats. By fundamentally rejecting the notion of inherent trust within the network, ZTA introduces a rigorous framework of continuous verification and strict access controls that adapt to the complexities of modern digital environments. Implementing this architecture involves a comprehensive redesign of security systems—from identity verification and device security to network segmentation and real-time threat detection. Despite its challenges, the strategic adoption of Zero-Trust principles significantly strengthens an organization’s defense mechanisms. It not only prevents unauthorized access but also minimizes the impact of potential breaches, thereby enhancing overall security resilience. Thus, as organizations continue to evolve and expand their digital footprints, embracing Zero-Trust Architecture becomes crucial for maintaining robust and dynamic cybersecurity defenses in an increasingly vulnerable global landscape.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== In what ways does the implementation of Zero-Trust architecture transform an organization's cybersecurity strategy, specifically with regard to tackling the obstacles presented by antiquated technologies, societal opposition, and the requirement for expandability? Talk about how the fundamental elements of Zero-Trust, such network segmentation, device security, and identity verification, improve security resilience while taking into account how difficult it is to apply this paradigm in contemporary digital contexts. {passage 0} ========== Globally, today’s organizations are increasingly vulnerable to a wide array of cybersecurity threats. These range from sophisticated phishing schemes to aggressive ransomware attacks, underscoring the urgent need for more effective security frameworks. Among the most promising of these frameworks is Zero-Trust Architecture (ZTA), a cybersecurity strategy that fundamentally abandons the traditional assumption that everything inside an organization’s network should be trusted. Instead, Zero-Trust operates on a foundational principle of “never trust, always verify,” applying strict access controls and continuous verification to every access request, regardless of origin. This approach challenges the conventional perimeter-centric model of security, which relies on defending the boundary between ‘safe’ internal networks and ‘unsafe’ external ones. In the Zero-Trust model, trust is neither location-dependent nor static; it is contingent on dynamic, context-based policies that evaluate each request for network access on its own merits, incorporating user identity, device security posture, and other behavioral analytics. The importance of Zero-Trust Architecture in modern cybersecurity cannot be overstated. As digital transformation accelerates and organizations adopt cloud technologies and mobile workforces, the traditional security perimeter has dissolved, creating new vulnerabilities and attack surfaces. Zero-Trust addresses these challenges by securing an environment where users, devices, applications, and data are distributed globally, thus necessitating robust mechanisms for protecting data not just at the perimeter, but at every point of digital interaction. By verifying all entities and enforcing strict access controls, Zero-Trust helps prevent unauthorized access and contains lateral movement within the network, significantly enhancing the organization’s overall security posture and resilience against cyber threats. Core Components of Zero-Trust Architecture Zero-Trust Architecture dismantles the old network security model that relies on a secure perimeter and instead uses several core components that enforce its strict security protocols. These components work in unison to ensure that security is maintained not just at the edges, but throughout the network by continuously verifying and limiting access. Identity Verification: At the heart of Zero-Trust is robust identity and access management (IAM), which ensures that only verified users and devices can access network resources. IAM systems utilize advanced authentication methods, such as multi-factor authentication (MFA), to verify identities reliably before granting access. Device Security: Each device attempting to access the network must be secured and compliant with the organization’s security policies. Zero-Trust frameworks often employ device security enforcement mechanisms like endpoint security solutions, which assess devices for compliance before allowing connection to the network. Network Segmentation: This involves dividing the network into smaller, manageable segments, each with its own strict access controls. Network segmentation limits the potential damage in case of a breach by isolating segments from one another, thereby preventing an attacker from moving laterally across the network. Least Privilege Access: This principle ensures that users and devices are granted the minimum level of access necessary to perform their functions. Access rights are strictly controlled and regularly reviewed to ensure they are appropriate, reducing the risk of insider threats and data breaches. Real-Time Threat Detection and Response: Zero-Trust architectures utilize advanced monitoring tools to detect and respond to threats in real-time. These systems analyze network traffic and user behavior to identify suspicious activities, enabling immediate response to potential security incidents. Implementation Strategy Implementing Zero-Trust Architecture requires a strategic approach that encompasses assessing existing infrastructures, designing appropriate security frameworks, and integrating advanced technologies. This section outlines a clear path for organizations to follow, ensuring a comprehensive and secure transition to a Zero-Trust environment. Assessing Current Security Posture and Infrastructure: Begin by conducting a thorough audit of your current security measures and network architecture. This assessment should identify vulnerabilities, outdated systems, and areas lacking sufficient protection, providing a baseline for the Zero-Trust implementation. Identifying Sensitive Data and Systems: Determine which data and systems are critical to the organization’s operations and require higher levels of security. This step involves mapping out data flows and understanding where sensitive information resides and how it is accessed. Designing a Zero-Trust Network Architecture: Based on the assessments, design a network architecture that incorporates Zero-Trust principles such as micro-segmentation and least privilege. This design should ensure that security is enforceable and effective at every layer of the network. Deploying Zero-Trust Policies and Controls: Implement policies that enforce strict identity verification, device compliance, and access controls based on the least privilege principle. These policies should be dynamically applied and capable of adapting to changes in the threat landscape and organizational needs. Continuous Evaluation and Adaptation of Security Measures: Zero-Trust is not a set-and-forget solution; it requires ongoing evaluation and adaptation. Regularly review and update security policies, controls, and system configurations to keep up with evolving security threats and technological advances. Challenges in Adopting Zero-Trust Architecture Adopting Zero-Trust Architecture presents several challenges that organizations must navigate to ensure a successful transition. One of the primary hurdles is cultural resistance within the organization. Zero-Trust necessitates a shift from the traditional security mindset, which can be substantial as it changes fundamental aspects of how employees access systems and data. Employees and management alike may be wary of the increased security measures, viewing them as obstacles to productivity rather than enhancements to security. Overcoming this cultural barrier requires thorough training and clear communication to demonstrate the benefits and necessity of a Zero-Trust approach, emphasizing its role in safeguarding both personal and organizational data. Another significant challenge is the complexity and cost associated with implementing a Zero-Trust model, particularly when integrating with legacy systems. Many organizations operate on outdated infrastructure that is not readily compatible with Zero-Trust principles, making the transition technically challenging and financially demanding. Upgrading these systems or finding workarounds often involves substantial time and resource investment. Additionally, scalability can pose difficulties as organizations grow and their network environments become more complex. Ensuring that the Zero-Trust architecture can scale effectively without compromising security or performance requires continuous adaptation and possibly significant changes to the network and security infrastructure. These challenges demand a committed, strategic approach to ensure that the security architecture can evolve in tandem with the organization. ​​Zero-Trust Architecture stands as a transformative approach in the realm of cybersecurity, shifting the traditional security paradigm to effectively combat the increasing frequency and sophistication of cyber threats. By fundamentally rejecting the notion of inherent trust within the network, ZTA introduces a rigorous framework of continuous verification and strict access controls that adapt to the complexities of modern digital environments. Implementing this architecture involves a comprehensive redesign of security systems—from identity verification and device security to network segmentation and real-time threat detection. Despite its challenges, the strategic adoption of Zero-Trust principles significantly strengthens an organization’s defense mechanisms. It not only prevents unauthorized access but also minimizes the impact of potential breaches, thereby enhancing overall security resilience. Thus, as organizations continue to evolve and expand their digital footprints, embracing Zero-Trust Architecture becomes crucial for maintaining robust and dynamic cybersecurity defenses in an increasingly vulnerable global landscape. https://agileblue.com/zero-trust-architecture-implementation-and-challenges/",Internet/Technology,Effect Analysis,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","I'm tired of wearing eye-sight glasses now and planning laser surgery for my eyes. The issue is I have a very thin cornea, so will I be considered an unsuitable candidate for laser eye surgery, and what other factors could disqualify a person from undergoing the procedure?","The eye has an outer layer called the cornea. Some people’s corneas can undergo changes in their shape, leading to vision issues, such as astigmatism and myopia. Laser eye surgery is a medical procedure that reshapes this layer. Precisely how laser eye surgery reshapes the cornea depends on the vision condition that the treatment aims to correct. Laser eye surgery can fix vision issues, such as nearsightedness and farsightedness. The surgery is quick, and people remain awake throughout the procedure. It is also usually painless — if a person experiences pain, it usually indicates there have been complications. This article discusses what laser eye surgery is, who it can help, costs, duration of the surgery, recovery time, and any associated short- and long-term risks. What is laser eye surgery (LASIK or PRK) SCIENCE PHOTO LIBRARY/Getty Images LASIK stands for laser-assisted in situ keratomileusis and is the most common type of refractive eye surgery. LASIK was first patented in 1989 and has become the most commonTrusted Source treatment for refractive eye errors. The procedure involves lasers to reshape the cornea. Who may it help? According to the American Academy of Ophthalmology, over 150 million Americans use corrective eyewear, such as glasses or contact lenses, to compensate for refractive errors. Refractive errors occur when the eye does not bend — or refract — the light to properly focus on the retina in the back of the eye. This is usually due to the shape of the cornea. Farsightedness The clinical name for farsightedness is hyperopia. People with this condition can see objects in the distance clearly, but other things can appear blurry at close distance. Farsightedness is due to the curvature of the cornea being too flat. Laser eye surgery can correct this by reshaping the cornea to have a steeper curve. Nearsightedness Nearsightedness, known as myopia or short-sightedness, is where a person can see objects close to them clearly. However, distant objects can appear blurred. This is due to the curvature of the cornea being too steep. Healthcare professionals can correct this through laser eye surgery by reshaping the cornea. Astigmatism People with astigmatism have a differently-shaped eye that characterizes this condition. The eye of someone without the condition is round, like a soccer ball, while with astigmatism, the eye may have more of a football-like shape. It is possible to correct this irregular curvature of the cornea with laser eye surgery in some cases. Get our Eye Health Newsletter Receive expert advice, tips to manage your symptoms, and the latest on condition breakthroughs delivered straight to your inbox. Enter your email Also sign up for our popular Heart Health newsletter Your privacy is important to us People who are not suitableTrusted Source candidates for laser eye surgery include those who: have had a change in their eye prescription in the last 12 months take medications that may cause changes in vision are in their 20s or younger, although some experts recommend not being under 18 years have thin corneas, which may not be stable following laser surgery are pregnant or nursing Benefits The main benefit of laser eye surgery is that mostTrusted Source people no longer have to wear corrective eyewear to see clearly. Individuals may choose to undergo the procedure for several reasons, including: being unable to wear contact lenses but preferring not to wear glasses, perhaps for cosmetic reasons wishing to undertake activities, such as sports, that require a person not to wear glasses or contact lenses having the convenience of not having to wear corrective eyewear A person is more at riskTrusted Source of developing complications if they have the followingTrusted Source eye conditions: eye infections, such as keratitis or ocular herpes significant cataracts — people with this condition will not have corrected vision after laser surgery glaucoma large pupils keratoconus, a disease that makes the cornea thinner and unstable over time As with all surgeries, a person may experience complications, including: Dry eyes: Up to 95%Trusted Source of people who have laser eye surgery may experience dry eyes after the procedure, where the eyes produce fewer tears. Lubricating eye drops can help with this symptom. Glare or halo: 20% of people undergoing laser eye surgery may experience visual changes such as glare, halo, or sensitivity to light. Double or blurry vision: As many as 1 in 50 people may report blurriness and feel there is something in their eyes. Diffuse lamellar keratitis — also called “sands of Sahara” syndrome — may be the cause. Other complications a person may experience include: eye infection corneal flap complications red or bloodshot whites of the eye Most symptoms should resolve after the first few days, so an individual experiencing any symptoms after this time should consult with a medical professional. The Food & Drug Administration (FDA) suggests laser eye surgery usually takes less than 30 minutesTrusted Source. Others estimate the procedure will take around 5 minutes per eye. People undergoing laser eye surgery should expect the following: They will sit in a chair and recline, so they are flat on their back underneath a laser device and computer screen. The surgical team will clean the area around the eye and place numbing drops in the eye. Surgeons will use a lid speculum, a medical instrument, to hold the eyelids open. A laser will cut a flap in the cornea, and the surgeon will then lift this open. People will need to stare at a light to keep their eyes still while the laser works. The laser will then reshape the surface of the cornea. The surgeon will then place the flap back into position and apply a shield to protect the eye. Recovery time The FDATrusted Source notes that after surgery, a person may feel as though their eye is burning, itchy, or that there is a foreign object present. The surgeon may recommend a mild pain reliever, such as acetaminophen, to help with these sensations. Surgeons will provide people with an eye shield to protect their eyes, as there will be no stitches holding the flap in place. The guard helps prevent rubbing the eye or accidentally applying pressure, such as during sleep. Individuals will usually take a few days off from work so they can recover. They should schedule an appointment to see their eye doctor within the first 24–48 hours after surgery to undergo an eye examination. The doctor will make sure the eyes are healing as they should. After this, a person will need several additional appointments over the first 6 months. Results It may take up to 6 monthsTrusted Source for a person’s vision to stabilize after laser eye surgery. They may notice their vision fluctuates for a while after the procedure, but this should not be a cause for concern. However, it is common for vision to vary for the initial few months following surgery. Additionally, sometimes laser eye surgery may accidentally over- or under-correct a person’s sight. This might require further surgery to rectify, which healthcare professionals usually called enhancement. It is also important to remember that corrected vision can regress years after the procedure. The cost of LASIK surgery will be different depending on where the person lives. Other surgeons may use various equipment or techniques, which the price may reflect. Health insurance companies usually categorize LASIK as an elective or cosmetic procedure and do not typically cover these treatments. In 2020, the American Refractive Surgery Council estimated that LASIK surgery might cost around $4,200 per eye, on average. Although laser eye surgery can be expensive, it is crucial that people thoroughly do their research before undergoing treatment at reduced prices. There may be a reason the price is so low, which may increase the risk of complications."," Only use the provided text to answer the question, no outside sources. I'm tired of wearing eye-sight glasses now and planning laser surgery for my eyes. The issue is I have a very thin cornea, so will I be considered an unsuitable candidate for laser eye surgery, and what other factors could disqualify a person from undergoing the procedure? The eye has an outer layer called the cornea. Some people’s corneas can undergo changes in their shape, leading to vision issues, such as astigmatism and myopia. Laser eye surgery is a medical procedure that reshapes this layer. Precisely how laser eye surgery reshapes the cornea depends on the vision condition that the treatment aims to correct. Laser eye surgery can fix vision issues, such as nearsightedness and farsightedness. The surgery is quick, and people remain awake throughout the procedure. It is also usually painless — if a person experiences pain, it usually indicates there have been complications. This article discusses what laser eye surgery is, who it can help, costs, duration of the surgery, recovery time, and any associated short- and long-term risks. What is laser eye surgery (LASIK or PRK) SCIENCE PHOTO LIBRARY/Getty Images LASIK stands for laser-assisted in situ keratomileusis and is the most common type of refractive eye surgery. LASIK was first patented in 1989 and has become the most commonTrusted Source treatment for refractive eye errors. The procedure involves lasers to reshape the cornea. Who may it help? According to the American Academy of Ophthalmology, over 150 million Americans use corrective eyewear, such as glasses or contact lenses, to compensate for refractive errors. Refractive errors occur when the eye does not bend — or refract — the light to properly focus on the retina in the back of the eye. This is usually due to the shape of the cornea. Farsightedness The clinical name for farsightedness is hyperopia. People with this condition can see objects in the distance clearly, but other things can appear blurry at close distance. Farsightedness is due to the curvature of the cornea being too flat. Laser eye surgery can correct this by reshaping the cornea to have a steeper curve. Nearsightedness Nearsightedness, known as myopia or short-sightedness, is where a person can see objects close to them clearly. However, distant objects can appear blurred. This is due to the curvature of the cornea being too steep. Healthcare professionals can correct this through laser eye surgery by reshaping the cornea. Astigmatism People with astigmatism have a differently-shaped eye that characterizes this condition. The eye of someone without the condition is round, like a soccer ball, while with astigmatism, the eye may have more of a football-like shape. It is possible to correct this irregular curvature of the cornea with laser eye surgery in some cases. Get our Eye Health Newsletter Receive expert advice, tips to manage your symptoms, and the latest on condition breakthroughs delivered straight to your inbox. Enter your email Also sign up for our popular Heart Health newsletter Your privacy is important to us People who are not suitableTrusted Source candidates for laser eye surgery include those who: have had a change in their eye prescription in the last 12 months take medications that may cause changes in vision are in their 20s or younger, although some experts recommend not being under 18 years have thin corneas, which may not be stable following laser surgery are pregnant or nursing Benefits The main benefit of laser eye surgery is that mostTrusted Source people no longer have to wear corrective eyewear to see clearly. Individuals may choose to undergo the procedure for several reasons, including: being unable to wear contact lenses but preferring not to wear glasses, perhaps for cosmetic reasons wishing to undertake activities, such as sports, that require a person not to wear glasses or contact lenses having the convenience of not having to wear corrective eyewear A person is more at riskTrusted Source of developing complications if they have the followingTrusted Source eye conditions: eye infections, such as keratitis or ocular herpes significant cataracts — people with this condition will not have corrected vision after laser surgery glaucoma large pupils keratoconus, a disease that makes the cornea thinner and unstable over time As with all surgeries, a person may experience complications, including: Dry eyes: Up to 95%Trusted Source of people who have laser eye surgery may experience dry eyes after the procedure, where the eyes produce fewer tears. Lubricating eye drops can help with this symptom. Glare or halo: 20% of people undergoing laser eye surgery may experience visual changes such as glare, halo, or sensitivity to light. Double or blurry vision: As many as 1 in 50 people may report blurriness and feel there is something in their eyes. Diffuse lamellar keratitis — also called “sands of Sahara” syndrome — may be the cause. Other complications a person may experience include: eye infection corneal flap complications red or bloodshot whites of the eye Most symptoms should resolve after the first few days, so an individual experiencing any symptoms after this time should consult with a medical professional. The Food & Drug Administration (FDA) suggests laser eye surgery usually takes less than 30 minutesTrusted Source. Others estimate the procedure will take around 5 minutes per eye. People undergoing laser eye surgery should expect the following: They will sit in a chair and recline, so they are flat on their back underneath a laser device and computer screen. The surgical team will clean the area around the eye and place numbing drops in the eye. Surgeons will use a lid speculum, a medical instrument, to hold the eyelids open. A laser will cut a flap in the cornea, and the surgeon will then lift this open. People will need to stare at a light to keep their eyes still while the laser works. The laser will then reshape the surface of the cornea. The surgeon will then place the flap back into position and apply a shield to protect the eye. Recovery time The FDATrusted Source notes that after surgery, a person may feel as though their eye is burning, itchy, or that there is a foreign object present. The surgeon may recommend a mild pain reliever, such as acetaminophen, to help with these sensations. Surgeons will provide people with an eye shield to protect their eyes, as there will be no stitches holding the flap in place. The guard helps prevent rubbing the eye or accidentally applying pressure, such as during sleep. Individuals will usually take a few days off from work so they can recover. They should schedule an appointment to see their eye doctor within the first 24–48 hours after surgery to undergo an eye examination. The doctor will make sure the eyes are healing as they should. After this, a person will need several additional appointments over the first 6 months. Results It may take up to 6 monthsTrusted Source for a person’s vision to stabilize after laser eye surgery. They may notice their vision fluctuates for a while after the procedure, but this should not be a cause for concern. However, it is common for vision to vary for the initial few months following surgery. Additionally, sometimes laser eye surgery may accidentally over- or under-correct a person’s sight. This might require further surgery to rectify, which healthcare professionals usually called enhancement. It is also important to remember that corrected vision can regress years after the procedure. The cost of LASIK surgery will be different depending on where the person lives. Other surgeons may use various equipment or techniques, which the price may reflect. Health insurance companies usually categorize LASIK as an elective or cosmetic procedure and do not typically cover these treatments. In 2020, the American Refractive Surgery Council estimated that LASIK surgery might cost around $4,200 per eye, on average. Although laser eye surgery can be expensive, it is crucial that people thoroughly do their research before undergoing treatment at reduced prices. There may be a reason the price is so low, which may increase the risk of complications. https://www.medicalnewstoday.com/articles/laser-eye-surgery#summary",Medical,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","I have sleep apnea and just found out I am pregnant. I want to know what effect my sleep apnea will have on my pregnancy. Using this article, please explain the symptoms, risks, and treatments. Use at least 400 words.","What to Do About Sleep Apnea During Pregnancy Suddenly snoring all the time in pregnancy? It could be a symptom of sleep apnea. Here are the major signs to have on your radar, plus what to do next. save article Save this article to view it later on your Bump dashboard . It’s free! profile picture of Korin Miller By Korin Miller Updated May 3, 2024 Medically Reviewed by Kendra Segura, MD|Fact Checked by Denise Porretto pregnant woman sleeping in bed at night Image: PR Image Factory | Shutterstock Getting plenty of rest is crucial during pregnancy, but unfortunately you might also notice more sleep disturbances while you’re expecting. If you’ve been snoring or you’re suddenly dealing with morning headaches, you could be dealing with sleep apnea during pregnancy. While sleep apnea is a common condition outside of pregnancy, being an expectant mom raises your risk of developing it. Research has found that anywhere from 3 to 27 percent of pregnant women experience obstructive sleep apnea, depending on gestational age (it’s more common toward the third trimester) and method of diagnosis. So what’s the connection between sleep apnea and pregnancy, and what should you do if you suspect you have it? Ahead, experts explain risk factors, treatment and more. In this article: What is obstructive sleep apnea? Can pregnancy cause sleep apnea? Risk factors for sleep apnea in pregnancy Symptoms of sleep apnea in pregnancy How to treat sleep apnea during pregnancy When to see your doctor What Is Obstructive Sleep Apnea? Sleep apnea is a common condition in which your breathing stops and starts several times while you sleep, preventing your body from getting enough oxygen, the National Heart, Lung, and Blood Institute (NHLBI) explains. Sleep apnea is classified into two categories: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea, the more common type, is when your upper airway becomes blocked several times while you sleep, reducing or completely stopping airflow, the NHLBI says. Central sleep apnea happens when your brain doesn’t send the signals you need to breathe, which can be caused by another health condition. Obstructive sleep apnea “increases the carbon dioxide level in your blood, which makes your brain force you to wake up—briefly—to breathe,” says Jade Wu, PhD, a board-certified behavioral sleep medicine specialist and author of Hello Sleep: The Science and Art of Overcoming Insomnia without Medications. This can happen multiple times an hour or even as often as every two minutes or more during the night, she says. “Most people who have it don’t realize it because they don’t become fully awake each time they have an apnea,” Wu adds. Related Video Pregnancy Symptoms 101: Pregnancy Gas Obstructive sleep apnea “fragments sleep and reduces sleep quality,” says Christopher Winter, MD, a neurologist and sleep medicine physician with Charlottesville Neurology and Sleep Medicine and host of the Sleep Unplugged podcast. Can Pregnancy Cause Sleep Apnea? While sleep apnea is fairly common outside of pregnancy, pregnancy can “absolutely” increase the risk of developing the condition, Winter says. The main reasons there’s a connection between sleep apnea and pregnancy are: Weight gain. The risk of developing obstructive sleep apnea increases as you gain weight in pregnancy, Winter says. In addition to your body weight increasing, your breast tissue may grow and add more weight to your chest, increasing the risk of sleep apnea, Wu says. Anatomical factors. “Just the presence of baby pushing up into the chest cavity can change breathing dynamics,” Winter says. Hormonal changes. Pregnancy hormones are no joke. “Estrogen increases can cause nasal congestion, which makes it harder to breathe,” Wu says. Risk Factors for Sleep Apnea in Pregnancy A few factors can raise your risk of developing sleep apnea in pregnancy. “The biggest risk factor is having a history of sleep apnea or snoring before pregnancy,” Wu says. Having obesity before you become pregnant also raises your risk, Winter says. Other risk factors, according to the NHLBI, include: A family history of obstructive sleep apnea Having heart or kidney failure Being older Having large tonsils and a thick neck Symptoms of Sleep Apnea in Pregnancy The biggest symptom of sleep apnea during pregnancy is snoring, Wu says. (Of course, most people don’t know they snore, so you might just hear about this from your partner or another person you live with.) But snoring doesn’t necessarily mean that you have obstructive sleep apnea, Wu says. There are a few other symptoms to have on your radar, according to Winter: Feeling especially tired during the day Waking up with a headache Atypical weight gain for pregnancy Peeing a lot Snoring or choking during your sleep Elevated blood pressure Fragmented sleep How to Treat Sleep Apnea During Pregnancy There’s a range of treatment options when it comes to sleep apnea during pregnancy. Wu says doctors usually treat milder cases of obstructive sleep apnea with the following: Having you sleep on your side Suggesting using a wedge pillow to help keep your airway open when you sleep Suggesting using a dental device to help keep your jaw forward when you sleep If you have moderate to severe sleep apnea, your doctor will likely recommend that you use a continuous positive airway pressure machine (CPAP), Winter says. This provides continuous air pressure throughout your airways while you sleep to keep them open and help you breathe, the NHLBI says. Wu says that this form of therapy “has gotten so advanced that they can be quite comfortable and unobtrusive.” She adds, “I’ve had plenty of patients say they feel soothed by their CPAP and can’t settle down to sleep without it now.” When to See Your Doctor If you think you have symptoms of obstructive sleep apnea, Wu says it’s time to reach out to your provider. “One major problem with obstructive sleep apnea is that it can take a long time to get in to see a sleep specialist and to get the testing required to be diagnosed and treated,” she says. There’s not a lot of data on whether obstructive sleep apnea in pregnancy will continue after baby’s born. “Risk for obstructive sleep apnea should go down after baby’s born, but it’s very possible that once you’ve had it, you continue to have elevated risk,” Wu says. “It’s important to keep follow-ups with your sleep doctor to continue to monitor symptoms.” Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances. Plus, more from The Bump: These Are the Safest Pregnancy Sleeping Positions Natural Remedies to Help You Sleep Better During Pregnancy The 13 Best Pregnancy Pillows, According to Pregnant Moms Sources save article Was this article helpful? Already a member? Log In","""================ ======= What to Do About Sleep Apnea During Pregnancy Suddenly snoring all the time in pregnancy? It could be a symptom of sleep apnea. Here are the major signs to have on your radar, plus what to do next. save article Save this article to view it later on your Bump dashboard . It’s free! profile picture of Korin Miller By Korin Miller Updated May 3, 2024 Medically Reviewed by Kendra Segura, MD|Fact Checked by Denise Porretto pregnant woman sleeping in bed at night Image: PR Image Factory | Shutterstock Getting plenty of rest is crucial during pregnancy, but unfortunately you might also notice more sleep disturbances while you’re expecting. If you’ve been snoring or you’re suddenly dealing with morning headaches, you could be dealing with sleep apnea during pregnancy. While sleep apnea is a common condition outside of pregnancy, being an expectant mom raises your risk of developing it. Research has found that anywhere from 3 to 27 percent of pregnant women experience obstructive sleep apnea, depending on gestational age (it’s more common toward the third trimester) and method of diagnosis. So what’s the connection between sleep apnea and pregnancy, and what should you do if you suspect you have it? Ahead, experts explain risk factors, treatment and more. In this article: What is obstructive sleep apnea? Can pregnancy cause sleep apnea? Risk factors for sleep apnea in pregnancy Symptoms of sleep apnea in pregnancy How to treat sleep apnea during pregnancy When to see your doctor What Is Obstructive Sleep Apnea? Sleep apnea is a common condition in which your breathing stops and starts several times while you sleep, preventing your body from getting enough oxygen, the National Heart, Lung, and Blood Institute (NHLBI) explains. Sleep apnea is classified into two categories: obstructive sleep apnea and central sleep apnea. Obstructive sleep apnea, the more common type, is when your upper airway becomes blocked several times while you sleep, reducing or completely stopping airflow, the NHLBI says. Central sleep apnea happens when your brain doesn’t send the signals you need to breathe, which can be caused by another health condition. Obstructive sleep apnea “increases the carbon dioxide level in your blood, which makes your brain force you to wake up—briefly—to breathe,” says Jade Wu, PhD, a board-certified behavioral sleep medicine specialist and author of Hello Sleep: The Science and Art of Overcoming Insomnia without Medications. This can happen multiple times an hour or even as often as every two minutes or more during the night, she says. “Most people who have it don’t realize it because they don’t become fully awake each time they have an apnea,” Wu adds. Related Video Pregnancy Symptoms 101: Pregnancy Gas Obstructive sleep apnea “fragments sleep and reduces sleep quality,” says Christopher Winter, MD, a neurologist and sleep medicine physician with Charlottesville Neurology and Sleep Medicine and host of the Sleep Unplugged podcast. Can Pregnancy Cause Sleep Apnea? While sleep apnea is fairly common outside of pregnancy, pregnancy can “absolutely” increase the risk of developing the condition, Winter says. The main reasons there’s a connection between sleep apnea and pregnancy are: Weight gain. The risk of developing obstructive sleep apnea increases as you gain weight in pregnancy, Winter says. In addition to your body weight increasing, your breast tissue may grow and add more weight to your chest, increasing the risk of sleep apnea, Wu says. Anatomical factors. “Just the presence of baby pushing up into the chest cavity can change breathing dynamics,” Winter says. Hormonal changes. Pregnancy hormones are no joke. “Estrogen increases can cause nasal congestion, which makes it harder to breathe,” Wu says. Risk Factors for Sleep Apnea in Pregnancy A few factors can raise your risk of developing sleep apnea in pregnancy. “The biggest risk factor is having a history of sleep apnea or snoring before pregnancy,” Wu says. Having obesity before you become pregnant also raises your risk, Winter says. Other risk factors, according to the NHLBI, include: A family history of obstructive sleep apnea Having heart or kidney failure Being older Having large tonsils and a thick neck Symptoms of Sleep Apnea in Pregnancy The biggest symptom of sleep apnea during pregnancy is snoring, Wu says. (Of course, most people don’t know they snore, so you might just hear about this from your partner or another person you live with.) But snoring doesn’t necessarily mean that you have obstructive sleep apnea, Wu says. There are a few other symptoms to have on your radar, according to Winter: Feeling especially tired during the day Waking up with a headache Atypical weight gain for pregnancy Peeing a lot Snoring or choking during your sleep Elevated blood pressure Fragmented sleep How to Treat Sleep Apnea During Pregnancy There’s a range of treatment options when it comes to sleep apnea during pregnancy. Wu says doctors usually treat milder cases of obstructive sleep apnea with the following: Having you sleep on your side Suggesting using a wedge pillow to help keep your airway open when you sleep Suggesting using a dental device to help keep your jaw forward when you sleep If you have moderate to severe sleep apnea, your doctor will likely recommend that you use a continuous positive airway pressure machine (CPAP), Winter says. This provides continuous air pressure throughout your airways while you sleep to keep them open and help you breathe, the NHLBI says. Wu says that this form of therapy “has gotten so advanced that they can be quite comfortable and unobtrusive.” She adds, “I’ve had plenty of patients say they feel soothed by their CPAP and can’t settle down to sleep without it now.” When to See Your Doctor If you think you have symptoms of obstructive sleep apnea, Wu says it’s time to reach out to your provider. “One major problem with obstructive sleep apnea is that it can take a long time to get in to see a sleep specialist and to get the testing required to be diagnosed and treated,” she says. There’s not a lot of data on whether obstructive sleep apnea in pregnancy will continue after baby’s born. “Risk for obstructive sleep apnea should go down after baby’s born, but it’s very possible that once you’ve had it, you continue to have elevated risk,” Wu says. “It’s important to keep follow-ups with your sleep doctor to continue to monitor symptoms.” Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances. Plus, more from The Bump: These Are the Safest Pregnancy Sleeping Positions Natural Remedies to Help You Sleep Better During Pregnancy The 13 Best Pregnancy Pillows, According to Pregnant Moms Sources save article Was this article helpful? Already a member? Log In https://www.thebump.com/a/sleep-apnea-during-pregnancy ================ ======= I have sleep apnea and just found out I am pregnant. I want to know what effect my sleep apnea will have on my pregnancy. Using this article, please explain the symptoms, risks, and treatments. Use at least 400 words. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Effect Analysis,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","I have the Iphone 15, but the 16 is coming out, and I need to decide if I want to upgrade again. please list the features only the 16 has that the 15 doesn't have, make sure to list any drawbacks the new features may have. Highlight camera features, but I don't care about the size. I need a summary of the features at the end. Do not mention the other phone in the summary.","While Apple's latest models bring a variety of enhancements, the most significant change is support for Apple Intelligence, a new AI system that transforms how you interact with your device by offering smarter notifications, text summarization, and contextual information. The ‌iPhone 16‌ also features the Action Button and Camera Control button, which provide more intuitive ways to access key functions. Design and Displays The ‌iPhone 16‌ introduces several design and display upgrades over the ‌iPhone 15‌. The shift to vertically arranged cameras facilitates spatial video capture and looks more modern. Durability is also improved with the next-generation Ceramic Shield, which is twice as strong as the previous version. Additionally, the customizable Action Button replaces the traditional Ring/Silent switch and a new Camera Control button streamlines photography. ‌iPhone 15‌ ‌iPhone 16‌ Diagonally arranged rear cameras Vertically arranged rear cameras ~2–4 nits minimum brightness 1 nit minimum brightness Ceramic Shield front glass Next-generation Ceramic Shield front glass (2x stronger) Improved thermal design for better heat dissipation Easier battery service Ring/Silent switch Action Button Camera Control capacitive button with sapphire crystal cover Available in Green, Blue, Pink, Black, and Yellow finishes Available in Teal, Ultramarine, Pink, Black, and White finishes Artificial Intelligence The ‌iPhone 16‌ includes support for Apple Intelligence, a significant upgrade absent in the ‌iPhone 15‌. This artificial intelligence system enhances the iPhone's ability to understand and process personal context, offering features like Visual Intelligence, which can recognize objects and scenes through the camera and provide relevant information, such as restaurant or product details. ‌iPhone 16‌ Apple Intelligence (including priority notifications, text summarization, system-wide writing tools, audio transcription, Genmoji creation, personalized suggestions, and more) Visual Intelligence, allowing users to pull up contextual information about objects or scenes in front of the camera (such as restaurant details or product info) Apple Intelligence features like priority notifications, text summarization, and system-wide writing tools can significantly enhance the experience of using the device, making the ‌iPhone 16‌ a substantial upgrade over the ‌iPhone 15‌ in this area. Chip, Memory, and Connectivity The ‌iPhone 16‌ brings notable improvements in performance and connectivity over the ‌iPhone 15‌, driven by the A18 chip built with TSMC's 3nm process, which is more efficient and powerful than the ‌iPhone 15‌'s A16 chip. The 6-core CPU is up to 30% faster, while the upgraded 16-core Neural Engine is optimized for running generative models, doubling the speed of machine learning tasks. In terms of graphics, the ‌iPhone 16‌'s 5-core GPU delivers a 40% boost in performance and introduces hardware-accelerated ray tracing, enhancing gaming and visual effects. Memory and connectivity also see significant upgrades, with the ‌iPhone 16‌ offering 8GB of RAM, a 33% increase over the ‌iPhone 15‌, and the introduction of Wi-Fi 7 and Thread networking for better wireless performance and smart home integration. ‌iPhone 15‌ ‌iPhone 16‌ A16 Bionic chip (TSMC's ""N4P"" enhanced 5nm process) A18 chip (TSMC's ""N3E"" enhanced ‌3nm‌ process) 6-core CPU 6-core CPU (up to 30% faster) 16-core Neural Engine Upgraded 16-core Neural Engine optimized for generative models (runs ML models 2x faster) 5-core GPU 5-core GPU (up to 40% faster) Hardware-accelerated ray tracing 6GB memory 8GB memory (+33%) Wi-Fi 6 Wi‑Fi 7 (802.11be) with 2x2 MIMO Thread networking technology The performance gains with the A18 chip and enhanced GPU are particularly meaningful for users who engage in gaming, video editing, or other graphics-heavy tasks. The hardware-accelerated ray tracing will greatly benefit gamers, making the ‌iPhone 16‌ capable of rendering more realistic lighting and shadows. Meanwhile, the Neural Engine upgrade doubles the speed of machine learning tasks such as Apple Intelligence. For everyday users, the jump from 6GB to 8GB of memory ensures better multitasking and future-proofing, while Wi-Fi 7 and Thread networking will improve connectivity speeds and compatibility with smart home devices. The ‌iPhone 16‌'s improvements are substantial for users who demand higher performance and future-ready wireless tech, though those who use their devices more casually might notice less immediate impact. The ‌iPhone 16‌ enhances the already impressive camera setup from the ‌iPhone 15‌. The Ultra Wide camera has been upgraded with an ƒ/2.2 aperture, providing better low-light performance compared to the ƒ/2.4 aperture on the ‌iPhone 15‌. The ‌iPhone 16‌ also introduces Macro photography and Macro video recording, enabling users to capture detailed close-up shots, while the Camera Control button brings new levels of ease and precision to shooting photos and videos. ‌iPhone 15‌ ‌iPhone 16‌ 48-megapixel Main camera with ƒ/1.6 aperture 48-megapixel Fusion camera with ƒ/1.6 aperture 12-megapixel Ultra Wide camera with ƒ/2.4 aperture 12-megapixel Ultra Wide camera with ƒ/2.2 aperture for improved-low light performance Anti-reflective coating on Fusion camera lens Macro photography and Macro video recording, including slo‑mo and time‑lapse Photo­graphic Styles Next-generation Photo­graphic Styles Spatial video recording at 1080p at 30 fps 4K video recording at 24 fps, 25 fps, 30 fps or 60 fps 4K Dolby Vision video recording at 24 fps, 25 fps, 30 fps or 60 fps 1080p HD video recording at 25 fps, 30 fps or 60 fps 1080p Dolby Vision video recording at 25 fps, 30 fps or 60 fps Cinematic mode up to 4K HDR at 30 fps Cinematic mode up to 4K Dolby Vision at 30 fps QuickTake video QuickTake video (up to 4K at 60 fps in Dolby Vision HDR) Launch the Camera App: Pressing the Camera Control button immediately opens the camera app. Capture Photos: A single press of the button captures a photo, providing a quick and tactile way to take pictures. Record Videos: A press and hold action allows you to start recording a video. Half-Press for Focus and Exposure (upcoming feature): A light, half-press will lock focus and exposure, allowing you to reframe the shot without losing focus. Trackpad-Like Control: The capacitive sensor on the button acts like a trackpad, enabling gestures to control zoom, cycle through filters, or switch between lenses by sliding your finger across the button. Third-Party App Integration: The Camera Control button can also be used to trigger third-party camera apps, giving more flexibility to users who prefer other photography tools. Camera Function Overlay: A light touch gesture reveals a clean preview and quick access to key camera controls like zoom or exposure settings. Visual Intelligence Activation: The Camera Control button is integrated with Visual Intelligence, allowing users to pull up contextual information about objects or scenes in front of the camera. The ‌iPhone 16‌ brings several enhancements to audio recording over the ‌iPhone 15‌. While the ‌iPhone 15‌ offers stereo recording, the ‌iPhone 16‌ introduces Spatial Audio recording, providing a more immersive sound experience, particularly with playback on the Apple Vision Pro headset. Additional features like wind noise reduction and the new Audio Mix function further improve the quality and flexibility of recorded audio, making the ‌iPhone 16‌ a more capable device for capturing high-quality sound. ‌iPhone 15‌ ‌iPhone 16‌ Stereo recording Spatial Audio and stereo recording Wind noise reduction Audio Mix Battery Life and Charging The ‌iPhone 16‌ brings noticeable improvements in battery life and charging efficiency compared to the ‌iPhone 15‌. With up to 22 hours of battery life on the ‌iPhone 16‌ and 27 hours on the ‌iPhone 16‌ Plus, the new models offer a modest boost. In addition, MagSafe wireless charging is now significantly faster, supporting up to 25W with a 30W adapter, a 66.67% increase over the ‌iPhone 15‌'s 15W limit. iPhone 15: Up to 20 hours of battery life iPhone 15 Plus: Up to 26 hours of battery life iPhone 16: Up to 22 hours of battery life iPhone 16 Plus: Up to 27 hours of battery life ‌MagSafe‌ wireless charging up to 15W with 20W adapter or higher ‌MagSafe‌ wireless charging up to 25W with 30W adapter or higher (+66.67%)"," Only use the provided text to answer the question, no outside sources. I have the Iphone 15, but the 16 is coming out, and I need to decide if I want to upgrade again. please list the features only the 16 has that the 15 doesn't have, make sure to list any drawbacks the new features may have. Highlight camera features, but I don't care about the size. I need a summary of the features at the end. Do not mention the other phone in the summary. While Apple's latest models bring a variety of enhancements, the most significant change is support for Apple Intelligence, a new AI system that transforms how you interact with your device by offering smarter notifications, text summarization, and contextual information. The ‌iPhone 16‌ also features the Action Button and Camera Control button, which provide more intuitive ways to access key functions. Design and Displays The ‌iPhone 16‌ introduces several design and display upgrades over the ‌iPhone 15‌. The shift to vertically arranged cameras facilitates spatial video capture and looks more modern. Durability is also improved with the next-generation Ceramic Shield, which is twice as strong as the previous version. Additionally, the customizable Action Button replaces the traditional Ring/Silent switch and a new Camera Control button streamlines photography. ‌iPhone 15‌ ‌iPhone 16‌ Diagonally arranged rear cameras Vertically arranged rear cameras ~2–4 nits minimum brightness 1 nit minimum brightness Ceramic Shield front glass Next-generation Ceramic Shield front glass (2x stronger) Improved thermal design for better heat dissipation Easier battery service Ring/Silent switch Action Button Camera Control capacitive button with sapphire crystal cover Available in Green, Blue, Pink, Black, and Yellow finishes Available in Teal, Ultramarine, Pink, Black, and White finishes Artificial Intelligence The ‌iPhone 16‌ includes support for Apple Intelligence, a significant upgrade absent in the ‌iPhone 15‌. This artificial intelligence system enhances the iPhone's ability to understand and process personal context, offering features like Visual Intelligence, which can recognize objects and scenes through the camera and provide relevant information, such as restaurant or product details. ‌iPhone 16‌ Apple Intelligence (including priority notifications, text summarization, system-wide writing tools, audio transcription, Genmoji creation, personalized suggestions, and more) Visual Intelligence, allowing users to pull up contextual information about objects or scenes in front of the camera (such as restaurant details or product info) Apple Intelligence features like priority notifications, text summarization, and system-wide writing tools can significantly enhance the experience of using the device, making the ‌iPhone 16‌ a substantial upgrade over the ‌iPhone 15‌ in this area. Chip, Memory, and Connectivity The ‌iPhone 16‌ brings notable improvements in performance and connectivity over the ‌iPhone 15‌, driven by the A18 chip built with TSMC's 3nm process, which is more efficient and powerful than the ‌iPhone 15‌'s A16 chip. The 6-core CPU is up to 30% faster, while the upgraded 16-core Neural Engine is optimized for running generative models, doubling the speed of machine learning tasks. In terms of graphics, the ‌iPhone 16‌'s 5-core GPU delivers a 40% boost in performance and introduces hardware-accelerated ray tracing, enhancing gaming and visual effects. Memory and connectivity also see significant upgrades, with the ‌iPhone 16‌ offering 8GB of RAM, a 33% increase over the ‌iPhone 15‌, and the introduction of Wi-Fi 7 and Thread networking for better wireless performance and smart home integration. ‌iPhone 15‌ ‌iPhone 16‌ A16 Bionic chip (TSMC's ""N4P"" enhanced 5nm process) A18 chip (TSMC's ""N3E"" enhanced ‌3nm‌ process) 6-core CPU 6-core CPU (up to 30% faster) 16-core Neural Engine Upgraded 16-core Neural Engine optimized for generative models (runs ML models 2x faster) 5-core GPU 5-core GPU (up to 40% faster) Hardware-accelerated ray tracing 6GB memory 8GB memory (+33%) Wi-Fi 6 Wi‑Fi 7 (802.11be) with 2x2 MIMO Thread networking technology The performance gains with the A18 chip and enhanced GPU are particularly meaningful for users who engage in gaming, video editing, or other graphics-heavy tasks. The hardware-accelerated ray tracing will greatly benefit gamers, making the ‌iPhone 16‌ capable of rendering more realistic lighting and shadows. Meanwhile, the Neural Engine upgrade doubles the speed of machine learning tasks such as Apple Intelligence. For everyday users, the jump from 6GB to 8GB of memory ensures better multitasking and future-proofing, while Wi-Fi 7 and Thread networking will improve connectivity speeds and compatibility with smart home devices. The ‌iPhone 16‌'s improvements are substantial for users who demand higher performance and future-ready wireless tech, though those who use their devices more casually might notice less immediate impact. The ‌iPhone 16‌ enhances the already impressive camera setup from the ‌iPhone 15‌. The Ultra Wide camera has been upgraded with an ƒ/2.2 aperture, providing better low-light performance compared to the ƒ/2.4 aperture on the ‌iPhone 15‌. The ‌iPhone 16‌ also introduces Macro photography and Macro video recording, enabling users to capture detailed close-up shots, while the Camera Control button brings new levels of ease and precision to shooting photos and videos. ‌iPhone 15‌ ‌iPhone 16‌ 48-megapixel Main camera with ƒ/1.6 aperture 48-megapixel Fusion camera with ƒ/1.6 aperture 12-megapixel Ultra Wide camera with ƒ/2.4 aperture 12-megapixel Ultra Wide camera with ƒ/2.2 aperture for improved-low light performance Anti-reflective coating on Fusion camera lens Macro photography and Macro video recording, including slo‑mo and time‑lapse Photo­graphic Styles Next-generation Photo­graphic Styles Spatial video recording at 1080p at 30 fps 4K video recording at 24 fps, 25 fps, 30 fps or 60 fps 4K Dolby Vision video recording at 24 fps, 25 fps, 30 fps or 60 fps 1080p HD video recording at 25 fps, 30 fps or 60 fps 1080p Dolby Vision video recording at 25 fps, 30 fps or 60 fps Cinematic mode up to 4K HDR at 30 fps Cinematic mode up to 4K Dolby Vision at 30 fps QuickTake video QuickTake video (up to 4K at 60 fps in Dolby Vision HDR) Launch the Camera App: Pressing the Camera Control button immediately opens the camera app. Capture Photos: A single press of the button captures a photo, providing a quick and tactile way to take pictures. Record Videos: A press and hold action allows you to start recording a video. Half-Press for Focus and Exposure (upcoming feature): A light, half-press will lock focus and exposure, allowing you to reframe the shot without losing focus. Trackpad-Like Control: The capacitive sensor on the button acts like a trackpad, enabling gestures to control zoom, cycle through filters, or switch between lenses by sliding your finger across the button. Third-Party App Integration: The Camera Control button can also be used to trigger third-party camera apps, giving more flexibility to users who prefer other photography tools. Camera Function Overlay: A light touch gesture reveals a clean preview and quick access to key camera controls like zoom or exposure settings. Visual Intelligence Activation: The Camera Control button is integrated with Visual Intelligence, allowing users to pull up contextual information about objects or scenes in front of the camera. The ‌iPhone 16‌ brings several enhancements to audio recording over the ‌iPhone 15‌. While the ‌iPhone 15‌ offers stereo recording, the ‌iPhone 16‌ introduces Spatial Audio recording, providing a more immersive sound experience, particularly with playback on the Apple Vision Pro headset. Additional features like wind noise reduction and the new Audio Mix function further improve the quality and flexibility of recorded audio, making the ‌iPhone 16‌ a more capable device for capturing high-quality sound. ‌iPhone 15‌ ‌iPhone 16‌ Stereo recording Spatial Audio and stereo recording Wind noise reduction Audio Mix Battery Life and Charging The ‌iPhone 16‌ brings noticeable improvements in battery life and charging efficiency compared to the ‌iPhone 15‌. With up to 22 hours of battery life on the ‌iPhone 16‌ and 27 hours on the ‌iPhone 16‌ Plus, the new models offer a modest boost. In addition, MagSafe wireless charging is now significantly faster, supporting up to 25W with a 30W adapter, a 66.67% increase over the ‌iPhone 15‌'s 15W limit. iPhone 15: Up to 20 hours of battery life iPhone 15 Plus: Up to 26 hours of battery life iPhone 16: Up to 22 hours of battery life iPhone 16 Plus: Up to 27 hours of battery life ‌MagSafe‌ wireless charging up to 15W with 20W adapter or higher ‌MagSafe‌ wireless charging up to 25W with 30W adapter or higher (+66.67%) https://www.macrumors.com/guide/iphone-15-vs-iphone-16/",Retail/Product,Fact Finding,Q&A Only refer to the attached document in providing your response.,Summarize the benefits of maternity leave for a mother and for a child.,"Having a baby is no small feat. Fortunately, taking time off work for maternity leave can give a new mother the chance to heal both physically and emotionally, as well as sufficient time to bond with and care for her newborn baby. Countless studies and research show that adequate paid maternity leave has a host of benefits for mother, baby and the entire family, such as decreased rehospitalization rates for both mother and baby, improved stress management and more consistent exercise. However, paid maternity leave is lacking in the U.S., which affects mothers, children and families. Read on to learn more about maternity leave, including the landscape of maternity leave in the U.S. and how maternity leave affects a person’s mental and physical health after childbirth. What Is Maternity Leave? Maternity leave is the time a mother takes off from work after having a baby. It’s generally a time for them to recover from childbirth and adjust to life with a newborn baby. However, maternity leave in the U.S. isn’t standardized, which can make it difficult to define. “The definition and scope of maternity leave and the mechanics of taking leave vary from organization to organization,” says Shayla Thurlow, vice president of people and talent acquisition at The Muse who has developed and administered parental leave programs for large and small organizations across various industries. How Does Maternity Leave Work? The U.S. is one of the few industrialized countries worldwide that doesn’t mandate paid parental leave. Maternity leave is meant to be a time for a mother to give all her focus and attention to her newborn baby, her health and her family, but the length of leave— and whether it’s paid and to what extent—varies based on a number of factors, including where you work, how long you’ve worked for your employer the number of employees they have. The Family and Medical Leave Act (FMLA) guarantees coverage for 12 workweeks of unpaid leave per year for qualifying family and medical reasons, including the birth of a baby, adoption or foster care placement, or when you or an immediate family member are seriously ill and in need of care. However, FMLA doesn’t cover all employees. Employers with at least 50 employees must allow parents 12 weeks of job-protected leave to care for their newborn, but pay during this time is not guaranteed, according to the International Labour Organization. To qualify for FMLA coverage: • You must work for a covered employer, including any public agency, any public or private elementary or secondary school, or a private employer with at least 50 employees within a 75-mile radius. • You must have worked at the company for at least 12 months. • You must have worked at least 1,250 hours for the company in the 12 months before your leave. Many new mothers take less than 12 weeks of maternity leave for various reasons, including (but not limited to) working for a company that doesn’t offer FMLA coverage and/or being unable to afford being out of work for that long. A 2014 analysis in Maternal and Child Health Journal found 41% of employed women in the U.S. received paid maternity leave for an average of three weeks, with only a 31% wage replacement. The research also noted that, on average, new mothers took 10 weeks of maternity leave, and the majority of women didn’t receive any compensation for that time away from work[1]. As Thurlow points out, some states require paid maternity leave, but it’s usually up to the employer to decide whether to provide paid maternity leave for its employees. “Though 12 weeks of unpaid leave is covered by federal law [in certain cases], many families are not in a financial position to use that time [without pay] and may be unable to have a long maternity leave,” she says. Maternity Leave Trends in the U.S. The U.S. is lacking when it comes to maternity leave benefits. Most adults don’t have access to paid family leave through their employers, according to a 2021 survey conducted by the U.S. Bureau of Labor Statistics. Furthermore, a 2019 Pew Research Center study of 41 nations found the U.S. is the only country that doesn’t mandate any paid leave for new parents. Among the other 40 nations, the smallest amount of paid maternity leave is two months in Ireland while Estonia offers more than a year and a half of paid parental leave[2]. Worldwide, very few countries don’t guarantee paid maternity leave; instead, more than 120 countries offer paid maternity leave and health benefits by law. At the lower end of the spectrum, only 33 countries mandate maternity leave that lasts less than 12 weeks. Meanwhile, as of 2021 in the U.S., only nine states and the District of Columbia have instituted some degree of paid parental leave. How Can Maternity Leave Impact Your Health? Taking maternity leave is essential not only for the health of the newborn, but also for the health of the mother. “Maternity leave [or the 12 weeks after birth] is often referred to as the fourth trimester,” says Suzanne Bovone, M.D., an OBGYN at Obstetrics and Gynecology of San Jose, part of the Pediatrix Medical Group in Campbell, California. “As each trimester of pregnancy brought changes for the woman and baby, the period after delivery is a continuation of change. Inadequate maternity leave can lead not only to anxiety and depression, but also relationship issues and the inability to return to work.” More than 12 weeks is needed for an adequate maternity leave, according to Dr. Bovone. “Many issues that need assistance are not even apparent until three to four months after delivery,” she says. “It almost becomes impossible to juggle the demands of self-care, childcare, relationships and work obligations.” According to Dr. Bovone, some complications of the side effects of the postpartum period may include: • Sleep deprivation • Increased stress levels • Loss of coping mechanisms • Inability to think clearly and ask for help • Negative thoughts and feelings • Pelvic floor issues • Impact on urinary and bowel function • Negative impact on sexual health “It may take months for one to recognize areas that need work,” she adds. “Unfortunately, with limited maternity leave, many [parents] cannot find the time to provide adequate self-care when they’re back at work.” Physical Health The body goes through major physical changes after having a baby, from pelvic floor disruption to urinary and bowel dysfunction. “Just as pregnancy physically changes one’s body over [more than] nine months, [recovery during] the postpartum period takes just as long,” says Dr. Bovone. “Maternity leave is a time for the woman to rest and recover.” Research shows the positive effect maternity leave has on physical health. For instance, a study in the American Economic Journal: Economic Policy observing health data on mothers in Norway both before and after paid maternity leave became mandated by law in 1977 found women who gave birth after 1977 experienced better overall health as they approached middle age. This improvement was particularly noticeable among women who worked low-income jobs and wouldn’t have taken unpaid leave previously—they were less likely to smoke or experience high blood pressure, had lower BMIs and were more likely to exercise regularly[3]. Paid maternity leave can also contribute to decreased infant mortality, as well as mother and infant rehospitalizations, according to a 2020 review in the Harvard Review of Psychiatry, which also found paid maternity leave to be associated with an increase in pediatric visit attendance and timely administration of infant immunizations[4]. A 2018 study in Maternal and Child Health Journal found similar results: Women who took paid maternity leave experienced a 47% decrease in the odds of rehospitalization for their infants and a 51% decrease in the odds of being rehospitalized themselves at 21 months postpartum[5]. The 2020 review in the Harvard Review of Psychiatry also found paid maternity leave can lead to an increase in the initiation and duration of breastfeeding. Paid maternity leave may lead to healthier habits as well. The 2018 study in Maternal and Child Health Journalalso found women who took paid maternity leave were nearly twice as likely to exercise and were able to better manage their stress levels compared to those who didn’t take paid maternity leave. Mental Health Maternity leave has a significant impact on mental health as well. “There are huge adjustments that come with a new baby,” says Thurlow. “Changes in family dynamics, sleep deprivation and bonding with a new baby create mental and emotional strains for new parents. The ability to take time off to adjust and create a new normal has proven beneficial for parents’ overall mental and emotional well-being.” Research shows a positive correlation between mental health and paid maternity leave as well. According to the same 2020 review in the Harvard Review of Psychology, paid maternity leave is associated with a decrease in postpartum maternal depression. Meanwhile, a 2012 study in the Journal of Mental Health Policies and Economicsfound having fewer than 12 weeks of maternity leave and fewer than eight weeks of paid maternity leave to be associated with increases in depressive symptoms[6]. And the longer the leave, the better: Longer paid maternity leaves are associated with decreased depressive symptoms until six months postpartum, according to a 2014 study in the Journal of Health Politics, Policy and Law[7]. Maternity leave can also mean less stress for postpartum mothers, which can trickle down in a positive way to affect family dynamics and relationships as well. A 2013 study in the Journal of Family Issues observed Australian two-parent families and found the length of maternity leave affected a mother’s mental health, quality of parenting and the couple’s relationship. What’s more, mothers who took more than 13 weeks of paid leave experienced significantly less psychological distress[8]. The positive effects of maternity leave aren’t just apparent immediately after a baby is born: Maternity leave can lead to better mental health later in life as well. A 2015 study in Social Science and Medicine using European data found longer maternity leaves to be associated with improved mental health in old age[9]. Emotional Health A mother’s emotional health can be influenced by maternity leave as well. Postpartum emotional health involves identity changes that go along with becoming a parent, says Dr. Bovone. “Our self-identity changes, as well as our relationships and interactions with our partners, families and friends,” she adds. New mothers may find it difficult to ask for help, and some may find being a parent isn’t what they thought it would be. “Priorities may change as well, and some struggle with this new perspective,” says Dr. Bovone. Fortunately, maternity leave can lead to better bonding experiences between mother and child. A 2018 study of 3,850 mothers in the U.S. found a significant correlation between the duration of paid maternity leave and positive mother-child interactions, such as secure attachment and empathy[10]. A decreased chance of domestic violence is also associated with paid parental leave. A 2019 study in Preventive Medicine found paid parental leave can be an effective strategy to prevent future instances of intimate partner violence. This connection could exist because paid leaves maintains household income and prevents financial stressors, increases gender equity (which is associated with less intimate partner violence against women) and gives parents time to bond with a child without having to worry about work[11]. What Experts Say About Maternity Leave Dr. Bovone and Thurlow both agree that adequate paid maternity leave is a necessity for the health and well-being of mothers, children and families as a whole. What’s more, maternity leave should be longer than what’s typically offered, according to Dr. Bovone. “Ideally, a year to care for oneself and the newborn is needed,” she says. “Coverage for breastfeeding issues, mental and emotional health, pelvic floor health and sexual health should be the norm and accessible to all. The American College of Obstetricians and Gynecologists supports the expansion of postpartum services, but the current medical system at OBGYN offices doesn’t allow adequate time nor payment for these services.” She stresses the importance of improved maternity leave, saying that not only is it beneficial to mothers, but also to families, communities and, ultimately, work environments. Thurlow believes maternity leave should be a minimum of 12 weeks, paid and federally mandated for all employers. “Maternity leave is good, but organizations should provide paid parental leave to truly support parents,” she says. She adds that maternity leave needs to be expanded. “Providing paid leave to a birthing parent shouldn’t be a discussion, but the issue is much larger. Only providing paid leave to a birthing parent doesn’t take into account families that are made whole by adoption, surrogacy or the placement of a child. Additionally, only offering maternity leave places a burden of childcare on one parent.”","Only refer to the attached document in providing your response. Summarize the benefits of maternity leave for a mother and for a child. Having a baby is no small feat. Fortunately, taking time off work for maternity leave can give a new mother the chance to heal both physically and emotionally, as well as sufficient time to bond with and care for her newborn baby. Countless studies and research show that adequate paid maternity leave has a host of benefits for mother, baby and the entire family, such as decreased rehospitalization rates for both mother and baby, improved stress management and more consistent exercise. However, paid maternity leave is lacking in the U.S., which affects mothers, children and families. Read on to learn more about maternity leave, including the landscape of maternity leave in the U.S. and how maternity leave affects a person’s mental and physical health after childbirth. What Is Maternity Leave? Maternity leave is the time a mother takes off from work after having a baby. It’s generally a time for them to recover from childbirth and adjust to life with a newborn baby. However, maternity leave in the U.S. isn’t standardized, which can make it difficult to define. “The definition and scope of maternity leave and the mechanics of taking leave vary from organization to organization,” says Shayla Thurlow, vice president of people and talent acquisition at The Muse who has developed and administered parental leave programs for large and small organizations across various industries. How Does Maternity Leave Work? The U.S. is one of the few industrialized countries worldwide that doesn’t mandate paid parental leave. Maternity leave is meant to be a time for a mother to give all her focus and attention to her newborn baby, her health and her family, but the length of leave— and whether it’s paid and to what extent—varies based on a number of factors, including where you work, how long you’ve worked for your employer the number of employees they have. The Family and Medical Leave Act (FMLA) guarantees coverage for 12 workweeks of unpaid leave per year for qualifying family and medical reasons, including the birth of a baby, adoption or foster care placement, or when you or an immediate family member are seriously ill and in need of care. However, FMLA doesn’t cover all employees. Employers with at least 50 employees must allow parents 12 weeks of job-protected leave to care for their newborn, but pay during this time is not guaranteed, according to the International Labour Organization. To qualify for FMLA coverage: • You must work for a covered employer, including any public agency, any public or private elementary or secondary school, or a private employer with at least 50 employees within a 75-mile radius. • You must have worked at the company for at least 12 months. • You must have worked at least 1,250 hours for the company in the 12 months before your leave. Many new mothers take less than 12 weeks of maternity leave for various reasons, including (but not limited to) working for a company that doesn’t offer FMLA coverage and/or being unable to afford being out of work for that long. A 2014 analysis in Maternal and Child Health Journal found 41% of employed women in the U.S. received paid maternity leave for an average of three weeks, with only a 31% wage replacement. The research also noted that, on average, new mothers took 10 weeks of maternity leave, and the majority of women didn’t receive any compensation for that time away from work[1]. As Thurlow points out, some states require paid maternity leave, but it’s usually up to the employer to decide whether to provide paid maternity leave for its employees. “Though 12 weeks of unpaid leave is covered by federal law [in certain cases], many families are not in a financial position to use that time [without pay] and may be unable to have a long maternity leave,” she says. Maternity Leave Trends in the U.S. The U.S. is lacking when it comes to maternity leave benefits. Most adults don’t have access to paid family leave through their employers, according to a 2021 survey conducted by the U.S. Bureau of Labor Statistics. Furthermore, a 2019 Pew Research Center study of 41 nations found the U.S. is the only country that doesn’t mandate any paid leave for new parents. Among the other 40 nations, the smallest amount of paid maternity leave is two months in Ireland while Estonia offers more than a year and a half of paid parental leave[2]. Worldwide, very few countries don’t guarantee paid maternity leave; instead, more than 120 countries offer paid maternity leave and health benefits by law. At the lower end of the spectrum, only 33 countries mandate maternity leave that lasts less than 12 weeks. Meanwhile, as of 2021 in the U.S., only nine states and the District of Columbia have instituted some degree of paid parental leave. How Can Maternity Leave Impact Your Health? Taking maternity leave is essential not only for the health of the newborn, but also for the health of the mother. “Maternity leave [or the 12 weeks after birth] is often referred to as the fourth trimester,” says Suzanne Bovone, M.D., an OBGYN at Obstetrics and Gynecology of San Jose, part of the Pediatrix Medical Group in Campbell, California. “As each trimester of pregnancy brought changes for the woman and baby, the period after delivery is a continuation of change. Inadequate maternity leave can lead not only to anxiety and depression, but also relationship issues and the inability to return to work.” More than 12 weeks is needed for an adequate maternity leave, according to Dr. Bovone. “Many issues that need assistance are not even apparent until three to four months after delivery,” she says. “It almost becomes impossible to juggle the demands of self-care, childcare, relationships and work obligations.” According to Dr. Bovone, some complications of the side effects of the postpartum period may include: • Sleep deprivation • Increased stress levels • Loss of coping mechanisms • Inability to think clearly and ask for help • Negative thoughts and feelings • Pelvic floor issues • Impact on urinary and bowel function • Negative impact on sexual health “It may take months for one to recognize areas that need work,” she adds. “Unfortunately, with limited maternity leave, many [parents] cannot find the time to provide adequate self-care when they’re back at work.” Physical Health The body goes through major physical changes after having a baby, from pelvic floor disruption to urinary and bowel dysfunction. “Just as pregnancy physically changes one’s body over [more than] nine months, [recovery during] the postpartum period takes just as long,” says Dr. Bovone. “Maternity leave is a time for the woman to rest and recover.” Research shows the positive effect maternity leave has on physical health. For instance, a study in the American Economic Journal: Economic Policy observing health data on mothers in Norway both before and after paid maternity leave became mandated by law in 1977 found women who gave birth after 1977 experienced better overall health as they approached middle age. This improvement was particularly noticeable among women who worked low-income jobs and wouldn’t have taken unpaid leave previously—they were less likely to smoke or experience high blood pressure, had lower BMIs and were more likely to exercise regularly[3]. Paid maternity leave can also contribute to decreased infant mortality, as well as mother and infant rehospitalizations, according to a 2020 review in the Harvard Review of Psychiatry, which also found paid maternity leave to be associated with an increase in pediatric visit attendance and timely administration of infant immunizations[4]. A 2018 study in Maternal and Child Health Journal found similar results: Women who took paid maternity leave experienced a 47% decrease in the odds of rehospitalization for their infants and a 51% decrease in the odds of being rehospitalized themselves at 21 months postpartum[5]. The 2020 review in the Harvard Review of Psychiatry also found paid maternity leave can lead to an increase in the initiation and duration of breastfeeding. Paid maternity leave may lead to healthier habits as well. The 2018 study in Maternal and Child Health Journalalso found women who took paid maternity leave were nearly twice as likely to exercise and were able to better manage their stress levels compared to those who didn’t take paid maternity leave. Mental Health Maternity leave has a significant impact on mental health as well. “There are huge adjustments that come with a new baby,” says Thurlow. “Changes in family dynamics, sleep deprivation and bonding with a new baby create mental and emotional strains for new parents. The ability to take time off to adjust and create a new normal has proven beneficial for parents’ overall mental and emotional well-being.” Research shows a positive correlation between mental health and paid maternity leave as well. According to the same 2020 review in the Harvard Review of Psychology, paid maternity leave is associated with a decrease in postpartum maternal depression. Meanwhile, a 2012 study in the Journal of Mental Health Policies and Economicsfound having fewer than 12 weeks of maternity leave and fewer than eight weeks of paid maternity leave to be associated with increases in depressive symptoms[6]. And the longer the leave, the better: Longer paid maternity leaves are associated with decreased depressive symptoms until six months postpartum, according to a 2014 study in the Journal of Health Politics, Policy and Law[7]. Maternity leave can also mean less stress for postpartum mothers, which can trickle down in a positive way to affect family dynamics and relationships as well. A 2013 study in the Journal of Family Issues observed Australian two-parent families and found the length of maternity leave affected a mother’s mental health, quality of parenting and the couple’s relationship. What’s more, mothers who took more than 13 weeks of paid leave experienced significantly less psychological distress[8]. The positive effects of maternity leave aren’t just apparent immediately after a baby is born: Maternity leave can lead to better mental health later in life as well. A 2015 study in Social Science and Medicine using European data found longer maternity leaves to be associated with improved mental health in old age[9]. Emotional Health A mother’s emotional health can be influenced by maternity leave as well. Postpartum emotional health involves identity changes that go along with becoming a parent, says Dr. Bovone. “Our self-identity changes, as well as our relationships and interactions with our partners, families and friends,” she adds. New mothers may find it difficult to ask for help, and some may find being a parent isn’t what they thought it would be. “Priorities may change as well, and some struggle with this new perspective,” says Dr. Bovone. Fortunately, maternity leave can lead to better bonding experiences between mother and child. A 2018 study of 3,850 mothers in the U.S. found a significant correlation between the duration of paid maternity leave and positive mother-child interactions, such as secure attachment and empathy[10]. A decreased chance of domestic violence is also associated with paid parental leave. A 2019 study in Preventive Medicine found paid parental leave can be an effective strategy to prevent future instances of intimate partner violence. This connection could exist because paid leaves maintains household income and prevents financial stressors, increases gender equity (which is associated with less intimate partner violence against women) and gives parents time to bond with a child without having to worry about work[11]. What Experts Say About Maternity Leave Dr. Bovone and Thurlow both agree that adequate paid maternity leave is a necessity for the health and well-being of mothers, children and families as a whole. What’s more, maternity leave should be longer than what’s typically offered, according to Dr. Bovone. “Ideally, a year to care for oneself and the newborn is needed,” she says. “Coverage for breastfeeding issues, mental and emotional health, pelvic floor health and sexual health should be the norm and accessible to all. The American College of Obstetricians and Gynecologists supports the expansion of postpartum services, but the current medical system at OBGYN offices doesn’t allow adequate time nor payment for these services.” She stresses the importance of improved maternity leave, saying that not only is it beneficial to mothers, but also to families, communities and, ultimately, work environments. Thurlow believes maternity leave should be a minimum of 12 weeks, paid and federally mandated for all employers. “Maternity leave is good, but organizations should provide paid parental leave to truly support parents,” she says. She adds that maternity leave needs to be expanded. “Providing paid leave to a birthing parent shouldn’t be a discussion, but the issue is much larger. Only providing paid leave to a birthing parent doesn’t take into account families that are made whole by adoption, surrogacy or the placement of a child. Additionally, only offering maternity leave places a burden of childcare on one parent.”",Medical,Find & Summarize,Text Transformation "Respond using only the text provided. Do not use prior training data or external knowledge to form your response. Structure your output in bullet point format, but if the user question asks for information related to a process, use a numbered list format.",Describe the protocol for dealing with clothing prior to beginning an autopsy.,"Introduction, Concepts and Principles It is assumed that all pathologists know the construction and requirements for reporting the findings of a complete postmortem examination. The following is a guide for use in converting the standard autopsy protocol into the report of a medicolegal autopsy. All of the usual descriptive technics should be maintained. Greater attention to detail, accurate description of abnormal findings, and the addition of final conclusions and interpretations, will bring about this transformation. The hospital autopsy is an examination performed with the consent of the deceased person's relatives for the purposes of: (1) determining the cause of death; (2) providing correlation of clinical diagnosis and clinical symptoms; (3) determining the effectiveness of therapy; (4) studying the natural course of disease processes; and (5) educating students and physicians. The medicolegal autopsy is an examination performed under the law, usually ordered by the Medical Examiner and Coroner 1 for the purposes of: (1) determining the cause, manner, 2 and time of death; (2) recovering, identifying, and preserving evidentiary material; (3) providing interpretation and correlation of facts and circumstances related to death; (4) providing a factual, objective medical report for law enforcement, prosecution, and defense agencies; and (5) separating death due to disease from death due to external causes for protection of the innocent. The essential features of a medicolegal autopsy are: (1) to perform a complete autopsy; (2) to personally perform the examination and observe all findings so that interpretation may be sound; (3) to perform a thorough examination and overlook nothing which could later prove of importance; (4) to preserve all information by written and photographic records; and (5) to provide a professional report without bias. Preliminary Procedures Before the clothing is removed, the body should be examined to determine the condition of the clothing, and to correlate tears and other defects with obvious injuries to the body, and to record the findings. The clothing, body, and hands should be protected from possible contamination prior to specific examination of each. A record of the general condition of the body and of the clothing should be made and the extent of rigo r and lividity, the temperature of the body and the environment, and any other data pertinent to the subsequent determination of the time of death also should be recorded. After the preliminary examination the clothing may be carefully removed by unbuttoning, unzippering, or unhooking to remove without tearing or cutting. If the clothing is wet or bloody, it must be hung up to dry in the air to prevent putrefaction and disintegration. Record and label each item of clothing. Preserve with proper identification for subsequent examination. Clothing may be examined in the laboratory with soft tissue x-ray and infrared photographs in addition to various chemical analyses and immunohematologic analyses. Autopsy Procedure -The..date, time and place of autopsy should be succinctly noted, and where and by whom it was performed, and any observers or participants should be named. The body should be identified, and all physical characteristics should be described. These include age, height, weight, sex, color of hair and eyes, state of nutrition and muscular development, scars,, and tattoos. Description of the teeth, the number present and absent, :and the general condition should be detailed noting any' abnormalities or deformities, or evidence of fracture, old or recent. In a separate paragraph or paragraphs describe all injuries, noting the number and characteristics of each including size, shape, pattern, and location in relation to anatomic landmarks. Describe the course, direction, and depth.of injuries and enumerate structures involved by the injury. Identify and label any'foreign object recovered ,and specify its relation to a given injury~ : ~, . ~:At' least one photograph should be taken to identify the body. Photograph injuries to document their location and be certain to, include a 'scale to show their size. Photographs can be used to demonstrate and correlate, external injuries with internal injuries and to demonstrate pathologic processes other than those of traumatic origin. ' Roentgenographic and fluoroscopic examinations tan be used to locate bullets or other radio-opaque objects, to identify the victim, and tO document fractures, anatomic deformities, and surgical procedures when such metallic.foreign bodies as plates, nails, screws, and wire sutures have been used. .. A general description of the head, neck, cervical spine., thorax, abdo2 men, genitalia, and extremities should be given in logical sequence. The course of wounds through various structures should be detailed remembering variations of position in relationships during life versus relationships after death and when supine on the autopsy table. Evidentiary items such as bullets, knives, or portions thereof, pellets or foreign materials, should be preserved and the point of recovery should be noted. Each should be labelled for proper identification. Each organ should be dissected and described, noting relationships and conditions.","Respond using only the text provided. Do not use prior training data or external knowledge to form your response. Structure your output in bullet point format, but if the user question asks for information related to a process, use a numbered list format. Introduction, Concepts and Principles It is assumed that all pathologists know the construction and requirements for reporting the findings of a complete postmortem examination. The following is a guide for use in converting the standard autopsy protocol into the report of a medicolegal autopsy. All of the usual descriptive technics should be maintained. Greater attention to detail, accurate description of abnormal findings, and the addition of final conclusions and interpretations, will bring about this transformation. The hospital autopsy is an examination performed with the consent of the deceased person's relatives for the purposes of: (1) determining the cause of death; (2) providing correlation of clinical diagnosis and clinical symptoms; (3) determining the effectiveness of therapy; (4) studying the natural course of disease processes; and (5) educating students and physicians. The medicolegal autopsy is an examination performed under the law, usually ordered by the Medical Examiner and Coroner 1 for the purposes of: (1) determining the cause, manner, 2 and time of death; (2) recovering, identifying, and preserving evidentiary material; (3) providing interpretation and correlation of facts and circumstances related to death; (4) providing a factual, objective medical report for law enforcement, prosecution, and defense agencies; and (5) separating death due to disease from death due to external causes for protection of the innocent. The essential features of a medicolegal autopsy are: (1) to perform a complete autopsy; (2) to personally perform the examination and observe all findings so that interpretation may be sound; (3) to perform a thorough examination and overlook nothing which could later prove of importance; (4) to preserve all information by written and photographic records; and (5) to provide a professional report without bias. Preliminary Procedures Before the clothing is removed, the body should be examined to determine the condition of the clothing, and to correlate tears and other defects with obvious injuries to the body, and to record the findings. The clothing, body, and hands should be protected from possible contamination prior to specific examination of each. A record of the general condition of the body and of the clothing should be made and the extent of rigo r and lividity, the temperature of the body and the environment, and any other data pertinent to the subsequent determination of the time of death also should be recorded. After the preliminary examination the clothing may be carefully removed by unbuttoning, unzippering, or unhooking to remove without tearing or cutting. If the clothing is wet or bloody, it must be hung up to dry in the air to prevent putrefaction and disintegration. Record and label each item of clothing. Preserve with proper identification for subsequent examination. Clothing may be examined in the laboratory with soft tissue x-ray and infrared photographs in addition to various chemical analyses and immunohematologic analyses. Autopsy Procedure -The..date, time and place of autopsy should be succinctly noted, and where and by whom it was performed, and any observers or participants should be named. The body should be identified, and all physical characteristics should be described. These include age, height, weight, sex, color of hair and eyes, state of nutrition and muscular development, scars,, and tattoos. Description of the teeth, the number present and absent, :and the general condition should be detailed noting any' abnormalities or deformities, or evidence of fracture, old or recent. In a separate paragraph or paragraphs describe all injuries, noting the number and characteristics of each including size, shape, pattern, and location in relation to anatomic landmarks. Describe the course, direction, and depth.of injuries and enumerate structures involved by the injury. Identify and label any'foreign object recovered ,and specify its relation to a given injury~ : ~, . ~:At' least one photograph should be taken to identify the body. Photograph injuries to document their location and be certain to, include a 'scale to show their size. Photographs can be used to demonstrate and correlate, external injuries with internal injuries and to demonstrate pathologic processes other than those of traumatic origin. ' Roentgenographic and fluoroscopic examinations tan be used to locate bullets or other radio-opaque objects, to identify the victim, and tO document fractures, anatomic deformities, and surgical procedures when such metallic.foreign bodies as plates, nails, screws, and wire sutures have been used. .. A general description of the head, neck, cervical spine., thorax, abdo2 men, genitalia, and extremities should be given in logical sequence. The course of wounds through various structures should be detailed remembering variations of position in relationships during life versus relationships after death and when supine on the autopsy table. Evidentiary items such as bullets, knives, or portions thereof, pellets or foreign materials, should be preserved and the point of recovery should be noted. Each should be labelled for proper identification. Each organ should be dissected and described, noting relationships and conditions. Describe the protocol for dealing with clothing prior to beginning an autopsy.",Medical,Find & Summarize,Text Transformation Provide a response based solely on the information provided in the prompt. External sources and prior knowledge must not be used.,What did the first circuit conclude?,"In the 2016 case United States v. McIntosh, the U.S. Court of Appeals for the Ninth Circuit considered the circumstances in which the appropriations rider bars CSA prosecution of marijuana-related activities. The court held that the rider prohibits the federal government only from preventing the implementation of those specific rules of state law that authorize the use, distribution, possession, or cultivation of medical marijuana. DOJ does not prevent the implementation of [such rules] when it prosecutes individuals who engage in conduct unauthorized under state medical marijuana laws. Individuals who do not strictly comply with all state-law conditions regarding the use, distribution, possession, and cultivation of medical marijuana have engaged in conduct that is unauthorized, and prosecuting such individuals does not violate [the rider]. Relying on McIntosh, the Ninth Circuit has issued several decisions allowing federal prosecution of individuals who did not “strictly comply” with state medical marijuana laws, notwithstanding the appropriations rider, and several district courts have followed that reasoning. As one example, in United States v. Evans, the Ninth Circuit upheld the prosecution of two individuals involved in the production of medical marijuana who smoked marijuana as they processed plants for sale. Although state law permitted medical marijuana use by “qualifying patients,” the court concluded that the defendants failed to show they were qualifying patients, and thus they could be prosecuted because their personal marijuana use did not strictly comply with state medical marijuana law. In the 2022 case United States v. Bilodeau, the U.S. Court of Appeals for the First Circuit also considered the scope of the appropriations rider. The defendants in Bilodeau were registered with the State of Maine to produce medical marijuana, but DOJ alleged that they distributed large quantities of marijuana to individuals who were not qualifying patients under Maine law, including recipients in other states. Following indictment for criminal CSA violations, the defendants sought to invoke the appropriations rider to bar their prosecutions. They argued that the rider “must be read to preclude the DOJ, under most circumstances, from prosecuting persons who possess state licenses to partake in medical marijuana activity.” DOJ instead urged the court to apply the Ninth Circuit’s standard, allowing prosecution unless the defendants could show that they acted in strict compliance with state medical marijuana laws. The First Circuit declined to adopt either of the proposed tests. As an initial matter, the court agreed with the Ninth Circuit that the rider means “DOJ may not spend funds to bring prosecutions if doing so prevents a state from giving practical effect to its medical marijuana laws.” However, the panel declined to adopt the Ninth Circuit’s holding that the rider bars prosecution only in cases where defendants strictly complied with state law. The court noted that the text of the rider does not explicitly require strict compliance with state law and that, given the complexity of state marijuana regulations, “the potential for technical noncompliance [with state law] is real enough that no person through any reasonable effort could always assure strict compliance.” Thus, the First Circuit concluded that requiring strict compliance with state law would likely chill state-legal medical marijuana activities and prevent the states from giving effect to their medical marijuana laws. On the other hand, the court also rejected the defendants’ more expansive reading of the rider, reasoning that “Congress surely did not intend for the rider to provide a safe harbor to all caregivers with facially valid documents without regard for blatantly illegitimate activity.” Ultimately, while the First Circuit held that the rider bars CSA prosecution in at least some cases where the defendant has committed minor technical violations of state medical marijuana laws, it declined to Congressional Research Service 4 “fully define [the] precise boundaries” of its alternative standard. On the record before it, the court concluded that “the defendants’ cultivation, possession, and distribution of marijuana aimed at supplying persons whom no defendant ever thought were qualifying patients under Maine law” and that a CSA conviction in those circumstances would not “prevent Maine’s medical marijuana laws from having their intended practical effect.” Considerations for Congress It remains to be seen whether and how the difference in reasoning between the Ninth Circuit and the First Circuit will make a practical difference in federal marijuana prosecutions. In theory, the First Circuit’s analysis could make it easier for defendants to invoke the appropriations rider to bar federal prosecutions, because they could do so even if they had not been in strict compliance with state law. In practice, however, resource limitations and enforcement priorities have historically meant that federal marijuana prosecutions target only individuals and organizations that have clearly not complied with state law. Thus, one of the First Circuit judges who considered Bilodeau agreed with the panel’s interpretation of the rider but wrote a concurrence noting that, in practice, the First Circuit’s standard might not be “materially different from the one that the Ninth Circuit applied.” While the medical marijuana appropriations rider restricts DOJ’s ability to bring some marijuana prosecutions, its effect is limited in several ways. First, marijuana-related activities that fall outside the scope of the appropriations rider remain subject to prosecution under the CSA. By its terms, the rider applies only to state laws related to medical marijuana; it does not bar prosecution of any activities related to recreational marijuana, even if those activities are permitted under state law. Second, as the Ninth Circuit has explained, even where the rider does apply, it “does not provide immunity from prosecution for federal marijuana offenses”—it simply restricts DOJ’s ability to expend funds to enforce federal law for as long as it remains in effect. If Congress instead opted to repeal the rider or allow it to lapse, DOJ would be able to prosecute future CSA violations as well as past violations that occurred while the rider was in effect, subject to the applicable statute of limitations. Third, participants in the cannabis industry may face numerous collateral consequences arising from the federal prohibition of marijuana in areas including bankruptcy, taxation, and immigration. Many of those legal consequences attach regardless of whether a person is charged with or convicted of a CSA offense, meaning the rider would not affect them. Because the medical marijuana appropriations rider applies to marijuana specifically, regardless of how the substance is classified under the CSA, rescheduling marijuana would not affect the rider. Congress has the authority to enact legislation to clarify or alter the scope of the appropriations rider, repeal the rider, or decline to include it in future appropriations laws. For instance, Congress could amend the rider to specify whether strict compliance with state medical marijuana law is required in order to bar prosecution under the CSA or provide a different standard that DOJ and the courts should apply. Congress could also expand the scope of the rider to bar the expenditure of funds on prosecutions related to recreational marijuana or other controlled substances. Beyond the appropriations context, Congress could also consider other changes to federal marijuana law that would affect its interaction with state law. Such changes could take the form of more stringent marijuana regulation—for instance, through increased DOJ funding to prosecute CSA violations or limiting federal funds for states that legalize marijuana. In contrast, most recent proposals before Congress seek to relax federal restrictions on marijuana or mitigate the disparity between federal and state marijuana regulation. Some proposals would remove marijuana from regulation under the CSA entirely or move it to a less restrictive schedule. Other proposed legislation would limit enforcement of federal marijuana law in states that elect to legalize marijuana. Additional proposals from the past few years would seek to address specific legal consequences of marijuana’s Schedule I status by, for example, Congressional Research Service 5 LSB10694 · VERSION 4 · UPDATED enabling marijuana businesses to access banking services or removing collateral consequences for individuals in areas such as immigration, federally assisted housing, and gun ownership.","Provide a response based solely on the information provided in the prompt. External sources and prior knowledge must not be used. What did the first circuit conclude? In the 2016 case United States v. McIntosh, the U.S. Court of Appeals for the Ninth Circuit considered the circumstances in which the appropriations rider bars CSA prosecution of marijuana-related activities. The court held that the rider prohibits the federal government only from preventing the implementation of those specific rules of state law that authorize the use, distribution, possession, or cultivation of medical marijuana. DOJ does not prevent the implementation of [such rules] when it prosecutes individuals who engage in conduct unauthorized under state medical marijuana laws. Individuals who do not strictly comply with all state-law conditions regarding the use, distribution, possession, and cultivation of medical marijuana have engaged in conduct that is unauthorized, and prosecuting such individuals does not violate [the rider]. Relying on McIntosh, the Ninth Circuit has issued several decisions allowing federal prosecution of individuals who did not “strictly comply” with state medical marijuana laws, notwithstanding the appropriations rider, and several district courts have followed that reasoning. As one example, in United States v. Evans, the Ninth Circuit upheld the prosecution of two individuals involved in the production of medical marijuana who smoked marijuana as they processed plants for sale. Although state law permitted medical marijuana use by “qualifying patients,” the court concluded that the defendants failed to show they were qualifying patients, and thus they could be prosecuted because their personal marijuana use did not strictly comply with state medical marijuana law. In the 2022 case United States v. Bilodeau, the U.S. Court of Appeals for the First Circuit also considered the scope of the appropriations rider. The defendants in Bilodeau were registered with the State of Maine to produce medical marijuana, but DOJ alleged that they distributed large quantities of marijuana to individuals who were not qualifying patients under Maine law, including recipients in other states. Following indictment for criminal CSA violations, the defendants sought to invoke the appropriations rider to bar their prosecutions. They argued that the rider “must be read to preclude the DOJ, under most circumstances, from prosecuting persons who possess state licenses to partake in medical marijuana activity.” DOJ instead urged the court to apply the Ninth Circuit’s standard, allowing prosecution unless the defendants could show that they acted in strict compliance with state medical marijuana laws. The First Circuit declined to adopt either of the proposed tests. As an initial matter, the court agreed with the Ninth Circuit that the rider means “DOJ may not spend funds to bring prosecutions if doing so prevents a state from giving practical effect to its medical marijuana laws.” However, the panel declined to adopt the Ninth Circuit’s holding that the rider bars prosecution only in cases where defendants strictly complied with state law. The court noted that the text of the rider does not explicitly require strict compliance with state law and that, given the complexity of state marijuana regulations, “the potential for technical noncompliance [with state law] is real enough that no person through any reasonable effort could always assure strict compliance.” Thus, the First Circuit concluded that requiring strict compliance with state law would likely chill state-legal medical marijuana activities and prevent the states from giving effect to their medical marijuana laws. On the other hand, the court also rejected the defendants’ more expansive reading of the rider, reasoning that “Congress surely did not intend for the rider to provide a safe harbor to all caregivers with facially valid documents without regard for blatantly illegitimate activity.” Ultimately, while the First Circuit held that the rider bars CSA prosecution in at least some cases where the defendant has committed minor technical violations of state medical marijuana laws, it declined to Congressional Research Service 4 “fully define [the] precise boundaries” of its alternative standard. On the record before it, the court concluded that “the defendants’ cultivation, possession, and distribution of marijuana aimed at supplying persons whom no defendant ever thought were qualifying patients under Maine law” and that a CSA conviction in those circumstances would not “prevent Maine’s medical marijuana laws from having their intended practical effect.” Considerations for Congress It remains to be seen whether and how the difference in reasoning between the Ninth Circuit and the First Circuit will make a practical difference in federal marijuana prosecutions. In theory, the First Circuit’s analysis could make it easier for defendants to invoke the appropriations rider to bar federal prosecutions, because they could do so even if they had not been in strict compliance with state law. In practice, however, resource limitations and enforcement priorities have historically meant that federal marijuana prosecutions target only individuals and organizations that have clearly not complied with state law. Thus, one of the First Circuit judges who considered Bilodeau agreed with the panel’s interpretation of the rider but wrote a concurrence noting that, in practice, the First Circuit’s standard might not be “materially different from the one that the Ninth Circuit applied.” While the medical marijuana appropriations rider restricts DOJ’s ability to bring some marijuana prosecutions, its effect is limited in several ways. First, marijuana-related activities that fall outside the scope of the appropriations rider remain subject to prosecution under the CSA. By its terms, the rider applies only to state laws related to medical marijuana; it does not bar prosecution of any activities related to recreational marijuana, even if those activities are permitted under state law. Second, as the Ninth Circuit has explained, even where the rider does apply, it “does not provide immunity from prosecution for federal marijuana offenses”—it simply restricts DOJ’s ability to expend funds to enforce federal law for as long as it remains in effect. If Congress instead opted to repeal the rider or allow it to lapse, DOJ would be able to prosecute future CSA violations as well as past violations that occurred while the rider was in effect, subject to the applicable statute of limitations. Third, participants in the cannabis industry may face numerous collateral consequences arising from the federal prohibition of marijuana in areas including bankruptcy, taxation, and immigration. Many of those legal consequences attach regardless of whether a person is charged with or convicted of a CSA offense, meaning the rider would not affect them. Because the medical marijuana appropriations rider applies to marijuana specifically, regardless of how the substance is classified under the CSA, rescheduling marijuana would not affect the rider. Congress has the authority to enact legislation to clarify or alter the scope of the appropriations rider, repeal the rider, or decline to include it in future appropriations laws. For instance, Congress could amend the rider to specify whether strict compliance with state medical marijuana law is required in order to bar prosecution under the CSA or provide a different standard that DOJ and the courts should apply. Congress could also expand the scope of the rider to bar the expenditure of funds on prosecutions related to recreational marijuana or other controlled substances. Beyond the appropriations context, Congress could also consider other changes to federal marijuana law that would affect its interaction with state law. Such changes could take the form of more stringent marijuana regulation—for instance, through increased DOJ funding to prosecute CSA violations or limiting federal funds for states that legalize marijuana. In contrast, most recent proposals before Congress seek to relax federal restrictions on marijuana or mitigate the disparity between federal and state marijuana regulation. Some proposals would remove marijuana from regulation under the CSA entirely or move it to a less restrictive schedule. Other proposed legislation would limit enforcement of federal marijuana law in states that elect to legalize marijuana. Additional proposals from the past few years would seek to address specific legal consequences of marijuana’s Schedule I status by, for example, Congressional Research Service 5 LSB10694 · VERSION 4 · UPDATED enabling marijuana businesses to access banking services or removing collateral consequences for individuals in areas such as immigration, federally assisted housing, and gun ownership.",Legal,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","My sister and her dog live in NYC. I've visited there and have always been fascinated with their tall buildings. Then I thought...someone has to clean those! Then next thing you know, window washing robotos popped up on my feed. How do these robots work? Also what does this mean for the people who do those jobs?","The skyscraper window-washing robots are here Skyline Robotics claims its autonomous robot Ozmo can clean windows three times faster than humans alone. By Mack DeGeurin Posted on Aug 28, 2024 10:06 AM EDT Share Tourists and workers alike jostling their way through New York’s bustling midtown may notice an odd sight next time they look up. Dozens of floors above ground, the world’s first commercial window-cleaning-robot will be thrusting its two white mechanical arms back and forth, soapy squeegees in hand. Skyline Robotics, the New York-based company behind the “Ozmo” cleaning robot, believe machines like theirs are faster and safer than traditional cleaning methods and could help address the potential shortage of human skyscraper window washers in coming years. It’s just the latest example of artificial intelligence and robotics merging together to perform real-word tasks once confined to people. Caption: The Ozmo robot uses a combination of computer vision, Lidar, and force sensors to determine when and how to clean windows. Credit: Skyline Robotics Starting this week, Skyline’s Ozmo robot will get to work cleaning windows at 1133 Avenue of the Americas, a 45-story Class A skyscraper owned and managed by the Durst Organization near New York’s Bryant Park. Ozmo was previously beta tested across several buildings in the city and Tel Aviv, Israel, but Skyline tells Popular Science this marks the first full-time deployment on an autonomous window-cleaning robot. Early prototypes of window-cleaning robots have been around for years, with some even tested on the original World Trade Center buildings. But those predecessors were imprecise and required a human reviewer to follow up and clean up messy spots the machine missed. Since then, modern skyscrapers have been built with sharper angles and more artistic designs, which can make cleaning them even more skill intensive. Ozmo uses Lidar and computer vision to ‘see’ what it’s cleaning Ozmo improves on older robot designs thanks to recent advances in robotics and artificial intelligence. The robot cleaner uses a combination of Lidar and computer vision, similar to what’s used in some autonomous vehicles, to scan a building’s surface and its particular curve and edge areas. Onboard force sensors let the robot determine how much pressure it needs to apply to clean a particular window most effectively. AI software, meanwhile, helps Ozmo stabilize itself even when presented with heavy gusts of wind. Since its initial beta tests, a Skyline spokesperson says they have equipped Ozmo with additional ultrasonic sensors and increased its robustness in order to properly handle taller buildings. And while the robot operates autonomously, Skyline says a team of human supervisors located on the building’s roof will still remotely monitor it. “We’re delivering the future of façade maintenance as Ozmo and human window cleaners work in unison to protect the health of buildings faster and safer than existing solutions,” Skyline Robotics CEO Michael Brown said. A Skyline spokesperson told Popular Science their product is a “robot as a service platform” and that total pricing will depend on the overall size of the surface’s being cleaned. Robots could make window cleaning even safer Window washing, especially amongst Manhattan’s concrete behemoths, isn’t for the faint of heart. Cleaners often operate hundreds of feet in the air supported by harness and working in tight corridors. Strong winds and other environmental factors can make an already nerve-racking job even more stress inducing. But even though harrowing videos occasionally surface showing workers dangerously dangling from rooftops or falling, window-washing is actually statistically safer than some might expect. Data compiled by the Occupational Safety and Health Administration (OSHA) lists only 20 fatalities involving window washers nationally between 2019 and 2023. Still, Skyline argues its robotics solution can make the industry even faster and more efficient. The company claims its human-aided robotic approach can clean windows three times faster than traditional window cleaning methods. Aside from pure speed, robots might one-day need to help fill in gaps in the aging window-asking workforce. A recent analysis of census and Department of Labor data compiled by the online job resource firm Zippia estimates around 70% of US-based window cleaners are over 40 years old. Just 9% of workers were reportedly between the ages of 20 and 30. At the same time, the appetite for new towers doesn’t seem to be subsiding. There are currently five towers over 980 feet currently under construction in Manhattan and many more smaller ones. Ozmo arrives during a time of increased automation nationwide, both in white collar service jobs and physical labor. Advanced large language models like those created by OpenAI and Google are already disrupting work and contributing to layoffs in the tech industry and beyond. Larger humanoid-style robots, though still nascent, may increasingly take on work once left to humans in manufacturing sectors. How human workers and labor groups respond to those impending changes could dictate how advancements in robotics evolve in the coming years. Skyline isn’t necessarily waiting for the dust to settle. The company says it has plans to expand Ozmo to buildings in Japan, Singapore, and London, moving forward.","[question] My sister and her dog live in NYC. I've visited there and have always been fascinated with their tall buildings. Then I thought...someone has to clean those! Then next thing you know, window washing robotos popped up on my feed. How do these robots work? Also what does this mean for the people who do those jobs? ===================== [text] The skyscraper window-washing robots are here Skyline Robotics claims its autonomous robot Ozmo can clean windows three times faster than humans alone. By Mack DeGeurin Posted on Aug 28, 2024 10:06 AM EDT Share Tourists and workers alike jostling their way through New York’s bustling midtown may notice an odd sight next time they look up. Dozens of floors above ground, the world’s first commercial window-cleaning-robot will be thrusting its two white mechanical arms back and forth, soapy squeegees in hand. Skyline Robotics, the New York-based company behind the “Ozmo” cleaning robot, believe machines like theirs are faster and safer than traditional cleaning methods and could help address the potential shortage of human skyscraper window washers in coming years. It’s just the latest example of artificial intelligence and robotics merging together to perform real-word tasks once confined to people. Caption: The Ozmo robot uses a combination of computer vision, Lidar, and force sensors to determine when and how to clean windows. Credit: Skyline Robotics Starting this week, Skyline’s Ozmo robot will get to work cleaning windows at 1133 Avenue of the Americas, a 45-story Class A skyscraper owned and managed by the Durst Organization near New York’s Bryant Park. Ozmo was previously beta tested across several buildings in the city and Tel Aviv, Israel, but Skyline tells Popular Science this marks the first full-time deployment on an autonomous window-cleaning robot. Early prototypes of window-cleaning robots have been around for years, with some even tested on the original World Trade Center buildings. But those predecessors were imprecise and required a human reviewer to follow up and clean up messy spots the machine missed. Since then, modern skyscrapers have been built with sharper angles and more artistic designs, which can make cleaning them even more skill intensive. Ozmo uses Lidar and computer vision to ‘see’ what it’s cleaning Ozmo improves on older robot designs thanks to recent advances in robotics and artificial intelligence. The robot cleaner uses a combination of Lidar and computer vision, similar to what’s used in some autonomous vehicles, to scan a building’s surface and its particular curve and edge areas. Onboard force sensors let the robot determine how much pressure it needs to apply to clean a particular window most effectively. AI software, meanwhile, helps Ozmo stabilize itself even when presented with heavy gusts of wind. Since its initial beta tests, a Skyline spokesperson says they have equipped Ozmo with additional ultrasonic sensors and increased its robustness in order to properly handle taller buildings. And while the robot operates autonomously, Skyline says a team of human supervisors located on the building’s roof will still remotely monitor it. “We’re delivering the future of façade maintenance as Ozmo and human window cleaners work in unison to protect the health of buildings faster and safer than existing solutions,” Skyline Robotics CEO Michael Brown said. A Skyline spokesperson told Popular Science their product is a “robot as a service platform” and that total pricing will depend on the overall size of the surface’s being cleaned. Robots could make window cleaning even safer Window washing, especially amongst Manhattan’s concrete behemoths, isn’t for the faint of heart. Cleaners often operate hundreds of feet in the air supported by harness and working in tight corridors. Strong winds and other environmental factors can make an already nerve-racking job even more stress inducing. But even though harrowing videos occasionally surface showing workers dangerously dangling from rooftops or falling, window-washing is actually statistically safer than some might expect. Data compiled by the Occupational Safety and Health Administration (OSHA) lists only 20 fatalities involving window washers nationally between 2019 and 2023. Still, Skyline argues its robotics solution can make the industry even faster and more efficient. The company claims its human-aided robotic approach can clean windows three times faster than traditional window cleaning methods. Aside from pure speed, robots might one-day need to help fill in gaps in the aging window-asking workforce. A recent analysis of census and Department of Labor data compiled by the online job resource firm Zippia estimates around 70% of US-based window cleaners are over 40 years old. Just 9% of workers were reportedly between the ages of 20 and 30. At the same time, the appetite for new towers doesn’t seem to be subsiding. There are currently five towers over 980 feet currently under construction in Manhattan and many more smaller ones. Ozmo arrives during a time of increased automation nationwide, both in white collar service jobs and physical labor. Advanced large language models like those created by OpenAI and Google are already disrupting work and contributing to layoffs in the tech industry and beyond. Larger humanoid-style robots, though still nascent, may increasingly take on work once left to humans in manufacturing sectors. How human workers and labor groups respond to those impending changes could dictate how advancements in robotics evolve in the coming years. Skyline isn’t necessarily waiting for the dust to settle. The company says it has plans to expand Ozmo to buildings in Japan, Singapore, and London, moving forward. https://www.popsci.com/technology/window-washing-robot-skyscrapers/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Internet/Technology,Find & Summarize,Text Transformation system instruction: [This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Present your answer in headed sections with an explanation for each section. Each explanation should be in bullet points with exactly three bullet points.],question: [which famous economists are mentioned?],"Free market economies: o Also known as laissez-faire economies, where governments leave markets to their own devices, so the market forces of supply and demand allocate scarce resources. o Economic decisions are taken by private individuals and firms, and private individuals own everything. There is no government intervention. o In reality, governments usually intervene by implementing laws and public services, such as property rights and national defence. o Adam Smith and Friedrich Hayek were famous free market economists. Adam Smith’s famous theory of the invisible hand of the market can be applied to free market economies and the price mechanism, which describes how prices are determined by the ‘spending votes’ of consumers and businesses. Smith recognised some of the issues with monopoly power that could arise from a free market, however. Hayek argued that government intervention makes the market worse. For example, shortly after the 1930s crash, he argued that the Fed caused the crash by keeping interest rates low, and encouraging investments which were not economically worthwhile: ‘malinvestments’. o What to produce: determined by what the consumer prefers o How to produce it: producers seek profits o For whom to produce it: whoever has the greatest purchasing power in the economy, and is therefore able to buy the good o Advantages: o Firms are likely to be efficient because they have to provide goods and services demanded by consumers. They are also likely to lower their average costs and make better use of scarce resources. Therefore, overall output of the economy increases. o The bureaucracy from government intervention is avoided. o Some economists might argue the freedom gained from having a free economy leads to more personal freedom. o Disadvantages: o The free market ignores inequality, and tends to benefit those who hold most of the wealth. There are no social security payments for those on low incomes. www.pmt.education o There could be monopolies, which could exploit the market by charging higher prices. o There could be the overconsumption of demerit goods, which have large negative externalities, such as tobacco. o Public goods are not provided in a free market, such as national defence. Merit goods, such as education, are underprovided. Command economy: o This is where the government allocates all of the scarce resources in an economy to where they think there is a greater need. It is also referred to as central planning. o Karl Marx saw the free market as unstable. He saw profits created in the free market as coming from the exploitation of labour, and by not paying workers to cover the value of their work. He argued for the “common ownership of the means of production”. o What to produce: determined by what the government prefers o How to produce it: governments and their employees o For whom to produce it: who the government prefers o Advantages: o It might be easier to coordinate resources in times of crises, such as wars. o The government can compensate for market failure, by reallocating resources. They might ensure everyone can access basic necessities. o Inequality in society could be reduced, and society might maximise welfare rather than profit. o The abuse of monopoly power could be prevented. o Disadvantages: o Governments fail, as do markets, and they may not be fully informed for what to produce. o They may not necessarily meet consumer preferences. o It limits democracy and personal freedom. Mixed economy: o This has features of both command and free economies and is the most common economic system today. There are different balances between command and free economies in reality, though. The UK is generally www.pmt.education considered quite central, whilst the US is slightly more free (although the government spends around 35% of GDP) and Cuba is more centrally planned. o The market is controlled by both the government and the forces of supply and demand. o Governments often provide public goods such as street lights, roads and the police, and merit goods, such as healthcare and education. o What to produce: determined by both consumer and government preferences o How to produce it: determined by producers making profits and the government o For whom to produce it: both who the government prefers and the purchasing power of private individuals. ","system instruction: [This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Present your answer in headed sections with an explanation for each section. Each explanation should be in bullet points with exactly three bullet points.] question: [which famous economists are mentioned?] context block: [Free market economies: o Also known as laissez-faire economies, where governments leave markets to their own devices, so the market forces of supply and demand allocate scarce resources. o Economic decisions are taken by private individuals and firms, and private individuals own everything. There is no government intervention. o In reality, governments usually intervene by implementing laws and public services, such as property rights and national defence. o Adam Smith and Friedrich Hayek were famous free market economists. Adam Smith’s famous theory of the invisible hand of the market can be applied to free market economies and the price mechanism, which describes how prices are determined by the ‘spending votes’ of consumers and businesses. Smith recognised some of the issues with monopoly power that could arise from a free market, however. Hayek argued that government intervention makes the market worse. For example, shortly after the 1930s crash, he argued that the Fed caused the crash by keeping interest rates low, and encouraging investments which were not economically worthwhile: ‘malinvestments’. o What to produce: determined by what the consumer prefers o How to produce it: producers seek profits o For whom to produce it: whoever has the greatest purchasing power in the economy, and is therefore able to buy the good o Advantages: o Firms are likely to be efficient because they have to provide goods and services demanded by consumers. They are also likely to lower their average costs and make better use of scarce resources. Therefore, overall output of the economy increases. o The bureaucracy from government intervention is avoided. o Some economists might argue the freedom gained from having a free economy leads to more personal freedom. o Disadvantages: o The free market ignores inequality, and tends to benefit those who hold most of the wealth. There are no social security payments for those on low incomes. www.pmt.education o There could be monopolies, which could exploit the market by charging higher prices. o There could be the overconsumption of demerit goods, which have large negative externalities, such as tobacco. o Public goods are not provided in a free market, such as national defence. Merit goods, such as education, are underprovided. Command economy: o This is where the government allocates all of the scarce resources in an economy to where they think there is a greater need. It is also referred to as central planning. o Karl Marx saw the free market as unstable. He saw profits created in the free market as coming from the exploitation of labour, and by not paying workers to cover the value of their work. He argued for the “common ownership of the means of production”. o What to produce: determined by what the government prefers o How to produce it: governments and their employees o For whom to produce it: who the government prefers o Advantages: o It might be easier to coordinate resources in times of crises, such as wars. o The government can compensate for market failure, by reallocating resources. They might ensure everyone can access basic necessities. o Inequality in society could be reduced, and society might maximise welfare rather than profit. o The abuse of monopoly power could be prevented. o Disadvantages: o Governments fail, as do markets, and they may not be fully informed for what to produce. o They may not necessarily meet consumer preferences. o It limits democracy and personal freedom. Mixed economy: o This has features of both command and free economies and is the most common economic system today. There are different balances between command and free economies in reality, though. The UK is generally www.pmt.education considered quite central, whilst the US is slightly more free (although the government spends around 35% of GDP) and Cuba is more centrally planned. o The market is controlled by both the government and the forces of supply and demand. o Governments often provide public goods such as street lights, roads and the police, and merit goods, such as healthcare and education. o What to produce: determined by both consumer and government preferences o How to produce it: determined by producers making profits and the government o For whom to produce it: both who the government prefers and the purchasing power of private individuals.]",Financial,Fact Finding,Q&A "Do not use any knowledge other than the provided document. After answering the question, quote in parentheses the section of the document that you referred to for your answer. Use capital letters for this quotation.",Summarize the reviews from the provided text.,"**Oben VH-R2 Reviews** Great product By Freddy 2/14/2023 Verified Buyer Community Member Excellent product Handy Easy Great price Was this review helpful to you? 0 0 Report Great Simple Monopod Mount By Brian 1/22/2023 Verified Buyer Community Member Works great. Love the quick mount locking action. Makes it really easy and quick to mount and remove camera. Just slide one side in and it flips to lock down securely. Was this review helpful to you? 0 0 Report Nice add on for the Oben ATM-2600 By Sam 8/2/2022 Verified Buyer This head works well with the Oben ATM-2600 6-Section Aluminum Monopod. good combo, camera mounts securely and no movement at all. I do use it often and have seen no problem with it so far. Was this review helpful to you? 1 0 Report great monopod accessary. By Mike 1/31/2022 Verified Buyer Community Member works really well, Especially like being able to tilt the head to shoot vertically. The quick attachment piece is proprietary,I wish a had a second one. Other ones I have don't work with it. So i need to remember when I move the piece from a lens to a camera body. No big deal. The quick release works really well. Was this review helpful to you? 1 0 Report Nice Tilt Head for Monopod By Katie 1/5/2022 Verified Buyer Community Member I'm using this tilt head with my Manfrotto monopod. It's very sturdy and doesn't move when locked down. I used it quite a bit on a trip to Yellowstone recently with my Sigma 150-500 lens and it worked perfectly. Really well priced- very pleased with it!","{Context} ================== **Oben VH-R2 Reviews** Great product By Freddy 2/14/2023 Verified Buyer Community Member Excellent product Handy Easy Great price Was this review helpful to you? 0 0 Report Great Simple Monopod Mount By Brian 1/22/2023 Verified Buyer Community Member Works great. Love the quick mount locking action. Makes it really easy and quick to mount and remove camera. Just slide one side in and it flips to lock down securely. Was this review helpful to you? 0 0 Report Nice add on for the Oben ATM-2600 By Sam 8/2/2022 Verified Buyer This head works well with the Oben ATM-2600 6-Section Aluminum Monopod. good combo, camera mounts securely and no movement at all. I do use it often and have seen no problem with it so far. Was this review helpful to you? 1 0 Report great monopod accessary. By Mike 1/31/2022 Verified Buyer Community Member works really well, Especially like being able to tilt the head to shoot vertically. The quick attachment piece is proprietary,I wish a had a second one. Other ones I have don't work with it. So i need to remember when I move the piece from a lens to a camera body. No big deal. The quick release works really well. Was this review helpful to you? 1 0 Report Nice Tilt Head for Monopod By Katie 1/5/2022 Verified Buyer Community Member I'm using this tilt head with my Manfrotto monopod. It's very sturdy and doesn't move when locked down. I used it quite a bit on a trip to Yellowstone recently with my Sigma 150-500 lens and it worked perfectly. Really well priced- very pleased with it! ================ {Query} ================== Summarize the reviews from the provided text. ================ {Task} ================== Do not use any knowledge other than the provided document. After answering the question, quote in parentheses the section of the document that you referred to for your answer. Use capital letters for this quotation.",Retail/Product,Summarize,Text Transformation "Answer in one complete sentence. Add the relevant quoted piece of text from the context document in italics, at the end of your response.","As per this Technology Transfer Agreement between Merck KGaA and Nitec Pharma, what responsibilities regarding clinical and technical development in Germany and Austria does Nitec Pharma agree to?","** TECHNOLOGY TRANSFER AGREEMENT ** Technology Transfer Agreement between Merck KGaA (“Merck”), Frankfurter Strasse 250, 64271 Darmstadt and Nitec Pharma AG (“Nitec Pharma”) Switzerland Preamble Merck has been marketing corticoids (Fortecortin, Decortin, Decortin H, Solu Decortin H) successfully – primarily in Germany – for many years. In order to support the corticoid business Merck started developing Prednison Night Time Release in 1998, which is a novel galenic formulation using the active agent prednison. For the treatment of rheumatoid arthritis (“RA”) the Project (as defined hereinafter) has not yet entered phase 3 of clinical testing. Merck due to limited resources and its focus on other business areas is unable to develop the Project until it is ready for marketing or to obtain a legal pharmaceutical licence for the Project. Merck therefore internally has decided to discontinue the Project. It now appears that Nitec Pharma may be able to resume the Project at its own cost and risk, see it through phase III clinical testing and obtain a license to market the Merchandise (as defined below) in Germany, Austria and other countries. In light of this development Merck is willing to transfer the Project to Nitec Pharma by turning over to Nitec Pharma all know-how acquired within the framework of and in connection with the Project and all pertinent industrial property rights. In particular Merck is willing to grant Nitec Pharma access to all data, which have accrued within the framework of the Project development and which are still to accrue pending the conclusion of the successful “Mutual Recognition Procedure”. As provided herein Nitec Pharma is willing to undertake to use all of its Commercially Reasonable Efforts (as defined below) to continue the clinical and technical development of the Project on its own, in particular using its own financial resources and at its own company risk and to obtain legal pharmaceutical approvals for relevant markets that have been identified by Nitec Pharma as promising markets and to confirm that Merck shall, under the terms specified in greater detail in section 6 hereof retain the right to market the Merchandise on an exclusive or non-exclusive basis in Germany and Austria and that such right shall only pass to Nitec Pharma as set forth in section 6 hereof. For this purpose the parties stipulate as follows: 1. Definitions “Technology Transfer Agreement” or “TTA” refers to this Agreement between Merck and Nitec Pharma. “Clinical Development” refers to the implementation of all clinical trials aimed at obtaining licences to market the Merchandise in Germany, Austria and other countries. “Commercially Reasonable Efforts” means those efforts and resources that Nitec Pharma would use were it developing, manufacturing, promoting and detailing the Active Agents as its own pharmaceutical products but taking into account clinical development results (including all safety, efficacy and cost issues), product labeling, regulatory review and approval issues, market potential, past performance, market potential, economic return, the general regulatory environment and competitive market conditions in the therapeutic area, all as measured by the facts and circumstances at the time such efforts are due. “Technical Development” refers to the implementation of all technical activities aimed at obtaining licences to market the Merchandise in Germany, Austria and other countries. “Approval” refers to the date on which an approval to market the Merchandise is granted in Germany and/or Austria. “Launch” refers to the day on which the Merchandise is brought onto the market in Germany and/or Austria. “Access to Data” refers to access to all data within Merck or affiliated enterprises of Merck within the meaning of § 15 of the German Stock Corporation Act (“Merck Group”) concerning the Project as well as concerning the Project periphery (e.g. Decortin, Decortin H), which are required or useful within the framework of Nitec Pharma’s activities described in this Agreement. “Initial Application” is the date on which the first application for a legal pharmaceutical licence for the Project is filed in a country, which is a member of the European Union. “Ex-factory Price” is the list price of the product without discounts by Merck Group to each independent customer. “Production Costs” are all costs incurred by Nitec Pharma in the complete provision of Merchandise to one of Merck’s supply depots. “Patents” refer to all of Merck Group’s patents and/or applications and utility models with respect to the Project. “Project” refers to the galenic formulation containing Active Agents and which releases the latter in a delayed manner as more specifically described in Annex I. “Merchandise” refers to the primary and secondary project packed and released for marketing. “Bulk-Ware” refers to the galenic formulation approved for marketing, which still needs to undergo primary and secondary packing. 2 “Packing Instruments” comprises primary and secondary packing for Merchandise. “Rheumatoid Arthritis” refers to the indication for which Nitec Pharma initially endeavours to obtain Approval. “Active Agents” refer to Prednison, Prednisolon and Methylprednisolon. “Skye Pharma” shall mean Skye Pharma AG with its head office in Muttenz, Switzerland, is the company, which has participated in the development of the Project from the technical aspect and which is meant to undertake production of the bulk-ware at its Lyon production site. “Jagotec” shall mean Jagotec AG, a Swiss corporation having its head office at Eptingerstr. 51 in CH-6052 Hergiswil, Switzerland. “Option Area” are the national territories of Germany and Austria. 2. Third Party Contracts 2.1. Merck, subject only to the restriction set forth specifically in section 6 hereof, hereby assigns to Nitec Pharma the agreement attached hereto as Appendix 2.1 “Skye/Jagotec DLA”) between Merck and SkyePharma/Jagotec concerning the development and production of the Project, on the precondition that SkyePharma /Jagotec shall give its required consent thereto. For the purpose of said assignment, Merck shall continue the agreement until then. 2.2. The content of the agreement with SkyePharma/Jagotec is known to Nitec Pharma. All documents pertaining thereto, including correspondence concerning the agreement as well as other documents, which are useful for the implementation and interpretation thereof, shall be delivered to Nitec Pharma following the signing hereof. 3. Transfer of Rights and Know-How 3.1. Merck hereby sells, assigns and promises to otherwise transfer to and Nitec Pharma hereby purchases, accepts assignment and promises to accept delivery and/or transfer of the entire know-how obtained within the framework of the development of the Project to date, including all clinical test and stability patterns, experimental charges and all (also electronic) documents, including the correspondence to date (“Know-How”). Upon conclusion hereof the Know-How becomes the property of Nitec Pharma and shall be transferred promptly to Nitec Pharma after the signature of this Agreement to the extent that such transfer requires action beyond the signature of this Agreement. Insofar as it is set out in documents, on data carriers or represented in another manner (“Represented Know-How”), Merck shall store the Know-How in safe keeping for Nitec Pharma pending delivery thereof to the latter. In addition, Merck shall grant Nitec Pharma access to all of its know-how obtained with respect to the Active Agent. 3 3.2. Nitec Pharma shall assemble the Represented Know-How by 31st December 2004 at the latest at Merck’s premises, submit such know-how for Merck’s approval, and Merck shall thereupon deliver the same to Nitec Pharma promptly. 3.3. If the results of the development work performed hitherto are protected by copyrights or other industrial property rights, said rights are hereby assigned to Nitec Pharma and Nitec Pharma accepts such assignment. In the same manner, and subject to the condition precedent of the conferral of the required approval pursuant to section 13.4 of the Skye/Jagotec DLA, all of the industrial property rights acquired by Merck from Skye Pharma or from Jagotec on the basis of the Skye/Jagotec DLA within the framework of or in connection with the Skye/Jagotec DLA, are hereby assigned to Nitec Pharma and Nitec Pharma accepts such assignment. 3.4. The purchase price for such Know-How, Represented Know-How and the property rights as defined hereinabove shall be […***…]. Payment shall become due upon signature of this Agreement. 3.5. Should an assignment pursuant to section 3.1 and 3.3 hereof be impossible for legal reasons, Nitec Pharma is hereby granted […***…] a worldwide, exclusive, unlimited and unrestricted perpetual license to use these property rights (with the right to sublicense but subject to the following sentence). Said right of use shall not be transferable in connection with marketing and distributing Merchandise in the Option Area, but shall be transformed into a transferable right of use for such purpose as soon as Nitec Pharma becomes entitled to market and distribute or have marketed and distributed Merchandise in the Option Area in accordance with the provisions set forth in sec. 6 hereof. 3.6. Should the results of the development performed hitherto contain inventions or ideas capable of being protected, Nitec Pharma shall be entitled hereupon to apply for relevant protections in its own name and at its own costs – and where required by law, by naming the inventors pursuant to the statutory provisions in force from time to time - in any countries. 3.7. Should it be reasonably necessary or beneficial for the development and production of the Project to allow access to know-how and/or copyrights and/or industrial property rights from outside the development of the Project, whether owned or licensed or otherwise available to Merck or any other company within the Merck Group, Merck hereby grants Nitec Pharma and undertakes to use its best efforts to procure that Nitec Pharma is granted by any other company within the Merck Group a non-exclusive, […***…] license to use such know-how and/or copyrights and/or industrial property rights. The right to transfer such right shall be limited to affiliates of Nitec Pharma within the meaning of § 15 German Stock Corporation Act. Transfers to any other persons shall be limited to the following purposes: ","Query: As per this Technology Transfer Agreement between Merck KGaA and Nitec Pharma, what responsibilities regarding clinical and technical development in Germany and Austria does Nitec Pharma agree to? Instruction: Answer in one complete sentence. Add the relevant quoted piece of text from the context document in italics, at the end of your response. Context: ** TECHNOLOGY TRANSFER AGREEMENT ** Technology Transfer Agreement between Merck KGaA (“Merck”), Frankfurter Strasse 250, 64271 Darmstadt and Nitec Pharma AG (“Nitec Pharma”) Switzerland Preamble Merck has been marketing corticoids (Fortecortin, Decortin, Decortin H, Solu Decortin H) successfully – primarily in Germany – for many years. In order to support the corticoid business Merck started developing Prednison Night Time Release in 1998, which is a novel galenic formulation using the active agent prednison. For the treatment of rheumatoid arthritis (“RA”) the Project (as defined hereinafter) has not yet entered phase 3 of clinical testing. Merck due to limited resources and its focus on other business areas is unable to develop the Project until it is ready for marketing or to obtain a legal pharmaceutical licence for the Project. Merck therefore internally has decided to discontinue the Project. It now appears that Nitec Pharma may be able to resume the Project at its own cost and risk, see it through phase III clinical testing and obtain a license to market the Merchandise (as defined below) in Germany, Austria and other countries. In light of this development Merck is willing to transfer the Project to Nitec Pharma by turning over to Nitec Pharma all know-how acquired within the framework of and in connection with the Project and all pertinent industrial property rights. In particular Merck is willing to grant Nitec Pharma access to all data, which have accrued within the framework of the Project development and which are still to accrue pending the conclusion of the successful “Mutual Recognition Procedure”. As provided herein Nitec Pharma is willing to undertake to use all of its Commercially Reasonable Efforts (as defined below) to continue the clinical and technical development of the Project on its own, in particular using its own financial resources and at its own company risk and to obtain legal pharmaceutical approvals for relevant markets that have been identified by Nitec Pharma as promising markets and to confirm that Merck shall, under the terms specified in greater detail in section 6 hereof retain the right to market the Merchandise on an exclusive or non-exclusive basis in Germany and Austria and that such right shall only pass to Nitec Pharma as set forth in section 6 hereof. For this purpose the parties stipulate as follows: 1. Definitions “Technology Transfer Agreement” or “TTA” refers to this Agreement between Merck and Nitec Pharma. “Clinical Development” refers to the implementation of all clinical trials aimed at obtaining licences to market the Merchandise in Germany, Austria and other countries. “Commercially Reasonable Efforts” means those efforts and resources that Nitec Pharma would use were it developing, manufacturing, promoting and detailing the Active Agents as its own pharmaceutical products but taking into account clinical development results (including all safety, efficacy and cost issues), product labeling, regulatory review and approval issues, market potential, past performance, market potential, economic return, the general regulatory environment and competitive market conditions in the therapeutic area, all as measured by the facts and circumstances at the time such efforts are due. “Technical Development” refers to the implementation of all technical activities aimed at obtaining licences to market the Merchandise in Germany, Austria and other countries. “Approval” refers to the date on which an approval to market the Merchandise is granted in Germany and/or Austria. “Launch” refers to the day on which the Merchandise is brought onto the market in Germany and/or Austria. “Access to Data” refers to access to all data within Merck or affiliated enterprises of Merck within the meaning of § 15 of the German Stock Corporation Act (“Merck Group”) concerning the Project as well as concerning the Project periphery (e.g. Decortin, Decortin H), which are required or useful within the framework of Nitec Pharma’s activities described in this Agreement. “Initial Application” is the date on which the first application for a legal pharmaceutical licence for the Project is filed in a country, which is a member of the European Union. “Ex-factory Price” is the list price of the product without discounts by Merck Group to each independent customer. “Production Costs” are all costs incurred by Nitec Pharma in the complete provision of Merchandise to one of Merck’s supply depots. “Patents” refer to all of Merck Group’s patents and/or applications and utility models with respect to the Project. “Project” refers to the galenic formulation containing Active Agents and which releases the latter in a delayed manner as more specifically described in Annex I. “Merchandise” refers to the primary and secondary project packed and released for marketing. “Bulk-Ware” refers to the galenic formulation approved for marketing, which still needs to undergo primary and secondary packing. 2 “Packing Instruments” comprises primary and secondary packing for Merchandise. “Rheumatoid Arthritis” refers to the indication for which Nitec Pharma initially endeavours to obtain Approval. “Active Agents” refer to Prednison, Prednisolon and Methylprednisolon. “Skye Pharma” shall mean Skye Pharma AG with its head office in Muttenz, Switzerland, is the company, which has participated in the development of the Project from the technical aspect and which is meant to undertake production of the bulk-ware at its Lyon production site. “Jagotec” shall mean Jagotec AG, a Swiss corporation having its head office at Eptingerstr. 51 in CH-6052 Hergiswil, Switzerland. “Option Area” are the national territories of Germany and Austria. 2. Third Party Contracts 2.1. Merck, subject only to the restriction set forth specifically in section 6 hereof, hereby assigns to Nitec Pharma the agreement attached hereto as Appendix 2.1 “Skye/Jagotec DLA”) between Merck and SkyePharma/Jagotec concerning the development and production of the Project, on the precondition that SkyePharma /Jagotec shall give its required consent thereto. For the purpose of said assignment, Merck shall continue the agreement until then. 2.2. The content of the agreement with SkyePharma/Jagotec is known to Nitec Pharma. All documents pertaining thereto, including correspondence concerning the agreement as well as other documents, which are useful for the implementation and interpretation thereof, shall be delivered to Nitec Pharma following the signing hereof. 3. Transfer of Rights and Know-How 3.1. Merck hereby sells, assigns and promises to otherwise transfer to and Nitec Pharma hereby purchases, accepts assignment and promises to accept delivery and/or transfer of the entire know-how obtained within the framework of the development of the Project to date, including all clinical test and stability patterns, experimental charges and all (also electronic) documents, including the correspondence to date (“Know-How”). Upon conclusion hereof the Know-How becomes the property of Nitec Pharma and shall be transferred promptly to Nitec Pharma after the signature of this Agreement to the extent that such transfer requires action beyond the signature of this Agreement. Insofar as it is set out in documents, on data carriers or represented in another manner (“Represented Know-How”), Merck shall store the Know-How in safe keeping for Nitec Pharma pending delivery thereof to the latter. In addition, Merck shall grant Nitec Pharma access to all of its know-how obtained with respect to the Active Agent. 3 3.2. Nitec Pharma shall assemble the Represented Know-How by 31st December 2004 at the latest at Merck’s premises, submit such know-how for Merck’s approval, and Merck shall thereupon deliver the same to Nitec Pharma promptly. 3.3. If the results of the development work performed hitherto are protected by copyrights or other industrial property rights, said rights are hereby assigned to Nitec Pharma and Nitec Pharma accepts such assignment. In the same manner, and subject to the condition precedent of the conferral of the required approval pursuant to section 13.4 of the Skye/Jagotec DLA, all of the industrial property rights acquired by Merck from Skye Pharma or from Jagotec on the basis of the Skye/Jagotec DLA within the framework of or in connection with the Skye/Jagotec DLA, are hereby assigned to Nitec Pharma and Nitec Pharma accepts such assignment. 3.4. The purchase price for such Know-How, Represented Know-How and the property rights as defined hereinabove shall be […***…]. Payment shall become due upon signature of this Agreement. 3.5. Should an assignment pursuant to section 3.1 and 3.3 hereof be impossible for legal reasons, Nitec Pharma is hereby granted […***…] a worldwide, exclusive, unlimited and unrestricted perpetual license to use these property rights (with the right to sublicense but subject to the following sentence). Said right of use shall not be transferable in connection with marketing and distributing Merchandise in the Option Area, but shall be transformed into a transferable right of use for such purpose as soon as Nitec Pharma becomes entitled to market and distribute or have marketed and distributed Merchandise in the Option Area in accordance with the provisions set forth in sec. 6 hereof. 3.6. Should the results of the development performed hitherto contain inventions or ideas capable of being protected, Nitec Pharma shall be entitled hereupon to apply for relevant protections in its own name and at its own costs – and where required by law, by naming the inventors pursuant to the statutory provisions in force from time to time - in any countries. 3.7. Should it be reasonably necessary or beneficial for the development and production of the Project to allow access to know-how and/or copyrights and/or industrial property rights from outside the development of the Project, whether owned or licensed or otherwise available to Merck or any other company within the Merck Group, Merck hereby grants Nitec Pharma and undertakes to use its best efforts to procure that Nitec Pharma is granted by any other company within the Merck Group a non-exclusive, […***…] license to use such know-how and/or copyrights and/or industrial property rights. The right to transfer such right shall be limited to affiliates of Nitec Pharma within the meaning of § 15 German Stock Corporation Act. Transfers to any other persons shall be limited to the following purposes: ",Legal,Find & Summarize,Text Transformation You must respond to the prompt using only information provided in the context block. Please limit your response to about 150 words.,What is the relationship between operating flexibility and the amount of cash a firm holds?,"2.2.3. How does D&I affect financial policies? The previous section argues that diversity and inclusion (D&I) could affect a firm’s operating flexibility. In addition, a literature in financial economics indicates that a firm’s operating flexibility affects its financial policies. Thus, D&I could affect a firm’s financial policies as well. A literature in finance theorizes and documents that more operating flexibility allows a firm to hold less cash. Opler et al. (1999) argue that firms hold cash for precautionary motive, e.g., in case of an unexpected loss or an unexpected opportunity to invest (see Almeida et al. (2014) for a review). Since operating flexibility could help a firm mitigate losses from negative shocks and expand more easily following positive shocks, more operating flexibility would imply less of a precautionary motive to hold cash. Empirically, Gu and Li (2021) document that flexible firms hold less cash, and Ghaly, Anh Dang, and Stathopoulos (2017) show that firms with more inflexibility due to a dependence on skilled labor hold more cash. Another literature in finance argues that more operating flexibility could affect a firm’s debt policies. Kraus and Litzenberger (1973) theorize that a firm chooses its optimal debt ratio by trading off the tax shield benefit of debt and the cost of financial distress related to debt, both of which Gu, Hackbarth, and Li (2020) argue could be affected by operating flexibility. The argument is that a firm’s flexibility to downsize mitigates its losses in bad times, leading to a lower expected cost of financial distress. In addition, a firm’s flexibility to scale up in good times results in a higher taxable income, which increases the value of the debt tax shield. In other words, operating flexibility could both decrease the cost and increase the benefit of using debt, so a more flexible firm would optimally use more debt in its capital structure. This prediction holds in many empirical studies across different dimensions of operating flexibility, including production flexibility (Reinartz and Schmid (2016)), pricing flexibility (D’Acunto et al. (2018)), and workforce flexibility (Simintzi, Vig, and Volpin (2015), Serfling (2016), Bates, Du, and Wang (2020)). Because D&I can affect operating flexibility, and operating flexibility can affect cash holdings and debt usage, D&I can affect these financial policies. If D&I increases a firm’s operating flexibility, then a diverse and inclusive firm (D&I firm) would hold less cash and use more debt. If D&I decreases a firm’s operating flexibility, then I would expect the opposite. Beyond an indirect channel, D&I considerations could directly affect a firm’s cash and debt holdings as well. On the one hand, direct spending on D&I practices, such as the costs of sexual harassment training or diversity hiring, could reduce a firm’s financial resources, e.g., less cash. On the other hand, because building a D&I culture is likely costly (Gorton and Zentefis (2020)), a firm could have an incentive to hold more cash and use less debt to keep the financial flexibility needed to maintain such a culture. Overall, it is an empirical question how a firm’s D&I affects its financial policies. I formally state these hypotheses below in their null forms below: H2a: a D&I firm on average does not use more debt in its capital structure than a nonD&I firm. H2b: a D&I firm on average does not hold more cash on its balance sheet than a non-D&I firm. ","You must respond to the prompt using only information provided in the context block. Please limit your response to about 150 words. What is the relationship between operating flexibility and the amount of cash a firm holds? 2.2.3. How does D&I affect financial policies? The previous section argues that diversity and inclusion (D&I) could affect a firm’s operating flexibility. In addition, a literature in financial economics indicates that a firm’s operating flexibility affects its financial policies. Thus, D&I could affect a firm’s financial policies as well. A literature in finance theorizes and documents that more operating flexibility allows a firm to hold less cash. Opler et al. (1999) argue that firms hold cash for precautionary motive, e.g., in case of an unexpected loss or an unexpected opportunity to invest (see Almeida et al. (2014) for a review). Since operating flexibility could help a firm mitigate losses from negative shocks and expand more easily following positive shocks, more operating flexibility would imply less of a precautionary motive to hold cash. Empirically, Gu and Li (2021) document that flexible firms hold less cash, and Ghaly, Anh Dang, and Stathopoulos (2017) show that firms with more inflexibility due to a dependence on skilled labor hold more cash. Another literature in finance argues that more operating flexibility could affect a firm’s debt policies. Kraus and Litzenberger (1973) theorize that a firm chooses its optimal debt ratio by trading off the tax shield benefit of debt and the cost of financial distress related to debt, both of which Gu, Hackbarth, and Li (2020) argue could be affected by operating flexibility. The argument is that a firm’s flexibility to downsize mitigates its losses in bad times, leading to a lower expected cost of financial distress. In addition, a firm’s flexibility to scale up in good times results in a higher taxable income, which increases the value of the debt tax shield. In other words, operating flexibility could both decrease the cost and increase the benefit of using debt, so a more flexible firm would optimally use more debt in its capital structure. This prediction holds in many empirical studies across different dimensions of operating flexibility, including production flexibility (Reinartz and Schmid (2016)), pricing flexibility (D’Acunto et al. (2018)), and workforce flexibility (Simintzi, Vig, and Volpin (2015), Serfling (2016), Bates, Du, and Wang (2020)). Because D&I can affect operating flexibility, and operating flexibility can affect cash holdings and debt usage, D&I can affect these financial policies. If D&I increases a firm’s operating flexibility, then a diverse and inclusive firm (D&I firm) would hold less cash and use more debt. If D&I decreases a firm’s operating flexibility, then I would expect the opposite. Beyond an indirect channel, D&I considerations could directly affect a firm’s cash and debt holdings as well. On the one hand, direct spending on D&I practices, such as the costs of sexual harassment training or diversity hiring, could reduce a firm’s financial resources, e.g., less cash. On the other hand, because building a D&I culture is likely costly (Gorton and Zentefis (2020)), a firm could have an incentive to hold more cash and use less debt to keep the financial flexibility needed to maintain such a culture. Overall, it is an empirical question how a firm’s D&I affects its financial policies. I formally state these hypotheses below in their null forms below: H2a: a D&I firm on average does not use more debt in its capital structure than a nonD&I firm. H2b: a D&I firm on average does not hold more cash on its balance sheet than a non-D&I firm. ",Financial,Find & Summarize,Text Transformation "Provide your response in a professional and formal tone. Use the information given in the document without referring to external sources or requiring additional context. Avoid using technical jargon or acronyms that are not explained within the document.",What is Open AI doing to make sure AI doesn't threaten human existence.,"3/8/24, 11:07 AM OpenAI Charter https://openai.com/charter 1/5 Our Charter describes the principles we use to execute on OpenAI’s mission. OpenAI Charter 3/8/24, 11:07 AM OpenAI Charter https://openai.com/charter 2/5 Published April 9, 2018 This document reflects the strategy we’ve refined over the past two years, including feedback from many people internal and external to OpenAI. The timeline to AGI remains uncertain, but our Charter will guide us in acting in the best interests of humanity throughout its development. 3/8/24, 11:07 AM OpenAI Charter https://openai.com/charter 3/5 OpenAI’s mission is to ensure that artificial general intelligence (AGI)—by which we mean highly autonomous systems that outperform humans at most economically valuable work—benefits all of humanity. We will attempt to directly build safe and beneficial AGI, but will also consider our mission fulfilled if our work aids others to achieve this outcome. To that end, we commit to the following principles: Broadly distributed benefits We commit to use any influence we obtain over AGI’s deployment to ensure it is used for the benefit of all, and to avoid enabling uses of AI or AGI that harm humanity or unduly concentrate power. Our primary fiduciary duty is to humanity. We anticipate needing to marshal substantial resources to fulfill our mission, but will always diligently act to minimize conflicts of interest among our employees and stakeholders that could compromise broad benefit. Long-term safety We are committed to doing the research required to make AGI safe, and to driving the broad adoption of such research across the AI community. We are concerned about late-stage AGI development becoming a competitive race without time for adequate safety precautions. Therefore, if a value-aligned, safety-conscious project comes close to building AGI before we do, we commit to stop competing with and start assisting this project. We will work out specifics in case-by-case agreements, but a typical triggering condition might be “a better-than-even chance of success in the next two years.” Technical leadership To be effective at addressing AGI’s impact on society, OpenAI must be on the cutting edge of AI capabilities— policy and safety advocacy alone would be insufficient. We believe that AI will have broad societal impact before AGI, and we’ll strive to lead in those areas that are directly aligned with our mission and expertise. Cooperative orientation We will actively cooperate with other research and policy institutions; we seek to create a global community working together to address AGI’s global challenges. We are committed to providing public goods that help society navigate the path to AGI. Today this includes publishing most of our AI research, but we expect that safety and security concerns will reduce our traditional publishing in the future, while increasing the importance of sharing safety, policy, and standards research. Menu 3/8/24, 11:07 AM OpenAI Charter https://openai.com/charter 4/5 Research API ChatGPT Company OpenAI © 2015 – 2024 Social Overview Index GPT-4 DALL·E 3 Sora Overview Pricing Docs Overview Team Enterprise Pricing Try ChatGPT About Blog Careers Charter Security Customer stories Safety Terms & policies Privacy policy Brand guidelines Twitter YouTube GitHub SoundCloud LinkedIn Back to top 3/8/24, 11:07 AM OpenAI Charter https://openai.com/charter 5/5","Provide your response in a professional and formal tone. Use the information given in the document without referring to external sources or requiring additional context. Avoid using technical jargon or acronyms that are not explained within the document. What is Open AI doing to make sure AI doesn't threaten human existence. 3/8/24, 11:07 AM OpenAI Charter https://openai.com/charter 1/5 Our Charter describes the principles we use to execute on OpenAI’s mission. OpenAI Charter 3/8/24, 11:07 AM OpenAI Charter https://openai.com/charter 2/5 Published April 9, 2018 This document reflects the strategy we’ve refined over the past two years, including feedback from many people internal and external to OpenAI. The timeline to AGI remains uncertain, but our Charter will guide us in acting in the best interests of humanity throughout its development. 3/8/24, 11:07 AM OpenAI Charter https://openai.com/charter 3/5 OpenAI’s mission is to ensure that artificial general intelligence (AGI)—by which we mean highly autonomous systems that outperform humans at most economically valuable work—benefits all of humanity. We will attempt to directly build safe and beneficial AGI, but will also consider our mission fulfilled if our work aids others to achieve this outcome. To that end, we commit to the following principles: Broadly distributed benefits We commit to use any influence we obtain over AGI’s deployment to ensure it is used for the benefit of all, and to avoid enabling uses of AI or AGI that harm humanity or unduly concentrate power. Our primary fiduciary duty is to humanity. We anticipate needing to marshal substantial resources to fulfill our mission, but will always diligently act to minimize conflicts of interest among our employees and stakeholders that could compromise broad benefit. Long-term safety We are committed to doing the research required to make AGI safe, and to driving the broad adoption of such research across the AI community. We are concerned about late-stage AGI development becoming a competitive race without time for adequate safety precautions. Therefore, if a value-aligned, safety-conscious project comes close to building AGI before we do, we commit to stop competing with and start assisting this project. We will work out specifics in case-by-case agreements, but a typical triggering condition might be “a better-than-even chance of success in the next two years.” Technical leadership To be effective at addressing AGI’s impact on society, OpenAI must be on the cutting edge of AI capabilities— policy and safety advocacy alone would be insufficient. We believe that AI will have broad societal impact before AGI, and we’ll strive to lead in those areas that are directly aligned with our mission and expertise. Cooperative orientation We will actively cooperate with other research and policy institutions; we seek to create a global community working together to address AGI’s global challenges. We are committed to providing public goods that help society navigate the path to AGI. Today this includes publishing most of our AI research, but we expect that safety and security concerns will reduce our traditional publishing in the future, while increasing the importance of sharing safety, policy, and standards research. Menu 3/8/24, 11:07 AM OpenAI Charter https://openai.com/charter 4/5 Research API ChatGPT Company OpenAI © 2015 – 2024 Social Overview Index GPT-4 DALL·E 3 Sora Overview Pricing Docs Overview Team Enterprise Pricing Try ChatGPT About Blog Careers Charter Security Customer stories Safety Terms & policies Privacy policy Brand guidelines Twitter YouTube GitHub SoundCloud LinkedIn Back to top 3/8/24, 11:07 AM OpenAI Charter https://openai.com/charter 5/5",Internet/Technology,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Discuss the similarities and differences between a simple installment loan and a mortgage. Explain in what situations one option should be chosen over the other. Limit the discussion to 250 words.,"Installment Loans A loan is something that is borrowed. In the case where this is a sum of money the amount that will be paid by the borrower will include the original amount plus interest. Some loans require full payment on the maturity date of the loan. The maturity date is when all principal and/or interest must be repaid to the the lender. Consider a one year loan of $1000 at a simple interest rate of 5%. At the end of one year (the maturity date) the borrower will pay back the original $1000 plus the interest of $50 for a total of $1050. For major purchases such as vehicles or furniture there is a different type of loan, called the installment loan. The average consumer cannot afford to pay $25000 or more for a new vehicle and they may not want to wait three or four years until they have saved enough money to do so. The qualifying consumer has the option of paying for the item with an installment loan. Installment loans do not require full repayment of the loan on a specific date. With an installment loan the borrower is required to make regular (installment) payments until the loan is paid off. Each installment payment will include an interest charge. An installment loan can vary in length from a few years to perhaps twenty years or more (in the case of real estate). Consider an installment loan for a $4000 television. The purchaser takes out a $4000 loan with a four-year term at an interest rate of 4.5%. The monthly installment payments will be $91.21. Although the television has a purchase price of $4000, the total cost to the purchaser will be more than $4000. The total of the installment payments will be: Total Installment Payments = Number of Installment Payments x Payment Amount = 4 years x 12 payments/year x $91.21/mth = $4378.08 The $4000 television ends up costing $4378.08 because the consumer is charged interest. Each payment includes an interest component that adds to the overall cost of the item. The total of the interest charges is referred to as the finance charge on the loan. Finance Charge The finance charge is the sum of the interest charges on a loan. These interest charges are embedded in the installment payments. To calculate the finance charge: Finance Charge = Total Installment Payments – Loan Amount = (Number of Installment Payments x Payment Amount) – Loan Amount For the $4000 television the finance charge will be calculated as follows: Finance charge = Total Installment Payments – Loan Amount = (4 years x 12 payments/year x $91.21/payment) – $4000 = $4378.08 – $4000 = $378.08 Over the 4-year term of the loan the purchaser will have paid the $4000 loan amount plus an additional $378.08 in interest (the finance charge). Sometimes the borrower will make an initial payment at the time of purchase. This is called a down payment. When a down payment is made the remaining amount is the amount financed or the loan amount. Amount Financed The amount financed or loan amount is the purchase price of the item less any down payment: Amount Financed = Purchase Price – Down Payment Consider the $4000 television. Assume the purchaser makes a down payment of $1500. The amount financed is: Purchase Price – Down Payment = $4000 – $1500 = $2500. In this case the purchaser borrows $2500 rather than $4000. The amount financed is therefore $2500. Assuming the same 4-year term and an interest rate of 4.5%, the installment payments on the $2500 will be reduced to $57.01 per month. In this case the finance charge will be calculated as follows: Finance charge = Total Installment Payments – Loan Amount = (4 years x 12 payments/year x $57.01/payment) – $2500 = $2736.48 – $2500 = $236.48 With the down payment of $2500 the total finance charges will be reduced to $236.48 from $378.08. The total cost of the television to the purchaser will be: Purchase Price + Finance Charge = $4000 + $236.48 = $4236.48 Alternatively we can calculate: Total Installment Payment + Down Payment = $2736.48 + $1500 = $4236.48 As one can see, the finance charges are a hidden but added cost. This cost will become more pronounced with more expensive purchases such as with real estate. Loan Payments When consumers obtain installment loans they often just trust the lender to determine the installment (periodic) loan payments. In Example1 Paul purchased a home entertainment system at a total cost of $6000. He obtained a three year loan at an interest rate of 7.5%. If Paul attempts to calculate his monthly payment by simply dividing the loan amount by the number of payments he will underestimate his monthly payment as he has ignored the interest component: $6000 ÷ 36 = $166.67 Paul’s actual monthly payment of $186.64 is slightly higher than Paul’s estimate because of the interest component. The actual amount of a periodic loan payment can be determined using a formula, a table or technology. In this section we will illustrate the use of a formula. Amortization Amortization is the process of spreading out a loan into a series of fixed payments. A portion of each payment will be applied to the interest charge and a portion will be applied to the principal amount of the loan. Although each payment is equal, the amount that applies to the interest versus the prinipal will change with each payment period. We can get a better sense of the impact that a loan payment has by examining the amortization schedule for a loan. Consider the amortization table for the installment loan in Example 5. Recall that the loan amount is $5000 at 6% for 5 years and annual payments are $1186.98. Note then that for each year the sum of the interest and principal is equivalent to the payment of $1186.98. Refer to Figure 1 for the amortization schedule of this loan. Mortgages A long term loan that is used for the purchase of a house is called a mortgage. It is called a mortgage because the lending agency requires that the house be used as collateral for the loan. This means that if the mortgage holder is unable to make the payments the lender can take possession of the house. Mortgages generally tend to be for longer time periods than an installment loan and the terms of the mortgage will often change over the course of the mortgage. Take for example the purchase of a house with a twenty year mortgage. The purchaser might sign a mortgage agreement for a five year term. The mortgage agreement will include the interest rate, the frequency of payments and additional rules which may allow the mortgage holder to make lump sum payments or change the payment amount. At the end of the five year term a new agreement will be required and the conditions of the mortgage usually change. Although it is possible to do the calculations manually, that is beyond the scope of this book. We will use technology to calculate the periodic payments and interest charges and to generate an amortization schedule. Example 8 will illustrate that amortizing a mortgage is similar to amortizing other loans except that the mortgage amortization generally involves many more payment periods.","[question] Discuss the similarities and differences between a simple installment loan and a mortgage. Explain in what situations one option should be chosen over the other. Limit the discussion to 250 words. ===================== [text] Installment Loans A loan is something that is borrowed. In the case where this is a sum of money the amount that will be paid by the borrower will include the original amount plus interest. Some loans require full payment on the maturity date of the loan. The maturity date is when all principal and/or interest must be repaid to the the lender. Consider a one year loan of $1000 at a simple interest rate of 5%. At the end of one year (the maturity date) the borrower will pay back the original $1000 plus the interest of $50 for a total of $1050. For major purchases such as vehicles or furniture there is a different type of loan, called the installment loan. The average consumer cannot afford to pay $25000 or more for a new vehicle and they may not want to wait three or four years until they have saved enough money to do so. The qualifying consumer has the option of paying for the item with an installment loan. Installment loans do not require full repayment of the loan on a specific date. With an installment loan the borrower is required to make regular (installment) payments until the loan is paid off. Each installment payment will include an interest charge. An installment loan can vary in length from a few years to perhaps twenty years or more (in the case of real estate). Consider an installment loan for a $4000 television. The purchaser takes out a $4000 loan with a four-year term at an interest rate of 4.5%. The monthly installment payments will be $91.21. Although the television has a purchase price of $4000, the total cost to the purchaser will be more than $4000. The total of the installment payments will be: Total Installment Payments = Number of Installment Payments x Payment Amount = 4 years x 12 payments/year x $91.21/mth = $4378.08 The $4000 television ends up costing $4378.08 because the consumer is charged interest. Each payment includes an interest component that adds to the overall cost of the item. The total of the interest charges is referred to as the finance charge on the loan. Finance Charge The finance charge is the sum of the interest charges on a loan. These interest charges are embedded in the installment payments. To calculate the finance charge: Finance Charge = Total Installment Payments – Loan Amount = (Number of Installment Payments x Payment Amount) – Loan Amount For the $4000 television the finance charge will be calculated as follows: Finance charge = Total Installment Payments – Loan Amount = (4 years x 12 payments/year x $91.21/payment) – $4000 = $4378.08 – $4000 = $378.08 Over the 4-year term of the loan the purchaser will have paid the $4000 loan amount plus an additional $378.08 in interest (the finance charge). Sometimes the borrower will make an initial payment at the time of purchase. This is called a down payment. When a down payment is made the remaining amount is the amount financed or the loan amount. Amount Financed The amount financed or loan amount is the purchase price of the item less any down payment: Amount Financed = Purchase Price – Down Payment Consider the $4000 television. Assume the purchaser makes a down payment of $1500. The amount financed is: Purchase Price – Down Payment = $4000 – $1500 = $2500. In this case the purchaser borrows $2500 rather than $4000. The amount financed is therefore $2500. Assuming the same 4-year term and an interest rate of 4.5%, the installment payments on the $2500 will be reduced to $57.01 per month. In this case the finance charge will be calculated as follows: Finance charge = Total Installment Payments – Loan Amount = (4 years x 12 payments/year x $57.01/payment) – $2500 = $2736.48 – $2500 = $236.48 With the down payment of $2500 the total finance charges will be reduced to $236.48 from $378.08. The total cost of the television to the purchaser will be: Purchase Price + Finance Charge = $4000 + $236.48 = $4236.48 Alternatively we can calculate: Total Installment Payment + Down Payment = $2736.48 + $1500 = $4236.48 As one can see, the finance charges are a hidden but added cost. This cost will become more pronounced with more expensive purchases such as with real estate. Loan Payments When consumers obtain installment loans they often just trust the lender to determine the installment (periodic) loan payments. In Example1 Paul purchased a home entertainment system at a total cost of $6000. He obtained a three year loan at an interest rate of 7.5%. If Paul attempts to calculate his monthly payment by simply dividing the loan amount by the number of payments he will underestimate his monthly payment as he has ignored the interest component: $6000 ÷ 36 = $166.67 Paul’s actual monthly payment of $186.64 is slightly higher than Paul’s estimate because of the interest component. The actual amount of a periodic loan payment can be determined using a formula, a table or technology. In this section we will illustrate the use of a formula. Amortization Amortization is the process of spreading out a loan into a series of fixed payments. A portion of each payment will be applied to the interest charge and a portion will be applied to the principal amount of the loan. Although each payment is equal, the amount that applies to the interest versus the prinipal will change with each payment period. We can get a better sense of the impact that a loan payment has by examining the amortization schedule for a loan. Consider the amortization table for the installment loan in Example 5. Recall that the loan amount is $5000 at 6% for 5 years and annual payments are $1186.98. Note then that for each year the sum of the interest and principal is equivalent to the payment of $1186.98. Refer to Figure 1 for the amortization schedule of this loan. Mortgages A long term loan that is used for the purchase of a house is called a mortgage. It is called a mortgage because the lending agency requires that the house be used as collateral for the loan. This means that if the mortgage holder is unable to make the payments the lender can take possession of the house. Mortgages generally tend to be for longer time periods than an installment loan and the terms of the mortgage will often change over the course of the mortgage. Take for example the purchase of a house with a twenty year mortgage. The purchaser might sign a mortgage agreement for a five year term. The mortgage agreement will include the interest rate, the frequency of payments and additional rules which may allow the mortgage holder to make lump sum payments or change the payment amount. At the end of the five year term a new agreement will be required and the conditions of the mortgage usually change. Although it is possible to do the calculations manually, that is beyond the scope of this book. We will use technology to calculate the periodic payments and interest charges and to generate an amortization schedule. Example 8 will illustrate that amortizing a mortgage is similar to amortizing other loans except that the mortgage amortization generally involves many more payment periods. https://opentextbc.ca/businesstechnicalmath/chapter/9-5-loans-mortgages/ ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Financial,Pros & Cons,Q&A "use only the context you are provided to answer. include every isp mentioned. use bullet points, then no more than 25 words to explain. focus on direct actions made.",what have isps done to transition into edge providers?,"Examples of ISPs Becoming Edge Providers AT&T. AT&T owns part of the internet backbone and is considered a Tier 1 ISP, meaning it has free access to the entire U.S. internet region.10 It is also a mobile carrier and provides voice services and video programming.11 In 2018, AT&T acquired Time Warner, a content creator that owns HBO and its affiliated edge provider HBO NOW, as well as other cable channels.12 The DOJ unsuccessfully attempted to block the merger.13 AT&T has announced plans to introduce a new edge provider—HBO Max—to stream video programming for no extra charge to AT&T customers who are also HBO subscribers; other customers will reportedly be charged a subscription fee.14 10 DrPeering.net. “Who Are the Tier 1 ISPs?” accessed on December 4, 2019, https://drpeering.net/FAQ/Who-are-the- Tier-1-ISPs.php. Edge providers associated with Tier 1 ISPs may have additional competitive advantages through the ISPs’ ability to send content to any part of the internet for free. Edge providers associated with other ISPs may have to pay or barter with Tier 1 or other ISPs to access certain destinations. Details on how Tier 1 ISPs compete with other ISPs are beyond the scope of this report. 11 See https://www.att.com/gen/general?pid=7462 for more information on the digital and communications infrastructure owned by AT&T. AT&T has stated that it considers its television subscription service to be a “video service” under the Communications Act of 1934, as amended, rather than a cable service. See AT&T Inc., SEC Form 10-K for the year ending December 31, 2014, p. 3. 12 Edmund Lee and Cecilia King, “U.S. Loses Appeal Seeking to Block AT&T-Time Warner Merger,” New York Times, February 26, 2019, https://www.nytimes.com/2019/02/26/business/media/att-time-warner-appeal.html. 13 Ibid; see CRS In Focus IF10526, AT&T-Time Warner Merger Overview, by Dana A. Scherer, for more information on the merger and the court case. 14 Helen Coster and Kenneth Li, “Behind AT&T’s Plan to Take on Netflix, Apple, and Disney with HBO Max,” Competition on the Edge of the Internet Congressional Research Service 5 Comcast. Comcast is an ISP, a cable television service, and a voice service provider. In 2011, Comcast became the majority owner of NBCUniversal, which owns television networks and broadcast stations, and thus obtained minority ownership of Hulu, an edge provider that streams video programming to subscribers.15 In 2019, Walt Disney Company obtained “full operational control” of Hulu, but Comcast retained its 33% financial stake.16 Comcast also announced plans to launch its own video streaming service, Peacock. Comcast reportedly plans to offer three subscription options for Peacock: a free option supported by ads, a premium version with more programming for a fee, and the premium version with no ads for a higher fee.17 The premium version is to be offered for free to subscribers of Comcast and Cox Communications. Verizon. Verizon owns part of the internet backbone and is considered a Tier 1 ISP.18 It is also a mobile carrier, and offers video, voice, and ISP services. In 2015, Verizon acquired AOL, an ISP and edge provider, and in 2016, it acquired the core business of Yahoo, an edge provider.19 It combined the edge provider products from these acquisitions—such as Yahoo Finance, Huffington Post, TechCrunch, and Engadget—in 2017 to create Oath.20 Examples of Edge Providers Becoming ISPs Google. Google is the largest subsidiary of the company Alphabet.21 It offers multiple products, including a search engine, email server, word processing, video streaming, and mapping/navigation system.22 Google generally relies on other ISPs to deliver its content, but entered the ISP market in 2010 when it announced Google Fiber. Google Fiber provides broadband internet service and video programming.23 Beginning in 2016, it suspended or ended some of its projects; as of October 2019, it had installed fiber optic cables in 18 cities.24 Reuters, October 25, 2019, https://www.reuters.com/article/us-media-at-t-hbo-max-focus/behind-atts-plan-to-take-on- netflix-apple-and-disney-with-hbo-max-idUSKBN1X4163. 15 Yinka Adegoke and Dan Levine, “Comcast Completes NBC Universal Merger,” Reuters, January 29, 2011, https://www.reuters.com/article/us-comcast-nbc/comcast-completes-nbc-universal-merger- idUSTRE70S2WZ20110129. 16 Lauren Feiner, Christine Wang, and Alex Sherman, “Disney to Take Full Control over Hulu, Comcast Has Option to Sell Its Stake in 5 years,” CNBC, May 14, 2019, https://www.cnbc.com/2019/05/14/comcast-has-agreed-to-sell-its- stake-in-hulu-in-5-years.html. 17 Gerry Smith, “NBC’s Peacock Bets Viewers Will Watch Ads to Stream for Free,” Bloomberg, January 16, 2020, https://www.bloomberg.com/news/articles/2020-01-16/nbc-s-peacock-bets-consumers-will-watch-ads-to-stream-for- free. 18 DrPeering.net. “Who Are the Tier 1 ISPs?” accessed on December 4, 2019, https://drpeering.net/FAQ/Who-are-the- Tier-1-ISPs.php. 19 Verizon, “Mergers & Acquisitions,” accessed on October 28, 2019, https://www.verizon.com/about/timeline- categories/mergers-acquisitions. 20 Tracey Lien, “Verizon Buys Yahoo for $4.8 Billion, and It’s Giving Yahoo’s Brand Another Chance,” Los Angeles Times, July 25, 2016, https://www.latimes.com/business/technology/la-fi-verizon-buys-yahoo-20160725-snap- story.html. 21 Larry Page, “G Is for Google,” Google Official Blog, August 10, 2015, https://googleblog.blogspot.com/2015/08/google-alphabet.html. 22 Google, “Our Products,” accessed on November 16, 2019, https://about.google/products. 23 Google, “Think Big with a Gig: Our Experimental Fiber Network,” February 10, 2010, https://googleblog.blogspot.com/2010/02/think-big-with-gig-our-experimental.html. 24 Jack Nicas, “Google’s High-Speed Web Plans Hit Snags,” Wall Street Journal, August 15, 2016, https://www.wsj.com/articles/googles-high-speed-web-plans-hit-snags-1471193165; Lauren Feiner, “Google Fiber’s High-Speed Internet Service Is Leaving Louisville After Ripping up Roads and Leaving Cables Exposed,” CNBC, February 7, 2019, https://www.cnbc.com/2019/02/07/google-fiber-pulls-out-of-louisville.html; Google, “Our Cities,” Competition on the Edge of the Internet Congressional Research Service 6 Facebook. As it attracted more users, Facebook expanded from providing an online platform that connects users to an online platform suitable for various activities, including fundraising, messaging, and commerce. In 2018, a spokesman confirmed that Facebook was pursuing another project, dubbed Athena.25 Athena is an experimental satellite that would beam internet access through radio signals. If successful, Athena would enable Facebook to become an ISP. Amazon. In addition to being a major online retailer, Amazon offers information technology infrastructure services through Amazon Web Services.26 In 2019, Amazon confirmed plans— dubbed Project Kuiper—to launch 3,236 satellites into low-Earth orbit to provide broadband internet across the world. If successful, Project Kuiper would enable Amazon to become an ISP.27","use only the context you are provided to answer. include every isp mentioned. use bullet points, then no more than 25 words to explain. focus on direct actions made. what have isps done to transition into edge providers? Examples of ISPs Becoming Edge Providers AT&T. AT&T owns part of the internet backbone and is considered a Tier 1 ISP, meaning it has free access to the entire U.S. internet region.10 It is also a mobile carrier and provides voice services and video programming.11 In 2018, AT&T acquired Time Warner, a content creator that owns HBO and its affiliated edge provider HBO NOW, as well as other cable channels.12 The DOJ unsuccessfully attempted to block the merger.13 AT&T has announced plans to introduce a new edge provider—HBO Max—to stream video programming for no extra charge to AT&T customers who are also HBO subscribers; other customers will reportedly be charged a subscription fee.14 10 DrPeering.net. “Who Are the Tier 1 ISPs?” accessed on December 4, 2019, https://drpeering.net/FAQ/Who-are-the- Tier-1-ISPs.php. Edge providers associated with Tier 1 ISPs may have additional competitive advantages through the ISPs’ ability to send content to any part of the internet for free. Edge providers associated with other ISPs may have to pay or barter with Tier 1 or other ISPs to access certain destinations. Details on how Tier 1 ISPs compete with other ISPs are beyond the scope of this report. 11 See https://www.att.com/gen/general?pid=7462 for more information on the digital and communications infrastructure owned by AT&T. AT&T has stated that it considers its television subscription service to be a “video service” under the Communications Act of 1934, as amended, rather than a cable service. See AT&T Inc., SEC Form 10-K for the year ending December 31, 2014, p. 3. 12 Edmund Lee and Cecilia King, “U.S. Loses Appeal Seeking to Block AT&T-Time Warner Merger,” New York Times, February 26, 2019, https://www.nytimes.com/2019/02/26/business/media/att-time-warner-appeal.html. 13 Ibid; see CRS In Focus IF10526, AT&T-Time Warner Merger Overview, by Dana A. Scherer, for more information on the merger and the court case. 14 Helen Coster and Kenneth Li, “Behind AT&T’s Plan to Take on Netflix, Apple, and Disney with HBO Max,” Competition on the Edge of the Internet Congressional Research Service 5 Comcast. Comcast is an ISP, a cable television service, and a voice service provider. In 2011, Comcast became the majority owner of NBCUniversal, which owns television networks and broadcast stations, and thus obtained minority ownership of Hulu, an edge provider that streams video programming to subscribers.15 In 2019, Walt Disney Company obtained “full operational control” of Hulu, but Comcast retained its 33% financial stake.16 Comcast also announced plans to launch its own video streaming service, Peacock. Comcast reportedly plans to offer three subscription options for Peacock: a free option supported by ads, a premium version with more programming for a fee, and the premium version with no ads for a higher fee.17 The premium version is to be offered for free to subscribers of Comcast and Cox Communications. Verizon. Verizon owns part of the internet backbone and is considered a Tier 1 ISP.18 It is also a mobile carrier, and offers video, voice, and ISP services. In 2015, Verizon acquired AOL, an ISP and edge provider, and in 2016, it acquired the core business of Yahoo, an edge provider.19 It combined the edge provider products from these acquisitions—such as Yahoo Finance, Huffington Post, TechCrunch, and Engadget—in 2017 to create Oath.20 Examples of Edge Providers Becoming ISPs Google. Google is the largest subsidiary of the company Alphabet.21 It offers multiple products, including a search engine, email server, word processing, video streaming, and mapping/navigation system.22 Google generally relies on other ISPs to deliver its content, but entered the ISP market in 2010 when it announced Google Fiber. Google Fiber provides broadband internet service and video programming.23 Beginning in 2016, it suspended or ended some of its projects; as of October 2019, it had installed fiber optic cables in 18 cities.24 Reuters, October 25, 2019, https://www.reuters.com/article/us-media-at-t-hbo-max-focus/behind-atts-plan-to-take-on- netflix-apple-and-disney-with-hbo-max-idUSKBN1X4163. 15 Yinka Adegoke and Dan Levine, “Comcast Completes NBC Universal Merger,” Reuters, January 29, 2011, https://www.reuters.com/article/us-comcast-nbc/comcast-completes-nbc-universal-merger- idUSTRE70S2WZ20110129. 16 Lauren Feiner, Christine Wang, and Alex Sherman, “Disney to Take Full Control over Hulu, Comcast Has Option to Sell Its Stake in 5 years,” CNBC, May 14, 2019, https://www.cnbc.com/2019/05/14/comcast-has-agreed-to-sell-its- stake-in-hulu-in-5-years.html. 17 Gerry Smith, “NBC’s Peacock Bets Viewers Will Watch Ads to Stream for Free,” Bloomberg, January 16, 2020, https://www.bloomberg.com/news/articles/2020-01-16/nbc-s-peacock-bets-consumers-will-watch-ads-to-stream-for- free. 18 DrPeering.net. “Who Are the Tier 1 ISPs?” accessed on December 4, 2019, https://drpeering.net/FAQ/Who-are-the- Tier-1-ISPs.php. 19 Verizon, “Mergers & Acquisitions,” accessed on October 28, 2019, https://www.verizon.com/about/timeline- categories/mergers-acquisitions. 20 Tracey Lien, “Verizon Buys Yahoo for $4.8 Billion, and It’s Giving Yahoo’s Brand Another Chance,” Los Angeles Times, July 25, 2016, https://www.latimes.com/business/technology/la-fi-verizon-buys-yahoo-20160725-snap- story.html. 21 Larry Page, “G Is for Google,” Google Official Blog, August 10, 2015, https://googleblog.blogspot.com/2015/08/google-alphabet.html. 22 Google, “Our Products,” accessed on November 16, 2019, https://about.google/products. 23 Google, “Think Big with a Gig: Our Experimental Fiber Network,” February 10, 2010, https://googleblog.blogspot.com/2010/02/think-big-with-gig-our-experimental.html. 24 Jack Nicas, “Google’s High-Speed Web Plans Hit Snags,” Wall Street Journal, August 15, 2016, https://www.wsj.com/articles/googles-high-speed-web-plans-hit-snags-1471193165; Lauren Feiner, “Google Fiber’s High-Speed Internet Service Is Leaving Louisville After Ripping up Roads and Leaving Cables Exposed,” CNBC, February 7, 2019, https://www.cnbc.com/2019/02/07/google-fiber-pulls-out-of-louisville.html; Google, “Our Cities,” Competition on the Edge of the Internet Congressional Research Service 6 Facebook. As it attracted more users, Facebook expanded from providing an online platform that connects users to an online platform suitable for various activities, including fundraising, messaging, and commerce. In 2018, a spokesman confirmed that Facebook was pursuing another project, dubbed Athena.25 Athena is an experimental satellite that would beam internet access through radio signals. If successful, Athena would enable Facebook to become an ISP. Amazon. In addition to being a major online retailer, Amazon offers information technology infrastructure services through Amazon Web Services.26 In 2019, Amazon confirmed plans— dubbed Project Kuiper—to launch 3,236 satellites into low-Earth orbit to provide broadband internet across the world. If successful, Project Kuiper would enable Amazon to become an ISP.27",Internet/Technology,Find & Summarize,Text Transformation Only use the text provided in the context block to answer the question.,"Why would ""hard"" science-fiction writers struggle to conceptualize the future?","Abstract Within thirty years, we will have the technological means to create superhuman intelligence. Shortly after, the human era will be ended. Is such progress avoidable? If not to be avoided, can events be guided so that we may survive? These questions are investigated. Some possible answers (and some further dangers) are presented. _What is The Singularity?_ The acceleration of technological progress has been the central feature of this century. I argue in this paper that we are on the edge of change comparable to the rise of human life on Earth. The precise cause of this change is the imminent creation by technology of entities with greater than human intelligence. There are several means by which science may achieve this breakthrough (and this is another reason for having confidence that the event will occur): o The development of computers that are ""awake"" and superhumanly intelligent. (To date, most controversy in the area of AI relates to whether we can create human equivalence in a machine. But if the answer is ""yes, we can"", then there is little doubt that beings more intelligent can be constructed shortly thereafter. o Large computer networks (and their associated users) may ""wake up"" as a superhumanly intelligent entity. o Computer/human interfaces may become so intimate that users may reasonably be considered superhumanly intelligent. o Biological science may find ways to improve upon the natural human intellect. The first three possibilities depend in large part on improvements in computer hardware. Progress in computer hardware has followed an amazingly steady curve in the last few decades [16]. Based largely on this trend, I believe that the creation of greater than human intelligence will occur during the next thirty years. (Charles Platt [19] has pointed out the AI enthusiasts have been making claims like this for the last thirty years. Just so I'm not guilty of a relative-time ambiguity, let me more specific: I'll be surprised if this event occurs before 2005 or after 2030.) What are the consequences of this event? When greater-than-human intelligence drives progress, that progress will be much more rapid. In fact, there seems no reason why progress itself would not involve the creation of still more intelligent entities -- on a still-shorter time scale. The best analogy that I see is with the evolutionary past: Animals can adapt to problems and make inventions, but often no faster than natural selection can do its work -- the world acts as its own simulator in the case of natural selection. We humans have the ability to internalize the world and conduct ""what if's"" in our heads; we can solve many problems thousands of times faster than natural selection. Now, by creating the means to execute those simulations at much higher speeds, we are entering a regime as radically different from our human past as we humans are from the lower animals. From the human point of view this change will be a throwing away of all the previous rules, perhaps in the blink of an eye, an exponential runaway beyond any hope of control. Developments that before were thought might only happen in ""a million years"" (if ever) will likely happen in the next century. (In [4], Greg Bear paints a picture of the major changes happening in a matter of hours.) I think it's fair to call this event a singularity (""the Singularity"" for the purposes of this paper). It is a point where our models must be discarded and a new reality rules. As we move closer and closer to this point, it will loom vaster and vaster over human affairs till the notion becomes a commonplace. Yet when it finally happens it may still be a great surprise and a greater unknown. In the 1950s there were very few who saw it: Stan Ulam [27] paraphrased John von Neumann as saying: One conversation centered on the ever accelerating progress of technology and changes in the mode of human life, which gives the appearance of approaching some essential singularity in the history of the race beyond which human affairs, as we know them, could not continue. Von Neumann even uses the term singularity, though it appears he is still thinking of normal progress, not the creation of superhuman intellect. (For me, the superhumanity is the essence of the Singularity. Without that we would get a glut of technical riches, never properly absorbed (see [24]).) In the 1960s there was recognition of some of the implications of superhuman intelligence. I. J. Good wrote [10]: Let an ultraintelligent machine be defined as a machine that can far surpass all the intellectual activities of any any man however clever. Since the design of machines is one of these intellectual activities, an ultraintelligent machine could design even better machines; there would then unquestionably be an ""intelligence explosion,"" and the intelligence of man would be left far behind. Thus the first ultraintelligent machine is the _last_ invention that man need ever make, provided that the machine is docile enough to tell us how to keep it under control. ... It is more probable than not that, within the twentieth century, an ultraintelligent machine will be built and that it will be the last invention that man need make. Good has captured the essence of the runaway, but does not pursue its most disturbing consequences. Any intelligent machine of the sort he describes would not be humankind's ""tool"" -- any more than humans are the tools of rabbits or robins or chimpanzees. Through the '60s and '70s and '80s, recognition of the cataclysm spread [28] [1] [30] [4]. Perhaps it was the science-fiction writers who felt the first concrete impact. After all, the ""hard"" science-fiction writers are the ones who try to write specific stories about all that technology may do for us. More and more, these writers felt an opaque wall across the future. Once, they could put such fantasies millions of years in the future [23]. Now they saw that their most diligent extrapolations resulted in the unknowable ... soon. Once, galactic empires might have seemed a Post-Human domain. Now, sadly, even interplanetary ones are. What about the '90s and the '00s and the '10s, as we slide toward the edge? How will the approach of the Singularity spread across the human world view? For a while yet, the general critics of machine sapience will have good press. After all, till we have hardware as powerful as a human brain it is probably foolish to think we'll be able to create human equivalent (or greater) intelligence. (There is the far-fetched possibility that we could make a human equivalent out of less powerful hardware, if were willing to give up speed, if we were willing to settle for an artificial being who was literally slow [29]. But it's much more likely that devising the software will be a tricky process, involving lots of false starts and experimentation. If so, then the arrival of self-aware machines will not happen till after the development of hardware that is substantially more powerful than humans' natural equipment.) But as time passes, we should see more symptoms. The dilemma felt by science fiction writers will be perceived in other creative endeavors. (I have heard thoughtful comic book writers worry about how to have spectacular effects when everything visible can be produced by the technically commonplace.) We will see automation replacing higher and higher level jobs. We have tools right now (symbolic math programs, cad/cam) that release us from most low-level drudgery. Or put another way: The work that is truly productive is the domain of a steadily smaller and more elite fraction of humanity. In the coming of the Singularity, we are seeing the predictions of _true_ technological unemployment finally come true. Another symptom of progress toward the Singularity: ideas themselves should spread ever faster, and even the most radical will quickly become commonplace. When I began writing, it seemed very easy to come up with ideas that took decades to percolate into the cultural consciousness; now the lead time seems more like eighteen months. (Of course, this could just be me losing my imagination as I get old, but I see the effect in others too.) Like the shock in a compressible flow, the Singularity moves closer as we accelerate through the critical speed.","Only use the text provided in the context block to answer the question. Why would ""hard"" science-fiction writers struggle to conceptualize the future? Abstract Within thirty years, we will have the technological means to create superhuman intelligence. Shortly after, the human era will be ended. Is such progress avoidable? If not to be avoided, can events be guided so that we may survive? These questions are investigated. Some possible answers (and some further dangers) are presented. _What is The Singularity?_ The acceleration of technological progress has been the central feature of this century. I argue in this paper that we are on the edge of change comparable to the rise of human life on Earth. The precise cause of this change is the imminent creation by technology of entities with greater than human intelligence. There are several means by which science may achieve this breakthrough (and this is another reason for having confidence that the event will occur): o The development of computers that are ""awake"" and superhumanly intelligent. (To date, most controversy in the area of AI relates to whether we can create human equivalence in a machine. But if the answer is ""yes, we can"", then there is little doubt that beings more intelligent can be constructed shortly thereafter. o Large computer networks (and their associated users) may ""wake up"" as a superhumanly intelligent entity. o Computer/human interfaces may become so intimate that users may reasonably be considered superhumanly intelligent. o Biological science may find ways to improve upon the natural human intellect. The first three possibilities depend in large part on improvements in computer hardware. Progress in computer hardware has followed an amazingly steady curve in the last few decades [16]. Based largely on this trend, I believe that the creation of greater than human intelligence will occur during the next thirty years. (Charles Platt [19] has pointed out the AI enthusiasts have been making claims like this for the last thirty years. Just so I'm not guilty of a relative-time ambiguity, let me more specific: I'll be surprised if this event occurs before 2005 or after 2030.) What are the consequences of this event? When greater-than-human intelligence drives progress, that progress will be much more rapid. In fact, there seems no reason why progress itself would not involve the creation of still more intelligent entities -- on a still-shorter time scale. The best analogy that I see is with the evolutionary past: Animals can adapt to problems and make inventions, but often no faster than natural selection can do its work -- the world acts as its own simulator in the case of natural selection. We humans have the ability to internalize the world and conduct ""what if's"" in our heads; we can solve many problems thousands of times faster than natural selection. Now, by creating the means to execute those simulations at much higher speeds, we are entering a regime as radically different from our human past as we humans are from the lower animals. From the human point of view this change will be a throwing away of all the previous rules, perhaps in the blink of an eye, an exponential runaway beyond any hope of control. Developments that before were thought might only happen in ""a million years"" (if ever) will likely happen in the next century. (In [4], Greg Bear paints a picture of the major changes happening in a matter of hours.) I think it's fair to call this event a singularity (""the Singularity"" for the purposes of this paper). It is a point where our models must be discarded and a new reality rules. As we move closer and closer to this point, it will loom vaster and vaster over human affairs till the notion becomes a commonplace. Yet when it finally happens it may still be a great surprise and a greater unknown. In the 1950s there were very few who saw it: Stan Ulam [27] paraphrased John von Neumann as saying: One conversation centered on the ever accelerating progress of technology and changes in the mode of human life, which gives the appearance of approaching some essential singularity in the history of the race beyond which human affairs, as we know them, could not continue. Von Neumann even uses the term singularity, though it appears he is still thinking of normal progress, not the creation of superhuman intellect. (For me, the superhumanity is the essence of the Singularity. Without that we would get a glut of technical riches, never properly absorbed (see [24]).) In the 1960s there was recognition of some of the implications of superhuman intelligence. I. J. Good wrote [10]: Let an ultraintelligent machine be defined as a machine that can far surpass all the intellectual activities of any any man however clever. Since the design of machines is one of these intellectual activities, an ultraintelligent machine could design even better machines; there would then unquestionably be an ""intelligence explosion,"" and the intelligence of man would be left far behind. Thus the first ultraintelligent machine is the _last_ invention that man need ever make, provided that the machine is docile enough to tell us how to keep it under control. ... It is more probable than not that, within the twentieth century, an ultraintelligent machine will be built and that it will be the last invention that man need make. Good has captured the essence of the runaway, but does not pursue its most disturbing consequences. Any intelligent machine of the sort he describes would not be humankind's ""tool"" -- any more than humans are the tools of rabbits or robins or chimpanzees. Through the '60s and '70s and '80s, recognition of the cataclysm spread [28] [1] [30] [4]. Perhaps it was the science-fiction writers who felt the first concrete impact. After all, the ""hard"" science-fiction writers are the ones who try to write specific stories about all that technology may do for us. More and more, these writers felt an opaque wall across the future. Once, they could put such fantasies millions of years in the future [23]. Now they saw that their most diligent extrapolations resulted in the unknowable ... soon. Once, galactic empires might have seemed a Post-Human domain. Now, sadly, even interplanetary ones are. What about the '90s and the '00s and the '10s, as we slide toward the edge? How will the approach of the Singularity spread across the human world view? For a while yet, the general critics of machine sapience will have good press. After all, till we have hardware as powerful as a human brain it is probably foolish to think we'll be able to create human equivalent (or greater) intelligence. (There is the far-fetched possibility that we could make a human equivalent out of less powerful hardware, if were willing to give up speed, if we were willing to settle for an artificial being who was literally slow [29]. But it's much more likely that devising the software will be a tricky process, involving lots of false starts and experimentation. If so, then the arrival of self-aware machines will not happen till after the development of hardware that is substantially more powerful than humans' natural equipment.) But as time passes, we should see more symptoms. The dilemma felt by science fiction writers will be perceived in other creative endeavors. (I have heard thoughtful comic book writers worry about how to have spectacular effects when everything visible can be produced by the technically commonplace.) We will see automation replacing higher and higher level jobs. We have tools right now (symbolic math programs, cad/cam) that release us from most low-level drudgery. Or put another way: The work that is truly productive is the domain of a steadily smaller and more elite fraction of humanity. In the coming of the Singularity, we are seeing the predictions of _true_ technological unemployment finally come true. Another symptom of progress toward the Singularity: ideas themselves should spread ever faster, and even the most radical will quickly become commonplace. When I began writing, it seemed very easy to come up with ideas that took decades to percolate into the cultural consciousness; now the lead time seems more like eighteen months. (Of course, this could just be me losing my imagination as I get old, but I see the effect in others too.) Like the shock in a compressible flow, the Singularity moves closer as we accelerate through the critical speed.",Internet/Technology,Explanation/Definition,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","I remember vaguely hearing about the Glass-Steagall Act while I was in college and that it was removed. What is the act exactly, and what are some of the pros and cons of the act being repealed?","The Glass-Steagall Act was passed under FDR as a response to the stock market crash of 1929. It effected a wall between commercial banking and investment banking, only to be partially repealed in 1999. While there exists consensus around what the Glass-Steagall Act pertains to, there’s disagreement around its influence on the financial markets. In particular, the debate has centered around the repeal’s effects on the 2008 financial crisis and whether it was a principal cause of the crisis. Notably, it remains relevant despite the introduction of recent legislation. In 2010, the Obama administration enacted the Dodd-Frank Act in response to the financial crisis. Similar to Glass-Steagall, it attempted to promote financial stability and protect the consumer, but Dodd-Frank did not reinstate the repealed provisions of Glass-Steagall. In the aftermath of the 1929 stock market crash, the Pecora Commission was tasked with investigating its causes. The Commission identified issues including risky securities investments that endangered bank deposits, unsound loans made to companies in which banks were invested, and conflicts of interest. Other issues included a blurring of the distinction between uninsured and insured practices, or an abusive practice of requiring joint purchases of multiple products. Congress attempted to address these issues with the Banking Act of 1933 and other legislation. While the effects of the Glass-Steagall Act were wide-ranging, it is equally important to note what the Glass-Steagall Act did not do. Beyond limiting the scope of activities for commercial and investment banks, the Act was not intended to limit the size or volume of such activities. Therefore, returning to the example of J.P. Morgan & Co., while the Act prohibited the bank from conducting all the same activities within a single organization, it did not prohibit the same activities (type and volume) if carried out separately through JPMorgan and Morgan Stanley. So when was the Glass-Steagall Act repealed? By the late 1990s, the Glass-Steagall Act had essentially become ineffective. In November 1999, then-President Bill Clinton signed the Gramm-Leach-Bliley Act (GLBA) into effect. GLBA repealed Sections 20 and 32 of the Glass-Steagall Act, which had prohibited the interlocking of commercial and investment activities. The partial repeal allowed for universal banking, which combines commercial and investment banking services under one roof. Many experts view GLBA as “ratifying, rather than revolutionizing” in that it simply formalized a change that was already ongoing. However, GLBA left intact Sections 16 and 21, which are still in place today. These continue to have practical effects on the industry today. For instance, they limit investment management firms such as Bridgewater Associates from offering checking accounts and prohibit commercial banks such as Wells Fargo from dealing in risky securities such as cattle futures. Between 1998 and 2006, the housing market and housing prices rose to previously unseen highs. As many readers already know, the market’s later crash was a primary cause of the Financial Crisis. A major determinant of the housing boom was the utilization of imprudent lending standards and subsequent growth of subprime mortgage loans. Most of these loans were made to homebuyers with factors that prevented them from qualifying for a prime loan. Many subprime loans also included tricky features that kept the initial payments low but subjected borrowers to risk if interest rates rose or house prices declined. Unfortunately, when housing prices started to fall, many borrowers found that they owed more on their houses than they were worth. According to the Financial Crisis Inquiry Commission (FCIC), which conducted the official government investigation into the crisis, the percentage of borrowers who defaulted on their mortgages months after the loan nearly doubled from 2006 to late 2007. Suspicious activity reports related to mortgage fraud grew 20-fold between 1996 and 2005, more than doubling between 2005 and 2009 (Chart 4). The losses from this fraud have been estimated at $112 billion. Did the Glass-Steagall Act’s repeal contribute to the deterioration in underwriting standards that fueled the housing boom and eventual collapse? Predictably, opinions are divided. On the one hand, those who believe the absence of Glass-Steagall did not cause the crisis highlight that offering mortgages has always been a core business for commercial banks, and so the banking system has always been exposed to high default rates in residential mortgages. Glass-Steagall was never intended to address or regulate loan qualification standards. In addition, while the Glass-Steagall Act limited the investment activities of commercial banks, it did not prevent non-depositories from extending mortgages that competed with commercial banks, or from selling these mortgages to investment banks. It also did not prevent investment banks from securitizing the mortgages to then sell to institutional investors. Nor did it address the incentives of the institutions that originated mortgages or sold mortgage-related securities. Because it did not directly address these issues, it’s unlikely the Glass-Steagall Act could have prevented the decline in mortgage underwriting standards that led to the housing boom of the 2000s. On the other hand, those who argue that the absence of Glass-Steagall did cause the crisis believe that the decline in underwriting standards was in fact partially, or indirectly, caused by the Act’s absence. Readers will recall from the beginning of the article that Glass-Steagall’s provisions addressed the conflicts of interest and other potential abuses of universal banks. After Glass-Steagall’s repeal, it is feasible that universal banks aimed to establish an initial market share in the securities market by lowering underwriting standards. Separately, universal banks might also self-deal and favor their own interests over those of their customers. Both of these incentives could have led to or exacerbated the decline in underwriting standards. While these results are not entirely conclusive, it does suggest that Glass-Steagall’s absence could have worsened underwriting standards. Had Glass-Steagall been in place, these universal banking institutions would not have been created. Nevertheless, the regulation would not have prevented new, investment-only entrants also looking to gain market share. And as we’ve already mentioned, the Glass-Steagall Act never directly addressed loan qualification standards or prevented non-depositors from extending, repackaging, and selling mortgages. It’s therefore unlikely that the Glass-Steagall Act could have prevented the decline in mortgage underwriting standards, but its absence could have aggravated the situation. The second major topic of discussion related to Glass-Steagall and the financial crisis surrounds the issue of “too big to fail” and systemic risks. When the failure of an institution could result in systemic risks, whereby there would be contagious, widespread harm to financial institutions, it was deemed too big to fail (TBTF). TBTF institutions are so large, interconnected, and important that their failure would be disastrous to the greater economic system. Should they fail, the associated costs are absorbed by government and taxpayers. If one accepts that systemic risk and TBTF institutions were major contributors to the 2008 crisis, then the debate turns to whether the absence of Glass-Steagall contributed to the creation of TBTF institutions and their disastrous effects. After all, the repeal of Glass-Steagall in 1999 set in motion the wave of mega-mergers that created huge financial conglomerates, many of which fall firmly within the TBTF camp. Ironically, Glass-Steagall’s repeal actually allowed for the rescue of many large institutions after the crisis: After all, JPMorgan Chase rescued Bear Stearns and Bank of America rescued Merrill Lynch, which would have been impermissible prior to the 1999 repeal. Both were already involved in commercial and investment banking when they saved the two failing investment banks. On balance, therefore, the evidence does not seem to support the view that Glass-Steagall’s absence was a cause of the financial crisis. Overall, while the general consensus is that Glass-Steagall's absence was not a principal cause of the crisis, the underlying culture of excessive risk-taking and short-term profit was real.","""================ ======= The Glass-Steagall Act was passed under FDR as a response to the stock market crash of 1929. It effected a wall between commercial banking and investment banking, only to be partially repealed in 1999. While there exists consensus around what the Glass-Steagall Act pertains to, there’s disagreement around its influence on the financial markets. In particular, the debate has centered around the repeal’s effects on the 2008 financial crisis and whether it was a principal cause of the crisis. Notably, it remains relevant despite the introduction of recent legislation. In 2010, the Obama administration enacted the Dodd-Frank Act in response to the financial crisis. Similar to Glass-Steagall, it attempted to promote financial stability and protect the consumer, but Dodd-Frank did not reinstate the repealed provisions of Glass-Steagall. In the aftermath of the 1929 stock market crash, the Pecora Commission was tasked with investigating its causes. The Commission identified issues including risky securities investments that endangered bank deposits, unsound loans made to companies in which banks were invested, and conflicts of interest. Other issues included a blurring of the distinction between uninsured and insured practices, or an abusive practice of requiring joint purchases of multiple products. Congress attempted to address these issues with the Banking Act of 1933 and other legislation. While the effects of the Glass-Steagall Act were wide-ranging, it is equally important to note what the Glass-Steagall Act did not do. Beyond limiting the scope of activities for commercial and investment banks, the Act was not intended to limit the size or volume of such activities. Therefore, returning to the example of J.P. Morgan & Co., while the Act prohibited the bank from conducting all the same activities within a single organization, it did not prohibit the same activities (type and volume) if carried out separately through JPMorgan and Morgan Stanley. So when was the Glass-Steagall Act repealed? By the late 1990s, the Glass-Steagall Act had essentially become ineffective. In November 1999, then-President Bill Clinton signed the Gramm-Leach-Bliley Act (GLBA) into effect. GLBA repealed Sections 20 and 32 of the Glass-Steagall Act, which had prohibited the interlocking of commercial and investment activities. The partial repeal allowed for universal banking, which combines commercial and investment banking services under one roof. Many experts view GLBA as “ratifying, rather than revolutionizing” in that it simply formalized a change that was already ongoing. However, GLBA left intact Sections 16 and 21, which are still in place today. These continue to have practical effects on the industry today. For instance, they limit investment management firms such as Bridgewater Associates from offering checking accounts and prohibit commercial banks such as Wells Fargo from dealing in risky securities such as cattle futures. Between 1998 and 2006, the housing market and housing prices rose to previously unseen highs. As many readers already know, the market’s later crash was a primary cause of the Financial Crisis. A major determinant of the housing boom was the utilization of imprudent lending standards and subsequent growth of subprime mortgage loans. Most of these loans were made to homebuyers with factors that prevented them from qualifying for a prime loan. Many subprime loans also included tricky features that kept the initial payments low but subjected borrowers to risk if interest rates rose or house prices declined. Unfortunately, when housing prices started to fall, many borrowers found that they owed more on their houses than they were worth. According to the Financial Crisis Inquiry Commission (FCIC), which conducted the official government investigation into the crisis, the percentage of borrowers who defaulted on their mortgages months after the loan nearly doubled from 2006 to late 2007. Suspicious activity reports related to mortgage fraud grew 20-fold between 1996 and 2005, more than doubling between 2005 and 2009 (Chart 4). The losses from this fraud have been estimated at $112 billion. Did the Glass-Steagall Act’s repeal contribute to the deterioration in underwriting standards that fueled the housing boom and eventual collapse? Predictably, opinions are divided. On the one hand, those who believe the absence of Glass-Steagall did not cause the crisis highlight that offering mortgages has always been a core business for commercial banks, and so the banking system has always been exposed to high default rates in residential mortgages. Glass-Steagall was never intended to address or regulate loan qualification standards. In addition, while the Glass-Steagall Act limited the investment activities of commercial banks, it did not prevent non-depositories from extending mortgages that competed with commercial banks, or from selling these mortgages to investment banks. It also did not prevent investment banks from securitizing the mortgages to then sell to institutional investors. Nor did it address the incentives of the institutions that originated mortgages or sold mortgage-related securities. Because it did not directly address these issues, it’s unlikely the Glass-Steagall Act could have prevented the decline in mortgage underwriting standards that led to the housing boom of the 2000s. On the other hand, those who argue that the absence of Glass-Steagall did cause the crisis believe that the decline in underwriting standards was in fact partially, or indirectly, caused by the Act’s absence. Readers will recall from the beginning of the article that Glass-Steagall’s provisions addressed the conflicts of interest and other potential abuses of universal banks. After Glass-Steagall’s repeal, it is feasible that universal banks aimed to establish an initial market share in the securities market by lowering underwriting standards. Separately, universal banks might also self-deal and favor their own interests over those of their customers. Both of these incentives could have led to or exacerbated the decline in underwriting standards. While these results are not entirely conclusive, it does suggest that Glass-Steagall’s absence could have worsened underwriting standards. Had Glass-Steagall been in place, these universal banking institutions would not have been created. Nevertheless, the regulation would not have prevented new, investment-only entrants also looking to gain market share. And as we’ve already mentioned, the Glass-Steagall Act never directly addressed loan qualification standards or prevented non-depositors from extending, repackaging, and selling mortgages. It’s therefore unlikely that the Glass-Steagall Act could have prevented the decline in mortgage underwriting standards, but its absence could have aggravated the situation. The second major topic of discussion related to Glass-Steagall and the financial crisis surrounds the issue of “too big to fail” and systemic risks. When the failure of an institution could result in systemic risks, whereby there would be contagious, widespread harm to financial institutions, it was deemed too big to fail (TBTF). TBTF institutions are so large, interconnected, and important that their failure would be disastrous to the greater economic system. Should they fail, the associated costs are absorbed by government and taxpayers. If one accepts that systemic risk and TBTF institutions were major contributors to the 2008 crisis, then the debate turns to whether the absence of Glass-Steagall contributed to the creation of TBTF institutions and their disastrous effects. After all, the repeal of Glass-Steagall in 1999 set in motion the wave of mega-mergers that created huge financial conglomerates, many of which fall firmly within the TBTF camp. Ironically, Glass-Steagall’s repeal actually allowed for the rescue of many large institutions after the crisis: After all, JPMorgan Chase rescued Bear Stearns and Bank of America rescued Merrill Lynch, which would have been impermissible prior to the 1999 repeal. Both were already involved in commercial and investment banking when they saved the two failing investment banks. On balance, therefore, the evidence does not seem to support the view that Glass-Steagall’s absence was a cause of the financial crisis. Overall, while the general consensus is that Glass-Steagall's absence was not a principal cause of the crisis, the underlying culture of excessive risk-taking and short-term profit was real. https://www.toptal.com/finance/investment-banking-freelancer/glass-steagall-act ================ ======= I remember vaguely hearing about the Glass-Steagall Act while I was in college and that it was removed. What is the act exactly, and what are some of the pros and cons of the act being repealed? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Financial,Pros & Cons,Q&A Use only the given sources to complete your responses. Do not use outside sources or any previous knowledge of the topic that you may have.,Can you list all of the ancient people mentioned by name in a bullet point list along with a brief description of their beliefs regarding the brain? ,"1) A BRIEF HISTORY OF NEUROSCIENCE Humans have long been interested in exploring the nature of mind. The long history of their enquiry into the relationship between mind and body is particularly marked by several twists and turns. However, brain is the last of the human organs to be studied in all seriousness, more particularly its relation with human mind. Around 2000 BC and for long since that time the Egyptians did not think highly of the brain. They would take out the brain via the nostrils and discarded it away before mummifying the dead body. Instead, they would take great care of the heart and other internal organs. However, a few Egyptian physicians seemed to appreciate the significance of the brain early on. Certain written records have been found where Egyptian physicians had even identified parts and areas in the brain. Besides, Egyptian papyrus, believed to have been written around 1700 BC, carried careful description of the brain, suggesting the possibility of addressing mental disorders through treatment of the brain. That is the first record of its kind in the human history (Figure 1). The Greek mathematician and philosopher, Plato (427-347) believed that the brain was the seat of mental processes such as memory and feelings (Figure 2). Later, another Greek physician and writer on medicine, Galen (130-200 AD) too, believed that brain disorders were responsible for mental illnesses. He also followed Plato in concluding that the mind or soul resided in the brain. However, Aristotle (384-322 BC), the great philosopher of Greece at that time, restated the ancient belief that the heart was the superior organ over the brain (Figure 3). In support of his belief, he stated that the brain was just like a radiator which stopped the body from becoming overheated, whereas the heart served as the seat of human intelligence, thought, and imagination, etc. Medieval philosophers felt that the brain was constituted of fluid-filled spaces called ventricles where the ‘animal spirits’ circulated to form sensations, emotions, and memories. This viewpoint brought about a shift in the previously held views and also provided the scientists with the new idea of actually looking into the brains of the humans and animals. However, no such ventricles as claimed by them were found upon examination nor did the scientists find any specific location for the self or the soul in the brain. In the seventeenth century, the French philosopher Rene Descartes (1596-1650) described mind and body as separate entities (Figure 4) yet they interacted with each other via the pineal gland, the only structure not duplicated on both sides of the brain. He maintained that the mind begins its journey from the pineal gland and circulates the rest of the body via the nerve vessels. His dualist view influenced the mind-body debate for Page 4 of 35 the next two centuries. However, through the numerous experiments undertaken in the 19th century, the scientists gathered evidences and findings which all emboldened the scientists to claim that the brain is the center of feelings, thoughts, self and behaviors. Just to give an example of the kind of experiments performed on a particular physical activity which pointed to the brain as the regulator of bodily actions, imagine activating a particular area of the brain through electrical stimulus, you would actually see it effectively impacting a corresponding body-part, say the legs by making them move. Through findings such as these as well as others, we have come of know also of the special activities of the electrical impulses and chemicals in the brain. Explorations continued into the later centuries and, by the middle of 20th century, human understanding of the brain and its activities have increased manifold. Particularly, towards the end of twentieth century, with further improvement in imaging technologies enabling the researchers to undertake investigation on functioning brains, the scientists were deeply convinced that the brain and the rest of the nervous systems monitored and regulated emotions and bodily behaviors (Figures 5 & 6). Since then, the brain together with the nervous system have become the center of attention as the basis of mental activities as well as physical behaviors, and gradually a separate branch of science called neuroscience focusing specifically on the nervous systems of the body has evolved in the last 40 so years. To better understand modern neuroscience in its historical context, including why the brain and nervous system have become the center of attention in the scientific pursuit of understanding the mind, it is useful to first review some preliminary topics in the philosophy of science. Science is a method of inquiry that is grounded in empirical evidence. Questions about the unknown direct the path of science as a method. Each newly discovered answer opens the door to many new questions, and the curiosity of scientists motivates them to answer those unfolding questions. When a scientist encounters a question, she or he develops an explanatory hypothesis that has the potential to answer it. But it is not enough to simply invent an explanation. To know if an explanation is valid or not, a scientist must test the hypothesis by identifying and observing relevant, objectively measurable phenomena. Any hypothesis that cannot be tested in this way is not useful for science. A useful hypothesis must be falsifiable, meaning that it must be possible to ascertain, based on objective observations, whether the hypothesis is wrong and does not explain the phenomena in question. If a hypothesis is not falsifiable, it is impossible to know whether it is the correct explanation of a phenomenon because we cannot test the validity of the claim. Why does the scientific method rely only on objective observations? Science is a team effort, conducted across communities and generations over space and time. For a hypothesis to be accepted as valid, it must be possible for any interested scientist to test it. For example, if we want to repeat an experiment that our colleague conducted last year, we need to test the hypothesis under the same conditions as the original experiment. This means it must be possible to recreate those conditions. The only way to do this in a precise and controlled manner is if the scientific method relies on empirical evidence. Page 5 of 35 Furthermore, conclusions in science are subject to peer review. This means that any scientist’s colleagues must be able to review and even re-create the procedures, analyses, and conclusions made by that scientist before deciding if the evidence supports the conclusions. Because we don’t have access to the subjective experiences of others, it is not possible to replicate experiments that are grounded in subjectivity because we cannot recreate the conditions of such an experiment, nor can we perform identical analyses of subjective phenomena across people. No matter how many words we use, we cannot describe a single subjective experience accurately enough to allow another person to experience it the same way. Consequently, we cannot have a replicable experiment if the evidence is not objective. Therefore, two necessary features of a scientific hypothesis are the potentials to falsify and replicate it. And both of these requirements are dependent on objectively measurable evidence. This is why we began with the claim that science is a method of inquiry that is grounded in empirical evidence. Neuroscience is a scientific discipline like any other, in that the focus of investigation is on objectively measurable phenomena. But unlike most other sciences, this poses a particularly challenging problem for neuroscience. How do we investigate the mind, which is subjective by nature, if empirical evidence is the only valid form of data to support a conclusion in science? The relationship between the mind and the body has become known as the “mind-body problem” in modern neuroscience and Western philosophy of mind, because there is a fundamental challenge to explain the mind in objective terms. Scientists view this relationship as a problem because their method of inquiry investigates phenomena from a third-person (he, she, it, they) perspective, while the subjective experience of the mind has a first-person (I, we) perspective. The mindbody problem has been a central, unresolved topic in Western philosophy of mind for centuries, and is a topic we will discuss in more detail in a later chapter of this textbook when we explore the neuroscience of consciousness. For now we can start simply by stating that the majority of scientists, including neuroscientists, hold the philosophical view that all phenomena are caused by physical processes, including consciousness and its related mental phenomena. This view might be proven wrong as inquiry proceeds, but is taken as the most simple (or parsimonious) starting point. Science uses the principle of parsimony, of starting with simple rather than complex explanations, as a way to facilitate production of falsifiable hypotheses: more complex explanations are built up as evidence accumulates and more simple explanations are excluded. Modern neuroscience investigates the brain and nervous system based on the working assumption that the objective physical states of those biological systems are the cause of the subjective mental states of the organism that has those biological systems. In other words, when you smell a fresh flower, taste a cup of chai, listen to the birds, feel the wind on your cheek, and see the clouds in the sky, those subjective experiences are caused by the momentary physical processes in your body, nervous system, and brain interacting with the physical environment. Under this philosophical view, then, mental states correlate with physical states of the organism, and by investigating those physical states scientists can understand the nature of those mental Page 6 of 35 states. So while this might seem counterintuitive based on the Buddhist method of inquiry, for a neuroscientist it is obvious to begin the investigation by focusing on physical phenomena; on the empirical evidence. Neuroscientists often equate the “neural correlates” of consciousness as consciousness itself. We will explore in more depth the relationship between form and function between the body and mind later in the textbook, as well as the philosophical view of materialism in neuroscience. It will also be helpful to introduce some basic concepts in neuroscience before exploring topics in more detail. The primary goal in this year of the neuroscience curriculum is that you become familiar with the brain and nervous system. The human brain is the most complex and extraordinary object known to all of modern science. Because of this immense complexity, it can be very challenging to encounter neuroscience in an introductory course such as this one. So patience is an important part of the learning process. First, neuroscience is still very much in its infancy as a scientific discipline, and there are vastly more questions than there are answers. Second, it can be a challenge for new students of neuroscience to simultaneously learn the details of the basic concepts while understanding and appreciating the broader conclusions. It’s like learning a language while also reading the literature of that language! Neuroscience is a scientific discipline with many different levels of exploration and explanation. Therefore, it is important for you to pay attention to the level at which are we speaking when you learn new concepts. For example, the brain and nervous system are made up of cells called neurons or nerve cells, which we will discuss in detail in Chapter 4. Neurons connect with each other to form complex networks, and from those different patterns of connection emerge different phenomena (such as a thought or a sensation) in the brain and ultimately in the mind. This may sound confusing at the moment, but we will explore these topics in more detail in later chapters. In neuroscience, levels of explanation can span from very low levels such as the molecular mechanisms involved in the neuron cells, to middle levels such as particular networks of neurons in the brain, to very high levels such as how humans engage in thoughts, speech, and purposeful actions. The brain is the bodily organ that is the center of the nervous system. But it might surprise you to learn that not all animals that have neurons have a brain! For example, jellyfish have neurons, but they don’t have a brain. Jellyfish are very simple organisms that live in the ocean, and their neurons allow them to sense some basic information about their environment. But because they don’t have a brain to process that environmental information, they can only react to their immediate environment. Without a brain, jellyfish cannot think, make plans for the future, have memories of the past, or make decisions. Their behavior is limited to reactions and reflexes. Complex networks of neurons in the human brain are the physiological substrates that support what we experience as human beings. But we are not the only species with a brain. Later in this textbook we will explore the relationship between brain complexity and behavior across species. For organisms that have a brain, information can flow along the complex networks of neurons in different ways. Some networks, also called pathways or systems, flow from the sensory organs to the brain, while others flow from the brain to the muscles of the Page 7 of 35 body. Afferent neurons, also called sensory neurons or receptor neurons, communicate information from the sensory organs to the brain. Efferent neurons, also called motor neurons, communicate information from the brain to the muscles of the body. Interneurons, also called association neurons, communicate information between neurons in the central nervous system and brain. This allows for the sensory and motor systems to interact, facilitating complex behaviors and integrating across the different sensory modalities. For example, to be able to reach for an object such as a teacup, your brain needs to link together your ability to sense the presence and location of the cup with your ability to control the muscles in your arm to grasp the cup. Interneurons perform this function. Finally, before starting your journey in learning about neuroscience, pause to contemplate some of the big questions and insights as they pertain to the Western science of the mind. As you go through this textbook and learn new concepts, it will be useful to think about them within the context of these big questions. For example, what is sentience? Is a brain required for sentience? The jellyfish we mentioned earlier can have basic sensations and react to the environment without a brain, but it cannot think or have memory. What are the necessary conditions to be sentient? What is the relationship between the mind and body? As a method of inquiry, can science directly investigate subjective experience? Or must we use alternative, and perhaps complementary methods of inquiry to achieve that? Do we perceive the physical world directly, or are our perceptions constructed? If the latter, how does that happen? 2) WHAT IS NEUROSCIENCE AND WHAT ARE ITS BRANCH SCIENCES? In the case of humans, it is the branch of science that studies the brain, the spinal cord, the nerves extending from them, and the rest of the nervous systems including the synapses, etc. Recall that neurons, or nerve cells, are the biological cells that make up the nervous system, and the nervous system is the complex network of connections between those cells. In this connection, it may involve itself with the cellular and molecular bases of the nervous system as well as the systems responsible for sensory and motor activities of the body. It also deals with the physical bases of mental processes of all levels, including emotions and cognitive elements. Thus, it concerns itself with issues such as thoughts, mental activities, behaviors, the brain and the spinal cord, functions of nerves, neural disorders, etc. It wrestles with questions such as What is consciousness?, How and why do beings have mental activities?, What are the physical bases for the variety of neural and mental illnesses, etc. In identifying the sub-branches within neuroscience, there are quite a few ways of doing so. However, here we will follow the lead of the Society for Neuroscience which identifies the following five branches: Neuro-anatomy, Developmental Neuroscience, Cognitive Neuroscience, Behavioral Neuroscience, and Neurology. Of these, Page 8 of 35 neuroanatomy concerns itself mainly with the issue of structures and parts of the nervous system. In this discipline, the scientists employ special dyeing techniques in identifying neurotransmitters and in understanding the specific functions of the nerves and nerve centers. Neurotransmitters are chemicals released between neurons for transmission of signals. When a neuron communicates with its neighboring cells, it releases neurotransmitters and its neighbors receive them. In developmental neuroscience, the scientists look into the phases and processes of development of nervous system, the changes they undergo after they have matured, and their eventual degeneration. In this regard, the scientists also investigate the ways neurons go about seeking connection with other neurons, how they establish the connection, and how they maintain the connection and what chemical changes and processes they have to undergo for these activities. Neurons make connections to form networks, and the different patterns of connectivity support different functions. Patterns of connectivity can change over different time scales, such as developmental changes over a lifetime from infancy to old age, but also in the short term such as learning a new concept. Neuroplasticity is the term that describes the capacity of the brain to change in response to stimulation or even damage: it is not a static organ, but is highly adaptable. In cognitive neuroscience, they study the functions of behaviors, perceptions, and memories, etc. By making use of non-invasive methods such as the PTE and MRI technologies that allow us to take detailed pictures of the brain without opening the skull, they look into the neural pathways activated during engagement in language, solutions, and other activities. Cognitive neuroscience studies the mind-body relationship by discovering the neural correlates to mental and behavioral phenomena. Behavioral neuroscience looks into the underpinning processes of human and animal behaviors. Using electrodes, they measure the neural electrical activities occurring alongside our actions such as visual perception, language use, and generating memories. Through fMRI scan techniques, another technology that allows us to take detailed motion pictures of brain activity over time without opening the skull, they strive to arrive at closer understanding of the brain parts in real time. Finally, neurology makes use of the fundamental research findings of the other disciplines in understanding the neural and neuronal disorders and strives to explore new innovative ways of detecting, preventing, and treating these disorders. 3) THE SUBJECT MATTER OF NEUROSCIENCE: THE MAIN SYSTEMS AND THEIR PARTS The field of neuroscience is the nervous system of animals in general and of humans in particular. In the case of humans, its nervous system has two main components: the central nervous system (CNS) and the peripheral nervous system (PNS) (Figure 7). The CNS comprises of the brain and the spinal cord. Their functions involve processing and interpreting the information received the senses, skin, muscles, etc. and giving responses Page 9 of 35 that direct and dictate specific actions such as particular movements by different parts of the body. The peripheral nervous system (PNS) includes all the rest of the nervous system aside from the central nervous system. This means that it comprises the 12 pairs of cranial nerves that originate directly from the brain and spread to different parts of the body bypassing the spinal cord, and the 31 pairs of spinal nerves that pass through the spinal cord and spread to different parts of the body. Thus, the PNS is mainly constituted of nerve. PNS is sometimes further classified into voluntary nervous system and the autonomic nervous system. This is based on the fact that the nerves in the former system are involved in making conscious movements, whereas those in the latter system make movements over which the person does not have control. Obviously, the former category of nerves includes those associated with the muscles of touch, smell, vision, and skeleton. The latter includes nerves spread over muscles attached with heart beats, blood pressure, glands, and smooth muscles. 4) AN EXCLUSIVE LOOK AT ‘NEURONS’, A FUNDAMENTAL UNIT OF THE BRAIN AND THE NERVOUS SYSTEM Neurons Neurons are the cellular units of the brain and nervous system, and are otherwise called nerve cells (Figure 8). Estimates of the number of brain neurons range from 50 billion to 500 billion, and they are not even the most numerous cells in the brain. Like hepatocyte cells in the liver, osteocytes in bone, or erythrocytes in blood, each neuron is a selfcontained functioning unit. Its internal components, the organelles, include a nucleus harboring the genetic material (DNA), energy-providing mitochondria, and proteinmaking ribosomes. As in most other types of cells, the organelles are concentrated in the main cell body. In addition, characteristic features of neurons are neurites—long, thin, finger-like or threadlike extensions from the cell body (soma). The two main types are dendrites and axons. Usually, dendrites receive nerve signals, while axons send them onward. The cell body of a neuron is about 10-100 micrometers across, that is 1/100th to 1/10th of one millimeter. Also, the axon is 0.2-20 micrometers in diameter, dendrites are usually slimmer. In terms of length, dendrites are typically 10-50 micrometers long, while axons can be up a few centimeters (inches). This is mostly the case in the central nervous system (Figure 9). Classification of neurons Page 10 of 35 There are numerous ways of classifying neurons among themselves. One of them is by the direction that they send information. On this basis, we can classify all neurons into the three: sensory neurons, motor neurons, and interneurons. The sensory neurons are those that send information received from sensory receptors toward the central nervous system, whereas the motor neurons send information away from the central nervous system to muscles or glands. The interneurons are those neurons that send information between sensory neurons and motor neurons. Here, the sensory neurons receive information from sensory receptors (e.g., in skin, eyes, nose, tongue, ears) and send them toward the central nervous system. Because of this, these neurons are also called afferent neurons as they bring informational input towards the central nervous system. Likewise, the motor neurons bring motor information away from the central nervous system to muscles or glands, and are thus called efferent neurons as they bring the output from the central nervous system to the muscles or glands. Since the interneurons send information between sensory neurons and motor neurons, thus serving as connecting links between them, they are sometimes called internuncial neurons. This third type of neurons is mostly found in the central nervous system. Another way of classifying the neurons is by the number of extensions that extend from the neuron’s cell body (soma) (Figure 10). In accordance with this system, we have unipolar, bipolar, and multipolar neurons. This classification takes into account the number of extensions extending initially from the cell body of the neuron, not the overall number of extensions. This is because there can be unipolar neurons which have more than one extensions in total. However, what the difference here is from the other two types of neurons is that these unipolar neurons shall have only one initial extension from the cell body. Most of the neurons are multipolar in nature. Synapses Synapses are communication sites where neurons pass nerve impulses among themselves. The cells are not usually in actual physical contact, but are separated by an incredibly thin gap, called the synaptic cleft. Microanatomically, synapses are divided into types according to the sites where the neurons almost touch. These sites include the soma, the dendrites, the axons, and tiny narrow projections called dendritic spines found on certain kinds of dendrites. Axospinodendrittic synapses form more than 50 percent of all synapses in the brain; axodendritic synapses constitute about 30 percent (Figure 11). How signals are passed among neurons Page 11 of 35 Neurons send signals to each other across the synapses. Initially, signals enter into the cell body of a neuron through their dendrites, and they pass down the axon until their arrival at the axon terminals. From there, the signal is sent across to the next neuron. Starting from the time the signal passes along the dendrites and axon, eventually reaching the axon terminal, it consists of moving electrically charges ions, but at a synapse while making that transition, it relies more on the structural shape of the chemical neurotransmitters. Every two neurons are separated by a gap, called synaptic cleft, at their synaptic site. The neuron preceding the synapse is known as pre-synaptic neuron and the one following the synapse is known as post-synaptic neuron. When the action potential of the pre-synaptic neuron is passed along its axon and reaches the other end of it, it causes synaptic vesicles to fuse or merge with the membrane. This releases the neurotransmitter molecules to pass or diffuse across the synaptic cleft to the post-synaptic membrane and slot into receptor sites (Figure 12). Neurotransmitter molecules slot into the same-shaped receptor sites in the postsynaptic membrane. A particular neurotransmitter can either excite a receiving nerve cell and continue a nerve impulse, or inhibit it. Which of these occurs depends on the type of membrane channel on the receiving cell. The interaction among neurons or between a neuron and another type of body cell, all occur due to the transfer of neurotransmitters. Thus, our body movements, mental thought processes, as well as feelings, etc. are all dependent on the transfer of neurotransmitters. In particular, let’s take a look into how the muscle movements happen due to the transfer of neurotransmitter. The axons of motor neurons extend from the spinal cord to the muscle fibers. For intending to perform any action, either of the speech or body, the command has to originate from the brain to the spinal cord. From the spinal cord, the command has to pass through motor neurons to the specific body parts, upon which the respective actions will be performed. The electrical impulse released along the axon of the motor neuron arrives at the axon terminal. Once they are there, then the neurotransmitters are secreted to carry the signals across the synapse. The receptors in the membrane of the muscles cells attach to the neurotransmitters and stimulate the electrically charged ions within the muscle cells. This leads to the contraction or extension of the respective muscles. Page 12 of 35 5) FACTS ABOUT HUMAN BRAIN Brain is a complex organ generally found in vertebrates. Of all the brains, human brain is even more complex. On average, a human brain weighs about one and a half kilogram, and has over 100 billion neurons. Each of these neurons is connected with several other neurons and thus, just the number of synapses (nerve cell connections) exceeds 100 trillion. The sustenance required to keep these neurons alive is supplied by different parts of the body. For example, 25 percent of the body total oxygen consumption is used up by the brain. Likewise, 25 percent of the glucose produced by our food is used up by it. Of the total amount of blood pumped out by our heart, 15 percent goes to the brain. Thus, from among the different parts of the body, the brain is the single part that uses the most amount of energy. The reason for this is because the brain engages itself in unceasing activity, day and night, of interpreting data form the internal and external environment, and respond to them. To protect this important organ from harm, it is naturally enclosed in three layers of protection, with an additional cushioning fluid in between. These layers are, in turn, protected with the hard covering, the skull, which is once again wound around by the skin of the scalp (Figure 13). The main function of the brain is to enhance the chance of survival of the person by proper regulation of the body conditions based on the brain’s reading of the internal and external environment. The way it carries out this function is by first registering the information received and responding to them by undertaking several activities. The brain also gives rise to inner conscious awareness alongside performing those processes. When the data, released by the different body senses, in the form of electrical impulses uninterruptedly arrive at the brain, the brain first of all checks their importance. When it finds them to be either irrelevant or commonplace, then it makes them dissolve by themselves and the concerned person doesn’t even generate an awareness of them. This is how only around 5 percent of the overall information received by the brain ever reaches our consciousness. For the rest of the information, the brain may process them, but they never become the subject of our consciousness. If, on the other hand, the information at hand is important or novel, the brain increases it impulses and allows it to active all over its parts. Remaining active for over a period of time, a conscious awareness unto this impulse is generated. Sometimes, in the wake of generating a conscious awareness, the brain sends commands to relevant muscles for either contraction or extension, thus making the body parts in question to engage in certain actions. Page 13 of 35 6) MAJOR PARTS OF HUMAN BRAIN Human brain is enclosed within its natural enclosures. In its normal form, it is found to be composed of three major parts (Figure 14). Cerebrum Of the three parts mentioned above, cerebrum is located in the uppermost position and is also the largest in size. It takes up ¾ of the entire brain size. It is itself composed of two brain hemispheres—the right and the left hemispheres. The two hemispheres are held together by a bridge like part called corpus callosum, a large bundle of neurons. The covering layer of the hemispheres is constituted of the cortex of which the average thickness is between 2 to 4 millimeters. The higher centers of coordinating and regulating human physical activities are located in the cortex areas, such as the motor center, proprioception center (proprioception is the sense of the relative position of the body in space, for example being aware that your arm is extended when reaching for the doorknob), language center, visual center, and auditory center. The outer surface of the cortex is formed of grooves and bulges because of which, despite being quite expansive, the cortex is able to be contained in the relatively small area. In terms of its basic composition, the outer layer of cortex is mostly made of gray matter, which is mainly comprised of cell bodies and nerve tissues formed out of nerve fibers. This matter is gray with a slight reddish shade in color. In the layer below, the cortex is formed of the white matter, which is, as the name suggests, white in color and mainly comprised of nerve tissues formed out of nerve fibers wrapped around with myelin sheath. Some nerve fibers wrapped in myelin sheath bind together the right and left hemispheres of the cerebrum, while others connect it with cerebellum, brainstem, and the spinal cord. Most of the brain parts belong to cerebrum, such as amygdala and hippocampus, as well as thalamus, hypothalamus, and other associated regions. In short, of the division into forebrain, midbrain, and hindbrain—in which the entirety of brain is accounted for, the cerebrum contains the whole of forebrain (Figure 15). The surface area of the cerebral cortex is actually quite large, and described above, it becomes folded to fit inside the skull. Humans are highly intelligent and creative animals not just because of the size of our brains, but also because of the complexity of the connections among our neurons. The folded nature of the human cortex promotes more complex connections between areas. For example, take a piece of blank paper, and draw five dots, one on each corner and one in the middle. Now draw lines from each dot to the other four dots. Imagine if these five dots were buildings, and the lines you drew were roads, then it would require more time to traverse from one corner to another corner than from one corner to the center. But what if you fold the four corners of the paper on top of Page 14 of 35 the center of the page? Suddenly all five of those dots become immediate neighbors, and it becomes very easy to walk from one “building” to another. The folding of the cortex has a similar effect. Neurons make connections with their neighbors, and if folding the cortex increases the number of neighbors each neuron has, then it also increases the complexity of the networks that can be formed among those neurons. Cerebellum Cerebellum is located below the cerebrum and at the upper back of the brainstem. Its name connotes its small size. Its mass is 1/10 of the whole brain. However, in terms of the number of neurons it contains, it exceeds that of the remaining parts of the central nervous system combined. This lump of nerve tissues, bearing the look of something cut in half, covers most of the back of brainstem. With the help of three pairs of fibers, collectively called cerebral peduncles, the brainstem is bound to the cerebellum. Like the cerebrum, it also has a wrinkled surface, but its grooves and bulges are finer and organized into more regular patterns. In terms of its physical structure, this too has a long groove in the center, with two large lateral lobes, one on each side. These lobes are reminiscent of the two hemispheres of the cerebrum and are sometimes termed cerebellar hemispheres. The cerebellum has a similar layered microstructure to the cerebrum. The outer layer, or cerebellar cortex, is gray matter composed of nerve-cell bodies and their dendrite projections. Beneath this is a medullary area of white matter consisting largely of nerve fibers. As of now, it has been established that cerebellum’s main function is in coordinating the body movement. Although, it may not initiate the movements, however it helps in the coordination and timely performance of movements, ensuring their integrated control. It receives data from spinal cord and other parts of the brain, and these data undergo integration and modification, contributing to the balance and smooth functioning of the movements, and thus helps in maintaining the equilibrium. Therefore, whenever this part of the brain is plagued by a disorder, the person may not lose total movement, but their ability of performing measured and steady movements is affected as also their ability to learn new movements. Within the division of entire brain into forebrain, midbrain, and hindbrain—cerebellum forms part of the hindbrain (Figure 16). Brainstem Brainstem is located below the cerebrum and in front of cerebellum. Its lower end connects with the spinal cord. It is perhaps misnamed. It is not a stem leading to a separate brain above, but an integral part of the brain itself. Its uppermost region is the midbrain comprising an upper “roof” incorporating the superior and inferior colliculi or Page 15 of 35 bulges at the rear, and the tegmentum to the front. Below the midbrain is the hindbrain. At its front is the large bulge of the pons. Behind and below this is the medulla which narrows to merge with the uppermost end of the body’s main nerve, the spinal cord. This part of the brain in associated with the middle and lower levels of consciousness. The eye movement involved in following a moving object in front of the eye is an example. The brainstem is highly involved in mid-to low-order mental activities, for example, the almost “automatic” scanning movements of the eyes as we watch something pass by. The gray and white matter composites of the brainstem are not as well defined as in other parts of the brain. The gray matter in this part of the brain possesses some of the crucial centers responsible for basic life functions. For example, the medulla houses groups of nuclei that are centers for respiratory (breathing), cardiac (heartbeat), and vasomotor (blood pressure) monitoring and control, as well as for vomiting, sneezing, swallowing, and coughing. When brainstem is damaged, that will immediately trigger danger to life by hindering heartbeat and respiratory processes (Figures 17 & 18). 7) WAYS OF ZONING AND SECTIONING THE HUMAN BRAIN FOR STUDY PURPOSES The two hemispheres Of the obviously so many different ways of zoning the human brain for study purposes, we will take up only a few of them as samples. As briefly mentioned before, a fully matured brain has three major parts. Of these the largest is the cerebrum. It covers around ¾ of the brain size. In terms of its outer structure, it is covered with numerous folds, and has a color of purple and gray blended. The cerebrum is formed by two cerebral hemispheres, accordingly called the right and the left hemisphere, that are separated by a groove, the medial longitudinal fissure. Between the two hemispheres, there is a bundle of nerve fibers that connects the two sides, almost serving like connecting rope holding the two in place. Called corpus callosum, if this were to be cut into two, the two hemispheres would virtually become two separate entities. Just as there are two hemispheres, that look broadly like mirror images to each other, on the two sides, likewise many of the brain parts exist in pairs, one on each side. However, due to the technological advances in general, and that of the MRI, in particular, it has been shown that, on average, brains are not as symmetrical in their left-right structure as was once believed to be , almost like mirror images (Figure 19). The two apparently symmetrical hemispheres and, within them, their other paired structures are also functionally not mirror images to each other. For example, for most Page 16 of 35 people, speech and language, and stepwise reasoning and analysis and so on are based mainly on the left side. Meanwhile, the right hemisphere is more concerned with sensory inputs, auditory and visual awareness, creative abilities and spatial-temporal awareness (Figure 20). The four or the six lobes Cerebrum is covered with bulges and grooves on its surface. Based on these formations, the cerebrum is divided into the four lobes, using the anatomical system. The main and the deepest groove is the longitudinal fissure that separates the cerebral hemispheres. However, the division into the lobes is made overlooking this fissure, and thus each lobe is spread on both the hemispheres. Due to this, we often speak of the four pairs of lobes. These lobes are frontal lobes, parietal lobes, occipital lobes, and temporal lobes (Figure 21). The names of the lobes are partly related to the overlying bones of the skull such as frontal and occipital bones. In some naming systems, the limbic lobe and the insula, or central lobe, are distinguished as separate from other lobes. Frontal lobes Frontal lobes are located at the front of the two hemispheres. Of all the lobes, these are the biggest in size as well as the last to develop. In relation to the other lobes, this pair of lobes is at the front of the parietal lobes, and above the temporal lobes. Between these lobes and the parietal lobes lies the central sulcus, and between these lobes and the temporal lobes lies the lateral sulcus. Towards the end of these lobes, i. e. the site where the pre-central gyrus is located also happens to be the area of the primary motor cortex. Thus, this pair of lobes is clearly responsible for regulating the conscious movement of certain parts of the body. Besides, it is known that the cortex areas within these lobes hold the largest number of neurons that are very sensitive to the dopamine neurotransmitters. Granting this, these lobes should also be related with such mental activities as intention, short-term memory, attention, and hope. When the frontal lobes are damaged, the person lacks in ability to exercise counter measures against lapses and tend to engage in untoward behaviors. These days, neurologist can detect these disorders quite easily. Parietal lobes Parietal lobes are positioned behind (posterior to) the frontal lobes, and above (superior to) the occipital lobes. Using the anatomical system, the central sulcus divides the frontal and parietal lobes, as mentioned before. Between the parietal and the occipital lobes lies Page 17 of 35 the parieto-occipital sulcus, whereas the lateral sulcus marks the dividing line between the parietal and temporal lobes. This pair of lobes integrates sensory information from different modalities, particularly determining spatial sense and navigation, and thus is significant for the acts of touching and holding objects. For example, it comprises somatosensory cortex, which is the area of the brain that processes the sense of touch, and the dorsal stream of the visual system, which supports knowing where objects are in space and guiding the body’s actions in space. Several portions of the parietal lobe are important in language processing. Occipital lobes The two occipital lobes are the smallest of four paired lobes in the human cerebral cortex. They are located in the lower, rearmost portion of the skull. Included within the region of this pair of lobes are many areas especially associated with vision. Thus, this lobe holds special significance for vision. There are many extrastriate regions within this lobe. These regions are specialized for different visual tasks, such as visual, spatial processing, color discrimination, and motion perception. When this lobe is damaged, the patient may not be able to see part of their visual field, or may be subjected to visual illusions, or even go partial or full blind. Temporal lobes Temporal lobe is situated below the frontal and parietal lobes. It contains the hippocampus and plays a key role in the formation of explicit long-term memory modulated by the amygdala. This means that it is involved in attaching emotions to all the data received from all senses. Adjacent areas in the superior, posterior, and lateral part of the temporal lobes are involved in high-level auditory processing. The temporal lobe is involved in primary auditory perception, such as hearing, and holds the primary auditory cortex. The primary auditory cortex receives sensory information from the ears and secondary areas process the information into meaningful units such as speech and words. The ventral part of the temporal cortices appears to be involved in high-level visual processing of complex stimuli such as faces and scenes. Anterior parts of this ventral stream for visual processing are involved in object perception and recognition. Limbic System The structures of the limbic system are surrounded by an area of the cortex referred to as the limbic lobe. The lobe forms a collarlike or ringlike shape on the inner surfaces of the cerebral hemispheres, both above and below the corpus callosum. As such, the limbic lobe comprises the inward-facing parts of other cortical lobes, including the temporal, parietal, and frontal, where the left and right lobes curve around to face each other. Page 18 of 35 Important anatomical parts of this lobe are hippocampus and amygdala, associated with memory and emotions respectively. Insular cortex (or insula) Insular lobe is located between the frontal, parietal, and temporal lobes. As suggested by its name, it is almost hidden within the lateral sulcus, deep inside the core of the brain. It is believed to be associated with consciousness. Since data indicative of the inner status of the body, such as the heartbeat, body temperature, and pain assemble here, it is believed to impact the equilibrium of the body. Besides, it is also believed to be related with several aspects of the mind, such as the emotions. Among these are perception, motor regulation, self-awareness, cognition, and inter-personal emotions. Thus, insular lobe is considered to be highly related with mental instability. The forebrain, the midbrain, and the hindbrain The divisions of the brain so far, either into the two hemispheres or the four or six lobes are solely based on the cerebrum alone. None of the above divisions included any portion either of the cerebellum or the brainstem. Yet another way of dividing the portions of the brain is into the forebrain, the midbrain, and the hindbrain (Figure 22. This is the most comprehensive division of the brain, leaving no parts of it outside. There are two systems of presenting this division: one, on the basis of the portions of the brain during early development of the central nervous system, and the other, based on the full maturation of those early parts into their respective regions of an adult brain. Here, we follow the latter system. The forebrain The forebrain is so called because of its extension to the forefront of the brain. It is the largest among the three divisions. It even spreads to the top and back part of the brain. It houses both the hemispheres, as well as the entire portion of the part known as the diencephalon. Diencephalon comprises of the hippocampus, which is associated with memory, and the amygdala, which is associated with emotions. Besides them, the forebrain also includes both the thalamus and the hypothalamus, of which the former is the part of the brain that processes information received from other parts of the central nervous system and the peripheral nervous system into the brain, and the latter which is involved is several activities such as appetite, sexuality, body temperature, and hormones. Page 19 of 35 The midbrain The midbrain is located below the forebrain and above the hindbrain. It resides in the core of the brain, almost like a link between the forebrain and the midbrain. It regulates several sensory processes such as that of the visual and auditory ones, as well as motor processes. This is also the region where several visual and auditory reflexive responses take place. These are involuntary reflexes in response to the external stimuli. Several of the masses of gray matter, composed mainly of the cell bodies, such as the basal ganglia linked with movement are also present in the midbrain. Of the above three major divisions of the brain, the midbrain belongs to the brainstem, and of the two main systems within the nervous system, it belongs to the central nervous system. The hindbrain The hindbrain is located below the end-tip of the forebrain, and at the exact back of the midbrain. It includes cerebellum, the pons, and the medulla, among others. Of these, the cerebellum has influence over body movement, equilibrium, and balance. The pons not only brings the motor information to the cerebellum, but is also related with the control over sleep and wakeful states. Finally, the medulla is responsible for involuntary processes of the nervous system associated with such activities as respiration and digestion. In terms of anatomy, pons is uppermost part, and beneath it the cerebellum and the medullae, which tapers to merge with the spinal cord. Vertical organization of the brain The organization of the brain layers can be said to represent a certain gradation of mental processes (Figure 23). The uppermost brain region, the cerebral cortex, is mostly involved in conscious sensations, abstract thought processes, reasoning, planning, working memory, and similar higher mental processes. The limbic areas on the brain’s innermost sides, around the brainstem, deal largely with more emotional and instinctive behaviors and reactions, as well as long-term memory. The thalamus is a preprocessing and relay center, primarily for sensory information coming from lower in the brainstem, bound for the cerebral hemispheres above. Moving down the brainstem into the medulla are the so-called ‘vegetative’ centers of the brain, which sustain life even if the person has lost consciousness. Anatomical directions and reference planes of the brain To enable us to identify the precise location in the brain, both vertically and horizontally, it is important to be familiar with certain technical terms used by the neuroscientists. In Page 20 of 35 terms of anatomy, the front of the brain, nearest the face, is referred to as the anterior end, and polar opposite to the anterior end is the posterior end, referring to the back of the head. Superior (sometimes called dorsal) refers to the direction toward the top of the head, and inferior (sometimes called ventral) refers to the direction toward the neck/body. In terms of reference planes, the sagittal plane divides the brain into left and right portions, the coronal plane divides the brain into anterior and posterior portions, and the axial (sometimes called horizontal) plane divides the brain into superior and inferior portions (Figure 24). In both the above contexts, we can further specify the location of a particular portion or plane in terms of its position, direction, and depth in relation to the whole brain. Likewise, for each of the planes themselves, we can further speak in terms of position, direction, and depth in relation to the whole brain as well as in relation to the individual planes. Also, when representing brain parts and structures, a lateral view illustrates the section or lobes, etc. from the perspective of a whole brain, whereas a medial view illustrates the section in the dissected manner. 8) DIFFERENT TYPES OF BRAINS In general, the number of living beings who possess brain is numerous. Their brains vary both in size and function. However, if you ask whether all brains completely differ from each other. Definitely not. There are features that are common to almost all brains, such as that all brains are composed mainly of neurons, and that they all have the function of protecting the individual being from internal and external dangers. So, although there are various types of brains, here we shall focus mainly on the differences in brain types between vertebrates and invertebrates in general, and the differences within the vertebrates in particular. As you know, vertebrates are those animals who have backbone, and invertebrates do not have backbone. Most of the invertebrates do not have brain. However, those, among them, who do possess brain, theirs is usually a simple brain, composed of very few neurons. Note that majority of the animals on this earth are invertebrates. The vertebrates make up only two percent of the entire animal population. The unicellular organisms, because of practical existential reason, usually tend to be very sensitive to light. Organisms such as sea-urchins are slightly more complex and are multi-cellular. They have a few nerve cells that regulate the function of looking for sustenance and providing protection from possible dangers. Slightly more complex than the types of sea-urchins are earthworm and jellyfish, which have neurons that assist them in fighting hostile external Page 21 of 35 environment (Figure 25). It is interesting to know that the neurons these simple organisms have are similar to the human neurons in terms of structure, function, as well as their neurotransmitters. If you ask, what is the difference then? There hardly is any connection between the nerves in the invertebrates. Besides that, the nerves almost cover their entire bodies. For example, among the invertebrates, earthworms (Figure 26) have one of the simplest types of brains, possessing only a few neurons. Their brains regulate only a few simple tasks such as eating food and doing a few simple body movements, not any higher actions. The network of neurons that process and interpret the information received from the earthworm’s body parts is present in the earthworm’s head. However, even if that network were to be removed from its body, no noticeable changes would be observe in its behavior. Still, among the invertebrates, grasshoppers and bees have slightly more complex brains. Scientists have begun to understand the relation between their brains and the corresponding behaviors (Figure 27). The ants, also an invertebrate, have more complex behavior, but have a very tiny brain. Likewise, the mosquitoes perform the function of flying in the space, suck blood from others, etc. However, their brain size is still no more than a small dot. Among the vertebrates, the mice are generally quite smart, yet have brains weighing no more than 2 grams. Their entire brain size is equivalent to that of the human hypothalamus. Though generally it is said the bigger the brain, the greater the intellect. However, in actuality it is the overall area of cortices, not just the overall bulk that determines the level of intellect. Among the vertebrates, there are mammals and non-mammals. Birds and fish are examples of non-mammals. It is known that the brains of mammals and non-mammals differ greatly in terms of complexity in the areas of composition, neurons, synapses, etc. Though they still have the same basic parts and structures, they differ in the overall brain size in relation to their bodies. Besides that, depending on which parts play out more in their life, they differ in the relative size of specific parts of the brain and body. For example, birds and fish have relatively very small olfactory bulb. Also, these nonmammalian animals lack brain cortex. Cerebral cortex is a special brain part, quite prominent in primates including the humans. Not only this, human beings are known to have a disproportionately large cortex (Figures 28 & 29). The average weight of human brain amounts to only one and a half percent of their body weight. However, it consumes 20 percent of the food required by the whole body. So, the larger the brain is the greater the amount of energy consumption. Therefore, bigger brain Page 22 of 35 is not always a sign of boon to the individual species. This may be the reason why there are no many species with larger brains in the history of evolution. Social animals that depend on their social community for survival are said to have larger brains. For example, dolphins, who hunt in groups, have fairly large brain. Although, the brains of elephants and whales are much bigger in size than that of the humans, but humans have the largest brains in proportionate to their body sizes. 9) FACTS ABOUT HUMAN SPINAL CORD Spinal cord is located within the vertebrae of the backbone. It extends from brainstem down to the first lumbar vertebra. It is roughly the width of a conventional pencil, tapering at it base even thinner. It is comprised of a bundle of fibers, and the fibers are long projections of nerve cells, extending from the base of the brain to the lower region of the spine. The spinal cord carries information to and from the brain and all parts of the body except the head, which is served by the cranial nerves. The signals that travel along the spinal cord are known as nerve impulses. Data from the sensory organs in different parts of the body is collected via the spinal nerves and transmitted along the spinal cord to the brain. The spinal cord also sends motor information, such as movement commands, from the brain out to the body, again transmitted via the spinal nerve network. In terms of its anatomy, the spinal cord (Figure 30) is constituted of what is known as white matter and gray matter. The gray matter, which forms the core of the spinal cord, is composed mainly of nerve cell bodies and forms an external look of a butterfly. The white matter surrounds the gray matter and its nerve fibers play a significant role of establishing connection between different parts of the spinal cord as well as between the brain and the spinal cord. The outer regions of white matter insulate the long projecting nerve fibers (axons) coming out from the neurons. In the gray matter of the spinal cord, there are numerous low-key nerve centers that can perform certain fundamental movement responses. However, the nerve centers within the spinal cord are regulated by the brain. The ability of the humans in consciously controlling the bowl movement is an example in this regard. The fact that infants frequent to toilets more often than the adults and that many have bedwetting problem is due to the brain being not fully developed as well as lacking in control over urine. Thus, the spinal cord serves as a pathway of connection between the brain, the rest of the body, and internal organs. The spinal cord stays in contact with the majority of body organs through the medium of nerves. Page 23 of 35 10) PERIPHERAL NERVOUS SYSTEM As discussed above, the whole of nervous system is divided into the central nervous system (CNS) and the peripheral nervous system (PNS). Of these two, we have already discussed the central nervous system constituted by the brain and the spinal cord. So here, we will take up the remaining part, i.e. the peripheral nervous system. The peripheral nervous system is a complex network of nerves extending across the body, branching out from 12 pairs of cranial nerves originating in the brain and 31 pairs of spinal nerves emanating from the spinal cord. It relays information between the body and the brain in the form of nerve impulses. It has an afferent division (through which messages are sent to the brain) and an efferent division (which carries messages from the brain to the body). Finally, there is the autonomic nervous system, which shares some nerve structures with both the CNS and PNS. It functions ‘automatically’ without conscious awareness, controlling basic functions, such as body temperature, blood pressure, and heart rate. Sensory input travels quickly from receptor points throughout the body via the afferent networks of the PNS to the brain, which processes, coordinates, and interprets the data in just fractions of a second. The brain makes an executive decision that is conveyed via the efferent division of the PNS to muscles, which take the needed action. The twelve pairs of cranial nerves There are 12 pairs of cranial nerves (Figure 31). They are all linked directly to the brain and do not enter the spinal cord. They allow sensory information to pass from the organs of the head, such as the eyes and ears, to the brain and also convey motor information from the brain to these organs—for example, directions for moving the mouth and lips in speech. The cranial nerves are named for the body part they serve, such as the optic nerve for the eyes, and are also assigned Roman numerical, following anatomical convention. Of these, some are associated with sensory information and others with motor information, while some are associated with both the kinds of information. How cranial nerves attach The cranial nerves I and II connect to the cerebrum, while cranial nerves III to XII connect to the brainstem. The fibers of sensory cranial nerves each project from a cell body that is located outside the brain itself, in sensory ganglia or elsewhere along the trunks of sensory nerves. The thirty-one pairs of spinal nerves Page 24 of 35 There are 31 pairs of spinal nerves (Figure 32). These branch out from the spinal cord, dividing and subdividing to form a network connecting the spinal cord to every part of the body. The spinal nerves carry information from receptors around the body to the spinal cord. From here the information passes to the brain for processing. Spinal nerves also transmit motor information from the brain to the body’s muscles and glands so that the brain’s instructions can be carried out swiftly. Each of the 31 pairs of spinal nerves belongs to one of the four spinal regions--- cervical, thoracic, lumbar, and sacral. Of them, the cervical region has eight pairs, the thoracic has twelve pairs, the lumbar has five, and finally, the sacral has six pairs. How spinal nerves attach As mentioned above, human spinal cord is located within the vertebrae of the backbone. So, one may wonder how the spinal nerves attach to the spinal cord. There are gaps in the vertebrae of the backbone through which spinal nerves enter the spinal cord (Figure 33). The nerves divide into spinal nerve roots, each made up of tiny rootlets that enter the back and front parts of the cord. 11) A SLIGHTLY DETAILED LOOK AT THE SENSES How do our brain and the environment interact? Here is how. First the senses come in contact with the external stimuli such as light, sound wave, pressure, etc. to which the corresponding senses respond. Then those sense data are sent along the respective sensory nerves in the form of electrical signals which eventually reach their respective sites on the brain cortices. That is when we shall have the perception of the respective objects. SEEING Let’s now take up each of the senses, one by one. First, we discuss the sense of vision. We shall look into the following topics surrounding the sense of vision: the structure of eye, its receptor cells, the visual pathway, and the range of light frequency different animals, including humans, have access to. Page 25 of 35 STRUCTURE OF EYE The eyeball is a fluid-filled orb. It has a hole in the front called pupil. At the back of the eyeball, there is retina which is a sheet of nerve cells. Some of the retinal cells are lightsensitive (photoreceptive). In the center of the retina, there is a tiny pitted area called fovea, densely packed with cones which are color-picking, light-sensitive cells and are significant in detecting detailed, sensitive image of the object. Between the pupil and the retina is a lens that adjusts to help the light passing through pupil to focus on the surface of the retina. The pupil is surrounded by a muscular ring of pigmented fibers called iris. The iris is responsible for people having different eye colors, and it also controls the amount of light entering into the eye. The pupil is covered by a transparent layer of clear tissue called cornea which merges with the tough outer surface or the ‘white’ of the eye called sclera. In the back of the eye, there is a hole (optic disk) through which the optic nerves pass through to enter the brain (Figure 34). LIGHT-RECEPTIVE CELLS As mentioned before, retina is located at the back of the eye, and is composed of lightreceptive cells (photoreceptors). There are, in the main, two types of photoreceptors in the retina: cone cells and rod cells. The cone cells detect the color components from amongst the visible light spectrum, and are also responsible for detecting fine detail. However, cone photoreceptors require a huge amount of light to perform its function well. Cone cells in the humans are of three types: red-, blue-, and green-sensing cones, each detecting the respective colors. They are all formed on the surface and around the fovea. On the other hand, the rod cells are formed on the periphery of retina. These cells can detect images even in dim light. However, these cells mainly detect shape and motion, not so much the color. Of these two types of photoreceptors, the rods are much more sensitive to light, so much so that even with just a few light particles, they can at least generate a faint image. Besides, the manner of concentration of these cells in and around fovea impacts greatly the sensitivity of the sensation of the object. The majority of the 6 million cone cells are concentrated in the fovea, whereas all of the more than 120 million rod cells are spread around the fovea. Since the rods are spread over a larger area of the retina, they are relatively less concentrated, and thus, when one sees objects, they are not seen that clearly and detailed. Page 26 of 35 VISUAL PATHWAYS The light reflected from the visual objects first enters the pupil through cornea, and through pupil it enters deeper into the eyes. The iris that surrounds the pupil controls the amount of light entering the eyes by changing its shapes, due to which the pupil appears to contract when the light is bright and sharp, and expands when it is less bright. Afterwards, the light passes through the lens which bends (refracts) the light, making the light to converge on the retina. If focusing on a near object, the lens thickens to increase refraction, but if the object is distant, the lens needs to flatten. The light then hits the photoreceptors in the retina, some of which fire, sending electrical signals to the brain via the optic nerve. Information received from the outer environment upon coming in contact with eyes has to travel right to the back of the brain where the relevant cortex (visual cortex) is, and only there it is turned into a conscious vision. Here is the pathway through which the information passes from the eyes to the optic nerves to the visual cortex: the signals from the eyes passes through the two optic nerves and converge at a crossover junction called the optic chiasm. The fibers carrying the signals continue on to form the optic tracts, one on each side, which end at the lateral geniculate nucleus, part of the thalamus. However, the signals continue to the visual cortex via bands of nerve fibers, called the optic radiation (Figure 35). RANGE OF LIGHT WAVELENGTH THAT DIFFERENT ANIMALS, INCLUDING HUMANS, HAVE ACCESS TO In the course of evolution, by means of natural selection, different species of organisms, including the humans, have evolved eyes with varying structures and functions. That range of electromagnetic spectrum visible to the human eyes is called the visible light, which range from 400 to 700 nanometers on the wavelength. That is, from the violet, with the shorter wavelengths, to red, with longer wavelengths. Lights with wavelengths outside of the above range are normally not visible to humans. This illustrates the difference in the structure of eyes among different species of organisms. For example, the vultures and rabbits have different eye from each other. Due to that, vultures can see much farther than the rabbits do, yet cannot see as widely as the rabbits do. Likewise, the infrared light that the humans cannot see is visible to some types of fish and birds. Some birds can tell a male bird from a female bird just by looking at the infrared light reflected from their wings. Likewise, there are two main features distinct in the eyes of the bees that the humans do not have. First, their eyes can detect infrared light that the humans cannot. Second, their Page 27 of 35 visual processing is five-fold speedier than that of the humans. For example, when the bees observe a normal moving object, they do not see that as moving. Rather, they are said to see that in the form of a series of distinct temporal instances. What accounts for such a unique feature of the bees’ eyes? Their eyes are composed of six-sided lens, covered with about 4500 circular discs. These lens let in just the lights reflected from the object they focus on and not from around it. Besides that, unlike human eyes, the eyes of the bees are said to have nine types of light receptors. Because of the speed of the visual processing that the bees possess, they have a advantage of being able to negotiate their movement so well even while moving with so much speed with the least incidents of ever bumping against objects, etc. Also, often we wonder about the sharp lights reflected back from the eyes of cats and other animals of that family. That is now understood to be due to the fact that all the lights entering their eyes fail to be absorbed in the retina, and are thus reflected back by the membrane called the reflective white. HEARING The ear is divided into three sections: the outer ear, the middle ear, and the inner ear. The outer ear has three further sections: the visible part of the ear called the pinna, the auditory canal, and the eardrum. The middle ear has three tiny bone structures that help in our hearing process: malleus (hammer), incus (anvil), and stapes (stirrup). The inner ear has several parts, of which the important ones are oval window, cochlea, and auditory nerve. The outer ear funnels sound waves along the auditory canal to the eardrum which is situated towards the inner end of the air canal. Immediate after the eardrum, the three tiny bones of the middle ear are attached one after the other. The sound waves cause the eardrum to vibrate, which in turn causes this chain of bones to vibrate. The vibration eventually reaches a membrane known as the oval window, the start of the inner ear. The oval window is slightly smaller than the ear drum in diameter. Because of this, when the vibration enters from the middle ear into the inner ear, the vibration becomes more consolidated. Inner ear is situated deep under the skull. Commensurate with the force of sound waves striking the ear drum, the stapes will accordingly cause the oval window to vibrate. Due to this, the fluids filling the chambers of cochlea will move, causing basilar membrane to vibrate. This stimulates the sensory hair cells on the organ of corti transforming the pressure waves into electrical impulses. These impulses pass through auditory nerve to the temporal lobe and from there to the auditory cortex (Figure 36). Page 28 of 35 Because of the way human ear is structured, it has access to a limited range of sound frequency. That is between 20 and 20000 Hertz. Sounds beyond that range are not audible to the humans. Sounds vary in terms of their pitch, and the receptors corresponding to them are found in the various parts of the cochlea. The receptors for low pitch sounds are located in the front part of cochlea, whereas receptors for the higher and the highest pitch sounds are found in the middle and inner end, respectively, of the cochlea. SMELL The area within each nasal cavity that contains the olfactory receptor cells is known as the olfactory epithelium. A small amount of the air entering the nostrils will pass over the epithelium, which is covered in mucus. Smell molecules in the air dissolve in this mucus, bringing receptors into direct contact with the smell molecules. Three cell types are within the epithelium: in addition to the receptor cells, there are supporting cells which produce a constant supply of mucus and, basal cells, which produce new receptor cells every few weeks. The larger the epithelium is, the keener the sense of smell. Dogs, for example, have a considerably larger olfactory epithelium than humans. Like the sense of taste, smell is a chemical sense. Specialized receptors in the nasal cavity detect incoming molecules, which enter the nose on air currents and bind to receptor cells. Sniffing sucks up more odor molecules into the nose, allowing you to ‘sample’ a smell. Olfactory receptors located high up in the nasal cavity send electrical impulses to the olfactory bulb, in the limbic area of the brain, for processing. Odors are initially registered by receptor cells in the nasal cavity. These send electrical impulses along dedicated pathways to the olfactory bulb (each nostril connects to one olfactory bulb). The olfactory bulb is the smell gateway to the brain. It is part of the brain’s limbic system, the seat of our emotions, desires, and instincts, which is why smell can trigger strong emotional reactions. Once processed by the olfactory bulb, data is then sent to various areas of the brain, including the olfactory cortex adjacent to the hippocampus. Unlike data gathered by the other sense organs, odors are processed on the same side, not opposite, side of the brain as the nostril the sensory data was sent from (Figure 37). How do the olfactory receptors detect the different odors? Different smells are produced from different molecular structures of smell. Research shows that each receptor has zones on it. Therefore, when a specific smell enters the nose, only the receptors forming a conforming pattern, not every receptor, is activated. That is how the specific smell is Page 29 of 35 detected. So far the scientists have identified eight primary odors: camphorous, fishy, malty, minty, musky, spermatic, sweaty, and urinous. TASTE Taste and smell are both chemical senses. Therefore, tongue can detect taste only when the receptors in it bind to incoming molecules, generating electrical signals that pass through the related cranial nerves to the specific brain areas. Thus, the pathway of gustatory electrical impulses begins with mouth, going to medulla, continues to the thalamus, then to primary gustatory areas of the cerebral cortex. A person can experience the basic five flavors (sweet, sour, salty, bitter, and umami) by merely activating the taste receptors on the tongue. However, the flavors produced from the combination of these can be detected by tongue only in interaction with the sense of smell. Compared with cold food, we experience the hot food to produce greater taste. This is because, during such time, smell particles rising from the hot food bind to and excite the smell receptors inside the nose, making us also to sense their smell. Before the smell particles and taste particles are detected by the smell receptors and taste receptors respectively, these particles have to dissolve in the liquid solvents in the nose and mouth respectively. So they are similar on that front. However, what is different between the two is that while the taste receptors are not actual neurons, but a special type of cells, the smell receptors are actual neurons. Due to this difference, we see a marked difference in the degree of sensitivity towards the chemical particles. The smell receptors are 300 hundred times more sensitive (Figure 38). The tongue is the main sensory organ for taste detection. It is the body’s most flexible muscular organ. It has three interior muscles and three pairs of muscles connecting it to the mouth and throat. Its surface is dotted with tiny, pimplelike structures called papillae. Papillae are easily visible to naked eyes. Within each papilla are hundreds of taste buds and they are distributed across the tongue. Four types of papillae have been distinguished---vallate, filiform, foliate, and fungiform. Each type bears a different amount of taste buds. A taste bud is composed of a group of about 25 receptor cells alongside supporting cells layered together. In general, humans have 5000 to 10,000 taste buds, and each bud may carry 25 to 100 taste receptor cells within it. At the tip of each cell, there is a hole through which taste chemical particles enter and come in contact with the receptor molecules. The tiny hair-like receptors inside these receptor cells can hold only particular taste particles. Earlier, scientists believed that different parts of the tongue are dedicated to detecting specific tastes. However, according to recent researches, all tastes are detected equally across the tongue, and the tongue is well supplied with nerves Page 30 of 35 that carry taste-related data to the brain. Other parts of the mouth such as the palate, pharynx, and epiglottis can also detect taste stimuli. TOUCH There are many kinds of touch sensations. These include light touch, pressure, vibration, and temperature as well as pain, and awareness of the body position in space. The skin is the body’s main sense organ for touch. There are around 20 types of touch receptor that respond to various types of stimuli. For instance, light touch, a general category that covers sensations ranging from a tap on the arm to stroking a cat’s fur, is detected by four different types of receptor cells: free nerve endings, found in the epidermis; Merkel’s disks, found in deeper layers of the skin; Meissner’s corpuscles, which are common in the palms, soles of the feet, eyelids, genitals, and nipples; and, finally, the root hair plexus, which responds when the hair moves. Pacinian and Ruffini corpuscles respond to more pressure. The sensation of itching is produced by repetitive low-level stimulation of nerve fibers in the skin, while feeling ticklish involves more intense stimulation of the same nerve endings when the stimulus moves over the skin (Figure 39). As for the manner in which touch information finally makes its way to the brain, a sense receptor, when activated, sends information about touch stimuli as electrical impulses along a nerve fiber of the sensory nerve network to the nerve root on the spinal cord. The data enters the spinal cord and continues upward to the brain. The processing of sensory data is begun by the nuclei in the upper (dorsal) column of the spinal cord. From the brainstem, sensory data enters the thalamus, where processing continues. The data then travels to the postcentral gyrus of the cerebral cortex, the location of the somatosensory cortex. Here, it is finally translated into a touch perception. Somatosensory cerebral cortex curls around the brain like a horseshoe. Data from the right side of the body ends on the left side of the brain, and vice versa. THE SIXTH SENSE Proprioception is sometimes referred to as the sixth sense. It is our sense of how our bodies are positioned and moving in space. This ‘awareness’ is produced by part of the somatic sensing system, and involves structures called proprioceptors in the muscles, tendons, joints, and ligaments that monitor changes in their length, tension, and pressure linked to changes in position. Proprioceptors send impulses to the brain. Upon processing this information, a decision can be made—to change position or to stop moving. The brain then sends signals back to the muscles based on the input from the proprioceptors— Page 31 of 35 completing the feedback cycle. This information is not always made conscious. For example, keeping and adjusting balance is generally an unconscious process. Conscious proprioception uses the dorsal column-medial lemniscus pathway, which passes through the thalamus, and ends in the parietal lobe of the cortex. Unconscious proprioception involves spinocerebellar tracts, and ends in the cerebellum. Proprioception is impaired when people are under the influence of alcohol or certain drugs. The degree of impairment can be tested by field sobriety tests, which have long been used by the police in cases of suspected drunk-driving. Typical tests include asking someone to touch their index finger to their nose with eyes closed, to stand on one leg for 30 seconds, or to walk heel-to-toe in a straight line for nine steps. MIXED SENSES Sensory neurons respond to data from specific sense organs. Visual cortical neurons, for example, are most sensitive to signals from the eyes. But this specialization is not rigid. Visual neurons have been found to respond more strongly to weak light signals if accompanied by sound, suggesting that they are activated by data from the ears as well as the eyes. Other studies show that in people who are blind or deaf, some neurons that would normally process visual or auditory stimuli are “hijacked” by the other senses. Hence, blind people hear better and deaf people see better. SYNESTHESIA Most people are aware of only a single sensation in response to one type of stimulus. For example, sound waves make noise. But some people experience more than one sensation in response to a single stimulus. They may “see” sounds as well as hear them, or “taste” images. Called synesthesia, this sensory duplication occurs when the neural pathway from a sense organ diverges and carries data on one type of stimulus to a part of the brain that normally processes another type (Figure 40). PERCEPTION AS A CONSTRUCT Do we perceive the external world directly, or do we perceive a constructed reality? Neuroscience finds that the latter is a more accurate description. When our sensory organs detect something in the environment, they are responding to a physical stimulus. For example, the photoreceptor cells in the retina of the eye respond to photon particles traveling through space. These photons stimulate the receptor neurons, and start a chain reaction of neural signals to the primary visual cortex in the brain, where it becomes a perception. While the visual perception correlates with the physical stimulus, they are not Page 32 of 35 one and the same. It was described earlier that photons have a wavelength, and the wavelength can vary among photons. Each numerical difference in the wavelength of a photon correlates with a difference in the perception of color. That is, photons with a wavelength of around 500 nanometers correlate with perceiving the color blue, while a wavelength of around 700 nanometers correlates with perceiving the color red. While the physical property of wavelength exists objectively in the world, the perceived color only exists subjectively and depends on our ability to detect it. The colors we perceive are not physical properties, but rather the psychological correlates of the physical property of wavelength of light. Moreover, there are many wavelengths that we cannot detect, so our perceptions selectively represent the physical world. The same principle applies to the other senses. Each sensory modality we have has two components: the physical stimulus that is detected by the sensory organ, and the psychological perception that results from it. We do not directly perceive the wavelength of light, rather we perceive the result of how the photon particles stimulate the visual pathway. Therefore, we can say that perception is a construction that is grounded in detecting physical phenomena, but we do not directly perceive those phenomena. Nor do we perceive all objective phenomena, only those that we are capable of detecting. If perception is a construction and a limited representation of objective phenomena, why did it evolve that way? We need to be able to react to environmental circumstances to survive. To find food, to avoid predators, to meet mates, to care for offspring, to engage in social behavior, all of these actions require the ability to detect and respond to changes in the physical environment. But sensory systems can evolve to be simply good enough for survival. It is not necessary to have complete, direct perception to survive. In fact, recall the facts we discussed earlier about how the human brain is very demanding for the body’s resources. More sophisticated sensory systems require more resources, and if those resource requirements are not of great utility to the organism, then evolution likely will not favor increasing the level of sophistication. In addition, there is often a trade-off between speed and accuracy in neural systems and resulting behaviors. When it comes to visual perception, seeing a danger with less accuracy and surviving is more important than seeing a danger directly and not surviving! Page 33 of 35 12)CONSCIOUSNESS AND THE BRAIN WHAT IS CONSCIOUSNESS? Consciousness is important as well as essential. Without it, life would have no meaning. However, once we embark on identifying its nature, it is certain to find it to be like nothing else. A thought, feeling, or idea seems to be a different kind of thing from the physical objects that make up the rest of the universe. The contents of our minds cannot be located in space or time. Although to the neuroscientists the contents of our minds appear to be produced by particular types of physical activity in the brain, it is not known if this activity itself forms consciousness or if brain activity correlates with a different thing altogether that we call “the mind” or consciousness (Figure 41). If consciousness is not simply brain activity, this suggests that the material universe is just one aspect of reality and that consciousness is part of a parallel reality in which entirely different rules apply. MONISM AND DUALISM The philosophical stands of those positing the relation between mind and body can be broadly brought under two divisions: monism and dualism. According to the former, every phenomenon in the universe can be ultimately reduced to a material thing. Consciousness too is identical to the brain activity that correlates with it. However, the fact that not every physical thing has consciousness is because only in those physical bodies where complex physical processes evolved over a long period of time did cognitive mechanism develop. Thus, consciousness never existed in parallel with the material universe as an independent entity of its own. According to the latter, consciousness is not physical but exists in another dimension to the material universe. Certain brain processes are associated with the consciousness, but they are not identical to each other. Some dualists believe consciousness may even exist without the brain processes associated with it. LOCATING CONSCIOUSNESS Human consciousness arises from the interaction of every part of a person with their environment. We know that the brain plays the major role in producing conscious awareness but we do not know exactly how. Certain processes within the brain, and neuronal activity in particular areas, correlate reliably with conscious states, while others do not. Page 34 of 35 Different types of neuronal activity in the brain are associated with the emergence of conscious awareness. Neuronal activity in the cortex, and particularly in the frontal lobes, is associated with the arousal of conscious experience. It takes up to half a second for a stimulus to become conscious after it has first been registered in the brain. Initially, the neuronal activity triggered by the stimulus occurs in the “lower” areas of the brain, such as the amygdala and thalamus, and then in the “higher” brain, in the parts of the cortex that process sensations. The frontal cortex is activated usually only when an experience becomes conscious, suggesting that the involvement of this part of the brain may be an essential component of consciousness. REQUIREMENTS OF CONSCIOUSNESS Every state of conscious awareness has a specific pattern of brain activity associated with it. These are commonly referred to as the neural correlates of consciousness. For example, seeing a patch of yellow produces one pattern of brain activity, seeing grandparents, another. If the brain state changes from one pattern to another, so does the experience of consciousness. Consciousness arises only when brain cells fire at fairly high rates. So, neural activity must be complex for consciousness to occur, but not too complex. If all the neurons are firing, such as in an epileptic seizure, consciousness is lost. The processes relevant to consciousness are generally assumed to be found at the level of brain cells rather than at the level of individual molecules or atoms. Yet it is also possible that consciousness does arise at the far smaller atomic (quantum) level, and if so it may be subject to very different laws. Many neuroscientists hold the philosophical view of materialism; that there is only one fundamental substance in the universe and that is physical material. How, then, is subjective experience of the mind explained? Through a process known as emergence. Emergence is a process described as the production of a phenomenon from the interactions or processes of several other phenomena. For example, the molecule that is water is composed of two hydrogen atoms and one oxygen atom. The hydrogen and oxygen atoms on their own do not have the quality of wetness that water has. But when you combine them to form the molecule, and you have enough water molecules, then the property of wetness emerges from those interactions. Neuroscientists use this as an analogy, and argue that when many neurons are combined, consciousness emerges from those interactions. This analogy serves as a useful description within the viewpoint of materialism, but it is not an explanation, as we have yet to demonstrate the mechanisms involved in such an emergence.","Can you list all of the ancient people mentioned by name in a bullet point list along with a brief description of their beliefs regarding the brain? Use only the given sources to complete your responses. Do not use outside sources or any previous knowledge of the topic that you may have. 1) A BRIEF HISTORY OF NEUROSCIENCE Humans have long been interested in exploring the nature of mind. The long history of their enquiry into the relationship between mind and body is particularly marked by several twists and turns. However, brain is the last of the human organs to be studied in all seriousness, more particularly its relation with human mind. Around 2000 BC and for long since that time the Egyptians did not think highly of the brain. They would take out the brain via the nostrils and discarded it away before mummifying the dead body. Instead, they would take great care of the heart and other internal organs. However, a few Egyptian physicians seemed to appreciate the significance of the brain early on. Certain written records have been found where Egyptian physicians had even identified parts and areas in the brain. Besides, Egyptian papyrus, believed to have been written around 1700 BC, carried careful description of the brain, suggesting the possibility of addressing mental disorders through treatment of the brain. That is the first record of its kind in the human history (Figure 1). The Greek mathematician and philosopher, Plato (427-347) believed that the brain was the seat of mental processes such as memory and feelings (Figure 2). Later, another Greek physician and writer on medicine, Galen (130-200 AD) too, believed that brain disorders were responsible for mental illnesses. He also followed Plato in concluding that the mind or soul resided in the brain. However, Aristotle (384-322 BC), the great philosopher of Greece at that time, restated the ancient belief that the heart was the superior organ over the brain (Figure 3). In support of his belief, he stated that the brain was just like a radiator which stopped the body from becoming overheated, whereas the heart served as the seat of human intelligence, thought, and imagination, etc. Medieval philosophers felt that the brain was constituted of fluid-filled spaces called ventricles where the ‘animal spirits’ circulated to form sensations, emotions, and memories. This viewpoint brought about a shift in the previously held views and also provided the scientists with the new idea of actually looking into the brains of the humans and animals. However, no such ventricles as claimed by them were found upon examination nor did the scientists find any specific location for the self or the soul in the brain. In the seventeenth century, the French philosopher Rene Descartes (1596-1650) described mind and body as separate entities (Figure 4) yet they interacted with each other via the pineal gland, the only structure not duplicated on both sides of the brain. He maintained that the mind begins its journey from the pineal gland and circulates the rest of the body via the nerve vessels. His dualist view influenced the mind-body debate for Page 4 of 35 the next two centuries. However, through the numerous experiments undertaken in the 19th century, the scientists gathered evidences and findings which all emboldened the scientists to claim that the brain is the center of feelings, thoughts, self and behaviors. Just to give an example of the kind of experiments performed on a particular physical activity which pointed to the brain as the regulator of bodily actions, imagine activating a particular area of the brain through electrical stimulus, you would actually see it effectively impacting a corresponding body-part, say the legs by making them move. Through findings such as these as well as others, we have come of know also of the special activities of the electrical impulses and chemicals in the brain. Explorations continued into the later centuries and, by the middle of 20th century, human understanding of the brain and its activities have increased manifold. Particularly, towards the end of twentieth century, with further improvement in imaging technologies enabling the researchers to undertake investigation on functioning brains, the scientists were deeply convinced that the brain and the rest of the nervous systems monitored and regulated emotions and bodily behaviors (Figures 5 & 6). Since then, the brain together with the nervous system have become the center of attention as the basis of mental activities as well as physical behaviors, and gradually a separate branch of science called neuroscience focusing specifically on the nervous systems of the body has evolved in the last 40 so years. To better understand modern neuroscience in its historical context, including why the brain and nervous system have become the center of attention in the scientific pursuit of understanding the mind, it is useful to first review some preliminary topics in the philosophy of science. Science is a method of inquiry that is grounded in empirical evidence. Questions about the unknown direct the path of science as a method. Each newly discovered answer opens the door to many new questions, and the curiosity of scientists motivates them to answer those unfolding questions. When a scientist encounters a question, she or he develops an explanatory hypothesis that has the potential to answer it. But it is not enough to simply invent an explanation. To know if an explanation is valid or not, a scientist must test the hypothesis by identifying and observing relevant, objectively measurable phenomena. Any hypothesis that cannot be tested in this way is not useful for science. A useful hypothesis must be falsifiable, meaning that it must be possible to ascertain, based on objective observations, whether the hypothesis is wrong and does not explain the phenomena in question. If a hypothesis is not falsifiable, it is impossible to know whether it is the correct explanation of a phenomenon because we cannot test the validity of the claim. Why does the scientific method rely only on objective observations? Science is a team effort, conducted across communities and generations over space and time. For a hypothesis to be accepted as valid, it must be possible for any interested scientist to test it. For example, if we want to repeat an experiment that our colleague conducted last year, we need to test the hypothesis under the same conditions as the original experiment. This means it must be possible to recreate those conditions. The only way to do this in a precise and controlled manner is if the scientific method relies on empirical evidence. Page 5 of 35 Furthermore, conclusions in science are subject to peer review. This means that any scientist’s colleagues must be able to review and even re-create the procedures, analyses, and conclusions made by that scientist before deciding if the evidence supports the conclusions. Because we don’t have access to the subjective experiences of others, it is not possible to replicate experiments that are grounded in subjectivity because we cannot recreate the conditions of such an experiment, nor can we perform identical analyses of subjective phenomena across people. No matter how many words we use, we cannot describe a single subjective experience accurately enough to allow another person to experience it the same way. Consequently, we cannot have a replicable experiment if the evidence is not objective. Therefore, two necessary features of a scientific hypothesis are the potentials to falsify and replicate it. And both of these requirements are dependent on objectively measurable evidence. This is why we began with the claim that science is a method of inquiry that is grounded in empirical evidence. Neuroscience is a scientific discipline like any other, in that the focus of investigation is on objectively measurable phenomena. But unlike most other sciences, this poses a particularly challenging problem for neuroscience. How do we investigate the mind, which is subjective by nature, if empirical evidence is the only valid form of data to support a conclusion in science? The relationship between the mind and the body has become known as the “mind-body problem” in modern neuroscience and Western philosophy of mind, because there is a fundamental challenge to explain the mind in objective terms. Scientists view this relationship as a problem because their method of inquiry investigates phenomena from a third-person (he, she, it, they) perspective, while the subjective experience of the mind has a first-person (I, we) perspective. The mindbody problem has been a central, unresolved topic in Western philosophy of mind for centuries, and is a topic we will discuss in more detail in a later chapter of this textbook when we explore the neuroscience of consciousness. For now we can start simply by stating that the majority of scientists, including neuroscientists, hold the philosophical view that all phenomena are caused by physical processes, including consciousness and its related mental phenomena. This view might be proven wrong as inquiry proceeds, but is taken as the most simple (or parsimonious) starting point. Science uses the principle of parsimony, of starting with simple rather than complex explanations, as a way to facilitate production of falsifiable hypotheses: more complex explanations are built up as evidence accumulates and more simple explanations are excluded. Modern neuroscience investigates the brain and nervous system based on the working assumption that the objective physical states of those biological systems are the cause of the subjective mental states of the organism that has those biological systems. In other words, when you smell a fresh flower, taste a cup of chai, listen to the birds, feel the wind on your cheek, and see the clouds in the sky, those subjective experiences are caused by the momentary physical processes in your body, nervous system, and brain interacting with the physical environment. Under this philosophical view, then, mental states correlate with physical states of the organism, and by investigating those physical states scientists can understand the nature of those mental Page 6 of 35 states. So while this might seem counterintuitive based on the Buddhist method of inquiry, for a neuroscientist it is obvious to begin the investigation by focusing on physical phenomena; on the empirical evidence. Neuroscientists often equate the “neural correlates” of consciousness as consciousness itself. We will explore in more depth the relationship between form and function between the body and mind later in the textbook, as well as the philosophical view of materialism in neuroscience. It will also be helpful to introduce some basic concepts in neuroscience before exploring topics in more detail. The primary goal in this year of the neuroscience curriculum is that you become familiar with the brain and nervous system. The human brain is the most complex and extraordinary object known to all of modern science. Because of this immense complexity, it can be very challenging to encounter neuroscience in an introductory course such as this one. So patience is an important part of the learning process. First, neuroscience is still very much in its infancy as a scientific discipline, and there are vastly more questions than there are answers. Second, it can be a challenge for new students of neuroscience to simultaneously learn the details of the basic concepts while understanding and appreciating the broader conclusions. It’s like learning a language while also reading the literature of that language! Neuroscience is a scientific discipline with many different levels of exploration and explanation. Therefore, it is important for you to pay attention to the level at which are we speaking when you learn new concepts. For example, the brain and nervous system are made up of cells called neurons or nerve cells, which we will discuss in detail in Chapter 4. Neurons connect with each other to form complex networks, and from those different patterns of connection emerge different phenomena (such as a thought or a sensation) in the brain and ultimately in the mind. This may sound confusing at the moment, but we will explore these topics in more detail in later chapters. In neuroscience, levels of explanation can span from very low levels such as the molecular mechanisms involved in the neuron cells, to middle levels such as particular networks of neurons in the brain, to very high levels such as how humans engage in thoughts, speech, and purposeful actions. The brain is the bodily organ that is the center of the nervous system. But it might surprise you to learn that not all animals that have neurons have a brain! For example, jellyfish have neurons, but they don’t have a brain. Jellyfish are very simple organisms that live in the ocean, and their neurons allow them to sense some basic information about their environment. But because they don’t have a brain to process that environmental information, they can only react to their immediate environment. Without a brain, jellyfish cannot think, make plans for the future, have memories of the past, or make decisions. Their behavior is limited to reactions and reflexes. Complex networks of neurons in the human brain are the physiological substrates that support what we experience as human beings. But we are not the only species with a brain. Later in this textbook we will explore the relationship between brain complexity and behavior across species. For organisms that have a brain, information can flow along the complex networks of neurons in different ways. Some networks, also called pathways or systems, flow from the sensory organs to the brain, while others flow from the brain to the muscles of the Page 7 of 35 body. Afferent neurons, also called sensory neurons or receptor neurons, communicate information from the sensory organs to the brain. Efferent neurons, also called motor neurons, communicate information from the brain to the muscles of the body. Interneurons, also called association neurons, communicate information between neurons in the central nervous system and brain. This allows for the sensory and motor systems to interact, facilitating complex behaviors and integrating across the different sensory modalities. For example, to be able to reach for an object such as a teacup, your brain needs to link together your ability to sense the presence and location of the cup with your ability to control the muscles in your arm to grasp the cup. Interneurons perform this function. Finally, before starting your journey in learning about neuroscience, pause to contemplate some of the big questions and insights as they pertain to the Western science of the mind. As you go through this textbook and learn new concepts, it will be useful to think about them within the context of these big questions. For example, what is sentience? Is a brain required for sentience? The jellyfish we mentioned earlier can have basic sensations and react to the environment without a brain, but it cannot think or have memory. What are the necessary conditions to be sentient? What is the relationship between the mind and body? As a method of inquiry, can science directly investigate subjective experience? Or must we use alternative, and perhaps complementary methods of inquiry to achieve that? Do we perceive the physical world directly, or are our perceptions constructed? If the latter, how does that happen? 2) WHAT IS NEUROSCIENCE AND WHAT ARE ITS BRANCH SCIENCES? In the case of humans, it is the branch of science that studies the brain, the spinal cord, the nerves extending from them, and the rest of the nervous systems including the synapses, etc. Recall that neurons, or nerve cells, are the biological cells that make up the nervous system, and the nervous system is the complex network of connections between those cells. In this connection, it may involve itself with the cellular and molecular bases of the nervous system as well as the systems responsible for sensory and motor activities of the body. It also deals with the physical bases of mental processes of all levels, including emotions and cognitive elements. Thus, it concerns itself with issues such as thoughts, mental activities, behaviors, the brain and the spinal cord, functions of nerves, neural disorders, etc. It wrestles with questions such as What is consciousness?, How and why do beings have mental activities?, What are the physical bases for the variety of neural and mental illnesses, etc. In identifying the sub-branches within neuroscience, there are quite a few ways of doing so. However, here we will follow the lead of the Society for Neuroscience which identifies the following five branches: Neuro-anatomy, Developmental Neuroscience, Cognitive Neuroscience, Behavioral Neuroscience, and Neurology. Of these, Page 8 of 35 neuroanatomy concerns itself mainly with the issue of structures and parts of the nervous system. In this discipline, the scientists employ special dyeing techniques in identifying neurotransmitters and in understanding the specific functions of the nerves and nerve centers. Neurotransmitters are chemicals released between neurons for transmission of signals. When a neuron communicates with its neighboring cells, it releases neurotransmitters and its neighbors receive them. In developmental neuroscience, the scientists look into the phases and processes of development of nervous system, the changes they undergo after they have matured, and their eventual degeneration. In this regard, the scientists also investigate the ways neurons go about seeking connection with other neurons, how they establish the connection, and how they maintain the connection and what chemical changes and processes they have to undergo for these activities. Neurons make connections to form networks, and the different patterns of connectivity support different functions. Patterns of connectivity can change over different time scales, such as developmental changes over a lifetime from infancy to old age, but also in the short term such as learning a new concept. Neuroplasticity is the term that describes the capacity of the brain to change in response to stimulation or even damage: it is not a static organ, but is highly adaptable. In cognitive neuroscience, they study the functions of behaviors, perceptions, and memories, etc. By making use of non-invasive methods such as the PTE and MRI technologies that allow us to take detailed pictures of the brain without opening the skull, they look into the neural pathways activated during engagement in language, solutions, and other activities. Cognitive neuroscience studies the mind-body relationship by discovering the neural correlates to mental and behavioral phenomena. Behavioral neuroscience looks into the underpinning processes of human and animal behaviors. Using electrodes, they measure the neural electrical activities occurring alongside our actions such as visual perception, language use, and generating memories. Through fMRI scan techniques, another technology that allows us to take detailed motion pictures of brain activity over time without opening the skull, they strive to arrive at closer understanding of the brain parts in real time. Finally, neurology makes use of the fundamental research findings of the other disciplines in understanding the neural and neuronal disorders and strives to explore new innovative ways of detecting, preventing, and treating these disorders. 3) THE SUBJECT MATTER OF NEUROSCIENCE: THE MAIN SYSTEMS AND THEIR PARTS The field of neuroscience is the nervous system of animals in general and of humans in particular. In the case of humans, its nervous system has two main components: the central nervous system (CNS) and the peripheral nervous system (PNS) (Figure 7). The CNS comprises of the brain and the spinal cord. Their functions involve processing and interpreting the information received the senses, skin, muscles, etc. and giving responses Page 9 of 35 that direct and dictate specific actions such as particular movements by different parts of the body. The peripheral nervous system (PNS) includes all the rest of the nervous system aside from the central nervous system. This means that it comprises the 12 pairs of cranial nerves that originate directly from the brain and spread to different parts of the body bypassing the spinal cord, and the 31 pairs of spinal nerves that pass through the spinal cord and spread to different parts of the body. Thus, the PNS is mainly constituted of nerve. PNS is sometimes further classified into voluntary nervous system and the autonomic nervous system. This is based on the fact that the nerves in the former system are involved in making conscious movements, whereas those in the latter system make movements over which the person does not have control. Obviously, the former category of nerves includes those associated with the muscles of touch, smell, vision, and skeleton. The latter includes nerves spread over muscles attached with heart beats, blood pressure, glands, and smooth muscles. 4) AN EXCLUSIVE LOOK AT ‘NEURONS’, A FUNDAMENTAL UNIT OF THE BRAIN AND THE NERVOUS SYSTEM Neurons Neurons are the cellular units of the brain and nervous system, and are otherwise called nerve cells (Figure 8). Estimates of the number of brain neurons range from 50 billion to 500 billion, and they are not even the most numerous cells in the brain. Like hepatocyte cells in the liver, osteocytes in bone, or erythrocytes in blood, each neuron is a selfcontained functioning unit. Its internal components, the organelles, include a nucleus harboring the genetic material (DNA), energy-providing mitochondria, and proteinmaking ribosomes. As in most other types of cells, the organelles are concentrated in the main cell body. In addition, characteristic features of neurons are neurites—long, thin, finger-like or threadlike extensions from the cell body (soma). The two main types are dendrites and axons. Usually, dendrites receive nerve signals, while axons send them onward. The cell body of a neuron is about 10-100 micrometers across, that is 1/100th to 1/10th of one millimeter. Also, the axon is 0.2-20 micrometers in diameter, dendrites are usually slimmer. In terms of length, dendrites are typically 10-50 micrometers long, while axons can be up a few centimeters (inches). This is mostly the case in the central nervous system (Figure 9). Classification of neurons Page 10 of 35 There are numerous ways of classifying neurons among themselves. One of them is by the direction that they send information. On this basis, we can classify all neurons into the three: sensory neurons, motor neurons, and interneurons. The sensory neurons are those that send information received from sensory receptors toward the central nervous system, whereas the motor neurons send information away from the central nervous system to muscles or glands. The interneurons are those neurons that send information between sensory neurons and motor neurons. Here, the sensory neurons receive information from sensory receptors (e.g., in skin, eyes, nose, tongue, ears) and send them toward the central nervous system. Because of this, these neurons are also called afferent neurons as they bring informational input towards the central nervous system. Likewise, the motor neurons bring motor information away from the central nervous system to muscles or glands, and are thus called efferent neurons as they bring the output from the central nervous system to the muscles or glands. Since the interneurons send information between sensory neurons and motor neurons, thus serving as connecting links between them, they are sometimes called internuncial neurons. This third type of neurons is mostly found in the central nervous system. Another way of classifying the neurons is by the number of extensions that extend from the neuron’s cell body (soma) (Figure 10). In accordance with this system, we have unipolar, bipolar, and multipolar neurons. This classification takes into account the number of extensions extending initially from the cell body of the neuron, not the overall number of extensions. This is because there can be unipolar neurons which have more than one extensions in total. However, what the difference here is from the other two types of neurons is that these unipolar neurons shall have only one initial extension from the cell body. Most of the neurons are multipolar in nature. Synapses Synapses are communication sites where neurons pass nerve impulses among themselves. The cells are not usually in actual physical contact, but are separated by an incredibly thin gap, called the synaptic cleft. Microanatomically, synapses are divided into types according to the sites where the neurons almost touch. These sites include the soma, the dendrites, the axons, and tiny narrow projections called dendritic spines found on certain kinds of dendrites. Axospinodendrittic synapses form more than 50 percent of all synapses in the brain; axodendritic synapses constitute about 30 percent (Figure 11). How signals are passed among neurons Page 11 of 35 Neurons send signals to each other across the synapses. Initially, signals enter into the cell body of a neuron through their dendrites, and they pass down the axon until their arrival at the axon terminals. From there, the signal is sent across to the next neuron. Starting from the time the signal passes along the dendrites and axon, eventually reaching the axon terminal, it consists of moving electrically charges ions, but at a synapse while making that transition, it relies more on the structural shape of the chemical neurotransmitters. Every two neurons are separated by a gap, called synaptic cleft, at their synaptic site. The neuron preceding the synapse is known as pre-synaptic neuron and the one following the synapse is known as post-synaptic neuron. When the action potential of the pre-synaptic neuron is passed along its axon and reaches the other end of it, it causes synaptic vesicles to fuse or merge with the membrane. This releases the neurotransmitter molecules to pass or diffuse across the synaptic cleft to the post-synaptic membrane and slot into receptor sites (Figure 12). Neurotransmitter molecules slot into the same-shaped receptor sites in the postsynaptic membrane. A particular neurotransmitter can either excite a receiving nerve cell and continue a nerve impulse, or inhibit it. Which of these occurs depends on the type of membrane channel on the receiving cell. The interaction among neurons or between a neuron and another type of body cell, all occur due to the transfer of neurotransmitters. Thus, our body movements, mental thought processes, as well as feelings, etc. are all dependent on the transfer of neurotransmitters. In particular, let’s take a look into how the muscle movements happen due to the transfer of neurotransmitter. The axons of motor neurons extend from the spinal cord to the muscle fibers. For intending to perform any action, either of the speech or body, the command has to originate from the brain to the spinal cord. From the spinal cord, the command has to pass through motor neurons to the specific body parts, upon which the respective actions will be performed. The electrical impulse released along the axon of the motor neuron arrives at the axon terminal. Once they are there, then the neurotransmitters are secreted to carry the signals across the synapse. The receptors in the membrane of the muscles cells attach to the neurotransmitters and stimulate the electrically charged ions within the muscle cells. This leads to the contraction or extension of the respective muscles. Page 12 of 35 5) FACTS ABOUT HUMAN BRAIN Brain is a complex organ generally found in vertebrates. Of all the brains, human brain is even more complex. On average, a human brain weighs about one and a half kilogram, and has over 100 billion neurons. Each of these neurons is connected with several other neurons and thus, just the number of synapses (nerve cell connections) exceeds 100 trillion. The sustenance required to keep these neurons alive is supplied by different parts of the body. For example, 25 percent of the body total oxygen consumption is used up by the brain. Likewise, 25 percent of the glucose produced by our food is used up by it. Of the total amount of blood pumped out by our heart, 15 percent goes to the brain. Thus, from among the different parts of the body, the brain is the single part that uses the most amount of energy. The reason for this is because the brain engages itself in unceasing activity, day and night, of interpreting data form the internal and external environment, and respond to them. To protect this important organ from harm, it is naturally enclosed in three layers of protection, with an additional cushioning fluid in between. These layers are, in turn, protected with the hard covering, the skull, which is once again wound around by the skin of the scalp (Figure 13). The main function of the brain is to enhance the chance of survival of the person by proper regulation of the body conditions based on the brain’s reading of the internal and external environment. The way it carries out this function is by first registering the information received and responding to them by undertaking several activities. The brain also gives rise to inner conscious awareness alongside performing those processes. When the data, released by the different body senses, in the form of electrical impulses uninterruptedly arrive at the brain, the brain first of all checks their importance. When it finds them to be either irrelevant or commonplace, then it makes them dissolve by themselves and the concerned person doesn’t even generate an awareness of them. This is how only around 5 percent of the overall information received by the brain ever reaches our consciousness. For the rest of the information, the brain may process them, but they never become the subject of our consciousness. If, on the other hand, the information at hand is important or novel, the brain increases it impulses and allows it to active all over its parts. Remaining active for over a period of time, a conscious awareness unto this impulse is generated. Sometimes, in the wake of generating a conscious awareness, the brain sends commands to relevant muscles for either contraction or extension, thus making the body parts in question to engage in certain actions. Page 13 of 35 6) MAJOR PARTS OF HUMAN BRAIN Human brain is enclosed within its natural enclosures. In its normal form, it is found to be composed of three major parts (Figure 14). Cerebrum Of the three parts mentioned above, cerebrum is located in the uppermost position and is also the largest in size. It takes up ¾ of the entire brain size. It is itself composed of two brain hemispheres—the right and the left hemispheres. The two hemispheres are held together by a bridge like part called corpus callosum, a large bundle of neurons. The covering layer of the hemispheres is constituted of the cortex of which the average thickness is between 2 to 4 millimeters. The higher centers of coordinating and regulating human physical activities are located in the cortex areas, such as the motor center, proprioception center (proprioception is the sense of the relative position of the body in space, for example being aware that your arm is extended when reaching for the doorknob), language center, visual center, and auditory center. The outer surface of the cortex is formed of grooves and bulges because of which, despite being quite expansive, the cortex is able to be contained in the relatively small area. In terms of its basic composition, the outer layer of cortex is mostly made of gray matter, which is mainly comprised of cell bodies and nerve tissues formed out of nerve fibers. This matter is gray with a slight reddish shade in color. In the layer below, the cortex is formed of the white matter, which is, as the name suggests, white in color and mainly comprised of nerve tissues formed out of nerve fibers wrapped around with myelin sheath. Some nerve fibers wrapped in myelin sheath bind together the right and left hemispheres of the cerebrum, while others connect it with cerebellum, brainstem, and the spinal cord. Most of the brain parts belong to cerebrum, such as amygdala and hippocampus, as well as thalamus, hypothalamus, and other associated regions. In short, of the division into forebrain, midbrain, and hindbrain—in which the entirety of brain is accounted for, the cerebrum contains the whole of forebrain (Figure 15). The surface area of the cerebral cortex is actually quite large, and described above, it becomes folded to fit inside the skull. Humans are highly intelligent and creative animals not just because of the size of our brains, but also because of the complexity of the connections among our neurons. The folded nature of the human cortex promotes more complex connections between areas. For example, take a piece of blank paper, and draw five dots, one on each corner and one in the middle. Now draw lines from each dot to the other four dots. Imagine if these five dots were buildings, and the lines you drew were roads, then it would require more time to traverse from one corner to another corner than from one corner to the center. But what if you fold the four corners of the paper on top of Page 14 of 35 the center of the page? Suddenly all five of those dots become immediate neighbors, and it becomes very easy to walk from one “building” to another. The folding of the cortex has a similar effect. Neurons make connections with their neighbors, and if folding the cortex increases the number of neighbors each neuron has, then it also increases the complexity of the networks that can be formed among those neurons. Cerebellum Cerebellum is located below the cerebrum and at the upper back of the brainstem. Its name connotes its small size. Its mass is 1/10 of the whole brain. However, in terms of the number of neurons it contains, it exceeds that of the remaining parts of the central nervous system combined. This lump of nerve tissues, bearing the look of something cut in half, covers most of the back of brainstem. With the help of three pairs of fibers, collectively called cerebral peduncles, the brainstem is bound to the cerebellum. Like the cerebrum, it also has a wrinkled surface, but its grooves and bulges are finer and organized into more regular patterns. In terms of its physical structure, this too has a long groove in the center, with two large lateral lobes, one on each side. These lobes are reminiscent of the two hemispheres of the cerebrum and are sometimes termed cerebellar hemispheres. The cerebellum has a similar layered microstructure to the cerebrum. The outer layer, or cerebellar cortex, is gray matter composed of nerve-cell bodies and their dendrite projections. Beneath this is a medullary area of white matter consisting largely of nerve fibers. As of now, it has been established that cerebellum’s main function is in coordinating the body movement. Although, it may not initiate the movements, however it helps in the coordination and timely performance of movements, ensuring their integrated control. It receives data from spinal cord and other parts of the brain, and these data undergo integration and modification, contributing to the balance and smooth functioning of the movements, and thus helps in maintaining the equilibrium. Therefore, whenever this part of the brain is plagued by a disorder, the person may not lose total movement, but their ability of performing measured and steady movements is affected as also their ability to learn new movements. Within the division of entire brain into forebrain, midbrain, and hindbrain—cerebellum forms part of the hindbrain (Figure 16). Brainstem Brainstem is located below the cerebrum and in front of cerebellum. Its lower end connects with the spinal cord. It is perhaps misnamed. It is not a stem leading to a separate brain above, but an integral part of the brain itself. Its uppermost region is the midbrain comprising an upper “roof” incorporating the superior and inferior colliculi or Page 15 of 35 bulges at the rear, and the tegmentum to the front. Below the midbrain is the hindbrain. At its front is the large bulge of the pons. Behind and below this is the medulla which narrows to merge with the uppermost end of the body’s main nerve, the spinal cord. This part of the brain in associated with the middle and lower levels of consciousness. The eye movement involved in following a moving object in front of the eye is an example. The brainstem is highly involved in mid-to low-order mental activities, for example, the almost “automatic” scanning movements of the eyes as we watch something pass by. The gray and white matter composites of the brainstem are not as well defined as in other parts of the brain. The gray matter in this part of the brain possesses some of the crucial centers responsible for basic life functions. For example, the medulla houses groups of nuclei that are centers for respiratory (breathing), cardiac (heartbeat), and vasomotor (blood pressure) monitoring and control, as well as for vomiting, sneezing, swallowing, and coughing. When brainstem is damaged, that will immediately trigger danger to life by hindering heartbeat and respiratory processes (Figures 17 & 18). 7) WAYS OF ZONING AND SECTIONING THE HUMAN BRAIN FOR STUDY PURPOSES The two hemispheres Of the obviously so many different ways of zoning the human brain for study purposes, we will take up only a few of them as samples. As briefly mentioned before, a fully matured brain has three major parts. Of these the largest is the cerebrum. It covers around ¾ of the brain size. In terms of its outer structure, it is covered with numerous folds, and has a color of purple and gray blended. The cerebrum is formed by two cerebral hemispheres, accordingly called the right and the left hemisphere, that are separated by a groove, the medial longitudinal fissure. Between the two hemispheres, there is a bundle of nerve fibers that connects the two sides, almost serving like connecting rope holding the two in place. Called corpus callosum, if this were to be cut into two, the two hemispheres would virtually become two separate entities. Just as there are two hemispheres, that look broadly like mirror images to each other, on the two sides, likewise many of the brain parts exist in pairs, one on each side. However, due to the technological advances in general, and that of the MRI, in particular, it has been shown that, on average, brains are not as symmetrical in their left-right structure as was once believed to be , almost like mirror images (Figure 19). The two apparently symmetrical hemispheres and, within them, their other paired structures are also functionally not mirror images to each other. For example, for most Page 16 of 35 people, speech and language, and stepwise reasoning and analysis and so on are based mainly on the left side. Meanwhile, the right hemisphere is more concerned with sensory inputs, auditory and visual awareness, creative abilities and spatial-temporal awareness (Figure 20). The four or the six lobes Cerebrum is covered with bulges and grooves on its surface. Based on these formations, the cerebrum is divided into the four lobes, using the anatomical system. The main and the deepest groove is the longitudinal fissure that separates the cerebral hemispheres. However, the division into the lobes is made overlooking this fissure, and thus each lobe is spread on both the hemispheres. Due to this, we often speak of the four pairs of lobes. These lobes are frontal lobes, parietal lobes, occipital lobes, and temporal lobes (Figure 21). The names of the lobes are partly related to the overlying bones of the skull such as frontal and occipital bones. In some naming systems, the limbic lobe and the insula, or central lobe, are distinguished as separate from other lobes. Frontal lobes Frontal lobes are located at the front of the two hemispheres. Of all the lobes, these are the biggest in size as well as the last to develop. In relation to the other lobes, this pair of lobes is at the front of the parietal lobes, and above the temporal lobes. Between these lobes and the parietal lobes lies the central sulcus, and between these lobes and the temporal lobes lies the lateral sulcus. Towards the end of these lobes, i. e. the site where the pre-central gyrus is located also happens to be the area of the primary motor cortex. Thus, this pair of lobes is clearly responsible for regulating the conscious movement of certain parts of the body. Besides, it is known that the cortex areas within these lobes hold the largest number of neurons that are very sensitive to the dopamine neurotransmitters. Granting this, these lobes should also be related with such mental activities as intention, short-term memory, attention, and hope. When the frontal lobes are damaged, the person lacks in ability to exercise counter measures against lapses and tend to engage in untoward behaviors. These days, neurologist can detect these disorders quite easily. Parietal lobes Parietal lobes are positioned behind (posterior to) the frontal lobes, and above (superior to) the occipital lobes. Using the anatomical system, the central sulcus divides the frontal and parietal lobes, as mentioned before. Between the parietal and the occipital lobes lies Page 17 of 35 the parieto-occipital sulcus, whereas the lateral sulcus marks the dividing line between the parietal and temporal lobes. This pair of lobes integrates sensory information from different modalities, particularly determining spatial sense and navigation, and thus is significant for the acts of touching and holding objects. For example, it comprises somatosensory cortex, which is the area of the brain that processes the sense of touch, and the dorsal stream of the visual system, which supports knowing where objects are in space and guiding the body’s actions in space. Several portions of the parietal lobe are important in language processing. Occipital lobes The two occipital lobes are the smallest of four paired lobes in the human cerebral cortex. They are located in the lower, rearmost portion of the skull. Included within the region of this pair of lobes are many areas especially associated with vision. Thus, this lobe holds special significance for vision. There are many extrastriate regions within this lobe. These regions are specialized for different visual tasks, such as visual, spatial processing, color discrimination, and motion perception. When this lobe is damaged, the patient may not be able to see part of their visual field, or may be subjected to visual illusions, or even go partial or full blind. Temporal lobes Temporal lobe is situated below the frontal and parietal lobes. It contains the hippocampus and plays a key role in the formation of explicit long-term memory modulated by the amygdala. This means that it is involved in attaching emotions to all the data received from all senses. Adjacent areas in the superior, posterior, and lateral part of the temporal lobes are involved in high-level auditory processing. The temporal lobe is involved in primary auditory perception, such as hearing, and holds the primary auditory cortex. The primary auditory cortex receives sensory information from the ears and secondary areas process the information into meaningful units such as speech and words. The ventral part of the temporal cortices appears to be involved in high-level visual processing of complex stimuli such as faces and scenes. Anterior parts of this ventral stream for visual processing are involved in object perception and recognition. Limbic System The structures of the limbic system are surrounded by an area of the cortex referred to as the limbic lobe. The lobe forms a collarlike or ringlike shape on the inner surfaces of the cerebral hemispheres, both above and below the corpus callosum. As such, the limbic lobe comprises the inward-facing parts of other cortical lobes, including the temporal, parietal, and frontal, where the left and right lobes curve around to face each other. Page 18 of 35 Important anatomical parts of this lobe are hippocampus and amygdala, associated with memory and emotions respectively. Insular cortex (or insula) Insular lobe is located between the frontal, parietal, and temporal lobes. As suggested by its name, it is almost hidden within the lateral sulcus, deep inside the core of the brain. It is believed to be associated with consciousness. Since data indicative of the inner status of the body, such as the heartbeat, body temperature, and pain assemble here, it is believed to impact the equilibrium of the body. Besides, it is also believed to be related with several aspects of the mind, such as the emotions. Among these are perception, motor regulation, self-awareness, cognition, and inter-personal emotions. Thus, insular lobe is considered to be highly related with mental instability. The forebrain, the midbrain, and the hindbrain The divisions of the brain so far, either into the two hemispheres or the four or six lobes are solely based on the cerebrum alone. None of the above divisions included any portion either of the cerebellum or the brainstem. Yet another way of dividing the portions of the brain is into the forebrain, the midbrain, and the hindbrain (Figure 22. This is the most comprehensive division of the brain, leaving no parts of it outside. There are two systems of presenting this division: one, on the basis of the portions of the brain during early development of the central nervous system, and the other, based on the full maturation of those early parts into their respective regions of an adult brain. Here, we follow the latter system. The forebrain The forebrain is so called because of its extension to the forefront of the brain. It is the largest among the three divisions. It even spreads to the top and back part of the brain. It houses both the hemispheres, as well as the entire portion of the part known as the diencephalon. Diencephalon comprises of the hippocampus, which is associated with memory, and the amygdala, which is associated with emotions. Besides them, the forebrain also includes both the thalamus and the hypothalamus, of which the former is the part of the brain that processes information received from other parts of the central nervous system and the peripheral nervous system into the brain, and the latter which is involved is several activities such as appetite, sexuality, body temperature, and hormones. Page 19 of 35 The midbrain The midbrain is located below the forebrain and above the hindbrain. It resides in the core of the brain, almost like a link between the forebrain and the midbrain. It regulates several sensory processes such as that of the visual and auditory ones, as well as motor processes. This is also the region where several visual and auditory reflexive responses take place. These are involuntary reflexes in response to the external stimuli. Several of the masses of gray matter, composed mainly of the cell bodies, such as the basal ganglia linked with movement are also present in the midbrain. Of the above three major divisions of the brain, the midbrain belongs to the brainstem, and of the two main systems within the nervous system, it belongs to the central nervous system. The hindbrain The hindbrain is located below the end-tip of the forebrain, and at the exact back of the midbrain. It includes cerebellum, the pons, and the medulla, among others. Of these, the cerebellum has influence over body movement, equilibrium, and balance. The pons not only brings the motor information to the cerebellum, but is also related with the control over sleep and wakeful states. Finally, the medulla is responsible for involuntary processes of the nervous system associated with such activities as respiration and digestion. In terms of anatomy, pons is uppermost part, and beneath it the cerebellum and the medullae, which tapers to merge with the spinal cord. Vertical organization of the brain The organization of the brain layers can be said to represent a certain gradation of mental processes (Figure 23). The uppermost brain region, the cerebral cortex, is mostly involved in conscious sensations, abstract thought processes, reasoning, planning, working memory, and similar higher mental processes. The limbic areas on the brain’s innermost sides, around the brainstem, deal largely with more emotional and instinctive behaviors and reactions, as well as long-term memory. The thalamus is a preprocessing and relay center, primarily for sensory information coming from lower in the brainstem, bound for the cerebral hemispheres above. Moving down the brainstem into the medulla are the so-called ‘vegetative’ centers of the brain, which sustain life even if the person has lost consciousness. Anatomical directions and reference planes of the brain To enable us to identify the precise location in the brain, both vertically and horizontally, it is important to be familiar with certain technical terms used by the neuroscientists. In Page 20 of 35 terms of anatomy, the front of the brain, nearest the face, is referred to as the anterior end, and polar opposite to the anterior end is the posterior end, referring to the back of the head. Superior (sometimes called dorsal) refers to the direction toward the top of the head, and inferior (sometimes called ventral) refers to the direction toward the neck/body. In terms of reference planes, the sagittal plane divides the brain into left and right portions, the coronal plane divides the brain into anterior and posterior portions, and the axial (sometimes called horizontal) plane divides the brain into superior and inferior portions (Figure 24). In both the above contexts, we can further specify the location of a particular portion or plane in terms of its position, direction, and depth in relation to the whole brain. Likewise, for each of the planes themselves, we can further speak in terms of position, direction, and depth in relation to the whole brain as well as in relation to the individual planes. Also, when representing brain parts and structures, a lateral view illustrates the section or lobes, etc. from the perspective of a whole brain, whereas a medial view illustrates the section in the dissected manner. 8) DIFFERENT TYPES OF BRAINS In general, the number of living beings who possess brain is numerous. Their brains vary both in size and function. However, if you ask whether all brains completely differ from each other. Definitely not. There are features that are common to almost all brains, such as that all brains are composed mainly of neurons, and that they all have the function of protecting the individual being from internal and external dangers. So, although there are various types of brains, here we shall focus mainly on the differences in brain types between vertebrates and invertebrates in general, and the differences within the vertebrates in particular. As you know, vertebrates are those animals who have backbone, and invertebrates do not have backbone. Most of the invertebrates do not have brain. However, those, among them, who do possess brain, theirs is usually a simple brain, composed of very few neurons. Note that majority of the animals on this earth are invertebrates. The vertebrates make up only two percent of the entire animal population. The unicellular organisms, because of practical existential reason, usually tend to be very sensitive to light. Organisms such as sea-urchins are slightly more complex and are multi-cellular. They have a few nerve cells that regulate the function of looking for sustenance and providing protection from possible dangers. Slightly more complex than the types of sea-urchins are earthworm and jellyfish, which have neurons that assist them in fighting hostile external Page 21 of 35 environment (Figure 25). It is interesting to know that the neurons these simple organisms have are similar to the human neurons in terms of structure, function, as well as their neurotransmitters. If you ask, what is the difference then? There hardly is any connection between the nerves in the invertebrates. Besides that, the nerves almost cover their entire bodies. For example, among the invertebrates, earthworms (Figure 26) have one of the simplest types of brains, possessing only a few neurons. Their brains regulate only a few simple tasks such as eating food and doing a few simple body movements, not any higher actions. The network of neurons that process and interpret the information received from the earthworm’s body parts is present in the earthworm’s head. However, even if that network were to be removed from its body, no noticeable changes would be observe in its behavior. Still, among the invertebrates, grasshoppers and bees have slightly more complex brains. Scientists have begun to understand the relation between their brains and the corresponding behaviors (Figure 27). The ants, also an invertebrate, have more complex behavior, but have a very tiny brain. Likewise, the mosquitoes perform the function of flying in the space, suck blood from others, etc. However, their brain size is still no more than a small dot. Among the vertebrates, the mice are generally quite smart, yet have brains weighing no more than 2 grams. Their entire brain size is equivalent to that of the human hypothalamus. Though generally it is said the bigger the brain, the greater the intellect. However, in actuality it is the overall area of cortices, not just the overall bulk that determines the level of intellect. Among the vertebrates, there are mammals and non-mammals. Birds and fish are examples of non-mammals. It is known that the brains of mammals and non-mammals differ greatly in terms of complexity in the areas of composition, neurons, synapses, etc. Though they still have the same basic parts and structures, they differ in the overall brain size in relation to their bodies. Besides that, depending on which parts play out more in their life, they differ in the relative size of specific parts of the brain and body. For example, birds and fish have relatively very small olfactory bulb. Also, these nonmammalian animals lack brain cortex. Cerebral cortex is a special brain part, quite prominent in primates including the humans. Not only this, human beings are known to have a disproportionately large cortex (Figures 28 & 29). The average weight of human brain amounts to only one and a half percent of their body weight. However, it consumes 20 percent of the food required by the whole body. So, the larger the brain is the greater the amount of energy consumption. Therefore, bigger brain Page 22 of 35 is not always a sign of boon to the individual species. This may be the reason why there are no many species with larger brains in the history of evolution. Social animals that depend on their social community for survival are said to have larger brains. For example, dolphins, who hunt in groups, have fairly large brain. Although, the brains of elephants and whales are much bigger in size than that of the humans, but humans have the largest brains in proportionate to their body sizes. 9) FACTS ABOUT HUMAN SPINAL CORD Spinal cord is located within the vertebrae of the backbone. It extends from brainstem down to the first lumbar vertebra. It is roughly the width of a conventional pencil, tapering at it base even thinner. It is comprised of a bundle of fibers, and the fibers are long projections of nerve cells, extending from the base of the brain to the lower region of the spine. The spinal cord carries information to and from the brain and all parts of the body except the head, which is served by the cranial nerves. The signals that travel along the spinal cord are known as nerve impulses. Data from the sensory organs in different parts of the body is collected via the spinal nerves and transmitted along the spinal cord to the brain. The spinal cord also sends motor information, such as movement commands, from the brain out to the body, again transmitted via the spinal nerve network. In terms of its anatomy, the spinal cord (Figure 30) is constituted of what is known as white matter and gray matter. The gray matter, which forms the core of the spinal cord, is composed mainly of nerve cell bodies and forms an external look of a butterfly. The white matter surrounds the gray matter and its nerve fibers play a significant role of establishing connection between different parts of the spinal cord as well as between the brain and the spinal cord. The outer regions of white matter insulate the long projecting nerve fibers (axons) coming out from the neurons. In the gray matter of the spinal cord, there are numerous low-key nerve centers that can perform certain fundamental movement responses. However, the nerve centers within the spinal cord are regulated by the brain. The ability of the humans in consciously controlling the bowl movement is an example in this regard. The fact that infants frequent to toilets more often than the adults and that many have bedwetting problem is due to the brain being not fully developed as well as lacking in control over urine. Thus, the spinal cord serves as a pathway of connection between the brain, the rest of the body, and internal organs. The spinal cord stays in contact with the majority of body organs through the medium of nerves. Page 23 of 35 10) PERIPHERAL NERVOUS SYSTEM As discussed above, the whole of nervous system is divided into the central nervous system (CNS) and the peripheral nervous system (PNS). Of these two, we have already discussed the central nervous system constituted by the brain and the spinal cord. So here, we will take up the remaining part, i.e. the peripheral nervous system. The peripheral nervous system is a complex network of nerves extending across the body, branching out from 12 pairs of cranial nerves originating in the brain and 31 pairs of spinal nerves emanating from the spinal cord. It relays information between the body and the brain in the form of nerve impulses. It has an afferent division (through which messages are sent to the brain) and an efferent division (which carries messages from the brain to the body). Finally, there is the autonomic nervous system, which shares some nerve structures with both the CNS and PNS. It functions ‘automatically’ without conscious awareness, controlling basic functions, such as body temperature, blood pressure, and heart rate. Sensory input travels quickly from receptor points throughout the body via the afferent networks of the PNS to the brain, which processes, coordinates, and interprets the data in just fractions of a second. The brain makes an executive decision that is conveyed via the efferent division of the PNS to muscles, which take the needed action. The twelve pairs of cranial nerves There are 12 pairs of cranial nerves (Figure 31). They are all linked directly to the brain and do not enter the spinal cord. They allow sensory information to pass from the organs of the head, such as the eyes and ears, to the brain and also convey motor information from the brain to these organs—for example, directions for moving the mouth and lips in speech. The cranial nerves are named for the body part they serve, such as the optic nerve for the eyes, and are also assigned Roman numerical, following anatomical convention. Of these, some are associated with sensory information and others with motor information, while some are associated with both the kinds of information. How cranial nerves attach The cranial nerves I and II connect to the cerebrum, while cranial nerves III to XII connect to the brainstem. The fibers of sensory cranial nerves each project from a cell body that is located outside the brain itself, in sensory ganglia or elsewhere along the trunks of sensory nerves. The thirty-one pairs of spinal nerves Page 24 of 35 There are 31 pairs of spinal nerves (Figure 32). These branch out from the spinal cord, dividing and subdividing to form a network connecting the spinal cord to every part of the body. The spinal nerves carry information from receptors around the body to the spinal cord. From here the information passes to the brain for processing. Spinal nerves also transmit motor information from the brain to the body’s muscles and glands so that the brain’s instructions can be carried out swiftly. Each of the 31 pairs of spinal nerves belongs to one of the four spinal regions--- cervical, thoracic, lumbar, and sacral. Of them, the cervical region has eight pairs, the thoracic has twelve pairs, the lumbar has five, and finally, the sacral has six pairs. How spinal nerves attach As mentioned above, human spinal cord is located within the vertebrae of the backbone. So, one may wonder how the spinal nerves attach to the spinal cord. There are gaps in the vertebrae of the backbone through which spinal nerves enter the spinal cord (Figure 33). The nerves divide into spinal nerve roots, each made up of tiny rootlets that enter the back and front parts of the cord. 11) A SLIGHTLY DETAILED LOOK AT THE SENSES How do our brain and the environment interact? Here is how. First the senses come in contact with the external stimuli such as light, sound wave, pressure, etc. to which the corresponding senses respond. Then those sense data are sent along the respective sensory nerves in the form of electrical signals which eventually reach their respective sites on the brain cortices. That is when we shall have the perception of the respective objects. SEEING Let’s now take up each of the senses, one by one. First, we discuss the sense of vision. We shall look into the following topics surrounding the sense of vision: the structure of eye, its receptor cells, the visual pathway, and the range of light frequency different animals, including humans, have access to. Page 25 of 35 STRUCTURE OF EYE The eyeball is a fluid-filled orb. It has a hole in the front called pupil. At the back of the eyeball, there is retina which is a sheet of nerve cells. Some of the retinal cells are lightsensitive (photoreceptive). In the center of the retina, there is a tiny pitted area called fovea, densely packed with cones which are color-picking, light-sensitive cells and are significant in detecting detailed, sensitive image of the object. Between the pupil and the retina is a lens that adjusts to help the light passing through pupil to focus on the surface of the retina. The pupil is surrounded by a muscular ring of pigmented fibers called iris. The iris is responsible for people having different eye colors, and it also controls the amount of light entering into the eye. The pupil is covered by a transparent layer of clear tissue called cornea which merges with the tough outer surface or the ‘white’ of the eye called sclera. In the back of the eye, there is a hole (optic disk) through which the optic nerves pass through to enter the brain (Figure 34). LIGHT-RECEPTIVE CELLS As mentioned before, retina is located at the back of the eye, and is composed of lightreceptive cells (photoreceptors). There are, in the main, two types of photoreceptors in the retina: cone cells and rod cells. The cone cells detect the color components from amongst the visible light spectrum, and are also responsible for detecting fine detail. However, cone photoreceptors require a huge amount of light to perform its function well. Cone cells in the humans are of three types: red-, blue-, and green-sensing cones, each detecting the respective colors. They are all formed on the surface and around the fovea. On the other hand, the rod cells are formed on the periphery of retina. These cells can detect images even in dim light. However, these cells mainly detect shape and motion, not so much the color. Of these two types of photoreceptors, the rods are much more sensitive to light, so much so that even with just a few light particles, they can at least generate a faint image. Besides, the manner of concentration of these cells in and around fovea impacts greatly the sensitivity of the sensation of the object. The majority of the 6 million cone cells are concentrated in the fovea, whereas all of the more than 120 million rod cells are spread around the fovea. Since the rods are spread over a larger area of the retina, they are relatively less concentrated, and thus, when one sees objects, they are not seen that clearly and detailed. Page 26 of 35 VISUAL PATHWAYS The light reflected from the visual objects first enters the pupil through cornea, and through pupil it enters deeper into the eyes. The iris that surrounds the pupil controls the amount of light entering the eyes by changing its shapes, due to which the pupil appears to contract when the light is bright and sharp, and expands when it is less bright. Afterwards, the light passes through the lens which bends (refracts) the light, making the light to converge on the retina. If focusing on a near object, the lens thickens to increase refraction, but if the object is distant, the lens needs to flatten. The light then hits the photoreceptors in the retina, some of which fire, sending electrical signals to the brain via the optic nerve. Information received from the outer environment upon coming in contact with eyes has to travel right to the back of the brain where the relevant cortex (visual cortex) is, and only there it is turned into a conscious vision. Here is the pathway through which the information passes from the eyes to the optic nerves to the visual cortex: the signals from the eyes passes through the two optic nerves and converge at a crossover junction called the optic chiasm. The fibers carrying the signals continue on to form the optic tracts, one on each side, which end at the lateral geniculate nucleus, part of the thalamus. However, the signals continue to the visual cortex via bands of nerve fibers, called the optic radiation (Figure 35). RANGE OF LIGHT WAVELENGTH THAT DIFFERENT ANIMALS, INCLUDING HUMANS, HAVE ACCESS TO In the course of evolution, by means of natural selection, different species of organisms, including the humans, have evolved eyes with varying structures and functions. That range of electromagnetic spectrum visible to the human eyes is called the visible light, which range from 400 to 700 nanometers on the wavelength. That is, from the violet, with the shorter wavelengths, to red, with longer wavelengths. Lights with wavelengths outside of the above range are normally not visible to humans. This illustrates the difference in the structure of eyes among different species of organisms. For example, the vultures and rabbits have different eye from each other. Due to that, vultures can see much farther than the rabbits do, yet cannot see as widely as the rabbits do. Likewise, the infrared light that the humans cannot see is visible to some types of fish and birds. Some birds can tell a male bird from a female bird just by looking at the infrared light reflected from their wings. Likewise, there are two main features distinct in the eyes of the bees that the humans do not have. First, their eyes can detect infrared light that the humans cannot. Second, their Page 27 of 35 visual processing is five-fold speedier than that of the humans. For example, when the bees observe a normal moving object, they do not see that as moving. Rather, they are said to see that in the form of a series of distinct temporal instances. What accounts for such a unique feature of the bees’ eyes? Their eyes are composed of six-sided lens, covered with about 4500 circular discs. These lens let in just the lights reflected from the object they focus on and not from around it. Besides that, unlike human eyes, the eyes of the bees are said to have nine types of light receptors. Because of the speed of the visual processing that the bees possess, they have a advantage of being able to negotiate their movement so well even while moving with so much speed with the least incidents of ever bumping against objects, etc. Also, often we wonder about the sharp lights reflected back from the eyes of cats and other animals of that family. That is now understood to be due to the fact that all the lights entering their eyes fail to be absorbed in the retina, and are thus reflected back by the membrane called the reflective white. HEARING The ear is divided into three sections: the outer ear, the middle ear, and the inner ear. The outer ear has three further sections: the visible part of the ear called the pinna, the auditory canal, and the eardrum. The middle ear has three tiny bone structures that help in our hearing process: malleus (hammer), incus (anvil), and stapes (stirrup). The inner ear has several parts, of which the important ones are oval window, cochlea, and auditory nerve. The outer ear funnels sound waves along the auditory canal to the eardrum which is situated towards the inner end of the air canal. Immediate after the eardrum, the three tiny bones of the middle ear are attached one after the other. The sound waves cause the eardrum to vibrate, which in turn causes this chain of bones to vibrate. The vibration eventually reaches a membrane known as the oval window, the start of the inner ear. The oval window is slightly smaller than the ear drum in diameter. Because of this, when the vibration enters from the middle ear into the inner ear, the vibration becomes more consolidated. Inner ear is situated deep under the skull. Commensurate with the force of sound waves striking the ear drum, the stapes will accordingly cause the oval window to vibrate. Due to this, the fluids filling the chambers of cochlea will move, causing basilar membrane to vibrate. This stimulates the sensory hair cells on the organ of corti transforming the pressure waves into electrical impulses. These impulses pass through auditory nerve to the temporal lobe and from there to the auditory cortex (Figure 36). Page 28 of 35 Because of the way human ear is structured, it has access to a limited range of sound frequency. That is between 20 and 20000 Hertz. Sounds beyond that range are not audible to the humans. Sounds vary in terms of their pitch, and the receptors corresponding to them are found in the various parts of the cochlea. The receptors for low pitch sounds are located in the front part of cochlea, whereas receptors for the higher and the highest pitch sounds are found in the middle and inner end, respectively, of the cochlea. SMELL The area within each nasal cavity that contains the olfactory receptor cells is known as the olfactory epithelium. A small amount of the air entering the nostrils will pass over the epithelium, which is covered in mucus. Smell molecules in the air dissolve in this mucus, bringing receptors into direct contact with the smell molecules. Three cell types are within the epithelium: in addition to the receptor cells, there are supporting cells which produce a constant supply of mucus and, basal cells, which produce new receptor cells every few weeks. The larger the epithelium is, the keener the sense of smell. Dogs, for example, have a considerably larger olfactory epithelium than humans. Like the sense of taste, smell is a chemical sense. Specialized receptors in the nasal cavity detect incoming molecules, which enter the nose on air currents and bind to receptor cells. Sniffing sucks up more odor molecules into the nose, allowing you to ‘sample’ a smell. Olfactory receptors located high up in the nasal cavity send electrical impulses to the olfactory bulb, in the limbic area of the brain, for processing. Odors are initially registered by receptor cells in the nasal cavity. These send electrical impulses along dedicated pathways to the olfactory bulb (each nostril connects to one olfactory bulb). The olfactory bulb is the smell gateway to the brain. It is part of the brain’s limbic system, the seat of our emotions, desires, and instincts, which is why smell can trigger strong emotional reactions. Once processed by the olfactory bulb, data is then sent to various areas of the brain, including the olfactory cortex adjacent to the hippocampus. Unlike data gathered by the other sense organs, odors are processed on the same side, not opposite, side of the brain as the nostril the sensory data was sent from (Figure 37). How do the olfactory receptors detect the different odors? Different smells are produced from different molecular structures of smell. Research shows that each receptor has zones on it. Therefore, when a specific smell enters the nose, only the receptors forming a conforming pattern, not every receptor, is activated. That is how the specific smell is Page 29 of 35 detected. So far the scientists have identified eight primary odors: camphorous, fishy, malty, minty, musky, spermatic, sweaty, and urinous. TASTE Taste and smell are both chemical senses. Therefore, tongue can detect taste only when the receptors in it bind to incoming molecules, generating electrical signals that pass through the related cranial nerves to the specific brain areas. Thus, the pathway of gustatory electrical impulses begins with mouth, going to medulla, continues to the thalamus, then to primary gustatory areas of the cerebral cortex. A person can experience the basic five flavors (sweet, sour, salty, bitter, and umami) by merely activating the taste receptors on the tongue. However, the flavors produced from the combination of these can be detected by tongue only in interaction with the sense of smell. Compared with cold food, we experience the hot food to produce greater taste. This is because, during such time, smell particles rising from the hot food bind to and excite the smell receptors inside the nose, making us also to sense their smell. Before the smell particles and taste particles are detected by the smell receptors and taste receptors respectively, these particles have to dissolve in the liquid solvents in the nose and mouth respectively. So they are similar on that front. However, what is different between the two is that while the taste receptors are not actual neurons, but a special type of cells, the smell receptors are actual neurons. Due to this difference, we see a marked difference in the degree of sensitivity towards the chemical particles. The smell receptors are 300 hundred times more sensitive (Figure 38). The tongue is the main sensory organ for taste detection. It is the body’s most flexible muscular organ. It has three interior muscles and three pairs of muscles connecting it to the mouth and throat. Its surface is dotted with tiny, pimplelike structures called papillae. Papillae are easily visible to naked eyes. Within each papilla are hundreds of taste buds and they are distributed across the tongue. Four types of papillae have been distinguished---vallate, filiform, foliate, and fungiform. Each type bears a different amount of taste buds. A taste bud is composed of a group of about 25 receptor cells alongside supporting cells layered together. In general, humans have 5000 to 10,000 taste buds, and each bud may carry 25 to 100 taste receptor cells within it. At the tip of each cell, there is a hole through which taste chemical particles enter and come in contact with the receptor molecules. The tiny hair-like receptors inside these receptor cells can hold only particular taste particles. Earlier, scientists believed that different parts of the tongue are dedicated to detecting specific tastes. However, according to recent researches, all tastes are detected equally across the tongue, and the tongue is well supplied with nerves Page 30 of 35 that carry taste-related data to the brain. Other parts of the mouth such as the palate, pharynx, and epiglottis can also detect taste stimuli. TOUCH There are many kinds of touch sensations. These include light touch, pressure, vibration, and temperature as well as pain, and awareness of the body position in space. The skin is the body’s main sense organ for touch. There are around 20 types of touch receptor that respond to various types of stimuli. For instance, light touch, a general category that covers sensations ranging from a tap on the arm to stroking a cat’s fur, is detected by four different types of receptor cells: free nerve endings, found in the epidermis; Merkel’s disks, found in deeper layers of the skin; Meissner’s corpuscles, which are common in the palms, soles of the feet, eyelids, genitals, and nipples; and, finally, the root hair plexus, which responds when the hair moves. Pacinian and Ruffini corpuscles respond to more pressure. The sensation of itching is produced by repetitive low-level stimulation of nerve fibers in the skin, while feeling ticklish involves more intense stimulation of the same nerve endings when the stimulus moves over the skin (Figure 39). As for the manner in which touch information finally makes its way to the brain, a sense receptor, when activated, sends information about touch stimuli as electrical impulses along a nerve fiber of the sensory nerve network to the nerve root on the spinal cord. The data enters the spinal cord and continues upward to the brain. The processing of sensory data is begun by the nuclei in the upper (dorsal) column of the spinal cord. From the brainstem, sensory data enters the thalamus, where processing continues. The data then travels to the postcentral gyrus of the cerebral cortex, the location of the somatosensory cortex. Here, it is finally translated into a touch perception. Somatosensory cerebral cortex curls around the brain like a horseshoe. Data from the right side of the body ends on the left side of the brain, and vice versa. THE SIXTH SENSE Proprioception is sometimes referred to as the sixth sense. It is our sense of how our bodies are positioned and moving in space. This ‘awareness’ is produced by part of the somatic sensing system, and involves structures called proprioceptors in the muscles, tendons, joints, and ligaments that monitor changes in their length, tension, and pressure linked to changes in position. Proprioceptors send impulses to the brain. Upon processing this information, a decision can be made—to change position or to stop moving. The brain then sends signals back to the muscles based on the input from the proprioceptors— Page 31 of 35 completing the feedback cycle. This information is not always made conscious. For example, keeping and adjusting balance is generally an unconscious process. Conscious proprioception uses the dorsal column-medial lemniscus pathway, which passes through the thalamus, and ends in the parietal lobe of the cortex. Unconscious proprioception involves spinocerebellar tracts, and ends in the cerebellum. Proprioception is impaired when people are under the influence of alcohol or certain drugs. The degree of impairment can be tested by field sobriety tests, which have long been used by the police in cases of suspected drunk-driving. Typical tests include asking someone to touch their index finger to their nose with eyes closed, to stand on one leg for 30 seconds, or to walk heel-to-toe in a straight line for nine steps. MIXED SENSES Sensory neurons respond to data from specific sense organs. Visual cortical neurons, for example, are most sensitive to signals from the eyes. But this specialization is not rigid. Visual neurons have been found to respond more strongly to weak light signals if accompanied by sound, suggesting that they are activated by data from the ears as well as the eyes. Other studies show that in people who are blind or deaf, some neurons that would normally process visual or auditory stimuli are “hijacked” by the other senses. Hence, blind people hear better and deaf people see better. SYNESTHESIA Most people are aware of only a single sensation in response to one type of stimulus. For example, sound waves make noise. But some people experience more than one sensation in response to a single stimulus. They may “see” sounds as well as hear them, or “taste” images. Called synesthesia, this sensory duplication occurs when the neural pathway from a sense organ diverges and carries data on one type of stimulus to a part of the brain that normally processes another type (Figure 40). PERCEPTION AS A CONSTRUCT Do we perceive the external world directly, or do we perceive a constructed reality? Neuroscience finds that the latter is a more accurate description. When our sensory organs detect something in the environment, they are responding to a physical stimulus. For example, the photoreceptor cells in the retina of the eye respond to photon particles traveling through space. These photons stimulate the receptor neurons, and start a chain reaction of neural signals to the primary visual cortex in the brain, where it becomes a perception. While the visual perception correlates with the physical stimulus, they are not Page 32 of 35 one and the same. It was described earlier that photons have a wavelength, and the wavelength can vary among photons. Each numerical difference in the wavelength of a photon correlates with a difference in the perception of color. That is, photons with a wavelength of around 500 nanometers correlate with perceiving the color blue, while a wavelength of around 700 nanometers correlates with perceiving the color red. While the physical property of wavelength exists objectively in the world, the perceived color only exists subjectively and depends on our ability to detect it. The colors we perceive are not physical properties, but rather the psychological correlates of the physical property of wavelength of light. Moreover, there are many wavelengths that we cannot detect, so our perceptions selectively represent the physical world. The same principle applies to the other senses. Each sensory modality we have has two components: the physical stimulus that is detected by the sensory organ, and the psychological perception that results from it. We do not directly perceive the wavelength of light, rather we perceive the result of how the photon particles stimulate the visual pathway. Therefore, we can say that perception is a construction that is grounded in detecting physical phenomena, but we do not directly perceive those phenomena. Nor do we perceive all objective phenomena, only those that we are capable of detecting. If perception is a construction and a limited representation of objective phenomena, why did it evolve that way? We need to be able to react to environmental circumstances to survive. To find food, to avoid predators, to meet mates, to care for offspring, to engage in social behavior, all of these actions require the ability to detect and respond to changes in the physical environment. But sensory systems can evolve to be simply good enough for survival. It is not necessary to have complete, direct perception to survive. In fact, recall the facts we discussed earlier about how the human brain is very demanding for the body’s resources. More sophisticated sensory systems require more resources, and if those resource requirements are not of great utility to the organism, then evolution likely will not favor increasing the level of sophistication. In addition, there is often a trade-off between speed and accuracy in neural systems and resulting behaviors. When it comes to visual perception, seeing a danger with less accuracy and surviving is more important than seeing a danger directly and not surviving! Page 33 of 35 12)CONSCIOUSNESS AND THE BRAIN WHAT IS CONSCIOUSNESS? Consciousness is important as well as essential. Without it, life would have no meaning. However, once we embark on identifying its nature, it is certain to find it to be like nothing else. A thought, feeling, or idea seems to be a different kind of thing from the physical objects that make up the rest of the universe. The contents of our minds cannot be located in space or time. Although to the neuroscientists the contents of our minds appear to be produced by particular types of physical activity in the brain, it is not known if this activity itself forms consciousness or if brain activity correlates with a different thing altogether that we call “the mind” or consciousness (Figure 41). If consciousness is not simply brain activity, this suggests that the material universe is just one aspect of reality and that consciousness is part of a parallel reality in which entirely different rules apply. MONISM AND DUALISM The philosophical stands of those positing the relation between mind and body can be broadly brought under two divisions: monism and dualism. According to the former, every phenomenon in the universe can be ultimately reduced to a material thing. Consciousness too is identical to the brain activity that correlates with it. However, the fact that not every physical thing has consciousness is because only in those physical bodies where complex physical processes evolved over a long period of time did cognitive mechanism develop. Thus, consciousness never existed in parallel with the material universe as an independent entity of its own. According to the latter, consciousness is not physical but exists in another dimension to the material universe. Certain brain processes are associated with the consciousness, but they are not identical to each other. Some dualists believe consciousness may even exist without the brain processes associated with it. LOCATING CONSCIOUSNESS Human consciousness arises from the interaction of every part of a person with their environment. We know that the brain plays the major role in producing conscious awareness but we do not know exactly how. Certain processes within the brain, and neuronal activity in particular areas, correlate reliably with conscious states, while others do not. Page 34 of 35 Different types of neuronal activity in the brain are associated with the emergence of conscious awareness. Neuronal activity in the cortex, and particularly in the frontal lobes, is associated with the arousal of conscious experience. It takes up to half a second for a stimulus to become conscious after it has first been registered in the brain. Initially, the neuronal activity triggered by the stimulus occurs in the “lower” areas of the brain, such as the amygdala and thalamus, and then in the “higher” brain, in the parts of the cortex that process sensations. The frontal cortex is activated usually only when an experience becomes conscious, suggesting that the involvement of this part of the brain may be an essential component of consciousness. REQUIREMENTS OF CONSCIOUSNESS Every state of conscious awareness has a specific pattern of brain activity associated with it. These are commonly referred to as the neural correlates of consciousness. For example, seeing a patch of yellow produces one pattern of brain activity, seeing grandparents, another. If the brain state changes from one pattern to another, so does the experience of consciousness. Consciousness arises only when brain cells fire at fairly high rates. So, neural activity must be complex for consciousness to occur, but not too complex. If all the neurons are firing, such as in an epileptic seizure, consciousness is lost. The processes relevant to consciousness are generally assumed to be found at the level of brain cells rather than at the level of individual molecules or atoms. Yet it is also possible that consciousness does arise at the far smaller atomic (quantum) level, and if so it may be subject to very different laws. Many neuroscientists hold the philosophical view of materialism; that there is only one fundamental substance in the universe and that is physical material. How, then, is subjective experience of the mind explained? Through a process known as emergence. Emergence is a process described as the production of a phenomenon from the interactions or processes of several other phenomena. For example, the molecule that is water is composed of two hydrogen atoms and one oxygen atom. The hydrogen and oxygen atoms on their own do not have the quality of wetness that water has. But when you combine them to form the molecule, and you have enough water molecules, then the property of wetness emerges from those interactions. Neuroscientists use this as an analogy, and argue that when many neurons are combined, consciousness emerges from those interactions. This analogy serves as a useful description within the viewpoint of materialism, but it is not an explanation, as we have yet to demonstrate the mechanisms involved in such an emergence.",Medical,Fact Finding,Q&A "Only use the information provided to you in the prompt question and context block that has been included, NEVER use external resources or prior knowledge. Responses should be exactly two paragraphs in length. If you don't know something because it's not provided in the document, say ""Don't know - information not found."" Bullet points or sentence fragments should never be used unless specifically requested. Focus on common-sense, obvious conclusions with specific factual support from the prompt.",When an inventor is granted a United States Patent what has the inventor given up or surrendered and what has the inventor received in exchange?,"What Are Patents? Patents are a form of intellectual property that give their holders the exclusive right to practice their inventions (i.e., make, use, sell, offer to sell, or import them) for a limited period of time. The Constitution gives Congress the power to grant patent rights to inventors by authorizing Congress to “promote the Progress of Science and useful Arts, by securing for limited Times to . . . Inventors the exclusive Right to their respective . . . Discoveries.”13 Since 1790, Congress has enacted patent laws granting inventors certain exclusive rights in their inventions for a period of time.14 (Currently, patents expire 20 years after the date that the patent application that gave rise to the patent was filed.15) Patents represent a “quid pro quo” by which the inventor publicly discloses an invention in exchange for time-limited, exclusive rights to practice it. 16 In the United States, USPTO is responsible for evaluating patent applications and granting patents on qualifying inventions, as explained below.17 11 See, e.g., id.; ALLIANCE OF U.S. STARTUPS AND INVENTORS FOR JOBS, Why Patents Matter, https://www.usij.org/whypatents-matter/ (last visited Mar. 28, 2024). 12 See, e.g., Gene Quinn, A Kinder, Gentler ‘Death Squad’: Ten Years in, Despite Some Reforms, the USPTO Is Still Killing U.S. Patents, IP WATCHDOG (Sept. 19, 2021, 12:15 PM), https://ipwatchdog.com/2021/09/19/kinder-gentlerdeath-squad-ten-years-despite-reforms-uspto-still-killing-u-s-patents/id=137765/; Oil States Energy Servs. v. Greene’s Energy Grp., 584 U.S. 325, 345–47 (2018) (Gorsuch, J., dissenting). 13 U.S. CONST. art. I, § 8, cl. 8. 14 See, e.g., 35 U.S.C. § 271 (setting forth how patents may be infringed). 15 Id. § 154(a)(2). Patent terms can be extended in some circumstances, such as delays by USPTO in reviewing a patent application. See id. §§ 154(b), 156. 16 J.E.M. Ag Supply, Inc. v. Pioneer Hi-Bred Int’l, Inc., 534 U.S. 124, 142 (2001) (“The disclosure required by the Patent Act is ‘the quid pro quo of the right to exclude.’” (quoting Kewanee Oil Co. v. Bicron Corp., 416 U.S. 470, 484 (1974))); see also Universal Oil Prods. Co. v. Globe Oil & Refin. Co., 322 U.S. 471, 484 (1944) (“As a reward for inventions and to encourage their disclosure, the United States offers a . . . monopoly to an inventor who refrains from keeping his invention a trade secret. But the quid pro quo is disclosure of a process or device in sufficient detail . . . .”). 17 See infra “How Do Inventors Obtain a Patent?”. Once granted, the holder of a valid patent has the exclusive right to make, use, sell, or import the invention in the United States until the patent expires.18 Any other person who practices the invention without permission from the patent holder infringes the patent and is liable for monetary damages, and possibly subject to injunctive relief, if sued by the patentee. 19 Patents have the attributes of personal property, and the patentee may sell or assign the patent to another person.20 A patentee may also license other persons to practice the invention, granting them permission to make, use, sell, or import the invention, usually in exchange for consideration (such as monetary royalties).21 What Inventions Can Be Patented? In order to be patented, an invention must meet four substantive requirements: The invention must be (1) directed to patentable (or “eligible”) subject matter, (2) new, (3) nonobvious, and (4) useful.22 In addition to these four substantive patentability requirements, the Patent Act imposes minimum requirements for the technical disclosure of the invention in the patent application, which must adequately describe and distinctly claim the invention.23 As discussed in this report, PTAB administers certain proceedings in which petitioners may seek to invalidate a patent previously granted by USPTO on the grounds that the patent fails to satisfy certain of these requirements. This section briefly surveys these patentability requirements. Eligible Subject Matter Requirement The Patent Act allows inventors to obtain patents on any new and useful “process, machine, manufacture, or composition of matter, or . . . improvement thereof.”24 Examples of technological areas for patentable inventions include pharmaceuticals, biotechnology, chemistry, computer hardware and software, electrical engineering, mechanical engineering, and manufacturing processes.25 By contrast, the Supreme Court has long held that “laws of nature, natural phenomena, and abstract ideas” are not patentable.26 The Court has reasoned that to permit a monopoly on the “‘basic tools of scientific and technological work’ . . . might tend to impede innovation more than it would tend to promote it.”27 In a series of cases in the 2010s, the Supreme Court established a two-step test for patentable subject matter, sometimes called the Alice test or the Alice/Mayo framework.28 The first step 18 35 U.S.C. § 271(a). 19 Id. §§ 271, 281, 283–285. 20 Id. § 261. 21 License, BLACK’S LAW DICTIONARY (10th ed. 2014); 35 U.S.C. § 271(a). 22 See 35 U.S.C. §§ 101–103. 23 Id. § 112; see generally Hickey, supra note 4, at 12–14. 24 35 U.S.C. § 101. 25 See USPTO, PATENT TECHNOLOGY CENTERS MANAGEMENT, https://www.uspto.gov/patent/contact-patents/patenttechnology-centers-management (last visited Mar. 28, 2024) (listing technological divisions for USPTO examiners). 26 Diamond v. Diehr, 450 U.S. 175, 185 (1981); see generally Hickey, supra note 4, at 10–20 (overviewing development of the law of patent-eligible subject matter). 27 Mayo Collaborative Servs. v. Prometheus Lab’ys, Inc., 566 U.S. 66, 71 (2012) (quoting Gottschalk v. Benson, 409 U.S. 63, 67 (1972)). 28 See Alice Corp. Pty. Ltd. v. CLS Bank Int’l, 573 U.S. 208 (2014); Ass’n for Molecular Pathology v. Myriad Genetics, Inc., 569 U.S. 576 (2013); Mayo Collaborative Servs., 566 U.S. at 66. USPTO has issued guidelines for its patent examiners to determine whether a patent application seeks to claim ineligible subject matter. See 2019 Revised Patent Subject Matter Eligibility Guidance, 84 Fed. Reg. 50 (Jan. 7, 2019).","Instructions: Only use the information provided to you in the prompt question and context block that has been included, NEVER use external resources or prior knowledge. Responses should be exactly two paragraphs in length. If you don't know something because it's not provided in the document, say ""Don't know - information not found."" Bullet points or sentence fragments should never be used unless specifically requested. Focus on common-sense, obvious conclusions with specific factual support from the prompt. Context: What Are Patents? Patents are a form of intellectual property that give their holders the exclusive right to practice their inventions (i.e., make, use, sell, offer to sell, or import them) for a limited period of time. The Constitution gives Congress the power to grant patent rights to inventors by authorizing Congress to “promote the Progress of Science and useful Arts, by securing for limited Times to . . . Inventors the exclusive Right to their respective . . . Discoveries.”13 Since 1790, Congress has enacted patent laws granting inventors certain exclusive rights in their inventions for a period of time.14 (Currently, patents expire 20 years after the date that the patent application that gave rise to the patent was filed.15) Patents represent a “quid pro quo” by which the inventor publicly discloses an invention in exchange for time-limited, exclusive rights to practice it. 16 In the United States, USPTO is responsible for evaluating patent applications and granting patents on qualifying inventions, as explained below.17 11 See, e.g., id.; ALLIANCE OF U.S. STARTUPS AND INVENTORS FOR JOBS, Why Patents Matter, https://www.usij.org/whypatents-matter/ (last visited Mar. 28, 2024). 12 See, e.g., Gene Quinn, A Kinder, Gentler ‘Death Squad’: Ten Years in, Despite Some Reforms, the USPTO Is Still Killing U.S. Patents, IP WATCHDOG (Sept. 19, 2021, 12:15 PM), https://ipwatchdog.com/2021/09/19/kinder-gentlerdeath-squad-ten-years-despite-reforms-uspto-still-killing-u-s-patents/id=137765/; Oil States Energy Servs. v. Greene’s Energy Grp., 584 U.S. 325, 345–47 (2018) (Gorsuch, J., dissenting). 13 U.S. CONST. art. I, § 8, cl. 8. 14 See, e.g., 35 U.S.C. § 271 (setting forth how patents may be infringed). 15 Id. § 154(a)(2). Patent terms can be extended in some circumstances, such as delays by USPTO in reviewing a patent application. See id. §§ 154(b), 156. 16 J.E.M. Ag Supply, Inc. v. Pioneer Hi-Bred Int’l, Inc., 534 U.S. 124, 142 (2001) (“The disclosure required by the Patent Act is ‘the quid pro quo of the right to exclude.’” (quoting Kewanee Oil Co. v. Bicron Corp., 416 U.S. 470, 484 (1974))); see also Universal Oil Prods. Co. v. Globe Oil & Refin. Co., 322 U.S. 471, 484 (1944) (“As a reward for inventions and to encourage their disclosure, the United States offers a . . . monopoly to an inventor who refrains from keeping his invention a trade secret. But the quid pro quo is disclosure of a process or device in sufficient detail . . . .”). 17 See infra “How Do Inventors Obtain a Patent?”. Once granted, the holder of a valid patent has the exclusive right to make, use, sell, or import the invention in the United States until the patent expires.18 Any other person who practices the invention without permission from the patent holder infringes the patent and is liable for monetary damages, and possibly subject to injunctive relief, if sued by the patentee. 19 Patents have the attributes of personal property, and the patentee may sell or assign the patent to another person.20 A patentee may also license other persons to practice the invention, granting them permission to make, use, sell, or import the invention, usually in exchange for consideration (such as monetary royalties).21 What Inventions Can Be Patented? In order to be patented, an invention must meet four substantive requirements: The invention must be (1) directed to patentable (or “eligible”) subject matter, (2) new, (3) nonobvious, and (4) useful.22 In addition to these four substantive patentability requirements, the Patent Act imposes minimum requirements for the technical disclosure of the invention in the patent application, which must adequately describe and distinctly claim the invention.23 As discussed in this report, PTAB administers certain proceedings in which petitioners may seek to invalidate a patent previously granted by USPTO on the grounds that the patent fails to satisfy certain of these requirements. This section briefly surveys these patentability requirements. Eligible Subject Matter Requirement The Patent Act allows inventors to obtain patents on any new and useful “process, machine, manufacture, or composition of matter, or . . . improvement thereof.”24 Examples of technological areas for patentable inventions include pharmaceuticals, biotechnology, chemistry, computer hardware and software, electrical engineering, mechanical engineering, and manufacturing processes.25 By contrast, the Supreme Court has long held that “laws of nature, natural phenomena, and abstract ideas” are not patentable.26 The Court has reasoned that to permit a monopoly on the “‘basic tools of scientific and technological work’ . . . might tend to impede innovation more than it would tend to promote it.”27 In a series of cases in the 2010s, the Supreme Court established a two-step test for patentable subject matter, sometimes called the Alice test or the Alice/Mayo framework.28 The first step 18 35 U.S.C. § 271(a). 19 Id. §§ 271, 281, 283–285. 20 Id. § 261. 21 License, BLACK’S LAW DICTIONARY (10th ed. 2014); 35 U.S.C. § 271(a). 22 See 35 U.S.C. §§ 101–103. 23 Id. § 112; see generally Hickey, supra note 4, at 12–14. 24 35 U.S.C. § 101. 25 See USPTO, PATENT TECHNOLOGY CENTERS MANAGEMENT, https://www.uspto.gov/patent/contact-patents/patenttechnology-centers-management (last visited Mar. 28, 2024) (listing technological divisions for USPTO examiners). 26 Diamond v. Diehr, 450 U.S. 175, 185 (1981); see generally Hickey, supra note 4, at 10–20 (overviewing development of the law of patent-eligible subject matter). 27 Mayo Collaborative Servs. v. Prometheus Lab’ys, Inc., 566 U.S. 66, 71 (2012) (quoting Gottschalk v. Benson, 409 U.S. 63, 67 (1972)). 28 See Alice Corp. Pty. Ltd. v. CLS Bank Int’l, 573 U.S. 208 (2014); Ass’n for Molecular Pathology v. Myriad Genetics, Inc., 569 U.S. 576 (2013); Mayo Collaborative Servs., 566 U.S. at 66. USPTO has issued guidelines for its patent examiners to determine whether a patent application seeks to claim ineligible subject matter. See 2019 Revised Patent Subject Matter Eligibility Guidance, 84 Fed. Reg. 50 (Jan. 7, 2019). Question: When an inventor is granted a United States Patent what has the inventor given up or surrendered and what has the inventor received in exchange?",Legal,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",I have sleep apnea. My friend sent me this article that contains a promising medication that could help me with sleep apnea and weight loss. Explain the connection between the mentioned medication and sleep apnea and the benefits it may include. Use at least 400 words.,"Tirzepatide Significantly Reduces Sleep Disruptions Alicia Ault June 22, 2024 Add to Email Alerts 28 2407 ORLANDO, Fla. — The diabetes and weight loss drug tirzepatide (Mounjaro for type 2 diabetes; Zepbound for obesity) was so effective at reducing sleep disruptions in patients with obesity and obstructive sleep apnea (OSA) that 40% to 50% no longer needed to use a continuous pressure airway positive (CPAP) device, according to two new studies. Tirzepatide, a long-acting glucose-dependent insulinotropic polypeptide (GIP) receptor agonist and glucagon-like peptide-1 (GLP-1) receptor agonist, also lowered C-reactive protein levels and systolic blood pressure. And patients taking the medication lost 18% to 20% of their body weight. The SURMOUNT-OSA studies ""mark a significant milestone in the treatment of OSA, offering a promising new therapeutic option that addresses both respiratory and metabolic complications,"" said lead author Atul Malhotra, MD, professor of medicine at University of California San Diego School of Medicine and director of sleep medicine at UC San Diego Health. The two double-blind randomized controlled trials in patients with obesity and moderate-to-severe OSA were conducted at 60 sites in nine countries. The results were presented here at the American Diabetes Association (ADA) 84th Scientific Sessions and simultaneously published online in the New England Journal of Medicine. OSA affects 1 billion people worldwide and 30 million American adults, many of whom are undiagnosed. Obesity is a common risk factor. According to the ADA, 40% of those with obesity have OSA and 70% of those with OSA have obesity. CPAP is an effective and the most-used intervention for OSA, but many patients refuse to use the device, stop using it, or cannot use it. Should tirzepatide eventually gain US Food and Drug Administration (FDA) approval for OSA, it would be the first drug approved for the condition. ""This new drug treatment offers a more accessible alternative for individuals who cannot tolerate or adhere to existing therapies,"" said Malhotra. Huge Reduction in Episodes, Severity For the two studies, patients were enrolled who had moderate-to-severe OSA, defined as more than 15 events per hour (using the apnea–hypopnea index [AHI]) and a body mass index of 30 kg/m2 or greater. Those not using a CPAP device were enrolled in study 1, and those using a CPAP device were enrolled in study 2. Participants received either the maximum tolerated dose of tirzepatide (10 or 15 mg by once-weekly injection) or placebo for 1 year. In study 1, 114 individuals received tirzepatide and 120 received placebo. For study 2, 119 patients received tirzepatide and 114 received placebo. All participants received regular lifestyle counseling sessions about nutrition and were instructed to reduce food intake by 500 kcal/day and to engage in at least 150 min/week of physical activity. Enrollment was limited to 70% men to ensure adequate representation of women. At baseline, 65% to 70% of participants had severe OSA, with more than 30 events/hour on the AHI scale and a mean of 51.5 events/hour By 1 year, patients taking tirzepatide had 27 to 30 fewer events/hour compared with 4 to 6 fewer events/hour for those taking placebo. Up to half of those who received tirzepatide in both trials had less than 5 events/hour or 5 to 14 AHI events/hour and an Epworth Sleepiness Scale score of 10 or less. Those thresholds ""represent a level at which CPAP therapy may not be recommended,"" write the authors. Patients in the tirzepatide group also had a decrease in systolic blood pressure from baseline of 9.7 mm Hg in study 1 and 7.6 mm Hg in study 2 at Week 48. The most common adverse events were diarrhea, nausea, and vomiting, which occurred in approximately a quarter of patients taking tirzepatide. There were two adjudicated-confirmed cases of acute pancreatitis in those taking tirzepatide in study 2. Patients who received tirzepatide also reported fewer daytime and nighttime disturbances, as measured using the Patient-Reported Outcomes Measurement Information System Short Form scale for Sleep-Related Impairment and Sleep Disturbance. Tirzepatide Plus CPAP Are Best Writing in an accompanying editorial, Sanjay R. Patel, MD, noted that although clinical guidelines have recommended that weight loss strategies be incorporated as part of OSA treatment, ""the integration of obesity management into the approaches to care for obstructive sleep apnea has lagged."" As many as half of patients abandon CPAP therapy within 3 years, writes Patel, who is professor of medicine and epidemiology at the University of Pittsburgh, and medical director of the UPMC Comprehensive Sleep Disorders program. ""An effective medication to treat obesity is thus an obvious avenue to pursue,"" he writes. Patel noted the large reductions in the number of events on the AHI scale. He writes that the improvement in systolic blood pressure ""was substantially larger than effects seen with CPAP therapy alone and indicate that tirzepatide may be an attractive option for those patients who seek to reduce their cardiovascular risk."" Patel raised concerns about whether patients outside of a trial would stick with therapy, noting studies have shown high rates of discontinuation of GLP-1 receptor agonists. And, he writes, ""Racial disparities in the use of GLP-1 receptor agonists among patients with diabetes arouse concern that the addition of tirzepatide as a treatment option for obstructive sleep apnea without directly addressing policies relative to coverage of care will only further exacerbate already pervasive disparities in clinical care for obstructive sleep apnea."" Commenting on the study during the presentation of the results, Louis Aronne, MD, said he believes the trials demonstrate ""the treatment of obesity with tirzepatide plus CPAP is really the optimal treatment for obstructive sleep apnea and obesity-related cardiometabolic risks."" Aronne is the Sanford I. Weill professor of metabolic research at Weill Cornell Medical College, New York. Aronne added there is still much to learn. It is still not clear whether tirzepatide had an independent effect in the OSA trial — as has been seen in other studies where the drug clearly reduced cardiovascular risk — or whether the positive results were primarily due to weight loss. ""I believe that over time we'll see that this particular effect in sleep apnea is related to weight,"" he said.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== I have sleep apnea. My friend sent me this article that contains a promising medication that could help me with sleep apnea and weight loss. Explain the connection between the mentioned medication and sleep apnea and the benefits it may include. Use at least 400 words. {passage 0} ========== Tirzepatide Significantly Reduces Sleep Disruptions Alicia Ault June 22, 2024 Add to Email Alerts 28 2407 ORLANDO, Fla. — The diabetes and weight loss drug tirzepatide (Mounjaro for type 2 diabetes; Zepbound for obesity) was so effective at reducing sleep disruptions in patients with obesity and obstructive sleep apnea (OSA) that 40% to 50% no longer needed to use a continuous pressure airway positive (CPAP) device, according to two new studies. Tirzepatide, a long-acting glucose-dependent insulinotropic polypeptide (GIP) receptor agonist and glucagon-like peptide-1 (GLP-1) receptor agonist, also lowered C-reactive protein levels and systolic blood pressure. And patients taking the medication lost 18% to 20% of their body weight. The SURMOUNT-OSA studies ""mark a significant milestone in the treatment of OSA, offering a promising new therapeutic option that addresses both respiratory and metabolic complications,"" said lead author Atul Malhotra, MD, professor of medicine at University of California San Diego School of Medicine and director of sleep medicine at UC San Diego Health. The two double-blind randomized controlled trials in patients with obesity and moderate-to-severe OSA were conducted at 60 sites in nine countries. The results were presented here at the American Diabetes Association (ADA) 84th Scientific Sessions and simultaneously published online in the New England Journal of Medicine. OSA affects 1 billion people worldwide and 30 million American adults, many of whom are undiagnosed. Obesity is a common risk factor. According to the ADA, 40% of those with obesity have OSA and 70% of those with OSA have obesity. CPAP is an effective and the most-used intervention for OSA, but many patients refuse to use the device, stop using it, or cannot use it. Should tirzepatide eventually gain US Food and Drug Administration (FDA) approval for OSA, it would be the first drug approved for the condition. ""This new drug treatment offers a more accessible alternative for individuals who cannot tolerate or adhere to existing therapies,"" said Malhotra. Huge Reduction in Episodes, Severity For the two studies, patients were enrolled who had moderate-to-severe OSA, defined as more than 15 events per hour (using the apnea–hypopnea index [AHI]) and a body mass index of 30 kg/m2 or greater. Those not using a CPAP device were enrolled in study 1, and those using a CPAP device were enrolled in study 2. Participants received either the maximum tolerated dose of tirzepatide (10 or 15 mg by once-weekly injection) or placebo for 1 year. In study 1, 114 individuals received tirzepatide and 120 received placebo. For study 2, 119 patients received tirzepatide and 114 received placebo. All participants received regular lifestyle counseling sessions about nutrition and were instructed to reduce food intake by 500 kcal/day and to engage in at least 150 min/week of physical activity. Enrollment was limited to 70% men to ensure adequate representation of women. At baseline, 65% to 70% of participants had severe OSA, with more than 30 events/hour on the AHI scale and a mean of 51.5 events/hour By 1 year, patients taking tirzepatide had 27 to 30 fewer events/hour compared with 4 to 6 fewer events/hour for those taking placebo. Up to half of those who received tirzepatide in both trials had less than 5 events/hour or 5 to 14 AHI events/hour and an Epworth Sleepiness Scale score of 10 or less. Those thresholds ""represent a level at which CPAP therapy may not be recommended,"" write the authors. Patients in the tirzepatide group also had a decrease in systolic blood pressure from baseline of 9.7 mm Hg in study 1 and 7.6 mm Hg in study 2 at Week 48. The most common adverse events were diarrhea, nausea, and vomiting, which occurred in approximately a quarter of patients taking tirzepatide. There were two adjudicated-confirmed cases of acute pancreatitis in those taking tirzepatide in study 2. Patients who received tirzepatide also reported fewer daytime and nighttime disturbances, as measured using the Patient-Reported Outcomes Measurement Information System Short Form scale for Sleep-Related Impairment and Sleep Disturbance. Tirzepatide Plus CPAP Are Best Writing in an accompanying editorial, Sanjay R. Patel, MD, noted that although clinical guidelines have recommended that weight loss strategies be incorporated as part of OSA treatment, ""the integration of obesity management into the approaches to care for obstructive sleep apnea has lagged."" As many as half of patients abandon CPAP therapy within 3 years, writes Patel, who is professor of medicine and epidemiology at the University of Pittsburgh, and medical director of the UPMC Comprehensive Sleep Disorders program. ""An effective medication to treat obesity is thus an obvious avenue to pursue,"" he writes. Patel noted the large reductions in the number of events on the AHI scale. He writes that the improvement in systolic blood pressure ""was substantially larger than effects seen with CPAP therapy alone and indicate that tirzepatide may be an attractive option for those patients who seek to reduce their cardiovascular risk."" Patel raised concerns about whether patients outside of a trial would stick with therapy, noting studies have shown high rates of discontinuation of GLP-1 receptor agonists. And, he writes, ""Racial disparities in the use of GLP-1 receptor agonists among patients with diabetes arouse concern that the addition of tirzepatide as a treatment option for obstructive sleep apnea without directly addressing policies relative to coverage of care will only further exacerbate already pervasive disparities in clinical care for obstructive sleep apnea."" Commenting on the study during the presentation of the results, Louis Aronne, MD, said he believes the trials demonstrate ""the treatment of obesity with tirzepatide plus CPAP is really the optimal treatment for obstructive sleep apnea and obesity-related cardiometabolic risks."" Aronne is the Sanford I. Weill professor of metabolic research at Weill Cornell Medical College, New York. Aronne added there is still much to learn. It is still not clear whether tirzepatide had an independent effect in the OSA trial — as has been seen in other studies where the drug clearly reduced cardiovascular risk — or whether the positive results were primarily due to weight loss. ""I believe that over time we'll see that this particular effect in sleep apnea is related to weight,"" he said. https://www.medscape.com/viewarticle/tirzepatide-significantly-reduces-sleep-disruptions-2024a1000bm1",Medical,Effect Analysis,Q&A "Using only the information provided in the context block, provide the answer in a bullet point list, bolding the reasoning keyword and following it with a description in unbolded text like this: * **Reasoning Keyword**: Explanation....",How should I handle credit card debt?,"Your First Step—Making a Financial Plan What are the things you want to save and invest for? • a home • a car • an education • a comfortable retirement • your children • medical or other emergencies • periods of unemployment • caring for parents Make your own list and then think about which goals are the most important to you. List your most important goals first. Decide how many years you have to meet each specific goal, because when you save or invest you’ll need to find a savings or investment option that fits your time frame for meeting each goal. Many tools exist to help you put your financial plan together. You’ll find a wealth of information, including calculators and links to non-commercial resources at Investor.gov. KNOW YOUR CURRENT FINANCIAL SITUATION Sit down and take an honest look at your entire financial situation. You can never take a journey without knowing where you’re starting from, and a journey to financial security is no different. You’ll need to figure out on paper your current situation—what you own and what you owe. You’ll be creating a “net worth statement.” On one side of the page, list what you own. These are your “assets.” And on the other side list what you owe other people, your “liabilities” or debts. Subtract your liabilities from your assets. If your assets are larger than your liabilities, you have a “positive” net worth. If your liabilities are greater than your assets, you have a “negative” net worth. You’ll want to update your “net worth statement” every year to keep track of how you are doing. Don’t be discouraged if you have a negative net worth. If you follow a plan to get into a positive position, you’re doing the right thing. KNOW YOUR INCOME AND EXPENSES The next step is to keep track of your income and your expenses for every month. Write down what you and others in your family earn, and then your monthly expenses. PAY YOURSELF OR YOUR FAMILY FIRST Include a category for savings and investing. What are you paying yourself every month? Many people get into the habit of saving and investing by following this advice: always pay yourself or your family first. Many people find it easier to pay themselves first if they allow their bank to automatically remove money from their paycheck and deposit it into a savings or investment account. Likely even better, for tax purposes, is to participate in an employer-sponsored retirement plan such as a 401(k), 403(b), or 457(b). These plans will typically not only automatically deduct money from your paycheck, but will immediately reduce the taxes you are paying. Additionally, in many plans the employer matches some or all of your contribution. When your employer does that, it’s offering “free money.” Any time you have automatic deductions made from your paycheck or bank account, you’ll increase the chances of being able to stick to your plan and to realize your goals. FINDING MONEY TO SAVE OR INVEST If you are spending all your income, and never have money to save or invest, you’ll need to look for ways to cut back on your expenses. When you watch where you spend your money, you will be surprised how small everyday expenses that you can do without add up over a year. Small Savings Add Up to Big Money How much does a cup of coffee cost you? If you buy a cup of coffee every day for $1.00 (an awfully good price for a decent cup of coffee, nowadays), that adds up to $365.00 a year. If you saved that $365.00 for just one year, and put it into a savings account or investment that earns 5% a year, it would grow to $465.84 by the end of 5 years, and by the end of 30 years, to $1,577.50. That’s the power of “compounding.” With compound interest, you earn interest on the money you save and on the interest that money earns. Over time, even a small amount saved can add up to big money. If you are willing to watch what you spend and look for little ways to save on a regular schedule, you can make money grow. You just did it with one cup of coffee. If a small cup of coffee can make such a huge difference, start looking at how you could make your money grow if you decided to spend less on other things and save those extra dollars. If you buy on impulse, make a rule that you’ll always wait 24 hours to buy anything. You may lose your desire to buy it after a day. And try emptying your pockets and wallet of spare change at the end of each day. You’ll be surprised how quickly those nickels and dimes add up! PAY OFF CREDIT CARD OR OTHER HIGH INTEREST DEBT Speaking of things adding up, few investment strategies pay off as well as, or with less risk than, merely paying off all high interest debt you may have. Many people have wallets filled with credit cards, some of which they’ve “maxed out” (meaning they’ve spent up to their credit limit). Credit cards can make it seem easy to buy expensive things when you don’t have the cash in your pocket—or in the bank. But credit cards aren’t free money. Most credit cards charge high interest rates—as much as 18 percent or more—if you don’t pay off your balance in full each month. If you owe money on your credit cards, the wisest thing you can do is pay off the balance in full as quickly as possible. Virtually no investment will give you the high returns you’ll need to keep pace with an 18 percent interest charge. That’s why you’re better off eliminating all credit card debt before investing savings. Once you’ve paid off your credit cards, you can budget your money and begin to save and invest. Here are some tips for avoiding credit card debt: Put Away the Plastic Don’t use a credit card unless your debt is at a manageable level and you know you’ll have the money to pay the bill when it arrives. Know What You Owe It’s easy to forget how much you’ve charged on your credit card. Every time you use a credit card, write down how much you have spent and figure out how much you’ll have to pay that month. If you know you won’t be able to pay your balance in full, try to figure out how much you can pay each month and how long it’ll take to pay the balance in full. Pay Off the Card with the Highest Rate If you’ve got unpaid balances on several credit cards, you should first pay down the card that charges the highest rate. Pay as much as you can toward that debt each month until your balance is once again zero, while still paying the minimum on your other cards. The same advice goes for any other high interest debt (about 8% or above) which does not offer the tax advantages of, for example, a mortgage. Now, once you have paid off those credit cards and begun to set aside some money to save and invest, what are your choices? ","How should I handle credit card debt? Using only the information provided in the context block, provide the answer in a bullet point list, bolding the reasoning keyword and following it with a description in unbolded text like this: * **Reasoning Keyword**: Explanation.... Your First Step—Making a Financial Plan What are the things you want to save and invest for? • a home • a car • an education • a comfortable retirement • your children • medical or other emergencies • periods of unemployment • caring for parents Make your own list and then think about which goals are the most important to you. List your most important goals first. Decide how many years you have to meet each specific goal, because when you save or invest you’ll need to find a savings or investment option that fits your time frame for meeting each goal. Many tools exist to help you put your financial plan together. You’ll find a wealth of information, including calculators and links to non-commercial resources at Investor.gov. KNOW YOUR CURRENT FINANCIAL SITUATION Sit down and take an honest look at your entire financial situation. You can never take a journey without knowing where you’re starting from, and a journey to financial security is no different. You’ll need to figure out on paper your current situation—what you own and what you owe. You’ll be creating a “net worth statement.” On one side of the page, list what you own. These are your “assets.” And on the other side list what you owe other people, your “liabilities” or debts. Subtract your liabilities from your assets. If your assets are larger than your liabilities, you have a “positive” net worth. If your liabilities are greater than your assets, you have a “negative” net worth. You’ll want to update your “net worth statement” every year to keep track of how you are doing. Don’t be discouraged if you have a negative net worth. If you follow a plan to get into a positive position, you’re doing the right thing. KNOW YOUR INCOME AND EXPENSES The next step is to keep track of your income and your expenses for every month. Write down what you and others in your family earn, and then your monthly expenses. PAY YOURSELF OR YOUR FAMILY FIRST Include a category for savings and investing. What are you paying yourself every month? Many people get into the habit of saving and investing by following this advice: always pay yourself or your family first. Many people find it easier to pay themselves first if they allow their bank to automatically remove money from their paycheck and deposit it into a savings or investment account. Likely even better, for tax purposes, is to participate in an employer-sponsored retirement plan such as a 401(k), 403(b), or 457(b). These plans will typically not only automatically deduct money from your paycheck, but will immediately reduce the taxes you are paying. Additionally, in many plans the employer matches some or all of your contribution. When your employer does that, it’s offering “free money.” Any time you have automatic deductions made from your paycheck or bank account, you’ll increase the chances of being able to stick to your plan and to realize your goals. FINDING MONEY TO SAVE OR INVEST If you are spending all your income, and never have money to save or invest, you’ll need to look for ways to cut back on your expenses. When you watch where you spend your money, you will be surprised how small everyday expenses that you can do without add up over a year. Small Savings Add Up to Big Money How much does a cup of coffee cost you? If you buy a cup of coffee every day for $1.00 (an awfully good price for a decent cup of coffee, nowadays), that adds up to $365.00 a year. If you saved that $365.00 for just one year, and put it into a savings account or investment that earns 5% a year, it would grow to $465.84 by the end of 5 years, and by the end of 30 years, to $1,577.50. That’s the power of “compounding.” With compound interest, you earn interest on the money you save and on the interest that money earns. Over time, even a small amount saved can add up to big money. If you are willing to watch what you spend and look for little ways to save on a regular schedule, you can make money grow. You just did it with one cup of coffee. If a small cup of coffee can make such a huge difference, start looking at how you could make your money grow if you decided to spend less on other things and save those extra dollars. If you buy on impulse, make a rule that you’ll always wait 24 hours to buy anything. You may lose your desire to buy it after a day. And try emptying your pockets and wallet of spare change at the end of each day. You’ll be surprised how quickly those nickels and dimes add up! PAY OFF CREDIT CARD OR OTHER HIGH INTEREST DEBT Speaking of things adding up, few investment strategies pay off as well as, or with less risk than, merely paying off all high interest debt you may have. Many people have wallets filled with credit cards, some of which they’ve “maxed out” (meaning they’ve spent up to their credit limit). Credit cards can make it seem easy to buy expensive things when you don’t have the cash in your pocket—or in the bank. But credit cards aren’t free money. Most credit cards charge high interest rates—as much as 18 percent or more—if you don’t pay off your balance in full each month. If you owe money on your credit cards, the wisest thing you can do is pay off the balance in full as quickly as possible. Virtually no investment will give you the high returns you’ll need to keep pace with an 18 percent interest charge. That’s why you’re better off eliminating all credit card debt before investing savings. Once you’ve paid off your credit cards, you can budget your money and begin to save and invest. Here are some tips for avoiding credit card debt: Put Away the Plastic Don’t use a credit card unless your debt is at a manageable level and you know you’ll have the money to pay the bill when it arrives. Know What You Owe It’s easy to forget how much you’ve charged on your credit card. Every time you use a credit card, write down how much you have spent and figure out how much you’ll have to pay that month. If you know you won’t be able to pay your balance in full, try to figure out how much you can pay each month and how long it’ll take to pay the balance in full. Pay Off the Card with the Highest Rate If you’ve got unpaid balances on several credit cards, you should first pay down the card that charges the highest rate. Pay as much as you can toward that debt each month until your balance is once again zero, while still paying the minimum on your other cards. The same advice goes for any other high interest debt (about 8% or above) which does not offer the tax advantages of, for example, a mortgage. Now, once you have paid off those credit cards and begun to set aside some money to save and invest, what are your choices? ",Financial,Fact Finding,Q&A Only use information from the context in your response. Focus on things someone can do without help from a professional.,How can I mitigate the risks of investing?,"What about risk? All investments involve taking on risk. It’s important that you go into any investment in stocks, bonds or mutual funds with a full understanding that you could lose some or all of your money in any one investment. While over the long term the stock market has historically provided around 10% annual returns (closer to 6% or 7% “real” returns when you subtract for the effects of inflation), the long term does sometimes take a rather long, long time to play out. Those who invested all of their money in the stock market at its peak in 1929 (before the stock market crash) would wait over 20 years to see the stock market return to the same level. However, those that kept adding money to the market throughout that time would have done very well for themselves, as the lower cost of stocks in the 1930s made for some hefty gains for those who bought and held over the course of the next twenty years or more. It is often said that the greater the risk, the greater the potential reward in investing, but taking on unnecessary risk is often avoidable. Investors best protect themselves against risk by spreading their money among various investments, hoping that if one investment loses money, the other investments will more than make up for those losses. This strategy, called “diversification,” can be neatly summed up as, “Don’t put all your eggs in one basket.” Investors also protect themselves from the risk of investing all their money at the wrong time (think 1929) by following a consistent pattern of adding new money to their investments over long periods of time. Once you’ve saved money for investing, consider carefully all your options and think about what diversification strategy makes sense for you. While the SEC cannot recommend any particular investment product, you should know that a vast array of investment products exists—including stocks and stock mutual funds, corporate and municipal bonds, bond mutual funds, certificates of deposit, money market funds, and U.S. Treasury securities. Diversification can’t guarantee that your investments won’t suffer if the market drops. But it can improve the chances that you won’t lose money, or that if you do, it won’t be as much as if you weren’t diversified. What are the best investments for me? The answer depends on when you will need the money, your goals, and if you will be able to sleep at night if you purchase a risky investment where you could lose your principal. For instance, if you are saving for retirement, and you have 35 years before you retire, you may want to consider riskier investment products, knowing that if you stick to only the “savings” products or to less risky investment products, your money will grow too slowly—or, given inflation and taxes, you may lose the purchasing power of your money. A frequent mistake people make is putting money they will not need for a very long time in investments that pay a low amount of interest. On the other hand, if you are saving for a short-term goal, five years or less, you don’t want to choose risky investments, because when it’s time to sell, you may have to take a loss. Since investments often move up and down in value rapidly, you want to make sure that you can wait and sell at the best possible time. How Can I Protect Myself? ASK QUESTIONS! You can never ask a dumb question about your investments and the people who help you choose them, especially when it comes to how much you will be paying for any investment, both in upfront costs and ongoing management fees. Here are some questions you should ask when choosing an investment professional or someone to help you: • What training and experience do you have? How long have you been in business? • What is your investment philosophy? Do you take a lot of risks or are you more concerned about the safety of my money? • Describe your typical client. Can you provide me with references, the names of people who have invested with you for a long time? • How do you get paid? By commission? Based on a percentage of assets you manage? Another method? Do you get paid more for selling your own firm’s products? • How much will it cost me in total to do business with you? Your investment professional should understand your investment goals, whether you’re saving to buy a home, paying for your children’s education, or enjoying a comfortable retirement. Your investment professional should also understand your tolerance for risk. That is, how much money can you afford to lose if the value of one of your investments declines? An investment professional has a duty to make sure that he or she only recommends investments that are suitable for you. That is, that the investment makes sense for you based on your other securities holdings, your financial situation, your means, and any other information that your investment professional thinks is important. The best investment professional is one who fully understands your objectives and matches investment recommendations to your goals. You’ll want someone you can understand, because your investment professional should teach you about investing and the investment products. How Should I Monitor My Investments? Investing makes it possible for your money to work for you. In a sense, your money has become your employee, and that makes you the boss. You’ll want to keep a close watch on how your employee, your money, is doing. Some people like to look at the stock quotations every day to see how their investments have done. That’s probably too often. You may get too caught up in the ups and downs of the “trading” value of your investment, and sell when its value goes down temporarily—even though the performance of the company is still stellar. Remember, you’re in for the long haul. Some people prefer to see how they’re doing once a year. That’s probably not often enough. What’s best for you will most likely be somewhere in between, based on your goals and your investments. But it’s not enough to simply check an investment’s performance. You should compare that performance against an index of similar investments over the same period of time to see if you are getting the proper returns for the amount of risk that you are assuming. You should also compare the fees and commissions that you’re paying to what other investment professionals charge. While you should monitor performance regularly, you should pay close attention every time you send your money somewhere else to work. Every time you buy or sell an investment you will receive a confirmation slip from your broker. Make sure each trade was completed according to your instructions. Make sure the buying or selling price was what your broker quoted. And make sure the commissions or fees are what your broker said they would be. Watch out for unauthorized trades in your account. If you get a confirmation slip for a transaction that you didn’t approve beforehand, call your broker. It may have been a mistake. If your broker refuses to correct it, put your complaint in writing and send it to the firm’s compliance officer. Serious complaints should always be made in writing. Remember, too, that if you rely on your investment professional for advice, he or she has an obligation to recommend investments that match your investment goals and tolerance for risk. Your investment professional should not be recommending trades simply to generate commissions. That’s called “churning,” and it’s illegal. How Can I Avoid Problems? Choosing someone to help you with your investments is one of the most important investment decisions you will ever make. While most investment professionals are honest and hardworking, you must watch out for those few unscrupulous individuals. They can make your life’s savings disappear in an instant. Securities regulators and law enforcement officials can and do catch these criminals. But putting them in jail doesn’t always get your money back. Too often, the money is gone. The good news is you can avoid potential problems by protecting yourself. Let’s say you’ve already met with several investment professionals based on recommendations from friends and others you trust, and you’ve found someone who clearly understands your investment objectives. Before you hire this person, you still have more homework. Make sure the investment professional and her firm are registered with the SEC and licensed to do business in your state. And find out from your state’s securities regulator whether the investment professional or her firm have ever been disciplined, or whether they have any complaints against them. You’ll find contact information for securities regulators in the U.S. by visiting the website of the North American Securities Administrators Association (NASAA) at www.nasaa.org or by calling (202) 737-0900. You should also find out as much as you can about any investments that your investment professional recommends. First, make sure the investments are registered. Keep in mind, however, the mere fact that a company has registered and files reports with the SEC doesn’t guarantee that the company will be a good investment. Likewise, the fact that a company hasn’t registered and doesn’t file reports with the SEC doesn’t mean the company is a fraud. Still, you may be asking for serious losses if, for instance, you invest in a small, thinly traded company that isn’t widely known solely on the basis of what you may have read online. One simple phone call to your state regulator could prevent you from squandering your money on a scam. Be wary of promises of quick profits, offers to share “inside information,” and pressure to invest before you have an opportunity to investigate. These are all warning signs of fraud. Ask your investment professional for written materials and prospectuses, and read them before you invest. If you have questions, now is the time to ask.• How will the investment make money? • How is this investment consistent with my investment goals? • What must happen for the investment to increase in value? • What are the risks? • Where can I get more information? Finally, it’s always a good idea to write down everything your investment professional tells you. Accurate notes will come in handy if ever there’s a problem. Some investments make money. Others lose money. That’s natural, and that’s why you need a diversified portfolio to minimize your risk. But if you lose money because you’ve been cheated, that’s not natural, that’s a problem. Sometimes all it takes is a simple phone call to your investment professional to resolve a problem. Maybe there was an honest mistake that can be corrected. If talking to the investment professional doesn’t resolve the problem, talk to the firm’s manager, and write a letter to confirm your conversation. If that doesn’t lead to a resolution, you may have to initiate private legal action. You may need to take action quickly because legal time limits for doing so vary. Your local bar association can provide referrals for attorneys who specialize in securities law. At the same time, call or write to us and let us know what the problem was. Investor complaints are very important to the SEC. You may think you’re the only one experiencing a problem, but typically, you’re not alone. Sometimes it takes only one investor’s complaint to trigger an investigation that exposes a bad broker or an illegal scheme. Complaints can be filed online with us by going to www.sec.gov/complaint.shtml.","Only use information from the context in your response. Focus on things someone can do without help from a professional. How can I mitigate the risks of investing? What about risk? All investments involve taking on risk. It’s important that you go into any investment in stocks, bonds or mutual funds with a full understanding that you could lose some or all of your money in any one investment. While over the long term the stock market has historically provided around 10% annual returns (closer to 6% or 7% “real” returns when you subtract for the effects of inflation), the long term does sometimes take a rather long, long time to play out. Those who invested all of their money in the stock market at its peak in 1929 (before the stock market crash) would wait over 20 years to see the stock market return to the same level. However, those that kept adding money to the market throughout that time would have done very well for themselves, as the lower cost of stocks in the 1930s made for some hefty gains for those who bought and held over the course of the next twenty years or more. It is often said that the greater the risk, the greater the potential reward in investing, but taking on unnecessary risk is often avoidable. Investors best protect themselves against risk by spreading their money among various investments, hoping that if one investment loses money, the other investments will more than make up for those losses. This strategy, called “diversification,” can be neatly summed up as, “Don’t put all your eggs in one basket.” Investors also protect themselves from the risk of investing all their money at the wrong time (think 1929) by following a consistent pattern of adding new money to their investments over long periods of time. Once you’ve saved money for investing, consider carefully all your options and think about what diversification strategy makes sense for you. While the SEC cannot recommend any particular investment product, you should know that a vast array of investment products exists—including stocks and stock mutual funds, corporate and municipal bonds, bond mutual funds, certificates of deposit, money market funds, and U.S. Treasury securities. Diversification can’t guarantee that your investments won’t suffer if the market drops. But it can improve the chances that you won’t lose money, or that if you do, it won’t be as much as if you weren’t diversified. What are the best investments for me? The answer depends on when you will need the money, your goals, and if you will be able to sleep at night if you purchase a risky investment where you could lose your principal. For instance, if you are saving for retirement, and you have 35 years before you retire, you may want to consider riskier investment products, knowing that if you stick to only the “savings” products or to less risky investment products, your money will grow too slowly—or, given inflation and taxes, you may lose the purchasing power of your money. A frequent mistake people make is putting money they will not need for a very long time in investments that pay a low amount of interest. On the other hand, if you are saving for a short-term goal, five years or less, you don’t want to choose risky investments, because when it’s time to sell, you may have to take a loss. Since investments often move up and down in value rapidly, you want to make sure that you can wait and sell at the best possible time. How Can I Protect Myself? ASK QUESTIONS! You can never ask a dumb question about your investments and the people who help you choose them, especially when it comes to how much you will be paying for any investment, both in upfront costs and ongoing management fees. Here are some questions you should ask when choosing an investment professional or someone to help you: • What training and experience do you have? How long have you been in business? • What is your investment philosophy? Do you take a lot of risks or are you more concerned about the safety of my money? • Describe your typical client. Can you provide me with references, the names of people who have invested with you for a long time? • How do you get paid? By commission? Based on a percentage of assets you manage? Another method? Do you get paid more for selling your own firm’s products? • How much will it cost me in total to do business with you? Your investment professional should understand your investment goals, whether you’re saving to buy a home, paying for your children’s education, or enjoying a comfortable retirement. Your investment professional should also understand your tolerance for risk. That is, how much money can you afford to lose if the value of one of your investments declines? An investment professional has a duty to make sure that he or she only recommends investments that are suitable for you. That is, that the investment makes sense for you based on your other securities holdings, your financial situation, your means, and any other information that your investment professional thinks is important. The best investment professional is one who fully understands your objectives and matches investment recommendations to your goals. You’ll want someone you can understand, because your investment professional should teach you about investing and the investment products. How Should I Monitor My Investments? Investing makes it possible for your money to work for you. In a sense, your money has become your employee, and that makes you the boss. You’ll want to keep a close watch on how your employee, your money, is doing. Some people like to look at the stock quotations every day to see how their investments have done. That’s probably too often. You may get too caught up in the ups and downs of the “trading” value of your investment, and sell when its value goes down temporarily—even though the performance of the company is still stellar. Remember, you’re in for the long haul. Some people prefer to see how they’re doing once a year. That’s probably not often enough. What’s best for you will most likely be somewhere in between, based on your goals and your investments. But it’s not enough to simply check an investment’s performance. You should compare that performance against an index of similar investments over the same period of time to see if you are getting the proper returns for the amount of risk that you are assuming. You should also compare the fees and commissions that you’re paying to what other investment professionals charge. While you should monitor performance regularly, you should pay close attention every time you send your money somewhere else to work. Every time you buy or sell an investment you will receive a confirmation slip from your broker. Make sure each trade was completed according to your instructions. Make sure the buying or selling price was what your broker quoted. And make sure the commissions or fees are what your broker said they would be. Watch out for unauthorized trades in your account. If you get a confirmation slip for a transaction that you didn’t approve beforehand, call your broker. It may have been a mistake. If your broker refuses to correct it, put your complaint in writing and send it to the firm’s compliance officer. Serious complaints should always be made in writing. Remember, too, that if you rely on your investment professional for advice, he or she has an obligation to recommend investments that match your investment goals and tolerance for risk. Your investment professional should not be recommending trades simply to generate commissions. That’s called “churning,” and it’s illegal. How Can I Avoid Problems? Choosing someone to help you with your investments is one of the most important investment decisions you will ever make. While most investment professionals are honest and hardworking, you must watch out for those few unscrupulous individuals. They can make your life’s savings disappear in an instant. Securities regulators and law enforcement officials can and do catch these criminals. But putting them in jail doesn’t always get your money back. Too often, the money is gone. The good news is you can avoid potential problems by protecting yourself. Let’s say you’ve already met with several investment professionals based on recommendations from friends and others you trust, and you’ve found someone who clearly understands your investment objectives. Before you hire this person, you still have more homework. Make sure the investment professional and her firm are registered with the SEC and licensed to do business in your state. And find out from your state’s securities regulator whether the investment professional or her firm have ever been disciplined, or whether they have any complaints against them. You’ll find contact information for securities regulators in the U.S. by visiting the website of the North American Securities Administrators Association (NASAA) at www.nasaa.org or by calling (202) 737-0900. You should also find out as much as you can about any investments that your investment professional recommends. First, make sure the investments are registered. Keep in mind, however, the mere fact that a company has registered and files reports with the SEC doesn’t guarantee that the company will be a good investment. Likewise, the fact that a company hasn’t registered and doesn’t file reports with the SEC doesn’t mean the company is a fraud. Still, you may be asking for serious losses if, for instance, you invest in a small, thinly traded company that isn’t widely known solely on the basis of what you may have read online. One simple phone call to your state regulator could prevent you from squandering your money on a scam. Be wary of promises of quick profits, offers to share “inside information,” and pressure to invest before you have an opportunity to investigate. These are all warning signs of fraud. Ask your investment professional for written materials and prospectuses, and read them before you invest. If you have questions, now is the time to ask.• How will the investment make money? • How is this investment consistent with my investment goals? • What must happen for the investment to increase in value? • What are the risks? • Where can I get more information? Finally, it’s always a good idea to write down everything your investment professional tells you. Accurate notes will come in handy if ever there’s a problem. Some investments make money. Others lose money. That’s natural, and that’s why you need a diversified portfolio to minimize your risk. But if you lose money because you’ve been cheated, that’s not natural, that’s a problem. Sometimes all it takes is a simple phone call to your investment professional to resolve a problem. Maybe there was an honest mistake that can be corrected. If talking to the investment professional doesn’t resolve the problem, talk to the firm’s manager, and write a letter to confirm your conversation. If that doesn’t lead to a resolution, you may have to initiate private legal action. You may need to take action quickly because legal time limits for doing so vary. Your local bar association can provide referrals for attorneys who specialize in securities law. At the same time, call or write to us and let us know what the problem was. Investor complaints are very important to the SEC. You may think you’re the only one experiencing a problem, but typically, you’re not alone. Sometimes it takes only one investor’s complaint to trigger an investigation that exposes a bad broker or an illegal scheme. Complaints can be filed online with us by going to www.sec.gov/complaint.shtml.",Financial,Find & Summarize,Text Transformation "Instructions: * Respond using only the information contained in the prompt or context * Use bullet points when the answer has more than one item or explanation.",What is the difference between the medicinal treatments for gouty arthritis and pseudogout?,"GOUT A. GOALS 1. Understand pathogenesis of gouty arthritis 2. Learn pharmacologic treatment for gout B. CASE • 55-year-old man with history of episodic pain and swelling in the 1st MTP joints • Started allopurinol one week earlier • Physical examination showed rock-hard lump on right pina and hot, tender purplish-blue swelling in the knee and the left midfoot. • Serum uric acid concentration 7.8 mg/dl • Synovial fluid aspirate contained intracellular needle-shaped crystals with strong negative birefringence THE FOUR PHASES OF GOUT 1. Asymptomatic hyperuricemia Serum urate is typically raised (>7 mg/dl for men and >6 mg/dl for women) for 20 years before the first attack of gouty arthritis or urolithiasis 2. Acute gouty arthritis The first attach usually occurs between the 4th and 6th decades. Onset before the age of 30 years raises the question of an unusual form of gout, perhaps related to an enzymatic defect that causes purine overproduction. Precipitating factors are antihyperuricemic therapy (probenecid, allopurinol), diuretics, IV heparin, cyclosporine, trauma, surgery, alcohol (beer), chronic lead poisoning, dietary excess, hemorrhage, foreign protein therapy, and infections. Medical conditions associated with gout are obesity, diabetes mellitus, hypertriglyceridemia, hypertension, atherosclerosis, syndrome X (resistance to insulin-stimulated glucose uptake, hyperinsulinemia, hypertension, and dyslipoproteinemia with high levels of plasma triglycerides and high-density lipoprotein cholesterol). Usually a single joint is affected, and the first metatarsophalangeal joint is the most commonly affected site. The attack begins suddenly and is common at night. Involvement is usually in the lower extremities. The involved joint becomes dusky, red, and swollen. Pain is intense and “the night is passed in torture”. The pathogenesis of acute gouty arthritis is centered about the monosodium urate crystal, which is always present. Of interest, hyperuricemia is often present but is not necessary for the reaction to occur. Urate crystals, which were likely deposited in synovium, are thought to “flake off” and initiate an intense inflammatory response. The crystals become heavily coated with IgG and iron, both of which increase their inflammatory potential. Leukocytes are necessary for the reaction; almost all of the crystals in an affected joint have been ingested at the height of the reaction. The release of lysosomal mediators and the release of superoxide anion contribute to the local inflammation. Many serum factors mediate the inflammatory response, including complement, fibronectin, IgG, and a number of cytokines among which is transforming growth factor-beta. Leukocytosis, fever, and high erythrocyte sedimentation rate may accompany the acute attack. Radiographs are normal in the acute phase. 3. Intercritical gout. Most patients will have a second attack 6 – 24 months after the first attack. The period between attacks is known as the intercritical period. Joints appear normal during this time. 4. Chronic tophaceous gout. Eventually, patients may enter a phase of chronic polyarticular gout without painfree periods. This may occur 3-42 years after the first attack; the average period is about 12 years. Tophi are a manifestation of the inability to eliminate urate as rapidly as it is produced. Urate deposits appear in the cartilage, synovium, tendons, and soft tissues. A favored location is extensor surfaces and pressure points, and the lesions may resemble rheumatoid nodules. In untreated disease, massive destruction of joints may occur. Tophi have been reported to resolve over periods of years in patients who receive probenecid or allopurinol. E. PRINCIPLES OF THERAPY 1. Asymptomatic hyperuricemia First, consider the multiple causes of secondary hyperuricemia: consider drugs, renal insufficiency, myeloproliferative and lymphoproliferative diseases, hemolytic anemia, anemias associate with ineffective erythropoiesis, psoriasis, Paget’s disease of bone, and enzyme defects (see below). Treatment is not recommended for asymptomatic hyperuricemia. Exceptions to this rule are enzyme defects that lead to lifelong hyperuricemia. Exceptions to this rule are enzyme defects that lead to lifelong hyperuricemia (examples: deficiency of hypoxanthine-guanine phosphoribosyltransferase in the Lesch-Nyhan syndrome, partial deficiency of HGPRT, superactivity of 5-phosphoribosyl – 1- pyrophosphate) and the hyperuricemia associated with tumor chemotherapy. 2. Acute gouty arthritis Principles of treating acute gout include use of nonsteroidal antiinflammatory drugs, colchicines, and corticosteroids. Do not attempt to reduce plasma urate concentrations in the patient who is experiencing an acute attack. 1. NONSTEROIDAL ANTI-INFLAMMATORY DRUGS Treatment of acute gouty arthritis is based upon the judicious use of nonsteroidal anti-inflammatory drugs (NSAIDS). Many of these agents are effective. Maximum-dose NSAID treatment is started at the first sign of an attack and the dose is lowed within a day or two and continued until the arthritis has resolved. NSAIDS are also effective in the well-established attack. Indocin (starting dose 50 mg po TID or QID) is often employed; the dose is tapered to 0 after about 1 week. Renal insufficiency is a contraindication to this therapy so is active peptic ulcer disease. Consider a history of bleeding from the upper gastrointestinal tract when deciding upon therapy for acute gout. Undesirable side effects of traditional NSAIDS: Gastric/esophageal irritation, exacerbations of peptic ulcers, anti-platelet effects, reversible hepatocellular toxicity, decreased creatinine clearance, skin rashes, aspirin-like reactions in the presence of the rhinitis, nasal polyposis, and asthma syndrome, and headaches and confusion in the elderly. Aspirin increases renal retention of uric acid in low doses, whereas high doses (3.5-5.0 gm/day) are uricosuric. It is avoided as an agent to treat an acute attack of gout. 2. COLCHICINE Colchicine can be used to treat acute gout, but should be limited to low oral doses or cautious intravenous use (the latter for the hospitalized patient only). Colchicine should be used in reduced doses or avoided altogether in the patient with renal insufficiency. Some clinicians will give a brief course of oral colchicines, 2-3 tablets a week, in geriatric patients or patients with renal insufficiency. No patient should receive the traditional high-dose treatment in which numerous tablets of colchicines are given by mouth. This therapy can cause very servere diarrhea and dehydration. Intravenous administration should be given according to strict guidelines: (1) Single IV doses should not exceed 1 to 2 mg and the total cumulative dose should not be > 4mg, (2) No additional colchicines should be prescribed for 7 days, (3) the dose of IV colchicines should be halved in those with creatinine clearance < 50 ml/min and in those > 65 years of age in whom the creatinine clearance is not known. Patients with renal insufficiency, especially those who are on dialysis, are at risk of developing colchicine neuromyopathy. This complication is characterized by elevated CPK and muscle weakness. Discontinuation of colchicine leads to improvement in the myopathy over several w3eeks. Associated neuropathy resolves more slowly. 3. CORTICOSTEROIDS Intraarticular corticosteroids are very useful in breaking attacks of acute gout and have special value when other treatments cannot be utilized. In some instances, ACTH injections or oral corticosteroids are required. F. LONGTERM PROPHYLACTIC TREATMENT a. PROPHLAXIS Prophylaxis of the acute attack can be achieved by administering daily low doses of colchicine (0.5 or 0.6 mg tablet by mouth, 1 or 2 times daily; or in the presence of renal insufficiency, one tablet 3 times per week). An alternate prophylactic drug is Indocin, 25 mg by mouth twice a day. ALWAYS USE PROPHYLAXIS WHEN STARTING DRUGS TO LOWER THE SERUM URIC ACID LEVEL. b. URICOSURIG THERAPY Uricosuric agents facilitate urate excretion by the kidney and increase urate clearance and the fractional excretion of filtered urate. Probenecid is the most commonly used drug in this class. It is started at a dose of 0.5 gm/.day, and the dose is increased gradually to 1 – 3 gm/day, given in 2-3 divided doses. Renal insufficiency and a history of nephrolithiasis are contraindications to uricosuric treatment. c. XANTHINE OXIDASE INHIBITION The xanthine oxidase inhibitor, allopurinol, is used long-term to lower serum uric acid. It is indicated in overproduction of urate (examples: 24 hour urine uric acid >0.8 gm while on a normal diet; enzyme defect that leads to lifelong overproduction such as deficiency of hypoxanthine-guanine phosphoribosyltransferase), Tophi, renal insufficiency, nephrolithiasis, or intolerance to uricosuric agents. Allopurinol can paradoxically initiate acute polyarticular gout. For this reason, it should never be used in the patient who is experiencing acute gouty arthritis. Remember to start prophylactic treatment and to continue it for at least 6 weeks when allopurinol is started. The dose of allopurinol should be adjusted according to the patient’s renal function. The nomogram for maintenance allopurinol, adapted from Am J Med 76:43, 1984, is: CCr 0, 100 mg every 3 days; CCr 10, 100 mg every 2 days; CCR 20, 100 mg/day; CCR 40, 150 mg/day; CCr 60, 200 mg/day CCr 80, 250 mg/day; CCr 100, 300 mg/day; CCr 120, 350 mg/day CCr 140, 400 mg/day The risk in using allopurinol in renal insufficiency is the allopurinol hypersensitivity syndrome. Use of diuretics is also a risk factor. The syndrome develops within 2 – 4 weeks of starting allopurinol and mortality is 20%. It is characterized by skin rash, fever hepatocellular injury, Leukocytosis, eosinophilia, and worsening renal function. Also, be aware that allopurinol causes potentiation of azathioprine, which as a purine analogue is metabolized by xanthine oxidase. The use of allopurinol requires a 50 to 75% reduction in the azathioprine dose. Careful monitoring of the leukocyte count is required; the margin between leucopenia and inadequate immunosuppression is narrow. II. PSEUDEOGOUT Pseudogout refers to articular disease associated with calcium pyrophosphate dehydrate crystals in synovial fluid or synovium. It is often associated with chondrocalcinosis, a radiographic finding in which calcium-containing crystals are visualized in fibrocartilage or articular cartilage. It is discussed here because some clinical features resemble gout. Differentiation from grout is important; the Pseudogout patient should not receive allopurinol. Pseudogout can occur as a hereditary disease, as a sporadic disease, or as a condition that is associated with metabolic diseases or trauma. The hereditary disease usually shows an autosomal dominant pattern of inheritance. Pseudogout is clearly associated with OLD AGE, and associations with hyperparathyroidism, hemochromatosis, hypothyroidism, amyloidosis, hypomagnesemia, and hypophosphatasia have been reported. The manifestations of Pseudogout are: 1. Acute inflammation in one or more joints lasting for several days to 2 weeks. Joints commonly involved are: knees (50%), wrists, and shoulders. As with gout, the attacks can occur spontaneously or be provoked by trauma, surgery or severe illness. 2. About one half of these patients have progressive degeneration of numerous joints, and acute flares of arthritis may be superimposed on the degenerative problem. 3. About 50% of patients have pseudo-rheumatoid presentation with multiple joint involvement. Rheumatoid factor is present in 10% of these patients, leading to confusion with rheumatoid arthritis. ","GOUT A. GOALS 1. Understand pathogenesis of gouty arthritis 2. Learn pharmacologic treatment for gout B. CASE • 55-year-old man with history of episodic pain and swelling in the 1st MTP joints • Started allopurinol one week earlier • Physical examination showed rock-hard lump on right pina and hot, tender purplish-blue swelling in the knee and the left midfoot. • Serum uric acid concentration 7.8 mg/dl • Synovial fluid aspirate contained intracellular needle-shaped crystals with strong negative birefringence THE FOUR PHASES OF GOUT 1. Asymptomatic hyperuricemia Serum urate is typically raised (>7 mg/dl for men and >6 mg/dl for women) for 20 years before the first attack of gouty arthritis or urolithiasis 2. Acute gouty arthritis The first attach usually occurs between the 4th and 6th decades. Onset before the age of 30 years raises the question of an unusual form of gout, perhaps related to an enzymatic defect that causes purine overproduction. Precipitating factors are antihyperuricemic therapy (probenecid, allopurinol), diuretics, IV heparin, cyclosporine, trauma, surgery, alcohol (beer), chronic lead poisoning, dietary excess, hemorrhage, foreign protein therapy, and infections. Medical conditions associated with gout are obesity, diabetes mellitus, hypertriglyceridemia, hypertension, atherosclerosis, syndrome X (resistance to insulin-stimulated glucose uptake, hyperinsulinemia, hypertension, and dyslipoproteinemia with high levels of plasma triglycerides and high-density lipoprotein cholesterol). Usually a single joint is affected, and the first metatarsophalangeal joint is the most commonly affected site. The attack begins suddenly and is common at night. Involvement is usually in the lower extremities. The involved joint becomes dusky, red, and swollen. Pain is intense and “the night is passed in torture”. The pathogenesis of acute gouty arthritis is centered about the monosodium urate crystal, which is always present. Of interest, hyperuricemia is often present but is not necessary for the reaction to occur. Urate crystals, which were likely deposited in synovium, are thought to “flake off” and initiate an intense inflammatory response. The crystals become heavily coated with IgG and iron, both of which increase their inflammatory potential. Leukocytes are necessary for the reaction; almost all of the crystals in an affected joint have been ingested at the height of the reaction. The release of lysosomal mediators and the release of superoxide anion contribute to the local inflammation. Many serum factors mediate the inflammatory response, including complement, fibronectin, IgG, and a number of cytokines among which is transforming growth factor-beta. Leukocytosis, fever, and high erythrocyte sedimentation rate may accompany the acute attack. Radiographs are normal in the acute phase. 3. Intercritical gout. Most patients will have a second attack 6 – 24 months after the first attack. The period between attacks is known as the intercritical period. Joints appear normal during this time. 4. Chronic tophaceous gout. Eventually, patients may enter a phase of chronic polyarticular gout without painfree periods. This may occur 3-42 years after the first attack; the average period is about 12 years. Tophi are a manifestation of the inability to eliminate urate as rapidly as it is produced. Urate deposits appear in the cartilage, synovium, tendons, and soft tissues. A favored location is extensor surfaces and pressure points, and the lesions may resemble rheumatoid nodules. In untreated disease, massive destruction of joints may occur. Tophi have been reported to resolve over periods of years in patients who receive probenecid or allopurinol. E. PRINCIPLES OF THERAPY 1. Asymptomatic hyperuricemia First, consider the multiple causes of secondary hyperuricemia: consider drugs, renal insufficiency, myeloproliferative and lymphoproliferative diseases, hemolytic anemia, anemias associate with ineffective erythropoiesis, psoriasis, Paget’s disease of bone, and enzyme defects (see below). Treatment is not recommended for asymptomatic hyperuricemia. Exceptions to this rule are enzyme defects that lead to lifelong hyperuricemia. Exceptions to this rule are enzyme defects that lead to lifelong hyperuricemia (examples: deficiency of hypoxanthine-guanine phosphoribosyltransferase in the Lesch-Nyhan syndrome, partial deficiency of HGPRT, superactivity of 5-phosphoribosyl – 1- pyrophosphate) and the hyperuricemia associated with tumor chemotherapy. 2. Acute gouty arthritis Principles of treating acute gout include use of nonsteroidal antiinflammatory drugs, colchicines, and corticosteroids. Do not attempt to reduce plasma urate concentrations in the patient who is experiencing an acute attack. 1. NONSTEROIDAL ANTI-INFLAMMATORY DRUGS Treatment of acute gouty arthritis is based upon the judicious use of nonsteroidal anti-inflammatory drugs (NSAIDS). Many of these agents are effective. Maximum-dose NSAID treatment is started at the first sign of an attack and the dose is lowed within a day or two and continued until the arthritis has resolved. NSAIDS are also effective in the well-established attack. Indocin (starting dose 50 mg po TID or QID) is often employed; the dose is tapered to 0 after about 1 week. Renal insufficiency is a contraindication to this therapy so is active peptic ulcer disease. Consider a history of bleeding from the upper gastrointestinal tract when deciding upon therapy for acute gout. Undesirable side effects of traditional NSAIDS: Gastric/esophageal irritation, exacerbations of peptic ulcers, anti-platelet effects, reversible hepatocellular toxicity, decreased creatinine clearance, skin rashes, aspirin-like reactions in the presence of the rhinitis, nasal polyposis, and asthma syndrome, and headaches and confusion in the elderly. Aspirin increases renal retention of uric acid in low doses, whereas high doses (3.5-5.0 gm/day) are uricosuric. It is avoided as an agent to treat an acute attack of gout. 2. COLCHICINE Colchicine can be used to treat acute gout, but should be limited to low oral doses or cautious intravenous use (the latter for the hospitalized patient only). Colchicine should be used in reduced doses or avoided altogether in the patient with renal insufficiency. Some clinicians will give a brief course of oral colchicines, 2-3 tablets a week, in geriatric patients or patients with renal insufficiency. No patient should receive the traditional high-dose treatment in which numerous tablets of colchicines are given by mouth. This therapy can cause very servere diarrhea and dehydration. Intravenous administration should be given according to strict guidelines: (1) Single IV doses should not exceed 1 to 2 mg and the total cumulative dose should not be > 4mg, (2) No additional colchicines should be prescribed for 7 days, (3) the dose of IV colchicines should be halved in those with creatinine clearance < 50 ml/min and in those > 65 years of age in whom the creatinine clearance is not known. Patients with renal insufficiency, especially those who are on dialysis, are at risk of developing colchicine neuromyopathy. This complication is characterized by elevated CPK and muscle weakness. Discontinuation of colchicine leads to improvement in the myopathy over several w3eeks. Associated neuropathy resolves more slowly. 3. CORTICOSTEROIDS Intraarticular corticosteroids are very useful in breaking attacks of acute gout and have special value when other treatments cannot be utilized. In some instances, ACTH injections or oral corticosteroids are required. F. LONGTERM PROPHYLACTIC TREATMENT a. PROPHLAXIS Prophylaxis of the acute attack can be achieved by administering daily low doses of colchicine (0.5 or 0.6 mg tablet by mouth, 1 or 2 times daily; or in the presence of renal insufficiency, one tablet 3 times per week). An alternate prophylactic drug is Indocin, 25 mg by mouth twice a day. ALWAYS USE PROPHYLAXIS WHEN STARTING DRUGS TO LOWER THE SERUM URIC ACID LEVEL. b. URICOSURIG THERAPY Uricosuric agents facilitate urate excretion by the kidney and increase urate clearance and the fractional excretion of filtered urate. Probenecid is the most commonly used drug in this class. It is started at a dose of 0.5 gm/.day, and the dose is increased gradually to 1 – 3 gm/day, given in 2-3 divided doses. Renal insufficiency and a history of nephrolithiasis are contraindications to uricosuric treatment. c. XANTHINE OXIDASE INHIBITION The xanthine oxidase inhibitor, allopurinol, is used long-term to lower serum uric acid. It is indicated in overproduction of urate (examples: 24 hour urine uric acid >0.8 gm while on a normal diet; enzyme defect that leads to lifelong overproduction such as deficiency of hypoxanthine-guanine phosphoribosyltransferase), Tophi, renal insufficiency, nephrolithiasis, or intolerance to uricosuric agents. Allopurinol can paradoxically initiate acute polyarticular gout. For this reason, it should never be used in the patient who is experiencing acute gouty arthritis. Remember to start prophylactic treatment and to continue it for at least 6 weeks when allopurinol is started. The dose of allopurinol should be adjusted according to the patient’s renal function. The nomogram for maintenance allopurinol, adapted from Am J Med 76:43, 1984, is: CCr 0, 100 mg every 3 days; CCr 10, 100 mg every 2 days; CCR 20, 100 mg/day; CCR 40, 150 mg/day; CCr 60, 200 mg/day CCr 80, 250 mg/day; CCr 100, 300 mg/day; CCr 120, 350 mg/day CCr 140, 400 mg/day The risk in using allopurinol in renal insufficiency is the allopurinol hypersensitivity syndrome. Use of diuretics is also a risk factor. The syndrome develops within 2 – 4 weeks of starting allopurinol and mortality is 20%. It is characterized by skin rash, fever hepatocellular injury, Leukocytosis, eosinophilia, and worsening renal function. Also, be aware that allopurinol causes potentiation of azathioprine, which as a purine analogue is metabolized by xanthine oxidase. The use of allopurinol requires a 50 to 75% reduction in the azathioprine dose. Careful monitoring of the leukocyte count is required; the margin between leucopenia and inadequate immunosuppression is narrow. II. PSEUDEOGOUT Pseudogout refers to articular disease associated with calcium pyrophosphate dehydrate crystals in synovial fluid or synovium. It is often associated with chondrocalcinosis, a radiographic finding in which calcium-containing crystals are visualized in fibrocartilage or articular cartilage. It is discussed here because some clinical features resemble gout. Differentiation from grout is important; the Pseudogout patient should not receive allopurinol. Pseudogout can occur as a hereditary disease, as a sporadic disease, or as a condition that is associated with metabolic diseases or trauma. The hereditary disease usually shows an autosomal dominant pattern of inheritance. Pseudogout is clearly associated with OLD AGE, and associations with hyperparathyroidism, hemochromatosis, hypothyroidism, amyloidosis, hypomagnesemia, and hypophosphatasia have been reported. The manifestations of Pseudogout are: 1. Acute inflammation in one or more joints lasting for several days to 2 weeks. Joints commonly involved are: knees (50%), wrists, and shoulders. As with gout, the attacks can occur spontaneously or be provoked by trauma, surgery or severe illness. 2. About one half of these patients have progressive degeneration of numerous joints, and acute flares of arthritis may be superimposed on the degenerative problem. 3. About 50% of patients have pseudo-rheumatoid presentation with multiple joint involvement. Rheumatoid factor is present in 10% of these patients, leading to confusion with rheumatoid arthritis. Instructions: * Respond using only the information contained in the prompt or context * Use bullet points when the answer has more than one item or explanation. What is the difference between the medicinal treatments for gouty arthritis and pseudogout?",Medical,Concept Comparison,Q&A Answer the question based on the below text only. Do not use any external resources or previous knowledge. Give your answer as bullet points with a maximum of two sentences per bullet point.,"According to the document, summarize the comments by Avishai Abrahami.","Wix Reports Second Quarter 2024 Results Accelerated bookings growth, driven by key product initiatives, and FCF margin expansion in Q2 builds momentum for 2H ● Meaningful bookings growth acceleration with total bookings of $458.4 million, up 15% y/y, as a result of strong Wix Studio uptake, benefits from growing AI capabilities and commerce platform expansion as well as positive response to the price increase implemented earlier this year ○ Bookings growth accelerated across both Self Creators and Partners ○ Continue to expect bookings growth acceleration to 16% y/y in 2H at the high end of full year guidance range ● Total revenue of $435.7 million exceeded expectations, up 12% y/y, driven by strong Partners growth of 29% y/y ● Record take rate of 1.68%, driven by transaction revenue growth of 21% y/y as we added a new payment partner to Wix Payments ● Continued margin expansion with Q2 FCF 1 margin of 27%, driven by additional operating leverage ○ High end of increased full year FCF 1 outlook positions us to achieve the Rule of 40 milestone this year, one full year ahead of plan NEW YORK, August 7, 2024 -- Wix.com Ltd. (Nasdaq: WIX), the leading SaaS website builder platform globally, 2 today reported financial results for the second quarter of 2024. In addition, the Company provided its outlook for the third quarter and an updated outlook for full year 2024. Please visit the Wix Investor Relations website at https://investors.wix.com/ to view the Q2'24 Shareholder Update and other materials. “Excellent Q2 results capped off a strong first half of 2024, fueled by successful execution of our strategic initiatives, solid business fundamentals and continued product innovation,” said Avishai Abrahami, Wix Co-founder and CEO. “We made incredible strides towards our key growth pillars and drove significant bookings growth acceleration this quarter. First, Wix Studio continued to outperform expectations, as Studio subscription purchases accelerated, retention remained strong and the number of Studio accounts purchasing multiple subscriptions ramped. We also continued to execute against our AI strategy with the release of 17 AI business assistants so far this year. These assistants are improving the user creation experience while minimizing the amount of support resources required from us. With dozens more still slated to launch this year, AI assistants will soon be everywhere on our platform and in nearly every product. Finally, expansion of our commerce platform with the addition of a new Wix Payments partner resulted in record take rate of 1.68% in Q2. We expect these product initiatives to increasingly become more meaningful drivers of growth in the years to come.” “Strong execution of our key growth initiatives and solid business fundamentals drove incredible growth momentum and additional margin expansion this quarter,” added Lior Shemesh, CFO at Wix. “Year-over-year bookings growth accelerated to 15% in Q2 from 10% in Q1 as a result of our growth initiatives as well as the price increase implemented earlier this year. Notably, this growth was underpinned by bookings growth acceleration across both Self Creators and Partners businesses. These key product initiatives paired with solid user behavior are expected to drive continued bookings growth acceleration to 16% in 2H at the high end of our expectations. In addition, we delivered further margin expansion this quarter as our stable cost base drove operating leverage, resulting in Q2 FCF margin of 27%. With continued operating leverage expected for the full year, we are increasing our full year FCF outlook. We are now positioned to achieve the Rule of 40 milestone this year at the high end of our guidance range, one year ahead of our three-year plan.” Q2 2024 Financial Results ● Total revenue in the second quarter of 2024 was $435.7 million, up 12% y/y ○ Creative Subscriptions revenue in the second quarter of 2024 was $312.1 million, up 9% y/y ○ Creative Subscriptions ARR increased to $1.28 billion as of the end of the quarter, up 10% y/y ● Business Solutions revenue in the second quarter of 2024 was $123.6 million, up 20% y/y ○ Transaction revenue 3 was $53.9 million, up 21% y/y ● Partners revenue 4 in the second quarter of 2024 was $148.4 million, up 29% y/y ● Total bookings in the second quarter of 2024 were $458.4 million, up 15% y/y ○ Creative Subscriptions bookings in the second quarter of 2024 were $329.0 million, up 12% y/y ○ Business Solutions bookings in the second quarter of 2024 were $129.4 million, up 24% y/y ● Total gross margin on a GAAP basis in the second quarter of 2024 was 67% ○ Creative Subscriptions gross margin on a GAAP basis was 83% ○ Business Solutions gross margin on a GAAP basis was 28% ● Total non-GAAP gross margin in the second quarter of 2024 was 68% ○ Creative Subscriptions gross margin on a non-GAAP basis was 84% ○ Business Solutions gross margin on a non-GAAP basis was 30% ● GAAP net income in the second quarter of 2024 was $39.5 million, or $0.71 per basic share and $0.68 per diluted share ● Non-GAAP net income in the second quarter of 2024 was $99.6 million, or $1.80 per basic share and $1.67 per diluted share ● Net cash provided by operating activities for the second quarter of 2024 was $120.0 million, while capital expenditures totaled $7.2 million, leading to free cash flow of $112.8 million ● Excluding capital expenditures and other expenses associated with the build out of our new corporate headquarters, free cash flow for the second quarter of 2024 would have been $117.8 million, or 27% of revenue ● Completed $225 million of share repurchases, marking over $1 billion of share repurchases executed since 2021 ● Total employee count at the end of Q2’24 was 5,242, flat q/q ____________________ 1 Free cash flow excluding expenses associated with the buildout of our new corporate headquarters. 2 Based on the number of active live sites as reported by key competitors' figures, independent third-party-data and internal data as of Q1 2024. 3 Transaction revenue is a portion of Business Solutions revenue, and we define transaction revenue as all revenue generated through transaction facilitation, primarily from Wix Payments, as well as Wix POS, shipping solutions and multi-channel commerce and gift card solutions. 4 Partners revenue is defined as revenue generated through agencies and freelancers that build sites or applications for other users (“Agencies”) as well as revenue generated through B2B partnerships, such as LegalZoom or Vistaprint (“Resellers”). We identify Agencies using multiple criteria, including but not limited to, the number of sites built, participation in the Wix Partner Program and/or the Wix Marketplace or Wix products used (incl. Wix Studio). Partners revenue includes revenue from both the Creative Subscriptions and Business Solutions businesses. In Q1 2024, the definition was slightly revised to exclude revenue generated from agreements with enterprise users that, by their nature, are more suitable to be categorized under revenue generated by Self Creators. Such revision had an immaterial impact on prior period amounts. Financial Outlook Our guidance for the second half of the year reflects the momentum built up in the first six months, particularly from the strong traction of our key product initiatives and solid business fundamentals. We are updating our full year bookings outlook to $1,802 - $1,822 million, or 13-14% y/y growth, compared to previous guidance of $1,796 - $1,826 million, or 12-14% y/y growth. This outlook reflects the continued expectation that y/y bookings growth will accelerate to 16% in 2H at the high end of our guidance range, as a result of accelerating growth across both Self Creators and Partners. Acceleration is expected to be driven by continued Wix Studio outperformance, benefits from our AI products and our expanded commerce platform, as well as strong user uptake of the price increase implemented earlier this year. Bookings acceleration in 2024 is expected to translate into y/y revenue growth acceleration in 2025. We are also updating our full year revenue outlook to $1,747 - $1,761 million, or 12-13% y/y, compared to $1,738 - $1,761 million, or 11-13% y/y growth, previously. We expect total revenue growth in Q3’24 of $440 - $445 million, or 12-13% y/y growth.","Answer the question based on the below text only. Do not use any external resources or previous knowledge. Give your answer as bullet points with a maximum of two sentences per bullet point. According to the document, summarize the comments by Avishai Abrahami. Wix Reports Second Quarter 2024 Results Accelerated bookings growth, driven by key product initiatives, and FCF margin expansion in Q2 builds momentum for 2H ● Meaningful bookings growth acceleration with total bookings of $458.4 million, up 15% y/y, as a result of strong Wix Studio uptake, benefits from growing AI capabilities and commerce platform expansion as well as positive response to the price increase implemented earlier this year ○ Bookings growth accelerated across both Self Creators and Partners ○ Continue to expect bookings growth acceleration to 16% y/y in 2H at the high end of full year guidance range ● Total revenue of $435.7 million exceeded expectations, up 12% y/y, driven by strong Partners growth of 29% y/y ● Record take rate of 1.68%, driven by transaction revenue growth of 21% y/y as we added a new payment partner to Wix Payments ● Continued margin expansion with Q2 FCF 1 margin of 27%, driven by additional operating leverage ○ High end of increased full year FCF 1 outlook positions us to achieve the Rule of 40 milestone this year, one full year ahead of plan NEW YORK, August 7, 2024 -- Wix.com Ltd. (Nasdaq: WIX), the leading SaaS website builder platform globally, 2 today reported financial results for the second quarter of 2024. In addition, the Company provided its outlook for the third quarter and an updated outlook for full year 2024. Please visit the Wix Investor Relations website at https://investors.wix.com/ to view the Q2'24 Shareholder Update and other materials. “Excellent Q2 results capped off a strong first half of 2024, fueled by successful execution of our strategic initiatives, solid business fundamentals and continued product innovation,” said Avishai Abrahami, Wix Co-founder and CEO. “We made incredible strides towards our key growth pillars and drove significant bookings growth acceleration this quarter. First, Wix Studio continued to outperform expectations, as Studio subscription purchases accelerated, retention remained strong and the number of Studio accounts purchasing multiple subscriptions ramped. We also continued to execute against our AI strategy with the release of 17 AI business assistants so far this year. These assistants are improving the user creation experience while minimizing the amount of support resources required from us. With dozens more still slated to launch this year, AI assistants will soon be everywhere on our platform and in nearly every product. Finally, expansion of our commerce platform with the addition of a new Wix Payments partner resulted in record take rate of 1.68% in Q2. We expect these product initiatives to increasingly become more meaningful drivers of growth in the years to come.” “Strong execution of our key growth initiatives and solid business fundamentals drove incredible growth momentum and additional margin expansion this quarter,” added Lior Shemesh, CFO at Wix. “Year-over-year bookings growth accelerated to 15% in Q2 from 10% in Q1 as a result of our growth initiatives as well as the price increase implemented earlier this year. Notably, this growth was underpinned by bookings growth acceleration across both Self Creators and Partners businesses. These key product initiatives paired with solid user behavior are expected to drive continued bookings growth acceleration to 16% in 2H at the high end of our expectations. In addition, we delivered further margin expansion this quarter as our stable cost base drove operating leverage, resulting in Q2 FCF margin of 27%. With continued operating leverage expected for the full year, we are increasing our full year FCF outlook. We are now positioned to achieve the Rule of 40 milestone this year at the high end of our guidance range, one year ahead of our three-year plan.” Q2 2024 Financial Results ● Total revenue in the second quarter of 2024 was $435.7 million, up 12% y/y ○ Creative Subscriptions revenue in the second quarter of 2024 was $312.1 million, up 9% y/y ○ Creative Subscriptions ARR increased to $1.28 billion as of the end of the quarter, up 10% y/y ● Business Solutions revenue in the second quarter of 2024 was $123.6 million, up 20% y/y ○ Transaction revenue 3 was $53.9 million, up 21% y/y ● Partners revenue 4 in the second quarter of 2024 was $148.4 million, up 29% y/y ● Total bookings in the second quarter of 2024 were $458.4 million, up 15% y/y ○ Creative Subscriptions bookings in the second quarter of 2024 were $329.0 million, up 12% y/y ○ Business Solutions bookings in the second quarter of 2024 were $129.4 million, up 24% y/y ● Total gross margin on a GAAP basis in the second quarter of 2024 was 67% ○ Creative Subscriptions gross margin on a GAAP basis was 83% ○ Business Solutions gross margin on a GAAP basis was 28% ● Total non-GAAP gross margin in the second quarter of 2024 was 68% ○ Creative Subscriptions gross margin on a non-GAAP basis was 84% ○ Business Solutions gross margin on a non-GAAP basis was 30% ● GAAP net income in the second quarter of 2024 was $39.5 million, or $0.71 per basic share and $0.68 per diluted share ● Non-GAAP net income in the second quarter of 2024 was $99.6 million, or $1.80 per basic share and $1.67 per diluted share ● Net cash provided by operating activities for the second quarter of 2024 was $120.0 million, while capital expenditures totaled $7.2 million, leading to free cash flow of $112.8 million ● Excluding capital expenditures and other expenses associated with the build out of our new corporate headquarters, free cash flow for the second quarter of 2024 would have been $117.8 million, or 27% of revenue ● Completed $225 million of share repurchases, marking over $1 billion of share repurchases executed since 2021 ● Total employee count at the end of Q2’24 was 5,242, flat q/q ____________________ 1 Free cash flow excluding expenses associated with the buildout of our new corporate headquarters. 2 Based on the number of active live sites as reported by key competitors' figures, independent third-party-data and internal data as of Q1 2024. 3 Transaction revenue is a portion of Business Solutions revenue, and we define transaction revenue as all revenue generated through transaction facilitation, primarily from Wix Payments, as well as Wix POS, shipping solutions and multi-channel commerce and gift card solutions. 4 Partners revenue is defined as revenue generated through agencies and freelancers that build sites or applications for other users (“Agencies”) as well as revenue generated through B2B partnerships, such as LegalZoom or Vistaprint (“Resellers”). We identify Agencies using multiple criteria, including but not limited to, the number of sites built, participation in the Wix Partner Program and/or the Wix Marketplace or Wix products used (incl. Wix Studio). Partners revenue includes revenue from both the Creative Subscriptions and Business Solutions businesses. In Q1 2024, the definition was slightly revised to exclude revenue generated from agreements with enterprise users that, by their nature, are more suitable to be categorized under revenue generated by Self Creators. Such revision had an immaterial impact on prior period amounts. Financial Outlook Our guidance for the second half of the year reflects the momentum built up in the first six months, particularly from the strong traction of our key product initiatives and solid business fundamentals. We are updating our full year bookings outlook to $1,802 - $1,822 million, or 13-14% y/y growth, compared to previous guidance of $1,796 - $1,826 million, or 12-14% y/y growth. This outlook reflects the continued expectation that y/y bookings growth will accelerate to 16% in 2H at the high end of our guidance range, as a result of accelerating growth across both Self Creators and Partners. Acceleration is expected to be driven by continued Wix Studio outperformance, benefits from our AI products and our expanded commerce platform, as well as strong user uptake of the price increase implemented earlier this year. Bookings acceleration in 2024 is expected to translate into y/y revenue growth acceleration in 2025. We are also updating our full year revenue outlook to $1,747 - $1,761 million, or 12-13% y/y, compared to $1,738 - $1,761 million, or 11-13% y/y growth, previously. We expect total revenue growth in Q3’24 of $440 - $445 million, or 12-13% y/y growth.",Financial,Find & Summarize,Text Transformation Answer only based on information from the below text. Use a bulleted list.,Find and summarize each instance where the text talks about convenience. Please make it highly detailed.,"Smart trams have successfully addressed the problem.The main objective of this initiative is to reduce the length of time that customers have to wait before they can pay their bills [1]. The pricing and billing for the items in the cart are automated. This application comprises an Arduino Uno, an LCD display, a buzzer, RFID tags, and an RFID reader. The Arduino development board used in this system has fully accessible input/output pins to enable communication with the reader. The trolley is outfitted with an RFID reader, and each product is linked to an RFID tag [2]. Once the products have been placed in the shopping cart, the RFID reader quickly deciphers the tags. The relevant information, such as the product's name, price, and quantity, is then shown on the LCD screen. The user will receive a prompt to scan the product using an automated alert system equipped with a buzzer. As a result, a bill is produced immediately on the cart. The eradication of human error is a direct result of the full automation of the process. Every day, a substantial amount of people are attracted to shopping malls in order to participate in shopping, self-improvement, and entertainment [3]. With the increasing popularity of online shopping, traditional retail stores have faced challenges in maintaining their customer base. Shopping malls have been actively seeking innovative methods to offer a customized shopping experience in order to attract and retain customers. An effective approach involves employing intelligent individuals to monitor and oversee the movement of shopping carts. Autonomous shopping carts, which are engineered to replicate human locomotion, possess the capability to autonomously track customers, thereby obviating the necessity for them to manually propel the cart [4]. This technology provides shoppers with simplicity and convenience, enabling them to concentrate on their purchases while deriving pleasure from the experience. While a customer is making purchases, their location is monitored by an intelligent trolley that integrates numerous sensors and cameras. The utilization of intelligent shopping carts that monitor human movements provides the benefit of augmenting a customised shopping experience. Patrons are able ABSTRACT Time is an expensive resource in our fast-paced society, and people frequently lose a good deal of it waiting at supermarket and shopping mall checkout counters. An automated intelligent shopping cart has been designed for supermarkets to solve the shortcomings of the current billing systems. This trolley reduces the amount of time customers spend at the checkout counter, improving convenience and saving time, by scanning products using the Atmega 328 controller and RFID tags. Customers can better their shopping experience by monitoring the amount of items and the overall cost thanks to the digital document shown on an LCD. With electronic bills sent via email and thorough purchase information available through the shop's website, the intelligent cart manages shopping and payment procedures, allowing customers to buy things and leave the store fast. In order to manage product and customer information, this system needs an Arduino board, an RFID reader, an RFID tag, an LCD display, a database manager, and a website. Leveraging the Internet of Things (IoT) for smooth connection with the worldwide network, the administrator can access this information anywhere. Keywords: Arduino UNO; Ultrasonic sensor; IR sensor; DC motors; RFID reader; LCD display; Atmega328 controller; Motor drivers. Irish Interdisciplinary Journal of Science & Research (IIJSR) Volume 8, Issue 2, Pages 113-122, April-June 2024 ISSN: 2582-3981 [114] to effortlessly traverse the establishment, circumventing the necessity to push their shopping cart or be concerned with its misplacement. By effortlessly concentrating on the products they are interested in purchasing, they are able to dedicate more time to perusing [5]. Customers with limited mobility or disabilities get an added level of assistance from intelligent shopping carts that track and follow them. These customers may find it difficult to propel a shopping cart. Nevertheless, the intelligent trolley presents a viable resolution that holds the capacity to augment the ease and pleasure derived from the act of shopping [6]. In addition, the integration of intelligent shopping carts—which possess the capability to independently navigate and accompany customers—substantially augments the shopping experience in terms of convenience and effectiveness. Consumers are able to effortlessly locate the desired products, incorporate them into their shopping carts, and proceed to the subsequent item without the necessity of monitoring their carts. As a result, patrons are able to enhance their shopping experience through time conservation and a reduction in the customary anxiety linked to the procedure [7]. By maintaining a linear trajectory, the robot is capable of traversing the lane of shopping racks with ease. An ultrasonic sensor is additionally affixed to the front of the robotic vehicle. The sensor is utilized to determine the user's proximity to the robot [8]. The customer is monitored by the robot from a predetermined distance as they navigate the shopping lane. The system therefore recommends a sophisticated shopping cart for contemporary shopping malls. A smart shopping cart that makes use of Internet of Things (IoT) technology is the proposed concept [9]. A versatile application and Radio Frequency Identification (RFID) sensors are integrated into it. Additionally, an Arduino microcontroller is also present. RFID sensors operate via wireless transmission. The process consists of two essential elements: an RFID tag affixed to every item and a user-specific RFID reader that efficiently scans the item data. The corresponding data for each item is then displayed within the mobile application. The client effectively oversees the shopping list using the adaptable application in accordance with their personal preferences. The shopping information is subsequently transmitted remotely to the employee, who generates the charges. The primary aim of this testing framework is to eliminate arduous shopping processes and technical administration complications. Subsequently, the proposed framework may be readily deployable and verifiable in an extensive operational setting [10]. This clarifies the rationale behind the proposed model's higher level of stringency in comparison to alternative methodologies. The integration of state-of-the-art technologies into a smart shopping cart is intended to revolutionize the traditional shopping experience in multiple ways. It optimizes operational effectiveness through the provision of user-friendly functionalities that streamline the process of item retrieval and diminish the duration of shopping [11]. Digital shopping lists, automated item scanning, and user-friendly payment methods substantially enhance convenience. By encouraging the use of reusable bags, reducing plastic waste, and informing customers about sustainable products, the cart promotes sustainability. By providing customers with real-time pricing comparisons, discounts, and promotions, cost-effectiveness is achieved and they are able to make more informed decisions. The shopping cart incorporates accessibility features that accommodate a diverse array of customers, including individuals with disabilities. Customer access to recipes, nutritional information, and personalized recommendations, while retailers gain insights into consumer behavior, purchasing patterns, and inventory management that are driven by data. Irish Interdisciplinary Journal of Science & Research (IIJSR) Volume 8, Issue 2, Pages 113-122, April-June 2024 ISSN: 2582-3981 [115] Ensuring safety through the implementation of secure locking mechanisms, RFID technology for item tracking, and hazard alarms, seamless connectivity with mobile devices is provided. Constant advancements in functionality and design ensure that the shopping cart remains at the forefront of market trends, with the ultimate goal of improving the customer experience by providing a seamless, enjoyable, and expedient journey that cultivates loyalty towards the retailer.","Find and summarize each instance where the text talks about convenience. Please make it highly detailed. Answer only based on information from the below text. Use a bulleted list. Smart trams have successfully addressed the problem.The main objective of this initiative is to reduce the length of time that customers have to wait before they can pay their bills [1]. The pricing and billing for the items in the cart are automated. This application comprises an Arduino Uno, an LCD display, a buzzer, RFID tags, and an RFID reader. The Arduino development board used in this system has fully accessible input/output pins to enable communication with the reader. The trolley is outfitted with an RFID reader, and each product is linked to an RFID tag [2]. Once the products have been placed in the shopping cart, the RFID reader quickly deciphers the tags. The relevant information, such as the product's name, price, and quantity, is then shown on the LCD screen. The user will receive a prompt to scan the product using an automated alert system equipped with a buzzer. As a result, a bill is produced immediately on the cart. The eradication of human error is a direct result of the full automation of the process. Every day, a substantial amount of people are attracted to shopping malls in order to participate in shopping, self-improvement, and entertainment [3]. With the increasing popularity of online shopping, traditional retail stores have faced challenges in maintaining their customer base. Shopping malls have been actively seeking innovative methods to offer a customized shopping experience in order to attract and retain customers. An effective approach involves employing intelligent individuals to monitor and oversee the movement of shopping carts. Autonomous shopping carts, which are engineered to replicate human locomotion, possess the capability to autonomously track customers, thereby obviating the necessity for them to manually propel the cart [4]. This technology provides shoppers with simplicity and convenience, enabling them to concentrate on their purchases while deriving pleasure from the experience. While a customer is making purchases, their location is monitored by an intelligent trolley that integrates numerous sensors and cameras. The utilization of intelligent shopping carts that monitor human movements provides the benefit of augmenting a customised shopping experience. Patrons are able ABSTRACT Time is an expensive resource in our fast-paced society, and people frequently lose a good deal of it waiting at supermarket and shopping mall checkout counters. An automated intelligent shopping cart has been designed for supermarkets to solve the shortcomings of the current billing systems. This trolley reduces the amount of time customers spend at the checkout counter, improving convenience and saving time, by scanning products using the Atmega 328 controller and RFID tags. Customers can better their shopping experience by monitoring the amount of items and the overall cost thanks to the digital document shown on an LCD. With electronic bills sent via email and thorough purchase information available through the shop's website, the intelligent cart manages shopping and payment procedures, allowing customers to buy things and leave the store fast. In order to manage product and customer information, this system needs an Arduino board, an RFID reader, an RFID tag, an LCD display, a database manager, and a website. Leveraging the Internet of Things (IoT) for smooth connection with the worldwide network, the administrator can access this information anywhere. Keywords: Arduino UNO; Ultrasonic sensor; IR sensor; DC motors; RFID reader; LCD display; Atmega328 controller; Motor drivers. Irish Interdisciplinary Journal of Science & Research (IIJSR) Volume 8, Issue 2, Pages 113-122, April-June 2024 ISSN: 2582-3981 [114] to effortlessly traverse the establishment, circumventing the necessity to push their shopping cart or be concerned with its misplacement. By effortlessly concentrating on the products they are interested in purchasing, they are able to dedicate more time to perusing [5]. Customers with limited mobility or disabilities get an added level of assistance from intelligent shopping carts that track and follow them. These customers may find it difficult to propel a shopping cart. Nevertheless, the intelligent trolley presents a viable resolution that holds the capacity to augment the ease and pleasure derived from the act of shopping [6]. In addition, the integration of intelligent shopping carts—which possess the capability to independently navigate and accompany customers—substantially augments the shopping experience in terms of convenience and effectiveness. Consumers are able to effortlessly locate the desired products, incorporate them into their shopping carts, and proceed to the subsequent item without the necessity of monitoring their carts. As a result, patrons are able to enhance their shopping experience through time conservation and a reduction in the customary anxiety linked to the procedure [7]. By maintaining a linear trajectory, the robot is capable of traversing the lane of shopping racks with ease. An ultrasonic sensor is additionally affixed to the front of the robotic vehicle. The sensor is utilized to determine the user's proximity to the robot [8]. The customer is monitored by the robot from a predetermined distance as they navigate the shopping lane. The system therefore recommends a sophisticated shopping cart for contemporary shopping malls. A smart shopping cart that makes use of Internet of Things (IoT) technology is the proposed concept [9]. A versatile application and Radio Frequency Identification (RFID) sensors are integrated into it. Additionally, an Arduino microcontroller is also present. RFID sensors operate via wireless transmission. The process consists of two essential elements: an RFID tag affixed to every item and a user-specific RFID reader that efficiently scans the item data. The corresponding data for each item is then displayed within the mobile application. The client effectively oversees the shopping list using the adaptable application in accordance with their personal preferences. The shopping information is subsequently transmitted remotely to the employee, who generates the charges. The primary aim of this testing framework is to eliminate arduous shopping processes and technical administration complications. Subsequently, the proposed framework may be readily deployable and verifiable in an extensive operational setting [10]. This clarifies the rationale behind the proposed model's higher level of stringency in comparison to alternative methodologies. The integration of state-of-the-art technologies into a smart shopping cart is intended to revolutionize the traditional shopping experience in multiple ways. It optimizes operational effectiveness through the provision of user-friendly functionalities that streamline the process of item retrieval and diminish the duration of shopping [11]. Digital shopping lists, automated item scanning, and user-friendly payment methods substantially enhance convenience. By encouraging the use of reusable bags, reducing plastic waste, and informing customers about sustainable products, the cart promotes sustainability. By providing customers with real-time pricing comparisons, discounts, and promotions, cost-effectiveness is achieved and they are able to make more informed decisions. The shopping cart incorporates accessibility features that accommodate a diverse array of customers, including individuals with disabilities. Customer access to recipes, nutritional information, and personalized recommendations, while retailers gain insights into consumer behavior, purchasing patterns, and inventory management that are driven by data. Irish Interdisciplinary Journal of Science & Research (IIJSR) Volume 8, Issue 2, Pages 113-122, April-June 2024 ISSN: 2582-3981 [115] Ensuring safety through the implementation of secure locking mechanisms, RFID technology for item tracking, and hazard alarms, seamless connectivity with mobile devices is provided. Constant advancements in functionality and design ensure that the shopping cart remains at the forefront of market trends, with the ultimate goal of improving the customer experience by providing a seamless, enjoyable, and expedient journey that cultivates loyalty towards the retailer.",Internet/Technology,Find & Summarize,Text Transformation Only use the document provided. Limit the response to two sentences. Provide a piece of evidence from the text after your answer.,What do the three elements of the cycle of risk mitigation and and crisis management strategies entail?,"**Risk, Crisis and Resilience Services** Global Reach, Rapid Response and Local Expertise Your safety and security are our mission. We provide clear, targeted, flexible pre- and post-incident solutions built around that primary priority. Our expert team has operated in more than 80 countries and across multiple disciplines, including kidnap for ransom, extortion, detention and evacuation as well as security training, risk assessments and business continuity planning. Our team of specialist crisis and risk advisors are strategically located across North America, Europe, Africa, the Middle East and Asia. Constellis’ risk analysts monitor, research and advise on current and emerging threats. This enables us to deliver a global spread of expertise and vital rapid-response capabilities with outstanding local and regional knowledge, contacts and language capabilities. Managing Organizational Risk Organizations need to take risks in order to succeed. Managing that risk allows opportunities to be pursued while reducing the potential for negative impact. Our Risk, Crisis and Resilience services help corporate and governmental institutions, international organizations and small to medium sized businesses disrupt threats and eliminate vulnerabilities to effectively exercise control over the risks taken while enhancing organizational resilience. We work with our customers to employ a full cycle of risk mitigation and crisis management strategies: Avert We help reduce the likelihood of a serious incident. Improved threat and vulnerability awareness Anticipating dangers Comprehensive context & risk assessment Enhanced risk treatment measures Good risk intelligence Reliable travel tracking Effective personal safety & security training Prepare We ready you to protect your business and mitigate negative consequences in worst-case scenarios. Broad scenario development Extensive contingency & continuity planning Crisis management training Respond We ensure timely deployment of appropriate internal and external resources. Manage an incident Provide business continuity Bring the situation under control as quickly as possible Risk, Crisis and Resilience Services We incorporate all the current risk, crisis, business continuity and organizational resilience standards in our methodology including ISO 31000, 22301, 22316, BS 65000, CEN/TS 17091 as well as the principles of Enterprise Security Risk Management. Our bespoke approach is tailored to each customer’s unique needs and concerns. Our risk, crisis and resilience services incorporate the following: Personnel Risk Your people are your greatest asset and ensuring their safety and security is not only an essential part of being a good employer but also a necessary step in meeting your duty of care obligations. Our personnel risk services ensure that you are providing the right information and training for the people who work for you to help them look after themselves and make better decisions and also enable you to properly assist them when they encounter problems. These tailored services include: Personal security training (HEAT) Travel security briefings Travel safety & security planning Travel safety platform through our partner LifeLine Response: Global threat intel Location-based tracking Proactive travel security alerts 2-way mass notification Organizational Risk Organizations face numerous risks not only when operating in complex and fragile environments but also in those places where they least expect to encounter problems. We lead the way for our customers, helping them to develop policies, processes and procedures, allowing them to evaluate and manage risk and succeed in their business endeavors. Good risk management is about facilitating operations and managing risk to an acceptable level, not obstructing business activities. Our organizational risk advisory and management services provide the necessary support to ensure that you have the right system and management in place to meet your needs. These services include: Security risk briefings Threat monitoring Strategic risk assessments Organizational resilience reviews Security management planning Security management training Crisis Management When the worst happens, we deliver rapid, targeted and adaptable crisis management, communications and response solutions to enable our customers to overcome the challenges they face. Constellis’ crisis response consultants are well-versed in providing advice and support in the heat of a crisis as well as before a crisis strikes, helping you to be better prepared to deal with all the problems you may face when a critical incident threatens your business. We cover all kinds of crisis scenarios and have extensive experience in dealing with kidnapping, piracy, extortion and detention. We offer a turnkey solution that comprises training, planning, response and recovery services including: Crisis response for all scenarios Crisis management planning Crisis communications planning Business continuity planning Contingency planning (including evacuation) Crisis management training Crisis simulation exercises Crisis communications training Insight and Analysis Accurate, timely information is an essential component to any risk management program. At Constellis, our insight and analysis services integrate strategic understanding with local and empirical knowledge, enabling our customers to make effective decisions for existing operations and future investments. We draw on a large network of resources to deliver social, economic, political and security intelligence to our customers through bespoke reporting services including: Security Threat Assessments Geographical Risk Analysis & Reporting Kidnap for Ransom Analysis & Reporting Special Assignments"," ======= Only use the document provided. Limit the response to two sentences. Provide a piece of evidence from the text after your answer. ---------- ======= **Risk, Crisis and Resilience Services** Global Reach, Rapid Response and Local Expertise Your safety and security are our mission. We provide clear, targeted, flexible pre- and post-incident solutions built around that primary priority. Our expert team has operated in more than 80 countries and across multiple disciplines, including kidnap for ransom, extortion, detention and evacuation as well as security training, risk assessments and business continuity planning. Our team of specialist crisis and risk advisors are strategically located across North America, Europe, Africa, the Middle East and Asia. Constellis’ risk analysts monitor, research and advise on current and emerging threats. This enables us to deliver a global spread of expertise and vital rapid-response capabilities with outstanding local and regional knowledge, contacts and language capabilities. Managing Organizational Risk Organizations need to take risks in order to succeed. Managing that risk allows opportunities to be pursued while reducing the potential for negative impact. Our Risk, Crisis and Resilience services help corporate and governmental institutions, international organizations and small to medium sized businesses disrupt threats and eliminate vulnerabilities to effectively exercise control over the risks taken while enhancing organizational resilience. We work with our customers to employ a full cycle of risk mitigation and crisis management strategies: Avert We help reduce the likelihood of a serious incident. Improved threat and vulnerability awareness Anticipating dangers Comprehensive context & risk assessment Enhanced risk treatment measures Good risk intelligence Reliable travel tracking Effective personal safety & security training Prepare We ready you to protect your business and mitigate negative consequences in worst-case scenarios. Broad scenario development Extensive contingency & continuity planning Crisis management training Respond We ensure timely deployment of appropriate internal and external resources. Manage an incident Provide business continuity Bring the situation under control as quickly as possible Risk, Crisis and Resilience Services We incorporate all the current risk, crisis, business continuity and organizational resilience standards in our methodology including ISO 31000, 22301, 22316, BS 65000, CEN/TS 17091 as well as the principles of Enterprise Security Risk Management. Our bespoke approach is tailored to each customer’s unique needs and concerns. Our risk, crisis and resilience services incorporate the following: Personnel Risk Your people are your greatest asset and ensuring their safety and security is not only an essential part of being a good employer but also a necessary step in meeting your duty of care obligations. Our personnel risk services ensure that you are providing the right information and training for the people who work for you to help them look after themselves and make better decisions and also enable you to properly assist them when they encounter problems. These tailored services include: Personal security training (HEAT) Travel security briefings Travel safety & security planning Travel safety platform through our partner LifeLine Response: Global threat intel Location-based tracking Proactive travel security alerts 2-way mass notification Organizational Risk Organizations face numerous risks not only when operating in complex and fragile environments but also in those places where they least expect to encounter problems. We lead the way for our customers, helping them to develop policies, processes and procedures, allowing them to evaluate and manage risk and succeed in their business endeavors. Good risk management is about facilitating operations and managing risk to an acceptable level, not obstructing business activities. Our organizational risk advisory and management services provide the necessary support to ensure that you have the right system and management in place to meet your needs. These services include: Security risk briefings Threat monitoring Strategic risk assessments Organizational resilience reviews Security management planning Security management training Crisis Management When the worst happens, we deliver rapid, targeted and adaptable crisis management, communications and response solutions to enable our customers to overcome the challenges they face. Constellis’ crisis response consultants are well-versed in providing advice and support in the heat of a crisis as well as before a crisis strikes, helping you to be better prepared to deal with all the problems you may face when a critical incident threatens your business. We cover all kinds of crisis scenarios and have extensive experience in dealing with kidnapping, piracy, extortion and detention. We offer a turnkey solution that comprises training, planning, response and recovery services including: Crisis response for all scenarios Crisis management planning Crisis communications planning Business continuity planning Contingency planning (including evacuation) Crisis management training Crisis simulation exercises Crisis communications training Insight and Analysis Accurate, timely information is an essential component to any risk management program. At Constellis, our insight and analysis services integrate strategic understanding with local and empirical knowledge, enabling our customers to make effective decisions for existing operations and future investments. We draw on a large network of resources to deliver social, economic, political and security intelligence to our customers through bespoke reporting services including: Security Threat Assessments Geographical Risk Analysis & Reporting Kidnap for Ransom Analysis & Reporting Special Assignments ---------- ======= What do the three elements of the cycle of risk mitigation and and crisis management strategies entail?",Unknown,Find & Summarize,Text Transformation "For this task, answer questions exclusively from the knowledge you gain from the information within the prompt. Head each paragraph of your response with a bolded question pertaining to the information following it.",Summarize the key points of menu labeling into the form of paragraphs.,"Research Evaluating the Impact of Menu Labeling It is difficult to predict what effect, if any, mandatory restaurant menu labeling will have on food purchasing and health outcomes. However, changes in behavior following implementation of calorie labeling regulations in other jurisdictions prior to publication of the final federal rule (e.g., New York City, Philadelphia, and King County, WA) may provide some insight. Studies of the Impact of Menu Labeling on Calories Purchased Studies examining the relationship between menu labeling and calorie purchasing behavior have yielded mixed findings. Although consumers often report ordering fewer calories as a result of menu labeling, studies examining restaurant transaction data have not consistently reported a decrease in calories purchased after implementation of menu labeling. This section discusses several studies that have evaluated the impact of menu labeling, using survey and transaction data, on calories purchased. 17 Findings from current research are limited because existing studies often vary in scope and methodology. 18 For example, several of the studies that did not find a post-labeling decrease in calories purchased were conducted by the same group of researchers using samples from lowincome communities in New York, NY and Newark, NJ, 19 and research has shown that there are socioeconomic disparities in calorie label use, with higher-income individuals being more likely to notice calorie labels.20 Another study limited its sample population to one chain of restaurants in King County, WA. 21 An additional factor to consider is the time frame between implementation of menu labeling and an assessment of purchasing behavior, as there needs to be enough time for an effect to take place. One study, for instance, did not find an effect at four to six months postmandatory menu labeling, but it did find a decrease in calories purchased 18 months after implementation.22 Another study that did not find an effect of menu labeling on calories purchased examined outcomes two months after implementation, which may not have been enough time for an effect to take place.23 In addition, most of these studies relied on self-reported data to assess customers’ awareness and use of calorie labels. Such self-reporting may not be accurate, as evidenced by the inconsistencies between reported calories purchased and actual calories purchased as indicated on receipts.24 Finally, these studies analyzed the number of calories purchased but not changes in calories consumed, which may differ in response to menu labeling. For example, in full-service restaurants, customers may be more likely to share a meal or eat half the meal and take the rest home, which would not be captured by transaction data. Similarly, in fast food or carry-out establishments, customers may consume only a portion of their meal, which would not be captured by transaction data. Studies of the Impact of Menu Labeling on Sales and Revenue In 2009, Starbucks commissioned a Stanford University study to determine how the menu labeling mandate in New York City (NYC) affected its overall sales.25 Findings indicate that after the implementation of mandatory calorie labeling, average calories per transaction fell by 6% at Starbucks, an effect that lasted 10 months after the calorie posting commenced. This effect was primarily found for food purchases, as the average food calories per transaction fell by 14% (i.e., approximately 14 calories per transaction), while average beverage calories per transaction did not substantially change. Changes in beverage calories may not be reflected in transaction data. For example, if a customer orders a latte and substitutes skim milk for 2% milk, or asks for one pump of syrup instead of the usual three or four, those substitutions would not be captured by transaction data because the cost of the latte would not change. This study also assessed the impact of calorie posting on Starbucks revenue, reporting no statistically significant change in revenue as a result of calorie labeling. Because cost data associated with the policy was unavailable, profits were not measured directly. The effect on revenue was divided into (1) the effect on the number of transactions and (2) the effect on revenue per transaction. The study found that daily store transactions increased by 1.4% on average, while revenue per transaction decreased by 0.8% on average for all Starbucks in NYC, resulting in a zero net impact of calorie posting on Starbucks revenues. In NYC Starbucks stores located within 100 meters of a Dunkin Donuts, daily revenue increased by 3.3% on average. To determine consumers’ preliminary knowledge of calories in Starbucks food and beverages, surveys were administered before and after the introduction of a calorie-posting law in Seattle.26 Pre-menu labeling survey data indicate that Starbucks customers tended to be inaccurate in predicting the number of calories in their beverage and food orders. Specifically, in this study, consumers overestimated the number of calories in beverages and underestimated the number of calories in food. This is consistent with the study’s finding that calorie posting discouraged individuals from purchasing food but not beverages. Because consumers tended to underestimate the number of calories in food items, seeing the posted caloric value, which was greater than initially expected, may have led consumers to reduce their food purchases. However, because consumers tended to overestimate beverage calories, calorie posting may not have discouraged people from purchasing beverages. Proponents of menu labeling argue that, in addition to affecting consumer purchasing behavior, mandatory menu labeling may incentivize restaurants to offer lower calorie options and provide consumers with healthier choices. A study in the American Journal of Preventive Medicine reported that new menu items in restaurant chains in 2013 contained approximately 60 fewer calories compared with menu items in 2012—a 12% drop in calories.27 This voluntary action by large chain restaurants may have been in anticipation of the ACA’s federal menu-labeling provisions which will be in effect May 7, 2018. ","Question: Summarize the key points of menu labeling into the form of paragraphs. Context: Research Evaluating the Impact of Menu Labeling It is difficult to predict what effect, if any, mandatory restaurant menu labeling will have on food purchasing and health outcomes. However, changes in behavior following implementation of calorie labeling regulations in other jurisdictions prior to publication of the final federal rule (e.g., New York City, Philadelphia, and King County, WA) may provide some insight. Studies of the Impact of Menu Labeling on Calories Purchased Studies examining the relationship between menu labeling and calorie purchasing behavior have yielded mixed findings. Although consumers often report ordering fewer calories as a result of menu labeling, studies examining restaurant transaction data have not consistently reported a decrease in calories purchased after implementation of menu labeling. This section discusses several studies that have evaluated the impact of menu labeling, using survey and transaction data, on calories purchased. 17 Findings from current research are limited because existing studies often vary in scope and methodology. 18 For example, several of the studies that did not find a post-labeling decrease in calories purchased were conducted by the same group of researchers using samples from lowincome communities in New York, NY and Newark, NJ, 19 and research has shown that there are socioeconomic disparities in calorie label use, with higher-income individuals being more likely to notice calorie labels.20 Another study limited its sample population to one chain of restaurants in King County, WA. 21 An additional factor to consider is the time frame between implementation of menu labeling and an assessment of purchasing behavior, as there needs to be enough time for an effect to take place. One study, for instance, did not find an effect at four to six months postmandatory menu labeling, but it did find a decrease in calories purchased 18 months after implementation.22 Another study that did not find an effect of menu labeling on calories purchased examined outcomes two months after implementation, which may not have been enough time for an effect to take place.23 In addition, most of these studies relied on self-reported data to assess customers’ awareness and use of calorie labels. Such self-reporting may not be accurate, as evidenced by the inconsistencies between reported calories purchased and actual calories purchased as indicated on receipts.24 Finally, these studies analyzed the number of calories purchased but not changes in calories consumed, which may differ in response to menu labeling. For example, in full-service restaurants, customers may be more likely to share a meal or eat half the meal and take the rest home, which would not be captured by transaction data. Similarly, in fast food or carry-out establishments, customers may consume only a portion of their meal, which would not be captured by transaction data. Studies of the Impact of Menu Labeling on Sales and Revenue In 2009, Starbucks commissioned a Stanford University study to determine how the menu labeling mandate in New York City (NYC) affected its overall sales.25 Findings indicate that after the implementation of mandatory calorie labeling, average calories per transaction fell by 6% at Starbucks, an effect that lasted 10 months after the calorie posting commenced. This effect was primarily found for food purchases, as the average food calories per transaction fell by 14% (i.e., approximately 14 calories per transaction), while average beverage calories per transaction did not substantially change. Changes in beverage calories may not be reflected in transaction data. For example, if a customer orders a latte and substitutes skim milk for 2% milk, or asks for one pump of syrup instead of the usual three or four, those substitutions would not be captured by transaction data because the cost of the latte would not change. This study also assessed the impact of calorie posting on Starbucks revenue, reporting no statistically significant change in revenue as a result of calorie labeling. Because cost data associated with the policy was unavailable, profits were not measured directly. The effect on revenue was divided into (1) the effect on the number of transactions and (2) the effect on revenue per transaction. The study found that daily store transactions increased by 1.4% on average, while revenue per transaction decreased by 0.8% on average for all Starbucks in NYC, resulting in a zero net impact of calorie posting on Starbucks revenues. In NYC Starbucks stores located within 100 meters of a Dunkin Donuts, daily revenue increased by 3.3% on average. To determine consumers’ preliminary knowledge of calories in Starbucks food and beverages, surveys were administered before and after the introduction of a calorie-posting law in Seattle.26 Pre-menu labeling survey data indicate that Starbucks customers tended to be inaccurate in predicting the number of calories in their beverage and food orders. Specifically, in this study, consumers overestimated the number of calories in beverages and underestimated the number of calories in food. This is consistent with the study’s finding that calorie posting discouraged individuals from purchasing food but not beverages. Because consumers tended to underestimate the number of calories in food items, seeing the posted caloric value, which was greater than initially expected, may have led consumers to reduce their food purchases. However, because consumers tended to overestimate beverage calories, calorie posting may not have discouraged people from purchasing beverages. Proponents of menu labeling argue that, in addition to affecting consumer purchasing behavior, mandatory menu labeling may incentivize restaurants to offer lower calorie options and provide consumers with healthier choices. A study in the American Journal of Preventive Medicine reported that new menu items in restaurant chains in 2013 contained approximately 60 fewer calories compared with menu items in 2012—a 12% drop in calories.27 This voluntary action by large chain restaurants may have been in anticipation of the ACA’s federal menu-labeling provisions which will be in effect May 7, 2018. System Instructions: For this task, answer questions exclusively from the knowledge you gain from the information within the prompt. Head each paragraph of your response with a bolded question pertaining to the information following it.",Retail/Product,Summarize & Format,Text Transformation "Answer the question by using only information extracted from the context block. Do not use your own knowledge or outside sources of information. If you can't answer the question with information extracted from the context block only, output 'I can't answer due to lack of context'.",How does lowering the search costs in digital markets impact the price competition of online retailers?,"Reducing Search Costs For Buyers and Sellers Buyers face search costs in obtaining and processing information about the prices and product features of seller offerings. These costs include the opportunity cost of time spent searching, as well as associated expenditures such as driving, telephone calls, computer fees, and magazine subscriptions. Similarly, sellers face search costs in identifying qualified buyers for their products, such as market research, advertising, and sales calls Several Internet-based technologies lower buyer search costs. Many sites help buyers identify appropriate seller offerings: for example, search engines like Alta Vista, Yahoo!, or Google.com; business directories like the one provided by Yahoo!; or specialized product and price comparison agents for specific markets, such as Pricewatch and Computer ESP for computers and components, Expedia and Travelocity for airline tickets and other travel products, Shopper.com and Yahoo Shopping for electronics, and Dealtime for books and music. Online agents like the one provided by R-U-Sure.com monitor consumer behavior and help buyers identify the most desirable prices and product offerings without requiring them to take specific action. Internet technology can also lower the cost to buyers of acquiring information about the reputations of market participants. Such reputations may be provided as part of the marketplace (for example, on eBay), or through specialized intermediaries, such as Bizrate, which rates retailers on specific attributes (like service, product quality, and delivery promptness) by surveying consumers who have recently purchased products from these retailers. The Internet lowers seller search costs as well, by allowing sellers to communicate product information cost-effectively to potential buyers, and by offering sellers new ways to reach buyers through targeted advertising and one-on-one marketing. By reducing search costs on both sides of the market, it appears likely that buyers will be able to consider more product offerings and will identify and purchase products that better match their needs, with a resulting increase in economic efficiency. But the reduction in search costs combined with new capabilities of information technology can set off more complex market dynamics, too. The Impact of Lower Search and Information Costs on Market Competition It may seem clear that lower search and information costs should push markets toward a greater degree of price competition, and this outcome is certainly plausible, especially for homogeneous goods. On the other hand, online retailers can use Internet technology to provide differentiated and customized products, and thus avoid competing purely on price. I will explore these possibilities in turn. The Benefits to Buyers of Greater Price Competition Lower search costs in digital markets will make it easier for buyers to find low-cost sellers, and thus will promote price competition among sellers. This effect will be most pronounced in commodity markets, where lowering buyers’ search costs may result in intensive price competition, wiping out any extraordinary seller profits. It may also be significant in markets where products are differentiated, reducing the monopoly power enjoyed by sellers and leading to lower seller profits while increasing efficiency and total welfare (Bakos, 1997). Some online markets may have lower barriers to entry or smaller efficient scales, thus leading to a larger number of sellers at equilibrium, and correspondingly lower prices and profits. In particular, certain small-scale sellers may have a brighter future in a wired world if they can identify appropriate niches, because they can more easily be searched for and discovered, as search costs online are less determined by geography. It may thus be expected that online markets will have more intense price competition, resulting in lower profits as well as the passing to consumers of savings from lower cost structures. For instance, online shoppers may expect a 20 to 30 percent discount for items normally priced $30-500 (Tedeschi, 1999). ","Answer the question by using only information extracted from the context block. Do not use your own knowledge or outside sources of information. If you can't answer the question with information extracted from the context block only, output 'I can't answer due to lack of context'. Reducing Search Costs For Buyers and Sellers Buyers face search costs in obtaining and processing information about the prices and product features of seller offerings. These costs include the opportunity cost of time spent searching, as well as associated expenditures such as driving, telephone calls, computer fees, and magazine subscriptions. Similarly, sellers face search costs in identifying qualified buyers for their products, such as market research, advertising, and sales calls Several Internet-based technologies lower buyer search costs. Many sites help buyers identify appropriate seller offerings: for example, search engines like Alta Vista, Yahoo!, or Google.com; business directories like the one provided by Yahoo!; or specialized product and price comparison agents for specific markets, such as Pricewatch and Computer ESP for computers and components, Expedia and Travelocity for airline tickets and other travel products, Shopper.com and Yahoo Shopping for electronics, and Dealtime for books and music. Online agents like the one provided by R-U-Sure.com monitor consumer behavior and help buyers identify the most desirable prices and product offerings without requiring them to take specific action. Internet technology can also lower the cost to buyers of acquiring information about the reputations of market participants. Such reputations may be provided as part of the marketplace (for example, on eBay), or through specialized intermediaries, such as Bizrate, which rates retailers on specific attributes (like service, product quality, and delivery promptness) by surveying consumers who have recently purchased products from these retailers. The Internet lowers seller search costs as well, by allowing sellers to communicate product information cost-effectively to potential buyers, and by offering sellers new ways to reach buyers through targeted advertising and one-on-one marketing. By reducing search costs on both sides of the market, it appears likely that buyers will be able to consider more product offerings and will identify and purchase products that better match their needs, with a resulting increase in economic efficiency. But the reduction in search costs combined with new capabilities of information technology can set off more complex market dynamics, too. The Impact of Lower Search and Information Costs on Market Competition It may seem clear that lower search and information costs should push markets toward a greater degree of price competition, and this outcome is certainly plausible, especially for homogeneous goods. On the other hand, online retailers can use Internet technology to provide differentiated and customized products, and thus avoid competing purely on price. I will explore these possibilities in turn. The Benefits to Buyers of Greater Price Competition Lower search costs in digital markets will make it easier for buyers to find low-cost sellers, and thus will promote price competition among sellers. This effect will be most pronounced in commodity markets, where lowering buyers’ search costs may result in intensive price competition, wiping out any extraordinary seller profits. It may also be significant in markets where products are differentiated, reducing the monopoly power enjoyed by sellers and leading to lower seller profits while increasing efficiency and total welfare (Bakos, 1997). Some online markets may have lower barriers to entry or smaller efficient scales, thus leading to a larger number of sellers at equilibrium, and correspondingly lower prices and profits. In particular, certain small-scale sellers may have a brighter future in a wired world if they can identify appropriate niches, because they can more easily be searched for and discovered, as search costs online are less determined by geography. It may thus be expected that online markets will have more intense price competition, resulting in lower profits as well as the passing to consumers of savings from lower cost structures. For instance, online shoppers may expect a 20 to 30 percent discount for items normally priced $30-500 (Tedeschi, 1999). How does lowering the search costs in digital markets impact the price competition of online retailers?",Retail/Product,Effect Analysis,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]","I've heard that natural deodorant is better for you than regular deodorant. Based on this article, can you explain why? Please used at least 400 words.","Antiperspirants mostly use aluminum-based salts to block the sweat glands from releasing sweat, while deodorants use ingredients that help neutralize odor. Contrary to popular belief, there is no evidence to prove that aluminum can cause Alzheimer’s disease or breast cancer. Deodorants don't have aluminum, but experts say it's still a good idea to opt for natural options because deodorants often contain additives like artificial fragrances or parabens. Many deodorants on the market are now advertised as “natural” and “aluminum-free” because of consumer fears about the health risks associated with aluminum. But there are a lot of details to unpack. Aluminum is only used in antiperspirants, but not in deodorants. And there’s been no evidence to prove that it causes Alzheimer’s disease or breast cancer, the two main concerns about aluminum. Antiperspirants mostly use aluminum-based salts to temporarily block the opening of the sweat glands from releasing sweat, and they usually also include ingredients that help reduce odor, according to Kristina Collins, MD, FAAD, a board-certified dermatologist based in Austin, TX. Deodorants, on the other hand, use ingredients that help neutralize the odor that occurs as bacteria metabolize sweat. Some people prefer using “natural deodorants” to minimize the risk of coming in contact with harmful ingredients, but do these products work? “Natural deodorant reduces the scent of the sweat, but does not reduce the amount of sweat the body produces,” Collins told Verywell. “So if your main concern is the appearance of sweat in the armpit area of your shirt, deodorant will be completely ineffective in reducing the dreaded armpit sweat marks.” The 13 Best Clinical Strength Deodorants and Antiperspirants, Tested and Reviewed Does Aluminum in Antiperspirants Really Cause Alzheimer’s Disease? The theory about aluminum in antiperspirants causing Alzheimer’s disease came about in the ’60s and ’70s, when researchers found increased levels of aluminum in the brains of Alzheimer’s patients, according to Mark Mapstone, PhD, the vice chair for research in neurology at the University of California, Irvine, School of Medicine. “Because aluminum is toxic to brain cells, scientists speculated that the aluminum present in the brains of these people was acquired from the environment and may be responsible for the death of brain cells,” Mapstone told Verywell. While research has found that exposure to aluminum is associated with neurological symptoms, Mapstone said these studies exposed their subjects to much higher concentrations of the metal than what is found in antiperspirants.1 And, according to Collins, there have been no substantiated or randomized studies demonstrating that antiperspirant use specifically causes Alzheimer’s disease. “There is a small amount of absorption of aluminum into the skin and circulation when applied to the skin as an antiperspirant,” Collins said. “However, because of the limited body surface for topical application of these products, that absorption is incredibly small—much smaller, in fact, than the absorption of aluminum in food products.” Do Aluminum-Based Antiperspirants Cause Breast Cancer? Some studies early in this century suggested that an earlier age of breast cancer diagnosis was associated with frequent use of aluminum-based antiperspirants or deodorants, but other studies found no such association. A 2016 study found an apparent association, but only among women who had used antiperspirants or deodorants several times daily before the age of 30. It didn’t provide clear evidence of causation.2 No studies have successfully found a link between an increased risk of breast cancer and antiperspirant use, according to Jennifer Hartman, NP, a nurse practitioner specializing in surgical breast oncology. “It is often mistakenly associated with breast cancer especially because the location of use is close to the location of most breast cancers—upper outer quadrant of the breasts—but products applied anywhere on the body or ingested could impact breast tissue regardless of location,” she said. Should You Use Natural Deodorants? How Do You Pick the Right One? While the evidence about the health risks associated with antiperspirants and deodorants is lacking, Collins said there’s still good reason to opt for the more natural option. Many antiperspirants and some deodorants contain additives like artificial fragrances or parabens that can cause irritation or skin concerns, such as contact dermatitis, she said. Aerosolized spray antiperspirants also sometimes contain a harmful chemical called benzene. What to Know About the Carcinogen Benzene Found in Some Popular Sunscreens “If a person doesn’t sweat very much and they just want to control their body odor, a natural deodorant would be a great choice,” Collins said. The most effective ingredients to look for when selecting a natural deodorant, according to Collins, are ones that help to reduce bacteria on the skin in the armpit. Alpha hydroxy acids (AHAs), such as glycolic acid or mandelic acid, can be used to reduce the dead skin cells in the armpit that bacteria feed off of and encourage healthy cell turnover, Collins said. Tea tree oil is another useful ingredient thanks to its natural antibacterial capabilities, and some deodorants also include probiotics to help boost “good” bacteria and encourage a healthy microbiome balance. Armpit Rash from Deodorant Does Coconut Oil Work as a Natural Deodorant? Coconut oil is another popular choice for those committed to using natural products on their pits, especially on TikTok. Collins said coconut oil contains natural antibacterial properties and is a common ingredient in a variety of natural deodorants, but it’s unlikely to work as effectively on its own. It would also likely rub off faster or absorb faster than an actual deodorant. “It wouldn’t hurt you, but I think this TikTok trend is probably going to leave a lot of people with some stinky armpits,” Collins said. And no matter what ingredients your deodorant includes, it won’t work for an indefinite amount of time. “As the sweat continues to build up, the product is washed away and odor resumes,” Collins said. “The solution for those who are really committed to use of natural deodorants may be to use antibacterial soap in the arm","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I've heard that natural deodorant is better for you than regular deodorant. Based on this article, can you explain why? Please used at least 400 words. Antiperspirants mostly use aluminum-based salts to block the sweat glands from releasing sweat, while deodorants use ingredients that help neutralize odor. Contrary to popular belief, there is no evidence to prove that aluminum can cause Alzheimer’s disease or breast cancer. Deodorants don't have aluminum, but experts say it's still a good idea to opt for natural options because deodorants often contain additives like artificial fragrances or parabens. Many deodorants on the market are now advertised as “natural” and “aluminum-free” because of consumer fears about the health risks associated with aluminum. But there are a lot of details to unpack. Aluminum is only used in antiperspirants, but not in deodorants. And there’s been no evidence to prove that it causes Alzheimer’s disease or breast cancer, the two main concerns about aluminum. Antiperspirants mostly use aluminum-based salts to temporarily block the opening of the sweat glands from releasing sweat, and they usually also include ingredients that help reduce odor, according to Kristina Collins, MD, FAAD, a board-certified dermatologist based in Austin, TX. Deodorants, on the other hand, use ingredients that help neutralize the odor that occurs as bacteria metabolize sweat. Some people prefer using “natural deodorants” to minimize the risk of coming in contact with harmful ingredients, but do these products work? “Natural deodorant reduces the scent of the sweat, but does not reduce the amount of sweat the body produces,” Collins told Verywell. “So if your main concern is the appearance of sweat in the armpit area of your shirt, deodorant will be completely ineffective in reducing the dreaded armpit sweat marks.” The 13 Best Clinical Strength Deodorants and Antiperspirants, Tested and Reviewed Does Aluminum in Antiperspirants Really Cause Alzheimer’s Disease? The theory about aluminum in antiperspirants causing Alzheimer’s disease came about in the ’60s and ’70s, when researchers found increased levels of aluminum in the brains of Alzheimer’s patients, according to Mark Mapstone, PhD, the vice chair for research in neurology at the University of California, Irvine, School of Medicine. “Because aluminum is toxic to brain cells, scientists speculated that the aluminum present in the brains of these people was acquired from the environment and may be responsible for the death of brain cells,” Mapstone told Verywell. While research has found that exposure to aluminum is associated with neurological symptoms, Mapstone said these studies exposed their subjects to much higher concentrations of the metal than what is found in antiperspirants.1 And, according to Collins, there have been no substantiated or randomized studies demonstrating that antiperspirant use specifically causes Alzheimer’s disease. “There is a small amount of absorption of aluminum into the skin and circulation when applied to the skin as an antiperspirant,” Collins said. “However, because of the limited body surface for topical application of these products, that absorption is incredibly small—much smaller, in fact, than the absorption of aluminum in food products.” Do Aluminum-Based Antiperspirants Cause Breast Cancer? Some studies early in this century suggested that an earlier age of breast cancer diagnosis was associated with frequent use of aluminum-based antiperspirants or deodorants, but other studies found no such association. A 2016 study found an apparent association, but only among women who had used antiperspirants or deodorants several times daily before the age of 30. It didn’t provide clear evidence of causation.2 No studies have successfully found a link between an increased risk of breast cancer and antiperspirant use, according to Jennifer Hartman, NP, a nurse practitioner specializing in surgical breast oncology. “It is often mistakenly associated with breast cancer especially because the location of use is close to the location of most breast cancers—upper outer quadrant of the breasts—but products applied anywhere on the body or ingested could impact breast tissue regardless of location,” she said. Should You Use Natural Deodorants? How Do You Pick the Right One? While the evidence about the health risks associated with antiperspirants and deodorants is lacking, Collins said there’s still good reason to opt for the more natural option. Many antiperspirants and some deodorants contain additives like artificial fragrances or parabens that can cause irritation or skin concerns, such as contact dermatitis, she said. Aerosolized spray antiperspirants also sometimes contain a harmful chemical called benzene. What to Know About the Carcinogen Benzene Found in Some Popular Sunscreens “If a person doesn’t sweat very much and they just want to control their body odor, a natural deodorant would be a great choice,” Collins said. The most effective ingredients to look for when selecting a natural deodorant, according to Collins, are ones that help to reduce bacteria on the skin in the armpit. Alpha hydroxy acids (AHAs), such as glycolic acid or mandelic acid, can be used to reduce the dead skin cells in the armpit that bacteria feed off of and encourage healthy cell turnover, Collins said. Tea tree oil is another useful ingredient thanks to its natural antibacterial capabilities, and some deodorants also include probiotics to help boost “good” bacteria and encourage a healthy microbiome balance. Armpit Rash from Deodorant Does Coconut Oil Work as a Natural Deodorant? Coconut oil is another popular choice for those committed to using natural products on their pits, especially on TikTok. Collins said coconut oil contains natural antibacterial properties and is a common ingredient in a variety of natural deodorants, but it’s unlikely to work as effectively on its own. It would also likely rub off faster or absorb faster than an actual deodorant. “It wouldn’t hurt you, but I think this TikTok trend is probably going to leave a lot of people with some stinky armpits,” Collins said. And no matter what ingredients your deodorant includes, it won’t work for an indefinite amount of time. “As the sweat continues to build up, the product is washed away and odor resumes,” Collins said. “The solution for those who are really committed to use of natural deodorants may be to use antibacterial soap in the arm https://www.verywellhealth.com/do-natural-deodorants-really-work-7255872",Medical,Explanation/Definition,Q&A "This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points with the proper noun and key word bolded, followed by a short explanation with no, unasked for information.","What states, mentioned in the text, have enacted some type of prohibition or restriction on price rises during proclaimed emergencies and specifically mention the key word,""fuel"", by name.","State Price-Gouging Laws Many states have enacted some type of prohibition or limitation on price increases during declared emergencies. Generally, these state laws take one of two basic forms. Some states prohibit the sale of goods and services at what are deemed to be “unconscionable” or “excessive” prices in the area and during the period of a designated emergency. Other states have established a maximum permissible increase in the prices for retail goods during a designated emergency period. Many statutes of both kinds include an exemption if price increases are the result of increased costs incurred for procuring the goods or services in question. Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 2 Examples of State Statutes Prohibitions on “Excessive” or “Unconscionable” Pricing One common way that states address price gouging is to ban prices that are considered to be (for example) “excessive” or “unconscionable,” as defined in the statute or left to the discretion of the courts. These statutes generally bar such increases during designated emergency periods. The process for emergency designation is also usually defined in the statute. Frequently, the state’s governor is granted authority to designate an emergency during which the price limitations are in place. For example, the New York statute provides that: During any abnormal disruption of the market for consumer goods and services vital and necessary for the health, safety and welfare of consumers, no party within the chain of distribution of such consumer goods or services or both shall sell or offer to sell any such goods or services or both for an amount which represents an unconscionably excessive price.5 The statute defines abnormal disruption of the market as a real or threatened change to the market “resulting from stress of weather, convulsion of nature, failure or shortage of electric power or other source of energy, strike, civil disorder, war, military action, national or local emergency … which results in the declaration of a state of emergency by the governor.”6 The statute provides only for criminal liability and leaves the ultimate decision as to whether a price is “unconscionably excessive” to prosecutors (for charging purposes) and to the courts, with no separate cause of action created for private parties. As guidance in such cases, the statute notes that if there is a “gross disparity” between the price during the disruption and the price prior to the disruption, or if the price “grossly exceeds” the price at which the same or similar goods are available in the area, such disparity will be considered prima facie evidence that a price is unconscionable.7 Similarly, Florida’s statute bars “unconscionable pricing” during declared states of emergency.8 If the amount being charged represents a “gross disparity” from the average price at which the product or service was sold in the usual course of business (or available in the “trade area”) during the 30 days immediately prior to a declaration of a state of emergency, it is considered prima facie evidence of “unconscionable pricing,” which constitutes an “unlawful act or practice.” 9 However, pricing is not considered unconscionable if the increase is attributable to additional costs incurred by the seller or is the result of national or international market trends.10 As with the New York statute, the Florida statute offers guidance, but the question of whether certain prices during an emergency are deemed “unconscionable” is ultimately left to the courts. Many state price-gouging laws are triggered only by a declaration of emergency in response to localized conditions. Thus, they will generally not apply after a declared emergency ends or in areas not directly affected by a particular emergency or natural disaster. However, at least two Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 3 states have laws prohibiting excessive pricing that impose liability even without a declaration of any type of emergency. Maine law prohibits “unjust or unreasonable” profits in the sale, exchange, or handling of necessities, defined to include fuel.11 Michigan’s consumer protection act simply prohibits “charging the consumer a price that is grossly in excess of the price at which similar property or services are sold.” 12 Prohibitions of Price Increases Beyond a Certain Percentage In contrast to a general ban on “excessive” or “unconscionable” pricing, some state statutes leave less to the courts’ discretion and instead place limits on price increases of certain goods during emergencies. For example, California’s anti-price-gouging statute states that for a period of 30 days following the proclamation of a state of emergency by the President of the United States or the governor of California or the declaration of a local emergency by the relevant executive officer, it is unlawful to sell or offer certain goods and services (including emergency and medical supplies, building and transportation materials, fuel, etc.) at a price more than 10% higher than the price of the good prior to the proclamation of emergency.13 As a defense, a seller can show that the price increase was directly attributable to additional costs imposed on it by the supplier of the goods or additional costs for the labor and material used to provide the services.14 The prohibition lasts for 30 days from the date of issuance of the emergency proclamation.15 West Virginia has also adopted an anti-price-gouging measure based on caps to percentage increases in price during times of emergency. The West Virginia statute provides that upon a declaration of a state of emergency by the President of the United States, the governor, or the state legislature, it is unlawful to sell or offer to sell certain critical goods and services “for a price greater than ten percent above the price charged by that person for those goods and services on the tenth day immediately preceding the declaration of emergency.” 16 West Virginia also provides an exception for price increases attributable to increased costs on the seller imposed by the supplier or to added costs of providing the goods or services during the emergency.17 Some states use language barring “unconscionable” or “excessive” pricing in a manner similar to the state statutes described in the previous section but define these terms with hard caps instead of leaving their exact definition to the discretion of the courts. For example, the Alabama statute makes it unlawful for anyone to “impose unconscionable prices for the sale or rental of any commodity or rental facility during the period of a declared state of emergency.” 18 However, it provides that prima facie evidence of unconscionable pricing exists “if any person, during a state of emergency declared pursuant to the powers granted to the Governor, charges a price that exceeds, by an amount equal to or in excess of 25%, the average price at which the same or similar commodity or rental facility was obtainable in the affected area during the last 30 days Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 4 immediately prior to the declared state of emergency.” 19 As with most other state price-gouging statutes, the statute does not apply if the price increase is attributable to reasonable costs incurred by the seller in connection with the rental or sale of the commodity.20 A few other states have imposed caps on price increases during emergencies even tighter than the one imposed by the aforementioned statutes. Some state statutes ban any price increase during periods of emergency. For example, in Georgia, it is considered an “unlawful, unfair and deceptive trade practice” for anyone doing business in an areas where a state of emergency has been declared to sell or offer for sale at retail any goods or services identified by the Governor in the declaration of the state of emergency necessary to preserve, protect, or sustain the life, health, or safety of persons or their property at a price higher than the price at which such goods were sold or offered for sale immediately prior to the declaration of a state of emergency.21 As with other state gouging statutes, the Georgia statute provides an exception for price increases that reflect “an increase in cost of the goods or services to the person selling the goods or services or an increase in the cost of transporting the goods or services into the area.” ","This task requires you to answer questions based solely on the information provided in the prompt. You are not allowed to use any external resources or prior knowledge. Give your answer in bullet points with the proper noun and key word bolded, followed by a short explanation with no, unasked for information. What states, mentioned in the text, have enacted some type of prohibition or restriction on price rises during proclaimed emergencies and specifically mention the key word,""fuel"", by name. State Price-Gouging Laws Many states have enacted some type of prohibition or limitation on price increases during declared emergencies. Generally, these state laws take one of two basic forms. Some states prohibit the sale of goods and services at what are deemed to be “unconscionable” or “excessive” prices in the area and during the period of a designated emergency. Other states have established a maximum permissible increase in the prices for retail goods during a designated emergency period. Many statutes of both kinds include an exemption if price increases are the result of increased costs incurred for procuring the goods or services in question. Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 2 Examples of State Statutes Prohibitions on “Excessive” or “Unconscionable” Pricing One common way that states address price gouging is to ban prices that are considered to be (for example) “excessive” or “unconscionable,” as defined in the statute or left to the discretion of the courts. These statutes generally bar such increases during designated emergency periods. The process for emergency designation is also usually defined in the statute. Frequently, the state’s governor is granted authority to designate an emergency during which the price limitations are in place. For example, the New York statute provides that: During any abnormal disruption of the market for consumer goods and services vital and necessary for the health, safety and welfare of consumers, no party within the chain of distribution of such consumer goods or services or both shall sell or offer to sell any such goods or services or both for an amount which represents an unconscionably excessive price.5 The statute defines abnormal disruption of the market as a real or threatened change to the market “resulting from stress of weather, convulsion of nature, failure or shortage of electric power or other source of energy, strike, civil disorder, war, military action, national or local emergency … which results in the declaration of a state of emergency by the governor.”6 The statute provides only for criminal liability and leaves the ultimate decision as to whether a price is “unconscionably excessive” to prosecutors (for charging purposes) and to the courts, with no separate cause of action created for private parties. As guidance in such cases, the statute notes that if there is a “gross disparity” between the price during the disruption and the price prior to the disruption, or if the price “grossly exceeds” the price at which the same or similar goods are available in the area, such disparity will be considered prima facie evidence that a price is unconscionable.7 Similarly, Florida’s statute bars “unconscionable pricing” during declared states of emergency.8 If the amount being charged represents a “gross disparity” from the average price at which the product or service was sold in the usual course of business (or available in the “trade area”) during the 30 days immediately prior to a declaration of a state of emergency, it is considered prima facie evidence of “unconscionable pricing,” which constitutes an “unlawful act or practice.” 9 However, pricing is not considered unconscionable if the increase is attributable to additional costs incurred by the seller or is the result of national or international market trends.10 As with the New York statute, the Florida statute offers guidance, but the question of whether certain prices during an emergency are deemed “unconscionable” is ultimately left to the courts. Many state price-gouging laws are triggered only by a declaration of emergency in response to localized conditions. Thus, they will generally not apply after a declared emergency ends or in areas not directly affected by a particular emergency or natural disaster. However, at least two Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 3 states have laws prohibiting excessive pricing that impose liability even without a declaration of any type of emergency. Maine law prohibits “unjust or unreasonable” profits in the sale, exchange, or handling of necessities, defined to include fuel.11 Michigan’s consumer protection act simply prohibits “charging the consumer a price that is grossly in excess of the price at which similar property or services are sold.” 12 Prohibitions of Price Increases Beyond a Certain Percentage In contrast to a general ban on “excessive” or “unconscionable” pricing, some state statutes leave less to the courts’ discretion and instead place limits on price increases of certain goods during emergencies. For example, California’s anti-price-gouging statute states that for a period of 30 days following the proclamation of a state of emergency by the President of the United States or the governor of California or the declaration of a local emergency by the relevant executive officer, it is unlawful to sell or offer certain goods and services (including emergency and medical supplies, building and transportation materials, fuel, etc.) at a price more than 10% higher than the price of the good prior to the proclamation of emergency.13 As a defense, a seller can show that the price increase was directly attributable to additional costs imposed on it by the supplier of the goods or additional costs for the labor and material used to provide the services.14 The prohibition lasts for 30 days from the date of issuance of the emergency proclamation.15 West Virginia has also adopted an anti-price-gouging measure based on caps to percentage increases in price during times of emergency. The West Virginia statute provides that upon a declaration of a state of emergency by the President of the United States, the governor, or the state legislature, it is unlawful to sell or offer to sell certain critical goods and services “for a price greater than ten percent above the price charged by that person for those goods and services on the tenth day immediately preceding the declaration of emergency.” 16 West Virginia also provides an exception for price increases attributable to increased costs on the seller imposed by the supplier or to added costs of providing the goods or services during the emergency.17 Some states use language barring “unconscionable” or “excessive” pricing in a manner similar to the state statutes described in the previous section but define these terms with hard caps instead of leaving their exact definition to the discretion of the courts. For example, the Alabama statute makes it unlawful for anyone to “impose unconscionable prices for the sale or rental of any commodity or rental facility during the period of a declared state of emergency.” 18 However, it provides that prima facie evidence of unconscionable pricing exists “if any person, during a state of emergency declared pursuant to the powers granted to the Governor, charges a price that exceeds, by an amount equal to or in excess of 25%, the average price at which the same or similar commodity or rental facility was obtainable in the affected area during the last 30 days Gasoline Price Increases: Federal and State Authority to Limit “Price Gouging” Congressional Research Service 4 immediately prior to the declared state of emergency.” 19 As with most other state price-gouging statutes, the statute does not apply if the price increase is attributable to reasonable costs incurred by the seller in connection with the rental or sale of the commodity.20 A few other states have imposed caps on price increases during emergencies even tighter than the one imposed by the aforementioned statutes. Some state statutes ban any price increase during periods of emergency. For example, in Georgia, it is considered an “unlawful, unfair and deceptive trade practice” for anyone doing business in an areas where a state of emergency has been declared to sell or offer for sale at retail any goods or services identified by the Governor in the declaration of the state of emergency necessary to preserve, protect, or sustain the life, health, or safety of persons or their property at a price higher than the price at which such goods were sold or offered for sale immediately prior to the declaration of a state of emergency.21 As with other state gouging statutes, the Georgia statute provides an exception for price increases that reflect “an increase in cost of the goods or services to the person selling the goods or services or an increase in the cost of transporting the goods or services into the area.” ",Legal,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","Give an overview of the MBTI test and explain its connection to Jungian psychology. What are the possible applications of the MBTI in the areas of psychiatry and patient-doctor communications, and what are the best ways to implement this? What are the implied limitations of using the MBTI in a clinical setting?","The Myers-Briggs type indicator (MBTI) is a measure of personality type based on the work of psychologist Carl Jung. Isabel Myers developed the MBTI during the Second World War to facilitate better working relationships between healthcare professionals, particularly nurses.[1] She modeled this questionnaire on Jung's theory of ""individual preference,"" which suggests that seemingly random variation in human behavior is attributable to fundamental individual differences in mental and emotional functioning.[2] Myers described these variations as simply different ways individuals prefer to use their minds. The indicator operationalizes these preferences with questions indicating the individual's propensity towards 1 end of a dipole in 4 categories: Energy Perceiving Judging Orientation Energy Energy encompasses the scale of extraversion to introversion. Those tending towards extraversion direct their attention to external experiences and actions, deriving energy from those around them. Those tending towards introversion direct their attention towards inner thoughts and ideas, acquiring energy from solitude. Perceiving Perceiving describes how individuals prefer to intake information on the sensing scale versus intuitive types. Sensing types prefer to gather information using the 5 senses. They require gathering facts before understanding general ideas and patterns. Intuitive types prefer to rely on instincts and view problems from the ""big picture"" perspective, realizing general patterns before identifying constituent facts. Judging Judging categorizes how individuals prefer to make decisions from thinking to feeling. Thinkers rely on logic and facts, while feelers seek harmony in resolving an issue. Orientation Orientation applies to the preferred lifestyle on the scale of judging to perceiving. Those preferring judgment tend towards an orderly, decisive, and settled lifestyle, while those who prefer a more flexible, unpredictable existence align with the perceiving type.[1] Sixteen personality types are possible with the combinations of 2 poles in 4 different categories. The representation of these types is with 4 letters indicating the individual's propensity in each category. For example, someone tending towards extraversion in energy, intuition in perceiving, thinking in judging, and perceiving in orientation would have the personality type ENTP. The goal of the Myers-Briggs typology is to increase awareness of oneself and others and advance through Jung's ""individuation."" This process is describable as the integration, differentiation, and development of one's traits and skills.[2] One can begin analyzing and applying those preferences in work and personal endeavors by understanding one's individual preferences. Issues of Concern Myer's primary intended application of the MBTI was for team building in the healthcare setting. Differences in approach to problem-solving and communication have the potential to create barriers to teamwork. Understanding these different thinking and perceiving preferences through MBTI typology can inform strategic changes to workflow and evaluation techniques.[3] Clinical Significance Although the MBTI was not designed for clinical use, it has had application to some patient populations. In psychology and psychiatry, the MBTI may help understand specific patient populations, such as those suffering from suicidality and unipolar depression. In both populations, greater tendencies towards introversion energy and perception orientation have been identified compared to the normative population. The researchers suggest that with more confirmatory samples, these correlations may be useful in identifying vulnerability in patients with affective disorder.[4][5] Most significantly, the MBTI may have applications to fostering communication between healthcare professionals and patients. It is important to consider possible communication differences between the provider and the patient. For example, some research suggests that there are significantly more introverts, intuitive perceivers, thinking deciders, and judging-oriented individuals among a doctor population compared to a general adult population, which consists of more extroverts, sensing-perceivers, feeling deciders, and perceiving-orientated persons.[6] These potential differences can affect patients' interpretations of their provider encounters. A doctor tending towards intuitive perception and thinking judgment may be inclined to approach communication with the following attitudes: Respect my intelligence and desire to understand Demonstrate your competence Answer my questions honestly Give me options to see a pattern [6] However, a patient tending towards sensing, perceiving, and feeling decisions may approach communication with the following attitudes: Listen carefully to me Give me your complete attention Be warm and friendly Give me facts with a personal touch Provide practical information about my condition [6] Suggested approaches to remedy these differences include applying the MBTI typology in communication skills training for health care professionals.[6][7] Formal and structured approaches to instructing professionalism and communication have demonstrated greater effectiveness than passive observational learning, which is critical as improved patient-physician communication correlates better health outcomes as welanded legal action.[8][9][10] Nursing, Allied Health, and Interprofessional Team Interventions All members of the interprofessional healthcare team would do well to have at least a general understanding of the MBTI grading system, as it can facilitate patient interactions, increase empathy for how a patient views their life and world, facilitate interprofessional team communication and collaboration, and lead to improved communication with patients., leading to improved patient outcomes.","""================ ======= The Myers-Briggs type indicator (MBTI) is a measure of personality type based on the work of psychologist Carl Jung. Isabel Myers developed the MBTI during the Second World War to facilitate better working relationships between healthcare professionals, particularly nurses.[1] She modeled this questionnaire on Jung's theory of ""individual preference,"" which suggests that seemingly random variation in human behavior is attributable to fundamental individual differences in mental and emotional functioning.[2] Myers described these variations as simply different ways individuals prefer to use their minds. The indicator operationalizes these preferences with questions indicating the individual's propensity towards 1 end of a dipole in 4 categories: Energy Perceiving Judging Orientation Energy Energy encompasses the scale of extraversion to introversion. Those tending towards extraversion direct their attention to external experiences and actions, deriving energy from those around them. Those tending towards introversion direct their attention towards inner thoughts and ideas, acquiring energy from solitude. Perceiving Perceiving describes how individuals prefer to intake information on the sensing scale versus intuitive types. Sensing types prefer to gather information using the 5 senses. They require gathering facts before understanding general ideas and patterns. Intuitive types prefer to rely on instincts and view problems from the ""big picture"" perspective, realizing general patterns before identifying constituent facts. Judging Judging categorizes how individuals prefer to make decisions from thinking to feeling. Thinkers rely on logic and facts, while feelers seek harmony in resolving an issue. Orientation Orientation applies to the preferred lifestyle on the scale of judging to perceiving. Those preferring judgment tend towards an orderly, decisive, and settled lifestyle, while those who prefer a more flexible, unpredictable existence align with the perceiving type.[1] Sixteen personality types are possible with the combinations of 2 poles in 4 different categories. The representation of these types is with 4 letters indicating the individual's propensity in each category. For example, someone tending towards extraversion in energy, intuition in perceiving, thinking in judging, and perceiving in orientation would have the personality type ENTP. The goal of the Myers-Briggs typology is to increase awareness of oneself and others and advance through Jung's ""individuation."" This process is describable as the integration, differentiation, and development of one's traits and skills.[2] One can begin analyzing and applying those preferences in work and personal endeavors by understanding one's individual preferences. Issues of Concern Myer's primary intended application of the MBTI was for team building in the healthcare setting. Differences in approach to problem-solving and communication have the potential to create barriers to teamwork. Understanding these different thinking and perceiving preferences through MBTI typology can inform strategic changes to workflow and evaluation techniques.[3] Clinical Significance Although the MBTI was not designed for clinical use, it has had application to some patient populations. In psychology and psychiatry, the MBTI may help understand specific patient populations, such as those suffering from suicidality and unipolar depression. In both populations, greater tendencies towards introversion energy and perception orientation have been identified compared to the normative population. The researchers suggest that with more confirmatory samples, these correlations may be useful in identifying vulnerability in patients with affective disorder.[4][5] Most significantly, the MBTI may have applications to fostering communication between healthcare professionals and patients. It is important to consider possible communication differences between the provider and the patient. For example, some research suggests that there are significantly more introverts, intuitive perceivers, thinking deciders, and judging-oriented individuals among a doctor population compared to a general adult population, which consists of more extroverts, sensing-perceivers, feeling deciders, and perceiving-orientated persons.[6] These potential differences can affect patients' interpretations of their provider encounters. A doctor tending towards intuitive perception and thinking judgment may be inclined to approach communication with the following attitudes: Respect my intelligence and desire to understand Demonstrate your competence Answer my questions honestly Give me options to see a pattern [6] However, a patient tending towards sensing, perceiving, and feeling decisions may approach communication with the following attitudes: Listen carefully to me Give me your complete attention Be warm and friendly Give me facts with a personal touch Provide practical information about my condition [6] Suggested approaches to remedy these differences include applying the MBTI typology in communication skills training for health care professionals.[6][7] Formal and structured approaches to instructing professionalism and communication have demonstrated greater effectiveness than passive observational learning, which is critical as improved patient-physician communication correlates better health outcomes as welanded legal action.[8][9][10] Nursing, Allied Health, and Interprofessional Team Interventions All members of the interprofessional healthcare team would do well to have at least a general understanding of the MBTI grading system, as it can facilitate patient interactions, increase empathy for how a patient views their life and world, facilitate interprofessional team communication and collaboration, and lead to improved communication with patients., leading to improved patient outcomes. https://www.ncbi.nlm.nih.gov/books/NBK554596/ ================ ======= Give an overview of the MBTI test and explain its connection to Jungian psychology. What are the possible applications of the MBTI in the areas of psychiatry and patient-doctor communications, and what are the best ways to implement this? What are the implied limitations of using the MBTI in a clinical setting? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Effect Analysis,Q&A You must only respond using information that is found in the provided context block. You must not use any other outside sources when forming an answer to the user's question. You may use markdown to format an answer.,Summarise how the laws are likely to impact these two groups.,"Speech Rights of Adults Much of the material targeted by age verification laws is protected speech when accessed by adults. With respect to pornography, sexual content that depicts adults but is not legally obscene is protected speech with respect to adults even if it might qualify as speech “harmful to minors.” With respect to social media, the Supreme Court has recognized that social media enables individuals to “engage in a wide array of protected First Amendment activity.” A law may burden adult speech even if it specifically targets material accessed by minors. The Supreme Court’s decision in Reno struck down the Communications Decency Act (CDA) primarily on the basis that the law would impermissibly burden adult speech. The reasons for believing the CDA would burden adult speech may apply to contemporary age verification laws. The Reno court determined that the CDA’s ban on transmitting indecent material to minors would burden adult speech “in the absence of a viable age verification process,” because distributors of material would fear liability for transmitting material to minors. The Court also observed that a website operator’s decision to adopt age verification may block adults from lawful content if the adults lack material required for verification, such as a credit card. Lower courts have suggested that age verification may further burden adult speech by deterring adult users who are not willing to provide identifying information to access potentially embarrassing content. In a different context, the Supreme Court held that a requirement that cable television operators block sexual programming unless a viewer requests access to the programming in writing would “restrict viewing by [cable] subscribers who fear for their reputations” should their request be made public. Speech Rights of Minors Minors, like adults, possess free speech rights under the First Amendment. The Supreme Court has repeatedly held that, except in “relatively narrow and well-defined circumstances,” government has no more power to restrict speech for minors than it does for adults. Laws that target social media websites may fall outside these “narrow” circumstances. The Supreme Court has struck down other laws that attempted to restrict the dissemination of protected speech to minors, including laws involving violent video games and movies with nudity. Social media allows minors to access a broad array of protected speech, meaning a law restricting minors’ access to social media may have a greater impact on minors’ speech rights than narrower laws the Supreme Court has previously struck down. Pornography age verification laws may also impact minors’ access to constitutionally protected material. State laws that seek to mandate age verification for pornography often apply to “material harmful to minors,” a term that tracks the language used by the Supreme Court in Ginsberg v. New York and Miller v. California. Although the Supreme Court has upheld restrictions on physical distribution of material harmful to minors, federal appellate courts have raised issues with such restrictions as they might apply on the internet. For example, the Third Circuit held in multiple decisions that COPA’s definition of “material that is harmful to minors” was unconstitutionally vague and overbroad. The Miller definition of obscenity depends on whether “the average person, applying contemporary community standards” would find that the material in question “appeals to the prurient interest.” Definitions of material “harmful to minors” incorporate this language and specify that the question is whether someone “applying contemporary community standards” would find the material “appeals to the prurient interest” of minors. In cases that involve physical distribution of offensive material, the relevant “community standards” are those of the material’s recipient. The Third Circuit observed that applying a “contemporary community standards” requirement to internet communications, which are typically available worldwide, would subject all material on the internet to the standards of “the most puritanical communities.” The Supreme Court has not decided how to apply “contemporary community standards” to internet communications, beyond concluding that the use of “contemporary community standards” alone did not render COPA unconstitutional. Some Justices have expressed support for a nationwide Congressional Research Service 4 “community standard,” while other Justices have suggested that the standards should depend on where material is received, as is the case with laws that do not involve the internet.","System instruction: You must only respond using information that is found in the provided context block. You must not use any other outside sources when forming an answer to the user's question. You may use markdown to format an answer. question: Summarise how the laws are likely to impact these two groups. context: Speech Rights of Adults Much of the material targeted by age verification laws is protected speech when accessed by adults. With respect to pornography, sexual content that depicts adults but is not legally obscene is protected speech with respect to adults even if it might qualify as speech “harmful to minors.” With respect to social media, the Supreme Court has recognized that social media enables individuals to “engage in a wide array of protected First Amendment activity.” A law may burden adult speech even if it specifically targets material accessed by minors. The Supreme Court’s decision in Reno struck down the Communications Decency Act (CDA) primarily on the basis that the law would impermissibly burden adult speech. The reasons for believing the CDA would burden adult speech may apply to contemporary age verification laws. The Reno court determined that the CDA’s ban on transmitting indecent material to minors would burden adult speech “in the absence of a viable age verification process,” because distributors of material would fear liability for transmitting material to minors. The Court also observed that a website operator’s decision to adopt age verification may block adults from lawful content if the adults lack material required for verification, such as a credit card. Lower courts have suggested that age verification may further burden adult speech by deterring adult users who are not willing to provide identifying information to access potentially embarrassing content. In a different context, the Supreme Court held that a requirement that cable television operators block sexual programming unless a viewer requests access to the programming in writing would “restrict viewing by [cable] subscribers who fear for their reputations” should their request be made public. Speech Rights of Minors Minors, like adults, possess free speech rights under the First Amendment. The Supreme Court has repeatedly held that, except in “relatively narrow and well-defined circumstances,” government has no more power to restrict speech for minors than it does for adults. Laws that target social media websites may fall outside these “narrow” circumstances. The Supreme Court has struck down other laws that attempted to restrict the dissemination of protected speech to minors, including laws involving violent video games and movies with nudity. Social media allows minors to access a broad array of protected speech, meaning a law restricting minors’ access to social media may have a greater impact on minors’ speech rights than narrower laws the Supreme Court has previously struck down. Pornography age verification laws may also impact minors’ access to constitutionally protected material. State laws that seek to mandate age verification for pornography often apply to “material harmful to minors,” a term that tracks the language used by the Supreme Court in Ginsberg v. New York and Miller v. California. Although the Supreme Court has upheld restrictions on physical distribution of material harmful to minors, federal appellate courts have raised issues with such restrictions as they might apply on the internet. For example, the Third Circuit held in multiple decisions that COPA’s definition of “material that is harmful to minors” was unconstitutionally vague and overbroad. The Miller definition of obscenity depends on whether “the average person, applying contemporary community standards” would find that the material in question “appeals to the prurient interest.” Definitions of material “harmful to minors” incorporate this language and specify that the question is whether someone “applying contemporary community standards” would find the material “appeals to the prurient interest” of minors. In cases that involve physical distribution of offensive material, the relevant “community standards” are those of the material’s recipient. The Third Circuit observed that applying a “contemporary community standards” requirement to internet communications, which are typically available worldwide, would subject all material on the internet to the standards of “the most puritanical communities.” The Supreme Court has not decided how to apply “contemporary community standards” to internet communications, beyond concluding that the use of “contemporary community standards” alone did not render COPA unconstitutional. Some Justices have expressed support for a nationwide Congressional Research Service 4 “community standard,” while other Justices have suggested that the standards should depend on where material is received, as is the case with laws that do not involve the internet.",Legal,Summarize,Text Transformation Formulate your answer using only the provided text; do not draw from any outside sources.,What is HR 4319?,"Background on the 2024 Farmworker Protection Rule DOL indicates that the purpose of the Farmworker Protection Rule is to strengthen “protections for agricultural workers,” enhance the agency’s “capabilities to monitor H-2A program compliance and take necessary enforcement actions against program violators,” and ensure that “hiring H-2A workers does not adversely affect the wages and working conditions of similarly employed workers” in the United States. The rule amends existing regulations and includes provisions that encompass six areas: (1) “protections for worker voice and empowerment,” (2) “clarification of termination for cause,” (3) “immediate effective date for updated adverse effect wage rate,” (4) “enhanced transparency for job opportunity and foreign labor recruitment,” (5) “enhanced transparency and protections for agricultural workers,” and (6) “enhanced integrity and enforcement capabilities.” In the pending litigation, the first set of provisions, i.e., “protections for worker voice and empowerment” is most relevant. This set revises 20 C.F.R. § 655.135(h) and adds two new subsections, (m) and (n). DOL has stated that these provisions aim to protect H-2A workers by “explicitly protecting certain activities all workers must be able to engage in without fear of intimidation, threats, and other forms of retaliation”; safeguarding “collective action and concerted activity for mutual aid and protection”; allowing workers to decline to listen to “employer speech regarding protected activities without fear of retaliation”; permitting workers to “designate a representative of their choosing in certain interviews”; and authorizing workers to “invite or accept guests to worker housing.” The rule states that it “does not require employers to recognize labor organizations or to engage in any collective bargaining activities such as those that may be required by the [National Labor Relations Act].” The National Labor Relations Act (NLRA) is a law that gives collective bargaining rights to workers who qualify as “employees” under the definition in the statute. The NLRA explicitly excludes agricultural workers from the definition of “employee.” Kansas v. U.S. Department of Labor On June 10, 2024, Kansas and 16 other states, a trade association of growers, and a private farm filed a complaint against DOL in the U.S. District Court for the Southern District of Georgia, arguing, among other things, that the Farmworker Protection Rule violates the NLRA because it gives H-2A agricultural workers collective bargaining rights when the NLRA explicitly excludes agricultural workers from having those rights. The plaintiffs subsequently filed a motion for a preliminary injunction and temporary restraining order seeking a stay of the effective date of the Farmworker Protection Rule or, in the alternative, a temporary restraining order until the court grants an injunction. The court held a hearing on the motion on August 2, 2024, and on August 26, 2024, the federal district court judge granted the plaintiffs’ motion for a preliminary injunction. Plaintiffs’ Arguments The arguments below were raised in the plaintiffs’ motion for preliminary injunction. This Sidebar does not cover every argument the plaintiffs advanced. The Rule Violates the NLRA The plaintiffs argued that the rule is not in accordance with existing law and that DOL is providing collective bargaining protection to H-2A workers. According to the plaintiffs, parts of the rule are almost a direct copy of certain provisions in the NLRA, such as those regarding unfair labor practices and representatives and elections. The plaintiffs acknowledged that the rule does not expressly declare that H2A workers have a right to unionize and collectively bargain, but they claim that the protections conferred by the rule effectively confer such rights in contravention of the NLRA. The Rule Exceeds DOL’s Authority Under the INA The plaintiffs also argued that DOL has very limited authority to issue regulations under 8 U.S.C. § 1188. Specifically, the plaintiffs state that Section 1188(a), which is the part of the statute DOL relied on to promulgate the rule, is being misinterpreted by the agency. According to the plaintiffs, DOL is supposed to neutralize any adverse effects from an influx of H-2A workers and not necessarily take affirmative steps to improve the working conditions for H-2A workers. In addition, according to the plaintiffs, Section 1188(a) does not explicitly give DOL rulemaking authority. The plaintiffs filed this lawsuit before the Supreme Court’s decision in Loper Bright Enterprises v. Raimondo, which overturned the Chevron doctrine. The Chevron doctrine directed courts to defer to an agency’s reasonable interpretation of ambiguous statutes the agency administers. The plaintiffs argued that because Congress’s intent was clear in 8 U.S.C. § 1188, DOL was not entitled to Chevron deference. Relatedly, the plaintiffs pointed out that DOL relies on caselaw that existed before the Supreme Court overruled the Chevron doctrine rather than on the statute itself. DOL’s Arguments The arguments below were raised in DOL’s response to the plaintiffs’ motion for preliminary injunction. This Sidebar does not cover every argument DOL advanced. The Rule Does Not Violate the NLRA In summary, DOL argued that the rule does not require employers to recognize unions or engage in collective bargaining and is therefore not in violation of the NLRA. According to DOL, the rule expands on existing H-2A anti-discrimination provisions, and individuals who fall outside the NLRA’s definition of “employee” can still be protected by other statutes and regulations. DOL states that the rule does just that by granting protections to those not covered by the NLRA. Finally, DOL argues that the rule and the NLRA do not conflict with one another. The Rule Is a Proper Exercise of DOL’s Statutory Obligation DOL responded to the plaintiffs’ argument that the rule exceeded its authority by stating that the INA grants it rulemaking authority. DOL pointed out that provisions in 8 U.S.C. § 1188 expressly reference DOL regulations and that Congress authorized it to implement the mission of the statute through regulation. Further, DOL argued that H-2A workers will become more attractive to U.S. employers if they receive fewer protections than U.S. workers and that this in turn will “adversely affect” U.S. workers. The goal of the rule, according to DOL, is to place H-2A workers on similar footing as U.S. workers to prevent an adverse effect in the long run. Lastly, DOL maintained that it has historically understood the “adverse effect” requirement “as requiring parity between the terms and conditions of employment provided to H-2A workers ... and as establishing a baseline ‘acceptable’ standard for working conditions below which [U.S. workers] would be adversely affected.” DOL filed its response after the Supreme Court announced the overruling of Chevron in Loper Bright Enterprises. Citing Loper Bright Enterprises in a footnote, DOL argued that the best reading of Section 1188 was that Congress had delegated to DOL broad, discretionary authority to take action to prevent adverse effects to workers in the United States. The agency claimed that the rule is an appropriate exercise of this discretionary authority, including because the rule “ensures that agricultural employers cannot use the H-2A workforce to undermine workers in the United States who seek better wages and working conditions.”","Formulate your answer using only the provided text; do not draw from any outside sources. Provided text: The Court’s Order on the Motion for Preliminary Injunction On August 26, 2024, a federal district court judge granted the plaintiffs’ motion for preliminary injunction. The judge found that the plaintiffs met their burden to show that they were entitled to preliminary relief. First, the judge held that the plaintiffs were likely to succeed on the merits of their case. The judge initially determined that the rule falls within DOL’s rulemaking authority under 8 U.S.C. § 1188 but found that the rule conflicts with the NLRA. Specifically, the judge stated that DOL had “not shown a consequential difference between the rights protected by the [rule] and those given to nonagricultural workers by the NLRA,” that the rule “creates a right not previously bestowed by Congress,” and that DOL failed to show that Congress intended to give agricultural workers a right to participate in collective bargaining. The judge further found that just because DOL has rulemaking authority does not mean it can “create law or protect newly-created rights of agricultural workers.” Therefore, the court held that the plaintiffs were likely to succeed on the merits of their claim. The judge further held that the plaintiffs met their burden with regard to the other factors needed to support a preliminary injunction. The judge also found that, although the plaintiffs were entitled to preliminary relief, that relief should be narrowly tailored and party-specific. According to the court, nationwide relief is generally disfavored, as “national uniformity is not a proper consideration,” and a nationwide injunction in this case is unwarranted. The judge determined that the court is able to provide a tailored preliminary injunction that addresses the plaintiffs’ harms and can offer relief “without issuing a nationwide injunction.” DOL filed a motion for reconsideration of the scope of the judge’s order, but the motion was denied. Considerations for Congress Members of Congress have taken differing views on the Farmworker Protection Rule. Before the rule was finalized, several Members of Congress wrote a letter in November 2023 to Acting DOL Secretary Su and DHS Secretary Mayorkas in support of the rule, stating that the rule represents an opportunity to improve working conditions for H-2A workers and “improve enforcement capabilities of agencies against abusive employers.” Following the rule’s publication in April 2024, Representative Scott Franklin introduced a resolution of disapproval under the Congressional Review Act to rescind the rule, H.J. Res. 135. This resolution would prohibit DOL from any future similar rulemaking. He and the co-sponsors maintain that the rule will increase costs for agricultural producers and allow H-2A workers to unionize. There are other options if Congress chooses to respond to DOL’s Farmworker Protection Rule. First, Congress may consider amending the NLRA’s definition of “employee” to include agricultural workers, thereby allowing H-2A agricultural workers to receive collective bargaining rights. Alternatively, Congress could amend the NLRA and other laws to authorize or prohibit different labor requirements contained in the Farmworker Protection Rule that are not expressly addressed under existing statutes. Congress could also consider making changes to the H-2A visa program itself. For example, the Affordable and Secure Food Act (S. 4069) in the 118th Congress would, among other things, reform the H-2A visa program by adding worker protections and by providing visas for year-round jobs. A similar bill, the Farm Workforce Modernization Act of 2023 (H.R. 4319), has been introduced in the House during this Congress. Earlier versions of this bill introduced in the 116th and 117th Congresses passed the House. What is HR 4319?",Legal,Fact Finding,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Discuss how Sensory Processing Sensitivity is currently measured and what some of the impacts that Sensory Processing Sensitivity would have on someone's everyday life or activities.,"Sensory Processing Sensitivity (SPS) is considered a temperament or personality trait. It refers to a person's sensitivity to subtle environmental stimuli, the depth and intensity with which these stimuli are processed, and the impact this has in terms of emotional and physiological reactivity (e.g., the extent to which a person is easily disturbed by crowds and chaotic situations and the consequent need to withdraw and unwind). A highly sensitive person is characterised by a (greatly) increased degree of SPS. Since the existing limited scientific research suggested that there is a link between high SPS and the development of mental and physical symptoms (such as fatigue), we conducted a number of studies on how the concept is measured, and what the possible link is with (other) personality traits and some clinical outcomes. In a first study, the psychometric properties of the Dutch version of the Highly Sensitive Person Scale (HSPS) developed by Aron and Aron (1997) were explored in a general population sample (N=998), a sample of patients suffering from (chronic) fatigue complaints (N=340), and a sample of chronic pain patients (N=337). Results demonstrated that the scale was a valid and reliable measure of the ‘Sensory Processing Sensitivity’ construct. A bi-factor model, consisting of a general sensitivity factor and three separate factors, provided the best fit to the data in each sample. The three separate factors, capturing different dimensions of sensory processing sensitivity, were labelled ‘Ease of Excitation’, ‘Sensory and Aesthetic Sensitivity’, and ‘Low Sensory Threshold’. Distinct patterns of associations were found between these factors and the Big Five personality traits (De Gucht et al., 2023). During the validation process of the HSPS it became apparent that this scale offers a restricted perspective on the Sensory Processing Sensitivity concept. Based on the current literature, several different dimensions can be distinguished within this concept, namely (1) (heightened) sensitivity to (subtle) sensory stimuli, including neutral perceptual sensitivity to both internal and external stimuli, affective sensitivity, and associative sensitivity, (2) sensory discomfort, and (3) emotional or physiological reactivity. The fact that these dimensions are not adequately covered by the HSPS developed by Aron & Aron (1997) was the starting point for study 2, focusing on the development of a more comprehensive scale, the Sensory Processing Sensitivity Questionnaire (SPSQ). The item pool generated for the development of the SPSQ consisted of 60 items. After exploratory factor analysis, 43 items remained, divided into six specific factors: (1) Sensory Sensitivity to Subtle Internal and External Stimuli, (2) Emotional and Physiological Reactivity, (3) Sensory Discomfort, (4) Sensory Comfort, (5) Social-Affective Sensitivity, and (6) Aesthetic Sensitivity. Confirmatory factor analysis indicated that a higher-order bi-factor model consisting of two higher-order factors (a positive and negative dimension), a general sensitivity factor and six specific factors had the best fit. Strong positive associations were found between Emotional and Physiological Reactivity, the negative higher-order dimension, and Neuroticism; the same holds for the association between Aesthetic Sensitivity, the positive higher-order dimension, and Openness. Emotional and Physiological Reactivity and the negative higher-order dimension showed clear associations with clinical outcomes (i.e., anxiety, depression, somatic complaints, and fatigue) (De Gucht et al., 2022). With 43 items, the SPSQ is an extensive questionnaire. Incorporating such a questionnaire in research including multiple variables may lead to surveys becoming quite long. One of the problems with long surveys is that they often result in lower response rates, which can have an impact on the generalizability of the findings due to non-response bias. For this reason, we decided to develop a short form (study 3), similar in content and structure to the original scale, and possessing strong psychometric qualities. Such an abbreviated version of the SPSQ has the advantage of measuring many both positive and negative characteristics of SPS and doing so using a limited number of items. The Short Form (SPSQ-SF) was developed using a split-sample validation design. Within a large selection sample, items were retained based on impact on internal consistency reliability, fit to the hierarchical structure of the original SPSQ, and information curves based on a Graded Response Model. In the replication sample, the dimensionality and fit to the latent structure of the SPSQ were evaluated. The results of our study indicate a good fit of the SPSQ-SF. It is strongly correlated to the original SPSQ. Convergent, discriminant and concurrent validity was established in relation to other instruments measuring aspects of SPS, Big Five personality traits and clinical outcomes, respectively (De Gucht & Woestenburg, manuscript submitted for publication).","[question] Discuss how Sensory Processing Sensitivity is currently measured and what some of the impacts that Sensory Processing Sensitivity would have on someone's everyday life or activities. ===================== [text] Sensory Processing Sensitivity (SPS) is considered a temperament or personality trait. It refers to a person's sensitivity to subtle environmental stimuli, the depth and intensity with which these stimuli are processed, and the impact this has in terms of emotional and physiological reactivity (e.g., the extent to which a person is easily disturbed by crowds and chaotic situations and the consequent need to withdraw and unwind). A highly sensitive person is characterised by a (greatly) increased degree of SPS. Since the existing limited scientific research suggested that there is a link between high SPS and the development of mental and physical symptoms (such as fatigue), we conducted a number of studies on how the concept is measured, and what the possible link is with (other) personality traits and some clinical outcomes. In a first study, the psychometric properties of the Dutch version of the Highly Sensitive Person Scale (HSPS) developed by Aron and Aron (1997) were explored in a general population sample (N=998), a sample of patients suffering from (chronic) fatigue complaints (N=340), and a sample of chronic pain patients (N=337). Results demonstrated that the scale was a valid and reliable measure of the ‘Sensory Processing Sensitivity’ construct. A bi-factor model, consisting of a general sensitivity factor and three separate factors, provided the best fit to the data in each sample. The three separate factors, capturing different dimensions of sensory processing sensitivity, were labelled ‘Ease of Excitation’, ‘Sensory and Aesthetic Sensitivity’, and ‘Low Sensory Threshold’. Distinct patterns of associations were found between these factors and the Big Five personality traits (De Gucht et al., 2023). During the validation process of the HSPS it became apparent that this scale offers a restricted perspective on the Sensory Processing Sensitivity concept. Based on the current literature, several different dimensions can be distinguished within this concept, namely (1) (heightened) sensitivity to (subtle) sensory stimuli, including neutral perceptual sensitivity to both internal and external stimuli, affective sensitivity, and associative sensitivity, (2) sensory discomfort, and (3) emotional or physiological reactivity. The fact that these dimensions are not adequately covered by the HSPS developed by Aron & Aron (1997) was the starting point for study 2, focusing on the development of a more comprehensive scale, the Sensory Processing Sensitivity Questionnaire (SPSQ). The item pool generated for the development of the SPSQ consisted of 60 items. After exploratory factor analysis, 43 items remained, divided into six specific factors: (1) Sensory Sensitivity to Subtle Internal and External Stimuli, (2) Emotional and Physiological Reactivity, (3) Sensory Discomfort, (4) Sensory Comfort, (5) Social-Affective Sensitivity, and (6) Aesthetic Sensitivity. Confirmatory factor analysis indicated that a higher-order bi-factor model consisting of two higher-order factors (a positive and negative dimension), a general sensitivity factor and six specific factors had the best fit. Strong positive associations were found between Emotional and Physiological Reactivity, the negative higher-order dimension, and Neuroticism; the same holds for the association between Aesthetic Sensitivity, the positive higher-order dimension, and Openness. Emotional and Physiological Reactivity and the negative higher-order dimension showed clear associations with clinical outcomes (i.e., anxiety, depression, somatic complaints, and fatigue) (De Gucht et al., 2022). With 43 items, the SPSQ is an extensive questionnaire. Incorporating such a questionnaire in research including multiple variables may lead to surveys becoming quite long. One of the problems with long surveys is that they often result in lower response rates, which can have an impact on the generalizability of the findings due to non-response bias. For this reason, we decided to develop a short form (study 3), similar in content and structure to the original scale, and possessing strong psychometric qualities. Such an abbreviated version of the SPSQ has the advantage of measuring many both positive and negative characteristics of SPS and doing so using a limited number of items. The Short Form (SPSQ-SF) was developed using a split-sample validation design. Within a large selection sample, items were retained based on impact on internal consistency reliability, fit to the hierarchical structure of the original SPSQ, and information curves based on a Graded Response Model. In the replication sample, the dimensionality and fit to the latent structure of the SPSQ were evaluated. The results of our study indicate a good fit of the SPSQ-SF. It is strongly correlated to the original SPSQ. Convergent, discriminant and concurrent validity was established in relation to other instruments measuring aspects of SPS, Big Five personality traits and clinical outcomes, respectively (De Gucht & Woestenburg, manuscript submitted for publication). https://www.universiteitleiden.nl/en/research/research-projects/social-and-behavioural-sciences/hypersensitivity-stimulus-perception-information-processing-and-reporting-of-emotional-and-somatic-symptoms ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Medical,Effect Analysis,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]","Please summarize what Montelukast is used for and tell me if there are any serious side effects. This is important to me, so please be detained and provide your response in two paragraphs.","Why is this medication prescribed? Montelukast is used to prevent wheezing, difficulty breathing, chest tightness, and coughing caused by asthma in adults and children 12 months of age and older. Montelukast is also used to prevent bronchospasm (breathing difficulties) during exercise in adults and children 6 years of age and older. Montelukast is also used to treat the symptoms of seasonal (occurs only at certain times of the year), allergic rhinitis (a condition associated with sneezing and stuffy, runny or itchy nose) in adults and children 2 years of age and older, and perennial (occurs all year round) allergic rhinitis in adults and children 6 months of age and older. Montelukast should be used to treat seasonal or perennial allergic rhinitis only in adults and children who cannot be treated with other medications. Montelukast is in a class of medications called leukotriene receptor antagonists (LTRAs). It works by blocking the action of substances in the body that cause the symptoms of asthma and allergic rhinitis. How should this medicine be used? Montelukast comes as a tablet, a chewable tablet, and granules to take by mouth. Montelukast is usually taken once a day with or without food. When montelukast is used to treat asthma, it should be taken in the evening. When montelukast is used to prevent breathing difficulties during exercise, it should be taken at least 2 hours before exercise. If you are taking montelukast once a day on a regular basis, or if you have taken a dose of montelukast within the past 24 hours, you should not take an additional dose before exercising. When montelukast is used to treat allergic rhinitis, it may be taken at any time of day. Take montelukast at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take montelukast exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. If you are giving the granules to your child, you should not open the foil pouch until your child is ready to take the medication. You may pour all of the granules directly from the packet into your child's mouth to be swallowed immediately. Do not use montelukast to treat a sudden attack of asthma symptoms. Your doctor will prescribe a short-acting inhaler to use during attacks. Talk to your doctor about how to treat symptoms of a sudden asthma attack. If your asthma symptoms get worse or if you have asthma attacks more often, be sure to call your doctor. If you are taking montelukast to treat asthma, continue to take or use all other medications that your doctor has prescribed to treat your asthma. Do not stop taking any of your medications or change the doses of any of your medications unless your doctor tells you that you should. If your asthma is made worse by aspirin, do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) during your treatment with montelukast. Montelukast controls the symptoms of asthma and allergic rhinitis but does not cure these conditions. Continue to take montelukast even if you feel well. Do not stop taking montelukast without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking montelukast, tell your doctor and pharmacist if you are allergic to montelukast or any other medications, or any of the ingredients in montelukast tablet, chewable tablet, or granules. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention gemfibrozil (Lopid), phenobarbital and rifampin (Rifadin, Rimactane, in Rifamate, Rifater). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects. tell your doctor if you have or have ever had liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking montelukast, call your doctor. if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent damage to your brain that can cause severe intellectual disability), you should know that the chewable tablets contain aspartame that forms phenylalanine. What special dietary instructions should I follow? Unless your doctor tells you otherwise, continue your normal diet. What should I do if I forget a dose? Skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Do not take more than one dose of montelukast in a 24 hour period. What side effects can this medication cause? Montelukast may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: headache heartburn stomach pain tiredness diarrhea"," Only use the provided text to answer the question, no outside sources. Please summarize what Montelukast is used for and tell me if there are any serious side effects. This is important to me, so please be detained and provide your response in two paragraphs. Why is this medication prescribed? Montelukast is used to prevent wheezing, difficulty breathing, chest tightness, and coughing caused by asthma in adults and children 12 months of age and older. Montelukast is also used to prevent bronchospasm (breathing difficulties) during exercise in adults and children 6 years of age and older. Montelukast is also used to treat the symptoms of seasonal (occurs only at certain times of the year), allergic rhinitis (a condition associated with sneezing and stuffy, runny or itchy nose) in adults and children 2 years of age and older, and perennial (occurs all year round) allergic rhinitis in adults and children 6 months of age and older. Montelukast should be used to treat seasonal or perennial allergic rhinitis only in adults and children who cannot be treated with other medications. Montelukast is in a class of medications called leukotriene receptor antagonists (LTRAs). It works by blocking the action of substances in the body that cause the symptoms of asthma and allergic rhinitis. How should this medicine be used? Montelukast comes as a tablet, a chewable tablet, and granules to take by mouth. Montelukast is usually taken once a day with or without food. When montelukast is used to treat asthma, it should be taken in the evening. When montelukast is used to prevent breathing difficulties during exercise, it should be taken at least 2 hours before exercise. If you are taking montelukast once a day on a regular basis, or if you have taken a dose of montelukast within the past 24 hours, you should not take an additional dose before exercising. When montelukast is used to treat allergic rhinitis, it may be taken at any time of day. Take montelukast at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take montelukast exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. If you are giving the granules to your child, you should not open the foil pouch until your child is ready to take the medication. You may pour all of the granules directly from the packet into your child's mouth to be swallowed immediately. Do not use montelukast to treat a sudden attack of asthma symptoms. Your doctor will prescribe a short-acting inhaler to use during attacks. Talk to your doctor about how to treat symptoms of a sudden asthma attack. If your asthma symptoms get worse or if you have asthma attacks more often, be sure to call your doctor. If you are taking montelukast to treat asthma, continue to take or use all other medications that your doctor has prescribed to treat your asthma. Do not stop taking any of your medications or change the doses of any of your medications unless your doctor tells you that you should. If your asthma is made worse by aspirin, do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) during your treatment with montelukast. Montelukast controls the symptoms of asthma and allergic rhinitis but does not cure these conditions. Continue to take montelukast even if you feel well. Do not stop taking montelukast without talking to your doctor. Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient. Other uses for this medicine This medication may be prescribed for other uses; ask your doctor or pharmacist for more information. What special precautions should I follow? Before taking montelukast, tell your doctor and pharmacist if you are allergic to montelukast or any other medications, or any of the ingredients in montelukast tablet, chewable tablet, or granules. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention gemfibrozil (Lopid), phenobarbital and rifampin (Rifadin, Rimactane, in Rifamate, Rifater). Your doctor may need to change the doses of your medications or monitor you more carefully for side effects. tell your doctor if you have or have ever had liver disease. tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking montelukast, call your doctor. if you have phenylketonuria (PKU, an inherited condition in which a special diet must be followed to prevent damage to your brain that can cause severe intellectual disability), you should know that the chewable tablets contain aspartame that forms phenylalanine. What special dietary instructions should I follow? Unless your doctor tells you otherwise, continue your normal diet. What should I do if I forget a dose? Skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one. Do not take more than one dose of montelukast in a 24 hour period. What side effects can this medication cause? Montelukast may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away: headache heartburn stomach pain tiredness diarrhea https://medlineplus.gov/druginfo/meds/a600014.html",Medical,Find & Summarize,Text Transformation Only include information available in the following text in your answer. Do not use any information or prior knowledge not included in the text. Limit your answer to 600 words or less.,How do the three new variables in the UTAUT 2 model improve our understanding of continued usage of Spotify Premium?,"Due to technological advancement, technology acceptance and adoption became an important and distinct topic of this study, especially regarding e-commerce (Rahi et al., 2020). The UTAUT 2 model was developed in research by Venkatesh et al. (2012) to enhance the explanatory power of the previous UTAUT version (Venkatesh et al., 2003). The original UTAUT model which consist of four variables which is effort expectancy (EE), performance expectancy (PE) facilitating condition (FC) and social influence (SI), was highly used by scholars to predict the intention to use new technology. Despite its’ popularity, the model was not lacking of criticism due to its incapability to include essential determinant of technology usage behaviour (Beh et al., 2019). To overcome those criticism, Venkatesh et al. (2012) compensate the limitation of the original UTAUT with the additional three variables which is habit (HB), hedonic motivation (HM) and price value (PV). On top of that, the UTAUT 2 also focusing to the post usage behaviour. Various literature has confirming that the capability of the UTAUT 2 in explaining the continuance behaviour of technology usage. Since Spotify Premium is considered a new technology in music industry, thus, it suits well with the concept in UTAUT. Furthermore, despite having high explanatory power, (Rondan-Cataluña et al., 2015) confirmed that UTAUT 2 has better predictive power compared to other technological acceptance model. Thus, provide a valid reason why the study relies on this model to predict continuance behaviour of subscribing the Spotify Premium among university students in Malaysia. Unravelling the continue of subscribing Spotify Premium 5 2.2 BI BI can be categorised as intention to use of continue of use of particular services. In the context of this study, BI refers to the intention to continue of subscribing the Spotify Premium. Continue of use always related to the behavioural of loyalty (Han et al., 2009). Since many of music streaming available in the market and each providers are offering unique features (Weinberger and Bouhnik, 2020), thus, critical to understand the reason behind the continued use of the application so that the service providers can guarantee their service remain competitive, for business sustainability and the ability to survive in a tough business environment. It is useless for the company to enhance its services if they fail to retain current customers or attract new clients. Furthermore, to increase the continue of use could be considered as a main goal in the service providers (Batouei et al., 2020). 2.3 EE EE is the level of convenience consumers experience when utilising a technology (Venkatesh et al., 2012). In this research, EE refers to the convenience of Spotify Premium usage among university students in Malaysia. Moreover, convenience refers to the ease in application usage; thus, the higher intention to use and continued usage. Also, university students classified as Generation Y (Gen. Y) are closely connected with technology use and thus experienced ease in utilising the Spotify Premium. Hence, EE is expected to produce a positive relationship with BI to continue the Spotify Premium subscription. Strengthened by a previous study, which discovered that EE has a positive relationship with BI regarding the usage of smartwatch (Beh et al., 2019), mobile financial services (Rahman et al., 2020), continued music streaming subscription (Lüders, 2020) and e-hailing technology. Therefore, this study proposes the following: Hypothesis 1 (H1) EE has a positive relationship with BI of Spotify Premium subscription. 2.4 FC FC’s refer to a person’s beliefs in the technical support available to advocate new technology use (Venkatesh et al., 2012). This study examined the availability of Spotify’s support for premium subscribers concerning the application. Paid music services require fast and up-to-date technology, namely advanced electronic equipment and an internet connection to ensure smooth and seamless music streaming. FC’s such as the skills and ability to handle the devices are crucial factors and predictors of BI due to rapid technological changes in the music streaming industry, such as computers, smartphones, tablets, the internet, online customer support (Pinochet et al., 2019). This research examined previous literature in proving the positive relationship between FC and BI, such as the study by Beh et al. (2019) and Rahman et al. (2020). University students also found that FC and BI was positively related in the context of learning management system (Sharif et al., 2019). Hence, this paper proposed that: Hypothesis 2 (H2) FC has positive effects on the BI of the Spotify Premium subscription. 6 M.S.M. Suhod et al. 2.5 Habit Habit (HB) is the extent to which an individual believes his behaviour is a result of experience; the individual tends to perform that behaviour automatically based on learning from past experience (Venkatesh et al., 2012). Habit occurs when one consistently performs an activity, such as when they experience joy and happiness while performing the activities or when the activity suits the individual. According to Soares et al. (2020), habit could be influenced by past behaviour and personal experience in applying particular system or products. If past experience produced favourable results, there is high tendency to transform the particular behaviour to become a habit. Past studies showed that habit produced a positive relationship with BI (Ameri et al., 2020; Nikolopoulou et al., 2020; Soares et al., 2020). From that, the study proposed: Hypothesis 3 (H3) Habit has positive effects on BI of Spotify Premium subscription 2.6 HM HM is the enjoyment or pleasure from technology usage (Venkatesh et al., 2012). This study defined HM as the enjoyment of Spotify Premium usage to enjoy music streaming. Based on research by Beh et al. (2019), HM showed a positive relationship with BI in the usage of smartwatches. Plus, Greece university students showed that their HM had a positive relationship with BI concerning mobile phone usage (Nikolopoulou et al., 2020). Hence, this paper suggested: Hypothesis 4 (H4) HM produced a positive effect on the BI of the Spotify Premium subscription. 2.7 PE PE refers to the competence of applications or new technology to assist users in performing certain activities substantially and conveniently (Venkatesh et al., 2012). A study by Malik (2017) stated that users are more interested in applications that improve their performance and productivity through better content knowledge and thus resulting in content awareness and the ability to provide an application that performs well. Previous studies on the continued use of technology discovered that PE has a positive relationship with BI (Ameri et al., 2020; Nikolopoulou et al., 2020; Rahman et al., 2020). With regards to that, the study proposed: Hypothesis 5 (H5) PE has a positive effect on the BI of Spotify Premium subscription. 2.8 PV PV refers to the relationship between consumers’ cognitive trade-off between the benefits gained versus the amount paid for the services (Venkatesh et al., 2012). Spotify Premium users will continue their subscription if the subscription is worth paying based on the services provided. Plus, when there is beneficial experience from using the Spotify Premium, or the received benefits are greater than the cost. Previously, it was discovered that the PV has a positive relationship with the continued subscription of music streaming services (Lüders, 2020). Unravelling the continue of subscribing Spotify Premium 7 Additionally, the PV created a positive relationship with the BI on the continued subscription to music streaming (Lüders, 2020) and continued use of mobile financial services (Rahman et al., 2020). Consequently, the study proposed: Hypothesis 6 (H6) PV produced positive effects on the BI of Spotify Premium subscription. 2.9 SI According to Venkatesh et al. (2012), SI refers to the extent of family and friend’s influence on consumers in terms of the decision to use technology. In this particular research, SI is the extent to which a university student perceives the influential person can cause them to believe that they should subscribe to Spotify Premium. Since in campus life, majority of the students spent their time with their colleague and they tend to share the experience with their people around them. Hence, what are their surrounding behaviour and thinking will have an impact in their daily life. Family and friend’s perception will influence the students’ decision. Furthermore, most students are encouraged by trend and peer pressure. SI has a positive relationship with the BI of pharmacy students’ continued use of the mobile-based educational application (Ameri et al., 2020) and Greece students’ continued use of mobile phones in their study (Nikolopoulou et al., 2020). Therefore, the study suggested:","Only include information available in the following text in your answer. Do not use any information or prior knowledge not included in the text. Limit your answer to 600 words or less. Due to technological advancement, technology acceptance and adoption became an important and distinct topic of this study, especially regarding e-commerce (Rahi et al., 2020). The UTAUT 2 model was developed in research by Venkatesh et al. (2012) to enhance the explanatory power of the previous UTAUT version (Venkatesh et al., 2003). The original UTAUT model which consist of four variables which is effort expectancy (EE), performance expectancy (PE) facilitating condition (FC) and social influence (SI), was highly used by scholars to predict the intention to use new technology. Despite its’ popularity, the model was not lacking of criticism due to its incapability to include essential determinant of technology usage behaviour (Beh et al., 2019). To overcome those criticism, Venkatesh et al. (2012) compensate the limitation of the original UTAUT with the additional three variables which is habit (HB), hedonic motivation (HM) and price value (PV). On top of that, the UTAUT 2 also focusing to the post usage behaviour. Various literature has confirming that the capability of the UTAUT 2 in explaining the continuance behaviour of technology usage. Since Spotify Premium is considered a new technology in music industry, thus, it suits well with the concept in UTAUT. Furthermore, despite having high explanatory power, (Rondan-Cataluña et al., 2015) confirmed that UTAUT 2 has better predictive power compared to other technological acceptance model. Thus, provide a valid reason why the study relies on this model to predict continuance behaviour of subscribing the Spotify Premium among university students in Malaysia. Unravelling the continue of subscribing Spotify Premium 5 2.2 BI BI can be categorised as intention to use of continue of use of particular services. In the context of this study, BI refers to the intention to continue of subscribing the Spotify Premium. Continue of use always related to the behavioural of loyalty (Han et al., 2009). Since many of music streaming available in the market and each providers are offering unique features (Weinberger and Bouhnik, 2020), thus, critical to understand the reason behind the continued use of the application so that the service providers can guarantee their service remain competitive, for business sustainability and the ability to survive in a tough business environment. It is useless for the company to enhance its services if they fail to retain current customers or attract new clients. Furthermore, to increase the continue of use could be considered as a main goal in the service providers (Batouei et al., 2020). 2.3 EE EE is the level of convenience consumers experience when utilising a technology (Venkatesh et al., 2012). In this research, EE refers to the convenience of Spotify Premium usage among university students in Malaysia. Moreover, convenience refers to the ease in application usage; thus, the higher intention to use and continued usage. Also, university students classified as Generation Y (Gen. Y) are closely connected with technology use and thus experienced ease in utilising the Spotify Premium. Hence, EE is expected to produce a positive relationship with BI to continue the Spotify Premium subscription. Strengthened by a previous study, which discovered that EE has a positive relationship with BI regarding the usage of smartwatch (Beh et al., 2019), mobile financial services (Rahman et al., 2020), continued music streaming subscription (Lüders, 2020) and e-hailing technology. Therefore, this study proposes the following: Hypothesis 1 (H1) EE has a positive relationship with BI of Spotify Premium subscription. 2.4 FC FC’s refer to a person’s beliefs in the technical support available to advocate new technology use (Venkatesh et al., 2012). This study examined the availability of Spotify’s support for premium subscribers concerning the application. Paid music services require fast and up-to-date technology, namely advanced electronic equipment and an internet connection to ensure smooth and seamless music streaming. FC’s such as the skills and ability to handle the devices are crucial factors and predictors of BI due to rapid technological changes in the music streaming industry, such as computers, smartphones, tablets, the internet, online customer support (Pinochet et al., 2019). This research examined previous literature in proving the positive relationship between FC and BI, such as the study by Beh et al. (2019) and Rahman et al. (2020). University students also found that FC and BI was positively related in the context of learning management system (Sharif et al., 2019). Hence, this paper proposed that: Hypothesis 2 (H2) FC has positive effects on the BI of the Spotify Premium subscription. 6 M.S.M. Suhod et al. 2.5 Habit Habit (HB) is the extent to which an individual believes his behaviour is a result of experience; the individual tends to perform that behaviour automatically based on learning from past experience (Venkatesh et al., 2012). Habit occurs when one consistently performs an activity, such as when they experience joy and happiness while performing the activities or when the activity suits the individual. According to Soares et al. (2020), habit could be influenced by past behaviour and personal experience in applying particular system or products. If past experience produced favourable results, there is high tendency to transform the particular behaviour to become a habit. Past studies showed that habit produced a positive relationship with BI (Ameri et al., 2020; Nikolopoulou et al., 2020; Soares et al., 2020). From that, the study proposed: Hypothesis 3 (H3) Habit has positive effects on BI of Spotify Premium subscription 2.6 HM HM is the enjoyment or pleasure from technology usage (Venkatesh et al., 2012). This study defined HM as the enjoyment of Spotify Premium usage to enjoy music streaming. Based on research by Beh et al. (2019), HM showed a positive relationship with BI in the usage of smartwatches. Plus, Greece university students showed that their HM had a positive relationship with BI concerning mobile phone usage (Nikolopoulou et al., 2020). Hence, this paper suggested: Hypothesis 4 (H4) HM produced a positive effect on the BI of the Spotify Premium subscription. 2.7 PE PE refers to the competence of applications or new technology to assist users in performing certain activities substantially and conveniently (Venkatesh et al., 2012). A study by Malik (2017) stated that users are more interested in applications that improve their performance and productivity through better content knowledge and thus resulting in content awareness and the ability to provide an application that performs well. Previous studies on the continued use of technology discovered that PE has a positive relationship with BI (Ameri et al., 2020; Nikolopoulou et al., 2020; Rahman et al., 2020). With regards to that, the study proposed: Hypothesis 5 (H5) PE has a positive effect on the BI of Spotify Premium subscription. 2.8 PV PV refers to the relationship between consumers’ cognitive trade-off between the benefits gained versus the amount paid for the services (Venkatesh et al., 2012). Spotify Premium users will continue their subscription if the subscription is worth paying based on the services provided. Plus, when there is beneficial experience from using the Spotify Premium, or the received benefits are greater than the cost. Previously, it was discovered that the PV has a positive relationship with the continued subscription of music streaming services (Lüders, 2020). Unravelling the continue of subscribing Spotify Premium 7 Additionally, the PV created a positive relationship with the BI on the continued subscription to music streaming (Lüders, 2020) and continued use of mobile financial services (Rahman et al., 2020). Consequently, the study proposed: Hypothesis 6 (H6) PV produced positive effects on the BI of Spotify Premium subscription. 2.9 SI According to Venkatesh et al. (2012), SI refers to the extent of family and friend’s influence on consumers in terms of the decision to use technology. In this particular research, SI is the extent to which a university student perceives the influential person can cause them to believe that they should subscribe to Spotify Premium. Since in campus life, majority of the students spent their time with their colleague and they tend to share the experience with their people around them. Hence, what are their surrounding behaviour and thinking will have an impact in their daily life. Family and friend’s perception will influence the students’ decision. Furthermore, most students are encouraged by trend and peer pressure. SI has a positive relationship with the BI of pharmacy students’ continued use of the mobile-based educational application (Ameri et al., 2020) and Greece students’ continued use of mobile phones in their study (Nikolopoulou et al., 2020). How do the three new variables in the UTAUT 2 model improve on our understanding of continued usage of Spotify Premium?",Internet/Technology,Find & Summarize,Text Transformation "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.","What are the implications of the recent NCAA settlements, and what might it mean for the future of athlete compensation in college sports? Write in a minimum of 200 words.","Formal settlement documents were filed with the Northern District Court of California Friday to advance the settlement approval process to resolve class-action lawsuits involving the NCAA and the Atlantic Coast Conference, Big Ten Conference, Big 12 Conference, Pac-12 Conference and Southeastern Conference (Autonomy 5 conferences). The settlement documents address three cases – House v. NCAA, Hubbard v. NCAA and Carter v. NCAA – involving back damages and future benefits for Division I student-athletes. ""This is another important step in the ongoing effort to provide increased benefits to student-athletes while creating a stable and sustainable model for the future of college sports,"" said the commissioners of the five conferences and the NCAA president. ""While there is still much work to be done in the settlement approval process, this is a significant step toward establishing clarity for the future of all of Division I athletics while maintaining a lasting education-based model for college sports, ensuring the opportunity for student-athletes to earn a degree and the tools necessary to be successful in life after sports."" The Settlement The settlement addresses three primary issues: payment of back damages for claims relating to name, image and likeness (NIL), academic-related awards and other benefits; increased benefits from institutions to student-athletes going forward, including additional NIL opportunities for student-athletes directly with the institution; and eliminating scholarships limits in favor of roster limits. The settlement calls for total back damages of approximately $2.78 billion, to be paid over 10 years, equating to approximately $280 million annually with distribution of back damages as determined by plaintiffs. Going forward, the settlement allows the A5 conference member institutions (and other DI schools that choose to participate in the new structure) to provide increased benefits to student-athletes, including for NIL. If approved by the court, this model will allow schools to provide up to 22% of the average Autonomy 5 athletic media, ticket, and sponsorship revenue to student-athletes, starting in the 2025-26 academic year. The future model could result in student-athletes receiving $1.5 billion to $2 billion in new benefits annually. The new benefits that may be made available to student-athletes would be in addition to the myriad benefits currently provided to student-athletes, including free tuition, room & board, educational grants, academic support and tutoring, medical and mental health resources & support, nutrition resources & support, life skills development, superior coaching and training and extended medical coverage after they stop competing. Adding these existing benefits together with the benefits to be available under the new model, many A5 schools would be providing nearly 50 percent of athletics revenue to their student-athletes. Under the new model, institutions may pay student-athletes directly for their NIL rights. Any institutional NIL payments would apply toward the 22% cap. Third parties may continue to enter into NIL agreements with student-athletes. Such agreements will be subject to review to ensure they are legitimate, fair market value agreements and not used for pay-for-play. NIL payments by third parties would not apply toward the 22% cap but must be disclosed to a clearinghouse for review. The new model allows for the establishment of a robust and effective enforcement and oversight program to ensure the new NIL model achieves its objectives. The establishment of a clearinghouse for NIL payments over $600 would give institutions access to information about external NIL activities, providing a level of transparency that does not currently exist to allow for better management of third-party influence and better assurance of legitimate NIL activity. Lastly, scholarship limits will be eliminated in all sports, and roster limits will be established. Institutions have the discretion to offer partial or full scholarships provided they do not exceed the roster limits. This change will allow institutions to provide additional scholarships to student-athletes in the future. Next Steps The settlement must be approved by the court before it becomes final, a process expected to take several months. If the court preliminarily approves the settlement, the class members will be provided notice of the settlement. Class members with claims for monetary damages based on prior conduct will have an opportunity to opt out of the settlement if they choose. Class members—including incoming student-athletes—will also receive notice and be allowed to present objections to the future relief/model to the court. Unresolved Issues While approval of the settlement would be a significant step forward, there would still be pending issues to be addressed that highlight the continuing need for federal legislation. These issues include: The settlement does not resolve the patchwork of state laws, many of which may conflict with the settlement. These laws will need to be preempted by federal legislation in order for the settlement to be effective. The settlement does not address ongoing efforts to designate student-athletes as employees under state and federal labor and employment laws. These efforts by the NLRB and plaintiffs' attorneys pose a direct threat to both the sustainability of sports programs (especially for non-revenue generating ones) and to the baseline of support provided to all athletes. ""This settlement is an important step forward for student-athletes and college sports, but it does not address every challenge,"" said the A5 conference commissioners and NCAA president. ""The need for Federal legislation to provide solutions remains. If Congress does not act, the progress reached through the settlement could be significantly mitigated by state laws and continued litigation.""","[question] What are the implications of the recent NCAA settlements, and what might it mean for the future of athlete compensation in college sports? Write in a minimum of 200 words. ===================== [text] Formal settlement documents were filed with the Northern District Court of California Friday to advance the settlement approval process to resolve class-action lawsuits involving the NCAA and the Atlantic Coast Conference, Big Ten Conference, Big 12 Conference, Pac-12 Conference and Southeastern Conference (Autonomy 5 conferences). The settlement documents address three cases – House v. NCAA, Hubbard v. NCAA and Carter v. NCAA – involving back damages and future benefits for Division I student-athletes. ""This is another important step in the ongoing effort to provide increased benefits to student-athletes while creating a stable and sustainable model for the future of college sports,"" said the commissioners of the five conferences and the NCAA president. ""While there is still much work to be done in the settlement approval process, this is a significant step toward establishing clarity for the future of all of Division I athletics while maintaining a lasting education-based model for college sports, ensuring the opportunity for student-athletes to earn a degree and the tools necessary to be successful in life after sports."" The Settlement The settlement addresses three primary issues: payment of back damages for claims relating to name, image and likeness (NIL), academic-related awards and other benefits; increased benefits from institutions to student-athletes going forward, including additional NIL opportunities for student-athletes directly with the institution; and eliminating scholarships limits in favor of roster limits. The settlement calls for total back damages of approximately $2.78 billion, to be paid over 10 years, equating to approximately $280 million annually with distribution of back damages as determined by plaintiffs. Going forward, the settlement allows the A5 conference member institutions (and other DI schools that choose to participate in the new structure) to provide increased benefits to student-athletes, including for NIL. If approved by the court, this model will allow schools to provide up to 22% of the average Autonomy 5 athletic media, ticket, and sponsorship revenue to student-athletes, starting in the 2025-26 academic year. The future model could result in student-athletes receiving $1.5 billion to $2 billion in new benefits annually. The new benefits that may be made available to student-athletes would be in addition to the myriad benefits currently provided to student-athletes, including free tuition, room & board, educational grants, academic support and tutoring, medical and mental health resources & support, nutrition resources & support, life skills development, superior coaching and training and extended medical coverage after they stop competing. Adding these existing benefits together with the benefits to be available under the new model, many A5 schools would be providing nearly 50 percent of athletics revenue to their student-athletes. Under the new model, institutions may pay student-athletes directly for their NIL rights. Any institutional NIL payments would apply toward the 22% cap. Third parties may continue to enter into NIL agreements with student-athletes. Such agreements will be subject to review to ensure they are legitimate, fair market value agreements and not used for pay-for-play. NIL payments by third parties would not apply toward the 22% cap but must be disclosed to a clearinghouse for review. The new model allows for the establishment of a robust and effective enforcement and oversight program to ensure the new NIL model achieves its objectives. The establishment of a clearinghouse for NIL payments over $600 would give institutions access to information about external NIL activities, providing a level of transparency that does not currently exist to allow for better management of third-party influence and better assurance of legitimate NIL activity. Lastly, scholarship limits will be eliminated in all sports, and roster limits will be established. Institutions have the discretion to offer partial or full scholarships provided they do not exceed the roster limits. This change will allow institutions to provide additional scholarships to student-athletes in the future. Next Steps The settlement must be approved by the court before it becomes final, a process expected to take several months. If the court preliminarily approves the settlement, the class members will be provided notice of the settlement. Class members with claims for monetary damages based on prior conduct will have an opportunity to opt out of the settlement if they choose. Class members—including incoming student-athletes—will also receive notice and be allowed to present objections to the future relief/model to the court. Unresolved Issues While approval of the settlement would be a significant step forward, there would still be pending issues to be addressed that highlight the continuing need for federal legislation. These issues include: The settlement does not resolve the patchwork of state laws, many of which may conflict with the settlement. These laws will need to be preempted by federal legislation in order for the settlement to be effective. The settlement does not address ongoing efforts to designate student-athletes as employees under state and federal labor and employment laws. These efforts by the NLRB and plaintiffs' attorneys pose a direct threat to both the sustainability of sports programs (especially for non-revenue generating ones) and to the baseline of support provided to all athletes. ""This settlement is an important step forward for student-athletes and college sports, but it does not address every challenge,"" said the A5 conference commissioners and NCAA president. ""The need for Federal legislation to provide solutions remains. If Congress does not act, the progress reached through the settlement could be significantly mitigated by state laws and continued litigation."" https://www.ncaa.org/news/2024/7/25/media-center-settlement-documents-filed-in-college-athletics-class-action-lawsuits#:~:text=The%20settlement%20calls%20for%20total,damages%20as%20determined%20by%20plaintiffs. ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Legal,Summarize,Text Transformation "You should answer the following question as concisely as possible, using only the provided text and no outside information.",From where did the study get its criteria for determining if a student was suffering from addiction?,"Theoretically, Problematic Online Game Use (POGU) and online game addiction are the same; they refer to an excessive online game use that results in negative impact (Kim & Kim, 2010). This is asserted by theoretical perspective from Young (1998), in his theory, POGU is derived from the characteristics of people suffering from internet addiction (IA), which is based on the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-V). Addictive behavior can be defined as a condition where an individual is addicted to a certain thing he loves on various occasions, which emerges from a lack of behavioral control, making them feel guilty when they do not satisfy their desire. This asserts that addiction is compulsive and lack of control aspect of behavior (Griffiths, 2005). They usually do what they love on any occasion. How to distinguish between addiction and addiction tendencies, researchers refer to the proposed criteria in the DSM-5 (American Psychiatric Association, 2013) which explains that the severity of the disorder is based on the extent to which it interferes with daily activities. The proposed criteria in question are continuous and repeated use of the Internet to play games, often with other players, causing clinically significant disturbance or distress that is characterized as unsuccessful attempts to control online gaming behaviour, an increase in the amount of time playing online games, playing online games has become a dominant activity in an individual's life, health problems and relationships with others arise as a result of playing online games by individuals and this in a 12 month period. Online game gains its popularity among adolescents, it offers a number of attractiveness, making adolescents prefer to play game than to study, and this has become habit among adolescents. In addition to impulsivity and aggression, enjoyment and competitive feelings can be associated with gambling addiction because dark personality traits are associated with higher levels of enjoyment and satisfaction with one's unhappiness can be facilitated by games (James, Kavanagh, Jonason, Chonody and Scrutton, 2014). There are some motivations that make someone playing online game. According to (Yee, 2006), there are ten subcomponents of motivation, causing ones to play online game, they are categorized into three components, namely achievement, social, and immersion. APJII's survey result in 2017 proves that the largest online game users were in the age of 19-34 years old (49.52%, or 70.94 million users). The survey conducted by the Ministry of Communication and Information Technology revealed that Indonesia has the sixth-largest internet users in the world, and most of them are adolescents aged 15 to 19 years old, the age of high school and university students. This phenomenon is opposite to what university students should do. Students have a number of duties in university. The students supposed to study, obey the rule, respect the teacher, be discipline, and maintain the university reputation. The present study aimed to see the level of online game addiction and online use motive among the students of Semarang State University. As Wijayanti (2013) argued, one's motive in playing online game affects their level of addiction. METHOD This was a prevalence study with cross-sectional survey approach. The study was conducted in Semarang State University. The population of the study was all students of Semarang State University. By using random sampling technique, 568 students were selected as the subjects of study. The data of study were collected using two scales, addiction scale and online game use motives scale. Addiction scale used in the present study was adapted from Game Addiction Scale developed by Lemmens, Valkenburg, & Peter (2009). This scale consists of 21 categories with 3 categories on each aspect related to the seven criteria for online gaming addiction according to Lemmens, Valkenburg and Peter, which are silence, tolerance, mood swings, relapse. , addiction, conflict and problems. This tool has a Cronbach Alpha score of 0.94. There are no adverse factors in this measurement tool. Besides, online game use motives scale was adapted from instrument developed by Demetrovics et al. (2011), namely, motives for Online Gaming Questionnaire (MOGQ). This scale consists of 27 items that measure seven aspects of gambling motivation: escape (escape from reality), cope (overcome stress and distress), fantasy (gambling identity and experience), skill development (such as attention and coordination), Recreation (entertainment and fun), Competition (challenge and compete with others) and Social (establishment and maintenance of social relationship). MOGQ is the first tool designed to measure the motivation of online gamers of all ages. These include the major gambling motives identified in previous studies and exhibit high internal consistency. Univariate data analysis and bivariate correlation were employed. There were five interval criteria to interpret the percentage, Very Low, Low, Fair, High, and Very High. The result was categorized as Very High if its percentage is in the range of 84%-100%. It was categorized as High if its percentage is in the range of 68%-83%. It was categorized as Fair if its percentage is in the range of 52%-67%. It was categorized as Low if its percentage is in the range of 36%-51%. While it was categorized as Very Low if its percentage is in the range of 20%-35%. Data analysis using correlation analysis and multiple linear regression. Researchers used the application of Statistical Product and Service Solution (SPSS) version 22.","System Instruction: You should answer the following question as concisely as possible, using only the provided text and no outside information. Question: From where did the study get its criteria for determining if a student was suffering from addiction? Context: Theoretically, Problematic Online Game Use (POGU) and online game addiction are the same; they refer to an excessive online game use that results in negative impact (Kim & Kim, 2010). This is asserted by theoretical perspective from Young (1998), in his theory, POGU is derived from the characteristics of people suffering from internet addiction (IA), which is based on the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-V). Addictive behavior can be defined as a condition where an individual is addicted to a certain thing he loves on various occasions, which emerges from a lack of behavioral control, making them feel guilty when they do not satisfy their desire. This asserts that addiction is compulsive and lack of control aspect of behavior (Griffiths, 2005). They usually do what they love on any occasion. How to distinguish between addiction and addiction tendencies, researchers refer to the proposed criteria in the DSM-5 (American Psychiatric Association, 2013) which explains that the severity of the disorder is based on the extent to which it interferes with daily activities. The proposed criteria in question are continuous and repeated use of the Internet to play games, often with other players, causing clinically significant disturbance or distress that is characterized as unsuccessful attempts to control online gaming behaviour, an increase in the amount of time playing online games, playing online games has become a dominant activity in an individual's life, health problems and relationships with others arise as a result of playing online games by individuals and this in a 12 month period. Online game gains its popularity among adolescents, it offers a number of attractiveness, making adolescents prefer to play game than to study, and this has become habit among adolescents. In addition to impulsivity and aggression, enjoyment and competitive feelings can be associated with gambling addiction because dark personality traits are associated with higher levels of enjoyment and satisfaction with one's unhappiness can be facilitated by games (James, Kavanagh, Jonason, Chonody and Scrutton, 2014). There are some motivations that make someone playing online game. According to (Yee, 2006), there are ten subcomponents of motivation, causing ones to play online game, they are categorized into three components, namely achievement, social, and immersion. APJII's survey result in 2017 proves that the largest online game users were in the age of 19-34 years old (49.52%, or 70.94 million users). The survey conducted by the Ministry of Communication and Information Technology revealed that Indonesia has the sixth-largest internet users in the world, and most of them are adolescents aged 15 to 19 years old, the age of high school and university students. This phenomenon is opposite to what university students should do. Students have a number of duties in university. The students supposed to study, obey the rule, respect the teacher, be discipline, and maintain the university reputation. The present study aimed to see the level of online game addiction and online use motive among the students of Semarang State University. As Wijayanti (2013) argued, one's motive in playing online game affects their level of addiction. METHOD This was a prevalence study with cross-sectional survey approach. The study was conducted in Semarang State University. The population of the study was all students of Semarang State University. By using random sampling technique, 568 students were selected as the subjects of study. The data of study were collected using two scales, addiction scale and online game use motives scale. Addiction scale used in the present study was adapted from Game Addiction Scale developed by Lemmens, Valkenburg, & Peter (2009). This scale consists of 21 categories with 3 categories on each aspect related to the seven criteria for online gaming addiction according to Lemmens, Valkenburg and Peter, which are silence, tolerance, mood swings, relapse. , addiction, conflict and problems. This tool has a Cronbach Alpha score of 0.94. There are no adverse factors in this measurement tool. Besides, online game use motives scale was adapted from instrument developed by Demetrovics et al. (2011), namely, motives for Online Gaming Questionnaire (MOGQ). This scale consists of 27 items that measure seven aspects of gambling motivation: escape (escape from reality), cope (overcome stress and distress), fantasy (gambling identity and experience), skill development (such as attention and coordination), Recreation (entertainment and fun), Competition (challenge and compete with others) and Social (establishment and maintenance of social relationship). MOGQ is the first tool designed to measure the motivation of online gamers of all ages. These include the major gambling motives identified in previous studies and exhibit high internal consistency. Univariate data analysis and bivariate correlation were employed. There were five interval criteria to interpret the percentage, Very Low, Low, Fair, High, and Very High. The result was categorized as Very High if its percentage is in the range of 84%-100%. It was categorized as High if its percentage is in the range of 68%-83%. It was categorized as Fair if its percentage is in the range of 52%-67%. It was categorized as Low if its percentage is in the range of 36%-51%. While it was categorized as Very Low if its percentage is in the range of 20%-35%. Data analysis using correlation analysis and multiple linear regression. Researchers used the application of Statistical Product and Service Solution (SPSS) version 22.",Internet/Technology,Fact Finding,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]","According to this article, what are the reasons that Plantir is growing its getting more commercial clients? Please tell me in easy to understand terms, I'm not an expert at this stuff.","Palantir reported its Q2 FY24 earnings, where total revenue grew 27% YoY to $678M beating estimates. Out of the $678M in revenue, Government revenue accounted for roughly 55% of Total Revenue, growing 23% YoY. But the main hero of this growth story is its Commercial segment which is growing at a faster rate of 33% YoY and accounting for a growing share of Total Revenue when we compare it to the prior year. Particularly, when it comes to the Commercial revenue segment, its US market saw a growth rate of 55% YoY to $159M. While it saw a slowdown in its growth pace on a sequential basis to 6%, its annual growth rate indicates a reacceleration in trend, boosting investor optimism. This was driven by persistent demand for their enterprise platform, AIP (Artificial Intelligence Platform), that makes artificial capabilities useful to large organizations, providing them with a structural advantage over their competitors. What is even more impressive is that over 4 years ago, Palantir had just 14 commercial customers in the US. With the launch of AIP over a year ago, its US commercial customer count stands at 295, growing 83% YoY, as it captures the enterprise AI opportunity as the management claims that they solve the “prototype to production” problem like no other company. In Q2, the company closed 96 Commercial deals with at least $1M of TCV (Total Contract Value), which grew 45% YoY and 10% QoQ. However, with a closer look at this data point, we can see that the company saw a sequential acceleration in its $5M and $10M deals, which grew 22% and 80% QoQ to 33 and 27 respectively. This is driven by a combination of a higher volume of existing customers signing expansion deals with deepening product-level relationships as well as new customer acquisition where they leverage their go-to-market motion of bootcamps and pilots to accelerate customer journey towards high-value production use cases, with TCV growing 152% YoY in the US Commercial segment. At the same time, Palantir and Microsoft (MSFT) also announced a significant advancement in their partnership in August, where Palantir will deploy their suite of products in Microsoft Azure Government and in the Azure Government Secret and Top Secret Clouds, enabling operators to safely and responsibly build AI-driven operational workloads across Defense and Intelligence verticals for the US government. This should further drive deeper adoption of AIP in the federal sector, thus boosting the top line. Shifting gears to profitability, Palantir generated $254M in Adjusted Operating income, which grew 88% YoY with a margin expansion of 1200 basis points to 37%. Simultaneously, the company also achieved GAAP operating profitability for the sixth consecutive quarter with a GAAP operating margin of 16%, up 1400 basis points YoY. It is incredible that operating expenses just grew just 6% YoY for the magnitude of revenue growth. In other words, it saw its revenue growth accelerate while expanding margins at the same time, unlocking the “holy grail” in the world of SaaS with a Rule of 40 score from 57 in Q1 to 64 in Q2. I believe that this is made possible by its go-to-market strategy, which focuses on AIP Bootcamps and AIPCon that leverages the strength of its product to unlock potential client AI use cases instead of hoarding large numbers of salespeople. So far, with this strategy, it is seeing a steady increase in the number of clients along with existing clients expanding their usage of the platform, with the 12-month revenue from Top 20 customers growing 9% YoY to $57M/customer, thus enabling it to unlock operating leverage.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== According to this article, what are the reasons that Plantir is growing its getting more commercial clients? Please tell me in easy to understand terms, I'm not an expert at this stuff. {passage 0} ========== Palantir reported its Q2 FY24 earnings, where total revenue grew 27% YoY to $678M beating estimates. Out of the $678M in revenue, Government revenue accounted for roughly 55% of Total Revenue, growing 23% YoY. But the main hero of this growth story is its Commercial segment which is growing at a faster rate of 33% YoY and accounting for a growing share of Total Revenue when we compare it to the prior year. Particularly, when it comes to the Commercial revenue segment, its US market saw a growth rate of 55% YoY to $159M. While it saw a slowdown in its growth pace on a sequential basis to 6%, its annual growth rate indicates a reacceleration in trend, boosting investor optimism. This was driven by persistent demand for their enterprise platform, AIP (Artificial Intelligence Platform), that makes artificial capabilities useful to large organizations, providing them with a structural advantage over their competitors. What is even more impressive is that over 4 years ago, Palantir had just 14 commercial customers in the US. With the launch of AIP over a year ago, its US commercial customer count stands at 295, growing 83% YoY, as it captures the enterprise AI opportunity as the management claims that they solve the “prototype to production” problem like no other company. In Q2, the company closed 96 Commercial deals with at least $1M of TCV (Total Contract Value), which grew 45% YoY and 10% QoQ. However, with a closer look at this data point, we can see that the company saw a sequential acceleration in its $5M and $10M deals, which grew 22% and 80% QoQ to 33 and 27 respectively. This is driven by a combination of a higher volume of existing customers signing expansion deals with deepening product-level relationships as well as new customer acquisition where they leverage their go-to-market motion of bootcamps and pilots to accelerate customer journey towards high-value production use cases, with TCV growing 152% YoY in the US Commercial segment. At the same time, Palantir and Microsoft (MSFT) also announced a significant advancement in their partnership in August, where Palantir will deploy their suite of products in Microsoft Azure Government and in the Azure Government Secret and Top Secret Clouds, enabling operators to safely and responsibly build AI-driven operational workloads across Defense and Intelligence verticals for the US government. This should further drive deeper adoption of AIP in the federal sector, thus boosting the top line. Shifting gears to profitability, Palantir generated $254M in Adjusted Operating income, which grew 88% YoY with a margin expansion of 1200 basis points to 37%. Simultaneously, the company also achieved GAAP operating profitability for the sixth consecutive quarter with a GAAP operating margin of 16%, up 1400 basis points YoY. It is incredible that operating expenses just grew just 6% YoY for the magnitude of revenue growth. In other words, it saw its revenue growth accelerate while expanding margins at the same time, unlocking the “holy grail” in the world of SaaS with a Rule of 40 score from 57 in Q1 to 64 in Q2. I believe that this is made possible by its go-to-market strategy, which focuses on AIP Bootcamps and AIPCon that leverages the strength of its product to unlock potential client AI use cases instead of hoarding large numbers of salespeople. So far, with this strategy, it is seeing a steady increase in the number of clients along with existing clients expanding their usage of the platform, with the 12-month revenue from Top 20 customers growing 9% YoY to $57M/customer, thus enabling it to unlock operating leverage. https://seekingalpha.com/article/4720671-palantir-80x-pe-pure-nosebleed#source=first_level_url%3Ahome%7Csection%3Atrending_articles%7Crecommendation_type%3Adefault%7Cline%3A11",Financial,Find & Summarize,Text Transformation You must respond using only information provided in the prompt. Explain your reasoning with at least 2 supporting points without using direct quotes over 5 words.,summarize the info from the answer to question 1 in a 3-column table,"Betsy L. Graseck Analyst, Morgan Stanley & Co. LLC Q So, a couple of questions here. Just, one, Jamie, could you talk through the decision to raise the dividend kind of mid-cycle, it felt like, preCCAR? And also, help us understand how you're thinking about where that payout ratio, that dividend payout ratio, range should be. Because over the past several years, it's been somewhere between 24% and 32%. And so, is this suggesting we could be towards the higher-end of that range or even expanding above that? And then I also just wanted to understand the buyback and the keeping of the CET1 at 15% here. The minimum is 11.9%. I know it's – we have to wait for Basel III Endgame re-proposal to come through and all that, but should we be expecting that, hey, we're going to hold 15% CET1 until we know all these rules? Thanks. ...................................................................................................................................................................................................................................................... Jamie Dimon Chairman & Chief Executive Officer, JPMorgan Chase & Co. A Yeah. So, Betsy, before I answer the question, I want to say something on behalf of all of us at JPMorgan and, me personally, thrilled to have you on this call. For those that don't know, Betsy has been through a terrible medical episode and it's a reminder to all of us how lucky we are to be here. But, Betsy, in particular, the amount of respect we have, not just in your work, but in your character over the last 20 plus years has been exceptional. So, on behalf of all of us, I just want to welcome you back and thrilled to have you here. And so, you're asking a pertinent question. So, we're earning a lot of money. Our capital cup runneth over, and that's why we've increased the dividend. And if you're asking me what we'd like to do is to pay out something like a third, a third of normalized earnings. Of course, it's hard to calculate always what normalized earnings are, but we don't mind being a little bit ahead of that sometimes, a little bit behind that sometimes. If I could give people kind of consistent dividend guidance, et cetera, I think the far more important question is the 15%. So, look at the 15%, I'm going to oversimplify it, that basically will prepare us for the total Basel Endgame today, roughly. The specifics don't matter that much. 5 Jamie Dimon Chairman & Chief Executive Officer, JPMorgan Chase & Co. A Remember, we can do a lot of things to change that in the short-run or the long-run, but it looks like Basel III Endgame may not be the worst case. It'll be something less than that. So, obviously, when and if that happens, it would free up a lot of capital, and I'm going to say in the order of $20 billion or something like that. And, yes, we've always had the capital hierarchy the same way, which is we're going to use capital to build our business first, I mean, pay the dividend – steady dividend, build the business, and if we think it's appropriate to buy back stock. We're continuing to buy back stock at $2 billion a quarter (sic). I personally do not want to buy back a lot more than that at these current prices. I think you've all heard me talk about the world, things like that. So, waiting in preparation for Basel. Hopefully we'll know something later, and then we can be much more specific with you all. But in the meantime, there's also – it's very important to put in mind, there are short-term uses for capital that are good for shareholders, that could reduce our CET1 too. So, you may see us do things in the short-run that will increase earnings, increase capital, that are using up that capital. Jeremy mentioned on the – on one of the things that we know, the balance sheet and how we use the balance sheet for credit and trading, we could do things now. So, it's a great position to be in. We're going to be very, very patient. I urge all the analysts to keep in mind, excess capital is not wasted capital, it's earnings in store. We will deploy it in a very good way for shareholders in due course. ...................................................................................................................................................................................................................................................... Betsy L. Graseck Analyst, Morgan Stanley & Co. LLC Q Excellent. Thank you so much. ...................................................................................................................................................................................................................................................... Jeremy Barnum Chief Financial Officer, JPMorgan Chase & Co. A And yeah, Betsy, I just wanted to add my welcome back thoughts as well, and just a very minor edit to Jamie's answer. I think he just misspoke when he said $2 billion a year in buybacks. The trajectory is $2 billion... ...................................................................................................................................................................................................................................................... Jamie Dimon Chairman & Chief Executive Officer, JPMorgan Chase & Co. A Oh. Sorry. $2 billion a quarter. Yeah. ...................................................................................................................................................................................................................................................... Jeremy Barnum Chief Financial Officer, JPMorgan Chase & Co. A ...a quarter. Otherwise, I have nothing to add to Jamie's very complete answer. But welcome back, Betsy. ...................................................................................................................................................................................................................................................... Betsy L. Graseck Analyst, Morgan Stanley & Co. LLC Q Okay. Thank you so much, and appreciate it. Looking forward to seeing you at Investor Day on May 20th. ...................................................................................................................................................................................................................................................... Jeremy Barnum Chief Financial Officer, JPMorgan Chase & Co. A Excellent. Us too. ...................................................................................................................................................................................................................................................... Operator: Thank you. Our next question comes from Jim Mitchell with Seaport Global. You may proceed. ...................................................................................................................................................................................................................................................... 6 Jim Mitchell Analyst, Seaport Global Securities LLC Q Hey. Good morning. Jeremy, can you speak to the trends you're seeing with respect to deposit migration in the quarter, if there's been any change? Have you seen that migration start to slow or not? ...................................................................................................................................................................................................................................................... Jeremy Barnum Chief Financial Officer, JPMorgan Chase & Co. A Yeah. Good question, Jim. I think the simplest and best answer to that is: not really. So, as we've been saying for a while, migration from checking and savings to CDs is sort of the dominant trend with this driving the increase in weighted average rate paid in the consumer deposit franchise, that continues. We continue to capture that money-in-motion at a very high rate. We're very happy about what that means about the consumer franchise and level of engagement that we're seeing. I'm aware that there's a little bit of a narrative out there about are we seeing the end of what people sometimes refer to as cash sorting. We've looked at that data. We see some evidence that maybe it's slowing a little bit. We're quite cautious on that. We really sort of don't think it makes sense to assume that in a world where checking and savings is paying effectively zero and the policy rate is above 5% that you're not going to see ongoing migration. And frankly, we expect to see that even in a world where – even if the current yield curve environment were to change and meaningful cuts were to get reintroduced and we would actually start to see those, we would still expect to see ongoing migration and yield-seeking behavior. So, it's quite conceivable and this is actually on the yield curve that we had in fourth quarter that had six cuts in it. We were still nonetheless expecting an increase in weighted average rate paid as that migration continues. So, I would say no meaningful change in the trends and the expectation for ongoing migration is very much still there. ...................................................................................................................................................................................................................................................... Jim Mitchell Analyst, Seaport Global Securities LLC Q Okay. And just a follow-up on that and just sort of bigger picture on NII. Is that sort of the biggest driver of your outlook? Is it migration? Is it the forward curve? Is it balances? It sounds like it's migration, but just I'd be curious to hear your thoughts on the biggest drivers of upside or downside. .................................................................................................................................................................................................................................. Jeremy Barnum Chief Financial Officer, JPMorgan Chase & Co. A Yeah. So, I mean I think the drivers of, let's say, what's embedded in the current guidance is actually not meaningfully different from what it was in the fourth quarter, meaning it's the current yield curve, which is a little bit stale now. But the snap from quarter-end had roughly three cuts in it. So, it's the current yield curve, it's what I just said, the expectation of ongoing internal migration. There is some meaningful offset from Card revolve growth, which while it's a little bit less than it was in prior years, is still a tailwind there.","You must respond using only information provided in the prompt. Explain your reasoning with at least 2 supporting points without using direct quotes over 5 words. Betsy L. Graseck Analyst, Morgan Stanley & Co. LLC Q So, a couple of questions here. Just, one, Jamie, could you talk through the decision to raise the dividend kind of mid-cycle, it felt like, preCCAR? And also, help us understand how you're thinking about where that payout ratio, that dividend payout ratio, range should be. Because over the past several years, it's been somewhere between 24% and 32%. And so, is this suggesting we could be towards the higher-end of that range or even expanding above that? And then I also just wanted to understand the buyback and the keeping of the CET1 at 15% here. The minimum is 11.9%. I know it's – we have to wait for Basel III Endgame re-proposal to come through and all that, but should we be expecting that, hey, we're going to hold 15% CET1 until we know all these rules? Thanks. ...................................................................................................................................................................................................................................................... Jamie Dimon Chairman & Chief Executive Officer, JPMorgan Chase & Co. A Yeah. So, Betsy, before I answer the question, I want to say something on behalf of all of us at JPMorgan and, me personally, thrilled to have you on this call. For those that don't know, Betsy has been through a terrible medical episode and it's a reminder to all of us how lucky we are to be here. But, Betsy, in particular, the amount of respect we have, not just in your work, but in your character over the last 20 plus years has been exceptional. So, on behalf of all of us, I just want to welcome you back and thrilled to have you here. And so, you're asking a pertinent question. So, we're earning a lot of money. Our capital cup runneth over, and that's why we've increased the dividend. And if you're asking me what we'd like to do is to pay out something like a third, a third of normalized earnings. Of course, it's hard to calculate always what normalized earnings are, but we don't mind being a little bit ahead of that sometimes, a little bit behind that sometimes. If I could give people kind of consistent dividend guidance, et cetera, I think the far more important question is the 15%. So, look at the 15%, I'm going to oversimplify it, that basically will prepare us for the total Basel Endgame today, roughly. The specifics don't matter that much. 5 Jamie Dimon Chairman & Chief Executive Officer, JPMorgan Chase & Co. A Remember, we can do a lot of things to change that in the short-run or the long-run, but it looks like Basel III Endgame may not be the worst case. It'll be something less than that. So, obviously, when and if that happens, it would free up a lot of capital, and I'm going to say in the order of $20 billion or something like that. And, yes, we've always had the capital hierarchy the same way, which is we're going to use capital to build our business first, I mean, pay the dividend – steady dividend, build the business, and if we think it's appropriate to buy back stock. We're continuing to buy back stock at $2 billion a quarter (sic). I personally do not want to buy back a lot more than that at these current prices. I think you've all heard me talk about the world, things like that. So, waiting in preparation for Basel. Hopefully we'll know something later, and then we can be much more specific with you all. But in the meantime, there's also – it's very important to put in mind, there are short-term uses for capital that are good for shareholders, that could reduce our CET1 too. So, you may see us do things in the short-run that will increase earnings, increase capital, that are using up that capital. Jeremy mentioned on the – on one of the things that we know, the balance sheet and how we use the balance sheet for credit and trading, we could do things now. So, it's a great position to be in. We're going to be very, very patient. I urge all the analysts to keep in mind, excess capital is not wasted capital, it's earnings in store. We will deploy it in a very good way for shareholders in due course. ...................................................................................................................................................................................................................................................... Betsy L. Graseck Analyst, Morgan Stanley & Co. LLC Q Excellent. Thank you so much. ...................................................................................................................................................................................................................................................... Jeremy Barnum Chief Financial Officer, JPMorgan Chase & Co. A And yeah, Betsy, I just wanted to add my welcome back thoughts as well, and just a very minor edit to Jamie's answer. I think he just misspoke when he said $2 billion a year in buybacks. The trajectory is $2 billion... ...................................................................................................................................................................................................................................................... Jamie Dimon Chairman & Chief Executive Officer, JPMorgan Chase & Co. A Oh. Sorry. $2 billion a quarter. Yeah. ...................................................................................................................................................................................................................................................... Jeremy Barnum Chief Financial Officer, JPMorgan Chase & Co. A ...a quarter. Otherwise, I have nothing to add to Jamie's very complete answer. But welcome back, Betsy. ...................................................................................................................................................................................................................................................... Betsy L. Graseck Analyst, Morgan Stanley & Co. LLC Q Okay. Thank you so much, and appreciate it. Looking forward to seeing you at Investor Day on May 20th. ...................................................................................................................................................................................................................................................... Jeremy Barnum Chief Financial Officer, JPMorgan Chase & Co. A Excellent. Us too. ...................................................................................................................................................................................................................................................... Operator: Thank you. Our next question comes from Jim Mitchell with Seaport Global. You may proceed. ...................................................................................................................................................................................................................................................... 6 Jim Mitchell Analyst, Seaport Global Securities LLC Q Hey. Good morning. Jeremy, can you speak to the trends you're seeing with respect to deposit migration in the quarter, if there's been any change? Have you seen that migration start to slow or not? ...................................................................................................................................................................................................................................................... Jeremy Barnum Chief Financial Officer, JPMorgan Chase & Co. A Yeah. Good question, Jim. I think the simplest and best answer to that is: not really. So, as we've been saying for a while, migration from checking and savings to CDs is sort of the dominant trend with this driving the increase in weighted average rate paid in the consumer deposit franchise, that continues. We continue to capture that money-in-motion at a very high rate. We're very happy about what that means about the consumer franchise and level of engagement that we're seeing. I'm aware that there's a little bit of a narrative out there about are we seeing the end of what people sometimes refer to as cash sorting. We've looked at that data. We see some evidence that maybe it's slowing a little bit. We're quite cautious on that. We really sort of don't think it makes sense to assume that in a world where checking and savings is paying effectively zero and the policy rate is above 5% that you're not going to see ongoing migration. And frankly, we expect to see that even in a world where – even if the current yield curve environment were to change and meaningful cuts were to get reintroduced and we would actually start to see those, we would still expect to see ongoing migration and yield-seeking behavior. So, it's quite conceivable and this is actually on the yield curve that we had in fourth quarter that had six cuts in it. We were still nonetheless expecting an increase in weighted average rate paid as that migration continues. So, I would say no meaningful change in the trends and the expectation for ongoing migration is very much still there. ...................................................................................................................................................................................................................................................... Jim Mitchell Analyst, Seaport Global Securities LLC Q Okay. And just a follow-up on that and just sort of bigger picture on NII. Is that sort of the biggest driver of your outlook? Is it migration? Is it the forward curve? Is it balances? It sounds like it's migration, but just I'd be curious to hear your thoughts on the biggest drivers of upside or downside. .................................................................................................................................................................................................................................. Jeremy Barnum Chief Financial Officer, JPMorgan Chase & Co. A Yeah. So, I mean I think the drivers of, let's say, what's embedded in the current guidance is actually not meaningfully different from what it was in the fourth quarter, meaning it's the current yield curve, which is a little bit stale now. But the snap from quarter-end had roughly three cuts in it. So, it's the current yield curve, it's what I just said, the expectation of ongoing internal migration. There is some meaningful offset from Card revolve growth, which while it's a little bit less than it was in prior years, is still a tailwind there. summarize the info from the answer to question 1 in a 3-column table ",Financial,Summarize,Text Transformation "Answer using only information in the prompt. Answer in full sentences, but the word or phrase that provides a direct answer to the prompt should be in bold text.",Which treatments are suitable for children?,"Treatment options include: • No treatment: Up to 65% of viral warts including plantar warts resolve by themselves without any treatment within two years of appearing. Plantar warts that are not causing any adverse symptoms such as pain should be left alone. • Salicylic acid paints and gels: These are available in different strengths. Salicylic acid works by removing the outer dead layers of skin and triggering the immune system into clearing the virus. Before applying the paint, the feet should be soaked in warm water and thickened skin filed away with a pumice stone or emery board. Care should be taken not to scrape the surrounding normal skin to avoid spreading the virus. Treatment should be daily for at least 12 weeks and is usually most convenient at bedtime. The paint /gel should be applied carefully to the wart, not the surrounding normal skin. Cover the lesion with a dressing to allow the treatment to work effectively. If the wart becomes too sore, treatment should be stopped for a few days, then resumed. • Cryotherapy. (See patient information leaflet on cryotherapy). Freezing the warts with liquid nitrogen (a very cold gas), may be available at your doctor’s surgery or podiatrist. Thick warts need to be shaved before freezing to allow the cold to get into the skin. Ideally, cryotherapy should be repeated every three to four weeks. It is painful and may cause blisters and burns, and because of this is not usually recommended in children. Several freezes may be needed to clear warts and it does not always work. Using a salicylic acid preparation in between freezes may improve the effectiveness. • Duct Tape: Although there is conflicting evidence regarding the effectiveness of duct tape in the treatment of cutaneous warts, it might still be well worth trying, especially in children. The wart should be covered with duct tape for six days, and if the tape falls off it should be replaced with a fresh piece. The tape should then be removed, and the affected area soaked in luke-warm water and the wart pared down to remove any dead skin cells. The wart should then be left uncovered overnight, and the duct tape reapplied once again in the morning. This can be continued for up to two months. • Other approved topical treatments for plantar warts include formaldehyde gel, glutaraldehyde and silver nitrate caustic pencils. • Other preparations include topical dithranol, podophyllotoxin, 5- fluorouracil trichloroacetic acid and bleomycin injections. • Contact immunotherapy with a chemical paint such as diphencyprone causes an allergic skin reaction that may boost the body’s immune reaction against the wart virus. • Surgical removal of warts is an option if topical treatments do not work. Options include tissue destructive laser therapy or curettage and cautery after a local anaesthetic injection into the skin. These procedures are painful and can lead to uncomfortable scarring. The wart may come back in the scar after surgery. • Photodynamic therapy and other lasers (Pulsed Dye Laser and NdYAG) have also been used but are not widely available for treatment of warts. • Complementary and alternative treatments include hypnotherapy, homeopathy, acupuncture, and herbal treatment.","System instructions: Answer using only information in the prompt. Answer in full sentences, but the word or phrase that provides a direct answer to the prompt should be in bold text. Context: Treatment options include: • No treatment: Up to 65% of viral warts including plantar warts resolve by themselves without any treatment within two years of appearing. Plantar warts that are not causing any adverse symptoms such as pain should be left alone. • Salicylic acid paints and gels: These are available in different strengths. Salicylic acid works by removing the outer dead layers of skin and triggering the immune system into clearing the virus. Before applying the paint, the feet should be soaked in warm water and thickened skin filed away with a pumice stone or emery board. Care should be taken not to scrape the surrounding normal skin to avoid spreading the virus. Treatment should be daily for at least 12 weeks and is usually most convenient at bedtime. The paint /gel should be applied carefully to the wart, not the surrounding normal skin. Cover the lesion with a dressing to allow the treatment to work effectively. If the wart becomes too sore, treatment should be stopped for a few days, then resumed. • Cryotherapy. (See patient information leaflet on cryotherapy). Freezing the warts with liquid nitrogen (a very cold gas), may be available at your doctor’s surgery or podiatrist. Thick warts need to be shaved before freezing to allow the cold to get into the skin. Ideally, cryotherapy should be repeated every three to four weeks. It is painful and may cause blisters and burns, and because of this is not usually recommended in children. Several freezes may be needed to clear warts and it does not always work. Using a salicylic acid preparation in between freezes may improve the effectiveness. • Duct Tape: Although there is conflicting evidence regarding the effectiveness of duct tape in the treatment of cutaneous warts, it might still be well worth trying, especially in children. The wart should be covered with duct tape for six days, and if the tape falls off it should be replaced with a fresh piece. The tape should then be removed, and the affected area soaked in luke-warm water and the wart pared down to remove any dead skin cells. The wart should then be left uncovered overnight, and the duct tape reapplied once again in the morning. This can be continued for up to two months. • Other approved topical treatments for plantar warts include formaldehyde gel, glutaraldehyde and silver nitrate caustic pencils. • Other preparations include topical dithranol, podophyllotoxin, 5- fluorouracil trichloroacetic acid and bleomycin injections. • Contact immunotherapy with a chemical paint such as diphencyprone causes an allergic skin reaction that may boost the body’s immune reaction against the wart virus. • Surgical removal of warts is an option if topical treatments do not work. Options include tissue destructive laser therapy or curettage and cautery after a local anaesthetic injection into the skin. These procedures are painful and can lead to uncomfortable scarring. The wart may come back in the scar after surgery. • Photodynamic therapy and other lasers (Pulsed Dye Laser and NdYAG) have also been used but are not widely available for treatment of warts. • Complementary and alternative treatments include hypnotherapy, homeopathy, acupuncture, and herbal treatment. Question: Which treatments are suitable for children?",Medical,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",What happens when faces are quickly flashed in one's peripheral vision? Summarize the role of peripheral vision in the flashed face distortion effect in 200 words or fewer.,"In our lifetimes, we encounter hundreds of thousands of faces. Each person's unique exposure to faces largely determines their ""face space""—a model of how we encode, perceive, and remember the faces that we see. Cross-cultural differences, such as the other-race effect, demonstrate that we are generally more accurate at recognizing faces of ethnicities we are more familiar with. But even within cultures, people differ greatly in which faces will elicit a sense of trustworthiness, approachability, or attractiveness. Another factor has an even greater effect on how we perceive a face—where the face is positioned relative to our central or peripheral vision. Something very strange happens when a sequence of faces is quickly presented in our peripheral vision. This was first demonstrated in 2011 in a powerful illusion discovered by Jason Tangen, Sean Murphy, and Matthew Thompson, called the ""flashed face distortion effect"" After a few seconds of staring at the central fixation cross, the faces peripherally presented faces start to appear deformed, cartoonish, and even grotesque. However, upon closer inspection, one can tell the faces are perfectly normal and have not been altered. Several studies have attempted to explain the mechanisms underlying this phenomenon. Is it the fact that the faces are aligned at the eyes? Is it because they are presented quickly (4-5 faces per second)? Is it dependent on which faces follow each other or how centrally or peripherally they are shown? The Role of Peripheral Vision A study by Bowden et al. (2019) explored the role of peripheral vision. We know that everything in peripheral vision looks blurry compared to central vision. This is because peripheral stimuli are processed by retinal rod cells that have poor spatial acuity. So it could be that the intrinsic blur of peripheral vision makes the faces appear distorted. However, Bowden et al. compared peripherally presented faces to centrally presented faces manipulated by blur. Although they found some evidence of face distortion in central vision using blurred faces, the effect was much larger when using un-blurred peripheral faces. Another study by Balas and Pearson (2019) tested additional factors that may influence the illusion. They again found that peripheral presentation makes a big difference, as does the presentation speed. Notably, the orientation of the faces presented did not seem to matter. In other words, upside-down faces produced a similar distortion effect as upright faces. This is surprising because, in most aspects of face perception, upside-down faces produce weak effects due to their general unfamiliarity (a prime example of this is the Thatcher Effect). Do We All Perceive the Same Distortions When Looking at Peripherally Flashed Faces? Earlier research by Afraz and Cavanagh (2009) found that peripheral distortion effects are quite idiosyncratic. Their study presented participants with faces and other stimuli in different positions of their peripheral vision. Participants were asked to make various judgments, such as the gender and age of faces or the aspect ratio of shapes. They found that the very same stimulus can appear differently depending on where it is placed within the observer's peripheral vision. For example, a neutral face might appear male in the upper right corner, but in the lower right corner, the same face might appear female. These differences are stable over time for a particular observer but vary substantially between observers. Therefore, the particularities of the visual distortions we experience in peripheral vision may be responsible for the particular ways flashed faces appear distorted. Further research is needed to identify the neural mechanisms behind these effects, whether they occur when we observe non-human faces, and whether they serve any adaptive purpose.","""================ ======= In our lifetimes, we encounter hundreds of thousands of faces. Each person's unique exposure to faces largely determines their ""face space""—a model of how we encode, perceive, and remember the faces that we see. Cross-cultural differences, such as the other-race effect, demonstrate that we are generally more accurate at recognizing faces of ethnicities we are more familiar with. But even within cultures, people differ greatly in which faces will elicit a sense of trustworthiness, approachability, or attractiveness. Another factor has an even greater effect on how we perceive a face—where the face is positioned relative to our central or peripheral vision. Something very strange happens when a sequence of faces is quickly presented in our peripheral vision. This was first demonstrated in 2011 in a powerful illusion discovered by Jason Tangen, Sean Murphy, and Matthew Thompson, called the ""flashed face distortion effect"" After a few seconds of staring at the central fixation cross, the faces peripherally presented faces start to appear deformed, cartoonish, and even grotesque. However, upon closer inspection, one can tell the faces are perfectly normal and have not been altered. Several studies have attempted to explain the mechanisms underlying this phenomenon. Is it the fact that the faces are aligned at the eyes? Is it because they are presented quickly (4-5 faces per second)? Is it dependent on which faces follow each other or how centrally or peripherally they are shown? The Role of Peripheral Vision A study by Bowden et al. (2019) explored the role of peripheral vision. We know that everything in peripheral vision looks blurry compared to central vision. This is because peripheral stimuli are processed by retinal rod cells that have poor spatial acuity. So it could be that the intrinsic blur of peripheral vision makes the faces appear distorted. However, Bowden et al. compared peripherally presented faces to centrally presented faces manipulated by blur. Although they found some evidence of face distortion in central vision using blurred faces, the effect was much larger when using un-blurred peripheral faces. Another study by Balas and Pearson (2019) tested additional factors that may influence the illusion. They again found that peripheral presentation makes a big difference, as does the presentation speed. Notably, the orientation of the faces presented did not seem to matter. In other words, upside-down faces produced a similar distortion effect as upright faces. This is surprising because, in most aspects of face perception, upside-down faces produce weak effects due to their general unfamiliarity (a prime example of this is the Thatcher Effect). Do We All Perceive the Same Distortions When Looking at Peripherally Flashed Faces? Earlier research by Afraz and Cavanagh (2009) found that peripheral distortion effects are quite idiosyncratic. Their study presented participants with faces and other stimuli in different positions of their peripheral vision. Participants were asked to make various judgments, such as the gender and age of faces or the aspect ratio of shapes. They found that the very same stimulus can appear differently depending on where it is placed within the observer's peripheral vision. For example, a neutral face might appear male in the upper right corner, but in the lower right corner, the same face might appear female. These differences are stable over time for a particular observer but vary substantially between observers. Therefore, the particularities of the visual distortions we experience in peripheral vision may be responsible for the particular ways flashed faces appear distorted. Further research is needed to identify the neural mechanisms behind these effects, whether they occur when we observe non-human faces, and whether they serve any adaptive purpose. https://www.psychologytoday.com/us/blog/illusions-delusions-and-reality/202303/why-faces-look-distorted-in-our-periphery ================ ======= What happens when faces are quickly flashed in one's peripheral vision? Summarize the role of peripheral vision in the flashed face distortion effect in 200 words or fewer. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Find & Summarize,Text Transformation Respond using only information provided. Do not use any external knowledge or information.,Assume I just bought this product. How do I use it?,"WARNINGS Read the instructions carefully as they contain important information about safety, use and maintenance of the product. IMPORTANT: READ THIS MANUAL THOROUGHLY AND KEEP IT WITH CARE FOR FUTURE REFERENCE. • These instructions are an integral part of the product and, throughout the entire life of the product, must be kept and be available. The documentation should be given to the subsequent owners of the product. • Attention: this coff ee maker requires a heat source for its operation and develops pressure inside. Failure to comply with the instructions may cause the risk of burn or the coff ee maker burst. • Before each use, make sure the coff ee maker is not damaged and is complete with all its parts. In case of doubts, contact the dealer or the manufacturer. • Remove the packaging materials of the coff ee maker and any warning inside it before use. • This appliance is not intended for use by persons (including children) with reduced physical, sensory or mental capabilities, or lack of experience and knowledge. • Keep out of reach of children. • Use the coff ee maker for the purpose that it was designed for. The product is intended for household use only. • Do not leave the appliance unattended during operation. • Do not touch the hot surface of the coff ee maker. The surfaces get hot, therefore use the handle (1) to move the coff ee maker. • Never use the coff ee maker without water in the heater. • Never use other liquids in the heater or the upper part, the coff ee maker is intended to be used with water only. • The coff ee maker is designed to be used only with water and ground coff ee for Moka for household use: do not use other products (e.g. barley, cocoa, coff ee extracts, tea, COFFEE FOR PERCOLATING FILTERS OR ESPRESSO MACHINES, etc.). • Make sure the steam jet is oriented far from the user, by ensuring the safety valve is not oriented towards the user. • Do not leave the coff ee maker on the heat source for too long to prevent any change in colour. • Make sure the coff ee maker is properly closed before use. • When using a gas heat source, the fl ame must not go beyond the rim of the heater. • In case of induction/electric/ceramic glass plate, never use the highest heat, but maintain a medium setting. In case of induction plate, never use the boost function. • Do not open or close the coff ee maker by forcing the column (1). • Never use the coff ee maker in the oven or in a microwave. • During use, close the cup support base (7) of the coff ee maker. • In case of malfunctioning, do not use the product and contact the dealer or the manufacturer. • After use, allow the coff ee maker to cool down before opening it. • After use, place the coff ee maker on suitable surfaces, as its base reaches high temperatures. Do not store it in contact with fl ammable surfaces that might deteriorate with the heat. • Choose only original Bialetti spare parts suitable for the model used. • At the end of dispensing there might be some water in the heater. Such residue helps avoid possible changes in colour of the heater surface in case the coff ee maker is left on the heat source for a prolonged period of time after dispensing. • In case of malfunctioning, do not use the product and contact the dealer or the manufacturer. INSTRUCTIONS FOR USE First use of the product • When using the coff ee maker for the fi rst time, wash it thoroughly, only with water, and make at least 3 cups of coff ee, discarding them (do not drink them). • For the use on induction, check the compatibility of the diameter of the coff ee maker heater with the technical features of the hob. • Check the coff ee maker is complete with all its components and is properly positioned, as shown in the fi gure. Check the coff ee maker is complete with safety valve, funnel fi lter, gasket and fi lter plate and that these parts are in the correct position (5-6-3-2). • Do not drink the fi rst 3 dispensing operations of coff ee as they are necessary for enhancing the aroma of coff ee at best. • Make sure the safety valve is not oriented towards the user. • Hand wash only without using detergents and abrasive sponges to preserve its features over the time. • Use ground coff ee for Moka, that is with a suitable grinding, and never use fi ne grinding coff ee. • Never press coff ee into the funnel. • Store each part of the coff ee maker completely dry and without closing it. • Replace the gasket, if worn. It is recommended to replace it at least once a year anyway. • Do not beat the funnel to remove the coff ee, as it might get damaged or get ovalized, jeopardizing a proper sealing. MAKING COFFEE 1. Remove the cup support base (7 - upper part of the coff ee maker) and, without forcing the column (1), rotate clockwise the heater (4 - lower part of the coff ee maker) Fig. A. 2. Fill the heater (4) with cold water without exceeding the opening of the safety valve level (Fig. B). 3. Insert the funnel fi lter (6) into the heater (4). Fig. C. 4. Fill the funnel fi lter (6) with ground coff ee for Moka, without pressing it down, taking care not to leave coff ee powder on the rim of the coff ee maker, Fig. D. 5. Assemble the cup support base (7) on the heater (4), by rotating the heater counterclockwise, and tighten well, without pressing too much and avoiding to force the column (1), Fig. E. 6. Put the coff ee maker on the heat source with the cups underneath the column (1) on the cup support base (7), Fig.F. In case of fl ame, make sure that it does not go beyond the rim of the coff ee maker. In case of induction/ electric/ceramic glass plate, do not use the highest heat. BIALETTI INSPECTION SAFETY VALVE (5) The Bialetti valve has been patented and designed to guarantee the use of the coff ee maker in complete safety. Using the coff ee maker with drinking water might entail the risk of formation of lime scale in the hole of the valve, causing its clogging. To avoid clogging arising from lime scale, just move the small piston coming out of the valve along its axis during the normal washing operations, Fig. F. It is advisable to carry out this inspection periodically to ensure its proper operation. The safety valve is a protective element and should intervene only in conditions of abnormal operation or use of the coff ee maker. CLEANING AND MAINTENANCE • Before carrying out cleaning and maintenance, wait for the appliance to cool down completely. • It is advisable to clean the coff ee maker in all its parts on a regular basis, including the dispensing column, which must be free from coff ee powder obstructions. • After each use, wash with warm water without detergents and/or abrasive materials (the product CANNOT be put in the dishwasher). • Store the product perfectly dry in all its parts and not closed to prevent any build-up of stains/oxidations. • Regularly perform the decalcifi cation procedure: 1. Fill the heater with water as per normal preparation. 2. Add two teaspoons of citric acid or vinegar. 3. Reassemble the product and, without adding any coff ee powder, dispense once. 4. Throw away the solution obtained. 5. Wash the coff ee maker under running water and make coff ee. • Do not beat the funnel to remove the coff ee, as it might get damaged or get ovalized, avoiding a proper sealing. • Regularly check that the holes of the fi lter plate (2) are not obstructed, otherwise open them using a brush with delicate bristles or a needle. • Periodically check the internal components and, in case of wearing or damage, replace them only with original Bialetti spare parts suitable for the model used. • Replace the gasket (3), if worn. It is advisable to replace it at least once a • At the end of the life of the product, dispose it in a waste collection centre. • The adequate waste sorting and the correct disposal contribute to avoid negative impacts on the environment and public health and permit recycling of the materials which the product is made of. • For more detailed information regarding the available collection systems, contract the local refuse centre or the store where the product was purchased.","Assume I just bought this product. How do I use it? Respond using only information provided. Do not use any external knowledge or information. WARNINGS Read the instructions carefully as they contain important information about safety, use and maintenance of the product. IMPORTANT: READ THIS MANUAL THOROUGHLY AND KEEP IT WITH CARE FOR FUTURE REFERENCE. • These instructions are an integral part of the product and, throughout the entire life of the product, must be kept and be available. The documentation should be given to the subsequent owners of the product. • Attention: this coff ee maker requires a heat source for its operation and develops pressure inside. Failure to comply with the instructions may cause the risk of burn or the coff ee maker burst. • Before each use, make sure the coff ee maker is not damaged and is complete with all its parts. In case of doubts, contact the dealer or the manufacturer. • Remove the packaging materials of the coff ee maker and any warning inside it before use. • This appliance is not intended for use by persons (including children) with reduced physical, sensory or mental capabilities, or lack of experience and knowledge. • Keep out of reach of children. • Use the coff ee maker for the purpose that it was designed for. The product is intended for household use only. • Do not leave the appliance unattended during operation. • Do not touch the hot surface of the coff ee maker. The surfaces get hot, therefore use the handle (1) to move the coff ee maker. • Never use the coff ee maker without water in the heater. • Never use other liquids in the heater or the upper part, the coff ee maker is intended to be used with water only. • The coff ee maker is designed to be used only with water and ground coff ee for Moka for household use: do not use other products (e.g. barley, cocoa, coff ee extracts, tea, COFFEE FOR PERCOLATING FILTERS OR ESPRESSO MACHINES, etc.). • Make sure the steam jet is oriented far from the user, by ensuring the safety valve is not oriented towards the user. • Do not leave the coff ee maker on the heat source for too long to prevent any change in colour. • Make sure the coff ee maker is properly closed before use. • When using a gas heat source, the fl ame must not go beyond the rim of the heater. • In case of induction/electric/ceramic glass plate, never use the highest heat, but maintain a medium setting. In case of induction plate, never use the boost function. • Do not open or close the coff ee maker by forcing the column (1). • Never use the coff ee maker in the oven or in a microwave. • During use, close the cup support base (7) of the coff ee maker. • In case of malfunctioning, do not use the product and contact the dealer or the manufacturer. • After use, allow the coff ee maker to cool down before opening it. • After use, place the coff ee maker on suitable surfaces, as its base reaches high temperatures. Do not store it in contact with fl ammable surfaces that might deteriorate with the heat. • Choose only original Bialetti spare parts suitable for the model used. • At the end of dispensing there might be some water in the heater. Such residue helps avoid possible changes in colour of the heater surface in case the coff ee maker is left on the heat source for a prolonged period of time after dispensing. • In case of malfunctioning, do not use the product and contact the dealer or the manufacturer. INSTRUCTIONS FOR USE First use of the product • When using the coff ee maker for the fi rst time, wash it thoroughly, only with water, and make at least 3 cups of coff ee, discarding them (do not drink them). • For the use on induction, check the compatibility of the diameter of the coff ee maker heater with the technical features of the hob. • Check the coff ee maker is complete with all its components and is properly positioned, as shown in the fi gure. Check the coff ee maker is complete with safety valve, funnel fi lter, gasket and fi lter plate and that these parts are in the correct position (5-6-3-2). • Do not drink the fi rst 3 dispensing operations of coff ee as they are necessary for enhancing the aroma of coff ee at best. • Make sure the safety valve is not oriented towards the user. • Hand wash only without using detergents and abrasive sponges to preserve its features over the time. • Use ground coff ee for Moka, that is with a suitable grinding, and never use fi ne grinding coff ee. • Never press coff ee into the funnel. • Store each part of the coff ee maker completely dry and without closing it. • Replace the gasket, if worn. It is recommended to replace it at least once a year anyway. • Do not beat the funnel to remove the coff ee, as it might get damaged or get ovalized, jeopardizing a proper sealing. MAKING COFFEE 1. Remove the cup support base (7 - upper part of the coff ee maker) and, without forcing the column (1), rotate clockwise the heater (4 - lower part of the coff ee maker) Fig. A. 2. Fill the heater (4) with cold water without exceeding the opening of the safety valve level (Fig. B). 3. Insert the funnel fi lter (6) into the heater (4). Fig. C. 4. Fill the funnel fi lter (6) with ground coff ee for Moka, without pressing it down, taking care not to leave coff ee powder on the rim of the coff ee maker, Fig. D. 5. Assemble the cup support base (7) on the heater (4), by rotating the heater counterclockwise, and tighten well, without pressing too much and avoiding to force the column (1), Fig. E. 6. Put the coff ee maker on the heat source with the cups underneath the column (1) on the cup support base (7), Fig.F. In case of fl ame, make sure that it does not go beyond the rim of the coff ee maker. In case of induction/ electric/ceramic glass plate, do not use the highest heat. BIALETTI INSPECTION SAFETY VALVE (5) The Bialetti valve has been patented and designed to guarantee the use of the coff ee maker in complete safety. Using the coff ee maker with drinking water might entail the risk of formation of lime scale in the hole of the valve, causing its clogging. To avoid clogging arising from lime scale, just move the small piston coming out of the valve along its axis during the normal washing operations, Fig. F. It is advisable to carry out this inspection periodically to ensure its proper operation. The safety valve is a protective element and should intervene only in conditions of abnormal operation or use of the coff ee maker. CLEANING AND MAINTENANCE • Before carrying out cleaning and maintenance, wait for the appliance to cool down completely. • It is advisable to clean the coff ee maker in all its parts on a regular basis, including the dispensing column, which must be free from coff ee powder obstructions. • After each use, wash with warm water without detergents and/or abrasive materials (the product CANNOT be put in the dishwasher). • Store the product perfectly dry in all its parts and not closed to prevent any build-up of stains/oxidations. • Regularly perform the decalcifi cation procedure: 1. Fill the heater with water as per normal preparation. 2. Add two teaspoons of citric acid or vinegar. 3. Reassemble the product and, without adding any coff ee powder, dispense once. 4. Throw away the solution obtained. 5. Wash the coff ee maker under running water and make coff ee. • Do not beat the funnel to remove the coff ee, as it might get damaged or get ovalized, avoiding a proper sealing. • Regularly check that the holes of the fi lter plate (2) are not obstructed, otherwise open them using a brush with delicate bristles or a needle. • Periodically check the internal components and, in case of wearing or damage, replace them only with original Bialetti spare parts suitable for the model used. • Replace the gasket (3), if worn. It is advisable to replace it at least once a • At the end of the life of the product, dispose it in a waste collection centre. • The adequate waste sorting and the correct disposal contribute to avoid negative impacts on the environment and public health and permit recycling of the materials which the product is made of. • For more detailed information regarding the available collection systems, contract the local refuse centre or the store where the product was purchased.",Retail/Product,Fact Finding,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",What are some frequent difficulties that Finance and Accounting (F&A) teams face when dealing with period-end close task? Please provide solutions in bold font.,"Why Is Year-End Close Important? This form of annual reporting stands as a resource for organizations when establishing budget, long-term, and short-term goals. With this financial data, organizational leaders can make informed decisions to greatly benefit their company – but it all starts with accurate reporting. There are multiple aspects of year-end close that must be considered when finalizing your company’s financial assets at the end of the fiscal year. The year-end close process includes: Adhering to legal/government regulations Modifying journal entries Preparing financial statements Balancing accounts When accountants have these benchmarks in mind, they can enjoy several benefits associated with a successful year-end close. Benefits of a Successful Year-End Close The year-end close process can help organizations improve and optimize their operations in several ways – not only can it identify areas for improvement throughout the financial process, but it also helps decision-makers determine areas to allocate resources. This ultimately enhances the overall financial performance of the entire business. Accuracy & Compliance The year-end close process ultimately confirms the accuracy of an organization’s financial reporting for the entire fiscal year – giving leaders and decision makers a crystal-clear view of the business’s financial performance and health. Financial data is verified, and accounts are reconciled during this process, ensuring that the company is complying with accounting standards and regulations. Decision-Making & Planning As we’ve discussed, the year-end close process is essential for future financial planning and budgeting. This level of reporting allows leadership to make informed decisions based on reliable data – highlighting potential problems, trends, and areas primed for growth - a huge help when planning for the next year. Now that you know why year-end close is critical for your company, do you know how to do it properly? Let’s talk about it. Best Practices for Year-End Close Businesses must keep accurate financial reporting data for proper planning and decision making, but the year-end close process is known to be both time-consuming and complicated. Lucky for you, BlackLine is on your side - and we’ve listed out the most important steps to take during your year-end close process: Prepare In Advance They say preparation is the key to success, and when we’re talking about closing your financial records at the end of the fiscal year, they couldn’t be more correct. If you operate throughout the year with your year-end close process in mind, you can save a lot of time and stress come the end of Q4. As you manage your financial data throughout the year, keep these tasks in mind: Understanding applicable tax deadlines and implications Analyzing your organization’s tax duties Auditing and verifying financial data (which you should have been doing every step of the way) Taking advantage of the applicable tax credits and tax deductions Analyze Your Company’s Finances Now that you’ve been keeping accurate records and a close eye on your company’s financial data for the entirety of the fiscal year, it’s time to conduct an in-depth financial review. This review should consist of the following tasks: Analyzing revenue and expenses Evaluating asset and liability statements (receivables, payables, loans, and inventory) Discovering and correcting anomalies Through this detailed financial analysis, you will be empowered to identify opportunities for growth and savings in the next year, as well as fix inconsistencies that arise in your organization’s liability and asset accounts before you prepare your financial statements.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. What are some frequent difficulties that Finance and Accounting (F&A) teams face when dealing with period-end close task? Please provide solutions in bold font. Why Is Year-End Close Important? This form of annual reporting stands as a resource for organizations when establishing budget, long-term, and short-term goals. With this financial data, organizational leaders can make informed decisions to greatly benefit their company – but it all starts with accurate reporting. There are multiple aspects of year-end close that must be considered when finalizing your company’s financial assets at the end of the fiscal year. The year-end close process includes: Adhering to legal/government regulations Modifying journal entries Preparing financial statements Balancing accounts When accountants have these benchmarks in mind, they can enjoy several benefits associated with a successful year-end close. Benefits of a Successful Year-End Close The year-end close process can help organizations improve and optimize their operations in several ways – not only can it identify areas for improvement throughout the financial process, but it also helps decision-makers determine areas to allocate resources. This ultimately enhances the overall financial performance of the entire business. Accuracy & Compliance The year-end close process ultimately confirms the accuracy of an organization’s financial reporting for the entire fiscal year – giving leaders and decision makers a crystal-clear view of the business’s financial performance and health. Financial data is verified, and accounts are reconciled during this process, ensuring that the company is complying with accounting standards and regulations. Decision-Making & Planning As we’ve discussed, the year-end close process is essential for future financial planning and budgeting. This level of reporting allows leadership to make informed decisions based on reliable data – highlighting potential problems, trends, and areas primed for growth - a huge help when planning for the next year. Now that you know why year-end close is critical for your company, do you know how to do it properly? Let’s talk about it. Best Practices for Year-End Close Businesses must keep accurate financial reporting data for proper planning and decision making, but the year-end close process is known to be both time-consuming and complicated. Lucky for you, BlackLine is on your side - and we’ve listed out the most important steps to take during your year-end close process: Prepare In Advance They say preparation is the key to success, and when we’re talking about closing your financial records at the end of the fiscal year, they couldn’t be more correct. If you operate throughout the year with your year-end close process in mind, you can save a lot of time and stress come the end of Q4. As you manage your financial data throughout the year, keep these tasks in mind: Understanding applicable tax deadlines and implications Analyzing your organization’s tax duties Auditing and verifying financial data (which you should have been doing every step of the way) Taking advantage of the applicable tax credits and tax deductions Analyze Your Company’s Finances Now that you’ve been keeping accurate records and a close eye on your company’s financial data for the entirety of the fiscal year, it’s time to conduct an in-depth financial review. This review should consist of the following tasks: Analyzing revenue and expenses Evaluating asset and liability statements (receivables, payables, loans, and inventory) Discovering and correcting anomalies Through this detailed financial analysis, you will be empowered to identify opportunities for growth and savings in the next year, as well as fix inconsistencies that arise in your organization’s liability and asset accounts before you prepare your financial statements. https://www.blackline.com/blog/closing-the-books-best-practices-for-year-end-close/",Financial,Summarize & Simplify,Text Transformation """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","My son came home from school and told me about one of his classmates who had scary skin. I am not sure what he is referring to, but I suspect it is eczema. My son says that he is afraid of playing with the classmate because he doesn't want to get scaly skin like a lizard. I am not really sure what eczema is, aside from being a skin condition. Please tell me more about it.","Eczema, or atopic dermatitis, is a common chronic skin condition that can lead to recurrent infections and poor quality of life if left untreated. Recognized as the ""itch that rashes"" due to the rash that results from scratching or rubbing, the hallmark of eczema is dry, itchy skin prone to infections. This activity explores the pathogenesis of eczema, acknowledging the intertwined roles of genetic and environmental factors. Learners will gain valuable insights into recognizing eczema across different age brackets, effective evaluation techniques, proactive management of flare-ups, and preventative measures against recurring infections associated with untreated eczema. The course discussion also highlights the role of interprofessional collaboration in improving outcomes for patients with this condition. Objectives: Identify the pathophysiology of eczema. Evaluate the adverse effects of poorly controlled eczema. Implement appropriate treatment options for eczema. Communicate the importance of improving care coordination among the interprofessional team to improve outcomes for patients with eczema. Eczema, or atopic dermatitis, is the most common form of dermatitis.[1] Many factors, including genetic and environmental factors, are thought to play a part in the pathogenesis of eczema. It is most commonly seen in children but can be seen in adults as well. People with eczema tend to have dry, itchy skin prone to infection. The condition is commonly known as the ""itch that rashes"" because dry, itchy skin leads to a rash due to scratching or rubbing the skin. The exact etiology of eczema is not entirely understood, but it is believed to be a combination of genetic and environmental factors.[2] Genetic Factors There is a strong genetic component to eczema, with a family history of eczema, asthma, or allergies commonly found in affected individuals. Several genes associated with eczema have been identified, including those involved in the skin barrier function and the immune system. Filaggrin Gene One of the most well-known genes associated with eczema is the filaggrin gene (FLG). This gene provides instructions for making a protein called filaggrin, which is important in maintaining the skin barrier function. Mutations in this gene have been linked to eczema and other skin conditions and are thought to increase susceptibility to environmental irritants and allergens.[3][4] Other Skin Barrier Genes In addition to the filaggrin gene, other genes involved in the skin barrier function have been implicated in the development of eczema. These include genes involved in lipid synthesis and transport, such as the ceramide synthase gene and the ABCA12 gene.[5] Immune-related Genes Several genes involved in the immune response have also been associated with eczema, including genes that regulate T-cells, cytokines, and immunoglobulins. These genes include interleukin (IL)-4, IL-13, IL-31, signal transducer and activator of transduction (STAT)3, and Fc fragment of immunoglobulin (Ig)E receptor Ig (FCER1G). Overall, the genetic factors involved in eczema are complex and likely involve multiple genes and genetic pathways. Although genetic testing is not routinely used to diagnose eczema, understanding the disease's genetic basis can help identify individuals at increased risk and guide treatment approaches. Environmental Factors Environmental factors also play a role in the development of eczema. Patients with eczema have a defect in their skin barrier function, leading to increased water loss and susceptibility to environmental irritants and allergens. Common triggers for eczema flares include exposure to irritants such as detergents, soaps, solvents, and allergens such as dust mites, pet dander, and certain foods. Other factors that can exacerbate eczema symptoms include stress, changes in temperature and humidity, and infections. Immune System Activation In addition to genetic and environmental factors, the immune system is also thought to play a role in the development of eczema. Patients with eczema have an overactive immune response to environmental triggers, leading to inflammation and skin damage. Research shows there is a genetic component to eczema. One common mutation has been observed in FLG, a vital gene for skin cell maturity. This gene is responsible for creating the tough, flat corneocytes that form the outermost protective layer of skin. In a patient with normal skin cells, the corneocytes are tightly packed in an organized manner. A patient with an FLG mutation will have a dysfunctional skin barrier due to the haphazard organization of the skin cells.[7] This dysfunction causes a ""leaky"" skin barrier, allowing water loss and decreased protection from harmful substances. People with eczema also have reduced numbers of β-defensins in the skin. β-defensins are host defense peptides vital for fighting off certain bacteria, viruses, and fungi. A decrease in these peptides leads to increased colonization and infection, especially with Staphylococcus aureus (S. aureus).","""================ ======= Eczema, or atopic dermatitis, is a common chronic skin condition that can lead to recurrent infections and poor quality of life if left untreated. Recognized as the ""itch that rashes"" due to the rash that results from scratching or rubbing, the hallmark of eczema is dry, itchy skin prone to infections. This activity explores the pathogenesis of eczema, acknowledging the intertwined roles of genetic and environmental factors. Learners will gain valuable insights into recognizing eczema across different age brackets, effective evaluation techniques, proactive management of flare-ups, and preventative measures against recurring infections associated with untreated eczema. The course discussion also highlights the role of interprofessional collaboration in improving outcomes for patients with this condition. Objectives: Identify the pathophysiology of eczema. Evaluate the adverse effects of poorly controlled eczema. Implement appropriate treatment options for eczema. Communicate the importance of improving care coordination among the interprofessional team to improve outcomes for patients with eczema. Eczema, or atopic dermatitis, is the most common form of dermatitis.[1] Many factors, including genetic and environmental factors, are thought to play a part in the pathogenesis of eczema. It is most commonly seen in children but can be seen in adults as well. People with eczema tend to have dry, itchy skin prone to infection. The condition is commonly known as the ""itch that rashes"" because dry, itchy skin leads to a rash due to scratching or rubbing the skin. The exact etiology of eczema is not entirely understood, but it is believed to be a combination of genetic and environmental factors.[2] Genetic Factors There is a strong genetic component to eczema, with a family history of eczema, asthma, or allergies commonly found in affected individuals. Several genes associated with eczema have been identified, including those involved in the skin barrier function and the immune system. Filaggrin Gene One of the most well-known genes associated with eczema is the filaggrin gene (FLG). This gene provides instructions for making a protein called filaggrin, which is important in maintaining the skin barrier function. Mutations in this gene have been linked to eczema and other skin conditions and are thought to increase susceptibility to environmental irritants and allergens.[3][4] Other Skin Barrier Genes In addition to the filaggrin gene, other genes involved in the skin barrier function have been implicated in the development of eczema. These include genes involved in lipid synthesis and transport, such as the ceramide synthase gene and the ABCA12 gene.[5] Immune-related Genes Several genes involved in the immune response have also been associated with eczema, including genes that regulate T-cells, cytokines, and immunoglobulins. These genes include interleukin (IL)-4, IL-13, IL-31, signal transducer and activator of transduction (STAT)3, and Fc fragment of immunoglobulin (Ig)E receptor Ig (FCER1G). Overall, the genetic factors involved in eczema are complex and likely involve multiple genes and genetic pathways. Although genetic testing is not routinely used to diagnose eczema, understanding the disease's genetic basis can help identify individuals at increased risk and guide treatment approaches. Environmental Factors Environmental factors also play a role in the development of eczema. Patients with eczema have a defect in their skin barrier function, leading to increased water loss and susceptibility to environmental irritants and allergens. Common triggers for eczema flares include exposure to irritants such as detergents, soaps, solvents, and allergens such as dust mites, pet dander, and certain foods. Other factors that can exacerbate eczema symptoms include stress, changes in temperature and humidity, and infections. Immune System Activation In addition to genetic and environmental factors, the immune system is also thought to play a role in the development of eczema. Patients with eczema have an overactive immune response to environmental triggers, leading to inflammation and skin damage. Research shows there is a genetic component to eczema. One common mutation has been observed in FLG, a vital gene for skin cell maturity. This gene is responsible for creating the tough, flat corneocytes that form the outermost protective layer of skin. In a patient with normal skin cells, the corneocytes are tightly packed in an organized manner. A patient with an FLG mutation will have a dysfunctional skin barrier due to the haphazard organization of the skin cells.[7] This dysfunction causes a ""leaky"" skin barrier, allowing water loss and decreased protection from harmful substances. People with eczema also have reduced numbers of β-defensins in the skin. β-defensins are host defense peptides vital for fighting off certain bacteria, viruses, and fungi. A decrease in these peptides leads to increased colonization and infection, especially with Staphylococcus aureus (S. aureus). https://www.ncbi.nlm.nih.gov/books/NBK538209/ ================ ======= My son came home from school and told me about one of his classmates who had scary skin. I am not sure what he is referring to, but I suspect it is eczema. My son says that he is afraid of playing with the classmate because he doesn't want to get scaly skin like a lizard. I am not really sure what eczema is, aside from being a skin condition. Please tell me more about it. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Explanation/Definition,Q&A You can only respond using information in the context block.,What is the difference between supply-side economics and trickle-down economics?," In this paper I discuss what can be learned about “trickle-down” ideas from recent empirical evidence on tax incidence. Tax incidence, defined as the effect of tax policies on the distribution of welfare, provides an ideal framework because of the explicit focus on tracing the impacts of a policy beyond the directly affected group (ex. the rich). I arrive at three main lessons. First, recent evidence finds that business income taxes do affect the earnings of workers, but these effects are mostly a result of rent-sharing and taxation of rents, not from traditional supply-side channels. Second, there are systematic differences in the types of workers that are affected by the tax policies, so to understand how taxing businesses or business owners affects the distribution of welfare, it is not sufficient to treat workers/labor as a class. Third, across different income tax policies that statutorily affect the rich, the burden is generally ultimately born by the rich. I conclude with a discussion of fruitful avenues of further research, particularly on how tax incidence depends on various institutional features of labor markets, product markets and tax systems. There are two ideas of government. There are those who believe that if you just legislate to make the well-to-do prosperous, that their prosperity will leak through on those below. The Democratic idea has been that if you legislate to make the masses prosperous their prosperity will find its way up and through every class that rests upon it. - William Jennings Bryan (1896) 1 to the needy. Mr. Hoover was an engineer. He knew that water trickles down. Put it uphill and let it go and it will reach the driest little spot. But he didn’t know that money trickled up. Give it to the people at the bottom and the people at the top will have it before night, anyhow. But it will at least have passed through the poor fellow’s hands. They saved the big banks, but the little ones went up the flue. - Will Rogers (1932), first use of “trickle down” The idea of “trickle-down” originated from political debates to describe the economic policies of a party or politician. There was never a formal concept of “trickle-down economics” in the sense of economic theory. The term-of-art was used to describe policies that directly benefited to rich but were justified by arguments they would ultimately also benefit the middle class and poor. In fact, the term was not originally used by those advocating for such policies, but as a critique of the political discourse promoting such policies. While the term “trickle-down” was not used by William Jennings Bryan in his 1896 speech as he was running for president, the rhetoric was present in the introductory quote above. The term was first introduced by humorist and vaudville performer Will Rogers in a column critiquing then-President Herbert Hoover’s economic policies, also quoted above. The term, and the critique it embodied, stuck with politicians and parties that promoted economic policies where the direct benefits were for the rich, particularly those with respect to tax policies.1 The relationship between trickle-down ideas, tax policy and economics was secured during the Ronald Reagan administration, when the proposed tax cuts where linked to the recently articulated “supply-side” economic theory. Supply-side economics, broadly developed around the ideas of economists Robert Mundell and Arthur Laffer, focused on growth through reducing marginal income tax rates and promoting investment 1William J. Bennett, a conservative politician who served in the administrations of Ronald Reagan and George H. W. Bush, lamented in his 2007 book, “Humorist Will Rogers referred to the theory that cutting taxes for higher earners and businesses was a ”trickle-down” policy, a term that has stuck over the years.” 2 through lower capital income tax rates and deregulation. These ideas had a natural relationship with trickle-down ideas in that the direct beneficiaries of lower marginal and capital tax rates were disproportionately the rich - those that faced the highest marginal tax rates and disproportionately owned the capital - but the theory stated that this would ultimately benefit lower income consumers/workers through growth (led by capital investment), employment and lower prices. The Reagan administration turned to “supply-side” rhetoric to promote large marginal rate and business income tax cuts, and the concepts of supply-side and trickle-down tax policies have been linked since.2 Figure 1 shows the Google Trends of the term “trickle down” since 2005, and reveals that spikes in its use are concentrated around changes in tax policy or U.S. presidential elections where tax policy was on the agenda. 1.2. Economic Analysis of Trickle-Down In this article I will discuss the idea of trickle-down as it relates to taxes. I will focus on tax policies that have direct effects on the rich and capital owners - tax rates faced by high income households and capital tax policies specifically related to growth (supply-side) - with a focus on how the effects of these policies “trickle down” to lower income households or workers. Given that trickle-down originated as a political debate, I will discuss both positive analyses of these policies and normative frameworks that apply to the policies. Given this, the best economic framework to study these questions is the theory of tax incidence. Tax incidence is the study of the impact of taxes on the distribution of welfare, 3 and it derives from the insight that the person or entity with the the legal or statutory obligation to make the tax payment may not be the only one whose welfare is affected by the tax. In this way, the study of tax incidence maps directly onto trickle-down ideas by taking the direct or statutory beneficiary of the tax policy and following how it affects the distribution of welfare across the economy (whom does it trickle to?). Therefore, this paper will frame trickle-down ideas through positive and normative applications of tax incidence. I focus primarily on new empirical research about how taxing capital or the rich affect “the distribution of welfare.” Various economic models offer competing predictions about whether to expect that taxing capital owners at the top of the income distribution affects lower earning workers, if so, in what direction and by what channel. In the wake of this, some supply-side advocates have lamented how it has been used to promote trickledown ideas. In a 2007 article titled, How Supply-Side Economics Trickled Down, Bruce Bartlett, a former Reagan advisor wrote, “most accept the basic ideas of supply-side economics – that incentives matter, that high tax rates are bad for growth, and that inflation is fundamentally a monetary phenomenon. . . . Today, supply-side economics has become associated with an obsession for cutting taxes under any and all circumstances. No longer do its advocates in Congress and elsewhere confine themselves to cutting marginal tax rates – the tax on each additional dollar earned – as the original supply-siders did. Rather, they support even the most gimmicky, economically dubious tax cuts with the same intensity. ... today it is common to hear tax cutters claim, implausibly, that all tax cuts raise revenue.” Yet, another former Reagan advisor David Stockman has issued a competing complaint arguing that supply-side economics was always a cover for trickle-down ideas stating, “It’s kind of hard to sell ’trickle down,’ so the supply-side formula was the only way to get a tax policy that was really ’trickle down.’ Supply-side is ’trickle-down’ theory.” Therefore, it is ultimately an empirical question as to whether, and how, changes in these tax rates affect workers. Advances in data quality, particularly administrative linked firm-worker data, econometric methods for identifying causal effects of tax policies, and micro-economic theory on product and labor markets have led to new insights about whether and how taxes that directly affect the rich / capital owners ultimately affect lower earning workers. I review this new literature according to themes related to trickle-down and supply-side tax ideas and arrive at three main lessons. First, recent evidence finds that business income taxes do affect the earnings of workers, but these effects are mostly a result of rent-sharing and taxation of rents, not from traditional supply-side channels. Second, there are systematic differences in the types of workers that are affected by the tax policies, so to understand how taxing businesses or business owners affects the distribution of welfare, it is not sufficient to treat workers/labor as a class. Third, across different income tax policies that statutorily affect the rich, the burden is generally ultimately born by the rich. I conclude by arguing that from a policy standpoint, considering who bears the burden of a tax in isolation is insufficient for addressing trickle-down ideas or critiques and advocate for a more unified discussion of the efficiency and equity consequences of both tax and spending policies.","You can only respond using information in the context block.] What is the difference between supply-side economics and trickle-down economics? In this paper I discuss what can be learned about “trickle-down” ideas from recent empirical evidence on tax incidence. Tax incidence, defined as the effect of tax policies on the distribution of welfare, provides an ideal framework because of the explicit focus on tracing the impacts of a policy beyond the directly affected group (ex. the rich). I arrive at three main lessons. First, recent evidence finds that business income taxes do affect the earnings of workers, but these effects are mostly a result of rent-sharing and taxation of rents, not from traditional supply-side channels. Second, there are systematic differences in the types of workers that are affected by the tax policies, so to understand how taxing businesses or business owners affects the distribution of welfare, it is not sufficient to treat workers/labor as a class. Third, across different income tax policies that statutorily affect the rich, the burden is generally ultimately born by the rich. I conclude with a discussion of fruitful avenues of further research, particularly on how tax incidence depends on various institutional features of labor markets, product markets and tax systems. There are two ideas of government. There are those who believe that if you just legislate to make the well-to-do prosperous, that their prosperity will leak through on those below. The Democratic idea has been that if you legislate to make the masses prosperous their prosperity will find its way up and through every class that rests upon it. - William Jennings Bryan (1896) 1 to the needy. Mr. Hoover was an engineer. He knew that water trickles down. Put it uphill and let it go and it will reach the driest little spot. But he didn’t know that money trickled up. Give it to the people at the bottom and the people at the top will have it before night, anyhow. But it will at least have passed through the poor fellow’s hands. They saved the big banks, but the little ones went up the flue. - Will Rogers (1932), first use of “trickle down” The idea of “trickle-down” originated from political debates to describe the economic policies of a party or politician. There was never a formal concept of “trickle-down economics” in the sense of economic theory. The term-of-art was used to describe policies that directly benefited to rich but were justified by arguments they would ultimately also benefit the middle class and poor. In fact, the term was not originally used by those advocating for such policies, but as a critique of the political discourse promoting such policies. While the term “trickle-down” was not used by William Jennings Bryan in his 1896 speech as he was running for president, the rhetoric was present in the introductory quote above. The term was first introduced by humorist and vaudville performer Will Rogers in a column critiquing then-President Herbert Hoover’s economic policies, also quoted above. The term, and the critique it embodied, stuck with politicians and parties that promoted economic policies where the direct benefits were for the rich, particularly those with respect to tax policies.1 The relationship between trickle-down ideas, tax policy and economics was secured during the Ronald Reagan administration, when the proposed tax cuts where linked to the recently articulated “supply-side” economic theory. Supply-side economics, broadly developed around the ideas of economists Robert Mundell and Arthur Laffer, focused on growth through reducing marginal income tax rates and promoting investment 1William J. Bennett, a conservative politician who served in the administrations of Ronald Reagan and George H. W. Bush, lamented in his 2007 book, “Humorist Will Rogers referred to the theory that cutting taxes for higher earners and businesses was a ”trickle-down” policy, a term that has stuck over the years.” 2 through lower capital income tax rates and deregulation. These ideas had a natural relationship with trickle-down ideas in that the direct beneficiaries of lower marginal and capital tax rates were disproportionately the rich - those that faced the highest marginal tax rates and disproportionately owned the capital - but the theory stated that this would ultimately benefit lower income consumers/workers through growth (led by capital investment), employment and lower prices. The Reagan administration turned to “supply-side” rhetoric to promote large marginal rate and business income tax cuts, and the concepts of supply-side and trickle-down tax policies have been linked since.2 Figure 1 shows the Google Trends of the term “trickle down” since 2005, and reveals that spikes in its use are concentrated around changes in tax policy or U.S. presidential elections where tax policy was on the agenda. 1.2. Economic Analysis of Trickle-Down In this article I will discuss the idea of trickle-down as it relates to taxes. I will focus on tax policies that have direct effects on the rich and capital owners - tax rates faced by high income households and capital tax policies specifically related to growth (supply-side) - with a focus on how the effects of these policies “trickle down” to lower income households or workers. Given that trickle-down originated as a political debate, I will discuss both positive analyses of these policies and normative frameworks that apply to the policies. Given this, the best economic framework to study these questions is the theory of tax incidence. Tax incidence is the study of the impact of taxes on the distribution of welfare, 3 and it derives from the insight that the person or entity with the the legal or statutory obligation to make the tax payment may not be the only one whose welfare is affected by the tax. In this way, the study of tax incidence maps directly onto trickle-down ideas by taking the direct or statutory beneficiary of the tax policy and following how it affects the distribution of welfare across the economy (whom does it trickle to?). Therefore, this paper will frame trickle-down ideas through positive and normative applications of tax incidence. I focus primarily on new empirical research about how taxing capital or the rich affect “the distribution of welfare.” Various economic models offer competing predictions about whether to expect that taxing capital owners at the top of the income distribution affects lower earning workers, if so, in what direction and by what channel. In the wake of this, some supply-side advocates have lamented how it has been used to promote trickledown ideas. In a 2007 article titled, How Supply-Side Economics Trickled Down, Bruce Bartlett, a former Reagan advisor wrote, “most accept the basic ideas of supply-side economics – that incentives matter, that high tax rates are bad for growth, and that inflation is fundamentally a monetary phenomenon. . . . Today, supply-side economics has become associated with an obsession for cutting taxes under any and all circumstances. No longer do its advocates in Congress and elsewhere confine themselves to cutting marginal tax rates – the tax on each additional dollar earned – as the original supply-siders did. Rather, they support even the most gimmicky, economically dubious tax cuts with the same intensity. ... today it is common to hear tax cutters claim, implausibly, that all tax cuts raise revenue.” Yet, another former Reagan advisor David Stockman has issued a competing complaint arguing that supply-side economics was always a cover for trickle-down ideas stating, “It’s kind of hard to sell ’trickle down,’ so the supply-side formula was the only way to get a tax policy that was really ’trickle down.’ Supply-side is ’trickle-down’ theory.” Therefore, it is ultimately an empirical question as to whether, and how, changes in these tax rates affect workers. Advances in data quality, particularly administrative linked firm-worker data, econometric methods for identifying causal effects of tax policies, and micro-economic theory on product and labor markets have led to new insights about whether and how taxes that directly affect the rich / capital owners ultimately affect lower earning workers. I review this new literature according to themes related to trickle-down and supply-side tax ideas and arrive at three main lessons. First, recent evidence finds that business income taxes do affect the earnings of workers, but these effects are mostly a result of rent-sharing and taxation of rents, not from traditional supply-side channels. Second, there are systematic differences in the types of workers that are affected by the tax policies, so to understand how taxing businesses or business owners affects the distribution of welfare, it is not sufficient to treat workers/labor as a class. Third, across different income tax policies that statutorily affect the rich, the burden is generally ultimately born by the rich. I conclude by arguing that from a policy standpoint, considering who bears the burden of a tax in isolation is insufficient for addressing trickle-down ideas or critiques and advocate for a more unified discussion of the efficiency and equity consequences of both tax and spending policies.",Financial,Find & Summarize,Text Transformation Present your answer without any extraneous information.,How can schools transition from in-person classes to an online teaching model?,"Contemporary Issues In Education Research – December 2010 Volume 3, Number 12 17 Virtual Teaching And Strategies: Transitioning From Teaching Traditional Classes To Online Classes Bob Barrett, Franklin University, USA ABSTRACT As more technology has become available in many parts of the globe, a new type of student population has emerged. The traditional student image of higher learning has been somewhat limited in many countries, but given the impact of the Internet, this traditional “student body” has changed. Rather than being limited to regional demographics, the student body for educational institutions offering online courses has changed drastically. In fact, these online courses have started yet another chapter in the history of education, known as virtual learning communities. While online instructors may start out teaching students from local areas, this particular opportunity has been changing over the past decade. In fact, many online instructors have noted an increase in a more diversified student population in their classes. Further, they have realized the need to update their teaching skills, practices and strategies in order to accommodate the changing needs of the learners in the classroom, as well as updating their own teaching portfolio. This paper will provide a brief overview of current recruitment and hiring methods used in the traditional hiring versus online hiring of educators. Also, this paper will address the growing concerns of current traditional teachers as they approach the decision to transition over to online learning and how to obtain proper online instruction. Finally, this paper will overview how one online university has approached online teacher training for both experienced instructors, as well as new teaching recruits as they prepare to transition from traditional classrooms over to virtual classes. Keywords: Virtual learning; teachings strategies; traditional learning; online learning; online teaching strategies; online teacher training; teacher training INTRODUCTION s more technology has become available in many parts of the globe, a new type of student population has emerged. The traditional student image of higher learning has been somewhat limited in many countries, but given the impact of the Internet, this traditional “student body” has changed. Rather than being limited to regional demographics, the student body for educational institutions offering online courses has changed drastically. In fact, these online courses have started yet another chapter in the history of education, known as virtual learning communities.  In 2008, Sloan Consortium reports that there are approximately 4 million college students are currently enrolled in fully online courses.  In 2006, Sloan Consortium reported there were 3.2 million postsecondary students in the United States that took at least one online course; this represents a 25% increase over the previous year. (http://www.nacol.org). Further, there is also a growing need for online instruction in the K-12 market. A Contemporary Issues In Education Research – December 2010 Volume 3, Number 12 18  K-12 online learning is a new field consisting of an estimated $300 million market, which is growing at an estimated annual pace of 30% annually.  „45 of the 50 states, plus Washington D.C., have a state virtual school or online initiative, full-time online schools, or both.  „24 states, as well as Washington, DC, have statewide full-time online schools.  Many virtual schools show annual growth rates between 20 and 45%.  35 states have state virtual schools or state-led online programs. (http://www.nacol.org). While online instructors may start out teaching students from local areas, this particular opportunity has been changing over the past decade. In fact, many online instructors have noted an increase in a more diversified student population in their classes. Further, they have realized the need to update their teaching skills, practices and strategies in order to accommodate the changing needs of the learners in the classroom, as well as updating their own teaching portfolio. Teaching business and management has changed over the past decades in terms of the types of delivery, especially with the use of technology. The use of online learning has helped to increase student enrollments, diversify the variety of student input and perspectives, as well as increase the exposure of instructors to bigger learning demands of the learners. As a result, virtual instructors today need to develop and enhance their teaching strategies and methodologies in order to meet the growing needs of today’s online learning population. No longer are instructors focusing on teaching just local learners, but they must also concentrate on teaching students from a variety of international locations. This paper will focus on transitioning new and current instructors teaching in a live classroom setting to prepare them to teach online. The online learning environment differs from the physical, live classroom setting in terms of student population, use of technology, and vast ranges of time zones shared by a variety of students in an online course. As a result, it is important for adequate and appropriate online training/instruction be afforded to this specific population of educators. PURPOSE Due to the technological advancements in the online environment, online instructors must have a different type of skills sets in order to compete in today’s online learning environment. As a result, interviewers and HR personnel must create and implement different practices and procedures in order to determine the best possible candidate for an online teaching position. Thus, this paper will help to provide an open forum for the audience to determine if there is a need for change. Currently, recruiting and hiring methods used in the traditional hiring versus online hiring of educators do differ. When organizations are seeking qualified personnel to teach for their educational institutions, they may also need to gather and assess more information in order to best determine which candidate best “fits” the needs of the organization and position. As a result, there is a growing need for interviewers to capture more substantial data in order to help assist others in the hiring process. Further, they may need to employ different methods for recruiting and hiring. A new type of employee is needed to fill online instructional positions, so candidates must have certain skills sets. While many traditional instructors enjoy teaching in a live, physical classroom, many are starting to consider the possibility of transitioning over to online learning and how to obtain proper online instruction. Due to the lack of classroom space and declining enrollments, many colleges and universities have started to consider and implement online learning courses and programs. As a result, they have been changing their traditional approach to teacher training to that of an online learning environment. This change has been quite effective since many traditional instructors have been considering or have been assigned to teach online courses. While there is still a large population of graduates who have learned in the traditional learning environment (on-ground classes), there is a growing number of adult learners obtaining their degrees from online universities (with the same type of accreditation as their on-ground counterparts). As a result, both online and on-ground graduates are now seeking additional education in order to compete for online (adjunct) teaching opportunities. Contemporary Issues In Education Research – December 2010 Volume 3, Number 12 19 While distance education has been happening over the past 3-4 decades, the evolution of online learning has been growing rapidly in the higher education field. As this field has been seeing more and more online programs appear, many of the administrative and training departments of various colleges and universities have realized the need to help current and potential online instructors in preparing for online teaching in terms of current teaching strategies used – both from the live (on-ground) environment, as well as those strategies used in the online learning environment. Many colleges and universities now recruit, hire, and train potential online instructors via the Internet in terms of their electronic postings of jobs. There are four major areas that many universities must consider in the area of instructor recruitment and hiring. First, they need to reconsider their approach to recruitment, hiring, and training of current and future instructors for employment in the area of the online teaching. Second, they need to look at the best practices of other leading educational institutions to see how they are conducting their recruitment and training of online instructors. Third, they need to update their technological and skill requirements for online instructors to make sure that they are hiring the best for their educational institution. . Barbara Smith (2000), chief learning officer for Burson-Marsteller stated that ""If we don't have the best people creating the best product, we can't compete. What I'm after is creating the best people in the industry. E-learning is an option that provides us with a real competitive edge- -it helps us maximize our intellectual capital"" (para. 2). During this process, these educational institutions should examine the potential networking efforts, which could be possible for current and potential online instructors to meet others interested in online teaching during these instructional workshops, seminars, or courses. The following section will discuss the issues of recruitment and hiring. In particular, a discussion will be held on the characteristics of online instructor. Finally, there will be a brief overview of the online teacher training. RECRUITMENT AND HIRING OF POTENTIAL ONLINE INSTRUCTORS When organizations are seeking qualified personnel to teach for their educational institutions, they may also need to gather and assess more information in order to best determine which candidate best “fits” the needs of the organization and position. As a result, there is a growing need for interviewers to capture more substantial data in order to help assist others in the hiring process. Further, they may need to employee different methods for recruiting and hiring. Due to the technological advancements in the online environment, online instructors must have a different type of skills sets in order to compete in today’s online learning environment. As a result, interviewers and HR personnel must create and implement different practices and procedures in order to determine the best possible candidate for an online teaching position. CHARACTERISTICS OF AN ONLINE INSTRUCTOR What are the characteristics of a good and bad online instructor? Roueche, Roueche, and Milliron (1995) stated, “Adjunct faculty are increasingly important players in the teaching and learning process. It is in the college’s best interest of appreciating the investment value of them, and ultimately in the interest of establishing and maintaining the college’s reputation for teaching excellence” (p. 120). As noted early, many online teaching positions are being filled by part-time instructors. Many colleges and universities have found that this helps to reduce some administration of benefits and pay – so part-time faculty have been a “quick fix” for their current need. However, it should be noted for the purposes of this paper that there may be a change in this situation within the next decade or two as more part-time faculty seek more pay and benefits (i.e., union organization). TRAINING INSTRUCTORS ONLINE While some teaching tools may be effective in one learning environment, they may not be as successful in another. Therefore, as each environment is unique, as well as the learners in it, the teacher needs to assess their virtual environment and determine if change is necessary. However, not all educators may be as flexible in their teaching method, and they may not be willing to change. This leads us to the following question. Do educators incorporate different teaching strategies and techniques to meet the ever-changing needs of these virtual learners in terms of learning from their cultural differences in order to enhance the learning experiences of all? Contemporary Issues In Education Research – December 2010 Volume 3, Number 12 20 While we may hope that all educators are continuously improving their teaching methods and classrooms, we must recognize the fact that some may not. In the traditional classroom, there was an “expected” structure of teaching and layout of the classroom. However, in the virtual learning environment, educators have had to “unlearn” their old way of thinking in terms of teaching methodologies. In turn, online educators have had to learn new ways of implementing and nurturing learning for their virtual student populations. The key to success is our ability to think, visualize, and implement. White (2002) noted “Nowhere is thinking more evident than in the textual environment of the online classroom. If writing is thinking, then online students display their thinking throughout the course, illustrating their individual styles and changing attitudes.” (p. 6) Along this same line of thinking, educators can incorporate various strategies to help draw upon the experiences of all class members – rather than just a select few. CONCLUSION Traditionally, teachers have been expected serve as role models as they lead classroom discussions, collected and graded assignments, and provide leadership and guidance to their students. However, over the past two decades, the role and function of the instructor has changed drastically due to economic, technological, and educational factors. In any event, the area of online instruction has started to attract more and more students, as well as more instructors. In order to meet this growing demand for better qualified, online instructors, many schools have had to rethink their recruiting, hiring, and training efforts. Thus, there is a growing need to offer better quality online teacher training to current and potential online instructors to better enable these instructors to meet the ever- changing need of their online learning populations. AUTHOR INFORMATION Dr. Bob Barrett received his Ed.D. at The George Washington University; his M.B.E. at The University of the District of Columbia; and his B.A. at Shepherd University. He has completed additional Studies at University of Maryland - College Park, USDA Graduate School, and Gallaudet University. Dr. Barrett's current research interests are: Human Resource Development (HRD); Human Resource Management (HRM); Virtual Management Teams; Stakeholder Theory/Ethics; Logic/Dominant Logic; Disability/BDEP. REFERENCES 1. NACOL. http://www.nacol.org. Retrieved June 15, 2009. 2. National Center for Education Statistics, 2003. 3. Preece, J. (2000). Online communities: Designing usability, supporting sociability. Chichester: Wiley. 4. Roueche, J.E., Roueche, S.D., and Milliron, M.D. (1995). Strangers in their own land: Parts-time faculty in American’s community colleges. Washington D.C.: Community College Press. 5. Smith, B. (2000). Online Learning: The Competitive Edge: Companies blend E-learning into their business strategies to maximize intellectual capital. InformationWeek.com Retrieved September 22, 2010, http://www.informationweek.com/801/learn.htm. 6. White, K.W., Weight, B.H. (2000). The online teaching guide: A handbook of attitudes, strategies, and techniques for the virtual classroom. Needham Heights, MA: Allyn & Bacon.","Present your answer without any extraneous information. How can schools transition from in-person classes to an online teaching model? Contemporary Issues In Education Research – December 2010 Volume 3, Number 12 17 Virtual Teaching And Strategies: Transitioning From Teaching Traditional Classes To Online Classes Bob Barrett, Franklin University, USA ABSTRACT As more technology has become available in many parts of the globe, a new type of student population has emerged. The traditional student image of higher learning has been somewhat limited in many countries, but given the impact of the Internet, this traditional “student body” has changed. Rather than being limited to regional demographics, the student body for educational institutions offering online courses has changed drastically. In fact, these online courses have started yet another chapter in the history of education, known as virtual learning communities. While online instructors may start out teaching students from local areas, this particular opportunity has been changing over the past decade. In fact, many online instructors have noted an increase in a more diversified student population in their classes. Further, they have realized the need to update their teaching skills, practices and strategies in order to accommodate the changing needs of the learners in the classroom, as well as updating their own teaching portfolio. This paper will provide a brief overview of current recruitment and hiring methods used in the traditional hiring versus online hiring of educators. Also, this paper will address the growing concerns of current traditional teachers as they approach the decision to transition over to online learning and how to obtain proper online instruction. Finally, this paper will overview how one online university has approached online teacher training for both experienced instructors, as well as new teaching recruits as they prepare to transition from traditional classrooms over to virtual classes. Keywords: Virtual learning; teachings strategies; traditional learning; online learning; online teaching strategies; online teacher training; teacher training INTRODUCTION s more technology has become available in many parts of the globe, a new type of student population has emerged. The traditional student image of higher learning has been somewhat limited in many countries, but given the impact of the Internet, this traditional “student body” has changed. Rather than being limited to regional demographics, the student body for educational institutions offering online courses has changed drastically. In fact, these online courses have started yet another chapter in the history of education, known as virtual learning communities.  In 2008, Sloan Consortium reports that there are approximately 4 million college students are currently enrolled in fully online courses.  In 2006, Sloan Consortium reported there were 3.2 million postsecondary students in the United States that took at least one online course; this represents a 25% increase over the previous year. (http://www.nacol.org). Further, there is also a growing need for online instruction in the K-12 market. A Contemporary Issues In Education Research – December 2010 Volume 3, Number 12 18  K-12 online learning is a new field consisting of an estimated $300 million market, which is growing at an estimated annual pace of 30% annually.  „45 of the 50 states, plus Washington D.C., have a state virtual school or online initiative, full-time online schools, or both.  „24 states, as well as Washington, DC, have statewide full-time online schools.  Many virtual schools show annual growth rates between 20 and 45%.  35 states have state virtual schools or state-led online programs. (http://www.nacol.org). While online instructors may start out teaching students from local areas, this particular opportunity has been changing over the past decade. In fact, many online instructors have noted an increase in a more diversified student population in their classes. Further, they have realized the need to update their teaching skills, practices and strategies in order to accommodate the changing needs of the learners in the classroom, as well as updating their own teaching portfolio. Teaching business and management has changed over the past decades in terms of the types of delivery, especially with the use of technology. The use of online learning has helped to increase student enrollments, diversify the variety of student input and perspectives, as well as increase the exposure of instructors to bigger learning demands of the learners. As a result, virtual instructors today need to develop and enhance their teaching strategies and methodologies in order to meet the growing needs of today’s online learning population. No longer are instructors focusing on teaching just local learners, but they must also concentrate on teaching students from a variety of international locations. This paper will focus on transitioning new and current instructors teaching in a live classroom setting to prepare them to teach online. The online learning environment differs from the physical, live classroom setting in terms of student population, use of technology, and vast ranges of time zones shared by a variety of students in an online course. As a result, it is important for adequate and appropriate online training/instruction be afforded to this specific population of educators. PURPOSE Due to the technological advancements in the online environment, online instructors must have a different type of skills sets in order to compete in today’s online learning environment. As a result, interviewers and HR personnel must create and implement different practices and procedures in order to determine the best possible candidate for an online teaching position. Thus, this paper will help to provide an open forum for the audience to determine if there is a need for change. Currently, recruiting and hiring methods used in the traditional hiring versus online hiring of educators do differ. When organizations are seeking qualified personnel to teach for their educational institutions, they may also need to gather and assess more information in order to best determine which candidate best “fits” the needs of the organization and position. As a result, there is a growing need for interviewers to capture more substantial data in order to help assist others in the hiring process. Further, they may need to employ different methods for recruiting and hiring. A new type of employee is needed to fill online instructional positions, so candidates must have certain skills sets. While many traditional instructors enjoy teaching in a live, physical classroom, many are starting to consider the possibility of transitioning over to online learning and how to obtain proper online instruction. Due to the lack of classroom space and declining enrollments, many colleges and universities have started to consider and implement online learning courses and programs. As a result, they have been changing their traditional approach to teacher training to that of an online learning environment. This change has been quite effective since many traditional instructors have been considering or have been assigned to teach online courses. While there is still a large population of graduates who have learned in the traditional learning environment (on-ground classes), there is a growing number of adult learners obtaining their degrees from online universities (with the same type of accreditation as their on-ground counterparts). As a result, both online and on-ground graduates are now seeking additional education in order to compete for online (adjunct) teaching opportunities. Contemporary Issues In Education Research – December 2010 Volume 3, Number 12 19 While distance education has been happening over the past 3-4 decades, the evolution of online learning has been growing rapidly in the higher education field. As this field has been seeing more and more online programs appear, many of the administrative and training departments of various colleges and universities have realized the need to help current and potential online instructors in preparing for online teaching in terms of current teaching strategies used – both from the live (on-ground) environment, as well as those strategies used in the online learning environment. Many colleges and universities now recruit, hire, and train potential online instructors via the Internet in terms of their electronic postings of jobs. There are four major areas that many universities must consider in the area of instructor recruitment and hiring. First, they need to reconsider their approach to recruitment, hiring, and training of current and future instructors for employment in the area of the online teaching. Second, they need to look at the best practices of other leading educational institutions to see how they are conducting their recruitment and training of online instructors. Third, they need to update their technological and skill requirements for online instructors to make sure that they are hiring the best for their educational institution. . Barbara Smith (2000), chief learning officer for Burson-Marsteller stated that ""If we don't have the best people creating the best product, we can't compete. What I'm after is creating the best people in the industry. E-learning is an option that provides us with a real competitive edge- -it helps us maximize our intellectual capital"" (para. 2). During this process, these educational institutions should examine the potential networking efforts, which could be possible for current and potential online instructors to meet others interested in online teaching during these instructional workshops, seminars, or courses. The following section will discuss the issues of recruitment and hiring. In particular, a discussion will be held on the characteristics of online instructor. Finally, there will be a brief overview of the online teacher training. RECRUITMENT AND HIRING OF POTENTIAL ONLINE INSTRUCTORS When organizations are seeking qualified personnel to teach for their educational institutions, they may also need to gather and assess more information in order to best determine which candidate best “fits” the needs of the organization and position. As a result, there is a growing need for interviewers to capture more substantial data in order to help assist others in the hiring process. Further, they may need to employee different methods for recruiting and hiring. Due to the technological advancements in the online environment, online instructors must have a different type of skills sets in order to compete in today’s online learning environment. As a result, interviewers and HR personnel must create and implement different practices and procedures in order to determine the best possible candidate for an online teaching position. CHARACTERISTICS OF AN ONLINE INSTRUCTOR What are the characteristics of a good and bad online instructor? Roueche, Roueche, and Milliron (1995) stated, “Adjunct faculty are increasingly important players in the teaching and learning process. It is in the college’s best interest of appreciating the investment value of them, and ultimately in the interest of establishing and maintaining the college’s reputation for teaching excellence” (p. 120). As noted early, many online teaching positions are being filled by part-time instructors. Many colleges and universities have found that this helps to reduce some administration of benefits and pay – so part-time faculty have been a “quick fix” for their current need. However, it should be noted for the purposes of this paper that there may be a change in this situation within the next decade or two as more part-time faculty seek more pay and benefits (i.e., union organization). TRAINING INSTRUCTORS ONLINE While some teaching tools may be effective in one learning environment, they may not be as successful in another. Therefore, as each environment is unique, as well as the learners in it, the teacher needs to assess their virtual environment and determine if change is necessary. However, not all educators may be as flexible in their teaching method, and they may not be willing to change. This leads us to the following question. Do educators incorporate different teaching strategies and techniques to meet the ever-changing needs of these virtual learners in terms of learning from their cultural differences in order to enhance the learning experiences of all? Contemporary Issues In Education Research – December 2010 Volume 3, Number 12 20 While we may hope that all educators are continuously improving their teaching methods and classrooms, we must recognize the fact that some may not. In the traditional classroom, there was an “expected” structure of teaching and layout of the classroom. However, in the virtual learning environment, educators have had to “unlearn” their old way of thinking in terms of teaching methodologies. In turn, online educators have had to learn new ways of implementing and nurturing learning for their virtual student populations. The key to success is our ability to think, visualize, and implement. White (2002) noted “Nowhere is thinking more evident than in the textual environment of the online classroom. If writing is thinking, then online students display their thinking throughout the course, illustrating their individual styles and changing attitudes.” (p. 6) Along this same line of thinking, educators can incorporate various strategies to help draw upon the experiences of all class members – rather than just a select few. CONCLUSION Traditionally, teachers have been expected serve as role models as they lead classroom discussions, collected and graded assignments, and provide leadership and guidance to their students. However, over the past two decades, the role and function of the instructor has changed drastically due to economic, technological, and educational factors. In any event, the area of online instruction has started to attract more and more students, as well as more instructors. In order to meet this growing demand for better qualified, online instructors, many schools have had to rethink their recruiting, hiring, and training efforts. Thus, there is a growing need to offer better quality online teacher training to current and potential online instructors to better enable these instructors to meet the ever- changing need of their online learning populations. AUTHOR INFORMATION Dr. Bob Barrett received his Ed.D. at The George Washington University; his M.B.E. at The University of the District of Columbia; and his B.A. at Shepherd University. He has completed additional Studies at University of Maryland - College Park, USDA Graduate School, and Gallaudet University. Dr. Barrett's current research interests are: Human Resource Development (HRD); Human Resource Management (HRM); Virtual Management Teams; Stakeholder Theory/Ethics; Logic/Dominant Logic; Disability/BDEP. REFERENCES 1. NACOL. http://www.nacol.org. Retrieved June 15, 2009. 2. National Center for Education Statistics, 2003. 3. Preece, J. (2000). Online communities: Designing usability, supporting sociability. Chichester: Wiley. 4. Roueche, J.E., Roueche, S.D., and Milliron, M.D. (1995). Strangers in their own land: Parts-time faculty in American’s community colleges. Washington D.C.: Community College Press. 5. Smith, B. (2000). Online Learning: The Competitive Edge: Companies blend E-learning into their business strategies to maximize intellectual capital. InformationWeek.com Retrieved September 22, 2010, http://www.informationweek.com/801/learn.htm. 6. White, K.W., Weight, B.H. (2000). The online teaching guide: A handbook of attitudes, strategies, and techniques for the virtual classroom. Needham Heights, MA: Allyn & Bacon.",Internet/Technology,Find & Summarize,Text Transformation Give me your answer as a full sentence. Answer the question only using the context provided in the document.,Can anyone file an Amicus Brief?,"**LEGAL BRIEF** A legal brief is a document that makes an argument as to why the person filing the brief should win the case or otherwise see his motion granted. This document contains the issues in dispute, the facts of the matter, and arguments in support of the party’s position. A legal brief that is submitted with a motion can also be referred to as a “memorandum of law.” This usually happens at the trial court level. To explore this concept, consider the following legal brief definition. Definition of Legal Brief Noun A short and concise statement A document that presents a legal argument to a court explaining why that party should prevail over the other. Origin 1250-1300 Middle English bref What is a Legal Brief A legal brief is a document that is submitted to a court by a party to a lawsuit. In the document, that party lists the reasons why he should prevail over the other party or parties to the lawsuit. Legal briefs are often submitted together with a motion at the trial court level. These legal briefs are referred to as “legal memorandums,” or “memorandums of law.” A legal brief is different from a law school brief. In law school, students are typically asked to prepare a “brief” that gives an overview of a case, such as the issue at hand and an analysis of the facts. An example of a legal brief that can be considered a memorandum of law is one that accompanies a motion for summary judgment. A motion for summary judgment explains to the court why it is impossible for the opposing party to win the case, and requests that it be dismissed. Upon the court’s granting of summary judgment, the case is then effectively over. Legal briefs are also filed with the appellate court when an appeal has been entered. While trial courts hold trials to establish the facts of a case, appellate courts are more interested in whether or not the trial court made a mistake in issuing the decision that it did. Therefore, almost all appeals are heard via the briefs that are filed by the parties. Arguments are then heard from the parties’ attorneys, which are made based on the points presented in the legal briefs. Cases that are of a higher caliber and that are granted a writ of certiorari by the Supreme Court, can be argued on one of two examples of legal briefs: a merit brief, or an amicus brief. Merits briefs are filed by the parties to the case and, like at the lower court level, argue each side’s reasons they should win. Amicus briefs, however, are filed by people who are not parties to the case, but who have information to support one point of view or the other. These briefs focus on policy-related issues, and/or finer points of law. They can also explain why the case should be decided in favor of one party over the other when the law does not clearly apply to the issues at hand. Amicus briefs are typically filed by experts who specialize in the topics that are being discussed. For example, legal briefs are often filed by the American Civil Liberties Union (ACLU) on civil rights cases because they are experts on the subject, even if they are not directly involved with the parties to the case. Anyone can file an amicus brief to a case, so long as the court allows it. How to Write a Legal Before writing a legal brief, the person writing the brief should first consult the rules of the court to which the brief will be submitted. Different courts have different rules insofar as how to write a legal brief, such as the format of the brief, the number of pages that are permitted, and the presentation of citations. Court rules are normally published and, if the court has a website, the rules are usually posted there as well for easy reference. The State Bar of Wisconsin compiled a list of helpful tips on how to write a legal brief from judges who have extensive experience reading them. What follows are a few of their suggestions on how to write a legal brief that is better than average: Parties Should Persuade, Not Argue – A brief is effective when the judge reading it wonders why the parties to the action are arguing over such an obvious issue. Briefs Should Be Concise – Most cases can be boiled down to a single issue, so less is more when crafting a strong argument. Points Should Be Accurate – The parties should not argue points they are unable to prove. Relief Should Be Requested – The parties should not hesitate to be specific in the relief they’re requesting. Those drafting legal briefs often get caught up in raising all the facts of a case within that brief. This often results in the key points of a case getting buried in the other details being presented, and an otherwise good argument is lost. The last thing a brief should do is anger or bore the judge reading it. Therefore, only the best arguments should be presented, not every argument. It is also good to use the names of the parties, rather than “plaintiff” or “appellant.” This keeps the reader engaged in the narrative that is being told, and makes the argument that is being presented more persuasive to the person reading it. The more a judge can be drawn into reading a brief, the better chance that party has of prevailing at trial. Another common mistake is a failure to back up good arguments with good citations. Often, the person drafting a brief will cite case law and assume the judge is familiar with the facts of that case. It is therefore assumed that the judge will understand why that case is being cited with little or no explanation as to why. This is not necessarily true. Case citations should be accompanied by a brief explanation that clarifies the relevance of the holding whenever possible. If the case is not read thoroughly by the party citing it, it can actually work against him by acting as ammunition for the other side. In other words, he may be using an argument against his case, rather than for it. Formatting and Language of Legal Briefs There are specific rules regarding the formatting and language of a legal brief, depending on the court. As far as the U.S. Supreme Court is concerned, legal briefs must be written in 12-point type, in Century Schoolbook font. This is referred to as the “Supreme Court font.” Each legal brief submitted to the Supreme Court must be accompanied by a signed certificate that confirms that the brief’s formatting and language is in compliance with the imposed word limitations. The author’s signature must be notarized if he is not a member of the Bar of the Supreme Court or counsel of record. The word count, which is given by the word processing system that is used to draft the brief, must be listed on the certificate. The word count refers only to the text of the document and its footnotes. It does not include the additional sections of the brief, which can include the table of contents, the table of cited authorities, and/or any appendix that may be affixed to it. Nor are block quotations detailing constitutional provisions, treaties, statutes, ordinances, and regulations involved in the case included in the word count. Briefs submitted to the U.S. Supreme Court must be bound in booklet format, on paper cut to exactly 6 1/2″ x 9 1/4″, and the color, weight, and brightness of the paper is specified, as are the margins, size of footnotes, and the gutter. In addition to rules regarding formatting and language, the Supreme Court also has binding requirements for its briefs. Briefs should be saddle-stitched, which is the neat, center-spine stapling that is usually used for pamphlets, or perfect-bound, which is like the binding that joins together the pages of a book. Bindings made from plastic, metal, or string are not allowed, nor are spiral bindings. Even the color of the cover of the brief bears significance with the Supreme Court. For instance, an orange cover tells the Court that the brief is in opposition to a writ of certiorari. A light blue cover identifies a merits brief of Petitioner or Appellant, and a light green cover is attached to briefs of amicus curiae in support of Petitioner or Appellant. These are only a few of the colors that are used for Supreme Court brief covers. All of these requirements can be found on the Supreme Court’s website. Legalese It used to be that simple legal writing was frowned upon by the courts. To compensate, attorneys began writing in “legalese,” which is legal writing that is convoluted and confusing to most people. Terms like “heretofore,” “aforementioned,” and “thereafter” are considered legalese. Simpler legal writing uses fewer words, is clearer to the reader, and is significantly shorter in the number of total pages. When attorneys remove the legalese from their briefs, they are able to convey the same message that might otherwise have been lost in their use of more complicated legal terms. Legal Brief Sample The rules of the court to which a brief will be submitted take precedence over any legal brief sample that may be referenced in drafting the brief. While Appellate briefs are rarely published, those looking for sample legal briefs can reference the Supreme Court’s . This series contains full texts of some of the briefs that have been submitted for argument before the Supreme Court. Related Legal Terms and Issues Notary – A person authorized to perform certain legal tasks, such as the certification of contracts, deeds, or other documents that are referenced in court. Writ of Certiorari – An order issued by a higher court demanding a lower court forward all records of a specific case for review","[Task] ================== Give me your answer as a full sentence. Answer the question only using the context provided in the document. ================ [Question] ================== Can anyone file an Amicus Brief? ================ [Text] ================== **LEGAL BRIEF** A legal brief is a document that makes an argument as to why the person filing the brief should win the case or otherwise see his motion granted. This document contains the issues in dispute, the facts of the matter, and arguments in support of the party’s position. A legal brief that is submitted with a motion can also be referred to as a “memorandum of law.” This usually happens at the trial court level. To explore this concept, consider the following legal brief definition. Definition of Legal Brief Noun A short and concise statement A document that presents a legal argument to a court explaining why that party should prevail over the other. Origin 1250-1300 Middle English bref What is a Legal Brief A legal brief is a document that is submitted to a court by a party to a lawsuit. In the document, that party lists the reasons why he should prevail over the other party or parties to the lawsuit. Legal briefs are often submitted together with a motion at the trial court level. These legal briefs are referred to as “legal memorandums,” or “memorandums of law.” A legal brief is different from a law school brief. In law school, students are typically asked to prepare a “brief” that gives an overview of a case, such as the issue at hand and an analysis of the facts. An example of a legal brief that can be considered a memorandum of law is one that accompanies a motion for summary judgment. A motion for summary judgment explains to the court why it is impossible for the opposing party to win the case, and requests that it be dismissed. Upon the court’s granting of summary judgment, the case is then effectively over. Legal briefs are also filed with the appellate court when an appeal has been entered. While trial courts hold trials to establish the facts of a case, appellate courts are more interested in whether or not the trial court made a mistake in issuing the decision that it did. Therefore, almost all appeals are heard via the briefs that are filed by the parties. Arguments are then heard from the parties’ attorneys, which are made based on the points presented in the legal briefs. Cases that are of a higher caliber and that are granted a writ of certiorari by the Supreme Court, can be argued on one of two examples of legal briefs: a merit brief, or an amicus brief. Merits briefs are filed by the parties to the case and, like at the lower court level, argue each side’s reasons they should win. Amicus briefs, however, are filed by people who are not parties to the case, but who have information to support one point of view or the other. These briefs focus on policy-related issues, and/or finer points of law. They can also explain why the case should be decided in favor of one party over the other when the law does not clearly apply to the issues at hand. Amicus briefs are typically filed by experts who specialize in the topics that are being discussed. For example, legal briefs are often filed by the American Civil Liberties Union (ACLU) on civil rights cases because they are experts on the subject, even if they are not directly involved with the parties to the case. Anyone can file an amicus brief to a case, so long as the court allows it. How to Write a Legal Before writing a legal brief, the person writing the brief should first consult the rules of the court to which the brief will be submitted. Different courts have different rules insofar as how to write a legal brief, such as the format of the brief, the number of pages that are permitted, and the presentation of citations. Court rules are normally published and, if the court has a website, the rules are usually posted there as well for easy reference. The State Bar of Wisconsin compiled a list of helpful tips on how to write a legal brief from judges who have extensive experience reading them. What follows are a few of their suggestions on how to write a legal brief that is better than average: Parties Should Persuade, Not Argue – A brief is effective when the judge reading it wonders why the parties to the action are arguing over such an obvious issue. Briefs Should Be Concise – Most cases can be boiled down to a single issue, so less is more when crafting a strong argument. Points Should Be Accurate – The parties should not argue points they are unable to prove. Relief Should Be Requested – The parties should not hesitate to be specific in the relief they’re requesting. Those drafting legal briefs often get caught up in raising all the facts of a case within that brief. This often results in the key points of a case getting buried in the other details being presented, and an otherwise good argument is lost. The last thing a brief should do is anger or bore the judge reading it. Therefore, only the best arguments should be presented, not every argument. It is also good to use the names of the parties, rather than “plaintiff” or “appellant.” This keeps the reader engaged in the narrative that is being told, and makes the argument that is being presented more persuasive to the person reading it. The more a judge can be drawn into reading a brief, the better chance that party has of prevailing at trial. Another common mistake is a failure to back up good arguments with good citations. Often, the person drafting a brief will cite case law and assume the judge is familiar with the facts of that case. It is therefore assumed that the judge will understand why that case is being cited with little or no explanation as to why. This is not necessarily true. Case citations should be accompanied by a brief explanation that clarifies the relevance of the holding whenever possible. If the case is not read thoroughly by the party citing it, it can actually work against him by acting as ammunition for the other side. In other words, he may be using an argument against his case, rather than for it. Formatting and Language of Legal Briefs There are specific rules regarding the formatting and language of a legal brief, depending on the court. As far as the U.S. Supreme Court is concerned, legal briefs must be written in 12-point type, in Century Schoolbook font. This is referred to as the “Supreme Court font.” Each legal brief submitted to the Supreme Court must be accompanied by a signed certificate that confirms that the brief’s formatting and language is in compliance with the imposed word limitations. The author’s signature must be notarized if he is not a member of the Bar of the Supreme Court or counsel of record. The word count, which is given by the word processing system that is used to draft the brief, must be listed on the certificate. The word count refers only to the text of the document and its footnotes. It does not include the additional sections of the brief, which can include the table of contents, the table of cited authorities, and/or any appendix that may be affixed to it. Nor are block quotations detailing constitutional provisions, treaties, statutes, ordinances, and regulations involved in the case included in the word count. Briefs submitted to the U.S. Supreme Court must be bound in booklet format, on paper cut to exactly 6 1/2″ x 9 1/4″, and the color, weight, and brightness of the paper is specified, as are the margins, size of footnotes, and the gutter. In addition to rules regarding formatting and language, the Supreme Court also has binding requirements for its briefs. Briefs should be saddle-stitched, which is the neat, center-spine stapling that is usually used for pamphlets, or perfect-bound, which is like the binding that joins together the pages of a book. Bindings made from plastic, metal, or string are not allowed, nor are spiral bindings. Even the color of the cover of the brief bears significance with the Supreme Court. For instance, an orange cover tells the Court that the brief is in opposition to a writ of certiorari. A light blue cover identifies a merits brief of Petitioner or Appellant, and a light green cover is attached to briefs of amicus curiae in support of Petitioner or Appellant. These are only a few of the colors that are used for Supreme Court brief covers. All of these requirements can be found on the Supreme Court’s website. Legalese It used to be that simple legal writing was frowned upon by the courts. To compensate, attorneys began writing in “legalese,” which is legal writing that is convoluted and confusing to most people. Terms like “heretofore,” “aforementioned,” and “thereafter” are considered legalese. Simpler legal writing uses fewer words, is clearer to the reader, and is significantly shorter in the number of total pages. When attorneys remove the legalese from their briefs, they are able to convey the same message that might otherwise have been lost in their use of more complicated legal terms. Legal Brief Sample The rules of the court to which a brief will be submitted take precedence over any legal brief sample that may be referenced in drafting the brief. While Appellate briefs are rarely published, those looking for sample legal briefs can reference the Supreme Court’s . This series contains full texts of some of the briefs that have been submitted for argument before the Supreme Court. Related Legal Terms and Issues Notary – A person authorized to perform certain legal tasks, such as the certification of contracts, deeds, or other documents that are referenced in court. Writ of Certiorari – An order issued by a higher court demanding a lower court forward all records of a specific case for review",Legal,Find & Summarize,Text Transformation Only use the information found within the provided context. Answer using bullet points with explanations for each.,What are the most impactful 2023 developments for Hasbro?,"Fiscal year 2023 was a year of transformation for our business. Following the October 2022 announcement of our revised strategic plan, we embarked upon an ambitious, multi-year transformation guided by our revamped strategy. Since that announcement, we have been able to create efficiencies in our supply chain, improve our inventory position, lower our costs, and reinvest back into the business. During fiscal 2023, we strengthened our leadership team with industry veterans and turnaround experts and have focused our strategic investments on our most valuable and profitable franchises across games, toys, licensing and entertainment. This focused strategy also led to the decision to sell certain non-core parts of our business, including the Entertainment One film and television business not relating to Hasbro and family-oriented brands, which we refer to as Hasbro Brands and Family Brands. In 2023, we experienced stronger than expected market headwinds within our Consumer Products business, resulting in our difficult decision to take additional headcount reductions and accelerate the process of certain organizational structure changes that is expected to result in the reallocation of people and resources, both in effort to strengthen our foundation and position Hasbro for growth.","Only use the information found within the provided context. Answer using bullet points with explanations for each. What are the most impactful 2023 developments for Hasbro? Fiscal year 2023 was a year of transformation for our business. Following the October 2022 announcement of our revised strategic plan, we embarked upon an ambitious, multi-year transformation guided by our revamped strategy. Since that announcement, we have been able to create efficiencies in our supply chain, improve our inventory position, lower our costs, and reinvest back into the business. During fiscal 2023, we strengthened our leadership team with industry veterans and turnaround experts and have focused our strategic investments on our most valuable and profitable franchises across games, toys, licensing and entertainment. This focused strategy also led to the decision to sell certain non-core parts of our business, including the Entertainment One film and television business not relating to Hasbro and family-oriented brands, which we refer to as Hasbro Brands and Family Brands. In 2023, we experienced stronger than expected market headwinds within our Consumer Products business, resulting in our difficult decision to take additional headcount reductions and accelerate the process of certain organizational structure changes that is expected to result in the reallocation of people and resources, both in effort to strengthen our foundation and position Hasbro for growth.",Retail/Product,Summarize & Format,Text Transformation "In a 3-5 sentence paragraph based solely on the provided context block, answer the user's question. Outside knowledge is strictly prohibited.",What are the benefits and/or drawbacks of this acquisition?," Contact: Corporate Communications, USJ Co. 81-6-6465-3333 US MEDIA GIANT, COMCAST NBCUNIVERSAL TO PURCHASE 51% OWNERSHIP OF USJ CO., LTD. OSAKA (Sept. 28, 2015) – USJ Co., Ltd., the operating company of Universal Studios Japan, announced today that Comcast NBCUniversal agreed to purchase 51% of ownership of USJ from the current shareholders. This acquisition will show the strong commitment of Comcast NBCUniversal to grow and evolve Universal Studios Japan and as we work with NBCUniversal and its Universal Parks & Resorts division, the entire group’s global strategy in theme park business will accelerate. Also today, Glenn Gumpel, who served as Chief Executive Officer of USJ since 2004, announced to step down from the current position effective when the transaction closes. Universal Parks & Resorts has named Jean-Louis Bonnier as the new Chief Executive Officer. Glenn Gumpel said, “Universal Studios Japan will continue to progress along with its basic policies such as the successful marketing strategy which has boosted the attendance these recent years and look forward to even further growth utilizing a financial strength and a great platform Comcast NBCUniversal will give.” About Universal Studios Japan Bring You the Best of the Worldas a theme park where its guests can have the world’s best experiences and create the world’s best memories, Universal Studios Japan offers the world-class entertainment such as authentic attractions and shows, based on not only Hollywood blockbusters but also very popular world class entertainment brands, and a variety of seasonal events entertain its guests to the fullest fun. In recent years, Universal Studios Japan has constantly offered new entertainment one after another such as Universal Wonederland area where family guests enjoy meeting with popular characters, Universal Cool Japan event offering attractions themed on world-renowned Japanese entertainment brands, and The Wizarding World of Harry Potter which has been gathering attention of both domestic and international guests. These efforts resulted in not only a record-high attendance made in FY 2014 but also positioning of the Park as a prominent entertainment and leisure landmark drawing much greater number of guests from distant areas in Japan as well as overseas. About Comcast: Comcast Corporation (Nasdaq: CMCSA, CMCSK) is a global media and technology company with two primary businesses, Comcast Cable and NBCUniversal. Comcast Cable is one of the nation's largest video, high-speed Internet and phone providers to residential customers under the XFINITY brand and also provides these services to businesses. About NBCUniversal: NBCUniversal owns and operates a valuable portfolio of news and entertainment television networks, a premier motion picture company, significant television production operations, a leading television stations group, world-renowned theme parks, and a suite of leading Internet-based businesses. NBCUniversal is a subsidiary of Comcast Corporation. About Universal Parks & Resorts: Universal Parks & Resorts, a unit of Comcast NBCUniversal, offers guests around the globe today’s most relevant and popular entertainment experiences. With three-time Academy Award winner Steven Spielberg as creative consultant, its theme parks are known for immersive experiences that feature some of the world’s most thrilling and technologically advanced film- and television-based attractions. Comcast NBCUniversal wholly owns Universal Studios Hollywood, which includes Universal CityWalk Hollywood. It also owns Universal Orlando Resort, a world-class destination resort featuring two theme parks (Universal Studios Florida and Universal’s Islands of Adventure), four resort hotels, and Universal CityWalk Orlando. Comcast NBCUniversal also has license agreements with Universal Studios Japan in Osaka, Japan and Universal Studios Singapore at Resorts World Sentosa, Singapore. In addition, Comcast NBCUniversal has recently announced plans for a theme park in Beijing and an indoor theme park to be developed as part of the Galactica Park project in Moscow. ＊ ＊ ＊ Universal Studios Japan aims for the world’s best entertainment, a place where memories that lasts a lifetime are made. Please call the information center （Tel : 0570-20-0606） for any general information in regards to Universal Studios Japan. The Official Universal Studios Japan website can be accessed via computer, cell phone and smart phone. ＊ ＊ ＊","Context Block: Contact: Corporate Communications, USJ Co. 81-6-6465-3333 US MEDIA GIANT, COMCAST NBCUNIVERSAL TO PURCHASE 51% OWNERSHIP OF USJ CO., LTD. OSAKA (Sept. 28, 2015) – USJ Co., Ltd., the operating company of Universal Studios Japan, announced today that Comcast NBCUniversal agreed to purchase 51% of ownership of USJ from the current shareholders. This acquisition will show the strong commitment of Comcast NBCUniversal to grow and evolve Universal Studios Japan and as we work with NBCUniversal and its Universal Parks & Resorts division, the entire group’s global strategy in theme park business will accelerate. Also today, Glenn Gumpel, who served as Chief Executive Officer of USJ since 2004, announced to step down from the current position effective when the transaction closes. Universal Parks & Resorts has named Jean-Louis Bonnier as the new Chief Executive Officer. Glenn Gumpel said, “Universal Studios Japan will continue to progress along with its basic policies such as the successful marketing strategy which has boosted the attendance these recent years and look forward to even further growth utilizing a financial strength and a great platform Comcast NBCUniversal will give.” About Universal Studios Japan Bring You the Best of the Worldas a theme park where its guests can have the world’s best experiences and create the world’s best memories, Universal Studios Japan offers the world-class entertainment such as authentic attractions and shows, based on not only Hollywood blockbusters but also very popular world class entertainment brands, and a variety of seasonal events entertain its guests to the fullest fun. In recent years, Universal Studios Japan has constantly offered new entertainment one after another such as Universal Wonederland area where family guests enjoy meeting with popular characters, Universal Cool Japan event offering attractions themed on world-renowned Japanese entertainment brands, and The Wizarding World of Harry Potter which has been gathering attention of both domestic and international guests. These efforts resulted in not only a record-high attendance made in FY 2014 but also positioning of the Park as a prominent entertainment and leisure landmark drawing much greater number of guests from distant areas in Japan as well as overseas. About Comcast: Comcast Corporation (Nasdaq: CMCSA, CMCSK) is a global media and technology company with two primary businesses, Comcast Cable and NBCUniversal. Comcast Cable is one of the nation's largest video, high-speed Internet and phone providers to residential customers under the XFINITY brand and also provides these services to businesses. About NBCUniversal: NBCUniversal owns and operates a valuable portfolio of news and entertainment television networks, a premier motion picture company, significant television production operations, a leading television stations group, world-renowned theme parks, and a suite of leading Internet-based businesses. NBCUniversal is a subsidiary of Comcast Corporation. About Universal Parks & Resorts: Universal Parks & Resorts, a unit of Comcast NBCUniversal, offers guests around the globe today’s most relevant and popular entertainment experiences. With three-time Academy Award winner Steven Spielberg as creative consultant, its theme parks are known for immersive experiences that feature some of the world’s most thrilling and technologically advanced film- and television-based attractions. Comcast NBCUniversal wholly owns Universal Studios Hollywood, which includes Universal CityWalk Hollywood. It also owns Universal Orlando Resort, a world-class destination resort featuring two theme parks (Universal Studios Florida and Universal’s Islands of Adventure), four resort hotels, and Universal CityWalk Orlando. Comcast NBCUniversal also has license agreements with Universal Studios Japan in Osaka, Japan and Universal Studios Singapore at Resorts World Sentosa, Singapore. In addition, Comcast NBCUniversal has recently announced plans for a theme park in Beijing and an indoor theme park to be developed as part of the Galactica Park project in Moscow. ＊ ＊ ＊ Universal Studios Japan aims for the world’s best entertainment, a place where memories that lasts a lifetime are made. Please call the information center （Tel : 0570-20-0606） for any general information in regards to Universal Studios Japan. The Official Universal Studios Japan website can be accessed via computer, cell phone and smart phone. ＊ ＊ ＊ System Instructions: In a 3-5 sentence paragraph based solely on the provided context block, answer the user's question. Outside knowledge is strictly prohibited. Question: Can you explain the relationship between all the companies mentioned here in simple terms, including subsidiaries, etc.?",Financial,Find & Summarize,Text Transformation "Only utilize the information provided to you, and refer to it to respond to any query. Omit any clarifications, that would reach outside the scope of the provided materials. Declare: ""I need more provided context"", when a User query implies interest in a new field or topic.",Please provide an analysis of the US-Mexico border and how a more efficient border would impact the economy.,"Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Economic Impact of aMore Efficient US-MexicoBorder How Reducing Wait Times at Land Ports of Entry Would Promote Commerce, Resilience, and Job Creation Report Contributors: Alejandro Brugués Rodríguez, John Byrd, Noé Arón Fuentes Flores, David Gaytan, John Gibson, Camila Hernández, Mayra Maldonado, Jason Marczak, Jorge Eduardo Mendoza Cota, Roberto Ransom, and Ignacia Ulloa Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Atlantic Council’s nonpartisan Adrienne Arsht Latin America Center (AALAC) broadens understanding of regional transformations while demonstrating why Latin America and the Caribbean matter for the world. The center focuses on pressing political, economic, and social issues that will define the region’s trajectory, proposing constructive, results-oriented solutions to inform public sector, business, and multilateral action based on a shared vision for a more prosperous, inclusive, and sustainable future. AALAC – home to the premier Caribbean Initiative – builds consensus for action in advancing innovative policy perspectives within select lines of programing: U.S. policy in the Western Hemisphere; Colombia’s future; Venezuela’s multidimensional crisis; Central American prosperity; US-Mexico ties; China in the Americas; Brazil’s trajectory; Caribbean development; regional economic development and commerce; and energy transitions. Jason Marczak serves as the center’s senior director. This report is written and published in accordance with the Atlantic Council Policy on Intellectual Independence. The authors are solely responsible for its analysis and recommendations. The Atlantic Council and its donors do not determine, nor do they necessarily endorse or advocate for, any of this report’s conclusions. Atlantic Council 1030 15th Street NW, 12th Floor Washington, DC 20005 For more information, please visit www.AtlanticCouncil.org. ISBN-13: 978-1-61977-250-2 September 2022 A joint report by the Atlantic Council’s Adrienne Arsht Latin America Center, the University of Texas at El Paso’s Hunt Institute for Global Competitiveness, and El Colegio de la Frontera Norte. Atlantic Council ADRIENNE ARSHT LATIN AMERICA CENTER The Economic Impact of aMore Efficient US-MexicoBorder How Reducing Wait Times at Land Ports of Entry Would Promote Commerce, Resilience, and Job Creation (The first of a two-part series on the US-Mexico Border) Report Contributors: Alejandro Brugués Rodríguez, John Byrd, Noé Arón Fuentes Flores, David Gaytan, John Gibson, Camila Hernández, Mayra Maldonado, Jason Marczak, Jorge Eduardo Mendoza Cota, Roberto Ransom, and Ignacia Ulloa Table of Contents EXECUTIVE SUMMARY 6 INTRODUCTION 7 WHY INVEST IN THE US-MEXICO BORDER? 8 BORDER WAIT TIMES: A CONTINUED CHALLENGE 9 THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER 11 The United States: Increased border efficiency would strengthen the economy 12 Mexico: The potential economic gains of a more efficient border 15 CONCLUSION 17 METHODOLOGY 18 APPENDICES 19 ACKNOWLEDGMENTS 38 THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER “We know that long wait times at the border can hurt our businesses and economy, especially in my district. Ensuring our ports of entry have sufficient funding to reduce wait times is necessary to keep our economy on track and ensure businesses on both sides of the border succeed.” The Hon. Juan Vargas Representative (D-CA-51) US HOUSE OF REPRESENTATIVES “Strengthened US-Mexico collaboration at our border will unlock significant economic growth, promote supply chain resilience, and boost competitiveness, benefiting Mexican workers and families. These benefits will reverberate far beyond the border, reaching states throughout Mexico. Now is the time to invest in initiatives to create an even more efficient and secure shared border.” H.E. Luz Maria de la Mora Subsecretary of International Commerce, Secretariat of the Economy UNITED MEXICAN STATES “Our border communities rely on efficient and effective infrastructure for work, trade, tourism and other economic exchanges across the US-Mexico border. As the North American region seeks to retain its competitive global advantage, it is more important than ever for these communities to have access to top-notch ports of entry, staffing and technology. With the proper tools for border management, our border cities will be enabled to prosper now and well into the future.” The Hon. Tony Gonzales Representative (R-TX-23) US HOUSE OF REPRESENTATIVES 5 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Executive Summary Improvements in border management and the adoption of new technologies at the US-Mexico border have the potential to enhance security and generate economic benefits for the United States and Mexico through expedited flows of goods and people. Reduced border wait times would lead to more traffic entering the United States from Mexico, both in terms of commercial trucks loaded with goods for US consumers and shoppers ready to buy US goods. This report quantifies the economic impact of this additional commerce and cross-border spending, which would lead to further economic prosperity in the two countries. Research shows that a 10-minute reduction in wait times could lead to an additional $26 million worth of cargo entering the United States each month via commercial vehicles. This translates to more than $312 million in further commerce from Mexico into the United States annually. The extra inventory of finished and intermediate goods would drive down US domestic prices, creating increased economic well-being for US citizens. This report also finds that reducing border wait times by 10 minutes has a positive annual impact of $5.4 million on the US economy due to purchases by additional families and individuals entering the United States from Mexico. While the immediate effect of these purchases is most evident in border communities, economic benefits would spread to the continental United States due to the economic linkages between local economies, with approximately 25 percent of the total impact reaching non-border states. Beyond the $312 million in added commerce from Mexico into the United States, a 10-minute reduction in border wait times would promote the creation of nearly 18,700 direct and indirect jobs in Mexico, increase labor income per sector by an average of $17,474, and simulate growth for various Mexican economic sectors, particularly manufacturing, wholesale trade, and mining. More specifically, a one-minute reduction in border wait times would increase the average production (or output) per sector—for Mexico’s top ten sectors exporting to the United States—by 2 percent. This reduction in border wait times would also boost intermediate sales and aggregate demand in Mexico by 2.4 percent and 1.7 percent, respectively. These findings illustrate the economic benefits of prioritizing investments at the US-Mexico border to reduce commercial and noncommercial wait times. They are understood as the lower range of the potential national-level economic benefits of deepened US-Mexico collaboration to create a more efficient and secure border. A forthcoming second study will build on these findings, disaggregating the economic impact of reduced wait times for US and Mexican states and counties at the border and beyond. Trucks pass through the U.S. border and into the United States from Juarez, Mexico in El Paso, Texas, U.S. June 18, 2018. REUTERS/Mike Blake 6 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Introduction The US-Mexico border is a hub of cultural and commercial exchange, fostering continued growth and collaboration between the United States and Mexico. Stretching over 2,000 miles, it has more than forty-four active ports of entry, with fifteen million US and Mexican citizens residing in border counties. In July 2022 alone, the United States and Mexico traded over $65 billion in goods,1 with more than $53 billion crossing the southern border via trucks and trains.2 Approximately five million US jobs depend on trade with Mexico,3 meaning that one in every twenty-nine workers in the United States has a job created or supported by US-Mexico trade. These jobs are spread throughout the US economy in terms of geography and industries. In Mexico’s automotive sector, US-Mexico trade supports more than one million jobs directly and 4.5 million indirectly.4 In addition to importing and exporting final products, the United States and Mexico jointly produce goods. Cross-border production sharing has contributed to greater economic integration, resilience, and competitiveness while helping to insulate the US and Mexican economies from global competitors. Similarly, US-Mexico trade in services contributes to the commercial relationship, with over $62 billion traded in 2019.5 On July 12, 2022, US President Joseph R. Biden and Mexican President Andrés Manuel López Obrador met in Washington, DC, to discuss how safer and more efficient borders would enhance shared commerce.6 During their meeting, the United States committed to investing $3.4 billion and Mexico $1.5 billion to undertake major projects to modernize land ports of entry on the northern and southern borders. These efforts will create jobs, bolster shared security, and enhance supply chain resilience by promoting legitimate trade and travel. New investments should continue to enhance shared commerce while addressing long-standing efficiency and security challenges, including excessive wait times, inconsistent federal policies, outdated screening technologies, and the illicit flow of weapons, drugs, contraband, and people. Future US-Mexico cooperation should also build on prior efforts to modernize border infrastructure, expedite processing times, and implement joint production programs through accords such as the United States Mexico-Canada Agreement (USMCA). It could also prioritize new information-sharing infrastructure, shared defense strategies, bilateral-processing mechanisms, and expanded trusted traveler programs. The long-term institutionalization of standing working groups like the US-Mexico High-Level Economic Dialogue (HLED) will help the United States and Mexico align priorities and advance shared development goals moving forward—as evidenced through the joint commitments made at the September 12, 2022, HLED meeting.7 This report—the first in a two-part series—shows that US-Mexico cooperation aimed at creating a more efficient, resilient, and secure border will enhance shared commerce and economic well-being through the expedited flow of goods and people. Reduced border wait times would allow more commercial and noncommercial vehicles to enter the United States from Mexico, bolstering cross border trade and spending and stimulating competitiveness, economic integration, and job creation. This report includes national-level findings, while a second report disaggregates results by county and state, showing that investing in the US-Mexico border will pay dividends far beyond the border. 7 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Why Invest in the US-Mexico Border? The United States and Mexico rely on each other to meet their populations’ demand for goods and services. Mexico stands as one of the United States’ largest trading partners in terms of goods, ranking first in 2019 with more than $614 billion in total (two-way) goods traded that year.8 Recent disruptions to cross-border commerce illustrate this interdependence, with important economic implications for populations on both sides of the border. As COVID-19 first raged worldwide, shutting down economies in the spring of 2020, the US-Mexico border was not immune to the global lockdown. Disruptions in cross-border flows of goods and people resulted in unemployment, curtailed retail sales, and decreased revenue for the tourism industry. In Texas alone, the tourism industry lost $1.02 billion over the course of eight months of border closures. In Mexico, agricultural exports decreased 5.9 percent between March and May of 2020, with a 17.9 percent decrease in sugar exports compared to 2019.9 Avocados are another example of US-Mexico economic interdependence. Approximately nine of ten avocados in US supermarkets come from Mexico.10 In 2021 alone, the United States imported more than 1.1 million metric tons of avocados from Mexico, totaling over $2.8 billion. However, a temporary suspension of avocado imports—due to a verbal threat received by a US inspector in Michoacán—led to concerns over shortages and price increases across the United States.11 Fortunately, the eight-day suspension did not have a lasting impact on local economies or spoil the fruit waiting for export. Soon after the suspension was lifted, avocados quickly returned to US supermarkets to satisfy consumer demand. The story of COVID-related commerce disruptions and the avocado example not only illustrate the two countries’ economic interdependence but also the importance of safe and efficient borders. According to US Customs and Border Protection (CBP), the average border-crossing wait time per truck regularly surpasses 125 minutes during regular-to-peak crossing hours.12 Multiplied by the average of 19,617 trucks crossing the border daily, the lost revenue amounts to millions of dollars annually for the United States and Mexico. Cross-border spending by noncommercial entities (families and individuals) also directly impacts the US and Mexican economies. Cities along the southern border of the United States have become attractive commercial poles that draw customers from Mexico up to 75 miles (120 kilometers) away for daily consumption of goods and services. This is partly due to trade mechanisms becoming antiquated under new international trade agreements (originally designed to retain customers in local markets and supply border counties with national products) and the limitations of the Mexican domestic market, which often translates to higher prices and lower quality in goods such as food, clothing, footwear, and household equipment. The United States and Mexico have created a series of tools to expedite border crossings for pedestrians, trains, and commercial and noncommercial vehicles, including Unified Cargo Processing,13 Global Entry, Secure Electronic Network for Travelers Rapid Inspection (SENTRI),14 Customs Trade Partnership Against Terrorism,15 and other trusted traveler programs. However, these mechanisms only serve a small portion of daily border crossers, given high annual fees and other prohibitive eligibility requirements. For example, only 175,000 citizens in the United States and Mexico have become SENTRI card holders.16 Building on these and other programs is essential as US and Mexican leaders work together to tap the full economic potential of our shared border. 8 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Border Wait Times: A Continued Challenge Bottlenecks at land ports of entry along the US-Mexico border present a long-term challenge for economic integration, supply chain resilience, and competitiveness. While international production sharing programs such as the USMCA and the Maquiladora Export Industry17 have promoted mutually beneficial trade, they have contributed to border congestion by increasing the volume of vehicles requiring border inspections. Congestion and associated wait times are compounded by outdated technologies and limited information sharing within and between agencies in Mexico and the United States. Curtailing the illegal flow of weapons, drugs, contraband, and people also requires stringent and time-consuming border inspections that may lead to border delays. As shown in Figure 1, non-expedited cargo (commercial vehicles) entering the United States from Mexico undergoes a multistep inspection process. The first processing step involves examination by Mexican border agents who verify paperwork for outgoing goods, ensuring that tariffs are accurately assigned.18 Once cargo reaches US inspection booths, CBP officers first examine relevant documentation for incoming merchandise and drivers, who are then subject to automated regulation and tariff compliance reviews. At the officers’ discretion, cargo can undergo an additional canine or gamma ray inspection before being cleared for crossing. Noncommercial vehicles entering the United States from Mexico also undergo a multistep inspection process. Depending on the type of border crossing (i.e., land or bridge), vehicles could be required to pay tolls in cash or via electronic toll collection systems. Once completed, vehicles continue to US inspection points, where they can undergo up to two separate inspections. At the primary inspection booth, CBP officials verify travelers’ documentation and inquire about the purpose of their visit to the United States. If the Interagency Border Inspection System finds records of norm violation,20 CBP officers direct the vehicle toward secondary inspection. At the secondary inspection, officers conduct a thorough identity investigation, after which access to the United States is either granted or denied. Figure 1: Inspection Process for Commercial Vehicles at the US-Mexico Border19 1. Mexican Export Lot 2. US Federal Compound 3. State Safety Facility Warehouse / Yard Mexican export documentation verifications and cargo inspection selection Mexican export cargo inspection CBP primary inspection (document inspection) Secondary inspection VACIS, X-Ray, FMCSA `Others Visual vehicle safety inspection Detailed state truck safety inspection Warehouse / Yard Mexico United SOURCE: US Department of Transportation, Federal Highway Administration, “Border-wide Assessment of Intelligent Transportation System (ITS) Technology—Current and Future Concepts,” https://ops.fhwa.dot.gov/publications/fhwahop12015/ch2.htm, 2022. 9 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Trucks wait in a long queue for border customs control to cross into the U.S., in one of the main roads of Tijuana, Mexico, April 18, 2019. REUTERS/Andres Martinez Casares - RC1CE4339C90 Despite the implementation of numerous interventions to enhance the border-user experience, border users consulted while preparing this report expressed concerns about inconsistent federal policies that are not well attuned to their needs.21 For example, outdated technologies at port facilities lead to inaccurate time projections on official agency platforms, making border users turn to social media to better estimate wait and crossing times. Similarly, double inspection processes and unstandardized documentation requirements in different ports of entry generate delays in border crossings, which ultimately increase transport expenses. Finding ways to efficiently process the large volume of commercial and noncommercial vehicles crossing the border while safeguarding national security should remain a priority for the bilateral relationship. This will improve the border-user experience and result in substantial economic gains for both countries. 10 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER The Economic Impact of a More Efficient US-Mexico Border Reduced wait times at the US-Mexico directly impact the US and Mexican economies through increased cross border commerce (commercial vehicles) and spending (noncommercial vehicles). This section quantifies the nationwide dollar value that would result from additional traffic entering the United States from Mexico following a 10-minute reduction in border wait times. The economic impact is estimated for the US and Mexican economies. OUR APPROACH The Atlantic Council’s Adrienne Arsht Latin America Center partnered with the Hunt Institute for Global Competitiveness at the University of Texas at El Paso and El Colegio de la Frontera Norte to produce this two-part study. Findings in this first report result from roundtables, focus groups, and individual consultations carried out virtually across both countries and in-person in Washington, DC; El Paso, Texas; and Tijuana, Mexico; and the analysis of economic data from the United States and Mexico. This study utilizes two economic models; one uses US data, emphasizing the US economy, and another employs Mexican data, focusing on the Mexican economy. As a starting point, both sides of the border were viewed independently to account for discrepancies in data availability and the specific methodologies of local partners and stakeholders. By later harmonizing findings and data, the scope and range of results were extended, ultimately determining the costs and benefits of reducing border wait times for both economies. USEFUL TERMS • Commercial traffic: loaded or unloaded vehicles (usually trucks or trains) that cross the US-Mexico border with the intent to distribute goods produced in the country of origin. • Expenditure: the amount of money spent by noncommercial entities (families and individuals). • Aggregate demand: the total amount of demand for all finished goods and services produced in an economy. • Final good: a product that the final consumer uses or consumes. It does not require any additional processing. • Gross output: the measure of total economic activity in the production of new goods and services during an accounting period. • Labor income: the sum of employee compensation (wages and benefits) and proprietor income. • Intermediate good: a product used to produce a final good. • Intermediate sale: the sale of intermediate goods used in the production of final goods. • Noncommercial traffic: vehicles carrying passengers (tourists, workers, others) that do not transport goods to sell in the destination country. 11 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER The United States: Border Efficiency to Strengthen the Economy By John Byrd, John Gibson, Mayra Maldonado, and Roberto Ransom. University of Texas at El Paso’s Hunt Institute for Global Competitiveness Improved border management and the implementation of new technologies at the US-Mexico border have the potential to enhance border security and expedite legitimate trade and travel, stimulating the US and Mexican economies. A more efficient border would allow more commercial and noncommercial traffic to enter the United States from Mexico, resulting in additional goods for US consumers and businesses and more shoppers buying US goods and services. KEY TAKEAWAYS: A 10-minute reduction in wait times at the US-Mexico border would: • Five-hundred thirty-two additional commercial vehicles loaded with goods entering the United States from Mexico every month would generate an additional commercial intake of nearly $26 million monthly or $312 million annually. The extra inventory resulting from increased imports would reduce US domestic prices, thus promoting economic well-being for US citizens. • Sixty-thousand two-hundred forty additional noncommercial vehicles entering the United States from Mexico every month would generate an additional economic intake of $450,000 monthly, or $5.4 million annually. Border states would absorb approximately 75 percent of this economic impact, and the other 25 percent would reach non-border states in the United States. The Economic Impact of Additional Commercial Crossings In 2021, more than 4.7 million container trucks loaded with over $345.9 million worth of cargo entered the United States from Mexico via the US-Mexico border.22 Research shows that a one minute reduction in commercial wait times would result in 53 additional commercial crossings (see regression analysis in Appendix B). This means that a 10-minute reduction in wait times would result in approximately another 532 container trucks entering the United States every month. These containers may be loaded or unloaded. Therefore, estimating the economic impact of additional commercial crossings would require determining the proportion of loaded containers entering the United States via land ports of entry and the average cargo value of loaded containers. Data from the US Bureau of Transportation shows that approximately 73.1 percent of containers crossing the US-Mexico border are loaded with an average value of $66,798. Table 1 shows a breakdown of the average container value and the number of loaded and unloaded containers crossing the border through individual border counties. 12 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table 1: Proportion of Loaded Containers and Average Container Value (2019) State County Loaded Containers 2019 Unloaded Containers 2019 Loaded + Unloaded Containers Exports 2019 Imports 2019 Total Trade 2019 Average Value per Truck Texas El Paso 610,869 184,426 795,295 $31,717,503,019 $46,613,712,212 $78,331,215,231 $76,307 Texas Hudspeth 0 0 0 $- $- $- $- Texas Presidio 8,418 1,791 10,209 $144,896,195 $200,275,710 $345,171,905 $23,791 Texas Val Verde 59,951 15,651 75,602 $2,068,951,047 $3,082,037,002 $5,150,988,049 $51,409 Texas Maverick 149,732 30,298 180,030 $7,453,868,613 $22,197,870,144 $29,651,738,757 $148,251 Texas Webb 1,711,670 658,639 2,370,309 $95,124,653,587 $135,741,587,991 $230,866,241,578 $79,304 Texas Starr 38,611 17,958 56,569 $92,580,893 $387,724,994 $480,305,887 $10,042 Texas Hidalgo 502,312 213,297 715,609 $13,222,562,811 $23,522,857,942 $36,745,420,753 $46,829 Texas Cameron 153,280 134,796 288,076 $8,910,096,389 $8,930,388,221 $17,840,484,610 $58,262 New Mexico Luna 15,960 794 16,754 $23,980,387 $116,358,933 $140,339,320 $7,291 New Mexico Dona Ana 114,701 19,916 134,617 $14,098,068,953 $16,344,483,518 $30,442,552,471 $142,496 Arizona Yuma 28,342 8,823 37,165 $506,644,995 $875,099,032 $1,381,744,027 $30,876 Arizona Pima 303 12 315 $3,518,870 $1,794,662 $5,313,532 $5,923 Arizona Santa Cruz 293,771 66,136 359,907 $10,369,174,240 $15,633,063,045 $26,002,237,285 $53,215 Arizona Cochise 21,775 8,253 30,028 $802,531,798 $1,153,252,535 $1,955,784,333 $52,962 California San Diego 798,230 258,912 1,057,142 $17,279,207,288 $32,480,486,882 $49,759,694,170 $40,691 California Imperial 258,227 134,805 393,032 $7,023,568,716 $11,087,270,453 $18,110,839,169 $42,936 Total US Border 4,766,152 1,754,507 6,520,659 $208,841,807,801 $318,368,263,276 $527,210,071,077 Average $66,798 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF using data from the Department of Transportation and the US Census Bureau. Based on these findings, a 10-minute reduction in commercial wait times would allow $26 million23 in additional cargo value to enter the United States monthly or $312 million annually. This added commerce from Mexico into the United States consists of various finished and intermediate goods demanded by US consumers and businesses. While it may be argued that additional consumer goods entering the United States via the southern border would result in fewer jobs in the United States, the extra inventory generated by these other imports would also drive down domestic prices. Furthermore, the inflow of intermediate goods serves as vital inputs that support US businesses. As such, more data and analysis are required to determine which of these offsetting effects dominate. The Economic Impact of Additional Noncommercial Crossings24 Improvements in border management tools and practices could also expedite the flow of noncommercial crossings, with positive repercussions for the US economy due to additional cross border spending. In 2021, nearly 126 million people entered the United States from Mexico to purchase goods and services from US businesses. As shown in Table 2, these purchases generated an economic impact of $12.3 billion for the US economy.25 While the four US border states—Arizona, California, New Mexico, and Texas—absorb 75 percent of this impact, approximately 25 percent 13 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table 2: Economic Impact of Cross-Border Spending in the United States (2022) Impact Employment Labor Income Value Added Output 1 - Direct 2 - Indirect 3 - Induced 60,619.16 $1,812,022,814.56 $2,765,047,740.91 $5,036,142,293.41 21,166.07 $1,234,825,927.30 $1,980,607,178.46 $4,118,866,436.04 18,648.05 $977,441,701.68 $1,771,486,445.19 $3,177,688,817.94 100,433.29 $4,024,290,443.54 $6,517,141,364.56 $12,332,697,547.38 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. bleeds directly into non-border states. This means that spending by shoppers from Mexico in US border states has an economic impact of $3.1 billion in the other forty-six US states. Research finds that a 10-minute reduction in wait times at the US-Mexico border would result in an average of approximately 5,020 additional noncommercial crossings every month, or 60,240 every year (see regression results in Appendix B). Determining the economic impact of these additional crossings requires data on the spending patterns of noncommercial crossers and a model to assess the economic impact of this spending. Appendix C provides technical details on how the data and model were used to calculate impact. Research shows that a 10-minute reduction in noncommercial wait times at the US-Mexico border would lead to a $450,000 positive economic impact on the US economy every month. Over the course of one year, this would add up to a monetary intake of $5.4 million. The top three industries that would most benefit from additional cross-border spending is concentrated in areas where tourists or temporary visitors are likely to spend money, particularly retail, full service restaurants, and general merchandise industries. For further information on sector-specific impacts, see Appendix C. Trucks wait in a queue for border customs control, to cross into the United States, at the Zaragoza-Ysleta border crossing bridge in Ciudad Juarez, Mexico April 30, 2020. REUTERS/Jose Luis Gonzalez 14 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Mexico: The Potential Economic Gains of Border Efficiency By David Gaytan, Noé Arón Fuentes Flores, Alejandro Brugués Rodríguez, and Jorge Eduardo Mendoza Cota. El Colegio de la Frontera Norte KEY TAKEAWAYS: A one-minute reduction in wait times at the US-Mexico border would: • Boost Mexican exports to the United States, increasing sectoral output by an average of 2 percent, intermediate sales by an average of 2.4 percent, and aggregate demand by an average of 1.7 percent. Sectors benefiting the most from reduced commercial wait times are those for which production is largely driven by US demand for export goods such as mining, manufacturing, wholesale trade, and agriculture. A 10-minute reduction in wait times at the US-Mexico border would: • Create nearly 18,700 additional direct and indirect Mexican jobs. These posts would be largely concentrated in financial services; wholesale trade; sports, cultural, and other recreational services; and professional, scientific, and technical services. • Lead to an overall increase of $174,474 in labor income. Expediting the flow of commercial traffic from Mexico into the United States would boost cross-border commerce, which impacts aggregate demand in Mexico, causing a change in total gross output and intermediate sales.26 These effects can be disaggregated by sector in the Mexican economy. Macroeconomic Impact of Additional Commercial Crossings Determining the sectoral economic impact of a more efficient US-Mexico border requires understanding the relationship between Mexico’s exports per sector and US demand for export goods. The United States stands as Mexico’s largest export market, with approximately 80 percent of Mexican exports destined for the United States.27 Nearly 100 percent of these exports are concentrated in ten sectors,28 accounting for $349 billion in 2018 and $358 billion in 2019 (for more information, see Appendix F).29 Therefore, this study only considers Mexico’s top-ten sectors in terms of exports to the United States. Within this group, the manufacturing and maquiladora export industries are particularly important, producing more than 60 percent of Mexico’s total exports to the United States. Today, Mexico stands as the top US supplier of motor vehicles and motor vehicle parts.30 Findings show that, on average, Mexican exports to the United States drive 38 percent of Mexican production (or output) per sector (for a detailed breakdown, see Appendix F). For mining, manufacturing, wholesale trade, and agriculture, exports to the United States drive more than 50 percent of total gross output. These four sectors alone are responsible for 84.4 percent of the total dollar value generated from exports to the United States, accounting for $664.26 billion out of the total $787.16 billion in total production. A significant portion of Mexican exports enters the United States via land ports across the US-Mexico border. An average of twenty-eight commercial vehicles with export goods arrive at the border every hour, with the average truck taking approximately 20 minutes to cross the border (for more information, see Appendix D3). Reducing wait times would boost Mexican exports by allowing additional commercial crossings into the United States. This would strengthen Mexican supply chains by stimulating the exchange of intermediate and final goods between sectors in response to the increased demand for export goods. Given that approximately 73.1 percent of containers crossing the US-Mexico border are loaded with an average value of $66,798,31 a one-minute reduction in commercial wait times would increase 15 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER sectoral output (total gross output) by an average of 2 percent. This output growth would be driven by a 1.7 percent increase in average demand per sector, occurring as a result of additional Mexican exports entering the United States. Intermediate sales (the sectoral exchange of intermediate goods for the production of additional export goods) would grow by an average of 2.4 percent per sector. Appendix D includes a detailed description of the two models used in the analysis, a queuing and input-output model. As Figure 2 shows, the benefits of increased commercial crossings into the United States are unequally distributed across sectors of the Mexican economy. The mining, manufacturing, and wholesale trade sectors experience the highest growth rates in production, at 3.62 percent, 3.62 percent, and 3.33 percent, respectively. These three sectors also have the largest increase in aggregate demand, growing at 3.88 percent, 5.20 percent, and 3.63 percent, respectively. Regarding intermediate sales, the agricultural and mining sectors have growth rates higher than 3 percent. Appendix F has a detailed breakdown of nominal and percentage growth in production (total gross output), intermediate sales, and aggregate demand following a one-minute reduction in border wait times. Economic Impact on Employment and Labor Income of Additional Commercial Crossings Moreover, this study finds that a 10-minute reduction in border wait times would promote the creation of nearly 18,700 indirect and direct jobs in Mexico over the course of one year, with 5,505 new positions opening in financial and insurance services, 3,684 in mass media information, 3,216 in wholesale trade, and 2,448 in professional, scientific, and technical posts. The loss in labor is far smaller, with an estimated 793 jobs lost in manufacturing and 210 in the transportation, postage, and warehousing sectors. (For detailed analysis, see Appendix G). A ten-minute reduction in commercial wait times would also result in a $174,474 increase in labor income. When disaggregated by sector, labor income growth is higher in the wholesale trade, financial and insurance services, information services, and mining sectors. Interestingly, this change would lead to more equitable distribution of labor income across Mexican economic sectors. However, the variation is driven mainly by increased production by sector rather than overall productivity. (For more information, see Appendix G). Figure 2: Growth of Total Gross Output, Aggregate Demand, and Intermediate Sales Total Production Growth Aggregate Demand Growth Intermediate Sales GrowthSOURCE: In-house prepared graph based on estimates for 2018 data, obtained from the National Institute of Statistics and Geography, 2022. 16 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Conclusion Trucks wait in a long queue for border customs control to cross into the United States at the World Trade Bridge in Nuevo Laredo, Mexico April 2, 2019. REUTERS/Daniel Becerril A more efficient US-Mexico border would expedite legitimate trade and travel, enhancing cross-border commerce and benefiting the US and Mexican economies. Streamlined border crossings could be achieved through improvements in border management practices and the adoption of new technologies. These efforts would also bolster shared security between the United States and Mexico. This report focused on the economic impact of expediting commercial and noncommercial crossings from Mexico into the United States. Reduced border wait times would increase the supply of goods and services for US consumers and stimulate spending in the United States while boosting Mexican exports into the United States. This would lead to an increasingly competitive, economically integrated, and resilient bilateral relationship. In the United States, a 10-minute reduction in border wait times would facilitate the crossing of 532 additional loaded trucks every month, generating an added commercial intake of nearly $26 million per month. In one year, the economic impact on the US economy would be $312 million. Similarly, it would allow 60,240 additional noncommercial vehicles to enter the United States every month, generating an extra economic intake of $450,000 monthly, or $5.4 million annually. The benefits of increased cross-border commerce and spending would extend throughout the United States due to the economic linkages between local economies. For Mexico’s top ten export sectors to the United States, a one minute reduction in commercial wait times would, on average, increase production (total gross output) by 2 percent, intermediate sales by 2.4 percent, and aggregate demand by 1.7 percent. Results show the mining, manufacturing, wholesale trade, and agricultural sectors would benefit the most from additional commerce from Mexico into the United States. Historically, more than 50 percent of production in these sectors has been driven by US demand for export goods. Expediting the flow of commercial vehicles from Mexico into the United States by ten minutes would increase labor income by $174,474 and promote the creation of nearly 18,700 additional direct and indirect jobs in Mexico, particularly in financial services; mass media information; wholesale trade; and professional, scientific, and technical services. These numbers illustrate the lower-bound economic gains that would result from reduced wait times at the US-Mexico border, stemming from potential improvements in border management practices and tools. They emphasize the economic interdependence of the United States and Mexico, outlining how a further coordinated, binational approach to the border would benefit both countries. A subsequent study will disaggregate national-level findings and thus determine the impact of a more efficient and secure US-Mexico border at the state and county level in the United States and Mexico. 17 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Methodology US-focused analysis The Hunt Institute for Global Competitiveness used a two-step process to calculate the economic impact of reducing border wait times for commercial and noncommercial crossings. First, regression analysis was employed to determine the relationship between average wait times (in minutes) and the average number of crossings (commercial and noncommercial) at major US-Mexico land ports of entry. Additional factors impacting this relationship, such as employment and crime on both sides of the border, the number of lanes in operation, and total expenditures made by the US Department of Homeland Security (DHS), were considered. The analysis used data from various sources, including CBP, the US Department of Transportation’s Bureau of Transportation Statistics, the US Department of Labor’s Bureau of Labor Statistics, Instituto Nacional de Estadística y Geografía (INEGI, or National Institute of Statistics and Geography), and the Instituto Mexicano de Seguro Social (Mexican Institute of Social Security). To account for disruptions in border traffic patterns stemming from COVID-19 and its accompanying policy changes, the study captures data between April 2016 and December 2019, before the pandemic’s onset. The second step in the analysis was quantifying the economic impact of additional crossings resulting from reduced wait times. Because of the different types of data available for commercial and noncommercial crossings; this study used various methods to quantify their effects. For commercial crossings, the proportion of loaded container crossings and the average value per container— obtained from the US Department of Transportation—were used to determine the dollar value associated with increased container crossings. For noncommercial crossings, survey data from the City of El Paso’s International Bridges Department on travel and spending patterns were used to model the economic impact of spending by additional noncommercial crossers. Appendices A through C include more technical information and a detailed, step by-step explanation of the analysis. Mexico-focused analysis El Colegio de la Frontera Norte used a three-step process and two economic models to determine the economic impact of reduced border wait times for commercial vehicles. The analysis used data from the US Bureau of Transportation Statistics, CBP, the North American Industry Classification System (NAICS), Mexico’s INEGI, Automated Census Information System (ACIS), and Servicio de Administración Tributaria (SAT, or Tax Administration Service). The first step was to estimate the average inspection rate of commercial vehicles at US-Mexico border land ports of entry (see Appendix D3 for detailed analysis). Then, a queuing model was used to determine how reduced wait times affect Mexican exports to the United States. Finally, an input-output model was implemented to establish how changes in exports affect production (total gross output), intermediate sales, and aggregate demand for Mexico’s top ten sectors in terms of exports to the United States. Appendix D provides a detailed, technical description of the queueing and input output models, while Appendix F includes analysis results. 18 ATLANTIC COUNCIL THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendices The following Appendices provide additional details on the economic analysis summarized in the main report. Given its technical nature, this section can be skipped by more casual readers. Appendices A, B, and C explain the US-focused analysis by the Hunt Institute for Global Competitiveness and Appendices D, E, F, and G expand on the Mexico-focused analysis by El Colegio de la Frontera Norte. US-FOCUSED ANALYSIS APPENDIX A 20 Provides a detailed description of the data used in the regression analysis. APPENDIX B 24 Outlines the regression model used to estimate the relationship between border wait times and commercial and noncommercial crossings. APPENDIX C 25 Gives an overview of IMPLAN and how it was used to measure the economic impact of noncommercial crossings. MEXICO-FOCUSED ANALYSIS APPENDIX D 28 Provides more details on the input-output and queuing models. APPENDIX E 31 Describes the data used in the analysis. APPENDIX F 32 Explains the economic impact analysis with and without reduced border wait times. APPENDIX G 36 Describes the analysis of economic impact on employment and labor income. 19 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX A: DATA USED FOR THE FIXED EFFECTS MODEL While report results are presented at the national level, the analysis by the Hunt Institute for Global Competitiveness is built from county level data focusing on major US-Mexico land ports of entry. Map 1 shows the counties on the US-Mexico border for which data was collected and analyzed. These counties have one or more land ports of entry. Map 2 presents CBP sectors and selected counties’ ports of entry within each sector. Map 1. US Border Counties on the US-Mexico Border SOURCE: The Hunt Institute for Global Competitiveness and El Colegio de la Frontera Norte (COLEF). 20 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Map 2. CBP Sectors Along the US-Mexico Border SOURCE: The Hunt Institute for Global Competitiveness and COLEF using data from CBP. Table A1 lists every US county that touches the US-Mexico border. The list includes the name of every port of entry within that county, the names of the corresponding Mexican counties, and the CBP sector that contains that county. 21 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table A1: US-Mexico Border States, Counties, Cities, Ports of Entry, Mexican Sister Cities, and CBP Sectors State County City PoE Sister City CBP Sector California Arizona New Mexico Texas San Diego San Ysidro San Ysidro Tijuana, Baja California San Diego Sector, California Otay Mesa Otay Mesa - Commercial Otay Mesa - Passenger Otay Mesa - Pedestrian Cross Border Express Tecate Tecate Imperial Calexico Calexico - East Mexicali, Baja California El Centro Sector, California Calexico - West Andrade Andrade Yuma San Luis San Luis - San Luis I San Luis Rio Colorado, Sonora Yuma Sector, Arizona San Luis - San Luis II Pima Lukeville Lukeville Puerto Peñasco, Sonora Tucson Sector, Arizona Sasabe Sasabe Sáric, Sonora Santa Cruz Nobales Nogales - Deconcini Nogales, Sonora Nogales - Mariposa Nogales - Morley Gate Cochise Naco Naco Naco, Sonora Douglas Douglas (Raul Hector Castro) Agua Prieta, Sonora Luna Columbus Columbus Asencion, Chihuahua El Paso Sector, New Mexico Doña Ana Santa Teresa Santa Teresa - Santa Teresa Port of Entry Ciudad Juarez, Chihuahua El Paso El Paso El Paso - Bridge of the Americas (BOTA) Ciudad Juarez, Chihuahua El Paso Sector, Texas El Paso - Paso del Norte (PDN) El Paso - Stanton DCL El Paso - Ysleta Hudspeth Fort Hancock Fort Hancock - Fort Hancock El Paso Fabens Fabens - Tornillo Guadalupe, Chihuahua Presidio Presidio Presidio Ojinaga, Chihuahua Big Bend Sector, Texas Val Verde Del Rio Del Rio Acuña, Coahuila Del Rio Sector, Texas Maverick Eagle Pass Eagle Pass - Bridge I Piedras Negras, Coahuila Eagle Pass - Bridge II Webb Laredo Laredo - Bridge I Nuevo Laredo, Tamaulipas Laredo Sector, Texas Laredo - Bridge II Laredo - Colombia Solidarity Laredo - World Trade Bridge Starr Roma Roma Ciudad Miguel Aleman, Tamaulipas Rio Grande Rio Grande City Camargo, Tamaulipas Rio Grande Valley Sector Hidalgo County Hidalgo/ Pharr Hidalgo/Pharr - Anzalduas International Bridge Reynosa, Tamaulipas Hidalgo/Pharr - Hidalgo Hidalgo/Pharr - PharrProgreso - Donna International Bridge Hidalgo Progreso Progreso - Donna International Bridge Rio Bravo, Tamaulipas Progreso - Progreso International Bridge Cameron Brownsville Brownsville - B&M Matamoros, Coahuila Brownsville - Gateway Brownsville - Los Indios Brownsville - Veterans International SOURCE: The Hunt Institute for Global Competitiveness and El Colegio de la Frontera Norte (COLEF) using data from CBP. 22 ATLANTIC COUNCIL APPENDIX A THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Running the necessary regressions to determine the impact of border wait times on border crossings requires data on several variables in various geographies. The data gathered for the regression analysis includes: 1. Average wait times: Border wait times at ports of entry were obtained from CBP. The research team used this data to estimate the monthly average border wait time (in minutes) for every land port of entry. This data was available for commercial vehicles, personal vehicles, and pedestrian modes of crossing, but not for rail crossings.32 Commercial vehicle data for the Hudspeth port of entry were unavailable for this variable.33 2. Total number of crossings per month: Data was captured from the US Department of Transportation’s Bureau of Transportation Statistics for each port of entry on the US-Mexico border and mode of crossing (commercial vehicles, noncommercial vehicles, and pedestrian crossings). The analysis uses these data to estimate the total number of crossings per city and county. The data for the Fort Hancock port of entry was unavailable for this variable. 3. Number of operational lanes per month: The total number of operating lanes per hour per port of entry was taken from the CBP for every port of entry. This analysis used the point of entry level data to estimate the number of operational lanes by city and county. The research team estimated an hourly average for every port of entry, using it to estimate a monthly average of the number of lanes in operation per port of entry. The commercial vehicles data for the Eagle Pass port of entry were not available for this variable. 4. Total number of existing lanes: The total number of existing lanes for every port of entry was captured from CBP. Commercial vehicle data for the Fort Hancock port of entry were unavailable for this variable. 5. Total employment (United States): The monthly data of total non-farm employment information for each US county on the US-Mexico border with ports of entry was obtained from the US Department of Labor’s Bureau of Labor Statistics. 6. Total employment (Mexico): The monthly data on total non-farm employment for each of the Mexican counties on the US-Mexico border with a port of entry was acquired from the Instituto Mexicano del Seguro Social (IMSS or Mexico’s Institute of Social Security). 7. Illegal Apprehensions: CBP provided its complete monthly number of illegal apprehensions for every sector within the southern border. See Map 2 for the boundaries of each CBP sector. This variable serves as a measure of crime in the United States. 8. Homicide rate: The total number of homicides per county was obtained for every northern Mexican municipality from the Secretariado Ejecutivo del Sistema Nacional de Seguridad Publica (Mexico’s Executive Secretary of the National Public Security System), the Mexican agency that compiles the total number of homicides per county. Mexican population data is available from two Mexican agencies, the Instituto Nacional de Estadística y Geografía (INEGI or the National Institute of Statistics and Geography) and the Consejo Nacional de Población (CONAPO or the National Council on Population). This variable serves as a measure of crime in Mexico. 9. Federal Expenditures (United States): Federal costs data were obtained for the following federal agencies: CBP, US Coast Guard, Transportation Security Administration, Federal Law Enforcement Training Center, and US Immigration and Customs Enforcement. These expenses were gathered for the following counties: San Diego and Imperial in California; Yuma, Pima, Santa Cruz, and Cochise in Arizona; Luna and Doña Ana in New Mexico; and El Paso, Presidio, Val Verde, Maverick, Webb, Starr, Hidalgo, and Cameron in Texas. 10. Trade: The data obtained from the US Trade Census consists of the value of the total imports and exports that cross the US-Mexico border ports of entry every month. 23 ATLANTIC COUNCIL APPENDIX B THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX B: FIXED EFFECTS MODEL Calculating the economic impact of a more efficient and secure border, requires understanding the relationship between wait times and the number of border crossings. The data across counties shows a low yet positive correlation between noncommercial crossings and wait times, suggesting that increased wait times are associated with more border crossings.34 This counterintuitive finding is explained by the fact that increased border usage (or border congestion) results in both longer wait times and more crossings. Therefore, to determine the underlying relationship between border wait time and crossings, the research team used an econometric model to control for other factors that may influence border crossings. The following equation is estimated by fixed effects using monthly county-level data from April 2016 through December 2019.35 crossit = β1waitit + β2Xit+ i+uit ,t = 1,2, ..., T In the estimation equation, crossit and waitit denote the number of crossings (either commercial or noncommercial) and average wait times in county i at time t, respectively. All additional time-varying explanatory variables are included in Xit, while i denotes the time constant fixed effect for county i and uit denotes the error term.36 The additional controls in Xit account for other factors influencing crossings and include a measure of employment in the United States and Mexico, a measure of crime in both countries, the number (or proportion) of lanes in operation, total expenditures by DHS, and a measure of trade (included in the commercial regression only). The left panel of Table B1 provides regression results for commercial crossings, while the right panel shows results for noncommercial crossings. The coefficient estimate on wait times is of primary interest, which is negative and statistically significant in both regressions. Specifically, the analysis found that a one-minute reduction in wait times results in 53 additional commercial crossings and 502 noncommercial crossings on average per month. The coefficient on wait times in the commercial crossing regression is statistically significant at 10 percent. Each additional commercial crossing represents another cargo container (loaded or unloaded) crossing into the United States via a land port of entry. The coefficient on wait times in the noncommercial crossings regression is statistically significant at 5 percent. Each additional noncommercial crossing represents a personal vehicle crossing into the United States via a land port of entry. Regression results suggest an inverse relationship between wait times and commercial and noncommercial border crossings. Including additional time-varying controls and time-constant fixed effects helped to reverse the counterintuitive finding of a positive correlation reported above. As such, Table B1 describes the underlying relationship between border wait times and border crossings. These findings can be used to determine how improved border management techniques or the adoption of new technologies affect commercial and noncommercial border crossings. Table B1: Fixed Effects Regression Results Regression Results Commercial Crossings Noncommercial Crossings Wait times -53.23* -502.05** (30.34) (227.18) Employment in US 0.03 0.23 (0.05) (0.41) Employment in Mexico -0.01 0.05 (0.02) (0.17) Crime in US -0.03 -1.16*** (0.04) (0.43) Crime in Mexico -17.60*** -30.00 (5.56) (98.12) Lanes operational 487.29 314031.50*** (1998.54) (68954.24) DHS Expenditures -0.002** 0.01 (0.001) (0.01) Trade 8.92E-06*** - (5.09E-07) - Constant 8307.01 268168.40*** (6615.80) (48439.59) Sample Size 554 585 R^2 0.95 0.76 SOURCE: The Hunt Institute for Global Competitiveness and the COLEF, using data from the US Department of Transportation. NOTE: The standard error is in parentheses. ***Statistically significant at 1 percent. **Statistically significant at 5 percent. *Statistically significant at 10 percent. 24 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX C: ECONOMIC IMPACT ANALYSIS OF BORDER CROSSINGS The regression results presented in Appendix B established a link between border wait times and commercial and noncommercial crossings. This serves as the first step in understanding the economic impact of reduced border wait times. Additional data is needed to determine the economic impact of reductions in border wait times. The following subsections explain the steps taken to produce the economic impact results described in the main text. Appendix C1: Economic Impact of Commercial Crossings The regression results described in Appendix B indicate that a one-minute reduction in average commercial wait times results in approximately fifty-three additional container crossings per month. Data from the US Department of Transportation’s Bureau of Transportation Statistics were used to estimate that approximately 73.1 percent of these containers would be loaded with an average value of $66,798 (for a detailed breakdown of the proportion of loaded containers crossing the US-Mexico border and their average cargo value, see table 1 on page 13). This means that a 10-minute reduction in wait times would result in 532 additional container crossings, of which 388 would be loaded with $25,879,549 in cargo value. Appendix C2: Economic Impact of Noncommercial Crossings Individuals crossing from Mexico into the United States make purchases on the US borders and in states, contributing to local economies. Due to underlying economic linkages, this spending has an amplified national impact. To estimate this impact, the research team used IMPLAN—a regional economic impact software—, data on expenditure patterns, and the average number of border crossings aggregated to the county level. Below is an overview of the data and model used to estimate the economic impact of the expenditures that result from these noncommercial border crossings. A 2019 study by the City of El Paso International Bridges Department quantifies the social and economic cross-border activities from vehicle and pedestrian crossings through the El Paso–Ciudad Juárez port of entry. The study consisted of two surveys. First, a short questionnaire administered to US-Mexico border crossers between October 1 and December 31, 2019. Residents who indicated Mexico as their primary place of residence received an entry survey, while those indicating the United States as their primary place of residence received an exit survey. The entry survey captured the planned activities and expenditures of those traveling to El Paso from Ciudad Juárez, while the exit survey captured the activities and spending already made by those traveling to Ciudad Juárez from El Paso. 25 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Survey respondents were asked questions related to four categories: • Demographics • Reasons for crossing • Anticipated spending (including the area of spending) • Trip characteristics This report focused on survey responses related to the intended destination (El Paso or other) and expected spending across various categories. The survey results indicate that approximately 80 percent of individuals crossing the border (by vehicle and as pedestrians) remained in El Paso, while 20 percent continued to another location. Of the 80 percent who stayed in El Paso, approximately 64 percent of those who crossed by vehicle and 47 percent who crossed as pedestrians reported positive expected expenditures. The survey data breaks down the dollar amount individuals expected to spend within twenty categories.37 This information was used to calculate the average expenditure per crosser, for both vehicle and pedestrian crossings. These expenditures were then scaled by the total number of vehicle and pedestrian crossings in 2019 (after scaling by the proportion of crossers who remained in El Paso and reported spending money) to determine the average expenditure of crossings in 2019 for El Paso County. To establish the economic impact of these expenditures at the national level, the average expenditures by crossers in 2019 were computed for the following border counties: • Texas: Presidio, Val Verde, Maverick, Webb, Starr, Hidalgo, and Cameron • New Mexico: Luna and Doña Ana • Arizona: Yuma, Pima, Santa Cruz, and Cochise • California: San Diego and Imperial Unfortunately, detailed expenditure data were unavailable for the other border counties. However, the El Paso survey was used with the assumption that spending patterns across the twenty categories do not change across counties. First, the average expenditures per crosser for each category was recovered from the El Paso survey. These expenditures were then scaled up or down based on the average household income in the neighboring Mexican state relative to the average household income in Chihuahua (the Mexican state neighboring El Paso). Once this income adjustment was made, the average 2019 expenditures were scaled by the number of vehicle and pedestrian crossings in 2019 for each border county listed above. This exercise reveals the total spending in the twenty categories for each of the sixteen border counties considered in the analysis.38 These findings were used as inputs into IMPLAN to estimate the economic impact of expenditures by individuals crossing the US-Mexico border. First, the twenty expenditure categories from the survey were mapped into comparable IMPLAN industries. Then, industry output (spending) was reduced in these industries for each of the sixteen counties. Twenty adverse output (spending) events were modeled separately in the sixteen counties for a total of 320 events. The rest of the United States was then built up, county-by county for Texas, New Mexico, Arizona, and California; and state-by state for the non-border states. Finally, the national-level analysis was run using IMPLAN’s multiregion input-output feature, allowing for additional indirect linkages between regions within the analysis. Tables C2.1 and C2.2 present the main findings. 26 ATLANTIC COUNCIL APPENDIX C THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Table C2.1: Economic Impact of Removing Cross-Border Spending in the United States (2022) Impact Employment Labor Income Value Added Output 1 - Direct 2 - Indirect 3 - Induced -60,619.16 -$1,812,022,814.56 -$2,765,047,740.91 -$5,036,142,293.41 -21,166.07 -$1,234,825,927.30 -$1,980,607,178.46 -$4,118,866,436.04 -18,648.05 -$977,441,701.68 -$1,771,486,445.19 -$3,177,688,817.94 -100,433.29 -$4,024,290,443.54 -$6,517,141,364.56 -$12,332,697,547.38 Source: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. As shown on Table C2.1, removing cross-border spending by noncommercial crossers results in approximately 100,433 fewer jobs in the United States. Approximately 60 percent of this job loss is directly caused by reduced expenditure. The remaining 40 percent is due to indirect and induced effects. Removing cross border spending would also result in a loss of $12,332,697,547 in economic output. Approximately 41 percent of this output loss is explained by the direct effects of reducing expenditures and 59 percent by indirect or induced effects. Table C2.2 includes the top five most impacted industries in terms of output lost due to the reduction in cross-border spending by noncommercial crossers. As expected, these industries are concentrated in areas where tourists or temporary visitors would likely spend money. The three sectors with the largest output loss include retail, full-service restaurants, and general merchandise. As such, the entire output loss within these industries was due to sectoral linkages with other areas experiencing direct impacts. IMPLAN results in Table C2 can be combined with the regression results in Appendix B to determine the economic impact of reducing noncommercial border wait times. The research team divided the total output loss resulting from eliminating noncommercial crossings by the total number of crossers in 2019, 87,812,443.39 This yields a value of $140.44 which can be interpreted as the output loss associated with losing one noncommercial crosser or the output gain associated with one additional noncommercial crosser. Table C2.2: Top Five Industries with Reductions in Economic Output from Removing Cross-Border Spending in the United States (2022) Impact 1 - Direct 2 - Indirect 3 - InducedImpact output Industry display Impact output Impact output Impact output Retail: Clothing and ccessories -$2,161,062,814.49 -$707,698.49 -$23,321,554.17 -$2,185,092,067.16 Other real estate services $0.00 -$740,224,149.66 -$130,392,264.37 -$870,616,414.03 Full service restaurants -$713,075,639.37 -$28,572,142.09 -$65,051,510.06 -$806,699,291.52 General merchandise -$575,957,329.13 -$2,040,513.78 -$36,955,115.99 -$614,952,958.90 Management $0.00 -$397,735,328.22 -$56,187,767.71 -$453,923,095.93 1 2 3 4 5 Source: The Hunt Institute for Global Competitiveness and the COLEF, using IMPLAN. 27 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER APPENDIX D: DESCRIPTION OF THE INPUT-OUTPUT AND QUEUING MODELS Appendix D1: The queueing model This study uses a queuing model to evaluate how wait times for commercial vehicles at the US-Mexico border affect Mexican exports to the United States. A queueing model mathematically describes a queuing system, making specific assumptions about the probabilistic nature of the number and type of servers (commercial vehicles), the arrival and service processes (border processing rates), and the queue discipline and organization. For this study, this can be described as: E'j,t = E'j,0- ∆ %(λ-μ)*αj ∑ E'j,0 (1) Where; E'j,t = commercial vehicles processed per hour at t ≥1. E'j,0 = commercial vehicles processed per hour at t=0. λ = the average number of commercial vehicles arriving per hour.40 μ = the average number of commercial vehicles dispatched per hour.41 α = the share of sectoral exports in total exports per hour (E'j,0 / ∑ E'j,0). ∑ E'j,0 = the total number of commercial vehicles per hour in the economy. The E'j,0 vector also serve as a measure of Mexican exports, given that commercial vehicles entering the United States are loaded with Mexican goods. In equation (1), the assigned volume is the number of commercial vehicles arriving at a border checkpoint every hour (λ), while the volume processed is the processing capacity of the checkpoint per hour (μ). To conduct the queuing analysis, these two variables must be known beforehand. Appendix D3 shows how they were defined. Besides the variables λ and μ, the queuing model considers other key variables, including the value of exports transported by commercial vehicles and the number of lanes in operation. The former was determined using data from the US Department of Transportation’s Bureau of Transportation Statistics (see Appendix C1), and the latter with data from CBP. Additionally, this study considers the system in its steadystate of operation, i.e., during time intervals when λ and μ behave normally. This means that anomalous states of operation are removed from the analysis (such as the first 30 minutes in the workday when personnel perform preparatory activities). As equation (1) shows, when the volume of commercial vehicles in the system is processed immediately [(λ-μ) = 0], there would be no queues. As a result, wait times would be insignificant, and the value of Mexican exports entering the United States in commercial vehicles would be E'j,0. However, when the assigned volume of commercial vehicles is greater than the volume of vehicles processed [(λ-μ) > 0], a queue forms, leading to increased wait times and reducing the number of commercial vehicles crossing the border with Mexican export goods (reducing E'j,t). This calculation produces approximate wait times, which are sufficiently accurate to understand the overall distribution of traffic between land ports of entry across the US-Mexico border. Once approximate wait times are established, it is important to verify the model’s validity. Using a chi-square goodness of fit test, the observed distribution of the variables λ and μ is compared with their theoretical distribution, demonstrating the degree of adjustment between the sample (the average service rate for one checkpoint) and the population (the average service rate for all checkpoints across the US-Mexico border). This hypothesis test concludes, with a certain degree of statistical significance, that the sample in this study is representative of the full population. 28 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix D2: Intersectoral input-output model Input-output models are a form of macroeconomic analysis based on the interdependencies (the flow of goods and services) between different economic sectors. They are commonly used to estimate the impacts of positive or negative economic shocks and their ripple effects throughout an economy. This study uses an input-output model to determine how increased Mexican exports stemming from reduced border wait times (previously established using a queuing model; see Appendix D1) affect aggregate demand in Mexico (calculated as aggregate demand = C + I + G + Nx, where: C = consumer spending; I = private investment and corporate spending; G = government spending; and Nx = net exports (exports minus imports). Economic sectors respond to increases in aggregate demand directly by supplying final goods (increasing output) or indirectly by producing intermediate goods for sectors that respond directly (increasing intermediate sales). Therefore, findings are then used to calculate the impact on total gross output and intermediate sales across sectors of the Mexican economy. Equation (2) estimates the impact of increased demand for Mexican exports on output per sector: Xj,0= (I-A)-1Yj,0 (2) Where: Xj,0 = the total gross output vector per sector at t=0. (I-A)-1 = the Leontief inverse (or the matrix of indirect and direct multipliers). In which I = identity matrix and A = technical coefficient matrix. Yj,0 = the aggregate demand vector per sector at t=0. Therefore, equation (2) could be re-written as: Xj,0= (I-A)-1E'j,0 (3) Where: E'j,0 = the exports vector per sector at t=0. As discussed in Appendix D1, E'j,0 can be interpreted as “commercial vehicles processed by the customs system every hour” and equation (3) expressed as: Xj,t = (I-A)-1E'j,t (4) Where E'j,0 = commercial vehicles processed per hour at t ≥ 1. This interpretation makes two assumptions: (a) that the system operates at full capacity and (b) that the volume of commercial vehicles in the system is processed immediately [(λ-μ) = 0], resulting in no wait times (see Appendix D1). In other words, the input-output model is static. However, this is not always the case, given that commercial vehicle arrivals and departures to and from border checkpoints do not happen at fixed intervals (they are uncertain). Therefore, by incorporating specific trajectories describing the behavior of E'j,t (changes to the number of commercial vehicles processed by customs checkpoints due to reduced wait times), the static input output model can be used to estimate the impact of increased Mexican exports on total gross output per sector. This is calculated with the equation: Lj,t = ∑ [Xj,t+Xj,0] (5) Where: Lj,t = the impact on total gross output. Xj,0 = the total gross output vector per sector at t=0 (before reduced wait times and no changes to E'j,0). Xj,t = the total gross output vector per sector at t ≥1 (after reduced wait times and changes to E'j,t). j = 1- n sectors. 29 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix D3: Establishing the assigned volume and processing rate of commercial vehicles Estimating the average processing capacity of a port of entry requires data on the volume of commercial vehicles serviced and the number of lanes, hours, and days in operation for that port of entry. For land ports of entry across the US-Mexico border, these data were obtained from the Bureau of Transportation Statistics’ Border Crossing Data.42 Table D3 shows data for the Otay Mesa port of entry in Baja, California, the third-busiest on the US-Mexico border.43 The Otay Mesa example helps to illustrate how processing capacity was calculated for other ports of entry as part of this study. On average, one lane in the Otay Mesa port of entry operates 65 hours per week. Together, its ten lanes would operate 650 hours per week, meaning that, together, the lanes of the Otay Mesa port of entry operate for approximately 33,800 hours in one year (52 weeks). Given that 962,577 commercial vehicles are serviced per year, a total of 18,511 trucks would cross the border weekly. For one lane, this translates to 1,851 trucks per week, 370 per day, and 28.5 per hour. Having established the number of commercial vehicles serviced per hour (28.5 vehicles), an M/M/1 queue was simulated (see Appendix D1) to estimate the average processing capacity (μ), showing that border wait times for commercial vehicles are approximately 21.5 minutes.44 Enhanced border management practices and the implementation of new technologies would improve the processing capacity of ports of entry, reduce commercial wait times, and allow more Mexican exports to enter the United States. This would boost total gross output, aggregate demand, and intermediated sales across various sectors in the Mexican economy, as well as employment and labor income (see Appendices F and G for input-output analysis results). Table D3: Data for the Otay Mesa Port of Entry Item Value Total number of commercial vehicles serviced per year Hours in operation per day Days in operation per week Maximum number of lanes in operation 962,577 13 5 10 FUENTE: Cálculos propios con base en Información procedente de y 0], a queue forms, leading to increased wait times and reducing the number of commercial vehicles crossing the border with Mexican export goods (reducing E'j,t). This calculation produces approximate wait times, which are sufficiently accurate to understand the overall distribution of traffic between land ports of entry across the US-Mexico border. Once approximate wait times are established, it is important to verify the model’s validity. Using a chi-square goodness of fit test, the observed distribution of the variables λ and μ is compared with their theoretical distribution, demonstrating the degree of adjustment between the sample (the average service rate for one checkpoint) and the population (the average service rate for all checkpoints across the US-Mexico border). This hypothesis test concludes, with a certain degree of statistical significance, that the sample in this study is representative of the full population. 28 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix D2: Intersectoral input-output model Input-output models are a form of macroeconomic analysis based on the interdependencies (the flow of goods and services) between different economic sectors. They are commonly used to estimate the impacts of positive or negative economic shocks and their ripple effects throughout an economy. This study uses an input-output model to determine how increased Mexican exports stemming from reduced border wait times (previously established using a queuing model; see Appendix D1) affect aggregate demand in Mexico (calculated as aggregate demand = C + I + G + Nx, where: C = consumer spending; I = private investment and corporate spending; G = government spending; and Nx = net exports (exports minus imports). Economic sectors respond to increases in aggregate demand directly by supplying final goods (increasing output) or indirectly by producing intermediate goods for sectors that respond directly (increasing intermediate sales). Therefore, findings are then used to calculate the impact on total gross output and intermediate sales across sectors of the Mexican economy. Equation (2) estimates the impact of increased demand for Mexican exports on output per sector: Xj,0= (I-A)-1Yj,0 (2) Where: Xj,0 = the total gross output vector per sector at t=0. (I-A)-1 = the Leontief inverse (or the matrix of indirect and direct multipliers). In which I = identity matrix and A = technical coefficient matrix. Yj,0 = the aggregate demand vector per sector at t=0. Therefore, equation (2) could be re-written as: Xj,0= (I-A)-1E'j,0 (3) Where: E'j,0 = the exports vector per sector at t=0. As discussed in Appendix D1, E'j,0 can be interpreted as “commercial vehicles processed by the customs system every hour” and equation (3) expressed as: Xj,t = (I-A)-1E'j,t (4) Where E'j,0 = commercial vehicles processed per hour at t ≥ 1. This interpretation makes two assumptions: (a) that the system operates at full capacity and (b) that the volume of commercial vehicles in the system is processed immediately [(λ-μ) = 0], resulting in no wait times (see Appendix D1). In other words, the input-output model is static. However, this is not always the case, given that commercial vehicle arrivals and departures to and from border checkpoints do not happen at fixed intervals (they are uncertain). Therefore, by incorporating specific trajectories describing the behavior of E'j,t (changes to the number of commercial vehicles processed by customs checkpoints due to reduced wait times), the static input output model can be used to estimate the impact of increased Mexican exports on total gross output per sector. This is calculated with the equation: Lj,t = ∑ [Xj,t+Xj,0] (5) Where: Lj,t = the impact on total gross output. Xj,0 = the total gross output vector per sector at t=0 (before reduced wait times and no changes to E'j,0). Xj,t = the total gross output vector per sector at t ≥1 (after reduced wait times and changes to E'j,t). j = 1- n sectors. 29 ATLANTIC COUNCIL APPENDIX D THE ECONOMIC IMPACT OF A MORE EFFICIENT US-MEXICO BORDER Appendix D3: Establishing the assigned volume and processing rate of commercial vehicles Estimating the average processing capacity of a port of entry requires data on the volume of commercial vehicles serviced and the number of lanes, hours, and days in operation for that port of entry. For land ports of entry across the US-Mexico border, these data were obtained from the Bureau of Transportation Statistics’ Border Crossing Data.42 Table D3 shows data for the Otay Mesa port of entry in Baja, California, the third-busiest on the US-Mexico border.43 The Otay Mesa example helps to illustrate how processing capacity was calculated for other ports of entry as part of this study. On average, one lane in the Otay Mesa port of entry operates 65 hours per week. Together, its ten lanes would operate 650 hours per week, meaning that, together, the lanes of the Otay Mesa port of entry operate for approximately 33,800 hours in one year (52 weeks). Given that 962,577 commercial vehicles are serviced per year, a total of 18,511 trucks would cross the border weekly. For one lane, this translates to 1,851 trucks per week, 370 per day, and 28.5 per hour. Having established the number of commercial vehicles serviced per hour (28.5 vehicles), an M/M/1 queue was simulated (see Appendix D1) to estimate the average processing capacity (μ), showing that border wait times for commercial vehicles are approximately 21.5 minutes.44 Enhanced border management practices and the implementation of new technologies would improve the processing capacity of ports of entry, reduce commercial wait times, and allow more Mexican exports to enter the United States. This would boost total gross output, aggregate demand, and intermediated sales across various sectors in the Mexican economy, as well as employment and labor income (see Appendices F and G for input-output analysis results). Table D3: Data for the Otay Mesa Port of Entry Item Value Total number of commercial vehicles serviced per year Hours in operation per day Days in operation per week Maximum number of lanes in operation 962,577 13 5 10 FUENTE: Cálculos propios con base en Información procedente de y ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","I'm pursuing a Masters in Public Health. For class tomorrow, I am leading a discussion on the state of medical knowledge about Long COVID. Based on this article, please write a summary of the challenges associated with describing and studying Long COVID.","Introduction More than 4 years after the COVID-19 pandemic began, millions of people continue to suffer long-term sequelae of SARS-CoV-2 infection. Yet, despite thousands of academic papers (including 170 systematic reviews) mentioning “long COVID”, “post-acute (sequelae of) COVID-19”, “chronic COVID-19”, or “post-COVID-19 condition” in their titles or abstracts, many clinicians remain unsure of how to evaluate and manage individuals with post-COVID-19 condition (also known as long COVID). Reasons for this uncertainty include conflicting definitions; the existence of multiple putative pathophysiological mechanisms; the lack of a single, agreed upon and accessible biomarker that could be used for diagnosis, monitoring, and research; and changes in the natural history of this condition over time caused by (for example) viral evolution, vaccination, and novel therapeutics. All of these reasons are reflected in the sheer volume of research already published and the pace at which new papers are appearing. There are signs that virological, immunological, and other basic science research appears to be close to producing clinically relevant breakthroughs in diagnosis and treatment to augment current clinical practice, which is based largely on a rehabilitation therapy model of alleviating symptoms and optimising functional performance. Particularly in the early months of the pandemic, many people living with long COVID were undiagnosed, disbelieved, inadequately assessed, or inappropriately treated, an experience some individuals described as “medical gaslighting”. The dearth of clinical knowledge and scarcity of services at that crucial time helps explain the rapid emergence of online communities, which fulfilled important roles in mutual support, information provision, activism, and research. In this interdisciplinary Review, we had three goals. First, to make sense of the extensive research literature on long COVID, including literature on epidemiology, basic science, lived experience, and clinical trials of therapy. Second, to bring this state-of-the-science summary into dialogue with current approaches and dilemmas in clinical practice. And third, to acknowledge and respond to the call “for patients’ ongoing contributions to be recognised and used to combat the suffering of multitudes”. Definitions The persisting sequelae and longer-term complications of COVID-19 were named long COVID by patients on May 20, 2020; the term was widely taken up and used by people living with these sequelae. The term long COVID, defined somewhat vaguely, was later formally adopted by public health bodies in the USA, although WHO uses the term post-COVID condition and the UK National Institute for Health and Clinical Excellence prefers ongoing symptomatic COVID-19 and post-COVID-19 syndrome. These terms are defined in table 1. None of them requires a positive laboratory or lateral flow test. The absence of consensus on a name or definition partly reflects prevailing confusion about underlying disease processes and natural history. Research would benefit from greater consensus on definitions, and ideally, such definitions should reflect pathological mechanisms. However, different definitions might be appropriate for different non-research purposes (eg, clinical care and monitoring, service planning, peer support, and activism). Symptoms of long COVID and their impact Manifestations of long COVID are heterogeneous, multisystemic (the condition can affect any and all organ systems), and can change over time. But patterns that are both diagnostically and prognostically important can usually be discerned through a careful history-taking process (panel 1). Many but not all people with long COVID have pre-existing conditions (including asthma, allergies, attention deficit hyperactivity disorder, musculoskeletal pain, diabetes, poor mental health, insomnia, headaches, chronic fatigue, and frailty), which can exacerbate—and be exacerbated by—long COVID. When comorbidities are present, management requires a personalised approach that takes both long COVID guidance and other relevant factors (eg, patient priorities, practicalities, and the need to avoid investigation fatigue and polypharmacy) into account. There are many parallels between long COVID and other known or suspected infection-associated chronic syndromes (also known as post-acute infection syndromes), including the sequelae of other coronaviruses (SARS-CoV and MERS-CoV), West Nile virus, Epstein–Barr virus, and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Given these examples, the increased morbidity and mortality from organ damage in COVID-19 will possibly continue for years (in West Nile Virus, for example, all-cause mortality was significantly elevated for at least 8 years after infection). Long COVID—one disease or many? Initial advancements in our understanding of long COVID involved detailed analyses of patient-reported symptoms from surveys and electronic health records. These studies, most of which were undertaken by clinicians and did not include metabolic profiling, generated various long COVID phenotypes on the basis of symptom clusters (see examples in table 2, which are listed by sample size). Clinical phenotyping studies applied different methods to different samples and—unsurprisingly—therefore produced different cluster patterns (or no clusters at all). In all studies, there was considerable overlap between clusters, which is consistent with (but does not prove) the hypothesis that long COVID is, broadly speaking, “a single, multisystemic multifaceted post-viral disease rather than different pathologically-independent subsyndromes”. However, an alternative hypothesis is that multiple discrete pathological processes do exist but produce overlapping phenotypes (eg, fatigue might have more than one pathological pathway), as we discuss in panel 2.","""================ ======= Introduction More than 4 years after the COVID-19 pandemic began, millions of people continue to suffer long-term sequelae of SARS-CoV-2 infection. Yet, despite thousands of academic papers (including 170 systematic reviews) mentioning “long COVID”, “post-acute (sequelae of) COVID-19”, “chronic COVID-19”, or “post-COVID-19 condition” in their titles or abstracts, many clinicians remain unsure of how to evaluate and manage individuals with post-COVID-19 condition (also known as long COVID). Reasons for this uncertainty include conflicting definitions; the existence of multiple putative pathophysiological mechanisms; the lack of a single, agreed upon and accessible biomarker that could be used for diagnosis, monitoring, and research; and changes in the natural history of this condition over time caused by (for example) viral evolution, vaccination, and novel therapeutics. All of these reasons are reflected in the sheer volume of research already published and the pace at which new papers are appearing. There are signs that virological, immunological, and other basic science research appears to be close to producing clinically relevant breakthroughs in diagnosis and treatment to augment current clinical practice, which is based largely on a rehabilitation therapy model of alleviating symptoms and optimising functional performance. Particularly in the early months of the pandemic, many people living with long COVID were undiagnosed, disbelieved, inadequately assessed, or inappropriately treated, an experience some individuals described as “medical gaslighting”. The dearth of clinical knowledge and scarcity of services at that crucial time helps explain the rapid emergence of online communities, which fulfilled important roles in mutual support, information provision, activism, and research. In this interdisciplinary Review, we had three goals. First, to make sense of the extensive research literature on long COVID, including literature on epidemiology, basic science, lived experience, and clinical trials of therapy. Second, to bring this state-of-the-science summary into dialogue with current approaches and dilemmas in clinical practice. And third, to acknowledge and respond to the call “for patients’ ongoing contributions to be recognised and used to combat the suffering of multitudes”. Definitions The persisting sequelae and longer-term complications of COVID-19 were named long COVID by patients on May 20, 2020; the term was widely taken up and used by people living with these sequelae. The term long COVID, defined somewhat vaguely, was later formally adopted by public health bodies in the USA, although WHO uses the term post-COVID condition and the UK National Institute for Health and Clinical Excellence prefers ongoing symptomatic COVID-19 and post-COVID-19 syndrome. These terms are defined in table 1. None of them requires a positive laboratory or lateral flow test. The absence of consensus on a name or definition partly reflects prevailing confusion about underlying disease processes and natural history. Research would benefit from greater consensus on definitions, and ideally, such definitions should reflect pathological mechanisms. However, different definitions might be appropriate for different non-research purposes (eg, clinical care and monitoring, service planning, peer support, and activism). Symptoms of long COVID and their impact Manifestations of long COVID are heterogeneous, multisystemic (the condition can affect any and all organ systems), and can change over time. But patterns that are both diagnostically and prognostically important can usually be discerned through a careful history-taking process (panel 1). Many but not all people with long COVID have pre-existing conditions (including asthma, allergies, attention deficit hyperactivity disorder, musculoskeletal pain, diabetes, poor mental health, insomnia, headaches, chronic fatigue, and frailty), which can exacerbate—and be exacerbated by—long COVID. When comorbidities are present, management requires a personalised approach that takes both long COVID guidance and other relevant factors (eg, patient priorities, practicalities, and the need to avoid investigation fatigue and polypharmacy) into account. There are many parallels between long COVID and other known or suspected infection-associated chronic syndromes (also known as post-acute infection syndromes), including the sequelae of other coronaviruses (SARS-CoV and MERS-CoV), West Nile virus, Epstein–Barr virus, and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Given these examples, the increased morbidity and mortality from organ damage in COVID-19 will possibly continue for years (in West Nile Virus, for example, all-cause mortality was significantly elevated for at least 8 years after infection). Long COVID—one disease or many? Initial advancements in our understanding of long COVID involved detailed analyses of patient-reported symptoms from surveys and electronic health records. These studies, most of which were undertaken by clinicians and did not include metabolic profiling, generated various long COVID phenotypes on the basis of symptom clusters (see examples in table 2, which are listed by sample size). Clinical phenotyping studies applied different methods to different samples and—unsurprisingly—therefore produced different cluster patterns (or no clusters at all). In all studies, there was considerable overlap between clusters, which is consistent with (but does not prove) the hypothesis that long COVID is, broadly speaking, “a single, multisystemic multifaceted post-viral disease rather than different pathologically-independent subsyndromes”. However, an alternative hypothesis is that multiple discrete pathological processes do exist but produce overlapping phenotypes (eg, fatigue might have more than one pathological pathway), as we discuss in panel 2. http://ciar.org/h/PIIS014067362401136X.pdf ================ ======= I'm pursuing a Masters in Public Health. For class tomorrow, I am leading a discussion on the state of medical knowledge about Long COVID. Based on this article, please write a summary of the challenges associated with describing and studying Long COVID. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Find & Summarize,Text Transformation "You are a bot designed to assist federal employees with checking compliance with NIST (National Institute of Standards and Technology) standards. You will be provided a context by the user in the form of an excerpt from the relevant NIST Standards Guide. Only use the provided context to inform responses. All claims made in the response should be verifiably true using only the provided context. At the end of each response, include a list of all links to other sources that appear in the context. ","What is the difference between a ""mobile device"" and a ""portable device""?","Mobile and Portable Devices Portable and mobile devices that operate in the Cellular Radiotelephone Service (47 CFR 22 Subpart H), the Personal Communications Service (PCS) (47 CFR 24), the Satellite Communications Service (47 CFR 25), the Wireless Communications Service (47 CFR 27), the Maritime Service (ship earth stations only) (47 CFR 80), and Specialized Mobile Radio Service (47 CFR 24, 25, 27, 80 (ship earth stations devices only) and 90) at frequencies of 1.5 GHz or below and their effective radiated power (ERP) is 1.5 watts or more, or if they operate at frequencies above 1.5 GHz and their ERP is 3 watts or more, are subject to RF emissions requirements as specified in the rule part that they operate under. All of these portable and mobile devices are also subject to the routine environmental evaluation for RF exposure requirement of 47 CFR 2.1091 (bottom of page 706) (mobile devices) and/or 47 CFR 2.1093 (page 708) (portable devices) prior to equipment authorization or use. Portable devices operating in the Wireless Medical Telemetry Service (WMTS) (47 CFR Part 95 Subpart H) and the Medical Device Radio communications Service (MEDRADIO) (47 CFR 95 Subpart I) are subject to RF emissions limits as specified in the rule part they operate under and also to routine environmental evaluation for RF exposure prior to equipment authorization or use. Unlicensed PCS (47 CFR Part 15 Subpart D), Unlicensed National Information Infrastructure (U-NII) (47 CFR Part 15 Subpart E), and millimeter wave devices (47 CFR Part 15 Subpart C) are subject to RF emission requirements specified in the rule section they operate in and are also subject to routine environmental evaluation for RF exposure prior to equipment authorization or use if their ERP is 3 watts or more or if they meet the definition of a portable device. All other mobile and portable devices are categorically excluded from routine environmental evaluation for RF exposure. The FCC differentiates mobile and portable devices by the proximity to the user during use. Mobile devices, covered under 47 CFR 2.1091 (page 706), are defined as a transmitting device designed to be used in other than fixed locations and generally used in a manner that the radiating structure is at least 20 cm from the body of the user or nearby persons. Examples of mobile and portable devices include cellular and PCS mobile telephones with vehicle mounted antennas and other radio devices that use vehicle mounted antennas. These devices must be evaluated for exposure potential with respect to Maximum Permissible Exposure (MPE) limits for field strength or power density or with respect to specific absorption rate (SAR) limits, whichever is most appropriate for the specific use and operating configuration of the device. Portable devices, covered under 47 CFR 2.1093 (page 708), are defined as a transmitting device designed to be used so the radiating structure is within 20 cm of the body of the user. These devices include handheld cellular phones and PCS mobile phones that incorporate the radiating antenna into the hand-piece and wireless transmitters carried close to the body. RF evaluation must be based on specific absorption rate (SAR) limits.","You are a bot designed to assist federal employees with checking compliance with NIST (National Institute of Standards and Technology) standards. You will be provided a context by the user in the form of an excerpt from the relevant NIST Standards Guide. Only use the provided context to inform responses. All claims made in the response should be verifiably true using only the provided context. At the end of each response, include a list of all links to other sources that appear in the context. User: What is the difference between a ""mobile device"" and a ""portable device""? Context: Mobile and Portable Devices Portable and mobile devices that operate in the Cellular Radiotelephone Service (47 CFR 22 Subpart H), the Personal Communications Service (PCS) (47 CFR 24), the Satellite Communications Service (47 CFR 25), the Wireless Communications Service (47 CFR 27), the Maritime Service (ship earth stations only) (47 CFR 80), and Specialized Mobile Radio Service (47 CFR 24, 25, 27, 80 (ship earth stations devices only) and 90) at frequencies of 1.5 GHz or below and their effective radiated power (ERP) is 1.5 watts or more, or if they operate at frequencies above 1.5 GHz and their ERP is 3 watts or more, are subject to RF emissions requirements as specified in the rule part that they operate under. All of these portable and mobile devices are also subject to the routine environmental evaluation for RF exposure requirement of 47 CFR 2.1091 (bottom of page 706) (mobile devices) and/or 47 CFR 2.1093 (page 708) (portable devices) prior to equipment authorization or use. Portable devices operating in the Wireless Medical Telemetry Service (WMTS) (47 CFR Part 95 Subpart H) and the Medical Device Radio communications Service (MEDRADIO) (47 CFR 95 Subpart I) are subject to RF emissions limits as specified in the rule part they operate under and also to routine environmental evaluation for RF exposure prior to equipment authorization or use. Unlicensed PCS (47 CFR Part 15 Subpart D), Unlicensed National Information Infrastructure (U-NII) (47 CFR Part 15 Subpart E), and millimeter wave devices (47 CFR Part 15 Subpart C) are subject to RF emission requirements specified in the rule section they operate in and are also subject to routine environmental evaluation for RF exposure prior to equipment authorization or use if their ERP is 3 watts or more or if they meet the definition of a portable device. All other mobile and portable devices are categorically excluded from routine environmental evaluation for RF exposure. The FCC differentiates mobile and portable devices by the proximity to the user during use. Mobile devices, covered under 47 CFR 2.1091 (page 706), are defined as a transmitting device designed to be used in other than fixed locations and generally used in a manner that the radiating structure is at least 20 cm from the body of the user or nearby persons. Examples of mobile and portable devices include cellular and PCS mobile telephones with vehicle mounted antennas and other radio devices that use vehicle mounted antennas. These devices must be evaluated for exposure potential with respect to Maximum Permissible Exposure (MPE) limits for field strength or power density or with respect to specific absorption rate (SAR) limits, whichever is most appropriate for the specific use and operating configuration of the device. Portable devices, covered under 47 CFR 2.1093 (page 708), are defined as a transmitting device designed to be used so the radiating structure is within 20 cm of the body of the user. These devices include handheld cellular phones and PCS mobile phones that incorporate the radiating antenna into the hand-piece and wireless transmitters carried close to the body. RF evaluation must be based on specific absorption rate (SAR) limits.",Legal,Fact Finding,Q&A Formulate responses using only information from the provided text. Do not use any outside knowledge and do not use prior knowledge to inform your response.,"Briefly identify and explain the parts of section 2015 related to water. ","Several provisions of AWIA Title II, “Drinking Water System Improvement,” amend SDWA to revise existing drinking water programs, reauthorize appropriations, and establish new drinking water infrastructure grant programs. SDWA authorizes the regulation of contaminants in public water systems. Enacted in 1974, the act was last broadly amended in 1996.17 The act is implemented through programs that (1) establish national primary drinking water regulations and monitoring and reporting requirements for contaminants present in water delivered by public water systems, (2) promote water system compliance through technical and financial assistance and capacity development programs, and (3) address public water systems’ preparedness for emergencies.18 The act established a federalstate partnership in which states, tribes, and territories may be delegated primary implementation and enforcement authority (i.e., primacy) for the drinking water program.19 17 SDWA Amendments of 1996 (P.L. 104-182). 18 In addition, SDWA Part C includes programs to protect underground sources of drinking water. CRS Report RL31243, Safe Drinking Water Act (SDWA): A Summary of the Act and Its Major Requirements, by Mary Tiemann, provides an overview of SDWA and includes statistics and tables on the numbers and types of regulated public water systems. 19 Currently, 49 states, the territories, and the Navajo Nation have applied for and received primacy for the drinking water program. EPA retains implementation and enforcement authority for Wyoming, the District of Columbia, and America’s Water Infrastructure Act of 2018 (P.L. 115-270): Drinking Water Provisions Congressional Research Service 6 One key component of SDWA is the requirement that EPA establish national primary drinking water regulations for contaminants that may adversely affect human health and are likely to be present in public water supplies.20 EPA has issued regulations for more than 90 contaminants. These include numerical standards or treatment techniques for drinking water disinfectants and their byproducts, microorganisms, radionuclides, organic chemicals, and inorganic chemicals.21 The SDWA Amendments of 1996 (P.L. 104-182) reauthorized appropriations for most SDWA programs through FY2003. Although the authority has expired for most appropriations, Congress has continued to appropriate funds for the ongoing SDWA programs.22 Even though the authorization of appropriations may expire, program authority (i.e., an agency’s “enabling” authority) does not expire unless there is a “sunset” date for that authority or if Congress repeals it through subsequent laws. Drinking Water State Revolving Fund Program Authorized in 1996, the DWSRF program provides federal financial assistance to communities to finance drinking water infrastructure improvements.23 SDWA Section 1452 authorizes EPA to make annual grants to states to capitalize their state revolving loan fund.24 The statute requires states to provide a 20% match. States may use DWSRF financing for public water system projects needed to comply with federal drinking water standards and address risks to human health. The primary type of DWSRF financial assistance are low interest rate loans. SDWA Section 1452 authorizes states to provide additional subsidization (including forgiveness of principal) to disadvantaged communities.25 The federal capitalization grants together with state funds (e.g., state match, loan repayments, leveraged bonds, and other state sources) are intended to build a sustainable source of drinking water infrastructure funding for the state. The authorization of appropriation for DWSRF expired in FY2003. Congress has continued to provide funds for the DWSRF program through annual appropriations. From FY1997 through FY2018, Congress appropriated over $23.33 billion for the DWSRF program. The appropriation for DWSRF program generally ranged between $820.0 million in FY2000 and $1.39 billion in FY2010.26 DWSRF Program Revisions (AWIA Sections 2002, 2015, and 2022) AWIA makes the most substantial revisions to the DWSRF provisions of SDWA since the program was authorized in 1996. These revisions expand the eligible uses of DWSRF financial assistance, provide states with additional flexibility to administer the DWSRF program, and include provisions intended to make DWSRF assistance more accessible to public water systems. 27 AWIA Section 2015(a) amends SDWA to expressly state that DWSRF funds can be used for projects to replace or rehabilitate aging treatment, storage, or distribution systems.28 Under EPA guidance, these replacement and rehabilitation projects have been eligible for financial assistance from the DWSRF if needed to protect public health. According to EPA’s needs survey, this category of projects accounts for 66.1% of the estimated drinking water infrastructure need.29 Prior to AWIA, these activities were not previously explicitly identified in statute.30 Section 2015 also revises existing DWSRF provisions that address financial assistance for disadvantaged communities. These amendments increase the portion of a state’s capitalization grant that states may dedicate to additional subsidization and extend the amortization period for loans made to disadvantaged communities. Before AWIA, states could use 30% of their annual capitalization grants to subsidize loans for disadvantaged communities.31 Section 2015(c) of AWIA increases that proportion to 35% while conditionally requiring states to use at least 6% of their capitalization grant for these subsidies.32 The section also amends the SDWA DWSRF provisions to extend the amortization period for loans made to disadvantaged communities from 30 to 40 years. Section 2015(d) of AWIA also extends the repayment and amortization period for all projects financed by the DWSRF. Previously, SDWA required DWSRF financing recipients to pay the initial principal and interest payments within one year of project completion. This amendment extends the date of that initial payment to 18 months after project completion. This section also authorizes the extension of the amortization period for projects that receive DWSRF assistance from 20 to 30 years. Section 2015(e) requires EPA to evaluate and include the cost to replace lead service lines in the drinking water infrastructure needs survey, which EPA completes every four years.33 EPA uses the needs survey to allot the DWSRF appropriation among the states. 34 In conducting the needs survey, EPA has not previously requested that public water systems report the cost to replace these lines.35 AWIA specifies that the cost to replace lead lines must be included in the needs survey (to the extent practicable), which may potentially affect some states’ allotments of DWSRF capitalization grants. Section 2015(g) of AWIA requires EPA to gather specified information on DWSRF administration from state drinking water administrators and report to Congress on best practices for implementing the DWSRF to facilitate the application process and to improve DWSRF financial management and sustainability. Source Water Assessment and Protection In 1996, Congress added source water assessment provisions to SDWA to encourage protection of drinking water sources. 36 Section 1453 required states to develop source water assessment programs that delineate areas from which public water systems receive water and identify the origins of regulated contaminants to determine threats to water systems. States were authorized to fund these activities from 10% of their DWSRF capitalization grant for FY1996 and FY1997.37 Section 2015(f) of AWIA removes this fiscal year limitation and accordingly authorizes states to use a portion of their capitalization grant to fund these source water assessments or update an existing source water assessment.38 The 1996 SDWA amendments required states to conduct source water assessments as a condition of adopting modified monitoring requirements. 39 However, the 1996 amendments did not authorize states to fund implementation of source water protection plans from their DWSRF capitalization grants. AWIA Section 2002 authorizes states to fund implementation of surface drinking water sources protection efforts and activities from the 10% set-aside of a state’s annual DWSRF capitalization grant. Source water protection is also addressed in the “Protecting Source Water” section of this report.","Formulate responses using only information from the provided text. Do not use any outside knowledge and do not use prior knowledge to inform your response. Briefly identify and explain the parts of section 2015 related to water. Several provisions of AWIA Title II, “Drinking Water System Improvement,” amend SDWA to revise existing drinking water programs, reauthorize appropriations, and establish new drinking water infrastructure grant programs. SDWA authorizes the regulation of contaminants in public water systems. Enacted in 1974, the act was last broadly amended in 1996.17 The act is implemented through programs that (1) establish national primary drinking water regulations and monitoring and reporting requirements for contaminants present in water delivered by public water systems, (2) promote water system compliance through technical and financial assistance and capacity development programs, and (3) address public water systems’ preparedness for emergencies.18 The act established a federalstate partnership in which states, tribes, and territories may be delegated primary implementation and enforcement authority (i.e., primacy) for the drinking water program.19 17 SDWA Amendments of 1996 (P.L. 104-182). 18 In addition, SDWA Part C includes programs to protect underground sources of drinking water. CRS Report RL31243, Safe Drinking Water Act (SDWA): A Summary of the Act and Its Major Requirements, by Mary Tiemann, provides an overview of SDWA and includes statistics and tables on the numbers and types of regulated public water systems. 19 Currently, 49 states, the territories, and the Navajo Nation have applied for and received primacy for the drinking water program. EPA retains implementation and enforcement authority for Wyoming, the District of Columbia, and America’s Water Infrastructure Act of 2018 (P.L. 115-270): Drinking Water Provisions Congressional Research Service 6 One key component of SDWA is the requirement that EPA establish national primary drinking water regulations for contaminants that may adversely affect human health and are likely to be present in public water supplies.20 EPA has issued regulations for more than 90 contaminants. These include numerical standards or treatment techniques for drinking water disinfectants and their byproducts, microorganisms, radionuclides, organic chemicals, and inorganic chemicals.21 The SDWA Amendments of 1996 (P.L. 104-182) reauthorized appropriations for most SDWA programs through FY2003. Although the authority has expired for most appropriations, Congress has continued to appropriate funds for the ongoing SDWA programs.22 Even though the authorization of appropriations may expire, program authority (i.e., an agency’s “enabling” authority) does not expire unless there is a “sunset” date for that authority or if Congress repeals it through subsequent laws. Drinking Water State Revolving Fund Program Authorized in 1996, the DWSRF program provides federal financial assistance to communities to finance drinking water infrastructure improvements.23 SDWA Section 1452 authorizes EPA to make annual grants to states to capitalize their state revolving loan fund.24 The statute requires states to provide a 20% match. States may use DWSRF financing for public water system projects needed to comply with federal drinking water standards and address risks to human health. The primary type of DWSRF financial assistance are low interest rate loans. SDWA Section 1452 authorizes states to provide additional subsidization (including forgiveness of principal) to disadvantaged communities.25 The federal capitalization grants together with state funds (e.g., state match, loan repayments, leveraged bonds, and other state sources) are intended to build a sustainable source of drinking water infrastructure funding for the state. The authorization of appropriation for DWSRF expired in FY2003. Congress has continued to provide funds for the DWSRF program through annual appropriations. From FY1997 through FY2018, Congress appropriated over $23.33 billion for the DWSRF program. The appropriation for DWSRF program generally ranged between $820.0 million in FY2000 and $1.39 billion in FY2010.26 DWSRF Program Revisions (AWIA Sections 2002, 2015, and 2022) AWIA makes the most substantial revisions to the DWSRF provisions of SDWA since the program was authorized in 1996. These revisions expand the eligible uses of DWSRF financial assistance, provide states with additional flexibility to administer the DWSRF program, and include provisions intended to make DWSRF assistance more accessible to public water systems. 27 AWIA Section 2015(a) amends SDWA to expressly state that DWSRF funds can be used for projects to replace or rehabilitate aging treatment, storage, or distribution systems.28 Under EPA guidance, these replacement and rehabilitation projects have been eligible for financial assistance from the DWSRF if needed to protect public health. According to EPA’s needs survey, this category of projects accounts for 66.1% of the estimated drinking water infrastructure need.29 Prior to AWIA, these activities were not previously explicitly identified in statute.30 Section 2015 also revises existing DWSRF provisions that address financial assistance for disadvantaged communities. These amendments increase the portion of a state’s capitalization grant that states may dedicate to additional subsidization and extend the amortization period for loans made to disadvantaged communities. Before AWIA, states could use 30% of their annual capitalization grants to subsidize loans for disadvantaged communities.31 Section 2015(c) of AWIA increases that proportion to 35% while conditionally requiring states to use at least 6% of their capitalization grant for these subsidies.32 The section also amends the SDWA DWSRF provisions to extend the amortization period for loans made to disadvantaged communities from 30 to 40 years. Section 2015(d) of AWIA also extends the repayment and amortization period for all projects financed by the DWSRF. Previously, SDWA required DWSRF financing recipients to pay the initial principal and interest payments within one year of project completion. This amendment extends the date of that initial payment to 18 months after project completion. This section also authorizes the extension of the amortization period for projects that receive DWSRF assistance from 20 to 30 years. Section 2015(e) requires EPA to evaluate and include the cost to replace lead service lines in the drinking water infrastructure needs survey, which EPA completes every four years.33 EPA uses the needs survey to allot the DWSRF appropriation among the states. 34 In conducting the needs survey, EPA has not previously requested that public water systems report the cost to replace these lines.35 AWIA specifies that the cost to replace lead lines must be included in the needs survey (to the extent practicable), which may potentially affect some states’ allotments of DWSRF capitalization grants. Section 2015(g) of AWIA requires EPA to gather specified information on DWSRF administration from state drinking water administrators and report to Congress on best practices for implementing the DWSRF to facilitate the application process and to improve DWSRF financial management and sustainability. Source Water Assessment and Protection In 1996, Congress added source water assessment provisions to SDWA to encourage protection of drinking water sources. 36 Section 1453 required states to develop source water assessment programs that delineate areas from which public water systems receive water and identify the origins of regulated contaminants to determine threats to water systems. States were authorized to fund these activities from 10% of their DWSRF capitalization grant for FY1996 and FY1997.37 Section 2015(f) of AWIA removes this fiscal year limitation and accordingly authorizes states to use a portion of their capitalization grant to fund these source water assessments or update an existing source water assessment.38 The 1996 SDWA amendments required states to conduct source water assessments as a condition of adopting modified monitoring requirements. 39 However, the 1996 amendments did not authorize states to fund implementation of source water protection plans from their DWSRF capitalization grants. AWIA Section 2002 authorizes states to fund implementation of surface drinking water sources protection efforts and activities from the 10% set-aside of a state’s annual DWSRF capitalization grant. Source water protection is also addressed in the “Protecting Source Water” section of this report.",Legal,Find & Summarize,Text Transformation "Provide a concise answer (less than 100 words), using only the information provided below.","In the context of the Gender Recognition Act 2004, what makes something a gender-specific offence?","3 Evidence (1) An application under section 1(1)(a) must include either— (a) a report made by a registered medical practitioner practising in the field of gender dysphoria and a report made by another registered medical practitioner (who may, but need not, practise in that field), or (b) a report made by a chartered psychologist practising in that field and a report made by a registered medical practitioner (who may, but need not, practise in that field). (2) But subsection (1) is not complied with unless a report required by that subsection and made by— (a) a registered medical practitioner, or (b) a chartered psychologist, practising in the field of gender dysphoria includes details of the diagnosis of the applicant’s gender dysphoria. (3) And subsection (1) is not complied with in a case where— (a) the applicant has undergone or is undergoing treatment for the purpose of modifying sexual characteristics, or (b) treatment for that purpose has been prescribed or planned for the applicant, unless at least one of the reports required by that subsection includes details of it. (4) An application under section 1(1)(a) must also include a statutory declaration by the applicant that the applicant meets the conditions in section 2(1)(b) and (c). (5) An application under section 1(1)(b) must include evidence that the applicant has changed gender under the law of an approved country or territory. Gender Recognition Act 2004 (c. 7) 3 (6) Any application under section 1(1) must include— (a) a statutory declaration as to whether or not the applicant is married, (b) any other information or evidence required by an order made by the Secretary of State, and (c) any other information or evidence which the Panel which is to determine the application may require, and may include any other information or evidence which the applicant wishes to include. (7) The Secretary of State may not make an order under subsection (6)(b) without consulting the Scottish Ministers and the Department of Finance and Personnel in Northern Ireland. (8) If the Panel which is to determine the application requires inform","What evidence is required to obtain a Gender Recognition Certificate in the UK? Provide a concise answer (less than 100 words), using only the information provided below. ""3 Evidence (1) An application under section 1(1)(a) must include either— (a) a report made by a registered medical practitioner practising in the field of gender dysphoria and a report made by another registered medical practitioner (who may, but need not, practise in that field), or (b) a report made by a chartered psychologist practising in that field and a report made by a registered medical practitioner (who may, but need not, practise in that field). (2) But subsection (1) is not complied with unless a report required by that subsection and made by— (a) a registered medical practitioner, or (b) a chartered psychologist, practising in the field of gender dysphoria includes details of the diagnosis of the applicant’s gender dysphoria. (3) And subsection (1) is not complied with in a case where— (a) the applicant has undergone or is undergoing treatment for the purpose of modifying sexual characteristics, or (b) treatment for that purpose has been prescribed or planned for the applicant, unless at least one of the reports required by that subsection includes details of it. (4) An application under section 1(1)(a) must also include a statutory declaration by the applicant that the applicant meets the conditions in section 2(1)(b) and (c). (5) An application under section 1(1)(b) must include evidence that the applicant has changed gender under the law of an approved country or territory. Gender Recognition Act 2004 (c. 7) 3 (6) Any application under section 1(1) must include— (a) a statutory declaration as to whether or not the applicant is married, (b) any other information or evidence required by an order made by the Secretary of State, and (c) any other information or evidence which the Panel which is to determine the application may require, and may include any other information or evidence which the applicant wishes to include. (7) The Secretary of State may not make an order under subsection (6)(b) without consulting the Scottish Ministers and the Department of Finance and Personnel in Northern Ireland. (8) If the Panel which is to determine the application requires inform""",Legal,Find & Summarize,Text Transformation Only use the document provided to answer the question. Cite the section of text you are basing your response on.,"Using the provided document, what terrain may cause connection issues for WISPs?","**Rural access** One of the great challenges for Internet access in general and for broadband access in particular is to provide service to potential customers in areas of low population density, such as to farmers, ranchers, and small towns. In cities where the population density is high, it is easier for a service provider to recover equipment costs, but each rural customer may require expensive equipment to get connected. While 66% of Americans had an Internet connection in 2010, that figure was only 50% in rural areas, according to the Pew Internet & American Life Project.[141] Virgin Media advertised over 100 towns across the United Kingdom ""from Cwmbran to Clydebank"" that have access to their 100 Mbit/s service.[30] Wireless Internet service providers (WISPs) are rapidly becoming a popular broadband option for rural areas.[142] The technology's line-of-sight requirements may hamper connectivity in some areas with hilly and heavily foliated terrain. However, the Tegola project, a successful pilot in remote Scotland, demonstrates that wireless can be a viable option.[143] The Broadband for Rural Nova Scotia initiative is the first program in North America to guarantee access to ""100% of civic addresses"" in a region. It is based on Motorola Canopy technology. As of November 2011, under 1000 households have reported access problems. Deployment of a new cell network by one Canopy provider (Eastlink) was expected to provide the alternative of 3G/4G service, possibly at a special unmetered rate, for areas harder to serve by Canopy.[144] In New Zealand, a fund has been formed by the government to improve rural broadband,[145] and mobile phone coverage. Current proposals include: (a) extending fiber coverage and upgrading copper to support VDSL, (b) focusing on improving the coverage of cellphone technology, or (c) regional wireless.[146] Several countries have started Hybrid Access Networks to provide faster Internet services in rural areas by enabling network operators to efficiently combine their XDSL and LTE networks.","{Document} ========== **Rural access** One of the great challenges for Internet access in general and for broadband access in particular is to provide service to potential customers in areas of low population density, such as to farmers, ranchers, and small towns. In cities where the population density is high, it is easier for a service provider to recover equipment costs, but each rural customer may require expensive equipment to get connected. While 66% of Americans had an Internet connection in 2010, that figure was only 50% in rural areas, according to the Pew Internet & American Life Project.[141] Virgin Media advertised over 100 towns across the United Kingdom ""from Cwmbran to Clydebank"" that have access to their 100 Mbit/s service.[30] Wireless Internet service providers (WISPs) are rapidly becoming a popular broadband option for rural areas.[142] The technology's line-of-sight requirements may hamper connectivity in some areas with hilly and heavily foliated terrain. However, the Tegola project, a successful pilot in remote Scotland, demonstrates that wireless can be a viable option.[143] The Broadband for Rural Nova Scotia initiative is the first program in North America to guarantee access to ""100% of civic addresses"" in a region. It is based on Motorola Canopy technology. As of November 2011, under 1000 households have reported access problems. Deployment of a new cell network by one Canopy provider (Eastlink) was expected to provide the alternative of 3G/4G service, possibly at a special unmetered rate, for areas harder to serve by Canopy.[144] In New Zealand, a fund has been formed by the government to improve rural broadband,[145] and mobile phone coverage. Current proposals include: (a) extending fiber coverage and upgrading copper to support VDSL, (b) focusing on improving the coverage of cellphone technology, or (c) regional wireless.[146] Several countries have started Hybrid Access Networks to provide faster Internet services in rural areas by enabling network operators to efficiently combine their XDSL and LTE networks. ---------------- {System Instruction} ========== Only use the document provided to answer the question. Cite the section of text you are basing your response on. ---------------- {Question} ========== Using the provided document, what terrain may cause connection issues for WISPs?",Internet/Technology,Find & Summarize,Text Transformation You must only respond using information from the provided PDF. You must not use any external information. You must present and provide citations only if they are relevant.,What doctrine or doctrines does Kagan use to argue against the Court's decision to overrule Chevron?,"JUSTICE KAGAN, with whom JUSTICE SOTOMAYOR and JUSTICE JACKSON join,* dissenting. For 40 years, Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc., 467 U. S. 837 (1984), has served as a cornerstone of administrative law, allocating responsibility for statutory construction between courts and agencies. Under Chevron, a court uses all its normal interpretive tools to determine whether Congress has spoken to an issue. If the court finds Congress has done so, that is the end of the matter; the agency’s views make no difference. But if the court finds, at the end of its interpretive work, that Congress has left an ambiguity or gap, then a choice must be made. Who should give content to a statute when Congress’s instructions have run out? Should it be a court? Or should it be the agency Congress has charged with administering the statute? The answer Chevron gives is that it should usually be the agency, within the bounds of reasonableness. That rule has formed the backdrop against which Congress, courts, and agencies—as well as regulated parties and the public—all have operated for decades. It has been applied in thousands of judicial decisions. It has become part of the warp and woof of modern government, supporting regulatory efforts of all kinds—to name a few, keeping air and water clean, food and drugs safe, and financial markets honest. And the rule is right. This Court has long understood Chevron deference to reflect what Congress would want, and so to be rooted in a presumption of legislative intent. Congress knows that it does not—in fact cannot—write perfectly complete regulatory statutes. It knows that those statutes will inevitably contain ambiguities that some other actor will have to resolve, and gaps that some other actor will have to fill. And it would usually prefer that actor to be the responsible agency, not a court. Some interpretive issues arising in the regulatory context involve scientific or technical subject matter. Agencies have expertise in those areas; courts do not. Some demand a detailed understanding of complex and interdependent regulatory programs. Agencies know those programs inside-out; again, courts do not. And some present policy choices, including trade-offs between competing goods. Agencies report to a President, who in turn answers to the public for his policy calls; courts have no such accountability and no proper basis for making policy. And of course Congress has conferred on that expert, experienced, and politically accountable agency the authority to administer—to make rules about and otherwise implement—the statute giving rise to the ambiguity or Put all that together and deference to the agency is the almost obvious choice, based on an implicit congressional delegation of interpretive authority. We defer, the Court has explained, “because of a presumption that Congress” would have “desired the agency (rather than the courts)” to exercise “whatever degree of discretion” the statute allows. Smiley v. Citibank (South Dakota), N. A., 517 U. S. 735, 740–741 (1996). Today, the Court flips the script: It is now “the courts (rather than the agency)” that will wield power when Congress has left an area of interpretive discretion. A rule of judicial humility gives way to a rule of judicial hubris. In recent years, this Court has too often taken for itself decision-making authority Congress assigned to agencies. The Court has substituted its own judgment on workplace health for that of the Occupational Safety and Health Administration; its own judgment on climate change for that of the Environmental Protection Agency; and its own judgment on student loans for that of the Department of Education. See, e.g., National Federation of Independent Business v. OSHA, 595 U. S. 109 (2022); West Virginia v. EPA, 597 U. S. 697 (2022); Biden v. Nebraska, 600 U. S. 477 (2023). But evidently that was, for this Court, all too piecemeal. In one fell swoop, the majority today gives itself exclusive power over every open issue—no matter how expertise-driven or policy-laden—involving the meaning of regulatory law. As if it did not have enough on its plate, the majority turns itself into the country’s administrative czar. It defends that move as one (suddenly) required by the (nearly 80-year-old) Administrative Procedure Act. But the Act makes no such demand. Today’s decision is not one Congress directed. It is entirely the majority’s choice. And the majority cannot destroy one doctrine of judicial humility without making a laughing-stock of a second. (If opinions had titles, a good candidate for today’s would be Hubris Squared.) Stare decisis is, among other things, a way to remind judges that wisdom often lies in what prior judges have done. It is a brake on the urge to convert “every new judge’s opinion” into a new legal rule or regime. Dobbs v. Jackson Women’s Health Organization, 597 U. S. 215, 388 (2022) (joint opinion of Breyer, SOTOMAYOR, and KAGAN, JJ., dissenting) (quoting 1 W. Blackstone, Commentaries on the Laws of England 69 (7th ed. 1775)). Chevron is entrenched precedent, entitled to the protection of stare decisis, as even the majority acknowledges. In fact, Chevron is entitled to the supercharged version of that doctrine because Congress could always overrule the decision, and because so many governmental and private actors have relied on it for so long. Because that is so, the majority needs a “particularly special justification” for its action. Kisor v. Wilkie, 588 U. S. 558, 588 (2019) (opinion of the Court). But the majority has nothing that would qualify. It barely tries to advance the usual factors this Court invokes for overruling precedent. Its justification comes down, in the end, to this: Courts must have more say over regulation—over the provision of health care, the protection of the environment, the safety of consumer products, the efficacy of transportation systems, and so on. A longstanding precedent at the crux of administrative governance thus falls victim to a bald assertion of judicial authority. The majority disdains restraint, and grasps for power. ","You must only respond using information from the provided PDF. You must not use any external information. You must present and provide citations only if they are relevant. What doctrine or doctrines does Kagan use to argue against the Court's decision to overrule Chevron? JUSTICE KAGAN, with whom JUSTICE SOTOMAYOR and JUSTICE JACKSON join,* dissenting. For 40 years, Chevron U. S. A. Inc. v. Natural Resources Defense Council, Inc., 467 U. S. 837 (1984), has served as a cornerstone of administrative law, allocating responsibility for statutory construction between courts and agencies. Under Chevron, a court uses all its normal interpretive tools to determine whether Congress has spoken to an issue. If the court finds Congress has done so, that is the end of the matter; the agency’s views make no difference. But if the court finds, at the end of its interpretive work, that Congress has left an ambiguity or gap, then a choice must be made. Who should give content to a statute when Congress’s instructions have run out? Should it be a court? Or should it be the agency Congress has charged with administering the statute? The answer Chevron gives is that it should usually be the agency, within the bounds of reasonableness. That rule has formed the backdrop against which Congress, courts, and agencies—as well as regulated parties and the public—all have operated for decades. It has been applied in thousands of judicial decisions. It has become part of the warp and woof of modern government, supporting regulatory efforts of all kinds—to name a few, keeping air and water clean, food and drugs safe, and financial markets honest. And the rule is right. This Court has long understood Chevron deference to reflect what Congress would want, and so to be rooted in a presumption of legislative intent. Congress knows that it does not—in fact cannot—write perfectly complete regulatory statutes. It knows that those statutes will inevitably contain ambiguities that some other actor will have to resolve, and gaps that some other actor will have to fill. And it would usually prefer that actor to be the responsible agency, not a court. Some interpretive issues arising in the regulatory context involve scientific or technical subject matter. Agencies have expertise in those areas; courts do not. Some demand a detailed understanding of complex and interdependent regulatory programs. Agencies know those programs inside-out; again, courts do not. And some present policy choices, including trade-offs between competing goods. Agencies report to a President, who in turn answers to the public for his policy calls; courts have no such accountability and no proper basis for making policy. And of course Congress has conferred on that expert, experienced, and politically accountable agency the authority to administer—to make rules about and otherwise implement—the statute giving rise to the ambiguity or Put all that together and deference to the agency is the almost obvious choice, based on an implicit congressional delegation of interpretive authority. We defer, the Court has explained, “because of a presumption that Congress” would have “desired the agency (rather than the courts)” to exercise “whatever degree of discretion” the statute allows. Smiley v. Citibank (South Dakota), N. A., 517 U. S. 735, 740–741 (1996). Today, the Court flips the script: It is now “the courts (rather than the agency)” that will wield power when Congress has left an area of interpretive discretion. A rule of judicial humility gives way to a rule of judicial hubris. In recent years, this Court has too often taken for itself decision-making authority Congress assigned to agencies. The Court has substituted its own judgment on workplace health for that of the Occupational Safety and Health Administration; its own judgment on climate change for that of the Environmental Protection Agency; and its own judgment on student loans for that of the Department of Education. See, e.g., National Federation of Independent Business v. OSHA, 595 U. S. 109 (2022); West Virginia v. EPA, 597 U. S. 697 (2022); Biden v. Nebraska, 600 U. S. 477 (2023). But evidently that was, for this Court, all too piecemeal. In one fell swoop, the majority today gives itself exclusive power over every open issue—no matter how expertise-driven or policy-laden—involving the meaning of regulatory law. As if it did not have enough on its plate, the majority turns itself into the country’s administrative czar. It defends that move as one (suddenly) required by the (nearly 80-year-old) Administrative Procedure Act. But the Act makes no such demand. Today’s decision is not one Congress directed. It is entirely the majority’s choice. And the majority cannot destroy one doctrine of judicial humility without making a laughing-stock of a second. (If opinions had titles, a good candidate for today’s would be Hubris Squared.) Stare decisis is, among other things, a way to remind judges that wisdom often lies in what prior judges have done. It is a brake on the urge to convert “every new judge’s opinion” into a new legal rule or regime. Dobbs v. Jackson Women’s Health Organization, 597 U. S. 215, 388 (2022) (joint opinion of Breyer, SOTOMAYOR, and KAGAN, JJ., dissenting) (quoting 1 W. Blackstone, Commentaries on the Laws of England 69 (7th ed. 1775)). Chevron is entrenched precedent, entitled to the protection of stare decisis, as even the majority acknowledges. In fact, Chevron is entitled to the supercharged version of that doctrine because Congress could always overrule the decision, and because so many governmental and private actors have relied on it for so long. Because that is so, the majority needs a “particularly special justification” for its action. Kisor v. Wilkie, 588 U. S. 558, 588 (2019) (opinion of the Court). But the majority has nothing that would qualify. It barely tries to advance the usual factors this Court invokes for overruling precedent. Its justification comes down, in the end, to this: Courts must have more say over regulation—over the provision of health care, the protection of the environment, the safety of consumer products, the efficacy of transportation systems, and so on. A longstanding precedent at the crux of administrative governance thus falls victim to a bald assertion of judicial authority. The majority disdains restraint, and grasps for power. ",Legal,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",I'm doing a retail forecasting analysis of consumer behavior and the economy. Please summarize the changes in the fashion industry first and then tell me in two paragraphs how companies cope with them from both consumer and retailer perspectives.,"Uncertainty in the face of headwinds With conflicts in Europe and the Middle East and strained international relations elsewhere, geopolitics is the number-one concern for fashion industry executives going into 2024, followed by economic volatility and inflation. Some 62 percent of executives in this year’s survey, conducted in September, cite geopolitical instability as the top risk to growth. Economic volatility is cited by 55 percent and inflation is mentioned by 51 percent (compared with 78 percent last year). The global average headline rate of inflation is predicted to moderate to 5.8 percent—still high on a historical basis—from 6.9 percent in 2023.1 Against a challenging economic backdrop, executive views of the industry’s prospects are more divided than in any year since the launch of the BoF–McKinsey Executive Survey in 2017. While 26 percent of survey respondents say they expect conditions to improve year on year, 37 percent see them remaining the same and 38 percent think they will worsen. Uncertainty within the industry reflects the broader economic situation, albeit with regional divergence. Going into 2024, pressure on household incomes is expected to dampen demand for apparel and prompt trading down across categories. Still, there are geographic outliers that may offer comfort. One is India, where consumer confidence hit a four-year high in September 2023.2 India-based executives are more optimistic than those in Western countries, with 85 percent of respondents to McKinsey’s Global Economics Intelligence survey saying that conditions have improved in the past six months.3 China’s economy is facing challenges, but the country’s consumers show a higher intent to shop for fashion in 2024 than consumers in both the United States and Europe. Ten themes for 2024 To prepare for challenges and be alert to opportunities, leading fashion companies will likely prioritize contingency planning for the coming year. A key theme will be companies keeping a firm grip on costs and inventories while driving growth by precisely managing prices. Brands and suppliers can expect an increasingly competitive environment. But they will also have opportunities, with consumers discovering new styles, tastes, and priorities—all presenting routes to value creation. As previously done, this year’s report highlights ten emerging themes that will be high on leadership agendas. Global economy: Fragmented future. In 2024, the global economic outlook will continue to be unsettled, as financial, geopolitical, and other challenges weigh on consumer confidence. Fashion markets in China, Europe, and the United States will likely face headwinds, some of which reflect individual regional dynamics. Suppliers, brands, and retailers may need to bolster contingency planning and manage for uncertainty. Climate urgency. The frequency and intensity of extreme weather-related events in 2023 mean the climate crisis is an even more urgent priority than in previous years. With physical and transition risks rising across continents, the industry must not delay in tackling emissions and building resilience into supply chains. Consumer shifts: Vacation mode. Consumers are gearing up for the biggest year of travel since before the pandemic. But a shift in values means expectations are evolving, even as shopping remains a priority. Brands and retailers should refresh distribution and category strategies to reflect the new reality. The new face of influence. It’s time for brand marketers to update their influencer playbooks, as a new guard of creative personalities wins fans. Working with opinion leaders in 2024 will require a different type of partnership, an emphasis on video, and a willingness to loosen the reins on creative control. Outdoors reinvented. Technical outdoor clothing and “gorpcore” are in demand as consumers embrace healthier lifestyles. In 2024, more outdoor brands are expected to launch lifestyle collections. At the same time, lifestyle brands will likely embed technical elements into collections, blurring the lines between functionality and style. Fashion system: Generative AI’s creative crossroads. After generative AI’s (gen AI) breakout year in 2023, more use cases are emerging across the industry. Capturing value will require fashion players to look beyond automation and explore gen AI’s potential to enhance the work of human creatives. Fast fashion’s power play. Fast-fashion competition is set to be fiercer than ever. Challengers, led by Shein and Temu, are bringing new tactics on price, customer experience, and speed. Success for disruptors and incumbents could hinge on adapting to new consumer preferences while navigating the regulatory agenda. All eyes on brand. Brand marketing is expected to be back in the spotlight as the fashion industry manages a switch away from performance marketing. Brands may benefit from forging emotional connections with consumers as marketers rewrite playbooks to emphasise long-term brand building. Sustainability rules. The era of fashion industry self-regulation is drawing to a close. Across jurisdictions, new rules will have significant effects on both consumers and fashion players. Brands and manufacturers may consider revamping business models to align with the changes ahead. Bullwhip snaps back. Shifts in consumer demand have created a “bullwhip effect,” by which order volatility reverberates unpredictably through supply chains. Suppliers will likely face pressure as brands and retailers focus on transparency and strategic partnerships. Looking ahead As the industry continues to be challenged by geopolitical and economic headwinds, fashion leaders in 2024 will look to strike a careful balance between managing uncertainty and seizing opportunities. With cost-saving tactics mostly exhausted, companies may focus on growing sales, underpinned by new pricing and promotion strategies. Across the industry, net intent to raise prices is more than 50 percent, according to the BoF–McKinsey Executive Survey. At the same time, reduced cost pressures could provide a potential boost to performance. As climate change brings increasingly extreme weather events and global temperatures rise, the coming year is likely to mark a heightened industry focus on environmental, social, and governance issues. Our survey shows that the topic is seen as both the number-one priority and number-one challenge for industry executives. The most successful companies will find a balance between sustainability initiatives, risk management, and commercial imperatives. In an uncertain world, consumer discretionary spend will be weighted toward trusted categories and brands. Hard luxury goods—jewelry, watches, and leather—will likely be in demand, reflecting their potential investment value in tough economic times. Consumers are expected to travel more and continue spending more time outdoors. And they prefer emotional connections and authenticity over celebrity endorsements. All told, executives are bracing for a strategically complex year ahead. To counter uncertainty, leading companies will prepare for a range of outcomes. The most successful will become more resilient, better equipped to manage the challenges, and ready to accelerate when the storm clouds begin to clear.","""================ ======= Uncertainty in the face of headwinds With conflicts in Europe and the Middle East and strained international relations elsewhere, geopolitics is the number-one concern for fashion industry executives going into 2024, followed by economic volatility and inflation. Some 62 percent of executives in this year’s survey, conducted in September, cite geopolitical instability as the top risk to growth. Economic volatility is cited by 55 percent and inflation is mentioned by 51 percent (compared with 78 percent last year). The global average headline rate of inflation is predicted to moderate to 5.8 percent—still high on a historical basis—from 6.9 percent in 2023.1 Against a challenging economic backdrop, executive views of the industry’s prospects are more divided than in any year since the launch of the BoF–McKinsey Executive Survey in 2017. While 26 percent of survey respondents say they expect conditions to improve year on year, 37 percent see them remaining the same and 38 percent think they will worsen. Uncertainty within the industry reflects the broader economic situation, albeit with regional divergence. Going into 2024, pressure on household incomes is expected to dampen demand for apparel and prompt trading down across categories. Still, there are geographic outliers that may offer comfort. One is India, where consumer confidence hit a four-year high in September 2023.2 India-based executives are more optimistic than those in Western countries, with 85 percent of respondents to McKinsey’s Global Economics Intelligence survey saying that conditions have improved in the past six months.3 China’s economy is facing challenges, but the country’s consumers show a higher intent to shop for fashion in 2024 than consumers in both the United States and Europe. Ten themes for 2024 To prepare for challenges and be alert to opportunities, leading fashion companies will likely prioritize contingency planning for the coming year. A key theme will be companies keeping a firm grip on costs and inventories while driving growth by precisely managing prices. Brands and suppliers can expect an increasingly competitive environment. But they will also have opportunities, with consumers discovering new styles, tastes, and priorities—all presenting routes to value creation. As previously done, this year’s report highlights ten emerging themes that will be high on leadership agendas. Global economy: Fragmented future. In 2024, the global economic outlook will continue to be unsettled, as financial, geopolitical, and other challenges weigh on consumer confidence. Fashion markets in China, Europe, and the United States will likely face headwinds, some of which reflect individual regional dynamics. Suppliers, brands, and retailers may need to bolster contingency planning and manage for uncertainty. Climate urgency. The frequency and intensity of extreme weather-related events in 2023 mean the climate crisis is an even more urgent priority than in previous years. With physical and transition risks rising across continents, the industry must not delay in tackling emissions and building resilience into supply chains. Consumer shifts: Vacation mode. Consumers are gearing up for the biggest year of travel since before the pandemic. But a shift in values means expectations are evolving, even as shopping remains a priority. Brands and retailers should refresh distribution and category strategies to reflect the new reality. The new face of influence. It’s time for brand marketers to update their influencer playbooks, as a new guard of creative personalities wins fans. Working with opinion leaders in 2024 will require a different type of partnership, an emphasis on video, and a willingness to loosen the reins on creative control. Outdoors reinvented. Technical outdoor clothing and “gorpcore” are in demand as consumers embrace healthier lifestyles. In 2024, more outdoor brands are expected to launch lifestyle collections. At the same time, lifestyle brands will likely embed technical elements into collections, blurring the lines between functionality and style. Fashion system: Generative AI’s creative crossroads. After generative AI’s (gen AI) breakout year in 2023, more use cases are emerging across the industry. Capturing value will require fashion players to look beyond automation and explore gen AI’s potential to enhance the work of human creatives. Fast fashion’s power play. Fast-fashion competition is set to be fiercer than ever. Challengers, led by Shein and Temu, are bringing new tactics on price, customer experience, and speed. Success for disruptors and incumbents could hinge on adapting to new consumer preferences while navigating the regulatory agenda. All eyes on brand. Brand marketing is expected to be back in the spotlight as the fashion industry manages a switch away from performance marketing. Brands may benefit from forging emotional connections with consumers as marketers rewrite playbooks to emphasise long-term brand building. Sustainability rules. The era of fashion industry self-regulation is drawing to a close. Across jurisdictions, new rules will have significant effects on both consumers and fashion players. Brands and manufacturers may consider revamping business models to align with the changes ahead. Bullwhip snaps back. Shifts in consumer demand have created a “bullwhip effect,” by which order volatility reverberates unpredictably through supply chains. Suppliers will likely face pressure as brands and retailers focus on transparency and strategic partnerships. Looking ahead As the industry continues to be challenged by geopolitical and economic headwinds, fashion leaders in 2024 will look to strike a careful balance between managing uncertainty and seizing opportunities. With cost-saving tactics mostly exhausted, companies may focus on growing sales, underpinned by new pricing and promotion strategies. Across the industry, net intent to raise prices is more than 50 percent, according to the BoF–McKinsey Executive Survey. At the same time, reduced cost pressures could provide a potential boost to performance. As climate change brings increasingly extreme weather events and global temperatures rise, the coming year is likely to mark a heightened industry focus on environmental, social, and governance issues. Our survey shows that the topic is seen as both the number-one priority and number-one challenge for industry executives. The most successful companies will find a balance between sustainability initiatives, risk management, and commercial imperatives. In an uncertain world, consumer discretionary spend will be weighted toward trusted categories and brands. Hard luxury goods—jewelry, watches, and leather—will likely be in demand, reflecting their potential investment value in tough economic times. Consumers are expected to travel more and continue spending more time outdoors. And they prefer emotional connections and authenticity over celebrity endorsements. All told, executives are bracing for a strategically complex year ahead. To counter uncertainty, leading companies will prepare for a range of outcomes. The most successful will become more resilient, better equipped to manage the challenges, and ready to accelerate when the storm clouds begin to clear. https://www.mckinsey.com/industries/retail/our-insights/state-of-fashion ================ ======= I'm doing a retail forecasting analysis of consumer behavior and the economy. Please summarize the changes in the fashion industry first and then tell me in two paragraphs how companies cope with them from both consumer and retailer perspectives. ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Retail/Product,Explanation/Definition,Q&A This task requires you to answer a question based solely on the information provided in the prompt. You may not use any outside information/knowledge.,Please explain firewalls available and how they work.,"Internet Connection Firewall Today, there are three basic ways that home users connect to the Internet. The first is through a device called a modem. A modem allows you to connect to the Internet using your regular telephone line. You are only connected to the Internet when you actually dial your Internet Service Provider (ISP). This is a relatively slow way of connecting to the Internet, but much less costly than the other two options. The other two options are connecting to the Internet through your cable television service (cable), or connecting through specialized telephone wire run between the nearest telephone switching site and your house [digital subscriber line (DSL)]. Both ways are expensive compared to using a standard modem, but the speeds can be 20 or more times faster using cable or DSL. In reality, cable and DSL connections also require modems. However, when we talk about connecting to the Internet through a modem we are normally talking about using a standard telephone line for the connection. In the case of a cable or DSL connection, your computer is constantly connected to the Internet. This exposes your computer to the possibility of being hacked. Hacking is when an unauthorized person attempts to gain control of your computer for purposes of stealing data or causing malicious damage. One step that can be taken to deter hackers is placing a hardware or software firewall between your computer and the Internet. All messages entering or leaving the computer pass through the firewall, which examines each message and blocks those that do not meet the specified security criteria. Although a hardware firewall is always considered to be more effective than a software firewall, it is considerably more expensive. To save Windows XP users from having to invest additional money for basic security, Microsoft has included a software Internet Connection Firewall ICF) that can be used without additional charge.","System Instruction: [This task requires you to answer a question based solely on the information provided in the prompt. You may not use any outside information/knowledge. ] Question: [Please explain firewalls available and how they work.] Context Block: [Internet Connection Firewall Today, there are three basic ways that home users connect to the Internet. The first is through a device called a modem. A modem allows you to connect to the Internet using your regular telephone line. You are only connected to the Internet when you actually dial your Internet Service Provider (ISP). This is a relatively slow way of connecting to the Internet, but much less costly than the other two options. The other two options are connecting to the Internet through your cable television service (cable), or connecting through specialized telephone wire run between the nearest telephone switching site and your house [digital subscriber line (DSL)]. Both ways are expensive compared to using a standard modem, but the speeds can be 20 or more times faster using cable or DSL. In reality, cable and DSL connections also require modems. However, when we talk about connecting to the Internet through a modem we are normally talking about using a standard telephone line for the connection. In the case of a cable or DSL connection, your computer is constantly connected to the Internet. This exposes your computer to the possibility of being hacked. Hacking is when an unauthorized person attempts to gain control of your computer for purposes of stealing data or causing malicious damage. One step that can be taken to deter hackers is placing a hardware or software firewall between your computer and the Internet. All messages entering or leaving the computer pass through the firewall, which examines each message and blocks those that do not meet the specified security criteria. Although a hardware firewall is always considered to be more effective than a software firewall, it is considerably more expensive. To save Windows XP users from having to invest additional money for basic security, Microsoft has included a software Internet Connection Firewall ICF) that can be used without additional charge.]",Internet/Technology,Find & Summarize,Text Transformation "Only use information in the context block to answer the question. Your answer should be understandable to individuals with a general, but not advanced, knowledge of computer science. Keep your answer to 250 words or less.",What are the differences between serverless computing and the microservice software style?,"Cloud computing provides the ability of computation services via the Internet. According to the NIST definition [156], traditional cloud computing has three service categories: “Infrastructure as a Service” (IaaS), “Platform as a Service” (PaaS), and “Software as a Service” (SaaS). Specifically, IaaS allows software developers to configure and use computation, storage, and network resources. For example, AWS provides the computation service like Elastic Compute Cloud (AWS EC2) [6] and the storage service like Simple Storage Service (AWS S3) [7]. However, IaaS does not hide the operation complexity of the application; thus, developers are still responsible for resource provisioning, runtime configuration, application code management, etc. SaaS allows software developers to directly use the cloud provider’s applications, such as Gmail [30] and Docs [29] provided by Google. SaaS completely hides the underlying operation complexity, but use cases are limited. Moreover, developers completely lose control of the application. PaaS allows software developers to develop, run, and manage applications using the execution environment supported by the cloud provider. For example, Google provides the App Engine [27], while Azure offers App Service [16]. PaaS compromises the operation complexity between IaaS and SaaS, but software developers still are responsible for and manage some underlying tasks. To ease the cloud management burden on software developers, cloud providers presented a new paradigm, i.e., serverless computing. Serverless computing is similar to PaaS; differently, it almost hides all complex underlying management tasks for developers, i.e., “server-less”, and it also allows developers to control their applications. Serverless computing-related applications (a.k.a., serverless applications) follow the microservice software style, which decomposes the application into a subset of independent tasks. However, the differences between serverless applications and microservice-based applications are as follows. First, the serverless application’s unit (a.k.a., serverless function) is a smaller granularity than the unit of the microservice-based application. Second, microservice-based applications still make developers face the additional effort of underlying tasks like scalability, fault tolerance, and load balancing. Third, serverless functions adopt the event-driven pattern while microservices are usually responsive to their interfaces. In addition, serverless computing is more suitable for short-lived and bursty applications because its platforms provide high and automatic scalability, while microservices are suited for long-running and stable applications. Serverless computing is an emerging and potential cloud computing paradigm, and its significant advantage is to free software developers from the burden of complex and error-prone server management tasks. Serverless computing provides “Backend as a Service” (BaaS) and “Function as a Service” (FaaS) [120], as shown in Fig. 2. Specifically, BaaS represents tailor-made cloud services provided by cloud providers, e.g., cloud storage and notification services. These services can service FaaS optionally to simplify the backend functionality development for software developers. FaaS represents that software developers can write stateless, event-driven serverless functions, making them focus on the logic of serverless applications. Generally, FaaS is the core of serverless computing, allowing developers to develop and control their applications. To better understand serverless computing, we introduce its key characteristics as follows. • Functionality and no operations (NoOps): In serverless platforms, software developers can select their most appropriate and familiar languages (e.g., Python, JavaScript, and Java) to write the function-level code snippet to create serverless applications. Moreover, serverless platforms provide user-friendly integrated development environments (IDEs). For the deployment of serverless applications, software developers only need to upload their application code to the serverless platform without complex environment configuration. In addition, BaaS is the equivalent of off-the-shelf backend functionality. Its related services can be directly applied in the application by developers to replace similar backend functionalities. Therefore, developers do not have to redevelop these functionalities and deal with server configurations. Auto-scaling: Serverless platforms can automatically scale function instances horizontally and vertically according to the application workload dynamics. Horizontal scaling is to launch (i.e., scale-in) new function instances or recycle (i.e., scale-out) running ones, while vertical scaling is to add (i.e., scale-up) or remove (i.e., scale-down) the amount of computation and other resources from running function instances. After completing requests, the corresponding function instances and allocated resources will retain in memory for a short time to prepare to be reused by subsequent requests of the same function. If there are no subsequent requests, these instances and resources will be automatically recycled by the serverless platform, i.e., scaling to zero. However, scaling to zero makes incoming new requests face the cold start problem, which takes a long time to prepare required runtime environments from scratch. • Utilization-based billing: In serverless computing, software developers charge for the actually allocated or consumed resources of the serverless application in the fine-granular execution unit. For example, AWS Lambda’s pricing is related to the allocated memory, and Azure Functions considers the consumed memory. On the other hand, serverless functions are event-driven; thus, they will not run without being triggered, and developers do not pay any cost. This feature eliminates the concern of paying for idle resources. In summary, the billing pattern of serverless computing is relatively reasonable and inexpensive compared with traditional cloud computing, which requires always renting and paying resources in memory on standby. Separation of computation and storage: Serverless computing adopts the separation way of computation and storage, i.e., separately scaling and independently provisioning and pricing. Generally, computation refers to stateless serverless functions, while storage represents cloud storage services provided by cloud providers to store data from the serverless function. This separation way can ensure the auto-scaling ability of the serverless platform for bursty workloads. • Additional limitations: Cloud providers set some additional limitations for serverless functions to keep the vital auto-scaling feature of serverless platforms. Generally, these limitations contain function execution timeout, deployment package size, local disk size, memory allocation maximum, etc. Moreover, different serverless platforms have different demands regarding these additional limitations. The above key characteristics show the unique advantages of serverless computing. In addition, some features and limitations will also essentially influence the development of cloud-based applications. ","Question: What are the differences between serverless computing and the microservice software style? System Prompt: Only use information in the context block to answer the question. Your answer should be understandable to individuals with a general, but not advanced, knowledge of computer science. Keep your answer to 250 words or less. Context Block: Cloud computing provides the ability of computation services via the Internet. According to the NIST definition [156], traditional cloud computing has three service categories: “Infrastructure as a Service” (IaaS), “Platform as a Service” (PaaS), and “Software as a Service” (SaaS). Specifically, IaaS allows software developers to configure and use computation, storage, and network resources. For example, AWS provides the computation service like Elastic Compute Cloud (AWS EC2) [6] and the storage service like Simple Storage Service (AWS S3) [7]. However, IaaS does not hide the operation complexity of the application; thus, developers are still responsible for resource provisioning, runtime configuration, application code management, etc. SaaS allows software developers to directly use the cloud provider’s applications, such as Gmail [30] and Docs [29] provided by Google. SaaS completely hides the underlying operation complexity, but use cases are limited. Moreover, developers completely lose control of the application. PaaS allows software developers to develop, run, and manage applications using the execution environment supported by the cloud provider. For example, Google provides the App Engine [27], while Azure offers App Service [16]. PaaS compromises the operation complexity between IaaS and SaaS, but software developers still are responsible for and manage some underlying tasks. To ease the cloud management burden on software developers, cloud providers presented a new paradigm, i.e., serverless computing. Serverless computing is similar to PaaS; differently, it almost hides all complex underlying management tasks for developers, i.e., “server-less”, and it also allows developers to control their applications. Serverless computing-related applications (a.k.a., serverless applications) follow the microservice software style, which decomposes the application into a subset of independent tasks. However, the differences between serverless applications and microservice-based applications are as follows. First, the serverless application’s unit (a.k.a., serverless function) is a smaller granularity than the unit of the microservice-based application. Second, microservice-based applications still make developers face the additional effort of underlying tasks like scalability, fault tolerance, and load balancing. Third, serverless functions adopt the event-driven pattern while microservices are usually responsive to their interfaces. In addition, serverless computing is more suitable for short-lived and bursty applications because its platforms provide high and automatic scalability, while microservices are suited for long-running and stable applications. Serverless computing is an emerging and potential cloud computing paradigm, and its significant advantage is to free software developers from the burden of complex and error-prone server management tasks. Serverless computing provides “Backend as a Service” (BaaS) and “Function as a Service” (FaaS) [120], as shown in Fig. 2. Specifically, BaaS represents tailor-made cloud services provided by cloud providers, e.g., cloud storage and notification services. These services can service FaaS optionally to simplify the backend functionality development for software developers. FaaS represents that software developers can write stateless, event-driven serverless functions, making them focus on the logic of serverless applications. Generally, FaaS is the core of serverless computing, allowing developers to develop and control their applications. To better understand serverless computing, we introduce its key characteristics as follows. • Functionality and no operations (NoOps): In serverless platforms, software developers can select their most appropriate and familiar languages (e.g., Python, JavaScript, and Java) to write the function-level code snippet to create serverless applications. Moreover, serverless platforms provide user-friendly integrated development environments (IDEs). For the deployment of serverless applications, software developers only need to upload their application code to the serverless platform without complex environment configuration. In addition, BaaS is the equivalent of off-the-shelf backend functionality. Its related services can be directly applied in the application by developers to replace similar backend functionalities. Therefore, developers do not have to redevelop these functionalities and deal with server configurations. Auto-scaling: Serverless platforms can automatically scale function instances horizontally and vertically according to the application workload dynamics. Horizontal scaling is to launch (i.e., scale-in) new function instances or recycle (i.e., scale-out) running ones, while vertical scaling is to add (i.e., scale-up) or remove (i.e., scale-down) the amount of computation and other resources from running function instances. After completing requests, the corresponding function instances and allocated resources will retain in memory for a short time to prepare to be reused by subsequent requests of the same function. If there are no subsequent requests, these instances and resources will be automatically recycled by the serverless platform, i.e., scaling to zero. However, scaling to zero makes incoming new requests face the cold start problem, which takes a long time to prepare required runtime environments from scratch. • Utilization-based billing: In serverless computing, software developers charge for the actually allocated or consumed resources of the serverless application in the fine-granular execution unit. For example, AWS Lambda’s pricing is related to the allocated memory, and Azure Functions considers the consumed memory. On the other hand, serverless functions are event-driven; thus, they will not run without being triggered, and developers do not pay any cost. This feature eliminates the concern of paying for idle resources. In summary, the billing pattern of serverless computing is relatively reasonable and inexpensive compared with traditional cloud computing, which requires always renting and paying resources in memory on standby. Separation of computation and storage: Serverless computing adopts the separation way of computation and storage, i.e., separately scaling and independently provisioning and pricing. Generally, computation refers to stateless serverless functions, while storage represents cloud storage services provided by cloud providers to store data from the serverless function. This separation way can ensure the auto-scaling ability of the serverless platform for bursty workloads. • Additional limitations: Cloud providers set some additional limitations for serverless functions to keep the vital auto-scaling feature of serverless platforms. Generally, these limitations contain function execution timeout, deployment package size, local disk size, memory allocation maximum, etc. Moreover, different serverless platforms have different demands regarding these additional limitations. The above key characteristics show the unique advantages of serverless computing. In addition, some features and limitations will also essentially influence the development of cloud-based applications. ",Internet/Technology,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","explain the pros and cons of the three different medications for opioid use disorder, in plain language, for someone who is not a medical person","Methadone Methadone is a slow-acting opioid agonist indicated in the treatment of OUD and opioid withdrawal management. Although methadone is only available through approved opioid treatment programs, federal and state laws allow take-home doses for select patients who have demonstrated treatment progress [14, 15]. Methadone treatment aims to suppress opioid withdrawal, block the effects of illicit opioids, reduce opioid craving, and facilitate patient engagement in psychosocial and nonpharmacological interventions. Methadone treatment has shown superiority over abstinence-based approaches [16]. While methadone is a frequently utilized medication in MAT, both patients and providers should be aware of the potential risks associated with treatment. Methadone treatment increases the risk of arrhythmias including QT interval prolongation and torsades des pointes [17, 18]. Obtaining a history of structural heart disease, arrhythmia, syncope, and other risk factors for QT interval prolongation is critical before starting treatment. Methadone also presents with numerous drug-drug interactions due to cytochrome P450 isoenzymes involved in its metabolism. MAT providers should closely monitor for interactions that could potentiate or synergize methadone’s effects on a patient. Methadone is safe for use in pregnant patients [14, 15]. Practice guidelines published by the American Society of Addiction Medicine (ASAM) Methadone Action Group [14, 15] recommend an initial dose range from 10 mg to 30 mg, reassessing every 2–4 h when peak levels are reached. Following an initiation period, methadone dosing is based on the goals of treatment and patient dependence. Less than 30 mg per day can lessen acute withdrawal but is not as effective in suppressing cravings. Most patients fare better if their initial 30 mg to 40 mg per-day dose is gradually increased to a 60 mg to 120 mg per day maintenance dose. Randomized trials have shown that patients demonstrate better retention in treatment with higher doses of 80–100 mg per day [19, 20]. A dose-response effect is observed for methadone treatment retention rates [21, 22]. Doses above 120 mg per day are utilized with select patients due to the increased purity of heroin and the strength of prescription opioids resulting in increased difficulty to block opioid effects. The optimal length of treatment is not well established; however, relapse rates are highest for patients who drop out [14, 15]. Naltrexone Naltrexone is a long-acting, full opioid antagonist. Like buprenorphine, naltrexone can be prescribed in the outpatient setting for OUD. Unlike buprenorphine, naltrexone can also be prescribed outpatient for alcohol use disorder treatment [14, 15]. Both formulations, oral and extended-release (ER) injectable, have demonstrated treatment efficacy; however, oral naltrexone is not recommended except under limited circumstances because retention in depot naltrexone is better than usually observed in studies utilizing oral naltrexone [23]. Trials are often limited due to high dropout rates and poor adherence [14, 15]. Adding an agent that improves dopaminergic function to complement naltrexone is a novel approach being studied to encourage adherence [24]. Treatment goals include prevention of relapse, inhibition of illicit opioid effects, opioid craving reduction, and the facilitation of patient engagement in psychosocial and nonpharmacological interventions [14, 15]. Oral naltrexone is best for those who can be closely supervised and are highly motivated because it has high rates of nonadherence and a high risk for overdose upon relapse [23]. ER injectable naltrexone is most effective for patients who have failed other MAT options or are unable to obtain agonist treatment. Both formulations are generally well tolerated; however, patients should be cautioned regarding the high-risk opioid overdose with subsequent relapse due to diminished tolerance and heightened sensitivity [14, 15]. Before naltrexone administration, the patient must be adequately detoxified from opioids with no physical dependence. A naloxone challenge can be utilized when uncertain of detoxification, monitoring for signs and symptoms of withdrawal. Oral naltrexone can be dosed at 50 mg daily or three times weekly with two 100 mg doses followed by one 150 mg dose. ER injectable naltrexone can be given every 3–4 weeks by deep intramuscular injection in the gluteal muscle at a set dosage of 380 mg per injection [14, 15]. Naltrexone ER is associated with side effects such as insomnia, clinically insignificant elevation of transaminases, hypertension, naso-pharyngitis, and influenza [25]. Although naltrexone does not reduce respiratory drive, relapse with high-dose opioids may result in accidental overdose death due to diminished opioid tolerance. Unlike methadone and buprenorphine, naltrexone ER is not recommended for use in pregnant or breastfeeding women [14, 15]. Buprenorphine Buprenorphine is a partial opioid agonist utilized to treat OUD [26]. Buprenorphine has the ability to relieve a patient’s drug cravings while maintaining a higher safety profile than other MAT medications. Due to buprenorphine’s “ceiling effect,” increasing dosages will not cause equally increasing respiratory depression in patients [27]. As such, buprenorphine is less likely to cause fatal respiratory depression during overdose [28, 29]. Caution should be applied when combining buprenorphine with other sedative medications, potentially causing higher levels of sedation. Buprenorphine, like methadone, is safe for use in pregnant patients [14, 15]. It demonstrates less peak-dosing suppression of fetal heart rate and less severe neonatal abstinence syndrome than methadone [25]. A critical distinction of buprenorphine therapy is its ability for outpatient prescription following the Drug Addiction Treatment Act (DATA) of 2000 [30]. Any physician can prescribe buprenorphine following completion of an online training course. This distinction can increase access to MAT in otherwise inaccessible patient populations. Following a closely monitored initiation phase, dosing is usually 2 mg to 4 mg to reduce the risk of precipitating withdrawal [14, 15]. If well tolerated, the dose can be increased fairly rapidly to a dose that provides stable effects for 24 h and is effective, with evidence suggesting that doses of 16 mg and greater may be more effective at suppressing illicit opioid use [23]. The FDA recommendation limits dosing to 24 mg per day because higher doses may increase diversion risk [14, 15]. Retention on buprenorphine across low (2 mg–6 mg per day), medium (7 mg–15 mg per day), and high (≥16 mg per day) doses is significantly superior to placebo [31]. However, only high-dose buprenorphine reduces opioid use significantly compared to placebo [32]. Buprenorphine can also be administered with naloxone as a single-dose tablet or buccal film [14, 15]. The goal of combining naloxone, an opioid antagonist, with buprenorphine is to discourage buprenorphine abuse. If the buprenorphine/naloxone product is crushed for the purpose of injection, naloxone will antagonize the agonistic effects of buprenorphine [33]. The FDA recently approved several new buprenorphine formulations for the treatment of OUD, including an ER injection, but data regarding their effectiveness are limited [14, 15]. Some emergency departments are now initiating buprenorphine therapy to patients experiencing withdrawal symptoms [34]. This new strategy has demonstrated promising results toward improving rates of MAT initiation, and its expansion is likely to continue over time [34, 35]. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends appropriate counseling and social support programs for patients receiving buprenorphine therapy [36] “Group-based” buprenorphine treatments have gained interest since their inception, providing both buprenorphine prescription and group counseling together in a destigmatized environment. This model also increases the number of patients that a single physician could treat, addressing areas with limited access to MAT providers [37]. Some studies have suggested possible benefits of this treatment model [38, 39], particularly in prolonging treatment retention. Despite these advantages, the available supporting research has been limited and varied [38]. A 2017 literature review [39] examined 10 studies, 4 of which utilized small-group models and 6 of which utilized group psychotherapy. The authors concluded that there was limited evidence to support group-based buprenorphine therapy but that much of the literature available was either weak or potentially biased. Based on the limited research available and isolated reports of success, this practice has some feasibility and expands buprenorphine access for patients.","""================ ======= Methadone Methadone is a slow-acting opioid agonist indicated in the treatment of OUD and opioid withdrawal management. Although methadone is only available through approved opioid treatment programs, federal and state laws allow take-home doses for select patients who have demonstrated treatment progress [14, 15]. Methadone treatment aims to suppress opioid withdrawal, block the effects of illicit opioids, reduce opioid craving, and facilitate patient engagement in psychosocial and nonpharmacological interventions. Methadone treatment has shown superiority over abstinence-based approaches [16]. While methadone is a frequently utilized medication in MAT, both patients and providers should be aware of the potential risks associated with treatment. Methadone treatment increases the risk of arrhythmias including QT interval prolongation and torsades des pointes [17, 18]. Obtaining a history of structural heart disease, arrhythmia, syncope, and other risk factors for QT interval prolongation is critical before starting treatment. Methadone also presents with numerous drug-drug interactions due to cytochrome P450 isoenzymes involved in its metabolism. MAT providers should closely monitor for interactions that could potentiate or synergize methadone’s effects on a patient. Methadone is safe for use in pregnant patients [14, 15]. Practice guidelines published by the American Society of Addiction Medicine (ASAM) Methadone Action Group [14, 15] recommend an initial dose range from 10 mg to 30 mg, reassessing every 2–4 h when peak levels are reached. Following an initiation period, methadone dosing is based on the goals of treatment and patient dependence. Less than 30 mg per day can lessen acute withdrawal but is not as effective in suppressing cravings. Most patients fare better if their initial 30 mg to 40 mg per-day dose is gradually increased to a 60 mg to 120 mg per day maintenance dose. Randomized trials have shown that patients demonstrate better retention in treatment with higher doses of 80–100 mg per day [19, 20]. A dose-response effect is observed for methadone treatment retention rates [21, 22]. Doses above 120 mg per day are utilized with select patients due to the increased purity of heroin and the strength of prescription opioids resulting in increased difficulty to block opioid effects. The optimal length of treatment is not well established; however, relapse rates are highest for patients who drop out [14, 15]. Naltrexone Naltrexone is a long-acting, full opioid antagonist. Like buprenorphine, naltrexone can be prescribed in the outpatient setting for OUD. Unlike buprenorphine, naltrexone can also be prescribed outpatient for alcohol use disorder treatment [14, 15]. Both formulations, oral and extended-release (ER) injectable, have demonstrated treatment efficacy; however, oral naltrexone is not recommended except under limited circumstances because retention in depot naltrexone is better than usually observed in studies utilizing oral naltrexone [23]. Trials are often limited due to high dropout rates and poor adherence [14, 15]. Adding an agent that improves dopaminergic function to complement naltrexone is a novel approach being studied to encourage adherence [24]. Treatment goals include prevention of relapse, inhibition of illicit opioid effects, opioid craving reduction, and the facilitation of patient engagement in psychosocial and nonpharmacological interventions [14, 15]. Oral naltrexone is best for those who can be closely supervised and are highly motivated because it has high rates of nonadherence and a high risk for overdose upon relapse [23]. ER injectable naltrexone is most effective for patients who have failed other MAT options or are unable to obtain agonist treatment. Both formulations are generally well tolerated; however, patients should be cautioned regarding the high-risk opioid overdose with subsequent relapse due to diminished tolerance and heightened sensitivity [14, 15]. Before naltrexone administration, the patient must be adequately detoxified from opioids with no physical dependence. A naloxone challenge can be utilized when uncertain of detoxification, monitoring for signs and symptoms of withdrawal. Oral naltrexone can be dosed at 50 mg daily or three times weekly with two 100 mg doses followed by one 150 mg dose. ER injectable naltrexone can be given every 3–4 weeks by deep intramuscular injection in the gluteal muscle at a set dosage of 380 mg per injection [14, 15]. Naltrexone ER is associated with side effects such as insomnia, clinically insignificant elevation of transaminases, hypertension, naso-pharyngitis, and influenza [25]. Although naltrexone does not reduce respiratory drive, relapse with high-dose opioids may result in accidental overdose death due to diminished opioid tolerance. Unlike methadone and buprenorphine, naltrexone ER is not recommended for use in pregnant or breastfeeding women [14, 15]. Buprenorphine Buprenorphine is a partial opioid agonist utilized to treat OUD [26]. Buprenorphine has the ability to relieve a patient’s drug cravings while maintaining a higher safety profile than other MAT medications. Due to buprenorphine’s “ceiling effect,” increasing dosages will not cause equally increasing respiratory depression in patients [27]. As such, buprenorphine is less likely to cause fatal respiratory depression during overdose [28, 29]. Caution should be applied when combining buprenorphine with other sedative medications, potentially causing higher levels of sedation. Buprenorphine, like methadone, is safe for use in pregnant patients [14, 15]. It demonstrates less peak-dosing suppression of fetal heart rate and less severe neonatal abstinence syndrome than methadone [25]. A critical distinction of buprenorphine therapy is its ability for outpatient prescription following the Drug Addiction Treatment Act (DATA) of 2000 [30]. Any physician can prescribe buprenorphine following completion of an online training course. This distinction can increase access to MAT in otherwise inaccessible patient populations. Following a closely monitored initiation phase, dosing is usually 2 mg to 4 mg to reduce the risk of precipitating withdrawal [14, 15]. If well tolerated, the dose can be increased fairly rapidly to a dose that provides stable effects for 24 h and is effective, with evidence suggesting that doses of 16 mg and greater may be more effective at suppressing illicit opioid use [23]. The FDA recommendation limits dosing to 24 mg per day because higher doses may increase diversion risk [14, 15]. Retention on buprenorphine across low (2 mg–6 mg per day), medium (7 mg–15 mg per day), and high (≥16 mg per day) doses is significantly superior to placebo [31]. However, only high-dose buprenorphine reduces opioid use significantly compared to placebo [32]. Buprenorphine can also be administered with naloxone as a single-dose tablet or buccal film [14, 15]. The goal of combining naloxone, an opioid antagonist, with buprenorphine is to discourage buprenorphine abuse. If the buprenorphine/naloxone product is crushed for the purpose of injection, naloxone will antagonize the agonistic effects of buprenorphine [33]. The FDA recently approved several new buprenorphine formulations for the treatment of OUD, including an ER injection, but data regarding their effectiveness are limited [14, 15]. Some emergency departments are now initiating buprenorphine therapy to patients experiencing withdrawal symptoms [34]. This new strategy has demonstrated promising results toward improving rates of MAT initiation, and its expansion is likely to continue over time [34, 35]. The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends appropriate counseling and social support programs for patients receiving buprenorphine therapy [36] “Group-based” buprenorphine treatments have gained interest since their inception, providing both buprenorphine prescription and group counseling together in a destigmatized environment. This model also increases the number of patients that a single physician could treat, addressing areas with limited access to MAT providers [37]. Some studies have suggested possible benefits of this treatment model [38, 39], particularly in prolonging treatment retention. Despite these advantages, the available supporting research has been limited and varied [38]. A 2017 literature review [39] examined 10 studies, 4 of which utilized small-group models and 6 of which utilized group psychotherapy. The authors concluded that there was limited evidence to support group-based buprenorphine therapy but that much of the literature available was either weak or potentially biased. Based on the limited research available and isolated reports of success, this practice has some feasibility and expands buprenorphine access for patients. https://pubmed.ncbi.nlm.nih.gov/35285220/ ================ ======= explain the pros and cons of the three different medications for opioid use disorder, in plain language, for someone who is not a medical person ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Pros & Cons,Q&A Respond to questions or requests using only the information contained in the text that is provided to you.,Summarize and list the cases used to support the policy in this document in chronological order.,"Attorney Fees The Freedom of Information Act is one of more than a hundred different federal statutes that contain a ""fee-shifting"" provision permitting the trial court to award reasonable attorney fees and litigation costs to a plaintiff who has ""substantially prevailed.""1 The FOIA's attorney fees provision requires courts to engage in a two-step substantive inquiry. The court must determine first if the plaintiff is eligible for an award of fees and/or costs and it must then determine if the plaintiff is entitled to the award.2 Even if a plaintiff meets both of these tests, the award of fees and costs is entirely within the discretion of the court.3 Threshold Issues The FOIA's attorney fees provision limits an award to fees and costs incurred in litigating a case brought pursuant to the FOIA;4 accordingly, fees and other costs are generally 1 5 U.S.C. § 552(a)(4)(E)(i) (2006), amended by OPEN Government Act of 2007, Pub. L. No. 110-175, 121 Stat. 2524. 2 See, e.g., Tax Analysts v. DOJ, 965 F.2d 1092, 1093 (D.C. Cir. 1992); Church of Scientology v. USPS, 700 F.2d 486, 489 (9th Cir. 1983); see also Wheeler v. IRS, 37 F. Supp. 2d 407, 411 n.1 (W.D. Pa. 1998) (""The test for whether the court should award a FOIA plaintiff litigation costs is the same as the test for whether attorney fees should be awarded.""). 3 See, e.g., Lissner v. U.S. Customs Serv., 56 F. App'x 330, 331 (9th Cir. 2002) (stating that review of attorney fee award is for abuse of discretion); Anderson v. HHS, 80 F.3d 1500, 1504 (10th Cir. 1996) (""Assessment of attorney's fees in an FOIA case is discretionary with the district court.""); Detroit Free Press, Inc. v. DOJ, 73 F.3d 93, 98 (6th Cir. 1996) (""We review the court's determination [to grant fees] for an abuse of discretion.""); Young v. Dir., No. 92-2561, 1993 WL 305970, at *2 (4th Cir. 1993) (noting that court has discretion to deny fees even if eligibility threshold is met); Maynard v. CIA, 986 F.2d 547, 567 (1st Cir. 1993) (holding that a decision on whether to award attorney fees ""will be reversed only for an abuse of . . . discretion""); Tax Analysts, 965 F.2d at 1094 (""sifting of those [fee] criteria over the facts of a case is a matter of district court discretion""); Hersh & Hersh v. HHS, No. 06-4234, 2008 WL 2725497, at *1 (N.D. Cal. July 10, 2008) (""If a plaintiff demonstrates eligibility for fees, the district court may then, in the exercise of its discretion, determine that the plaintiff is entitled to an award of fees and costs.""); Bangor Hydro-Elec. Co. v. U.S. Dep't of the Interior, 903 F. Supp. 160, 170 (D. Me. 1995) (""Awards of litigation costs and attorney fees under FOIA are left to the sound discretion of the trial court.""). 4 See Nichols v. Pierce, 740 F.2d 1249, 1252-54 (D.C. Cir. 1984) (refusing to award fees for (continued...) not awarded for services rendered at the administrative level.5 Furthermore, the Court of Appeals for the District of Columbia Circuit has held that FOIA litigation costs related to disputes with third parties, ""who are not within the government's authority or control, with respect to litigation issues that were neither raised nor pursued by the government, cannot form the basis of a fee award under 5 U.S.C. § 552(a)(4)(E).""6 A threshold eligibility matter concerns precisely who can qualify for an award of attorney fees. The D.C. Circuit has found that the Supreme Court's decision in Kay v. Ehrler7 establishes that subsection (a)(4)(E)(i) of the FOIA does not authorize the award of fees to a pro se non-attorney plaintiff, because ""the word 'attorney,' when used in the context of a feeshifting statute, does not encompass a layperson proceeding on his own behalf.""8 In order to 4 (...continued) plaintiff's success under Administrative Procedure Act, 5 U.S.C. §§ 701-706 (2006), resulting in order to agency to issue regulations, despite plaintiff's claim of victory under FOIA subsection (a)(1)), because Complaint failed to assert claim under or rely specifically on FOIA). 5 See AutoAlliance Int'l, Inc. v. U.S. Customs Serv., No. 02-72369, slip op. at 3 (E.D. Mich. Mar. 23, 2004) (denying attorney fees for time spent on ""administrative appeals that should have been completed prior to filing suit""); Inst. for Wildlife Prot. v. U.S. Fish & Wildlife Serv., No. 02-6178, slip op. at 6 (D. Or. Dec. 3, 2003) (deducting hours spent on FOIA administrative process for fee-calculation purposes); Nw. Coal. for Alternatives to Pesticides v. Browner, 965 F. Supp. 59, 65 (D.D.C. 1997) (""FOIA does not authorize fees for work performed at the administrative stage.""); Associated Gen. Contractors v. EPA, 488 F. Supp. 861, 864 (D. Nev. 1980) (concluding that attorney fees are unavailable for work performed at administrative level); cf. Kennedy v. Andrus, 459 F. Supp. 240, 244 (D.D.C. 1978) (rejecting attorney fees claim for services rendered at administrative level under Privacy Act, 5 U.S.C. § 552a (2006)), aff'd, 612 F.2d 586 (D.C. Cir. 1980) (unpublished table decision). But see Or. Natural Desert Ass'n v. Gutierrez, 442 F. Supp. 2d 1096, 1101 (D. Or. 2006) (awarding fees for work performed at the administrative level, on the rationale that ""exhaustion of remedies is required and provides a sufficient record for the civil action"") (appeal pending); McCoy v. BOP, No. 03-383, 2005 WL 1972600, at *4 (E.D. Ky. Aug. 16, 2005) (permitting fees for work on plaintiff's administrative appeal, on the rationale that it ""was necessary to exhaust administrative remedies""), reconsideration denied, No. 03-383 (E.D. Ky. Oct. 6, 2005); cf. Tule River Conservancy v. U.S. Forest Serv., No. 97-5720, slip op. at 16-17 (E.D. Cal. Sept. 12, 2000) (allowing attorney fees for pre-litigation research on ""how to exhaust [plaintiff's] administration remedies prior to filing suit"" and on ""how to file FOIA complaint""). 6 Judicial Watch, Inc. v. U.S. Dep't of Commerce, 470 F.3d 363, 373 (D.C. Cir. 2006). 7 499 U.S. 432 (1991). 8 Benavides v. BOP, 993 F.2d 257, 259 (D.C. Cir. 1993) (explaining Kay decision); see Bensman v. U.S. Fish & Wildlife Serv., 49 F. App'x 646, 647 (7th Cir. 2002) (""Even when a pro se litigant performs the same tasks as an attorney, he is not entitled to reimbursement for his time.""); Sukup v. EOUSA, No. 02-0355, 2007 WL 2405716, at *1 (D.D.C. Aug. 23, 2007) (""Pro se plaintiffs may not recover attorney's fees under the FOIA.""); Deichman v. United States, No. 2:05cv680, 2006 WL 3000448, at *7 (E.D. Va. Oct. 20, 2006) (holding that pro see litigant cannot (continued...) be eligible for attorney fees, therefore, a FOIA plaintiff must have a representational relationship with an attorney.9 Furthermore, Kay indicated that no award of attorney fees should be made to a pro se plaintiff who also is an attorney. 10 Because the fee-shifting provision of the FOIA was intended ""'to encourage potential claimants to seek legal advice before commencing litigation,'""11 and because a pro se attorney, by definition, does not seek out the ""'detached and objective perspective necessary'"" to litigate his FOIA case,12 the overwhelming majority of courts have agreed with Kay and have held that a pro se attorney is not eligible for a fee award that otherwise would have had to be paid to counsel.13 This is particularly so because 8 (...continued) recover attorney fees under FOIA); Lair v. Dep't of the Treasury, No. 03-827, 2005 WL 645228, at *6 (D.D.C. Mar. 21, 2005) (explaining that ""pro-se non-attorney . . . may not collect attorney fees"" (citing Benavides)), reconsideration denied, 2005 WL 1330722 (D.D.C. June 3, 2005). 9 See Kooritzky v. Herman, 178 F.3d 1315, 1323 (D.C. Cir. 1999) (holding that for all similarly worded fee-shifting statutes, ""the term 'attorney' contemplates an agency relationship between a litigant and an independent lawyer""); see also Blazy v. Tenet, 194 F.3d 90, 94 (D.C. Cir. 1999) (concluding that attorney need not file formal appearance in order for litigant to claim fees for consultations, so long as attorney-client relationship existed) (Privacy Act case); cf. Anderson v. U.S. Dep't of the Treasury, 648 F.2d 1, 3 (D.C. Cir. 1979) (indicating that when an organization litigates through in-house counsel, any payable attorney fees should not ""exceed[] the expenses incurred by [that party] in terms of [in-house counsel] salaries and other out-of-pocket expenses""). ","Respond to questions or requests using only the information contained in the text that is provided to you. Summarize and list the cases used to support the policy in this document in chronological order. Attorney Fees The Freedom of Information Act is one of more than a hundred different federal statutes that contain a ""fee-shifting"" provision permitting the trial court to award reasonable attorney fees and litigation costs to a plaintiff who has ""substantially prevailed.""1 The FOIA's attorney fees provision requires courts to engage in a two-step substantive inquiry. The court must determine first if the plaintiff is eligible for an award of fees and/or costs and it must then determine if the plaintiff is entitled to the award.2 Even if a plaintiff meets both of these tests, the award of fees and costs is entirely within the discretion of the court.3 Threshold Issues The FOIA's attorney fees provision limits an award to fees and costs incurred in litigating a case brought pursuant to the FOIA;4 accordingly, fees and other costs are generally 1 5 U.S.C. § 552(a)(4)(E)(i) (2006), amended by OPEN Government Act of 2007, Pub. L. No. 110-175, 121 Stat. 2524. 2 See, e.g., Tax Analysts v. DOJ, 965 F.2d 1092, 1093 (D.C. Cir. 1992); Church of Scientology v. USPS, 700 F.2d 486, 489 (9th Cir. 1983); see also Wheeler v. IRS, 37 F. Supp. 2d 407, 411 n.1 (W.D. Pa. 1998) (""The test for whether the court should award a FOIA plaintiff litigation costs is the same as the test for whether attorney fees should be awarded.""). 3 See, e.g., Lissner v. U.S. Customs Serv., 56 F. App'x 330, 331 (9th Cir. 2002) (stating that review of attorney fee award is for abuse of discretion); Anderson v. HHS, 80 F.3d 1500, 1504 (10th Cir. 1996) (""Assessment of attorney's fees in an FOIA case is discretionary with the district court.""); Detroit Free Press, Inc. v. DOJ, 73 F.3d 93, 98 (6th Cir. 1996) (""We review the court's determination [to grant fees] for an abuse of discretion.""); Young v. Dir., No. 92-2561, 1993 WL 305970, at *2 (4th Cir. 1993) (noting that court has discretion to deny fees even if eligibility threshold is met); Maynard v. CIA, 986 F.2d 547, 567 (1st Cir. 1993) (holding that a decision on whether to award attorney fees ""will be reversed only for an abuse of . . . discretion""); Tax Analysts, 965 F.2d at 1094 (""sifting of those [fee] criteria over the facts of a case is a matter of district court discretion""); Hersh & Hersh v. HHS, No. 06-4234, 2008 WL 2725497, at *1 (N.D. Cal. July 10, 2008) (""If a plaintiff demonstrates eligibility for fees, the district court may then, in the exercise of its discretion, determine that the plaintiff is entitled to an award of fees and costs.""); Bangor Hydro-Elec. Co. v. U.S. Dep't of the Interior, 903 F. Supp. 160, 170 (D. Me. 1995) (""Awards of litigation costs and attorney fees under FOIA are left to the sound discretion of the trial court.""). 4 See Nichols v. Pierce, 740 F.2d 1249, 1252-54 (D.C. Cir. 1984) (refusing to award fees for (continued...) not awarded for services rendered at the administrative level.5 Furthermore, the Court of Appeals for the District of Columbia Circuit has held that FOIA litigation costs related to disputes with third parties, ""who are not within the government's authority or control, with respect to litigation issues that were neither raised nor pursued by the government, cannot form the basis of a fee award under 5 U.S.C. § 552(a)(4)(E).""6 A threshold eligibility matter concerns precisely who can qualify for an award of attorney fees. The D.C. Circuit has found that the Supreme Court's decision in Kay v. Ehrler7 establishes that subsection (a)(4)(E)(i) of the FOIA does not authorize the award of fees to a pro se non-attorney plaintiff, because ""the word 'attorney,' when used in the context of a feeshifting statute, does not encompass a layperson proceeding on his own behalf.""8 In order to 4 (...continued) plaintiff's success under Administrative Procedure Act, 5 U.S.C. §§ 701-706 (2006), resulting in order to agency to issue regulations, despite plaintiff's claim of victory under FOIA subsection (a)(1)), because Complaint failed to assert claim under or rely specifically on FOIA). 5 See AutoAlliance Int'l, Inc. v. U.S. Customs Serv., No. 02-72369, slip op. at 3 (E.D. Mich. Mar. 23, 2004) (denying attorney fees for time spent on ""administrative appeals that should have been completed prior to filing suit""); Inst. for Wildlife Prot. v. U.S. Fish & Wildlife Serv., No. 02-6178, slip op. at 6 (D. Or. Dec. 3, 2003) (deducting hours spent on FOIA administrative process for fee-calculation purposes); Nw. Coal. for Alternatives to Pesticides v. Browner, 965 F. Supp. 59, 65 (D.D.C. 1997) (""FOIA does not authorize fees for work performed at the administrative stage.""); Associated Gen. Contractors v. EPA, 488 F. Supp. 861, 864 (D. Nev. 1980) (concluding that attorney fees are unavailable for work performed at administrative level); cf. Kennedy v. Andrus, 459 F. Supp. 240, 244 (D.D.C. 1978) (rejecting attorney fees claim for services rendered at administrative level under Privacy Act, 5 U.S.C. § 552a (2006)), aff'd, 612 F.2d 586 (D.C. Cir. 1980) (unpublished table decision). But see Or. Natural Desert Ass'n v. Gutierrez, 442 F. Supp. 2d 1096, 1101 (D. Or. 2006) (awarding fees for work performed at the administrative level, on the rationale that ""exhaustion of remedies is required and provides a sufficient record for the civil action"") (appeal pending); McCoy v. BOP, No. 03-383, 2005 WL 1972600, at *4 (E.D. Ky. Aug. 16, 2005) (permitting fees for work on plaintiff's administrative appeal, on the rationale that it ""was necessary to exhaust administrative remedies""), reconsideration denied, No. 03-383 (E.D. Ky. Oct. 6, 2005); cf. Tule River Conservancy v. U.S. Forest Serv., No. 97-5720, slip op. at 16-17 (E.D. Cal. Sept. 12, 2000) (allowing attorney fees for pre-litigation research on ""how to exhaust [plaintiff's] administration remedies prior to filing suit"" and on ""how to file FOIA complaint""). 6 Judicial Watch, Inc. v. U.S. Dep't of Commerce, 470 F.3d 363, 373 (D.C. Cir. 2006). 7 499 U.S. 432 (1991). 8 Benavides v. BOP, 993 F.2d 257, 259 (D.C. Cir. 1993) (explaining Kay decision); see Bensman v. U.S. Fish & Wildlife Serv., 49 F. App'x 646, 647 (7th Cir. 2002) (""Even when a pro se litigant performs the same tasks as an attorney, he is not entitled to reimbursement for his time.""); Sukup v. EOUSA, No. 02-0355, 2007 WL 2405716, at *1 (D.D.C. Aug. 23, 2007) (""Pro se plaintiffs may not recover attorney's fees under the FOIA.""); Deichman v. United States, No. 2:05cv680, 2006 WL 3000448, at *7 (E.D. Va. Oct. 20, 2006) (holding that pro see litigant cannot (continued...) be eligible for attorney fees, therefore, a FOIA plaintiff must have a representational relationship with an attorney.9 Furthermore, Kay indicated that no award of attorney fees should be made to a pro se plaintiff who also is an attorney. 10 Because the fee-shifting provision of the FOIA was intended ""'to encourage potential claimants to seek legal advice before commencing litigation,'""11 and because a pro se attorney, by definition, does not seek out the ""'detached and objective perspective necessary'"" to litigate his FOIA case,12 the overwhelming majority of courts have agreed with Kay and have held that a pro se attorney is not eligible for a fee award that otherwise would have had to be paid to counsel.13 This is particularly so because 8 (...continued) recover attorney fees under FOIA); Lair v. Dep't of the Treasury, No. 03-827, 2005 WL 645228, at *6 (D.D.C. Mar. 21, 2005) (explaining that ""pro-se non-attorney . . . may not collect attorney fees"" (citing Benavides)), reconsideration denied, 2005 WL 1330722 (D.D.C. June 3, 2005). 9 See Kooritzky v. Herman, 178 F.3d 1315, 1323 (D.C. Cir. 1999) (holding that for all similarly worded fee-shifting statutes, ""the term 'attorney' contemplates an agency relationship between a litigant and an independent lawyer""); see also Blazy v. Tenet, 194 F.3d 90, 94 (D.C. Cir. 1999) (concluding that attorney need not file formal appearance in order for litigant to claim fees for consultations, so long as attorney-client relationship existed) (Privacy Act case); cf. Anderson v. U.S. Dep't of the Treasury, 648 F.2d 1, 3 (D.C. Cir. 1979) (indicating that when an organization litigates through in-house counsel, any payable attorney fees should not ""exceed[] the expenses incurred by [that party] in terms of [in-house counsel] salaries and other out-of-pocket expenses""). ",Legal,Summarize & Format,Text Transformation You are required to answer questions based solely on the information provided in the prompt. You will not use any outside resources or internal knowledge.,What are the risks associated with high interest rates on mortgages?,"Mortgage Classifications Mortgages can be classified into several categories based on their characteristics. The broadest distinction is between government-insured mortgages and conventional mortgages. Government- insured mortgages have mortgage insurance from a government agency, such as FHA, VA, or USDA, whereas conventional mortgages do not have government insurance. As previously noted, this insurance pays the lender if the borrower defaults. Borrowers can also be classified into two broad groups based on their credit history: prime and non-prime. Although there is no single agreed-upon definition, prime borrowers generally have very good credit and are offered more attractive mortgage terms, such as better interest rates, than non-prime borrowers. Non-prime borrowers exhibit one or more factors that make them appear riskier to lenders, such as past credit problems or a lack of complete income and asset documentation. Conventional mortgages can be broken down into two additional groups, conforming and nonconforming mortgages. Conforming loans are loans eligible to be purchased in the secondary market by Fannie Mae and Freddie Mac, two GSEs that are discussed later in this report. To be a conforming loan, the mortgage must meet certain creditworthiness thresholds (such as a minimum credit score) and be less than the “conforming loan limit,” a legal cap on the principal balance of the mortgage that can vary based on the geographic area where the house is located.18 Borrowers with conforming loans are usually prime borrowers. Nonconforming loans can be broken down into three additional categories depending on the reason they are not conforming. First, nonconforming loans above the conforming loan limit are called jumbo loans.19 Second, Alt-A loans are for near-prime borrowers who may have credit problems or who do not have complete documentation for income or assets. Third, subprime loans are generally for the riskiest borrowers; they either have low credit scores, documentation issues, or some other factor that makes them appear to be riskier to lenders. Subprime borrowers are likely to be charged a higher interest rate to compensate the lender for the additional risk.20 Risks Associated with Holding Mortgages When a lender originates a mortgage, it accepts certain risks. The three major risks are credit, prepayment, and funding risk. Credit risk refers to the risk that the lender bears if a borrower does not repay the mortgage on time. 21 Prepayment risk is the risk that a mortgage will be paid off sooner than expected, typically by a borrower refinancing the mortgage or selling the home. This is more likely to happen when interest rates fall, because borrowers are more likely to refinance their mortgages to take advantage of lower interest rates. 22 When a borrower refinances, the lender is paid in full the amount owed, but it now has to reinvest those funds at a time when its expected return on new investments is lower because interest rates have fallen. Although prepayment risk is a risk associated with falling interest rates, there are also risks for lenders that come from rising interest rates. One of these risks, called funding risk, arises because some lenders borrow money in the short term to fund long-term investments, such as 30-year mortgages. Short-term interest rates are typically lower than long-term interest rates because of the additional risk associated with lending money for a longer period of time. Lenders, therefore, can profit from the difference, or spread, between the short-term and long-term rates. If interest rates rise, then the lender will have to borrow funds at a higher interest rate, while still earning the same interest rate on the mortgage. As long as the short-term rate stays below the long-term return, the lender would profit on the difference, although its profits would be lower than if the short-term interest rates had not increased. If short-term rates increase above the fixed return on the mortgage, then the investment would no longer be profitable. Another lender’s risk associated with rising interest rates is opportunity costs. If interest rates rise, but lender’s money is tied up in long-term mortgages made at lower interest rates, then the lender is missing out on higher returns that it could be earning if it were able to originate mortgages or make other investments at the higher current interest rate. The lender that originates a mortgage does not necessarily have to bear all of the associated risks. In some cases, the borrower could bear some of these risks. Adjustable-rate mortgages, for example, transfer the risk that interest rates might rise from the lender to the borrower. Lenders can also sell mortgages to investors, who then bear the risks associated with the mortgage. The market for buying and selling mortgages is called the secondary market, which is described below. The Secondary Market After a lender originates a mortgage loan, the lender has several options. The lender could choose to hold the mortgage in its portfolio or sell it to another entity. Mortgages are bought and sold in the secondary market to domestic and international investors. When a mortgage is sold, the mortgage servicer may change. In any case, the borrower continues to send monthly mortgage payments to the mortgage servicer.23 The servicer remits the payments to the entity that purchased the mortgage. The secondary market plays an important role in providing funding for loans made in the primary market. When a mortgage is sold in the secondary market, the lender can use the proceeds to fund additional new mortgages in the primary market. If the lender holds the mortgage in its portfolio, the lender has fewer available funds to make new mortgages. Furthermore, selling the loan to another entity allows the lender to transfer mortgage lending risks to the buyer. Securitization When a lender sells a mortgage in the secondary market, the new mortgage holder can hold the mortgage as a whole loan. When held as a whole loan, the mortgage is in the portfolio of the new mortgage holder, and the new mortgage holder bears the risks associated with the mortgage. Alternatively, the new mortgage holder may choose to securitize the mortgage instead of holding it as a whole loan.24 Mortgage securitization comes in many different forms, but generally speaking, the process involves a financial institution acquiring and combining (pooling together) many different mortgages and then issuing a mortgage-backed security (MBS). An MBS can be divided into different pieces, or tranches, that are sold to investors.25 The investors do not own the underlying mortgages but are buying the right to receive the future stream of payments that come from those mortgages. A servicer collects the payments of all the borrowers whose mortgages are part of the security and remits the payments to the investors. For investors, purchasing MBS offers several benefits compared with holding whole mortgages. Most notably, an MBS is generally more liquid than whole mortgages, meaning it is easier to quickly sell an MBS at the current price. Because the market for MBS is more liquid than the market for whole mortgages, MBS might be attractive to investors who would not otherwise choose to invest in mortgages. More investors in the mortgage market, in turn, can mean more funding is available for lenders to offer mortgages. More funding available in the primary market, and the existence of a secondary market where lenders know they can easily sell the mortgages they make, can result in lower interest rates that lenders charge to borrowers. Although securitization may have several advantages, it may also present several disadvantages. Securitization—and the secondary market in general—requires additional participants to facilitate the flow of credit than when a loan is held by the originator. Additional participants, with some acting on behalf of others, can increase costs and introduce competing incentives for the various participants and potential conflicts of interest. For example, more participants in the transaction may result in a principal-agent problem, a situation in which one entity (the agent) is supposed to work on behalf of another entity (the principal), but the agent may have an incentive to act in its own best interest rather than in the best interest of the principal. For example, mortgage servicers act on behalf of investors to evaluate a borrower for mortgage workout options or to begin the foreclosure process when a borrower falls behind on mortgage payments, as specified by a contract between the investor and the servicer. However, in some cases, a servicer may have an incentive to choose the option that is in its own best interest rather than in the best interest of the investor, and the investor might not be well positioned to police the servicer’s actions.26","What are the risks associated with high interest rates on mortgages? Mortgage Classifications Mortgages can be classified into several categories based on their characteristics. The broadest distinction is between government-insured mortgages and conventional mortgages. Government- insured mortgages have mortgage insurance from a government agency, such as FHA, VA, or USDA, whereas conventional mortgages do not have government insurance. As previously noted, this insurance pays the lender if the borrower defaults. Borrowers can also be classified into two broad groups based on their credit history: prime and non-prime. Although there is no single agreed-upon definition, prime borrowers generally have very good credit and are offered more attractive mortgage terms, such as better interest rates, than non-prime borrowers. Non-prime borrowers exhibit one or more factors that make them appear riskier to lenders, such as past credit problems or a lack of complete income and asset documentation. Conventional mortgages can be broken down into two additional groups, conforming and nonconforming mortgages. Conforming loans are loans eligible to be purchased in the secondary market by Fannie Mae and Freddie Mac, two GSEs that are discussed later in this report. To be a conforming loan, the mortgage must meet certain creditworthiness thresholds (such as a minimum credit score) and be less than the “conforming loan limit,” a legal cap on the principal balance of the mortgage that can vary based on the geographic area where the house is located.18 Borrowers with conforming loans are usually prime borrowers. Nonconforming loans can be broken down into three additional categories depending on the reason they are not conforming. First, nonconforming loans above the conforming loan limit are called jumbo loans.19 Second, Alt-A loans are for near-prime borrowers who may have credit problems or who do not have complete documentation for income or assets. Third, subprime loans are generally for the riskiest borrowers; they either have low credit scores, documentation issues, or some other factor that makes them appear to be riskier to lenders. Subprime borrowers are likely to be charged a higher interest rate to compensate the lender for the additional risk.20 Risks Associated with Holding Mortgages When a lender originates a mortgage, it accepts certain risks. The three major risks are credit, prepayment, and funding risk. Credit risk refers to the risk that the lender bears if a borrower does not repay the mortgage on time. 21 Prepayment risk is the risk that a mortgage will be paid off sooner than expected, typically by a borrower refinancing the mortgage or selling the home. This is more likely to happen when interest rates fall, because borrowers are more likely to refinance their mortgages to take advantage of lower interest rates. 22 When a borrower refinances, the lender is paid in full the amount owed, but it now has to reinvest those funds at a time when its expected return on new investments is lower because interest rates have fallen. Although prepayment risk is a risk associated with falling interest rates, there are also risks for lenders that come from rising interest rates. One of these risks, called funding risk, arises because some lenders borrow money in the short term to fund long-term investments, such as 30-year mortgages. Short-term interest rates are typically lower than long-term interest rates because of the additional risk associated with lending money for a longer period of time. Lenders, therefore, can profit from the difference, or spread, between the short-term and long-term rates. If interest rates rise, then the lender will have to borrow funds at a higher interest rate, while still earning the same interest rate on the mortgage. As long as the short-term rate stays below the long-term return, the lender would profit on the difference, although its profits would be lower than if the short-term interest rates had not increased. If short-term rates increase above the fixed return on the mortgage, then the investment would no longer be profitable. Another lender’s risk associated with rising interest rates is opportunity costs. If interest rates rise, but lender’s money is tied up in long-term mortgages made at lower interest rates, then the lender is missing out on higher returns that it could be earning if it were able to originate mortgages or make other investments at the higher current interest rate. The lender that originates a mortgage does not necessarily have to bear all of the associated risks. In some cases, the borrower could bear some of these risks. Adjustable-rate mortgages, for example, transfer the risk that interest rates might rise from the lender to the borrower. Lenders can also sell mortgages to investors, who then bear the risks associated with the mortgage. The market for buying and selling mortgages is called the secondary market, which is described below. The Secondary Market After a lender originates a mortgage loan, the lender has several options. The lender could choose to hold the mortgage in its portfolio or sell it to another entity. Mortgages are bought and sold in the secondary market to domestic and international investors. When a mortgage is sold, the mortgage servicer may change. In any case, the borrower continues to send monthly mortgage payments to the mortgage servicer.23 The servicer remits the payments to the entity that purchased the mortgage. The secondary market plays an important role in providing funding for loans made in the primary market. When a mortgage is sold in the secondary market, the lender can use the proceeds to fund additional new mortgages in the primary market. If the lender holds the mortgage in its portfolio, the lender has fewer available funds to make new mortgages. Furthermore, selling the loan to another entity allows the lender to transfer mortgage lending risks to the buyer. Securitization When a lender sells a mortgage in the secondary market, the new mortgage holder can hold the mortgage as a whole loan. When held as a whole loan, the mortgage is in the portfolio of the new mortgage holder, and the new mortgage holder bears the risks associated with the mortgage. Alternatively, the new mortgage holder may choose to securitize the mortgage instead of holding it as a whole loan.24 Mortgage securitization comes in many different forms, but generally speaking, the process involves a financial institution acquiring and combining (pooling together) many different mortgages and then issuing a mortgage-backed security (MBS). An MBS can be divided into different pieces, or tranches, that are sold to investors.25 The investors do not own the underlying mortgages but are buying the right to receive the future stream of payments that come from those mortgages. A servicer collects the payments of all the borrowers whose mortgages are part of the security and remits the payments to the investors. For investors, purchasing MBS offers several benefits compared with holding whole mortgages. Most notably, an MBS is generally more liquid than whole mortgages, meaning it is easier to quickly sell an MBS at the current price. Because the market for MBS is more liquid than the market for whole mortgages, MBS might be attractive to investors who would not otherwise choose to invest in mortgages. More investors in the mortgage market, in turn, can mean more funding is available for lenders to offer mortgages. More funding available in the primary market, and the existence of a secondary market where lenders know they can easily sell the mortgages they make, can result in lower interest rates that lenders charge to borrowers. Although securitization may have several advantages, it may also present several disadvantages. Securitization—and the secondary market in general—requires additional participants to facilitate the flow of credit than when a loan is held by the originator. Additional participants, with some acting on behalf of others, can increase costs and introduce competing incentives for the various participants and potential conflicts of interest. For example, more participants in the transaction may result in a principal-agent problem, a situation in which one entity (the agent) is supposed to work on behalf of another entity (the principal), but the agent may have an incentive to act in its own best interest rather than in the best interest of the principal. For example, mortgage servicers act on behalf of investors to evaluate a borrower for mortgage workout options or to begin the foreclosure process when a borrower falls behind on mortgage payments, as specified by a contract between the investor and the servicer. However, in some cases, a servicer may have an incentive to choose the option that is in its own best interest rather than in the best interest of the investor, and the investor might not be well positioned to police the servicer’s actions.26 You are required to answer questions based solely on the information provided in the prompt. You will not use any outside resources or internal knowledge.",Financial,Fact Finding,Q&A "Answer the question using only information gathered from the prompt. Every time you name an animal, capitalize it.","For each animal mentioned in the document, summarize the text pertaining to it.","Hatchery Salmon Naturally spawned fish are genetically diverse and therefore considered to be more vigorous than the genetically more similar hatchery fish. Consequently, agency scientists have distinguished between hatchery-raised and wild salmon to maximize production of the latter. Over the years, these distinctions have been controversial in several respects. In 1993 NMFS issued its Interim Hatchery Listing Policy on how to consider hatchery fish in listing determinations for Pacific salmon and steelhead species. The interim policy concluded that hatchery fish could be in the same evolutionarily significant unit (ESU) as wild fish.20 Eventually, a federal court found that the interim policy violated the ESA by listing below the species level. The court found that if hatchery and wild salmon were in the same ESU, they should not have different listing status.21 NMFS revised the policy to reflect the court’s decision. The final hatchery listing policy (HLP) was released four years later, in 2005.22 The HLP requires NMFS to consider the status of the ESU as a whole, rather than the status of only the wild fish within the ESU, when determining whether to list the species. It also provides that the entire ESU would be listed, rather than just the wild fish. Two suits were filed in two different district courts. One suit challenged how the HLP affected steelhead trout. Two types of groups sued in the steelhead case: groups that wanted wild fish considered as distinct from hatchery fish, and groups that wanted to require NMFS to make no distinction between the origins of fish. The court found the HLP was invalid because it was not based on the best available scientific data.23 The court found the HLP undermined a fundamental purpose of the ESA—to preserve natural, self-sustaining populations. The court further found it scientifically questionable whether risk assessment criteria developed by NMFS for making status determinations could be applied to fish populations that included both hatchery and wild fish, since the criteria were designed to be applied only to wild fish. NMFS’s downlisting of steelhead from endangered to threatened by applying the HLP was ruled invalid. But the court upheld the NMFS decision to include hatchery and wild fish in the same ESU. The Ninth Circuit Court of Appeals upheld only a portion of the steelhead decision.24 The appellate court distinguished between the two steps of the listing process: defining the species, and then determining whether the species should be listed. The Ninth Circuit agreed with NMFS that the effects of hatchery fish on wild fish could be considered at the listing phase, not the definitional stage. The court gave discretion to NMFS’s science, although it noted that there may not be scientific consensus regarding the threat hatchery fish pose to wild fish. The appellate court reversed the lower court’s holding that downlisting the fish was invalid, finding that hatchery fish did not necessarily put wild fish at risk. A second suit was based on how the HLP affected salmon. In this case, the court held that NMFS properly considered hatchery and wild fish as having different extinction risks in its listing decision.25 The court rejected the plaintiffs’ argument that special regulations regarding taking salmon had to apply uniformly to hatchery and wild fish. The Ninth Circuit Court affirmed the lower court’s decision.26 Steller Sea Lions The western population of Steller sea lions was listed in 1990 as endangered under the ESA, and their abundance has been declining for several decades. 27 Starting in late 1998, NMFS prepared three biological opinions28 that were based on the hypothesis that intense fishing for pollock, Pacific cod, and Atka mackerel off Alaska was causing localized depletion of these fish and therefore starving Steller sea lions. Critics among commercial fishermen argued that NMFS based its biological opinion on a scientifically untested hypothesis to make a jeopardy finding on fishing levels and practices under the ESA, while NMFS insisted on a higher standard of certainty for the science under the Magnuson-Stevens Fishery Conservation and Management Act, supporting fishery management measures to address localized fish depletion problems. In a fourth biological opinion on authorization of these fisheries, NMFS took a different approach, after Steller sea lion feeding studies and population trends at some rookery sites raised questions about the localized depletion hypothesis. Litigation on this issue was settled early in 2003.29 In response, NMFS (1) published an addendum to its 2001 biological opinion to clarify the effects of the fisheries on Steller sea lions and their critical habitat and (2) completed a Final Programmatic Supplemental Environmental Impact Statement and Record of Decision concerning the Alaska groundfish fishery. In early December 2010, NMFS restrictions on commercial Atka mackerel and Pacific cod fishing in the western Aleutians to protect western Steller sea lions reignited this controversy.30 As a result of litigation challenging the NMFS determination that commercial fishing jeopardized those Steller sea lions, a court ordered NMFS to prepare an environmental impact statement for Steller sea lion protection measures. 31 Gray Wolves in Eastern States Wolves are an adaptable species, as shown by their behavior and by their presence in a tremendous variety of ecosystems.32 Variations in color, size, and bone structure have led some mammalogists to designate wolves in different areas as different subspecies or populations, whereas other experts would recognize only a single species with variability. Biologists commonly describe their colleagues as lumpers or splitters, based on their inclinations in classifying organisms. As the names suggest, lumpers are those who tend to minimize differences, and see one or a few species, perhaps with some variations, while splitters tend to emphasize those differences, dividing a species into many subspecies, or populations. As one well-known mammalogist once stated: “Splitters make very small units—their opponents say that if they can tell two animals apart, they place them in different genera, and if they cannot tell them apart, they place them in different species. Lumpers make large units—their opponents say that if a carnivore is neither a dog nor a bear they call it a cat.” 33 For wolves, which are (or were) found in temperate and polar areas throughout the Northern Hemisphere, some observers (splitters) have argued that there are as many as 24 subspecies in North America and 8 in Europe and Asia.34 More recently, lumpers have had the upper hand in the scientific community. However, that tide may be changing. In May 2011, the U.S. Fish and Wildlife Service (FWS) proposed recognizing a third species of wolf (Canis lycaon), in addition to the gray and red wolf.35 The wolves being considered for this new species designation live (or lived) primarily in the eastern United States. In the ESA context, the academic debate has considerable significance. Under the ESA, if a taxon is listed (for example the genus Hylobates), then all of the species of gibbons which belong to that genus are all protected. Similarly, if Canis lupus is listed, then all wolves (subspecies, and DPS) belonging to that species are all protected. However, if FWS concludes that there are animals commonly referred to as wolves, but which do not belong to Canis lupus at all, then those wolves would lose their ESA protections unless or until they won ESA protection on their own merits. From a scientific viewpoint, designating wolves found in the eastern United States as a separate species is not assured. For example, the encyclopedic Mammal Species of the World discusses the validity of Canis lycaon as a distinct species and concludes that evidence for separation is equivocal.36 However, it does not currently consider this wolf in the East to be a distinct species. Moreover, the North American consortium of national professionals who manage the Integrated Taxonomic Information System (ITIS, the source considered authoritative on taxonomy and taxonomic validity in the United States and its territories, Mexico, and Canada) currently considers this wolf as a subspecies (Canis lupus lycaon). 37 The validity debate considers evidence related to mitochondrial DNA, morphology, evidence of hybridization with coyotes, the natural variability of widely distributed species, and the extremely low population densities that make conclusive evidence difficult to obtain. A change in the taxonomic status would, in effect, de-list any remaining eastern wolves on the basis of that new status, rather than on an assessment of its conservation status. Only a new decision to list would return such wolves to a protected status. ","Context: Hatchery Salmon Naturally spawned fish are genetically diverse and therefore considered to be more vigorous than the genetically more similar hatchery fish. Consequently, agency scientists have distinguished between hatchery-raised and wild salmon to maximize production of the latter. Over the years, these distinctions have been controversial in several respects. In 1993 NMFS issued its Interim Hatchery Listing Policy on how to consider hatchery fish in listing determinations for Pacific salmon and steelhead species. The interim policy concluded that hatchery fish could be in the same evolutionarily significant unit (ESU) as wild fish.20 Eventually, a federal court found that the interim policy violated the ESA by listing below the species level. The court found that if hatchery and wild salmon were in the same ESU, they should not have different listing status.21 NMFS revised the policy to reflect the court’s decision. The final hatchery listing policy (HLP) was released four years later, in 2005.22 The HLP requires NMFS to consider the status of the ESU as a whole, rather than the status of only the wild fish within the ESU, when determining whether to list the species. It also provides that the entire ESU would be listed, rather than just the wild fish. Two suits were filed in two different district courts. One suit challenged how the HLP affected steelhead trout. Two types of groups sued in the steelhead case: groups that wanted wild fish considered as distinct from hatchery fish, and groups that wanted to require NMFS to make no distinction between the origins of fish. The court found the HLP was invalid because it was not based on the best available scientific data.23 The court found the HLP undermined a fundamental purpose of the ESA—to preserve natural, self-sustaining populations. The court further found it scientifically questionable whether risk assessment criteria developed by NMFS for making status determinations could be applied to fish populations that included both hatchery and wild fish, since the criteria were designed to be applied only to wild fish. NMFS’s downlisting of steelhead from endangered to threatened by applying the HLP was ruled invalid. But the court upheld the NMFS decision to include hatchery and wild fish in the same ESU. The Ninth Circuit Court of Appeals upheld only a portion of the steelhead decision.24 The appellate court distinguished between the two steps of the listing process: defining the species, and then determining whether the species should be listed. The Ninth Circuit agreed with NMFS that the effects of hatchery fish on wild fish could be considered at the listing phase, not the definitional stage. The court gave discretion to NMFS’s science, although it noted that there may not be scientific consensus regarding the threat hatchery fish pose to wild fish. The appellate court reversed the lower court’s holding that downlisting the fish was invalid, finding that hatchery fish did not necessarily put wild fish at risk. A second suit was based on how the HLP affected salmon. In this case, the court held that NMFS properly considered hatchery and wild fish as having different extinction risks in its listing decision.25 The court rejected the plaintiffs’ argument that special regulations regarding taking salmon had to apply uniformly to hatchery and wild fish. The Ninth Circuit Court affirmed the lower court’s decision.26 Steller Sea Lions The western population of Steller sea lions was listed in 1990 as endangered under the ESA, and their abundance has been declining for several decades. 27 Starting in late 1998, NMFS prepared three biological opinions28 that were based on the hypothesis that intense fishing for pollock, Pacific cod, and Atka mackerel off Alaska was causing localized depletion of these fish and therefore starving Steller sea lions. Critics among commercial fishermen argued that NMFS based its biological opinion on a scientifically untested hypothesis to make a jeopardy finding on fishing levels and practices under the ESA, while NMFS insisted on a higher standard of certainty for the science under the Magnuson-Stevens Fishery Conservation and Management Act, supporting fishery management measures to address localized fish depletion problems. In a fourth biological opinion on authorization of these fisheries, NMFS took a different approach, after Steller sea lion feeding studies and population trends at some rookery sites raised questions about the localized depletion hypothesis. Litigation on this issue was settled early in 2003.29 In response, NMFS (1) published an addendum to its 2001 biological opinion to clarify the effects of the fisheries on Steller sea lions and their critical habitat and (2) completed a Final Programmatic Supplemental Environmental Impact Statement and Record of Decision concerning the Alaska groundfish fishery. In early December 2010, NMFS restrictions on commercial Atka mackerel and Pacific cod fishing in the western Aleutians to protect western Steller sea lions reignited this controversy.30 As a result of litigation challenging the NMFS determination that commercial fishing jeopardized those Steller sea lions, a court ordered NMFS to prepare an environmental impact statement for Steller sea lion protection measures. 31 Gray Wolves in Eastern States Wolves are an adaptable species, as shown by their behavior and by their presence in a tremendous variety of ecosystems.32 Variations in color, size, and bone structure have led some mammalogists to designate wolves in different areas as different subspecies or populations, whereas other experts would recognize only a single species with variability. Biologists commonly describe their colleagues as lumpers or splitters, based on their inclinations in classifying organisms. As the names suggest, lumpers are those who tend to minimize differences, and see one or a few species, perhaps with some variations, while splitters tend to emphasize those differences, dividing a species into many subspecies, or populations. As one well-known mammalogist once stated: “Splitters make very small units—their opponents say that if they can tell two animals apart, they place them in different genera, and if they cannot tell them apart, they place them in different species. Lumpers make large units—their opponents say that if a carnivore is neither a dog nor a bear they call it a cat.” 33 For wolves, which are (or were) found in temperate and polar areas throughout the Northern Hemisphere, some observers (splitters) have argued that there are as many as 24 subspecies in North America and 8 in Europe and Asia.34 More recently, lumpers have had the upper hand in the scientific community. However, that tide may be changing. In May 2011, the U.S. Fish and Wildlife Service (FWS) proposed recognizing a third species of wolf (Canis lycaon), in addition to the gray and red wolf.35 The wolves being considered for this new species designation live (or lived) primarily in the eastern United States. In the ESA context, the academic debate has considerable significance. Under the ESA, if a taxon is listed (for example the genus Hylobates), then all of the species of gibbons which belong to that genus are all protected. Similarly, if Canis lupus is listed, then all wolves (subspecies, and DPS) belonging to that species are all protected. However, if FWS concludes that there are animals commonly referred to as wolves, but which do not belong to Canis lupus at all, then those wolves would lose their ESA protections unless or until they won ESA protection on their own merits. From a scientific viewpoint, designating wolves found in the eastern United States as a separate species is not assured. For example, the encyclopedic Mammal Species of the World discusses the validity of Canis lycaon as a distinct species and concludes that evidence for separation is equivocal.36 However, it does not currently consider this wolf in the East to be a distinct species. Moreover, the North American consortium of national professionals who manage the Integrated Taxonomic Information System (ITIS, the source considered authoritative on taxonomy and taxonomic validity in the United States and its territories, Mexico, and Canada) currently considers this wolf as a subspecies (Canis lupus lycaon). 37 The validity debate considers evidence related to mitochondrial DNA, morphology, evidence of hybridization with coyotes, the natural variability of widely distributed species, and the extremely low population densities that make conclusive evidence difficult to obtain. A change in the taxonomic status would, in effect, de-list any remaining eastern wolves on the basis of that new status, rather than on an assessment of its conservation status. Only a new decision to list would return such wolves to a protected status. Question: For each animal mentioned in the document, summarize the text pertaining to it. System Instructions: Answer the question using only information gathered from the prompt. Every time you name an animal, capitalize it.",Legal,Find & Summarize,Text Transformation Only use the text that is provided to answer the question. Answer using complete sentences. The answer must be a minimum of 3 sentences.,"Based only on the information in the article above, which fitness equipment brands specialize in weight/strength training equipment?","**The Top 9 Gym Equipment Brands for Business Success in 2024** Are you a startup gym owner ready to make a significant impact on the fitness industry this year? In a market flooded with endless options, pinpointing the right gym equipment manufacturer to partner with is pivotal for your business’s success. After rigorous research and analysis, Yanre Fitness stands out as the best brand of gym equipment for startup gym owners aiming for business success in 2024. With over a decade of experience in the fitness industry, I’ve consulted gyms across the country, helping them scale their operations and maximize profits. The insights on this list are grounded in real-world experience and in-depth market research, making them invaluable for business owners in this space. Keep reading to discover the top gym equipment brands that can propel a business to greater heights this year. 1. Technogym – Best in Luxury Fitness Solutions Country and City: Cesena FC, Italy Established Date: 1983 Technogym, the Wellness Company, is a global leader in creating top-of-the-line fitness equipment tailored to various markets, including private homes, fitness clubs, hotels, spas, and rehabilitation centers. The brand is synonymous with wellness, a philosophy that encourages a balanced lifestyle through regular exercise, nutritious eating, and a positive mental attitude. Key Products: Treadmills and Strength Equipments Takeaway Note: Technogym excels in offering luxurious, design-forward fitness solutions backed by decades of innovation and quality craftsmanship. However, their products often come with a premium price tag, which may be a consideration for budget-conscious business owners. 2. Power Systems – Best in Comprehensive Fitness Solutions Country and City: Tennessee, United States Established Date: 1986 Power Systems stands out as a complete solution provider in the sports and fitness industries, offering a wide range of quality fitness and performance products. The brand is deeply committed to innovation, customer service, and education. Their slogan, “Power. Performance. Results,” aptly summarizes their philosophy that their products and elite customer service empower their diverse clientele to achieve optimal outcomes. Key Products: Strength and Functional Equipments Takeaway Note: Power Systems offers a comprehensive range of quality fitness products, backed by an unwavering commitment to customer satisfaction. However, the brand’s vast product line can sometimes make the selection process overwhelming for new business owners. 3. Yanre Fitness – Best in Durable Equipment Solutions Country and City: Wuhu, China Established: 1997 Yanre Fitness is a brand that has been steadily rising in popularity, thanks to its modern, functional, and convenient commercial gym equipment. Particularly excelling in the strength training segment, the brand uses durable materials that promise longevity and consistent performance over time. The brand is unwavering in its commitment to quality, making it a popular choice among gym owners. Key Products: Cardio and Strength Equipments Takeaway Note: Yanre Fitness delivers on both quality and affordability, making it an excellent choice for gym owners who are budget-conscious yet unwilling to compromise on equipment longevity. Whether looking to upgrade an existing gym or set up a new facility, they offer a seamless, cost-effective pathway to achieving your business goals. 4. Matrix Fitness – Best in Technologically Advanced Solutions Country and City: Wisconsin, United States Established Date: 2001 Matrix Fitness, a brand under Johnson Health Tech (JHT), excels in producing some of the most technologically advanced fitness equipment available today. Being part of a larger, globally recognized organization, the brand benefits from a vast international research and development network, allowing them to innovate and offer cutting-edge solutions. Key Products: Commercial Fitness and Cardio Equipments Takeaway Note: Matrix Fitness leads the pack in delivering technologically advanced and meticulously designed gym equipment. However, the sophistication of their equipment may come with a steeper learning curve for gym-goers unfamiliar with advanced fitness tech. 5. Gym 80 – Best in Precision Craftsmanship Country and City: Sarstedt, Germany Established: 1980 Gym 80 has become a byword for training quality, revolutionizing the way we work out. For instance, tenowned for its excellent biomechanics, precision craftsmanship, and clear design, the brand continually pushes the boundaries of what strength equipment can achieve. Their reputation in the industry stands as a testament to their commitment to quality and innovation. Key Products: Weight Stacks and Plate Loaded Equipments Takeaway Note: Gym 80 offers exceptional quality by blending traditional craftsmanship with advanced technology. However, this level of attention to detail comes with a higher price point. Therefore, if budget constraints are a significant concern, this brand might not be the most cost-effective option. 6. Tunturi New Fitness – Best in Holistic Wellness Country and City: Almere, Netherlands Established Date: 1922 Tunturi New Fitness doesn’t just sell gym equipment; they offer a philosophy of holistic well-being for both body and mind. They understand that health is more than just physical fitness, and that’s why their product range is designed to promote a balanced mind as well as a healthy body. With a strong focus on quality, longevity, and overall wellness, Tunturi New Fitness aims to be a lifelong partner in your health journey. Key Products: Strength and Cardio Equipments Takeaway Note: Choosing Tunturi New Fitness means investing in equipment that’s designed for the long haul, encompassing both physical and mental well-being. However, their philosophy-driven approach and the additional features focused on holistic wellness may feel overwhelming or unnecessary for any gym’s needs. 7. Rogue Fitness – Best in Strength Training Country and City: Ohio, United States Established Date: 2006 Rogue Fitness stands as a giant in the area of strength and conditioning equipment, with a product line that includes everything from barbells to power racks and sleds. Their dedication to quality is evident, serving as the official equipment supplier to prestigious competitions like the CrossFit Games, USA Weightlifting, the Arnold Strongman Classic, and the World’s Strongest Man competition. Key Products: Plates and Crossfit Equipments Takeaway Note: For business owners seeking to attract a clientele who appreciates high-quality, durable strength training equipment, Rogue Fitness provides a substantial competitive advantage. However, the premium pricing of their equipment requires a significant initial investment, potentially affecting the business’s budget. 8. NordicTrack – Best in Versatile Strength Equipment Country and City: Utah, USA Established Date: 1975 NordicTrack stands out for its comprehensive and versatile range of strength training equipment suitable for both home and commercial gyms. With a focus on high-quality and user-friendly design, the brand caters to various strength workout needs, ensuring that gym-goers and fitness enthusiasts can achieve their goals effectively. Key Products: Ellipticals and Strength Equipments Takeaway Note: NordicTrack’s versatile range of strength equipment makes it a one-stop-shop for all the fitness facility’s needs. However, while the brand promises durability and variety, their advanced machines may require regular software updates, which could be a long-term consideration in terms of maintenance and user experience. 9. True Fitness – Best in Customer-Centric Equipment Country and City: Missouri, United States Established Date: 1981 True Fitness specializes in creating premium, customer-first fitness equipment, encompassing cardio, strength, and functional training. For instance, the company prioritizes responsiveness in service, superior quality in product, and expertise in design. What sets them apart is their comprehensive customer care, not just at the point of sale, but also during and after the purchase. Key Products: Elliptical Trainers and Cardio Equipments Takeaway Note: True Fitness offers a range of equipment that aligns with a customer-first philosophy, enhancing user experience and potentially increasing customer loyalty. However, their focus on premium products may mean a higher upfront investment for businesses. 10. 3 Tips to Consider When Choosing the Best Brand of Gym Equipment Navigating the diverse market of gym equipment requires consideration beyond merely pricing or popular opinion. This section outlines 5 critical factors to facilitate the selection of a gym equipment brand that aligns with business goals and demonstrates lasting reliability. 1. Track Record of Quality: Opt for brands with a strong historical credibility and track record of quality and service, with positive peer reviews and endorsements from reputable professionals. 2. Readily Available Customer Support: According to Styku, buying a gym equipment is a considerable investment. Look for brands with favorable warranty terms covering significant components and offering reasonable periods, plus a commitment to excellent after-sales service, with readily available customer support and repair services. 3. Favorable Financing Terms: Consider the value offered against the cost, with brands that might seem expensive but provide durability, advanced features, and better service. According to Glofox, financing options can be a lifeline. Brands that offer favorable financing or leasing terms understand the industry’s economic challenges and are committed to fostering long-term partnerships."," **The Top 9 Gym Equipment Brands for Business Success in 2024** Are you a startup gym owner ready to make a significant impact on the fitness industry this year? In a market flooded with endless options, pinpointing the right gym equipment manufacturer to partner with is pivotal for your business’s success. After rigorous research and analysis, Yanre Fitness stands out as the best brand of gym equipment for startup gym owners aiming for business success in 2024. With over a decade of experience in the fitness industry, I’ve consulted gyms across the country, helping them scale their operations and maximize profits. The insights on this list are grounded in real-world experience and in-depth market research, making them invaluable for business owners in this space. Keep reading to discover the top gym equipment brands that can propel a business to greater heights this year. 1. Technogym – Best in Luxury Fitness Solutions Country and City: Cesena FC, Italy Established Date: 1983 Technogym, the Wellness Company, is a global leader in creating top-of-the-line fitness equipment tailored to various markets, including private homes, fitness clubs, hotels, spas, and rehabilitation centers. The brand is synonymous with wellness, a philosophy that encourages a balanced lifestyle through regular exercise, nutritious eating, and a positive mental attitude. Key Products: Treadmills and Strength Equipments Takeaway Note: Technogym excels in offering luxurious, design-forward fitness solutions backed by decades of innovation and quality craftsmanship. However, their products often come with a premium price tag, which may be a consideration for budget-conscious business owners. 2. Power Systems – Best in Comprehensive Fitness Solutions Country and City: Tennessee, United States Established Date: 1986 Power Systems stands out as a complete solution provider in the sports and fitness industries, offering a wide range of quality fitness and performance products. The brand is deeply committed to innovation, customer service, and education. Their slogan, “Power. Performance. Results,” aptly summarizes their philosophy that their products and elite customer service empower their diverse clientele to achieve optimal outcomes. Key Products: Strength and Functional Equipments Takeaway Note: Power Systems offers a comprehensive range of quality fitness products, backed by an unwavering commitment to customer satisfaction. However, the brand’s vast product line can sometimes make the selection process overwhelming for new business owners. 3. Yanre Fitness – Best in Durable Equipment Solutions Country and City: Wuhu, China Established: 1997 Yanre Fitness is a brand that has been steadily rising in popularity, thanks to its modern, functional, and convenient commercial gym equipment. Particularly excelling in the strength training segment, the brand uses durable materials that promise longevity and consistent performance over time. The brand is unwavering in its commitment to quality, making it a popular choice among gym owners. Key Products: Cardio and Strength Equipments Takeaway Note: Yanre Fitness delivers on both quality and affordability, making it an excellent choice for gym owners who are budget-conscious yet unwilling to compromise on equipment longevity. Whether looking to upgrade an existing gym or set up a new facility, they offer a seamless, cost-effective pathway to achieving your business goals. 4. Matrix Fitness – Best in Technologically Advanced Solutions Country and City: Wisconsin, United States Established Date: 2001 Matrix Fitness, a brand under Johnson Health Tech (JHT), excels in producing some of the most technologically advanced fitness equipment available today. Being part of a larger, globally recognized organization, the brand benefits from a vast international research and development network, allowing them to innovate and offer cutting-edge solutions. Key Products: Commercial Fitness and Cardio Equipments Takeaway Note: Matrix Fitness leads the pack in delivering technologically advanced and meticulously designed gym equipment. However, the sophistication of their equipment may come with a steeper learning curve for gym-goers unfamiliar with advanced fitness tech. 5. Gym 80 – Best in Precision Craftsmanship Country and City: Sarstedt, Germany Established: 1980 Gym 80 has become a byword for training quality, revolutionizing the way we work out. For instance, tenowned for its excellent biomechanics, precision craftsmanship, and clear design, the brand continually pushes the boundaries of what strength equipment can achieve. Their reputation in the industry stands as a testament to their commitment to quality and innovation. Key Products: Weight Stacks and Plate Loaded Equipments Takeaway Note: Gym 80 offers exceptional quality by blending traditional craftsmanship with advanced technology. However, this level of attention to detail comes with a higher price point. Therefore, if budget constraints are a significant concern, this brand might not be the most cost-effective option. 6. Tunturi New Fitness – Best in Holistic Wellness Country and City: Almere, Netherlands Established Date: 1922 Tunturi New Fitness doesn’t just sell gym equipment; they offer a philosophy of holistic well-being for both body and mind. They understand that health is more than just physical fitness, and that’s why their product range is designed to promote a balanced mind as well as a healthy body. With a strong focus on quality, longevity, and overall wellness, Tunturi New Fitness aims to be a lifelong partner in your health journey. Key Products: Strength and Cardio Equipments Takeaway Note: Choosing Tunturi New Fitness means investing in equipment that’s designed for the long haul, encompassing both physical and mental well-being. However, their philosophy-driven approach and the additional features focused on holistic wellness may feel overwhelming or unnecessary for any gym’s needs. 7. Rogue Fitness – Best in Strength Training Country and City: Ohio, United States Established Date: 2006 Rogue Fitness stands as a giant in the area of strength and conditioning equipment, with a product line that includes everything from barbells to power racks and sleds. Their dedication to quality is evident, serving as the official equipment supplier to prestigious competitions like the CrossFit Games, USA Weightlifting, the Arnold Strongman Classic, and the World’s Strongest Man competition. Key Products: Plates and Crossfit Equipments Takeaway Note: For business owners seeking to attract a clientele who appreciates high-quality, durable strength training equipment, Rogue Fitness provides a substantial competitive advantage. However, the premium pricing of their equipment requires a significant initial investment, potentially affecting the business’s budget. 8. NordicTrack – Best in Versatile Strength Equipment Country and City: Utah, USA Established Date: 1975 NordicTrack stands out for its comprehensive and versatile range of strength training equipment suitable for both home and commercial gyms. With a focus on high-quality and user-friendly design, the brand caters to various strength workout needs, ensuring that gym-goers and fitness enthusiasts can achieve their goals effectively. Key Products: Ellipticals and Strength Equipments Takeaway Note: NordicTrack’s versatile range of strength equipment makes it a one-stop-shop for all the fitness facility’s needs. However, while the brand promises durability and variety, their advanced machines may require regular software updates, which could be a long-term consideration in terms of maintenance and user experience. 9. True Fitness – Best in Customer-Centric Equipment Country and City: Missouri, United States Established Date: 1981 True Fitness specializes in creating premium, customer-first fitness equipment, encompassing cardio, strength, and functional training. For instance, the company prioritizes responsiveness in service, superior quality in product, and expertise in design. What sets them apart is their comprehensive customer care, not just at the point of sale, but also during and after the purchase. Key Products: Elliptical Trainers and Cardio Equipments Takeaway Note: True Fitness offers a range of equipment that aligns with a customer-first philosophy, enhancing user experience and potentially increasing customer loyalty. However, their focus on premium products may mean a higher upfront investment for businesses. 10. 3 Tips to Consider When Choosing the Best Brand of Gym Equipment Navigating the diverse market of gym equipment requires consideration beyond merely pricing or popular opinion. This section outlines 5 critical factors to facilitate the selection of a gym equipment brand that aligns with business goals and demonstrates lasting reliability. 1. Track Record of Quality: Opt for brands with a strong historical credibility and track record of quality and service, with positive peer reviews and endorsements from reputable professionals. 2. Readily Available Customer Support: According to Styku, buying a gym equipment is a considerable investment. Look for brands with favorable warranty terms covering significant components and offering reasonable periods, plus a commitment to excellent after-sales service, with readily available customer support and repair services. 3. Favorable Financing Terms: Consider the value offered against the cost, with brands that might seem expensive but provide durability, advanced features, and better service. According to Glofox, financing options can be a lifeline. Brands that offer favorable financing or leasing terms understand the industry’s economic challenges and are committed to fostering long-term partnerships. ================ Based only on the information in the article above, which fitness equipment brands specialize in weight/strength training equipment? ================ Only use the text that is provided to answer the question. Answer using complete sentences. The answer must be a minimum of 3 sentences.",Retail/Product,Fact Finding,Q&A This task requires you to answer questions based solely on the information provided in the prompt and context block. You are not allowed to use any external resources or prior knowledge.,What was the first circuits ruling on the United States v Evans?,"Funding Limitations on Medical Marijuana Prosecutions In each fiscal year since FY2015, Congress has included provisions in appropriations acts that prohibit DOJ from using appropriated funds to prevent certain states and territories and the District of Columbia from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” The FY2024 provision lists 52 jurisdictions, including every U.S. jurisdiction that had legalized medical cannabis use at the time it was enacted. On its face, the appropriations rider bars DOJ from taking legal action against the states directly in order to prevent them from promulgating or enforcing medical marijuana laws. In addition, federal courts have interpreted the rider to prohibit certain federal prosecutions of private individuals or organizations that Congressional Research Service 3 produce, distribute, or possess marijuana in accordance with state medical marijuana laws. In those cases, criminal defendants have invoked the rider before trial, seeking either the dismissal of their indictments or injunctions barring prosecution. By contrast, courts have generally declined to apply the rider outside the context of initial criminal prosecutions. For instance, the Ninth Circuit has held that the provision does not “impact[ ] the ability of a federal district court to restrict the use of medical marijuana as a condition of probation.” In the 2016 case United States v. McIntosh, the U.S. Court of Appeals for the Ninth Circuit considered the circumstances in which the appropriations rider bars CSA prosecution of marijuana-related activities. The court held that the rider prohibits the federal government only from preventing the implementation of those specific rules of state law that authorize the use, distribution, possession, or cultivation of medical marijuana. DOJ does not prevent the implementation of [such rules] when it prosecutes individuals who engage in conduct unauthorized under state medical marijuana laws. Individuals who do not strictly comply with all state-law conditions regarding the use, distribution, possession, and cultivation of medical marijuana have engaged in conduct that is unauthorized, and prosecuting such individuals does not violate [the rider]. Relying on McIntosh, the Ninth Circuit has issued several decisions allowing federal prosecution of individuals who did not “strictly comply” with state medical marijuana laws, notwithstanding the appropriations rider, and several district courts have followed that reasoning. As one example, in United States v. Evans, the Ninth Circuit upheld the prosecution of two individuals involved in the production of medical marijuana who smoked marijuana as they processed plants for sale. Although state law permitted medical marijuana use by “qualifying patients,” the court concluded that the defendants failed to show they were qualifying patients, and thus they could be prosecuted because their personal marijuana use did not strictly comply with state medical marijuana law. In the 2022 case United States v. Bilodeau, the U.S. Court of Appeals for the First Circuit also considered the scope of the appropriations rider. The defendants in Bilodeau were registered with the State of Maine to produce medical marijuana, but DOJ alleged that they distributed large quantities of marijuana to individuals who were not qualifying patients under Maine law, including recipients in other states. Following indictment for criminal CSA violations, the defendants sought to invoke the appropriations rider to bar their prosecutions. They argued that the rider “must be read to preclude the DOJ, under most circumstances, from prosecuting persons who possess state licenses to partake in medical marijuana activity.” DOJ instead urged the court to apply the Ninth Circuit’s standard, allowing prosecution unless the defendants could show that they acted in strict compliance with state medical marijuana laws. The First Circuit declined to adopt either of the proposed tests. As an initial matter, the court agreed with the Ninth Circuit that the rider means “DOJ may not spend funds to bring prosecutions if doing so prevents a state from giving practical effect to its medical marijuana laws.” However, the panel declined to adopt the Ninth Circuit’s holding that the rider bars prosecution only in cases where defendants strictly complied with state law. The court noted that the text of the rider does not explicitly require strict compliance with state law and that, given the complexity of state marijuana regulations, “the potential for technical noncompliance [with state law] is real enough that no person through any reasonable effort could always assure strict compliance.” Thus, the First Circuit concluded that requiring strict compliance with state law would likely chill state-legal medical marijuana activities and prevent the states from giving effect to their medical marijuana laws. On the other hand, the court also rejected the defendants’ more expansive reading of the rider, reasoning that “Congress surely did not intend for the rider to provide a safe harbor to all caregivers with facially valid documents without regard for blatantly illegitimate activity.” Ultimately, while the First Circuit held that the rider bars CSA prosecution in at least some cases where the defendant has committed minor technical violations of state medical marijuana laws, it declined to Congressional Research Service 4 “fully define [the] precise boundaries” of its alternative standard. On the record before it, the court concluded that “the defendants’ cultivation, possession, and distribution of marijuana aimed at supplying persons whom no defendant ever thought were qualifying patients under Maine law” and that a CSA conviction in those circumstances would not “prevent Maine’s medical marijuana laws from having their intended practical effect.” Considerations for Congress It remains to be seen whether and how the difference in reasoning between the Ninth Circuit and the First Circuit will make a practical difference in federal marijuana prosecutions. In theory, the First Circuit’s analysis could make it easier for defendants to invoke the appropriations rider to bar federal prosecutions, because they could do so even if they had not been in strict compliance with state law. In practice, however, resource limitations and enforcement priorities have historically meant that federal marijuana prosecutions target only individuals and organizations that have clearly not complied with state law. Thus, one of the First Circuit judges who considered Bilodeau agreed with the panel’s interpretation of the rider but wrote a concurrence noting that, in practice, the First Circuit’s standard might not be “materially different from the one that the Ninth Circuit applied.” While the medical marijuana appropriations rider restricts DOJ’s ability to bring some marijuana prosecutions, its effect is limited in several ways. First, marijuana-related activities that fall outside the scope of the appropriations rider remain subject to prosecution under the CSA. By its terms, the rider applies only to state laws related to medical marijuana; it does not bar prosecution of any activities related to recreational marijuana, even if those activities are permitted under state law. Second, as the Ninth Circuit has explained, even where the rider does apply, it “does not provide immunity from prosecution for federal marijuana offenses”—it simply restricts DOJ’s ability to expend funds to enforce federal law for as long as it remains in effect. If Congress instead opted to repeal the rider or allow it to lapse, DOJ would be able to prosecute future CSA violations as well as past violations that occurred while the rider was in effect, subject to the applicable statute of limitations. Third, participants in the cannabis industry may face numerous collateral consequences arising from the federal prohibition of marijuana in areas including bankruptcy, taxation, and immigration. Many of those legal consequences attach regardless of whether a person is charged with or convicted of a CSA offense, meaning the rider would not affect them. Because the medical marijuana appropriations rider applies to marijuana specifically, regardless of how the substance is classified under the CSA, rescheduling marijuana would not affect the rider. Congress has the authority to enact legislation to clarify or alter the scope of the appropriations rider, repeal the rider, or decline to include it in future appropriations laws. For instance, Congress could amend the rider to specify whether strict compliance with state medical marijuana law is required in order to bar prosecution under the CSA or provide a different standard that DOJ and the courts should apply. Beyond the appropriations context, Congress could also consider other changes to federal marijuana law that would affect its interaction with state law. Such changes could take the form of more stringent marijuana regulation—for instance, through increased DOJ funding to prosecute CSA violations or limiting federal funds for states that legalize marijuana. In contrast, most recent proposals before Congress seek to relax federal restrictions on marijuana or mitigate the disparity between federal and state marijuana regulation.","System Instructions: [This task requires you to answer questions based solely on the information provided in the prompt and context block. You are not allowed to use any external resources or prior knowledge.] Question: [What was the first circuits ruling on the United States v Evans?] Context Block: [Funding Limitations on Medical Marijuana Prosecutions In each fiscal year since FY2015, Congress has included provisions in appropriations acts that prohibit DOJ from using appropriated funds to prevent certain states and territories and the District of Columbia from “implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.” The FY2024 provision lists 52 jurisdictions, including every U.S. jurisdiction that had legalized medical cannabis use at the time it was enacted. On its face, the appropriations rider bars DOJ from taking legal action against the states directly in order to prevent them from promulgating or enforcing medical marijuana laws. In addition, federal courts have interpreted the rider to prohibit certain federal prosecutions of private individuals or organizations that Congressional Research Service 3 produce, distribute, or possess marijuana in accordance with state medical marijuana laws. In those cases, criminal defendants have invoked the rider before trial, seeking either the dismissal of their indictments or injunctions barring prosecution. By contrast, courts have generally declined to apply the rider outside the context of initial criminal prosecutions. For instance, the Ninth Circuit has held that the provision does not “impact[ ] the ability of a federal district court to restrict the use of medical marijuana as a condition of probation.” In the 2016 case United States v. McIntosh, the U.S. Court of Appeals for the Ninth Circuit considered the circumstances in which the appropriations rider bars CSA prosecution of marijuana-related activities. The court held that the rider prohibits the federal government only from preventing the implementation of those specific rules of state law that authorize the use, distribution, possession, or cultivation of medical marijuana. DOJ does not prevent the implementation of [such rules] when it prosecutes individuals who engage in conduct unauthorized under state medical marijuana laws. Individuals who do not strictly comply with all state-law conditions regarding the use, distribution, possession, and cultivation of medical marijuana have engaged in conduct that is unauthorized, and prosecuting such individuals does not violate [the rider]. Relying on McIntosh, the Ninth Circuit has issued several decisions allowing federal prosecution of individuals who did not “strictly comply” with state medical marijuana laws, notwithstanding the appropriations rider, and several district courts have followed that reasoning. As one example, in United States v. Evans, the Ninth Circuit upheld the prosecution of two individuals involved in the production of medical marijuana who smoked marijuana as they processed plants for sale. Although state law permitted medical marijuana use by “qualifying patients,” the court concluded that the defendants failed to show they were qualifying patients, and thus they could be prosecuted because their personal marijuana use did not strictly comply with state medical marijuana law. In the 2022 case United States v. Bilodeau, the U.S. Court of Appeals for the First Circuit also considered the scope of the appropriations rider. The defendants in Bilodeau were registered with the State of Maine to produce medical marijuana, but DOJ alleged that they distributed large quantities of marijuana to individuals who were not qualifying patients under Maine law, including recipients in other states. Following indictment for criminal CSA violations, the defendants sought to invoke the appropriations rider to bar their prosecutions. They argued that the rider “must be read to preclude the DOJ, under most circumstances, from prosecuting persons who possess state licenses to partake in medical marijuana activity.” DOJ instead urged the court to apply the Ninth Circuit’s standard, allowing prosecution unless the defendants could show that they acted in strict compliance with state medical marijuana laws. The First Circuit declined to adopt either of the proposed tests. As an initial matter, the court agreed with the Ninth Circuit that the rider means “DOJ may not spend funds to bring prosecutions if doing so prevents a state from giving practical effect to its medical marijuana laws.” However, the panel declined to adopt the Ninth Circuit’s holding that the rider bars prosecution only in cases where defendants strictly complied with state law. The court noted that the text of the rider does not explicitly require strict compliance with state law and that, given the complexity of state marijuana regulations, “the potential for technical noncompliance [with state law] is real enough that no person through any reasonable effort could always assure strict compliance.” Thus, the First Circuit concluded that requiring strict compliance with state law would likely chill state-legal medical marijuana activities and prevent the states from giving effect to their medical marijuana laws. On the other hand, the court also rejected the defendants’ more expansive reading of the rider, reasoning that “Congress surely did not intend for the rider to provide a safe harbor to all caregivers with facially valid documents without regard for blatantly illegitimate activity.” Ultimately, while the First Circuit held that the rider bars CSA prosecution in at least some cases where the defendant has committed minor technical violations of state medical marijuana laws, it declined to Congressional Research Service 4 “fully define [the] precise boundaries” of its alternative standard. On the record before it, the court concluded that “the defendants’ cultivation, possession, and distribution of marijuana aimed at supplying persons whom no defendant ever thought were qualifying patients under Maine law” and that a CSA conviction in those circumstances would not “prevent Maine’s medical marijuana laws from having their intended practical effect.” Considerations for Congress It remains to be seen whether and how the difference in reasoning between the Ninth Circuit and the First Circuit will make a practical difference in federal marijuana prosecutions. In theory, the First Circuit’s analysis could make it easier for defendants to invoke the appropriations rider to bar federal prosecutions, because they could do so even if they had not been in strict compliance with state law. In practice, however, resource limitations and enforcement priorities have historically meant that federal marijuana prosecutions target only individuals and organizations that have clearly not complied with state law. Thus, one of the First Circuit judges who considered Bilodeau agreed with the panel’s interpretation of the rider but wrote a concurrence noting that, in practice, the First Circuit’s standard might not be “materially different from the one that the Ninth Circuit applied.” While the medical marijuana appropriations rider restricts DOJ’s ability to bring some marijuana prosecutions, its effect is limited in several ways. First, marijuana-related activities that fall outside the scope of the appropriations rider remain subject to prosecution under the CSA. By its terms, the rider applies only to state laws related to medical marijuana; it does not bar prosecution of any activities related to recreational marijuana, even if those activities are permitted under state law. Second, as the Ninth Circuit has explained, even where the rider does apply, it “does not provide immunity from prosecution for federal marijuana offenses”—it simply restricts DOJ’s ability to expend funds to enforce federal law for as long as it remains in effect. If Congress instead opted to repeal the rider or allow it to lapse, DOJ would be able to prosecute future CSA violations as well as past violations that occurred while the rider was in effect, subject to the applicable statute of limitations. Third, participants in the cannabis industry may face numerous collateral consequences arising from the federal prohibition of marijuana in areas including bankruptcy, taxation, and immigration. Many of those legal consequences attach regardless of whether a person is charged with or convicted of a CSA offense, meaning the rider would not affect them. Because the medical marijuana appropriations rider applies to marijuana specifically, regardless of how the substance is classified under the CSA, rescheduling marijuana would not affect the rider. Congress has the authority to enact legislation to clarify or alter the scope of the appropriations rider, repeal the rider, or decline to include it in future appropriations laws. For instance, Congress could amend the rider to specify whether strict compliance with state medical marijuana law is required in order to bar prosecution under the CSA or provide a different standard that DOJ and the courts should apply. Beyond the appropriations context, Congress could also consider other changes to federal marijuana law that would affect its interaction with state law. Such changes could take the form of more stringent marijuana regulation—for instance, through increased DOJ funding to prosecute CSA violations or limiting federal funds for states that legalize marijuana. In contrast, most recent proposals before Congress seek to relax federal restrictions on marijuana or mitigate the disparity between federal and state marijuana regulation. ]",Legal,Fact Finding,Q&A You are required to provide a response using only the information included in the context block. you are forbidden from using any external knowledge.,"What are the risks and benefits for using AI in healthcare, education, and national security?","Artificial Intelligence Technologies in Selected Sectors AI technologies have potential applications across a wide range of sectors. A selection of broad, crosscutting issues with application-specific examples of ongoing congressional interest are discussed in the CRS report Artificial Intelligence: Background, Selected Issues, and Policy Considerations. Those issues and examples include implications for the U.S. workforce, international competition and federal investment in AI R&D, standards development, and ethical AI—including questions about bias, fairness, and algorithm transparency (for example, in criminal justice applications). In addition to those issues and applications, three areas of potential use that may be of growing interest to Congress—particularly in light of the advances in, and widespread availability of, GenAI tools—are health care, education, and national security. In other parts of the federal government, experts have asserted a need to understand the impacts and future directions of AI applications in these areas. For example, the chief AI officer at the Department of Health and Human Services, Greg Singleton, at a June 2023 Health Innovation Summit discussed “the role that AI will play in health care, as well as the importance of regulations.” A May 2023 Department of Education report, Artificial Intelligence and the Future of Teaching and Learning, describes the rising interest in AI in education and highlights reasons to address AI in education now. And the 2023 Annual Threat Assessment of the U.S. Intelligence Community states, “New technologies—particularly in the fields of AI and biotechnology—are being developed and are proliferating faster than companies and governments can shape norms, protect privacy, and prevent dangerous outcomes.” This section will discuss some of the potential benefits and concerns with the use of AI technologies in these sectors. Health Care Numerous companies and researchers have been developing and testing AI technologies for use in health care—for example, to improve the drug development process by increasing efficiency and decreasing time and cost, to detect diseases earlier, and to more consistently analyze medical data. A 2022 report by the Government Accountability Office identified a variety of ML-based technologies to assist with the diagnostic processes for five selected diseases—certain cancers, diabetic retinopathy (an eye condition that can cause blindness in diabetic patients), Alzheimer’s disease, heart disease, and COVID-19—though these ML technologies have generally not been widely adopted. Some hospitals have also experimented with using voice recognition, and associated ML and natural language processing technology, to assist doctors and patients. While there are many encouraging developments for using AI technologies in health care, stakeholders have remarked on the slow progress in using AI broadly within health care settings, and various challenges remain. Researchers and clinicians have raised questions about the accuracy, security, and privacy of these technologies; the availability of sufficient health data on which to train systems; medical liability in the event of adverse outcomes; the adequacy of current user consent processes; and patient access and receptivity. These questions reflect the potential risks from using AI systems. For example, a poorly designed system might lead to misdiagnosis; systems trained on biased data can reflect or amplify those biases in their outputs; and if a flawed AI system is adopted widely, it might result in widespread injury to patients. Education According to the U.S. Department of Education, AI, ML, and related technologies “will have powerful impacts on learning, not only through direct supports for students, but also by empowering educators to be more adaptive to learner needs and less consumed by routine, repetitive tasks.” The report also notes that AI in education presents risks, including apprehension from parents and educators and the potential for AI algorithms to be biased, possibly leading to unfair decisions about what or how a student should learn. The rapid development of AI chatbots and the public release of ChatGPT in November 2022 have spurred debate among teachers and education administrators. Some teachers have begun using these AI tools in their classrooms, highlighting benefits such as making lessons more interactive, aiding the development of critical thinking skills, teaching students media literacy, generating personalized lesson plans, saving teachers time on administration, and aiding students whose first language is not English. Others have raised concerns about students using the systems to cheat on assignments by writing essays and taking tests for them, with some school systems banning the use of chatbots on their networks. Numerous researchers and companies have been developing and deploying detection tools to identify text generated by AI, though there remain issues with the accuracy of these tools. Stakeholders have also raised concerns about data privacy risks, including, for example, whether information shared or stored in AI-enabled systems is used for further product training without gaining explicit user consent and, more broadly, whether such systems are subject to federal or state privacy laws, such as the Family Educational Rights and Privacy Act. National Security AI technologies have a wide range of national security applications, including intelligence, surveillance, and reconnaissance; logistics; cyber operations; command and control; semiautonomous and autonomous vehicles; and weapons systems. Since at least 2017, the U.S. military has begun integrating AI systems into combat systems and discussing AI as a key technology to ensure future warfighting capabilities. At the same time, other countries, including China and Russia, have released national plans and statements of intent to lead in the development of AI technologies. The Department of Defense’s (DOD’s) unclassified investments in AI have grown from just over $600 million in FY2016 to approximately $1.1 billion in FY2023, with DOD maintaining over 685 active AI projects. DOD has an AI strategy, which outlines the following aims: delivering AI-enabled capabilities for key missions; partnering with leading private sector technology companies, academia, and global allies; cultivating a leading AI workforce; and leading in military ethics and AI safety. The intelligence community (IC) has also released a strategy for using AI—the AIM Initiative—as well as AI ethics principles and an AI ethics framework for the IC. While AI holds to potential to assist the IC in its work, AI systems also “pose grave security challenges for which [the United States is] currently unprepared, including the development of novel cyber weapons, large-scale disinformation attacks, and the design of advanced biological weapons.”","System Instructions: You are required to provide a response using only the information included in the context block. you are forbidden from using any external knowledge. Question: What are the risks and benefits for using AI in healthcare, education, and national security? Context Block: Artificial Intelligence Technologies in Selected Sectors AI technologies have potential applications across a wide range of sectors. A selection of broad, crosscutting issues with application-specific examples of ongoing congressional interest are discussed in the CRS report Artificial Intelligence: Background, Selected Issues, and Policy Considerations. Those issues and examples include implications for the U.S. workforce, international competition and federal investment in AI R&D, standards development, and ethical AI—including questions about bias, fairness, and algorithm transparency (for example, in criminal justice applications). In addition to those issues and applications, three areas of potential use that may be of growing interest to Congress—particularly in light of the advances in, and widespread availability of, GenAI tools—are health care, education, and national security. In other parts of the federal government, experts have asserted a need to understand the impacts and future directions of AI applications in these areas. For example, the chief AI officer at the Department of Health and Human Services, Greg Singleton, at a June 2023 Health Innovation Summit discussed “the role that AI will play in health care, as well as the importance of regulations.” A May 2023 Department of Education report, Artificial Intelligence and the Future of Teaching and Learning, describes the rising interest in AI in education and highlights reasons to address AI in education now. And the 2023 Annual Threat Assessment of the U.S. Intelligence Community states, “New technologies—particularly in the fields of AI and biotechnology—are being developed and are proliferating faster than companies and governments can shape norms, protect privacy, and prevent dangerous outcomes.” This section will discuss some of the potential benefits and concerns with the use of AI technologies in these sectors. Health Care Numerous companies and researchers have been developing and testing AI technologies for use in health care—for example, to improve the drug development process by increasing efficiency and decreasing time and cost, to detect diseases earlier, and to more consistently analyze medical data. A 2022 report by the Government Accountability Office identified a variety of ML-based technologies to assist with the diagnostic processes for five selected diseases—certain cancers, diabetic retinopathy (an eye condition that can cause blindness in diabetic patients), Alzheimer’s disease, heart disease, and COVID-19—though these ML technologies have generally not been widely adopted. Some hospitals have also experimented with using voice recognition, and associated ML and natural language processing technology, to assist doctors and patients. While there are many encouraging developments for using AI technologies in health care, stakeholders have remarked on the slow progress in using AI broadly within health care settings, and various challenges remain. Researchers and clinicians have raised questions about the accuracy, security, and privacy of these technologies; the availability of sufficient health data on which to train systems; medical liability in the event of adverse outcomes; the adequacy of current user consent processes; and patient access and receptivity. These questions reflect the potential risks from using AI systems. For example, a poorly designed system might lead to misdiagnosis; systems trained on biased data can reflect or amplify those biases in their outputs; and if a flawed AI system is adopted widely, it might result in widespread injury to patients. Education According to the U.S. Department of Education, AI, ML, and related technologies “will have powerful impacts on learning, not only through direct supports for students, but also by empowering educators to be more adaptive to learner needs and less consumed by routine, repetitive tasks.” The report also notes that AI in education presents risks, including apprehension from parents and educators and the potential for AI algorithms to be biased, possibly leading to unfair decisions about what or how a student should learn. The rapid development of AI chatbots and the public release of ChatGPT in November 2022 have spurred debate among teachers and education administrators. Some teachers have begun using these AI tools in their classrooms, highlighting benefits such as making lessons more interactive, aiding the development of critical thinking skills, teaching students media literacy, generating personalized lesson plans, saving teachers time on administration, and aiding students whose first language is not English. Others have raised concerns about students using the systems to cheat on assignments by writing essays and taking tests for them, with some school systems banning the use of chatbots on their networks. Numerous researchers and companies have been developing and deploying detection tools to identify text generated by AI, though there remain issues with the accuracy of these tools. Stakeholders have also raised concerns about data privacy risks, including, for example, whether information shared or stored in AI-enabled systems is used for further product training without gaining explicit user consent and, more broadly, whether such systems are subject to federal or state privacy laws, such as the Family Educational Rights and Privacy Act. National Security AI technologies have a wide range of national security applications, including intelligence, surveillance, and reconnaissance; logistics; cyber operations; command and control; semiautonomous and autonomous vehicles; and weapons systems. Since at least 2017, the U.S. military has begun integrating AI systems into combat systems and discussing AI as a key technology to ensure future warfighting capabilities. At the same time, other countries, including China and Russia, have released national plans and statements of intent to lead in the development of AI technologies. The Department of Defense’s (DOD’s) unclassified investments in AI have grown from just over $600 million in FY2016 to approximately $1.1 billion in FY2023, with DOD maintaining over 685 active AI projects. DOD has an AI strategy, which outlines the following aims: delivering AI-enabled capabilities for key missions; partnering with leading private sector technology companies, academia, and global allies; cultivating a leading AI workforce; and leading in military ethics and AI safety. The intelligence community (IC) has also released a strategy for using AI—the AIM Initiative—as well as AI ethics principles and an AI ethics framework for the IC. While AI holds to potential to assist the IC in its work, AI systems also “pose grave security challenges for which [the United States is] currently unprepared, including the development of novel cyber weapons, large-scale disinformation attacks, and the design of advanced biological weapons.”",Internet/Technology,Pros & Cons,Q&A Respond using only information contained in the context block.,"According to the shareholder letter, what are the differences between all US and Japanese companies?","This year, I would like to describe two other investments that we expect to maintain indefinitely. Like Coke and AMEX, these commitments are not huge relative to our resources. They are worthwhile, however, and we were able to increase both positions during 2023. At yearend, Berkshire owned 27.8% of Occidental Petroleum’s common shares and also owned warrants that, for more than five years, give us the option to materially increase our ownership at a fixed price. Though we very much like our ownership, as well as the option, Berkshire has no interest in purchasing or managing Occidental. We particularly like its vast oil and gas holdings in the United States, as well as its leadership in carbon-capture initiatives, though the economic feasibility of this technique has yet to be proven. Both of these activities are very much in our country’s interest. Not so long ago, the U.S. was woefully dependent on foreign oil, and carbon capture had no meaningful constituency. Indeed, in 1975, U.S. production was eight million barrels of oil-equivalent per day (“BOEPD”), a level far short of the country’s needs. From the favorable energy position that facilitated the U.S. mobilization in World War II, the country had retreated to become heavily dependent on foreign – potentially unstable – suppliers. Further declines in oil production were predicted along with future increases in usage. 9 For a long time, the pessimism appeared to be correct, with production falling to five million BOEPD by 2007. Meanwhile, the U.S. government created a Strategic Petroleum Reserve (“SPR”) in 1975 to alleviate – though not come close to eliminating – this erosion of American self-sufficiency. And then – Hallelujah! – shale economics became feasible in 2011, and our energy dependency ended. Now, U.S. production is more than 13 million BOEPD, and OPEC no longer has the upper hand. Occidental itself has annual U.S. oil production that each year comes close to matching the entire inventory of the SPR. Our country would be very – very – nervous today if domestic production had remained at five million BOEPD, and it found itself hugely dependent on non-U.S. sources. At that level, the SPR would have been emptied within months if foreign oil became unavailable. Under Vicki Hollub’s leadership, Occidental is doing the right things for both its country and its owners. No one knows what oil prices will do over the next month, year, or decade. But Vicki does know how to separate oil from rock, and that’s an uncommon talent, valuable to her shareholders and to her country. * * * * * * * * * * * * Additionally, Berkshire continues to hold its passive and long-term interest in five very large Japanese companies, each of which operates in a highly-diversified manner somewhat similar to the way Berkshire itself is run. We increased our holdings in all five last year after Greg Abel and I made a trip to Tokyo to talk with their managements. Berkshire now owns about 9% of each of the five. (A minor point: Japanese companies calculate outstanding shares in a manner different from the practice in the U.S.) Berkshire has also pledged to each company that it will not purchase shares that will take our holdings beyond 9.9%. Our cost for the five totals ¥1.6 trillion, and the yearend market value of the five was ¥2.9 trillion. However, the yen has weakened in recent years and our yearend unrealized gain in dollars was 61% or $8 billion. Neither Greg nor I believe we can forecast market prices of major currencies. We also don’t believe we can hire anyone with this ability. Therefore, Berkshire has financed most of its Japanese position with the proceeds from ¥1.3 trillion of bonds. This debt has been very well-received in Japan, and I believe Berkshire has more yen-denominated debt outstanding than any other American company. The weakened yen has produced a yearend gain for Berkshire of $1.9 billion, a sum that, pursuant to GAAP rules, has periodically been recognized in income over the 2020-23 period. In certain important ways, all five companies – Itochu, Marubeni, Mitsubishi, Mitsui and Sumitomo – follow shareholder-friendly policies that are much superior to those customarily practiced in the U.S. Since we began our Japanese purchases, each of the five has reduced the number of its outstanding shares at attractive prices. 10 Meanwhile, the managements of all five companies have been far less aggressive about their own compensation than is typical in the United States. Note as well that each of the five is applying only about 1⁄3 of its earnings to dividends. The large sums the five retain are used both to build their many businesses and, to a lesser degree, to repurchase shares. Like Berkshire, the five companies are reluctant to issue shares. An additional benefit for Berkshire is the possibility that our investment may lead to opportunities for us to partner around the world with five large, well-managed and well-respected companies. Their interests are far more broad than ours. And, on their side, the Japanese CEOs have the comfort of knowing that Berkshire will always possess huge liquid resources that can be instantly available for such partnerships, whatever their size may be. Our Japanese purchases began on July 4, 2019. Given Berkshire’s present size, building positions through open-market purchases takes a lot of patience and an extended period of “friendly” prices. The process is like turning a battleship. That is an important disadvantage which we did not face in our early days at Berkshire. ","system instruction: Respond using only information contained in the context block. question: According to the shareholder letter, what are the differences between all US and Japanese companies? context block: This year, I would like to describe two other investments that we expect to maintain indefinitely. Like Coke and AMEX, these commitments are not huge relative to our resources. They are worthwhile, however, and we were able to increase both positions during 2023. At yearend, Berkshire owned 27.8% of Occidental Petroleum’s common shares and also owned warrants that, for more than five years, give us the option to materially increase our ownership at a fixed price. Though we very much like our ownership, as well as the option, Berkshire has no interest in purchasing or managing Occidental. We particularly like its vast oil and gas holdings in the United States, as well as its leadership in carbon-capture initiatives, though the economic feasibility of this technique has yet to be proven. Both of these activities are very much in our country’s interest. Not so long ago, the U.S. was woefully dependent on foreign oil, and carbon capture had no meaningful constituency. Indeed, in 1975, U.S. production was eight million barrels of oil-equivalent per day (“BOEPD”), a level far short of the country’s needs. From the favorable energy position that facilitated the U.S. mobilization in World War II, the country had retreated to become heavily dependent on foreign – potentially unstable – suppliers. Further declines in oil production were predicted along with future increases in usage. 9 For a long time, the pessimism appeared to be correct, with production falling to five million BOEPD by 2007. Meanwhile, the U.S. government created a Strategic Petroleum Reserve (“SPR”) in 1975 to alleviate – though not come close to eliminating – this erosion of American self-sufficiency. And then – Hallelujah! – shale economics became feasible in 2011, and our energy dependency ended. Now, U.S. production is more than 13 million BOEPD, and OPEC no longer has the upper hand. Occidental itself has annual U.S. oil production that each year comes close to matching the entire inventory of the SPR. Our country would be very – very – nervous today if domestic production had remained at five million BOEPD, and it found itself hugely dependent on non-U.S. sources. At that level, the SPR would have been emptied within months if foreign oil became unavailable. Under Vicki Hollub’s leadership, Occidental is doing the right things for both its country and its owners. No one knows what oil prices will do over the next month, year, or decade. But Vicki does know how to separate oil from rock, and that’s an uncommon talent, valuable to her shareholders and to her country. * * * * * * * * * * * * Additionally, Berkshire continues to hold its passive and long-term interest in five very large Japanese companies, each of which operates in a highly-diversified manner somewhat similar to the way Berkshire itself is run. We increased our holdings in all five last year after Greg Abel and I made a trip to Tokyo to talk with their managements. Berkshire now owns about 9% of each of the five. (A minor point: Japanese companies calculate outstanding shares in a manner different from the practice in the U.S.) Berkshire has also pledged to each company that it will not purchase shares that will take our holdings beyond 9.9%. Our cost for the five totals ¥1.6 trillion, and the yearend market value of the five was ¥2.9 trillion. However, the yen has weakened in recent years and our yearend unrealized gain in dollars was 61% or $8 billion. Neither Greg nor I believe we can forecast market prices of major currencies. We also don’t believe we can hire anyone with this ability. Therefore, Berkshire has financed most of its Japanese position with the proceeds from ¥1.3 trillion of bonds. This debt has been very well-received in Japan, and I believe Berkshire has more yen-denominated debt outstanding than any other American company. The weakened yen has produced a yearend gain for Berkshire of $1.9 billion, a sum that, pursuant to GAAP rules, has periodically been recognized in income over the 2020-23 period. In certain important ways, all five companies – Itochu, Marubeni, Mitsubishi, Mitsui and Sumitomo – follow shareholder-friendly policies that are much superior to those customarily practiced in the U.S. Since we began our Japanese purchases, each of the five has reduced the number of its outstanding shares at attractive prices. 10 Meanwhile, the managements of all five companies have been far less aggressive about their own compensation than is typical in the United States. Note as well that each of the five is applying only about 1⁄3 of its earnings to dividends. The large sums the five retain are used both to build their many businesses and, to a lesser degree, to repurchase shares. Like Berkshire, the five companies are reluctant to issue shares. An additional benefit for Berkshire is the possibility that our investment may lead to opportunities for us to partner around the world with five large, well-managed and well-respected companies. Their interests are far more broad than ours. And, on their side, the Japanese CEOs have the comfort of knowing that Berkshire will always possess huge liquid resources that can be instantly available for such partnerships, whatever their size may be. Our Japanese purchases began on July 4, 2019. Given Berkshire’s present size, building positions through open-market purchases takes a lot of patience and an extended period of “friendly” prices. The process is like turning a battleship. That is an important disadvantage which we did not face in our early days at Berkshire. ",Financial,Fact Finding,Q&A Respond using only the provided text without any external information.,Explain how retinol helps skin in a month.," 1. Retinol alleviates aging related conditions of human skin The skin phenotypes of each individual enrolled were collected at five time points. Principal coordinates analysis (PCoA) revealed that participants experienced an overall change in skin phenotype after application of retinol. The Adonis test demonstrated significant separation from Day 0 for Day 21 (adj.p=0.010) and Day 28 (adj.p=0.017), indicating an altered phenotype compared to the baseline (Fig.S1A). Moreover, more than half (eight out of fourteen) of the phenotypic measurements, including water content in the stratum corneum (WCSC), transepidermal water loss (TEWL), pH value, percentage of the red area, and various wrinkle parameters (number, length, area, and volume), exhibited significant changes compared to the baseline (Fig.1). The topical use of the retinol resulted in enhanced water retention capability of the skin, with a 31.4% increase in WCSC (adj.p=0.050, Wilcoxon paired test) and an 18.4% decrease in TEWL at day 28 (adj.p=0.004, adj.p=0.050, Wilcoxon paired test), respectively. Notably, WCSC on day 28 showed a significant increase not only compared to the baseline but also compared to days 7 and 14 (adj.p=0.004, adj.p=0.050, Wilcoxon paired test), suggesting that the stratum corneum's water retention ability improves with prolonged retinol use. The decrease in TWEL indicated that retinol markedly improved and repaired the skin barrier, helping to retain skin moisture and prevent water loss. Retinol also demonstrated its effectiveness in sedative and anti-inflammatory skincare properties, as evidenced by a significant reduction in the size of red areas: a decrease of 11.6% on day 21 and 13.2% on day 28 compared to the baseline level (Table S2). The pH values of the skin cheek surface exhibited a decline from 7.21 (average value on Day 0) to 6.72 (average value on Day 28) while using retinol, indicating the gradual formation of a weakly acidic environment on the facial skin, suggesting that retinol can modulate and maintain acid-base balance of skin. Meanwhile, multiple wrinkle-related indicators, including the wrinkle number, length, area, and volume at the corners of the eyes, displayed significant reductions starting from Day 7 compared to the pre-retinol use conditions (Table S2). Specifically, the wrinkle number decreased significantly on Day 7, 21 and 28, with the most substantial reduction observed on Day 21 and 28, resulting in a 27.8% decrease relative to baseline. The wrinkle length significantly decreased at all four sampling time points compared to baseline. By Day 28, the average wrinkle length decreased from 68.7μm to 42μm, representing a reduction of 38.8% compared to baseline. Wrinkle area exhibited significant reductions on Day 7 and 21, with a notable decrease of 34.8% observed on Day 21. Finally, the wrinkle volume exhibited a significant decrease of 26.9% at Day 7. These findings highlight the potent anti-aging properties of retinol and its efficacy in improving facial wrinkle conditions. (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. bioRxiv preprint doi: https://doi.org/10.1101/2024.06.26.600860; this version posted June 27, 2024. The copyright holder for this preprint Figure 1 The temporal variation of skin phenotypic traits Statistical significance levels of data relative to baseline changes were assessed using the Wilcoxon paired test and adjusted using the Benjamini & Hochberg (BH) method. Displayed results are adjusted p values. Unmarked indicates nonsignificance, * indicates adj.p ≤ 0.1, ** indicates adj.p ≤ 0.05. Data are shown in Table S2. 2. Retinol reshapes human skin microbiome microecology. The application of the retinol had a dramatic impact on the restructuring of skin microbiome microecology (Fig.S1C). Species-level alpha diversity (Shannon diversity index and species evenness index) was significantly lower on day 7 compared to day 0 (Fig.2B, p=0.031, paired Wilcoxon test). This decrease in diversity could be attributed to an imbalance in the relative distribution of certain species within the microbial community. Specifically, there was a significant decrease in the relative abundance of Corynebacterium accolens, a skin bacterium ranked among the top 20 abundant species, on day 7 compared to the baseline (Fig. S1B). This reduction may have allowed other species to occupy a relatively larger ecological niche, resulting in a decline in microbial diversity. Notably, opportunistic pathogens such as Stenotrophomonas maltophilia, Acinetobacter johnsonii, Pseudomonas sp., and Sphingomonas hankookensis showed significant decreases in their relative abundances at three consecutive time points compared to the baseline (Fig.2C). This suggests that the retinol-containing skincare product possesses antimicrobial properties and can reduce the colonization of pathogenic bacteria on the skin surface. We also noticed an increase in the relative abundance of Neisseriales species incertae sedis (Fig.S1B) and Corynebacterium jeddahense (Fig.2C). However, their specific functions remain unclear. (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. bioRxiv preprint doi: https://doi.org/10.1101/2024.06.26.600860; this version posted June 27, 2024. The copyright holder for this preprint Figure 2 Effects of retinol on the structure of skin microbiome. (A) Gene pathway enrichment analysis based on ReporterScore. A ReporterScore with an absolute value greater than 1.64 indicates significant enrichment of the gene pathway, with positive or negative signs denoting upregulation or downregulation compared to the control group (Day 0, baseline). (B) Skin microbiome Alpha diversity indexes. (C) Intergroup differential species abundance changes. Statistical significance levels of data relative to baseline changes were assessed using the Wilcoxon paired test. Displayed results are p values. Unmarked indicates non-significance, * indicates p ≤ 0.05, ** indicates p≤ 0.01. Retinol also exerts an impact on the functionality of the skin microbiome. Starting from Day 14, several microbial gene pathways displayed altered regulation levels (Fig. 2A). Notably, the thiamine (Vitamin B1) metabolism gene pathway was enriched on both Day 14 and Day 21, marked by a peak in the abundance of a thiamine metabolite, biotin thiamine, on Day 14, which significantly increased compared to Day 0 (Fig. S2A). Metabolomic data also showed that the microbial and host thiamine metabolic pathway was significantly (p=0.026) enriched on Day 14, marked by increased intensities of pyruvic acid and L-Tyrosine (Fig. S2A). All the three (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. bioRxiv preprint doi: https://doi.org/10.1101/2024.06.26.600860; this version posted June 27, 2024. The copyright holder for this preprint substances are biosynthetic precursors of thiamin. Thiamin has a variety of benefits for the skin, including increasing the expression of collagen, promoting skin cell growth and repair, and maintaining skin elasticity. Our findings suggest that retinol helps to promote the synthesis and utilization of thiamine by the skin microbiome, thereby enhancing the function and health of the skin barrier. Furthermore, the riboflavin metabolism pathway showed enrichment on Day 14 (Fig. 2A), accompanied by a notable decrease in the abundance of riboflavin on Day 14, while the intensity of riboflavin 5’-phosphate sodium, a bio-active form of riboflavin, exhibited an increase relative to baseline on Day 21 and Day 28(Fig. S2A). Riboflavin phosphate sodium salt form is an essential micronutrient, and plays an important role in the health of the skin, mucous membranes, and eyes. Retinol makes microorganisms more inclined to utilize or convert riboflavin into the active form, riboflavin 5’-phosphate sodium. Additionally, certain gene pathways demonstrated decreased expression levels, including biofilm formation of Vibrio cholerae and flagellar assembly were down-regulated on Day 21. And the bacterial secretion system and O-antigen nucleotide sugar biosynthesis, both were consistently down-regulated during the last three time points(Fig. 2A). The down-regulation implies that retinol may possess antimicrobial and anti-inflammatory capabilities by inhibiting bacterial metabolic activity, secretion of bacterial products, and influencing the integrity of bacterial structure. 3. Retinol stimulates skin microbiota’s secretion of diverse beneficial metabolites for synergistic anti-aging effects. We further utilized MetOrigin to perform tracing analysis of metabolites (based on the databases of MetOrigin tracking to determine whether they originated from the host, microorganisms, or co-metabolism) and metabolic pathway enrichment analysis. Of note, nicotinate and nicotinamide metabolism pathway (hsa00760) enriched in the host on Day 21 , and supported by increment of N1-methyl-4-pyridone-3-carboxamide which is associated with this pathway In the microbe, degradation of flavonoids (ko00946), phenylalanine, tyrosine and tryptophan biosynthesis (ko00400), and biosynthesis of various plant secondary metabolites (ko00999) were up-regulated (Fig. 3A). Based on the databases of MetOrigin, we found a variety of microbial-origin metabolites significantly related to the enrichment of the above pathways, some of which have been reported or experimentally verified to be beneficial to the skin. Maesopsin and apigenin were related to ko00946, where apigenin was known as an anti-tumor substance that is particularly helpful in preventing and reversing the formation of abnormal skin49–52. Quinic acid, 3-dehydroquinic acid and protocatechuic acid were related to ko00400, where quinic acid was reported to have an antiphotoaging effect by protecting human dermal fibroblasts53,54 and protocatechuic acid was demonstrated to have anti-oxidate and anti-aging effects by inducing dermal fibroblasts to synthesis type-1 collagen55–57. In ko00999, (+)- pinoresinol and secoisolariciresinol were significantly related, the former was reported to stimulate keratinocyte proliferation58,59 and the latter was reported to suppress atopic dermatitis in the mouse when administered orally60","Explain how retinol helps skin in a month. Respond using only the provided text without any external information. 1. Retinol alleviates aging related conditions of human skin The skin phenotypes of each individual enrolled were collected at five time points. Principal coordinates analysis (PCoA) revealed that participants experienced an overall change in skin phenotype after application of retinol. The Adonis test demonstrated significant separation from Day 0 for Day 21 (adj.p=0.010) and Day 28 (adj.p=0.017), indicating an altered phenotype compared to the baseline (Fig.S1A). Moreover, more than half (eight out of fourteen) of the phenotypic measurements, including water content in the stratum corneum (WCSC), transepidermal water loss (TEWL), pH value, percentage of the red area, and various wrinkle parameters (number, length, area, and volume), exhibited significant changes compared to the baseline (Fig.1). The topical use of the retinol resulted in enhanced water retention capability of the skin, with a 31.4% increase in WCSC (adj.p=0.050, Wilcoxon paired test) and an 18.4% decrease in TEWL at day 28 (adj.p=0.004, adj.p=0.050, Wilcoxon paired test), respectively. Notably, WCSC on day 28 showed a significant increase not only compared to the baseline but also compared to days 7 and 14 (adj.p=0.004, adj.p=0.050, Wilcoxon paired test), suggesting that the stratum corneum's water retention ability improves with prolonged retinol use. The decrease in TWEL indicated that retinol markedly improved and repaired the skin barrier, helping to retain skin moisture and prevent water loss. Retinol also demonstrated its effectiveness in sedative and anti-inflammatory skincare properties, as evidenced by a significant reduction in the size of red areas: a decrease of 11.6% on day 21 and 13.2% on day 28 compared to the baseline level (Table S2). The pH values of the skin cheek surface exhibited a decline from 7.21 (average value on Day 0) to 6.72 (average value on Day 28) while using retinol, indicating the gradual formation of a weakly acidic environment on the facial skin, suggesting that retinol can modulate and maintain acid-base balance of skin. Meanwhile, multiple wrinkle-related indicators, including the wrinkle number, length, area, and volume at the corners of the eyes, displayed significant reductions starting from Day 7 compared to the pre-retinol use conditions (Table S2). Specifically, the wrinkle number decreased significantly on Day 7, 21 and 28, with the most substantial reduction observed on Day 21 and 28, resulting in a 27.8% decrease relative to baseline. The wrinkle length significantly decreased at all four sampling time points compared to baseline. By Day 28, the average wrinkle length decreased from 68.7μm to 42μm, representing a reduction of 38.8% compared to baseline. Wrinkle area exhibited significant reductions on Day 7 and 21, with a notable decrease of 34.8% observed on Day 21. Finally, the wrinkle volume exhibited a significant decrease of 26.9% at Day 7. These findings highlight the potent anti-aging properties of retinol and its efficacy in improving facial wrinkle conditions. (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. bioRxiv preprint doi: https://doi.org/10.1101/2024.06.26.600860; this version posted June 27, 2024. The copyright holder for this preprint Figure 1 The temporal variation of skin phenotypic traits Statistical significance levels of data relative to baseline changes were assessed using the Wilcoxon paired test and adjusted using the Benjamini & Hochberg (BH) method. Displayed results are adjusted p values. Unmarked indicates nonsignificance, * indicates adj.p ≤ 0.1, ** indicates adj.p ≤ 0.05. Data are shown in Table S2. 2. Retinol reshapes human skin microbiome microecology. The application of the retinol had a dramatic impact on the restructuring of skin microbiome microecology (Fig.S1C). Species-level alpha diversity (Shannon diversity index and species evenness index) was significantly lower on day 7 compared to day 0 (Fig.2B, p=0.031, paired Wilcoxon test). This decrease in diversity could be attributed to an imbalance in the relative distribution of certain species within the microbial community. Specifically, there was a significant decrease in the relative abundance of Corynebacterium accolens, a skin bacterium ranked among the top 20 abundant species, on day 7 compared to the baseline (Fig. S1B). This reduction may have allowed other species to occupy a relatively larger ecological niche, resulting in a decline in microbial diversity. Notably, opportunistic pathogens such as Stenotrophomonas maltophilia, Acinetobacter johnsonii, Pseudomonas sp., and Sphingomonas hankookensis showed significant decreases in their relative abundances at three consecutive time points compared to the baseline (Fig.2C). This suggests that the retinol-containing skincare product possesses antimicrobial properties and can reduce the colonization of pathogenic bacteria on the skin surface. We also noticed an increase in the relative abundance of Neisseriales species incertae sedis (Fig.S1B) and Corynebacterium jeddahense (Fig.2C). However, their specific functions remain unclear. (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. bioRxiv preprint doi: https://doi.org/10.1101/2024.06.26.600860; this version posted June 27, 2024. The copyright holder for this preprint Figure 2 Effects of retinol on the structure of skin microbiome. (A) Gene pathway enrichment analysis based on ReporterScore. A ReporterScore with an absolute value greater than 1.64 indicates significant enrichment of the gene pathway, with positive or negative signs denoting upregulation or downregulation compared to the control group (Day 0, baseline). (B) Skin microbiome Alpha diversity indexes. (C) Intergroup differential species abundance changes. Statistical significance levels of data relative to baseline changes were assessed using the Wilcoxon paired test. Displayed results are p values. Unmarked indicates non-significance, * indicates p ≤ 0.05, ** indicates p≤ 0.01. Retinol also exerts an impact on the functionality of the skin microbiome. Starting from Day 14, several microbial gene pathways displayed altered regulation levels (Fig. 2A). Notably, the thiamine (Vitamin B1) metabolism gene pathway was enriched on both Day 14 and Day 21, marked by a peak in the abundance of a thiamine metabolite, biotin thiamine, on Day 14, which significantly increased compared to Day 0 (Fig. S2A). Metabolomic data also showed that the microbial and host thiamine metabolic pathway was significantly (p=0.026) enriched on Day 14, marked by increased intensities of pyruvic acid and L-Tyrosine (Fig. S2A). All the three (which was not certified by peer review) is the author/funder. All rights reserved. No reuse allowed without permission. bioRxiv preprint doi: https://doi.org/10.1101/2024.06.26.600860; this version posted June 27, 2024. The copyright holder for this preprint substances are biosynthetic precursors of thiamin. Thiamin has a variety of benefits for the skin, including increasing the expression of collagen, promoting skin cell growth and repair, and maintaining skin elasticity. Our findings suggest that retinol helps to promote the synthesis and utilization of thiamine by the skin microbiome, thereby enhancing the function and health of the skin barrier. Furthermore, the riboflavin metabolism pathway showed enrichment on Day 14 (Fig. 2A), accompanied by a notable decrease in the abundance of riboflavin on Day 14, while the intensity of riboflavin 5’-phosphate sodium, a bio-active form of riboflavin, exhibited an increase relative to baseline on Day 21 and Day 28(Fig. S2A). Riboflavin phosphate sodium salt form is an essential micronutrient, and plays an important role in the health of the skin, mucous membranes, and eyes. Retinol makes microorganisms more inclined to utilize or convert riboflavin into the active form, riboflavin 5’-phosphate sodium. Additionally, certain gene pathways demonstrated decreased expression levels, including biofilm formation of Vibrio cholerae and flagellar assembly were down-regulated on Day 21. And the bacterial secretion system and O-antigen nucleotide sugar biosynthesis, both were consistently down-regulated during the last three time points(Fig. 2A). The down-regulation implies that retinol may possess antimicrobial and anti-inflammatory capabilities by inhibiting bacterial metabolic activity, secretion of bacterial products, and influencing the integrity of bacterial structure. 3. Retinol stimulates skin microbiota’s secretion of diverse beneficial metabolites for synergistic anti-aging effects. We further utilized MetOrigin to perform tracing analysis of metabolites (based on the databases of MetOrigin tracking to determine whether they originated from the host, microorganisms, or co-metabolism) and metabolic pathway enrichment analysis. Of note, nicotinate and nicotinamide metabolism pathway (hsa00760) enriched in the host on Day 21 , and supported by increment of N1-methyl-4-pyridone-3-carboxamide which is associated with this pathway In the microbe, degradation of flavonoids (ko00946), phenylalanine, tyrosine and tryptophan biosynthesis (ko00400), and biosynthesis of various plant secondary metabolites (ko00999) were up-regulated (Fig. 3A). Based on the databases of MetOrigin, we found a variety of microbial-origin metabolites significantly related to the enrichment of the above pathways, some of which have been reported or experimentally verified to be beneficial to the skin. Maesopsin and apigenin were related to ko00946, where apigenin was known as an anti-tumor substance that is particularly helpful in preventing and reversing the formation of abnormal skin49–52. Quinic acid, 3-dehydroquinic acid and protocatechuic acid were related to ko00400, where quinic acid was reported to have an antiphotoaging effect by protecting human dermal fibroblasts53,54 and protocatechuic acid was demonstrated to have anti-oxidate and anti-aging effects by inducing dermal fibroblasts to synthesis type-1 collagen55–57. In ko00999, (+)- pinoresinol and secoisolariciresinol were significantly related, the former was reported to stimulate keratinocyte proliferation58,59 and the latter was reported to suppress atopic dermatitis in the mouse when administered orally60",Medical,Summarize,Text Transformation Your answer should be drawn only from the provided context block. Respond concisely.,"Of the circuit courts mentioned, which single court did not address Alabama but did address a state on the east coast? ","Appellate Courts Split on Legal Challenges to State Laws Banning Certain Medical Treatments for Transgender Minors Updated April 4, 2024 Public debate and attention has focused on whether certain medical treatments should be available for transgender minors to address a discordance between a person’s sex characteristics and gender identity. A number of states have passed laws prohibiting specific treatments for minors, including puberty blocking medication (“puberty blockers”), hormones, and surgical procedures. Several states assert, among other things, that the treatments are too experimental and can have potentially irreversible effects. Parents of transgender minors, among others, argue that these laws deny critical medical care to transgender minors and discriminate based on sex or transgender status in violation of the Equal Protection Clause of the Fourteenth Amendment. Some litigation has also alleged that these laws violate state constitutions. In cases challenging the laws of Arkansas, Alabama, Tennessee, Kentucky, Indiana, and Idaho, plaintiffs sought federal court orders to preliminarily enjoin these states from enforcing the laws until final resolution of the cases. Several lower courts granted these preliminary injunctions, in part based on the conclusion that the plaintiffs were likely to succeed on the merits of their equal protection claims. Three federal courts of appeals analyzed whether the lower courts had erred in their rulings and issued opinions reaching different conclusions. The Eighth Circuit upheld a preliminary injunction of Arkansas’s law, while the Eleventh Circuit held that a district court erred in enjoining the Alabama law, and the Sixth Circuit reversed preliminary injunctions that were issued against the Kentucky and Tennessee laws. Two other appellate courts reviewed preliminary injunctions and issued orders without accompanying opinions as of yet. The Seventh Circuit, after hearing oral argument, issued a stay of the lower court’s preliminary injunction against application of Indiana’s law, meaning that the law can go into effect while the case proceeds. By contrast, the Ninth Circuit denied a motion to stay a preliminary injunction against Idaho’s law, meaning that that law may not be enforced for now. This Sidebar focuses on aspects of the appellate court opinions addressing whether plaintiffs are likely to prevail on their claims that the laws violate the Equal Protection Clause. The three courts that have issued opinions reached different conclusions on at least two important legal questions relevant to the issue: (1) whether the challenged laws amount to sex classifications within the meaning of the Equal Protection Clause, and (2) what standard of review a court should apply when analyzing these challenges. The Congressional Research Service https://crsreports.congress.gov LSB11057 Congressional Research Service 2 courts’ analyses of these questions are consequential, as the likelihood of a state action being upheld or invalidated under the Equal Protection Clause may turn significantly on how a court resolves them. These recent decisions not only dictate how lower courts within these circuits analyze such equal protection challenges, but also may inform other courts’ approaches to similar equal protection challenges. Equal Protection Background The Fourteenth Amendment’s Equal Protection Clause prohibits states from denying individuals “the equal protection of the laws.” In the most general terms, states must not classify or differentiate among similarly situated individuals in a manner that violates this constitutional guarantee. When analyzing an equal protection challenge, a court must first determine which legal standard to apply. The most deferential standard of equal protection review is rational basis, under which a court will generally uphold a challenged classification as long as it is reasonably related to a legitimate government purpose. Courts subject classifications based on sex, however, to a more stringent standard—intermediate scrutiny. If intermediate scrutiny applies, the parties seeking to defend a sex-based classification must show an “exceedingly persuasive justification” or “important government interest” for classifying individuals based on sex and must demonstrate that the classification is “substantially related” to achieving that interest. In equal protection challenges raised in another context—school restroom access—several federal appellate courts have concluded that laws prohibiting transgender individuals from access consistent with their gender identity amount to sex-based classifications subject to intermediate scrutiny. In addition, the Fourth and Ninth Circuits have held that transgender individuals constitute a quasi-suspect class for equal protection purposes—that is, a class of individuals who warrant heightened protection under the law—and that transgender-based classifications are subject to intermediate scrutiny on that basis. Challenges to State Laws in Federal Appellate Courts When analyzing the legal bases for the preliminary injunctions at issue, the appellate courts considering the challenges to the Arkansas, Tennessee, Kentucky, and Alabama laws differed on the applicable standard of review. The Eighth Circuit construed the Arkansas law as classifying individuals based on sex, held that intermediate scrutiny applied, and concluded it was likely that the plaintiffs would prevail on their claim. By contrast, both the Sixth and Eleventh Circuits held that rational basis review applied and that the challenged laws neither contained a sex classification nor targeted a quasi-suspect class. (The Sixth and Eleventh Circuits also rejected arguments related to the Due Process Clause of the Fourteenth Amendment, further discussion of which is beyond the scope of this Sidebar.) Eighth Circuit: Brandt v. Rutledge The Eighth Circuit affirmed a district court’s preliminary injunction of Arkansas’s law banning “gender transition procedures” for minors, reasoning that the law was a sex classification that did not satisfy intermediate scrutiny. Arkansas’s law bans procedures and drugs intended to remove or alter “physical or anatomical characteristics or features that are typical for the individual’s biological sex” or “create physiological or anatomical characteristics that resemble a sex different from the individual’s biological sex.” Specific medical services identified in the law include puberty blockers, “cross-sex hormones,” and “gender reassignment surgery.” Prohibited procedures do not include those for individuals “born with a medically verifiable disorder of sex development.” Reviewing the injunction, the Eighth Circuit reasoned that the law discriminates on the basis of sex because medical procedures permitted for minors of one sex are denied to minors of another sex. For instance, a minor born as a male can be prescribed testosterone, but a minor born as a female is not permitted to receive that treatment. The court thus viewed the law as subject to intermediate scrutiny. The Congressional Research Service 3 state’s asserted justification for the law was its interest in protecting minors from “experimental medical treatment” and regulating medical ethics. The Eighth Circuit concluded that there was substantial evidence to support the district court’s findings that the medical treatments were a recognized standard of care and “supported by medical evidence … subject to rigorous study.” The Eighth Circuit accordingly determined that the lower court was not wrong to conclude the law’s prohibition was likely to fail intermediate scrutiny, as it was not substantially related to the state’s interest in protecting minors from experimental treatment and regulation of medical ethics. The full Eighth Circuit later denied a petition for rehearing en banc, with five judges dissenting from the denial and several others indicating that an appeal from a final judgment would offer the court a more comprehensive record to review. Following a trial in the case, the district court entered a permanent injunction against enforcement of the law, and that decision is now pending before the Eighth Circuit, which has granted a petition for an initial hearing en banc. Eleventh Circuit: Eknes-Tucker v. Governor of Alabama In contrast to the Eighth Circuit’s analysis in Brandt, the Eleventh Circuit held that specific provisions of a similar Alabama law did not amount to a sex-based or quasi-suspect classification for equal protection purposes. The court concluded that the challenged provisions were “best understood as a law that targets specific medical interventions for minors,” or as classifying based on age, and that it was “exceedingly likely” that the provisions satisfied rational basis review. The challenged provisions of Alabama’s law prohibit any person from prescribing or administering “puberty blocking medication,” “supraphysiologic doses of testosterone or other androgens to females,” and “supraphysiologic doses of estrogen to males,” when given “to attempt[] to alter the appearance of or affirm the minor’s perception of his or her gender or sex, if that appearance or perception is inconsistent with the minor’s sex as defined in this act.” The law’s other provisions, which were not challenged in the Eknes-Tucker lawsuit, include a prohibition of specific surgical procedures. The Alabama law defines a minor as a person under the age of 19, and defines sex to mean “‘[t]he biological state of being male or female, based on the individual’s sex organs, chromosomes, and endogenous hormone profiles.’” The Eleventh Circuit rejected the plaintiffs’ assertion that the provisions classify based on sex because the law uses sex-based terms to criminalize certain treatments. The law refers to sex, the court decided, only because the medical interventions at issue concern physiological sex characteristics. “[I]t is difficult to imagine how a state might regulate the use of puberty blockers and cross-sex hormones . . . in specific terms without referencing sex in some way,” the court observed. More significantly, the court reasoned that the challenged provisions do not distinguish between men and women by denying an opportunity to one sex but not the other—a key feature of sex-based classifications for equal protection purposes. Rather, in the court’s view, the restrictions on puberty blockers and hormone treatment apply to all minors, regardless of sex. The appellate court also rejected the argument, adopted by the lower court, that a classification based on gender nonconformity “indirectly classifies on the basis of sex.” The appellate court held that the lower court had relied on inapposite precedent to reach that conclusion, including a Supreme Court decision interpreting Title VII of the Civil Rights Act of 1964. That decision, the court reasoned, addressed a federal statute, not the different text and meaning of the Equal Protection Clause, and did not concern the regulation of medical treatments. The Eleventh Circuit also rejected the view that transgender persons constitute a quasi-suspect class distinct from sex. The court did observe that the challenged provisions prohibit medical treatment for minors that only gender nonconforming or transgender individuals would want to undergo. Addressing that distinction, the court stated that the law would trigger heightened scrutiny if regulating medical treatment were “a pretext for invidious discrimination against such individuals.” In the case before the court, however, “the district court did not find that Alabama’s law was based on invidious discrimination.” Nor did the challenged Congressional Research Service 4 provisions “further any particular gender stereotype.” Rather, the provisions, in the court’s view, refer to and “reflect[] biological differences between males and females.” In a concurring opinion, Judge Brasher agreed that rational basis review was the applicable standard but added that even if intermediate scrutiny applied to the challenged provisions of Alabama’s law, it was likely the state would satisfy that standard. The plaintiffs have filed a petition seeking en banc review of the panel decision.","Your answer should be drawn only from the provided context block. Respond concisely. Of the circuit courts mentioned, which single court did not address Alabama but did address a state on the east coast? Appellate Courts Split on Legal Challenges to State Laws Banning Certain Medical Treatments for Transgender Minors Updated April 4, 2024 Public debate and attention has focused on whether certain medical treatments should be available for transgender minors to address a discordance between a person’s sex characteristics and gender identity. A number of states have passed laws prohibiting specific treatments for minors, including puberty blocking medication (“puberty blockers”), hormones, and surgical procedures. Several states assert, among other things, that the treatments are too experimental and can have potentially irreversible effects. Parents of transgender minors, among others, argue that these laws deny critical medical care to transgender minors and discriminate based on sex or transgender status in violation of the Equal Protection Clause of the Fourteenth Amendment. Some litigation has also alleged that these laws violate state constitutions. In cases challenging the laws of Arkansas, Alabama, Tennessee, Kentucky, Indiana, and Idaho, plaintiffs sought federal court orders to preliminarily enjoin these states from enforcing the laws until final resolution of the cases. Several lower courts granted these preliminary injunctions, in part based on the conclusion that the plaintiffs were likely to succeed on the merits of their equal protection claims. Three federal courts of appeals analyzed whether the lower courts had erred in their rulings and issued opinions reaching different conclusions. The Eighth Circuit upheld a preliminary injunction of Arkansas’s law, while the Eleventh Circuit held that a district court erred in enjoining the Alabama law, and the Sixth Circuit reversed preliminary injunctions that were issued against the Kentucky and Tennessee laws. Two other appellate courts reviewed preliminary injunctions and issued orders without accompanying opinions as of yet. The Seventh Circuit, after hearing oral argument, issued a stay of the lower court’s preliminary injunction against application of Indiana’s law, meaning that the law can go into effect while the case proceeds. By contrast, the Ninth Circuit denied a motion to stay a preliminary injunction against Idaho’s law, meaning that that law may not be enforced for now. This Sidebar focuses on aspects of the appellate court opinions addressing whether plaintiffs are likely to prevail on their claims that the laws violate the Equal Protection Clause. The three courts that have issued opinions reached different conclusions on at least two important legal questions relevant to the issue: (1) whether the challenged laws amount to sex classifications within the meaning of the Equal Protection Clause, and (2) what standard of review a court should apply when analyzing these challenges. The Congressional Research Service https://crsreports.congress.gov LSB11057 Congressional Research Service 2 courts’ analyses of these questions are consequential, as the likelihood of a state action being upheld or invalidated under the Equal Protection Clause may turn significantly on how a court resolves them. These recent decisions not only dictate how lower courts within these circuits analyze such equal protection challenges, but also may inform other courts’ approaches to similar equal protection challenges. Equal Protection Background The Fourteenth Amendment’s Equal Protection Clause prohibits states from denying individuals “the equal protection of the laws.” In the most general terms, states must not classify or differentiate among similarly situated individuals in a manner that violates this constitutional guarantee. When analyzing an equal protection challenge, a court must first determine which legal standard to apply. The most deferential standard of equal protection review is rational basis, under which a court will generally uphold a challenged classification as long as it is reasonably related to a legitimate government purpose. Courts subject classifications based on sex, however, to a more stringent standard—intermediate scrutiny. If intermediate scrutiny applies, the parties seeking to defend a sex-based classification must show an “exceedingly persuasive justification” or “important government interest” for classifying individuals based on sex and must demonstrate that the classification is “substantially related” to achieving that interest. In equal protection challenges raised in another context—school restroom access—several federal appellate courts have concluded that laws prohibiting transgender individuals from access consistent with their gender identity amount to sex-based classifications subject to intermediate scrutiny. In addition, the Fourth and Ninth Circuits have held that transgender individuals constitute a quasi-suspect class for equal protection purposes—that is, a class of individuals who warrant heightened protection under the law—and that transgender-based classifications are subject to intermediate scrutiny on that basis. Challenges to State Laws in Federal Appellate Courts When analyzing the legal bases for the preliminary injunctions at issue, the appellate courts considering the challenges to the Arkansas, Tennessee, Kentucky, and Alabama laws differed on the applicable standard of review. The Eighth Circuit construed the Arkansas law as classifying individuals based on sex, held that intermediate scrutiny applied, and concluded it was likely that the plaintiffs would prevail on their claim. By contrast, both the Sixth and Eleventh Circuits held that rational basis review applied and that the challenged laws neither contained a sex classification nor targeted a quasi-suspect class. (The Sixth and Eleventh Circuits also rejected arguments related to the Due Process Clause of the Fourteenth Amendment, further discussion of which is beyond the scope of this Sidebar.) Eighth Circuit: Brandt v. Rutledge The Eighth Circuit affirmed a district court’s preliminary injunction of Arkansas’s law banning “gender transition procedures” for minors, reasoning that the law was a sex classification that did not satisfy intermediate scrutiny. Arkansas’s law bans procedures and drugs intended to remove or alter “physical or anatomical characteristics or features that are typical for the individual’s biological sex” or “create physiological or anatomical characteristics that resemble a sex different from the individual’s biological sex.” Specific medical services identified in the law include puberty blockers, “cross-sex hormones,” and “gender reassignment surgery.” Prohibited procedures do not include those for individuals “born with a medically verifiable disorder of sex development.” Reviewing the injunction, the Eighth Circuit reasoned that the law discriminates on the basis of sex because medical procedures permitted for minors of one sex are denied to minors of another sex. For instance, a minor born as a male can be prescribed testosterone, but a minor born as a female is not permitted to receive that treatment. The court thus viewed the law as subject to intermediate scrutiny. The Congressional Research Service 3 state’s asserted justification for the law was its interest in protecting minors from “experimental medical treatment” and regulating medical ethics. The Eighth Circuit concluded that there was substantial evidence to support the district court’s findings that the medical treatments were a recognized standard of care and “supported by medical evidence … subject to rigorous study.” The Eighth Circuit accordingly determined that the lower court was not wrong to conclude the law’s prohibition was likely to fail intermediate scrutiny, as it was not substantially related to the state’s interest in protecting minors from experimental treatment and regulation of medical ethics. The full Eighth Circuit later denied a petition for rehearing en banc, with five judges dissenting from the denial and several others indicating that an appeal from a final judgment would offer the court a more comprehensive record to review. Following a trial in the case, the district court entered a permanent injunction against enforcement of the law, and that decision is now pending before the Eighth Circuit, which has granted a petition for an initial hearing en banc. Eleventh Circuit: Eknes-Tucker v. Governor of Alabama In contrast to the Eighth Circuit’s analysis in Brandt, the Eleventh Circuit held that specific provisions of a similar Alabama law did not amount to a sex-based or quasi-suspect classification for equal protection purposes. The court concluded that the challenged provisions were “best understood as a law that targets specific medical interventions for minors,” or as classifying based on age, and that it was “exceedingly likely” that the provisions satisfied rational basis review. The challenged provisions of Alabama’s law prohibit any person from prescribing or administering “puberty blocking medication,” “supraphysiologic doses of testosterone or other androgens to females,” and “supraphysiologic doses of estrogen to males,” when given “to attempt[] to alter the appearance of or affirm the minor’s perception of his or her gender or sex, if that appearance or perception is inconsistent with the minor’s sex as defined in this act.” The law’s other provisions, which were not challenged in the Eknes-Tucker lawsuit, include a prohibition of specific surgical procedures. The Alabama law defines a minor as a person under the age of 19, and defines sex to mean “‘[t]he biological state of being male or female, based on the individual’s sex organs, chromosomes, and endogenous hormone profiles.’” The Eleventh Circuit rejected the plaintiffs’ assertion that the provisions classify based on sex because the law uses sex-based terms to criminalize certain treatments. The law refers to sex, the court decided, only because the medical interventions at issue concern physiological sex characteristics. “[I]t is difficult to imagine how a state might regulate the use of puberty blockers and cross-sex hormones . . . in specific terms without referencing sex in some way,” the court observed. More significantly, the court reasoned that the challenged provisions do not distinguish between men and women by denying an opportunity to one sex but not the other—a key feature of sex-based classifications for equal protection purposes. Rather, in the court’s view, the restrictions on puberty blockers and hormone treatment apply to all minors, regardless of sex. The appellate court also rejected the argument, adopted by the lower court, that a classification based on gender nonconformity “indirectly classifies on the basis of sex.” The appellate court held that the lower court had relied on inapposite precedent to reach that conclusion, including a Supreme Court decision interpreting Title VII of the Civil Rights Act of 1964. That decision, the court reasoned, addressed a federal statute, not the different text and meaning of the Equal Protection Clause, and did not concern the regulation of medical treatments. The Eleventh Circuit also rejected the view that transgender persons constitute a quasi-suspect class distinct from sex. The court did observe that the challenged provisions prohibit medical treatment for minors that only gender nonconforming or transgender individuals would want to undergo. Addressing that distinction, the court stated that the law would trigger heightened scrutiny if regulating medical treatment were “a pretext for invidious discrimination against such individuals.” In the case before the court, however, “the district court did not find that Alabama’s law was based on invidious discrimination.” Nor did the challenged Congressional Research Service 4 provisions “further any particular gender stereotype.” Rather, the provisions, in the court’s view, refer to and “reflect[] biological differences between males and females.” In a concurring opinion, Judge Brasher agreed that rational basis review was the applicable standard but added that even if intermediate scrutiny applied to the challenged provisions of Alabama’s law, it was likely the state would satisfy that standard. The plaintiffs have filed a petition seeking en banc review of the panel decision.",Medical,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","My neighbor has been adding to his property all around his home over many years, annexing land from his neighbors. What technique is he using to acquire this real estate? What's required to make this happen? How can I protect my land from his actions?","ADVERSE POSSESSION By: George Coppolo, Chief Attorney SUMMARY Connecticut law recognizes adverse possession as a way to acquire title to property. Adverse possession is a method of acquiring title to real estate, accomplished by an open, visible, and exclusive possession uninterruptedly for a 15-year period (CGS § 52-575; Whitney v. Turmel 180 Conn. 147 (1980)). Connecticut also recognizes the right to acquire a right-of-way or other easement by continuous, uninterrupted use of someone else's land for 15 years (CGS § 47-37). The legislature has amended this law three times during the past 10 years- in 1996, 1999, and 2002. Legislation passed in 1996 authorizes a landowner who wishes to interrupt an adverse possession claim, in addition to things already required, to serve a notice on the adverse possessor and record it on the land records (PA 96-249). Such service and notice is an interruption of the use and possession and prevents the acquisition of a right by continuing the use and possession thereafter. Legislation adopted in 1999 protects land belonging to a nonprofit land-holding organization from adverse possession. The act applies to non-stock corporations whose principal purposes include the conservation and preservation of land (PA 99-64). PA 02-66 prohibits adverse possession claims on certain types of land owned by investor-owned water companies. The law in other states is similar to Connecticut's. The main difference is that some jurisdictions have established a shorter or longer period, and some have established different time periods for different types of property. CONNECTICUT Adverse possession can create an absolute title to real estate, which is as good as title by deed from the record owner. But adverse possession as record title requires evidence showing the existence of all elements necessary for adverse possession, and apparently this can be done only in a judicial proceeding to which those to be bound by the decision have been made parties. The essential elements of an adverse possession sufficient to create title to land in a claimant are that the owner is ousted of possession and kept out uninterruptedly for 15 years by an open, visible, and exclusive possession by the claimant, under a claim of right, with the intention of using the property as his own, and without the owner's consent. The possession must be hostile and under a claim of right, actual, open, notorious, exclusive, continuous, and uninterrupted (Goodman v. Quadrato, 142 Conn. 398 (1954)). The 15-year period comes from CGS § 52-575 which establishes this time frame for an owner to assert his ownership claim over an adverse possessor. A landowner who wishes to interrupt an adverse possession claim may serve a notice on the adverse possessor and record it on the land records. Such service and notice is an interruption of the use and possession and prevents the acquisition of a right by continuing the use and possession thereafter. The notice must be served on the adverse possessor, his agent, or guardian if they are in Connecticut, in the same way lawsuit papers are served. Otherwise, a copy of the notice must be affixed to the house on the land in question or to some other conspicuous part of the premises. The notice and papers indicating the notice was served must be recorded in the land records of the town where the land is located within three months after service. When the adverse possessor is unknown, the notice must be given by conspicuously posting a copy on the property, serving it on the person to whom the taxes were last assessed, and recording it on the land records. The law prohibits adverse possession of: 1. certain types of land owned by investor-owned water companies (CGS § 47-27(b)); 2. land belonging to a non-profit corporation organized under Connecticut law with land conservation or preservation as one of its principal purposes (CGS § 47-27(b)); and 3. certain railroad and canal land (CGS § 47-26).","""================ ======= ADVERSE POSSESSION By: George Coppolo, Chief Attorney SUMMARY Connecticut law recognizes adverse possession as a way to acquire title to property. Adverse possession is a method of acquiring title to real estate, accomplished by an open, visible, and exclusive possession uninterruptedly for a 15-year period (CGS § 52-575; Whitney v. Turmel 180 Conn. 147 (1980)). Connecticut also recognizes the right to acquire a right-of-way or other easement by continuous, uninterrupted use of someone else's land for 15 years (CGS § 47-37). The legislature has amended this law three times during the past 10 years- in 1996, 1999, and 2002. Legislation passed in 1996 authorizes a landowner who wishes to interrupt an adverse possession claim, in addition to things already required, to serve a notice on the adverse possessor and record it on the land records (PA 96-249). Such service and notice is an interruption of the use and possession and prevents the acquisition of a right by continuing the use and possession thereafter. Legislation adopted in 1999 protects land belonging to a nonprofit land-holding organization from adverse possession. The act applies to non-stock corporations whose principal purposes include the conservation and preservation of land (PA 99-64). PA 02-66 prohibits adverse possession claims on certain types of land owned by investor-owned water companies. The law in other states is similar to Connecticut's. The main difference is that some jurisdictions have established a shorter or longer period, and some have established different time periods for different types of property. CONNECTICUT Adverse possession can create an absolute title to real estate, which is as good as title by deed from the record owner. But adverse possession as record title requires evidence showing the existence of all elements necessary for adverse possession, and apparently this can be done only in a judicial proceeding to which those to be bound by the decision have been made parties. The essential elements of an adverse possession sufficient to create title to land in a claimant are that the owner is ousted of possession and kept out uninterruptedly for 15 years by an open, visible, and exclusive possession by the claimant, under a claim of right, with the intention of using the property as his own, and without the owner's consent. The possession must be hostile and under a claim of right, actual, open, notorious, exclusive, continuous, and uninterrupted (Goodman v. Quadrato, 142 Conn. 398 (1954)). The 15-year period comes from CGS § 52-575 which establishes this time frame for an owner to assert his ownership claim over an adverse possessor. A landowner who wishes to interrupt an adverse possession claim may serve a notice on the adverse possessor and record it on the land records. Such service and notice is an interruption of the use and possession and prevents the acquisition of a right by continuing the use and possession thereafter. The notice must be served on the adverse possessor, his agent, or guardian if they are in Connecticut, in the same way lawsuit papers are served. Otherwise, a copy of the notice must be affixed to the house on the land in question or to some other conspicuous part of the premises. The notice and papers indicating the notice was served must be recorded in the land records of the town where the land is located within three months after service. When the adverse possessor is unknown, the notice must be given by conspicuously posting a copy on the property, serving it on the person to whom the taxes were last assessed, and recording it on the land records. The law prohibits adverse possession of: 1. certain types of land owned by investor-owned water companies (CGS § 47-27(b)); 2. land belonging to a non-profit corporation organized under Connecticut law with land conservation or preservation as one of its principal purposes (CGS § 47-27(b)); and 3. certain railroad and canal land (CGS § 47-26). https://www.cga.ct.gov/2006/rpt/2006-R-0032.htm ================ ======= My neighbor has been adding to his property all around his home over many years, annexing land from his neighbors. What technique is he using to acquire this real estate? What's required to make this happen? How can I protect my land from his actions? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Legal,Effect Analysis,Q&A "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",what are the health benefits of laughter and what are the symptoms of having dry eyes and what are some of the ingreients in the eye drops,"t Objective: To assess efficacy and safety of laughter exercise in patients with symptomatic dry eye disease. Design: Non-inferiority randomised controlled trial. Setting: Recruitment was from clinics and community and the trial took place at Zhongshan Ophthalmic Center, Sun Yat-sen University, the largest ophthalmic centre in China, between 18 June 2020 to 8 January 2021. Participants: People with symptomatic dry eye disease aged 18-45 years with ocular surface disease index scores ranging from 18 to 80 and tear film break-up time of eight seconds or less. Interventions: Participants were randomised 1:1 to receive laughter exercise or artificial tears (0.1% sodium hyaluronic acid eyedrop, control group) four times daily for eight weeks. The laughter exercise group viewed an instructional video and participants were requested to vocalise the phrases ""Hee hee hee, hah hah hah, cheese cheese cheese, cheek cheek cheek, hah hah hah hah hah hah"" 30 times per five minute session. Investigators assessing study outcomes were masked to group assignment but participants were unmasked for practical reasons. Main outcome measures: The primary outcome was the mean change in the ocular surface disease index (0-100, higher scores indicating worse ocular surface discomfort) from baseline to eight weeks in the per protocol population. The non-inferiority margin was 6 points of this index score. Main secondary outcomes included the proportion of patients with a decrease from baseline in ocular surface disease index score of at least 10 points and changes in dry eye disease signs, for example, non-invasive tear break up time at eight weeks. Results: 299 participants (mean age 28.9 years; 74% female) were randomly assigned to receive laughter exercise (n=149) or 0.1% sodium hyaluronic acid (n=150). 283 (95%) completed the trial. The mean change in ocular surface disease index score at eight weeks was -10.5 points (95% confidence interval (CI) -13.1 to -7.82) in the laughter exercise group and -8.83 (-11.7 to -6.02) in the control group. The upper boundary of the CI for difference in change between groups was lower than the non-inferiority margin (mean difference -1.45 points (95% CI -5.08 to 2.19); P=0.43), supporting non-inferiority. Among secondary outcomes, the laughter exercise was better in improving non-invasive tear break up time (mean difference 2.30 seconds (95% CI 1.30 to 3.30), P<0.001); other secondary outcomes showed no significant difference. No adverse events were noted in either study group. Conclusions: The laughter exercise was non-inferior to 0.1% sodium hyaluronic acid in relieving subjective symptoms in patients with dry eye disease with limited corneal staining over eight weeks intervention. Trial registration: ClinicalTrials.gov NCT04421300. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. PubMed Disclaimer Conflict of interest statement Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the National Natural Science Foundation of China (82070922, 82201142) and the High-level Hospital Construction Project (303020101) for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== what are the health benefits of laughter and what are the symptoms of having dry eyes and what are some of the ingreients in the eye drops {passage 0} ========== t Objective: To assess efficacy and safety of laughter exercise in patients with symptomatic dry eye disease. Design: Non-inferiority randomised controlled trial. Setting: Recruitment was from clinics and community and the trial took place at Zhongshan Ophthalmic Center, Sun Yat-sen University, the largest ophthalmic centre in China, between 18 June 2020 to 8 January 2021. Participants: People with symptomatic dry eye disease aged 18-45 years with ocular surface disease index scores ranging from 18 to 80 and tear film break-up time of eight seconds or less. Interventions: Participants were randomised 1:1 to receive laughter exercise or artificial tears (0.1% sodium hyaluronic acid eyedrop, control group) four times daily for eight weeks. The laughter exercise group viewed an instructional video and participants were requested to vocalise the phrases ""Hee hee hee, hah hah hah, cheese cheese cheese, cheek cheek cheek, hah hah hah hah hah hah"" 30 times per five minute session. Investigators assessing study outcomes were masked to group assignment but participants were unmasked for practical reasons. Main outcome measures: The primary outcome was the mean change in the ocular surface disease index (0-100, higher scores indicating worse ocular surface discomfort) from baseline to eight weeks in the per protocol population. The non-inferiority margin was 6 points of this index score. Main secondary outcomes included the proportion of patients with a decrease from baseline in ocular surface disease index score of at least 10 points and changes in dry eye disease signs, for example, non-invasive tear break up time at eight weeks. Results: 299 participants (mean age 28.9 years; 74% female) were randomly assigned to receive laughter exercise (n=149) or 0.1% sodium hyaluronic acid (n=150). 283 (95%) completed the trial. The mean change in ocular surface disease index score at eight weeks was -10.5 points (95% confidence interval (CI) -13.1 to -7.82) in the laughter exercise group and -8.83 (-11.7 to -6.02) in the control group. The upper boundary of the CI for difference in change between groups was lower than the non-inferiority margin (mean difference -1.45 points (95% CI -5.08 to 2.19); P=0.43), supporting non-inferiority. Among secondary outcomes, the laughter exercise was better in improving non-invasive tear break up time (mean difference 2.30 seconds (95% CI 1.30 to 3.30), P<0.001); other secondary outcomes showed no significant difference. No adverse events were noted in either study group. Conclusions: The laughter exercise was non-inferior to 0.1% sodium hyaluronic acid in relieving subjective symptoms in patients with dry eye disease with limited corneal staining over eight weeks intervention. Trial registration: ClinicalTrials.gov NCT04421300. © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. PubMed Disclaimer Conflict of interest statement Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/disclosure-of-interest/ and declare: support from the National Natural Science Foundation of China (82070922, 82201142) and the High-level Hospital Construction Project (303020101) for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. https://pubmed.ncbi.nlm.nih.gov/39260878/",Medical,Fact Finding,Q&A " Only use the provided text to answer the question, no outside sources. [user request] [context document]",Explain the benefits for a tech company of upgrading their frontend codebase from the AngularJS framework to the modern Angular framework in less than 200 words.,"The Risks of Sticking with Outdated Frameworks Security Vulnerabilities Every software framework, including Angular, has vulnerabilities that are discovered and patched over time. Running an outdated version means your application is exposed to known security issues that could have been mitigated with an upgrade. For example, Angular has had several security updates over the years addressing issues such as Cross-Site Scripting (XSS) and dependency vulnerabilities. By not upgrading, you leave your application susceptible to attacks that can compromise user data and damage your company's reputation. Example: In AngularJs 1.6.3, a critical security vulnerability was discovered that allowed attackers to execute arbitrary JavaScript code via the ngSanitize service. This issue was patched in a subsequent release. Companies still running Angular 1.6.3 or earlier are at risk of exploitation. Despite Angular 1.6.3 being an old version, it serves as an example because many legacy systems still run on AngularJS (Angular 1.x), and these systems are particularly vulnerable if not properly maintained. Performance Improvements Each new version of Angular introduces performance optimizations that make your application faster and more efficient. These improvements are often the result of extensive research and development by the Angular team, and they can have a significant impact on your application's load times and responsiveness. Example: Angular 9 introduced the Ivy compiler, which drastically reduced the size of compiled JavaScript bundles, leading to faster load times and improved performance. Applications that have not upgraded to Angular 9 or later are missing out on these substantial gains. Compatibility and Support Frameworks evolve to support new web standards, browser features, and third-party integrations. Running an outdated version of Angular can lead to compatibility issues with modern tools and libraries, making it harder to integrate new features or technologies into your application. Example: Angular 12 introduced strict mode, which improves maintainability and reduces the likelihood of runtime errors. It also provides better support for TypeScript 4.2, which includes new language features and performance enhancements. Sticking with an older version may result in compatibility issues and technical debt. Developer Satisfaction Developer satisfaction is crucial for retaining top talent and ensuring high productivity levels. Developers prefer working with the latest technologies to stay current with industry trends and advance their careers. Using an outdated tech stack can lead to frustration and decreased motivation, as developers may feel they are missing out on learning and growth opportunities. Nobody wants to work with old technologies that do not provide the modern conveniences, performance improvements, and security features available in newer versions. Example: A team of developers working with an outdated version of Angular might feel demotivated compared to their peers who are using the latest version with advanced features and improved tooling. This can lead to higher turnover rates as developers seek opportunities that allow them to work with cutting-edge technologies. Compliance and Regulatory Requirements Many industries, especially those dealing with sensitive information like finance and healthcare, are subject to strict regulatory requirements. Using outdated software can lead to non-compliance, resulting in fines and legal consequences. Regulatory bodies often require that software be up-to-date and free of known vulnerabilities. Example: In the banking sector, projects are often marked as security risks if they use outdated npm packages with known vulnerabilities. This non-compliance can lead to audits and penalties. Tools like Black Duck and SonarQube (Sonar) scans are frequently used to ensure compliance by identifying and reporting outdated or vulnerable dependencies. Black Duck, for instance, provides detailed reports on open-source component risks, helping teams understand the implications of using outdated libraries. Current Angular Versions As of June 2024, the current supported versions of Angular are 18, 17, 16. Angular follows a regular release cycle with Long-Term Support (LTS) versions that receive updates for an extended period (12 months), providing stability and security for production applications. Unsupported Angular Versions It's important to be aware of the Angular versions that are no longer supported, as they do not receive security updates or bug fixes. Angular versions v2 to v15 are no longer supported. Using these unsupported versions can expose your application to security risks and compatibility issues. Overcoming the Resistance to Upgrade Managers often resist upgrading frameworks due to concerns about the perceived disruption to business delivery. However, the risks associated with running outdated software can far outweigh the temporary inconvenience of an upgrade. Here are some strategies to help convince your manager: Highlight Security Risks: Emphasize the importance of security in protecting user data and maintaining trust. Provide examples of high-profile security breaches that were the result of outdated software. Explain that the cost of a security incident, in terms of both financial impact and reputation damage, can be far greater than the cost of an upgrade. Example: The Equifax data breach in 2017, which exposed the personal information of 147 million people, was partly due to an unpatched vulnerability in a web application framework. This breach resulted in a $700 million settlement. Demonstrate Cost Savings: While the initial investment in upgrading may seem high, it can lead to long-term cost savings by reducing technical debt, minimizing downtime, and improving developer efficiency. Provide a cost-benefit analysis that compares the costs of an upgrade to the potential costs of security breaches, performance issues, and maintenance of outdated code. Example: A study by IBM found that the average cost of a data breach is $3.86 million. Investing in regular upgrades can mitigate these risks and save significant costs in the long run. Showcase Success Stories: Provide case studies of companies that have successfully upgraded their frameworks and reaped the benefits. Highlight improvements in security, performance, and developer productivity. This can help alleviate fears and demonstrate the tangible benefits of staying up-to-date. Example: A major e-commerce company upgraded from AngularJS to Angular 10 and saw a 30% improvement in page load times, resulting in a 15% increase in user engagement and a 10% boost in sales. Plan for Minimal Disruption: Develop a detailed upgrade plan that minimizes disruption to business delivery. This can include phased rollouts, thorough testing, and parallel development to ensure a smooth transition. Demonstrating a well-thought-out plan can help reassure managers that the upgrade will not negatively impact ongoing projects. Example: Conduct a pilot upgrade with a smaller, less critical part of the application to identify potential issues and develop solutions before rolling out the upgrade to the entire system. Creating a Framework or Developer Experience (DX) Team One effective strategy to ensure regular upgrades and maintenance of frameworks is to establish a dedicated Framework or Developer Experience (DX) team. This team can take responsibility for monitoring updates, assessing their impact, and planning upgrades without disrupting the core business activities. Example: A large tech company established a DX team tasked with maintaining the development environment and ensuring all frameworks and libraries are up-to-date. This team conducted regular audits using tools like Black Duck and SonarQube to identify outdated dependencies and potential security risks. They then worked with development teams to plan and implement upgrades in a phased and controlled manner, ensuring minimal disruption to ongoing projects. Example: A financial institution formed a Framework Team to handle all aspects of framework maintenance, including Angular upgrades. This team used automated tools to scan for vulnerabilities and compliance issues, producing regular reports and actionable insights. By centralizing this responsibility, the institution was able to stay compliant with regulatory requirements and avoid potential security risks associated with outdated software."," Only use the provided text to answer the question, no outside sources. Explain the benefits for a tech company of upgrading their frontend codebase from the AngularJS framework to the modern Angular framework in less than 200 words. The Risks of Sticking with Outdated Frameworks Security Vulnerabilities Every software framework, including Angular, has vulnerabilities that are discovered and patched over time. Running an outdated version means your application is exposed to known security issues that could have been mitigated with an upgrade. For example, Angular has had several security updates over the years addressing issues such as Cross-Site Scripting (XSS) and dependency vulnerabilities. By not upgrading, you leave your application susceptible to attacks that can compromise user data and damage your company's reputation. Example: In AngularJs 1.6.3, a critical security vulnerability was discovered that allowed attackers to execute arbitrary JavaScript code via the ngSanitize service. This issue was patched in a subsequent release. Companies still running Angular 1.6.3 or earlier are at risk of exploitation. Despite Angular 1.6.3 being an old version, it serves as an example because many legacy systems still run on AngularJS (Angular 1.x), and these systems are particularly vulnerable if not properly maintained. Performance Improvements Each new version of Angular introduces performance optimizations that make your application faster and more efficient. These improvements are often the result of extensive research and development by the Angular team, and they can have a significant impact on your application's load times and responsiveness. Example: Angular 9 introduced the Ivy compiler, which drastically reduced the size of compiled JavaScript bundles, leading to faster load times and improved performance. Applications that have not upgraded to Angular 9 or later are missing out on these substantial gains. Compatibility and Support Frameworks evolve to support new web standards, browser features, and third-party integrations. Running an outdated version of Angular can lead to compatibility issues with modern tools and libraries, making it harder to integrate new features or technologies into your application. Example: Angular 12 introduced strict mode, which improves maintainability and reduces the likelihood of runtime errors. It also provides better support for TypeScript 4.2, which includes new language features and performance enhancements. Sticking with an older version may result in compatibility issues and technical debt. Developer Satisfaction Developer satisfaction is crucial for retaining top talent and ensuring high productivity levels. Developers prefer working with the latest technologies to stay current with industry trends and advance their careers. Using an outdated tech stack can lead to frustration and decreased motivation, as developers may feel they are missing out on learning and growth opportunities. Nobody wants to work with old technologies that do not provide the modern conveniences, performance improvements, and security features available in newer versions. Example: A team of developers working with an outdated version of Angular might feel demotivated compared to their peers who are using the latest version with advanced features and improved tooling. This can lead to higher turnover rates as developers seek opportunities that allow them to work with cutting-edge technologies. Compliance and Regulatory Requirements Many industries, especially those dealing with sensitive information like finance and healthcare, are subject to strict regulatory requirements. Using outdated software can lead to non-compliance, resulting in fines and legal consequences. Regulatory bodies often require that software be up-to-date and free of known vulnerabilities. Example: In the banking sector, projects are often marked as security risks if they use outdated npm packages with known vulnerabilities. This non-compliance can lead to audits and penalties. Tools like Black Duck and SonarQube (Sonar) scans are frequently used to ensure compliance by identifying and reporting outdated or vulnerable dependencies. Black Duck, for instance, provides detailed reports on open-source component risks, helping teams understand the implications of using outdated libraries. Current Angular Versions As of June 2024, the current supported versions of Angular are 18, 17, 16. Angular follows a regular release cycle with Long-Term Support (LTS) versions that receive updates for an extended period (12 months), providing stability and security for production applications. Unsupported Angular Versions It's important to be aware of the Angular versions that are no longer supported, as they do not receive security updates or bug fixes. Angular versions v2 to v15 are no longer supported. Using these unsupported versions can expose your application to security risks and compatibility issues. Overcoming the Resistance to Upgrade Managers often resist upgrading frameworks due to concerns about the perceived disruption to business delivery. However, the risks associated with running outdated software can far outweigh the temporary inconvenience of an upgrade. Here are some strategies to help convince your manager: Highlight Security Risks: Emphasize the importance of security in protecting user data and maintaining trust. Provide examples of high-profile security breaches that were the result of outdated software. Explain that the cost of a security incident, in terms of both financial impact and reputation damage, can be far greater than the cost of an upgrade. Example: The Equifax data breach in 2017, which exposed the personal information of 147 million people, was partly due to an unpatched vulnerability in a web application framework. This breach resulted in a $700 million settlement. Demonstrate Cost Savings: While the initial investment in upgrading may seem high, it can lead to long-term cost savings by reducing technical debt, minimizing downtime, and improving developer efficiency. Provide a cost-benefit analysis that compares the costs of an upgrade to the potential costs of security breaches, performance issues, and maintenance of outdated code. Example: A study by IBM found that the average cost of a data breach is $3.86 million. Investing in regular upgrades can mitigate these risks and save significant costs in the long run. Showcase Success Stories: Provide case studies of companies that have successfully upgraded their frameworks and reaped the benefits. Highlight improvements in security, performance, and developer productivity. This can help alleviate fears and demonstrate the tangible benefits of staying up-to-date. Example: A major e-commerce company upgraded from AngularJS to Angular 10 and saw a 30% improvement in page load times, resulting in a 15% increase in user engagement and a 10% boost in sales. Plan for Minimal Disruption: Develop a detailed upgrade plan that minimizes disruption to business delivery. This can include phased rollouts, thorough testing, and parallel development to ensure a smooth transition. Demonstrating a well-thought-out plan can help reassure managers that the upgrade will not negatively impact ongoing projects. Example: Conduct a pilot upgrade with a smaller, less critical part of the application to identify potential issues and develop solutions before rolling out the upgrade to the entire system. Creating a Framework or Developer Experience (DX) Team One effective strategy to ensure regular upgrades and maintenance of frameworks is to establish a dedicated Framework or Developer Experience (DX) team. This team can take responsibility for monitoring updates, assessing their impact, and planning upgrades without disrupting the core business activities. Example: A large tech company established a DX team tasked with maintaining the development environment and ensuring all frameworks and libraries are up-to-date. This team conducted regular audits using tools like Black Duck and SonarQube to identify outdated dependencies and potential security risks. They then worked with development teams to plan and implement upgrades in a phased and controlled manner, ensuring minimal disruption to ongoing projects. Example: A financial institution formed a Framework Team to handle all aspects of framework maintenance, including Angular upgrades. This team used automated tools to scan for vulnerabilities and compliance issues, producing regular reports and actionable insights. By centralizing this responsibility, the institution was able to stay compliant with regulatory requirements and avoid potential security risks associated with outdated software. https://dev.to/this-is-angular/the-importance-of-upgrading-frameworks-a-case-for-angular-5c91",Internet/Technology,Effect Analysis,Q&A "If you cannot answer the question using the given text, respond with ""The text does not contain what you are looking for.""","Using only the provided text, Is Sickle Cell Disease hereditary?","**What is Sickle Cell Disease?** Sickle cell disease (SCD) is a group of inherited red blood cell disorders. Red blood cells contain hemoglobin, a protein that carries oxygen. Healthy red blood cells are round, and they move through small blood vessels to carry oxygen to all parts of the body. In someone who has SCD, the hemoglobin is abnormal, which causes the red blood cells to become hard and sticky and look like a C-shaped farm tool called a “sickle.” The sickle cells die early, which causes a constant shortage of red blood cells. Also, when they travel through small blood vessels, they get stuck and clog the blood flow. This can cause pain and other serious complications (health problems) such as infection, acute chest syndrome and stroke. Types of SCD There are several types of SCD. The specific type of SCD a person has depends on the genes they inherited from their parents. People with SCD inherit genes that contain instructions, or code, for abnormal hemoglobin. Below are the most common types of SCD: HbSS People who have this form of SCD inherit two genes, one from each parent, that code for hemoglobin “S.” Hemoglobin S is an abnormal form of hemoglobin that causes the red cells to become rigid, and sickle shaped. This is commonly called sickle cell anemia and is usually the most severe form of the disease. HbSC People who have this form of SCD inherit a hemoglobin “S” gene from one parent and a gene for a different type of abnormal hemoglobin called “C” from the other parent. This is usually a milder form of SCD. Infographic: 5 Facts You Should Know About Sickle Cell Disease Infographic: 5 Facts You Should Know About Sickle Cell Disease Did you know SCD affects people from many parts of the world? HbS beta thalassemia People who have this form of SCD inherit a hemoglobin “S” gene from one parent and a gene for beta thalassemia, another type of hemoglobin abnormality, from the other parent. There are two types of beta thalassemia: “zero” (HbS beta0) and “plus” (HbS beta+). Those with HbS beta0-thalassemia usually have a severe form of SCD. People with HbS beta+-thalassemia tend to have a milder form of SCD. There also are a few rare types of SCD, such as the following: HbSD, HbSE, and HbSO People who have these forms of SCD inherit one hemoglobin “S” gene and one gene that codes for another abnormal type of hemoglobin (“D”, “E”, or “O”). The severity of these rarer types of SCD varies. Sickle Cell Trait (SCT) HbAS People who have sickle cell trait (SCT) inherit a hemoglobin “S” gene from one parent and a normal gene (one that codes for hemoglobin “A”) from the other parent. People with SCT usually do not have any of the signs of the disease. However, in rare cases, a person with SCT may develop health problems; this occurs most often when there are other stresses on the body, such as when a person becomes dehydrated or exercises strenuously. Additionally, people who have SCT can pass the abnormal hemoglobin “S” gene on to their children. Cause of SCD SCD is a genetic condition that is present at birth. It is inherited when a child receives two genes—one from each parent—that code for abnormal hemoglobin. Diagnosis SCD is diagnosed with a simple blood test. In children born in the United States, it most often is found at birth during routine newborn screening tests at the hospital. In addition, SCD can be diagnosed while the baby is in the womb. Diagnostic tests before the baby is born, such as chorionic villus sampling and amniocentesis, can check for chromosomal or genetic abnormalities in the baby. Chorionic villus sampling tests a tiny piece of the placenta, called chorionic villus. Amniocentesis tests a small sample of amniotic fluid surrounding the baby. Because children with SCD are at an increased risk of infection and other health problems, early diagnosis and treatment are important. Complications People with SCD may start to have signs of the disease during the first year of life, usually around 5 months of age. Symptoms and complications of SCD are different for each person and can range from mild to severe. Learn about the complications. Prevention and Treatment of SCD Complications General Prevention Strategies Management of SCD is focused on preventing and treating pain episodes and other complications. Prevention strategies include lifestyle behaviors as well as medical screening and interventions to prevent SCD complications. Lifestyle Behaviors There are simple steps that people with SCD can take to help prevent and reduce the occurrence of pain crises, including the following: Drink plenty of water. Try not to get too hot or too cold. Try to avoid places or situations that cause exposure to high altitudes (for example, flying, mountain climbing, or cities with a high altitude). Try to avoid places or situations with exposure to low oxygen levels (for example, mountain climbing or exercising extremely hard, such as in military boot camp or when training for an athletic competition). Simple steps to prevent harmful infections include the following: Wash your hands often. Washing hands with soap and clean water many times each day is one of the best ways people with SCD, their family members, and other caregivers can help prevent an infection. Prepare food safely. Bacteria can be especially harmful to children with SCD. Medical Screenings & Interventions to Prevent SCD Complications Prevention of Infections Vaccines can protect against harmful infections. It is important that children with SCD get all regular childhood vaccines. Similarly, it is important for children and adults to get the flu vaccine every year, as well as the pneumococcal vaccine and any others recommended by a doctor. Penicillin greatly reduces the risk of infections in people with HbSS and has been shown to be even more effective when it is started earlier. To decrease the risk of infection, it’s important that young children with HbSS take penicillin (or other antibiotic prescribed by a doctor) every day until at least 5 years of age. Penicillin on a daily basis is usually not prescribed for children with other types of SCD unless the severity of the disease is similar to that of HbSS, such as HbS beta0-thalassemia. Prevention of Vision Loss Yearly visits to an eye doctor to look for damage to the retina (the part of your eye that senses light and sends images to your brain) are important for people with SCD to avoid vision loss. If possible, it’s best to see an eye doctor who specializes in diseases of the retina. If the retina is damaged by excessive blood vessel growth, laser treatment often can prevent further vision loss. Prevention of Stroke Children who are at risk for stroke can be identified using a special type of exam called transcranial Doppler ultrasound (TCD). If the child is found to have an abnormal TCD, a doctor might recommend frequent blood transfusions (a procedure in which new blood is put into a person’s body through a small plastic tube inserted into a person’s blood vessels) to help prevent a stroke. People who have frequent blood transfusions are usually watched closely because there can be serious side effects. For example, because blood contains iron, transfusions can lead to a condition called iron overload, in which too much iron builds up in the body. Iron overload can cause life-threatening damage to the liver, heart, and other organs. Therefore, it is important for people with SCD receiving regular blood transfusions to also receive treatment to reduce excess iron in the body. This type of treatment is known as iron chelation therapy. Prevention of Severe Anemia Blood transfusions may be used to treat severe anemia. A sudden worsening of anemia resulting from infection or enlargement of the spleen (an organ in the upper left side of the abdomen) is a common reason for a transfusion. As with preventing stroke, frequent blood transfusions can cause iron overload, and iron chelation therapy may be needed to reduce excess iron in the body. Management of Pain Crises When pain crises do occur, clinical management may include the following: Intravenous fluids (giving fluids directly into a person’s vein) Pain-reducing medicine Hospitalization for severe pain crises Specific Treatments to Prevent SCD Complications SCD is a disease that worsens over time. Treatments are available that can prevent complications and lengthen the lives of those who have this condition. These treatment options and their effects can be different for each person, depending on the symptoms and severity of their disease. It is important to understand the benefits and risks of each treatment option. Currently, the FDA has approved four treatments for SCD[1].","{Task} If you cannot answer the question using the given text, respond with ""The text does not contain what you are looking for."" ================ {Text Passage} **What is Sickle Cell Disease?** Sickle cell disease (SCD) is a group of inherited red blood cell disorders. Red blood cells contain hemoglobin, a protein that carries oxygen. Healthy red blood cells are round, and they move through small blood vessels to carry oxygen to all parts of the body. In someone who has SCD, the hemoglobin is abnormal, which causes the red blood cells to become hard and sticky and look like a C-shaped farm tool called a “sickle.” The sickle cells die early, which causes a constant shortage of red blood cells. Also, when they travel through small blood vessels, they get stuck and clog the blood flow. This can cause pain and other serious complications (health problems) such as infection, acute chest syndrome and stroke. Types of SCD There are several types of SCD. The specific type of SCD a person has depends on the genes they inherited from their parents. People with SCD inherit genes that contain instructions, or code, for abnormal hemoglobin. Below are the most common types of SCD: HbSS People who have this form of SCD inherit two genes, one from each parent, that code for hemoglobin “S.” Hemoglobin S is an abnormal form of hemoglobin that causes the red cells to become rigid, and sickle shaped. This is commonly called sickle cell anemia and is usually the most severe form of the disease. HbSC People who have this form of SCD inherit a hemoglobin “S” gene from one parent and a gene for a different type of abnormal hemoglobin called “C” from the other parent. This is usually a milder form of SCD. Infographic: 5 Facts You Should Know About Sickle Cell Disease Infographic: 5 Facts You Should Know About Sickle Cell Disease Did you know SCD affects people from many parts of the world? HbS beta thalassemia People who have this form of SCD inherit a hemoglobin “S” gene from one parent and a gene for beta thalassemia, another type of hemoglobin abnormality, from the other parent. There are two types of beta thalassemia: “zero” (HbS beta0) and “plus” (HbS beta+). Those with HbS beta0-thalassemia usually have a severe form of SCD. People with HbS beta+-thalassemia tend to have a milder form of SCD. There also are a few rare types of SCD, such as the following: HbSD, HbSE, and HbSO People who have these forms of SCD inherit one hemoglobin “S” gene and one gene that codes for another abnormal type of hemoglobin (“D”, “E”, or “O”). The severity of these rarer types of SCD varies. Sickle Cell Trait (SCT) HbAS People who have sickle cell trait (SCT) inherit a hemoglobin “S” gene from one parent and a normal gene (one that codes for hemoglobin “A”) from the other parent. People with SCT usually do not have any of the signs of the disease. However, in rare cases, a person with SCT may develop health problems; this occurs most often when there are other stresses on the body, such as when a person becomes dehydrated or exercises strenuously. Additionally, people who have SCT can pass the abnormal hemoglobin “S” gene on to their children. Cause of SCD SCD is a genetic condition that is present at birth. It is inherited when a child receives two genes—one from each parent—that code for abnormal hemoglobin. Diagnosis SCD is diagnosed with a simple blood test. In children born in the United States, it most often is found at birth during routine newborn screening tests at the hospital. In addition, SCD can be diagnosed while the baby is in the womb. Diagnostic tests before the baby is born, such as chorionic villus sampling and amniocentesis, can check for chromosomal or genetic abnormalities in the baby. Chorionic villus sampling tests a tiny piece of the placenta, called chorionic villus. Amniocentesis tests a small sample of amniotic fluid surrounding the baby. Because children with SCD are at an increased risk of infection and other health problems, early diagnosis and treatment are important. Complications People with SCD may start to have signs of the disease during the first year of life, usually around 5 months of age. Symptoms and complications of SCD are different for each person and can range from mild to severe. Learn about the complications. Prevention and Treatment of SCD Complications General Prevention Strategies Management of SCD is focused on preventing and treating pain episodes and other complications. Prevention strategies include lifestyle behaviors as well as medical screening and interventions to prevent SCD complications. Lifestyle Behaviors There are simple steps that people with SCD can take to help prevent and reduce the occurrence of pain crises, including the following: Drink plenty of water. Try not to get too hot or too cold. Try to avoid places or situations that cause exposure to high altitudes (for example, flying, mountain climbing, or cities with a high altitude). Try to avoid places or situations with exposure to low oxygen levels (for example, mountain climbing or exercising extremely hard, such as in military boot camp or when training for an athletic competition). Simple steps to prevent harmful infections include the following: Wash your hands often. Washing hands with soap and clean water many times each day is one of the best ways people with SCD, their family members, and other caregivers can help prevent an infection. Prepare food safely. Bacteria can be especially harmful to children with SCD. Medical Screenings & Interventions to Prevent SCD Complications Prevention of Infections Vaccines can protect against harmful infections. It is important that children with SCD get all regular childhood vaccines. Similarly, it is important for children and adults to get the flu vaccine every year, as well as the pneumococcal vaccine and any others recommended by a doctor. Penicillin greatly reduces the risk of infections in people with HbSS and has been shown to be even more effective when it is started earlier. To decrease the risk of infection, it’s important that young children with HbSS take penicillin (or other antibiotic prescribed by a doctor) every day until at least 5 years of age. Penicillin on a daily basis is usually not prescribed for children with other types of SCD unless the severity of the disease is similar to that of HbSS, such as HbS beta0-thalassemia. Prevention of Vision Loss Yearly visits to an eye doctor to look for damage to the retina (the part of your eye that senses light and sends images to your brain) are important for people with SCD to avoid vision loss. If possible, it’s best to see an eye doctor who specializes in diseases of the retina. If the retina is damaged by excessive blood vessel growth, laser treatment often can prevent further vision loss. Prevention of Stroke Children who are at risk for stroke can be identified using a special type of exam called transcranial Doppler ultrasound (TCD). If the child is found to have an abnormal TCD, a doctor might recommend frequent blood transfusions (a procedure in which new blood is put into a person’s body through a small plastic tube inserted into a person’s blood vessels) to help prevent a stroke. People who have frequent blood transfusions are usually watched closely because there can be serious side effects. For example, because blood contains iron, transfusions can lead to a condition called iron overload, in which too much iron builds up in the body. Iron overload can cause life-threatening damage to the liver, heart, and other organs. Therefore, it is important for people with SCD receiving regular blood transfusions to also receive treatment to reduce excess iron in the body. This type of treatment is known as iron chelation therapy. Prevention of Severe Anemia Blood transfusions may be used to treat severe anemia. A sudden worsening of anemia resulting from infection or enlargement of the spleen (an organ in the upper left side of the abdomen) is a common reason for a transfusion. As with preventing stroke, frequent blood transfusions can cause iron overload, and iron chelation therapy may be needed to reduce excess iron in the body. Management of Pain Crises When pain crises do occur, clinical management may include the following: Intravenous fluids (giving fluids directly into a person’s vein) Pain-reducing medicine Hospitalization for severe pain crises Specific Treatments to Prevent SCD Complications SCD is a disease that worsens over time. Treatments are available that can prevent complications and lengthen the lives of those who have this condition. These treatment options and their effects can be different for each person, depending on the symptoms and severity of their disease. It is important to understand the benefits and risks of each treatment option. Currently, the FDA has approved four treatments for SCD[1]. ================ {Question} Using only the provided text, Is Sickle Cell Disease hereditary?",Medical,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",How is a screen test for Colorectal cancer performed and what makes one more likely to get it? How much smoking should I have done in order to need a screening for lung cancer?,"## Colorectal cancer Colorectal cancer is cancer that starts in the colon or rectum. Some factors that increase colorectal cancer risk include physical inactivity, a diet high in red and processed meats, excess body weight, smoking, alcohol use, and a personal or family history of colorectal cancer or polyps. ### What you can do #### Get screened. Regular colorectal cancer screening is one of the best ways to prevent colorectal cancer. Most colorectal cancers start with a polyp – a small growth in the colon or rectum. Screening can help to find colorectal cancer early, when it’s smaller, hasn’t spread, and might be easier to treat. Certain screening tests can also help prevent colorectal cancer by finding and removing polyps before they turn into cancer. The American Cancer Society recommends the following for people at average risk for colorectal cancer: - **Everyone** **should start regular screening at** **age 45.** - People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening **through** **age** **75.** - **For people ages 76 to** **85,** the decision to be screened should be based on a person’s preferences, life expectancy, health, and screening history. - **People over age** **85** should no longer get colorectal cancer screening. Screening can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). These options are listed below. ### Screening tests for colorectal cancer #### Stool-based tests - Fecal immunochemical test (FIT)* every year, **or** - Guaiac-based fecal occult blood test (gFOBT)* every year, **or** - Stool DNA test (MT-sDNA) every 3 years* #### Visual (structural) exams of the colon and rectum - Colonoscopy every 10 years, **or** - CT colonography (virtual colonoscopy)* every 5 years, **or** - Flexible sigmoidoscopy* every 5 years *If a person gets screened with a test other than colonoscopy, any abnormal test result should be followed up with colonoscopy. If you're at high risk of colorectal cancer based on family history or other factors, you may need to start screening before age 45, be screened more often, or get specific tests. There are some differences between these tests to consider, **but the most important thing is to get screened, no matter which test you choose.** Talk to a health care provider about which tests might be good options for you, and to your insurance provider about your coverage. If you don't have insurance or can't afford cancer screening, [find free and low-cost screening options.](https://www.cancer.org/cancer/screening/get-screened.html) ## Lung cancer [Lung cancer](https://www.cancer.org/cancer/types/lung-cancer.html) is the second most common type of cancer in men in the US and the leading cause of cancer death. ### What you can do #### Get screened. The American Cancer Society recommends yearly lung cancer screening with a low-dose CT (LDCT) scan for people who: - **Are ages 50 to 80 years** and smoke or used to smoke **AND** - **Have at least a 20 pack-year history of smoking** (A pack-year is equal to smoking 1 pack of cigarettes per day for a year. For example, a person could have a 20 pack-year history by smoking 1 pack a day for 20 years or by smoking 2 packs a day for 10 years.) Before deciding to get screened, people should talk to their health care provider about the purpose of screening, how it's done, the benefits, limitations, and possible harms of screening. People who still smoke should be counseled about quitting and offered resources to help them quit. #### Avoid tobacco and exposures. Not all lung cancers are preventable. But there are things you can do to lower your risk. - If you don’t smoke, don’t start. Avoid breathing in other people’s smoke. - If you smoke, call the American Cancer Society at 1-800-227-2345 or visit [Empowered to Quit](https://www.cancer.org/cancer/risk-prevention/tobacco/empowered-to-quit.html) for help quitting. While smoking tobacco is the leading cause of cancer, not all people who get lung cancer smoke. Other ways you can help lower your risk: - Avoid all products with tobacco. - Stay away from secondhand smoke. - Avoid or limit exposure to cancer-causing chemicals that might be in the home or workplace.","""================ ======= ## Colorectal cancer Colorectal cancer is cancer that starts in the colon or rectum. Some factors that increase colorectal cancer risk include physical inactivity, a diet high in red and processed meats, excess body weight, smoking, alcohol use, and a personal or family history of colorectal cancer or polyps. ### What you can do #### Get screened. Regular colorectal cancer screening is one of the best ways to prevent colorectal cancer. Most colorectal cancers start with a polyp – a small growth in the colon or rectum. Screening can help to find colorectal cancer early, when it’s smaller, hasn’t spread, and might be easier to treat. Certain screening tests can also help prevent colorectal cancer by finding and removing polyps before they turn into cancer. The American Cancer Society recommends the following for people at average risk for colorectal cancer: - **Everyone** **should start regular screening at** **age 45.** - People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening **through** **age** **75.** - **For people ages 76 to** **85,** the decision to be screened should be based on a person’s preferences, life expectancy, health, and screening history. - **People over age** **85** should no longer get colorectal cancer screening. Screening can be done either with a sensitive test that looks for signs of cancer in a person’s stool (a stool-based test), or with an exam that looks at the colon and rectum (a visual exam). These options are listed below. ### Screening tests for colorectal cancer #### Stool-based tests - Fecal immunochemical test (FIT)* every year, **or** - Guaiac-based fecal occult blood test (gFOBT)* every year, **or** - Stool DNA test (MT-sDNA) every 3 years* #### Visual (structural) exams of the colon and rectum - Colonoscopy every 10 years, **or** - CT colonography (virtual colonoscopy)* every 5 years, **or** - Flexible sigmoidoscopy* every 5 years *If a person gets screened with a test other than colonoscopy, any abnormal test result should be followed up with colonoscopy. If you're at high risk of colorectal cancer based on family history or other factors, you may need to start screening before age 45, be screened more often, or get specific tests. There are some differences between these tests to consider, **but the most important thing is to get screened, no matter which test you choose.** Talk to a health care provider about which tests might be good options for you, and to your insurance provider about your coverage. If you don't have insurance or can't afford cancer screening, [find free and low-cost screening options.](https://www.cancer.org/cancer/screening/get-screened.html) ## Lung cancer [Lung cancer](https://www.cancer.org/cancer/types/lung-cancer.html) is the second most common type of cancer in men in the US and the leading cause of cancer death. ### What you can do #### Get screened. The American Cancer Society recommends yearly lung cancer screening with a low-dose CT (LDCT) scan for people who: - **Are ages 50 to 80 years** and smoke or used to smoke **AND** - **Have at least a 20 pack-year history of smoking** (A pack-year is equal to smoking 1 pack of cigarettes per day for a year. For example, a person could have a 20 pack-year history by smoking 1 pack a day for 20 years or by smoking 2 packs a day for 10 years.) Before deciding to get screened, people should talk to their health care provider about the purpose of screening, how it's done, the benefits, limitations, and possible harms of screening. People who still smoke should be counseled about quitting and offered resources to help them quit. #### Avoid tobacco and exposures. Not all lung cancers are preventable. But there are things you can do to lower your risk. - If you don’t smoke, don’t start. Avoid breathing in other people’s smoke. - If you smoke, call the American Cancer Society at 1-800-227-2345 or visit [Empowered to Quit](https://www.cancer.org/cancer/risk-prevention/tobacco/empowered-to-quit.html) for help quitting. While smoking tobacco is the leading cause of cancer, not all people who get lung cancer smoke. Other ways you can help lower your risk: - Avoid all products with tobacco. - Stay away from secondhand smoke. - Avoid or limit exposure to cancer-causing chemicals that might be in the home or workplace. https://www.cancer.org/cancer/risk-prevention/understanding-cancer-risk/cancer-facts/cancer-facts-for-men.html ================ ======= How is a screen test for Colorectal cancer performed and what makes one more likely to get it? How much smoking should I have done in order to need a screening for lung cancer? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Fact Finding,Q&A "Solely utilize information found in the text within the prompt to answer, do not rely on any other information when drawing conclusions. Try to avoid using complex legal terms, simplify for easier reading where possible.",Give the names of all of the courts in which Smith's case has been considered according to the context document.,"Before trial, Smith moved to dismiss the indictment for lack of venue, citing the Constitution’s Venue Clause, Art. III, §2, cl. 3, and its Vicinage Clause, Amdt. 6. Smith argued that trial in the Northern District of Florida was improper because he had accessed StrikeLines’ website from his home in Mobile (in the Southern District of Alabama) and the servers storing StrikeLines’ data were located in Orlando (in the Middle District of Florida). The District Court concluded that factual disputes related to venue should be resolved by the jury and denied Smith’s motion to dismiss without prejudice. The jury found Smith guilty, and Smith moved for a judgment of acquittal based on improper venue. See Fed. Rule Crim. Proc. 29. The District Court denied the motion, reasoning that the effects of Smith’s crime were felt at StrikeLines’ headquarters, located in the Northern District of Florida. On appeal, the Eleventh Circuit determined that venue was improper, but disagreed with Smith that a trial in an improper venue barred reprosecution. The Eleventh Circuit therefore vacated Smith’s conviction for theft of trade secrets. Held: The Constitution permits the retrial of a defendant following a trial in an improper venue conducted before a jury drawn from the wrong district. Pp. 3–16. (a) Except as prohibited by the Double Jeopardy Clause, it “has long been the rule that when a defendant obtains a reversal of a prior, unsatisfied conviction, he may be retried in the normal course of events.” United States v. Ewell, 383 U. S. 116, 121. In all circumstances outside of the Speedy Trial Clause, the strongest appropriate remedy for trial error is a new trial, not a judgment barring reprosecution. Pp. 3–4. 2 SMITH v. UNITED STATES Syllabus (1) Text and precedent provide no basis for concluding that violations of the Venue and Vicinage Clauses are exceptions to the retrial rule. The Venue Clause mandates that the “Trial of all Crimes . . . shall be held in the State where the . . . Crimes shall have been committed.” Art. III, §2, cl. 3. Nothing about this language suggests that a new trial in the proper venue is not an adequate remedy for its violation. Smith primarily argues that the Venue Clause aims to prevent the infliction of additional harm on a defendant who has already undergone the hardship of an initial trial in a distant and improper place. But the mere burden of a second trial has never justified an exemption from the retrial rule. See Ewell, 383 U. S., at 121. Indeed, while the most convenient trial venue for a defendant would presumably be where he lives, the Venue Clause is keyed to the location of the alleged crimes. The Clause does not allow “variation . . . for convenience of the . . . accused,” Johnston v. United States, 351 U. S. 215, 221, and this Court has repeatedly rejected objections based on the hardships created when a defendant is prosecuted far from home.","Solely utilize information found in the text within the prompt to answer, do not rely on any other information when drawing conclusions. Try to avoid using complex legal terms, simplify for easier reading where possible. Before trial, Smith moved to dismiss the indictment for lack of venue, citing the Constitution’s Venue Clause, Art. III, §2, cl. 3, and its Vicinage Clause, Amdt. 6. Smith argued that trial in the Northern District of Florida was improper because he had accessed StrikeLines’ website from his home in Mobile (in the Southern District of Alabama) and the servers storing StrikeLines’ data were located in Orlando (in the Middle District of Florida). The District Court concluded that factual disputes related to venue should be resolved by the jury and denied Smith’s motion to dismiss without prejudice. The jury found Smith guilty, and Smith moved for a judgment of acquittal based on improper venue. See Fed. Rule Crim. Proc. 29. The District Court denied the motion, reasoning that the effects of Smith’s crime were felt at StrikeLines’ headquarters, located in the Northern District of Florida. On appeal, the Eleventh Circuit determined that venue was improper, but disagreed with Smith that a trial in an improper venue barred reprosecution. The Eleventh Circuit therefore vacated Smith’s conviction for theft of trade secrets. Held: The Constitution permits the retrial of a defendant following a trial in an improper venue conducted before a jury drawn from the wrong district. Pp. 3–16. (a) Except as prohibited by the Double Jeopardy Clause, it “has long been the rule that when a defendant obtains a reversal of a prior, unsatisfied conviction, he may be retried in the normal course of events.” United States v. Ewell, 383 U. S. 116, 121. In all circumstances outside of the Speedy Trial Clause, the strongest appropriate remedy for trial error is a new trial, not a judgment barring reprosecution. Pp. 3–4. 2 SMITH v. UNITED STATES Syllabus (1) Text and precedent provide no basis for concluding that violations of the Venue and Vicinage Clauses are exceptions to the retrial rule. The Venue Clause mandates that the “Trial of all Crimes . . . shall be held in the State where the . . . Crimes shall have been committed.” Art. III, §2, cl. 3. Nothing about this language suggests that a new trial in the proper venue is not an adequate remedy for its violation. Smith primarily argues that the Venue Clause aims to prevent the infliction of additional harm on a defendant who has already undergone the hardship of an initial trial in a distant and improper place. But the mere burden of a second trial has never justified an exemption from the retrial rule. See Ewell, 383 U. S., at 121. Indeed, while the most convenient trial venue for a defendant would presumably be where he lives, the Venue Clause is keyed to the location of the alleged crimes. The Clause does not allow “variation . . . for convenience of the . . . accused,” Johnston v. United States, 351 U. S. 215, 221, and this Court has repeatedly rejected objections based on the hardships created when a defendant is prosecuted far from home. Give the names of all of the courts in which Smith's case has been considered according to the context document.",Legal,Find & Summarize,Text Transformation Answer this question using only the text provided. Do not include additional online sourcing.,What is a catalyst fee?,"**TALKING TURKEY: IMPACT FUND FILES AMICUS BRIEF TO PROTECT CATALYST FEES FOR PLAINTIFFS** Nov 14 Meredith Dixon, Impact Fund Law Fellow Last week, the Impact Fund and fifteen fellow public interest legal organizations filed an amicus brief in the California Court of Appeals defending plaintiffs’ right to catalyst fees in public interest lawsuits. “Catalyst fees” are one type of attorneys’ fees designed to compensate attorney time spent on public interest lawsuits that catalyze a change in the defendant’s behavior. Not only do catalyst fees incentivize private enforcement, but they also address a specific and serious concern. Plaintiffs face the risk that defendants will vigorously litigate for months or years and then—on the eve of or during trial—fix the very problem challenged in the litigation, moot the case, and escape compensating plaintiffs for the time and effort required to call attention to the problem. In Direct Action Everywhere v. Diestel Turkey Ranch, the plaintiff encountered just this situation after it filed a false advertising lawsuit alleging that Diestel was deceiving customers about the condition in which it kept animals on its properties. Several days into the trial, Diestel voluntarily removed the allegedly false statements from its website as part of a “website refresh.” Our brief describes California’s decades-long recognition of the role of attorneys’ fees in encouraging private enforcement of the state’s civil rights laws. The trial court denied Direct Action’s motion for catalyst fees for multiple reasons, two of which stood out to the Impact Fund and its allies. First, the court scorned the plaintiff’s reason for bringing the lawsuit and, second, it criticized the plaintiff’s activities outside the courtroom. Ultimately, the court held that plaintiffs do not deserve fees when they file litigation consistent with their organizational goals or fail to behave in a manner “above reproach” before and during the litigation. Our brief describes California’s decades-long recognition of the role of attorneys’ fees in encouraging private enforcement of the state’s civil rights laws. The State Legislature and Supreme Court have defined the factors that determine whether a plaintiff is entitled to attorneys’ fees, and the trial court’s order bore little resemblance to the established analysis. If the trial court’s reasoning is allowed to stand, courts could withhold fees simply because an organizational plaintiff files mission-aligned litigation or acts in a manner that displeases them, from issuing press releases to engaging in protests or policy advocacy, regardless of whether those acts violate any law or have any effect on the litigation. This is not what the legislature or supreme court intended. California courts have long recognized that catalyst fees are key to encouraging public interest litigation, and the Impact Fund and amici continue to defend the proper catalyst fee analysis. ","{Article} ================== **TALKING TURKEY: IMPACT FUND FILES AMICUS BRIEF TO PROTECT CATALYST FEES FOR PLAINTIFFS** Nov 14 Meredith Dixon, Impact Fund Law Fellow Last week, the Impact Fund and fifteen fellow public interest legal organizations filed an amicus brief in the California Court of Appeals defending plaintiffs’ right to catalyst fees in public interest lawsuits. “Catalyst fees” are one type of attorneys’ fees designed to compensate attorney time spent on public interest lawsuits that catalyze a change in the defendant’s behavior. Not only do catalyst fees incentivize private enforcement, but they also address a specific and serious concern. Plaintiffs face the risk that defendants will vigorously litigate for months or years and then—on the eve of or during trial—fix the very problem challenged in the litigation, moot the case, and escape compensating plaintiffs for the time and effort required to call attention to the problem. In Direct Action Everywhere v. Diestel Turkey Ranch, the plaintiff encountered just this situation after it filed a false advertising lawsuit alleging that Diestel was deceiving customers about the condition in which it kept animals on its properties. Several days into the trial, Diestel voluntarily removed the allegedly false statements from its website as part of a “website refresh.” Our brief describes California’s decades-long recognition of the role of attorneys’ fees in encouraging private enforcement of the state’s civil rights laws. The trial court denied Direct Action’s motion for catalyst fees for multiple reasons, two of which stood out to the Impact Fund and its allies. First, the court scorned the plaintiff’s reason for bringing the lawsuit and, second, it criticized the plaintiff’s activities outside the courtroom. Ultimately, the court held that plaintiffs do not deserve fees when they file litigation consistent with their organizational goals or fail to behave in a manner “above reproach” before and during the litigation. Our brief describes California’s decades-long recognition of the role of attorneys’ fees in encouraging private enforcement of the state’s civil rights laws. The State Legislature and Supreme Court have defined the factors that determine whether a plaintiff is entitled to attorneys’ fees, and the trial court’s order bore little resemblance to the established analysis. If the trial court’s reasoning is allowed to stand, courts could withhold fees simply because an organizational plaintiff files mission-aligned litigation or acts in a manner that displeases them, from issuing press releases to engaging in protests or policy advocacy, regardless of whether those acts violate any law or have any effect on the litigation. This is not what the legislature or supreme court intended. California courts have long recognized that catalyst fees are key to encouraging public interest litigation, and the Impact Fund and amici continue to defend the proper catalyst fee analysis. ================ {Task Information} ================== Answer this question using only the text provided. Do not include additional online sourcing. ================ {Query} ================== What is a catalyst fee?",Legal,Explanation/Definition,Q&A Answer based only on the information provided in the prompt.,Why are opioids used so much in the United States?,"Policymakers interested in addressing the opioid epidemic may want to understand why the United States consumes a disproportionate amount of opioids. The scientific evidence suggests that many factors may influence this disparity between the United States and other economically advanced countries. This report synthesizes the scientific research to explain relevant factors regarding the difference between opioid consumption in the United States and other comparable industrialized countries, such as the G-7 countries. A review of scientific literature on international and domestic opioid use pointed to several factors affecting the difference in consumption per capita.3 Prescribing practices of health care providers appear to be a primary factor affecting consumption. U.S. health care providers prescribe opioids more frequently, at higher doses, and throughout more stages of pain treatment—including as a first-line treatment—than their European counterparts. Use of higher-potency opioids—with greater morphine milligram equivalents (MMEs) per dose—appears especially high in the United States compared with other countries. Although there is generally no agreed upon threshold value of what constitutes a “high potency” opioid,4 clinical guidelines and research studies often use MMEs per day or per dose to establish a threshold.5 The MME metric allows for standardization of dose across different opioid analgesics. Table 1 lists the MME conversion factors of several commonly used opioid analgesics, as defined by the U.S. Centers for Disease Control and Prevention (CDC).6 Clinical guidelines published by the World Health Organization (WHO) and others discourage using high-potency opioids and opioids as a first-line treatment for long-term chronic noncancer pain management.7 Several additional factors besides higher prescribing practices may explain the higher relative use of opioids in the United States. It is possible the United States has a greater prevalence of pain, and that Americans experience, or at least self-report, more intense pain. Americans may receive more opioids at more frequent points in care rather than more comprehensive approaches to pain management, such as those that use combinations of pharmaceutical, psychological, and physical therapies. Higher opioid-prescribing practices may be driven by insurance reimbursement systems that incentivize opioids over alternative pain treatments, cost structures that promote more efficient care, or evaluations that prioritize patient satisfaction and conflate it with pain management. Compared with most of its European counterparts, the U.S. medical system allows for more autonomy for health care providers, imposes fewer national government regulations on health care practices, and permits more direct-to-provider marketing practices. In addition, prescription drug monitoring programs (PDMPs) in the United States are decentralized. PDMPs in the United States are generally structured to monitor bad actors and generally not designed to promote best practices aligned with clinical guidance. More broadly, cultural differences, such as expectations about pain relief and entitlements to opioid treatment, may also explain the greater reliance on pharmacological treatments in the United States. Health care systems that provide more expansive access to care may allow for greater preventive care and more multimodal approaches to pain, in part because there may be fewer barriers to using these types of treatments. Moreover, providers operating in highly regulated systems may be less susceptible to the direct and indirect influences experienced by American providers, such as profit-driven fee-for-service incentives or direct-to-provider pharmaceutical marketing. The U.S. federal government leaves the majority of medical practice regulation to individual states. This decentralized system may impose rules governing prescribing practices (e.g., those instituted in European countries to prevent adverse outcomes of opioid use) at a slower pace than those imposed by centrally governed health care systems.","System Instructions: Answer based only on the information provided in the prompt. Question: Why are opioids used so much in the United States? Context: Policymakers interested in addressing the opioid epidemic may want to understand why the United States consumes a disproportionate amount of opioids. The scientific evidence suggests that many factors may influence this disparity between the United States and other economically advanced countries. This report synthesizes the scientific research to explain relevant factors regarding the difference between opioid consumption in the United States and other comparable industrialized countries, such as the G-7 countries. A review of scientific literature on international and domestic opioid use pointed to several factors affecting the difference in consumption per capita.3 Prescribing practices of health care providers appear to be a primary factor affecting consumption. U.S. health care providers prescribe opioids more frequently, at higher doses, and throughout more stages of pain treatment—including as a first-line treatment—than their European counterparts. Use of higher-potency opioids—with greater morphine milligram equivalents (MMEs) per dose—appears especially high in the United States compared with other countries. Although there is generally no agreed upon threshold value of what constitutes a “high potency” opioid,4 clinical guidelines and research studies often use MMEs per day or per dose to establish a threshold.5 The MME metric allows for standardization of dose across different opioid analgesics. Table 1 lists the MME conversion factors of several commonly used opioid analgesics, as defined by the U.S. Centers for Disease Control and Prevention (CDC).6 Clinical guidelines published by the World Health Organization (WHO) and others discourage using high-potency opioids and opioids as a first-line treatment for long-term chronic noncancer pain management.7 Several additional factors besides higher prescribing practices may explain the higher relative use of opioids in the United States. It is possible the United States has a greater prevalence of pain, and that Americans experience, or at least self-report, more intense pain. Americans may receive more opioids at more frequent points in care rather than more comprehensive approaches to pain management, such as those that use combinations of pharmaceutical, psychological, and physical therapies. Higher opioid-prescribing practices may be driven by insurance reimbursement systems that incentivize opioids over alternative pain treatments, cost structures that promote more efficient care, or evaluations that prioritize patient satisfaction and conflate it with pain management. Compared with most of its European counterparts, the U.S. medical system allows for more autonomy for health care providers, imposes fewer national government regulations on health care practices, and permits more direct-to-provider marketing practices. In addition, prescription drug monitoring programs (PDMPs) in the United States are decentralized. PDMPs in the United States are generally structured to monitor bad actors and generally not designed to promote best practices aligned with clinical guidance. More broadly, cultural differences, such as expectations about pain relief and entitlements to opioid treatment, may also explain the greater reliance on pharmacological treatments in the United States. Health care systems that provide more expansive access to care may allow for greater preventive care and more multimodal approaches to pain, in part because there may be fewer barriers to using these types of treatments. Moreover, providers operating in highly regulated systems may be less susceptible to the direct and indirect influences experienced by American providers, such as profit-driven fee-for-service incentives or direct-to-provider pharmaceutical marketing. The U.S. federal government leaves the majority of medical practice regulation to individual states. This decentralized system may impose rules governing prescribing practices (e.g., those instituted in European countries to prevent adverse outcomes of opioid use) at a slower pace than those imposed by centrally governed health care systems.",Medical,Explanation/Definition,Q&A "Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. [user request] [context document]",I am trying to find one statistic but I don't know which one I'm looking for. Can you make a list of all the statistics included in this text?,"With a large portion of face-to-face visits off the table during the pandemic, healthcare providers have had to look for new ways to interact with non-emergency patients. Doctors have been able to consult patients remotely, diagnose conditions, and even review X-rays and CT scans in high definition – often collaboratively with other experts in remote locations. In turn, people have become more accepting of remote healthcare services and telemedicine, with Ernest Young reporting that 54% of patients with chronic diseases now accept remote healthcare. That’s a welcome trend: research shows that 30% of hospital visits from patients with common chronic conditions are in fact unnecessary, tie-up resources, and cost the industry upwards of $8.3 billion per year. For patients, the online approach means better and safer access, less wasted time, and lower costs. The ability to see a doctor regardless of location has helped democratize healthcare access for many people in underserved areas. Solutions for emergency response Much like connectivity sits at the core of remote healthcare, it can drive up the efficacy of emergency response during the “golden hour”, the time when effective medical intervention can mean the difference between life and death. Historically, it’s been impossible to share data between ambulances, A&E departments, and experts in a way that enables a real-time response. A 5G-powered remote emergency channel that links to a command centre gives doctors equipped with VR glasses the same view as if they were actually inside the ambulance. Doctors receive data on a patient’s vital signs in real-time on a large screen in the command centre, including the patient's ECG, ultrasound image, blood pressure, heart rate, oxygen saturation, and temperature. The patient's medical history can be quickly established, doctors can guide paramedics in the ambulance, and patients can be admitted to hospital immediately after arrival with their details and condition known. This isn’t something for the future – many hospitals in China are already using this solution. Discover How is the World Economic Forum bringing data-driven healthcare to life? Speed and precision with AI Alongside remote technologies and 5G, AI is emerging as a key technology in the tech-powered healthcare armory. It’s been instrumental, for example, along with the rapid rollout of COVID-19 vaccines, the large-scale virtual screening for potential drugs and shortening the simulation time from one month to less than one day. Equally, AI can offset a shortage of specialists, such as ultrasound experts who can interpret echocardiograms to diagnose heart disease. A single expert can diagnose just 40 cases per day, which for patients translates into a waiting time of nearly one week. By training algorithms in small-sample data for 10 heart conditions, we’ve developed the B Ultrasound solution that can speed up the diagnosis process by between five to 10 times. Proactive healthcare with wearables In addition to B Ultrasound, since 2018 we’ve been working with more than 80 hospitals in China on the world's largest heart-health research project. With the consent of the research subjects, we’ve collected anonymized data from nearly 3.1 million people. Our smart wearable devices can collect signals from users in real-time, identify abnormal heart rhythms with AI, and upload the results to Huawei Research. Cloud AI then pushes information about high-risk people to the remote medical management platform of the hospitals we’re working with, so that healthcare workers can take appropriate measures.","Answer the question based solely on the information provided in the passage. Do not use any external knowledge or resources. I am trying to find one statistic but I don't know which one I'm looking for. Can you make a list of all the statistics included in this text? With a large portion of face-to-face visits off the table during the pandemic, healthcare providers have had to look for new ways to interact with non-emergency patients. Doctors have been able to consult patients remotely, diagnose conditions, and even review X-rays and CT scans in high definition – often collaboratively with other experts in remote locations. In turn, people have become more accepting of remote healthcare services and telemedicine, with Ernest Young reporting that 54% of patients with chronic diseases now accept remote healthcare. That’s a welcome trend: research shows that 30% of hospital visits from patients with common chronic conditions are in fact unnecessary, tie-up resources, and cost the industry upwards of $8.3 billion per year. For patients, the online approach means better and safer access, less wasted time, and lower costs. The ability to see a doctor regardless of location has helped democratize healthcare access for many people in underserved areas. Solutions for emergency response Much like connectivity sits at the core of remote healthcare, it can drive up the efficacy of emergency response during the “golden hour”, the time when effective medical intervention can mean the difference between life and death. Historically, it’s been impossible to share data between ambulances, A&E departments, and experts in a way that enables a real-time response. A 5G-powered remote emergency channel that links to a command centre gives doctors equipped with VR glasses the same view as if they were actually inside the ambulance. Doctors receive data on a patient’s vital signs in real-time on a large screen in the command centre, including the patient's ECG, ultrasound image, blood pressure, heart rate, oxygen saturation, and temperature. The patient's medical history can be quickly established, doctors can guide paramedics in the ambulance, and patients can be admitted to hospital immediately after arrival with their details and condition known. This isn’t something for the future – many hospitals in China are already using this solution. Discover How is the World Economic Forum bringing data-driven healthcare to life? Speed and precision with AI Alongside remote technologies and 5G, AI is emerging as a key technology in the tech-powered healthcare armory. It’s been instrumental, for example, along with the rapid rollout of COVID-19 vaccines, the large-scale virtual screening for potential drugs and shortening the simulation time from one month to less than one day. Equally, AI can offset a shortage of specialists, such as ultrasound experts who can interpret echocardiograms to diagnose heart disease. A single expert can diagnose just 40 cases per day, which for patients translates into a waiting time of nearly one week. By training algorithms in small-sample data for 10 heart conditions, we’ve developed the B Ultrasound solution that can speed up the diagnosis process by between five to 10 times. Proactive healthcare with wearables In addition to B Ultrasound, since 2018 we’ve been working with more than 80 hospitals in China on the world's largest heart-health research project. With the consent of the research subjects, we’ve collected anonymized data from nearly 3.1 million people. Our smart wearable devices can collect signals from users in real-time, identify abnormal heart rhythms with AI, and upload the results to Huawei Research. Cloud AI then pushes information about high-risk people to the remote medical management platform of the hospitals we’re working with, so that healthcare workers can take appropriate measures. https://www.weforum.org/agenda/2021/10/smart-technologies-transforming-healthcare/",Medical,Find & Summarize,Text Transformation "Answer in a full sentence, no less than 50 words, and cite the part of the text that supports your statement.",Under the EEOC does an employer always have to modify the dress code to accommodate for an employee's religious practices?,"## U.S. Equal Employment Opportunity Commision ### Prohibited Employment Policies/Practices Under the laws enforced by EEOC, it is illegal to discriminate against someone (applicant or employee) because of that person's race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. It is also illegal to retaliate against a person because he or she complained about discrimination, filed a charge of discrimination, or participated in an employment discrimination investigation or lawsuit. ### The law forbids discrimination in every aspect of employment. The laws enforced by EEOC prohibit an employer or other covered entity from using neutral employment policies and practices that have a disproportionately negative effect on applicants or employees of a particular race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), or national origin, or on an individual with a disability or class of individuals with disabilities, if the polices or practices at issue are not job-related and necessary to the operation of the business. The laws enforced by EEOC also prohibit an employer from using neutral employment policies and practices that have a disproportionately negative impact on applicants or employees age 40 or older, if the policies or practices at issue are not based on a reasonable factor other than age. ### Job Advertisements It is illegal for an employer to publish a job advertisement that shows a preference for or discourages someone from applying for a job because of his or her race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. ### Recruitment It is also illegal for an employer to recruit new employees in a way that discriminates against them because of their race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. ### Application & Hiring It is illegal for an employer to discriminate against a job applicant because of his or her race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. For example, an employer may not refuse to give employment applications to people of a certain race. If an employer requires job applicants to take a test, the test must be necessary and related to the job and the employer may not exclude people of a particular race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, or individuals with disabilities. In addition, the employer may not use a test that excludes applicants age 40 or older if the test is not based on a reasonable factor other than age. If a job applicant with a disability needs an accommodation (such as a sign language interpreter) to apply for a job, the employer is required to provide the accommodation, so long as the accommodation does not cause the employer significant difficulty or expense. ### Background Checks See ""Pre-Employment Inquiries"" below. ### Job Referrals It is illegal for an employer, employment agency or union to take into account a person's race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information when making decisions about job referrals. ### Job Assignments & Promotions It is illegal for an employer to make decisions about job assignments and promotions based on an employee's race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. For example, an employer may not give preference to employees of a certain race when making shift assignments and may not segregate employees of a particular national origin from other employees or from customers. If an employer requires employees to take a test before making decisions about assignments or promotions, the test may not exclude people of a particular race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), or national origin, or individuals with disabilities, unless the employer can show that the test is necessary and related to the job. In addition, the employer may not use a test that excludes employees age 40 or older if the test is not based on a reasonable factor other than age. ### Pay And Benefits It is illegal for an employer to discriminate against an employee in the payment of wages or employee benefits on the bases of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. Employee benefits include sick and vacation leave, insurance, access to overtime as well as overtime pay, and retirement programs. For example, an employer many not pay Hispanic workers less than African-American workers because of their national origin, and men and women in the same workplace must be given equal pay for equal work. ### Discipline & Discharge An employer may not take into account a person's race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information when making decisions about discipline or discharge. For example, if two employees commit a similar offense, an employer many not discipline them differently because of their race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. ### Reasonable Accommodation & Disability The law requires that an employer provide reasonable accommodation to an employee or job applicant with a disability, unless doing so would cause significant difficulty or expense for the employer. Reasonable Accommodation & Pregnancy, Childbirth, or Related Medical Conditions The law requires that an employer provide reasonable accommodation to a qualified employee or job applicant with a known limitation related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions, unless doing so would cause significant difficulty or expense for the employer. ### Reasonable Accommodation & Religion The law requires an employer to reasonably accommodate an employee's religious beliefs or practices, unless doing so would cause difficulty or expense for the employer. This means an employer may have to make reasonable adjustments at work that will allow the employee to practice his or her religion, such as allowing an employee to voluntarily swap shifts with a co- worker so that he or she can attend religious services. ### Training & Apprenticeship Programs It is illegal for a training or apprenticeship program to discriminate on the bases of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. For example, an employer may not deny training opportunities to African-American employees because of their race. In some situations, an employer may be allowed to set age limits for participation in an apprenticeship program. ### Harassment It is illegal to harass an employee because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. It is also illegal to harass someone because they have complained about discrimination, filed a charge of discrimination, or participated in an employment discrimination investigation or lawsuit. Harassment can take the form of slurs, graffiti, offensive or derogatory comments, or other verbal or physical conduct. Sexual harassment (including unwelcome sexual advances, requests for sexual favors, and other conduct of a sexual nature) is also unlawful. Although the law does not prohibit simple teasing, offhand comments, or isolated incidents that are not very serious, harassment is illegal if it is so frequent or severe that it creates a hostile or offensive work environment or if it results in an adverse employment decision (such as the victim being fired or demoted). ### Terms & Conditions Of Employment The law makes it illegal for an employer to make any employment decision because of a person's race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. That means an employer may not discriminate when it comes to such things as hiring, firing, promotions, and pay. It also means an employer may not discriminate, for example, when granting breaks, approving leave, assigning work stations, or setting any other term or condition of employment. ### Pre-Employment Inquiries (General) As a general rule, the information obtained and requested through the pre-employment process should be limited to those essential for determining if a person is qualified for the job; whereas, information regarding race, sex, national origin, age, and religion are irrelevant in such determinations. Although state and federal equal opportunity laws do not clearly forbid employers from making pre-employment inquiries that relate to, or disproportionately screen out members based on race, color, sex, national origin, religion, or age, such inquiries may be used as evidence of an employer's intent to discriminate unless the questions asked can be justified by some business purpose. Therefore, inquiries about organizations, clubs, societies, and lodges of which an applicant may be a member or any other questions, which may indicate the applicant's race, sex, national origin, disability status, age, religion, color or ancestry if answered, should generally be avoided. Similarly, employers should not ask for a photograph of an applicant. If needed for identification purposes, a photograph may be obtained after an offer of employment is made and accepted. ### Pre-Employment Inquiries and: * Race * Height & Weight * Financial Information * Unemployed Status * Background Checks * Religious Affiliation Or Beliefs * Citizenship * Marital Status, Number Of Children * Gender * Disability * Medical Questions & Examinations ### Dress Code In general, an employer may establish a dress code which applies to all employees or employees within certain job categories. However, there are a few possible exceptions. While an employer may require all workers to follow a uniform dress code even if the dress code conflicts with some workers' ethnic beliefs or practices, a dress code must not treat some employees less favorably because of their national origin. For example, a dress code that prohibits certain kinds of ethnic dress, such as traditional African or East Indian attire, but otherwise permits casual dress would treat some employees less favorably because of their national origin. Moreover, if the dress code conflicts with an employee's religious practices and the employee requests an accommodation, the employer must modify the dress code or permit an exception to the dress code unless doing so would result in undue hardship. Similarly, if an employee requests an accommodation to the dress code because of his disability, the employer must modify the dress code or permit an exception to the dress code, unless doing so would result in undue hardship. ### Constructive Discharge/Forced To Resign Discriminatory practices under the laws EEOC enforces also include constructive discharge or forcing an employee to resign by making the work environment so intolerable a reasonable person would not be able to stay."," ========== ## U.S. Equal Employment Opportunity Commision ### Prohibited Employment Policies/Practices Under the laws enforced by EEOC, it is illegal to discriminate against someone (applicant or employee) because of that person's race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. It is also illegal to retaliate against a person because he or she complained about discrimination, filed a charge of discrimination, or participated in an employment discrimination investigation or lawsuit. ### The law forbids discrimination in every aspect of employment. The laws enforced by EEOC prohibit an employer or other covered entity from using neutral employment policies and practices that have a disproportionately negative effect on applicants or employees of a particular race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), or national origin, or on an individual with a disability or class of individuals with disabilities, if the polices or practices at issue are not job-related and necessary to the operation of the business. The laws enforced by EEOC also prohibit an employer from using neutral employment policies and practices that have a disproportionately negative impact on applicants or employees age 40 or older, if the policies or practices at issue are not based on a reasonable factor other than age. ### Job Advertisements It is illegal for an employer to publish a job advertisement that shows a preference for or discourages someone from applying for a job because of his or her race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. ### Recruitment It is also illegal for an employer to recruit new employees in a way that discriminates against them because of their race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. ### Application & Hiring It is illegal for an employer to discriminate against a job applicant because of his or her race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. For example, an employer may not refuse to give employment applications to people of a certain race. If an employer requires job applicants to take a test, the test must be necessary and related to the job and the employer may not exclude people of a particular race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, or individuals with disabilities. In addition, the employer may not use a test that excludes applicants age 40 or older if the test is not based on a reasonable factor other than age. If a job applicant with a disability needs an accommodation (such as a sign language interpreter) to apply for a job, the employer is required to provide the accommodation, so long as the accommodation does not cause the employer significant difficulty or expense. ### Background Checks See ""Pre-Employment Inquiries"" below. ### Job Referrals It is illegal for an employer, employment agency or union to take into account a person's race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information when making decisions about job referrals. ### Job Assignments & Promotions It is illegal for an employer to make decisions about job assignments and promotions based on an employee's race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. For example, an employer may not give preference to employees of a certain race when making shift assignments and may not segregate employees of a particular national origin from other employees or from customers. If an employer requires employees to take a test before making decisions about assignments or promotions, the test may not exclude people of a particular race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), or national origin, or individuals with disabilities, unless the employer can show that the test is necessary and related to the job. In addition, the employer may not use a test that excludes employees age 40 or older if the test is not based on a reasonable factor other than age. ### Pay And Benefits It is illegal for an employer to discriminate against an employee in the payment of wages or employee benefits on the bases of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. Employee benefits include sick and vacation leave, insurance, access to overtime as well as overtime pay, and retirement programs. For example, an employer many not pay Hispanic workers less than African-American workers because of their national origin, and men and women in the same workplace must be given equal pay for equal work. ### Discipline & Discharge An employer may not take into account a person's race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information when making decisions about discipline or discharge. For example, if two employees commit a similar offense, an employer many not discipline them differently because of their race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. ### Reasonable Accommodation & Disability The law requires that an employer provide reasonable accommodation to an employee or job applicant with a disability, unless doing so would cause significant difficulty or expense for the employer. Reasonable Accommodation & Pregnancy, Childbirth, or Related Medical Conditions The law requires that an employer provide reasonable accommodation to a qualified employee or job applicant with a known limitation related to, affected by, or arising out of pregnancy, childbirth, or related medical conditions, unless doing so would cause significant difficulty or expense for the employer. ### Reasonable Accommodation & Religion The law requires an employer to reasonably accommodate an employee's religious beliefs or practices, unless doing so would cause difficulty or expense for the employer. This means an employer may have to make reasonable adjustments at work that will allow the employee to practice his or her religion, such as allowing an employee to voluntarily swap shifts with a co- worker so that he or she can attend religious services. ### Training & Apprenticeship Programs It is illegal for a training or apprenticeship program to discriminate on the bases of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. For example, an employer may not deny training opportunities to African-American employees because of their race. In some situations, an employer may be allowed to set age limits for participation in an apprenticeship program. ### Harassment It is illegal to harass an employee because of race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. It is also illegal to harass someone because they have complained about discrimination, filed a charge of discrimination, or participated in an employment discrimination investigation or lawsuit. Harassment can take the form of slurs, graffiti, offensive or derogatory comments, or other verbal or physical conduct. Sexual harassment (including unwelcome sexual advances, requests for sexual favors, and other conduct of a sexual nature) is also unlawful. Although the law does not prohibit simple teasing, offhand comments, or isolated incidents that are not very serious, harassment is illegal if it is so frequent or severe that it creates a hostile or offensive work environment or if it results in an adverse employment decision (such as the victim being fired or demoted). ### Terms & Conditions Of Employment The law makes it illegal for an employer to make any employment decision because of a person's race, color, religion, sex (including gender identity, sexual orientation, and pregnancy), national origin, age (40 or older), disability or genetic information. That means an employer may not discriminate when it comes to such things as hiring, firing, promotions, and pay. It also means an employer may not discriminate, for example, when granting breaks, approving leave, assigning work stations, or setting any other term or condition of employment. ### Pre-Employment Inquiries (General) As a general rule, the information obtained and requested through the pre-employment process should be limited to those essential for determining if a person is qualified for the job; whereas, information regarding race, sex, national origin, age, and religion are irrelevant in such determinations. Although state and federal equal opportunity laws do not clearly forbid employers from making pre-employment inquiries that relate to, or disproportionately screen out members based on race, color, sex, national origin, religion, or age, such inquiries may be used as evidence of an employer's intent to discriminate unless the questions asked can be justified by some business purpose. Therefore, inquiries about organizations, clubs, societies, and lodges of which an applicant may be a member or any other questions, which may indicate the applicant's race, sex, national origin, disability status, age, religion, color or ancestry if answered, should generally be avoided. Similarly, employers should not ask for a photograph of an applicant. If needed for identification purposes, a photograph may be obtained after an offer of employment is made and accepted. ### Pre-Employment Inquiries and: * Race * Height & Weight * Financial Information * Unemployed Status * Background Checks * Religious Affiliation Or Beliefs * Citizenship * Marital Status, Number Of Children * Gender * Disability * Medical Questions & Examinations ### Dress Code In general, an employer may establish a dress code which applies to all employees or employees within certain job categories. However, there are a few possible exceptions. While an employer may require all workers to follow a uniform dress code even if the dress code conflicts with some workers' ethnic beliefs or practices, a dress code must not treat some employees less favorably because of their national origin. For example, a dress code that prohibits certain kinds of ethnic dress, such as traditional African or East Indian attire, but otherwise permits casual dress would treat some employees less favorably because of their national origin. Moreover, if the dress code conflicts with an employee's religious practices and the employee requests an accommodation, the employer must modify the dress code or permit an exception to the dress code unless doing so would result in undue hardship. Similarly, if an employee requests an accommodation to the dress code because of his disability, the employer must modify the dress code or permit an exception to the dress code, unless doing so would result in undue hardship. ### Constructive Discharge/Forced To Resign Discriminatory practices under the laws EEOC enforces also include constructive discharge or forcing an employee to resign by making the work environment so intolerable a reasonable person would not be able to stay. ========== Under the EEOC does an employer always have to modify the dress code to accommodate for an employee's religious practices? ========== Answer in a full sentence, no less than 50 words, and cite the part of the text that supports your statement.",Legal,Find & Summarize,Text Transformation "{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== [user request] {passage 0} ========== [context document]",Please compare the results of the five major cities and explain why the housing prices are different in the cities. Please use dot points to explain the results in simple terms.,"According to the OECD Report (2004) and Cox (2021) in Demographia International Housing Affordability 2021, Australian housing prices are overvalued and unaffordable. These reports indicated a 51.8 percent and 40 percent overvaluation in 2004 and 2021, respectively. The ratios of house prices to incomes and rents are also at the highest quantile of the OECD countries since 2003. In terms of affordability, Cox (2021) indicated that the median multiple of national house prices to household income was 6.4 times in Australia compared to the US’s 3.7 and UK’s 4.6 times in 2016. In the third quarter of 2021, the national house price to household income ratio deteriorated to 12.1 times to become severely unaffordable comparing to 5.1 times in UK and 5.0 times in the US (Cox 2022). In Sydney, it was 15.3 times, Melbourne 9.7 times, Adelaide 8 times, Perth 7.1 times and Brisbane 7.4 times, respectively. Generally, all five Australian major cities are in the severely unaffordable category. Sydney has become the second least affordable metropolitan in the world after Hong Kong. This overvaluation and severe unaffordability concur with increases in debt-to-income ratio, place Australia’s housing at the top quantile of the OECD countries. A recent study on the Australian housing market by Cho et al. (2021) asserts that the steadily increasing housing prices have attributed to a steady decline of home ownership. Additionally, they also found that the fundamental housing prices of all Australian cities are significantly overvalued. Melbourne and Sydney had their housing prices overvalued for the last two decades. The authors content that the near zero interest rate was one of the variables that affects the fundamental prices of the housing in Australia. Figure 1 presents the development of Australia housing prices from 1996 to 2021. As can be seen from this figure, housing prices have surpassed the performance of GDP per capital in the past few years. Since the Global Financial Crisis (GFC) in 2008, researchers and industry analysts have been predicting an imminent housing market meltdown. Nonetheless, in the absence of a prominent trigger, the housing market crash predictions remains a common subject of talk until recently. In the past decade, despite being overvalued and coupled with high debt-to-income ratio, mortgage stress remains insignificant due to record low interest rates. An easing of monetary policy offers liquidity to the market whilst a contracting monetary policy works in the opposite direction. The historical low interest rate was one of the key factors that drove housing prices to greater heights (Cho et al. 2021). However, the recent surge in inflation rate has prompted the Reserve Bank of Australia to increase its cash rate each month since May 2022. These moves drive mortgage rates higher. The current high inflation and growing mortgage rates environment has put homeowners and investors into a new and uncertain situation. Based on the Spearman’s rho results shown in Table 1, among the five cities under study, housing values of Sydney and Melbourne are positively associated and this relationship is significant. However, housing prices in these two cities are negatively associated with those of Adelaide, Brisbane and Gold Coast and Perth. Results also indicated that Adelaide, Brisbane and Gold Coast and Perth are positively associated with each other. On the other hand, analysis of the relationship between mortgage rate with variables included in this study indicate that there is an inverse relationship between mortgage rate with housing price of all cities, but this relationship is only significant for Sydney and Melbourne. A plausible reason is a higher mortgage rate in a stagnant wage growth and a high inflation environment has deteriorated borrowing power. With that, a house price correction is inevitable for the top two severely unaffordable cities. In addition, the mortgage rate was found to have a significant positive relationship with inflation rate and WTI crude, but it reported a significant negative relationship with ASX 200 performance. The increasing CPI over the past twelve months shows a negative relationship with housing prices in all five cities, but only Sydney and Melbourne are significantly affected. CPI is also showing a significant positive relationship with WTI crude and mortgage rate. In addition, result of the analysis also indicates a significant inverse relationship between CPI and ASX200 performance. A rise in WTI crude has two effects on housing. First, it brings about diminishing of spending power on other goods and services for individuals together with a lower demand of housing (Fereidouni 2010; Grossman et al. 2019). Second, it increases logistic cost which escalates building material and labour costs. Both forces are contradictory as the first one leads to more supply than demand, hence, a decrease in housing price whilst the latter push up housing prices due to higher construction cost. Spearman’s rho correlation analysis indicates a mild significant positive impact of WTI crude on Sydney’s housing price. Other cities however are displaying insignificant relationship with WTI crude movements. The literature generally indicates a negative relationship between the performance of the share market and interest rates (Bayer et al. 2013). A higher interest rate discourages investment and promotes savings. In addition, as investment in housing represents a substitution of share investment, a negative relationship is expected. Nonetheless, only Brisbane and Gold Coast, Perth and Adelaide are displaying the expected sign in the Spearman’s rho test analysis but insignificant. On the contrary, for the more affluent cities, such as Sydney and Melbourne, stock market performance is positively related to housing price movement. Possible explanations for this phenomenon are (i) investors are more affluent in these two cities and, therefore, are financially capable of forming a more diversified investment portfolio, (ii) investors from these two larger cities have better financial literacy and hence, value portfolio diversification more and do not view property and stock investment as substitutes. Bootstrap regression analysis was conducted on the variables under study and the findings are discussed in the next section. 5.3. Bootstrap Regression Analysis and Results As can been seen from Table 2, regressions are performed on five models to gauge the relations of housing performance across five cities with independent variables including mortgage rates, WTI crude index and ASX200 index. Results of R2 obtained from the analyses indicate that independent variables included in the model are able to explain variations of the housing performance in Sydney by 84.4 percent and Melbourne 87.5 percent, whereas the other three cities are in the range of 0.1 to 5 percent. The findings in Panel 1 (Sydney) and 2 (Melbourne) reveal that there is a significant negative relationship between mortgage rate and housing performance of Sydney and Melbourne. These findings are consistent with Chong (2020), Xu and Tang (2014) and Chong and Liew 2020). However, housing prices in smaller cities including Perth, Adelaide and Brisbane and Gold Coast are unaffected by interest rate during the study period. Indeed, larger cities, such as Sydney and Melbourne, display different characteristics comparing to other cities in Australia (Cho et al. 2021).","{instruction} ========== In your answer, refer only to the context document. Do not employ any outside knowledge {question} ========== Please compare the results of the five major cities and explain why the housing prices are different in the cities. Please use dot points to explain the results in simple terms. {passage 0} ========== According to the OECD Report (2004) and Cox (2021) in Demographia International Housing Affordability 2021, Australian housing prices are overvalued and unaffordable. These reports indicated a 51.8 percent and 40 percent overvaluation in 2004 and 2021, respectively. The ratios of house prices to incomes and rents are also at the highest quantile of the OECD countries since 2003. In terms of affordability, Cox (2021) indicated that the median multiple of national house prices to household income was 6.4 times in Australia compared to the US’s 3.7 and UK’s 4.6 times in 2016. In the third quarter of 2021, the national house price to household income ratio deteriorated to 12.1 times to become severely unaffordable comparing to 5.1 times in UK and 5.0 times in the US (Cox 2022). In Sydney, it was 15.3 times, Melbourne 9.7 times, Adelaide 8 times, Perth 7.1 times and Brisbane 7.4 times, respectively. Generally, all five Australian major cities are in the severely unaffordable category. Sydney has become the second least affordable metropolitan in the world after Hong Kong. This overvaluation and severe unaffordability concur with increases in debt-to-income ratio, place Australia’s housing at the top quantile of the OECD countries. A recent study on the Australian housing market by Cho et al. (2021) asserts that the steadily increasing housing prices have attributed to a steady decline of home ownership. Additionally, they also found that the fundamental housing prices of all Australian cities are significantly overvalued. Melbourne and Sydney had their housing prices overvalued for the last two decades. The authors content that the near zero interest rate was one of the variables that affects the fundamental prices of the housing in Australia. Figure 1 presents the development of Australia housing prices from 1996 to 2021. As can be seen from this figure, housing prices have surpassed the performance of GDP per capital in the past few years. Since the Global Financial Crisis (GFC) in 2008, researchers and industry analysts have been predicting an imminent housing market meltdown. Nonetheless, in the absence of a prominent trigger, the housing market crash predictions remains a common subject of talk until recently. In the past decade, despite being overvalued and coupled with high debt-to-income ratio, mortgage stress remains insignificant due to record low interest rates. An easing of monetary policy offers liquidity to the market whilst a contracting monetary policy works in the opposite direction. The historical low interest rate was one of the key factors that drove housing prices to greater heights (Cho et al. 2021). However, the recent surge in inflation rate has prompted the Reserve Bank of Australia to increase its cash rate each month since May 2022. These moves drive mortgage rates higher. The current high inflation and growing mortgage rates environment has put homeowners and investors into a new and uncertain situation. Based on the Spearman’s rho results shown in Table 1, among the five cities under study, housing values of Sydney and Melbourne are positively associated and this relationship is significant. However, housing prices in these two cities are negatively associated with those of Adelaide, Brisbane and Gold Coast and Perth. Results also indicated that Adelaide, Brisbane and Gold Coast and Perth are positively associated with each other. On the other hand, analysis of the relationship between mortgage rate with variables included in this study indicate that there is an inverse relationship between mortgage rate with housing price of all cities, but this relationship is only significant for Sydney and Melbourne. A plausible reason is a higher mortgage rate in a stagnant wage growth and a high inflation environment has deteriorated borrowing power. With that, a house price correction is inevitable for the top two severely unaffordable cities. In addition, the mortgage rate was found to have a significant positive relationship with inflation rate and WTI crude, but it reported a significant negative relationship with ASX 200 performance. The increasing CPI over the past twelve months shows a negative relationship with housing prices in all five cities, but only Sydney and Melbourne are significantly affected. CPI is also showing a significant positive relationship with WTI crude and mortgage rate. In addition, result of the analysis also indicates a significant inverse relationship between CPI and ASX200 performance. A rise in WTI crude has two effects on housing. First, it brings about diminishing of spending power on other goods and services for individuals together with a lower demand of housing (Fereidouni 2010; Grossman et al. 2019). Second, it increases logistic cost which escalates building material and labour costs. Both forces are contradictory as the first one leads to more supply than demand, hence, a decrease in housing price whilst the latter push up housing prices due to higher construction cost. Spearman’s rho correlation analysis indicates a mild significant positive impact of WTI crude on Sydney’s housing price. Other cities however are displaying insignificant relationship with WTI crude movements. The literature generally indicates a negative relationship between the performance of the share market and interest rates (Bayer et al. 2013). A higher interest rate discourages investment and promotes savings. In addition, as investment in housing represents a substitution of share investment, a negative relationship is expected. Nonetheless, only Brisbane and Gold Coast, Perth and Adelaide are displaying the expected sign in the Spearman’s rho test analysis but insignificant. On the contrary, for the more affluent cities, such as Sydney and Melbourne, stock market performance is positively related to housing price movement. Possible explanations for this phenomenon are (i) investors are more affluent in these two cities and, therefore, are financially capable of forming a more diversified investment portfolio, (ii) investors from these two larger cities have better financial literacy and hence, value portfolio diversification more and do not view property and stock investment as substitutes. Bootstrap regression analysis was conducted on the variables under study and the findings are discussed in the next section. 5.3. Bootstrap Regression Analysis and Results As can been seen from Table 2, regressions are performed on five models to gauge the relations of housing performance across five cities with independent variables including mortgage rates, WTI crude index and ASX200 index. Results of R2 obtained from the analyses indicate that independent variables included in the model are able to explain variations of the housing performance in Sydney by 84.4 percent and Melbourne 87.5 percent, whereas the other three cities are in the range of 0.1 to 5 percent. The findings in Panel 1 (Sydney) and 2 (Melbourne) reveal that there is a significant negative relationship between mortgage rate and housing performance of Sydney and Melbourne. These findings are consistent with Chong (2020), Xu and Tang (2014) and Chong and Liew 2020). However, housing prices in smaller cities including Perth, Adelaide and Brisbane and Gold Coast are unaffected by interest rate during the study period. Indeed, larger cities, such as Sydney and Melbourne, display different characteristics comparing to other cities in Australia (Cho et al. 2021). https://www.mdpi.com/1911-8074/16/2/61",Financial,Explanation/Definition,Q&A Give an answer using only the context provided.,How are interest rates set?,"NBER WORKING PAPER SERIES HOW DO BANKS SET INTEREST RATES? Leonardo Gambacorta Working Paper 10295 http://www.nber.org/papers/w10295 NATIONAL BUREAU OF ECONOMIC RESEARCH 1050 Massachusetts Avenue Cambridge, MA 02138 February 2004 This research was done during a period as a visiting scholar at the NBER. The views expressed herein are those of the author and not necessarily those of the Banca d’Italia or the National Bureau of Economic Research. ©2004 by Leonardo Gambacorta. All rights reserved. Short sections of text, not to exceed two paragraphs, may be quoted without explicit permission provided that full credit, including © notice, is given to the source. How Do Banks Set Interest Rates? Leonardo Gambacorta NBER Working Paper No. 10295 February 2004 JEL No. E44, E51, E52 ABSTRACT The aim of this paper is to study cross-sectional differences in banks interest rates. It adds to the existing literature in two ways. First, it analyzes in a systematic way both micro and macroeconomic factors that influence the price setting behavior of banks. Second, by using banks’ prices (rather than quantities) it provides an alternative way to disentangle loan supply from loan demand shift in the “bank lending channel” literature. The results, derived from a sample of Italian banks, suggest that heterogeneity in the banking rates pass-through exists only in the short run. Consistently with the literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change their prices less. Heterogeneity in the pass-through on the interest rate on current accounts depends mainly on banks’ liability structure. Bank’s size is never relevant. Leonardo Gambacorta Banca d’Italia Research Department Via Nazionale, 91 00184 Rome, Italy gambacorta.leonardo@insedia.interbusiness.it 1. Introduction1 This paper studies cross-sectional differences in the price setting behavior of Italian banks in the last decade. The main motivations of the study are two. First, heterogeneity in the response of bank interest rates to market rates helps in understanding how monetary policy decisions are transmitted through the economy independently of the consequences on bank lending. The analysis of heterogeneous behavior in banks interest setting has been largely neglected by the existing literature. The vast majority of the studies on the “bank lending channel” analyze the response of credit aggregates to a monetary policy impulse, while no attention is paid on the effects on prices. This seems odd because, in practice, when banks interest rates change, real effects on consumption and investment could be produced also if there are no changes in total lending. The scarce evidence on the effects of monetary shocks on banks prices, mainly due to the lack of available long series of micro data on interest rates, contrasts also with some recent works that highlight a different adjustment of retail rates in the euro area (see, amongst others, de Bondt, Mojon and Valla, 2003). Second, this paper wants to add to the “bank lending channel” literature by identifying loan supply shocks via banks’ prices (rather than quantities). So far to solve the “identification problem” it has been claimed that certain bank-specific characteristics (i.e. size, liquidity, capitalization) influence only loan supply movements while banks’ loan demand is independent of them. After a monetary tightening, the drop in the supply of credit should be more important for small banks, which are financed almost exclusively with deposits and equity (Kashyap and Stein, 1995), less liquid banks, that cannot protect their loan portfolio against monetary tightening simply by drawing down cash and securities (Stein, 1998; Kashyap and Stein, 2000) and poorly capitalized banks, that have less access to markets for uninsured funding (Peek and Rosengren, 1995; Kishan and Opiela, 2000; van den Heuvel, 2001a; 2001b).2 The intuition of an identification via prices of loan supply shift is very simple: if loan demand is not perfectly elastic, also the effect of a monetary 1 This study was developed while the author was a visiting scholar at the NBER. The opinions expressed in this paper are those of the author only and in no way involve the responsibility of the Bank of Italy and the NBER. 2 All these studies on cross-sectional differences in the effectiveness of the “bank lending channel” refer to the US. The literature on European countries is instead far from conclusive (see Altunbas et al., 2002; Ehrmann et al., 2003). For the Italian case see Gambacorta (2003) and Gambacorta and Mistrulli (2003). 3 tightening on banks’ interest rate should be more pronounced for small, low-liquid and lowcapitalized banks . Apart from these standard indicators other bank-specific characteristics could influence banks’ price-setting behavior (Weth, 2002). Berlin and Mester (1999) claim that banks which heavily depend upon non-insured funding (i.e. bonds) will adjust their deposit rates more (and more quickly) than banks whose liabilities are less affected by market movements. Berger and Udell (1992) sustain that banks that maintain a close tie with their customers will change their lending rates comparatively less and slowly. In this paper the search for heterogeneity in banks’ behavior is carried out by using a balanced panel of 73 Italian banks that represent more than 70 per cent of the banking system. Heterogeneity is investigated with respect to the interest rate on short-term lending and that on current accounts. The use of microeconomic data is particularly appropriate in this context because aggregation may significantly bias the estimation of dynamic economic relations (Harvey, 1981). Moreover, information at the level of individual banks provides a more precise understanding of their behavioral patterns and should be less prone to structural changes like the formation of EMU. The main conclusions of this paper are two. First, heterogeneity in the banking rates pass-through exists, but it is detected only in the short run: no differences exist in the longrun elasticities of banking rates to money market rates. Second, consistently with the existing literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change less their prices. Heterogeneity in the pass-through on the interest rate on current accounts depends mainly on banks’ liability structure. Bank’s size is never relevant. The paper is organized as follows. Section 2 describes some institutional characteristics that help to explain the behavior of banking rates in Italy in the last two decades. Section 3 reviews the main channels that influence banks’ interest rate settings trying to disentangle macro from microeconomic factors. After a description of the econometric model and the data in Section 4, Section 5 shows the empirical results. Robustness checks are presented in Section 6. The last section summarizes the main conclusions. 4 2. Some facts on bank interest rates in Italy Before discussing the main channels that influence banks’ price setting, it is important to analyze the institutional characteristics that have influenced Italian bank interest rates in the last two decades. The scope of this section is therefore to highlight some facts that could help in understanding differences, if any, with the results drawn by the existing literature for the eighties and mid-nineties. For example, there is evidence that in the eighties Italian banks were comparatively slow in adjusting their rates (Verga, 1984; Banca d’Italia, 1986, 1988; Cottarelli and Kourelis, 1994) but important measures of liberalization of the markets and deregulation over the last two decades should have influenced the speed at which changes in the money market conditions are transmitted to lending and deposit rates (Cottarelli et al. 1995; Passacantando, 1996; Ciocca, 2000; Angelini and Cetorelli, 2002). In fact, between the mid-1980s and the early 1990s all restrictions that characterized the Italian banking system in the eighties were gradually removed. In particular: 1) the lending ceiling was definitely abolished in 1985; 2) foreign exchange controls were lifted between 1987 and 1990; 3) branching was liberalized in 1990; 4) the 1993 Banking Law allowed banks and special credit institutions to perform all banking activities. In particular, the 1993 Banking Law (Testo Unico Bancario, hereafter TUB) completed the enactment of the institutional, operational and maturity despecialization of the Italian banking system and ensured the consistency of supervisory controls and intermediaries’ range of operations within the single market framework. The business restriction imposed by the 1936 Banking Law, which distinguished between banks that could raise short-term funds (“aziende di credito”) and those that could not (“Istituti di credito speciale”), was eliminated.3 To avoid criticism of structural breaks, the econometric analysis of this study will be based on the period 1993:03-2001:03, where all the main reforms of the Italian banking system had already taken place. 3 For more details see Banca d’Italia, Annual Report for 1993. 5 The behavior of bank interest rates in Italy reveals some stylized facts (see Figures 1 and 2). First, a remarkable fall in the average rates since the end of 1992. Second a strong and persistent dispersion of rates among banks. These stylized facts suggest that both the time series and the cross sections dimensions are important elements in understanding the behavior of bank interest setting. This justifies the use of panel data techniques. The main reason behind the fall in banking interest rates is probably the successful monetary policy aiming at reducing the inflation rate in the country to reach the Maastricht criteria and the third stage of EMU. As a result, the interbank rate decreased by more than 10 percentage points in the period 1993-1999. Excluding the 1995 episode of the EMS crisis, it is only since the third quarter of 1999 that it started to move upwards until the end of 2000 when it continued a declining trend. From a statistical point of view, this behavior calls for the investigation of a possible structural break in the nineties.4 The second stylized fact is cross-sectional dispersion among interest rates. Figure 2 shows the coefficient of variation for loan and deposit rates both over time and across banks in the period 1987-2001.5 The temporal variation (dotted line) of the two rates show a different behavior from the mid of the nineties when the deposit rate is more variable, probably for a catching-up process of the rate toward a new equilibrium caused by the convergence process. Also the cross-sectional dispersion of the deposit rate is greater than that of the loan rate, especially after the introduction of euro.6 4 In the period 1995-98, that coincides with the convergence process towards stage three of EMU, it will be necessary to allow for a change in the statistical properties of interest rates (see Appendix 2). 5 The coefficient of variation is given by the ratio of the standard errors to the mean. The series that refer to the variability “over time” shows the coefficient of variation in each year of monthly figures. In contrast, the series that capture the variability “across banks” shows the coefficient of variation of annual averages of bankspecific interest rates. 6 In the period before the 1993 Banking Law deposit interest rates were quite sticky to monetary policy changes. Deposit interest rate rigidity in this period has been extensively analyzed also for the US. Among the market factors that have been found to affect the responsiveness of bank deposit rates are the direction of the change in market rates (Ausubel, 1992; Hannan and Berger, 1991), if the bank interest rate is above or below a target rate (Hutchison, 1995; Moore, Porter and Small, 1990; Neumark and Sharpe, 1992) and market concentration in the bank’s deposit market (Hannan and Berger, 1991). Rosen (2001) develops a model of price settings in presence of heterogeneous customers explaining why bank deposits interest rates respond sluggishly to some extended movements in monetary market rates but not to others. Hutchinson (1995) presents a model of bank deposit rates that includes a demand function for customers and predicts a linear (but less than one for one) relationship between market interest rate changes and bank interest rate changes. Green (1998) claims that the rigidity is due to the fact that bank interest rate management is based on a two-tier pricing system; banks offer accounts at market related interest rates and at posted rates that are changed at discrete intervals. 6 3. What does influence banks’ interest rate setting? The literature that studies banks’ interest rate setting behavior generally assumes that banks operate under oligopolistic market conditions.7 This means that a bank does not act as a price-taker but sets its loan rates taking into account the demand for loans and deposits. This section reviews the main channels that influence banks interest rates (see Figure 3). A simple analytical framework is developed in Appendix 1. Loan and deposit demand The interest rate on loans depends positively on real GDP and inflation (y and p). Better economic conditions improve the number of projects becoming profitable in terms of expected net present value and, therefore, increase credit demand (Kashyap, Stein and Wilcox, 1993). As stressed by Melitz and Pardue (1973) only increases in permanent income (yP) have a positive influence on loan demand, while the effect due to the transitory part (yT) could also be associated with a self-financing effect that reduces the proportion of bank debt (Friedman and Kuttner, 1993).8 An increase in the money market rate (iM) raises the opportunity cost of other forms of financing (i.e. bonds), making lending more attractive. This mechanism also boosts loan demand and increases the interest rate on loans. The interest rate on deposits is negatively influenced by real GDP and inflation. A higher level of income increases the demand for deposits9 and reduces therefore the incentive for banks to set higher deposit rates. In this case the shift of deposit demand should be higher if the transitory component of GDP is affected (unexpected income is generally first deposited on current accounts). On the contrary, an increase in the money market rate, ceteris paribus, makes more attractive to invest in risk-free securities that represent an alternative to detain deposits; the subsequent reduction in deposits demand determines an upward pressure on the interest rate on deposits. 7 For a survey on modeling the banking firm see Santomero (1984). Among more recent works see Green (1998) and Lim (2000). 8 Taking this into account, in Section 4 I tried to disentangle the two effects using a Beveridge and Nelson (1981) decomposition. 9 The aim of this paper is not to answer to the question if deposits are input or output for the bank (see Freixas and Rochet, 1997 on this debate). For simplicity here deposits are considered a service supplied by the bank to depositors and are therefore considered an output (Hancock, 1991). 7 Operating cost, credit risk and interest rate volatility The costs of intermediation (screening, monitoring, branching costs, etc.) have a positive effect on the interest rate on loans and a negative effect on that of deposits (efficiency is represented by e). The interest rate on lending also depends on the riskiness of the credit portfolio; banks that invest in riskier project will have a higher rate of return in order to compensate the higher percentage of bad loans that have to be written off (j). Banking interest rates are also influenced by interest rate volatility. A high volatility in the money market rate (σ) should increase lending and deposit rates. Following the dealership model by Ho and Saunders (1981) and its extension by Angbazo (1997) the interest rate on loans should be more affected by interbank interest rate volatility with respect to that on deposits (diL/dσ>diD/dσ). This should reveal a positive correlation between interest rate volatility and the spread. Interest rate channel Banking interest rates are also influenced by monetary policy changes. A monetary tightening (easing) determines a reduction (increase) of reservable deposits and an increase (reduction) of market interest rates. This has a “direct” and positive effect on bank interest rates through the traditional “interest rate channel”. Nevertheless, the increase in the cost of financing could have a different impact on banks depending on their specific characteristics. There are two channels through which heterogeneity among banks may cause a different impact on lending and deposit rates: the “bank lending channel” and the “bank capital channel”. Both mechanisms are based on adverse selection problems that affect banks fundraising but from different perspectives. Bank lending channel According to the “bank lending channel” thesis, a monetary tightening has effect on bank loans because the drop in reservable deposits cannot be completely offset by issuing other forms of funding (i.e. uninsured CDs or bonds; for an opposite view see Romer and Romer, 1990) or liquidating some assets. Kashyap and Stein (1995, 2000), Stein (1998) and Kishan and Opiela (2000) claim that the market for bank debt is imperfect. Since nonreservable liabilities are not insured and there is an asymmetric information problem about 8 the value of banks’ assets, a “lemon’s premium” is paid to investors. According to these authors, small, low-liquid and low-capitalized banks pay a higher premium because the market perceives them more risky. Since these banks are more exposed to asymmetric information problems they have less capacity to shield their credit relationships in case of a monetary tightening and they should cut their supplied loans and raise their interest rate by more. Moreover, these banks have less capacity to issue bonds and CDs and therefore they could try to contain the drain of deposits by raising their rate by more. In Figure 3 three effects are highlighted: the “average” effect due to the increase of the money market rate (which is difficult to disentangle from the “interest rate channel”), the “direct” heterogeneous effect due to bank-specific characteristics (Xt-1) and the “interaction effect” between monetary policy and the bank-specific characteristic (iM Xt-1). These last two effects can genuinely be attributed to the “bank lending channel” because bank-specific characteristics influence only loan supply movements. Two aspects deserve to be stressed. First, to avoid endogeneity problems bank-specific characteristics should refer to the period before banks set their interest rates. Second, heterogeneous effects, if any, should be detected only in the short run while there is no a priori that these effects should influence the long run relationship between interest rates. Apart from the standard indicators of size (logarithm of total assets), liquidity (cash and securities over total assets) and capitalization (excess capital over total assets),10 two other bank-specific characteristics deserve to be investigated: a) the ratio between deposits and bonds plus deposits; b) the ratio between long-term loans and total loans. The first indicator is in line with Berlin and Mester (1999): banks that heavily depend upon non-deposit funding (i.e. bonds) will adjust their deposits rates by more (and more quickly) than banks whose liabilities are less affected by market movements. The intuition of this result is that, other things being equal, it is more likely that a bank will adjust her terms 10 It is important to note that the effect of bank capital on the “bank lending channel” cannot be easily captured by the capital-to-asset ratio. This measure, generally used by the existing literature to analyze the distributional effects of bank capitalization on lending, does not take into account the riskiness of a bank portfolio. A relevant measure is instead the excess capital that is the amount of capital that banks hold in excess of the minimum required to meet prudential regulation standards. Since minimum capital requirements are determined by the quality of bank’s balance sheet activities, the excess capital represents a risk-adjusted measure of bank capitalization that gives more indications on the probability of a bank default. Moreover, the excess capital is a relevant measure of the availability of the bank to expand credit because it directly controls for prudential regulation constraints. For more details see Gambacorta and Mistrulli (2004). 9 for passive deposits if the conditions of her own alternative form of refinancing change. Therefore an important indicator to analyze the pass-through between market and banking rates is the ratio between deposits and bonds plus deposits. Banks which use relatively more bonds than deposits for financing purpose fell more under pressure because their cost increase contemporaneously and to similar extent as market rates. The Berger and Udell (1992) indicator represents a proxy for long-term business; those credit institutions that maintain close ties with their non-bank customers will adjust their lending rates comparatively less and slowly. Banks may offer implicit interest rate insurance to risk-averse borrowers in the form of below-market rates during periods of high market rates, for which the banks are later compensated when market rates are low. Having this in mind, banks that have a higher proportion of long-term loans should be more inclined to split the risk of monetary policy change with their customers and preserve credit relationships. For example, Weth (2002) finds that in Germany those banks with large volumes of longterm business with households and firms change their prices less frequently than the others. Bank capital channel The “bank capital channel” is based on three hypotheses. First, there is an imperfect market for bank equity: banks cannot easily issue new equity for the presence of agency costs and tax disadvantages (Myers and Majluf, 1984; Cornett and Tehranian, 1994; Calomiris and Hubbard, 1995; Stein, 1998). Second, banks are subject to interest rate risk because their assets have typically a higher maturity with respect to liabilities (maturity transformation). Third, regulatory capital requirements limit the supply of credit (Thakor, 1996; Bolton and Freixas, 2001; Van den Heuvel, 2001a; 2001b). The mechanism is the following. After an increase of market interest rates, a lower fraction of loans can be renegotiated with respect to deposits (loans are mainly long term, while deposits are typically short term): banks suffer therefore a cost due to the maturity mismatch that reduces profits and then capital accumulation.11 If equity is sufficiently low and it is too costly to issue new shares, banks reduce lending (otherwise they fail to meet 11 In Figure 3, the cost per unit of asset due to the maturity transformation at time t-1 ( ρit −1 ) is multiplied by the actual change in the money market rate ( ∆iM ). For more details see Appendix 1. 10 regulatory capital requirements) and amplify their interest rate spread. This determines therefore an increase in the interest rates on loans and a decrease in that on deposits:12 in the oligopolistic version of the Monti-Klein model, the maturity transformation cost has the same effect of an increase in operating costs. Industry structure The literature underlines two possible impacts of concentration on pricing behavior of banks (Berger and Hannan, 1989). A first class of models claims that more concentrated banking industry will behave oligopolistically (structure-performance hypothesis), while another class of models stresses that concentration is due to more efficient banks taking over less efficient counterparts (efficient-structure hypothesis). This means that in the first case lower competition should result in higher spreads, while in the second case a decrease in managerial costs due to increased efficiency should have a negative impact on the spread. In the empirical part great care will be given therefore to the treatment of bank mergers (see Appendix 2). Nevertheless, the scope of this paper is not to extract policy implications about this issue, for which a different analysis is needed. The introduction of bank-specific dummy variables (µi) tries to control for this and other missing aspects.13 4. Empirical specification and data The equations described in Figure 3 and derived analytically in Appendix 1 are expressed in levels. Nevertheless, since interest rates are likely to be non-stationary variables, an error correction model has been used to capture bank’s interest rate setting.14 Economic theory on oligopolistic (and perfect) competition suggests that, in the long run, both banking rates (on lending and deposits) should be related to the level of the monetary 12 The “bank capital channel” can also be at work even if capital requirement is not currently binding. Van den Heuvel (2001a) shows that low-capitalized banks may optimally forgo lending opportunities now in order to lower the risk of capital inadequacy in the future. This is interesting because in reality, most banks are not constrained at any given time. 13 In Section 6 this hypothesis will be tested introducing a specific measure of the degree of competition that each banks faces. For a more detailed explanation on the effect of concentration on the pricing behavior of Italian banks see Focarelli and Panetta (2003). 14 This is indeed the standard approach used for interest rate equations (Cottarelli et al. 1995; Lim, 2000; Weth 2002). From a statistical point of view, the error correction representation is adopted because the lending rate and the deposit rate result to be cointegrated with the money market rate. 11 rate, that reflects the marginal yield of a risk-free investment (Klein, 1971). We have: 2 (1) 1 ∆i L k ,t = µ k + å κ j ∆i L k ,t − j + å ( β j + β *j X k ,t −1 ) ∆i M t − j + ϕ p t + δ 1 ∆ ln y tP + δ 2 ∆ ln y tT + λX k ,t −1 + j =1 j =0 φ∆ ( ρ k ,t −1 ∆i M t ) + (α + α X k ,t −1 )i L k ,t −1 + (γ + γ * X k ,t −1 )i M t −1 + θ j k ,t + ξ e k ,t + ψσ t + Φ k ,t + ε k ,t * 1 2 (2) ∆i D k ,t = µ k + å κ j ∆i D k ,t − j + å ( β j + β *j X k ,t −1 )∆i M t − j + ϕ p t + δ 1 ∆ ln y tP + δ 2 ∆ ln y tT + λX k ,t −1 + j =1 j =0 φ∆ ( ρ k ,t −1 ∆i M t ) + (α + α X k ,t −1 )i D k ,t −1 + (γ + γ * X k ,t −1 )i M t −1 + ξ e k ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:032001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1.15 The model allows for fixed effects across banks, as indicated by the bank-specific intercept µi. The long-run elasticity between each banking rate and the money market rate is given by: (γ + γ * X k ,t −1 ) /(α + α * X k ,t −1 ) . Therefore to test if the pass-through between the money market rate and the banking rate is complete it is necessary to verify that this elasticity is equal to one. If this is the case there is a one-to-one long-run relationship between the lending (deposit) rate and the money market rate, while the individual effect µi influences the bank-specific mark-up (mark-down). The loading coefficient (α + α * X k ,t −1 ) must be significantly negative if the assumption of an equilibrium relationship is correct. In fact, it represents how many percent of an exogenous variation from the steady state between the rates is brought back towards the equilibrium in the next period.16 The degree of banks’ interest rate stickiness in the short run can be analyzed by the impact multiplier ( β 0 + β 0* X k ,t −1 ) and the total effect after three months.17 15 For more details on data sources, variable definitions, merger treatment and trimming of the sample see Appendix 2. 16 Testing for heterogeneity in the loading coefficient means to verify if α * is significant or not. At the same time heterogeneity in the long-run elasticity can be proved if α *γ − αγ * is statistically different from zero. 17 In the first case heterogeneity among banks is simply tested through the significance of β 0 while in the * second case, since the effect is given by a convolution of the structural parameters it is possible to accept the 12 The variable Xk,t-1 represents a bank-specific characteristic that economic theory suggests to influence only loan and deposit supply movements, without affecting loan and deposit demands. In particular, all bank-specific indicators ( χ k ,t ) have been re-parameterized in the following way: N æ ö ç T å χ k ,t ÷ ÷ /T X k ,t = χ k ,t − ç å k =1 ç t =1 N ÷ ç ÷ è ø Each indicator is therefore normalized with respect to the average across all the banks in the respective sample, in order to obtain a variable whose sum over all observations is zero.18 This has two implications. First, the interaction terms between interest rates and X k , t −1 in equations (1) and (2) are zero for the average bank (this because X k ,t −1 =0). Second, the coefficients β0, β1, α and γ are directly interpretable as average effects. To test for the existence of a “bank capital channel” we have introduced the variable ρ k , t −1∆iM that represents the bank-specific cost of monetary policy due to maturity transformation. In particular ρ k , t −1 measures the loss per unit of asset a bank suffers when the monetary policy interest rate is raised of one percent. The cost at time t is influenced by the maturity transformation in t-1. This variable is computed according to supervisory regulation relative to interest rate risk exposure that depends on the maturity mismatch among assets and liabilities (see Appendix 2 for further details). To work out the real cost we have therefore multiplied ρ k , t −1 for the realized change in interest rates. Therefore ρ k , t −1∆iM represents the cost (gain) that a bank suffers (obtain) in each quarter. As formalized in Appendix 1, this measure influences the level of bank interest rates. Since the model is expressed in error correction form we have included this variable in first difference as well. null hypothesis of absence of heterogeneity if and only if éë β 0α * + β 0* (1 + α + κ 1 ) + β1* + γ * ùû X k ,t −1 + α * β 0* X k2,t −1 is equal to zero. The significance of this expression has been checked using the delta method (Rao, 1973). 18 The size indicator has been normalized with respect to the mean on each single period. This procedure removes trends in size (for more details see Ehrmann et al., 2003). 13 4.1 Characteristics of the dataset The dataset includes 73 banks that represent more than 70 per cent of total Italian banking system in term of loans over the whole sample period. Since information on interest rates is not available for Mutual banks, the sample is biased towards large banks. Foreign banks and special credit institution are also excluded. This bias toward large banks has two consequences. First, the distributional effects of the size variable would be treated with extreme cautious because a “small” bank inside this sample could not be considered with the same characteristic using the full population of Italian banks.19 The size grouping in this study mainly controls for variations in scale, technology and scope efficiencies across banks but it is not able to shed light on differences between Mutual and other banks. Second, results for the average bank will provide more “macroeconomic insights” than studies on the whole population (where the average bank dimension is very small). Table 2 gives some basic information on the dataset. Rows are organized dividing the sample with respect to the bank-specific characteristics that are potential candidates to cause heterogeneous shifts in loan supply in case of a monetary policy shock. On the columns, the table reports summary statistics for the two interest rates and for each indicator. Several clear patterns emerge. Considering size, small banks charge higher interest rates on lending but show a lower time variation. This fits with the standard idea of a close customer relationships between small firms and small banks that provides them with an incentive to smooth the effect of a monetary tightening (Angelini, Di Salvo and Ferri, 1998). Moreover, small banks are more liquid and capitalized than average and this should help them to reduce the effect of cyclical variation on supplied credit. On the liability side, the percentage of deposits (overnight deposits, CDs and savings accounts) is greater among small banks, while their bonds issues are more limited than the ones of large banks. Nevertheless, there are no significant differences that emerge in the level and volatility of the interest rate on current accounts. 19 In particular, banks that are considered “small” in this study are labeled as “medium” in other studies for the Italian banking system that analyze quantities (see for example, Gambacorta, 2003; Gambacorta and Mistrulli, 2004). This is clear noting that the average assets of a “small” bank in my data (1.6 billions of euros) over the sample period is very similar to that of the “medium” bank of the total system (1.7 billions of euros). 14 High-liquid banks are smaller than average and are more capitalized. These characteristics should reduce the speed of the “bank lending channel” transmission through interest rates. In particular, since deposits represent a high share of their funding they should have a smoother transmission on passive rates. Well-capitalized banks make relatively more short-term loans. They are in general not listed and issue less subordinated debt to meet the capital requirement. This evidence is consistent with the view that, ceteris paribus, capitalization is higher for those banks that bear more adjustment costs from issuing new (regulatory) capital. Well-capitalized banks charge a higher interest rate on lending; this probably depend upon their higher ratios of bad loans that increase their credit risk. In other words their higher capitalization is necessary to face a riskier portfolio. Moreover, the interest rate on deposit is lower for low-capitalized banks indicating that agents do not perceive these deposits as riskier than those at other banks. This has two main explanations. First, the impact of bank failures has been very small in Italy, especially with respect to deposits.20 Second, the presence of deposit insurance that insulates deposits of less capitalized banks from the risk of default.21 The Berlin-Mester and the Berger-Udell indicators seem to have a high power in explaining heterogeneity in banks’ price setting behavior. Differences in the standard deviations of the two groups are particularly sensitive, calling for a lower interest rates variability of banks with a high percentage of deposits and long-term loans. 20 During our sample period, the share of deposits of failed banks to total deposits approached 1 per cent only twice, namely in 1987 and 1996 (Boccuzzi, 1998). 21 Two explicit limited-coverage deposit insurance schemes (DISs) currently operate in Italy. Both are funded ex-post; that is, member banks have a commitment to make available to the Funds the necessary resources should a bank default. All the banks operating in the country, with the exception of mutual banks, adhere to the main DIS, the ‘Fondo Interbancario di Tutela dei Depositi’ (FITD). Mutual banks (‘Banche di Credito Cooperativo’) adhere to a special Fund (‘Fondo di Garanzia dei Depositanti del Credito Cooperativo’) created for banks belonging to their category. The ‘Fondo Interbancario di Tutela dei Depositi’ (FITD), the main DIS, is a private consortium of banks created in 1987 on a voluntary basis. In 1996, as a consequence of the implementation of European Union Directive 94/19 on deposit guarantee schemes, the Italian Banking Law regulating the DIS was amended, and FITD became a compulsory DIS. FITD performs its tasks under the supervision of and in cooperation with the banking supervision authority, Banca d’Italia. The level of protection granted to each depositor (slightly more than 103,000 euros) is one of the highest in the European Union. FITD does not adopt any form of deposit coinsurance. 15 5. Results The main channels that influence the interest rate on short term lending and that on current accounts are summarized, respectively, in Tables 3 and 4. The first part of each table, show the influence of the permanent and transitory component of real GDP and inflation. These macro variables capture cyclical movements and serves to isolate shifts in loan and deposit demand from monetary policy changes. The second part of the tables presents the effects of bank’s efficiency, credit risk and interest rate volatility. The third part highlights the effects of monetary policy. These are divided into four components: i) the immediate pass-through; ii) the one-quarter pass-through; iii) the long-run elasticity between each banking rate and the monetary policy indicator; iv) the loading coefficient of the cointegrating relationship.22 The last part of the tables shows the significance of the “bank capital channel”. Each table is divided in five columns that highlight, one at the time, heterogeneous behavior of banks with different characteristics in the response to a monetary shock. The existence of distributional effects is tested for all the four components of the monetary policy pass-through. The models have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test).23 22 The immediate pass-trough is given by the coefficient β 0 + β 0* X k ,t −1 and heterogeneity among banks is simply tested through the significance of β 0* . The effect for a bank with a low value of the characteristic under 0.25 evaluation is worked out through the expression β 0 + β 0* X k0.25 , t −1 , where X k , t −1 is the average for the banks below the first quartile. Vice versa the effect for a bank with a high value of the characteristic is calculated using X k0.75 , t −1 . The total effect after three months for the average bank is given by β 0 (1 + α1 + κ 1 ) + β1 + γ ' while heterogeneity among banks can be accepted if and only if the expression éë β 0α * + β 0* (1 + α + κ 1 ) + β1* + γ * ùû X k ,t −1 + α * β 0* X k2,t −1 is equal to zero. The long run elasticity is given by: (γ + γ * X k ) /(α + α * X k ) , while the loading coefficient is α1 + α1* X k ,t −1 . Standard errors have been approximated with the “delta method” (Rao, 1973). 23 In the GMM estimation, instruments are the second lag of the dependent variable and of the bank-specific characteristics included in each equation. Inflation, GDP growth rate and the monetary policy indicator are considered as exogenous variables. 16 Loan and deposit demand As predicted by theory only changes in permanent income have a positive and significant effect on the interest rate on short term lending while the transitory component is never significant. In fact, as discussed in Section 3, the effect of transitory changes may be also due to a self-financing effect that reduces the proportion of bank debt. On the contrary the interest rate on deposits is negatively influenced by real GDP. In this case the effect is higher when a change in the transitory component occurs because it is directly channeled through current accounts. The effect of inflation is positive on both interest rates but is significantly higher for short-term lending. Operating costs, credit risk and interest rate volatility Bank’s efficiency reduces the interest rate on loans and increase that of deposits. Nevertheless, the effect is not always significant at conventional levels, especially in the equation for the interest rate on current accounts. These results call for further robustness checks using a cost-to-asset ratio (see Section 6). The relative amount of bad loans has a positive and significant effect on the interest rate on loans. This is in line with the standard result that banks that invest in riskier project ask for a higher rate of return to compensate credit risk. Both banking rates are positively correlated with money market rate volatility. The correlation is higher for the interest rate on loans with respect to that of deposits. This is consistent with the prediction of the dealership model by Ho and Saunders (1981) and its extension by Angbazo (1997) where an increase in interbank interest rate volatility is associated with a higher spread. Bank capital channel As expected the “bank capital channel” (based on the maturity mismatch between bank’s assets an liabilities, see Section 3) has a positive effect on the interest rate on shortterm lending and a negative effect on the interest rate on current account. The absolute values of the coefficients are greater in the first case calling for a stronger adjustment on credit contracts than on deposits. Since this channel can be interpreted similarly to a general 17 increase in the costs for the banks, it is worth comparing this result with that obtained for the efficiency indicator. In both cases the effect is strongest for the interest rate on short-term lending and this is consistent with the view that the interest rate on deposit is more sluggish. Interest rate channel A monetary tightening positively influences banks’ interest rate. After a one per cent increase in the monetary policy indicator, interest rate on short term lending are immediately raised of around 0.5 per cent and of around 0.9 per cent after a quarter. Moreover, the passthrough is complete in the long run (the null hypothesis of a unitary elasticity is accepted in all models). The reaction of the short term lending rate is higher with respect to previous studies on the Italian case and this calls for an increase in competition after the introduction of the 1993 Banking Law. Cottarelli et al. (1995), analyzing the period 1986:02-1993:04, find that the immediate pass through is of around 0.2, while the effect after three months is 0.6 per cent. Their long run elasticity is equal to 0.9 per cent but also in their model the null hypothesis of a complete pass-through in the long run is accepted.24 The long run elasticity of the interest rate on current accounts is around 0.7 per cent. This result is in line with the recent findings by de Bondt et al. (2003) under a similar sample period and only a little higher with respect to the long-run elasticity in Angeloni et al. (1995) for the period 1987:1-1993:04.25 The standard answer to the incomplete pass-through of money market changes on the deposit rate is the existence of market power by banks. Another explanation is the presence of compulsory reserves. To analyze this, we can refer to the theoretical elasticity in the case 24 The main differences between Cottarelli et al. (1995) and this paper are three. First, they use the Treasury bill rate as the reference monetary interest rate. However from the early nineties this indicator became less important as “reference rate” because the interbank market became more competitive and efficient (Gaiotti, 1992). This is indeed stated also by Cottarelli et al. (page 19). Second, they do not include macro variables controls in their equation. Third, their dataset is based on monthly data. To allow comparability among the results of this paper and those in Cottarelli et al. (1995) I have: 1) checked the results to different monetary policy indicators (i.e. the interbank rate; see Section 6); 2) excluded the macro variables from equation (1) to verify if the results were sensitive to their inclusion. In all cases the conclusion of an increase of speed in the reaction of short-term interest rate on loans to money market rate resulted unchanged. 25 The VAR model in Angeloni et al. considers the interest rate on total deposits (sight, time deposits and CDs), which is typically more reactive to monetary policy than that on current account because the service component in time deposits and CDs is less important. This means that in comparing our result with Angeloni et al. we are underestimating the potential effect of competition. 18 of perfect competition.26 This benchmark case is very instructive because it allows to analyze what happens if banks are price takers (they take as given not only the monetary market rate but also the interest rate on loans and that on deposits), set the quantity of loans and deposits and obtain a zero profit (the sum of the intermediation margins equals management costs). In this case the long-run elasticities become: ∂iL ∂i = 1 and D = 1 − α where α is the fraction of ∂iM ∂iM deposits invested in risk-free assets (this includes the “compulsory” reserves). Therefore in principle, an incomplete pass-through from market rates to deposits rates is also consistent with the fact that banks decide (or are constrained by regulation) to detain a certain fraction of their deposits in liquid assets. The loading coefficients are significantly negative. It is around –0.4 in the loan equation and –0.6 in the current account equation. This means that if an exogenous shock occurs, respectively 40 and 60 per cent of the deviation is canceled out within the first quarter in each banking rate. Bank lending channel In case of a monetary shock, banks with different characteristics behave differently only in the short run. On the contrary no heterogeneity emerges in the long run relationship between each banking rate and the monetary policy indicator. Considering each bank’s specific characteristic one at the time (Tables 3 and 4), interest rates of small, liquid and well-capitalized banks react less to a monetary policy shock. Also the Berlin-Mester and the Berger-Udell indicators have an high power in explaining heterogeneity in banks’ price setting behavior. Nevertheless, the robustness of these distributional effects has to be checked in a model that takes all these five indicators together into account. In this model, in order to save degrees of freedom, the long-run elasticity between the money market rate and the short- 26 The case of perfect competition can be easily obtained from equation (A1.8) and A1.9) in Appendix 1 considering loan and deposit demand (equations A1.3 and A1.4) infinitely elastic with respect the bank rates (c0→∞, d0→∞). Moreover, we will consider the benchmark case were no heterogeneity emerges in the “bank lending channel” (b1=0) and bonds can be issued at the risk free rate (b0=1). See Freixas and Rochet (1997) for an analogous treatment. 19 term lending rate has been imposed to one; that with the interest rate on current account has been fixed to 0.7. Results are reported in Table 5. Interest rates on short-term lending of liquid and wellcapitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change less their prices. Size is not significant. This evidence matches with previous results on lending. Liquid banks can protect their loan portfolio against a monetary tightening simply by drawing down cash and securities (Gambacorta, 2003). Well-capitalized banks that are perceived as less risky by the market are better able to raise uninsured funds in order to compensate the drop in deposits (Gambacorta and Mistrulli, 2004). Therefore the effects on lending detected for liquid and well-capitalized banks are mirrored by their higher capacity to insulate the clients also from the effects on interest rates. It is interesting to note that, in contrast with the evidence for the US (Kashyap and Stein; 1995), the interaction terms between size and monetary policy are insignificant. The fact that the interest rate on short term lending of smaller banks is not more sensitive to monetary policy than that of larger banks is well documented in the literature for Italy and reflects the close customer relationship between small banks and small firms (Angeloni et al. 1995; Conigliani et al., 1997; Angelini, Di Salvo and Ferri, 1998; Ferri and Pittaluga, 1996). This result is also consistent with Ehrmann et al. (2003) where size does not emerge as a useful indicator for the distributional effect of monetary policy on lending not only in Italy but also in France, Germany and Spain. As regards the interest rate on current accounts, the Berlin-Mester indicator is the only bank-specific characteristic that explains heterogeneity in banks price setting behavior. In particular, banks that heavily depend upon non-deposit funding (banks with a low BM indicator) will adjust their interest rate on current account by more (and more quickly) than banks whose liabilities are less affected by market movements. As explained in Section 3, the intuition of this result is that, other things being equals, it is more likely that a bank will adjust her terms on deposits if the other conditions of her refinancing change. The liability structure seems to influence not only the short-run adjustment but also the loading coefficient. This implies that banks with a high BM ratio react less when there is a deviation in the long run mark-down: banks with a higher percentage of deposits have more room in adjusting their prices toward the optimal equilibrium. As expected, no cross sectional 20 differences emerges among banks due to size, liquidity and capitalization because current accounts are typically insured. 6. Robustness checks The robustness of the results has been checked in several ways. The first test was to introduce as additional control variable a bank-specific measure of the degree of competition that each bank faces in the market. In particular, the average value of the Herfindahl index in the different “local markets” (corresponding to the administrative provinces of Italy) in which the bank operates was introduced in each equation. The reason of this test is that the fixed effect (that captures also industry structure) remains stable over the whole period while the degree of competition could change over time due to the effect of concentration. Therefore this test allows us also to check if the treatment of bank mergers is carried out properly. The Herfindahl index did not show to be statistically significant and the results of the study did not change. The second test was to use as bank’s efficiency indicator the cost-to-total asset ratio instead than the ratio of total loans and deposits to the number of branches. In all cases the results remained unchanged. The third test was to consider if different fiscal treatments over the sample period could have changed deposit demand (from June 1996 the interest rate on current account is subject to a fiscal deduction of 27 per cent; 12.5 per cent before). However, using the net interest rate on current account instead than the gross rate nothing changed. The fourth robustness check was the introduction of a dummy variables to take into account of the spike in the change of the repo interest rate caused by the EMS crisis in the first quarter of 1995. Also in this case results remained the same. The fifth test was to introduce additional interaction terms combining the bank-specific characteristic with inflation, permanent and transitory changes in real income. The reason for this test is the possible presence of endogeneity between bank characteristics and cyclical factors. Performing the test, however, nothing changed, and the double interactions were almost always not significant (it turned out to be statistically not different from zero in the case of the interaction of capitalization and permanent income). 21 The final robustness check was to introduce a dummy variable that indicates if the bank belongs to a group (1) or not (0). Banks belonging to a group may be less influenced by monetary changes if they can benefit of an internal liquidity management; in other words, bank holding companies establish internal capital markets in an attempt to allocate capital among their various subsidiaries (Houston and James, 1998; Upper and Worms, 2001). The introduction of this dummy did not change the results of the study. 7. Conclusions This paper investigates which factors influence price setting behavior of Italian banks. It adds to the existing literature in two ways. First, it analyzes systematically a wide range of micro and macroeconomic variables that have an effect on bank interest rates: permanent and transitory changes in income, interest and credit risk, interest rate volatility, banks’ efficiency. Second, the analysis of banks’ prices (rather than quantities) provides an alternative way to disentangle loan supply from loan demand shift in the “bank lending channel” literature. The search for heterogeneity in banks’ behavior is carried out by using a balanced panel of 73 Italian banks that represent more than 70 per cent of the banking system. The use of microeconomic data help in reducing the problems of aggregation that may significantly bias the estimation of dynamic economic relations and it is less prone to structural changes like the formation of EMU. The main results of the study are the following. First, heterogeneity in the banking rates pass-through exists, but it is detected only in the short run: no differences exist in the long-run elasticities of banking rates to the money market rate. Second, consistently with the existing literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change their prices less. Heterogeneity in the pass-through on the interest rate on current accounts depends on banks’ liability structure. Bank’s size is never relevant. Appendix 1 - A simple theoretical model This Appendix develops a one-period model of a risk neutral bank that operates under oligopolistic market conditions. The balance sheet of the representative bank is as follows: (A1.1) L + S = D + B + K where L stands for loans, S for securities, D for deposits, B for bonds, K for capital. The bank holds securities as a buffer against contingencies. We assume that security holdings are a fixed share of the outstanding deposits (α). They represent a safe asset and fruit the risk-free interest rate.27 We have therefore: (A1.2) S = α D For simplicity, bank capital is exogenously given in the period and greater than capital requirements.28 The bank faces a loan demand and a deposit demand. The first one is given by: (A1.3) Ld = c0 i L + c1 y + c 2 p + c3 i M (c0<0, c1>0, c2>0, c3>0) that is negatively related to the interest rate on loans (il ) and it is positively related to real income (y) and prices (p) and the opportunity cost of self-financing, proxied by the money market interest rate (im).29 Alternatively S can be considered as the total amount of bank’s liquidity, where α is the coefficient of free and compulsory reserves. In this case reserves are remunerated by the money market rate fixed by the Central Bank. This alternative interpretation does not change the results of the model. 27 28 In the spirit of the actual BIS capital adequacy rules, capital requirements on credit risks are given by a fixed amount (k) of loans. If bank capital perfectly meets Basle standard requirement the amount of loans would be L=K/k. We rule out this possibility because banks typically hold a buffer as a cushion against contingencies (Wall and Peterson, 1987; Barrios and Blanco, 2001). Excess capital allows them to face capital adjustment costs and to convey positive information on their economic value (Leland and Pile, 1977; Myers and Majluf, 1984). Another explanation is that banks face a private cost of bankruptcy, which reduces their expected future income (Dewatripont and Tirole, 1994). Van den Heuvel (2001a) argues that even if capital requirement is not currently binding, a low capitalized bank may optimally forego profitable lending opportunities now, in order to lower the risk of future capital inadequacy. A final explanation for the existence of excess capital is given by market discipline; well-capitalized banks obtain a lower cost of uninsured funding, such as bonds or CDs, because they are perceived less risky by the market (Gambacorta and Mistrulli, 2004). 29 As far as the GDP is concerned, there is no clear consensus about how economic activity affects credit demand. Some empirical works underline a positive relation because better economic conditions would 23 The deposit demand is standard. It depends positively on the interest rate on deposits, the level of real income (the scale variable) and the price level and negatively on the interest rate on securities that represent an alternative to the investment to deposits. (A1.4) D d = d 0id + d1 y + d 2 p + d 3im (d0>0, d1>0, d2>0, d3<0) Because banks are risky and bonds are not insured, bond interest rate incorporates a risk premium that we assume depends on specific banks’ characteristics. The latter are balance sheet information or institutional characteristics exogenously given at the end of previous period. (A1.5) ib ( im , xt −1 ) = b0im + b1im xt −1 + b2 xt −1 (b0>1) In other words, this assumption implies that the distributional effects via the bank lending channel depends on some characteristics that allow the bank to substitute insured, typically deposits, with uninsured banks’ debt, like bonds or CDs (Romer and Romer, 1990). For example, theory predicts that big, liquid and well-capitalized banks should be perceived less risky by the market and obtain a lower cost on their uninsured funding (b2<0). Moreover they could react less to monetary change (b1<0) The effects of the so-called “bank capital channel” are captured by the following equation: (A1.6) C MT = ρt −1∆im ( L + S ) (ρ >0) where C MT represents the total cost suffered by the bank in case of a change in monetary policy due to the maturity transformation. Since loans have typically a longer maturity than improve the number of project becoming profitable in terms of expected net present value and, therefore, increase credit demand (Kashyap, Stein and Wilcox, 1993). This is also the hypothesis used in Bernanke and Blinder (1988). On the contrary, other works stress the fact that if expected income and profits increase, the private sector has more internal source of financing and this could reduce the proportion of bank debt (Friedman and Kuttner, 1993). A compromise position is taken by Melitz and Pardue (1973): only increases in permanent income have a positive influence on loan demand, while the effect due to the transitory part could also be associated with a self-financing effect in line with Friedman and Kuttner. Taking this into account, in the econometric part (see Section 4) I will try to disentangle the two effects using a Beveridge and Nelson (1981). For simplicity in the model I assume that the first effect dominates and that a higher income determines an increase in credit demand (c2>0). This is indeed consistent with the evidence provided by Ehrmann et al. (2001) for the four main countries of the euro area. 24 bank fund-raising, the variable ρ represents the cost (gain) per unit of asset that the bank incurs in case of a one per cent increase (decrease) in the monetary policy interest rate. The cost of intermediation is given by: (A1.7) C IN = g1 L + g 2 D (g1>0, g2>0) where the component g1L can be interpreted as screening and monitoring cost while g2D as the cost of the branching.30 Loans are risky and, in each period, a percentage j of them is written off from the balance sheet, therefore reducing bank’s profitability. The representative bank maximizes her profits subject to the balance-sheet constraint. The bank optimally sets the interest rates on loans and deposits (iL, iD), while she takes the money market interest rate (iM) as given (it is fixed by the Central Bank). Max π = (iL − j ) L + im S − iD D − iB B − C MT − C IN il ,id s.t. L+Q = D+ B+ K Solving the maximization problem, the optimal levels of the two interest rates are: (A1.8) iL = Ψ 0 + Ψ1 p + (Ψ 2 + Ψ 3 xt −1 )im + Ψ 4 y P + Ψ 5 ρt −1∆im + Ψ 6 j + Ψ 7 xt −1 (A1.9) id = Φ 0 + Φ1 p + (Φ 2 + Φ 3 xt −1 )im + Φ 4 y P + Φ 5 ρt −1∆im + Φ 6 xt −1 where: g1 c b c c b 1 > 0 ; Ψ1 = 2 > 0 ; Ψ 2 = 0 + 3 > 0 ; Ψ 3 = 1 ; Ψ 4 = 1 > 0 ; Ψ 5 = ; 2 −2c0 2 −2c0 −2c0 2 2 b (1 − α ) −d 3 α g d b 1 Φ0 = − 2 < 0 ; Ψ7 = 2 Φ2 = 0 + + >0; Φ1 = − 2 < 0 ; Ψ6 = ; 2 2d 0 2 2 2d 0 2 2 d b (1 − α ) α b (1 − α ) Φ3 = − 1 ; Φ 4 = − 1 < 0 ; Φ5 = − < 0 ; Φ6 = 2 . 2d 0 2 2d 0 2 Ψ0 = 30 The additive linear form of the management cost simplifies the algebra. The introduction of a quadratic cost function would not have changed the result of the analysis. An interesting consequence of the additive form of the management cost is that bank’s decision problem is separable: the optimal interest rate on deposits is independent of the characteristic of the loan market while the optimal interest rate on loans is independent of the characteristics of the deposit market. For a discussion see Dermine (1991). 25 Equation (A1.8) states that a monetary tightening determines an increase in the interest rate on loans (Ψ2>0): the total effect could be divided into two parts: the “bank lending channel” (b0/2>0) and the “opportunity cost” effect (-c3/2c0>0) The effect of a monetary squeeze is smaller if the bank-specific characteristic reduces the impact of monetary policy on the cost of funding (b1<0 and Ψ3<0). In this case banks have a greater capacity to compensate the deposit drop by issuing uninsured funds at a lower price. Loan interest rate reacts positively to an output expansion (Ψ4>0) and to a raise in prices (Ψ1>0). The effect of the so-called “bank capital channel” is also positive ( Ψ 5 > 0 ); due to the longer maturity of bank assets with respect to liabilities (ρ>0), in case of a monetary tightening ( ∆im >0) the bank suffers a cost and a subsequent reduction in profit; given the capital constraint, this effect determines an increase in loan interest rates (the mirror effect is a decrease in lending). The equation (A1.9) for deposit interest rate is slightly different. Also in this case the impact of a monetary tightening is positive (Φ2>0) but it can now be split in three parts: the “bank lending channel” (b0(1-α)/2>0), the “opportunity cost” (-d3/2d0>0) and the “liquidity buffer”(α/2>0) effects. The intuition of this result is that a monetary squeeze automatically increase the cost of borrowing of bank uninsured fund and the return on securities (the alternative investment for depositors); therefore the first two effects push the bank to increase the interest rate on deposits to raise more insured funds. The percentage of deposits invested in securities (α) act, on the one hand, as a simple “reserve coefficient” that reduces the effectiveness of the “bank lending channel” while, on the other, it increases the revenue on liquid portfolio and the market power of the bank to offset the interest rate on deposits. The distributional effects of monetary policy are equal to the ones described above for the interest rate on loans. The effects on the cost of deposits are smaller for banks with certain characteristics only if b1<0 and Ψ3<0. Deposit interest rate reacts negatively to an output expansion (Φ4<0) and to an increase in prices (Φ1<0). An economic expansion pushes the deposits demand to the left and causes a decrease in cost of deposits (remember that deposit demand is upward sloping with respect to id). The effect should be greater for increases in transitory income. Also the effect of the “bank capital channel” are negative (Φ5<0); as we have seen, in case of a monetary tightening (ρ ∆im >0) the bank suffers a cost and a reduction in profit; this induces the bank to increase her interest rate margin, reducing the interest rates on deposits. 26 Appendix 2 – Technical details on the data The dataset has been constructed using three sources. Interest rates are taken from the 10-day report survey conducted by the Bank of Italy. Bank’s balance sheet information comes from the Banking Supervision Register at the Bank of Italy. Data on macroeconomic variables are taken from the International Financial Statistics. Data on interest rates refer to transactions in euros (Italian lira before 1999). The deposit interest rate is the weighted average rate paid by the single banks on current accounts, which are highly homogenous deposits products.31 The rate on domestic shortterm lending for the single bank is the weighted average of all lending positions. From this computation, overdraft fees are excluded. The choice of the short-term rate as a measure of the bank interest lending pass-through is due to several reasons. First, short-term lending excludes subsidized credit. Second, short-term loans typically are not collateralised and this allows insulating the “bank lending” channel from the “balance sheet” channel. Broadly speaking, the pass-through from market interest rates to the interest rate on loans does not depend upon market price variations that influence the value of collateral. Nearly half of bank’s business is done at this rate. Both interest rates are posted rates that are changed at discrete intervals (often less frequently than weekly, see Green, 1998). In our case, the quarterly frequency of the data is sufficient enough to capture all relevant changes due to a monetary policy shock. Both rates are gross of fiscal deduction. The interest rate taken as monetary policy indicator is that on repurchase agreements between the Bank of Italy and credit institutions in the period 1993-1998, and the interest rates on main refinancing operation of the ECB for the period 1999-2001.32 31 Current accounts are the most common type of deposit (at the end of 2001 they represented around 70 per cent of total bank deposits and passive repos). Current accounts allow unlimited checking for depositor that can close the account without notice. The bank, in turn, can change the remuneration of the account at any point in time. Therefore differences in deposit rates are not influenced by heterogeneity in maturity (see Focarelli and Panetta, 2003). 32 As pointed out by Buttiglione, Del Giovane and Gaiotti (1997), in the period under investigation the repo rate mostly affected the short-term end of the yield curve and, as it represented the cost of banks’ refinancing, it represented the value to which market rates and bank rates eventually tended to converge. The interest rate on main refinancing operation of the ECB does not present any particular break with the repo rate. 27 The cost a bank suffers from her maturity transformation function is due to the different sensitivity of her assets and liabilities to interest rates. Using a maturity ladder, we have: å(χ ⋅ A −ζ P ) *100 ρ = åA j j j j j i j j where Aj (Pj) is the amount of assets (liabilities) of j months-to-maturity and χj (ζj) measures the increase in interest on assets (liabilities) of class j due to a one-per-cent increase in the monetary policy interest rate (∆im=0.01). In other words, if å ( χ ⋅ A − ζ P ) >0, ρ j j j j i j represents the cost per unit of asset bank i suffers in case the monetary policy interest rate is raised of one percentage point. We obtain χi and ζi directly from supervisory regulation on interest rates risk exposure. In particular, the regulation assumes, for any given class j of months-to-maturity: 1) the same sensitivity parameter (χj =ζj) and 2) a non-parallel shift of the yield curve (∆im=0.01 for the first maturity class and then decreasing for longer maturity classes). Then, for each bank, after having classified assets and liabilities according to their months-to-maturity class, we have computed the bank specific variable ρi . This variable has been then multiplied by the change of the monetary policy indicator (∆im) to obtain the realized loss (or gain) per unit of asset in each quarter. In assembling our sample, the so-called special credit institutions (long-term credit banks) have been excluded since they were subject to different supervisory regulations regarding the maturity range of their assets and liabilities. Nevertheless, special long-term credit sections of commercial banks have been considered part of the banks to which they belonged. Particular attention has been paid to the treatment of mergers. In practice, it has been assumed that these have been taken place at the beginning of the sample period, summing the balance-sheet items of the merging parties. For example, if bank A has been incorporated by bank B at time t, bank B has been reconstructed backward as the sum of the 28 merging banks before the merger. Bank interest rates have been reconstructed backwards using as weights short-term loans and current accounts of the merging parties.33 Only banks reporting detailed lending and deposit rates over the whole sample period were considered. I refrain from adopting short time series to ensure sufficient asymptotic in the context of the error correction estimation. Bank observations that were missing or misreported or that constituted clear outliers were excluded from the sample. Bad loans are defined as loans for which legal procedures aimed at their repayment have been started. The permanent component of GDP has been computed using the Beveridge and Nelson (1981) decomposition. An ARIMA model (1,1,1) was applied to the logarithm of the series. Computations have been carried out using the algorithm described in Newbold (1990). Robustness of the results have been checked by means of a statistical analysis of the residuals. The possible presence of structural breaks in interest rates series have been investigated by means of the procedure developed by Banerjee, Lumsdaine and Stock (1992). Figure A1 shows sequential test for changes in the mean of each interest rate series. The hypothesis of this procedure is that, if there is a break, its date is not known a priori but rather is gleaned from the data. The results clearly show that unit-root/no-break null can be rejected at the 2.5 per cent critical value level against the stationarity/mean-shift alternative for the period 1995:03-1998:03. In equation (1) and (2) a convergence dummy, that takes the value of 1 in this period and 0 elsewhere, has been introduced. 33 The same methodology has been used, among others by Peek and Rosengreen (1995), Kishan and Opiela (2000) and Ehrmann et al. (2001). References Altunbas Y., Fazylow O. and Molyneux P. (2002), “Evidence on the Bank Lending Channel in Europe”, Journal of Banking and Finance, forthcoming. Angbazo, L. (1997), “Commercial Bank Net Interest Margins, Default Risk, Interest-rate risk, and Off-balance Sheet Banking”, Journal of Banking and Finance, Vol. 21, pp. 55-87. Angelini P. and Cetorelli N. (2002), ""The effects of regulatory reform on competition in the banking industry"", Journal of Money, Credit and Banking, forthcoming. Angelini, P., P. Di Salvo and G. Ferri (1998), “Availability and Cost of Credit for Small Businesses: Customer Relationships and Credit Cooperatives”, Journal of Banking and Finance, Vol. 22, No. 6-8, pp. 925-54. Angeloni I., Buttiglione L., Ferri G. and Gaiotti E. (1995), “The Credit Channel of Monetary Policy across Heterogeneous Banks: The Case of Italy”, Banca d’Italia, Temi di discussione, No. 256. Ausubel L. M. (1992), Rigidity and Asymmetric Adjustment of Bank Interest Rates, mimeo. Banca d’Italia (1986), Modello trimestrale dell’economia italiana, Banca d’Italia, Temi di discussione, No. 80. Banca d’Italia (1988), Modello mensile del mercato monetario, Banca d’Italia, Temi di discussione, No. 108. Banerjee A., Lumsdaine R.L. and Stock J.H. (1992), “Recursive and Sequential Tests of the UnitRoot and Trend Break Hypotheses: Theory and International Evidence”, Journal of Business and Economic Statistics, Vol. 10, No. 3, pp.271-87. Berger A.N. and Udell G.F. (1992), “Some Evidence on the Empirical Significance of Credit Rationing”, Journal of Political Economy, Vol.100, No. 5, pp. 1047-77. Berlin M. and Mester L.J. (1999), “Deposits and Relationship Lending”, Review of Financial Studies, Vol. 12, No. 3, pp. 579-607. Bernanke B. and Blinder A.S. (1988), “Is it Money or Credit, or Both or Neither? Credit, Money and Aggregate Demand”, American Economic Review, Vol. 78, No. 2, pp. 435-9. Paper and Proceedings of the One-Hundredth Annual Meeting of the American Economic Association. Beveridge S. and Nelson C. (1981), “A New Approach to the Decomposition of Economics Time Series into Permanent and Transitory Components with Particular Attention to Measurement of the ‘Business Cycle’”, Journal of Monetary Economics, Vol. 21, pp. 151-74. Boccuzzi, G. (1998), La crisi dell'impresa bancaria. Profili economici e giuridici, Giuffrè, Milano. Bolton, P. and Freixas X. (2001), “Corporate Finance and the Monetary Transmission Mechanism”, CEPR, Discussion Paper Series, No. 2982. Calomiris C.W. and Hubbard G.R. (1995), “Internal Finance and Investment: Evidence from the Undistributed Profit Tax of 1936-37”, Journal of Business, Vol. 68. No. 4. Ciocca P. (2000), La nuova finanza in Italia. Una difficile metamorfosi (1980-2000), Bollati Boringhieri, Torino. Cornett M. M. and Tehranian H. (1994), “An Examination of Voluntary Versus Involuntary Security Issuances by Commercial Banks: The Impact of Capital Regulations on Common Stock Returns”, Journal of Financial Economics, Vol. 35, pp. 99-122. Cottarelli C. and Kourelis A. (1994), “Financial Structure, Bank Lending Rates and the Transmission Mechanism of Monetary Policy”, IMF Staff Papers, Vol. 41, No. 4, pp.587-623. Cottarelli C., Ferri G. and Generale A. (1995), “Bank Lending Rates and Financial Structure in Italy: A Case Study”, IMF Working Papers, No. 38. 30 de Bondt G., Mojon B. and Valla N. (2003), “The Adjustment of Retail Rates in the Euro Area: Is It (Really) Sluggish?”, European Central Bank, mimeo. Dermine J. (1991), Discussion to Vives. X., “Banking Competition and European Integration”, in Giovannini A. and Mayer C., European Financial Integration, Cambridge, Cambridge University Press. Dewatripont M. and Tirole J. (1994), The Prudential Regulation of Banks, Cambridge, Massachusetts, MIT Press. Ehrmann M., Gambacorta L., Martinez Pagés J., Sevestre P. and Worms A. (2003), “Financial Systems and the Role of Banks in Monetary Policy Transmission in the Euro Area”, in Angeloni I., Kashyap A. and Mojon B., Monetary Policy Transmission in the Euro Area, Cambridge, Cambridge University Press. Focarelli D. and Panetta F. (2003), “Are Merger Beneficial to Consumers? Evidence from the Market for Bank Deposits”, American Economic Review, forthcoming. Friedman B. and Kuttner K. (1993), “Economic Activity and the Short-Term Credit Markets: an Analysis of Prices and Quantities”, Brooking Papers on Economic Activity, Vol. 2, pp. 193-283. Freixas X. and Rochet J. (1997), Microeconomics of Banking, Cambridge, MIT Press. Gaiotti E. (1992), “L’evoluzione delle tecniche di controllo monetario nel modello mensile della Banca d’Italia”, mimeo, Banca d’Italia. Gambacorta L. (2003), “The Italian Banking System and Monetary Policy Transmission: Evidence from Bank Level Data”, in Angeloni, I., A. Kashyap and B. Mojon (eds.), Monetary Policy Transmission in the Euro Area, Cambridge, Cambridge University Press. Gambacorta L. and Mistrulli P. (2004), “Does Bank Capital Affect Lending Behavior?”, Journal of Financial Intermediation, forthcoming. Green C.J. (1998), “Banks as Interest Rate Managers”, Journal of Financial Services Research, Vol. 14, n. 3, pp. 189-208. Hancock D. (1991), A Theory of Production for the Financial Firm, Norwell, Massachusetts, Kluwer Academic Publishers. Hannan T.H. and Berger A.N. (1991), “The Rigidity of Prices: Evidence From Banking Industry”, American Economic Review, Vol. 81, pp.938-45. Harvey (1981), Time Series Models, Oxford, Allan. Ho T.S.Y. and Saunders A. (1981), The Determinants of Bank Interest Margins: Theory and Empirical Evidence”, Journal of Financial and Quantitative Analysis, Vol. 16, No. 2, pp. 581600. Houston J.F. and James C. (1998), “Do Bank Internal Capital Market Promote Lending?”, Journal of Banking and Finance, Vol. 22, pp. 899-918. Hutchison D.E. (1995), “Retail Bank Deposit Pricing: An Intertemporal Asset Pricing Approach”, Journal of Money Credit and Banking, Vol. 27, pp. 217-31. Kashyap A. and Stein J.C. (1995), “The Impact of Monetary Policy on Bank Balance Sheets”, Carnegie Rochester Conference Series on Public Policy, Vol. 42, pp.151-195. Kashyap A. and Stein J.C. (2000), “What Do a Million Observations on Banks Say About the Transmission of Monetary Policy”, American Economic Review, Vol. 90, No. 3, pp. 407-28. Kashyap A., Stein J.C. and Wilcox D. (1993). Monetary Policy and Credit Conditions: Evidence from the Composition of External Finance, American Economic Review, Vol. 83, pp. 78-98. Kishan R.P. and Opiela T.P. (2000), “Bank Size, Bank Capital and the Bank Lending Channel”, Journal of Money, Credit and Banking, Vol. 32, No. 1, pp. 121-41. Klein M. (1971), “A Theory of the Banking Firm”, Journal of Money, Credit and Banking, Vol. 3, No. 2, pp. 205-18. 31 Leland H.E. and Pile D.H. (1977), “Informational Asymmetries, Financial Structures and Financial Intermediation”, The Journal of Finance, Vol. 32, pp. 371-87. Lim G.C. (2000), “Bank Interest Rate Adjustments: Are They Asymmetric?”, The Economic Record, Vol. 77, no. 237, pp.135-147. Melitz J. and Pardue M. (1973), “The Demand and Supply of Commercial Bank Loans”, Journal of Money, Credit and Banking, Vol. 5, No. 2, pp. 669-92. Moore G.R., Porter R.D. and Small D.H. (1990), “Modelling the Disaggregated Demands for M2 and M1: the U.S. Experience in the 1980s”, Proceedings of a Federal Reserve Board Conference on Monetary Aggregates and Financial System Behavior. Myers S.C. and Majluf N.S. (1984), “Corporate Finance and Investment Decisions when Firms Have Information that Investors Do Not Have”, Journal of Financial Economics, Vol. 13, pp.187-221. Neumark D. and Sharpe S.A. (1992), “Market Structure and the Nature of Price Rigidity: Evidence From the Market for Consumer Deposits”, Quarterly Journal of Economics, Vol. 107, pp.65780. Newbold P. (1990), “Precise and Efficient Computation of the Beveridge-Nelson Decomposition of Economic Time Series”, Journal of Monetary Economics, Vol. 26, pp. 453-457. Passacantando F. (1996), “Building an Institutional Framework for Monetary Stability”, BNL Quarterly Review, Vol. 49, No. 196, pp. 83-132. Peek J. and Rosengren E.S. (1995), “Bank Lending and the Transmission of Monetary Policy”; in Peek J. and E.S. Rosengren (eds.), Is Bank Lending Important for the Transmission of Monetary Policy?, Federal Reserve Bank of Boston Conference Series No. 39, pp. 47-68. Petersen M. and Rajan R. (1994), “The Benefits of Lending Relationships: Evidence from Small Business Data”, Journal of Finance, Vol. 49, pp.3-37. Rosen R.J. (2001), What Goes Up Must Come Down? Asymmetries and Persistence in Bank Deposit Rates, Indiana University, mimeo. Santomero A.M. (1984), “Modeling the Banking Firm: A Survey”, Journal of Money Credit and Banking, Vo. 16, n. 4, pp. 576-602. Stein J.C. (1998), “An Adverse-Selection Model of Bank Asset and Liability Management with Implications for the Transmission of Monetary Policy”, RAND Journal of Economics, Vol. 29, No. 3, pp. 466-86. Thakor A.V. (1996), “Capital Requirements, Monetary Policy, and Aggregate Bank Lending: Theory and Empirical Evidence”, The Journal of Finance, Vol. 51, No. 1, pp. 279-324. Upper C. and Worms A. (2001), “Estimating Bilateral Exposures in the German Interbank Market: Is There a Danger of Contagion?”, in BIS (ed.), Marrying the Macro and Microprudential Dimensions of Financial Stability, BIS papers, No. 1, pp. 211-29. Van den Heuvel S.J. (2001a), “The Bank Capital Channel of Monetary Policy”, University of Pennsylvania, mimeo. Van den Heuvel S.J. (2001b), “Banking Conditions and the Effects of Monetary Policy: Evidence from U.S. States”, University of Pennsylvania, mimeo. Van den Heuvel S.J. (2003), “Does Bank Capital Matter for Monetary Transmission?”, FRBNY Economic Policy Review, forthcoming. Verga G. (1984), “La determinazione dei tassi bancari in Italia: un’analisi per gli anni più recenti”, Banca, Impresa, Società, Vol. 3, No. 1, pp.65-84. Weth M.A. (2002), “The Pass-Through from Market Interest Rates to Bank Lending Rates in Germany”, Discussion Paper No 11, Economic Research Center of the Deutsche Bundesbank. Table 1 VARIABLES DESCRIPTION Variables Dependent variables Fixed effects Symbols iLt Interest rate on domestic short term loans iDt Interest rate on current account deposits µi imt Macro variables Description y tP , y Tt pt Bank-specific dummy variable Monetary policy indicator Permanent and transitory components of real GDP computed using the Beveridge and Nelson (1981) decomposition Inflation rate Size: log of total assets (Kashyap and Stein, 1995; Ehrmann et al. 2003) Liquidity: cash and securities over total assets (Stein, 1998; Kashyap and Stein, 2000) Excess capital: difference between regulatory capital and capital requirements (Peek and Rosengren, 1995; Kishan and Opiela, 2000; Gambacorta and Mistrulli, 2004) Deposit strength: ratio between deposits and bonds plus deposits (Berlin and Mester,1999; Weth, 2002) Credit relationship: ratio between long term loans and total loans (Berger and Udell, 1992) Bank-specific characteristics that influence the “bank lending channel” X it −1 Measure for the “bank capital channel” ρit −1 Risk-measure jit Efficiency ratio eit Interest rate volatility σt Cost per unit of asset that the bank incurs in case of a one per cent increase in MP Ratio between bad loans and total loans. This variable captures the riskiness of lending operations and should be offset by a higher expected yield of loans. Management efficiency: ratio of total loans and deposits to the number of branches. Interest rate volatility: coefficient of variation of iM . Control variables Φ it Convergence dummy: step dummy that takes the value of 1 in the period 1995:03-1998:03 and 0 elsewhere. Seasonal dummies. Note: For more information on the definition of the variables see Appendix 2. 18 18 18 18 Big banks Small banks Liquid banks (2) Low liquid banks 18 18 18 18 18 18 Well capitalized banks Low capitalized banks Banks with high BM ratio Banks with low BM ratio (3) (4) Banks with high BU ratio (5) Banks with low BU ratio (1) 73 Number of banks Total sample Bank-characteristics (*) 8.51 10.97 11.78 7.77 9.71 9.42 9.51 9.33 9.28 10.02 9.51 Mean 2.59 2.12 1.49 2.24 2.73 2.81 2.72 2.73 2.81 2.73 2.72 St. dev. 3.69 4.00 4.88 3.69 3.69 4.75 3.69 4.42 3.69 5.03 3.69 Min 15.06 16.12 16.12 15.06 16.12 15.93 15.94 14.86 15.06 16.12 16.12 Max Interest rate on short term lending 2.80 4.68 5.15 2.41 3.68 3.53 3.57 3.61 3.57 3.55 3.58 Mean 1.67 1.44 0.96 1.45 1.80 1.79 1.80 1.71 1.74 1.79 1.79 St. dev. 0.65 0.53 0.74 0.52 0.52 0.74 0.65 0.73 0.73 0.52 0.52 Min 7.36 7.43 8.21 7.35 7.18 8.21 8.21 7.35 7.35 8.21 8.21 Max Interest rate on current accounts definition of the variables see Appendix 2. The sources of the dataset are Bank of Italy supervisory returns and 10-days reports. 21.92 8.51 6.58 27.00 9.66 24.28 4.67 43.75 51.15 1.55 16.20 Size (1) 19.98 28.26 29.69 18.56 26.15 20.82 33.07 14.91 19.01 25.11 24.00 Liq. (2) 3.80 3.95 4.46 3.42 6.86 1.49 4.27 3.13 2.56 4.81 3.91 Cap. (3) 71.84 93.13 98.53 66.10 85.49 78.40 86.27 72.43 77.60 84.40 82.40 BM (4) 53.29 22.46 28.72 45.30 37.22 38.46 36.15 43.66 38.98 41.72 37.66 BU (5) average ratio below the third quartile. Since the characteristics of each bank could change through time, percentiles have been worked out on mean values. For more details on the long-term loans and total loans. A bank with a ""high"" characteristic has the average ratio above the first quartile of the distribution. (*) A bank with a ""low""characteristic has the capital requirements. (4) The Berlin and Mester indicator (BM) is the ratio between deposits and deposits plus bonds. (5) The Berger and Udell indicator (BU) is the ratio between government securities over total assets. (3) The capital ratio is given by excess capital divided by total assets. Excess capital is the difference between regulatory capital and total interest rate are annualized and given in percentages. (1) The size indicator is given by total asset (billions of euros). (2) The liquidity indicator is represented by the sum of cash and Ex special credit institutions, foreign banks and ""banche di credito cooperativo"" are excluded. The sample represents more than 70 per cent of total system in terms of lending. All SUMMARY STATISTICS (1993:03-2001:03) Table 2 Table 3 RESULTS FOR THE EQUATION ON THE INTEREST RATE ON SHORT-TERM LENDING This table shows the results of the equation for the interest rate on short term lending. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and a bank specific characteristic: ∆ iL k ,t = µ k + 2 1 j =1 j =0 å κ j ∆iL k ,t − j + å ( β j + β *j X k ,t −1 )∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + λX k ,t −1 + φ∆ ( ρ k ,t −1∆iM t ) + + (α + α X k ,t −1 )iL k ,t −1 + (γ + γ * X k ,t −1 )iM t −1 + θ jk ,t + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:03-2001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. Dependent variable: quarterly change of the interest rate on short-term lending (1) Size Coeff. (2) Liquidity (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. S.Error Coeff. 0.017 0.012 0.025 0.145 *** 0.032 ** 0.012 0.015 0.013 0.026 0.149 *** 0.025 ** 0.012 0.018 0.187 *** 0.012 0.043 *** 0.024 0.026 0.015 0.010 0.020 Costs, credit risk and int.rate volatility Bank's efficiency: -0.004 ** 0.002 -0.001 Bad loans: 0.020 *** 0.002 0.016 *** Interest rate volatility: 0.011 *** 0.001 0.012 *** 0.002 -0.006 ** 0.002 0.017 *** 0.001 0.010 *** 0.002 0.001 0.001 -0.001 0.020 *** 0.014 *** 0.001 -0.001 0.002 0.019 *** 0.001 0.012 *** 0.001 0.002 0.001 Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.569 *** 0.027 0.003 0.556 *** 0.028 0.586 *** 0.026 0.031 0.018 0.027 0.036 0.023 0.418 0.022 0.026 0.465 *** 0.030 0.497 *** 0.023 0.028 0.529 *** 0.032 0.463 *** 0.034 0.000 0.033 0.035 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.938 *** 0.013 0.000 0.913 *** 0.015 0.971 *** 0.014 0.016 0.878 *** 0.159 0.017 0.889 *** 0.016 0.863 *** 0.013 0.000 0.014 0.012 Long run elasticity Average bank: Ho: unitary long run elasticity (p-val.) Ho: no heterogeneity (p-value) Low characteristic High characteristic 1.017 *** 0.014 0.056 0.509 0.996 *** 0.014 1.049 *** 0.016 0.015 1.012 *** 0.235 0.924 0.026 0.992 *** 0.012 1.040 *** 0.018 0.489 0.644 0.016 0.023 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.017 0.000 0.017 0.020 Bank capital channel Loan demand Inflation: Permanent Income: Transitory Income: Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations S.Error Coeff. (3) Capitalization 0.159 *** 0.019 0.033 ** 0.015 0.012 0.031 0.145 *** 0.030 *** 0.013 0.403 *** 0.414 *** 0.383 *** 0.941 *** 0.962 *** 0.920 *** 0.954 *** 0.958 *** 0.949 *** 0.869 *** 0.862 *** 0.878 *** -0.477 *** 0.023 -0.422 *** 0.000 -0.505 *** 0.026 -0.391 *** -0.441 *** 0.023 -0.451 *** 0.019 -0.507 *** 0.000 0.023 -0.482 *** 0.019 -0.539 *** 0.023 0.035 0.028 0.026 -0.234 *** -0.519 *** 0.043 -0.382 *** 0.000 0.021 -0.434 *** 0.020 -0.330 *** 0.104 * 0.055 0.409 *** 0.070 0.178 *** 0.051 0.197 *** 0.066 0.109 * 0.066 0.000 0.949 0.087 2336 0.000 0.367 0.099 2336 0.000 0.702 0.088 2336 0.000 0.185 0.000 0.101 2336 73 0.116 0.057 2336 73 1.023 *** 0.012 0.037 0.011 0.015 0.474 *** 0.456 *** 1.031 *** 1.015 *** 0.987 *** 1.005 *** 0.014 0.816 0.822 0.015 0.015 0.536 *** 0.529 *** 0.012 0.047 0.883 0.013 0.012 73 0.996 *** 0.018 0.000 0.018 0.018 0.533 *** 73 0.982 *** 0.990 *** 0.978 *** -0.381 *** 73 Table 4 RESULTS FOR THE EQUATION ON INTEREST RATE ON CURRENT ACCOUNTS This table shows the results of the equation for the interest rate on current accounts. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and a bank specific characteristic: ∆i D k , t = µ k + 2 1 j =1 j =0 åκ j ∆iD k ,t − j + å ( β j + β *j X k ,t −1)∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + λX k ,t −1 + φ∆( ρ k ,t −1∆iM t ) + + (α + α X k ,t −1 )iD k ,t −1 + (γ + γ * X k ,t −1 )iM t −1 + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:03-2001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. (1) Size Dependent variable: quarterly change of the interest rate on current accounts Coeff. (2) Liquidity S.Error Coeff. (3) Capitalization (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. S.Error Coeff. Deposit demand Inflation: Permanent Income: Transitory Income: 0.049 *** 0.015 0.091 *** -0.058 *** 0.006 -0.048 *** -0.222 *** 0.012 -0.204 *** 0.012 0.058 *** 0.006 -0.058 *** 0.012 -0.223 *** 0.015 0.005 0.011 0.099 *** -0.024 * -0.102 *** 0.008 0.039 *** 0.013 -0.052 *** 0.012 -0.202 *** 0.009 0.004 0.010 Costs, credit risk and int.rate volatility Bank's efficiency: Interest rate volatility: 0.001 0.001 ** 0.001 0.001 0.001 0.002 *** 0.001 0.001 0.001 0.001 *** 0.002 0.001 0.012 *** 0.005 *** 0.001 0.000 0.002 * 0.002 *** 0.001 0.001 Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.413 *** 0.013 0.000 0.400 *** 0.015 0.429 *** 0.012 0.411 *** 0.010 0.000 0.010 0.010 0.410 *** 0.008 0.742 0.009 0.009 0.418 *** 0.009 0.000 0.009 0.010 0.388 *** 0.408 *** 0.366 *** 0.008 0.000 0.007 0.010 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.546 *** 0.009 0.000 0.512 *** 0.010 0.588 *** 0.008 0.006 0.540 *** 0.000 0.006 0.536 *** 0.008 0.542 *** 0.006 0.776 0.006 0.008 Long run elasticity Average bank: Ho: unitary long run elasticity (p-val.) Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.685 *** 0.013 0.000 0.905 0.688 *** 0.014 0.682 *** 0.013 0.007 0.000 0.444 0.006 0.009 0.675 *** 0.661 *** 0.010 0.000 0.717 0.010 0.011 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.016 0.000 0.017 0.017 Bank capital channel Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations 0.431 *** 0.394 *** 0.541 *** 0.551 *** 0.530 *** 0.551 *** 0.535 *** 0.507 *** 0.526 *** 0.493 *** -0.572 *** 0.018 -0.646 *** 0.000 -0.537 *** 0.018 -0.657 *** -0.610 *** 0.023 -0.634 *** 0.018 -0.609 *** 0.016 0.020 -0.645 *** 0.017 -0.564 *** 0.020 0.000 0.019 0.025 -0.725 *** -0.795 *** 0.016 -0.572 *** 0.000 0.019 -0.610 *** 0.017 -0.533 *** -0.055 *** 0.015 -0.036 *** 0.012 -0.049 *** 0.009 -0.039 *** 0.013 -0.034 *** 0.009 0.000 0.976 0.960 2336 0.785 0.094 2336 0.000 0.340 0.092 2336 0.508 0.095 2336 73 0.000 73 0.676 *** 0.007 0.049 0.007 0.009 0.663 *** 0.694 *** 0.670 *** 0.699 *** 0.009 0.000 0.205 0.010 0.009 0.544 *** 0.451 *** 0.387 *** 0.009 0.000 0.463 0.009 0.011 0.953 0.091 2336 0.685 *** 0.008 0.000 0.008 0.008 0.411 *** 0.409 *** 0.000 73 0.643 *** 0.631 *** 0.654 *** -0.760 *** 73 0.669 *** 0.000 73 Table 5 BANK LENDING CHANNEL This table shows the results of the equation for the interest rate on short-term lending (panel A) and current accounts (panel B) when all bank-specific characteristics are taken simultaneously into account. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and each bank-specific characteristic: ∆iψ k ,t = µ k + 2 5 1 5 å κ j ∆iψ k ,t − j + å å ( β j + β *j X k , m,t −1)∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + å λm X k , m,t −1 + j =1 m =1 j = 0 + φ∆ ( ρ k ,t −1∆iM t ) + (α + m =1 5 å α m* X k ,m,t −1)(iψ k ,t −1 − γ iM t −1) + θ jk ,t + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t m =1 with i ψ= quarterly change of the interest rate on short-term lending or current accounts k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Bank-specific characteristics are size,liquidity, capitalization, Berlin-Mester and Berger-Udell indicators (m =5). Data are quarterly (1992:032001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. (1) Size Coeff. (2) Liquidity S.Error Coeff. (3) Capitalization S.Error Coeff. (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. (A) Dependent variable is the quarterly change of the interest rate on short-term lending Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.452 *** 0.062 0.159 0.492 *** 0.064 0.393 *** 0.080 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.879 *** 0.039 0.639 0.895 *** 0.058 0.857 *** 0.040 0.891 *** 0.868 *** Long run elasticity All banks: 1.000 1.000 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic -0.354 *** 0.050 -0.354 *** 0.681 -0.377 *** 0.072 -0.354 *** -0.324 *** 0.092 -0.354 *** Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations - 0.000 - 0.452 *** 0.476 *** 0.421 *** 0.879 *** - 0.062 0.027 0.058 0.069 0.039 0.317 0.036 0.033 - 0.452 *** 0.558 *** 0.308 *** 0.879 *** 0.914 *** 0.847 *** 1.000 - 0.050 -0.354 *** 0.990 0.063 -0.318 *** 0.046 -0.399 *** 0.062 0.043 0.065 0.110 0.039 0.744 0.082 0.075 0.050 0.536 0.070 0.095 0.452 *** 0.519 *** 0.375 *** 0.062 0.016 0.050 0.084 0.883 *** 0.876 *** 0.039 0.879 *** 0.913 0.050 0.888 *** 0.047 0.873 *** 0.039 0.912 0.039 0.053 1.000 - 0.460 *** 0.437 *** 0.879 *** - -0.354 *** -0.332 *** -0.375 *** 0.062 0.702 0.059 0.077 0.452 *** 1.000 - 0.050 -0.354 *** 0.761 0.089 -0.332 *** 0.085 -0.376 *** 0.050 0.773 0.086 0.095 0.073 0.985 2336 73 (B) Dependent variable is the quarterly change of the interest rate on current accounts Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.452 *** 0.042 0.972 0.453 *** 0.043 0.452 *** 0.050 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.545 *** 0.033 0.160 0.572 *** 0.032 0.524 *** 0.043 0.546 *** 0.545 *** Long run elasticity Average bank: 0.700 0.700 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic -0.570 *** 0.043 -0.570 *** 0.388 -0.537 *** 0.048 -0.565 *** -0.612 *** 0.074 -0.575 *** Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations 0.000 73 - - 0.915 0.180 2336 0.452 *** 0.470 *** 0.434 *** 0.545 *** - 0.042 0.129 0.050 0.037 0.033 0.978 0.038 0.033 - 0.452 *** 0.479 *** 0.419 *** 0.545 *** 0.566 *** 0.517 *** 0.700 - 0.043 -0.570 *** 0.820 0.050 -0.607 *** 0.047 -0.523 *** 0.042 0.529 0.054 0.074 0.033 0.481 0.055 0.045 0.043 0.481 0.019 0.025 0.452 *** 0.497 *** 0.406 *** 0.042 0.112 0.062 0.062 0.590 *** 0.516 *** 0.033 0.545 *** 0.203 0.045 0.563 *** 0.039 0.525 *** 0.033 0.224 0.041 0.034 0.700 - 0.509 *** 0.400 *** 0.545 *** - -0.570 *** -0.452 *** -0.680 *** 0.042 0.032 0.044 0.054 0.452 *** 0.700 - 0.043 -0.570 *** 0.004 0.062 -0.589 *** 0.054 -0.550 *** 0.043 0.575 0.059 0.051 Fig. 1 Banking interest rates (quarterly data, percentage points) 19.0 3-month interbank rate Repo rate 17.0 Interest rate on current accounts Estimation period 1993:03-2001:03 Short term lending rate 15.0 13.0 Euro 11.0 9.0 7.0 5.0 Period before T.U.B. 1987:01-1993:02 3.0 1.0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Fig. 2 Cross sectional and time series dispersion of interest rates 0.350 (a) Interest rate on short-term loans 0.300 0.250 0.200 0.150 0.100 0.050 0.000 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 1998 1999 2000 2001 0.350 (b) Interest rate on current accounts 0.300 0.250 0.200 0.150 0.100 0.050 0.000 1987 1988 1989 ACROSS BANKS 1990 1991 1992 OVER TIME 1993 1994 1995 1996 1997 Fig. 3 Determinants of bank’s interest rates i L = f ( y P , y T , p, i M , + ? + + X t −1 , i M X t −1 , ρ t −1 ∆i M , j , costs , σ , µ k ) ? + + + ? + Loan demand Interest rate channel Bank lending channel Cost of intermediation, credit risk and interest rate volatility Bank capital channel Deposit demand i D = f ( y P , y T , p, i M , − − − + Industry structure X t −1 , i M X t −1 , ρ t −1 ∆i M , costs , σ , µ k ) ? − − ? + Note: the meaning of all the symbols is reported in Table 1. Fig. A1 Search for mean shift breaks (monthly data, sequential minimum unit root tests) 0 Dec-87 Dec-88 Dec-89 Dec-90 Dec-91 Dec-92 Dec-93 Dec-94 Dec-95 Dec-96 Dec-97 Dec-98 Dec-99 -1 -2 -3 -4 -5 -6 -7 Interest rate on current accounts -8 Interest rate on short-term loans 3-month interbank market rate -9 10% critical value 2.5% critical value -10 Note: The estimated model tests for a shift in the constant. No trend is included. Sequential statistic are computed using the sample 1984:7-2002:12, sequentially incrementing the date of the hypothetical shift. A fraction equal to 15 per cent of the total sample at the beginning and at the end of the sample is not considered for the test. For more details see Banerjee, Lumsdaine and Stock (1992). ","Give an answer using only the context provided. How are interest rates set? NBER WORKING PAPER SERIES HOW DO BANKS SET INTEREST RATES? Leonardo Gambacorta Working Paper 10295 http://www.nber.org/papers/w10295 NATIONAL BUREAU OF ECONOMIC RESEARCH 1050 Massachusetts Avenue Cambridge, MA 02138 February 2004 This research was done during a period as a visiting scholar at the NBER. The views expressed herein are those of the author and not necessarily those of the Banca d’Italia or the National Bureau of Economic Research. ©2004 by Leonardo Gambacorta. All rights reserved. Short sections of text, not to exceed two paragraphs, may be quoted without explicit permission provided that full credit, including © notice, is given to the source. How Do Banks Set Interest Rates? Leonardo Gambacorta NBER Working Paper No. 10295 February 2004 JEL No. E44, E51, E52 ABSTRACT The aim of this paper is to study cross-sectional differences in banks interest rates. It adds to the existing literature in two ways. First, it analyzes in a systematic way both micro and macroeconomic factors that influence the price setting behavior of banks. Second, by using banks’ prices (rather than quantities) it provides an alternative way to disentangle loan supply from loan demand shift in the “bank lending channel” literature. The results, derived from a sample of Italian banks, suggest that heterogeneity in the banking rates pass-through exists only in the short run. Consistently with the literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change their prices less. Heterogeneity in the pass-through on the interest rate on current accounts depends mainly on banks’ liability structure. Bank’s size is never relevant. Leonardo Gambacorta Banca d’Italia Research Department Via Nazionale, 91 00184 Rome, Italy gambacorta.leonardo@insedia.interbusiness.it 1. Introduction1 This paper studies cross-sectional differences in the price setting behavior of Italian banks in the last decade. The main motivations of the study are two. First, heterogeneity in the response of bank interest rates to market rates helps in understanding how monetary policy decisions are transmitted through the economy independently of the consequences on bank lending. The analysis of heterogeneous behavior in banks interest setting has been largely neglected by the existing literature. The vast majority of the studies on the “bank lending channel” analyze the response of credit aggregates to a monetary policy impulse, while no attention is paid on the effects on prices. This seems odd because, in practice, when banks interest rates change, real effects on consumption and investment could be produced also if there are no changes in total lending. The scarce evidence on the effects of monetary shocks on banks prices, mainly due to the lack of available long series of micro data on interest rates, contrasts also with some recent works that highlight a different adjustment of retail rates in the euro area (see, amongst others, de Bondt, Mojon and Valla, 2003). Second, this paper wants to add to the “bank lending channel” literature by identifying loan supply shocks via banks’ prices (rather than quantities). So far to solve the “identification problem” it has been claimed that certain bank-specific characteristics (i.e. size, liquidity, capitalization) influence only loan supply movements while banks’ loan demand is independent of them. After a monetary tightening, the drop in the supply of credit should be more important for small banks, which are financed almost exclusively with deposits and equity (Kashyap and Stein, 1995), less liquid banks, that cannot protect their loan portfolio against monetary tightening simply by drawing down cash and securities (Stein, 1998; Kashyap and Stein, 2000) and poorly capitalized banks, that have less access to markets for uninsured funding (Peek and Rosengren, 1995; Kishan and Opiela, 2000; van den Heuvel, 2001a; 2001b).2 The intuition of an identification via prices of loan supply shift is very simple: if loan demand is not perfectly elastic, also the effect of a monetary 1 This study was developed while the author was a visiting scholar at the NBER. The opinions expressed in this paper are those of the author only and in no way involve the responsibility of the Bank of Italy and the NBER. 2 All these studies on cross-sectional differences in the effectiveness of the “bank lending channel” refer to the US. The literature on European countries is instead far from conclusive (see Altunbas et al., 2002; Ehrmann et al., 2003). For the Italian case see Gambacorta (2003) and Gambacorta and Mistrulli (2003). 3 tightening on banks’ interest rate should be more pronounced for small, low-liquid and lowcapitalized banks . Apart from these standard indicators other bank-specific characteristics could influence banks’ price-setting behavior (Weth, 2002). Berlin and Mester (1999) claim that banks which heavily depend upon non-insured funding (i.e. bonds) will adjust their deposit rates more (and more quickly) than banks whose liabilities are less affected by market movements. Berger and Udell (1992) sustain that banks that maintain a close tie with their customers will change their lending rates comparatively less and slowly. In this paper the search for heterogeneity in banks’ behavior is carried out by using a balanced panel of 73 Italian banks that represent more than 70 per cent of the banking system. Heterogeneity is investigated with respect to the interest rate on short-term lending and that on current accounts. The use of microeconomic data is particularly appropriate in this context because aggregation may significantly bias the estimation of dynamic economic relations (Harvey, 1981). Moreover, information at the level of individual banks provides a more precise understanding of their behavioral patterns and should be less prone to structural changes like the formation of EMU. The main conclusions of this paper are two. First, heterogeneity in the banking rates pass-through exists, but it is detected only in the short run: no differences exist in the longrun elasticities of banking rates to money market rates. Second, consistently with the existing literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change less their prices. Heterogeneity in the pass-through on the interest rate on current accounts depends mainly on banks’ liability structure. Bank’s size is never relevant. The paper is organized as follows. Section 2 describes some institutional characteristics that help to explain the behavior of banking rates in Italy in the last two decades. Section 3 reviews the main channels that influence banks’ interest rate settings trying to disentangle macro from microeconomic factors. After a description of the econometric model and the data in Section 4, Section 5 shows the empirical results. Robustness checks are presented in Section 6. The last section summarizes the main conclusions. 4 2. Some facts on bank interest rates in Italy Before discussing the main channels that influence banks’ price setting, it is important to analyze the institutional characteristics that have influenced Italian bank interest rates in the last two decades. The scope of this section is therefore to highlight some facts that could help in understanding differences, if any, with the results drawn by the existing literature for the eighties and mid-nineties. For example, there is evidence that in the eighties Italian banks were comparatively slow in adjusting their rates (Verga, 1984; Banca d’Italia, 1986, 1988; Cottarelli and Kourelis, 1994) but important measures of liberalization of the markets and deregulation over the last two decades should have influenced the speed at which changes in the money market conditions are transmitted to lending and deposit rates (Cottarelli et al. 1995; Passacantando, 1996; Ciocca, 2000; Angelini and Cetorelli, 2002). In fact, between the mid-1980s and the early 1990s all restrictions that characterized the Italian banking system in the eighties were gradually removed. In particular: 1) the lending ceiling was definitely abolished in 1985; 2) foreign exchange controls were lifted between 1987 and 1990; 3) branching was liberalized in 1990; 4) the 1993 Banking Law allowed banks and special credit institutions to perform all banking activities. In particular, the 1993 Banking Law (Testo Unico Bancario, hereafter TUB) completed the enactment of the institutional, operational and maturity despecialization of the Italian banking system and ensured the consistency of supervisory controls and intermediaries’ range of operations within the single market framework. The business restriction imposed by the 1936 Banking Law, which distinguished between banks that could raise short-term funds (“aziende di credito”) and those that could not (“Istituti di credito speciale”), was eliminated.3 To avoid criticism of structural breaks, the econometric analysis of this study will be based on the period 1993:03-2001:03, where all the main reforms of the Italian banking system had already taken place. 3 For more details see Banca d’Italia, Annual Report for 1993. 5 The behavior of bank interest rates in Italy reveals some stylized facts (see Figures 1 and 2). First, a remarkable fall in the average rates since the end of 1992. Second a strong and persistent dispersion of rates among banks. These stylized facts suggest that both the time series and the cross sections dimensions are important elements in understanding the behavior of bank interest setting. This justifies the use of panel data techniques. The main reason behind the fall in banking interest rates is probably the successful monetary policy aiming at reducing the inflation rate in the country to reach the Maastricht criteria and the third stage of EMU. As a result, the interbank rate decreased by more than 10 percentage points in the period 1993-1999. Excluding the 1995 episode of the EMS crisis, it is only since the third quarter of 1999 that it started to move upwards until the end of 2000 when it continued a declining trend. From a statistical point of view, this behavior calls for the investigation of a possible structural break in the nineties.4 The second stylized fact is cross-sectional dispersion among interest rates. Figure 2 shows the coefficient of variation for loan and deposit rates both over time and across banks in the period 1987-2001.5 The temporal variation (dotted line) of the two rates show a different behavior from the mid of the nineties when the deposit rate is more variable, probably for a catching-up process of the rate toward a new equilibrium caused by the convergence process. Also the cross-sectional dispersion of the deposit rate is greater than that of the loan rate, especially after the introduction of euro.6 4 In the period 1995-98, that coincides with the convergence process towards stage three of EMU, it will be necessary to allow for a change in the statistical properties of interest rates (see Appendix 2). 5 The coefficient of variation is given by the ratio of the standard errors to the mean. The series that refer to the variability “over time” shows the coefficient of variation in each year of monthly figures. In contrast, the series that capture the variability “across banks” shows the coefficient of variation of annual averages of bankspecific interest rates. 6 In the period before the 1993 Banking Law deposit interest rates were quite sticky to monetary policy changes. Deposit interest rate rigidity in this period has been extensively analyzed also for the US. Among the market factors that have been found to affect the responsiveness of bank deposit rates are the direction of the change in market rates (Ausubel, 1992; Hannan and Berger, 1991), if the bank interest rate is above or below a target rate (Hutchison, 1995; Moore, Porter and Small, 1990; Neumark and Sharpe, 1992) and market concentration in the bank’s deposit market (Hannan and Berger, 1991). Rosen (2001) develops a model of price settings in presence of heterogeneous customers explaining why bank deposits interest rates respond sluggishly to some extended movements in monetary market rates but not to others. Hutchinson (1995) presents a model of bank deposit rates that includes a demand function for customers and predicts a linear (but less than one for one) relationship between market interest rate changes and bank interest rate changes. Green (1998) claims that the rigidity is due to the fact that bank interest rate management is based on a two-tier pricing system; banks offer accounts at market related interest rates and at posted rates that are changed at discrete intervals. 6 3. What does influence banks’ interest rate setting? The literature that studies banks’ interest rate setting behavior generally assumes that banks operate under oligopolistic market conditions.7 This means that a bank does not act as a price-taker but sets its loan rates taking into account the demand for loans and deposits. This section reviews the main channels that influence banks interest rates (see Figure 3). A simple analytical framework is developed in Appendix 1. Loan and deposit demand The interest rate on loans depends positively on real GDP and inflation (y and p). Better economic conditions improve the number of projects becoming profitable in terms of expected net present value and, therefore, increase credit demand (Kashyap, Stein and Wilcox, 1993). As stressed by Melitz and Pardue (1973) only increases in permanent income (yP) have a positive influence on loan demand, while the effect due to the transitory part (yT) could also be associated with a self-financing effect that reduces the proportion of bank debt (Friedman and Kuttner, 1993).8 An increase in the money market rate (iM) raises the opportunity cost of other forms of financing (i.e. bonds), making lending more attractive. This mechanism also boosts loan demand and increases the interest rate on loans. The interest rate on deposits is negatively influenced by real GDP and inflation. A higher level of income increases the demand for deposits9 and reduces therefore the incentive for banks to set higher deposit rates. In this case the shift of deposit demand should be higher if the transitory component of GDP is affected (unexpected income is generally first deposited on current accounts). On the contrary, an increase in the money market rate, ceteris paribus, makes more attractive to invest in risk-free securities that represent an alternative to detain deposits; the subsequent reduction in deposits demand determines an upward pressure on the interest rate on deposits. 7 For a survey on modeling the banking firm see Santomero (1984). Among more recent works see Green (1998) and Lim (2000). 8 Taking this into account, in Section 4 I tried to disentangle the two effects using a Beveridge and Nelson (1981) decomposition. 9 The aim of this paper is not to answer to the question if deposits are input or output for the bank (see Freixas and Rochet, 1997 on this debate). For simplicity here deposits are considered a service supplied by the bank to depositors and are therefore considered an output (Hancock, 1991). 7 Operating cost, credit risk and interest rate volatility The costs of intermediation (screening, monitoring, branching costs, etc.) have a positive effect on the interest rate on loans and a negative effect on that of deposits (efficiency is represented by e). The interest rate on lending also depends on the riskiness of the credit portfolio; banks that invest in riskier project will have a higher rate of return in order to compensate the higher percentage of bad loans that have to be written off (j). Banking interest rates are also influenced by interest rate volatility. A high volatility in the money market rate (σ) should increase lending and deposit rates. Following the dealership model by Ho and Saunders (1981) and its extension by Angbazo (1997) the interest rate on loans should be more affected by interbank interest rate volatility with respect to that on deposits (diL/dσ>diD/dσ). This should reveal a positive correlation between interest rate volatility and the spread. Interest rate channel Banking interest rates are also influenced by monetary policy changes. A monetary tightening (easing) determines a reduction (increase) of reservable deposits and an increase (reduction) of market interest rates. This has a “direct” and positive effect on bank interest rates through the traditional “interest rate channel”. Nevertheless, the increase in the cost of financing could have a different impact on banks depending on their specific characteristics. There are two channels through which heterogeneity among banks may cause a different impact on lending and deposit rates: the “bank lending channel” and the “bank capital channel”. Both mechanisms are based on adverse selection problems that affect banks fundraising but from different perspectives. Bank lending channel According to the “bank lending channel” thesis, a monetary tightening has effect on bank loans because the drop in reservable deposits cannot be completely offset by issuing other forms of funding (i.e. uninsured CDs or bonds; for an opposite view see Romer and Romer, 1990) or liquidating some assets. Kashyap and Stein (1995, 2000), Stein (1998) and Kishan and Opiela (2000) claim that the market for bank debt is imperfect. Since nonreservable liabilities are not insured and there is an asymmetric information problem about 8 the value of banks’ assets, a “lemon’s premium” is paid to investors. According to these authors, small, low-liquid and low-capitalized banks pay a higher premium because the market perceives them more risky. Since these banks are more exposed to asymmetric information problems they have less capacity to shield their credit relationships in case of a monetary tightening and they should cut their supplied loans and raise their interest rate by more. Moreover, these banks have less capacity to issue bonds and CDs and therefore they could try to contain the drain of deposits by raising their rate by more. In Figure 3 three effects are highlighted: the “average” effect due to the increase of the money market rate (which is difficult to disentangle from the “interest rate channel”), the “direct” heterogeneous effect due to bank-specific characteristics (Xt-1) and the “interaction effect” between monetary policy and the bank-specific characteristic (iM Xt-1). These last two effects can genuinely be attributed to the “bank lending channel” because bank-specific characteristics influence only loan supply movements. Two aspects deserve to be stressed. First, to avoid endogeneity problems bank-specific characteristics should refer to the period before banks set their interest rates. Second, heterogeneous effects, if any, should be detected only in the short run while there is no a priori that these effects should influence the long run relationship between interest rates. Apart from the standard indicators of size (logarithm of total assets), liquidity (cash and securities over total assets) and capitalization (excess capital over total assets),10 two other bank-specific characteristics deserve to be investigated: a) the ratio between deposits and bonds plus deposits; b) the ratio between long-term loans and total loans. The first indicator is in line with Berlin and Mester (1999): banks that heavily depend upon non-deposit funding (i.e. bonds) will adjust their deposits rates by more (and more quickly) than banks whose liabilities are less affected by market movements. The intuition of this result is that, other things being equal, it is more likely that a bank will adjust her terms 10 It is important to note that the effect of bank capital on the “bank lending channel” cannot be easily captured by the capital-to-asset ratio. This measure, generally used by the existing literature to analyze the distributional effects of bank capitalization on lending, does not take into account the riskiness of a bank portfolio. A relevant measure is instead the excess capital that is the amount of capital that banks hold in excess of the minimum required to meet prudential regulation standards. Since minimum capital requirements are determined by the quality of bank’s balance sheet activities, the excess capital represents a risk-adjusted measure of bank capitalization that gives more indications on the probability of a bank default. Moreover, the excess capital is a relevant measure of the availability of the bank to expand credit because it directly controls for prudential regulation constraints. For more details see Gambacorta and Mistrulli (2004). 9 for passive deposits if the conditions of her own alternative form of refinancing change. Therefore an important indicator to analyze the pass-through between market and banking rates is the ratio between deposits and bonds plus deposits. Banks which use relatively more bonds than deposits for financing purpose fell more under pressure because their cost increase contemporaneously and to similar extent as market rates. The Berger and Udell (1992) indicator represents a proxy for long-term business; those credit institutions that maintain close ties with their non-bank customers will adjust their lending rates comparatively less and slowly. Banks may offer implicit interest rate insurance to risk-averse borrowers in the form of below-market rates during periods of high market rates, for which the banks are later compensated when market rates are low. Having this in mind, banks that have a higher proportion of long-term loans should be more inclined to split the risk of monetary policy change with their customers and preserve credit relationships. For example, Weth (2002) finds that in Germany those banks with large volumes of longterm business with households and firms change their prices less frequently than the others. Bank capital channel The “bank capital channel” is based on three hypotheses. First, there is an imperfect market for bank equity: banks cannot easily issue new equity for the presence of agency costs and tax disadvantages (Myers and Majluf, 1984; Cornett and Tehranian, 1994; Calomiris and Hubbard, 1995; Stein, 1998). Second, banks are subject to interest rate risk because their assets have typically a higher maturity with respect to liabilities (maturity transformation). Third, regulatory capital requirements limit the supply of credit (Thakor, 1996; Bolton and Freixas, 2001; Van den Heuvel, 2001a; 2001b). The mechanism is the following. After an increase of market interest rates, a lower fraction of loans can be renegotiated with respect to deposits (loans are mainly long term, while deposits are typically short term): banks suffer therefore a cost due to the maturity mismatch that reduces profits and then capital accumulation.11 If equity is sufficiently low and it is too costly to issue new shares, banks reduce lending (otherwise they fail to meet 11 In Figure 3, the cost per unit of asset due to the maturity transformation at time t-1 ( ρit −1 ) is multiplied by the actual change in the money market rate ( ∆iM ). For more details see Appendix 1. 10 regulatory capital requirements) and amplify their interest rate spread. This determines therefore an increase in the interest rates on loans and a decrease in that on deposits:12 in the oligopolistic version of the Monti-Klein model, the maturity transformation cost has the same effect of an increase in operating costs. Industry structure The literature underlines two possible impacts of concentration on pricing behavior of banks (Berger and Hannan, 1989). A first class of models claims that more concentrated banking industry will behave oligopolistically (structure-performance hypothesis), while another class of models stresses that concentration is due to more efficient banks taking over less efficient counterparts (efficient-structure hypothesis). This means that in the first case lower competition should result in higher spreads, while in the second case a decrease in managerial costs due to increased efficiency should have a negative impact on the spread. In the empirical part great care will be given therefore to the treatment of bank mergers (see Appendix 2). Nevertheless, the scope of this paper is not to extract policy implications about this issue, for which a different analysis is needed. The introduction of bank-specific dummy variables (µi) tries to control for this and other missing aspects.13 4. Empirical specification and data The equations described in Figure 3 and derived analytically in Appendix 1 are expressed in levels. Nevertheless, since interest rates are likely to be non-stationary variables, an error correction model has been used to capture bank’s interest rate setting.14 Economic theory on oligopolistic (and perfect) competition suggests that, in the long run, both banking rates (on lending and deposits) should be related to the level of the monetary 12 The “bank capital channel” can also be at work even if capital requirement is not currently binding. Van den Heuvel (2001a) shows that low-capitalized banks may optimally forgo lending opportunities now in order to lower the risk of capital inadequacy in the future. This is interesting because in reality, most banks are not constrained at any given time. 13 In Section 6 this hypothesis will be tested introducing a specific measure of the degree of competition that each banks faces. For a more detailed explanation on the effect of concentration on the pricing behavior of Italian banks see Focarelli and Panetta (2003). 14 This is indeed the standard approach used for interest rate equations (Cottarelli et al. 1995; Lim, 2000; Weth 2002). From a statistical point of view, the error correction representation is adopted because the lending rate and the deposit rate result to be cointegrated with the money market rate. 11 rate, that reflects the marginal yield of a risk-free investment (Klein, 1971). We have: 2 (1) 1 ∆i L k ,t = µ k + å κ j ∆i L k ,t − j + å ( β j + β *j X k ,t −1 ) ∆i M t − j + ϕ p t + δ 1 ∆ ln y tP + δ 2 ∆ ln y tT + λX k ,t −1 + j =1 j =0 φ∆ ( ρ k ,t −1 ∆i M t ) + (α + α X k ,t −1 )i L k ,t −1 + (γ + γ * X k ,t −1 )i M t −1 + θ j k ,t + ξ e k ,t + ψσ t + Φ k ,t + ε k ,t * 1 2 (2) ∆i D k ,t = µ k + å κ j ∆i D k ,t − j + å ( β j + β *j X k ,t −1 )∆i M t − j + ϕ p t + δ 1 ∆ ln y tP + δ 2 ∆ ln y tT + λX k ,t −1 + j =1 j =0 φ∆ ( ρ k ,t −1 ∆i M t ) + (α + α X k ,t −1 )i D k ,t −1 + (γ + γ * X k ,t −1 )i M t −1 + ξ e k ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:032001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1.15 The model allows for fixed effects across banks, as indicated by the bank-specific intercept µi. The long-run elasticity between each banking rate and the money market rate is given by: (γ + γ * X k ,t −1 ) /(α + α * X k ,t −1 ) . Therefore to test if the pass-through between the money market rate and the banking rate is complete it is necessary to verify that this elasticity is equal to one. If this is the case there is a one-to-one long-run relationship between the lending (deposit) rate and the money market rate, while the individual effect µi influences the bank-specific mark-up (mark-down). The loading coefficient (α + α * X k ,t −1 ) must be significantly negative if the assumption of an equilibrium relationship is correct. In fact, it represents how many percent of an exogenous variation from the steady state between the rates is brought back towards the equilibrium in the next period.16 The degree of banks’ interest rate stickiness in the short run can be analyzed by the impact multiplier ( β 0 + β 0* X k ,t −1 ) and the total effect after three months.17 15 For more details on data sources, variable definitions, merger treatment and trimming of the sample see Appendix 2. 16 Testing for heterogeneity in the loading coefficient means to verify if α * is significant or not. At the same time heterogeneity in the long-run elasticity can be proved if α *γ − αγ * is statistically different from zero. 17 In the first case heterogeneity among banks is simply tested through the significance of β 0 while in the * second case, since the effect is given by a convolution of the structural parameters it is possible to accept the 12 The variable Xk,t-1 represents a bank-specific characteristic that economic theory suggests to influence only loan and deposit supply movements, without affecting loan and deposit demands. In particular, all bank-specific indicators ( χ k ,t ) have been re-parameterized in the following way: N æ ö ç T å χ k ,t ÷ ÷ /T X k ,t = χ k ,t − ç å k =1 ç t =1 N ÷ ç ÷ è ø Each indicator is therefore normalized with respect to the average across all the banks in the respective sample, in order to obtain a variable whose sum over all observations is zero.18 This has two implications. First, the interaction terms between interest rates and X k , t −1 in equations (1) and (2) are zero for the average bank (this because X k ,t −1 =0). Second, the coefficients β0, β1, α and γ are directly interpretable as average effects. To test for the existence of a “bank capital channel” we have introduced the variable ρ k , t −1∆iM that represents the bank-specific cost of monetary policy due to maturity transformation. In particular ρ k , t −1 measures the loss per unit of asset a bank suffers when the monetary policy interest rate is raised of one percent. The cost at time t is influenced by the maturity transformation in t-1. This variable is computed according to supervisory regulation relative to interest rate risk exposure that depends on the maturity mismatch among assets and liabilities (see Appendix 2 for further details). To work out the real cost we have therefore multiplied ρ k , t −1 for the realized change in interest rates. Therefore ρ k , t −1∆iM represents the cost (gain) that a bank suffers (obtain) in each quarter. As formalized in Appendix 1, this measure influences the level of bank interest rates. Since the model is expressed in error correction form we have included this variable in first difference as well. null hypothesis of absence of heterogeneity if and only if éë β 0α * + β 0* (1 + α + κ 1 ) + β1* + γ * ùû X k ,t −1 + α * β 0* X k2,t −1 is equal to zero. The significance of this expression has been checked using the delta method (Rao, 1973). 18 The size indicator has been normalized with respect to the mean on each single period. This procedure removes trends in size (for more details see Ehrmann et al., 2003). 13 4.1 Characteristics of the dataset The dataset includes 73 banks that represent more than 70 per cent of total Italian banking system in term of loans over the whole sample period. Since information on interest rates is not available for Mutual banks, the sample is biased towards large banks. Foreign banks and special credit institution are also excluded. This bias toward large banks has two consequences. First, the distributional effects of the size variable would be treated with extreme cautious because a “small” bank inside this sample could not be considered with the same characteristic using the full population of Italian banks.19 The size grouping in this study mainly controls for variations in scale, technology and scope efficiencies across banks but it is not able to shed light on differences between Mutual and other banks. Second, results for the average bank will provide more “macroeconomic insights” than studies on the whole population (where the average bank dimension is very small). Table 2 gives some basic information on the dataset. Rows are organized dividing the sample with respect to the bank-specific characteristics that are potential candidates to cause heterogeneous shifts in loan supply in case of a monetary policy shock. On the columns, the table reports summary statistics for the two interest rates and for each indicator. Several clear patterns emerge. Considering size, small banks charge higher interest rates on lending but show a lower time variation. This fits with the standard idea of a close customer relationships between small firms and small banks that provides them with an incentive to smooth the effect of a monetary tightening (Angelini, Di Salvo and Ferri, 1998). Moreover, small banks are more liquid and capitalized than average and this should help them to reduce the effect of cyclical variation on supplied credit. On the liability side, the percentage of deposits (overnight deposits, CDs and savings accounts) is greater among small banks, while their bonds issues are more limited than the ones of large banks. Nevertheless, there are no significant differences that emerge in the level and volatility of the interest rate on current accounts. 19 In particular, banks that are considered “small” in this study are labeled as “medium” in other studies for the Italian banking system that analyze quantities (see for example, Gambacorta, 2003; Gambacorta and Mistrulli, 2004). This is clear noting that the average assets of a “small” bank in my data (1.6 billions of euros) over the sample period is very similar to that of the “medium” bank of the total system (1.7 billions of euros). 14 High-liquid banks are smaller than average and are more capitalized. These characteristics should reduce the speed of the “bank lending channel” transmission through interest rates. In particular, since deposits represent a high share of their funding they should have a smoother transmission on passive rates. Well-capitalized banks make relatively more short-term loans. They are in general not listed and issue less subordinated debt to meet the capital requirement. This evidence is consistent with the view that, ceteris paribus, capitalization is higher for those banks that bear more adjustment costs from issuing new (regulatory) capital. Well-capitalized banks charge a higher interest rate on lending; this probably depend upon their higher ratios of bad loans that increase their credit risk. In other words their higher capitalization is necessary to face a riskier portfolio. Moreover, the interest rate on deposit is lower for low-capitalized banks indicating that agents do not perceive these deposits as riskier than those at other banks. This has two main explanations. First, the impact of bank failures has been very small in Italy, especially with respect to deposits.20 Second, the presence of deposit insurance that insulates deposits of less capitalized banks from the risk of default.21 The Berlin-Mester and the Berger-Udell indicators seem to have a high power in explaining heterogeneity in banks’ price setting behavior. Differences in the standard deviations of the two groups are particularly sensitive, calling for a lower interest rates variability of banks with a high percentage of deposits and long-term loans. 20 During our sample period, the share of deposits of failed banks to total deposits approached 1 per cent only twice, namely in 1987 and 1996 (Boccuzzi, 1998). 21 Two explicit limited-coverage deposit insurance schemes (DISs) currently operate in Italy. Both are funded ex-post; that is, member banks have a commitment to make available to the Funds the necessary resources should a bank default. All the banks operating in the country, with the exception of mutual banks, adhere to the main DIS, the ‘Fondo Interbancario di Tutela dei Depositi’ (FITD). Mutual banks (‘Banche di Credito Cooperativo’) adhere to a special Fund (‘Fondo di Garanzia dei Depositanti del Credito Cooperativo’) created for banks belonging to their category. The ‘Fondo Interbancario di Tutela dei Depositi’ (FITD), the main DIS, is a private consortium of banks created in 1987 on a voluntary basis. In 1996, as a consequence of the implementation of European Union Directive 94/19 on deposit guarantee schemes, the Italian Banking Law regulating the DIS was amended, and FITD became a compulsory DIS. FITD performs its tasks under the supervision of and in cooperation with the banking supervision authority, Banca d’Italia. The level of protection granted to each depositor (slightly more than 103,000 euros) is one of the highest in the European Union. FITD does not adopt any form of deposit coinsurance. 15 5. Results The main channels that influence the interest rate on short term lending and that on current accounts are summarized, respectively, in Tables 3 and 4. The first part of each table, show the influence of the permanent and transitory component of real GDP and inflation. These macro variables capture cyclical movements and serves to isolate shifts in loan and deposit demand from monetary policy changes. The second part of the tables presents the effects of bank’s efficiency, credit risk and interest rate volatility. The third part highlights the effects of monetary policy. These are divided into four components: i) the immediate pass-through; ii) the one-quarter pass-through; iii) the long-run elasticity between each banking rate and the monetary policy indicator; iv) the loading coefficient of the cointegrating relationship.22 The last part of the tables shows the significance of the “bank capital channel”. Each table is divided in five columns that highlight, one at the time, heterogeneous behavior of banks with different characteristics in the response to a monetary shock. The existence of distributional effects is tested for all the four components of the monetary policy pass-through. The models have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test).23 22 The immediate pass-trough is given by the coefficient β 0 + β 0* X k ,t −1 and heterogeneity among banks is simply tested through the significance of β 0* . The effect for a bank with a low value of the characteristic under 0.25 evaluation is worked out through the expression β 0 + β 0* X k0.25 , t −1 , where X k , t −1 is the average for the banks below the first quartile. Vice versa the effect for a bank with a high value of the characteristic is calculated using X k0.75 , t −1 . The total effect after three months for the average bank is given by β 0 (1 + α1 + κ 1 ) + β1 + γ ' while heterogeneity among banks can be accepted if and only if the expression éë β 0α * + β 0* (1 + α + κ 1 ) + β1* + γ * ùû X k ,t −1 + α * β 0* X k2,t −1 is equal to zero. The long run elasticity is given by: (γ + γ * X k ) /(α + α * X k ) , while the loading coefficient is α1 + α1* X k ,t −1 . Standard errors have been approximated with the “delta method” (Rao, 1973). 23 In the GMM estimation, instruments are the second lag of the dependent variable and of the bank-specific characteristics included in each equation. Inflation, GDP growth rate and the monetary policy indicator are considered as exogenous variables. 16 Loan and deposit demand As predicted by theory only changes in permanent income have a positive and significant effect on the interest rate on short term lending while the transitory component is never significant. In fact, as discussed in Section 3, the effect of transitory changes may be also due to a self-financing effect that reduces the proportion of bank debt. On the contrary the interest rate on deposits is negatively influenced by real GDP. In this case the effect is higher when a change in the transitory component occurs because it is directly channeled through current accounts. The effect of inflation is positive on both interest rates but is significantly higher for short-term lending. Operating costs, credit risk and interest rate volatility Bank’s efficiency reduces the interest rate on loans and increase that of deposits. Nevertheless, the effect is not always significant at conventional levels, especially in the equation for the interest rate on current accounts. These results call for further robustness checks using a cost-to-asset ratio (see Section 6). The relative amount of bad loans has a positive and significant effect on the interest rate on loans. This is in line with the standard result that banks that invest in riskier project ask for a higher rate of return to compensate credit risk. Both banking rates are positively correlated with money market rate volatility. The correlation is higher for the interest rate on loans with respect to that of deposits. This is consistent with the prediction of the dealership model by Ho and Saunders (1981) and its extension by Angbazo (1997) where an increase in interbank interest rate volatility is associated with a higher spread. Bank capital channel As expected the “bank capital channel” (based on the maturity mismatch between bank’s assets an liabilities, see Section 3) has a positive effect on the interest rate on shortterm lending and a negative effect on the interest rate on current account. The absolute values of the coefficients are greater in the first case calling for a stronger adjustment on credit contracts than on deposits. Since this channel can be interpreted similarly to a general 17 increase in the costs for the banks, it is worth comparing this result with that obtained for the efficiency indicator. In both cases the effect is strongest for the interest rate on short-term lending and this is consistent with the view that the interest rate on deposit is more sluggish. Interest rate channel A monetary tightening positively influences banks’ interest rate. After a one per cent increase in the monetary policy indicator, interest rate on short term lending are immediately raised of around 0.5 per cent and of around 0.9 per cent after a quarter. Moreover, the passthrough is complete in the long run (the null hypothesis of a unitary elasticity is accepted in all models). The reaction of the short term lending rate is higher with respect to previous studies on the Italian case and this calls for an increase in competition after the introduction of the 1993 Banking Law. Cottarelli et al. (1995), analyzing the period 1986:02-1993:04, find that the immediate pass through is of around 0.2, while the effect after three months is 0.6 per cent. Their long run elasticity is equal to 0.9 per cent but also in their model the null hypothesis of a complete pass-through in the long run is accepted.24 The long run elasticity of the interest rate on current accounts is around 0.7 per cent. This result is in line with the recent findings by de Bondt et al. (2003) under a similar sample period and only a little higher with respect to the long-run elasticity in Angeloni et al. (1995) for the period 1987:1-1993:04.25 The standard answer to the incomplete pass-through of money market changes on the deposit rate is the existence of market power by banks. Another explanation is the presence of compulsory reserves. To analyze this, we can refer to the theoretical elasticity in the case 24 The main differences between Cottarelli et al. (1995) and this paper are three. First, they use the Treasury bill rate as the reference monetary interest rate. However from the early nineties this indicator became less important as “reference rate” because the interbank market became more competitive and efficient (Gaiotti, 1992). This is indeed stated also by Cottarelli et al. (page 19). Second, they do not include macro variables controls in their equation. Third, their dataset is based on monthly data. To allow comparability among the results of this paper and those in Cottarelli et al. (1995) I have: 1) checked the results to different monetary policy indicators (i.e. the interbank rate; see Section 6); 2) excluded the macro variables from equation (1) to verify if the results were sensitive to their inclusion. In all cases the conclusion of an increase of speed in the reaction of short-term interest rate on loans to money market rate resulted unchanged. 25 The VAR model in Angeloni et al. considers the interest rate on total deposits (sight, time deposits and CDs), which is typically more reactive to monetary policy than that on current account because the service component in time deposits and CDs is less important. This means that in comparing our result with Angeloni et al. we are underestimating the potential effect of competition. 18 of perfect competition.26 This benchmark case is very instructive because it allows to analyze what happens if banks are price takers (they take as given not only the monetary market rate but also the interest rate on loans and that on deposits), set the quantity of loans and deposits and obtain a zero profit (the sum of the intermediation margins equals management costs). In this case the long-run elasticities become: ∂iL ∂i = 1 and D = 1 − α where α is the fraction of ∂iM ∂iM deposits invested in risk-free assets (this includes the “compulsory” reserves). Therefore in principle, an incomplete pass-through from market rates to deposits rates is also consistent with the fact that banks decide (or are constrained by regulation) to detain a certain fraction of their deposits in liquid assets. The loading coefficients are significantly negative. It is around –0.4 in the loan equation and –0.6 in the current account equation. This means that if an exogenous shock occurs, respectively 40 and 60 per cent of the deviation is canceled out within the first quarter in each banking rate. Bank lending channel In case of a monetary shock, banks with different characteristics behave differently only in the short run. On the contrary no heterogeneity emerges in the long run relationship between each banking rate and the monetary policy indicator. Considering each bank’s specific characteristic one at the time (Tables 3 and 4), interest rates of small, liquid and well-capitalized banks react less to a monetary policy shock. Also the Berlin-Mester and the Berger-Udell indicators have an high power in explaining heterogeneity in banks’ price setting behavior. Nevertheless, the robustness of these distributional effects has to be checked in a model that takes all these five indicators together into account. In this model, in order to save degrees of freedom, the long-run elasticity between the money market rate and the short- 26 The case of perfect competition can be easily obtained from equation (A1.8) and A1.9) in Appendix 1 considering loan and deposit demand (equations A1.3 and A1.4) infinitely elastic with respect the bank rates (c0→∞, d0→∞). Moreover, we will consider the benchmark case were no heterogeneity emerges in the “bank lending channel” (b1=0) and bonds can be issued at the risk free rate (b0=1). See Freixas and Rochet (1997) for an analogous treatment. 19 term lending rate has been imposed to one; that with the interest rate on current account has been fixed to 0.7. Results are reported in Table 5. Interest rates on short-term lending of liquid and wellcapitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change less their prices. Size is not significant. This evidence matches with previous results on lending. Liquid banks can protect their loan portfolio against a monetary tightening simply by drawing down cash and securities (Gambacorta, 2003). Well-capitalized banks that are perceived as less risky by the market are better able to raise uninsured funds in order to compensate the drop in deposits (Gambacorta and Mistrulli, 2004). Therefore the effects on lending detected for liquid and well-capitalized banks are mirrored by their higher capacity to insulate the clients also from the effects on interest rates. It is interesting to note that, in contrast with the evidence for the US (Kashyap and Stein; 1995), the interaction terms between size and monetary policy are insignificant. The fact that the interest rate on short term lending of smaller banks is not more sensitive to monetary policy than that of larger banks is well documented in the literature for Italy and reflects the close customer relationship between small banks and small firms (Angeloni et al. 1995; Conigliani et al., 1997; Angelini, Di Salvo and Ferri, 1998; Ferri and Pittaluga, 1996). This result is also consistent with Ehrmann et al. (2003) where size does not emerge as a useful indicator for the distributional effect of monetary policy on lending not only in Italy but also in France, Germany and Spain. As regards the interest rate on current accounts, the Berlin-Mester indicator is the only bank-specific characteristic that explains heterogeneity in banks price setting behavior. In particular, banks that heavily depend upon non-deposit funding (banks with a low BM indicator) will adjust their interest rate on current account by more (and more quickly) than banks whose liabilities are less affected by market movements. As explained in Section 3, the intuition of this result is that, other things being equals, it is more likely that a bank will adjust her terms on deposits if the other conditions of her refinancing change. The liability structure seems to influence not only the short-run adjustment but also the loading coefficient. This implies that banks with a high BM ratio react less when there is a deviation in the long run mark-down: banks with a higher percentage of deposits have more room in adjusting their prices toward the optimal equilibrium. As expected, no cross sectional 20 differences emerges among banks due to size, liquidity and capitalization because current accounts are typically insured. 6. Robustness checks The robustness of the results has been checked in several ways. The first test was to introduce as additional control variable a bank-specific measure of the degree of competition that each bank faces in the market. In particular, the average value of the Herfindahl index in the different “local markets” (corresponding to the administrative provinces of Italy) in which the bank operates was introduced in each equation. The reason of this test is that the fixed effect (that captures also industry structure) remains stable over the whole period while the degree of competition could change over time due to the effect of concentration. Therefore this test allows us also to check if the treatment of bank mergers is carried out properly. The Herfindahl index did not show to be statistically significant and the results of the study did not change. The second test was to use as bank’s efficiency indicator the cost-to-total asset ratio instead than the ratio of total loans and deposits to the number of branches. In all cases the results remained unchanged. The third test was to consider if different fiscal treatments over the sample period could have changed deposit demand (from June 1996 the interest rate on current account is subject to a fiscal deduction of 27 per cent; 12.5 per cent before). However, using the net interest rate on current account instead than the gross rate nothing changed. The fourth robustness check was the introduction of a dummy variables to take into account of the spike in the change of the repo interest rate caused by the EMS crisis in the first quarter of 1995. Also in this case results remained the same. The fifth test was to introduce additional interaction terms combining the bank-specific characteristic with inflation, permanent and transitory changes in real income. The reason for this test is the possible presence of endogeneity between bank characteristics and cyclical factors. Performing the test, however, nothing changed, and the double interactions were almost always not significant (it turned out to be statistically not different from zero in the case of the interaction of capitalization and permanent income). 21 The final robustness check was to introduce a dummy variable that indicates if the bank belongs to a group (1) or not (0). Banks belonging to a group may be less influenced by monetary changes if they can benefit of an internal liquidity management; in other words, bank holding companies establish internal capital markets in an attempt to allocate capital among their various subsidiaries (Houston and James, 1998; Upper and Worms, 2001). The introduction of this dummy did not change the results of the study. 7. Conclusions This paper investigates which factors influence price setting behavior of Italian banks. It adds to the existing literature in two ways. First, it analyzes systematically a wide range of micro and macroeconomic variables that have an effect on bank interest rates: permanent and transitory changes in income, interest and credit risk, interest rate volatility, banks’ efficiency. Second, the analysis of banks’ prices (rather than quantities) provides an alternative way to disentangle loan supply from loan demand shift in the “bank lending channel” literature. The search for heterogeneity in banks’ behavior is carried out by using a balanced panel of 73 Italian banks that represent more than 70 per cent of the banking system. The use of microeconomic data help in reducing the problems of aggregation that may significantly bias the estimation of dynamic economic relations and it is less prone to structural changes like the formation of EMU. The main results of the study are the following. First, heterogeneity in the banking rates pass-through exists, but it is detected only in the short run: no differences exist in the long-run elasticities of banking rates to the money market rate. Second, consistently with the existing literature for Italy, interest rates on short-term lending of liquid and well-capitalized banks react less to a monetary policy shock. Also banks with a high proportion of long-term lending tend to change their prices less. Heterogeneity in the pass-through on the interest rate on current accounts depends on banks’ liability structure. Bank’s size is never relevant. Appendix 1 - A simple theoretical model This Appendix develops a one-period model of a risk neutral bank that operates under oligopolistic market conditions. The balance sheet of the representative bank is as follows: (A1.1) L + S = D + B + K where L stands for loans, S for securities, D for deposits, B for bonds, K for capital. The bank holds securities as a buffer against contingencies. We assume that security holdings are a fixed share of the outstanding deposits (α). They represent a safe asset and fruit the risk-free interest rate.27 We have therefore: (A1.2) S = α D For simplicity, bank capital is exogenously given in the period and greater than capital requirements.28 The bank faces a loan demand and a deposit demand. The first one is given by: (A1.3) Ld = c0 i L + c1 y + c 2 p + c3 i M (c0<0, c1>0, c2>0, c3>0) that is negatively related to the interest rate on loans (il ) and it is positively related to real income (y) and prices (p) and the opportunity cost of self-financing, proxied by the money market interest rate (im).29 Alternatively S can be considered as the total amount of bank’s liquidity, where α is the coefficient of free and compulsory reserves. In this case reserves are remunerated by the money market rate fixed by the Central Bank. This alternative interpretation does not change the results of the model. 27 28 In the spirit of the actual BIS capital adequacy rules, capital requirements on credit risks are given by a fixed amount (k) of loans. If bank capital perfectly meets Basle standard requirement the amount of loans would be L=K/k. We rule out this possibility because banks typically hold a buffer as a cushion against contingencies (Wall and Peterson, 1987; Barrios and Blanco, 2001). Excess capital allows them to face capital adjustment costs and to convey positive information on their economic value (Leland and Pile, 1977; Myers and Majluf, 1984). Another explanation is that banks face a private cost of bankruptcy, which reduces their expected future income (Dewatripont and Tirole, 1994). Van den Heuvel (2001a) argues that even if capital requirement is not currently binding, a low capitalized bank may optimally forego profitable lending opportunities now, in order to lower the risk of future capital inadequacy. A final explanation for the existence of excess capital is given by market discipline; well-capitalized banks obtain a lower cost of uninsured funding, such as bonds or CDs, because they are perceived less risky by the market (Gambacorta and Mistrulli, 2004). 29 As far as the GDP is concerned, there is no clear consensus about how economic activity affects credit demand. Some empirical works underline a positive relation because better economic conditions would 23 The deposit demand is standard. It depends positively on the interest rate on deposits, the level of real income (the scale variable) and the price level and negatively on the interest rate on securities that represent an alternative to the investment to deposits. (A1.4) D d = d 0id + d1 y + d 2 p + d 3im (d0>0, d1>0, d2>0, d3<0) Because banks are risky and bonds are not insured, bond interest rate incorporates a risk premium that we assume depends on specific banks’ characteristics. The latter are balance sheet information or institutional characteristics exogenously given at the end of previous period. (A1.5) ib ( im , xt −1 ) = b0im + b1im xt −1 + b2 xt −1 (b0>1) In other words, this assumption implies that the distributional effects via the bank lending channel depends on some characteristics that allow the bank to substitute insured, typically deposits, with uninsured banks’ debt, like bonds or CDs (Romer and Romer, 1990). For example, theory predicts that big, liquid and well-capitalized banks should be perceived less risky by the market and obtain a lower cost on their uninsured funding (b2<0). Moreover they could react less to monetary change (b1<0) The effects of the so-called “bank capital channel” are captured by the following equation: (A1.6) C MT = ρt −1∆im ( L + S ) (ρ >0) where C MT represents the total cost suffered by the bank in case of a change in monetary policy due to the maturity transformation. Since loans have typically a longer maturity than improve the number of project becoming profitable in terms of expected net present value and, therefore, increase credit demand (Kashyap, Stein and Wilcox, 1993). This is also the hypothesis used in Bernanke and Blinder (1988). On the contrary, other works stress the fact that if expected income and profits increase, the private sector has more internal source of financing and this could reduce the proportion of bank debt (Friedman and Kuttner, 1993). A compromise position is taken by Melitz and Pardue (1973): only increases in permanent income have a positive influence on loan demand, while the effect due to the transitory part could also be associated with a self-financing effect in line with Friedman and Kuttner. Taking this into account, in the econometric part (see Section 4) I will try to disentangle the two effects using a Beveridge and Nelson (1981). For simplicity in the model I assume that the first effect dominates and that a higher income determines an increase in credit demand (c2>0). This is indeed consistent with the evidence provided by Ehrmann et al. (2001) for the four main countries of the euro area. 24 bank fund-raising, the variable ρ represents the cost (gain) per unit of asset that the bank incurs in case of a one per cent increase (decrease) in the monetary policy interest rate. The cost of intermediation is given by: (A1.7) C IN = g1 L + g 2 D (g1>0, g2>0) where the component g1L can be interpreted as screening and monitoring cost while g2D as the cost of the branching.30 Loans are risky and, in each period, a percentage j of them is written off from the balance sheet, therefore reducing bank’s profitability. The representative bank maximizes her profits subject to the balance-sheet constraint. The bank optimally sets the interest rates on loans and deposits (iL, iD), while she takes the money market interest rate (iM) as given (it is fixed by the Central Bank). Max π = (iL − j ) L + im S − iD D − iB B − C MT − C IN il ,id s.t. L+Q = D+ B+ K Solving the maximization problem, the optimal levels of the two interest rates are: (A1.8) iL = Ψ 0 + Ψ1 p + (Ψ 2 + Ψ 3 xt −1 )im + Ψ 4 y P + Ψ 5 ρt −1∆im + Ψ 6 j + Ψ 7 xt −1 (A1.9) id = Φ 0 + Φ1 p + (Φ 2 + Φ 3 xt −1 )im + Φ 4 y P + Φ 5 ρt −1∆im + Φ 6 xt −1 where: g1 c b c c b 1 > 0 ; Ψ1 = 2 > 0 ; Ψ 2 = 0 + 3 > 0 ; Ψ 3 = 1 ; Ψ 4 = 1 > 0 ; Ψ 5 = ; 2 −2c0 2 −2c0 −2c0 2 2 b (1 − α ) −d 3 α g d b 1 Φ0 = − 2 < 0 ; Ψ7 = 2 Φ2 = 0 + + >0; Φ1 = − 2 < 0 ; Ψ6 = ; 2 2d 0 2 2 2d 0 2 2 d b (1 − α ) α b (1 − α ) Φ3 = − 1 ; Φ 4 = − 1 < 0 ; Φ5 = − < 0 ; Φ6 = 2 . 2d 0 2 2d 0 2 Ψ0 = 30 The additive linear form of the management cost simplifies the algebra. The introduction of a quadratic cost function would not have changed the result of the analysis. An interesting consequence of the additive form of the management cost is that bank’s decision problem is separable: the optimal interest rate on deposits is independent of the characteristic of the loan market while the optimal interest rate on loans is independent of the characteristics of the deposit market. For a discussion see Dermine (1991). 25 Equation (A1.8) states that a monetary tightening determines an increase in the interest rate on loans (Ψ2>0): the total effect could be divided into two parts: the “bank lending channel” (b0/2>0) and the “opportunity cost” effect (-c3/2c0>0) The effect of a monetary squeeze is smaller if the bank-specific characteristic reduces the impact of monetary policy on the cost of funding (b1<0 and Ψ3<0). In this case banks have a greater capacity to compensate the deposit drop by issuing uninsured funds at a lower price. Loan interest rate reacts positively to an output expansion (Ψ4>0) and to a raise in prices (Ψ1>0). The effect of the so-called “bank capital channel” is also positive ( Ψ 5 > 0 ); due to the longer maturity of bank assets with respect to liabilities (ρ>0), in case of a monetary tightening ( ∆im >0) the bank suffers a cost and a subsequent reduction in profit; given the capital constraint, this effect determines an increase in loan interest rates (the mirror effect is a decrease in lending). The equation (A1.9) for deposit interest rate is slightly different. Also in this case the impact of a monetary tightening is positive (Φ2>0) but it can now be split in three parts: the “bank lending channel” (b0(1-α)/2>0), the “opportunity cost” (-d3/2d0>0) and the “liquidity buffer”(α/2>0) effects. The intuition of this result is that a monetary squeeze automatically increase the cost of borrowing of bank uninsured fund and the return on securities (the alternative investment for depositors); therefore the first two effects push the bank to increase the interest rate on deposits to raise more insured funds. The percentage of deposits invested in securities (α) act, on the one hand, as a simple “reserve coefficient” that reduces the effectiveness of the “bank lending channel” while, on the other, it increases the revenue on liquid portfolio and the market power of the bank to offset the interest rate on deposits. The distributional effects of monetary policy are equal to the ones described above for the interest rate on loans. The effects on the cost of deposits are smaller for banks with certain characteristics only if b1<0 and Ψ3<0. Deposit interest rate reacts negatively to an output expansion (Φ4<0) and to an increase in prices (Φ1<0). An economic expansion pushes the deposits demand to the left and causes a decrease in cost of deposits (remember that deposit demand is upward sloping with respect to id). The effect should be greater for increases in transitory income. Also the effect of the “bank capital channel” are negative (Φ5<0); as we have seen, in case of a monetary tightening (ρ ∆im >0) the bank suffers a cost and a reduction in profit; this induces the bank to increase her interest rate margin, reducing the interest rates on deposits. 26 Appendix 2 – Technical details on the data The dataset has been constructed using three sources. Interest rates are taken from the 10-day report survey conducted by the Bank of Italy. Bank’s balance sheet information comes from the Banking Supervision Register at the Bank of Italy. Data on macroeconomic variables are taken from the International Financial Statistics. Data on interest rates refer to transactions in euros (Italian lira before 1999). The deposit interest rate is the weighted average rate paid by the single banks on current accounts, which are highly homogenous deposits products.31 The rate on domestic shortterm lending for the single bank is the weighted average of all lending positions. From this computation, overdraft fees are excluded. The choice of the short-term rate as a measure of the bank interest lending pass-through is due to several reasons. First, short-term lending excludes subsidized credit. Second, short-term loans typically are not collateralised and this allows insulating the “bank lending” channel from the “balance sheet” channel. Broadly speaking, the pass-through from market interest rates to the interest rate on loans does not depend upon market price variations that influence the value of collateral. Nearly half of bank’s business is done at this rate. Both interest rates are posted rates that are changed at discrete intervals (often less frequently than weekly, see Green, 1998). In our case, the quarterly frequency of the data is sufficient enough to capture all relevant changes due to a monetary policy shock. Both rates are gross of fiscal deduction. The interest rate taken as monetary policy indicator is that on repurchase agreements between the Bank of Italy and credit institutions in the period 1993-1998, and the interest rates on main refinancing operation of the ECB for the period 1999-2001.32 31 Current accounts are the most common type of deposit (at the end of 2001 they represented around 70 per cent of total bank deposits and passive repos). Current accounts allow unlimited checking for depositor that can close the account without notice. The bank, in turn, can change the remuneration of the account at any point in time. Therefore differences in deposit rates are not influenced by heterogeneity in maturity (see Focarelli and Panetta, 2003). 32 As pointed out by Buttiglione, Del Giovane and Gaiotti (1997), in the period under investigation the repo rate mostly affected the short-term end of the yield curve and, as it represented the cost of banks’ refinancing, it represented the value to which market rates and bank rates eventually tended to converge. The interest rate on main refinancing operation of the ECB does not present any particular break with the repo rate. 27 The cost a bank suffers from her maturity transformation function is due to the different sensitivity of her assets and liabilities to interest rates. Using a maturity ladder, we have: å(χ ⋅ A −ζ P ) *100 ρ = åA j j j j j i j j where Aj (Pj) is the amount of assets (liabilities) of j months-to-maturity and χj (ζj) measures the increase in interest on assets (liabilities) of class j due to a one-per-cent increase in the monetary policy interest rate (∆im=0.01). In other words, if å ( χ ⋅ A − ζ P ) >0, ρ j j j j i j represents the cost per unit of asset bank i suffers in case the monetary policy interest rate is raised of one percentage point. We obtain χi and ζi directly from supervisory regulation on interest rates risk exposure. In particular, the regulation assumes, for any given class j of months-to-maturity: 1) the same sensitivity parameter (χj =ζj) and 2) a non-parallel shift of the yield curve (∆im=0.01 for the first maturity class and then decreasing for longer maturity classes). Then, for each bank, after having classified assets and liabilities according to their months-to-maturity class, we have computed the bank specific variable ρi . This variable has been then multiplied by the change of the monetary policy indicator (∆im) to obtain the realized loss (or gain) per unit of asset in each quarter. In assembling our sample, the so-called special credit institutions (long-term credit banks) have been excluded since they were subject to different supervisory regulations regarding the maturity range of their assets and liabilities. Nevertheless, special long-term credit sections of commercial banks have been considered part of the banks to which they belonged. Particular attention has been paid to the treatment of mergers. In practice, it has been assumed that these have been taken place at the beginning of the sample period, summing the balance-sheet items of the merging parties. For example, if bank A has been incorporated by bank B at time t, bank B has been reconstructed backward as the sum of the 28 merging banks before the merger. Bank interest rates have been reconstructed backwards using as weights short-term loans and current accounts of the merging parties.33 Only banks reporting detailed lending and deposit rates over the whole sample period were considered. I refrain from adopting short time series to ensure sufficient asymptotic in the context of the error correction estimation. Bank observations that were missing or misreported or that constituted clear outliers were excluded from the sample. Bad loans are defined as loans for which legal procedures aimed at their repayment have been started. The permanent component of GDP has been computed using the Beveridge and Nelson (1981) decomposition. An ARIMA model (1,1,1) was applied to the logarithm of the series. Computations have been carried out using the algorithm described in Newbold (1990). Robustness of the results have been checked by means of a statistical analysis of the residuals. The possible presence of structural breaks in interest rates series have been investigated by means of the procedure developed by Banerjee, Lumsdaine and Stock (1992). Figure A1 shows sequential test for changes in the mean of each interest rate series. The hypothesis of this procedure is that, if there is a break, its date is not known a priori but rather is gleaned from the data. The results clearly show that unit-root/no-break null can be rejected at the 2.5 per cent critical value level against the stationarity/mean-shift alternative for the period 1995:03-1998:03. In equation (1) and (2) a convergence dummy, that takes the value of 1 in this period and 0 elsewhere, has been introduced. 33 The same methodology has been used, among others by Peek and Rosengreen (1995), Kishan and Opiela (2000) and Ehrmann et al. (2001). References Altunbas Y., Fazylow O. and Molyneux P. (2002), “Evidence on the Bank Lending Channel in Europe”, Journal of Banking and Finance, forthcoming. Angbazo, L. (1997), “Commercial Bank Net Interest Margins, Default Risk, Interest-rate risk, and Off-balance Sheet Banking”, Journal of Banking and Finance, Vol. 21, pp. 55-87. Angelini P. and Cetorelli N. (2002), ""The effects of regulatory reform on competition in the banking industry"", Journal of Money, Credit and Banking, forthcoming. Angelini, P., P. Di Salvo and G. Ferri (1998), “Availability and Cost of Credit for Small Businesses: Customer Relationships and Credit Cooperatives”, Journal of Banking and Finance, Vol. 22, No. 6-8, pp. 925-54. Angeloni I., Buttiglione L., Ferri G. and Gaiotti E. (1995), “The Credit Channel of Monetary Policy across Heterogeneous Banks: The Case of Italy”, Banca d’Italia, Temi di discussione, No. 256. Ausubel L. M. (1992), Rigidity and Asymmetric Adjustment of Bank Interest Rates, mimeo. Banca d’Italia (1986), Modello trimestrale dell’economia italiana, Banca d’Italia, Temi di discussione, No. 80. Banca d’Italia (1988), Modello mensile del mercato monetario, Banca d’Italia, Temi di discussione, No. 108. Banerjee A., Lumsdaine R.L. and Stock J.H. (1992), “Recursive and Sequential Tests of the UnitRoot and Trend Break Hypotheses: Theory and International Evidence”, Journal of Business and Economic Statistics, Vol. 10, No. 3, pp.271-87. Berger A.N. and Udell G.F. (1992), “Some Evidence on the Empirical Significance of Credit Rationing”, Journal of Political Economy, Vol.100, No. 5, pp. 1047-77. Berlin M. and Mester L.J. (1999), “Deposits and Relationship Lending”, Review of Financial Studies, Vol. 12, No. 3, pp. 579-607. Bernanke B. and Blinder A.S. (1988), “Is it Money or Credit, or Both or Neither? Credit, Money and Aggregate Demand”, American Economic Review, Vol. 78, No. 2, pp. 435-9. Paper and Proceedings of the One-Hundredth Annual Meeting of the American Economic Association. Beveridge S. and Nelson C. (1981), “A New Approach to the Decomposition of Economics Time Series into Permanent and Transitory Components with Particular Attention to Measurement of the ‘Business Cycle’”, Journal of Monetary Economics, Vol. 21, pp. 151-74. Boccuzzi, G. (1998), La crisi dell'impresa bancaria. Profili economici e giuridici, Giuffrè, Milano. Bolton, P. and Freixas X. (2001), “Corporate Finance and the Monetary Transmission Mechanism”, CEPR, Discussion Paper Series, No. 2982. Calomiris C.W. and Hubbard G.R. (1995), “Internal Finance and Investment: Evidence from the Undistributed Profit Tax of 1936-37”, Journal of Business, Vol. 68. No. 4. Ciocca P. (2000), La nuova finanza in Italia. Una difficile metamorfosi (1980-2000), Bollati Boringhieri, Torino. Cornett M. M. and Tehranian H. (1994), “An Examination of Voluntary Versus Involuntary Security Issuances by Commercial Banks: The Impact of Capital Regulations on Common Stock Returns”, Journal of Financial Economics, Vol. 35, pp. 99-122. Cottarelli C. and Kourelis A. (1994), “Financial Structure, Bank Lending Rates and the Transmission Mechanism of Monetary Policy”, IMF Staff Papers, Vol. 41, No. 4, pp.587-623. Cottarelli C., Ferri G. and Generale A. (1995), “Bank Lending Rates and Financial Structure in Italy: A Case Study”, IMF Working Papers, No. 38. 30 de Bondt G., Mojon B. and Valla N. (2003), “The Adjustment of Retail Rates in the Euro Area: Is It (Really) Sluggish?”, European Central Bank, mimeo. Dermine J. (1991), Discussion to Vives. X., “Banking Competition and European Integration”, in Giovannini A. and Mayer C., European Financial Integration, Cambridge, Cambridge University Press. Dewatripont M. and Tirole J. (1994), The Prudential Regulation of Banks, Cambridge, Massachusetts, MIT Press. Ehrmann M., Gambacorta L., Martinez Pagés J., Sevestre P. and Worms A. (2003), “Financial Systems and the Role of Banks in Monetary Policy Transmission in the Euro Area”, in Angeloni I., Kashyap A. and Mojon B., Monetary Policy Transmission in the Euro Area, Cambridge, Cambridge University Press. Focarelli D. and Panetta F. (2003), “Are Merger Beneficial to Consumers? Evidence from the Market for Bank Deposits”, American Economic Review, forthcoming. Friedman B. and Kuttner K. (1993), “Economic Activity and the Short-Term Credit Markets: an Analysis of Prices and Quantities”, Brooking Papers on Economic Activity, Vol. 2, pp. 193-283. Freixas X. and Rochet J. (1997), Microeconomics of Banking, Cambridge, MIT Press. Gaiotti E. (1992), “L’evoluzione delle tecniche di controllo monetario nel modello mensile della Banca d’Italia”, mimeo, Banca d’Italia. Gambacorta L. (2003), “The Italian Banking System and Monetary Policy Transmission: Evidence from Bank Level Data”, in Angeloni, I., A. Kashyap and B. Mojon (eds.), Monetary Policy Transmission in the Euro Area, Cambridge, Cambridge University Press. Gambacorta L. and Mistrulli P. (2004), “Does Bank Capital Affect Lending Behavior?”, Journal of Financial Intermediation, forthcoming. Green C.J. (1998), “Banks as Interest Rate Managers”, Journal of Financial Services Research, Vol. 14, n. 3, pp. 189-208. Hancock D. (1991), A Theory of Production for the Financial Firm, Norwell, Massachusetts, Kluwer Academic Publishers. Hannan T.H. and Berger A.N. (1991), “The Rigidity of Prices: Evidence From Banking Industry”, American Economic Review, Vol. 81, pp.938-45. Harvey (1981), Time Series Models, Oxford, Allan. Ho T.S.Y. and Saunders A. (1981), The Determinants of Bank Interest Margins: Theory and Empirical Evidence”, Journal of Financial and Quantitative Analysis, Vol. 16, No. 2, pp. 581600. Houston J.F. and James C. (1998), “Do Bank Internal Capital Market Promote Lending?”, Journal of Banking and Finance, Vol. 22, pp. 899-918. Hutchison D.E. (1995), “Retail Bank Deposit Pricing: An Intertemporal Asset Pricing Approach”, Journal of Money Credit and Banking, Vol. 27, pp. 217-31. Kashyap A. and Stein J.C. (1995), “The Impact of Monetary Policy on Bank Balance Sheets”, Carnegie Rochester Conference Series on Public Policy, Vol. 42, pp.151-195. Kashyap A. and Stein J.C. (2000), “What Do a Million Observations on Banks Say About the Transmission of Monetary Policy”, American Economic Review, Vol. 90, No. 3, pp. 407-28. Kashyap A., Stein J.C. and Wilcox D. (1993). Monetary Policy and Credit Conditions: Evidence from the Composition of External Finance, American Economic Review, Vol. 83, pp. 78-98. Kishan R.P. and Opiela T.P. (2000), “Bank Size, Bank Capital and the Bank Lending Channel”, Journal of Money, Credit and Banking, Vol. 32, No. 1, pp. 121-41. Klein M. (1971), “A Theory of the Banking Firm”, Journal of Money, Credit and Banking, Vol. 3, No. 2, pp. 205-18. 31 Leland H.E. and Pile D.H. (1977), “Informational Asymmetries, Financial Structures and Financial Intermediation”, The Journal of Finance, Vol. 32, pp. 371-87. Lim G.C. (2000), “Bank Interest Rate Adjustments: Are They Asymmetric?”, The Economic Record, Vol. 77, no. 237, pp.135-147. Melitz J. and Pardue M. (1973), “The Demand and Supply of Commercial Bank Loans”, Journal of Money, Credit and Banking, Vol. 5, No. 2, pp. 669-92. Moore G.R., Porter R.D. and Small D.H. (1990), “Modelling the Disaggregated Demands for M2 and M1: the U.S. Experience in the 1980s”, Proceedings of a Federal Reserve Board Conference on Monetary Aggregates and Financial System Behavior. Myers S.C. and Majluf N.S. (1984), “Corporate Finance and Investment Decisions when Firms Have Information that Investors Do Not Have”, Journal of Financial Economics, Vol. 13, pp.187-221. Neumark D. and Sharpe S.A. (1992), “Market Structure and the Nature of Price Rigidity: Evidence From the Market for Consumer Deposits”, Quarterly Journal of Economics, Vol. 107, pp.65780. Newbold P. (1990), “Precise and Efficient Computation of the Beveridge-Nelson Decomposition of Economic Time Series”, Journal of Monetary Economics, Vol. 26, pp. 453-457. Passacantando F. (1996), “Building an Institutional Framework for Monetary Stability”, BNL Quarterly Review, Vol. 49, No. 196, pp. 83-132. Peek J. and Rosengren E.S. (1995), “Bank Lending and the Transmission of Monetary Policy”; in Peek J. and E.S. Rosengren (eds.), Is Bank Lending Important for the Transmission of Monetary Policy?, Federal Reserve Bank of Boston Conference Series No. 39, pp. 47-68. Petersen M. and Rajan R. (1994), “The Benefits of Lending Relationships: Evidence from Small Business Data”, Journal of Finance, Vol. 49, pp.3-37. Rosen R.J. (2001), What Goes Up Must Come Down? Asymmetries and Persistence in Bank Deposit Rates, Indiana University, mimeo. Santomero A.M. (1984), “Modeling the Banking Firm: A Survey”, Journal of Money Credit and Banking, Vo. 16, n. 4, pp. 576-602. Stein J.C. (1998), “An Adverse-Selection Model of Bank Asset and Liability Management with Implications for the Transmission of Monetary Policy”, RAND Journal of Economics, Vol. 29, No. 3, pp. 466-86. Thakor A.V. (1996), “Capital Requirements, Monetary Policy, and Aggregate Bank Lending: Theory and Empirical Evidence”, The Journal of Finance, Vol. 51, No. 1, pp. 279-324. Upper C. and Worms A. (2001), “Estimating Bilateral Exposures in the German Interbank Market: Is There a Danger of Contagion?”, in BIS (ed.), Marrying the Macro and Microprudential Dimensions of Financial Stability, BIS papers, No. 1, pp. 211-29. Van den Heuvel S.J. (2001a), “The Bank Capital Channel of Monetary Policy”, University of Pennsylvania, mimeo. Van den Heuvel S.J. (2001b), “Banking Conditions and the Effects of Monetary Policy: Evidence from U.S. States”, University of Pennsylvania, mimeo. Van den Heuvel S.J. (2003), “Does Bank Capital Matter for Monetary Transmission?”, FRBNY Economic Policy Review, forthcoming. Verga G. (1984), “La determinazione dei tassi bancari in Italia: un’analisi per gli anni più recenti”, Banca, Impresa, Società, Vol. 3, No. 1, pp.65-84. Weth M.A. (2002), “The Pass-Through from Market Interest Rates to Bank Lending Rates in Germany”, Discussion Paper No 11, Economic Research Center of the Deutsche Bundesbank. Table 1 VARIABLES DESCRIPTION Variables Dependent variables Fixed effects Symbols iLt Interest rate on domestic short term loans iDt Interest rate on current account deposits µi imt Macro variables Description y tP , y Tt pt Bank-specific dummy variable Monetary policy indicator Permanent and transitory components of real GDP computed using the Beveridge and Nelson (1981) decomposition Inflation rate Size: log of total assets (Kashyap and Stein, 1995; Ehrmann et al. 2003) Liquidity: cash and securities over total assets (Stein, 1998; Kashyap and Stein, 2000) Excess capital: difference between regulatory capital and capital requirements (Peek and Rosengren, 1995; Kishan and Opiela, 2000; Gambacorta and Mistrulli, 2004) Deposit strength: ratio between deposits and bonds plus deposits (Berlin and Mester,1999; Weth, 2002) Credit relationship: ratio between long term loans and total loans (Berger and Udell, 1992) Bank-specific characteristics that influence the “bank lending channel” X it −1 Measure for the “bank capital channel” ρit −1 Risk-measure jit Efficiency ratio eit Interest rate volatility σt Cost per unit of asset that the bank incurs in case of a one per cent increase in MP Ratio between bad loans and total loans. This variable captures the riskiness of lending operations and should be offset by a higher expected yield of loans. Management efficiency: ratio of total loans and deposits to the number of branches. Interest rate volatility: coefficient of variation of iM . Control variables Φ it Convergence dummy: step dummy that takes the value of 1 in the period 1995:03-1998:03 and 0 elsewhere. Seasonal dummies. Note: For more information on the definition of the variables see Appendix 2. 18 18 18 18 Big banks Small banks Liquid banks (2) Low liquid banks 18 18 18 18 18 18 Well capitalized banks Low capitalized banks Banks with high BM ratio Banks with low BM ratio (3) (4) Banks with high BU ratio (5) Banks with low BU ratio (1) 73 Number of banks Total sample Bank-characteristics (*) 8.51 10.97 11.78 7.77 9.71 9.42 9.51 9.33 9.28 10.02 9.51 Mean 2.59 2.12 1.49 2.24 2.73 2.81 2.72 2.73 2.81 2.73 2.72 St. dev. 3.69 4.00 4.88 3.69 3.69 4.75 3.69 4.42 3.69 5.03 3.69 Min 15.06 16.12 16.12 15.06 16.12 15.93 15.94 14.86 15.06 16.12 16.12 Max Interest rate on short term lending 2.80 4.68 5.15 2.41 3.68 3.53 3.57 3.61 3.57 3.55 3.58 Mean 1.67 1.44 0.96 1.45 1.80 1.79 1.80 1.71 1.74 1.79 1.79 St. dev. 0.65 0.53 0.74 0.52 0.52 0.74 0.65 0.73 0.73 0.52 0.52 Min 7.36 7.43 8.21 7.35 7.18 8.21 8.21 7.35 7.35 8.21 8.21 Max Interest rate on current accounts definition of the variables see Appendix 2. The sources of the dataset are Bank of Italy supervisory returns and 10-days reports. 21.92 8.51 6.58 27.00 9.66 24.28 4.67 43.75 51.15 1.55 16.20 Size (1) 19.98 28.26 29.69 18.56 26.15 20.82 33.07 14.91 19.01 25.11 24.00 Liq. (2) 3.80 3.95 4.46 3.42 6.86 1.49 4.27 3.13 2.56 4.81 3.91 Cap. (3) 71.84 93.13 98.53 66.10 85.49 78.40 86.27 72.43 77.60 84.40 82.40 BM (4) 53.29 22.46 28.72 45.30 37.22 38.46 36.15 43.66 38.98 41.72 37.66 BU (5) average ratio below the third quartile. Since the characteristics of each bank could change through time, percentiles have been worked out on mean values. For more details on the long-term loans and total loans. A bank with a ""high"" characteristic has the average ratio above the first quartile of the distribution. (*) A bank with a ""low""characteristic has the capital requirements. (4) The Berlin and Mester indicator (BM) is the ratio between deposits and deposits plus bonds. (5) The Berger and Udell indicator (BU) is the ratio between government securities over total assets. (3) The capital ratio is given by excess capital divided by total assets. Excess capital is the difference between regulatory capital and total interest rate are annualized and given in percentages. (1) The size indicator is given by total asset (billions of euros). (2) The liquidity indicator is represented by the sum of cash and Ex special credit institutions, foreign banks and ""banche di credito cooperativo"" are excluded. The sample represents more than 70 per cent of total system in terms of lending. All SUMMARY STATISTICS (1993:03-2001:03) Table 2 Table 3 RESULTS FOR THE EQUATION ON THE INTEREST RATE ON SHORT-TERM LENDING This table shows the results of the equation for the interest rate on short term lending. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and a bank specific characteristic: ∆ iL k ,t = µ k + 2 1 j =1 j =0 å κ j ∆iL k ,t − j + å ( β j + β *j X k ,t −1 )∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + λX k ,t −1 + φ∆ ( ρ k ,t −1∆iM t ) + + (α + α X k ,t −1 )iL k ,t −1 + (γ + γ * X k ,t −1 )iM t −1 + θ jk ,t + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:03-2001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. Dependent variable: quarterly change of the interest rate on short-term lending (1) Size Coeff. (2) Liquidity (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. S.Error Coeff. 0.017 0.012 0.025 0.145 *** 0.032 ** 0.012 0.015 0.013 0.026 0.149 *** 0.025 ** 0.012 0.018 0.187 *** 0.012 0.043 *** 0.024 0.026 0.015 0.010 0.020 Costs, credit risk and int.rate volatility Bank's efficiency: -0.004 ** 0.002 -0.001 Bad loans: 0.020 *** 0.002 0.016 *** Interest rate volatility: 0.011 *** 0.001 0.012 *** 0.002 -0.006 ** 0.002 0.017 *** 0.001 0.010 *** 0.002 0.001 0.001 -0.001 0.020 *** 0.014 *** 0.001 -0.001 0.002 0.019 *** 0.001 0.012 *** 0.001 0.002 0.001 Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.569 *** 0.027 0.003 0.556 *** 0.028 0.586 *** 0.026 0.031 0.018 0.027 0.036 0.023 0.418 0.022 0.026 0.465 *** 0.030 0.497 *** 0.023 0.028 0.529 *** 0.032 0.463 *** 0.034 0.000 0.033 0.035 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.938 *** 0.013 0.000 0.913 *** 0.015 0.971 *** 0.014 0.016 0.878 *** 0.159 0.017 0.889 *** 0.016 0.863 *** 0.013 0.000 0.014 0.012 Long run elasticity Average bank: Ho: unitary long run elasticity (p-val.) Ho: no heterogeneity (p-value) Low characteristic High characteristic 1.017 *** 0.014 0.056 0.509 0.996 *** 0.014 1.049 *** 0.016 0.015 1.012 *** 0.235 0.924 0.026 0.992 *** 0.012 1.040 *** 0.018 0.489 0.644 0.016 0.023 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.017 0.000 0.017 0.020 Bank capital channel Loan demand Inflation: Permanent Income: Transitory Income: Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations S.Error Coeff. (3) Capitalization 0.159 *** 0.019 0.033 ** 0.015 0.012 0.031 0.145 *** 0.030 *** 0.013 0.403 *** 0.414 *** 0.383 *** 0.941 *** 0.962 *** 0.920 *** 0.954 *** 0.958 *** 0.949 *** 0.869 *** 0.862 *** 0.878 *** -0.477 *** 0.023 -0.422 *** 0.000 -0.505 *** 0.026 -0.391 *** -0.441 *** 0.023 -0.451 *** 0.019 -0.507 *** 0.000 0.023 -0.482 *** 0.019 -0.539 *** 0.023 0.035 0.028 0.026 -0.234 *** -0.519 *** 0.043 -0.382 *** 0.000 0.021 -0.434 *** 0.020 -0.330 *** 0.104 * 0.055 0.409 *** 0.070 0.178 *** 0.051 0.197 *** 0.066 0.109 * 0.066 0.000 0.949 0.087 2336 0.000 0.367 0.099 2336 0.000 0.702 0.088 2336 0.000 0.185 0.000 0.101 2336 73 0.116 0.057 2336 73 1.023 *** 0.012 0.037 0.011 0.015 0.474 *** 0.456 *** 1.031 *** 1.015 *** 0.987 *** 1.005 *** 0.014 0.816 0.822 0.015 0.015 0.536 *** 0.529 *** 0.012 0.047 0.883 0.013 0.012 73 0.996 *** 0.018 0.000 0.018 0.018 0.533 *** 73 0.982 *** 0.990 *** 0.978 *** -0.381 *** 73 Table 4 RESULTS FOR THE EQUATION ON INTEREST RATE ON CURRENT ACCOUNTS This table shows the results of the equation for the interest rate on current accounts. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and a bank specific characteristic: ∆i D k , t = µ k + 2 1 j =1 j =0 åκ j ∆iD k ,t − j + å ( β j + β *j X k ,t −1)∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + λX k ,t −1 + φ∆( ρ k ,t −1∆iM t ) + + (α + α X k ,t −1 )iD k ,t −1 + (γ + γ * X k ,t −1 )iM t −1 + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t * with k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Data are quarterly (1993:03-2001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. (1) Size Dependent variable: quarterly change of the interest rate on current accounts Coeff. (2) Liquidity S.Error Coeff. (3) Capitalization (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. S.Error Coeff. Deposit demand Inflation: Permanent Income: Transitory Income: 0.049 *** 0.015 0.091 *** -0.058 *** 0.006 -0.048 *** -0.222 *** 0.012 -0.204 *** 0.012 0.058 *** 0.006 -0.058 *** 0.012 -0.223 *** 0.015 0.005 0.011 0.099 *** -0.024 * -0.102 *** 0.008 0.039 *** 0.013 -0.052 *** 0.012 -0.202 *** 0.009 0.004 0.010 Costs, credit risk and int.rate volatility Bank's efficiency: Interest rate volatility: 0.001 0.001 ** 0.001 0.001 0.001 0.002 *** 0.001 0.001 0.001 0.001 *** 0.002 0.001 0.012 *** 0.005 *** 0.001 0.000 0.002 * 0.002 *** 0.001 0.001 Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.413 *** 0.013 0.000 0.400 *** 0.015 0.429 *** 0.012 0.411 *** 0.010 0.000 0.010 0.010 0.410 *** 0.008 0.742 0.009 0.009 0.418 *** 0.009 0.000 0.009 0.010 0.388 *** 0.408 *** 0.366 *** 0.008 0.000 0.007 0.010 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.546 *** 0.009 0.000 0.512 *** 0.010 0.588 *** 0.008 0.006 0.540 *** 0.000 0.006 0.536 *** 0.008 0.542 *** 0.006 0.776 0.006 0.008 Long run elasticity Average bank: Ho: unitary long run elasticity (p-val.) Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.685 *** 0.013 0.000 0.905 0.688 *** 0.014 0.682 *** 0.013 0.007 0.000 0.444 0.006 0.009 0.675 *** 0.661 *** 0.010 0.000 0.717 0.010 0.011 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.016 0.000 0.017 0.017 Bank capital channel Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations 0.431 *** 0.394 *** 0.541 *** 0.551 *** 0.530 *** 0.551 *** 0.535 *** 0.507 *** 0.526 *** 0.493 *** -0.572 *** 0.018 -0.646 *** 0.000 -0.537 *** 0.018 -0.657 *** -0.610 *** 0.023 -0.634 *** 0.018 -0.609 *** 0.016 0.020 -0.645 *** 0.017 -0.564 *** 0.020 0.000 0.019 0.025 -0.725 *** -0.795 *** 0.016 -0.572 *** 0.000 0.019 -0.610 *** 0.017 -0.533 *** -0.055 *** 0.015 -0.036 *** 0.012 -0.049 *** 0.009 -0.039 *** 0.013 -0.034 *** 0.009 0.000 0.976 0.960 2336 0.785 0.094 2336 0.000 0.340 0.092 2336 0.508 0.095 2336 73 0.000 73 0.676 *** 0.007 0.049 0.007 0.009 0.663 *** 0.694 *** 0.670 *** 0.699 *** 0.009 0.000 0.205 0.010 0.009 0.544 *** 0.451 *** 0.387 *** 0.009 0.000 0.463 0.009 0.011 0.953 0.091 2336 0.685 *** 0.008 0.000 0.008 0.008 0.411 *** 0.409 *** 0.000 73 0.643 *** 0.631 *** 0.654 *** -0.760 *** 73 0.669 *** 0.000 73 Table 5 BANK LENDING CHANNEL This table shows the results of the equation for the interest rate on short-term lending (panel A) and current accounts (panel B) when all bank-specific characteristics are taken simultaneously into account. The model is given by the following equation, which includes interaction terms that are the product of the monetary policy indicator and each bank-specific characteristic: ∆iψ k ,t = µ k + 2 5 1 5 å κ j ∆iψ k ,t − j + å å ( β j + β *j X k , m,t −1)∆iM t − j + ϕ pt + δ1∆ ln ytP + δ 2∆ ln ytT + å λm X k , m,t −1 + j =1 m =1 j = 0 + φ∆ ( ρ k ,t −1∆iM t ) + (α + m =1 5 å α m* X k ,m,t −1)(iψ k ,t −1 − γ iM t −1) + θ jk ,t + ξ ek ,t + ψσ t + Φ k ,t + ε k ,t m =1 with i ψ= quarterly change of the interest rate on short-term lending or current accounts k=1,…, N (k=number of banks) and t=1, …,T (t= periods). Bank-specific characteristics are size,liquidity, capitalization, Berlin-Mester and Berger-Udell indicators (m =5). Data are quarterly (1992:032001:03) and not seasonally adjusted. The panel is balanced with N=73 banks. Lags have been selected in order to obtain white noise residuals. The description of the variables is reported in Table 1. The model have been estimated using the GMM estimator suggested by Arellano and Bond (1991) which ensures efficiency and consistency provided that the models are not subject to serial correlation of order two and that the instruments used are valid (which is tested for with the Sargan test). A bank with “low characteristic” has the average ratio of the banks below the first quartile, a bank with ""high characterisic” has the average ratio of the banks above third quartile. For more details on the data see Appendix 2. *=significance at the 10 per cent; **=significance at the 5 per cent; ***=significance at the 1 per cent. (1) Size Coeff. (2) Liquidity S.Error Coeff. (3) Capitalization S.Error Coeff. (5) Long term loans/ Total loans S.Error Coeff. S.Error (4) Dep./(Bonds+Dep.) S.Error Coeff. (A) Dependent variable is the quarterly change of the interest rate on short-term lending Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.452 *** 0.062 0.159 0.492 *** 0.064 0.393 *** 0.080 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.879 *** 0.039 0.639 0.895 *** 0.058 0.857 *** 0.040 0.891 *** 0.868 *** Long run elasticity All banks: 1.000 1.000 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic -0.354 *** 0.050 -0.354 *** 0.681 -0.377 *** 0.072 -0.354 *** -0.324 *** 0.092 -0.354 *** Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations - 0.000 - 0.452 *** 0.476 *** 0.421 *** 0.879 *** - 0.062 0.027 0.058 0.069 0.039 0.317 0.036 0.033 - 0.452 *** 0.558 *** 0.308 *** 0.879 *** 0.914 *** 0.847 *** 1.000 - 0.050 -0.354 *** 0.990 0.063 -0.318 *** 0.046 -0.399 *** 0.062 0.043 0.065 0.110 0.039 0.744 0.082 0.075 0.050 0.536 0.070 0.095 0.452 *** 0.519 *** 0.375 *** 0.062 0.016 0.050 0.084 0.883 *** 0.876 *** 0.039 0.879 *** 0.913 0.050 0.888 *** 0.047 0.873 *** 0.039 0.912 0.039 0.053 1.000 - 0.460 *** 0.437 *** 0.879 *** - -0.354 *** -0.332 *** -0.375 *** 0.062 0.702 0.059 0.077 0.452 *** 1.000 - 0.050 -0.354 *** 0.761 0.089 -0.332 *** 0.085 -0.376 *** 0.050 0.773 0.086 0.095 0.073 0.985 2336 73 (B) Dependent variable is the quarterly change of the interest rate on current accounts Immediate pass-through Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.452 *** 0.042 0.972 0.453 *** 0.043 0.452 *** 0.050 Pass-through after a quarter Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic 0.545 *** 0.033 0.160 0.572 *** 0.032 0.524 *** 0.043 0.546 *** 0.545 *** Long run elasticity Average bank: 0.700 0.700 Loading of the long run relationship Average bank: Ho: no heterogeneity (p-value) Low characteristic High characteristic -0.570 *** 0.043 -0.570 *** 0.388 -0.537 *** 0.048 -0.565 *** -0.612 *** 0.074 -0.575 *** Miss-specification tests MA(1), MA(2) (p-value) Sargan test (p-value) No of banks, no of observations 0.000 73 - - 0.915 0.180 2336 0.452 *** 0.470 *** 0.434 *** 0.545 *** - 0.042 0.129 0.050 0.037 0.033 0.978 0.038 0.033 - 0.452 *** 0.479 *** 0.419 *** 0.545 *** 0.566 *** 0.517 *** 0.700 - 0.043 -0.570 *** 0.820 0.050 -0.607 *** 0.047 -0.523 *** 0.042 0.529 0.054 0.074 0.033 0.481 0.055 0.045 0.043 0.481 0.019 0.025 0.452 *** 0.497 *** 0.406 *** 0.042 0.112 0.062 0.062 0.590 *** 0.516 *** 0.033 0.545 *** 0.203 0.045 0.563 *** 0.039 0.525 *** 0.033 0.224 0.041 0.034 0.700 - 0.509 *** 0.400 *** 0.545 *** - -0.570 *** -0.452 *** -0.680 *** 0.042 0.032 0.044 0.054 0.452 *** 0.700 - 0.043 -0.570 *** 0.004 0.062 -0.589 *** 0.054 -0.550 *** 0.043 0.575 0.059 0.051 Fig. 1 Banking interest rates (quarterly data, percentage points) 19.0 3-month interbank rate Repo rate 17.0 Interest rate on current accounts Estimation period 1993:03-2001:03 Short term lending rate 15.0 13.0 Euro 11.0 9.0 7.0 5.0 Period before T.U.B. 1987:01-1993:02 3.0 1.0 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 Fig. 2 Cross sectional and time series dispersion of interest rates 0.350 (a) Interest rate on short-term loans 0.300 0.250 0.200 0.150 0.100 0.050 0.000 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 1998 1999 2000 2001 0.350 (b) Interest rate on current accounts 0.300 0.250 0.200 0.150 0.100 0.050 0.000 1987 1988 1989 ACROSS BANKS 1990 1991 1992 OVER TIME 1993 1994 1995 1996 1997 Fig. 3 Determinants of bank’s interest rates i L = f ( y P , y T , p, i M , + ? + + X t −1 , i M X t −1 , ρ t −1 ∆i M , j , costs , σ , µ k ) ? + + + ? + Loan demand Interest rate channel Bank lending channel Cost of intermediation, credit risk and interest rate volatility Bank capital channel Deposit demand i D = f ( y P , y T , p, i M , − − − + Industry structure X t −1 , i M X t −1 , ρ t −1 ∆i M , costs , σ , µ k ) ? − − ? + Note: the meaning of all the symbols is reported in Table 1. Fig. A1 Search for mean shift breaks (monthly data, sequential minimum unit root tests) 0 Dec-87 Dec-88 Dec-89 Dec-90 Dec-91 Dec-92 Dec-93 Dec-94 Dec-95 Dec-96 Dec-97 Dec-98 Dec-99 -1 -2 -3 -4 -5 -6 -7 Interest rate on current accounts -8 Interest rate on short-term loans 3-month interbank market rate -9 10% critical value 2.5% critical value -10 Note: The estimated model tests for a shift in the constant. No trend is included. Sequential statistic are computed using the sample 1984:7-2002:12, sequentially incrementing the date of the hypothetical shift. A fraction equal to 15 per cent of the total sample at the beginning and at the end of the sample is not considered for the test. For more details see Banerjee, Lumsdaine and Stock (1992). ",Financial,Explanation/Definition,Q&A "[question] [user request] ===================== [text] [context document] ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",What are the differences between antibacterial soap and regular soap? Which soap would you recommend as being better for preventing ilness? Answer in a minimum of 200 words.,"We’re exposed to millions of germs and bacteria every day. Many of us use antibacterial products to reduce our risk of getting sick or passing germs and bacteria onto others – but are they really more effective at killing the “bad guys” than regular soap? Eric Haugen, MD, UnityPoint Health helps us understand the pros and cons. Antibacterial Soap Antibacterial soap (also called antimicrobial or antiseptic) is any cleaning product with active antimicrobial ingredients added and not found in regular soaps. “An antimicrobial is something that works to kills microorganisms or stops their growth. For example, antibiotics and antibacterial soaps are used to fight bacteria,” Dr. Haugen says. Antibacterial soaps used to contain the chemical triclosan, but the U.S. Food and Drug Administration (FDA) banned it from household and health care products, because research suggests it may impact hormone levels and bacterial resistance. “While bacteria sound like a bad thing, it can actually be good for you. Your body needs bacteria to maintain a healthy, balanced environment on your skin,"" Dr. Haugen says. If you’re not sure if your soap is antibacterial, look for the word “antibacterial” on the label. The FDA says a Drug Fact Label is another sign a hand soap or body wash has antibacterial ingredients in it. Pros of Antibacterial Soap Antibacterial soap still kills bad bacteria, but it shouldn’t be overused. It's easy to find in most stores. Cons of Antibacterial Soap Overuse of antibacterial products can reduce the healthy bacteria on your skin. Added chemicals to antibacterial soaps can remove natural oils, making skin drier. Using antibacterial soap or hand sanitizer can make people think they do not have to wash their hands as thoroughly or frequently. Tips for Using Hand Sanitizer When soap and running water are unavailable, using hand sanitizers with at least 60 percent alcohol levels can be an effective alternative. “While hand sanitizer is nice in a pinch, it doesn’t eliminate all germs and should not be used when hands are visibly greasy or dirty,” Dr. Haugen says. The Centers for Disease Control and Prevention (CDC) recommends the following tips for children and adults using hand sanitizer: Apply enough hand sanitizer to cover all surfaces of the hands. Rub sanitizer on hands covering the tops, between fingers and fingertips. Keep rubbing until hands are dry or for about 20 seconds. Regular or Plain Soap Regular soap is designed to decrease water’s surface tension and lift dirt and oils off surfaces, so it can be easily rinsed away. Though regular soap does not contain added antibacterial chemicals, it's effective in getting rid of bacteria and other virus-causing germs. Pros of Regular Soap Antibacterial soaps are no more effective than regular soap and water for killing disease-causing germs. Regular soap tends to be less expensive than antibacterial soap and hand sanitizers. Regular soap won’t kill healthy bacteria on the skin’s surface. Cons of Regular Soap People may not wash hands thoroughly enough for regular soap to kill bad bacteria. You must look at the labels closely to find a regular soap. 5 Steps for Effective Handwashing “It’s more important for you to focus on your handwashing technique than what type of soap you use. Washing hands with soap (either antibacterial or regular) and water is one of the best ways to remove germs, avoid getting sick and prevent the spread of germs to others,” Dr. Haugen says. The CDC recommends these five tips for effective handwashing: Wet. Place your hands under running (cold or warm) water and add soap. Lather. Rub your hands together, making a soapy lather. Scrub. Wash the front and back of hands, between your fingers and under nails for at least 20 seconds or two rounds of the song “Happy Birthday.” Rinse. Place your hands well under running (cold or warm) water until the soap is gone. Dry. hands thoroughly with a clean towel or air dry them. Have little ones around? Read 6 ways to make handwashing fun for kids next.","[question] What are the differences between antibacterial soap and regular soap? Which soap would you recommend as being better for preventing ilness? Answer in a minimum of 200 words. ===================== [text] We’re exposed to millions of germs and bacteria every day. Many of us use antibacterial products to reduce our risk of getting sick or passing germs and bacteria onto others – but are they really more effective at killing the “bad guys” than regular soap? Eric Haugen, MD, UnityPoint Health helps us understand the pros and cons. Antibacterial Soap Antibacterial soap (also called antimicrobial or antiseptic) is any cleaning product with active antimicrobial ingredients added and not found in regular soaps. “An antimicrobial is something that works to kills microorganisms or stops their growth. For example, antibiotics and antibacterial soaps are used to fight bacteria,” Dr. Haugen says. Antibacterial soaps used to contain the chemical triclosan, but the U.S. Food and Drug Administration (FDA) banned it from household and health care products, because research suggests it may impact hormone levels and bacterial resistance. “While bacteria sound like a bad thing, it can actually be good for you. Your body needs bacteria to maintain a healthy, balanced environment on your skin,"" Dr. Haugen says. If you’re not sure if your soap is antibacterial, look for the word “antibacterial” on the label. The FDA says a Drug Fact Label is another sign a hand soap or body wash has antibacterial ingredients in it. Pros of Antibacterial Soap Antibacterial soap still kills bad bacteria, but it shouldn’t be overused. It's easy to find in most stores. Cons of Antibacterial Soap Overuse of antibacterial products can reduce the healthy bacteria on your skin. Added chemicals to antibacterial soaps can remove natural oils, making skin drier. Using antibacterial soap or hand sanitizer can make people think they do not have to wash their hands as thoroughly or frequently. Tips for Using Hand Sanitizer When soap and running water are unavailable, using hand sanitizers with at least 60 percent alcohol levels can be an effective alternative. “While hand sanitizer is nice in a pinch, it doesn’t eliminate all germs and should not be used when hands are visibly greasy or dirty,” Dr. Haugen says. The Centers for Disease Control and Prevention (CDC) recommends the following tips for children and adults using hand sanitizer: Apply enough hand sanitizer to cover all surfaces of the hands. Rub sanitizer on hands covering the tops, between fingers and fingertips. Keep rubbing until hands are dry or for about 20 seconds. Regular or Plain Soap Regular soap is designed to decrease water’s surface tension and lift dirt and oils off surfaces, so it can be easily rinsed away. Though regular soap does not contain added antibacterial chemicals, it's effective in getting rid of bacteria and other virus-causing germs. Pros of Regular Soap Antibacterial soaps are no more effective than regular soap and water for killing disease-causing germs. Regular soap tends to be less expensive than antibacterial soap and hand sanitizers. Regular soap won’t kill healthy bacteria on the skin’s surface. Cons of Regular Soap People may not wash hands thoroughly enough for regular soap to kill bad bacteria. You must look at the labels closely to find a regular soap. 5 Steps for Effective Handwashing “It’s more important for you to focus on your handwashing technique than what type of soap you use. Washing hands with soap (either antibacterial or regular) and water is one of the best ways to remove germs, avoid getting sick and prevent the spread of germs to others,” Dr. Haugen says. The CDC recommends these five tips for effective handwashing: Wet. Place your hands under running (cold or warm) water and add soap. Lather. Rub your hands together, making a soapy lather. Scrub. Wash the front and back of hands, between your fingers and under nails for at least 20 seconds or two rounds of the song “Happy Birthday.” Rinse. Place your hands well under running (cold or warm) water until the soap is gone. Dry. hands thoroughly with a clean towel or air dry them. Have little ones around? Read 6 ways to make handwashing fun for kids next. https://www.unitypoint.org/news-and-articles/antibacterial-soap-vs-regular-soap-which-one-is-better ===================== [instruction] Answer the question using only the information provided in the context. Do not rely on external knowledge or sources.",Retail/Product,Find & Summarize,Text Transformation Use only the provided text to answer the question. Do not use external information or any prior knowledge. Avoid using contractions in your writing.,How do the metrics of occupancy rate and property capitalization rate compare in regards to their usefulness to developers?,"Multifamily properties that generate stable revenues (via collection of rents from tenants) have predictable profitability levels, which can make them attractive investments. By contrast, the profit potential of riskier properties, such as those experiencing above-normal vacancy rates and rental income declines (e.g., due to neighborhood location, poor management, or upkeep), may be less predictable yet still be attractive investments. After substantial rehabilitation, a rental property may appeal to tenants with more stable and higher incomes and possibly fetch a higher resale value—or it may still fail to generate the anticipated rental income, resulting in substantially greater losses. Thus, risker financial investment opportunities may translate into greater profits or greater losses. Real estate properties are categorized as Class A, Class B, and Class C, which provides developers and lenders with the financial risk characteristics of the prospective investment properties (defined in more detail in the text box below). Restating the preceding investment strategy, acquiring a riskier Class C property may initially be less expensive and have greater profit potential than a less risky Class A property investment. If, however, a Class C property after rehabilitation would continue to generate low or below-market rents, the losses are likely to be significant. In short, developers decide whether to invest in low- or high-risk multifamily projects. One criterion for determining whether to invest in Class A, Class B, or Class C income- generating properties is current and expected future performance of rents. Anticipated rent growth is a favored metric developers use to evaluate a prospective investment’s profitability.10 Occupancy rates also provide information about anticipated rent increases or decreases. As multifamily properties’ occupancy rates increase (decrease), the overall rental income the properties generate is more likely to increase (decrease).11 A related concept, the property capitalization (cap) rate, is the annual net operating income generated by the property divided by its purchase price. In other words, the cap rate measures a property’s yield, the annual return in the form of (rental) income generated by the investment. (The cap rate does not account for any outstanding debt such as a mortgage amount.) The interpretation of a high cap rate, however, may be ambiguous. Although a higher cap rate may be indicative of higher profit potential, it may also be indicative of a limited ability to raise future rents on some tenants (e.g., the elderly, those with higher delinquency rates, and those currently with long leases).","system instruction: [Use only the provided text to answer the question. Do not use external information or any prior knowledge. Avoid using contractions in your writing.] question: [How do the metrics of occupancy rate and property capitalization rate compare in regards to their usefulness to developers?] context block: [Multifamily properties that generate stable revenues (via collection of rents from tenants) have predictable profitability levels, which can make them attractive investments. By contrast, the profit potential of riskier properties, such as those experiencing above-normal vacancy rates and rental income declines (e.g., due to neighborhood location, poor management, or upkeep), may be less predictable yet still be attractive investments. After substantial rehabilitation, a rental property may appeal to tenants with more stable and higher incomes and possibly fetch a higher resale value—or it may still fail to generate the anticipated rental income, resulting in substantially greater losses. Thus, risker financial investment opportunities may translate into greater profits or greater losses. Real estate properties are categorized as Class A, Class B, and Class C, which provides developers and lenders with the financial risk characteristics of the prospective investment properties (defined in more detail in the text box below). Restating the preceding investment strategy, acquiring a riskier Class C property may initially be less expensive and have greater profit potential than a less risky Class A property investment. If, however, a Class C property after rehabilitation would continue to generate low or below-market rents, the losses are likely to be significant. In short, developers decide whether to invest in low- or high-risk multifamily projects. One criterion for determining whether to invest in Class A, Class B, or Class C income- generating properties is current and expected future performance of rents. Anticipated rent growth is a favored metric developers use to evaluate a prospective investment’s profitability.10 Occupancy rates also provide information about anticipated rent increases or decreases. As multifamily properties’ occupancy rates increase (decrease), the overall rental income the properties generate is more likely to increase (decrease).11 A related concept, the property capitalization (cap) rate, is the annual net operating income generated by the property divided by its purchase price. In other words, the cap rate measures a property’s yield, the annual return in the form of (rental) income generated by the investment. (The cap rate does not account for any outstanding debt such as a mortgage amount.) The interpretation of a high cap rate, however, may be ambiguous. Although a higher cap rate may be indicative of higher profit potential, it may also be indicative of a limited ability to raise future rents on some tenants (e.g., the elderly, those with higher delinquency rates, and those currently with long leases).]",Financial,Concept Comparison,Q&A "Use only information from the provided text to answer questions. Do not use outside knowledge and do not answer based on common sense. If you can't determine the answer based on the provided text, you should say ""I can't find the answer to your question in the provided text.""","In brief, what are 2-3 issues foreseen with this bill?","On July 20, 2022, the House Energy and Commerce Committee voted 53-2 to advance the American Data Privacy and Protection Act (ADPPA), H.R. 8152, to the full House of Representatives. The ADPPA would create a comprehensive federal consumer privacy framework. Some commentators have noted the bill’s novel compromises on two issues that have impeded previous attempts to create a national privacy framework: whether to preempt state privacy laws and whether to create a private right of action. The bipartisan bill is co-sponsored by House Energy and Commerce Committee Chairman Frank Pallone, Jr. and Ranking Member Cathy McMorris Rogers, and is promoted in the Senate by Commerce Committee Ranking Member Roger Wicker. In a joint statement, Representatives Pallone and McMorris Rodgers and Senator Wicker described the bill as “strik[ing] a meaningful balance” on key issues. Senate Commerce Committee Chair Maria Cantwell has critiqued the ADPPA as having “major enforcement holes,” prompting other commentators to question whether the Senate will pass the bill. This Sidebar first provides a summary of the version of the ADPPA ordered to be reported by the House Commerce Committee on July 20. It then compares several of the bill’s key provisions to other privacy bills from the 117th and 116th Congresses before examining some considerations for Congress. Summary of the Bill The ADPPA would govern how companies across different industries treat consumer data. While not an exhaustive summary, some key facets of the bill are as follows:  Covered Entities. The bill would apply to most entities, including nonprofits and common carriers. Some entities, such as those defined as large data holders that meet certain thresholds and service providers that use data on behalf of other entities (including covered entities, government entities, and other service providers), would face different or additional requirements.  Covered Data. The bill would apply to information that “identifies or is linked or reasonably linkable” to an individual.  Duties of Loyalty. The bill would prohibit covered entities from collecting, using, or transferring covered data beyond what is reasonably necessary and proportionate to provide a service requested by the individual, unless the collection, use, or disclosure would fall under one of seventeen permissible purposes. It also would create special protections for certain types of sensitive covered data, defined as sixteen different categories of data. Among other things, the bill would require covered entities to get a consumer’s affirmative, express consent before transferring their sensitive covered data to a third party, unless a specific exception applies.  Transparency. The bill would require covered entities to disclose, among other things, the type of data they collect, what they use it for, how long they retain it, and whether they make the data accessible to the People’s Republic of China, Russia, Iran, or North Korea.  Consumer Control and Consent. The bill would give consumers various rights over covered data, including the right to access, correct, and delete their data held by a particular covered entity. It would further require covered entities to give consumers an opportunity to object before the entity transfers their data to a third party or targets advertising toward them.  Youth Protections. The bill would create additional data protections for individuals under age 17, including a prohibition on targeted advertising, and it would establish a Youth Privacy and Marketing Division at the Federal Trade Commission (FTC). These additional protections would only apply when the covered entity knows the individual in question is under age 17, though certain social media companies or large data holders would be deemed to “know” an individual’s age in more circumstances.  Third-Party Collecting Entities. The bill would create specific obligations for third-party collecting entities, which are entities whose main source of revenue comes from processing or transferring data that they do not directly collect from consumers (e.g., data brokers). These entities would have to comply with FTC auditing regulations and, if they collect data above the threshold amount of individuals or devices, would have to register with the FTC. The FTC would establish a searchable registry of third-party collecting entities and a “Do Not Collect” mechanism by which individuals could request that all registered entities refrain from collecting covered data relating to the individual. The ADPPA has bipartisan support, and various interest groups and commentators, such as the Electronic Privacy Information Center, the Center for Democracy & Technology, and the Washington Post’s editorial board, have expressed enthusiasm for the bill. In an August 25 letter to House Speaker Nancy Pelosi, forty-eight different public interest groups urged Congress to move the ADPPA forward through Congress, stating that the bill is a “meaningful compromise” and that a failure to act may “forestall progress on this issue for years to come.” At the same time, some Members of Congress and other commentators have raised concerns with the bill. Senators Cantwell and Schatz, for example, have both criticized the bill’s failure to impose a “duty of loyalty” on covered entities. While the ADPPA has various requirements that are classified under a “Duty of Loyalty” heading, these requirements differ from those included in COPRA or the Data Care Act. COPRA’s “duty of loyalty” would prohibit businesses from engaging in “harmful” data practices, which the bill defines to mean using covered data “in a manner that causes or is likely to cause” injury to the subject of the covered data. The Data Care Act’s “duty of loyalty” would prohibit covered providers from using data in a way that would “benefit the [provider] to the detriment of the end user” and would “result in reasonably foreseeable and material physical harm” or “be unexpected and highly offensive” to the end user. The ADPPA’s “Duty of Loyalty” imposes a data minimization requirement and defines several specific prohibited data practices, but it does not broadly prohibit providers from acting in ways that could harm individuals. Some have also raised concerns over the ADPPA’s preemption provisions. The Attorney General of California sent Congress a letter co-signed by nine other state attorneys general criticizing the ADPPA because it would set a “ceiling” for privacy rights rather than a “floor.” These state attorneys general argue that states should be allowed to adopt their own privacy laws so they can “legislate responsively” to changes in technology and practices. In the Commerce Committee’s July 20 markup of the ADPPA, some Members expressed similar concerns over the ADPPA’s preemption of state law. Other Members and commentators have pushed back on these criticisms, pointing to the strengths of the ADPPA’s protections and the importance of setting a federal standard.","On July 20, 2022, the House Energy and Commerce Committee voted 53-2 to advance the American Data Privacy and Protection Act (ADPPA), H.R. 8152, to the full House of Representatives. The ADPPA would create a comprehensive federal consumer privacy framework. Some commentators have noted the bill’s novel compromises on two issues that have impeded previous attempts to create a national privacy framework: whether to preempt state privacy laws and whether to create a private right of action. The bipartisan bill is co-sponsored by House Energy and Commerce Committee Chairman Frank Pallone, Jr. and Ranking Member Cathy McMorris Rogers, and is promoted in the Senate by Commerce Committee Ranking Member Roger Wicker. In a joint statement, Representatives Pallone and McMorris Rodgers and Senator Wicker described the bill as “strik[ing] a meaningful balance” on key issues. Senate Commerce Committee Chair Maria Cantwell has critiqued the ADPPA as having “major enforcement holes,” prompting other commentators to question whether the Senate will pass the bill. This Sidebar first provides a summary of the version of the ADPPA ordered to be reported by the House Commerce Committee on July 20. It then compares several of the bill’s key provisions to other privacy bills from the 117th and 116th Congresses before examining some considerations for Congress. Summary of the Bill The ADPPA would govern how companies across different industries treat consumer data. While not an exhaustive summary, some key facets of the bill are as follows:  Covered Entities. The bill would apply to most entities, including nonprofits and common carriers. Some entities, such as those defined as large data holders that meet certain thresholds and service providers that use data on behalf of other entities (including covered entities, government entities, and other service providers), would face different or additional requirements.  Covered Data. The bill would apply to information that “identifies or is linked or reasonably linkable” to an individual.  Duties of Loyalty. The bill would prohibit covered entities from collecting, using, or transferring covered data beyond what is reasonably necessary and proportionate to provide a service requested by the individual, unless the collection, use, or disclosure would fall under one of seventeen permissible purposes. It also would create special protections for certain types of sensitive covered data, defined as sixteen different categories of data. Among other things, the bill would require covered entities to get a consumer’s affirmative, express consent before transferring their sensitive covered data to a third party, unless a specific exception applies.  Transparency. The bill would require covered entities to disclose, among other things, the type of data they collect, what they use it for, how long they retain it, and whether they make the data accessible to the People’s Republic of China, Russia, Iran, or North Korea.  Consumer Control and Consent. The bill would give consumers various rights over covered data, including the right to access, correct, and delete their data held by a particular covered entity. It would further require covered entities to give consumers an opportunity to object before the entity transfers their data to a third party or targets advertising toward them.  Youth Protections. The bill would create additional data protections for individuals under age 17, including a prohibition on targeted advertising, and it would establish a Youth Privacy and Marketing Division at the Federal Trade Commission (FTC). These additional protections would only apply when the covered entity knows the individual in question is under age 17, though certain social media companies or large data holders would be deemed to “know” an individual’s age in more circumstances.  Third-Party Collecting Entities. The bill would create specific obligations for third-party collecting entities, which are entities whose main source of revenue comes from processing or transferring data that they do not directly collect from consumers (e.g., data brokers). These entities would have to comply with FTC auditing regulations and, if they collect data above the threshold amount of individuals or devices, would have to register with the FTC. The FTC would establish a searchable registry of third-party collecting entities and a “Do Not Collect” mechanism by which individuals could request that all registered entities refrain from collecting covered data relating to the individual. The ADPPA has bipartisan support, and various interest groups and commentators, such as the Electronic Privacy Information Center, the Center for Democracy & Technology, and the Washington Post’s editorial board, have expressed enthusiasm for the bill. In an August 25 letter to House Speaker Nancy Pelosi, forty-eight different public interest groups urged Congress to move the ADPPA forward through Congress, stating that the bill is a “meaningful compromise” and that a failure to act may “forestall progress on this issue for years to come.” At the same time, some Members of Congress and other commentators have raised concerns with the bill. Senators Cantwell and Schatz, for example, have both criticized the bill’s failure to impose a “duty of loyalty” on covered entities. While the ADPPA has various requirements that are classified under a “Duty of Loyalty” heading, these requirements differ from those included in COPRA or the Data Care Act. COPRA’s “duty of loyalty” would prohibit businesses from engaging in “harmful” data practices, which the bill defines to mean using covered data “in a manner that causes or is likely to cause” injury to the subject of the covered data. The Data Care Act’s “duty of loyalty” would prohibit covered providers from using data in a way that would “benefit the [provider] to the detriment of the end user” and would “result in reasonably foreseeable and material physical harm” or “be unexpected and highly offensive” to the end user. The ADPPA’s “Duty of Loyalty” imposes a data minimization requirement and defines several specific prohibited data practices, but it does not broadly prohibit providers from acting in ways that could harm individuals. Some have also raised concerns over the ADPPA’s preemption provisions. The Attorney General of California sent Congress a letter co-signed by nine other state attorneys general criticizing the ADPPA because it would set a “ceiling” for privacy rights rather than a “floor.” These state attorneys general argue that states should be allowed to adopt their own privacy laws so they can “legislate responsively” to changes in technology and practices. In the Commerce Committee’s July 20 markup of the ADPPA, some Members expressed similar concerns over the ADPPA’s preemption of state law. Other Members and commentators have pushed back on these criticisms, pointing to the strengths of the ADPPA’s protections and the importance of setting a federal standard. Use only information from the provided text to answer questions. Do not use outside knowledge and do not answer based on common sense. If you can't determine the answer based on the provided text, you should say ""I can't find the answer to your question in the provided text."" In brief, what are 2-3 issues foreseen with this bill?",Legal,Find & Summarize,Text Transformation Answer the following question using only the information provided in the prompt. Do not use any external resources to formulate your answer.,What are the advantages of using Wi-Fi or cellular networks to send EEWs compared to FEMA communication pathways?,"According to the 2023 USGS National Seismic Hazard Model (NSHM), nearly 75% of the area of the conterminous United States, Alaska, and Hawaii could experience damaging earthquake shaking. According to the USGS, the congressionally requested NSHM update utilized the latest techniques and technologies and incorporated more data to identify nearly 500 additional faults in the United States. The USGS considers the NSHM an essential tool to help engineers and others mitigate the impact of earthquake hazards on people and property. The NSHM will benefit the USGS-led ShakeAlert, an earthquake early warning (EEW) system operating in California, Oregon, and Washington by providing more information about faults and potential shaking intensity. People and automated systems receive an EEW before potential strong ground shaking reaches their locations after detecting an earthquake. Upon receiving the alerts, people can protect themselves and automated systems can protect property from the impending shaking. EEW is among the most challenging types of emergency communications, in part because earthquakes cannot be predicted and occur suddenly. In addition, mass notification to high-risk areas must occur within seconds of earthquake detection to be effective. In 2021, EEWs sent via the Federal Emergency Management Agency (FEMA) communication pathways often did not arrive before intense shaking occurred. EEWs sent in 2021 via cell phone applications over Wi-Fi or cellular networks were typically faster, and most alerts arrived before intense shaking occurred. Congress may be interested in how to improve emergency communications, especially for mass notifications, using FEMA communication pathways or the First Responder Network so that alerts arrive before the shaking occurs.","System Instructions: Answer the following question using only the information provided in the context block. Do not use any external resources to formulate your answer. Question: What are the advantages of using Wi-Fi or cellular networks to send EEWs compared to FEMA communication pathways? Context Block: According to the 2023 USGS National Seismic Hazard Model (NSHM), nearly 75% of the area of the conterminous United States, Alaska, and Hawaii could experience damaging earthquake shaking. According to the USGS, the congressionally requested NSHM update utilized the latest techniques and technologies and incorporated more data to identify nearly 500 additional faults in the United States. The USGS considers the NSHM an essential tool to help engineers and others mitigate the impact of earthquake hazards on people and property. The NSHM will benefit the USGS-led ShakeAlert, an earthquake early warning (EEW) system operating in California, Oregon, and Washington by providing more information about faults and potential shaking intensity. People and automated systems receive an EEW before potential strong ground shaking reaches their locations after detecting an earthquake. Upon receiving the alerts, people can protect themselves and automated systems can protect property from the impending shaking. EEW is among the most challenging types of emergency communications, in part because earthquakes cannot be predicted and occur suddenly. In addition, mass notification to high-risk areas must occur within seconds of earthquake detection to be effective. In 2021, EEWs sent via the Federal Emergency Management Agency (FEMA) communication pathways often did not arrive before intense shaking occurred. EEWs sent in 2021 via cell phone applications over Wi-Fi or cellular networks were typically faster, and most alerts arrived before intense shaking occurred. Congress may be interested in how to improve emergency communications, especially for mass notifications, using FEMA communication pathways or the First Responder Network so that alerts arrive before the shaking occurs.",Internet/Technology,Fact Finding,Q&A "Please answer the following question in one sentence, using only information found in the text provided below: ",What factors can impact a person's target replacement rate for retirement? ,"The first issue is to define the concept of adequate saving, which is surprisingly controversial.3 For pur- poses of this paper, we define adequate saving as sufficient to provide a household with an expected standard of living in retirement that is commensurate with its standard of living during its working years. This definition has the advantage of conforming to people's ""common sense"" views of how they would like to live their lives. But it comes with an important caveat. Our definition focuses on expected retirement living standards rel- ative to pre-retirement living standards. Many things can go wrong between saving the right amount to maintain living standards on an expected basis and being able to maintain living standards in actuality. Individuals face numerous risks in preparing for retirement. Disability or layoffs may stop people from working as long as they had planned and hence reduce their ability to accumulate wealth. Assets may ac- crue less than the expected rate of return over time. A household may face disproportionate uninsured health care costs, including those associated with long-term care. People may face mental or physical de- clines that require expensive daily assistance. Household members may live longer than expected, which, while generally a good thing, has the side effect of generating higher saving needs to maintain pre-retire- ment living standards. Alternatively, a person may become widowed and thus lose important sources of income in retirement. Children may present unexpected financial burdens. Many of these concerns relate to adequate insurance (for example, against risks associated with disability, rate of return, inflation, health care costs, health status, lifespan, and children's circumstances) as op- posed to adequate saving, but the two issues are related and both are part of retirement preparation. So- cial Security, of course, is intended to cover only a portion of adequate retirement income, not all of it. In the absence of well-functioning insurance markets, people will to some extent need to save more in order to partially self-insure and be in a position to mitigate the negative consequences of adverse outcomes. A definition of adequate saving that allows people to self-insure against all risks is probably an exces- sively high standard for all but the super-rich. But the distinction between saving enough to maintain ex- pected living standards in retirement and saving enough to insure against all risks helps explain why there are different standards for ""adequate saving."" One approach to measuring whether people are saving adequately is to compare their wealth accumula- tion behavior to that implied by an economic model that prescribes that people save optimally.4 The standard economic approach is to equate the household's discounted marginal utility of consumption in 3 For a recent review of the literature on the adequacy of retirement saving, see Mackenzie (forthcoming). 4 Engen, Gale, and Uccello (1999); Gale, Scholz, and Seshadri (2009); Scholz, Seshadri, and Khitatrakun (2006). 5 each period. This approach has the advantage of being fully consistent with economic theory, but it is not always easy for people to translate this approach into practical advice, or to see where their preparations land them relative to the benchmark. And the results are sensitive to model specification, especially in the presence of major changes, such as those that occur in family size, marital status, or work status.5 A more common, intuitive, and flexible approach focuses on replacement rates. A replacement rate is a ratio of post-retirement income to pre-retirement income. The target replacement rate that a household should aim for is one that will allow it to replicate its pre-retirement living standards in retirement. It is essential to emphasize that 100 percent is not a natural benchmark for an adequate replacement. The typ- ical advice of financial planners is to target a replacement rate of between 70 and 85 percent and some evidence suggests this is consistent with optimal models of saving.6 Table 1 provides an extremely stylized example of how target replacement ratios in this range might come about. Suppose a worker earns $100 in gross wages, and has $62 remaining after work expenses, mort- gage costs, retirement saving contributions, health insurance premiums, payroll taxes, and federal and state income taxes. Suppose the worker reaches age 65, pays off the mortgage, and retires. The payments for work expenses, the mortgage, 401(k) contributions, payroll taxes, and health insurance stop (the last because the worker becomes eligible for Medicare) and let's say taxes fall by one-third (because income declines and because there are currently benefits in the tax code for the elderly). That means the worker would only need $70 per year in retirement to replace the living standard that $100 provided during working years, or a 70 percent replacement rate. This stylized example serves to show that adequate retirement income need not replace 100 percent of pre-retirement income and that there may be a sizable difference between saving enough and saving ""a lot."" For example, in the scenario above, if Social Security and a defined benefit plan replaced two-thirds of the worker's wages in retirement, very little additional saving would be required to maintain pre-retire- ment living standards in retirement. Several qualifications are crucial. First, it is not clear what the ""right"" pre-retirement wage should be for purposes of the calculation. Oft-used measures include final earnings, an average of the highest three or five years of earnings, or average lifetime earnings. Empirical measures of the target replacement rate are sensitive to which measure is used as the denominator. Second, different households will have different target replacement rates. Factors such as the presence of children during working years or increased health needs during retirement years will influence how much spending is needed in retirement to main- tain pre-retirement living standards. The target replacement rate would be higher to the extent that pre- retirement expenses on mortgages, health insurance, retirement contributions, and taxes were lower, or to the extent that post-retirement health care needs or bequest motives were stronger. Third, different 5 Dushi et al. (2016). 6 Scholz and Seshadri (2009); Engen, Gale, and Uccello (1999). 6 households may want to include varying measures of assets as sources of available retirement income. Some might want to tap housing equity, while others may choose not to do so. For all of these reasons, the replacement rate needed to maintain pre-retirement living standards in retirement will vary across house- holds. ","Please answer the following question in one sentence, using only information found in the text provided below: What factors can impact a person's target replacement rate for retirement? The first issue is to define the concept of adequate saving, which is surprisingly controversial.3 For pur- poses of this paper, we define adequate saving as sufficient to provide a household with an expected standard of living in retirement that is commensurate with its standard of living during its working years. This definition has the advantage of conforming to people's ""common sense"" views of how they would like to live their lives. But it comes with an important caveat. Our definition focuses on expected retirement living standards rel- ative to pre-retirement living standards. Many things can go wrong between saving the right amount to maintain living standards on an expected basis and being able to maintain living standards in actuality. Individuals face numerous risks in preparing for retirement. Disability or layoffs may stop people from working as long as they had planned and hence reduce their ability to accumulate wealth. Assets may ac- crue less than the expected rate of return over time. A household may face disproportionate uninsured health care costs, including those associated with long-term care. People may face mental or physical de- clines that require expensive daily assistance. Household members may live longer than expected, which, while generally a good thing, has the side effect of generating higher saving needs to maintain pre-retire- ment living standards. Alternatively, a person may become widowed and thus lose important sources of income in retirement. Children may present unexpected financial burdens. Many of these concerns relate to adequate insurance (for example, against risks associated with disability, rate of return, inflation, health care costs, health status, lifespan, and children's circumstances) as op- posed to adequate saving, but the two issues are related and both are part of retirement preparation. So- cial Security, of course, is intended to cover only a portion of adequate retirement income, not all of it. In the absence of well-functioning insurance markets, people will to some extent need to save more in order to partially self-insure and be in a position to mitigate the negative consequences of adverse outcomes. A definition of adequate saving that allows people to self-insure against all risks is probably an exces- sively high standard for all but the super-rich. But the distinction between saving enough to maintain ex- pected living standards in retirement and saving enough to insure against all risks helps explain why there are different standards for ""adequate saving."" One approach to measuring whether people are saving adequately is to compare their wealth accumula- tion behavior to that implied by an economic model that prescribes that people save optimally.4 The standard economic approach is to equate the household's discounted marginal utility of consumption in 3 For a recent review of the literature on the adequacy of retirement saving, see Mackenzie (forthcoming). 4 Engen, Gale, and Uccello (1999); Gale, Scholz, and Seshadri (2009); Scholz, Seshadri, and Khitatrakun (2006). 5 each period. This approach has the advantage of being fully consistent with economic theory, but it is not always easy for people to translate this approach into practical advice, or to see where their preparations land them relative to the benchmark. And the results are sensitive to model specification, especially in the presence of major changes, such as those that occur in family size, marital status, or work status.5 A more common, intuitive, and flexible approach focuses on replacement rates. A replacement rate is a ratio of post-retirement income to pre-retirement income. The target replacement rate that a household should aim for is one that will allow it to replicate its pre-retirement living standards in retirement. It is essential to emphasize that 100 percent is not a natural benchmark for an adequate replacement. The typ- ical advice of financial planners is to target a replacement rate of between 70 and 85 percent and some evidence suggests this is consistent with optimal models of saving.6 Table 1 provides an extremely stylized example of how target replacement ratios in this range might come about. Suppose a worker earns $100 in gross wages, and has $62 remaining after work expenses, mort- gage costs, retirement saving contributions, health insurance premiums, payroll taxes, and federal and state income taxes. Suppose the worker reaches age 65, pays off the mortgage, and retires. The payments for work expenses, the mortgage, 401(k) contributions, payroll taxes, and health insurance stop (the last because the worker becomes eligible for Medicare) and let's say taxes fall by one-third (because income declines and because there are currently benefits in the tax code for the elderly). That means the worker would only need $70 per year in retirement to replace the living standard that $100 provided during working years, or a 70 percent replacement rate. This stylized example serves to show that adequate retirement income need not replace 100 percent of pre-retirement income and that there may be a sizable difference between saving enough and saving ""a lot."" For example, in the scenario above, if Social Security and a defined benefit plan replaced two-thirds of the worker's wages in retirement, very little additional saving would be required to maintain pre-retire- ment living standards in retirement. Several qualifications are crucial. First, it is not clear what the ""right"" pre-retirement wage should be for purposes of the calculation. Oft-used measures include final earnings, an average of the highest three or five years of earnings, or average lifetime earnings. Empirical measures of the target replacement rate are sensitive to which measure is used as the denominator. Second, different households will have different target replacement rates. Factors such as the presence of children during working years or increased health needs during retirement years will influence how much spending is needed in retirement to main- tain pre-retirement living standards. The target replacement rate would be higher to the extent that pre- retirement expenses on mortgages, health insurance, retirement contributions, and taxes were lower, or to the extent that post-retirement health care needs or bequest motives were stronger. Third, different 5 Dushi et al. (2016). 6 Scholz and Seshadri (2009); Engen, Gale, and Uccello (1999). 6 households may want to include varying measures of assets as sources of available retirement income. Some might want to tap housing equity, while others may choose not to do so. For all of these reasons, the replacement rate needed to maintain pre-retirement living standards in retirement will vary across house- holds. ",Financial,Find & Summarize,Text Transformation "Using only the provided text, answer all following questions and follow all guidelines that are explicitly given. ","What is the meaning of ""forward-looking statements,"" what terms are listed as examples, and why should the reader be made aware of these kinds of statements according to the text?","JOANN Receives Court Approval for Prepackaged Financial Recapitalization Plan Apr 25, 2024 Expects to Emerge from Court-Supervised Process in the Coming Days with the Lowest Level of Debt in More than a Decade HUDSON, Ohio, April 25, 2024 (GLOBE NEWSWIRE) -- JOANN Inc. (“JOANN” or the “Company”), the nation’s category leader in sewing and fabrics with one of the largest arts and crafts offerings, today announced that the U.S. Bankruptcy Court for the District of Delaware has confirmed the Company’s Prepackaged Joint Plan of Reorganization. JOANN expects to successfully complete its financial restructuring and emerge from the court supervised process in the coming days. As reiterated throughout this expedited process, the Company’s more than 800 store locations remain open and JOANN.com continues to offer supplies for any creative need, and the Company was able to preserve the jobs of its more than 18,000 Team Members in connection with this process. About JOANN For 80 years, JOANN has inspired creativity in the hearts, hands, and minds of its customers. From a single storefront in Cleveland, Ohio, the nation’s category leader in sewing and fabrics and one of the fastest growing competitors in the arts and crafts industry has grown to include 829 store locations across 49 states and a robust e-commerce business. With the goal of helping every customer find their creative Happy Place, JOANN serves as a convenient single source for all of the supplies, guidance, and inspiration needed to achieve any project or passion. Forward-Looking Statements This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. The Company intends such forward-looking statements to be covered by the safe harbor provisions for forward-looking statements contained in Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Readers can generally identify forward-looking statements by the use of forward-looking terminology such as “anticipate,” “believe,” “continue,” “could,” “estimate,” “expect,” “intend,” “may,” “might,” “plan,” “potential,” “predict,” “seek,” “vision,” “should,” or the negative thereof or other variations thereon or comparable terminology. Forward-looking statements include those we make regarding the Company’s ability to continuing operating its business and implement the restructuring pursuant to the Chapter 11 cases, including the timetable of completing such transactions, if at all. The preceding list is not intended to be an exhaustive list of all of the Company’s forward-looking statements. The Company has based these forward-looking statements on its current expectations, assumptions, estimates and projections. While the Company believes these expectations, assumptions, estimates and projections are reasonable, such forward-looking statements are only predictions and involve known and unknown risks and uncertainties, many of which are beyond the Company’s control. Given these risks and uncertainties, readers are cautioned not to place undue reliance on such forward-looking statements. The forward-looking statements included elsewhere in this press release are not guarantees. Any forward-looking statement that the Company makes in this press release speaks only as of the date of such statement. Except as required by law, the Company does not undertake any obligation to update or revise, or to publicly announce any update or revision to, any of the forward-looking statements, whether as a result of new information, future events or otherwise after the date of this press release.","Using only the provided text, answer all following questions and follow all guidelines that are explicitly given. What is the meaning of ""forward-looking statements,"" what terms are listed as examples, and why should the reader be made aware of these kinds of statements according to the text? JOANN Receives Court Approval for Prepackaged Financial Recapitalization Plan Apr 25, 2024 Expects to Emerge from Court-Supervised Process in the Coming Days with the Lowest Level of Debt in More than a Decade HUDSON, Ohio, April 25, 2024 (GLOBE NEWSWIRE) -- JOANN Inc. (“JOANN” or the “Company”), the nation’s category leader in sewing and fabrics with one of the largest arts and crafts offerings, today announced that the U.S. Bankruptcy Court for the District of Delaware has confirmed the Company’s Prepackaged Joint Plan of Reorganization. JOANN expects to successfully complete its financial restructuring and emerge from the court supervised process in the coming days. As reiterated throughout this expedited process, the Company’s more than 800 store locations remain open and JOANN.com continues to offer supplies for any creative need, and the Company was able to preserve the jobs of its more than 18,000 Team Members in connection with this process. About JOANN For 80 years, JOANN has inspired creativity in the hearts, hands, and minds of its customers. From a single storefront in Cleveland, Ohio, the nation’s category leader in sewing and fabrics and one of the fastest growing competitors in the arts and crafts industry has grown to include 829 store locations across 49 states and a robust e-commerce business. With the goal of helping every customer find their creative Happy Place, JOANN serves as a convenient single source for all of the supplies, guidance, and inspiration needed to achieve any project or passion. Forward-Looking Statements This press release contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. The Company intends such forward-looking statements to be covered by the safe harbor provisions for forward-looking statements contained in Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended. Readers can generally identify forward-looking statements by the use of forward-looking terminology such as “anticipate,” “believe,” “continue,” “could,” “estimate,” “expect,” “intend,” “may,” “might,” “plan,” “potential,” “predict,” “seek,” “vision,” “should,” or the negative thereof or other variations thereon or comparable terminology. Forward-looking statements include those we make regarding the Company’s ability to continuing operating its business and implement the restructuring pursuant to the Chapter 11 cases, including the timetable of completing such transactions, if at all. The preceding list is not intended to be an exhaustive list of all of the Company’s forward-looking statements. The Company has based these forward-looking statements on its current expectations, assumptions, estimates and projections. While the Company believes these expectations, assumptions, estimates and projections are reasonable, such forward-looking statements are only predictions and involve known and unknown risks and uncertainties, many of which are beyond the Company’s control. Given these risks and uncertainties, readers are cautioned not to place undue reliance on such forward-looking statements. The forward-looking statements included elsewhere in this press release are not guarantees. Any forward-looking statement that the Company makes in this press release speaks only as of the date of such statement. Except as required by law, the Company does not undertake any obligation to update or revise, or to publicly announce any update or revision to, any of the forward-looking statements, whether as a result of new information, future events or otherwise after the date of this press release.",Legal,Explanation/Definition,Q&A "Provide your response in a professional and formal tone. Use the information given in the document without referring to external sources or requiring additional context. Avoid using technical jargon or acronyms that are not explained within the document.",What are all of the different landline features available on the 5ESS Class 5 electronic switching system?,"CentraNet CustoPAK ® ® USER GUI DE Telephone Number Verizon Telephone Number Switch Type:  GTD-5  5ESS  DMS 100  DMS 10 © 2002 Verizon Communications www.verizon.com/smallbiz Downloaded from www.Manualslib.com manuals search engine 3056-0402Thank You for Selecting Verizon CentraNet ® CustoPAK® Service. 1 Downloaded from www.Manualslib.com manuals search engineTable of Contents Introduction to This Guide.............................................................................. 4 Overview of Your CustoPAK System ............................................................... 6 Terms You Should Know................................................................................ 8 CustoPAK Basic Features ✓ Assume Dial “9” .................................................................................. 9 ❑ ✓ ❑ Call Hold ............................................................................................. 10 ✓ Call Transfer ........................................................................................ 11 ❑ ✓ Consultation Hold ................................................................................ 12 ❑ ✓ Direct Inward/Outward Dialing (DID/DOD).............................................. 13 ❑ ✓ Distinctive Ringing (Inside/Outside Ringing) ......................................... 13 ❑ ✓ Intercom ............................................................................................. 14 ❑ ✓ Three-Way Calling ............................................................................... 15 ❑ ✓ Touch-Tone ......................................................................................... 16 ❑ CustoPAK Selectable Features ❑ Automatic Callback .............................................................................. 18 ❑ Call Forwarding Options ....................................................................... 19 ❑ Call Forwarding ................................................................................... 20 ❑ Call Forwarding – Busy Line................................................................. 22 ❑ Call Forwarding – Don’t Answer ........................................................... 23 ❑ Call Pick-Up – Group ........................................................................... 24 ❑ Call Restriction Options ........................................................................ 25 ❑ Call Waiting ....................................................................................... 26 ❑ Cancel Call Waiting (Tone Block) ......................................................... 27 ❑ Dial Call Waiting (for Intercom dialing)................................................... 28 ❑ Hunting ............................................................................................. 29 ❑ Speed Dialing .................................................................................... 30 2 Downloaded from www.Manualslib.com manuals search engine CustoPAK Optional Features ❑ 69 .................................................................................................. 32 ❑ Busy Redial ....................................................................................... 33 ❑ Call Block ( 60)................................................................................. 34 ❑ Call Park ........................................................................................... 35 ❑ Call Park – Directed .......................................................................... 36 ❑ Call Trace .......................................................................................... 37 ❑ Caller ID ........................................................................................... 38 ❑ Caller ID – Number Only .................................................................... 39 ❑ Enhanced Call Forwarding .................................................................. 40 ❑ Executive Busy Override ..................................................................... 41 ❑ Last Number Redial ........................................................................... 41 ❑ Priority Call........................................................................................ 42 ❑ Select Call Forwarding ....................................................................... 43 Voice Mail and CustoPAK ............................................................................ 44 * * Appendix.................................................................................................... 45 Intercom Code Charts............................................................................. 46 Speed Dialing Code Charts ..................................................................... 49 CustoPAK Feature Activation/Deactivation Codes ...................................... 52 Feature Availability by Switch Type .......................................................... 53 Your CustoPAK Feature Selections........................................................... 54 Please be sure to read the Introduction and Overview sections of this guide prior to operating your new CustoPAK system. 3Introduction to This Guide This guide is intended to provide you with information to help you learn to operate the features within your new CustoPAK system and get the most out of its many benefits. Before you begin using your new CustoPAK system, it is important to know your switch type, or the type of equipment in the Verizon central office that handles your telephone service. Your switch type is shown on the front cover of this guide and may affect which features are available with your CustoPAK system. Basic Features are automatically activated for each of your lines when you purchase your CustoPAK system.Upon installation of your system, your Verizon representative will assist you in filling out your Feature Grid (see Appendix). Once complete, this grid indicates which features you have selected for each of your CustoPAK lines. The Appendix section also contains your Intercom and Speed Calling code charts. You may wish to make copies of these handy tools and distribute them to other users in your CustoPAK system for easy reference. Selectable Features are available for each of your CustoPAK lines at no additional monthly charge, but must be installed to be used.1The Overview section which follows this Introduction will begin to acquaint you with your new CustoPAK system and the many benefits it provides. Optional Features are available at an additional charge per line and must also be installed to be used.1We are delighted that you have chosen Verizon. We hope this guide makes the transition to your new CustoPAK system as smooth as possible. The Features section of this guide describes the three types of features which are available to choose from: You may select as many or as few of the Selectable and Optional features as you like for each of your CustoPAK lines, and may change them at any time. Should you need assistance selecting additional features or changing features, your Verizon representative is available to guide you. All features available with CustoPAK are included in this guide regardless of whether you have selected them for your system. 1 To install these features, contact your Verizon representative. Installation charges may apply. 4 Downloaded from www.Manualslib.com manuals search engine For Customer Services, call 1-800 -483-5000 In Hawaii, call 643-4411 5Overview of Your CustoPAK System Your CustoPAK system is a central office-based service, meaning all equipment required to operate the system is in the Verizon central office. That also means you have purchased a reliable, worry-free telephone system, as our central offices are monitored 24 hours a day, 365 days a year. Your CustoPAK system can grow as your business grows. It has the capacity to handle up to 30 telephone lines, and offers a flexible package of features designed specifically with the small business customer in mind. You can select which features you want for each of your CustoPAK lines based on your business and communications needs. You may add or change features at any time by contacting your Verizon representative (additional charges may apply). CustoPAK can be customized to perform as a complete telephone system working on standard single-line telephones or as feature-rich access lines enhancing your existing telephone system. When used with existing telephone systems, features like Call Transfer, Three-Way Calling and Consultation Hold give you the functionality of a built-in second line. When using these features, other lines remain free for incoming or outgoing calls. And, Call Forwarding and Call Transfer allow you to easily transfer your calls to another location outside your system without additional equipment. Most of the features are activated by the use of codes. You’ll find all of the information required to activate the CustoPAK features listed in the Features section of this guide. Your CustoPAK system comes with a 30-day satisfaction guarantee (except California). We are confident that this system is the right solution for your business needs. However, with this guarantee you are entitled to a full credit of the CustoPAK charges and a change back to your previous Verizon service if you are not satisfied and notify us within 30 calendar days. Repair The Repair Center handles service problems and out-of-service conditions on your telephone lines and/or features, and the wiring to your location. It does not handle and cannot fix your telephone equipment. For problems with the wiring inside your business, you may repair it yourself, hire a contractor or an electrician, or call Verizon. Verizon does this type of repair for a fee based on the amount of time and the cost of the materials required to correct the problem. For information on these services, contact your Verizon representative. The Verizon repair number is 1-800-483-2000. The Repair Center is open 24 hours a day, including holidays. Help Desk The CentraNet/Voice Mail Help Desk was established to answer your questions about the operation of your CentraNet CustoPAK and Voice Mail services. Our Help Desk will explain how the services and features operate, e.g., How do I transfer a call? How do I reset my Passcode? If you have questions about your CentraNet CustoPAK service, please call the Help Desk at 1-800 - 483 -2000. The Help Desk is available Monday-Friday between the hours of 5 a.m.-7 p.m. and Saturday between the hours of 7 a.m.- 4 p.m. Pacific Time. The Help Desk is closed on Sunday. IMPORTANT INFORMATION: Verizon is in the process of updating all our central office switches to provide access to Per Call Blocking. This feature allows you to prevent the appearance of your phone number on Caller ID display units on a per call basis. Press * 6 Downloaded from www.Manualslib.com manuals search engine 6 7 before placing an outgoing call to activate this feature. 7Terms You Should KnowCustoPAK Basic Features Confirmation Tone Three short bursts of tone heard when using some CustoPAK features. The confirmation tone lets you know you have completed the activation or deactivation of the features.The features listed in this section are automatically included on each of your CustoPAK lines. These basic features are the backbone of your new CustoPAK system. Three of these features, Consultation Hold, Call Transfer and Three-Way Calling provide you with the functionality of a built-in second line. Regional Calling Area The area within which Verizon can provide local and regional toll calling services. Switch Type This term identifies the types of equipment in Verizon’s central office that handles your telephone service. Your switch type is shown on the front cover of this guide. It is very important to be aware of your switch type, as it may affect which features are available with your CustoPAK system. Assume Dial “9” This convenient feature allows you to place calls outside of the CustoPAK system without having to dial the access code “9”. NOTE: Verizon has automatically activated this feature. You cannot activate or deactivate the feature as you choose. Switchhook The buttons or bar generally located under the receiver on a standard desk telephone or electronic set. The switchhook initiates dial tone and is used to operate some of the CustoPAK features. Tap Flash Recall Link These terms refer to preprogrammed buttons on some telephones, that when used replace the switchhook. If your telephone is equipped with one of these buttons, always use it instead of the switchhook to operate the CustoPAK features. 8 Downloaded from www.Manualslib.com manuals search engine 9Call HoldNOTES: Call Hold allows you to place an established call on hold for an extended period of time—provided neither you nor the other person hangs up—freeing up the line to place or receive another call. Use Call Hold to help improve response time while reducing equipment costs and callbacks.1.) Only one call can be placed on hold at a time per telephone line. 2.) A holding call cannot be added to another call. 3.) Call Hold overrides Dial Call Waiting and Call Waiting. When you put a call on hold to use the line to make or receive a second call, a third incoming call will receive a busy signal. To place an established call on hold: Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Call Transfer Listen for dial tone.Press *You will hear confirmation tone, followed by dial tone.This valuable feature enables you to transfer an incoming call to any other number either inside or outside of your CustoPAK system. You can privately speak with the called party to announce the call prior to completing the transfer. Use Call Transfer as an efficient way to process misdirected calls and reduce message-taking and call handling time. The call is on hold. Place the handset beside the telephone—do not hang up!To transfer an incoming call: 0 1 . To place another call, while the first caller is on hold:Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Listen for dial tone. To transfer to an internal CustoPAK line, dial the intercom code assigned to the internal line. To transfer to an outside line dial the number to which you wish to transfer the call. Privately announce the transfer to the recipient. Hang up.  Key in destination phone number of the third party. Wait for the party to answer. If you encounter a busy signal, no answer or if an error is made in dialing, press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set) twice to connect to the original party. When party answers you may consult privately. To return to a call that is on hold: Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Listen for confirmation tone. Press * 0 1 (you may now talk to the person that was on hold). -OR- Hang up (your phone will ring). Lift the handset (you may now talk to the party that was on hold). 10 Downloaded from www.Manualslib.com manuals search engine -OR-  Hang up (the call is automatically transferred). NOTES: 1.) If you receive a busy signal, no answer or if an error is made in dialing, press the switchhook twice to reconnect to the original call. 2.) You cannot transfer a call while on a Three-Way or Call Waiting call. 3.) A call placed from a CustoPAK line to a number outside the system cannot be transferred to another number outside the system. 4.) Call Transfer may generate local, regional toll or long distance charges. 11Consultation HoldDirect Inward/Outward Dialing (DID/DOD) Consultation Hold provides a temporary or “soft” hold without having to dial an activation code. This allows you to place another call for private consultation or to initiate a three-way call. Use Consultation Hold to quickly verify customer inquiries and reduce costly and time-consuming callbacks.Direct Inward Dialing allows you to receive incoming calls directly at your station. This can help enhance customer service by allowing incoming callers to quickly reach you without the delay of a call transfer. Direct Outward Dialing improves efficiency by enabling you to place calls to locations outside the system without first dialing an access code or going through a central attendant. To place a call on hold: Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Listen for dial tone. Dial the third party (if you encounter a busy signal, no answer or if an error is made in dialing, press the switchhook twice to reconnect to the original call). When the third party answers, you may consult privately before reconnecting to the original call. To return to the original caller: Allow the third party to hang up. Press the switchhook twice (if the switchhook is only pressed once, a three-way call will be established). NOTES: 1.) Consultation Hold overrides Dial Call Waiting and Call Waiting. When you put a call on hold to use the line to place a second call, a third incoming call will receive a busy signal. 2.) Call Forwarding cannot be activated while a call is on Consultation Hold. 12 Downloaded from www.Manualslib.com manuals search engine NOTE: Verizon has automatically activated this feature. You cannot activate or deactivate the feature as you choose. Distinctive Ringing (Inside/Outside Ringing) CustoPAK Distinctive Ringing provides you with the ability to distinguish between internal and external incoming calls, allowing you to greet customers and callers from outside of your system more professionally. Internal calls—calls placed by someone within the CustoPAK system using the Intercom feature—will ring with a single ring. External calls—calls made from outside of the CustoPAK system— are identified by a double ring. This feature is not available in the GTD-5 switch. NOTES: 1.) Many telephone sets have their own distinctive ringing patterns that are not associated with CustoPAK Distinctive Ringing. 2.) Priority Call and Distinctive Ringing cannot be on the same CustoPAK line, since they share the same ring patterns. 3.) On forwarded calls, the ring pattern will be based on the original line, not the forwarding line. 4.) On transferred calls, the ring pattern will be based on the transferring line, not the original line. 5.) Verizon has automatically activated this feature. You cannot activate or deactivate the feature as you choose. 13IntercomThree-Way Calling The Intercom feature allows you to speak to, or transfer a call to, any other person within your CustoPAK system—without incurring local usage charges. Simply dial the two-digit code that was assigned to the line. See the Appendix on page 45 of this guide to locate the Intercom Code Chart for your switch type. The intercom codes are pre-assigned and programmed by Verizon.Three-Way Calling enables you to add a third party from either inside or outside of your CustoPAK system to any established call to create a three-way conference arrangement. This maximizes line efficiency and reduces costly and time-consuming callbacks by allowing you to obtain answers to urgent inquiries from two separate sources in a single call — reducing the costs and lost productivity of multiple telephone calls. To use the Intercom feature: Pick up the handset and listen for dial tone. Dial the intercom code: 20#– 49 #2–#for DMS 10 switch types. 7 # for 5ESS, GTD-5 and DMS 100 switch types. NOTE: For the Intercom feature to function properly, individual telephone numbers must be assigned to a Multi-Line Hunt group. While engaged in a two-way conversation: Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Listen for dial tone. Dial the number of the party you wish to add to the call (if you encounter a busy signal, no answer or an error is made in dialing, press the switchhook twice or hang up to reconnect to the original call). Announce that you are setting up a conference call. Press the switchhook again (the three-way conference is established). NOTES: 1.) You may use Three-Way Calling to add another person no matter who placed the original call. However, if you placed both calls and they are outside of your CustoPAK system, when you hang up the other two people will automatically disconnect. 2.) Three-Way Calling may generate local, regional toll or long distance charges. If you hang up, you will be billed the appropriate charges for the portion of the call for which you are responsible. 3.) You cannot establish a three-way call using the Automatic Callback feature. 4.) A three-way conference cannot be made between an established call and a Call Waiting call. 14 Downloaded from www.Manualslib.com manuals search engine 15Touch-Tone Touch-Tone provides the ability to push-button dial on tone-signaling telephones to access CustoPAK features and dial telephone numbers. Rotary dial telephones are not compatible with CustoPAK service. NOTE: Verizon has automatically activated this feature. You cannot activate or deactivate the feature as you choose. 16 Downloaded from www.Manualslib.com manuals search engine CustoPAK Selectable Features The features listed in this section are available for each of your CustoPAK lines at no additional monthly charge. You may select as many or as few of these features as you like, giving you the flexibility to customize each individual CustoPAK line in the manner which best suits your business. As you read through this sec- tion, be aware of your switch type (found on the front cover of this guide), since some features are not available for certain switch types. To add or change features at any time after your initial installation, contact your Verizon representative. 17Automatic CallbackCall Forwarding Options When you encounter a busy line within your CustoPAK system, a code can be dialed which will connect you when both lines are idle. The request will remain active for 30 minutes unless canceled. Use Automatic Callback to increase productivity by eliminating “telephone tag”, manual callbacks and unnecessary dialing. This feature only works within the CustoPAK system, and the system can only accommodate one request at a time per line. This feature is not available in the GTD-5 switch type.Your CustoPAK system can be equipped with one or all of its five Call Forwarding options. You may select or combine these features to meet your business needs. The Call Forwarding options and their descriptions can be found by referring to the list below: Option Section Page Call Forwarding ..................................... Selectable Features .................................. 20 To activate Automatic Callback once you’ve reached a busy line within your CustoPAK system:Call Forwarding – Busy Line ................. Selectable Features .................................. 22 Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set).Call Forwarding – Don’t Answer............ Selectable Features .................................. 23 Listen for dial tone.Press *Listen for confirmation tone.Hang up (when the called line is idle, your line will ring with a distinctive ring). 5 Enhanced Call Forwarding1 .................... Optional Features ..................................... 40 Select Call Forwarding1.......................... Optional Features ..................................... 43 2 . To cancel an Automatic Callback request: Lift handset and press Listen for confirmation tone. Hang up. # 5 2 . NOTES: 1.) If an Automatic Callback is not answered by the originating station, the request will be canceled. 2.) Automatic Callback can only be active on one station at a time. 3.) An Automatic Callback request can only be activated if the called number is in a busy condition and within the CustoPAK group. 1 18 Downloaded from www.Manualslib.com manuals search engine Additional charges apply. 19Call ForwardingNOTES: This Call Forwarding option allows you to have all incoming calls forwarded to a pre-determined telephone number either inside or outside the CustoPAK system. Call Forwarding provides you with the flexibility to choose your own forward-to number, to change it as often as you like and to turn the feature on or off as needed. When activated, it overrides Call Forwarding – Busy Line/ Don’t Answer and gives you the mobility you need to be productive outside the office and after hours.1.) Calls forwarded outside the system are subject to local, regional toll or long distance charges, as applicable. 2.) To confirm that Call Forwarding is on, press * 7 2 and if the feature is on you will hear a fast busy tone. If it is off you’ll hear normal dial tone. 3.) You can place calls when Call Forwarding is on, however, you cannot answer incoming calls. You will hear one short ring each time a call forwards to remind you that the service is on. 4.) Call Forwarding overrides Call Waiting, Dial Call Waiting, Hunting arrange- ments and Call Forwarding – Busy Line/Don’t Answer. 5.) Voice Mail service will not work when Call Forwarding is on, unless you have activated forwarding to the Voice Mail service access number. 6.) A line with Call Forwarding activated cannot have an Automatic Callback request initiated against it. To turn Call Forwarding on: Lift the handset and listen for dial tone. Press * At the tone, dial the telephone number you want your calls forwarded to. When the call is answered, the feature has been activated. If the call is not answered, hang up and repeat the above steps within two minutes. The feature is activated when you hear the confirmation tone. 7 2 . To turn Call Forwarding off:  Press * 7 3 (two short tones indicate that the service has been turned off). 20 Downloaded from www.Manualslib.com manuals search engine 21Call Forwarding – Busy LineCall Forwarding – Don’t Answer This feature automatically routes incoming calls to a pre-determined number (either inside or outside of your CustoPAK system) when your line is busy. Use Call Forwarding – Busy Line to improve customer service by forwarding calls to alternate answering points, ensuring that all incoming calls are covered. This feature can be separate on the line or can be combined with Call Forwarding – Don’t Answer. The forward-to number must be programmed by Verizon.This feature automatically routes incoming calls to a telephone number (either inside or outside of your CustoPAK system, or to Voice Messaging) when your line is unanswered after a pre-determined number of rings (4-ring maximum). Use Call Forwarding – Don’t Answer to improve customer service by forwarding calls to alternate answering points, ensuring that no opportunities are lost due to an unanswered call. This feature can be separate on the line or can be combined with Call Forwarding – Busy Line. The forward-to number must be programmed by Verizon. NOTES: 1.) Calls forwarded outside the system are subject to local, regional toll or long distance charges, as applicable. 2.) Call Forwarding – Busy Line overrides Dial Call Waiting (see page 29). Therefore, if you place a call to a number with Call Forwarding – Busy Line, the call is forwarded and the Dial Call Waiting treatment is not given during a busy condition. 3.) Call Forwarding overrides Call Forwarding – Busy Line. 4.) For Multi-Line Hunt groups, Call Forwarding – Busy Line can only be assigned on a group basis and will apply to every line in the group. 5.) Call Forwarding – Busy Line can only be assigned to the last member of a Series Hunt group. 6.) If you have Voice Messaging, it is not necessary to subscribe to this feature. 7.) Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose. 22 Downloaded from www.Manualslib.com manuals search engine NOTES: 1.) Calls forwarded outside the system are subject to local, regional toll or long distance charges, as applicable. 2.) Call Forwarding overrides Call Forwarding – Don’t Answer. 3.) Call Waiting and Dial Call Waiting override Call Forwarding – Don’t Answer. 4.) For Multi-Line Hunt groups, Call Forwarding – Don’t Answer can only be assigned on a group basis and will apply to every line in the group. 5.) If the forward-to number is busy, the call will not forward. The line will continue to ring, or you may get a busy signal, depending upon the location of the forward-to number. 6.) If you have Voice Messaging, it is not necessary to subscribe to this feature. 7.) Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose. 23Call Pick-Up – GroupCall Restriction Options Call Pick-Up – Group enables you to answer (pick-up) calls directed to any other line within your Call Pick-Up group by dialing a code. If more than one person tries to pick-up the call, the first user will receive the call, and the others will receive a busy signal as confirmation that the call was answered. Use Call Pick-Up – Group to provide maximum call coverage and ensure against missed calls.This feature enables you to select and control the incoming and outgoing calling capabilities of each of your CustoPAK lines. Each line can only be equipped with one Call Restriction option, which has been programmed by Verizon. To use Call Pick-Up – Group: Lift the handset and listen for dial tone. Press * 1 7 NOTE: Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose. If you want to add or update Call Restriction options, please contact your Verizon representative. (the incoming call is connected to your station). To use Call Pick-Up – Group when you are already on the phone: Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Listen for dial tone. Press * 0 1 to put the first call on hold. Press * 1 7 (the incoming call is connected to your station). NOTES: 1.) You cannot use Call Pick-Up – Group to connect to an Automatic Callback call. 2.) If more than one line in your Call Pick-Up group is ringing, you cannot select which line to answer. The system will automatically direct the pick-up to the call that came in first. 3.) All lines in a Multi-Line Hunt group must be in the same Call Pick-Up group. 24 Downloaded from www.Manualslib.com manuals search engine 25Call Waiting This valuable feature provides an audible tone while you are on the line that alerts you of another incoming call. You then have the option to either place the present call on hold to answer the incoming call or to disregard it. The calling party will receive ringing tone instead of a busy tone. Use Call Waiting to maximize line efficiency and improve customer service by ensuring prompt responses to urgent inquiries. Cancel Call Waiting (Tone Block) When you don’t want to be disturbed or interrupted during an important call, you can temporarily deactivate Call Waiting. You can activate Cancel Call Waiting before you place a call or at any point during the conversation. Cancel Call Waiting works only for the length of one call. When you hang up, Call Waiting returns automatically to your phone. To cancel the Call Waiting tone before placing a call: After hearing the Call Waiting tone: Lift the handset and listen for dial tone. Either end your first call or tell the person to whom you are speaking that you are going to put them on hold.Press * Press and release the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set) to put the first person on hold and answer the second call in the GTD-5 switch.Listen for confirmation tone, followed by normal dial tone. Dial the telephone number.   7 0 . To cancel the Call Waiting tone during a call: Press and release the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set), listen for the flash tone, then dial * 0 1 to put the first person on hold and answer the second call in the DMS 100, DMS 10 and 5ESS switches (may also be required for GTD-5 switch).Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Press * To return to the first call and put the second call on hold, repeat bullet two or three (depending on switch type). You can alternate between calls as often as desired by repeating bullets two or three (depending on switch type).NOTE: In some areas you can only activate Cancel Call Waiting before placing a call. 7 0 (you will reconnect automatically to your call). NOTES: 1.) Call Waiting allows you to have two calls on your line at the same time (one on hold and one to whom you are talking). A third caller will hear a busy signal. 2.) Call Waiting cannot be assigned to lines in a Multi-Line Hunt group. 3.) Call Waiting overrides Call Forwarding – Busy Line/Don’t Answer. 4.) Call Forwarding overrides Dial Call Waiting. 5.) Series Hunting overrides Call Waiting, which should be assigned to the last number of a Series Hunt group. 6.) A three-way conference cannot be made between an established call and a Call Waiting call. 7.) If Call Waiting and Call Forwarding – Don’t Answer are active on the same line and you choose to ignore the Call Waiting tone, the call will forward to your Call Forwarding – Don’t Answer number. 26 Downloaded from www.Manualslib.com manuals search engine 27Dial Call Waiting (for Intercom dialing)Hunting This feature allows you to send a Call Waiting tone to another line within your CustoPAK system when that line is busy, letting the called party know that some- one is trying to reach them. The called party then has the option to answer or ignore the Call Waiting tone. Use Dial Call Waiting to help ensure the timely and efficient flow of information within your business. This feature is not available for GTD-5 switch types.Hunting allows your business to reduce busy signals and increase accessibility by expanding call coverage. A Hunting arrangement begins with a call to a lead, or pilot number and searches for an idle line beginning with the first number of a pre-assigned Hunt group and ending with the last number in the group. Upon dialing an internal station number and hearing a busy tone: Hang up. Lift the handset and listen for dial tone. Press * Dial the number of the busy station (the called party hears a Call Waiting tone). Remain off-hook until the called party answers. 5 4 and listen for confirmation tone. NOTES: NOTES: 1.) When a Multi-Line Hunt group is assigned to a CustoPAK customer, individual telephone numbers must be assigned in order for the Intercom feature to work. 2.) Call Waiting cannot be assigned to lines in a Hunt group. 3.) Automatic Callback cannot be activated against lines in a Hunt group. 4.) Call Forwarding and Call Forwarding – Busy Line/Don’t Answer can only be assigned to a Multi-Line Hunt group on a group basis. 5.) All lines in a Multi-Line Hunt group must be in the same Call Pick-Up group. 6.) Caller ID will work in a Hunt group, however, the feature must be assigned to every line in the Hunt group. 7.) Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose. 1.) Dial Call Waiting only works within your CustoPAK system. 2.) Dial Call Waiting cannot be assigned to lines in a Multi-Line Hunt group. 3.) Dial Call Waiting overrides Call Forwarding – Busy Line/Don’t Answer. 4.) Call Forwarding overrides Dial Call Waiting. 5.) If Call Waiting and Call Forwarding – Don’t Answer are active on the same line and the called party chooses to ignore the Dial Call Waiting tone, the call will forward to the called party’s Call Forwarding – Don’t Answer number. 6 .) Series Hunting overrides Dial Call Waiting, which should be assigned to the last number of a Series Hunt group. 28 Downloaded from www.Manualslib.com manuals search engine 29Speed Dialing Speed Dialing allows you to call frequently dialed numbers by using an abbreviated code, reducing dialing time and time spent searching for telephone numbers. Speed Dialing gives you the flexibility to create and edit your own Speed Dialing list. The Speed Dialing short list consists of 8 numbers unless you have a 5ESS switch type, which provides a 6-number Speed Dialing list. CustoPAK Optional Features The following features are available for each of your CustoPAK lines at an additional monthly charge per line. As you read through this section, be aware of your switch type (found on the front cover of this guide), since some of these Optional features are not available for certain switch types. To add or change any of these features after your initial installation, contact your Verizon representative. To establish/add or change a number on your Speed Dialing list: Lift the handset and listen for dial tone. Press * 7 4 Press 1 (GTD-5 only, skip this step in all other switches). Press the Speed Dialing code numbers to be programmed (2-9 for all switches except 5ESS, press 2-7 for 5ESS). Dial the telephone number to be assigned to the code, along with any required access codes, ( i.e., long distance carrier access code) up to 28 digits. Listen for confirmation tone. Hang up. Repeat steps for each code number to be programmed. # and listen for confirmation tone. To place a Speed Call from the short list: Lift the handset and listen for dial tone. Press # 1 (all switches) and then dial the Speed Dialing code number (2-9 or 2-7 depending on what switch type you have). See page 50 for Speed Dialing code charts. Wait for party to answer. NOTES: 1.) OPTIONAL: After you press # 1 and the code number, press # again for a quicker connection. 2.) Service codes such as 911, cannot be programmed. 3.) Fully restricted lines cannot have Speed Dialing. 4.) Customers may experience a 2- to 3-second timing delay when activating Speed Dialing codes that match other feature activation codes. 30 Downloaded from www.Manualslib.com manuals search engine 31* 69Busy Redial This convenient feature automatically stores and allows you to redial the number of the last person who called you. *69 only works on calls made from numbers within your regional calling area and can be used whether you answered the last call or not. If you return the call and the number is busy, *69 will monitor the busy line and attempt to connect your call for up to 30 minutes, unless canceled. In most cases, your phone will ring with a series of short-short-long rings when the number you called is no longer busy. This feature is not available in the DMS 10 switch type.After reaching a busy line within your regional calling area, this convenient service allows you to dial a code that will automatically connect you when both lines are idle. Once activated, Busy Redial will monitor the busy line and attempt to connect your call for up to 30 minutes, unless canceled. You will be alerted with a special ring when the call is returned. You can use Busy Redial to help reduce multiple callbacks, dialing time and lost productivity. This feature is not available in the DMS 10 switch type. After dialing a busy number: To activate * 69: Hang up. Lift the handset and listen for dial tone.Lift the handset and listen for dial tone. Press *Press * 6 6 . You will hear two normal ringing tones or an announce- ment. If the called number is still busy, a voice recording will tell you that your call is next in line. Hang up. When the number you called is no longer busy, your telephone will ring with a series of short-short-long rings (ringing tones may vary). Lift the handset. You will hear normal ringing tone. 6 9 (a voice recording may provide additional instructions). To deactivate * 69: Lift the handset and listen for dial tone. Press * 8 9 . NOTES: 1.) If you hear the Call Waiting tone while you are on the line, you have two choices: you can use *69 to call back later, or you can use Call Waiting during the call. 2.) A *69 callback will not activate a Call Waiting tone; the line must be idle. 3.) *69 and Automatic Callback cannot be on the same line. 4.) This feature must be applied to all members of a Hunt group. 5.) *69 ring patterns may duplicate those of Distinctive Ringing. 6.) *69 will not work when activated against a line with Call Forwarding. 32 Downloaded from www.Manualslib.com manuals search engine To deactivate Busy Redial: Lift the handset and listen for dial tone. Press * 8 6 . NOTES: 1.) The number you called will not ring until you pick up your telephone. 2.) Occasionally, the person you are calling uses the phone before Busy Redial can complete your call. If this happens, a voice recording will tell you to hang up and reactivate Busy Redial. 3.) You can use Busy Redial to return calls to more than one busy number at a time. 4.) When your phone rings with a short-short-long ring, you need to answer by the third series of rings or Busy Redial will pause and try to complete your call 5 minutes later. 5.) Busy Redial and Automatic Callback cannot be on the same line. 6.) This feature must be applied to all members of a Hunt group. 7.) Busy Redial will not activate a Call Waiting tone. 33Call Block (*60) Call Block provides you with the capability to block up to 12 external telephone numbers (within your regional calling area) from calling your number, preventing unwanted and nuisance calls. Once activated, any calls from these 12 numbers will be routed to an intercept message. For your protection, calls from outside of your regional calling area and operator-handled calls cannot be blocked. This feature is not available in the DMS 10 switch type.Call Park To access the Call Block feature:To “park” a call against your number: Lift the handset and listen for dial tone.Tell the person to whom you are speaking that you are going to put them on hold. Press *Listen to the voice-recorded instructions for Call Block options.Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Press * Hang-up. 6 0 . GTD-5 switch type only: If you are a member of a Hunt group, you must: Lift the handset and listen for dial tone. Press Listen to the voice-recorded instructions for Call Block options. # 6 0 . Call Park functions like Call Pick-Up except that the call is already in progress. You can “park” an established call on your line against your own number, freeing up your line to place or receive another call. The parked call can be retrieved from any other station within the CustoPAK system, including your own. Only one call can be parked against a CustoPAK line at a given time. This feature is not available in the DMS 10 switch type. 1 1 and listen for confirmation tone. To retrieve a call you “parked” against your number: Lift the handset and listen for dial tone. Press * Begin your conversation. 1 3 and listen for confirmation tone. NOTES: 1.) Blocked calls will not be forwarded on any Call Forwarding arrangement and will not appear on Caller ID displays. 2.) Call Block takes precedence over Series Hunting. 3.) This feature must be applied to all members of a Hunt group. 34 Downloaded from www.Manualslib.com manuals search engine NOTES: 1.) If a parked call is not retrieved, the parking station will be recalled when idle. 2.) A station in the “call parked” condition cannot use the Three-Way Calling feature. 3.) Call Waiting will not activate against a number in a “parked” condition. 35Call Park – DirectedCall Trace This feature is an enhancement to Call Park. It performs the same functions as Call Park, but it allows you to park calls against any number in the CustoPAK system except your own. Only one call can be parked against a CustoPAK line at a given time. This feature is not available for GTD-5 and DMS 10 switch types.This protective feature enables you to trace the number of the last threatening or harassing call received, as long as the call originates from within your regional calling area. The calling party’s number will automatically be reported to Verizon, and in some areas you will be charged for each successful trace. This feature is not available in the DMS 10 switch type. To park a call against another CustoPAK number: Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set).  Press * 1 4 . If you receive a life-threatening or harassing call: Hang up. Lift the handset and listen for dial tone. Press * A voice recording will tell you if the call trace has been completed successfully. To take legal action, record the exact date and time of the call and contact Verizon within 10 days at the number provided by the voice recording. If you forget that number, call the Customer Contact Center for assistance. If the situation is an emergency, call your local law enforcement agency. Dial the Intercom number of the station where you wish to park the call. Hang-up. To retrieve parked calls from any line: Lift the handset and listen for dial tone. Press * 1 2 . If a call is parked against the line from which you are retrieving it, you will be automatically connected. If you are retrieving the call from a different line, dial the Intercom number of the line that the call is parked against.  Begin your conversation. NOTES: 1.) If a parked call is not retrieved, the parking station will be recalled when idle. 2.) The station in the “call parked” condition and the station with Call Park – Directed activated cannot use the Three-Way Calling or Executive Busy Override features. 3.) Call Waiting will not activate against a number in a “parked” condition. 4.) Call Park – Directed cannot be used to answer an Automatic Callback call. 5.) Call Park – Directed cannot be activated against a line with Call Forwarding. 6.) Call Park – Directed cannot be applied to a member of a Hunt group. 7.) Call Park – Directed overrides Series Hunting and Call Forwarding – Don’t Answer. 8.) The Call Park – Directed access code and the station number must be dialed before you know if the call has already been retrieved. 36 Downloaded from www.Manualslib.com manuals search engine 5 7 and follow the voice-recorded instructions. NOTES: 1.) If you successfully trace a call and choose to take further action, you must contact Verizon within 10 days or the call record will no longer be stored in the system. 2.) The records of any Call Trace request will be released only to a law enforcement agency. 3.) In some areas, Call Trace is available on a pay-per-use or subscription basis. 4.) Call Trace cannot trace a call that was forwarded by way of Call Forwarding or Call Forwarding – Busy Line. 5.) If Call Trace is activated after receiving a Call Waiting tone, the waiting call will be traced, whether answered or not. 6.) This feature must be applied to all members of a Hunt group. 37Caller IDCaller ID – Number Only Caller ID, along with compatible display telephones or separate Caller ID display box, lets you view the listed name and number of the incoming call before you pick it up. Use Caller ID to help improve customer service by personalizing your greetings and gathering information pertinent to a call before you answer it. You can also use the service to prioritize and screen calls when you are expecting an important call from a customer or supplier. Caller ID display devices vary in design, available features and the amount of information that may be retained in memory. The service will display information between the first and second rings for most calls, including long distance. However, some calls may be shown as “Out-of-Area” or as “Private Number” and the information will not be displayed. This feature is not available in the DMS 10 switch type.Caller ID – Number Only, along with compatible display telephones or separate Caller ID display box, lets you view the number of the incoming call before you pick it up. Use Caller ID – Number Only to help improve customer service by personalizing your greetings and gathering information pertinent to a call before you answer it. You can also use the service to prioritize and screen calls when you are expecting an important call from a customer or supplier. Caller ID display devices vary in design, available features and the amount of numbers that may be retained in memory. Caller ID will display numbers between the first and second rings for most calls, including long distance. However, some calls may be shown as “Out-of-Area” or as “Private Number” and the number will not be displayed. This feature is not available in the DMS 10 switch type. NOTES:NOTES: 1.) This feature must be applied to all members of a Hunt group. 2.) If Call Forwarding or Select Call Forwarding is activated, the call information will not be displayed at the forward-from location, but will be passed to the forward-to number. 3.) With Call Forwarding – Busy Line, the call information will not be passed to the forward-to number. 4.) With Call Waiting, the call information will not be displayed, unless the line has Call Waiting ID and the phone has the appropriate display unit. 5.) Caller ID is not available with Off Premises station lines or Foreign Exchange station lines. 6.) Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose.1.) This feature must be applied to all members of a Hunt group. 2.) If Call Forwarding or Select Call Forwarding is activated, the calling number will not be displayed at the forward-from location, but will be passed to the forward-to number. 3.) With Call Forwarding – Busy Line, the calling number will not be passed to forward-to number. 4.) With Call Waiting, the calling number will not be displayed, unless the line has Call Waiting ID and the phone has the appropriate display unit. 5.) Caller ID – Number Only is not available with Off Premises station lines or Foreign Exchange station lines. 6.) Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose. 38 Downloaded from www.Manualslib.com manuals search engine 39Enhanced Call ForwardingExecutive Busy Override Using a toll free 800 number, you can forward calls from anywhere in the country to any other number of your choice (pager, cellular phone, work phone or home phone). Enhanced Call Forwarding has been installed with a default destination number that you have chosen, and provides you with the flexibility to override the default number whenever necessary. This feature is not avail- able in the DMS 10 switch type.Executive Busy Override allows you to gain access to a busy line within your CustoPAK system by dialing a code, thus establishing a three-way call. The called number will receive a warning tone prior to the establishment of the three-way conference call. The person to whom the called party is speaking can be either inside or outside of the CustoPAK system. This feature is not available in the GTD-5 switch type. While using Enhanced Call Forwarding, certain buttons always have the same standard function:Upon reaching a busy internal station:   Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Press * 4 0 (both parties will hear break-in tone and you can now join the conversation). Press8to jump to the Main Menu.Press9to hear a menu again.Press0to hear help information.Press * to return to the previous menu.NOTES: If you’re entering a string of digits (a phone number or a time) and make a mistake, press * to clear the entry so you can start over again.After entering a string of digits, press # to end the string.1.) If a three-way conference is already in progress on the called number, the feature will not operate. 2.) If the called party presses the switchhook (or the Tap/Flash/Recall/Link button, depending on the telephone set), the overriding party will be disconnected from the three-way call. If any of the three parties hang up, the remaining two parties will still be connected. Calling Enhanced Call Forwarding From a touch-tone telephone: Dial 1-888-483-3230. Enter your 10-digit Enhanced Call Forwarding account number, then press Enter your Verizon-provided temporary PIN, then press # . If this is the first time you’ve used Enhanced Call Forwarding, you’ll be prompted to create your new 6- to 10-digit PIN. Refer to your Enhanced Call Forwarding User Guide for detailed information on how to use this feature. # . Last Number Redial This convenient service enables you to be connected to the last number you dialed. Use Last Number Redial to save time and improve efficiency by reducing dialing time and time spent looking for telephone numbers. This feature is not available for 5ESS and DMS 10 switch types. To be connected to the last number you dialed: Lift the handset and listen for dial tone. Press # 7 7 and wait for the call to connect. NOTE: If you called both numbers when establishing a three-way conference, the second number is the one stored for a Last Number Redial request. 40 Downloaded from www.Manualslib.com manuals search engine 41Priority CallSelect Call Forwarding Priority Call enables you to program up to 12 numbers—from within your regional calling area—to be identified with a special ring pattern (short-long- short). Use Priority Call to help you know when an important call comes in so you can give superior service to your high-priority callers. This feature is not available in the DMS 10 switch type.Select Call Forwarding lets you program up to 12 numbers — from within your regional calling area— that you wish to have call forwarded. When a number on your Select Call Forwarding list calls you, it will be forwarded to the number you have programmed to receive the call. Calls from all other numbers will be handled in the normal manner. You can program calls to forward to virtually any number— local or long distance — and Select Call Forwarding allows you to change your forward-to number whenever necessary. Use Select Call Forwarding to remain accessible and give top priority to your most important callers. This feature may generate local, regional toll or long distance charges. This feature is not available in the DMS 10 switch type. To turn Priority Call on or off: Lift the handset and listen for dial tone. Press * Listen to the voice recording for instructions on how to turn Priority Call on or off, and how to change or review your Priority Call list. 6 1 . To update your Priority Call list:  Press * 6 1 and follow the voice-recorded instructions. If your list is full, you must erase one number before you can add another. To turn Select Call Forwarding on or off: Lift the handset and listen for dial tone. Press * Listen to the voice recording for instructions on how to turn your Select Call Forwarding service on and off and how to change or review your Select Call Forwarding list. NOTES: 1.) The Priority Call special ring will not follow a Call Forwarding or Select Call Forwarding call. 2.) This feature must be applied to all members of a Hunt group. 3.) The Priority Call special ring will not hunt. 4.) This feature will not work on a Hunt group’s pilot number. 6 3 . To update your Select Call Forwarding list:  Press * 6 3 and follow the voice-recorded instructions. If your list is full, you must delete one number before you can add another. NOTES: 1.) When Select Call Forwarding is on and a call forwards: - Calls from numbers on your Select Call Forwarding list cannot be answered at the forward-from number, however, they will generate one short ring to remind you that the call is being forwarded. The forward-to number will ring normally. - All calls from numbers not on your Select Call Forwarding list will ring normally and can be answered. - If you also have Call Forwarding and it is turned on, all calls from phone numbers not on your Select Forwarding list will forward to the number you have chosen as the Call Forwarding Select destination. 2.) Blocked calls will not forward. 3.) This feature must be applied to all members of a Hunt group. 4.) Select Call Forwarding overrides all other Call Forwarding arrangements. 42 Downloaded from www.Manualslib.com manuals search engine 43Voice Mail and CustoPAKAppendix Verizon Voice Mail offers an efficient, businesslike way to capture important messages when you’re away from the office or on the phone 24 hours a day, 365 days a year. If you are unable to answer your line, or you are using your line (line busy), up to 3 calls can forward to your mailbox.Intercom Code Charts GTD-5, 5ESS and DMS 100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 You can set up your Verizon Voice Mail to enable callers to transfer out of the mailbox to a local telephone number selected by you for live answering. In addition to a Main Greeting, Verizon Voice Mail offers the option of an Alternate Greeting for times when you are away from the office. If you wish to transfer a caller on your line to another CustoPAK line which has Verizon Voice Mail: Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Dial the Intercom number. IF the line is answered, press the switchhook for a three-way call. If you wish to exit, simply hang up and the two parties will remain in conference. IF the line is not answered, you can hang up after the first ring, and the caller will forward to the second station line user’s mailbox greeting. The caller can then leave a recorded message in the second mailbox user’s mailbox. DMS 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Speed Dialing Code Charts GTD-5, DMS 100 and DMS 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 5ESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 CustoPAK Feature Activation/Deactivation Codes . . . . . . . . . . . . . . . . . . . . . . 52 Feature Availability by Switch Type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Your CustoPAK Feature Selections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 NOTE: Please refer to the Verizon Voice Mail User Guide for information on how to use your mailbox. 44 Downloaded from www.Manualslib.com manuals search engine 45Intercom Code Charts GTD-5, 5ESS and DMS 100 Intercom Code Chart The following charts are provided for you to list your Intercom codes. Each telephone number has been assigned an intercom code, and depending on your switch type, you must press # either before or after the Intercom code number. These Intercom codes have been programmed by Verizon. Instructions for using the Intercom feature are found below and also on page 14 of this guide. To make an Intercom call: Pick up the handset and listen for dial tone. Press the Intercom code 2 Press the Intercom code # 0 2 #–49 –#7(DMS 10). # (GTD-5, 5ESS and DMS 100). 46 Downloaded from www.Manualslib.com manuals search engine Name Code Telephone Number 20# 21# 22# 23# 24# 25# 26# 27# 28# 29# 30# 31# 32# 33# 34# 35# 36# 37# 38# 39# 40# 41# 42# 43# 44# 45# 46# 47# 48# 49# 47Speed Dialing Code Charts DMS 10 Intercom Code Chart Name Code Telephone Number #2 #3 #4 #5 The following charts are provided for you to list your Speed Dialing codes. The length of your individual Speed Dialing list is determined by your switch type. Your switch type can be found on the front cover of this guide. Be sure to use the Speed Dialing list that corresponds to your switch type. The instructions for setting up a list and making calls using Speed Dialing can be found below and also on page 30 of this guide. To establish or change your Speed Dialing list: #6 #7 Lift the receiver and listen for dial tone. Press *  Press # 7 4 and listen for dial tone. 1 .(GTD-5 only, skip this step in all other switches). Press the Speed Dialing 1-digit code number to be programmed (see pages 50-51). Dial the telephone number to be assigned to the code. Listen for confirmation tone. Hang up. Repeat steps for each Speed Dialing code number to be programmed. To make a call using Speed Dialing: 48 Downloaded from www.Manualslib.com manuals search engine Lift the receiver and listen for dial tone. Press # 1 .(all switches) and then dial the Speed Dialing code number (see pages 50-51). You will hear the called number ringing. Wait for party to answer. 49GTD-5, DMS 100 and DMS 10 Speed Dialing List Name Code Telephone Number 5ESS Speed Dialing List Name Code 22 33 44 55 66 77 Telephone Number 8 9 50 Downloaded from www.Manualslib.com manuals search engine 51CustoPAK® Feature Activation/Deactivation Codes FeatureActivation Code *69 Automatic Callback Busy Redial Call Block Call Forwarding Call Hold Call Park Call Park – Directed Call Pick-Up – Group Call Trace Cancel Call Waiting Dial Call Waiting Executive Busy Override*69 *52 *66 *60 *72 *01 *11 *14 *17 *57 *70 *54 *40 20# - 49# for 5ESS, IntercomGTD-5 and DMS 100. #2 - #7 for DMS 10. #77 61 63 74, then #1 (GTD-5 only) to program. 2 - 9 to use feature for all switches, except the 5ESS. 2 - 7 to use feature for the 5ESS. Last Number Redial Priority Call Select Call Forwarding * Speed Dialing * * Deactivation or Retrieval Code 89 #52 86 * * *73 *01 *13 *12 Feature Availability by Switch Type Feature GTD-5 Basic Features Assume Dial “9” Call Hold Call Transfer Consultation Hold Direct Inward/Outward Dialing (DID/DOD) Distinctive Ringing (Inside/Outside Ringing) Intercom Dialing Three-Way Calling Touch-Tone Selectable Features Automatic Callback Call Forwarding Call Forwarding – Busy Line Call Forwarding – Don’t Answer Call Pick-Up – Group Call Restriction Options Call Waiting Cancel Call Waiting Dial Call Waiting Hunting Speed Dialing Optional Features: 69 Busy Redial Call Block ( 60) Call Park Call Park – Directed Call Trace Caller ID services Enhanced Call Forwarding Executive Busy Override Last Number Redial Priority Call Select Call Forwarding Voice Mail * * 52 Downloaded from www.Manualslib.com manuals search engine ✓ ✓ ✓ ✓ ✓ ✓(30) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓(8) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Switch Type 5ESS DMS 100 DMS 10 ✓ ✓ ✓ ✓ ✓ ✓ ✓(30) ✓ ✓✓ ✓ ✓ ✓ ✓ ✓ ✓(30) ✓ ✓✓ ✓ ✓ ✓ ✓ ✓ ✓(6) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓(6)✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓(8)✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓(8) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 53Your CustoPAK® Feature Selections Feature Telephone Numbers Basic Features Assume Dial “9” Call Hold Call Transfer Consultation Hold Direct Inward/Outward Dialing (DID/DOD) Distinctive Ringing (Inside/Outside Ringing) Intercom Dialing Three-Way Calling Touch-Tone Selectable Features Automatic Callback Call Forwarding Call Forwarding – Busy Line Call Forwarding – Don’t Answer Call Pick-Up – Group Call Restriction Options Call Waiting Cancel Call Waiting Dial Call Waiting Hunting Speed Calling Optional Features: 69 Busy Redial Call Block ( 60) Call Park Call Park – Directed Call Trace Caller ID services Enhanced Call Forwarding Executive Busy Override Last Number Redial Priority Call Select Call Forwarding Voice Mail * * 54 Downloaded from www.Manualslib.com manuals search engine 55Notes __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ 56 Downloaded from www.Manualslib.com manuals search engine ","Provide your response in a professional and formal tone. Use the information given in the document without referring to external sources or requiring additional context. Avoid using technical jargon or acronyms that are not explained within the document. What are all of the different landline features available on the 5ESS Class 5 electronic switching system? CentraNet CustoPAK ® ® USER GUI DE Telephone Number Verizon Telephone Number Switch Type:  GTD-5  5ESS  DMS 100  DMS 10 © 2002 Verizon Communications www.verizon.com/smallbiz Downloaded from www.Manualslib.com manuals search engine 3056-0402Thank You for Selecting Verizon CentraNet ® CustoPAK® Service. 1 Downloaded from www.Manualslib.com manuals search engineTable of Contents Introduction to This Guide.............................................................................. 4 Overview of Your CustoPAK System ............................................................... 6 Terms You Should Know................................................................................ 8 CustoPAK Basic Features ✓ Assume Dial “9” .................................................................................. 9 ❑ ✓ ❑ Call Hold ............................................................................................. 10 ✓ Call Transfer ........................................................................................ 11 ❑ ✓ Consultation Hold ................................................................................ 12 ❑ ✓ Direct Inward/Outward Dialing (DID/DOD).............................................. 13 ❑ ✓ Distinctive Ringing (Inside/Outside Ringing) ......................................... 13 ❑ ✓ Intercom ............................................................................................. 14 ❑ ✓ Three-Way Calling ............................................................................... 15 ❑ ✓ Touch-Tone ......................................................................................... 16 ❑ CustoPAK Selectable Features ❑ Automatic Callback .............................................................................. 18 ❑ Call Forwarding Options ....................................................................... 19 ❑ Call Forwarding ................................................................................... 20 ❑ Call Forwarding – Busy Line................................................................. 22 ❑ Call Forwarding – Don’t Answer ........................................................... 23 ❑ Call Pick-Up – Group ........................................................................... 24 ❑ Call Restriction Options ........................................................................ 25 ❑ Call Waiting ....................................................................................... 26 ❑ Cancel Call Waiting (Tone Block) ......................................................... 27 ❑ Dial Call Waiting (for Intercom dialing)................................................... 28 ❑ Hunting ............................................................................................. 29 ❑ Speed Dialing .................................................................................... 30 2 Downloaded from www.Manualslib.com manuals search engine CustoPAK Optional Features ❑ 69 .................................................................................................. 32 ❑ Busy Redial ....................................................................................... 33 ❑ Call Block ( 60)................................................................................. 34 ❑ Call Park ........................................................................................... 35 ❑ Call Park – Directed .......................................................................... 36 ❑ Call Trace .......................................................................................... 37 ❑ Caller ID ........................................................................................... 38 ❑ Caller ID – Number Only .................................................................... 39 ❑ Enhanced Call Forwarding .................................................................. 40 ❑ Executive Busy Override ..................................................................... 41 ❑ Last Number Redial ........................................................................... 41 ❑ Priority Call........................................................................................ 42 ❑ Select Call Forwarding ....................................................................... 43 Voice Mail and CustoPAK ............................................................................ 44 * * Appendix.................................................................................................... 45 Intercom Code Charts............................................................................. 46 Speed Dialing Code Charts ..................................................................... 49 CustoPAK Feature Activation/Deactivation Codes ...................................... 52 Feature Availability by Switch Type .......................................................... 53 Your CustoPAK Feature Selections........................................................... 54 Please be sure to read the Introduction and Overview sections of this guide prior to operating your new CustoPAK system. 3Introduction to This Guide This guide is intended to provide you with information to help you learn to operate the features within your new CustoPAK system and get the most out of its many benefits. Before you begin using your new CustoPAK system, it is important to know your switch type, or the type of equipment in the Verizon central office that handles your telephone service. Your switch type is shown on the front cover of this guide and may affect which features are available with your CustoPAK system. Basic Features are automatically activated for each of your lines when you purchase your CustoPAK system.Upon installation of your system, your Verizon representative will assist you in filling out your Feature Grid (see Appendix). Once complete, this grid indicates which features you have selected for each of your CustoPAK lines. The Appendix section also contains your Intercom and Speed Calling code charts. You may wish to make copies of these handy tools and distribute them to other users in your CustoPAK system for easy reference. Selectable Features are available for each of your CustoPAK lines at no additional monthly charge, but must be installed to be used.1The Overview section which follows this Introduction will begin to acquaint you with your new CustoPAK system and the many benefits it provides. Optional Features are available at an additional charge per line and must also be installed to be used.1We are delighted that you have chosen Verizon. We hope this guide makes the transition to your new CustoPAK system as smooth as possible. The Features section of this guide describes the three types of features which are available to choose from: You may select as many or as few of the Selectable and Optional features as you like for each of your CustoPAK lines, and may change them at any time. Should you need assistance selecting additional features or changing features, your Verizon representative is available to guide you. All features available with CustoPAK are included in this guide regardless of whether you have selected them for your system. 1 To install these features, contact your Verizon representative. Installation charges may apply. 4 Downloaded from www.Manualslib.com manuals search engine For Customer Services, call 1-800 -483-5000 In Hawaii, call 643-4411 5Overview of Your CustoPAK System Your CustoPAK system is a central office-based service, meaning all equipment required to operate the system is in the Verizon central office. That also means you have purchased a reliable, worry-free telephone system, as our central offices are monitored 24 hours a day, 365 days a year. Your CustoPAK system can grow as your business grows. It has the capacity to handle up to 30 telephone lines, and offers a flexible package of features designed specifically with the small business customer in mind. You can select which features you want for each of your CustoPAK lines based on your business and communications needs. You may add or change features at any time by contacting your Verizon representative (additional charges may apply). CustoPAK can be customized to perform as a complete telephone system working on standard single-line telephones or as feature-rich access lines enhancing your existing telephone system. When used with existing telephone systems, features like Call Transfer, Three-Way Calling and Consultation Hold give you the functionality of a built-in second line. When using these features, other lines remain free for incoming or outgoing calls. And, Call Forwarding and Call Transfer allow you to easily transfer your calls to another location outside your system without additional equipment. Most of the features are activated by the use of codes. You’ll find all of the information required to activate the CustoPAK features listed in the Features section of this guide. Your CustoPAK system comes with a 30-day satisfaction guarantee (except California). We are confident that this system is the right solution for your business needs. However, with this guarantee you are entitled to a full credit of the CustoPAK charges and a change back to your previous Verizon service if you are not satisfied and notify us within 30 calendar days. Repair The Repair Center handles service problems and out-of-service conditions on your telephone lines and/or features, and the wiring to your location. It does not handle and cannot fix your telephone equipment. For problems with the wiring inside your business, you may repair it yourself, hire a contractor or an electrician, or call Verizon. Verizon does this type of repair for a fee based on the amount of time and the cost of the materials required to correct the problem. For information on these services, contact your Verizon representative. The Verizon repair number is 1-800-483-2000. The Repair Center is open 24 hours a day, including holidays. Help Desk The CentraNet/Voice Mail Help Desk was established to answer your questions about the operation of your CentraNet CustoPAK and Voice Mail services. Our Help Desk will explain how the services and features operate, e.g., How do I transfer a call? How do I reset my Passcode? If you have questions about your CentraNet CustoPAK service, please call the Help Desk at 1-800 - 483 -2000. The Help Desk is available Monday-Friday between the hours of 5 a.m.-7 p.m. and Saturday between the hours of 7 a.m.- 4 p.m. Pacific Time. The Help Desk is closed on Sunday. IMPORTANT INFORMATION: Verizon is in the process of updating all our central office switches to provide access to Per Call Blocking. This feature allows you to prevent the appearance of your phone number on Caller ID display units on a per call basis. Press * 6 Downloaded from www.Manualslib.com manuals search engine 6 7 before placing an outgoing call to activate this feature. 7Terms You Should KnowCustoPAK Basic Features Confirmation Tone Three short bursts of tone heard when using some CustoPAK features. The confirmation tone lets you know you have completed the activation or deactivation of the features.The features listed in this section are automatically included on each of your CustoPAK lines. These basic features are the backbone of your new CustoPAK system. Three of these features, Consultation Hold, Call Transfer and Three-Way Calling provide you with the functionality of a built-in second line. Regional Calling Area The area within which Verizon can provide local and regional toll calling services. Switch Type This term identifies the types of equipment in Verizon’s central office that handles your telephone service. Your switch type is shown on the front cover of this guide. It is very important to be aware of your switch type, as it may affect which features are available with your CustoPAK system. Assume Dial “9” This convenient feature allows you to place calls outside of the CustoPAK system without having to dial the access code “9”. NOTE: Verizon has automatically activated this feature. You cannot activate or deactivate the feature as you choose. Switchhook The buttons or bar generally located under the receiver on a standard desk telephone or electronic set. The switchhook initiates dial tone and is used to operate some of the CustoPAK features. Tap Flash Recall Link These terms refer to preprogrammed buttons on some telephones, that when used replace the switchhook. If your telephone is equipped with one of these buttons, always use it instead of the switchhook to operate the CustoPAK features. 8 Downloaded from www.Manualslib.com manuals search engine 9Call HoldNOTES: Call Hold allows you to place an established call on hold for an extended period of time—provided neither you nor the other person hangs up—freeing up the line to place or receive another call. Use Call Hold to help improve response time while reducing equipment costs and callbacks.1.) Only one call can be placed on hold at a time per telephone line. 2.) A holding call cannot be added to another call. 3.) Call Hold overrides Dial Call Waiting and Call Waiting. When you put a call on hold to use the line to make or receive a second call, a third incoming call will receive a busy signal. To place an established call on hold: Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Call Transfer Listen for dial tone.Press *You will hear confirmation tone, followed by dial tone.This valuable feature enables you to transfer an incoming call to any other number either inside or outside of your CustoPAK system. You can privately speak with the called party to announce the call prior to completing the transfer. Use Call Transfer as an efficient way to process misdirected calls and reduce message-taking and call handling time. The call is on hold. Place the handset beside the telephone—do not hang up!To transfer an incoming call: 0 1 . To place another call, while the first caller is on hold:Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Listen for dial tone. To transfer to an internal CustoPAK line, dial the intercom code assigned to the internal line. To transfer to an outside line dial the number to which you wish to transfer the call. Privately announce the transfer to the recipient. Hang up.  Key in destination phone number of the third party. Wait for the party to answer. If you encounter a busy signal, no answer or if an error is made in dialing, press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set) twice to connect to the original party. When party answers you may consult privately. To return to a call that is on hold: Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Listen for confirmation tone. Press * 0 1 (you may now talk to the person that was on hold). -OR- Hang up (your phone will ring). Lift the handset (you may now talk to the party that was on hold). 10 Downloaded from www.Manualslib.com manuals search engine -OR-  Hang up (the call is automatically transferred). NOTES: 1.) If you receive a busy signal, no answer or if an error is made in dialing, press the switchhook twice to reconnect to the original call. 2.) You cannot transfer a call while on a Three-Way or Call Waiting call. 3.) A call placed from a CustoPAK line to a number outside the system cannot be transferred to another number outside the system. 4.) Call Transfer may generate local, regional toll or long distance charges. 11Consultation HoldDirect Inward/Outward Dialing (DID/DOD) Consultation Hold provides a temporary or “soft” hold without having to dial an activation code. This allows you to place another call for private consultation or to initiate a three-way call. Use Consultation Hold to quickly verify customer inquiries and reduce costly and time-consuming callbacks.Direct Inward Dialing allows you to receive incoming calls directly at your station. This can help enhance customer service by allowing incoming callers to quickly reach you without the delay of a call transfer. Direct Outward Dialing improves efficiency by enabling you to place calls to locations outside the system without first dialing an access code or going through a central attendant. To place a call on hold: Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Listen for dial tone. Dial the third party (if you encounter a busy signal, no answer or if an error is made in dialing, press the switchhook twice to reconnect to the original call). When the third party answers, you may consult privately before reconnecting to the original call. To return to the original caller: Allow the third party to hang up. Press the switchhook twice (if the switchhook is only pressed once, a three-way call will be established). NOTES: 1.) Consultation Hold overrides Dial Call Waiting and Call Waiting. When you put a call on hold to use the line to place a second call, a third incoming call will receive a busy signal. 2.) Call Forwarding cannot be activated while a call is on Consultation Hold. 12 Downloaded from www.Manualslib.com manuals search engine NOTE: Verizon has automatically activated this feature. You cannot activate or deactivate the feature as you choose. Distinctive Ringing (Inside/Outside Ringing) CustoPAK Distinctive Ringing provides you with the ability to distinguish between internal and external incoming calls, allowing you to greet customers and callers from outside of your system more professionally. Internal calls—calls placed by someone within the CustoPAK system using the Intercom feature—will ring with a single ring. External calls—calls made from outside of the CustoPAK system— are identified by a double ring. This feature is not available in the GTD-5 switch. NOTES: 1.) Many telephone sets have their own distinctive ringing patterns that are not associated with CustoPAK Distinctive Ringing. 2.) Priority Call and Distinctive Ringing cannot be on the same CustoPAK line, since they share the same ring patterns. 3.) On forwarded calls, the ring pattern will be based on the original line, not the forwarding line. 4.) On transferred calls, the ring pattern will be based on the transferring line, not the original line. 5.) Verizon has automatically activated this feature. You cannot activate or deactivate the feature as you choose. 13IntercomThree-Way Calling The Intercom feature allows you to speak to, or transfer a call to, any other person within your CustoPAK system—without incurring local usage charges. Simply dial the two-digit code that was assigned to the line. See the Appendix on page 45 of this guide to locate the Intercom Code Chart for your switch type. The intercom codes are pre-assigned and programmed by Verizon.Three-Way Calling enables you to add a third party from either inside or outside of your CustoPAK system to any established call to create a three-way conference arrangement. This maximizes line efficiency and reduces costly and time-consuming callbacks by allowing you to obtain answers to urgent inquiries from two separate sources in a single call — reducing the costs and lost productivity of multiple telephone calls. To use the Intercom feature: Pick up the handset and listen for dial tone. Dial the intercom code: 20#– 49 #2–#for DMS 10 switch types. 7 # for 5ESS, GTD-5 and DMS 100 switch types. NOTE: For the Intercom feature to function properly, individual telephone numbers must be assigned to a Multi-Line Hunt group. While engaged in a two-way conversation: Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Listen for dial tone. Dial the number of the party you wish to add to the call (if you encounter a busy signal, no answer or an error is made in dialing, press the switchhook twice or hang up to reconnect to the original call). Announce that you are setting up a conference call. Press the switchhook again (the three-way conference is established). NOTES: 1.) You may use Three-Way Calling to add another person no matter who placed the original call. However, if you placed both calls and they are outside of your CustoPAK system, when you hang up the other two people will automatically disconnect. 2.) Three-Way Calling may generate local, regional toll or long distance charges. If you hang up, you will be billed the appropriate charges for the portion of the call for which you are responsible. 3.) You cannot establish a three-way call using the Automatic Callback feature. 4.) A three-way conference cannot be made between an established call and a Call Waiting call. 14 Downloaded from www.Manualslib.com manuals search engine 15Touch-Tone Touch-Tone provides the ability to push-button dial on tone-signaling telephones to access CustoPAK features and dial telephone numbers. Rotary dial telephones are not compatible with CustoPAK service. NOTE: Verizon has automatically activated this feature. You cannot activate or deactivate the feature as you choose. 16 Downloaded from www.Manualslib.com manuals search engine CustoPAK Selectable Features The features listed in this section are available for each of your CustoPAK lines at no additional monthly charge. You may select as many or as few of these features as you like, giving you the flexibility to customize each individual CustoPAK line in the manner which best suits your business. As you read through this sec- tion, be aware of your switch type (found on the front cover of this guide), since some features are not available for certain switch types. To add or change features at any time after your initial installation, contact your Verizon representative. 17Automatic CallbackCall Forwarding Options When you encounter a busy line within your CustoPAK system, a code can be dialed which will connect you when both lines are idle. The request will remain active for 30 minutes unless canceled. Use Automatic Callback to increase productivity by eliminating “telephone tag”, manual callbacks and unnecessary dialing. This feature only works within the CustoPAK system, and the system can only accommodate one request at a time per line. This feature is not available in the GTD-5 switch type.Your CustoPAK system can be equipped with one or all of its five Call Forwarding options. You may select or combine these features to meet your business needs. The Call Forwarding options and their descriptions can be found by referring to the list below: Option Section Page Call Forwarding ..................................... Selectable Features .................................. 20 To activate Automatic Callback once you’ve reached a busy line within your CustoPAK system:Call Forwarding – Busy Line ................. Selectable Features .................................. 22 Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set).Call Forwarding – Don’t Answer............ Selectable Features .................................. 23 Listen for dial tone.Press *Listen for confirmation tone.Hang up (when the called line is idle, your line will ring with a distinctive ring). 5 Enhanced Call Forwarding1 .................... Optional Features ..................................... 40 Select Call Forwarding1.......................... Optional Features ..................................... 43 2 . To cancel an Automatic Callback request: Lift handset and press Listen for confirmation tone. Hang up. # 5 2 . NOTES: 1.) If an Automatic Callback is not answered by the originating station, the request will be canceled. 2.) Automatic Callback can only be active on one station at a time. 3.) An Automatic Callback request can only be activated if the called number is in a busy condition and within the CustoPAK group. 1 18 Downloaded from www.Manualslib.com manuals search engine Additional charges apply. 19Call ForwardingNOTES: This Call Forwarding option allows you to have all incoming calls forwarded to a pre-determined telephone number either inside or outside the CustoPAK system. Call Forwarding provides you with the flexibility to choose your own forward-to number, to change it as often as you like and to turn the feature on or off as needed. When activated, it overrides Call Forwarding – Busy Line/ Don’t Answer and gives you the mobility you need to be productive outside the office and after hours.1.) Calls forwarded outside the system are subject to local, regional toll or long distance charges, as applicable. 2.) To confirm that Call Forwarding is on, press * 7 2 and if the feature is on you will hear a fast busy tone. If it is off you’ll hear normal dial tone. 3.) You can place calls when Call Forwarding is on, however, you cannot answer incoming calls. You will hear one short ring each time a call forwards to remind you that the service is on. 4.) Call Forwarding overrides Call Waiting, Dial Call Waiting, Hunting arrange- ments and Call Forwarding – Busy Line/Don’t Answer. 5.) Voice Mail service will not work when Call Forwarding is on, unless you have activated forwarding to the Voice Mail service access number. 6.) A line with Call Forwarding activated cannot have an Automatic Callback request initiated against it. To turn Call Forwarding on: Lift the handset and listen for dial tone. Press * At the tone, dial the telephone number you want your calls forwarded to. When the call is answered, the feature has been activated. If the call is not answered, hang up and repeat the above steps within two minutes. The feature is activated when you hear the confirmation tone. 7 2 . To turn Call Forwarding off:  Press * 7 3 (two short tones indicate that the service has been turned off). 20 Downloaded from www.Manualslib.com manuals search engine 21Call Forwarding – Busy LineCall Forwarding – Don’t Answer This feature automatically routes incoming calls to a pre-determined number (either inside or outside of your CustoPAK system) when your line is busy. Use Call Forwarding – Busy Line to improve customer service by forwarding calls to alternate answering points, ensuring that all incoming calls are covered. This feature can be separate on the line or can be combined with Call Forwarding – Don’t Answer. The forward-to number must be programmed by Verizon.This feature automatically routes incoming calls to a telephone number (either inside or outside of your CustoPAK system, or to Voice Messaging) when your line is unanswered after a pre-determined number of rings (4-ring maximum). Use Call Forwarding – Don’t Answer to improve customer service by forwarding calls to alternate answering points, ensuring that no opportunities are lost due to an unanswered call. This feature can be separate on the line or can be combined with Call Forwarding – Busy Line. The forward-to number must be programmed by Verizon. NOTES: 1.) Calls forwarded outside the system are subject to local, regional toll or long distance charges, as applicable. 2.) Call Forwarding – Busy Line overrides Dial Call Waiting (see page 29). Therefore, if you place a call to a number with Call Forwarding – Busy Line, the call is forwarded and the Dial Call Waiting treatment is not given during a busy condition. 3.) Call Forwarding overrides Call Forwarding – Busy Line. 4.) For Multi-Line Hunt groups, Call Forwarding – Busy Line can only be assigned on a group basis and will apply to every line in the group. 5.) Call Forwarding – Busy Line can only be assigned to the last member of a Series Hunt group. 6.) If you have Voice Messaging, it is not necessary to subscribe to this feature. 7.) Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose. 22 Downloaded from www.Manualslib.com manuals search engine NOTES: 1.) Calls forwarded outside the system are subject to local, regional toll or long distance charges, as applicable. 2.) Call Forwarding overrides Call Forwarding – Don’t Answer. 3.) Call Waiting and Dial Call Waiting override Call Forwarding – Don’t Answer. 4.) For Multi-Line Hunt groups, Call Forwarding – Don’t Answer can only be assigned on a group basis and will apply to every line in the group. 5.) If the forward-to number is busy, the call will not forward. The line will continue to ring, or you may get a busy signal, depending upon the location of the forward-to number. 6.) If you have Voice Messaging, it is not necessary to subscribe to this feature. 7.) Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose. 23Call Pick-Up – GroupCall Restriction Options Call Pick-Up – Group enables you to answer (pick-up) calls directed to any other line within your Call Pick-Up group by dialing a code. If more than one person tries to pick-up the call, the first user will receive the call, and the others will receive a busy signal as confirmation that the call was answered. Use Call Pick-Up – Group to provide maximum call coverage and ensure against missed calls.This feature enables you to select and control the incoming and outgoing calling capabilities of each of your CustoPAK lines. Each line can only be equipped with one Call Restriction option, which has been programmed by Verizon. To use Call Pick-Up – Group: Lift the handset and listen for dial tone. Press * 1 7 NOTE: Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose. If you want to add or update Call Restriction options, please contact your Verizon representative. (the incoming call is connected to your station). To use Call Pick-Up – Group when you are already on the phone: Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Listen for dial tone. Press * 0 1 to put the first call on hold. Press * 1 7 (the incoming call is connected to your station). NOTES: 1.) You cannot use Call Pick-Up – Group to connect to an Automatic Callback call. 2.) If more than one line in your Call Pick-Up group is ringing, you cannot select which line to answer. The system will automatically direct the pick-up to the call that came in first. 3.) All lines in a Multi-Line Hunt group must be in the same Call Pick-Up group. 24 Downloaded from www.Manualslib.com manuals search engine 25Call Waiting This valuable feature provides an audible tone while you are on the line that alerts you of another incoming call. You then have the option to either place the present call on hold to answer the incoming call or to disregard it. The calling party will receive ringing tone instead of a busy tone. Use Call Waiting to maximize line efficiency and improve customer service by ensuring prompt responses to urgent inquiries. Cancel Call Waiting (Tone Block) When you don’t want to be disturbed or interrupted during an important call, you can temporarily deactivate Call Waiting. You can activate Cancel Call Waiting before you place a call or at any point during the conversation. Cancel Call Waiting works only for the length of one call. When you hang up, Call Waiting returns automatically to your phone. To cancel the Call Waiting tone before placing a call: After hearing the Call Waiting tone: Lift the handset and listen for dial tone. Either end your first call or tell the person to whom you are speaking that you are going to put them on hold.Press * Press and release the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set) to put the first person on hold and answer the second call in the GTD-5 switch.Listen for confirmation tone, followed by normal dial tone. Dial the telephone number.   7 0 . To cancel the Call Waiting tone during a call: Press and release the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set), listen for the flash tone, then dial * 0 1 to put the first person on hold and answer the second call in the DMS 100, DMS 10 and 5ESS switches (may also be required for GTD-5 switch).Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Press * To return to the first call and put the second call on hold, repeat bullet two or three (depending on switch type). You can alternate between calls as often as desired by repeating bullets two or three (depending on switch type).NOTE: In some areas you can only activate Cancel Call Waiting before placing a call. 7 0 (you will reconnect automatically to your call). NOTES: 1.) Call Waiting allows you to have two calls on your line at the same time (one on hold and one to whom you are talking). A third caller will hear a busy signal. 2.) Call Waiting cannot be assigned to lines in a Multi-Line Hunt group. 3.) Call Waiting overrides Call Forwarding – Busy Line/Don’t Answer. 4.) Call Forwarding overrides Dial Call Waiting. 5.) Series Hunting overrides Call Waiting, which should be assigned to the last number of a Series Hunt group. 6.) A three-way conference cannot be made between an established call and a Call Waiting call. 7.) If Call Waiting and Call Forwarding – Don’t Answer are active on the same line and you choose to ignore the Call Waiting tone, the call will forward to your Call Forwarding – Don’t Answer number. 26 Downloaded from www.Manualslib.com manuals search engine 27Dial Call Waiting (for Intercom dialing)Hunting This feature allows you to send a Call Waiting tone to another line within your CustoPAK system when that line is busy, letting the called party know that some- one is trying to reach them. The called party then has the option to answer or ignore the Call Waiting tone. Use Dial Call Waiting to help ensure the timely and efficient flow of information within your business. This feature is not available for GTD-5 switch types.Hunting allows your business to reduce busy signals and increase accessibility by expanding call coverage. A Hunting arrangement begins with a call to a lead, or pilot number and searches for an idle line beginning with the first number of a pre-assigned Hunt group and ending with the last number in the group. Upon dialing an internal station number and hearing a busy tone: Hang up. Lift the handset and listen for dial tone. Press * Dial the number of the busy station (the called party hears a Call Waiting tone). Remain off-hook until the called party answers. 5 4 and listen for confirmation tone. NOTES: NOTES: 1.) When a Multi-Line Hunt group is assigned to a CustoPAK customer, individual telephone numbers must be assigned in order for the Intercom feature to work. 2.) Call Waiting cannot be assigned to lines in a Hunt group. 3.) Automatic Callback cannot be activated against lines in a Hunt group. 4.) Call Forwarding and Call Forwarding – Busy Line/Don’t Answer can only be assigned to a Multi-Line Hunt group on a group basis. 5.) All lines in a Multi-Line Hunt group must be in the same Call Pick-Up group. 6.) Caller ID will work in a Hunt group, however, the feature must be assigned to every line in the Hunt group. 7.) Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose. 1.) Dial Call Waiting only works within your CustoPAK system. 2.) Dial Call Waiting cannot be assigned to lines in a Multi-Line Hunt group. 3.) Dial Call Waiting overrides Call Forwarding – Busy Line/Don’t Answer. 4.) Call Forwarding overrides Dial Call Waiting. 5.) If Call Waiting and Call Forwarding – Don’t Answer are active on the same line and the called party chooses to ignore the Dial Call Waiting tone, the call will forward to the called party’s Call Forwarding – Don’t Answer number. 6 .) Series Hunting overrides Dial Call Waiting, which should be assigned to the last number of a Series Hunt group. 28 Downloaded from www.Manualslib.com manuals search engine 29Speed Dialing Speed Dialing allows you to call frequently dialed numbers by using an abbreviated code, reducing dialing time and time spent searching for telephone numbers. Speed Dialing gives you the flexibility to create and edit your own Speed Dialing list. The Speed Dialing short list consists of 8 numbers unless you have a 5ESS switch type, which provides a 6-number Speed Dialing list. CustoPAK Optional Features The following features are available for each of your CustoPAK lines at an additional monthly charge per line. As you read through this section, be aware of your switch type (found on the front cover of this guide), since some of these Optional features are not available for certain switch types. To add or change any of these features after your initial installation, contact your Verizon representative. To establish/add or change a number on your Speed Dialing list: Lift the handset and listen for dial tone. Press * 7 4 Press 1 (GTD-5 only, skip this step in all other switches). Press the Speed Dialing code numbers to be programmed (2-9 for all switches except 5ESS, press 2-7 for 5ESS). Dial the telephone number to be assigned to the code, along with any required access codes, ( i.e., long distance carrier access code) up to 28 digits. Listen for confirmation tone. Hang up. Repeat steps for each code number to be programmed. # and listen for confirmation tone. To place a Speed Call from the short list: Lift the handset and listen for dial tone. Press # 1 (all switches) and then dial the Speed Dialing code number (2-9 or 2-7 depending on what switch type you have). See page 50 for Speed Dialing code charts. Wait for party to answer. NOTES: 1.) OPTIONAL: After you press # 1 and the code number, press # again for a quicker connection. 2.) Service codes such as 911, cannot be programmed. 3.) Fully restricted lines cannot have Speed Dialing. 4.) Customers may experience a 2- to 3-second timing delay when activating Speed Dialing codes that match other feature activation codes. 30 Downloaded from www.Manualslib.com manuals search engine 31* 69Busy Redial This convenient feature automatically stores and allows you to redial the number of the last person who called you. *69 only works on calls made from numbers within your regional calling area and can be used whether you answered the last call or not. If you return the call and the number is busy, *69 will monitor the busy line and attempt to connect your call for up to 30 minutes, unless canceled. In most cases, your phone will ring with a series of short-short-long rings when the number you called is no longer busy. This feature is not available in the DMS 10 switch type.After reaching a busy line within your regional calling area, this convenient service allows you to dial a code that will automatically connect you when both lines are idle. Once activated, Busy Redial will monitor the busy line and attempt to connect your call for up to 30 minutes, unless canceled. You will be alerted with a special ring when the call is returned. You can use Busy Redial to help reduce multiple callbacks, dialing time and lost productivity. This feature is not available in the DMS 10 switch type. After dialing a busy number: To activate * 69: Hang up. Lift the handset and listen for dial tone.Lift the handset and listen for dial tone. Press *Press * 6 6 . You will hear two normal ringing tones or an announce- ment. If the called number is still busy, a voice recording will tell you that your call is next in line. Hang up. When the number you called is no longer busy, your telephone will ring with a series of short-short-long rings (ringing tones may vary). Lift the handset. You will hear normal ringing tone. 6 9 (a voice recording may provide additional instructions). To deactivate * 69: Lift the handset and listen for dial tone. Press * 8 9 . NOTES: 1.) If you hear the Call Waiting tone while you are on the line, you have two choices: you can use *69 to call back later, or you can use Call Waiting during the call. 2.) A *69 callback will not activate a Call Waiting tone; the line must be idle. 3.) *69 and Automatic Callback cannot be on the same line. 4.) This feature must be applied to all members of a Hunt group. 5.) *69 ring patterns may duplicate those of Distinctive Ringing. 6.) *69 will not work when activated against a line with Call Forwarding. 32 Downloaded from www.Manualslib.com manuals search engine To deactivate Busy Redial: Lift the handset and listen for dial tone. Press * 8 6 . NOTES: 1.) The number you called will not ring until you pick up your telephone. 2.) Occasionally, the person you are calling uses the phone before Busy Redial can complete your call. If this happens, a voice recording will tell you to hang up and reactivate Busy Redial. 3.) You can use Busy Redial to return calls to more than one busy number at a time. 4.) When your phone rings with a short-short-long ring, you need to answer by the third series of rings or Busy Redial will pause and try to complete your call 5 minutes later. 5.) Busy Redial and Automatic Callback cannot be on the same line. 6.) This feature must be applied to all members of a Hunt group. 7.) Busy Redial will not activate a Call Waiting tone. 33Call Block (*60) Call Block provides you with the capability to block up to 12 external telephone numbers (within your regional calling area) from calling your number, preventing unwanted and nuisance calls. Once activated, any calls from these 12 numbers will be routed to an intercept message. For your protection, calls from outside of your regional calling area and operator-handled calls cannot be blocked. This feature is not available in the DMS 10 switch type.Call Park To access the Call Block feature:To “park” a call against your number: Lift the handset and listen for dial tone.Tell the person to whom you are speaking that you are going to put them on hold. Press *Listen to the voice-recorded instructions for Call Block options.Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Press * Hang-up. 6 0 . GTD-5 switch type only: If you are a member of a Hunt group, you must: Lift the handset and listen for dial tone. Press Listen to the voice-recorded instructions for Call Block options. # 6 0 . Call Park functions like Call Pick-Up except that the call is already in progress. You can “park” an established call on your line against your own number, freeing up your line to place or receive another call. The parked call can be retrieved from any other station within the CustoPAK system, including your own. Only one call can be parked against a CustoPAK line at a given time. This feature is not available in the DMS 10 switch type. 1 1 and listen for confirmation tone. To retrieve a call you “parked” against your number: Lift the handset and listen for dial tone. Press * Begin your conversation. 1 3 and listen for confirmation tone. NOTES: 1.) Blocked calls will not be forwarded on any Call Forwarding arrangement and will not appear on Caller ID displays. 2.) Call Block takes precedence over Series Hunting. 3.) This feature must be applied to all members of a Hunt group. 34 Downloaded from www.Manualslib.com manuals search engine NOTES: 1.) If a parked call is not retrieved, the parking station will be recalled when idle. 2.) A station in the “call parked” condition cannot use the Three-Way Calling feature. 3.) Call Waiting will not activate against a number in a “parked” condition. 35Call Park – DirectedCall Trace This feature is an enhancement to Call Park. It performs the same functions as Call Park, but it allows you to park calls against any number in the CustoPAK system except your own. Only one call can be parked against a CustoPAK line at a given time. This feature is not available for GTD-5 and DMS 10 switch types.This protective feature enables you to trace the number of the last threatening or harassing call received, as long as the call originates from within your regional calling area. The calling party’s number will automatically be reported to Verizon, and in some areas you will be charged for each successful trace. This feature is not available in the DMS 10 switch type. To park a call against another CustoPAK number: Tell the person to whom you are speaking that you are going to put them on hold. Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set).  Press * 1 4 . If you receive a life-threatening or harassing call: Hang up. Lift the handset and listen for dial tone. Press * A voice recording will tell you if the call trace has been completed successfully. To take legal action, record the exact date and time of the call and contact Verizon within 10 days at the number provided by the voice recording. If you forget that number, call the Customer Contact Center for assistance. If the situation is an emergency, call your local law enforcement agency. Dial the Intercom number of the station where you wish to park the call. Hang-up. To retrieve parked calls from any line: Lift the handset and listen for dial tone. Press * 1 2 . If a call is parked against the line from which you are retrieving it, you will be automatically connected. If you are retrieving the call from a different line, dial the Intercom number of the line that the call is parked against.  Begin your conversation. NOTES: 1.) If a parked call is not retrieved, the parking station will be recalled when idle. 2.) The station in the “call parked” condition and the station with Call Park – Directed activated cannot use the Three-Way Calling or Executive Busy Override features. 3.) Call Waiting will not activate against a number in a “parked” condition. 4.) Call Park – Directed cannot be used to answer an Automatic Callback call. 5.) Call Park – Directed cannot be activated against a line with Call Forwarding. 6.) Call Park – Directed cannot be applied to a member of a Hunt group. 7.) Call Park – Directed overrides Series Hunting and Call Forwarding – Don’t Answer. 8.) The Call Park – Directed access code and the station number must be dialed before you know if the call has already been retrieved. 36 Downloaded from www.Manualslib.com manuals search engine 5 7 and follow the voice-recorded instructions. NOTES: 1.) If you successfully trace a call and choose to take further action, you must contact Verizon within 10 days or the call record will no longer be stored in the system. 2.) The records of any Call Trace request will be released only to a law enforcement agency. 3.) In some areas, Call Trace is available on a pay-per-use or subscription basis. 4.) Call Trace cannot trace a call that was forwarded by way of Call Forwarding or Call Forwarding – Busy Line. 5.) If Call Trace is activated after receiving a Call Waiting tone, the waiting call will be traced, whether answered or not. 6.) This feature must be applied to all members of a Hunt group. 37Caller IDCaller ID – Number Only Caller ID, along with compatible display telephones or separate Caller ID display box, lets you view the listed name and number of the incoming call before you pick it up. Use Caller ID to help improve customer service by personalizing your greetings and gathering information pertinent to a call before you answer it. You can also use the service to prioritize and screen calls when you are expecting an important call from a customer or supplier. Caller ID display devices vary in design, available features and the amount of information that may be retained in memory. The service will display information between the first and second rings for most calls, including long distance. However, some calls may be shown as “Out-of-Area” or as “Private Number” and the information will not be displayed. This feature is not available in the DMS 10 switch type.Caller ID – Number Only, along with compatible display telephones or separate Caller ID display box, lets you view the number of the incoming call before you pick it up. Use Caller ID – Number Only to help improve customer service by personalizing your greetings and gathering information pertinent to a call before you answer it. You can also use the service to prioritize and screen calls when you are expecting an important call from a customer or supplier. Caller ID display devices vary in design, available features and the amount of numbers that may be retained in memory. Caller ID will display numbers between the first and second rings for most calls, including long distance. However, some calls may be shown as “Out-of-Area” or as “Private Number” and the number will not be displayed. This feature is not available in the DMS 10 switch type. NOTES:NOTES: 1.) This feature must be applied to all members of a Hunt group. 2.) If Call Forwarding or Select Call Forwarding is activated, the call information will not be displayed at the forward-from location, but will be passed to the forward-to number. 3.) With Call Forwarding – Busy Line, the call information will not be passed to the forward-to number. 4.) With Call Waiting, the call information will not be displayed, unless the line has Call Waiting ID and the phone has the appropriate display unit. 5.) Caller ID is not available with Off Premises station lines or Foreign Exchange station lines. 6.) Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose.1.) This feature must be applied to all members of a Hunt group. 2.) If Call Forwarding or Select Call Forwarding is activated, the calling number will not be displayed at the forward-from location, but will be passed to the forward-to number. 3.) With Call Forwarding – Busy Line, the calling number will not be passed to forward-to number. 4.) With Call Waiting, the calling number will not be displayed, unless the line has Call Waiting ID and the phone has the appropriate display unit. 5.) Caller ID – Number Only is not available with Off Premises station lines or Foreign Exchange station lines. 6.) Verizon must automatically activate this feature. You cannot activate or deactivate the feature as you choose. 38 Downloaded from www.Manualslib.com manuals search engine 39Enhanced Call ForwardingExecutive Busy Override Using a toll free 800 number, you can forward calls from anywhere in the country to any other number of your choice (pager, cellular phone, work phone or home phone). Enhanced Call Forwarding has been installed with a default destination number that you have chosen, and provides you with the flexibility to override the default number whenever necessary. This feature is not avail- able in the DMS 10 switch type.Executive Busy Override allows you to gain access to a busy line within your CustoPAK system by dialing a code, thus establishing a three-way call. The called number will receive a warning tone prior to the establishment of the three-way conference call. The person to whom the called party is speaking can be either inside or outside of the CustoPAK system. This feature is not available in the GTD-5 switch type. While using Enhanced Call Forwarding, certain buttons always have the same standard function:Upon reaching a busy internal station:   Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Press * 4 0 (both parties will hear break-in tone and you can now join the conversation). Press8to jump to the Main Menu.Press9to hear a menu again.Press0to hear help information.Press * to return to the previous menu.NOTES: If you’re entering a string of digits (a phone number or a time) and make a mistake, press * to clear the entry so you can start over again.After entering a string of digits, press # to end the string.1.) If a three-way conference is already in progress on the called number, the feature will not operate. 2.) If the called party presses the switchhook (or the Tap/Flash/Recall/Link button, depending on the telephone set), the overriding party will be disconnected from the three-way call. If any of the three parties hang up, the remaining two parties will still be connected. Calling Enhanced Call Forwarding From a touch-tone telephone: Dial 1-888-483-3230. Enter your 10-digit Enhanced Call Forwarding account number, then press Enter your Verizon-provided temporary PIN, then press # . If this is the first time you’ve used Enhanced Call Forwarding, you’ll be prompted to create your new 6- to 10-digit PIN. Refer to your Enhanced Call Forwarding User Guide for detailed information on how to use this feature. # . Last Number Redial This convenient service enables you to be connected to the last number you dialed. Use Last Number Redial to save time and improve efficiency by reducing dialing time and time spent looking for telephone numbers. This feature is not available for 5ESS and DMS 10 switch types. To be connected to the last number you dialed: Lift the handset and listen for dial tone. Press # 7 7 and wait for the call to connect. NOTE: If you called both numbers when establishing a three-way conference, the second number is the one stored for a Last Number Redial request. 40 Downloaded from www.Manualslib.com manuals search engine 41Priority CallSelect Call Forwarding Priority Call enables you to program up to 12 numbers—from within your regional calling area—to be identified with a special ring pattern (short-long- short). Use Priority Call to help you know when an important call comes in so you can give superior service to your high-priority callers. This feature is not available in the DMS 10 switch type.Select Call Forwarding lets you program up to 12 numbers — from within your regional calling area— that you wish to have call forwarded. When a number on your Select Call Forwarding list calls you, it will be forwarded to the number you have programmed to receive the call. Calls from all other numbers will be handled in the normal manner. You can program calls to forward to virtually any number— local or long distance — and Select Call Forwarding allows you to change your forward-to number whenever necessary. Use Select Call Forwarding to remain accessible and give top priority to your most important callers. This feature may generate local, regional toll or long distance charges. This feature is not available in the DMS 10 switch type. To turn Priority Call on or off: Lift the handset and listen for dial tone. Press * Listen to the voice recording for instructions on how to turn Priority Call on or off, and how to change or review your Priority Call list. 6 1 . To update your Priority Call list:  Press * 6 1 and follow the voice-recorded instructions. If your list is full, you must erase one number before you can add another. To turn Select Call Forwarding on or off: Lift the handset and listen for dial tone. Press * Listen to the voice recording for instructions on how to turn your Select Call Forwarding service on and off and how to change or review your Select Call Forwarding list. NOTES: 1.) The Priority Call special ring will not follow a Call Forwarding or Select Call Forwarding call. 2.) This feature must be applied to all members of a Hunt group. 3.) The Priority Call special ring will not hunt. 4.) This feature will not work on a Hunt group’s pilot number. 6 3 . To update your Select Call Forwarding list:  Press * 6 3 and follow the voice-recorded instructions. If your list is full, you must delete one number before you can add another. NOTES: 1.) When Select Call Forwarding is on and a call forwards: - Calls from numbers on your Select Call Forwarding list cannot be answered at the forward-from number, however, they will generate one short ring to remind you that the call is being forwarded. The forward-to number will ring normally. - All calls from numbers not on your Select Call Forwarding list will ring normally and can be answered. - If you also have Call Forwarding and it is turned on, all calls from phone numbers not on your Select Forwarding list will forward to the number you have chosen as the Call Forwarding Select destination. 2.) Blocked calls will not forward. 3.) This feature must be applied to all members of a Hunt group. 4.) Select Call Forwarding overrides all other Call Forwarding arrangements. 42 Downloaded from www.Manualslib.com manuals search engine 43Voice Mail and CustoPAKAppendix Verizon Voice Mail offers an efficient, businesslike way to capture important messages when you’re away from the office or on the phone 24 hours a day, 365 days a year. If you are unable to answer your line, or you are using your line (line busy), up to 3 calls can forward to your mailbox.Intercom Code Charts GTD-5, 5ESS and DMS 100 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 You can set up your Verizon Voice Mail to enable callers to transfer out of the mailbox to a local telephone number selected by you for live answering. In addition to a Main Greeting, Verizon Voice Mail offers the option of an Alternate Greeting for times when you are away from the office. If you wish to transfer a caller on your line to another CustoPAK line which has Verizon Voice Mail: Press the switchhook (or the Tap/Flash/Recall/Link button, depending on your telephone set). Dial the Intercom number. IF the line is answered, press the switchhook for a three-way call. If you wish to exit, simply hang up and the two parties will remain in conference. IF the line is not answered, you can hang up after the first ring, and the caller will forward to the second station line user’s mailbox greeting. The caller can then leave a recorded message in the second mailbox user’s mailbox. DMS 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Speed Dialing Code Charts GTD-5, DMS 100 and DMS 10 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 5ESS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 CustoPAK Feature Activation/Deactivation Codes . . . . . . . . . . . . . . . . . . . . . . 52 Feature Availability by Switch Type. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Your CustoPAK Feature Selections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 NOTE: Please refer to the Verizon Voice Mail User Guide for information on how to use your mailbox. 44 Downloaded from www.Manualslib.com manuals search engine 45Intercom Code Charts GTD-5, 5ESS and DMS 100 Intercom Code Chart The following charts are provided for you to list your Intercom codes. Each telephone number has been assigned an intercom code, and depending on your switch type, you must press # either before or after the Intercom code number. These Intercom codes have been programmed by Verizon. Instructions for using the Intercom feature are found below and also on page 14 of this guide. To make an Intercom call: Pick up the handset and listen for dial tone. Press the Intercom code 2 Press the Intercom code # 0 2 #–49 –#7(DMS 10). # (GTD-5, 5ESS and DMS 100). 46 Downloaded from www.Manualslib.com manuals search engine Name Code Telephone Number 20# 21# 22# 23# 24# 25# 26# 27# 28# 29# 30# 31# 32# 33# 34# 35# 36# 37# 38# 39# 40# 41# 42# 43# 44# 45# 46# 47# 48# 49# 47Speed Dialing Code Charts DMS 10 Intercom Code Chart Name Code Telephone Number #2 #3 #4 #5 The following charts are provided for you to list your Speed Dialing codes. The length of your individual Speed Dialing list is determined by your switch type. Your switch type can be found on the front cover of this guide. Be sure to use the Speed Dialing list that corresponds to your switch type. The instructions for setting up a list and making calls using Speed Dialing can be found below and also on page 30 of this guide. To establish or change your Speed Dialing list: #6 #7 Lift the receiver and listen for dial tone. Press *  Press # 7 4 and listen for dial tone. 1 .(GTD-5 only, skip this step in all other switches). Press the Speed Dialing 1-digit code number to be programmed (see pages 50-51). Dial the telephone number to be assigned to the code. Listen for confirmation tone. Hang up. Repeat steps for each Speed Dialing code number to be programmed. To make a call using Speed Dialing: 48 Downloaded from www.Manualslib.com manuals search engine Lift the receiver and listen for dial tone. Press # 1 .(all switches) and then dial the Speed Dialing code number (see pages 50-51). You will hear the called number ringing. Wait for party to answer. 49GTD-5, DMS 100 and DMS 10 Speed Dialing List Name Code Telephone Number 5ESS Speed Dialing List Name Code 22 33 44 55 66 77 Telephone Number 8 9 50 Downloaded from www.Manualslib.com manuals search engine 51CustoPAK® Feature Activation/Deactivation Codes FeatureActivation Code *69 Automatic Callback Busy Redial Call Block Call Forwarding Call Hold Call Park Call Park – Directed Call Pick-Up – Group Call Trace Cancel Call Waiting Dial Call Waiting Executive Busy Override*69 *52 *66 *60 *72 *01 *11 *14 *17 *57 *70 *54 *40 20# - 49# for 5ESS, IntercomGTD-5 and DMS 100. #2 - #7 for DMS 10. #77 61 63 74, then #1 (GTD-5 only) to program. 2 - 9 to use feature for all switches, except the 5ESS. 2 - 7 to use feature for the 5ESS. Last Number Redial Priority Call Select Call Forwarding * Speed Dialing * * Deactivation or Retrieval Code 89 #52 86 * * *73 *01 *13 *12 Feature Availability by Switch Type Feature GTD-5 Basic Features Assume Dial “9” Call Hold Call Transfer Consultation Hold Direct Inward/Outward Dialing (DID/DOD) Distinctive Ringing (Inside/Outside Ringing) Intercom Dialing Three-Way Calling Touch-Tone Selectable Features Automatic Callback Call Forwarding Call Forwarding – Busy Line Call Forwarding – Don’t Answer Call Pick-Up – Group Call Restriction Options Call Waiting Cancel Call Waiting Dial Call Waiting Hunting Speed Dialing Optional Features: 69 Busy Redial Call Block ( 60) Call Park Call Park – Directed Call Trace Caller ID services Enhanced Call Forwarding Executive Busy Override Last Number Redial Priority Call Select Call Forwarding Voice Mail * * 52 Downloaded from www.Manualslib.com manuals search engine ✓ ✓ ✓ ✓ ✓ ✓(30) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓(8) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ Switch Type 5ESS DMS 100 DMS 10 ✓ ✓ ✓ ✓ ✓ ✓ ✓(30) ✓ ✓✓ ✓ ✓ ✓ ✓ ✓ ✓(30) ✓ ✓✓ ✓ ✓ ✓ ✓ ✓ ✓(6) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓(6)✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓(8)✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓(8) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 53Your CustoPAK® Feature Selections Feature Telephone Numbers Basic Features Assume Dial “9” Call Hold Call Transfer Consultation Hold Direct Inward/Outward Dialing (DID/DOD) Distinctive Ringing (Inside/Outside Ringing) Intercom Dialing Three-Way Calling Touch-Tone Selectable Features Automatic Callback Call Forwarding Call Forwarding – Busy Line Call Forwarding – Don’t Answer Call Pick-Up – Group Call Restriction Options Call Waiting Cancel Call Waiting Dial Call Waiting Hunting Speed Calling Optional Features: 69 Busy Redial Call Block ( 60) Call Park Call Park – Directed Call Trace Caller ID services Enhanced Call Forwarding Executive Busy Override Last Number Redial Priority Call Select Call Forwarding Voice Mail * * 54 Downloaded from www.Manualslib.com manuals search engine 55Notes __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ __________________________________________________________ 56 Downloaded from www.Manualslib.com manuals search engine ",Internet/Technology,Fact Finding,Q&A """================ ======= [context document] ================ ======= [user request] ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""","Given the recent advancements of mRNA technology, how might future influenza vaccines be designed to provide a more comprehensive protection against emerging variants, potentially reducing the need for annual revaccinations?","Annually, seasonal influenza is responsible for millions of infections and hundreds of thousands of deaths. The current method for managing influenza is vaccination using a standardized amount of the influenza virus’ primary surface antigen, hemagglutinin (HA), as the intended target of the immune response. This vaccination strategy results in vaccines with variable efficacy year to year due to antigenic drift of HA, which can be further exacerbated by manufacturing processes optimizing growth of vaccine virus in eggs. Due to these limitations, alternative vaccine platforms are actively being explored to improve influenza vaccine efficacy, including cell-based, recombinant protein, and mRNA vaccines. mRNA’s rapid, in vitro production makes it an appealing platform for influenza vaccination, and the success of SARS-CoV-2 mRNA vaccines in the clinic has encouraged the development of mRNA vaccines for other pathogens. Here, the immunogenicity and protective efficacy of a quadrivalent mRNA vaccine encoding HA from four seasonal influenza viruses, A/California/07/2009 (H1N1), A/Hong Kong/4801/2014 (H3N2), B/Brisbane/60/2008 (B-Victoria lineage), and B/Phuket/3073/2013 (B-Yamagata lineage), was evaluated. In mice, a 120 μg total dose of this quadrivalent mRNA vaccine induced robust antibody titers against each subtype that were commensurate with titers when each antigen was administered alone. Following A/California/04/2009 challenge, mice were fully protected from morbidity and mortality, even at doses as low as 1 μg of each antigen. Additionally, a single administration of 10 μg of quadrivalent mRNA was sufficient to prevent weight loss caused by A/California/04/2009. These results support the promise of this mRNA vaccine for prevention and mitigation of influenza vaccine.The results presented here are encouraging and support the effectiveness of GLB quadrivalent influenza mRNA vaccines in generating HA-targeted neutralizing antibody responses which have been well-documented to correlate with protection from disease44,45,46. In addition to antibodies targeting HA, T cells are also an important immune mediator of infection and deserve analyses in future studies47. The presence of pre-existing CD4+ T cells has been shown to correlate with protection from influenza disease in humans, while memory CD8+ T cell activity is associated with protection from emerging influenza viruses48,49,50. An early study of influenza mRNA vaccines by Petsch et al. found mice vaccinated with PR8 HA mRNA exhibited CD4+ responses against a variety of MHC class II PR8 peptides as well as greater CD8+ cytotoxic activity than controls when tested with MHC class I PR8 peptides. The mRNA platform is a powerful development in vaccine technology, not only in regards to their flexibility, speed, and scalability, but in that they offer an alternative approach to the development of a universal influenza vaccine. To that end, in a 2022 paper by Arevalo et al., vaccination with mRNA encoding 20 different HAs, representative of all A and B subtypes, induced humoral responses against all antigens and protected mice and ferrets from influenza challenge with matched and mismatched strains22. Furthermore, a natural extension of immunization with multivalent HA mRNA vaccines are multi-antigenic mRNA vaccines. In 2020 Freyn et al. reported broad protection in mice vaccinated with modified mRNA encoding conserved sequences from HA, NA, M2, and NP on a single strand of mRNA at a dose as low as 50 ng23. A recent study of a pentavalent modified mRNA vaccine targeting HA, NA, NP, and matrix protein 2 (M2) from B/Victoria/2/1987-like lineage and HA from B/Yamagata/16/1988-like lineage was found to induce broadly cross-reactive antibodies against ancestral and contemporary B viruses from both lineages, as well as protect mice from morbidity and mortality following challenge with a panel of influenza B viruses24. Similarly, a 2022 study of mRNA vaccines containing HA, NA, NP, and M2 targeting group 2 influenza viruses was found to protect mice from all challenge viruses, even when administered as a single dose of 125 ng25. These results demonstrate the promise of mRNA vaccines to improve breadth and efficacy of influenza vaccines.","""================ ======= Annually, seasonal influenza is responsible for millions of infections and hundreds of thousands of deaths. The current method for managing influenza is vaccination using a standardized amount of the influenza virus’ primary surface antigen, hemagglutinin (HA), as the intended target of the immune response. This vaccination strategy results in vaccines with variable efficacy year to year due to antigenic drift of HA, which can be further exacerbated by manufacturing processes optimizing growth of vaccine virus in eggs. Due to these limitations, alternative vaccine platforms are actively being explored to improve influenza vaccine efficacy, including cell-based, recombinant protein, and mRNA vaccines. mRNA’s rapid, in vitro production makes it an appealing platform for influenza vaccination, and the success of SARS-CoV-2 mRNA vaccines in the clinic has encouraged the development of mRNA vaccines for other pathogens. Here, the immunogenicity and protective efficacy of a quadrivalent mRNA vaccine encoding HA from four seasonal influenza viruses, A/California/07/2009 (H1N1), A/Hong Kong/4801/2014 (H3N2), B/Brisbane/60/2008 (B-Victoria lineage), and B/Phuket/3073/2013 (B-Yamagata lineage), was evaluated. In mice, a 120 μg total dose of this quadrivalent mRNA vaccine induced robust antibody titers against each subtype that were commensurate with titers when each antigen was administered alone. Following A/California/04/2009 challenge, mice were fully protected from morbidity and mortality, even at doses as low as 1 μg of each antigen. Additionally, a single administration of 10 μg of quadrivalent mRNA was sufficient to prevent weight loss caused by A/California/04/2009. These results support the promise of this mRNA vaccine for prevention and mitigation of influenza vaccine.The results presented here are encouraging and support the effectiveness of GLB quadrivalent influenza mRNA vaccines in generating HA-targeted neutralizing antibody responses which have been well-documented to correlate with protection from disease44,45,46. In addition to antibodies targeting HA, T cells are also an important immune mediator of infection and deserve analyses in future studies47. The presence of pre-existing CD4+ T cells has been shown to correlate with protection from influenza disease in humans, while memory CD8+ T cell activity is associated with protection from emerging influenza viruses48,49,50. An early study of influenza mRNA vaccines by Petsch et al. found mice vaccinated with PR8 HA mRNA exhibited CD4+ responses against a variety of MHC class II PR8 peptides as well as greater CD8+ cytotoxic activity than controls when tested with MHC class I PR8 peptides. The mRNA platform is a powerful development in vaccine technology, not only in regards to their flexibility, speed, and scalability, but in that they offer an alternative approach to the development of a universal influenza vaccine. To that end, in a 2022 paper by Arevalo et al., vaccination with mRNA encoding 20 different HAs, representative of all A and B subtypes, induced humoral responses against all antigens and protected mice and ferrets from influenza challenge with matched and mismatched strains22. Furthermore, a natural extension of immunization with multivalent HA mRNA vaccines are multi-antigenic mRNA vaccines. In 2020 Freyn et al. reported broad protection in mice vaccinated with modified mRNA encoding conserved sequences from HA, NA, M2, and NP on a single strand of mRNA at a dose as low as 50 ng23. A recent study of a pentavalent modified mRNA vaccine targeting HA, NA, NP, and matrix protein 2 (M2) from B/Victoria/2/1987-like lineage and HA from B/Yamagata/16/1988-like lineage was found to induce broadly cross-reactive antibodies against ancestral and contemporary B viruses from both lineages, as well as protect mice from morbidity and mortality following challenge with a panel of influenza B viruses24. Similarly, a 2022 study of mRNA vaccines containing HA, NA, NP, and M2 targeting group 2 influenza viruses was found to protect mice from all challenge viruses, even when administered as a single dose of 125 ng25. These results demonstrate the promise of mRNA vaccines to improve breadth and efficacy of influenza vaccines. https://www.nature.com/articles/s41541-023-00752-5#:~:text=Seasonal%20quadrivalent%20mRNA%20vaccine%20prevents%20and%20mitigates%20influenza%20infection%20%7C%20npj%20Vaccines ================ ======= Given the recent advancements of mRNA technology, how might future influenza vaccines be designed to provide a more comprehensive protection against emerging variants, potentially reducing the need for annual revaccinations? ================ ======= You are an expert in question answering. Your task is to reply to a query or question, based only on the information provided by the user. It should only use information in the article provided.""",Medical,Find & Summarize,Text Transformation "For this task, you must only answer using the context block provided. Prior knowledge and external resources are disallowed.",Summarise the court findings of the Silkroad case,"Silk Road In 2013, federal authorities shut down Silk Road, which they alleged was “the most sophisticated and extensive criminal marketplace on the Internet,” enabling tens of thousands of users to anonymously buy and sell illegal drugs, malicious software, and other illicit goods and services. 38 Federal prosecutors charged the site’s creator with, among other things, conspiracy to commit money laundering under Section 1956. 39 The prosecutors alleged that the site’s creator conspired to conduct “financial transactions” involving the proceeds of unlawful activity—namely, narcotics trafficking and computer hacking—with the intent to promote the carrying on of such activity.40 In defending this charge, Silk Road’s creator argued that his alleged conduct— facilitating the exchange of Bitcoin for illegal goods and services—did not involve “financial transactions” within the meaning of Section 1956, which defines that term to include (among other things) transactions “involving one or more monetary instruments.” 41 Specifically, the site’s creator contended that because Bitcoin does not qualify as a “monetary instrument”—which Section 1956 defines to mean the currency of a country, personal checks, bank checks, money orders, investment securities, or negotiable instruments—transactions involving Bitcoin do not represent “financial transactions” under Section 1956.42 The U.S. District Court for the Southern District of New York rejected this argument, holding that transactions involving Bitcoin can qualify as “financial transactions” under Section 1956 because they fall under a separate category of transactions identified by the relevant statutory definition: transactions involving “the movement of funds.”43 Specifically, the court reasoned that Bitcoin transactions involve “the movement of funds” because the term “funds” includes “money,” which in turn refers to “an object used to buy things.” 44 Because Bitcoin can be used to buy things, the court reasoned that Bitcoin transactions involve “the movement of funds” and therefore qualify as “financial transactions” under Section 1956.45 As a result, the court explained, “[o]ne can money launder using Bitcoin.” 46 AlphaBay Similarly, in 2017, federal prosecutors brought money-laundering conspiracy charges against the creator of AlphaBay, another online marketplace that allowed its users to exchange virtual currency for illicit goods and services.47 The prosecutors alleged that by facilitating the exchange of virtual currencies (including Bitcoin, Monero, and Ether) for illegal narcotics and other illicit goods and services, the site’s creator had conspired to conduct “financial transactions” involving the proceeds of unlawful activities. 48 However, the federal government dismissed these charges after AlphaBay’s creator died in July 2017.49 Virtual Currency Payment Systems Used for Illicit Purposes Federal prosecutors have also pursued charges against the developers of certain virtual currency payment systems allegedly designed to facilitate illicit transactions and launder the proceeds of criminal activity.50 Specifically, prosecutors have charged these developers with conspiring to commit money laundering and operating unlicensed money transmitting businesses under Sections 1956 and 1960, respectively. In adjudicating the second category of charges, courts have concluded that the relevant virtual currency payment systems were “unlicensed money transmitting businesses” under Section 1960, rejecting the argument that the provision applies only to money transmitters that facilitate cash transactions. e-Gold In 2007, federal prosecutors charged e-Gold—an “alternative payment system” and virtual currency purportedly backed by stored physical gold—and its founders and director with money laundering and operating an unlicensed money transmitting business.51 The prosecutors alleged that e-Gold “was widely accepted as a payment mechanism for transactions involving credit card and identification fraud, high yield investment programs and other investment scams, and child exploitation” because of the anonymity it offered its users.52 In charging the defendants for failing to register their business, prosecutors alleged that e-Gold operated as an “unlicensed money transmitting business” in each of the three ways identified by Section 1960—the provision criminalizing the operation of “unlicensed money transmitting businesses.” Specifically, the prosecutors alleged that e-Gold (1) lacked a required state money transmitter license, (2) failed to comply with the BSA’s federal registration requirements for “money transmitting businesses” (requirements set forth in Section 5330 of Title 31), and (3) was involved in the transmission of funds that were “known to have been derived from a criminal offense” or that were “intended to be used to promote and support unlawful activity.” 53 In defending these charges, the defendants presented an intricate argument for the proposition that Section 1960 applies only to businesses that facilitate cash (as opposed to virtual currency) transactions. Specifically, the defendants argued that because Section 1960 does not define the term “money transmitting business,” it must “borrow” the definition of that term in Section 5330—the BSA provision establishing federal registration requirements for “money transmitting businesses.” 54 The defendants further reasoned that (1) Section 5330 provides that an entity is a “money transmitting business” only if it must file currency transaction reports (CTRs), and (2) businesses that do not facilitate cash transactions need not file CTRs.55 Accordingly, under the defendants’ theory, a business like e-Gold that does not facilitate cash transactions does not qualify as a “money transmitting business” under Section 5330 and (by extension) Section 1960. 56 The U.S. District Court for the District of Columbia rejected this argument, holding that e-Gold was indeed a “money transmitting business” under Section 1960 for two reasons. First, the court rejected the defendants’ contention that Section 1960 must “borrow” Section 5330’s definition of “money transmitting business.” 57 The court rejected this argument on the grounds that Section 1960 contains its own definition of the term “money transmitting” and does not reflect an intent to “borrow” the definition of “money transmitting business” from Section 5330.58 The court further explained that because e-Gold was a business engaged in “money transmitting” as defined by Section 1960—that is, “transferring funds on behalf of the public”—it was a “money transmitting business” under Section 1960.59 Second, the court evaluated whether e-Gold also qualified as a “money transmitting business” under Section 5330—an issue that remained relevant because of the federal government’s charge that the defendants violated Section 1960 by violating Section 5330’s registration requirements. The court concluded that e-Gold was indeed a “money transmitting business” under Section 5330, rejecting the defendants’ argument that e-Gold did not fall within that category because it was not required to file CTRs.60 Specifically, the court rejected the argument that a business is required to file CTRs only if it facilitates cash transactions. Instead, the court explained that because the statute imposing CTR obligations imposes such obligations when money transmitting businesses facilitate cash transactions (as opposed to if they facilitate such transactions), all money transmitting businesses have a continuing obligation to file CTRs “in the eventuality that they ever are involved” in a reportable cash transaction.61 The court accordingly concluded that because e-Gold was required to file CTRs and satisfied the other elements of the relevant statutory definition, e-Gold was a “money transmitting business” under Section 5330 even though it did not process cash transactions.62 After the court denied the defendants’ motion to dismiss the charges for operating an unlicensed money transmitting business, the defendants pleaded guilty to those charges and money laundering.","Summarise the court findings of the Silkroad case Silk Road In 2013, federal authorities shut down Silk Road, which they alleged was “the most sophisticated and extensive criminal marketplace on the Internet,” enabling tens of thousands of users to anonymously buy and sell illegal drugs, malicious software, and other illicit goods and services. 38 Federal prosecutors charged the site’s creator with, among other things, conspiracy to commit money laundering under Section 1956. 39 The prosecutors alleged that the site’s creator conspired to conduct “financial transactions” involving the proceeds of unlawful activity—namely, narcotics trafficking and computer hacking—with the intent to promote the carrying on of such activity.40 In defending this charge, Silk Road’s creator argued that his alleged conduct— facilitating the exchange of Bitcoin for illegal goods and services—did not involve “financial transactions” within the meaning of Section 1956, which defines that term to include (among other things) transactions “involving one or more monetary instruments.” 41 Specifically, the site’s creator contended that because Bitcoin does not qualify as a “monetary instrument”—which Section 1956 defines to mean the currency of a country, personal checks, bank checks, money orders, investment securities, or negotiable instruments—transactions involving Bitcoin do not represent “financial transactions” under Section 1956.42 The U.S. District Court for the Southern District of New York rejected this argument, holding that transactions involving Bitcoin can qualify as “financial transactions” under Section 1956 because they fall under a separate category of transactions identified by the relevant statutory definition: transactions involving “the movement of funds.”43 Specifically, the court reasoned that Bitcoin transactions involve “the movement of funds” because the term “funds” includes “money,” which in turn refers to “an object used to buy things.” 44 Because Bitcoin can be used to buy things, the court reasoned that Bitcoin transactions involve “the movement of funds” and therefore qualify as “financial transactions” under Section 1956.45 As a result, the court explained, “[o]ne can money launder using Bitcoin.” 46 AlphaBay Similarly, in 2017, federal prosecutors brought money-laundering conspiracy charges against the creator of AlphaBay, another online marketplace that allowed its users to exchange virtual currency for illicit goods and services.47 The prosecutors alleged that by facilitating the exchange of virtual currencies (including Bitcoin, Monero, and Ether) for illegal narcotics and other illicit goods and services, the site’s creator had conspired to conduct “financial transactions” involving the proceeds of unlawful activities. 48 However, the federal government dismissed these charges after AlphaBay’s creator died in July 2017.49 Virtual Currency Payment Systems Used for Illicit Purposes Federal prosecutors have also pursued charges against the developers of certain virtual currency payment systems allegedly designed to facilitate illicit transactions and launder the proceeds of criminal activity.50 Specifically, prosecutors have charged these developers with conspiring to commit money laundering and operating unlicensed money transmitting businesses under Sections 1956 and 1960, respectively. In adjudicating the second category of charges, courts have concluded that the relevant virtual currency payment systems were “unlicensed money transmitting businesses” under Section 1960, rejecting the argument that the provision applies only to money transmitters that facilitate cash transactions. e-Gold In 2007, federal prosecutors charged e-Gold—an “alternative payment system” and virtual currency purportedly backed by stored physical gold—and its founders and director with money laundering and operating an unlicensed money transmitting business.51 The prosecutors alleged that e-Gold “was widely accepted as a payment mechanism for transactions involving credit card and identification fraud, high yield investment programs and other investment scams, and child exploitation” because of the anonymity it offered its users.52 In charging the defendants for failing to register their business, prosecutors alleged that e-Gold operated as an “unlicensed money transmitting business” in each of the three ways identified by Section 1960—the provision criminalizing the operation of “unlicensed money transmitting businesses.” Specifically, the prosecutors alleged that e-Gold (1) lacked a required state money transmitter license, (2) failed to comply with the BSA’s federal registration requirements for “money transmitting businesses” (requirements set forth in Section 5330 of Title 31), and (3) was involved in the transmission of funds that were “known to have been derived from a criminal offense” or that were “intended to be used to promote and support unlawful activity.” 53 In defending these charges, the defendants presented an intricate argument for the proposition that Section 1960 applies only to businesses that facilitate cash (as opposed to virtual currency) transactions. Specifically, the defendants argued that because Section 1960 does not define the term “money transmitting business,” it must “borrow” the definition of that term in Section 5330—the BSA provision establishing federal registration requirements for “money transmitting businesses.” 54 The defendants further reasoned that (1) Section 5330 provides that an entity is a “money transmitting business” only if it must file currency transaction reports (CTRs), and (2) businesses that do not facilitate cash transactions need not file CTRs.55 Accordingly, under the defendants’ theory, a business like e-Gold that does not facilitate cash transactions does not qualify as a “money transmitting business” under Section 5330 and (by extension) Section 1960. 56 The U.S. District Court for the District of Columbia rejected this argument, holding that e-Gold was indeed a “money transmitting business” under Section 1960 for two reasons. First, the court rejected the defendants’ contention that Section 1960 must “borrow” Section 5330’s definition of “money transmitting business.” 57 The court rejected this argument on the grounds that Section 1960 contains its own definition of the term “money transmitting” and does not reflect an intent to “borrow” the definition of “money transmitting business” from Section 5330.58 The court further explained that because e-Gold was a business engaged in “money transmitting” as defined by Section 1960—that is, “transferring funds on behalf of the public”—it was a “money transmitting business” under Section 1960.59 Second, the court evaluated whether e-Gold also qualified as a “money transmitting business” under Section 5330—an issue that remained relevant because of the federal government’s charge that the defendants violated Section 1960 by violating Section 5330’s registration requirements. The court concluded that e-Gold was indeed a “money transmitting business” under Section 5330, rejecting the defendants’ argument that e-Gold did not fall within that category because it was not required to file CTRs.60 Specifically, the court rejected the argument that a business is required to file CTRs only if it facilitates cash transactions. Instead, the court explained that because the statute imposing CTR obligations imposes such obligations when money transmitting businesses facilitate cash transactions (as opposed to if they facilitate such transactions), all money transmitting businesses have a continuing obligation to file CTRs “in the eventuality that they ever are involved” in a reportable cash transaction.61 The court accordingly concluded that because e-Gold was required to file CTRs and satisfied the other elements of the relevant statutory definition, e-Gold was a “money transmitting business” under Section 5330 even though it did not process cash transactions.62 After the court denied the defendants’ motion to dismiss the charges for operating an unlicensed money transmitting business, the defendants pleaded guilty to those charges and money laundering. For this task, you must only answer using the context block provided. Prior knowledge and external resources are disallowed.",Legal,Summarize,Text Transformation Answer the question in the prompt based only on the text provided in the prompt itself.,"The text below includes the reactions of a number of organizations to proposed changes to the availability of legal aid in the United Kingdom. According to the text, what is the financial case against these changes?","The most vulnerable will not get the help they need People need advice across different areas of legal scope to solve their problems sustainably Respondents also observed that the client groups who seek help with these areas are amongst the most vulnerable, usually they have multiple problems or experience ‘clusters’ of interrelated problems so need a seamless (or ’holistic’) service. The blanket removal of many areas of civil law from legal aid funding will prevent many people with mental health problems from accessing legal support for issues that cannot be neatly delineated into different types and are often central to managing their mental health. Mind/Rethink joint response Members of migrant communities, may be more likely to present particularly complex cases involving a range of different factors, or to find that language and cultural barriers mean that it is more difficult for them to resolve cases without legal aid support. Migrants Rights Network Priority debts, which could lead to the loss of a home, must be balanced with other key debts, such as council tax arrears and energy bill arrears, which also have a profound effect on consumers’ lives. Addressing a housing related debt in isolation is impracticable and unlikely to lead to a sustainable financial solution. Consumer Focus Wales As a matter of principle, we think that the Government’s list of criteria justifying the retention of legal aid should be supplemented by acknowledging cases where the disparity of resources between the parties is such as to unduly restrict the effective participation of one party in the proceedings for redress. Justice While the attempt to offer legal aid to victims of domestic violence is welcome, it does not cover other vulnerabilities in these cases such as substance misuse, disabilities, and mental health problems. Coordinated Action Against Domestic Abuse To exclude areas of law such as housing and debt from the legal aid scheme denies victims of violence the support they need to live a life free from violence. National Federation of Women’s Institutes Agencies also questioned whether the new proposed definitions and criteria for the scope of civil funding could work actually in practice. The gateways for demonstrating domestic violence are very limited and confined to ongoing proceedings…they do not reflect the pathways victims of domestic violence access to find help and support. Gingerbread It is nonsensical to create a system where the victim would be entitled to legal aid for related family law proceedings if the perpetrator of domestic violence had been convicted of assault occasioning actual bodily harm, but would be denied legal aid and have to represent herself if the perpetrator had been cautioned for the same offence. Rights of Women All the areas which will remain in scope are clearly important, but we believe the definitions and tests proposed would involve greater bureaucracy and problems of legal challenge and interpretation (and) result in many vulnerable people being unable to get the help they need at an early stage if definitions are set too tightly… for example, advising only on debts where a home is at ‘immediate risk’ is not practical, as most clients have multiple debts which must be addressed for them to achieve a sustainable financial position. Citizens Advice No legal aid will mean no help or advice for many There was a widespread view from respondents that for the ‘out of scope’ categories, the Green Paper contained misleading assertions about alternative sources of advice, and the capacity within the pro-bono and voluntary sectors to provide appropriate help. For example, National Debtline do not provide face-to-face debt advice and refer cases requiring specialist legal advice elsewhere.5 The ability of clients to use paid for, or conditional fee (CFA) and insurance funded services as an alternative to public funding was also questioned. The implication that charities like Disability Alliance are available to help people in the advent of legal aid cuts misrepresents the reality that we do not provide such support. Disability Alliance The Green Paper mentions IPSEA, the Advisory Centre for Education (ACE) and Parent Partnership Services (PPS) as alternative sources of support to legal aid in education cases…they do not have the capacity, and in some cases do not have the remit to deliver the level of support parents need in SEN education cases. Ambitious about Autism Reducing legal aid in the area of employment law will increase the demand on our free helpline but in the current economic climate it is unlikely that we will be able to meet the additional demand. Working Families One of the major barriers to the greater use of CFAs is disbursement funding and the costs of investigation. These costs are substantial in clinical negligence claims. Action Against Medical Accidents Legal aid saves the public purse money Many responses pointed to the value of legal aid, both in terms of its social value and its outcomes for clients, but also in terms of the cost savings to the justice system and to other statutory services, and the Government’s broader agenda to improve family and relationship support. Legal aid in administrative justice represents exceptional value for money. For example, welfare benefits legal aid cost £28.3 million in 2009/10, representing less than 0.18 per cent of the £16 billion value of unclaimed benefits. The success rate of legally-aided clients in this and several other administrative jurisdictions is over 90 per cent. Administrative Justice and Tribunals Council There is a strong case for targeting legal aid investment where it can have the greatest impact – this involves taking a broader view than simply looking at issues of loss of liberty or imminent homelessness, but should involve reconfiguring services to be more client-centred and targeting services better at those client groups for whom getting advice has the greatest beneficial impact. Youth Access In many of our cases at the CLC, the provision of legal advice and assistance can help resolve problems quickly and prevent matters from escalating. Removing access to legal advice in many civil and family law matters removes the possibility for problems to be resolved early and efficiently without the need for litigation. Childrens’ Legal Centre Proposals to withdraw legal aid when combined with the evidence of the lack of awareness of alternative support services will undermine Government’s broader agenda for relationship support...and increases the risk of the divorcing and separating population’s personal indebtedness...Couples spend an average of £28,000 when a marriage ends. National Family Mediation If the legal aid cuts go through and people are denied a lawyer for custody cases, I will lose all chance of ever seeing my children again. Client from Crossroads Women’s Centre Respondents found evidence to back this up such as the Legal Services Research Centre’s work on exclusion and legal problems.6 The General Council of the Bar for example had commissioned a ‘cohort’ analysis which compared the outcomes for advice seekers recorded by the LSRC’s civil and social justice survey as between those who sought help from informal sources, non-legal service providers, and legal aid providers. This identified a statistically significant better level of outcomes from legal aid services.7 The Law Society, LAPG, ILPA, EHRC, LASA, ASA and many others referred to the ‘business case’ research by Citizens Advice which used LSC outcomes and data from the LSRC’s civil and social justice survey to estimate (on 2008-9 figures) the cost-benefit ratio for key civil categories of legal aid advice. This research looked at the ‘adverse consequences’ of civil problems and found that: • for every £1 of legal aid expenditure on housing advice, the state potentially saves £2.34 • for every £1 of legal aid expenditure on debt advice, the state potentially saves £2.98 • for every £1 of legal aid expenditure on benefits advice, the state potentially saves £8.80 • for every £1 of legal aid expenditure on employment advice, the state potentially saves £7.13.8 Some respondents referred to work undertaken by the New Economics Foundation for the Law Centres Federation also suggested that the ‘social return’ for legal help for clients with the most complex problems could be as high £10 to every £1 invested.9 ","The text below includes the reactions of a number of organizations to proposed changes to the availability of legal aid in the United Kingdom. According to the text, what is the financial case against these changes? The most vulnerable will not get the help they need People need advice across different areas of legal scope to solve their problems sustainably Respondents also observed that the client groups who seek help with these areas are amongst the most vulnerable, usually they have multiple problems or experience ‘clusters’ of interrelated problems so need a seamless (or ’holistic’) service. The blanket removal of many areas of civil law from legal aid funding will prevent many people with mental health problems from accessing legal support for issues that cannot be neatly delineated into different types and are often central to managing their mental health. Mind/Rethink joint response Members of migrant communities, may be more likely to present particularly complex cases involving a range of different factors, or to find that language and cultural barriers mean that it is more difficult for them to resolve cases without legal aid support. Migrants Rights Network Priority debts, which could lead to the loss of a home, must be balanced with other key debts, such as council tax arrears and energy bill arrears, which also have a profound effect on consumers’ lives. Addressing a housing related debt in isolation is impracticable and unlikely to lead to a sustainable financial solution. Consumer Focus Wales As a matter of principle, we think that the Government’s list of criteria justifying the retention of legal aid should be supplemented by acknowledging cases where the disparity of resources between the parties is such as to unduly restrict the effective participation of one party in the proceedings for redress. Justice While the attempt to offer legal aid to victims of domestic violence is welcome, it does not cover other vulnerabilities in these cases such as substance misuse, disabilities, and mental health problems. Coordinated Action Against Domestic Abuse To exclude areas of law such as housing and debt from the legal aid scheme denies victims of violence the support they need to live a life free from violence. National Federation of Women’s Institutes Agencies also questioned whether the new proposed definitions and criteria for the scope of civil funding could work actually in practice. The gateways for demonstrating domestic violence are very limited and confined to ongoing proceedings…they do not reflect the pathways victims of domestic violence access to find help and support. Gingerbread It is nonsensical to create a system where the victim would be entitled to legal aid for related family law proceedings if the perpetrator of domestic violence had been convicted of assault occasioning actual bodily harm, but would be denied legal aid and have to represent herself if the perpetrator had been cautioned for the same offence. Rights of Women All the areas which will remain in scope are clearly important, but we believe the definitions and tests proposed would involve greater bureaucracy and problems of legal challenge and interpretation (and) result in many vulnerable people being unable to get the help they need at an early stage if definitions are set too tightly… for example, advising only on debts where a home is at ‘immediate risk’ is not practical, as most clients have multiple debts which must be addressed for them to achieve a sustainable financial position. Citizens Advice No legal aid will mean no help or advice for many There was a widespread view from respondents that for the ‘out of scope’ categories, the Green Paper contained misleading assertions about alternative sources of advice, and the capacity within the pro-bono and voluntary sectors to provide appropriate help. For example, National Debtline do not provide face-to-face debt advice and refer cases requiring specialist legal advice elsewhere.5 The ability of clients to use paid for, or conditional fee (CFA) and insurance funded services as an alternative to public funding was also questioned. The implication that charities like Disability Alliance are available to help people in the advent of legal aid cuts misrepresents the reality that we do not provide such support. Disability Alliance The Green Paper mentions IPSEA, the Advisory Centre for Education (ACE) and Parent Partnership Services (PPS) as alternative sources of support to legal aid in education cases…they do not have the capacity, and in some cases do not have the remit to deliver the level of support parents need in SEN education cases. Ambitious about Autism Reducing legal aid in the area of employment law will increase the demand on our free helpline but in the current economic climate it is unlikely that we will be able to meet the additional demand. Working Families One of the major barriers to the greater use of CFAs is disbursement funding and the costs of investigation. These costs are substantial in clinical negligence claims. Action Against Medical Accidents Legal aid saves the public purse money Many responses pointed to the value of legal aid, both in terms of its social value and its outcomes for clients, but also in terms of the cost savings to the justice system and to other statutory services, and the Government’s broader agenda to improve family and relationship support. Legal aid in administrative justice represents exceptional value for money. For example, welfare benefits legal aid cost £28.3 million in 2009/10, representing less than 0.18 per cent of the £16 billion value of unclaimed benefits. The success rate of legally-aided clients in this and several other administrative jurisdictions is over 90 per cent. Administrative Justice and Tribunals Council There is a strong case for targeting legal aid investment where it can have the greatest impact – this involves taking a broader view than simply looking at issues of loss of liberty or imminent homelessness, but should involve reconfiguring services to be more client-centred and targeting services better at those client groups for whom getting advice has the greatest beneficial impact. Youth Access In many of our cases at the CLC, the provision of legal advice and assistance can help resolve problems quickly and prevent matters from escalating. Removing access to legal advice in many civil and family law matters removes the possibility for problems to be resolved early and efficiently without the need for litigation. Childrens’ Legal Centre Proposals to withdraw legal aid when combined with the evidence of the lack of awareness of alternative support services will undermine Government’s broader agenda for relationship support...and increases the risk of the divorcing and separating population’s personal indebtedness...Couples spend an average of £28,000 when a marriage ends. National Family Mediation If the legal aid cuts go through and people are denied a lawyer for custody cases, I will lose all chance of ever seeing my children again. Client from Crossroads Women’s Centre Respondents found evidence to back this up such as the Legal Services Research Centre’s work on exclusion and legal problems.6 The General Council of the Bar for example had commissioned a ‘cohort’ analysis which compared the outcomes for advice seekers recorded by the LSRC’s civil and social justice survey as between those who sought help from informal sources, non-legal service providers, and legal aid providers. This identified a statistically significant better level of outcomes from legal aid services.7 The Law Society, LAPG, ILPA, EHRC, LASA, ASA and many others referred to the ‘business case’ research by Citizens Advice which used LSC outcomes and data from the LSRC’s civil and social justice survey to estimate (on 2008-9 figures) the cost-benefit ratio for key civil categories of legal aid advice. This research looked at the ‘adverse consequences’ of civil problems and found that: • for every £1 of legal aid expenditure on housing advice, the state potentially saves £2.34 • for every £1 of legal aid expenditure on debt advice, the state potentially saves £2.98 • for every £1 of legal aid expenditure on benefits advice, the state potentially saves £8.80 • for every £1 of legal aid expenditure on employment advice, the state potentially saves £7.13.8 Some respondents referred to work undertaken by the New Economics Foundation for the Law Centres Federation also suggested that the ‘social return’ for legal help for clients with the most complex problems could be as high £10 to every £1 invested.9 ",Legal,Fact Finding,Q&A